BOROUGH OF LEWISHAM ANNUAL REPORT 1971 Medical Officer of Health LEW 59 BOROUGH OF LEWISHAM ANNUAL REPORT 1971 Medical Officer of Health CONTENTS Page Introduction 3 Health Committee 5 Health Staff 6 The Borough 9 General Provision of Health Services in Area 9 Vital Statistics 12 HEALTH CENTRES 18 SPECIAL REPORTS 21 Psychiatry 21 Geriatrics 22 Venereal Disease 23 Developmental Paediatrics 25 Infant Mortality 26 Poliomyelitis 26 Infective Hepatitis 28 Cervical Cytology 28 Nursing Homes 29 Emergency Services 29 Advice by M.O.H. to other departments 30 MATERNAL AND CHILD HEALTH 32 Midwifery 32 District Nursing 35 Health Visiting 38 Screening Clinic (Louise House) 46 Congenital Malformations 48 FAMILY PLANNING 49 LOAN SERVICE 52 DENTAL SERVICES 53 Maternal and Child Health 55 School Dental Services 56 SCHOOL HEALTH SERVICE 57 Handicapped Pupils Register 59 Deaf Register 60 School Medical Inspection 61 1 Page HEALTH EDUCATION 67 CHIROPODY SERVICE 69 INFECTIOUS DISEASES 71 Chest Clinics 73 Mass Radiography 75 Immunisation and Vaccination 78 Food Poisoning 79 Laboratory Facilities 79 ENVIRONMENTAL HEALTH 80 Summary of Inspections and Notices Served by Public Health Inspectors 82 Factories 83 Offices, Shops and Railway Premises Act 85 Disinfection and Personal Cleansing 86 Prevention of Damage by Pests 87 Rag Flock and Other Filling Materials Act 90 Destruction of Pigeons and Foxes 90 Pet Animals Act 90 Atmospheric Pollution 90 Housing Acts 92 Milk 97 Icecream 97 Food 98 Pharmacy and Poisons 100 Legal Proceedings 101 Water Supply 102 Mortuaries 105 Immigrants 105 2 TO THE MAYOR, ALDERMEN, AND COUNCILLORS OF THE LONDON BOROUGH OF LEWISHAM I have the honour of presenting a report on the Health Services in Lewisham for the year 1971. The most notable single event during the year was the opening of the Jenner Health Centre. The initial stages of use of the building has gone extremely well, due undoubtedly to the willing co-operation of everyone concerned. The building was designed to assist the integration of the Health Services to the greater benefit of people. To the time of writing, the building has achieved this objective. On the 31st December, 1971, three family doctors were practising from the building, the fourth doctor commencing on 1st January, 1972. There has been much discussion over the years concerning the family doctor team. The Jenner Health Centre shows that the team is much larger than many people realised. The basic members of the general practitioner team might be considered to be the health visitor, district nurse, the midwife, the administrative staff and the family doctor. There is a wider group who provide health services for the patient: the local authority medical officer, chiropodist, dental surgeon, school nurse, clinic nurse, bathing attendant and other medical and paramedical workers. The family doctor may need to establish contact with all these together with members of staff of the Social Services Department. This confirms the need to provide buildings in which all who contribute services can co-operate at the "patient" level. The Jenner Health Centre was named after Dr. Edward Jenner who in 1796 carried out the first successful vaccination against smallpox. In the year when this centre was opened, vaccination of infants against smallpox ceased to be routinely advised. This is a direct result of the immunisation programme which has reduced the incidence of smallpox throughout the world so that it is now safe to discontinue the measure. The value of Jenner's work was only slowly recognised in this country. New forms of immunisation take a considerable time to become acceptable to the population at large. Only about half of the children are being immunised against measles and this is insufficient to eradicate measles. It is unfortunate that the public have to be convinced of Jenner's basic finding—immunisation saves lives—each time a new vaccine is proved. During the year the Lewisham Borough Council took direct responsibility for the Family Planning services, apart from the youth advisory and marital advice aspects. These services had formerly been administered on an agency basis by the Family Planning Association and I would like to record my appreciation of the work of the Association in developing services in the Borough and in enabling the transfer to take place smoothly. The services available continue to expand. The work of the public health inspector continues to increase, particularly in the field of housing, with improvement grants and the registration of houses of multiple occupation as two major aspects. There is little doubt that the work of the inspectorate together with the other activities of the Health Department, does much to improve the quality of life of those who live and work in Lewisham. I would like to express my gratitude to the Chairman and Members of the Health Committee in particular, and to all other Members of the Council for their support 3 of the Health Department during the year: to the Town Clerk and Chief Executive, chief officers of the Council, to officers of other statutory and voluntary bodies from whom I have constantly received willing help, I also wish to record my thanks. The devotion of the staff of the Health Department to their work is recorded in this report; and I thank them for their loyalty and support. A. W. TRANTER, Medical Officer of Health. Health Department, 185 Lewisham High Street, S.E.13. 4 HEALTH COMMITTEE, 1971 The Mayor Councillor P. GORIN Chairman : Councillor S. G. C. HARDY, b.e.m. Vice-Chairman : Councillor A. R. JINKINSON Alderman O. A. Nurse Councillor C. A. Cook „ D. T. Crowley „ W. J. Fisher „ R. D. Godsiff „ N. J. Gregory Councillor J. C. Henry „ Mrs. D. Hurren „ R. H. Mooney „ P. W. Philpot „ D. Richards „ D. B. F. Wenham Co-opted Members : Mr. J. B. Cohen, l.d.s. r.c.s. Dr. P. Freeman, l.r.c.s., l.R.c.p., l.r.f.p.s. Mr. F. H. E. Hook, f.p.s. 5 HEALTH DEPARTMENT AS AT 31.12.71 Medical Officer of Health and Principal School Medical Officer, Inner London Education Authority A. W. TRANTER, m.b., m.r.c.s., d.p.h., d.c.h. Deputy Medical Officer of Health T. TRACE, m.b., ch.b., d.p.h. Principal 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. Senior Medical Officer: Daphne P. Richards, m.b., b.s., d.c.h., d.p.h. Vacancy Assistant Senior Medical Officers: 5 Full-time Medical Officers in Department: 6 Full-time 30 sessional M.O.s occupying 8 full-time positions Chief Dental Officer and Principal School Dental Officer: Clare M. Leeming, b.d.s. Senior Dental Officers: Susan Marguerita Shillito, b.d.s. Vacancy Orthodontist: Honika Brazil, b.d.s., dip.orth. Dental Officers : 4 full-time 10 sessional 5 Dental Auxiliaries and 15 Dental Surgery Assistants Public Analyst: J. H. Shelton, f.r.i.C. Chief Nursing Officer: Dorothy M. Coe, s.r.n., r.f.n., s.c.m., h.v., c & g. Technical Teachers Certificate dip.soc. Assistant Chief Nursing Officer: Valerie J. Buckingham, s.r.n., r.f.n., s.c.m., m.t.d., n.d.n.cert. Area Nursing Officers : Elizabeth M. Gleeson, s.r.n., s.c.m., h.v., Renee Humphries, s.r.n., s.c.m., d.n.cert. C & G Technical Teachers Certificate, Rose Evans, s.r.n., s.c.m., d.n.cert. Diploma in Social Sciences Maureen Allen, s.r.n., s.c.m., h.v., dip.soc. Vacancy 6 Group Advisers : Margaret Henley, s.r.n., s.R.c.n., s.c.m., h.v. Annie R. West, s.r.n., s.c.m., h.v. (Amersham Road) (Central Lewisham) Joan Hawkins, s.R.n., s.c.m., r.f.n., h.v. Joyce Ellis, s.r.n., h.v. (Spalding) (Jenner) Rose Pedel, s.r.n., h.v. Marion P. Webb, s.r.n., s.c.m., h.v., q.n.cert. (Boundfield) (Kingswear) 2 Vacancies Centre Superintendents : Anna Flemm, s.r.n., s.c.m., h.v. Margaret M. Sammon, s.r.n., s.c.m., b.t.a. (Trewsbury) (Lewisham Chest Clinic) Audrey I. Urwin, s.r.n., s.c.m., h.v. Helen Buckley, s.r.n., s.c.m., h.v. (Heathside) (Downham) Anne McGarry, s.r.n., q.n.cert., h.v. (Lind) 33 Health Visitors (+4 Vacancies); 3 T.B. Visitors; 24 School Nurses ( + 5 Vacancies); 23 Clinic Nurses (+1 Vacancy); 5 Clinic Auxiliaries (+2 Vacancies); 5 Trainee Health Visitors ( + 3 Vacancies) Nursing Officer (Training) : 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. W. H. Carr, s.r.n. Olive N. Dawson, s.r.n., s.c.m. Gladys M. Cruttenden, s.r.n. Violet J. Elliston, s.r.n. Francesca Farrow, s.r.n. 64 District Nurses (+1 Vacancy) Senior Midwives : Margaret J. Williams, s.r.n., s.C.m. Vacancy 17 Midwives ( + 6 Vacancies) Chief Chiropodist IV : B. Dalton, m.ch.s., s.r.ch., m.r.s.h. Chief Chiropodists I: P. V. Rhodes, m.ch.s., s.r.ch. Irene E. Yeomans, m.ch.s., s.r.ch. Senior Chiropodists : E. V. Tozer, m.ch.s., s.r.ch. Alice Playle, m.ch.s., s.r.ch. Rosemary Hobin, m.ch.s., s.r.ch. 1 full-time Chiropodist ( + 2 Vacancies); 16 sessional Chiropodists; 1 Trainee Chiropodist Health Education Officer: R. W. Allen, m.a.ph.i., m.i.h.e. 1st Assistant Health Education Officer: Muriel E. Morgan, s.r.n., s.c.m. (part i), o.n.c., h.v. 2 Assistants Home Safety Officers : L. Selway W. H. Wildish Chief Public Health Inspector: A. J. Phillips, m.a.p.h.i. 7 Assistant Chief Public Health Inspectors : J. H. Willis, d.f.c., d.m.a., m.a.p.h.i. r. Mahoney, m.a.p.h.i. J. E. Waring, m.a.p.h.i Senior Public Health Inspectors : H. W. Ellery, m.a.p.h.i. J. W. Bevan, m.a.p.h.i. D. W. Foster K. G. Burt J. A. G. White, m.a.p.h.i. Assistant Senior Public Health Inspectors : T. W. McCarthy, m.a.p.h.i. R. W. Bradstock, m.a.p.h.i. L. J. Cleverly, m.a.p.h.i. J. Hills M. R. Chapman, m.a.p.h.i. A. J. Thrussell, d.m.a., m.a.p.h.i. Vacancy 16 Public Health Inspectors 2 vacancies; 6 Trainee Public Health Inspectors 2 vacancies; 1 Senior Technical Assistant; 20 Technical Assistants Cleansing Disinfecting and Bathing Station Superintendent: H. W. Wellbelove (Lewisham) 2 Assistant Superintendents; 11 Miscellaneous Staff Mortuary Keeper and Coroner's Court Officer: W. C. Spear (Lewisham) Mortuary Keeper: C. C. Evans (Deptford) Pest Control Foreman : R. A. Sharman 6 Operatives Caretakers : R. L. Bullen (Central Lewisham) R. McAllister (Amersham Road) D. G. Rock (Jenner) Storekeeper: D. F. Mooney ADMINISTRATIVE STAFF Chief Administrative Officer: E. W. Cheesman Principal Administrative Officers: R. Shrive D. M. Minear, dip.soc. Senior Administrative Officers : E. A. Halpin C. R. Coleman, d.m.a. W. Fancy, b.sc.(econ.), d.m.a. Administrative Officers : J. A. W. Warton, a.c.i.s. L. A. Stokes 20 Administrative Assistants; 1 Chief Officer's Personal Assistant; 11 Clerical Officers; 25 Clerical Assistants ( + 3 vacancies); 9 part-time Clerical Assistants 8 THE BOROUGH The Borough of Lewisham covers approximately 13.4 square miles, and is bounded by the Boroughs of Greenwich, Bromley and Southwark and by the River Thames on the north. Three rivers run through the area, the Ravensbourne, the Pool and the Quaggy. The area consists of the low-lying Ravensbourne Valley running north to south with high ground rising on either side to high points at Crystal Palace and Sydenham standing at 250' above the Thames with 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. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA Hospitals There are six hospitals within the area of the Borough, but many patients are referred to others for various reasons. The following is a list of those to which the majority of Borough patients normally attend: — Lewisham, Lewisham High Street, S.E.13 Lewisham Group Hospital Management Committee Grove Park, Marvels Lane, S.E.12 ,, Hither Green, Hither Green Lane, S.E.13 ,, St. John's, Morden Hill, S.E.13 ,, New Cross General, Avonley Road, S.E.14 Board of Governors of Guy's Hospital Children's Hospital, Sydenham, S.E.26 .... Bromley Group Hospital Management Committee Miller Wing, Greenwich High Road, S.E.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 Psychiatric hospitals that serve this area are Bexley (Bexley Group Hospital Management Committee), Cane Hill (Cane Hill Group Hospital Management Committee) and Darenth Park (Darenth and Stone Group Hospital Management Committee) which is the main centre for mental subnormality. General Practitioners There are 128 general practitioners serving patients in Lewisham. The numbers serving broad areas of the Borough are : Bellingham, Catford, Lewisham, Hither Green, 34 Sydenham, Forest Hill, Brockley, 45 Deptford, 22 Blackheath, Lee, Grove Park, Downham, 27 Chest Clinics Deptford Chest Clinic, Harton Street, S.E.8 Lewisham Chest Clinic, 1 Blagdon Road, S.E.13 Venereal Diseases Clinics King's College Hospital, Denmark Hill, S.E.5 Miller General Wing, Greenwich District Hospital, S.E.10 St. John's Hospital, Morden Hill, S.E.13 Dreadnought Seamen's Hospital, Greenwich, S.E.10 9 PREMISES Comprehensive Health Centre Name and Address Services Jenner 201 Stanstead Road, S.E.23 Executive Council Services:— 4 Family Doctors 1 General Dental Practitioner Forest Hill Child Guidance Unit (opening 1972) Child Health, Child Development, Family Planning, Ante-Natal, Immunisation, Health Education, Cytology, Speech Therapy, Minor Ailments, Creche, Food Sales, Special Investigation Clinics, Slimming Group, Mothers' Club. 2 Local Authority Dental Surgeries, Chiropody Clinic. Health Centres and Clinics Name and Address Services Amersham Road, Amersham Road, S.E.I4 Ante-Natal, Child Health, Child Development, Immunsation, Mothercraft, Ancillary Food Sales, Special Advisory, Cytology, Special Investigation, Family Planning, Slimming Group, Mothers' Club 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.13 Ante-Natal, Relaxation Classes, Child Health, Immunisation, Mothercraft, Family Planning, Ancillary Food Sales, Cytology, Occasional Creche, Special Advisory, Language Classes, Slimming Group Deptford S.T.C., Reginald Square, S.E.8 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, Speech Therapy, Mothers' Club, Slimming Group 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, Minor Ailments, Health Education, Screening, Slimming Group 10 Name and Address Services Lee and Blackheath, Methodist Church Hall, Lee High Road, S.E.12 Child Health, Immunisation, Ancillary Food Sales, Mothers' Club Lewisham S.T.C., 78 Lewisham Park, S.E.13 Vision, Minor Ailments, Special Investigation, Audiometry Lewisham Hospital, S.E.13 Auditory Training Unit, Orthoptics, Hearing Investigation, Special Investigation Lind, Oxestalls Road, S.E.8 Child Health, Child Development, Ancillary Food Sales, Cytology, Ante-Natal, Slimming Group, Mothers' Club, Family Planning, Health Education 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.13 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, Health Education Sydenham S.T.C., Adamsrill School, Lower Sydenham, S.E.26 Minor ailments Children's Hospital, S.E.26 Special Investigation 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, Creche Trewsbury Road, All Saints' Parish Church Hall, Trewsbury Road, S.E.26 Child