17C.43374 AC. 4385 III W.C. The health of LAMBETH Annual report 1971 A.L. THROWER, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. LAM 60 LONDON BOROUGH OF LAMBETH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1971 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 and Protection Committee 5 Staff of the Health Directorate 7 Introductory remarks of Medical Officer of Health 8 SECTION A: Statistics and Social Conditions of the Area General 13 Births; Birth Rate 13 Still Births; Deaths; Death Rate 14 Maternal Mortality 14 Infantile Mortality 15 Vital Statistics for Years 1962-1971 17 Classification of Causes of Deaths 18 Notes on Vital Statistics 24 Deaths from Cancer of the Lung and Bronchus 26 Road Traffic Accidents 26 SECTION B: Prevalence of and Control over Infectious and Other Diseases Notifiable Diseases 28 Notifications other than Tuberculosis 29 Age Distribution of Infectious Diseases 30 Notes on Infectious Diseases 32 Salmonella Infections 35 Notification of Tuberculosis 36 Report of Chest Physicians 36 SECTION C: Personal Health Services Maternity and Child Health Services 40 Screening for Phenylketonuria 41 Dental Treatment for Expectant and Nursing Mothers and Children under 5 years 43 Cervical Cytology Screening Service 44 Family Planning 45 Health Visiting 47 Domiciliary Midwifery Service 48 Midwives Act 1951 49 Ancilliary Staff 50 3 SECTION C: Personal Health Services (continued) Page District Nursing 50 Health Education 52 In-Service Training 53 Control of Venereal Diseases 54 Observation/Handicap Register 61 Advisory Service to Directorate of Social Services 72 Medical Examination of Staff 73 International Certificates of Vacinnation 74 Vaccination and Immunisation 75 Tuberculosis 78 B.C.G. Vaccination 78 Chiropody 79 Registration of Nursing Homes 80 Loan of Nursing Equipment 81 • SECTION D: Environmental Health Services Food Hygiene and control of sale of certain foods 84 Control of Drainage and Plumbing Works 85 Abatement of Nuisances other than repair of dwellings 86 Factories and Outworkers 87 Registration of Certain Premises 92 Diseases of Animals Act 92 Clean Air 92 Rodent Control 93 Disinfection and Disinfestation 94 Laundry Service for Incontinent Persons 94 Control of Food and Drugs on Sale 94 Control of Imported Food 94 Containers 95 Investigation of Unsound Food 95 Condemnation of Unsound Food 95 Control of Food Factories, Large Wholesale Depots and Stores 96 Environmental Health Education 96 Housing — Clearance 96 Individual Unfit Houses 97 Modernisation and Improvement 97 Repair and Maintenance 98 Prevention of Overcrowding, Control of , Multiple Occupation 98 Qualification Certificates 100 4 SECTION E: General Page Water Supply 104 Swimming Pools 107 Housing (Medical Grounds) 108 Home Dialysis Machines 109 Sewers 109 Burial or Cremation of the Dead 110 Hospital Facilities 110 Ambulance Facilities 111 Public Health Laboratory Service 111 SECTION F: School Health Service Report of Principal School Medical Officer 114 5 LONDON BOROUGH OF LAMBETH HEALTH AND PROTECTION COMMITTEE Period from 1st January, 1971 to 13th May, 1971 The Worshipful the Mayor of Lambeth Alderman Jack Westbury (Ex-officio) The Deputy Mayor of Lambeth Alderman George Harrison Hickmore, J.P. (Ex-officio) Chairman Alderman Walter C. Dennis, J.P. Vice-Chairman Councillor W.G.C. Vinnell Alderman T. Cleasby Councillor Mrs. J. Brittain Councillor Mrs. M.F. Brown Councillor Mrs. L.M. Burton Councillor J.F.E. Cartwright Councillor J.R. Ebling Councillor Miss H. Jellie Councillor A. Pfaff Councillor D.F. Renwick Councillor D.E.J. Smith Co-opted Members Dr. G.I. Taylor Mr. B.A. McSwiney Mrs. V.B. Dennis 6 HEALTH AND PROTECTION COMMITTEE Period from 13th May, 1971 to 31st December, 1971 The Worshipful the Mayor of Lambeth Alderman George W.M. West, J.P. (Ex-officio) The Deputy Mayor of Lambeth Councillor W.A. Johnson (Ex-officio) Chairman Councillor C.J. Blau Vice-Chairman Councillor D.D. Prentice Alderman Walter C. Dennis, J.P. Alderman V.S. Mathews Alderman H. Rees Councillor H.A. Bavin Councillor V. Bogazzi Councillor Mrs. I.D. Brown Councillor K.L. Enwright Councillor Miss H. Jellie Councillor Mrs. P.J. Moberly Councillor M.M. Noble Councillor W. Seeley Councillor S.L.H. Shah Co-opted Members Mr. B.A. McSwiney Dr. G.P. Sparrow Dr. John L. Day 7 STAFF OF HEALTH DIRECTORATE Director of Health Services, 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. Chief Medical Officer N. Christina Walsh, M.B., B.Ch., D.C.H., D.P.H. Assistant Director of Health Services T.J. Amos Principal Administrative Officer K. Sherlock Chief Nursing Officer Miss E. Early Principal Nursing Officer Miss A. Swift Chief Dental Officer B.M.S. Spalding 8 Mr. Mayor, Ladies and Gentlemen, I have pleasure in presenting to you my annual report on the health of the London Borough of Lambeth for the year 1971. The year has brought a number of changes and has seen the responsibility for several services including day nurseries, home help and mental health, pass from my Directorate to the new Directorate of Social Services which had to be set up by 1st April, 1971 under the Local Authority Social Services Act 1970. The Education (Handicapped Children) Act 1970 transferred responsibility for junior training schools from 1st April to the Inner London Education Authority. The home nursing service which, in the past, has been provided by the Lambeth District Nursing Joint Committee on the Council's behalf, was operated directly by the Health Directorate from 1st April, 1971. These changes required a substantial reorganisation within the Directorate. Expansion of family planning has continued in both clinic and domiciliary services and a 75% grant under the Urban Aid Programme was approved by the Home Office lor the cost of the expansion of this service. Towards the end of 1971 a working party was set up in the Borough to plan a completely free and greatly expanded service to start in 1972 and to make arrangements for transferring the service from the Family Planning Association to Council control. Consideration is being given to the introduction of geriatric clinics as a logical extension of general screening procedures for "at risk" groups of the community and to the establishment of two pilot geriatric clinics under Section 12 of the Health Service and Public Health Act, 1968, subject to the approval of the Department of Helath and Social Security. The main objective of the clinics will be to prevent or retard deterioration to the health of the elderly, to discover by simple procedures defects or deficiencies and to advise or refer for treatment where necessary. It is hoped that the opening of two piiot clinics will take place next year. The planning of new buildings to replace unsatisfactory premises and for the expansion and improvement of existing services has continued throughout the year. The up-dated 5 year capital building programme includes plans for eight health centres. A new purpose-built maternity and child health centre called Belthorn and situated at Belthorn Crescent, off Weir Road, SW2, was due to be opened this year but unfortunately the contractor engaged on the work went into liquidation and, due to this and other difficulties, it will not be ready until next year. 9 The chances of introduction of smallpox into Britain has substantially diminished due to the fact that the area of the world in which smallpox now exists, and the populations in which transmission of smallpox is still occurring, have been greatly reduced. It is considered that the number of serious complications from vaccination in childhood, though few, is now out of proportion to the risk to children from smallpox. The Secretary of State has therefore accepted the advice of the Joint Committee on vaccination and immunisation that vaccination against smallpox need not now be recommended as a routine procedure in early childhood and this procedure has now been discontinued in Lambeth. Protection will still be offered to travellers to and from areas of the world where smallpox is endemic or where eradication programmes are in progress. The movement of population out of the Borough has continued, and it would appear that since 1965 some 35,000 residents have moved out of the Borough. Substantial movements of population in and out of the Borough add to the difficulties of maintaining essential contacts with families and children. Mr. D.E. Armstrong, principal administrative officer in my Directorate, retired on 31st January after almost 46 years service, most of it with the London County Council. Mr. Armstrong obtained his Bachelor of Science degree, which he passed with first class honours, at the remarkably early age of 19 years. He entered the service of the London County Council in 1925 as an assistant scientific officer, only to embark after 3 years on a new career in administration in the Health Department. Two years later, at the age of 26, he achieved the distinction of becoming a Doctor of Philosophy (Chemistry). Mr. Armstrong played a considerable part in planning and consolidating the Health Department's services both before and after the creation of the new London Borough of Lambeth and he made a major contribution to their subsequent expansion. The smooth transition of services during the difficult months of reorganisation in 1965 owed much to his administrative qualities and enabled the changeover to take effect without any loss of service or inconvenience to the public. Miss D.M. Barber, assistant principal nursing officer, and non-medical supervisor of midwives in Lambeth, retired from the joint service of the Council and the Inner London Education Authority on 31st March, and it is with great regret that I learned of her death while this report was in preparation. Miss Barber was an examiner for the Central Midwives Board and had for many years given lectures on emergency midwifery to all London Ambulance personnel. I am pleased to have this opportunity of thanking the Chairman and members of the Health and Protection Committee and other members of the Council for their interest and support throughout the year. My thanks are also due to the Chief Executive and my fellow Directors, and I am most grateful for the co-operation which I have recieved from Dr. A.B. Stewart, Medical Adviser, Inner London Education Authority and his staff, and to hospital staffs and 10 general practitioners, with whom the department is in daily contact. 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 Director of Health Services. 11 Section A Statistics and Social Conditions of the Area 12 STATISTICS AND SOCIAL CONDITIONS OF THE AREA In the North the London Borough of Lambeth has a common boundary — down the middle of the Thames — with the Cities of London and Westminster, and is flanked by the Boroughs of Southwark and Wandsworth and, in the South has common boundaries with the Boroughs of Bromley, Croydon and Merton. The land surface rises from 12 feet above sea level at the river to 50 feet at Brixton, 150 feet at West Norwood, 200 feet at Streatham and about 379 feet at and near the Crystal Palace. The perimeter of the Borough measures 19½ miles and its total area is approximately 10½ square miles. In terms of population, Lambeth is the largest of the Inner London Boroughs. The Borough has approximately 600 acres of park and open spaces including Brockwell, Kennington, Ruskin, Norwood, Archbishop's and Vauxhall Parks, Myatt's Fields Streatham Common and parts of Clapham and Tooting Bec Commons. Amongst the world famous buildings within its boundaries are Lambeth Palace, The Oval Cricket Ground, The County Hall, The Royal Festival Hall, the Headquarters of the London Fire Brigade and the Transport Museum at Clapham. For Parliamentary purposes the Borough is divided into five constituencies, Vauxhall, Brixton, Norwood, Streatham and Clapham, each returning one Member of Parliament. For Borough Council elections the Borough is divided into a total of 20 wards each returning three Councillors. Four members are returned to Greater London Council. 13 STATISTICS GENERAL Area of Borough 6727 acres Number of Wards 20 Number of Parliamentary Constituencies 5 Population (Mid-year estimate 1971) 304,410 Density of Population (i.e. number of persons per acre) 45.25 Number of marriages during the year 2,424 Marriage rate per 1,000 population 8.0 Rateable Value of District (1st April, 1971) £20,644,636 Sum represented by a penny rate (1971/1972) £197,000 Number of separately rated houses and flats at 1st April, 1971 94,774 VITAL STATISTICS LIVE BIRTHS Legitimate Illegitimate Totals Males 2,210 536 2,746 Females 2,048 481 2,529 Totals 4,258 1,017 5,275 Live Birth Rate per 1,000 home population 17.32* Birth Rate corrected for comparison with other areas 15.24 Comparability factor supplied by Registrar General 0.88 Birth Rate per 1,000 Home Population England and Wales 16.0 * Birth Rate per 1,000 Home Population Inner London Area 15.1 * Birth Rate per 1,000 Home Population Outer London Area 15.3 Birth Rate per 1,000 Home Population Greater London Area 15.2 Illegitimate live Births per cent of total live births 19.28 Illegitimate Live Births per cent of total live births Inner London Are 16.6 Illegitimate Live Births per cent of total live births Outer London Area 8.6 Illegitimate Live Births per cent of total live births Greater L ondon Area 11.5 *Crude Rate 14 STILL BIRTHS Legitimate Illegitimate Totals Males 19 11 30 Females 34 5 39 Totals 53 16 69 Still Birth Rate per 1,000 Total Births (i.e. Live and Still) 12.9 Still Birth Rate per 1,000 total births England and Wales 12.2 Still Birth Rate per 1,000 total births Inner London Area .. 11.5 Still Birth Rate per 1,000 total births Outer London Area .. 11.9 Still Birth Rate per 1,000 total births Greater London Area .. 11.7 DEATHS Males Females Totals 1,735 1,775 3,510 Death Rate per 1,000 home population 11.5* Death Rate corrected for comparison with other areas 12.3 Comparability Factor (supplied by Registrar Geneal) 1.07 Death Rate per 1,000 home population England and Wales 11.6* Death Rate per 1,000 home population Inner London Area 12.3* Death Rate per 1,000 home population Outer London Area 11.0* Death Rate per 1,000 home population Greater London Area 11.5* MATERNAL MORTALITY Number of Women dying in consequence of Childbirth Nil Maternal Mortality Rate per 1,000 total births — Maternal Mortality Rate per 1,000 total births Inner London Area 0.17 Maternal Mortality rate per 1,000 total births Outer London Area 0.10 Maternal Mortality Rate per 1,000 total births Greater London Area 0.12 *Crude Rate 15 INFANTILE MORTALITY Deaths of infants under one year of age Legitimate Illegitimate Totals Males 46 18 64 Females 29 8 37 Totals 75 26 101 Death Rate of infants under one year of age per 1,000 live births 19.0 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 19.2 Death Rate of infants under one year of age per 1,000 live births Outer London Area 16.4 Death Rate of infants under one year of age per 1,000 live births Greater London Area 17.4 Deaths of infants under four weeks of age Legitimate Illegitimate Totals Males 31 14 45 Females 21 5 26 Totals 52 19 71 Neo-natal Mortality Rate (Deaths under four weeks per 1,000 live births) 13.4 Neo-Natal Mortality Rate England and Wales 12.0 Neo-Natal Mortality Rate Inner London Area 12.7 Neo-Natal Mortality Rate Outer London Area 10.9 Neo-Natal Mortality Rate Greater London Area 11.6 16 Deaths of infants under one week of age Legitimate Illegitimate Totals Males 24 11 35 Females 18 5 23 Totals 42 16 58 Early Neo-Natal Mortality Rate (Deaths under one week per 1,000 live births) 11.0 Early Neo-Natal Mortality Rate England and Wales 10.0 Early Neo-Natal Mortality Rate Inner London Area 10.6 Early Neo-Natal Mortality Rate Outer London Area 9.1 Early Neo-Natal Mortality Rate Greater London Area 9.7 Perinatal Mortality Rate (Still births and deaths under one week per 1,000 total births) 23.7 Perinatal Mortality Rate England and Wales 22.0 Perinatal Mortality Rate Inner London Area 22.0 Perinatal Mortality Rate Outer London Area 20.9 Perinatal Mortality Rate Greater London Area 21.3 17 SUMMARY OF VITAL STATISTICS FOR THE TEN YEAR PERIOD 1962-1971 METROPOLITAN BOROUGH OF LAMBETH Year Population Deaths *Death Rate Live Births *Live Birth Rate Deaths of Infants under 1 year of age Infantile Morality Rate Maternal Deaths Maternal Mortality Rate 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 1965-1971 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 1970 321,260 3,472 11.6 5,559 15.22 113 20.3 3 .53 1971 304,410 3,510 12.3 5,275 15.24 101 19.0 - - *As adjusted by comparability factor 18 19 LONDON BOROUGH OF LAMBETH NUMBERS OF DEATHS BY CAUSE, IN SEX AND AGE GROUPS DURING 1971 Cause of Death Sex Total All Ages Under 4 weeks 4 weeks and under 1 year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over B4 Enteritis and other Diarrhoeal Diseases M - - - - - - - - - - - - F 2 1 - - - - - - - - - 1 B5 Tuberculosis of Respiratory System M 8 - - - - - 1 - 2 2 2 1 F 4 - - - - - - - - 2 2 - B6 (1) Late effects of Respiratory T.B. M 3 - - - - - - - 1 - 1 1 F 2 - - - - - - - - 1 1 - B6(2) Other Tuberculosis M - - - - - - - - - - - - F 1 - - - - - - - 1 - - - B11 Meningococcal Infection M 1 - - - - - - - 1 - - - F - - - - - - - - - - - - B17 Syphilis and its Sequelae M 3 - - - - - - - - 1 2 - F 1 - - - - - - - - - - 1 B18 Other Infective and Parasitic Diseases M 4 - - - - - 1 2 - - 1 - F 2 - 1 - - - - - - - - 1 B19( 1) Malignant Neoplasm, Buccal