BOROUGH OF LEWISHAM LEW 57 ANNUAL REPORT 1969 Medical Officer of Health CONTENTS Page Introduction 3 Dr. Waldron 5 Health Committee 7 Health Staff 8 The Borough 11 General Provision of Health Services in Area 11 Vital Statistics 15 HEALTH CENTRES 20 MATERNAL AND CHILD HEALTH 21 Midwifery 21 District Nursing 23 Health Visiting 25 Cervical Cytology 28 Congenital Malformations 28 DAY CARE OF CHILDREN 30 FAMILY PLANNING 31 LOAN SERVICE 33 DENTAL SERVICES 34 Maternal and Child Health 34 School Dental Services 35 SCHOOL HEALTH SERVICE 36 Handicapped Pupils Register 37 Deaf Register 38 School Medical Inspection 38 MEDICAL AND FAMILY SOCIAL WORK 44 HOME HELP SERVICE 47 HEALTH EDUCATION 48 CHIROPODY SERVICE 50 MENTAL HEALTH 52 Social Work 52 Special Advisory Clinics 52 Training Centres 53 Short and Long Term Care 53 Honor Lea Hostel 54 75 Arbuthnot Road 54 Day Rehabilitation Centres 55 Social Clubs 55 Industrial Work 55 Volunteer and Voluntary Organisations 57 Special Report 57 1 Page INFECTIOUS DISEASES 59 Chest Clinics - 61 Food Poisoning 63 Mass Radiography 65 Immunisation and Vaccination 67 Laboratory Facilities 67 Rubella Vaccine Trial 68 ENVIRONMENTAL HEALTH 69 Summary of Inspections and Notices Served by Public Health Inspectors 71 Factories 73 Offices, Shops and Railway Premises Act 75 Noise 76 Disinfection and Personal Cleansing 77 Prevention of Damage by Pests 77 Swimming Baths 78 Rag Flock and Other Filling Materials Act 78 Destruction of Pigeons 78 Pet Animals Act 78 Atmospheric Pollution 79 Housing Acts 81 Milk 86 Icecream 87 Food 87 Pharmacy and Poisons 90 Legal Proceedings 90 Water Supply 91 Home Dialysis 94 Mortuaries 94 Immigrants 95 REHOUSING ON SPECIAL MEDICAL GROUNDS 95 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 1969. On 6th November Dr. Waldron, the Medical Officer of Health, retired; clearly this report is mainly on the work carried out under his wise and kindly leadership. An appreciation of Dr. Waldron's service follows this preamble. The incidence of general sickness as shown by returns from the Department of Health and Social Security was normal, although there was an increase over the previous year in the last month, due to the influenza outbreak in the country at this time. Following the normal pattern, the incidence of infectious diseases rose over the previous year, caused entirely by the usual biennial occurrence of measles. The increase was somewhat less than previously experienced. Vital statistics for the Borough revealed a drop in the birth rate of 1.9 per 1,000 of the estimated population. This is the largest percentage drop since the birth rate commenced to fall in 1965, but is in keeping with the national trend. The death rate of 11.9 per 1,000 estimated population was lower than the previous year, but calls for no special comment as it was entirely within the normal range. An outbreak of food poisoning occurred at a school just within the Borough boundary in September, but in spite of exhaustive investigation the cause was not proven. However, it was thought that solanine may have been the agent, particularly since the only food consumed by all of those affected was potato. The hygiene of all the food handlers involved could not be faulted, and the premises and utensils were well up to modern standards of cleanliness. Mr. A. J. Phillips, the Chief Public Health Inspector, reports in the body of this report on cases referred to the Department for home dialysis. This service, which involves the co-ordinated effort of many agencies, is an example of what can be achieved by co-operative effort, by departments of the Council and outside Authorities, where a need is manifest and urgent. A further increase in the number of children treated for verminous infestation occurred and this is to be regretted. Progress in the improvement of housing conditions generally was again achieved. Full use is made of the powers contained in the Housing Acts and many owners are taking advantage of the grants available to them for the betterment of their properties. The Domiciliary Family Planning Service run by the Council and the Clinic Service provided on an agency basis by the Family Planning Association is still expanding and is meeting a specific need. Liaison and attachment schemes of health visitors and district nurses to general practitioners within the Borough are being developed and where these are in operation they are working well to the benefit * of the public and to the satisfaction of doctors and nursing staff concerned. As pointed out elsewhere in the Report, in this Borough there is a high percentage of "single handed" practices which retards the development of full attachment. There are signs that more group practices are evolving. Liaison between the hospital service and the Department was improved during the year. In particular the Mental Health Section was modified during 1969 by the re-organisation of the social work on a team basis, each team working to one consultant psychiatrist's hospital team. This close identification of purpose is working well and has already created a more rational approach to the problems faced by the teams. 3 Health Education takes a foremost place in the work of the Health Department. Many invitations are received from schools, old people's and welfare organisations of widely different kinds, for speakers, films and demonstrations from the Health Education Section and by other sections of the Health Department. It is gratifying to be able to report that many of the staff participate in satisfying the demand, and have found that they have a talent for this sort of work. This report outlines the work during 1969 of the Health Department staff, to whose efforts I gladly pay tribute. I wish to thank the Town Clerk and other Chief Officers for their help and advice during the year. In conclusion, my thanks are due to the Chairmen and members of the relevant Committees for the support afforded to the Department, to Dr. Waldron and to myself during 1969. A. W. TRANTER, Medical Officer of Health. Health Department, Deptford Town Hall, New Cross Road, S.E.14 4 DR. WALDRON, M.D., D.P.H. F. R. WALDRON, M.D., D.P.H. On 6th November Dr. Waldron, the Medical Officer of Health, retired after a lifetime of public service, during which his kindly but firm leadership gained for him great respect. His wise judgment and ability in the very many aspects of his work were highly regarded; he was always approachable and his calm temperament and good humour endeared him to all. We wish Dr. and Mrs. Waldron a long and happy retirement. In 1927 Dr. Waldron was an assistant in general practice in Preston, Lancashire. It was this experience which led him to decide that in the social and preventive approach to the practice of medicine lay the greatest opportunities. As a result he obtained his D.P.H. and Diploma in Midwifery as a postgraduate student in Dublin in 1929-30. This was followed by his appointment as Resident Medical Officer at the East Lancashire Sanatorium especially to study tuberculosis. Between 1931 and 1933 Dr. Waldron was Assistant Medical Officer and T.B. Officer at Huddersfield, Yorkshire, where he was able to introduce special methods for the treatment of tuberculosis. It was in 1934 that Dr. Waldron came to south-east London when he was appointed to the post of Deputy Medical Officer of Health and T.B. Officer for the Metropolitan Borough of Greenwich. In 1935 the London County Council appointed him as honorary consultant in tuberculosis to St. Alfege's Hospital. He obtained his Doctorate of Medicine (M.D.) in this year. During 1936 Dr. Waldron was appointed Medical Officer of Health for the Metropolitan Borough of Greenwich. During this first part of his service with the Borough as M.O.H., which lasted until his release under Ministry of Health scheme to H.M. Forces in 1943, he introduced various schemes which were adopted by the Borough. Among them were a scheme for pupil midwife training by an association of the Municipal Maternity Home with King's College Hospital (1937); a diphtheria immunisation scheme (1937); in 1938 the Council accepted reports: 1. Antitheumatic scheme in association with the Miller General Hospital; and 2. Cyanide disinfestation scheme. These last two schemes were placed in abeyance because of the national crisis. In 1938-39 he organised and deployed the Council's casualty services. On Dr. Waldron's release in 1943 to H.M. Forces, the Council commended his services during the "blitz" by a special resolution of the Council. From 1944 to 1945 Dr. Waldron was first in Normandy and then in Germany. He entered Belsen concentration camp on 15th April, 1945. During this period he was Mentioned in Despatches. The post-war period brought many changes in Dr. Waldron's career, but before the first of the major changes, he introduced in 1947 a scheme for disinfestation involving the establishment of a special anti-fly and mosquito squad. This idea, which was accepted and implemented by the Council, was adopted by other boroughs, and is still in existence. 5 In 1948 Dr. Waldron was appointed Divisional Medical Officer (Division 6 L.C.C.), a post he held, together with that of M.O.H., until June, 1949, when a new appointment was made to the latter post. He was at that time responsible for the organisation of transfer of services (maternal and child health) to the L.C.C. and for the organisation and co-ordination of services in the new Division (Deptford, Greenwich and Woolwich). Some main new approaches at this time included the initiation of liaison groups involving hospital consultants, general practitioners and medical and nursing representatives of the Division. Between 1949 and 1950 Dr. Waldron became a member of the Greenwich and Deptford Hospital Management Committee, and subsequently became its vicechairman, a post which he held until his retirement. About 1953 Dr. Waldron initiated local consultation at officer level between statutory and voluntary bodies on problem families. This later became the "co-ordinating committee". The year 1954-55 saw Dr. Waldron elected as President of the Metropolitan Branch of the Society of Medical Officers of Health. Another honour was accorded to him in 1956-57 when he became President of the West Kent Medico-Chirurgical Society. A scheme of attachment for general practitioners to local authority centres was started by Dr. Waldron in 1956. This developed and became the pattern throughout the Division by 1962. It was used as an example in other areas. In anticipation of the Mental Health Act, 1959, he initiated a special discussion group of consultant psychiatrists, general practitioners, divisional medical, nursing and social worker staff and voluntary bodies in 1958. The London Government Act, 1963, which reorganised and reshaped the pattern of administration of local government in the London area created a vast number of problems, particularly so for Dr. Waldron because in September, 1964, he became part-time M.O.H. for the Metropolitan Borough of Lewisham in addition to his other appointments (£ M.O.H. Metropolitan Borough of Lewisham, \ M.O.H. London Borough of Lewisham and J Divisional Medical Officer, L.C.C.). During September, 1964, he placed the first report on the proposed organisation, function and approach to the installation of the new Health Department before the new Health Committee. On 1st April, 1965, the Health Department of the London Borough of Lewisham commenced to function. The last three years have seen the continuing development of the Health Department's services, and many new schemes have been adopted and brought into operation based on the administrative foundations so well laid down under Dr. Waldron's leadership. 6 HEALTH COMMITTEE, 1969 The Mayor (Councillor W. L. BRIDGER) Chairman: Councillor F. M. JUDGE, m.p.s. Vice-Chairman: Councillor G. N. COPLAND Alderman Mrs. M. J. Chrisp Councillor Mrs. W. Brydon „ Mrs. G. M. Chandler J. W. Earl W. Hall S. G. C. Hardy, b.e.m. Councillor Mrs. D. Hurren „ Mrs. G. J. Manners „ Mrs. D. E. New „ T. A. Pickup Mrs. P. L. Silk „ T. W. Turner 7 HEALTH DEPARTMENT as at 31.12.69 Medical Officer of Health and Principal School Medical Officer, Inner London Education Authority A. W. TRANTER, m.b., d.p.h., d.c.h. Deputy Medical Officer of Health Vacancy Senior Medical Officer: Betty E. Shortland, m.b., b.s., d.p.h., d.t.m.h. Enid C. Vincent, m.b., ch.b., d.p.h. G. S. Sethi, m.b., b.s., d.p.h., d.t.m.h., d.i.h. Assistant Senior Medical Officers: 5 Full-time 34 sessional M.O.s occupying 8 full-time vacancies Chief Dental Officer and Principal School Dental Officer: Clare M. Leeming, b.d.s. Senior Dental Officers: P. Sivagurunathan, f.d.s., l.d.s., r.c.s. Vacancy Orthodontist (Part-time) Ann D. Ward, b.d.s., dip.orth. P. S. Bernard, b.d.s., dip.orth. Dental Officers: 7 sessional 4 Dental Auxiliaries and 11 Dental Surgery Assistants Public Analyst: J. H. Shelton, f.r.i.c. Principal Nursing Officer: Dorothy M. Coe, s.r.n., r.f.n., s.c.m., h.v., c & o. Technical Teachers Certificate Diploma in Social Sciences Assistant Principal Nursing Officer and Non-Medical Supervisor of Midwives Valerie J. Buckingham, s.r.n., r.f.n., s.c.m., m.t.d., n.d.n.cert. 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 Rose Evans, s.r.n., s.c.m., d.n.cert. Renee Humphries, s.r.n., s.c.m., d.n.cert. Maureen Allen, s.r.n., s.c.m., h.v. 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), h.v. Vacancy 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) Joan Hawkins, s.r.n., s.c.m., r.f.n., h.v. Helen Buckley, s.r.n., s.c.m., h.v. (Spalding House) (Downham) Janet Rose, s.r.n., c.m.b. (part t), 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; 26 School Nurses; 20 Clinic Nurses; 7 Clinic Auxiliaries; 8 Trainee Health Visitors; 1 Organiser of Playgroups 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 8 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: P. V. Rhodes, m.ch.s., m.r.s.h., f.r.m.s., Irene E. Yeomans, m.ch.s. m.i.biol., a.r.p.s. 2 vacancies 16 sessional Chiropodists; 1 Trainee Chiropodist Principal Mental Health Officer: Zena Mason, b.a., a.i.m.s.w. Senior Mental Health Officers: Rosemary E. Evans, dip.social studies, D. G. Shaw, s.r.n., r.m.n., c.s.w. a.a.p.s.w. E. C. N. Nevill 12 Mental Health Officers Honor Lea Hostel: Warden: E. W. Murray, r.m.p.a. Deputy: D. W. Bacon, r.m.n. 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), G. F. Hunt (Deptford) 15 Assistants Supervisors of Day Centres: P. W. Postle (New Cross) C. W. Beckett (Cambridge) 4 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: Vacancy (Deptford) Audrey P. Ray (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. 2 Assistants Home Safety Officers: L. Selway W. H. Wildish 9 Chief Public Health Inspector: A. J. Phillips, m.a.p.h.i. Assistant Chief Public Health Inspectors: J. H. Willis, d.f.c., d.m.a., 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 K. G. Burt L. J. Cleverly, m.a.p.h.i. 13 Public Health Inspectors 4 vacancies; 6 Trainee Public Health Inspectors; 1 Senior Technical Assistant; 8 Technical Assistants, 3 vacancies Bathing Station Superintendents: H. W. Wellbelove (Deptford) J. G. Beale (Lewisham) 2 Assistant Superintendents; 11 Miscellaneous Staff Mortuary Keeper and Coroner's Court Officer: W. C. Spear (Lewisham) Mortuary Keeper: C. B. Evans (Deptford) Pest Control Foreman: R. A. Sharman 6 Operatives ADMINISTRATIVE STAFF Chief Administrative Officer: E. W. Cheeseman Principal Administrative Officers: Vacancy D. M. Minear 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; 6 part-time Clerical Assistants 10 THE BOROUGH The Borough of Lewisham covers approximately 13.4 square miles, and is bounded by the Boroughs of Greenwich, Bromley and Southward 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.I3 Lewisham Group Hospital Management Committee Grove Park, Marvels Lane, S.E.I2 „ Hither Green, Hither Green Lane, S.E.I3 „ St. John's, Morden Hill, S.E.13 „ New Cross General, Avonley Road, S.E.I4 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.10 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.I8 Woolwich Group Hospital Management Committee The London Teaching Hospitals The Pyschiatric 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 123 general practitioners serving patients in Lewisham. The numbers serving broad areas of the Borough are: Bellingham, Catford, Lewisham, Hither Green, 40 Sydenham, Forest Hill, Brockley, 34 Deptford 26 Blackheath, Lee, Grove Park, Downham, 23 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 11 HEALTH CENTRES AND CLINICS: Maternal and Child Health, and School Health Name and Address Type of Clinic Amersham Road, Amersham Road, S.E.14 Ante-Natal, Child Health, Child Development, Immunisation, Mothercraft, Ancillary Food Sales, Special Advisory, Cytology, Special Investigation. Bellingham, Community Centre, Bellingham Green, S.E.6 Child Health, Immunisation, Ancillary Food Sales Boundfield Road, Community Centre, S.E.6 Child Health, Immunisation, Ancillary Food Sales Cytology, Child Development, Health Education Central Lewisham, 410 Lewisham High Street, S.E.I3 Ante-Natal, Relaxation Classes, Child Health, Immunisation, Mothercraft, Family Planning, Ancillary Food Sales, Cytology, Occasional Creche, Special Advisory Language Classes Deptford S.T.C., Reginald Square, S.E.8 Ear, nose and throat, vision, orthoptics, minor ailments, speech therapy Downham, 24 Churchdown, Downham, Kent Ante-Natal, Child Health, Child Development, Immunisation, Mothercraft, Family Planning, Relaxation, Ancillary Food Sales, Minor Ailments, Vision, Speech Therapy, Special Investigation Flower House, 1 Winnet House, Beckenham Hill Road, S.E.6 Ante-Natal, Child Health, Immunisation, Mothercraft, Relaxation, Family Planning, Ancillary Food Sales, Child Development, Health Education Forest Hill, St. Saviour's Church Hall, Brockley Rise, S.E.23 Child Health, Immunisation, Ancillary Food Sales Grove Park, Methodist Church Hall, Burnt Ash Hill, S.E.12 Child Health, Immunisation, Ancillary Food Sales Heathside, Merton Place, S.E.10 Child Health, Immunisation, Ancillary Food Sales, Home Making Hither Green, Methodist Church Hall, 53 Torridon Road, S.E.6 Child Health, Immunisation, Ancillary Food Sales Kingswear Dartmouth Road, S.E.23 Ante-Natal, Child Health, Immunisation, Mothercraft, Family Planning, Occasional Creche, Ancillary Food Sales, Cytology, Mental Health, Minor Ailments, Health Education Lee and Blackheath, Methodist Church Hall, Lee High Road, S.E.12 Child Health, Immunisation, Ancillary Food Sales Lewisham S.T.C. 78 Lewisham Park, S.E.I3 Vision, minor ailments, special investigation, audiology Lewisham Hospital, S.E.I3 Auditory training unit, orthoptics, hearing investigation, special investigation. Lind Oxestalls Road, S.E.8 Child Health, Child Development, Ancillary Food Sales Cytology Samuel Pepys School, Wallbutton Road, S.E.14 Minor ailments Speedwell Speedwell Street, S.E.8 Ante-Natal, Child Health, Child Development, Immunisation, Special Investigation Family Planning St. Mary's St. Mary's Church Hall Ladywell Road, S.E.I3 Child Health, Ancillary Food Sales Spalding House, 2 Spalding House, Honor Oak Estate, S.E.4 Ante-Natal, Child Health, Immunisation, Family Planning, Ancillary Food Sales, Vision, Minor ailments, Mothercraft Sydenham S.T.C., Adamsrill School, Lower Sydenham, S.E.26 Minor ailments Children's Hospital, S.E.26 Special investigation 12 Sydenham London City Central Mission Wells Park Road, S.E.26 Child Health, Immunisation, Ancillary Food Sales Tranquil Vale, All Saints' Hall, Tranquil Vale, S.E.3 Ante-Natal, Child Health, Immunisation, Occasional Creche Trewsbury Road, All Saints' Parish Church Hall, Trewsbury Road, S.E.26 Child Health, Immunisation, Mothercraft, Relaxation Health Education Day Nurseries Health Centre, Amersham Road, S.E.I4 41 Rushey Green, S.E.6. 67 Perry Rise, S.E.23 Dental Surgeries S.T.C. 78 Lewisham Park, S.E.I3 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 Sedgehill School, Sedgehill Road, S.E.6 Catford County S.G. School, Bellingham Road, S.E.6 Chiropody Clinics Amersham Road, Health Centre, S.E.I4 Kingswear, Dartmouth Road, S.E.23 28 Sangley Road, S.E.6 Downham Health Centre, Churchdown Lind, Oxestalls Road, S.E.8 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 Perry Rise Baptist Church, Perry Rise, S.E.23 Hostel Accommodation (Mental Health) Honor Lea, 103/117 Brockley Rise, S.E.23 Cleansing and Disinfecting Stations Wearside Road, S.E.I3 Speedwell Street, S.E.8 Mortuaries Ladywell Road, S.E.I3 Watson Street, S.E.8 13 VITAL STATISTICS Area of the borough 8,579 acres. Population Census 1961 290,582 Estimate of Registrar General at midyear 1969 282,080 Rateable Value Rateable value of the borough at April 1,1969 £ 12,477,671 Estimated net product of a penny rate 1969/70 £48,750 Estimated number of separately assessed dwellings at April, 1 1969 89,029 Births Males Females Total Legitimate 1,993 1,900 3,893 Illegitimate 311 313 624 Totals 2,304 2,213 4,517 Crude birth rate per 1,000 of the estimated population 16-0 Adjusted birth rate for comparative purposes (Area comparability factor=0.96) 15-4 Ratio of adjusted birth rate to national rate 0-94 Illegitimate live births as percentage of all live births 14-0 Stillbirths Total (40 males and 22 females) 62 Rate per 1,000 live and stillbirths 13-5 (males 17-1, females 9.8) Deaths Total (1,723 males, 1,644 females) 3,367 Crude death rate per 1,000 population 11 • 8 Adjusted death rate (area comparability factor= 0-96) 11*4 Ratio of adjusted death rate to national rate 0-96 Infant mortality Infant deaths (all deaths of liveborn children under one year) Males Females Total Legitimate 47 32 79 Illegitimate 11 3 14 Totals 58 35 93 Death rate of all infants per 1000 li vebirths 20-6 Death rate of legitimate infants per 1000 legitimate livebirths 20-2 Death rate of illegitimate infants per 1000 illegitimate livebirths 22-4 Death rate of male infants per 1000 male livebirths 25-2 Death rate of female infants per 1000 female livebirths 15-8 Neonatal deaths (under 4 weeks of age) 60 (39 males, 21 females) Males per 1000 male livebirths 16-9 Females per 1000 female livebirths 9-5 All infants per 1000livebirths 13-3 Early neonatal deaths (under 1 week of age) 50 (29 males, 21 females) Males per 1000 male livebirths 12-6 Females per 1000 female livebirths 9-5 All infants per 1000 livebirths 11-1 Perinatal mortality (deaths under 1 week plus stillbirths) 112 (69 males. 