The health of LAMBETH Annual report 1972 A.L. THROWER, M.B., B.S., M.R.C.S., L.R.C.P.,l M.F.C P., D.P.H. LAM 61 LONDON BOROUGH OF LAMBETH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1972 A.L. THROWER, M.B., B.S., M.R.C.S., L.R.C.P., M.F.C.P., D.P.H. 2 CONTENTS OF REPORT Page Members of the Health and Protection Committee 5—6 Staff of the Health Directorate 7 Introductory remarks 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 1963—1972 17 Classification of causes of deaths 18 Notes on Vital Statistics 24 Deaths from Cancer of the Lung and Bronchus 26 Road Traffic Accidents 27 SECTION B: Prevalence of and Control over infectious and Other Diseases Notifiable Diseases 30 Notifications other than Tuberculosis 31 Age distribution of Infectious Diseases 32 Notes on Infectious Diseases 34 Salmonella Infections 39 Report of Chest Physician 40 Notification of Tuberculosis 40 SECTION C: Personal Health Services Maternity and Child Health Services 44 Screening for Phenylketonuria 45 Dental Treatment for Expectant and Nursing Mothers and Children under 5 years 46—47 Cervical Cytology Screening Service 48 Family Planning 49 Geriatric Clinics 52 Health Visiting 52 Domiciliary Midwifery Service 54 Midwives Act 1951 54 Ancilliary Staff 55 3 SECTION C: Personal Health Services (continued) Page District Nursing 55 Hospital Liaison Schemes 55 Control of Venereal Diseases 56 Health Education 57 Observation/Handicap Register 69 Medical Examination of Staff 88 Advisory Service to Social Services Directorate 89 International Certificates of Vaccination 90 Vaccination and Immunisation 90 Tuberculosis 93 B.C.G. Vaccination 93 Chiropody 94 Registration of Nursing Homes 95 Loan of Nursing Equipment 96 • SECTION D: Environmental Health Services Food Hygiene and Control of Sale of Certain Foods 98 Control of Drainage and Plumbing Works 99 Abatement of Nuisances other than repair of dwellings 99 Factories and Outworkers 100 Registration of Certain Premises 105 Diseases of Animals Act 105 Clean Air 105 Pest Control 106 Disinfection and Disinfestation 107 Laundry Service for Incontinent Persons 107 Control of Food and Drugs on Sale 107 Control of Imported Food 107 Containers 108 Investigation of Unsound Food 108 Condemnation of Unsound Food 108 Control of Food Factories, Large Wholesale Depots and Stores 108 Environmental Health Education 109 Housing — Clearance 110 Individual Unfit Houses 110 Modernisation and Improvement 110 Repair and Maintenance 112 Prevention of Overcrowding, Control of Multiple Occupation 113 General Improvement Areas 113 Qualification Certificates 114 4 SECTION E: General Page Water Supply 116 Swimming Pools 120 Housing (Medical Grounds) 121 Compulsory Removal, Section 47 121 Home Dialysis Machines 121 Sewers 122 Burial or Cremation of the Dead 123 Hospital Facilities 123 Ambulance Facilities 124 Public Health Laboratory Service 124 SECTION F: School Health Service Report of Principal School Medical Officer 126 5 LONDON BOROUGH OF LAMBETH HEALTH AND PROTECTION COMMITTEE Period from 1st January, 1972 to 17th May, 1972 The Worship 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. Gillian P. Sparrow Dr. John L. Day 6 LONDON BOROUGH OF LAMBETH HEALTH AND PROTECTION COMMITTEE Period from 17th May, 1972 to 31st December, 1972 The Worship the Mayor of Lambeth Councillor W.A. Johnson (Ex-officio) The Deputy Mayor of Lambeth Councillor Mrs. M.V. Kidd (Ex-officio) Chairman Councillor C.J. Blau Vice-Chairman Councillor D.D. Prentice Alderman Walter C. Dennis, J.P. Alderman V.S. Mathews 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 W. Seeley Councillor S.L.H. Shah Councillor Mrs. F. Walker Councillor D.W. Wendon 'Co-opted Members Dr. Gillian P. Sparrow Dr. K. Mayne Mrs. M. Haston 7 STAFF OF HEALTH DIRECTORATE Director of Health Services, Medical Officer of Health and Principle School Medical Officer A.L. Thrower, M.B., B.S., M.R.C.S., L.R.C.P., M.F.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. Christine Walsh, M.N., B.Ch., B.A.O., D.C.H., D.P.H., Assistant Director of Health Services T.J. Amos, D.M.A. Principle Administrative Officer K. Sherlock Chief Nursing Officer Miss E. Early, S.R.N., S.C.M., H.V. Cert. Principle Nursing Officer Miss A. Swift, S.R.N., S.C.M., H.V. Cert. Chief Dental Officer B.M. Spalding, L.D.S., D.D.P.H., R.C.S. (Eng.) 8 Mr. Mayor, Ladies and Gentlemen, I have pleasure in presenting to you my report on the health of the Borough during 1972. While the number of services provided by the Health Services Directorate continued to expand during the year, long term planning considerations have been dominated by the proposed re_organisation of the National Health Service on April 1st, 1974. The integration of the three separate branches (the personal health services and school health service, hospital services and general practitioner services) into a unified whole has been recognised for many years, and a major reform of this nature involves considerable time and effort by individual members of the Directorate. It is hoped that after April, 1974, the present boundary of the Borough will be maintained as an administrative unit, and representations have been made to the Secretary of State to try to ensure that services in the Borough are not divided. During the year free family planning facilities were made available to all those who live and work in the Borough, and Clinics formerly run by the Family Planning Association have been taken over by the Council. This move was accompanied by a widescale publicity campaign, and the results have been most encouraging. The Council has taken a lease on premises at 47 Tulse Hill from the Queen's Institute of District Nursing, the premises has been renamed Brockwell Clinic and a Family Planning Clinic is now in operation. It is also proposed to extend the family planning service further by introducing a free vasectomy service in 1973. A happy event this year was the opening of Belthorn Maternity and Child Health Centre, which is the second purpose built centre to be opened by the London Borough of Lambeth since April, 1965, and sessions started on August 21st. This new centre replaced Clapham Park School Treatment Centre and Poynders Gardens Maternity and Child Health Centre which provided insufficient accommodation for satisfactory provision and development of services in the area. Application has been made for a new Maternity, Child Health and School Treatment Centre at Lambeth Walk to the Department of Health and Social Security under section 22 of the National Health Act, 1944. The updated Capital Rolling Programme includes plans for five Health Centres and it is hoped that work on the first, at Clapham Manor, will commence in the latter half of 1973. In an attempt to widen the net of Health Services serving the elderly in Lambeth, and as a logical extension of general screening procedures for "at risk" groups of the community, two pilot geriatric clinics were started during the year. The operation of these clinics will be scrutinised after a year in order to evaluate their success in reaching the elderly population. 9 A cause for growing concern during the year has been the increase of incidence of venereal disease, especially among the young. A joint working party formed with Wandsworth was set up to try and evaluate methods of improving the existing services. The recruitment of a full time Health Education Officer during the year has helped to promote the work of the directorate. Health Education embraces a wide range of topics and extends to some extent to all sections of the public. Lectures, Discussion Groups, Film Shows and Exhibitions are held at schools, Clubs and in Libraries. Perhaps what could have been one of the most disrupting events during the year was the Directorate's move from Blue Star House in Brixton to new office premises in Bromfelde Road, Stockwell. These consist of the old Annie McCall Maternity Hospital building which has been entirely refurbished, and the adjoining houses, numbers 37 and 39 Jeffrey's Road. 1 am delighted with the ease and efficiency with which this major relocation was conducted. Miss E.M. House, centre nursing officer in my Directorate, retired in April after 25 years service, most of it with the fomer Lambeth District Nursing Association. Apart from a period during the war years when she served in the Queen Alexandras Imperial Nursing Service Reserve, she has spent the whole of her working life in the nursing service in South_West London. Miss G.M. Blake, School Nursing Sister at Stockwell School Treatment Centre, retired from the Council's service on 30th November, 1971. A former Nursing Sister for the L.C.C. Miss Blake transferred to the service of the new London Borough of Lambeth in 1965. I would like to take this opportunity to thank Miss House, Miss Blake and all members of staff who have served the Directorate and ensure the present high standard of services. May I express my gratitude to members of the Council and particularly the Chairman and Members of the Health and Protection Committee for their help and encouragement throughout the year. My thanks are also due to the Chief Executive and my fellow Directors, to Dr. A.B. Stewart, Medical Adviser Inner London Education Authority and his staff and to the hospital staffs and general practitioners with whom the department is in frequent contact. 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 Vauxhal! Parks, Myatt's Fields, Streatham Common and parts of Clapham and Tooting Bee Commons. Amongst the world famous buildings within its boundaries are Lambeth Palace, The Oval Cricket Ground, The County Hall, The Royal Festival Hall, the Headquarters of the London Fire Brigade and the Transport Museum at Clapham. For Parliamentary purposes the Borough is divided into five consitituencies, 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 6,727 acres Number of Wards 20 Number of Parliamentary Constituencies 5 Population (Mid_year estimate 1972) 301,690 Density of Population (i.e. number of persons per acre) 44.84 Number of marriages during the year 2,547 Marriage rate per 1,000 population 8.4 Rateable Value of District (1st April, 1972) £20,712.309 Sum represented by a penny rate (1972/1973) £197,800 Number of separately rated houses and flats at 1st April, 1972 95,778 VITAL STATISTICS LIVE BIRTHS Legitimate Illegitimate Totals Males 1,896 521 2,417 Females 1,796 477 2,273 Totals 3,692 998 4,690 Live Birth Rate per 1,000 home population 15.5 * Birth Rate corrected for comparision with other areas 14.0 Comparability factor supplied by Registrar General .90 Birth Rate per 1,000 Home Population England and Wales 14.8 * Birth Rate per 1,000 Home Population Inner London Area 13.7 * Birth Rate per 1,000 Home Population Outer London Area 14.3 * Birth Rate per 1,000 Home Population Greater London Area 14.1 * Illegitimate live Births per cent of total live births 21.0 Illegitimate Live Births per cent of total live births Inner London Area 17.5 Illegitimate Live Births per cent of total live births Outer London Area 8.5 Illegitimate Live Births per cent of total live births Greater London Area 11.7 * Crude Rate 14 STILL BIRTHS Legitimate Illegitimate Totals Males 14 4 18 Females 21 11 32 Totals 35 15 50 Still Birth Rate per 1,000 total births (i.e. Live and Still) 11 Still Birth Rate per 1,000 total births England and Wales 12 Still Birth Rate per 1,000 total births Inner London Area 11.4 Still Birth Rate per 1,000 total births Outer London Area 11.0 Still Birth Rate per 1,000 total births Greater London Area 11.2 DEATHS Males Females Total 1,793 1,734 3,527 Death Rate per 1,000 home population 11.7 * Death Rate corrected for comparison with other areas 12.5 Comparability Factor (supplied by Registrar General) 1.07 Death Rate per 1,000 home population England and Wales 12.1 Death Rate per 1,000 home population Inner London Area 12.4 * Death Rate per 1,000 home population Outer London Area 11.4 * Death Rate per 1,000 home population Greater London Area 11.8 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 0.16 Maternal Mortality Rate per 1,000 total births Outer London Area 0.22 Maternal Mortality Rate per 1,000 total births Greater London Area 0.20 * Crude Rate 15 INFANTILE MORTALITY Deaths of infants under one year of age Legitimate Illegitimate Totals Males 39 11 50 Females 28 11 39 Totals 67 22 89 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 17.0 Death Rate of infants under one year of age per 1,000 live births Inner London Area 19.9 Death Rate of Infants under one year of age per 1,000 live births Outer London Area 15.6 Death Rate of infants under one year of age per 1,000 live births Greater London Area 17.1 Deaths of infants under four weeks of age Legitimate Illegitimate Totals Males 25 7 32 Females 21 7 28 Totals 46 14 60 Neo_natal Mortality Rate (Deaths under four weeks per 1,000 live births) 13 Neo_natal Mortality Rate England and Wales 12 Neo_natal Mortality Rate Inner London Area 13.7 Neo_natal Mortality Rate Outer London Area 10.6 Neo_natal Mortality Rate Greater London Area 11.7 16 Deaths of infants under one week of age Legitimate Illegitimate Totals Males 22 6 28 Females 14 6 20 Totals 36 12 48 Early Neo_natal Mortality Rate (Deaths under one week per 1,000 live births) 10 Early Neo_natal Mortality Rate England and Wales 10 Early Neo_natal Mortality Rate Inner London Area 11.6 Early Neo_natal Mortality Rate Outer London Area 8.8 Early Neo_natal Mortality Rate Greater London Area 9.8 Perinatal Mortality Rate (Still births and deaths under one week per 1,000 total births) 21 Perinatal Mortality Rate England and Wales 22 Perinatal Mortality Rate Inner London Area 22.9 Perinatal Mortality Rate Outer London Area 19.7 Perinatal Mortality Rate Greater London Area 20.9 17 SUMMARY OF VITAL STATISTICS FOR THE TEN YEAR PERIOD 1963_1972 METROPOLITAN BOROUGH OF LAMBETH 1963_1964 Year Population Deaths 'Death Rate Live Births *Live Birth Rate Deaths of Infants under 1 year of age Infantile Mortality Rate Maternal Deaths Maternal Mortality Rate 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_1972 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 _ _ 1972 301,690 3,527 12.5 4,690 14.0 89 19.0 _ _ *As adjusted by comparability factor. 18 19 LONDON BOROUGH OF LAMBETH NUMBERS OF DEATHS BY CAUSE, IN SEX AND AGE GROUPS DURING 1972 Cause of Death Sex Total all ages Under 4 weeks 4 weeks and under 1 year Age in years 5_14 15_24 25_34 35_44 45_54 55_64 65_74 75 and over B2 Typhoid Fever M _ _ _ _ _ _ _ _ _ _ _ _ F 1 _ _ _ _ _ _ _ _ 1 _ _ B4 Enteritis and Other Diarrhoeal Diseases M F 1 _ _ _ _ _ _ _ _ _ 1 _ B5 Tuberculosis of Respiratory System F 8 3 _ _ _ _ 1 _ 1 _ 3 3 1 1 1 B6(2) Other Tuberculosis M 1 _ _ _ _ _ _ _ _ 1 _ _ F 1 _ _ _ _ _ _ 1 _ _ _ _ B11 Meningococcal Infection M 1 _ _ _ _ 1 _ _ _ _ _ _ F 2 _ 1 1 _ _ _ _ _ _ _ _ B17 Syphilis and its Sequelae M 3 _ _ _ _ _ _ _ 1 _ _ 2 F 2 _ _ _ _ _ _ _ _ 1 _ 1 B18 Other Infective Parasitic Diseases M 2 _ _ _ 1 _ _ 1 _ _ _ _ F 2 _ _ _ _ _ _ _ _ _ 1 1 B19(1) Malignant Neoplasm, Buccal Cavity etc. M 5 _ _ _ _ _ _ _ _ 1 3 1 F 1 _ _ _ _ _ _ _ _ 1 _ _ B19(2) Malignant Neoplasm, Oesophagus M 10 _ _ _ _ _ _ 1 1 4 2 2 F 10 _ _ _ _ _ _ 1 1 2 2 4 B19(3) Malignant Neoplasm, Stomach M 41 _ _ _ _ _ _ _ 3 17 11 10 F 30 _ _ _ _ _ 1 _ 1 3 8 17 B19(4) Malignant Neoplasm, Intestine M 32 _ _ _ _ _ _ 1 2 10 7 12 F 57 _ _ _ _ _ _ _ _ 6 16 35 B19(5) Malignant Neoplasm, Larynx M 9 _ _ _ _ _ _ _ _ 2 4 3 F _ _ _ _ _ _ _ _ _ _ _ _ 819(6) Malignant Neoplasm, Lung, Bronchus M 194 _ _ _ _ _ 1 2 18 55 78 40 F 71 _ _ _ _ _ _ 3 6 18 21 23 B19(7) Malignant Neoplasm, Breast M _ _ _ _ _ _ _ _ _ _ _ _ F 70 _ _ _ _ _ _ 4 12 13 15 26 B19(8) Malignant Neoplasm, Uterus F 27 _ _ _ _ _ 2 2 4 6 3 10 B19(9) Malignant Neoplasm, Prostate M 23 _ _ _ _ _ _ _ _ 5 5 13 B19I10) Leukaemia M 9 _ _ _ _ 2 _ 1 _ 1 3 2 F 11 _ _ _ 1 _ _ 1 _ 1 2 6 B19(11) Other Malignant Neoplasms M 100 1 _ _ 1 _ 3 2 8 32 36 17 F 89 _ _ 2 _ 1 2 3 14 15 21 31 B20 Benign and Unspecified Neoplasms M 3 _ _ _ _ _ _ 2 _ _ _ 1 F 3 _ _ 1 _ _ _ _ 1 _ 1 _ B21 Diabetes Mellitus M 10 _ _ _ _ _ _ _ _ 3 3 4 F 10 _ _ _ 1 1 _ _ 1 _ _ 7 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 B22 Avitaminoses, etc. M 1 _ _ _ _ _ _ _ _ _ _ 1 F 1 _ _ _ _ _ _ _ _ _ _ 1 B46(1) Other Endocrine etc. Diseases M 3 1 _ _ _ _ _ _ _ 2 _ _ F 8 _ 1 _ 1 _ _ _ _ _ 2 4 B23 Anaemias M 6 _ _ _ _ 1 _ _ 2 1 1 1 F 6 _ _ _ _ _ 1 _ _ _ _ 5 B46I3) Mental Disorders M 7 _ _ _ _ 1 1 _ 2 1 _ 2 F 9 _ _ _ 1 _ _ _ _ 1 2 5 B24 Meningitis M 3 1 1 _ _ _ _ _ _ _ 1 _ F 1 1 B46(4) Multiple Sclerosis M 2 _ _ _ _ _ _ _ 1 _ 1 _ F 4 _ _ _ _ _ _ 1 _ 3 _ _ B46(5) Other Diseases of Nervous System M 11 _ _ _ _ _ _ _ 2 1 3 5 F 13 _ 1 1 _ _ _ _ _ _ 4 7 B26 Chronic Rheumatic Heart Disease M 10 _ _ _ _ _ _ _ 1 1 5 3 F 33 _ _ _ _ _ 1 _ 2 7 8 15 B27 Hypertensive Disease M 39 _ _ _ _ _ _ 2 5 9 11 12 F 48 _ _ _ _ _ _ _ 2 6 15 25 B28 Ischaemic Heart Disease M 460 _ _ _ _ 1 1 9 44 123 165 117 F 285 _ _ _ _ _ _ 2 3 30 72 178 B29 Other Forms of Heart Disease M 59 _ _ _ _ _ 3 1 5 5 10 35 F 124 _ _ _ _ _ 1 _ _ 4 17 102 B30 Cerebrovascular Disease M 132 _ _ _ _ _ _ 2 7 29 47 47 F 217 _ _ _ _ 1 2 5 15 41 153 B46(6) Other Diseases of Circulatory System M 73 _ _ _ _ _ _ 1 3 12 27 30 F 90 _ _ _ 1 _ _ _ 2 5 17 65 B31 Influenza M 9 _ _ _ _ _ _ _ 1 _ 2 6 F 8 _ _ _ _ _ _ 1 _ 1 1 5 B32 Pneumonia M 150 3 3 1 _ 1 1 _ 5 13 43 80 F 198 2 5 _ _ _ _ 1 _ 3 24 163 B33(1) Bronchitis and Emphysema M 157 _ 2 _ _ _ _ 1 6 37 47 64 F 54 _ _ _ _ _ _ _ 2 8 10 34 B33(2) Asthma M 4 _ _ _ 1 _ 1 _ 1 1 F 5 _ _ _ _ 1 1 1 _ 1 _ 1 B46(7) Other Diseases of Respiratory System M 21 _ 6 2 _ _ _ _ 4 4 5 F 17 _ _ _ _ 1 _ 1 1 _ 4 10 B34 Peptic Ulcer M 17 _ _ _ _ _ _ _ _ 2 9 6 F 15 _ _ _ _ _ _ _ _ 2 3 10 B35 Appendicitis M 1 _ _ _ _ _ _ _ _ 1 _ _ F 1 _ _ _ _ _ _ _ _ _ 1 _ 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 6 1 — — — — — — — — 1 4 F 14 1 — — — — — — — 1 2 10 B37 Cirrhosis of Liver M 6 — — — — — — — 1 3 2 — F 6 — — — — — — — 1 3 1 1 B46(8) Other Diseases of Digestive System M 14 — — — — 1 — — 2 2 4 5 F 22 — — — — — — — 1 5 5 11 B38 Nephritis and Nephrosis M 4 — — — — — — — — 1 2 1 F 13 — — 1 — — — 1 — 5 2 4 B39 Hyperplasia of Prostate M 6 — — — — — — — — — 2 4 B46I9) Other Diseases, Genito—Urinary System M 12 — 1 — 1 — 1 — — 1 2 6 F 16 — — — — — — 1 — 3 1 11 B46I10) Diseases of Skin, Subcutaneous Tissue M — — — — — — — — — — — — F 3 — — — — — — — — — — 3 846(11) Diseases of Musculoskeletal System M 6 — — — — — — — — 2 1 3 F 27 — — — — — — — — 2 5 20 B42 Congenital Anomalies M 17 7 3 1 1 — 2 — 1 1 1 F 10 5 1 1 — — 1 1 — 1 — — B43 Birth Injury, Difficult Labour etc. M 13 12 1 — — — — — — — — — F 11 11 — — — — — — — — — — B44 Other Causes of Perinatal Mortality M 6 6 — — — — — — — — — — F 8 8 — — — — — — — — — — B45 Symptoms and III Defined Conditions M 6 — 1 — — — 1 — — — — 4 F 5 — 1 — — — — — — 1 — 3 BE47 Motor Vehicle Accidents M 25 — — 1 3 5 2 4 4 1 5 F 10 — — — 2 2 1 — — 3 1 1 E48 All Other Accidents M 24 — 3 3 7 — 1 1 2 3 4 F 35 — 1 2 — — 3 2 1 2 6 18 BE49 Suicide and Self—inflicted Injuries M 23 — — — 4 5 3 5 2 4 — F 20 — — — — 3 3 2 5 2 4 1 BE50 All Other External Causes M 9 — _ 2 1 3 1 2 F 6 — — — — 1 1 3 — — 1 — TOTAL ALL CAUSES M 1,793 32 18 8 11 24 20 35 131 397 556 561 F 1,734 28 11 9 7 11 19 34 65 181 341 1,028 GRAND TOTAL 3,527 60 29 17 18 35 39 69 196 578 897 1,589 24 VITAL STATISTICS POPULATION The Registrar_General's mid_year estimate for the year 1972 is 301,690. This is a decrease of 2,720 on the figure for the year 1971, and of 37,870 compared with mid_1965. The number of live births exceeded the deaths, giving a natural increase of 1,163. 