Cavity, etc. M 6 - - - - - - - 1 1 3 1 F 4 - - - - - - - - 1 3 - B19(2) Malignant Neoplasm, Oesophagus M 6 - - - - - - - 1 2 2 1 F 8 - - - - - - - - 3 1 4 B19(3) Malignant Neoplasm, Stomach M 47 - - - - - - - 4 14 23 6 F 29 - - - - - - - 2 5 7 15 B19(4) Malignant Neoplasm, Intestine M 46 - - - - - - 1 1 8 21 15 F 55 - - - - - - 1 2 9 13 30 B19(5) Malignant Neoplasm, Larynx M 6 - - - - - - - 1 3 2 - F - - - - - - - - - - - - B19(6) Malignant Neoplasm, Lung, Bronchus M 207 - - - - - - - 21 70 72 44 F 64 - - - - - 1 1 8 11 24 19 B19(7) Malignant Neoplasm, Breast M - - - - - - - - - - - - F 73 - - - - - 2 2 8 21 12 28 B19(8) Malignant Neoplasm, Uterus F 30 - - - - - - 2 9 3 6 10 B19(9) Malignant Neoplasm, Prostate M 23 - - - - - - - 1 5 10 7 B19( 10) eukaemia M 4 - - - - - - - 1 1 - 2 F 7 - - - - - 1 - - 2 3 1 B19(11) Other Malignant Neoplasms M 100 - - 1 1 2 - 3 12 24 28 29 F 101 - - - - 1 - 2 15 24 24 35 B20 Benign and Unspecified Neoplasms M 7 - 1 - - - - - 1 2 1 2 F 6 - - - - 1 - - - - 3 2 B21 Diabetes Mellitus M 12 - - - - - 1 - 1 4 4 2 F 17 - - - - - 1 1 - - 4 11 20 21 Cause of Death Sex Total All Ages Under 4 weeks 4 weeks and under 1 year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over B46(1) Other Endocrine etc. Diseases M 3 - - - - - - - - 2 - 1 F 8 - - 1 1 - - 1 1 1 - 3 B23 Anaemias M 6 - - - - - - 1 - 1 3 1 F 10 - - 1 - - - - - - 1 8 B46(3) Mental Disorders M 6 - - - - - - - 1 2 2 1 F 5 - - - - - - - 1 2 - 2 B24 Meningitis M 3 2 - - - - - - - 1 - - F - - - - - - - - - - — ' B46(4) Multiple Sclerosis M 2 - - - - - - - - - 2 - F 4 - - - - - 2 - 1 - - 1 B46(5) Other Diseases of Nervous System M 21 - 2 1 - 3 - 2 1 3 6 3 F 19 - - 2 - - - - 2 - 6 9 B25 Active Rheumatic Fever M 1 - - - - - - - - - 1 - F - - - - - - - - - - - - B26 Chronic Rheumatic Heart Disease M 16 - - - - - 2 2 1 5 3 3 F 40 - - - - - 1 - 1 10 11 17 B27 Hypertensive Disease M 41 - - - - - - 3 7 8 9 14 F 37 - - - - - - 1 5 2 8 21 B28 Ischaemic Heart Disease M 419 - - - - - - 8 42 102 141 126 F 330 - - - - - 2 3 11 34 83 197 B29 Other Forms of Heart Disease M 60 - - - 1 - 1 3 3 6 10 36 F 138 - - - - - - 2 1 1 14 120 B30 Cerebrovascular Disease M 150 - - - - 1 3 5 9 36 39 57 F 229 - - - - 1 1 - 4 18 46 159 B46(6) Other Diseases of Circulatory System M 51 - - - - - - - 2 11 14 24 F 93 - - - - - - - 3 7 15 68 B31 Influenza M 1 - - - - - - - - - - 1 F 5 - - - - - — — — — 2 3 B32 Pneumonia M 95 5 5 - - - - 2 5 12 15 51 F 133 - 1 2 - - - - - 1 20 109 B33(1) Bronchitis and Emphysema M 123 - 1 - - - 1 5 20 54 42 F 75 - - - - - - - 3 11 18 43 B33(2) Asthma M 4 - - - 1 - - - - 3 - - F 2 - - - - - - - - - 2 - B46(7) Other Diseases of Respiratory System M 17 - 4 1 - - — — — 3 2 7 F 20 - 7 - - 1 — — 1 1 1 9 B34 Peptic Ulcer M 22 - - - - - - - - 5 8 9 F 12 - - - — — — — — 1 2 9 B35 Appendicitis M 1 - - - - - - - - - - 1 F - - - - - - - - - - - - 22 23 Cause of Death Sex Total All Ages Under 4 weeks 4 weeks and under 1 year Age in years 1 -4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over B36 Intestinal Obstruction and Hernia M 2 - - - - - - - - - 1 1 F 9 2 - - - - - - - - 1 6 B37 Cirrhosis of Liver M 6 - - - - - - 2 - 4 - - F 11 - - - - — — — 2 5 2 2 B46(8) Other Diseases of Digestive System M 12 - - 1 - - - 1 1 3 3 3 F 28 - - - - - - - - 2 6 20 B38 Nephritis and Nephrosis M 9 - - - - - - 1 2 2 2 2 F 10 - - - 1 - 1 - - 2 1 5 B39 Hyperplasia of Prostate M 7 - - - - - - - - 2 2 3 B46 (9) Other Diseases, Genitc-Urinary System M 13 - - - - - - - 1 2 3 7 F 11 - - - 1 - - 1 - - 1 8 B40 Abortion F 1 - - - - - 1 - - - - - B46( 11) Diseases of Musculo-skeletal System M 13 - - - - - - - 2 2 1 8 F 23 - - - - 1 - 1 1 - 5 15 B42 Congenital Anomalies M 23 13 1 2 1 - 1 1 1 1 1 1 F 10 5 1 - - — 1 1 - 1 - 1 B43 Birth Injury, Difficult Labour, etc. M 20 20 - - - - - - - - - - F 5 5 - - - - - - - - - - B44 Other causes of Perinatal Mortality M 5 5 - - - - - - - - - - F 13 13 - - - - - - - - - B45 Symptoms and III Defined Conditions M 5 - - - - - 1 1 - - 1 2 F 5 - - - - - - - - - - 5 BE47 Motor Vehicle Accidents M 25 - - 1 2 6 2 3 — 3 4 4 F 19 - - - 3 2 2 - 2 2 5 3 BE48 All other accidents M 37 - 5 2 3 2 3 5 8 4 3 2 F 39 - - 3 4 2 2 2 4 4 3 15 BE49 Suicide and Self-inflicted Injuries M 25 - - - - 2 4 4 6 5 2 2 F 18 - - - - 2 2 3 2 6 1 2 BE50 All other external causes M 8 - - - - 3 - 2 2 - 1 - F 7 - 1 - - 2 2 - 1 1 - - TOTAL ALL CAUSES M 1,735 45 19 9 9 19 20 53 148 385 505 523 F 1,775 26 11 9 10 13 22 24 91 194 357 1,018 GRAND TOTAL 3,510 71 30 18 19 32 42 77 239 579 862 1,541 24 VITAL STATISTICS POPULATION The Registrar-General's mid-year estimate for the year 1971 is 304,410. This is a decrease of 16,850 on the figure for the year 1970, and of 35,150 compared with mid-1965. The reason for the drastic decrease in population over the last year is due to the fact that the mid-1971 figure is based on the 1971 Census and is, therefore, more realistic. The number of live births exceeded the deaths, giving a natural increase of 1,765. 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 5,310 1 to 4 years 18,990 5 to 14 years 40,000 15 to 64 years 202,510 65 years and over 37,600 Total 304,410 LIVE BIRTHS The total number of live births occurring to residents of the Borough was 5,275 comprising 2,746 males and 2,529 females. This figure was 284 less than that for 1970, giving a corrected birth rate of 15.24 per 1,000 population. The rate for England and Wales was 16.0 and the rates for Inner, Outer and Greater London Areas are 15.1, 15.3 and 15.2 respectively. During the year there were 1,017 illegitimate live births. This figure is 83 less than for 1970 giving a percentage of illegitimate live births per cent of total live births of 19.3 and compares unfavourably with those for Inner London, Outer and Greater London Areas which are 16.6, 8.6 and 11.5 respectively. STILL BIRTHS Still births for the year numbered 69, which is a decrease of 17 to the 1970 figure, and gives a still birth rate of 12.9. The rate for England and Wales is 12.2 and for the Greater London Area it is 11.7. 25 DEATHS Allowing for inward and outward transfer the total number of deaths comprising 1,735 males and 1,775 females was 3,510. The corrected death rate at 12.3 per 1,000 population is higher than England and Wales (11.6 crude rate) and the crude rates for Inner, Outer and Greater London Areas are 12.3, 11.0 and 11.5 respectively. Sixty-eight 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. 1,604 occurring out of a total of 3,510. Malignant neoplasms of all forms ranked second. 43 people took their own lives compared to 46 in 1970 and motor vehicle accidents accounted for 44 deaths, a decrease of 2 on the figure for last year. There were no deaths of mothers as a result of diseases of pregnancy or childbirth. The maternal mortality rate per 1,000 births for Inner London, Outer London and Greater London Areas are 0.17, 0.10 and 0.12 respectively. INFANTILE MORTALITY One hundred and one infants died before reaching 1 year of age, 12 less than in 1970. The infantile mortality rate fell to 19.0 per 1,000 live births compared with 20.3 last year. The causes of death fell into the undermentioned categories:- Cause of death Male Female Total Birth injury, difficult labour, etc. 20 5 25 Other causes of perinatal mortality 5 13 18 Congenital anomalies 14 6 20 Other diseases of respiratory system 4 7 11 Pneumonia 10 1 11 Other diseases of nervous system 2 - 2 Meningitis 2 - 2 Benign and unspecified neoplasms 1 - 1 Other infective and parasitic diseases - 1 1 Enteritis and other diarrhoeal diseases - 1 1 Bronchitis and emphysema 1 - 1 Intestinal obstruction and hernia - 2 2 All other accidents 5 - 5 All other external causes - 1 1 64 37 101 26 DEATHS FROM CANCER OF THE LUNG AND BRONCHUS There was an increase in the number of deaths from cancer of the lung and bronchus, 271 occurring compared with 252 in 1970. The deaths were distributed amongst the various age groups as follows:- Age Male Female Totals 25-34 years - (1) 1 (-) 1 (1) 35-44 years - (2) 1 (1) 1 (3) 45-54 years 21 ( 21) 8 (10) 29 (31) 55-64 years 70 ( 66) 11 (18) 81 (84) 65-74 years 72 (76) 24 (15) 96(91) 75 and over 44 (30) 19 (12) 63 (42) 207 (196) 64 (56) 271 (252) The figures in brackets are those for the year 1970. ROAD TRAFFIC ACCIDENTS My thanks are due to the Director of Civil Engineering and Public Services for the following information regarding road traffic accidents occurring in the London Borough of Lambeth during the year 1971. The figures shown refer not only to Lambeth residents but also to persons living in other areas who were involved in accidents in the Borough. The number of fatalities shown may not agree, therefore, with those in the list of causes of death supplied by the Registrar-General. The Registrar-General's figures refer to Lambeth residents only, and the death may have occurred within the Borough of Lambeth or outside the district. No. of Accidents Killed Seriously Injured Slightly Injured Adult 1,864, (1,859) 26 (25) 295 (369) 2,069 (2,107) Children 540 ( 569) 5 ( 6) 97 (128) 531 ( 515) 2,404 (2,428) 31 (31) 392 (497) 2,600 (2,622) The figures in brackets are those for the year 1970. 27 Section B Prevalence of and Control over Infectious and other Diseases 28 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 neonatorium Paratyphoid Fever Plague Relapsing fever Scarlet fever Smallpox Tetanus Tuberculosis Typhoid fever Typhus Whooping cough Yellow fever 29 CORRECTED NUMBER OF NOTIFICATIONS, EXCLUDING TUBERCULOSIS RECEIVED DURING 1971 Disease First Quarter Second Quarter Third Quarter Fourth Quarter Totals Grand Total M F M F M F M F M F Scarlet Fever 12 6 5 3 — 3 17 12 29 Whooping Cough 6 6 7 4 2 2 _ 3 15 15 30 Measles 183 175 124 104 47 56 15 10 369 345 714 Dysentery 5 8 1 6 7 5 13 12 26 31 57 Acute Meningitis 4 1 1 3 1 2 1 1 7 7 14 Infective Jaundice 11 6 5 8 6 5 5 9 27 28 55 Malaria _ — 2 1 3 — 2 — 7 1 8 Paratyphoid Fever _ _ _ _ _ _ _ - — _ _ Food Poisoning 4 1 1 2 3 5 2 4 10 12 22 Typhoid Fever — — — — — — — — — — — Ophthalmia Neonatorium — — 1 2 — 1 1 2 2 5 7 TOTALS 225 203 147 133 69 76 39 44 480 456 936 30 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 33 23 5 4 2 2 — — 75 1 year _ _ 1 4 44 62 3 _ 1 • 1 _ 1 117 2 years 1 1 _ _ 50 47 2 2 2 - _ _ 105 3 years - 1 3 5 58 51 - 4 _ - 2 2 126 4 years 4 2 - _ 45 46 1 2 _ _ - - 100 5-9 years 8 5 7 3 124 98 9 7 _ 1 3 8 273 10-14 years 1 2 _ _ 4 4 _ _ _ _ 1 5 17 15-24 years 1 1 1 — 3 3 _ 1 _ _ 7 5 22 25 years and over 1 _ _ — 1 1 6 10 1 3 13 7 43 Age unknown 1 — _ _ 7 10 — 1 1 - 1 — 21 TOTALS 17 12 15 15 369 345 26 31 7 7 27 28 899 31 NOTIFICATION OF INFECTIOUS DISEASES - AGE DISTRIBUTION (Contd.) Age Group Malaria Paratyphoid Fever Food Poisoning Typhoid Fever Ophthalmia neonatorium Totals M F M F M F M F M F Under 5 years 1 1 5-14 years 1 — 5 _ _ 6 15-44 years 6 1 — — 3 8 — — — — 18 45-64 years _ _ _ _ _ _ _ _ - _ - 65 and over — — _ _ - 4 - _ _ - 4 Age unknown — — — — 1 — — — 2 5 8 TOTALS 7 1 _ _ 10 12 _ _ 2 5 37 GRAND TOTAL 899 37 936 32 NOTIFICATIONS OTHER THAN TUBERCULOSIS The number of notifications received during the year decreased by 699; 936 cases of infectious disease being notified compared with 1,635 in 1970. CONTROL OF INFECTED INDIVIDUALS Public Health Inspectors visit the dwellings of persons known to be infected or having been in contact with an infectious disease where advice, surveillance or exclusion from normal occupation may help to prevent the spread of the disease. Where necessary specimens from patients or samples of suspected food are collected and submitted for investigation to the Public Health Laboratory whose services in this connection are invaluable. DYSENTERY 57 perse ns were notified as suffering from dysentery and following investigation of these a number of carriers of the disease came to light. Frequently one or more carriers are found amongst a patient's home contacts and these are kept under surveillance until cleared. FOOD POISONING etc. 36 cases of food poisoning, notified or otherwise ascertained, were investigated by public health inspectors. All cases were sporadic, 12 being due to Salmonella Typhimurium, 21 to other Salmonellae and in 3 cases the cause was not found. 8 other instances of Salmonellae infection were not considered to be food borne. Outbreak of Food Poisoning — St. Thomas' Hospital Following a ball arranged by the students of St. Thomas' Hospital at Cobham in Surrey in June, a number of persons suffered from sickness and diarrhoea. The infecting organism was found to be Salmonella St. Paul. In all some 800 persons attended the ball mostly employed in the Hospital service — but not all from St. Thomas'. 33 St. Thomas' Hospital Authorities took the necessary measures to prevent spread within the hospital and arranged screening of all persons attending the ball to whom they had access. All hospitals and Medical Officers of Health in the London area were alerted and information was sent to the Medical Officers of Health of those authorities in whose areas affected persons were known to reside. The organism was isolated from 150 persons, but there were no secondary cases. The premises and staff of the catering firm supplying the food were checked by the Medical Officer of Health of the area, with negative results. It was not possible to identify the vehicle of infection as no specimens of the food were available. EPIDEMICS In no case did the incidence of any disease reach epidemic proportions but prompt action in the early stages of any known or suspected case is an essential factor in the prevention of spread of disease. For this reason close liaison and co-operation is maintained between Boroughs, Schools, Nurseries and Hospitals and this plays a large part in supplying early information of epidemic threatening situations. In this field it is unusual to encounter less than full co-operation from organisations, businesses and members of the public once the need has been explained. INTERNATIONAL Individuals arriving in this country from areas abroad where certain diseases are prevalent and who are unable to produce satisfactory evidence of vaccination are notified that they will be placed under surveillance during the period of incubation of the disease. Information from ports of entry was received in respect of 16 persons coming from smallpox infected areas and 5 from cholera areas. All were visited and kept under surveillance. No cases developed. An increasing number of people spending holidays abroad risk infections other than those covered by the international regulations, principally typhoid fever and other salmonella infections. At the request of employers a number of 34 specimens from such persons engaged in food handling were taken for examination. These were in all cases satisfactory but some of the cases reported under "Food Poisoning" were probably contracted abroad. SCOPE OF SERVICE 202 visits were made by Public Health Inspectors in connection with communicable diseases during 1971. An unrecorded number of visits was also made by non-technical staff for the collection of pathological specimens and their delivery to the laboratory for examination. SCARLET FEVER Twenty-nine cases were notified, the same number as in 1970. WHOOPING COUGH There was a sharp decrease in the number notified, thirty compared with eighty-one in 1970. MEASLES There was a reduction in the incidence of measles, 714 cases being notified compared with 1,467 in 1970. ACUTE MENINGITIS Fourteen cases were notified, the same number as in 1970. INFECTIVE JAUNDICE Fifty-five cases were notified this year. MALARIA Eight cases were notified as compared to two in 1970. OPHTHALMIA NEONATORIUM Seven cases were notified as compared to two in 1970. 35 SALMONELLA INFECTIONS (NOT FOOD BORNE) INCIDENTS AND CASES CAUSATIVE AGENT GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC CASES notified or ascertained TOTAL No. of outbreaks and sporadic cases COLS. 1+3 + 5 TOTAL No. of cases COLS. 2 + 4 + 5 No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained 1 2 3 4 5 6 7 1. S Typhimurium _ _ 1 2 2 3 4 2. Other Salmonellae _ _ 1 2 2 3 4 3. TOTAL _ _ 2 4 4 6 8 Details of Salmonella infections due to Salmonella other than S. Typhimurium (not food borne) Type of Salmonellae Montevideo _ _ 1 2 _ 1 2 Saint Paul _ _ _ _ 1 1 1 Untyped _ _ _ _ 1 1 1 TOTAL _ _ 1 2 2 3 4 36 TUBERCULOSIS CORRECTED NUMBER OF NOTIFICATIONS RECEIVED DURING THE YEAR 1971 AGE RESPIRATORY OTHER MENINGES and C.N.S. Total M F M F M F Under 1 year — — — — — — — 1 year — — — — — — — 2-4 years 1 — 1 — — — 2 5-9 years — — — — — — — 10-14 years 1 — — — — — 1 15-19 years 2 4 1 — 1 — 8 20-24 years 6 5 1 3 — — 15 25-34 years 10 5 3 1 — — 19 35-44 years 12 8 2 1 1 — 24 45-54 years 14 5 — 2 — — 21 55-64 years 11 — — 1 — — 12 65-74 years 8 1 — — — — 9 75 and over 5 3 — — — — 8 Age unknown — — — — — — — TOTAL 70 31 8 8 2 — 119 Male Female Cases of fatal tuberculosis not notified before death. 7 4 I am indebted to Dr. H.J. Anderson for the following report on the work of St. Thomas' Chest Clinic for the year Report on the work of the Chest Clinic, St. Thomas's Hospital, 1971 The North Lambeth Chest Clinic is completely integrated in the Chest Clinic of St. Thomas's Hospital and, therefore, many referrals do not live in the actual Clinic area. 37 The three chest wards at the South-Western Hospital are used for all types of chest illness. It can be seen that a quarter of the admissions with tuberculosis were homeless men. Without the T.B. Hostel run by the Lambeth Council at Knights Hill it would be very difficult to make suitable plans for aftercare. 