I LAM 56 LONDON BOROUGH OF LAMBETH m ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1967 m 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 1967 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 the Health Committee 5 Staff of Health Department 9 Introductory remarks of Medical Officer of Health 10 SECTION A: Statistics and Social Conditions of the Area General 15 Births; Birth Rate; Still Births 15 Deaths; Death Rate 16 Maternal Mortality 16 Infantile Mortality 17 Vital Statistics for Years 1958 -1967 19 Classification of Causes of Death 20 Notes on Vital Statistics 23 Deaths from Cancer of the Lung and Bronchus 24 Road Traffic Accidents. 25 SECTION B: Prevalence of, and Control over. Infectious and other Diseases Notifiable diseases 27 Notifications other than Tuberculosis 28 Age Distribution of Infectious Diseases 29 Notes on Infectious Diseases 31 Salmonella Infections 32 Notification of Tuberculosis 33 Report of Chest Physician 33 SECTION C; Personal Health Services Maternity and Child Welfare Centres 38 Cervical cytology Screening Service 38 Family Planning 39 Occasional creches 39 Health Visiting 40 Home Nursing 41 Loan of Nursing'Equipment 41 Incontinence Pads 42 Domiciliary Midwifery Service 42 Midwives Act 1951 43 Day Nurseries 43 Child Minding 46 'Handicap' Registers 46 Prevention of Break-up of Families 47 Health Services — Family Case Workers 48 Vaccination and immunisation 49 International Certificates of Vaccination 49 3 Peronal Health Services (continued) Page Tuberculosis 49 B.C.G. Vaccination 49 Mental Health Services 50 St. Thomas' Hospital - Community Study in Lambeth 51 Recuperative Holidays 53 Chiropody 53 Home Help Service 53 Statistics — Personal Health Services. 54 SECTION D: Environmental Health Services Abatement of Nuisances 78 Summary of Work done by District Public Health Inspectors 79 Public Health Acts 1936 and 1961 - Works in default 81 Sealing of Disused Drains 81 Drainage Emergency Service 82 Legal Proceedings 82 Disinfection 82 Disinfestation 83 Prevention of Damage by Pests Act 1949 83 Atmospheric Pollution - Clean Air Act 1956 85 Factories Act 1961 86 Noise Abatement Act 1960 88 Medical Arrangements for Long-stay Immigrants 89 Pet Animals Act 1951 89 Animal Boarding Establishments Act 1963 89 Riding Establishments Act 1964 89 Diseases of Animals Act 1950 89 Slum Clearance Programme 1966 -1970 90 Individual Unfit Houses and Parts of Houses 91 Action under Part II of the Housing Act 1957 91 Housing Acts 1961/64 - Houses in Multiple Occupation 92 Housing (Financial Provision) Act 1958 93 House Improvement grants 93 Improvement Areas 94 Rehousing and Overcrowding 94 Inspection and Supervision of Food and Food Premises 95 Food Hygiene (Market Stalls and Delivery Vehicles) Regulations 1966 and (Amendment) Regulations 1966 96 Food Premises 97 Food and Drugs Act 1955 97 Milk and Dairies (General) Regulations 1959 97 Milk (Special Designation) Regulations 1963 97 Services under Food and Drugs Act 1955 98 Public Health Imported Food (Regulations) 1937 98 Sampling of Food and Drugs 99 Legal Proceedings 103 Unsound Food 104 Food Complaints 105 4 SECTION E: General Page Water Supply 109 Swimming Pools 112 Sewers 113 National Assistance Act 1948 113 Pharmacy and Poisons Act 1933 114 Establishments for Massage and Special Treatment 114 Hairdressers and Barbers 114 Care of the Aged 114 Laundry Service for Aged Incontinent 115 Home Bathing Service 115 Medical Examination of Staff 115 Health Education 115 Hospital Facilities 117 Ambulance Facilities 117 Public Health Laboratory Service 117 SECTION F: School Health Service Report of the Principal School Medical Officer 119 5 LONDON BOROUGH OF LAMBETH HEALTH COMMITTEE Period from 1st January, 1967 to 24th May, 1967 The Worshipful the Mayor of Lambeth Councillor S.H. Gurney, J.P. fEx-officio) The Deputy Mayor of Lambeth Councillor Ewan G. Carr, J.P. (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. 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 I NViRONMENTAL HTALTII SllB-COMMlTTEF 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 7 LONDON BOROl fiH OF LAMBETH HEALTH COMMITTEE Period from 24th May, 1967 to 31st December, 1967 The Worshipful the Mayor of Lambeth Councillor H.W. Lockwood, J.P. (Ex-officio) The Deputy Mayor of Lambeth Councillor S.H. Gurney, J.P. fEx-officio! Chairman Councillor G.F.S. Light Vice-Chairman Councillor T. Cleasby Alderman Mrs. Mary Marock Alderman A.M. Nelson-Barrett, J.P. Councillor W.A. Brownett Councillor P.C.H. Cary Councillor Mrs. D.R. Colls Councillor G.A. Gold, LL.B., Councillor D.F. How 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. Gwyneth Taylor 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 HFALTH DFPARTMFNT 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 J.M. Roberts J.A. Spall — Appointed 27th November, 1967 Principal Nursing Officer Miss B. Thorn — Retired 10th February, 1967 Miss E. Early - Appointed 9th February, 1967 Deputy Principal Nursing Officer Miss A. Swift - Appointed 1st March, 1967 Principal Mental Health Social Worker A.J. Shriever Deputy Principal Mental Health Social Worker MissC.A.Budd - Retired 31st July, 1967 Mr. T.A. Hawley - Appointed 2nd October, 1967 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 R.C. Charlton 10 Health Department, Blue Star House, 234/244 Stockwell Road, Brixton, S.W.9. Tel: 01-274-7722 To the Mayor, Aldermen and Burgesses of the London Borough of Lambeth Mr. Mayor. Ladies and Gentlemen. 1 have pleasure in presenting my annual report on the health of the London Borough of Lambeth for the year 1967. This is my third report as your Medical Officer of Health. The variations in the vital statistics compared with those of previous years are no greater than may normally be expected. Other than measles, which tends to occur bi-annually, there were no major outbreaks of infectious disease. The planning of the development and improvement of health services over the whole Borough continued. To meet the increasing need for the day care of severely subnormal children and the decreasing availability of places in junior training schools run by other boroughs, two junior training schools (105 places) are to be provided as a matter of urgency in converted premises. These will be replaced in due course by larger purpose-built schools providing sufficient places to meet the expected needs of the Borough. To relieve the immediate need for additional places 20 children are being taken daily to the training school at the Manor Hospital, Epsom, and a further 6 to the school at Queen Mary's Hospital. Carshalton. The three year plan which was revised in September 1967 provides for the replacement of two junior training schools in converted premises by purpose-built schools, and of the male adult training centre at Clapham by a larger centre with accommodation for men and women, for a mental health day centre in converted premises and a hostel for subnormal children. The plan also provides for an additional day nursery, one maternity and child health centre, two health centres and the replacement of two existing day nurseries. St. Martin's day nursery was opened during the year and is the first purpose-built health service building to be completed since the formation of the London Borough of Lambeth on 1st April 1965, although planning was well advanced prior to that date. The nursery replaced Streatham Hill Day Nursery which had to be closed prematurely in December 1966 because of structural defects. Occupancy of the new nursery commenced on 1st May 1967 and the building was officially opened by His Worship The Mayor on 15th July 1967. Of the many children requiring day nursery care for social reasons some do not 11 need to attend for the whole day. A number of places at St. Martin's Nursery were set aside for children to attend for half-days (mornings or afternoons) only, thus enabling a larger number of children to use the places available. Consideration is being given to the extension of this practice to other suitable day nurseries. Partly because of lack of nursery school facilities within the Borough the demand for part-time pre-school play group facilities continued and the number of applications to form groups increased. The Council authorised the payment of grants to a number of play groups which fulfilled prescribed conditions, to assist them in their work. In viewof the economic situation the Council decided to postpone implementation of the National Health Service (Family Planning) Act 1967 and continued existing arrangements with the Family Planning Association. Discussions with the Association with a view to the provision of a domiciliary service for special cases are however proceeding. The cervical cytology service for the detection of early cervical cancer which was started on a small scale in 1966 is now extended to all women living or working in the Borough of Lambeth, where formerly it was limited to Lambeth residents over 35 years of age. Improved laboratory facilities made this possible. St. Thomas' Hospital was created a district hospital with special responsibility for the medical care of the population of part of Lambeth. This development was seen by the Hospital authorities as providing both the opportunity and the need for investigating the demand for hospital services in this area of London. A series of studies was projected with the object of providing information needed for the planning of the services. The health department was asked to assist and details of the project are contained in the body of my report. The inter-borough arrangements with Southwark Borough Council for the provision of a laundry service for incontinent persons continued during the year. Plans are well in hand for the setting up of the Council's own laundry service at Streatham Baths, which will enable Lambeth to operate directly an improved and more extensive service. In my report for 1966 I mentioned the problem with which the department is faced regarding houses-in-multiple occupation, and that it was my intention to report fully on the registration scheme which was commenced in October of that year. This report appears on pages 93 - 9J Improvement of housing conditions is an important function of the health department and a considerable amount of work has been done by theinspectorate in dealing with houses-in-multiple occupation, slum clearance and improvement grants both discretionary and standard. 12 Reference is made in the body of the report to the extensive campaign on food hygiene which was begun in the latter part of the year. The booklets prepared by the department had a wide circulation and aroused much interest. It is gratifying to note that many enquiries came from outside the Borough, e.g. from training establishments, schools and voluntary organisations. It is evident from experience gained in promoting this campaign that, to be effective, information and advice must be in simple basic terms using all forms of media to gain the interest of the food handlers and the general public. It is also essential that efforts should be persistent and continuous. My thanks are due to the Council's Public Relations Officer and his staff for the help and advice given. For the greater part of 1967 the department continued to function geographically in two parts, the personal health services at Blue Star House and the environmental health services at Offley Road. However at the end of the year the environmental services moved into offices at Blue Star House. It is now possible for the department to operate as one unit with all its advantages. Shortage of field staff, particularly health visitors, continues to be a problem although in the latter part of the year there was a slight improvement. Plans are in hand to sponsor a larger number of student health visitors and it is hoped that when they qualify they will join the staff of the department and so alleviate the present situation. Two senior members of the staff of the department retired during the year; Miss B. Thorn, Principal Nursing Officer and Miss C.A. Budd, Deputy Principal Mental Health Social Worker. Miss Thorn had served Lambeth for more than twenty years, first as superintendent health visitor in the Metropolitan Borough, then as Principal Nursing Officer in Division 8 of the former London County Council and latterly in a similar capacity with the London Borough of Lambeth. The whole of Miss Budd's thirty years' service, most of it with the London County Council, was devoted to the welfare of the mentally subnormal. The experience of both these officers has been of particular value in the setting up of the new department, and during its first 2x/i years. I am pleased to acknowledge with gratitude the encouragement and help given to me by the Chairman and members of the Health Committee and the support and interest of all other members of the Council. My thanks are also due to the other Chief Officersof the Council, to Dr. A.B. Stewart, Medical Adviser to the Inner London Education Authority, and his staff, to general practitioners and hospital staffs with whom the department is in daily contact and finally to the members of the staff of the Health Department for their loyal and conscientious service. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, A.L. TIIROWKR Medical Officer of Health. 13 Section A Statistics and Social Conditions of the Area. 14 STATISTICS AND SOCIAL CONDITIONS OF THE 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 19'/2 miles and its total area is approximately 10l/2 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 Bee 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 Greater London Council. 15 STATISTICS GENERAL Area of Borough 6727 acres Number of Wards 20 Number of Parliamentary Constituencies 5 Population (Mid-year estimate 1967) 338,130 Density of Population (i.e. number of persons per acre) 50.26 Number of marriages during the year 2,889 Marriage rate per 1,000 population 8.6 Rateable Value of District (1st April 1967) £20,276,799 Sum represented by a penny rate (1967/1968) £81,000 Number of separately rated houses and flats at 1st April, 1967 92,954 VITAL STATISTICS LIVE BIRTHS Legitimate Illegitimate Totals Males 2,887 551 3,438 Females 2,756 605 3,361 Totals 5,643 1,156 6,799 Live Birth Rate per 1,000 home population 20.11 Birth Rate corrected for comparison with other areas 17.9 Comparability factor supplied by Registrar General 0.89 Birth Rate per 1,000 Home Population England and Wales 17.2 Birth Rate per 1,000 Home Population Inner London Area 16.5 Birth Rate per 1,000 Home Population Outer London Area 15.4 Birth Rate per 1,000 Home Population Greater London Area 15.8 Illegitimate live Births per cent of total live births 17.0 Illegitimate Live Births per cent of total live births Inner London Area 15.3 Illegitimate Live Births per cent of total live births Outer London Area 8.7 Illegitimate Live Births per cent of total live births Greater London Area 11.4 16 STILL BIRTHS Legitimate Illegitimate Totals Males 43 11 54 Females 47 4 51 Totals 90 15 105 Still Birth Rate per 1,000 Total Births (i.e. Live and Still) 15.2 Still Birth Rate per 1,000 total births England & Wales 14.8 Still Birth Rate per 1,000 total births Inner London Area 13.5 Still Birth Rate per 1,000 total births Outer London Area 13.1 Still Birth Rate per 1,000 total births Greater London Area 13.3 DEATHS Males Females Totals 1,830 1,782 3,612 Death Rate per 1,000 home population 10.68 Death Rate corrected for comparison with other areas 11.3 Comparability Factor (supplied by Registrar General) 1.06 Death Rate per 1,000 home population England & Wales 11.2 Death Rate per 1,000 home population Inner London Area 11.1 Death Rate per 1,000 home population Outer London Area 10.8 Death Rate per 1,000 home population Greater London Area 10.9 MATFRNAL MORTALITY Number of Women dying in consequence of Childbirth 1 Maternal Mortality Rate per 1,000 total births 0.14 Maternal Mortality Rate per 1,000 total births Inner London Area 0.45 Maternal Mortality rate per 1,000 total births Outer London Area 0.25 Maternal Mortality Rate per 1,000 total births Greater London Area 0.33 17 INFANTILE MORTALITY Deaths of infants under one year of age Legitimate Illegitimate Totals Males 62 16 78 Females 58 13 71 120 29 149 Death Rate of infants under one year of age per 1,000 live births 21.9 Death Rate of infants under one year of age per 1,000 live births England & Wales 18.3 Death Rate of infants under one year of age per 1,000 live births Inner London Area 19.8 Death Rate of infants under one year of age per 1,000 live births Outer London Area 17.4 Death Rate of infants under one year of age per 1,000 live births Greater London Area 18.4 Deaths of infants under four weeks of age Legitimate Illegitimate Totals Males 40 12 52 Females 40 10 50 80 22 102 Neo-natal Mortality Rate (Deaths under four weeks per 1,000 live births) 15.0 Neo-Natal Mortality Rate England 5& Wales 12.5 Neo-natal Mortality Rate Inner London Area 13.5 Neo-natal Mortality Rate Outer London Area 12.4 Neo-natal Mortality Rate Greater London Area 12.9 18 Deaths of infants under one week of age Legitimate Illegitimate Totals Males 34 10 44 Females 34 8 42 68 18 86 Early Neo-natal Mortality Rate (Deaths under one week per 1,000 live births) 12.6 Early Neo-natal Mortality Rate England & Wales 10.8 Early Neo-natal Mortality Rate Inner London Area 11.5 Early Neo-natal Mortality Rate Outer London Area 10.8 Early Neo-natal Mortality Rate Greater London Area 11.1 Perinatal Mortality Rate (Still births and deaths under one week per 1,000 total births) 27.6 Perinatal Mortality Rate England and Wales 25.4 Perinatal Mortality Rate Inner London Area. 24.9 Perinatal Mortality Rate Outer London Area 23.7 Perinatal Mortality Rate Greater London Area 24.2 19 SUMMARY OF VITAL STATISTICS FOR THE TEN YEAR PERIOD 1958 - 1967 METROPOLITAN BOROUGH OF LAMBETH 1958-1964 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 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 - 1967 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 1967 338,130 3,612 11.3 6,799 17.9 149 21.9 1 .14 *As adjusted by comparability factor. 