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 4,950 1 to 4 years 16,750 5 to 14 years 45,700 15 to 64 years 196,780 65 years and over 37,510 Total 301,690 LIVE BIRTHS The total number of live births occurring to residents of the Borough was 4,690 comprising 2,417 males and 2,273 females. This figure was 585 less than that for 1971, giving a corrected birth rate of 14.0 per 1,000 population. The rate for England and Wales was 14.8 and the rates for Inner, Outer and Greater London Areas are 13.7, 14.3 and 14.1 respectively. During the year there were 998 illegitimate live births. The figure is 19 less than for 1971 giving a percentage of illegitimate live births per cent of total live births of 21.2 and compares unfavourably with those for Inner London, Outer and Greater London Areas which are 17.5, 8.5 and 11.7 respectively. STILL BIRTHS Still births for the year numbered 50, which is a decrease of 19 to the 1971 figure, and gives a still birth rate of 11.0. The rate for England and Wales is 12.0 and for the Inner London, Outer and Greater London Area it is 11.4, 11.0 and 11.2 respectively. 25 DEATHS Allowing for inward and outward transfers, the total number of deaths, comprising 1,793 males and 1,734 females, was 3,527. The corrected death rate of 12.5 per 1,000 population is higher than England and Wales which is 12.1 and the rates for Inner, Outer and Greater London Areas are 12.4, 11.4 and 11.8 respectively. Seventy 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, 1,570 occurring out of a total of 3,527. Malignant neoplasms of all forms ranked second. 43 people took their own lives, the same number as in 1971, and motor vehicle accidents account for 35 deaths, a decrease of 9 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 0.16, 0.22 and 0.20 respectively. INFANTILE MORTALITY Eighty_nine infants died before reaching 1 year of age, 12 less than in 1971. The infantile mortality rate is 19.0 per 1,000 live births, which is the same as last year. 26 The causes of death fell into the undermentioned categories:— Cause of death Male Female Total Birth injury, difficult labour, etc. 13 11 24 Congenital anomalies 10 6 16 Other causes of perinatal mortality 6 8 14 Pneumonia 6 7 13 Other diseases of respiratory system 6 — 6 Meningitis 2 1 3 Intestinal obstruction and hernia 1 1 2 Symptoms and ill defined conditions 1 1 2 Other endocrine etc. diseases 1 1 2 Bronchitis and emphysema 2 — 2 Other diseases, genito-urinary system 1 — 1 Other diseases of nervous system — 1 1 Other malignant neoplasms 1 — 1 Meningococcal infection — 1 1 All other accidents — 1 1 50 39 89 DEATHS FROM CANCER OF THE LUNG AND BRONCHUS There was a small decrease in the number of deaths from cancer of the lung and bronchus, 265 occurring compared with 271 in 1971. 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 (—) 3 (1) 5(1) 45-54 years 18(21) 6 (8) 24(29) 55-64 years 55(70) 18 (11) 73(81) 65-74 years 78(72) 21 (24) 99(96) 75 and over 40(44) 23 (19) 63(63) 194 (207) 71(64) 265 (271) 27 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 1972. 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 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 1,942(1,864) 22(26) 285(295) 2,124(2,069) Children 584(540) 5(5) 108(97) 598(531) 2,526(2,404) 27(31) 393(392) 2,722 (2,600) The figures in brackets are those for the year 1971. 29 Section B Prevalence of and Control over Infectious and other Diseases 30 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES The undermentioned diseases are notifible within the Borough of Lambeth Acute encephalitis Acute meningitis Actue poliomyelitis Anthrax Cholera Diphtheria Dysentery (amoebic or bacillary) Food Poisoning Infective jaundice Leprosy Leptospirosis Malaria Measles Ophthalmia neonatorum Paratyphoid Fever Plague Relapsing fever Scarlet fever Smallpox Tetanus Tuberculosis Typhoid fever Typhus Whooping cough Yellow fever 31 CORRECTED NUMBER OF NOTIFICATIONS, EXCLUDING TUBERCULOSIS RECEIVED DURING 1972 Disease First Quarter Second Quarter Third Quarter Fourth Quarter Totals Grand Total M F M F M F M F M F Scarlet Fever 1 5 10 2 2 4 8 6 21 17 38 Whooping Cough 2 1 — — 1 — 2 — 5 1 6 Measles 39 44 108 81 118 111 218 170 483 406 889 Dysentery 15 14 14 9 7 7 3 1 39 31 70 Acute Meningitis 1 1 3 — 3 2 2 2 9 5 14 Typhoid Fever — — — — — — 1 1 1 1 2 Malaria — 1 — 1 1 1 — — 1 3 4 Food Poisoning 4 4 5 — 6 2 11 12 26 18 44 Cholera — — — — — — — 1 — 1 1 Ophthalmia Neonatorium 1 1 — — — — — — 1 1 2 Infective Jaundice 9 7 5 4 4 4 5 2 23 17 40 TOTALS 72 78 145 97 142 131 250 195 609 501 1,110 NOTIFICATION OF INFECTIOUS DISEASES — AGE DISTRIBUTION Age Group Scarlet Fever Whooping Cough Measles Dysentery Acute Meningitis Totals M F M F M F M F M F Under 1 year — — — 30 14 3 4 2 2 55 1 year 2 — 2 — 46 52 2 2 — — 106 2 years 1 1 3 1 58 40 4 1 1 — 110 3 years — 3 — — 73 48 2 3 1 1 131 4 years 5 — — — 74 58 3 1 — — 141 5—9 years 10 10 — — 185 176 13 8 1 — 403 10—14 years 2 2 — — 9 2 5 3 — — 23 15—24 years 1 1 — — 4 5 2 3 2 2 20 25 years and over — — — — 1 4 5 6 2 — 18 Age unknown — — — — 3 7 — — — — 10 TOTALS 21 17 5 1 483 406 39 31 9 5 1,017 NOTIFICATION OF INFECTIOUS DISEASES — AGE DISTRIBUTION (Contd.) Age Group Typhoid Fever Malaria Food Poisoning Choiera Ophthalmia Neonatorum Infective Janudice Totals M F M F M F M F M F M F Under 5 years 1 — — 1 7 5 — — — — — 1 15 5—14 years — — — 1 7 5 — — — — 8 5 26 15—44 years — — 1 — 7 4 — — — — 11 8 31 45—64 years — 1 — 1 3 2 — — — — 3 3 13 65 and over — — — — 1 2 — — — — 1 — 4 Age unknown — — — — 1 — — 1 1 1 — — 4 TOTALS 1 1 1 3 26 18 — 1 1 1 23 17 93 GRAND TOTAL 1,017 93 1,110 34 NOTIFICATIONS OTHER THAN TUBERCULOSIS The number of notifications received during the year increased by 174; 1,110 cases of infectious disease being notified compared with 936 in 1971. 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 70 persons 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. 44 cases of food poisoning, notified or otherwise ascertained, were investigated by public health inspectors. FOOD POISONING - (SALMONELLA) On 13th January a message was received from a local practitioner that there was a family outbreak of food poisoning in his practice. The persons affected were Asians- a family of man, wife and three children and two brothers of the wife. These seven persons shared a meal on the evening of 11th January which consisted of corned beef, tinn.ed peas and packet rice. The ingredients of the meal were made into a hash and heated in a frying pan. No other food was eaten at this meal, and although none was available for examination the two corned beef tins were recovered. The first persons were affected within about 12 hours and the remainder over the next 15 to 18 hours. 35 The Public Health Laboratory discounted involvement of the peas and rice, and were unable to isolate pathogens from the tins. The laboratory then reported the presence of S. colindale, S. eimsbuettel and S. derby in the faeces of all seven patients. Further enquiries showed that these same people shared a meal consisting of chicken, rice and split peas three to four days before the onset of symptoms. The chicken was bought some 24 hours before consumption and kept in a refrigerator then stewed for two hours. It was found to be one of a consignment from another part of the country which were not prepared prior to dispatch, nor individually wrapped. It is not known whether evisceration took place at the retail butcher or at home. The Health Department of the area in which the chicken farm is situated was informed of the findings. FOOD POISONING - (STAPHYLOCOCCAL) One evening a general practitioner was asked to see a couple who were suffering from acute gastro enteritis which they attributed to some tongue bought earlier that day in a shop adjoining their home. Fortunately the purchase, which was from a newly opened tin, was made just prior to closing on early closing day, and the doctor suggested that the tin of tongue should be put aside for examination. The slicing machine had been cleansed immediately on closure of the shop. Bacteriological examination showed the presence of Staph. Aureus in small numbers in the vomit of one patient and the faeces of the other, and a heavy growth from the can which had contained the tongue. 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. 36 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. TYPHOID Two cases were notified. 1. In July information was received from a local hospital that a man had been admitted two days previously and Salmonella typhi isolated from his stool. He had been on a tour in Bulgaria and two days before he was due to return had been taken ill with diarrhoea and sickness and, after being hospitalised for just over a week with a diagnosis of Pancreatitis, had discharged himself and returned home on 23rd. He was almost immediately re-admitted to hospital where he died three days later death being certified as due to (a) Pancreatitis and (b) Typhoid. Investigations amongst the family contacts proved negative but it was reported that the patient drank a good deal of water on the holiday. 2. On 11th October it was reported by the South Western Hospital that Salmonella typhi had been isolated from the blood of a woman of 62 years admitted on 7th October, with an illness originally diagnosed as lobar pneumonia and treated with ampicillin. The date of onset of the illness was 20th September. The patient had been to Spain with her grandson and his parents from 9th to 24th September, and the grandson had had a transient gastroenteritis on 19th and the patient had headache and malaise on 20th. The family was careful not to drink the local water and had Vichy water, but sucked the ice cubes with which it was cooled. The organism was only isolated from the blood of the patient, and not from her stools, nor was it isolated from any other members of the party. 37 Another puzzling feature was the long time after onset that the organism was in the blood, especially in view of the fact that her illness had been treated with ampicillin. CHOLERA One case was notified. On 12th November the department was informed of isolation of Vib. cholera - inaba from the stool of a young lady who had recently arrived from Australia, who had consulted her doctor on 9th November and he took the specimen. The history is as follows She arrived in this country on 3rd November and had gastro-enteritis on the 5th. She was seen by a doctor from this department on the afternoon of the 12th November and, although being free of symptoms, was admitted to hospital for investigation and clearance. Her flat-mate was also investigated and found not to be infected. It was later learned that another passenger on the flight from another part of the country had also developed cholera. At the same time an outbreak of cholera was reported amongst passengers on an outward bound flight to Australia. This plane was at Bahrein at approximately the same time as the London bound plane, and a common food source was suspected. SCARLET FEVER Thirty-eight cases were notified compared to twenty-nine in 1971. WHOOPING COUGH There was a further decrease in the number notified, six compared with thirty in 1971, and eighty-one in 1970. MEASLES There was an increase in the incidence of measles, 889 cases being notified compared with 714 in 1971. ACUTE MENINGITIS Fourteen cases were notified, the same number as in 1971. 38 MALARIA Four cases were notified as compared to eight in 1971. OPHTHALMIA NEONATORIUM Two cases were notified as compared to eight in 1971. INFECTIVE JAUNDICE Forty cases were notified as compared to seven in 1971. SALMONELLA INFECTIONS (NOT FOOD BORNE) INCIDENTS AND CASES CAUSATIVE AGENT GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC CASES TOTAL Number of outbreaks and sporadic cases Columns (1+3+5) TOTAL Number of cases Columns (2+4+5) Number of separate outbreaks Number of cases notified or ascertained Number of separate outbreaks Number of cases notified or ascertained Notified or ascertained 1 2 3 4 5 6 7 1. S Typhimurium — — 1 3 5 6 8 2. Other Salmonellae (a) — — 2 4 3 5 7 3. TOTAL — — 3 7 8 11 15 Details of Salmonella infections due to Salmonellae other than S Typhimurium (not food borne) to be given here (the totals of this Table should equal the totals in line 2 of Table II above) Type of Salmonellae St. Paul — — 1 2 — 1 2 Enteritidis — — 1 2 — 1 2 Anatum — — — — 1 1 1 Un—named — — — — 2 2 2 40 TUBERCULOSIS CORRECTED NUMBER OF NOTIFICATIONS RECEIVED DURING THE YEAR AGE RESPIRATORY OTHER MENNINGES and CNS TOTAL M F M F M F Under 1 year — — — — — — — 1 year 1 — — — — — 1 2-4 years — — — — — — — 5-9 years — 1 — — — — 1 10-14 years 1 — 1 1 — — 3 15-19 years 5 2 1 1 — — 9 20-24 years 3 1 — 2 1 — 7 25-34 years 6 6 8 5 — 1 26 35-44 years 9 3 2 1 1 — 16 45-54 years 5 3 1 2 — — 11 55-64 years 9 2 1 1 — — 13 65-71 years 9 1 — 2 — — 12 75 and over 3 2 — 2 — — 7 Age unknown — — — — — — — TOTAL 51 21 14 17 2 1 106 Cases of fatal tuberculosis not notified before death. Male Female 3 — I am indebted to Dr. K.M. Citron for the following report on the work of Battersea Chest Clinic for the year. "The Battersea Chest Clinic area covers a very small area in Lambeth. This area is as follows:- Wix's Lane in the South to Southville Street in the North. In the other direction from Robertson Street to Clpaham High Street". 41 TUBERCULOUS PATIENTS ON REGISTER AT 31st DECEMBER, 1972 LAMBETH PART OF THE BOROUGH Men Women Children Pulmonary 24 20 3 Non Pulmonary 2 5 — WORK OF CHEST CLINIC - 1972 Clinic Sessions 218 Number of new patients 483 Number of old patients 1,860 43 Section C Personal Health Services 44 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. The new Belthorn Maternity, Child Health and School Treatment Centre at 1 Belthorn Crescent, SW12 (adjacent to the Weir Maternity Hospital) opened for clinic sessions in August 1972. It is the second purpose built centre to be opened by the London Borough of Lambeth since April 1965, and it replaced Poynders Gardens Child Health Sub-centre and Clapham Park School Treatment Centre, which provided insufficient accommodation for satisfactory provision and development of services in the area. The Centre serves the western part of the Streatham Hill area and provides a full range of maternity and child health services, a foot clinic, two dental surgeries, office accommodation for health visitors, district nurses and other field staff. Mothers attend at child health centres with infants from the age of two weeks for the purpose of being advised by health visitors and clinic doctors about mothercraft and care of their children and for routine developmental examinations by clinic medical officers. Mothers may attend as often as they wish but are invited to attend 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 examinations. As required, children are referred for further examinations to the Borough's Developmental Clinics held at selected child health centres where they are seen by specialist in developmental peadiatrics, who refer them to assessment centres, if necessary, or will 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. For women, ante-natal and post-natal, cervical cytology, family planning clinics and health education are provided. At four centres evening child health clinics are provided for working mothers. Health Visitors working from the centres visit mothers with children under five in their homes, as well as other members of the family, and old people whether a part of a family unit or living alone. Mothers and families know the health centres as a focal point where they can contact the health visitor and consult with the clinic medical officers. 