BOROUGH OF LEWISHAM ANNUAL REPORT 1968 Medical Officer of Health CONTENTS Page Introduction 3 Health Committee 5 Health Staff 6 The Borough 9 General Provision of Health Services in Area 9 Vital Statistics 12 HEALTH CENTRES 17 MATERNAL AND CHILD HEALTH 18 Midwifery 18 District Nursing 20 Health Visiting 22 Cervical Cytology 23 Day Nurseries and Child Minders 24 Congenital Malformations 25 Family Planning 27 LOAN SERVICE 29 DENTAL SERVICES 30 School for Dental Auxiliaries 30 Maternal and Child Health 31 Dental Health Education 32 School Dental Services 34 SCHOOL HEALTH SERVICE 35 Handicapped Pupils Register 35 Deaf Register 36 School Medical Inspection 37 MEDICAL AND FAMILY SOCIAL WORK 43 HOME HELP SERVICE 45 HEALTH EDUCATION 46 CHIROPODY SERVICE 48 MENTAL HEALTH 50 Emergency Work 50 Guardianship 50 Early Care Unit 51 Training Centres 51 Mental Subnormality Liaison Committee 52 Honor Lea Hostel 52 Day Centres 52 INFECTIOUS DISEASES 54 Chest Clinics 56 Mass Radiography 58 Immunisation and Vaccination 60 1 Page ENVIRONMENTAL HEALTH 61 Summary of Inspections and Notices Served by Public Health Inspectors 63 Factories 65 Offices, Shops and Railway Premises Act 66 Noise 68 Disinfection and Personal Cleansing 68 Prevention of Damage by Pests 69 Swimming Baths 69 Rag Flock and Other Filling Materials Act 70 Destruction of Pigeons 70 Pet Animals Act 70 Atmospheric Pollution 70 Housing Acts 73 Milk 75 Icecream 76 Food 77 Pharmacy and Poisons 80 Legal Proceedings 80 Water Supply 81 Home Dialysis 85 Mortuaries 85 Immigrants 85 FLOODING (SPECIAL REPORT) 87 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 1968. This is the fourth in the present series and meets the requirements of the Department of Health and Social Security and the Inner London Education Authority. The incidence of general sickness as shown by returns for the Department of Health and Social Security is marginally greater than last year though significantly less than 1966. 1968 was a favourable year as regards infectious disease and no special comment is called for. In mid-year measles vaccine became available and from July an attempt was made to immunise children between the ages of 4 and 7. This was to try to stem the expected epidemic of the autumn and winter months. Although too early for proper evaluation the impression gained at the end of the year was that a significant effect had been obtained. Vital statistics for the Borough revealed marginal fluctuations, but indicated the continuance of the favourable trend of recent years. One third of all the deaths in the area now occur over the age of 75. This fact calls for increasing attention to the allied problem of quantity and quality of physical and spiritual care in terminal illnesses of the aged. Towards the end of the year a Domiciliary Family Planning service conducted by an experienced medical officer was established in the department to complement the expanding clinic service provided on an agency basis by the Family Planning Association. This meets a specific need and may well be considered by the Health Committee as worthy of extension. Home dialysis was arranged for three patients with advanced kidney disease during the year. The adaptation of the home and the installation of special equipment, while a formidable undertaking is an exercise in co-operation between the Local Health Authority and the teaching hospitals concerned. The benefit to the patient is undoubted while the saving of hospital beds and special in-patient facilities is significant. Mr. A. J. Phillips, the Chief Public Health Inspector was appointed liaison officer for the many agencies involved in the arrangements for this new venture in community care. A special note is included in the report of the effect of the disastrous floods of September on the health services. Some apprehension was felt that illness from shock and exposure or spread of infection from contamination would be widespread. The situation was closely watched and no death or dangerous illness attributable to the incident could be recorded at the end of the year. A further slight increase in the incidence of verminous infestation and scabies is recorded. This occurrence tends to confirm a suspicion that resistance to present methods of treatment may be developing. It is hoped that some special research into this may be possible in the near future. The improvement of housing conditions continued, and good progress was made in clearing away many worn-out properties to make way for new. It is also gratifying to note that there was an increase in the number of standard and discretionary grants during the year. This procedure which has not been used in the past to the extent it was hoped for, nevertheless has proved of great value in bringing many houses within the Borough up to a reasonable standard of fitness and amenity. 3 Food supervision is an important aspect of the Department's work, and whilst there is a continuing improvement in general food hygiene, there is an ever present need to be vigilant to ensure that standards do not drop and that the latest methods of food hygiene technology are introduced wherever necessary. Staff shortages and difficulties of accommodation for training and rehabilitation were still in evidence during the year, but despite these problems expansion in Mental Health community services continue. A reference to this section of the Report will show the extent to which the Department is able to help those in need of its support. Health education is a most important feature of the Health Department's work and its conscious expansion, particularly in the field of illustrations, practical demonstrations, and the number of various exhibitions arranged can be seen by reading the section on Health Education in the body of this report. Many aspects of this work require the close co-operation of various organisations and members of the staff, and I am glad to pay tribute to them for this. This opportunity is again taken to record the fact that my report outlines the work during 1968 of loyal colleagues of all grades in the Health Department. The ever available help and guidance of the Town Clerk and other chief officers is gratefully acknowledged. In conclusion I wish to thank the Chairmen and members of relevant Committees for the support afforded to the Department and myself during 1968. F. R. WALDRON, Medical Officer of Health. Health Department, Deptford Town Hall, New Cross Road, S.E.14 4 HEALTH COMMITTEE, 1967 The Mayor (Alderman C. A. COMBES, j.p.) Chairman: Councillor MRS. D. E. NEW Vice-Chairman: Councillor J. W. EARL Alderman Mrs. M. J. Crisp Councillor Mrs. E. M. Bridger „ Mrs. W. Brydon ” Mrs. I. D. M. Caulfield ” W. Hall ” S. G. C. Hardy Councillor Mrs. D. Hurren „ F. M. Judge, m.p.s. „ P. W. Philpot „ Mrs. P. L. Silk „ P. M. Sims „ I. W. Turner Co-opted Members: J. B. Cohen, l.d.s., r.c.s. P. Freeman, l.r.c.s., l.r.c.p., l.r.f.p.s. F. H. E. Hook, m.p.s. 5 HEALTH DEPARTMENT as at 31.12.68 (a) Medical Officer of Health and Principal School Medical Officer, Inner London Education Authority F. R. WALDRON, m.d., d.p.h. (a) Deputy Medical Officer of Health and Deputy 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. Betty E. Shortland, m.b., b.s., d.p.h. Enid C. Vincent, m.b., ch.b., d.p.h. Senior Assistant Medical Officers: Islay C. Barne, m.r.c.s., l.r.c.p., m.r.c.o.g. Vacancy Medical Officers in Departments G. S. Sethi, m.b., b.s., d.p.h., d.t.m.h., d.i.h. Mary M. Bools, m.b., ch.b., b.a.o. 41 sessional M.O.s occupying 16 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. P. Sivagurunathan, f.d.s., l.d.s., r.c.s. (a) Dental Officers: Joyce Smail, l.d.s. (Part-time) and 7 sessional 4 Dental Auxiliaries and 10 Dental Surgery Assistants Orthodontist (Part-time) Ann D. Ward, b.d.s., dip.orth. Public Analyst: H. Amphlett Williams, ph.d., a.c.g.f.c., f.r.i.c., f.r.s.h. (a) Nursing Officer (Maternal & Child Health and School Health): Dorothy M. Coe, 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 Technical Teachers Certificate C & G Technical Teachers Certificate Diploma in Social Sciences Senior 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) Fanny Stevens, s.r.n., r.f.n., c.m.b. (Part I). Vacancy (Kingswear) Centre Superintendents: Nora Miller, s.r.n., r.f.n., s.c.m., h.v. Margaret M. Sammon, s.r.n., s.c.m., b.t.a. (Flower House) (Lewisham Chest Clinic) Maureen Allen, s.r.n., s.c.m., h.v. Helen Buckley, s.r.n., s.c.m., h.v. (Spalding House) (Downham) Janet McCrudden, s.r.n., c.m.b. (Part I), h.v. Anne McGarry, s.r.n., c.m.b. (Part I), (Speedwell) q.n.cert., h.v. (Lind) Anna Flemm, s.r.n., s.c.m., h.v. Rose Pedel, s.r.n., c.m.b. (Part I), h.v. (Trewsbury) (Boundfield) Audrey I. Urwin, s.r.n., c.m.b., h.v. (Heathside) 35 Health Visitors; 4 T.B. Visitors; 22 School Nurses; 3 Clinic Auxiliaries 8 Trainee Health Visitors 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 20 Trainee Nursery Nurses 6 Nursing Officer (Midwifery and District Nursing): Valerie J. Buckingham, s.r.n., s.c.m., m.t.d. Assistants: Renee R. Humphries, s.r.n., s.c.m., d.n.cert. Rose Evans, s.r.n., s.c.m., d.n.cert. 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 Senior Midwives: Margaret J. Williams, s.r.n., c.m.b. Vacancy Midwives(30); Pupil Midwives (up to 16) 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. 1 Chiropodist; 16 sessional Chiropodists; 1 Trainee Chiropodist Principal Mental Health Officer: Zena Mason, b.a., a.i.m.s.w. Assistant Principal: A. G. Knight Senior Mental Health Officer: Rosemary E. Evans, dip.social studies, a.a.p.s.w. 14 Mental Health Social Workers Honor Lea Hostel: Warden: E. W. Murray, r.m.p.a. Deputy: 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 Principal Social Worker: Eileen L. Stocker, Dips. Social Studies and Casework, a.a.p.s.w. Assistant Principal: Betty J. Hardy, b.a.(soc.sc.)., Dip. Applied Social Studies 4 Social Workers; 3 Family Case Workers; 2 Care Committee Organisers; 1 Trainee Social Worker Home Help Organisers: Ivy I. Stittle (Deptford) Beatrice Kneller (Rushey Green) Muriel Wakeford (Sydenham) Marie L. Webb (Grove Park) 4 Assistants; 630 Home Helps Health Education Officer: R. W. Allen, m.a.p.h.i., m.i.h.e. 1st Assistant Health Education Officer: Marie Sharp, s.r.n., h.v., m.i.h.e. 1 Assistant Home Safety Officer: L. Selway 7 Chief Public Health Inspector: A. J. Phillips, m.a.p.h.i. Assistant Chief Public Health Inspectors: J. H. Willis, 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. W. Ellery, 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. Assistant Senior Public Health Inspectors: R. L. Davis, m.a.p.h.i. R. W. Bradstock, m.a.p.h.i. J. Hills, m.a.p.h.i. K. G. Burt, m.a.p.h.i. 14 Public Health Inspectors, 1 Vacancy, 7 Trainee Public Health Inspectors 8 Technical Assistants, 4 Vacancies Bathing Station Superintendents: H. W. Wellbelove (Deptford) J. G. Beale (Lewisham) 2 Assistant Superintendents; 18 Miscellaneous Staff Mortuary Keepers: C. B. Evans (Deptford) W. C. Spear (Lewisham) Pest Control Foreman: R. A. Sharman 6 Operatives ADMINISTRATIVE STAFF Chief Administrative Officer: G. A. LANGLEY Principal Administrative Officers: D. M. Minear E. W. Cheesman Senior Administrative Officers: S. Burridge R. Shrive W. Fancy, b.sc.(econ.)., d.m.a. Administrative Officers: C. R. Coleman, d.m.a. L. Thorpe, d.f.c. 23 Administrative Assistants; 1 Chief Officer's Personal Assistant 18 Clerical Officers; 31 Clerical Assistants 8 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. 18 Woolwich Group Hospital Management Committee The London Teaching Hospitals The Psychiatric hospitals that serve this area are Bexley (Bexley Group Hospital Management Committee), Cane Hill (Cane Hill Group Hospital Management Committee), and Darenth Park (Darenth and Stone Group Hospital Management Committee) which is the main centre for mental subnormality. General Practitioners There are 133 general practitioners serving patients in Lewisham. The numbers serving broad areas of the Borough are: Bellingham, Catford, Lewisham, Hither Green, 43 Sydenham, Forest Hill, Brockley, 37. Deptford, 27. Blackheath, Lee, Grove Park, Downham, 26. Chest Clinics Deptford Chest Clinic, Harton Street, S.E.8. Lewisham Chest Clinic, 1 Blagdon Road, S.E. 13. Venereal Diseases Clinics King's College Hospital, Denmark Hill, S.E.5. Miller General Wing, Greenwich District Hospital, S.E.10 St. John's Hospital, Morden Hill, S.E. 13 Dreadnought Seamen's Hospital Greenwich, S.E.10 9 HEALTH CENTRES AND CLINICS: Maternal and Child Health, and School Health Name and Address Type of Clinic Amersham Road, Amersham Road, S.E.I4 Bellingham, Community Centre, Bellingham Green, S.E.6 Boundfield Road, Community Centre, S.E.6 Central Lewisham, 410 Lewisham High Street, S.E.I3 Deptford S.T.C., Reginald Square, S.E.8 Downham, 24 Churchdown, Downham, Kent Ante-Natal, Child Health, Child Development, Immunisation, Mothercraft, Ancillary Food Sales, Special Advisory, Cytology, Special Investigation, Family Planning Child Health, Immunisation, Ancillary Food Sales Child Health, Immunisation, Ancillary Food Sales, Cytology, Child Development, Health Education Ante-Natal, Relaxation Classes, Child Health, Immunisation, Mothercraft, Family Planning, Ancillary Food Sales, Cytology, Occasional Creche, Special Advisory, Language Classes Ear, nose and throat, vision, orthoptics, minor ailments, speech therapy Ante-Natal, Child Health, Child Development, Immunisation, Mothercraft, Family Planning, Relaxation, Ancillary Food Sales, Minor Ailments, Vision, Speech Therapy, Special Investigation Ante-Natal, Child Health, Immunisation, Mothercraft, Relaxation, Family Planning, Ancillary Food Sales, Child Development, Health Education Child Health, Immunisation, Ancillary Food Sales Child Health, Immunisation, Ancillary Food Sales Child Health, Immunisation, Ancillary Food Sales, Home Making Child Health, Immunisation, Ancillary Food Sales Ante-Natal, Child Health, Immunisation, Mothercraft, Family Planning, Occasional Creche, Ancillary Food Sales, Cytology, Mental Health, Minor Ailments, Health Education Child Health, Immunisation, Ancillary Food Sales Vision, minor ailments, special investigation, audiology Auditory training unit, orthoptics, hearing investigation, special investigation. Child Health, Child Development, Ancillary Food Sales Cytology Minor ailments Ante-Natal, Child Health, Child Development, Immunisation, Special Investigation Family Planning Child Health, Ancillary Food Sales Ante-Natal, Child Health, Immunisation, Family Planning, Ancillary Food Sales, Vision, Minor ailments, Mothercraft Minor ailments Special investigation Flower House, 1 Winnet House, Beckenham Hill Road, S.E.6 Forest Hill, St. Saviour's Church Hall, Brockley Rise, S.E.23 Grove Park, Methodist Church Hall, Burnt Ash Hill, S.E.12 Heathside. Merton Place, S.E.10 Hither Green, Methodist Church Hall, 53 Torridon Road, S.E.6 Kingswear Dartmouth Road, S.E.23 Lee and Blackheath, Methodist Church Hall, Lee High Road, S.E.12 Lewisham S.T.C. 78 Lewisham Park, S.E.I3 Lewisham Hospital, S.E.13 Lind Oxestalls Road, S.E.8 Samuel Pepys School, Wallbutton Road, S.E. Speedwell Speedwell Street, S.E.8 St. Mary's St. Mary's Church Hall, Lady well Road, S.E.13 Spalding House, 2 Spalding House, Honor Oak Estate, S.E.4 Sydenham S.T.C., Adamsrill School, Lower Sydenham, S.E.26 Children's Hospital, S.E.26 10 Sydenham London City Central Mission, Wells Park Road, S.E.26 Tranquil Vale, All Saints' Hall, Tranquil Vale, S.E.3 Trewsbury Road, All Saints' Parish Church Hall, Trewsbury Road, S.E.26 Day Nurseries Health Centre, Amersham Road, S.E.14 41 Rushey Green, S.E.6. 67 Perry Rise, S.E.23 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 S.T.C. Sedgehill School, Sedgehill Road, S.E.6 Chiropody Clinics Amersham Road, Health Centre, S.E.14 Kingswear, 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 New Cross Day Centre, Goodwood Road, S.E.14 Training Centres (Mental Health) 69 Perry Rise, S.E.23 Deptford Central Methodist Mission, Creek Road, S.E.8 Methodist Church Hall, Kitto Road, S.E.14 Hostel Accommodation (Mental Health) Honor Lea, 103/117 Brockley Rise, S.E.23 Cleansing and Disinfecting Stations Wearside Road, S.E.13 Speedwell Street, S.E.8 Mortuaries Ladywell Road, S.E.13 Watson Street, S.E.8 Child Health, Immunisation, Ancillary Food Sales Ante-Natal, Child Health, Immunisation, Occasional Creche Child Health, Immunisation, Mothercraft, Relaxation, Health Education 11 VITAL STATISTICS Area of the borough 8,579 acres. Population Census 1961 290,582 Estimate of Registrar General at midyear 1968 281,140 Rateable Value Rateable value of the borough at April 1,1968 £12,329,092 Estimated net product of a penny rate 1968/9 £48,500 Estimated number of separately assessed dwellings at April, 1 1968 87,997 Births Males Females Total Legitimate 2,231 2,121 4,352 Illegitimate 347 330 677 Totals 2,578 2,451 5,029 Crude birth rate per 1,000 of the estimated population 17.9 Adjusted birth rate for comparative purposes (Area comparability factor= 0.96) 17.2 Ratio of adjusted birth rate to national rate 1.02 Stillbirths Total (32 males and 20 females) 52 Rate per 1,000 live and stillbirths 10.2 (males 12.3, females 8.1) Deaths Total (1,785 males, 1,648 females) 3,433 Crude death rate per 1,000 population 12.2 Adjusted death rate (area comparability factor=0.96) 11.7 Ratio of adjusted death rate to national rate 0.98 Infant mortality Infant deaths (all deaths of liveborn children under one year) Males Females Total Legitimate 38 36 74 Illegitimate 12 8 20 Totals 50 44 94 Death rate of all infants per l000 livebirths 18.7 Death rate of legitimate infants per 1000 legitimate livebirths 17.0 Death rate of illegitimate infants per 1000 illegitimate livebirths 29.5 Death rate of male infants per 1000 male livebirths 19.4 Death rate of female infants per 1000 female livebirths 17.9 Neonatal deaths (under 4 weeks of age) 64 (34 males, 30 females) Males per 1000 male livebirths 13.2 Females per 1000 female livebirths 12.2 All infants per 1000 livebirths 12.7 Early neonatal deaths (under 1 week of age) 61 (33 males, 28 females) Males per 1000 male livebirths 12.8 Females per 1000 female livebirths 11.4 All infants per 1000 livebirths 12.1 Perinatal mortality (deaths under 1 week plus stillbirths) 113 (65 males, 48 females) Males per 1000 live and still male births 24.9 Females per 1000 live and still female births 19.4 All infants per 1000 live and stillbirths 22.2 Reproductive wastage (stillbirths plus all infant deaths) 146 Males per 1000 live and still male births 31.4 Females per 1000 live and still female births 25.9 All infants per 1000 live and stillbirths 28.7 Maternal deaths Maternal deaths 4 Maternal mortality rate per 1000 live and stillbirths 0.8 12 Table 1 TOTAL DEATHS BY CAUSE AND AGE REGISTERED DURING 1967 Cause of Death Sex All Ages Under 4 wks 4 wks under 1 year Age in years 1- 5- 15- 25- 35- 45- 55- 65- 75+ Total all causes M 1 785 34 16 9 10 15 16 37 117 349 521 661 F 1 648 30 14 10 3 9 12 20 78 155 330 987 B4 Enteritis and other diarrhoel diseases M 1 — 1 — — — — — — — - — F 1 — — — — — — — — — — 1 B5 Tuberculosis of Respiratory system M 14 - - - - - - 1 2 2 8 1 F 2 - - - - - - - - - 1 - B6 Other Tuberculosis,including late effects M 2 F - - - - - - - - - - - - B17 Syphilis and its sequelae M - - - - - - - - - - - - F 1 - - - - - - - - - - 1 B18 Other Infective and Parasitic diseases M 2 - — 1 - - - - - - 1 — F 1 1 B19(l) Malignant Neoplasm Stomach M 33 - - - - - - 2 4 9 14 4 F 32 - - - - - - - 2 4 8 18 B19(2) Malignant Neoplasm —Lung, Bronchus M 171 - - - - - 1 1 20 57 56 36 F 43 - - - - - 1 — 6 9 11 16 B19(3) Malignant Neoplasm M — — — — — — — — — — - - F 53 - - - - - - 1 13 11 12 16 B19(4)Malignant Neoplasm —Uterus F 16 - - - - - - 1 2 2 6 5 B19(5) Leukaemia M 9 — 1 — 1 — — - - 3 3 1 F 9 — — 1 1 — — — 1 — 3 3 B19(6) Other Malignant Neoplasms, etc. M 177 - - — 1 3 3 6 13 48 57 46 F 148 — — — — 3 1 4 15 26 41 58 B20 Benign and unspecified Neoplasms M 3 1 — — — — — 1 — — 1 — F 6 - 1 — — — 1 2 1 1 — — B21 Diabetes Mellitus M 6 - - - - - - - - 2 2 2 F 19 - - - - - - - - 3 8 8 B46(l) Other Endocrine etc. diseases M 5 — — — 1 — — — — 1 1 2 F 4 - - 1 — — — — 1 — — 2 B23 Anaemias M 3 - - - - - - - - - 2 — F 4 - - - - 1 - — 1 — — 2 B46(3) Mental Disorders M 2 - - - - - - - - - - 2 F 6 - - - - - - - - - - 6 B24 Meningitis M 2 1 - - - - - - - 1 - - F 2 - - - - - - 1 - - 1 — B46(4) Other diseases of Nervous System, etc. M 16 - - - 1 - - 1 1 3 5 5 F 22 - - 2 1 - - — 3 3 2 11 B26 Chronic Rheumatic Heart Disease M 17 - - - - 1 — 3 4 7 2 F 22 - - - - - 2 9 2 9 B27 Hypersensitive disease M 29 - - - - - 1 2 6 10 10 F 33 - - - - - 2 7 24 B28 Ischaemic heart disease M 459 - - - - - 1 8 34 115 130 171 F 368 - - - - - 1 6 35 89 237 B29 Other forms of Heart disease M 55 - 1 1 - 1 8 17 27 F 78 - 1 1 - 1 2 1 2 3 11 56 B30 Cerebrovascular disease M 151 - - - - 1 1 6 6 19 36 82 F 275 - - - - 1 1 1 7 15 51 199 B46(5) Other diseases of Circulatory system M 63 - - - - 1 1 3 5 10 17 26 F 85 - - - - - 1 — 3 18 63 B31 Influenza M 3 - - - - - - - - - 1 2 F 9 - - - - - - - - 1 2 6 B32 Pneumonia M 135 1 3 1 - - — 7 36 87 F 149 - 4 1 1 - — 3 3 22 115 B33(l) Bronchitis and Emphysema M 217 1 - - - 5 31 79 101 F 73 - 1 - - - 6 3 12 51 B33(2) Asthma M 2 - - — 1 — — 1 — — — — F 4 - - - 1 — — — 2 — 1 B46(6) Other diseases of Respiratory System M 23 - 3 - - - - 1 4 4 11 F 29 1 3 1 - - - 1 2 1 4 16 B34 Peptic Ulcer M 20 - - - - - - - 4 — 6 10 F 10 - - - - - - - - 3 2 5 B35 Appendicitis M 2 - - 1 - - - - 1 - - - F 1 - - - - - - - - - - - B36 Intestinal Obstruction and Hernia M 9 - - - - - - - 1 2 2 4 F 8 1 - - - - - - - - 2 5 B37 Cirrhosis of Liver M 2 - - - - - - - 1 1 — — F 2 - - - - - - - - 1 1 - B46(7) Other diseases of Digestive System M 17 — — — 1 - - 1 1 6 4 4 F 15 — — — — 1 — — 1 3 3 7 B38 Nephritis and Nephrosis M 2 - - - - - - - - - 1 1 F 4 - - - - - - - - 1 2 1 B39 Hyperplasia of Prostate M 11 - - - - - - - - 1 4 6 B46(8) Other diseases, Genito-Urinary System M 15 - - - - - - - 2 — 5 8 F 19 - - - - - - 1 — 2 3 13 B40 Abortion F 2 — — — — — 1 1 - - - - B41 Other Complications of Pregnancy, etc. F 2 - - - - - 1 1 — — — — B46(9) Diseases of Skin, Subcutaneous Tissue M 