BOROUGH OF LEWISHAM ANNUAL REPORT 1966 Medical Officer of Health CONTENTS Page Introduction 5 Public Health Committee 7 Public Health Staff 7 The Borough 10 General Provision of Health Services in Area 10 Vital Statistics 13 PERSONAL HEALTH SERVICES 18 Midwifery 18 Cervical Cytology 19 Day Nurseries and Child Minders 20 At Risk and Handicap Register 21 Health Visiting 23 Loan Service 25 District Nursing 26 Dental Services 27 Chiropody Service 30 School Health 31 HEALTH EDUCATION 40 COMMUNITY HEALTH SERVICES 42 Mental Health 42 Home Help Service 47 INFECTIOUS DISEASES 49 Chest Clinics 52 Mass Radiography 54 Immunisation and Vaccination 57 ENVIRONMENTAL HEALTH 59 Summary of Inspections and Notices Served 60 Factories 61 Outworkers 63 Offices, Shops and Railway Premises Act 63 Disinfection and Personal Cleansing 65 Prevention of Damage by Pests 66 Swimming Baths 66 Rag Flock and Other Filling Materials Act 67 Destruction of Pigeons 67 Pet Animals Act 67 Animal Boarding Establishments Act 67 Riding Establishments Act 67 Atmospheric Pollution 67 Housing 70 Milk 73 Icecream 74 Food 75 Pharmacy and Poisons 80 Legal Proceedings 80 Water Supply 80 Mortuaries 83 Immigrants 83 MISCELLANEOUS 85 National Survey of Leukaemia 85 Family Planning 85 Nursing Homes 86 Medical Pointing of Housing Applications 87 TO THE MAYOR, ALDERMEN AND MEMBERS OF THE COUNCIL 1 have the honour to submit my report on the Health Services in the Borough for the year 1966. This has been a year of consolidation of services, and also a year of expansion. Planning in conjunction with representatives of the Inner London Education Authority, Inner London Executive Council, Inner London Local Medical Committee, Ministry of Health officials and members of the Health Committee has taken place, culminating in a firmly based scheme for the building of a number of Health Centres over the next decade. The Health Education Section of the Department is now well equipped and is involved in many activities in the field of preventive medicine. The cumulative effect of the many talks, more often than not illustrated with films and other material aids, together with the constant display of health propaganda posters and leaflets is difficult to measure, but in many small ways the workers in the field notice an increasing awareness and practice by the public of the precepts of good health expounded to them. Health visiting services in many parts of the Borough are handicapped by inadequate or unsuitable premises. In some instances Health Visitors have no facilities for interviewing mothers in their district. In others, premises are draughty and lack proper washing and other essential amenities. In spite of these difficulties the service functions with quite remarkable efficiency due to the excellent efforts of the staff. Nevertheless the need for suitable premises must be emphasised and it is hoped that the provision of Health Centres will not be long delayed. The maternal and School Health Dental services show an increasing number of attendances at clinics. Centres to cover the Sydenham, Forest Hill and Brockley areas are urgently needed. Schoolchildren from these areas have to be provided with transport to take them to clinics in other parts of the Borough. Increasing Mental Health services provided during the year included additional special advisory clinics. In addition to other liaison committees a Mental Subnormality Liaison Committee was established. This committee, which meets quarterly, helps to promote understanding between the various branches of the health service concerned with this aspect of mental health. The specialist advice is of great value in considering the need of the Council's mental health services for the future. These aspects of the service and other important developments receive comment in the body of this report. There were no major outbreaks of infectious disease during 1966 and the incidence of disease generally compares very favourably with previous years. The Infant Mortality Rate of 21.6 compares with a rate of 23.3 in 1965 for the Borough and rates of 17.8 for London and a National figure of 18.9. The majority of deaths which contribute to the infant mortality rate are due to congenital disturbances or abnormalities. Research into causation and the possibility of prevention continues. Some improvement in the staff position of the Public Health Inspectorate has enabled a greater deployment of staff to be made in connection with the provisions of the Offices, Shops and Railway Premises Act, and for more detailed work in connection with Housing to be carried out. This section's activities are still hampered, however, by staff shortages, particularly in technical assistants. The difficulty here is mainly one of accommodation. 5 At the start of this preamble I spoke about 1966 as being a year of consolidation and expansion of many aspects of the Department's work, and of plans for the future development of services. This reflects a dynamic and forward looking attitude by all concerned with the health of the Borough. I am especially grateful to the Chairman and Members of the Health Committee, the Town Clerk, other Chief Officers and not least to the members of the Health Department staff for their support and enthusiasm during an inspiring year. F. R. WALDRON, Medical Officer of Health. 6 HEALTH COMMITTEE, 1966 The Mayor (Alderman H. M. WEST, J.P.) Chairman: Councillor F. W. BULLION, O.B.E., J.P. Vice-Chairman: Councillor A. A. GROVES Alderman Mrs. M. J. Chrisp Councillor H. W. Eames, M.B.E., M.A., LL.B. „ Mrs. J. R. Steyne „ P. E. J. Forward „ J. F. W. Waldon „ W. Hall F. M. Judge, M.P.S. Councillor A. H. Boon „ F. J. Keep „ Mrs. D. I. Cox „ Mrs. G. M. M. Land „ Mrs. D. E. Eagles „ A. J. Pinnegar 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.) HEALTH DEPARTMENT as at 31.12.66 (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 Officer: A. G. Poulsen-Hansen, M.D., D.P.H., D.T.M.H. Senior Assistant Medical Officers: Betty E. Shortland, M.B., B.S., D.P.H. Isobel Smith, M.B., B.S., M.R.C.P., 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. Enid C. Vincent, M.B., Ch.B., D.P.H. Janet P. Boakes, M.R.C.S., L.R.C.P., M.B., B.S. 10 Vacancies and 45 sessional M.O.s (a) Chief Dental Officer: Edith Mahler, M.D., L.D.S. (a) Dental Officers: Clare M. Leeming, B.D.S. R. H. Sainsbury, B.D.S., L.D.S., R.C.S. Joyce Smail, L.D.S. P. Sivagurunathan, F.D.S., L.D.S., R.C.S. 3 vacancies; 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. Maureen Allen, S.R.N., S.C.M., H.V. 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. Rose Evans, S.R.N., S.C.M., D.N. Certs. Midwives (30); Pupil Midwives (up to 16) Superintendent (District Nursing): Elsie K. Ford, S.R.N., S.C.M.. H.V. and D. N. Certs. Assistant Superintendent (District Nursing): 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. Senior Chiropodists: P. W. Capon, L.Ch., M.Ch.D., S.R.Ch. P. V. Rhodes, M.Ch.S. Irene E. Yeomans, M.Ch.S. 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 Social Workers Honor Lea Hostel: Warden; B. W. Murray, R.M.P.A. Assistant Warden: T. W. MacMillan and 3 Assistants Visiting Medical Officer: D. J. Adderley, M.R.C.S., L.R.C.P., D.P.M. Supervisors of Training Centres: Alice M. Potter Alice J. Thompson H. F. Weaver and 15 Assistants Supervisors of Day Centres: P. W. Postle Gillian Beckett, M.A.D.T. and 3 Instructors (a) Principal Social Worker: Eileen L. Stocker, Dips. Social Studies and Casework, A.A.P.S.W. (a) Assistant Principal Social Worker: Betty J. Hardy, B.A., (Soc.Sc) and 3 Social Workers Family Case Workers: Anne V. Dey, M.A., Dip. Social Studies and Julia Sarkic, S.R.N., S.C.M., H.V., Dip. Social Applied Social Studies Studies, Tavistock A.C.C. Home Help Organisers: Ivy I. Stittle Beatrice Kneller Muriel Wakeford. and 5 Assistants 630 Home Helps 8 Care Committee Organisers, Chest Clinics: Vera L. Verrall* Ethel M. Robertson (Acting) Veronica Ollerenshaw * Absent on Training Course Social Worker V.D. Clinic: Vacancy 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 3 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. Assistant Senior Public Health Inspectors: H. W. Ellery, M.A.P.H.I. G. Belshaw, M.A.P.H.I. 17 District Public Health Inspectors and 11 Technical Assistants. Bathing Station Superintendents: H. W. Wellbelove 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 (Head of Section) (Head of Section) (Head of Section) W. Fancy, B.Sc. (Econ) G. M. Jobbins C. R. Coleman, D.M.A., (Senior Assistant) (Senior Assistant) (Senior Assistant) A. C. Shoult (Senior Assistant) Sadie Attfield (Senior Assistant) 9 Administrative 14 Administrative and clerical and clerical assistants 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. 9 THE BOROUGH The Borough of Lewisham covers approximately eleven square miles, and is bounded by the Boroughs of Greenwich, Bromley and Southwark and by the River Thames on the north. Three rivers run through the area, the Ravensbourne, the Pool and the Quaggy. The area consists of the low-lying Ravensbourne Valley running north to south with high ground rising on either side to high points at Crystal Palace and Sydenham standing at 250' above the Thames and Hilly Fields at 150' on the west side, and Downham and Blackheath at 150' on the east side. The level of land drops sharply to a basin of reclaimed marsh along the river at Deptford. London clay is the prevalent surface soil, which overlays chalk in certain areas such as St. John's and Blackheath. Below this lies Thanet Sand which overlays the Woolwich beds of gravel and the Blackheath beds of gravel and sand. Over one third of all the Borough's industries are concerned with some form of engineering. Industry is concentrated mainly in Catford, Lewisham, Leeand Deptford. The Borough is densely populated, but well provided with open spaces. Housing estates owned by the Greater London Council are at Downham and Bellingham, and estates owned by the Lewisham Borough Council are in the Grove Park, Bellingham and Forest Hill areas. Rebuilding in the Deptford area is mainly being undertaken by the Lewisham Borough Council in co-operation with the Greater London Council. The main building programme in Deptford at present is the new estate by the Thames. GENERAL PROVISION OF HEALTH SERVICES IN AREA Hospitals There are six hospitals within the area of the Borough, but many patients are referred to others for various reasons. The following is a list of those to which the majority of Borough patients normally attend. Lewisham, Lewisham High Street, S.E.13 Lewisham Group Hospital Management Committee Grove Park, Marvels Lane, S.E.12 „ Hither Green, Hither Green Lane, S.E.13 „ St. John's, Morden Hill, S.E.13 „ New Cross General. Avonley Road, S.E.14 Board of Governors of Guy's Hospital Children's Hospital, Sydenham, S.E.26 Bromley Group Hospital Management Committee Miller Wing, Greenwich High Road. S.E.13 Greenwich District Hospital, St. Alfege's Wing, Vanbrugh Hill, S.E.10 Greenwich and Deptford Group Hospital Management Committee Brook General, Shooters Hill Road, S.E. 18 Woolwich Group Hospital Management Committee The London Teaching Hospitals The Psychiatric hospitals that serve this area are Bexley (Bexley Group Hospital Management Committee), Cane Hill (Cane Hill Group Hospital Management Committee), and Darenth Park (Darenth and Stone Group Hospital Management Committee) which is the main centre for mental subnormality. General Practitioners There are 133 general practitioners serving patients in Lewisham. The numbers serving broad areas of the Borough are: Bellingham, Catford, Lewisham, Hither Green, 43 Sydenham, Forest Hill, Brockley, 37. Deptford, 27. Blackheath, Lee, Grove Park, Downham, 26. Chest Clinics Deptford Chest Clinic, Harton Street, S.E.8. Lewisham Chest Clinic, 1 Blagdon Road, S.E.13. Venereal Diseases Clinics King's College Hospital, Denmark Hill, S.E.5. Miller General Wing, Greenwich District Hospital, S.E.10 St. John's Hospital, Morden Hill, S.E.13 Dreadnought Seamen's Hospital Greenwich, S.E.10 10 HEALTH CENTRES AND CLINICS Name, Address, and Telephone No. Type of Clinic Amersham Road, Ante-Natal. Child Health, Toddlers, Immunisation, Amersham Road, S.E.I4. Mothercraft, Welfare Food Sales, Vaccination, Special 692 4417 Advisory, Cytology Bellingham, Child Health, Immunisation, Welfare Food Sales, Community Centre, Bellingham Green, Vaccination S.E.6. Blackheath Hill, Child Health, Immunisation, Vaccination, Welfare Merton Place, S.E.10 Food Sales 692 3518 Boundfield Road, Ante-Natal, Child Health, Immunisation, Welfare Community Centre, S.E.6 Food Sales, Vaccination 698 3585 Central Lewisham, Ante-Natal, Child Health, Immunisation, Mothercraft, 410 Lewisham High Street, S.E.13 Family Planning, Welfare Food Sales, Cytology, 690 1182 Occasional Creche, Vaccination, Special Advisory Downham, Ante-Natal, Child Health, Toddlers' Immunisation, 24 Churchdown, Downham, Kent. Mothercraft, Family Planning, Relaxation, Welfare 698 1344 Food Sales, Vaccination Flower House, Ante-Natal, Child Health, Immunisation, Mother- 1 Winnett House, craft, Relaxation, Family Planning, Welfare Food Beckenham Hill Road, S.E.6 Sales 698 5498 Forest Hill, Child Health, Immunisation, Vaccination, Welfare St. Saviour's Church Hall, Food Sales Brockley Rise, S.E.23. Gosterwood Street, Child Health, Immunisation, Vaccination, Welfare St. Luke's Hall. S.E.8. Food Sales Grove Park, Child Health, Immunisation Vaccination, Welfare Methodist Church Hall, Food Sales Burnt Ash Hill, S.E.I2. Hither Green, Child Health, Immunisation, Welfare Food Sales, Methodist Church Hall Vaccination 53 Torridon Road, S.E.6. Gloucester Hall, Child Health, Immunisation, Vaccination, Welfare Frankham Street, S.E.8. Food Sales Lee and Blackheath, Child Health, Immunisation, Welfare Food Sales, Methodist Church Hall, Vaccination Lee High Road, S.E.I2 Louise House, Ante-Natal, Child Health, Immunisation, Mother- Dartmouth Road, S.E.23. craft, Vaccination, Family Planning, Occasional 699 2257 Creche, Welfare Food Sales, Cytology Speedwell Street, S.E.8. Ante-Natal 692 6401 St. Mary's, Child Health, Welfare Food Sales St. Mary's Church Hall, Ladywell Road, S.E.13. Spalding House, Ante-Natal, Child Health, Immunisation, Family 2 Spalding House, Planning, Welfare Food Sales, Vaccination Honor Oak Estate, S.E.4. 639 1479 Sydenham Hill, Child Health, Immunisation, Welfare Food Sales, Tenants' Clubroom, Vaccination Sydenham Hill, S.E.26. Tranquil Vale W.C., Ante-Natal, Child Health, Immunisation, Occasional All Saints' Hall, Creche, Vaccination Tranquil Vale, S.E.3. Trewsbury Road, Child Health, Immunisation, Mothercraft, Vaccination All Saints' Parish Church Hall Trewsbury Road, S.E.26 778 3204 11 SCHOOL HEALTH SERVICE The Inner London Education Authority is responsible for providing comprehensive facilities for free medical and dental treatment to school children. Treatment centres (listed below) are provided for the following, directly by the Authority or by arrangement with the South East Metropolitan Regional Hospital Board: Minor ailments Ear, Nose and Throat Dental Orthoptics Vision Special investigation Health Centre, Amersham Road, Special investigation S.E.14 692 4417 Deptford S.T.C., Reginald Square. Ear, nose and throat, vision, orthoptics, minor ailments, S.E.8. 692 1722 dental, speech therapy Downham Health Centre, Churchdown, Minor ailments, vision, dental, speech therapy, special Downham 698 1344 investigation. Samuel Pepys School, Minor ailments Wallbutton Road, S.E. Turnham S.T.C., 2 Spalding House, Vision, minor ailments Honor Oak Estate, S.E.4 639 1479 Lewisham S.T.C., 78 Lewisham Park, Vision, minor ailments, dental, special investigation, S.E.13. 690 1691 audiology Lewisham Hospital, S.E.13 690 4311 Auditory training unit, orthoptics, hearing investigation special investigation. Sydenham S.T.C., Adamsrill School, Minor ailments Lower Sydenham, S.E.26 699 6625 Children's Hospital, S.E.26 778 7031 Special investigation School for Dental Auxiliaries, Dental New Cross Hospital, S.E. 13 639 7761 Day Nurseries Health Centre, Amersham Road, S.E.14 41 Rushey Green, S.E.6. 67 Perry Rise, S.E.23 Dental Surgeries 78 Lewisham Park, S.E.13 Downham Health Centre, Churchdown, Downham Reginald Square, S.E.8 School for Dental Auxiliaries, New Cross, S.E.14 Chiropody Amersham Road, Health Centre, S.E.14 Louise House. Dartmouth Road, S.E.23 28 Sangley Road, S.E.6 Day Rehabilitation Centres (Mental Health) Cambridge Day Centre, Burnt Ash Hill, S.E.12 Princess Louise Institute, Hales Street, S.E.8. Training Centres (Mental Health) 69 Perry Rise, S.E.23. St. Peter's Hall, Cranfield Road, S.E.4. St. Michael's Church Hall, Knoyle Street, S.E.14. Hostel Accommodation (Mental Health) Honor Lea, 103/117 Brockley Rise, S.E.23. Cleansing and Disinfecting Stations Wearside Road, S.E.13. Speedwell Street, S.E.8. Mortuaries Ladywell Road, S.E.13. Watson Street, S.E.8. 12 VITAL STATISTICS Area of the borough 8,579 acres. Population Census 1961 290,582 Estimate of Registrar General at midyear 1966 289,130 Rateable Value Rateable value of the borough at April 1, 1966 £ 11,952,630 Estimated net product of a penny rate 1966/7 £47,500 Estimated number of separately assessed dwellings at April, 1 1966 85.503 Births Males Females Total Legitimate 2,451 2,368 4,819 Illegitimate 373 359 732 Totals 2,824 2,727 5,551 Crude birth rate per 1,000 of the estimated population 19-2 Adjusted birth rate for comparative purposes (Area comparability factor= 0.96) 18'4 Stillbirths Total (43 males and 42 females) 85 Rate per 1,000 live and stillbirths 15-1 (males 15.0 females 15.2) Deaths Total (1,795 males, 1,611 females) 3,406 Crude death rate per 1,000 population 11-8 Adjusted death rate (areacomparability factor 0.96) 11*3 Infant mortality Infant deaths (all deaths of liveborn children under one year) Males Females Total Legitimate 66 40 106 Illegitimate 7 7 14 Totals 73 47 120 Death rate of all infants per 1000 livebirths 21-6 Death rate of legitimate infants per 1000 legitimate livebirths 22 0 Death rate of illegitimate infants per 1000 illegitimate livebirths 19-1 Death rate of male infants per 1000 male livebirths 25-8 Death rate of female infants per 1000 female livebirths 17-2 Neonatal deaths (under 4 weeks of age) 88 (54 males, 34 females) Males per 1000 male livebirths 19-1 Females per 1000 female livebirths 12-5 All infants per 1000 livebirths 15-8 Early neonatal deaths (under 1 week of age) 79 (51 males, 28 females) Males per 1000 male livebirths 18-1 Females per 1000 female livebirths 10-3 All infants per 1000 livebirths 14-2 Perinatal mortality (deaths under 1 week plus stillbirths) 164 (94 males, 70 females) Males per 1000 live and still male births 32'8 Females per 1000 live and still female births 25-3 All infants per 1000 live and stillbirths 29-1 Reproductive wastage (stillbirths plus all infant deaths) 205 Males per 10001 ive and still male births 40-5 Females per 1000 live and still female births 32-1 All infants per 1000 live and stillbirths 36-4 Maternal deaths Maternal deaths 1 Maternal mortality rate per 1000 live and stillbirths 0-2 13 Table 1 TOTAL DEATHS BY CAUSE AND AGE REGISTERED DURING 1966 Disease Sex All ages Under Atuks. 4 tvks under 1 year 1- 5- 15- 25- 35- 45- 55- 65- 75 & over  All causes M 1795 54 19 6 5 20 26 41 132 341 476 675 F 1611 34 13 11 5 11 15 34 73 188 346 881 1. T.B. Respiratory M 7 - - - — — — — 1 1 4 1 F 6 - - - - - - 1 — 2 1 2 2. T.B. Other M 1 - - - - - 1 - - - - - F - - - - - - - - - - - - 3. Syphilitic Disease M 4 - - - - - - - - - 3 1 F 5 - - - - - - - - 2 1 2 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 1 — 1 - - - - - - - - - 9. Other Infective & Parasitic Diseases M - - - - - - - - - - - - F 1 - - - - - 1 - - - - - 10. Malignant Neoplasm of Stomach M 49 - - - - - 1 — 5 10 20 13 F 22 - - - - - - - - 4 8 10 11. Malignant Neoplasm of Lung, Bronchus M 169 - - - - - - 2 15 50 65 37 F 36 - - - - - - 3 5 6 12 10 12. Malignant Neoplasm of Breast M — — — — — — — — — — — — F 55 - - - - - 1 4 9 21 6 14 13. Malignant Neoplasm F 22 - - - - - 1 2 1 8 6 4 14. Malignant Other & Lymp. Neoplasms M 169 — — — — 3 3 5 13 33 43 69 F 164 — — 1 — 1 1 6 13 38 50 54 15. Leukaemia, Aleukaemia M 16 — — — 1 1 1 1 2 5 3 2 F 9 — — — — 1 — 1 2 1 1 3 16. Diabetes M 11 - - - - - - 1 2 3 3 2 F 23 - - - - - - 1 — — 8 14 17. Vascular Lesions of Nervous System M 162 — 1 — — — 2 5 5 13 41 95 F 255 - - - - - 1 3 11 21 50 169 18. Coronary Disease, Angina M 429 - - - - - - 10 41 102 121 155 F 302 — — 1 — — 1 — 5 40 81 174 19. Hypertension with Heart Disease M 21 - - - - - - 1 1 2 4 13 F 25 - - - - - - 1 1 — 7 6 20. Other Heart Disease M 91 — — 1 — 1 1 2 8 8 27 43 F 166 — — — — 1 2 3 10 16 30 104 21. Other Ci rculatory M 63 — — — — 1 1 — 4 14 17 26 F 72 - - - - - 2 1 3 2 16 48 22. Influenza M 4 - - - - - - - - - 2 2 F 3 — — — — — — — — — 1 2 23. Pnuemonia (including Pneu. of Newborn) M 139 .