CONTENTS Page Introduction 3 Health Committee 5 Health Staff 7 The Borough 8 General Provision of Health Services in Area 8 Vital Statistics 11 HEALTH CENTRES 16 MATERNAL AND CHILD HEALTH 17 Midwifery 17 District Nursing 19 Health Visiting 21 Cervical Cytology 22 Day Nurseries and Child Minders 22 Congenital Malformations 23 LOAN SERVICE 26 DENTAL SERVICES 27 Dental Caries Survey 28 Maternal and Child Health 28 Dental Health Education 28 School Dental Services 30 School for Dental Auxiliaries 32 SCHOOL HEALTH SERVICE 33 Handicapped Pupils Register 34 Deaf Register 35 School Medical Inspection 35 School Treatment Centres 41 SOCIAL WORK (SCHOOLS AND GENERAL) 42 HOME HELP SERVICE 44 HEALTH EDUCATION 45 CHIROPODY SERVICE 47 MENTAL HEALTH 49 Early Care Unit 49 Mental Subnormality Liaison Committee 50 Psychiatric Advice 50 Honor Lea Hostel 50 Day Centres 50 INFECTIOUS DISEASES 52 Chest Clinics 57 Mass Radiography 58 Immunisation and Vaccination 61 1 Page ENVIRONMENTAL HEALTH 62 Summary of Inspections and Notices Served by Public Health Inspectors 63 Factories 64 Offices, Shops and Railway Premises Act 66 Disinfection and Personal Cleansing 68 Preventation of Damage by Pests 68 Swimming Baths 69 Rag Flock and Other Filling Materials Act 69 Destruction of Pigeons 69 Pet Animals Act 69 Atmospheric Pollution 70 Housing Acts 72 Milk 74 Icecream 74 Food 75 Pharmacy and Poisons 79 Legal Proceedings 80 Water Supply 81 Mortuaries 84 Immigrants 85 2 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE LONDON BOROUGH OF LEWISHAM I have the honour to present a report on the Health Services in Lewisham for the year 1967. This is the third in the series and, in addition to meeting the requirements of the Ministry of Health, contains material on the School Health Services submitted to the Inner London Education Authority. In recent years, many formal and informal consultations, with relevant agencies, have taken place on the provision of comprehensive health centres. During 1967, it could be said that the end of the beginning had been reached when a report on a long term flexible plan had been accepted by the Council and the site of the first centre decided upon. The most important of various legislative measures affecting Health Services in 1967 is the Family Planning Act, which lays duties upon the Council. This will be implemented by the department, according to the directions of the Health Committee. The incidence of general sickness in the working population of the Borough, as shown by returns from the Ministry of Social Security, is lower than in 1966. Although several contacts and suspects needed investigation, it is pleasing to record that no cases of Diphtheria, Poliomyelitis or Smallpox occurred during the year. It would be very wrong to be complacent about this and efforts continue, especially by our health visitors, against the tendency to apathy in a community which has fortunately escaped the impact of these killer diseases in recent years. Several cases of Typhoid, due to infection from outside, were notified and investigated. A death from Tetanus, the first for many years, was a tragic reminder of the need to emphasise the facts of prevention in this as in many other such diseases. One case of Anthrax was notified, single cases also occurring in 1965 and 1962. A vaccine is now available to those whose occupations place them "at risk". No such workplace exists in Lewisham Notes on the work of the two Chest Clinics, submitted by the consultants, are included in this report, as is also a graph showing the dramatic decline in the incidence of Tuberculosis in recent years. The general death rate shows a slight fall compared to 1966. Of interest is the finding that there is a significant decrease in the number of deaths under the age of 65 in relation to the total. The Infant Mortality Rate, which is generally regarded as an index of the standard of social medicine in an area, shows a very favourable trend. Over 3,000 deaths occurred due to disease of the heart and circulation in the age group 45-65. Many authorities feel that there is scope for preventive action and there is no doubt that methods of population screening and periodical medical checks would show dividends here. Deaths from lung cancer in men and women once again showed increases on the previous year's figures. The majority of these deaths are premat ure as the occurrences are largely preventable. Although the Council's Health, Welfare, Housing and Amenity Services for the Elderly have expanded, there are still deficiencies, especially in supervised accommodation and long-stay geriatric beds, it is encouraging to be able to record that at the end of 1967, a decision to appoint a Consultant Physician and to enlarge the provision of geriatric beds was being implemented by the South East Metropolitan Regional Hospital Board. 3 Despite staff shortages and difficulties of accommodation for training and rehabilitation, expansion in Mental Health community services continues, as may be seen by reference to this section of the report. Further strides have been made in the development and expansion in Health Education and Home Safety measures during 1967. These have been directed at various population groups and risk areas in the Borough. By the end of the year, most of the Borough was subject to smoke control orders. The small remaining district is due for major redevelopment and will, in due course, conform to requirements. A table is included to show climatic conditions and degrees of atmospheric pollution in 1967, as recorded at four observation points. It is apparent that pollution tends to be greater in the northern part of the Borough where the sulphur content also is significantly and consistently high. The investigation of vehicle exhaust fumes at near-pavement level at selected points at peak traffic hours calls for investigation. It is felt that this factor in air pollution might have a greater effect on the public health than is generally appreciated. An account of the work of the Inspectorate in investigating complaints received from members of the public and in the fields of housing and slum clearance and supervision of food hygiene is included in the report. Too often the value of this service to the community is under-estimated. Co-operation and liaison between all sections of the department and voluntary and statutory agencies in the area continued to expand in 1967. Progress is reflected by the accounts of various schemes of attachment to general practitioners and hospitals mentioned in the report. In addition, informal meetings and discussion groups are now regular features of departmental arrangement. It is sometimes not appreciated that a large volume of professional and technical training takes place. Pupils and students of various disciplines undergo recognised full-time courses ranging from three months to two years. About fifty such individuals are catered for during the year. This is stimulating to all concerned and provides a very satisfactory contribution to future staffing needs. This opportunity is taken to record the fact that my report outlines the work during 1967 of loyal colleagues of all grades in the Health Department. I am grateful too for the ever available help and guidance of the Town Clerk and other Chief Officers. In conclusion, the support afforded to the Department and myself, by the Chairmen and members of relevant Committees, is gratefully acknowledged. F. R. WALDRON, Medical Officer of Health. Health Department, Deptford Town Hall, New Cross Road, S.E.14. 4 HEALTH COMMITTEE, 1967 The Mayor (Councillor J. D. DAY, 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. „ J. F. W. Waldon „ P. E. J. Forward „ Mrs. D. Hurren Councillor A. H. Boon „ F. M. Judge, M.P.S. „ Mrs. D.I. Cox „ Mrs. G. M. M. Land „ Mrs. D. E. Eagles A. J. Pinnegar 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.) F. H. E. Hook. M.P.S. HEALTH DEPARTMENT as at 31.12.67 (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. Enid C. Vincent, M.B., Ch.B., D.P.H. D. J. Daly, M.B.. B.S. 42 sessional M.O.s occupying 13 full-time vacancies (a) Chief Dental Officer and Principal School Dental Officer: Edith Mahler, M.D., L.D.S. (a) Senior Dental Officers: Clare M. Leeming, B.D.S. Vacancy (a) Dental Officers: P. Sivagurunathan, F.D.S., L.D.S., R.C.S. Joyce Smail, L.D.S. 7 sessional Dental Officers occupying 3 vacancies 3 Dental auxiliaries and 9 Dental surgery assistants Orthodontist (Part-time) Ann D. Ward, B.D.S., Dip.Orth. Public Analyst: H. Aniphlett 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, S.R.N., R.F.N., S.C.M., H.V., C & G. Technical Teachers Certificate Diploma in Social Sciences (a) Assistants 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 Diploma in Social Sciences 5 Centre Superintendents: Margaret Henley, S.R.N., R.C.N., C.M.B., H.V. Annie R. West, S.R.N., S.C.M., H.V. (Amersham Road) (Central Lewisham) Nora Miller, S.R.N., R.F.N., S.C.M., H.V. Fanny Stevens. S.R.N., R.F.N. C.M.B. (Part I). (Flower House) H.V. (Louise House) Margaret M. Sammon, S.R.N., S.C.M., B.T.A., Maureen Allen, S.R.N., S.C.M., H.V. H.V. (Lewisham Chest Clinic) (Spalding House) 35 Health Visitors; 4 T.B. Visitors; (a) 29 School Nurses; 20 Clinic Nurses (21 Students) Day Nursery Matrons: Elizabeth R. Venning, S.R.N. Margaret D. Philpot. R.F.N. (Amersham Road) (Rushey Green) Glenys L. Crandon, S.E.N. (Perry Rise) 4 Deputy Matrons; 25 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. Assistants: Renee R. Humphries, S.R.N., S.C.M., D.N.Cert. Rose Evans, S.R.N., S.C.M., D.N.Cert. 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. Senior District Nurses: Ellen F. Spry, S.R.N., C.M.B. (Part I) Dora S. Pilbrow, S.R.N. 64 District Nurses Chief Chiropodist: B. Dalton, M.Ch.S., S.R.Ch., M.R.S.H. Senior Chiropodists: Penelope J. Tagoe, M.Ch.S., S.R.Ch. P. V. Rhodes, M.Ch.S. Irene E. Yeomans, M.Ch.S. 16 sessional Chiropodists Principal Mental Health Officer: Zena Mason B.A., A.l.M.S.W. Assistant Principal: A. G. Knight 14 Mental Health Social Workers Honor Lea Hostel: Warden: E. W. Murray, R.M.P.A. Assistant: T. W. MacMillan, S.R.N., R.M.N., B.T.A. 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 (Lewisham Junior) Alice J. Thomson (Brockley) H. F. Weaver (Deptford) 15 Assistants Supervisors of Day Centres: P. W. Postle (New Cross) C. W. Beckett (Cambridge) 3 Instructors (a) Principal Social Worker: Eileen L. Stocker, Dips. Social Studies and Casework, A.A.P.S.W. (a) Assistant Principal Betty J. Hardy, B.A. (Soc.Sc)., Dip. Applied Social Studies 5 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. Elizabeth Vanderbergh, LL.B., Diploma Social Studies Care Committee Organisers, Chest Clinics: (Acting) Veronica Ollerenshaw (Lewisham) Ethel M. Robertson (Deptford) Social Worker V.D. Clinic: Vacancy Home Help Organisers: Ivy I. Stittle (Deptford) Beatrice Kneller (Rushey Green) Muriel Wakeford (Sydenham) 5 Assistants 630 Home Helps 6 Health Education Officer: R. W. Allen, M.A.P.H I., M.I.H.E. Assistant: Marie Sharp. S.R.N., H.V., M.I.H.E. 3 Assistants Home Safety Officer: L. Selway 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. G. L. Belshaw, M.A.P.H.I. Assistants: H. W. Ellery, M.A.P.H.I. R. L. Davis, M.A.P.H.I. 13 Public Health Inspectors 7 Technical Assistants 4 vacancies 5 vacancies Bathing Station Superintendents: H. W. Wellbelove (Deptford) J. G. Beale (Lewisham) 2 Assistants ; 20 Miscellaneous Staff Mortuary Keepers: C. B. Evans (Deptford) W. C. Spear (Lewisham) Pest Control Foreman: R. A. Sharman 6 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) A. C. Shoult (Senior Assistant) W. Fancy, B.Sc. (Econ) D. Newland. C. R. Coleman, D.M.A., (Senior Assistant) (Senior Assistant) (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. 7 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, Lee and 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.I 8 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. School for Dental Auxiliaries: New Cross General Hospital, Avonley Road. S.E.14. 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.I 3. 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 8 HEALTH CENTRES AND CLINICS: Maternal and Child Health, and School Health Name, Address, and Telephone No. Type of Clinic Amersham Road, Ante-Natal, Child Health, Toddlers, Immunisation, Amersham Road, S.E.14 Mothercraft, Ancillary Food Sales, Special Advisory, 692 4417 Cytology, Special Investigation Bellingham, Child Health, Immunisation, Ancillary Food Sales Community Centre, Bellingham Green. S.E.6 Blackheath Hill, Child Health, Immunisation, Ancillary Food Sales Merton Place, S.E. 10 692 3518 Boundfield Road, Ante-Natal, Child Health, Immunisation, Ancillary Community Centre, S.E.6 Food Sales 698 3585 Central Lewisham, Ante-Natal, Psychoprophylaxis Classes, Child Health, 410 Lewisham High Street, S.E.13 Immunisation, Mothercraft, Family Planning, Ancillary 690 1182 Food Sales, Cytology, Occasional Creche, Special Advisory Deptford S.T.C., Ear, nose and throat, vision, orthoptics, minor ailments, Reginald Square, S.E.8 692 1722 dental, speech therapy Downham, Ante-Natal, Child Health, Toddlers, Immunisation, 24 Churchdown. Downham, Kent Mothercraft, Family Planning. Relaxation, Ancillary 698 1344 Food Sales, Minor Ailments, Vision, Dental, Speech Therapy, Special Investigation Flower House, Ante-Natal, Child Health, Immunisation. Mother- 1 Winnett House. craft. Relaxation, Family Planning, Ancillary Food Beckenham Hill Road, S.E.6 Sales 698 5498 Forest Hill, Child Health, Immunisation, Ancillary Food Sales St. Saviour's Church Hall, Brockley Rise, S.E.23 Gosterwood Street, Child Health, Immunisation, Ancillary Food Sales St. Luke's Hall S.E.8 Grove Park, Child Health, Immunisation, Ancillary Food Sales Methodist Church Hall, Burnt Ash Hill, S.E.12 Hither Green, Child Health, Immunisation, Ancillary Food Sales Methodist Church Hall 53 Torridon Road, S.E.6 Gloucester Hall, Child Health, Immunisation, Ancillary Food Sales Frankham Street, S.E.8 Lee and Blackheath. Child Health, Immunisation, Ancillary Food Sales Methodist Church Hall, Lee High Road, S.E. 12 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. Louise House, Ante-Natal, Child Health, Immunisation, Mother- Dartmouth Road, S.E.23 craft, Family Planning, Occasional Creche, Ancillary 699 2257 Food Sales, Cytology Samuel Pepys School, Minor ailments Wallbutton Road, S.E. Speedwell Street, S.E.8 Ante-Natal 692 6401 St. Mary's, Child Health, Ancillary Food Sales St. Mary's Church Hall, Ladywell Road, S.E.13 9 Spalding House, Ante-Natal, Child Health, Immunisation, Family 2 Spalding House, Planning, Ancillary Food Sales, Vision, Minor ailments Honor Oak Estate, S.E.4 639 1479 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 Sydenham, Hill, Child Health, Immunisation, Ancillary Food Sales Tenants' Clubroom, Sydenham Hill, S.E.26 Tranquil Vale, Ante-Natal, Child Health, Immunisation, Occasional All Saints' Hall, Creche Tranquil Vale, S.E.3 Trewsbury Road, Child Health, Immunisation, Mothercraft, Psycho- All Saints' Parish Church Hall prophylaxis Classes Trewsbury Road, S.E.26 778 3204 Day Nurseries Health Centre, Amersham Road, S.E.14 41 Rushey Green, S.E.6. 67 Perry Rise, S.E.23 Home Nurses District Office 41 Rushey Green, S.E.6 Dental Surgeries S.T.C. 78 Lewisham Park, S.E.13 S.T.C. Downham Health Centre, Churchdown, Downham S.T.C. Reginald Square, S.E.8 School for Dental Auxiliaries, New Cross, S.E.14 Chiropody Clinics Amersham Road. Health Centre, S.E. 14 Louise House, Dartmouth Road, S.E.23 28 Sangley Road, S.E.6 Home Help (Area Offices) Deptford Town Hall, S.E.14 41 Rushey Green, S.E.6 266 Kirkdale, S.E.26 354 Baring Road, S.E.12 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, Knoylc Street, S.E.14 Hostel Accommodation (Mental Health) Honor Lea, 103/117 Brockley Rise, S.E.23 Cleansing and Disinfecting Stations Wearsidc Road, S.E.13 Speedwell Street, S.E.8 Mortuaries Ladywell Road, S.E.13 Watson Street, S.E.8 10 VITAL STATISTICS Area of the borough 8,579 acres. Population Census 1961 290,582 Estimate of Registrar General at midyear 1967 289,700 Rateable Value Rateable value of the borough at April 1, 1967 £12,329,092 Estimated net product of a penny rate 1967/8 £48,500 Estimated number of separately assessed dwellings at April, 1 1967 87,997 Births Males Females Total Legitimate 2,366 2,240 4,606 Illegitimate 357 345 702 Totals 2,723 2,585 5,308 Crude birth rate per 1,000 of the estimated population 18.3 Adjusted birth rate for comparative purposes (Area comparability factor=0 .96) 17.6 Stillbirths Total (39 males and 25 females) 64 Rate per 1,000 live and stillbirths 11.9 (males 14 • 1 females 9.6) Deaths Total (1,707 males, 1,633 females) 3,340 Crude death rate per 1,000 population 11.5 Adjusted death rate (area comparability factor=0.97) 11.2 Infant mortality 1 nfant deaths (all deaths of liveborn children under one year) Males Females Total Legitimate 46 27 73 Illegitimate 10 3 13 Totals 56 30 86 Death rate of all infants per 1000 livebirths 16.2 Death rate of legitimate infants per 1000 legitimate livebirths 15.8 Death rate of illegitimate infants per 1000 illegitimate livebirths 18.5 Death rate of male infants per 1000 male livebirths 20.6 Death rate of female infants per 1000 female livebirths 11.6 Neonatal deaths (under 4 weeks of age) 54 (36 males, 18 females) Males per 1000 male livebirths 13.2 Females per 1000 female livebirths 7.0 All infants per 1000 livebirths 10.2 Early neonatal deaths (under 1 week of age) 46 (30 males, 16 females) Males per 1000 male livebirths 11.0 Females per 1000 female livebirths 6.2 All infants per 1000livebirths 8.7 Perinatal mortality (deaths under 1 week plus stillbirths) 110 (69 males, 41 females) Males per 1000 live and still male births 25'0 Females per 1000 live and still female births 15.7 All infants per 1000 live and stillbirths 20.5 Reproductive wastage (stillbirths plus all infant deaths) 150 Males per 1000 live and still male births 34.4 Females per 1000 live and still female births 21.1 All infants per 1000 live and stillbirths 27.9 Maternal deaths Maternal deaths 1 Maternal mortality rate per 1000 live and stillbirths 0.2 11 12 Table 1 TOTAL DEATHS BY CAUSE AND AGE REGISTERED DURING 1967 Disease Sex All ages Under 4 ivks 4 tvks. under lyear 1- 5- 15- 25- 35- 45- 55- 65- 75 8c over  All causes... M 1707 36 20 7 8 16 17 35 126 343 452 647 F 1633 18 12 6 4 9 13 23 66 159 333 990 1. T.B. Respiratory M 6 — — — — — — — — 1 3 2 F 5 - - - - - - 2 3 — — — 2. T.B. Other M - - - - - - - - - - - - F 2 - - - - - - - - 1 1 — 3. Syphilitic Disease M 8 - - - - - - - - 1 3 4 F 8 - - - - - - - 1 — 3 4 4. Diphtheria M - - - - - - - - - - - - F - - - - - - - - - - - - 5. Whooping Cough M - - - - - - - - - - - - F - - - - - - - - - - - - 6. Meningococcal Infection M F 2 — 1 - - - - - - 1 - - 7. Acute Poliomyelitis M - - - - - - - - - - - - h - - - - - - - - - - - - 8. Measles M - - - - - - - - - - - - F - - - - - - - - - - - - -9. Other Infective & Parasitic Diseases M 4 - - - - - 1 — 1 1 1 — F 1 - - - - - - - - - 1 — 10. Malignant Neoplasm M 42 - - - - - 1 2 1 12 12 14 F 33 - - - - - - - 2 6 4 21 11. Malignant Neoplasm of Lung, Bronchus M 196 - - - - - - 3 18 61 69 45 F 42 - - - - - - - 6 8 18 10 12. Malignant Neoplasm of Breast M 1 - - - - - - - - - 1 — F 63 - - - - - 1 3 9 15 16 19 13. Malignant Neoplasm of Uterus F 21 - - - - - 1 2 1 5 4 8 14. Malignant Other & I A mp. Neoplasms M 184 — 1 1 2 1 2 4 17 39 D8 59 F 156 — — 1 1 1 2 4 10 33 4.