I LAm 57 LONDON BOROUGH OF LAMBETH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1968 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 tINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1968 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 7 Introductory remarks of Medical Officer of Health 8 SECTION A: Statistics and Social Conditions of the Area General 13 Births; Birth Rate; Still Births 13-14 Deaths; Death Rate 14 Maternal Mortality 14 Infantile Mortality 15 Vital Statistics for Years 1959-1968 17 Classification of Causes of Death 18 Notes on Vital Statistics 23 Deaths from Cancer of the Lung and Bronchus 25 Road Traffic Accidents 25 SECTION B: Prevalence of, and Control over, Infectious and other Di seases Notifiable Diseases 29 Notifications other than Tuberculosis 30 Age Distribution of Infectious Diseases 31 Notes on Infectious Diseases 33 Salmonella Infections 36 Notification of Tuberculosis 38 Report of Chest Physician 38 SECTION C: Personal Health Services Maternity and Child Health Centres 45 Cervical Cytology Screening Service 46 Family Planning 46 Occasional Creches 47 Day Nurseries 47 Child Minding 48 'Handicap' Registers 50 Standing Committee for Co-ordination 50 Health Services - Family Case Workers 51 Domiciliary Midwifery Service 51 Midwives Act, 1951 52 Loan of Nursing Equipment 52 Incontinence Pads 53 Vaccination and Immunisation 53 International Certificates of Vaccination 54 Tuberculosis 54 Health Visiting 54 3 Peronal Health Services (continued) Page Recuperative Holidays 55 Chiropody 56 Home Help Service 56 Mental Health Services 57 Statistics - Personal Health Service 59 SECTION D: Environmental Health Services New Legislation 83 The Trade Descriptions Act 1968 83 Summary of Work done by District Public Health Inspectors 83 Public Health Acts 1936 and 1961 - Works in Default 85 Sealing of Disused Drains 85 Drainage Emergency Service 85 Legal Proceedings 85 Works in Default 86 Disinfection 87 Disinfestation 88 Prevention of Damage by Pests Act 1949 88 Atmospheric Pollution - Clean Air Act 1956 88 Factories Act 1961 89 Pet Animals Act 1951 91 Animal Boarding Establishments Act 1963 91 Riding Establishments Act 1964 91 Diseases of Animals Act 1950 92 Slum Clearance Programme 1966-1970 92 Individual Unfit Houses and Parts of Houses 94 Action under Part II of the Housing Act 1957 94 Housing Acts 1961 and 1964 - Houses in Multiple Occupation 95 House Improvement Grants 96 Improvement Areas 96 Legal Proceedings 96 Rehousing and Overcrowding 97 Inspection and Supervision of Food and Food Premises 97 Food Hygiene (Market Stalls and Delivery Vehicles) Regulations 1966 and (Amendment) Regulations 1966 98 Food and Drugs Act 1955 98 Milk and Dairies (General) Regulations 1959 98 Milk (Special Designation) Regulations 1963 99 Services under Food and Drug Act 1955 99 Sampling of Food and Drugs 100 Public Health Imported Food (Regulations) 1937 105 Legal Proceedings 106 Unsound Food 107 Food Complaints 108 4 SECTION E: General Page Water Supply 111 Swimming Pools 115 Sewers 116 National Assistance Act 1948 117 Pharmacy and Poisons Act 1933 117 Establishments for Massage and Special Treatment 117 Hairdressers and Barbers 118 Care of the Aged 118 Laundry Service for Aged Incontinent 119 Home Bathing Service 119 Medical Examination of Staff 119 Health Education 119 Hospital Facilities 120 Ambulance Facilities 120 Public Health Laboratory Service 120 SECTION F: School Health Service Report of the Principal School Medical Officer 122 5 LONDON BOROUGH OF LAMBETH HEALTH COMMITTEE Period from 1st January, 1968 to 22nd May, 1968 The Worshipful the Mayor of Lambeth Councillor H.W. Lockwood, J.P. The Deputy Mayor of Lambeth Councillor S.H. Gurney, J.P. 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, 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. Gwyneth Taylor Representing Teaching Hospitals Association - Mr. B.A. McSwiney Representing Lambeth District Nursing Association — Mr. W.J. Hobby 6 LONDON BOROUGH OF LAMBETH HEALTH AND WELFARE COMMITTEE Period from 22nd May, 1968 to 31st December, 1968 The Worshipful the Mayor of Lambeth Alderman Walter C. Dennis, J.P. The Deputy Mayor of Lambeth Councillor D.T. Campbell, J.P. Chairman Alderman Mrs. M.F. Steere, B.A. Vice-chairman Miss H. Jellie Councillor Mrs. D.D. Brimacombe Councillor Mrs. L.M. Burton Councillor G.F. Carey Councillor Miss F. Clark Councillor J.R. Ebling Councillor S.J. Fitchett Councillor W.F.R. Fuller Councillor R. Picard Councillor G.B.F. Pisani Councillor N.J.B. Roux Co-opted Members Representing Inner London Medical Committee — Dr. Gwyneth Taylor Representing Teaching Hospitals Association - Mr. B.A. McSwiney 7 STAFF OF HEALTH DEPARTMENT Medical Officer of Health and Principal School Medical Officer A.L. Thrower, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Associate Medical Officer of Health F. Summers, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Deputy Medical Officer of Health N. Christina Walsh, M.B., B.Ch., D.C.H., D.P.H. Principal Administrative Officer D.E. Armstrong Deputy Principal Administrative Officers J.M. Roberts J.A. Spall Principal Nursing Officer Miss E. Early Deputy Principal Nursing Officer Miss A. Swift Principal Mental Health Social Worker A.J. Shriever Assistant Principal Mental Health Social Worker T.A. Hawley Principal Social Worker (Health Services) Miss M. le S. Kitchin Assistant 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 8 Public Health Department, Blue Star House, 234/244 Stockwell Road, S.W.9. Tel: 01-274 7722 To the Mayor, Aldermen and Burgesses of the London Borough of Lambeth Mr. Mayor, Ladies and Gentlemen, I have pleasure in presenting my report on the health of the Borough for the year 1968. The population has continued to fall despite an annual excess of births over deaths. Allowing for this natural increase there has been a movement of population out of the Borough of over 23,000 since 1965. While this movement of population has had little effect generally on demands on the Council's health services, it has caused difficulties in maintaining essential contact with the mobile families. This was particularly the case with the protection of children against infectious disease, which required the completion of a course of immunisation extending over the early months of life. Despite these difficulties and the reluctance of some parents to recognise the need for the protection of their children in the absence of any evidence of disease, a reasonably satisfactory level of immunity against diphtheria and poliomyelitis has been maintained. Any appreciable fall in the level of immunity would bring about a serious risk of outbreaks of these diseases. With regard to the Domiciliary Midwifery Service an increasing number of confinements are taking place in hospital, but at the same time there has been a substantial increase in the number of early discharges from hospital requiring supervision of mothers and babies in their home by the domiciliary midwives. An interesting development is the proposed allocation of a small number of beds at the Weir Maternity Hospital as a general practitioner obstetric unit. Patients admitted for confinement would be attended by general practitioner obstetricians and domiciliary midwives, as if they were at home, but the facilities of the hospital would be readily available in the case of need. It is hoped that the unit will be open early in 1969. Planning for the development and improvement of services has continued actively throughout the year, and it is expected that several new buildings will open within the next two years. The first two junior training schools in the Borough opened at the beginning of the autumn term. These two schools, housed in converted premises, provide accommodation for 105 mentally handicapped children, many of whom had previously to attend training centres in other boroughs. These two schools will be replaced by purpose built premises within the next two 9 or three years, providing together more than 200 places. With the kind cooperation of the hospital authority the number of those children attending the training school at the Manor hospital, Epsom, was increased from 20 to 30. The close relationship with St. Thomas' hospital as district hospital for a part of Lambeth has continued. Discussions are taking place on the development of a comprehensive psychiatric service based on the South Western hospital in which the local authority will play a full part. Despite the comparatively high level of day nursery provision (10 nurseries 596 places) there is a continuing unsatisfied demand. One additional day nursery (60 places) is planned. To increase the number of children using the nurseries, arrangements for part-time attendance of some children whose needs could be met in this way were extended to six nurseries, with great success. The advice and help of the staff of the department has been freely available to voluntary organisations or groups of people wishing to open play groups. Financial assistance totalling over £3,000 has also been given, and a grant under the Urban Programme is being sought to enable substantially increased assistance to be given in 1969. Although financial restrictions prevented full implementation of the provisions of the National Health Service (Family Planning) Act 1967, a domiciliary family planning service for those considered to need it was started at the Council's request by the Family Planning Association, which also continued to receive payments in respect of Lambeth patients attending their clinics. Other developments which occurred during the year included the introduction of a domiciliary chiropody service for physically handicapped and disabled persons who are unable to attend for treatment at foot clinics, and the immunisation of children against measles. During the year there was an outbreak of infection due to Salmonella Oranienberg at a hospital in the Borough which necessitated its temporary closure. Details of action taken to deal with the outbreak are given in the body of this Report. I am glad to acknowledge my indebtedness to the Chairman of the Health (subsequently Health and Welfare) Committee and to other members of the Council for their interest and encouragement during the year. Thanks also go to my fellow Chief Officers, to Dr. A.B. Stewart, Medical Adviser, Inner London Education Authority, and especially to the staff of my own department without whose able and willing co-operation little could had been achieved. 10 I am most appreciative of the help and co-operation of the family doctors and hospital staffs situate in the Borough with whom the department is in almost daily contact throughout the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, A.L. THROWER Medical Officer of Health 11 Section A Statistics and Social Conditions of the Area 12 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 19½ miles and its total area is approximately 10½ square miles. In terms of population, Lambeth is the largest of the London Boroughs. The Borough has approximately 600 acres of park and open spaces including Brockwell, Kennington, Ruskin, Norwood, Archbishop's and Vauxhall Parks, Myatt's Fields, Streatham Common and parts of Clapham and Tooting Bec Commons. Amongst the world famous buildings within its boundaries are Lambeth Palace, The Oval Cricket Ground, The County Hall, The Royal Festival Hall, the Headquarters of the London Fire Brigade and the Transport Museum at Clapham. For Parliamentary purposes the Borough is divided into five constituencies, Vauxhall, Brixton, Norwood, Streatham and Clapham, each returning one member of Parliament. For Borough Council elections the Borough is divided into a total of 20 wards each returning three Councillors. Four members are returned to the Greater London Council. 13 STATISTICS GENERAL Area of Borough 6,727 acres Number of Wards 20 Number of Parliamentary Constituencies 5 Population (Mid-year estimate 1968) 329,250 Density of Population (i.e. number of persons per acre) 48.94 Number of marriages during the year 2,951 Marriage rate per 1,000 population 8.96 Rateable Value of District (1st April 1968) £20,354,938 Sum represented by a penny rate (1968/1969) £80,450 Number of separately rated houses and flats at 1st April, 1968 93,846 VITAL STATISTICS LIVE BIRTHS Legitimate Illegitimate Totals Males 2,666 657 3,323 Females 2,706 556 3,262 Totals 5,372 1,213 6,585 Live Birth rate per 1,000 home population 20.00* Birth rate corrected for comparison with other areas 17.6 Comparability factor supplied by Registrar General 0.88 Birth rate per 1,000 home population England and Wales 16.9 Birth rate per 1,000 home population Inner London area 16.9* Birth rate per 1,000 home population Outer London area 16.1* Birth rate per 1,000 home population Greater London area 15.25 Illegitimate live births per cent of total live births 18.4 Illegitimate live births per cent of total live births Inner London area 15.5 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 11.5 *Crude birth rate 14 STILL BIRTHS Legitimate Illegitimate Totals Males 34 8 42 Females 31 10 41 Totals 65 18 83 Still birth rate per 1,000 total births (i.e. live and still) 12.4 Still birth rate per 1,000 total births England and Wales 14.0 Still birth rate per 1,000 total births Inner London area 13.1 Still birth rate per 1,000 total births Outer London area 13.7 Still birth rate per 1,000 total births Greater London area 13.5 DEATHS Males Females Totals 2,016 1,881 3,897 Death rate per 1,000 home population 11.8* Death rate corrected for comparison with other areas 12.63 Comparability factor (supplied by Registrar-General) 1.07 Death rate per 1,000 home population England and Wales 11.9 Death rate per 1,000 home population Inner London area 11.9* Death rate per 1,000 home population Outer London area 11.4* Death rate per 1,000 home population Greater London area 11.62 MATERNAL MORTALITY Number of women dying in consequence of childbirth 5 Maternal Mortality rate per 1,000 total births 0.75 Maternal Mortality rate per 1,000 total births Inner London area 0.58 Maternal Mortality rate per 1,000 total births Outer London area 0.27 Maternal Mortality rate per 1,000 total births Greater London area 0.39 *Crude death rate 15 INFANTILE MORTALITY Deaths of infants under 1 year of age Legitimate Illegitimate Totals Males 55 16 71 Females 46 11 57 Totals 101 27 128 Death rate of infants under 1 year of age per 1,000 live births 19.4 Death rate of infants under 1 year of age per 1,000 live births England and Wales 18.0 Death rate of infants under 1 year of age per 1,000 live births Inner London area 19.8 Death rate of infants under 1 year of age per 1,000 live births Outer London area 17.7 Death rate of infants under 1 year of age per 1,000 live births Greater London area 18.6 Deaths of infants under 4 weeks of age Legitimate Illegitimate Totals Males 37 13 50 Females 30 9 39 Totals 67 22 89 Neo-natal mortality rate (Deaths under 4 weeks per 1,000 live births) 13.5 Neo-natal mortality rate England and Wales 12.3 Neo-natal mortality rate Inner London area 14.0 Neo-natal mortality rate Outer London area 12.1 Neo-natal mortality rate Greater London area 12.8 Deaths of infants under 1 week of age Legitimate Illegitimate Totals Males 33 12 45 Females 24 7 31 Totals 57 19 76 16 Early neo-natal mortality rate (Deaths under 1 week per 1,000 live births) 11.5 Early neo-natal mortality rate England and Wales 10.5 Early neo-natal mortality rate Inner London area 12.4 Early neo-natal mortality rate Outer London area 10.7 Early neo-natal mortality rate Greater London area 11.4 Perinatal mortality rate (Still births and deaths under 1 week per 1,000 total births) 23.8 Perinatal mortality rate England and Wales 25.0 Perinatal mortality rate Inner London area 25.3 Perinatal mortality rate Outer London area 24.3 Perinatal mortality rate Greater London area 24.7 SUMMARY OF VITAL STATISTICS FOR THE TEN YEAR PERIOD 1959 - 1968 METROPOLITAN BOROUGH OF LAMBETH 1959 - 1964 Year Population Deaths *Death Rate Live Births *Live Birth Rate Deaths of Infants under 1 year of age Infantil Mortality Rate Maternal Deaths Maternal Mortality Rate 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 - 19680 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 1968 329,250 3,897 12.63 6,585 17.6 128 19.4 5 .75 *As adjusted by comparability factor. 