43 females) Males per 1000 live and still male births 29-4 Females per 1000 live and still female births 19-2 All infants per 1000 live and stillbirths 24-4 Reproductive wastage (stillbirths plus all infant deaths) 155 Males per 10001ive and still male births 41-8 Females per 1000 live and still female births 25-5 All infants per 1000 live and stillbirths 33-8 Maternal deaths Maternal deaths 3 Maternal mortality rate per 1000 live and stillbirths 0-7 15 Table 1 TOTAL DEATHS BY CAUSE AND AGE REGISTERED DURING 1969 Cause of Death Sex All ages Under 4 iv ks 4 toks under 1 year Age in years 1- 5- 15- 25- 35- 45- 55- 65- 75 + Total all causes M 1,723 39 19 10 3 12 10 32 111 346 549 592 F 1,644 21 14 1 2 10 14 24 86 182 321 969 B4 Enteritis and other diarrhoeal diseases M 2 2 — — — — — — — — — — F 1 — 1 — — — — — — — — — B5 Tuberculosis of Respiratory system M 11 — — — — — — 1 1 6 — 3 F 1 — — — — — — — — — 1 — B6 Other Tuberculosis, including late effects M 5 — — — — — — — 1 2 2 — F 1 — — — — — — — — 1 — — B17 Syphilis and its sequelae M 1 — — — — — — — — — — 1 F 1 — — — — — — — — — 1 — B18 Other Infective and Parasitic diseases M 2 — — — — — — — — — 1 1 F 2 — — — — — — — — 2 — — B19(l) Malignant Neoplasm Buccal Cavity, etc. M 4 1 2 1 F 3 — — — — — — — — — 2 1 B19(2) Malignant Neoplasm Oesophagus M 3 — — — — — — — — 1 1 1 F 7 — — — — — — — — 2 1 4 B19(3) Malignant Neoplasm Stomach M 49 — — — — — — — 8 16 16 9 F 46 — — — — — — 1 3 6 17 19 B19(4)Malignant Neoplasm Intestine M 50 — — — — — 1 1 2 15 14 17 F 54 — — — — — — — 6 6 13 29 B 19(5) Larynx M 5 — — — — — — — — 2 2 1 F 2 — — — — — — — — 2 — — B19(6) Malignant Neoplasm, Lung, Bronchus M 194 — — — — — — 1 17 55 86 35 F 47 — — — — — — — 8 11 16 17 B19(7) Malignant Neoplasm —Breast M 2 — — — — — — — — 1 1 F 63 — — — — — — 5 13 20 6 19 B19(8) Malignant Neoplasm —Uterus F 23 1 2 1 7 5 7 B19(9) Malignant Neoplasm —Prostate M 22 — — — — — — — — — 9 13 B19(10) Leukaemia M 5 — — — — — — — — — 1 3 F 8 — — — 1 1 — — — 2 1 3 B 19(11) Other Malignant Neoplasms M 80 — — 2 1 1 2 2 8 24 23 17 F 89 — — — — 1 1 4 11 20 20 32 B20 Benign and unspecified Neoplasms M 3 — — — — — — 1 — — 1 1 F 3 — — — — — — 1 — — — 2 B21 Diabetes Mellitus M 10 — — — — — — — — 7 1 2 F 14 — — — — — — — — 1 3 10 B22 Avitaminoses, etc. M — — — — — — — — — — — F 1 — — — — — — — — — — 1 B46(l) Other Endocrine etc. diseases M 3 — 1 1 — — — — — — 1 — F 7 — — — — — 1 — — 2 1 3 B23 Anaemias M 3 — — — — — — — — — — 2 F 6 — 1 1 — — — — — — — 4 B46(3) Mental Disorders M — — — — — — — — — — — 2 F 6 — — — — — — — — — — 6 B24 Meningitis M — — — — — — — — — — — — F 1 — — — — — — — — — — B46(4) Other diseases of Nervous System, etc. M 22 — 2 1 1 — 1 1 1 8 7 F 22 — 1 — — 1 — 1 2 1 8 8 B26 Chronic Rheumatic Heart Disease M 20 — — — — — 1 3 1 4 8 3 F 29 — — — — — 1 1 3 11 5 8 B27 Hypersensitive disease ... M 25 — — — — — — — 5 2 8 10 F 37 — — — — — — 1 1 1 10 24 B28 Ischaemic heart disease M 400 — — — — — 1 7 32 93 137 130 F 330 — — — — — 1 1 10 29 66 223 B29 Other forms of Heart disease M 36 1 1 — — — — 4 1 4 7 — F 63 2 — 3 — 5 53 B30 Cerebrovascular disease M 175 — 1 — — — — 1 3 29 57 84 F 263 — — — — 1 2 — 5 15 48 191 B46(5) Other diseases of Circulatory system M 69 — — — — — — — 2 10 25 32 F 111 — — — — — 1 2 6 22 80 B31 Influenza M 9 — — — — — — — 1 3 1 4 F 10 — — — — — — — 1 4 2 3 B32 Pneumonia M 126 1 6 1 — 1 1 2 6 6 29 71 F 141 — 5 — — — — 1 3 10 21 101 B33(l) Bronchitis and Emphysema M 195 — — — — — — — 8 33 F 58 — — — — — — 1 2 5 16 34 B33(2) Asthma M — — — — — — — — — — — — F 4 — — — — — 1 — 2 — — — B46(6) Other diseases of Respiratory System M 22 — 5 2 — 1 — — 1 4 2 7 F 22 — 4 — — — — 1 — 1 2 — B34 Peptic Ulcer M 12 — — — — — — — 1 5 2 4 F 17 — — — — — — — 1 2 5 9 B35 Appendicitis M 1 — — — — — — — — — — — F 1 — — — — — — — — — — — B36 Intestinal Obstruction and Hernia M 1 — — — — — — — — — — 1 F 6 — — — — — — — 1 — 2 3 B37 Cirrhosis of Liver M 3 — — — — — — — 1 — — — F 2 — — — — — — — — — 1 — B46(7) Other diseases of Digestive System M 14 1 — — — — — — — 4 4 5 F 32 — — — — — — — 2 6 6 18 B38 Nephritis and Nephrosis M 8 — — — — — — — 1 2 3 2 F 6 — — — — — — — — 1 1 4 16 Table 1—continued Cause of Death Sex All ages Under 4 tvks 4 toks under 1 year Age in years 1- 5- 15- 25- 35- 45- 55- 65- 75 + B39 Hyperplasia of Prostate M 14 — — — — — — — — — 3 11 B46(8) Other diseases, M 10 — — — — — — — 1 1 3 5 Genito-Urinary System F 19 — — — — — — 1 1 2 2 13 B40 Abortion F 2 — — — — — 1 1 — — — — B41 Other Complications of Pregnancy, etc. F 1 — — — — — — — — — — — B46(10) Diseases of M 5 1 3 — 1 Musculo-skeletal System F 9 — — — — 1 — — 1 1 2 4 B42 Congenital Anomalies M 8 4 3 — — — — — — — — — F 9 5 1 — — — —— 1 — 1 — 1 B43 Birth Injury, Difficult M 25 25 — — — — — — — — — — Labour, etc. F 8 8 — — — — — — — — — — B44 Other causes of perinatal M 5 5 — — — — — — — — — — Mortality F 7 7 — — — — — — — — — — B45 Symptoms and ill-defined M 4 — — — — — — — — — — 4 conditions F 3 — — — — — — — — — — 3 BE47 Motor Vehicle M 19 — — 2 1 6 — 1 1 5 1 2 accidents F 4 — — — — 1 1 — 1 — — 1 BE48 All other accidents M 19 — — — — 1 2 3 1 4 3 5 F 31 1 1 — 1 1 1 — 1 1 7 17 BE49 Suicide and self-inflicted M 16 — — — — 1 1 4 4 1 3 2 injuries F 11 — — — — 1 1 — 2 3 2 2 BE50 All other external M 4 — — — — — — — 1 2 — 1 causes F — — — — — — — — — — — — HEART DISEASE The percentage of cardiovascular and atherosclerotic disease as a group has not varied much during the past ten years, as table 2 shows. This group of deaths, taken as a single cause, rank above any other single cause of death among the population. Table 2 HEART AND CIRCULATION MORTALITY [##]Year Deaths from Total heart & circulation {all ages) Age group 45-65 Total - deaths in borough Percentage Coronary diseases Other heart diseases Other circulatory diseases Coronary diseases Total (e) (h) (i) of(g)of (h) (j) (f)of (h) (k) (a) (b) (c) (e) (f) (g) (h) (d) 1959 599 485 155 1,239 142 215 3,448 36 6-2 41 1960 496 423 147 1,066 143 212 3,280 32 6-5 4-3 1961 609 516 153 1,278 162 236 3,380 38 70 4-8 1962 657 417 145 1,219 181 256 3,376 36 7-6 5-4 1963 707 400 142 1,249 174 245 3,404 37 7-2 51 1964 654 301 142 1,097 166 235 3,317 33 71 50 1965 740 304 150 1,194 206 268 3,436 35 7-8 60 1966 731 303 135 1,169 188 257 3,406 34 7-5 5-5 1967 750 246 158 1,154 201 262 3,340 35 7-8 60 1968 827 234 148 1,209 190 250 3,433 35 7-3 5-6 1969 730 210 180 1,120 164 220 3,367 33 6-6 4-9 17 LUNG CANCER Health Education was continued with the object of discouraging 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 MALE FEMALE Year All cancer deaths Lung cancer deaths (c) as % of (b) All cancer deaths Lung cancer deaths (f)as % of(e) (a) (b) (c) (d) (e) (f) (g) 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 1969 414 194 47 342 47 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 of these three. Table 4 MORBIDITY SHOWN IN INSURANCE CERTIFICATES [##]Weekly average for period ending 1968 1969[/##] January 28 2,368 1,877 February 25 1,416 1,785 March 25 1,481 1,624 April 22 1,014 1,036 May 20 1,008 929 June 17 947 904 July 15 850 863 August 12 858 807 September 9 911 831 October 7 1,112 997 November 4 1,250 1,021 December 2 1,044 1,065 December 30 1,026 1,845 Weekly average for the year 1968 1,195 „ „ „ „ „ 1969 1,199 18 19 Table 5 GENERAL STATISTICS FROM 1960 Year Population Death rate * % dying under age 45 % dying underage 65 Birth rate * Maternal Death rate † Still-birth rate † Infant mortality rate * * Pulmonary Tuberculosis Notif rate † † Death rate † † 1960 290,630 11 .3 8.8 30.1 16.8 0.2 18.3 21 .7 68 6 1961 289,130 11.7 7.4 28.5 17.7 0.2 18 8 20.6 73 8 1962 291,150 11.6 80 30.6 18.9 0.5 13.3 18.6 56 9 1963 291,180 11.7 8.7 31.2 19.3 0.4 15.2 23.5 66 8 1964 291,670 11.4 8.9 31 . 1 19.9 0.5 11.7 22.9 64 2 1965 289,560 11.9 9.3 31 .6 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 1969 282,080 11.9 6.3 27.8 16.0 0.7 13.5 20.6 33 4 * Per 1,000 population. † per 1,000 Registered Live and Still Births ** Per 1,000 Registered livebirths † † Per 100,000 population HEALTH CENTRES A new purpose.built centre in Oxestalls Road, S.E.8, named the Lind Health Centre, opened in March. Ante-natal, child health, health education, cervical cytology and school treatment sessions are held and there is also a chiropody clinic. The introduction of family planning sessions was under consideration at the end of the year. In December work commenced on the building of the Council's first comprehensive health centre at Stanstead Road, S.E.23, which, it is hoped, will open early in 1971. 20 MATERNAL AND CHILD HEALTH DOMICILIARY MIDWIFERY Valerie J. Buckingham, S.R.N., R.F.N., S.C.M., M.T.D., N.D.N.Cert. (Assistant Principal Nursing Officer) During 1969 there was a fall in the birthrate of 1.9 per 1,000 population within the Borough. There were a smaller number of domiciliary confinements: 574 compared with 849 in the previous year. The domiciliary confinement rate (the number of domiciliary births as a percentage of all live births) was 12.7% for the year. The Early Discharge Scheme remained popular. There were 1,284 early discharges compared with 1,361 in 1968. Although these figures suggest a fall in the use of the service, they should be olfset against the decrease of 550 births in the year. The Early Discharge rate for the year was 28.5%, making the proportion of maternity patients cared for by the domiciliary midwives 41.2% of the total births. There were a number of stalf changes during the year; six of our experienced midwives have left us and two new midwives have been appointed. In addition to the 547 patients delivered in their own homes a further 124 were booked for domiciliary confinements but they were subsequently delivered in hospital. Of this number, 45 patients were admitted to hospital in labour for the following reasons:— Premature labour—10 patients Incoordinate uterine action—10 patients Ante-partum haemorrhage—9 patients Foetal distress—7 patients Delay in the second stage—5 patients Abnormal presentation—1 patient Other reasons—3 patients. Ante-Natal Care forms a major part of the domiciliary midwife's role, co-operating with the general practitioner obstetrician to provide dual care for many of the Early Discharge patients, in addition to the service provided for the patients booked for domiciliary confinement. 7,943 ante-natal attendances were made, a decline on the previous year when 8,991 were made, but this figure is proportionately high for the number of domiciliary confinements, thus proving a wider involvement with the early discharge patients. 8,834 ante-natal home visits were also made during the year. Careful ante-natal follow-up resulted in changed bookings for 79 patients for the following reasons:— Post maturity—34 patients Toxaemia and hypertension—16 patients Ante-partum haemorrhage—6 patients Rhesus incompatibility—3 patients Abnormal presentation—2 patients Anaemia—2 patients Social reasons—2 patients Other reasons—14 patients. The Emergency Obstetric Unit operating from Lewisham Hospital was called out on 16 occasions. Premature Babies.—There were 16 premature babies born at home, of this number 5 were transferred to the Special Care Baby Unit at Lewisham Hospital, while 11 were nursed at home. 21 Screening for Phenylketonuria A highly specialised screening programme for every baby in the Borough was adopted as a result of the Department of Health recommendation E/C 109/1/68. The Scriver test (plasma chromatography) is being used for the early detection of phenylketonuria and other allied disorders. The midwives were specially instructed in the taking of blood by heel stab at the pathological department of Lewisham Hospital. The test is taken whenever possible on the ninth day of life, the domiciliary midwives being responsible for the babies born at home and those discharged early, while the hospital midwives undertake the test on all babies staying in hospital the full ten days. As the scheme had not been adopted by the hospitals in the Bromley area, Lewisham babies born outside the Borough are followed up after discharge by the domiciliary midwives. The screening commenced in October and to the end of December 670 blood specimens had been taken by the domiciliary midwives. Some positive results have been received but on second examination the results have been normal in all but one case and that baby is still undergoing investigations. Pupil Midwife Training The Greenwich District Hospital commenced a Part II Training School in July, and the first pupil midwife to undertake District training commenced in September. Pupil midwives are now trained from Lewisham Hospital and Greenwich District Hospital. The declining number of domiciliary confinements has affected the training programme and the emphasis is now upon the social services available to the community. As many deliveries as possible are made available to the pupil midwives, but the Central Midwives Board has now agreed to accept any number of deliveries, however small for each pupil, instead of a minimum of six complete cases. There were 49 pupil midwives who completed training during the year and a further 13 are in training at the present time. Liaison Scheme with Domiciliary Midwives working within Lewisham Hospital Planning has been going on throughout the year to establish a scheme to incorporate the domiciliary midwives into the early discharge programme, the idea being to give a greater continuity of care to patients who are only in hospital for a very short time. Many difficulties have been experienced, particularly with accommodation within the unit, but most of these have been overcome and the scheme is to commence early in the new year. Staff Training Resuscitation of the New Born is an important part of the midwives' duty—only a very few babies require special treatment. To assist the midwife to establish respirations in a baby needing help neonatal resuscitation tubes and laryngoscopes have been made available to the midwives. Proficiency in the use of this equipment is maintained by practise on a model which is available at the Special Care Baby Unit at Lewisham Hospital. Statutory Refresher Courses During the year three midwives attended refresher courses as required by the Central Midwives Board. Maternal Deaths Under the procedure laid down by the Department of Health for the confidential enquiry into maternal deaths, five maternal deaths were investigated. 22 DISTRICT NURSING Valerie J. Buckingham, S.R.N., R.F.N., S.C.M., M.T.D., N.D.N.Cerl. (Assistant Principal Nursing Officer) The District Nursing Service was used to its fullest capacity during the year with an increase of 7,115 visits above the figure for the previous year—164,427 in 1968, 171,542 in 1969. The number of patients referred for treatment within the home dropped by 824 patients—4,625 in 1968, 3,801 in 1969; there were fewer children under the age of 5 years seen at home and also in the age group 5 to 64 years, but there was an increase of 537 patients of 65 years and over. This changing pattern demonstrates the practical aspect of the district nursing sister working within the doctors' surgeries. Liaison Scheme with General Practitioners At the beginning of the year 12 nursing sisters and one male charge nurse were working in liaison schemes serving 30 doctors. Owing to a fixed establishment of staff it was not possible to expand the scheme very far during the year, but three further liaisons have been established, serving 5 doctors, making a total at the end of the year of 16 members of staff working in liaison schemes and serving 35 doctors. Most of the treatment sessions within the surgeries are in the late afternoon prior to the evening surgery—lack of space has made this arrangement necessary. The amount of work undertaken by the nursing sisters varies from one practice to another, but during the year a total of 1,278 injections, plus 1,634 other treatments, were carried out within surgeries. There has been a growing appreciation of this scheme, as both the doctor and the patient are helped and the sister sees the doctor regularly for discussion about her work. For the patient who is at work it is only necessary for him to leave his job an hour earlier instead of taking a morning off to attend the surgery or go to an outpatients department or wait at home for the nurse to call. For the elderly who are mobile and who can attend the surgery for treatment the visit provides a good reason to leave the house for a short while and the social contacts are valuable to those who are lonely. District Nurses Employed (Full time equivalents)—66 State Registered Nurses—Female 46 State Registered Nurses—Male 11 State Enrolled Nurses—Female 9. Thirteen members of staff left during the year and vacancies were easily filled. Retirements We were very sorry to say good-bye to two of our senior district nursing sistersMiss I. Cheeseman and Mrs. A. K. Buss. Mrs. Buss had spent 34 years in district nursing and Miss Cheeseman 32 years—both served with the Ranyard Mission until 1965 when the service was transferred to the London Borough of Lewisham. A combined retirement party was held for them on the 2nd July, 1969, when staff past and present met to wish them a happy retirement after so many years of devoted service. Staff Training During the year three nursing sisters and one male charge nurse were successful in obtaining the National Certificate of District Nursing. One State Enrolled nurse prepared for the assessment of the Queen's Institute of District Nursing and passed successfully. 23 A total of 21 members of staff attended in-service courses on various aspects of the work. The following subjects were included:— Rehabilitation in the home Domiciliary care of the patient with cancer Loneliness Health surveillance of the older age group. Two senior district nursing sisters attended a special Practical Workers Instructors course. Observation Visits During the year 67 persons accompanied the district nursing sisters on their visits to patients. They were:— 49 pupil midwives 5 occupational therapy students 12 hospital student nurses 1 World Health visitor. Integrated Courses The programme of integrated nurse training with King's College Hospital has changed slightly; the students now spend eight days on the district in their first year and a longer period of nine weeks during their third year. Three students completed their third-year programme and three new candidates undertook eight days during their first year. Geriatric Liaison Scheme A district nursing sister has been working for part of the week at the Geriatric Unit of Hither Green Hospital, acting as liaison officer between the hospital and the district nursing service. The scheme commenced in January and initially the running of the day hospital was included in co-operation with the physiotherapists. The day hospital opened for two days weekly and selected patients were brought to the hospital by ambulance. The patients were thoroughly examined by the geriatrician and treatment recommended; the district nursing sister was responsible for passing his instructions to the appropriate colleagues responsible for the patients. Rehabilitation is the main objective of both the day hospital and the geriatric wards and with the liaison sister in close contact with the district and the hospital, it is possible to allow the patient to return home earlier perhaps with regular visits to the day hospital. The scheme has grown during the year and the day hospital is now staffed with hospital sisters; the district nursing sister concentrates on the assessment visits with the geriatrician; during the year 286 assessment or follow-up visits were made. Bathing of Elderly People To accommodate the increasing demand for bathing of elderly people who are not sick but are incapacitated, due to age, an increase of bathing attendants was necessary. Eight female and two male bathing attendants are now employed. 10,688 baths were carried out during the year, a rise of 24.7% over the previous year—8,568 in 1968. The nursing sisters supervise this work so that immediate assistance may be given should any patient require nursing care. In-Service Training for Bathing Attendants A course of training was arranged for the new members of the staff, consisting of five study days—one day a week for five weeks. They were instructed in hygiene, methods of nursing care, the technique of lifting, etc. The services offered to the elderly by the local authority were given in detail as the bathing attendant has many opportunities for passing on valuable information. Two days revision were also given to the existing staff who followed the course the previous year. 24 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 (Principal Nursing Officer) The health visitor, as a "non-crisis" visitor, is in a unique position within the health and welfare services. Her work is mainly preventive with the objective of promoting and maintaining the total physical and mental health of all members of the family. She is concerned with the medical and psychological and the social needs of the family, giving advice to families in their own homes, in the doctor's surgery or in the clinic or health centre. Work with Mothers and Young People The health visitor visits mothers with new babies in their own homes. She has no right of entry but is seldom refused. She becomes aware of the need to visit through the notification of each birth sent by the hospital or midwife to the local authority and can then help to ensure that care is adequate and that as far as possible each child progesses normally. By her ability to recognise any deviation from the normal, physically, mentally or socially, she can give help and support to the parents towards the normal development of their children. She ensures that the parents understand the need for prophylaxis, and visits all children who are on the observation and "At Risk" register. In addition, the health visitor ensures that the requirements of the Nurseries and Child Minders Regulation Act relating to the daily minding of young children are understood and that contraventions are detected and remedied. Some of the problems met are due to conditions related to poor housing, matrimonial, financial or health and diet difficulties. One of the alarming tragedies of the present day is the increase in the number of "battered" babies, and the number of children who are left alone in their homes. The varying needs and differing standards of families from other countries need special consideration. "Touchhungry children" is a description given to children who are left alone for long periods during the day. All children need contact with others to learn how to play, and to be talked to; this is important for speech and mental and physical development. Many children are backward in speech, not through any physical defect but because they lack speech stimulation. General Practitioner/Health Visitor Attachment Schemes for attachment of health visitors to general practice within the Borough are being developed. Efforts are being made in suitable circumstances to alter the visiting areas of health visitors from geographical areas based around their health centres to practice areas. Progress toward this arrangement is limited to some extent because of the low ratio of health visitors employed to general practitioners in group practice, and the high percentage of "single" doctor practices, within the Borough. Where premises and conditions are suitable, health visitors agree unanimously that job satisfaction and the quality of service offered to the public are very much higher than before. Medical records and health visitors' records are both readily available to doctor and health visitor and regular consultation reduces the possibility of conflicting advice being given to patients. The doctor also gains knowledge of members of the family rarely seen, such as husband, school children and adult siblings. Many previously hidden problems where help had not been sought are brought to light and solved. For successful attachment/liaison schemes planning is essential. A visit by a nursing officer and medical officer is made to discuss with the general practitioner the work of a health visitor and follow-up visits are made at six-monthly intervals. 25 Apart from formalised arrangements the majority of health visitors have good contact with local doctors and call in at their surgeries to discuss cases. Two practices on the border of the Borough have health visitors from both Lewisham and a neighbouring borough going in and this arrangement seems successful. Attachment and Liaison Arrangements Groups Family Doctors Health Visitors Full attachments (H.V. area modified) 7 19 7 Liaison (H.V. area not modified) 2 6 2 Total 9 25 9 Staffing and Training of Health Visitors During 1969 the number of health visitors employed remained constant. Eight students who were sponsored for training by the Council were successful in the health visitors' examination and are now working as health visitors with the Council. Six students are at present training for the Certificate and if successful will be appointed as health visitors in September, 1970. In addition, students undergoing the four-year integrated nurse training course leading to qualification in general nursing, district nursing and health visiting received practical experience in the Borough. These students have to be of university entrance standard. Students in each of the four years of the course received this training during the year, the general nursing training part being taken at King's College Hospital in conjunction with Croydon College of Technology. Refresher Courses and In-Service Training All nursing staff attended courses and lectures outside or within the Borough, dealing with varied subjects of interest. Hospitals Health visitors have maintained and increased links with local hospitals. They attend paediatric and ante-natal sessions and a health visitor does valuable work in the diabetic out-patients department, linking hospital and home visiting. The health visitor attached to the spina bifida clinic at Sydenham Children's Hospital is able to provide the consultant with details about the home, school and general management of the child and can also give valuable help and support to the parents of the handicapped child, bringing in the social services and aids as required. The number of these children is increasing; there are now between 40-50 children in Lewisham. Health visitors have attended geriatric out-patient sessions and day hospitals and attended group discussions with other members of the team at the Hither Green and Lewisham hospitals. The work in liaison with the venereal disease out-patient department at St. John's Hospital continued, in addition to discussions regarding patients and follow-up of contacts, opportunities for health education in preventive measures are observed and undertaken. Surveys The health visitors continue to be involved in many surveys, such as:— 1. Greater London Council Research and Intelligence Unit—Spina Bifida; 2. Medical Research Council/London School of Economics—National Survey of Health and Development; 3. Paediatric Research Unit at Guy's Hospital—South East Regional Survey; 4. National Child Development Study; 5. I.L.E.A. Rubella vaccine trial; 6. G.L.C. Research Unit—Survey of the work of health visitors. 