THE HEALTH OF LAMBETH ANNUAL REPORT 1969 a. l. thrower, m.b., b.s., m.r.c.S., l.r.c.p., d.p.h. R LAM 58 LONDON BOROUGH OF LAMBETH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1969 A. L. THROWER, M B., B.S., M.R.C.S.., L.R.C.P., D.P.H. 2 CONTENTS OF REPORT Page Members of the Health Committee 5 Staff of Health Department 9 Introductory remarks of Medical Officer of Health 10 SECTION A: Statistics and Social Conditions of the Area General Births; Birth Rate; Still Births 15-16 Deaths; Death Rate 16 Maternal Mortality 16 Infantile Mortality 17 Vital Statistics for Years 1959-1969 19 Classification of Causes of Death 20 Notes on Vital Statistics 26 Deaths from Cancer of the Lung and Bronchus 28 Road Traffic Accidents 28 SECTION B: Prevalence of, and Control over, Infectious and Other Diseases Notifiable Diseases 31 Notifications other than Tuberculosis 32 Age distribution of Infectious Diseases 33 Notes on Infectious Diseases 35 Salmonella Infections 37 Notification of Tuberculosis 38 Report of Chest Physician 38 SECTION C: Personal Health Services Maternity and Child Health Service 44 Cervical Cytology Screening Service 46 Family Planning 47 Health Visiting 49 Domiciliary Midwifery Service 52 Midwives Act 1951 53 Health Education 54 Day Nurseries 57 Child Minding 61 Toys Project 62 Registered Play Groups 62 In-Service Training 62 Observation/Handicap Register 63 3 SECTION C: Personal Health Services (continued) Page Medical Examination of Staff 70 Advisory service to the Children's Department 71 Advisory service to the Welfare Department 72 Standing Committee for Co-ordination 73 Health Services - Family Case Workers 75 International Certificates of Vaccination 75 Vaccination and Immunisation 77 Tuberculosis 80 B.C.G. Vaccination 80 Home Nursing 81 Loan of Nursing Equipment 83 Mental Health Service 84 Priority Dental Service 100 Chiropody 102 Home Help Service 104 Recuperative Holidays 105 SECTION D: Environmental Health Services Housing — Clearance Areas declared 107 Individual Unfit Houses 107 Unfit part of premises 107 Modernisation and Improvement 108 Repair and maintenance 108 Control of Multiple Occupation 108 Means of escape in case of fire 108 Qualification Certificates 109 Certificates of Disrepair 109 House Purchase 109 Rehousing and Overcrowding 109 Abatement of Nuisances 110 Works in default 110 Choked Drains - Emergency Service 110 Sealing of Disused Drains 110 Drainage Work 111 Food Hygiene — Imported Food 111 Bacteriological and other examinations 111 Sampling of Food and Drugs 112 Complaints 112 Inspection of Unfit Food 113 Method of Disposal of Unsound Food 113 Food Premises 113 Licensed Milk premises 114 4 SECTION D: Environmental Health Services (continued) Page Atmospheric Pollution — Smoke Control Areas 115 National Survey 115 Environmental Health Generally — Infectious Diseases 115 Disinfection and Disinfestation 116 Rates and Mice 116 Pharmacy and Poisons 117 Pet Animal Establishments 117 Animal Boarding and Riding Establishments 117 Diseases of Animals 117 Long-stay Immigrants 117 Massage and Special Treatment 118 Hairdressers and Barbers 118 Care of the Aged 118 Laundry Service for Aged Incontinent 118 Compulsory Removal 119 Burial or Cremation of the Dead 119 Home Dialysis Units 119 Nursing Homes 120 Noise 120 Factories and Outworkers 120 SECTION E: General Water Supply 127 Swimming Pools 129 Sewers 131 Hospital Facilities 132 Ambulance Facilities 132 Public Health Laboratory Service 132 SECTION F: School Health Service Report of the Principal School Medical Officer 134 5 LONDON BOROUGH OF LAMBETH HEALTH COMMITTEE Period from 1st January, 1969, to 24th May, 1969 The Worshipful the Mayor of Lambeth Alderman Walter C. Dennis, J.P. (Ex-officio) The Deputy Mayor of Lambeth Alderman Donald Taylor Campbell, J.P. (Ex-officio) Chairman Alderman Mrs. M.F. Steere, B.A. Vice-Chairman Councillor Miss H. Jellie Councillor Mrs. D.D. Brimacombe Councillor Mrs. L.M. Burton Councillor G.F. Carey (deceased 26.1.69) Councillor Miss F. Clark Councillor J.R. Ebling Councillor S.J. Fitchett Councillor W.F.R. Fuller Councillor R. Pickard Councillor G.B.F. Pisani Councillor F.S.G. Rigger Councillor L.J.B. Roux Councillor R.F. Turtill Co-opted Members Representing Inner London Local Medical Committee - Dr. G.I. Taylor Representing Teaching Hospitals Association - Mr. B.A. McSwiney 6 MENTAL HEALTH (GUARDIANSHIP) SUB-COMMITTEE Chairman Alderman Mrs. M.F. Steere, B.A. Vice-Chairman Councillor Miss H. Jellie Councillor G.F. Carey (deceased 26.1.69) Councillor F.S.G. Rigger NURSERY and CHILD-MINDERS SUB-COMMITTEE Chairman Alderman Mrs. M.F. Steere, B.A. Vice-Chairman Councillor Miss H. Jellie Councillor Mrs. D.D. Brimacombe Councillor Miss F. Clark Councillor S.J. Fitchett Councillor R. Pickard 7 HEALTH COMMITTEE Period from 24th May, 1969, to 31st December, 1969 The Worshipful the Mayor of Lambeth Alderman Donald Taylor Campbell, J.P. (Ex-officio) The Deputy Mayor of Lambeth Alderman Jack Westbury (Ex-officio) Chairman Alderman Mrs. M.F. Steere, B.A. Vice-Chairman Councillor Miss H. Jellie Alderman T. Cleasby Councillor D. Ayres Councillor Mrs. M. Becker Councillor Mrs. D.D. Brimacombe Councillor Mrs. M.F. Brown Councillor Mrs. L.M. Burton Councillor Miss F. Clark Councillor S.J. Fitchett Councillor D.F. How Councillor R. Pickard Councillor L.J.E. Roux (deceased 30.8.69) Co-opted Members Representing Inner London Local Medical Committee - Dr. G.I. Taylor Representing Teaching Hospitals Association - Mr. B.A. McSwiney 8 MENTAL HEALTH (GUARDIANSHIP) SUB-COMMITTEE Chairman Alderman Mrs. M.F. Steere, B.A. Vice-Chairman Councillor Miss H. Jellie Alderman T. Cleasby NURSERY and CHILD-MINDERS SUB-COMMITTEE Chairman Alderman Mrs. M.F. Steere, B.A. Vice-Chairman Councillor Miss H. Jellie Councillor Mrs. D.D. Brimacombe Councillor Miss F. Clark Councillor S.J. Fitchett Councillor R. Pickard 9 STAFF OF HEALTH DEPARTMENT Medical Officer of Health and Principal School Medical Officer A.L. Thrower, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Associate Medical Officer of Health F. Summers, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Deputy Medical Officer of Health N. Christina Walsh, M.B., B.Ch., D.C.H., D.P.H. Principal Administrative Officer D.E. Armstrong Deputy Principal Administrative Officers 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 Acting Assistant Principal Social Worker (Health Services) Miss T. Watts Chief Dental Officer B.M.S. Spalding Chief Public Health Inspector H. Plinston Deputy Chief Public Health Inspector R.C. Charlton 10 Mr. Mayor, Ladies and Gentlemen, I have the honour to present my report on the health of the Borough for 1969, the fifth year since the London Borough came into being on the 1st April 1965. The Council and the Health Department can, I believe, look back with some satisfaction on the progress which has been made during those years. Initially services which had been designed on a countywide basis by the London County Council had to be reorganised to fit the Borough's needs. In particular this necessitated the urgent provision of two temporary junior training schools for severely mentally handicapped children, where none existed before, and of a maternity and child health centre to serve an area previously attached to a centre situated in the new borough of Wandsworth. Because of the urgency of the need all were provided by the adaptation of existing buildings. The planning of new buildings to replace these and other unsatisfactory premises and for the expansion and improvement of existing services has continued throughout the period. The first two purpose-built premises - a junior training school and a maternity and child health centre, both replacements - are expected to open early in 1970. Also planned for over the next five years are four day nurseries (one, additional to present provision, to be provided under the Urban Programme) three health centres, one maternity and child health centre, a second junior training school, an adult training centre and hostels for mentally handicapped children and adults. Two day centres for the mentally ill, of which the Borough has none at present, are planned in adapted premises. This will reduce dependence on centres provided by other boroughs or by voluntary bodies as well as helping to meet needs, at present unsatisfied, for this service. The movement of population out of the Borough, to which I referred in my report for 1968, has continued. Allowing for the excess of births over deaths it appears that some 30,000 residents have moved out of the Borough since 1965. The total population fell from 339,560 in 1965 to 325,070 in 1969 (mid-year estimates). During the same period the annual total of births fell by about 20% from 7,439 in 1965 to 5,978 in 1969. Substantial movements of population in and out of the Borough add to the difficulties of maintaining essential contacts with families with children. The proportion of confinements taking place at home has continued to fall, and is now less than 8%, while early discharges from hospital after confinement are increasing. Domiciliary midwives are thus spending an increasing proportion of their time on post-natal care. This trend seems likely to lead to a hospital-based midwifery service, with hospital midwives visiting homes to attend the small number of women confined at home and to give post-natal care to those discharged early from hospital. 11 An important advance was made in July when effect was given to the Council's decision to implement in full, mainly through the agency of the Family Planning Association, the provisions of the National Health Service (Family Planning) Act 1967. As a result free examination and advice is available to all Lambeth residents who seek it, with an expanding domiciliary service for those who need it. The extension of the requirements of the Nurseries and Child Minders Regulation Act 1948 to women minding one or two children at once brought within its scope a large number of child-minders who had previously been exempt from registration. It was soon evident that the initial visiting of applicants for registration should continue long beyond the three months allowed for the completion or registration procedures. By the end of the year more than 500 applicants had received one or more preliminary visits, and 109 registrations had been completed. There is no doubt that the extended requirements will contribute to the prevention of unsatisfactory child-minding. Every encouragement and help has been given to suitable persons wishing to start pre-school playgroups, and to those already running them. A grant under the Urban Programme made increased financial assistance available for groups catering for children from areas of social need, and the total of such assistance is likely to reach £10,000 in the next year. I am pleased to be able to report that the number of health visitors, which had fallen to a disturbingly low level in 1967 has been substantially increased as a result of the sponsorship by the Council in successive years of considerable numbers of student health visitors. It is hoped that the present trend will continue until a sufficient total is reached, and maintained. The Housing Act 1969 which came into effect on 25th August 1969 placed on local authorities a duty to cause an inspection of their districts to be made from time to time with a view to dealing with a wide range of unsatisfactory conditions. New provisions relating to increased maximum improvement and standard grants; the conversion of controlled tenancies to regulated tenancies, if the dwelling is in good repair, and provided with standard amenities; compensation in respect of unfit houses subject to action by the Council; and an amendment to the standard of fitness, are welcomed. 12 In particular, the new special grant applicable to houses in multiple occupation, together with control provisions relating to schemes for the registration of houses in multiple occupation, will be of great assistance in dealing with this immense problem. I am convinced that a scheme for the registration of houses in multiple occupation covering the whole of the Borough, and incorporating the new control provisions is necessary, not only to provide vital information, but to enable measures to be taken to improve standards in these houses. I am pleased to have this opportunity of thanking the Chairman and members of the Health and Welfare Committee and other members of the Council for their interest and support throughout the year. I am also most grateful for the co-operation which I have received from Dr. A.B. Stewart, Medical Adviser, Inner London Education Authority and his staff, and from my fellow chief officers. I pay tribute to the excellent and, I believe, mutually beneficial relationships which have continued with the family doctors and hospitals in the area, particularly with St. Thomas' Hospital which is the district hospital for a large part of the Borough. Lastly and perhaps most important, I wish to express my deep sense of gratitude to the staff of my own department for their able and willing help and support. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, A.L. THROWER Medical Officer of Health 13 Section A Statistics and Social Conditions of the Area 14 STATISTICS AND SOCIAL CONDITIONS OF THE AREA In the North the London Borough of Lambeth has a common boundary down the middle of the Thames - with the Cities of London and Westminster, and is flanked by the Boroughs of Southwark and Wandsworth and, in the South has common boundaries with the Boroughs of Bromley, Croydon and Merton. The land surface rises from 12 feet above sea level at the river to 50 feet at Brixton, 150 feet at West Norwood, 200 feet at Streatham and about 379 feet at and near the Crystal Palace. The perimeter of the Borough measures 1916 miles and its total area is approximately 101/2 square miles. In terms of population, Lambeth is the largest of the London Boroughs. The Borough has approximately 600 acres of park and open spaces including Brockwell, Kennington, Ruskin, Norwood, Archbishop's and Vauxhall Parks, Myatt's Fields, Streatham Common and parts of Clapham and Tooting 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 or Parliament. For Borough Council elections the Borough is divided into a total of 20 wards each returning three Councillors. Four members are returned to Greater London Council. 15 STATISTICS GENERAL Area of Borough 6727 acres Number of Wards 20 Number of Parliamentary Constituencies 5 Population (Mid-year estimate 1969) 325,070 Density of Population (i.e. number of persons per acre) 48.32 Number of marriages during the year 2,547 Marriage rate per 1,000 population 7.8 Rateable Value of District (1st April 1969) £20,430,955 Sum represented by a penny rate (1969/1970) £80,500 Number of separately rated houses and flats as 1st April, 1969 94,120 VITAL STATISTICS LIVE BIRTHS Legitimate Illegitimate Totals Males 2,504 586 3,090 Females 2,349 539 2,888 Totals 4,853 1,125 5,978 Live Birth Rate per 1,000 home population 18.38* Birth Rate corrected for comparison with other areas 16.17 Comparability factor supplied by Registrar General 0.88 Birth Rate per 1,000 Home Population England and Wales 16.3 Birth Rate per 1,000 Home Population Inner London Area 15.7 * Birth Rate per 1,000 Home Population Outer London Area 15.7 * Birth Rate per 1,000 Home Population Greater London Area 15.7 * Illegitimate live Births per cent of total live births 18.8 Illegitimate Live Births per cent of total live births Inner London Area 15.4 Illegitimate Live Births per cent of total live births Outer London Area 8.3 Illegitimate Live Births per cent of total live births Greater London Area 11.0 * Crude Rate 16 STILL BIRTHS Legitimate Illegitimate Totals Males 32 10 42 Females 24 2 26 Totals 56 12 68 Still Birth Rate per 1,000 Total Births (i.e. Live and Still) 11.2 Still Birth Rate per 1,000 total births England and Wales 13.0 Still Birth Rate per 1,000 total births Inner London Area 13.4 Still Birth Rate per 1,000 total births Outer London Area 12.3 Still Birth Rate per 1,000 total births Greater London Area 12.7 DEATHS Males Females Totals 1,889 1,863 3,752 Death Rate per 1,000 home population 11.54* Death Rate corrected for comparison with other areas 12.46 Comparability Factor (supplied by Registrar General) 1.08 Death Rate per 1,000 home population England and Wales 11.8 Death Rate per 1,000 home population Inner London Area 11.9* Death Rate per 1,000 home population Outer London Area 11.2* Death Rate per 1,000 home population Greater London Area 11.5* MATERNAL MORTALITY Number of Women dying in consequence of Childbirth 2 Maternal Mortality Rate per 1,000 total births 0.33 Maternal Mortality Rate per 1,000 total births Inner London Area 0.21 Maternal Mortality rate per 1,000 total births Outer London Area 0.19 Maternal Mortality Rate per 1,000 total births Greater London Area 0.20 * Crude Rate 17 INFANTILE MORTALITY Deaths of infants under one year of age Legitimate Illegitimate Totals Males 56 15 71 Females 52 13 65 Totals 108 28 136 Death Rate of infants under one year of age per 1,000 live births 22.75 Death Rate of infants under one year of age per 1,000 live births England and Wales 18.0 Death Rate of infants under one year of age per 1,000 live births Inner London Area 20.4 Death Rate of infants under one year of age per 1,000 live births Outer London Area 16.2 Death Rate of Infants under one year of age per 1,000 live births Greater London Area 17.9 Deaths of infants under four weeks of age Legitimate Illegitimate Totals Males 45 10 55 Females 29 8 37 Totals 74 18 92 Neo-natal Mortality Rate (Deaths under four weeks per 1,000 live births) 15.38 Neo-Natal Mortality Rate England and Wales 10.0 Neo-natal Mortality Rate Inner London Area 13.3 Neo-natal Mortality Rate Outer London Area 10.8 Neo-natal Mortality Rate Greater London Area 11.7 18 Deaths of infants under one week of age Legitimate Illegitimate Totals Males 42 9 . 51 Females 25 5 30 Totals 67 14 81 Early Neo-natal Mortality Rate (Deaths under one week per 1,000 live births) 13.5 Early Neo-natal Mortality Rate England and Wales 10.0 Early Neo-natal Mortality Rate Inner London Area 11.7 Early Neo-natal Mortality Rate Outer London Area .. 9.2 Early Neo-natal Mortality Rate Greater London Area .. 10.2 Perinatal Mortality Rate (Still births and deaths under one week per 1,000 total births) 21.5 Perinatal Mortality Rate England and Wales 23.0 Perinatal Mortality Rate Inner London Area 25.0 Perinatal Mortality Rate Outer London Area 21.4 Perinatal Mortality Rate Greater London Area 22.8 19 SUMMARY OF VITAL STATISTICS FOR THE TEN YEAR PERIOD 1959-1969 METROPOLITAN BOROUGH OF LAMBETH 1959-1964 Year Population Deaths * Death Rate Live Births * Live Birth Rate Deaths of Infants under 1 year of age Infantile Mortality Rate Maternal Deaths Maternal Mortality Rate 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 1965-1969 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 1969 325,070 3,752 12.46 5,978 16.17 136 22.75 2 .33 * As adjusted by comparability factor. 