1971 Total attendance in Chest Department 10,819 Total No. of B.C.G. vaccinations 170 No. of outpatient bronchoscopies 46 No. of new cases Ca. bronchus diagnosed in outpatients 47 No. of new cases of tuberculosis notified, North Lambeth 74 No. of patients on chemotherapy 134 Break down of South-Western (Chest Ward's) admissions, by diagnosis in 1971 Tuberculosis 72 Cancer 55 Bronchitis and Cor Pulmonale 75 Other diagnosis 46 248 This figure shows change due to increasing age of patients. No less than 24 of the 72 cases of tuberculosis were men from lodging houses and of no fixed abode; of these 6 have already defected from outpatient treatment. Three (3) of these have been readmitted to other hospitals with further tuberculous disease. The children's Contact Clinic has diminished in numbers since there is a higher incidence of tuberculosis in the older age group, with fewer children at risk. The number of outpatient bronchoscopies and other tests for bronchial carcinomas have increased. Treatment can often be palliative only and arrangements for terminal care must be made in good time. The district nurses, home helps and other council services have given a great deal of help to these patients. 39 Section C Personal Health Services 40 PERSONAL HEALTH SERVICES MATERNITY AND CHILD HEALTH SERVICES There are thirteen Maternity and Child Health Centres in the Borough, some in purpose-built or adapted accommodation and others in rented premises. Streatham Vale Child Health Clinic, at which one child health session a week only was held, was closed due to declining attendances on 24th June, 1971, and the session transferred to Streatham Common Maternity and Child Health Centre where more satisfactory clinic facilities are readily available. In reaching this decision, the Committee were influenced by the fact that many of the persons using the Streatham Vale Clinic were from Mitcham and Wandsworth, and that most of the users attend not for clinic treatment but to purchase welfare foods and nutrients. 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 ir vited 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 diphtheria, whooping cough, tetanus, poliomyelitis and measles, as well as creche facilities. A letter was received from the Department of Health and Secial Security reviewing the indications for offering vaccination against smallpox in Great Britain at the present time. The area of the world in which smallpox now exists and the population in which transmission of smallpox is still occurring have been greatly reduced. The chances of introduction of smallpox into Britain have substantially diminished and it is considered that the number of serious complications from vaccination in childhood, though few, is now out of proportion to the risk to children from smallpox. The Secretary of State has therefore accepted the advice of the Joint Committee on Vaccination and Immunisation that vaccination against smallpox need not now be recommended as a routine procedure in early childhood and this procedure has discontinued in Lambeth in August 1971. Protection will be offered however, to travellers to and from areas of the world where smallpox is endemic or where eradication programmes are in progress. 41 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 centre as a focal point where they can contact the health visitor and visit at intervals for consultation with the clinic medical officers. 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 metobolic 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 71,066 attendances at child health and toddlers' sessions and 1,010 attendances at ante-natal and post-natal clinic sessions. The Council provides facilities at some centres for general practitioner obstetricians to see their own booked maternity patients and 131 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 at many child health centres. There were 1,299 sessions during the period at which 15,441 attendances were made. CHILD HEALTH CENTRES Number of children attending during the year Born in 1971 4,159 Born in 1970 4,245 Born in 1966-1969 6,393 Total 14,797 42 Number of sessions held during the year by Medical Officers 311 Health Visitors 47 Sessional General Practitioners 2,441 Hospital Medical Staff 103 Total 2,902 PRIORITY DENTAL SERVICE Staff for this service, which provides dental treatment for expectant and nursing mothers and children under five years, are jointly employed by the Inner London Education Authority and the Borough except that dental surgery assistants are Borough employees. Details of staffing are given under the School Dental Service Report. There has again been an increase of attendances of pre-schoolchildren, expectant and nursing mothers in relation to the previous year. 99 sessions were devoted by dental officers or the dental auxiliary to the treatment of these priority groups, including 17 sessions for Health Education. There were also 27 sessions for the inspection of 3 year old children under the 3rd birthday card Scheme. Parents attending with their children have been given advice on dental care and offered an appointment for their children either for treatment or re-inspection at a surgery. 2 talks have been given on dental health to Mothers Clubs. Provision is also made for the dental treatment of children at Shirley Oaks on one whole day per week. B.M. Spalding, L.D.S., D.D.P.H. R.C.S. (Eng) Chief Dental Officer 43 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 245 13 Subsequent visits 364 19 Total visits 609 32 Number of additional course of treatment, other than the first course, commenced during the year 16 — Treatment provided during the year Number of fillings 480 24 Teeth filled 421 22 Teeth extracted 55 3 General anaesthetics given 19 — Emergency visits by patients 31 — Patients x-rayed 6 5 Patients treated by scaling and/or removal of stains from teeth 117 5 Teeth otherwise conserved 82 — Number of courses of treatment completed during the year 150 4 B. Patients supplied with a full upper or full lower denture - first time — — Patients supplied with other dentures — 1 Number of dentures supplied — 1 C. General anaesthetics administered by Dental Officers — — 44 D. Inspections during year - First inspections 485 10 Patients in above who required treatment 220 10 Patients in above who were offered treatment 219 10 Number of dental officer sessions (i.e. equivalent half days) devoted to maternity and child welfare patients during the period 126.0 CERVICAL CYTOLOGY A limited service of screening for cancer of the cervix began in Lambeth clinics in May 1966 under Section 28 of the National Health Service Act 1946. A shortage of pathological facilities, particularly trained laboratory technicians, was the limiting factor at that time and priority was given to women aged 35 years and over. Increased hospital resources have since been allocated to expand cytological services and smear tests can now be offered to all women living or working in Lambeth. A total of six sessions per week are held in Lambeth clinics and, in addition to the smear test for cervical cancer, a full gynaecological examination is carried out and patients are examined clinically for signs of early breast cancer. The closest co-operation is maintained with family doctors and hospital services. Appointments for a repeat test after three years are offered to all women attending the clinics. Women over 35 years and those in socio-economic groups 1V and V are considered to be a high risk and the following details for 1971 are therefore particularly encouranging: Attendances -Economic Group Under 35 581 I 357 .(16.0%) Over 35 1,673 II 12 ( 0.5%) III 857 (38.0%) Total 2,254 IV 621 (27.5%) V 407 (18.0%) 2,254 45 Cervical Cytology screening is carried out by many other agencies such as hospitals, family doctors and family planning clinics. It is difficult therefore, to estimate the full provision of this service in Lambeth but Family Planning Association records show that 2,685 tests were carried out in 1971. The majority of women who attend ante-natal or post-natal clinics are tested and family doctors who screen patients over 35 are paid a special National Health Service fee. In addition to local efforts health education material publicising the need to be screened is provided nationally by the Health Education Council and the Women's National Cancer Control Campaign (formerly the National Cervical Cancer Prevention Campaign). The latter organisation also owns a mobile unit to provide cancer screening facilities in poor response areas in London and has offered its use to Lambeth for a period up to four weeks from 1st October, 1972. Clinic Number called Number examined Results Negative Positive Retaken South London Hospital 524 414 383 1 30 Streatham Common 842 635 584 _ 51 Loughborough A/M 117 86 78 3 5 Loughborough P/M 670 509 483 3 23 Moffat 214 164 141 _ 23 West Norwood 447 343 335 _ 8 Bon Marche 92 91 84 1 6 TOTAL 2,906 2,242 2,088 8 146 Dr. M.P. Elman Principal Medical Officer FAMILY PLANNING 1971 During the year the Borough used the Family Planning Association on an agency basis. All Lambeth residents were entitled to free advice, and in addition free supplies were given to cases of medical or social need. Attendances rose from 17,670 in 1970 to 20,915 in 1971, and the number of patients seen from 7,985 in 1970 to 8,979 in 1971. 46 The number of doctor sessions during the year was 1,227 an average of 23-24 a week. Five additional doctor sessions were started during the year and arrangements were made for five further sessions to open early in 1972. The domiciliary service to bring advice and supplies to women in their own homes was also expanded during the year. 349 patients were seen of whom 205 were new cases. The figures for 1970 were 244 and 166. This service to 349 patients required 580 doctor visits and 907 nurse visits, an expensive exercise but very well worthwhile because most of these mothers were reluctant to go to the family planning clinics, some too shy, some too feckless, but most of them just weighed down and depressed by having to look after several small children - often without a husband to help and support them. Each case was specially recommended by a health visitor or social worker, and the applications were approved by a principal medical officer in the health department. Not one application was refused during the year. Towards the end of 1971 a working party was set up in the borough to plan a completely free and greatly expanded service to start in 1972 and to make arrangements for taking over the service in stages from the Family Planning Association. Dr. M.P. Elman Principal Medical Officer THE CHIEF NURSING OFFICER'S REPORT 1971 was an eventful year for the Nursing Services. Due to the setting-up of the newly formed Social Services Directorate a gradual hand-over of responsibility for a variety of work took place. Relationships with former nursing colleagues changed from line management to nursing advice. On 1st April we welcomed the District Nurses to the staff of the Borough. Miss L. Baker and Miss E. Keatley, formerly Superintendent and Deputy Superintendent respectively of the former Lambeth District Nursing Association retired after ensuring the smooth transition of the service. While all these changes were taking place, a new Nursing Management Structure was introduced to meet the changed needs. The responsibility for Health Education remained with the Chief Nursing Officer. 47 The number of "attachments" of Health Visitors to General Practitioners increased from two to seven; eleven district nurses were "attached" by the end of the year. Liaison arrangements with hospitals were developed and expanded, particularly in paediatrics. HEALTH VISITING Fourteen students sponsored by the Borough successfully completed the course, and joined the staff in September. Although the ratio of staff to population was improved this was due to a decline in population rather than an increase in the numbers of Health Visitors. Recruitment improved, but this only kept pace with the numbers leaving. The chief reason for resignations was husbands obtaining posts outside London. An increased amount of time was spent on Health Education, and on visits to the elderly. During the year 5,643 visits to Centres were recorded, outside clinic session times. These were made by individuals seeking help and advice on a wide variety of problems. The average time spent with each of these callers was 37.5 minutes. Records were specially kept in order to have a picture of work not normally recorded for statistical purposes. The two evening clinic sessions held weekly proved to meet a need and plans were made during the year for a further two sessions in other parts of the Borough. These sessions are primarily Child Health Sessions, but also attract a number of mothers seeking advice outside this field. Creche sessions continued to be well attended, despite the increase in numbers of alternative services, indicating the continued need for mothers to be relieved of their small children for an occasional morning or afternoon, for a wide variety of reasons. Indications for the future are that there will be an increase in General Practitioner attachments, and an increase in casual callers at the Centres. Due to the decline in the number of births, there will be a reduced number of attendances at Child Health Sessions. This reduction in attendances will also be affected by the gradual increase in the numbers of attachment schemes where General Practitioners and Health Visitors hold sessions on practice premises. Three persons were removed to Institutions under Section 47 of The National Assistance Act 1946 as amended by the National Assistance (Amendment) Act of 1951. 48 HEALTH VISITING Cases visited by Health Visitors Children born in 1971 5,693 Children born in 1970 5,698 Children born in 1966-69 12,470 23,861 Persons aged 65 and over 3,165 * Mentally disordered persons 366 Ø Persons, excluding Maternity cases discharged from hospital (other than Mental Hospitals) 82 + Number of Tuberculous households visited 7 Number of households visited on account of other infectious diseases 94 Other Cases 4,801 Number of Tuberculous Households visited by Tuberculosis Visitors 398 Total number of effective visits and re-visits 82,872 Total number of unsuccessful visits 17,673 *Included in this figure are 315 persons who were visited at the special request of the general practitioner or hospital. ØIncluded in this figure are 54 persons who were visited at the special request of the general practitioner or hospital. + Included in this figure are 32 persons who were visited at the special request of the general practitioner or hospital. Domiciliary Midwifery At the end of March, Miss L. Barber, who had been the non medical Supervisor of Midwives in the area for many years, retired. It was with great regret that we learned of her death while this report was in preparation. The number of home confinements continued to fall, and this was not balanced off by an increase in early discharges from hospital. The total number of births in the borough fell as also did the percentage of home confinements. Health Visitors were involved in a number of continuing research projects although no major research project commenced. 