* 61 15. Leukaemia, Aleukaemia M 12 - - - - - - - 3 2 3 4 F 13 — — — 3 1 — 1 — 2 3 3 16. Diabetes \1 4 - - - - - - - - - 1 3 F 10 - - - - - - - - - 4 6 17. Vascular Lesions of M 157 - - - - - 1 3 5 16 62 80 F 301 - - - - - - 2 6 21 S3 219 18. Coronary Disease, M 438 - - - - - 2 10 53 115 106 152 F 312 - - - - - - - 7 26 69 210 19. Hypertension with Heart Disease ... M 15 - - - - - - - - 3 5 7 F 23 - - - - - - - - 1 5 17 20. Other Heart Disease \1 79 - - - - - 2 1 7 7 20 42 F 129 - - - - - 1 1 4 7 16 100 21. Other Circulatory Disease M 60 - - - - - - - 3 17 17 23 F 98 - - - - - - - 2 10 18 68 22. Influenza M 1 - - - - - - - - - - - F 1 - - - - - - - - - - 1 23. Pnuemonia (including Pneu. of Newborn) M 129 1 5 2 1 1 — — 1 8 28 82 F 137 1 3 3 — — — — 2 6 24 98 24. Bronchitis M 132 — 5 1 — — 1 — 4 21 33 65 F 40 — 2 1 - - - - - 2 4 31 25. Other Diseases of M 16 — 2 - - - - - 1 2 6 5 F 9 - - - - - - - 1 1 1 6 26. Ulcer of Stomach & M 25 — — — — — 1 — — 5 7 12 F 12 - - - - - - - - 2 2 8 27. Gastritis, Enteritis & Diarrhoea M 7 — 2 - - - - - - - 1 4 F 12 - - - - - - - - - 3 9 28. Nephritis & Nephrosis M 6 - - - - - - - 1 1 1 3 I 6 - - - - - - - 1 1 1 3 29. Hyperplasia of Prostate M 10 - - - - - - - - 1 — 9 30. Pregnancy, Childbirth, F 1 - - - - - - - - - - - 31. Congenital M 15 9 3 1 2 — — — ations F 6 1 4 — — — — — 1 — — — 32. Other Defined & 111- M 93 26 2 2 2 1 — 2 3 13 19 23 F 127 16 2 1 . 1 1 3 5 7 30 61 33. Motor Vehicle Accidents M 23 - - - 1 4 2 3 2 6 1 4 F 19 — — — — 3 1 1 1 2 — 11 34. All other Accidents M 25 — — — 2 7 1 3 1 7 1 3 F 19 — — — — 2 — 1 — — 4 12 35. Suicide M 18 — — — — 2 2 4 3 3 2 2 F 25 — — — — 1 6 2 4 2 6 4 36. Homicide & Operations of War M 1 - - - - - - - - - - - F - - - - - - - - - - - - 13 Table 3 LUNG CANCER Year MALE FEMALE All cancer deaths Lung cancer deaths (c) as V of lb) All cancer deaths Lung cancer deaths (f)as % of(e)  (a) (b) (c) (d) (e) (f) (g) 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 1967 435 196 45 328 42 13 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 2 HEART AND CIRCULATION MORTALITY Year (a) Deaths from Total heart & circulation (all ages) (e) Age group 45.65 Total . deaths in borough (h) Percentage Coronary diseases (b) Other heart diseases (c) Other circulatory diseases (d) Total (f) Coronary diseases (g) (e) of (h) (i) (f)of (h) (j) (g)of (A) (k)   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 41 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 51 1964 654 301 142 1,097 235 166 3,317 33 7.1 50 1965 740 304 150 1,194 268 206 3,436 35 7.8 60 1966 731 303 135 1,169 257 188 3,406 34 7.5 5.5 1967 750 246 158 1,154 262 201 3,340 35 7.8 60 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. 14 Table 4 MORBIDITY SHOWN IN INSURANCE CERTIFICATES Weekly average for period ending 1966 1967  January 24 1,508 1,444 February 21 1,889 1,310 March 21 1,684 1,211 April 18 1,242 1,076 May 16 1,172 1,142 June 13 1,228 965 July 11 928 922 August 8 880 926 September 5 908 900 October 3 1,025 1,092 October 31 1,418 1,200 November 28 1,443 1,301 December 26 1,216 1,491 Weekly average for the year 1966 1 253 1967 1 163 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. 15 Table 5 GENERAL STATISTICS FROM 1950 Year Population Death rate • % dying under age 45 dying underage 65 Birth rate * Maternal Death rate t Still.birth rate t Infant mortality rate * * Pulmonary Tuberculosis Notif. rate f f Death rate 11  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 33.6 150 0.6 14.5 23.9 148 35 1952 303,010 11.5 9.9 32.1 14.8 0.2 16.5 25.2 132 20 1953 300,830 11.6 8.7 30.2 14.6 0.2 21.7 23.5 151 23 1954 298,020 10.5 8.0 31 .4 14.4 0.2 16.1 19.6 129 19 1955 296,290 11.1 7.1 28.4 14.1 0.9 18.8 15.6 141 12 1956 293,940 11.8 7.0 28.9 14.6 0.5 18.8 20.5 101 15 1957 291,870 11.3 7.6 31.2 14.8 0.5 18.4 15.3 124 15 1958 291,220 11.2 8.4 29.7 15.2 0.2 18.0 25.5 108 10 1959 290,660 11.9 7.7 29.5 16.2 0.8 19.4 18.5 74 8 1960 290,630 11.3 8.8 30.1 16.8 0.2 18.3 21.7 68 6 1961 289,130 11.7 7.4 28.5 17.7 0.2 18.8 20.6 73 8 1962 291,150 11.6 80 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 .6 200 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 1967 289,700 116 6.7 27.5 18.3 0.2 11.9 16.2 36 4 * Per 1,000 population. t per 1,000 Registered Live and Still Births * * Per 1,000 Registered livebirths f t Per 100,000 population HEALTH CENTRES Under powers contained in Sections 21 and 46 of the National Health Service Act, 1946 (Amended), the Council has decided to establish a number of Comprehensive Health Centres within the Borough in order to provide a unified service. It is essential that the range of services for an area should be contained under one roof. At present, in many parts of the Borough health clinics are housed in old and unsuitable buildings, and it is therefore timely to replan the provision to match up to present day standards. Future trends in preventive and curative medicine must also be allowed for. The first Health Centre to be established will be that planned for the Stanstead Road area. This will contain surgeries and examination rooms for six general practitioners, facilities for ante-natal and child care, dental surgeries, a chiropody suite, minor ailments centre, child guidance unit, home help office, and many other associated services such as cervical cytology, family planning and general health education. 16 MATERNAL AND CHILD HEALTH DOMICILIARY MIDWIFERY Joan M. Goodman, S.R.N., S.C.M., M.T.D., Q.N.Cert., Nursing Officer (Midwifery and District Nursing) The lowering of the birth rate together with an increase in the obstetric beds available has been evident to some extent in the Borough in 1967. This has resulted in a decrease in the number of domiciliary confinements (1,180) although the length of time spent in hospital by lying-in mothers becomes less and less. The overlap of work between the domiciliary midwife and her hospital counterpart is greater, and her role changing as she participates more in the total care of the mother who is booked for either a home or hospital confinement or a planned early discharge which has the benefit of both schemes. The full-time midwifery staff of the Borough is now 24. three part-time midwives are also employed. Pupil Midwife Training Eighteen midwives are approved by the Central Midwives Board and train pupil midwives for the district experience which is required in the last three months of their year's training. During 1967, 58 pupils completed their district training. During this period pupil midwives must live in approved accommodation. This is sometimes at home, sometimes with a Council midwife, but more frequently in lodgings. Finding suitable landladies who will not object to the pupil midwives' irregular hours of work and meals, is sometimes difficult. The hospital as the employing authority advertises, and inspection of premises is made jointly by Matron of Lewisham Hospital and the Supervisor of Midwives of the Borough. Staff Training Five midwives attended one of the Post Certificate Courses which are statutory under the Rules of the Central Midwives Board for all practising midwives. Three midwives attended study days organised by the London Boroughs Training Committee and four others attended the inservice course in "Aspects of Mental Illness." All midwives have attended a two-day course in the psychoprophylaxis method of preparing women for childbirth. Instruction in this method is greatly in demand by expectant mothers and three midwives are holding well-attended classes. Patient Care Out of 1,590 patients who were booked for home delivery only 1,180 were eventually delivered there. 249 were admitted to hospital for various reasons, the three largest groups being for Toxaemia, Post Maturity and delay in labour. A scheme whereby the midwives continued to care for mothers and babies for a longer period than usual has been tried out in the Forest Hill/Sydenham area since September, 1966. The essence of the scheme was flexibility, the mother and baby being discharged to the care of the health visitor when the mother expressed her readiness to attend the Child Health Clinic. In the first year out of 450 patients, 309 were looked after by midwives for a longer period than 10 days. 17 In 1967 a young lady celebrated her 21st birthday; she was born in Sydenham in 1946, and weighed 2 lb. In those days special premature baby units were rare and heated ambulances and portable incubators were non existent. She was nursed at home by a midwife who cared for her for 6 months until she weighed 6£ lb. Although she now lives in Surrey, her parents have never forgotten the midwife who kept her alive, and who still works in the Borough Midwifery Service, and she was invited to and attended the 21st birthday party. Liaison with the Hospital Service The Maternity Liaison Committees met at intervals during 1967, and some small changes were made in the maternity catchment areas. It is regrettably necessary for the expectant mothers of Lewisham who need or desire a hospital confinement to be divided between 5 maternity units, 4 of which are outside the Borough. The hospitals concerned are:— Lewisham Hospital Maternity Unit St. Alfege's Wing Maternity Unit Beckenham Maternity Hospital Bromley Maternity Hospital, which has two branches at Masons Hill and Widmore Road As each of these units maintains a scheme with the Lewisham Borough for the nursing of planned early discharges great co-operation is needed to ensure that continuous care is given throughout pregnancy, labour and post-natal period, whether part of it is spent in hospital or at home. 1,074 patients were nursed for the hospitals under these schemes. Liaison with General Practitioner Obstetricians 14 General Practitioner Obstetricians attend the midwives ante-natal clinics; and a total of 12,140 attendances were made. Although this is a reduction in the number seen in 1966 (15,172), the number of ante-natal visits paid at the homes has increased and was 12,642 (9,607 in 1966); 24,262 post-natal visits were made by midwives. Special Liaison with Lewisham Hospital The Emergency Obstetric Unit from Lewisham Hospital was called out 24 times during the year. The Premature Baby Unit is sent out when required to transfer small or delicate babies to the special care unit—usually in a portable incubator which is always kept heated and ready at the hospital. Maternal Deaths 3 maternal deaths were investigated under the scheme inaugurated by the Ministry of Health for the Confidential Enquiry into maternal deaths, whereby the Medical Officer of Health is responsible for initiating enquiry into such deaths whether at home or in hospital. 18 DISTRICT NURSING Joan M. Goodman, S.R.N., S.C.M., M.T.D., Q N.Cert., Nursing Officer (Midw ifery and District Nursing) The existence and availability of the Local Authorities Home Nursing Services are known to the hospitals and the family doctors as well as the general public and the service may be called upon for many purposes. A general practitioner from whom the nurses take their instructions is always in charge of the case. Except where Night Sitters are provided through the Marie Curie Cancer Service, a night service is not provided. Some nurses are on duty every evening to do late visits to all patients and these nurses remain "on call" that night for urgent emergencies. Staff Recruitment During 1967, the number of staff employed upon district nursing has remained constant. The team system of working has been carried a step further by attaching one or two State Enrolled Nurses and an Auxiliary (Bathing Attendant) to each group of Nursing Sisters or Male Charge Nurses. Training In order to maintain the high standard of efficiency of the service all new Sisters are expected to take the examination for the National Certificate for District Nursing and admission to the Queens Institute Roll. This course lasts 4 months for the State Registered Nurse with a reduction of one month if the candidate holds in addition the Certificate of the Central Midwives Board. Seven Nursing Sisters took the Course during the year and all were successful. As stated above, State Enrolled Nurses are now accepted as part of the district nursing team, and it became evident that these nurses should be given some inservice training, to correspond with the district training given to their State Registered colleagues. As at present the members of this grade are small, a combined scheme of training was organised with four adjacent boroughs. The Queens Institute of District Nursing set and mark the examination papers and undertake the practical assessment of the work. Two nurses sat the examination in 1967, and both were successful. Two student nurses taking an integrated course at King's College Hospital for State Registration and the Health Visitors Certificate spent six weeks with the district nursing service. On completion of this special training, a further period of district nursing will allow them to sit for the National Certificate. Post Certificate Courses for Existing Staff One Assistant Nursing Officer completed the training course for the District Nursing Certificate, and another a special midwifery refresher course. This enables both of them to supervise and help in the administration of both services with benefit and economy in organisation. Two Non-Resident Post Certificate Courses were arranged by the Queens Institute of District Nursing and eight sisters attended. The yearly inservice course of lectures in "Aspects of Mental Health", was again arranged for all groups of nursing personnel and eight district nursing staff attended. The London Boroughs Training Committee held two study days at which four district nurses were allotted places. In addition one district nursing sister attended a seven-week day release course on "Living with Disability", which followed a two-day study period. These courses have been all appreciated by the staff. 19 Lectures and Talks Were given by members of the staff on the work of the District Nurse and various subjects closely linked with their work. Visits to the District Nursing Service Visits were paid by a varying number of interested visitors including research interviewers, wardens and matrons of old people's homes, social workers, pupil midwives, student nurses from local hospitals and eleven medical students from London Teaching Hospitals. Patient Care Over 2,000 more visits were paid in 1967, than in the previous year. 2,915 new patients were visited of whom 1,836 were over 65 years of age. The number of patients who only require injections grows less and many heavy exacting cases are nursed at home. These take considerable time and often require two nurses to attend together. The lack of any relatives to help with elderly confused patients means that the Nursing Staff are often under severe strain. Equipment The issue of disposable nursing equipment assists the nursing staff by saving time and energy and is greatly appreciated. Disposable incontinence pads are used in increasing quantities, and the incontinent laundry service is in demand for many cases. The lending of equipment especially commodes goes up each year, especially as the number of geriatric cases increases. Liaison Scheme with General Practitioners Towards the end of the year arrangements were made for five district nursing sisters and one male charge nurse to work more closely with the family doctors. These nurses visit the surgery twice a week, at an agreed time, and using one of the consulting rooms see any patients who require, or can be given treatment there. The doctor is present for a short time during the visit. This scheme enables doctor and district nurse to discuss any patients on his list that she or her colleagues in the group are visiting as well as the patients she may attend in the surgery. Liaison with the Hospital Service Following a suggestion from the Orthopaedic Surgeon at Lewisham Hospital, a scheme was devised to help the busy and overworked Casualty Department, and therefore benefit the patients who attend there. It was decided that certain groups of patients could be saved return visits if further treatment, for example the removal of stitches, could be done at home by the district nurses. In particular elderly patients who would need Ambulance or Car transport, or the mother of very young children would be saved the journey. The scheme commenced in October, and is progressing slowly and steadily. Special Liaison Schemes The Tripartite scheme for the earlier diagnosis of breast cancer arranged between King's College Hospital, a practitioner in Forest Hill, and the Local Health Authority Nursing Staff came to a conclusion in August, 1967. During the year 600 women attended for "screening", and five cases of breast cancer were discovered. In an effort to assist the Mental Health Section district nurses visited a number of E.S.N, and mentally handicapped children and young people. 20 21 Table 6 VISITS TO HOMES Children born in 1967 5,759 1966 7,201 1962-65 12,626 Total 25,586 Persons aged 65 or over 503 Mentally disordered persons 139 Persons, excluding maternity cases, discharged from hospital (other than mental hospitals) 117 Infectious disease 92 Tuberculous households visited by tuberculosis visitors (including 54 visits by district health visitors) 2,490 Other visits (special reports on overcrowding, housing for M.O.H.) 193 Grand Total 29,120 HEALTH VISITING Dorothy At. Coe, S.R.N., R.F.N., S.C.M., H.V.. C. & G., Technical Teachers' Certificate, Diploma in Social Studies, Borough (Maternal and Child Health and School Health) Nursing Officer During the year six student health visitors completed the in-training courses and were appointed to the staff as health visitors. Parentcraft Classes These continue to be well attended. Special evening sessions for both parents are held. Mothers Clubs These are very popular. A good supply of speakers on a wide range of topics were invited from various sources. The talks were well received and added much to the attraction of the Clubs. School Nursing Routine visits are paid to all nursery schools and classes. Hygiene examinations, both routine and special, are organised in all schools. Several cases of scalp ringworm were successfully investigated, isolated and referred for treatment. Health Education in Schools This service has been requested by many Heads of schools, and sessions will be made available to younger children. This is an expanding need and is met by Health Visitors and School Nursing Sisters who have taken the Technical Teachers' City and Guilds Certificate. Liaison with Hospitals Health visitors provide an important link with local hospitals by attending outpatients clinics and undertaking follow-up visiting of diabetic, ante-natal and paediatric patients. Surveys The survey into leukaemia continued, and a survey into spina bifida commenced during the year. Visits to Establishments Many students and others visited the Council's clinics, schools and day nurseries during the year. Among them were some 330 hospital nurses, 24 social science students, 4 overseas visitors, 3 doctors (for special observation) and 12 schoolgirls. Lectures and Talks Have been given by nursing staff to voluntary and statutory associations and to groups in hospitals and schools. Health Visitor Students Six students received practical instruction in the Borough. These were "Integrated nurse training" students from King's College Hospital. DAY NURSERIES AND CHILD MINDERS Private Day Nurseries There are twenty-six private nurseries and play groups registered with the Council under the Nurseries and 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 their safety and well-being. At the end of the year places for 668 children were available. So far as possible formal application is discouraged until the Council's officers have had an opportunity to visit and discuss the project with the applicant. A report is then made on the suitability of the premises for use as a day nursery. On receipt of the completed application the appropriate Public Health Inspector deals with fire precautions. In certain defined cases Town Planning approval must be obtained. The application is finally placed before the Health Committee before the Council issues a certificate of registration. 