— 11 — — — — 2 6 12 27 81 F 159 3 3 1 — 2 — 1 3 4 17 125 24. Bronchitis M 157 - - - - - - - 6 33 55 63 F 57 — 4 1 — — — 2 — 5 14 31 25. Other Diseases of M 21 — - 1 — — — — 1 3 5 11 F 8 - - - - - - - - - 1 6 26. Ulcer of Stomach & M 26 - - - - - - - - 11 7 8 F 7 - - - - - - - - - 4 3 27. Gastritis, Enteritis M 5 — 2 1 - - - - - 1 — 1 F 15 1 1 — — 1 2 10 28. Nephritis & Nephrosis M 14 — - - 1 — — 1 1 4 3 4 F 10 - - - - - - - 1 — 3 4 29. Hyperplasia of Prostate M 14 - - - - - - - 1 1 3 9 30. Pregnancy, Childbirth, F 1 - - - - 1 - - - - - - 31. Congenital Malformations M 12 6 2 1 — 1 — 1 — — 1 — F 17 9 3 1 1 — 1 — — 1 — 1 32. Other Defined & 111- M 133 47 2 — 2 1 3 3 9 17 15 34 F 127 22 1 1 2 - 1 3 5 12 18 62 33. Motor Vehicle Accidents M 28 - - - - 8 2 5 5 3 1 4 F 11 — — — — 1 — 1 2 — 3 4 34. All other Accidents M 29 1 — 2 1 3 6 1 2 10 3 — F 22 — — 4 1 2 — 1 1 3 2 8 35. Suicide M 19 - — — — 1 4 1 4 5 3 1 F 9 — — — 2 2 — 1 1 2 1 36. Homicide & Operations of War M 1 - - - - - - - - - - - F 1 - - - - - - - - - - -- 14 HEART DISEASE The percentage of cardiovascular and atherosclerotic disease as a group has not varied much during the past ten years as table 2 shows. This group of deaths, taken as a single cause, rank above any other single cause of death among the population. Table 2 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) (h) (i) of(f)of (h) (j) (g)of (h) (k)  (a) (b) (c) (e) (f) (g) (h) (d) 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 70 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 1966 731 303 135 1,169 257 188 3,406 34 7.5 5.5 LUNG CANCER The Health Education team continued with all the methods at their disposal to discourage cigarette smoking, but it is an uphill battle which will go on without let.up until lung cancer ceases to be of any significance as a cause of death. Table 3 LUNG CANCER Year MALE FEMALE All cancer deaths Lung cancer deaths (c)as % of lb) All cancei. deaths Lung cancer deaths (f)as Vo of(e)  (a) (b) (c) (d) (e) (/) (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 1966 403 169 42 308 36 12 15 LOCAL SICKNESS The Regional Controller of the Ministry of Social Security 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 4 MORBIDITY SHOWN IN INSURANCE CERTIFICATES Weekly average for period ending 1965 1966  January 25 1,814 1,508 February 22 1,286 1,889 March 22 1,549 1,684 April 19 1,511 1,242 May 17 1,167 1,172 June 14 866 1,228 July 12 853 928 August 9 812 880 September 6 760 908 October 4 1,031 1,025 November 1 1,178 1,418 November 29 1,207 1,443 December 27 1,163 1,216 Weekly average for the year 1965 1,171 ,, ,,1966 1,253 Table 5 GENERAL STATISTICS FROM 1950 Year Population Death rate * % dying under age 45 dying under age 65 Birth rate * Maternal Death rate t Still.birth rate t Infant mortality rate * * Pulmonary Tuberculosis Notif. rate f f Death rate t t  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 296,290 111 7.1 28.4 141 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 1966 289,130 11.8 8.6 30.2 19.2 0.2 15.1 21 .6 47 5 * Per 1,000 population. t per 1,000 Registered Live and Still Births * * Per 1,000 Registered livebirths †t Per 100,000 population PERSONAL HEALTH SERVICES DOMICILIARY MIDWIFERY The changing pattern in maternity services generally was evident to a small degree in Lewisham as shown by an increase in the number of patients delivered in hospital and discharged early to be cared for in the community. In 1965 domiciliary midwives delivered 1,498 mothers at home and cared for 951 who were discharged early. In 1966 the numbers were 1,337 and 1,100 respectively. The Central Midwives Board in their most recent report, emphasise the importance of regarding the maternity service as a whole, from the point of view of midwifery practice and training. Staff With the withdrawal of midwifery services on an agency basis by the Nursing Sisters of St. John the Divine, and the Salvation Army it became necessary for the Council to assume responsibility for domiciliary services in the part of Deptford and South London formerly covered by this association. The arrangement took effect from 1st April 1966. Parting with such long established and efficient services was a matter for great regret and it is a matter for congratulation that the Borough midwifery staff shouldered the additional responsibility without any lessening of services given. The full time midwifery staff of the Borough is now 26, 6 part-time midwives are also employed. Training Fourteen midwives are approved by the Central Midwives Board as district teaching midwives, and train pupil midwives for three months district experience that is required in the second period of their training. During the year 37 pupil midwives completed their district training and a further 14 were in training at the end of the year. Only one, who was herself pregnant, failed her examination. An inspection of pupil midwife training carried out on behalf of the Central Midwives Board during the year showed that the local arrangements were commendable. Liaison with the General Practitioner Service The arrangements whereby 18 General Practitioners attend midwives ante-natal clinics continued. A total of 15,172 clinic attendances were made at the fourteen weekly ante-natal sessions. A further 9,607 ante-natal home visits and 26,848 post-natal visits were made by midwives. Liaison with the Hospital Services Domiciliary midwives paid 1958 visits to expectant mothers to assess whether on social grounds a hospital confinement was necessary, or whether a planned early discharge was possible. Out of the 1,100 early discharges nursed by domiciliary midwives, 298 were at some period originally booked for a home delivery, 501 were planned discharges and the remainder came home for some reason. The Emergency Obstetric Unit from Lewisham Hospital was called out 16 times during the year. This service is obtained by either doctor or midwife telephoning the Headquarters Control of the Greater London Council Ambulance Serv'ce who, having contacted the nearest hospital providing such a service, send an ambulance there to collect the team. The Emergency Obstetric Unit is used for all grave emergencies of pregnancy labour, and the post-natal period. This includes cases of threatened abortion where the family doctor may be called to deal with a sudden emergency. The premature baby unit is sent out from Lewisham Hospital when required. 46 premature babies, i.e. those weighing 5i lbs or less, were born at home, of those, 10 were admitted to hospital. 18 Resuscitation of Infants A new small portable apparatus—the Blease Samson Neo-natal resuscitator has been specially designed to ventilate the lungs of a newly born baby with safety. It can be used with air or oxygen on babies who are not breathing well at birth. Six of these were purchased and distributed to selected midwives but fortunately, the necessity to use them has only occurred once. Analgesia in Labour Every midwife is qualified to give inhalation analgesia in childbirth. The majority of midwives are using the Teccota, Mark V apparatus for administering Trilene. A new machine called the Entonox giving a 50/50 mixture of nitrous oxide and oxygen from a single cylinder in which the gases have been pre-mixed has been approved as safe by the Medical Research Council and the Central Midwives Board. Three of these machines were purchased when additional equipment was required in April. Pethidine, which is administered by intra-muscular injection is available either alone or in addition to inhalation analgesia. Maternal Deaths 4 maternal deaths occurred in 1966. These were investigated jointly by the Medical Officer of Health and a Consultant Obstetrician under the procedure laid down by the Ministry of Health for the Confidential Enquiry into Maternal Deaths. Cervical Cytology The facilities offered by the Council for cervical cytology were further extended during the year. In addition to the two clinics in operation in 1965, a third clinic was opened at Louise House, Dartmouth Road, S.E.23 in May. The number of women applying for appointments at the Central Lewisham Clinic, 410 Lewisham High Street, S.E. 13 increased to such an extent that it was found necessary to establish a second session at this centre in March. Further demand resulted in the planning of a clinic at Flower House Centre, Flower House Estate, S.E.6 to open in January, 1967. A Cervical cytology service is necessarily dependent on the existence of sufficient trained laboratory technicians to undertake the microscopic examination of the smears taken. Special acknowledgement must be made to Doctor H. Barnett, Consultant Pathologist to Lewisham Hospital and Doctor Graham Thomas, Consultant Pathologist to the Greenwich District Hospital for their co-operation and help in this service. Patients are seen at clinics as a result of personal application for an appointment, or referral by a family doctor. The patients are interviewed by a doctor, have a pelvic examination, and then the smear is taken. All clinical findings and smear results are notified to the family doctor. The table below gives the findings from all clinics for the year. Table 6 Total smears 2,326 Malignancy positive smears 11 Cervical erosions 589 Cervical Polyps 92 Trichomonas vaginitis 38 Pus and evidence of non-specific infection 75 Moniliasis 12 Uterine fibroids 66 Prolapse 5 ? Pregnancy 5 Endometriosis 1 Cervicitis 45 Abdominal mass 1 19 DAY NURSERIES AND CHILD MINDERS Private Day Nurseries There are thirteen 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 319 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 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 health centres regularly. At 31st December, 1966 there were 96 voluntary child-minders registered to mind 119 children and 51 statutory child-minders authorised to mind 285 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. Day nurseries, playgroups and child minders are visited by the Health Visitors. This surveillance is considered to be a most important aspect of the visitor's work, and it is mainly due to their constant vigilance that the recognised abuses of child minding are not allowed to develop. However, there is the ever present danger of unofficial or unauthorised child minders operating and whenever such cases are brought to notice an immediate investigation is made and action taken. 20 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. 61 adoption and boardingout reports were examined and reports on 38 prospective parents were scrutinised during 1966. BOARDING-OUT OF CONTACTS OF TUBERCULOSIS The Medical Officer of Health arranges, on the recommendation of Chest Physicians, for the boarding-out of children who would be exposed to infection from tuberculosis in their own homes, or whose parents are receiving residential treatment for tuberculosis. Boarding-out is also arranged for children who have been B.C.G. vaccinated and who should not be in contact with persons infected by tuberculosis until the protection given by such vaccination is fully developed. Number of children boarded-out 11 BLIND AND PARTIALLY SIGHTED PERSONS During the year 212 examinations were arranged in connection with certification under the National Assistance Act, 1948, of blind and partially sighted persons. In addition, certificates accepted from other local authorities and hospitals numbered 34. This certification facilitates the provision of the council's welfare services for the blind and partially sighted. RECUPERATIVE HOLIDAYS Recuperative holidays are provided on medical recommendation for persons who have recently been under medical treatment and who need rest, fresh air and good food. Persons in need of supervision, medical and nursing care require convalescence which is the responsibility of the appropriate Hospital Board. Arrangements are made for adults, expectant mothers and nursing mothers, and children under 5 years not attending school. Recommendations for recuperative holidays for children of school age are referred to the Inner London Education Authority. A weekly charge is made for adults according to their financial circumstances and there is a small charge for children under 5 not attending school. Recuperative holidays arranged during 1966 were as follows:— Table 7 Expectant and Nursing Mothers 5 Tuberculous Adults 6 Other Adults 112 Psychiatric patients 10 Accompanied Children 33 Unaccompanied Children placcd by I.L.E.A. 135 AT RISK AND HANDICAP REGISTER The future Observation Register Registers are kept of those children who are considered to be at risk of developing physical or mental defects, and those who have a handicap. The "At Risk" Register enables supervision to be maintained of those children who, by reason of abnormal circumstances occurring before, during or after birth, are in danger of developing a handicap. Periodic examination by clinic doctors of 21 such children allow for the early recognition and treatment of handicapping conditions. The sources of information which lead to a child being placed on the register are varied, and include birth notifications, paediatric departments of hospitals, general practitioners, clinic doctors or health visitors. Once a handicap is confirmed, the child is transferred to the Handicap Register and is reviewed periodically to ensure that treatment where necessary is being continued, and that the degree of handicap has not altered. In the fourth year of life, the child, whether handicapped mentally or physically, is assessed as to its educational needs, and suitable education or training is planned. At this stage close liaison is maintained with the Education Officer, heads and teachers of ordinary and special schools, hospital consultant staff and superintendents of hospitals, schools, etc. In future it is intended that a comprehensive Observation Register will be kept consisting of a punched index card for each child and incorporating the "At Risk" categories as well as Handicapping Conditions. Type of school, training centre etc. will also be shown. This scheme is also under consideration by the Inner London Education Authority. It is hoped that other Boroughs in the Inner London Education Authority area will adopt a comparable method. This would facilitate the interchange of information between Boroughs when a child moves, as frequently happens. It is intended that this register will be used for regular reference and up-to-date information. It should ensure that every child receives all possible care and advantages available and also aid in future research to help extend and improve services as necessary. The following figures relate to the Registers during 1966: Table 8 AT RISK REGISTER Total number of live births 5,644 Children placed on register during 1966 — 673 Children discharged from register 343 (including removals away, deaths etc) Transferred to handicap register 13 Population 0-5 years 20,810 Number of children on register at 31st December, 1966 748 Handicap Register — 0-5 years of age Number of children on register at 31st December, 1966 321 CO-OPERATION WITH CHILDREN'S DEPARTMENT The Children's Officer is required to obtain medical reports on every child to be placed for adoption or boarding out. The necessary medical examinations can be arranged by the Health Department at the request of the Children's Officer, and reports are submitted to the Medical Officer of Health for scrutiny and approval. Where necessary, further information is obtained by consultation with hospital and family doctors. Child Care Officers and Health Visitors exchange information about families and children involved, and work in liaison with each other. Care is needed especially in connection with the health and family history of children offered for adoption. In some cases prospective adopters are interviewed in order that any abnormalities in a child, or the chance of developing hereditary diseases may be discussed. Medical certificates for prospective adoptive parents are also scrutinised as part of the assessment of these persons as suitable adopters. Health Visitors are trained to recognise early signs of social and medical deprivation, and may notify the Medical Officer of Health of children who may need to be taken into care, and again child care officers and health visitors work in cooperation with the families of these children. 22 Advice is given to the Children's Officers on the appropriate residential placing for mentally ill persons aged 16-18 years who are in care. Reports are also received from Juvenile Courts to ensure that psychiatric services are available for children in care. Table 9 Medical Reports on prospective adoptive parents scrutinised 38 Number of adoption cases 32 Suitable for adoption 31 Suitable for adoption subject to conditions Nil Not suitable for adoption, but suitable for boarding out 1 Number of boarding out cases 29 HEALTH VISITING The health visitor's course, which follows general nursing and midwifery training, has been extended to a full year. The lengthened course contains more specialist training in social work which is designed to assist her in dealing with inadequate or neglectful parents, the giving of advice on the emotional and social needs of children, and dealing with families where the parents are physically and/or mentally handicapped. Apart from the usual advice on baby feeding, clothing and illness in the family, health visitors are called upon to advise on such matters as budgeting, family allowances and ways to prevent accidents. Because of her position as a regular family visitor, the health visitor is invariably the first to recognize the symptoms of failure and to bring them to the notice of the specialist services. During the past decade there has been a fairly heavy influx of immigrant families who tend to congregate in certain areas of the borough and it is in these areas that pressure of work for the health visitor becomes intensified. In general immigrant children make excellent physical progress, but are usually retarded in speech development, social responses and play. Constant supervision is therefore required by the health visitor to encourage parents and child-minders to appreciate the need for play, talking and stimulative care of children. Parentcraft classses Are held weekly in all health centres, and mothers clubs are encouraged in the larger centres. These are well attended. Mother's Clubs A number of Mothers' Clubs are in existence at the various health centres, an example of which is the one at Louise House. This club came into existence during September with the support of the Health Visitor and by the end of the year attendances were so high that they had to be controlled by the introduction of a waiting list. Speakers and demonstrators arranged by the mothers themselves have attended and among their subjects has been the following: flower arrangements, beauty consultations, Sirdar knitting wools, needs of "problem" girls, and hand-made jewellery. School Health Health visitors supervise the work of school nurses and clinic nurses. Routine visits are paid to all nursery schools and classes. Hygiene examinations and medical examinations of children, both routine and special, are organised in all local authority schools. Health education in schools by health visitors has been expanded during the last year. More and more head teachers appreciate the value of health education carried out by demonstrations and talks dealing with preparation for family life. The subject is more complex in large comprehensive schools and health visitors in adjoining centres have to unite to provide a satisfactory programme. Many schoolgirls attend the Day Nurseries and clinic creches, helping with the care of young children and are often encouraged to take up nursery nurse or general nurse training. 23 Liaison with Hospitals Health visitors provide an important link with local hospitals by attending outpatient clinics and visiting diabetics, ante-natal and paediatric patients. Surveys Health visitors take part in various surveys which are reported on more fully elsewhere in this volume. The subjects include leukaemia, measles, vaccination follow-up and home safety investigations, and in schools, surveys of height and weight of school children and the incidence of verrucae are now in force. Visits to Establishments Over 300 nurses from King's College, Lewisham and St. John's Hospitals have visited clinics, schools and day nurseries for observation visits as required in their syllabus of training. Social science students from colleges and the Children's Department also visit for instruction and observation. Lectures and talks Have been given by nursing staff to groups in hospitals, schools and other voluntary and statutory associations as required. Refresher Courses During 1966 four health visitors and three school nurses attended courses and four school nurses attended in-service training. Field Work Instructors Eight health visitors have taken the field work instructors' course, which is essential in providing the health visitor students practical training as required by the London Training Committee. Health Visitor Students Four students are now receiving practical instruction in the Borough. In addition, we are also providing practical training for "six integrated nurse training" students from King's College Hospital and health visitor training for the Royal College of Nursing, and National Council of the United Kingdom. Four students are sponsored for training by the Borough, three of whom are receiving practical training in other boroughs. General Practitioner—Health Visitor Attachment Four health visitors have been seconded to work in General Practitioner surgeries, holding "well-baby" clinics and to carry out limited visiting. Lack of premises and grouping makes it difficult to expand this service at the present time. Auxiliary Staff State Registered Nurses and State Enrolled Nurses are employed to assist the health visitors in their routine work, and to relieve pressure from expanding services and heavy case loads carried by many of the staff. Today, the pressure of work is intensified as parents become more aware of the services available to them. Dealing with people of different cultures and standards requires time, patience and a depth of understanding in order to encourage them to provide a reasonable standard of child care and homemaking for the family. DOWNHAM HEALTH CENTRE This is a purpose built centre owned by the Inner London Education Authority but managed by a voluntary committee. This Committee, of which the Hon. Secretary is Mr. E. J. Steuart Tennent, is responsible for providing a minor ailments service not only in this Centre but in two sub-centres at Coopers Lane and Ballamore Schools. Mr. Tennent has provided the following statistics relating to the minor ailments service:— 24 Table 10 Attendances Referred to clinic doctor Referred to other doctors Downham Health Centre 12,093 404 222 Coopers Lane School 5,200 384 52 Ballamore School 1,838 — 67 The Voluntary Committee is also responsible for the general running of the building, e.g. heating, lighting,cleaning, and employs a resident caretaker to assist in this work. The committee met on three occasions during the year, the Medical Officer of Health being represented by the Nursing Officer (Maternal and Child Health and School Health). Problems relating to the general running of the building and to the services provided therein are discussed at these meetings. 