49 Attendance by midwives:Confinements Doctor not booked 2 Doctor booked 244 Number of hospital cases discharged to midwife before tenth day 841 ANTE-NATAL AND POST-NATAL CLINICS Number of Sessions held by Medical Officers — Midwives 89 Sessional General Practitioners 93 Number of women attending for ante-natal examination 283 Number of women attending for post-natal examination 25 Mothercraft and Relaxation Classes Number of women attending (a) Hospital booked 70 (b) Domiciliary booked 17 Total 87 Total number of attendances 528 MIDWIVES ACT 1951 The Council is the supervising authority for all midwives practising in the Borough under the Midwives Act, 1951. During the year 217 midwives notified the Council of their intention to practise in the Borough; 50 Ancillary Staff in Child Health Services Clinic auxiliaries and Clinic Nurses continue to make a valuable contribution to the nursing services, by enabling 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 began as Clinic Nurses. District Nursing In April 1971 the District Nursing Service came under the direct control of Lambeth Council, having previously been provided on an agency basis by the Lambeth District Nursing Service with the help of a grant from the Council. Discussions took place before the appointed day to make the change over as smooth as possible so that neither patients nor staff should suffer in any way. The Health Directorate was most grateful to both Miss L. Baker and Miss E. Keetley her deputy for the tremendous help given prior to April 1971 and was sorry indeed to know that both would be retiring before this date. The district nurses continued as previously to cover the hours from 8.30 am10 pm seven days a week. During these hours requests for nursing are made through the nursing officers and telephoned to the nurse concerned when the nurses meet in their centres each afternoon to collect the details of new patients and organise the following days work. During the night hours and the week ends, callers are connected by Emergency Control to the nursing officer on call. In this way it hoped that in having only one number to ring, requests for nursing service, mostly from general practitioners and hospital, are made simple for the caller. The total number of nursing staff transferred to Lambeth Council in April was 53 full and 7 part-time. This included all grades of the full time staff, one was appointed to the post of Area Nursing Officer, and two to Centre Nursing Officer posts. Five were Bathing Attendants who continue to work to the District Nurses and were joined by those who previously worked to the Old Peoples Visitor. During the year the numbers of both nursing and ancillary staff have increased. This was necessary firstly because of the demand from general practitioners for attachment schemes; secondly because of the need to offer staff more refresher courses and study days, both important in these days 51 of rapid change in medical and nursing fields. The third reason for increasing staff is the earlier discharge home of patients from hospital. In 1971 the number of new patients referred and treatments given has increased, and with more General Practitioners Attachment Schemes, and more use being made of nursing skills by hospitals, this increase is likely to-continue. In 1971 the number of new patients referred was 4,653 compared with 4,525 in 1970, and treatments given were 160,405 in 1971, compared with 154,703 in 1970. Training is important for nurses who wish to work in the community services since treating patients at home requires staff to be adaptable, to use their initiative, to have a thorough knowledge of other services and facilities which can be used to help to make patients as comfortable and happy as possible at home, and to prevent for as long as possible their being removed to hospital or institutional life. It was possible for 8 nurses to attend the District Nurse Course at either Croydon or Chiswick Polytechnics in September 1971, and all passed the examination. The opportunity arose also for a number of staff to attend a refresher course, which is offered each five years for all staff, or one day courses or conferences with particularly relevant subjects. Two one-week courses were organised by St. Thomas's Hospital for community nurses. These were most successful and staff were very appreciative of the hospitality given. It is proposed that next year lectures on subjects particularly requested by nursing staff should be organised in the Health Directorate as in-service post certificate training. The district nurses themselves have also contributed towards the training of others, mostly from hospitals. The emphasis in many training courses is very much on community needs and each year a number of students visit the nurses to identify the needs of people in their own homes, and to see that facilities and services provided by Local Authorities and voluntary organisations. Overseas visitors also find this kind of visit of immense value, particularly those from under developed countries. Gradually the number of requests by general practitioners for an attachment of or liaison with a district nurse is increasing. The requests are controlled by the rate at which surgery premises are improved or replaced, but availability of nursing staff who are interested in such schemes is another factor. Those schemes already organised are working well, and the doctors involved have nothing but praise for the contribution the district nurse makes to a busy practice. Much time during the year has been given to reviewing the district nursing service and to make an assessment of patient needs as well as doctor and hospital possible future needs. A night service to give some relief to relatives of sick, usually elderly patient who are restless, disturbed and sometimes 52 confused at night, so preventing the relative from getting a good night's rest is much needed. An expansion of the home bathing service is under consideration to meet the waiting list of patients recommended for this service. It is likely that next year St. Thomas's Hospital will commence a pilot scheme for day surgery, when the patient will have a minor operation in the morning and come home in the afternoon. It is agreed that Lambeth district nurses will be involved in the follow up and care of these patients. This will make a fuller use of nursing skills and will help make for even closer co-operation with hospitals. Total number of persons nursed during the year 5,963 Number aged under 5 at first visit during the year 425 Number aged 65 and over at first visit in the year 3,323 Total number of visits during the year 160,405 Health Education Increasirg interest in Health Education amongst teaching staff in secondary schools has been encouraging this year, and several pilot projects have been mounted in order to try and meet specific needs within each school. Groups of 4th year girls attending the nearby Child Health Centre for their classes on Parentcraft has helped relieve accommodation problems at one school. Participation with teaching staff with established health education and parentcraft courses has been a useful way of relating relevant subjects to the physical, mental and social health teaching in the community, and 6th Form discussion groups on problems arising from unwanted pregnancies, venereal disease, drug addiction etc. has reinforced our belief that these subjects need to be introduced earlier in their school life. Debates on "Smoking" with 5th and 6th year students resulted in resounding victories for those against the motion "That Smoking is beneficial and socially acceptable". It is hoped that the converted upper school pupils will impress upon the lower school children the error of their ways ! The winter courses at the Adolescent Hostels continue to prove to be a source of much useful discussion on parental responsibility; Mothers Clubs continue to thrive and have doubled in number in the last two years. Relaxation and Mothercraft Classes have been well attended, and we continue to receive requests for Speakers to talk to Youth Clubs, Colleges of Further Education, Mother and Baby Homes, Hospitals etc., on a variety of subjects. A Certificated course given by a Health Visitor at a teacher training college on 53 1st Aid and the School Service has, by popular request been extended to include secondary as well as primary school would-be teachers, and we welcome this opportunity to encourage closer liaison between the teaching and community nursing professions. The Dental Exhibition again demanded our attention, although "The Expectant Mother" found it difficult to compete with phantom heads, the dental chair etc. where there was lively audience participation. Nevertheless it is encouraging to find that, when questioned, the youngsters were very knowledgeable about the diet and hygiene needs for good health. Monthly meeting continued with the object of disseminating information, examining new visual aids and discussing course contents for various teaching activities. Whilst appreciating the need to concentrate on subjects such as Family Planning, Venereal Diseases, Smoking, Drugs and Alcoholism, it has always been the endeavour to include them in a general course where individual responsibility for good physical, mental and social health can be related to our teaching. Training Health visitor students from the Polytechnic of the South Bank, and Croydon Technical College are placed in Lambeth for field-work training, along with student midwives from King's College Hospital and the South London Hospital. Fourteen students sponsored by Lambeth began their Health Visitor training in September. None of these students were placed in the Borough for their training. Although it would appear from the statistics that the number of visitors to the establishments of the Directorate of Health has decreased, it must be remembered that the Day Nurseries — always a popular place of interest — are now in the Directorate of Social Services, and, therefore, visits to them are not included in our figures. Happily, liaison with all the Directorates and I.L.E.A. continues smoothly, and participation in each other's training programmes has become well established. Requests for Community Experience for Hospital Staff continues, and plans have been made for selected nurses to spend longer periods at the Centres when the new G.N.C. and C.M.B. syllabi are implemented. Bearing in mind that the health visitor students and student midwives must have fieldwork, supervised practical work and alternative experience throughout the year, there is a need for constant appraisal of visits and lectures so that the efficiency of the staff and the well being of clients shall not be sacrificed in the cause of "training". It is gratifying to find that there is no lack of enthusiasm for 54 Field Work Instructor, Practical Work Instructor and Management courses, and staff appear to welcome the opportunity to refresh themselves through the great variety of courses and lectures offered. A series of lectures in Hospital for dealing with Current Hospital Practice, provided a welcome opportunity to discuss common problems with hospital colleagues, and with 1974 in view, this experience is valuable in developing closer relationships for the future. "Training" and "communication" must go hand in hand if liaison between all the services for the community is to be effective. CONTROL OF VENEREAL DISEASE In Lambeth, the number of known, new cases of sexually transmitted diseases increased from 5,083 in 1970 to 6,297 in 1971. Syphilis increased to 97 from 68 cases in 1970, gonorrhoea 1,345 (1,153) and other venereal condition; 4,855 (3,862). These statistics do not reveal the true extent of infection, however, as venereal diseases are not notifiable and a number of cases may go unrecorded if patients attend their general practitioner for treatment. In addition, an unknown number of people may remain untreated, many of them unsuspecting females who are infected by gonorrhoea but have no apparent symptoms. These cases pose a serious problem in the fight to control infection, because they become reservoirs of disease and if undetected can start a chain of infection affecting hundreds of people. Arrangements for the employment by the Council of the full-time equivalent of 2.8 visitors and their attachment to the venereal disease clinics at St. Thomas's, St. Giles (formerly held at King's College Hospital) and South London Hospital continued. Contact tracing involves an interview with the infected person and a visit to the contact in an effort to persuade him or her to attend the clinic for examination. This is a time consuming exercise and often necessitates working long irregular hours and taking meals at odd times to fit in to the needs of patients and contacts. The work requires tact, patience and perseverance and is an effective way of breaking the chain of infection in the short term. 1,039 visits to contacts were made in 1971 as compared to 572 in 1970; the decrease in visits during 1970 was due to shortage of staff during part of the year. The dangers of and efforts to prevent the spread of venereal disease has been included in the programme of Health Education displays of posters and distribution of pamphlets at maternity and child health clinics, and 55 discussion during the teaching of mothercraft and ante-natal care in schools. Venereal disease and the means by which infection is spread are included in health education programmes at colleges of further education and on talks to mothers' clubs. Special teaching on this subject has also been given on request to schools, colleges and other groups. The increasing incidence of venereal disease is of particular concern in Greater London, where it is estimated that half the national total of new cases of gonorrhoea are diagnosed. The Chief Medical Officer to the Department of Health and Social Security convened a special conference in July 1971 to discuss effective control measures in the area. The conference was attended by medical officers of health, consultant venereologists, contact tracers, representatives of regional hospitals authorities and family doctors and it was agreed that priority should be given to tracing possible sources of infection. Local authorities were urged to consider the recruitment and attachment of contact tracers to special clinics at hospitals in their areas or, in the absence of special clinics, to designate health visitors to act as a liaison officers with the hospitals concerned. These various factors were taken into consideration by the Health Education Council in its discussions last year with officers of the Department of Health and Social Security, St. Thomas's Hospital and the Health Departments of Lambeth and Wandsworth to formulate an effective health education campaign. The areas of Lambeth and Wandsworth linked to the special clinic at St. Thomas's Hospital have been chosen for a pilot survey in order to evaluate the effectiveness of the publicity material to be produced for use eventually throughout the country. The main aims of the campaign can be expressed as follows: (i) to increase the proportion of contacts traced and persuaded to attend a special clinic for treatment (ii) to make the communities concerned more aware of the nature of the V.D. problem in their localities and of their general responsibility to prevent these diseases from spreading. The campaign will be conducted in stages and as a first step will be directed at patients at clinics and their contacts, particularly the 18-24 age group who record the highest incidence of syphilis and gonorrhoea. Certain selected sites will be used to monitor results and further sites will be brought into the campaign as the target audience is gradually extended to the general population. Suggested sites are in colleges of further education, libraries, welfare centres, and other places open to public access. A variety of methods of health education will be employed, but initially, an exhibition display and leaflets will be used. 56 Monitoring and evaluation will be conducted by the Health Education Council and it intends to recruit three research assistants to be based at the departments concerned. A Steering Committee has been established on which the Director of Health Services serves. The project is expected to last about a year and has attracted a grant of £50,000 from the Department of Health and Social Security. The Council will not be expected to incur any financial expenditure as a consequence of co-operation in the campaign, but the success of this venture will depend to a great extent on the assistance of the staff to implement the programme at its various stages and in this respect it will be regarded in the same light as any other health education campaign. Similarly, the co-operation of the Council will be sought in selecting and making available suitable sites for exhibitions and lectures. Miss E. Early Chief Nursing Officer MOTHER'S CLUB HOME NURSE HELPING ONE OF OUR SENIOR CITIZENS CHILDREN'S CRECHE 61 OBSERVATION/HANDICAP REGISTER The geographical distribution and the numbers of handicapped children in Lambeth, according to Child Health Centres, is shown in Table 1. It is interesting to note that the rate (one handicapped child per thousand normal children under 5) has considerably increased since 1969 in all but three Child Health Centre areas (Table 2). Table 3 shows the occurrence of some handicaps in the population of under 5's. It would be extremely difficult to assess the incidence of the handicaps in the population of under 5's on a National scale, as the appropriate figures are not readily available. We can, however, compare the incidence of handicaps in Lambeth with the figures quoted in the National Child Development Study for seven year olds. (Table 4). Battered Babies Syndrome: Table 5 shows the pattern of referral of battered babies to the Observation Handicap Register. The sudden increase of notification in 1970 followed the ve detailed procedure of reporting of cases of battered babies elaborated by the Director of Health and circulated among General Practitioners, Hospitals, and other agencies. It is unfortunate that, except for King's College Hospital, the level of notification of battered babies was not maintained. The monthly conferences held at King's College Hospital, mentioned by Professor C. Eric Stroud in his evaluation at the close of this Report, proved to be of great value to the understanding of this difficult problem. Paediatric Developmental Assessment Clinics: The need for an early developmental assessment of children in order to diagnose a developmental delay or an initial handicap has been discussed and stressed in previous annual Reports. Every child who attends the Developmental Assessment Clinic is evaluated with regard to the following functions: Motor, Visual, Auditory, Language, Learning, Drive, Emotional and Social, together with a physical, examination. The initial developmental screening of young children takes place in Child Health Centres. 