20 21 LONDON BOROUGH OF LAMBETH CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1969 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 B5 Tuberculosis Respiratory M 13 - - - - - - - - 2 10 1 F 3 - - - - - - - - 1 2 - B6 Tuberculosis. Other M 5 - - - - - - - 1 2 2 - F 3 - - - - - - 1 - 1 - 1 B17 Syphilitic Disease M 3 - - - - - - - - - - 3 F 3 - - - - - - - - - 1 2 B9 Whooping Cough M 1 - - 1 - - - - - - - - F - - - - - - - - - - - - B11 Meningococcal Infections M - - - - - - - - - - - - F 2 - - - 1 - - - - - 1 - B14 Measles M - - - - - - - - - - - - F 2 - 1 1 - - - - - - - - B18 Other Infective and Parasitic Diseases M - - - - - - - - - - - - F 4 - 1 - - - - 1 - 2 - - B19(3) Malignant Neoplasm, Stomach M 42 - - - - - - 1 5 10 11 15 F 42 - - - - - 1 1 2 3 16 19 B19(6) Malignant Neoplasm, Lung, Bronchus M 184 - - - - - - 1 19 61 72 31 F 45 - - - - - - - 8 9 18 10 B19(7) Malignant Neoplasm, Breast M - - - - - - - - - - - - F 65 - - - - - - 4 10 17 16 18 B19( 1) Malignant Neoplasm, Buccal Cavity, etc. M 11 - - - - - - 1 - 2 5 3 F 5 - - - - - - 2 - 1 1 1 B19(2) Malignant Neoplasm, Oesophagus M 11 - - - - - - - 1 3 5 2 F 10 - - - - - - - 1 1 5 3 B19(4) Malignant Neoplasm, Intestine M 41 - - - - - - 1 4 10 16 10 F 70 - - - - - - - 6 10 19 35 B19(5) Malignant Neoplasm, Larynx M 3 - - - - - - - - 1 - 2 F 2 - - - - - - - 1 - - - B19(9) Malignant Neoplasm, Prostate M 19 - - - - - - - - 2 7 10 B19(8) Malignant Neoplasm, Uterus F 24 - - - - - - 1 5 4 8 6 B19(l 1) Other Malignant Neoplasms M 104 - - - - 1 6 4 19 26 28 20 F 107 - - 2 1 - 1 7 10 29 27 30 B 19(10) Leukaemia, M 13 - - 2 - - 1 2 1 2 1 4 F 7 - - - - - - 3 2 - 1 1 B20 Benign and Unspectified Neoplasms M 5 - - - - 1 - 1 - 2 1 - F 6 - 1 - - - 1 - - 2 1 1 B21 Diabetes Mellitus M 7 - - - - 1 - - 1 2 2 1 F 17 - - - - - - 1 1 4 5 6 B46(l) Other Endocrine etc, Diseases M 4 1 - - 1 - - - - 2 - - F 10 - - - - - - - - 2 3 4 B23 Anaemias M 3 - - - - 1 - - - 2 - - F 8 - - - - - 1 - - 1 - 6 22 CAUSE OF DEATH Sex Total All ages Under 4 weeks 4 weeks and under 1 year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over B46(2) Other Diseases of Blood, etc M 2 - - - - - 1 - - - - 1 F - - - - - - - - - - - - B46(3) Mental Disorders M 2 - - - - - - - - 1 - 1 F 2 - - - - - - - - - - 2 B4 Enteritis and other Diarrhoeal Diseases M 4 1 3 - - - - - - - - - F 3 - 1 - - - - - - 1 - 1 B24 Meningitis M - - - - - - - - - - - - F 1 - - - - - - - - - 1 -- B46(4) Other Diseases of Nervous System, etc. M 30 - 1 - 1 1 1 - 5 2 10 9 F 28 - 2 - - 1 1 1 3 5 8 7 B26 Chronic Rheumatic Heart Disease M 22 - - - - 2 - 2 5 8 2 3 F 32 - - - - - - 1 3 8 11 9 B27 Hypertensive Disease M 41 - - - - - 1 2 4 10 7 17 F 42 - - - - - - - 2 2 17 21 B28 Ischaemic Heart Disease M 465 - - - - - 3 14 53 119 161 112 F 353 - - - - - 1 4 13 29 88 218 B29 Other forms of Heart Disease M 51 - - - - 1 - 2 2 8 16 22 F 112 - - - - - 1 1 2 8 12 88 B30 Cerebrovascular Disease M 107 - - - - - - 3 7 20 34 43 F 239 - - - - 1 - 1 8 20 50 159 B46(5) Other Diseases of Circulatory System M 56 - - - - - 2 6 10 21 17 F 92 1 - - - - 1 1 1 7 16 65 B31 Influenza M 19 - - - - - - 1 1 2 12 3 F 18 - - - - - - 1 3 6 2 6 B32 Pneumonia M 130 - 6 1 - - - 1 6 15 24 77 F 163 3 8 2 1 - - 1 2 12 23 111 B33(l) Bronchitis and Emphysema M 204 - - - - - - 1 10 34 86 73 F 70 - - - - - - 1 1 8 9 51 B33(2) Asthma M 4 - - - - 2 - - - - 2 - F 7 - - 1 - - - 1 - 2 1 2 B46(6) Other Diseases of Respiratory System M 21 1 4 1 - - 1 - - 4 5 5 F 18 - 6 1 - - - - 1 1 2 7 B34 Peptic Ulcer M 19 - - - - 2 - - 3 1 8 5 F 14 - - - - - - 1 - 2 3 8 B35 Appendicitis M 1 - - - - - 1 - - - - - F 1 - - - - - - - - - - 1 B36 Intestinal Obstruction and Hernia M 7 - - - - - - - - - 5 2 F 15 2 1 - - - - - - - 3 9 B37 Cirrhosis of Liver M 3 - - - - - - - 1 1 1 - F 11 - - - - 1 - 2 3 3 3 1 B46(7) Other Diseases of Digestive System M 11 - - - - - - 2 2 2 2 3 F 33 - - - - 1 - - - 2 10 20 B38 Nephritis and Nephrosis M 13 - - - - 1 3 2 1 2 2 2 F 11 - - - - - - 1 - 4 2 4 3 24 25 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 B39 Hyperplasia of Prostate M 11 - - - - - - - - - 5 6 B46(8) Other Diseases, Genitourinary System M 13 - - - - 1 1 - 2 2 1 6 F 9 - - - - - - - 1 2 3 3 B41 Other Pregnancy, etc. F 2 - - - - 2 - - - - - - B46(9) Diseases of Skin, Subcutaneous Tissue M - - - - - - - - - - - - F 3 - - - - - - - 1 - 2 B46(10) Diseases of Musculoskeletal System M 5 - - - - - - - - 1 2 2 F 21 - - - 1 - - - 1 2 4 13 B42 Congenital Anomalies M 27 9 2 4 2 2 2 - 4 1 1 - F 16 5 4 1 1 - - - - 2 2 1 B43 Birth Injury, Difficult Labour, etc. M 24 24 - - - - - - - - - - F 16 16 - - - - - - - - - - B44 Other Causes of Perintal Mortality M 19 19 - - - - - - - - - - F 8 8 - - - - - - - - - - B45 Symptons and Ill-Defined Diseases M 2 - - - - - 1 - 1 - - - F 14 1 - - - - 1 - 1 - 2 10 BE47 Motor Vehicle Accidents M 26 - - 1 5 3 2 - 2 3 5 5 F 13 - - - 2 1 2 - 1 3 2 2 BE48 All Other Accidents M 51 - - 7 3 4 4 5 7 4 7 10 F 34 1 4 3 3 2 3 2 2 3 11 BE49 Suicide and Self-inflicted Injuries M 28 - - - - 3 3 4 4 8 5 1 F 20 - - - - 1 1 6 4 7 1 - B50 All Other External Causes M 5 - - - - 1 3 - - - 1 - F 7 1 1 1 - - 1 2 - - 1 - TOTAL ALL CAUSES M 1,889 55 16 17 12 27 34 52 177 387 585 527 F 1,863 37 28 13 10 11 14 49 98 226 402 975 GRAND TOTAL 3,752 92 44 30 22 38 48 101 275 613 987 1,502 26 VITAL STATISTICS POPULATION The Registrar-General's mid-year estimate for the year 1969 is 325,070. This is a decrease of 4,180 on the figure for the year 1968. The number of live births exceeded the deaths, giving a natural increase of 2,226. 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 6,200 1 to 4 years 23,000 5 to 14 years 39,300 15 to 64 years 215,570 65 years and over 41,000 Total 325,070 LIVE BIRTHS The total number of live births occurring to residents of the Borough was 5,978 comprising 3,090 males and 2,888 females. This figure was 607 less than that for 1968 giving a reduced corrected birth rate of 16.17 per 1,000 population. The rate for England and Wales was 16.3 and the rates for the Inner, Outer and Greater Londo Areas were 15.7 in each instance. During the year there were 1,125 illegitimate live births. This figure is 88 less than for 1968 but due to the reduction in the total number of live births, the percentage, 18.8 is slightly higher and compares unfavourably with those for the Inner London, Outer and Greater London Areas which are 15.4, 8.3 and 11.0 respectively. STILL BIRTHS Stillbirths for the year numbered 68. This is 15 fewer than for 1968 and owing to this and to the reduction in the total number of births, the stillbirth rate at 11.2 is lower than that for last year (12.4) which was itself lower than that for 1967 (15.2). The rate is also lower than those for England and Wales, and the Greater London Area. (13.0 and 12.7 respectively). 27 DEATHS Allowing for inward and outward transfers the total number of deaths comprising 1,889 males and 1,863 females was 3,752. The corrected death rate at 12.46 per 1,000 population is slightly higher than those for England and Wales and the Greater London Area. Sixty-six per cent of the total deaths occurred in persons aged 65 and over. Heart and diseases of the circulatory system accounted for the largest number of deaths, 1,609 occurring out of a total of 3,752. Malignant neoplasms of all forms ranked second. 48 people took their own lives compared to 49 in 1968 and motor vehicle accidents accounted for 39 deaths, and increase of 5 on the figure for last year. Two mothers died as a result of diseases of pregnancy or childbirth giving a maternal mortality rate of .33 per 1,000 total births. This figure compares very favourably with those for England and Wales and the Inner, Outer and Greater London Areas. INFANTILE MORTALITY One hundred and thirty-six infants died before reaching 1 year of age, 5 more than in 1968. The infantile mortality rate rose to 22.75 per 1,000 live births compared with 19.4 last year, and 21.9 in 1967. The causes of death fell into the undermentioned categories Cause of death Male Female Total Birth injury, difficult labour, etc. 24 16 40 Other causes of perinatal mortality 19 8 27 Other infective and parasitic diseases - 1 1 Pneumonia 6 11 17 Other diseases of the circulatory system - 1 1 Other diseases of respiratory system 5 6 11 Enteritis and diarrhoeal diseases 4 1 5 Internal obstruction and hernia - 3 3 Congenital anomalies 11 9 20 Symptons and ill defined diseases - 1 1 28 Cause of death Male Female Total Measles - 1 1 Benign and unspecified Neoplasms - 1 1 Other Endocrine etc. diseases 1 1 2 Other diseases of the nervous system 1 2 3 All other accidents - 1 1 All other external causes - 2 2 71 65 136 DEATHS FROM CANCER OF THE LUNG AND BRONCHUS There was a reduction in the number of deaths from cancer of the lung and bronchus 229 occurring compared with 259 in 1968. The deaths were distributed amongst the various age groups as follows Age Male Female Totals 25-34 years -(-) -(-) -(-) 35-44 years 1(3) -(-) 1(3) 45-54 years 19(24) 8(7) 27(31) 55-64 years 61(80) 9(12) 70(92) 65-74 years 72(79) 18(14) 90(93) 75 years and over 31(22) 10(18) 41(40) 184(208) 45(51) 229(259) The figure in brackets are those for the year 1968 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 1969. 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. 29 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 Adult 1,861(2,025) 27(17) 326(328) 1,988(2,124) Children 615 ( 620) 7( 4) 139(141) 547 ( 556) 2,476 (2,645) 34(21) 465 (469) 2,535 (2,680) The figures in brackets are those for the year 1968. 30 Section B Prevalence of and Control over Infectious and other Diseases 31 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES The undermentioned diseases are notifible within the Borough of Lambeth Acute encephalitis Acute meningitis Acute poliomyelitis Anthrax Cholera Diphtheria Dysentery (amoebic or bacillary) Food Poisoning Infective jaundice Leprosy Leptospirosis Malaria Measles Ophthalmia neonatorum Paratyphoid Fever Plague Relapsing fever Scarlet fever Smallpox Tetanus Tuberculosis Typhoid fever Typhus Whooping cough Yellow fever 32 CORRECTED NUMBER OF NOTIFICATIONS, EXCLUDING TUBERCULOSIS RECEIVED DURING 1969 Disease First Quarter Second Quarter Third Quarter Fourth Quarter Totals Grand Total M F M F M F M F M F Scarlet Fever 5 7 10 8 3 4 5 5 23 24 47 Whooping Cough 9 10 7 9 - 1 1 3 17 23 40 Measles 454 437 198 173 127 115 10 7 789 732 1,521 Dysentery 4 7 12 10 9 12 1 1 26 30 56 Acute Meningitis 4 2 - 2 3 1 1 1 8 6 14 Infective Jaundice 8 10 11 2 9 4 - - 28 16 44 Malaria - - - - 1 2 - - 1 2 3 Paratyphoid Fever - - - - 1 - - - 1 - 1 Food Poisoning 7 2 - - - - 2 - 9 2 11 Typhoid Fever • • - - • 1 - - - 1 1 Ophthalmia Neonatorium 1 - - - 1 " 1 - 3 - 3 TOTALS 492 475 238 204 154 140 21 17 906 835 1,741 33 NOTIFICATION OF INFECTIOUS DISEASES - AGE DISTRIBUTION Age Group Scarlet Fever Whooping Cough Measles Dysentery Acute Meningitis Infective Jaundice Totals M F M F M F M F M F M F Under 1 year _ - 3 3 43 35 1 2 _ 3 _ - 90 1 year 1 - 3 4 134 116 1 3 1 - - - 263 2 years - 1 146 110 3 4 2 2 - • 268 3 years 2 4 6 10 127 145 3 4 1 - 1 1 304 4 years 3 6 103 101 2 1 1 - 217 5-9 years 11 11 4 6 218 191 11 4 - 1 2 3 462 10-14 years 2 - 1 - 10 21 4 - - - 8 1 47 15-24 years 3 1 - - 6 6 - 5 2 - 8 4 35 25 years and over 1 1 - - - 4 1 7 1 - 9 5 29 Age unknown - - - - 2 3 - - - - - 2 7 TOTALS 23 24 17 23 789 732 26 30 8 6 28 16 1,722 34 NOTIFICATION OF INFECTIOUS DISEASES - AGE DISTRIBUTION (Contd.) Age Group Malaria Paratyphoid Fever Food Poisoning Typhoid Fever Ophthalmia Neonatorum Totals M F M F M F M F M F Under 5 years _ _ _ - 3 _ _ - _ - 3 5-14 years - - - - - - - - - - - 15-44 years - - 1 - 5 2 - 1 - - 9 45-64 years * - - - - - - - - - - 65 and over - - - - 1 - - - - - 1 Age unknown 1 2 - - - - - - 3 - 6 TOTALS 1 2 1 - 9 2 - 1 3 - 19 GRAND TOTAL 1,722 19 1,741 35 NOTIFICATIONS OTHER THAN TUBERCULOSIS The number of notifications received during the year increased by 367; 1,741 cases of infectious disease being notified compared with 1,374 in 1968. No cases of poliomyelitis or diphtheria occurred. TYPHOID FEVER On the 8th June, Mrs. M. left Bombay and arrived at London Airport the next day. She had recently married and came to Lambeth to join her husband's family. A celebration party was held on the 14th June. Mrs. M. felt unwell on the 22nd June and was admitted to hospital on the 30th. On the 8th July information was received that she was suffering from typhoid fever. From her arrival in this country the patient had had little contact with persons other than her family and friends at the wedding party. Among these were some who had previously suffered from typhoid fever and who might have been carriers of the disease. All specimens proved negative however and it was assumed that the patient had contracted the infection abroad. No secondary cases occurred. PARATYPHOID FEVER Mr. R. visited Spain on holiday and returned on the 27th July. He was taken ill on the 3rd August and was admitted to hospital on the 11th. Three days later the laboratory confirmed the presence of salmonella paratyphoid B. phage type Beccles in the patient's stool. Mr. R. had spent a few days at work, visited friends and stayed overnight with his parents in Wales before his admission to hospital. All known contacts were traced and investigated but no secondary cases occurred. MEASLES There was an increase in the incidence of measles, 1,521 cases being notified compared with 900 in 1968. The majority of the cases occurred in the first quarter of the year. SCARLET FEVER Forty-seven cases were notified compared with 56 in 1968. 36 WHOOPING COUGH There was a reduction in the number of cases notified, 40 compared with 94 in 1968. DYSENTERY Fifty-six cases were notified - a reduction of 86 on last year. ACUTE MENINGITIS Fourteen cases were notified, compared to 4 cases in the period 1st October to 31st December, 1968. INFECTIVE JAUNDICE Forty-four cases were notified, compared to 56 cases in the period 15th June to 31st December. 1968. MALARIA Three cases were notified. OPTHALMIA NEONATORUM Three cases were notified compared to one in 1968. FOOD POISONING 24 cases, notified (11) or otherwise ascertained, were investigated. Following a party at Sunbury a general outbreak of S. VIRCHOW occurred leading to four cases in Lambeth. A similar outbreak originating in Dorchester resulted in two cases of S. IRANGI. The remaining 18 cases were sporadic, 2 due to S.typhi-murium, 14 to other salmonellae and 4 in which the cause was unknow. SALMONELLA INFECTIONS (NOT FOOD BORNE) Two family outbreaks involving 5 persons and 4 sporadic cases were due to S. TYPHI-MURIUM. One family of two persons and six sporadic cases were due to other salmonellae. 37 SALMONELLA INFECTIONS (NOT FOOD BORNE) INCIDENTS AND CASES Causative agent GENERAL No. of separate outbreaks OUTBREAKS No. of cases notified or ascertained FAMILY No. of separate outbreaks OUTBREAKS No. of cases notified or ascertained SPORADIC CASES Notified or ascertained TOTAL No. of outbreaks and sporadic cases columns (1+3+5) TOTAL No. of cases columns (2+4+5) 1. S. typhimurium 1 2 3 2 4 5 5 4 6 6 7 9 2. Other Salmonellae (a) 1 2 6 7 8 3. TOTAL 3 7 10 13 17 DETAILS OF SALMONELLA INFECTIONS DUE TO SALMONELLAE OTHER THAN S. TYPHIMURIUM (NOT FOOD BORNE) Type of Salmonellae Heidelberg 3 3 3 Virchow 1 2 2 3 4 Un-named 1 1 1 TOTAL 1 2 6 7 8 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 1 year 1 - - - - - 1 2-4 years 1 1 - - - - 2 5-9 years - 1 - - - - 2 10-14 years - 1 - - - - 1 15-19 years 3 1 - - - - 4 20-24 years 2 1 1 - - - 4 25-34 years 12 4 7 2 - - 25 35-44 years 11 1 2 3 - - 17 45-54 years 8 2 - 1 - - 11 55-64 years 8 3 1 2 - - 14 65-74 years 6 6 1 1 - - 14 75 and over 3 - - - - - 3 Age unknown - - - 1 - - 1 TOTAL 55 21 12 11 1 - 100 Male Female Cases of fatal tuberculosis not 3 notified before death. I am indebted to Dr. C.F. Price for the following report on the work of St. Francis' Chest Clinic for the year:- REPORT ON CHEST CLINIC WORK 1969 "The following tables are extracts from the Annual Return of Chest Clinic work as now prepared for the Department of Health and Social Security. It includes cases with evidence of tuberculosis not notified under the Tuberculosis Regulations but requiring Chest Clinic observation and advice. 39 TABLE 1: Number of cases of Tuberculosis (whether notified or not) under treatment, supervision, or observation at 31st December, 1969. Men Women Children Total Number of cases (including both out-patients and in-patients). Respiratory 592 401 13 1,006 Non-Respiratory 22 18 - 40 TOTAL 614 419 13 1,046 Number of cases included above whose broncho-pulmonary secretion was positive during the year 24. 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, 1969. Men Women Children Total Group 1 11 6 3 20 Respiratory Non- bacteriologically confirmed. Group II 8 2 - 10 Group III 2 - - 2 TOTAL 21 8 3 32 Group I 1 1 - 2 Respiratory Bacteriologically confirmed. Group II 8 1 1 10 Group III 1 - - 1 TOTAL 10 2 1 13 Non-respiratory 3 2 - 5 TOTAL NEW CASES 34 12 4 50 Whilst these tables give a picture of Chest Clinic work the incidence of new infectious 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. Most 40 cases of tuberculosis are now diagnosed following hospital attendance for examination and investigation and it is becoming customary for hospital medical officers to defer notification until the diagnosis and the presence of infection has been confirmed bacteriologically by examination of sputum or other pathological specimen. This is reflected in a fall of the total notified cases as compared with previous years although, as will be seen from Table 4 there has been an increase in the number of newly diagnosed cases added to the clinic register in the year. TABLE 3: ###] [Respiratory Tuberculosis Non-Respiratory Tuberculosis Number of cases diagnosed during the year 1969 Men Women Children Total Men Women Children Total 10 2 1 13 4 1 - 5 Deaths 6 1 - 7 - - - - Deaths: There were 7 deaths among chest clinic patients directly attributable to tuberculosis - as low a figure as ever previously recorded. All were respiratory cases and all were more than 60 years old. There was only one female death and this in the case of a patient age 65 years who had extensive lung damage as the result of tuberculosis recurring over the previous forty years. Of the 6 men all but one were over 65 years old and age changes played a contributory part in the cause of death. Two were residents in the Council's hostel for tuberculosis men at Knight's Hill and both these men had developed tuberculosis infection resistant to standard treatment. One was however over 82 years of age. The other male deaths, as in recent previous years, also reflected the problems now arising from the onset of drug resistance and neglect in old age as a contributing cause of death. There were 25 other known deaths among chest clinic patients including 8 due to cancer of the lung. The majority of deaths however were due to age and cardiovascular diseases. 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 1969 * 1,046 50 7 * Includes observation cases. Tuberculosis Incidence: There was a decrease in the incidence of tuberculosis and the total number of 18 newly notified cases with confirmed infectious disease, added to the clinic register in one year, is the lowest recorded. Of these, 5 were of English racial origin, 5 West Indian, 2 African, 1 Indian and 1 Burmese. As in previous years the male incidence was considerably higher than the female - of the 18 cases, 14 were men, 4 women. Treatment: The majority of patients were given anti-tuberculosis chemotherapy at home and where necessary the services of the district nurse were called upon to give injections. A minority of patients suffering from severe infection and in need of in-patient care and others with an inadequate social and domestic background were admitted to hospital for an initial period of treatment. An average of five tuberculosis beds were kept occupied in Dulwich Hospital during the year. 42 B.C.G. Vaccination: The Chest Clinic service offers B.C.G. Vaccination against tuberculosis to contacts at special risk and who have missed or are not old enough to qualify for vaccination under the School Medical Service B.C.G. Scheme. During the year, 91 such vaccinations were performed at the Chest Clinic. Home Visiting: The Council provides the services of one full time tuberculosis Health Visitor with office accommodation at the Chest Clinic giving access to patients records and facilities for discussion of case problems with the Chest Physician." 