45 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 metabolic disorder which if left untreated may lead to mental subnormality. Positive cases are referred to hospital for treatment. There were 58,436 attendances at child health and toddler's sessions and 626 attendances at ante-natal and post-natal clinic sessions. The Council provides facilities at some centres for general practitioners obstetricians to see their own booked maternity patients and 149 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 available at many child health centres. There were 1,376 sessions during the period at which 15,964 attendances were made. CHILD HEALTH CENTRES Number of children attending during the year. Born in 1972 3,321 Born in 1971 4,109 Born in 1967-1970 6,026 Total 13,456 Number of sessions held during the year by Medical Officers 342 Health Visitors 30 Sessional General Practitioners 1,783 Hospital Medical Staff 68 Total 2,223 46 DENTAL SERVICE During the year there was an acute shortage of dental officers and the effect of this is evident in the rather disappointing amount of time spent on pre-school children's treatment although the number of completed cases shows an increase over last year. More sessions were spent than last year on inspection of 3 year olds in connection with a birthday card scheme, when children are invited to attend at two of our Maternity and Child Health Centres; associated with these visits is an opportunity to advise mothers on the dental care of their children, 19% of these children attending were found to need dental treatment. In addition to provision of treatment at surgeries within the borough, a surgery is provided at Shirley Oaks where both school children and pre-school children may obtain treatment. With the opening of Belthorn Maternity and Child Health Centre this will provide a useful link between Mothers and Pre-schoolchildren attending for other services and the dental facilities provided there and it is anticipated that there will be upward trend of pre-schoolchildren provided with inspection and treatment at this centre. After a disappointing year due to staff shortage it is hoped that it will be possible to expand our service for pre-schoolchildren and extend the 3 year old birthday card scheme to cover the whole borough. B.M. Spalding, L.D.S., D.D.P.H.R.C.S. (Eng) Chief Dental Officer 47 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 246 6 Subsequent visits 300 21 Total visits 546 27 Number of additional courses of treatment, other than the first course, commenced during the year 45 — Treatment provided during the year Number of fillings 339 7 Teeth filled 304 7 Teeth extracted 16 1 General anaesthetics given 7 — Emergency visits by patients 19 — Patients x-rayed 4 — Patients treated by scaling and/or removal of stains from teeth 205 4 Teeth otherwise conserved 47 — Number of courses of treatment completed during the year 176 3 B. Patients supplied with a full upper or full lower denture - first time — 1 Patients supplied with other dentures — 2 Number of dentures supplied — 5 C. General anaesthetics administered by Dental Officers — — 48 D. Inspections during year— First inspections 412 1 Patients in above who required treatment 211 2 Patients in above who were offered treatment 193 1 Patients re-inspected during year 44 1 Number of dental officer sessions (i.e. equivalent half days) devoted to maternity and child health patients during the period 108.5 CERVICAL CYTOLOGY SCREENING SERVICE 1972 Five Clinics were held each week at five centre in the Borough, two daytime and three evening. 2,130 women were screened in three clinics during the year, 86 tests were repeated, and none were positive. Sessions were also held at South London Hospital, County Hall, the Bon Marche, and at the GPO Streatham. Repeat tests were offered to women who had an earlier one three years previously at one of our clinics. This year, throughout October, the Women's National Cancer Control Campaign made available to the Council their mobile unit for Cervical Cytology testing. This was its first visit to Lambeth and considerable interest was aroused. 633 women were tested (making the total for the year 2,981), 449 for the first time. 118 tests were repeated, and one was positive. The caravan was sited in Brixton Market for two weeks, and on Tulse Hill Estate and China Walk Estate for one week each. The visit was preceded by an intensive publicity campaign. Full information about location, dates and times of the sessions at the caravan was sent to family doctors and hospitals in the Borough as well as to voluntary associations, businesses, and all public authorities. Posters were exhibited throughout the Borough, advertisements placed in the local press, and hundreds of leaflets distributed by volunteers. The Mayor and Mayoress very kindly visited the caravan on the first day and attendances were consistently good throughout ther period. The number of women over 35 years who have attended the clinics has continued to rise satisfactorily, 2,170 in 1972 compared with 1,673 in the previous year. The greatest number attending were from socio. economic group 3, followed by group 4. The figures were:- 49 Attendances Socio-Economic Group Under age 35 811 1 56 Over age 35 2,170 2 336 3 1,261 4 842 5 486 Our Clinic Doctors, and Nursing Staff continue to encourage women in Group 4 and 5 to avail themselves of the service, but reluctance obviously persists. Clinic Number called Number examined Results Negative Positive Retaken South London Hospital 640 478 433 — 45 Streatham Common 593 467 409 — 58 Loughborough A/M 265 189 186 — 3 Loughborough P/M 445 324 319 — 5 Moffat 218 156 140 — 16 West Norwood 609 489 485 — 4 GPO Streatham 115 115 101 — 14 County Hall 104 104 86 — 18 Bon Marche 26 26 19 — 7 Caravan 633 633 514 1 118 TOTAL 3,648 2,981 2,692 1 288 Dr. E.P. Hulbert Senior Medical Officer FAMILY PLANNING 1972 Great changes took place in this service in Lambeth during the year. From January 1st to April 1st the Family Planning Association ran all the clinics on an agency basis with free advice to all residents and in addition free supplies to cases of medical or social need. From April 1st, the council decided that both advice and supplies should be supplied free to all residents and people who work in the Borough, and voted a generous sum of money. The free service was widely publicised. Advertisements in the local press, an article in "Lambeth Local", posters, leaflets in General Practitioners Surgeries, clinics and libraries were only part of the campaign. 50 The response was immediate and startling. Thirteen extra doctor sessions each week were started by the Family Planning Association between April 1st and July 1st to deal with the increased demand. One hundred telephone calls a day were made to the central booking office set up at Brockwell Clinic. This office received calls for the whole of the South West London Branch of the Family Planning Association covering six boroughs, but most of the enquiries came from Lambeth residents. In the first six months of the free service new patients increased by 68%, total attendances by 26% and clinic sessions by 46%. It was particularly encouraging to note that 34% of new patients in this period had had no previous professional advice about family planning and that the percentage of new patients aged under 20 years was 17.6%. On July 1st the Council took over responsibility of all clinics in the Borough except those held at Lambeth Hospital and the South London Hospital. The smoothness of the takeover was due in no small measure to the cooperation and help of all the staff previously employed by the Family Planning Association; they consented to work for Lambeth without exception. FAMILY DOCTORS In and around the Borough, family doctors have been kept fully informed of developments in the service, and prescriptions given to patients attending their own family doctors surgeries are now honoured in the family planning clinics. HOSPITAL VISITING Specially trained nurses continue to visit maternity wards and post natal clinics at the South London Hospital, St. Thomas' and Lambeth Hospitals. Various methods of birth control are discussed and arrangements for appointments at the nearest clinics can be made at this time when the patient is well motivated towards birth control. YOUNG PERSONS CLINICS In July 1972 a young persons clinic was started at Brockwell centre. This is an informal clinic for teenagers who cannot discuss their problems with their parents and who are often too shy to approach their family doctors. Increasing concern has been felt at the rise in numbers of illegitimate births to girls aged 19 years and younger. The fact that 323 such babies were born in Lambeth in 1970 indicated the extent of the problem. The clinic is held weekly and timed 51 at 4.30 - 6.30 pm so that both schoolgirls and working girls can attend. Young couples are encouraged to attend together. Sexual problems are discussed and contraceptive advice and supplies are given if required. The average age of those attending these special clinics is 17. There have been 91 new cases and 144 total attendances between 18th July, 1972, and the end of the year. It is hoped to expand this service in 1973. DOMICILIARY FAMILY PLANNING This service, run for us on an agency basis by the Family Planning Association, is designed to give advice and supplies to girls who are not able to go to our regular clinics. 280 people were visited including 217 new cases. There were 352 doctor visits and 758 nurse visits. It is interesting to note that of the 217 new domiciliary cases only 91 (42%) came from the United Kingdom; also that about 15% of women who started as domiciliary cases were persuaded to become clinic attenders after a few visits at home. In all, nearly 11,000 people were helped by the family planning services in 1972. Dr. M.P. Elman Principal Medical Officer STATISTICS Period New Patients Attendances Clinic Sessions 1.4.71 -31.12.71 2,758 15,470 927 1.4.72-31.12.72 4,395 20,680 1,373 Increase 59.4% 33.7% 48.1% Number of cases seen in 1972:- Family Planning Clinics 7,192 Domiciliary 466 Lambeth Clinics 2,671 Brook Advisory Clinics 501 Brockwell Young Persons Clinic 144 Total 10,974 52 GERIATRIC CLINICS In the early part of the year approval was given by the Department of Health and Social Security for the setting up of two pilot preventive geriatric clinics. The aim was to discover any defects and disabilities which might be present in elderly people, and to give advice and refer to their general practitioners where appropriate. The clinics are much appreciated by the old persons who are able to discuss their health and its associated problems at leisure, and not feel that they are wasting a busy practitioner's time. The number of defects discovered which are not known to the individual may be small, but the reassurance which is afforded is of great value. At the same time it is often possible to put them in touch with other departments of the Council such as Social Services and Housing. Dr. F. Summers Associate Medical Officer of Health THE CHIEF NURSING OFFICER'S ANNUAL REPORT 1972 Expansion of services continued during 1972, particularly in the geriatric services, home nursing services and family planning. From the 1st May a new post of Health Education Officer was created, and health education was no longer the responsibility of the nursing services. This did not diminish the participation of the nursing staff in health education. The number of attachments of nursing staff to general practitioners continued to increase slowly. Liaison arrangements with hospitals developed and expanded during the year to cover a wide variety of patient groups. HEALTH VISITING The ratio of staff to population once again showed an improvement and once again this was due to a decline in population rather than to an increase in numbers of staff. Twelve students sponsored by the Borough successfully completed the course and joined the staff. Visits to the elderly increased in number and the overall amount of time spent on geriatrics increased. This was partly due to the opening of two geriatric clinic sessions. 53 During the year five thousand visits to centres were recorded outside clinic session times. Individuals attending outside clinic times come because they have a specific problem to discuss and their visits to the centres tend to be rather longer than the visits during clinic session times. The average amount of time was thirty minutes. The recording of these visits both in the terms of number of visitors and time spent has provided a facet of the work of health visitors which had gone unrecognised. The number of evening clinic sessions was increased during the year and there are now four sessions held regularly. Attendances at these sessions vary, and are lower than day time sessions but there does appear to be a need to provide a service of this sort for mothers who cannot attend during the day. Creche sessions continue to be well attended in spite of the increase in the number of alternative services indicating a continued need for mothers to be relieved of their small children for the occasional morning or afternoon. The increase in the number of well baby sessions held in general practitioner surgeries has resulted in a decrease in the number of clinic attendances. However, the reduction in the number of attendances enables both medical and nursing staff to give more time to mothers attending. These mothers frequently have problems they wish to discuss not always related to the care of their under fives. Cases visited by Health Visitors Number of cases (included in total) seen at special request of Total Number Hospital G.P. Children born in 1972 5,010 13 32 Other children aged under 5 16,654 17 40 Persons aged between 5 and 16 seen as part of health visiting (i.e. excluding those seen as part of school health service) 1,633 15 67 Persons aged between 17 and 64 3,430 44 156 Persons aged 65 and over 4,317 214 429 Household visited on account of tuberculosis 22 1 7 Households visited on account of other infectious diseases 137 1 13 Households visited for any other reason 2,109 101 116 Total number of effective visits and revisits 90,664 Total number of unsuccessful visits 20,581 54 Domiciliary Midwifery As expected, the number of domiciliary confinements continued to fall, and also the number of early discharges. There was a disproportionate decline in the percentage of home confinements as compared with hospital confinements but there was also a marked decrease in the number of births overall. Domiciliary Midwives Domiciliary midwives spend an increasing amount of time on broader aspects of community services. This included health education and attendance at general practitioner ante natal sessions. Attendances by midwives Domiciliary Confinements 125 Number of hospital confinements conducted by domiciliary midwives 34 Number of hospital cases discharged to midwife before tenth day 847 ANTE-NATAL AND POST-NATAL CLINICS Number of sessions held by Medical Officers 1 Midwives 72 Sessional General Practitioners 70 Number of women attending for ante-natal examinations 118 Number of women attending for post-natal examinations 13 Ante-natal Mothercraft and Relaxation Classes (a) Hospital booked 143 (b) Domiciliary booked 18 Total 161 Total attendances 549 MIDWIVES ACT 1951 The Council is the supervising authority for all midwives practising in the Borough under the Midwives Act, 1951. 55 During the year 294 midwives notified the Council of their intention to practise in the Borough. Ancillary Staff in Health Centres Clinic Nurses, many of whom are promoted to school nurse grade, have continued to make a valuable contribution to the services. There are always a number of students sponsored by the Borough for health visitor training who have previously been clinic nurses. District Nursing 1972 was the first full year during which the Directorate was responsible for the domiciliary nursing services, having taken the service over in 1971 from the Lambeth District Nursing Association. It was found necessary during the year to increase the number of nurses employed, and also the scope of the service. Bathing Attendants working to the District Nurses make a valuable contribution to the overall care of the elderly and handicapped within the Borough. In September a night nursing service was introduced. On occasion a State Registered Nurse is provided to enable a patient to remain at home when relatives are very anxious not to have to send them to hospital. A night sitter service also began. The object of this service is te relieve relatives for one or two nights a week, in order to enable them to have a peaceful night. There is every indication that there is a need for these services, and it is anticipated that there will be expansion in this. Total number of persons nursed during the year 7,249 Number aged under 5 at first visit during the year 579 Number aged 65 and over at first visit in the year 3,720 Total number of visits during the year 184,044 Hospital Liaison Schemes Paediatric nursing liaison schemes have been operating for some time with both St. Thomas' Hospital and King's College Hospital. During 1972 two new schemes commenced, one in Geriatric care and the other in medical nursing. These arrangements have had the support and encouragement of the hospital, medical, social work and nursing staff and no major difficulties have been encountered. It is hoped to arrange a visit to every Geriatric case discharged from hospital. The liaison health visitor refers patients not living on her own clinic area to the appropriate health visitor or the District Nurse, whichever seems to be the more appropriate. 