62 Children whose rate of development does not satisfy doctors and health visitors are referred to Developmental Assessment Clinics, which are conducted in different parts of the Borough. In 1971 a total of 192 children had their first examination at Developmental Clinics of the Borough; 12 more Lambeth children were developmentally assessed by Dr. O. Nietupska at King's College Hospital. One must remember that a developmental assessment is a continuous process; one cannot limit it to one or two examinations and then endeavour, on this basis, to predict the child's future achievement. The continued assessment is carried out to some degree by all people concerned with a particular child, i.e. parents, nursery nurses, etc., and the information from the fieldworkers makes a vital contribution to the paediatric assessment. Table 6 shows the ages of children referred to Paediatric Developmental Assessment clinics from various Child Health Centres. It is hoped that with the improvement of screening techniques in Child Health Centres, children will be referred to Developmental Assessment Clinics at an even younger age than they are at present. The paediatric developmental assessment is always followed by an appropriate remedial action, i.e. medical, social, or educational, leading to improvement of the child's condition. Some children received educational treatment from a home teacher. Many children were placed in day nurseries and play groups for stimulation and socialisation, and some were referred to Child Guidance Clinics, etc. The majority had diagnostic appointments at Braidwood Audiology Unit, followed by therapy when necessary. Many children were referred to Paediatric Departments of local hospitals for investigation, diagnosis, and treatment. Education and counselling of parents which constitutes a vital factor in the improvement of a child's progress in all aspects of his development, was not carried out to an adequate degree; this was due to shortage of staff and to the fact that there is no social worker attached to either Observation/ Handicap Register, or to Developmental Assessment Service. The early assessment and subsequent treatment of young developmentally delayed children resulted in the improvement of their functioning, and in consequence in a reduction in the number of children referred for statutory mental examination at the age of 5 years. (Table 7). It is interesting to note that with the improved facilities for the identification of handicaps more cases are coming to light, for example, speech delay and language disorder. It is equally rewarding to note that the faciltiies for speech therapy, and for promotion of speech development have also increased, as indicated by Table 8. 63 We are pleased that even mild hearing defects of various origins are diagnosed early and referred immediately to Braidwood Audiology Unit for investigation and treatment. (Table 9). Handicapped Children in the Special Care Unit: As in previous years, severely multihandicapped children are placed in the Special Care Unit attached to Tulse Hill Day Nursery; the number of attendances there is 11. Transport for these children is provided. Some multihandicapped children are still on the waiting list, being cared for by their families. Handicapped Children in Day Nurseries: Recommendation to the Social Services Department for admission of a young child to a day nursery from Developmental Assessment Clinics and Observation/Handicap Register, is carefully weighed and considered with regard to the benefit the child will derive from spending most of the day away from his home and among other children. The correct selection, and the right attitude and enthusiasm of the day nursery staff leads to improvement in a child's social adjustment, speech development, general progress and emotional stability in almost 100% of cases. It is regrettable that in 1969 there were 65 handicapped children placed in day nurseries; in 1971 there were only 70, in spite of the increased number of places available. The distribution of handicapped children in the day nurseries is as follows Chestnut Day Nursery 6 Coldharbour Day Nursery 7 Coral Day Nursery 7 Cowley Day Nursery 6 Cressett Day Nursery 7 Cynthia Moseley Day Nursery 8 Groveway bay Nursery 3 Lambeth Walk Day Nursery 1 St. Martin's Day Nursery 8 St. John's Day Nursery 11 Tulse Hill Day Nursery 6 70 64 The uneven distribution of handicapped children in the nurseries does not reflect the size of the handicapped children population in a particular day nursery area. This lack of correlation results from the inability of parents to bring the handicapped child to the nursery, owing to home circumstances (maternal illness, other young children in the home, etc. etc.). The need for transport for all handicapped children to ordinary day nurseries cannot be over-stressed. Liaison with Lambeth Council Health Department In the previous annual Report we described the liaison with King's College Hospital as seen from our point of view. This year we have asked Professer C. Eric Stroud for his evaluation of the existing liaison and he has very kindly sent us his views which are quoted below :- "Liaison with Lambeth Council Health Services Department The Department of Child Health at King's College Hospital and in King's College Hospital Medical School has during the past 2 years enjoyed and increased its liaison and involvement with the Health Department of the Borough of Lambeth. This liaison has been developed in many ways. One of the Principal Medical Officers, Dr. Nietupska, has been very generously attached to our Department and attends regularly to take part in the teaching of medical students, as well as carrying out skilled developmental testing of many of our patients. Her regular attendance at our hospital has increased the efficienc with which we are able to communicate with each other about the children and families who are under our joint care. In addition, a Health Visitor has been attached to our Department and attends regularly to co-ordinate the care of children between the local authority and the hospital. One of the most important developments in our co-operation has been the organisation of regular meetings which take place on the third Thursday of each month, at which problems of battered babies or socially deprived children are discussed by medical social workers from the hospital authority, as well as by social workers and the staff of the Department of Child Health and the Local Authority. This has resulted in our being able to decide a policy for each case which is agreed to by all the workers and authorities concerned. Our Department in the Hospital has been very grateful to the Local Authority for teaching our medical students and also for giving the students a regular experience of the working of welfare clinics in the local authority. We hope that the liaison and co-operation which has been developed will be increased so that the hospital and local authority care of children will be a highly 65 efficient and well-orientated exercise. We also hope that it might be possible at some time in the future to make joint appointments so that individual doctors or paramedical personnel may have defined duties and responsibilities, both inside hospital and in the community. The stimulus for the development of the integration of the work of the hospital and the community has stemmed very largely from the Health Department of Lambeth Council and we are very grateful to Dr. Thrower for this stimulus and for his continued help and support." (signed) C. Eric Stroud Post Graduate Training of Medical Officers Medical Officers employed by the Council attended several courses organised by various academic bodies; the main topic was the health and the education of a normal and/or handicapped child. The number of doctors given the opportunity was not very high because the shortage of medical staff in Lambeth is considerable. The main event of in-service training was the one day Conference of "Day to Day Care of the Handicapped Child" in January 1971. The team of expert speakers was chaired by Dr. A.L. Thrower. The Conference was extremely well attended by doctors working full-time and part-time for the Borough, several Health Visitors, and also two teachers from former Training Centres. The expert catering by Mr. Wild and his team added to the success of the Conference. In April, November, and December, several groups of doctors from other authorities in England, Wales, and Scotland, received training in developmental assessment of children by a doctor from our Department, at the request of the Society of Medical Officers of Health. The teaching sessions were carried out in Tulse Hill and Coral Day Nursery, and the hospitality of staff in both Nurseries was greatly appreciated by the post-graduate students. Dr. O. Nietupska, Principal Medical Officer 66 OBSERVATION/HANDICAP REGISTER - 31st December, 1971 TABLE 1 Child Health Centre Area Population 0—5 years Number of children on O/HR Clapham 2,393 52 Loughborough 2,695 95 Moffat 1,737 37 North Brixton 1,653 27 Riggindale (NOW STREATHAM COMMON) 1,904 26 Rose Mc Andrew 2,644 84 Royal Street 526 14 St. Anne's 899 18 Streatham Hill 3,138 88 Tulse Hill 2,457 57 West Norwood 2,651 70 TOTAL 22,697 568 OBSERVATION/HANDICAP REGISTER - 31st December, 1971 COMPARISON OF RATES (PER THOUSAND) OF HANDICAP BETWEEN 1969 AND 1971 ACCORDING TO THE CHILD HEALTH CENTRE TABLE 2 Child Health Centre May 1969 December 1971 Clapham 11.8 21.7 Loughborough 16.8 35.3 Moffat 25.2 21.3 North Brixton 16.7 16.3 Riggindale (NOW STREATHAM COMMON) 19.2 13.6 Rose McAndrew 13.9 31.8 Royal Street 12.5 26.6 St. Anne's 10.3 20.0 Streatham Hill 14.5 28.0 Tulse Hill 15.4 23.2 West Norwood 13.9 26.4 TOTAL 15.5 25.0 67 OBSERVATION/HANDICAP REGISTER - 31st DECEMBER, 1971 TABLE 3 INCIDENCE OF HANDICAPS Year of Birth General Developmental Delay Blind and Partially Sighted Deaf and Partial Hearing Delayed Language Development without Hearing Defect Cerebral Palsy Spina Bifida with or without Hydrocephalus Multi Handicapped not severely Mentally Retarded All Severely Mentally Retarded Multi Handicapped and severely Mentally Retarded 1971 7 2 3 7 6 4 4 4 7 1970 6 4 4 3 6 1 11 12 3 1969 23 5 17 21 8 2 21 13 10 1968 24 5 12 30 12 3 30 13 5 1967 9 1 1 16 1 - 14 9 4 TOTAL 69 17 37 70 33 10 80 51 22 NUMBER OF CHILDREN WITH DOWN'S SYNDROM 25 68 OBSERVATION/HANDICAP REGISTER - 31st December, 1971 TABLE 4 COMPARISON OF RATE (PER THOUSAND) OF HANDICAPS Handicap Lambeth 1971 National Child Development Study 1968 Age (0.5) Age (0-7) Blind and Partially Sighted 0.7 1.9 Deaf and Partially Hearing 1.6 1.1 Language Delay and Disorder 3.1 Figures Not Available Cerebral Palsy 1.4 2.0 Spina Bifida 0.4 0.7 Mongols 1.1 0.6 OBSERVATION/HANDICAP REGISTER - 31st December, 1971 TABLE 5 BATTERED BABY SYNDROME AS REPORTED TO TO OBSERVATION/HANDICAP REGISTER 1968 1969 1970 1971 5 11 26 32 One child died as a result of being battered 69 OBSERVATION/HANDICAP REGISTER - 31st December, 1971 TABLE 6 CHILDREN REFERRED TO PAEDIATRIC DEVELOPMENTAL ASSESSMENT CLINICS FROM JANUARY TO DECEMBER 1971 CHILD HEALTH CENTRES Streatham Common Streatham Hill Tulse Hill Rose McAndrew Clapham Loughboro Moffett North Brixton West Norwood St. Annes Royal Street TOTAL 0-1 3 2 6 2 - 4 - 2 4 3 - 26 1 + 1 8 4 6 2 6 4 - 2 1 - 34 2+ 3 2 1 5 6 9 1 5 3 1 2 38 3+ 4 8 2 7 2 3 5 2 4 4 2 43 4-4,6/12 2 2 1 4 1 1 1 5 4 1 6 28 4,6/12-5 5 1 - 4 1 7 - 3 1 1 - 23 TOTAL 18 23 14 • 28 12 30 11 17 18 11 10 192 Age in Years 70 OBSERVATION/HANDICAP REGISTER - 31st December, 1971 TABLE 7 CHILDREN REFERRED FROM THE DIRECTORATE OF HEALTH DEPARTMENTS FOR STATUTORY EXAMINATION Year of Referral Number Referred Number found to be E.S.N. 1968 396 181 1969 314 183 1970 312 174 1971 191 146 71 OBSERVATION/HANDICAP REGISTER - 31st December, 1971 TABLE 8 CHILDREN WITH DELAYED SPEECH DEVELOPMENT (NOT DEAF) AGED 0 -5 Date of Birth O/H.R May 1969 O/H.R January 1972 1964 9 1965 10 1966 6 1967 - 16 1968 - 30 1969 - 21 1970 - 3 TOTAL: 25 70 Under Speech Therapist Supervision: 2 23 72 OBSERVATION/HANDICAP REGISTER - 31st December, 1971 TABLE 9 REFERRALS FOR AUDIOLOGICAL ASSESSMENT FROM DEVELOPMENTAL CLINICS AND CHILD HEALTH CENTRES Borough of Age Distribution origin 0- 1 1 2-4 Lambeth 5 10 128 Local Authority X 0 2 18 Local Authority Y 1 5 25 Local Authority Z 0 0 0 ADVISORY SERVICE TO DIRECTORATE OF SOCIAL SERVICES The Local Authority Social Services Act 1970 became operative in April 1971. In Lambeth it was decided to implement the Act as from January, 1971. From that date, the services provided by the former Children's and Welfare Departments, and certain Personal Health Services provided by the Health Department, became the statutory responsibility of the new Social Services Directorate. At the same time, with the re-organisation of the Health Directorate itself, its function to provide an Advisory Medical Service to the Social Services Directorate became clearly defined. Senior Medical Officers continue to provide general advice on medical aspects of child care for children of all ages over the whole range of child 'caring' services, both day and residential. This includes children in foster homes, family group homes, residential nurseries, daily minders and play groups. Medical advice on individual children, particularly the handicapped child and those at risk of handicapping conditions, continued to be available and provided to individual Social Workers. The uptake and utilization of this information varied in some circumstances. This was mainly due to the disturbance and upheaval caused by re-organisation of the Health and Social Services Directorates. However the problems are not insolvable and I look forward to the smooth running of the Directorates in their changing roles with a consequent total improvement in the quality of services to the community. 73 Because of shortage of medical staff, it was not possible to provide more than minimal medical oversight of residential homes for the aged and many of the adult day care services; however, with the increase in senior staffing in the Health Directorate in 1972, it is envisaged that this shortfall will be remedied. Medical Examination of Staff The pattern of this service did not alter in 1971. The total number of medical examinations increased by over 300 due to increased intake and increase of staff turnover in the Social Services and Public Services Directorates. All entrants, with certain few exceptions, continued to be given a full medical examination and staff were required to have a chest x-ray at the time of examination or within the previous year. For staff at risk, mainly those working with children, protection against prevalent infectious diseases was advised. These medical examinations provide a screening service for entrants, detecting early symptomless conditions requiring observation or treatment. When related to the work undertaken by the individual employee, some of the conditions were found to be a definite contra indication or risk. Regrettably, it has not been possible, because of staffing restrictions, to expand this service to include evaluation and surveillance of the total environment of staff. The health and happiness of workers relate not only to the physical environment but to the other hazards of their occupations, the boredom of repetitive work, the adjustments to human contacts, the causes of friction and anxiety and the lack of job satisfaction. The evaluation of the psychological as well as the physical fitness of the worker is no less important than the job analysis in terms of the total physical and psychological environment in which the worker must carry out his particular tasks. The Directorate of Health Services gives professional advice to the other Directorates within the Council's service with regard to individual staff problems in which a medical basis may prove to be an over-riding factor with consequent benefit to the individual concerned, to the referring Directorate, and the services of the Council as a whole. Dr. N.C. Walsh Chief Medical Officer 74 Staff Medical for 1971 Men Women Total Health 12 69 81 Administration and Legal 16 14 30 Social Services 87 485 572 Finance - - - Development 135 - 135 Public Services 415 27 442 Libraries 2 12 14 Housing and Property 26 79 105 Management Services 6 6 12 Other Boroughs 9 8 17 TOTAL 708 700 1,408 INTERNATIONAL CERTIFICATES OF VACCINATION Certificates of recent successful vaccionation/inoculation are required by persons travelling to certain countries abroad. After completion by the vaccinating doctor (normally the person's own doctor) the certificate must be taken or sent for authentication of the doctor's signature by the Medical Officer of Health for the area in which the doctor practises. In Lambeth signatures on certificates are authenticated in the Health Department, Blue Star House, 234/244 Stockwell Road, SW9. 75 Prophylaxis Vaccination 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 45,904, 36,103 were vaccinated by the Council's doctors and 9,801 by general practitioners. Primary Reinforcing Diphtheria 4,415 6,058 Whooping Cough 4,160 2,845 Tetanus 4,455 6,411 Poliomyelitis 4,523 6,196 Smallpox 1,521 295 Measles 2,321 — Rubella 2,704 — It is estimated that 73% of the population aged 0-4 has been immunised against diphtheria. As the chances of introducing smallpox into this country has now lessened considerably due to world wide action, it is not now considered necessary to recommend vaccination against smallpox as a routine procedure in early childhood. Protection can still be offered to travellers to and from areas of the world where smallpox is endemic or where eradication programmes are in progress. 