20 21 LONDON BOROUGH OF LAMBETH CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1967 CAUSES 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 12 - - - - - - 1 1 2 7 1 F 3 - - - - - - - 1 1 - 1 2. Tuberculosis. Other M 2 - - - - - - - - 1 - 1 F 1 - - - - - - - - - 1 - 3. Syphilitic Disease M 6 - - - - - - - 1 3 1 1 F 1 - - - - - - - - - - 1 5- Whooping Cough M 1 - 1 - - - - - - - - - F - - - - - - - - - - - - 6. Meningococcal Infections M 1 - 1 - - - - - - - - - F - - - - - - - - - - - - 8. Measles M 1 - - - - 1 - -- - - - - F - - - - - - - - - - - 9. Other Infective and Parasitic Diseases M 2 - 1 - - - - - - 1 - - F - - - - - - - - - - - - 10. Malignant Neoplasm, Stomach M 49 - - - - - - 1 8 13 15 12 F 36 - - - - - - - 1 4 13 18 11. Malignant Neoplasm. Lung. Bronchus M 209 - - - - - - 3 18 61 93 34 F 58 - - - - - - 2 8 20 20 8 12- Malignant Neoplasm. Breast M - - - - - - - - - - - - F 68 - - - - - 1 3 16 17 15 16 13. Malignant Neoplasm, Uterus F 36 - - - - - 1 3 9 9 7 7 14. Other Malignant and Lymphatic Neoplasms M 197 - - 1 1 1 2 4 20 54 57 57 F 168 - - - 1 1 - 5 20 35 52 54 15. Leukaemia, Aleukaemia M 8 - - 1 - 1 - - 1 4 1 - F 16 - - 1 - 1 - 2 2 2 2 6 16. Diabetes M 8 - - - - - - 1 1 2 3 1 F 7 - - - - - - 1 1 - - 5 17. Vascular Lesions of Nervous System M 118 - - - - - 1 1 6 21 26 63 F 216 - - - - 1 1 7 11 23 44 129 18- Coronary Disease, Angina M 426 - - - - - 1 7 57 114 143 104 F 287 - - - - - 1 - 6 35 89 156 19. Hypertension with Heart Disease M 12 - - - - - - - - 2 6 4 F 23 - - - - - - - -- - 3 20 20. Other Heart Disease M 106 - - - - 1 3 2 10 19 28 43 F 194 - - - - 1 1 3 11 14 31 133 21- Other Circulatory Disease M 80 - - - - - - 4 7 16 31 22 F 104 - - - - - - 1 3 7 26 67 22. Influenza M 2 - - - - - - - - - 1 1 F 1 - - - - - - - - - - 1 23. Pneumonia M 110 3 8 3 - - - - 7 12 30 47 F 173 - 7 2 - - - 2 5 7 26 124 24. Bronchitis M 159 - 2 1 - - - 1 6 27 50 72 F 79 - 3 1 - - - 1 2 8 21 43 25. Other Diseases of Respiratory System M 30 - - - - - 1 - 1 5 13 10 F 15 - 1 1 - - - - - 2 6 5 26. IJlcer of Stomach and Duodenum M 16 - - - - - - - - 7 7 2 F 16 - - - - - - - 2 3 1 10 22 CAUSE OF DEATH Sex Total All ages Under 4 weeks 4 weeks and under 1 year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over 27. Gastritis, Enteritis and Diarrhoea M 8 1 3 - - - - 1 - - 2 1 F 22 1 3 - - - - - 1 1 7 9 28. Nephritis and Nephrosis M 13 - - - - - - 2 3 1 3 4 F 7 1 - - 1 1 - - - 1 2 1 29. Hyperplasia of Prostate M 12 - - - - - - - - 1 3 8 30. Pregnancy, Childbirth, Abortion F 1 - - - - - 1 - - - - - 31. Congenital Malformations M 20 10 4 - 1 - - - 1 1 2 1 F 18 5 4 3 - - - - 1 2 • 3 32. Other Defined and Ill-Defined Diseases M 118 38 4 1 3 2 4 2 10 15 20 19 F 169 42 2 3 2 2 1 5 10 14 32 56 33. Motor Vehicle Accidents M 30 - - 1 1 12 1 5 1 5 2 2 F 15 - - 1 1 1 - - 2 - - 10 34- All Other Accidents M 44 - 2 4 1 6 3 4 3 9 6 6 F 28 1 - - - 1 1 2 4 3 2 14 35- Suicide M 27 - - - - 3 8 2 5 4 4 1 F 18 - - - - 1 4 - 3 7 1 2 36* Homicide and Operstions of War M 3 - - . - - 1 1 1 - - - F 2 - 1 1 - - - - - - - - TOTAL ALL CAUSES M 1,830 52 26 12 7 27 25 42 168 400 554 517 F 1,782 50 21 13 5 10 12 37 119 215 401 899 GRAND TOTAL 3,612 102 47 25 12 37 37 79 287 615 955 1.416 23 VITAL STATISTICS POPULATION The Registrar-General's mid-year estimate for the year 1967 is 338,130. This is a decrease of 1,270 on the figure for the year 1966. BIRTHS The total number of births occurring to residents of the Borough was 6,799 comprising 3,438 males and 3,361 females. This figure was 573 less than that for 1966 giving a reduced corrected birth rate of 17.9 per 1,000 population. The rate, however, is higher than that for England and Wales which is 17.2 and the rates for the Inner, Outer and Greater London Areas which are 16.5, 15.4 and 15.8 respectively. During the year there were 1,156 illegitimate live births. This figure is twenty less than that for 1966, but due to the reduction in the total number of live births, the percentage, 17%, is higher and compares unfavourably with those for the Inner London, Outer and Greater London Areas which are 15.3, 8.7 and 11.4 respectively. STILL BIRTHS Stillbirths for the year numbered 105. This is 8 fewer than for 1966 but again owing to the reduction in the total number of births, the stillbirth rate at 15.2 is the same as that for last year. The rate, however, is higher than those for England and Wales, and the Greater London Area. DEATHS Allowing for inward and outward transfers the total number of deaths comprising 1,830 males and 1,782 females was 3,612. The corrected death rate at 11.3 per 1,000 population approximates to those for England and Wales and Inner London but is slightly higher than the rates for the Outer and Greater London Areas. Sixty-five per cent of the total deaths occurred in persons aged 65 years and over. Heart and diseases of the circulatory system accounted for the largest number of deaths, 1,232 occurring out of a total of 3,612. Malignant neoplasms of all forms ranked second. Twenty-two fewer people took their own lives than in 1966 and motor vehicle accidents accounted for 45 deaths, a decrease of 6 on the figure for last year. One mother died as a result of diseases of pregnancy or childbirth giving a maternal mortality rate of 0.14 per 1,000 total births. This figure compares very favourably with those for England and Wales and the Inner, Outer and Greater London Areas. 24 INFANTILE MORTALITY One hundred and forty nine infants died before reaching 1 year of age, 4 less than in 1966. Due, however, to the reduction in the total number of live births the infantile mortality rate rose to 21.9 per 1,000 live births compared with 20.8 last year. The causes of death fell into the undermentioned categories:- Cause of death Male Female Total Whooping cough 1 - 1 Meningococcal Infection 1 — 1 Infective and parasitic diseases 1 — 1 Pneumonia 11 7 18 Bronchitis 2 3 5 Other diseases of respiratory system — 1 1 Gastritis, enteritis and diarrhoea 4 4 8 Nephritis and nephrosis - 1 1 Congenital malformations 14 9 23 Other defined and ill defined diseases 42 44 86 Accidents 2 1 3 Homicide - 1 1 78 71 149 DEATHS FROM CANCER OF THE LUNG AND BRONCHUS There was a reduction in the number of deaths from cancer of the lung and bronchus, 267 occurring compared with 282 in 1966. The deaths were distributed amongst the various age groups as follows:- Age Male Female Totals 25 - 34 years - (1) - (-) - (1) 35 - 44 years 3 (7) 2 (-) 5 (7) 45 - 54 years 18 (21) 8 (8) 26 (29) 55 - 64 years 61 (77) 20 (10) 81 (87) 65 - 74 years 93 (80) 20 (23) 113 (103) 75 years and over 34 (39) 8 (16) 42 (55) 209 (225) 58 (57) 267 (282) The figure in brackets are those for the year 1966. 25 ROAD TRAFFIC ACCIDENTS My thanks are due to the Borough Engineer and Surveyor for the following information regarding road traffic accidents occurring in the Borough of Lambeth during the year 1967. 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. No. of Seriously Slightly accidents Killed injured injured Adults 1,931 (2,186) 19 (42) 353 (393) 2,040 (2,394) Children 574 (562) 3 (3) 102(100) 558 (508) 2,505 (2,748) 22 (45) 455 (493) 2,598 (2,902) The figures in brackets are those for the year 1966. 26 Section B Prevalence of and Control over Infectious and other Diseases 27 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 28 CORRECTED NUMBER OF NOTIFICATIONS, EXCLUDING TUBERCULOSIS RECEIVED DURING 1967 Disease First Quarter Second Quarter Third Quarter Fourth Quarter Totals Grand Total M F M F M F M F M F Scarlet Fever 14 6 8 5 3 3 3 4 28 18 46 Whooping Cough 16 14 12 5 23 25 13 14 64 58 122 Measles 881 907 242 260 49 46 14 10 1186 1223 2409 Dysentery 7 6 16 9 7 12 8 6 38 33 71 Meningococcal Infection 1 1 1 - - 1 1 - 3 2 5 Acute Pneumonia 7 6 4 1 - - 4 4 15 11 26 Erysipelas - 2 1 1 1 1 1 3 3 7 10 Food Poisoning 3 1 1 2 4 3 - 4 8 10 18 Puerperal Pyrexia 0 24 - 12 - 15. - 27 - 78 78 Ophthalmia Neonatorium 1 2 - - 1 1 1 1 2 4 6 TOTALS 930 969 285 295 88 107 44 73 1347 1444 2791 29 NOTIFICATION OF INFECTIOUS DISEASES - 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 - - 15 14 68 77 3 2 2 - 181 1 year 2 1 8 5 179 166 4 1 - - 366 2 years 4 2 9 9 218 170 4 2 - - 418 3 years 2 4 14 10 160 199 5 2 - - 396 4 years 4 2 6 5 162 175 1 1 - - 356 5—9 years 14 6 11 13 353 398 10 4 1 - 810 10-14 years - 1 - - 18 17 2 1 - - 39 15-24 years 1 2 - - 5 5 1 4 - 1 19 25 years and over 1 - - 1 6 6 8 15 - 1 38 Age unknown - - 1 1 17 10 - 1 " - 30 TOTALS 28 18 64 58 1186 1223 38 33 3 2 2653 30 NOTIFICATION OF INFECTIOUS DISEASES - AGE DISTRIBUTION (Contd.) Age Group Acute Pneumonia Erysipelas Food Poisoning Puerperal Pyrexis Ophthalmia Neonatorum Totals M F M F M F M F M F Under 5 years 2 1 - - - 1 - - 2 4 10 5-14 years 1 - - - 3 - - - - - 4 15-44 years 3 3 2 1 4 3 - 78 - - 94 45-64 years 7 3 1 3 1 5 - - - - 20 65 & over 2 4 - 3 - 1 - - - - 10 Age unknown - - - - - - - - - - - TOTALS 15 11 3 7 8 10 - 78 2 4 138 GRAND TOTAL 138 2653 2791 31 NOTIFICATIONS OTHER THAN TUBERCULOSIS The number of notifications received during the year increased by 844. No case of poliomyelitis or diphtheria occurred and the Borough was free from typhoid and paratyphoid fever. MEASLES There was an increase in the incidence of measles, 2409 cases being notified compared with 1451 in 1966. The majority of the cases occurred in the first quarter of the year. SCARLET FEVER Forty-six cases were notified compared with 75 in 1966. WHOOPING COUGH There was a reduction in the number of cases notified, 122 compared with 184 in 1966. DYSENTERY Seventy-one cases were notified - a reduction of 8 on last year. MENINGOCOCCAL INFECTION Three more cases were notified than in 1966. PNEUMONIA Fewer cases were notified, 26 compared with 42 last year. ERYSIPELAS Ten cases were notified compared with 9 in 1966. FOOD POISONING There was an increase of 5 in the number of cases notified. The cases were sporadic and there was no general or family outbreak. In addition to the notified cases ten were brought to the notice of the health department other than by formal notification. These also were sporadic. The causative agent in 3 cases was salmonella typhi-murium and in the others salmonella Stanley (2) panama (3) butantan (1) and oranienburg (1). In the remaining cases the causative organism was unknown. 32 SALMONELLA INFECTIONS (NOT FOOD BORNE) INCIDENTS AND CASES CAUSATIVE AGENT GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC TOTAL TOTAL No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained CASES notified or ascertained No. of outbreaks and sporadic cases COLS. 1 +3 +5 No. of cases COLS. 2+4+5 1 2 3 4 5 6 7 1. S Typhimurium 2 6 5 7 11 2. Other Salmonellae 2 4 3 5 7 3. TOTAL 4 10 8 12 18 Details of Salmonella infections due to Salmonella other than S. Typhimurium (not food borne) Type of Salmonellae Brandenberg 1 1 1 Indiana 1 2 1 2 3 Stanley 1 2 1 2 3 TOTAL 2 4 3 5 7 33 TUBERCULOSIS CORRECTED NUMBER OF NOTIFICATIONS RECEIVED DURING THE YEAR AGE RESPIRATORY OTHER MENINGES, and C.N.S. TOTAL M F M F M F Under 1 year 2 - - . - - 2 1 year - - - - - - 2-4 years 1 2 1 - - - 4 5-9 years 2 1 - - - - 3 10-14 years 3 1 1 - - - 5 15—19 years - 4 1 - 1 1 7 20-24 years 5 1 1 1 - - 8 25-34 years 13 11 2 2 1 - 29 35—44 years 8 5 2 3 1 2 21 45-54 years 11 5 2 - - - 18 55—64 years 9 1 - - 1 - 11 65-74 years 4 1 1 1 - - 7 75 & over 3 2 - - - - 5 Age unknown 1 - - - - - 1 TOTAL 62 34 11 7 4 3 121 I am indebted to Dr. C.F. Price for the following report on the work of St. Francis’ Chest Clinic for the year:- REPORT ON CHEST CLINIC WORK 1967 Table I is an extract of the Annual Return of Chest Clinic work as now prepared for the Ministry of Health. It includes cases with evidence of tuberculosis not notified under the Tuberculosis Regulations but requiring a period of Chest Clinic observation. TABLE I 1. Number of cases of tuberculosis (whether notified or not) on the register as being under treatment or supervision at 31st December. RESPIRATORY NON-RESPIRATORY Men Women Children Total Men Women Children Total 629 488 16 1,133 19 20 1 40 34 2. Number of cases of respiratory tuberculosis (whether notified or not) included in 1. added to the register during the year ended 31st December excluding transfers from other clinics. NOT BACTERIOLOGICALLY CONFIRMED BACTERIOLOGICALLY CONFIRMED Men Women Children Total Men Women Children Total Group I 15 10 3 28 2 2 - 4 Group II 4 2 - 6 4 3 - 7 Group III 2 2 - 4 1 3 - 4 TOTALS 21 14 3 38 7 8 - 15 3. Number of cases of non-respiratory tuberculosis (whether notified or not) added to Clinic Register, excluding transfers from other clinics. Men Women Children Total 8 5 1 14 4. Number of cases included in I. whose bronch-pulmonary secretion was positive during the year 17 Whilst this Table gives a picture of Chest Clinic work the incidence of new tuberculosis cases in the Borough is more accurately shown in the following Table 1A which is a record of cases first diagnosed during the year and formally notified under the Tuberculosis Regulations. These figures refer only to that part of Lambeth which is in the South East Metropolitan Regional Hospital Board area, served by the Chest Clinic in St. Francis’ Hospital. TABLE 1A RESPIRATORY TUBERCULOSIS NON-RESPIRATORY TUBERCULOSIS Men Women Children Total Men Women Children Total Number of cases diagnosed during the year 1967 17 7 3 27 3 3 - 6 Deaths 6 2 - 8 - - - - 35 DEATHS During the year there were eight deaths among chest clinic patients directly due to tuberculosis. Of these two were female - both aged over 75 years old - and each had been living under neglected conditions at home and the disease was not diagnosed until they were admitted to hospital in their final illness. Of the six male patients, four were residents at the Knight'’s Hill Hostel for tuberculous men and were not normally resident in Lambeth. There were thirteen other chest clinic patients who died during the year. All were over 50 years of age and nine of them were over 70 years old. Almost half of these deaths were due to bronchitis and respiratory infections, three were caused by cancer of the lung, the rest were the result of senile changes including cardio-vascular degeneration. TUBERCULOSIS INCIDENCE The number of new cases of tuberculosis is the lowest recorded in any year. The racial origins of the 33 newly notified cases were English 18, West Indian 8, Indian 3, Eireann 2, Nigerian 1, Italian 1. Male new cases outnumbered females by .2 to 1. The majority of these cases were in the older age groups,two thirds of the men were over 50 years of age. Half the females were over 50 years old, the other half in the 30-40 years age group. Most cases came to light as a result of chest X-ray examinations arranged by general practitioners referring their patients to hospital outpatient departments and chest clinics, to mass radiography units and other X-ray departments providing chest X-ray facilities. Whilst contact examination continues to be a routine procedure at the chest clinic - and during the year all known contacts were offered chest X-ray - the number of cases so discovered is falling and of those found to be infected most are classified as observation only - even though some may be given prophylactic chemotherapy. There were three contacts found to have active notifiable disease - all children in contact with the same source case. 36 Table 2 compares Chest Clinic figures for tuberculosis since 1951 and demonstrates the continued fall in the total number of cases on the register, the reduction in incidence and the overall decline in the death rate. TABLE 2 Year Total on Register New cases diagnosed Deaths 1951 1,541 266 62 1952 1,512 152 38 1953 1,434 115 39 1954 1,395 159 20 1955 1,281 86 12 1956 1,242 80 21 1957 1,252 128 7 1958 1,214 118 7 1959 1,240 86 8 1960 1,239 89 12 1961 1,159 77 23 1962 1,144 60 18 1963 *1,411 46 17 1964 *1,380 47 11 1965 *1,357 42 12 1966 *1,234 37 9 1967 *1,173 33 8 *including observation cases TRE ATMENT The majority of new cases in Table 2 were given treatment initially in hospital and subsequently continued chemo-therapy as outpatients. A small number of patients were re-admitted for relapse usually following difficulties with the treatment drugs. An average of 15 tuberculosis beds were kept occupied in Dulwich Hospital including five for patients admitted from the Knight's Hill Hostel for tuberculous men. HOME VISITING This essential aspect of the chest clinic service was maintained by the full time Tuberculosis Health Visitor provided by the Council. The Visitor is responsible for advising patients in their home on matters of hygiene and the prevention of infection and arranges the examination of contacts at the chest clinic. Office accommodation is provided for her at the clinic with access to patients’ medical records and facilities for full discussion of case problems with the Chest Physician. 37 Section C Personal Health Services 38 PERSONAL HEALTH SERVICES MATERNITY AND CHILD WELFARE CENTRES There are thirteen maternity and child welfare centres in the borough, some in purpose built or adapted accommodation and others in rented premises. The Council provides facilities at some centres for general practitioner obstetricians to see their own booked maternity patients and 225 such sessions were held during the year. Dental treatment is provided for expectant and nursing mothers and children under five years, the attendance being 78 and 213 respectively. The service is provided in conjunction with that for school children, combined use being made of staff and premises. Mothercraft and relaxation classes are held by domiciliary midwives and health visitors in the maternity and child welfare centres for both hospital and domiciliary booked cases. 