Health, Immunisation, Mothercraft, Health Education Dental Surgeries S.T.C., 78 Lewisham Park, S.E.13 S.T.C., Downham Health Centre, Churchdown, Downham S.T.C., Reginald Square, S.E.8 School for Dental Auxiliaries, New Cross, S.E.14 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.14 Kingswear, Dartmouth Road, S.E.23 28 Sangley Road, S.E.6 Downham Health Centre, Churchdown Lind, Oxestalls Road, S.E.8 Cleansing, Disinfecting and Bathing Stations Wearside Road, S.E.13 Speedwell Street, S.E.8 (closed October 1971) Mortuaries Ladywell Road, S.E.13 Watson Street, S.E.8 11 VITAL STATISTICS Area of the borough 8,579 acres. England Lewisham and Wales Population Census 1961 290,582 Estimate of Registrar-General at midyear 1971 266,700 48,815,000 Rateable Value Rateable value of the borough at April 1, 1971 £12,692,719 Estimated net product of a penny rate 1971-72 £118,800 Estimated number of separately assessed dwellings at April 1, 1971 89,874 Births Males Females Total Legitimate 1,716 1,674 3,390 717,491 Illegitimate 348 298 646 65,674 Totals 2,064 1,972 4,036 783,165 Crude birth rate per 1,000 of the estimated population 15.1 16.0 Adjusted birth rate for comparative purposes (Area comparability factor—0.96) 14.5 16.0 Ratio of adjusted birth rate to national rate 0.91 1.0 Illegitimate live births as percentage of all live births 16.0 8.0 Stillbirths Total (27 males and 19 females) 46 9,898 Rate per 1,000 live and stillbirths (males 12.9, females 9.5) 11.0 12.5 Deaths Total 1,652 males, 1,679 females) 3,331 567,345 Crude death rate per 1,000 population 12.5 11.6 Adjusted death rate (Area comparability factor—0.96) 12.0 11.6 Ratio of adjusted death rate to national rate 1.03 1.0 12 England Lewisham and Wales Infant mortality Infant deaths (all deaths of live born children under one year) Males Females Total Legitimate 41 33 74 12,140 Illegitimate 12 7 19 1,586 Totals 53 40 93 13,726 Death rate of all infants per 1,000 livebirths 23.0 17.5 Death rate of legitimate infants per 1,000 legitimate livebirths 21.8 16.9 Death rate of illegitimate infants per 1,000 illegitimate livebirths 29.4 24.1 Death rate of male infants per 1,000 male livebirths 25.7 Death rate of female infants per 1,000 female livebirths 20.3 Neonatal deaths (under 4 weeks of age) (35 males, 24 females) 59 9,113 Males per 1,000 male livebirths 16.9 Females per 1,000 female livebirths 12.2 All infants per 1,000 livebirths 14.6 11.6 Early neonatal deaths (under 1 week of age) (33 males, 22 females) 55 7,750 Males per 1,000 male livebirths 16.0 Females per 1,000 female livebirths 11.2 All infants per 1,000 livebirths 13.6 9.9 Perinatal mortality (deaths under 1 week plus stillbirths) (60 males, 41 females) 101 17.648 Males per 1,000 live and still male births 28.7 Females per 1,000 live and still female births 20.6 All infants per 1,000 live and stillbirths 24.7 22.3 Reproductive wastage (stillbirths plus all infant deaths) 139 Males per 1,000 live and still male births 38.3 Females per 1,000 live and still female births 29.6 All infants per 1,000 live and stillbirths 34.1 29.8 Maternal deaths Maternal deaths Maternal mortality rate per 1,000 live and stillbirths 13 Table 1 TOTAL DEATHS BY CAUSE AND AGE REGISTERED DURING 1971 Cause of Death Sex All ages Under 4 wks 4 wks under 1 year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 + B4 Enteritis and other diarrhoeal diseases M 2 - 2 - - - - - - - - - F 2 1 - - - - - - - - - - B5 Tuberculosis of Respiratory system M 4 - - - - - - 1 1 - 2 - F 3 - - - - - - - - - 1 2 B6(l) Late effects of Respiratory Tuberculosis M 4 - - - - - - - - 2 - 7 F 2 - - - - - - - 1 1 - - B6(2) Other Tuberculosis M 2 - - - - - - - 1 - 1 - F 1 - - - - - - - - - 1 - Bll Meningococcal Infection M - - - - - - - - - - - - F 1 - - - - - - - - - - - B17 Syphilis and its sequelae M - - - - - - - - - - - - F 1 - - - - - - - - - - 1 B18 Other Infective and Parasitic Diseases M 1 - - - - - - - - - - - F 1 — 1 - - - - - - - - - B19(l) Malignant Neoplasm, Buccal Cavity, etc M 4 - - - - - - - - - 2 2 F 1 - - - - - - - - - - 1 B19(2) Malignant Neoplasm, Oesophagus M 8 - - - - - - 1 - 1 3 3 F 10 - - - - - - - - - 6 4 B19(3) Malignant Neoplasm, Stomach M 46 - - - - - - - 4 10 18 14 F 41 - - - - - - 1 2 8 11 19 B19(4) Malignant Neoplasm, Intestine M 43 - - - - - - 1 3 11 12 16 F 51 - - - - - - 1 3 10 15 22 B19(5) Malignant Neoplasm, M 3 - - - - - - - 1 1 - 1 F - - - - - - - - - - - - B19(6) Malignant Neoplasm, Lung, Bronchus M 208 - - - - - 2 2 15 63 89 37 F 57 - - - - - - 3 7 17 14 16 B19(7) Malignant Neoplasm, Breast M - - - - - - - - - - - F 74 - - - - - - 1 14 23 19 17 B19(8) Malignant Neoplasm, Uterus F 27 - - - - - - - 4 5 9 9 B19(9) Malignant Neoplasm, Prostate M 20 - - - - - - - - 2 8 10 B 19(10) Leukaemia M 7 — — — - - 2 1 - - 1 3 F 10 — — 1 1 - 1 - - 1 4 2 B19(ll) Other Malignant Neoplasms M 94 — — 1 2 1 2 1 12 36 20 19 F 87 - - - - - - 3 11 19 21 33 B20 Benign and Unspecified Neoplasms M 2 - - - - - - - - - - 1 F 2 - - - - - - - - - - - B21 Diabetes Mellitus M 13 — — — — 1 - - 1 1 2 8 F 20 — — — - 1 - 1 2 - 5 11 B22 Avitaminoses, etc. M 5 - - - - - - - - - - 5 F 9 - - - - - - - - - - 9 B46(l) Other Endocrine etc. Diseases M 1 - - - - - - - - - - - F 5 - - - - - - - 1 - 3 1 B23 Anaemias M 1 - - - - - - - - - - 1 F 8 - - - - - - - - - 2 6 B46(2) Other Diseases of Blood, etc. M - - - - - - - - - - - - F 2 - - - - - - - - - 1 1 B46(3) Mental Disorders M 2 - - - - - - - - - 1 1 F 6 - - - - - - - - - - 6 B24 Meningitis M 2 - - - - - - - - - - - F 2 - - - - - - - - - - 2 B46(4) Multiple Sclerosis M - - - - - - - - - - - - F 1 - - - - - - - - - - - B46(5) Other Diseases of Nervous System M 12 — — — - 1 - - 2 2 3 4 F 13 - - - - - - - - - 4 8 B26 Chronic Rheumatic Heart Disease M 20 - - - - - - - - 5 6 9 F 41 - - - - - - 1 - 6 12 22 B27 Hypertensive Disease M 23 - - - - - - - 3 3 9 8 F 29 - - - - - - 1 - 2 5 21 B28 Ischaemic Heart Disease M 435 - - - - - - 9 39 106 158 123 F 355 - - - - - - 1 3 34 90 227 B29 Other forms of Heart Disease M 44 - - - - - - 1 - 6 14 23 F 68 — — 1 — — - 1 2 2 5 57 B30 Cerebrovascular Disease M 144 — 1 - - - - - 6 23 42 72 F 254 - - - - - - 2 8 15 49 180 B46(6) Other Diseases of Circulatory System M 61 - - - - - - - 3 5 23 30 F 94 - - - - - 1 2 - 5 20 66 B31 Influenza M - - - - - - - - - - - F 2 - - - - - - - - - - 2 B32 Pneumonia M 117 — 6 — 1 - - 1 4 10 23 72 F 162 — 4 — 1 - - - - 5 15 137 B33(l) Bronchitis and Emphysema M 122 - - - - - - 2 7 21 42 50 F 44 - - - - - - - 2 3 9 30 B33(2) Asthma M 3 — — - - 1 - 1 - 1 - - F 5 - - - - - - - 2 1 1 1 B46(7) Other Diseases of Respiratory System M 24 — 5 - - - - - 1 4 9 5 F 21 — 2 1 - - - - 1 2 5 10 B34 Peptic Ulcer M 16 — — 1 - - - - 2 1 6 6 F 6 - - - - - - - - - 2 4 B35 Appendicitis M - - - - - - - - - - - F 1 - - - - - - - - - - 1 14 Table 1—continued Cause of Death Sex All ages Undei 4 wks 4 wks &. under 1 year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 + B36 Intestinal Obstruction and Hernia M 6 1 1 3 1 F 8 — 1 - - - - - - - - 7 B37 Cirrhosis of Liver M 1 - - - - - - - - 1 - - F 3 - - - - - - 1 1 1 — — B46(8) Other Diseases of Digestive System M 12 1 - - - - - 1 — 2 6 2 F 26 1 - - - - - - 2 5 5 13 B38 Nephritis and Nephrosis M 9 - - - - - - 1 2 2 1 3 F 13 - - - - - - - - 2 3 8 B39 Hyperplasia of Prostate M 11 - - - - - - - - - 5 6 B46(9) Other Diseases, Genitourinary System M 12 - - - - - - - 1 2 1 8 F 21 - - - - - 1 — 2 2 6 10 B46(l 1) Diseases of Musculoskeletal System M 7 - - - - - - - - 1 2 4 F 24 - - - - - - - - 1 4 19 B42 Congenital Anomalies M 13 6 1 — 1 1 — 1 1 1 1 — F 13 4 5 1 1 1 — — — — 1 — B43 Birth Injury, Difficult Labour, etc. M 10 10 - - - - - - - - - - F 9 9 - - - - - - - - - - B44 Other Causes of Perinatal Mortality M 17 17 - - - - - - - - - - F 9 9 - - - - - - - - - - B45 Symptoms and 111 Defined Conditions M 4 — 2 - - - - - - - - 2 F 5 — 2 - - - - - - - - 3 BE47 Motor Vehicle Accidents M 20 — — 4 1 5 1 — 1 2 2 4 F 10 2 1 1 1 5 BE48 All other Accidents M 24 1 1 3 7 2 3 1 2 3 1 F 10 1 - - - - 1 4 4 BE49 Suicide and Self-inflicted Injuries M 10 2 - 4 3 - 1 F 7 — — — — 1 1 1 2 — 1 1 BE50 All other External Causes M 3 2 1 F 2 — 1 — — — — 1 — — — — Total all causes M 1,652 35 18 7 10 19 10 31 117 330 519 556 F 1,679 24 16 8 4 3 6 21 72 173 354 998 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, ranks 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 all heart diseases (e) of (h) (g)of (h) (f) of (h) (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) 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 5.1 1964 654 301 142 1,097 166 235 3,317 33 7.1 5.0 1965 740 304 150 1,194 206 268 3,436 35 7.8 6.0 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 6.0 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 1970 777 208 143 1,128 191 232 3,428 33 6.8 5.6 1971 790 225 155 1,170 182 224 3,331 35 6.7 5.5 15 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)os % of{b) All cancer deaths Lung cancer deaths (/) as % of(e) (a) (b) (c) (d) (e) (f) (g) 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 1970 417 194 47 364 54 15 1971 433 208 48 358 57 16 LOCAL SICKNESS The Regional Controller of the Department of Health and 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 1970 1971 January 26 2,336 1,209 February 23 1,097 790 March 23 1,139 988 April 20 1,001 881 May 18 924 880 June 15 790 696 July 13 665 767 August 10 743 716 September 7 699 652 October 5 869 799 November 2 1.013 887 November 30 952 895 December 28 738 860 Weekly average for the year 1970 997 Weekly average for the year 1971 848 16 17 Table 5 GENERAL STATISTICS FROM 1962 Year Population Death rate * % dying under age 45 % dying under age 65 Birth rate * Maternal Death rate † Stillbirth rate † Infant mortality rate ** Pulmonary T uberculosis Notif. rate †† Death rate †† 1962 291,150 11.6 8.0 30.6 18.9 0.5 13.3 18.6 56 9 1963 291,180 11.7 8.7 31.2 19.3 0.4 15.2 23.5 66 8 1964 291,670 11.4 8.9 31.1 19.9 0.5 11.7 22.9 64 2 1965 289,560 11.9 9.3 31.6 20.0 0.7 14.0 23.3 54 6 1966 289,130 11.8 8.6 30.2 19.2 0.2 15.1 21.6 47 5 1967 289,700 11.5 6.7 27.5 18.3 0.2 11.9 16.2 36 4 1968 281,140 12.2 6.8 27.2 17.9 0.8 10.2 18.7 43 6 1969 282,080 11.9 6.3 27.8 16.0 0.7 13.5 20.6 33 4 1970 279,350 12.3 7.2 27.3 15.7 0.9 13.5 22.3 42 4 1971 266,700 12.5 6.4 27.1 15.1 0.0 11.0 23.0 32 5 ♦Per 1,000 population tPer 1,000 Registered Live and Still Births **Per 1,000 Registered livebirths ffPer 100,000 population HEALTH CENTRES The year saw the opening in October of Lewisham's first comprehensive health centre, the Jenner Health Centre named after Dr. Edward Jenner, the pioneer of vaccination against smallpox. Situated in Forest Hill at the junction of Stanstead Road and Brockley Rise, the Centre is conveniently placed for easy access by road and public transport from all parts of the surrounding district. It has been designed to provide a full range of health services for between twenty and twenty-five thousand people living within an area of about one square mile, and to anticipate as far as possible future progress in preventive and curative medicine. With new developments and ideas the precise functions of the centre are bound to be modified and the internal design is therefore flexible. Wherever possible partitions are non load-bearing so that rooms can be adapted in the light of changing needs. Natural light and ventilation have been provided for every room except in rooms facing the main road where double glazing has been provided to reduce traffic noise and mechanical ventilation has been installed. A special feature is the PABX1 automatic telephone system with 10 exchange lines and up to 49 extensions. The exchange numbers are in sequence so that any free line is automatically found by the switchboard and callers are not frustrated or kept waiting. Internal calls can be made from one extension to another without the intervention of the operators and outside calls can be transferred direct between extensions or held while the same telephone is used to make an internal call not overheard by the caller on the exchange line. Indicator panels operated by a push button in each doctor's surgery are provided in the waiting areas, so that he can indicate when he is ready to see the next patient. The building is provided with oil-fired central heating throughout and there is ample car parking space for patients, visitors and staff. SERVICES PROVIDED Family Doctors Four general medical practitioners practise from the Centre, each having his own consulting and examination rooms. The Centre has been so designed that other family doctors could practise from the Centre. Treatment In the treatment centre Health Department nursing staff carry out treatment under the direction of the family doctors and deal with the minor ailments of schoolchildren. Dentistry A general dental surgeon practises from the centre and there are also two dental surgeries in which dentists employed jointly by the Council and the Inner London Education Authority provide free dental treatment for schoolchildren, expectant and nursing mothers and children under the age of five. Health Department Clinics Medical staff organise clinics for expectant and nursing mothers, young children, vaccination and immunisation, cervical cytology, family planning and for medical screening. 18 Specialist Clinics for Schoolchildren Specialist clinics are held and dental treatment is provided for children at school by the Inner London Education Authority in association with the South East Metropolitan Regional Hospital Board. Chiropody Facilities have been provided by the Council for three chiropody chairs. At present two chairs are in use giving treatment mainly to old and handicapped people. Child Guidance A major child guidance unit will operate from the Centre. This service is provided by the Inner London Education Authority in association with the South East Metropolitan Regional Hospital Board. Bathing A bathroom with hair-washing and drying facilities is provided, primarily for the use of handicapped people. Creche There is a playroom where small children are minded while the mothers see their doctor or receive some other service from the Centre. In order to give the group stability, some children in special need attend regularly. The Centre is also the office base for all health visitors, district nurses, school nurses and midwives who serve the area. An "Open Day" was held on 25 September between 10 a.m. and 4 p.m. to give members of the public a chance to visit the Centre. Some 1,100 persons took advantage of the opportunity. After a brief statement by an officer of the Health Department explaining the purpose of the Centre, they were shown around the building in groups of 10 to 14 by staff from the department, about 20 of whom acted as stewards and had been briefed to answer questions. Approximately 65% of the visitors were elderly, 30% middle aged and 5% young; a lively interest was displayed by most of them and, almost without exception, comments were favourable. The official opening ceremony was performed by the Mayor, Councillor P. Gorin, at a reception on the morning of 20 November. The Mayor, who was accompanied by the Mayoress, was introduced by the Chairman of the Health Committee, Councillor S. G. C. Hardy, B.E.M. Dr. Guy S. Wigley, Deputy Medical Adviser of the Greater London Council and Inner London Education Authority, proposed a vote of thanks. After the brief ceremony the 90 invited guests present, members and representatives of local and other community services, were given the opportunity of being shown around the Centre by staff of the Health Department. An illustrated brochure is available for visitors to the Centre, to students and others interested. Voluntary Workers The Child Health Clinic sessions held at St. Saviour's Hall, Brockley Rise, transferred into the new Centre, and mention must be made of the work of the Voluntary Committee which for so many years had organised the Forest Hill Infant Welfare Centre. 