56 CONTROL OF VENEREAL DISEASES In April the Health Education Council's Research project began with the two aims of increasing the proportion of contacts traced and persuaded to attend for treatment and to increase the general awareness on the nature of the problem. The project is being carried out in co-operation with the Boroughs of Lambeth and Wandsworth and St. Thomas' Hospital. The project is planned for one year and includes an intensifying of Health Education. The incidence of sexually transmitted disease has continued to increase. The three Welfare Officers employed by Lambeth are based in Hospital Clinics and follow-up patients mainly in Lambeth and Wandsworth, but also in some circumstances patients living in other areas. The results of the Health Education Council's Research will make a valuable contribution to our knowledge of the effectiveness of present methods of encouraging infected persons to such treatment, and to the most helpful way of using Health Education resources for prevention. Venereal Diseases — Statistics Returns relating to new cases of patients treated at Clinics during 1972 Clinic Total Cases LYDIA, ST. THOMAS' Syphilis 163 (42) Gonorrhea 2,038 (654) Other conditions 10,843 (2,996) Total 13,044 (3,692) ST. GILES. "A" BLOCK KING'S COLLEGE Syphilis 50 (25) Gonorrhea 739 (336) Other conditions 2,502 (861) Total 3,291 (1,222) 57 SOUTH LONDON HOSPITAL Syphilis 23 (9) Gonorrhea 125 (62) Other conditions 1,166 (435) Total 1,314 (506) GRAND TOTAL 17,649 (5,420) Number in brackets denote Lambeth residents only. Number of NEW CASES in the year giving addresses in the London Borough of Lambeth when attending venereal diseases clinics — 7,105. Miss E. Early, Chief Nursing Officer ANNUAL REPORT, 1972 Health Education has continued throughout the year as an integral part of the Health Directorate Service. With the appointment of our first Health Education Officer in June, 1972, and the establishment, with supporting staff, of a Health Education Section, it is intended that the service will be stimulated and expand. Health Education with the Directorate Health Education concerns all persons working within the Health Directorate. It is an essential part of the work of the nursing personnel. To ensure that all nursing personnel can benefit from the section, alternate monthly Health Education meetings are held at selected Maternity and Child Health Centres to which all staff are invited. The main topics discussed in 1972 were, cancer education, birth and children's play. Throughout the year, posters and leaflets have been issued on many topics both in Maternity and Child Health Centres and on Borough boards, to promote a public awareness, and to give information, particularly with regard to family planning, cervical cytology, and the safe use of medicines. Mothers Clubs are organised by Health Visitors, and include a high health education content. 58 Health Education in School Notification of the Health Education Officer's appointment was sent to all schools in the borough, and a relationship established with I.L.E.A. at the Lambeth Teachers Centre, to introduce the Health Education Officer to teachers in the area and to discuss Health Education. Arising from these meetings, teachers from Junior and Secondary Schools visited the section. Junior Schools The Health Education Officer spoke at one Junior School Parent/Teacher meeting on sex education, prior to the Health Visitor teaching in the school, and gave anti-smoking education at two Junior Schools on request. Secondary Schools Health Visitors continued the health education programmes already in progress in the following schools :- Stockwell Manor School Dick Shepperd School Vauxhall Manor School and the Health Education Officer arranged programmes among others on topics such as drugs, contraception, sexually transmitted diseases, at the following schools, undertaking some talks herself or using outside lecturers— St. Gerrad's Secondary School (Boys) Strand Secondary School (Boys) Vauxhall Manor Secondary School Teachers are encouraged in every way to undertake health education themselves, and together with nursing personnel, students, and other staff, frequently visit the section for advice, to preview films and to see and loan teaching materials and media available. She gave three talks on pesonal relationship's and sex education to a teenage group organised by social workers from the Social Services Directorate. Health Education to General Public Care of Medicines In July 1972 an Exhibit on the safe use of medicines was mounted for ten days at the Lambeth Festival of Safety. This Exhibit attracted great interest and a "spot" interview broadcast on Radio London. 59 It is estimated that 40,000 people visited the Festival and many participated in the questionnaire designed by the Health Education Officer, on the safe care of medicines. Information from the questionnaire showed that 25% of people keep their medicines in a kitchen cupboard, and only 13% in a locked bathroom cupboard. The majority of people (57%) disposed of old medicines down the toilet, but only 4% returned unused medicines to the chemist. 16% disposed of unused medicines in the dustbin. This questionnaire, in itself, had identified the need for further health education in this area. Cancer Education The visit of the Women's National Cancer Control Caravan/Mobile Clinic to Lambeth in October, 1972, stimulated health education on cancer and associated subjects. Talks were offered to all female clerical staff in the Directorate, and the Health Education Officer gave four talks to 41 members of staff. Similar talks were requested, and given, to all the midwifery staff, and to four women's organisations. Anti-Smoking Three staff meetings were arranged to discuss anti-smoking clinics and Dr. Collins, Chest Physician at St. Thomas' Hospital, and Dr. H.O. Williams, Chest Physician at the Whittington Hospital, each attended one meeting. General Health Education Nineteen talks were requested by clubs and organisations on such subjects as general health, health in old age, diets for various age-groups, hypothermia, care of the feet, and cancer education. These were undertaken by health visitors, the Chief Chiropodist, or the Health Education Officer. The Health Education Officer spoke to the Brixton Rotary Club and to the L.O.P.W.A. general meeting both on the subject of "Health Education in Lambeth". Freeman's factory requested talks on personal hygiene to all their staff, and the Health Education Officer spoke to 16 groups at the factory. These talks were illustrated by slides taken at the factory. The Vice-President of Costa Rica on his visit to the Health Directorate was shown a selection of Health Education materials and media in which he expressed great interest. 60 During 1972 209 fiins were loaned from the section for use in Lambeth. Relationship was established and continued with the Health Education Council, Family Planning Association, Lambeth Social Services Directorate, and Lambeth Old People's Welfare Association, as well as several other organisations (A.S.H. and R.S.H.) in an attempt to co-ordinate and promote the service. The Health Education Officer was invited and attended the following conferences A.S.H. I.L.E.A. Hammersmith Health Department Medical Recording Service The British Temperance Society —"Smoking and Young People" —"Health Education Conference for Teachers and Health Education Officers" —"Drug Education" —"The Medical Recording Service" —"New Media in Health Education" The Health Education Officer has attended six committee meetings on the Lambeth/Wandsworth V.D. project (sponsored by the H.E.C.) and three meetings of the South London Working Party on Education about Sexually Transmitted Diseases, and one meeting of the London Boroughs H.E. Training and Research Committee. During 1972 an attempt has been made to establish a small Health Education media resource centre for the use of all persons concerned with health education, to assess the needs of the Borough, and to establish relationships with various personnel. It is hoped that a foundation has been laid, from which an efficient and worthwhile service can operate and expand to the priority areas. Thelma Bamford Health Education Officer CHIROPODY DENTAL SERVICE BELTHORN MATERNITY, CHILD HEALTH AND SCHOOL TREATMENT CENTRE CHILD HEALTH CLINIC CONSULTATION WITH HEALTH VISITOR CHILDREN'S CRECHE PROPHYLAXIS 69 THE STRUCTURE OF CARE OF MENTALLY HANDICAPPED CHILDREN IN LAMBETH DIRECTORATE OF HEALTH In the Lambeth Directorate of Health, the care of children is divided between two administrative sections according to the child's age: the pre-school child and the school child. PRE SCHOOL CHILDREN (AGE GROUP 0-5) The mentally handicapped children are monitored in the Handicapped Child Unit, similarly to all other handicapped children. Centrally, the Unit consists of three senior doctors, one area nursing officer, one clerk and her assistant. Three other doctors, experienced in developmental assessment, work for the Unit in the field. The Unit is in close contact with doctors in Child Health Centres, with Health Visitors, with general practitioners and with Hospital paediatric departments. A pattern of co-operation is gradually emerging in relation to the Social Services Directorate: the principal medical officer in charge of the Handicapped Child Unit is also medical adviser to the Social Services Department on problems connected with young children; it is hoped that a specialist social worker may soon be appointed to work exclusively with the handicapped under-fives. The Inner London Education Authority is responsible for the education of handicapped children, including those under the age of five; unfortunately, places for the latter are scarce. It has, however, made available the services of Braidwood Audiology Unit for the under-fives. The plan to which the Handicapped Child Unit works is as follows :- A. Early identification B. Complete assessment and follow-up C. Prompt medical and surgical treatment D. Parent Guidance and help E. Suitable placement and education F. Final placement in the Community A. EARLY IDENTIFICATION OF MENTALLY HANDICAPPED CHILDREN The Unit has elaborated a method of collecting information regarding handicapped children and suspected handicapped children. The figures which we will be quoting refer not to the number of handicapped children in Lambeth but to the number of handicapped children known to us and entered on the Observation Hanidcap Index. These figures fluctuate from day to day 70 as information is gathered. Nevertheless, it seems that we are able to trace the majority of the handicapped under-five population as our figures are not very different from the national ones. "AT RISK REGISTER" Until a few years ago, this Authority had a very large centrally organised "At Risk Register" of babies who had an "at risk" factor in their history. Our own survey, carried out in Lambeth in 1969, shows that, contrary to expectations children on the "At Risk Register" do not yield the expected rate of handicaps and that information about the vast majority of mentally handicapped children did not come from the "At Risk Register" but from hospitals, general practitioners, Child Health Centres and other sources. Our observations were confirmed by many other workers and subsequently the "At Risk Register" was discontinued. At present, children whose history or progress warrant additional observation are noted in the individual child Health Centre and a special effort is made by Health Visitors and Clinic doctors to follow them closely. If in doubt, the Clinic doctor or Health Visitor refers the child to Developmental Assessment Clinics for advice. If a child suspected of a possible handicap is already followed up in the hospital (e.g. low birth weight babies as at St. Thomas' Hospital) we do not duplicate the developmental assessment examination but a follow-up is carried out on the basis of the exchange of information between the hospital and our own department. OBSERVATION HANDICAP INDEX The recommendations for inclusion of a child in the observation handicap index come from many sources, hospitals, child health centres, birth notification and discharges from midwifery services, both domiciliary and hospital. However, no child is entered on the observation handicap index without the appropriate hospital consultant's confirmation of the diagnosis. The severely mentally handicapped child is usually identified initially in hospital. If however, the mental handicap has developed later in the child's life or the child has moved into the area from somewhere else, or the diagnosis was missed in hospital, the information on the observation handicap index will come later from other sources. The under-five population in Lambeth is presented in the Table as follows:- 71 TABLE 1 OBSERVATION HANDICAP INDEX FOR 0-5 DECEMBER 1972 Trend in Population of 0-5 Year on 31st December Number of under-fives Live Births Birth Rate (for Lambeth) Infant mortality rate for Lambeth Neonatal mortality rate for Lambeth 1972 21,560 4,690 14.6 19.0 10.0 1971 22,697 5,344 16.4 19.0 11.0 1970 27,600 5,559 16.4 20.3 12.4 1969 29,200 5,978 16.7 22.75 15.38 TABLE 2 OBSERVATION HANDICAP INDEX FOR 0-5 DECEMBER 1972 Number of Children under the age of 5 (Child Health Centre Areas) Belthorn 1,777 Clapham (St. Peter's) 2,009 Loughborough 1,938 Moffat 2,286 North Brixton 1,441 Streatham Common (Baldry Gardens) 1,912 Streatham Hill (Kirkstall) 1,299 St. Anne's 1,014 Rose McAndrew 3,234 Tulse Hill 2,235 West Norwood 2,415 Total: 21,560 The figures for the Observation Handicap Index are as follows:- 72 TABLE 3 OBSERVATION HANDICAP INDEX FOR 0-5 DECEMBER 1972 Handicapped Children on Observation Handicap Index 1972 Boys 320 Girls 205 Total 525 Handicapped (with specific diagnosis) Handicapped (under observation) Observation only (no diagnosis yet) 474 483 9 42 525 Single handicap 287 Multi-handicap x 2 112 196 x 3 39 x 4 34 x 5 11 73 Clinic Number of children Number of handicaps Obsvn. only Spec. Educ.* Soc. Deprivn.** Boys Girls Total x 1 x 2 x 3 x 4 x 5 Belthorn 18 13 31 19 6 — 2 — 5 4 8 Clapham 30 20 50 30 10 3 3 1 3 9 4 Loughborough 53 29 82 47 19 4 5 1 6 14 9 Moffat 19 13 32 15 2 5 3 — 7 3 4 North Brixton 24 10 34 20 4 3 3 — 3 3 4 Rose McAndrew 43 27 70 36 14 6 3 2 9 13 7 St. Anne's 11 10 21 10 4 1 3 1 2 7 2 St. Thomas' 4 4 8 3 1 2 — 1 1 — 2 Streatham Common 22 15 37 19 10 1 5 1 1 8 4 Streatham Hill 31 20 51 28 11 6 1 3 1 7 5 Tulse Hill 27 21 48 30 12 3 1 — 2 6 12 West Norwood 38 23 61 31 17 5 5 1 2 10 4 Totals 320 205 525 288 111 39 34 11 42 84 65 *as anticipated at present **as additional factor 74 TABLE 4 OBSERVATION HANDICAP INDEX FOR 0-5 DECEMBER 1972 Mentally Handicapped Children (SSN) As at 31st December Number of Children (inc. Down's Syndrome) Rate (per 1,000 0-5 population) 1972 71 3.29 1971 51 2.24 1970 90 3.22 1969 114 3.91 Down's Syndrome only (Mongols) As at 31st December Down's Syndrome Rate per 1,000 of 0-5 population Per cent of all SSN children 1972 25 1.15 35% 1971 25 1.10 48% 1970 37 1.34 41.01% 1969 47 1.64 41.22% 75 TABLE 5 OBSERVATION HANDICAP INDEX FOR 0 5 DECEMBER 1972 Distribution of Down's Syndrome according to Child Health Centre's Population 0-5 Population: 21,560 Rate per Population: 1,159 Child Health Centre Number Rate per 1,000 population Belthorn 1 0.56 Clapham 3 1.496 Lough borough 5 2.5 Moffat 2 0.87 North Brixton 1 0.69 Rose McAndrew 6 1.81 St. Anne's 2 1.98 St. Thomas' 0 — Streatham Hill 1 0.7 Streatham Common 1 0.52 Tulse Hill 2 0.89 West Norwood 1 0.41 Total 25 Total Rate 1.159 76 TABLE 6 OBSERVATION HANDICAP INDEX FOR 0-5 DECEMBER 1972 Non-Mentally Handicapped Children (Under-Five Population: 21,560) Handicaps No. of Handicaps Rate per 1,000 Developmental Delay 89 4.128 Convulsions (all types) 69 3.200 Cerebral Palsy 12 0.556 Spina Bifida 6 0.278 Profound Hearing Loss 12 0.556 Hearing Loss 46 2.1 Blind 4 0.18 Partially Blind 6 0.278 Squint, with or without visual defect 59 2.736 Speech Delay (normal hearing) **** 82 3.803 Language Disorder 7 0.324 Battered Babies 31 1.4 Congenital heart malformation (under observation) 40 1.8 Social deprivation (additional factor of physical - - handicap) 62 2.8 Special education required in future * 88 4.08 Others (blood disorders, etc.) 112 - * as anticipated at present 77 TABLE 7 OBSERVATION HANDICAP INDEX FOR 0-5 DECEMBER 1972 Mentally Handicapped Children (SSN) with other Handicaps Handicaps No. of Handicaps Per 100 SSN Spina Bifida 2 2.8 Cerebral Palsy 11 15.4 Blind 1 1.4 Severe Visual Defect 4 5.6 Severe Hearing Defect 2 2.8 Multi-handicapped 18 25.3 **** N.B The absence of psychiatric handicaps in this Table is caused by lack of information from hospitals dealing with psychiatric cases, and not to the absence of psychiatric problems in the 0-5 population in Lambeth. TABLE 8 OBSERVATION HANDICAP INDEX FOR 0-5 DECEMBER 1972 Non-SSN Handicapped Children Handicaps No. of Handicaps Per 100 Non-SSN Spina Bifida 6 1.4 Cerebral Palsy 12 2.8 Blind 4 0.9 Severe Visual Defect 6 1.4 Severe Hearing Defect 12 2.8 Multi-handicapped **** 129 26% General developmental delay, plus additional mild handicaps. 