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. Tests for the detection of phenylketonuria are carried out by health visitors on all babies before the age of eight weeks. Phenylketonuria is a metabolic disorder which if left untreated may lead to mental subnormality. Other services available at the welfare centres include infant welfare, cervical cytology, toddlers’ and family planning sessions. Chiropody and creche facilities are also provided. CERVICAL CYTOLOGY SCREENING SERVICE-1967 The two weekly clinics for the collection of cervical smears, which were established in 1966, continued to operate and provide a limited service to well women aged 35 years and over who were resident in Lambeth. During the Spring of 1967 the South East and South West Regional Metropolitan Hospital Boards successfully recruited laboratory technicians for the reading of cervical smears and offered further facilities to the Borough, with the results that three additional weekly clinics were established at West Norwood, Loughborough and Moffat Welfai Centres. The waiting lists which had grown up during the earlier months were gradually eliminated and it was possible to extend the service to all women resident in the Borough, and, later to those non-residents who were in employment in the Borough A talk and film show was arranged for female Council employees and .those inter- J ested in the service were invited to attend special sessions held in the Town Hal 39 Health visitors in the field did much to encourage mothers to attend the clinics and every effort was made to persuade women, at risk, in Social Class IV and V to attend for a smear test. The statistics show that approximately one in every 150 smears examined were positive. Seven percent of women examined had to attend for a repeat smear. Many of these were found to be suffering from conditions such as trichonomas vaginalis, monilia or cervictis. These cases were referred to the general practitioners for treatment, and a repeat smear arranged after the conditions had been successfully treated. A small percentage who had menopausal change readings and whose smears showed some slight cell changes were recalled at the request of the pathologist after intervals ranging from 1 to 12 months. FAMILY PLANNING The Health Committee considered very carefully the implementation in Lambeth of the National Health Service (Family Planning) Act, 1967 which gives local health authorities power to provide family planning advice to all who seek it, free of charge. However, it was decided at this time not to extend the Council’s existing arrangements which are restricted to cases of medical need, but to review the matter in twelve months time. The Council continued to allow the Family Planning Association the free use of clinic premises in which to hold sessions and also made per capita payments to the association in respect of married women referred for family planning advice on medical grounds. Two hundred and fifty six mothers needing advice on medical grounds were referred to the Family Planning Association. Discussions with the Family Planning Association have been authorised with the aim of starting a domiciliary service in the borough for special cases. OCCASIONAL CRECHES These are provided at many 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 take part in the activities of the centre where the creche is held. Groups of ten to twenty children are admitted for periods of 2 to 3 hours. The aim is to provide facilities for children to play with others when no other opportunity is available and to provide some relief for mothers when no alternative arrangement can be made. The increased public awareness of the needs of the under 5 year olds and their mothers had led to an increased demand for such facilities and a number of new sessions commenced during the year. Where they are available they are of 40 benefit to mothers and children and this is an encouragement to all concerned. At the end of the year each centre had a waiting list. Number of sessions held during the year 1,542 Number of attendances 18,532 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. No major changes in the pattern of work took place during the year. In spite of staffing difficulties the services were not only maintained, but limited expansion was possible. Health Visiting Staff In the early months of the year recruitment remained difficult. In the latter part, however, the position improved. Five student health visitors, sponsored by the borough, successfully completed their training and joined the staff and ten commenced their training in September. Health visitor students from Croydon Technical College and the University of Surrey are allocated to Lambeth for practical work placement. Six members of the health visiting staff are designated as 'Field work’ instructors to undertake responsibility for the day to day practical training of these students. In addition, students from St. Thomas’ Hospital, undertaking integrated training, were given the opportunity of obtaining practical experience for a limited period in Lambeth although their placements for such training were outside the borough. Staff are encouraged to attend all available courses, including recognised refresher courses for nursing staff, teaching courses, projectionist courses, and various conferences on subjects in which individual members of the staff have show special interest. Throughout the year staff meetings took place in alternate months attended by health visitors, midwives, school nurses and clinic nurses. 41 HOME NURSING The Lambeth District Nursing Joint Committee continued to provide, on behalf of the Council, a home nursing service throughout the borough, for which it receives an appropriate grant from the Council. In addition, service is given in a small area in the north of the borough by the Catholic Nursing Institute. During the year the two bodies provided service to 4,722 patients of which 3,712 were newly referred and the nurses made a total of 146,433 visits. 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 202 132 Stool Commodes 139 84 Easicarri Hoist 1 1 Extra sling for hoist 1 - Bed Cradles 6 4 Fracture Planks 40 5 Zimmer Walking Aids 4 2 Mattresses — Dunlopillo 2 2 Mattresses with covers 2 1 Plastic covers for Mattresses 2 - Homecraft Walking Frame 7 2 Tripod Walking Aid - 1 Restwell Back Rest 9 5 Adult Cot Bed 1 - Hospital Bed - 1 Zimmer Heavy Duty Lifter with attachments 1 Hire Ripple Bed from 7/8/67 to 24/9/67 1 Returned to Talley Surgical Co. Twenty-one fire guards were lent to necessitous families with children under 12 years of age, or to necessitous old, handicapped or blind persons. Eight were returned. 42 INCONTINENCE PADS Supplied of incontinence pads have been issued to 136 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. DOMICILIARY MIDWIFERY SERVICE The trend for hospital confinement continued and the Council midwives delivered a hundred fewer patients at home than in 1966, but the number of early discharges of maternity patients from hospital increased. The future of the domiciliary service of midwives will be verv interesting to watch and to see on what lines it will develop. Late in 1967, an interesting discussion of senior midwifery staff of the Weir Hospital and the supervisors of midwives of Wandsworth and Lambeth was held on the possibility of a general practitioner unit being set up. The patients would go into hospital, the doctor and domiciliary midwife would attend and deliver the patient in hospital. The mother and baby would remain in hospital a short time (48 hours maximum) then return to her home for the rest of her nursing care provided her condition was satisfactory. This plan, it was thought, would give the mother in carefully selected patients the best possible service. A few midwives visited and gave short talks in some of the Mother and Baby Homes in the area. These were greatly appreciated by the residents. Classes in relaxation and training for labour are gradually increasing. During the year 34 student midwives were allocated to the Council midwives for their district training of three months. This is the most interesting part of midwifery training and introduces nurses to the health and social services outside the hospital. The student midwives come from the South London Hospital, Annie McCall Hospital and Dulwich Hospital. 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 24 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. 43 MIDWIVES ACT, 1951 The Council is the supervising authority for all midwives practising in the Borough under the Midwives Act, 1951. During the year 235 midwives notified the Council of their intention to practise in the Borough. DAY NURSERIES The Council operates ten day nurseries at which 587 places are provided. There were 131,704 attendances during the year. Occupation of St. Martins day nursery commenced on 1st May, 1967 and the building was officially opened by His Worship The Mayor on 15th July, 1967. This new nursery provides fifty places for the under 5 year olds and takes children from the area formerly served by Streatham Hill day nursery which had to be closed due to structural defects. In addition, a part-time group has been established at the nursery to cater for the increased number of referals of cases of social need. After a slow start this has proved to be valuable, not only in decreasing the waiting list but in many cases was of greater benefit to the children than full time attendance. The nurseries provide a valuable service in preventing the break-up of families and each takes a quota of 'handicapped children’ . The children may be either socially or physically handicapped and in a group of normal children frequently make rapid progress which enables them to advance more normally when they reach school age. There is no doubt that some of these children could be catered for in nursery school and classes if this type of provision was available. The special unit at Tulse Hill Day Nursery has continued to provide for the exceptional needs of nine children. Of the ten day nurseries in the Borough, seven are ‘training nurseries’ and provide for a total of 60 students. Recruitment of students has not been difficult, applications exceeding the number of vacancies and during the year 30 students successfully completed their training. Recruitment of qualified nursery nurses, however, has been difficult. Each nursery has on its staff nursery assistants, many of whom have long service and make a valuable contribution to the work. 44 45 46 CHILD MINDING The Council is responsible for the registration and supervision of day nurseries playgroups, and child minders under the Nurseries and Child Minders Regulation Act 1948. The Council also operates a scheme for the voluntary registration of minders who care for one or two children under the age of five years. Suitable persons with good standards receive a small weekly sum. They are required to attend the local child welfare centre with the children at regular intervals, and are also visited in their homes by health visitors. The scheme has been invaluable in maintaining a high standard of care for many children. At the end of 1967 there were 76 voluntary minders caring for 99 children. There was an increasing number of applications from persons wishing to mind more than two children as well as a few wanting to open private day nurseries. These are used by parents who wish to work but whose child is not eligible for a place in a Council nursery. Because of the lack of nursery school facilities within the borough, the demand for part-time playgroup facilities has continued, and the number of applications to form groups increased. Well organised groups are able to provide the opportunity for creative play, stimulation and the companionship necessary for the normal development of the three and four year olds. During the year 17 new or amended registrations were made of premises or persons providing facilities for 321 children, and at 31 December there was a total of 36 premises or person registered caring for 757 children. The Council has authorised the payment of grants to a number of playgroups to assist them in their work. An increasing amount of time was spent by officers of the Health Department in the inspection and supervision of private day-care facilities for children under five years. The Health Visitors maintain contact with the children not cared for in their own homes by visiting all groups and childminders, and a senior nursing officer visits all playgroups and nurseries at intervals. Regular visiting ensures that a high standard of child care is maintained. ‘HANDICA’ REGISTERS Much importance is attached to the development and maintenance of a complete register of all babies and young children who have congenital handicaps, or who, because of adverse factors occurring during the mother’s pregnancy or labour, are ‘at risk’ of developing such handicap. Information provided by general practitioners, hospitals and midwives is supplemented by the observations of clinic doctors and health visitors. 47 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 if any may be taken. Reviews are held at regular intervals of all these children who may be in need of special education. PREVENTION OF BREAK-UP OF FAMILIES Standing Committee for Co-Ordination The Standing Committee for Co-ordination continued its work during the year. Quarterly meetings were held, two under the Chairmanship of the Children’s Officer and two under that of the Chief Welfare Officer, a new chairman being elected annually in June. The Committee 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 officers of the Ministry of Social Security. Its main business is to review services, receive reports, consider Government and other circulars and agree procedures for the improvement of co-ordinating machinery. The problem of individual families are only discussed when points of law or principle are involved, when difficulties in fusing departmental routine have arisen or when families have been provided with sheltered accommodation at assessed rents, with casework support. Two such families have been housed during the year, and a Residential Rehabilitation Unit has been established in the Welfare department. A report from the Immigrants Advisory Committee and two Ministry circulars on homeless families and the prevention of homelessness, both with a bearing on housing problems and rent control, were discussed at some length during the year. The Brixton office of the Ministry of Social Security tried an experiment in rent control on two estates, one Greater London and the other Lambeth Borough Council, relating to tenants in danger of eviction for arrears whilst in receipt of supplementary benefit rent allotment. Unfortunately this only proved that the sole satisfactory form of control in these circumstances is when the Ministry is able to deduct rent at source and pay the landlord direct, which can only be done in a strictly limited number of selected long term cases. Arrangements were made for the Secretary of the Committee to be notified by the Treasurer of the Greater London Council of mortgage default cases, for circulation in the same manner as the information supplied by both the Greater London Council and Borough Housing departments on rent arrears. The routines for notification and circulation are working satisfactorily, but the position with regard to preventive work is not satisfactory. There is not enough margin of staff time as yet in the combined 48 Housing, Health, Children's and Education Services to provide effective social work for the very large number of families now seriously in arrears. Those notified during 1967 totalled 250. In addition to the Chief Officer Standing Committee 94 Co-ordinating case conferences were held, requested by:- The Children’s department 30 Lambeth Housing department 20 Principal Nursing Officer 16 Welfare department 9 Divisional School Care organiser 5 G.L.C. Housing department 3 N.S.P.C.C. 3 South London Family Service unit 3 Ministry of Social Security 1 Probation Service 1 The Old Bailey 1 Maudsley Hospital 1 Dr. Barnardo’s 1 94 HEALTH SERVICES - FAMILY CASEWORKERS Throughout the year there was a waiting list of multi-problem families which were discussed at Co-ordinating Committee Conferences or were rehoused in Lambeth from other boroughs where they had been receiving casework which was still considered necessary. Consequently both caseworkers employed by the department carried the maximum caseload possible without defeating the purpose of the service which is to provide a co-ordinating worker who can give more time to the problems of the family than can be given by any combination of normal services. The two caseworkers were concerned with a total of 42 families involving 169 children. All were long-term cases, a number arising from incurable parental inadequacy due to mental subnormality; the problems of others stemmed from drink, gambling, an increasing number of drug takers, and an increasing number of parents discharged from psychiatric treatment with an anti-social personality problem unresponsive to psychiatric help. Common features amongst the majority were debt, including hire purchase, rent arrears and meter breaking; marital disharmony, often with physical violence; bad school attendance and potential or actual juvenile delinquency; the father’s irregular employment (and in one or two cases virtual unemployability) and the mother's apathy owing to ill-health. Many of the children on the other hand, though near-illiterate, were in robust physical and mental health and well worth a great deal of hard work in the hope of preventing a repetition of their parents’ social patterns. Child neglect, in the superficial sense of dirt and lack of training, was another common factor, but child cruelty as such extremely rare. 49 VACCINATION AND IMMUNISATION Patents 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. INTERNATIONAL CERTIFICATES OF VACCINATION Certificates of recent successful vaccination/inoculation are required by persons travelling to certain countries abroad. After completion by the vaccinating doctor (normally the persons’ s own doctor) the certificate must be taken or sent for authentication of the doctor’s signature by the Medical Officer of Health for the area in which the doctor practises. In Lambeth signatures on certificates are authenticated in the Health Department, Blue Star House, 234/244, Stockwell Road, S.W.9. TUBERCULOSIS 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. There were 3,972 patients on chest clinic registers at 31st December. T.B. health visitors made 3,529 effective home visits and 56 patients 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 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. The protection is offered to all 13 year old school-children each year and during the period 494 contacts and 2,060 school-children were vaccinated. 