7 6 IMMUNISATION AND VACCINATION 1971 Immunisation: Completed Primary Courses — Number of persons under age 16 Type of vaccine or dose Year of Birth Others under age 16 Total 1971 1970 1969 1968 1964 67 1 Quadruple DTPP - - - - - - - 2 Triple DTP 1,387 2,402 289 55 14 13 4,160 3. Diphtheria/Pertussis - - - - - - - 4 Diphtheria/Tetanus 16 26 10 22 20 160 254 5. Diphtheria - 1 - - - - 1 6. Pertussis - - - - - - 7. Tetanus - - 3 2 - 36 41 8. Salk - - - - - - 9. Sabin 1,408 2,418 311 91 42 253 4,523 10. Measles 12 1,235 610 216 118 130 2,321 11. Rubella - - - - - 2,704 2,704 12. Total — Diphtheria 1,403 2,429 299 77 34 173 4,415 13. Total - Whooping cough 1,387 2,402 289 55 14 13 4,160 14. Total — Tetanus 1.403 2,428 302 79 34 209 4,452 15. Total — Poliomyelitis 1,408 2,418 311 91 42 253 4,523 77 IMMUNISATION: REINFORCING DOSES - NUMBER OF PERSONS UNDER AGE 16 Type of vaccine or dose Year of Birth Others under age 16 Total 1971 1970 1969 1968 1964-67 1. Quadruple DTPP - - - - - - - 2. Triple DTP 14 772 1,663 168 28 200 2,845 3. Diphtheria/Pertussis - - - - - - - 4 Diphtheria/Tetanus " 25 119 113 169 2,780 3,206 5. Diphtheria - - - - 1 6 7 6. Pertussis - - - - - - - 7. Tetanus - - 1 3 3 353 360 8 Salk - - - - - - - 9. Sabin 5 791 1,783 277 211 3,129 6,196 10. Total - Diphtheria 14 797 1,782 281 198 2.986 6,058 11 Total - Whooping cough 14 772 1.663 168 28 200 2.845 12 Total Tetanus 14 797 1,783 284 200 3,333 6,411 13. Total Poliomyelitis 5 791 1,783 277 211 3,129 6.196 78 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 Tuberculosis health visitors and reimburses the hospital authorities a proportion of the cost of social work with chest clinic patients. There were 3,978 patients on chest clinic registers at 31st December, 1971. The T.B. health visitors made 3,795 effective home visits and 131 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 schoolchildren each year and during the period 303 contacts and 1,929 schoolchildren were vaccinated. TUBERCULIN TEST AND B.C.G. VACCINATIONS Number of persons vaccinated through the Authority's approved arrangements under Section 28 of the National Health Service Act. A. CONTACTS (Circular 19/64) 1. Skin tested 481 2. Found positive 250 3. Found negative 231 4. Vaccinated 303 B. SCHOOLCHILDREN AND STUDENTS (Circular 19/64) 1. Skin tested 2,421 2. Found positive 478 3. Found negative 1,943 4. Vaccinated 1,929 79 CHIROPODY Chiropody Service is provided by the Council for Borough residents within the following priority groups 1. Persons of pensionable age (men over 65 and women over 60) 2. The handicapped 3. Expectant and nursing mothers 4. Schoolchildren Treatment is carried out at twelve Council foot clinics, nine Directorate of Social Service old peoples homes, four voluntary homes, three private surgeries and in the patients own home for those who are housebound. The following statistics show the level of service provided during the year A. NUMBER OF PERSONS TREATED 1. Persons of pensionable age — 6,647 2. The handicapped — 36 3. Expectant mothers — Nil 4. Schoolchildren — 9 5. TOTAL - 6,692 (1970 = 7,493) B. NUMBER OF TREATMENTS GIVEN 1. In clinics — 26,217 2. In patients homes — 11,662 3. In old peoples homes — 2,597 4. In chiropodists surgeries — 1,969 5. TOTAL - 42,445 (1970 = 38,462) On 4th October, 1971 Mr. D.A.D. Sydenham M.Ch.S., S.R.Ch., was appointed to the new post of Chief Chiropodist to provide a closer professional over-sight of the Service. During 1972 it is hoped, in addition to an expansion in the level of service, to recruit more full time chiropodists which should result in a more effective and economical service. 80 REGISTRATION OF NURSING HOMES UNDER SECTIONS 187 TO 194 OF PUBLIC HEALTH ACT 1936, AS AMENDED BY THE NURSING HOMES ACT 1963 — Number of homes Number of beds provided Maternity Other Total 1. Homes registered during the year - - - - 2. Homes whose registrations were withdrawn during the year - - - - 3. Homes on the register at the end of the year 6 45 114 159 81 LOAN OF NURSING EQUIPMENT AND FIREGUARDS During the year the following articles of equipment were loaned through the Health Department Articles Issued Returned Armchair Commodes 146 101 Stool Commodes 59 40 Tripod Walking Aid 2 4 Homecraft Walking Aid 5 6 Zimmer Walking Aid 14 6 Penryn Hoist 3 2 Easi Carri Hoist 2 Nil Hoyer Travel Hoist Nil 1 Back Rest 12 12 Bed Cradle 12 13 Rubber Bed Pans Nil Nil Mattress 1 2 Cot Bed Nil 1 Pole Nil 1 Rubber Sheeting 41 yards Nil Fireguards 20" 2 Nil Fireguards 24" 2 Nil Fireguards 30" 4 Nil Ripple Beds (Hire) 6 6 Ripple Beds (Property of London Borough of Lambeth) 2 2 Fracture Boards 45 37 INCONTINENCE Supplies of incontinence pads (54,808) and Padding Rolls (1,584) have been issued to 328 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. 96 incontinence garments have been issued. Protective liners (19,000) were issued to 49 patients. 83 Section D Environmental Health Services 84 Dr. F. Summers, Associate Medical Officer of Health and Mr. H. Plinston, Chief Public Health Inspector, report as follows GENERAL The trend for the number of applications for grants to modernise houses and for Qualification Certificates to increase each year continued. Permission was granted for the Inspectorate to be increased by one Senior and four District Public Health Inspectors, but it proved impossible to recruit additional inspectors. The effect was that routine inspections of food premises, factories, etc., were not fully carried out, and without an adequate clerical staff to maintain proper records it is not possible even to monitor the situation. Systematic inspection is essential if a satisfactory standard of cleanliness is to be maintained and food handlers are to be educated to appreciate the importance of personal and food hygiene. The necessity for constant vigilance in this and other areas of environmental health cannot be disregarded without consequent risk to the public. FOOD HYGIENE AND CONTROL OF SALE OF CERTAIN FOODS All premises (from market stalls to large factories) where food is prepared, stored or offered for sale are subject to inspection by Public Health Inspectors. Advice is given on the types of construction, fittings and equipment that are available and owners and staff are instructed in the best methods of handling and rotating stocks. Particular emphasis is placed on the hygiene necessary to prevent food poisoning. Where premises do not meet the requirements of the Food Hygiene (General) Regulations, 1960, owners are informed and, if necessary, court proceedings are instituted. 24 Summonses were issued involving 4 defendants. 19 Convictions were obtained and fines totalling £71 were imposed with £7 costs. Food premises subject to these Regulations are shown below, grouped in accordance with the trade principally carried on in them. With small shops aspiring to become supermarkets, fish shops selling chickens and restaurants providing containers for "take-away" food, categories cannot be otherwise than arbitrary and in some cases single premises may appear under more than one classification. 85 Bakers 94 Butchers 149 Cafes and Restaurants 296 Canteens 74 Confectioners 318 Delicatessen 14 Fish Shops 87 Greengrocers 180 Grocers 248 Supermarkets 55 'Public House, Off Licenses, and Clubs, 372 Food Factories and Wholesalers 40 The dealer's licenses issued under Milk (Special Designation) Regulation 1963 were for a period up to five years ending on 31st December, 1970, and it was necessary to issue new licenses during the year. The number of milk licenses in force are as follows Dealers (Pasteurisers) 2 Dealers (Ultra Heat Treated) Nil Dealers (Pre-packed) Untreated Nil Pasteurised 223 Sterilised 184 Ultra Heat Treated 117 There are 122 stalls in recognised street markets in the Borough selling food and these are kept under surveillance by the Public Health Inspectors. Inspections are also made under the Food Hygiene (Market Stalls and Delivery Vehicles) Regulation 1966 of the various itinerant food traders, mostly selling ice cream, in the Borough. CONTROL OF DRAINAGE AND PLUMBING WORKS Drainage and plumbing plans are checked by the Public Health Inspectors with regard to drainage and other aspects of legislation and this entails consultation with the Directorate of Civil Engineering and Public Services, owners, architects, surveyors and builders, and this work has increased particularly in the conversions of old property. 86 The drainage and plumbing is checked as the work proceeds and during the year there were 828 premises in which such work was being carried out. When buildings are demolished efforts are made to trace and properly seal off all disused drains. The Ministry of Agriculture, Fisheries and Food requested local authorities during the year to give priority to the work as it is an important aspect of rodent control. During the year 226 drains were sealed. ABATEMENT OF NUISANCES OTHER THAN REPAIR OF DWELLINGS These nuisances cover a wide range of matters which can effect the environment. Where owners fail to carry out the necessary works to abate a nuisance the Public Health Inspectorate arrange for the work to be done in default of the owner either by private contractors, or by a works order to other Directorates. Notices were served in respect of nuisances found as under Public Health Act 1936 Section 39. Provisions as to drainage, etc. of existing buildings 734 Section 45. Buildings having defective closets capable of repair 399 Section 75. Provision of dustbins 90 Section 83. Cleansing of filthy or verminous premises 2 Section 84. Cleansing or destruction of filthy or verminous articles 1 Public Health Act 1961 Section 17. Remedying of stopped-up drains 178 Section 34. Removal of accumulations of rubbish in the open air 329 L.C.C. (G.P.) Act 1925 Section 33. Fencing of sites 22 G.L.C. (G.P.) Act 1967 Section 23. Restoration of water supply 1 87 FACTORIES ACT 1961 The Factories Act requires the local authority to (a) Enforce the provisions regarding sanitary conveniences in all factories and to enforce the provisions relating to cleanliness, overcrowding, temperature, ventilation, and drainage of floors in any factory in which mechanical power is not used. (b) Maintain a register of outworkers and to inspect all premises where outwork is carried out. (c) Inspect basement bakehouses to see that they are suitable for such use as regards construction, height, light, ventilation and any hygienic respect. Three basement bakehouses which have been in continuous use since 1937 had their licenses renewed. 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 (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities. 44 - - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 708 - - - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises). 51 51 - - TOTAL 803 51 - - 88 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 To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want on cleanliness (S.1) - - - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient - - - - — (b) Unsuitable or defective - - - - - (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Out-work) - - - - - TOTAL - - - - - 00 CD 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 3 Lace, lace curtains and nets - Curtains and furniture hangings 2 Furniture and upholstery - Electro-plate - File making - Brass and brass articles - Fur pulling - Iron and steel cables and chains - 90 Part VII of the Act (continued) Nature of Work Section 133 Section 134 No. of outworkers in August list required by Section 133 11) (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) Iron and Steel anchors and grapnels Cart gear Locks, latches and keys Umbrellas, etc. Artificial flowers 1 Nets, other than wire nets Tents Sacks Racquet and tennis balls Paper bags 1 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 91 Part VIII of the Act (continued) 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) Brush making Pea picking Feather sorting Carding, etc. of buttons etc. Stuffed toys Basket making Chocolates and sweetmeats Cosaques, Christmas stockings, etc. Textile weaving Lampshades 2 TOTAL 137 - - - - - 92 REGISTRATION OF CERTAIN PREMISES Premises which require to be registered because of the trade or business which is carried on there are first inspected for suitability and after registration periodical re-inspections are made. Registered premises are as follows Rag Flock and other Filling Materials 6 Pt. II Poisons 101 Pet Shops 15 Hairdressers and Barbers 227 Massage and Special Treatment 35 Riding Establishments 2 Veterinary inspection of riding establishments is carried out by the Veterinary Surgeon of the Corporation of London as an agent of the Council. This Officer is also available for inspection of animal boarding establishments. DISEASES OF ANIMALS ACT Arrangements have been made for the Corporation of London, who have the essential verterinary staff, to enforce all the necessary provisions of the Act, as agents of the London Borough of Lambeth. No formal action under the Act, or Orders made thereunder, was necessary during the year. CLEAN AIR Smoke Control Orders made under the Clean Air Act 1956 now cover 4480.80 acres and affect some 76.947 premises in the Borough. The potential delays in smoke control progress due to inadequate supplies of smokeless solid fuel have been overcome and authoritative guarantees of adequate supplies have now been given by the industry, but the rate-payers are continuing to show a preference to convert smoke producing appliances to gas burning appliances. 93 The checking of plans of new chimneys continued during the year to ensure control of the emissions of the oxides of sulphur through chimneys of adequate height. PEST CONTROL RODENT CONTROL The trend for the number of rat infestations both above and below ground to slowly decrease each year was continued in 1971, on the other hand, the trend for mice infestations to increase continued and many more infestations had to be treated with a rodenticide other than Warfarin. Comparative figures are shown below: 1970 1971 Complaints 3,397 4,340 Investigations 4,388 6,017 Revisits 8,097 10,043 Baitings 6,898 8,111 Rat-Infestations 918 871 Mice-Infestations 2,479 3,468 Drain Tests 54 34 Treatment in domestic premises is carried out free of charge, but a charge is made for commercial premises and owners of the latter are encouraged to employ private servicing companies to ease the demand on the Council's staff. Treatment of the sewers for rats is carried out in conjunction with the Directorate of Civil Engineering and Public Services, and involves the baiting of some 3,000 manholes. PIGEON CONTROL Flocks of feral pigeons which reach proportions causing a nuisance are reduced as far as practicable by a private contractor working under the general direction of the Public Health Inspector. 94 CONTROL OF FOXES Foxes have been seen in the Streatham, Norwood, and Herne Hill areas but as yet no evidence exists that they constitute a health hazard or serious nuisance. DISINFECTION AND DISINFESTATION It is now rare that disinfection is required in the home following an infectious disease but the disinfection of articles in the stoving apparatus at Wanless Road Depot increased to 13,528. These included items from (a) Hospitals, Treatment Centres, etc. 3,500 (b) Tuberculosis Hostel 8,200 (c) Public Libraries (Books) 111 The disinfestation of premises for insects continues to be a major part of the work of the disinfecting staff in the house and during the year 5,129 rooms were sprayed. Laundry Service for Incontinent Persons The collection and delivery of laundry in this service is made by the Disinfecting Staff. 52,616 articles were collected during 5,682 visits to 251 homes. CONTROL OF FOOD AND DRUGS ON SALE IN LAMBETH Samples of food and drugs on sale are regularly submitted to the Public Analyst for chemical examination and to the Public Health Laboratory Service for bacteriological examination. 1,699 informal and 300 formal samples of food yielded unsatisfactory reports from the Public Analyst in respect of 93 on analysis and 32 on labelling. 24 samples were submitted for bacteriological examination. CONTROL OF IMPORTED FOOD Some food is imported directly into the country at a wharf in the Borough. Physical, chemical or bacteriological examination of the food is made before it is released for distribution for sale, any unsatisfactory consignments being destroyed, proceeded and repacked, re-exported or released for animal feeding under strict control. 95 CONTAINERS The imported Food Regulations 1968 allowed food to be imported into the country without inspection at the port of entry. This food must be packed in sealed containers and inspection of the food is made at the final inland destination by the local Public Health Inspector. A number of such containers are consigned to food premises in Lambeth and the Senior Public Health Inspectors (Food) have to make decisions regarding large quantities of imported food of considerable value and during the year examined such products as bacon, cheese, egg whites, lemon juice, tomato puree, and pig rind. Physical, chemical or bacteriological examination of the food is made before it is released for distribution, any unsatisfactory consignments being destroyed or processed. INVESTIGATION OF UNSOUND FOOD The public continue to bring to the notice of the Public Health Inspectorate food which they consider to be unsound after purchase. During the year 213 complaints were investigated. Advice is given to shop keepers on the rotation of stock of prepacked food as one of the common forms of complaint is of stale food. CONDEMNATION OF UNSOUND FOOD Unsound food found, as a result of inspection or complaint but mainly by voluntary surrender, is disposed of through the refuse disposal services of the Greater London Council or where possible by release to firms specialising in processing such commodities for use other than for human consumption. Over 30 tons of food were condemned, including 7 tons of cooked meat and meat products and 11½ tons of frozen food made unfit by the breakdown of refrigerated cabinets. 