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 must approve their registration and impose any necessary requirements. 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 on the understanding that they bring the children to health centres regularly. At the year end there were 147 voluntary child minders registered to mind 258 children and 55 statutory child minders authorised to mind 258 children. 22 CERVICAL CYTOLOGY This service is conducted at Health Centres by doctors assisted by Health Visitors and Clinic Nurses. The number of sessions held at Flower House Health Centre and at the Goldsmiths' Community Health Centre, Boundfield Road has increased. Stores and factories employing female labour are to be approached with a view to offering facilities for cervical cytology coupled with talks on health education at the firms' premises. 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 Dr. 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. The table below gives the findings from all clinics during the year. Table 7 Total attendances 2,377 Number of cases referred to G.P. or hospital 748 Number of smears found positive for malignancy 15 Because of pressure on places available, waiting lists for admission have to be maintained. In the long term, the Council planned additional Nursery will help to meet a growing need for this demand. In the meantime, steps must be taken to encourage the establishment of high standard private day nurseries and child minders and to seek ways of supporting the mother of very young children in providing care in their own homes. CONGENITAL MALFORMATIONS Figures are supplied to the Registrar-General of all congenital malformations recorded at birth. During the year the scheme was extended to congenital malformations not reported at birth but observed within the child's first year. The co-operation of hospitals and general practitioners in this arrangement is, of course, essential. The Registrar-General's collation of these returns, which is published periodically, enables changes in the national and regional patterns to be detected. Children are not identified to the Registrar-General individually, but all such children are considered for placing on the Health Department's register of handicapped and those at risk of becoming handicapped. An intensive follow-up is now a routine procedure. During the year a total of 156 malformations were reported. This figure represents 3.0 per cent, of the net male births and 1.9 per cent, of the net female births in the Borough. 23 The Council's Day Nurseries There are three; Rushey Green, Perry Rise (Shaftesbury House) and Amersham Road, and the number of approved places 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 need for admission 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, cases are normally reviewed financially every six months and fully once a year. Deaf, blind or partially sighted children may be admitted for a period of up to fifteen hours a week without charge. The numbers are limited to four at Amersham Road and Rushey Green day nurseries. There is a Special Unit at Shaftesbury House for fifteen severely subnormal children, no charge being made, except for 6d. a day in respect of a mid-day meal. Day nurseries, playgroups and child minders are supervised by Health Visitors. This surveillance is considered to be a most important aspect of their work, and it is mainly due to their constant vigilance that many abuses of child minding are prevented. However, there is an ever present danger of unofficial or unauthorised minding. Whenever this is brought to notice an immediate investigation is made and action taken. Training for the Nursery Nurses Examination Board Certificate is undertaken at all of the Council's day nurseries in conjunction with the Brixton and Southwark Colleges of Further Education. Creches are provided at four centres. Provision is made for autistic children and those with social handicaps, e.g. speech difficulties in children from families whose parents do not speak English. Creches are also used by mothers attending various clinic sessions. Table 8 Day Nursery Admissions Discharges  Amersham Road 81 81 Rushey Green 76 78 Shaftesbury House 41 40 Table 9 Congenital malformations reported 0.1 Anencephalus 4 0.4 Hydrocephalus 4 0.5 Microcephalus 2 0.6 Other defects of brain 1 0.8 Spina Bifida 9 0.9 Other defects of spinal cord 1 Total: Central Nervous System 21 1.5 Other defects of eye 1 1.7 Defects of ear causing impairment of hearing 1 1.8 Accessory auricle 6 1.9 Other defects of ear 2 Total: Ear and Eye 10 2.1 Cleft Lip 4 2.2 Cleft Palate 5 2.3 Hiatus Hernia 1 2.7 Rectal and anal atresia 1 Total: Alimentary system 11 3.0 Congenital heart disease (not otherwise specified) 11 3.6 Intraventricular septal defect 4 3.7 Persistent ductus arterious 2 3.8 Endocardial fibroelastosis 3 Total: Heart and great vessels 20 Total: Respiratory system Nil 5.0 Defects of uro-genital system (not otherwise specified) 2 5.2 Polycystic kidney, all forms 2 5.6 Hypospadias, epispadias 4 5.7 Other defects of male genitalia 7 5.8 Defects of female genitalia (includes female pscudo-hermaphroditism) 1 Total: Uro-genital system 16 6.2 Reduction deformities (amelia, hemimelia, phocomelia, etc.) 1 6.3 Polydactyly 12 6.4 Syndactyly 1 6.5 Dislocation of hip 3 6.6 Talipes 34 6.8 Other defects of hand 5 Total: Limbs 56 7.1 Defects of skull and face 2 7.3 Other defects of spine 1 7.5 Chrondrodystrophy 1 Total: Other skeletal 4 8.1 Other defects of the face and neck 1 8.2 Defects of muscles 1 8.3 Vascular defects of skin, subcutaneous tissues, and mucous branes (including lymphatic defects) 3 8.4 Other defects of skin (including ichthyosis congenita) 3 8.7 Defects of spleen 1 8.9 Exomphalos, omphalocele 1 Total: Other systems 10 9.6 Mongolism 8 Total: Other malformations 8 Table 10 Congenital malformations reported: by parity Parity Number of children 0 34 1 40 2 27 3 17 4 7 5 1 6 3 7 1 8 — 9 — 10 1 131 24 Table 11 Congenital malformations reported: according to maternal age Age Number of children 16 2 17 5 18 3 19 7 20 13 21 9 22 14 23 10 24 15 25 8 26 5 27 4 28 10 29 3 30-34 11 35-39 5 40-44 6 45-49 1 131 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. 73 adoption and boarding-out reports were examined and reports on 57 prospective parents were scrutinised during the year. BLIND AND PARTIALLY SIGHTED PERSONS 209 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 68. This certification facilitates the provision of the Council's welfare services. RECUPERATIVE HOLIDAYS These 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 or 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 five years, not attending school. Children of school age are dealt with under arrangements provided by the l.L.E.A. A weekly charge is made for adults according to their financial circumstances and there is a small charge for children under five not attending school. The number arranged during 1967 was as follows:— Table 12 Expectant and Nursing Mothers 3 Tuberculous Adults 3 Other Adults 141 Psychiatric patients 21 Accompanied Children 43 Unaccompanied Children (I.L.E.A. Scheme) 122 25 LOAN SERVICE The Central Stores are at the Health Department, Town Hall. 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 13 Equipment No. issued during 1967 Total stock held on stock register No. on loan at present Air Rings 26 40 37 Back Rests 44 52 26 Bed Cradles 38 55 35 Bed Pans 27 41 40 Cot Beds 1 2 2 Commodes 294 498 465 Easi-Carry Hoists 10 14 10 Easi-Carry Hoist Slings 4 7 5 Fracture Boards 30 63 54 Hospital Beds with Pulley 3 22 16 Mattress (Dunlopillo) 6 20 19 Mattress (Hair) 5 11 9 Penrhyn Bed Lifts 11 26 26 Ripple Beds 5 3 3 Rubber Sheets (6' x 3'). 32 76 71 Tripod Walking Sticks 8 36 27 Urinals (Glass) 16 16 16 Zimmer Walking Frames 53 67 66 Wheelchairs 40 51 39 Totals 653 1,100 966 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. 26 DENTAL SERVICES Dr. E. Mahler, M.D., L.D.S., Chief Dental Officer and Principal School Denial Officer reports Accommodation for Dental Services School for Dental Auxiliaries (4 surgeries), New Cross General Hospital, S.E.I4 Deptford Schools Treatment Centre (2 surgeries), Reginald Square, S.E.8 Lewisham Schools Treatment Centre (2 surgeries), 78 Lewisham Park, S.E.I3 Downham Schools Treatment Centre (2 surgeries), Churchdown, Downham School for Dental Auxiliaries This establishment, sponsored by the General Dental Council, is directed by Mr. J. V. Bingay, O.B.E., and close co-operation is maintained with the Borough Service. It contains a clinic (4 surgeries), conducted by two dental officers and two dental auxiliaries on the staff of the Borough Health Department. By joint agreement, the School is responsible for the routine inspection and treatment of groups of schoolchildren in Lewisham, in addition to those of a neighbouring Authority. During the year approximately 18,557 attendances were made by Lewisham children and 9,089 teeth were conserved. In addition to receiving oral hygiene instructions each child is taught the proper use of the toothbrush. This is of course, general practice in every clinic in the Borough. Orthodontics This is a small but increasing specialty. Mrs. Ward, an orthodontic specialist, joined the staff in October, and conducts one session a week with dental officers and five sessions a week on her own. Table 14 Cases remaining from previous year 289 New cases commenced during the year 330 Cases completed during the year 46 Cases discontinued during the year 3 Number of removable appliances fitted 288 Number of fixed appliances fitted 13 Pupils referred to Hospital Consultant 47 The treatment is carried out on three levels: dental officers; specialist orthondontist; and consultants at. Guys, Lewisham and King's College Hospitals. The Central Dental Laboratory Provides all orthondontic appliances, dentures, crowns and inlays. Orders are completed within approximately two weeks and this service is satisfactory. Anaesthesia General anaesthetic sessions average one per week. Fifteen to eighteen children per session are treated, about twenty by given appointments. Emergency cases are always fitted in at short notice as necessary. Dr. A. Whitfield attends Deptford and Lewisham Treatment Centres. Dr. E. C. Dawson attends Downham Treatment Centre. Local anaesthesia is used extensively for routine dental treatment as the dental officer finds necessary. 27 Following the special Ministry of Health enquiry during the year on facilities for emergencies, great care was taken to cover all of the points raised. (a) Power operated suction apparatus (Rotabine) have been installed in all three centres. (b) Three new Walton anaesthetic machines have been in use since April, 1967. These enable effective inflation of the lungs to be carried out. Oral airways are available. (c) All dental chairs have been tested and can quickly be moved into a horizontal position. (d) All three centres are equipped with surgical swab holders and tongue forceps. Suitable drugs are available. (e) Anaesthetists are familiar with the relevant Ministry Circular. Dental Caravan The new caravan has been used on two occasions in the school grounds of Adamsrill School (Infants and Junior Mixed). This is an ideal solution of the "broken appointments" problem and has proved a great success with the heads of schools, parents and children. It is hoped that in the not too distant future every Fnner London Borough will have a caravan which can be used for school children, many mothers and toddlers and handicapped children in special schools and training centres. At present, where schools are too far from clinics, minibuses are available, bringing about ten children per session, escorted either by School Care Committee workers or dental surgery assistants, approximately twice a week per centre in term time. This arrangement also applies to children under school age and day nurseries. Dental Caries Survey A survey of five-year-old school entrants was carried out between January and July, in seventeen schools and involved 1,278 children. Only nineteen per cent, were found to be dentally fit, while eighty-one per cent. had an average of four teeth decayed, missing or filled. This corresponds with the findings in the other Inner London Boroughs. This is something of an indictment of the community's attention to dental hygiene. Maternal and Child Health Under Section 22 of the National Health Service Act 1946, local authorities should provide treatment for the priority classes, children under school age and expectant and nursing mothers. This service has been expanded very energetically (see tables). Three day-nurseries, two creches and nursery school classes are inspected at least once a year and treatment is provided for the children whose parents sign the consent form. Transport is arranged. Junior and Adult Training Centres The Junior Training Centres and both Adult Training Centre were inspected. Treatment is provided for a number of children in the Dental Centres, while some who proved unmanageable were referred to hospital. A list of those requiring attention in the adult training centres was circulated to N.H.S. dentists in the Borough, who have offered to undertake the necessary treatment. Dental Health Education It is of the greatest importance to introduce children at the earliest opportunity to oral hygiene and problems of diet. The best way to achieve this is by bringing the service to the children at health centres. The three-year- old birthday invitation is very effective and an obvious choice of approach. Approximately seven sessions per week 28 have been held since September, 1967, when an average of four sessions per week were provided. Three dental health educators specially trained to talk to mothers with babies in arms and toddlers attend health centres on certain days. They give advice on oral hygiene, diet, and the right age to introduce the child to dentistry without fear. One dental auxiliary, and two dental surgery assistants make up the team. They are young married women who are enthusiastic, persuasive and competent. 1,448 mothers of toddlers were counselled in 149 sessions, averaging 9.7 per session during the year. Mothers of young children appear particularly susceptible to advice and anxious to avoid the misuse of feeders and syrupy liquids. If necessary the children are referred to dental clinics for full clinical examination and treatment by the dental surgeon. The dental auxiliary is particularly competent in the treatment of very young patients. For a few months and as an experiment, one session per week was devoted to a group of expectant mothers. While it made them more aware of the necessity of dental treatment for themselves, it was found that they were much more concerned with their pregnancy and forthcoming confinement. A talk on dental health education was given to student midwives by the dental auxiliary. Nearly every one of the thirty-nine inspections (11,200 children) provided an opportunity for a talk on oral hygiene, either by the dental health educator of the Inner London Education Authority or by dental auxiliaries and student auxiliaries, by permission of the Director of the School. During the autumn a special campaign was launched co-ordinated with the Health Education Section and the I.L.E.A. Eighteen junior schools were visited, several excellent films were shown and talks were given with visual aids. It was gratifying to find that the majority of children had not forgotten their oral hygiene drill nor Pierre the Clown who visited the Borough in 1966. Dental health education in secondary schools was started in a small way to give experience for future planning as about seventy-five per cent. of the children suffer from peridontal disease (infection of the gums). It is the responsibility of the School Dental Service to make available annual dental inspections to all school children in the Borough and to offer treatment to all who need it, and whose parents sign consent forms. The demand for treatment is steadily increasing and it has not been possible to fulfil obligations owing to shortage of premises and staff. This is particularly apparent in the Sydenham and Forest Hill areas, where approximately 8,000 children in twenty schools have not been inspected since January, 1966. It is hoped to open a dental centre with two surgeries in Louise House Health Centre, Dartmouth Road, S.E.26, and a surgery in Sedgehill Comprehensive School in the near future. 29 Table 15 DENTAL SERVICES FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS A:Attendances and Treatment Number of Visits for Treatment During Year Children 0-4 (intcl.) Expectant and Nursing Mothers First Visit 587 21 Subsequent Visits 1,808 59 Total Visits 2,395 79 Number of Add'1 Courses of Treatment other than the First Courses commenced during year 33 3 Treatment provided during the year— Number of Fillings 2,290 76 Teeth Filled 1,890 52 Teeth Extracted 110 9 General Anaesthetics given 39 1 Emergency Visits by Patients 30 1 Patients X-Rayed 9 15 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 340 20 Teeth Otherwise Conserved 401 Teeth Root Filled 5 Inlays 2 Crowns 11 Number of Courses of Treatment Completed During the Year 368 — B: Inspections Number of Patients given First Inspections During Year A 1,014 D 24 Number of Patients in A. and D. above who Required Treatment B 636 E 23 Number of Patients in B. and E. above who were Offered Treatment C 606 F 23 C: Sessions Number of Dental Officer Sessions (i.e. Equivalent Complete Half Days) Devoted to Maternity and Child Welfare Patients: For Treatment 351 For Health Education 66.5 SCHOOL DENTAL SERVICES 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 suDDlied bv the dental clinics: Table 16 LEWISHAM I.L.E.A. 1. School Roll 41,280 412,555 2. Number of Sessions (iv) Treatment—ordinary 2807.3 27185.4 Treatment—General Anaesthetic 49.8 532.9 Inspection 122.1 1449.2 Total 2979.2 29167.5 30 Table 16—continued 3. First Inspections LEWISHAM I.L.E.A. (a) Number of first inspections in school 11,673 124,389 (b) Number of first inspections at clinic 2,961 47,886 (c) Total 14,634 172,275 (d) Total as percentage of school roll (3(c) as percentage of l) 35.5 41.8 (e) No. inspected found to require treatment 10,156 112,824 (f) Percentage of no. inspected found to require treatment 69.4 65.6 (g) No. offered treatment 10,121 109,203 (h) Percentage of no. requiring treatment offered treatment 99.7 96.8 (i) Percentage of no. requiring treatment elected for private treatment 0.3 3.2 4. Reinspections (a) Reinspections at school — 2,091 (b) Reinspections at clinic 396 14,160 (c) Total 396 16,251 (d) No. of reinspections as percentage of first inspections (4(c) as percentage of 3 (c)) 2.7 9.4 (e) No. reinspected found to require treatment 301 10,134 (f) Percentage of no. reinspected found to require treatment (4(e) as percentage of 4 (c)) 76.0 62.4 5. Number of appointments given to: (a) New cases (i) 8,263 132,511 (b) On treatment cases 23,919 187,868 Number of attendances made by: (c) New cases (i) 5,365 72,727 (d) On treatment cases 17,141 141,435 (e) Emergencies (ii) 441 4,069 (f) Total attendances 22,947 218,231 6. Response rate: (a) New cases (5(c) as percentage of 5(a)) 64.9 54.9 (b) On treatment cases (5(d) as percentage of 5(b)) 71.7 75.3 7. Cases discharged dentally fit (iii) 3,492 58,369 8. Lapse Rate (treatment not completed) Item 5(c) plus 5(e) less item 7 expressed as percentage of (5(c) + 5(e) 39.9 24.0 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) The great difference between 1966 and 1967, total figures reflects the change in policy which was operative from September, 1966. 