26 The National Child Development Survey, 1958, is now undertaken by health visitors and school nurses. During the last 11 years the progress of a selected group of children has been studied. The health, educational progress and adjustment of environment of the children has been followed and the percentage of children remaining in the survey is encouraging. The health visitors have made special visits to the home and completed questionnaires for 2% of children born in 1958. These children, numbering 16,000 in all, were born in the week 3rd-9th March, 1958. It is expected that the survey will provide valuable information for the research team to increase the understanding of child development and the promotion of child health. Work for the School Health Service The health visitors and school nurses are responsible for the general health and care of children in nursery classes and nursery schools. The health visitor's close contact with the family environment can be useful to the head teacher in understanding the behaviour of the children. Treatment centres are available in the Borough to deal with minor ailments and verrucae, etc. Health education classes are held in all centres and in many schools; these are taken by health visitors or school nurses who have taken the City and Guilds Technical Teachers' Certificate. More junior schools and also the academic streams in senior schools are showing interest in the talks and group discussions arranged by the health visitors. Visitors Between 400-500 hospital nurses from King's College Hospital, Lewisham and Greenwich hospitals visited establishments for observation of the services. Students from various colleges attending courses for child care studies, social science, teacher training, etc., have attended discussion groups with nursing officers and visited establishments in the Borough. Visitors from Ethiopia, Egypt, Trinidad, Thailand, Libya, etc., were taken around health centres and day nurseries; many of the requests having come from the Foreign Office and British Council. Lectures were given at regular intervals to hospital staff at King's College Hospital and local hospitals on subjects related to social aspects of disease and the preventive services. Talks on the work of health visitors and school nurses in schools were given to 200 Froebel student teachers. The quality of the preventive service has a direct effect on the need for the curative services. While a great deal has been done to improve the quality of service to the public, many members of staff are hampered by having to work in unsatisfactory premises where there is no privacy for interviewing and full observation of the child. Church halls are usually inadequately heated and draughty buildings. Table 6 VISITS TO HOMES Children born in 1969 5,245 1968 6,279 1964-67 12,511 Total 24,035 Persons aged 65 or over 364 Mentally disordered persons 83 Persons, excluding maternity cases, discharged from hospital (other than mental hospitals) 64 Infectious disease 63 Tuberculous households visited by tuberculosis visitors (including 22 visits by district health visitors) 1,967 Other visits (special reports on overcrowding, housing for M.O.H.) 395 Grand Total 26,971 27 CERVICAL CYTOLOGY Regular sessions have continued throughout the year at all the main health centres in the Borough. In addition, special sessions were held in one large new store in Lewisham for the benefit of the female staff. A new scheme, authorised by the Health Committee in October, 1968, was put into operation at the Lind Health Centre and has been very successful. This scheme involved working through general practitioners, and two practices in the Lind area were approached in this respect. It was agreed that letters signed by the doctors be sent to all women patients in the appropriate age range on their lists. The letters invited women to attend the Lind Health Centre for a smear test, and asked them to make their own appointments at the clinic. In the case of the first practice the doctors themselves wished to undertake the testing of their own patients; the tests for the second practice were to be carried out by a medical officer employed by the Health Department. In both cases the clerical work was to be done by the Health Department, who would also supply the clinic staff required. The scheme came fully into operation in the first week of July. By November an opportunity had been given to all the women concerned in these practices to have a test carried out. A second letter was then sent to all who had not availed themselves of this first opportunity and this resulted in a few more acceptances. It is proposed that a regular cytology session should continue to be held at the Lind Health Centre on a monthly basis in the future. In view of the success of this enterprise similar schemes are being arranged in other parts of the Borough for the future. CONGENITAL MALFORMATIONS Figures are supplied to the Registrar-General of all congenital malformations recorded at birth or observed during a child's first year of life. The co-operation of hospitals and general practitioners in this arrangement is, of course, essential and the periodic publication by the Registrar-General of the collated returns enables changes in national and regional patterns to be detected and examined. Children are not identified individually to the Registrar-General but locally all such children are considered for placing on the Lewisham Observation Register of handicapped and those at risk of becoming handicapped. An intensive follow-up of children placed on the register is now a routine procedure. With effect from 1st January, 1969, the list of abnormalities in the coding list used in connection with notification to the Registrar-General was shortened, the change being made to bring the G.R.O.'s list in line with the current edition of the International Classification of Diseases. This in part accounts for the reduced number of notifications as compared with previous years. During the year a total of 86 children were reported, which figure represents 1.9% of total live births in the Borough. 28 Table 7 Congenital malformations reported 0.1 Anencephalus 7 0.4 Hydrocephalus 5 0.6 Other specified malformations of brain or spinal cord 1 0.8 Spina Bifida 6 0.9 Unspecified malformations of brain, spinal cord and nervous system 1 Total: Central Nervous System 20 1.1 Anophthalmos and microphthalmos 1 1.6 Unspecified malformations of ear 1 1.8 Accessory auricle 1 1.9 Other specified malformations of ear 1 Total: Ear and Eye 4 2.1 Cleft lip 5 2.2 Cleft palate 6 2.7 Rectal and anal atresia 3 2.9 Other specified malformations of intestinal tract 3 Total: Alimentary System 17 3.0 Unspecified malformations of heart and great vessels 12 3.9 Specified malformations of heart and great vessels 2 Total: Heart and Great Vessels 14 4.0 Unspecified malformations of respiratory system 1 Total: Respiratory System 1 5.1 Indeterminate sex and true hermaphroditism 1 5.6 Extrophy of bladder 1 5.7 Hypospadias, epispadias 3 5.9 Other specified malformations of urino-genilal organs 1 Total: Urino-genital System 6 6.0 Polydactyly 8 6.1 Syndactyly 2 6.2 Reduction deformity—hand or arm 1 6.5 Talipes 19 6 6 Congenital dislocation of hip 2 6.8 Unspecified malformations of leg or pelvis 2 6.9 Unspecified limb malformations 1 Total: Limbs 35 7.0 Other malformations of musculoskeletal system (including congenital hernias) 1 7.1 Malformations of skull or face bones 1 7.4 Malformations of sternum and ribs 2 7.5 Chondrodystrophy 1 Total: Other parts of Musculoskeletal System 5 8.2 Other unspecified malformations of muscles, skin and fascia 1 8.4 Other specified malformations of skin, including ichthyosis congenita 2 Total: Other Systems 3 9.5 Other syndromes specified due to chromosomal abnormality 1 9.6 Down's syndrome (mongolism) 3 Total: Other Malformations 4 Table 8 Congenital malformations reported: by parity Parity Number of Children 0 28 1 23 2 17 3 6 4 3 5 5 6 1 8 2 18 1 86 29 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. 73 adoption and boarding-out reports were examined and reports on 68 prospective parents were scrutinised during the year. BLIND AND PARTIALLY SIGHTED PERSONS 148 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 78. This certification facilitates the provision of the Council's welfare services. RECUPERATIVE HOLIDAYS These are provided on medical recommendation for persons who have recently been under medical treatment and who need rest, fresh air and good food. Persons in need of supervision or medical and nursing care require convalescence which is the responsibility of the appropriate Hospital Board. Arrangements are made for adults, expectant mothers and nursing mothers, and children under five years, not attending school. Children of school age are dealt with under arrangements provided by the 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 1969 was as follows:— Table 9 1969 Expectant and Nursing Mothers 1 Tuberculous Adults 1 Other Adults 91 Psychiatric patients 20 Accompanied Children 34 Unaccompanied Children (I.L.E.A. Scheme) 84 DAY CARE OF CHILDREN Health Department Day Nurseries There was a heavy demand for places in the three day nurseries which were fully occupied with priority class children throughout the year. Full day care is essential in some parts of the Borough, primarily to provide help for the mother who has to go out to work. The Early Care Unit at the Shaftesbury House Day Nursery (15 mentally subnormal children under the age of 5 years) continued to provide a valuable service. Selection of suitable staff for the exacting work in this unit is extremely important. 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 55 49 Rushey Green 80 71 Shaftesbury House 59 51 30 The nursery students who completed the two-year course of training were successful in the Nursery Nurse Examination Board examination. At the end of the year 15 students were receiving practical training in the nurseries and theory in the Southwark or Brixton colleges of technology. Private Day Nurseries, Childminders and Pre-School Playgroups Following the passing of the Health Services and Public Health Act, 1968, the work of inspection, registration and supervision of all groups was intensified. An assistant nursing officer, specially appointed for this aspect of the work, accompanied by a medical officer, visited all premises for which applications for registration had been made. Health visitors visited and reported on all established groups. Follow-up visits are essentail to maintain satisfactory standards and check on changes in staff and attendances. An organiser of playgroups and childminders was appointed during the year. The organiser has given valuable advice to new and established groups, including the purchase of equipment and the provision of suitable activities for the children. She also forms the link between the Council and voluntary organisations. The organiser also visits childminders providing full day care to ensure that satisfactory care is given and to observe and offer help over a longer period. A scheme for providing financial assistance to playgroups accepting a quota of priority class children was approved, and under this scheme grants totalling £895 were paid to 11 groups. In cases of financial difficulty the Council met the fees of playgroups or childminders for the reception of priority class children. Eight private nurseries or playgroups were registered by the Council under the Nurseries and Child Minders Regulations Act, 1948, during the year. At the end of the year there were 47 registered nurseries or groups authorised to provide whole or part day care for up to 1,188 children. The coming into force of the penal clause of Section 60 of the Health Services and Public Health Act, 1968, involved a heavy volume of work early in the year in the registration of women who had been minding one or two children, for which registration was not previously necessary. Altogether, during the year, 337 persons were registered for the minding of up to 563 children. FAMILY PLANNING The arrangement whereby the Family Planning Association acts as agent for the Council in providing a family planning service from Health Department premises on a deficiency grant basis continued and during the year additional weekly sessions were introduced at the Heathside and Speedwell health centres, the latter being special youth advisory service sessions. At the end of the year the following sessions were being held:— Central Lewisham 3 Amersham Road 2 Speedwell 2 Louise House 5 Flower House 3 Downham 2 Heathside 1 Spalding House 2 A scheme was introduced whereby general practitioners providing and fitting intra-uterine devices free to women in necessitous circumstances could claim a fee from the Council. During the year the base for the Council's domiciliary service was transferred from the Amersham Road to the Speedwell Health Centre. The following table gives details of the service provided during the year:— 31 Table 11 1968 (9 mths only) 1969 No. of first domiciliary visits by Medical Officer 108 126 No. of visits by patients to clinic 104 307 No. of persons aged 30 or over at first visit 48 51 No. of persons with 5 or more pregnancies prior to first visit 60 48 1 am indebted to the Branch Organising Secretary of the Family Planning Association for the following figures of work carried out by the Family Planning Association within the Borough during the year. It should be mentioned that special youth advisory sessions were started at Speedwell Street in October, and that the marital advice session was transferred from the branch office to Louise House, Dartmouth Road, at the beginning of November. Table 12 No. of Clinics 9 No. of Clinics Sessions Held 985 No. of Doctor Sessions Held 1,428 No. of Cytological Smears Taken 1,740 Positive 8 No. of Patients Officially Referred by Hospitals 119 „ Notified by Hospital 85 „ Officially Referred by L.A. 177 „ Notified by L.A. 208 New Patients First Visit this Year Repeat Visits Medical Cases Socially Needy Cases Brockley 280 620 1,086 5 15 Downham 117 264 516 17 8 Forest Hill 848 2,071 3,685 72 117 Lewisham Central 585 1,401 3,247 14 36 Lewisham—Flower House 305 1,045 1,448 35 35 Lewisham—Hospital 144 400 402 18 59 New Cross—Amersham Road 366 744 1,575 17 48 New Cross—Heathside 63 85 81 2 1 New Cross—Speedwell 157 172 324 8 24 New Cross—Speedwell Y.A.C. 19 19 11 — — Total 2,884 6,821 12,375 188 343 Note.—First visits include new patients, therefore equals number of individual patients. These records do not include patients who visited the clinics for supplies only. 32 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 liomes 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 tabic shows:— Table 13 Equipment No. issued during 1968 Total stock held on stock register No. on loan at present Air Rings 34 66 61 Back Rests 70 103 100 Bed Cradles 52 109 107 Bed Pans 36 68 65 Cot Beds 1 2 2 Commodes 314 711 706 Easi-Carry Hoists 10 17 17 Easi-Carry Hoist Slings 4 13 8 Fracture Boards 34 112 92 Hospital Beds with Pulley 10 38 19 Inflatable Toilet Sets 3 12 2 Mattress (Dunlopillo) 1 24 21 Mattress (Hair) 11 30 10 Mattress Covers 16 37 16 Penrhyn Bed Lifts 11 34 32 Ripple Beds 10 7 7 Rubber Sheets (6' x 3'). 43 128 105 Sorbo Rings 3 5 3 Tripod Walking Sticks 13 50 50 Urinals (Glass) 19 28 21 Zimmer Walking Frames 93 167 145 Wheelchairs 55 67 62 Totals 843 1,828 1,651 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. 33 DENTAL SERVICES Dr. E. Mahler, who held the joint appointment of Chief Dental Officer/Principal School Dental Officer with the London Borough of Lewisham and the Inner London. Education Authority, retired during the year, her last day of service being 30th November, 1969. Dr. Mahler commenced duty on 5th July, 1965, and through her energy and drive raised the standard of the dental service most noticeably. Improvements were effected in the dental surgeries and particular attention was paid to the renewal of equipment with the most modern types available. She had a special interest in dental health education both in the schools and by counselling mothers of preschool children attending the Council's health centres. In this respect the puppet show featuring Peter and Paul Molar, Mr. Giant Toothbrush, Jimmy Germ and other characters was extremely popular with school children and created considerable interest in other boroughs. Despite her complete dedication and involvement in the work of her section, Dr. Mahler was always willing to discuss personal problems with her staff and colleagues and to take an interest in their problems. Her colleagues were always sure of her support and she was well liked by them all. Dr. Mahler can truly be said to have laid the foundations of a modern dental service in the Borough. 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 Catford County School (1 surgery) Bellingham Road, S.E.6 Table 14 DENTAL SERVICES FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS At Attendances and Treatment Number of Visits for Treatment During Year Children 0-4 (inch) Expectant and Nursing Mothers First Visit 1,052 10 Subsequent Visits 1,927 13 Total Visits 2,979 23 Number of Add'l Courses of Treatment other than the First Courses commenced during year 94 — Treatment provided during the year— Number of Fillings 2,413 17 Teeth Filled 2,148 15 Teeth Extracted 222 3 General Anaesthetics given 65 — Emergency Visits by Patients 111 2 Patients X-Rayed 10 2 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 813 5 Teeth Otherwise Conserved 408 — Teeth Root Filled — Inlays — Crowns — Number of Courst of Treatment Completed During the Year 623 2 34 B: Inspections Number of Patients given First Inspections During Year A 1,089 D 11 Number of Patients in A and D above who Required Treatment B 747 E 10 Number of Patients in B and E above who were Offered Treatment C 747 F 10 C: Sessions Number of Dental Officer Sessions (i.e. Equivalent Complete Half Days) Devoted to Maternal and Child Health• For Treatment 435.7 For Health Education 124.3 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 15 School Roll 43,808 Number of sessions: Inspection 213.4 Ordinary treatment 4,204.6 General anesthetic 31.4 Orthodonic 301.6 Health education 128.8 Total sessions 4,879.8 Inspections—Number of children given: First inspection at school 18,985 First inspection at clinic 3,954 Percentage found to require treatment 71.7 Reinspection at school or clinic in 1969 640 Percentage found to require treatment 85.3 Visits for treatment: Number of first visits 6,967 Number of subsequent visits 22,480 Total visits 29,447 Emergencies 1,116 Additional courses commenced 1,041 Number did not attend 11,366 Treatment given: Number of fillings: In permanent teeth 14,868 In temporary teeth 10,205 Number of extractions: Of permanent teeth 902 Of temporary teeth 3,046 Number of other operations (prophylaxis, X-rays, inlays, crowns, etc.) 11,949 Courses of treatment completed 4,974 Orthodontics: Number of new cases 212 Number of removable appliances fitted 356 Number of fixed appliances fitted 26 Sessional averages: First visits 1.5 Subsequent visits 5.0 Emergencies 0.2 Did not attend 2.5 Fillings: In permanent teeth 3.7 In temporary teeth 2.2 Extractions: Of permanent teeth 0.2 Of temporary teeth 0.7 Ratio of permanent teeth filled to permanent teeth extracted 13.7 Ratio of temporary teeth filled to temporary teeth extracted 3.0 35 SCHOOL HEALTH SERVICE The Inner London Education Authority is responsible for the school health service, but by virtue of an agreement required by Section 32 of the London Government Act, 1963, there is joint use by the Authority and the Borough Council of professional staff premises and equipment. The Medical Officer of Health is the Principal School Medical Officer of the Inner London Education Authority for the area and responsible to that authority for the day-to-day running of the service. The health of the 43,808 children of school age in the Borough has, during the year, continued to be good and supervision of all aspects of the health of these children has been maintained. Children are medically examined routinely on at least four occasions during their school life, i.e. at entry to school at 5 years, at 7 to 8 years of age, at entry to secondary school and again before the statutory school leaving age of 15 years. Parents are invited to attend at these examinations. In addition, many special medical inspections are carried out, both in school and in the home by school doctors, in response to requests by parents, teachers or education authorities for advice about various aspects of children's health, fitness for ordinary school, etc. Recommendations for placement at special schools, speech therapy, home tuition and provision of transport to and from school may be made as a result of these special medical examinations. Some of the school doctors are specially qualified to carry out tests of intelligence for ascertainment of children who are educationally subnormal, and these tests are carried out at special inspections. In addition, arrangements are made for the reinspection in school of some children who, at their routine examination, are considered to require continued observation. Annual hygiene inspections and vision tests are carried out by school nurses and all children have an audiometer test soon after school entry and later in their school life should any doubt about their hearing arise. Defects of vision or hearing may be investigated at vision and audiology clinics held in the school treatment centres by specialist doctors. Special investigation clinics are held throughout the Borough for the treatment of school children of such conditions as obesity, eneuresis and minor behaviour disorders. These clinics are staffed by school doctors and social workers. Wherever possible handicapped children are educated in ordinary schools, but for some children this is not possible and arrangements may be made for placement by the Inner London Education Authority at special day and boarding schools. 