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. A large number of articles were in demand during the year as the following table shows. Table 11 Equipment No. issued during 1966 Total stock held on stock register No. on loan at present Air Rings 20 28 26 Back Rests 33 40 39 Bed Cradles 44 43 39 Bed Pans 18 36 28 Cot Beds Nil 2 1 Commodes 204 344 340 Easi-Carry Hoists 9 14 11 Fracture Boards 26 39 38 Hospital Beds & Pulley 11 18 18 Mattress (Dunlopillo) 6 22 19 Mattress (Hair) 8 11 10 Penrhyn Bed Lifts 15 22 22 Ripple Beds 1 3 1 Rubber Sheets (6' X 3'). 26 59 54 Tripod Walking Sticks 27 22 21 Zimmer Walking Frames 35 49 43 Wheelchairs 50 37 33 Totals 533 789 743 Attention is drawn to the great increase in use of this valuable service. Close contact is maintained with voluntary bodies such as the British Red Cross Society and also the Council's Welfare Department in order to ensure that no overlapping occurs. 25 DISTRICT NURSING Section 25—National Health Service 1946 The existence and availability of the Local Authority's Home Nursing Services are known to the hospitals and the family doctors, and the services are called upon for any purpose. Patients on discharge from hospital may be referred to their own doctor from whom the nurses take instructions. No all night service is provided but nurses are available if required urgently, and the Marie Curie Night Sisters are available for cancer cases. Staff Recruitment and Training On 1st April, 1966, two small general district areas covered by the Nursing Sisters of St. John the Divine were absorbed into the Borough Council Service without difficulty. The total number of staff has remained steady throughout the year and no difficulties over recruitment have arisen. In order to obtain a high standard of efficiency all new entrants are expected to take the examination for the National Certificate of District Nursing and admission to the Queens Institute Roll. Nine nursing sisters took the Course in 1966 and all were successful. In co-operation with the Departments of Occupational Therapy and Physical Medicine at Lewisham Hospital, district nurses have each spent two days there, learning the best and most up-to-date methods of handling patients who have suffered from illnessess, involving loss of muscular function and co-ordination. This experience has proved very valuable and so far 49 out of the total of 66 full and part-time staff have attended. Two non-resident Post Graduate Courses were arranged by the Queen's Institute of District Nursing and 10 nurses attended. The London Boroughs Training Committee held a study day for District Nurses in May and again in November. Three members of staff were allocated places at each. An Inservice course of lectures on aspects of mental health was arranged and five district nurses attended. It is essential that all members of the staff have some knowledge of this subject as mental ill health is increasing in the community. Patient Care Despite an increase in the number of patients attending for the first time (5,546 as compared with 4,406 in 1965) there was a slight drop in those aged 65 years and over (2,579 in 1966 and 2,787 in 1965). Even so elderly patients comprised nearly half of the total number of new patients. The extension of auxiliaries to assist with bathings has been appreciated. Only 155 children under 5 years required home nursing. Equipment Disposable incontinence pads are provided in all appropriate cases. Usually the district nurse is in attendance. In the few cases where this is not so, the superintendent requests the appropriate nurse to pay a visit to assess the need. No charge is made for the pads. The incontinent laundry service is still in demand for many other cases. Loan equipment has been increased and renewed and is in great demand. Earlier Diagnosis of Breast Cancer A scheme to make an earlier diagnosis of breast cancer was suggested by the Professor of Surgery of a near-by teaching hospital. Two general practitioners in partnership were interested and the health authority agreed to provide accommodation and nursing staff. The surgeon agreed to come to the local authority clinic to see any patients requiring a second opinion whenever necessary and to admit any woman requiring treatment without delay. The Local Executive Council provided the doctors with the most up-to-date list of all women patients over 25 years of age. 26 A carefully worded letter was compiled to emphasize that this was a check offered to every female patient in the practice by her family doctor. The first contact was considered very important as the timid patient with a morbid fear of cancer is the one required to reach. A certain number of women are invited to attend each week. It has been noticeable that the elderly ladies form a high percentage of the attenders. The time convenient to general practitioners (4-6 p.m.) may be difficult for women with families of school age. Tn the 4 months up to the end of 1966 434 women were invited. 162 attended 14 came uninvited (heard from relatives or neighbours). The nursing sister in attendance fills in a short questionnaire, the patient is then examined by the doctor. It there is any doubt as to the diagnosis, or confirmation is required of a positive diagnosis, the doctor arranges for the hospital consultant to attend shortly. As every patient has been told by sister that the doctor may seek a second opinion the patients are not alarmed when this occurs. They appreciate the advantage of the consultant coming to see them than the more ordinary routine of having to go to a hospital out-patient department. Out of the 176 who attended: 3 have been admitted to hospital for operation 32 are having further investigation. It appears that none of these women would have come to the ordinary surgery with the symptoms they had when they attended the clinic. Questioning all age groups seems to show that very few women examine their breasts as routine, although some confess to a vague fear of cancer. The value of the clinic is that patients are being requested to attend, feeling that they are in good health, and are taking part in a scheme to assist their family doctor. If this attitude could be encouraged and clinics of this nature extended, it seems that the general practitioner could play a vital part, through his personal relationship with his patients, in getting hospital treatment for women with breast cancer with the least possible delay. DENTAL SERVICES We have been fortunate in attracting enthusiastic staff to this section of the Health Department and this together with the continued replacement of equipment by the most modern type available has helped materially in the improvement of the standard of service available. The use of Council transport for children attending schools some distance from dental centres has proved to be most successful. Younger children are escorted either by members of the staff or by School Care Committee workers. The orthodontic side of the service, i.e. the straightening of irregular teeth, continues to expand and during the year 42 patients were referred to consultant services at Lewisham Hospital and 12 patients were referred to St. Alfege's Hospital for treatment. So far 120 removable appliances have been fitted. Each of the dental surgeons employed in the Council's service attends to their own patients guided by, and in consultation with, specialist orthodontists. A feature has been made of dental health education during the year, 65 sessions having been devoted to this purpose at Central Lewisham and Amersham Road Health Centres, where talks were given to mothers and pre-school children. A dental hygienist visited 16 schools following dental inspections to give similar instruction to the children. Pierre the Clown (sponsored by the Fruit Growers' Association) visited 29 schools (infants and juniors), the junior mental health training centre and two day nurseries to urge the importance of eating apples as a means of cleaning teeth. 27 B: Inspections Number of Patients given First Inspections During Year A 1,207 D 4 Number of Patients in A. and D. above who Required Treatment B 583 E 4 Number of Patients in B. and E. above who were Offered Treatment C 482 F 4 C: Sessions Number of Denial Officer Sessions (i.e. Equivalent Complete Half Days) Devoted to Maternity and Child Welfare Patients: For Treatment 288.3 For Health Education 43 School for Dental Auxiliaries I am indebted to Mr. J. V. Bingay, Director of the School for Dental Auxiliaries for the following report on the work of the School: 28 Children attending the Council's three day nurseries were inspected at six-monthly intervals and treatment arranged as required. Treatment is also available to expectant and nursing mothers. Postgraduate courses and Conferences (a) One full-time officer attended a residential course dealing with treatment of handicapped children. (b) The Chief Dental Officer took part in a weekend course in Paedodontia, and orthodontics. The Annual General Meeting of the British Dental Association was attended by a part-time Dental Officer and the Chief Dental Officer. Table 12 DENTAL SERVICES FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER5 YEARS A: Attendances and Treatment Number of Visits for Treatment During Year Children 0-4 (incl.) Expectant and Nursing Mothers First Visit 622 10 Subsequent Visits 1,368 6 Total Visits 1,990 16 Number of Add'l Courses of Treatment other than the First Courses commenced during year 29 1 Treatment provided during the year— Number of Fillings 1,616 25 Teeth Filled 1,470 15 Teeth Extracted 40 1 General Anaesthetics given 12 — Emergency Visits by Patients 34 2 Patients X-Rayed 1 1 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 453 4 Teeth Otherwise Conserved 857 Teeth Root Filled 1 Inlays 1 Crowns — Number of Courses of Treatment Completed During the Year 341 1 Established within the walls of the School for Dental Auxiliaries at New Cross Hospital is a London Borough of Lewisham Dental Clinic. This is at present staffed by a Dental Officer, Mrs. Clare Leeming, and three certificated Dental Auxiliaries, Mrs. Beedham, Miss Solomons and Mrs. King. All four are Officers of the London Borough of Lewisham Health Dept. but seconded to the School for Dental Auxiliaries for the purpose of staffing the Local Authority Dental Clinic established there in 1963 as a unit of the former London County Council Dental Health Services. As Director of the School I would like to say that the Local Authority Dental Unit is carrying out work of extreme value in the clinical field, including as it does advanced conservative and orthodontic procedures. These procedures are, of course, carried out by the Dental Officer. Although the routine inspections in the local schools are normally the responsibility of the Dental Officers on the teaching staff of the School for Dental Auxiliaries, the Local Authority Clinic undertakes the function of regular re-inspection of those children who attend as the result of the now well-established recall system which includes over 7,000 child patients. Mrs. Leeming as the Officer responsible for the carrying out of inspections under the recall system has also, as part of her duties, the allocation of the various categories of patients found to require treatment as the result of these examinations. Some of these who are in need of advanced techniques are retained by her for treatment which she herself carries out. Others are allocated to the Dental Auxiliaries whom she herself supervises, the remainder and, of course, the greater proportion are referred back to the Clinical Department of the School to be treated by students under the strict supervision of the qualified dental teaching staff. The establishment of a Local Authority Unit within this School has proved to be outstandingly successful and I would like to express my appreciation of the happy relations which exist between the Officers of the School and those employed by the London Borough of Lewisham. Much of this goodwill is due to the encouragement and support which is so unselfishly given to us by the M.O.H., the Chief Dental Officer and other members of the Health Department. In partiuclar I would like to thank Mrs. Leeming for the way she has handled her Clinic and for her unfailing good humour and sense of cooperation. During the course of the year 1966 the School dealt with over 25,000 attendances for treatment. Approximately 10,000 teeth were conserved and each child who attended received oral hygiene treatment and was instructed in the proper use of the tooth brush. Dental health education talks by our senior students are now routine in most of the local authority schools within the Lewisham area and indeed these students are also in constant demand for the purpose of such talks in other Greater London Boroughs. I cannot praise too highly the co-operative attitude shown by the head teachers of the schools with which we are associated. It is evident to me that even the most nervous student embarking upon the first of her talks is soon put at ease by the kindly welcome she invariably receives from the school staff. It is now known that the scheme for the training of dental auxiliaries at New Cross is no longer in the experimental stage, the Government having accepted that dental auxiliaries have a valuable contribution to make to the dental health of the community. I am confident, therefore, that the future will provide even closer ties than those which now so happily exist, between this School and our colleagues of the local authority services. 29 CHIROPODY SERVICE Mr. B. Dalton, Chief Chiropodist, reports:— Three full-time and one part-time Clinics are maintained by the Council served by a Chief and three full-time Senior Chiropodists and 18 part-time Chiropodists. An average of 82 sessions per week were worked during the year under review, full time staff working approximately 1,858 and part-time staff 2,453 sessions. A transport service is operated for handicapped patients utilising Council transport and drivers, conveying an average of 35 patients per week to and from the three Clinics. The past year has seen some changes in the general running of the Clinics aimed at increased efficiency. Each Clinic now has a fairly well defined area from which patients are accepted, thus allowing the same appointment interval to operate at each Clinic. Special treatments have been made available at Amersham Road for obstinate cases of verrucae, corns and tissue breakdown. A policy of trying various forms of treatment, new drugs, materials, equipment, and experimenting with the interval between appointments has been commenced in order to form the basis of an enquiry. One session per week is attended at Lewisham Hospital by one of the Council's ChiroDodists to enable a service to function there. Table 13 STATISTICAL SUMMARY OF ATTENDANCES 1966 1965 Number of sessions 4,311 4,973 Appointment bookings 31,132 33,129 Children of or below school age 1,415 1,471 Adults: Male 5,255 5,957 Female 21,350 23,548 Total 26,605 29,505 Fee paying attendances (adults) 7,987 10,442 Free attendances (adults) 18,618 19,063 Table 14 NEW CASES ATTENDANCES ANALYSIS Age groups Number attending clinics 0-4 6 5-14 181 Males 15-64 119 Females 15-59 296 Males over 65 176 Females over 60 498 Total 1,276 30 SCHOOL HEALTH SERVICE The health and well-being of Lewisham schoolchildren remains high. Medical examination of all children on entry to primary school, at the age of seven years, on transfer to secondary school and at school leaving age has continued. Audiometric testing is carried out on all children on entry to school. Those in whom any defect of hearing is indicated are referred for specialist investigation and treatment. Annual examination for personal hygiene is also carried out in school. Respiratory tract infections and asthma continue to be major causes of absenteeism. Both day open air schools in the Borough had waiting lists for admission during most of the year. This always included a proportion of such cases. Acquired heart and circulatory disease continue to decrease. However, the incidence of children with abnormalities of haemoglobin appears to shew an increase co-incident with the rise in immigrants from the Mediterranean littoral living in the area. Two of the commonest medical problems are nocturnal enuresis and obesity. Various techniques and methods of treatment are tried for these children, but it is found that both conditions provide most intractable problems in many cases. Handicapped Pupils. The comprehensive observation register has been described elsewhere. This will include full details concerning children suffering from physical, mental or serious socio-medical handicap. Every effort is made to integrate these children into ordinary schools. However, a small proportion, for whom this is not possible or suitable, attend lay schools providing specialist teaching and care in this or neighbouring boroughs. A still smaller proportion are receiving treatment and education at boarding special schools. The School Health Service continues to endeavour to safeguard the interests of handicapped school children. Close liaison with the Youth Employment Service continues to develop in an effort to assist the handicapped school-leavers. Haemophiliac Children. The department is co-operating in a national survey being undertaken by Dr. K. N. Dormandy, of the Royal Free Hospital Medical School and the Medical Research Council, into the care and education of haemophiliac children. It is hoped that eventually better facilities for the short-term treatment of these children will become available throughout the country. As well as helping in their general wellbeing and development, this should avoid the need for the long periods of absence from school which so many of them have at present. SPECIAL SCHOOLS At the beginning of the year, there were six Special Day Schools in the Borough plus a special teaching unit for young deaf and blind children, which is accommodated in Hither Green Hospital. The schools are :— 1. The Nansen School for Partially Sighted Children. 2. Meeting House Primary School for Educationally Sub-normal children. 3. Plassey School for Physically Handicapped Children (Primary Mixed and Secondary School age girls). 4. Lee Manor Secondary School for Physically Handicapped Boys. 5. Woodlands Primary Day Open Air School. 6. Brent Knoll Primary and Secondary Day Open Air School. At the end of the summer term in July, the two schools for physically handicapped children were closed. At the beginning of the academic year in September, the pupils were transferred to the new school for the physically handicapped at Charlton Park in the London Borough of Greenwich. 