43 Section C Personal Health Services 44 PERSONAL HEALTH SERVICES MATERNITY AND CHILD HEALTH SERVICE There are fourteen Maternity and Child Health Centres in the Borough, some in purpose-built or adapted accommodation and others in rented premises. Because of the difficulty in persuading mothers living in Ferndale Court, Ferndale Road, S.W.9. to bring their children to the Rose McAndrew Centre, the Committee agreed to the provision of a branch clinic in a ground floor flat at Ferndale Court, rented from the Housing Department. Sessions to be provided at the clinic include child health, vaccination and immunisation, cervical cytology and family planning. Mothers attend at child health centres with infants from the age of two weeks for the purpose of getting advice from health visitors and clinic doctors about mothercraft and care of their children and for routine developmental examinations by clinic medical officers. Mothers may attend as often as they wish but are invited to attend for routine developmental examinations at three monthly intervals for the first year. Thereafter, they should attend at six monthly intervals until the child's second birthday, after which they should attend at least once yearly for medical examination. As required, children are referred for further developmental examinations to the Borough's Developmental Clinics held at selected child health centres where they are seen by specialists in developmental paediatrics, who refer them to assessment centres, if necessary, or continue to keep them under supervision. Other services available for children at the centres include routine prophylaxis against smallpox, diphtheria, whooping cough, tetanus, poliomyelitis and measles, as well as creche facilities. For mothers, ante-natal and post-natal, cervical cytology and family planning clinics and health education are provided. At two centres evening child health clinics are provided for working mothers. Health visitors working from the centres visit mothers and children under five in their homes, as well as other members of the family, and including old people whether as part of a family unit or living alone. Mothers and families know the health centres as a focal point where they can contact the health visitor and visit at intervals for consultation with the clinic medical officers. 45 Priority Dental Treatment Dental treatment is provided for expectant and nursing mothers and children under five years; the attendances being 22 and 553 respectively. The service is provided in conjunction with that for school children, combined use being made of the staff and premises. Screening for Phenylketonuria All new-born babies have a screening test at the age of six days, using the Guthrie method, for the detection of phenylketonuria. This is normally carried out in hospital on babies born in hospital and by domiciliary midwives on children born at home and on those babies discharged from hospital before six days. This test is used to detect the presence of phenylketones in the blood which result from a metabolic disorder which if left untreated may lead to mental subnormality. Positive cases can be referred to hospital for treatment and development is then normal. There were 72,211 attendances at child health and toddlers' sessions and 1,661 attendances at ante-natal and post-natal clinics sessions. The Council provides facilities at some centres for general practitioner obstetricians to see their own booked maternity patients and 268 such sessions were held during the period. Creches at which mothers may leave their children for the duration of the session (normally 3 hours) are held in many child health centres. There were 1,428 sessions during the period at which 17,871 attendances were made. CHILD HEALTH CENTRES Number of children attending during the year - Born in 1969 4,743 Born in 1968 5,139 Born in 1964-1967 5,758 Total 15,640 46 Number of sessions held during the year by Medical Officers 323 Health Visitors 3 Sessional General Practitioners 2,452 Hospital Medical Staff 52 Total 2,830 Number of children referred elsewhere 885 Number of children on "at risk" register at the end of the year 549 CERVICAL CYTOLOGY SCREENING SERVICE This service was established in 1966 with two weekly clinics for well women over 35 who were resident in Lambeth. During 1967 and 1968 increased pathological facilities became available so that in 1969 five clinics were held every week, three of which were evening clinics. Women of any age who live or work in Lambeth may attend and are actively encouraged to do so by health visitors. Some excellent publicity leaflets and posters have been provided by the Women's National Cancer Control Campaign and the Council for Health Education. Only ten appointments are made for each session so that in addition to the smear test each patient has a urine examination, a full gynaecological examination, and examination of the breasts to screen for early breast cancer. Our doctors instruct each woman on how to examine her own breasts and there is time also for discussion of marital problems, if required. The family doctors are informed of all results, whether negative or positive, and patients are invited to have a second test after 3 years. In 1969 a start was made on re-testing those women who had had their first smear test in 1966. In 1969 although 2,257 women asked for appointments only 1,749 actually attended for examination in the Lambeth clinics. About nine times this number, however, had smear tests from other agencies, i.e. hospital gynaecological departments, general practitioners, and family planning clinics. 47 The incidence of cancer of the cervix is highest in women over 35 and in social classes IV and V. This borough in common with most local authorities in South-East England is reaching about half to two-thirds of the target figure needed for effective screening in numbers of women tested, but the women at greatest risk are not coming forward. Only 20% of women over 35 are being screened, and many of those in social classes IV and V are reluctant to have this examination. It is hoped that some of the high risk women will be reached early in 1970 when a clinic will be started in one of the blocks of flats used for temporary accommodation of homeless families. Clinic Number called Number examined Results Negative Positive Retaken Riggindale 511 409 368 3 37 South London Hosp. 511 413 360 - 53 Moffat 213 143 120 2 21 West Norwood 459 383 365 - 18 Loughborough 559 401 375 6 19 TOTAL 2,253 1,749 1,589 11 148 (Sgd) Dr. M.P. Elman, Senior Medical Officer FAMILY PLANNING The main bulk of the family planning services in the Borough is provided by the Family Planning Association, acting as the Council's agents. Since July 1969 the Council has made a grant to the Association to cover the whole cost of providing the service to Lambeth residents. The Association also provides training for the doctors, nurses, and layworkers who man the clinics. Premises, heating, lighting, cleaning, and a certain amount of equipment are provided in Lambeth by the Council, while the Family Planning Association provides trained medical and nursing staff for examination and advice, secretarial staff, and contraceptive equipment and supplies. Patients are referred to the 48 clinics by hospitals (after confinement or gynaecological treatment), health visitors, their family doctors, or by friends and neighbours. By the end of 1969 there were seven centres in the Borough, three in hospital premises and four in local authority centres. Some centres have several sessions a week and some have "double doctor sessions" so that in 1969 there were no less than 1,025 doctor sessions. In addition, about 200 new cases and 800 re-attendances were seen at the twice weekly birth control clinics which are held at King's College Hospital and provided by the International Planned Parenthood Federation. We have no way of knowing how many women seek advice on family planning from their own family doctors, but the number must be considerable. A great step forward was taken when Lambeth Council implemented the National Health Service (Family Planning) Act of 1967 in July 1969. This Act enables local health authorities to provide free consultation for all and free supplies for those referred on medical grounds and in necessitous cases. Since July 1969 no Lambeth resident has paid a fee for birth control advice at F.P.A. clinics. Supplies must still be paid for except in medical and social cases. It is interesting to note that all clinics in the Borough were busier during the last five months of 1969 and there was an increase of fifteen per cent in new patients recorded for the year, as compared with a drop of two per cent reported in 1968, and the total number of patients seen showed an increase of seventeen per cent for 1969. More sessions are held in the evenings (when clinic premises are not being used for child health clinics) than in the daytime. This arrangement satisfactorily meets the needs because many women are working and so prefer to attend evening sessions. (Sgd) Dr. M.P. Elman Senior Medical Officer DOMICILIARY SERVICE Although clinics are provided in the borough at different times of the day, there will always be some women who because of difficult home circumstances, cannot attend. Many of these women have large families and tend not to be able to care adequately for them. In August 1968 it was arranged for the F.P.A. to start a domiciliary family planning service for a few selected cases, the cost being met by the Council. The following referrals have been selected ar random from the records. (1) "Mrs. X age 24, has 5 children. Family living in one room. Family Planning has been discussed before but Mrs. X finds it too difficult to get to a clinic." 49 (2) "Mrs. Y age 43. Mr. Y is having psychiatric treatment and is of little help to his wife. She has been meaning to get Family Planning advice but never gets round to it. Although there are only two children, this couple could not cope with another child at present." (3) "Mrs. Z age 27, has had four children and is constantly changing cohabitees. Living on Social Security." Referrals are usually made by the health visitors although family doctors, probation officers, child care officers, or personnel in statutory or voluntary welfare services may contact the Health Department with requests for home visiting. A specialist team of doctor and nurse is available. The doctor will contact the family doctors and ask permission to visit his patient. Both the family doctor and the referring agency will be informed of the outcome. After the F.P.A. doctor's first visit the domiciliary nurse will take over until the doctor's next visit. Visits will continue until the patient is able to accept and become established on the method most suitable for her and her husband. 150 families had been visited by the end of 1969. The cost of the domiciliary service is £10 a year per family. (Sgd) Dr M P. Elman Senior Medical Officer The Principal Nursing Officer, Miss E. Early, reports as follows HEALTH VISITING Due chiefly to the Department's Sponsorship Scheme for health visitor students the improvement in staffing achieved in 1968 was maintained throughout the year. Fourteen students successfully completed their training in September and joined the staff as qualified health visitors. Ten new students commenced training at the same time. This improvement made it possible to reduce case loads and widen the scope of the work. An increased number of staff now undertake combined school nursing health visiting, concentrating on the primary schools, and particularly on the younger children. This in turn has extended the scope of health education in primary schools and has also resulted in an improved immunisation state in the schools concerned and greater stability in staffing. There was an increase in visits to the elderly and to the mentally ill and handicapped. The tendency continued for an increase in requests for advice by telephone and also in the numbers of callers at child health centres at other than recognised clinic session times. 50 Extra curricular activities of health visitors included both sound and vision broadcasting, and teaching at Technical Colleges and Colleges of Further Education. Changes forecast for the future indicate that there may be greater demands on the health visitor. There is an increased awareness on the part of family doctors of the contribution being made to their patients' well-being by the Local Authority nursing services, and there is every indication that if the staffing situation remains favourable attachments of staff to general practices will be the developing pattern, co-existing with the present pattern of work. No matter where children under the age of 5 years are cared for it is the responsibility of the health visitor to keep an eye on their health, both mental and physical, and in the foreseeable future she will still be the most readily available source of help to mothers in time of stress. Ancillary Staff Clinic auxiliaries and clinic nurses make a valuable contribution to the nursing services. They enabled health visitors to be relieved of duties which do not require their specialised training. After a period of in-service training, the majority of clinic nurses become school nurses, and undertake duties offering greater responsibility and scope. There are always a number of student health visitors sponsored by the Borough who originally commenced as clinic nurses. Health Visiting and Midwifery Students A total of 17 health visitor students from Borough Polytechnic, the University of Surrey and Croydon Polytechnic received their practical training in the Borough. In addition to Part II Student Midwives placed for three months, an additional 24 student midwives were given generalised experience in the Community Health Services. Other Students and Visitors to the Department Requests for visits of observation and facilities for practical work placement of students continued to increase. Periods involved varied from single visits to programmes of several weeks. 51 The largest single group of students was hospital student nurses. Facilities were provided for over 600 student nurses during the year. These visits have been included in nurse training for a number of years with the object of giving students some insight into the social aspects of disease. The new General Nursing Council syllabus will increase the amount of time allocated to this aspect of nursing. Students who visited the nursing services included students studying economics, social sciences, teaching, child care and speech therapy. Overseas visitors came from all continents excepting Antarctica. Every effort is made to make visits as interesting and instructive as possible, but the time involved is steadily increasing. HEALTH VISITING Cases visited by Health Visitors Children born in 1969 5,691 Children born in 1968 6,078 Children born in 1964-67 14,625 26,394 Persons aged 65 and over 227* Mentally disordered persons 413 Persons, excluding Maternity cases discharged from hospital (other than Mental Hospitals) 94+ Number of Tuberculous households visited 7 Number of households visited on account of other infectious diseases 94 Other cases 4,406 Number of Tuberculous Households visited by Tuberculosis Visitors 421 Total number of effective visits and re-visits 82,252 Total number of unsuccessful visits 17,542 52 * Included in this figure are 37 persons who were visited at the special request of the general practitioner or hospital. t Included in this figure are 38 persons who were visited at the special request of the general practitioner or hospital. + Included in this figure are 25 persons who were visited at the special request of the general practitioner or hospital. Domiciliary Midwifery The number of home confinements has continued to decline, and at the same time the number of early discharges from hospital has continued to increase. This position should level off in the near future, assuming that there will always be a number of women who prefer to have their babies at home. In September the General Practitioner Obstetric Unit at the Weir Hospital opened. This enabled general practitioner obstetricions and local authority midwives to look after their patients during labour, and arrange for planned discharge within a period of up to 48 hours. The Weir catchment area includes a part of Wandsworth in addition to a small area of Lambeth. The scheme provides a service which has the advantage of giving the mother the protection of hospital confinement, and the benefits of a much shorter separation from her family, with continuity of care throughout, by the same medical and midwifery staff. Early in the year the Guthrie Test replaced the Phenistix test for phenylketonuria in part of the Borough, and had extended to the whole area by the end of the year. Domiciliary midwives took over the responsibility for following up hospital confinement cases where for some reason a re-test was required. At the end of the year there were nine midwives directly employed; the Lambeth District Nursing Association and the South London Hospital continued to provide a service on an agency basis in parts of the Borough, and participated in providing 24 hour coverage. It is worth recording that there was a number of home confinements sufficient to provide the required experience for 36 student midwives from Kings College Hospital and South Western London Hospital Group during the year. The 24 hour supervision of the service shared with the Boroughs of Southwark and Wandsworth through the Lambeth Emergency Control Service continues to work satisfactorily. 53 DOMICILIARY MIDWIFERY Attendance by midwives Confinements Doctor not booked 22 Doctor booked 421 Number of hospital cases discharged to midwife before tenth day 784 ANTE-NATAL AND POST NATAL CLINICS Number of Sessions held by Medical Officers 3 Midwives 14 Sessional General Practitioners 208 Number of women attending for ante-natal examination 580 Number of women attending for post-natal examination 34 Mothercraft and Relaxation Classes Number of women attending (a) Hospital booked 55 (b) Domiciliary booked 36 Total 91 Total number of attendances 836 MIDWIVES ACT, 1951 The Council is the supervising authority for all midwives practising in the Borough under the Midwives Act, 1951. During the year 283 midwives notified the Council of their intention to practise in the Borough. 54 HEALTH EDUCATION Looking back, 1969 was a year of expansion. The Health Education Working Party met monthly under the Chairmanship of the Assistant Principal Nursing Officer having responsibility for this aspect of the work. The Committee planned programmes and selected posters and pamphlets to fit in with monthly topics featured throughout the borough. Centres arranged displays and exhibitions and group talks on the selected topic. Much of the display material was original being devised and made by the staff concerned. Mothers Clubs in child health centres continued to grow in size and number, providing a valuable medium for health education as well as being a useful form of group therapy. Five centres now have regular meetings. Arrangements were made for small children to be looked after while their mothers joined in the group activities. Midwives and health visitors co-operated in providing ante-natal classes and health visitors have continued to visit the South London Hospital to participate in classes for expectant mothers. Other audiences included Mothers Clubs in various settings, guides, brownies, young wives, expectant mothers, schoolchildren and students. Venues included schools, colleges of further education, churches, mother and baby homes, out-patients departments, childrens homes and hostels for working adolescents. Topics included the danger of drugs, sex education, family planning, first aid, home safety, child care, road safety and personal hygiene. To meet a request by a member of the Inner London Education Authority staff facilities were made available for the photographing of the Council's health services in action. As a result we acquired an interesting and attractive set of slides which have already proved their worth as visual aids. We are grateful for the loan of extra equipment by the Public Relations Officer and for the help given by the Safety Officer. 