17 18 19 LONDON BOROUGH OF LAMBETH CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1968 CAUSE OK DEATH Sex Total All ages Under 4 weeks 4 weeks and under 1 year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over 1. Bacillary Dysentery, Amoebiasis M 1 - - - - - - - 1 - - - F - - - - - - - - - - - - 2. Enteritis and other Diarrhoeal Diseases M 1 - 1 - - - - - - - - - F 3 -- 2 1 - - - - - - - - 3. Tuberculosis of Respiratory System M 15 - - - - - - - 2 4 3 6 F 4 - - - - - 1 1 1 - 1 - 4. Other Tuberculosis, incl. late effects M 3 - - - - - - - 3 - - F 2 - - - - - - 1 1 - - - 5. Syphilis and its Sequelae M - - - - - - - - - - - - F 2 - - - - - - - - - 1 1 6. Other Infective and Parasitic Diseases M 4 - 1 - - - - 2 1 - - - F 5 - - - - 1 - 1 - 1 1 1 7. Malignant Neoplasm-Stomach M 49 - - - - - - 1 3 13 22 10 F 41 - - - - - - - 6 4 11 20 8. Mlignant Neoplasm - Lung, Bronchus M 208 - - - - - - 3 24 80 79 22 F 51 - - - - - - - 7 12 14 18 9. Malignant Neoplasm - Breast M - - - - - - - - - - - - F 71 - - - - 1 1 5 11 23 14 16 10. Malignant Neoplasm - Uterus F 22 - - - - - 1 2 4 4 8 3 11. Leukaemia M 12 - - - 2 1 1 1 - 2 2 3 F 11 - - - 1 1 - - - 1 3 5 12. Other Malignant Neoplasms, etc. M 203 - - - 2 5 4 9 16 52 51 64 F 155 - - - - 3 1 3 10 35 36 67 13. Benign and Unspecified Neoplasms M 8 - - - - 1 1 1 1 2 - 2 F 6 - - - 1 - - 1 1 - 1 2 14. Diabetes Mellitus M 13 - - - - - - 2 - 2 4 5 F 16 - - - - - - - - 6 5 5 15. Other Endocrine etc. Diseases M 3 - - - - - - - - 2 - 1 F 6 - - - - - - - - 1 1 4 16. Anaemias M 3 - - 1 - - - 1 - - 1 - F 10 - - - - - - - - 1 1 8 17. Other Diseases of Blood, etc. M 1 - - - - - - - 1 - - - F - - - - - - - - - - - - 18. Mental Disorders M 3 - - - - - - 1 1 - - 1 F 4 - - - - - 1 - - - - 3 19. Meningitis M 5 - - 2 1 - - - - - 1 1 F 1 - - - - - - - - - - 1 20. Other Diseases of Nervous System, etc. M 31 - 1 1 - 2 2 2 3 7 6 7 F 28 - - - - - - 3 1 4 8 12 CAUSE OK DEATH Sex Total Alt ages Under 4 weeks 4 weeks and under 1 year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over 21. Chronic Rheumatic Heart Disease M 21 - - - - 1 1 2 4 5 6 2 F 31 - - - - 1 - 1 3 4 8 14 22. Hypertensive Disease M 35 - - - - - 1 2 3 14 8 7 F 35 - - - - - - - 3 4 7 21 23. Ischaemic Heart Disease M 482 - - - - - - 11 46 131 159 135 F 337 - - - - - - 2 9 32 91 203 24. Other forms of Heart Disease M 65 - - - 1 - 3 2 5 10 8 36 F 132 - - - - - - - 4 4 18 106 25. Cerebrovascular Disease M 142 - - - 1 - 1 4 12 21 43 60 F 231 - - - - - 1 1 7 30 54 138 26. Other Diseases of Circulatory System M 76 - - - - - - - 1 17 23 35 F 102 - - - - - - 2 3 9 15 73 27. Influenza M 10 - - - - - - 2 1 1 2 4 F 23 - - - - - - - - 1 3 19 28. Pneumonia M 162 1 7 1 - 1 1 1 4 13 45 88 F 214 2 6 1 - 1 1 1 2 3 27 170 29. Bronchitis and Emphysema M 189 - - - - - - - 6 36 70 77 F 79 - 2 - - - - - 3 12 13 49 30. Asthma M 7 - - - 3 1 - 1 1 1 - - F 8 - - - - 1 1 1 2 3 - - 20 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 31. Other Diseases of Respiratory System M 20 1 5 3 - - 1 - - 3 3 4 F 18 - 3 - - - - 1 1 - 2 11 32. Peptic Ulcer M 21 - 1 - - - - 1 1 5 9 4 F 13 - - - - - 1 - - - 3 9 33. Appendicitis M - - - - - - - - - - - - F 1 - - - - 1 - - - - - - 34. Intestinal Obstruction and Hernia M 9 1 1 - - - - - - - 1 6 F 6 - - - - - - - - - 1 5 35. Cirrhosis of Liver M 9 - - - - - - 2 1 4 2 - F 6 - - - - - - - 2 1 3 - 36. Other Diseases of Digestive System M 15 - - 1 - - - - 4 4 6 F 27 2 1 - 1 - - 1 2 2 8 10 37. Nephritis and Nephrosis M 7 - - - - - 1 - - 2 2 2 F 5 - - - - - - 1 - 1 1 2 38. Hyperplasia of Prostate M 5 - - - - - - - - - 1 4 39. Other Diseases. Genito-Urinary System M 12 - - - - - 1 2 2 2 3 2 F 18 - - - - - - - 3 2 5 8 40. Abortion F 4 - - - - 2 1 1 - - - - 41. Other complications of Pregnancy, etc. F 1 - - - - - - 1 - - - - 42. Diseases of skin, Subcutaneous Tissue M 3 - - - - - - - - 1 - 2 F 1 - - - - - - - - 1 - - 21 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 44. Diseases of Musculo-Skeletal System M 7 - - - - - - - 1 1 3 2 F 20 - - - - - 1 1 2 3 2 11 45. Congenital Anomalies M 18 7 3 1 1 - - 1 - 3 1 1 F 18 8 2 1 1 1 - - 1 - 2 2 46. Birth Injury, Difficult Labour, etc. M 23 23 - - - - - - - - - - F 12 12 - - -- - - - - - - - 7. Other Causes of Perinatal Morality M 16 16 - - - - - - - - - - F 12 12 - - - - - - - - - - 48. Symptoms and Ill-Defined conditions M 4 - - - - - - 1 1 - - 2 F 7 - 1 - - - - - 1 1 - 4 49. Motor Vehicle Accidents M 24 - - 2 2 3 2 4 2 5 3 1 F 10 - - - 1 3 - - 2 2 - 2 50. All other Accidents M 37 - 1 5 3 4 2 2 1 9 2 8 F 41 2 1 5 - - 2 - 3 2 1 25 51. Sucide and Self-inflicted Injuries M 25 - - - - 4 7 2 4 5 1 2 F 24 - - - - 2 1 2 5 4 7 3 52. All other external causes M 9 1 - - - 1 - 3 - 3 - 1 F 7 1 - - - - 3 - - 1 1 1 TOTAL ALL CAUSES M 2,016 50 21 17 16 24 29 66 149 463 568 613 F 1,881 39 18 8 5 18 17 33 100 214 377 1,052 GRAND TOTAL 3,897 89 39 25 21 42 46 99 249 677 945 1,665 22 23 VITAL STATISTICS POPULATION The Registrar General's mid-year estimate of population for the year 1968 is 329,250. This is a decrease of 8,880 on the figure for 1967. The number of live births exceeded the deaths, giving a natural increase of 2,688. This would, therefore, appear to indicate a movement of residents out of the Borough. Based on information supplied by the Greater London Research and Intelligence Unit a breakdown of the estimated population is as follows Under 1 year 6,450 1 to 4 years 24,050 5 to 14 years 38,900 15 to 64 years 219,150 65 years and over 40,700 Total 329,250 LIVE BIRTHS The total number of live births occurring to residents of the Borough of Lambeth was 6,585 comprising 3,323 males and 3,262 females. This was a reduction of 214 on the figure for 1967. The corrected birth rate at 17.6 per 1,000 home population was, however, higher than those for England and Wales and the Inner, Outer and Greater London Areas. Of the total number of live births 1,213 were illegitimate, 57 more than last year, giving a percentage of 18.4 of total live births. This compared unfavourably with the rates for the Inner, Outer and Greater London areas which were 15.5, 8.7 and 11.5 respectively. STILL BIRTHS There was a reduction in the number of still births, 83 occurring compared with 105 in 1967, giving a reduced still birth rate of 12.4 per 1,000 total births. This rate compared favourably with those for England and Wales and the Inner, Outer and Greater London areas all of which are higher. 24 DEATHS There were 285 more deaths in 1968 than in 1967, 3,897 occurring compared with 3,612 last year. This combined with the decrease in the population gives an increased corrected death rate of 12.63 per 1,000 home population. The rate is higher than these for England and Wales and the Greater London Area which are 11.9 and 11.62 respectively. Heart and associated diseases accounted for the largest number of deaths. Malignant neoplasms of all forms ranked second, followed by the combined deaths from Influenza, Pneumonia, Bronchitis and Emphysema, Asthma and other diseases of the respiratory system. Nineteen persons died from tuberculosis of the respiratory system and five from other forms compared with 15 and 3 respectively in 1967. Two people died from syphilis and its sequelae compared with 7 last year. Motor vehicle accidents accounted for 34 deaths, and this is a reduction of 11 on the figure for 1967. Deaths from suicide and self-inflicted injuries increased by 4, 49 deaths occurring compared with 45 in 1967. There were 5 maternal deaths compared with 1 in 1967 giving a maternal mortality rate of 0.75 per 1,000 total births. Forty-three per cent of all deaths, 613 males and 1,052 females were persons aged 75 years or over. INFANTILE MORTALITY Fewer infants died before reaching one year of age, 128 compared with 149 in 1967 giving a reduced infantile mortality rate of 19.4 per 1,000 live births, which is one of the lowest on record. The causes of death fell into the following categories :- Cause of death Male Female Total Enteritis and other Diarrhoeal Diseases 1 2 3 Infective and Parasitic Diseases 1 - 1 Diseases of the Nervous System 1 - 1 Pneumonia 8 8 16 Bronchitis and Emphysema - 2 2 Diseases of respiratory system 6 3 9 25 Peptic ulcer 1 - 1 Intestinal Obstruction and Hernia 2 - 2 Other diseases of Digestive system - 3 3 Congenital Anomalies 10 10 20 Birth Injury, Difficult Labour, etc. 23 12 35 Other causes of perinatal mortality 16 12 28 Symptoms and ill defined conditions - 1 1 Accidents 1 3 4 All other external causes 1 1 2 Totals 71 57 128 DEATHS FROM CANCER OF THE LUNG AND BRONCHI'S There was a reduction in the number of deaths from cancer of the lung and bronchus, 259 occurring compared with 267 in 1967. The deaths amongst men were four times as great as amongst women 208 compared with 51 and were distributed amongst the various age groups as follows Age Male Female Total 35 - 44 years 3(3) - (2) 3(5) 45 - 54 years 24 (18) 7(8) 31 (26) 55 - 64 years 80 (61) 12 (20) 92 (81) 65 - 74 years 79 (93) 14 (20) 93 (113) 75 years and over 22 (34) 18(8) 40 (42) 208 (209) 51 r58) 259 (267) The figures in brackets are those for the year 1967. 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 1968. 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. 26 The number of fatalities shown may not agree, therefore, with those in the list of causes of death supplied by the Registrar-General. The RegistrarGeneral's figures refer to Lambeth residents only, and the death may have occurred within the Borough of Lambeth or outside the district. No. of Accidents Killed Seriously Injured Slightly Injured Adults 2,025 (1,931) 17 (19) 328 (353) 2,124 (2,040) Children 620 (574) 4 (3) 141 (102) 556 (558) 2,645 (2,505) 21 (22) 469 (455) 2,680 (2,598) The figures in brackets are those for the year 1967. 27 Section B Prevalence of and Control over Infectious and other Diseases 28 PREVALENCE OF AND CONTROL OVKR INFECTIOUS AND OTHER DISEASES NOTIFICATION Public Health (Infective Jaundice) Regulations, 1968 On 15th June, 1968, Infective Janudice became notifiable under the abovementioned Regulations. Health Services and Public Health Act, 1968 The above-mentioned Act became operative on 1st October, 1968. Part III of the Act deals with notifiable disease and food poisoning. Previous provisions relating to the notification procedures for cases of infectious disease and for cases of food poisoning were different one from another, and were set out in different statutes (Public Health Act 1916 and Food and Drugs Act 1955). The 1968 Act repeals the provisions in the 1916 and 1955 Acts relating to notification procedures and sets out unified procedures. The Public Health (Infectious Diseases) Regulations, 1968 The above-mentioned Regulations, which came into operation on 1st October, 1968, consolidated into one instrument, with amendments, all existing regulations relating to the notification and prevention of infectious disease. The principal changes from earlier Regulations are :- (a) any obligation to notify a case of disease now rests solely on a medical practitioner. (b) changes and additions are made to the list of diseases which are to be notified. Acute primary pneumonia, acute influenzal pneumonia, and puerperal pyrexia are no longer to be notified and tetanus and yellow fever are to be notified for the first time. (c) leptospirosis, hitherto to be notified only in certain areas, is to be notified throughout England and Wales. fd) the powers of a medical officer of health of a district to vaccinate contacts and persons suffering from smallpox have been extended to other diseases. (e) the powers of a local authority to require a person to stop work in order to prevent spread of infection, are extended to permit action in cases of food poisoning. 29 Consequently, from 1st October, 1968, the undermentioned diseases are notifiable within the Borough of Lambeth:- Acute encephalitis Ophthalmia neonatorum Acute meningitis Paratyphoid fever Acute poliomyelitis Plague Anthrax Relapsing fever Cholera Scarlet fever Diphtheria Smallpox Dysentery ("amoebia or bacillary) Tetanus Food Poisoning Tuberculosis Infective jaundice Typhoid fever Leprosy Typhus Leptospirosis Whooping cough Malaria Yellow fever Measles Notification of the diseases listed below is no longer required Acute influenzal pneumonia Acute primary pneumonia Erysipelas Membranous croup Puerperal Pyrexia By an order made under Section 50 of the Act of 1968, the notification fee payable to medical practitioners was increased to five shillings from 1st October, 1968. 30 CORRECTED NUMBER OF NOTIFICATIONS OTHER TI1AN TUBERCULOSIS RECEIVED DURING 1968 Disease First Quarter Second Quarter Third Quarter Fourth Quarter Totals Grand Total M F M F M F M F M F Scarlet Fever 9 6 9 15 4 1 8 4 30 26 56 Whooping Cough 19 10 4 21 12 8 10 10 45 49 94 Measles 11 12 44 37 43 45 165 343 463 437 900 Dysentery 38 31 10 16 7 15 14 11 69 73 142 Meningococcal Infection 1.1.68- 30.9.68. 4 2 _ _ 1 _ _ 4 3 7 Acute Meningitis 1.10.68 - 31.12.68. _ _ _ _ _ _ 2 2 2 2 4 Acute Pneumonia 1.1.68 - 30.9.68. 10 2 2 _ _ 2 _ _ 12 4 16 Paratyphoid Fever _ 1 _ _ 1 _ _ _ 1 1 2 Erysipelas 1.1.68- 30.9.68. _ _ _ 1 _ 1 _ 2 2 Food Poisoning 11 11 7 5 ' 3 2 5 9 26 27 53 Puerperal Pyrexia 1.1.68- 30.9.68. _ 6 9 _ 32 _ 47 47 Ophthalmia Neonatorium - _ _ _ _ 1 _ _ _ 1 1 Infective Jaundice 15.6.68 - 31.12.68. _ _ 2 1 18 13 7 9 27 23 50 TOTALS 102 81 78 105 88 121 411 388 679 695 1,374 31 NOTIFICATION OF INFECTIOUS DISEASES - AGE DISTRIBUTION Age Group Scarlet Fever Whooping Cough Measles Dysentery Meningococcal Infection 1.1.68- 30.9.68. Acute Meningitis 1.10.68- 31.12.68. Infective Jaundice 15.6.68- 31.12.68. Ophthalmia Neonatorum Totals M F M F M F M F M F M F M F M F Under 1 year - 2 7 6 28 18 5 3 1 2 1 1 - - - 1 75 1 - 1 2 4 5 73 68 6 9 1 - - - - - - - 169 2- 3 - 5 8 76 63 3 4 - - - - 1 3 - - 166 3- 3 2 9 15 70 74 6 3 1 1 - 1 - - - - 185 4 - 3 4 2 5 63 57 6 3 - - - - - - - - 143 5-9 12 9 14 8 139 140 16 21 1 - - - 11 6 - - 377 10- 14 4 2 2 1 6 4 8 7 - - - - 3 4 - - 41 15-24 3 4 1 1 3 2 3 8 - - - - 5 5 - - 35 25 and over 1 1 1 - 3 4 15 13 - - - - 6 3 - - 47 Age unknown - - - - 2 7 1 2 - - 1 - 1 2 - - 16 TOTALS 30 26 45 49 463 437 69 73 4 3 2 2 27 23 - 1 1,254 32 NOTIFICATION OF INFECTIOUS DISEASES - AGE DISTRIBUTION (Contd.) Age Group Acute Pueumonia 1.1.68 - 30.9.68. Paratyphoid Fever Erysipelas 1.1.68 - 30.9.68. Food Poisoning Puerperal Pyrexia 1.1.68 - 30.9.68. Totals M F M F M F M F M F Under 5 years 2 1 - - - - 6 1 - - 10 5- 14 - - - 1 - - 5 7 - _ 13 15 - 44 2 - - - - 1 9 12 - 47 71 45 - 64 4 1 1 - - 1 4 4 . - 15 65 and over 4 2 - - - - 2 2 - - 10 Age unknown - - - - - - - 1 - - 1 TOTALS 12 4 1 1 - 2 26 27 - 47 120 GRAND TOTAL 120 1,254 1,374 33 NOTIFICATIONS OTHER THAN TUBERCULOSIS The number of notifications received during the year fell considerably, 1,374 cases of infectious disease being notified compared with 2,791 in 1967. No case of Diphtheria, poliomyelitis or acute encephalitis occurred and the Borough was free from typhoid fever. MEASLES Nine hundred cases were notified compared with 2,409 in 1967 but as that year was an "epidemic year" this was to be expected. SCARLET FEVER Fifty six cases were notified compared with 46 in 1967. WHOOPING COUGH There was a reduction in the number of cases, 94 being notified compared with 122 last year. DYSENTERY There was an increase in the number of cases of dysentery notified during the year, 142 cases occurring compared with 71 in 1967. MENINGOCOCCAL INFECTION Seven cases were notified in the first nine months of the year. From 1st October 1968 this disease ceased to be notifiable. ACUTE MENINGITIS Four cases were notified in the period 1st October to 31st December, 1968 in accordance with the provisions of the Health Services and Public Health Act, 1968 and the Public Health (Infectious Diseases) Regulations 1968. ACUTE PNEUMONIA Sixteen cases were notified up to 30th September 1968 after which date the disease ceased to be notifiable. 34 PARATYPHOID FEVER Two cases were notified during the year. One case occurred in a school girl who was taken ill in February 1968 and was found to be excreting Salmonella paratyphi B. Investigations were carried out but the source of infection remained obscure. All contacts were negative and no further cases occurred. The second case was a man who had returned from holiday in Beirut. He was resident outside the district but was admitted to hospital in Lambeth where the disease was confirmed. The organism isolated was Salmonella paratyphi B. The Medical Officer of Health of the district in which the patient was resident was informed and the necessary investigations and precautions carried out. Unfortunately the patient died. There is little doubt that the infection was contracted whilst the man was on holiday abroad. ERYSIPELAS This disease ceased to be notifiable after 30th September, 1968 but two cases were notified in the first nine months of the year. PUERPERAL PYREXIA Under the provisions of the Health Services and Public Health Act, 1968 and The Public Health (Infectious Diseases) Regulations 1968, Puerperal Pyrexia ceased to be notifiable after 30th September, 1968. From 1st January to 30th September 47 cases were notified in the Borough of Lambeth. OPHTHALMIA NEONATORUM One case only was notified during the year, compared with 6 in 1967. INFECTIVE JAUNDICE This disease became notifiable on 15th June 1968 under the Public Health (Infective Jaundice) Regulations 1968. Fifty cases were notified during the remainder of the year. FOOD POISONING Fifty three notifications were received during the year and eleven cases were brought to the notice of the Health department other than by formal notification. Fifty six were sporadic cases and the remaining 8 occurred in 3 families. 35 The causative organism was identified in 15 cases as follows S. Typhimurium 3 Salmonella Bareilly 2 Salmonella Dublin 1 Salmonella Enteritidis 1 Salmonella Muenchen 1 Salmonella Newport 1 Salmonella Reading 2 Salmonella Sinstorf 1 Salmonella Stanley 2 Salmonella Thompson 1 In the remaining 49 cases the causative agent was unknown. 36 SALMONELLA INFECTIONS (NOT FOOD BORNE) INCIDENTS AND CASES CAUSATIVE AGENT GENERAL No. of separate outbreaks OUTBREAKS No. of cases notified or ascertained FAMILY C No. of separate outbreaks OUTBREAKS No. of cases notified or ascertained SPORADIC CASES notified or ascertained TOTAL No. of outbreaks and sporadic cases COLS. (1+3+5) TOTAL No. of cases COLS. (2+4+5) 1 2 3 4 5 6 7 1. S. Typhimurium 5 11 1 6 12 2. Other Salmonellae (a) 3 88 1 3 8 12 99 3. TOTAL 3 88 6 14 9 18 111 Details of Salmonella infections due to Salmonellae other than S. Typhimurium (not food borne) Type of Salmonellae Eimsbuettel 1 1 1 Virchow 2 2 2 Enteritidis 1 3 1 3 Panama 1 1 1 Indiana 2 2 2 Reading 1 1 1 Senftenburg 1 3 1 3 Unidentified 1 1 1 Oranienburg 1 80 1 80 Do. (Anaerobic) 1 5 1 5 37 During the year an outbreak of Salmonella Oranienburg occurred in a hospital of 184 beds. The Medical Officer of Health was informed and it became necessary to close the hospital. This action was reported to the Ministry of Health. Screening of faecal samples from all patients and staff was carried out involving a total of 590 persons. Patients were discharged home or to convalescence as soon as possible if cleared, and transferred to an isolation hospital if positive. A criterion for clearance was 6 negative stools, but before the hospital was re-opened 6 more negatives were required from food handlers and from nursing staff on the maternity ward. It was apparent that there was need for improvement in the methods used by the kitchen staff and intensive hygienic measures were instituted. Samples of water, food and swabs from the working surfaces and equipment were taken and sent to the laboratory for examination. All tests proved negative. Originally the outbreak was dealt with as a food borne infection but it later became apparent that there was also some spread by direct person to person transmission. The outbreak was considered to have come to an end by late July and the hospital was then re-opened in stages, but before this happened the whole of the premises and staff quarters were disinfected and lectures given to all staff. Salmonella Oranienburg was isolated from 80 members of the staff and patients and the following organisms were also identified during the screening, Salmonella Seftenburg, Panama, Reading and Indiana. 