31 Postgraduate Courses The Chief Dental Officer attended a symposium of child dental health, the Annual Conference of the British Dental Association and a course in administration. The Senior Dental Officer attended the symposium of child dental health and two fulltime dental officers took part in orthodontic courses. School for Dental Auxiliaries i am indebted to Mr. J. V. Bingay, O.B.E., Director of the School for Dental Auxiliaries for the following report on the work of the School: It is with pleasure that I state that during the course of the year ended 31st December, 1967, the liaison between the School for Dental Auxiliaries and the Medical and Dental Services of the London Borough of Lewisham has reached a stage of development where it has been possible for students from this school, under the control and guidance of Dr. E. Mahler, the Chief Dental Officer, to take part in formal school inspections by giving dental health talks to children prior to the inspections which are, of course, carried out by dental surgeons. The Borough clinic which is situated in the school has once again proved the value of the close co-ordination of the dental services provided by Lewisham and the General Dental Council. 1 would like to take this opportunity to express my thanks to the Deputy Mayor of Lewisham, Councillor Mrs. C. L. Cole who, at the School's Annual Prizegiving, welcomed our guest of honour Miss Mary Henry, S.R.N., Registrar of the General Nursing Council, with great charm. Finally, 1 wish to extend my grateful thanks to Dr. Waldron, and the members of Dr. Waldron's staff, who have helped us in such an unselfish way during the past year. Table 17 Dental Work carried out by Senior Students of the School for Dental Auxiliaries Total attendances for treatment 18,557 Total number of fillings inserted 9,089 Total number of deciduous teeth extracted 495 In addition each child attending was instructed in the basic principles of oral hygiene and where appropriate, dental health instruction (including diet), was given both to individual children, groups of patients and their parents. The figures quoted above do not include attendances, restorations and extractions carried out by the dental staff of the London Borough of Lewisham based on the school. Separate returns are made in respect of these officers. 32 SCHOOL HEALTH SERVICE This is the third Annual Report on the School Health Service in Lewisham since the implementation of the Greater London Local Government Act, and the reorganisation of services in the London Boroughs. Close liaison with the Inner London Education Authority and the Medical Adviser's Department at County Hall has been maintained. The overall health of schoolchildren in Lewisham remains good. As before, all children have had a full medical examination, including an audiometer test during their first term on admission to school. For all children attending ordinary schools further examinations have been made at seven or eight years of age, on entering secondary school and before finally leaving school. Annual personal hygiene examinations have continued and the need for these has been shown by the occasional detection of children with scabies in schools in different parts of the Borough. Nocturnal enuresis and obesity remain two of the commonest problems. Owing to the apparent increase in the numbers of children with these conditions three additional special clinic sessions per week were commenced during the year. Two of these are held in the School Health Centre, at 78 Lewisham Park and the other at the Churchdown Health Centre, Downham. Existing sessions at the Amersham Road Health Centre and Sydenham Children's Hospital continue. An average of fourteen children are seen per session. It should be noted that neither amphetamine drugs or any of their derivatives are now prescribed in these clinics, having been superseded by medication which has been shown to be free of serious habit forming side-effects. Special Schools There arc now four special day-schools in Lewisham and a unit in Sedgehill Comprehensive Secondary School for partially hearing children. 1. The Nansen School for Partially Sighted Children, 59 Pendragon Road, Downham 2. Meeting House Primary School for the Educationally Sub-normal, Roundtable Road, Downham 3. Woodlands Open Air School for Delicate Children of Primary School Age, Shroffold Road, Downham 4. Brent Knoll School for Delicate Children of Primary and Secondary School Age, Beacon Road, S.E.I3 All of these schools take some handicapped pupils who are resident in adjacent Boroughs in addition to Lewisham children. Those attending Brent Knoll School continue to be temporarily accommodated in the Hither Green Primary School in Beacon Road. It is anticipated that the new building, now being erected on the site of the old Brent Knoll School in Mayow Road. Forest Hill, will be completed and ready for the children to move in at the commencement of the next academic year in September, 1968; they will then be joined by the pupils of Woodlands School which is due for demolition. As mentioned in last year's report Lewisham children needing education in a special school for physically handicapped pupils now attend the new Charlton Park School in the Borough of Greenwich. In September this year the special teaching unit for young deaf and blind children was moved from Hither Green Hospital, to more suitable accommodation at the Witney School for partially sighted children in Southwark. 33 Handicapped Pupils Register The handicapped pupils section of the comprehensive observation register is now well established. An index card showing personal details, handicap, family and hospital doctor, type of education and school attended is completed for each child whose home address is within the Borough, irrespective of whether he or she attends a school in Lewisham or elsewhere. A file containing medical details for each child is also retained in the Health Department, and copies of the information are forwarded to the doctor in the schools. This register ensures that each child receives all help and special facilities available as well as forming a basis from which future requirements for the medical and educational care of handicapped children can be predicted. Table 18 OBSERVATION/HANDICAP REGISTER Schoolchildren Type of School No. attending Day school No. attending Boarding school Total Physically handicapped 59 8 67 Delicate 80 26 106 Deaf 28 8 36 Partially hearing 33 2 35 Blind — 5 5 Partially sighted 21 1 22 Autistic 5 1 6 E.S.N. 376 48 424 Maladjusted 35 52 87 Other — 4 4 Hospital school — 6 6 Totals 583 215 798 Home tuition 6 Training Centre 26 Special Care Unit 16 Special Hospital 1 Approved school 6 Number of children at Woodlands O.A. School 42 Number of children at Woodlands Autistic Unit 3 Number of children at Brent Knoll O.A. School 31 Table 19 Year of Birth of School Children on Observation!Handicap Register Year of Birth No. of schoolchildren 1950 5 1951 51 1952 99 1953 140 1954 144 1955 115 1956 138 1957 138 1958 141 1959 102 I960 120 1961 93 1962 88 1963 9 1964 5 1965 1 1,389 34 DEAF REGISTER Schoolchildren The total number of children on the Deaf Register is 294. Of these 261 are schoolchildren, 12 have left school (these remain on the deaf register until they are 18 years of age), and 21 are under school age. Of the 261 schoolchildren, 38 are deaf and 223 suffer from partial hearing. Table 20 Type of School No. attending Day school No. attending Boarding school Total Deaf 27 8 35 Partially hearing 33 2 35 Physically handicapped 3 1 4 Delicate 2 — 2 E.S.N. 5 2 7 Maladjusted 1 — 1 Other — 2 2 188 partially hearing children attend ordinary schools. Three deaf children with rubella syndrome attend a Training Centre (1) and a Special Care Unit (2). 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 and the overall figures for prophylaxis. They also show the proportion of children found with unsatisfactory physical conditions, 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 41,280 as at May, 1967. For comparative purposes, wherever possible, figures are also shown for the whole of the area covered by the Authority, based on a total school roll of 412,555 at the same date. Table 21 Lewisliani I.L.E.A. Routine Inspections Number inspected 16,551 158,668 Number found not to warrant examination (7 plus 'specials scheme') - 1,648 Percentage of No. inspected of:— Parent present 56.2 53.5 Care Committee present 78.6 79.1 No. vaccinated against smallpox 73.0 73.0 No. immunised against diphtheria 90.8 86.6 No. immunised against whooping cough 80.5 77.4 No. vaccinated against poliomyelitis 87.7 84.8 Physical condition unsatisfactory 0.2 0.5 Referred for treatment of defects 15.5 13.9 Referred for treatment of defects other than vision 8.2 7.1 Non-Routine Inspections (i) Specials 5,559 52,935 (ii) Re-inspections 5,226 72,423 Total (i) and (ii) 10,785 125,358 No. of routine inspections as percentage of school roll 40.1 38.5 No. of non-routine inspections as percentage of school roll 26.1 30.4 35 ROUTINE MEDICAL INSPECTIONS—DEFECTS Number of children noted for treatment or observation expressed as a rate per 1,000 inspeced. Table 22 No. inspected Defects * LEWISHAM Total I.L.E.A. 16,551 158,668 Skin T 12.87 8.19 O 8.34 10.45 Eyes- (a) Vision T 79.09 74.02 O 25.13 52.49 (b) Squint T 9.79 7.46 O 3.69 5.70 (c) Other T 2.60 1.83 O 4.41 2.82 Ears— (a) Hearing T 7.31 5.72 O 6.89 7.35 (b) Otitis Media T 1.87 1.92 O 1.69 3.76 (c) Other T 0.60 0.68 O 0.66 1.06 Nose and Throat T 6.40 6.93 O 25.50 28.68 Speech T 2.96 3.85 O 5.50 7.38 Lymphatic Glands T 0.66 0.45 O 6.77 8.33 Heart T 2.72 2.31 O 4.29 8.40 Lungs T 6.10 4.63 O 8.76 11.45 Developmental— (a) Hernia T 0.86 1.03 0 2.62 2.78 (b) Other T 1.66 1.53 O 4.86 6.06 Orthopaedic— (a) Posture T 1.27 1.15 O 4.89 5.64 (b) Feet T 3.81 4.36 O 11.96 14.22 (c) Other T 1.81 1.97 O 3.63 5.58 Nervous System— (a) Epilepsy T 1.75 1.39 O 1.45 1.51 (b) Other T 0.24 0.73 O 1.09 1.68 Psychological— (a) Development T 0.73 1.41 O 3.32 5.36 (b) Stability T 1.57 2.10 O 10.45 9.57 Abdomen T 0.30 0.28 O 0.60 1.34 Other T 20.36 17.25 O 26.95 35.87 *T= 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. 36 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 23 LEWISHAM I.L.E.A. 1. Comprehensive Surveys (a) Number examined 28,179 277,606 (b) Number (occasions) found verminous 123 3,093 (c) Percentage found verminous 0.44 1.11 2. Selective Surveys (a) Number examined 8,677 121,086 (b) Number (occasions) found verminous 177 3,225 (c) Percentage found verminous 2.04 2.66 3. (a) Total times vermin found (1(b) + 2(b) 300 6,313 (b) Total % found verminous [3 (a) as % of 1 (a) + 2 (a)] 0.81 1.58 (c) No. of individual pupils found verminous 280 4,467 (d) % of individual pupils found verminous (of school roll) 0.68 1.08 4. Action taken with verminous cases (a) Advice and/or Lorexane 220 5,356 (b) Further action 80 957 (c) 4 (b) expressed as a percentage of 4 (a) 36.36 17.87 Analysis of 4(b) cases—referrals of hardcore cases to bathing centres Voluntary attendances at bathing centres No. of pupils 80 771 No. of statutory notices issued — 7 No. cleansed at centres following statutory notices Voluntarily — 5 Compulsorily — 2 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. 37 Table 24 NON-ROUTINE MEDICAL INSPECTIONS Type of Inspection LEW1SHAM I.L.E.A. Area Reinspections 5,226 72,423 Bathing centre inspections — scabies 23 140 „ „ „ — other 10 76 Employment certificates 656 5,490 Theatrical children — 389 School journeys 2,945 23,434 Recuperative holidays—pre-departure 36 1,163 Recuperative holidays—on return — 2 Secondary School annual surveys — 1,730 Candidates for higher awards 1 46 Nautical school entrants — 112 Outward bound courses — 241 Infectious disease investigation 287 301 T.B. contacts — 5 Boarding schools for the Delicate—pre-departure 4 161 Boarding schools for the Delicate—on return 1 35 Handicapped pupils—statutory examination 162 2,293 Handicapped pupils—periodic special defect examination 494 5,725 Research investigations and enquiries 15 64 4,634 41,407 SPECIALS—At request of:— Head teacher—child's name entered in special book 110 1,627 Head teacher—others 221 3,488 School nurse—following health survey 218 758 School nurse—others 18 1,174 Divisional (Education) Officer 34 824 District Care Organiser or Care Committee 25 413 Parent 196 1,275 School medical officer 55 1,378 877 10,937 OTHERS:— Accident on school premises 23 37 Boxing—reference from schools, A.B.A., or similar ation - 93 For free travel 1 14 Reference: (i) connected with remedial exercises 2 124 foot classes (ii) by gymnast or physiotherapist Referred by hospital — 7 Referred by speech therapist 1 7 Referred by general practitioner — 5 Miscellaneous 21 304 48 591 Total of all Non-Routine Medical Inspections 10,785 125,358 38 39 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 25 Number tested Percentage of number tested C—Boys and Girls A—Not wearing glasses B—Wearing 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 Treatmcnt Noted for Observation Total noted for treatment or Observation Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Lewisham 7,606 7,466 85.0 83.2 4.5 4.8 3.3 3.8 3.5 3.7 4.2 4.0 1.8 2.2 1.1 2.0 4.5 5.7 8.7 2.8 11.5 I.L.E.A. Area 67,700 64,057 81.3 79.7 6.5 6.7 5.1 5.3 5.1 5.4 3.6 4.2 1.8 2.0 1.7 2.0 3.3 4.2 8.9 6.3 15.2 Table 26 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 I.L.E.A. No. inspected at 7-plus Routine Inspections 4,431 35,767 No. inspected at 7-plus Experimental Scheme Inspections — 2,256 Defects A B A B Skin 17.83 — 18.12 11.97 Eyes- Vision 95.01 - 136.13 142.29 Squint 12.41 — 15.10 14.63 Other 3.61 — 4.50 2.22 Ears— Hearing 16.25 - 16.72 13.30 Otitis Media 2.31 — 5.84 6.61 Other 1.81 — 2.43 1.33 Nose and Throat 33.18 — 39.03 33.69 Speech 8.35 — 12.19 9.75 Lymphatic Glands 7.45 — 8.58 7.98 Heart 8.35 — 9.98 8.42 Lungs 14.22 — 17.47 16.40 Developmental- Hernia 4.97 — 4.17 5.32 Other 5.42 — 9.06 4.43 Orthopaedic— Posture 4.51 — 6.46 11.52 Feet 15.12 — 19.68 13.74 Other 4.06 — 6.60 6.65 Nervous System- Epilepsy 2.93 — 3.02 3.55 Other 1.13 — 2.99 3.10 Psychological— Development 7.90 - 8.95 15.96 Stability 14.67 — 14.51 19.95 Abdomen 0.45 — 1.73 0.44 Other 44.91 — 58.04 93.09 Column 'A' refers to 7-pIus routine medical inspections Column 'B' refers to 7-plus experimental scheme inspections 40 Deptford and Downham School Treatment Centres These two centres are maintained by Voluntary Committees in agreement with the Inner London Education Authority. Both committees are responsible for heating, lighting and cleaning, for minor ailments clinics and the appointment of staff required for that service. The Committees initially pay the running expenses of the buildings and certain of the salaries and wages, the whole of the expenditure being reimbursed by the Inner London Education Authority through payments in the form of regular grants. Accounts are kept and produced for audit, detailing all expenditure. The Medical Officer of Health is represented on the Deptford Committee by Miss E. Stocker, the Council's Principal Social Worker and on the Downham Committee by Mrs. D. M. Coe, the Borough Nursing Officer (Maternal and Child Health and School Health Services). Both Committees meet regularly to discuss the management of the Centres. 41 SOCIAL WORK (SCHOOLS AND GENERAL) Miss E. Stocker, Dips. Social Studies and Casework, A.A.P.S. W., Principal Social Worker Social Workers Are members of the health department team and provide a casework service. Family caseworkers give help to families presenting multiple problems and concentrate on prevention and rehabilitation. School health social workers are concerned with socio/medical symptoms, work in school clinics (and one hospital out-patient clinic where there is a special unit), and educational units for handicapped children. Some work is undertaken in connection with specific health problems such as venereal diseases and the follow-up of children referred to hospital. Social Workers are also involved in hospital liaison arrangements, for example, with the Hearing Aid Centre at the New Cross General Hospital. Staff Two members of staff, one family caseworker and one school health social worker, were accepted for Applied Social Studies Courses in 1967, and one family caseworker resigned to start her own family. The Assistant Principal Social Worker returned after a successfully completed Applied Social Studies Course at Hull University. Accommodation The section moved to improved accommodation in June, at 83 Amersham Road, S.E.14. Telephone No. 01-692 6104. School Health Social Workers Were attached to the following:— (a) Local Authority Clinics:— Amersham Special Investigation Clinic — Health Centre, Amersham Road, S.E.14 Downham Special Investigation Clinic — Downham Health Centre, Churchdown. Downham Lewisham Special Investigation Clinic — School Treatment Centre, 78 Lewisham Park, S.E. 13 Lewisham Audiology Clinic — 78 Lewisham Park, S.E. 13 Sydenham Special Investigation Clinic — Children's Hospital, S.E.26 Deptford Ear, Nose and Throat Clinic — Reginald Square, S.E.8 (b) Hospital Clinic:— Lewisham Hospital—Hearing Investigation Clinic (c) Special Educational Units:— Sedgehill School Partially Hearing Unit Woodlands School Autistic Unit Hither Green Hospital Deaf/Blind Unit Following discussions on services available for handicapped children and young people, it was agreed that future policy would be to attach a trained Social Worker to all special schools. As a result a Medical Social Worker from the section commenced at Woodlands Open Air School in the autumn term. 42 Family Caseworkers Skilled in casework techniques gave help to approximately forty families during the year. Referrals came mainly from case conferences, but policy now is that any department or agency may refer. Caseloads were kept small and co-operation with other departments and agencies was maintained. Co-ordinating Committee The Principal Social Worker is one of the department's representatives on the Committee, which is composed of Council Officers and allied agencies such as the Probation Service. The Committee discusses departmental social service programmes, considers problems of policy in relation to special difficulties in family situations, and receives reports of case conferences. During the year there were eight meetings. Training Students were accepted from professional and pre-professional courses for varying periods of practical work. Members of staff attended seminars and lectures in connection with specific aspects of their work, and attended the following conferences and courses:— London Boroughs Training Committees — Family Casework London Boroughs Training Committees — Group Work Leicester University (A.P.S.W.) — The Disturbed Child London School of Economics — Professional Student Supervision Association of Psychiatric Social Workers — Autistic Children I.L.E.A. — The Needs of Deaf Children Chest Clinics Each of the two chest clinics has a welfare officer attached who acts as Secretary to the Care Committee, advises on facilities available, and gives help with practical problems. Both the Deptford and Lewisham Care Committees met on eight occasions during the year, when funds, grants, outings, etc. were considered to supplement and facilitate the welfare of patients suffering from the chest conditions. V.D. Clinics It has not been possible to arrange social worker attachment