31 At mid-term in October, all pupils attending Brent Knoll Day Open Air School were transferred temporarily to accommodation at Hither Green School in Beacon Road prior to demolition and rebuilding of the Open Air School on the original site in Mayow Road. Although environmental conditions in Beacon Road are not those of an Open Air School, all facilities of medical and nursing care and special education and transport etc. are provided. PROBLEM CASE CONFERENCES At these conferences, which are held approximately once a month, the needs of children who present special educational difficulties are discussed. Problems are mainly of a psychiatric nature and many of the children are referred to Child Guidance Clinics or to an Educational Psychologist. Arrangements for remedial teaching or special tutorial classes are also made. The conference meets under the chairmanship of an I.L.E.A. District Inspector and is attended by the Divisional Care Organiser and the Divisional Officer (Education) with members of their staff. Also present are a Senior Assistant Medical Officer representing the Principal School Medical Officer, Educational Psychologists, Specialist teachers, Headteachers and others concerned with the welfare and education of individual children under discussion. The meetings give a valuable opportunity for discussing many facets of medical, social and educational problems of schoolchildren resident in the borough. SCHOOL CARE SERVICE I am indebted to Miss I. M. Rowe, the Divisional School Care Organiser, for the following report on the work of the School Care Service: There were twenty voluntary School Care Workers recruited during 1966—mainly introduced by other voluntary workers in the district. Personal introduction has always been preferred in this area, although some workers have come from other sources, such as articles in the press or in magazines. Unfortunately an article in the South East London Mercury in March 1966 brought no response. However, efforts are continually being made, recruiting and training being part of the function of a School Care Organiser. Any suggestions regarding sources of recruitment are always welcomed by myself and the staff, and quickly followed up. Of the 109 County Schools in Lewisham (over 40,000 school population) 10 primary schools and five secondary schools are without Workers at the present time, and others have inadequate coverage. The situation, of course, changes rapidly and may be quite different by the time this report comes to print. The demands made on the School Care Service would be insupportable were it not for the dual system of voluntary workers supported by the professional staff, and I would like to take this opportunity of thanking the voluntary workers for their loyalty and devotion to the children of Lewisham over the years. At the same time I would like to thank the School Health Staff, and my own, for the way in which they work together for the good of the school children in this Borough. DEPTFORD SCHOOLS TREATMENT CENTRE The Deptford Schools Treatment Centre is run by a Voluntary Committee comprised of ten members. The function of the Committee is to manage and run the centre, and there is at least one visit made each month by a member of the Committee to ensure that all is in order and to hear and note any complaints. There is a full Committee meeting every quarter by which all matters and correspendence are fully discussed, and recommendations made. 32 Records are kept of all sessions and attendances for each department of the Clinic and these are summarised and presented to the Committee at each meeting. A quarterly grant is made by the l.L.E.A. to meet the expenses of the centre, together with the wages of the nursing staff and cleaners. The grant is in fact paid to the Secretary who is responsible for its use. The Secretary also prepares yearly accounts which give details as to how the grant is allocated under the various items of expenditure. 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 found with physical condition unsatisfactory and the percentage referred for treatment of all defects, and of defects other than vision. The statistics quoted in this section have been supplied by the Inner London Education Authority and are based on a school roll of 40,744 as at May 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 408,777 at the same date. Table 15 Lewisham l.L.E.A. Routine Inspections Number inspected 15,454 157,092 Number found not to warrant examination (7 plus 'specials scheme') — 1,981 Percentage of No. inspected of:— Parent present 53.5 52.5 Care Committee present 76.3 80.1 No. vaccinated against smallpox 76.4 75.4 No. immunised against diphtheria 89.5 86.7 No. immunised against whooping cough 78.7 76.4 No. vaccinated against poliomyelitis 85.5 83.7 Physical condition unsatisfactory 0.3 0.5 Referred for treatment of defects 13.9 13.7 Referred for treatment of defects other than vision 7.1 7.1 Non.Routine Inspections (i) Specials 4,958 50,370 (ii) Re.inspections 4,782 71,241 Total (i) and (ii) 9,740 121,611 No. of routine inspections as percentage of school roll 37.9 38.4 No. of non.routine inspections as percentage of school roll 23.9 29.8 33 ROUTINE MEDICAL INSPECTIONS—DEFECTS Number of children noted for treatment or observation expressed as a rate per ,1000 inspected. Table 16 LEWISHAM Total l.L.E.A. No. inspected Defects 15,454 157,092 * Skin T 8.93 7.80 O 6.60 8.84 Eyes. (a) Vision T 74. 03 71.56 O 25.30 51.29 (b) Squint T 6.79 7.42 O 3.43 5.56 (c) Other T 3.04 1.95 Ears— O 2.85 2.42 (a) Hearing T 5.50 5.81 O 6.34 6.89 (b) Otitis Media T 1 .36 1 .67 O 2.26 3.80 (c) Other T 0.26 0.92 O 0.58 0.87 Nose and Throat T 7.70 7.50 O 27.76 29 06 Speech T 2.78 3.68 O 4.46 7.22 Lymphatic Glands T 0.84 0.59 O 6.92 9.08 Heart T 2.26 2.30 O 4.99 8.85 Lungs T 5.18 4.70 O 8.35 11.37 Developmental— (a) Hernia T 1.16 1.01 O 3.24 2.72 (b) Other T 1 .29 1 .34 O 3.36 5.60 Orthopaedic— (a) Posture T 1 .16 1.18 O 4.53 5.42 (b) Feet T 2.91 5.31 O 11.45 14.20 (c) Other T 2.39 2.03 O 3.30 5.25 Nervous System— (a) Epilepsy T 2.52 1 .42 O 1 .16 1.27 (b) Other T 0.26 0.68 O 0.87 1.70 Psychological— (a) Development T 1.29 1.41 O 2.59 4.62 (b) Stability T 2.07 1 .91 O 9.32 8.25 Abdomen T 0.26 0.32 O 0.65 118 Other T 16.11 15.96 O 21.87 32.57 * = Treatment 0=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. 34 35 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 17 LEWISHAM I.L.E.A. 1. Comprehensive Surveys (a) Number examined 25,625 266,224 (b) Number (occasions) found verminous 92 2,994 (c) Percentage found verminous 0.36 1.12 2. Selective Surveys (a) Number examined 5,371 122,060 (b) Number (occasions) found verminous 135 2,984 (c) Percentage found verminous 2.51 2.44 3. (a) Total times vermin found (1(b) + 2 (b) 227 5,978 (b) Total % found verminous [3 (a) as % of 1 (a) + 2 (a)] 0.73 1.54 (c) No. of individual pupils found verminous 171 4,085 (d) % of individual pupils found verminous (of school roll) 0.42 1.00 4. Action taken with verminous cases (a) Advice and/or Lorexane 136 5,039 (b) Further action 91 939 (c) 4 (b) expressed as a percentage of 4 (a) 66.91 18.63 Analysis of 4(b) cases—referrals of hardcore cases to bathing centres Voluntary attendances at bathing centres No. of pupils 91 850 No. of statutory notices issued — 6 No. cleansed at centres following statutory notices Voluntarily - 6 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 Dental health education received especial attention during this year; many talks and instructions to children regarding proper care of teeth were given. 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 18 LEWISHAM I.L.E.A. 1. School Roll 40,744 408,777 2. Number of Sessions Treatment—ordinary (iv) 2304.9 26453.0 Treatment—General Anaesthetic 34.6 496.3 Inspection 110.3 558.0 Total 2449.8 27507.3 Table 18—continued 3. First Inspections LEWISHAM l.L.E.A. (a) Number of first inspections in school 11,693 34,500 (b) Number of first inspections at clinic 1,925 49,420 (c) Total 13,618 83,920 (d) Total as percentage of school roll (3(c) as percentage ofl) 33.4 20.5 (e) No. inspected found to require treatment 8,735 58,600 (f) Percentage of no. inspected found to require treatment 64.1 69.8 (g) No. offered treatment 8,566 55,739 (h) Percentage of no. requiring treatment offered treatment 98.1 95.1 (i) Percentage of no. requiring treatment elected for private treatment 1.9 4.9 4. Reinspections (a) Reinspections at school 112 (b) Reinspections at clinic 1,004 20,541 (c) Total 1,004 20,653 (d) No. of reinspections as percentage of first inspections (4(c) as percentage of 3 (c)) 7.4 24.6 (e) No. reinspected found to require treatment 699 13,397 (f) Percentage of no. reinspected found to require treatment (4(e) as percentage of 4 (c)) 69.6 64.9 5. Number of appointments given to: (a) New cases (i) 7,847 151,512 (b) On treatment cases 16,685 181,460 Number of attendances made by: (c) New cases (i) 4,281 74,341 (d) On treatment cases 11,941 136,242 (e) Emergencies (ii) 354 4,140 (f) Total attendances 16,576 214,723 6. Response rate: (a) New cases (5(c) as percentage of 5(a) 54.6 49.1 (b) On treatment cases (5(d) as percentage of 5(b)) 71.6 75.1 7. Cases discharged dentally fit (iii) 3,269 60,252 8. Lapse Rate (treatment not completed) Item 5(c) plus 5(e) less item 7 expressed as percentage of (5(c) + 5(e) 29.5 23.2 Note: (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 1090.2 supervisory sessions (Supervisory sessions being those sessions worked jointly by a dental officer and a dental auxiliary). (v) Includes 369.6 supervisory sessions. 36 37 Table 19 NON-ROUTINE MEDICAL INSPECTIONS Type of Inspection LEWISHAM l.L.E.A. Area Reinspections 4,782 71,241 Bathing centre inspections — scabies — 51 ,, ,, other 5 87 Employment certificates 436 5,103 Theatrical children 82 509 School journeys 2,803 22,153 Recuperative holidays—pre-departure 84 1,163 Recuperative holidays—on return — 8 Secondary School annual surveys 1 1,987 Candidates for higher awards — 44 Nautical school entrants — 136 Outward bound courses 30 209 Infectious disease investigation — 74 T.B. contacts — 3 Boarding schools for the Delicate—pre-departure — 216 Boarding schools for the Delicate—on return 1 25 Handicapped pupils—statutory examination 113 1,871 Handicapped pupils—periodic special defect examination 659 5,412 Research investigations and enquiries 44 204 4,258 39,255 SPECIALS—At request of:— Head teacher—child's name entered in special book 105 1,504 Head teacher—others 146 3,368 School nurse—following health survey 154 748 School nurse—others 38 1,224 Divisional (Education) Officer 27 836 District Care Organiser or Care Committee 25 433 Parent 95 1,122 School medical officer 38 1,152 628 10,387 OTHERS:— Accident on school premises 22 33 Boxing—reference from schools, A.B.A., or similar association - 25 For free travel — 3 Reference: (i) connected with remedial exercises } - 50 foot classes (ii) by gymnast or physiotherapist Referred by hospital - 3 Referred by speech therapist — 2 Referred by general practitioner — 2 Miscellaneous 50 610 72 728 Total of all Non-Routine Medical Inspections 9,740 121,611 38 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 20 Percentage of number tested C—Boys and Girls Number tested A—Not wearing glasses B— Weari ng 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 for Treatment Noted for Observation Total noted for treat. went or Observation Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Lewisham 7,073 6,401 84.7 82.4 4.2 5.4 3.7 3.9 3.6 41 4.3 41 1.8 2.1 1.3 2.1 4.1 5.2 8.5 2.9 11.4 l.L.E.A. Area 62,402 60,053 80.7 78.6 6.4 6.8 5.5 5.5 5.4 5.6 3.8 4.5 1.8 2.3 1.8 2.3 31 4.2 9.2 6.6 15.8 Table 21 COMPARISON OF DEFECTS NOTED AT 7.PLUS ROUTINE AND 7.PLUS 'SPECIAL' MEDICAL INSPECTIONS IN 1966 Number of children noted for treatment and observation expressed as a rate per 1,000 inspected LEWISHAM l.L.E.A. No. inspected at 1.plus Routine Inspections 4,151 34,240 No. inspected at 1.plus Experimental Scheme Inspections — 2,727 Defects A B A B Skin 1301 15.01 9.90 Eyes—Vision 95.64 — 138.41 164.28 Squint 11.08 — 12.44 14.30 Other 4.34 — 3.77 4.77 Ears—Hearing 13.25 17.09 17.60 Otitis Media 2.89 — 5.08 5.50 Other 1 .69 — 2.07 1 .83 Nose and Throat 34.21 — 39.22 34.10 Speech 6.75 — 12.18 15.40 Lymphatic Glands 6.75 — 9.35 9.53 Heart 6.26 — 10.86 11.73 Lungs 13.97 — 17.26 22.37 Developmental—Hernia 5.30 4.44 6.23 Other 5.30 — 7.89 7.33 Orthopaedic—Posture 5.06 6.13 14.67 Feet 14.94 — 20.74 19.80 Other 3.37 — 6.19 5.13 Nervous System—Epilepsy 2.17 — 2.54 2.93 Other 0.96 — 2.75 2.93 Psychological—Development 5.30 8.03 18.33 Stability 14.45 — 13.79 20.90 Abdomen 2.17 — 1.75 1.10 Other 38 06 — 50.76 103.04 Column 'A' refers to 7.plus routine medical inspections Column 'B' refers to 7.plus experimental scheme inspections 39 HEALTH EDUCATION The Section began the year by staging the Medicines with Care Exhibition which was sponsored by the Pharmaceutical Society. As this exhibition was being staged for the first time in a London Borough, the President of the Society and the Mayor took part in the opening ceremony. The exhibition was an attempt to publicise the need for care in the handling and storage of drugs of all kinds, the misuse of medicines being responsible for over 500 deaths each year. During the year the Quarterly Health Bulletin increased its circulation to 7,000. It is distributed widely by the sending of copies to general medical practitioners for use in their waiting rooms, to various clubs for the young and old, to the Old People's Luncheon Clubs, and it is given out with Meals on Wheels. Copies also go to schools, to the Council's clinics and to the Borough libraries for distribution. In-service training is a function of the section and discussion groups were arranged on many subjects, and for the near future we look forward to arranging short courses of instruction on themes such as Clean Food. Health visitors and other members of the staff are assisted in their own health education programmes. Visual aids have been supplied together with charts and scripts. The staff gave talks to various organisations, including schools. Health education in schools is given as a matter of routine practice by health visitors and school nurses, particularly to teenage girls. Posters and pamphlets are continuously being distributed, the section having during the year produced three pamphlets of its own. On the information side of health education, the Section is engaged on the third edition of the brochure "Health Services and How to Obtain Them". Material on many subjects is gradually being collected so that speakers can come to the Section for information as well as for visual aids. Photographs are also being accumulated with a view to future exhibitions. A system for obtaining home safety statistics and guidance as to how to reduce home accidents has been started in conjunction with the two neighbouring Boroughs of Southwark and Greenwich. Reply-paid forms are being given by doctors and hospital casualty departments to patients who have had a home accident. These forms are filled in by the patient and sent back to the Health Education Section. The age groupings and types of accidents should give useful guidance as to what subjects need the most urgent attention. During October a start was made on a "Home Safety Area". A portion of the Borough was outlined on a map and street by street all the householders in the area received a letter outlining the Council's wish to help prevent accidents. A list was given of possible home hazards and reference was made to the forthcoming visit by a Council adviser to help them spot the dangers in their own home if they so wished. As the premises were visited advice was given and in certain cases pamphlets were also distributed. Of the homes where people have answered the door, one in two has allowed the visitor in to look for potential dangers. Visitors have been well received and already steps are being taken to remedy some of the hazards found. At the end of the year the Section organised a dental hygiene project which involved Pierre the Clown visiting many schools in the Borough, talking to infants and juniors on the need for cleaning teeth and the various ways in which it can be done. He invited the children to join the Apple Club and gave each child an apple on behalf of the Fruit Producers' Council. Pierre was sponsored by the General Dental Council and undoubtedly got his message over to the children (see Page 27). Although an audience of 5,000 children in a week had to be guaranteed, in fact 9,200 children saw the performance and each received the aforementioned apple and leaflets on dental health and hygiene. 40 Throughout the year the section was guided by a panel of representatives of the various disciplines of the Health Department, and is pleased to report that it has been engaged in practically all of the subjects outlined in the Cohen Report as matters calling for health education. 41 Table 22 Film Shows 138 Talks 62 Film strips, tapes etc 47 Student sessions 50 COMMUNITY HEALTH SERVICES Mental Health Community care for mentally disordered persons living in Lewisham is provided by a team of 14 mental health officers, organised on an area basis, led by the Principal Mental Health Officer and working under the direction of a Senior Medical Officer. The number of persons receiving some form of community care continued to rise steadily throughout the year, from a total of 888 in January to 1,191 at 31st December. Statutory duties connected with the compulsory admission of mentally disordered persons to hospital are undertaken by the more experienced mental health officers working on a rota basis, these duties at night and weekends being shared with the London Borough of Greenwich for the combined area. During the year Lewisham mental health officers were concerned in the compulsory removal of 156 persons to hospital for observation or treatment and those carrying out rota standby duty were required to deal with 179 emergencies. In addition to home visiting, the services provided by the Health Department comprise special clinics, a day nursery early care unit, three training centres for the mentally subnormal and a hostel, two day centres, two social clubs and domiciliary occupational therapy for the mentally ill. Mental Subnormality Special Clinics. Special advisory clinics for young backward children and their mothers continued at the Central Lewisham Health Centre and owing to the high number of referrals, principally from health visitors, the frequency of these clinics was increased to one every fortnight. In addition monthly sessions were introduced at the Amersham Road Health Centre for children living in the northern part of the borough. During the year 63 children attended 23 sessions at the Central Lewisham Clinic and 33 were seen at 13 sessions at Amersham Road. As part of the Council's arrangements for improving liaison with the hospital service in the field of mental subnormality, combined assessment clinics, conducted by the special clinic medical officer and a consultant psychiatrist from Darenth Park hospital were introduced. At these clinics, which are held six-weekly at the Central Lewisham Health Centre, subnormal persons whose continued care in the community presents special problems are examined. Early Care Unit. A high proportion of the children seen at the special advisory clinics were recommended for admission to the Early Care Unit which forms part of the Shaftesbury House day nursery. The unit has places for 12 subnormal infants and there was a waiting list for admission throughout the year. By the end of the year plans were well advanced for bringing extra accommodation into use to provide places for three extra children but the need for further units of this type had become clear. Training Centres. The Lewisham junior training centre has places for 120 subnormal or severely subnormal children of school age who have been found, after formal examination, to be unsuitable for education in school. In the centre the children are helped to make the most of their limited capabilities and trained to become socially acceptable. Places in the Centre are made available to children from the London Boroughs of Lambeth and Southwark as well as those from Lewisham. The centre was full throughout the year with, at times, a waiting list for admission. At the end of the year 95 of the places were filled by Lewisham children and two further children were awaiting admission. Building work to add a special care unit for 12 doubly handicapped children to the centre was almost completed by the end of the year and the unit was expected to open early in 1967. Training at the two adult training centres (Brockley, 60 females and Deptford, 65 males) has been much hampered by the poor standard of church hall accom- 42 Christmas Festivities, Lewisham Junior Training Centre modation provided. Strenuous efforts were made during the year to find a suitable site on which to build a mixed centre to replace both these centres and at the end of the year the purchase of a suitable site in central Lewisham was under active consideration. Some minor improvements were carried out at both centres and those at Brockley facilitated the teaching of cookery and laundry work. Simple industrial out-work is carried out at both centres and despite storage difficulties it has been possible considerably to widen the range of work undertaken. The laundering of articles used by the three training centres is now carried out by the Brockley trainees. The conversion of the Brockley centre into a mixed establishment was considered and agreed in principle but implementation of this decision had to be deferred because of limitations imposed by the unsatisfactory premises. At the start of the year some places in the Brockley centre were occupied by trainees from the London Boroughs of Lambeth and Southwark and some at the Deptford centre were filled by trainees from Greenwich and Southwark. Trainees from Southwark were withdrawn and transferred to centres in their own area during the year and there have since been some vacant places at both centres. At the end of the year 41 places at Brockley (21 Lewisham trainees) and 58 places at Deptford (38 Lewisham trainees) were occupied. 