38 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 - - - - - - - 1- - - - - - - - 2-4 1 1 1 - - - 3 5-9 - 2 - - - - 2 10- 14 - - - - - - - 15- 19 - 1 - - - - 1 20-24 5 4 2 1 - - 12 25 - 34 5 11 7 2 - - 25 35-44 9 4 1 4 - - 18 45 - 54 6 - - 5 - - 11 55-64 11 2 - 2 - - 15 65-74 10 - - 1 - - 11 75 and over 3 1 - - - - 4 Age unknown - - - 1 - - 1 TOTALS 50 26 11 16 - - 103 I am indebted to Dr. C.F. Price for the following report on the work of the Chest clinic REPORT ON CHEST CLINIC WORK 1968 The following tables are extracts from the Annual Return of Chest Clinic work as now propared 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. 39 Table 1. Number of cases of tuberculosis (whether notified or not) under treatment, supervision, or observation at 31st December, 1968. Men Women Children Totalp Number of cases (including both outpatients and in-patients) Respiratory 644 466 19 1,129 Non-respiratory 22 23 1 46 Total 666 489 20 1,175 Number of cases included above whose broncho-pulmonary secretion was positive during the year 21 Table 2. Number of cases of tuberculosis (whether notified or not) new to the clinic (but excluding transfers from other clinics) during the year ended 31st December, 1968. Men Women Children Total Respiratory Non-bacteriologically confirmed Group I 8 6 3 17 Group II 5 3 - 8 Group III 2 - - 2 Total 15 9 3 27 Respiratory Bacteriologically confirmed Group I 8 3 - 11 Group II 11 3 - 14 Group III 6 - - 6 Total 25 6 - 31 Non-respiratory 2 4 - 6 Total new cases 42 19 3 64 Whilst these tables give a picture of Chest Clinic work the incidence of new tuberculosis cases in the Borough is more accurately shown in the following Table 3 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. 40 TABLE 3 Respiratory Tuberculosis Non-Respiratory Tuberculosis Men Women Children Total Men Women Children Total Number of cases diagnosed during the year 1968 28 9 - 37 2 3 - 5 Deaths 12 2 - 14 - - - - DEATHS There were 14 deaths during the year directly attributable to tuberculosis. This is an increase of six over the previous year's figure but can be attributed to a similar number of deaths among residents at the Knight's Hill Hostel for tuberculous men who were not normally resident in the Borough of Lambeth. There were two female deaths only, one was an old standing case with severe permanent lung damage, the other a case of neglect to take medical advice where the disease was not diagnosed and not notified until after daath. Of the male deaths all were over 60 years of age including those resident at the Hostel and the other six all reflected the problem of neglected old age. Three of them were more than 80 years old and were admitted to hospital in a final stage of tuberculosis for which they had not previously sought nor had been given advice and treatment. One was a coroner's case diagnosed at the post-mortem examination. Nineteen other chest clinic patients died during the year, 13 men and six women. The majority of male deaths were attributable to age and cardiovascular disease, then to bronchitis and respiratory infections and then to lung cancer. The female deaths were in the main attributable to cardiac disorder following long standing non-tuberculous lung disease, and others to growths in the lungs secondary to cancer elsewhere. 41 TABLE 4 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 1968 * 1,175 42 14 * includes observation cases TUBERCULOSIS INCIDENCE There was a slight increase in the incidence of tuberculosis as compared with the previous year but Table 4 suggests that on average there has been little change over the past four years. Of the 64 new cases added to the register 42 were notified as suffering from active or potentially active disease, 37 were respiratory cases. The majority . 62.5% - were of English and Scottish racial origin, of the other new cases, 9 were of Eirean, 8 of West Indian, 2 of Nigerian, 2 of Indian and one each of Chinese, Zambian and Italian origin. As will be seen from Table 2 the male incidence continues to outnumber the women by two to one - but overall most cases were discovered in Groups I and II that is in the earliest and less advanced stages of the disease. 42 TREATMENT Modern anti-tuberculosis chemo-therapy enabled the majority of patients to receive treatment at home under the care of the attendant medical practitioner and with Chest Clinic supervision. The services of the District Nurse were used to give patient injections where necessary. Admission to hospital was arranged only in those cases where the disease was of such severity as to require inpatient hospital facilities and nursing care or where the social and personal circumstances of the patient were inadequate or unsuitable for domiciliary treatment. An average of five tuberculosis beds were kept occupied in Dulwich Hospital during the year. B.C.G. VACCINATION The Chest Clinic service offers B.C.G. vaccination against tuberculosis to contacts at special risk who have missed or are not yet old enough to qualify for vaccination under the School Medical Service B.C.G. scheme. During the year 210 such B.C.G. vaccinations were performed at the Chest Clinic. HOME VISITING The Council provides one full time Tuberculosis Health Visitor to maintain this essential aspect of the Chest Clinic service covering matters of hygiene and prevention of infection in the ho me and among contacts. The Visitor also provides a most valuable liaison between the patient receiving treatment at home, his attendant medical practitioner and the Chest Physician - a service of widening scope as the use of domiciliary treatment increases. Office accommodation is provided for the Health Visitor at the Chest Clinic with access to patients' medical records and facilities for discussion of case problems with the Chest Physician. I am indebted to Dr. H.J. Anderson for the following report on the work of the Chest Clinic for 1968 THE NORTH LAMBETH CHEST CLINIC The North Lambeth Chest Clinic continues to serve the same proportion of Lambeth as before. In addition, patients are of course referred to it from all over the country. All types of chest illness's are seen and dealt with, and research continues into the cause of such diseases. During 1968 several Sanatoria for Chest Diseases' were closed by the Ministry of Health, and this has naturally made increasing demands on the chest services of the Hospital. This includes both the beds in St Thomas' Hospital proper, and the beds in the South Western Hospital. You will know that a Respiratory Unit was transferred to the South Western Hospital, from the Western 43 Fever Hospital in December 1968, and although this is under the charge of the Professor of Medicine, St Thomas' Hospital, it will naturally be used, if arfd when necessary, for other patients in the South Western Hospital. It would seem that owing to some of the re-routing of public transport which has taken place in this area, fewer buses are available for the Chest Clinic patients. The Hospital authorities have this clearly in mind, and discussions are going on with the appropriate authorities. Domiciliary Visits continue as before, and there is little doubt that the increased number of contacts which have been traced in the last year, have placed an extra burden on the Health Visitor. Chemotherapy in the home continues as before. It will be seen that the number of new cases of pulmonary tuberculosis runs at approximately three per week, although the majority of these are not from this district. A numerical summary of the work of the Clinic is set out below. 1968 No. notified cases on Register 1,939 No. of new cases 40 this district 100 others. No. of deaths 11 No. B.C.G. 180 Attendances at Clinic (not including A.P.'s) 11,179 Chemotherapy at home 144 Awaiting admission Nil A.P. refills including non-Lambeth cases Nil 44 Section C Personal Health Services 45 PERSONAL HEALTH SERVICES MATERNITY AND CHILD HEALTH CENTRES There are thirteen Maternity and Child Health Centres in the Borough, some in purpose built or adapted accommodation, and others in rented premises. Premises in Kirkstall Road have been converted for use as a new Maternity and Child Health Centre and will improve the facilities in the Streatham Hill area. Improvements have been made to the West Norwood Centre, including the provision of new floor coverings. During the year plans were approved for a new Maternity and Child Health and School Treatment Centre in Weir Road, S.W.12, which will replace unsatisfactory converted and rented premises and provide first class facilities for the Clapham Park area of the Borough. Facilities are provided by the Council at some of the Centres for general practitioner obstetricians to see their own booked maternity patients and 224 such sessions were held during the year. Dental treatment is provided for expectant and nursing mothers and children under five years, the attendances being 25 and 657 respectively. The service is provided in conjunction with that for school children, combined use being made of the staff and premises. National Welfare foods (dried milk, cod liver oil and orange juice) are issued at approved prices at all the Maternity and Child Health Centres. In addition, certain proprietary baby foods are supplied on the recommendation of clinic doctors or health visitors to children who attend the centre. Tests for the detection of phenylketonuria, a metabolic disorder which, if left untreated, may lead to mental subnormality, are carried out by health visitors on all babies before the age of eight weeks. Mothercraft and relaxation classes are held by domiciliary midwives and health visitors in the Maternity and Child Health Centres for both hospital and domiciliary booked patients. There were 76,717 attendances at child health and toddlers' sessions and 2,357 attendances at ante-natal and post-natal clinic sessions. The Health and Welfare Committee considered the report of the Sheldon Committee on the Medical Functions and Medical Staffing of Child Welfare Centres and was pleased to note that the bulk of the recommendations were already normal practice in Lambeth. The change of name to Child Health Services as more properly describing the preventive functions of the former Child Welfare Service was agreed. 46 CERVICAL CYTOLOGY SCREENING SERVICE - 1968 During 1968 the Regional Hospital Boards successfully recruited staff and facilities were made available to extend the exfoliative cytology screening service. It was not found necessary to open additional clinics as the service operating throughout the borough was sufficient to meet the steady demand. The screening service was available to well women of all ages resident or working in the borough. Five weekly sessions continued to operate throughout the year from five different centres. The evening sessions at the South London Hospital and Riggindale Child Health Centre proved to be popular for those women who found it difficult to attend clinics during the day. Following a request from the Medical Adviser of the Greater London Council, a team from the Health Department carried out a number of sessions at County Hall for female staff employed there. Of the 593 women examined seven were referred for hospital investigation. Details of the total numbers examined in each clinic are given in the following tables. Of the women recalled for repeat smears many were found to have minor gynaecological disorders where treatment was necessary before an accurate reading of the smear could be confirmed. CLINIC Number Examined Results Negative Positive Retaken Riggindale 353 316 1 36 South London Hospital 419 361 — 58 Moffat 165 131 4 30 West Norwood 310 267 10 33 Loughborough 443 382 9 52 Total 1,690 1,457 24 209 FAMILY PLANNING 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. Although it was not possible for economic reasons to implement the new powers given to local health authorities to provide family planning advice to all who seek it free of charge, the Health and Welfare Committee was able to agree 47 to certain increases in charges proposed by the Family Planning Association for cases referred by the Council on medical grounds. The Association was also given authority to provide domiciliary consultations for women specially referred by the Council as in need of this service. CRECHES Creches at which mothers may leave their children for the duration of the session (Normally 3 hours) are held in many health centres. There is a continually increasing demand for this service which provides facilities for children under school age to have opportunities for group play and relieves hard pressed mothers for short periods. A number of new sessions were commenced during the year. During the period under review 1,532 sessions were held at which 19,514 attendances were made. DAY NURSERIES During 1968 the ten day nurseries continued to provide a happy environment for 596 Lambeth children. As the demand for places for those with special needs remained high, it was decided to extend part-time facilities to other nurseries. This started last year at St. Martin's Nursery as an experiment and proved to be successful and invaluable for those children for whom a whole day away from mother and home could be upsetting. There are now ten part-time groups in the borough, giving an extra 60 places. Many emergency places had to be found during the year to prevent children being received into care. Deserted fathers and those temporarily on their own when the wife was in hospital were able to be helped. All the nurseries accepted a proportion of handicapped children, and approximately 60 attended daily giving help not only to the child but also some welcome relief to mother. Tulse Hill Special Unit continued to make provision for nine children with more severe disabilities. Staffing the nurseries continued to be difficult, and as student nursery nurses normally complete their training by the age of 18 years it is inevitable that the majority, after some experience, will be attracted by other posts. There is an establishment of 60 students in the 7 training nurseries taking the 2 year Nursery Nurses Examination Board course and examination. There were 90 applicants for the 30 available places. Advantage was taken of the training facilities at Croydon Technical College as well as Brixton and Southwark 48 Colleges for Further Education. 28 students passed the N.N.E.B. examination during the year, the majority remaining for at least a short period as Staff Nursery Nurses and four were accepted for teacher or nurse training. The student teachers often give welcome help during their vacations. As in previous years it was possible for some staff to go on refresher and other courses. These were greatly appreciated and of benefit since they provided stimulation and new ideas, and gave the opportunity for discussion with colleagues from similar establishments. Two matrons attended the Annual Conference of the National Association of Nursery Matrons at Brighton, when the subject of the Plowden Report was discussed. Because of the difficulty in obtaining good domestic staff in the nurseries in Central Lambeth, a night cleaning service was introduced initially to two and later to a third nursery. This worked well relieving matrons the responsibility of engaging staff and of the necessity, on occasion, of using nursing staff for domestic duties. The Town Hall Catering Staff was most helpful in providing suitable meals when one nursery was without a cook for three months. Many minor improvements have been carried out to day nurseries, including the provision of additional toilet accommodation and heating improvements at Chestnut Nursery, extensions to the balcony enclosures at Coldharbour Lane and the re-paving of part of the grass area at Coral Nursery as a play space. At Cowley Nursery a new babies nursery and bathroom have been formed, new bed storage units provided and a newboiler installed. Heating improvements have also been provided at the Cynthia Mosely Nursery. CHILD MINDING In November 1968 The Health Services and Public Health Act, 1968, Section 60, amended the Nurseries and Child-Minders Regulation Act, 1948 so that it became necessary for all child minders who receive for reward one child or more for more than two hours during the day to be registered with the Council. Formerly those minding one or two children were not required to register. The amendments increase the power for Local Health Authorities to refuse registration of unsatisfactory minders; and enable them to fix the maximum number of children to be received into a home; to make requirements concerning the number, qualification and experience of the people who look after the children; to enforce satisfactory maintenance of premises; to enforce safety and fire precautions; to require the keeping of records and the making of satisfactory arrangements for feeding the children. Increased maximum penalties for offences are also provided. 