50 MENTAL HEALTH SERVICES Mental Health Social Workers Cases are referred to the mental health social workers from a very wide range of agencies, and increasingly, as the service becomes better known locally, from members of the general public. Much time and skill is needed is assessing the needs of cases at the time of referral and in providing an effective casework service for patients and their families. Mental health social workers are also authorised by the Council to act as mental welfare officers under the Mental Health Act, 1959, in cases where compulsory admission to hospital is required. In order to deal with emergencies outside office hours a twenty-four hour service is maintained in conjunction with the neighbouring boroughs of Southwark and Wandsworth, and operated through the Lambeth Emergency Control Service. In view of the general shortage of trained personnel, five trainee mental health social workers have been appointed. After a period of practical experience and inservice training they are to be seconded on full-time training courses leading to recognised professional social work qualifications. Two of the trainees have already started on full-time courses and, in addition, two experienced but unqualified mental health social workers are on similar courses. By this means, the majority of the social work staff will be fully qualified within the next two to three years. Day Care and Training Facilities By the end of the year plans were well advanced for the adaptation of premises for use as junior training schools for a total of 105 children. The former Macaulay School, Clapham, will provide for 60 children and will include a special care unit for 10 children, and a large house in Garrads Road, Streatham, will provide for 45 children. Both of these premises will eventually be replaced by purpose built schools and plans are almost complete for the first of these which will be located in the Blenheim Gardens Redevelopment Area. It will cater for 114 children and will incorporate a therapeutic pool which will be used by the children for therapeutic training and recreational activities. In the meantime we have been grateful for the continued use of facilities at junior training schools in Wandsworth, Southwark and Lewisham, and at the Fountain School at Queen Mary’s Hospital, Carshalton. In view of the general shortage of accommodation, agreement was reached with the Manor Hospital, Epsom, for up to 20 Lambeth children to attend their hospital school on a daily basis. In spite of the distance involved the scheme has been working extremely well. A small number of children who are too handicapped to attend a junior training school receive regular tuition from a Home Teacher. Ten children under 5 years of age attend the Special Nursery Unit for subnormal children at Tulse Hill Day Nursery and a number of others attend ordinary day nurseries throughout the Borough. 51 The Clapham Adult Training Centre continues to provide industrial work and social training for mentally subnormal men and boys over 16 years of age from Lambeth and Wandsworth. A high standard of work is carried out and an incentive payment scheme is in operation. It has not yet been possible to provide adult training facilities on a mixed basis and the women and girls continue to attend centres in Wandsworth and Lewisham. Meetings with the Borough Architect’s department have commenced in order to plan a 150 place centre in the Loughborough Park Redevelopment Area which will replace the Clapham Centre in 4 to 5 years time and cater for mentally subnormal adults of both sexes. There are no day centres for the mentally ill in the borough but a number of Lambeth patients are financially sponsored at the Castle Day Rehabilitation Centre and the Camberwell Day Centre, both in Southwark. Others attend the Crossways Rehabilitation Centre run by the Institute of Social Psychiatry. Residential Services Mentally ill patients needing a period of rehabilitation, or longer term sheltered accommodation after discharge from hospital, are sponsored by the borough in homes and hostels administered by other local authorities and by voluntary organisations. Mentally subnormal children and adults are catered for similarly and periods of short term care are also arranged to give relief to families where this is required. Day Hospitals for Mentally 111 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. ST. THOMAS’S HOSPITAL-COMMUNITY STUDY IN LAMBETH St. Thomas's Hospital was created a district hospital with special responsibility for the medical care of the population of Lambeth. This development was seen by the Hospital authorities as producing both the opportunity and the need for investigating the demand for hospital care in this area of London. A series of Studies was projected with the object of providing information about the health of the population needed for the planning of the hospital services. 52 The proposed studies, to be carried out under the direction of Dr.W.W. Holland, Reader in the Department of Clinical Epidemiology and Social Medicine, will extend over a period of about three years. The objects of the studies are as follows:- (a) To measure the frequency of particular diseases in the population (b) To assess the medical care being actually received by the patients found (c) To investigate sociological factors influencing the demand for medical care with people in similar conditions. The health department was asked to assist by allowing access to the records of births and deaths kept by the department, the use of health department premises for carrying out clinical examinations, the allocation of medical officers to participate in the clinical examinations and the allocation of nursing staff to make home visits to persons in the survey. Two medical officers, one full-time and the other sessional, and three nursing staff were attached to Dr. Holland’s team. Premises were also made available. The first survey was carried out in February /March 1967 on the prevalence of cardior-espiratory disease. Prior to the actual clinical survey, courses were held for those specialising in the various interviews and tests. A random sample of the population was selected from an area in the North of the borough covering Bishops, Princes, Oval, Stockwell, Larkhall and Ferndale Wards.Approximately 5,500 dwellings were visited and the occupants asked for details of name, date of birth, sex, marital status, occupation, schooling, attendance as an in or out-patient at any hospital within the previous six months and the presence of major disabilities.This information was successfully obtained from approximately 92.2% of all the people living in the defined area and a total of 8,000 persons were enumerate From this total a random sample of 3,000 was selected from different age, sex and social class groups. Each received a questionnaire — simple questions on the presence of respiratory and cardio-vascular symptoms. In those cases where the questionnaire was not returned a follow-up visit was paid by one of the field workers. Following the return of the questionnaire a random sample of some 800 individuals was selected for examination in the clinical part of the study. Of the 800 selected, 600 answered positively to one or more of the questions in that they reported symptoms of respiratory or cardio-vascular disease. The clinical examination was carried out at two centres, the Elizabeth Bullock School Treatment Centre, 346 Wandsworth Road, S.W.8. and Northcote House, 37 Royal Street, S.E.1. 53 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 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 hotels etc., approved by the health department. A total of 157 holidays were provided as follows:— Expectant and nursing mothers and children under five 65 Psychiatric patients 10 Persons of pensionable age 43 Other adults 39 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 1,676 at which 10,317 treatments were given. HOME HELP SERVICE The demand for the service was maintained during the year. Approximately 89% of the households serviced contained a person over the age of 65 years. 1,979 new applications for the service were received, and a total of 8,522 visits were made. 34 ANTE-NATAL AND POST NATAL CLINICS Number of Sessions held by: Medical Officers 4 Midwives 30 Sessional General Practitioners 261 Number of women attending for ante-natal examination 1,108 Number of women attending for post-natal examination 94 Mothercraft and Relaxation Classes Number of women attending:- (a) Hospital booked 87 (b) Domiciliary booked 67 Total 154 Total number of attendances 487 55 DENTAL TREATMENT FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS ATTENDANCES AND TREATMENT A. Number of vists for Treatment during the year:— Children Expectant and 0-4 (incl) Nursing Mothers First visit 88 39 Subsequent visits 125 39 Total visits 213 78 Number of additional courses of treatment, other than the first course, commenced during the year 4 1 Treatment provided during the year:— Number of fillings 125 47 Teeth filled 115 42 Teeth extracted 36 12 General anaesthetics given 11 1 Emergency visits by patients 22 5 Patients x-rayed Patients treated by scaling and/or removal of stains from teeth 2 25 Teeth otherwise conserved 224 Number of courses of treatment completed during the year 30 22 B. Patients supplied with a full upper or full lower denture - first time 1 Patients supplied with other dentures 1 Number of dentures supplied 2 C. General anaesthetics administered by Dental Officers 5 D. Inspections during year - First inspections 89 30 Patients in above who required treatment 73 29 Patients in above who were offered treatment 73 29 Number of dental officer sessions (i.e. equivalent half days) devoted to maternity and child welfare patients during the period 43.1 56 HEALTH VISITING Cases visited by Health Visitors:— Children born in 1967 6,520 Children born in 1966 6,562 Children born in 1962-65 15,044 28,126 Persons aged 65 and over 69* Mentally disordered persons 23ø Persons, excluding Maternity cases discharged from hospital (other than Mental Hospitals) 20+ Number of Tuberculous households visited 7 Number of households visited on account of other infectious diseases 26 Other Cases 2,409 Number of Tuberculous Households visited by Tuberculosis Visitors 609 Total number of effective visits and re-visits 64,692 Total number of unsuccessful visits 12,314 *Included in this figure are 10 persons who were visited at the special request of the general practitioner or hospital. øIncluded in this figure are 7 persons who were visited at the special request of the general practitioner or hospital. +Included in this figure are 15 persons who were visited at the special request of the general practitioner or hospital. HOME NURSING Total number of persons nursed during the year 4,722 Number aged under 5 at first visit during the year 457 Number aged 65 and over at first visit in the year 2,870 Total number of visits during the year 146,433 HOME HELP SERVICE Persons for whom service was provided during the year:- Aged 65 or over 3,801 Chronic sick and tuberculous persons 367 Mentally disordered 5 Maternity cases 90 Others 326 Total 4.589 57 DOMICILIARY MIDWIFERY Attendance by midwives:Confinements Doctor not booked 9 Doctor booked 796 Number of hospital cases discharged to midwife before tenth day 584 CHILD WELFARE CENTRES Number of children attending during the year Born in 1967 5,548 Born in 1966 5,817 Born in 1962-1965 6,486 Total 17,851 Number of sessions held during the year by Medical Officers 227 Health Visitors 11 Sessional General Practitioners 2,420 Hospital Medical Staff 95 Total 2,753 Number of children referred elsewhere 832 Number of children on “at risk” register at the end of the year 2,217 58 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 1 - 7 7 2. Homes whose registrations were withdrawn during the year - - - 3. Homes on the register at the end of the year 9 99 121 220 59 DAY NURSERIES Nurseries maintained by the Authority or by Voluntary organisations under Section 22 of National Health Service Act 1946 Number at end of the year 10 Number of approved places 587 Average daily attendance 512 Number of children on register at the end of the year 626 DAILY MINDERS AND REGISTERED NURSERIES Nurseries and Child Minders Regulation Act 1948 Number of Premises registered at the end of the year 24 Number of places 628 Daily minders registered at end of year 12 Number of children minded at end of year 129 National Health Service Act 1946, Section 22 Number of Daily minders receiving fees from the Authority at the end of the year 76 Number of places and children minded at end of the year 99 60 CHIROPODY SERVICE Details of statistics on chiropody treatment year ending 31st December 1967 Number of persons treated during year ending 31st December 1967 By local authorities (1) By voluntary organisations (2) Total (3) 1. Persons aged 65 and over 2542 3022 5564 2. Expectant mothers 3 - 3 3. Children under 5 - - - 4. Others 76 - 76 5. Total 2621 3022 5643 Number of treatments given during year ending 31st December 1967 1. In clinics 10,317 19,012 29,329 2. In patients’ homes - 6,780 6,780 3. In old peoples’ homes 2,429 - 2,429 4. In chiropodists’ surgeries - 1,135 1,135 5. Total 12,746 26,927 39,673 61 IMMUNISATION AND VACCINATION 1967 Immunisation: Completed Primary Courses— Number of persons under age 16 Type of Vaccine or dose Year of birth Others under age 16 Total 1967 1966 1965 1964 1960-63 1. Quadruple DTPP - 1 1 - - - 2 2. Triple DTP 2,288 2,488 202 70 120 16 5,184 3. Diphtheria/Pertussis - - - - - - - 4. Diphtheria/Tetanus 3 13 15 23 364 619 1,037 5. Diphtheria 2 - - - 1 2 5 6. Pertussis - - - - - - - 7. Tetanus - - - - 2 15 17 8. Salk - - - - - - - 9. Sabin 1,220 3,212 492 239 754 871 6,788 10. Total — Diphtheria 2,293 2,502 218 93 485 637 6,228 11. Total-Whooping Cough 2,288 2,489 203 70 120 16 5,186 12. Total-Tetanus 2,291 2,502 218 93 486 650 6,240 13. Total—Poliomyelitis 1,220 3,213 493 239 754 871 6,790 62 IMMUNISATION: REINFORCING DOSES-NUMBER OF PERSONS UNDER AGE 16 Type of Vaccine or dose Year of Birth Others under age 16 Total 1967 1966 1965 1964 1960-63 1. Quadruple DTPP - - - - 1 - 1 2. Triple DTP - 1673 1607 167 542 85 4,074 3. Diphtheria/Pertussis - - - - - - - 4. Diphtheria/Tetanus - 32 52 35 2,330 1,335 3,784 5. Diphtheria - - 1 - 4 13 18 6. Pertussis - - - - - - - 7. Tetanus - - - - 7 37 44 8. Salk - - - - - - - 9. Sabin - 126 89 25 2,425 874 3,539 10. Total-Diphtheria - 1,705 1,660 202 2,877 1,433 7,877 11. Total-Whooping Cough - 1,673 1,607 167 543 85 4,075 12. Total-Tetanus - 1,705 1,659 202 2,880 1,457 7,903 13. Total— Poliomyelitis - 126 89 25 2,426 874 3,540 63 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 - 13 23 16 1,837 702 87 2,678 Re-vaccination - - - - 1 15 91 107 TUBERCULIN TEST AND B.C.G. VACCINATION Number of persons vaccinated through the Authority’s approved arrangements under Section 28 of the National Health Service Act. A. CONTACTS (Circular 19/64) (i) No. skin tested 920 (ii) No. found positive 515 (iii) No. found negative 405 64 (iv) No. vaccinated 494 B. SCHOOL CHILDREN AND STUDENTS (Circular 19/64) (i) No. skin tested 2,424 (ii) No. found positive 280 (iii) No. found negative 2,051 (iv) No. vaccinated 2,060 65 MENTAL HEALTH Number of persons under Local Health Authority care at 31st December 1967 Mentally 111 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 3 99 165 65 40 67 45 92 72 94 76 821 2 Attending workshops/occupation training centres 12 11 27 17 10 5 50 44 51 35 262 3 Awaiting entry to workshops/ occupation training centres 9 9 1 2 16 12 13 16 78 4 Receiving home training 2 2 2 2 8 5 Awaiting home training 6 Resident in L.A. home/hostel 6 6 10 7 Awaiting residence in L.A. home/hostel 8 Resident at L.A. expense in other homes/hostels 7 7 1 4 5 4 2 1 6 37 9 Resident at L.A. expense by boarding out in private household 8 1 1 10 66 MENTAL HEALTH Number of persons under Local Health Authority care at 31st December 1967 Mentally 111 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) (lb) (17) (18) ( 19) 10 Attending day hospitals 11 Receiving home (a) suitable to visits and not attend a included in training lines 2—10 centre 8 7 6 6 5 1 33 (b) others 3 3 74 143 23 9 45 34 16 11 22 16 399 12 Number of children under age 16 attending training centres who have not been included in item 2 overleaf because they do not come within the categories covered in columns (1) to (18) Male NIL Female NIL 13 Number of persons included in item 6 overleaf who reside in accommodation provided under the National Assistance Act, 1948 Male NIL Female NIL (57 MENTAL HEALTH Number of patients awaiting entry to hospital, admitted for temporary residential care or admitted to guardianship during 1967 Mentally 111 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 of waiting list for admission to hospital at end of year (a) In urgent need of hospital care 8 4 12 (b) Not in urgent need of hospital care 1 2 1 4 (c) Total 1 10 5 16 2. Number of admissions for temporary residential care (e.g. to relive the family) (a) ToN.H.S. hospitals 1 3 3 3 15 9 5 3 42 (b) To L.A. residential accommodation (c) Elsewhere 2 5 7 (d) Total 1 3 3 3 17 14 5 3 49 68 MENTAL HEALTH Number of patients awaiting entry to hospital, admitted for temporary residential care or admitted to guardianship during 1967 Guardian Mentally 111 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. (a) Admission 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 (59 MENTAL HEALTH Number of persons referred to Local Health Authority during year ended 31st December 1967 Referred by Mentally 111 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 92 181 1 2 3 279 (b) Hospitals, on discharge from in-patient treatment 64 69 2 1 3 2 1 1 3 2 148 (c) Hospitals, after or during out-patient or day treatment 1 73 94 2 2 1 2 1 176 (d) Local education authorities 1 3 4 2 10 13 18 7 13 4 75 (e) Police and courts 155 29 1 7 1 193 (f) Other sources 2 3 200 266 23 12 22 20 15 12 4 4 583 (g) Total 4 6 588 641 3 1 37 27 51 30 34 18 8 6 1,454 70 MENTAL HEALTH STATISTICS FOR 1967 WORKSHOPS, OCCUPATIONAL CENTRES AND TRAINING CENTRES AS AT 31st DECEMBER 1967 TABLE1-Workshops or occupational centres for the mentally ill 1 Premises Number of premises and places provided 2 Places — TABLE2-Training centres for the subnormal or severely subnormal (including special units) Age group provided for Number of premises Places Junior Adult 3 Under 16 1 9 4 16 and over 1 90 5 Junior and adult 6 Total 2 9 90 TABLE 3 - Special units (included in table 2 above) providing for the severely subnormal with gross physical handicaps or gross behaviour difficulties 1 Special Units within training centres 7 Premises - 8 Places - 2 Self contained units independent of training centres 9 Premises - 10 Places - 71 TABLE 4 — Places made available to or by other authorities or organisations Type of authority or organisation Places in workshops of occupational centres for the mentally ill Places in training centres for the subnormal or severely subnormal Places in special units for the severely subnormal Places made available to other authorities or to hospitals Junior Adult 11 Local authority 35 12 Hospital 13 Total 35 Places made available to the authority by other authorities or organisations 14 Local authority 19 73 39 15 Hospital 18 4 16 Other organisations 4 8 2 17 Total 23 91 47 6 TABLE 5 - Adjusted figures for places Net number of places available to the authority Workshops or occupational centres 18 Line 2 + line 17 - line 13 23 Training centres Junior 19 Line 6 + line 17 — line 13 100 ø Adult 20 Line 6 + line 17 - line 13 102 Special Units 21 Lines 8 + 10 - 17 - line 13 6 ø excludes 34 subnormal/severely subnormal children aged under 5 attending the Authority's day nurseries 72 MENTAL HEALTH STATISTICS FOR 1967 HOMES. HOSTELS. SOCIAL CENTRES AND CLUBS AS AT 31st DECEMBER 1967 TABLE 1 - Homes and hostels Age group provided for For the mentally ill For the subnormal or severely subnormal Number of premises Number of places Number of premises Number of places Junior Adult 1. Under 16 - - - - - 2. 