24 adult trainees from Lewisham attended centres in Greenwich where facilities were superior to those within the borough. Annual Seaside Holiday 33 trainees from the three training centres, accompanied by members of the supervisory staff, took part in the annual seaside holiday for inner London training centres at St. Mary's Bay Holiday Camp, Dymchurch, Kent. Short-term care The demand for the provision of short term residential care for subnormal persons in accordance with Ministry of Health Circular 5/52 to provide relief for their families continued to grow. During the year this form of residential care was provided for 30 adults and 60 children; of these 26 were found accommodation in hospital and 64 in approved homes. Considerable difficulty was encountered in finding suitable placings for some persons, particularly badly handicapped children, and the lack of any appropriate homes within easy reach of the borough was the cause of some concern. Long-Term care The obtaining of places in hospital for subnormal persons requiring long-term residential care continued to be difficult. During the year hospital admissions were arranged for 12 persons and at the end of the year 11 persons were awaiting admission. Places in approved homes were found for 6 subnormal persons during the year. Altogether 32 persons are now being maintained by the Council in such homes. Co-operation with Hospital Service Following the issue of Ministry of Health Circular 24/65 in December, 1965, consideration was given to securing more effective liaison with the mental subnormality hospital service. A Mental Subnormality Liaison Committee was set up in 1966 with membership comprising a consultant psychiatrist from Darenth Park Hospital, a medical subnormality specialist from the Inner London Education Authority and a local general practitioner as well as senior officers of the Council's mental health team. This committee meets quarterly and is proving of considerable help in the provision of specialist advice both generally and in relation to particular problems, in the planning of the Council's mental health services and in promoting a better mutual understanding between the separate branches of the health service in this field. Other developments included the Combined Assessment Clinic, to which reference has already been made, and regular visits to Darenth Park Hospital to see patients from Lewisham by a mental health officer who also carried out social work with the 43 patients' families. A survey carried out by this officer revealed that there were 87 Lewisham patients in the hospital (48 male, 39 female) of whom 30 had been patients for more than twenty years, 7 between ten and thirty years and 17 between five and ten years. There is no doubt that the rehabilitation of hospital patients can be greatly helped by visits to them and their families by a Health Department social worker who can also provide support for those parents with emotional problems following the admission of their children to hospital. Mental Illness Honor Lea Hostel. The hostel continued to be well occupied throughout the year. Improved accommodation was provided for the deputy warden and his family and this necessitated a reduction in the number of places available for residents to 53. During the year there were 44 admissions (24 men and 20 women) and 35 residents (16 men and 19 women) left. Of those admitted, 31 were from hospital, 11 were from the patients' own homes or lodgings and 2 were from other hostels. 11 residents left the hostel to go to their own homes, 6 went into lodgings and 4 were transferred to other hostels. 14 patients had to return to hospital during the year but it is gratifying to note that in every case this was arranged on an informal basis without the need for compulsory procedures. Applications for admission to the hostel are accepted in respect of persons whose normal address is anywhere in inner London or the London Boroughs of Bexley and Bromley. At the end of the year there were 50 residents of whom 18 came from Lewisham addresses. Selection of residents is carried out by a senior medical officer, the hostel warden and the hostel social worker, who normally interview each applicant either in hospital or at the hostel. In selecting a resident an attempt is made to see sufficiently far ahead to ensure that there is a good chance of the person becoming fully independent within a reasonable period of time although no maximum period of stay is laid down. Considerable importance is attached to willingness to enter employment. Some very disturbed and difficult persons have been accepted but it has become clear that the number of these must be limited so as not to put too great a strain on staff or other residents. Residents are given help and arrangement to obtain employment by the hostel warden and their work has been very encouraging. Of those in residence at the end of the year 44 were in full or part-time employment, including several recently admitted after many years in hospital. As an experiment arrangements were made for two parties of hostel residents who were considered to be unable to make their own arrangements for a holiday, or to take a holiday on their own, to spend a week at hotels on the south-east coast accompanied by a social worker. These schemes proved most successful and will be repeated in future years. The problem of the blocking of places in the hostel by residents who no longer require the degree of supervision provided there but are not quite ready for complete independence has caused some concern. To alleviate the difficulty the Council agreed to purchase a house which will be converted into bed-sitter accommodation for 6 persons recovering from mental illness, drawn principally from the hostel, who will look after themselves with support from a visiting social worker. The admission of 7 mentally ill persons not suitable for Honor Lea to homes or hostels provided by voluntary organisations was arranged during the year. At the end of the year 19 such persons were being maintained by the Council. Day Centres The two day centres for the rehabilitation of mentally ill persons are accommodated in rented premises. At the Cambridge day centre in Lee the premises are reasonably satisfactory for the purpose but as the Council does not have exclusive use of them 44 there were difficulties over the storage of materials and the use of any machinery was not possible. During the year the Council entered into an agreement with the owners for the erection of a prefabricated hut for the Council's exclusive use as storeroom and workshop and the use of this hut has overcome the storage problem and enables several items of machinery to be introduced. The premises of the Princess Louise centre in Deptford are most unsatisfactory. The Council have however entered into negotiations for the exclusive hiring of modern accommodation of facilities elsewhere in Deptford as a replacement centre. The number of patients at the Princess Louise centre, which did not open until November, 1965 rose very slowly but by the end of 1966 there were 25 on the roll of that centre and 35 on the register of the Cambridge day centre. During the year 21 persons from the two centres were able to move on to outside employment. Domiciliary Occupational Therapy A position of senior occupational therapist which had been vacant since the Council assumed responsibility for mental health services was filled late in the year. The officer appointed, who is a member of the mental health team provides occupational therapy on medical recommendation for mentally ill persons in their own homes. At the end of the year 11 persons were being helped in this way. Social Clubs Weekly meetings of the Tideway and Saville social clubs for mentally ill persons continued throughout the year and a number of outings and visits to places of interest and entertainments were arranged for the Club members. Each month a party of patients from Bexley Hospital was entertained to a social evening with members of the Tideway Club in Deptford. Altogether there were 25 persons on the register of the Saville Club and 45 on that of the Tideway Club at the end of the year. Psychiatric Advice Monthly meetings were held of all available members of the mental health team including hostel and day centre supervisory staff which were attended by psychiatrists from Bexley and Cane Hill hospitals and these meetings proved most useful as a forum for the discussion of particular and more general problems in relation to mental illness and the general dissemination of information. Representatives of the Children's and Welfare departments and a general practitioner who is visiting medical officer to the Honor Lea Hostel also attended these meetings. A Psychiatric Liaison Committee was set up during the year to meet at quarterly intervals and give advice to the M.O.H. on policy matters and the planning of services. Membership of this committee comprises the Deputy Medical Officer of Health, consultant psychiatrists from Bexley and Cane Hill Hospitals, the visiting medical officer for the Honor Lea hostel, a senior representative of the Welfare Department and senior members of the mental health team. All mental health officers who were available attended regular monthly case conferences at Bexley Hospital. Staff Training Two mental health officers who were seconded to "Younghusband" courses in 1965 continued this full-time training throughout 1966, and in August an assistant supervisor from the Deptford Training Centre commenced a year's whole-time course at Durham Technical College leading to the Diploma of the Central Training Council for Teachers of the Mentally Handicapped. Other courses attended during the year by members of the mental health team included a refresher course for supervisory staff of adult training centres (Supervisor of the Brockley Training Centre), British Epilepsy Association Social Worker's Course (Assistant Principal Mental Health Officer), National Association for Mental Health courses for hostel supervisory staff (Warden of Honor Lea Hostel) and for staffs of special care units (Assistant 45 Supervisor, Lewisham training centre) and London Boroughs' Training Committee course for matrons of day nurseries and supervisors of training centres (Supervisor, Lewisham Training Centre). Conferences attended included those of the National Association for Mental Health (Annual Conference, Child Guidance Inter-Clinic Conference and Conference for London Boroughs on Medical and Social Aspects of Subnormality) and the Federation of Associations of Mental Health Workers. An experimental course of seven weekly lectures on different aspects of mental disorder by psychiatrists from Bexley and Darenth Park hospitals was held towards the end of the year for a representative group of about twenty-five Health Department field workers. The course proved successful and a series of similar courses is proposed so that all field staff will have an opportunity of attending. Co-operation with Voluntary Bodies A move towards the setting up of a local Association for Mental Health was welcomed and encouraged. At a meeting of representatives of interested organisations and individuals held in June a Steering Committee was chosen; the Chairman of the Health Committee was elected as Chairman of this committee and the Principal Mental Health Officer attended its meetings as my representative. Close relations were maintained with the Lewisham Society for Mentally Handicapped Children. The Lewisham training centre premises were made available to the Society for meetings and social events and the Principal Mental Health Officer and training centre supervisory staff attended the Society's meetings. During the year the Society very kindly made available to the Health Department a newly purchased minibus for the conveyance of mentally subnormal infants to the early care unit pending the delivery of the Council's own vehicle. Generous donations by the Society to the three training centres and the early care unit at Christmas were much appreciated. A proposal by the Southwark Diocesan Children's Council to establish a day centre in Deptford for mentally subnormal children received the active support of the Health Department, the Senior Medical Officer in charge of the mental health team and the Principal Mental Health Officer representing the department on the working committee set up to make preliminary arrangements. The centre will cater for 30 subnormal children between the ages of seven and fourteen with 10 normal children of the same age group for two hours on Saturday mornings in the first instance with the possibility of Sunday sessions later. Work for educationally subnormal school leavers in Deptford by the Albany Institute continued and expanded during the year and a grant towards these activities was made by the Council. The Friends of Honor Lea continued to provide social and material help for the residents of the hostel which was greatly appreciated. Family Casework 1.—During the year 33 families received casework help, which involved frequent and constant support on a long term basis. The total number of children in these families was 151. 13 were lone parents. This service which is provided by professionally qualified social workers is primarily for families presenting multiple problems although short term cases and assessments as to family need may be undertaken. These families were known to many statutory and voluntary agencies and in the majority there was total family disturbance. Initial areas of difficulty were seen as follows:— (a) Family relationships (b) Social relations with the community 46 M.O.H. Annual report 1966 Borough of Lewisham II S.G. Earl A226. 10.10.64 Akinson 935 QAM My hofs-D512 (c) Home and child care (d) Health, physical and mental (e) Work potential and employment (f) Income and use of money (g) Housing (h) Education, school development In this group of families there were a significant number of parents showing evidence of poor physical condition or definite ill health, symptoms associated with personality problems and underlying mental disorder. Psychological difficulties appeared in problems of inter-personal relationships which affected parental functioning. Experience continues to indicate that early recognition and assessment of family disturbance is important if help is to be given at an appropriate time and in order to mobilise resources within and without the family. 2.—Medico social work arising from school clinics has provided opportunity for preventive work and social workers have continued to offer a casework service to parents of handicapped children attending special educational units, i.e. Sedgehill School Partially Hearing Unit; Hither Green Hospital Deaf/Blind Unit and Woodlands School Autistic Unit. The aim is to see the child's problems against the background of his total situation. During the year there was a noticeable increase in the number of children attending special schools referred for social worker help and plans have now been made to attach a social worker (health services) to each special school. In both fields of work co-operation with other statutory and voluntary social work agencies was regarded as vital. Students from basic and casework courses have continued to be accepted for varying periods of practical work experience. HOME HELP SERVICE The Council's home help service continued to be heavily used throughout the year. Details of service being provided at the end of the year with corresponding figures for 1965 follow. Premises were found in the Grove Park area for a further office to relieve pressure on the Rushey Green office and it is hoped that after suitable adaptations have been carried out, the office will be able to open by the summer of 1967. A number of premises were inspected as possible alternatives to the Sydenham office, which is badly sited for its area of service, but none proved suitable and the search for conveniently sited premises continues. Talks on the work of the Health department were given by officers representing different sections of the department to groups of home helps on nine occasions and attendances totalled 248. These talks, designed to make the home help feel she is a valued member of the Health department team, which were followed by informal discussions of particular and general problems, proved most popular with helps and their organising staff and it is intended to make these meetings a regular feature. A review of the working of the service was carried out during the year by Dr. Dorothy Egan, a Principal Medical Officer of the Greater London Council who is seconded to the Health Dept. for 2 sessions per week. In the course of her review Dr. Egan visited the three home help offices and discussed the day-to-day operation and procedures of the service with the organising staff. The implementation of her recommendations, designed to improve liaison with other services and to make more effective use of the organising staff by relieving them as far as possible of routine clerical work were subsequently considered at one of the meetings periodically held with the organisers and attended by senior officers representing all aspects of the department's work. 47 Table 23 CASES RECEIVING SERVICE AS AT 31st DECEMBER 1966 (1965 figures in brackets) Office Maternity Tuberculosis Age 65 and over Aged under 65 Chronic sick Others Total Deptford Town Hall 1 3 613 54 4 675 New Cross Road, S.E.14 (-) (4) (600) (40) (12) (662) 41 Rushey Green, S.E.6 2 11 1,350 155 37 1,555 (5) (16) (1,310) (154) (48) (1,533) 266 Kirkdale, 3 14 696 67 19 799 Sydenham, S.E.26 (5) (15) (661) (61) (15) (757) Totals 6 28 2,659 276 60 3,029 (10) (35) (2,571) (261) (75) (2,952) No. of home helps at end of 1966:—(a) Whole time 7 (8) (b) Part time 627 (589) (c) Whole time, equivalent of (b) 343 (322) 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 Cholera Diphtheria Dysentery (bacillary or amoebic) Encephalitis, acute Enteric fever Erysipelas Food poisoning Malaria Measles Membranous croup Meningococcal infection Ophthalmia neonatorum Plague Pneumonia, acute influenzal Pneumonia, acute primary Poliomyelitis, acute Puerperal pyrexia Relapsing fever Scarlet fever Smallpox Tuberculosis, all forms Typhoid fever, including paratyphoid Typhus fever Whooping cough NUMBER OF NOTIFIED CASES (Corrected for revised diagnosis) during the year 1966 with comparative figures for the previous six years. Table 24 Diseases Cases notified 1966 1965 1964 1963 1962 1961 1960 Anthrax — 1 — — 1 — — Diphtheria — — — — — — — Dysentery 152 159 226 870 234 119 433 Encephalitis (acute) — — — — — 1 — Enteric or typhoid fever 1 1 2 12 4 2 Erysipelas 18 19 20 7 2 21 26 Food poisoning 34 20 19 13 19 34 34 Malaria — — 1 — 2 — 2 Measles 2,017 3,014 1,553 3,186 544 5,678 356 Meningococcal infection 3 1 2 1 4 5 8 Ophthalmia neonatorum 3 3 1 5 1 2 2 Pneumonia 35 37 35 75 36 85 54 Poliomyelitis (acute) — — — — — — 2 Puerperal pyrexia 36 75 55 47 74 46 79 Scarlet fever 82 161 197 103 71 129 218 Tuberculosis 148 157 203 210 191 223 221 Whooping cough 169 108 190 258 54 111 483 TOTALS 2,698 3,753 2,503 4,806 1,249 6,468 1,927 49 Table 25 NOTIFICATIONS OF INFECTIOUS DISEASES IN 1966 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 Dysentery 6 5 15 16 6 5 16 15 2 2 5 14 10 16 5 10 1 3 66 86 Erysipelas — — — — — — 1 — — — — — 1 — 5 9 2 — 9 9 Food Poisoning 2 1 1 2 1 4 1 — 1 — 1 5 4 5 1 4 1 — 13 21 Measles 48 46 281 297 292 294 380 335 8 14 10 7 2 3 — — — — 1,021 996 Meningococcal Infection 1 2 — — — — — — — — — — — — — — — 3 Ophthalmia Neonatorum 1 2 — — — — — — — — — — — — — — — — 1 2 Pneumonia — — — 1 — — 2 1 — — 2 — 5 1 8 3 7 5 24 11 Puerperal Pyrexia — — — — — — — — — — — 23 — 13 — — — — — 36 Scarlet Fever 1 1 6 3 9 6 17 26 2 4 5 1 — 1 — — — — 40 42 Tuberculosis — — 1 — — 2 3 4 3 4 10 12 20 24 38 9 13 5 88 60 Typhoid — — — — — — — — — — — — — 1 — — — — — 1 Whooping Cough 8 11 26 29 13 21 18 33 2 4 1 1 1 1 68 101 50 Table 26 FOOD POISONING CASES general outbreaks family outbreaks sporadic cases total total Causative agent No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained Notified or ascertained No. of outbreaks and sporadic cases columns (1 + 3+5) No. of cases columns (2+4+5) 1 2 3 4 5 6 7 S. Typhimurium — — — — 6 6 6 Other Salmonellae — — 1 3 9 10 12 Cause unknown — — — — 23 23 23 TOTAL — — 1 3 38 39 41 DETAILS OF FOOD POISONING DUE TO SALMONELLAE OTHER THAN S.TYPHIMURIUM Type of salmonella Panama 1 1 1 Bovis Morbificans 1 1 1 Group C 2 2 2 Group B 7 7 7 Group E 1 1 1 Salmonella infection, not food borne NIL MEASLES The number of cases which occurred was fewer than in 1965 (2,017 as compared with 3,014). As this disease normally makes a biennial appearance it was not surprising that the numbers were fewer than in the previous year. However, it must be said that the figures are high when compared with other "off peak" years. SCARLET FEVER The number of cases was eighty-two in 1966, and is the lowest incidence recorded since 1962 (seventy-one cases). The general trend through the years is downwards, but as the disease nowadays is of a mild type it is probable that many of the very mild cases do not get notified. WHOOPING COUGH This was a fairly average year for the incidence of this disease, there being one hundred and sixty-nine cases notified as against one hundred and eight cases the previous year and one hundred and ninety in 1964. The numbers ought to be getting less each year, and would no doubt do so if every susceptible child were to take advantage of the whooping cough immunisation scheme. DYSENTERY The number of cases notified was slightly less than in the previous year, one hundred and fifty-two cases as against one hundred and fifty-nine cases. There were no large outbreaks and no special comment is called for except to emphasise once again that the way to eliminate this disease is by the adoption of the highest hygienic standards in connection with all apparatus of the water closet and with hand washing. 