49 In a memorandum issued for the guidance of Local Health Authorities, the Minister of Health drew attention to the provisions of the Health Services and Public Health Act, 1968 and made recommendations regarding inspection, registration and supervision and good relationship with prospective applicants. The close co-operation with planning departments and the Fire Authority on means of escape in case of fire and fire precautions generally is stressed. The Minister also recommends that greater care should be taken in checking the health of applicants and persons they employ to look after children including a suggestion that a declaration of health should be completed by each person who should be asked to consent to the Medical Officer of Health consulting her own doctor if necessary. At present the Council 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 health Centre with the children and are also visited in their homes by health visitors. With the extension of the Nurseries and Child Minders Regulation Act all existing voluntarily registered minders will be required to register under statutory provisions. The voluntary registration scheme will therefore cease on 31st January 1969, the date by which the voluntary minders are required to seek statutory registration. The comprehensive nature of the new provisions means that the Health Department will have to deal with a wider range of standards among applicants a proportion of whom will undoubtedly be unacceptable for registration. To ensure that those refused registration do not continue to mind children, and that registered minders continue to observe satisfactory standards frequent and regular visiting by senior nursing officers and health visitors will be necessary. As from 1st February 1969 it will be an offence for an unregistered person to mind children. It is, therefore, desirable that all those brought within the scope of the Act should be registered by that date. With this in mind the Council approved new arrangements for ensuring that applications are dealt with speedily, the appointment of additional staff, and proposals for giving extensive publicity to the new requirements. Grants were given to a number of play groups during the year, and next year it is hoped to increase the assistance the Council is able to provide. An application has been made to the Department of Health and Social Security for a special grant for this purpose under the Urban Programme. The majority of the play group leaders are most co-operative and provide a valuable service for the children attending the groups. 50 "HANDICAP" REGISTERS Much importance is attached to the development and maintenance of a complete register of all babies and young children who have congenital handicaps, or who, because of adverse factors occurring during the mother's pregnancy or labour, are "at risk" of developing such handicap. Information provided by general practitioners, hospitals and midwives is supplemented by the observations of clinic doctors and health visitors. Every child whose name is on the handicap and observation register is reviewed by a senior medical officer at appropriate intervals so that any necessary remedial action 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 tor Co-ordination The Committee continued to meet quarterly, twice under the Chairmanship of the Chief Welfare Officer and twice under that of the Housing Manager. Throughout the year a high proportion of the time was spent at the quarterly Meetings and at meetings convened by the Associate Town Clerk to the growing problem of preventing homelessness due to rent arrears. New procedure was introduced in January 1968 to draw the attention of social workers to the urgent need for preventive work to avoid eviction; this was applicable to tenants in Borough and Greater London Council housing, G.L.C. mortgage defaulters and a small proportion of tenants living in private property (only 4 such cases occurred in 1968). A total of 258 cases were considered. 104 individual Case Conferences were held; 65 of these were concerned with families seriously at risk through gross arrears totalling £4,960. Apart from social workers in the Local Authority and I.L.E.A. the Family Service Unit, Family Welfare Association, Probation Service, and N.S.P.C.C. were to varying extents involved in preventive work, but in spite of these combined efforts not all evictions could be prevented even if staffing permitted more intensive case workers. There remain families who refuse to pay rent and in fact appear to prefer living in homeless family accommodation. 51 HEALTH SERVICES - FAMILY CASEWORKERS A third full-time family caseworker was appointed in November, 1968, but there is still a waiting list for this service, of families referred through interdepartmental case conferences. They are all specially difficult families, with multiple problems, who need more time and individual help than can be given by normal fieldworkers if family breakdown is to be prevented, not only through rent arrears, but also through marital disharmony, promiscuity, prison sentences, drink and, increasingly often, drugs, all of which render the children particularly vulnerable to neglect. During 1968 the caseworkers worked with 41 such families, having between them a total of 194 children DOMICILIARY MIDWIFERY SERVICE The number of domiciliary confinements continued to fall but this reduction is partly balanced by the rise in the number of mothers who, having had their babies in hospital, are discharged home before the tenth day after birth, mainly at 48 hours, to the care of the domiciliary midwife. The pattern for the future, however, is not clearly defined. Clinics are held in maternity and child health 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. There has been an increase in the number of classes for expectant mothers taken by the midwives, mainly in relaxation and mothercraft. In addition classes in relaxation were given each week in three of the homes for mothers and babies. During the year meetings were arranged between representatives from St. James' Hospital, general practitioner obstetricians and the boroughs of Wandsworth and Lambeth regarding the establishment of a General Practitioner Obstetric Unit at the Weir Maternity Hospital. A scheme was agreed by the Health and Welfare Committee and it is anticipated that it will become operative in 1969. There are three Part II Midwifery Training Schools - South London Hospital, Annie McCall Hospital and Dulwich Hospital - from which pupil midwives are allocated to the Lambeth domiciliary midwives for their three months district training. Owing to the decrease in domiciliary confinements, the Central Midwives Board has stated that, instead of at least ten home confinements being attended during a pupil midwife's district training, six would be approved for their final examination, provided a satisfactory social studies programme was arranged. The first programme commenced in December 1968 and was greatly appreciated by the pupil midwives involved and made the community services far more realistic for nurses who had worked only in hospital. 52 The twentyfour hour supervision of the service shared with the Boroughs of Southwark and Wandsworth through the Emergency Control Service contined to work satisfactorily. Two members of the midwifery staff retired during the year, Miss A. Owston and Mrs. A.F. Williams. Both these ladies gave many years service to the mothers of Lambeth, the former for 22 years and the latter for 26. Thanks are due once more to the Lambeth District Nursing Association and the Hospital Authorities for their co-operation and help during the year. MIDWIVES ACT, 1951 The Council is the supervision authority for all midwives practising in the Borough under the Midwives Act, 1951. During the twelve months ended 31st December 1968, 235 midwives notified the Council of their intention to practise in the Borough. 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 the purpose. During the year, the following articles of equipment were loaned through the Health Department:— Issued Returned 254 Armchair Commodes 214 130 Stool Commode 116 Nil Tripod Walking Aid 2 4 Penryn Hoist 6 7 Homecraft Walking Aids Nil 8 Zimmer Walking Aids 6 1 Hospital Bed with lifting pole 2 Nil Dunlopillo Mattress 2 13 Back Rests 8 9 Bed Cradle 4 2 Easi Carri Hoist with sling Nil 34 Fracture Boards 9 5 20" Fireguards Nil 6 24" " Nil 53 Issued Returned 23 30" " 3 1 54" Nil 38 yards Rubber sheeting Nil 2 Adult Cot Beds 1 1 Toilet sheet - rubber Nil 6 Bed Pans - rubber Nil 3 (Hire) Ripple beds 1 " 2 Stoke Mandeville patient 1 Air ring Nil 1 Receiver Nil 1 Canny Ryall Syringe Nil 6 Millpuff Pillow/covers Nil 20 ml Glass syringe Nil Johnson and Johnson Liners Boxes of 100 - Issue 5554 boxes to 17 patients. Polyweb Incontinence pads Boxes of 72 - Issue 378 boxes to 249 patients. Incontinence garments Issue 28 INCONTINENCE PADS Supplies of incontinence pads have been issued to 249 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. VACCINATION AND IMMUNISATION Parents are encouraged to have their babies vaccinated against diphtheria, whooping cough, tetanus, poliomyelitis and smallpox. This may be done, either by the Council's doctors at Maternity and Child Health Centres or by general practitioners. Re-inforcing doses are also given to older children under similar arrangements. 54 INTERNATIONAL CERTIFICATES OF VACCINATION Certificates of recent successful vaccination/inoculations are required by persons travelling to certain countries abroad. After completion by the vaccination doctor (normally the person's own doctor) the certificate must be taken or sent for authentication of the doctor's signature by the Medical Officer of Health for the area in which the doctor practises. In Lambeth, signatures on certificates are authenticated in the Health Department, Blue Star House, 234/244, Stockwell Road, S.W.9. TUBERCULOSIS 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 who are based at the chest clinics. There were 4,018 patients on chest clinic registers at 31st December 1968. The T.B. Health Visitors made 3,409 effective home visits and 55 patients received extra nourishment or other benefits. The Council is responsible for Knights Hill Hostel for homeless infective tuberculous men, which provides 29 places. It is extensively used by other Inner London Boroughs, there being only three such hostels in London. 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 398 contacts and 2,078 school children were vaccinated. HEALTH VISITING The health visiting service is provided by the Council under Section 24 of the National Health Service Act 1946. The work has many facets, embracing directly or indirectly all the social services provided for every member of the family. The health visitor 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. 55 The improvement in staff recruitment reported in my Annual Report for 1967 has been maintained throughout the year. Nine health visitor students sponsored by the Borough successfuly completed their training and joined the staff in September. Sixteen students commenced training at the same time. It was, therefore, possible to widen the scope of the work and to re-introduce combined Health Visitor/School Nurse duties in some areas of the Borough. Reports from the thirteen maternity and child health centres indicate a marked increase in the number of mothers telephoning for help and advice, and also in the number of people calling at the centres at other than recognised clinic session times. There was an increase in the amount of time spent both in the clinic and on home visiting where mental illness was a factor. Clinic attendances have tended to be less in number, but more time consuming. The drop in numbers is accounted for by the reduced number of births. Due to the improvement in staffing generally it was possible to accept an increased number of health visitor students for the University of Surrey and the Croydon College of Technology. Staff attended the further periods of training required by the Council for the training of Health Visitors for Field Work Instructors. Recruits for training facilities continued to increase and have now reached saturation point. Visits of observation were arranged for 600 hospital student nurses and members of the health visiting staff participated in student lectures on the social aspects of disease. Many requests for training facilities and visits of observation came from tutors to various social studies courses. A number of overseas visitors requested short programmes of studies and every effort was made to provide the experience needed. A total of 722 students and visitors visited the norsing services for periods varying from half a day, but in 39 instances they were a week or longer. Students came from Brazil, Greece, Sweden, India and other countries. 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 176 holidays were provided as follows :- Expectant and nursing mothers and children under five 55 Psychiatric patients 14 Persons of pensionable age 61 Other adults 46 56 CHIROPODY The 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 by the Council at six centres for certain priority classes including the aged, expectant and nursing mothers, school children and the handicapped. During the latter part of the year the Council extended the service to include domiciliary treatment. During the year 2,376 patients were treated involving 11,064 treatments. In addition, the departments provides chiropody service in welfare homes for which the Welfare Department pays. Service was provided for 381 people and 2,454 treatments were given. HOME HELP SERVICE The service is organised in three areas staffed by a home help organiser and clerical staff based in officers in Offley Road (North Lambeth), Loughborough Maternity and Child Health Centre (Lambeth Central), and Riggindale Road Maternity and Child Health Centre (Lambeth South) The service was provided to 4,381 applicants during the year. During the year approximately four-fifths of the applicants to whome the service was provided were over 65 years of age. The remaining 20% were families and individuals with a wide variety of needs. Morning and evening home helps provided a service which prevented the necessity to receive children into care. Free help was given to households where mothers suffered from toxaemia of pregnancy. Confinement cases continued to make only limited demands on the service. Although the provision of specially trained home helps to teach mothers how to run their homes was made in only a few cases, the results were most encouraging. In-service training was given to new entrants to the Home Help staff, and refresher courses were arranged for the more experienced. Discussion revealed the concern which home helps feel for their clients, and aided in planning future courses. 57 MENTAL HEALTH SERVICES Mental Health Social Workers Mental Health Social Workers deal with the care in the community of the mentally ill and mentally subnormal. They provide support and guidance to patients and their families and ensure that they receive appropriate community care and other social and medical services as required. Much time and skill is needed in assessing the needs of patients at the time of referral and in providing an effective casework service for patients and their families. Mental health social workers also have a statutory responsibility in connection with compulsory admission to hospital of the mentally disordered, when this is necessary. They also assist in arranging informal admissions for their patients when this is more appropriate. A twenty-four hour service is maintained in conjunction with the neighbouring boroughs of Wandsworth and Southwark to deal with emergencies and operates through the Lambeth Emergency Control Centre. In order to develop the mental health social work service on a team basis, and to provide adequate supervision and consultation for field staff, two posts of senior mental health social workers were added to the Department's establishment. Each senior is responsible for the supervision of an area team, the allocation and review of cases, consultation and advice on casework and statutory duties, and participation in the Department's trainee scheme. Day Care and Training Facilities Under Section 28 of the National Health Service Act a local health authority is required to provide centres for the training of children under the age of sixteen years who have been reported to it by the local education authority as being unsuitable for education at school. As no junior training schools passed to Lambeth from the London County Council in 1965, the Council has been hard pressed to provide the necessary facilities and has had to make use of places at centres in other boroughs and at hospitals. The Council's first two junior training schools, at Garrards Road, Streatham and Rectory Grove, Clapham, opened in September 1968 and have reduced the pressure to some extent. Both are in converted properties and will be replaced within the next three years by purpose build schools, catering for all Lambeth children requiring this service. Construction has started on a junior training school at Blenheim Gardens. The Health and Welfare Committee considered a circular from the appropriate Ministries seeking comments on the proposal that the responsibility for the education and training of mentally subnormal children should pass from local health authorities to local education authorities. The Committee supported this 58 proposal in principle but emphasized some of the difficulties which might occur during the transitional period in Inner London where the health and education services are run by different authorities. The Government has now announced its intention to introduce legislation to effect the transfer of responsibility. The Clapham Adult Training Centre provides 90 places for subnormal men over 16 years of age. There are 55 Lambeth men attending the Centre, the remaining places being occupied by trainees from other boroughs; 33 Lambeth women attend adult training centres in other boroughs. It is the intention that training centres for adult subnormals should remain the responsibility of local health authorities. There is increasing pressure for places in adult centres and as the Clapham Centre is fully occupied, the Health and Welfare Committee agreed to the daily attendance of up to 30 trainees at Manor Hospital, Epsom. This arrangement will continue until the new adult centre, Somerleyton Road, S.W.9. for which plans were recently agreed, is completed. This will replace the Clapham Centre and with 150 places should meet the immediate needs of the whole Borough. Home Training Mentally subnormal children, who are unable to attend training schools due to a physical handicap, receive tuition appropriate to their needs from a home teacher. The teacher who is employed by Lambeth also visits children in other boroughs. Residential Care 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 Ill Persons There is no day hospital within the Borough, but a number of Lambeth patients attend Maudsley, Tooting Bec, West Park and St. Georges 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. 