as yet, although it is hoped to do so in the not too distant future. There is considerable evidence that these diseases are increasing in incidence, especially in the younger age groups. There is a great need for the application of social counselling and health education to this problem. Investigation or treatment as needed is, of course, confidential and available on application to the following local centres:— St. John's Hospital. Morden Hill, S.E.I3 Male: Monday, 5.00 p.m. Tuesday and Saturday, 10.00 a.m. Female: Monday, 2.30 p.m. Thursday, 5.00 p.m. 43 HOME HELP SERVICE Heavy demands continued to be made on the home help service, and this was reflected in an increase of approximately 2.5 per cent. in the number of households being served at the end of the year. Details of the service then being provided, with corresponding figures for 1966 appear below. Very heavy pressure continued to fall on the staff of the Rushey Green Home Help Office. Unavoidable delays occurred in the adaptation of new premises at Grove Park, to serve as a fourth home help office to relieve the strain. The work was however well advanced by the end of the year, and it is hoped that it will open early in 1968. Staff training in the form of lectures by senior officers on different aspects of the work of the Health Department continued. The object is to indicate that the home help is a valued member of the Health team. These have proved popular with home helps and supervisory staff. Table 27 CASES RECEIVING SERVICE AS AT 31st DECEMBER 1967 (1966 figures in brackets) Office Maternity Tuberculosis Age 65 and over Aged under 65 Chronic sick Others Total Deptford Town Hall 2 3 608 47 3 663 New Cross Road, S.E.14 (1) (3) (613) (54) (4) (675) 41 Rushey Green, S.E.6 4 17 1,422 163 21 1,627 (2) (11) (1,350) (155) (37) (1,555) 266 Kirkdale, 5 11 709 68 23 816 Sydenham, S.E.26 (3) (14) (696) (67) (19) (799) Totals 11 31 2,739 278 47 3,106 (6) (28) (2,659) (276) (60) (3,029) No. ofhome helps at end of 1967:—(a) Whole time 7 (7) (b) Part time 646 (627) (c) Whole time, equivalent of (b) 349 (343) 44 HEALTH EDUCATION Mr. R. Allen, M.A.P.H.I., M.I.H.E., Health Education Officer The year has seen the gradual accumulation of material and equipment enabling the section to widen the scope of its activities. The work falls under several headings:— (a) Giving information about the services available through the Health Department. This involves the production and periodic amendment of a "Guide to the Health Services", and the giving of talks on the work of the department. (b) Arranging talks, discussions, film, film-strip and tape shows on the many ways of preventing disease, immunisation, cervical cytology, change of habits, need for excercise and proper diet, etc. Posters and pamphlets are distributed on all of these subjects. (c) Arranging in-service training for the Health Department staff". (d) The production and distribution of a 20-page quarterly Health Bulletin (circulation 7,500), with seasonal and topical variations in the ways of achieving health and home safety. Mental Health Week (4th June to 10th June), was publicised by means of posters, car-stickers, pamphlets and articles in the local press. Three shop window displays were organised and a stand was sited in a large local multiple store. A public meeting was held and the Council's training centres were opened to the public. Senior pupils at several local schools were shown a film and given a talk on mental health, and some of them were taken round a training centre. A three-week dental campaign was carried out in collaboration with the new ILEA Health Educator. Films were shown and talks and demonstrations given at fifteen schools to about 3,500 children. Many students and trainee-teachers have come to the section for help on various projects. Every effort was made to give as much help as possible so that the teachers of tomorrow not only recognise their important part in health education, but they also know that co-operation can be obtained from the Health Education Section of the department. Trainee teachers, in the long run, have a more useful influence over the coming generation in teaching them the tenets of healthy living, and warning them against anti-healthy habits. During the year talks were given on home safety and a short film on the subject was included as a filler on many other occasions. Late in the year a technical assistant was seconded from the Environmental Health Section and house-to-house visits were started in an area where oil-heaters are widely used—and sometimes misused. Advice was given and a pamphlet produced by the Section was distributed directly to householders and through the local vendors of paraffin. Complaints by health visitors and home nurses about home hazards were also investigated, and advice and help given. Cervical cytology has been publicised and talks illustrated by film-strips have been given to women's groups. These talks also dealt with the subject of self-examination of the breast. The Section distributes technical periodicals. Lewisham has joined with other boroughs to provide a Local Government Annotation Service (LOGA), which is used by the Section to obtain copies of articles requested by the staff. Technical books are gradually being added to the small health department library, and frequent use is made of the public library facilities in preference to the purchase of expensive text books. 45 The Section has had energetic co-operation from the doctors, dentists, chiropodists, health visitors, home nurses, public health inspectors, and other members of the staff who, as practising experts in the various disciplines have given many of the talks. The Health Education Panel comprising representatives of the different sections of the Health Department has played an active part in developing health education and in providing material for the Health Bulletin. Table 28 Film Shows 188 Talks 71 Film strips, tapes etc. 30 Student sessions 42 46 CHIROPODY SERVICE Mr. B. Dalton, M.Ch.S., S.R.Ch., M.R.S.H., Chief Chiropodist Four clinics, three full-time and one part-time, are maintained by the Council, and one chief, five full-time and seventeen sessional chiropodists are on the Health Department staff. There is, at the clinic, an average waiting time of twelve weeks between appointments. This is regrettably due to continued shortage of chiropodists. There were 4,517 (4,311) sessions during the year. Full-time staff carried out 2,346 (1,858) of these and part-time staff did 2,171 (2,453). An average of 88 (82) sessions per week was provided during the year. 1,700 elderly, infirm, or handicapped patients were taken to and from the clinics by departmental transport, the average appointment interval for this special service was fifteen weeks. Fourteen domiciliary visits were made to persons of under pensionable age who were chronically ill and house bound. Simple appliances were made for thirty-five patients not sufficiently severely afflicted to require orthopedic treatment or surgical footwear, but who would have required considerably more than routine chiropody treatment. Twenty special cases were successfully completed, these being patients where the condition required long and frequent attention to find the best treatment or combination of methods to resolve the condition. In these cases admission to hospital was undoubtedly prevented. After some delay, due to nondelivery of equipment, the session at Lewisham Hospital commenced in September. Liaison has been maintained throughout the year with the foot clinic provided by a voluntary agency at the Deptford Central Methodist Mission and has now been established with the Brook Lane Medical Mission. The plan approved by the Council for the sponsoring of suitable students wishing to train as chiropodists has not as yet been implemented but it is hoped to do so in the coming year. In the long run this will help to stimulate and maintain the standard of the professional worker employed by the Council and also increase the supply of chiropodists. It is estimated that to maintain the present inadequate service and to contain the elderly population growth, accommodation will be required for sixteen full-time chiropodists by 1972. By that time eighteen per cent. of the population will require some chiropodial attention. Improvement of the service is dependent on increasing the capacity to twelve full-time chiropodists as soon as possible. On this basis the number should rise to twenty by 1972. This would allow for a reduction in the appointment interval to an optimum of eight weeks, and the annual rate of growth to be contained. 47 Table 29 STATISTICAL SUMMARY OF ATTENDANCES 1967 1966 Number of sessions 4,517 4,311 Appointment bookings 32,083 31,132 Children of or below school age 1,454 1,415 Adults: Male 5,424 5,255 Female 22,123 21,350 Total 27,547 26,605 Fee paying attendances (adults) 8,233 7,987 Free attendances (adults) 20,768 20,033 Table 30 NEW CASES ATTENDANCES ANALYSIS Age groups Number attending clinics 1967 1966 0-4 2 6 5-14 181 181 Males 15-64 114 119 Females 15-59 320 296 Males over 65 173 176 Females over 60 520 498 Total 1,310 1,276 48 MENTAL HEALTH Miss Z. Mason, B.A., A.I.M.S. W., Principal Mental Health Officer During the year, 437 mentally ill and 422 subnormal or severely subnormal persons were referred to the Department and at the year end a total of 1,252 individuals were receiving some form of community care. The Special Advisory Clinics The Special Advisory Clinics for young retarded children continued to be held at the Central Lewisham and Amersham Road Health Centres. During the year thirty-eight sessions were held and ninety-five children were assessed. The Early Care Unit The Early Care Unit in the Shaftesbury House Day Nursery was fully occupied and there continues to be a waiting list for admission. During the year, improvements to the nursery premises made possible a most welcome increase of three places in the accommodation to a total of fifteen. Training Centres The Lewisham (Junior) Training Centre remains fully occupied, a proportion of the places being made available to children living in Southwark and Lambeth. At the end of the year, eighty-seven Lewisham children were on the roll, with a further eight due to commence after the Christmas Holidays. Twenty-one places were filled by children from other areas. A special care unit for twelve doubly handicapped children erected as an addition to the centre opened in February. Since its opening heavy pressure on the admission list has been felt and it is clear that further places will be required. A site in central Lewisham has been acquired on which a new adult training centre is planned to replace the existing ones in Brockley and Deptford and to provide additional places. Planning of this centre was well advanced by the end of the year. Following a meeting with representatives of the Ministry of Health, the Council approved a modification of its development plan. This now provides for an increase in the number of places to 140 at the new centre. A second junior training centre with sixty places to enable class sizes at the present centre to be reduced is also approved. Thirty-six special care places will be provided. As a temporary measure, pending the opening of the purpose-built adult training centre, the Council approved the transfer of the Brockley centre into superior church hall accommodation and negotiations for the use of these premises were at an advanced stage by the end of the year. A number of female adults living in Lewisham who had been attending a training centre in Greenwich, were transferred to the Brockley centre and at the same time a similar number of male trainees from Greenwich who had been attending the Deptford centre were transferred to centres in Greenwich. Annual Seaside Holiday Forty-two trainees from the three 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, Dymchurch, Kent. Short-term Care Short-term residential care, in accordance with Ministry of Health Circular 5/52, to provide relief for their families, was arranged for twenty-four subnormal adults and forty-eight children. Of these eighteen were found accommodation in hospital and fifty-seven in approved homes. 49 Long-term Care Although the obtaining of hospital places for persons requiring long-term hospital care continued to be difficult, admissions were arranged for five persons, including one on a five-day week basis. At the end of the year, five persons were still awaiting admission. Places in approved homes were found for eighteen subnormal persons during the year. Altogether forty-three are now being maintained by the Council in this type of accommodation. Mental Subnormality Liaison Committee This Committee whose membership comprises a hospital consultant, a specialist in mental subnormality and a general practitioner, as well as senior officers of the Health Department, met on three occasions during the year. The Committee gave valuable advice on policy and planning services for the mentally subnormal. Psychiatric Advice The Psychiatric Liaison Committee, comprising consultants from Bexley and Cane Hill Hospitals, a general practitioner and a representative of the Welfare Service, as well as members of the Mental Health team, met quarterly and gave valuable advice on policy and planning of services for the mentally ill. Monthly meetings of all social workers and staff of establishment for the mentally ill, and attended by consultants also proved most useful for the discussion of specific and general problems and the disemmination of information. Honor Lea Hostel This was fully occupied throughout the year. Altogether there were 40 admissions (25 men and 15 women) and 36 residents (22 men and 14 women) discharged. Of the residents who were discharged 11 went to their own homes and 10 into lodgings. 15 residents returned voluntarily to hospital during the year. The work record of the residents was very encouraging and at the end of the year, all were engaged in outside employment. Two groups of hostel personnel, unable to make their own arrangements were provided with a week's seaside holiday accompanied by a Social Worker. The blocking of hostel places by those whose condition is such that they no longer need support but have no other accommodation continues to cause some concern. During the year the Council arranged for the conversion of a suitable house to bed-sitter accommodation for persons considered fit. This unit will be used primarily for ex-residents of Honor Lea. Day Centres In June the Princess Louise Day Centre in Deptford, was discontinued and modern, specially adapted premises named the New Cross Day Centre was opened. By the end of the year there were thirty patients on the roll there and thirty on the roll of the Cambridge Day Centre in Lee. During the year twenty persons were able to leave centres to take up outside employment. Social Clubs Weekly meetings of the two evening social clubs for mentally ill persons continued. The Saville Club was transferred to the Lewisham Training Centre and renamed the Perryrise Club. Altogether there were eighteen persons on the roll of the Perryrise Club and forty-five on the roll of the Tideway Club at the end of the year. 50 Staff A Psychiatric Social Worker position in the mental health team which had become vacant was replaced by one of Senior Mental Health Officer. The officer filling this position, a qualified psychiatric social worker, has special responsibility for the day centres and for casework with persons living in the northern part of the Borough. A Mental Health Social Worker has been seconded from general duties to concentrate on the special problem of alcoholism and drug addiction, working under the general direction of a consultant who has a special interest in these conditions. Staff Training Two members of the mental health team returned to the department from courses of whole time training and two more were seconded. One of these is sponsored for a course leading to the Mental Health Certificate and one to a "Younghusband" course. An assistant supervisor from the Deptford Training Centre completed a oneyear course for teachers of the mentally handicapped adult at Durham Technical College and a member of the Lewisham (junior) Training Centre staff commenced a two-year course leading to the Diploma of the Central Training Council for Teachers of the Mentally Handicapped. An in-service course of six lectures by a consultant from Darenth Park Hospital on clinical and social aspects of mental subnormality was arranged for members of the Section. A second course of lectures for Health Department field staff on psychiatric aspects of their work was conducted by consultants from both Bexley and Darenth Park. Student Attachments Following the recruitment of two Senior Mental Health Officers, the Mental Health team was able to play a greater part in student training. During 1967, casework training was provided for three students from full-time social work courses and help was also given to the training of psychiatric nurses from Springfield Hospital. The training included a one-week programme of visits to local authority establishments. One-day visits of observation by nursing, health visitor, child-care and social science students took place regularly. Four students from the course for Teachers of the Mentally Handicapped came to the Junior Training Centre for their practical placements and two students from the Departments of Education of Goldsmiths' College undertook an educational project with mentally handicapped young men at the Deptford Training Centre. Lewisham Association for Mental Health Members of the mental health team gave much assistance and advice to a steering committee set up to prepare for the establishment of a Lewisham Association for Mental Health. The Association was formally constituted at a public meeting held in October, and a Senior Medical Officer and the Principal Mental Health Officer attend meetings of the excutive committee as advisers. 