96 CONTROL OF FOOD FACTORIES, LARGE WHOLESALE DEPOTS AND STORES These are visited regularly by the Senior Public Health Inspector (Food) to ensure the maintenance of the highest standard of hygiene and include milk bottling plants, and factories making sausages, meat pies, pastries and ice-cream and bacon processing plants. ENVIRONMENTAL HEALTH EDUCATION No spccial campaigns were mounted during 1971, but, in their daily contact with members of the public and food handlers particularly, the public health inspectors constantly advise and instruct on matters of hygiene. Formal instruction or organised groups on any aspect of Public Health Inspection is readily given on request, and lectures were given to various schools and organisations. HOUSING The work of the Public Health Inspectorate covers many aspects of housing, in particular 1. the clearance of unfit areas of houses, individual unfit houses and parts of houses. 2. the modernisation and improvement of the existing housing stock. 3. the repair and maintenance of existing housing stock. 4. the prevention of overcrowding, control of multiple occupation and means of escape in case of fire. 5. the inspection of houses where qualification certificates are applied for. Clearance During 1971 the Council declared 5 Clearance areas containing 111 houses with 389 persons. 15 houses were demolished. 97 Individual unfit houses and Parts of Houses Action was taken under Part II of the Housing Act 1957 in respect of twentytwo (22) individual unfit houses. Twenty (20) Closing Orders were made and two (2) Demolition Orders. Four Closing Orders were determined. Twenty-three Closing Orders were made in respect of parts of buildings, i.e. mainly underground rooms and attic rooms. One undertaking not to use part of a building for human habitation was accepted. The modernisation and improvement of the existing Housing Stock Housing Act 1964/69 575 applications for discretionary grant involving conversion and improvements were dealt with and 331 approved. 371 applications for standard grant were received and 262 approved. 32 applications for Special Grant (houses in Multiple Occupation) were dealt with and 2 approved. Following informal and formal action under Section 15 of the Housing Act 1961 (provision of amenities) additional amenities were secured as follows (a) Baths/showers 99 (b) Water closets 84 (c) Sinks/wash-hand basins 69 (d) Hot water supplies 52 General Improvement Areas Housing Act 1969 Work has been in progress to define provisional boundaries for a programme of General Improvement Areas, to determine procedures involved for properly realizing the potential of areas, and to determine the criteria by which priority areas may be established. The programme which has been agreed by the Council covers the declaration of fifty General Improvement Areas according to a provisional order of priority over the next ten years. The first of these areas, the Birkbeck Hill Area, has now formally been declared under Section 28 of the 1969 Act. It is anticipated that five General Improvement Areas will be declared each year and already surveys have been put in hand of three Areas in order that this target might be reached. The Public Health Inspectorate are actively involved in dealing with these areas and are responsible for the following:- 98 (a) comprehensive survey (b) multiple occupation of houses (control and application of the registration scheme). (c) repair and improvement of the houses, i.e. dealing with house improvement grant applications. (d) enforcement action to secure improvement where tenant representations are received. (e) enforcement action under the Housing and Public Health Acts to secure the repair of houses and abatement of nuisances. The repair and maintenance of existing housing stock The repair and maintenance of dwelling houses has been mainly obtained by using the provisions of the Public Health Acts in respect of nuisances but Section 72 of the Housing Act 1969 which amended Section 9 of the Housing Act 1957 was used to secure the repair of 12 houses, where substantial disrepair existed. Action under the provisions of the Public Health Acts resulted in 1109 houses with defects being repaired. During 1971 the Council made 137 Management Orders enabling them to apply the Housing (Management of Houses in Multiple Occupation) Regulations 1962 to the houses. By informal and formal action, repairs and proper standards of management were secured to these houses. It is the standard procedure to require all houses in multiple occupation to be properly managed, repaired and kept in a clean condition and owners/tenants are made aware of this requirement by informal and formal action. Nine Management Orders were determined due to the houses being converted into self contained flats or purchased by the Council. Three Section 14 notices under the Housing Act 1961 were carried out in default of the owners. The prevention of overcrowding, control of multiple occupation Overcrowding is still one of the major problems in dealing with multiple occupation and in order to deal with this the Council implemented a registration scheme in July, 1970. The scheme is in two parts (I) Informatory and (II) Regulatory. 99 The informatory part requires persons in control to register with the Council giving the occupation of the house with the amenities available. Part 11 requires the person in control to obtain prior approval before letting a house in multiple occupation. The effect of the scheme will not be seen for some years but during 1971, 601 houses were registered under Part I and 50 under Part II. During the year the Council gave 386 Directions limiting the number of individuals or households or both that may occupy houses in multiple occupation. The figures are disappointing but the houses in multiple occupation section has not had a full establishment, i.e. 20 Technical Assistants and 4 Senior Public Health Inspectors. Additional amenities were secured in twenty-two houses where Directions had been given and these Directions were varied. Twelve Directions were revoked due to houses being acquired and converted by Housing Associations or by the Council. Access by Officers is still a serious problem and it was found necessary to obtain 11 Warrants of Entry. Means of escape in case of fire Means of escape in case of fire were provided in 64 houses. Informal action secured 9, formal 38 and 17 were installed in default or by arrangement with the owners. Housing Act 1969 Section 60 Provision is made in this section for dealing with parts of buildings which cannot be provided with means of escape in case of fire at reasonable expense, i.e. tall buildings with attic rooms where secondary means of escape is impracticable or cost of installation is unreasonable. Two attics were made the subject of Closing Orders after consultation with the Greater London Council. General A total of 11,682 visits and revisits were made by the staff dealing with houses in multiple occupation. 100 The Inspection of Houses where Qualification Certificates are applied for Housing Act 1969 Part III This work has increased considerably and a by-product of this has been the lepair and improvement of many houses. Improvement Cases No. of applications for qualification certificates Section 44(2) 232 No. of certificates of provisional approval issued 160 No. of qualification certificates issued under Section 46(3) 52 Standard Amenities Already Provided No. of applications for qualification certificate Section 44(1) 2,598 No. of qualification certificates issued under Section 45(2) in respect of 1. dwellings with rateable value of £90 or more 452 2. dwellings with rateable value of £60 or less than £90 136 3. dwellings with rateable value of less than £60 1 Exemption for Low Income Tenants Section 54 No. of certificates issued under Section 55 5 408 applications were refused for the following reason:- 1. lack of amenities 54 2. substantial disrepair 80 3. lack of amenities and disrepair 274 101 239 applications were withdrawn for a variety of reasons. 665 letters with schedules of disrepair were sent to owners. 764 applications were carried over to 1972. The Future of Qualification Certificates There is every indication that the Government will considerably amend the present provisions for granting qualification certificates and as a long term policy they will probably be phased out (1975). The Housing Finance Bill which has aroused considerable controversy will probably become law in July, 1972, and only then will the full implications of the present Bill which may be amended be known. 103 Section E General 104 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 London Borough of Lambeth during the year "The report relates to the Board's direct supply to the Lambeth administrative area and its several parts. The information does not relate to private supplies and supplies from other Water Undertakings (if any). 1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1971. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after the analytical 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. (c) (i) The Board has no record of the number of structually separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1971, was 304,410. (ii) No houses were permanently supplied by stand-pipe. (d) No artificial fluoride is being added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations River Thames — dervied water from the Thames Valley group. Well water from Honor Oak Pumping Station. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. 105 Average Results of the Chemical Examination of Water Supplied to the London Borough of Lambeth during 1971 Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO4 4 hrs. at 27°C. B.O.D. 5 days at 20°C. (1) (2) (3) (4) (5) (6) (7) River Thames — derived 364 0.029 0.084 6.1 1.04 - Honor Oak 3 0.065 0.011 0.2 0.05 Description of the Sample Hardness (total) CaC03 Hardness (noncarbonate) CaCO3 Magnesium as Mg Sodium as Na Potassium as K Chloride as C1 (8) (9) (10) (11) (12) (13) River Thames — derived 281 90 5 23.5 5.1 34 Honor Oak 293 53 15 Description of the Sample Phosphate as PO4 Silicate as SiO2 Sulphate as SO4 Natural Fluoride as F Surfaceactive Material as Manoxol OT (14) (15) (16) (17) (18) (19) River Thames — derived 2.3 10 64 0.15 0.02 Honor Oak 0.43 Description of the Sample Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micromhos) (20) (21) (22) (23) River Thames — derived 0.1 13 7.8 580 Honor Oak 0.0 6 7.2 530 106 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1971 of the Water Supplied to the London Borough of Lambeth BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Number of samples Agar plate count per ml. Coliform count E. Coli count Source of supply 20-24 hours at 37°C 3 days at 22°C Per cent samples negative in 100 ml. Count per 100 ml Per cent samples negative in 100 ml. Count per 100 ml 20-24 hours at 37°C 3 days at 22°C Per cent samples negative in 100 ml. Per cent samples negative in 100 ml. River Thames — derived 8,154 53.9 40.37 12.2 54.91 5.1 3901 8.4 99.51 99.97 Honor Oak 62 0.0 7 87.10 0.4 88.71 0.2 63 0.2 19 100.0 100.0 107 SWIMMING BATHS UNDER CONTROL OF THE GREATER LONDON COUNCIL 1 am indebted to the Scientific Adviser of the Greater London Council for the following report on the bacteriological examination of the water during 1971. Number of Samples Agar count per ml. 24 hr. at 37°C. Presumptive Coliform without E.coli in 100 ml. E. Coli in 100 ml. 0-10 11-100 More than 100 Brockwell Park (winter) 4 4 — — — — Kennington Park (winter) 4 4 — — — — Shirley Oaks Children's Home 24 24 — — _ — St. Martins-in-theFields School 18 15 — — 1 2 Ashby Mill School 24 23 — — 1 — Brockwell Park and Kennington Park Lidos From 1st April, 1971 the above lidos were no longer the responsibility of the G.L.C. Thus samples were taken only during the first three months when the condition of both baths was found to be satisfactory. Shirley Oaks Children's Home All samples were satisfactory. Dick Sheppard School This bath was being rebuilt and was out of use during 1971. It should be operational during 1972. 108 Parkside School This bath was taken over by Ashby Mill School. Apart from one sample containing 1 Presumptive Coliform per 100 ml., all samples were found to be satisfactory. St. Martin-in-the-Fields School On one occasion, there was no free chlorine present, the water was turbid and found to be polluted. There was also some foaming due to the presence of detergent. It was decided to empty, clean and refill the bath, when the condition of the bath was found to be satisfactory. One other incidence of Coliform bacteria was due to low free chlorine which was rectified. In order to maintain high standards, new schoolkeepers or relief schoolkeepers were given detailed instructions on testing procedures. All queries were dealt with as quickly as possible. HOUSING ON MEDICAL GROUNDS Report on the activities of the Health Department for the year ended 31st December, 1971 1,040 cases were dealt with on the following grounds Lambeth Borough Council ½ year to 31.12.71 Year Health 904 1,669 Social Services (referrals) 16 23 Insanitary conditions » 15 32 Special cases 8 21 Cases previously investigated and now rehoused by L.B.C. 78 126 Greater London Council Health 4 5 Cases previously investigated and now 15 19 rehoused by G.L.C. — — 1,040 1,895 109 HOME DIALYSIS During the year the Council was not requested by the hospitals to adapt any premises for installation of Home Dialysis units, so that the number of persons in the Borough carrying out such treatment remained at four. In July one person, who owned the property in which he lived, moved out of the borough but it was not possible to make use of the premises for another patient. At the end of the year another, living in Council property, died, and arrangements were made for a patient from a local hospital to take over the letting, although such arrangements were not finalised until early into 1972. SEWERS I am indebted to the Director of Civil Engineering and Public Services for supplying me with the following information with regard to sewers within the Borough. Some £100,000 has been spent on general maintenance of the Council's sewers. This includes flushing, cleansing and minor repairs. Contractors have been employed for the works of jetting, winching and television inspection. The works at Loughborough Park which I outlined in my report to you of the 7th May, 1971, were completed in August 1971. During the year the sewers in parts of Baldry Gardens, Braxted Park, Copley Road and Streatham Common South Side were relaid at a cost of £80,000. The sewers were in a poor structural condition and generally undersize. In connection with the redevelopment of Myatts Field South Housing Scheme Phases 1,2,3 and 7, it was necessary to abandon certain lengths of public sewers and to provide a new network at an estimated cost of £78,000. The works were commenced in September, 1971, but will not be completed until this summer. A new length of public sewer was laid in St. Faith's Road from September 1971 to January 1972 at a cost of £14,000 to provide an outfall from the Peabody Trust's Development at Knight's Hill. The work was paid for by the Trust. 110 Due to development which had taken place at Bishop Thomas Grant School and in the area of Etherstone Green it was found necessary to enlarge the sewers in parts of Oakdale Road and Valley Road. The works were commenced in January, 1971, and completed in April, 1971, at a cost of £20,000 approximately. Work has commenced on relaying the sewers in Heybridge Avenue and the remaining length of Streatham Common South. The contract sum is £77,000. The site works commenced in January, 1972, and are estimated to take nine months. The works are necessary due to the poor condition of the existing sewers. A length of the sewer in Stockwell Park Road was relaid in March, 1971, at a cost of £3,800 and a short length of sewer was diverted at the rear of No's 34.44 (even) Gipsy Hill, for a cost of £1,800 during the same month. Following the television inspection, other schemes are being prepared for the renewal of sewers in various parts of the Borough. The programme of redevelopment is not having such a large impact this year as it did last year. 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. 41 such funerals were arranged and whenever possible the Council's expenses were recovered. HOSPITAL FACILITIES The undermentioned hospitals are located in the Borough Lambeth Hospital, Brook Drive, SE11. South Western Hospital, Landor Road, SW9. Kings College Hospital, Denmark Hill, SE5. Belgrave Hospital for Children, Clapham Road, SW9. St. Thomas' Hospital, Westerminster Bridge, SE1. St. Thomas' Babies Hospital, Black Prince Road, SE11. General Lying-in Hospital, York Road, SE1. Royal Waterloo Hospital, Waterloo Road, SE1. South London Hospital for Women, Clapham Common South, SW4. Weir Maternity Hospital, Weir Road, SW12. British Home and Hospital for Incurables, Crown Lane, SW16. 