Librasy A-102. For disposal pl. AC 43376 Medical Officer of Health LEW 53 REPORT 1965 London Borough of Lewisham <b CONTENTS Page Introduction 5 Public Health Committee 7 Public Health Staff 7 Vital Statistics 9 PERSONAL HEALTH SERVICES 16 Midwifery 16 Care of Mothers and Young Children 17 "Risk" and "Handicap" Registers 19 District Nursing 20 Dental 23 Chiropody 24 Cervical Cytology 25 School Health 27 Investigation of Plantar Warts 36 HEALTH EDUCATION 38 COMMUNITY HEALTH SERVICES 39 Mental Health 39 Problem Families—Co-ordinating Committee 42 Home Helps 43 INFECTIOUS DISEASES 45 ENVIRONMENTAL HEALTH 57 Summary of Inspections and Notices Served 58 Factories 60 Outworkers 62 Offices, Shops and Railway Premises Act 62 Disinfection and Personal Cleansing 65 Prevention of Damage by Pests 65 Swimming Baths 66 Rag Flock and Other Filling Materials Act 66 Destruction of Pigeons 66 Pet Animals Act 66 Children's Nightdresses 67 Atmospheric Pollution 67 Housing 70 Food 73 Water Supply 78 Mortuaries 81 Immigrants 81 MISCELLANEOUS 83 National Survey of Leukaemia 83 Nursing Homes 83 National Child Development Study 84 Suicide 84 Incontinence Pads 85 Staff Medicals 85 Index 86 List of Tables 88 TO THE MAYOR, ALDERMEN AND MEMBERS OF THE COUNCIL I have the honour to submit my report on the Health Services in the Borough for the year 1965. This is the first of a new series, and is in accordance with Circular 1/66 of the Ministry of Health addressed to Medical Officers of Health of the new London Boroughs. The inclusion of data relative to the first quarter makes it possible to provide a review for the complete year. The events leading up to the implementation on April 1st, 1965 of the London Government Act, 1963, would need several volumes to detail. Suffice it to say that with the encouragement and support of the Chairman and Members of the Health Committee and the loyal co-operation of my colleagues, the reorganisation took place without any dislocation or diminution of health services to the community. An immediate need was the establishment of emergency services for midwifery and mental health. This was met by setting up a control centre in co-operation with London Borough of Greenwich, providing cover for both areas, with economy in manpower. The arrangement worked satisfactorily throughout the year. The Council showed wisdom and foresight in approving the setting up of a Health Education Section within the department. There has in recent years been an increasing emphasis on this subject, which is such an important function of all workers in the field of preventive medicine. It is now possible to co-ordinate activities, provide materials and programme campaigns. District Nursing services over the greater portion of the Borough became a direct responsibility of the Council, with the absorption of the Ranyard Mission personnel in April. It was decided to postpone for one year the taking over of midwifery services provided on an agency basis in two small districts by the Nursing Sisters of St. John the Divine and the Salvation Army respectively. The Mental Health Section of the Department has been strengthened and additional community services provided. Honor Lea Hostel, newly opened by the London County Council shortly before the transfer of powers, has already proved its usefulness in this field. Not only Lewisham residents but those from other inner London Boroughs may be admitted. The Health Committee considered the need for some reorganisation and expansion of the Home Help service and decisions were being put into effect by the end of the year. The activities of the Public Health Inspectorate were hampered by continued staff shortages. Nevertheless, progress was continued in the clean air programme, the implementation of requirements under the Offices, Shops and Railway Premises Act, the control of houses in multiple occupation and in food hygiene inspection. Four areas were represented for clearance to the Housing Committee. It is pleasing to be able to report that there were no outbreaks of major infectious disease during the year, but this must not give rise to complacency. Prevention calls for eternal vigilance. Several typhoid and dysentery carriers came under supervision and contact investigations were necessary when a case of diphtheria occurred in an adjacent borough. For the first time for many years a case of Anthrax was notified and a report was made to the Ministry of Health on a possible loophole observed in the Anthrax Regulations. 5 Steps were taken in April to form a Co-ordinating Committee of Officers of the Council, together with representatives of other statutory bodies and voluntary organisations having an interest in 'family care'. The working of this most useful co-operative effort is discussed in the chapter on 'Community Health'. In the chapter on Maternal and Child Health, reference is made to the 'At Risk Register' for infants. This is a most important procedure, providing basis for research, supervision of observed defects, early treatment and forward planniing for special educational or other needs. Another notable development was the provision of cervical cytology centres as part of the campaign against cancer. It is hoped that eventually this service will be available to all general practitioners, so that pressure on local authority clinics may be reduced. Accidents to the young and elderly provide a tragic record of preventable injury, often fatal. It is ironic to note that a Lewisham resident has a far greater chance of death from violence than, for example, from tuberculous disease. Fires caused by wrongly used or defective oil heaters occur frequently during winter months. From October to the end of the year special propaganda efforts were made to bring home to families with young children or elderly relations the great dangers involved. As an addition to the special appeals issued, Mr. White of the Public Health Inspectorate, prepared an excellent booklet on Fire Precautions, which was widely circulated. Medical Officers of Health of Inner London Boroughs were appointed Principal School Medical Officers by the Inner London Education Authority. This ensures that the local school medical, dental nursing and social services are administered within the Health Department. A close liaison has been built up between this Department and that of the Medical Advisor, Greater London Council. One of the most important community questions facing the new borough is in the field of the elderly and chronic sick. Excellent services are provided by the Health, Housing and Welfare Departments in close co-operation with the voluntary associations. Unfortunately there are gaps remaining and one of these is the lack of geriatric beds and special cover in the area of Metropolitan Lewisham. The position was somewhat prejudiced by the publication of a report in 1964 with majority conclusions to the effect that such provision was unnecessary. During the year, many consultations with representatives of hospital and family doctors have taken place, and at the year end there was definite hope that positive favourable recommendations would result. Special efforts have been made to increase co-operation with hospitals and family doctors. Discussions have taken place on the possibility of establishing Health Centres so that services divided in the National Health frame work might be brought into closer union. Several plans are now under consideration. Experiments in the attachment of health visitors and midwives to group practices are being carried out and the use of facilities at ante natal centres by general practitioner obstetricians continue. It is my privilege to present to you an account of the activities of the department. In doing so, the loyalty and enthusiasm of the staff whose day-to-day labours are reflected therein is acknowledged wholeheartedly. In conclusion, I would like to thank the Chairman and Members of the Health Committee, and the Town Clerk and other Chief Officers for their ever ready help and support during a trying but successful year. F. R. WALDRON, Medical Officer of Health. 6 PUBLIC HEALTH COMMITTEE as at December, 1965 The Mayor (Councillor F. A. F1SK, J.P.) Chairman: Councillor F. W. BULLION, I.I.S.O. Vice-Chairman: Councillor A. A. GROVES Alderman Mrs. M. J. Chrisp Councillor H. W. Eames, M.A., LL.B. „ Mrs. J. R. Steyne „ P. E. J. Forward „ J.F.W.Waldon „ F. M. Judge, M.P.S. Councillor A. H. Boon „ Mrs. G. M. M. Land „ C. A. Cook „ A. J. Pinnegar „ Mrs. D. I. Cox „ E. Richards, B. Pharm. (Hons.) „ Mrs. D. E. Eagles Ph.C. Representing London Executive Council: Councillor W. Hall Co-opted Members: P. Freeman, L.R.C.P., L.R.C.S., L.R.F.P.S. M. R. Luckham-Down, L.D.S., R.C.S. (Eng.) STAFF OF HEALTH DEPARTMENT as at 31.12.65 (a) Medical Officer of Health and Principal School Medical Officer, Inner London Education Authority (Lewisham): F. R. WALDRON, M.D., D.P.H. (a) Deputy Medical Officer of Health and P.S.M.O. : A. W. TRANTER, M.B., D.C.H., D.P.H. Senior Medical Officers: Anna L. Frenkiel, B.A., M.R.C.S., L.R.C.P., A. G. Poulsen-Hansen, M.D., D.P.H., D.T.M.H. D.R.C.O.G., D.C.H., D.P.H. Assistant Medical Officers: Islay C. Barne, M.R.C.S., L.R.C.P., M.R.C.O.G. Evelyn S. Priddle, B.M., B.Ch. Betty E. Shortland, M.B., B.S., D.P.H. Isobel Smith, M.B., B.S., M.R.C.P., D.P.H. 2 Vacancies and 45 sessional M.O.s (a) Chief Dental Officer: Edith Mahler, M.D., L.D.S. (a) Dental Officers: J. Kelly, L.D.S. Clare M. Leeming, B.D.S. 5 Sessional dentists; 3 Dental auxiliaries and 7 Dental surgery assistants. Public Analyst: H. Amphlett Williams, Ph.D., A.C.G.F.C., F.R.I.C., F.R.S.H. (a) Nursing Officer (Maternal & Child Health and School Health): Dorothy M. Coe, R.F.N., S.R.N., S.C.M., H.V., C & G. Technical Teachers Certificate (a) Assistant Nursing Officers (M & CH and SH): Elizabeth M. Gleeson, S.R.N., S.C.M., H.V., Jean Edwards, S.R.N., S.C.M., H.V., C & G. C & G. Technical Teachers Certificate Technical Teachers Certificate. 7 Centre Superintendents: Margaret Henley, R.S.C.N., S.R.N., C.M.B. Sylvia Wallace, S.R.N., S.C.M., H.V. (Part 1), H.V. Fanny Stevens, R.F.N., S.R.N., C.M.B. (Part I) H.V. Nora Miller, S.R.N., C.M.B., (Part I)., H.V. Margaret M. Sammon, S.R.N., S.C.M., H.V., T.A.Cert. 35 Health Visitors; 5 T.B. Health Visitors; (a) 22 School Nurses; 18 Clinic Nurses; 3 Day Nursery Matrons; 4 Deputy Matrons; 21 Nursery Nurses and 3 Nursery Wardens. Nursing Officer (Midwifery and District Nursing): Joan M. Goodman, S.R.N., S.C.M., M.T.D., Q.N., CERT. Assistant Nursing Officers: Frances H. Peare, S.R.N., S.C.M. 1. Vacancy Midwives (30); Pupil Midwives (up to 16) Area Superintendent District Nursing: Elsie K. Ford, S.R.N., S.C.M., H.V. and D. N. Certs. Assistant Area Superintendent: Renee R. Humphries, S.R.N., S.C.M., D.N. CERT. District Nurses (65) Chief Chiropodist: B. Dalton, M.Ch.S., S.R.Ch., M.R.S.H. Chiropodists (4) and 15 sessional Chiropodists. Principal Mental Health Officer: Zena Mason, B.A., A.I.M.S.W. Assistant Principal Mental Health Officer: A. G. Knight and 13 Mental Health Officers Honor Lea Hostel: Warden: B. W. Murray Assistant Warden : T. W. MacMillan and 3 Assistants Supervisors of Training Centres: Alice M. Potter Alice J. Thompson H. F. Weaver and 14 Assistants Supervisors of Day Centres: P. W. Postle Gillian Beckett, M.A.D.T. and 3 Instructors (a) Senior Social Worker: Eileen L. Stocker, Dips. Social Studies and Casework, A.A.P.S.W. (a) Assistant Senior Social Worker: Betty J. Hardy, B.A., (Soc.Sc) Family Case Workers: Anne V. Dey M.A., Dip. Social Studies. Julia Sarkic, S.R.N., S.C.M., H.V., Dip. Social Studies. and 6 Social workers Home Help Organisers: Ivy I. Stittle Beatrice Kneller Muriel Wakeford. and 5 Assistants 609 Home Helps Welfare Organisers, Chest Clinics: Vera L. Verrall Ethel M. Robertson Social Worker V.D. Clinic: Vacancy 8 Health Education Officer: R. W. Allen, M.A.P.H.I. Assistant Health Education Officer: Iris Holloway, S.R.N., S.C.M., H.V. and 2 assistants Chief Public Health Inspector: A. J. Phillips, M.A.P.H.I. Assistant Chief Public Health Inspectors: H. E. Green, M.A.P.H.I. J. Craven, F.A.P.H.I. J. E. Waring, M.A.P.H.I. Senior Public Health Inspectors: H. Tolson, M.A.P.H.I. R. Mahoney, M.A.P.H.I. J. A. G. White, M.A.P.H.I. J. W. Bevan, M.A.P.H.I. R. C. Brittain, M.A.P.H.I. H. W. Ellery, M.A.P.H.I. G. Belshaw, M.A.P.H.I. H. W. WeUbelove J. G. Beale 2 Assistants and 20 Miscellaneous Staff Mortuary Keepers: C. B. Evans W. C. Spear Pest Control Foreman: R. A. Sharman 9 Operatives (a) Joint Appointments, Borough Council/I.L.E.A. ADMINISTRATIVE STAFF Chief Administrative Officer: G. A. LANGLEY Personal Health Services: Community Health Services: Environmental Health Services: E. W. Cheesman D. M. Minear R. Shrive CHead of Section) (Head of Section) (Head of Section) W. Fancy, B.Sc. (Econ) G. M. Joblin C. R. Coleman, D.M.A., (Senior Assistant) (Senior Assistant) (Senior Assistant) A. C. Shoult (Senior Assistant) Sadie Attfield (Senior Assistant) 8 Administrative and clerical assistants 14 Administrative and clerical 19 Administrative and clerical assistants. assistants; 14 Field Staff (Clinics etc.) Secretariat and Staff: S. Burridge (Head of Section) Supplies and Wages: 2 Clerical Assistants L. Thorpe, D.F.C., (Head of Section) Thelma Dean S. Bott (Senior Assistant) (M.O.H.'s Secretary) 11 Administrative and clerical assistants. VITAL STATISTICS Area The area of the borough is 8,579 acres. Population Census 1961 290,582 Estimate of Registrar General at midyear 1965 289,560 Rateable Value Rateable value of the borough at April 1, 1965 £11,872,018 Estimated net product of a penny rate 1965/6 £ 47,250 Estimated number of separately assessed dwellings at April, 1 1965 84,695 Births Males Females Total Legitimate Illegitimate 2,521 356 2,567 347 5,088 703 Totals 2,877 2,914 5,791 Crude birth rate per 1,000 of the estimated population 200 Adjusted birth rate for comparative purposes (Area comparability factor=0.96) 19.2 Stillbirths Total (40 males and 42 females) 82 Rate per 1,000 live and stillbirths (males 13.7 females 14.2) 140 Deaths Total (1,886 males, 1,550 females) 3,436 Crude death rate per 1,000 population 11.9 Adjusted death rate (area comparability factor=0.97) 11.5 Infant mortality Infant deaths (all deaths of liveborn children under one year) Males Female Total Legitimate 75 37 112 Illegitimate 14 9 23 Totals 89 46 135 Death rate of all infants per 1000 livebirths 23.3 Death rate of legitimate infants per 1000 legitimate livebirths 22.0 Death rate of illegitimate infants per 1000 illegitimate livebirths 32.7 Death rate of male infants per 1000 male livebirths 30.9 Death rate of female infants per 1000 female livebirths 15.8 Neonatal deaths (under 4 weeks of age) 91 (66 males, 25 females) Males per 1000 male livebirths 22.9 Females per 1000 female livebirths 8.6 All infants per 1000 livebirths Early neonatal deaths (under 1 week of age) 15.7 86 (61 males, 25 females) Males per 1000 male livebirths 21.2 Females per 1000 female livebirths 8.6 All infants per 1000 livebirths 14.8 Perinatal mortality (deaths under 1 week plus stillbirths) 168 (101 males, 67 females) Males per 1000 live and still male births 34.6 Females per 1000 live and still female births 22.7 All infants per 100 live and stillbirths 28.6 Reproductive wastage (stillbirths plus all infant deaths) 217 Males per 1000 live and still male births 44.2 Females per 1000 live and still female births 29.8 All infants per 1000 live and stillbirths 37.0 Maternal deaths Maternal deaths 4 Maternal mortality rate ner 1000 live and stillbirths 0.7 Deaths from certain causes Tuberculosis of respiratory system 17 Other forms of tuberculosis — Respiratory diseases (other than tuberculosis) (Code Nos. 22-25) 580 Cancer (Code Nos. 10-15) 741 Heart and circulation diseases (Code Nos. 17-21) 1,586 Suicide 35 10 Table 1 TOTAL DEATHS BY CAUSE AND AGE REGISTERED DURING 1965 Disease Sex All ages Under 4 wks. 4 wks under 1 year 1- 5- 15- 25- 35- 45- 55- 65- 75 & over All causes M 1886 66 23 7 8 15 17 64 364 167 485 670 F 1550 25 21 5 4 8 7 48 77 159 306 890 1. T.B. Respiratory M 12 - - - - — 2 1 1 2 4 2 F 5 - - - - - - - - 2 1 1 2. T.B. Other M - - - - - - - - - - - - F - - - - - - - - - - - - 3. Syphilitic Disease M 5 - - - - - - - - - 2 3 F 5 - - - - - - - - - 1 4 4. Diphtheria M - - - - - - - - - - - - F - - - - - - - - - - - - 5. Whooping Cough M - - - - - - - - - - - - F - - - - - - - - - - - - 6. Meningococcal Infection M 1 1 - - - - - - - - - F - - - - - - - - - - - - 7. Acute Poliomyelitis M - - - - - - - - - - - - F - - - - - - - - - - - - 8. Measles M - - - - - - - - - - - - F - - - - - - - - - - - - 9. Other Infective & Parasitic Diseases M 1 - - - - - 1 - - - - F 7 — — 1 — 1 3 — 1 1 10. Malignant Neoplasm of Stomach M 48 — - 2 — 7 13 13 13 F 26 - - - - - - 1 — 3 11 11 11. Malignant Neoplasm of Lung, Bronchus M 204 - - - - - 1 3 30 78 67 25 F 31 - - - - - - - 6 7 12 6 10. Malignant Neoplasm of Breast M — — — — — — — — — — — — F 66 - - - - - - 7 16 12 13 18 13. Malignant Neoplasm of Uterus F 19 - - - - - - 4 5 3 4 3 14. Malignant Other & Lymp. Neoplasms M 167 — — 3 2 — — 10 16 37 41 58 F 158 — — — 1 2 1 5 10 32 30 77 15. Leukaemia, Aleukaemia M 9 - - - - - 1 — 1 1 2 4 F 13 — — — — 2 — 1 2 1 1 6 16. Diabetes M 3 — — — 1 — —■ — — 1 — 1 F 10 - - - - - - - 1 1 4 4 17. Vascular Lesions of of Nervous System M 173 1 1 2 3 9 25 43 89 F 219 — 1 — — — — 6 3 15 47 147 18. Coronary Disease, Angina M 452 - - - - - - 12 60 107 135 138 1- 288 - - - - - - - 8 31 71 178 19. Hypertension with Heart Disease ... M 21 - - - - - - - 1 2 5 13 F 31 - - - - - - - 3 4 8 16 20. Other Heart Disease M 95 - - - - - - 6 5 14 10 60 F 157 - - - - - 1 4 8 9 18 117 21. Other Circulatory Disease M 67 - - - - - - 1 3 9 22 32 F 83 - - - - - - 1 1 33 15 63 22. Influenza M 1 — — — — — — — — — 1 — F 1 - - - - - - - - - 1 — 23. Pnuemonia (including Pneu. of Newborn) \1 151 2 6 — — 1 — 2 7 11 31 91 F 147 — 7 1 2 — — — 1 4 25 107 24. Bronchitis M 188 2 2 — 1 — — 1 9 35 61 77 F 61 — 3 1 — — 1 1 — 5 12 38 25. Other Diseases of Respiratory System M 18 — 1 — 1 — — 1 — 1 6 8 F 13 1 - - - - - - 2 3 7 26. Ulcer of Stomach & Duodenum M 16 - - - - - - 1 1 1 8 5 F 13 - - - - - - - - 3 3 7 27. Gastritis, Enteritis M 6 2 — 1 — — 2 1 F 14 - 4 1 2 — 7 28. Nephritis & Nephrosis M 8 - - - - - - 1 1 — 5 1 F 6 - - - - - - 1 1 2 2 29. Hyperplasia of Prostate M 10 - - - - - - - - - 3 7 30. Pregnancy, Childbirth, F 4 — — — — 1 1 2 — — — — 31. Congenital Malformations M 20 11 5 1 1 — — — 1 1 — F 10 4 3 1 — — — — 1 1 — — 32. Other Defined & 111- Defined Diseases M 134 51 3 1 2 1 7 10 13 18 28 F 120 21 1 1 - 2 11 4 10 17 53 33. Motor Vehicle Accidents M 26 — 2 3 2 3 1 6 3 6 F 9 — — 2 — 1 — 1 — 1 2 2 34. All other Accidents M 24 — 2 1 1 2 3 5 2 2 1 5 F 23 — 1 — — 1 — — 2 4 2 13 35. Suicide M 24 — — 4 3 5 3 5 1 3 F 11 - - - - - 1 1 2 3 2 2 36. Homicide & Operations of War M 2 — — 1 — 1 — — — — — — F - - - - - - - - - - - - 11 Table 2 SOCIAL CLASS RELATED TO CAUSE OF DEATH Code No. Cause of death Male Female I II Ill IV V Total I II Ill IV V Total 1 T uberculosis, respiratory 1 4 2 2 9 3 2 5 2 Tuberculosis, other forms — — — — — — — 3 Syphilitic disease — — 2 2 1 5 — — 2 1 — 3 4 Diphtheria - - - - - - - - - - - 5 Whooping cough - - - - - - - -- - - - - 6 Meningococcal infections - - - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - - - 8 Measles - - - - - - - - - - - - 9 Other infective and parasitic diseases - - - - 1 1 - 1 3 1 1 6 10 Malignant neoplasm, stomach 2 6 17 17 6 48 1 3 8 6 6 24 11 Malignant neoplasm, lung, bronchus 4 27 96 44 32 203 1 2 13 6 5 27 12 Malignant neoplasm, breast - - - - - - 2 13 36 7 7 65 13 Malignant neoplasm, uterus - - - - - - - 1 9 4 2 16 14 Other malignant and lymphatic neoplasms 4 20 74 41 19 158 2 17 77 36 23 155 15 Leukaemia, aleukaemia — — 6 — 2 8 1 1 7 4 — 13 16 Diabetes 1 1 1 3 1 — 6 2 1 10 17 Vascular lesions of nervous system 6 19 72 41 33 171 6 24 95 51 31 207 18 Coronary disease, angina 11 66 210 103 51 441 8 33 139 63 36 279 19 Hypertension with heart disease 1 2 6 8 5 22 1 3 6 10 7 27 20 Other heart disease 3 12 63 17 22 117 2 18 66 22 29 137 21 Other circulatory disease 2 3 30 8 8 51 — 3 39 29 16 87 22 Influenza — — — — 1 1 — — — 1 — 1 23 Pneumonia 4 13 72 30 28 147 3 8 66 36 21 134 24 Bronchitis 3 13 76 53 43 188 1 3 29 15 9 57 25 Other diseases of respiratory system 2 9 4 3 18 - _ 5 5 2 12 26 Ulcer of stomach and duodenum — 1 5 3 5 14 1 2 3 — 4 10 27 Gastritis, enteritis and diarrhoea — 2 1 1 2 6 — 1 8 3 2 14 28 Nephritis and nephrosis — 1 3 2 2 8 — 2 2 2 — 6 29 Hyperplasia of prostate — — 2 4 2 8 — — — — — — 30 Pregnancy, childbirth, abortion — — — — — — 1 1 2 — — 4 31 Congenital malformations — 1 11 5 2 19 — — 5 4 1 10 32 Other defined and ill defined diseases 4 19 52 28 27 130 6 21 45 26 20 118 33 Motor vehicle accidents 1 13 6 6 26 — 1 4 4 — 9 34 All other accidents 1 2 8 6 7 24 2 3 10 5 1 21 35 Suicides 1 5 10 3 5 24 — 2 5 3 1 11 36 Homicide and operations of war — — — 2 — 2 — — — — — — Totals 47 215 843 431 316 1852 39 163 693 348 225 1468 Percentage 3 12 45 23 17 100 3 11 47 24 15 100 No social class assessed — — — — — 34 — — — — — 82 There are various discrepancies between the above table and table 1 owing to different methods of assessment, and for comparative purposes therefore it is safer to group the causes of death which are linked together. Thus code numbers 10 to 15 may be regarded as all different kinds of cancer, while numbers 17 to 21 are all diseases of the heart and circulation. Similarly 22 to 25 are best grouped together. HEART DISEASE Cardiovascular and atherosclerotic disease as a group are responsible for more deaths than any other single cause. A glance at table 3 will show that the percentage of deaths from these illnesses in the borough is 35% of all deaths. 