55 57 DAY NURSERIES - 1969 The ten day nurseries in Lambeth provided excellent care from 7.30 or 8 a.m. to 6 p.m. daily for 596 children with special needs (social and/or medical), and there continued to be a waiting list for this service. Requests came mainly from health visitors, child care officers and an increasing number from hospitals. During the previous year, provision was made for some children to attend part-time at five nurseries, to give the equivalent of an additional 60 places and so lessen the waiting list. Unfortunately it was found that in one nursery full use was not being made by the parents of the part-time unit, and so it was decided to revert to full time placements. Many emergency places were provided for children to prevent their reception into care. It is unfortunate to find a growing number of families where mother has deserted and father is struggling to keep the family together. Each nursery accommodated a few handicapped children and it was encouraging for the staff who worked tremendously hard with these little ones to see in some cases great improvement, which enabled the children to go on to special or even ordinary schools. Tulse Hill Special Unit continued to provide good day care for nine severely handicapped children. The staff in the Unit has given devoted service in the work that needs great patience and understanding. The staffing situation fluctuated throughout the year. Although there were times when a full staff was achieved, the turnover remained high, mainly because of the high number of young girls who want to move to other types of nursery work to gain experience. There was a large number of applicants for the 30 Nursery Nurse Training places, which enabled candidates to be carefully selected, thus reducing the number of failures. 21 students who sat for the N.N.E.B. examination during the year passed, and three went on to take nurse training. Several staff, having had a few years nursery experience since qualification, went to refresher courses, and ten attended a most useful and interesting week's course on the Immigrant Child. The speakers were from Commonwealth and other countries and each talked of the history and culture patterns of his own land. Two matrons attended the Annual Conference of the National Association of Nursery Matrons at Llandudno, when the theme was "Children in the Social Structure of Today", and two staff attended a useful course at Bristol on the Handicapped Child. 58 A study day on the subject of play was organised for all nursing staff. The nursery nurses exhibited creative work done by the children and toys which could be made from a variety of things which would normally have been thrown away. Two of the staff gave an excellent talk on the use of junk as play material for the under 5's. In recent years it has become increasingly difficult to obtain cooks for work in day nurseries. A good cook is of the utmost importance since she relieves Matron of much worry. Having been without a cook for three months in one nursery, it was decided to try using frozen foods. This meant a less highly skilled person was required in the kitchen and domestic staff could be reduced. The foods have been most successful, and enjoyed by both children and staff. The variety and palatability as well as nutritional value are excellent. Night cleaning was extended and is now in operation in five nurseries. This avoids the problem of having the floors cleaned whilst children are at the nursery, as well as meeting the difficulty of recruitment of suitable domestic staff. Apart from students, there was several hundreds of visitors to nurseries during the year. These included people from overseas, health visitors, nurses, midwives, and speech therapy students, teacher trainees, schoolgirls, potential playgroup leaders. Help was given to several students doing projects on children under 5. The year ended with Christmas parties in all the nurseries, which were made to look most attractive through the enthusiastic efforts of the staff and the children, and the parties were very much enjoyed by all. DAY NURSERIES Nurseries maintained by the Authority or by Voluntary organisations under Section 22 of National Health Service Act 1946 Day Nurseries Part-time Nursery Groups Number at end of the year 10 5 Number of approved places 527 60 Average daily attendance 509 - Number of children on register at the end of the year 579 108 59 60 61 CHILD MINDERS The beginning of the year saw a positive deluge of names and addresses of would-be registered child minders - proof that the publicity posters and cards in shop windows announcing the implementation of the Act had not gone unnoticed. Initial applications and inquiries totalled nearly 700. Visiting them would be a formidable task indeed, and it was with relief that we welcomed an additional Nursing Officer. Of 507 applicants visited during the year 272 had either moved, gone to work, or were persuaded to cease minding. It is interesting to note that a number of minders requested registration only to legalise their caring for the child of a friend; they had no wish to continue when this child left them. Of the remainder, only a relatively small percentage qualified for immediate recommendation to the Committee for registration. The rest needed to comply with safety regulations before such recommendations could be put forward - and getting fireguards fixed during a long hot summer proved to be no mean task; many applicants required several visits before registration could be recommended. In a Borough with a population coming from such a wide range of backgrounds, standards must be flexible. Where a child is happy and well cared for the aim has been to raise the standard of care rather than reject the application. Experience has shown that only by constant supervision can these standards be maintained, and the questions of diet and the concept of play are two factors where a change of attitude can only be encouraged by regular visiting - a task that has been undertaken by the health visitors, who in many cases have already formed relationships with the child minders on which they can build. Nevertheless it is felt that it is necessary to "educate" Child Minders in a more formal manner, and it is proposed to arrange visits of small groups to day nurseries and centres during the coming year. DAILY MINDERS AND REGISTERED NURSERIES Nurseries and Child Minders Regulation Act 1948 Number of Premises registered at the end of the year 41 Number of places 995 Daily minders registered at end of year 101 Number of children minded at end of year 333 62 TOYS PROJECT We have long been aware of the need of many children in the Borough for the stimulation of play, and it was hoped that we could be able to demonstrate this need through the child minders. An invitation to a member of the Health Department from the Divisional Education Officer to sit on a committee to discuss how to introduce toys into the homes was therefore most welcome. Examples of the types of toys that could be produced in the craft classes at school were shown to us, and it was decided to request constructive, unbreakable wooden play material that was not bulky and would therefore not cause any mess or take up too much room. It was suggested that they be introduced on loan as an educational aid, and that a pilot scheme be undertaken by Loughborough Child Health Centre, the supervising health visitor to report on the reaction of the child minder, the children, and, indeed, the parents. The Council was prepared to make a grant to the project to cover the cost of materials, and it is hoped that the resultant awareness of the need for play by the pupils who will make the toys will help to alleviate the problem in the next generation. REGISTERED PLAY GROUPS Registered Play Groups made a considerable contribution to the facilities for the pre-school child. During the year 3 meetings of leaders were held, one to discuss the Borough's Sponsorship Scheme, the other two to enable nursing officers and play group leaders to discuss matters of mutual interest. At each of these meetings a film was shown, following a lively and frank exchange of views. The willingness of play group leaders to accept children who need special help has been appreciated by not only the mothers and children, but also the medical and nursing personnel in the Health Department and Hospitals who are concerned with their progress and development. Without these groups, over 1,000 children would have been deprived of the opportunity of group play and of learning to use material and facilities not available in their own homes. Financial aid has been given in a variety of ways; grants for play equipment, deficiency grants, sponsorship of children and payment of fees for training staff. IN SERVICE TRAINING Training programmes were arranged for all staff for whom the Medical Officer of Health has responsibility. 63 For the first time outside visits of interest were included in the home help's programme. Particularly popular were the visits to Occupational Therapy Department of King's College and St. Francis Hospitals. Their courses had a final "Any Questions" session and the questions asked revealed a deep understanding and sympathy for the problems of the recipients of the service. Two study days were arranged for nursing staff; one on Play and the other on Health Education in schools. At the "Play" day, the slides made for use as visual aids were shown. The Children's Librarian spoke on "Books for Young Children". Numbers of day nursery staff provided an exhibition of toys made from junk. All members of nursery staff, and a number of outsiders interested in the subject were able to attend for some part of the day. At the invitation of the Children's Officer, a member of health visiting staff took part in the training of housemothers at Shirley Oaks. Nursing Officers have participated in courses arranged by the London Boroughs Training Committee, and have given talks on careers in nursing in Secondary Schools. OBSERVATION/HANDICAP REGISTER OF CHILDREN AGED UNDER FIVE YEARS Handicap is regarded as a disability which permanently or for a substantial part of a child's life interferes with his growth, development, activity and social adjustment. The Observation/Handicap Register is not a list of medical handicaps but a living, ever changing record/index of children in their particular social and family setting who have emotional, mental and physical disabilities. Their basic needs are just the same as those of any other children and any other families, but specific needs are greater because they have to strive harder. The general aim of Observation/Handicap Register for children aged under five is to co-ordinate all services available for the handicapped child, local and national, statutory and voluntary, medical, social and educational. The specific aims are Early identification of a handicapped child Full medical and social assessment Early and appropriate treatment Guidance and assistance for parents and the family Follow-up and re-assessment Appropriate educational treatment. 64 Very few children indeed have only one handicap. The majority have two or more, some of which are secondary - "a handicap breeds handicaps". The main handicap is usually obvious; the others are generally less obvious and, therefore, may be missed, but are as detrimental to the child's future as the main handicap if not dealt with. The analysis of information obtained from the Observation/Handicap Register provides valuable indications as to what improvement should be made in all the services for handicapped children and stresses priorities. It may also suggest ways for better deployment of professional workers (of whom there is a great shortage). The Observation/Handicap Register for under fives in this Local Authority was made the responsibility of a Senior Medical Officer on whose medical judgement based on evidence obtained, the child's name is entered on the Register. A continuous review of information and a continuing assessment enables appropriate recommendations to be varied and a considered decision reached before final removal from the Handicap Register. Every case submitted for entry into the Observation/Handicap Register has to be confirmed by the diagnosis of a Hospital consultant. Not all children on the Observation/Handicap Register require the same degree of care; not all of them remain on the Register for the same length of time. All of them, however, require a great deal of thought and time for the right decision to be made. The following information has been obtained from analysis of the Observation/Handicap Register 65 Number of Children on Observation/Handicap Register (as at 30th May 1969) in Areas of Maternity and Child Health Centres TABLE I Welfare Centre area Number of handicapped children on 30th May, 1969 No. of battered babies Rate per 1,000 Clapham 39 (2) 11.8 Loughborough 68 – 16.8 Moffat 41 (1) 25.2 North Brixton 32 (2) 16.7 Riggindale 40 (2) 19.2 Rose McAndrew 56 – 13.9 Royal Street 8 – 12.5 St. Anne's 12 – 10.3 Streatham Hill 58 (5) 14.5 Tulse Hill 51 (2) 15.4 West Norwood 45 (1) 13.9 TOTAL 449 (15) 15.5 Number of Children Under the Age of Five with Different Handicaps TABLE II physical handicap(s) Physical handicap & mild mental retardation Physical handicap and severe mental retardation Severe mental retardation predominantly Only mild mental retardation 256 29 39 71 54 66 The Most Common Physical Handicaps Found Among Severely Mentally Retarded Children Under Five TABLE III Defect Number Incidence per /100 S.M.R. M F Total Cerebral palsy 6 10 16 14.5 Deaf 1 2 3 2.5 Mongol 19 28 47 42.8 Lack of speech 6 8 14 12.7 Congenital heart malformation 4 8 12 10.9 Blind 2 3 5 44.5 Visual defect 8 7 15 13.6 General convulsions 6 8 14 12.4 Congenital malformation of urinary tract 5 5 10 9.1 67 Severely Mentally Retarded Children Under Five According to Maternity and Child Health Centre Areas TABLE IV Welfare Centre Area Total S.S.N. Rate per 1,000 Clapham 14 4.2 Loughborough 11 3.2 Moffat 11 6.8 North Brixton 9 4.7 Riggindale 7 3.3 Rose McAndrew 17 4.3 Royal Street – – St. Anne's 5 4.2 Streatham Hill 14 3.5 Tulse Hill 12 3.6 West Norwood 14 4.3 TOTAL 110 3.8 It seems that the figures for severely mentally retarded children under 5 in Lambeth are higher than those estimated by A. Kushlik. TABLE V Actually in Lambeth Estimated for Lambeth All severely mentally retarded 110 108 Mongols 47 29 68 (A. Kushlik, "Method of Evaluating the Effectiveness of Paediatric Care for Severely Retarded Children, 1967). The files of children under five on the Observation/Handicap Register make sad reading: physical suffering, emotional deprivation, social stress, depressed and fatigued mothers, break down of families, gruesome housing conditions, and still inadequate provisions. DEVELOPMENTAL PAEDIATRIC CLINICS The needs for early diagnosis of a handicapping condition is well known. The need for assessment of what the child can do is not less important. The Developmental examination concerns itself with establishing whether the child is functioning on the level expected for his age. His hearing and vision, language and speech, drive and emotional characteristics, ability to learn and motor development, are tested and assessed. The age of children referred to Developmental Clinics varies from three months (the youngest patient) to four years plus. Children who are suspected of delayed development are referred to Developmental Clinics by the health visitors and clinic doctors. At these clinics they are seen by medical officers who are skilled in developmental assessments, by a consultant psychiatrist and a clinical psychologist. Further investigations, if required, are offered by Braidwood Audiology Unit, (I.L.E.A.) and by the appropriate consultants in hospitals. The social needs of children attending Developmental Clinic are sometimes even more pronounced than the developmental defect. A senior nursing officer in the Department and the senior medical officer responsible discuss and outline a plan of action in each individual case. LIAISON WITH TEACHING HOSPITALS A handicapped child needs comprehensive care. The close co-operation with hospital services is absolutely vital for the child's welfare. Queen Mary's Hospital for Children, Carshalton A senior registrar was seconded to this Department for one session per week, to assist with the problems of severely retarded children. Besides helping with individual cases, the registrar carried out a great deal of teaching of doctors and of social workers in the Mental Health Department and the Children's Department. 69 Manor Hospital, Epsom A Consultant Psychiatrist and her staff hold joint Development Clinics once a month with the Senior Medical Officer for specially selected children. King's College Hospital The S.M.O. is seconded from Health Department for one day per week for the purpose of teaching the medical students and carrying out Developmental Examinations of children attending King's College Hospital and Belgrave Hospital. Doctors working in Child Health Clinics attend teaching rounds, on a rota basis, in King's College Hospital and Belgrave Hospital. St. Thomas' Hospital Doctors from Child Health Centres participate in clinical rounds at St. Thomas' Hospital. IN-SERVICE TRAINING OF HEALTH DEPARTMENT STAFF IN DEVELOPMENTAL PAEDIATRICS Regular monthly meetings during lunch time were arranged for the purpose of studying the problems of a child's development, normal and abnormal. Films were shown and comments were given by a Consultant in Developmental Paediatrics and this was followed by a discussion on a variety of subjects, i.e. Mental Retardation, Lead Poisoning, Battered Babies, etc. A study group of Health Visitors and Clinic Doctors with theoretical and practical training in Developmental Paediatrics is to start soon under the guidance of a Consultant to Guy's Hospital. (Sgd) Dr. O. Nietupska Senior Medical Officer 70 SERVICE TO OTHER DEPARTMENTS Medical Examination of Staff In 1965 when the Personal Health Services, Welfare and Children's Department, came over to the Borough, the Health Department assumed responsibility for the medical examination and medical supervision of the staff of these and other departments in the Borough. All entrants who have not passed a Local Authority Medical Examination within the last 5 years are given a full medical examination, including chest X-ray either at the time of entry, or after a period of six months as appropriate. Their family doctor is informed of any significant findings. Staff at risk are advised to have full protection against diphtheria, poliomyelitis and small-pox, not only for their own safety but in the interest of the communities in which they work. Close liaison is maintained with heads of departments and the family doctors of sick staff so as to ensure their fitness to resume work and, where possible, to adapt the work situation to meet the needs of the individual concerned. The underlying concept is that of a preventive health service in which examination of entrants provides a screening service for each employee, and evaluation of their medical suitability for the work to be undertaken, an assessment of fitness of sick staff to resume former employment; and also, where appropriate, adaptation of work situation or, if necessary, change of occupation. It is envisaged that this service should be extended so as to provide a more comprehensive and a more frequent screening cover with the object of maintaining a high level of health, job satisfaction, and efficiency amongst all employees. 