59 FUTURE DEVELOPMENTS - HOSPITAL/LOCAL AUTHORITY During the year discussions commenced with St. Thomas' Hospital regarding the development of a comprehensive psychiatric service for the Borough based on the South Western Hospital, Landor Road. The scheme will include a psychiatric in-patient unit and a psycho-geriatric assessment unit with in-patient beds and a day hospital. The local authority will participate fully in the project and will be responsible for the administration and management of a day centre for the mentally ill which will be sited on the hospital premises. ANTE-NATAL AND POST NATAL CLINICS Number of Sessions held by:— Medical Officers 1 Midwives 38 Sessional General Practitioners 236 Number of women attending for ante-natal examination 806 Number of women attending for post-natal examination 45 Mothercraft and Relaxation Classes Number of women attending: (a) Hospital booked 58 (b) Domiciliary booked 49 Total 107 Total number of attendances 556 DENTAL TREATMENT FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS A. Number of visits for Treatment during the year:— Children 0-4 (incl) Expectant and Nursing Mothers First visit 229 13 Subsequent visit 428 12 Total visits 657 25 60 Number of additional courses of treatment, other than the first course, commenced during the year — — Treatment provided during the year:— Number of fillings 564 13 Teeth filled 484 13 Teeth extracted 82 4 General anaesthetics given 32 3 Emergency visits by patients 38 1 Patients x-rayed 2 — Patients treated by scaling and/or removal of stains from teeth 62 8 Teeth otherwise conserved 340 — Teeth root filled — 6 Number of courses of treatment completed during the year 105 4 B. Patients supplied with a full upper or full lower denture - first time — — Patients supplied with other dentures Number of dentures supplied — — C. General anaesthetics administered by Dental Officers — — D. Inspections during year — First inspections 220 14 Patients above who required treatment 162 11 Patients in above who were offered treatment 162 11 Number of dental officer sessions (i.e. equivalent half days) devoted to maternity and child welfare patients during the period. 87.2 HEALTH VISITING Cases visited by Health Visitors:— Children born in 1968 6,301 Children born in 1967 5,682 Children born in 1963-66 12,983 24,966 61 Persons aged 65 and over 43* Mentally disordered persons 234ǿ Persons, excluding Maternity cases discharged from hospital (other than Mental Hospitals) 51+ Number of Tuberculous households visited 2 Number of households visited on account of other infectious diseases 86 Other cases 3,904 Number of tuberculous households visited by tuberculosis visitors 476 Total number of effective visits and re-visits 67,686 Total number of unsuccessful visits 14,667 * Included in this figure are 7 persons who were visited at the special request of the general practitioner or hospital. ǿ Included in this figure are 13 persons who were visited at the special request of the general practitioner or hospital. + Included in this figure are 3 persons who were visited at the special request of the general practitioner or hospital. HOME NURSING Total number of persons nursed during the year 4,007 Number aged under 5 at first visit during the year 451 Number aged 65 and over at first visit in the year 3,050 Total number of visits during the year 154,578 HOME HELP SERVICE Persons for whom service was provided during the year:— Aged 65 or over 3,662 Chronic sick and tuberculous persons 252 Mentally disordered 17 Maternity cases 114 Others 336 Total 4,381 62 DOMICILIARY MIDWIFERY Attendances by midwives Confinements Doctor not booked 11 Doctor booked 636 Number of hospital cases discharged to midwife before tenth day 704 CHILD HEALTH CENTRES Number of children attending during the year:— Born in 1968 5,538 Born in 1967 5,137 Born in 1963-1966 5,877 Total 16,552 Number of sessions held during the year by:— Medical Officers 141 Health Visitors 24 Sessional General Practitioners 2,323 Hospital Medical Staff 102 Total 2,590 Number of children referred elsewhere 814 Number of children on "at risk" register at the end of the year 2,070 63 REGISTRATION OF NURSING HOMES UNDER SECTIONS 187 TO 194 OF PUBLIC HEALTH ACT 1936, AS AMENDED BY THE NURSING HOMES ACT 1963 Number of Homes Number of beds provided Maternity Other Total 1. Homes registered during the year — — — — 2. Homes whose registrations were withdrawn during the year 1 16 — 16 3. Homes on the register at the end of the year 9 83 121 204 64 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 596 Average daily attendance 505 Number of children on register at the end of the year 641 DAILY MINDERS AND REGISTERED NURSERIES Nurseries and Child Minders Regulation Act 1948 Number of Premises registered at the end of the year 28 Number of places 712 Daily minders registered at end of year 21 Number of children minded at end of year 184 National Health Service Act 1946, Section 22 Number of Daily minders receiving fees from the Authority at the end of the year 156 Number of places and children minded at the end of the year 262 65 Table 1 - Completed Primary Courses - Number of persons under age 16 Type of vaccine or dose Year of birth Others under age 16 Total 1968 1967 1966 1965 1961-1964 1. Quadruple DTPP — — — — — — — 2. Triple DTP 2,055 2,717 218 66 64 16 5,136 3. Diphtheria/Pertussis — — — — — — — 4. Diphtheria/Tetanus — 23 26 28 548 553 1,178 5. Diphtheria — — — — 1 7 8 6. Pertussis — — — — — — — 7. Tetanus — — — — 3 28 31 8. Salk — — — — — — — 9. Sabin 2,013 3,401 444 176 655 1,144 7,833 10. Measles — 169 418 322 1,912 126 2,947 11. Total (Diphtheria) 2,055 2,740 244 94 613 1,874 7,620 12. Total (Whooping cough) 2,055 2,717 218 66 64 16 5,136 13. Total (Tetanus) 2,055 2,740 244 94 616 1,902 7,651 14. Total (Polio) 2,013 3,401 444 176 655 1,144 7,833 66 Table 2 - Reinforcing Doses - Number of persons under age 16 Type of vaccine or dose Year of birth Others under age 16 Total 1968 1967 1966 1965 1961-1964 1. Quadruple DTPP — — — — — — — 2. Triple DTP — 1,417 1,608 150 260 55 3,490 3. Diphtheria/Pertussis — — — — — — — 4. Diphtheria/Tetanus — 36 83 62 3,145 2,385 5,711 5. Diphtheria — 2 — 1 17 43 63 6. Pertussis — — — — — — — 7. Tetanus — — — — 7 80 87 8. Salk — — — — — — — 9. Sabin — 413 434 79 2,940 1,720 5,586 10. Measles — — — — — — — 11. Total (Diphtheria) — 1,455 1,691 213 3,422 2,483 9,264 12. Total (Whooping cough) — 1,417 1,608 150 260 55 3,490 13. Total (Tetanus) — 1,453 1,691 . 212 3,412 2,510 9,278 14. Total (Polio) — 413 434 79 2,940 1,720 5,586 SMALLPOX VACCINATION Persons aged under 16 Return for Year Ended 31st December, 1968. Age at date of vaccination Number of persons vaccinated (or revaccinated during period) Number of cases specially reported during period Number vaccinated Number revaccinated (a) Generalised Vaccinia (b) Post-Vaccinal Encepha lomyelitis (c) Death from Complications of vaccination other than (a) and (b) 3 months 2 — — — — 3-6 months 19 — — — — 6-9 months 18 — — — — 9-12 months 17 — — — — 1 1,725 1 — — — 4 712 15 — — — 5-15 120 33 — — — TOTAL 2,613 49 — — — 67 68 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 763 (ii) No. found positive 446 (iii) No. found negative 317 (iv) No. vaccinated 398 B. SCHOOL CHILDREN AND STUDENTS (Circular 19/64) (i) No. skin tested 2,418 (ii) No. found positive 301 (iii) No. found negative 2,117 (iv) No. vaccinated 2,078 fi9 MENTAL HEALTH STATISTICS FOR 1968 Number of patients awaiting entry to hospital, admitted for Temporary Residential Care, or admitted to Guardianship during 1968 Mentally Ill Elderly Mental Infirm Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) 1. Number of persons in L.H.A. area on waiting list for admission to hospital at end of year. (a) In urgent need of hospital care 1 3 4 (b) Not in urgent need of hospital care 6 2 8 (c) Total 1 9 2 12 2. Number of admissions for temporary residential care (e.g. to relieve the family) (a) To N.H.S. hospitals 6 4 12 4 6 3 35 (b) To L.A. residential accommodation (c) Elsewhere 6 3 2 11 (d) Total 6 4 18 7 6 5 46 70  Guardian Mentally Ill Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) 3. (a) Admission to guardianship during the year L.H.A. Other Total (b) Total number under guard* ianship at end of year L.H.A. 2 1 3 Other Total 2 1 3 71 MENTAL HEALTH STATISTICS FOR 1968 Number of persons referred to Local Health Authority during year ended 31st December 1968 Referred by Mentally 111 Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under a ge 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 practioners 2 44 58 104 (b) Hospitals, on discharge from in-patient treatment 1 56 57 3 1 2 3 1 1 1 126 (c) Hospitals, after or during outpatient or day treatment 44 69 1 1 2 3 3 3 126 (d) Local education authorities 3 4 1 13 3 14 5 8 4 55 (e) Police and courts 17 15 1 33 (f) Other sources 1 171 241 4 2 12 8 8 7 2 4 460 (g) Total 3 4 336 441 3 1 18 6 31 19 19 15 3 5 904 72 MENTAL HEALTH STATISTICS FOR 1968 WORKSHOPS, DAY CENTRES AND TRAINING CENTRES AS AT 31st DECEMBER 1968 TABLE 1 - Workshops, or day centres for the mentally ill Number of premises and places provided 1 Premises — 2 Places — TABLE 2 - Training centres for the subnormal or severely subnormal (including special units) Age group provided for Number of premises Places Junior Adult 3 Under 16 3 114 4 16 and over 1 90 5 Junior and adult 6 Total 4 114 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 1 8 Places 10 2 Self contained units independent of training centres 9 Premises 10 Places 73 TABLE 4 - Places made available to or by other authorities or organisations Type of authority or organisation Places in workshops or day centres for the mentally ill Places in training centres for the subnormal or severely subnormal Places in special units for the severely subnormal * Junior Adult Places made available to other authorities or to hospitals (include in tables 1-3) 11 Local authority 31 12 Hospital 13 Total 31 Places made available to the authority by other authorities or organisations (do not include in tables 1-3) 14 Local authority 18 9 35 15 Hospital 25 6 4 16 Other organisations 13 2 7 2 17 Total 31 36 48 6 * Figures in this column also included under * above (to be consistent with entries in tables 2 and 5) 74 TABLE 5 - Adjusted figures for places Net number or places available to the authority Workshops or day centres 18 Line 2 + line 17 - line 13 31 Training centres (including special units) Junior 19 Line 6 + line 17 - line 13 150 6 Adult 20 Line 6 + line 17 - line 13 107 Special Units 21 Lines 8 + 10 + 17 - line 13 16 6 Excludes 21 places occupied at Council day nurseries by subnormal/severely subnormal children under 3 MENTAL HEALTH STATISTICS FOR 1968 HOMES, HOSTELS, SOCIAL CENTRES AND CLUBS AS AT 31st DECEMBER 1968 TABLE 1 - Homes and Hostels Age group provided for For the mentally ill For the subnormal or severely subnormal Number of premises Number of premises 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 — 75 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. (Include in table 1) 9 Local authority — — — — 10 Hospital — — — — 11 Total — — — — Places made available to the authority by other authorities or organisations. (Do not include in table 1) 12 Local authority 8 — — — 13 Hospital — — — — 14 Other organisations 20 — 8 17 15 Total 28 — 8 17 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 — — — — 76 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 28 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 8 Adult 23 Line 4 + line 15 - line 11 17 PUBLIC HEALTH ACT 1936, (sections 187 to 194) MENTAL HEALTH ACT 1959, (section 15 (1) RETURN OF MENTAL NURSING HOMES REGISTERED AT 31st DECEMBER 1968 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 Psychopathic Subnormal or severely subnormal Mentally ill Psychopathic Subnormal or severely subnormal (1) (2) (3) (4) (5) (6) (7) (8) (9) (a) St. Michael's Convent 22 22 Yes Total 22 22 Number of registrations during 1968 which were (a) refused NONE (b) cancelled NONE Note: For beds which may be used by more than 1 category of patient, columns 3 to 8 may be bracketed as necessary. 77 PUBLIC HEALTH ACT 1936 (Sections 187 to 194) MENTAL HEALTH ACT 1959 (section 15 (1)) RETURN OF MENTAL NURSING HO'MES AUTHORISED TO DETAIN PATIENTS AT 31st DECEMBER 1968 Part I Number of admissions during 1968 Mentally Ill 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 — — — — — — — — — — (b) Compulsory admissions for observation under Section 25 — — — — — — — — — — (c) Compulsory admissions for observation under Section 29 — — — — — — — — — — (d) 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 — — — — — — — — — — 78 PUBLIC HEALTH ACT 1936 (Sections 187 to 194) MENTAL HEALTH ACT 1959 (section 15 (1)) RETURN OF MENTAL NURSING HOMES AUTHORISED TO DETAIN PATIENTS AT 31st DECEMBER 1968 Number of admissions during 1968 Mentally Ill 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) (k) By direction of Home Secretary under Section 73 — — — — — — — — — -— (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 (I) — — — — — — — — — — (q) Admissions under Section 135 — — — — — — — — — — (r) Admissions under Section 136 — — — — — — — — — — (s) Total admissions — — — — — 2 — — — 2 79 Part II Number of cases who completed a period of observation under sections 25 or 29 of the Act Action taken at end of period of detention Mentally Ill 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) Remained in home (or transferred to another mental nursing home or hospital for psychiatric treatment, and detained under the Act (b) As for (a) above but not detained under the Act (c) Remained in home Cor transferred to another nursing home or hospital) for nonpsychiatric treatment (d) Left mental nursing home 2 2 (e) Died in mental nursing home Note. (1) If a patient completes more than one period of observation, each period should be counted. 80 Part III Number of cases of use of compulsory powers (a) and (b) - following informal admission (c) and (d) - prior to informal residence Action taken Mentally Ill 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) Patients detained under section 25 or 29 when already in the home on an informal basis (b) Patients detained under section 26 when already in the home on an informal basis (c) Patients remaining on an informal basis after detention in the home under section 25 or 29 (d) Patients remaining on an informal basis after detention in the home under section 26 81 Part IV Number of patients resident in mental nursing homes (including any temporarily absent and expected to return) on 31st December 1968 Category of patient Mentally Ill 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) Patients subject to detention under the Act but excluding any detained under section 30(2) (b) Mentally disordered patients not subject to detention but including any temporarily detained under section 30(2) 16 6 22 (c) Other patients 82 Section D Environmental Health Services 83 ENVIRONMENTAL HEALTH SERVICES PUBLIC HEALTH INSPECTION NEW LEGISLATION The following Regulations and Orders, the enforcement of which is the responsibility of the Council, were made during the year Fees for Game and Other Licences (Variation) Order, 1968 The Plant Variation and Seeds Act, 1964 (Commencement No. 2) Order, 1968 The Slaughter of Animals (Prevention of Cruelty) Regulations (Appointed Day No. 2) Order, 1968 The Slaughterhouses (Hygiene) Regulations (Appointed Day No. 2) Order, 1968 The Poisons (No. 2) Rules, 1968 The Imported Food Regulations, 1968 The Trade Descriptions Act, 1968 THE TRADE DESCRIPTIONS ACT 1968 This Act which replaces the Merchandise Marks Acts 1887/1953 came into force on 30th November 1968 imposing a duty on local weights and measures authorities to enforce its provisions. The Trade Descriptions Act 1968 is in essence, the general law of criminal misdescription and its provisions overlap in many respects those of other and more specialised legislation, such as the Food & Drugs Act 1955. Arrangements have been made for the Senior Public Health I nspectors (Food) to investigate all complaints relating to food and drugs with the exception of those complaints relating primarily to weight and price. A very close liaison is maintained with the Weights & Measures Inspectorate and the Town Clerk. SUMMARY OF WORK BY DISTRICT PUBLIC HEALTH INSPECTORS (1) Inspections Houses/flats inspected under Public Health Act, 1936 5,392 Re-visits Houses/Flats 5,641 84 (2) Other Inspections and Visits Prevention of Damage by Pests Act, 1949 120 Infectious Diseases 322 Factories Act, 1961—Outworkers 684 Pet Animals Act, 1951 30 Food Premises 2,823 Non-effective visits 3,201 (3) Nuisances and Notices Notices served—Public Health Acts, 1936 and 1961 (a) Informal 898 (b) Statutory 3,684 Notices complied with—Public Health Acts, 1936 and 1961 (a) Informal 785 (b) Statutory 2,973 (4) Legal Proceedings Summonses applied for 192 Nuisance Orders made by Magistrates 35 (5) Drainage Plans examined 380 Examinations and Tests 1,520 (6) Complaints Dealt with during year 3,423 (7) Land Charges Act, 1925 Enquiries dealt with 4,657 (8) Rent Act, 1957 Applications for Certificates of Disrepair 1. Number of applications for certificates during 1968 5 2. Decisions not to issue Certificates Undertakings on Form K accepted 2 3. Decisions to issue Certificates (a) in respect of some, but not all defects 2 (b) in respect of all defects 3 4. Undertakings given by landlords under paragraph 5 of the First Schedule 2 85 5. Undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil 6. Certificates issued 3 Applications for Cancellations of Certificates 7. Applications by landlords to Local Authority for cancellation of Certificates Nil 8. Objections by tenants to cancellation of Certificates Nil 9. Decisions by Local Authority to cancel in spite of tenants objections Nil 10. Certificates cancelled by Local Authority. Nil PUBLIC HEALTH ACT. 1936-SECTIONS 39 and 45 PUBLIC HEALTH ACT. 1961-SECTIONS 17 and 18 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 32 cases. SEALING OE DISUSED DRAINS Many infestations of rats can be traced to disused 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 drain runs. 150 drains were sealed under the supervision of the drainage assistant. 