51 PREVALENCE OF and CONTROL OVER INFECTIOUS AND OTHER DISEASES NOTIFIABLE DISEASES The undermentioned diseases are notifiable by medical practitioners to the Medical Officer of Health:— Anthrax Plague Cholera Pneumonia, acute influenzal Diphtheria Pneumonia, acute primary Dysentery (bacillary or amoebic) Poliomyelitis, acute Encephalitis, acute Puerperal pyrexia Enteric fever Relapsing fever Erysipelas Scarlet fever Food poisoning Smallpox Malaria Tuberculosis, all forms Measles Typhoid fever, including paratyphoid Membranous croup Typhus fever Meningococcal infection Whooping cough Ophthalmia neonatorum NUMBER OF NOTIFIED CASES (Corrected for revised diagnosis) during the year 1967 with comparative figures for the previous six years. Table 31 Diseases Cases notified 1967 1966 1965 1964 1963 1962 1961 Anthrax 1 - 1 — — 1 — Diphtheria — — — — — — — Dysentery 90 152 159 226 870 234 119 Encephalitis (acute) - — — — — — 1 Enteric or typhoid fever 3 1 1 2 12 4 2 Erysipelas 16 18 19 20 7 2 21 Food poisoning 22 34 20 19 13 19 34 Malaria — — — 1 — 2 — Measles 2,561 2,017 3,014 1,553 3,186 544 5,678 Meningococcal infection — 3 1 2 1 4 5 Ophthalmia neonatorum 5 3 3 1 5 1 2 Pneumonia 43 35 37 35 75 36 85 Poliomyelitis (acute) — — — — — — — Puerperal pyrexia 67 36 75 55 47 74 46 Scarlet fever 174 82 161 197 103 71 129 Tuberculosis 116 148 157 203 210 191 223 Whooping cough 130 169 108 190 258 54 111 TOTALS 3,228 2,698 3,753 2,503 4,806 1,249 6,468 52 53 Table 32 NOTIFICATIONS OF INFECTIOUS DISEASES IN 1967 SHOWING SEX AND AGE GROUPS Diseases Under 1 1- 3- 5- 10- 15- 25- 45- 65+ Total M F M F M F M F M F M F M F M F M F M F Anthrax - - - - - - - - - - - - - 1 - - - - - 1 Dysentery 2 2 8 5 5 9 9 8 6 1 8 3 7 10 3 - - 4 48 42 Erysipelas - - - - - - - - - - 1 - 1 2 4 4 — 4 6 10 Food Poisoning 2 - 2 2 - 2 1 1 — — 1 1 2 3 4 — 1 — 13 9 Measles 74 61 432 445 383 365 391 356 17 9 12 11 2 2 — 1 — — 1,311 ,250 Ophthalmia Neonatorum 1 4 - - - - - - - - - - - - - - - - 1 4 Paratyphoid B - - - - - - - - - - - - - - 1 - - - 1 — Pneumonia — — — — 1 — 1 — 1 1 2 1 1 10 9 4 6 6 21 22 Puerperal Pyrexia - - - - - - - - - - - 32 - 35 - - - - - 67 Scarlet Fever 1 1 6 10 20 19 47 54 1 3 6 4 1 1 — — — — 82 92 Tuberculosis — 1 — — — 2 2 1 2 2 5 9 17 15 32 11 12 5 70 46 Typhoid - - 1 - - - - - - - 1 - - - - - - - 2 — Whooping Cough 3 4 14 32 12 16 21 24 — 3 1 - - - - - - - 51 79 Table 33 FOOD POISONING CASES Causative agent GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC CASES TOTAL TOTAL 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 — — — — 5 5 5 Other Salmonellae — — — — 5 5 5 Cause unknown — — — — 15 15 15 TOTAL - - - - 25 25 25 DETAILS OF FOOD POISONING DUE TO SALMONELLAE OTHER THAN S. TYPHIMURIUM Type of salmonella Drypool - - - - 1 1 1 Stanley - - - - 1 l 1 Group B - - - - 2 2 2 Group D - - - - 1 1 1 Salmonella infection, not food borne NIL MEASLES The number of cases which occurred was up on the previous year (2,561 as compared with 2,017), but as this disease normally makes a biennial appearance, this was to be expected, and the incidence can be considered as "normal". SCARLET FEVER There were 174 cases compared with 82 in the previous year (the lowest incidence recorded). This was disappointing as it was hoped that the numbers would keep low. However, comparisons over the last decade show that the number was not abnormally high. WHOOPING COUGH Fewer cases occurred in 1967 (130 as compared with 169 the previous year). This is not particularly favourable as smaller numbers have occurred in some years of the past decade. DYSENTERY The year produced the lowest recorded figures, and this is most encouraging. However, if this incidence is to be maintained or improved upon, constant attention must be given to the need for the highest standards in personal hygiene and food handling. 54 TETANUS A resident of the Borough, a cook in a hospital kitchen in a neighbouring area, died of tetanus. It was thought that the patient who had suffered a cut on the hand some two weeks before became infected through his injury. The instrument and possible source of the infection could not be identified with certainty. Following this incident the precautions available for the protection of Council's staff engaged in duties that could bring them into contact with possibly infected soil or other material were overhauled by a senior medical officer of the department. ANTHRAX A patient was notified as a clinical case of anthrax though direct bacteriological tests proved negative. Later a serological test proved positive. She was employed as a packer at a bone-meal factory in another part of London. It was considered that infected bone-meal, which was delivered to the factory from elsewhere, was the source of this patient's infection. All necessary action to prevent further cases of the disease were taken by the Authorities concerned. 55 TUBERCULOSIS A decrease in the number of cases notified continues. The following graph, in illustrating this, is a tribute to all those concerned in the eradication of the disease which was at one time justly called "The Captain of the Men of Death". PULMONARY TUBERCULOSIS 1950 to 1967 (CASES NOTIFIED PER 100,000 POPULATION WITH CENTRED TREND) 56 Table 34 TUBERCULOSIS NOTIFICATIONS AT AGES Age periods New cases notified Totals Respiratory NonRespiratory M F M F M F 0- — 1 — — — 1 1- — — — — — — 2- — 2 — — — 2 5- 2 1 — — 2 1 10- 2 2 — — 2 2 15- 1 4 — 1 1 5 20- 3 4 1 — 4 4 25- 9 6 1 2 10 8 35- 7 6 — 1 7 7 45- 20 5 1 — 21 5 55- 10 3 1 3 11 6 65- 8 2 1 1 9 3 75+ 3 2 — — 3 2 TOTALS 65 38 5 8 70 46 CHEST CLINIC, LEWISHAM I am indebted to Dr. M. Farquharson for the following report concerning the Chest Clinic at Blagdon Road of which she is the Consultant Physician: The reduction in the number of newly notified cases of tuberculosis has continued in 1967. 44 cases were diagnosed at the Chest Clinic as compared with 78 in 1966. This figure comprises 28 men, 12 women and 4 children. The total tuberculosis register has been reduced by 194 to 1,547. The contact clinics were well attended during the year and B.C.G. was given to 190 infants and children. The Health Visitors carried out 4,367 home visits. The overall work of the Chest Clinic continues at a steady level. There were 20,273 attendances (excluding after-care) and 2,059 new patients were examined. Acute chest infections, chronic bronchitis, emphysema and asthma have been the most frequent problem, and for the third year in succession the number of new cases of carcinoma of the lung have exceeded those of tuberculosis. 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 Consultant Physician: The clinic remains busy, even hectic at times. It is a hive of clinical industry, but special considerations have always been in the forefront of our minds. How can we best help the patient to help himself? This attitude fosters a ready response, and many patients, even though they live out of Deptford, like to retain contact. The greater part of the work, however, is concerned with people residing within fairly easy reach of the clinic. Over the years, I have found that bronchitis and its complications is prevalent in Deptford, and in addition to the extremes of life is seen particularly in middle-aged males and among quite a number of young people. Much of the present work of the 57 clinic deals with bronchitis and its complications. There is also the aftercare of a large number of cases of pulmonary tuberculosis, most of it now cured or quiescent, leaving lung scars doubtless responsible for various chest symptoms. There is in addition much investigation to exclude pulmonary neoplasms. The new notifications from tuberculosis in 1967 remain fairly steady at 79. 19 of these were positive soon after diagnosis, and some were quite severe in extent. There are now relatively few cases of non-pulmonary tuberculosis such as tuberculosis of glands, but they still crop up from time to time. Among the thousand or so known cases of pulmonary tuberculosis, 34 produced positive sputum for tubercle bacilli during the year. Many of the new cases came from Carrington House, and a fair number of elderly bronchitic males were also seen from there. I have notes of 37 pulmonary neoplasms found in 1967. Heavy smoking remains, in my view one of the largest single factors in the causation. I noted down the heavy cigarette smokers amongst those attending with chest symptoms, and found 77 males and 26 females smoking over thirty cigarettes daily. Some of my patients have expressed concern at the proposed move of the Deptford Chest Clinic to the New Greenwich District Hospital, chiefly on the grounds of increased distance and associations with the present department. The total attendance figure during the year was just short of 6,000 in number. 1,442 were new cases with varying chest symptoms attending the clinic for the first time. MASS RADIOGRAPHY UNIT I am indebted to Dr. Morgan the Director of the Unit for information or work done in the borough during 1967 on which the following tables are based. Table 35 Patients Men Women Total General analysis: X-rayed 6,273 4,525 10,798 Previously x-rayed 3,411 1,918 5,329 Reviewed 211 127 338 Abnormal after review 159 91 250 A nalysis of abnormalfilms: Cases considered tuberculous (a) No further action required — — — (b) Occasional supervision only 7 1 8 (c) Requiring treatment 12 3 15 (d) Still under investigation 4 2 6 (e) Refused further investigation 1 — 1 Previously known tuberculous cases 15 12 27 Non-tuberculous cases (a) Investigated (See table 36 for detailed breakdown) 35 22 57 (b) Still under investigation 4 3 7 Cardio-vascular lesions 15 20 35 Abnormalities requiring no action 65 27 92 58 Table 36 NON-TUBERCULOUS ABNORMALITIES MEN WOMEN Carcinoma of bronchus 3 Carcinoma of bronchus 1 Silicosis 1 Metastases from Car. of breast 1 Asbestosis 1 Carcinoma of breast 1 Bronchiectasis 3 Sarcoidosis 2 Pneumonitis 8 Pneumonitis 9 Chronic bronchitis and emphysema 6 Chronic bronchitis 1 Fibrosis 2 Pleural thickening 2 Pleural thickening 3 Depressed sternum 1 Hiatus hernia 1 Bony abnormality of Scapula 1 Multiple exostosis 1 Pericardial pad of fat 1 Encysted effusion 1 Elevation of diaphragm 1 Bony islet in rib 1 Died undiagnosed 1 Pericardial pad of fat 1 Eventration of diaphragm 3 35 22 59 60 Table 37 Men Women Total Cases of tuberculosis requiring treatment or close supervision Men NOT PREVIOUSLY EXAMINED (included in previous columns) Total NUMBERS Men CASES Men Women Total Women Total Womnen Small Public Surveys 662 548 1,210 — 1 1 433 351 784 — — — Public Surveys—Examination of Special Groups 200 66 266 — — — 22 28 50 — — — Regular Site (New Cross) 1,609 1,531 3,140 1 2 3 556 826 1,382 — 1 1 Firms 3,203 1,145 4,348 1 — 1 1,555 635 2,190 1 — 1 Hospitals, Colleges etc. 403 1,162 1,565 1 — 1 186 725 911 1 — 1 Homes and Hostels 196 73 269 9 — 9 110 42 152 6 — 6 TOTAL 6,273 4,525 10,798 12 3 15 2,862 2,607 5,469 8 1 9 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 2 months and 5 years were offered immunisation at health centres and from 5-12 years in 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. Medical practitioners in the Borough are supplied, free of cost, with poliomyelitis vaccine for persons under the age of 40, and diphtheria, whooping cough, tetanus and smallpox vaccine. Table 38 IMMUNISATION AND VACCINATION Type of vaccine or dose Primary courses completed Year of birth Others underage 16 yrs. Total 1967 1966 1965 1964 196063 Diphtheria 2,277 2,124 236 125 567 332 5,661 Whooping Cough 2,264 2,113 229 121 160 12 4,899 Tetanus 2,277 2,121 238 131 569 486 5,822 Polio 940 2,843 360 206 781 508 5,638 Reinforcing dose Diphtheria — 1,593 1,419 225 2,989 937 7,163 Whooping Cough — 1,550 1,375 211 667 58 3,861 Tetanus — 1,593 1,420 226 2,979 984 7,202 Polio — 24 42 10 2,961 1,001 4,038 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 53 36 63 77 2,271 969 155 3,624 Re-vaccination - - - - - 26 169 195 LABORATORY FACILITIES The following represents work carried out by the Southern Group Laboratory on behalf of the Council during 1967. Table 39 Specimens Number Remarks Faeces 397 Negative 41 Shigella sonnei 5 Salmonella typhimurium 5 Salmonella panama 1 B.coli, type 0126 1 B.coli, type 055 2 Staphylococcus aureus 5 Clostridium welchii Swabs from nose and throat etc. 19 Negative 4 B-haemolytic streptococci 2 Staphylococcus aureus Water (various) 2 Food 4 488 61 ENVIRONMENTAL HEALTH Mr. A. J. Phillips, M.A.P.H.I., Chief Public Health Inspector During 1967 following new legislation, it became possible to deal with urgent nuisances more quickly, and also to arrange for the speedy re-instatement of water supplies cut off by the Metropolitan Water Board for defective supply pipes or fittings. It is also now possible to take statutory action to improve food hygiene in markets and stalls and in food delivery vehicles. Housing Following some staff reorganisation a considerable increase was achieved in work under the Housing Acts. Additional visits were paid to houses in multi-occupation and in view of several recent fires, emphasis has been placed on means of escape, not only by carrying out works to the premises but also by talks to the occupiers on the dangers of fire, particularly the storage and use of paraffin in paraffin oil burning appliances. The inspection of premises included in clearance programmes continued, and additional premises were added. Improvement of existing houses was also encouraged. While the number of initial visits for mortgage surveys was slightly reduced it was possible to give more attention to follow-up visits to existing mortgaged properties, particularly to check on occupation. Offices, Shops and Railway Premises The number of visits paid during the year was similar to 1966, but the number of cases where it was necessary to draw attention to defects was halved. It was noted, however, that a number of premises were without a thermometer, a first-aid box, or a hot water supply, and it is hoped that these deficiencies will be attended to in the near future. Clean Air Smoke Control Orders affecting the Deptford Park and Brookmill areas came into force during 1967, adding a further 2,241 dwellings to those already under Orders. The Bell Green Smoke Control Order, dealing with 4,208 properties was made during the year and will become operative in 1968. Only a very small part of the Borough now remains to be dealt with and as this is under consideration for redevelopment, completion of the smoke control programme is held up at present. Food Increased visits were possible to restaurants and cafes during the year, and some marked improvements in hygiene were noticeable in many cases, but unfortunately there is still room for greater care in food preparation in some of these premises. The number of adulturated samples was reasonably small and most of these related to incorrect labelling which was rectified after consultation with the manufacturers. Proceedings were taken in fifty-seven cases under the Food and Drugs Act for the sale of unfit food or containers and resulted in fines and costs of over £700. Many of these were as a result of complaints by members of the public, or relating to foreign objects found in food, mouldy meat pies and dirty milk bottles. Some of this could be avoided if shopkeepers paid more attention to proper stock rotation. Public Health Acts Slightly fewer Public Health Act notices were served as compared with last year. Major items remedied included defective roofs, gutters, floors, dampness and wall and ceiling plaster. 62 Pests Rat and mice infestations increased slightly. 1.803 properties required treatment compared with 1,704 in 1966, but retreatments fell from 3,339 to 3,118. There was however, a decrease in the number of mouse infested properties and this suggests that greater care in the storage of food may have been responsible. There has been a marked increase in the number of verminous children cleansed at the Disinfecting Stations, 512 as against 394. Treatment for scabies has risen for children from 251 to 517, and for adults from 195 to 360. It was also necessary to disinfest many more rooms and articles. It is difficult to see the reason for this with the improved housing conditions; it is however, hoped that this rise is only temporary and that the figures for 1968 will show a considerable improvement. Table 40 SUMMARY OF INSPECTIONS BY PUBLIC HEALTH INSPECTORS Reason for inspection Total On complaint 3,732 House to house 1,947 Improvement giants 1,492 Houses in multiple occupation 1,555 Rent Acts 20 Mortgage survey 982 Other Housing Act visits 1,048 Notice from builder 1,246 Infectious diseases 215 Infestation 251 Factories, mechanical 80 Factories, non-mechanical 90 Outworkers 121 Clean Air inspections 1,335 Pet Animals Act 19 Offices, Shops, etc. Act 1,153 Common Lodging Houses 6 Fireguards 33 Hairdressers 19 Pharmacy and poisons 170 Icecream premises 75 Restaurants, cafes, etc. 1,397 Bakehouses 22 Food shops and stalls 1,414 Other shops and stalls 123 Food inspections 567 Sampling 269 All other matters 4,513 Revisits 12,535 Total—all inspectors 36,429 Table 41 SUMMARY OF NOTICES SERVED Informal notices: Public Health Act, 1936 845 Factories Act 5 Housing Act, 1957 43 Housing Act, 1961 41 Offices, Shops and Railway Premises Act, 1963 555 Total 1,149 63 Table 41—continued SUMMARY OF NOTICES SERVED Statutory notices: Public Health Act, 1936 464 Clean Air Act, 1956* 123 Housing Act, 1957 1 Housing Act, 1961 73 Byelaws 42 Prevention of Damage by Pests Act, 1949 2 Total 705 * The vast majority of these were for late applications and were served to safeguard Ministry and Borough Council grant. PUBLIC HEALTH ACT, 1936 The number of houses in which defects were remedied after formal action as a result of abatement notices was 441, and as a result of abatement orders was 8. Table 42 DETAILS OF REPAIRS CARRIED OUT Repairs Total Brickwork repaired 14 Chimneys and flues repaired 7 Dampness remedied 632 Doors and door frames repaired or renewed 51 Drains cleared 35 Drains repaired 2 Dry rot remedied 5 Dustbins supplied 12 Fire grates etc., repaired or renewed 7 Flooring repaired or renewed 111 Flushing cisterns repaired, renewed or cleansed 35 Flush pipes repaired or renewed 1 Glazing 10 Gutters repaired 114 Gullies renewed, repaired or cleansed 32 Refuse cleared 18 Rainwater pipes cleared 59 Roofs repaired 294 Sashcords renewed 134 Sinks replaced 45 Soil pipes repaired, ventilated or renewed 24 Walls and ceilings cleansed 2 Walls and ceiling plaster repaired 201 Water closets repaired or renewed 83 Water service pipes repaired or renewed, water supply restored 32 Windows and frames repaired or renewed 86 Yards and areas pave 12 Other repairs 48 TOTALS 2,106 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 64 means for draining floors where wet processes are carried on, are enforced by the council in factories in which mechanical power is not used. The provisions of section 7 are also applied to certain building operations and works of engineering construction, etc. A local authority is required to keep a register of factories where it is responsible for the enforcement of any of the provisions mentioned above. Close co-operation is maintained with H.M. Inspectors of Factories so that any faults found by them during the course of their visits and for which it is the duty of the local authority to take action, are notified to the Health Department. Similarly the public health inspectors notify H.M. Inspectors. H.M. Inspectors also forward to the Health Department details of new factories, the introduction of mechancial power or other information which may assist the local authority. Special attention is paid to factory canteens. These are visited by the Council's food inspectors and opportunity is taken to discuss with staff the need to maintain a good standard of food hygiene. The Medical Officer of Health is required to report on the administration of part I (factories) and part VIII (outworkers) which are administered by the local authority. Details follow— Table 43 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 65 90 - - (ii) Factories not included in (i) in which section 7 is enforced by the local authority 570 80 5 - (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 64 64 - - TOTAL 699 234 5 - Table 44 CASES IN WHICH DEFECTS WERE FOUND Defects No. of defects Found Remedied Referred 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 2 2 - 1 - (b) unsuitable or defective 7 7 - 3 - (c) not separate for sexes - - - - Other offences against the Act (not including offences relating to outwork) - - - - - TOTAL 9 9 — 4 — 65 OUTWORKERS Under section 133 of the Factories Act 1961, the occupier of every factory and every contractor employed by him must keep lists showing the names and addresses of all outworkers directly employed by him and of the places where they are employed. He must send to the 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 Council by notice in writing to the occupier or any contractor employed by him to prohibit the employment of any persons as home workers in premises which the Council regard as injurious or dangerous to health. The Home Work Order, 1911, specified the kinds of work to which these two sections apply. The types of work consist mainly of wearing apparel and textiles, the making of paper bags, boxes, brushes, baskets, artificial