1 - - - - - - 1 - - - - F - - - - - - - - - - - - B46(10) Diseases of Musculo-skeletal System M 3 - - - - - - - - 2 1 - F 8 - - - - - - - - - 1 7 B42 Congenital Anomalies M 10 5 3 - - - - - - 1 1 - F 13 8 3 1 - - - - - - - 1 B43 Birth Injury, Difficult Labour, etc. M 16 16 - - - - - - - - - - F 10 10 - - - - - - - - - - B44 Other causes of perinatal Mortality M 9 9 - - - - - - - - - - F 9 9 - - - - - - - - - - B45 Symptoms and ill-defined conditions M 2 - - - - - - - - - - 2 F 5 1 - - - - - - - - 4 BE47 Motor Vehicle accidents M 15 — — 1 3 3 3 — 2 — 2 1 F 8 — — — — 1 — — 1 — 2 4 BE48 All other accidents M 25 — 2 4 1 3 1 2 2 4 2 4 F 23 - - 1 — — — — 1 4 2 15 BE49 Suicide and self-inflictected injuries M 22 - — — — 4 3 2 4 2 4 3 F 11 - - - - - 2 1 2 5 1 — BE50 All other external causes M 4 — 2 — — — — — 2 — — — F 4 — 1 1 — — 2 — — — — — HEART DISEASE The percentage of cardiovascular and atherosclerotic disease as a group has not varied much during the past ten years as table 2 shows. This group of deaths, taken as a single cause, rank above any other single cause of death among the population. Table 2 HEART AND CIRCULATION MORTALITY Year (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) (h) (i) of(f) of (h) (j) (g)of (h) (k) 1959 599 485 155 1,239 215 142 3,448 36 6.2 4.1 1960 496 423 147 1,066 212 143 3,280 32 6.5 4.3 1961 609 516 153 1,278 236 162 3,380 38 7.0 4.8 1962 657 417 145 1,219 256 181 3,376 36 7.6 5.4 1963 707 400 142 1,249 245 174 3,404 37 7.2 5.1 1964 654 301 142 1,097 235 166 3,317 33 7.1 5.0 1965 740 304 150 1,194 268 206 3,436 35 7.8 6.0 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 6.0 1968 827 234 148 1,209 250 190 3,433 35 7.3 5.6 LUNG CANCER The Health Education team continued with all the methods at their disposal to discourage cigarette smoking, but it is an uphill battle which will go on without let-up until lung cancer ceases to be of any significance as a cause of death. Table 3 LUNG CANCER Year All cancer deaths MALE FEMALE Lung cancer deaths (c)as % of(b) All cancer deaths Lung cancer deaths (f)as % of(e) (a) (b) (c) (d) (e) (f) (g) 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 1968 390 171 44 301 43 14 14 LOCAL SICKNESS The Regional Controller of the Ministry of Social Security sends a weekly return indicating the first certificates of sickness benefit received in the local offices. The areas served by these local offices are in the main coterminous with postal districts of London and do not coincide with borough boundaries. Lewisham is served mainly by three offices, "Lewisham", "Downham", and "Deptford", and a fair representation of the trend of sickness within the borough can be given by quoting the combined figures for these three. Table 4 MORBIDITY SHOWN IN INSURANCE CERTIFICATES Weekly average for period ending 1967 1968 January 30 1,444 2,368 February 27 1,310 1,416 March 26 1,211 1,481 April 23 1,076 1,014 May 21 1,142 1,008 June 18 965 947 July 16 922 850 August 13 926 858 September 10 900 911 October 8 1,092 1,112 November 5 1,200 1,250 December 3 1,301 1,044 December 31 1,491 1,026 Weekly average for the year 1967 1,163 „ „ „ 1968 1,195 15 Table 5 GENERAL STATISTICS FROM 1950 Year Population Death rate * % dying underage 45 % dying underage 65 Birth rate * Maternal Death rate † Still.birth rate † Infant mortality rate * * Pulmonary Tuberculosis Notif rate † † Death rate † † 1950 304,880 10.9 11.5 35.5 15.6 0.8 15.6 26.8 197 30 1951 303,240 11.6 9.9 33.6 15.0 0.6 14.5 23.9 148 35 1952 303,010 11.5 9.9 32.1 14.8 0.2 16.5 25.2 132 20 1953 300,830 11.6 8.7 30.2 14.6 0.2 21.7 23.5 151 23 1954 298,020 10.5 8.0 31.4 14.4 0.2 16.1 19.6 129 19 1955 296,290 11.1 7.1 28.4 14.1 0.9 18.8 15.6 141 12 1956 293,940 11.8 7.0 28.9 14.6 0.5 18.8 20.5 101 15 1957 291,870 11.3 7.6 31.2 14.8 0.5 18.4 15.3 124 15 1958 291,220 11.2 8.4 29.7 15.2 0.2 18.0 25.5 108 10 1959 290,660 11.9 7.7 29.5 16.2 0.8 19.4 18.5 74 8 1960 290,630 11.3 8.8 30.1 16.8 0.2 18.3 21.7 68 6 1961 289,130 11.7 7.4 28.5 17.7 0.2 18.8 20.6 73 8 1962 291,150 11.6 8.0 30.6 18.9 0.5 13.3 18.6 56 9 1963 291,180 11.7 8.7 31.2 19.3 0.4 15.2 23.5 66 8 1964 291,670 11.4 8.9 31.1 19.9 0.5 11.7 22.9 64 2 1965 289,560 11.9 9.3 31.6 20.0 0.7 14.0 23.3 54 6 1966 289,130 11.8 8.6 30.2 19.2 0.2 15.1 21.6 47 5 1967 289,700 11.5 6.7 27.5 18.3 0.2 11.9 16.2 36 4 1968 281,140 12.2 6.8 27.2 17.9 0.8 10.2 18.7 43 6 *Per 1,000 population. †Per 1,000 Registered Live and Still Births * *Per 1,000 Registered livebirths † †Per 100,000 population HEALTH CENTRES Plans were approved by the former Ministry of Health for the Council's first comprehensive health centre in Stanstead Road/Brockly Rise and, following a public enquiry, the Minister of Housing and Local Government granted planning permission for this centre. Detailed planning proceeded throughout the year for this centre which it is hoped will open early in 1971. The centre will provide consulting suites for six general practitioners, a full range of local health authority services including chiropody and family planning, two local authority dental surgeries and one general dental service surgery, an Inner London Education Authority child guidance clinic, a home help office and office accommodation for nursing and midwifery staff. There was a marked improvement during the year in the standard of premises used for maternal and child health. The Kingswear Health Centre, is purpose built with three consulting rooms, health education area, treatment centre, chiropody clinic and office accommodation for health visitors, occupying the ground floor of a block of flats in Dartmouth Road, Forest Hill, opened in August. Services previously provided in very unsatisfactory accommodation in Louise House nearby were transferred to this centre and the centre programme has since been expanded. A similar but smaller ground floor purpose built centre off Blackheath Hill, named the Heathside Centre, opened later in the year and services which had been provided in a prefabricated building were transferred to the new centre. Premises in Speedwell Street, Deptford, formerly used to provide residential nursing accommodation with some clinic work were adapted during the year and a new centre, named the Speedwell Health Centre opened there in December. With the opening of this centre it was possible to transfer services and staff from the overcrowded Amersham Road Centre. A purpose built centre in Oxestalls Road, S.E.8, forming part of the Royal Victoria Yard Development scheme was handed over to the Council by the Greater London Council in December and equipping of this centre, named the Lind Health Centre, was proceeding at the end of the year in anticipation of opening early in 1969. Weekly child health sessions held in a Tenant's Club-room in Sydenham Hill which was unsatisfactory both from the accommodation and location point of view were transferred to the London City Mission Hall in Wells Park Road, Sydenham, which is proving much more suitable, Much needed improvements were carried out at certain existing centres. A rearrangement of rooms used by staff at the Central Lewisham Centre enabled an additional room to be brought into use for health visitor interviewing and some satisfactory creche accommodation. Improved office accommodation was provided for health visiting staff at the Spalding House and Trewsbury Road Centres, and extra accommodation was provided at the Grove Park Centre to enable health visitors to be based there. Refrigerators are now held at all centres. 17 MATERNAL AND CHILD HEALTH DOMICILIARY MIDWIFERY Valerie J. Buckingham, S.R.N., S.C.M., M.T.D. (Midwifery and District Nursing) During the year a changing pattern of patient care in the Domiciliary Midwifery service has become evident with the fall in domiciliary confinements. The birth rate dropped only 0.3% but there was a swing in favour of Planned Early Discharge from hospital, particularly during the second half of the year. Domiciliary confinements were: January to June — 530 = 20.3 % of total births July to December— 319 = 10.8% of total births thus giving an overall domiciliary confinement rate of 16.4% for the year. The increased popularity of the Planned Early Discharge Scheme is evident; there were 1,361 early discharges = 26.4% of total births as against 1,075 in the previous year. It is interesting to note that the domiciliary midwives nursed 43% of all patients delivered within the Borough; at present 20 full-time and 2 part-time midwives are employed. In addition to the 849 patients confined in their own homes a further 252 patients were booked for domiciliary confinement but were subsequently delivered in hospital. Good comprehensive ante-natal care given by the midwives and general practitioners resulted in 180 patients being transferred to the care of a consultant obstetrician for the following reasons: Post maturity—60 patients Anti-partum haemorrhage—24 patients Pre-eclampsia—17 patients Abnormal presentations—16 patients Anaemia—7 patients Rhesus incompatibility—3 patients Of the 72 patients who were admitted to hospital because of complications occurring during labour the following are of interest: Primary uterine inertia—23 patients Delay in the second stage—17 patients Foetal distress—10 patients Abnormal presentation—8 patients Ante-partum haemorrhage—4 patients The Emergency Obstetric Unit This unit, operating from Lewisham Hospital, was called out on 15 occasions. Premature Babies 25 premature babies were born at home; of this number 6 were transferred to hospital while 19 were nursed at home. Dual Care Ante-Natal Scheme During the year general practitioner obstetricians within the Borough have undertaken ante-natal care for their patients who are booked for confinement in Lewisham Hospital. About 30 general practitioner obstetricians are in this scheme and 14 of these doctors also attend the midwives ante-natal clinics. Thus where possible the patient attends the clinic where she can be seen by the doctor and the midwife. Attendances at ante-natal clinics amounted to 8,991 a decline on the previous year, but the number of ante-natal visits made to the patient's own home (11,176) remained constant. Post-natal visits made by the midwives totalled 22,248. 18 Pupil Midwife Training The bi-annual inspection of the midwifery training programme by the Central Midwives Board took place in January and this was considered entirely satisfactory. With the anticipated decline in domiciliary confinements, a course of community care and social services was designed and submitted for consideration and subsequently approved. It is now acceptable for each pupil midwife to deliver six instead of ten patients in their own homes. During the year 53 pupil midwives completed the period of district experience and a further 12 were in training at the end of the year. Fifteen midwives are approved by the Central Midwives Board as teachers. Staff Training The Central Midwives Board have extended the practice of the domiciliary midwife to include a procedure of infiltration of the perineum prior to an episiotomy. It was necessary to give some in-service training on the subject and a course was arranged with the Maternity department at Lewisham Hospital. Each midwife spent 3 days in hospital to acquire practical experience and a lecture-demonstration was given by Mr. A. L. Gunn, f.r.c.s., f.r.c.o.g. Closer supervision of the rhesus negative patients and a high incidence of anaemia have resulted in more frequent blood examinations. To facilitate the acquiring of these specimens, approval was obtained for the midwives to be instructed in venu puncture. In co-operation with the Pathological Laboratory at Lewisham Hospital each midwife spent half a day in the laboratory taking blood specimens under supervision. The incubation of babies who fail to breath satisfactorily at birth has been added to the midwives practice. A lecture was given on the subject and a demonstration of the technique, but practical experience would be essential to acquire any degree of skill and this is to be arranged. Statutory Refresher Courses During the year 2 midwives attended refresher courses as required by the Central Midwives Board. Maternal Deaths Under the procedure laid down by the Ministry of Health for the confidential enquiry into maternal deaths, three maternal deaths were investigated. 19 DISTRICT NURSING Valerie J. Buckingham, S.R.N., S.C.M., M.T.D. (Midwifery and District Nursing) The demand for the services of the district nurses continued during the year with referral from hospitals, family doctors and the general public, which resulted in an increase of 660 patients and 11,013 visits. Table 6 Patients and visits Total number of patients 4,626 Total number of visits 164,484 Average number of visits to each patient 36 The number of children under 5 years of age, treated by the district nurses rose from 143 in 1967 to 363 in 1968. The number of visits to this group amounted to 1,052 making an average of three visits to each child. This is significant as the number of very sick children nursed at home is small, while the majority of children are referred from the hospitals' casualty departments for the removal of sutures. This is a service very much appreciated by the mothers who are saved a journey to the hospital and the possibility of a long wait as well as caring for a small frightened child. In the security of the home the children co-operate very well. The patients in the age group 65 years and over declined by 678 to 2,108 (2,786 in 1967); however an increased number of visits were made: 137,273 (125,590 in 1967). Very often more than a single daily visit is required for many of these patients and for the gravely ill two or three visits are made daily. Table 7 District Nurses employed (full time equivalents) State Registered Nurses—female 48 State Registered Nurses—male 11 State Enrolled Nurses—female 7 66 Eight members of the staff left during the year but there was no difficulty in filling the vacancies. Liaison Schemes with General Practitioners At the beginning of the year five district nursing sisters and one male charge nurse worked for two afternoons each week in doctors' surgeries. The advantages of these liaison schemes to the doctors and the sisters encouraged an expansion of the service and now 12 nursing sisters and one male charge nurse are involved serving 30 doctors. Bathing of Elderly People Many elderly people who are not sick but are incapacitated due to age are bathed weekly by bathing attendants. During the year 8,568 baths were carried out (2,268 in 1967) by one male and five attendants. District nursing sisters supervised this work so that immediate assistance may be given should any patient require nursing care. Staff Training It is the aim that each member of the staff holds a District Nursing Certificate. During the year 10 state registered nurses were successful in obtaining the National Certificate of District Nursing. State enrolled nurses take the District Nursing assessment of the Queen's Institute of District Nursing. Six members of the staff prepared for this assessment and were subsequently successful. 20 To foster interest and improve the service offered by the bathing attendants a short course of instruction of one day a week for four weeks was organised. The six members of the staff attended and they were instructed in hygiene, methods of nursing care, the technique of lifting and diabetes. A comprehensive picture of the services of the local authority were also given, All appreciated the course and felt better prepared for the task they were undertaking. Refresher Courses Six district nursing sisters attended refresher courses organised by the Queen's Institute of District Nursing. Two senior district nursing sisters attended a special Practical Workers Instructors course. Integrated Courses Integrated nursing training arranged by King's College hospital trains nursing students for the State Register, the Health Visitors Certificate and a ten weeks course of district nursing. This latter course does not at present include a District Nursing certificate but the students can sit for the District Nursing examination after a further period of training following the completion of their contract with King's College Hospital. Three students spent 3 weeks gaining district experience in their second year and a further three students spent two weeks with the district nurses in their first year of integrated training. Observation Visits During the year 82 persons visited the patients in their own homes with the district nurses. They were:— 53 Pupil Midwives 13 Hospital Student Nurses 11 Medical Students 4 Occupational Therapy Students 1 Warden Special Lectures District nurses attended conferences and lectures of special interest to their work; these included "Diets for the Elderly", "Crime Prevention and the Elderly" and "Resuscitation and External Heart Massage". One district nursing sister attended the two-day Conference of the Royal Society for the Prevention of Accidents. Drugs and Their Effects This was the subject of a special lecture requested by the district nursing staff as many of the drugs in current usage were new to them. They asked for an opportunity to discuss some of the apparent side effects of these preparations. Dr. J. S. Staffurth, m.d., f.r.c.p., Clinical Tutor at Lewisham Hospital gave an excellent lecture which provoked many questions and brought everyone up to date. Home Bathing Attendants This service was started in Lewisham in December 1962 with the employment of a woman to help with domiciliary bathing and cleansing to work primarily under the direction and supervision of the district nurses. During this first year the number of cleansings and bathings carried out was 1,286. It became clear that the demand for such help was very great, and during the past five years the service has continually expanded to the extent that during 1968, some 10,571 cleansings and bathings were carried out by the six bathing attendants employed In addition some 1,272 home bathings were carried out by staff of the cleansing stations. It is envisaged that during 1969 the home bathing service provided by the staff of the cleansing stations and the home bathing attendants will be integrated under the Nursing Officer (Midwifery and District Nursing). 21 HEALTH VISITING Dorothy M. 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 the number of health visitors on the establishment was maintained and it was possible to expand the services to the public. Apart from the usual advice on feeding, general care, and the promotion of health within the family circle, stycar hearing testing is done in the home. This has the advantage of supervising the developmental progress of children who do not attend infant health clinics or well baby clinics in surgeries. It is accepted that the parents of many children at social risk do not avail themselves of the services available to them and in view of this the services need to be taken to them. During the interviews with the mother in the home the health visitors are able to detect early symptoms of retardation or defect, and will when necessary refer the child to the general practitioner or hospital for further investigation. Detection of symptoms of 'battered baby' is often possible when visiting. Follow-up visits of patients referred by consultants or medical social workers are carried out by the health visitors who are able to assess the social needs of the patient and family and bring in the services appropriate to the need, e.g. home help, district nurse etc. Although this refers to patients in all age groups, old people not in need of visits on medical grounds are referred to geriatric social workers. Mothers clubs, creche sessions and talks on subjects of interest are very popular in the health centres. The increased liaison with general medical practitioners has proved to be of value in promoting a greater understanding of the needs of people and in forming good relationships between the family doctor and the staff of the health department. General practitioners have described the service as being extremely valuable. The stimulation to staff and public by providing new and improved services in the Kingswear and Speedwell health centres has been striking, and quickly established a full and valuable service for the particular areas. The numbers of infant health and educational sessions have been expanded. Refresher courses and in service courses and lectures on a number of subjects have been arranged for the health visitors. This is a valuable provision which keeps the nurse up to date with new projects and attitudes. Health visitors have formed strong links with the local hospital specialist services, and attend outpatient clinics dealing with ante-natal (social needs), paediatric, diabetic and spinabifida, venereal disease patients, reporting to the consultants details of the home conditions and possible progress of the patient while cared for in the home. This can be of tremendous help to the consultant in deciding the action to be taken for each individual patient. Child minding and play groups have increased in number during the year. Health visitors are being more and more involved in the regular visiting and regularly reporting on the individual cases, bringing to the notice of central staff the need for further investigation into unsatisfactory conditions. A complete list of all minders, private day nurseries and play groups is available at central office. Talks and lectures have been undertaken by health visitors on a variety of subjects in schools, women's clubs, geriatric clubs, shops and laundries with large female staffs. Many visitors from this country and abroad have been received in the centres and had discussions relating to the services offered to the Lewisham public. Child care officers, social workers and students studying social services receive talks, visits and discussions, centrally by the nursing officers each term. Lectures dealing with the social aspects of illness are given to third year nurses in King's College Hospital and Lewisham Hospital groups. Visits of observation to all health premises are 22 arranged. This is an essential part of the S.R.N. syllabus; approximately 300 hospital nurses visit each year. 8 student health visitors sponsored by the Council are receiving training and will join the health visitor staff in September 1969 at the end of their one year course. Six newly trained health visitors trained in Lewisham have now joined the staff. In addition, students undergoing the integrated nurse training course receive practical experience in the Borough. These students who have at least 2 subjects in G.C.E. 