16 and over - - - - - 3. Junior and adult 4. Total - - - - - Homes and hostels for the elderly mentally infirm provided under the National Health Service Act, 1946 5 premises - 6 places - Homes and hostels included in line 4 which were specifically provided for the mentally disordered under the National Assistance Act, 1948 7 premises - 8 places - TABLE 2 — Places in homes/hostels made available to or by other authorities or organisations Type of authority or organisation For the mentally ill For the elderly mentally infirm For the subnormal or severely subnormal Junior Adult Places made available to other authorities or to hospitals. 9. Local authority - - - - 10. Hospital - - - - 11. Total 73 TABLE 2 - continued Places made available to the authority by other authorities or organisations. 12. Local authority 10 - — — 13. Hospital 14. Other organisations 14 - 7 16 15. Total 24 - 7 16 TABLE 3 - Social centres and clubs provided under the National Health Service Act, 1946 Category of person catered for Number of centres or clubs Junior Adult Mixed Total 16. Mentally ill — — — — 17. Subnormal or severely subnormal - - - - 18. Elderly mentally infirm - - - - 19. Total - - - - TABLE 4 - Adjusted figures for places in homes and hostels Net number of places available to the authority For the mentally ill 20. Line 4 + line 15 - line 11 24 For the elderly mentally infirm 21. Line 6 + line 15 - line 11 For the subnormal or severely subnormal Junior 22. Line 4 + line 15 - line 11 7 Adult 23. Line 4 + line 15 - line 11 16 74 PUBLIC HEALTH ACT 1936, (sections 187 to 194) MENTAL HEALTH ACT 1959. (section 15 (1) RETURN OF MENTAL NURSING HOMES REGISTERED AT 31st DECEMBER 1967 Name of mental nursing home Total number of beds Number of beds available for (see note 1) Whether authorised to detain patients Patients aged under 16 Patients aged 16 and over Mentally ill Psycho pathic Subnormal or severely subnormal Mentally ill Psychopathic Subnormal or severely subnormal (1) (2) (3) (4) (5) 16) (7) (8) (9) (a) ST. MICHAEL’S CONVENT 22 22 Yes Total 22 22 Number of registrations during 1967 which were (a) refused NONE (b) cancelled NONE 75 PUBLIC HEALTH ACT 1936 (section 187 to 194) MENTAL HEALTH ACT 1959 (section 15(1)) RETURN OF MENTAL NURSING HOMES AUTHORISED TO DETAIN PATIENTS Number of admissions during 1967 Mentally III Psychopathic Subnormal Severely subnormal Total M. F. M. F. M. F. M. F. M. F. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (a) Informal admissions — — — — — 4 — — - 4 (b) Compulsory admissions for observation under Section 25 — — — — — — — — - - (c) Compulsory admissions for observation under Section 29 — — — — — — — — - - (I) Compulsory admissions for treatment under Section 26 — — — — — — — — - - (e) Transfers from guardianship under section 41 (2)d — — — — — — - — - - (f) Removals from Northern Ireland under Section 87 — — — — — — — — - - (g) Compulsory admissions on court orders under Section 60 — — — — — - - — - - (h) Compulsory admissions on court orders under Section 61 — — — — — — - — - - (j) Compulsory admissions on court orders under Section 65 — — — — — — - — - - (k) By direction of Home Secretary under Section 73 — — — - — — — — - - 76 PUBLIC HEALTH ACT 1936 (section 187 to 194) MENTAL III ALTH ACT 1959 (section 15(1)) RETURN OF MENTAL NURS1NG HOMES AUTHORISED) TO DETAIN PATIENTS Number of .admissions during 1967 Mental 111 Psycehopathic Subnormal Severely subnormal Total M. F. M. F. M. F. M. F. M. F. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (1) Removals from Northern Ireland, Channel Islands or Isle of Man under Section 88 - - — - — - — - - - (m) Removals from Northern Ireland, Channel Islands or Isle of Man under Section 89 - - — - — — — - - - (n) Admissions under Section 64(1) - - — - — — - - - - (o) Admissions under Section 68 - - — - — - — - - - (p) Admissions under Section 71(1) - - — — — — - - - - (q) Admissions under Section 135 - - - — — - - - - - ( r) Admissions under Section 136 - - — — — — - - - - (s) Total admissions - - — — — 4 — - — 4 Number of patients resident in mental nursing homes (including any temporarily absent and expected to return) on 31st December 1967 Patients subject to detention under the (a) Act but excluding any detained under section 30(2) - — — — — — — - — - Mentally disordered patients not subject (b) to detention but including any temporarily detained under section 30(2) - — — - — 16 — 6 — 22 (c) Other patients — 77 Section D Environmental Health Services 78 ENVIRONMENTAL HEALTH SERVICES PUBLIC HEALTH INSPECTION ABATEMENT OF NUISANCES GREATER LONDON COUNCIL ( GENERAL POWERS) ACT, 1967 This Act, which came into force during the year, contains several public health provisions. Section 23 provides that where any statutory undertaker ceases to supply water to any building used for human habitation, or to a place where persons are employed, by reason of the defective state of the supply pipe or water fittings, or the absence thereof, or failure to comply with any enactment relating thereto the borough council may, after giving a requisite notice of intention, execute such works as are necessary to secure the restoration of the supply of water. Provision is made for the recovery of expenses incurred in so doing. This is a most helpful adjunct to the existing powers contained in Part IV of the Public Health Act, 1936. Section 24 (a) amends Section 17 of the Public Health Act, 1961 relating to the summary power to remedy stopped up drains, private sewers, water closets and soil pipes. Section 24 (d) amends Section 18 of the Public Health Act, 1961 under which a borough Council may, after giving not less than seven days notice that a drain of private sewer is not sufficiently maintained and kept in good repair, cause the drain or sewer to be repaired. Provision is made for the recovery of expenses reasonably incurred in so doing up to £100 whereas Section 18 of the Public Health Act, 1961 provides a limit of £50. It is a matter of regret that this statutory limitation of £100 was not higher because building costs continue to rise, and further it is not always possible to make a firm estimate of the cost of drainage works, particularly where old drains are concerned. It is obvious that careful use will have to be made of the Section because it is unfortunate that where such a notice is served and the reasonable costs exceed £100 the Council can only recover £100 and the remaining cost must be met by the Council. Section 25 provides that Section 26 of the Public Health Act, 1961 shall apply throughout Greater London. Under this Section where any premises are in such a state as to be prejudicial to health or a nuisance and unreasonable delay in remedying the defective state would be occasioned by following the normal nuisance abatement procedure, the local authority may serve, in place of an abatement notice, a notice stating their intention to remedy the defective state and specifying the defects concerned. Provision is made for the service of a counter 79 notice stating a persons intention to remedy the defects specified and in default for the local authority to carry out works and recover the reasonable costs incurred in so doing. This is a most useful provision which has been available to the whole of the country with the exception of the Inner London Boroughs since 1965, due to the provisions of Schedule II of the London Government Act, 1963. Representations had been made by seven Inner London Boroughs, including Lambeth, in respect of this omission because the precise power was available to the former Metropolitan Boroughs under a London County Council (General Powers) Act made in 1955. SUMMARY OF WORK DONE BY DISTRICT PUBLIC HEALTH INSPECTORS (1) Inspections Houses/flats inspected under Public Health Act, 1936 4,283 Separate lettings 446 Re-visits Houses/Flats 4,202 Separate lettings 147 (2) Other Inspections and Visits Miscellaneous 3,185 Prevention of Damage by Pests Act, 1949 105 Infectious Diseases 303 National Assistance Acts, 1948 and 1951 (aged and infirm) 7 Factories Act, 1961 - Outworkers 160 Pet Animals Act, 1951 7 Noise Nuisances 157 Food Premises 2,581 Non-effective visits 3,424 (3) Nuisances and Notices Notices served - Public Health Acts, 1936 and 1961 (a) Informal 1,035 (b) Statutory 1,548 Notices complied with - Public Health Acts, 1936 and 1961 (a) Informal 838 (b) Statutory 802 80 (4) Legal Proceedings Summonses applied for 100 Nuisance Orders made by Magistrates 10 (5) Drainage Plans examined 27 Examinations and Tests 734 (6) Complaints Dealt with during year 3,414 (7) Land Charges Act. 1925 Enquiries dealt with 4,773 (8) Rent Act. 1957 Applications for Certificates of Disrepair 4 1. Number of applications for certificates during 1967 Nil Applications carried forward to 1968 Nil 2. Decisions not to issue Certificates Nil Undertakings on Form K accepted 2 3. Decisions to issue Certificates (a) in respect of some, but not all defects 3 (b) in respect of all defects 1 4. Undertakings given by landlords under paragraph 5 of the First Schedule 2 5. Undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil 6. Certificates issued 2 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 3 9. Decisions by Local Authority to cancel in spite of tenants objections Nil 10. Certificates cancelled by Local Authority 1 (9) Improvements effected as a result of Service of Notices under the Public Health Acts, 1936 and 1961 1. Brickwork — walls repaired or rebuilt 22 2. Drains cleared, repaired, etc. 163 3. Dampness remedied 428 4. Fireplaces and ranges repaired/renewed 18 81 5. Floors repaired 100 6. Flues repaired 5 7. Internal walls repaired 126 8. Ceilings repaired 141 9. Rainwater pipes/gutters repaired/renewed 101 10. Roofs repaired 188 11. Rooms cleansed - 12. Sinks provided/renewed 10 13. Soil pipes repaired and renewed 14 14. Staircases repaired 16 15. Staircases or passages cleansed 6 16. Waste pipes repaired/renewed 63 17. Water closet apartments cleansed 1 18. Water closet pans and traps renewed 46 19. Water closets — general repairs 40 20. Water closet - flushing apparatus repaired or renewed 66 21. Water supplies provided 12 22. Water services pipes repaired 38 23. Window sash cords renewed 131 24. Windows repaired or renewed 94 25. Miscellaneous improvements 76 Total 1,765 PUBLIC HEALTH ACT. 1936 - SECTIONS 39 and 45 PUBLIC HEALTH ACT. 1961 - SECTIONS 17 and 18 Work required to be done for 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 40 cases. SEALING OF DISUSED DRAINS Many infestations of 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. 258 drains were sealed under the supervision of the drainage assistant. 734 drainage systems were tested in respect of new premises and 312 tested in existing premises. 82 NUISANCE ARISING FROM STOPPED-UP DRAINS - EMERGENCY SERVICE This service to carry out emergency rodding of stopped-up drains is carried out, free of charge, on application from owners or occupiers. The service is highly successful and is much appreciated by the ratepayers. 81 drains were cleared as a matter of urgency during the year. LEGAL PROCEEDINGS Statutory action was taken in respect of 100 cases for failure to comply with Notice under Section 93 of the Public Health Act, 1936. Nuisance Orders were obtained in 10 cases and in each case costs of £2 were awarded to the Council. Details of the Orders are as set out below:- Date Address Magistrate's Decision 5. 4.67 74, Fentiman Road, S.W.8. Nuisance Order - 21 days 19. 4.67 26, Wincott Street, S.E.ll. -do- 21 days 6. 6.67 59, Hackford Road, S.W.9. -do- 14 days 27. 6.67 30, Wincott Street, S.E.ll. -do- 21 days 27. 6.67 103, Elm Park, S.W.2. -do- 14 days 24.10.67 44, Pulross Road, S.W.9. -do- 21 days 24.10.67 21, Redan Terrace, S.E.5. -do- 21 days 3.11.67 25, Bonnington Square, S.W.8. -do- 14 days 28.11.67 302, Coldharbour Lane, S.W.9. -do- 21 days 6.12.67 168, Gleneagle Road, S.W.16. -do— 28 days 37 cases were adjourned sine die and 49 cases withdrawn following the carrying out of works to abate nuisance. The remaining 4 cases are awaiting hearing. DISINFECTION The following is a summary of the work carried out by the staff of the Wanless Road Disinfecting Station. Number of premises sprayed in which cases of infectious disease occurred 123 Number of rooms included in above 215 Total number of rooms sprayed for all purposes 2,836 Number of articles disinfected 8,891 Number of library books disinfected 1,052 Number of disinfection certificates issued 16 83 DISINFEST ATION Number of houses visited 230 Number of rooms sprayed 689 Number of houses re-visited 31 There were many complaints during the year of insect infestation. The usual offenders were wood boring beetles, ants, cockroaches, carpet beetles and wasps. The total number of visits made by the staff of the Disinfecting Station for all purposes was 1,763. PREVENTION OF DAMAGE BY PFSTS ACT, 1949 Rat and mice destruction in dwelling-houses and business premises is carried out under the direction of the Rodent Officer. In the case of dwelling houses treatment is undertaken by the Local Authority free of charge, but in the case of business premises a charge is made. During the year 2021 complaints were received and investigated, 3,333 baitings being carried out. 1,346 complaints were in respect of brown rats, 667 in respe. t of mice and 8 complaints were not justified. Sewer Treatment Baiting of the sewers is carried out by the Borough Engineer's Department to reduce the number of rats living in them. It is difficult to kill off all the rats in the sewers as access to the sewers 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 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 where traffic jams can easily occur whilst baiting is in progress. During the year the Borough Engineer's Department laid 6,000 baits in the sewers in the Borough. 84 PREVENTION OF DAMAGE BY PESTS ACT, 1949 ~ SECTION 4 Treatment for Rodent Infestation in Default The following case, which is unusual and probably unique, merits special mention:— During the course of an investigation into rodent infestation on neighbouring lands, which gave all the signs of a surface infestation, the trail led to a large lock-up warehouse where all kinds of general foods and merchandise were stored by the owner. Upon preliminary inspection a quantity of various kinds of foodstuffs was found deposited on the premises, and after inspection by the public health Inspector approximately 10 cwts were seized and taken before a Justice of the Peace who condemned the food and ordered it to be destroyed. The owner had claimed before the Justice of the Peace that:— (a) the foodstuffs were not intended for sale for human consumption but were for (i) personal consumption (ii) shipment to British Honduras for mixture with warfarin as a rat bait. (b) that the food was bought by him on the written undertaking that it was not to be sold for human consumption. Unfortunately, this undertaking could not be produced. Further investigation of the rodent infestation which had been confirmed, revealed further quantities of food lying beneath merchandise of all kinds. The owner proved unco-operative and it was necessary to obtain a warrant to enforce entry. This time 19 cwts of foodstuffs were seized and again dealt with by a Justice of the Peace. It became increasingly obvious as the investigation proceeded that the rodent infestation could not possibly be dealt with whilst the premises remained in such a hopelessly desordered condition. In addition there was a real health danger to children who gained entry to the premises from an adjoining site. On expiry of a notice served under Section 4 of the Prevention of Damage by Pests Act, 1949 works in default were put into operation. They were carried out by the public health inspectors and a labour team provided by the Borough Engineer and Surveyor. The premises were systematically cleared of all useless material which formed an ideal environment for rats. Further quantities of food, a total of 2 tons, 10 cwts, 3 qrs were seized and dealt with by a Justice of the Peace. Other material, no less than 91 tons, was removed from the premises and disposed of. In addition, a large quantity of marketable merchandise was removed by a dealer upon agreement with the owner, and public health inspector. 89 Despite bad conditions underfoot, rat and insect infestation, and unpleasant smells, the personnel engaged completed their work and it is a tribute to them that the premises are now in a reasonable condition, the rodent infestation cleared and a menace to health removed. ATMOSPHERIC POLLUTION - CLEAN AIR ACT, 1956 Smoke Control Areas Areas No. 16, 17 and 18 became operative, whilst Nos. 19 and 20 were confirmed by the Minister of Housing and Local Government to become operative in 1968. The impetus given to the Gas Industry by the discovery and exploitation of North Sea Gas, was reflected by an increased demand for gas heaters to replace obsolete heating equipment with grant assistance. Conversely, the demand in Smoke Control Areas for "off-peak" electric storage heaters continued to be disappointingly small. Demand for solid fuel appliances also slackened. National Survey Due to the departmental re-organisation it was not possible to co-operate with the Ministry of Technology at Stevenage to the same extent as before. One Volumetric Measurement Station (for Smoke and sulphur dioxide) was maintained at Norwood Technical College, Knight's Hill, S.E.27. Number of inspections/revisits 14,728 Number of Notices served under Section 12 of the Clean Air Act, 1965 21 Number of prosecutions Nil Number of smoke observations (Timed) 77 Number of smoke observations (Untimed) 215 86 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 81 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authorities 1,032 216 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 43 58 - Total 1,209 355 - 87 2. Cases in which Defects were found - Particulars Number of cases in which defects were found Found ftmed ied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.l) 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 1 1 - 1 (c) Not separate for sexes 2 2 - 2 Other offences against the Act (not including offences relating to Outwork). 