12 Table 3 HEART AND CIRCULATION MORTALITY Year Deaths from Total heart & circulation (all ages) Age group 45-65 Total - deaths in borough Percentage Coronary diseases Other heart diseases Other circulatory diseases Total Coronary diseases (e) of (h) {f) of (h) (g) of (h) (i) (j) (k) (a) (b) (c) (d) (e) (f) (,8) (h) 1956 508 604 161 1,273 214 104 3,465 37 6.2 3.0 1957 499 498 150 1,147 216 138 3,309 35 6.6 4.2 1958 540 507 142 1,189 209 140 3,272 36 6.4 4.3 1959 599 485 155 1,239 215 142 3,448 36 6.2 4.1 1960 496 423 147 1,066 212 143 3,280 32 6.5 4.3 1961 609 516 153 1,278 236 162 3,380 38 7.0 4.8 1962 657 417 145 1,219 256 181 3,376 36 7.6 5.4 1963 707 400 142 1,249 245 174 3,404 37 7.2 5.1 1964 654 301 142 1,097 235 166 3,317 33 7.1 5.0 1965 740 304 150 1,194 268 206 3,436 35 7.8 6.0 LUNG CANCER It is to be regretted that once again deaths from the cancers, and in particular, lung cancer have risen. That there is a connection between cigarette smoking and lung cancer is now generally accepted by the public, but it cannot be said that there has been any significant diminution so far in the amount of cigarette smoking in spite of the publicity given to its harmful effects. The Health Education team is vitally concerned with this problem and are continually using all the methods at their disposal to discourage cigarette smoking, especially among young people. By co-operating with the Inner London Education Authority the section provides lecturers, information and propaganda for use in local schools, and it is perhaps in this way that the most effective work is done. Nevertheless, if only parents would set an example by not smoking cigarettes themselves in the presence of their children progress would be more rapid. This major problem could be resolved by a change in attitude of young people if smoking were considered as not so much a sign of being grown-up but of immaturity. Table 4 LUNG CANCER Year MALE FEMALE All cancer deaths Lung cancer deaths (c)as % of (b) All cancer deaths Lung cancer deaths (f)as % of(e) (a) (b) (c) (d) (e) (f) (g) 1956 389 150 39 319 19 6 1957 378 145 38 297 29 10 1958 353 149 42 267 27 10 1959 401 167 42 314 28 9 1960 412 189 46 323 22 7 1961 373 157 42 276 19 7 1962 408 186 46 286 24 8 1963 351 163 46 296 27 9 1964 422 201 48 304 34 11 1965 428 204 48 313 31 10 Certain statistics have thus been extracted from the last table and grouped in this way. They are shown in the following table which also includes the percentage of each social class for each disease or group of diseases. The percentages should be compared with those in table 4 for all deaths, but for certain groups it will be realised that the numbers are too small for comparison year by year. 13 Table 5 GROUPED DEATHS IN SOCIAL CLASS Code Nos. Group Male Female I II III IV V Total I II III IV V Total 10-15 Cancers No. 10 52 193 102 59 417 7 37 150 63 43 300 % 2 13 46 25 14 100 1 12 50 21 15 100 17-21 Heart and circulation No. 23 102 381 177 119 802 17 81 345 175 119 737 % 3 13 47 22 15 100 2 11 47 24 16 100 22-25 Lung, not TB or cancer No 7 28 1 57 87 75 354 4 11 100 S7 32 204 % 2 8 44 25 21 100 2 5 49 28 16 100 33,34 Accidents No. 1 3 21 12 13 50 2 4 14 9 1 30 % 2 6 42 24 26 100 7 13 47 30 3 100 35 Suicides No. 1 5 10 3 5 24 - 7 5 3 1 11 % 4 21 42 12 21 100 — 18 46 27 9 100 LOCAL SICKNESS The Regional Medical Officer of the Ministry of National Insurance sends a weekly return indicating the first certificates of sickness benefit received in the local offices. The areas served by these local offices are in the main coterminous with postal districts of London and do not coincide with borough boundaries. Lewisham is served mainly by three offices, "Lewisham," "Downham," and "Deptford," and a fair representation of the trend of sickness within the borough can be given by quoting the combined figures for these three. Table 6 MORBIDITY SHOWN IN INSURANCE CERTIFICATES Weekly average for period ending 1964 1965 January 26 1,624 1,814 February 23 1,297 1,286 March 23 1,195 1,549 April 20 1,058 1,511 May 18 857 1,167 June 15 852 866 July 13 825 853 August 10 702 812 September 7 780 760 October 5 945 1,031 November 2 1.290 1,178 November 30 1,301 1.207 December 28 1,064 1,163 Weekly average for the year 1964 1,043 1965 1,171 14 Table 7 GENERAL STATISTICS FROM 1950 Year Population Death rate * % dying under age 45 % dying under age 65 Birth rate * Maternal Death rate † Still-birth rate † Infant mortality rate ** Pulmonary Tuberculosis Notif. rate †† Death rate † †  1950 304,880 10.9 11.5 35.5 15.6 0.8 15.6 26.8 197 30 1951 303,240 11.6 9.9 33.6 15.0 0.6 14.5 23.9 148 35 1952 303,010 11.5 9.9 32.1 14.8 0.2 16.5 25.2 132 20 1953 300,830 11.6 8.7 30.2 14.6 0.2 21.7 23.5 151 23 1954 298,020 10.5 8.0 31.4 14.4 0.2 16.1 19.6 129 19 1955 296,290 11.1 7.1 28.4 14.1 0.9 18.8 15.6 141 12 1956 293,940 11.8 7.0 28.9 14.6 0.5 18.8 20.5 101 15 1957 291,870 11.3 7.6 31.2 14.8 0.5 18.4 15.3 124 15 1958 291,220 11.2 8.4 29.7 15.2 0.2 18.0 25.5 108 10 1959 290,660 11.9 7.7 29.5 16.2 0.8 19.4 18.5 74 8 1960 290,630 11.3 8.8 30.1 16.8 0.2 18.3 21.7 68 6 1961 289,130 11.7 7.4 28.5 17.7 0.2 18.8 20.6 73 8 1962 291,150 11.6 8.0 30.6 18.9 0.5 13.3 18.6 56 9 1963 291,180 11.7 8.7 31.2 19.3 0.4 15.2 23.5 66 8 1964 291,670 11.4 8.9 31.1 19.9 0.5 11.7 22.9 64 2 1965 289,560 11.9 9.3 31.6 20.0 0.7 14.0 23.3 54 6 * Per 1,000 population. † per 1,000 Registered Live and Still Births * * Per 1,000 Registered livebirths †† Per 100,000 population PERSONAL HEALTH SERVICES DOMICILIARY MIDWIFERY SERVICE This service which operates under section 23 of the National Health Service Act, 1946 and under the rules of the Central Midwives Board is an excellent example of close liaison between the four main parts of the National Health Service Act, i.e., Ministry of Health, Hospital, General Medical, and Local Health authority services. Domiciliary Antenatal and Post-natal Care There are 14 antenatal sessions held weekly at clinics. All expectant mothers who book midwives are also booked with a general practitioner for maternity medical services. The number of mothers attending the antenatal clinics remained steady throughout the year. The midwives paid 6,982 antenatal home visits, and 1,498 babies were born at home and visited afterwards for at least 10 days. Liaison between Domiciliary Midwives and General Practitioners Since 1962, any general practitioner obstetrician who undertakes the care of a number of maternity cases, is offered the use of a Council's antenatal clinic to see these patients, and at the same time the appropriate midwife is in attendance. Twentyfive doctors availed themselves of these facilities. Liaison between Domiciliary Midwifery and Hospital Services The three local Hospital Management Committees convened Maternity Liaison Committees where representatives of hospital staff, general practitioners and local health authorities met regularly to discuss various problems and to try to improve wherever possible the services available to the mothers. Domiciliary midwives paid 1,134 visits to expectant mothers to assess whether on social grounds a confinement in hospital was necessary or, where a hospital confinement was arranged, whether a planned early discharge home was possible. 951 mothers were discharged from hospital less than 10 days after delivery and nursed by the domiciliary midwifery service. Of this number just over 200 originally were booked for home confinement and sent to hospital for some complication arising in pregnancy or labour. 439 were planned early discharges and the remainder were discharged early, either due to shortage of beds or because the baby died. Planned early discharge from hospital is undoubtedly popular and has come to stay. It is regrettable that in large wards it has an unsettling effect on patients whose medical or home conditions preclude such an arrangement, and an increasing number of these patients tend to discharge themselves. They, of course, receive the same after care but present an increasing problem to the domiciliary midwives. Night rota and off duty rota arrangements The night rota and off duty rota continued to work smoothly. Only very close co-operation with the Control Centre makes these rotas possible. This centre, which is shared with the London Borough of Greenwich, has functioned since the middle of March, 1965. It is staffed by specially recruited men who are accustomed to dealing with the general public and with emergencies—i.e., retired police officers. All calls from patients, after office hours, at weekends and on Bank Holidays, are referred by the Control Centre staff to the appropriate midwife. (See also Home Nursing and Mental Health). A supervisor of midwives is on call at all times. 16 MATERNAL MORTALITY The Department has continued with the confidential investigation of all maternal deaths, that is deaths directly due to pregnancy and childbirth, (formerly a function of the Public Health Department of the London County Council). They include those attributable to abortion as well as deaths ascribed to other causes associated with pregnancy. In each case information on ante-natal care is obtained from the local health authority clinic, general practitioner, general practitioner obstetrician, and from maternity home or hospital (both in-patients and out-patients) and brought together. Besides facts about the patient's physical condition, other information centrally gathered concerns the follow-up of missed appointments, the need, and availability of a hospital bed or domestic help and, where the domiciliary midwife was in attendance, a description of the labour and puerperium. If a post-mortem has been carried out a copy of the report is obtained. The appropriate consultant obstetrician adds his own report describing the labour and puerperium. He also comments upon any difficulty or delay in obtaining medical aid or hospital admission; the availability and any use of the "flying squad", and the presence of an anaesthetist. The completed history of each case is passed to the Regional Assessor selected by the Ministry of Health. The Regional Assessor forwards his assessment to the Ministry, indicating whether he considers there was any failure in the administrative arrangements, clinical management or of co-operation from the patient or her relative. The investigations are conducted solely for scientific purposes to assist in the prevention of further maternal deaths. The information about individual deaths is strictly confidential, but the Ministry of Health publishes a triennial analysis. During the year 4 maternal deaths occurred and were reported upon. DAY NURSERIES AND CHILD MINDERS Private Day Nurseries There are seven private nurseries registered with the Council under the Nurseries & Child-Minders Regulation Act, 1948. The Act regulates premises which are not wholly or mainly private dwellings in which children under the upper limit of compulsory school age are received to be looked after for the day or part of the day, in order to secure the safety and well being of the children. So far as possible formal application is discouraged until the Council's officers have had an opportunity to visit the premises to discuss the project with the applicant and to report upon the suitability of the premises for use as a day nursery. On receipt of the completed application form the Borough Surveyor and the Town Planning Officer are asked to deal with fire escape provisions and land development requirements respectively. The Health Committee approves the application before the premises can be registered as a day nursery. Places are available for 174 children in these private day nurseries. Child Minders There are two types of child-minders, i.e. voluntary and statutory. The voluntary scheme applies to daily minding of one or two children under the age of five and not attending school. The statutory scheme is applied to those minding three or more children who register under the Nurseries and Child-Minders Regulation Act, 1948. Under both schemes registrations are considered on their merits after the applicants are visited and interviewed at their homes. In the case of statutory child-minders the 17 Health Committee approves their registration and imposes any requirements necessary as to numbers and other conditions. Mothers pay a mutually agreed amount to minders for the care of their children. A small fee is paid by the Council to voluntary registered child-minders to encourage them to bring the children to welfare centres regularly. At 31st December, 1965 there were 129 voluntary child-minders registered to mind 201 children and 46 statutory child-minders authorised to mind 276 children. Council's Day Nurseries The Council owns three day nurseries; one at Rushey Green, one at Perry Rise (Shaftesbury House) and one at Amersham Road. The number of approved places in these nurseries is 59, 35 and 58 respectively. Day nurseries are provided for children under five years of age where the child has only one parent who has to go out to work, where the mother is in ill-health and cannot care adequately, where home circumstances are detrimental to health or where the mother is compelled to go out to work as an economic necessity. With each application a report on family conditions and necessity for admission to a day nursery is provided by the health visitor. A daily charge is made to parents according to their financial circumstances. Unless their circumstances change in the meantime, all cases are reviewed financially at least every six months and fully at least annually. Deaf, blind and partially sighted children are also admitted to the Council's nurseries for a period of up to fifteen hours a week without charge, the numbers of blind and partially sighted children being limited to four at each of Amersham Road and Rushey Green day nurseries. There is a Special Unit at Shaftesbury House day nursery for twelve severely sub-normal children, no charge is made for this service except for 6d. a day in respect of a mid-day meal. ADOPTION AND BOARDING-OUT Before a child is placed for adoption or boarding-out a medical report is obtained by the Council's Children's Officer. The report is usually made by a general practitioner, visiting medical officer of a residential nursery or a hospital doctor. Although these medical reports meet the statutory requirements it is the Council's practice for such reports to be submitted to the Medical Officer of Health before a child is adopted or boarded-out. The medical certificates in respect of the prospective adopting parents are scrutinised before the children are placed with them. 47 adoption and boardingout reports were examined and reports on 30 prospective parents were scrutinised during 1965. BOARDING-OUT OF CONTACTS OF TUBERCULOSIS Boarding-out of child tuberculosis contacts is arranged by this Department on the recommendation of Chest Physicians, for children exposed to infection in their own homes or whose parents are receiving residential treatment for tuberculosis and cannot arrange for the care of their children. Boarding-out is also arranged for segregation during B.C.G. vaccination. The number of children Boarded-out during 1965 was six. BLIND AND PARTIALLY SIGHTED PERSONS During the year 205 examinations were arranged in connection with certification under the National Assistance Act 1948 of blind or partially sighted persons. In addition, certificates accepted from other local authorities and hospitals numbered 34. This certification is necessary to facilitate the Council's scheme for providing welfare services for the blind and partially sighted. 18 REHABILITATION OF MOTHERS (MOTHERCRAFT UNIT) The Council uses the Violet Melchett Mothercraft Unit for the care of mothers and babies with breast feeding difficulties and dietetic upset, for instance, where breast feeding has to be established or where the baby is not thriving because of prematurity or persistent vomiting. The normal period of training in this unit is four to six weeks. A weekly charge is made according to the financial circumstances of the parents. Only one mother and baby were sent to this unit for training during 1965. RECUPERATIVE HOLIDAYS Recuperative holidays are provided on medical recommendation for adults who have recently been under medical treatment for a specific condition and who need rest, fresh air and good food but no medical or nursing care. Persons in need of regular supervision and organised nursing care require convalescence which is the responsibility of the appropriate Regional Hospital Board. Arrangements are also made for expectant nursing mothers and children under five years not attending school. Recommendations for recuperative holidays for school children are referred to the Inner London Education Authority for placing. A weekly charge is made according to the financial circumstances for adults and there is a small charge for children under five not attending school. Recuperative holidays arranged by the Council during 1965 were as follows:— Table 8 Expectant & Nursing Mothers — 5 Tuberculosis—adults — 4 Other adults — 115 Psychiatric — 9 Accompanied children — 29 Unaccompanied children placed by I.L.E.A. — 113 "RISK" AND "HANDICAP" REGISTERS The Department keeps a register of children under five years of age at risk of developing physical or mental defects and also keeps a record of children deemed handicapped. The "At Risk" or "Observation" register is designed to provide supervision for those specially liable infants where abnormal pregnancy, delivery or puerperium has been noted or when deviation from the normal is suspected. This "screening" enables therapeutic or remedial measures to be applied, thus preventing or modifying gross defects. The initial information is obtained from birth notifications, pediatric departments of hospitals, general Practitioners, clinic doctors, health visitors or other sources. When a handicap is confirmed the child is transferrred from the "At Risk" to the "Handicapped Register". In the fourth or fifth year of life, the handicapped child is assessed as to educational needs so that suitable education or training can be planned. At this stage close liaison is maintained with the Education Officer, head teachers of ordinary and special schools, superintendents of hospital schools, etc. 19 The appended figures relate to the register during 1965. Table 9 Total live births 5,850 Placed on "At Risk" register within one month of birth 393 Population 0-5 years 20,810 Children at risk on 31.12.65 born during 1965 326 Total children at risk 0-5 years on 31.12.65 419 Children 0-5 years on handicapped register 364 CO-OPERATION WITH CHILDREN'S DEPARTMENT Health Visitors who notify the Medical Officer of Health of children who may need to be taken into care are trained to recognise the social and medical indications of deprivation and distress. They are responsible for a great deal of the informal work which may be necessary to prevent the break up of families. Two residential nurseries have been visited and advice given on matters of hygiene and child care. Advice is also offered to persons in charge of private residential nurseries at which children are placed by the Children's Officer. Medical examinations are arranged at the request of the Children's Officer before a child is placed in a home or with foster parents. Child Care Officers and health visitors exchange information and keep in close contact with families concerned. The Children's Officer is informed whenever a child who is "in care" has his or her name placed on the handicap register. Close co-operation is specially called for in connection with adoption and boarding out cases where the question of abnormality arises the prospective parents are offered an interview, and if necessary there is a consultation with the family doctor. Advice is also given to the Children's Department on the most appropriate residential placing for mentally ill persons in care aged 16 to 18. Reports are received from the Juvenile Courts to ensure that psychiatric services are available for children in care. The following table relates to the nine months from April, 1965. Table 10 Medical Reports on prospective adoptive parents scrutinised 30 Number of adoption cases 20 Suitable for adoption 18 Suitable to adoption subject to conditions 1 Not suitable for adoption but suitable for boarding-out 1 Number of boarding-out cases 27 Parents interviewed by Medical Officer to advise on implications of hereditary disease 4 DISTRICT NURSING The District Nursing Service which is governed by section 25 of the National Health Service Act, 1946, was passed from the Ranyard Nursing Service to the Borough Council, on 1st April, 1965, (with the exception of a small area which continued 20 "Team Work" District Nurse and Home Help in attendance on the sick on an agency basis by the Nursing Sisters of St. John the Divine). The changeover was made smoothly and all members of the staff co-operated to the fullest extent. In general the service is used mostly by the older patients suffering from chronic illness. The trend for patients to need care over a long period continues. Liaison between District Nursing and General Practitioners In 1964 the group system of administering the district nursing service had been introduced; and the advantages of this scheme became apparent in 1965 as general practitioners began to know and meet more regularly the group of nurses nursing in their areas. A most interesting survey of the new cases in the half year April-September 1965 revealed that 150 general practitioners used the service during that period. Of these 14 referred more than 20 cases in the six months 9 „ between 15-20 „ „ „ „ „ 13 „ „ 10-15 „ „ „ „ „ 28 „ „ 5-10 „ „ „ „ „ 86 „ less than 5 „ „ „ „ „ Liaison between District Nursing and Hospital Service Hospital Ward Sisters and Medico-Social Workers maintain a close partnership with the service. 38 student nurses and one ward sister paid domiciliary visits with the district nursing staff as part of the enrichment of their hospital experience. Rota duty and Night attendance service A new rota system allowing alternate weekends off duty and giving all staff the equivalent of a 5 day working week was commenced on 1st November. All calls outside office hours are referred through the Control Centre (see Domiciliary Midwifery) to the Superintendant or deputy on duty. One member of each group in rotation is on late evening duty and takes emergency night calls. The night attendance service is financed through the Marie Curie Memorial Foundation. An attendant who will sit up at night and relieve the relatives in cases of terminal cancer is available in the borough. This is a short term service which is used intermittently but is of great value. Twelve patients made use of the service during the year. Bathing Attendants 1 male and 3 female bathing attendants were employed to bed-bath patients who, while under the overall supervision of the District Nurses, do not require skilled nursing. This help has so far only been available in Metropolitan Lewisham but it is hoped to extend the service to the whole borough in the near future. The number of home-baths carried out by Bathing Attendants during the year was 4,422. LOAN SERVICE Any article of equipment which will assist in the nursing of people in their own homes can be borrowed provided:— (a) it is not required for permanent use (b) it is not of a type which has to be made to measure, and therefore can be used by successive persons with the same requirement. 