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 in this unit spend part of the school week participating in normal school classes, but attend the special unit for specialised teaching. Children with severe hearing defects or who are maladjusted attend day schools in neighbouring boroughs, and physically handicapped children attend Charlton Park School in Greenwich. A new school for educationally subnormal children is planned for the Borough in 1970. Observation Register The names of children who are handicapped and whose home address is in the Borough are listed in the Observation Register, whether or not they attend schools outside the Borough. An index card is kept for each child showing handicap, family 36 HEARING TESTS At six feet distance tester whispers to child which toy to pick up HEARING TESTS Using equipment to test frequency range of child's hearing Hearing test—child aged six months and hospital doctor and the school attended. A confidential file containing medical details for each child is kept in the Health Department and is kept up to date with information from hospitals, school doctors and education authorities. Copies of relevant information are forwarded to doctors in the schools. The register ensures that each child receives all of the help and special facilities that are available to it and also provides statistics from which future requirements for medical and educational care of handicapped children can be predicted. Table 16 OBSERVATION/HANDICAP REGISTER Type of School Schoolchildren Total No. attending Day school No. attending Boarding school Physically handicapped 89 11 100 Delicate 112 39 151 Deaf 39 11 50 Partially hearing 44 2 46 Blind — 6 6 Partially sighted 29 1 30 Autistic 12 1 13 E.S.N. 563 60 623 Maladjusted 50 73 123 Other — 5 5 Hospital school — 7 7 Totals 938 216 1,154 Home tuition 13 Training Centre 40 Special Care Unit 26 Special Hospital 6 Approved school 8 Number of children at Woodlands O.A. School 48 Number of children at Woodlands Autistic Unit 3 Number of children at Brent Knoll O.A. School 46 Table 17 Year of Birth of School Children on Observation!Handicap Register Year of Birth No. of schoolchildren 1951 82 1952 94 1953 169 1954 189 1955 170 1956 184 1957 186 1958 189 1959 167 1960 187 1961 161 1962 155 1963 99 1964 46 1965 10 1966 1 2,089 37 DEAF REGISTER Schoolchildren Many children on the register have moderate hearing losses and manage in ordinary schools with special measures such as favourable position in class or with a hearing aid. Others who are deaf in one ear only compensate with the good ear and are not handicapped. These children have not been assessed as needing special education. Table 18 Children Attending Special Schools or Units (Special School/Unit Age Range 2 years to 16+ years) Type of Schooll Unit Day Boarding Total Deaf 40 9 (3 weekly) 49 Partially hearing 26 1 27 Partially hearing with additional handicap — 1 1 Physically handicapped 2 — 2 Physically handicapped with additional handicap — 1 1 Deaf/Blind 2 — 2 Delicate — — — E.S.N. 8 — 8 Maladjusted — 1 1 Others Junior Training Centre 4 Early Care Unit — Residential Care 8 Total number of children on register: 356. Under school age: 12 SCHOOL MEDICAL INSPECTION 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 43,808 as at May, 1969. Table 19 Routine inspections: Number inspected 16,827 Number found not to warrant examination (7 plus "specials scheme") — Percentage of No. inspected of: Parent present 56.8 Care Committee present 61.5 No. vaccinated against smallpox 71.8 No. immunised against diphtheria 92.0 No. immunised against whooping cough 85.8 No. vaccinated against poliomyelitis 91.0 Physical condition unsatisfactory 0.1 Referred for treatment of defects 15.2 Referred for treatment of defects other than vision 8.3 Non-routine inspections: (i) Specials 5,638 (ii) Re-inspections 5,717 Total (i) and (ii) 11,355 No. of routine inspections as percentage of school roll 38.4 No. of non-routine inspections as percentage of school roll 25.9 38 ROUTINE MEDICAL INSPECTIONS—DEFECTS Number of children noted for treatment or observation expressed as a rate per 1,000 inspected. Table 20 No. inspected 16,827 Defects * Skin T 10.46 O 14.68 Eyes—(a) Vision T 75.24 O 37.32 (b) Squint T 8.91 O 4.81 (c) Other T 1.37 O 5.94 Ears—(a) Hearing T 5.59 O 7.73 (b) Otitis T 1.55 Media O 3.51 (c) Other T 0.36 O 1.07 Nose and Throat T 6.24 O 31.14 Speech T 4.34 O 5.59 Lymphatic Glands T 1.60 O 14.32 Heart T 1.67 O 5.53 Lungs T 7.19 O 10.93 Developmental—(a) Hernia T 2.61 O 4.99 (b) Other T 1.19 O 6.72 Orthopaedic—(a) Posture T 1.49 O 4.40 (b) Feet T 4.22 O 13.49 (c) Other T 2.32 O 3.51 Nervous System—(a) Epilepsy T 2.14 O 1.60 (b) Other T 0.83 O 1.55 Psychological—(a) Development T 1.49 O 3.68 (b) Stability T 2.97 O 11.53 Abdomen T 0.24 O 0.53 Other T 21.34 O 34.47 *T=Treatment *O = Observation This table is an analysis, in accordance with the classification used by the Department of Education and Science, of defects found at routine inspections. 39 Personal Hygiene The appended table relates to surveys undertaken and also indicates action taken with verminous cases found as a result of the surveys: Table 21 1. Comprehensive Surveys: (a) Number examined 29,379 (b) Number (occasions) found verminous 153 (c) Percentage found verminous 0.52 2. Selective Surveys: (a) Number examined 17,327 (b) Number (occasions) found verminous 348 (c) Percentage found verminous 2.01 3. (a) Total times vermin found [l(b)+2(b)] 501 (b) Total % found verminous [3(a) as % of l(a)+2(a)] 1.07 (c) No. of individual pupils found verminous 372 (d) % of individual pupils found verminous (of school roll) 0.85 4. Action taken with verminous cases: (a) Advice and/or Lorexane 403 (b) Further action 98 (c) 4(b) expressed as a percentage of 4(a) 24.31 Analysis of 4(b) cases—referrals of hardcore cases to bathing centres Voluntary attendances at bathing centres: No. of pupils 98 No. of statutory notices issued — No. cleansed at centres following statutory notices: Voluntarily — 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. 40 Table 22 NON-ROUTINE MEDICAL INSPECTIONS Type of Inspection Re-inspections 5,717 Bathing centre inspections—scabies — —other 12 Employment certificates 714 Theatrical children — School journeys 3,158 Recuperative holidays—pre-departure 41 —on return — Secondary School annual surveys — Candidates for higher awards 16 Nautical school entrants 14 Outward bound courses 5 Infectious disease investigation 151 T.B. contacts — Boarding schools for the Delicate—pre-departure 20 —on return 1 Handicapped pupils—statutory examination 178 —periodic special defect examination 596 Research investigations and enquires 3 4,909 SPECIALS—At request of:— Head teacher—child's name entered in special book 158 —others 231 School nurse—following health survey 77 —others 16 Divisional (Education) Officer 32 District Care Organiser or Care Committee 15 Parent 116 School medical officer 68 713 OTHERS:— Accident on school premises 12 Boxing—reference from schools, A.B.A., or similar assotion — For free travel — Reference: (i) connected with remedial exercises 1 foot classes (ii) by gymnast or physiotherapist — Referred by—hospital — —speech therapist — —general practitioner — Miscellaneous 3 16 Total of all Non-Routine Medical Inspections 11,355 41 42 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 23 Number tested Percentage of number tested C—Boys and Girls A—Not wearing glasses B—Wearing glasses Percentage of number tested with and without glasses 6/6 6/9 6/12 or worse Noted for treatment 6/6 6/9 6/12 or worse Noted for treatment Noted for ment Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls 8,150 7,893 85.4 82.9 5.0 5.5 3.1 4.1 3.1 3.9 4.1 3.5 1.5 2.1 0.9 1.9 3.6 5.3 7.9 Table 24 COMPARISON OF DEFECTS NOTED AT 7-PLUS ROUTINE AND 7-PLUS 'SPECIAL' MEDICAL INSPECTIONS IN 1969 Number of children noted for treatment and observation expressed as a rate per 1,000 inspected No. inspected at 1-plus Routine Inspections 4,604 No. inspected at 1-plus Experimental Scheme Inspections — Defects A B Skin 28.5 — Eyes—Vision 112.5 — Squint 13.0 — Other 3.7 — Ears—Hearing 14.8 — Otitis Media 5.2 — Other 1.9 — Nose and Throat 45.0 — Speech 11.1 — Lymphatic Glands 18.0 — Heart 8.3 — Lungs 16.9 — Development—Hernia 8.7 — Other 10.2 — Orthopaedic—Posture 6.7 — Feet 20.2 — Other 6.3 — Nervous System—Epilepsy 3.3 — Other 3.2 — Psychological—Development 7.4 — Stability 17.6 — Abdomen 0.4 — Other 62.8 — Column "A" refers to 7-plus routine medical inspections Column "B" refers to 7-plus experimental scheme inspections 43 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, mobilising inter-disciplinary resources, and liaising with other statutory and voluntary agencies. School Health Social Work Service During the year the development of this service continued and in co-operation with social workers jointly employed by other London boroughs and the Inner London Education Authority, working parties were set up to evaluate and clarify the function of school health social workers. The result showed a need to provide individual and family casework for children showing early emotional problems or suffering from enuresis or obesity attending special investigation clinics. An interesting experiment, in which a medical social worker participated with a doctor, was undertaken; this involved setting up a discussion group for mothers of children attending the Amersham Road Special Investigation Clinic. Similar help was also needed for children attending special schools and units, as a wide range of problems were presented. Collaboration with the School Care Service and other agencies was maintained. It was also possible during the year to look at the needs of physically handicapped children and those thought to be suffering from epilepsy. An increasing number of requests were made by the medical adviser, I.L.E.A., for special reports when children were being considered for boarding school placement. School health social worker attachment was as follows:— (a) Local Authority Clinics Amersham Road Special Investigation Clinic Health Centre, Amersham Road, S.E.14 Downham Special Investigation Clinic Downham Health Centre, Churchdown, Downham Kingswear Special Investigation Clinic Kingswear Health Centre, Dartmouth Road, S.E.23 Lewisham Special Investigation Clinic School Treatment Centre, 78 Lewisham Park, S.E.I3 Lewisham Audiology Clinic School Treatment Centre, 78, Lewisham Park, S.E.13 Speedwell Special Investigation Clinic Speedwell Centre, Speedwell Street, S.E.8 Sydenham Special Investigation Clinic Children's Hospital, S.E.26 (b) Hospital Clinic Lewisham Hospital Hearing Investigation Clinic (c) Hospital Liaison New Cross Hospital Hearing Aid Centre (d) Special Educational Units Sedgehill Partially Hearing Unit Brent Knoll School Autistic Unit (e) Special School Brent Knoll School for the delicate 44 Chest Clinic Welfare Service The two care committee organisers were both based at Lewisham Chest Clinic during 1969. They continued to act as Secretaries to the Chest Clinic Care Committees and were available to assist patients. During the year the Lewisham Chest Clinic Care Committee met on five occasions and the Deptford Chest Clinic Care Committee met on four occasions, when fund raising, grants, holidays and outings were discussed. Family Casework Casework help continued to be offered to forestall family breakdown in multiproblem family situations. Among these were the chronically sick and inadequate where frequent and prolonged contact was necessary, and a smaller group where short-term intervention at a time of family crisis was effective. Aspects that particularly emerged included the need to engage both parents, the capacity to tolerate and contain intense anxieties, both from the family and the community, and an understanding of the dynamics of human relationships. There was a broadening of referral boundaries, especially from general practitioners, and a number of self referrals from families whose requests for help were often subtle and oblique. Fortyfour families received long-term casework help in 1969 when 1,620 home visits/ office interviews were undertaken. Co-ordinating Committee The Co-ordinating Committee met on eight occasions during the year and 59 case conferences were convened at the request of various agencies, as follows:— Lewisham Housing Department 4 G.L.C. Housing Department 20 Welfare Service 2 Divisional School Care Organiser 6 Children's Service 16 Education Officer's Department 1 N.S.P.C.C. 1 Health Department 9 Annual Events We acknowledge with thanks voluntary contributions which enabled a Christmas party for 58 children to be held at the Town Hall. In addition, many families were able to have a family outing, due to a number of guest tickets for the pantomime which were made available by the Council. These were particularly welcome because many families known to the section rarely enjoy this experience. Voluntary Organisations Co-operation with voluntary agencies and associations was maintained and social workers became more involved with community projects. We should particularly like to acknowledge gifts and contributions from various associations at Christmas time, which social workers and family caseworkers made available to children and their families with special needs. Hospital Liaison During 1969 existing ties with hospitals were strengthened and an increasing number of referrals were made by the Children's Hospital, Sydenham, and the Maudsley Hospital to both social workers and family caseworkers. Workers participated in study days with nursing staff at the former and attended case discussions at the latter. 45 Staff Social workers attended talks, day conferences and courses in relation to specific aspects of their work as follows:— "The Family and the Chronically 111 Child"—Royal College of G.P.s, R.C.G.P. "The Battered Child"—Dilemmas in Management—St. Bartholomew's Hospital "Battered Children"—N.S.P.C.C. "Social Work with Immigrants"—Africa Centre "Community Work in London"—London Council of Social Service "Course for Potential Supervisors"—L.B.T.C. "Working with the Family as a Group"—L.B.T.C. "Introduction to Student Supervision"—University Extension Course "Loneliness"—Royal Society of Health "Problems of Adolescence"—Royal Society of Health "The Visually Handicapped Child"—Royal Society of Health "Children Who Don't Talk"—Inter Clinic Child Guidance Conference "Modern Aids to Hearing"—College of Deaf Welfare "Compulsive Gambling and the Family"—Churches' Council on Gambling. Students Placements continued to be provided for professional and pre-professional course students for varying periods of practical work. In addition, social administration students visited the section for discussions with staff and talks were given to students from other departments and other disciplines. 46 HOME HELP SERVICE Heavy demands continued to be made on the home help service. There was an increase in the number of households provided with help of the order of 4£%, the vast bulk of this increased work-load falling on the Grove Park office in Baring Road, S.E.12, which opened in 1968. As in previous years, about 90% of this service was provided for the aged and infirm. Difficulty was experienced in recruiting home helps to work in certain areas of the Borough and there was a slight reduction in the number of helps employed, the number at the end of the year being 626. Table 25 CASES RECEIVING SERVICE AS AT 31st DECEMBER 1969 (1968 figures in brackets) Office Maternity Tuberculosis Aged 65 and over Aged under 65 chronically sick Others Total Deptford Town Hall, S.E.8 — 2 625 58 8 693 (—) (2) (612) (42) (5) (661) 41 Rushey Green, S.E.6 4 5 742 91 13 855 (1) (5) (779) (92) (8) (885) 266 Kirkdale, Sydenham, S.E.26 2 10 800 60 24 896 (4) (11) (777) (57) (24) (873) 354 Baring Road, S.E.12 — 7 833 89 8 937 (1) (8) (714) (72) (18) (813) Totals 6 24 3,000 298 53 3,381 (6) (26) (2,882) (263) (55) (3,232) 47 HEALTH EDUCATION Mr. R. W. Allen, M.A.P.H.I., Health Education Officer This year has again seen growth in the size of the section and the scope of the work, which can be summarised as follows:— (a) The giving of information about the health service by means of press releases, talks to groups of the public and to schools, etc., and the production of another edition of "Guide to the Health Services." This, naturally, involves close co-operation with the Public Relations Officer's Department at Catford. (b) The arranging of talks, discussions, films, fiimstrip slides and tape shows on health and home safety hazards, and their prevention by means of immunisation, screening tests, exercise and appropriate change of habit, etc. Posters and pamphlets are designed and printed and these, together with many available from other sources, are used to amplify the various messages. Demonstrations and exhibitions are also organised. (c) The arranging of in-service training lectures for staff. (d) The production and distribution of a quarterly 20-page Health Bulletin (circulation 7,500). (e) Co-operation with teachers in various schools in "liberal studies" courses involving sex education and the arranging of talks on similar subjects when requested. Early in the year the section was invited by the Warden of Goldsmiths' College to arrange for a speaker and organise a week's exhibition on "Community Care of the Adolescent in Lewisham". This was in connection with their annual education conference. Dr. E. Vincent, S.M.O., spoke for the Health Department and Mr. Noel Hustler, Children's Officer, spoke about the work of the Children's Department, particularly that concerned with adolescent problems. Students come for help on various health projects, but tend now to come in groups rather than singly, which accounts for the drop in the number of sessions. Home safety continues to involve the section. Many examples of misuse of heating appliances and hazards of various kinds are referred by health visitors and social workers so that practical advice can be given by the home safety officers. The appointment of a second home safety officer, who had previously been involved in civil defence, allowed the section to arrange an extensive series of "Kiss of Life" talks and demonstrations, especially in schools. During the year more than 4,000 people have been taught and have had an opportunity to practise resuscitation on the models used by the section. This will no doubt be a regular part of the work in future. Co-operation with the Library Service helps to provide text books for staff and reprints from journals not circulated by the section. In this respect the section makes much use of LOGA, the Local Government Annotations Service. Three lunch-time talks were given to the staff, as follows:— The Cultural Background of West Indians Dr. Violet Moody The Need for Breast Feeding for the First Two Weeks Prof. Eric Stroud Geriatrics—the Link Between the Hospital and the L.A. Dr. Peter Meisner In view of the importance of health education on the subject of obesity, an experimental slimming club was run at a new health centre. The lessons learned will be applied to more of such clubs at centres throughout the Borough. The section produced a series of colour slides showing "The Work of a Health Visitor" and "A Day at a Day Nursery". Together with suitable scripts these will be used to give a more local flavour to talks on these subjects. 48 Together with the local division of the I.L.E.A. a conference was held at Adamsrill Junior School for heads and teachers in the Forest Hill area on the subject of health education in schools. Dr. E. Vincent read a paper and there was a good discussion, followed by a question and answer session. At the same time an exhibition was staged by the section of the material and help available to teachers. This was the first of several such conferences. Late in the year the section was involved in the public relations aspect of the food poisoning outbreak, whereby, subject to the guidance of the Public Relations Officer, the section handled all press enquiries. The annual competition for members of the Health Department staff, in which entries consisted of group and individual posters or models with a health education impact, produced a most useful set of material for use by the section. The standard was again very high and for the second time the Cup for the best group entry was won by Kingswear Health Centre. It must be emphasised that the most important work of the section is in helping others, such as doctors, dentists, health visitors, district nurses, public health inspectors, chiropodists, etc., to be health educators. In this part of the work most encouraging co-operation has been received from every direction. Films, filmstrips, slides, tapes, scripts, charts and advice are available to all members of the department who in their everyday contact with the public are practising health educators. The panel of representatives of the various health department disciplines continues to help guide the section and also to provide material for the Health Bulletin. The following is a summary of health education sessions of various kinds:— Table 26 Films 280 Filmstrips, slides or tapes 108 Student sessions 39 Talks by H.E. Section 245 Talks by H.V.s and Nursing Officers 773 Talks by Medical Officers 99 Talks by Chiropodists 2 Talks by Public Health Inspectors 14 Talks by Mental Health Officers 42 49 CHIROPODY SERVICE Mr. B. Da/ton, M.Ch.S., S.R.Ch., M.R.S.H., Chief Chiropodist The Council maintains six chiropody surgeries in the Borough and employs 1 chief, 3 full-time and 17 part-time chiropodists. This force serves the 282,080 population. The average appointment interval is 12 weeks. 6,489 persons or 2.3% (approx,) of residents regularly attend the chiropody surgeries on average four times annually. A total of 4,373 (4,595) sessions was worked during the year; full-time staff working 2,427 (2,397) sessions and part-time staff working 1,946 (2,198) sessions. This gives an overall average of 85 (88) sessions per week throughout the year. Treatments numbering 1,703 (1,547) were given to 542 (528) elderly, infirm or handicapped persons transported to the various surgeries; the average appointment interval for this service is 16 (15) weeks. Domiciliary visits totalling 31 (25) were made to 13 housebound persons of under pensionable age. Satisfactory appliances were completed for 348 (282) persons at Amersham Road surgery. Some 1,288 treatments were given to patients requiring special treatment, using special techniques and equipment which it would not be economic to have generally available. Under the Council's plan for sponsored chiropody training two students are at present attending college. Two chiropody surgeries have commenced during the year, one at Lind Health Centre, Oxestalls Road, S.E.8, and the other at Downham Health Centre, Churchdown, Bromley, Kent. Contact has been maintained with Deptford Central Methodist Mission and Brook Lane Medical Mission. Two talks were given during the year. A pilot investigation into an assessment of optimum methods of treatment for verrucae, using different chemicals, was launched at the beginning of the year. The project was twofold: 1. to record the optimum method of treatment, using the well-known remedies; 2. to explore more thoroughly optimum methods, using little-known or newer treatments. It very soon became evident that there were more clinical types of verrucae than had been realised hitherto, and different types required considerable variation in the mode of application of the same chemical. In view of this, the initial brief of the investigation was modified in order to catalogue and describe accurately the clinical appearance of the various types encountered, to which reference would be made subsequently. For the purpose of this investigation and for the sake of simplicity, viral infection as a major causative agent was assumed. Age of peak incidence was found to be somewhat earlier than previous surveys by others revealed. The 4 : 1 female to male incidence ratio was confirmed. A lengthy incubation period was also noticed. It is proposed to report, in the following year, the results of this initial cataloguing. Table 27 ANALYSIS OF BOOKINGS AND ATTENDANCES AT FOOT CLINICS Clinic Sessions Bookings Attendances Failures No. of persons attending 1969 1968 1969 1968 1969 1968 1969 1968 1969 Deptford Bathing Centre 98 88 753 809 712 689 41 120 103 Amersham Road 1,902 1,860 12,479 13,476 11,144 12,198 1,335 1,278 2,245 Kingswear, Dartmouth Road 962 1,063 5,852 6,528 5,243 5,974 609 554 1,464 Sangley Road 1 186 1,584 9,442 11,116 8,575 9,995 867 1,121 2,208 Lind, Oxestalls Road 137 – 750 – 707 – 43 – 237 Downham, Churchdown, Downham 88 – 491 – 442 – 49 – 232 Totals 4,373 4,595 29,767 31,929 26,823 28,856 2,944 3,073 6,489 50 Table 28 STATISTICAL SUMMARY OF ATTENDANCES 1969 1968 Number of sessions 4,373 4,568 Appointment bookings 29,767 31,929 Children of or below school age 1,772 2,015 Adults: Male 4,923 5,335 Female 20,128 21,510 Total 25,051 26,841 Fee paying attendances (adults) 6,187 7,333 Free attendances (adults) 20,636 21,523 Table 29 NEW CASES Age groups ATTENDANCES ANALYSIS Number attending clinics 1969 1968 0-4 10 9 5-14 294 227 Males 15-64 383 109 Females 15-59 891 258 Males over 65 1,308 179 Females over 60 3,603 435 Total 6,489 1,217 51 MENTAL HEALTH Miss Z. Mason, B.A., A.I.M.S.W., Principal