71 Examinations carried out during the year numbered, 1,145. Details are given below:- Health Department 290 Children's Department 167 Welfare Department 237 Town Clerk's Department 44 Borough Architects Department 135 Borough Engineer & Surveyor's Department 134 Establishment Department 119 Libraries Department 12 Other Local Authorities 7 1,145 (Sgd) Dr. N.C. Walsh Deputy Medical Officer of Health Advisory Service to the Children's Department One senior medical officer in the department works in close liaison with the Children's Department in providing advice on the medical aspects of children in care. All residential nurseries, family homes and hostels belonging to the Children's Department are visited once or twice yearly in order to provide medical advice on health and hygiene generally and, in specific instances, advice on the care of children with special problems or handicaps. Discussion with the child's general practitioner, who is also the Visiting Medical Officer to the home, takes place at these visits and on other occasions as required. Measures to investigate and control any outbreaks of infection which may occur are taken in consultation with the Visiting Medical Officer and the local Medical Officer of Health for residential establishments situated outside the Borough. Child care officers have ready access to the senior medical officer for consultation, advice and guidance on any medical problems arising in the course of their work. The oversight of various medical reports of children fostered or boarded out, and medical reports on adoptions are the responsibility of this medical officer. She is also a member of the Children's Department's Adoption Panel and acts as the liaison officer with medical colleagues in other fields who 72 may be dealing with medical aspects of children in care. On matters of medical policy there is close consultation between the Medical Officer of Health, or his deputy, and the Children's Officer and Senior Officers in his department. (Sgd) Dr. N.C. Walsh Deputy Medical Officer of Health Advisory Service to the Welfare Department The many and varied activities of the Welfare Department include the provision of residential accommodation for the aged - healthy, infirm and disabled - and some young permanently disabled persons. Temporary accommodation is also provided for homeless families in primary and intermediate accommodation. Visiting Medical Officers who are also general practitioners to the residents are appointed to these various establishments by the Medical Officer of Health. A senior medical officer in the Health Department with a senior nursing officer pays periodic visits to these homes to supervise and advise on health and hygiene matters and on the general medical and nursing care of the residents. A screening audiometry service is provided so that residents who might benefit from hearing aids can be referred for specialist advice. Arrangements are being made for a local opticians to provide a service in homes, and a chiropodist visits the homes regularly to give necessary treatment. When dental treatment is required, residents go out to a local dentist. It is intended to provide child health clinics and other screening services in one of the Homeless Family Units, so enabling these families to benefit from the preventive services of which they would otherwise not avail themselves. A playgroup is already provided. (Sgd) Dr. N.C.Walsh Deputy Medical Officer of Health 73 PREVENTION OF BREAK-UP OF FAMILIES STANDING COMMITTEE FOR CO-ORDINATION The Committee met quarterly, twice under the Chairmanship of the Housing Manager, and twice under that of the Associate Town Clerk. Throughout the year, as in 1968, a high proportion of the Committee's time was given to the prevention of homelessness, particularly among those families with whom multiple debt is of long standing, has often become habitual, many of whom have already been through the homeless family cycle. Rent arrears, even of £50 and over, are usually only one item; twice as much again is often owed for H.P. (some of it subject to Court commital orders) and for electricity and gas, both frequently cut off following meter rifling, sometimes accompanied by illegal connection to main or landing supplies. The number of these hardcore persistent debt families is increasing, just as the total number of families who endanger their tenancies (largely through sheer irresponsibility towards rent) increases annually. The combined figures for Lambeth Council and Greater London Council tenants living in Lambeth who were notified to the Committee as in danger of eviction rose from 258 in 1968 to 338 in 1969. In July 1969 an Arrears Sub-Committee was therefore formed under the Chairmanship of the Associate Town Clerk, consisting of Assistant Chief Officers from the Children's, Housing and Welfare Depts., and the Principal Nursing Officer, with the Principal Social Worker (Health Services), who is Secretary to the Standing Committee, as Secretary. It should be noted that the bulk of the information concerning the families discussed by the Sub-Committee came from the health visitors and the School Care Organisation, who together have more comprehensive records of families with dependent children than any other service. Powers were delegated to the Sub-Committee to arrange for both casework and rent guarantees, and in November 1969, it was further agreed that the Children's, Health, Housing and Welfare Departments should each, on the recommendation of the Arrears Sub-Committee, accept five families at any one time, in addition to their normal caseloads, specifically for intensive visiting in the hope of establishing rent control. The main causes for arrears have been shown to be (a) extravagence and a poor perception of priorities on good incomes (several families in danger of eviction were running cars, had telephones, and carried heavy H.P. commitments on such items as washing machines, three piece suites and, in one or two cases even fitted carpets) 74 (b) bad budgeting on low incomes (expensive unnutritious diet, tinned food, bought pies, buns, crisps, excessive pocket money to children for sweets, ices, soft drinks; and 'fashion' clothes and shoes with no wear in them) (c) drink and gambling, often coupled, and often accompanied by very irregular employment, marital disharmony, and delinquency. A number of fathers in this group consider it simply not worth while to work "for fifteen bob a week", the difference between their earning capacity and what they can draw for Social Security for doing nothing. (d) drug dependence, steadily increasing in a number of forms; even when legally prescribed, drugs are becoming a factor which shows signs of competing with alcoholism in producing the really bedrock homes, stripped of all comfort, disorganised, dirty, the parents prone to violence, apathy or despair. To preserve a sense of proportion it is necessary to stress that though these "arrears" families present over 80% of the Standing Committee, Arrears Sub-Committee, and individual case conference work, they form only roughly 2% of the Lambeth population. During 1969 individual case conferences (more prolonged discussion than can be given at the Arrears Sub-Committee, with a greater number of activity involved workers present) were held concerning 98 families. These were requested by:- Lambeth Housing Department 43 Children's Department 22 Divisional School Care Organiser 8 Principal Nursing Officer 6 G.L.C. Housing Department 3 Welfare Department 3 Psychiatrists 3 Family Service Unit 2 Probation Service 2 Social Security 2 Health Services Caseworkers 2 Mental Health 1 Standing Committee 1 98 (Sgd) Miss M. le Kitchen 75 HEALTH SERVICES Family Caseworkers There are three full time family caseworkers in the Department and three I.L.E.A. school health social workers who do combined duties at school Clinics and with a limited number of problem families. 45 families were covered, having between them a total of 231 children. Referrals were from Case Conferences and from the Arrears Sub-Committee. The latter were families in danger of eviction and were initially taken on for 3 months' casework, but two proved to be long term cases; it is gratifying to note that none of the families were evicted, one cleared the rent completely; the rent was however only the presenting problem, and the caseworker is still working with the family because of the serious marital problems. The turnover in this type of casework is always slow. It takes time to form a working relationship with mentally subnormal or emotionally disturbed parents and once the caseworker has gained their confidence it is equally slow helping the family to make the best use of their capabilities and to modify their often aggressive behaviour towards those trying to help them. Co-ordination with Statutory and Voluntary Social Work Agencies is an important part of the caseworkers' role. Since taking on cases from this Arrears Sub-Committee there has been closer co-operation and co-ordinating between the Caseworkers and the Housing and Welfare Departments. Dr. Isaacs, Psychiatrist from the Maudsley Hospital, has had two hourly sessions every three weeks with the caseworkers and these consultations have been invaluable. He has been able to see some of the parents either at the Maudsley or one of his other hospital clinics when an emergency has arisen and in some cases this has prevented the breakup of a family. (Sgd) Miss T. Watts INTERNATIONAL CERTIFICATES OF VACCINATION Certificates of recent successful vaccination/inoculation are required by persons travelling to certain countries abroad. After completion by the vaccinating doctor (normally the persons's own doctor) the certificate must be taken or sent for authentication of the doctor's signature by the Medical Officer of Health for the area in which the doctor practises. 76 In Lambeth signatures on certificates are authenticated in the Health Department, Blue Star House, 234/244 Stockwell Road, S.W.9. Prophylaxis Vaccinnation and immunisation against certain diseases is undertaken both by the Council's doctors at maternity and child health centres and schools and by general practitioners. During the period the following numbers were protected against the diseases specified. Of the total of 53,295, 43,184 were vaccinated by the Council's doctors and 10,111 by general practitioners. Primary Reinforcing Smallpox Diphtheria Whooping Cough Tetanus Polio Measles 2,156 5,295 4,492 5,325 5,924 824 115 8,960 3,428 8,975 7,799 It is estimated that 74% of the population aged 0-4 had been immunised against diphtheria. 77 IMMUNISATION AND VACCINATION 1969 Immunisation: Completed Primary Courses — Number of persons under age 16 Type of Vaccine or dose Year of birth Others under age 16 Total 1969 1968 1967 1966 1962-65 1. Quadruple DTPP – – – – – – – 2. Triple DTP 1,640 2,594 167 46 34 11 4,492 3. Diphtheria/Pertussis – – – – – – – 4. Diphtheria/Tetanus 4 20 9 26 260 476 795 5. Diphtheria – – – – – 2 8 6. Pertussis – – – – – – – 7. Tetanus – – – – 4 34 38 8. Salk – – – – – – – 9. Sabin 1,613 2,654 232 134 535 756 5,924 10. Total — Diphtheria 1,644 2,614 176 72 300 489 5,295 11. Total — Whooping Cough 1,640 2,594 167 46 34 11 4,492 12. Total - Tetanus 1,644 2,614 176 72 298 521 5,325 13. Total — Poliomyelitis 1,613 2,654 232 134 535 756 5,924 14. Measles – 104 265 191 241 25 826 78 IMMUNISATION: REINFORCING DOSES - NUMBER OF PERSONS UNDER AGE 16 Type of Vaccine or Dose Year of birth Others under age 16 Total 1969 1968 1967 1966 1962-65 1. Quadruple DTPP – – – – – – – 2. Triple DTP – 1,083 1,872 153 267 53 3,428 3. Diphtheria/Pertussis – – – – – – – 4. Diphtheria/Tetanus – 13 59 54 3,098 2,230 5,454 5. Diphtheria – – 1 – 24 53 78 6. Pertusis – – – – – – – 7. Tetanus – 2 4 1 18 68 93 8. Salk – – – – – – – 9. Sabin – 1,053 1,825 184 3,138 1,599 7,799 10. Total — Diphtheria – 1,096 1,932 207 3,389 2,336 8,960 11. Total — Whooping Cough – 1,083 1,872 153 267 53 3,428 12. Total — Tetanus – 1,098 1,935 208 3,383 2,351 8,975 13. Total — Poliomyelitis – 1,053 1,825 184 3,138 1,599 7,799 79 SMALLPOX VACCINATION Number of Persons Vaccinated Age 0–3 months 4–6 months 7–9 months 10–11 months 1 year 2–4 years 5–15 years Total Primary – 10 22 19 1,221 785 99 2,156 Re-vaccination – – – – – 19 96 115 80 TUBERCULOSIS The Council is responsible for services for the prevention of tuberculosis and the care and after care of tuberculosis patients in the community. These services function 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 or pays the full cost of T.B. health visitors and reimburses the hospital authorities a proportion of the cost of social work with chest clinic patients. There were 3,992 patients on chest clinic registers at 31 December 1969. T.B. health visitors made 2,915 effective home visits and 166 patients received extra nourishment or other benefits. The Council is responsible for Knight's Hill Hostel for homeless infective T.B. men which provides 29 places. It is used extensively by other Inner London Boroughs, there being only three such hostels in London. B.C.G. Vaccination B.C.G. Vaccination against T.B. 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 357 contacts and 2,260 school-children were vaccinated. 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. CONTACT (Circular 19/64) (i) No. skin tested 739 (ii) No found positive 442 (iii) No. found negative 297 (iv) No. vaccinated 357 B. SCHOOL CHILDREN AND STUDENTS (Circular 19/64) (i) No. skin tested 2,777 (ii) No. found positive 413 (iii) No. found negative 2,364 (iv) No. vaccinated 2,259 81 Home Nursing The Lambeth District Nursing Joint Committees provides, on behalf of the Council, a home nursing service throughout the Borough, for which it receives an appropriate grant from the Council. In addition, service is given in a small area in the extreme north of the Borough by the Catholic Nursing Institute. The two bodies provided service to 5,242 patients of which 3,968 were newly referred and a total of 149,248 visits was made by the nursing staff. During the year the Council decided to terminate its arrangements with the District Nursing Joint Committee and to provide directly a home nursing service from 1 April 1971. The Catholic Nursing Institute will continue to operate in a smaii area in the north of the borough. HOME NURSING Total number of persons nursed during the year 5,321 Number aged under 5 at first visit during the year 522 Number aged 65 and over at first visit in the year 3,021 Total number of visits during the year 149,248 82 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 2 38 – 38 3. Homes on the register at the end of the year 6 45 114 159 83 LOAN OF NURSING EQUIPMENT AND FIREGUARDS Articles of nursing equipment are loaned free of charge to persons being nursed in their own homes. Smaller articles are loaned by the District Nursing Association, or through the medical loan depots of the Lambeth Division of the British Red Cross Society, to whom the Council makes a grant for this purpose. During the year the following articles of equipment were loaned through the Health Department Articles Delivered Returned Armchair Commodes 197 95 Stool Commodes 97 105 Tripod Walking Aids – 1 Penryn Hoists – 1 Homecraft Walking Aids 7 12 Zimmer Walking Aid 4 6 Hospital Beds 6 1 Mattresses 4 – Plastic Mattress Covers 4 – Dunlopillo Mattresses 2 2 Adult Cot Bed – 1 McLoughlin Sani-chair 1 – Back Rests 8 11 Bed Cradles 17 12 Easi-carri Hoists with slings 2 4 Fracture Boards 59 28 Rubber Sheeting 36" 42 yds. – Rubber Toilet Seat 2 – Rubber Bed Pans 6 – Ripple Bed (property of London Borough of Lambeth) 1 1 Ripple Bed — Hire from Talley Surgical Co. 2 1 Child's Cot Bed with Mattress 1 – Fire Guards 24 5 INCONTINENCE Supplies of incontinence pads have been issued to 624 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. 84 Incontinence garments in the following sizes have been issued:- Small 19 Medium 16 Large 19 Protective liners were also issued to 75 patients. MENTAL HEALTH SERVICES The Mental Health Services continued to expand during the year and dealt with an increased rate of referrals. Difficulties were still encountered in terms of staff shortages and limited facilities generally, but there were some interesting developments. Mental Health Social Work The mental health social work services were further strengthened by the Council's decision to provide a third senior mental health social worker. This will lead to the development of the service on area lines and give incentive to the building up of the area teams on a professional team-work basis. The benefits of the department's training programme began to be felt as trainees returned from full-time courses. Others continued their period of training and will return to the department in 1970 and 1971. Adult Training Centre Changes A number of mentally handicapped men from other Local Authorities, who had been attending Clapham Adult Training Centre, were withdrawn during the year thus making it possible to integrate the Lambeth women who had previously travelled daily to training centres in other areas. A number of trainees continued to make good use of the day training facilities at the Manor Hospital, Epsom, and it is expected that this arrangement will continue until Lambeth's purpose-built centre is opened. Junior Training School Developments Construction of the Windmill Junior Training School, Mandrell Road, was well advanced by the end of the year in preparation for its opening in 1970. Designed to accommodate 114 children, the school is planned on one level as a double octagon, with the assembly hall and therapeutic pool forming the focal centres. Classrooms and other facilities are grouped round the perimeter in each case. 85 In the meantime, the needs of mentally handicapped children have been provided for at the Council's two temporary junior training schools, at Streatham, which will be replaced by the Windmill School, and at Clapham, which will later be replaced by another purpose-built school in Monkton Street. We have been most grateful too, for the facilities provided for a number of Lambeth children at the Junior Training Schools at the Manor Hospital, Epsom, and Queen Mary's Hospital, Carshalton. These children will be transferred to Lambeth schools when the Windmill School is completed. Hospital Links Cane Hill Hospital, Coulsdon, which provides psychiatric hospital services for East Lambeth, has been in the process of reorganising its Social Work Department on the lines of a joint service with the Local Authorities in its catchment area. The scheme provides for a high level of continuity of care and strengthens the links between the Hospital and the community. One of our mental health social workers has been acting as a joint Lambeth/Cane Hill social worker since July and the arrangement has already proved of great benefit. This is in addition to the existing arrangement whereby one of the consultant psychiatrists from Cane Hill Hospital provides consultant sessions to the department on a regular basis. Discussions have continued with representatives of the St. Thomas' and South Western Hospitals regarding the development of their plans for a comprehensive psychiatric service in which the Borough's Mental Health Services will be actively involved. Links with the Manor and Queen Mary's Hospitals have already been mentioned. We are also grateful for a great deal of assistance from their medical staff in terms of consultation and advice. Definite links of this type prove to be invaluable, but some of the communication problems can be appreciated when it is noted that the department is involved more or less frequently with psychiatric services of one type or another which are provided by at least 21 hospitals! Future Plans Preparations were well advanced by the end of the year for the setting up of a pilot area office providing social services for the Clapham Town and Larkhall wards of the Borough. When this becomes operational, mental health social work for that district will be based on the area office. 