21 The following table shows the number and type of articles loaned:— Table 11 Equipment No. issued since 1.4.65 Total stock held On stock register No. on Loan at Present Air Rings 13 18 18 Back Rests 10 25 19 Bed Cradles 8 17 11 Bed Pans 10 17 17 Cot Beds 1 2 1 Commodes 105 252 227 Easi-Carry Hoists 6 13 10 Fracture Boards 11 20 15 Hospital Beds & Pulley 6 19 12 Mattress (Dunlopillo) 4 20 14 Mattress (Hair) 3 4 3 Penrhyn Bed Lifts 10 18 18 Ripple Beds 1 3 1 Rubber Sheets (6' x 30). 20 37 34 Tripod Walking Sticks 4 22 15 Zimmer Walking Frames 13 19 18 Wheelchairs 6 10 7 231 440 DISTRICT NURSING STAFF, TRAINING AND POST GRADUATE COURSES The number of district nurses operating within the borough at 31st December was as follows: 1 Superintendent 1 Assistant Superintendent 40 District Trained Nurses (including 11 men) 4 District Trained Nurses part-time 9 State Registered Nurses 6 State Registered Nurses part-time 2 State Enrolled Nurses 1 State Enrolled Nurse part-time and at the Nursing Sisters of St. John the Divine 2 District Trained Nursing Sisters 2 part-time State Registered Nurses 1 Nursing Auxiliary Three District Nursing Sisters completed their district training during the year and obtained the National Certificate for District Nursing. Six District Nurses attended a week's post graduate course held by the Queen's Institute of District Nursing. DISTRICT NURSES' TRANSPORT Most of the full-time staff make use of motorised transport. At the present time 28 full-time staff have cars, 10 have scooters and the remaining 13 of the full-time staff use bicycles or public transport. 22 DENTAL SERVICES (MATERNAL AND CHILD HEALTH) In addition to the provision of treatment for school children at the four dental clinics, facilities are also available at the same clinics to expectant and nursing mothers and to children under the age of five years. Efforts have especially been made to increase the number of treatment sessions for very young children, by inspections carried out in day nurseries and at toddlers' clinics. Gradually the number of attendances at such sessions showed increase from a nil figure in July and August. Of two nurseries inspected, over 90% acceptances resulted and attendances for treatment were excellent. Transport was provided to take the children to and from the nurseries and the clinics. Inspections were started in November at toddlers' clinics held in the Amersham Road Health Centre, an average of 15 to 25 toddlers being examined each week. Children requiring treatment were referred to the dental clinic and advice given to mothers on diet and oral hygiene. The under-mentioned figures relate to the work of the Maternal and Child Health Dental Service from 1st April to 31st December 1965:— Table 12 No. of persons examined No. who commenced treatment No. of courses of treatment completed Scalings & gum treatments given Fillings given Silver Nitrate given Extractions made Expectant and Nursing mothers 3 2 - 2 - - - Children under 5 and not eligible for school dental service 268 112 91 - 96 2 23 SCHOOL FOR DENTAL AUXILIARIES This school for training dental auxiliaries is provided under the auspices of the General Dental Council at the New Cross Hospital. The Director of the training school, Mr. J. V. Bingay, M.B.E., L.D.S., R.C.S., has submitted the following figures in respect of work carried out by the students:— Table 13 (a) Total attendances for treatment 22,235 (b) Number of permanent teeth conserved 3,635 (c) Number of deciduous teeth conserved 5,981 (d) Total number of teeth conserved 9,616 (e) Number of deciduous teeth extracted 797 Each child who attended, received prophylactic treatment and was instructed in the proper observance of oral hygiene. A high percentage of the children were treated by topical application of Stannous Fluoride with the consent and co-operation of the parent or guardian. The School for Dental Auxiliaries is responsible for treating pupils from various schools in Lewisham and Mr. Bingay reports generous support of his establishment by these schools, the Heads of which also requested that student auxiliaries should talk on various aspects of Dental health education to the pupils. The figures quoted in this section do not relate to the work of the two dental Surgeons who are employed by the Council and who work from the School; this information is recorded in the section dealing with the school dental service. 23 CHIROPODY SERVICE It is with deep regret that I have to report the death of the Chief Chiropodist, Mr. L. R. Smart, on December 15th. Mr. Smart was appointed to the staff of the London County Council in April 1961 as a Senior Chiropodist, and served both in division 6 (Deptford, Greenwich and Woolwich) and in division 7 (Camberwell and Lewisham). Shortly before April 1965 he was appointed as Chief Chiropodist to the new London Borough of Lewisham, which position he held until his death. Mr. Smart was held in the highest esteem by his colleagues, both for the high standards of his professional work and for his ability to form a happy relationship both with staff and with patients. He will be greatly missed. The clinical chiropody service is operated from three centres; Louise House, Sangley Road and Amersham Road. The first two of these clinics, Louise House and Sangley Road, were opened in 1947, and the other, Amersham Road, a year or two later. The staff operating the chiropody service consists of one chief chiropodist and four senior chiropodists, full-time, supplemented by sixteen sessional chiropodists. During the year approximately 2,058 sessions were worked by the full-time staff and approximately 2,915 sessions by the part-time staff. Since the inauguration of the London Borough of Lewisham there has been an average of 95 sessions per week worked from the three centres with facilities for 10 chiropodists. During most weeks since the changeover sessions have been quite well staffed and the allocation of 110 sessions has been very nearly met. The figures showed a considerable increase over the previous year due, in the main to the engagement of additional sessional staff, but some improvement in efficiency at the Sangley Road clinic was due to the appointment of a clinic clerk there in September, 1965. Since the changeover the Council has operated quite successfully a transport system to and from each of the three clinics for patients unable to avail themselves of public transport because of some physical disability or medical condition, the transport for this venture being supplied from the Council's vehicles. Table 14 STATISTICAL SUMMARY OF ATTENDANCES 1965 1964 Number of sessions 4,973 3,626 Appointment bookings 33,129 22,047 Children of or below school age 1,471 715 Adults: Male 5,957 3,598 Female 23,548 15,992 Total 29,505 19,590 Fee paying attendances (adults) 10,442 5,895 Free attendances (adults) 19,063 13,695 24 Table 15 CLINIC ANALYSIS TOTALS Clinic Total Sessions Total Appointments Booked Total Attendances Total Failures Average Percentage Failures Amersham Road 1,699 *(N.A.) 13,732 (N.A.) 12,667 (N.A.) 1,202 (N.A.) 9.5 % (N.A.) Louise House 1,363 (1,132) 7,499 (6,691) 7,205 (6,413) 397 (549) Sic 5.5 (12.0) Sic Sangley Road 1,911 (1,777) 11,898 (10,733) 11,104 (9,732) 977 (937) 8.8 (10) Totals 4,973 (3,626) 33,129 (22,047) 30,976 (20,305) 1,476 (1,913) Sic 7.9 (11) Sic *Comparative figures not available Table 16 NEW CASES ATTENDANCES ANALYSIS Age Group Amersham Road Louise House Sangley Road 0—4 Nil (N.A.) 1 (2) Nil (1) 5—16 55 (N.A.) 67 (48) 94 (78) Adult Males 161 (N.A.) 52 (65) 128 (118) Adult Females 249 (N.A.) 224 (316) 341 (333) RETURN VISITS Age Group Amersham Road Louise House Sangley Road 0—4 5 (N.A.) 7 (2) 1 (4) 5—16 186 (N.A.) 373 (187) 667 (377) Adult Males 2,496 (N.A.) 1,038 (920) 2,061 (1,824) Adult Females 9,568 (N.A.) 5,363 (4,873) 7,772 (6,997) CERVICAL CYTOLOGY Two diagnostic clinics are in operation in the borough, one in Amersham Road Health Centre, S.E.14, and the second in the Central Lewisham Health Centre, 410, Lewisham High Street, S.E.13. In May, 1966 a third clinic will be opened at Louise House, Dartmouth Road, S.E.23. The clinics are available to women on individual application for appointment or when referred by family doctors. The practitioner concerned is informed of the attendance and about all findings. All women have a short gynaecological history taken, followed by pelvic examination and cervical smear. 25 The first clinic commenced on the 7th July, 1965 as a Wednesday evening session at Amersham Road and it is associated with the Pathological Department of the Miller General Hospital. The table below shows the findings from July, 1965 to February, 1966:— Table 17 Total Smears 401 Malignancy positive smears 4 Cervical erosion 103 Cervical polyps 27 Trichomonas Vaginalis 10 Pus and evidence of non-specific infection 9 Moniliasis 7 Uterine Fibroids 6 Rectocele, cystocele or prolapse requiring treatment 3 Ovarian Cyst 1 Pregnancy 1 Endometriosis 1 The second clinic opened on January, 15th, 1966, as a morning session at Central Lewisham Health Centre, in association with the Pathological Department of Lewisham Hospital. During the part of January and whole of February, ninetyseven patients were examined with an average attendance of sixteen per session. The examinations and smears have shown the following abnormalities. Table 18 Total Smears 97 Malignancy positive smears 2 Cervical erosion 45 Cervical polyps 3 Trichomonas Vaginalis 1 Pus and evidence of nonspecific infection 2 Moniliasis 1 Uterine fibroids 4 Prolapse 2 Stress incontinence 1 The high proportion of abnormalities detected justifies the clinical procedures adopted and the existence of the clinics. At Amersham Road a Health Education Officer attends and instructs women on the method of detection of cancer of the breasts, by palpation. The Health Education team has played an important role in supporting cancer prevention in the borough and talks have been given to groups of women in various organisations or at privately organised gatherings. The demand has caused a two months' waiting period for appointments and relief clinics have been arranged until the third clinic opens. One of the inhibiting factors in the project is the time involved in the microscopic examination of the slides and the shortage of laboratory technicians. This shortage of laboratory workers limits the number of women who can be examined. 26 Experiments in automatic photoscreening are now well advanced and if proved successful will greatly aid in this most rewarding preventive field. There must be a close link between the pathologist, gynaecologist, clinic medical officer and general practitioner, because it is imperative for women showing abnormal smears to have further investigation or treatment, preferably in the hospital where the smear was diagnosed. The need for unlimited availability of this service is emphasised by the results obtained. Six cases of malignancy have been detected in the pre-symptomatic stage, i.e. when treatment can assure 100% cure. In addition, many other morbid conditions requiring treatment have been found. Special acknowledgement is due to Dr. Graham Thomas, Consultant Pathologist to the Greenwich District Hospital and Dr. H. Barnett, Consultant Pathologist to Lewisham Hospital for their cooperation. There is some evidence that defects of personal hygiene in the male and female may be associated with cancer of the uterine cervix. It has also been observed that where the male circumcision is practised, the incidence of cancer of the cervix is significantly less. In view of the fact that cancer occurs more frequently in the breast than in the uterus, we are trying out the possibility of linking screening for breast tumors at these clinics. Eventually general practitioners will be able to use cervical cytology smear facilities without restriction and with the expansion of services it should be possible to provide a routine and repeat service for all at risk. It is hoped that action now being taken by the Ministry of Health and Regional Hospital Boards will, in a short time, remove the difficulties the laboratories experience in extending their services. SCHOOL HEALTH The health and well-being of Lewisham schoolchildren remains high. Children are medically examined on entry to primary school, at the age of seven years, or on transfer to secondary school and finally at school leaving age. A comprehensive annual examination is also carried out, for vision defects, skin complaints and personal hygiene. A number of School doctors have commented on temporary hearing defects produced by chronic upper respiratory tract infection. All children suffering from protracted nasal discharge, recurring attacks of sore throat or tonsillar hypertrophy are referred for treatment. Impairment of hearing may affect their progress at school. Upper respiratory tract infection, asthma and bronchitis are the chief causes of absenteeism. In some cases attacks of asthma are so frequent and so incapacitating that special day open air school admission is sought to ensure continuity of education and adequate treatment. Heart and circulatory disease is generally on the decrease due to a fall in the incidence of acute rheumatism. The evaluation of heart murmurs is one of the more difficult problems facing the School doctor. Coarctation of the aorta is perhaps the most important congenital heart disease to be detected early and treatment is most rewarding. Femoral pulses are investigated as a routine by all school doctors. 27 One of the commonest medical problems in the service is the obese child, both sexes being affected equally. The peak of incidence coincides with the pre-pubertal stage of development and seems to be found mainly in the lower streams of secondary schools. Considerable effort is needed to persuade parents that excess weight is related to faulty dietary habits and excess food intake. This subject merits continuous effort in the field of health education. Handicapped pupils. A register of handicapped children is being prepared. The criteria of handicap are clearly defined, with the exception of socio-medical factors which are responsible for a few cases on the register, conditions are connected with physical or mental illness requiring constant attention or specialist care. A considerable proportion of children with serious defects are now integrated successfully into ordinary schools. Safeguarding the interests of handicapped school children is one of the most important tasks of the School Health Service. Health Education Health education in schools is undertaken by school doctors, health visitors school nurses and members of the health education section. While the latter tend to address an entire school, health visitors and school nurses as well as school doctors carry out health education informally, addressing individuals or groups of pupils. School Health Service—Joint Scheme An agreement, probably to be confirmed in the following terms between the Inner London Education Authority and the London Borough of Lewisham, provides the basis upon which the school health service is now run. "A joint scheme under Section 32 of the London Government Act, 1963 is to be agreed between the Inner London Education Authority and the London Borough of Lewisham, whereby, subject to the approval of the Secretary of State for Education and Science and the Minister of Health, provision will be made for the joint use of the professional services, premises and equipment for the health services, provided by the Inner London Education Authority. The Medical Officer of Health for the Borough of Lewisham will be appointed by the Inner London Education Authority as its principal school medical officer to exercise local responsibility for the administration of the school health service, with a view to the co-ordination and integration of this service with the other health services in the Borough. Regular consultation between the Principal School Medical Officer and the Inner London Education Authority will be maintained through the medium of the Authority's central Medical Adviser, with a view to ensuring common standards and practices so far as necessary in the school health service throughout the Authority's area in London." The statistics quoted in this section have been supplied by the Inner London Education Authority and are based on a school roll of 40,532 as at 20th January 1966. For comparative purposes, wherever possible, figures are also shown for the whole of the area covered by the Inner London Education Authority, based on a total school roll of 409,664 at the same date. School Medical Inspections. The figures provide an analysis of routine and non-routine medical inspections with, for routine inspections, the percentage attendance of parents and care committee representatives, the overall figures for prophylaxis, the proportion of children 28 found with physical condition unsatisfactory and the percentage referred for treatment of all defects, and of defects other than vision. Table 19 Lewisham I.L.E.A. Routine Inspections Number inspected 14,816 156,936 Number found not to warrant examination (7 plus 'specials scheme') — 1,901 Percentage of No. inspected of:-— Parent present 52.5 51.8 Care Committee present 84.0 81.9 No. vaccinated against smallpox 75.4 74.6 No. immunised against diphtheria 88.8 86.6 No. immunised against whooping cough 78.1 74.1 No. vaccinated against poliomyelitis 84.2 82.8 Physical condition unsatisfactory 0.2 0.4 Referred for treatment of defects 14.2 13.3 Referred for treatment of defects other than vision 5.5 6.3 Non-Routine Inspections (i) Specials 4,955 50,705 (ii) Re-inspections 5,105 69,520 Total (i) and (ii) 10,060 120,225 No. of routine inspections as percentage 36.6 38.3 of school roll No. of non-routine inspections as 24.8 29.3 percentage of school roll ROUTINE MEDICAL INSPECTIONS—DEFECTS Number of children noted for treatment or observation expressed as a rate per 1,000 inspected Table 20 LEWISHAM Total I.L.E.A. No. inspected 14,816 156,936 Skin Defects * T 6.95 5.83 O 6.55 6.53 Eyes—(a) Vision T 91.93 75.69 O 24.03 54.70 (b) Squint T 6.75 6.63 O 2.83 4.52 (c) Other T 2.16 2.16 O 2.50 2.17 Ears—(a) Hearing T 4.79 4.95 O 4.39 6.12 (b) Otitis T 1.82 1.61 Media O 1.62 3.46 (c) Other T 0.13 0.75 O 0.20 0.75 29 Table 20—continued Total I.L.E.A.  LEWISHAM Nose and Throat T 6.21 8.26 O 29.02 30.29 Speech T 1.89 2.96 O 4.18 6.77 Lymphatic Glands T 0.07 0.34 O 4.45 6.44 Heart T 1.96 2.00 O 4.59 7.94 Lungs T 3.10 3.54 O 817 10-11 Developmental— (a) Hernia T 1.55 1.05 O 2.16 2.03 (b) Other T 0.67 1.12 O 1.15 4.15 Orthopaedic— (a) Posture T 0.88 1.05 O 4.25 5.53 (b) Feet T 2.02 4.28 O 18.97 11.93 (c) Other T 1.62 2.09 O 2.50 5.40 Nervous System— (a) Epilepsy T 1.28 1.28 O 1.15 1.59 (b) Other T 0.27 0.98 O 1.21 1.70 Psychological— (a) Development T 0.67 1.11 O 2.56 4.21 (b) Stability T 0.61 1.33 O 9.25 7.30 Abdomen T 0.27 0.17 O 0.13 0.67 Other T 12.55 14.36 O 23.56 29.39 *Treatment O—Observation This table is an analysis, in accordance with the classification used by the Department of Education and Science, of defects found at routine inspections. Personal hygiene The appended table relates to surveys undertaken and also indicates action taken with verminous cases found as a result of the surveys: Table 21 LEWISHAM l.L.E.A. 1. Comprehensive Surveys (a) Number examined 22,432 271,748 (b) Number (occasions) found verminous 105 2,874 (c) Percentage found verminous 0.47 1.06 30 Table 21—continued LEW1SHAM L.L.E.A. 2. Selective Surveys (a) Number examined 9,049 131,618 (b) Number (occasions) found verminous 163 2,885 (c) Percentage found verminous 1 -80 2-19 3. (a) Total times vermin found (1(b) + 2 (b) 268 5,759 (b) Total % found verminous [3 (a) as % of 1 (a) + 2 (a)] 0-85 ! 43 (c) No. of individual pupils found verminous 249 3,583 (d) % of individual pupils found verminous (of school roll) 0-61 0-87 4. Action taken with verminous cases (a) Advice and/or Lorexane 168 4.835 (b) Further action 100 924 (c) 4(b) expressed as a percentage of 4 (a) 59-5 191 Analysis of 4(b) cases—referrals of hardcore cases to bathing centres Voluntary attendances at bathing centres No. of pupils 100 887 No. of statutory notices issued — 2 No. cleansed at centres following statutory notices Voluntarily — 2 Compulsorily — — Emphasis is placed on children being cleansed by parents at home. Other members of the family may, in the privacy that the home affords, also use the Lorexane shampoo hence eradicating a possible source to a child, of recurring infestation. Dental Services An efficient and comprehensive school dental service calls for a high standard of organisation. The co-operation of head teachers and of staff in the health department is vital. Attendance at the four dental centres has improved during the year and the establishment of dental staff has been increased in relation to the school population and the known need for treatment. A modest scheme has been started to provide transport for children at primary and junior schools which are not particularly close to a dental centre and where access by public transport is not easy. This arrangement has proved most successful. The following summary of the work of the school dental service has been supplied by the Medical Adviser to the Inner London Education Authority, based on returns supplied by the dental clinics: Table 22 LEW1SHAM l.L.E.A. 1. School Roll 40,532 409,664 2. Number of Sessions (iv) Treatment—ordinary 2256-4 27255-0 Treatment—General Anaesthetic 30 0 488-6 Inspection 1230 965-0 Total 2409-4 28708-6 31 Table 22—continued 3. First Inspections LEWISHAM I.L.E.A. (a) Number of first inspections in school 11,146 79,879 (b) Number of first inspections at clinic 3,100 38,733 (c) Total 14,246 118,612 (d) Total as percentage of school roll (3(c) as percentage ofl) 351 29 0 (e) No. inspected found to require treatment 8,696 76,575 (f) Percentage of no. inspected found to require treatment 61-0 64-6 (g) No. offered treatment 7,736 68,416 (h) Percentage of no. requiring treatment offered treatment 890 89-3 (i) Percentage of no. requiring treatment elected for private treatment 11-0 10-7 4. Reinspections (a) Reinspections at school — 51 (b) Reinspections at clinic 1,373 12,009 (c) Total 1,373 12,060 (d) No. of reinspections as percentage of first inspections (4(c) as percentage of 3 (c)) 9-6 10-2 (e) No. reinspected found to require treatment 696 7,910 (f) Percentage of no. reinspected found to require treatment (4(e) as percentage of 4 (c)) 50-7 65-6 5. Number of appointments given to: (a) New cases (i) 12,531 163,442 (b) On treatment cases 13,408 186,267 Number of attendances made by: (c) New cases (i) 6,503 72,187 (d) On treatment cases 10,457 140,944 (e) Emergencies (ii) 311 4,931 (f) Total attendances 17,271 218,062 6. Response rate: (a) New cases (5(c) as percentage of 5(a)) 51 -9 44-2 (b) On treatment cases (5(d) as percentage of 5(b)) 78-0 75-7 7. Cases discharged dentally fit (iii) 4,666 55,989 8. Lapse Rate (treatment not completed) Item 5(c) plus 5(e) less item 7 expressed as percentage of (5(c) + 5(e) 31-5 27-4 mte: 1. Item 8 of this table is an approximation; it assumes that all emergencies are new cases and that the number of on-treatment cases at the beginning and end of the year do not vary markedly. It attempts to express failure to complete treatment. 