19 The Centre, one of several in Lewisham, grew from the original Forest Hill School for Mothers. This had been founded in 1908 and was held in the Mission Hall, Perry Rise. Other similar activities developed in this area so in 1914 the school transferred to the Mission Hall in Ewart Road where it adopted the name of the Forest Hill Infant Welfare Centre. Three years later the Centre transferred to the Salvation Army Hall in Wastdale Road, where it remained until 1928 when it moved for a stay of one year into the old St. Saviour's Hall, Brockley Rise. From 1929 until 1944 the Centre was accommodated in the Methodist Hall, Brockley Rise, from where it had to move when the premises were severely damaged by enemy action. For the next two years it was housed in the Central Methodist Hall, Stanstead Road, and from 1946 until 1956 in St. James's Hall, Stanstead Road. In 1956 the Centre made its final move back to Brockley Rise into the new St. Saviour's Hall which had been rebuilt after having been almost completely destroyed during the war. In its beginnings the Centre had been supported entirely by voluntary contributions but subsequently grants were obtained at various times from public authorities, such as the Board of Education, Ministry of Health, Lewisham Metropolitan Borough Council, London County Council, and Lewisham London Borough Council. Additionally, over a period of some thirty years the Centre had benefited from donations from such sources as the Alexandra Rose Day Fund and, occasionally, the Sunday Cinemas Fund. The history of the Centre is one of continued steady expansion and improvement despite the disadvantages of so many enforced changes of accommodation, and reflects years of devoted service by the officers and members of the Voluntary Committee and all persons associated with the work of the Centre. There has always been the closest co-operation between the Voluntary Committee and the local health authority whose medical and nursing staff have worked in the Centre from its beginning. The magnificent efforts over the years by all concerned contributed to the undoubted success of the Forest Hill Infant Welfare Centre in helping to establish and maintain the services in the area. The links between the Health Department and the Voluntary Committee will not be entirely broken as some of the members will continue to work in the new Centre. Future Progress In September the Health Committee confirmed a decision taken in 1967 providing for the complete coverage of the borough by comprehensive health centres, approved the broad areas to be served by these centres and authorised the appropriate officers to proceed with all possible speed to identify and acquire sites for the implementation of the plan by 1 April, 1974. Detailed drawings of a small health centre in Honor Oak with surgeries for the general practitioners were approved by the Department of Health and tenders were invited before the end of the year. Formal Department of Health approval was received to plans for the provision of two of the health centres to be included in the development programme on sites which have been identified in Deptford and Lee. The centre in Deptford will include individual surgeries for six general practitioners and the one in Lee will have four consulting suites, which will be used by two partnerships. The Council gave approval to the provision of land forming part of a redevelopment area in Lower Sydenham for a centre to serve that area. Eight general practitioners in two partnerships expressed an intention to practise from the centre. 20 SPECIAL REPORTS It is a pleasure to include in this report the following items from consultants in two important fields of medicine. PSYCHIATRY Dr. A. Norton, Consultant Psychiatrist, Bexley Hospital The chief event in the psychiatric field in 1971 was without doubt the implementation of the Social Services Act on 1st April. Next in importance was the memorandum from the Department of Health and Social Security on Hospital Services for the Mentally 111 published in December 1971. This memorandum continues and extends the policy laid down many years ago of transferring many of the major functions of psychiatric hospitals to facilities nearer to where the patients live—to psychiatric units in general hospitals, to day hospitals and to out-patient departments. Lewisham is not, unfortunately, very high on the list of areas likely to acquire a psychiatric unit in the near future, but the establishment of a psychiatric day hospital may not be so far off. Meanwhile, the out-patient services at Lewisham Hospital remain fully stretched, as they have been for many years, their growth limited only by the staff and accommodation available. In 1971, for example, there were over 5,000 out-patient attendances of which 10% were new cases. Since 1970 the out-patient work at St. John's has also expanded. The increase in self-poisoning since the war is a nation-wide phenomenon and the Borough of Lewisham provides no exception to this trend. This increase in self-poisoning contrasts with the national fall in suicide rates. Britain is the exception in Western Europe for showing this decline consistently in the past decade. The reasons are uncertain but may well include more effective methods of resuscitation carried out in intensive care units, the efforts of the Samaritans and the investigation, treatment, help and care given to those who have already attempted suicide, for it is well known that such people carry a higher risk of repeating the attempt, sometimes successfully. There has been a steady increase in the numbers admitted to Lewisham Hospital in the past few years for this cause and the investigation and treatment of such people forms a substantial part of the work of the Psychiatric Department there. No great step forward has been made in 1971 in the treatment of psychiatric illnesses, but it has become more and more clear that the introduction earlier of long-acting phenothiazine drugs, given by injection, to prevent relapses in schizophrenic patients was a major advance. Most drugs used in psychiatry have some unpleasant side-effects, and this may lead patients on essential maintenance treatment to stop taking these drugs, to take them only intermittently or to take them only in reduced dosage. The advantage of the long-acting phenothiazine drugs is that one knows that patients are actually getting the medication that they are supposed to be having. More than 100 patients now attend the psychiatric out-patient department monthly, or more often, for their injections. The giving of these drugs and the pursuit of patients who default from the clinic is an important part of the work of the two psychiatric nurses who have recently been appointed to the staff of the Health Department. They began work in December 1971. These nurses also perform a valuable function in continuing the nursing care of patients recently discharged from psychiatric hospitals back to the community. They may well also be able to employ their nursing skill to avert the admission of a few elderly patients to a psychiatric hospital. It is too early yet to fully evaluate the work that psychiatric nurses can do in the community, but this is a field that may well expand in the future and already a useful beginning has been made. 21 GERIATRICS Dr. R. V. Boyd, Consultant Physician in Geriatrics, Greenwich District Hospital (Dr. P. Meisner, Consultant Physician in Geriatrics, Lewisham Hospital, was in the United States of America at the time of compilation of this report.) It is common knowledge that the population of the United Kingdom has increased rapidly over the last hundred years, and the term "population explosion" has many times been applied to this increase. What is not so often realised is that within the general population explosion has been a disproportionate growth in the number of elderly persons. A hundred years ago the population of England and Wales was 22,700,000 with 1,750,000 over-65's (4½%); in 1971 the population of England and Wales was 48,600,000 with 6,350,000 over-65's (13%). Not only is there this vast increase in the number of elderly but there have also been complex changes in social structure and habits. The elderly are surprisingly resilient, however, and only one in twenty of the over-65's lead an institutional existence in hospital or old people's home, the vast majority continuing to live in the community. It is highly important, both on humanitarian and on economic grounds, that every effort be made to support the elderly so that they can remain in the community. A large factor in attaining this end is the preservation of health, by high social standards (including housing, food, clothing, heating, and social contacts and personal interests) and early detection of illness so that permanent disability can be prevented or minimised. Concerning the early detection of illness, there are difficulties because the elderly tend not to seek medical help but to accept limitations as being due to old age and, therefore, untreatable. It is tragic when problems which are treatable are not diagnosed, and sometimes gross disease is accepted as "old age" and left to become irremediable. The speciality of geriatrics has shown that the ageing process itself does not cause gross disability, and such symptoms as inability to walk, incontinence and confusion are due to diseases—and many of these diseases are treatable. In working with the elderly, one is impressed by the support that relatives and neighbours give to the disabled elderly. It is commonplace to say that people neglect their responsibilities to the elderly nowadays, but studies from different parts of the country show that this, as a generalisation, is untrue. Rather the opposite; those in contact with the elderly often give considerable help to an extent that is remarkable. There are now many people concerned with helping the elderly both in local authority departments and in the National Health Service, but where many people are involved, co-ordination of services may be difficult to organise. There is an awareness of possible overlapping of services (or of possible gaps); liaison is already taking place, and it is to be hoped that co-operation will continue and progress. 22 VENEREAL DISEASE In previous years the machinery in Lewisham for venereal disease contact tracin has varied. However, in response to a request from the Chief Medical Office: Department of Health and Social Security, a nursing officer was designated a liaison officer in this respect in December 1971. Cases notified to the liaison office are now passed on to the appropriate health visitor for action in contact tracing. In respect of health education in this field, slides illustrating the importar aspects of venereal diseases were shown on thirty occasions, to students and schoc children. There were also some ten other occasions when venereal diseases wer included in health education talks. In all cases, teaching on this subject is giver in the general context of responsibility in personal relationships, to young person in schools, further education establishments and technical colleges. Articles on th subject were printed in two issues of "Your Health", a regular bulletin issued b the Health Education Section, which has a circulation of some 7,500 person through clinics, libraries, young groups, schools, doctors' surgeries, etc. The following table relates to residents of Lewisham and has been compiled fror information received from the larger clinics in London. Other residents attendin smaller clinics and their own doctors are excluded but, nevertheless, the figure show a disturbing increase in the number of new cases. 