78 B. COMPLETE ASSESSMENT AND FOLLOW-UP Mentally handicapped children, as well as other handicapped children, attend developmental assessment clinics which are arranged at several levels: (a) Local Authority developmental assessment clinics are carried out by four doctors employed by Lambeth. The clinics take place in venues chosen for the convenience of mothers' transport, and where necessary, are carried out in the child's own home. The figures for numbers of children seen in Local Authority assessment clinics are as follows TABLE 9 OBSERVATION HANDICAP INDEX FOR 0-5 DECEMBER 1972 Number of Children seen in developmental assessment clinics in Lambeth Age Number 1972 1971 0- 1 7 26 1 - 2 27 34 2-3 43 38 3-4 61 43 4 - 4½ 36 28 4-½ 36 25 Totals 210 192 (b) Assessment at Braidwood Audiology Unit. Children with hearing or speech defects (be they mentally handicapped or of normal intelligence) are seen at Braidwood Audiology Unit where the services of an audiologist, a senior speech therapist, two educational psychologists, a teacher of the deaf and a social worker, are available. The senior speech therapist and one of the educational psychologists specialise in language disorders. The second psychologist is mainly concerned with the assessment of mentally handicapped (severe) children. 79 (c) Once a month a joint clinic at Braidwood Audiology Centre looks at handicapped children with neuro-muscular abnormalities. The clinic is staffed by Dr. Klein and Dr. Peter Robson (paediatrician from Guy's Hospital and King's College Hospital) and the "developmental doctors" who refer the children from their own assessment clinics. (d) One of the general practitioners in this area has a developmental assessment clinic for the young children in her own practice and also sees children at the request of the Handicapped Child Unit. (e) Some mentally retarded children, as well as others, were until now assessed in King's College Hospital at the request of consultants. From October 1971 to October 1972 (before the Sheldon Centre which is attached to the Belgrave Hospital, was officially open) out of 127 children seen there, the number of Lambeth children was 54 (not all severely mentally handicapped). There is a school of thought in the medical profession, that developmental assessment of mentally handicapped children as a method of detecting additional handicaps is not effective at an early age, and that medical and para-medical staff should be differently deployed. Our experience shows that many additional handicaps were discovered by the early and repeated assessments of mentally handicapped children and appropriate medical and other agencies were alerted. In view of having had this experience, we would favour an even earlier developmental assessment of children than is now done in this area. This problem is discussed later in this report. FOLLOW UP When a handicapped child has progressed sufficiently to be able to function at the level of his age in all parameters of development, he or she is removed from the Observation Handicap Index. If the nature and degree of the child's handicap allows, and moreover is coupled with an appropriate personality and a helpful home, he or she is recommended for ordinary school. Children who will not be able to function in the ordinary schools are recommended to the Inner London Education Authority for admission to special schools. Almost all mentally handicapped children belong to the latter category. C. PROMPT MEDICAL AND SURGICAL TREATMENT The child population in Lambeth is in the fortunate situation of having available Departments of Child Health in several hospitals. Children are treated early and nearly 100% of the mentally handicapped are investigated and followed 80 up. The Handicapped Child Unit ensures that appointments in hospitals are regularly kept. In some cases of default an escort can be arranged. If, in the course of observation, referrals to other specialists are thought to be required, these are arranged with the co-operation of general practitioners and paediatricians. Contrary to what occurs in many other parts of England, children in Lambeth may often be attending three, four or sometimes five hospitals. On several occasions, the Handicapped Child Unit was responsible for establishing one "key paediatrician" taking the overall care of a particular child whose parents were "shopping around" for better services. D. PARENTAL GUIDANCE AND HELP This service is very inadequate. GENETIC COUNSELLING This is more often offered to parents now than in previous years. It is carried out by the paediatricians in charge, or by consultants, in one of the legional genetic advisory centres. Some general practitioners prefer to carry out their own genetic counselling; the advice of a geneticist is always available to general practitioners. To be effective, genetic counselling should be followed up by further guidance of parents in order to clarify and reinforce the advice given. At present we do not have this kind of parental counselling. Parents often have wildly misleading impressions as to the cause and extent of their child's handicap. They often are able to repeat correctly medical terms, but are unable to relate its significance to the actual handicap and to the difficulty the child is experiencing and, therefore, they are unable to assist the child in everyday harmonious development. (This is confirmed by a survey carried out on families of handicapped children in Lambeth; the result will be available shortly). The guidance of parents with regard to the daily routine and care of the handicapped child is not readily available. The reasons for this are manifold. 1. The parents of mentally handicapped children do not readily attend Child Health Centres. 2. The Health Visitors are expert on handling and advising with regard to "well children" but on the whole are not trained to give practical help on handling the daily situation in which a mother caring for a mentally handicapped child finds herself (e.g. feeding, changing nappies, helping with motor progress, etc.). 81 3. The hospital outpatient departments, although very much appreciated by parents, are not a suitable venue for long and detailed explanation of manipulative procedures. 4. The shortage of Local Authority medical staff prevents parent counselling clinics being established. 5. The Social Services Directorate still adheres to the philosphy of generic social workers, therefore, specialisation in the care of young handicapped children among social workers is not available. It is hoped now that with the decreasing numbers of mentally handicapped children and the increasing interest of professional workers at all levels and in all professions, a parent counselling service will be properly structured in the near future. Some discussions with a multi-disciplinary approach have already taken place in Lambeth on this matter. E. STRUCTURE PLACEMENT AND EDUCATION DAILY PLACEMENT The placement of achild should serve the child's interests as well as the family's welfare. Because of the scarcity of places for mentally handicapped children, the child's interests cannot always be the primary consideration in choosing the placement. (Children attending day hospital for treatment for therapeutic purposes are not included in this section, inasmuch as we have so little information regarding the number of children attending, frequency of attendance and length of time spent on treatment). 82 TABLE 10 OBSERVATION HANDICAP INDEX FOR 0-5 DECEMBER 1972 Number of all Handicapped Children in ordinary Day Nurseries Number of all children Handicapped children 1972 1972 1971 Coldharbour Lane 80 10 7 Coral 52 1 7 Cowley 60 6 6 Cresset 50 7 7 Cynthia Mosley 70 6 8 Chestnut 80 7 6 Groveway 62 7 3 Lambeth Walk 40 0 1 St. John's 45 4 11 St. Martin's 50 6 8 Tulse Hill 60 3 6 Totals 649 57 70 The mentally handicapped children are placed as follows In ordinary day nurseries In Lily Davis Special Playgroup 5 (voluntary services) 12 In Special Care Unit (attached to Tulse Hill Day Nursery) 9 Edgeson House (in Westminster) 4 Children in the ordinary day nurseries attend full time; in Lily Davis Special Playgroup, mornings only; in Tulse Hill Special Care Unit, children are cared for during the whole day, but the Unit is closed for school holidays. The children attending Edgeson House are in an unfavourable situation because the long distance which they have to travel each day reduce their attendance by three hours per day and adds the physical fatigue of travelling to their existing handicap. 83 A few children attend, mostly for short periods, private playgroups but this is not a suitable arrangement. The day nurseries are now the responsibility of the Social Services Directorate, but the policy of placing about 10% of handicapped children in a day nursery, which was initiated by the Health Department when it was responsible for day nurseries, is still adhered to. The population in day nurseries since the establishment of the Directorate of Social Services has, however, changed considerably; many socially deprived children who did not attend anywhere were "discovered" by social. workers and placed in day nurseries on the priority of social handicap. This policy proved to be extremely valuable by bringing out into the open the population of children who would otherwise escape our attention until the time they reached school. On the other hand, it has created a situation whereby the increased demands of these socially and emotionally deprived children on the personal support of the staff has resulted in handicapped children not receiving the same attention as in the past. It is imperative that with the existing social conditions in Lambeth, more specialised daily placement should be available for handicapped children if they are to derive experience in forming personal relationships and to receive sensory stimulation, which is the fundamental purpose of daily placement of handicapped children in day nurseries. Several mentally retarded and physically handicapped children have attended, on a part-time basis, the nursery class at one of the schools for physically handicapped children. This arrangement is not being continued. When approaching the age of five, mentally handicapped children are recommended to the Inner London Education Authority for placement in special schools for ESN children (severe). The medical information on these children is, of course, available to the Education Authority very much earlier. Lambeth has more schools for handicapped children than any other borough. 84 TABLE 11 OBSERVATION ON HANDICAP INDEX FOR 0-5 DECEMBER 1972 Number of children on Roll at Special Schools (Not necessarily Lambeth children) School Number of children Mortimer (Delicate) 200 Grove House (Deaf) 80 Hyde Farm (Mala) 46 Willowfield (Mala) 33 Shelley ESN (Severe) 46 Windmill ESN (Severe) 114 Clapham Park (partially sighted) 110 Lansdowne (ESN) 146 Turney (ESN) 183 Elm Court (delicate) 115 Aspen House (delicate) 112 Cotswold (physically handicapped) 50 Thurlow Park (physically handicapped) 98 Excepting Shelley and Windmill Schools which are kept solely for Lambeth children, the rest of the schools have a proportion of children from other local authority areas. The number of places in Shelley and Windmill schools in the lower age range is not sufficient to cover the needs of mentally handicapped children even though the numbers have fallen. Mentally retarded children discharged from day nurseries are put on the waiting list for one of these schools and often the period of waiting is as long as twelve months. A very few individual children are placed in neighbouring schools for ESN children (severe! but the waiting list is still long, especially for severely subnormal children with multiple handicaps. On the other hand, if because of the shortage of places at school mentally handicapped children over the age of five were kept in the Special Care Unit in the Day Nursery, they would completely block the waiting list for this Unit. Fourteen under-fives still await admission at the time of writing this report. A kind of "halfway houses" for which Social Services would supply premises, the Inner London Education Authority would provide teaching, and the Handicapped Child 85 Unit would carry out medical assessment, seems to be the only way to bridge this break of continuity in the care of mentally handicapped children. The total number of handicapped children in Lambeth attending schools is a follows TABLE 12 OBSERVATION HANDICAP INDEX FOR 0-5 DECEMBER 1972 Number of Handicapped Children on Roll at Special Schools - Lambeth Children only Special schools for: Total Lambeth children attending Delicate 225 Partially Sighted 24 Physically Handicapped 54 Partially Hearing 47 Maladjusted 28 ESN 264 ESN (severe) 160 RESIDENTIAL PLACEMENT Lambeth Local Authority does not have residential homes or hostels for mentally handicapped children, although some provision is planned for the near future. The children who need residential placement are of three types. Those who are so seriously mentally and physically handicapped that they cannot be looked after at home and require special nursing, those whose behaviour is such that they cannot be contained either at home or in an ordinary day placement in Lambeth, and those who are socially deprived children and are rejected by their parents, either because of economic difficulties or because of parents' psychological problems. The residential placemens are of three main types. Short-term care Long-term care in hospitals, and Long-term residential care in special homes run privately, mostly outside London. 86 Short-term care in hospital is offered by: Queen Mary's Hospital, Carshalton King's College Hospital Belgrave Hospital The impact of hospital admission on normal children is well known; the recent longitudinal follow-ups (J. Douglas and others) point to severe sequelae in behaviour and educational difficulties lasting as long as twenty years and over. One should, therefore, envisage that the impact of hospital admissions on mentally handicapped children is at least, if not more serious. Until, alternative provisions are available, we are more than grateful for the tremendous and vital help offered by the above hospitals. The quality of care in private residential homes outside Lambeth, where children are placed, often changes rapidly, depending on movements of members of staff. On the whole, although there may be no lack of kindness, there is frequently a serious lack of real knowledge of the needs of mentally handicapped children. Vacancies in private residential homes are very few and often while awaiting placement in one of these homes a child may have several short terms of care in different hospitals, a stay with a foster mother, or at a children's home. The latest available figures of mentally handicapped children in voluntary private establishments refer to 1971. The Social Services Directorate has undertaken to supply the more recent figures soon. EARLY EDUCATION Mentally handicapped children are not a defined medical entity but they all have one big problem in common - learning difficulty. Normal children progress spontaneously through stages of intellectual maturation; the mentally handicapped child needs educational intervention for this purpose, and especially an early educational intervention. For a young child, the natural teachers are the parents, and the natural classroom is the child's home. The parents of a handicapped child must be taught how to be a teacher to the child. The place to teach the parents should be their home. The provision for home teaching of parents and their mentally handicapped children is non-existent. In the past, this Health Department had the services of a home teacher (Mrs. K. Wigham) but when the education of mentally handicapped children became the responsibility of the Education Department, the home teacher left the Department to teach in a school for ESN (severe) pupils. 