2. (i) A 'new case' is a patient called to the surgery to start a course of treatment or to see if treatment is required; a patient attending more than once in this manner during the year is recorded on each occasion as a 'new case' attended. (ii) An 'emergency' is a patient who attends a surgery without an appointment and is given immediate treatment. (iii) 'Cases discharged dentally fit' refers to (a) those cases recorded as 'Courses of Treatment completed' and (b) any 'new cases' (referred to in Note (i) above) who, upon attending the surgery, were found not to require treatment, both categories being mutually exclusive. (iv) Includes 1016-7 supervisory sessions (Supervisory sessions being those sessions worked jointly by a dental officer and a dental auxiliary) 32 Table 23 NON-ROUTINE MEDICAL INSPECTIONS Type of Inspection LEWISHAM I.L.E.A. Area Reinspections 5,105 69,520 Bathing centre inspections — scabies — 19 „ „ — other — 33 Employment certificates 492 4,939 Theatrical children 9 379 School journeys 2,741 22,193 Recuperative holidays—pre-departure 18 871 Recuperative holidays—on return — 6 Secondary School annual surveys — 1,921 Candidates for higher awards — 38 Nautical school entrants — 107 Outward bound courses 9 137 Infectious disease investigation — 103 T.B. contacts — 5 Boarding schools for the Delicate—pre-departure 1 213 Boarding schools for the Delicate—on return 2 17 Handicapped pupils—statutory examination 77 1,781 Handicapped pupils—periodic special defect examination 814 5,404 Research investigations and enquiries 6 282 4,169 38,448 SPECIALS—At request of:— Head teacher—child's name entered in special book 115 1,468 Head teacher—others ... 167 4,050 School nurse—following health survey 130 807 School nurse—others 137 1,686 Divisional (Education) Officer 35 894 District Care Organiser or Care Committee 51 593 Parent 60 1,131 695 10,629 OTHERS:— Accident on school premises 21 44 Referred by school medical officer 12 364 Boxing—reference from schools, A.B. A., or similar association 31 Rheumatism follow-up (GPH,449) — 2 For free travel 2 Reference: (i) connected with remedial exercises foot classes } " 27 (ii) by gymnast or physiotherapist Referred by hospital — 1 Referred by speech therapist 1 2 Referred by general practitioner 7 Miscellaneous 57 1,148 91 1,628 Total of all Non-Routine Medical Inspections 10,060 120,225 33 P£ ROUTINE MEDICAL INSPECTIONS—VISION This table is a statement of the visual acuity of pupils whose vision was tested at routine medical inspections, divided into those not wearing and those wearing glasses, together with the proportions noted for treatment or observation. Table 24 Number tested Percentage of number tested c—Boys and Girls A—Not wearing glasses b— Wea ring glasses Percentage of number tested with and without glasses 6/6 6/9 6/12 or worse Noted for treatment 6/6 6/9 6/12 or worse Noted for treatment Noted Jor Treatment Noted for Observation Total noted for treatment or Observation Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Lewisham 6,549 6,257 85-7 82-8 4-5 3-8 4-4 4-4 50 1-7 3-3 3-8 0-9 1-6 1-2 3-6 41 7-3 10-6 2-8 13-4 i.L.E.A. Area 61,571 59,176 80-3 77-6 6-3 6-8 5-8 5-9 5-8 6-2 3-7 4-6 1-9 2-4 20 2-7 31 4-7 9-8 71 16-9 infectious diseases in schools When a pupil is absent from school and the cause is known or suspected to be due to infectious disease, the head of the school notifies the medical officer of health. These notifications are uncorrected for diagnosis but form the best available index of the trend of infectious disease in the school community; they are the only figures available in respect of diseases which are not statutorily notifiable. When the number of cases of infectious disease reported from a particular school indicates the possibility of an outbreak, special visits are paid by the medical and nursing staff in order to investigate the situation and take whatever action is necessary. The numbers of cases reported during the nine months to 31st December, 1965 are given below:— Table 25 Chicken pox: 754 Dysentery, Diarrhoea, Enteritis: 66 Food Poisoning: 1 German Measles: 57 Influenza: 8 Impetigo: 15 Jaundice: 4 Measles: 231 Mumps: 30 Conjunctivitis and Ophthalmia 10 Ringworm: 8 Scabies: 7 Scarlet Fever: 36 Sore Throat: 32 Tonsillitis: 56 Whooping Cough: 15 Hepatitis: 1 Glandular fever 1 Meningitis (virus): 1 Table 26 Communicable Disease Surveys Lewisham l.L.E.A. Number examined for: Athlete's foot 9,363 59,876 Plantar Warts 10,519 64,456 Dysentery 76 4,770 Other communicable diseases 4,353 34,690 Total 24,311 163,792 Social work (School Health Service) and family case work School clinics This service, provided under the Education Act, 1944 was originally established by the London County Council. The staff now involved, though recruited by the Inner London Education Authority, are deployed by the Principal School Medical Officer as an integral part of the Health Department team. 35 The following special clinics are attended by social workers who deal with appointments and the follow up of cases and some problems arising. They work as members of a team in co-operation with Medical Officers and Nursing Staff conducting the clinics. (1) Special investigation—155 sessions. (2) Audiology—43 sessions. (3) Hearing investigation—28 sessions. (4) Hearing Aid centre, New Cross General Hospital—8 sessions. Handicapped Children 30 children with significant hearing losses and family problems arising were dealt with during the year, one social worker is particularly concerned with the children attending a partially hearing unit attached to a school. An interesting development in 1965 was the establishment of a special unit at Hither Green Hospital for children between the ages of two and seven with combined visual and auditory defects. This is provided by the Inner London Education Authority and was opened in February. The Assistant Senior Social Worker was attached to the unit as a member of the team working with the six children involved and to give case-work help to their families. In July, following a request from the Medical Adviser to the Greater London Council the Senior Social Worker attended regular case conferences at an Autistic unit and provided casework help for the children's parents. Although small numbers are involved in these very special groups of handicapped children a very important need is being met by these arrangements. Educationally sub-normal pupils Section 57 of the Education Act, 1944 (as amended by the Mental Health Act, 1959) deals with the examination and reporting to the Education Authority of children who are considered unsuitable for education at school, the review of cases previously reported to the Education Authority and the cancellation of the report where the child on re-examination is found to be suitable for education at school. Seventy-five examinations were held during the year. Employment of school-children Children under the age of 13 years may not be employed. Over this age, employment is subject to the passing of a medical examination. 501 children were examined with a view to the issue of employment certificates. Investigation of Plantar Warts in Schoolchildren Plantar warts on children's feet usually cause pain and may lead to loss of school time. The cause is thought to be a virus, but the way in which infection is spread is unknown; at various times attention has concentrated on the sharing of slippers, floors at swimming baths and floors where physical education is carried out in barefeet. The development of a plantar wart is liable to escape notice until it becomes painful. 36 The Health Committee agreed that it would be useful to carry out an extended investigation covering all the children at a selection of schools into the incidence of plantar warts; the correlation, if any, with barefoot physical education or swimming; methods of early detection and treatment. The Medical Adviser of the Greater London Council welcomed the investigation and has assisted in the preparations for it; the statistical section of his department will be collaborating in the analysis of the results. With the agreement of the Education Officer of the Inner London Education Authority the Heads of the selected schools were approached and fifteen agreed to take part. These schools have a total of 8,239 pupils on their rolls including all age groups and approximately equal numbers of boys and girls. Arrangements were made to explain the survey to the parents of the children involved and to all general practitioners in the Borough inviting their co-operation. Discussions took place on the treatments used at the various minor ailments clinics. Preparations were made for teachers of physical education and school nursing sisters to carry out foot inspections according to a prescribed schedule. The survey will commence on 1st. February, 1966. It is hoped to have some useful results in the first year but the whole investigation will probably extend over several years. 37 HEALTH EDUCATION The Cohen report said that the health educator "must do more than provide information. He must seek to persuade people to respond to health education measures and to counteract anti-health pressure, notably those which invest particular products or habits with a meretricious glamour." On subjects for health education it said:— "Among the subjects on which more education is much needed are human relationships, sex education; mental and dental health, the early diagnosis of certain types of cancer; recreation and the proper use of leisure; foot health, clean air; fluoridation. It is notable that the health habits of middle-aged men are probably worse now than forty years ago: despite advances in treatment their improvement in expectation of life has been slow, and much less marked than among women." "The skill of the new Health Educators will be used to attract support from a wide range of interests and to provide suitable publicity and other backing for the valuable work now being done by medical officers of health, health visitors, public health inspectors and other staff." The Health Education section of the department undertakes the provision of all kinds of visual aids, including films, film-strips, overhead projection, posters and pamphlets. Films are hired, and the apparatus taken to the respective clinics, mothers' clubs, old people's clubs, and thus to a wide variety of audiences. Local material, both in the form of charts and lecture information is prepared. Several "in-service" training discussions and film shows have been arranged. For example a film was shown and discussion held on the subject of psychoprophylaxis, to which health visitors, midwives, and general practitioner obstetricians were invited. A shop window has been put at the Council's disposal by the Women's Voluntary Service, and each month a display was arranged to coincide with the subject being featured for the month by the various Health Centres. A Pharmaceutical Exhibition has been arranged for January and a Home Safety Campaign is to start in March 1966. On April the first, the first number of a new Health Bulletin was published. It was prepared and printed before the actual amalgamation, being developed from the Home Safety Bulletin previously produced by the Lewisham Health Department. It now deals with health matters as well as those of home safety and has a distribution of 5,500 issued quarterly. Health Education involves making the public aware of the facilities available through the Health Department. The Section therefore compiled a brochure on "Health Services and how to obtain them" which has been widely distributed, giving details of the different services available and their functions together with a list of clinics, with local doctors and voluntary organisations. This account would not be complete without an acknowledgement of the help received from the Council's Public Relations Officer who has been vitally concerned in publicising through the local press and other sources the various facilities of the department offered to the public such as cervical cytology, and immunisation. 38 COMMUNITY HEALTH SERVICES MENTAL HEALTH Mental Subnormality At the beginning of the year the London County Council held a special monthly clinic for backward children at the Central Lewisham Health Centre. This served the area of the former metropolitan Borough of Lewisham, and children from Deptford attended a similar clinic in Greenwich. Since April, children who were already attending at Greenwich, have continued to do so but all newly referred children from the Deptford area have attended the Lewisham Centre, where, to meet the heavier demand, sessions have been increased. The clinic was conducted throughout the year by a medical officer who specialises in mental subnormality. During the year 18 sessions were conducted and a total of 61 children attended. Since the 1st April 31 examinations under Section 57 Education Act, 1944 were carried out. A special unit for 9 mentally subnormal infants is accommodated in the Shaftesbury House day nursery. This unit which has been enlarged to take a total of 12 children has been redesignated the "Early Care Unit". Fifteen subnormal infants attended during the year, the average daily attendance being 10* 3. Minibus transport has now been provided by the Health Department for the children and their mothers. There are three training centres for the mentally subnormal in the Borough. The Junior Training Centre purpose-built by the London County Council in 1959, provides for 120 children of school age. The Brockley and Deptford centres accommodate 60 female and 65 male adults respectively in hired church hall premises. The centres serve the London Boroughs of Southwark, Lambeth and Greenwich as well as Lewisham. A number of adult trainees from Lewisham attend training centres in the Borough of Greenwich. The Brockley and Deptford centre premises are unsatisfactory and are scheduled for early replacement by a purpose-built centre in Southwark. When these new premises open the majority of the adult trainees in Lewisham will be transferred. There will still remain a need in Lewisham and efforts are being made to find a building which can be suitably adapted or a site on which one can be built. A Twelve-place special care unit as an annexe to the Junior Training Centre has been planned and it is hoped that building will commence in the spring of 1966. Pending the opening of this annexe, the Council agreed to maintain two places in the Children's Centre of the Croydon and District Spastic Society. The medical officer who conducts the special clinic attends the Junior Training Centre each week to carry out medical assessments, the intention being that each child shall be re-viewed once a year. A speech therapist also attends for one session weekly. Simple industrial out-work is carried on by the trainees at Brockley and further industrial work has been introduced at Deptford. At each centre the money received from work sales is divided between the trainees proportionately. A new activity for both centres has been the introduction of swimming instructions at a nearby swimming bath. 39 Nineteen trainees in the charge of members of the supervisory staff took part in the annual two week seaside holiday at St. Mary's Bay, Kent. One assistant supervisor, who had been seconded to the course for the National Association for Mental Health examination, returned to duty in July after having been awarded her diploma. Refresher courses were attended by three members of the staff and a number are taking a course of evening lectures at Goldsmith's college. The supervisor of the Lewisham centre completed an evening course on Montessori methods. The placing of subnormal children and adults for periods of short-term care under the provisions of Circular 5/52 continued throughout the year and, despite some difficulty in finding appropriate placings, 21 adults and 39 children were dealt with. Of these 21 were found accommodation in hospital and 39 in approved homes. Of the applications for long term residential care 19 admissions were arranged. At the end of the year, 22 individuals were being maintained by the Council in approved homes and 9 children and 7 adults were awaiting hospital admission. One severely subnormal woman was transferred to the guardianship of the Council on 1st April, 1965, in accordance with Statutory Instrument 1474. A responsible medical officer has been appointed and designated members of the Health Committee have been authorised to deal with the renewal of guardianship orders. Before the appointed day the London County Council considered the problem raised by the admission of women and girls with a history of mental disorder to a mother and baby home in the Borough. Approval for case conferences at the home was commended to Lewisham Council. Accordingly a psychiatric social worker in the mental health team now pays weekly visits to the home for consultation with the medical and nursing staff and undertakes all necessary social work arising. Emergency Service The Council and the London Borough of Greenwich have a joint arrangement for dealing with emergencies outside normal office hours, duties for the combined area being shared by officers of the two boroughs in rotation. Officers within easy reach may be on call at their homes and for others accommodation is provided at Hither Green Hospital. Since April Lewisham officers on night or weekend duty have been called to deal with 113 emergency cases. Liaison with the hospital service and general practitioners is covered by monthly meetings attended by Consultants from Psychiatric hospital medical staff, mental health officers and supervisory staff of the Council's hostel and day centres. Monthly case conferences are held at Bexley Hospital the catchment area of which serves the greater part of the borough. These regular meetings are proving of considerable value in fostering liaison. Honor Lea Hostel The first purpose-built hostel for the mentally ill was opened by the London County Council in 1964, in Lewisham. Responsibility for its management passed to the Borough in April, 1965. The hostel has places for up to 58 persons of both sexes who have recovered from their illness but require a period of rehabilitation in a sheltered environment. 40 Honor Lea Hostel for the Mentally 111 Places are made available to suitable persons from anywhere in inner London and only a minority of the residents are from Lewisham addresses. Selection is carried out by a Medical Officer, a social worker and the hostel warden. They interview individuals recommended for admission in hospital, or at the hostel. Those who are accepted are encouraged to obtain employment and the possibility of being able to do this within a short time is regarded as being of great advantage. In April a mental health officer was attached to the hostel to carry out social work. Towards the end of the year it was found necessary to allocate another officer to share this work. During 1965 57 persons (13 re-admissions) were accepted having been referred from 23 hospitals. 47 individuals left the hostel and eight of these were considered fully recovered. There were forty four persons in residence at the year end. To provide much needed information on the effect of living in the hostel and the type of person most likely to benefit, a detailed statistical record of progress, observed at regular intervals has been instituted. Considerable difficulty was found in filling the vacancy for Deputy Warden early in the year. The accommodation was unsatisfactory for a married man and towards the end of the year improvements to provide a self-contained flat, were being carried out. Two mentally ill persons requiring residential accommodation but unsuitable for the hostel were placed in approved homes run by voluntary organisations. On December 31st 1965, a total of 14 such persons were being maintained by the Council. At the beginning of the year a small day centre was opened for up to 19 chronic mentally ill persons on 3 half days each week. From March this centre was open for five whole days weekly. The premises however were most unsatisfactory and in June new premises were found where up to 40 individuals can be accommodated. A second day centre for up to 30 people was opened in November. These are mainly accepted on the recommendation of a psychiatrist and the aim is to assist in the process of rehabilitation. Day time occupation normally takes the form of simple industrial out work and those who take part receive a nominal daily payment of 2s. Free mid-day meals are also provided and travelling expenses refunded. Regular reports on the progress of persons attending the centre are submitted to referring agencies. Social Clubs Members of the mental health team organise two social clubs (one shared with the London Borough of Greenwich) which aim to provide contacts and interests for those who are socially isolated, and to help them to gain confidence. These have a preventive as well as a rehabilitative function and each club meets on one evening in the week. Four seaside outings were arranged, other visits to places of interest and entertainments being provided by local organisations and individuals. Since September patients from Bexley Hospital have been invited to one of the clubs once a month. The Hospital Management Committee provide a coach for this most successful experiment which it is hoped to make a permanent arrangement. 