Mental Health Officer During the year 280 mentally subnormal and 233 mentally ill persons were referred to the department and at the end of the year 795 mentally subnormal persons and 508 who were mentally ill were receiving some form of community care. Social Work At the beginning of 1969 social work was reorganised on a team basis, each team working to one consultant psychiatrist's hospital team. This made possible much closer co-operation with the hospital service by developing more informal and direct channels of communication, allowing more opportunities for case discussion and creating, we believe, a greater feeling of unity with hospital colleagues. One further development in co-operation this year has been a regular weekly visit by a social worker to Cane Hill Hospital. The promotion of two mental health social workers to the position of "Senior Mental Health Officer" later in the year made it possible for each team to be supervised by an experienced senior officer. There are now four social work teams: one working to Cane Hill Hospital, whose catchment area includes the S.E.26 and S.E.23 districts of the Borough, and three working to Bexley Hospital consultants' teams —two based on Lewisham Hospital out-patient clinics and one covering the Deptford area served by out-patient clinics, formerly at the Miller Hospital, now at the new Greenwich District Hospital. Apart from the catchment area hospitals, a number of referrals come from the psychiatric departments of the London teaching hospitals, the Maudsley Hospital and Mabledon Hospital, Dartford, and from general practitioners and other sources. Social work for the mentally handicapped has continued to be organised on a geographical basis, but one social worker has remained outside the team structure to enable her to undertake liaison work with the training centres, early and special care units and the special clinics; she works under the direct supervision of the Assistant Principal Mental Health Officer. One senior mental health officer specialises in the problems of alcoholism and addiction and liaises closely with the specialist units at Bexley Hospital and attends a session one evening a week at Castlewood Day Hospital. During the year he developed contacts with voluntary organisations and other colleagues working in this field and attended the first British Summer School for Alcoholism held at Birmingham in September. All social workers, except for one newly-appointed member of staff, undertook statutory duties under the Mental Health Act, 1959, on a rota basis. After 10 p.m. on weekdays and at weekends and statutory holidays the rota is operated jointly with the Borough of Greenwich. During the year the Mental Health Section received 250 calls outside normal office hours requesting immediate action with a view to organising hospital admission under the terms of the Mental Health Act, 1959. During the year a survey of long-stay patients in Bexley Hospital was undertaken by a senior mental health officer in collaboration with a consultant psychiatrist. The results have not yet been analysed, but it is hoped that the survey will provide information about the social needs of the mentally ill and will be helpful in planning community services in the future. SERVICES FOR THE MENTALLY HANDICAPPED Special Advisory Clinics A specialist in subnormality, who is a member of the Medical Adviser's Department, Inner London Education Authority, continues to hold clinics for backward children under the age of 5 years at Amersham Road and Central Lewisham Health Centres. During the year 40 sessions were held and 184 appointments offered; 144 children were seen. 52 The Early Care Unit The 15 places at the Early Care Unit, Shaftesbury Day Nursery, were fully occupied throughout the year. There continued to be a waiting list for admission and children were selected to fill vacancies mainly on the basis of social priority, having due regard to the needs of each child. Junior Training Centre Throughout the year the Junior Training Centre has been fully occupied. The five children from Lambeth were transferred to a new centre opened by the Borough of Lambeth and at the end of the year all the children attending the Lewisham centre were resident in the Borough of Lewisham. For the first time this year we had a substantial waiting list. On 31st December nine children over the age of 5 years were waiting for places. These figures are an indication of the increasing problem of mental handicap. A growing number of children with severe mental and physical handicaps are surviving the early years. In many cases their handicaps are so severe that they cannot benefit from the facilities offered in the Junior Training Centre. These children present considerable problems to their families owing to the degree of care and supervision they require. The Council endeavours to help these families and thus delay admission to long-term residential care by providing a special care unit attached to the Junior Training Centre. In October, 1969, the number of special care places was increased from 12 to 30 by adding an annexe to the existing unit to take six more children and by opening a temporary special care unit at the Baptist Church Hall. Perry Rise, S.E.23, to accommodate 12 children. Part of the cost of the temporary special care unit will be reimbursed by an Urban Programme grant from the Central Government. In addition to a senior assistant supervisor, a supervisor/teacher and seven attendants, a physiotherapist is employed for two sessions per week to help those children suffering from physical handicaps. Adult Training Centres Owing to redevelopment in Deptford the Adult Training Centre had to move from St. Michael's Church Hall to the Methodist Central Hall, Creek Road, S.E.8. This has made possible some improvement in facilities, such as the provision of separate dining room. The Brockley Adult Training Centre moved from St. Peter's Church Hall to better premises at the Methodist Church Hall, Kitto Road, S.E.14. In October the Borough of Lambeth were able to make their own arrangements for 15 women trainees from Lambeth who had been attending the Brockley Adult Training Centre. This made possible some reduction in the numbers on the roll. At the end of the year a total of 57 men and 46 women were attending adult training centres, all, except one who came from Southwark, residents of the Borough of Lewisham. All-London Annual Seaside Holiday Nineteen adults and 17 children accompanied by members of the staff went on the two-week annual holiday to St. Mary's Bay, Dymchurch. Later in the summer a group of 20 children from the nursery classes of the Junior Training Centre went for two weeks holiday, also to St. Mary's Bay, accompanied by their own staff and the mental health social worker responsible for liaison work with the centre. Short-Term Care Short-term residential care, to provide relief for their families, was provided for 43 mentally subnormal children and 23 adults. 58 of these were found places in approved homes and eight in hospitals. 53 Long-Term Care Obtaining places for persons requiring long-term hospital accommodation became increasingly difficult during the year but admissions were arranged for eight persons. Nevertheless, there were eight persons still awaiting admission at the end of the year. The number of persons for whom long-term care in approved homes is necessary grew during the year at an accelerating rate. At the end of the year the Council was financially responsible for the maintenance of 20 mentally ill persons, compared with 14 at the end of 1965, and the number of mentally subnormal persons for whom the Council was similarly responsible rose even more rapidly, from 23 to 59 over the same period, including an increase of 16 persons during 1969. These increases are, if the number of Lewisham residents accommodated at Honor Lea (which rose from 6 to 18 over the same four years period) are included with the mentally ill persons maintained in approved homes, very closely in line with the trend in the totals for all local authorities in England and Wales. The increases in the number of mentally ill for whom care is arranged is in accordance with national changes in the method of treating mental illness. The increase in the number of mentally subnormal is most marked among children and among the severely subnormal (again in line with national trends) and appears to be a product of the improved chances of such children surviving at birth, changes in family structure and attitudes towards care of their subnormal members, and more widespread knowledge of the facilities available. Although more places were obtained during the year, this was not without much difficulty as the demand by most local authorities for places in suitable homes continues to grow. Honor Lea Hostel In spite of staff shortages, Honor Lea has continued to be fully occupied for most of the year. During 1969 there were 26 admissions (including 3 re-admissions) plus 3 admissions for short-term care. 21 came direct from hospital, 5 from home and 3 from lodgings. There were 32 discharges—10 returned to hospital, 7 to home and 15 to lodgings. Many ex-residents still require the support of the hostel and their successful maintenance in the community has sometimes depended on the fact that they have been able to return to the hostel at frequent intervals to discuss problems with the staff or just to renew old friendships. During the year further rooms were converted to form a second self-care unit. A total of six residents can now be helped through having the opportunity to cater and look after themselves, thus gaining confidence before making the next step to returning to independent life in the community. A good employment record has been maintained throughout the year and all residents able to work have been found jobs, mainly through the efforts of the Warden; those not able to go to outside employment immediately on admission were admitted to one of the day centres for a period of rehabilitation. Work absenteeism continues to be below national average. 75 Arbuthnot Road This year saw the beginning of a new venture, a "half-way house" for those who have been mentally ill and have recovered sufficiently to be able to cater for themselves but still need the support of sheltered accommodation. 75 Arbuthnot Road is a three-storied, terraced house converted into two single flatlets sharing a kitchen and five double flatlets, each with its own kitchen-dining room. There are no resident staff, but a senior mental health officer keeps in close touch. At the end of the year there were in residence one married couple, one mother and baby and two women occupying the two single flatlets. Two other residents were due to move in within a few days. One mother and child, admitted when the house opened, have been able to move back to their original home after a stay of a few months. 54 DAY REHABILITATION CENTRES The statistics quoted below reflect a difference in emphasis in the functions of the day centres: the New Cross centre being geared more towards rehabilitation-backto-work, with a more pressurised work programme; and the Cambridge day centre serving the needs of the longer-term patient. Both centres, however, have a number of members whose chances of return to unsheltered employment are remote but who are enabled, through the social contact and purposeful routine of the centre, to stay out of hospital. Table 30 New Cross Cambridge Number on register—December, 1969 29 23 New admissions during 1969 29 18 Discharged 35 28 (i) Returned to work 15 4 (ii) Transferred to other centres 2 2 (iii) Transferred to I.R.U. (Dept. of Employment and Productivity) – 2 (iv) Returned to hospital 6 7 (v) Suspended due to behaviour problems 2 – (vi) Left for other reasons 10 13 Therapeutic Group The group has continued to meet on one evening a week throughout the year under the leadership of two mental health social workers. This is an on-going group with new members joining from time to time. The total number of persons on the roll at the end of the year was 13. This includes some residents from Honor Lea Hostel. Social Clubs This year, one psychiatric social club, meeting in the Forest Hill area, closed down owing to lack of demand in that neighbourhood. It was felt that an improvement in other local social facilities, such as those provided by churches in that area, and closer co-operation between mental health social workers and local organisations may have resulted in a greater acceptance of the mentally ill into other social groups, resulting in a consequent decrease in the need for a social club with a "psychiatric" label. The Tideway social club continues to meet at the New Cross day centre, but is now organised by two volunteers, with a social worker visiting in an advisory capacity. A social club at The Albany, Deptford (outside the sphere of the Health Department) welcomes the mentally ill as members. Club activitiesfor the mentally handicapped are provided entirely by voluntary organisations. Weekly evening clubs are held at the Congregational Church Hall, Lee, S.E.I2, and at the Lewisham Training Centre, S.E.23. There is also a Saturday morning club at the Lewisham Training Centre organised by the Southwark Diocesan Board of Education in conjunction with the Lewisham Society for Mentally Handicapped Children; the Council has supported this club to the extent of paying the wages of a driver for the Society's minibus. Industrial Work The Supervisor of New Cross Psychiatric Rehabilitation Centre, who has this particular responsibility, showed considerable energy and ingenuity in obtaining contracts from firms for paid work to be carried out by trainees at the adult centres and those persons attending the day centres to prepare themselves for employment in the community. Most of this was assembly work and packing, and gross earnings from contracts at the day centres reached £3,600; £1,850 was paid out in ex-gratia 55 payments and reimbursement of fares to persons attending the day centres. Preparations were made for taking up a contract for packing a variety of surgical supplies for the hospital service; it is envisaged that this will provide continuous interesting and well-paid work for all the centres. Mental Health Education 1969 Acceptance and understanding of the mentally ill and mentally subnormal person in the community depends to a large extent upon informing and educating the public about the problems of mental ill-health and the services which exist to help in this field. During the past year there has been an increased demand for talks on the various aspects of the work of the Mental Health Services from schools, church clubs and other interested groups within the Borough. A total of 40 talks have been given by members of the mental health staff throughout the year:— 1. Seventeen lectures given to schools within the Borough. This includes three lectures on specific subjects (stress, alcoholism and the use and abuse of drugs), given as part of the curriculum of a Health Education course at a college of further education; 2. Eight lectures to church clubs and other groups; 3. Fifteen lectures to groups of visiting students (social workers, health visitors and nurses). Mental Health Week 1969 During Mental Health Week the three training centres, two psychiatric day centres and Honor Lea psychiatric hostel were open to visitors, and there was a good response to the invitation. Members of the mental health staff played an active part in this year's symposium arranged by the Lewisham Association for Mental Health and held at the Deptford Town Hall. The symposium was on "Rehabilitation in the Community" and it was very well attended. Students Social Work.—The mental health section has continued to play a part in the training of social workers. At the beginning of the year there were two second-year students from the Chiswick Polytechnic "Certificate in Social Work" course spending three days per week in the department. These were followed in February, 1969, by two more students from the same course who stayed until June, the last four weeks of their stay being full time. From 23rd June two students from the Bedford College social science course spent four weeks observing the functions of the mental health section. In September a mature student from the University of London extra-mural social science course began a full-time placement until December. Two students from the Chiswick course began a part-time placement in September and were still in the section at the end of the year. All students, except those on observation placements, carried a small supervised caseload. There have been 17 social work students and 6 teacher training course students on one-day observation placements; also 10 new entrants to the Borough's welfare services. Teachers of the Mentally Handicapped.—The Junior Training Centre has accepted three students from the Chiswick Polytechnic course this year for observation placement followed by periods of six weeks teaching practice. Nursing and Health Visitor Students.—Mental health is now becoming an important part of the student nurse and health visitor's curriculum and the demand for day observation placements in the mental health section has greatly increased this year. A total of 20 nursing and health visitor students have visited the section and their programme has included discussion on the work of the section and visits to day rehabilitation and training centres and to Honor Lea Hostel. 56 Secondment of Staff to Full-Time Training In the summer of 1969 one member of staff completed a two-year course leading to the certificate of the Central Council of Teachers of the Mentally Handicapped; one social worker qualified as a psychiatric social worker after completing a one-year mental health course at the London School of Economics; and another social worker successfully completed the two-year course at the Chiswick Polytechnic, leading to the "Certificate in Social Work". In September, two social workers were seconded to begin a two-year "Certificate in Social Work course and one social worker gained a place on the one-year course for mature students at the Enfield College of Technology. The number of staff now fully qualified in accordance with N.J.C. conditions are:— Social workers—9 with 3 more expecting to qualify during the next two years. Teachers of the mentally handicapped—10. Volunteer and Voluntary Organisations In keeping with the trend in other fields of social action, the department recognises the need for community involvement in helping to meet the needs of the mentally disordered. Voluntary workers not only supplement the work of professional staff, but have a valuable contribution to make of their own. Particularly where there is loneliness and isolation, the volunteer can often bridge a gap between the individual and the community in ways which are outside the scope of the professional. How to recruit volunteers? How to use them most effectively? What kind of help from the department (informal discussion with social workers, group meetings of volunteers with professionals, a more formal kind of basic training) would give the best support? Much thought has been given to these questions in recent months and a beginning has been made in finding some answers. One mental health social worker has been given the special responsibility of investigating ways in which volunteers could be used and in co-ordinating their work. During the year the Tideway Social Club has been handed over to volunteer organisers, a scheme has begun, in conjunction with the Lewisham Association for Mental Health, for long-stay patients in Bexley Hospital who have no relatives, to be visited regularly by volunteers. Efforts are being made in co-operation with the Lewisham Council of Social Service to recruit volunteers willing to do supportive home visiting and club work. The department acknowledges the good work of those local organisations concerned with the problems of the mentally disordered—The Friends of Honor Lea, the Lewisham Association for Mental Health and the Lewisham Society for Mentally Handicapped Children—with whom close links have been maintained. The increasing interest in our work shown by young people has been one of the most encouraging features this year. Task Force have provided many young volunteers and local schools and youth organisations have visited our centres and offered help. As in previous years, we continue to rely on those well-established organisations such as the Brighton Guardianship Society, the Mental After-Care Association, the National Society for Mentally Handicapped Children and many others, without whom we should be at a loss to provide residential care for those who can no longer live in their own homes. SPECIAL REPORT As a result of the closure of a nursing home near Southampton on 5th December, emergency action had to be taken in respect of four mentally subnormal children placed there, two by the Children's Department and two by the Health Department, it is always difficult to find suitable residential accommodation for mentally subnormal children, and on this occasion the task was made even more difficult as some of the children in the nursing home had been suffering from sonne dysentery. 57 Two of the Lewisham children were excreting dysentery bacilli and the other two were contacts. No local arrangements could be made in Southampton for the reception of the children nor could any arrangments in Lewisham be made. Six children were also being maintained in the nursing home by the London Borough of Southwark, and the problem was eventually resolved when the Medical Officer of Health and the Children's Officer for Southwark arranged to open up an unused sick bay of a Southwark children's home to accommodate all ten children temporarily. Arrangements were made for the staffing of this unit by agency nurses, but unfortunately some difficulty was experienced over the supply of such nurses over the Christmas holiday. Part of the deficit at this time was covered by the Health Department's nursing staff who volunteered to look after the children. 58 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, the following diseases are notifiable to the Medical Officer of Health:— Acute encephalitis Acute meninigitis Acute poliomyelitis Anthrax Cholera Diphtheria Dysentery (amoebic or bacillary) . Food poisoning Infective jaundice Leprosy Leptospirosis Malaria Measles Ophthalmia neonatorum Paratyphoid fever Plague Relapsing fever Scarlet fever Small pox Tetanus Tuberculosis Typhoid fever Typhus Whooping cough Yellow fever NUMBER OF NOTIFIED CASES (Corrected for revised diagnosis) during the year 1969 with comparative figures for the previous six years. Table 31 Diseases Cases notified 1969 1968 1967 1966 1965 1964 1963 Anthrax – – 1 – 1 – – Diphtheria – – – – – – – Dysentery 137 46 90 152 159 226 870 Encephalitis (acute) – 1 – – – – – Enteric or typhoid fever 1 2 3 1 1 2 12 Infective jaundice 47 21 – – – – – Food poisoning 36 20 22 34 20 19 13 Malaria 1 1 – – – 1 – Measles 1,787 799 2,561 2,017 3,014 1,553 3,186 Meningococcal infection 24 16 – 3 1 2 1 Ophthalmia neonatorum 2 1 5 3 3 1 5 Poliomyelitis (acute) – – – – – – – Scarlet fever 86 105 174 82 161 197 103 Tuberculosis 107 132 116 148 157 203 210 Whooping cough 32 146 130 169 108 190 258 TOTALS 2,260 1,290 3,102 2,609 3,625 2,394 4,658 59 60 Table 32 NOTIFICATIONS OF INFECTIOUS DISEASES IN 1969 SHOWING SEX AND AGE GROUPS Disease Under 1 1– 2– 4– 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 M F Dysentery 3 3 8 3 14 18 6 4 18 16 6 4 3 11 9 9 – 2 – – 67 70 Food Poisoning 4 3 1 2 – 2 – – 1 – – 2 3 5 3 4 2 3 — 1 14 22 Infective Jaundice – – – – 2 1 – – 2 2 3 2 10 10 6 5 3 1 – – 26 21 Malaria – – – – – – – – – – – – – – 1 – – – – 1 – Measles 39 42 117 121 296 295 138 131 286 287 7 19 1 4 2 2 – – – – 886 901 Meningococcal infection 3 – 1 1 1 1 – 2 4 1 2 1 1 1 2 3 – – – – 14 10 Opthalmia Neonatorum 2 – – – – – – – – – – – – – – – – – – – 2 – Scarlet Fever – – – – 6 4 4 4 19 32 6 5 1 5 – – – – – – 36 50 Tuberculosis – – – – – 1 – – – 4 1 4 4 8 24 8 27 8 13 5 63 44 Typhoid – – – – – – – – – 1 – – – 1 – – – – – – – 1 Whooping Cough 1 3 – 4 7 4 1 – 6 4 1 – – 1 – – – – – – 16 16 MEASLES The number of cases was 1,787, which was very low considering that the year was one which is normally considered to be a year for the normal biennial heavy occurence of the disease. DYSENTERY The number of cases, 137, was more than in the previous two years. WHOOPING COUGH The year produced 32 cases, which was the lowest recorded. It is to be hoped that this illness will shortly become as rare as the more serious diseases have become in this century. TUBERCULOSIS Table 33 TUBERCULOSIS NOTIFICATIONS AT AGES Age periods New cases notified Non- Totals Respiratory Respiratory M F M F M F 0– – – – – – – 1– – – – – – – 2– – 1 – – 1 – 5– – 2 – 2 – 4 10– 1 4 – – 1 4 15– 1 2 – – 1 2 20– 3 6 – – 3 6 25– 9 6 5 – 14 6 35– 10 2 – – 10 2 45– 14 3 1 3 15 6 55– 12 2 – – 12 2 65– 7 3 1 – 8 3 75+ 5 1 – 1 5 2 TOTALS 62 32 7 6 70 37 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 the number of new cases of tuberculosis seen at the Lewisham Chest Clinic has been 50. The figure comprises 28 men, 17 women and 5 children. The total tuberculosis register has been reduced by 185 to 1,185. B.C.G. was given to 243 infants and children. Our three chest clinic visitors carried out 3,690 visits. The total Clinic attendances (excluding after care) were 19,321. Over 6,000 patients were sent for chest x-ray by their general practitioners, and new patients attending for clinical examination numbered 1,869. This year we have again found over 100 new cases of cancer of the lung. There has again been an increase in the number of patients presenting with asthma and chronic bronchitis; the Clinic is taking part in the asthma investigation being carried out by the South East Metropolitan Thoracic Society. 