'A' level are accepted for this joint training. The S.R.N. part is taken at King's College Hospital in conjunction with Croydon College. We now have students in the 1st, 2nd, 3rd and 4th year of training. At the end of the 4 years the nurse is qualified in general nursing, midwifery and health visiting, and can choose to work in any of these spheres. Table 8 VISITS TO HOMES Children born in 1968 5,716 ” ” 1967 7,210 ” ” 1963-66 Total 13,171 26,097 Persons aged 65 or over 668 Mentally disordered persons 189 Persons, excluding maternity cases, discharged from hospital (other than mental hospitals) 93 Infectious disease 55 Tuberculous households visited by tuberculosis visitors (including 55 visits by district health visitors) 1,906 Other visits (special reports on overcrowding, housing for M.O.H.) 215 Grand Total 29,223 CERVICAL CYTOLOGY Monthly sessions continued throughout the year at the Flower House and fortnightly sessions at Boundfield Road health centres, and extra weekly sessions were introduced at the Amersham Road, Central Lewisham, and Kingswear centres. In addition, stores and other work places where large numbers of female staff are employed were approached with a view to arranging special sessions for their staff. An encouraging response was received and a number of special sessions were arranged. Despite the initial interest in cervical cytology the number of women coming foward for examination at the Council's centres was disappointing. A better response is received when general practitioners make a direct approach to their patients suggesting examination but the general practitioners are often inhibited from making such an approach because of the amount of clerical work involved in identifying the women needing the test from the practice records, writing to them inviting them to special sessions and making arrangements for the sessions. The Health Committee considered the problem in October and authorised the Health Department's co-operation in a suitable scheme to assist general practitioners, either by providing a doctor, clinic nurse and clerk to undertake the whole procedure on their behalf with the general practitioners merely signing the letters, or by carrying out the preliminary work with the general practitioners conducting the clinical work themselves either in their surgeries or in the Health Department premises. Consultations with the appropriate authorities on the setting up of an acceptable scheme were in progress at the end of the year. 23 The table below summarises the findings from all the Council's centres for the year: Table 9 Total attendances 2,002 Number of cases referred to G.P. or hospital 408 Number of smears found positive for malignancy 9 DAY NURSERIES AND CHILD MINDERS Health Department Day Nurseries The three day nurseries were fully occupied throughout the year and the heavy demand for places persisted. Staffing has been maintained at a high standard. Each application for a nursery place is covered by a report from the health visitor giving details of the need for admission and a note of the family conditions. All the children accepted in the nurseries were within the priority classes for admission. Some children are referred on medical advice for retarded development due to unsatisfactory home conditions or lack of stimulation in the home. Many children have language difficulties when admitted but they soon respond to the close contact of other children and the general care provided. The early care unit in the Shaftesbury House nursery (15 severely mentally subnormal children) continued to provide a valuable service both by encouraging and assisting the development of these very backward children and by giving their mothers respite during the day. This is especially important for the mother who has more than one handicapped child, or has several young children to care for. The long waiting list for places emphasises the need for additional nurseries. Planning continued during the year for the provision of two extra nurseries on identified sites in Lee and Honor Oak and the provision of two further nurseries in the second half of the Health Department's 10-year development programme was approved by the Council. Student nursery nurses received training in the day nurseries and the Brixton and Southwark Colleges of Further Education. A satisfactory exchange arrangement with students from the I.L.E.A. is in force and much appreciated particularly in view of the extension of the nursery nurse certificate syllabus to cover the care of children up to the age of seven years (previously five years). This arrangement will enable the students to work in nursery classes and schools as well as in day and residential nurseries. The Shaftesbury House day nursery has now been formally recognised as a training nursery. The following table shows the number of admissions and discharges for the three day nurseries during the year:— Table 10 Day Nursery Admissions Discharges Amersham Road 79 79 Rushey Green 87 90 Shaftesbury House 49 46 A number of improvements to the premises of the nurseries were effected during the year. At Shaftesbury House new floor coverings and sanitary facilities were improved. The kitchen was modernised and a french window was provided for the playroom to give direct access to the garden. At Rushey Green, new floor coverings brightened up the rooms considerably and a new washing machine was provided. A new covered pram shed has proved most valuable. Food mixers have been provided for all three nurseries. 24 Private Day Nurseries & Child-Minders Thirteen private nurseries or play groups were registered by the Council under the Nurseries & Child-Minders Regulation Act, 1948 during the year. At the end of the year there were 39 registered nurseries or groups authorised to provide whole or part day care for up to 1,013 children. Section 60 of the Health Services and Public Health Act, 1968, which came into force on 1st November extended the scope of the Nurseries & Child-Minders Regulation Act and the Council's powers and responsibilities thereunder. It became a requirement for women minding children other than relatives for reward for two hours or more in any day to be registered, although a three-months period of grace before unregistered minding of one or two children became an offence. At the end of the year there were 66 statutorily registered minders of more than two children and arrangements were in hand for the registration of some 150 other women who had previously been registered as voluntary minders of one or two children. To encourage the development of day care services following the receipt of Ministry of Health Circular 37/68 the Health Committee approved the placing of priority group children with approved private nurseries or child minders with payment of the fees by the Council in necessitous cases and recovery of an assessed charge from the parents. The giving of financial assistance to nurseries or play groups prepared to accept priority group children was also approved and active consideration was being given at the end of the year to the formulation of a suitable scheme. To help stimulate the siting of new nurseries and groups and deal with other work resulting from the implementation of the suggestions contained in the Ministry Circular and the Council's increased responsibilities under the Nurseries & Child-Minders Regulation Act additional central staff, including an extra Assistant Nursing Officer and an Organiser of Play Groups and Child-Minders, were authorised. 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 144 malformation were reported. This figure represents 2.9% of total live births in the Borough. Table 11 Congenital malformations reported 0.1 Anencephalus 6 0.4 Hydrocephalus 3 0.8 Spina Bifida 5 Total: Central Nervous System 14 1.8 Accessory auricle 1 Total: Ear and Eye 1 2.1 Cleft lip 4 2.2 Cleft palate 9 2.9 Other defects of alimentary system 1 Total: Alimentary system 14 3.0 Congenital heart disease (not otherwise specified) 22 3.3 Transposition of great vessels 2 3.6 Intraventricular septal defect 2 3.9 Other defects of heart and great vessels 2 Total: Heart and great vessels 28 25 4.1 Defects of nose (arhinia, choanal atresia or stenosis) 2 Total: Respiratory system 2 5.5 Other defects of bladder and urethra 1 5.6 Hypospadias, epispadias 8 5.7 Other defects of male genitalia 1 Total :Uro-genital system 10 6.2 Reduction deformities (amelia, hemimelia, phocomelia, etc.) 1 6.3 Polydactyly 19 6.4 Syndactyly 3 65 Dislocation of hip 4 6.6 Talipes 22 6.7 Other defects of shoulder girdle, upper arm, and forearm 1 6.8 Other defects of hand 1 6.9 Other defects of pelvic girdle and lower limb 1 Total: Limbs 52 7.5 Chrondrodystrophy 2 Total: Other skeletal 2 8.3 Vascular defects of skin, subcutaneous tissues, and mucous membranes (including lymphatic defects) 1 8.9 Exomphalos, omphalocele 2 Total: Other systems 3 9.1 Multiple Malformations (Not otherwise specified) 2 9.3 Other monster 1 9.6 Mongolism 15 Total: Other malformations 18 Table 12 Congenital malformations reported: by parity Parity Number of Children 0 30 1 37 2 19 3 23 4 13 5 4 6 1 7 3 8 1 9 1 10 — 11 1 — 133 ADOPTIONS 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. 71 adoption and boarding-out reports were examined and reports on 60 prospective parents were scrutinised during the year. BLIND AND PARTIALLY SIGHTED PERSONS 173 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 86. This certification facilitates the provision of the Council's welfare services. 26 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 I.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 1968 was as follows:— Table 13 Expectant and Nursing Mothers 1 Tuberculous Adults 6 Other Adults 101 Psychiatric patients 14 Accompanied Children 23 Unaccompanied Children (I.L.E.A. Scheme) 101 SURVEYS Nursing staff in the Health Department co-operated in two new surveys during the year, namely a Medical Research Council follow-up of mothers who have given birth to children with anencephaly or spina bifida cystica and a Ministry of Health survey into sub-clinical anaemia and vitamin D deficiency. Work in the following four surveys, which were started earlier, continued during the year:— Survey of Childhood Cancers—Dept. of Social Medical Medicine, Oxford University; National Survey of Health and Development—Medical Research Council; Care of Children with Spina Bifida—Greater London Council Research and Intelligence Unit; Virus Aetiology in Mental Deficiency—Dept. of Microbiology, St. George's Hospital Medical School. FAMILY PLANNING Following the passing of the National Health Service (Family Planning) Act, 1967, consultations were held with the Family Planning Association and agreement was reached on a scheme, which came into force on 1st April, 1968, whereby the Association acts as agents of the Council for the provision of a family planning clinical service. Under this arrangement no charges are made for advice or examination or for supplies in medical or necessitous non-medical cases, and the Council makes premises available and makes an annual deficiency grant to the Association. This arrangement with the Family Planning Association made possible a significant expansion of the number of weekly sessions held in Health Department premises and at the end of the year sessions were being held at the following centres:— Central Lewisham 2 Amersham Road 1 Speedwell 1 Louise House 3 Flower House 3 Downham 1 Spalding House 1 27 Further sessions were planned for the Heathside and Lind centres in the new year. In addition, in May, a domiciliary service linked with weekly clinic sessions at the Amersham Road centre was introduced by the Health Department for the provision of the intra-uterine device to women incapable of taking advantage of the normal clinical service. These sessions usually are conducted by an experienced medical officer to this work. Referrals for this service are received from a variety of agencies. The following table gives details of the service provided during the year:— Table 14 No. of first domiciliary visits by Medical Officer 108 No. of first visits by patients to clinic 104 No. of persons aged 30 or over at first visit 48 No. of persons with 5 or more pregnancies prior to first visit 60 28 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 show Table 15 Equipment No. issued during 1968 Total stock held on stock register No. on loan at present Air Rings 28 54 50 Back Rests 66 77 77 Bed Cradles 58 94 93 Bed Pans 27 53 48 Cot Beds 1 2 1 Commodes 313 609 596 Easi-Carry Hoists 12 17 16 Easi-Carry Hoist Slings 4 13 6 Fracture Boards 26 79 72 Hospital Beds with Pulley 7 38 15 Mattress (Dunlopillo) 2 24 22 Mattress (Hair) 1 28 8 Penrhyn Bed Lifts 8 34 31 Ripple Beds 11 6 6 Rubber Sheets (6' x 3'). 40 101 90 Tripod Walking Sticks 19 50 45 Urinals (Glass) 24 28 21 Zimmer Walking Frames 77 106 106 Wheelchairs 57 59 58 Totals 781 1,472 1,361 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. 29 DENTAL SERVICES Dr. E. Mahler, M.D., L.D.S., Chief Dental Officer and Principal School Dental Officer reports Accommodation for Dental Services School for Dental Auxiliaries (4 surgeries), New Cross General Hospital, S.E.14 Deptford Schools Treatment Centre (2 surgeries), Reginald Square, S.E.8 Lewisham Schools Treatment Centre (2 surgeries), 78 Lewisham Park, S.E.13 Downham Schools Treatment Centre (2 surgeries), Churchdown, Downham Sedgehill Comprehensive School (1 surgery), Bellingham, S.E.6 Sedgehill Comprehensive School (roll 1,500) The surgery is the first opened in a comprehensive school in Lewisham. Treatments were started on 13th May, and the equipment is of the most modern type. The surgery operates daily; one out of ten sessions is devoted to orthodontics and one for children from a neighbouring school (with the kind permission of the Headmaster of Sedgehill School). Due to the generous support of the teaching and medical staff, the surgery is part of the school, it has been a great sucess from the start and demand for treatment is increasing. Preparations are in progress to open a surgery at Catford Senior Girls Comprehensive School in 1969 with identical equipment and arrangements. School for Dental Auxiliaries This establishment continues to be sponsored by the General Dental Council, and is directed by Mr. T. H. Liptrot since the retirement on 31st March of Mr. J. V. Bingay, o.b.e. It contains a clinic, 4 surgeries conducted by two dental officers and two dental auxiliaries on the staff of the Health Department. By joint agreement the school is responsible for the routine treatment of groups of schoolchildren in the Borough in addition to those of a neighbouring Authority. Routine inspections for primary schoolchildren attending 14 schools (3,419 children) have been transferred to the Borough for the time being. Mr. T. H. Liptrot, Director, reports: The School for Dental Auxiliaries has now been established for some nine years and during that time it has been able to offer to the children of Lewisham a comprehensive dental service. It is very much to the credit of the parents of the children, to head teachers, and to the officers of the Lewisham Health Department, that they have increasingly taken advantage of the facilities available. The demands now made on the school for treatment are such that we have great difficulty in meeting them as promptly as we would wish. The school is looking for ways of increasing its service and to this end there is consultation from time to time with the officers of the Health Department, whose interest and support of the school is greatly appreciated. Without such co-operation our task would be a very difficult one. The location within the school of a unit of the Borough's School Dental Service is of the greatest help to us and to the patients, The school is also greatly indebted to the head teachers of the schools served by our clinic. Their willing co-operation and readiness to assist with the arrangements for patients and for providing the means for our students to gain experience in teaching dental health is of the greatest help to us. During 1968 the students of the school inserted 7,176 fillings for school children and pre-school children, and extracted 342 deciduous teeth. 30 Orthodontics Correction of faulty and irregular positioning of teeth has expanded dramatically since inspections of secondary school children have been resumed. The orthodontist Mrs. A. Ward has increased her sessions from 6 to 8. Table 16 ORTHODONTICS 1968 1967 New Cases commenced during the year 284 330 Number of removable appliances fitted 400 288 Number of fixed appliances fitted 27 13 There has been a noticable drop of patients referred to consultants. Dental Laboratory Central Laboratories provide (as before) all orthodontic appliances, dentures, inlays etc., but the orders have not always been completed in 2 weeks owing to shortage of technicians over a considerable period. The quality of the work is of the same high standard. Anaesthesia 48 sessions have taken place during the year. Dr. A. Whitfield attends Deptford and Lewisham school treatment centres, Dr. E. C. Dawson attends Downham school treatment centre. Local anaesthesia is used extensively for routine dental treatment. One selected child had his conservative treatment carried out under intravenous anaesthesia. Dental Anaesthetic emergencies The ambulance training unit gave a demonstration on resuscitation and mouth to mouth breathing followed by a film, at Lewisham Medical Centre in July. It was attended by dental officers, dental surgery assistants, health visitors and school nurses who assist at dental anaesthetic sessions. Dental Caravan The Inner London Education Authority Caravan has been in use for 68 sessions on three four-weekly occasions. Two were in term time and extremely well attended, the third period was during the summer vacation as a trial, to assess attendance. Although the children live in close vicinity and sessions were heavily over-booked, the failure rate was higher than expected. The dental caravan is an ideal solution for bringing dentistry to schools, acceptance rates soar, but unfortunately this cannot be followed up as two caravans have to be shared between 12 boroughs. It seems essential that the number of caravans should be increased to six, to enable two neighbouring boroughs to plan their programme well in advance, including deployment of staff. Maternal and Child Health This service has been maintained, but expanded only slightly due to temporary shortage of staff. 31 Table 17 DENTAL SERVICES FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER5 YEARS A: Attendances and Treatment Number of Visits for Treatment During Year Children 0-4 (incl.) Expectant and Nursing Mothers First Visit 859 18 Subsequent Visits 1,552 61 Total Visits 2,411 79 Number of Add'l Courses of Treatment other than the First Courses commenced during year 94 1 Treatment provided during the year— Number of Fillings 1,992 61 Teeth Filled 1,755 42 Teeth Extracted 208 27 General Anaesthetics given 78 2 Emergency Visits by Patients 49 2 Patients X-Rayed 16 5 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 653 11 Teeth Otherwise Conserved 498 Teeth Root Filled 3 Inlays 2 Crowns — Number of Courses of Treatment Completed During the Year 383 6 B: Inspections Number of Patients given First Inspections During Year A 620 D 15 Number of Patients in A. and D. above who Required Treatment B 428 E 15 Number of Patients in B. and E. above who were Offered Treatment C 425 F 15 C: Sessions Number of Dental Officer Sessions (i.e. Equivalent Complete Half Days) Devoted to Maternal and Child Health: For Treatment 403.1 For Health Education 41.5 Day nurseries have been inspected twice a year, nursery schools once a year including 2 creches, inspections of children at health centres have decreased, since no dental officers could be spared for sessions. Dental Health Education, Borough Services at health centres continued throughout the year. Four dental health educators have counselled 1,910 mothers in 180 sessions, averaging 10.6 a session. The team consists of 2 dental auxiliaries and 2 dental surgery assistants. An excellent leaflet has been prepared by the Health Education department "Will your child be afraid to smile?", warning mothers about misuse of vitamin syrups. It is distributed at welfare centres and given to parents of each new school entrant. An amusing coloured card with a revised nursery rhyme "Mary had a little tooth" is very popular with the young children. A lecture was given to the dental staff, health visitors and school nurses at Lewisham Hospital by Mr. O. Berman, Reader in preventive dentistry at the London Hospital Dental School, Whitechapel. 