23 24 Table 6 NUMBER OF NEW CASES IN THE YEAR Treatment Centre Totals All Conditions Syphilis Gonorrhoea Other Conditions 1971 1970 1969 1968 1967 1971 1970 1969 1968 1967 1971 1970 1969 1968 1967 1971 1970 1969 1968 1967 Middlesex Hospital 147 87 93 79 74 1 3 4 — 1 14 12 10 20 13 132 72 79 59 60 Greenwich District Hospital 534 488 423 397 371 8 12 3 7 11 165 159 129 101 103 361 317 291 289 257 London Hospital 182 120 118 122 67 5 1 3 3 5 38 28 26 34 11 139 91 89 85 51 St. Thomas's Hospital 213 178 160 84 48 — 2 2 1 3 37 34 31 13 8 176 142 127 70 37 St. John's Hospital 856 754 560 591 504 13 11 4 9 13 154 153 102 119 99 689 590 454 463 392 Dreadnought Seamen's Hospital 314 225 220 177 162 5 3 3 2 3 81 53 73 40 33 228 169 144 135 126 St. Giles's Hospital 329 229 219 166 113 3 3 4 1 4 91 54 40 34 21 235 172 175 131 88 TOTALS 2,575 2,081 1,793 1,616 1,339 35 35 23 23 40 580 493 411 361 288 1,960 1,553 1,359 1,232 1,011 DEVELOPMENTAL PAEDIATRICS The regular developmental assessment of infants and young children by paediatricians, family doctors and local authority medical officers is now accepted as a necessary and valuable service to children and parents. The main benefits accrue from the early detection of physical or mental handicap which may be responsive to treatment or require special facilities to enable a child to achieve his potential. A secondary benefit is the re-assurance or advice available to parents at the time of the examinations, and subsequently if required. Both clinic medical officers and family doctors who carry out developmental assessments in their own premises, work closely with health visitors who follow up any advice that has been given, and ensure that necessary services are made available by visits to the home. The keeping of an observation register of children who have physical or mental disabilities enables the Medical Officer of Health to correlate information from different sources—clinics, family doctors, hospitals. Social Services Departments, etc., and thus to ensure that a child who may be under the care of several agencies is in fact receiving all necessary services and that these are co-ordinated. Developmental assessments of children are carried out in all infant health clinics in the borough, and clinic doctors are specially trained in this branch of paediatrics. The examinations are done regularly—at three to four weeks, six months, one year, eighteen months, two years and then annually to school age: should there be need, a child will be seen more frequently. If, on examination, any significant deviation from the expected rate of development is noted, further investigations are arranged in consultation with the family doctor. Children who are not brought for an assessment are checked in their own home by the health visitor who notifies any defects which she may find. The developmental assessment of a child at any age includes appropriate tests for hearing and speech, vision, and those fine movements requiring accurate hand/ eye co-ordination, posture and large movements, a study of relationships, attitudes and intelligence (often demonstrated in play situations) and also a full physical examination of the child. Regular observation is necessary as very often defects do not become apparent until a certain level of development has been reached. Doctors and health visitors must therefore maintain a high standard of vigilance. The early detection of a handicap, distressing though it may be at the time to the parents, does lead to the best possible course of action being taken, involving appropriate investigations and providing all available services for the maximum benefit of a handicapped child. Table 7 CLINIC ATTENDANCES 1971 1971 Total attendances No. of children medically examined No. of children requiring referral No. of Clinic Sessions Full-time Medical Officers time Medical Officers First Quarter 11,718 6,286 191 157 361 Second Quarter 16,660 6,053 121 153 298 Third Quarter 15,912 5,972 85 169 290 Fourth Quarter 13,771 5,477 94 169 294 TOTAL 58,061 23,788 491 648 1,243 25 INFANT MORTALITY The rates of infant mortality in Lewisham remain above those for England and Wales generally. Although statistical tests show that there is no mathematical significance in the figures, there can be no cause for complacency here. The perinatal mortality rate for Lewisham (i.e. deaths of infants in the first week of life plus stillbirths per 1,000 births—including live and stillbirths), although still higher than that for England and Wales, has shown a reduction since 1970. The fall is entirely due to a reduction in the stillbirth rate which is now lower than the stillbirth rate for England and Wales. A reduction is also to be seen in the infant mortality rate for illegitimate babies in Lewisham but this is compensated by a slight rise in the legitimate infant death rate, so that the overall infant mortality rate is almost the same in 1971 as in 1970. Factors which influence infant mortality include the illegitimacy rate (which in Lewisham is twice that for England and Wales), and social conditions; it is probable that these factors contribute to the fact that Lewisham's figures are above the national average. POLIOMYELITIS A case of paralytic poliomyelitis in an adult female was notified in February 1971. The case history prior to notification and the subsequent investigations involved reveal the complexities of dealing with a major infectious disease in present day urban society. E. L. M. Millar (Public Health, London (1971) 85. 103-106) revises the present means of control of poliomyelitis, namely: "oral vaccination of all children in the neighbourhood of, or attending the same school as, a paralytic case. This and isolation of the case and school exclusion of household contacts forms the basis of control measures". He points out that the only uncertainty is in deciding how far the neighbourhood extends. In this particular case the onset of symptoms was some six days prior to the date of notification. No medical advice was sought for the first three days in spite of the severity of the symptoms which included weakness of the legs. The patient was due to attend hospital out-patients for a routine follow up and intended to use that opportunity to seek advice. She was subsequently transferred to Hither Green Hospital and notification was made by the consultant in infectious diseases to whose ward the patient had been admitted. The Department of Health and Social Security was notified. The patient's seventeen-month-old daughter had received her first dose of oral trivalent poliomyelitis vaccine exactly twenty-eight days prior to the onset of symptoms. The patient, her husband and two children (seventeen months and four years old) lived in a single room on the first floor of a two-storeyed house in which three other families also lived. One of these families (a woman and her school-aged son) lived on the same floor as the patient and shared the kitchen, toilet and bathroom with her. The other two families, one with six children (the landlord) and one with two children, occupied the ground floor; five of the children were of school age and attended different schools. The staircase, hall and front door were common to all families. Some rooms on the first floor were unoccupied and had been so for several weeks. There was no history of contact between either the patient or her family and any other occupant of the house. In spite of the lack of contact the school child living on the same floor was excluded from school. Since he travelled to an adjoining borough to school the Medical Officer of Health of the area was informed. 26 All occupants of the house were informed of the situation and were offered and accepted oral poliomyelitis vaccine which was given after faecal specimens had been collected from every occupant and sent for laboratory investigation to the Public Health Laboratory Service, Colindale. Preliminary results on two faecal specimens from the patient identified Polio virus type II supporting the provisional diagnoses of a Sabin-associated case of poliomyelitis. Marker tests, although not wholly reliable, were being proceeded with and were later notified as confirming vaccine strain of virus. At this stage a specimen of stool from one of the infants on the ground floor was also reported as positive for poliomyelitis virus type II. This child had not previously been immunised, was said to have no contact with the patient or her family or with any other children who had been recently immunised by oral poliomyelitis vaccine. Further investigation showed that this child was, in fact, being cared for regularly by an unregistered child minder (who subsequently became registered). With some difficulty the name and address was obtained and, again with difficulty, the names and addresses of other children being "minded" were obtained. Some of these children had recently been given oral poliomyelitis vaccine and could have been the source of this positive stool. All were observed and vaccine courses completed. Shortly afterwards the patient's husband and his two children left their lodgings and it was only possible through the hospital medical social worker to find his new address, which happened to be in another borough, to arrange follow up. No further cases occurred, and the child with the positive stool remained well. The patient was eventually discharged from hospital wearing calipers, with aids provided in the home, and home help. Various other social factors of interest arose during the investigation of this case. Both the patient and her husband were illiterate. They were not on the housing list because they were unable to complete the appropriate forms and did not reveal their difficulties and so obtain the assistance that was available. Once forms were completed housing was made available on overriding medical grounds but the accommodation provided by a housing aid society was preferred. The landlord and his family had spent some time in Germany, prior to arrival in this country, after leaving their country of origin. The other tenant of the ground floor (related to the landlord) had one child who had arrived from his former home (where polio is not uncommon) within the previous three months. Records of immunisation for this group of twelve people were not complete. However, records of immunisation against poliomyelitis-in this country were available for four of the children and a further two were said to have been immunised in Germany. During the period of observation a further young couple was found to be occupying one of the formerly empty rooms on the first floor. In spite of difficulties this couple were interviewed. After the situation had been explained, they were offered, and accepted, oral vaccine, but they left the area with no forwarding address shortly afterwards. Neither thought they had been previously immunised. At the time this case occurred legal steps were being taken to gain entry as the house was known to be in "multiple occupation" and entry had been refused. In conclusion (D. L. Miller et al Public Health London (1970) 84, 265-285): "Type 2 virus appears to spread to contacts of patients given trivalent vaccine more readily than types 1 and 3, and type 2 virus was isolated from the contact vaccine— associated cases more often than either of the other two types It is noteworthy that—type 1 virus has resumed its former position as the predominant infecting type in poliomyelitis, mainly owing to outbreaks caused by this type—type 3 virus which shows a greater tendency to revert to laboratory markers of virulence than 27 the other two types, was isolated from all but one of the vaccine-associated cases with residual paralysis recorded between 1962 and 1968. The safety of liveattenuated-virus vaccine has been one case in four million doses administered". I acknowledge the assistance given by the Lewisham Group Hospital, in particular the staff of Hither Green Hospital and the Public Health Laboratory Service. INFECTIVE HEPATITIS A mild outbreak of infective hepatitis occurred in May of this year at Christ Church, Forest Hill, Church of England Primary School, Perry Vale, S.E.23. Two confirmed cases involving children at the school were notified by general practitioners and a further two cases, one child and one teacher, were brought to the notice of the Health Department by the Head Teacher. All cases were in a single class and none had been immunised. In consultation with the Medical Adviser to the Inner London Education Authority and a Senior Medical Officer of the Department of Health and Social Security, it was decided to offer protection against infective hepatitis to all school contacts, both pupils and staff, using gammaglobulin. All general practitioners in the Borough were notified and an immunisation session was arranged at the school on Friday 21 May. Parents of the schoolchildren were sent a letter explaining the circumstances and pointing out that protection could alternatively be arranged through the family doctor. Prior parental consent was necessary in each case. At the school session 235 children and 21 adults were immunised in the following categories: Children Aged 5- 7 years 36 boys 38 girls 7-10 years 56 boys 47 girls Over 10 years 33 boys 25 girls 125 boys 110 girls Adults 5 males 16 females Arrangements were made for the remaining children to be immunised by their family doctors. One of the first two children notified was admitted to hospital because of complications of an associated diabetes. Two further cases subsequently occurred, both children, who had obviously been incubating the infection prior to immunisation. No further cases of the condition occurred in the school; all patients recovered satisfactorily. CERVICAL CYTOLOGY The examination of healthy women, by a simple smear test to detect early changes in the neck of the womb which could lead to cancer, is carried out in cytology clinics, for well women in seven centres in the borough, in all family planning clinics, and as part of the examination of women attending the adult screening clinic. In addition to the smear test both a full pelvic examination and breast palpation are carried out which not infrequently reveal other abnormalities requiring treatment. Patients attending cytology and adult screening clinics are also instructed by health visitors on self-examination of the breast. 28 It has been the practice from time to time to take the service into offices, factories, etc., in the borough. In 1971 a request was received from the Telephone Exchange in Lewisham, and a team from the health department went into the Exchange to offer and carry out smear tests on all women who wished to avail themselves of the service. Cervical smears are also taken by family doctors and when patients attend hospital. Place of Examination No. of women examined No. of women referred to G.P. with abnormalities or positive smear result Well-women Cytology Clinics 2,020 280 Adult Screening Clinics 285 28 Family Planning Clinics 3,271 65 TOTAL 5,576 373 NUnSINCi HUMtS There are five private nursing homes within the borough registered under the Public Health Act, 1936, and the Nursing Homes Act, 1963. One of these is a Mother and Baby Home and another is approved under the abortion Act, 1967, by the Department of Health and Social Security. ment of Health and Social Security. The total number of beds provided is as follows: For chronic cases 56 For medical cases 15 For surgical cases (including 9 for abortions) 14 For expectant and nursing mothers (plus 8 cots) 22 Total (plus 8 cots) 107 Regular inspections of these homes are carried out by officers of the Health Department and, in the one instance, the Department of Health and Social Security. EMERGENCY SERVICES Certain staff of the Health Department are available outside normal office hours through a Control Centre at Greenwich Town Hall—telephone 858 5001/2/3. This arrangement extends both overnight and throughout the weekend. The vast majority of calls received via this agency are for the District Nursing and Domiciliary Midwifery Services but there is also a Duty Medical Officer and a Senior Public Health Inspector on call on a rota basis. One of the more unusual calls received during the year was a request to identify two large insects unpacked from a case of bananas. There were found to be "mottled winged bush crickets" which are not infrequently imported with bananas from the West Indies and which do not constitute a hazard to health. 