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. This service is highly successful and is much appreciated by the ratepayers. 40 drains were cleared as a matter of urgency during the year. LEGAL PROCEEDINGS Statutory action was taken in respect of 192 cases for failure to comply with Notice under Section 93 of the Public Health Act, 1936. Abatement Orders were obtained in 35 cases, in the other cases work was carried out to abate the nuisance. 86 PUBLIC HEALTH ACT 1936 Appeal to Quarter Sessions Following the service of an abatement notice by the Council under Section 93 Public Health Act 1936 in respect of nuisance arising principally from dampness in the walls of a dwelling house, legal proceedings were instituted against the Owner in respect of default in complying with the requirements of the Notice. The Court of Summary Jurisdiction found the case proved and made a nuisance order requiring the defendant to abate the nuisance within 28 days. Following this decision the Owner carried out certain works designed to abate the dampness and comply with the nuisance order but the works were not considered satisfactory by the public health inspector. The Owner was so informed and the Council further intimated their intentions to abate the nuisance in default under the provisions of Section 95(2) Public Health Act 1936. Meanwhile, the Owner exercises his right to appeal to a Court of Quarter Sessions against the decision of the Court of Summary Jurisdiction. At the subsequent hearing the Associate Medical Officer of Health and Chief Public Health Inspector together with the District Public Health Inspector gave evidence. The Court dismissed the appeal with costs and directed that the necessary remedial works should be carried out by the Council in default within 21 days. WORKS IN DEFAULT With effect from 1st January 1968 the Environmental Health Services Division undertook the carrying out of works in default directly through an approved panel of builders with the following provisos (a) drainage works below ground would continue to be carried out by the Borough Engineer and Surveyor (b) where the estimated cost of works exceeds £1,000 the Borough Architect and Town Planning Officer would carry out the works on request. The functions carried out by the Health Department are 1. Nuisance Abatement (i) Works in default under Notices served under the Greater London Council (General Powers) Act, 1967 and Public Health Act 1961. 87 (ii) Works in default under the Public Health Act, 1936, including Nuisance Orders, which have not been complied with. (iii) Works in default under Section 4 Prevention of Damage by Pests Act, 1949. 2. Housing (i) Repair of unfit houses under Sections 9/10 Housing Act, 1957. (ii) Repair and improvement of houses in multiple occupation under Sections 14/18 Housing Act, 1961. (iii) Compulsory improvement of dwelling houses under Part II Housing Act, 1964. This procedure has worked remarkably well and prior consultation takes place between the Public Health Inspectors concerned and the contractors before works are commenced to ensure that only those works which can be properly executed under the relevant legislation are carried out. During the year 99 works in default were carried out — 81 under the Public Health Acts amounting to £3,265.8.3d and 18 under the Housing Acts amounting to £3,585.0.6d. 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 112 Number of rooms included in the above 241 Total number of rooms sprayed for all purposes 3,327 Number of articles disinfected 8,949 Number of library books disinfected 790 Number of disinfection certificates issued 7 88 DISIN FESTATION Number of houses visited 183 Number of rooms sprayed 546 Number of houses re-visited 22 Number of wasps nests destroyed 103 During the period in which household refuse was not being collected regularly a large number of complaints were received in respect of flies and maggots, particularly from blocks of flats provided with chutes or bulk containers. The disinfecting staff worked many extra hours in order to deal with these complaints. From 26th August to 13th September, 205 chutes and 100 bulk containers together with 47 private houses were treated with insecticide PREVENTION OF DAMAGE BY PESTS 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 2,556 complaints of rat and mice infestation were received as a result 3,562 visits and 6,234 re-visits were made. It was found that 11 of the complaints were not justified; 1,326 were in respect of brown rats and 1,219 in respect of mice. During the course of investigation 4,380 baitings were made. Sewer treatment for rats for the whole of the Borough was carried out during the year, inconjunction with the Borough Engineer & Surveyor's Department. CLEAN AIR ACT. 1956 During the year the undermentioned Smoke Control Area was confirmed by the Minister of Housing and Local Government No. 21—Tooting Bec Area The passing of a new Act, the Clean Air Act, 1968, will give the Council greater control over the sale for delivery of unauthorised fuels to premises in the Smoke Control Area. In addition, powers to deal with grit and dust and with dark 89 smoke from sources other than chimneys (which are already controlled by the 1956 Act) are reinforced. Number of inspections 16,493 Number of Notices served under Section 12 of the Clean Air Act, 1956 246 Number of prosecutions Nil Number of smoke observations (timed) 123 Number of smoke observations (untimed) 477 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 104 39 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authorities 1,040 400 — (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 40 72 — Total 1,184 511 — 90 2. Cases in which Defects were found Particulars Number of cases in which defects were found Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.l) 2 2 — — Overcrowding (S.2) — — — — Unreasonable Temperature (S.3) — — — — Inadequate Ventilation 1 1 — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7) (a) Insufficient — — — — (b) Unsuitable or defective 4 4 — 4 (c) Not separate for sexes — — — — Other offences against the Act (not including offences relating to Outwork) — — — — Total 7 7 — 4 No Prosecutions were instituted. 91 Part VIII of the Act Outworkers (Sections 133 and 134) Nature of Work Number of outworkers in list required by Section 110 (1) (c) (3) Wearing apparel making etc. 216 Curtains and Furniture hangings 3 Furniture and Upholstery 3 Brass and Brass Articles 1 Fur pulling 9 Artificial flowers 2 Paper bags 2 Boxes—wholly or partially paper 5 Carding, etc of buttons etc. 67 Stuffed toys 16 Lampshades 18 342 No notices were served or prosecutions instituted. PET ANIMALS ACT, 1951 During the year 30 visits were made to the 18 pet animal establishments licensed in the Borough. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 There are no Animal Boarding Establishments registered in the Borough. RIDING ESTABLISHMENTS ACT, 1964 There are three Riding Establishments licensed in the Borough. The Veterinary Officer, Corporation of London, carried out regular inspections of these establishments on behalf of the London Borough of Lambeth. 92 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. HOUSING SLUM CLEARANCE PROGRAMME - 1966 - 1970 During the year the following areas were represented as unfit for human habitation Areas Number of Houses Bedford Road Area Houses unfit for human habitation 120, 122, 124, 126, 128 (even) Bedford Road 5 Total 5 Aulton Place Area Houses unfit for human habitation 6, 7, 8, 9,10, 11, 12, 13, 14, 19, 20 Aulton Place 11 Houses included by means of bad arrangement 1 Total 12 Zennor Road Area Houses unfit for human habitation 10A, 2-10, 20-50 (even) Zennor Road 7A, 1-19, 23-31, 35-55 (odd)' 49 1-12 (cons) Potterton Buildings (Zennor Road) 1-6 (cons) Potterton Buildings (No. 261 Cavendish Road) 18 Total 67 93 Areas Number of Houses Hardess Street Area Houses unfit for human habitation 13, 15, 17, 19 Hardess Street 4 2-22 (even) 11 1, 3, 7, 9 Heme Hill Road 4 6, 8, 10, 12 4 30, 32, 34, 36 Padfield Road 4 12-20 (even) Cambria Road 5 Total 32 St. Gothard Road Area Houses unfit for human habitation 2-12 (even) St. Gothard Road 6 192-198 (even) Rommany Road 4 Total 10 Hamilton Road Area Houses unfit for human habitation 113, 115, 135, 137, 139, 141, 143 Hamilton Place 142, 144, 158 10 7, 9, 13, 15 Clive Road 4 Total 14 Auckland Hill Area Houses unfit for human habitation 13, 14, 15, 16 Uckland Place 4 15-25 (cons) Cranfield Villas 11 43, 57 , 59, 61, 63 , 71 Dunbar Street 26, 34 (even) 38 and 69 13 2, 4, 6, 7-19 (odd) Dunbar Place 10 Total 38 Industry Terrace (No. 2) Area Houses unfit for human habitation 23-29 (cons) Industry Terrace 7 11-15 (cons) Popes Road 5 Total 12 94 Lilford Road Area Houses unfit for human habitation 96, 98, 100, 102, 104, 106 Lilford Road 6 Total 6 Eden Road Area Houses unfit for human habitation 3, 5, 7, (7a & 9a) 9, 15,(15a & 17a) 25, 27, 29, 31, 33, 37, 39, 41, 45, 47 Eden Road 17 27, 29, 31, 33, 35, 37, 45, 47, 51 Woodcote Place 53, 55, 57, 59, 63, 65, 28, 30, 32 18 Total 35 Lyham Road Area (No. 2) Houses unfit for human habitation 10-24 (even) 30-38 (even) Lyham Road 13 Total 13 INDIVIDUAL UNFIT HOUSES AND PARTS OF HOUSES In addition to areas of unfit houses, there are a number of individual houses and parts of houses, particularly underground rooms, which are unfit for habitation. Action taken under Part II of the Housing Act, 1957 is as follows Section 16 (Individual Unfit Houses) 142, Lyham Road Closing Order made 9, Burnett Street ,, ,, ,, 8, Heme Hill Road ,, ,, ,, 19, Hardess Street ,, ,, ,, 22, Padfield Road ,, ,, ,, 21, Old Paradise Street ,, ,, ,, 11, Listowel Street ,, ,, ,, 14, Hurst Street ,, ,, ,, 26, Hurst Street ,, ,, ,, 84, Gipsy Hill ,, ,, ,, 233, Kennington Lane ,, ,, ,, 235, Kennington Lane ,, ,, ,, 237, Kennington Lane ,, ,, ,, 239, Kennington Lane ,, ,, ,, 95 Closing Order made 241, Kennington Lane ,, ,, ,, 243, Kennington Lane ,, ,, ,, 245, Kennington Lane ,, ,, ,, 39, Auckland Street ,, ,, ,, 40, Auckland Street ,, ,, ,, 41, Auckland Street ,, ,, ,, 35, Myatt Road ,, ,, ,, 2, Myatt Road ,, ,, ,, 4, Hurst Street ,, ,, ,, 6, Hurst Street ,, ,, ,, 22, Hurst Street ,, ,, ,, 8, Carfax Square ,, ,, ,, 18, Hurst Street ,, ,, ,, 16, Hurst Street ,, ,, ,, 9, Union Road Demolition Order 6, Marina Place Closing Order made CLOSING ORDERS were made in respect of the undermentioned properties Section 18 (Unfit Parts of Houses) 10a, Camden Hill Road 7a, Villa Road 17a, Old Town 132, Lilford Road 14, Bengeworth Road 294, Coldharbour Lane 29b, Milford Street 135, Gipsy Road 111, Palace Road 101, Railton Road 27, Belinda Road 138, Larkhall Lane 43, North Side, Clapham Common 324, Brixton Road 9a, Hayter Road 35, Chapel Road 7, Mayall Road 185, Mayall Road HOUSING ACTS 1961 and 1964 Houses in Multiple Occupation 35 applications have been received from owners under the Council's Registration Scheme for houses in multiple occupation and, of this total, 29 were required to be registered. 192 directions to prevent or reduce overcrowding were given in accordance with Section 19 of the Housing Act, 1961. 110 Orders applying Management Regulations were made under Section 12, and 41 Notices served under Section 16 requiring the provision of satisfactory means of escape from fire. The Senior Public Health Inspectors (Housing) and Technical Assistants have made 1,883 visits and 2,815 re-visits in connection with surveys, complaints and Greater London Council and Lambeth Borough Council's mortgage loans. 96 Improvement Grants Enquiries from property owners for improvement grants under the Housing Acts have continued throughout the year and, during the period under review applications for discretionary grants have been approved inrespect of 39 dwellings and for standard grants in respect of 98 dwellings. House improvement grants are dealt with administratively by the Town Clerk, but the technical aspects are dealt with by the Senior Public Health Inspectors. This involves surveillance of properties in connection with public health, housing laws, drainage and water closet byelaw requirements, and the assessment of costing. 1,557 inspections were carried out in respect of standard and discretionary grants. Improvement of Dwellings Not in an Improvement Area A tenant occupying a dwelling which is not in an improvement area and is not a tenement block, and which is without one or more of the standard amenities, may make representation in writing to the local authority with a view to the exercise by the Local Authority of their power under Section 19 of the Housing Act 1964. 10 applications for improvements have been received from tenants and specifications have been prepared by the Senior Public Health Inspectors; the specifications and Improvement Notices have been served on owners of properties in respect of these 10 applications. Legal Proceedings Three appeals were lodged against the service of Notices under Section 15 and 16, Housing Act 1961, and Section 90 Housing Act 1957, and one appeal against a Closing Order under Section 16 Housing Act 1957. All these appeals were dismissed and costs awarded to the Council. Six warrants for entry were obtained from the County Court under Section 161 Housing Act 1957, and Section 68 Housing Act 1964. It was necessary in one case to obtain the assistance of the police to gain entry. A number of Court cases are pending for contraventions under the Housing Acts. 97 REHOUSING AND OVERCROWDING APPLICATIONS FOR REHOUSING 1,618 cases have been dealt with during the year on the following grounds:- Lambeth Borough Council Health 1,300 Insanitary conditions 104 Special cases 39 Cases previously investigated and rehoused by Lambeth Borough Council 141 Greater London Council Health 20 Insanitary conditions 4 Cases previously investigated and rehoused by Greater London Council 10 1,618 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES The Imported Food Regulations 1968 These Regulations made jointly by the Minister of Agriculture, Fisheries and Food and the Minister of Health came into operation on 1st August 1968 and replace the Public Health (Imported Food) Regulations 1937/48. The new Regulations introduce several changes in procedure and provide for the transfer of certain powers from the Regulations to the Food and Drugs Act 1955 where there are comparable powers under that Act. Whilst the authority responsible for enforcement of the Regulations will normally be the Port Health Authority of the Port through which food is imported, in certain circumstances the responsible authority will be an inland local authority. The Council has considerable responsibilities in respect of Imported Food. 98 THE FOOD HYGIENE (MARKET STALLS & DELIVERY VEHICLES) (REGULATIONS 1966) (As Amended) A special joint sub-committee comprising members of the Control and Amenities, Highways and Works and Health Committee, set up by the Council in 1967 to consider the implementation of these complex Regulations reported during the present year. This Sub-Committee met on several occasions and took the opportunity of holding joint meetings with the food traders from all six street markets. In addition the Committee invited officers of the various traders organisations including the General Secretary of the National Market Traders Federation. There is no doubt that these discussions, which took place on a cordial basis, proved of immense value in ensuring that all street traders handling food were made fully aware of the requirements of the Council. In connection with the implementation of Regulations 13 (i) which requires the display on a food stall of the name and address of the person carrying on the business it was decided :- (i) that in the case of food traders not licensed by the Council the full name and address must be displayed on the stall, and (ii) that in the case of food traders licensed by the Council the full name and pitch No. was to be displayed provided the full name and address of the street trader was filed at the Town Hall. All food stalls have been re-visited by the Public Health Inspectors and advice given on the necessary measures required to comply with the Regulations and, in general, food traders have been keen to co-operate. FOOD AND DRUGS ACT, 1955 - SECTION 16 The number of registered premises is as follows:- Manufacture and/or