41 Co-operation with voluntary organisations The Health Department has co-operated with the National Society for Mentally Handicapped Children in arranging visits to the Lewisham training centre. Officers of the department regularly attend meetings of the Lewisham Branch which are held periodically at the Centre. Premises are made available to the Branch for a weekly evening club for subnormal children, and one member of the supervisory staff acts as voluntary club leader. A similar club, in another part of the Borough, sponsored by a church organisation, is visited by a Mental Health Officer. Transport for both clubs is provided by the Council's Welfare Department. The Lewisham Branch of the National Society has collected for a "Project Fund" which may eventually be used to provide equipment not otherwise obtainable for a new adult training centre. The Council has made a grant to the Albany Institute towards the cost of an experimental project involving intensive group work with educationally subnormal school leavers and suitable individuals have been referred to the Institute in this connection. An organisation of "Friends of Honor Lea" composed mainly of local residents has done much to provide benefits and entertainments for those living in the hostel, and regular meetings have been held in Honor Lea during the year. CO-ORDINATING COMMITTEE A meeting was convened by the Medical Officer of Health, to discuss co-ordinating machinery after the 1st April. At this meeting of representatives of the Health, Welfare, Children's and Housing Departments, together with the Divisional Officer (Education), I.L.E.A. and the Divisional School Care Organiser, I.L.E.A., the need for co-ordination was accepted and it was decided that the Co-ordinating Committee system developed in the London County Council health divisions should be re-established. The Co-ordinating Committees were started following the joint memorandum in 1950 from the Home Office, Ministry of Education and Ministry of Health regarding children neglected or ill-treated in their own homes. The Committee's responsibility for co-ordinating the efforts of all statutory and voluntary agencies undertaking work with families would continue. The main functions of the Committee would be (a) discussion of matters raising new principles or requiring policy decisions; (b) allocation of appropriate services to families presenting the most complicated or intractable problems: (c) nomination of families to be referred to the family caseworkers employed in the Health, Welfare or Children's Department; (d) dealing with requests for assistance from Housing Departments in connection with unsatisfactory tenants or reports from the Children's Department concerning families' help with rent under the Children and Young Persons Act, 1963; (e) reviewing the progress made by families referred to the Committee for any reason; (f) receiving reports on the activities of Intermediate Case Conferences; (g) receiving reports on all cases referred to the Children's Officer under Section 62 procedure. Initial members of the Committee were the Medical Officer of Health, Children's Officer, Chief Welfare Officer, the Housing and Estates Manager, the Senior Social Worker, Health Services acting as Secretary, the Divisional Education Officer, I.L.E.A., the Divisional School Care Organiser, I.L.E.A., the Principal Mental Health Officer and the Borough Nursing Officer (maternal and child health) and a representative of the Borough Treasurer and a representative of the Town Clerk. 42 Representatives from the G.L.C. Housing Department and the National Assistance Board were co-opted and in practice, it was found helpful for Welfare Officers from the Housing and Welfare Departments to be present. In addition representatives from other voluntary and statutory agencies attended as appropriate. During the period from 1st April to 31st December, the Co-ordinating Committee met on six occasions, when a variety of problems were discussed, both in relation to policy and to specific cases. CASE CONFERENCES Anyone, whether working in a statutory or voluntary capacity may ask the Secretary of the Co-ordinating Committee to convene a conference of field workers in order that a particular family's needs may be considered. The aim is to assess problems presented and by pooling information to formulate a plan for future supervision. However, when intractable difficulties arise and field workers fail to reach a decision or when special services are required, the case may be referred to the Co-ordinating Committee for further discussion. During the period 1st April—31st December, 35 such conferences were held on cases referred by the following departments and agencies: (a) Divisional School Care Organiser, I.L.E.A.—7; (b) National Society for Prevention of Cruelty to Children—3; (c) Greater London Council and Borough Housing Departments—3; (d) Welfare Department—4; (e) Children's Department—3; (f) Health Department—12; (g) Probation Officers—2; (h) Hospitals—1. FAMILY CASEWORK In the nine months period up to the end of the year, casework help was provided for 26 families presenting multiple problems. The average number of children in these families was six and in the majority severe parental inadequacy and immaturity was present. Intensive support was therefore necessary on account of the total family situation. HOME HELP SERVICE On 1st April 1965, the Council became responsible for the provision of the home help service in the borough formerly provided by the London County Council. Under the London County Council the service for the area now covered by the London Borough of Lewisham had for some years been organised from three offices, one in Deptford High Street, one at Rushey Green and another at Kirkdale. The latter office also served a part of the Metropolitan Borough of Camberwell which is now part of the London Borough of Southwark, but during March 1965, a reallocation of cases between home helps to conform with the new borough areas was carried out and helps attending households in Camberwell and some of the supervisory staff were transferred to a new office in that area. On 1st April the Deptford High Street premises were given up and the home help office was transferred to the Deptford Town Hall, which also accommodates the headquarters staff of the Health Department. 43 Each of the three offices is staffed by a home help organiser, with assistants, and clerical staff, and details of the service provided are given below:- Table 27 Office At end of December, 1965 No. of households receiving service No. of home helps Whole-time Part-time Deptford Town Hall, New Cross Road, S.E.14 662 1 108 41, Rushey Green, S.E.6 1,553 5 310 266, Kirkdale, Sydenham, S.E.26 757 171 2,952 8 589 (Wholetime eqvlt. 329.5) The case load for the Rushey Green Office is considered to be too large for convenient administration and the provision of a fourth office to relieve the pressure has been agreed in principle. Suitable premises are being sought for this purpose. Alternative premises are also being sought for the Sydenham office which is badly sited for the area it has to serve and is unsatisfactory. The recruitment of sufficient home helps continues to be difficult at times and the turn-over remains appreciable, the average for the three offices over the year being over 20%. At the end of the year arrangements were initiated for a series of talks to groups of home helps on the work of the Health and other departments of the Council, and the first of these talks is to be given in January, 1966. 44 PREVALENCE OF and CONTROL OVER INFECTIOUS AND OTHER DISEASES NOTIFIABLE DISEASES The undermentioned diseases are notifiable by medical practitioners to the Medical Officer of Health:— Anthrax Plague Cholera Pneumonia, acute influenzal Diphtheria Pneumonia, acute primary Dysentery (bacillary or amoebic) Poliomyelitis, acute Encephalitis, acute Puerperal pyrexia Enteric fever Relapsing fever Erysipelas Scarlet fever Food poisoning Smallpox Malaria Tuberculosis, all forms Measles Typhoid fever, including paratyphoid Membranous croup Typhus fever Meningococcal infection Whooping cough Ophthalmia neonatorum NUMBER OF NOTIFIED CASES (Corrected for revised diagnosis) during the year 1965 with comparative figures for the previous six years. Table 28 Diseases Cases notified 1965 1964 1963 1962 1961 1960 1959 Anthrax 1 - - 1 - - - Diphtheria - - - - - - - Dysentery 159 226 870 234 119 433 347 Encephalitis (acute) - - - - 1 - - Enteric or typhoid fever 1 2 12 4 2 - 6 Erysipelas 19 20 7 2 21 26 23 Food poisoning 20 19 13 19 34 34 49 Measles 3,014 1,553 3,186 544 5,678 356 3,418 Malaria - 1 - 2 - 2 - Meningococcal infection 1 2 1 4 5 8 3 Ophthalmia neonatorum 3 1 5 1 2 2 1 Pneumonia 37 35 75 36 85 54 151 Poliomyelitis (acute) - - - - - 2 7 Puerperal pyrexia 75 55 47 74 46 79 48 Scarlet fever 161 197 103 71 129 218 367 Tuberculosis 157 203 210 191 223 221 242 Whooping cough 108 190 258 54 111 483 369 TOTALS 3,753 2,503 4,806 1,249 6,468 1,927 5,044 45 46 Table 29 NOTIFICATIONS OF INFECTIOUS DISEASES IN 1965 SHOWING SEX AND AGE GROUPS Diseases Under 1 1- 3- 5- 10- 15- 25- 45- 65+ Total M F M F M F M F M F M F M F M F M F M F Anthrax - - - - - - - - - - - - - - 1 - - - 1 - Dysentery 4 - 13 9 18 10 15 6 7 1 15 16 9 20 5 8 2 1 88 71 Erysipelas - - - - - - - - - - - - 2 3 3 6 - 5 5 14 Food Poisoning 1 - 1 - - 1 - 2 - - 3 2 6 2 1 - 1 - 13 7 Measles 75 59 461 474 473 457 494 467 13 11 11 10 2 7 - - - - 1,529 1,485 Meningococcal Infection - - 1 - - - - - - - - - - - - - - - 1 - Ophthalmia Neonatorum - 3 - - - - - - - - - - - - - - - - - 3 Pneumonia - - - 1 - - 3 1 1 - 2 - 3 5 10 4 2 5 21 16 Puerperal Pyrexia - - - - - - - - - - - 30 - 45 - - - - - 75 Scarlet Fever - - 11 10 17 17 38 46 7 9 2 1 1 2 - - - - 76 85 Tuberculosis - - 2 2 1 - 2 1 1 2 10 14 34 15 39 11 15 8 104 53 Typhoid - - - - 1 - - - - - - - - - - - - - 1 - Whooping Cough 7 8 14 15 18 10 10 15 3 5 - 1 - 1 - 1 - - 52 56 Table 30 FOOD POISONING CASES Causative agent GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC CASES Notified or ascertained TOTAL No. of outbreaks and sporadic cases columns (1 + 3+5) TOTAL No. of cases columns (2+4+5) No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained 1 2 3 4 5 6 7 S. Typhimurium - - - - 3 3 3 Other Salmonellae - - - - 7 7 7 Cause unknown - - - - 17 17 17 TOTAL - - - - 27 27 27 DETAILS OF FOOD POISONING DUE TO SALMONELLAE OTHER THAN S.TYPHIMURIUM Type of salmonella Group B - - - - 5 5 5 Bovis Morbificans - - - - 1 1 1 Group D - - - - 1 1 1 Salmonella infection, not food borne NIL ANTHRAX During the year a case of Anthrax occurred affecting a resident of the Borough. The patient concerned had a small business office in the City where he employed one man and a girl. He is an importer of goat hair, but only he handles the material. He was in the habit of receiving through the post samples of 1 lb. and 2 lb. of goat hair which had not been treated. If however a quantity of the material is imported into the country it has to go to Liverpool for disinfection first, but this procedure apparently does not apply to small samples sent through the post. It therefore appears likely, that the cause of the infection was the untreated samples. MEASLES The usual biennial appearance of this disease in large numbers occurred in 1965 when 3,014 cases were recorded. This figure was not high when compared with 1963 (3,186 cases) and 1961 (5,678 cases). 47 Vaccination against measles is not yet provided as a routine protection. Investigations however, have been going forward with this aim in view and the department continued with such an investigation which the London County Council had commenced in collaboration with the Medical Research Council, and the clinical portion was completed during the year. The object of the investigation, for which 45,000 children aged between 10 months and 2 years were initially registered by their parents in the participating areas (Bristol, Edinburgh, Hull, Oxford, Portsmouth, Southampton, Southend, Yorkshire (West Riding), West Sussex, and the former administrative counties of London and Middlesex), is to determine the degree and duration of protection against measles given by a number of vaccines and the frequency and severity of vaccination reactions. During 1965 the local follow-up of children vaccinated in 1965 was completed and vaccine offered to those who had failed to complete the course in 1964 and to those who had been set aside as a control group, other than those who had in the meantime had measles. In this part of the investigation of the 631 children offered vaccination 235 (37.2%) completed the course. 270 children actually commenced the course and a few of the children offered vaccination who would have taken advantage of it were unable to do so because of their state of health at the time. The follow-up to test reactions has been completed and long-term follow-up on the effectiveness of the vaccine will be carried out by the Medical Research Council with the assistance of the Department where necessary. SCARLET FEVER The number of cases was 161 in 1965, the disease nowadays is of a mild type and generally responds well to treatment with modern drugs. It is probable that many very mild cases do not get notified. WHOOPING COUGH The number of cases was 108, a decrease of 82 over those of the previous year. The number would undoubtedly be much less if every susceptible child were to take advantage of the whooping cough immunisation scheme. DYSENTERY The number of cases again showed a quite substantial decrease over the previous year. Nevertheless there is no room for complacency as this disease can quite easily be prevented from occurring at all. The way to eliminate this disease from the community is for everybody simply to adopt the highest hygienic standards in connection with all apparatus of the water closet and with hand washing. TUBERCULOSIS 157 cases were notified, the lowest recorded for the area of the present borough. The rate per 100,000 of the population (54) was the lowest since 1950, and this fact is most encouraging. Among the responsibilities taken over by the Council on 1st April, 1965, under the London Government Act, 1963, were the following services formerly provided by the London County Council for the prevention of tuberculosis and the care and after-care of tuberculous persons in the Borough. The total number of such persons on the registers of the two chest clinics (Deptford and Lewisham) in the Borough on 31.12.65 was 3,091. 48 Post Hospital Rehabilitation Arrangements for the maintenance of tuberculous patients from the Borough who, on the recommendation of chest physicians, undergo courses of training and colonisation at village settlements, e.g. British Legion Village, Nr. Maidstone, Kent, Papworth Settlement, near Cambridge, and El Alamein Village, Nr. Andover. At the end of 1965, two such patients were at the British Legion Village. Hostel Accommodation Arrangements for the maintenance in hostel accommodation was provided by the former London County Council for homeless infective tuberculous men. This accommodation is in three hostels in London, now run by the Hammersmith, Islington and Lambeth Borough Councils respectively and. for ex-servicemen only, at the British Legion Village. It is intended for men with active or unstable tuberculous disease who do not require immediate hospital treatment or nursing but whose condition would be adversly affected by their living in lodging-houses where, also, they might be a public health risk. At the end of 1965, the Council was responsible for the cost of maintenance of five men in this accommodation. Chest Clinics—Services based on the chest clinics are as follows:— (a) Home care—The Council's tuberculosis visitors see patients in their homes to advise on diet, hygiene etc., to ascertain home conditions and needs, and to persuade contacts to attend the clinic. The total number of visits in the 9 months 1.4.65— 31.12.65 was 4,363. (b) Home Nurses—These are provided under the domiciliary nursing service to give patients nursing attention under the direction of the family doctor or chest physician. 5 patients were receiving such attention at the end of 1965. Nursing equipment, e.g. backrests, is made available on loan where necessary. (c) Home Helps—The Council's home helps are employed in the homes of bedfast patients and to care for children of mothers undergoing treatment. The number of patients receiving this service at the end of the year was 35. (d) Contacts—Boarding-out of child contacts is arranged where necessary to protect them from infection by tuberculosis in their own homes or to enable their parents to undergo treatment in hospital. One child was boarded out at 31st December, 1965. (e) Provision of Extra Nourishment (milk, butter, eggs) for necessitous patients on the recommendation of the chest physician. At the end of 1965, 100 patients were receiving this service from the Council or from the voluntary chest care committees. (f) Handicraft Classes—are held for patients able to attend the chest clinics, the instructor being provided by the local evening institute. Patients confined to their homes are given instruction by a visiting occupational therapist employed by the Council. At the end of 1965, 27 patients were attending classes but no patients were receiving instruction in their own homes. Voluntary Chest Clinic Care Committees—A voluntary care committee operates in association with each of the two chest clinics. The constitution of these committees, originally prescribed by the London County Council, has been revised to bring it up to date. During the year these committees have continued their valuable work of assisting patients and their families financially or in other ways where help was not available from official sources. The Council's chest clinic welfare officers act as secretaries to the committees. 49 B.C.G. Vaccination—B.C.G. vaccination for the prevention of tuberculosis is offered for susceptible (tuberculin negative) contacts of known tuberculosis patients, 13 yr. old school-children, and students at further education establishments. The number of vaccinations carried out during the 9 months 1.4.65—31.12.65 was 1,621. Table 31 TUBERCULOSIS NOTIFICATIONS AND DEATHS AT AGES New cases notified Deaths Age periods Respiratory NonRespiratory Totals Respiratory NonRespiratory Totals M F M F M F M F M F M F 0- - - - - - - - - - - - - 1- 2 1 - - 2 1 - - - - - - 2- 1 1 - - 1 1 - - - - - - 5- 2 1 - - 2 1 - - - - - - 10- 1 2 - - 1 2 - - - - - - 15- 6 1 - - 6 1 - - - - - - 20- 3 9 1 4 4 13 - - - - - - 25- 14 6 - - 14 6 2 - - - 2 - 35- 18 7 2 2 20 9 1 1 - - 1 1 45- 16 6 1 1 17 7 1 - - - 1 - 55- 22 4 - - 22 4 2 2 - - 2 2 65- 13 3 - - 13 3 4 1 - - 4 1 75+ 2 5 - - 2 5 2 1 - - 2 1 TOTALS 100 46 4 7 104 53 12 5 - - 12 5 Chest Clinic, Lewisham I am indebted to Dr. J. E. Stokes for the following report concerning the Chest Clinic at Blagdon Road of which he is the Chest Physician. The general trends of the last five years with work of the Chest Clinic have continued in 1965. There is a slight reduction in the total number of attendances (excluding after care) from 22,874 in 1964 to 20,566 in 1965 but this does not imply any reduction in the amount of work. The explanation of this paradox is that as the amount of tuberculosis to be dealt with decreases steadily the proportion of other conditions treated increases and they require more complicated and intensive treatment, with a quicker turnover. It may not be generally realised that the Chest Clinic provided a centre for the early diagnosis and treatment of cancer of the lungs and with the increasing integration of the work of the Chest Clinic with that of Grove Park Hospital and other centres such patients have immediate access to all recognised 50 PULMONARY TUBERCULOSIS 1950 to 1965 NOTIFICATION AND DEATH RATES (PER 100,000 POPULATION) 51 forms of treatment. In addition numerous cases of pneumonia, bronchitis, emphysema, heart conditions, cardiac failure and many other conditions are dealt with including hospital treatment by physicians who see the patient both in the Clinic and in hospital. The tuberculosis situation is improving steadily. The total number of new cases discovered during the year was 86 compared to 120 in 1964 and to 200 or 300 only a few years ago. There is no waiting list for hospital and all the machinery for the discovery and prevention of the disease is kept at full pressure. Over 3,000 contacts were examined, 254 children inoculated with B.C.G. and 4,588 home visits made by health visitors. Chest Clinic, Deptford I am indebted to Dr. J. P. V. Rigby for the following report concerning the Chest Clinic at Harton Street of which he is the Chest Physician. The Deptford Chest Clinic remained extremely busy during 1965. Over 1500 new patients were sent to me for investigation of chest symptoms by family doctors or other physicians, thus averaging 30 each week throughout the year, out of a total attendance of nearly 6,000 patients. There were in fact, 73 new cases of pulmonary tuberculosis diagnosed, excluding those transferred into North Lewisham from elsewhere. I saw 26 cases of lung cancer, some of whom had a lung successfully removed, and many more new cases of disabling bronchitis, often with cardiac complications. Lung cancer continues to be a problem both locally and nationally. According to the Registrar General this dread disease will reach an expected maximum in the 1970's, some 30 years or more after the peak of wartime and post-war cigarette smoking. There is however, some cheering evidence to suggest that cessation of smoking can halt the cancer tendency in some of those who are smoking heavily at present. It may be that lining cells turning cancerous in the bronchial tubes of the lungs cannot develop fully without continued whiffs of the tars in tobacco smoke. We now have hope that these abnormal cells can even be replaced by normal growing tissue again once the irritant smoke has gone, provided that the process has not gone too far. Though perhaps harder to prove, it seems likely that other factors like atmospheric pollution may also accelerate changes towards cancer just as it is known to worsen bronchitis. Anyone who leaves a car, or cleans a window ledge in local parts where smoke is still not controlled, will find a layer of dust to remove next day. This dust contains an acid substance called sulphur dioxide which when dissolved in water vapour, forms sulphuric acid capable of corroding stonework. Its effect on the lungs of local bronchitic sufferers can be well imagined. This dust and acid material arises from certain industrial and domestic chimneys. Back in 1960, I took part in the Medical Research Council investigation of the effects of air pollution on bronchitic patients in the London area. The whole study involved 1,000 patients, who kept diaries and recorded the days when their symptoms were most severe. It was found that the more severe symptoms coincided with days when the atmospheric pollution