5 5 - 5 Total 9 9 - 9 No Prosecutions were instituted. 88 Part VIII of the Act Outworkers (Sections 133 and 134) Nature of Work Number of outworkers in August list required by Section 110 (1) (c) (3) Wearing apparel — Making etc., cleaning and washing 58 Curtains — Making 1 Wigs - Making 1 Xmas cards 2 Carpet - Fitting 2 Artificial flowers - Making 1 Buttons — Packeting, etc. 56 Jewellery — Making 3 Total 124 No Notices were served or Prosecutions instituted. NOISE ABATEMENT ACT. 1960 INDUSTRIAL NOISE In response to the recommendations of the Committee on the problems of Noise, the Ministry of Housing and Local Government issued Circular 22/67 giving advice about the reduction of noise in factories, together with a booklet "Noises and the Worker". The Ministry of Labour has agreed that H.M. Factory Inspectors will make their knowledge and experience of the problem available to Local Authorities and will help them as far as possible in dealing with Industrial Noise. In London, the Greater London Council's Scientific Branch is also prepared to assist in taking noise measurements and giving advice- The Minister's recommendation that certain training should be made available to officers dealing with the problem of noise is being met through the agency of part-time courses at the South East London Technical College for public health inspectors. 89 Most of the complaints received relate to noise from factory machinery and methods of working, and during the year 66 complaints have been investigated. Of these, in 18 cases a reduction of noise to a tolerable level was obtained by informal action, and in 48 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. MEDICAL ARRANGEMENTS EOR LONG-STAY IMMIGRANTS During the year 762 advice notices were received from the Port Health Authorities and 681 successful visits were made by the Public Health Inspectors. PET ANIMALS ACT, 1951 During the year 27 visits were made to the 18 pet animal establishments licensed in the Borough. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 RIDING ESTABLISHMENTS ACT, 1964 There are two Animal Boarding Establishments and four Riding Establishments licensed in the Borough. The Veterinary Officer, Corporation of London, carries out regular inspections of these establishments on behalf of the London Borough of Lambeth. During the year 15 visits were made in Lambeth. DISEASES OF ANIMALS ACT, 1950 Arrangements have been 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 actions under the Act or orders made thereunder was necessary during the year, but the Veterinary Officer, Corporation of London, made 16 visits in Lambeth during the year. 90 HOUSING SLUM CLEARANCE PROGRAMME 1966-1970 During the year 130 houses in six areas have been represented as unfit for human habitation Areas Number of Houses Sidney Road Area Sidney Road Nos. 8, 10, 12, 14, 16, 18 & 20 7 Total 7 Moat Place Area Moat Place Nos. 1, 3, 7, 9, 13-27 (odd) and 2, 4, 6, 10, 12, 18-30 (even) 32 and 34. 26 Total 26 Chapel Road Area Chapel Road Nos. 1, 3, 5, 7, 9 & 11 Rothschild Street Nos. 5, 7 & 9 Denmark Walk Nos. 4, 5, 6, 7 & 9 Weaver Walk Nos. 1, 3, 5, 7, 9, 11, 13, 15, 17 & 19 24 Total 24 Norwood High Street Area Norwood High Street Nos. 24 & 26 Cotswold Street Nos. 1, 2, 3, 4, 5/6, 8, 9, 10 & 11 Ernest Avenue Nos. 2, 4, 6, 8, 10, 20, 22, 24, 26, 28 & 30 13, 15, 17, "Hope Cottage" rear of No. 20. Dunkirk Street Nos. 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 29, 31, 33 & 35 40 Total 40 91 Areas Number of Houses Willington Road Area Willington Road Nos. 1—15 (odd) 8 Total 8 Lyham Road Area Lyham Road 100-124 (even), 148 150, 152, 156, 158, 162-174 (even) 25 Total 25 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 human 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) 195, Tulse Hill Closing Order made 252, Brixton Hill Closing Order made 121, Palace Road Closing Order made 69, Norwood High Street Demolition Order 77, Norwood High Street Demolition Order 128, (Flat A), Cavendish Road Closing Order made 51, Millbrook Road Closing Order made 1, Rushcroft Road Compulsory Purchase Order 3, Elms Road Demolition Order 26, Tintern Street Closing Order made 1, Dalyell Road Closing Order made 1, Willington Road Closing Order made 103, Woodland Road Demolition Order 101, Woodland Road Demolition Order 1, Crawshay Road Demolition Order CLOSING ORDERS were made in respect of the undermentioned properties Section 18 (Unfit Parts of Houses) 148, Landor Road 13, Effra Road 17, Priory Grove 17a, Mostyn Road 29, Southwell Road 46, Rommany Road 207, Mayall Road 11, Medwin Street 7, Listow Road 15a, Old Town 92 HOUSING ACTS 1961 AND 1964 Houses in Multiple Occupation The multi-occupation of houses in Lambeth is not a new phenomenen but has existed for many years in certain areas without any real detriment or serious hazard to health. This is no longer true, because whereas those houses were occupied, in the main, by two families with well defined responsibilities in regard to cleanliness and maintenance we find three, four or more families in occupation. Inevitably there is over-occupation, lack of services and amenities and a greatly enhanced danger from fire due to inadequate means of escape. The problem is exacerbated by the conflict of habits and customs where a house is occupied by families with differing backgrounds and the sharing of facilities and amenities must perforce take place. Whilst the drift of population to the South East and the intense housing shortage are the major factors giving rise to the present unsatisfactory position, the continuing shortage of housing accommodation must not be allowed to deter local authorities, landlords and private organisations from using all possible means to improve living conditions under which a generation of children will grow to maturity. Information obtained from house-to-house surveys and a year's working of the London Borough of Lambeth (Registration of Houses in Multiple Occupation) Scheme 1966 confirm that there are two distinct problems in dealing with multiple occupation in the Borough. Firstly, the areas of old obsolescent houses, mainly in the six central wards, which are not unfit for human habitation under Section 4 Housing Act 1957 but are, to a marked degree, unfit for reasonable living conditions because of overcrowding and lack of basic amenities and services. Under existing powers the Department seeks to alleviate conditions by way of management orders, directions under Section 19 Housing Act, 1961 and wherever possible, by advice and suggestions on the spot by officers of the Department. Despite the efforts of a dedicated staff it is well apparent that this problem must be dealt with on an area basis. These are areas of the worse possible kind of housing stress and without a measure of decrowding it is well nigh impossible to find space for the installation of amenities, or indeed produce a viable unit of accommodation containing the basic standard amenities even for shared use by families. In this day and age of progress in practically every other facet of environmental health, is it too much to ask that each family has the use of these basic amenities? Whatever improvements are attained, it follows that there must be a measure of control to maintain standards achieved. This is where a Registration Scheme offers great advantages. Our present Scheme has revealed in operation certain hidden advantages, not the least important being the fact that its existence is notified on every Land Charge Search where properties are changing ownership. This has 93 resulted in many enquiries from solicitors acting for purchasers, estate agents and individual prospective owners when the opportunity has been taken to advise on the Council's requirements. In this way, many properties coming into multi-occupation are rendered satisfactory. The second problem is the spread of multi-occupation from certain defined areas to other parts of the Borough, which, until recently, were one family houses. These houses are, in many cases, too large for the present-day requirements of one family and, in the present housing situation, the creation of more units of accommodation is to be welcomed. However, each house is not always divided into self-contained units where there is control through Town Planning requirements and thus multiple occupation takes place without the prior knowledge or approval of the Council. It is imperative that control be achieved by some form of prior approval such as an amended Registration Scheme which would enable the Council to ensure that any property coming into multi-occupation would comply with the Council's minimum standards for the type of occupation envisaged. Control must be the essence of any future legislation designed to alleviate overcrowded living conditions and provide the services and amenities which are so vital to a happy and reasonable environment. HOUSING ACTS 1961 AND 1964 - HOUSES IN MULTIPLE OCCUPATION Number of visits and revisits made 1,827 Number of Notices served:— Section 12 44 Section 14 2 Section 15 15 Section 16 54 Section 19 62 HOUSING (FINANCIAL PROVISION) 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 387 visits and revisits were carried out. In addition, 516 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. 94 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 discretionary grants were made in respect of 68 dwellings totalling £25, 232, 13. 0. 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 standard grants in respect of 71 dwellings were made totalling £10,069.3.9d. Improvement Areas and Improvement of Houses outside Area Not all owners are willing to take advantage ofcthe Council's grants for improving houses and the Housing Act 1964 gives the Council power, under certain conditions, to require the provision of basic amenities. The procedure for improvement areas is very protracted and it has not yet been possible with the staff available, to carry 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 20 Notices have been served under this Section during the year. These notices require the owner to be given at least twelve months to carry out the works. REHOUSING AND OVERCROWDING APPLICATIONS FOR REHOUSING 826 cases were dealt with during the year on the following grounds:— Lambeth Borough Council Health 1273 Insanitary conditions 119 Special cases 21 Cases previously investigated and checked as being rehoused by Lambeth Borough Council 154 1567 95 Greater London Council Health 20 Insanitary conditions 3 Cases previously investigated and checked as being rehoused by Hreater London Council 9 32 1599 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES The pattern of work in the Food Division of the department has altered in some ways during the year. It is quite clear that the public is becoming increasingly "complaint conscious" and general interest in standards of hygiene in food premises is now very marked. Upwards of six million bottles of milk are produced every week in Lambeth and inevitably complaints are received about unsatisfactory bottles, but complaints would, I am sure, be reduced by at least 60% if only the public would stop misusing milk bottles. The Council's "clean food" campaign during the year created great interest, not only to shoppers but also staff and management of food premises generally. Requests were made by various organisations for lectures on food hygiene by the Health Inspectorate and this is of course a useful and effective way of bringing to the fore the dangers of food poisoning and the way in which everybody can play his or her part in the production of clean food. The year under review saw a speed up of "containerisation" transport of food which means that examination of food imported into this country can in certain circumstances be deferred until the container reaches its "inland" destination. As this practice increases, officers of authorities who previously have not been required to examine imported food, will find themselves having to do so. A certain amount of food, mainly dried and pasteurised frozen egg is already sampled in Lambeth under the Imported Food Regulations 1968, and owing to unsatisfactory results consignments do, from time to time, have to be re-exported. The following Regulations and Orders relating to food, the enforcement of which is the responsibility of the Council, were made during the year- Regulation or Order Slaughter of Poultry Act, 1967 Food (Control of Irradiation) Regulations, 1967 Slaughterhouses (Meat Inspection Grant) (Revocation) Regulations, 1967 96 Regulation or Order Meat Pie and Sausage Roll Regulations, 1967 Canned Meat Product Regulations, 1967 Sausage and Other Meat Product Regulations, 1967 Artificial Sweeteners in Food Regulations, 1967 Solvents in Food Regulations, 1967 Diseases of Animals (Milk Treatment) Order, 1967 Margarine Regulations, 1967 Labelling of Food Regulations, 1967 Coffee and Coffee Product Regulations, 1967 Solvents in Food (Amendments) Regulations, 1967 Ice-cream Regulations, 1967 THE FOOD HYGIENE (MARKET STALLS AND DELIVERY VEHICLES) REGULATIONS. 1966 AND (AMENDMENT) REGULATIONS, 1966 These Regulations came into force on 1st January 1967 and supersede corresponding requirements in the Food Hygiene (General) Regulations, 1960. The main changes from previous requirements are:- (i) before food is offered for sale, it must be separated from any food unfit for human consumption (ii) persons handling 'open' food must wear clean and washable overclothing, with minor specified exemptions (iii) delivery vehicles as well as stalls must bear the owner's name and address and identify the place where they are kept or garaged (iv) requirements as to the provision of water supply and washing facilities are extended to all food business (v) all stalls selling 'open' food, with minor exemptions, must be effectively covered and screened unless the stall is so designed and operated as to protect the food until sold (vi) requirements for disposal of waste are extended There are six recognised street markets in the Borough selling a variety of foods and the Council decided to set up a special joint committee comprising members of the Control and Amenities, Health and Highways and Works Committees to consider in detail the requirements of the regulations. This sub-committee met several times during the year, and arranged meetings with the traders and their officers to explain the Council's policy. Public Health Inspectors have visited all stalls to give advice and explain the requirements of the Regulations. 97 FOOD PREMISES During the year under review 1,927 inspections were made to food premises in the Borough. These inspections were made up as follows:— Factories 33 Bakehouses 38 Butchers 278 Fried Fish Shops 73 Ice Cream Premises 121 Milk Shops 68 Public Houses 42 Restaurants and Cafes 382 Dairies 23 Other Food Premises 75 Bakers 121 Grocery and Provisions 454 Greengrocers and Fruiterers 219 Total 1,927 FOOD AND DRUGS ACT, 1955 - SECTION 16 The number of registered premises is as follows:— Manufacture and/or sale of ice cream 509 Manufacture of sausages and preparation of preserved etc. food 243 Milk and Dairies (General) Regulations, 1959 — Regulation 8 Number of registered distributors 457 Number of registered dairies 3 Milk (Special Designation) Regulations, 1963 The following table shows the number of licences in force:- * Dealers Licences (Pre-packed) Untreated 171 Pasteurised 333 Sterilised 306 Ultra Heat Treated 55 Dealers (Pasteurisers) Licence 3 Dealers (Ultra Heat Treated) Licence 3 * Licences issued are valid for a period of five years. 