sale of ice cream 605 Manufacture of sausages and preparation of preserved etc. food 220 Milk and Dairies (General) Regulations, 1959 - Regulation 8 Number of registered distributors 456 Number of registered dairies 3 99 Milk (Special Designation) Regulations, 1963 The following table shows the number of licences in force * Dealers Licences (pre-packed) Untreated 55 Pasteurised 308 Sterilised 297 Ultra Heat Treated 73 Dealers (Pasteurisers) Licence 3 Dealers (Ultra Heat Treated) Licence 3 * Licences issued are valid for a period of five years. SERVICES UNDER THE FOOD AND DRUGS ACT, 1955 (a) Milk Supplies — 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 was 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:- 100 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 192 192 192 192 Grocer and provisions 352 352 164 164 Fish shops, wet, dry and fried 87 87 87 87 Bakers and bakehouses 99 99 99 99 Butchers 128 128 129 128 Confectioners 325 325 119 119 Restaurants, cafes, canteens and clubs 256 256 256 256 Dairies 3 3 3 3 Delicatessen 13 13 13 13 Food factories and warehouses 17 17 17 17 Public houses and off-licences 310 310 310 310 Milk distributors 456 456 Nil Nil Ice cream premises 605 605 81 81 Preserved food premises 220 220 220 220 SAMPLING OF FOOD AND DRUGS Chemical .Analysis 300 samples were procured formally 93 of which were milk, and 1,698 were procured informally. Set out below is a table of samples reported by the Public Analyst to be adulterated or otherwise unsatisfactory, showing action in each case Formal Samples Article Result of Analysis Action taken Smoked Saith Contained non-permited preservative Letter sent - stock used up Vodka Deficient in alcohol Sample repeated - genuine Rum Deficient in alcohol Sample repeated - genuine 101 Sausages - pork Deficient in meat Repeat sample satisfactory Milk (Channel Islands) 5% extraneous water Warning letter sent Sliced Peaches in water Misleading illustration on label Letter to manufacturers Informal Samples Tincture of Opium B.P. Deficient in Morphine Repeat sample - genuine Orange quick jell Labelling marked "Orange" but this referred to colour not flavour Letter to manufacturer Beef and Dumplings Labelling. The words "and gravy" had been omitted Letter to manufacturer Non-brewed condiment Deficient in acetic acid All stocks withdrawn Butter Excess water Further samples taken Milk cookies Labelling - no fat included Letter to manufacturer Lemonade Shandy Excess alcohol Letter to manufacturer Fancy Fruit Salad Labelling. Ingredients in wrong order Letter to manufacturer Tuna steak Labelling words "in oil" had been omitted Letter to manufacturer Milk Chocolate Biscuits Deficient in milk fat Letter to manufacturer Milk Chocolate Tea-cakes Deficient in milk fat Letter to manufacturer Potato crisps High peroxide value in oil Re-sampled Potato crisps High peroxide value in oil Re-sampled Dyed meat (3) Dye used was non-permitted 7 tons trimmed, 23 tons awaiting decision 102 Mixed spice Cheesey crisps Milk Choc. Biscuits Red cabbage Milk Choc, fingers Lemonade Shandy Mixed fruit Pineapple slices Milk Choc. Biscuits Rice Ground nutmeg Marvel Instant Milk Milk Top (Cream) Dutch cheese Canned strawberrie: Natural Health Rice (2) Milk (Vending machines) Spices (3) French capers Sliced Beetroot Milk Choc, malted High acid insoluble High peroxide value in oil Deficient in milk fat Labelling — words "in vinegar" omitted Deficient in milk fat Excess alcohol Labelling - ingredients listed in wrong order Labelling — words "in syrup" omitted Deficient in milk Foreign matter Deficient in volatile oil Labelled 'non fat' but contained some fat Labelling: Held to be creair Deficient in fat Deficient in sugar Contained live maggot Deficient in fat and milk solids not fat Infested with mites and maggots Cap of jar rusty Labelling Deficient in milk fat Re-samples Re-sampled Letter to manufacturer Letter to manufacturer Letter to manufacturer Referred to makers Repeat samples not available Letter to importers Repeat samples — genuine Letter to manufacturer Letter to wholesaler Awaiting decision of Ministry re this type of produce - do. - Further samples satisfactory - do. - - do. - - do. - Articles seized under Food and Drugs Act - do. - Letter to Manufacturer Formal sample taken satisfactory 103 Milk biscuits Beef Hamburgers Minced beef in onions Smoked Saith (3) Steak and Kidney Pie (3) Fruit salad Beef Hamburgers Fried cod Minced beef with onions Creamery Porcover Milk Tops Table Creams Non-brewed condiment Beef, ham and tongue paste Fruit slice Sauerkraut Pasta con Spinaci Deficient in milk fat Slightly deficient in meat Deficient in meat Contained illegal preservatives Deficient in kidney Ingredients listed in wrong order Deficient in meat Fat showed incipient rancidity Deficient in meat Contained less than 23% fat - do. - Consisted of gelatine and starch and contained nothing to justify the word "Cream" Deficient in acetic acid Deficient in meat Contained grape pips, but grapes or raisins not on list of ingredients Label had no English on it Infested with insect eggs - do. - Standard not in force - no action Repeat samples satisfactory Letter sent to Importers Further samples taken Letter sent to canners Repeat sample taken Further sample satisfactory Further sample taken Matter under consideration - do. Letter to manufacturer Further sample taken Further sample taken Letter to manufacturer Rest of consignment seized - do. - 104 Ground Pimento Fruit salad for diabetics Canned Macedoim Steak and Kidney Fruit salad (2) Canned Beef Canned Macedoine (2) Jam Baby Beetroot (3) Beef Sausages Tincture of Opiurr Poldine tables Ground nutmeg Glycerine B.P. Lambs Tongues (Canned) Non-brewerd condiment Grated Horse Raddish (2) Cherries in syrup Vanilla mould High mineral content Labelling; Fruits listed in wrong order Labelling; Vegetables listed in wrong order Pie Deficient in kidney Ingredients not present in amounts recommended Deficient in meat Labelling; Water included in list but not listed in correct order Deficient in soluble solids Labelling; Should be labellec "Beetroot in vinegar" Excess preservative Deficient in Morphine Deficient in Poldine Deficient in volatile oil Mislabelled Deficient in meat Deficient in acetic acid Brown and lacking pungency Deficient in sugar Labelling offence - do. Under consideration Repeat samples taken Repeat samples genuine - do. - - do. Under consideration Further sample taken New labels being provided Repeat samples taken Repeat Sample genuine Repeat sample genuine Repeat sample genuine Manufacturers communicated with Further samples taken Stock withdrawn from sale Consignment seized - do. Letter to manufacturers 105 Chopped dried onions Cherries in syrup Pork Luncheon Meat Jam Doughnut Strawberries in syrup Sausages Antipasta Low Fat spread Processed Cheese Tomato Puree (2) Milk Chocolate coated biscuits (2) Bacon and mushrooms in sauce Insect infestation Deficient in sugar Defective lacquer on can Contained no jam Deficient in sugar Excess preservative Some ingredients not listed Labelling - excess of moisture Excess moisture Low total solids figure Skimmed milk used Deficient in meat Supplies withdrawn Con signment seized Further samples satisfactory - do. Repeat sample genuine Letter sent - rectified Labelling being amended Referred to Town Clerk Repeat sample Under correspondence Repeat samples taken Unable to obtain further sample IMPORTED FOOD No. of Samples Pasteurised Frozen whole egg Holland 89 Pasteurised spray dried whole egg Denmark 76 Pasteurised spray dried egg yolk powder Denmark 87 Salad Cream base powder Denmark 2 Pasteurised spray dried egg albumen Denmark 16 Pasteurised spray dried whole egg Holland 40 Flake hen egg albumen pasteurised America 13 Dried whole egg China 12 106 Hen egg albumen crystals Holland 26 Hen egg albumen powder Holland 25 Pasteurised spray dried whole egg Poland 94 Hen egg albumen crystals America 12 Shrimps Hongkong 15 Lobster tails China 5 Peeled Prawns China 12 524 BACTKRIOLOG1CAL 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 252 (24 were void, the atmospheric shade temperature being over 65°F). Phosphatase Test 248 10 samples of milk which failed the Methylene Blue Test 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 3.12.68 Cigarette end in a loaf of bread Defendant found guilty Fined £15 Council awarded £2 costs. 107 3.12.68 Rusty nail found in a bread roll Case withdrawn Complainant not present. 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 Tons Cwts Qrts. Lbs. Canned Meats 1 18 1 14¾ Canned vegetables 1 18 1 27½ Canned fruit 1 15 3 25 ½ Meat 3 3 2 25¼ Fish 13 3 5½ Bacon 15 3 9 Soup 2 3 2½ Evaporated milk 2 2 20½ Marzipan 2 20 Pickles, sauces, etc. 2 1 27½ Jam, marmalade, etc. 3 3 7½ Flour 1 2 22 Fruit juices 1 — 11½ Cheese, butter, lard 4 2 16½ Biscuits 3 25½ Cereals 11¾ Frozen food 2 10 — — 13 17 — 21 The method of disposal of food surrendered or condemned as unsound Animal products, where practicable, were released to firms specialising in the manufacture of glue and similar commodities, and from whom satisfactory guarantees as to disposal have been obtained. As an additional precaution, unfit meat is stained. Some food waste which was suitable, was diverted to approved sources for utilisation as pig food. The balance was disposed of by the Food Inspectors at Falcon Wharf by agreement with the Greater London Council, Public Health Engineering Department. 108 FOOD COMPLAINTS - 1968 1. Chocolate 2. Bread Roll 3. Christmas Pudding 4. Egg Noodles 5. Milk Bottle (9) 6. Cake (Tinned) 7. Packet of Weetabix 8. Sponge (2) 9. Steak and Kidney Pie (2) 10. Bread (2) 11. Ice Lolly 12. Pint of Milk 13. Bread Roll 14. Pint of Milk 15. Scotch Broth (Tin) 16. Loaf of Bread (2) 17. Lobster Curry 18. Beef Pie (2) 19. Sliced Loaf 20. Portion of Chips 21. Chocolate Faster Eggs 22. Packet of Dates 23. Danish Loaf 24. Packet of Prawns 25. Quick Quaker Oats 26. Bacon 27. Pork Pie 28. Pork Pies 29. Loaf of Bread 30. Chicken Croquette 31. Steak and Kidney Pie 32. Pork Chops 33. Pint Milk (3) 34. Cream 35. Bottle of Milk 36. Apple Turnover 37. Packet Ry-King Swedish Crisp Bread 38. Fruit Yogurt (2) 39. Evaporated Milk 40. Sausage Roll 41. Loaf Bread 42. Packet Bread Rolls 43. Packet 1 doz. Sausage Rolls 44. Cake 45. Jar of Chutney 46. Steak Pie 47. Cheese Cake 48. Pint of Milk 49. Peas 50. Chocolates 51. Tin of Beef Casserole 52. Small Minature Hovis 53. Loaf Bread 54. Bacon Joint 55. Pint Milk 56. Corned Beef 57. Sponge Roll 58. Packet of Ostermilk 59. Cut Loaf 60. Cambridge Formula Loaf 61. Apple Pie (2) 62. Lambs Liver Foreign body (Metal) Dirt in substance of Roll Foreign body (Glass) Foreign body (Insects) Contained foreign matter Foreign body (Nail) Insect infestation Mouldy Mouldy Dirt in texture of Bread Foreign body (Metal) Coloured and unpleasent taste Foreign body (Nail) Contained foreign matter (Wire) Foreign body (Pins) Mouldy Foreign body (Insect) Mouldy Foreign body (Insect) Foreign body (Cigarette end) Foreign body (Insects) Offensive Smell Foreign body (Nail) Unpleasent smell Contained foreign matter (Rodent Excreta) Unfit Peculiar taste Mouldy Foreign body (Cigarette end) Contained Foreign body Unpleasent taste and smell Foreign body (Maggots) Contained foreign matter (Glass) Unpleasent taste Contained foreign matter (Mud) Mouldy Foreign body (Insects) Mouldy Contained foreign matter Foreign body (Beetle) Discoloured with Brown Substance Mouldy Mouldy Caused stomach upset Foreign body (Plaster) Bad Mouldy Contained foreign matter Unpleasent smell Mouldy Foreign body Foreign body Suspected stomach upset Foreign body (Maggots) Bad Bad Mouldy Foreign body (Maggots) Foreign body (Insects) Mouldy Mouldy Bad 109 63. Sandwiches 64. Beans (Tinned) 65. Steak and Kidney Pudding 66. Corned Beef (Tinned) 67. Cake 68. Steak and Kidney Pudding 69. Cream Cheese (Box) 70. Meat Pie 71. Steak and Kidney Pie 72. Liver Mouldy Bad Foreign body (Nail) Foreign body (Metallic) Foreign body (Insect) Mouldy Bad Foreign body (Glass) Foreign body (Matchstick) Fluke. Number of justified complaints — 72 Number of complaints — 151 With regard to the justified complaints listed above the appropriate action was taken in all cases. 110 Section E General 111 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). 1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1968. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any signs of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar General's estimates at 30th June, 1968, was 329,246. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride was added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations River Thames (Southern Group) Honor Oak Well No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on Tables A and B below. 112 (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are not considered to be plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. Special tests for lead have been carried out during 1968 on 100 premises where a lead supply pipe is installed. The premises were chosen to give an even distribution of samples throughout the whole of the Board's area. Two samples were collected from each premises; one was the first running of water standing in the lead pipe overnight and the other was a sample of water after running the tap for a few minutes. The results are set out in the accompanying table Lead content of water from main taps in consumers' premises Lead content (mg/1 Pb) Samples of water standing in lead pipe overnight Samples of water after running the tap Less than 0.01 10 37 0.01 31 57 0.02 21 4 0.03 8 1 0.04 9 0 0.05 5 0 0.06 5 0 0.07 4 1 0.08 1 0 0.09 3 0 0.10 1 0 0.12 1 0 0.16 1 0 100 premises 100 premises The above results are very satisfactory and the figures are within the limits of. the World Health Organisation European Standards for Drinking Water Quality. This states that the upper limit for lead in running water in the supply should not be more than 0.1 mg/1 (Pb); but where water undertakings continue to use lead piping the concentration of lead (as Pb) should not exceed 0.3 mg/1 after 16 hours contact with the pipes. 113 EXAMINATION OF WATER SUPPLY Bacteriological Results — Yearly Averages 1968 TABLE 'A' BEFORE TREATMENT Agar plate count per ml. Coliform count Escherichia coli count Source of Supply Number of Samples 20-24 hours at 37° C. 3 days at 37° C. Per cent. samples negative in 100 ml. Count per 100 ml. Per cent, samples negative in 100 ml. Count per 100 ml. Thames-derived South of River* — — — — — — — Honor Oak 36 0.3 51 97.22 — 100.0 — AFTER TREATMENT Agar plate count per ml. Coliform count E. coli count Source of Supply Number of Samples 20-24 hours at 37° C. 3 days at 22° C. Per cent, samples negative in 100 ml. Percent, samples negative in 100 ml. Thames-derived South of River* 1,931 10.8 99.79 100.0 Honor Oak 35 0.0 17 100.0 100.0 * Hampton, Surbiton and Walton 114 Average Results of Chemical Examination Milligrammes per litre (unless otherwise stated) TABLE 'B' Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO4 4 hrs at 27° C. B.O.D.. 5 days at 20° C. River Thames South of River* 156 0.023 0.081 4.0 1.22 Honor Oak 4 0.014 0.019 0.1 0.07 Description of the Sample Hardness (total) CaC03 Hardness (noncarbonate) CaC03 Magnesium as Mg Sodium Potassium as Na Sodium Potassium as K Chloride as C1 River Thames South of River* 271 73 4 22.9 5.3 33 Honor Oak 321 67 15 Description of the Sample Phosphate at P04 Silicate as Si02 Sulphate as S04 Natural Fluoride as F Surfaceactive Material as Manoxol OT CO 2 River Thames South of River* 2.0 10 62 0.30 0.02 Honor Oak 0.60 Description of the Sample Turbidity units Colour (Burgess units) pH value River Thames South of River* 0.1 14 7.9 Honor Oak 0.3 3 7.2 * Hampton, Surbiton and Walton. 115 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 analysis 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 these pools are subject to regular inspections and sampling of 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 1968:- No. of Samples Agar count per ml. 24 hrs. at 37° C Presumptive Coliform without E. Coli in 100 mis. E. coli in s. 0-10 11-100 More than 100 Brockwell Park Lido Summer 8 8 - - - - Winter 10 7 4 2 4 1 Kennington Park Lido Summer 12 11 1 - - 1 Winter 8 8 - - 1 1 Shirley Oaks Residential Home 22 22 - - 1 1 Dick Sheppard School 6 6 - - - - Parkside School 12 11 1 - 3 - St. Martin-in-theFields School 18 15 3 - 3 - 116 Brockwell Park Lido This open air bath was extensively used during the summer season when the results obtained were excellent. During the winter season, bathers are relatively few, and only manual addition of chemicals is possible. Five samples contained Coliform bacteria but the maximum number was 3 per 100 mis. In the circumstances appertaining this is satisfactory. Kennington Park Lido Eleven out of 12 samples taken during the summer season were satisfactory. The unsatisfactory sample arose when a minor plant fault developed. This was speedily rectified and satisfactory conditions restored. The samples taken during the winter contained Coliform bacteria, maximum number 4 per 100, and these results are satisfactory in the circumstances. Shirley Oaks Swimming Bath One sample out of 22 contained Coliform bacteria, 1 per 100 mis. The water at the time was well chlorinated and in excellent condition. A large number of bathers were in the water and the presence of Coliform bacteria ephemeral. Parkside School Swimming Bath Three samples out of 12 contained very small numbers of Coliform bacteria (1 or 2 per 100). In all cases adequate free chlorine residuals applied and the bacteria could not have been viable. St. Martin-in-the-Fields Swimming Bath Three samples out of 18 contained 1 or 2 per 100 Coliform bacteria, although free chlorine residuals were 2 p.p.m. and water treatment was satisfactory. Relatively large numbers of bathers were in the water, and the bactericidal action of the chlorine had not been completed at the times of sampling. SEWERS I am indebted to the Borough Engineer and Surveyor for suppling me with the following information with regard to sewers within the Borough. 