51 TUBERCULOSIS Once again it is pleasant to record a decrease in the number of cases notified (one hundred and fifty), and that the rate per 100,000 of the population (forty-seven) is the lowest recorded. Table 27 TUBERCULOSIS NOTIFICATIONS AND DEATHS AT AGES Age periods New cases notified Deaths Respiratory NonRespiratory Totals Respiratory NonRespiratory Totals M F M F M F M F M F M F 0- 1 — — — 1 — — — — — — — 1- — — — — — — — — — — — — 2- 1 2 — — 1 2 — — — — — — 5- 3 4 — — 3 4 — — — — — — 10- 3 3 — 1 3 4 — — — — — — 15- 2 5 1 1 3 6 — — — — — — 20- 6 5 1 1 7 6 — — — — — — 25- 3 14 1 3 4 17 — — 1 — 1 — 35- 15 7 — — 15 7 — 1 — — — 1 45- 17 4 — 1 17 5 1 — —- — 1 — 55- 21 3 — 1 21 4 I 2 — — 1 2 65- 9 2 1 — 10 2 4 1 — — 4 1 75+ 3 2 — 1 3 3 1 2 — — 1 2 TOTALS 84 51 4 9 88 60 7 6 1 — 8 6 CHEST CLINIC 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 main feature of the statistics of the Chest Clinic for 1966 is the continued reduction in the number of cases of tuberculosis. The number of new cases was 78 as opposed to 86 in 1965, but the total number on the register was reduced by 253 from 1,994 to 1,746. Accompanying this is a reduction in the number of contacts examined though this is offset by an increase of the number of children being referred for investigation from schools. Apart from tuberculosis there is little change in the numbers of cases of bronchitis, pneumonia, cancer and other non-tuberculous conditions being dealt with. The co-operation with Grove Park Hospital continues to be close and cordial. 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. 52 There were 73 additions to the Deptford Tuberculosis Register in 1966. This is a trickle compared with a decade or two ago when a couple of hundred or more was the rule, but vigilance against tuberculosis is still evidently necessary; it crops up sporadically in those citizens who fail to look after themselves in an urban environment where tubercle germs still lurk. Hence the cases which come from the local common lodging house, from the immigrants and, to a lesser extent than formerly, from the Londoner born and bred. At one time, tuberculosis was a disease common and often seen in florid form among those of Celtic origin who came to London from Ireland, Scotland and Wales, with little resistance to tubercle germs. This is still the position to some extent. The 73 cases comprised 53 men and 20 women. Their place of origin reads like a geography lesson. Of the 53 males. 48 were British born and 5 were coloured immigrants. These latter comprised 3 Nigerians, one Indian and one Jamaican. Of the 48 remaining cases, 22 were born in London, 5 in the Home Counties and 4 in the North Midlands. There were no less than 11 from Eire, 5 from Scotland and one only from Wales, making 17 males from the Celtic fringe of Britain. Enquiry of the birthplace of the 20 women revealed 10 Londoners, 2 more from Eire and one from Jersey, and 7 immigrants from further afield, comprising 3 West Indians and one each from Ghana, Pakistan, India and Tunisia. Tuberculosis may have been present in some of these cases before they arrived; some of the health checks applied abroad may not filter out all the cases. 8 of these persons died in the year of diagnosis, 7 from tuberculosis and one from other causes. Various additions and subtractions whittled down the Deptford Tuberculosis Register from 1,232 to 1,158 by the end of 1966. The 73 additions comprised 54 new tuberculosis notifications and I have added one new positive case who came to me by chance and who now prefers to stay under my care, 55 in all. There were also 10 established cases of tuberculosis previously known in Deptford who had moved away but who preferred to return to familiar haunts. Finally 18 known tuberculous cases from elsewhere in Britain came to make their home in Deptford. To make the numbers smaller there were 87 known cases of tuberculosis who moved out of Deptford, some under rehousing schemes or individual enterprise, but a significant number of individuals "disappeared" and then needed my time and ingenuity in trying to trace them. 11 people were regarded as absolutely cured and 4 more names came off for miscellaneous reasons. 37 deaths occurred on the Register and I shall now examine this group in more detail. 25 of the deaths were males and 12 females, with an average age of 64 and 65 respectively. The age range was 43 to 85 in males and 41 to 89 in the females. 7 of these deaths, as previously mentioned, were from advanced tuberculosis in cases too ill to save when first seen by any means of treatment. The remaining 30 had been largely cleared of tuberculosis as a result of treatment before succumbing to other diseases in which the chest featured prominently. Over and over again it appears that tuberculosis found and treated early does well, but if found late healing is then more difficult and scar formation with lung contracture may occur making the sufferer more liable to respiratory or cardiac failure later in life and the moral is plain. Thus 20 cases died of cardiorespiratory failure while 10 deaths were unrelated to the chest. The average time of survival from the time of diagnosis was 11 years in all cases. A collective total of 438 years of supervision had been given by the Chest Clinic, which is startling. One lady born in 1890 had been found tuberculous in 1911, 55 years previously by a predecessor of mine, and had been kept under close review 53 until recently when she died of another condition at the age of 76. A man born in 1889 had infectious tuberculosis found in 1916, was regarded as cured in 1946 but relapsed in 1956 and was treated and became non-infectious. He remained so and was seen frequently until he died aged 77 years of other causes. Finally it should not be thought that tuberculosis occupies all the time of the Chest Clinic today. A grand total of 1,495 new cases with chest symptoms was sent to me by local general medical practitioners for an opinion on the chest and altogether just under 6,000 people attended the clinic. I did an analysis of all persons attending in the first 3 months of 1966 and found that about one quarter were newly referred by doctors, and a quarter were established cases of tuberculosis attending for supervision and treatment. Rather less than a quarter were tuberculosis contact cases and the most numerous group were sufferers from bronchitis and kindred diseases, often disabling and requiring much treatment. Many cases were investigated in the search for lung cancer. I encountered 83 cases during the year who told me that they smoked in the region of 30 cigarettes daily some many more. One man claimed to smoke 100 cigarettes daily. The corresponding number of females smoking heavily was 33. Where I was successful in persuading them to reduce smoking, the chest symptoms were greatly eased. Heavy smoking of cigarettes is rightly condemned by a recent Ministry of Health statement. This warning should be taken by all if the risk of lung cancer is to be reduced and bad bronchitis made better instead of worse. MASS RADIOGRAPHY UNIT I am indebted to Dr. Morgan the Director of the Unit for information of work done in the borough during 1966 on which the following tables are based. Table 28 Patients Men Women Total General analysis: X-rayed 5 5,828 5,782 11,610 Previously x-rayed 3,126 2,365 5,491 Reviewed 247 152 399 Abnormal after review 186 101 287 Analysis of abnormal films: Cases considered tuberculous (a) No further action required — — — (b) Occasional supervision only 11 3 14 (c) Requiring treatment 14 7 21 (d) Still under investigation 2 — 2 (e) Refused further investigation — — — Previously known tuberculous cases 21 12 33 Non-tuberculous cases — — — (a) Investigated (See table 29 for detailed breakdown) 41 27 68 (b) Still under investigation 2 2 4 (c) D.N.A. further investigation — 1 1 Cardio-vascular lesions 26 21 47 Abnormalities requiring no action 69 28 97 54 Table 29 NON-TUBERCULOUS ABNORMALITIES MEN WOMEN Carcinoma of bronchus 7 Carcinoma of bronchus 2 Carcinoma of prostate— metastases in ribs and lung 1 Carcinoma of breast- secondary deposits in lung 1 Spontaneous pneumothorax 1 Sarcoidosis 2 Hamartoma 1 Bronchiectasis 3 Sarcoidosis 2 Pneumonitis 5 Pneumoconiosis (previously known) 1 Pleuro-pericardial cyst 1 Bronchiectasis 6 Chronic bronchitis and emphysema 5 Pneumonitis 4 Kyphoscoliosis 2 Chronic bronchitis and emphysema 13 Hiatus hernia 3 Retrosternal goitre 1 Abnormalities of diaphragm and mediastinum 2 Hiatus hernia 1 Abnormalities of diaphragm and and mediastinum 3 Pulmonary infarct 1 Failed to attend investigation 1 Still under investigation 2 Still under investigation 2 43 30 55 Table 30 Cases of tuberculosis requiring treatment or close supervision NOT PREVIOUSLY EXAMINED (included in previous columns) Men Women Total Men Women Total Men NUMBERS Women Total Men CASES Women Total Small Public Surveys 1,254 2,052 3,306 — 2 2 466 727 1,193 — 2 2 Public Surveys—Examination of Special Groups 540 173 713 1 1 2 436 72 508 — 1 1 Regular Site (New Cross) 1,731 1,329 3,060 2 3 5 1,118 582 1,700 1 3 4 Firms 1,282 355 1,637 4 — 4 678 151 829 2 — 2 Hospitals, Colleges etc. 494 1,208 1,702 — — — 342 688 1,030 — — — Homes and Hostels 527 665 1,192 7 1 8 86 145 231 5 1 6 TOTAL 5,828 5,782 11,610 14 7 21 3,126 2,365 5,491 8 7 15 56 PROPHYLAXIS Immunisation against the following diseases was offered at health centres and schools—Diphtheria, Whooping Cough, Tetanus, Poliomyelitis, Smallpox and Tuberculosis. Children between the ages of 2 months and 5 years were offered immunisation at health centres and from 5-12 years in schools. Special efforts were made during 1966 to obtain wider immunisation cover for children under 15 years and extra sessions were held at most schools. Adults between the ages of 15 and 40 years were offered immunisation against poliomyelitis. B.C.G. vaccination against tuberculosis was offered to all children in schools in their fourteenth year. The existing arrangements whereby medical practitioners in the borough are supplied, free of cost, with poliomyelitis vaccine for persons under the age of 40, and diphtheria, whooping cough and tetanus vaccine, has continued. Medical practitioners are able to obtain supplies of smallpox vaccine lymph from the Central Public Health Laboratory, Colindale Avenue, N.W.9 (COL 7041). Also available from this address are supplies of anthrax vaccine. The Council paid a fee of 5s. for each record of a completed course of immunisation, provided the record was received within three months of the completion of the course. Vaccination against Yellow Fever, Cholera, Enteric Fever and Typhus is available at the Hospital for Tropical Diseases, 4 St. Pancras Way, N.1 (Tel: EUS 4411, Ext. 137). Yellow Fever vaccination is also available at the Medical Department, Unilever House, Blackfriars, E.C.4 (Tel: KEN. 7474, Ext. 2841), and at 53 Cumberland Place, W.1 (Tel. AMB. 6456). At all centres patients are seen by appointment only, and immunisation is free of charge. Table 31 IMMUNISATION AND VACCINATION Type of vaccine or dose Primary courses completed Year of birth Others under age 16 yrs. Total 1966 1965 1964 1963 195962 Diphtheria 2,367 2,218 273 144 758 873 6,633 Whooping Cough 2,361 2,207 271 137 212 27 5,215 Tetanus 2,364 2,215 274 144 748 910 6,655 Polio 919 3,003 475 227 977 594 6,195 Polio 16-40 years— 96 Reinforcing dose Diphtheria — 1,490 1,363 240 5,198 6,719 15,010 Whooping Cough — 1,439 1,340 221 864 276 4,140 Tetanus — 1,487 1,362 237 5,116 5,523 13,725 Polio — 22 41 19 3,161 1,754 4,997 Polio 16-40 years— 69 Smallpox Vaccination Age at date of vaccination Months Years 0-3 3-6 6-9 9-12 1 yr. 2-4 yrs. 5-15 yrs. Total Vaccination 44 29 92 67 2,438 934 126 3,730 Re-vaccination — 31 160 191 57 LABORATORY FACILITIES The following relates to the work carried out by the public health laboratory on behalf of the Council during 1966. Table 32 Specimens Number Remarks Faeces 516 Negative 70 Shigella sonnei 1 Salmonella typhi 2 Salmonella derby 2 Salmonella Reading 4 Samonella poona 27 Samonella typhimurium 4 Staphylococcus aureus 1 B.coli 0111 Swabs from nose and throat etc. 20 Negative 3 Staphylococcus aureus 1 B-haem. streps Water (various) 5 Food 7 663 58 ENVIRONMENTAL HEALTH Mr. A. J. Phillips, Chief Public Health Inspector, reports: This has been the first full year of the London Borough and the Public Health Inspectors have now become more accustomed to the different procedures required by the changed legislation. It is regretted, however, that there is still no procedure for dealing with urgent nuisances or the reinstatement of water supply cut off due to defects. It is understood, however, that this may be remedied during 1967. Offices, Shops and Railway Premises It is pleasing to report that there has been a considerable increase in the number of inspections made, and that good progress in the remedying of defects has taken place. This has been made possible by a slight improvement in the number of inspectors appointed to fill serious gaps in the establishment. Details of the visits are shown in the following tables from which it will be seen that 1,220 registered premises received a general inspection during the year as compared with 371 the previous year. The inspectors found that on the whole the cleanliness of shop premises continues to improve as is shown by the fact that in only 9 cases was there a poor standard of cleanliness. It was surprising to find, however, that in spite of considerable publicity 189 premises were found to be without a first-aid outfit. Lack of a hot water supply was found in 122 premises and in 60 cases the lighting and heating of premises was not satisfactory. The number of accidents was only two less than in 1965, but again, fortunately, these were mostly of a minor character. There was one more serious case however, where it was necessary to institute legal proceedings. Clean Air One further smokeless area, Bellingham, came into existence during the year. This brought a further 3,200 dwellings under the control of the Clean Air Act. It was estimated that an annual tonnage of 3,000 tons of bituminous coal was to be replaced by gas, electricity, or other smokeless fuels. Two further smoke control Orders were made during the year which will become operative in 1967. It is hoped that the remainder of the Borough will be dealt with by Orders during 1967. Food The number of persons registered for the distribution of milk showed a slight decrease, and of the licences issued for the sale of special designations of milk it is interesting to note an increase in sterilised and ultra heat treated milk. Samples of milk taken during the year, except in one case, proved to be satisfactory. Of the other samples taken, a number of offences were brought to light of incorrect labelling. This was taken up with the wholesalers or manufacturers and subsequently rectified. There was again a considerable number of complaints of food sold containing foreign bodies or in an unwholesome condition and legal proceedings were instituted in many of the cases. Pest Control The upward trend of complaints of rats and mice continued in 1966. The complaints of rats were 1,040 compared with 889 and of mice 664 compared with 574 the previous year. The increase in rats is difficult to account for but may be due to the demolition of old properties to make way for redevelopment and the delay in sealing off of disused drains. Infestation by mice can still be attributed to carelessness in the storage of food, particularly in houses in multiple occupation where adequate storage accommodation is often lacking. Disinfection and Disinfestation Although 789 rooms were disinfected during the year compared with 434 last year and 24,951 articles compared with 22,148, many of these were treated as a precautionary measure after a long illness and there was no marked increase in verminous conditions. The number of persons treated at the two cleansing stations was about the same as the previous year. The number of persons treated for scabies, however, rose from 309 to 446. 59 Generally The tables show a slight increase in the number of visits carried out due, as already reported, to a slight improvement in the numbers of inspectors. The greatest increases were 4,094 complaints compared with 3,316, 101 house to house inspections instead of 5, over 100 more mortgage surveys bringing the total to over 1,000 as compared with the previous year. There was a large increase in both informal and formal notices served under the Public Health Acts, but it was not found necessary to serve so many notices under the Clean Air Act. The biggest increase in the work carried out was 632 cases of dampness remedied compared with 300. There were also increases in repairs to roofs, gutters, floors, plaster work and window frames. During 1966 it was possible to introduce the use of technical assistants into our work. It is proposed to extend this during 1967 and with a possible further improvement in the staff of inspectors it is hoped that the subsequent report may show Table 33 SUMMARY OF INSPECTIONS BY PUBLIC HEALTH INSPECTORS Reason for inspection Total On complaint 4,094 House to house 101 Improvement grants 490 Houses in multiple occupation 783 Rent Acts 23 Mortgage survey 1,054 Other Housing Act visits 911 Notice from builder 1,643 Infectious diseases 920 Infestation 197 Factories, mechanical 65 Factories, non-mechanical 42 Outworkers 70 Clean Air inspections 6,075 Pet Animals Act 18 Offices, Shops, etc. Act 1,299 Common Lodging Houses 15 Fireguards 66 Hairdressers 10 Pharmacy and poisons 133 Icecream premises 67 Restaurants, cafes, etc 1,039 Bakehouses 50 Food shops and stalls 654 Other shops and stalls 30 Food inspections 512 Sampling 319 All other matters 3,532 Revisits 13,096 Total—all inspectors 36,566 Table 34 SUMMARY OF NOTICES SERVED Informal notices: Public Health Act, 1936 1,025 Factories Act 22 Housing Act, 1957 4 Offices, Shops and Railway Premises Act, 1963 533 Total 1,584 60 Table 34—continued SUMMARY OF NOTICES SERVED Statutory notices: Public Health Act, 1936 574 Clean Air Act, 1956* 34 Housing Acts, 1957 and 1961 46 Byelaws 44 Total 698 *The vast majority of these were for late applications and were served to safeguard Ministry and Borough Council grant. Table 35 REPAIRS CARRIED OUT Repairs Total Brickwork repaired 40 Chimneys and flues repaired 6 Dampness remedied 632 Doors and door frames repaired or renewed 47 Drains repaired 41 Drinking water cisterns repaired — Dry rot remedied 16 Dustbins supplied 16 Fire grates etc., repaired or renewed 11 Flooring repaired or renewed 150 Flushing cisterns repaired, renewed or cleansed 26 Flush pipes repaired or renewed 4 Glazing 15 Gutters repaired 120 Gullies renewed, repaired or cleansed 23 Painting 8 Refuse cleared 22 Rainwater pipes cleared 42 Roofs repaired 277 Sashcords renewed 133 Sinks provided 50 Soil pipes repaired, ventilated or renewed 15 Walls and ceilings cleansed 5 Walls and ceiling plaster repaired 284 Water closets repaired or renewed 101 Water service pipes repaired or renewed, water supply restored 41 Windows and frames repaired or renewed 101 Yards and areas paved 33 Other repairs 78 TOTALS 2,337 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. 61 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. 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 36 INSPECTIONS Premises Number on register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which sections 1, 2, 3, 4 and 6 are to be enforced by local authorities 89 42 (ii) Factories not included in (i) in which section 7 is enforced by the local authority 768 65 22 (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 10 10 TOTAL 867 117 22 Table 37 CASES IN WHICH DEFECTS WERE FOUND Defects No. of defects Found Remedied Prosecutions instituted To HM Inspector By HM Inspector Want of cleanliness (S 1) — — — — — Overcrowding (S 2) — — — — — Unreasonable temperature (S 3) — — — — — Inadequate ventilation (S 4) — — — — — Ineffective drainage of floors (S 6) — — — — — Sanitary conveniences (S 7): (a) insufficient 14 2 — 2 — (b) unsuitable or defective 14 14 — 14 — (c) not separate for sexes 1 1 — 1 — Other offences against the Act (not including offences relating to outwork) 1 — — — — TOTAL 30 17 — 17 — 62 OUTWORKERS Under section 1333 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 or occupations concerned: Table 38 Trade Outworkers employed Clothing ... 130 Boxmaking ... 6 Lampshades ... 2 Rosettes ... 3 Lace ... 6 Curtains ... 7 Jewels ... 8 Toys 1 Wigs ... 