flowers, metal fittings, etc. The following is a list of such occupations:— Table 45 Trade Outworkers employed Clothing 118 Boxmaking 6 Millinery 9 Rosettes 3 Lace 5 Buttons 3 Jewels 5 Wigs 1 Leatherwork 6 156 The inspectors made 121 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 Of the items requiring attention, the most frequently recurring were the following:— Table 46 Abstract of the Act not displayed 171 Absence of a thermometer 103 Absence of a first-aid box 114 Absence of a hot water supply 74 Other matters to which it was necessary to draw attention were: Table 47 Insufficient heating 19 Insufficient lighting 23 Condition of floors and staircases 10 Insufficient washing facilities 34 Facilities for drying clothes 6 Insufficient ventilation 12 Insufficient sanitary accommodation 19 Absence of drinking water 11 Lack of seating facilities 3 Poor standard of cleanliness 2 Overcrowding 1 Deficient sanitary accommodation 16 Deficient washing accommodation 4 66 Re-inspections are made and, where these matters had not been put right, action was taken to enforce compliance. The measuring of offices is taking place and will be continued during 1968, in order that the overcrowding provisions can be fully implemented. Details of registration of premises and persons employed are shown in tables 48 and 49. Of 86 accidents reported during the year, 39 were specially investigated; most of these accidents were of a minor character. In several instances occupiers were asked to carry out alterations or repairs to prevent further accidents. The conditions in shop and office premises are undoubtedly improving as a result of this Act, and it is hoped that this trend will continue in the future. Table 48 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 13 558 216 Retail shops 18 1,654 644 Wholesale shops, warehouses — 93 22 Catering establishments open to the public, canteens 18 229 229 Fuel storage depots — 11 1 TOTALS 49 2,545 1,112 Table 49 PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE Class of work place Number of persons employed (1) (2) Offices 4,990 Retail Shops 9,284 Wholesale departments, warehouses 1,188 Catering establishments open to the public 1,461 Canteens 169 Fuel storage depots 63 Total 17,155 Total Males 7,412 Total Females 9,743 Table 50 EXEMPTIONS Class of premises No. of exemptions current at 31st Dec. No. of exemptions granted or extended during the year No. of exemptions withdrawn during year No. of cases where employees opposed application Appeals to Court against refused to grant or extend an exemption or the drawal of an exemption No. made No. allowed Sanitary conveniences (Sec. 9) Retail Shops Nil — 1 — -— — 67 NATIONAL ASSISTANCE ACT, 1948—SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951 No cases were removed to hospital or Part III accommodation by means of Orders granted under the above Acts. Several possible cases were kept under observation, and were subsequently admitted to hospital on medical grounds. DISINFECTION AND PERSONAL CLEANSING Details of the work carried out during the year are as follows: Table 51 Rooms disinfected or disinfested 965 Articles disinfected or disinfested 32,080 Verminous children cleansed 512 Verminous adults cleansed (Carrington House 374) 439 Treatment for scabies, children 517 Treatment for scabies, adults 360 Articles cleansed 128,249 Domiciliary bathing 10,910 WASPS, HORNETS AND THE LIKE Under the provisions of section 6 of the Local Government (Financial Provisions), Act 1963, the Council decided to introduce a service to assist residents to eradicate wasps, hornets and the like. It was decided to charge £1 for the services of the Council's staff and material in each case. During the year, fifty-three wasps nests were dealt with on this basis. Several nests were destroyed free where the occupier was unable to pay the charge. In a few cases it was not possible to deal with the nests because of their inaccessibility. ANTI-FLY CAMPAIGN During the period June to September, the usual measures were taken to deal with 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. The treatment of dustbins with powder supplied by the health department was carried out by the Borough Engineer & Surveyor's staff. The caretakers of blocks of flats were supplied with material to enable them to deal with refuse chutes and chambers. PREVENTION OF DAMAGE BY PESTS ACT, 1949 The following table shows rat and mice destruction carried out by pest operatives during 1967. No special comment is called for except to say that this is a continuing problem. Table 52 Local authority Type of Property Total Agricultural Dwelling houses (including council houses) All other (including business premises) Properties inspected as a result of (a) notification 19 2,740 240 2,999 — (b) survey 2 127 21 150 — (c) otherwise — — — — — Total inspections 21 2,867 261 3,149 — Properties inspected which were found to be infested by:— (a) Rats—major — — — — — (b) —minor 13 1,048 90 1,151 — (c) Mice—major — — — — — (d) —minor 3 586 63 652 — Infested properties treated 16 1,634 153 1,803 — Retreatments 44 2,709 365 3,118 — "Block" control schemes carried out 3, involving 48 premises 68 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 53 Bath Number of tests Variation of chlorine (p.p.m.) Ladywell 9 0.10—1-20 Forest Hill North 9 0. 00—0.74 Forest Hill South 9 0.01—1.00 Laurie Grove Large 5 0.01—1.35 Laurie Grove Small 9 0.00-1.80 Laurie Grove South 8 0. 03—1. 00 Downham 4 0.07—0.90 Bellingham (open air) 3 0.02—0.35 The water used for these baths is supplied by the Metropolitan Water Board and is sterilised by the breakpoint chlorination method, sodium carbonate and sodium metephosphate being used to control acidity and to keep the pH above 7.2. Colorimetric tests for free chlorine and pH value are also made at the baths at 9 a.m., 1 p.m., and 6 p.m. on weekdays and at 9 a.m. and 12 noon on Sundays, the results being recorded on log sheets kept for the purpose. The aim is to achieve a circulation of water every four hours, although it is rather more prolonged at the open-air baths. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 The Rag Flock and Other Filling Materials Act is designed to secure the use of clean filling materials in upholstered articles and other articles which are stuffed or lined. Six premises are registered for the use of filling materials for upholstery purposes, one of these being also registered for storage. Samples of these materials proved satisfactory on examination. DESTRUCTION OF PIGEONS This has continued during 1967, and railway bridges and several churches were visited regularly by the pigeon catchers. Some 2,500 birds as well as nests and eggs were destroyed. Although this number is not as great as in in the previous year, more complaints were investigated showing that the birds were more scattered around the Borough. Destruction was carried out principally by shooting and this makes the treatment of some buildings difficult owing to the large area of glass used in construction. One treatment by a narcotic was tried but the result was not very satisfactory for various reasons. Some trapping was also tried during the year and it is hoped to extend this method. The feeding of the birds by the public is a problem and some of the larger infestations are due to this fact. Damage to crops occurred during the year due to wood pigeons and some help was given to allotment holders in dealing with the nuisance. PET ANIMALS ACT, 1951 During the year 15 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. 69 ATMOSPHERIC POLLUTION Clean Air Act During 1967 two more areas were made the subject of Smoke Control Orders and particulars with regard to the areas are as follows: Name No. 22 (Deptford Park No. 23 (Brook mill) Acreage 234 93 No. of industrial premises 42 4 No. of commercial premises 54 91 No. of dwellings 1,158 1,083 No. of other premises 4 80 Total estimated cost of works £20,280 £35,500 Date: Order made 13.7.66 30.11.66 Order confirmed 2.11.66 20.2.67 Order operative 1.10.67 1.10.67 PROGRAMME At the end of December 1967, the position in relation to areas which have been or still are the subject of smoke control action was as follows: Table 54 Area No. and name No. of dwellings Date of operation Area No. and Name No. of dwellings Date of operation 1 Ladywell 1,409 1.9.59 Deptford 2 Southend 2,827 1,11.59 1 1,004 1.10.60 3 Brookdale 1,155 1.9.60 2 3,955 1.10.61 4 Penerley 3,367 1.10.60 3 2,914 1.10.62 5 Glenbow 2,059 1.9.60 4 2,138 1.10.63 6 Lewisham Park 3,716 1.8.61 4a 192 1.10.63 7 Sandhurst 2,187 1.8.61 5 1,680 1.10.64 8 Hazelbank 3,123 1.7.62 5a 63 1.10.64 9 Northover 3,226 1.9.62 6 1,437 1.12.65 10 Blythe Hill 2,586 1.10.62 11 Algernon 1,981 1.11.62 12 Brockley 4,402 1.7.63 13 Manor 6,932 1.10.63 14 Vancouver 2,731 1.6.64 15 Baring 5,232 1.7.64 16 Honor Oak 2,281 1.8.64 17 Blackheath 3,042 1.9.64 18 Sunderland 2,020 1.9.65 19 Sydenham 4,034 1.10.65 20 Mayow 2,000 1.11.65 21 Bellingham 3,208 1.11.66 22 Deptford Park 1,158 1.10.67 23 Brookmill 1.083 1.10.67 24 Bell Green 4,208 1.7.68 70 71 Table 55 ATMOSPHERIC CONDITIONS IN 1967 January February March April May June July August September October November December Average or actual Temperature—1 Mean C 5.3 6.6 8.2 8.6 11.9 15.5 18.9 17.3 14.9 12.1 6.5 5.0 10.9 Rainfall Total 2 in. 1.20 1 .28 1.18 2.22 3.50 2.33 1 .35 3.03 1.85 3 .19 1.67 2.06 24.86 Per cent. of average 1 56 133 97 104 213 120 90 72 114 158 56 104 110 Sunshine—1 Daily mean hrs. 2.06 3.08 5.49 4.81 6.16 7.13 7.90 6.04 4.02 3.13 2.27 1 .81 4.49 Per cent. of average 138 136 151 90 96 100 124 99 85 99 128 141 Wind—1 NE/E/SE % 12 30 3 49 18 18 13 22 17 6 25 3 19 s/sw/w % 73 55 78 23 71 50 70 65 53 86 57 59 61 NW/N/Calm % 15 15 19 28 11 32 17 13 30 8 18 38 20 Atmospheric pollution— Pool allotments Water insol. matter tpm 5.71 7.85 11.14 26.31 14.73 20.07 13.16 10.60 9.09 9.53 5.64 11.78 12.13 Water sol. matter tpm 2.18 3.29 3.19 3. 89 5.07 9.87 4.06 3.76 3.56 2.99 4.87 2.62 4.11 Sulphur + 1 .65 1.67 1.15 1.16 0.31 0.36 0.54 0.40 0.46 0.88 1.33 1.65 0.96 Lewisham Town Hall— Smoke, daily average * 107 56 63 51 52 41 55 48 62 55 189 131 76 Sulphur, daily average * 223 148 119 198 150 146 114 88 111 92 254 304 162 Valentine Court— Smoke, daily average * 74 81 33 33 22 11 14 14 22 17 136 74 45 Sulphur, daily average * 192 123 124 199 109 118 82 75 86 88 299 276 148 Deptford Town Hall— Smoke, dailv average ♦ 115 102 50 67 38 48 34 32 48 31 169 133 72 Sulphur, daily average * 258 201 50 225 161 157 108 100 92 100 262 356 181 Creekside— Smoke, daily average * 152 121 61 64 60 41 35 62 47 50 169 47 76 Sulphur, daily average ♦ 320 215 160 257 210 188 152 106 110 105 296 357 206 Weather Summary— Cold first mild later Dry at first unsettled and stormy later mild Cool, Dull and dry Exceptionally wet warm mainly fine unsettled unsettled Very wet stormy Sunny and cold Sunny Notes— 1Kew; 1 Lewisham; tpm: Tons per square mile per month; + as trioxide in MG per 100 sq. cms. per day; * microgrammes per cubic metre HOUSING ACTS, 1957—1964 (a) Clearance Areas These are groups of houses found unfit for human habitation and that the most satisfactory method of dealing with them is by demolition. In most cases the Council seeks to acquire the sites for redevelopment. This procedure is followed by the Greater London Council and Lewisham, a programme for the years 1965/70 having been agreed. Additional areas do come to light and when these are identified they are added to the programme. Table 56 Number of areas declared during 1967 5 Number of dwelling houses 218 Number of persons in occupation 570 Number of dwelling houses demolished during the year Coloured pink—unfit houses 198 Coloured grey—added houses 20 (b) Repair Apart from houses repaired as a result of action under the Public Health Acts 1936 and 1961, some properties are found to be unfit mainly due to extensive disrepair which could be remedied at reasonable expense. In these cases notices are served under the Housing Act 1957. Where the owner fails to comply, the Council is empowered to carry out the work in default. As a result of action taken six houses were made fit during the year after formal notices:— (a) by owners 4 (b) by the Council 2 (c) Closure or Demolition Individual dwellings or parts found to be unfit for human habitation and not capable of being made fit at reasonable expense can be dealt with by a Closing or Demolition Order. The owners are notified of the Council's intention and have an opportunity of making an offer of works to avoid the Order being made. Some details of this procedure durine 1967 are as follows:— Table 57 DEMOLITION AND CLOSING ORDERS Demolition Orders made 1 Persons displaced 4 Closing Orders made 6 Persons displaced 25 Closing Orders determined 2 Closing Orders revoked and Demolition Orders made 4 Houses demolished 8 Persons displaced 16 Parts of buildings closed 9 Persons displaced 23 HOUSES IN MULTIPLE OCCUPATION Under the 1961 Act these houses can be improved by the provision of additional amenities (sinks, hot water, baths, water closets, etc.) by improving the management, by reducing the number of occupants and by one of the most important items, means of escape in the case of fire. A great deal of work has been achieved in this type of property by informal approach to the owners. Unfortunately this type of occupation may occur in houses on mortgage to the Council and in these cases action has been possible with the co-operation of other Council departments. 72 Table 58 Houses where Management Orders were made 2 Houses where neglect of proper standards of management were made good By owners after informal action 15 By owners after formal action 6 By the Council in default 1 Houses in which additional services or facilities were provided By owners after informal action 23 By owners after formal action 15 By the Council in default Nil Houses provided with means of escape from fire By owners after informal action 27 By owners after formal action 33 By the Council in default 8 Houses where Directions were made to reduce or prevent overcrowding 21 Housing Act, 1964—Control Orders Houses in multiple occupation where, in spite of action under the Housing Act 1961. conditions have not improved may be taken over and managed by the Council and works of improvement carried out. During 1967 this action was taken in one case. Housing Acts, 1957—1964 (a) Improvement of Houses Grants are available to improve existing houses by providing running hot water, bathroom, internal water closets, etc. Under the Housing Act 1964, it is possible for tenants to ask the local authority to require the owner to provide these facilities. Under the same Act it is also possible to declare Improvement Areas. In these areas, owners are required to bring their properties up to a reasonable standard. Considerable publicity has been given during the year to these grants and it is hoped to extend this type of work during the coming years. Details of work carried out under this heading are as follows:— Dwellings where discretionary grants were made 38 Dwellings where standard grants were made 185 (b) Compulsory Improvement of Dwellings (Housing Act 1964) Improvement Areas declared to end of 1967 2 Dwellings improved in such areas as a result of formal action during 1967 11 Total to end of 1967 21 Dwellings, outside improvement areas, improved as a result of action following representation by tenants during 1967 5 Total to end of 1967 8 RENT ACT, 1957 The following table shows the applications for certificates of disrepair dealt with during the vear 1967. Table 59 Applications for certificates 6 Decisions not to issue certificates — Decisions to issue certificates 5 Undertakings given by landlords to repair 1 Undertakings refused for special reasons — Certificates of disrepair issued 6 Applications by landlords for cancellation of certificates 8 Objections by tenants to cancellation 6 Certificates cancelled 3 73 MILK The Milk and Dairies (General) Regulations, 1959 At the end of the year there were 208 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: Table 60 for sale of untreated milk 100 „ sale of pasteurised milk 179 „ sale of sterilised milk 164 „ sale of ultra heat treated milk 102 Examination of heat-treated milk 65 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 61 Type of milk Number of samples tested Pasteurised 64 Tuberculin tested (pasteurised) — Sterilised — Ultra heat-treated 1 65 Analysis of milk During the year under review 97 samples of milk were submitted to the public analyst by the Council's inspectors and all found to be genuine. The average composition of the samples were: milk fat 3.9%; solids not fat 8.7%; total solids 12.6%. The legal standard is 3.0% milk fat and 8.5% solids not fat (total solids 11.5%). ICECREAM Food Standards (Icecream) Regulations, 1959 Labelling of food (Amendment) Regulations, 1959 The composition of 45 icecream samples submitted to the public analyst during the year showed an average composition of 10.4% 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. 