61 CHEST CLINIC, DEPTFORD I am indebted to Dr. J. P. V. Rigby for the following report concerning the Chest Clinic at Harton Street, of which he is consultant physician. The first ever tuberculosis dispensary was started by Sir Robert Philip in Edinburgh in 1912. Deptford had its first tuberculosis dispensary in 1913, not on these premises, but in Amersham Road, S.E.14. In 1936 the Deptford Tuberculosis dispensary was moved to Harton Street, occupying the rear of the premises. The front part was occupied originally by an ante-natal clinic and later by a foot clinic. At the end of 1948 I was appointed physician to the clinic. The backlog of work was enormous, as the clinic had had no regular physician for eight months. By 1950 I had got a major x-ray unit installed in the rear of the clinic and the foot clinic had moved elsewhere. I installed myself in the front part of these premises, which were then known as the Deptford Chest Clinic. The long battle against tuberculosis which ensued meant a very great deal of work. There is still tuberculosis in the nearby common lodging house, Carrington House, and to some extent in the local population. The main work now is with chronic bronchitis and with the diagnosis and treatment of cancer of the lung. The work load is heavy and exceeds that of the total medical out-patients, either in the Miller Hospital or the Greenwich District Hospital, according to annual figures. Moving the clinic now, either to the Greenwich District Hospital or to the Miller Hospital, would be a formidable task, and in terms of actual money saved, probably not worthwhile. Storage of records and x-rays alone would present big problems. The difficulties over pathology tests could be got over, in my opinion. It would be preferable to stay working on the present site for very many reasons, chief of which is that the clinic is central for the patients. I am not enamoured of the idea to move Grove Park Hospital to the Miller Hospital. I think the country surroundings at Grove Park contribute to the cure of my chest patients. Neither wings of the Greenwich District Hospital can be said to be in country surroundings. During 1969 the new cases of tuberculosis were 39 in number, making a total of 927 on the tuberculosis register. The steady trickle of new tuberculosis cases continues, but is less than in previous years. The new cases consist of 29 males, 5 females over fifteen years and 5 children. This drop in numbers has been mainly in the females. Twelve of the cases were bacteriologically proved and had mycobacterium tuberculosis in the sputum, and 11 of these were males. In all, 20 cases on the Deptford Chest Clinic Tuberculosis Register had positive sputum during the year. The work load in 1969 was again heavy, with 6,138 total attenders, of which 1446 were new patients to the clinic. This was even more than in 1968. All these patients received clinical examination with x-ray and pathological tests as necessary. The great majority of the new cases were seen by the consultant physician. B.C.G. vaccination was given to 131 persons, mostly tuberculosis contacts, and some tuberculin negative adults. The two tuberculosis visitors did 3,228 successful and 1,007 unsuccessful visits to homes in the area, mainly in the follow up of tuberculosis families and their contacts. Unsuccessful visits imply a call at a house where no reply was received. The medical work at the clinic is shared between the physician and the assistant physician. The physician does five clinical sessions and the assistant four. The physician, who works full time, spends the remaining time reading literally hundreds of chest x-rays and dictating reports to private doctors who send the cases to the clinic. Visits are also made to nearby hospitals, mainly Grove Park Hospital, Greenwich District Hospital (formerly St. Alfege's) and the Miller General Hospital. Patients are also visited at home, usually at the request of general practitioners. 62 Welfare work is done at the clinic, as inevitably patients present non-medical, as well as medical, problems to the clinic staff. This particularly applies to the Carrington House inmates. Incidentally, the Deptford Chest Clinic is the nearest medical establishment to Carrington House, and there was a time when I would see any Carrington House patient at this clinic at almost any time, provided that he attended under his own steam, but after several ill people from Carrington House had been partly carried up to the clinic by their friends, the scheme had to be discontinued. I now hear that a part-time doctor is in attendance at Carrington House on Saturday mornings. From what I myself have seen at Carrington House in the past, however, I consider that much more than this is needed. I believe that some medical practitioners attend there by request to see their own patients. I still do see quite a number of Carrington House medical emergencies at the clinic quite apart from this. Among the Deptford population, middle-aged males with severe bronchitis still present a problem in management. Each year brings new cohorts of these patients, and despite energetic treatment, often they do not stand the winters well. The number of new cases of lung cancer again increased in 1969, part of a national increase. Of 36 cases seen, 30 were male and 6 female, all of middle age. By the end of 1969, 15 males and 5 of the 6 females of the series had already died, despite full-scale treatment, often including a major surgical operation on the chest, with or without deep x-ray treatment. The majority of these cases of lung cancer were heavy cigarette smokers. As elsewhere in England, heavy cigarette smoking is a national habit and is, in fact, a local pastime in Deptford. I saw 90 males and 60 females among my new patients who smoked over 20 cigarettes daily and usually between 30 and 40 per day. This showed a considerable increase on 1968. This year, 1969, only 20 of the 90 males were under 30 years of age, whereas 27 of the 60 women were under 30. Ten of these were girls under 20 years of age. I see many hundreds of young people, however, who do not smoke at all. Thus, at present, middle-aged males and certain younger females are the heavy smokers. It is, in fact, uncommon to find a middle-aged man who does not smoke in south east London today. All these heavy smokers are advised to smoke less, as smoking so often makes chest symptoms worse. Yet, if tobacco smokers all gave up smoking on a national scale, I feel that the effect upon the Revenue might be catastrophic. Yet governments may have to find alternative means of raising revenue as time goes on, if this unhealthy habit is to be finally abandoned. FOOD POISONING Table 34 FOOD POISONING CASES Causative agent General Outbreaks Family Outbreaks Sporadic Cases Total Total No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained Notified or ascertained No. of outbreaks and sporadic cases columns (1+3 + 5) ( No. of cases columns 2 + 4 + 5) 1 2 3 4 5 6 7 S. Tvphimurium – – – – 14 14 14 Other Salmonellae – – – – 22 22 22 Cause unknown 1 78 – – 35 36 113 Total 1 78 – – 71 72 149 63 Table 34—continued DETAILS OF FOOD POISONING DUE TO SALMONELLAE OTHER THAN S.TYPHIMURIUM Type of salmonella 1 2 3 4 5 6 7 Panama – – – – 6 6 6 Enteriditis – – – – 5 5 5 Stanley – – – – 4 4 4 Infantis – – – – 2 2 2 St. Paul – – – – 2 2 2 Virchow – – – – 1 1 1 Newport – – – – 1 1 1 Unamed – – – – 1 1 1 Salmonella infection, not food borne Nil An outbreak of food poisoning affecting 78 boys of the West Greenwich Secondary School occurred in September, 1969. The school is an annexe of a Greenwich school but is located in the Borough of Lewisham and investigations into the cause of the outbreak were undertaken by the Medical Officer of Health for Lewisham and members of his staff. Close liaison was maintained with the Inner London Education Authority public health inspectorate. All of the 78 boys affected were served at the first sitting of a midday school meal and of these boys 17 were admitted to hospital. Details of all items of food eaten by the boys were obtained, and enquiries were also made into the possibility that substances other than those consumed at the meal had been taken by the boys. The only item of food common to all was potato. During the exhaustive investigations carried out during the outbreak, samples of all food served from the school kitchen, dinner waste, specimens of blood, faeces and urine were subjected to intensive bacteriological, virological and chemical investigations. Biological tests on the residue of the potato were not inconsistent with the presence of enough solanine to have caused the symptoms, but a chemical analysis on the remainder of this potato sample showed that the total amount found was not excessive. 64 MASS RADIOGRAPHY UNIT I am indebted to Dr. Morgan, the director of the unit, for information of work done in the Borough during 1969, on which the following tables are based:— Table 35 Patients Men Women Total General analysis: X-rayed 5,101 4,975 10,076 Previously x-rayed 2,587 1,892 4,479 Reviewed 148 85 233 Abnormal after review 130 70 200 Analysis of abnormal films: Cases considered tuberculous (a) No further action required 1 1 2 (b) Occasional supervision only 2 2 4 (c) Requiring treatment 13 2 15 (d) Still under investigation – – – (e) Refused further investigation 1 – 1 Previously known tuberculous cases 7 – 7 Non-tuberculous cases (a) Investigated (See table 36 for detailed breakdown) 29 13 42 (b) Still under investigation 5 3 8 Cardio-vascular lesions 8 15 23 Abnormalities requiring no action 64 34 98 Table 36 NON-TUBERCULOUS ABNORMALITIES MEN WOMEN Bronchial carcinoma 7 Bronchial carcinoma 1 Sarcoidosis 2 Malignant pleural effusion from carcinoma of breast 1 Spontaneous pneumothorax 1 Suspect benign pulmonary neoplasm 1 Suspect neurofibroma 1 Retrosternal goitre 1 Pulmonary cyst 1 Bronchiectasis 1 Persistent thymus-thymectomy 1 Pneumonitis 9 Pneumonitis Bronchitis and emphysema group 2 Diaphragmatic hernia group 1 Pulmonary infarct 1 Pulmonary infarct 1 Pleural thickening 3 Linear fibrosis 1 Asthma 1 Fatty deposits in chest 1 Elevation of diaphragm 1 29 13 65 66 Table 37 Numbers examined 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 96 120 216 – – – 66 102 168 – – – Public Surveys—Examination of Special Groups 1,290 1,368 2,658 – – – 649 911 1,560 – – – Regular Sites 1,450 1,328 2,778 4 – 4 561 825 1,386 2 – 2 Firms-Routine 1,043 448 1,491 1 – 1 621 265 886 1 – 1 Contact (School) 6 370 376 – – – 6 362 368 – – – Hospitals, Colleges etc. 945 1,126 2,071 1 1 2 436 475 911 – – – Homes and Hostels 271 215 486 7 1 8 175 143 318 5 1 6 TOTAL 5,101 4,975 10,076 13 2 15 2,514 3,083 5,597 8 1 9 PROPHYLAXIS Immunisation against the following diseases was offered at health centres and schools —diphtheria, whooping cough, tetanus, poliomyelitis, smallpox and tuberculosis. Children between the ages 6 months and 5 years were offered immunisation at health centres and from 5-12 years in schools. Adults between the ages of 15 and 40 years were offered immunisation against poliomyelitis. B.C.G. vaccination against tuberculosis was offered to all children in schools in their fourteenth year. Medical practitioners in the Borough are supplied, free of cost, with poliomyelitis vaccine for persons under the age of 40, and diphtheria, whooping cough, tetanus, measles and smallpox vaccine. Table 38 IMMUNISATION AND VACCINATION Type of vaccine or dose Primary courses completed Year of birth Others underage 16 yrs. Total 1969 1968 1967 1966 196265 Diphtheria 266 1,554 166 80 444 214 2,724 Whooping Cough 266 1,537 162 71 231 71 2,338 Tetanus 266 1,554 167 77 446 257 2,767 Polio 152 2,298 261 118 581 274 3,684 Measles 2 212 674 337 497 35 1,757 Reinforcing dose Diphtheria 5 1,266 1,322 171 3,116 1,064 6,944 Whooping Cough 5 1,223 1,268 152 645 126 3,419 Tetanus 5 1,266 1,322 174 3,126 1,084 6,977 Polio 1 74 61 29 3,007 778 3,950 Smallpox Vaccination Age at date of vaccination Months Years 0-3 3-6 6-9 9-12 1 yr. 2-4 yrs. 5-15 yrs. Total Vaccination 34 34 35 55 1,560 923 139 2,780 Re-vaccination – – – – 13 77 243 333 LABORATORY FACILITIES The following represents work carried out by the Southern Group Laboratory on behalf of the Council during 1969:— Table 39 Specimens Number Remarks Faeces 1,100 Negative 142 Shigella Sonnei 5 Salmonella Typhimurium 5 Salmonella Panama 10 Salmonella Enteritidis 11 Salmonella Stanley 1 Salmonella Worthington 2 Salmonella Infantis 1 Salmonella Reading 3 Salmonella St. Paul 2 Salmonella Group B 1 Salmonella Unnamed 3 Staphylococcus Aureua 2 Cl. Welchii Urine (for S. Typhi) 9 Negative Water (various) 16 Food 65 Milk 14 Ice cream 49 Cream 12 1,453 67 Rubella Vaccine Trial The Health Department co-operated in the trial of a vaccine against rubella (German measles). Rubella is usually a mild disease, but when it is contracted in the first three months of pregnancy may give rise to congenital malformations of the baby in a proportion of cases. These malformations may affect the heart, or cause blindness or mental defect, and some children may be born with a combination of these defects. The Inner London Education Authority carried out the trial of a vaccine against rubella in seven girls schools in the London area, one of which was situated within the Borough of Lewisham. Vaccination was offered to all girls in the first two school years (11½ years to 13½ years of age) in this school. A blood test was taken from each girl participating, and the girl was inoculated. The blood samples were flown to the U.S.A. for estimations of the serum antibodies against rubella and subsequently more blood tests were taken to investigate any antibody rise after inoculation. Of those girls who had originally had no protection against the disease, the second blood tests showed that inoculation had produced a 99.6% rise of antibodies— sufficient to protect against rubella. 68 ENVIRONMENTAL HEALTH Mr. A. J. Phillips, M.A.P.H.I., Chief Public Health Inspector The more detailed summary of visits by public health inspectors and technical assistants, which was begun in 1968, shows that in 1969 the total number of visits was reduced by some 2,500, but this can be attributed to the fact that in 1968 over 3,000 visits were made as a result of the serious flooding. There are increases in the investigation of cases of food poisoning, in house-to-house inspections and offices and shops inspections, but a considerable decrease in the number of complaints received. Housing A survey of the Borough was carried out in anticipation of the Housing Act, 1969, to assess which areas were most likely to require redevelopment and those which should be improved. As required by Ministry Circular 92/1969, a programme of clearance areas for the years 1970-73 was prepared. It is hoped that this should deal with most of the outstanding areas in the Borough. One improvement area was surveyed for submission to the Council and further areas are in course of preparation. Considerable work will also be involved in the issue of qualification certificates which the Housing Act, 1969, brings into operation as a means of allowing owners to obtain an increase in rent of controlled houses where all amenities exist or where they are prepared to install them and where a reasonable standard of repair of the property also exists. This should help to increase the issue of improvement grants and be a further incentive to the improvement of houses to a reasonable standard. Close liaison is being maintained in this work with the Rent Officer. There were approximately the same number of houses dealt with in clearance areas in 1969 as in the previous year, but the rehousing of slightly more people was involved. There was an increase in the number of demolition and closing orders, but in 16 cases of the latter extensive repair was carried out and the orders subsequently revoked. Houses in multiple occupation continue to receive the attention of this section and both management and direction orders showed a marked increase. It was also necessary to carry out work in default in 25 cases to provide satisfactory means of escape in case of fire. Public Health Acts There was a decrease in formal and informal notices served under the Public Health Act. 1936, due no doubt to the drop in the number of complaints received. There was, however, a slight increase of notices served under the Public Health Act, 1961. The greatest defect was dampness, where it was necessary to deal with nearly 500 premises. Other items requiring most attention were floors, gutters, roofs, wall and ceiling plaster, repairs or renewal of water closets and the repair or renewal of window frames. Factories The number of factories in the Borough fell from 774 to 715. Two of the public health inspectors spent a considerable amount of time on this work during the year in order to bring the register up to date, and the total number of visits (1,198) was nearly double that of 1968, but only in 32 cases was it necessary to issue formal notices. Food There was a slight drop in the tonnage at the Continental Depot, but it still exceeded 170,000 tons. Attention of importers was drawn again to several instances of incorrect labelling. Samples were taken for pesticide residues. There was an increase 69 from 202 to 238 tons of unsound food surrendered by shopkeepers. There was little change in the number of registered food premises. An increase in the sampling of ice cream gave a result of Grade III in 9 cases and Grade IV for 6 samples. Steps were taken to rectify this with those concerned. Bacteriological samples of other food increased from 106 to 126. Three formal and 33 informal of the 745 samples submitted to the public analyst were found to be adulterated. Most of the offences related to labelling, which was rectified after informal action. Offices and Shops The number of registered premises at the end of 1969 showed a reduction in offices, retail shops and warehouses of over 300, but there was a slight increase in the number of catering establishments. The number of persons employed fell from 17,521 at the end of 1968 to 15,223 at the end of 1969. The inspectors report that this was partly due to the smaller shops where the shopkeeper was coping with his trade without the employment of staff. The number of accidents reported was also fewer and fortunately most were of a minor character and in no case was it necessary to institute legal proceedings. The visits paid to offices and shops showed a considerable increase on the previous year. Although the conditions on the whole were found to be satisfactory, it was surprising to note that in 48 cases, compared with 14 in 1968, attention had to be drawn to the poor standard of cleanliness. Pest and Verminous Conditions The slight fall in the number of rat complaints in 1968 was not maintained and 1,241 premises were found to be infested, compared with 1,070 in 1968. The mice complaints increased further, 1,137 premises being infested compared with 954. There was a considerable rise in mice complaints in business premises. There was a slight increase in the number of rooms disinfected or disinfested, but there was a sharp fall in the number of articles treated. It is pleasing to note that the number of verminous adults treated fell from 644 to 487 and the treatment of scabies was reduced from 1,085 to 957. It is regretted, however, that it was necessary to treat 665 verminous children, compared with 555 in 1968. 70 71 Table 40 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 LodgingHouses 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 – – – – – 2 – 8 – – – – 35 – 19 – – – 64 Clean Air Act – 3 – – 92 119 – 1 – – 2 – 2 – 75 49 – – 343 Clearance Areas – – – – 428 – – – – – – – – – 5 – – – 433 Complaints – 107 2 – 4,132 89 12 9 3 1 4 17 8 4 430 118 – 8 4,948 Consumer Protection Act – 4 – – 7 – – 1 – – 28 10 1 1 58 – 1 – 111 Drainage – 43 1 – 1,633 31 7 2 1 – 7 12 40 4 118 408 2 – 2,309 Fish Curing – 11 – – – – – – – – – 1 – – – – – – 12 Fish Frying – 48 – – – – – – – – – 48 – – 2 – – – 98 Food Poisoning – 14 – – 250 – – – – – – 3 8 1 26 – – – 302 House to House – – – – 1,380 – – – – – – – – – – – – – 1,380 Houses in Multiple Occupation – – – – 801 – – – – – – – – – 1 – – – 802 Housing Act, Section 9 – – – – 67 – – – – – – – – – – – – – 67 Housing Act, Section 16 – – – – 147 – – – – – – – – – – – – – 147 Ice Cream – 63 – – 3 16 – 3 1 – – 14 – – 2 – 10 – 112 Improvement Area – – – – 643 – – – – – – – – – – – – – 643 Improvement Grant – – – – 1,285 – – – – – – – – – 6 – – – 1,291 Infectious Diseases – 5 – – 664 – – – – – – 15 2 – 101 – – – 787 Infestation – 12 1 3 206 – – 1 – 1 12 41 2 6 34 – – 1 320 Milk – 27 – – – – – 2 1 – – – – – 3 – – – 33 Mortgages – – – – 735 – – – – – – – – – – – – – 735 Notice of Builder – 8 – – 410 6 – – 1 – 5 5 2 – 25 330 – 1 793 Offices, Shops and Railway Premises Act – 465 16 3 – 63 97 26 31 2 63 167 – 8 862 – 1 627 2,431 O.S.R. Accidents – 11 – – – 1 1 6 – – – – – 1 8 – – – 28 Outworkers – 1 – – 73 – 1 – – – – – – – – – – – 75 Pharmacy and Poisons Act – 47 4 – – – 2 39 1 – – – – 1 53 – – – 147 Pressed, Potted and Pickled Food – 14 – – – – – – – – – – – – – – – – 14 Rag Flock etc. Act – – – – – – – – – – – – – – – – – – 7 Rent Acts – – – – 19 – – – – – – – – – – – – – 19 Rodent Control – 27 – – 284 8 2 2 – 3 6 46 1 1 95 5 1 – 481 Sampling – 193 3 – 4 12 – 85 6 – 1 19 – 21 87 – 16 – 447 Sausage Manufacturer – 20 – – – 1 – – – – – – – – – – – – 21 Unsound Food – 156 – – 35 9 – 86 2 1 5 38 32 161 35 – – – 560 Food Hygiene – 654 7 2 36 34 3 68 26 10 263 834 72 14 87 – 328 – 2,438 Housing Applications – – – – 137 – – – – – – – – – 3 – – – 140 Registered Premises – 84 – – – 66 – 2 2 11 11 8 – – 3 – – – 187 Immigrants – – – – 287 – – – – – – – – – – – – – 287 Miscellaneous – 50 2 3 1,106 110 48 6 2 9 14 8 27 8 1,020 135 8 12 2,568 Flood Incident – 7 – – 454 1 – – – – – 4 1 – 17 – – – 484 Re-visits – 382 20 1 10,590 951 54 13 9 16 13 78 88 45 756 675 51 97 13,839 Totals – 2,456 56 16 25,908 1,519 227 360 86 54 434 1,368 321 276 3,938 1,720 418 746 39,903 Table 41 SUMMARY OF NOTICES SERVED Informal notices: Public Health Act, 1936 632 Factories Act 21 Offices, Shops and Railway Premises Act, 1963 279 Noise Abatement Act, 1960 2 Total 934 Statutory notices: Public Health Act, 1961 101 Public Health Act, 1936 324 Housing Act, 1961 46 Byelaws 58 Prevention of Damage by Pests Act, 1949 2 Factories Act, 1961 11 G.L.C. (General Powers) Acts 6 Total 548 PUBLIC HEALTH ACT, 1936 The number of houses in which defects were remedied was 270 after informal action and 381 after the service of abatement notices. Table 42 DETAILS OF REPAIRS CARRIED OUT Repairs Total Brickwork repaired 28 Chimneys and flues repaired 5 Dampness remedied 491 Doors and door frames repaired or renewed 31 Drains cleared 45 Drains repaired 3 Dry rot remedied 14 Dustbins supplied 6 Fire grates etc., repaired or renewed 4 Flooring repaired or renewed 89 Flushing cisterns repaired, renewed or cleansed 25 Flush pipes repaired or renewed 8 Glazing 4 Gutters repaired 92 Gullies renewed, repaired or cleansed 25 Refuse cleared 19 Rainwater pipes cleared 27 Roofs repaired 144 Sashcords renewed 86 Sinks replaced 41 Soil pipes repaired, ventilated or renewed 25 Walls and ceilings cleansed 1 Walls and ceiling plaster repaired 172 Water closets repaired or renewed 68 Water service pipes repaired or renewed, water supply restored 25 Windows and frames repaired or renewed 64 Yards and areas paved 14 Other repairs 24 TOTALS 1,580 72 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 of 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 fault 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 43 INSPECTIONS Premises Number on register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which sections 1, 2, 3, 4 and 6 are to be enforced by local authorities 18 21 – – (ii) Factories not included in (i) in which section 7 is enforced by the local authority 620 1,100 32 – (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 77 77 – – TOTAL 715 1,198 32 – 73 Table 44 CASES IN WHICH DEFECTS WERE FOUND Defects No. of defects Prosecutions instituted Found Remedied Referred To HM Inspector By HM Inspector Want of cleanliness (S 1) 1 1 2 – – Overcrowding (S 2) – – – – – Unreasonable temperature (S 3) – – – – – Inadequate ventilation (S 4) – – 2 – – Ineffective drainage of floors (S 6) – – – – – Sanitary conveniences (S 7): (a) insufficient 4 4 – 2 – (b) unsuitable or defective 25 25 – 2 – (c) not separate for sexes 2 2 – 1 – Other offences against the Act (not including offences relating to outwork) 3 – 3 – – TOTAL 35 32 7 5 – OUTWORKERS Under Section 133 of the Factories Act, 1961, the occupier of every factory and every contractor employed by him must keep lists showing the names and addresses of all outworkers directly employed by him and of the places where they are employed. He must send to the Council in February and in August of each year, copies of those lists showing all outworkers so employed by him during the preceding six months. Section 134 of the same Act empowers the Council by notice in writing to the occupier or any contractor employed by him to prohibit the employment of any persons as home workers in premises which the Council regard as injurious or dangerous to health. The Home Work Order, 1911, specified the kinds of work to which these two sections apply. The types of work consist mainly of wearing apparel and textiles, the making of paper bags, boxes, brushes, baskets, artificial flowers, metal fittings, etc. The following is a list of such occupations:— Table 45 Trade Outworkers employed Wearing apparel 99 Household linen 1 Lace 5 Artificial flowers 2 Box making 5 Lampshades 1 113 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. 