86 In addition to the two purpose-built Junior Training Schools already referred to, the Council's immediate plans include an Adult Training Centre in Somerleyton Road for 150 trainees, two thirty-place Day Centres for the mentally ill at the South Western Hospital and in Riggindale Road, and a twelveplace hostel for mentally handicapped children. These are to be followed by a second sixty-place Adult Training Centre, a second twelve-place hostel for mentally handicapped children, two twenty-five-place hostels for mentally handicapped adults, another thirty-place Day Centre for the mentally ill, and a thirty-place work centre for sheltered employment. TRAINING Trainee Mental Health Social Workers The Mental Health Social Worker Establishment includes five positions for trainees. Men or women between the ages of 21 and 35 are appointed, and are expected to have the minimum of 5 G.C.E. passes preferably including two at "A" level. Preference is given to Social Science Graduates and persons with practical experience of some form of social service. Trainee mental health social workers usually complete not less than one year of practical work in the department before commencing a full-time course of training. During this period they participate in an In-Service Training Programme and work in one of the social work teams under the supervision of a senior mental health social worker. It is the trainee's responsibility to apply for a place on a full-time training course, and the final selection of candidates rests with the University or College. University Postgraduate Professional Social Work Courses are of one to two years duration, while the Certificate in Social Work courses at Colleges of Further Education are two years in length. Full salary and training expenses are paid during this period on the undertaking that the officer remains in the Council's service for a minimum of two years after qualification. Trainee Teachers of Mentally Handicapped Children Young men or women aged 18 years and over are appointed and are expected to have a minimum of 5 "O" level G.C.E. passes including English. Trainee teachers usually complete not less than one year of practical work in a junior training school before commencing a full-time course of training. During this period they take an active part in the work of the school under the supervision of the head teacher. It is the trainee's responsibility to apply for a place on a two-year full-time training course at a College of Further Education, and the final selection of candidates rests with the College. Full salary and training expenses are paid during this period on the undertaking that the officer remains in the Council's service for a minimum of two years after qualification. (Sgd) A.J. Shriever Principal Mental Health Social Workers 87 MENTAL HEALTH Number of persons under Local Health Authority care at 31st December 1969 Mentally Ill Elderly mentally infirm Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) 1 Total number 2 105 175 2 37 25 54 52 91 70 88 70 771 2 Attending workshop/occupation training centres 14 14 25 16 13 11 63 51 53 37 297 3 Awaiting entry to workshop/ occupation training centres 5 2 1 10 6 2 26 4 Receiving home training 3 1 4 5 Awaiting home training 6 Resident in L.A. home/hostel 3 2 1 6 7 Awaiting residence in L.A. home/hostel 8 Resident at L.A. expense in other homes/hostels 11 11 1 3 4 5 4 4 1 8 52 9 Resident at L.A. expense by boarding out in private household 5 2 1 2 1 11 88 MENTAL HEALTH Number of persons under Local Health Authority care at 31st December 1969 Mentally Ill Elderly mentally infirm Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) 10 Attending day hospitals 1 1 11 Receiving home (a) suitable to visits and not attend a inlcuded in training lines 2-10 centre 3 2 3 5 3 2 19 13 50 (b) others 2 77 148 2 3 2 27 31 7 4 14 11 328 12 Number of children under age 16 attending training centres who have not been included in item 2 overleaf because they do not come within the categories covered in columns (1) to (18) Male – Female – 13 Number of persons included in item 6 overleaf who reside in accommodation provided under the National Assistance Act, 1948 Male – Female – 89 MENTAL HEALTH Number of patients awaiting entry to hospital, admitted for temporary residential care or admitted to guardianship during 1969 Mentally Ill Elderly mentally infirm Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) 1 Number of persons in L.H.A. area of waiting list for admission to hospital at end of year (a) In urgent need of hospital care 2 2 (b) Not in urgent need of hospital care 1 1 5 4 2. 13 (c) Total 1 1 7 4 2 15 2 Number of admissions for temporary residential care (e.g. to relieve family) (a) To N.H.S. hospitals 3 1 10 8 4 2 28 (b) To L.A. residential accommodation 2 2 (c) Elsewhere 1 2 5 3 1 12 . (d) Total 1 3 1 2 12 13 7 3 42 90 MENTAL HEALTH Number of patients awaiting entry to hospital, admitted for temporary residential care or admitted to guardianship during 1969 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 guardianship at end of year L.H.A. 1 1 2 Other Total 1 1 2 91 MENTAL HEALTH Number of persons referred to Local Authority during year ended 31st December 1969 Referred by Mentally Ill Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (a) General practitioners 1 46 72 1 1 1 122 (b) Hospitals, on discharge from in-patient treatment 52 59 3 1 1 4 4 1 1 1 127 (c) Hospitals, after or during out-patients or day treatment 65 81 1 4 3 1 2 1 158 (d) Local education authorities 1 1 4 3 8 6 38 23 3 5 92 (e) Police and courts 1 24 13 1 2 41 (f) Other sources 1 1 200 281 2 16 9 9 19 21 14 5 3 581 (g) Total 4 2 391 509 5 1 26 16 57 51 26 23 5 5 1,121 92 MENTAL HEALTH STATISTICS FOR 1969 WORKSHOPS, OCCUPATIONAL CENTRES AND TRAINING CENTRES AS AT 31st DECEMBER 1969 TABLE 1 — Workshops or occupational 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 – 93 TABLE 4 — Places made available to or by other authorities or organisations Type of authority or organisation Places in workshops of occupational centres for the mentally ill Places in training centres for the subnormal or severely subnormal Places in special units for the severely subnormal Junior Adult Places made available to other authorities or to hospitals 11 Local authority 1 12 Hospital 13 Total 1 Places made available to the authority by other authorities or organisations 14 Local authority 14 1 2 15 Hospital 32 24 5 16 Other organisations 15 2 8 2 17 Total 29 35 36 7 TABLE 5 - Adjusted figures for places Workshops or occupational centres 18 Line 2 + line 17–line 13 29 Net number of places available to the authority Training centres Junior 19 Line 6 + line 17 – line 13 149 † Adult 20 Line 6 + line 17 – line 13 123 Special Units 21 Lines 8 + 10- 17– line 13 17 † excludes 6 subnormal/severely subnormal children under 5 attending the Authority's day nurseries. 94 MENTAL HEALTH STATISTICS FOR 1969 HOMES, HOSTELS, SOCIAL CENTRES AND CLUBS AS AT 31st DECEMBER 1969 TABLE 1 — Homes and hostels Age group provided for For the mentally ill For the subnormal or severely subnormal Number of premises Number of places Number of premises Number of places Junior Adult 1. Under 16 – – – – – 2. 16 and over – – – – – 3. Junior and adult – – – – – 4. Total – – – – – Homes and hostels for the elderly mentally infirm provided under the National Health Service Act, 1946 5 premises – 6 places – Homes and hostels included in line 4 which were specifically provided for the mentally disordered under the National Assistance Act, 1948 7 premises – 8 places – TABLE 2 — Places in homes/hostels made available to or by other authorities or organisations Type of authority or organisation For the mentally ill For the elderly mentally infirm For the subnormal or severely subnormal Junior Adult Places made available to other authorities or to hospitals 9. Local authority – – – – 10. Hospital – – – – 11. Total – – – – 95 TABLE 2 — continued Places made available to the authority by other authorities or organsations. 12. Local authority 5 – 1 – 13. Hospital – – – – 14. Other organisations 22 – 12 18 15. Total 27 – 13 18 TABLE 3 — Social centres and clubs provided under the National Health Service Act, 1946 Category of person catered for Number of centres or clubs Junior Adult Mixed Total 16. Mentally ill – – – – 17. Subnormal or severely subnormal – – – – 18. Elderly mentally infirm – – – – 19. Total – – – – TABLE 4 — Adjusted figures for places in homes and hostels Net number of places available to the authority For the mentally ill 20. Line 4 + line 15 — line 11 27 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 13 Adult 23. Line 4 + line 15 - line 11 18 96 PUBLIC HEALTH ACT 1936, (sections 187 to 194) MENTAL HEALTH ACT 1959, (section 15 (1) RETURN OF MENTAL NURSING HOMES REGISTERED AT 31st DECEMBER, 1969 Name of mental nursing home Total number of beds Number of beds available for (see note 1) Whether authorised to detain patients Patients aged under 16 Patients aged 16 and over Mentally ill Psycho pathic Subnormal or severely subnormal Mentally ill Psycho pathic Subnormal or severely subnormal (1) (2) (3) (4) (5) (6) (7) (8) (9) (a) ST. MICHAEL'S CONVENT 22 22 Yes Total 22 Number of registrations during 1969 which were (a) refused NONE 22 (b) cancelled NONE 97 PUBLIC HEALTH ACT 1936 (section 187 to 194) MENTAL HEALTH ACT 1959 (section 15 (1) RETURN OF MENTAL NURSING HOMES AUTHORISED TO DETAIN PATIENTS Number of admissions during 1969 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 – – – – – 7 – – – 7 (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 – – – – – – – – – – (k) By direction of Home Secretary under Section 73 – – – – – – – – – – 98 PUBLIC HEALTH ACT 1936 (section 187 to 194 MENTAL HEALTH ACT 1959 (section 15 (1) RETURN OF MENTAL NURSING HOMES AUTHORISED TO DETAIN PATIENTS Number of admissions during 1969 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) (i) Removals from Northern Ireland, Channel Islands or Isle of Man under Section 88 – – – – – – – – – – (m) Removals from Northern Ireland, Channel Islands or Isle of Man under Section 89 – – – – – – – – – – (n) Admissions under Section 64(1) – – – – – – – – – – (o) Admissions under Section 68 – – – – – – – – – – (p) Admissions under Section 71(1) – – – – – – – – – – (q) Admissions under Section 135 – – – – – – – – – – (r) Admissions under Section 136 – – – – – – – – – – (s) Total admissions – – – – – 7 – – – 7 Number of patients resident in mental nursing homes (including any temporarily absent and expected to return) on 31st December 1969 (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 – – – 99 PUBLIC HEALTH ACT 1936 (section 187 to 194) MENTAL HEALTH ACT 1959 (section 15(1) Number of cases who completed a period of observation under Sections 25 or 29 of the Act Number of admissions during 1969 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 (or transferred to another nursing home or hospital) for non-psychiatric treatment. – – – – – – – – – – (d) Left mental nursing home – – – – – 7 – – – 7 (e) Died in mental nursing home – – – – – – – – – – 100 PRIORITY DENTAL SERVICE There has been a marked imcrease in the provision of dental treatment for the priority classes, expectant and nursing mothers and pre-school children. In 1966,46.2 sessions were devoted to this service and in 1969, 78.7 sessions (i.e. equivalent half days). As one would expect, the highest proportion of treatment is provided at the Norwood Treatment Centre, where there is provision of other services for these groups. The number of attendances has increased by ⅓rd since 1966 and the number of fillings almost doubled, and completed cases risen from 78 to 115. Three visits have been made to creches in order to give simple instruction in dental health to pre-school children. As a pilot scheme, birthday cards have been sent to children on their third birthday to invite them to have a dental inspection at a child health centre. The results so far have been encouraging and apart from the opportunity to invite parents to seek treatment, provision has been made for instructing parents and children in dental hygiene. Provision is also made for dental treatment at Shirley Oaks, one of the Children's Department's homes. Sessions take place once a week and inspection and treatment provided for a large proportion of the children in residence there. Instruction has also been given to the children on dental health. B.M. Spalding, L.D.S., R.C.S.(Eng.) Chief Dental Officer 101 DENTAL TREATMENT FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS ATTENDANCES AND TREATMENT A. Number of visits for Treatment during the year Children 0-4 (incl) Expectant and Nursing Mothers First visit 213 11 Subsequent visits 340 11 Total visits 553 22 Number of additional courses of treatment, other than the first course, commenced during the year 17 – Treatment provided during the year Number of fillings 418 15 Teeth filled 380 15 Teeth extracted 38 1 General anaesthetics given 17 – Emergency visits by patients 28 – Patients x-rayed – – Patients treated by scaling and/ or removal or stains from teeth 91 14 Teeth otherwise conserved 298 – Number of courses of treatment completed during the year 112 3 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 1 102  Children 0-4 (incl) Expectant and Nursing Mothers D. Inspections during year - First inspections 252 7 Patients in above who required treatment 158 7 Patients in above who were offered treatment 158 7 Number of dental officer sessions (i.e. equivalent half days) devoted to maternity and child welfare patients during the period 78.7 Chiropody During the year the Council decided that the chiropody service administered by Lambeth Old People's Welfare Association, to which the Council made a grant for the purpose, should be transferred to the Health Department. This includes the work in seven foot clinics, two private surgeries, four private old people's homes and a domiciliary service. It is hoped that full integration will be achieved by 1st April, 1970. In addition, 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. Under the Council scheme 12,100 treatments were given to 2,166 patients whilst under that provided by the Lambeth Old People's Welfare Association, 3,596 patients received 24,309 treatments. In addition, the department provides chiropody service in Welfare homes for which the Welfare Department pays. Service was provided for 625 people and 2,562 treatments were given. 103 CHIROPODY SERVICE Details of statistics on chiropody treatment year ending 31st December 1969 Number of persons treated during year ending 31st December 1969 By local authorities (1) By voluntary observations (2) Total (3)[/##] 1. Persons aged 65 and over 2,717 3,596 6,313 2. Expectant mothers – – – 3. Others 74 – 74 Total 2,791 3,596 6,387 Number of treatments given during year ending 31st December 1969 1. In clinics 11,025 17,010 28,035 2. In patients' homes 1,075 6,254 7,329 3. In old peoples' homes 2,562 – 2,562 4. In chiropodists' surgeries – 1,045 1,045 5. Total 14,662 24,309 38,971 104 HOME HELP SERVICE Officers Plans were developed during the year, for implementation in 1970, for the reorganisation of the service into four instead of three areas as at present, and for the provision of home help support in the area to be covered by the Pilot Area Officer (Seebohm), 361 Clapham Road. The fourth home help area office will be located at Clapham Baths, Clapham Manor Street, and the North area office will move shortly from Offley Road to 157 South Lambeth Road. Staff Organising staff comprised one senior organiser, 3 organisers and 8 assistant organisers assisted by 6 full-time and 1 part-time clerical staff. Home Visits There were 9,131 home visits made by organising staff in 1969, compared with 8,522 made in 1968. Home Helps At the end of the year there were 424 Home Helps working in the borough. This number is the equivalent of 293 full-time Home Helps working a 40-hour week. Approximately 560,000 hours were worked in households during the year. Time spent travelling between households accounted for a further 45,000 hours. The turnover of staff continued to be high, at about 30%. During the year 1,987 new applications for the services of a home help were received, 1,494 households ceased having help and 2,939 households were receiving help at the end of the year. 91% of patients were aged 65 and over, 5% were chronic sick aged under 65, and the remainder were made up of maternity, T.B., and various acutely sick people; morning and evening help was also supplied to families, and special help given for problem'families. 9,243 hours of help were given during the year to 42 families, involving 184 children who, without the support of the home help service, might otherwise have been received into care. The average cost per child for every week of service received is £1. Mrs. E. Wilson Senior Home Help Organiser 105 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 185 holidays were provided as follows Expectant and nursing mothers and children under five 69 Psychiatric patients 16 Persons of pensionable age 66 Other adults 34 106 Section D Environmental Health Services 107 Dr. F. Summers, Associate Medical Officer of Health, and Mr. H. Plinston, Chief Public Health Inspector, report as follows. ENVIRONMENTAL HEALTH The Public Health Inspectorate has four main functions. Housing Food Hygiene Atmospheric Pollution Environmental Health generally None of these can be considered in isolation and collectively they are closely associated with the work of almost all other Departments of the Council. The following summarises the work of the Public Health Inspectors within these four aspects of a very wide field. HOUSING Clearance Areas declared Lillieshall Road 19 houses 965 persons Rectory Gardens 20 houses Bowland Road 40 houses Wilcox Road 205 houses Individual Unfit Houses Closing Orders in lieu of Demolition Orders 26 Unfit parts of premises Closing Orders 29 Closing Orders determined after repair and improvement by owners. 3 108 Modernisation and Improvement Inspections 1,799 dwellings Discretionary Grants paid £17,612 74 dwellings Standard Grants paid £12,739 58 dwellings Improved to full standard following representations 13 dwellings Improved to reduced standard 1 dwelling Additional amenities installed 21 dwellings The improvement of houses in multiple occupation is difficult due to lack of space for installing amenities. Repair and Maintenance The Housing Act 1969 which came into effect on the 25th July, 1969, makes provision for a local authority to serve notices requiring the carrying out of repairs, and empowering the authority to carry out the works in default and recover the cost. By formal and informal action repairs and proper standards of Management were secured in 129 houses. Control of Multiple Occupation 161 Directions were given by the Council, requiring regular reinspection to ensure compliance. Staff were increasingly obstructed whilst trying to carry out inspections and Warrants of Entry had to be obtained from the Court of Petty Sessions. It was necessary to force an entry into four houses. Means of Escape in case of fire An ever increasing problem is the risk of fire in houses in multiple occupation. The lack of permanently secured appliances for space heating leads to the use of portable oil heaters. These are generally badly maintained and sited, and, with the congestion of furniture usually present in small rooms, a serious fire hazard results. 203 notices were served requiring the provision of satisfactory means of escape; in 59 houses the Council carried out the work in default and in 15 cases formal or informal action resulted in the owners complying. 5,414 visits were made to houses in multiple occupation. 109 Qualification Certificates - The Housing Act 1969 (operable from 25th July) provides in respect of lettings, previously controlled under the Rent Act 1957, for rents to be varied, subject to certain conditions being met. Applications were not received for attention by the Department until the last two months of the year. Applications for Qualification Certificates 643 Granted 9 Refused Nil Application for Provisional Approval 16 Granted 2 Refused Nil Certificates of Disrepair No applications were received. House Purchase Applicants for mortgages are required by the Council and the Greater London Council to undertake to conform to the provisions of the Housing Acts in respect of multiple occupation and to make comply with the Regulations and Underground Rooms in the property concerned. 905 visits were made in this connection and 663 visits in respect of property previously mortgaged to ascertain the condition and occupancy. Rehousing and Overcrowding 1,475 applications for rehousing received attention in respect of the following:- Lambeth Borough Council Greater London Council Health grounds 1,235 10 Insanitary conditions 69 5 Special cases 16 – Cases previously investigated and rehoused 132 8 110 Abatement of Nuisances 3,661 complaints were received, 4,986 inspections were carried out and 5,746 revisits made to premises. In 2,139 cases Statutory Notices were served; 56 Nuisance Orders were obtained after legal proceedings; 94 cases adjourned sine die and 89 cases were withdrawn. 781 cases were dealt with informally. As a result of action taken repairs including those listed below were carried out. Drainage work 216 Dampness 615 Flooring 161 Walls 178 Ceilings 282 Roofs 315 Rainwater pipes and gutters 172 Soil pipes 24 Waste pipes 86 Water closets 259 Water supplies 76 Windows 265 Staircases 37 Works in Default In 345 cases the Council carried out works required by notices in default of the owners. 