32 Talks on dental health are given to student midwives, once every term and to mothers clubs by Mrs. P. Munday, Dental Auxiliary. Dental Health Education at Schools This continues at schools and at the chairside on traditional lines. In November a novel puppet-show dental health campaign was launched which proved to be a "spectacular hit". It was created, organised and executed by two dental auxiliaries, Mrs. P. Munday, a member of the London Borough of Lewisham dental staff, and Mrs. J. Thomas, dental health educator for the Inner London Education Authority. Under the stimulating enthusiasm of these two puppeteers, a campaign was launched in the nursery and infants departments of the schools of the Borough, and, in all, 46 schools were visited and 9,653 children watched the 80 performances. All the necessary equipment was carried in the I.L.E.A. van, all the driving being done by Mrs. Thomas. On occasions when two schools were programmed in one morning or afternoon, help was given by the Health Education section in assembling and dismantling the puppet theatre with great speed. The official opening took place after one weeks run on 11th November at Adamsrill Infants' School, Sydenham, by kind invitation of Mrs. N. G. Piper, the Headmistress and her staff. Publicity was arranged by the I.L.E.A. Special guests at the opening were the Mayoress, Mrs. Combes, Councillor Mrs. New, Chairman of the Health Committee, Mr. K. C. B. Webster, Dental Adviser, I.L.E.A. and Mrs. E. Spackman for the General Dental Council. Later performances were seen by Admiral W. Holgate, Chief Dental Officer, Mr. J. Rodgers, Senior Dental Officer of the Department of Health and Social Security, and Mr. Colin Davis, Director of Oral Hygiene. The children enjoyed the show tremendously, participating in the story of horrible Jimmy Germ tempting sweet-loving Paul Molar in the disguise of a sweet, a lolly, and a cake with very sad results. Peter Molar knew better and when he simply couldn't resist eating a delicious cake he called on all his friends for help, Mr. Giant Toothbrush, Mrs. Toothpaste, Katy Carrot, Andrew Apple and last but not least, bespectacled, kind, Mr. Dentist. The majority of children got the message. Their appreciation was shown by their charming letters, amusing drawings and funny coloured posters of Jimmy Germ, their favourite character. The heads of all schools were most co-operative, and all arrangements went according to plan. Comments were most favourable about this new and entertaining approach to the ever present problem of dental health education. It gave the staff much food for thought in following up. The campaign will be resumed later in January, 1969 when 14 more schools will be visited including some junior mixed departments for their first year pupils. It is hoped that a repeat programme will be arranged by the Chief Dental Officer in the autumn term of 1969. Since inspections of secondary school children have commenced, concentrating on first and second year pupils, one significant fact has emerged. The great majority of these children have had inspections in their infant and junior mixed schools, but a hard core of approximately 20% received no treatment whatsoever, although parents opted for their family dentists. Several random enquiries were made, children either never attended or paid an occasional emergency visit. There is a special Inner London Education form SDS 12 which some parents have now received more than once, but they take no notice. It appears that no representation can be made to force them; one has the impression that they are unaware that their children aged 12, have permanent teeth only, the children themselves don't know either. In conclusion it should be repeated that obligation to carry out dental inspections cannot be fulfilled until more premises and staff are available. Inspections have increased by 18.7% due to the opening of Sedgehill surgery and the use of the caravan. 33 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 supplied by the dental clinics: Table 18 LEWISHAM I.L.E.A. School Roll 42,721 418,280 Number of sessions: Inspection 127.8 1,928.3 Ordinary treatment 3,242.8 27,493 .3 General anaesthetic 36.8 450.5 Orthodontic 254.3 826.6 Health education 4.0 1,665.3 Total sessions 3,665.7 32,364.0 Inspections: number of children given: First inspection at school 14,279 183,925 First inspection at clinic 3,076 47,336 Percentage found to require treatment 69.2 63 .6 Reinspection at school or clinic in 1968 554 14,750 Percentage found to require treatment 75.6 69.6 Visits for treatment: Number of first visits 5,709 54,655 Number of subsequent visits 18,318 124,838 Total visits 24,027 179,493 Emergencies 731 5,298 Additional courses commenced 810 8,239 Number did not attend 9,989 91,034 Treatment given: Number of fillings: In permanent teeth 11,011 91,198 In temporary teeth 7,998 65,917 Number of extractions: Of permanent teeth 1,181 5,323 Of temporary teeth 2,720 19,167 Number of other operations (prophylaxis, X.rays, inlays, crowns, etc.) 11,036 72,740 Courses of treatment completed 3,873 43,645 Orthodontics: Number of new cases 284 779 Number of removable appliances fitted 400 1,135 Number of fixed appliances fitted 27 48 Sessional averages: First visits 1.7 2.0 Subsequent visits 5.6 4.5 Emergencies 0.2 0.2 Did not attend 3.0 3.3 Fillings: In permanent teeth 3.4 3.3 In temporary teeth 2.4 2.4 Extractions: Of permanent teeth 0.4 0.2 Of temporary teeth 0.8 .7 Ratio of permanent teeth filled to permanent teeth extracted 7.8 14.9 Ratio of temporary teeth filled to temporary teeth extracted 2.5 3.0 34 SCHOOL HEALTH SERVICE During the year the supervision of the health of the schoolchildren of the Borough has continued under the control of the School Health Service which is fully comprehensive. Liaison has been maintained with the Inner London Education Authority, The Medical Adviser's Department at County Hall, and the head teachers of the various schools within the Borough. Tt is important that there should be an exchange of information between the three sections of the Health Service, i.e. the hospital services, general practitioner services and the local authority services, with regard to the health of the Borough's schoolchildren, and this interchange has continued. The health of the Borough's schoolchildren has remained good. Children are examined by the school doctor on at least four occasions during their school life; parents are invited to attend at each of these examinations in order that any problems may be discussed. In addition to the examination soon after school entry, examinations are undertaken at seven or eight years of age, at entry to secondary school, and in the year before the child's fifteenth birthday, when consideration is given to the child's suitability for employment after leaving school. Every child has an annual hygiene inspection and vision test, and an audiometer test is carried out on all infant school entrants, and on any child whose hearing is suspect at later stages in school life. The year has been marked by further expansion of the Special Investigation Clinics where treatment is undertaken for obesity, nocturnal enuresis, and some other behavioural problems. These clinics are staffed by school doctors and social workers, and school nurses, and children are referred to them after consultation with their family doctors. Vision and hearing defects are also investigated at the vision and audiology clinics by specialist doctors. The register of handicapped schoolchildren has been maintained. The register helps to ensure that every child receives all available help, and that suitability of school placement may be kept under review. In addition it forms a basis for statistics on which the planning of future facilities may be based. For those children who, by reason of their handicap are unable to attend ordinary schools, boarding and day special schools are available through the Inner London Education Authority. The special schools situated within the Borough are as follows: Nansen School for Partially Sighted Children, 59 Pendragon Road, Downham; Meeting House Primary School for the Educationally Subnormal, Roundtable Road, Downham; Brent Knoll School for the Delicate, Mayow Road, S.E.23. In addition there is a Partially Hearing Unit for children of secondary school age in Sedgehill Comprehensive School. Children with severe hearing defects attend day schools in neighbouring boroughs, and physically handicapped pupils attend Charlton Park School in the Borough of Greenwich. The children attending Brent Knoll School who were in temporary accommodation in Beacon Road were able to move in September to the new building in Mayow Road. Special arrangements have continued to be made during the year for home tuition for those children who for health reasons are unable to attend school, and in some cases transport has been arranged for children able to attend school, but unable to make the journey by public transport. 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. 35 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 19 OBSERVATION/HANDICAP REGISTER Schoolchildren Type of School No. attending Day school No. attending Boarding school Total Physically handicapped 71 9 80 Delicate 90 31 121 Deaf 31 9 40 Partially hearing 35 2 37 Blind — 5 5 Partially sighted 23 1 24 Autistic 7 1 8 E.S.N. 457 48 505 Maladjusted 40 58 98 Other — 4 4 Hospital school — 6 6 Totals 754 174 928 Home tuition 11 Training Centre 32 Special Care Unit 28 Special Hospital 7 Approved school 9 Number of children at Woodlands O.A. School 47 Number of children at Woodlands Autistic Unit 3 Number of children at Brent Knoll O.A. School 47 Table 20 Year of Birth of School Children on Observation/Handicap Register Year of Birth No. of schoolchildren 1950 5 1951 84 1952 97 1953 137 1954 152 1955 131 1956 158 1957 153 1958 154 1959 125 1960 139 1961 123 1962 125 1963 71 1964 18 1965 7 1966 1 1,680 DEAF REGISTER Schoolchildren Many children on the deaf register manage in ordinary schools with special measures, such as a favourable position in class and/or hearing aids. Some have a bilateral loss and compensate with the good ear and are not handicapped. These children have not 36 been ascertained as needing special education. The total number of children on the deaf register is 331. Of these 6 are under school age. Table 21 Children Attending Special Schools or Units Type of School/Unit Day Boarding Total Deaf 32 12 44 Partially hearing 28 — 28 Partially hearing with additional handicap — 1 1 Physically handicapped 2 — 2 Physically handicapped with additional handicap — 2 2 Deaf/Blind 2 — 2 Delicate 1 — 1 E.S.N. 5 1 6 Maladjusted 1 1 2 Others Training Centre 4 Early Care Unit 1 Residential Care 6 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 42,721 as at May, 1968. 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 22 Lewisham I.L.E.A. Routine Inspections Number inspected 16,398 157,376 Number found not to warrant examination (7 plus 'specials scheme') — 1,060 Percentage of No. inspected of:— Parent present 53.6 51.8 Care Committee present 72.2 74.6 No. vaccinated against smallpox 71.3 72.0 No. immunised against diphtheria 91 .2 87.3 No. immunised against whooping cough 83.3 79.7 No. vaccinated against poliomyelitis 89.2 86.1 Physical condition unsatisfactory 0.1 0.4 Referred for treatment of defects 14.8 13.8 Referred for treatment of defects other than vision 8.1 7.1 Non.Routine Inspections (i) Specials 4,565 49,696 (ii) Re-inspections 5,401 71,920 Total (i) and (ii) 9,966 121,616 No. of routine inspections as percentage of school roll 38.4 37.6 No. of non-routine inspections as percentage of school roll 23.3 29.1 37 ROUTINE MEDICAL INSPECTIONS—DEFECTS Number of children noted for treatment or observation expressed as a rate per 1,000 inspected. Table 23 No. inspected Defects * LEWISHAM 16,398 Total I.L.E.A. 157,376 Skin T 11.77 8.81 O 12.50 11.25 Eyes—(a) Vision T 72.63 72.77 O 25.92 52.16 (b) Squint T 9.21 8.21 O 3.23 4.71 (c) Other T 2.32 1.68 O 4.70 2.75 Ears—(a) Hearing T 6.71 5.76 O 5.85 7.18 (b) Otitis Media T 2.01 1.66 O 2.68 3.91 (c) Other T 0.24 0.57 O 0.43 0.93 Nose and Throat T 6.83 5.55 O 24.94 26.92 Speech T 3.42 4.07 O 5.79 6.99 Lymphatic Glands T 1.22 0.58 O 9.64 7.69 Heart T 2.62 2.48 O 5.92 8.39 Lungs T 7.20 5.41 O 9.78 11.74 Developmental— (a) Hernia T 1.52 1 .12 O 4.51 2.86 (b) Other T 1.40 1 .34 O 4.09 5.58 Orthopaedic— (a) Posture T 1.04 0.97 O 4.09 4.77 (b) Feet T 4.09 3.37 O 14.39 14.96 (c) Other T 2.07 2.06 O 3.66 5.08 Nervous System— (a) Epilepsy T 2.38 1.46 O 1.59 1 .41 (b) Other T 0.30 0.72 O 0.55 1.66 Psychological— (a) Development T 0.91 1.49 O 1 .89 5.36 (b) Stability T 1.71 2.40 O 9.45 10.83 Abdomen T 0.30 0.37 O 0.43 1.24 Other T 17.44 17.34 O 32.87 35.65 *T=Treatment *= 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. 38 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 24 LEWISHAM I.L.E.A. 1. Comprehensive Surveys (a) Number examined 28,894 285,917 (b) Number (occasions) found verminous 83 3,105 (c) Percentage found verminous 0.29 1.09 2. Selective Surveys (a) Number examined 8,562 116,716 (b) Number (occasions) found verminous 141 2,712 (c) Percentage found verminous 1.65 2.32 3. (a) Total times vermin found (1(b)+2(b) 224 5,817 (b) Total % found verminous [3 (a) as % of 1 (a) + 2 (a)] 0.60 1.44 (c) No. of individual pupils found verminous 174 4,372 (d) % of individual pupils found verminous (of school roll) 0.41 1.05 4. Action taken with verminous cases (a) Advice and/or Lorexane 183 5,001 (b) Further action 41 816 (c) 4 (b) expressed as a percentage of 4 (a) 22.40 16.32 Analysis of 4(b) cases—referrals of hardcore cases to bathing centres Voluntary attendances at bathing centres No. of pupils 41 750 No. of statutory notices issued — 3 No. cleansed at centres following statutory notices Voluntarily — 3 Compulsorily — — Emphasis is placed on children being cleansed by parents at home. Other members of the family may, in the privacy that the home affords, also use the Lorexane shampoo hence eradicating a possible source to a child, of recurring infestation. 39 Table 25 NON-ROUTINE MEDICAL INSPECTIONS Type of Inspection LEWISHAM I.L.E.A. Area Reinspections 5,401 71,920 Bathing centre inspections — scabies 16 38 „ „ „ other 6 71 Employment certificates 690 4,971 Theatrical children — 293 School journeys 2,323 22,286 Recuperative holidays—pre-departure 36 908 Recuperative holidays—on return 2 8 Secondary School annual surveys — 1,554 Candidates for higher awards 8 84 Nautical school entrants — 62 Outward bound courses — 125 Infectious disease investigation 9 44 T.B. contacts — 5 Boarding schools for the Delicate—pre-departure 1 192 Boarding schools for the Delicate—on return 11 37 Handicapped pupils—statutory examination 155 2,394 Handicapped pupils—periodic special defect examination 551 5,782 Research investigations and enquiries 1 46 3,809 38,900 SPECIALS—At request of:— Head teacher—child's name entered in special book 134 1,517 Head teacher—others 214 3,438 School nurse—following health survey 146 742 School nurse—others 13 1,063 Divisional (Education) Officer 23 759 District Care Organiser or Care Committee 16 305 Parent 130 1,160 School medical officer 45 1,381 721 10,365 OTHERS:— Accident on school premises 28 44 Boxing—reference from schools, A.B.A., or similar ation — — For free travel — 64 Reference: (i) connected with remedial exercises — 59 foot classes (ii) by gymnast or physiotherapist Referred by hospital — 5 Referred by speech therapist — 3 Referred by general practitioner — 5 Miscellaneous 7 251 35 431 Total of all Non-Routine Medical Inspections 9,966 121,616 40 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 26 Percentage of number tested C—Boys and Girls Number tested 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 Treatment Noted for Observation Total noted for treatment or Observation Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Lewisham 7,996 7,147 86.3 83.6 4.0 4.4 2.6 3.9 2.6 3.9 4.4 4.1 1.7 2.1 1.0 1.9 3.9 5.4 7.9 2.8 10.7 I.L.E.A. Area 69,314 66,340 82.6 80.6 6.1 6.7 4.9 5.2 4.8 5.4 3.3 3.8 1.5 1.9 1.5 1 .8 2.8 3.9 8.4 6.1 14.5 41 Table 27 COMPARISON OF DEFECTS NOTED AT 7-PLUS ROUTINE AND 7-PLUS 'SPECIAL' MEDICAL INSPECTIONS IN 1968 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 4,335 36,657 No. inspected at 7-plus Experimental Scheme Inspections — 2,160 Defects A B A B Skin 22.8 — 20.3 19.0 Eyes—Vision 94.3 — 135.5 138.9 Squint 13.6 — 14.7 111 Other 3.5 — 4.0 3.7 Ears—Hearing 16.1 — 16.9 17.6 Otitis Media 7.4 — 5.7 11.6 Other 0.5 — 1.3 3.2 Nose and Throat 35.3 — 36.3 32.4 Speech 10.4 — 11.3 9.7 Lymphatic Glands 15.2 — 9.3 21.8 Heart 8.1 — 11.0 11.1 Lungs 17.3 — 18.8 22.3 Developmental—Hernia 6.5 — 4.5 3.2 Other 8.5 — 8.3 6.0 Orthopaedic—Posture 4.2 — 4.7 7.4 Feet 14.5 — 17.3 15.3 Other 4.4 — 6.2 8.3 Nervous System—Epilepsy 4.6 — 3.1 3.2 Other 0.9 — 2.5 1.9 Psychological—Development 30 — 9.1 16.2 Stability 12.2 — 16.2 17.6 Abdomen 0.7 — 1.6 — Other 57.5 — 59.3 82.9 Column 'A' refers to 7-plus routine medical inspections Column 'B' refers to 7-plus experimental scheme inspections 42 MEDICAL AND FAMILY SOCIAL WORK Miss E. Stocker, Dips. Social Studies and Casework, A.A.P.S.W., Principal Social Worker Social Workers continued to provide a family orientated service in both fields of work which involved offering casework help, mobilizing inter-disciplinary resources, and liaising with other statutory and voluntary agencies. Medical Social Work Medical Social Work expanded during the year, particularly with children suffering from psycho-social and physical difficulties. This was due to two factors, firstly the implementation of I.L.E.A. policy to attach School Health Social Workers to all special schools (in addition to special educational units), and secondly the increase in the number of children referred to special school clinics. The function of the social worker regarding children entered on the Deaf Register remains as before, that is to consider the child in relation to the total situation, to liaise with other agencies, co-ordinate arrangements for treatment and provide social work help as appropriate. School Health Social Workers continued to be attached to:— (a) Local Authority Clinics:— Amersham Special Investigation Clinic — Health Centre, Amersham Road, S.E.14 Speedwell Special Investigation Clinic — Speedwell Centre, Speedwell Street, S.E.8 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 — School Treatment Centre, 78 Lewisham Park, S.E.13 Sydenham Special Investigation Clinic — Children's Hospital, S.E.26 (b) Hospital Clinic:— Lewisham Hospital—Hearing Investigation Clinic (c) Special Educational Units:— Sedgehill Partially Hearing Unit Brent Knoll School Autistic Unit (d) Special School:— Brent Knoll Day Open Air School Chest Clinics The Lewisham Care Committee Organiser returned to the department after completing a two-year full-time course in social work. Reorganisation of the work of the two Care Committee Organisers resulted in both being based at Lewisham, with attendance at the Deptford Chest Clinic for three sessions per week. The Lewisham Care Committee met on six occasions during the year and the Deptford Care Committee three, when fund raising, grants, holidays and outings were discussed. Family Casework 49 families with severe social and emotional handicaps received casework help in 1968 when 1,604 home visits/office interviews were undertaken. In the majority the need was for frequent and prolonged contact and referrals came mainly from case conferences of field workers because multiple problems were presented. However, an interesting trend was that there were a few direct referrals from parents and general practitioners which enabled help to be given at an earlier stage. Amongst families referred there were a significant number with difficulties stemming from physical and mental ill health. 43 Annual Events More than 70 children attended the Christmas party at the Deptford Town Hall and a small group of mothers enjoyed a day in the country in July, free from family commitments. Co-ordinating Committee The Co-ordinating Committee met on nine occasions during the year when the overall emphasis was on social diseases. 76 case conferences were convened at the request of various agencies as follows:— G.L.C. Housing Department — 39 Probation Service — 4 Children's Service — 9 Health Department — 5 Divisional School Care Organiser — 9 Welfare Service — 4 Lewisham Housing Department — 6 Staff Two members of staff returned after successfully completing professional social work courses. One School Health Social Worker obtained the University of Southampton Diploma in Applied Social Studies and the Certificate of the Institute of Medical Social Workers, and one Chest Clinic Care Committee Organiser obtained the Certificate in Social Work. Members of staff attended seminars and lectures in connection with specific aspects of their work, and attended the following conferences and courses:— I.L.E.A. "Social Worker Attachment to Special Schools" South East Regional Association for the Deaf, "The Royal National Institute for the Deaf" I.L.E.A.,"West Indian Background" N.A.M.H., "What's Wrong with the Mental Health Service" London School of Economics, "Theory and Practice of Casework Methods" London Borough of Lewisham, Health Department, "Aspects of Mental Health" Students Placements have continued to be provided for professional and pre-professional course students for varying periods of practical work. In addition Social Administration students have visited the Section for discussion with staff and talks have been given to students from other disciplines and other departments. 