29 ADVICE BY MEDICAL OFFICER OF HEALTH TO OTHER DEPARTMENTS Medical advice from the Health Department is sought by other departments of he local authority for a variety of reasons including the health of children and idults, hygiene matters in Council establishments, and environmental factors .fleeting health. Advice to Social Services Department (a) Adoption Medical assessments of children for adoption in 1971 40 including: Number examined by family doctor 7 Number examined by hospital paediatrician 2 Number examined by local authority doctor 31 Medical examinations of prospective adopters 86 Investigations into medical records of hospitals and family doctors on natural parents, and preliminary enquiries with medical histories of prospective adopters 67 All assessments and reports are scrutinised by a Principal Medical Officer who advises the adoption sub-committee on all medical aspects of adoption. (b) Fostering Medical examinations of children prior to fostering 22 Medical reports on prospective foster parents 71 Reports and assessments are scrutinised by a Principal Medical Officer who advises the Director of Social Services on medical aspects of fostering. (c) Recuperative Holidays In the nine-month period since the responsibility for arranging recuperative holidays has been that of the Social Services Department, advice on medical recommendations has been provided in 280 cases. (d) In addition, advice has been given on a regular day to day basis to individual social workers on medical matters, as well as to establishments, e.g. children's homes and day nurseries on matters of health and hygiene. All children in the Council's day nurseries are examined regularly by a medical officer of the Health Department, and visits to residential establishments and to individual homes in the community are made by medical officers, health visitors and public health inspectors as required, at the request of the Director of Social Services. Advice to Housing Department All medical reports regarding applications for rehousing on medical grounds are received and scrutinised by a Senior Medical Officer, who makes an assessment of the need and advises the Housing Department on the appropriate number of "points" to be awarded in this respect. In cases of urgent medical need for rehousing, a "special medical recommendation" may be made. Assessments made for "pointing" on medical grounds. (i) applicants for housing 35 per week (average); (ii) applicants for transfer 20 per week (average). i.e. a total of 3,000 per annum. Special Medical Recommendations made 1971: 128. 30 3. Advice to the Town Clerk's and Chief Executive's Department (a) New Staff All staff appointed to the Council's service complete a medical form giving details of their medical history. These forms are scrutinised by a medical officer who decides whether a medical examination will be required. Finally, a decision is made regarding a person's fitness for employment by the Council. Number of medical forms scrutinised in 1971 1,064 Number of medical examinations carried out 282 (b) Existing Staff Medical advice is requested for various reasons, e.g. infectious illnesses, prolonged absence from work because of ill health, disabled persons and employees who have been involved in accidents. Enquiries, examinations and interviews are carried out as required, and advice may be given in terms of certain restrictions in duties, unsuitability for particular types of work, and early retirement due to permanent unfitness. The Medical Officer of Health advises the Establishment Committee on all health matters in respect of Council employees. (c) Regular examination of certain groups of staff Men working in sewers have regular medical checks because of the special health hazards involved in their work. They are therefore examined annually by a medical officer. Heavy goods vehicle drivers require medical examinations prior to the first issue of their heavy goods vehicle licences and are also examined on renewal of the licence if they are over 60, or if they have had periods of sickness. All drivers employed by the Council are required to be examined by a medical officer for fitness to drive before employment and later after any absence from work because of ill-health. (d) Prevention of Tuberculosis Certain categories of staff, principally those in regular contact with children, are required to show evidence of a negative chest X-ray before entering the Council's service. 31 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 Chief Nursing Officer) Domiciliary Midwifery Service The work of the Domiciliary Midwives continued to change in character during the year as the preference for hospital delivery increased and the planned early discharge scheme absorbed many of the patients who would have been confined at home. There was a fall in the birth rate of 6.8% (4,456 in 1970—4,151 in 1971) and this may partly be attributed to the increase in family planning facilities. Domiciliary Confinements These totalled 260, a decline of 33.6% from the previous year. The percentage of domiciliary confinements to total births fell to 6.2% thus giving a hospital confinement rate of 93.8%. A General Practitioner Obstetrician was booked for 99.2% of the patients confined at home, but the doctor was present at only 10.7% of the deliveries. To maintain the high degree of skill of the domiciliary midwife the Domiciliary Liaison Scheme with Lewisham Hospital has continued; during the year 102 deliveries were conducted in hospital by the domiciliary midwives. The scheme has increased in popularity with the staff as it offers continuity in the care of patients and the full complement of staff are willingly participating in the scheme. An average of 25 cases are booked each month, but some cases become full hospital cases for various reasons such as the necessity for induction of labour. Owing to adverse factors listed below bookings for domiciliary confinements had to be changed for 41 patients. Admissions during Ante-natal period Anaemia 1 Urinary and renal investigations 1 Ante-partum haemorrhage 2 Pre-eclampsia 1 Post maturity 3 Admissions during Labour Premature labour 3 Breech presentation 1 Face presentation 1 Non-engagement of the head 2 Primary uterine inertia 6 Premature rupture of membranes 5 Foetal distress 3 Delay in second stage 4 Retained placenta 4 Admissions during Puerperium Secondary post partum haemorrhage 3 Puerperal pyrexia for investigation 1 32 The Emergency Obstetric Unit This was called on eight occasions, twice by General Practitioners requiring assistance with patients who were bleeding having had incomplete abortions. On six occasions the midwife called the unit for assistance with complicated deliveries. Ante-natal Care The principal of shared ante-natal care with General Practitioner Obstetricians and the hospital involves the domiciliary midwives. Many of the patients who are booked for 10-day stay in hospital or planned early discharge, receive ante-natal care at clinics where both the General Practitioner Obstetrician and the Midwife see patients. Attendance at ante-natal clinics amounted to 4,604 and an additional 6,038 ante-natal visits were paid by midwives to patients in their own homes. Many of these visits were paid to patients who failed to keep hospital appointments. The opening of the Jenner Health Centre in October provided an opportunity to increase the attachment of midwives to General Practitioner Obstetricians. Four doctors are working at the centre and two midwives are working with them. This change has necessitated the reorganisation of the working arrangements for the area; the geographical area has now been abandoned. Each of the eight midwives in the area works with a number of doctors; the amount of midwifery involvement in a practice decides the number of doctors a midwife can reasonably serve. Ante-natal care by the midwife is undertaken at the health centre. One of the advantages of "attachment" is the better communications between doctor and midwife and the fewer people who need to be involved in consultations when problems arise. The Planned Early Discharge Scheme The scheme continues to maintain its popularity, although there was a slight decrease in numbers (1,355 discharges in 1970—1,295 in 1971). The disturbing factor is the number of patients who discharge themselves from hospital haphazardly. There is no upper limit set to the number of patients who may be booked for planned early discharge. The categories of patient discharge were: — Planned 943 District transfer 45 Irregular 307 1,295 During the year 1,240 assessments of home circumstances were made in conjunction with the scheme. 124 homes were considered quite unsuitable. Patients from some of these unsuitable homes may have subsequently taken their own discharge against medical advice. It would appear that patients who left before the tenth day irregularly, did not settle or were unhappy in hospital. This is an interesting fact when considering the pressures for 100% hospital confinement. Pupil Midwife Training We have continued training programmes with Lewisham Hospital and the Greenwich District Hospital. Forty pupil midwives completed training during the year and a further nine pupil midwives are in training at the present time. Discussions took place during this year to investigate the possibility of undertaking a single period of midwifery training. The idea was acceptable and a training programme was subsequently submitted to the Central Midwives Board and agreed. The new course will be commencing in May 1972 with an intake of ten students. 33 Obstetric Nurse Training A programme of community care is arranged for one day during the ten-week course for obstetric nurses. We have been able to provide this experience for 36 students during the year. Premature Babies In addition to the three patients transferred to hospital in premature labour, nine other babies were born at home weighing less than 5lb. 8 ozs. Of this number three had to be transferred to hospital the remaining six progressed very well and thrived at home. Hospital Admissions—Babies Eleven babies were admitted to hospital during the early neo-natal period for the following reasons: — Cyanotic attacks 4 Oedema 1 Jaundice 3 Vomiting 1 Blood loss per rectum 1 Atresia and Down's syndrome 1 Screening for Phenylketonuria Midwives are continuing to undertake the Scriver test (Plasma Chromatography) on babies when 9 or 10 days old. During the year 1,343 tests were made; no positive cases were found, although some babies had to be tested up to three times to eliminate false positives. 34 DISTRICT NURSING Dorothy M. Coe, S.R.N., R.F.N., S.C.M., H.V., C. & G. Technical Teachers' Certificate, Diploma in Social Sciences (Chief Nursing Officer) Patient Care The improvement in the. communications between Doctors and Nurses as a result of the attachment of staff to General Practice, which occurred during the latter half of last year, has shown a changed pattern of care during this year. There has been an increase in the number of patients seen in the surgery and a subsequent adjustment in the number of patients referred for domiciliary care. 3,759 patients were referred for domiciliary care in 1971 (3,901 in 1970). Of the patients nursed at home there has been an increase in the number of high dependency cases which has resulted in a 3% increase in the number of visits paid to patients. 186,441 visits made in 1971 (181,038 in 1970) These statistics show an average of 49.5 visits to each patient, but in reality there is a large group of patients receiving monthly injections for anaemia and are seen twelve times during the year, while the paralysed patients and others with heart and other allied conditions, have two visits daily resulting in a maximum of 470 visits in the year for each patient. At the end of the year 1,852 patients were still receiving treatment. Treatment within Surgeries Although all the staff work to specific doctors it is only possible for 26 District Nursing Sisters to work within surgeries serving a total of 55 doctors. The opening of our first comprehensive Health Centre in October brought together two small surgery sessions and the same staff are now able to provide treatments for the patients of the four doctors instead of only two. It has only been possible to increase the provision of surgery treatment in one other practice as expansion is dependent upon availability of suitable accommodation. The flow of work through the surgeries has increased from 3,955 treatments given in 1970 to 5,792 treatments in 1971. Of this number 2,206 were injections and 3,586 were other treatments. Only a limited number of children are now nursed at home—130 under five years in 1971 as opposed to 166 in 1970. However, there were 192 treatments to children under five years given within the surgeries (this figure does not include immunisations which the doctor might undertake ifidependently of the Nursing Sister, who is not permitted to carry out such duties alone). Bathing Service of the Elderly and the Infirm There has been an increasing demand for this service and the number of patients bathed has increased but it has not been possible to improve the service to quite a large number of patients receiving baths once a fortnight. A total of 15,995 baths were given by twelve bathing attendants as against 13,586 in the previous year, the only hope of meeting the needs of this service would be an expansion in the number of persons employed. Geriatric Liaison Scheme Two District Nursing Sisters are employed specifically for the scheme, one full-time and the other part-time. Within the scheme there is emphasis upon rehabilitation 35 with the object of returning patients to their own homes for as long as possible thus allowing the aged in the community to remain independent. The Liaison Scheme acts as a monitoring process for patients particularly at risk, and the geriatric ward is then a treatment area, with patients being admitted for treatment and then transferred home when their condition improves or becomes stabilised. The success of a scheme of this kind lies in the means of communication and the following up of patients to assess performance and speedy re-admission should the need arise. The task is enormous and there are some limitations to the full operation of the scheme but there have been results of which we are justly proud. During the year the Geriatrician accompanied by the Liaison Sister undertook 286 examinations of patients within their own homes prior to their admission to the Geriatric Unit. Patients discharged from the unit are referred to the District Nursing Sisters and extra visits are made by the Liaison Sisters; 475 such visits were made during the year. The work of the Liaison Sister requires 38% of her time to be spent in the hospital working with the Geriatrician and the remainder on the district. Nursing Staff There were some staff changes during the year, but recruitment was generally good and vacancies were quickly filled. At the end of the year the establishment was: — State Registered Nurses (Female) 45 State Registered Nurses (Male) 10 State Enrolled Nurses (Female) 17 Bathing Attendants 12 Education Programmes for Staff District Nurse Training. Five members of staff undertook training for the National Certificate in District Nursing and all were successful in the examination. Practical Workers Instructor Course. Five members of the staff followed special courses to enable them to undertake practical teaching of students. First Line Management. Two members of staff, already undertaking Group Leader responsibilities, undertook First Line Management Courses, to further equip them for their task. % In-service Training—One-day Courses A total of twelve nurses attended study days on a variety of subjects including: — Community Coronary Care Renal Dialysis Care of the Feet Colostomy and Ileostomy Care, and Continuity of Patient Care In-service Training—Seven-day Courses In conjunction with St. Thomas's Hospital a full programme on "Current Hospital Practice" was arranged and eight State Registered Nurses participated. This venture was such a success that we hope to develop a further course with our own local hospital. In addition one other member of staff was able to attend a course on "Working in General Practice" and another on "Community care in the Seventies". 