74 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Of the items requiring attention, the most frequently recurring were the following:— Table 46 Abstract of the Act not displayed 149 Absence of a thermometer 99 Absence of a first-aid box 112 Although these numbers are a little lower than last year, it is surprising to find that they are still higher than was hoped. In order to overcome the first item, stocks of booklet 9b have been kept in the department to assist shopkeepers who have found difficulty in obtaining them for themselves. Of the other two items, the renewal of supplies in the first-aid box is often forgotten and the importance of one member of the staff being made responsible for the care of the box cannot be over emphasised. The thermometer seems to be a fragile item and its replacement after breakage is often overlooked. Other matters to which it was necessary to draw attention were:— Table 47 Insufficient heating 18 Insufficient lighting 10 Condition of floors and staircases 54 Insufficient washing facilities 30 Facilities for drying clothes 9 Insufficient ventilation 25 Insufficient sanitary accommodation 7 Absence of drinking water 3 Lack of seating facilities 4 Poor standard of cleanliness 48 Overcrowding 1 Deficient sanitary accommodation 28 Deficient washing accommodation 24 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 1969 showed a decrease of 402, whilst the number newly registered during the year increased by 45. The number of staff employed decreased from 17,521 to 15,223 (males 6,299 compared with 7,582 in 1968, and females 8,924 compared with 9,939). There were fewer accidents reported in 1969 (63 compared with 91) and most were fortunately of a minor character. Thirty-seven of the accidents were fully investigated and suggestions were made to avoid a further similar accident. Although it has been necessary to draw attention to a large number of items requiring attention, the conditions in shop and office premises undoubtedly continue to improve and it is hoped that this will be maintained in 1970. 75 Table 48 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 32 476 321 Retail shops 114 1,359 940 Wholesale shops, warehouses 3 69 26 Catering establishments open to the public, canteens 41 262 281 Fuel storage depots — 3 4 TOTALS 190 2,169 1,572 Table 49 PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE Class of work place Number of persons employed (1) (2) Offices 4,586 Retail Shops 8,020 Wholesale departments, warehouses 992 Catering establishments open to the public 1,453 Canteens 138 Fuel storage depots 34 Total 15,223 Total Males 6,299 Total Females 8,924 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. 76 DISINFECTION AND PERSONAL CLEANSING Details of the work carried out during the year are as follows:— Table 50 Rooms disinfected or disinfested 1,396 Articles disinfected or disinfested 19,326 Verminous children cleansed 665 Verminous adults cleansed (Carrington House 415) 487 Treatment for scabies, children 604 Treatment for scabies, adults 353 Articles cleansed 98,064 Domiciliary bathing 1,105 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 82 wasps nests were dealt with on this basis. Ten nests were destroyed free where the occupier was unable to pay the charge. In a few cases it was not possible to deal with the nests because of their inaccessibility. ANTI-FLY CAMPAIGN During the period June to September, the usual measures were taken to deal with fly breeding. Calls were made to potential sources, such as stables, piggeries and similar premises throughout the Borough. Vacant sites which were well known to the department as rubbish dumps were visited and deposits of litter removed and the ground sprayed with insecticide. The treatment of dustbins with powder supplied by the Health Department was carried out by the Borough Engineer and 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 1969. No special comment is called for except to say that this is a continuing problem:— Table 51 Type of Properly All other (including business premises) Total Local authority Dwelling houses (including council houses) Properties inspected as a result of (a) notification 14 3,678 291 3,983 (b) survey 1 85 9 95 (c) otherwise — — — — Total inspections 15 3,763 300 4,078 Properties inspected which were found to be infested by:— (a) Rats—major — — — — (b) —minor 6 1,145 90 1,241 (c) Mice—major — — — — (d) —minor 6 1,062 69 1,137 Infested properties treated 12 2,207 159 2,378 Retreatments 30 2,650 391 3,071 "Block" control schemes carried out 3, involving 37 premises 77 SWIMMING BATHS There are five public swimming baths in the Borough. The following table shows details of the laboratory tests taken during the year:— Table 52 Bath Number of tests Variation of chlorine (p.p.m.) Ladywell 2 1.00 — 1.02 Forest Hill North 2 0.4 — 0.5 Forest Hill South 2 0.4 — 0.7 Laurie Grove Large 1 0.5 Laurie Grove Small 2 1.6 — 0.6 Laurie Grove South 2 1.0 — 0.8 Downham 2 0.5 — 0.5 Bellingham (open air) 1 0.2 The water used for these baths is supplied by the Metropolitan Water Board and is sterilised by the breakpoint chlorination method, sodium carbonate and sodium metephosphate being used to control acidity and to keep the pH above 7.2. Colorimetric tests for free chlorine and pH value are also made at the baths at 9 a.m., 1 p.m and 6 p.m. on weekdays and at 9 a.m. and 12 noon on Sundays, the results being recorded on log sheets kept for the purpose. The aim is to achieve a circulation of water every four hours, although it is rather more prolonged at the open-air baths. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 The Rag Flock and Other Filling Materials Act is designed to secure the use of clean filling materials in upholstered articles and other articles which are stuffed or lined. Four premises are registered for the use of filling materials for upholstery purposes. Samples of these materials proved satisfactory on examination. DESTRUCTION OF PIGEONS The complaints received during 1969 showed that nuisance caused by pigeons is increasing and that most of the Borough is affected, although heavier concentrations appear to be present on sites in Catford and Forest Hill. The pigeon catchers, who are employed on a part-time basis, investigated the complaints and also paid regular visits to particularly badly affected sites, especially railway bridges and churches. 2,868 birds, as well as many nests and eggs, were destroyed during the year. 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. No treatment by a narcotic was used during the year but trapping was carried out by a firm of contractors at one site in Catford and two in Forest Hill. 315 birds were destroyed at the Catford site and 153 at one of the Forest Hill sites, but there was little success at the other site. The contractors will be engaged on similar work during 1970, The feeding of the birds by the public is a problem and some of the larger infestations are due to this fact, particularly the site in Rushey Green, Catford. 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 20 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. 78 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. Two such licences were 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 Apart from the Greater London Council Clearance Area in Forest Hill and an area in Deptford subject to redevelopment in the near future, the Clean Air Act Smoke Control Order programme is now complete. Table 53 Area No. and name No. of dwellings Date of operation Area No. and Name No. of dwellings Date of operation 1 Ladywell 1,409 1.9.59 Deptford 2 Southend 2,827 1.11.59 1 1,004 1.10.60 3 Brookdale 1,155 1.9.60 2 3,955 1.10.61 4 Penerley 3,367 1.10.60 3 2,914 1.10.62 5 Glenbow 2,059 1.9.60 4 2,138 1.10.63 6 Lewisham Park 3,716 1.8.61 4a 192 1.10.63 7 Sandhurst 2,187 1.8.61 5 1,680 1.10.64 8 Hazelbank 3,123 1.7.62 5a 63 1.10.64 9 Northover 3,226 1.9.62 6 1,437 1.12.65 10 Blythe Hill 2,586 1.10.62 11 Algernon 1,981 1.11.62 12 Brockley 4,402 1.7.63 13 Manor 6,932 1.10.63 14 Vancouver 2,731 1.6.64 15 Baring 5,232 1.7.64 16 Honor Oak 2,281 1.8.64 17 Blackheath 3,042 1.9.64 18 Sunderland 2,020 1.9.65 19 Sydenham 4,034 1.10.65 20 Mayow 2,000 1.11.65 21 Bellingham 3,208 1.11.66 22 Deptford Park 1,158 1.10.67 23 Brookmill 1,083 1.10.67 24 Bell Green 4,208 1.7.68 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 prohibits 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. 79 08 Table 54 ATMOSPHERIC CONDITIONS IN 1969 January February March April May June July August September October November December Average or actual Temperature—1 Mean C 6.4 2.3 4.5 8.5 12.1 14.3 17.9 16.9 14.7 13.1 6.3 3.7 10.1 Rainfall Total2 in. 1.96 1.85 2.32 0.28 1.45 1.11 3.37 2.36 0.21 0.16 2.57 1.53 19.17 Per cent. of averages 118 101 150 33 116 60 121 164 6 7 128 80 90 Sunshine—1 Daily mean hrs. 1.17 2.52 2.11 6.85 5.34 8.84 7.27 4.91 3.97 3.85 2.35 0.53 4.1 Per cent. of average 79 112 58 128 83 124 114 81 84 122 133 41 97 Wind—1 NE/E/SE % 18 36 74 29 26 35 16 19 48 13 7 27 29 S/SW/W °/ 74 27 19 50 57 41 40 38 28 55 66 42 44 NW/N/Calm % 8 37 7 21 17 24 44 43 24 32 27 31 27 Atmospheric pollution Creekside Depot Water insol. matter tpm 14.60 64.97 85.98 42.08 45.47 28.53 39.81 16.26 26.57 13.66 56.17 76.73 42.57 Water sol. matter tpm 7.41 12.51 13.24 5.99 14.62 12.17 12.97 9.43 7.41 5.33 11.06 11.44 10.30 Lewisham Town Hall— Smoke, daily average * 117 117 78 60 68 37 48 54 62 85 109 141 81 Sulphur, daily average * 203 296 274 133 138 149 140 123 105 112 116 230 168 Valentine Court— Smoke, daily average * 51 84 57 32 22 19 26 28 34 44 50 82 44 Sulphur, daily average * 167 256 236 104 112 131 118 98 111 96 95 195 143 Deptford Town Hall— Smoke, daily average * 85 114 116 63 46 52 66 85 84 145 Defective 123 89 Sulphur, daily average * 222 330 344 352 161 198 214 210 219 317 Meter 275 258 Creekside— Smoke, daily average * 65 136 103 35 54 36 42 49 51 63 97 140 73 Sulphur, daily average * 226 342 362 151 153 185 163 123 135 151 140 276 201 Weather Summary ... Dull and mild Cold with heavy snow Cold and dull Sunny but cold Dull, wet and thundery Sunny, heavy rain at times Sunny, some heavy rain Changeable with thundery spells Very dry Unusually warm and very dry Sunny cold some heavy rain & snow Cold and dull Notes— 1 Kew; * Lewisham; tpm: Tons per square mile per month; * microgrammes per cubic metre Consumer Protections 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 on fires 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. One contravention of these regulations was found during the year. Registration of Hairdressers The number of hairdressing establishments registered under the Greater London Council (General Powers) Act, 1967, is 217. Few contraventions of the byelaws made under the Act 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—1969 (a) Clearance Areas These are formed when groups of houses are found to be unfit for habitation under Section 4 of the Housing Act, 1957, as amended by the Housing Act, 1969, and when it is felt that the best method of dealing with conditions in an area is by way of demolition of all the properties. Following the declaration of an area, one of two ways of achieving this result is open to the Council: the first by way of a clearance order, or the more common procedure of acquiring the houses and land, generally by making a compulsory purchase order, so that the Council are able to carry out redevelopment. A survey of the Borough was carried out during the year to identify possible areas for this action in the years 1970-73. As a result, comparatively few areas of this nature are now thought to require this treatment. (b) Individual Unfit Dwellings There are several ways by which unfit dwellings are required to be made fit. Those which are found capable of being made fit at reasonable expense can be dealt with under Section 9 of the Housing Act, 1957, by the service of notices. It is usual to first serve an informal notice before taking formal action. The latter, if not complied with, can be subject to default action whereby the Council have the work done by the invitation of tenders and arranging a contract with a builder. The cost of this work can then be recovered in one of several ways. 81 When dwellings or parts of buildings are found to be unfit and not capable of being made fit at reasonable expense action can be initiated under Section 16 of the Housing Act, 1957, for the service of time and place notices. Undertakings can then be accepted from owners either to have the works carried out to make the premises fit for habitation or to cease using them for this purpose. If an undertaking is not accepted a demolition order (or a closing order in lieu) for a whole house or a closing order for part of a building can be made. In the case of Council loans for house purchase a schedule of work to make the house fit is made a condition of a loan. In this way many cases of unfitness are dealt with. Again, by the requirement that any grant made for improvement must result in the dwelling concerned being fit for habitation means that much is achieved by this process. A further method is by way of the qualification certificate procedure, a new concept brought in by the Housing Act, 1969. Under this the tenancy of a controlled dwelling reaching the required standard, which includes fitness for habitation, will qualify, on the issue of a certificate for conversion to a regulated basis and subject to fair rent fixing. The incentive provided by this method results in dwellings being made fit with the minimum of effort by the Council. (c) H ouses in Multiple Occupation The basic powers for dealing with these houses is contained in the Housing Act, 1961. As much attention as possible is given to these premises, as living condition in many of them present the department with its most urgent public health problem. The powers which have been extended by the Housing Acts 1964 and 1969 include provisions for dealing with management, additional amenities, means of escape from fire, the limiting of occupation and control of conditions by orders and registration schemes. A satisfactory outcome in relation to some of the actions is not easy to obtain, especially the provision of additional amenities and control of occupation, but, fortunately, the more important factor, i.e. means of escape from fire, can fairly readily be achieved and much has been done in this respect. (d) Improvements to Dwellings These can be accomplished in one of two ways. The first by the use of the grant schemes, which as amended by the Housing Act, 1969, provide strong incentives to owners of properties who wish to convert their houses to self-contained flats or to improve and repair individual dwellings. Maximum publicity and assistance, essential to success, are given to people concerned. The second method is by the use of the compulsory power given to the Council by Section 19 of the Housing Act, 1964. This is initiated by a tenant making a request to the Council for improvements and followed by the service of a notice on the landlord. In the event of non-compliance with a notice the Council can have the work carried out and the cost charged to the owner. The compulsory powers contained in the Housing Act, 1964, in conjunction with improvement areas have been repealed by the Housing Act, 1969, which now provides for the establishment of general improvement areas. The improvement of the dwellings and also of the environment of an area is intended to be achieved mainly by voluntary co-operation between the Council and persons concerned. The compulsory power given by Section 19 of the Housing Act, 1964, for individual dwellings, already mentioned above, will be available and other Housing Act powers to deal with unsatisfactory living conditions can be used in general improvement areas. In fact, the establishment of these areas will provide the department with the opportunity to deal with conditions by using the many powers and incentives available in a concentrated way. Several areas suitable for this treatment have been identified and detailed surveys in relation to a few have been carried out. 82 (e) Council Loans for House Purchase Properties which were the subject of applications to the Council for mortgages were surveyed and reported on by the health inspectors in relation to repairs, amenities, occupation and necessary fire precautions. The requirements as to these matters were made a condition of any loan offered. Specifications submitted by mortgagors were checked for approval and the work carried out was supervised prior to certification to the Borough Treasurer. As in previous years, the conditions imposed as to the provision of amenities gave rise to many improvement grant applications. The following is a summary of action in relation to the department's housing functions:— Table 55 HOUSING ACT, 1957—PART 2 No. of cases or notices served Dwellings made fit Section 9(1) Houses found unfit 7 2 „ 9(1 a) Houses requiring substantial repair — — „ 10 Default of sections 9(1) and 9(la) — — „ 16 Undertaking to carry out work — — „ 16 Undertakings not to use for habitation 12 — „ 17 Demolition Orders made 7 — „ 17 Houses demolished under demolition orders 5 — „ 17 Closing orders made in lieu of demolition orders 34 — „ 18 Closing orders on basements 16 — „ 18 Closing orders on other parts — — „ 24 Demolition orders revoked — — „ 27 Closing orders determined 16 16 „ 28 Closing orders converted to demolition orders — — Table 56 HOUSING ACT, 1957—PART 3 Number Section 42 Clearance areas declared 6 Dwellings in these areas 167 Persons in occupation 519 Unfit houses demolished in areas declared during 1969 and in previous years 32 Table 57 HOUSING (FINANCIAL PROVISIONS) ACT, 1958 No. of houses inspected No. of houses made fit Section 43 Council mortgages ... 324 470 83 Table 58 HOUSING ACTS 1957—1969—HOUSES IN MULTIPLE OCCUPATION Housing Act, 1957 Number Section 90 Overcrowding notices served — „ 90 Overcrowding abated — Housing Act, 1961 Section 12 Management orders made 30 „ 14 Informal management notices served — „ 14 Informal management notices complied with — „ 14 Formal management notices served — „ 14 Formal management notices complied with — „ 18 Work completed in default of management notices — „ 15 Informal notices served for amenities 3 „ 15 Informal botices complied with — „ 15 Formal notices served for amenities 132 „ 15 Formal notices complied with 7 „ 18 Work completed in default — „ 16 Informal notices served for means of escape 10 „ 16 Informal notices complied with 1 „ 16 Formal notice served for means of escape 152 „ 16 Formal notices complied with 20 „ 18 Work completed in default 25 „ 19 Directions made 32 Housing Act, 1964 Section 73 Control orders made — „ 73 Control orders in force 2 „ 73 Control orders determined — Housing Act, 1969—Action in lieu of provision of means of escape Section 60 Undertakings not to use parts of houses — „ 60 Closing orders made on parts of houses — Table 59 HOUSING ACT, 1969—PART 3—QUALIFICATION CERTIFICATES Number No. of dwellings made fit Section 44(2) Applications for provisional certificates 16 — „ 44(2) Provisional certificates issued — — „ 46(3) Qualification certificates issued — — 44(1) Applications for qualification certificates 334 — 45(2) Qualification certificates issued: R.V. £90 or more — — R.V. £60 and under £90 — — R.V. under £60 — — „ 55 Exemption certificates issued to tenants — — Table 60 HOUSING ACT, 1964—IMPROVEMENT AREAS During year to date Number of areas declared — 3 Number of dwellings improved to full standard 8 24 Number of dwellings improved to reduced standard — — Number of dwellings where work completed in default — — 84 Table 61 HOUSING ACT, 1969—GENERAL IMPROVEMENT AREAS During year Total to date Number of areas declared — — Grants in General Improvement Areas During the Year Approved Housing Assoc. Completed Tenanted O/occ. Improvement grants for conversions (resultant dwellings) — — — — Improvement grants for individual dwellings — — — — Standard grants — 2 — 1 No. of houses No. of Households Completed Special grants — — — No. of Dwellings Completed Improvements by Council with agreement of owner — — Table 62 HOUSING ACT, 1964—SECTION 19. REPRESENTATION BY TENANT In Improvement Areas In General Improvement Areas Outside Areas Number of representations during year — — 2 Number of improvement notices served — — 4 Number of undertakings given — — 1 Number of dwellings where work completed to: full standard: by owner — — 3 by Council in default — — — to reduced standard: by owner — — — by Council in default — — — Table 63 HOUSING ACT, 1964—TENEMENT BLOCKS In General Improvement Areas Outside General Improvement Areas Number of improvement notices served during year — — Number of undertakings given — — Number of dwellings where work completed to: full standard: by owner — — by Council in default — — to reduced standard: by owner — — by Council in default — — 85 Table 64 *HOUSING ACT, 1969—GRANTS Number of Approved Dwellings Completed Improvement (discretionary) grants 34 31 Standard grants 142 115 Extended standard grants 1 — Special grants (number of houses) — — *Including cases approved under old Acts and those in general improvement areas. Table 65 Made Fit Repairs Done Total number of dwellings made fit or repair work done as a result of enforcement action for improvements and completion of grant work 524 110 RENT ACT, 1957 The following table shows the applications for certificates of disrepair dealt with during the year 1969:— Table 66 Applications for certificates 2 Decisions not to issue certificates — Decisions to issue certificates 2 Undertakings given by landlords to repair — Undertakings refused for special reasons — Certificates of disrepair issued 3 Applications by landlords for cancellation of certificates 3 Objections by tenants to cancellation — Certificates cancelled 2 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 31st December, 1970, were issued during the year as follows:— Table 67 Licences issued during 1969 Total licences issued for sale of untreated milk 1 101 for sale of pasteurised milk 9 205 for sale of sterilised milk 5 176 for sale of ultra heat treated milk 6 119 Analysis of Milk During the year under review 62 samples of milk were submitted to the public analyst by the Council's inspectors of which five were deficient in milk solids. Legal proceedings were instituted against the dairy concerned regarding one of the adulterated samples. Two of the other samples were of sour milk due to faulty sealing of the cartons. In these cases suitable warnings and advice were given to the dairy involved. With regard to the remaining adulterated sample no further action was taken. 