207 by contractors directly engaged and 138 through the services of the Borough Engineer and the Borough Architect. Choked Drains - Emergency Service It is often possible to prevent a serious nuisance by dealing with a choked drain at an early stage. At the direction of the Public Health Inspector, the Drainage Assistant attempted emergency clearance in 64 cases and failed in only 19. No charge is made for this service. Sealing of Disused Drains Many rat infestations are due to dis-used drains not being properly sealed from the sewer. 149 drains were sealed under the supervision of the Drainage Assistant prior to demolition of property. 111 Drainage Work 1,500 tests were carried out on existing drainage and 189 drains were exposed for examination. 409 plans for alterations to drainage in existing premises and 153 for new buildings were received and examined. 1,385 tests were applied to new drainage works. FOOD HYGIENE Imported Food An increased amount and variety of imported food was received in the Borough without having been inspected at the port of entry. Products proved mainly satisfactory on sampling, unsatisfactory consignment being normally returned to the Country of origin. Samples submitted to the Public Health Laboratory were as follows No. of Samples Country of Origin Albumen Crystals 5 Sweden Dried Hen Egg Yolk 107 Denmark Dried Whole Hen Egg 25 Denmark Dried Hen Egg Albumen 9 Denmark Prawns 14 China Uncooked headless Prawns 62 Hong Kong Uncooked Prawn tails 11 China Uncooked Prawn tails 18 Indonesia Uncooked Prawns 4 China Cooked and peeled Prawns 10 Hong Kong Uncooked headless Prawns 37 China Dried Hen Egg 10 Denmark Frozen Whole Hen Egg 15 Holland Dried Hen Egg powder 10 Holland Bacteriological and other examinations 162 samples of milk were submitted to the Public Health Laboratory, of these 23 were void, the atmospheric shade temperature being above 65°F, 2 failed the Methylene Blue Test and one failed the Phosphatese Test. 112 The amount of untreated milk sold in the Borough is negligible and no samples were taken for examination for the presence of Brucella Arbortus. Other samples taken for bacteriological examination included ice cream, fresh cream, dairy cream, cakes and meat. Sampling of Food and Drugs 400 formal and 1,697 informal samples were submitted to the Public Analyst, who reported unfavourably on 106 in respect of analyasis and 23 in respect of labelling. 10 formal samples proved unsatisfactory as follows. Magnesium sulphate paste Orange drink Biscuits Margarine Iodised Celery salt Instant milk powder Instant milk granules Steak and Kidney pudding Steak and Kidney pie Mincemeat Deficient in magnesium sulphate Deficient in fruit juice Contained fat other than corn oil Contained fat other than corn oil No iodine detected Excess water Excess water Deficient in kidney Deficient in kidney Excess acetic acid In each case the matter was raised with the manufacturer. The Magnesium Sulphate Paste was withdrawn from sale and further samples of the other products subsequently proved satisfactory. Complaints 69 complaints of food being sold in an unfit condition were investigated. Many of these referred to mould, unpleasant taste and staleness but foreign matter present included pins, splinters, hair, muslin, washers, stones, nails, insects and animal droppings. In nine of theses cases legal proceedings were taken, the defendants found guilty and fines totalling £115 made. Costs of £25 were awarded to the Council. 113 Inspection of Unfit Food Usually at the request of shop keepers, large quantities of food were examined for fitness for human consumption. As a result the following food was surrendered and certificates were issued. Tons cwts lbs Carcase meat Cooked meat and meat products Canned meats Other canned foods Fresh fish Fresh fruit and vegetables Other foods 1 1 3 2 8 16 5 15 – 1 12 7 62 31 77 60 58 50 110 Method of Disposal of Unsound Food Where necessary unfit food was stained to prevent its use for human consumption. Suitable commodities were released to firms, specialising in the manufacture of glue or similar products, from whom satisfactory guarantees as to disposal had been obtained. Food suitable for feeding pigs was diverted to approved establishments and the remainder was disposed of by arrangement with the Greater London Council Public Health Engineering Department. Food Premises The following table showns the number of food premises by type of business in the borough. 114 No. of premises No. fitted to comply with Reg. 16 No. to where Reg. 19 applies No. fitted to comply with Reg. 19 Greengrocery and fruit 192 192 192 192 Grocery and provisions 350 350 200 200 Fish shops, wet, dry and fried 85 85 85 85 Bakers and bakehouses 99 99 99 99 Butchers 128 128 128 128 Confectioners 322 322 119 119 Restaurants, cafes, canteens and clubs 267 267 267 267 Dairies 3 3 3 3 Delicatessen 15 15 15 15 Food factories and warehouses 17 17 17 17 Public houses and Off-licences 310 310 310 310 Milk Distributors 451 451 – – Ice cream premises 1,153 1,153 170 170 Preserved food premises 197 197 197 197 Regulation 16 requires the provision of wash hand basins and Regulation 19 facilitates for washing of food and equipment. These premises are inspected regularly and 36 prosecutions resulting in 31 convictions were instituted. Licensed Milk Premises The following table shows the number of licences in force Dealers Licences (Pre-packed) Untreated 49 Pasteurised 309 Sterilised 298 Ultra Heat Treated 71 Dealers (Pasteurisers) Licence 3 Dealers (Ultra Heat Treated) Licence 3 115 ATMOSPHERIC POLLUTION Clean Air Act, 1956 Smoke Control Areas Three Smoke Control Orders (Nos. 21, 22 and 23) were confirmed by the Minister of Housing and Local Government covering areas of Streatham, Clapham and Streatham Vale. 19,665 inspectors and visits were made to premises and 369 observations (119 timed, 250 untimed) were made on chimneys. 382 smoke nuisances were abated after informal action and no abatement notices were required to be served. In spite of difficulties in the disposal of garden refuse few complaints of smoke from bonfires were received. Smoke Control Orders in force covered an area of over 2,900 acres involving 52,513 premises, with a further 847 acres (13,382 premises) covered by Orders made but not operative. National Survey It was possible to maintain only one Volumetric Measurement Station (for Smoke and Sulphur Dioxide) to assist in the National Survey. This was due to the co-operation of the Staff and Students of the Norwood Technical College, Knight's Hill, S.E.27. ENVIRONMENTAL HEALTH - GENERALLY The diversity of headings in this section gives some indication of the allembracing nature of "Environmental Health". Infectious Diseases 319 visits were made by Public Health Inspectors investigating cases of infectious disease. Tracing sources of infection and preventing its spread requires a tactful but persistent approach. 116 Specimens of suspected food and a great many specimens of faeces from patients and contacts were sent to the Public Health Laboratory for examination. The fullest co-operation of the Laboratory staff was always available and gratefully accepted. Disinfection and Disinfestation There was a marked increase in the numbers of complaints of fleas, mostly animal fleas, but it was not possible to find the cause. In addition to the work summarised below, the staff of the Disinfecting Station dealt with 1,318 infestations of insects, including ants, cockroaches, silver fish, woodworm, mites, carpet beetles and lice. 129 wasp nests were also destroyed. Disinfestation Bugs Fleas No. of premises visited 297 188 No. of rooms treated 957 882 Disinfection No. of premises visited 113 No. of rooms treated 201 Library books disinfected 346 Other articles disinfected 9.541 Rats and Mice 1,185 complaints of rats and 1,828 of mice were investigated by the Rodent Officer and his staff, resulting in 5,950 baitings being made in dwellings and business premises. 46 visits were made by Public Health Inspectors and 5 notices were served. The increase in complaints of mice was partly due to the better service offered by the Council and partly to the difficulty found by the public using proprietary poisons on mice resistant to "Warfarin". Baiting of sewers to reduce the rat population was carried out by the Borough Engineer's Department. Some 3,500 manhole covers required to be lifted and baits laid, the work frequently being hampered by traffic. The task is a large one and unfortunately can never result in completely rat-free sewers. 117 Pharmacy and Poisons 122 persons were entered or retained on the register required by the Pharmacy and Poisons Act, 1933, Section 21, of those persons selling poisons listed under Part II. Pet Animal Establishments 21 visits were made to the 18 establishments licensed in the Borough. Animal Boarding and Riding Establishments By arrangement with the Corporation of London, the Vetinary Officer, whose services are essential, acts as the agent of the Council and pays regular visits to these establishments to ensure the well being of the animals. No formal action proved necessary during the year. The Public Health Inspectors made 61 visits to check the condition of the premises. Diseases of Animals Similar arrangements with the Corporation of London Vetinary Officer exist in this connection. In December a report was received from the Divisional Officer of the Ministry of Agriculture, Fisheries and Food that a Siamese Kitten with symptoms of rabies was being isolated at the premises of a vetinary surgeon in the Borough. Earlier in the year there had been a case of rabies in a dog at Camberley but, as far as was known, the kitten, which was born in this country had had no contact with any animal from that area. The animal died shortly after notification was received and pathological examination proved negative for rabies. Long-stay Immigrants 881 advice notices of the arrival of immigrants proceeding to addresses in the Borough were received from the Port Health Authorities. The Public Health Inspectors successfully visited 426 of these and offered advice on medical arrangements etc. where necessary. 118 Massage or Special Treatment 42 establishments are licensed by the Council to give massage and "special treatment", which term covers chiropody, manicure, Galvanism, Faradism, Ionisation, Diathermcy (long and short wave), Sinusoidal currents, Ultra-violet, Infra-red, X or other rays. All premises were inspected and licences issued only to qualified persons. Hairdressers and Barbers Persons carrying on the business of a hair dresser or barber on any premises in the Borough are required to be registered by the Council in respect of those premises. The Public Health Inspectors made 50 inspections of such premises. Care of the Aged 1,109 new cases were brought to the notice of the Old People's Visitors, who are three State Registered Nurses. They deal in the main with old people suffering from various degenerative processes and by intensive care work endeavour to prevent them deteriorating to such an extent that removal to a hospital or institution is necessary. To do this they are able to call on many other statutory and voluntary agencies in this supportive work. 8,254 visits were made and 3,418 persons received help in some form or another. The Visitors supervise the work of the bathing attendants, who are employed to give suitable persons regular baths in their own homes, 3,491 baths were given. Laundry Service for Aged Incontinent The incontinent laundry service is provided under Section 28 of the National Health Service Act, 1946 and is almost entirely confined to old persons, although a few young chronic sick may from time to time benefit from it. It is a growing service which is carried out at the Council's laundry establishment at Streatham Baths, the collection and delivery being done by the staff of the disinfecting station. 271 persons received the service, involving 6,593 visits and the collection of 55,939 soiled articles. 119 Compulsory Removal It was necessary only once to exercise powers under Section 47 of the National Assistance Act, 1948 Miss B. was living in deplorable conditions with four dogs in a basement. She refused offers of help from the various domiciliary services available. The other occupants of the house were too old and feeble to be of any assistance. As she was therefore a danger, both to herself and others, an Order was obtained from the Court for her removal to an institution for three months. She died just before the Order was due for review. 441 old people were persuaded to enter hospitals or institutions voluntarily. Burial or Cremation of the Dead - National Assistance Act, 1948 Under Section 50 of the National Assistance Act 1948, the council is required to arrange for the burial or cremation of any person who has died, or been found dead, in the Borough, if it appears that no other satisfactory arrangements are being made. 38 such funerals were arranged and whenever possible the Council's expenses were recovered. Home Dialysis Units With the introduction of Home Dialysis Units (Kidney machines) it is possible for the pressure on restricted hospital facilities to be relieved by discharging to their homes people with kidney failure. The units are provided by the hospital service, but their installation requires adaptation to the patient's home. Early in 1968 a circular was received from the Ministry of Health notifying the Minister's approval to the making of arrangements by the Council (under Section 28 of the National Helath Service Act, 1946) " for the adaptation of any dwelling or the provision of any additional facilities which may be necessary for installing equipment for intermittent haemodyalisis". Late in 1968 a teaching hospital asked for such facilities to be provided for one of its patients residing in the Borough. It was found that the premises in which this patient resided were totally unsuited to such adaptation, so 120 special rehousing was arranged with the Housing Department. In conjunction with that Department, the Borough Architect and the Senior District Public Health Inspector arrangements were made for the necessary work to be carried out and the patient was able to move in early in the year under review. The second case was brought to our notice by the same hospital in November, and in this instance the adaptations were possible in the patient's own home. Here again the combined efforts of officers of the Architect's Department and the Senior Public Health Inspector resulted in a rapid and satisfactory adaptation of the premises. A letter of thanks was received from this patient. The cost of the adaptations has been borne entirely by the Council. Nursing Homes 30 visits were made to registered Nursing Homes and the premises inspected for suitability as to condition, amenities, etc. Noise 69 complaints were investigated of noise caused by factory machinery or methods of working. In 13 cases a reduction to a tolerable level was obtained by informal action. In the remaining 56 cases it was considered either that the best practicable means were already being used to minimise the noise or that it was not a nuisance within the meaning of the Act. Two vendors of ice cream, operating vehicles fitted with loudspeakers, were prosecuted for sounding chimes after 7 pm. One offender was fined £2 with £2 costs, and the other, who committed the same offence twice in one evening, was fined a total of £7 plus £2 costs. Factories and Outworkers Annexed to this Report is a table giving prescribed particulars on the administration of the Factories Act 1961. 121 PRESCRIBED PARTICULARS ON THE ADMINISTRATION OF THE FACTORIES ACT, 1961 Part I of the Act 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors) Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (0 (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 22 7 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,144 214 - - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 13 20 - - TOTAL 1,179 241 - - 122 2. Cases in which DEFECTS were found (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more "cases") Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred ToH.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) 1 1 1 Overcrowding (S.2) Unreasonable temperature (S.3) Inadequate ventilation (S.4) Ineffective drainage of floors (S.6) Sanitary Conveniences (S.7) 1 1 1 (a) Insufficient (b) Unsuitable or defective (c) Not separate for sexes Other offences against the Act (not including offences relating to Out-work) TOTAL 2 2 - 2 - 123 Part VIII of the Act OUTWORK (Sections 133 and 134) Nature of Work Section 133 Section 134 No. of out-workers in August list required by Section 133(1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing apparel Making etc., Cleaning and Washing 128 Household linen Lace, lace curtains and nets Curtains and furniture hangings 6 l urniture and upholstery 1 Hectro-plate Kile making Brass and brass articles 1 ur pulling 8 Iron and steel cables and chains 124 • 125 Nature of Work Section 133 Section 134 No. of out-workers in August list required by Section 133(1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Iron and Steel anchors and grapnels Cart gear Locks, latches and keys Umbrellas, etc., Artificial flowers 2 Nets, other than wire nets Tents Sacks Racquet and tennis balls Paper bags 2 The making of boxes or other receptacles or parts thereof made wholly or partically of paper 5 Brush making Pea picking Feather sorting Carding, etc., of buttons etc. 70 Stuffed toys 16 Basket making Chocolates and sweetmeats Cosaques, Christmas stockings, etc.. 1 Textile weaving 1 Lampshades 15 TOTAL 255 - - - - - 126 Section E General 127 WATER SUPPLY I am indebted to Dr. E. Windle Taylor, Director of Water Examination, Metropolitan Water Board, for the following report on the water supplied by the Board to the Borough of Lambeth during the year "The report relates to the Board's direct supply to the Lambeth administrative area and its several parts. The information does not relate to private supplies and supplies from other Water Undertakings (if any). The supply was satisfactory both as to quality and quantity throughout 1969. All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. The Board has no record of the number of structurally separate dwellings supplied in Lambeth, but the population supplied direct according to the Registrar General's estimates at 30th June, 1969 was 325,066. No houses were permanently supplied by standpipe. No fluoride was added, and where fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. The supply was derived from the following works and pumping stations River Thames — derived Honor Oak well Merton well No new sources of supply were instituted and there were no changes to the general scheme of supply in the area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the following pages. 