87 We, in this Authority, feel that the shortage of qualified teachers does not justify the lack of a teaching programme for the young mentally handicapped children. Non-professional "mothers" of the right personality can undertake the job of fostering child/mother involvement by building up a series of tasks leading to this purpose. This approach has been successfully tried in other areas and there is no reason why it should not be incorporated in the care of a mentally handicapped child's educational needs in Lambeth. At present, therefore, our mentally handicapped children have an added handicap to their specific learning difficulty: the teaching handicap. CONCLUSION With reference to the plan of care of handicapped children (see Page 1), the score of our endeavours appears to be as follows Early identification is achieved in reasonable degree, but there is still room for improvement. Complete assessment is carried out in a variety of ways, and leads to surfacing the medical, educational and social needs of the mentally handicapped child. We believe that early intervention benefits the handicapped child and his family, otherwise we would not have built and maintained the extensive system of early assessment. Prompt medical and surgical treatment is carried out in hospitals serving this area and we are deeply appreciative of this service. As regards psychiatric treatment, its extent and value (except in individual cases) cannot be assessed by us because of our lack of sufficient knowledge of the various methods of psychiatric treatment, and of approaches to psychiatric diagnoses in a young child. There is a clear indication for improvement of psychiatric education of doctors working in community child care, and there is also a great need for far more information being communicated by psychiatrists and for more personal involvement of community doctors in Psychiatric Departments, on the pattern adopted by some Paediatric Departments. Parent guidance (sensu stricto) is not adequately covered, except for some individual parents attending certain hospitals which deal specifically with the behaviour problems of handicapped children. 88 Help offered to parents of mentally handicapped children in improving, the environmental quality of everyday life is scarce, but this should be evaluated in the context of the general level of social conditions in Lambeth. The lack of specially trained health visitors and specially trained social workers undoubtedly accentuates shortcomings of this service. Suitable placement and education has already been discussed. FINAL PLACEMENT IN THE COMMUNITY The final placement in the community is at present carried out by the Social Services Directorate. It is hoped that in the foreseeable future, more appointments will occur for favourable placement. Dr. O. Nietupska Principal Medical Officer Medical Examination of Staff 1972 did not bring any change in the pattern of this service. It was not possible to appoint a senior medical officer for the staff health service. Consequently the expansion of our existing medical examination service to provide a more comprehensive health service for staff must now await the appointment of a senior medical officer with adequate nursing and administrative support and the use of a screening medical questionnaire for all entrants to the Council's service. The total number of medical examinations carried out during 1972 were as follows Directorate Men Women Total Health Services 26 93 119 Administration and Legal Services 26 59 85 Social Services 135 724 859 Finance 28 19 47 Development 246 36 282 Public Services 374 30 404 Amenity Services 40 38 78 Housing and Property Services 40 80 120 Management Services 26 18 44 Other boroughs 9 6 15 LBTC 3 3 6 LOPWA 2 2 4 2,063 Dr. N.C.Walsh Chief Medical Officer 89 ADVISORY SERVICE TO SOCIAL SERVICES DIRECTORATE In 1972 the Health Department appointed 3 senior medical officers to work with the principal medical officers in the Personal Health and Child Health Services, This enabled us to restructure the work within the department. We were thus able to provide more clinical information and advice on individual children with whom the Social Services Directorate were dealing, in particular, in the pre school age group where our knowledge of children is well documented in the Observation/ Handicap Register. Of particular concern in this group has been the abused child, with more incidents coming to our notice than in previous years. We are still far from satisfied with our system of identification and follow up of this vulnerable group. A structured system of liaison between the Social Services Directorate, local hospitals, family doctors, our own department and other workers involved needs to be established to close the gaps in our present procedures. We are looking closely at how best to provide help for the families of these children which is both practical, readily accessible and continuously available. During the year a senior medical officer took over responsibility for school medical examinations of primary school children in a large group home, working closely with the visiting medical officer, the consultant psychiatrist, social workers, and school nursing staff, in dealing with medico social problems arising in any of the homes. With our increased medical staff, we were able to make more frequent visits to the homes for the elderly and achieved a better understanding of the needs of the residents and the problems of caring for them. Over the past few years many more residents at the time of admission are in their 70's - 90's, frail, physically handicapped, mentally confused and incontinent, needing a lot of individual physical care and attention. In some homes, up to 30% of residents need individual help with personal toilet. With an increasing average age goes a degree of general apathy which is difficult to overcome. Time to sit with and talk to old people is an important part of the caring situation. There is a need for staff with time and skills to provide mental and physical activities and encourage residents to take part in community life both in and outside the home. Dr. N.C.Walsh, Chief Medical Officer 90 INTERNATIONAL CERTIFICATES OF VACCINATION Certificates of recent successful vaccination/inoculation are required by persons travelling to certain countries abroad. After completion by the vaccinating doctor (normally the 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 Directorate, Bromfelde Road, SW4 6PJ. 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. It is estimated that 73.7% of the population aged 0-4 has been immunised against diphtheria. During the period the following numbers were protected against the diseases specified. Of the total of 39,771, 30,507 were vaccinated by the Council's doctors and 9,264 by general practitioners. Primary orcing Diphtheria 4,013 5,717 Whooping Cough 3,706 2,533 Tetanus 4,080 5,954 Poliomyelitis 4,118 5,578 Smallpox 316 349 Measles 2,108 - Rubella 1,299 - 91 IMMUNISATION AND VACCINATION 1972 Immunisation: Completed Primary Courses — Number of persons under age 16 Type of vaccine or dose Year of Birth Others under age 16 Total 1972 1971 1970 1969 1965-68 1. Quadruple DTPP - - - - - - - 2. Triple DTP 1,185 2,199 249 48 24 1 3,706 3. Diphtheria/Pertussis - - - - - - - 4. Diphtheria/Tetanus 3 35 8 17 131 113 307 5. Diphtheria - - - - - - - 6. Pertussis - - - - - - - 7. Tetanus - - 1 - 20 46 67 8. Salk - - - - - - - 9. Sabin 1,208 2,245 260 75 147 183 4,118 10. Measles 9 1,376 522 97 94 10 2,108 11. Total — Diphtheria 1,183 2,234 257 65 155 114 4,013 12. Total — Whooping cough 1,185 2,199 249 48 24 1 3,706 13. Total — Tetanus 1,188 2,234 258 65 175 160 4,080 14. Total — Poliomyelitis 1,208 2,243 260 75 147 183 4,118 Rubella 1. Number of girls vaccinated between their 11th and 14th birthday 1,299 92 IMMUNISATION: REINFORCING DOSES - NUMBER OF PERSONS UNDER AGE 16 Type of vaccine or dose Year of Birth Others under age 16 Total 1972 1971 1970 1969 1965-68 1. Quadruple DTPP - - - - - - - 2. Triple DTP 19 672 1,449 164 209 20 2,533 3. Diphtheria/Pertussis - - - - - -q - 4. Diphtheria/T etanus 1 28 117 88 2,301 647 3,182 5. Diphtheria - - - 2 - - 2 6. Pertussis - - - - - - - 7. Tetanus 1 2 2 2 24 208 239 8. Salk - - - - - - - 9. Sabin 6 682 1,584 242 2,443 621 5,578 10. Total — Diphtheria 20 700 1,566 254 2,510 667 5,717 11. Total — Whooping cough 19 672 1,449 164 209 20 2,533 12. Total — Tetanus 21 702 1,568 254 2,534 875 5,954 13. Total — Poliomyelitis 6 682 1,584 242 2,443 621 5,578 93 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 3,496 patients on chest clinic registers at 31st December, 1372. T.B. health visitors made 3,238 effective home visits and 92 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 237 contacts and 2,312 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 510 2. Found positive 314 3. Found negative 196 4. Vaccinated 237 B. SCHOOLCHILDREN AND STUDENTS (Circular 19/64) 1. Skin tested 3,124 2. Found positive 600 3. Found negative 2,524 4. Vaccinated 2,312 94 CHIROPODY In 1972 under the guidance of the newly appointed Chief Chiropodist, the Chiropodist service was reshaped and expanded. The chief chiropodist inspected each foot clinic and old people's home condemning some of the clinics and advocating alterations where needed to others. Modern equipment has been installed in most of the clinics to ensure the best conditions to work under for both chiropodist and patient. The borough recruited 10 full-time chiropodist - there was one in 1971 - and coupled with the help of 13 part-time chiropodists the service was able to expand rapidly. Five new clinics were opened and three new old people's homes were given the service of a chiropodist, the result being 46,250 treatments given this year compared with 42,000 last year. The domiciliary service was also revised so that, for administrative purposes, the borough was divided into postal areas and enough chiropodist were employed in each area to cover the service. Each new patient was visited, treated and then either sent to a nearby foot clinic or if the patient was housebound the treatment would subsequently be carried on by one of the chiropodists which were allocated to that area. This resulted in the Chief Chiropodist treating 1,173 new patients during the year, of which 157 were recommended to clinics and the rest were put onto the domiciliary service. Each of the twelve homes in Lambeth are supplied with chiropody, and steps have been taken to improve the equipment. To educate the public in foot health the Chief Chiropodist has instructed all District Nurses on foot care which was then passed on to many of the old people. During the year the service was made completely free to old age pensioners, mentally and physically handicapped and expectant mothers. In 1973 it is hoped to finish re-equiping the clinics and start an appliance centre, so that a complete service can be given. D.A.D. Sydenham Chief Chiropodist 95 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 3 - 65 65 2. Homes whose registrations were withdrawn during the year 2 - 43 43 3. Homes on the register at the end of the year 7 45 136 181 96 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 390 259 Stool Commodes 50 52 Tripod Walking Aid 14 2 Homecraft Walking Aid 3 4 Zimmer Walking Aid 70 36 Penryn Hoist 10 7 Easi Carri Hoist 12 6 Hoyer Travel Hoist 3 2 Back Rest 42 20 Bed Cradle 44 19 Mattress 9 10 Cot Bed 4 2 Pole 3 2 Rubber Sheeting 178½ yards NIL Fireguards 17 1 Fracture Boards 86 43 Hospital Beds 7 5 INCONTINENCE Supplies of incontinence pads (75,440) and Padding Rolls (576) have been issued to 389 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. 232 incontinence garments have been issued. Protective liners (21,000) were issued to 47 patients. 97 Section D Environmental Health Services 98 Dr. F. Summers, Associate Medical Officer of Health and Mr. H. Plinston, Chief Public Health Inspector, report as follows GENERAL The acute shortage of experienced and suitably qualified public health inspectors and other ancillary staff continues to be one of the main difficulties in the field of environmental health. The necessity for constant vigilance in all fields of environmental health cannot be disregarded without consequent risk to the public, and the necessary surveillance of food premises, factories, etc., and the control of communicable diseases can be achieved only with a proper, trained and qualified staff. 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. 142 Summonses were issued involving 28 defendants. 105 Convictions were obtained and fines totalling £1,426 were imposed with £178 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. 99 Bakers 88 Butchers 143 Cafes and Restaurants 319 Canteens 77 Confectioners 312 Delicatessen 11 Fish Shops 98 Greengrocers 274 Grocers 257 Supermarkets 56 Public Houses, Off Licences and Clubs 363 Food Factories and Wholesalers 62 There are 114 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) Regulations 1966 of the various itinerant food traders, mostly selling ice cream, in the Borough. 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. 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. During the year 251 drains were sealed. ABATEMENT OF NUISANCES OTHER THAN REPAIR OF DWELLINGS These nuisances cover a wide range of matters which can affect 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. CONTROL OF DRAINAGE AND PLUMBING WORKS 100 Notices were served in respect of nuisances found as under:Public Health Act 1936 Section 39 Provisions as to drainage etc. of existing buildings 478 Section 44 Insufficient WC's 3 Section 45 Buildings having defective closets capable of repair 240 Section 48 Exposure of drains 2 Section 56 Paving of yards 4 Section 75 Provision of dustbins 47 Section 83 Cleansing of filthy or verminous articles 1 Public Health Act 1961 Section 17 Remedying of stopped-up drains 136 Section 18 Repair of drain or private sewer 4 Section 34 Removal of accumulations of rubbish in the open air 207 LCC (GP) Act 1925 Section 33 Fencing of sites 14 FACTORIES AND OUTWORK 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 706 _ _ _ (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) _ _ _ _ TOTAL 750 _ _ _ 101 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 — — — — — 102 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 67 - - - - - Household linen - - - - - - Lace, lace curtains and nets - - - - - - Curtains and furniture hangings 1 - - - - - Furniture and upholstery - - - - - - Electro-plate - - - - - - File making - - - - - - Brass and brass articles - - - - - - Fur pulling - - - - - - Iron and steel cables and chains - - - - - - 103 Part VIII of the Act (continued) Nature of Work Section 133 Section 134 No. of outworkers 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) 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 or paper - - - - - - 104 Part VIII of the Act (continued) Section 133 Section 134 Nature of Work No. of outworkers 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, Chritsmas stockings, etc. - - - - - - Textile weaving - - - - - - Lampshades 1 - - - - - TOTAL 71 - - - - - 105 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 :- Hairdressers and barbers 207 Massage and special treatment 35 Pet animals shops 19 Poisons Part II 95 Rag flock and other filling materials 6 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 veterinary staff, to enforce all the necessary provisions of the Act, as agents of the London Borough of Lambeth. No formal action under the Act, or Orders made thereunder, was necessary during the year. CLEAN AIR Smoke Control Orders made under the Clean Air Act 1956 now cover 4,947.36 acres and affect some 85,641 premises in the Borough. The agreed programme to make Smoke Control Orders over the whole Borough by 1975 continued during the year. In conversion from smoke producing appliances, ratepayers continued to show a preference for gas or electricity against solid smokeless fuel. 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. 106 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 1972. The Ministry of Agriculture, Fisheries and Food, concerned with the increase in the number of mice infestations over the past few years and the growing resistance of Warfarin, requested all local authorities in the Greater London area to carry out a survey of premises to ascertain the size of the problem. The results of this survey are awaited. For the first time for some years the number of mice infestations in Lambeth did not increase and may have now reached a peak in the Borough. Comparative figures are shown below 1971 1972 Complaints 4,340 4,260 Investigations 6,017 5,942 Re-visits 10,043 11,682 Baitings 8,111 7,751 Rat Infestations 871 793 Mice Infestations 3,468 3,391 Drain Tests 34 23 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. 107 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 is still necessary, and the numbers of articles dealt with are as follows >- (a) Hospitals, Treatment Centres, etc. 2,520 (b) Tuberculosis Hostel 9,000 (c) Public Libraries (Books) 229 The disinfestation of premises for insects continues to be a major part of the work of the disinfecting staff and during the year 4,913 rooms were sprayed. Laundry Service for Incontinent Persons The collection and delivery of laundry in this service is made by the Disinfecting Staff. 52,003 articles were collected from 275 clients. 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. 1,582 informal and 103 formal samples of food yielded unsatisfactory reports from the Public Analyst in respect of 54 on analysis and 36 on labelling. 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, processed and repacked, re-exported or released for animal feeding under strict control. 108 CONTAINERS The Imported Food Regulations 1968 allowed food to be importer1 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 220 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 33 tons of unsound food was disposed of. CONTROL OF FOOD FACTORIES, LARGE WHOLESALE DEPOTS AND STORES These are visited regularly by the Senior Public Health Inspectors (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. 