36 Visits to the District Nursing Service We are always pleased to welcome students to observe the work of the District Nurses. During the year we provided day courses for: — 10 Hospital Nurse Students 9 Physiotherapy Students 42 Pupil Midwives 2 Midwife Teacher Diploma Students The emphasis of the work is still concentrated upon the aged. 75.9% of patients attended during the year were over the age of 65 years. A random sample of 200 patients revealed 14 patients between 90 and 95 years of age and 71 patients between 80 and 89 years of age. The work can be particularly heavy at times but the harmony within the working groups makes the task possible and we are indebted to all the members of the nursing staff for their devotion to their patients and the work. 37 HEALTH VISITING Dorothy M. Coe, S.R.N., R.F.N., S.C.M., H.V., C. & G. Technical Teachers' Certificate, Diploma in Social Sciences (Chief Nursing Officer) In spite of many changes and challenges both nationally and locally, the health visitors continue to give loyal and effective service. Although they have beer involved in the changed organisation resulting from the introduction of a new management structure and the development of close liaison schemes with genera practitioners, hospitals and the new Social Services Department, their principal objective remains the provision of an effective service for the whole family. Many of the changes which have taken place are the result of increased interest shown by general practitioners and hospital staff and the introduction and acceptance of the health centre. The health visiting service has been in existence for over 100 years yet the health visitor often seems to go unrecognised and unsung, for it is a difficult profession to define and even more difficult to measure. Now, however, with the attachment of health visitors to general practitioners' surgeries, the public are becoming more aware of the health visitor's role. Health Centres The opening of the Jenner Centre in October has provided a valuable stimulus to the nursing staff. The team employed in the centre are working well to provide an integrated, comprehensive service for all age groups and appreciate the benefits resulting from the close relationships with general practitioners and staff in the centre. Problems and treatment can be dealt with during one visit thus avoiding the need for further referrals and appointments. The centre is already in demand from those wishing to hold teaching sessions for community and hospital nurses. General Practitioner/Health Visitor Attachments and Liaison Schemes Two health visitors are now fully attached and work from rebuilt modern surgeries— with three doctors in each group. They both agree that job satisfaction and the quality of family service offered to the public is improved. Their records are kept in the surgery with medical records and both are readily available to the doctor and health visitor. Regular consultation means that there is a unity of decision and the doctor obtains information about the family background since, frequently, the presenting complaint of the patient attending the surgery is only a reflection of the real family problem. More visits are paid to old people. Health visitors in attachment and liaison schemes find that the number of home visits has increased and a larger area than previously is covered. The number of these schemes is limited due to lack of suitable premises. Many more evening visits have to be made because people are not available during the day. Liaison with Hospitals Existing links with consultants and staff in hospital have continued and strengthened. Health visitors are involved in specialist duties with the following groups: spina-bifida, geriatrics, psychogeriatrics, diabetics and paediatrics. 38 Home Visiting This has become most complex for, with more mothers working, children are being minded in the homes of other people. Responsibility for the registration of childminders was, by the Local Authority Social Services Act 1970, transferred to the Social Services Department with effect from 1 April 1971. Regular visits to child-minders by health visitors continue for they have a statutory duty to visit all premises where there are children under the age of five years. The health and development of the children are checked and advice is given on health problems and diet, etc., when required. Observance on developmental progress, diet and general care is extremely important, especially when considering the type of upbringing experienced by some young children. Medical checks, screening and prophylaxis, are frequently missed. Follow-up with the parents is difficult because the mothers may be working or living in other areas. Health visitors are frequently concerned about the lack of opportunities necessary for development available to these children, who will one day be parents. It is an alarming prospect to envisage little children who are "strangers" in their own homes. Some may go from bed to minder and back to bed having little contact with brothers and sisters; rarely do they join in other activities with the family such as going shopping or to the park. They play with toys but never own them. This upbringing gives little preparation for family life and stability. The health visitors work very closely with their colleagues in the Social Services Department. Psychogeriatrics and Psychiatrics The pilot scheme, for assessment of psychogeriatric patients, linked with Bexley Hospital and Hither Green Hospital, has proved to be very successful. During the year two more health visitors received the necessary training and are now involved in this work. The health visitor provides a comprehensive report as a result of four days continuous intensive visiting and tests. These reports assist the consultants and family doctors in deciding on the treatment and the form of care which will be most beneficial to the patient. In addition two community psychiatric nurses joined the staff during the year. Both are State Registered Nurses and hold the Registered Mental Nurse certificate. The nurses are based in a health centre but have strong links with the Psychiatrists and local hospitals. This is a pilot scheme which is creating wide interest. Patients on continuous treatment can be followed up in their own homes. Indications already show that there will be a need for expansion in this service. Health visitors work closely with the community psychiatric nurses and are frequently able to help with home and family assessments. Clinical Sessions The number of clinical sessions has again increased and many more developmental sessions, using the appointment system, have been started. Evening sessions have been opened for the benefit of working mothers. Group sessions including sewing classes, speech classes for immigrants and mothers' clubs have continued to be held in many centres. The creches have been well used and the spina-bifida group which is well appreciated by the parents, has proved to be of tremendous benefit to the children. 39 Infant Developmental Examinations Showing Normal Development 40 41 INFANT AGED THREE WEEKS (a) Normal posture—supine (b) Raised by arms, showing inability to raise head (c) and (d) Demonstration of "startle ' response to noise or sudden movement, etc. (Moro reaction) INFANT AGED SIX MONTHS Normal prone position, raising head and trunk on hands Raised to sitting—no head lag 42 43 INFANT AGED SIX MONTHS Sitting with minimal support Held standing, takes weight on feet 44 INFANT AGED ONE YEAR Child aged 14 months, standing alone Child aged one year, accurate hand/eye co-ordination, pincer grasp, building bricks Health Education Health visitors continue to organise group and individual teaching in the centres. Requests for health visitors to carry out a full programme of talks during each school term has increased steadily. They are now involved in providing health education programmes in all but three secondary schools within the borough. Time is given for discussion with the pupils for it is important to answer their questions and to combat "old wives tales". More Head Teachers in junior schools are asking health visitors to give talks on hygiene and development. Nursing officers and health visitors have given talks and attended discussion groups and panels associated with Church Groups, Old People's Welfare, Clubs, Social Work Groups and other institutions including Day Care Courses for staff at Goldsmiths' College. Obesity clinics are now held with considerable success in five health centres catering for women who need to lose weight for health reasons. Family Planning Two health visitors are involved with the domiciliary family planning service and since 1 October when the Council accepted responsibility for providing the services, the health visitors are being increasingly involved in follow-up visits. School Nurses Five new schools opened during the year and many existing schools had additional classes added to accommodate the increasing number of schoolchildren in the borough. (Total school population is 45,874.) The school nurses carry out an annual comprehensive survey for each child. This includes vision testing—referrals for medical examinations are made as required. They also continue with their routine duties of preparation for medical examination and hygiene surveys. Children suffering from minor ailments and verrucae are referred and are treated by the school nurses employed in treatment centres. Cases of vermin and scabies are referred to the bathing centre. Health visitors continue to supervise the school health and social needs of children in nursery classes, nursery schools and infant schools thereby providing a valuable link between school staff, general practitioners and the family. Two school nurses are fully employed in carrying out audiology sweep testing in all the schools in the borough. Chest Clinics Health visitors carry out clinical and visiting services at the two chest clinics. Training All the health visitor students sponsored by the Council and other students receiving training in the borough were successful in the examination and training for the health visitors' certificate. Five health visitors were successful in the Field Work Instructor Course and two were successful in gaining the City and Guilds Technical Teachers Certificate. Twelve Field Work Instructors are involved in training health visitor students. 45 Three members of staff attended the Family Planning Course. In-service programmes have been organised for all nursing staff and many are joint programmes with local hospital nurses. The Health Department has assisted in the training of eighteen students for the four-year integrated course of Nurse Training. On the completion of this course they become qualified health visitors, district nurses and general trained nurses. Educational requirements for entry to this course—two Advanced and five Ordinary Level General Certificates of Education. Table 8 VISITS TO HOMES Children born in 1971 5,020 Children born in 1970 5,121 Children born in 1966-69 9,816 TOTAL 19,957 Persons aged 65 or over 575 Mentally disordered persons 80 Persons, excluding maternity cases, discharged from hospital (other than mental hospitals) 37 Infectious disease 36 Households of patients with tuberculosis and other chest conditions visited by tuberculosis visitors (including 9 visits by district health visitors) 979 Other visits (special reports on overcrowding, housing for M.O.H.) 408 GRAND TOTAL 22,516 Surveys Assistance with surveys carried out by nursing and medical staff, involving other bodies or organisations, include the following: — 1. Pfizer Poliomyelitis trials. 2. Rubella Survey—National Surveillance of congenital rubella defects. 3. Lewisham Hospital Survey on the effects of Rhesus incompatibility. 4. National Survey of Health Development. 5. Spina-bifida survey. 6. Effects of environment and education on size of family. 7. Deptford Educational Priority Area. In addition, surveys have been held by Health Department staff on the state of immunisation of age groups, etc. LOUISE HOUSE SCREENING CLINIC The adult screening clinic at Louise House has continued throughout 1971 with the exception of the period of the postal strike when it was not possible to notify clients of appointments: 428 men and 285 women attended the clinic during the year. Obesity, hypertension and previously untreated vision defects were the most frequently diagnosed abnormalities among men, while obesity, anaemia and gynaecological disorders were the most commonly discovered defects in women. 