98 SERVICES UNDER THE FOOD AND DRUGS ACT, 1955 (a) Milk Supplies — Brucells 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. No samples of imported liquid egg were submitted to the alpha-amylase test during the year. (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 Greengrocery and fruit 193 193 193 193 Grocery and provisions 331 331 154 154 Fish shops, wet, dry and fried 83 83 83 83 Bakers and bakehouses 92 92 92 92 Butchers 128 128 128 128 Confectioners 322 322 119 119 Restaurants, cafes, canteens & clubs 233 233 233 233 Dairies 18 18 18 18 Delicatessen 8 8 8 8 Food factories and warehouses 17 17 17 17 Public houses and Off-licences 280 280 280 280 Milk distributors 457 457 Nil Nil Ice cream premises 509 509 81 81 Preserved food premises 243 243 243 243 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. The following samples were submitted to the Public Health Laboratory for examination:— 99 Number of samples Pasteurised Frozen Whole Egg (China) 112 Pasteurised Frozen Whole Egg (Australia) 34 Frozen Shrimp (Kuwait) 1 Quick Frozen Peeled Prawns (Japan) 25 Prawns (Japan) 10 182 SAMPLING OF FOOD AND DRUGS Chemical Analysis 298 samples were procured formally, 92 of which were milk and 1,705 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:- Foimal samples Articles Result of Analysis Action taken Sausages, Pork Deficient in meat Further sample satisfactory Meat pie Filling contained potatoLetter sent to manufacturernd was only 13.1% of the pie Fruit cocktail Labelling offence Letter sent to manufacturer Sausages Slightly deficient in meat Further sample satisfactory Ice cream powder Labelling offence Matter taken up with manufacturer Fruit, dried Labelled 'Nut'n Date' but Label altered to read more date present than nut 'Date'n Nut' Cake, cream Contained fat other than No offence - labelling only butter fat required if Dairy Cream is used Meals snack Deficient in meat Sugar, cane No name of food on label Packages now labelled Fruit cocktail Fruit listed in wrong order Letter sent to manufacturer 100 Nutmeg Deficient in volatile oil Manufacturers informed Tomatoes, stuffed Not labelled in accordance Letter sent to Manufacturers — with rice, canned with labelling of FoodOrder stock discontinued Meat rissoles Deficient in meat Letter sent to producers Fruit salad Peaches not present in Letter sent — now satisfactory amounts recommended by Code of Practice Fruit canned Peaches not present in Letter sent - now satisfactory amounts recommended by Code of Practice Meals snack Composition not in accord- Further samples satisfactory ance with Code of Practice Jam Deficient in fruit Repeat samples found genuine Meals snack Not labelled in accord- Letter to producers ance with labelling of Food Order Pickles Not labelled in accord- Letter to producers ance with labelling of Food Order Vegetables, frozen Not labelled in accord- Letter to producers ance with labelling of Food Order Sulphur, flowers Labelled B.P. but Flowers Letter to Manufacturing Chemists of Sulphur was deleted from the B.P. in 1963 Fruit salad Labelled with fruits in Letter to canners wrong order of amounts present Chlorodyne Deficient in Chloroform Further sample satisfactory Fruit cocktail Composition not in accord- Letter sent to canners ance with Code of Practice Aspirin tablets Excess free salycylic acid Further sample satisfactory 101 Sage & Onion Labelled merely "Sage and Letter to manufacturers stuffing Onion" Ground nutmeg Deficient in volatile oil Further sample taken Milk chocolate Contained no milk fat Repeat samples satisfactory biscuits Dutch cheese Deficient in fat Repeat samples satisfactory Cheddar cheese Deficient in fat Repeat samples satisfactory Oil of Amber B.P.C. Labelling. Oil of Amber Letter sent to manufacturers Camphorated oil no longer in the B.P.C. B.P. & Eucalyptus Oil B.P. Chocolate flavoured Labelling not a drink but Referred to Town Clerk drink a drink powder Label found satisfactory Fruit salad in Composition not in accord- Repeat samples taken heavy syrup ance with Code of Practice Compound dusting Labelling — no warning label Referred to Chemist powder of Salycylic acid Spirit of Camphor Labelled B.P.C. but no Letter to manufacturers longer included in B.P.C. Glycerin of Borax Labelled B.P.C. but no Letter to manufacturers longer included in B.P.C. Tincture of Arnica Deficient in alcohol Repeat sample satisfactory Canned Macedoine Ingredients listed in Letter to manufacturers wrong order "Dijon" prepared Excess preservative Letter to importers mustard Prepared hot Not hot. Deficient in Stock withdrawn from sale mustard mustard oil Butter sponge Contained fat other than Letter sent to manufacturers butter fat Milk drink with No glucose present Dealt with by Public Analyst glucose 102 Fruit salad Peaches not present in Repeat samples satisfactory amount recommended by Code of Practice Ground Mace Deficient in volatile oil Repeat samples satisfactory Ground Nutmeg Deficient in volatile oil Repeat samples satisfactory Canned steak & Deficient in kidney Repeat samples satisfactory kidney pudding Rheumatism tablets Deficient in Salicylcimide Repeat samples taken Ear drops Deficient in Chloroform Repeat samples not now available Compound Ferrous Deficient in copper Dealt with direct by Sulphate tablets sulphate Public Analyst Kols Champaign Labelling — objection to Letter to manufacturers the use of the word "Champaign" Pickled red cabbage Labelling — 'Preservative' Letter to manufacturers declared conspicuously but omitted from list of ingredients Coconut coated Incipient rancidity of the Letter to manufacturers cakes coconut coating Brown rice Insect infestation Stock withdrawn Proprietary Slight deficiency in Further samples satisfactory Ergotamine tablets Ergotamine Milk chocolate Contained no milk fat Further samples satisfactory biscuits Canned vegetables Vegetables not listed in Further samples satisfactory order present Dutch cheese Slightly deficient in fat Further samples satisfactory Peanuts (in shell) Condition poor Peanuts not unfit to eat Shredded suet Deficient in fat Further sample satisfactory 103 Ground nutmeg Deficient in volatile oil Still under correspondence Steak & kidney Deficient in kidney Repeat samples satisfactory pies Bronchial mixture Deficient in acetic acid Letter sent to manufacturers Batter mix (Pancake) Labelling offence Stick on labels being provided Ground nutmeg Deficient in volatile oil Further sample satisfactory Orange drinks Deficient in fruit and sucrose Supply source removed BACTERIOLOGICAL AND OTHER EXAMINATIONS The following samples were submitted to the Public Health Laboratory for examination Ice cream 22 The 22 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 245 (27 were void, the atmospheric shade temperature being over 65°F) Fourteen failed to satisfy the prescribed test. Phosphatase Test 240 Of the fourteen samples of milk which failed the Methylene Blue Test 1 was of the raw milk bottled on the farm. The other thirteen 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:— Date Offence Magistrate's Decision 28.3.67 Food and Drugs Act, 1955 Defendant found guilty, but Complaint of cigarette end in given absolute discharge a sliced loaf of bread £3.0.0. costs awarded to the Council. 104 21.4.67 Food and Drugs Act, 1955 Case dismissed. No evidence Complaint of mould in pork pie to prove ownership of busines by defendant. 23.8.67 Food and Drugs Act, 1955 Defendant found guilty. Fined Complaint of rusty nail in £25,£5.5.0. costs awarded to milk bottle Council. 24.5.67 Food Hygiene (General) Defendant found guilty on Regulations 1960. eight summonses under the Regs. 5,6,14,16,19,23 Regulations and fined £5 in respect of each offence. £10 costs awarded to Council. 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 1 15 2 18 Vegetables 17 — 13 Fruit 1 2 3 21 Fish 3 3 1 Milk 2 24 Soup 118 Fruit juice 1 1 16 Creamed rice 2 19 Spaghetti 2 — 4 4-8 Prepared Bacon 4 — — Biscuits 14 Pickles 21 Sugar 2 Cheese 1 17 Butter 1 15 Flour 1 7 Pearl Barley 8 Semolina 19 Cereals 13 105 Tons Cwts. Qrts. Lbs. Tapioca 2 Frankfurters 3 10 Rice 1 1 Apple pie filling 14 Cornish pasties 15 Marmalade 17 Sweets 7 - — - Frozen foods 1 15 3 — Untreated Meat 1 6 1 19 Vegetables 4 3 16 Fish 5 2 4 Fruit 2 - 23 Groundnuts 7 - 16 American Maize 8 — — — Rodent Infested food 15- — 11 11 0 22 TOTAL 24 18 19 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 or 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 - 1967 Article Nature of Complaint 1. Tin of Dried Milk (National Dried) Black particles in top of dried milk 2. Pint of milk Nail in bottle of milk 3. Vitawheat Maggots 4. Minced Chicken in Jelly Mould and dirty face of. cap to chicken 5. Beefburgers Decomposing 106 6. Milk bottle Filmy deposit on internal base of milk bottle 7. Currant bun Material in currant bun 8. Carton of milk Bad 9. Pint of milk Dirty pint bottle of milk 10. Steak and kidney pie Mouldy beefsteak and kidney pie 11. Chocolate eclair Bad 12. Sliced loaf Bristle said to have been found in sliced loa 13. Bread Roll Colouring matter in bread roll 14. Pint of milk Silver paper in bottle of milk 15. Doughnut Doughnut containing foreign body 16. Bread Mould in bread 17. Sliced loaf Mould in bread 18. Sliced loaf Glass in pre-packed sliced loaf 19. Bread Mouldy 2 0. Robinson's Baby food Suspected to be bad 21. Loaf of bread Mouldy 22. Large loaf and small loaf Large loaf mouldy, small loaf maggoty 23. Nimble brown pre-packed sliced load Mouldy 24. Wine gums Wine gums containing foreign substance 25. Sultanas Maggots in pack of sultanas 26. Roll Foreign body in roll 27. Milk bottle Dirty milk bottle 28. Chicken and ham pie Bad 29. Wheatgerm loaf Smell to loaff also slight mould growth 30. Garden peas Sour smell to garden peas 31. Pint of milk Bad 32. Butter (half pound) Rancid 33. Pint of milk Bad 34. Milk bottle Dirty milk bottle 35. Tin of apricots Insects in tin of apricots 36. Empty milk bottle White paint spots inside bottle of milk 37. Tin of Italian tomatoes Inadequate tomato content in tin of Italian tomatoes 38. Butter (half pound) Rancid 39. Two portions of Chinese Food Two portions of Chinese food sold in old pineapple tin 40. Apricot pie Large spider in apricot pie 41. Walls Pork pie Nausea after eating pork pie 42. Tin of Scotch herrings Metal found in tin of scotch herrings 43. Loaf of bread Insect in pre-packed sliced loaf of bread 44. Meat Meat off 45. Bread Foreign matter in bread 46. One-third pint bottle of milk Dirty bottle, marks on internal surface 47. Pre-packed sandwich Pre-packed sandwich contained dark green mould 48. Loaf of bread Mould on loaf of bread 49. Loaf of bread Black substance in loaf of bread 50. Meat pie Mouldy pie 51. Two pork chops Maggot infestation 52. Joint of meat (% leg of lamb) Meat off 53. Bun Nail found in bun 54. Three pork pies Mouldy 55. Tin of Corned Beef Insect and piece of bone in tin of corned beef 56. Rum Ba Ba Piece of glass in Rum Ba Ba 57. Currants Fly in currants 58. Biscuits Abnormal and bitter taste to cream in biscuit 59. Pork pie Mouldy pork pie 60. Chocolate cake Infeated with insects 61. Sliced loaf 'Lyta' Sliced loaf mouldy 62. Rolls Insects in rolls 63. Angel cake Mouldy 64. Loaf of bread Mouldy 65. Royal currant buns Mouldy 107 66. Packet frozen peas Foreign body in packet of frozen peas 67. Fruit cake Mouldy 68. Cheesecake Nail found in cheese cake causing tooth to be chipped 69. Bottle of milk Brown stain on bottle 70. Loaf Black substance in cut loaf 71. Tin of grapefruit segments Bad 72. Bottle of milk Bottle of milk containing fruit fly pupae. Total number of complaints 148 Total number of justified complaints 72 With regard to the justified complaints listed above the appropriate action was taken in all cases. 108 Section E General 109 WATER SUPPLY I am indebted to Dr. E. Windle Taylor, Director of Water Examination, Metropolitan Water Board, for the following report on the water supplied by the Board to the Borough of Lambeth during the year:- "The report relates to the Board's direct supply to the Lambeth administrative area and its several parts. The information does not relate to private supplies and supplies from other Water Undertakings (if any). The supply was satisfactory both as to quality and quantity throughout 1967. All new and repaired mains are disinfected with chlorine, after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or 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, 1967 was 338,126. No houses were permanently supplied by standpipe. No fluoride was added, and where fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. The supply was derived from the following works and pumping stations:— River Thames via Hampton, Walton and Surbiton. Honor Oak well. No new sources of supply were instituted and there were no changes to the general scheme of supply in the area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on tables A and B below. The Board's river and well sources have not been considered to have a plumbosolvent action, on account of their hardness content and alkaline reaction. It should, however, be appreciated that all types of water pick up varying amounts of metal from piping, particularly when it is newly installed; this applies to copper, zinc, iron and also lead. 110 Tests for lead have been carried out in connection with chemical analyses of samples of running water collected from premises in the distribution system and I set out below the information obtained over the period 1st January to 31st December, 1967:- 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° C. Hampton 52 0.019 0. 090 4.2 1.10 Thames derived, South of River 156 0.021 0. 088 4.2 1.12 Honor Oak well 1 0.054 0. 024 0.4 Nil Description of the Sample H ardness (total) CaCO3 Hardness (noncarbonate) CaC03 Magnesium as Mg Sodium Potassium as Na Sodium Potassium as K Chloride as Cl Hampton 284 72 5 22.6 5.1 30 Thames-derived, South of River 272 69 5 22.6 5.1 30 Honor Oak well 300 45 10.5 3.4 13 Description of the Sample Phosphate as P04 Silicate as SiO2 Sulphate as SO4 Natural Fluoride as F Surfaceactive Material as Uanoxol OT CO2 Hampton 1.9 10 64 0. 30 0.01 Thames-derived, South of River 1.9 9 64 0.30 0.01 Honor Oak well 0.5 33 Description of the Sample Turbidity units Colour (Burgess units) PH value Electrical Conductivity (micromhos) Hampton 0. 1 11 7.9 590 Thames-derived. South of River 0. 1 12 7.9 580 Honor Oak wel1 0.3 3 7.3 500 111 EXAMINATION OF WATER SUPPLY Bacteriological Results — Yearly Averages 1967 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. Hampton River Thames, South of River Honor Oak well 54 0.0 1 100.0 - 100.0 - AFTER TREATMENT Source of supply 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. Hampton 1,158 7.3 99.91 100.0 River Thames, South of River 1,887 8.8 99.52 99.95 Honor Oak well 54 0.0 1 100.0 100.0 Lead content (mg/l Pb) water from main taps in consumers' premises Number of samples Per cent Less than 0.01 64 66.7 0.01 22 22.9 0.02 3 3.1 0.03 4 4.2 0.04 2 2.1 0.05 0 - 0.06 1 1.0 96 100.0 The above figures apply to the whole of the Board's area but it should be pointed out that the general characteristics of the water are similar throughout the area so that the findings are applicable to individual Boroughs. 112 The regular system of examination for lead in water in domestic premises will continue during 1968". Water from Wells There are a number of wells in use, the majority of which, however, supply water used only for industrial purposes. The water from two wells is used for drinking purposes, or for the preparation of food. Reports of the ananlysis of water from these wells are received regularly and have been satisfactory for the year under review. 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 pools are subject to regular inspections and sampling of the water. SWIMMING BATHS UNDER CONTROL OF THE GREATER LONDON COUNCIL I am indebted to the Scientific Adviser of the Greater London Council for the following report on the bacteriological examination of the water during 1967. No. of samples Agar count 1 ml. 37° C - 48 hours More than 100 Presumptive Coliform without E.coli.in 100 ml. E. coli in 100 ml. 0-10 11-100 Brockwell Park Lido Summer 10 10 — — — — Winter 10 6 4 - 1 - Kennington Park Lido Summer 10 10 — — — — Winter 6 6 - - 1 - Wood Vale Residential Home 26 20 4 2 — — Shirley Oaks Children's Home 24 20 4 — — — Dick Sheppard School 8 8 - - - - Parkside School 12 10 2 - - - St. Martin-in-the-Fields School 16 16 - - - - 113 The bacterial condition of the baths showed some improvement compared with the previous year. The agar counts were lower and no samples were found to contain E.coli organisms. Wood Vale Children's Home This establishment was closed at the end of the year. Parkside School At the end of the year, extensive repairs to the plant were put into operation. St. Martin-in-the-Fields School A complaint was received that algae were growing in the bath. After repairing the pump and maintaining a high free chlorine content level in the water, the algae were eradicated and the clear, blue colour of the water was restored. During the year under review both superintendents and schoolkeepers were instructed in a new method for carrying out free chlorine content tests. Orthotolidine, found to be carcinogenic, was replaced by D.P.D. No.l tablets (Diethyl-p-phenylene diamine). The necessary kit and chemicals were supplied. SEWERS I am indebted to the Borough Engineer and Surveyor for supplying me with the following information with regard to sewers within the Borough. During the year a sum of £43,000 was spent on the general maintenance, flushing and cleansing of the sewers for which the Council is the drainage authority. Part of the cleansing works were carried out under contract using a high pressure jetting method. The sewers in Grafton Square consisting of 375 linear yards of sewer varying in size between l5' and 12" internal diameter were relaid at an approximate cost of £14,000. NATIONAL ASSISTANCE ACT, 1948 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 29 funerals were arranged - 22 males and 7 females. The amount paid to funeral contractors was £551.16.0. The sum of £333.2.2. was received by way of grants, insurance policies and money found. The actual cost to the Council was, therefore, £218.13.10. 114 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. Licenses are only issued to qualified persons. The number of establishments licensed by the Council is 45. Inspections of the establishments were carried out by the Associate Medical Officer of Health. HAIRDRESSERS AND BARBERS Under the Greater London Council (General Powers) Act, 1967 persons wishing to carry on the business of a hairdresser or barber on any premises in the borough are required to be registered by the Council in respect of those premises. The appointed day fixed for registration in Lambeth is 1st April, 1968. During the year 87 inspections were made by the Public Health Inspectors. CARE OF THE AGED During the year 857 new cases were brought to the notice of the Health Department. The age groups into which these new cases were divided were as follows:- Male Female Total 60 - 69 years 40 68 108 70 - 74 years 66 95 161 75 - 79 years 59 132 191 80 - 89 years 97 243 340 90 - 94 years 10 42 52 95 years and over 14 5 273 584 857 The total number of visits made during the year was 5,692. 115 The number of old people persuaded to enter hospitals and institutions voluntarily was 290. It was necessary to take action under Section 47 of the National Assistance Act, 1948 in 5 cases. A total of 2,904 persons received help in some form or another. The number of cases on the register, including those from previous years is 5,385. LAUNDRY SERVICE FOR AGED INCONTINENT Number of persons receiving service 265 Total number of visits 6,011 Number of soiled articles collected 61,695 Total weight of laundry cleansed 54,446 1 bs. HOME BATHING SERVICE During the year 3,757 baths were given. MEDICAL EXAMINATION OF STAFF The Health Department undertakes for the Council medical examination of staff. 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 945. Details are given below:- Health Department 326 Children's Department 85 Town Clerk's Department 382* Welfare Department 147 Other Local Authorities 5 945 *Six months period only June-December, 1967 HEALTH EDUCATION Health education continued throughout the year. In addition to the Health Education Sub-Committee which met at monthly intervals, a Health Education Advisory Panel consisting of senior members of the department was constituted to formulate policy and assess the needs of health education in the Borough. 