44 HOME HELP SERVICE The demands on the home help service continued to increase as is shown by the figures below. The increase was of the order of 1 % in the number of households being served at the end of the year, the rate of increase being less than that of the previous year (2.5 per cent.). This is to be expected since the service mainly caters for the elderly, and the proportion of such people within the population is at the moment increasing by about 2½% per annum. During the year the pressure at Rushey Green was lessened by the opening of a fourth office at Grove Park, the case load there being made comparable to that at the other home help office. Table 28 CASES RECEIVING SERVICE AS AT 31st DECEMBER 1968 (1967 figures in brackets) Office Maternity Tuberculosis Age 65 and over Aged under 65 Chronic sick Others Total Deptford Town Hall New Cross Road, S.E.14 — 2 612 42 5 661 41 Rushey Green, S.E.6 1 5 779 92 8 885 266 Kirkdale, Sydenham, S.E.26 4 11 777 57 24 873 354 Baring Road, S.E.12 1 8 714 72 18 813 Totals 6 (11) 26 (31) 2,882 (2,739) 263 (278) 55 (47) 3,232 (3,106) No. of home helps at end of 1968:—(a) Whole time 6 (7) (b) Part time 651 (646) 45 HEALTH EDUCATION Mr. R. Allen, M.A.P.H.I., M.I.H.E., Health Education Officer This year has again seen a widening of activities as the section has grown in size and acquired more equipment. The scope of the work can be described as follows:— (a) The giving of information about the health services available by means of press releases, talks on the work of the department and the production and periodic amendment of a Guide to the Health Services. This involves close co-operation with the Borough Public Relations Officer. (b) The arranging of talks, discussions, film, film-strip, slide and tape shows on the many health and safety hazards and their prevention by immunisation, screening procedures, proper exercise and diet and changes of habit etc. Posters and pamphlets have been designed, produced and used with others available through various interested organisations. Demonstrations. (c) The arranging of in-service training lectures for staff. (d) The periodical production and distribution of a 20-page Health Bulletin (circulation 7,500). Mental Health Week in 1968 was publicised in the local press and also by means of posters and shop window displays. Talks were given and film shown on the subject of mental health to senior pupils in local schools, and the Council's training centres were opened to the public. Assistance was given towards the production of the Dental Puppet Show mentioned elsewhere in the report. As the work of the section has become known there have been increasing requests for talks, films, etc. in schools in addition to the regular sessions given by health visitors. In connection with G.C.E. subjects involving biology, talks have been requested showing the practical application of biology. The subject of family planning has also been requested but has only been given after the pupils concerned have been given a basic understanding of human reproduction. The number of students and trainee-teachers calling for help or "projects" have increased. It is particularly useful to be able to talk to future teachers, since they can pass on health education to so many of their pupils. They can also see the help that may be available to them through local authority health departments. Talks on cervical cytology led to special sessions being arranged on the premises of local industrial undertakings. A Home Safety Officer was appointed early in the year and more talks were able to be given on this subject. Health visitors and district nurses have referred 136 cases for investigation where hazards, particularly concerning the misuse of oil-heaters have been suspected. Two roads in the borough, largely consisting of houses in multiple occupation, were visited on a house to house basis to discover home safety hazards and give advice. Late in 1968 an officer, of the Civil Defence organisation, was seconded to the section. His knowledge of first-aid, home-nursing and resuscitation was immediately put to good use and he gave demonstrations and talks on these subjects to schools, mothers clubs etc. The Health Education Section distributes technical periodicals to the staff and through the Local Government Annotations Service (LOGA) arranges with the Libraries Department for reprints or copies of technical articles to be available for the staff on request. The small library held by the section is gradually being augmented, but wherever possible text-books are obtained through the Library Service with which a most useful liaison has been established. A competition, open to Health Department staff was organised in September. Individual and group entries were invited of posters, pamphlets, triptychs, mobiles 46 SOME HEALTH EDUCATION EXHIBITS "Kill that Fly" " Mental Health " " Diphtheria Immunisation " " Tuberculosis " or models with a health or home safety impact. A large number of entries were received which not only showed a high degree of skill and enthusiasm, but also showed how members of the staff put these messages across to the public. A shield, to be held for a year was presented to the winning group and a book-token given for the winning individual entry. In view of the high standard of the entries and the fact that a lot of very useful material was produced, this competition will become an annual event. Most encouraging co-operation has been received from doctors, dentists, chiropodists, health visitors, district nurses, public health inspectors and other members of the staff who, as the practising experts in the various disciplines, have given many of the talks. A panel of members of the different sections of the Health Department has helped to develop ideas and has provided such material for the Health Bulletin. Future developments include a series of half-day conferences for local teachers, organised jointly with the I.L.E.A. on the subject of Health Education in Schools with exhibitions of materials, equipment and facilities available to teachers who wish to teach health and home safety. Demonstrations and talks during the year included the following:— Table 29 Films 190 Filmstrips, slides or tapes 65 Student sessions 87 Talks by H.E. Section 93 Talks by H.V.s and Nursing Officers 727 Talks by Medical Officers 41 Talks by Chiropodist 8 Talks by P.H.I.s 7 Table 30 Lectures, Talks and Demonstrations given by Nursing Staff Number of talks Centres 604 Schools 90 Clubs 4 Hospitals 28 Shops 2 Laundry 1 Child Care Officers 2 Total 727 Subjects covered: Ante-natal: Water safety Development of foetus Prevention of burns and scalds Stages of labour Care of feet Care of expectant mothers Care of hair and skin Post-natal: Dental care Care of mother Coughs and colds Child development Fresh air and exercise Breast and artificial feeding Hearing tests, including audiometry Sterilization of feeding equipment Detection of cancer: Suitable clothing for babies and children cancer (education) Immunisation Cervical cytology Bathing and daily care of baby Self-examination of breasts Diet and welfare foods Family planning Importance of play and toys Venereal diseases Minor infections of newborn Public health services Minor accidents and first aid Careers in nursery nursing Home safety Hobbies in later life Health visitors are now teaching in junior schools as well as in secondary schools. 47 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 who employ one chief, four full-time and sixteen sessional chiropodists. This force serves the 281,140 inhabitants of Lewisham with an average appointment interval of twelve weeks. There were 4,595 (4,517) sessions during the year. Full-time staff carried out 2,397 (2,346) sessions, and part-time staff 2,198 (2,171) sessions. This gives an overall average of 88 (88) sessions per week throughout the year. Treatments numbering 1,547 (1,700) were given to 528 (543) elderly, infirm or handicapped patients transported to the clinics by the Council's vehicles. The average appointment interval for this service was 16 (15) weeks and 25 (14) visits were made to housebound persons of under pensionable age. Satisfactory appliances of a simple nature were made for 282 (35) patients. Some 156 (20) special cases were successfully resolved, these were patients whose conditions required special treatments, techniques, or drugs which it would not be economic to have generally available. NOTE: 1967 figures in brackets. Under the Council's plan for sponsoring the training of chiropodists, one student was in training at the end of the year. Further delay in commencing the clinic at Downham Health Centre was experienced but it is hoped to make a start in the New Year. The chiropody session at Lewisham Hospital was developing well. A report on Lewisham Old People's Welfare chiropody clinics was submitted after a tour of inspection; liaison was maintained throughout the year with the foot clinics provided by voluntary agencies at Methodist Mission and the Brook Lane Medical Mission. The clinic held at Louise House moved into new premises at Kingswear Health Centre, Dartmouth Road at the beginning of September. During the year, eight talks were given to various local clubs and schools and two short articles were written for the Health Bulletin. In order to contain the annual rate of growth, i.e. to prevent further lengthening of the appointment interval, at least one full-time senior chiropodist is urgently required. Slight improvement in the overall picture was dependent on there being accommodation for twelve full-time chiropodists. From a practical point of view, this means one chief, four senior and two basic chiropodists, the remainder being part-time staff. By 1972 the staff should have increased to six senior, three basic and remainder being part-time. The situation is still critical although one extra session has been allocated. Three extra sessions would be required to reduce the appointment interval to a reasonable level. This however would not allow for any future development which will require a decision regarding chiropody transport in general. The need for expansion of the chiropody service is manifest and the provision of suitable premises to allow for the necessary increase in the service is going ahead as quickly as possible. It is hoped that clinics will be opened at the Lind Health Centre in Oxestalls Road, Pepys Estate, Deptford, and at Downham Health Centre during 1969. A further clinic is planned for the new Health Centre, Stanstead Road, due to be completed during 1971 and, in the future development of certain other health centres, chiropody will be considered as an integral part of the services provided. 48 Table 31 ANALYSIS OF BOOKINGS AND ATTENDANCES AT FOOT CLINICS Bathing Centre Deptford Amersham Road S.E. 14 Kingswear Dartmouth Road Sangley Road S.E. 6 Totals 1968 1967 1968 1967 1968 1967 1968 1967 1968 1967 Sessions 88 96 1,887 1,745 1,036 1,114 1,584 1,567 4,595 4,517 Bookings 809 819 13,476 13,812 6,528 6,670 11,116 10,782 31,929 32,083 Attendances 689 690 12,198 12,505 5,974 6,059 9,995 9,738 28,856 29,001 Failure to attend 120 120 1,278 1,307 554 611 1,121 1,044 3,073 3,082 Table 32 STATISTICAL SUMMARY OF ATTENDANCES 1968 1967 Number of sessions 4,568 4,517 Appointment bookings 31,929 32,083 Children of or below school age 2,015 1.454 Adults: Male 5,335 5,424 Female 21,510 22,123 Total 26,841 27,547 Fee paying attendances (adults) 7,333 8,233 Free attendances (adults) 21,523 20,768 Table 33 NEW CASES ATTENDANCES ANALYSIS Age groups Number attending clinics 1968 1967 0-4 9 2 5-14 227 181 Males 15-64 109 114 Females 15-59 258 320 Males over 65 179 173 Females over 60 435 520 Total 1,217 1,310 49 MENTAL HEALTH Miss Z. Mason, B.A., A.I.M.S. W., Principal Mental Health Officer During the year 219 mentally subnormal and 323 mentally ill persons were referred to the department; at the end of the year a total of 1,087 mentally disordered persons were receiving some form of community care. Social Work A team of fourteen social workers provide a case-work service to mentally disordered persons and their families. For this purpose the Borough is divided into districts and each social worker has responsibility for all non-urgent referrals from his district. Casework is supervised in the South of the Borough by the Assistant Principal Mental Health Officer, and in the North by a Senior Mental Health Officer. One social worker specialises in alcoholism and problems of addiction. She liaises closely with the Alcoholics Unit, Bexley Hospital. Two social workers are mainly concerned with individuals placed in residential accommodation provided by the Borough at 'Honor Lea' Hostel, or in voluntary homes or hostels. Close liaison is maintained with the catchment area hospitals—Bexley Hospital, Dartford Heath; Cane Hill Hospital, Coulsdon Surrey; Darenth Park Hospital, Dartford, Kent. A monthly case conference is held at Bexley Hospital and is attended by all social workers. A social worker who has a special responsibility to liaise with subnormality hospitals, visits Darenth Park Hospital once a fortnight. Emergency Work Mental health social workers are appointed by the Borough as "Mental Welfare Officers" under Section 6 of the Mental Health Act, 1959, and carry out statutory duties on a rota basis. After 10 p.m. on week days and at week-ends the rota is operated jointly with the Borough of Greenwich. During the year the section received 333 calls requesting immediate action with a view to hospital admission. Guardianship Formal guardianship under the Mental Health Act, 1959, provides powers of control which may be necessary in the case of a small minority of mentally disordered persons for their own welfare or for the protection of other persons in instances when admission to hospital is not considered necessary. The Guardian may be either the local health authority or another person, but in the latter case, the sanction of the Authority has to be obtained before guardianship has any effect. The powers of a Guardian may be described as equivalent to those of a father over a child under the age of 14. There is only one person under formal guardianship to this Authority at present; she is a 22-year old severely subnormal girl whose mother is so mentally incapacitated as to be incapable of taking any responsibility or having any contact with her daughter. The girl is cared for by a foster mother under the auspices of the Guardianship Society, Brighton. She is visited and taken out by the Assistant Principal Mental Health Officer, who reports favourably on the care and attention she receives. The girl looks forward eagerly to these visits and they have undoubtedly helped; her behaviour and outlook have improved considerably by the personal attention she receives. Such visits are also made whenever possible to children and adults who are maintained by this Authority in registered homes but who are not under formal guardianship, to ensure that they are receiving adequate care and attention. These visits are helpful not only to the clients but also to the persons in whose care they are; the interest shown is appreciated and the support offered welcomed. In many instances the knowledge that these visits are made have also been helpful to the relatives. 50 Services for the Mentally Handicapped The Special Advisory Clinic The Special Advisory Clinic for mentally retarded children under the age of five years continued to be held at the Central Lewisham and Amersham Road Health Centres. During the year 39 sessions were held and 188 appointments were offered. The Early Care Unit The fifteen places at the Early Care Unit at Shaftesbury House Day Nursery were fully occupied, but there continued to be a waiting list for admission. Priority is given to children from families with social problems and to those who urgently need the training and stimulation the unit can provide. The Council agreed to maintain a third child at the creche run by the Greenwich Society for Mentally Handicapped Children and this helped to ease the waiting list. Training Centres The Lewisham Junior Training Centre has been fully occupied during the year. At the end of the year there were 109 Lewisham children on the roll and six from other boroughs. There was no waiting list in December 1968 but the numbers of children rising five years who will need training centre placement in 1969 and 1970 gave cause for concern. Although the numbers of children from other boroughs is gradually reducing and no new admissions are being accepted, it was felt that there would be a need for a second junior training centre within the next few years. A 60-place junior centre with a special care unit for 18 children has been written into the Ten Year Plan. The twelve-place special care unit for children with multiple handicaps continues to be under heavy pressure. Plans are in hand to add another six places in 1969. Some of the children attend part-time to give relief to as many families as possible. The total number of adults attending the two adult training centres at the end of the year was 112; 15 of these were from the Borough of Lambeth. Both adult centres will move to better premises in 1969. This is a temporary measure until the proposed 140-place, purpose built training centre is erected in central Lewisham and is ready for occupation. Annual Seaside Holiday 37 trainees from the three training centres, accompanied by members of the staff, joined the annual seaside holiday organised on behalf of the Inner London Boroughs by the London Borough of Hammersmith, at St. Mary's Bay, Dymchurch. An innovation this year was a group holiday for twenty children aged 5-7 years who were too young to be considered for the first holiday. This was organised by the supervisor of the junior training centre and the children were accompanied by the centre staff. Short Term Care Short term residential care to give relief to their families was provided for 36 children and 27 adults. 11 of these were accommodated in hospitals and 52 in approved homes. Long Term Care Obtaining places for individuals requiring long-term residential care continued to be difficult, especially for children. Admissions to hospitals were arranged for 1 adult and 7 children. Places in approved homes were found for 7 adults and 8 children. The total number now being maintained at the Council's expense is 43. Mental Subnormality Advisory Committee The Committee met twice during the year. Its membership comprises a consultant psychiatrist from the catchment area hospital, a general practitioner and senior officers of the Health Department and Medical Adviser's Department, County Hall. The Committee gave valuable advice on planning the services for the mentally handicapped. 51 Services for the Mentally III Liaison for Services concerned with the mentally ill The Psychiatric Liaison Committee, comprising consultant psychiatrists from Bexley and Cane Hill Hospitals, a general practitioner, a representative from the Welfare Department and Senior Officers of the Health Department met quarterly to discuss matters of policy and planning. Monthly meetings were held for mental health social workers, staffs of establishments for the mentally ill, hospitals' consultants and social workers. Representatives of the Welfare and Children's Departments attended, and from time to time, members of other sections of the Health Department. This proved a valuable forum for ironing out general problems of policy and procedure, and for integrating all services having a concern for the mentally ill. Honor Lea Hostel The hostel continued to be fully occupied for the first 9 months of 1968. There was a falling off in referrals during the last quarter of the year and there were 45 out of a possible 51 at the end of the year. In June, 1968 a self-care-unit comprising three bed-sitting rooms, dining room and kitchen, was set up in order to provide a further stage in rehabilitation for those who need to gain confidence in budgeting and catering for themselves, before moving out into the community. The unit accommodates three persons who are expected to do their own housework and to shop and cook for themselves. Other facilities of the hostel, including advice from the warden and his staff, continue to be available to them. The project has proved successful and a second self-care unit is to be set up in 1969. During 1968 the total number of admissions to the hostel were 33. Of the 35 who left the hostel during the year, 20 returned to their own homes or to lodgings or other hostels; 15 were re-admitted to hospital, 7 of these returned to "Honor Lea" after a short period of treatment. A rule of the hostel is that all residents must be willing and able to work. The work record of the residents continued to be very good and the absentee figures were below the national average. Three group holidays for a total of 25 residents unable to make their own arrangements were organised at Ramsgate. These groups were unaccompanied by members of staff, but they went to the care of an experienced landlady, well known to the department. Day Centres During the year 64 patients were admitted to the two day centres. At the end of the year there was a total of 64 on the register. 26 returned to outside employment during the year. The Supervisor of the New Cross Day Centre was given the additional responsibility for negotiating contracts for industrial work for the two day centres and the adult training centres. A steady flow of varied types of industrial work was maintained throughout the year. Gross earnings from industrial contracts at the day centres were approximately £2,500. £1,840 was spent on fares and ex gratia payments to persons attending the centres. Social Clubs Weekly meetings of the two social clubs continued to be held. An innovation this year was a group holiday for three members of the Tideway Club financed out of club funds. Therapeutic Group A new feature this year was the introduction of a weekly group meeting under the leadership of a social worker experienced in group work. This is for selected patients only. Over the year 32 patients, including six married couples, have attended the group. 