1 164 The inspectors made 70 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 A very marked increase in the number of visits to premises registered under the Act was possible during 1966. In addition to the slight improvement in the number of inspectors due to students qualifying during the year, it has been possible to obtain the temporary assistance of two inspectors who recently retired from other authorities and one of them has devoted his whole time to the enforcement of this Act. Of the items requiring attention, the most frequently recurring were the following: Table 39 Abstract of the Act not displayed 329 Absence of a thermometer 228 Absence of a first aid box 189 Absence of a hot water supply 122 Other matters to which it was necessary to draw attention were: Table 40 Insufficient heating 62 Insufficient lighting 59 Condition of floors and staircases 40 Insufficient washing facilities 34 Facilities for drying clothes 26 Insufficient ventilation 23 Insufficient sanitary accommodation 22 Absence of drinking water 13 Lack of seating facilities 9 Poor standard of cleanliness 9 63 Further inspections were made to ascertain whether these matters had been put right and where this was not so, further action was taken to enforce compliance. Some measuring of offices has already taken place and this will be continued during 1967 in order that the overcrowding provisions operative later in the year can be fully implemented. The number of registered premises in 1966 showed a decrease (by 229), whilst the number newly registered during the year also fell (by 33). The number of staff employed dropped from 17,635 to 17,317 (males 7,486 compared with 7,698 in 1965 and females 9,831 compared with 9,937). There were 86 accidents reported during the year and investigation of 49 of these again showed that they were mostly of a minor character. In several instances occupiers were asked to carry out alterations or repairs to obviate any further accidents. In one case, however, it was felt that there was considerable negligence, namely the absence of proper guarding to an opening in the floor of the bar in a public house. Legal proceedings were instituted under section 16(4) of the Act, and a fine of £15 was imposed after a plea of guilty by the defendants. The conditions in shop and office premises are undoubtedly slowly improving as a result of this Act, and it is hoped further inspections during 1967 will show that the improvements have been maintained. Table 41 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 12 570 168 Retail shops 31 1,663 806 Wholesale shops, warehouses 1 94 32 Catering establishments open to the public, canteens 17 212 214 Fuel storage depots — 12 — TOTALS 61 2,551 1,220 Table 42 PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE Class of work place Number of persons employed (1) (2) Offices 5,136 Retail Shops 9,356 Wholesale departments, warehouses 1,207 Catering establishments open to the public 1,394 Canteens 169 Fuel storage depots 55 Total 17,317 Total Males 7,486 Total Females 9,831 64 Table 43 EXEMPTIONS Class of premises No. of exemptions current at 31st 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 Sanitary conveniences(Sec.9) Retail Shops ... ... 1 ... ... ... Washing Facilities (Sec10) Retail shops ... ... 1 ... ... ... Table 44 PROSECUTIONS Section of Act or title of Regulation prosecuted No. of persons or companies prosecuted No. of informations laid No. of informations leading to a conviction Section 16 1 1 1 Table 45 INFORMAL NOTICES SERVED DURING 1966 FOR DEFECTS FOUND UNDER O.S.R. ACT 1963 Cleanliness 9 Other deficient washing accom- Overcrowding — modation 2 Heating 62 Drinking water 13 Provision of thermometer 228 Clothing accommodation 26 Ventilation 23 Seating facilities 9 Lighting 59 Dangerous machinery Insufficient sanitary accommodation 20 Floors and staircases 40 Deficient sanitary accommodation 2 Noise and vibration Insufficient washing facilities 34 First Aid 189 Hot water/warm water required 122 Abstract of Act 329 NATIONAL ASSISTANCE ACT, 1948—SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951 No cases were removed to hospital by means of Orders granted under the above Acts. Several possible cases were kept under observation, and were subsequently voluntarily removed to hospital on medical grounds. DISINFECTION AND PERSONAL CLEANSING Details of the work carried out during the year are as follows: Table 46 Rooms disinfected or disinfested 789 Articles disinfected or disinfested 24,951 Verminous children cleansed 391 Verminous adults cleansed 569 (Carrington House 504) Treatment for scabies, children 251 Treatment for scabies, adults 195 Articles cleansed 123,109 Domiciliary bathing * 10,164 *This figure includes 8,367 home baths carried out by the bathing attendants whose work is more fully reported upon on page 26. 65 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 The following table shows the work of rat and mice destruction carried out by the pest operatives during 1966. No special comment is called for except to say that this is a continuing problem which allows for no let up in combating these pests. Table 47 Type of Properly Local authority Dwelling houses (including council houses) All other (including business premises) Total Agricultural Properties inspected as a result of (a") notification 15 2,743 237 2,995 — (b) survey — 130 17 147 — (c) otherwise — — — — — Total inspections 15 2,873 254 3,142 — Properties inspected which were found to be infested by:— (a) Rats—major — — — — — (b) —minor 10 930 100 1,040 — (c) Mice—major — — — — — (d) —minor 4 589 71 664 — Infested properties treated 14 1,519 171 1,704 — Retreatments 37 2,746 556 3,339 — "Block" control schemes carried out Nil SWIMMING BATHS There are 5 public swimming baths in the Borough. 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.) Lady well ... 8 0.05—1.60 Forest Hill North ... 9 0.10—0.90 Forest Hill South ... 9 0.05—0.74 Laurie Grove Large ... 5 0.05—1.28 Laurie Grove Small ... 9 0.02—1 .28 Laurie Grove South ... 8 0.04—1.40 Downham ... 8 0.05—1.60 Bellingham (open air) ... 2 0.00—0.12 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. 66 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 A third part-time pigeon catcher was appointed during the year to cover the Deptford part of the Borough and he and the existing two catchers were responsible for the destruction of 3,682 pigeons as well as nests and a large number of eggs. Regular visits were paid to the railway bridges and some of the churches in the Borough where a great deal of the nesting takes place. Most of the birds were accounted for by shooting but in one case a licence was obtained from the Ministry of Agriculture and Fisheries for the use of a narcotic but this was only reasonably successful. This treatment will be tried out again during 1967. The destruction of pigeons still presents a very difficult problem as they are encouraged on the one hand by people feeding them which on the other hand leads to complaints by people who object to them. A number of complaints related to damage to crops but this was found in most cases to be due to wood pigeons which seem to be coming in to built-up areas more than before. PET ANIMALS ACT, 1951 During the year 21 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. 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. RIDING ESTABLISHMENTS ACT, 1964 There are two licensed riding establishments in the Borough. These are inspected and supervised by the Council's Veterinary Officer, Mr. G. S. Wiggins, M.R.C.V.S. ATMOSPHERIC POLLUTION Clean Air Act During 1966 one more area was made the subject of Smoke Control Orders and particulars with regard to the area are as follows: No. 21 Name (Bellingham) Acreage 270 No. of industrial premises 3 No. of commercial premises 35 No. of dwellings 3,208 No. of other premises 11 Present annual tonnage of bituminous coal to be replaced 3,000 67 68 Likely additional fuel required annually: (a) Electricity (KWHS) 400,000 (b) Gas (therms) 100,000 (c) Oil, etc. Nil (d) Solid smokeless fuel (tons) and hard cokes ... 1,600 Total estimated cost of works £56,000 Date: Order made 22.2.66 Order confirmed 26.4.66 Order operative 1.11.66 PROGRAMME At the end of December 1966, the position in relation to areas which have been or still are the subject of smoke control action was as follows: Table 49 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 22 Deptford Park 1,158 1.10.67 23 Brookmill 1,083 1.10.67 69 Table 50 ATMOSPHERIC CONDITIONS IN 1966 January February March April May June July August September October November December Average or actual Temperature— Mean maximum 54 9.3 10.9 12.2 17.1 21.9 20.3 20.6 19.3 14.6 8.7 8.8 14.1 Mean minimum 2.4 5.5 4.1 6.2 7.9 12.3 12.8 11.9 11.2 9.0 4.6 4.4 7.7 Mean 3.9 7.4 7.5 9.2 12.5 17.1 16.5 16.3 15.3 11.8 6.7 6.6 10.9 Diff. from average -0.4 +2.8 +0.8 -0.2 0.0 +1.2 —1.1 —1.0 +0.4 +0.7 —1.0 +1.2 +0.3 Highest maximum 12.0 13.0 14.0 20.0 26.0 27.0 26.0 26.0 23.0 19.0 14.0 12.0 27.0 Lowest minimum —70 0.0 0.0 0.0 +6.0 +8.0 +10.0 +10.0 +8.0 +6.0 +2.0 —2.0 —7.0 Rainfall Total 1.48 1.99 0.38 2.87 1.45 2.67 3.72 3.61 0.82 3.76 1.38 2.78 26.91 Per cent, of average 58 174 29 200 105 152 112 136 55 175 53 142 116 Sunshine— Daily mean 1.30 1.06 4.05 2.97 7.02 6.70 5.18 6.37 5.34 2.49 1.90 1.17 3.80 Per cent. of average 87 47 111 56 110 94 81 105 112 79 107 91 90 Wind— NE/E/SE 55 27 1 43 25 14 9 25 35 24 12 4 23 s/sw/w 34 61 68 40 62 62 51 51 43 41 46 72 53 NW/N/Calm 11 12 31 17 13 24 40 24 22 35 42 24 24 Atmospheric pollution— Pool allotments Water insol. matter 17.65 9.90 9.36 13.26 19.30 21.34 11.38 20.34 8.86 14.56 10.57 9.16 13.81 Water sol. matter 466 5.60 2.68 6.01 3.59 4.09 5.03 4.46 4.26 4.87 5.24 4.33 4.57 Sulphur 1.94 1.83 1.19 1.12 0.65 0.54 0.33 0.53 0.72 0.80 1.40 1.46 1.04 Letvisham Town Hall— Smoke, daily average 149 80 96 71 49 50 39 49 73 111 95 113 81 ,, maximum 348 180 240 142 113 112 62 90 140 193 376 480 — ,, minimum 48 32 24 33 8 11 18 15 14 55 12 28 — Sulphur, daily average 215 150 169 177 129 102 82 102 164 157 168 166 148 ,, maximum 527 273 369 304 305 223 170 179 489 325 264 424 — ,, minimum 43 57 66 84 59 37 50 35 65 58 96 58 — Valentine Court— Smoke, daily average 107 47 57 37 26 19 28 23 39 63 73 45 45 ,, maximum 324 128 156 82 74 44 135 64 92 135 232 344 — ,, minimum 36 14 12 11 6 6 4 3 4 28 12 6 — Sulphur, daily average 214 119 167 158 133 92 68 74 152 119 170 137 134 ,, maximum 496 244 384 248 270 222 110 124 534 208 399 368 — ,, minimum 60 47 64 74 42 34 33 29 53 29 83 57 — Deptford Town Hall— Smoke, daily average 162 82 114 72 50 41 58 50 66 60 120 139 85 ,, maximum 448 172 264 139 121 81 110 109 116 123 380 440 — ,, minimum 38 14 24 13 14 10 13 14 10 0 40 88 — Sulphur, daily average 290 164 203 205 136 98 86 101 180 176 200 198 170 ,, maximum 621 397 358 358 370 226 146 207 480 332 266 523 — ,, minimum 102 48 64 104 63 12 47 37 62 55 121 89 — Weather Summary— Cold early mild later Dull and wet Dry Dull and wet Changeable and warm Wet and warm Wet Cool and wet Dry Wet Cold and windy Wet and mild Notes— Kew; 1 Lewisham; tpm: Tons per square mile per month; + as trioxide in MG per 100 sq. cms. per day; * microgrammes per cubic metre 70 HOUSING The following is a summary of action during the year under the various housing powers:— HOUSING ACT 1957 Sections 9 and 10—Repairs No. of informal notices served 4 No. of formal notices served 13 No. of houses made fit by owners after service of notice 13 No. of houses made fit by owners after work in default by Council 2 Sections 16, 17 and 18—Undertakings, Closing Orders and Demolition Orders No. of Undertakings accepted—Section 16 4 No. of Closing Orders on whole houses—Section 17 12 No. of Demolition Orders on whole houses—Section 17 3 No. of Closing Orders on parts of buildings—Section 18 4 No. of Closing Orders under Sections 17 and 18 determined under Section 27 2 No. of Demolition Orders under Section 17 revoked under Section 24 NIL No. of houses demolished following Demolition Orders 5 Sections 42 and 43—Clearance Areas Due to pressure of other housing work and the shortage of staff no inspections were made during the year in relation to the Council's 1966/1970 programme. A local public enquiry was held during the year in respect of a Compulsory Purchase Order based on a clearance area declared by the Council at an earlier date. Housing Act 1961—Houses in multiple occupation—Management No. of notices of intention to make Order—Section 12 10 No. of Management Orders made—Section 12 8 No. of Management Notices—Section 14 4 Provision of amenities—Section 15 No. of informal notices 31 No. of formal notices 22 Fire precautions—Section 16 No. of informal notices. 35 No. of formal notices 26 Default Work—Section 18 No. of houses subject to Section 15 and 16 notices where work done by Council 2 Directions limiting occupation—Section 19 No. of notices of intention to make a Direction 12 No. of Directions made 9 Housing Act 1964 No Control Orders under Section 73 in connection with houses in multiple occupation were made. Improvement Areas—Section 13 Following an initial survey a second area comprising 417 dwellings was declared by the Council in December. The 77 dwellings requiring the provision of amenities can be improved to the full standard at reasonable cost. As in the first area the owner-occupiers are being pressed to carry out any necessary improvements to their properties with the offer of grant aid. Notices served in relation to dwellings in areas Preliminary—Section 14 35 Undertakings accepted—Section 24 1 Immediate—Section 16 16 Suspended—Section 17 18 Final—Section 17 3 No. of dwellings improved to full standard 2 Dwellings outside improvement areas—Section 19 No. of representations made by tenants 10 No. of preliminary notices served 7 No. of undertakings accepted 1 No. of immediate notices served 3 No. of dwellings improved to full standard 2 Housing (Financial Provisions) Act, 1958, House Purchase and Housing Act 1959, Housing Acts 1961 and 1964 I mprovement grants Standard o/occupied tenanted No. of applications approved 154 41 No. of applications refused 7 NIL No. of dwellings improved 95 29 Total amount paid £16,400 Average grant per dwelling £132 Discretionary o/occupied tenanted No. of applications approved 35 11 No. of applications refused 1 NIL No. of dwellings improved 29 8 Total amount paid £10,350 Average grant per dwelling £280 Housing (Financial Provisions) Act 1958 House purchase loans—Section 43 During the year 950 properties, which were the subject of applications to the Council for mortgages, were surveyed and reported on by the health inspectors in relation to repairs, amenities, occupation and necessary fire precautions. Specifications submitted by mortgagors were checked for approval and the work carried out was supervised prior to certification to the Borough Treasurer. As in previous years the conditions imposed as to the provision of amenities gave rise to many improvement grant applications. The conditions and control in relation to properties subject to a Council mortgage during the time the scheme has been in operation has resulted in many thousands of dwellings in the Borough being brought up to a high standard of fitness. 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 mittee in 1966. Sections 12 and 13 (management regulations) 7 Sections 14 (management notices) 1 Section 15 (provision of amenities) 7 Section 16 (fire precautions) 9 Section 19 (occupation directions) 11 71 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. RENT ACT, 1957 The following table shows the applications for certificates of disrepair dealt with during the year 1966. Table 51 Applications for certificates 11 Decisions not to issue certificates 1 Decisions to issue certificates 4 Undertakings given by landlords to repair 5 Undertakings refused for special reasons — Certificates of disrepair issued 4 Applications by landlords for cancellation of certificates 15 Objections by tenants to cancellation 5 Certificates cancelled 14 Table 52 HOUSES IN CLEARANCE AREAS AND UNFIT HOUSES ELSEWHERE (a) HOUSES DEMOLISHED Clearance areas Houses (Housing Act, 1957) Houses unfit for human habitation 26 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) 8 Local authority houses certified unfit by medical officer of health — (b) —UNFIT HOUSES CLOSED (Housing Act, 1957) Clearance Areas Houses ss 16,17 and 35 12 ss 17(3) and 26 — Parts of buildings closed under s. 18 8 (c) —PERSONS DISPLACED Persons From houses to be demolished in or adjoining clearance areas 1,046 From houses to be demolished not in or adjoining clearance areas - From houses to be closed 32 From parts of buildings to be closed 12 (d) —FAMILIES DISPLACED Families From houses to be demolished in or adjoining clearance areas 352 From houses to be demolished not in or adjoining clearance areas From houses to be closed 11 From parts of buildings to be closed 4 72 73 Table 52—continued (e) —UNFIT HOUSES MADE FIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED By owner By Local Authority After informal action by local authority 11 After formal notice under Public Health Acts 5 2 After formal notice under Housing Act 1957 - - Under s.24 Housing Act, 1957 - - (0 —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 - - MILK The Milk and Dairies (General) Regulations, 1959 At the end of the year there were 198 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, 1970, were issued during the year as follows: for sale of untreated milk 97 „ sale of pasteurised milk 166 „ sale of sterilised milk 155 „ sale of ultra heat treated milk 94 Examination of heat-treated milk 58 samples of heat-treated milk were submitted for examination during the year. One sample of pasteurised milk failed the methylene blue test. All of the other samples were found to be satisfactory. Table 53 Type of milk Number of samples tested Pasteurised 47 Tuberculin tested (pasteurised) 7 Sterilised 2 Ultra heat-treated 2 58 74 Analysis of milk During the year under review, 66 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 54 Period Samples Average composition of samples examined Percentage of Milk fat Solids not fat Total solids First quarter 17 3.56 8.50 12.06 Second quarter 22 3.51 8.64 12.15 Third quarter 17 3.71 8.65 12.36 Fourth quarter 10 4.00 8.76 12.76 TOTALS 66 3.69 8.64 12.33 The legal standard is 3.0 per cent milk fat and 8.5 per cent solids not fat (total solids 11.5%) ICECREAM Food Standards (Icecream) Regulations, 1959 Labelling of food (Amendment) Regulations, 1959 The composition of icecream samples submitted to the public analyst during the year showed an average composition of 9.5 % fat. 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 26 samples of icecream were submitted for bacteriological examination with the following results: Table 55 Samples % Grade I 20 77 Grade II 2 8 Grade III 1 4 Grade IV 3 11 TOTAL 26 100 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. 