was worst. Adverse weather conditions did not seem to matter so much. Incidentally, there is a high mortality among advanced bronchitis despite the most energetic treatment. Now a word about the vast increase in motor vehicles on the roads of Lewisham Borough and indeed most urban areas in Britain. They are dangerous in reckless hands and the noise they make is troublesome, but their exhaust fumes often contain 52 large amounts of unburnt oils and substances which are known to be cancer stimulators. Lead compounds are emitted and also carbon monoxide, a constituent of coal gas. I am glad I do not live on a main traffic road. I think that legislation should be introduced to render exhaust fumes less noxious. Perhaps electrically powered vehicles might be the answer in due course. I could write a book about some of the 69 new patients that I saw in 1965 from that outsize lodging house, Carrington House, which is conveniently near to the Deptford Chest Clinic. Many had pulmonary tuberculosis and much of this was active. Most of these men had significant chest disease, mostly bronchitis often in a severe form, and some were found to have lung cancer. Many of these men have "lived rough" at some stage before coming to Carrington House, and sleeping in the fresh air usually makes bronchitis worse. Many need a great deal of medical care. Apart from these new attenders, many previous attenders from Carrington House have come to the Chest Clinic on frequent occasions through the year for follow-up of tuberculosis or other diseases needing at times, emergency treatment and admission to hospital. Proximity to Carrington House has assisted my staff in the follow up of tuberculous cases who will be less easy to check if this clinic is moved two miles away into Greenwich. Though a number come, start treatment and disappear, some stick close to Carrington House. Recently, I saw one old man of 88, born locally and who has lived—so he says—in Carrington House for 48 years, when he became a widower left with 8 children and he still sees the children from time to time. He has bronchitis and is rather short of breath, but is otherwise well for his age. A final word about pulmonary tuberculosis in general. The present drug treatment is most efficient though it may have to be continued for 18 months or two years. New cases are still cropping up with moderate frequency, and the disease cannot yet be regarded as conquered. Death from it is more rare now, but it still causes a lot of morbidity and damage to working life. Vigilance is still necessary over follow-up cases under treatment and investigation of contact cases. Betterment of the patient's environment is still important and rehousing schemes especially valuable. MASS RADIOGRAPHY UNIT I am indebted to the Director of the Unit for information of work done in the borough during 1965 on which the following tables are based. Table 32 Patients Men Women Total General analysis X-rayed 7,025 5,081 12,106 Previously x-rayed 3,958 1,854 5,812 Reviewed 289 138 427 Abnormal after review 210 85 295 Analysis of abnormal films: Cases considered tuberculous: (a) no further action required - - - (b) occasional supervision only 13 4 17 (c) requiring treatment 13 5 18 (d) still under investigation 1 - 1 (e) refused further investigation 1 - 1 Previously known tuberculous cases 21 8 29 Non-tuberculous cases: (a) investigated 40 23 63 (b) still under investigation 1 2 3 Cardio-vascular lesions 27 16 43 No action required 88 25 113 53 54 Table 33 Cases of tuberculosis requiring treatment or close supervision NOT PREVIOUSLY EXAMINED (included previous columns) Men Women Total Men Women Total Men NUMBERS Women Total Men CASES Women Total Small Public Surveys 2,462 2,866 5,328 4 3 7 1,530 1,999 3,529 3 1 4 Public Surveys—Examination of Special Groups 851 71 922 - - - 60 45 105 - - - Regular Sites 1,901 1,112 3,013 5 1 6 765 705 1,470 5 1 6 Firms (Full Scale) 1.011 333 1,344 - - - 401 143 544 - - - Firms—Examination of Special Groups 283 57 340 - - - 60 24 84 - - - Colleges, Hospitals etc. 288 536 824 - - - 105 235 340 - - - Homes, Lodging Houses, etc. 229 106 335 4 1 5 146 76 222 1 - 1 7,025 5,081 12,106 13 5 18 3,067 3,227 6,294 9 2 11 IMMUNISATION AND VACCINATION Active immunisation against the following infectious diseases was offered at Health Centres and Schools within the Borough; Diphtheria, Whooping Cough, Tetanus, Poliomyelitis and Smallpox. Generally, immunisation was offered at some 17 Health Centres to children between the ages of 1 month and 5 years, and at schools up to the age of 15 years. Adults, between the ages of 15 and 40 years were also immunised against Poliomyelitis and Smallpox. Arrangements exist for Medical Practitioners in the Borough to be supplied free of cost, with Poliomyelitis Vaccine for persons up to the age of 40, and single or combined Diphtheria/Whooping Cough/Tetanus Antigens. Supplies of Smallpox vaccine lymph was obtained by Doctors direct from the Central Public Health Laboratory, Colindale Avenue, N.W.9. (COL 7041). Arrangements may also be made for the supply of Anthrax vaccine. Stocks of this are not kept, but are available from the Central Public Health Laboratory. The Council will pay a fee of 5/0d. for each completed record of immunisation, provided it is sent within 3 months of the completion of the Course. Vaccination against yellow fever may be carried out at certain centres. Hospital for Tropical Diseases, 4, St. Pancras Way, N.l. (Tel: EUS. 4411, Extn. 137) Medical Dept., Unilever House, Blackfriars, E.C.4.(Tel.: CEN. 7474, Ext. 2841) 53, Great Cumberland Place, W.l. (Tel: AMB. 6456). Patients are seen only by appointment. No charge is made. Vaccination against Cholera, Enteric Fever and Typhus is available at the Hospital for Tropical Diseases, 4, St. Pancras Way, N.l. (Tel: EUS. 4411, Ext. 137) by appointment only. The following figures regarding immunisation and vaccination are for the period 1st April to 31st December, 1965. It has not been found possible to include any figures for the first three months of the year because the areas covered by the former London County Council Divisional Offices were not coterminous with the former Metropolitan Boroughs. Table 34 IMMUNISATION AND VACCINATION Completed primary courses Type of vaccine or dose Year of Birth Others under age 16 Total 1965 1964 1963 1962 1958/61 Diphtheria 2,304 1,261 170 109 195 79 4,118 Whooping Cough 2,297 1,254 167 106 101 17 3,942 Tetanus 2,304 1,258 170 110 197 103 4,142 Poliomyelitis 932 2,002 356 225 608 427 4,550 55 Reinforcing doses Type of vaccine or dose Year of birth Others under age 16 Total 1965 1964 1963 1962 195861 Diphtheria - 1,343 735 186 1,694 528 4,486 Whooping Cough - 1,313 721 178 640 89 2,941 Tetanus - 1,342 734 184 1,680 430 4,370 Poliomyelitis - 64 40 25 1,749 773 2,651 Smallpox Vaccination Age on date of vaccination 0-3 mths . 3-6 mths 6-9 mths' 9-12 mths 1 yr. 2-4 yrs. 5-15 yrs. Total Number vaccinated 30 24 66 65 1,546 504 66 2,301 Number revaccinated - - - - 2 15 47 64 LABORATORY FACILITIES The following relates to the work carried out by the public health laboratory on behalf of the Council during 1965. Table 35 Specimens Number Remarks Faeces 684 Negative 56 Shigella sonnei 1 Shigella fiexneri 3 Salmonella typhi 5 Salmonella tennessee 1 „ thompson 1 „ heidelberg 1 „ bredeney 5 „ typhimurium 3 „ paratyphi B 1 Staphylococcus aureus 1 B. coli 026 2 B. coli 055 1 B. coli 0111 2 CI. welchii Swabs from nose and throat etc. 10 Negative 4 Staph, aureus 1 B-haem. streps. Blood culture 5 Negative Widal 3 Negative 1 Positive Water (various) 4 Food 2 797 56 ENVIRONMENTAL HEALTH Mr. A. J. Phillips, Chief Public Health Inspector, reports: The year has meant many changes and from April 1st the Public Health Inspectors have to accustom themselves to new boundaries and to considerable alteration in law and procedure. The principal changes included the repeal of the Public Health (London) Act, 1936 and the use of the Public Health Acts 1936 and 1961, operative in the rest of the Country, the repeal of much of the General Powers Acts and the fact that all the existing combined drains became classed as public sewers. It is hoped that some early action can be taken to remedy the deficiency which exist in the new procedure for dealing with urgent nuisances. Offices, Shops and Railway Premises A shortage of qualified health inspectors made the undertaking of work much more difficult and whilst 371 initial visits were made to premises under the Act, this was not a very high figure bearing in mind the number of premises which were or should be registered and it is hoped that a greater effort can be made during 1966. In those premises inspected it was found in most cases that the occupiers were cooperative in remedying the faults. Accidents reported during the year were fortunately of a minor character. Clean Air Four areas became operative during the year under review and this entailed a considerable number of cases being dealt with and although some delay occurred, the claims were dealt with as quickly as possible. There was a noticeable increase in the number of applications for gas fires in preference to solid fuel appliances. Food There were less imports at Hither Green Continental Depot during the year but the amount of unsound food was slightly in excess. On the whole the results of the analysis of samples was satisfactory. One adulteration found was due to the use of a colouring matter not permitted in this country. Samples of milk were satisfactory but some of the ice-creams were in the lower grades. Complaints of food sold containing foreign bodies or in poor condition were at about the same level as previous years. Legal proceedings were instituted in most cases. There were again a number of complaints of dirty milk bottles and some special attention to this problem is called for. Housing There are many inter-related factors and overlapping of technical functions involved in the various aspects of Housing work. These, when considered separately, fall into five main groups, viz; repairs, compulsory improvements, multiple occupation, Council mortgages and the grant aided improvement schemes. In any particular property a combination of procedures under the several statutes may be required. It follows that to achieve a satisfactory result, it is a distinct advantage to have, as is the case in this Borough, the control of all the technical functions. 57 Pest Control Complaints of rats and mice have increased again during the year. This is rather surprising so far as rats are concerned having regard to the fact that the number of takes in the baiting of the sewer manholes was very much smaller. This shows that it is not easy to relate surface infestation with that of the sewers. In the case of mice infestations it was found necessary to bait over a considerable period to get a complete elimination. Carelessness in the storage of food is almost invariably a major contributory factor. The number of premises found infested with bugs and fleas was fortunately remarkably small, but the number of verminous persons and articles dealt with at the two stations was higher than in previous years. It is to be hoped that the upward trend will not continue. The number of pigeons destroyed was slightly higher than the previous year. The chief cause of this continuing nuisance is the feeding of the birds by the general public. Outworkers Outwork is still on the decline and the figures show that the principal types carried out is in connection with the clothing trade. Generally The tables show lower figures for work carried out and this fact is due to the establishment of public health inspectors being twenty-five per cent below strength. It is hoped that improvement may be achieved by the use of technical assistants in certain aspects of the work. The real answer however is for a greater use of the student training scheme so that vacancies, particularly in the inner London Boroughs may be filled. Table 36 SUMMARY OF INSPECTIONS BY PUBLIC HEALTH INSPECTORS Reason for inspection TOTAL On complaint 3,316 House to house 5 Improvement grants 585 Houses in multiple occupation 650 Rent Acts 31 Mortgage survey 932 Other Housing Act visits 797 Notice from builder 1,491 Infectious diseases 997 Infestation 362 Factories, mechanical 77 Factories, non-mechanical 17 Outworkers 114 Clean Air inspections 5,490 Pet Animals Act 34 Offices, Shops, etc. Act 609 Common Lodging Houses 11 Fireguards 8 Hairdressers 21 Pharmacy and poisons 131 58 Table 36—continued Reason for inspection TOTAL Icecream premises 112 Restaurants, cafes, etc 971 Bakehouses 16 Food shops and stalls 945 Other shops and stalls 88 Food inspections 713 Sampling 305 All other matters 3,461 Revisits 12,775 Total—all inspectors 35,054 Table 37 SUMMARY OF NOTICES SERVED Intimation notices: Public Health (London) Act, 1936 216 Informal notices: Public Health Act, 1936 476 Factories Act 5 Housing Act, 1957 3 Offices, Shops and Railway Premises Act, 1963 225 Total 925 Statutory notices: Public Health (London) Act, 1936 112 Public Health Act, 1936 190 Clean Air Act, 1956* 353 Housing Acts, 1957 and 1961 7 Byelaws 44 Total 706 * The vast majority of these were for late applications and were served to safeguard Ministry and Borough Council grant. 59 Table 38 REPAIRS CARRIED OUT Repairs Total Brickwork repaired 20 Chimneys and flues repaired 5 Dampness remedied 300 Doors and door frames repaired or renewed 21 Drains repaired 11 Drinking water cisterns repaired - Dry rot remedied 7 Dustbins supplied 6 Fire grates etc., repaired or renewed 5 Flooring repaired or renewed 69 Flushing cisterns repaired, renewed or cleansed 28 Flush pipes repaired or renewed 10 Glazing 14 Gutters repaired 51 Gullies renewed, repaired or cleansed 19 Painting 3 Refuse cleared 8 Rainwater pipes cleared 30 Roofs repaired 134 Sashcords renewed 85 Sinks provided 38 Soil pipes repaired, ventilated or renewed 13 Walls and ceilings cleansed 2 Walls and ceiling plaster repaired 165 Water closets repaired or renewed 45 Water service pipes repaired or renewed, water supply restored 20 Windows and frames repaired or renewed 52 Yards and areas paved 7 Other repairs 40 TOTALS 1,208 FACTORIES Section 7 of the Factories Act, 1961, requiring the provision of sufficient and suitable sanitary conveniences is enforced by the council in all factories, whether mechanical power is used in the factory or not. The provisions of sections, 1, 2, 3, 4 and 6 relating to cleanliness, overcrowding, the maintenance of a reasonable temperature, the securing of adequate ventilation of workrooms and the furnishing of adequate means for draining floors where wet processes are carried on, are enforced by the council in factories in which mechanical power is not used. The provisions of section 7 are also applied to certain building operations and works of engineering construction, etc. A local authority is required to keep a register of factories with respect to which it is responsible for the enforcement of any of the provisions mentioned above. Close co-operation is maintained with HM Inspectors of Factories in that any defaults found by them during the course of their visits and for which it is the duty of the local authority to secure that remedial measures are taken, are notified to the health department. Similarly the public health inspectors notify HM Inspectors of any contraventions of the provisions of the Act which come within their jurisdiction. 60 HM Inspectors also forward to the health department details relating to the establishment of new factories, the introduction of mechanical power and other information which may come to their notice and which appears to affect factories subject to the control of the local authority. Special attention is paid to factories which provide canteens. These factories are visited by the council's food inspectors and the opportunity is taken to discuss with the canteen staff the various requirements needed to maintain a good standard in food hygiene. The medical officer of health is required in his annual report to the local authority to report specifically on the administration of, and furnish prescribed particulars with respect to, the matters under part I (factories) and part VIII (outworkers) which are administered by the local authority. Details follow:— Table 39 INSPECTIONS Premises Number on register Inspections Number of Written notices Occupiers prosecuted (i) Factories in which sections 1, 2, 3, 4 and 6 are to be enforced by local authorities 91 16 - - (ii) Factories not included in (i) in which section 7 is enforced by the local authority 770 77 5 - (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) - - - - TOTAL 861 93 5 - Table 40 CASES IN WHICH DEFECTS WERE FOUND Defects No. of defects Found Remedied Referred Prosecutions instituted To HM Inspector By HM Inspector Want of cleanliness (SI) - - - - - Overcrowding (S 2) - - - - - Unreasonable temperature (S 3) - - - - - Inadequate ventilation (S 4) - - - - - Ineffective drainage of floors (S 6) - - - - - Sanitary conveniences (S 7): (a) insufficient 2 2 - 2 - (b) unsuitable or defective 5 5 - 5 - (c) not separate for sexes 1 1 - 1 - Other offences against the Act (not including offences relating to outwork) - - - - - TOTAL 8 8 - 8 - 61 OUTWORKERS Under section 133 of the Factories Act, 1961 the occupier of every factory and every contractor employed by him must keep lists showing the names and addresses of all outworkers directly employed by him and of the places where they are employed, and must send to the district council in February and in August of each year, copies of those lists showing all outworkers so employed by him during the preceding six months. Section 134 of the same Act empowers the district council by notice in writing to the occupier of a factory or to any contractor employed by him to prohibit the employment of any persons as home workers in premises which the council regard as injurious or dangerous to health. The Home Work Order, 1911, specified the kinds of work to which these two sections apply. The types of work consist mainly of wearing apparel and textiles, the making of paper bags, boxes, brushes, baskets, artificial flowers, metal fittings, etc. The following is a list of occupations concerned: Table 41 Trade Out worker employed Clothing 165 Brushes 4 Boxmaking 10 Lampshades 1 Rosettes 2 Lace 7 Curtains 1 190 The inspectors made 114 visits during the year. Reports were submitted to the Council setting out the position with regard to outworkers in the borough. No adverse comments were made. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 There were 371 initial visits paid to premises during 1965 and these showed that many of the occupiers had already given the requirements of the Act some attention. It was surprising however, to find that in 124 cases there was no first aid box provided, although this was quickly remedied when attention was drawn to this deficiency. The other principal items requiring attention were as follows:— Abstract of the Act not exhibited 135 Absence of a thermometer 95 Absence of a hot water supply 60 Absence of a wash hand basin 32 Floor in need of repair 26 88 accidents were reported during the year and investigation of 43 of these showed that fortunately most of them were of a minor character and due principally to lack of care on the employee's part. Where the employer was asked to carry out any remedial works, these were dealt with without delay. 62 With reference to the special report of lighting standards as required by the Ministry of Labour L.A. Circular 9. Supplement No. 1, 127 visits were made under the Offices, Shops and Railway Premises Act during the last three months of 1965, made up as follows: Table 42 October November December Total Shops 26 73 11 110 Shops with offices 3 4 1 8 Offices 2 5 2 9 TOTALS 31 82 14 127 1. The standard of lighting was considered to be satisfactory in all cases and it was not necessary to serve notices under Sec. 8 (1) of the Act. 2. No examples of unsatisfactory lighting can be given. 3. No specific standard of lighting, in terms of lumens has been recommended. 4. No instance of excessive glare has been reported. The number of inspections to premises will be increased during 1966 with the greater deployment of the public health inspectors and technical assistants on to this work in order to complete the general survey of premises as soon as possible. The following statistical information has been passed to the Ministry of Labour under provisions contained in the Act. Table 43 REGISTRATIONS AND GENERAL INSPECTIONS Class of premises Number of premises registered during the year Total number of registered premises at end of year Number of registered premises receiving a general inspection during the year Offices 31 580 30 Retail shops 50 1,695 274 Wholesale shops, warehouses 2 94 1 Catering establishments open to the public, canteens 11 197 65 Fuel storage depots - 14 1 TOTALS 94 2,580 371 63 Table 44 PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE Class of work place Number of persons employed (1) (2) Offices 5,302 Retail shops 9,517 Wholesale departments, warehouses 1,194 Catering establishments open to the public 1,377 Canteens 167 Fuel storage depots 78 Total 17,635 Total Males 7,698 Total Females 9,937 Table 45 EXEMPTIONS Sanitary conveniencies (Sec. 9) Class of premises No. of exemptions current at 31 st Dec. No. of exemptions granted or extended during the year No. of applications refused or exemptions drawn during yr. No. of cases where employees opposed application Appeals to Court against refusal to grant or extend an exemption or the withdrawal of an exemption No. made No. allowed Offices Retail shops 1 1 Wholesale shops, warehouses Catering establishments open to public canteens Fuel storage depots Washing facilities (Sec. 10) Offices Retail shops 1 1 Wholesale shops, warehouses Catering establishments open to public, canteens Fuel storage depots NATIONAL ASSISTANCE ACT, 1948—SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951 Four cases were removed to hospital by means of Orders granted under the above Acts. Other possible cases were kept under observation and five were subsequently voluntarily removed to hospital on medical grounds. 