109 ENVIRONMENTAL HEALTH EDUCATION No special campaigns were mounted during 1972, 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 nursing staff of a local hospital, schools and organisations and in-service training to the staff of other Directorates. HOUSING In dealing with older houses there are two inter-related factors, namely, fitness and the need to secure improvements where so many houses are capable of rehabilitation. The present legal standard of fitness under Section 4, Housing Act 1957, in essence, is a structural standard which has worked well in the matter of the clearance of groups of unfit houses and the demolition or closure of individual unfit houses and parts of buildings used for human habitation. However, it is an entirely inadequate standard where an unfit house is found to be capable of repair at reasonable cost, because the local authority are unable to require the provision of essential services and amenities. In reality, Section 4 is a standard of 'unfitness' and in law a house must be considered fit unless it is so far defective in respect of certain specified matters that it is not reasonably suitable for occupation in that condition. There is an urgent need to review housing legislation, including mandatory powers, if living conditions in older houses are to keep pace with modern needs. Surveys carried out by the Public Health Inspectors in connection with the Registration Scheme for Houses in Multiple Occupation, and General Improvement Areas, reveal that houses which lack modern services and amenities are well on the way to permanent unfitness and unless corrective action is taken, they will continue to fall steadily behind modern standards until they become unfit and a statutory responsibility of the Council. Action is required not only to preserve houses which are a national asset but also in the interests of the people who must of necessity live in these houses, i.e. the privately rented sector. 110 Circular 50/72 of the Department of the Environment very aptly summed up the objective as follows, "that within a decade no one person shoula be required to live in an unfit or sub-standard house and that the first priority should be to deal with the worst conditions and to help those people most in need. In these areas of Inner London, including Lambeth, suffering from housing stress it is patently obvious from information gathered at first hand in the field that the twilight areas must be dealt with on an area basis. It will be necessary to take full account of health, welfare and sociological considerations but the cardinal need and the lynch pin of any concerted action must be the housing or rehousing if necessary of each and every family in dwellings which contain the basic amenities and services sufficient for a decent family life. Despite serious staffing difficulties the Inspectorate have continued to play a vital role in the attack on unsatisfactory housing conditions as the following statistics reveal Clearance of Unfit Houses During 1972, the Council declared under Part III Housing Act 1957, 16 Clearance Areas containing 149 houses. Individual Unfit Houses and Parts of Buildings Action under Part II Housing Act 1957, resulted in the making of 50 Closing Orders in respect of individual unfit houses and in addition 34 Closing Orders were made in respect of parts of buildings - mainly basement rooms and attic accommodation. The Modernisation and Improvement of the Existing Housing Stock During the year the Public Health Inspectorate dealt with the technical processing of no less than 1,141 applications for improvement grants. The following tables show the increase in this work since 1967. 111 TABLE 1 Applications for Improvement Grants Year Improvement Grants (Discretionary) Standard Grants and Special Grants (HMO's) Total 1967 41 122 163 1968 50 160 210 1969 176 117 293 1970 331 370 701 1971 523 397 920 1972 806 335 1,141 Totals 1,927 1,501 3,428 TABLE 2 Application Approved Year Improvement Grants (Discretionary) Standard Grants and Special Grants (HMO's) Total 1967 34 88 122 1968 40 93 133 1969 66 63 129 1970 188 151 339 1971 331 263 594 1972 503 257 760 Totals 1,162 915 2,077 N.B. The difference in the totals of TABLES 1 and 2 comprise applications not pursued, refused and applications still under administrative/technical review at the end of each year. At the end of 1972 no less than 700 applications were being processed. 112 TABLE 3 Discretionary Grants by Type of Applicant Year Owner/Occupier Landlord Total 1967 11 23 34 1968 20 20 40 1969 29 37 66 1970 73 115 188 1971 126 205 331 1972 178 325 503 Totals 437 725 1,162 Apart from the obvious improvements carried out by owner/occupiers it is salutary to note that as a result of the 725 improvement grants granted to landlords 1,562 dwellings have been either improved or provided by conversion. Many of the applications of improvement grants received from landlords have followed from surveys carried out by the Public Health Inspectorate since the advent of the Housing Act 1969. Additional amenities were secured in houses in multiple occupation mainly through informal action but in 23 cases it was necessary to serve formal notices under Section 15 Housing Act 1961. Once again it was surprising to receive no applications from tenants under Section 19, Housing Act 1964, calling for the provision of basic standard amenities. The Repair and Maintenance of Existing Housing Stock The nuisance abatement procedure under the Public Health Acts has been the main instrument in securing the repair of houses in respect of conditions which constituted a nuisance or were prejudicial to health, and 856 such notices were served. Notices were also served upon 5 houses under Section 9 (1(a)) Housing Act 1957 where substantial works of repair were required. 113 During 1972, the Council made 230 Management Orders applying The Housing (Management of Houses in Multiple Occupation) Regulations 1962 to houses where there was a failure to maintain proper standards of management. 6 Notices were served under Section 4 Housing Act 1961 to make good neglect of proper standards of management although it is true to say that in most cases informal action secures the desired improvement. The Prevention of Overcrowding and Control of Multiple Occupation Overcrowding and lack of space for essential services and amenities remain the major problems in houses in multiple occupation. The Registration Scheme which covers the whole Borough is (1) informatory, and (2) regulatory. Part I of the scheme requires persons in control to register with the Council giving details of occupation and amenities available - during the year, 806 fresh registrations were made. Part II which as regulatory requires persons in control to obtain prior approval before letting a house in multiple occupation. 61 applications were dealt with under Part II. During the year, 482 Directions were made under Section 19 Housing Act 1961, whilst no less than 482 notices were served under Section 16 Housing Act 1961 requiring adequate means of escape in case of fire. The importance of this work cannot be overstressed and the staff are to be congratulated upon their dedicated approach to this very onerous work. General Improvement Areas These areas are being dealt with by an inter-disciplinary approach and the Public Health Inspectorate have carried out surveys in no less than 1,636 houses in 5 potential Improvement Areas prior to Declaration. It will be interesting to see whether the desired co-operation with landlords can be achieved in order to secure an improvement in the quality of the environment and the houses in these areas. It may well be that in the areas of housing stress where the majority of houses are rented and occupied in intense multiple occupation a new approach will be necessary in order to secure control of occupancy and thereafter secure the desired improvements in living conditions. It is clear that the above surveys and the questionnaires filled in by the people living in these areas will be of immense value in the future when policy decisions have to be made. 114 The Inspection of Houses where Qualification Certificates are applied for During the year, Part III of the Housing Finance Act 1972 superseded Part III of the Housing Act 1969. Qualification Certificates have been the means of securing much needed improvements in controlled lettings because of the qualifying conditions namely the provision of all basic amenities, the dwelling to be in good repair having regard to age, character and locality and not to be unfit by Section 4 Housing Act 1957. Part IV Housing Finance Act 1972 which provides for 'general decontrol' under a staged programme based on rateable values is viewed with some trepidation because decontrol will take place whether or not the dwelling satisfies all the above conditions. If it is agreed that every dwelling should have the use of the full basic amenities for the exclusive use of the occupants of that dwelling then ways and means will have to be devised to attain that end because present mandatory powers are insufficient. As rent allowances are available in the private sector for the first time it is a pity the progress being made under the qualification certificate scheme could not have been retained. 115 Section E General 116 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 I refer to the Department of Health and Social Security Circular No. 1/73 and have pleasure in giving below and on the attached sheets the required information as far as it relates to the Board's direct supply to your administrative area and its several parts. You will understand that this information does not relate to private supplies or to supplies derived from or through other Water Undertakings (if any). 1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1972. (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 structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1972, was 301,686. (ii) No houses were permanently supplied by standpipe. . (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 - derived water from the Thames Valley group of works. 117 Well water from Honor Oak and Merton pumping stations. 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. Average results of the Chemical Examination of Water supplied to the London Borough of Lambeth during 1972 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 0.031 0.069 6.9 1.06 - Honor Oak 4 0.008 0.004 0.6 0.08 Merton 1 0.070 0.016 0.5 0.04 Description of the Sample Hardness (total) CaC03 Hardness (noncarbonate) CaCO3 Magnesium as Mg Sodium as Na Potassium as K Chloride as CI (8) (9) 3 (10) (11) (12) (13) River Thames — derived 274 82 5.0 24.5 5.5 35 Honor Oak 306 46 18.0 15 Merton 244 24 13.0 23 118 Description of the Sample Phosphate as P04 Silicate as Si02 Sulphate as SO4 Natural Fluoride as F Surfaceactive Material as Manoxol OT (14) (15) (16) (17) (18) (19) River Thames — derived 2.8 10 58 0.15 0.02 Honor Oak 0.35 Merton 0.40 Description of Turbidity £ol°Ur pH Etoctrical the Sample units ,Burge1ss value Conductivity units) (micromhos) (20) (21) (22) (23) River Thames — derived 0.1 13 7.9 570 Honor Oak 0.4 7 7.3 540 Merton 1.3 22 7.3 450 119 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1972 of water supplied to the London Borough of Lambeth Source of supply 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 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 8.087 42.3 41.94 10.2 56.76 4.0 3,891 10.0 99.85 99.97 Honor Oak 112 3.5 34 88.39 1.0 93 75 0.2 114 0.3 28 100.0 100.0 Merton Abbey 1 - - 100.0 - 100.0 - 1 5.7 - 100.0 100.0 120 SWIMMING BATHS UNDER CONTROL OF THE GREATER LONDON COUNCIL I am indebted to the Scientific Adviser of the Greater London Council for the following report on the bacteriological examination of the water during 1972. Swimming Bath Number of samples Colonies per ml. at 37°C. 24 hrs. Presumptive Coliform without E. coli 100 ml. E. coli in 100 ml. 0-10 11-100 More than 100 Shirley Oaks Residential Home 21 20 1 — — — Dick Sheppard School 8 7 1 — — — Ashby Mill School formerly Parkside 18 18 — — — — St. Martin-in-theFields School 18 14 2 2 — 2 Brockwell Park and Kennington Park lidos are not sampled and tested by the GLC. At St. Martin-in-the-Fields School, where on one occasion an unsatisfactory result was obtained this was due to a power cut which prevented the purification plant from working. 121 HOUSING ON MEDICAL GROUNDS Report on the activities of the Health Department for the year ended 31st December, 1972 :- 2,136 cases were dealt with on the following grounds Health 1,987 Insanitary conditions 14 Social Service referrals 17 Special cases 30 Cases previously investigated and now rehoused by Lambeth Borough Council 52 Health (GLC) 24 Rehoused (GLC) 12 2,136 COMPULSORY REMOVAL. SECTION 47 It was not necessary to remove any persons to Institutions under Section 47 of The National Assistance Act 1946 as amended by the National Assistance (Amendment) Act of 1951. HOME DIALYSIS During 1972 requests were made by local hospitals for the premises of five patients to be investigated with a view to adaptations being made for the installation of Home Dialysis units. In the event, only one adaptation was carried out during the year. In one other some difficulties were encountered in an owneroccupied house, but it is hoped that adaptation will be carried out in 1973. In the case of two others requests were made in December and will be commented on in next year's report. The fifth request was in respect of a Council tenant, who is awaiting rehousing in a purpose built dwelling in a new housing development which is not yet complete. Finally, in the early part of the year a patient from another Borough was rehoused on a reciprocical basis in Council accommodation left vacant by the death of the previous tenant. At the end of the year, therefore, there were four patients on dialysis in their own homes and four pending. 122 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. The works in connection with the Myatts Fields South Housing Scheme Phases 1, 2, 3 and 7, outlined in my memorandum of 8th May, 1972 were completed in 1972. The public sewer in Sussex Road was relaid at a cost of £12,000 in December 1972 to February 1973 to complete the sewer works in connection with the Loughborough Park Housing Redevelopment. In order to prepare the site for the Brixton Station Redevelopment the old Effra sewer crossing the site between Brixton Station Road and Canterbury Crescent was diverted along Popes Road at a cost of £18,000. The work was carried out in the period June 1972 - October 1972. The work of renewing the public sewers has continued with the following works:- The Streatham Common South Heybridge Avenue Scheme, commenced in January 1972 was completed in August 1972 at a total cost of £74,250. The second stage of the Streatham High Road scheme required to replace the old sewer in the road and to provide additional capacity for the run off from the widened road between Streatham Station and Streatham Common North Side was carried out between October 1972 and April 1973. The cost of this scheme was £35,000. Parts of the existing sewers in Mackay Road and Smedley Street were relaid in the period September - December 1972 at a cost of £10,500. Work commenced in December 1972 in Park Hill and Clarence Avenue to replace the sewer which is undersize and in a poor structural condition. This should be completed in September 1973. The tender price is £91,680. In February 1973 work commenced on relining the invert for 800 metres of the brick egg sewer in Norwood Road, together with a full relining of 200 metres. The works are between Croxted Road and Deerbrook Road. They are expected to take 6 months and to cost £58,000. 123 Works of flushing, baiting and jetting have continued as in previous years. The television survey continues to show sewers with structural defects and various schemes are being worked on with a view to their being incorporated into the Council's rolling programme. The Council's housing development programme has not had such a great effect on the public sewers during the past year as it did in 1970. 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. 45 such funerals were arranged and wherever 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 King's College Hospital, Denmark Hill, SE5 Belgrave Hospital for Children, Clapham Road, SW9 St. Thomas' Hospital, Westminster Bridge, SE1 St. Thomas's 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 124 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. 125 Section F School Health Service Report of the Principal School Medical Officer 126 LONDON BOROUGH OF LAMBETH SCHOOL HEALTH SERVICE Report of the Principal School Medical Officer for the year 1972 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 ILEA Education Welfare Service. Special investigation clinics also attended by school health social workers to which children suffering from obesity, enuresis and similar conditions may be referred, are held in a number of 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. School health social workers visit the families of the more acute cases, and maintain close liaison with the Education Welfare Social Workers. Whilst the increase in referrals to child guidance centres is a cause of concern, the health and welfare of school children in Lambeth generally continued to improve. School Health social workers are attached to the special schools which exist in Lambeth. During 1972 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). 