46 47 Table 9 RATES OF ATTENDANCE AND REFERRAL : PERCENTAGES OF ATTENDERS FOUND TO HAVE DEFECTS : ADULT SCREENING CLINIC (January 71 - December 71) No. of sessions Held No. of appointments sent No. of attenders A ttendance rate per 100 appointments Average attendance — per session Persons referred Persons found to have defects No. % of attenders No. % of attenders Men 52 1,089 428 39% 8 231 54% Ill 26% Women 47 745 285 38% 6 142 50% 87 31% Table 10 ANALYSIS OF DEFECTS BY TEST OR SYSTEM : ADULT SCREENING CLINIC (January 71 - December 71) No. of defects in each group No. of attenders Total No. of defects found Hearing defect Vision defect (untreated) Obesity Urine abnormality Respiratory abnormality Hypertension Blood abnormality Breast abnormality Pelvic abnormality Abnormal smear No. of defects 3 35 43 2 3 29 5 — — — Men 428 120 % of all defects 3% 29% 35% 2% 3% 24% 4% — — — No. of defects 3 8 22 4 1 10 21 4 16 8 Women 285 97 % of all defects 3% 8% 23% 4% 1% 10% 22% 4% 17% 8% 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. During the year a total of 79 children were reported, which figure represents 2.07 per cent, of total live births in the Borough. Table 11 CONGENITAL MALFORMATIONS REPORTED 0.1 Anencephalus 5 0.4 Hydrocephalus 4 0.5 Microcephalia 1 0.6 Other specified malformations of brain or spinal cord 2 0.8 Spina bifida 8 Total: Central Nervous System 20 1.8 Accessory auricle 1 1.9 Other specified malformations of ear 1 Total: Eye and Ear — 2 2.0 Unspecified malformations of alimentary system 1 2.1 Cleft lip 3 2.2 Cleft palate 3 2.4 Tracheo-oesophageal fistula, oesophageal atresia and stenosis 1 2.7 Rectal and anal atresia and stenosis 2 2.9 Other specified malformations of alimentary system 1 Total: Alimentary System — 11 3.0 Unspecified malformations of heart and circulatory system 3 3.9 Specified malformations of heart and circulatory system 2 Total: Heart and Circulatory System — 5 4.1 Malformations of nose 1 4.9 Other specified malformations of respiratory system 1 Total: Respiratory System — 2 5.0 Unspecified malformations of urino-genital organs 1 5.1 Indeterminate sex and true hermaphroditism 2 5.4 Malformations of male external genitalia 2 5.7 Hypospadias, epispadias 4 Total: Urino-genital System — 9 6.0 Polydactyly 12 6.1 Syndactyly 1 6.2 Reduction deformity hand or arm 3 6.5 Talipes 14 6.6 Congenital dislocation of hip 2 6.7 Other specified malformations of upper limb or shoulder 1 6.8 Other specified malformations of leg or pelvis 2 6.9 Unspecified limb malformations 1 Total: Limbs — 36 7.1 Malformations of skull or face bones 1 7.4 Malformations of sternum or ribs 1 Total: Other parts of Musculoskeletal System — 2 9.0 Other and unspecified congenital malformations 1 9.6 Down's syndrome (mongolism) 4 9.9 Multiple congenital malformations not specified 1 Total: Other Malformations — 6 93 48 Table 12 CONGENITAL MALFORMATIONS REPORTED : BY PARITY Parity Number of Children 0 28 1 22 2 15 3 5 4 3 5 4 6 2 79 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, 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. The number arranged during 1971 was as follows: — Table 13 1971 Expectant and Nursing Mothers 4 Other Adults 120 Psychiatric patients 14 Accompanied Children 15 Unaccompanied Children (I.L.E.A. Scheme) 81 BLIND AND PARTIALLY SIGHTED PERSONS 112 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 72. This certification facilitates the provision of the Council's welfare services. FAMILY PLANNING Since the implementation of the National Health Service (Family Planning) Act 1967, family planning clinics in the Borough continued to be run by the Family Planning Association, on an agency basis, mainly in local authority premises. On 1 October 1971 however, the Council commenced to administer these clinic services 49 directly, with two exceptions. A Youth Advisory Clinic (one session per week) is provided by the Association at one of the Health Centres, and a Brook Advisory Centres Limited Clinic is provided (one session per week) in Lewisham Hospital. A Marital Advice session previously provided by the Association was discontinued during the year when the present counsellor resigned. The Council continues to make financial payment to each of the above-mentioned organisations. The transfer of services was accomplished very smoothly and without interruption; clinics continued to be held in the same premises and with largely the same staffs of doctors, nurses and lay workers. The willing co-operation offered by the officers of the South East London Branch of the Family Planning Association and by the transferring clinic staffs contributed in no small measure to the success of the change-over. The Family Planning Association has been very active in the borough and has laid a sound basis from which the service can be maintained and extended. The links between the local authority and the Association will not of course be severed. Training facilities will continue to be available and Association speakers undertake engagements for various organisations in Lewisham. The voluntary hospital visiting scheme, introduced by the Association, continues in Lewisham Hospital where both the maternity and gynaecological wards are visited and non-medical questions from patients who wish to avail themselves of family planning services are discussed. Towards the end of the year approval under the Urban Programme was obtained for the introduction of two new family planning services: special clinics for at risk groups and a comprehensive follow-up scheme. The special clinics are for women who are in need of family planning advice but not receiving it because of race or language difficulties or lack of motivation or initiative. The follow-up scheme applies to all family planning clinics and involves reminder letters where appointments are not kept and, where appropriate, investigation and advice from a health visitor. It is never the intention however to badger people to attend clinics against their will. All the administrative arrangements necessary to set up the services had been completed by the end of the year and the services were to be introduced at the beginning of 1972. The domiciliary service, provided from the outset by the local authority, continues to flourish, the Borough being divided into two areas for this purpose with bases at the Speedwell and Boundfield Road Health Centres. A health visitor from each of these Centres spends one session per week visiting patients in conjunction with the doctor. There has been a slight change in the pattern of visiting in that the majority of revisits are now made by the doctor or the health visitor according to the circumstances, and only a minority by the doctor and health visitor together. The introduction of the special clinics under the Urban Programme should lead to a slight fall in the numbers of domiciliary patients. Since May 1971 there has been established a direct liaison between the domiciliary service and the Family Planning Association Vasectomy Clinic based in Dulwich Hospital which enables counselling of married couples resident in Lewisham to be carried out within the borough. This also leads to a significant reduction in the waiting time for the operation. There are no legal powers to provide financial assistance to men who require vasectomy. Consultation and advice throughout the service continues to be provided free of charge to patients without restriction by residence, and free supplies are available to medical and non-medical necessitous cases. Very largely as a result of the introduction of a new necessitous category "where there is a child in the family under the age of one year", the number of cases where free supplies were given increased from 565 in 1970 to 2,387 in 1971. 50 Table 14 DOMICILIARY SERVICE 1971 Number of new patients registered with Domiciliary Family Planning Service during the year 95 Number of re-visits by Medical Officer 287 Number of re-visits by Medical Officer and Nurse 56 Number of re-visits by Nurse 364 Number of visits by patients to clinic 198 Total consultations throughout the year 1,000 Table 15 CLINIC SERVICES Figures for the year are shown under two headings: (a) for the period January/September inclusive, and (b) for the remaining three months, with the exception of the Youth Advisory Clinic at Speedwell Health Centre where the figures shown are for the whole year. (a) (6) Total No. of Clinics 10 11 — No. of Clinic Sessions Held 973 336 1309 No. of Doctor Sessions Held 1388 477 1865 No. of Cytological Smears Taken 2336 935 3271 No. Found to be Positive 48 17 65 No. of Patients Referred to Clinics by Hospitals 370 120 490 No. of Patients Referred to Clinics from Local Authority Agencies 291 154 445 Clinic new Patients First Visit this Year Repeat Visits Necessitous Cases (a) (b) (a) Cb) (a) 0b) (a) (b) Amersham Road 299 83 777 89 1,453 600 171 156 Central Lewisham 525 154 787 224 1,881 1,079 275 42 Downham 176 38 401 49 652 305 76 75 Flower House 230 61 923, 86 1,005 487 84 39 Heathside 61 24 157 32 276 125 56 28 Jenner (commenced 13 December 1971) .. — 3 — 4 — 1 — 4 Lewisham Hospital 444 141 1,144 217 1,286 747 482 92 Lind 108 26 234 36 366 188 106 13 Louise House 689 193 2,287 271 2,922 1,429 274 78 Spalding House 173 69 545 75 742 295 40 41 Speedwell 105 33 264 33 756 224 81 123 Speedwell — Youth Advisory 99 177 424 51 Totals: Excluding Youth Advisory 2,810 825 7,519 1,116 11,339 5,480 1,645 691 Grand Totals 3,734 8,812 17,243 2,387 1970 (3.424) (8,061) (14,967) I am indebted to the South East London Branch Administrator of the Family Planning Association for the figures of work carried out within the borough by the Association during the period January/September inclusive, and at the Youth Advisory Clinic. 51 LOAN SERVICE Any article of equipment which will assist in the nursing of people in their own homes can be borrowed, provided:— (a) it is not required for permanent use; (b) it is not of a type which has to be made to measure, and therefore can be used by successive persons with the same requirement. A large number of articles were in demand during the year, as the following table shows: — Table 16 Equipment No. issued during 1971 At 31st December, 1971 Total stock held on stock register No. on loan Air Rings 47 125 97 Back Rests 91 167 166 Bed Cradles 79 180 178 Bed Pans 58 140 117 Commodes 403 1,082 1,029 Cot Beds 1 3 2 Easi-Carry Hoists 10 25 23 Easi-Carry Hoist Slings 10 30 21 Fireguards 27 205 205 Fracture Boards 32 144 136 Hospital Beds with Pulley 17 40 24 Inflatable Toilet Seats 12 25 15 Mattress (Dunlopillo) 2 23 21 Mattress (Hair) 17 32 21 Mattress Covers 22 64 34 Penrhyn Bed Lifts 16 48 46 Ripple Beds 14 11 10 Rubber Sheets (6 ft. x 3 ft.) 62 200 197 Sorbo Rings 41 49 40 Tripod Walking Sticks 12 58 57 Urinals (Glass) 43 116 72 Zimmer Walking Frames 119 303 265 Wheelchairs 62 95 94 TOTALS 1,197 3,165 2,870 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. In addition to the above figures 485 articles were loaned by the British Red Cross. 52 DENTAL SERVICES Mrs. C. M. Leeming, B.D.S. (Lond.), Chief Dental Officer and Principal School Dental Officer 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 (3 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. Jenner Health Centre (2 surgeries), 201 Stanstead Road, S.E.23. It is heartening to be able to report considerable alteration and expansion in accommodation during the past year. Good equipment and bright surroundings do much to encourage patients and staff alike. Deptford Schools Treatment Centre The School Dental Clinic at Reginald Square has been completely remodernised during the year with cheerful colour schemes and two warm waiting rooms. 78 Lewisham Park One of the waiting rooms in this building has been converted into an Orthodontic Surgery. Although the Orthodontist still travels around the borough there is a great advantage in doing much of the more exacting work in a purpose-built surgery. Jenner Health Centre The three dental surgeries were opened with the rest of the centre in November. There are two surgeries for the School Dental Service and one for a general practitioner. The demand for treatment has been considerable. Dental Health Education A team of Dental Officers, Auxiliaries and Dental Surgery Assistants visited a South East London School for a Dental Health Week. All the children were taught how to mix fillings and cements, putting them into real teeth. There were discussions on crowns and orthodontics. Some children mixed up alginates and took impressions of models. An automatic developer was brought in for the senior boys so they were able to develop films for themselves. The puppet show went round all the Infants Schools last year; it continues to produce tremendous excitement among the young children especially at Christmas time. The Dental Auxiliaries continue to attend child development clinics. They give talks on Dental Health to mothers' clubs and student midwives. 53 Dental Treatment It is encouraging to note that by the end of 1971 there had been an increase in the number of Dental Surgeons and Dental Auxiliaries working full-time for the borough. The number of children seen in the schools has almost trebled, indeed nearly every school in Lewisham was visited by a dental officer. Those children not seen were mainly in the very senior groups where the children were difficult to locate especially in examination time. Fortunately the increase in staff and the opening of the Jenner Health Centre allowed us to cope with the increased workload resulting from the School Dental Inspections. There has been a slight drop in the treatment sessions devoted to the pre-school child and expectant mothers. This was caused, to some extent, by the temporary closure of the clinic at Deptford and the necessary re-organisation which followed. Greenwich Schools There are, close to the Lewisham border, several schools whose pupils attend our Treatment Centres on a regular basis, so it has been agreed that Lewisham will accept full responsibility for the dental health of these children. The arrangement is possible only because of the improvement in accommodation at Reginald Square and will cease if more suitable facilities become available to the children. There has been a general improvement in the amount of work done in the clinics, particularly the increased ratio of permanent teeth conserved to those extracted and it is hoped that this trend will continue. SCHOOL FOR DENTAL AUXILIARIES Mr. T. H. Liptrot, Director, reports: — The Children's Dental Clinic associated with the School for Dental Auxiliaries continued to receive the support of the Health Department of the London Borough of Lewisham. The personal contact, interest and co-operation of Mrs. Clare Leeming, the Borough's Chief Dental Officer, was greatly appreciated by the staff and students. The authority's staff, led by the Senior Dental Officer, Mrs. Shillito, have contributed much to the work of the clinic. It has now become possible by increasing the number of inspections of children in schools and those recalled for regular examination, to bring under control the long lists of patients awaiting treatment. The school is fortunate in having the continued co-operation of the head teachers and staffs of the schools it serves. Without such help our task would be more difficult and we would achieve less. During 1971 the auxiliary students, under the supervision of the dental surgeons on the staff of the school, carried out nearly 10,000 fillings in permanent and deciduous teeth for schoolchildren in the area. 54 Table 17 DENTAL SERVICES FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS A : Attendances and Treatment Number of Visits for Treatment During Year Children 0-4 (incl.) Expectant and