64 Laundry Work in progress for the incontinent at one of the Council's Cleansing Stations DISINFECTION AND PERSONAL CLEANSING Details of the work carried out during the year are as follows : Table 46 Rooms disinfected or disinfested 434 Articles disinfected or disinfested 22,148 Verminous children cleansed 364 Verminous adults cleansed 549 Treatment for scabies, children 189 Treatment for scabies, adults 120 Articles cleansed 114.853 Domiciliary bathing * 5,846 *This figure includes 4.422 home baths carried out by the bathing attendants whose work is more fully reported upon on page 21 ANTI-FLY CAMPAIGN During the period June to September the usual measures were taken to deal with the control of fly breeding. Calls were made to potential sources, such as stables, piggeries and similar premises throughout the Borough. Vacant sites which were well known to the department as rubbish dumps were visited and deposits of litter removed and the ground sprayed with insecticide when considered necessary. The treatment of dustbins with powder supplied by the health department was carried out by the Borough Engineer & Surveyor. The caretakers of blocks of flats were supplied with the necessary material to enable them to deal with refuse chutes and chambers. PREVENTION OF DAMAGE BY PESTS ACT, 1949 A copy of the report covering the calendar year 1965 submitted to the Minister of Agriculture, Fisheries & Food, as required by the provisions of the above Act, is appended: Table 47 Type of Property Local authority Dwelling houses (including council houses) All other (including business premises) Total Agricultural Properties in borough 263 84,695 17,595 102,553 - Properties inspected as a result of (a) notification 17 2,097 166 2,280 - (b) survey 9 426 13 448 - (c) otherwise - - - - - Total inspections 26 2,523 179 2,728 - Properties inspected which were found to be infested by:- (a) Rats—major - - - - - (b) —minor 8 815 66 889 - (c) Mice—major - - - - - (d) —minor 4 527 43 574 - Infested properties treated 12 1,342 109 1,463 - Total treatments (including retreatments) 44 3,209 442 3,695 - "Block" control schemes carried out Nil 65 SWIMMING BATHS There are 5 public swimming baths in the borough, including the new Ladywell baths, Lewisham High Street opened December 12th, which replaced the old baths in Ladywell Road. The following table shows details of the laboratory tests taken during the year. Table 48 Bath Number of tests Variation of chlorine (p.p.m.) Ladywell West 7 0.08 — 1.25 Ladywell East 7 0.08 — 0.90 Ladywell (new baths) 1 0.25 Forest Hill North 8 0.25 — 1.40 Forest Hill South 8 0.15 — 1.20 Laurie Grove Large 7 0.20 — 1.68 Laurie Grove Small 8 0.12 — 1.48 Laurie Grove South 1 0.40 Downham 8 0.08 — 1.90 Bellingham (open air) 4 0.08 — 1.75 The water used for these baths is supplied by the Metropolitan Water Board and is sterilised by the breakpoint chlorination method, sodium carbonate and sodium metephosphate being used to control acidity and to keep the pH above 7.2. Colorimetric tests for free chlorine and pH value are also made at the baths at 9 a.m., 1 p.m., and 6 p.m. on weekdays and at 9 a.m. and 12 noon on Sundays, the results being recorded on log sheets kept for the purpose. The aim is to achieve a circulation of water every four hours, although it is rather more prolonged at the open-air baths. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 The Rag Flock and Other Filling Materials Act is designed to secure the use of clean filling materials in upholstered articles and other articles which are stuffed or lined. Six premises are registered for the use of filling materials for upholstery purposes, one of these being also registered for storage. Samples of these materials proved satisfactory on examination. DESTRUCTION OF PIGEONS The destruction of pigeons was carried out throughout the year by two part-time pigeon catchers. They accounted for the destruction of 3,041 pigeons in the area of the former Metropolitan Borough of Lewisham. It was not possible, because of shortage of staff, to extend the scheme into the Deptford area of the borough during 1965, but it is hoped to do so in the near future. PET ANIMALS ACT, 1951 During the year 23 premises were licensed as pet shops. In the main, the sale of pets at these premises consists of cage birds and tropical and coldwater fish. In general it has been found that pets are kept for sale under conditions which do not call for any particular comment and in no case has it been found necessary to attach special conditions for any licence which has been issued. 66 ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 Under the above Act, no person may keep a boarding establishment for animals (i.e. dogs or cats) except under the authority of a licence granted by the local authority for the area in which the establishment is situated. One such licence was granted during the year. CONSUMER PROTECTION ACT, 1961 THE CHILDREN'S NIGHTDRESSES REGULATIONS, 1964 These Regulations relate, among other things, to (a) the materials used in garments, which requires any fabric used to be of a kind capable of satisfying the requirement of the British Standard for fabrics "described as of low flammability"; and (b) the labelling of nightdresses made of fabrics which have been treated with chemicals to make them safer from fire. A number of test purchases were made and the garments submitted to an approved laboratory for examination. Three cases of contravention of the Children's Nightdresses Regulations occurred during the year, and legal proceedings were instituted against the offenders. ATMOSPHERIC POLLUTION Clean Air Act During 1965 one more area was made the subject of Smoke Control Orders and particulars with regard to the area are as follows: No. 6 Name (Deptford) Acreage 98 No. of industrial premises 4 No. of commercial premises 99 No. of dwellings 1,437 No. of other premises 12 Present annual tonnage of bituminous coal to be replaced 1,500 Likely additional fuel required annually: (a) Electricity (KWHS) Nil (b) Gas (therms) 340,000 (c) Oil, etc Nil (d) Solid smokeless fuel (tons) 1,500 Total estimated cost of works £49,250 Date: Order made 10.2.65 Order confirmed 12.5.65 Order operative 1.12.65 67 PROGRAMME At the end of December 1965, the position in relation to areas which have been or still are the subject of smoke control action was as follows: Table 49 Area No. and name No. of dwellings Date of operation Area No. and Name No. of dwellings Date of operation 1 Ladywell 1,409 1.9.59 Deptford 2 Southend 2,827 1.11.59 1 1,004 1.10.60 3 Brookdale 1,155 1.9.60 2 3,955 1.10.61 4 Penerley 3,367 1.10.60 3 2,914 1.10.62 5 Glenbow 2,059 1.9.60 4 2,138 1.10.63 6 Lewisham Park 3,716 1.8.61 4a 192 1.10.63 7 Sandhurst 2,187 1.8.61 5 1,680 1.10.64 8 Hazelbank 3,123 1.7.62 5a 63 1.10.64 9 Northover 3,226 1.9.62 6 1,437 1.12.65 10 Blythe Hill 2,586 1.10.62 11 Algernon 1,981 1.11.62 12 Brockley 4,402 1.7.63 13 Manor 6,932 1.10.63 14 Vancouver 2,731 1.6.64 15 Baring 5,232 1.7.64 16 Honor Oak 2,281 1.8.64 17 Blackheath 3,042 1.9.64 18 Sunderland 2,020 1.9.65 19 Sydenham 4,034 1.10.65 20 Mayow 2,000 1.11.65 21 Bellingham 3,208 1.11.66 The following map shows the area of the borough, coloured red, now covered by Smoke Control Orders in operation. The small area coloured blue is subject to a Smoke Control Order which becomes operative on 1st November, 1966. 68 LONDON BOROUGH OF LEWISHAM Clean Air Act, 1956 (Position at December 1965) 69 Table 50 ATMOSPHERIC CONDITIONS IN 1965 January February March April May June July August September October November December Average or actual Temperature—1 Mean maximum C 6.5 5.9 10.3 13. 2 17.0 19.7 19.3 20.7 17.1 15.9 8.2 8.2 13.5 Mean minimum C 2.7 2.1 3.2 5.6 9.1 11.3 12.3 12.5 9.5 8.4 3.8 3.5 7.0 Mean C 4.6 4.0 6.7 9.4 13.1 15.5 15.8 16.6 13.3 12.1 6.0 5.9 10.3 Diff. from average C + 0.3 —0.6 0.0 0.0 + 0-6 —0.4 —1.8 —0.7 —1.6 +0.1 -1.7 + 0.5 -0. 4 Highest maximum 2 C 12.0 10.0 21.0 18.0 28. 0 25.0 24. 0 25.0 20.0 23.0 15.0 13.0 28.0 Lowest minimum 2 C —2.0 -1.0 —4.0 3.0 6.0 8.0 9.0 11.0 7.0 3.0 —4.0 —5. 0 —5.0 Rainfall Total2 in. 1.50 0.59 1.38 Apparatus stolen 1.40 2.01 2.81 2.19 4.46 0.43 2.80 2.79 22.36 (11 months) Per cent. of average 1 ... 91 23 125 78 76 93 88 104 212 37 114 181 102 Sunshine—1 Daily mean hrs. 2.14 1.15 4.36 4.46 6.12 6.04 3.99 6.06 4.38 4.52 3.22 1.86 4.03 Per cent. of average ... 144 51 120 84 96 85 62 100 92 143 182 145 109 Wind—1 NE/E/SE % 23 25 43 9 24 19 11 40 5 58 40 4 25 S/SW/W % 62 19 41 49 54 63 58 48 73 28 32 76 50 NW/N/Calm % 15 56 16 42 22 18 31 12 22 14 28 20 25 Atmospheric pollution— Pool allotments Water insol. matter tpm 7.19 9.75 13.67 Apparatus stolen 12.55 8.66 20.14 8.73 11.38 9.56 8.36 7.01 10.64 (11 mths) Water sol. matter tpm 4.37 4.09 5.53 3.09 4.70 7.55 4.53 7.99 3.52 6.01 3.52 4.96 Sulphur + 2.30 2.05 1 .33 1.76 0.48 0.83 0.44 0.58 0.53 0.84 1.59 1.42 l.18 Lewisham Town Hall— Smoke, daily average * 151 120 97 85 42 42 40 53 70 112 138 166 93 „ maximum * 444 408 448 276 108 95 83 104 147 223 324 588 - „ minimum * 44 44 44 26 8 15 16 21 27 37 24 52 - Sulphur, daily average * 217 303 113 193 111 108 86 91 107 217 235 188 164 „ maximum * 588 574 333 446 211 249 166 274 219 489 603 607 - „ minimum * 43 92 28 70 54 30 44 35 52 72 72 94 - Valentine Court— Smoke, daily average * 114 106 94 60 30 26 15 19 33 70 94 152 68 „ maximum * 376 428 416 272 56 85 35 57 73 166 228 380 - „ minimum * 22 28 28 12 12 7 3 5 5 11 16 16 - Sulphur, daily average * 215 279 110 181 102 91 76 80 89 183 220 178 150 „ maximum * 556 663 320 439 269 213 145 234 165 404 512 496 - „ minimum * 31 103 36 62 30 21 32 30 43 71 60 57 - Deptford Town Hall— Smoke, daily average * 191 — 170 95 54 34 47 49 66 128 143 155 103 „ maximum * 512 — 424 192 160 108 73 122 126 269 324 528 - „ minimum * 38 — 35 38 8 4 13 24 28 28 35 36 - Sulphur, daily average * 290 — 262 185 125 116 102 100 103 308 274 239 191 „ maximum * 747 — 637 409 392 257 209 223 188 745 577 776 - „ minimum * 52 — 107 47 58 22 29 10 52 71 71 82 — Weather Summary— ... Cold early and late Dull, Cold & very dry Wintry at first warm at end Cool & showery Cloudy & warm Wet Cold, dull & wet Changeable & cool Wet, dull & cold Exceptionally dry Bright and cold Very Wet Notes— 1 Kew; 2Lewisham; tpm: Tons per square mile per month; + as trioxide in MG per 100 sq. cms. per day; * microgrammes per cubic metre HOUSES IN MULTIPLE OCCUPATION The powers contained in the Housing Act 1961 as amended by the Housing Act, 1964 in connection with standards of management, the provision of amenities, necessary fire precautions and control of occupation in houses in multiple occupation were used to the full extent by staff available during the year. The following shows the cases reported for formal action to the Housing Committee in 1965. Sections 12 and 13 (management regulations) 16 Section 14 (management notices) 3 Section 15 (provision of amenities) 20 Section 16 (fire precautions) 34 Section 19 (occupation directions) 63 In addition, a number of properties were dealt with by informal action, some of which arose from the referring of applicants for G.L.C. mortgages to the Department for appropriate guidance. It was possible in certain cases to improve conditions by persuading the landlord to apply for grant aid. Work in default of compliance with notices for the provision of amenities, fire precautions, and also for repairs under sections 9 and 10 of the Housing Act, 1957 at two properties was started, and this work was in progress at the end of the year. RENT ACT, 1957 The following table shows the applications for certificates of disrepair dealt with during the year 1965. Table 51 Applications for certificates 17 Decisions not to issue certificates 5 Decisions to issue certificates (a) in respect of some but not all the defects 4 (b) in respect of all defects 3 Undertakings given by landlords to repair 5 Undertakings refused for special reasons — Certificates of disrepair issued 7 Applications by landlords for cancellation of certificates 12 Objections by tenants to cancellation 5 Decisions to cancel in spite of tenants' objection 1 Certificates cancelled 8 Table 52 HOUSES IN CLEARANCE AREAS AND UNFIT HOUSES ELSEWHERE (a) —HOUSES DEMOLISHED Clearance areas Houses (Housing Act, 1957) Houses unfit for human habitation — Houses included by reason of bad arrangement — Houses or land acquired under s. 43 — Not in clearance areas Formal or informal procedure under s. 17(1) — Local authority houses certified unfit by medical officer of health 70 Table 52—continued (b) —UNFIT HOUSES CLOSED (Housing Act, 1957) Clearance Areas Houses ss 16,17 and 35 3 ss 17(3) and 26 — Parts of buildings closed under s. 18 2 (c) —PERSONS DISPLACED Persons From houses to be demolished in or adjoining clearance areas 30 From houses to be demolished not in or adjoining clearance areas 2 From houses to be closed 5 From parts of buildings to be closed 8 (d) —FAMILIES DISPLACED Families From houses to be demolished in or adjoining clearance areas 11 From houses to be demolished not in or adjoining clearance areas 2 From houses to be closed 3 From parts of buildings to be closed 3 (e) —UNFIT HOUSES MADE FIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED By owner By Local Authority After informal action by local authority - - After formal notice under Public Health Acts 275 - After formal notice under Housing Act 1957 3 1 Under s.24 Housing Act, 1957 — — (f) —UNFIT HOUSES IN TEMPORARY USE (Housing Act, 1957) Houses Separate dwellings Retained for temporary accommodation under ss. 17,46 and 48 - - Licensed for temporary occupation under ss. 34 or 53 - - (g) —PURCHASE OF HOUSES BY AGREEMENT Houses Occupants Houses in Clearance Areas other than those included in confirmed Clearance Orders or Compulsory Purchase Orders - - 71 IMPROVEMENT WORK The scope of work of the department under this heading expanded during the year by the use of the powers contained in the Housing Act, 1964, which among other things, gives the right to tenants in rented dwellings outside improvement areas to request the Council to require their landlords to carry out improvements up to the five point amenity standard. The use of this power is conditional on the property having a life of, and remaining fit for habitation for a period of at least fifteen years. It is also conditional on the work being carried out at reasonable expense. Several requests by tenants were dealt with, a few of which did not meet requirements mentioned but 13 cases were approved and reported to the Housing Committee for action under section 19. Following the declaration and advertisement of the first improvement area, comprising nearly 200 dwellings, under section 13 of the Housing Act, 1964, schedules of improvement work and estimates of the cost were prepared for each tenanted property. Towards the end of the year the Housing Committee gave authority for the service of the preliminary notices for all these properties. In the case of the owner. occupied houses in the area, which lack the standard amenities, the owner has been asked to co-operate in having the necessary work done and was informed of the possibility of grant aid in respect thereof. Consideration is now being given to the declaration of further areas so that all houses in the Borough capable of improvement to the five point standard can be dealt with in due course. Work in connection with applications for improvement grants resulted in the approval of a total of 47 discretionary grants and 132 standard grants during the year. As mentioned elsewhere a number of these grant applications arose from house purchase loans but a few followed action, some informally, in connection with multiple occupation. CLEARANCE OF UNFIT PROPERTIES During the year the remaining properties included in the Council's 1961/1965 clearance programme were inspected and as a result reports were submitted to the Housing Committee recommending the declaration of four areas comprising a total of 52 houses involving 65 families. Following the declaration of an area and subsequent making of a Compulsory Purchase Order by the former Deptford Borough Council a public inquiry was held in May 1965. The order was subsequently confirmed by the Minister. The clearance programme for the five years 1966/1970 was formulated and reported to the Housing Committee in June 1965 prior to submission to the Minister. Approximately 800 dwellings in 24 areas were recommended for inclusion in this programme. HOUSE PURCHASE LOANS During the year 932 properties, which were the subject of applications to the Council for house purchase loans, were surveyed and reported on by the health inspectors. In many of these cases the carrying out of specified repairs and the provision of any missing standard amenities for the dwelling were made a condition of the advance, and this work was supervised and approved in order to make the premises "in all respects fit for human habitation" as required by section 43 of the Housing (Financial Provisions) Act, 1958 under which mortgage loans are made. With regard to the provision of amenities, where the Council approved any lettings in the property, the provision of separate facilities were also required for each letting and in certain cases any necessary fire precaution work. 72 These conditions imposed by the Council gave rise in many instances to applications for assistance under one or other of the improvement grant schemes. In connection with mortgage advances it is interesting to note that the Greater London Council, when their scheme was in operation, made it a condition of an advance, for properties which were likely to be in multiple occupation, that the applicant consult the health inspector with regard to the requirements of the Housing Acts 1961 and 1964 which govern this type of property. This is a very welcome and worthwhile step and many inspections and reports were made during the year in connection with these cases. MILK The Milk and Dairies (General) Regulations, 1959 At the end of the year there were 217 persons registered for the distribution of milk from premises within the borough. There are no premises in the borough used as dairies. Milk (Special Designations) Licences Licences to expire on December 31, 1965, were issued during the year as follows: (the total numbers now current are shown in brackets) for sale of untreated milk 124 (124) „ sale of pasteurised milk 12 (235) „ sale of sterilised milk 8 (117) „ sale of ultra heat treated milk 12 (12) Examination of heat-treated milk 44 samples of pasteurised milk and 20 samples of tuberculin tested (pasteurised) milk were submitted for examination during the year. One sample of tuberculin tested (pasteurised) milk failed the methylene blue test. All of the other samples were found to be satisfactory. Analysis of milk During the year under review, 56 samples of milk were submitted for examination to the public analyst by the Council's inspectors; all were found to be genuine. The average composition of the samples is set out in the following table: Table 53 Period Samples Average composition of samples examined Percentage of Milk fat Solids not fat Total solids First quarter 6 3.68 8.82 12.5 Second quarter 24 3.44 8.63 12.07 Third quarter 13 3.62 8.68 12.30 Fourth quarter 13 3.88 8.75 12.63 TOTALS 56 3.61 8.69 12.30 The legal standard is 3.0 per cent milk fat and 8.5 per cent solids not fat (total solids 11.5%) 73 ICECREAM Food Standards (Icecream) Regulations, 1959 Labelling of food (Amendment) Regulations 1959 The composition of 13 icecream samples submitted to the public analyst during the year are shown in the appended table: Table 54 Samples Average percentage composition Fat Total solidsnot fat Water 13 8.2 24.9 66.9 GRADING Icecream is submitted to the Public Health Laboratory for bacteriological examination The icecream is graded according to the time taken to decolorise a dye, methylene blue. The test is a provisional one and because of the many factors which govern the hygienic quality of icecream it is recommended officially that judgement should be based on a series of samples and that too much attention should not be paid to the result of an individual sample. It is suggested that over a six-monthly period, at least 50 per cent of a vendor's samples should fall into grade 1, 80 per cent into grades 1 or 2, not more than 20 per cent into grade 3 and none into grade 4. During the year 35 samples of icecream were submitted for bacteriological examination with the following results: Table 55 Samples submitted % Grade I 14 40 Grade II 9 26 Grade III 4 11 Grade IV 8 23 TOTAL 35 100 In general, grades I and II are satisfactory, while grades III and IV may indicate some defect in manufacture, handling or storage. Such cases are followed up and advice given. FOOD GENERALLY Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 837; of these 7 were formal and 830 informal. After examination the public analyst reported that 54 of the samples were adulterated or below standard which amounted to 6.5 per cent of all the samples submitted. 