86 ICECREAM Food Standards (Icecream) Regulations, 1959 Labelling of food (Amendment) Regulations, 1959 The composition of 33 icecream samples submitted to the public analyst during the year showed an average composition of 7.6% 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 judgment 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 I, 80 per cent. into grades I or II, not more than 20 per cent. in grade III and none into grade IV. During the year 15 samples of icecream were submitted for bacteriological examination with the following results:— Table 68 Samples % Grade I 22 47 Grade II 10 21 Grade III 9 19 Grade IV 6 13 TOTAL 47 100 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. Table 69 FOOD GENERALLY Other Bacteriological Samples Cream 7 Cooked meats 20 Shellfish 32 Meat 13 Drinking water 8 Sausages 22 Tinned dog meat 16 Instant whip 3 Milk set 2 Lemon dessert 1 Mustard and cress 1 Water cress 1 Total 126 Adulteration The number of samples taken during the year under the Foods and Drugs Act was 745. After examination the public analyst reported that 36 samples were adulterated below standard or insufficiently described by label. This accounts for 4.8 per cent, of all samples submitted. 87 Table 70 Samples Analysed Articles Examined Adulterated Formal Informal Formal Informal Foodstuffs 1 426 — 19 Milk and cream 20 84 — 4 Other drinks 1 49 — Drugs and medicines 5 42 3 3 Miscellaneous 1 116 — 7 TOTALS 28 717 3 33 Table 71 Non-genuine Samples Article Formal or informal Adulteration or irregularity Action taken Strawberry colour Informal Inadequately labelled Manufacturer notified Orange instant chiffon Informal Contained non - permitted colouring matter Stocks withdrawn and destroyed Fruit salad, canned Informal Inadequately labelled Manufacturer notified Fruit salad, canned Informal „ „ Hamburger Informal Contained insufficient meat „ Milk Informal Sour and unfit for consumption Formal sample taken Milk Formal „ Referred for legal proceedings Milk Informal Added water Formal sample taken Milk Formal „ Legal proceedings taken Milk Formal „ Referred for legal proceedings Beef sausages Informal Presence of preservatives not declared Appropriate notice displayed Pork sausages Informal „ „ Pork sausages Informal „ Manufacturer notified Shredded beef suet Informal Deficient in fat Formal sample taken Green pigeon peas, canned Informal Incorrectly labelled Importers notified "Plamil" Informal „ Manufacturer notified Cream cheese Informal „ Importers notified Wafer biscuits Informal Labelled entirely in French „ Canned buttered chicken Informal Incorrectly labelled „ Steak and onion pie Informal Deficient in meat Manufacturer notified Tinda Informal Incorrectly labelled Importers notified Jamaican Okra Informal „ „ Vegetable pate Informal „ „ Dried non-fat milk Informal „ Manufacturer notified Geriatric pharmaton Informal „ Importers notified Instant non-fat milk Informal „ Manufacturer notified Macaroni loops Informal Unlabelled Warning letter to retailers Canned tomatoes Informal Seeds had sprouted and excessive mould Importers notified. Stock withdrawn Candied chestnuts in heavy vanilla sauce Informal Contained sorbic acid Importers notified Baby macaroons Informal Incorrectly labelled „ Fat free yoghurt Informal „ Label amended Life drops Informal „ Manufacturer notified Hot pepper sauce Informal Contained excessive lead Importers notified. Further formal samples satisfactory Tomato paste Informal Contained excessive copper Wholesalers notified. Stock withdrawn Tomato soup Informal Incorrectly labelled Importers notified Brown sauce Informal „ „ 88 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 (5) Bacon Tinned fruit (4) Beef steak pie Tinned pilchards (2) Crushed barley malt Milk (2) Cheese cake Frozen peas Boiled mint sweet Sugar Food Complaints Food complaints numbering 114 were received from members of the public during the year. In six instances legal proceedings were taken under the Food and Drugs Act, resulting in fines totalling £135. 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 72 Type of premises Number of premises Number provided with wash-hand basins Number with facilities for washing food and equipment Grocers and multiple grocers 301 301 301 Greengrocers 139 122 not applicable Bakers 88 88 88 Butchers 139 139 139 Confectioners 319 317 not applicable Catering Establishments 369 369 369 Fish shops 29 29 29 Fried fish shops 53 53 53 Public houses 165 165 165 Off licences 87 85 not applicable THE FOOD HYGIENE (MARKETS, STALLS 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 73 Licensed stallholders selling food 83 Unlicensed stalls on private forecourts or elsewhere 11 Shellfish stalls on private forecourts 12 Mobile grocery shops 18 89 PHARMACY AND POISONS The names of eight 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 125 persons previously registered were retained on the register. 133 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 and no licences were issued to slaughtermen. OFFENSIVE TRADES There are no offensive trades carried on in the Borough. LEGAL PROCEEDINGS During the year there were 13 cases of legal proceedings for infringement of various Acts, as follows:— Table 74 Number of cases Fines Costs £ s. d. £ s. d. Food and Drugs Act, 1955 6 135 0 0 40 9 0 Public Health Act, 1936 7 107 0 0 23 15 0 Total 13 242 0 0 64 4 0 REGISTRATION OF FOOD PREMISES New registrations in 1969 and the total, including previous years, are shown in the table below:— Table 75 Type 1969 Total Sale and storage of icecream 11 524 Manufacture of icecream — 14 Fish frying 3 53 Fish curing — 17 Preparation or manufacture of sausages 3 117 Preparation or manufacture of potted, pressed, pickled or preserved food 6 183 UNSOUND FOOD Approximately 238 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 ncecessary to contact wholesalers and various local authorities if it is intended for distribution elsewhere. The amount of unfit food was small. 90 Totals for the year are shown in the table:— Table 76 Country of origin Tonnage imported Spain 77,476 Italy 41,950 France 44,035 Yugoslavia 4,458 Algeria 1,902 Belgium 632 Switzerland 471 Israel 1,103 China 73 Hungary 21 Total 172,121 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 1969:— The supply was satisfactory both as to quality and quantity throughout 1969. 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, 1969, was 282,080. 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-derived water (Southern group of works) Well water from Deptford, Wilmington, Darenth, Bexley and Merton pumping stations. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown 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. Surveys carried out between 1966 and 1968 on analyses of water from consumers' premises confirmed this statement. 91 92 Table 77 Average results of the chemical examination of the water supplied to the Borough of Lewisham during 1969 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) CaCO3 Hardness (noncarbonate) CaCO3 Magnesium as Mg Sodium as Na Potassium as K Chloride as CI Phosphate as PO4 Silicate as SiO2 Sulphate as SO4 Natural Fluoride as F Surface-active material as Manoxol OT Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micromhos) River Thames-derived 371 0.024 0.083 4.4 1.05 282 79 5 24.0 5.4 32 2.1 9 58 0.25 002 0.1 11 7.9 550 Deptford 4 0.009 0.025 5.9 0.12 380 150 — — — 42 — — — 0.25 — 0.0 4 7.2 730 Wilmington 3 0.011 0.033 7.6 0.12 295 70 — — — 27 — — — 0.15 — 0.0 0 7.3 560 Darenth 4 0.006 0.016 4.6 0.12 276 54 — — — 18 — — — 0.15 — 0.0 2 7.4 490 Bexley 4 0.008 0.017 5.4 0.30 335 90 — — — 20 — — — 0.15 — 0.0 4 7.2 600 Merton 4 0.005 0.017 0.2 0.08 252 38 — — — 13 — — — 0.50 — 0.4 4 7.4 430 93 Table 78 Bacteriological Results—Yearly Averages, 1969 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 Number of samples Agar plate count per. ml. Coliform count E. coli count 20-24 hours at ire 3 days at 22°C. Per cent. samples negative in 100 ml. Count per 100 ml. Per cent. samples negative in 100 ml. Count per 100 ml. 20-24 hours at ire. 3 days at 22° C. Per cent. samples negative in 100ml. Per cent. samples negative in 100ml. River Thames-derived 8,196 66.5 — 39.79 19-0 53.97 70 3,698 12.9 — 99.89 100.0 Deptford 248 0.2 6 98.39 0-1 99.19 — 251 0.3 95 100.0 100.0 Wilmington 238 0.5 46 98.74 — 99.58 — 242 0.1 3 100.0 100.0 Darenth 250 0.1 13 100.0 — 100.0 — 251 0.0 3 100.0 100.0 Bexley 249 0.2 4 99.20 — 100.0 — 253 15.6 97 100.0 100.0 Merton 19 2.3 10 100.0 — 100.0 — 19 0.2 2 100.0 100.0 Home Dialysis Three cases were referred to the department during 1969 for the adaptation of a room to house the artificial kidney machine and other equipment. In two of the cases it was found that the premises occupied were not satisfactory and both patients were rehoused by the Council in more suitable accommodation. Unfortunately one of the patients died before the alterations to the room could be carried out, but in the other case the adaptation was completed satisfactorily. The third case was the wife of an owner-occupier and in this instance it was possible to adapt a room on the ground floor of the house for the machine. The alterations 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 79 Lewisham Mortuary Deptford Mortuary Total Bodies received from hospitals etc. 791 502 1,293 Others 392 252 644 Totals 1,183 754 1,937 Cremations and Burials The following statistics relating to cremations and burials are for the year 1st April, 1969 to 31st March, 1970:— Table 80 Cemetery No. of burials Hither Green 982 Grove Park 259 Ladywell 64 Brockley 65 Total 1,370 There were 1,686 cremations carried out at Hither Green Crematorium after certification by the Medical Officer of Health or deputy as Crematorum Referee. Two exhumations took place at the Council's cemeteries during the year. 94 MEDICAL ARRANGMENTS FOR LONG-STAY IMMIGRANTS At ports of arrival long-stay immigrants, both Commonwealth and alien, are referred to medical inspectors and given a pamphlet printed in languages which they are likely to understand. This is to encourage them to register with a medical practitioner in their place of residence so that he can arrange for them to go to a mass radiography unit, a chest clinic or a hospital for X-ray. The Health Department is notified of the names and addresses of immigrants entering the Borough with the object of ensuring that at an early date the immigrants are made aware of how to use the Health Service. An important aim of the department is to secure by persuasion that those from countries with a high incidence of tuberculosis have an X-ray of the chest as soon as possible. The following table, based on returns made to the Ministry of Health, shows the number notified to the department during 1969, 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 81 Country Number of Immigrants Number of first successful visits (a) Commonwealth Countries Caribbean 174 145 India 23 20 Pakistan 18 10 Other Asian 66 40 Africa 48 34 Other 14 12 (b) Non-Commonwealth Countries European 24 17 Other 10 9 TOTALS 377 287 REHOUSING ON SPECIAL MEDICAL GROUNDS In 1889 the London County Council was established under the Local Government Act, 1888. The Act gave the new county council jurisdiction over the area of the Metropolitan Board of Works, and this area, together with the City, was styled the Administrative County of London. The vestries and district boards were at the time essentially untouched. The London Government Act, 1899, set up the former 28 Metropolitan boroughs. Under the London Government Act, 1963, which came into force in 1965, the present Greater London Council and the London boroughs were brought into being. The London County Council, unlike other county councils, inherited housing powers from the Metropolitan Board of Works, and subsequently became the largest housing authority in the world. As the Metropolitan boroughs were public health authorities and housing services grew up out of the necessity for providing for the removal of insanitary dwellings and for the building of new and better housing for workers (the first real Act being the Housing of the Working Classes Act, 1890, with the subsequent long series of Housing Acts), they too had a major interest in housing problems. 95 Because of the devastation caused by the 1939-45 war and the lack of rebuilding and redevelopment during the war, the provision of housing became acute and means for the fair allocation of new units of housing as it became available after the war became an urgent administrative necessity. The systems used by the boroughs for the allocation of housing varied with each borough. In Metropolitan Deptford the selection was done by an Allocations Committee who based their priorities mainly on bedroom deficiency, although other factors were taken into consideration. The Lewisham Metropolitan Borough adopted a points scheme which was amended in 1954 and again in 1965 after the London Borough of Lewisham was formed from the areas of the former Metropolitan boroughs of Deptford and Lewisham. The present scheme for the allocation of points is operated by the Housing and Estates Manager and takes into consideration problems of overcrowding, shared accommodation, lack of facilities, badly situated facilities, separated families, medical factors, insanitary conditions and time on waiting list, etc. In addition, in 1968 the Borough Council adopted a new formula for rehousing on special medical grounds to deal with urgent medical problems. This, a step outside of the points scheme, caters for those in dire need of rehousing because of the medical problems involved. Under this scheme applicants can be rehoused directly on the recommendation of the Medical Officer of Health in consultation with the Housing and Estates Manager, without their being bound by any of the other rules of residence, etc. This last addition to the general allocation scheme has benefited residents of Lewisham who in the ordinary way would have had to wait, in some cases many years, for their turn under the points scheme. A few examples of the types of cases rehoused under this latest proviso follow:— Family Resident in Borough Medical grounds for rehousing Age years Accommodation Lone 83 58 Second floor and stairs Generalised osteo-arthritis, knee and spine Husband 50 50 House with stairs even at ground floor level Wife suffers from multiple sclerosis Wife 49 Son 17 Husband 30 3 Poor house in clearance area Daughter suffers from rheumatic heart disease and son from chronic chest infection Wife 30 Son 5 Daughter 3 Mother 51 5 Two rooms, shared heater and cistern Daughter suffers from active pulmonary tuberculosis Daughter 11 Husband 68 27 Second floor flat with stairs Husband suffers from rt. hemiplegia and high blood pressure Wife 63 Husband 60 6 Eight stairs to entrance and 35 stairs to bedroom on second floor Husband suffers from emphysema and breathlessness Wife 57 96 INDEX Page Adoption and Boarding Out 30 Adult Training Centres 53 Animal Boarding 79 Ante-natal Care 21 Anti-fly Campaign 77 Area of Borough 15 Atmospheric Pollution 79 Bacteriological Samples 87 Bathing of Elderly People 24 Births and Birthrate 15 Blind and Partially sighted persons 30 Borough, description of 11 Burials 94 Cervical Cytology 28 Chest Clinic Welfare Service 45 Chest Clinics 61 Chiropdy Service 50 Clean Air 79 Cleansing, Personal 77 Clearance Areas 81 Closure or demolition of unfit houses 83 Coin Operated Laundrettes 81 Congenital malformations 28 Consumer Protection Act 81 Continental Goods Depot 90 Co-ordinating Committee 45 Council Mortgages 83 Cremations 94 Day Care of Children 30 Day Centres 55 Day Nurseries 30 Day Nurseries, private 31 Deaf Register 38 Deaths and Deathrate 15 Deaths by Cancer 18 Deaths by cause and age 16 Demolition and Closing Orders 83 Demolition or Closure of unfit houses 83 Dental Service, Maternal and Child Health 34 Dental Service, Schools 35 Dental Services 34 Dental Services, Accommodation 34 Deptford Chest Clinic 62 Disinfection and Personal Cleansing 77 District Nursing 23 District Nursing, Geriatric Liaison Scheme 24 District Nursing, Liaison Scheme with General Practitioners 23 District Nursing, staff recruitment and training 23 Domiciliary Confinements 21 Dysentery 61 Early Care Unit 53 Early Discharge Scheme 21 Early Neonatal deaths 15 Emergency Obstetric Unit 21 Environmental Health 69 Exhumation 94 Page Factories 73 Family Casework 45 Family Planning 31 Flies 77 Food 87 Food Complaints 89 Food Hygiene (General) Regulations, 1960 89 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 89 Food Poisoning 63 Food Premises, registration 90 General Provision of Health Services 11 General Statistics from 1960 19 Geriatric Liaison Scheme 24 Hairdressers 81 Handicap Register 36 Health Centres 20 Health Education 48 Health Visiting 25 Heart Deseases 17 Home Dialysis 94 Home Help Service 47 Honor Lea Hostel 54 Houses in Multiple Occupation 82 Housing 81 Housing Act, 1969—Grants 86 Housing Act, Management Orders 84 Housing Act, Provision of means of escapc 84 Icecream 87 Immigrants 95 Immunisation and Vaccination 67 Improvement Areas 84 Improvement Work 82 Infant Mortality 15 Infectious Diseases 59 Junior Training Centre 53 Laboratory Facilities 67 Laundrettes 81 Legal Proceedings 90 Lewisham Chest Clinic 61 Loan Service 33 Loans for House Purchase 83 Local Sickness 18 Lung Cancer 18 Markets, Stalls and Delivery Vehicles 89 Mass Radiography Unit 65 Maternal Deaths 15 Measles 61 Medical and Family Social Work 44 Mental Health 52 Mental Health, Adult Training Centre 53 Mental Health Day Centres 55 Mental Health, Early Care Unit 53 Mental Health, Education 56 Mental Health, "Half Way House" 54 Mental Health, Industrial Work 55 Mental Health, Junior Training Centre 53 97 INDEX—continued Page Mental Health, long term care 54 Mental Health, short term care 53 Mental Health Social Work 52 Mental Health, Special Advisory Clinics 52 Mental Health, Special Report 57 Mental Health Therapeutic Group 55 Mental Health, Volunteers and Voluntary Organisations 57 Mice 77 Midwifery Service 21 Midwifery Training 22 Milk86 Morbidity shown in insurance certificates 18 Mortuaries 94 National Assistance Act, section 47 76 Neo-natal deaths 15 Noise 76 Observation/Handicap Register 36 Offensive Trades 90 Offices, Shops and Railway Premises 75 Outworkers 74 Perinatal Mortality 15 Pet Animals 78 Pharmacy and Poisons 90 Phenylketonuria 22 Pigeons 78 Play Groups 31 Population 15 Premature Babies 21 Prevention of Damage by Pests 77 Private Day Nurseries 31 Prophylaxis 67 Public Health Inspectors, repairs carried out 72 Public Health Inspectors, summary of inspections 71 Public Health Inspectors, summary of notices served 72 Pupil Midwife Training 22 Qualification Certificates 84 Page Rag, flock and other filling materials 78 Rateable Value 15 Rats and Mice 77 Recuperative Holidays 30 Registration of Hairdressers 81 Rehousing on Special Medical Grounds 95 Rent Act 86 Repair of unfit houses 81 Representation by Tenant 85 Reproductive Wastage 15 Riding Establishments 79 Rubella Vaccine Trial 68 Samples 88 School Dental Service 35 School Health Service 36 School Medical Inspections 38 Schoolchildren, Personal Hygiene 40 Schools, Social Work 44 Screening for Phenylketonuria 22 Sickness, Local 18 Slaughterhouses and Slaughterers 90 Smoke Control 79 Social Work, chest clinics 45 Social Work, schools and general 44 Social Work, staff 46 Social Work, training 46 Stalls 89 Stillbirths 15 Surveys 26 Swimming Baths 78 Tenement Blocks 85 Tuberculosis 61 Unsound Food 90 Vision, School Medical Inspections 42 Vital Statistics 15 Wasps, Hornets and the Like 77 Water Supply 91 Whooping Cough 61 98 TABLES No. Subject Page 1. Causes of death by age groups 16 2. Heart and circulation mortality 17 3. Cancer deaths 18 4. Morbidity shown in insurance certificates 18 5. General statistics from 1960 19 6. Health Visiting 27 7. Congenital malformations 29 8. Congenital malformations by parity 29 9. Recuperative holidays 30 10. Day Nurseries, admissions and discharges 30 11. Family Planning, Council's domiciliary service 32 12. Family Planning Association, clinics 32 13. District Nursing loan equipment 33 14. Dental Service, maternal and child health 34 15. Dental inspection of schoolchildren 35 16. Observation/Handicap, register schoolchildren by type of school 37 17. Observation/Handicap register, schoolchildren by year of birth 37 18. Deaf register, schoolchildren 38 19. Routine inspections of schoolchildren 38 20. Routine inspections of schoolchildren—defects 39 21. Personal hygiene of schoolchildren 40 22. Non routine medical inspection of schoolchildren 41 23. Routine inspections of schoolchildren—vision 42 24. Comparison of Defects noted "Special" medical inspections of schoolchildren 43 25. Home Help Service 47 26. Health Education, film shows, talks, etc. 49 27. Analysis of bookings and attendances—Chiropody 50 28. Summary of attendances—Chiropody 51 29. Attendances by age groups—Chiropody 51 30. Day Rehabilitation Centres 55 31. Notified cases of infectious diseases 59 32. Notification of infectious diseases by sex and age 60 33. Tuberculosis, notifications 61 34. Food Poisoning 63 35. Mass Radiography 65 36. Mass Radiography, non-tuberculous abnormalities 65 37. Mass Radiography, surveys 66 38. Immunisation and Vaccination 67 39. Laboratory facilities 67 40. Public Health Inspectors, summary of visits 71 41. Summary of notices 72 42. Repairs carried out 72 43. Factory inspections 73 44. Factory defects 74 45. Outworkers 74 46. O.S.R. Items requiring most frequent attention 75 47. O.S.R. Other matters requiring attention 75 48. O.S.R. Registrations and inspections 76 49. O.S.R. Persons employed76 50. Disinfection and Personal Cleansing 77 51. Rodent control 77 52. Swmiing baths 78 53. Clean Air Act programme 79 54. Atmospheric conditions 80 55. Housing Act, 1957—Part II 83 56. Housing Act, 1957—Part III 83 57. Housing (Financial Provisions) Act, 1958 83 58. Houses in Multiple Occupation 84 59. Qualification Certificates 84 60. Improvement Areas 84 61. General Improvement Areas 85 62. Housing Act, 1964—Representation by tenant 85 63. Tenement Blocks 85 64. Housing Act, 1969—Grants 86 65. Dwellings Made Fit 86 99 TABLES—continued No. Subject Page 66. Rent Act, 1957 86 67. Milk (Special Designations) Licences 86 68. Grading of icecream 87 69. Other bacteriological samples 87 70. Samples analysed 88 71. Non-genuine samples 88 72. Food Premises, washing facilities 89 73. Inspections of markets, stalls and delivery vehicles 89 74. Legal proceedings 90 75. Registration of food premises 90 76. Continental Goods Depot, tonnage imported 91 77. Water, chemical analysis 92 78. Water, bacteriological samples 93 79. Bodies received in mortuaries 94 80. Burials 94 81. Immigrants 95 Printed by E. G. Berryman & Sons, Ltd., Greenwich, S.E.10