75 FOOD GENERALLY Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 995; of these 16 were formal and 979 informal. After examination the public analyst reported that 85 of the samples were adulterated below standard or insufficiently described by the label which amounted to 8.5 per cent of all the samples submitted. Table 56 Samples Analysed Articles Examined Adulterated Formal Informal Total Formal Informal Total Beverages — 14 14 — — — Bread, Biscuits, Cakes — 35 35 — 7 7 Colouring matter 1 16 17 1 2 3 Cheese — 7 7 — — — Drugs — 28 28 — 2 2 Fats — 24 24 — 1 1 Fish — 44 44 — — — Flour — 13 13 — 3 3 Flavourings and condiments 4 206 210 3 12 15 Fruit and nuts — 119 119 1 4 5 Icecream — 14 14 — — — Jam, pastes 1 17 18 — — — Meats 4 7 11 1 4 5 Milk and cream 1 121 122 — 12 12 Sausages — 68 68 — 10 10 Soft drinks 1 27 28 — 2 2 Sweet confectionery 1 28 29 — — — Vegetables and cereals — 34 34 — 5 5 Wines — 2 2 — — — Miscellaneous 3 81 84 4 11 15 TOTALS 16 905 921 10 75 85 Table 57 Non-genuine samples Article Formal or Informal Adulteration or irregularity Action taken Cochineal colouring Informal Sample not made from cochineal Formal sample to be taken Blackcurrant health drink Informal Incorrect labelling Formal sample to be taken Cranadilla, canned Informal Contained excessive tin Letter to retailer Powdered thyme Informal Contained excessive lead Letter to retailer Dehydrated mint flakes Informal Contained excessive sand and silicious matter Letter to retailer Aspic jelly powder Informal Incorrect labelling Letter to retailer 76 Table 57—continued Article Formal or Informal Adulteration or irregularity Action taken Prepared Dijon mustard with white wine Informal Contained no measurable alcohol and excessive amount of sulphur dioxide Letter to retailer Pork sausages Informal Contained excessive fat No further action Tomato paste, canned Informal Contained excessive lead No further action Egg plants, canned Informal Contained excessive tin No further action "Sanfayna", canned (peppers and other vegetables) Informal Inadequately labelled Letter to retailer Milk loaf Informal Did not contain whole milk solids Further sample to be taken Cochineal Informal Sample not made from cochineal Formal sample to be taken Cochineal Formal Sample not made from cochineal Legal proceedings Blackcurrant health drink Formal Incorrect labelling Manufacturers agreed to change label Plain flour Informal Contained insufficient chalk Further sample to be taken Pizza with sauce Informal Contained excessive amount of tin and inadequately labelled Letter to manufacturers Rose hip tea Informal Inadequately labelled Letter to manufacturers Pork sausages Informal Contained insufficient meat No further action Pork sausages Informal Contained particles of bituminous paint or lining on surface No formal action Tips tea Informal Incorrectly labelled Formal sample to be taken Tips tea Formal Incorrectly labelled Packers to change description and omit the word "tips" Potted sardine in tomato Informal Contained excessive lead No formal action Fines Herbes Informal Incorrect labelling Manufacturers warned Kelp tablets Informal Incorrect labelling Manufacturers warned Blutworst Informal Contained sulphur dioxide Formal sample to be taken Blutworst Formal Contained sulphur dioxide Legal proceedings Pork and goose liver paste Informal Contained excessive tin No further stocks Pate de Foie pur Pore, canned Informal Contained excessive tin No further stocks Raw sugar mincemeat Informal Had objectionable soapy taste Letter to manufacturers Sweet pepper flakes Informal Incorrect labelling Letter to manufacturers 77 Table 57—continued Article Formal or Informal Adulteration or irregularity Action taken A wheat germ food Informal Contained only small proportion of wheat germ Further action pending Italian sauce, canned Informal Incorrect labelling Italian trade mission notified Cooking butter Informal The butter was rancid Packed for West Indian trade. No further action. Curry powder Formal Contained excessive lead Legal proceedings "Cassareep" flavouring Informal Incorrect labelling Letter to wholesalers Grapes Informal The proportion of arsenic and lead were excessive Spanish import. Ministry informed Pure Spanish grape juice Informal Contained excessive iron contamination No further action Sweet Chili sauce Informal Contained unauthorised artificial colouring matter Formal sample taken Sweet Chili sauce Formal Contained unauthorised artificial colouring matter Legal proceedings Pork sausages Informal Contained only 44% meat Formal sample to be taken Pork sausages Informal Contained 60% meat No further action Pure poultry seasoning Informal Incorrect labelling Letter to manufacturers Ground cummin seed Informal Contained excess amount of sand and extraneous mineral matter Formal sample to be taken Ground cummin seed Formal Contained excess amount of sand and extraneous mineral matter Importers notified Holland caraway Informal Contained excess amount of sand and extraneous mineral matter French imported Re-exported Nutmeg powder Informal Contained beetles and their larvae French imported. Re-exported Tea tips Informal Incorrect labelling Letter received undertaking to relabel omitting word "tips" Tea tips Informal Incorrect labelling »» Tea tips Formal Incorrect labelling »» Tea tips Formal Incorrect labelling „ Tomato purée Informal Contained excessive amount of fungus Formal sample to be taken Tomato puree Formal Contained excessive amount of fungus Legal proceedings Tender cooked beet Informal Contained undisclosed vinegar Sale discontinued 78 Table 57—continued Article Formal or Informal Adulteration or irregularity Action taken Camomile extract Informal Inadequate labelling Letter to retailer Prawns in Creole sauce Informal Incorrect labelling Further sample to be taken Pork sausages, preserved Informal Contained insufficient meat Subsequent sample genuine Pork sausages, preserved Informal Contained insufficient meat Subsequent sample genuine Pork sausages, preserved Informal Contained excessive sulphur dioxide Subseqeunt sample genuine Tomato paste, canned Informal Contained excessive tin and lead Stock withdrawn 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: Milk (8) Bread (6) Milk bottles (3) Fish fingers (2) Sweet confectionery (2) Steak and kidney pie (1) Chocolate bun (1) Buttered macaroni (1) Pork sausages (1) Orange crush (1) Corned beef (1) Spam (1) Rissoles (1) Liquid soup (1) Soup powder (1) Chocolate (1) Currant bun (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 and multiple grocers 348 348 348 Greengrcoers 201 171 not applicable Bakers 92 92 92 Butchers 142 142 142 Confectioners 369 361 not applicable Cafes and restaurants 167 167 167 Fish shops 37 37 37 Fried fish shops 32 32 32 Public houses 165 165 165 Off licences 95 93 not applicable 79 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 1966 Total Sale and storage of icecream 4 471 Manufacture of icecream — 9 Fish frying 1 49 Fish curing — 18 Preparation or manufacture of sausages 1 74 Preparation or manufacture of potted, pressed, pickled or preserved food 2 125 UNSOUND FOOD Approximately 71 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. 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 amount of unfit food was small (last year 3 tons). Totals for the year are shown in the table:— Table 60 Country of origin Tonnage imported Spain 69,002 Italy 41,586 France 28,016 Yugoslavia 6,800 Algeria 4,739 Hungary 1,089 Belgium 819 Roumania 156 Austria 151 Switzerland 55 Holland 48 Morocco 43 Israel 25 Germany 1 Total 152,530 80 Table 61 Unfit food Amount lbs. Artichokes 3,810 Apricots 2,094 Peaches 550 Potatoes 168 Tomatoes 78 Grapes 55 Total 6,755 In addition to the above 8,391 tins of herbs and spices were re-exported because of high lead content. PHARMACY AND POISONS The names of 8 persons were entered on the Council's list of persons entitled to sell poisons in Part 11 of the poisons list and the names of 160 persons previously registered were retained on the register. 168 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. One slaughterman's licence was issued during the year. OFFENSIVE TRADES There are no offensive trades carried on in the borough. LEGAL PROCEEDINGS During the year there were 27 cases of legal proceedings for infringements of various Acts as follows. Table 62 Number of cases Fines Costs £ s. d. £ s. d. Food and Drugs Act, 1955 23 311 0 0 56 14 0 Public Health Act, 1936 2 25 0 0 7 7 0 Offices, Shops and Railway Premises Act, 1963 1 15 0 0 - - - Byelaws 1 5 0 0 — — — Total 27 356 0 0 64 1 0 WATER SUPPLY Dr. E. Windle Taylor, Director of Water Examination for the Metropolitan Water Board reports as follows on the condition and supply of water to the Borough during 1966, 85.50. The number of dwelling houses supplied by pipe direct to the premises is and no premises are supplied by means of stand pipes. The supply is somewhat complicated due to the number of sources of water involved 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 and bacteriological quality of these sources are set out in the following tables. There were no new sources of public water supply instituted in your area during 1966, but extensions to trunk mains amounted to 814 yards. Furthermore there were no changes in the general scheme of supply to your Borough during 1966, but new service mains were laid in the area to the extent of 2,408 yards including the length of trunk mains already mentioned above. 81 Table 63 Average results of the chemical and bacteriological examination of the water supply to the Borough of Lewisham for 1966 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) Ca CO 3 Hardness noncarbonate CaCO3 Magnesium as Mg Chloride as CI Phosphate as PO4 Silicate as SiO4 Sulphate as SO4 Natural Fluoride as F Surfaceactive material as Manoxol OT Turbidity units Colour (Burgess units) PH value Electrical Conductivity (micromhos) Bexley 4 0.005 0.038 4.9 0.13 323 69 4 19 17 58 Nil 1 7.1 580 Darenth 4 0.012 0.041 4.6 0.11 273 42 2 18 14 24 0.2 1 7.1 510 Deptford 4 0.013 0.040 5.9 0.20 389 126 9 43 16 122 0.1 3 7.0 740 Wilmington 4 0.008 0.049 7.5 0.35 303 67 2 25 16 30 0.1 2 7.1 570 Merton Abbey Not in supply during the year. All Thames derived 363 0.030 0.088 4.1 1.26 285 78 5 32 1.7 8 64 0.20 0.01 0.1 15 7.9 570 82 Table 64 Bacteriological Results—Yearly Averages, 1966 of water supplied to the Borough of Lewisham Source of supply BEFORE TREATMENT AFTER TREATMENT Agar plate count per ml. Coliform count Escherichia coli count Agar plate count per. ml. Coliform count E. coli count Number of samples 20-24 hours at 37 °C 3 days at 22 °C. Per cent, samples negative in 100 ml, Count per 100 ml. Percent, samples negative in 100 ml. Count per 100 ml. Number of samples 20-24 hours at 37°C. 3 days at 22 °C. Percent.. samples negative in 100 ml. Percent, samples negative in 100 ml. Bexley 248 0.0 2 99.60 — 100.0 — 255 0.0 19 100.0 100.0 Darenth 248 0.3 67 97.18 0.1 98.79 — 254 0.0 1 100.0 100.0 Deptford 248 2.6 28 91.53 1.8 96.77 0.1 254 3.1 216 100.0 100.0 Wilmington 248 1.4 29 96.77 0.1 98.79 — 255 0.2 3 100.0 100.0 All Thames derived 3,569 14.1 99.44 99.97 83 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 65 Lewisham Mortuary Deptford Mortuary Total Bodies received from hospitals etc. 544 344 888 Others 522 268 790 Totals 1,066 612 1,678 Cremations and Burials The following statistics relating to cremations and burials are for the year 1st April, 1966 to 31st March, 1967. Table 66 Cemetery No. of burials Hither Green 994 Grove Park 297 Ladywell 65 Brockley 75 Total 1,431 There were 1,259 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 names 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. 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 1966, 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 67 Country Number of Immigrants „ Number of first successful visits (a) Commonwealth Countries Caribbean 301 217 India 34 24 Pakistan 8 4 Other Asian 14 10 Africa 65 45 Other 15 10 (b) Non-Commonwealth Countries European 15 11 Other 11 4 TOTALS 463 325 84 85 MISCELLANEOUS NATIONAL SURVEY OF LEUKAEMIA AND MALIGNANT DISEASES OF CHILDHOOD As in 1965 the Department has taken part in the National Survey of Leukaemia and Malignant Diseases of Childhood sponsored by the Department of Social Medicine, Oxford University and the Medical Research Council. The family histories and clinical backgrounds of children registered as having died from leukaemia or other malignant disease are thoroughly investigated in cooperation with family doctors. A similar detailed investigation is carried out in a control series of healthy children of the same age and sex. A total of six cases and six "controls" were investigated in 1966 and records forwarded to Oxford. All of the cases who had died in the previous year had diagnosis of malignant disease other than Leukaemia. This is to be a long-term survey extending over several years on a country-wide scale. It is hoped that the information obtained will contribute towards elucidating the aetiology of malignant diseaase in childhood. FAMILY PLANNING I am indebted to Mr. Harold Pring, Branch Organising Secretary to the South-East London Branch of the Family Planning Association for the following report on the work of the Association during 1966. The Family Planning Association is established exclusively for charitable purposes with the object of the relief of poverty and ill-health and the prevention and mitigation of their consequences in the special fields of family life, marital happiness and the birth and upbringing of healthy children. For the attainment of its objects it has power to provide under qualified medical direction centres and clinics at which facilities for medical advice and, where necessary, treatment for any or all of the following:— (a) Family limitation and the spacing of the birth of children by the employment of scientific methods of contraception. (b) Involuntary sterilitity in husband or wife and failure to conceive or to bear healthy children. (c) Difficulties connected with the marriage relationship for which medical advice or treatment is appropriate. (d) The taking of gynaecological and genito urinary specimens for diagnostic purposes. With the co-operation of your Council family planning clinics were established during or prior to 1966 in the following premises:— 2 Spalding House, St. Norbert Road, Brockley, S.E.4 Louise House, Dartmouth Road, Forest Hill, S.E.23 410 Lewisham High Street, S.E.13 1-2 Winnett House, Flower House Estate, S.E.6 Amersham Road Health Centre, S.E.14. 86 A further clinic was opened on the 3rd January, 1967 at the Downham Health Centre, Downham. A Clinic for the insertion of intra uterine contraceptive devices is also established at the Lewisham Hospital thanks to the kindness of the Hospital Management Committee. Table 68 Source from which patient came Hospital, officially referred 48 notified 20 Local authority, officially referred 117 notified 222 Friend or patient 922 Family Doctor 523 Transfer from other Clinics 452 Other sources 453 2,757 Age at first visit —20 256 20 24 941 25 29 656 30 34 490 over 34 414 2,757 Number of Pregnancies - prior to first visit 0 544 1 575 2 721 3 483 4 268 5 80 6 49 7 or more 37 2,757 NURSING HOMES Responsibility for the registration and inspection of six nursing homes is vested in the London Borough of Lewisham 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. Two are non-profit making homes, and one is registered for the reception and accommodation of mentally disordered persons. All these homes have been inspected during the year by a medical officer and a public health inspector. No new homes were registered during the year. The registration of one home was amended, the authorised number of patients being decreased by one. Table 69 31.12.66 No. of homes registered 6 Beds available:— Chronic sick, medical or surgical patients 65 Expectant or nursing mothers 21 Babies nursed by mothers 8 Mentally ill (informal admission only) 17 HOUSING A very close co-operation has developed between the Housing Department and the Health Department, where a Senior Medical Officer spends at least one session each week with a senior officer of the Housing Department in order to assess the housing applications supported by medical certificates. The medical certificates are supplied by the housing applicants' general practitioners or by hospital doctors. During the year all housing applications from the old Borough of Lewisham had to be repointed and all those from the old Borough of Deptford had to be pointed, as no points system had existed previously in Deptford. About 5,000 housing applications supported by medical evidence were dealt with during the year. Medical evidence received in support of transfer of tenants to other Council accommodation has been discussed and assessed for approximately 500 cases. It is often difficult to decide how many points are to be allocated for any particular ailment, but as long as the points are allocated consistently so that all similar conditions are given the same number of points, all applicants are given a fair deal. In cases of emergency where the points system could never get a family re-housed, the applicants have been referred to the Housing Committee as special cases on the recommendation of the Senior Medical Officer. All the cases referred to in this way have been given the O.K for rehousing by the Committee. A lecture, called "Method of Assessment of Families for re-housing", has been given to the Public Health Inspectors, Mental Health Workers, Health Visitors, and to Social Workers in the Welfare Department. 88 INDEX Page Adoption and Boarding Out 21 Analgesia in labour 19 Animal Boarding 67 Antenatal and Post-natal Care 18 Anti-fly campaign 66 Area of Borough 13 Atmospheric Pollution 67 Auxiliary Staff 24 Bathing Attendants 26 Births and Birthrate 13 Blind and Partially sighted persons 21 Borough, description of 10 Brockley Training Centre 42 Burials 83 Cancer, earlier diagnosis of breast cancer 26 Case Conferences 32 Cervical Cytology 19 Chest Clinics 52 Child Minders 20 Children's Department, co-operation with 22 Chiropody Service 30 Clean Air 67 Cleansing, Personal 65 Clearance Areas 70 Community Health Services 42 Continental Goods Depot 79 Cremations 83 Day Centres 44 Day Nurseries 20 Day Nurseries, private 20 Deaths and Deathrate 13 Deaths by Cancer 15 Dental Auxiliaries, School for 28 Dental Service. Maternal and Child Health 28 Dental Service, Schools 35 Dental Services 27 Deptford Chest Clinic 52 Deptford Schools Treatment Centre 32 Disinfection and Personal Cleansing 65 District Nursing 26 District Nursing, patient care 26 District Nursing, staff recruitment and training 26 Downham Health Centre 24 Dysentery 51 Early Care Unit 42 Early Neo-Natal deaths 13 Emergency Obstetric Service 18 Environmental Health 59 Exhumation 83 Factories 61 Family Casework 46 Family Planning 85 Field Work Instructors 24 Flies 66 Food 75 Food Poisoning 51 Page General Provision of Health Services 10 General Statistics from 1950 17 Haemophiliac Children 31 Handicap Register 21 Handicapped Children 31 Health Education 40 Health Visiting 23 Health Visiting, liaison with hospitals 24 Health Visiting, school health 23 Health Visitor, students 24 Health Visitors, refresher courses 24 Heart Disease 15 Home Help Service 47 Home Nursing 26 Home Nursing, staff training and Post graduate courses 26 Home Purchase Loans 71 Homes in Clearance Areas 70 Honor Lea Hostel 44 Houses in Multiple Occupation 71 Housing 70 Housing Applications, Medical pointing 87 Icecream 74 Immigrants 83 Immunisation and Vaccination Improvement Work 70 Incontinence Pads 26 Infant Mortality 13 Infectious Diseases 49 Junior Training Centre 42 Laboratory Facilities 58 Legal Proceedings 80 Lewisham Chest Clinic Leukaemia 85 Loans (House Purchase) 76 Loans Service 25 Lung Cancer 15 Mass Radiography Unit 54 Maternal Deaths 19 Measles 51 Mental Health 42 Mental Health, Social Clubs 45 Mice 66 Midwifery, Liaison between midwives and general practitioners 18 M idwifery Service 18 Midwifery Staff 18 Midwifery training 18 Midwifery with hospital services 18 Milk 73 Mortuaries 83 Mothers clubs 23 National Assistance Act, section 47 65 Neo-natal deaths 13 Nurses, visits to establishments 24 Nursing Homes 86 89 INDEX—continued Page Occupational Therapy, domiciliary 45 Offensive Trades 80 Offices, Shops & Railway Premises 63 Outworkers 63 Parentcraft Classes 23 Perinatal Mortality 13 Pet Animals 67 Pharmacy & Poisons 80 Pigeons 67 Population 13 Prevention of Damage by Pests 66 Prophylaxis 57 Psychiatric advice 45 Rag, Flock and other filling materials 67 Rateable Value 13 Rats and Mice 66 Recuperative Holidays 21 Rent Act 72 Reproductive Wastage 13 Resuscitation of infants 19 Riding Establishments 67 Risk and Handicap Registers 21 Samples 75 Scarlet Fever 51 Page School Care Service 32 School for Dental Auxiliaries 28 School Health 31 School Medical Inspection 33 Schoolchildren, Personal Hygiene 35 Sickness, Local 16 Slaughterhouses and Slaughterers 80 Smoke Control 67 Social Clubs 45 Special Schools 31 Stillbirths 13 Surveys 24 Swimming Baths 66 Training Centres 42 Tuberculosis 52 Tuberculosis, boarding out of contacts 21 Unfit Houses 72 Unsound Food 79 Vision, School Medical Inspections 38 Vital Statistics 13 Water Supply 80 Whooping Cough 51 90 TABLES No. Subject Page 1. Causes of death by age groups 14 2. Heart and circulation mortality 15 3. Cancer deaths 15 4. Morbidity shown in insurance certificates 16 5. General statistics from 1950 17 6. Cervical cytology 19 7. Recuperative holidays 21 8. At "Risk" and "Handicap" Registers 22 9. Adoption and Boarding out 23 10. Downham Health Centre, minor ailments 25 11. District Nursing loan equipment 25 12. Dental service, Maternity and child health 28 13. Summary of attendances—Chiropody 30 14 Clinic Analysis totals—Chiropody 30 15. Routine inspections of schoolchildren 33 16. Routine inspections of schoolchildren—Defects 34 17. Personal hygiene of schoolchildren—Surveys 35 18. Dental inspection of schoolchildren 35 19. Non routine medical inspections of schoolchildren 37 20. Routine inspections of schoolchildren—Vision 38 21. Comparison of Defects noted "Special" medical inspections of schoolchildren 39 22. Health Education, film shows, talks, etc 41 23. Home Helps 48 24. Notified cases of infectious diseases 49 25. Notification of infectious diseases by sex and age 50 26. Food poisoning cases 51 27. Tuberculosis, notifications and deaths 52 28. Mass Radiography 54 29. Mass Radiography, non-tuberculous abnormalities 55 30. Mass Radiography, surveys 56 31. Immunisation and Vaccination 57 32. Laboratory facilities 58 33. Sanitary inspections 60 34. Summary of notices 60 35. Repairs carried out 61 36. Factory inspections 62 37. Factory defects 62 38. Outworkers 63 39. O.S.R. Items requiring most frequent attention 63 40. O.S.R. Other matters requiring attention 63 41. O.S.R. Registrations and inspections 64 42. O.S.R. Persons employed 64 43. O.S.R. Exemptions 65 44. O.S.R. Prosecutions 65 45. O.S.R. Informal notices served 65 46. Disinfection and Personal Cleansing 65 47. Rodent Control 66 48. Swimming baths 66 49. Clean Air Act Programme 68 50. Atmospheric Conditions 69 51. Rent Act, 1957 72 52. Houses in Clearance Areas and unfit houses elsewhere 72 53. Examination of heat-treated milk 73 54. Analysis of milk 74 55. Grading of ice cream 74 56. Samples analysed 57. Non-genuine samples 75 58. Food Premises, washing facilities 78 59. Registration of food premises 79 60. Continental Goods Depot, tonnage imported 79 61. Continental Goods Depot, unfit food 80 62. Legal proceedings 80 63. Water, chemical analysis 81 64. Water, bacteriological samples 82 65. Bodies received in Mortuaries 83 66. Burials 83 67. Immigrants 84 68. Family Planning 86 69. Nursing Homes 86