128 The Board's river and well sources have not been considered to have a plumbosolvent action, on account of their hardness content and alkaline reaction. It should, however, be appreciated that all types of water pick up varying amounts of metal from piping, particularly when it is newly installed; this applies to copper, zinc, iron and also lead. Surveys carried out between 1966 and 1968 on analyses of water from consumers' premises confirmed this statement. Average Results of Chemical Examination Milligrames per litre (unless otherwise stated) Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMn04 4 hrs at 27° c. B.O.D. 5 days at 20° C. Thames-derived, 371 0.024 0.083 4.4 1.05 onor Oak well 4 0.045 0.021 0.2 0.10 Merton well 4 0.005 0.017 0.2 0.08 Description of the Sample Hardness (total) CaC03 Hardness (noncarbonate) CaC03 Magnesium as Mg Sodium Potassium as Na Sodium Potassium as K Chloride as CI Thames-derived 282 79 5 24.0 5.4 32 Honor Oak well 292 43 17 Merton well 252 38 13 Description of the Sample Phosphate as PO4 Silicate as Si02 Sulphate as SO4 Natural Fluoride as F Surfaceactive Material as Manoxol OT Thames-derived 2.1 9 58 0.25 0.02 Honor Oak well 0.50 Merton well 0.50 Description of the Sample Turbidity units Colour (Burgess units) PH value Electrical Conductivity (micromhos) Thames-derived 0.1 11 7.9 550 Honor Oak well 0.5 9 7.3 480 Merton well 0.4 4 7.4 430 129 EXAMINATION OF WATER-SUPPLY Bacteriological Results - Yearly Averages 1969 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 22°C. Per cent, samples negative in 100ml. Count per 100ml. Per cent, samples negative in 100ml. Count per 100ml. River Thames 8,196 66.5 39.79 19.0 53.97 7.0 Honor Oak well 81 0.0 3 97.53 0.1 100.0 - Merton well 19 2.3 10 100.0 - 100.0 - AFTER TREATMENT Source of supply Agar plate count per ml. Coliform count E. coli count Number of samples 20-24 hours at 37°C. 3 days at 22°C. Per cent, samples negative in 100ml. Per cent, samples negative in 100ml. River Thames 3,698 12.9 99.89 100.0 Honor Oak well 81 0.1 11 100.0 100.0 Merton well 19 0.2 2 100.0 100.0 Water from Wells Samples of well water used by industrial or commercial undertakings are examined both chemically and bacteriologically. During the year no unsatisfactory reports were received. Swimming Pools 130 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 1969. No. of samples Agar count per ml. 24 hr. at 37°C. Oresumptive Coliform without E. Coli in 100 ml. E. Coli in 100 ml. 0 - 10 10 - 100 More than 100 Brockwell Park Lido Summer 10 10 - - . _ Winter 10 10 - - 1 3 Kennington Park Lido Summer 10 10 - - - . Winter 8 8 - - 1 2 Parkside School 10 10 - - - - Shirley Oaks Residential Home 24 23 1 . - - Dick Sheppard School 10 9 1 . 1 - St. Martin-in-theFields School 20 19 1 - 1 . Brockwell Park Lido All samples were satisfactory during the summer season. During the winter season the water was treated with chemicals by hand. This is obviously not as efficient as mechanical purification. The formation of ice on the surface of the water hindered treatment and may have been the cause of the presence at certain times of small numbers of Coliform bacteria. Kennington Park Lido The results obtained were similar to Brockwell Park Lido. Shirley Oaks Swimming Bath All samples were found to be satisfactory. 131 Parkside School Swimming Bath All samples were found to be satisfactory. Dick Sheppard School One sample was unsatisfactory due to a plant failure but the necessary repairs were attended to. St. Martin-in-the-Fields School At the beginning of the year, a fault in the chlorinator developed. This gave rise to an unsatisfactory sample. The plant was speedily repaired and satisfactory conditions restored. In general the bacterial conditions of the baths showed some improvement compared with that of the previous year. Plans were made for the organisation of special courses for schoolkeepers and for Lido superintendents on swimming bath plant maintenance, on control of dosage and on routine tests for free chlorine content and pH value. The Scientific Branch and the Department of Mechanical and Electrical Services collaborated in drawing up a training scheme involving lectures, visits, practical demonstrations and discussions. These courses lasting two days were planned to take place during the following year. SEWERS I am indebted to the Borough Engineer and Surveyor for supplying me with the following information with regard to sewers within the Borough. During the year a sum of £42,600 was spent on the general maintenance, flushing and cleansing of the sewers for which the Council is the drainage authority. Part of the cleansing works were carried out under contract using high pressure jetting equipment and approximately 72 miles were cleansed by this method. Two contracts were completed for the reconstruction and laying of new sewers (a) Streatham High Road - Stage 1 at a cost of £11,280 which consisted of laying a new 15" diameter sewer 155 yards long in Natal Road. (b) Hawke Road - Stage 1 at a cost of £8,350 which consisted of laying of 110 yards of 21" diameter sewer and 65 yards of 18" diameter sewer 132 to take part of the flow from the Council's proposed development at Central Hill. 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.I. 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 provideds a comprehensive service for the examination of specimens submitted by Local Authorities and General Practitioners. The local laboratory is situated in County Hall. 133 Section F School Health Service Report of the Principle School Medical Officer 134 LONDON BOROUGH OF LAMBETH SCHOOL HEALTH SERVICE Report of the Principal School Medical Officer for the Year 1969 The Inner London Education Authority is responsible for the School Health Service, but by virtue of an agreement made under 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 is responsible to that Authority for the day-to-day running of the service. During the past five years the number of treatments given for various conditions in Local Authority clinics in Lambeth shown on the whole a most satisfactory downward trent, indicative of the steadily improving health of the Borough's school-children. The incidence of juvenile rheumatism had become so negligible that in May 1969 it was possible to wind up the Rheumatism Supervisory Service altogether, closing the last of the rheumatism clinics. Heart conditions, once closely associated with rheumatic damage, have naturally also decreased and the murmurs which are now referred from medical inspections for investigation frequently and happily prove to be of minor or of no clinical significance. Nutrition has greatly improved. The Special Investigation Clinics no longer have to carry stocks of cod liver oil and malt, haliborange and vitamin tablets; children falling below the height/weight ratio health average are rare, indeed obesity has become far more common, from over plentiful diet composed mainly of carbohydrates. This year even enuresis has shown a decline, from 221 new cases in 1968 to 175 new cases in 1969. The number of minor ailments treated remain much the same - figures for 1969 are given in the accompanying table - but the defects themselves have become progressively minor. Otorrhoea has almost disappeared because of early diagnosis of ear infections and treatment with antibiotics. Conjunctivitis, once a very common condition running through whole classes and even whole schools, was down to 27 cases for the whole Borough during 1969. Impetigo and allied skin conditions, equally prevalent at one time have also declined but more gradually, there were 196 cases in 1969 as against 283 in 1966. Apart from occasional accidents, e.g. cuts, abrasions, foreign bodies, the cases seen in the minor ailment clinics are in fact now predominantly plantar warts, verrucas and fungus infections. 135 There are 47,332 children on the school roll in the Borough. There are 103 schools of which 10 are special schools- 2 schools for delicate children 2 schools for educationally backward children 2 schools for physically handicapped children 2 schools for maladjusted children 1 school for partially sighted children 1 school for deaf childrert and there are 4 special units- a unit for autistic children a Rubella unit for deaf and blind children in any ordinary school and a remedial centre for linguistically deprived children a special unit for partially deaf children in an ordinary school Routine medical inspections are held in all schools. Children are examined four times - during their school life - on entry to infant, junior and secondary school, and on leaving. Numerous special examinations and follow-up re-inspections are carried out in addition whenever required. Each term the school nurses conduct special hygiene examinations. During the year medical officers undertook 16,747 routine medical ecaminations, 4,333 special examinations and 5,712 re-inspections. School nurses carried out a total of 36,657 health surveys. Information about children who require special educational help and observation in school is passed routinely to the head teachers and school doctor; concerned. Discussions are held with head teachers, parents, and career officers concerning school leavers for the purpose of ensuring the most suitable choice of career, and the provision of help for handicapped pupils. A liaison has been established with the Welfare Department for the follow-up of handicapped pupils in the community. Treatment facilities The School Health Service makes use of treatment facilities provided by the local authority, hospitals and general practitioners. Sessions provided in teaching hospitals include two vision sessions at King's College Hospital and one audiology session at Belgrave Hospital. All these sessions are attended by 136 social workers attached to the School Health Service, who arrange appointments and act as liaison officers with the hospital, the Inner London Education Authority, school care officers and school inquiry officers. Treatment facilities provided directly by the local authority include vision clinics (3 sessions weekly) in local authority premises, 1 orthoptic clinic and 4 special investigation clinics for treatment of enuresis, obesity and minor behaviour problems. Minor ailments, accidents and foot care are provided for in 5 Minor Ailment Clinics. Recently opened is the Braidwood Audiology Clinic, situated in the vicinity of the School for Deaf Children, and providing comprehensive assessment for children with impairment of hearing and speech. The clinic is staffed by an E.N.T. surgeon, an audiologist, and edui ational psychologist, speech therapist and a social worker. An audiology centre also opened in February 1969 at Barley Mow (Waterloo) Treatment Centre for North Lambeth children who fail to pass pure tone tests. Audiometry All children in the primary schools in the Borough have a sweep test by an experienced shcool nurse and those having hearing loss are followed up and investigated. It is hoped that next year a sweep test will be provided routinely in secondary schools as well. Special educational problems Many school children present complex problems of learning difficulties and behaviour. Close co-operation with all agencies involved in the solution of these problems helps with educational placement and provision of help to the children, school staff and children's parents. The agencies involved include teaching staff, school doctors, educational psychologist, child care officer, school inquiry officer, probation officer, schoolcare organiser, psychiatrist, etc. There is a shortage of places in E.S.N, schools and schools for maladjusted children in the Borough, and efforts are being made by the Inner London Education Authority to provide more vacancies. Placement of children in residential schools is the responsibility of the specialist staff at County Hall. There is a large number of children in the Borough requiring language stimulation and an early introduction to social life, therefore it is hoped that next year a number of nursery school classes will be provided in ordinary schools. 137 Prophylaxis Action has been taken to increase the number of school children protected against infectious diseases. 3,442 children have been immunised against diphtheria and tetanus, 3,019 vaccinated against polomyelitis, and 2,260 have had B.C.G. vaccination. A trial vaccination against rubella has been conducted in conjunction with I.L.E.A. in two secondary schools for girls. Recuperative Holidays Recuperative holidays for school children are provided at homes in Littlehampton and Bognor Regis run by the Inner London Education Authority. 210 children were accommodated for periods between two and four weeks. Health Education Health education in schools has been undertaken by health visitors, school doctors and nurses at the request of the head teacher. At present 4 health visitors hold regular Health Education sessions in schools. Doctors hold discussion groups on the problem of drugs, V.D., and personal relationships. The Health Education Team from I.L.E.A. visited several primary and secondary schools with their programmes on growing up, personal relationships, drugs, smoking and V.D. Student Health Service A preventive and advisory student health service has been continued in the Borough in 3 Colleges for Further Education - Brixton School of Building, Brixton College for Further Education and Kennington College. Doctors' sessions averaged .two weekly at Brixton School of Building, and one a week at the others. Regular medical and counselling advice was provided by the College doctor working closely with the College Welfare Officer. B.C.G. and poliomyelitis vaccination was provided in all 3 colleges. Health Education sessions were held and numerous problems including drugs and general health topics discussed. (Sgd) Dr K H Tlusty Senior Medical Officer 138 SCHOOL HEALTH STATISTICS FOR YEAR 1969 SCHOOL ROLL (May 1969) 47,332 SCHOOL MEDICAL INSPECTION Routine 16,747 Special 4,333 Re-inspections 5,712 No. of medical inspections per 1,000 pupils 566 Health Surveys - comprehensive 29,423 No. per 1,000 pupils 622 Percentage found verminous 1.3 Health Surveys - selective 7,234 No. per 1,000 pupils 153 Percentage found verminous 3.9 Audiometry- No. of children given sweep test 9,677 No. of children given pure tone test 575 No. of children referred to otologist at audiology centre 92 SCHOOL MEDICAL TREATMENT Hospital and Specialist Clinics Vision Centres:- Vision sessions 132 Number of new cases 274 Total attendances 1,544 Errors of refraction and squint 998 Other eye defects 21 Spectacles ordered 490 Orthoptic sessions 6 Number of new cases 8 Total attendances ■ 19 Ear, Nose and Throat Centres:- Sessions - Number of new cases - Total attendances . 139 LOCAL AUTHORITY CLINICS Audiology centres:- Sessions 49 Number of new cases 146 Total attendances 238 Special investigation clinics:- Sessions 131 Number of new cases 181 Total attendances 1,017 Minor ailment centres:- Sessions Medical officer 65 Nursing sister 566 Number of new cases seen by medical officer 450 Average per session 6.9 Number of new cases seen by nursing sister only 1,151 Average per session 2.0 Total attendances 10,601 Defects treated:- Athlete's foot 115 Verrucae 886 Ringworm on body 11 Impetigo 98 Other skin diseases 98 Eye diseases 27 Ear diseases 24 Miscellaneous: Bruises, lacerations, etc. 370 RECUPERATIVE HOLIDAY HOMES Schoolchildren (including nursery school children) Number admitted during year 175 140 SCHOOL DENTAL SERVICE 1969 REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER Five Year Review This is my fifth annual report and it seems to be a suitable time to look back to my first report and to compare it with the present situation. In 1965 standards of decoration of premises and of equipment were in need of improvement. It is pleasing to report that the surgeries are now generally in good decorative state and have more modern equipment. An additional surgery at Barley Mow Treatment Centre, to serve the needs of children in the northern part of the borough, and a second surgery at Brixton Treatment Centre, staffed by a dental auxiliary have opened. In 1965 little was being done on dental health education and in accordance with the policy of the London Education Authority at that time, dental inspections were carried out only of 5 year old school entrants. At the end of 1969 the staff consisted Principal School Dental Officer Senior dental officer 2 full time dental officers 5 sessional dental officers (2.1 full time equivalent) 1 dental auxiliary 8 full time dental surgery assistants Dental Health Education There has been a considerable increase in this important field during the year and this has been due in no small measure to the efforts of the newly appointed dental auxiliary. Lewisham had pioneered the use of puppet shows to get the dental health message across. As a result of the joint efforts of our dental auxiliary and the I.L.E.A. Dental Health Educator, many of our infant schools found the puppet shows instructive and entertaining. There has also been a heavy demand for talks in Junior Schools. A total of 71 schools were visited for dental health education purposes and this involved about 15,000 children. Some equipment was purchased in the year in order to provide more adequate and suitable audio-visual aids. It has been most encouraging to see the great interest shown by the schools in dental health. Efforts have been made to ensure that the dental health posters in the surgery waiting rooms are changed more often and requests by dental officers for leaflets have been met. 141 To provide dental staff with more information on the dental health material available a small exhibition was arranged. The display of posters, pamphlets, books, models and the showing of slides and films, all helped to make the afternoon session successful. Inspection and Treatment There has been marked increase in the number of school dental inspections. Numbers of inspection sessions carried out in the past five years were as follows - 1965 1966 1967 1968 1969 73.0 48.2 188 144.2 310.3 Despite the number of sessions devoted to school dental inspections, the number of visits for treatment increased from 13,375 last year to 14,428 in 1969. The Principal School Dental Officer administered general anaesthetics for 210 cases. There has also been an increase of orthodontic cases and their appropriate treatment. There has been an increase in the ratio of permanent teeth filled to teeth extracted, and the ratio of deciduous teeth filled to teeth extracted has improved very slightly. Further details of the treatment patterns are given in the statistics. Appointment The appointment of a senior dental officer has helped to create a career structure within the Borough. Barley Mow School Treatment Centre It was gratifying to note that the new surgery in the north of the borough finally opened. It is well equipped and there is adequate working space and good facilities for a high standard of dentistry. 142 Courses and Conferences It is most important that the dental staff should have the opportunity to keep abreast of latest developments in the profession. The following course and conferences were attended:- Dental Health Education Conference organised by the General Dental Council Orthodontic Course at Leeds organised by the British Society for the Study of Orthodontics Orthodontic Course at King's College Hospital Dental Symposium at Guy's British Dental Association Conference at Bournemouth British Association of Dental Auxiliaries Symposium in London Visitors Two dental surgeons visited the Borough from overseas, one from Sudan and the other from Thailand. Arrangements were also made for a student dental auxiliary to visit the Borough. My thanks are again due to the dental staff for their work during the year and I would like to thank all those in the Borough's Health Department for their interest and co-operation. B.M. Spalding, L.D.S., R.C.S.(Eng.) Principal School Dental Officer SCHOOL DENTAL SERVICE Number of Sessions: Inspection 310.3 Ordinary treatment 2,387.3 General anaesthetic 64.1 Orthodontic 52.2 Health education 337.4 Total sessions 3,151.3 Inspections: number of children given: First inspection at school 32,325 First inspection at clinic 3,463 Percentage found to require treatment 56.9 Re-inspection at school or clinic in 1969 1,004 Percentage found to require treatment 74.9 143 Visits for treatment Number of first visits 4,834 Number of subsequent visits 9,594 Total visits 14,428 Emergencies 412 Additional courses commenced 639 Number did not attend 9,100 Treatment given: Number of fillings: In permanent teeth 6,938 In temporary teeth 6,351 Number of extractions: Of permanent teeth 465 Of temporary teeth 1,951 Number of other operations 5,235 Courses of treatment completed 3,409 Orthodontics: Number of new cases 62 Number of removable appliances fitted 141 Number of fixed appliances fitted 3 Sessional averages: First visits 1.9 Subsequent visits 3.8 Emergencies 0.2 Did not attend 3.6 Fillings: In permanent teeth 2.8 In temporary teeth 2.5 Extractions: Of permanent teeth 0.2 Of temporary teeth 0.8 Ratio of permanent teeth filled to permanent teeth extracted 13.1 Ratio of temporary teeth filled to temporary teeth extracted 2.9 Staff: Number of dentists employed (F.T.E.) 5.2 Printed by London Borough of Lambeth '