74 Table 56 Samples analysed Articles Examined Adulterated Formal Informal Total Formal Informal Total Beverages - 19 19 - 1 1 Bread, biscuits, cake etc. - 35 35 — — — Colouring matter — 12 12 — — — Cheese — 4 4 — — — Drugs — 36 36 — — — Fats — 24 24 — 1 1 Fish - 41 41 — — — Flavourings and condiments 1 183 184 1 29 30 Fruit and nuts 2 116 118 2 7 9 Icecream - 15 15 — — — Jams, pastes etc. - 19 19 — — — Meats and preserved meats - 86 86 — 2 2 Milk and cream 2 105 107 — 3 3 Sausages 2 28 30 1 2 3 Sweet confectionery - 42 42 — 3 3 Vegetable and cereals — 34 34 — 2 2 Miscellaneous — 31 31 - — - TOTALS 7 830 837 4 50 54 Table 57 Non-genuine samples Article Formal or Informal Adulteration or irregularity Action taken Pure pork, canned Informal Incorrect labelling Importers notified Sponge cake mixture Informal Mixture damaged by an insect Legal proceedings taken Cherries in syrup canned Informal Colouring matter contained 3 dyes not permitted by the Colouring matter in Food Regulations Formal sample Pineapple juice Informal Incorrect labelling Manufacturer notified Rubbed sage Informal Excessive lead Formal sample Milk Informal Deficient in milk fat Formal sample taken and found genuine French mustard Informal Incorrect labelling Manufacturer notified Preserved pork sausages Informal Contained 60 % meat Formal sample Preserved pork sausages Informal Contained 58 % meat Formal sample Cherry rough, canned Informal Incorrect labelling Received undertaking from canners to cease exportation 75 Table 57—continued Article Formal or Informal Adulteration or irregularity Action taken Cherries in syrup, canned (2 samples) Formal Colouring matter contained 2 dyes not permitted by the Colouring matter in Food Regulations Legal proceedings instituted Grenadilla, canned Informal Excessive tin No further stocks Pineapple pie filling, canned Informal Incorrect labelling Canadian trade organisation notified Rubbed sage Formal Excessive lead Legal proceedings instituted Thyme powder Informal Excessive lead Formal sample Herbes de Provence Informal Excessive lead Formal sample Bouquet Garni Informal Incorrect labelling Formal sample Pork sausages Formal Contained 62 % meat Manufacturers warned Vongole al Naturale, canned (2 samples) Informal Incorrect labelling Stocks detained, relabelled and released Cooking butter, canned Informal Rancid No further action Sugar confectionery, "Flowerpots" (3 samples) Informal Contained colouring not permitted by Colouring matter in Food Regulations Imported from Geneva —consignee's local authority notified Curry powder Informal Excessive lead Imported from France —re-exported Fruits in syrup, canned (2 samples) Informal Incorrect labelling Imported from Italy— consignee's local authority notified Herbes de provence (9 samples) Informal Contained lead Imported from France —re-exported Thyme powder (11 samples) Informal Contained lead Imported from France re-exported Bouquet Catalan (2 samples) Informal Incorrect labelling Imported from France —re-exported Barbecue spice Informal Incorrect labelling Imported from France —re-exported Ox lung Informal Contained colouring not permitted by Colouring matter in Food Regulalations Imported from France for animal food— Ministry notified Instant low-fat milk, skimmed Informal Incorrectly labelled Vendor and canner notified—label altered to comply Rice Informal Contaminated by insects Stock returned to importers 76 OTHER SAMPLES In addition to samples submitted to the public analyst or bacteriologist for routine sampling, the following were submitted for various reasons, but mainly because of complaints received or as a result of enquiries made into cases of food poisoning: Bread (11) Bacon (1) Milk (3) Raspberry layer cake (1) Carrots, tinned (1) Lemonade (1) Christmas pudding (1) Icecream sundae (1) Corned beef (3) Evaporated milk (1) Self raising flour (1) Steak and kidney pie (1) Strawberries, tinned (1) Fried potato chip (1) Cheese (1) Zinc and castor oil cream (1) FOOD HYGIENE (GENERAL) REGULATIONS, 1960 The following table gives details of food premises grouped in categories of trade carried on in them and showing the number fitted to comply with regulation 16 (provision of wash-hand basins) and with regulation 19 (facilities for washing food and equipment) of the Food Hygiene (General) Regulations, 1960. Table 58 Type of premises Number of premises Number provided with wash-hand basins Number with facilities for washing food and equipment Grocers & multiple grocers 354 354 354 Greengrocers 203 173 not applicable Bakers 91 91 91 Butchers 139 139 139 Confectioners 361 355 not applicable Cafes & restaurants 159 159 159 Fish shops 37 37 37 Fried fish shops 32 32 32 Public houses 166 166 166 Off licences 94 92 not applicable REGISTRATION OF FOOD PREMISES During the year the following were registered, the total (including previous registrations still existing) being shown in the last column. Table 59 Type 1965 Total Sale and storage of icecream 9 473 Manufacture of icecream - 9 Fish frying 1 50 Fish curing — 18 Preparation or manufacture of sausages 1 76 Preparation or manufacture of potted, pressed, pickled or preserved food 5 128 UNSOUND FOOD Approximately 54 tons of food were surrendered as unfit for human consumption. This was dealt with by the Council's food inspectors and consisted of meat, fruit pulp, fish, vegetables etc. 77 CONTINENTAL GOODS DEPOT, HITHER GREEN Imports of perishable food from the continent through the Continental Freight Depot continues, and a small amount of food, mostly meat, has been exported. We are concerned insofar as unfit food or meat without proper documents may be imported, in which case we have to ensure that it is either destroyed or not used for human consumption. It may be necessary to contact wholesalers and various local authorities if it is intended for distribution elsewhere. The proportion of unfit food is again small (last year 0 003%). Totals for the year are shown in the table:— Table 60 Country of origin Tonnage imported Amount unfit and remarks (tons) Spain 76,666 3 ¾ potatoes Italy 37,472 1 peaches France 35,338 ¼ grapes Algeria 5,149 92 lbs. meat Yugoslavia 5,414 Belgium 1,218 Israel 50 Tunisia 71 Africa 75 Switzerland 24 Total 161,477 PHARMACY AND POISONS The names of 15 persons were entered on the Council's list of persons entitled to sell persons in Part II of the poisons list and the names of 155 persons previously registered were retained on the register. 170 visits were paid by the public health inspectors in connection with the granting and renewal of these licences. SLAUGHTERHOUSES AND SLAUGHTERMEN There are no slaughterhouses in the Borough. Two slaughtermen's licences were issued during the year. OFFENSIVE TRADES There are no offensive trades carried on in the borough. WATER SUPPLY Dr. E. Windle Taylor, The Director of Water Examination of the Metropolitan Water Board states that the water supplied both in quantity and quality during 1965 was satisfactory. The supply is somewhat complicated due to the number of sources consisting of River Thames derived filtered water from four of the Board's filtration stations in the Thames Valley and from four of the Board's wells in the Kent area. The details of the chemical quality of the water and the bacteriological quality of the sources are set out in the following tables. There were no new sources of water supply instituted in your area during 1965, but extensions to trunk mains amounted to 814 yards. Furthermore, there were no changes in the general scheme of supply to the Borough of Lewisham during 1965 but new service mains were laid in the Borough to the extent of 3,446 yards. 78 79 Table 61 Average results of the chemical and bacteriological examination of the water supply to the Borough of Lewisham for 1965 Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO4 4 hrs. at 27°C. Hardness (total) CoCO3 Hardness noncarbonate CaCO3 Magnesium as Mg Chloride as CI Phosphate as PO4 Silicate as Si02 Sulphate as S04 Natural Fluoride as F Surfaceactive material as Manoxol OT Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micromhos) Bexley 4 0.005 0.028 5.2 0.18 322 72 20 Nil Nil 7.2 580 Darenth 4 0.005 0.024 5.0 0.16 266 34 21 0.2 Nil 7.2 480 Deptford 4 0.007 0.030 5.6 0.18 360 116 39 0.1 Nil 7.1 690 Wilmington 4 0.020 0.025 6.9 0.14 290 56 25 0.2 2 7.2 540 All ThamesDerived 363 0.049 0.091 4.3 1.20 264 68 4 41 1.9 10 64 0.25 0.10 0.1 15 7.6 560 80 Table 62 Bacteriological Results—Yearly Averages, 1965 of water supplied to the Borough of Lewisham Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Agar plate count per. ml. Coli-form 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. Number of samples 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. Bexley 250 0.1 3 99.60 — 99.60 — 256 — 2 100.0 100.0 Darenth 251 0.1 4 100.0 — 100.0 — 256 0.1 3 100.0 100.0 Deptford 253 0.2 21 97.63 — 98.42 — 256 2.0 48 100.0 100.0 Wilmington No. 1 51 0.1 4 96.08 — 96.08 - 218 0.2 7 99.54 100.0 „ No. 2 168 0.7 14 100.0 — 100.0 All Thames-Derived 3,888 7.3 140 99.92 100.0 MORTUARIES, CREMATIONS, BURIALS AND EXHUMATIONS Mortuaries The two public mortuaries situated in the Borough receive bodies from other authorities' areas, mainly Greenwich, as well as from Lewisham. The number of bodies received into the Mortuaries during the year were as follows: Table 63 Lewisham Mortuary Deptford Mortuary Total Bodies received from hospitals etc. 632 378 1,010 Others 447 280 727 Totals 1,079 658 1,737 Cremations and Burials The following statistics relating to cremations and burials are for the year 1st April, 1965 to 31st March, 1966. Table 64 Cemetery No. of burials Hither Green 1,116 Grove Park 318 Ladywell 90 Brockley 72 Total 1,596 There were 1,282 cremations carried out at Hither Green Crematorium. One exhumation took place at Hither Green Cemetery. MEDICAL ARRANGEMENTS FOR LONG-STAY IMMIGRANTS At ports of arrival long-stay immigrants both Commonwealth and alien, are referred to medical inspectors and given a pamphlet printed in languages which they are likely to understand. This is to encourage them to register with a medical practitioner in their place of residence so that he can arrange for them to go to a mass radiography unit, a chest clinic or a hospital for X-ray. The health department is notified of the name and addresses of immigrants entering the borough with the object of ensuring that at an early date the immigrants are made aware of how to use the Health Service. An important aim of the department is to secure by persuasion that those from countries with a high incidence of tuberculosis have an X-ray of the chest as soon as possible. This applies particularly to people arriving from the Continent of Asia. 81 The following table, based on returns made to the Ministry of Health, shows the number of immigrants that have been notified to the department during 1965, and the number of successful visits made. Unsuccessful visits occur where the immigrant has moved out of the borough and has left no forwarding address. Towards the end of the year, however, much greater success was achieved in tracing transitory immigrants, as the landlords of temporary accommodation had been persuaded to keep records and inform us of the immigrants' whereabouts. Table 65 Country Number of Immigrants Number of first successful visits (a) Commonwealth Countries Carribean 527 328 India 42 17 Pakistan 7 7 Other Asian 18 6 Africa 81 54 Other 20 11 (b) Non-Commonealth Countries European 28 13 Other 8 5 TOTALS 731 441 82 MISCELLANEOUS NATIONAL SURVEY OF LEUKAEMIA AND MALIGNANT DISEASE OF CHILDHOOD During the year the Department has taken part in the national survey of leukaemia and malignant disease of childhood sponsored by the Department of Social Medicine, Oxford University, and the Medical Research Council. The family histories of children registered as having died from leukaemia or other malignant disease were investigated in co-operation with family doctors. A Medical Officer visited the parents of those children by special arrangement to enquire into the history of the child and the family, with special emphasis on x-ray investigation. A similar complete investigation was carried out in a control series of healthy children comparable for sex and age. A total of nine cases and nine "controls" were investigated in this way and complete records forwarded to Oxford. Because of the countrywide scale of these investigations, it is hoped that the information obtained will contribute towards elucidating the aetiology of malignant disease in childhood. NURSING HOMES Responsibility for the registration and inspection of nursing homes passed from the L.C.C. to the London Borough on 1st April 1965 and has since been exercised under Part VI of the Public Health Act 1936, the Nursing Homes Act, 1963, Part III of the Mental Health Act 1959 and the appropriate Regulations. At 1st January 1965 there were four registered nursing homes in the area of the present London Borough; one of these was registered for the accommodation of mentally disordered patients; none had been approved for the reception of maternity patients. Two non-profit making homes (which had been exempt from registration until the coming into force of the Nursing Homes Act 1963) were in the process of registration which was completed before 31st March 1965. The numbers of approved places by various categories were :— Table 66 31.12.64 31.12.65 Nursing homes registered 4 6 Maximum number of patients for which accommodation approved chronic sick, medical or surgical 35 65 Expectant or nursing mothers — 22 Babies nursed by mothers — 8 Mentally ill (informal only) 17 17 Total places 52 112 83 In addition to the two homes newly registered during the year, one home was re-registered in the name of the new proprietor and the former registration cancelled, and the registration of another home was amended to allow the accommodation of an additional surgical patient. NATIONAL CHILD DEVELOPMENT STUDY The department completed a follow-up study of the physical, sociological and educational status of children who are the survivors of the 1958 Perinatal Mortality survey. The study which was to relate findings to existing birth data, was completed by health visitors and school doctors. Seventy children residing in the Borough of Lewisham were involved. SUICIDE An investigation into the incidence of suicide and attempted suicide among residents of the former Metropolitan Borough of Lewisham was carried out with the help of the Department by Dr. G. I. Tewfik, M.D., D.P.M., Consultant Psychiatrist to Powick Hospital and lately Consultant to Bexley Hospital. Dr. Tewfik addressed a special meeting of the Health Committee in August on the subject. Dr. Tewfik was asked to enquire into suicide because the number of admissions to Lewisham Hospital for suicidal attempts in 1963 was four times as many as in 1957. The investigation was planned to discover whether the figures for successful suicide had also risen and if the Lewisham statistics coincided with the pattern for London and the country as a whole. 347 cases of suicide occurring in the Borough between the years 1950-1963 were studied; 215 males and 132 females. Comparing the rates for 1950-1956 with those of 1957-1963, there has been an increase of 31.2% males and 62.7% females. For the years 1955-1958 compared with the years 1959-1962, the rate has risen from 11.6 to 13.4 per hundred thousand, a rise of five places in the ranking order of London Boroughs. There has been a considerable ageing of the population with a decreased birth rate. There has been a slight increase in the number of divorced males and females and of widowed females. There has also been a gradual increase in the number of people living alone. In 1931 there were 0.84%, in 1951 3 5% and in 1961 4 6%. The numbers who were "foreign born" has also risen 0.76% in 1933, 2.3% in 1951 and 4.3% in 1961. Despite this only one case of attempted suicide in a coloured person could be recalled by the hospital staff. Compared with figures for England and Wales there has been an increase in the suicide rate in Lewisham in the 22-44 age group and in the elderly of both sexes. In his summing up Dr. Tewfik said "one can only conclude that either the psychiatric awareness of the general population has caused a change in the expression of distress from somatic to psychiatric channels, or what is more likely, is that there is a real increase in distress, misery and despair in the Lewisham District." In 1953 the Rev. Chad Varah advertised in the daily press for people contemplating suicide to telephone him on Mansion House 9000. Since that time the response to his invitation has been most remarkable. The callers have not all been about to commit suicide, but many have, and most of the rest have been in need of help, advice or just 84 friendship. It was found that many of the callers were not necessarily in need of professional advice from clergymen, doctors, psychiatrists or lawyers, as they often received the help they needed from the lay volunteers who turned up to assist the founder. All "Samaritans" are carefully chosen and trained for this sometimes very exacting work. After discussion with the Rev. Chad Varah it was decided that the best way that the Council could help the Samaritans was by judicially publicising their work and in particular the all important telephone number (Mansion House 9000) through the Health Bulletin, pamphlets and by word of mouth of officers who are likely to come into contact with people who are in distress. INCONTINENCE PADS The setting up of an incontinence pads service is under active consideration by the Council, and it is planned to operate a scheme for the provision of pads to incontinent patients and for the disposal of soiled ones, early in 1966. It is proposed that the distribution of incontinence pads will be made by the district nurses when in attendance upon incontinent patients. Arrangements will be made for the collection from the patient's home and for the disposal of soiled pads in a suitable incinerator to be installed at the Council's Cleansing Station at Wearside Road. The service will be extended to include the collection and disposal of soiled dressings or other materials arising in connection with domiciliary midwifery. MEDICAL EXAMINATION OF STAFF During the year 504 medical examinations (451 since the reorganisation of the Borough) of staff were carried out mainly in connection with the superannuation and sickness schemes and for some occupations for which medical examinations are considered advisable. 85 INDEX Page Page Adoption and Boarding Out 18 Handicapped Children 36 Animal Boarding 67 Handicap Register 19 Antenatal & Post-natal Care 16 Health Education 38 Anthrax 47 Health Education, Schoolchildren 28 Anti-fly campaign 65 Heart Disease 12 Area of Borough 9 Home Help Service 43 Atmospheric Pollution 67 Home Nursing 20 Home Nursing, staff training and Post graduate courses 22 Attendants 21 Home Nursing, Transport 22 B.C.G. Vaccinations 50 Homes in Clearance Areas 70 Births and Birthrate 0 Home Purchase Loans 72 Blind and Partially sighted persons 18 Honor Lea Hostel 40 Brockley Traning Centre 39 Burhls Houses in Multiple Occupation 70 Icecream 74 Care Committee (tuberculosis) 49 Immigrants 81 Case Conferences 43 Immunisation & Vaccination 55 Cervical Cytology 25 Improvement Work 72 Chest Clinics 49 Incontinence Pads 85 Child Developing Study 84 Infant Mortality 10 Child Minders 17 Infectious Diseases 45 Children's Department, co-operation with 20 Infectious Diseases, Schools 35 Children's Nightdresses 67 Chiropody Service 23 Clean Air 67 Junior Training Centre 39 Cleansing, Personal 65 Clearance Areas 72 Laboratory Facilities 56 Communicable disease, surveys (schools) 35 Lewisham Chest Clinic 50 Consumer Protection 67 Leukaemia 83 Co-operation with Voluntary Loans (House Purchase) 1- Organisations 42 Loan Service 21 Co-ordinating Committee 42 Lung Cancer 13 Cremations 81 Mass Radiography Unit 53 Maternal Deaths 17 Day Nurseries 7 Measles 47 Day nursenes, private 17 Medical Examinations of Staff 85 Deaths & Deathrate 0 Mental Health 39 Deaths by Cancer 3 Mental Health, Co-operation with Deaths by Social Class 1 - voluntary organisations 42 Dental Auxiliaries, School tor 2 Mental Health, Emergency Service 40 Dental Service. Maternal & Child Health 23 Mental Health, Social Clubs 41 Dental Service, Schools 31 Mental Subnormality 39 Deptford Chest Clinic 52 Mice 55 Deptford Training Centre 39 Midwifery, Liaison between midwives Disinfection and Personal Cleansing 65 and general practitioners 16 Dysentery 48 Midwifery, Night rota arrangements 16 Midwifery Service 16 Early Care Unit 39 Midwifery with Hospital services 16 Early Neo-Natal deaths 10 Milk 73 Educationally Sub-normal pupils 36 Mortuaries 81 Employment of schoolchildren 36 Mothercraft Unit 19 Environmental Health 57 Exhumation 81 National Assistance Act, section 47 64 National Child Development Study 84 Factories 60 Neo-natal deaths 10 Family Casework 43 Nightdresses, Children's 67 family casewonc Nursing Homes 83 Food 74 Nursing, Home 20 Food Poisoning 47 Offensive T rades 78 Offices, Shops & Railway Premises 62 General Statistics from 1950 15 Outworkers 62 86 INDEX—continued Page Page Perinatal Mortality 10 Shaftesbury House Day Nursery 39 Pet Animals 66 Sickness, Local 14 Pharmacy & Poisons 78 Slaughterhouses and Slaughterers 78 Pigeons 66 Smoke Control 67 Plantar Warts in Schoolchildren 36 Social Clubs 41 Population 9 Social Work (Schools Health Service) 35 Prevention of Damage by Pests 65 Stillbirths 10 Sub-normal pupils, educationally 36 Rag, Flock & Other filling materials 66 Suicide 84 Rateable Value 10 Swimming Baths 66 Rats & Mice 65 Recuperative Holidays 19 Tuberculosis 48 Rehabilitation of Mothers 19 Tuberculosis, boarding out of contacts 18 Rent Act 70 Tuberculosis, Graph 51 Reproductive Wastage 10 Tuberculosis, Hostel Accommodation 49 Risk & Handicap registers 19 Tuberculosis, Post Hospital rehabilitation 49 Samples 74 Unfit Houses 70 Scarlet Fever 48 Unsound Food 77 Schoolchildren, Employment of 36 Schoolchildren, Personal Hygiene 30 Vision, School Medical Inspections 34 Schoolchildren, Plantar Warts 36 Vital Statistics 9 School for Dental Auxiliaries 23 School Health 27 Water Supply 78 School Medical Inspection 28 Whooping Cough 48 87 TABLES No. Subject Page 1. Causes of death by age groups 11 2. Causes of death by social class 12 3. Heart and circulation mortality 4. Cancer deaths 13 5. Grouped deaths in social class 14 6. Mortality shown in insurance certificates 14 7. General statistics from 1950 8. Recuperative holidays 19 9. At "Risk" and "Handicap" Registers 20 10. Adoption and Boarding out 20 11. District Nursing loan equipment 22 12. Dental service, Maternity and child healt 13. School for Dental Auxiliaries 23 14. Summary of attendances—Chiropody 24 15. Clinic Analysis totals—Chiropody 16. Attendance Analysis—Chiropody 25 17. Cervical Cytology, Amersham Road Clinic 26 18. Cervical Cytology, Central Lewisham Clinic 26 19. Routine inspections of schoolchildren 29 20. Routine inspections of schoolchildren—Defects 29 21. Personal hygiene of schoolchildren—Surveys 30 22. Dental inspection of schoolchildren 31 23. Non routine medical inspections of schoolchildren 33 24. Routine inspections of schoolchildren—Vision 34 25. Infectious diseases of schoolchildren 35 26. Communicable Disease Surveys—Schoolchildren 27. Home Helps 44 28. Notified cases of infectious diseases 45 29. Notification of infectious diseases by sex and age 46 30. Food poisoning cases 47 31. Tuberculosis, notifications and deaths 50 32. Mass Radiography 33. Mass Radiography, surveys 54 34. Immunisation and Vaccination 35. Laboratory facilities 56 36. Sanitary inspections 37. Summary of notices 38. Repairs carried out 60 39. Factory inspection 61 40. Factory defects 61 41. Outworkers 62 42. O.S.R. Number of visits 63 43. O.S.R. Registrations and inspections 63 44. Persons employed, O.S.R 64 45. Exemption, O.S.R 64 46. Disinfection and Personal Cleansing 65 47. Rodent Control 48. Swimming baths 66 49. Clean Air Act Programme 50. Atmospheric Conditions 51. Rent Act, 1957 70 52. House in Clearance areas and unfit houses elsewhere 70 53. Analysis of milk 73 54. Analysis of ice-cream 74 55. Grading of ice-cream 74 56. Samples analysed 75 57. Adulterated samples 75 58. Food Premises, washing facilities 77 59. Registration of food premises 77 60. Continental Goods Depot 78 61. Water, chemical analysis 79 62. Water, bacteriological samples 80 63. Bodies received in Mortuaries 81 64. Burials 81 65. Immigrants 82 66. Nursing Homes 83 88