52 Staff Training One social worker and one member of the training centre staff were seconded for the second year of their full-time training courses. Another social worker was seconded for one year to the London School of Economics to complete his professional training as a psychiatric social worker, and a supervisor-instructor from the Brockley Training Centre was seconded to Durham Technical College on a one-year course leading to the diploma of the Central Training Council for Teachers of the Mentally Handicapped One social worker and two day centre supervisors attended day release courses organised by the London Boroughs Training Committee. An innovation this year was a two-week in-service training programme for newly appointed mental health social workers, organised by Bexley Hospital. Student Attachments The section continued to play an active part in the training of students. One-day visits of observation by nursing, health visitor, child care, teaching and social science students took place regularly. During 1968 case-work training was provided for five students from full-time social work courses and two students from social science diploma courses. Three students from the course for Teachers of the Mentally Handicapped came to the junior training centre for their practical work. Mental Health Week 10th—18th June, 1968 The Borough took part in Mental Health Week, organised nationally by the National Association for Mental Health and locally by the Lewisham Association for Mental Health. The Council's mental health establishments were open to the public and members of the mental health team gave talks and showed films to senior classes at six schools in the Borough. Parties of senior school children visited our centres and showed a keen interest. Co-operation with the Voluntary Organisations Throughout the year close links have been maintained with the Lewisham Society for Mentally Handicapped Children, the newly forried Lewisham Association for Mental Health and many other voluntary organisations. In particular we would like to acknowledge the help given by the Brighton Guardianship Society in finding both permanent and short-term accommodation for the mentally handicapped, and the Mental After-Care Association who have provided hostel accommodation for the mentally ill. 53 PREVALENCE OF and CONTROL OVER INFECTIOUS AND OTHER DISEASES NOTIFIABLE DISEASES Under the Health Services and Public Health Act, 1968, and the Public Health (Infectious Diseases) Regulations, 1968, which came into operation on 1st October 1968 the following diseases are now to be notified to the Medical Officer of Health:— Acute encephalitis Measles Acute meningitis Opthalmia neonatorum Acute poliomyelitis Paratyphoid fever Anthrax Plague Cholera Relapsing fever Diphtheria Scarlet fever Dysentery (amoebic or bacillary) Smallpox Food poisoning Tetanus Infective jaundice T uberculosis Leprosy Typhoid fever Leptospirosis Typhus Malaria Whooping Cough Yellow Fever NUMBER OF NOTIFIED CASES (Corrected for revised diagnosis) during the year 1968 with comparative figures for the previous six years. Table 34 Diseases Cases notified 1968 1967 1966 1965 1964 1963 1962 Anthrax — 1 — 1 — — 1 Diphtheria — — — — — — — Dysentery 46 90 152 159 226 870 234 Encephalitis (acute) 1 — — — — — — Enteric or typhoid fever 2 3 1 1 2 12 4 Erysipelas (To 30.9.68) 4 16 18 19 20 7 2 Infectivejaundice (From 15.6.68) 21 — — — — — — Food poisoning 20 22 34 20 19 13 19 Malaria 1 — — — 1 — 2 Measles 799 2,561 2,017 3,014 1,553 3,186 544 Meningococcal infection 16 — 3 1 2 1 4 Ophthalmia neonatorum 1 5 3 3 1 5 1 Pneumonia (To 30.9.68) 20 43 35 37 35 75 36 Poliomyelitis (acute) — — — — — — — Puerperal pyrexia (To 30-9.68) 11 67 36 75 55 47 74 Scarlet fever 105 174 82 161 197 103 71 Tuberculosis 132 116 148 157 203 210 191 Whooping cough 146 130 169 108 190 258 54 TOTALS 1,325 3,228 2,698 3,753 2,503 4,806 1,249 54 Table 35 NOTIFICATIONS OF INFECTIOUS DISEASES IN 1968 SHOWING SEX AND AGE GROUPS Disease Under 1 1- 3- 5- 10- 15- 25- 45- 65 + Total M F M F M F M F M F M F M F M F M F M F Dysentery 3 3 2 5 3 3 5 6 3 1 3 1 1 3 1 2 — 1 21 25 Encephalitis — — — — — — — 1 — — — — — — — — — — — 1 Erysipelas (to 30.9.68) — — — — — — — — — — — 1 — — — 1 1 1 1 3 Food Poisoning 1 — 4 — 1 2 1 2 1 — 2 1 1 1 — 1 — 2 11 9 Infective Jaundice (from 15.6.68) — — — — — 1 — — 1 1 7 4 4 2 — 1 — — 12 9 Malaria — — — — — — — — — — — — 1 — — — — — 1 — Measles 19 19 135 113 107 133 132 119 6 1 2 7 1 5 — — — — 402 397 Meningococcal infection 3 — — 2 — — 5 — 1 — 2 — — 1 1 — — — 12 4 Opthalmia Neonatorum 1 — — — — — — — — — — — — — — — — — 1 — Paratyphoid B — — — — — — — — — — — 1 — — — — — — — 1 Pneumonia (to 30.9.68) — — — — — — — — — — 1 1 — — 3 7 3 5 7 13 Puerperal Pyrexia (to 30.9.68) — — — — — — — — — — — 5 — 6 — — — — — 11 Scarlet Fever — — 3 2 15 10 30 32 — 8 2 1 2 — — — — — 52 53 Tuberculosis — — 3 1 1 — 1 3 — 4 5 11 25 21 26 9 15 7 76 56 Typhoid — — — — — — — 1 — — — — — — — — — — — 1 Whooping Cough 5 5 18 9 20 28 21 34 — 3 — 3 — — — — — — 64 82 55 MEASLES The number of cases was the lowest since 1962, but no significance can be attached to this fact, such a drop being expected as the numbers in the last "off" year were relatively high in this illness which normally makes a biennial appearance. DYSENTERY Another encouraging year, the figures being nearly half those of the previous year which was the lowest recorded. As this illness can so easily become prevalent again constant observation of the rules of hygiene is essential. SCARLET FEVER There were 105cases compared with 174in the previous year. This cannot be considered other than normal incidence, the figures having fluctuated between 71 and 197 during the past decade. WHOOPING COUGH The year produced 146 cases compared with 130 in the previous year. No special comment is called for as the figures were not abnormally high when related to the occurrences over the past decade. Table 36 TUBERCULOSIS NOTIFICATIONS AT AGES New cases notified Age periods Respiratory NonRespiratory Totals M F M F M F 0- — — — — — — 1- — 1 — — — 1 2- 4 — — — 4 — 5- 1 2 — 1 1 3 10- — 4 — — — 4 15- 1 4 — 1 1 5 20- 4 5 — 1 4 6 25- 10 8 2 3 12 11 35- 13 9 — 1 13 10 45- 11 4 — — 11 4 55- 15 5 — — 15 5 65- 12 2 1 1 13 3 75+ 3 3 — — 3 3 TOTALS 74 47 3 8 77 55 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: This year has seen a slight increase in the number of tuberculosis notifications. This emphasizes the need for continued vigilance in the prevention and control of tuberculosis. The new cases seen at the Lewisham Chest Clinic have risen from 44 in 1967 to 57 in 1968. This figure comprises 33 men, 21 women and 3 children The total tuberculosis register has been reduced by 177 to 1,370. B.C.G. was given to 178 infants and children. The health visitors carried out 4,167 home visits. The total clinic attendances (excluding after care) were 19,823; new patients attending for clinical examination numbered 1,994. This year we have seen more new cases of cancer of the lung than ever before, the increase being 25% on the figures for 1967, and the number of cases more than 56 double the tuberculosis notifications. During this year a special weekly session has been arranged for the investigation of the problems of asthma, and allergic conditions affecting the respiratory tract. 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: Though pleasure should rightly be expressed if the number of individuals dying from tuberculosis is decreased, I am not so sure that one should look forward to a decrease in tuberculosis notification without caution. If the case-finding services are proceeding at full tilt, then all is well if a drop occurs. But the fight may not be sufficiently sustained if this clinic is moved two miles away into the new Greenwich District Hospital. Such a move may impair our contact with known tuberculosis cases in North Lewisham, still 1,097 in number, to vanishing point. Carrington House, the nearby lodging house, at present furnishes us with many of our cases of tuberculosis, new and old. If this clinic moves far away from Carrington House, I think that all our carefully built-up contacts with these men may virtually cease. They will not, in my view, come two miles into Greenwich for treatment. The mass radiography unit does yeoman service every six months in visiting Carrington House, but speaking from the receiving end I know that, despite their efforts, on average only 100 or so of the total potential of 734 inmates actually get an x-ray done, and some of these are already known to me and attending the clinic. A significant percentage, though detected, disappear even before this clinic can interview them, and the appointments are usually given immediately after discovery. If the clinic moves away, follow up will become even more difficult. The other main point with regard to notifications concerns the criteria of diagnosis of tuberculosis. It has seldom been my policy to notify all the smallest or minimal cases of tuberculosis, though I search through the contacts. Some physicians, not necessarily local, are willing to notify some strongly positive tuberculin skin reactors with negative x-ray findings, and yet other general hospital physicians, not always nearby, sometimes omit notification of quite severe bilateral positive cases. It has always been difficult to obtain notification, and therefore knowledge of contacts, of non-pulmonary tuberculous conditions, such as renal or gynaecological tuberculosis. So even now the picture of tuberculous notification may be incomplete. With regard to deaths from tuberculosis, I also find frequently that if tuberculous patients die primarily from some other cause such as bronchitis or even pneumonia, then pulmonary tuberculosis may not be mentioned on the death certificate, even though it must have been, in my view, a major factor in the patient's decease. There were 95 new cases of respiratory tuberculosis in 1968, 24 of which were bacteriologically proved soon after diagnosis. There were also 6 non-respiratory notifications making a total of 101 new tuberculosis cases in all. This comprised 45 men, 41 women and 15 children. These numbers do not include a fairly large number of inward transfers of known tuberculosis cases from other clinic areas. I do nine sessions at the clinic and my assistant has now had his three sessions increased to four to help cope with the heavy case load. All patients attending are examined as well as having chest x-ray and other necessary tests. This involves more work, but is clinically rewarding. Some centres have huge attendance figures, but comparatively few patients actually seen by the physician, so 5,672 attenders last year meant a great deal of work. B.C.G. was given to 139 contacts or other adults found tuberculin negative. The health visitors carried out 1,943 home visits, 1,315 successful and 628 unsuccessful. The clinic had knowledge of 32 new cases of lung cancer during 1968, of which 26 were diagnosed here. Many cases of chest infections were dealt with through the year, and chronic bronchitis, emphysema and bronchial asthma remain some of the main problems. Heavy smoking of cigarettes is a notable feature of Deptford life and exacerbates many chest affections. 57 MASS RADIOGRAPHY UNIT I am indebted to Dr. Morgan, the director of the unit, for information of work done in the borough during 1968 on which the following tables are based. Table 37 Patients Men Women Total General analysis: X-rayed 4,262 3,479 7,741 Previously x-rayed 2,405 1,510 3,915 Reviewed 179 97 276 Abnormal after review 151 70 221 Analysis of abnormalfilms: Cases considered tuberculous (a) No further action required — — — (b) Occasional supervision only 4 3 7 (c) Requiring treatment 13 2 15 (d) Still under investigation — — — (e) Refused further investigation — — — Previously known tuberculous cases 14 6 20 Non-tuberculous cases (a) Investigated (See table 38 for detailed breakdown) 25 16 41 (b) Still under investigation 4 3 7 Cardio-vascular lesions 26 22 48 Abnormalities requiring no action 65 18 83 Table 38 NON-TUBERCULOUS ABNORMALITIES MEN WOMEN Carcinoma of bronchus 5 Fibrosis 3 Sarcoidosis 2 Pneumonitis 10 Bronchiectasis 1 Chronic bronchitis 1 Pneumonitis 9 Pleural thickening 1 Chronic bronchitis 1 Iron deficiency anaemia 1 Fibrosis 3 Pleural thickening 3 Asthma 1 Eosinophilic infiltration 1 Poly arteritis nodosa 1 25 16 58 Table 39 Cases of tuberculosis requiring treatment or close supervision NOT PREVIOUSLY EXAMINED (included in previous columns) NUMBERS CASES Men Women Total Men Women Total Men Women Total Men Women Total Small Public Surveys 123 166 289 — — — 89 123 212 — — — Public Surveys—Examination of Special Groups 603 349 952 — — — 177 189 366 — — — Regular Site (New Cross) 1,636 1,635 3,271 2 — 2 637 964 1,601 2 — 2 Firms Hospitals, Colleges etc. 1,204 1,084 2,288 3 1 4 738 580 1,318 2 — 2 Homes and Hostels 179 17 196 7 — 7 91 16 107 6 — 6 TOTAL 4,262 3,479 7,741 13 2 15 1,857 1,969 3,826 11 — 11 59 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 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 40 IMMUNISATION AND VACCINATION Type of vaccine or dose Primary courses completed Year of birth Others underage 16 yrs. Total 1968 1967 1966 1965 196164 Diphtheria 1,971 2,060 240 105 414 163 4.953 Whooping Cough 1,962 2,038 233 104 133 17 4,487 Tetanus 1,971 2,062 243 105 422 267 5,070 Polio 826 2,884 363 156 536 228 4,993 Reinforcing dose Diphtheria 3 1,540 1,430 229 3,087 924 7,213 Whooping Cough 1 1,480 1,363 192 744 152 3,932 Tetanus 3 1,540 1,442 228 3,103 1,001 7,317 Polio — 26 27 25 2,979 785 3,842 Smallpox Vaccination Age at date of vaccination Months Years Total 0-3 3-6 6-9 9-12 1 yr. 2-4 yrs. 5-15 yrs. Vaccination 41 30 62 56 2,114 969 160 3,432 Re-vaccination — — — — — 57 184 241 LABORATORY FACILITIES The following represents work carried out by the Southern Group Laboratory on behalf of the Council during 1968. Table 41 Specimens Number Remarks Faeces 330 Negative 18 Shigella sonnei 6 Salmonella typhimurium 4 Salmonella panama 2 Salmonella Enteritidis 1 Staphylococcus aureus Swabs from nose and throat etc. 5 Negative 1 B-haemolytic streptococci Water (various) 3 Food 16 Milk 4 Earth 9 399 60 ENVIRONMENTAL HEALTH Mr. A. J. Phillips, M.A.P.H.I., Chief Public Health Inspector During 1968 a more comprehensive record of visits paid by the health inspectors and technical assistants has been kept and a total of over 42,000 inspections was recorded. Of this number over 30,000 visits were made to dwelling houses for various reasons which are set out in the table. This shows the very wide field covered today by the health inspectors. Housing 14 further clearance areas involving 175 properties and 476 persons were dealt with during the year, a considerable increase compared with 1967. There was a rise in the number of Closing Orders made and this was accounted for by the effect of the flooding in September of houses in the Lewisham area where it was necessary to rehouse some of the occupants. The work of dealing with houses in multiple occupation continued at a satisfactory rate and again emphasis was placed on the fire prevention requirements. There was an increase in both discretionary and standard grants during 1968. It is hoped however that new legislation will help to make a very considerable increase in the improvement of existing houses. Public Health Acts There was a slight increase in both the formal and informal notices served under the Public Health Acts, 1936 and 1961 although it will be noted in the detail of repairs carried out that the figures are a little less than the previous year. The principal defects were again roofs, gutters, floors, dampness and wall and ceiling plaster. Food There was an increase in the tonnage at the Continental Depot and a number of samples were found to be incorrectly or insufficiently labelled and this was brought to the notice of the countries concerned. Samples submitted to the public analyst showed less than 5% to be non genuine and most of these related to labelling offences which were rectified after contact with the manufacturers. An increase in the number of bacteriological samples was possible during the year, a total of 160 being submitted for examination. It is pleasing to note that in only two cases was there an adverse report. Atmospheric Pollution The Bell Green Area involving 4,208 properties came into operation during 1968. There remain only two redevelopment areas not covered by smoke control orders and properties in these areas are being vacated at a steady rate. Complaints relating to pollution from factories and other sources have been investigated and steps taken to reduce this pollution. Guidance in relation to the height and construction of chimneys was given in a number of cases where new installations were involved. Offices and Shops The figures show a slight increase in the number of premises registered and receiving a general inspection. There was also a slight increase in the number of persons employed. It is regretted that it was necessary to institute legal proceedings in the case of one serious accident. It is surprising to note that the number of cases where there was no proper first-aid box or a thermometer shows no reduction. 61 Pests and Verminous Conditions Although there was a slight drop in the number of rat complaints, there was a sharp increase in the number of inspections for mice infestation. This is felt to be due to carelessness in many cases in the proper storage of food. It was possible to carry out seven block control schemes involving 323 premises during 1968 compared with 2 schemes and 48 properties in 1967. Last year a rise in verminous cases and treatment for scabies was reported. It was hoped that this was only temporary and would improve with better housing conditions. This has however not been the case. During 1968 555 verminous children and 644 adults were treated compared with 512 and 439 respectively in 1967. 682 children and 403 adults were treated for scabies compared with 517 and 360 in 1967. The number of rooms treated increased from 965 to 1,296 but there was a drop of nearly 5,000 in the articles required to be disinfected. It is hoped that the figures for 1969 will show a downward trend. 62 Table 42 SUMMARY OF INSPECTIONS BY PUBLIC HEALTH INSPECTORS AND VISITS MADE BY TECHNICAL ASSISTANTS Reason for Visit Type of premises Animal Boarding Establishments Food Shops Chemists Common Lodging Houses Dwelling Houses Factories Hairdressers Multiple Stores Off Licences Pet Shops Public Houses Restaurants and Cafes Schools Wholesale Shops and Warehouses Other Types of Premises Sites Markets, Stalls, etc. Offices Totals Canteens — 12 — 1 — 10 — 6 3 — 3 11 26 12 32 — — — 116 Clean Air Act — 29 — — 521 57 — — — — 1 — 1 1 13 15 — — 638 Clearance Areas — — — — 517 — — — — — — — — — — — — — 517 Complaints — 67 5 — 5,704 29 6 13 5 3 13 15 9 4 182 90 1 9 6,155 Consumer Protection Act — 8 — — 5 1 — 6 — — 22 7 6 12 13 — 37 — 117 Drainage — 28 — — 1,162 10 5 — 2 — 26 25 58 6 98 136 — 6 1,562 Fish Curing — 6 — — — — — — — — — — — — — — — — 6 Fish Frving — 22 — — — — — — — — — 9 — — 11 — — — 42 Food Poisoning — — — — 65 2 — — — — 1 2 7 1 14 — — — 92 House to House — — — — 24 — — — — — — — — — — — — — 24 Houses in Multiple Occupation — — — — 1,685 — — — — — — — — — — — — — 1,685 Housing Act, Section 9 — — — — 130 — — — — — — — — — — — — — 130 Housing Act, Section 16 — — — — 293 — — — — — — — — — — — — — 293 Ice Cream — 29 — — 1 3 — 4 2 — — 10 — — 1 — 5 — 55 Improvement Area — — — — 751 — — — — — — — — — — — — — 751 Improvement Grant — — — — 1,407 — — — — — — — — — — — — — 1,407 Infectious Diseases — 1 — — 220 — — — — — — 1 1 — 5 — — — '228 Infestation — 12 — 2 286 1 5 5 2 — 6 22 2 — 31 3 — — 377 Milk — 53 — — — — — 8 — — — — — — — — — — 61 Mortgages — — — — 1,158 — — — — — — — — — — — — — 1,158 Notice of Builder — 16 — — 453 27 1 — — — 3 2 — 35 56 127 — — 720 Offices, Shops and Railway Premises Act — 246 7 — — 6 49 25 10 1 96 220 1 10 539 1 — 223 1,434 O.S.R. Accidents — 24 1 — — — — 11 1 — — 3 2 1 5 — — — 48 Outworkers — 1 — — 62 1 — — — — — — — — — — — — 64 Pharmacy and Poisons Act — 66 4 — — 1 2 26 — 1 — — — 2 61 — — — 163 Pressed, Potted and Pickled Food — 17 — — — — — 1 — — — — — — — — — — 18 Rag Flock etc. Act — — — — — — — — — — — — — — 9 — — — 9 Rent Acts — — — — 12 — — — — — — — — — — — — — 12 Rodent Control — 28 — — 131 — 4 — — 1 3 11 1 1 19 8 — — 207 Sampling — 95 3 — 1 1 — 43 3 — 2 5 — 1 29 — 1 — 184 Sausage Manufacturer — 16 — — — 6 — — — — — — — — — — — — 22 Unsound Food — 179 — — 54 4 — 97 1 — 65 27 23 107 33 — 3 — 593 Food Hygiene — 393 2 3 28 34 — 81 7 — 322 857 25 31 119 — 507 2 2,411 Housing Applications — — — — 222 — — — — — — — — — — — — — 222 Registered Premises — 130 — — — 116 194 3 — 7 15 4 — 1 — — — — 470 Immigrants — — — — 384 — — — — — — — — — — — — — 384 Miscellaneous — 580 3 — 1,623 372 24 17 1 9 44 40 10 4 1,065 133 12 119 4,056 Flood Incident — 1 — — 3,023 — — — — — — — — — 5 — — — 3,029 Re-visits — 252 2 1 10,592 980 89 27 2 1 70 145 77 8 485 336 20 9 13,096 Totals — 2,311 27 7 30,514 1,661 379 373 39 23 692 1,416 249 237 2,825 849 586 368 42,556 63 Table 43 SUMMARY OF NOTICES SERVED Informal notices: Public Health Act, 1936 849 Factories Act 12 Housing Act, 1957 3 Housing Act, 1961 4 Offices, Shops and Railway Premises Act, 1963 240 Total 1,108 Statutory notices: Public Health Act, 1961 97 Public Health Act, 1936 387 Clean Air Act, 1956* 46 Housing Act, 1957 3 Housing Act, 1961 26 Byelaws 67 Prevention of Damage by Pests Act, 1949 2 Factories Act, 1961 2 Total 630 * The 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 was 390 after informal action; 427 after the service of Abatement notices and, 2 as a result of Abatement Orders. Table 44 DETAILS OF REPAIRS CARRIED OUT Repairs Total Brickwork repaired 25 Chimneys and flues repaired 6 Dampness remedied 575 Doors and door frames repaired or renewed 43 Drains cleared 50 Drains repaired 8 Dry rot remedied 9 Dustbins supplied 9 Fire grates etc., repaired or renewed 9 Flooring repaired or renewed 126 Flushing cisterns repaired, renewed or cleansed 41 Flush pipes repaired or renewed 3 Glazing 4 Gutters repaired 104 Gullies renewed, repaired or cleansed 28 Refuse cleared 20 Rainwater pipes cleared 29 Roofs repaired 223 Sashcords renewed 112 Sinks replaced 44 Soil pipes repaired, ventilated or renewed 32 Walls and ceilings cleansed — Walls and ceiling plaster repaired 191 Water closets repaired or renewed 73 Water service pipes repaired or renewed, water supply restored 23 Windows and frames repaired or renewed 77 Yards and areas paved 11 Other repairs 46 TOTALS 1,921 64 FACTORIES Section 7 of the Factories Act, 1961, requiring the provision of sufficient and suitable sanitary conveniences is enforced by the council in all factories, whether mechanical power is used in the factory or not. The provisions of sections, 1, 2, 3, 4 and 6 relating to cleanliness, overcrowding, the maintenance of a reasonable temperature, the securing of adequate ventilation of workrooms and the furnishing of adequate means for draining floors where wet processes are carried on, are enforced by the council in factories in which mechanical power is not used. The provisions of section 7 are also applied to certain building operations and works of engineering construction, etc. A local authority is required to keep a register of factories 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 