117 During the year a sum of £50,000 was spent on the general maintenance flushing and cleansing of the Council's sewers. Cleansing of approximately 80 miles of sewers was completed under contract using high pressure jetting. A new sewer in Kenbury Street had been provided to serve the Council's proposed development at Flaxman Road. This consisted of approximately 65 yards of 24 inch diameter concrete pipes plus 60 yards of 21 inch diameter pipe at a total approximate cost of £8,000. 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 Gases it appears to the Council that no suitable anangements for the disposal of the body has been or are being made. Forty-three funerals were carried out by the Council during the year under the Act. PHARMACY AND POISONS ACT, 1933 The number of persons entered or returned on the list under the Pharmacy and Poisons Act 1983 (Section 21) Part II was 190. ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENTS It is required under the London County Council (General Powers) Act 1920 for establishments giving massage or special treatment 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 43. Inspection of the establishments was carried out by the Associate Medical Officer of Health. 118 HAIRDRESSERS AND BARBERS The Council, in accordance with Section 21 of the Greater London Council (General Powers) Act 1967, fixed the appointed day as 1st April 1968 for the registration of hairdressers and barbers. During the year 220 certificates of registration were issued. CARE OF THE AGED During the year 1,411 new cases were brought to the notice of the Health Department. The old people's visitors made a total of 6,654 visits during the year and 495 old people were persuaded to enter hospitals and institutions voluntarily. A total of 3,216 received help in some form or another. The number of cases on the register including those from previous years is 6,796. The age groups into which the 1,411 new cases were divided are as follows:- Age Group Males Females Total 65-69 years 88 135 223 70-74 years 125 170 295 75-79 years 107 208 315 80-89 years 166 327 493 90-94 years 14 58 72 95 years and over 6 7 13 506 905 1,411 119 LAUNDRY SERVICE FOR AGED INCONTINENT The arrangements made with Southwark Borough Council for carrying out this service were discontinued on 31st March 1968 and the Council's own incontinent laundry service for the incontinent established at Streatham Baths came into operation. The total number of persons receiving benefit from the scheme during the year was 316. Total visits made were 5,793 and the total number of soiled articles collected was 56,583. HOME BATHING SERVICE The total number of baths given to aged persons during the year was 3,328. 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. The total number of examinations carried out during the year was 1,081. HEALTH EDUCATION Health Education activities have continued throughout the year and have included regular weekly parentcraft classes in secondary schools, talks on a variety of subjects in primary and secondary schools, talks to club groups in response to invitations from members, participation in exhibitions arranged by the Council and classes in Mother and Baby Homes. All grades of professional staff have taken part. The major part of health education has, however, been carried out by domiciliary midwives and health visitors. In order to better equip themselves for teaching activities members of the nursing staff have attended evening and week-end courses. Four health visitors successfully completed the evening course enabling them to sit for the examination for the City and Guilds Teaching Certificate. Five health visitors commenced the course in September. Members of the nursing staff are at present attending courses to enable them to act as projectionists when using films during the course of their group teaching activities. 120 HOSPITAL FACILITIES The undermentioned hospitals are located in the Borough Lambeth Hospital, Brook Drive, S.E.11. South Western Hospital, Landor Road, S.W.9. Annie McCall Maternity Hospital, Jeffreys Road, S.W.4. Kings College Hospital, Denmark Hill, S.E.5. Belgrave Hospital for Children, Clapham Road, S.W.9. St. Thomas' Hospital, Westminster Bridge, S.E.1. St. Thomas' Babies Hospital, Black Prince Road, S.E.11. 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. I 121 Section F School Health Service Report of the Principal School Medical Officer 122 LONDON BOROUGH OF LAMBETH SCHOOL HEALTH SERVICE Report of the Principal School Medical Officer for the Year 1968 The Inner London Education Authority is responsible for the school health service, but by virtue of an agreement required by Section 32 of the London Government Act 1963, there is joint use by the Authority and the Borough Council of professional staff premises and equipment. The Medical Officer of Health is the Principal School Medical Officer of the Inner London Education Authority for the area and responsible to that Authority for the day-to-day running of the service. The general health of school-children in Lambeth is good. In the great majority of families diet and clothing is of a very adequate standard, and parents are co-operative in obtaining the treatment recommended by the School Medical Officers. The number of new cases referred to special investigation clinics for bed wetting, obesity, minor behaviour difficulties and dysmenorrhoea shows a slight decrease from 228 in 1967 to 208 in 1968, and the same downward trend is more marked in rheumatism, orthopaedics, and minor ailments. The sole figure showing any increase is in audiology from 139 in 1967 to 140 in 1968. Physical condition is in fact very satisfactory, but unfortunately waiting lists for Child Guidance are becoming longer. This increase is largely due to the difficulties of those immigrant children whose parents precede them to this country, where they have two or three more children before they can afford to bring over eight to twelve year olds who have almost forgotten them, have never seen their younger brothers and sisters, and who suddenly have to adapt not only to a different culture and climate but also to busy parents, both of whom are often at work, instead of a leisurely indulgent grandmother. Arrangements continued with the London Boroughs of Southwark and Wandsworth for the treatment of verminous children and in addition bathing facilities were provided at the Elizabeth Bullock School Treatment Centre. This has helped to reduce travelling inconveniences and attendance difficulties and provides a service operated directly by the Borough. 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 16,264 routine examinations, 4,593 special examinations and 6,519 re-inspections. 123 School nurses carried out a total of 43,435 health surveys; 34,409 comprehensive, 5,609 selective and 3,417 in connection with communicable diseases. Early in their school life all children 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 a school treatment centre. Where results are still not satisfactory pupils are referred to an otologist for further investigation. 10,362 children were given a sweep test of whom 489 required a pure tone test, of these 54 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 while others are held in school treatment centres when the hospital authorities provide the specialist staff and the local authority the premises and nursing staff. Sessions provided in Teaching Hospitals include two vision sessions at King's College Hospital, an audiology session at the Belgrave Hospital, and an investigation session for heart diseases, enuresis, dietetics, and minor behaviour difficulties at St. Thomas' Hospital. All these sessions are attended by health service social workers who arrange appointments and act as liaison officers between the hospitals, school medical officers, and the I.L.E.A. school care committees and attendance officers. Health service social workers also attend special investigation clinics held in school treatment centres (see below). There are three vision clinics in Lambeth provided in local authority premises at which 3,637 attendances were made. Errors of refraction and squints numbered 1,680 while 44 other eye defects were found. Spectacles were ordered for 951 pupils. At one of the centres an orthoptic clinic is held at which 36 cases attended. Treatment facilities in Lambeth include special investigation clinics at which children suffering from obesity, enuresis and similar complaints are seen. A total of 157 special investigation sessions were held at which 1,096 attendances were made. At minor ailment clinics day to day treatment is given for minor skin, eye, ear and foot conditions. Normally, a nurse is in attendance at minor ailment sessions but occasional doctors' sessions are held. There were 48 sessions attended by a doctor and 583 by a nurse. Attendances totalled 10,504. SCHOOL DENTAL SERVICE An additional dental clinic to serve the north of the borough at the Barley Mow Centre, Frazier Street, S.E.1, opened towards the end of the period. 124 A total of 20,100 in spections and re-inspections of children's teeth were carried out by dental officers. It was found that approximately 61% of those inspected required treatment. Treatment is provided at six centres in the Borough. A total of 1,994 treatment sessions were held, at which 13,375 treatment cases and 513 emergency cases were seen. 54.3 general anaesthetic sessions were held; 55 new cases received specialist orthodontic treatment. RECUPERATIVE HOLIDAYS Recuperative holidays for school children are provided at homes at Deal and Bognor Regis run by the I.L.E.A. 150 Lambeth children were accommodated for periods between two and four weeks. HEALTH EDUCATION Health Education in schools continued throughout the year. Any opportunity to participate in Health Education in schools is welcomed by members of the staff of the Health Department. In addition to regular parentcraft classes in secondary schools, activities during 1968 included participation in programmes covering a wide field. Members of the staff who undertook this work included Medical Officers, Nursing Officers, Health Visitors and School Nurses. One Medical Officer and four members of the nursing staff attended a course of instruction and subsequently passed the examination for the City and Guilds Teaching Certificate. Five Health Visitors commenced the course in September, 1968. SCHOOL HEALTH STATISTICS FOR THE YEAR 1968 SCHOOL ROLL (May 1968) 46,613 SCHOOL MEDICAL INSPECTION Routine 16,264 Special 4,593 Re-inspections 6,519 125 No. of medical inspections per 1,000 pupils 587 Health Surveys - comprehensive 34,409 No. per 1,000 pupils 738 Percentage found verminous 1.4 Health Surveys - selective 5,609 No. per 1,000 pupils 120 Percentage found verminous 5.2 Audiometry - No. of children given sweep test 10,362 No. of children given pure tone test 489 No. of children referred to otologist at audiology centre 54 SCHOOL MEDICAL TREATMENT Hospital and Specialist Clinics Vision Centres:- Vision sessions 258 Number of new cases 528 Total attendances 3,637 Errors of refraction and squint 1,680 Other eye defects 44 Spectacles ordered 951 Orthoptic sessions:- 18 Number of new cases 9 Total attendances 36 Ear, nose and throat centres:- Sessions — Number of new cases — Total attendances — LOCAL AUTHORITY CLINICS Audiology centres:- Sessions 39 Number of new cases 140 Total attendances 210 Special investigation clinics:- Sessions 157 Number of new cases 208 Total attendances 1,096 126 Minor ailment centres:Sessions : Medical officer 48 Nursing sister 583 Number of new cases seen by medical officer 410 Average per session 8.5 Number of new cases seen by nursing sister only 1,637 Average per session 2.8 Total attendances 10,504 Defects treated:- Athlete's foot 165 Verrucae 971 Ringworm: body 6 Impetigo 83 Other skin diseases 139 Eye diseases 20 Ear diseases 10 Miscellaneous: Bruises, lacerations, etc. 417 RECUPERATIVE HOLIDAY HOMES Schoolchildren (including nursery school children) Number admitted during year 137 SCHOOL DENTAL SERVICE Number of Sessions : Inspection 144.2 Ordinaly treatment 1,994.7 General anaesthetic 54.3 Orthodontic 48.9 Health education 285.6 Total sessions 2,527.7 Inspection : First inspection at school 14,562 First inspection at clinic 4,434 Percentage found to require treatment 60.9 Re-inspection at school or clinic 1,104 Percentage found to require treatment 65.7" Visits for treatment : Number of first visits 4,554 Number of subsequent visits 8,821 Total visits 13,375 127 Emergencies 513 Additional courses commenced 718 Number did not attend 8,071 Treatment given : Number of fillings : In permanent teeth 6,887 In temporary teeth 5,705 Number of extractions : Of permanent teeth 592 Of temporary teeth 1,926 Number of other operations (prophylaxis, X-rays, inlays, crowns, etc.) 4,784 Courses of treatment completed 3,342 Orthodontics : Number of new cases 55 Number of removable appliances fitted 88 Number of fixed appliances fitted 4 Sessional averages : First visits 2.2 Subsequent visits 4.3 Emergencies 0.3 Did not attend 3.9 Fillings : In permanent teeth 3.4 In temporary teeth 2.8 Extractions : Of permanent teeth 0.3 Of temporary teeth 0.9 Ratio of permanent teeth filled to permanent teeth extracted 10.1 Ratio of temporary teeth filled to temporary teeth extracted 2.5 Staff : Number of dentists employed (effective whole-time equivalent) 4.3 REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER FOR 1968 The year's work shows a further consolidation of the dental service based on the foundations laid down as a result of the combined efforts of the I.L.E.A. and the borough. Efforts are always made to achieve the ideal dental service, but there are always limiting factors to prevent this coming to fruition, staff 128 changes, the number of surgeries available and the ratio of potential patients to dental officers. These factors have been the main difficulties that have had to be faced during the year. It would appear that there are three basic responsibilities of a school dental service 1. Regular school dental inspections 2. Provision of comprehensive treatment for those patients that opt for school dental service treatment 3. Dental Health Education School Dental Inspections These are essential in order to alert both children and parents to the need for regular dental care. Apart from the provision of patients for the school dental service, the inspections undoubtedly prompt parents to visit or re-visit their own dental surgeries in the general dental service. While there is no great difficulty in arranging for school dental inspections, regard has to be paid to two often conflicting responsibilities. There is a responsibility to the whole school population and a responsibility to treat children requiring school dental service treatment, within a reasonable time after the inspection. Neither of these responsibilities can be lightly disregarded and therefore during the year a compromise had to be reached. 14,562 pupils at 53 schools had their first inspection of the year with 60.9% found to require treatment, including first inspections in a surgery. Comprehensive Treatment The ability to carry out comprehensive treatment is partly dependent on the availability of modern equipment, together with a wide range of materials and instruments, these our surgeries now have. In reviewing the treatment carried out, it should be noted that owing to a period when there was a shortage of dental officers, the number of sessions was less than in the previous year. 6,887 fills were carried out in permanent teeth and 5,705 in deciduous teeth and this emphasises the importance attached to the preservation of the temporary teeth. Provision is made for orthodontic cases and apart from those cases treated by the staff, the Dental Department of King's College Hospital has always been most helpful in giving advice or providing treatment. Dental Health Education This is carried out at the chairside and in schools, Special arrangements were made for a talk and films to be given for a group of pupils at a large comprehensive school as part of a school course on health education. 129 Staff Staff as at 31st December was:- Principal School Dental Officer 1 Full time Dental Officers 3 Sessional Dental Officers 6 (2.4 whole time equivalents) Dental Auxiliary 1 Dental Surgery Assistants 8 The most important development regarding staff was the appointment of our first dental auxiliary, her duties being both clinical and dental health education. New Surgeries Extensive alterations were carried out at Brixton School Treatment Centre in order to provide an additional surgery. The existing waiting room was converted into a new surgery and modern equipment installed. The original surgery is now used by the dental auxiliary, two other rooms being used as a waiting room and an office. Preparations for the provision of a much needed surgery in the north of the borough are due to be completed early in the next year. Mobile Surgery The first experience was gained of using one of the I.L.E.A. mobiles; this was located in a school playground while one of the centres was being re-decorated. Courses and Conferences During the year, the staff attended various courses, on child Dental Health at the London Hospital Medical College, Orthodontics at Keal University and an X-ray course. The Principal School Dental Officer also attended the Annual Conference of the British Dental Association. A half day was devoted to a demonstration and films on emergency resuscitation. Thanks to the Staff My thanks are again due, not only to the dental staff, but also for the help and advice given to me by the staff in the Health Department.