127 School Medical Inspection There are 48,330 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 3 special units — a unit for autistic children 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 15,253 routine medical examinations, 3,012 special examinations and 5,548 re-inspections. School nurses carried out a total of 12,724 selective health surveys. 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 Social Services Department for the follow-up of handicapped pupils in the community. Treatment Facilities The School Health Service makes use of treatment facilities provided by the local authority, hospitals and general practitioners. Sessions provided in teaching hospitals include two vision sessions at King's College Hospital, one audiology session at Belgrave Hospital, and one enuretic clinic at St. Thomas' Hospital. 128 Treatment facilities provided directly by the Local authority include vision clinics (3 sessions weekly) in local authority premises, 1 orthoptic clinic and 4 special investigation clinics for treatment of enuresis, obesity and minor behaviour problems. Minor ailments, accidents and foot care are provided 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 Otologist, an audiologist, an education psychologist, speech therapist and a social worker. 141 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. Routine vision testing is performed after admission to infant school at the age of 5, then at the age of 7 and 11. 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 continuing shortage of places in ESN schools and schools for maladjusted children in the Borough. 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 lanquage stimulation and an early introduction to social life. New nursery classes have been opened in the Borough at which children selected by the Head Teachers 129 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; 1,088 children have been immunised against diphtheria and tetanus, 1,087 vaccinated against poliomyelitis, and 2,312 have had BCG vaccination. Health Education Health education in schools has been undertaken by health visitors, school doctors and nurses. The Borough Health Education Officer helped to arrange Health Education programmes in 11 secondary schools, 3 junior schools and 2 Colleges for Further Education. The programme covers personal relationship, anti-smoking, venereal diseases, birth control, etc. 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 three 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. Health education is an integral part of the student health service. Sessions were held on a wide range of general health topics, including drugs. Dr. K.H. Tlusty Principal Medical Officer 130 SCHOOL HEALTH STATISTICS FOR YEAR 1972 SCHOOL ROLL (May 1972) 48,330 SCHOOL MEDICAL INSPECTION Routine 15,253 Special 3,012 Re-inspections 5,548 Number of medical inspections per 1,000 pupils 493 Health Surveys - comprehensive 34,443 Number per 1,000 pupils 713 Percentage found verminous 2.5 Health Serveys - selective 12,724 Number per 1,000 pupils 263 Percentage found verminous 3.4 Audiometry Number of children given sweep test 6,224 Number of children given pure tons test 448 Number of children referred to otologist at audiology centre 110 SCHOOL MEDICAL TREATMENT Hospital and Specialist Clinics Vision Centres:- Vision sessions 187 Number of new cases 574 Total attendances 2,406 Errors of refraction and squint 603 Other eye defects 9 Spectacles ordered 727 Orthoptic sessions 36 Number of new cases 19 Total attendances 70 Ear, Nose and Throat Centres:- Sessions – Number of new cases – Total attendances – 131 LOCAL AUTHORITY CLINICS Audiology centres:- Sessions 8 Number of new cases 28 Total attendances 60 Special investigation clinics:- Sessions 125 Number of new cases 163 Total attendances 751 Minor ailment centres:- Sessions Medical officer 67 Nursing sister 595 Number of new cases seen by medical officer 310 Average per session 4.6 Number of new cases seen by nursing sister only 755 Average per session 1.3 Total attendances 7,358 Defects treated:- Athlete's foot 62 Verruca 750 Ringworm on body – Impetigo 35 Other skin diseases 17 Eye diseases 11 Ear diseases 6 Miscellaneous Bruises, lacerations, etc. 124 ANNUAL REPORT OF PRINCIPAL SCHOOL DENTAL OFFICER 1972 The writing of the annual report is always a time for reviewing the successes and failures of the provision of services for the community. Unfortunately there have been considerable difficulties during the year and these will be outlined in this report. 132 Staffing It is the problem of staffing that has caused most of our difficulties particularly the recruitment of dental officers. Our Senior Dental Officer resigned in September and one of our dental officers was appointed in his place. One full time dental officer moved to Australia, one left for Colchester to join her husband serving in H.M. Forces, a third resigned to study for the Diploma in Orthodontics. Two sessional dental officers left, one for a hospital appointment and another after many years service to take up an appointment in Lesotho. Our dental auxiliary left the district and it was impossible to replace her, this highlighted the problem of finding a suitable medium for dental auxiliary advertisements. The loss of so many dental officers meant that adequate and rapid replacement was not possible. There seems to be an increasing tendancy for dental surgeons after qualifying to take a local authority appointment for a short time and then return to a hospital or dental school for an appointment or further study. The dental surgery assistant staffing has been more satisfactory and no great difficulties have arisen to cover the dental officer sessions that were carried out. The level of salary of dental surgery assistants continues to cause concern and it is a measure of their loyalty that they do not leave to obtain better salaries elsewhere. The staffing position as at 31st December, 1972 was as follows:- Principal School Dental Officers 1 Senior Dental Officer 1 F.T. Dental Officer 1 Sessional Dental Officers 6 (2.0 F.T. equivalent) Sessional Anaesthetists 2 Dental Surgery Assistants 8 Premises and Equipment After many setbacks due to building delays, it was pleasing to see the opening of two new surgeries at Belthorn M.C.H. and School Treatment Centre to replace the one surgery at Clapham Park School Treatment Centre. The design and equipment plans for these surgeries had finally become a reality. The dental services occupy the major portion of the first floor, with two surgeries, recovery room, office, two waiting rooms one of which is for parents and a combined dark room and laboratory. These services provide good facilities for children and parents and pleasant working conditions for the staff. The Mayor of Lambeth officially opened the building and was able to see the dental suite during his tour of the premises. The full benefits of this purpose built dental suite stands 133 out in marked contrast to our other less desirable adapted premises. Apart from the Belthorn clinic, there is one surgery in the Waterloo area in the north of the borough, two surgeries at Stockwell, two at Brixton, one at West Norwood and one at Streatham. In addition there is a surgery in the grounds of Shirley Oaks where the Shirley Primary school is treated and some ILEA senior school children. It would seem that the situation has been reached when these adapted premises cannot be altered or modernised very much further. There are plans for dental services in four new Health Centres and one M.C.H.Centre. The net result will be a gain of four additonal surgeries than exist at present. Unfortunately some of these plans will not come to fruition until late in the 1970s. The equipment provided at all the premises is now of a high standard throughout and must compare very favourably with any other local or education authority. Particular attention has been paid to provision of equipment that can be used for the operators to work sitting down and so relieve any unnecessary physical strain. School Dental Inspection Despite carrying out less school inspections in 1972 compared with 1971, due to staff shortages, the cases referred for treatment has produced too big a work load for the surgeries and the balance between inspection and early treatment provision has required a re-appraisal of the situation. It is interesting to note, of the total number of school children inspected at junior and infant schools an average of 16% opted for School Dental Service treatment. Even with a full staff, the number of surgeries available would still not be able to cope with the demand following inspections, if all schools were inspected annually. A basic oral survey was incorporated with inspections for 5 and 12 year olds and will be the subject of a further publication when analysed. Treatment Despite the staff situation the total number of visits has increased compared with 1971. The shortage of dental officers is reflected in the slight decrease of fillings in permanent teeth and more obviously in the decrease of fillings in the deciduous dentition. An encouraging sign is that there has been a marked increase in the number of root fillings and this indicates greater efforts to conserve teeth rather than extract them. The ratio of teeth filled to extracted is well above the national average and is as follows Permanent teeth filled/extracted 9.8 : 1 Deciduous teeth filled/extracted 2.7 : 1 134 200 anaesthetics were administered by the P.S.D.O. during the year. There is also an increase in the number of new orthodontic cases accepted for active treatment. Prevention and Dental Health Education In the absence of fluoridation of the public water supply, topical fluoride gels have been applied to the teeth of suitable patients and a limited number of patients have had fissure sealants applied to permanent teeth. The published reports on this preventive measure are encouraging, especially the material being used, which involves activation by ultra violet light. It will be interesting to observe how long the sealants we have used remain in situ. Plaque control has also been adopted for many patients with the use of disclosing agents in combination with oral hygiene instruction. After two dental care exhibitions, our programme of dental health education in schools were restricted this year, largely due again to staff shortages. Pierre the clown visited a number of schools and this was followed by a questionnaire to a limited number of schools to try to assess the effectiveness of the visits. The results of this small survey are published at the end of this report. One visit was made to a parent/teacher association and this proved to be an interesting and rewarding evening. Liaison with King's College Hospital Dental School This helpful liaison has been maintained and as a result orthodontic advice or treatment is readily obtainable from the senior staff of King's. Occasional lectures are also given to senior dental students as a result of the Principal School Dental Officer continuing to be a lecturer at the Dental School. Courses and Conferences The following were attended during the year: The E itish Dental Association Conference Child Dental Health Course Dental Anaesthesia Course The borough were hosts for the I.L.E.A. and other London boroughs' dental auxiliary training session held on one afternoon. Hospitality was provided and a guest speaker held the attention of the auxiliaries with his lecture. 135 In conclusion This has undoubtedly been a difficult year because of the over-riding problem of dental officer shortage, but as far as possible every effort has been made to provide a comprehensive dental service for those children who have attended for treatment. Our attention has once again also been directed towards establishing preventive measures because in the long term surely we should not be content to provide more and more treatment when known preventive measures can reduce significantly the level of dental disease. April 1974 now seems but a short time ahead and it is awaited with both eager anticipation of the benefits of an integrated service and the feeling of stepping into the unknown and uncharted fields of operation of a new look dental service. One only hopes that this most prevalent of common diseases embraced in dental caries and gingival inflammation will continue to have due regard paid to them in terms of manpower, resources and financial provision in the new era of the National Health Service. As always my last words are to say thank you to the dental staff and also to the support and encouragement of both professional and administrative staff in the Health Directorate. B.M. Spalding, L.D.S., D.D.P.H.R.C.S.(Eng) Principal School Dental Officer SCHOOL DENTAL SERVICE Number of Sessions: Inspection 244.8 Ordinary treatment 2,611.6 General anaesthetic 62.1 Orthodontic 49.7 Health education 24.0 Total sessions 2,992.2 Inspections: number of children given: First inspection at school 25,286 First inspection at clinic 3,043 Percentage found to require treatment 51.8 Reinspection at school or clinic in 1972 385 Percentage found to require treatment 92.5 136 Visits for treatment: Number of first visits (including emergencies) 4,808 Number of subsequent visits 11,190 Total visits 15,998 Additional courses commenced 703 Number did not attend 7,163 Treatment given: Number of fillings: In permanent teeth 7,033 In temporary teeth 5,490 Number of extractions (excluding orthodontics) Of permanent teeth 481 Of temporary teeth 1,737 Number of other operations (prophylaxis. X-rays, inlays, crowns etc.) 7,334 Courses of treatment completed 3,302 Orthodontics: Number of new cases 46 Number of removable appliances fitted 111 Number of fixed appliances fitted 2 Number of orthodontic extractions: Of permanent teeth 153 Of temporary teeth 124 Sessional averages: (treatment sessions) First visits 1.8 Subsequent visits 4.3 Did not attend 2.7 Fillings: In permanent teeth 2.7 In temporary teeth 2.1 Extractions: Of permanent teeth 0.2 Of temporary teeth 0.7 *Ratio of permanent teeth filled to permanent teeth extracted 12.9 *Ratio of temporary teeth filled to temporary teeth extracted 2.9 Staff: Number of dentists employed at 31.12.72 (whole time equivalent) 4.2 Number of dental auxiliaries employed at 31.12.72 (whole time equivalent) – * Excluding orthodontic extractions. 137 QUESTIONNAIRE TO SCHOOLS ON DENTAL HEALTH As a follow up to the visit of Pierre the Clown to some schools within the borough, the co-operation was sought of Head Teachers to conduct a small survey based on a random sample of schools. The questionnaire was aimed to ascertain what the children had remembered about these visits and at the same time to try and obtain information about certain aspects of their home dental care. Teachers were asked to assist the children in completing the questionnaires but not to influence their answers. A total of 193 children completed the forms and they were divided by age and sex as follows:- Age Boys Girls Total 5 13 15 28 6 26 27 53 7 49 43 92 9 2 2 4 10 9 7 16 99 94 193 The questions and design of the forms are shown at the end of this report. The summary of replies to the question are given below. Did you enjoy the visit of Pierre the Clown ? Yes 99.5% No .5% Did Pierre the Clown talk to you about — Your teeth 73.6% The circus 17.1% Cleaning your teeth 68.9% Road safety 16.1% Are apples good for your teeth ? Yes 95.4% No 1.0% No reply 3.6% Have you got your own toothbrush ? Yes 93.8% No 4.7% No reply 1.5% 138 Do you clean your teeth ? Yes 77.7% No 1.0% Sometimes 19.7% No reply 1.6% When do you clean your teeth ? At night before going to bed Yes 67.9% No 12.9% No reply 19.2% After breakfast in the morning Yes 72.6% No 15.5% No reply 11.9% Comment It is appreciated that this is only a small survey and that it would therefore be unwise to draw any firm conclusions from it, only general comments is made. It is evident that the children of all ages enjoyed the visit of Pierre the Clown but because visits are made to schools about a variety of subjects and the association of a clown with circuses there is some confusion in the children's minds about the purpose of the visit. As the demonstration at schools included the effectiveness of eating an apple after eating a liquorice sweet it is not surprising that so high a proportion of children classified apples as good for health. That as high as nearly 5% have no toothbrush of their own would seem to show that a personal toothbrush is not considered a hygienic necessity in some homes. Nearly 20% of children in this survey are not regular toothbrushers. The sections on when toothbrushing is carried out seem to have caused a good deal of confusion regarding the answers and highlights the problems of children completing these survey forms even when teachers have been asked to supervise. I am grateful to the Head Teachers for both their advice in compiling the questionnaires and for allowing their children to complete the forms. 139 PIERRE THE CLOWN CHILD ASSESSMENT Age 1 Boy or Girl 2 1. Did you enjoy the visit of Pierre the Clown ? Yes 3 No 4 2. Did Pierre the Clown talk to you about — Your teeth 5 The Circus 6 Cleaning Your Teeth 7 Road Safety 8 3. Are apples good for your teeth ? Yes 9 No 10 4. Have you got your own toothbrush ? Yes 11 No 12 5. Do you clean your teeth ? Yes 13 No 14 Sometimes 15 6. When do you clean your teeth ? At night before going to bed ? Yes 16 No 17 After breakfast in the morning ? Yes 18 No 19