mechanical 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 45 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 16 18 — — (ii) Factories not included in (i) in which section 7 is enforced by the local authority 673 566 12 — (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 85 85 — — TOTAL 774 669 12 — Table 46 CASES IN WHICH DEFECTS WERE FOUND Defects No.of defects Prosecutions instituted Referred Found Remedied ToHM Inspector By HM Inspector Want of cleanliness (S1) — — — — — Overcrowding (S 2) — — — — — Unreasonable temperature (S 3) — — — — — Inadequate ventilation (S 4) — — — — — Ineffective drainage of floors (S 6) — — — — — 65 Sanitary conveniences (S 7): (a) insufficient 1 1 — — — (b) unsuitable or defective 12 12 — 1 — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to outwork) — — — — — TOTAL 13 13 — 1 — 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 47 Trade Outworkers employed Clothing 89 Boxmaking 3 Millinery 7 Rosettes 1 Lace 6 Brushes 1 Jewellery 4 Wigs 2 Leatherwork 2 Plastic goods 1 Rubber sheets 1 116 The inspectors made 64 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 48 Abstract of the Act not displayed 168 Absence of a thermometer 104 Absence of a first-aid box 114 Absence of a hot water supply 48 66 Other matters to which it was necessary to draw attention were: Table 49 Insufficient heating 6 Insufficient lighting 18 Condition of floors and staircases 28 Insufficient washing facilities 12 Facilities for drying clothes 6 Insufficient ventilation 6 Insufficient sanitary accommodation 6 Absence of drinking water — Lack of seating facilities — Poor standard of cleanliness 14 Overcrowding — Deficient sanitary accommodation 14 Deficient washing accommodation 6 Reinspections were made to ascertain whether these matters had been put right and where this was not so, further action was taken to enforce compliance. The number of registered premises in 1968 showed a slight increase (by 26), whilst the number newly registered during the year increased (by 36). The number of staff employed also increased from 17,155 (males 7,582 compared with 7,412 in 1967 and females 9,939 compared with 9,743). There were 91 accidents reported during the year and investigation of 48 of these again showed that they were mostly of a minor character, except in one case, where a lad suffered serious injury in dismantling and cleaning a bacon slicing machine. The firm concerned was prosecuted and a conviction obtained following a plea of guilty. In several instances occupiers were asked to carry out alterations or repairs to obviate any further accidents. The conditions in shop and office premises are undoubtedly improving as a result of this Act, and it is hoped further inspections during 1969 will show that the improvements have been maintained. Table 50 REGISTRATIONS AND GENERAL INSPECTIONS Class of premises Number of premises newly registered during the year Total number of registered premises at end of year Number of registered premises receiving one or more general inspections during the year Offices 22 575 223 Retail shops 37 1,641 681 Wholesale shops, warehouses 2 94 10 Catering establishments open to the public, canteens 24 250 250 Fuel storage depots — 11 1 TOTALS 85 2,571 1,165 67 Table 51 PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE Class of work place Number of persons employed (1) (2) Offices 5,137 Retail Shops 9,468 Wholesale departments, warehouses 1,190 Catering establishments open to the public 1,494 Canteens 169 Fuel storage depots 63 Total 17,521 Total Males 7,582 Total Females 9,939 NOISE There have been a number of complaints of noise nuisance. These are mainly from occupiers of premises close to industrial areas but there have also been complaints of noise from many of the building operations. Public health inspectors have been attending special courses at the South East London Technical College on noise control in order to be able to give advice on methods of reducing noise at source or muffling or enclosing noisy machines at operations. The noise complained of can often be greatly reduced and much has been achieved by advice and co-operation rather than by any formal action. 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 52 Rooms disinfected or disinfested 1,296 Articles disinfected or disinfested 27,475 Verminous children cleansed 555 Verminous adults cleansed (Carrington House 566) 644 Treatment for scabies, children 682 Treatment for scabies, adults 403 Articles cleansed 130,635 Domiciliary bathing 1,272 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, fifteen 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. 68 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 1968. No special comment is called for except to say that this is a continuing problem. Table 53 Type of Properly Local authority Dwelling houses (including council houses) All other (including business premises) Total Agricultural Properties inspected as a result of (a) notification 12 3,099 262 3,373 — (b) survey — 314 9 323 — (c) otherwise — — — — — Total inspections 12 3,413 271 3,696 — Properties inspected which were found to be infested by:— (a) Rats—major — — — — — (b) —minor 5 963 102 1,070 — (c) Mice—major — — — — — (d) —minor 2 894 58 954 — Infested properties treated 7 1,857 160 2,024 — Retreatments 23 2,951 428 3,402 — "Block" control schemes carried out 7, involving 323 premises 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 54 Bath Number of tests Variation of chlorine (p.p.m.) Ladywell 9 0.00 — 3.80 Forest Hill North 9 0.00 — 2.50 Forest Hill South 9 0.04 — 2.50 Laurie Grove Large 4 0.04 — 2.00 Laurie Grove Small 9 0.04 — 5.00 Laurie Grove South 9 0.03 — 1.20 Downham 9 0.06 — 1.60 Bellingham (open air) 2 0.02 — 0.25 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 69 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 1968, and railway bridges and several churches were visited regularly by the pigeon catchers. 3,064 birds as well as nests and eggs were destroyed. The complaints investigated showed 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 18 premises were licensed as pet shops. In the main, the sale of pets at these premises consists of cage birds and tropical and coldwater fish. In general it has been found that pets are kept for sale under conditions which do not call for any particular comment and in no case has it been found necessary to attach special conditions for any licence which has been issued. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 Under the above Act, no person may keep a boarding establishment for animals (i.e. dogs or cats) except under the authority of a licence granted by the local authority for the area in which the establishment is situated. One such licence was granted during the year. RIDING ESTABLISHMENTS ACT, 1964 There are two licensed riding establishments in the Borough. These are inspected and supervised by the Council's Veterinary Officer, Mr. G. S. Wiggins, M.R.C.V.S. ATMOSPHERIC POLLUTION Clean Air Act During 1968 one more area was made the subject of a Smoke Control Order and particulars with regard to the area are as follows: No. 24 Name (Bell Green) Acreage 380 No. of industrial premises 8 No. of commercial premises 128 No. of dwellings 4,280 No. of other premises 28 Total estimated cost of works £56,000 Date: Order made 25.1.67 Order confirmed 31.8.67 Order operative 1.7.68 70 PROGRAMME At the end of December 1968, the position in relation to areas was as follows: Table 55 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,ill 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 Apart from the Greater London Council Clearance Area in Forest Hill and an area in Deptford subject to redevelopment in the near future, this represents the completion of the Clean Air Act Smoke Control Order programme as it affects the Borough. A number of contraventions of smoke control orders were reported by the public health inspectors during the year. Most of the occupiers concerned had purchased coal in paper bags. The provision of the Clean Air Act, 1968, which will prohibit the delivery, purchase or acquiring of unauthorised fuel for use in smoke control areas, should reduce such contraventions. Many of the complaints regarding smoke were in respect of smoke nuisances from garden bonfires These are not prohibited in smoke control areas but it is an offence if the smoke causes a nuisance to the inhabitants of the neighbourhood at any time. Progress has been made in reducing the emission of smoke, grit and dust from industrial premises. One factory emitting a large amount of dust closed during the year and the installation of dust arrestment plant is progressing at another. There is no doubt that smoke control has already had a noticeable effect on the atmospheric conditions in the Borough. It is pleasing to note the absence of 'smog' in recent years which it is safe to say can be attributed to this improvement achieved by way of smoke control orders. 71 72 Table 56 ATMOSPHERIC CONDITIONS IN 1968 January February March April May June July August September October November December Average or actual Temperature—1 Mean C 5.0 3.4 7.6 9.3 11.3 16.2 16.7 16.5 15.1 13 .7 7.5 3 .4 10.5 Rainfall Total2 in. 2.52 1.07 0.93 1.55 1.88 1.75 2.18 3.21 7.70 2.00 2.19 2.22 29.20 Per cent. of averages 105 62 62 123 139 117 116 136 245 91 61 136 116 Sunshine—1 Daily mean hrs. 1.39 2.35 4.64 6.20 5.39 5.55 4.74 3.95 4.49 2.49 1.43 1.05 3.64 Per cent. of average 93 104 127 116 84 78 74 65 95 79 81 82 90 Wind—1 NE/E/SE % 11 57 26 37 46 31 34 26 26 19 48 34 33 S/SW/W % 67 28 11 41 35 59 33 36 53 72 25 30 41 NW/N/Calm % 22 15 63 22 19 10 33 38 21 9 27 36 26 Atmospheric pollution Creekside Depot Water insol. matter tpm 24.93 38.50 41.79 22.62 34.18 20.84 28.16 41.29 32.17 14.36 47.35 34.91 31.76 Water sol. matter tpm 7.57 13.60 9.58 9.85 9.94 7.80 8.13 8.30 15.15 8.30 10.37 9.09 9.81 Lewisham Town Hall— Smoke, daily average * 114 119 67 81 61 57 42 38 82 86 98 122 81 Sulphur, daily average • 275 283 155 146 151 97 120 146 112 160 207 266 176 Valentine Court— Smoke, daily average * 54 73 29 38 25 14 19 20 27 33 51 82 39 Sulphur, daily average * 228 237 148 135 109 81 91 101 85 130 139 190 139 Deptford Town Hall— Smoke, daily average • 105 104 57 64 59 39 48 45 56 73 102 130 73 Sulphur, daily average * 290 253 205 181 201 105 134 148 126 139 245 316 195 Creekside— Smoke, daily average * 131 129 71 60 53 34 35 40 27 74 96 122 73 Sulphur, daily average * 297 282 176 179 168 114 132 158 142 194 255 315 201 Weather Summary Cold first mild later Cold with severe night frosts Dry Cold first warmer later Cold and cloudy unsettled Dull and wet Dull and wet Wet and unsettled Dull and mild Cold first mild later Cold and dull [Notes— 1Kew; 2Lewisham; tpm: Tons per square mile per month; * microgrammes per cubic metre Consumer Protection Act, 1961 The provisions of this Act and the regulations made thereunder are enforced by the public health inspectors. Particular attention was given during the year to secure compliance with the Oil Heater Regulations at premises selling second.hand oil heaters to ensure that unsafe heaters were not on sale. The London Fire Brigade reported that they were called to 988 fires in 1967 in which oil heaters were involved. Retailers were advised to offer for sale only oil heaters which bore a BSI mark and specified warning notice, were in good condition and included operating instructions. Gas and electric fires were found on sale which did not comply with the Fireguard Regulations. Most second.hand dealers were supplied with details of the test probes in order that they could check for themselves the spacing between the bars of fireguards and their distance from the heating element or flames. The Toys (Safety) Regulations prohibit the sale of cellulose nitrate toys and limit the amount of lead, arsenic, antimony, barium, cadmium and chromium in the paint on toys. No contraventions of these Regulations were found during the year. Registration of Hairdressers All hairdressing establishments had to be re-registered under the provisions of the Greater London Council (General Powers) Act, 1967. New byelaws came into operation on 1st July, 1968. Few contraventions of the byelaws were found. In view of the increase in the use of wigs, hairdressers and wigmakers were warned of the dangers of using benzene, carbon' tetrachloride and trichloraethylene for cleaning wigs except in the open air or in well ventilated rooms. Coin Operated Launderettes There has been an increase in the number of complaints regarding noise and effluvia nuisances produced at these premises due not only to the greater number being opened but also due to the installation of larger boilers and machines and coin operated dry cleaning machines. The power to control the installation of the apparatus, the operation and maintenance of these premises is limited but every effort is made to persuade those installing the equipment and the subsequent operators to use the best practicable means to avoid complaints being made later when it may be more difficult to rectify the cause. 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 57 Number of areas declared during 1968 14 Number of dwelling houses 175 Number of persons in occupation 476 Number of dwelling houses demolished during the year Coloured pink—unfit houses 33 73 (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 four houses were made fit during the year after formal notices:— (a) by owners 3 (b) by the Council 1 (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 during 1968 are as follows:— Table 58 DEMOLITION AND CLOSING ORDERS Demolition Orders made 6 Closing Orders made 28 Closing Orders determined — Closing Orders revoked and Demolition Orders made — Houses demolished 10 Parts of buildings closed 13 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. Table 59 Houses where Management Orders were made 2 Houses where neglect of proper standards of management were made good By owners after informal action 10 By owners after formal action 2 By the Council in default — Houses in which additional services or facilities were provided By owners after informal action 22 By owners after formal action 8 By the Council in default — Houses provided with means of escape from fire By owners after informal action 22 By owners after formal action 9 By the Council in default 7 Houses where Directions were made to reduce or prevent overcrowding ... 9 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 1968 this action was taken in one case. 74 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 42 Dwellings where standard grants were made 199 (b) Compulsory Improvement of Dwellings (Housing Act 1964) Improvement Areas declared to end of 1968 1 Dwellings improved in such areas as a result of formal action during 1968 9 Total to end of 1968 30 Dwellings, outside improvement areas, improved as a result of action following representation by tenants during 1968 4 Total to end of 1968 12 RENT ACT, 1957 The following table shows the applications for certificates of disrepair dealt with during the year 1968. Table 60 Applications for certificates 4 Decisions not to issue certificates — Decisions to issue certificates 2 Undertakings given by landlords to repair 1 Undertakings refused for special reasons — Certificates of disrepair issued 2 Applications by landlords for cancellation of certificates 3 Objections by tenants to cancellation 1 Certificates cancelled 3 MILK The Milk and Dairies (General) Regulations, 1959 At the end of the year there were 226 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 61 Licences issued during 1968 Total licences issued for sale of untreated milk — 100 for sale of pasteurised milk 17 196 for sale of sterilised milk 7 171 for sale of ultra heat treated milk 11 113 Examination of heat-treated milk 43 samples of heat-treated milk were submitted for examination during the year. Two samples of pasteurised milk failed the methylene blue test. All of the other samples were found to be satisfactory. Analysis of milk During the year under review 91 samples of milk were submitted to the public analyst by the Council's inspectors and all found to be genuine. 75 ICECREAM Food Standards (Icecream) Regulations, 1959 Labelling of food (Amendment) Regulations, 1959 The composition of 24 icecream samples submitted to the public analyst during the year showed an average composition of 10.8% fat. Grading Icecream is submitted to the Public Health Laboratory for bacteriological examination The icecream is graded according to the time taken to decolorise a dye, methylene blue. The test is a provisional one and because of the many factors which govern the hygienic quality of icecream it is recommended officially that judgement should be based on a series of samples and that too much attention should not be paid to the result of an individual sample. It is suggested that over a six-monthly period, at least 50 per cent, of a vendor's samples should fall into grade 1, 80 per cent into grades 1 or 2, not more than 20 per cent into grade 3 and none into grade 4. During the year 15 samples of icecream were submitted for bacteriological examination with the following results: Table 62 Samples °/ /o Grade I ... 9 60 Grade II... 4 27 Grade III 2 13 Grade IV — — TOTAL 15 100 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. Other Bacteriological Samples Cream 30 Cooked meats 30 Shellfish 11 Fish cakes 8 Cream cakes 8 Trifles 4 Stewed steak 2 Egg noodles 2 Buttermilk 1 Horseradish sauce 1 Gooseberries 1 Cod liver oil 1 Egg macaroni 1 Vermicelli with egg 1 Soup nuts 1 Egg pasta 1 Egg noodles with spinach 1 Sausages 1 Pig's tongue 1 Total 106 76 FOOD GENERALLY Adulteration The number of samples taken during the year under the Food and Drugs Act was 1,050. After examination the public analyst reported that 51 samples were adulterated below standard or insufficiently described by label. This accounts for 4.9 per cent, of all samples submitted. Table 64 Samples Analysed Articles Examined Adulterated Formal Informal Formal Informal Foodstuffs 754 1 43 Milk and cream 4 90 — — Other drinks 2 88 — 3 Drugs and medicines — 56 — 1 Miscellaneous — 56 — 3 TOTALS 6 1,044 1 50 Table 65 Non-genuine Samples Formal Adulteration Article or informal or irregularity Action taken Brie cheese Informal Incorrect labelling Label altered Sugar confection Informal Contained Consignment ted colouring matter re-exported Sugar confection (menthe) Informal 1) „ Sugar confection Informal 99 99 Mackerel fillets, canned Informal Contained excessive No action—no tin other stock Plain flour Informal Contained excessive Manufacturers chalk and insufficient notified Evaporated peaches Informal iron Incorrect labelling Imported—importer pnntQptpn Pure apple juice Informal Incorrect labelling CUllldClCU Imported—importer contacted Pheasant Pate with Brandy Informal Contained no No action—no able amount of alcohol other stock Chicken truffle Pate Informal Contained green mould Stock exhausted Pork Pate with Port wine canned... Informal Contained excessive Manufacturer tin notified Pate de faie, canned Informal Contained insufficient fy Preserved pork sausages Informal Further samples meat satisfactory Preserved beef sausages Informal 99 99 Pork sausage Informal Contained sulphur Label altered dioxide Tomato paste, canned Informal Contained excessive Stock withdrawn Tomato paste, canned Informal tin 99 99 Creamed potatoes Informal Contained no cream Manufacturers or milk notified Creamed potatoes Formal 99 99 Creamed potatoes Informal 99 Inadequately labelled 99 Egg yellow Informal Label altered Rum Baba Informal Consisted of a rum Manufacturer flavoured Baba, notified ing no rum Green rock Informal Contained Stock withdrawn ted colouring matter and destroyed 77 Table 65—continued Article Formal or informal Adulteration or irregularity Action taken Plain flour Informal Contained insufficient chalk Manufacturers notified Plain flour Informal Lemon curd Informal Contained insufficient soluble solids Manufacturers notified Beef chow mein, canned Informal Contained insufficient meat No legal standard — no action Pork sausages Informal Contained insufficient meat Subsequent sample satisfactory Pork sausages Informal „ „ Frozen pork sausages Informal „ Manufacturer notified Fynbo cheese Informal Incorrect labelling Label altered Food colours Informal Inadequately labelled „ Colouring flavour No. 4 Informal „ „ Sugar confectionery: Mini sticks Informal „ „ Plain flour Informal Contained insufficient chalk Manufacturers notified Cornish ice cream Informal Contained extraneous matter consisting of nine small slivers of straw „ Boneless breast turkey Informal Inadequately labelled Label altered Parmesan grated cheese Informal Incorrect labelling Taken up with packers in Italy to amend label Chocolate liqueurs Informal Consisted of liqueurflavoured chocolates containing only 0.9% of alcohol by weight Label altered—to be sold as chocolates Boiled sweets Informal Contained non-permitted colouring matter Letter to importers Boiled sweets Informal „ „ Fruit lollies Informal „ „ Double Viennois (dessert) Informal Inadequate labelling Manufacturers notified Fresh large eggs Informal The eggs had been preserved with oil Legal proceedings taken Stored dates Informal Contained a live caterpillar Suppliers warned Pure natural apple juice Informal Contained the addition of carbon dioxide not labelled Letter to importers Guava jelly Informal Inadequately labelled Label altered Italian chutney Informal Incorrect labelling Letter to importers Italian chutney Informal „ „ Sal Volatile Informal Contained insufficient free ammonia Manufacturer notified Golden tips tea Informal Incorrectly labelled Letter to packers 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 into cases of food poisoning:— Bread (4) Meat pie Margarine (2) Blackcurrant drink Milk (2) Nut crunch Cod liver oil and malt (2) Nut ring Butter Bacon 78 Flour Instant whip Lamb Mint Crumpet Pork tongues Dates Mussels Horseradish sauce Stew Hot pepper Gooseberries Tinned peas Stewed steak Sausage roll Christmas pudding Food Complaints Food complaints numbering 129 were received from members of the public during the year. In 9 instances legal proceedings were taken under the Food and Drugs Act, resulting in 7 convictions, with fines totalling £110. One case was taken under the Milk and Dairies Regulations and resulted in a fine of £25. With a number of complaints where legal proceedings might have been appropriate, action was not possible owing to the unsatisfactory nature of the evidence. In other cases this was due to the unwillingness of complainants to appear in court. The remainder were dealt with informally by contact with the firms concerned 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 66 Type of premises Number of premises Number provided with wash-hand basins Number with facilities for washing food and equipment Grocers and multiple grocers 312 312 312 Greengrocers 147 131 not applicable Bakers 90 90 90 Butchers 139 139 139 Confectioners 329 324 not applicable Catering Establishments 372 372 372 Fish shops 29 29 29 Fried fish shops 53 53 53 Public houses 167 167 167 Off licences 87 85 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, 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 67 Licensed stallholders selling food 84 Unlicensed stalls on private forecourts or elsewhere 10 Shellfish stalls on private forecourts 11 Mobile grocery shops 21 79 PHARMACY AND POISONS The names of 16 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 143 persons previously registered were retained on the register. 