111 AMBULANCE FACILITIES The Greater London Council is responsible under Section 27 of the National Health Service Act, 1946, for the provision of the Ambulance Service in the area. PUBLIC HEALTH LABORATORY SERVICE The Public Health Laboratory Service provides a comprehensive service for the examination of specimens submitted by Local Authorities and General Practitioners. The local laboratory is situated in County Hall. Section F School Health Service Report of the Principal School Medical Officer 114 LONDON BOROUGH OF LAMBETH SCHOOL HEALTH SERVICE Report of the Principal School Medical Officer for the year 1971 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 Director of Health Services 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. Medical treatment of school children Arrangements for the provision of certain specialist clinics in conjunction with Regional Hospital Boards and Boards of Governors of Teaching Hospitals continued, some clinics being held in hospitals, and some in school treatment centres for which specialist staff were provided by the hospital. Most of the clinics in hospitals are attended by school health service social workers who act as liaison officers between hospitals, school medical officers and the I.L.E.A. Education Welfare Service. Special investigation clinics are attended by school health social workers. Children suffering from obesity, enuresis and similar conditions may be referred. Clinics are held in school treatment centres. Many of the referrals are for enuresis much of which proves on investigation to be caused by emotional and relationship difficulties at home. During the past year school health social workers have been visiting the families of the more acute cases, maintaining close liaison with the Education Welfare Social Workers. The health and material well-being of Lambeth school children have generally continued to improve, but referrals to child guidance centres have increased. Since September school health social workers have extended their activities to special schools, of which there are a considerable number in Lambeth. For the past term they have worked in close liaison with the Education Welfare Social Workers in 5 special schools (2 day open air, 1 for severely handicapped, 1 for partially sighted and 1 for the deaf) and at 2 special units (1 deaf/blind and 1 autistic unit). 115 School Medical Inspection There are 48,095 children on the school roll in the Borough. There are 116 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 children and there are 4 special units — a unit for autistic children a unit for deaf and blind (Rubella) children in an ordinary school 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. 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 16,159 routine medical examinations, 3,865 special examinations and 5,950 re-inspections. School nurses carried out a total of 9,653 selective health surveys. Last year there has been an increase in incidence of head lice and steps have been taken to control it. The increase was mainly due to resistance of the lice to organochlorides commonly used in treatment, but the use of a new medicament, prioderm, is proving effective. Information about children who require special educational help and observation in school is passed routinely to the head teacher and school doctors 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. 116 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. Treatment facilities provided directly by the Local Authority include vision clinics (3 sessions weekly) 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. Braidwood Audiology Clinic, situated in the vicinity of the School for Deaf Children is providing comprehensive assessment for children with impairment of hearing and speech. The clinic is staffed by an E.N.T. surgeon, an audiologist, an educational psychologist, speech therapist and a social worker. 60 new cases have been seen during the year. An audiology centre at Barley Mow School Treatment Centre (Waterloo) provides Investigation and Treatment for North Lambeth children who fail to pass pure tone testing. Audiometry All children in the primary schools in the Borough have a sweep test by a specially trained and experienced school nurse and those showing hearing loss are followed up and referred for investigation where necessary to an audiology unit. Vision All children including those attending nursery classes have their vision tested as soon as possible after admission. 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 parents. The agencies involved include teaching staff, school doctors, educational psychologist, child care officer, school inquiry officer, probation officer, school care organiser, psychiatrist, etc. There is a shortage of places provided in schools for the Educationally Subnormal and maladjusted children in the Borough, but efforts are being made by the Inner London Education Authority to provide more vacancies. 117 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. New nursery classes have been opened in the Borough at which children selected by Head Teachers attend on a half day basis — 30 in the morning, 30 in the afternoon. A few vacancies are kept open in each nursery class for children needing admission on socio-medical grounds. Prophylaxis Action has been taken to increase the number of school children protected against infectious diseases; 668 children have been immunised against diphtheria and tetanus, 915 vaccinated against poliomyelitis, and 1,929 have had B.C.G. vaccination. A new vaccine has been developed and Local Health Authorities were asked to offer protection against rubella to schoolgirls aged 13 because of the known association of certain foetal abnormalities with rubella infection in pregnancy. The first injections were given in December 1970, and the total number for 1971 is 2,704. 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 5 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 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 each at the other establishments. 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. 118 Health Education sessions were held and numerous problems including drugs and general health topics discussed. Dr. K.H. Tlusty Principal Medical Officer SCHOOL HEALTH STATISTICS FOR YEAR 1971 SCHOOL ROLL (May 1971) 48,095 SCHOOL MEDICAL INSPECTION Routine 16,159 Special 3,865 Re-inspections 5,950 No. of medical inspections per 1,000 pupils 540 Health Surveys - comprehensive 30,966 No. per 1,000 pupils 644 Percentage found verminous 2.1 Health Surveys - selective 9,653 No. per 1,000 pupils 201 Percentage found verminous 7.6 Audiometry No. of children given sweep test 6,899 No. of children given pure tone test 781 No. of children referred to otologist at audiology centre 165 SCHOOL MEDICAL TREATMENT Hospital Specialist Clinics Vision Centres Vision sessions 188 Number of new cases 454 Total attendances 2,437 Errors of refraction and squint 718 Other eye defects 36 Spectacles ordered • 649 119 Orthoptic sessions 19 Number of new cases 50 Total attendances 67 Ear, Nose and Throat Centres Sessions — Number of new cases — Total attendances — LOCAL AUTHORITY CLINICS Audiology centres Sessions 20 Number of new cases 60 Total attendances 123 Special investigation clinics Sessions 116 Number of new cases 155 Total attendances 883 Minor ailment centres :- Sessions: Medical officer 54 Nursing sister 613 Number of new cases seen by medical officer 607 Average per session 11.2 Number of new cases seen by nursing sister only 894 Average per session 1.5 Total attendances 9,910 Defects treated Athlete's foot 59 Verrucae 1,132 Ringworm on body 1 Impetigo 50 Other skin diseases 142 Eye diseases 10 Ear diseases 20 Miscellaneous: Bruises, lacerations etc. 163 120 ANNUAL REPORT OF PRINCIPAL SCHOOL DENTAL OFFICER 1971 This is the seventh annual report and looking back over these years, one reflects on all the changes and progress made by the dental service of the Inner London Education Authority. Two salient features are uppermost in one's mind, firstly the unique nature of the Inner London Education Authority dental service resulting in the opportunity for sharing ideas with colleagues in other inner London boroughs, and secondly the help and encouragement given at the local level by all the staff of our own Health Directorate in Lambeth. Staffing Without both adequate and suitable staff any plans for maintaining and improving the service are made null and void. The recruitment of dental officers still shows a satisfactory position and the appointment of full time staff is at present much easier. Paedontics requires a special understanding of children and a combination of patience, skill and tolerance. The treatment of children, especially from some special schools can be very demanding but our dental officers are able to manage the difficult child if sufficient time is given for their treatment. A dental officer is dependent on his or her supporting staff and the role of the dental surgery assistant cannot be overestimated. The dental surgery assistant duties demand understanding of children, tact and cheerfulness when dealing with children and parents, knowledge or surgery procedures and ability to cope with clerical work. The dental surgery assistant recruitment is not nearly as satisfactory as for dental officers and this is due to a large extent to the comparatively low salary scale especially for younger entrants to the service. The staff in position as at 31st December, 1971 was as follows Principal School Dental Officer Senior Dental Officer 3 Full Dental Officers 7 Sessional Dental Officers (2.6 F.T. equivalent) 1 Dental Auxiliary 8 Dental Surgery Assistants (1 Vacancy). 2 Sessional Anaesthetists were also employed. Provision of services Eight surgeries are now in operation, one staffed by a dental auxiliary and at the end of the year only 3 sessions were available for expanding the service. It was a great disappointment that completion of the replacement for Clapham Park S.T.C. with two surgeries was delayed and this has resulted 121 in a considerable "work load" developing in that area. A balance has to be maintained between the various aspects of the service; inspection, treatment, prevention and health education and constant review has been necessary to keep the balance right. Instruction in toothbrushing techniques using disclosing tablets and application of topical fluorides have formed an essential part of preventive measures. These procedures are time consuming and the time spent on them are not always truly reflected in the annual statistics. Inspection and Treatment Inspection With a school population of 48,095 it is not easy to achieve a high percentage of children inspected with the staff available and the clerical work involved. Both the numbers of sessions and the number of inspections has increased from last year and nearly reached the peak figure of 1969. About 60% of the school population had a school inspection, preference being given to the Infant and Junior Schools. The pattern of inspections since 1965 is given below 1965 1966 1967 1968 1969 1970 1971 Number of sessions 73 48.2 188.0 144.2 310.3 246 307 Number of children inspected 6,342 2,040 17,051 14,562 32,325 24,516 29,287 Treatment There has been an increase on last year of both sessions provided and of treatment carried out. Unfortunately there has been a slight increase in the number of permanent teeth extracted but a small but encouraging reduction of temporary teeth extracted. There has been an increase in both permanent and deciduous teeth filled compared to the previous year, but a slight increase in the attendances for emergency treatment. The number of patients accepted as new orthodontic cases, that is with appliance therapy, remains surprisingly low but orthodontic advice and where necessary treatment is readily available to those who desire it. There has been a welcome further reduction in the number of patients failing to attend. Arrangements were made for the use of the Inner London Education Authority mobile, specially designed for handicapped children, to be sited adjacent to three special schools and the time was well spent in making provision for the special needs of these children. 122 Links with Kings' College Hospital School of Dental Surgery A helpful link has been maintained with King's and patients can if need arises be readily referred for advice and/or treatment. The Principal School Dental Officer has also been appointed as a part time lecturer on Childrens' dentistry. These lectures have provided dental students with a deeper insight into prevention, dental health education and the role of dental public health. The contacts made with King's are invaluable and the opportunity to discuss matters of mutual interest with the dental staff have helped to maintain a good liaison Health Education Dental Health Education has again been a very important part of our work. Puppet shows were provided for 6,170 children at 36 schools, eight special schools were visited, one junior school for a talk and a film shown to teachers prior to a teaching project. During the year a booklet was devised on teaching projects for schools to incorporate dental health and a simple knowledge about the anatomy and physiology of jaws and teeth. One school carried out such a project and it is hoped to encourage other schools to do the same. A dental teach in was also held for some of the nursing staff and this provided an opportunity to inform them about current views on dental topics and to explain the purpose of the dental care exhibition. The second Dental Care Exhibition was held at the Town Hall. This kind of exhibition is only possible with the willing co-operation of a large number of people. Dental and Nursing staff of the Borough, the borough's Public Relations Staff, students from the School for Dental Auxiliaries and their staff, student dental hygienists from King's, the two Inner London Education Authority Dental Health Educators and the Inner London Education Authority dental laboratory staff worked together to present "SMILE". After the opening by the Mayor of Lambeth, the exhibition was open to the public for seven and a haif days. Arrangements were made for parties of schoolchildren to be conducted around the exhibition and it is estimated that altogether, 5,000 attended. The exhibition was widely advertised by the use of leaflets incorporating a competition and posters throughout the Borough. A number of chemists agreed to show a special display card in their windows in conjunction with a display of toobrushes and toopastes. The exhibition was divided into the following sections 123 1. Dental care for the expectant mother and baby 2. Dental care for the Pre school child 3. Form and function of teeth and jaws of animals 4. Toothbrushing techniques 5. Advice on diet and dental health 6. Fluoridation 7. Display of teaching models 8. Provision of manikins for children to cut cavities and fill teeth 9. A dental unit and chair 10. Work of a dental hygienist 11. Work of a dental technician 12. Promotion of apple sales by "Apples for Schools" 13. Display on dental health leaflets, posters, slides and loops 14. Information of the School Dental Service. The important aspect of the exhibition was participation by the children. Publicity was obtained by press reports and an interview for Radio London. The exhibition was open on the Saturday and a special feature of the Saturday morning was a visit by Pierre the Clown. "SMILE" provided a follow up to dental health education in schools and an opportunity for large numbers to be involved in a relatively short period of time. The content of the exhibition not only provided an opportunity to promote dental health but also enabled children to more closely acquaint themselves with dental procedures and thus reduce apprehension about dental treatment. The future This report is written at a time when fundamental changes are being planned for the integration of the health services, whatever the final outcome it is hoped 124 that due attention will be paid to the adequate provision for dental treatment and preventive services for children. My thanks are yet again due to all members of the Health Directorate staff for their continuing interest in the dental services. B.M. Spalding L.C.S., D.D.P.H. R.C.S. (Eng) Principal School Dental Officer SCHOOL DENTAL SERVICE Number of Sessions: Inspection 307.0 Ordinary treatment 2,601.4 General anaesthetic 54.9 Orthodontic 55.0 Health education 311.9 Total sessions 3,330.2 Inspection?: number of children given: First inspection at school 29,287 First inspection at clinic 3,347 Percentage found to require treatment 52.5 Re-inspection at school or clinic in 1971 393 Percentage found to require treatment 85.0 Visits for treatment: Number of first visits 4,669 Number of subsequent visits 10,145 Total visits 14,814 Emergencies 545 Additional courses commenced 621 Number did not attend 7,510 Treatment given: Number of fillings: In permanent teeth 7,209 In temporary teeth 5,995 125 Number of extractions: Of permanent teeth 482 Of temporary teeth 1,695 Number of other operations 6,073 Courses of treatment completed 3,358 Orthodontics: Number of new cases 26 Number of removable appliances fitted 130 Number of fixed appliances fitted 6 Sessional averages: First visits 1.7 Subsequent visits 3.7 Emergencies 0.2 Did not attend 2.8 Fillings: In permanent teeth 2.7 In temporary teeth 2.2 Extractions: Of permanent teeth 0.2 Of temporary teeth 0.7 Ratio of permanent teeth filled to permanent teeth extracted 13.1 Ratio of temporary teeth filled to temporary teeth extracted 3.1 Staff: Number of dentists employed (F.T.E.) 5.7