116 Support was given to campaigns held on a National level including a Mental Health Week held in June, sponsored by the National Association of Mental Health. The London Boroughs of Lambeth, Wandsworth and Merton presented a combined programme of films, talks and open days which aroused much interest throughout the Boroughs. A public safety exhibition was organised by the Council's Safety Officer in November at Streatham Baths. The contribution of the Health Department was "Safety in the Kitchen" and nursing staff and public health inspectors were in attendance throughout. Talks on a variety of subjects, using films, film strips, flannelgraphs and displays were given to expectant mothers, mothers with young children, outside groups, professional trainee groups and school children. These were attended by approximately 3,300 people. Concern at the increase of drug taking resulted in two lunch time film shows being held in the Town Hall for nursing and medical staff, child care officers, mental health social workers and teaching staff from the local senior schools making a total attendance of 110. Student dental hygienists from King's College Hospital Dental School commenced dental health education in the nurseries to the 3 - 5 year olds. In addition talks were given in two primary schools on sex education, and discussions' were held at a College for Further Education on various health topics. Despite the fact that considerable advances have been made in Food Hygiene knowledge and practice, there is still a division of opinion between those members of the public and some occupiers of food premises and their employees who are convinced of the necessity to handle food with care, and those who do not seem to worry about cleanliness. Accordingly, the Health Committee decided to hold a Food Hygiene Publicity Campaign during the year. The Public Relations Officer and his staff gave invaluable assistance and advice on planning the Campaign, and the following media was used:- (a) 10,000 copies of a Booklet on Food Hygiene - issued in two parts - one for the housewife and the other for traders and commercial food handlers. Requests for copies of this were received from colleges, schools, organisations and community associations from many parts of the country outside the Borough following publicity by the B.B.C. on television, and a reprint was necessary by the end of the year. (b) Talks to schools and local organisations were given by the public health inspectors, and many requests for talks were outstanding at the end of the year. 117 (c) Articles were prepared by the Public Relations Officer for the local press. (d) "Clean food" was adopted as the Health Department topic for the "Key of the Door" parties. (e) Sticker notices were prepared and distributed for display in food shops relating to dogs, smoking, handling of food and personal hygiene. (f) Personal visits made by public health inspectors to food premises. Basically, this campaign, which will continue, has set out to show that food poisoning need not happen, and that if the following common faults are eradicated, then there will be a dramatic reduction in illness caused by consumption of food:— (i) partial cooking and re-heating of food with unsatisfactory interim storage at room temperature before consumption of the food. (ii) over-exposure of "open" foods. (iii) unnecessary handling of foods HOSPITAL FACILITIES The undermentioned hospitals are located in the Borough:- Lambeth Hospital, Brook Drive, S.E.ll. 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.ll General Lying-in Hospital, York Road, S.E.1. Royal Waterloo Hospital, Waterloo Road, S.E.1. South London Hospital for Women, Clapham Common South, S.W.4. Weir Maternity Hospital, Weir Road, S.W.12. British Home and Hospital for Incurables, Crown Lane, S.W.16. 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. 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. 118 Section F School Health Service Report of the Principal School Medical Officer 119 LONDON BOROUGH OF LAMBETH SCHOOL HEALTH SERVICE Report of the Principal School Medical Officer for Year 1967. The School Health Service which is the staturory responsibility of the Inner London Education Authority is provided by the Health Department under an agreement between the Lambeth Borough Council and the Authority and includes the joint use of facilities and staff. The general health of school children throughout the Borough remains good. Medical Inspection returns show that the satisfactory downward trend in the number of new cases requiring treatment for specific conditions has continued. The only rising figure is that of children referred by the school medical officers to the special investigation centres, 228 new cases in 1967 compared with 185 in 1966. This increase is due to enuresis. Strong contributory causes in enuresis are poor training and poor housing conditions. There is no evidence of an increase in poor health. Minor ailments become annually more minor and are now largely a matter of simple nursing treatments. In consequence it proved possible to reduce the doctors' sessions at minor ailment centres. Arrangements continued with the London Boroughs of Southwark and Wandsworth for the treatment of verminous children. It is hoped to provide bathing facilities in the coming year at one of the school treatment centres in Lambeth. This should help to reduce travelling inconveniences to the parents, reduce attendance difficulties and provide a service operated directly by the Borough. Unfortunately it had not proved possible to open the projected Inner London Education Authority audiology centre in the north of the Borough by the end of the year. The service provided by the Belgrave Hospital remained extremely overcrowded, priority being given to children under five years of age. Immigration and population movements within Great Britain are bringing an increased number of older children from overseas and the provinces into the Borough and additional services are urgently needed in this sphere. SCHOOL MEDICAL INSPECTION All pupils are medically examined as a routine four times during their 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. During the year medical officers undertook 16,377 routine examinations, 4,467 special examinations, and 5,570 re-inspections. 120 School nurses carried out a total of 47,799 health surveys; 34,965 comprehensive, 6,885 selective and 5,949 in connection with communicable diseases. All children early in their school life are tested for hearing loss by a visiting school nurse using the sweep test method. Those who fail this test or about whom there is some doubt, are given further more accurate pure tone tests at school treatment centres. Where results are not satisfactory, pupils are referred to an otologist for further investigation. 8,359 children were given the sweep test, of whom 401 required a pure tone test, and of these 57 were referred to an otologist. MEDICAL TREATMENT OF SCHOOL CHILDREN Certain specialist clinics, at which only school children are seen, are run in conjunction with Regional Hospital Boards and the Boards of Governors of Teaching Hospitals. Some clinics are provided in hospitals, whilst 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 sessions and one audiology session at Belgrave Hospital and an investigation session for heart diseases, enuresis, dietetics and minor behaviour difficulties. All these sessions are attended by social workers (school health service) who arrange appointments and act as liaison officers with the hospitals and the Inner London Education Authority school care committees and school inquiry officers. Health service social workers also attend special investigation clinics held in school treatment centres. There are three vision clinics in local authority premises and an orthoptic clinic at one centre. Certain treatment facilities are provided directly by the local authority and in Lambeth these include special investigation clinics at which children suffering from obesity, enuresis and similar complaints are seen. Minor ailments and accidents are treated at minor ailment clinics. Normally only a nurse is in attendance but occasional medical officer sessions are held where needed. RECUPERATIVE HOLIDAYS Recuperative holidays for school children are provided at homes in Littlehampton and Bognor Regis run by the Inner London Education Authority. Some children are also sent by the Authority to voluntary homes. One hundred and fifty Lambeth children were accommodated for periods between two and four weeks. 121 HEALTH EDUCATION Health Education in schools continued throughout the year. The mobile health education unit visited the area frequently and a sessional medical officer has shown films and given talks on sex education. With the increasing problems of drug addiction, in order to inform teachers of the danger, film shows were organised. The films shown were "Narcotics — the Decision", "Hooked" and "Drugs and the Nervous System". Dental Health Education received attention and mention of this is made in the report of the Chief Dental Officer. One school accepted an offer to show the films "Johnnie and the D.K. Robot" and "No toothache for Eskimos". In special schools the school nurses continued to give talks and hold discussion groups. Films were also shown. SCHOOL HEALTH STATISTICS FOR YEAR 1967 SCHOOL ROLL (May 1967) 45,442 SCHOOL MEDICAL INSPECTION Routine 16,377 Special 4,467 Re-inspections 5,570 No. of medical inspections per 1,000 pupils 581 Health Surveys - comprehensive 34,965 No. per 1,000 pupils 769 Percentage found verminous 0.9 Health Surveys - selective 6,885 No. per 1,000 pupils 152 Percentage found verminous 5.7 Audiometry — No. of children given sweep test 8,359 No. of children given pure tone test 401 No. of children referred to otologist at audiology centre 57 122 SCHOOL MEDICAL TREATMENT Hospital and Specialist Clinics Vision Centres Vision sessions 289 Number of new cases 611 Total attendances 4,178 Errors of refraction and squint 1,666 Other eye defects 58 Spectacles ordered 1,140 Orthoptic sessions 21 Number of new cases 4 Total attendances 58 Ear, Nose and Throat Centres:- Sessions — Number of new cases — Total attendances — LOCAL AUTHORITY CLINICS Audiology centres:— Sessions 36 Number of new cases 139 Total attendances 234 Special investigation clinics:- Sessions 164 Number of new cases 228 Total attendances 1,158 Minor ailment centres:Sessions: Medical officer 58 Nursing sister 509 Number of new cases seen by medical officer 479 Average per session 8.3 Number of new cases seen by nursing sister only 1,285 Average per session 2.5 Total attendances , 11,654 Defects treated:- Athlete's foot 162 Verrucae 948 Ringworm: body 2 Impetigo 97 123 Other skin diseases 160 Eye diseases 25 Ear diseases 6 Miscellaneous: Bruises, lacerations, etc. 317 RECUPERATIVE HOLIDAY HOMES Schoolchildren (including nursery school children) Number admitted during year. 150 SCHOOL DENTAL SERVICES 1967 REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER In my report last year I said that 1966 had been a year of preparation and planning for the future. 1967 has seen the implementation of plans made jointly by the Council and the Inner London Education Authority. Lambeth has taken full share in giving effect to new schemes to develop a more progressive I.L.E.A. dental service. Staff In implementing the new schemes dental officers and dental surgery assistants have had to adopt new ideas which they have done willingly with excellent results. None of the schemes could have been developed successfully without their understanding and co-operation, to which I am glad to have the opportunity to pay tribute. Three sessional dental officers and three dental surgery assistants, two of them with long service, left during the year. Because of difficulty in recruiting dental officers, only one of those who left was replaced. Staff at 31 December 1967 were as follows — Principal school dental officer 1 Full time dental officers 3 Sessional dental officers 4 (1.7 whole time equivalent) Dental surgery assistants 6 School dental inspections It had for some time been the practice to limit dental inspections to new school entrants. In accordance with the I.L.E.A.'s revised policy, a start was made on dental inspection of all children at infants' and primary schools. While it is understood that there had been in the past some difficulty in arranging for inspections in their schools, it was found that with full prior consultation on the arrangements, willing co-operation of heads was almost invariably forthcoming. 124 The inspections again confirmed that there are large numbers of schoolchildren in need of dental treatment. Although the gross dental sepsis era has fortunately passed, there are still too many children not receiving regular dental care either from hospital, general practice, or local authority services. Invitations sent to parents of new school entrants to attend dental inspections of their children met with a reasonably satisfactory response. Many of the parents, while clearly being concerned for their children's well-being, showed little appreciation of the need for early dental attention. D.M.F. (Decayed, missing, filled) Surveys (i) New school entrants. A D.M.F. survey was carried out with the dental inspection of new school entrants. Results are summarised below: No. of schools No. of pupils D.M.F. 38 2,247 3.54 Different schools showed a wide variation from the average, between 1.53 to 5.45. The children inspected presented with 4,226 decayed savable teeth, 1,081 decayed unsavable teeth, and 1,556 teeth which were already filled. This indicates that an average of 2.3 teeth per child needed attention, and that 0.69 teeth per child had already been filled. (ii) Special schools. A special survey covering children of age range 5—16 years was carried out at special schools — Type of school D.M.F. Educationally subnormal 8.1 Partially sighted 6.0 Open Air (1) 6.9 Open Air (2) 4.0 Physically handicapped 9.6 Maladjusted 5.9 Some attempt was made to ascertain where treatment was being provided. It was apparent that there was a fairly small group obtaining dental care under hospital services, largely because of a medical condition. The amount of treatment required was sometimes extensive, and emphasized the need to provide adequate facilities for the treatment of handicapped children. Treatment provision Although, owing to shortage of dental officers, the total number of sessions was less than in 1966, and despite the increased number of sessions devoted to dental inspections, the number of conservations both for permanent and deciduous 125 teeth showed increases over the previous year from 7,882 to 8,220 and 5,203 to 5,767 respectively. The treatment pattern shows that over 12 permanent teeth were conserved for each permanent tooth extracted. This is a less satisfactory proportion than in 1966 (when it was 16 to 1). The difference is probably due to the inclusion in 1967 of children who, but for the increased number of dental inspections, might have remained untreated. A contributory factor may have been the reduction in the number of children referred to dental schools, which resulted from the improved arrangements for general anaesthesia in school dental clinics. Although 84% of dental inspections took place in schools compared with 29% in 1966, with a consequent saving of valuable surgery time, it was difficult, particularly at some clinics to meet demands for treatment following inspections. The acceptance rate at different schools varied widely; four produced less than 15% acceptance, while several showed over 50%. The acceptance rate has generally increased since the extension of dental inspections, evidence of the value of the revised system. Orthodontics No children's dentistry service can be complete without adequate provision for orthodontics and it has been possible to meet these needs including the full use of special orthodontic sessions at one centre. The arrangements for this service have worked well and it is now possible for a child to commence orthodontic treatment within about a month. Advice and acceptance of new cases is always available at the Orthodontic Department of Kings College Hospital Dental School and the assistance of the Consultants is greatly appreciated. The continued attendance of the Principal School Dental Officer on one half day per week has helped to maintain a personal contact and close co-operation. Dental health education As in previous years one month was devoted by the department specifically to dental health education. Pierre the Clown was booked for one week in November to give talks to schoolchildren. The response of head teachers to the suggestions that Pierre might visit their schools was overwhelming and many had to be disappointed. The week commenced with an official opening at a school at which we were priviledged to have the Mayor and Mayoress of Lambeth in attendance. The week's programme was most useful in focussing attention and arousing interest in dental health, and in gaining press publicity. Premises and Equipment The additional surgery which it was hoped would be opened to meet the needs of children in the north of the borough was unfortunately not ready by the end of the year. Each of the existing surgeries had been equipped by the end of the year with an airotor and a new general anaesthetic machine. 126 Courses and conferences One dental officer attended a course on clinical work. The principal school dental officer attended a course on administration, and the annual conference of the British Dental Association. Thanks to the staff The improvement of the dental service cannot be achieved without the help and advice of many of the Health Department staff. I would like to thank them for their willing cooperation throughout the year. SCHOOL DENTAL SERVICE STATISTICS NUMBER OF SESSIONS Inspection 188.0 Ordinary treatment 2,116.7 General anaesthetic 47.5 Total sessions 2,352.2 INSPECTIONS First inspection at school 17,051 First inspection at clinic 3,313 Percentage found to require treatment 60.9 Reinspection at school or clinic in 1967 1,627 Percentage found to require treatment 64.8 ORDINARY TREATMENT SESSIONS: New Cases: Number of appointments given 10,592 Number of attendances by appointment 5,719 On-treatment cases: Number of appointments given 14,512 Number of attendances by appointment 10,650 Other attendances (emergencies) 488 General anaesthetic session attendances 712 Total attendances 17,569 Number of first visits for treatment 4,509 Number of additional courses commenced 1,063 Fillings Permanent teeth 8,220 Deciduous teeth 5,767 Extractions Permanent teeth 576 Deciduous teeth 1,905 127 Other operations (prophylaxis, X-rays, inlays, crowns, etc.) 4,202 Sessional averages (related to ordinary treatment sessions) New-case appointments given 5.0 New-case attendances made 2.7 On-treatment appointments given 6.9 On-treatment attendances made 5.0 Emergencies 0.2 Fillings: Permanent teeth 3.9 Temporary teeth 2.7 Extractions: Permanent teeth 0.3 Temporary teeth 0.9 Other operations 2.0