159 visits were paid by the public health inspectors in connection with the granting and renewal of the 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. LEGAL PROCEEDINGS During the year there were 42 cases of legal proceedings for infringement of various Acts as follows:— Table 68 Number of cases Fines Costs £ s. d. £ s. d. Food and Drugs Act, 1955 28 229 10 0 57 15 0 Public Health Act, 1936 13 50 0 0 50 8 0 Offices, Shops and Railway Premises Act, 1963 1 20 0 0 — Total 42 299 10 0 108 3 0 REGISTRATION OF FOOD PREMISES New registrations in 1968 and the total including previous years are shown in the table below. Table 69 Type 1968 Total Sale and storage of icecream 15 527 Manufacture of icecream 1 14 Fish frying 2 50 Fish curing — 17 Preparation or manufacture of sausages — 114 Preparation or manufacture of potted, pressed, pickled or preserved food 10 177 UNSOUND FOOD Approximately 202 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. 80 Totals for the year are shown in the table:— Table 70 Country of origin Tonnage imported Spain 67,412 Italy 42,229 France 51,943 Yugoslavia 11,804 Algeria 1,007 Belgium 495 Switzerland 244 Israel 16 Tunisia 253 Ivory Coast 15 Total 175,418 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 1968: The supply was satisfactory both as to quality and quantity throughout 1968. All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1968, was 281,140. No houses were permanently supplied by standpipes. No artificial fluoride was added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. The supply was derived from the following works and pumping stations:— River Thames from Hampton, Kempton Park, Surbiton and Walton works. Deptford, Wilmington, Darenth and Bexley wells. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown in the following tables. On account of their hardness content and alkaline reaction the Board's river and well water supplies are not considered to be plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. Special tests for lead have been carried out during 1968 on 100 premises where a lead supply pipe is installed. The premises were chosen to give an even distribution of samples throughout the whole of the Board's area. Two samples were collected from each premises; one was the first running of water standing in the lead pipe overnight and the other was a sample of water after running the tap for a few minutes. 81 The results are set out in the accompanying table:— Table 71 Lead content (mg/1Pb) Samples of water standing in lead pipe overnight Samples of water after running the tap Less than 0.01 10 37 0 01 31 57 0 02 21 4 0 03 8 1 0 04 9 0 0 05 5 0 0 06 5 0 0 07 4 1 0 08 1 0 0 09 3 0 0 10 1 0 0 12 1 0 016 1 0 100 premises 100 premises The above results are very satisfactory and the figures are within the limits of the World Health Organisation European Standards for Drinking Water Quality. This states that the upper limit for lead in running water in the supply should not be more than 0.1 mg/1 (Pb); but where water undertakings continue to use lead piping the concentration of lead (asPb) should not exceed 0.3 mg/1 after 16 hours contact with the pipes. 82 83 Table 72 Average results of the chemical examination of the water supplied to the Borough of Lewisham during 1968 Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO4 4 hrs. at 27° C. Hardness (total) CaCO, Hardness (noncarbonate) CaCO s Magnesium as Mg Sodium as Na Potassium as K Chloride as CI Phosphate as PO4 Silicate as SiO4 Sulphate as SO Natural Fluoride as F Surface-active material as Manoxol OT Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micromhos) All Thames-derived 363 0.020 0.083 3.9 1.20 280 76 4 23.2 5.3 32 20 10 62 0.30 0.02 0.1 14 7.9 570 Deptford 4 0.006 0.028 6.3 0.15 386 145 — — — 43 — — — 0.30 — 0.0 1 7.2 760 Wilmington 4 0.010 0.026 6.5 0.21 296 65 — — — 26 — — — 0.15 — 0.0 1 7.3 550 Darenth 4 0.009 0.025 4.6 0.12 272 46 — — — 18 — — — 0.15 — 0.1 0 7.3 500 Bexlcy 4 0.007 0.019 5.3 0.15 329 80 — — — 21 — — — 0.15 — 0.0 1 7.2 580 84 Table 73 Bacteriological Results—Yearly Averages, 1968 of water supplied to the Borough of Lewisham Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Agar plate count per. ml. Coliform count E. coli count 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. Percent. samples negative in 100 ml. Percent. samples negative in 100 m/. All Thames-derived — — — — — — — 3,651 11.4 — 99.86 99.97 Deptford 219 01 98 9315 0.4 95.43 0.2 223 0.2 98 100.0 100.0 Wilmington 240 1.8 37 89.58 10 94.58 0.1 246 0.4 5 100.0 100.0 Darenth 246 0.1 18 97.15 0.1 97.97 0.1 253 0.0 1 100.0 100.0 Bexley 246 0.1 3 99.59 — 99.59 — 250 0.1 6 100.0 100.0 HOME DIALYSIS Three cases were referred to this department during 1968 for adaptation of a room to house the artificial kidney machine and other equipment. One house was owned by the G.L.C. and the other two were privately owned. In each case the owners gave their consent for the alterations which were carried out by the staff of the Housing and Estates Department. The hospital authorities were very satisfied with the rooms when completed and the home treatment of these cases made it possible for other patients to be admitted to hospital. 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 74 Lewisham Mortuary Deptford Mortuary Total Bodies received from hospitals etc. 666 427 1,093 Others 482 292 774 Totals 1,148 719 1,867 Cremations and Burials The following statistics relating to cremations and burials are for the year 1st April, 1968 to 31st March, 1969. Table 75 Cemetery No. of burials Hither Green 952 Grove Park 265 Ladywell 61 Brockley 81 Total 1,359 There were 1,551 cremations carried out at Hither Green Crematorium after certification by the Medical Officer of Health or deputy as Crematorium Referee. No exhumations took place at the Council's cemeteries during the year. 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. 85 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 1968, 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 76 Country Number of Immigrants Number of first successful visits (a) Commonwealth Countries Caribbean 253 220 India 38 30 Pakistan 17 14 Other Asian 34 25 Africa 52 45 Other 30 26 (b) Non-Commonwealth Countries European 17 14 Other 9 5 TOTALS 450 379 86 SPECIAL REPORT FLOODING During the heavy rains of September, the rivers Ravensbourne, Quaggy and Pool overflowed causing serious flooding in parts of the Borough. The following is an account of the occurrence as it affected the Health Department. The first intimation came on Sunday afternoon 15th September, from a message to the Emergency Control Centre which serves the Greenwich Health and Welfare Department and the Lewisham Health Department from Lewisham Police asking for the telephone number of the Lewisham Welfare Officer. The officer on duty telephoned the Medical Officer of Health and was given the required information with a request that the M.O.H. be informed if the Health Department could help. On monday morning a meeting of certain Councillors, representatives from the Town Clerk's, Health and Welfare Departments was held in Deptford Town Hall with the result that a Flood Control Centre was set up there. District nurses, home help organisers and public health inspectors were alerted and visits arranged to ascertain the extent of the damage. The Department placed at the disposal of the Welfare Department, who were most immediately and urgently involved, the Department's transport situated at the Disinfecting Station in Speedwell Street. It was not possible to use vehicles at Wearside Road at first because they could not be got out of the Depot due to the depth of water flooding the area. The prime necessity after the water had receded or had been pumped away by the fire brigade or Borough Engineer's Department was the provision of heaters to dry out the homes as speedily as possible. A local firm, on their own initiative, offered the use of all their available heaters for this purpose, and the Department through the central control, arranged to have them picked up and delivered to one of the affected areas straight away. The first three heaters were in operation in Watermead Road during Monday afternoon. This road was selected as being the first ready to start operations in, as the water had subsided sufficiently to make the use of heaters a practicable proposition. These heaters were operated by Army personnel under the general guidance of one of the public health inspectors. A general survey of the flooded areas was carried out by the public health inspectors during Monday to ascertain the extent of the flooding and the areas to which priority should be given for the use of heaters as they became available. A complaints reception centre was set up within the Department and all complaints were passed on to the public health inspectors or other officers and departments as appropriate for their investigation and action. Close liaison both directly and through central control was maintained with all other departments concerned and with outside agencies, police, fire brigade, army, R.A.F. etc. As more heaters became available further teams of public health inspectors, students, technical assistants, army and R.A.F. were brought into action, together with the necessary transport provided by the Borough Engineer and our own Department. The number of heaters that were subsequently brought into use was 150, some of which were under the control of the Housing and Estates Department, who were in a better position to supply the necessary labour force. Later in the week it was decided gradually to withdraw the public health inspectors from the direct control of the heaters (the control of these heaters being passed over to the Housing and Estate Manager's Department), because it was felt that they were better employed dealing with the innumerable problems that had arisen due to the flood, and which were within the ambit of their normal duties. During the first few days sufficient disinfectant was issued to deal with all of the known properties affected. Unfortunately, many people did not dilute it according to instructions and consequently they complained that not enough was distributed. 87 However, later wherever necessary, teams from the disinfecting stations carried out spraying with a deodorant to further help deal with this problem, particularly the smell rising from the underfloor space. The midwifery services were considerably disrupted. At least half of the midwives' telephones were out of order and travelling was very difficult. The police with their short-wave radio transmitters were of great assistance and many of the midwives visited their patients to confirm that their services were not required. During the period from the 14th to 18th September twelve babies were delivered at home and none arrived without the full assistance of the midwife which is commendable considering the difficulties, particularly of transport. Visits were made by the health visitors to all people living in the flooded areas who were known to them, and baby foods were distributed to all who needed them. The clinics in the areas were also kept open for the issuing of food throughout each day. The creche at Central Clinic was opened for the children of parents in temporary accommodation at the Saville. Toys and equipment were also loaned to children staying there. Large quantities of children's clothing were distributed by the health visitors. Prams were acquired and given free to those who had lost theirs in the floods. Emergency arrangements were made to accommodate a few children in the Day Nursery at Rushey Green whilst the parents were mopping up at home. In order to make sure that all complaints and information about individual properties had received attention, a second survey was carried out by the health inspectors on Tuesday, 24th September. It may never be known how many properties were affected by the flood but certainly 1,118 properties were brought to the Department's notice, although in some of the cases the damage was due to drain blockage. A quantity of food was condemned by the inspectors and advice was given to shopkeepers. Many public houses were also visited and arrangements were made in most cases for the brewers to collect stocks and replace. In one particular case, however, it was decided to destroy the contaminated stock. Many problems relating to defective properties remained as a result of the flooding, and some of these were still outstanding at the end of the year. The Home Help Service carried on with normal duties as far as possible during the flooding but some helps had difficulty in getting to the homes to which they were assigned and a few were turned back by the police because of the inaccessibility of their destination. Many of the home helps worked hours beyond their normal time to help families in clearing up after the flood and some of these did not make any claims for overtime. It can be said that those home helps who were working in properties that were within the flood areas, carried on doing all they could to help without fuss and without questioning whether or not any job came within their normal terms of work. It must be said that all of the staff involved in dealing with problems caused by the flood gave unstintingly of themselves, many of them working hours far beyond their normal call of duty. 88 INDEX Page Adoption and Boarding Out 26 Anaesthesia 31 Animal Boarding 70 Anti-fly campaign 69 Area of Borough 12 Atmospheric Pollution 70 Bacteriological Samples 76 Births and Birthrate 12 Blind and Partially sighted persons 26 Borough, description of 9 Burials 85 Cervical Cytology 23 Chest Clinics 56 Child Minders 24 Chiropody Service 48 Clean Air 68 Cleansing. Personal 21, 68 Clearance Areas 73 Closure or demolition of unfit houses 74 Coin Operated Laundrettes 73 Congenital malformations 25 Consumer Protection Act 73 Continental Goods Depot 80 Co-ordinating Committee 44 Cremations 85 Day Centres 52 Day Nurseries 24 Day Nurseries, private 25 Deaf Register 36 Deaths and Deathrate 12 Deaths by Cancer 14 Deaths by cause and age 13 Demolition and Closing Orders 74 Demolition or Closure of unfit houses 74 Dental Auxiliaries, School for 30 Dental Caravan 31 Dental Health Education 32 Dental Laboratory 31 Dental Service, Maternal and Child Health 31 Dental Service, Schools 34 Dental Services 30 Dental Services, Accommodation 30 Deptford Chest Clinic 57 Disinfection and Personal Cleansing 68 District Nursing 20 District Nursing, Liaison Scheme with General Practitioners 20 District Nursing, Patients Care 20 District Nursing, staff recruitment and training 20 Domiciliary Confinements 18 Dual Care Ante-natal Scheme 18 Dysentery 56 Early Care Unit 51 Early Neo-Natal deaths 12 Emergency Obstetric Unit 18 Environmemal Health 61 Exhumation 85 Page Factories 65 Family Casework 43 Family Planning 27 Flies 69 Flooding 87 Food 77 Food Complaints 79 Food Hygiene (General) Regulations, 1960 79 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 79 Food Premises, registration 80 General Provision of Health Services 9 General Statistics from 1950 16 Guardianship 50 Hairdressers 73 Handicapped Pupils Register 35 Health Centres 17 Health Education 46 Health Visiting 22 Heart Diseases 14 Home Dialysis 85 Home Help Service 45 Honor Lea Hostel 52 Houses in Multiple Occupation 74 Housing 73 Icecream 76 Immigrants 85 Immunisation and Vaccination 60 Improvement Work 75 Infant Mortality 12 Infectious Diseases 54 Laboratory Facilities 60 Laundrettes 73 Legal Proceedings 80 Lewisham Chest Clinic 56 Loan Service 29 Local Sickness 15 Lung Cancer 14 Markets, Stalls and Delivery Vehicles 79 Mass Radiography Unit 58 Maternal Deaths 12, 19 Measles 56 Medical and Family Social Work 43 Mental Health 50 Mental Health, annual seaside holiday 51 Mental Health Day Centres 52 Mental Health, Early Care Unit 51 Mental Health Emergency Work 50 Mental Health Guardianship 50 Mental Health, long term care 51 Mental Health, short term care 51 Mental Health Social Work 50 Mental Health, Special Advisory Clinics 51 Mental Health Therapeutic Group 52 Mental Health, training centres 51 Mental Subnormality Liaison Committee 52 Mice 69 Midwifery Service 18 Midwifery Staff 19 89 INDEX—continued Page Midwifery training 19 Milk 75 Morbidity shown in insurance certificates 15 Mortuaries 85 National Assistance Act, section 47 68 Neo-natal deaths 12 Noise 68 Offensive Trades 80 Offices, Shops & Railway Premises 66 Orthondontics 31 Outworkers 66 Perinatal Mortality 12 Pet Animals 70 Pharmacy & Poisons 80 Pigeons 70 Population 12 Premature Babies 18 Prevention of Damage by Pests 69 Private Day Nurseries 25 Prophylaxis 60 Public Health Inspectors, repairs carried out 64 Public Health Inspectors, summary of inspections 63 Public Health Inspectors, summary of notices served 64 Pupil Midwife Training 19 Rag, flock and other filling materials 70 Rateable Value 12 Rats and Mice 69 Recuperative Holidays 27 Registration of Hairdressers 73 Rent Act 75 Page Repair of unfit houses 74 Reproductive Wastage 12 Riding Establishments 70 Samples 77 Scarlet Fever 56 School Dental Service 34 School for Dental Auxiliaries 30 School Health Service 35 School Medical Inspections 37 Schoolchildren, Personal Hygiene 37 Schools, Social Work 43 Sickness, Local 15 Slaughterhouses and Slaughterers 80 Smoke Control 70 Social Work, chest clinics 43 Social Work, schools and general 43 Social Work, staff 44 Social Work, training 44 Stalls 79 Stillbirths 12 Surveys 27 Swimming Baths 69 Tuberculosis 56 Unsound Food 80 Vision, School Medical Inspections 41 Vital Statistics 12 Wasps, Hornets and the Like 68 Water Supply 81 Whooping Cough 56 90 TABLES No. Subject Page 1. Causes of death by age groups 13 2. Heart and circulation mortality 14 3. Cancer deaths 14 4. Morbidity shown in insurance certificates 15 5. General statistics from 1950 16 6. District Nursing—Patients and visits 20 7. District Nurses Employed 20 8. Health Visiting 23 9. Cervical cytology 24 10. Day Nurseries, admissions and discharges 24 11. Congenital malformations 25 12. Congenital malformations by parity 26 13. Recuperative holidays 27 14. Family Planning 28 15. District Nursing loan equipment 29 16. Orthodontics 31 17. Dental Service, maternal and child health 32 18. Dental inspection of schoolchildren 34 19. Observation/Handicap, register schoolchildren by type of school 36 20. Observation/Handicap register, schoolchildren by year of birth 36 21. Deaf register, schoolchildren 37 22. Routine inspections of schoolchildren 37 23. Routine inspections of schoolchildren—defects 38 24. Personal hygiene of schoolchildren 39 25. Non routine medical inspection of schoolchildren 40 26. Routine inspections of schoolchildren—vision 41 27. Comparison of Defects noted "Special" medical inspections of schoolchildren 42 28. Home Help Service 45 29. Health Education, film shows, talks, etc 47 30. Lectures, Talks and Demonstrations given by Nursing Staff 47 31. Analysis of bookings and attendances—Chiropody 49 32. Summary of attendances—Chiropody 49 33. Attendances by age groups—Chiropody 49 34. Notified cases of infectious diseases 54 35. Notification of infectious diseases by sex and age 55 36. Tuberculosis, notifications and deaths 56 37. Mass Radiography 58 38. Mass Radiography, non-tuberculous abnormalities 58 39. Mass Radiography, surveys 59 40. Immunisation and Vaccination 60 41. Laboratory facilities 60 42. Sanitary inspections 63 43. Summary of notices 64 44. Repairs carried out 64 45. Factory inspections 65 46. Factory defects 65 47. Outworkers 66 48. O.S.R. Items requiring most frequent attention 66 49. O.S.R. Other matters requiring attention 67 50. O.S.R. Registrations and inspections 67 51. O.S.R. Persons employed 68 52. Disinfection and Personal Cleansing 68 53. Rodent control 69 54. Swimming baths 69 55. Clean Air Act programme 71 56. Atmospheric conditions 72 57. Clearance areas 73 58. Demolition and Closing Orders 74 59. Houses in multiple occupation 74 60. Rent Act, 1957 75 61. Milk (Special Designations) Licences 75 62. Grading of icecream 76 63. Other bacteriological samples 76 64. Samples analysed 77 91 Subject Page 65. Non-genuine samples 77 66. Food Premises, washing facilities 79 67. Inspections of markets, stalls and delivery vehicles 79 68. Legal proceedings 80 69. Registration of food premises 80 70. Continental Goods Depot, tonnage imported 81 71. Lead content of water 82 72. Water, chemical analysis 83 73. Water, bacteriological samples 84 74. Bodies received in mortuaries 85 75. Burials 85 76. Immigrants 86 PRINTED BY E. G. BERRYMAN & SONS, LTD., GREENWICH, LONDON, S.E. 10.