74 During the year 24 samples of icecream were submitted for bacteriological examination with the following results: Table 62 Samples % Grade 1 18 75 Grade II 2 8 Grade III 3 13 Grade IV 1 4 TOTAL 24 100 In general, grades I and II are satisfactory, while grades III and IV may indicate some defect in manufacture, handling or storage. Such cases are followed up and advice given. FOOD GENERALLY Adulteration The number of samples taken during the year under the Food and Drugs Act was 913, all informal. After examination the public analyst reported that 56 of the samples were adulterated, below standard or insufficiently described by label. This accounts for 6.1 per cent. of all samples submitted. Table 63 Samples Analysed Articles Examined Adulterated Formal Informal Formal Informal Bread, biscuits, cakes — 32 — 9 Colouring matter — 8 — 1 Cheese — 49 — 7 Drugs — 18 — — Fats — 12 — 1 Fish — 23 — — Flour — 14 — 1 Flavouring and condiments — 153 — 6 Fruit and nuts — 55 - — 1 Icecream — 38 — — Jam and pastes — 18 — 2 Meats — 110 — 6 Milk and cream — 143 — 3 Soft drinks and beverages — 85 — 4 Sweet confectionery — 40 - 7 Vegetables cereals — 23 — — Wines — 1 — — Miscellaneous — 81 — 8 TOTALS — 913 — 56 75 Table 64 Non-genuine samples Article Formal or informal Adulteration or irregularity Action taken Supreme cream cheese Informal Contained insufficient milk fat Manufacturers warned Boursin with herbs— "Double cream cheese" Informal Contained insufficient milk fat Stock withdrawn and re-labelled to conform with Cheese Regulations Boursin with peppercorns— "Double cream cheese" Informal ,, Vlaadam cheese Informal Consisted of a full fat hard chccsc ,, Raucherschinken Informal Consisted of a chccsc with bacon compound ,, Boursin Informal Consisted of a full fat soft cheese ,, Soft ripened cheese Informal ,, ,, Cheese spread Informal Consisted of a cheese with caraway compound ,, Butterkasc Informal Consisted of a full fat soft cheese ,, Brie Informal ,, ,, Soft ripened cheese Informal ,, ,, Cheese preparation Informal Consisted of a cheesc with ham compound ,, Fynbo cheese Informal Consisted of a medium fat hard cheese ,, Cheese, Port Salut Safr Informal Consisted of a full fat soft cheese ,, Austrian smoked cheese Informal Consisted of medium fat hard cheese ,, Cheese with bacon Informal Consisted of a medium fat processed cheese with bacon ,, Cheese Informal Consisted of cheese spread ,, Baby Patre cheese Informal Consisted of a full fat soft cheese ,, Butter cheese spread Informal Consisted of a cheese spread containing only the normal proportion of butter fat ,, Grated Parmesan cheese Informal Incorrect labelling ,, White Stilton cheese Informal Contained excessive water No further action Colours for eggs Informal Contained unauthorised colouring matter Imported goods. Importer contacted 76 Table 64—continued Article Formal or informal Adulteration or irregularity Action taken Assorted fruits flavoured lollipops Informal Contained unauthorised artificial colouring matter Imported goods. Reexported ,, Informal ,, ,, Anchovy paste with butter Informal Contained non - permitted sorbic acid preservative Imported goods. Importer contacted Aspic jelly powder Informal Contained sulphur dioxide which was not disclosed on the label No further action Minced beef Informal Contained preservative Subsequent sample satisfactory. No further action Prepared Dijon mustard with white wine Informal Contained sulphur dioxide which was not disclosed on the label Imported goods. Importer notified Chutney Informal Inadequately labelled Home made goods. No further stock Low calorie salad dressing Informal Did not contain any oil Stock withdrawn. Container relabelled to comply with Salad Cream regulations Oyster flavoured sauce Informal Contained non - permitted benzoic acid Formal sample being taken Fish gravy Informal Incorrect labelling Formal sample being taken Cheese sauce mix Informal Contained undisclosed colouring matter Imported goods. Investigations continuing Preserved beef sausages Informal Contained insufficient meat Formal sample being taken Italian Cheddar cheese Informal Contained insufficient milk fat in the dry matter Found to be Parmesan — arrangements made for labelling or importation Beef Chow Mein, canned Informal Contained insufficient meat No action Chicken Chow Mein, canned Informal Contained insufficient chicken meat No action Sugar confectionery, Mirabelle bonbons Informal Contained a non-permitted colouring matter Re-exported Curry powder Informal Contained excessive lead Formal sample to be taken Lime juice cordial Informal Contained insufficient lime juice Still under investigation Fines Herbes Informal Incorrect labelling Label to be amended Ballottine aux Olives, canned Informal Incorrect labelling Re-exported 77 Table 64—continued Article Formal or informal Adulteration or irregularity Action taken Preserved beef sausages Informal Contained insufficient meat Further sample to be taken Chilli powder Informal Incorrectly labelled Label to be amended Drinking chocolate Informal Contained particles of hard white fat not mentioned on the label Investigation proceeding Channel Islands milk Informal Contained insufficient milk fat No further action Cake decorations—green dragees . Informal Contained non - permitted colouring matter Stock withdrawn and destroyed Cheese Informal Incorrectly labelled Importers notified Cheese Informal ,, ,, Medium fat soft cheese Informal Contained insufficient milk fat ,, Blackcurrant Health Drink Informal Incorrectly labelled No action Soft drinks powders: cocktail drinks Informal Contained non - permitted colouring matter Investigation proceeding Morello cherries, canned Informal Incorrect labelling Importers notified— to be re-labelled Game pate Informal Contained excessive lead Investigation proceeding Peanut butter Informal Contained Aflatoxin, the toxicity category being low Letter to manufacturers Sea salt Informal Incorrectly labelled In contact with importers Preserved pork sausages Informal Contained insufficient meat No action Ground cummin seed Informal Contained excessive sand and mineral matter No action OTHER SAMPLES In addition to those submitted to the public analyst or bacteriologist for routine examination, the following were submitted because of complaints received or as a result of enquiries made into cases of food poisoning:— Biscuit (1) Milk bottle (1) Bread (8) Luncheon meat roll (1) Crumpet (1) Fruit from trifle (1) Beef sausage (1) Butter (1) Lemonade (1) 78 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 65 Type of premises Number of premises Number provided with wash-hand basins Number with facilities for washing food and equipmentI Grocers and multiple grocers 223 223 223 Greengrocers 152 132 not applicable Bakers 98 98 98 Butchers 150 150 150 Confectioners 315 309 not applicable Cafes and restaurants 141 141 141 Fish shops 37 37 37 Fried fish shops 44 44 44 Public houses 166 166 166 Off licences 90 88 not applicable THE FOOD HYGIENE( MARKETS, STALLS AND DELIVERY VEHICLES) REGULATIONS, 1966 These regulations which came into force on the 1st January, 1967, are designed to improve the hygiene on stalls selling food and in vehicles used for the delivery of food. Several meetings were held with representatives of the stall holders in Douglas Way and Lewisham High Street and some improvement has been noted. Shellfish stalls on the forecourts of some of the public houses have been visited during the weekends and advice given on the risks of contamination. The following details indicate the extent of this work in the Borough Table 66 Licensed stallholders selling food 84 Unlicensed stalls on private forecourts or elsewhere 11 Shellfish stalls on private forecourts 11 Mobile grocery shops 20 Mobile toffee apple van 1 PHARMACY AND POISONS The names of 12 persons were entered on the Council's list of persons entitled to sell poisons in Part II of the poisons list and the names of 152 persons previously registered were retained on the register. 164 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. A licence was issued during the year to a journeyman slaughterer who lives in the Borough. OFFENSIVE TRADES There are no offensive trades carried on in the Borough. 79 LEGAL PROCEEDINGS During the year there were 70 cases of legal proceedings for infringement of various Acts as follows:— Table 67 Number of cases Fines Costs £ s. d. £ s. d. Food and Drugs Act, 1955 .. 57 573 0 0 164 10 0 Public Health Act, 1936 13 15 0 0 47 2 0 Total 70 588 0 0 211 12 0 REGISTRATION OF FOOD PREMISES New registrations in 1967 and the total including previous years are shown in the table below. Table 68 Type 1967 Total Sale and storage of icecream 20 506 Manufacture of icecream 2 12 Fish frying 1 35 Fish curing — 33 Preparation or manufacture of sausages — 115 Preparation or manufacture of potted, pressed, pickled or preserved food 5 193 UNSOUND FOOD Approximately 94 tons of food were surrendered as unfit for human consumption and dealt with by the Council's food inspectors. This included meat, fruit-pulp, fish, vegetables, etc. Some of the spoiling was caused by refrigerator breakdowns. 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, not used for human consumption or re-exported. 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. Totals for the year are shown in the table:— Table 69 Country of origin Tonnage imported Spain 63,926 Italy 48,509 France 45,671 Yugoslavia 993 Algeria 2,051 Belgium 567 Switzerland 82 Israel 21 America 15 Ethiopia 4 Total 161,839 80 WATER SUPPLY I am indebted to Dr. E. Windle Taylor, Director of Water Examination for the Metropolitan Water Board, for the following report on the condition and supply of water to the Borough during 1967: The supply of water was satisfactory both as regards to quality and quantity throughout the year. All new and repaired mains are disinfected with chlorine, after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains. These are returned to service only after results arc found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or other abnormality is immediately investigated. The Board has no record of the number of structurally separate dwellings supplied in the area, but the population supplied direct according to the Registrar-General's estimates of 30th June, 1967, was 289,700. No houses were permanently supplied by stand-pipe. No fluoride was added, and where fluoride is indicated in the analyses it represents that naturally occurring in the water. The supply is derived from the following works and pumping stations:— River Thames via Hampton, Kempton Park, Surbiton and Walton. Wells: Deptford, Wilmington, Darenth and Bexley. No new sources of supply were instituted and there were no changes to the general scheme of supply in the area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown in the following tables. The Board's river and well sources have not been considered to have a plumbosolvent action, on account of their hardness content and alkaline reaction. It should however, be appreciated that all types of water pick up varying amounts of metal from piping, particularly when it is newly installed; this applies to copper, zinc, iron and also lead. Tests for lead have been carried out in samples of running water collected from premises in the distribution system and I set out below the information obtained over the period 1st January to 31st December, 1967:— Table 70 Lead Content (mg/1.Pb) Water from Main Taps in Consumers' Premises Number of Samples per cent Less than 0.01 64 66.7 0.01 22 22.9 0.02 3 3.1 0.03 4 4.2 0.04 2 2.1 0.05 0 - 0.06 1 1.0 Total 96 100.0 The above figures apply to the whole of the Board's area but it should be pointed out that the general characteristics of the water are similar throughout the area so that findings are applicable to individual Boroughs. The regular system of examination for lead in water in domestic premises will continue during 1968. 81 Table 71 Average results of the chemical examination of the water supplied to the Borough of Lewisham 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. B.O.D. 5 days at 20° C. Hardness (total) CaCO3 Hardness (noncarbonate) CaCO3 Magnesium as Mg Sodium as Na Potassium as K Chloride as CI Phosphate as PO4 Silicate as SiO2 Sulphate as SO4 Natural Fluoride as F Surface-active material as Manoxol OT CO2 Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micromhos) All Thames-derived 363 0.024 0.089 4.1 1.12 — 282 73 5 22.5 5.1 30 1.9 10 64 0.30 0.01 0.1 12 7.9 590 Deptford 4 0.013 0.053 6.7 0.08 — 373 131 8 26 5.5 42 104 0.30 39 0.0 1 7.1 740 Wilmington 4 0.008 0.037 7.3 0.15 — 286 54 3 16.0 2.5 26 26 0.20 33 0.2 1 7.3 590 Darenth 4 0.009 0.033 4.7 0.10 — 270 46 2 11.0 1.9 18 24 0.15 24 0.0 0 7.3 510 Bexley 5 0.006 0.030 5.4 0.10 — 331 89 4 14.0 2.4 20 56 0.20 34 0.0 1 7.2 600 82 Table 72 Bacteriological Results—Yearly Averages, 1967 of water supplied to the Borough of Lewisham BEFORE TREATMENT AFTER TREATMENT Agar plate count per ml. Coliform count Escherichia coli count Agar plate count per. ml. Coliform count E. coli count Source of supply Number of samples 20-24 hours at 37°C 3 days at 22°C. Percent. samples negative in 100 ml. Count per 100 ml. Per cent. samples negative in 100 ml. Count per 100 ml. Number of samples 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Percent. samples negative in 100 ml. All Thames-derived - - - - - - - 3,578 12.2 — 99.75 99.97 Deptford 250 0.3 32 97.60 0.2 98.80 — 254 1.6 143 99.61 100.0 Wilmington 250 1.5 4 98.80 — 100.0 — 255 0.2 4 99.61 100.0 Darenth 247 0.0 7 99.19 — 99.60 — 253 0.2 1 100.0 100.0 Bexley 249 0.1 4 96.39 0.3 97.59 0.2 265 0.0 39 100.0 100.0 83 MORTUARIES, CREMATIONS, BURIALS AND EXHUMATIONS Mortuaries The two public mortuaries situated in the Borough serve other areas as well as Lewisham. The number of bodies received during the year is shown below:— Table 73 Lewisham Mortuary Deptford Mortuary Total Bodies received from hospitals etc. 660 431 1,091 Others 466 229 695 Totals 1,126 660 1,786 Cremations and Burials The following statistics relating to cremations and burials are for the year 1st April, 1967 to 31st March, 1968. Table 74 Cemetery No. of burials Hither Green 1,028 Grove Park 285 Ladywell 81 Brockley 95 Total 1,489 There were 1,504 cremations carried out at Hither Green Crematorium after certification by the Medical Officer of Health or deputy as Crematorium Referee. Four exhumations took place at the Council's cemeteries following the necessary Home Office Orders which specify the presence of a representative from the Health Department. 84 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 radiogaphy 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. The following table, based on returns made to the Ministry of Health, shows the number notified to the department during 1967, 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. Table 75 Country Number of Immigrants Number of first successful visits (a) Commonwealth Countries Caribbean 305 201 India 27 10 Pakistan 11 6 Other Asian 53 25 Africa 26 8 Other 24 11 (b) Non-Commonwealth Countries European 3 0 Other 5 2 TOTALS 454 263 85 INDEX Page Adoption and Boarding Out 25 Anaesthesia 27 Animal Boarding 69 Anthrax 55 Anti-fly campaign 68 Area of Borough 11 Atmospheric Pollution 70 Births and Birthrate 11 Blind and Partially sighted persons 25 Borough, description of 8 Burials 84 Cervical Cytology 22 Chest Clinics 57 Child Minders 22 Chiropody Service 47 Clean Air 70 Cleansing. Personal 68 Clearance Areas 72 Closure or demolition of unfit houses 72 Congenital malformations 23 Continental Goods Depot 80 Co-ordinating Committee 43 Creches 23 Cremations 84 Day Nurseries 22 Day Nurseries, private 22 Deaf Register 35 Deaths and Deathrate 11 Deaths by Cancer 13 Deaths by cause and age 12 Delivery Vehicles 79 Demolition and Closing Orders 72 Demolition or Closure of unfit houses 72 Dental Auxiliaries, School for 27 Dental Caravan 28 Dental Caries Survey 28 Dental Health Education 28 Dental Service, Maternal and Child Health 28 Dental Service, Schools 30 Dental Services 27 Dental Services, Accommodation 27 Deptford Chest Clinic 57 Deptford Schools Treatment Centre 33 Disinfection and Personal Cleansing 68 District Nursing 19 District Nursing, equipment 20 District Nursing, liaison scheme with general practitioners 20 District Nursing, liaison with the Hospital Service 20 District Nursing, patient care 20 District Nursing, special liaison schemes 20 District Nursing, staff recruitment and training 19 Downham School Treatment Centre 38 Dysentery 54 Early Care Unit 49 Early Neo-Natal deaths 11 Environmental Health 62 Exhumation 84 Page Factories 64 Family Casework 43 Flies 68 Food 75 Food Hygiene (General) Regulations, 1960 79 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 79 Food Poisoning 54 Food Premises, registration 80 General Provision of Health Services 8 General Statistics from 1950 15 Handicapped Pupils Register 34 Health Centres 16 Health Education 45 Health Education in Schools 45 Health Visiting, school nursing 21 Health Visitor, students 21 Health Visitors, visits to homes 21 Heart Disease 13 Home Help Service 44 Honor Lea Hostel 50 Houses in Multiple Occupation 72 Housing 72 Icecream 74 Immigrants 85 Immunisation and Vaccination 61 Improvement Work 72 Infant Mortality 11 Infectious Diseases 52 Laboratory Facilities 61 Legal Proceedings 80 Lewisham Chest Clinic 57 Loan Service 26 Local Sickness 14 Lung Cancer 13 Markets, Stalls and Delivery Vehicles 79 Mass Radiography Unit 58 Maternal Deaths 11, 18 Measles 54 Mental Health 49 Mental Health, annual seaside holiday 49 Mental Health, early care unit 49 Mental Health, long term care 50 Mental Health, short term care 49 Mental Health, special advisory clinics 49 Mental Health, training centres 49 Mental Subnormality Liaison Committee 50 Mice 68 Midwifery, Liaison between midwives and general practitioners 18 Midwifery, patient care 18 Midwifery Service 17 Midwifery, special liaison with Lewisham Hospital 18 Midwifery Staff 17 Midwifery training 17 Midwifery with hospital services 18 Milk 74 86 INDEX—continued Page Morbidity shown in insurance certificates 14 Mortuaries 84 Mothers clubs 21 National Assistance Act, section 47 68 Neo-natal deaths 11 Offices, Shops & Railway Premises 66 Orthondontics 27 Outworkers 66 Parentcraft Classes 21 Perinatal Mortality 11 Pet Animals 69 Pharmacy & Poisons 79 Pigeons 69 Population 11 Prevention of Damage by Pests 68 Private Day Nurseries 22 Prophylaxis 61 Psychiatric advice 50 Public Health Inspectors, repairs carried out 64 Public Health Inspectors, summary of inspections 63 Public Health Inspectors, summary of notices served 63 Rag, flock and other filling materials 69 Rateable Value 11 Rats and Mice 68 Recuperative Holidays 25 Rent Act 73 Repair of unfit houses 73 Reproductive Wastage 11 Riding Establishments 69 Page Samples 75 Scarlet Fever 54 School Dental Service 30 School for Dental Auxiliaries 27, 32 School Health 33 School Medical Inspections 35 Schoolchildren, Personal Hygiene 37 Schools, Social Work 42 Sickness, Local 14 Slaughterhouses and Slaughterers 79 Smoke Control 70 Social Work, accommodation 42 Social Work, chest clinics 43 Social Work, schools and general 42 Social Work, staff 42 Social Work, training 43 Social Work, V.D. clinics 43 Social Workers 42 Stalls 79 Stillbirths 11 Surveys 21 Swimming Baths 69 Tetanus 55 Tuberculosis 56 Vision, School Medical Inspections 39 Vital Statistics 11 Wasps, Hornets and the Like 68 Water Supply 81 Whooping Cough 54 87 TABLES No. Subject Page 1. Causes of death by age groups 12 2. Heart and circulation mortality 13 3. Cancer deaths 13 4. Morbidity shown in insurance certificates 14 5. General statistics from 1950 15 6. Health Visiting 21 7. Cervical cytology 22 8. Day Nurseries, admissions and discharges 23 9. Congenital malformations 24 10. Congenital malformations by parity 24 11. Congenital malformations according to maternal age 25 12. Recuperative holidays 25 13. District Nursing loan equipment 26 14. Orthodontics 27 15. Dental Service, maternal and child health 30 16. Dental inspection of schoolchildren 30 17. Dental work. School for Dental Auxiliaries 32 18. Observation/Handicap, register schoolchildren by type of school 34 19. Observation/Handicap register, schoolchildren by year of birth 34 20. Deaf register, schoolchildren 35 21. Routine inspections of schoolchildren 35 22. Routine inspections of schoolchildren—defects 36 23. Personal hygiene of schoolchildren 37 24. Non routine medical inspection of schoolchildren 38 25. Routine inspections of schoolchildren—vision 39 26. Comparison of Defects noted "Special" medical inspections of schoolchildren 40 27. Home Help Service 44 28. Health Education, film shows, talks, etc 47 29. Summary of attendances—Chiropody 48 30. Clinic Analysis totals—Chiropody 48 31. Notified cases of infectious diseases 52 32. Notification of infectious diseases by sex and age 53 33. Food poisoning cases 54 34. Tuberculosis, notifications and deaths 57 35. Mass Radiography 58 36. Mass Radiography, non-tuberculous abnormalities 59 37. Mass Radiography, surveys 60 38. Immunisation and Vaccination 61 39. Laboratory facilities 61 40. Sanitary inspections 63 41. Summary of notices 63 42. Repairs carried out 64 43. Factory inspections 65 44. Factory defects 65 45. Outworkers 66 46. O.S.R. Items requiring most frequent attention 66 47. O.S.R. Other matters requiring attention 66 48. O.S.R. Registrations and inspections 67 49. O.S.R. Persons employed 67 50. O.S.R. Exemptions 67 51. Disinfection and Personal Cleansing 68 52. Rodent control 68 53. Swimming baths 69 54. Clean Air Act programme 70 55. Atmospheric conditions 71 56. Clearance areas 72 57. Demolition and Closing Orders 72 58. Houses in multiple occupation 73 59. Rent Act, 1957 73 60. Milk (Special Designations) Licences 74 61. Examination of heat-treated milk 74 62. Grading of icecream 75 63. Samples analysed 75 64. Non-genuine samples 76 88 No. Subject Page 65. Food Premises, washing facilities 79. 66. Inspections of markets, stalls and delivery vehicles 79 67. Legal proceedings 80 68. Registration of food premises 80 69. Continental Goods Depot, tonnage imported 80 70. Lead content of water 81 71. Water, chemical analysis 82 72. Water, bacteriological samples 83 73. Bodies received in mortuaries 84 74. Burials 84 75. Immigrants 85 89