Nursing Mothers First Visit 670 8 Subsequent Visits 1,403 35 Total Visits 2,073 43 Number of Additional Courses of Treatment other than the First Courses commenced during year 78 — Treatment provided during the year- Number of Fillings 1,530 32 Teeth Filled 1,396 28 Teeth Extracted 276 4 General Anaesthetics given 70 2 Emergency Visits by Patients 69 — Patients X-Rayed 11 2 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 474 12 Teeth Otherwise Conserved 203 — Teeth Root Filled — 2 Inlays — 2 Crowns — 1 Number of Courses of Treatment Completed During the Year 403 7 B : Inspections Number of Patients given First Inspections During Year A 180 D 7 Number of Patients in A and D above who required treatment B 163 E 6 Number of Patients in B and E above who were offered treatment C 163 F 6 C : Sessions Number of Dental Officer Sessions (i.e. Equivalent Complete Half-Days) Devoted to Maternal and Child Health For Treatment 278.5 For Health Education 105.0 55 SCHOOL DENTAL SERVICES The following summary of the work of the school dental service has been supplied by the Medical Adviser to the Inner London Education Authority, based on returns supplied by the dental clinics: Table 18 School Roll 45,874 Number of sessions: Inspection 217.0 Ordinary treatment 4,440.4 General anaesthetic 70.1 Orthodontic 340.8 Health education 101.7 Total sessions 5,170.0 Inspections—Number of children given : First inspection at school 28,378 First inspection at clinic 2,801 Percentage found to require treatment 60.3 Reinspection at school or clinic in 1971 740 Percentage found to require treatment 80.9 Visits for treatment : Number of first visits 8,827 Number of subsequent visits 23,868 Total visits 32,695 Emergencies 1,316 Additional courses commenced 1,608 Number did not attend 11,207 Treatment given : Number of fillings : In permanent teeth 15,438 In temporary teeth 9,789 Number of extractions (excluding orthodontics) : Of permanent teeth 651 Of temporary teeth 2,815 Number of other operations (prophylaxis, X-rays, inlays, crowns, etc.) 14,221 Courses of treatment completed 5,593 Orthodontics: Number of new cases 117 Number of removable appliances fitted 349 Number of fixed appliances fitted 15 Number of orthodontic extractions : In permanent teeth 466 In temporary teeth 227 Sessional averages: First visits 1.8 Subsequent visits 4.9 Emergencies 0.3 Did not attend 2.3 Fillings: In permanent teeth 3.2 In temporary teeth 2.0 Extractions : Of permanent teeth 0.2 Of temporary teeth 0.6 Ratio of permanent teeth filled to permanent teeth extracted 20:1 Ratio of temporary teeth filled to temporary teeth extracted 3:1 56 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. Close liaison is maintained with the Medical Adviser's Department and the Education Officer's Department at County Hall and with the Divisional Education Officer's Department and head teachers in the Borough. No less important is the liaison which has been established with hospital consultants and family doctors. The number of children of school age in the Borough was 45,874 on 31st December, 1971, and their health remains good. The system of giving every child a minimum of four medical examinations during its school life continued, starting with that at school entry and terminating with the school leavers' examination at which particular attention is paid to the child's choice of future employment, and whether or not any medical condition may affect that choice. The School Health Service also arranges for special medical examinations where anxiety is felt by parents and teachers about the health of a child, for medical examination of children of 13 and over who undertake part-time employment, and for examination of the many children who are going on school journeys—both from the point of view of their fitness to go, and also to ascertain that they are free from any infection. During the year six schools in the Deptford Educational Priority Area took part in a trial of a new type of medical examination of five-year-old school entrants. School doctors and nurses who had been specially trained undertook the trial, throughout which accuracy and uniformity of testing were monitored by doctors from the Department of Education and Science and Guy's Hospital. Only six or seven children were seen at a session, and their parents were visited prior to this in order that various aspects of the child's previous history, which might have a bearing on his future development, could be elucidated. Parents were also encouraged to attend the forthcoming medical examination. Each child was weighed and measured and was given a normal physical examination, but in addition was given specialised tests to perform. A specimen of urine was also examined. By this method, those children who may require special help in school are more easily recognised. Subsequently it has been recommended that this form of entrant medical examination should be adopted throughout the Inner London area. My thanks are due to the head teachers of the participating schools. Wherever possible, children are educated in ordinary schools. Sometimes, because of a handicapping condition, this is not possible, and some children will have to attend special schools. The need for special placement may sometimes depend on the type of school building available locally. Thus a child with muscular weakness may be able to attend ordinary infant school, where the accommodation is all at ground level, but will be unable to manage the stairs of a junior school, or the hustle and bustle of a large comprehensive school and will then need special schooling. For children needing special schooling, doctors carry out examinations, at school or in the home, in order to recommend the type of special schooling most appropriate to the child's needs. Some school doctors are trained to assess the needs of the backward child, and if necessary, to recommend special schooling. The year has been notable for the inclusion in the educational system of the severely mentally handicapped child. This has meant that the Intermediate and Junior Training Centres have now become Watergate School and Greenvale School respectively. School doctors have been appointed to the new schools opened in the Borough 57 and these include St. William of York, Junior and Infants, Perrymount Junior and Infants, Horniman Junior and Infants, Meadowgate, a school for the educationally subnormal 5-16 years, and New Woodlands, a school and hostel for maladjusted children 5—16 years of age. The opening of Meadowgate School, adds to the provision already made at Meeting House School, for educationally subnormal pupils. Brent Knoll School is the other special school in the Borough and caters for delicate children. Children attending this school suffer from many diverse conditions, but a good proportion are asthmatic, or have chest diseases or are debilitated. Provision is made by the Inner London Education Authority for children with other handicapping conditions, such as blindness, deafness, physical disability and maladjustment, at day schools in neighbouring boroughs and close liaison is maintained with the Principal School Medical Officers of these Boroughs. In the tracing and continued surveillance of handicapped children, the Observation Register has an important role. Reviews by doctors, health visitors, school nurses, letters from hospitals and information from family doctors, are all co-ordinated in a confidential file, and a punch card kept up to date, with the object of providing the best possible services for any particular child. The register is also used in providing statistics upon which to estimate the requirement of future special school places. Of the 2,327 children on the register who attend school, 797 were attending ordinary school, 1,258 were attending day special school and 213 were attending boarding special school. One of the duties of a school medical officer is to maintain a satisfactory level of immunisation in the school, by ensuring that as many children as possible are protected. Sessions are therefore held in school for immunisation against diphtheria, tetanus, poliomyelitis and tuberculosis. During the year immunisation was also offered, for the first time, to girls in secondary schools against German measles (rubella). All girls who were thirteen, or would be thirteen by the end of the year were included, and it is envisaged that the offer of this protection will become a routine yearly procedure. 58 Table 19 OBSERVATION/HANDICAP REGISTER Schoolchildren Type of School No. attending Day School No. attending Boarding School Total Physically handicapped 65 12 77 Delicate 93 24 117 Blind 1 4 5 Partially sighted 33 3 36 Deaf 40 12 52 Partial hearing 36 2 38 Maladjusted 72 92 164 Autistic 6 2 8 ESN—school 710 55 765 school (severe) 166 — 166 school (special care) 34 — 34 Approved school — 5 5 Other 2 2 4 1,258 213 1,471 In Hospital/hospital school 45 Home tuition 14 Table 20 Year of Birth of Schoolchildren on Observation/Handicap Register Year of Birth No. of schoolchildren 1957 182 1958 206 1959 184 1960 189 1961 222 1962 241 1963 188 1964 169 1965 143 1966 107 1967 33 1968 3 1,867 Number on register 2,327 59 DEAF REGISTER Schoolchildren The register is used to ensure that the total needs of the children are met by medical supervision, appropriate educational placement or by social work help for the family. Many children on the register benefit simply by sitting in a more favourable position in the classroom and/or provision of hearing aids, but those in the following table have been assessed as in need of special education. Table 21 CHILDREN ATTENDING SPECIAL SCHOOLS OR UNITS (Special School /Unit Age Range 2 years to 16+ years) Type of School/ Unit Day Boarding Total Deaf 35 10 (3 weekly) 45 Partially hearing 41 3 44 Partially hearing with additional handicap 5 — 5 Physically handicapped 2 1 3 Physically handicapped with additional handicap — — — Deaf/Blind 2 — 2 Delicate — — — E.S.N 11 — 11 Maladjusted 1 — 1 Others E.S.N. (Severe) School 3 Early Care Unit 2 Residential Care 2 Total number of children on register: 321. Under school age: 11. 60 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 45,874 as at May, 1971. Table 22 Routine inspections: Number inspected 17,799 Number found not to warrant examination (7 plus "specials scheme") — Percentage of No. inspected of: Parent present 57.3 Care Committee present 38.1 No. vaccinated against smallpox 68.0 No. immunised against diphtheria 93.8 No. immunised against whooping cough 89.0 No. vaccinated against poliomyelitis 92.8 Physical condition unsatisfactory 0.2 Referred for treatment of defects 16.1 Referred for treatment of defects other than vision 8.9 Non-routine inspections: (i) Specials 5,323 (ii) Re-inspections 6,029 Total (i) and (ii) 11,352 No. of routine inspections as percentage of school roll 38.8 No. of non-routine inspections as percentage of school roll 24.7 61 ROUTINE MEDICAL INSPECTIONS—DEFECTS Number of children noted for treatment or observations expressed as a rate per 1,000 inspected. Table 23 Number inspected 17,799 Defects * Skin T 14.50 O 12.53 Eyes—(a) Vision T 79.89 O 32.87 (b) Squint T 11.35 O 4.66 (c) Other T 2.42 O 1.01 Ears—(a) Hearing T 8.65 O 7.58 (b) Otitis T 1.74 Media O 3.20 (c) Other T 2.13 O 1.35 Nose and Throat T 5.73 O 28.65 Speech T 4.38 O 7.14 Lymphatic Glands T 0.34 O 6.80 Heart T 3.37 O 5.11 Lungs T 11.29 O 8.98 Developmental—(a) Hernia T 1.63 O 4.49 (b) Other T 1.97 O 6.01 Orthopaedic—(a) Posture T 0.62 O 2.64 (b) Feet T 4.55 O 12.47 (c) Other T 2.58 O 2.08 Nervous System—(a) Epilepsy T 2.36 O 1.52 (b) Other T 0.56 O 0.90 Psychological—(a) Development T 0.73 O 3.88 (b) Stability T 2.25 O 10.51 Abdomen T 0.62 O 0.90 Other—(a) Debility T 0.45 O 0.67 (b) Enuresis T 9.16 O 19.44 (c) Obesity T 5.06 O 9.94 (d) Other T 2.81 O 0.84 *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. 62 Personal Hygiene The appended table relates to surveys undertaken and also indicates action taken with verminous cases found as a result of the surveys: Table 24 1. Comprehensive Surveys: (a) Number examined 22,943 (b) Number (occasions) found verminous 85 (c) Percentage found verminous 0.37 2. Selective Surveys : (a) Number examined 18,115 (b) Number (occasions) found verminous 306 (c) Percentage found verminous 1.69 3. (a) Total times vermin found [l(b) + 2(b)] 391 (b) Total percentage found verminous [3(a) as percentage of l(a) + 2(a)] 0.95 (c) Number of individual pupils found verminous 331 (d) Percentage of individual pupils found verminous (of school roll) 0.81 4. Action taken with verminous cases: (a) Advice and/or Lorexane 355 (b) Further action 36 (c) 4(b) expressed as a percentage of 4{a) 10.14 Analysis of 4(b) cases—referrals of hardcore cases to bathing centres Voluntary attendances at bathing centres : Number of pupils 36 Number of statutory notices issued — Number 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. 63 Table 25 NON-ROUTINE MEDICAL INSPECTIONS Type of Inspection Re-inspections 6,029 Bathing centre inspections—scabies — —other 20 Employment certificates 636 Theatrical children 16 School journeys 3,311 Recuperative holidays—pre-departure 24 —on return — Secondary School annual surveys — Candidates for higher awards 25 Nautical school entrants — Outward bound courses 4 Infectious disease investigation — T.B. contacts — Boarding schools for the Delicate—pre-departure 2 —on return — Handicapped pupils—statutory examination 113 —periodic special defect examinations 637 Research investigations and enquiries — 4,788 SPECIALS—At request of :— Head teacher—child's name entered in special book 121 —others 147 School nurse—following health survey 84 —others 8 Divisional (Education) Officer 28 District Care Organiser or Care Committee 12 Parent 86 School medical officer 44 530 OTHERS :— Accident on school premises — Boxing—reference from schools, A.B.A., or similar association — For free travel — Reference: (i) connected with remedial exercises — foot classes — (ii) by gymnast or physiotherapist — Referred by—hospital — —speech therapist — —general practitioner — Miscellaneous 5 5 TOTAL OF ALL NON-ROUTINE MEDICAL INSPECTIONS 11,352 64 65 ROUTINE MEDICAL INSPECTIONS—VISION This table is a statement of the visual acuity of pupils whose vision was tested at routine medical inspections, divided into those not wearing and those wearing glasses, together with the proportions noted for treatment or observation Table 26 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 Treatment Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls 8,968 8,747 87.2 84.2 4.2 4.7 2.9 3.7 2.9 3.8 3.3 3.6 1.4 1.9 0.9 1.9 3.5 5.8 8. Table 27 COMPARISON OF DEFECTS NOTED AT 7-PLUS ROUTINE AND 7-PLUS "SPECIAL" MEDICAL INSPECTIONS IN 1971 Number of children noted for treatment and observation expressed as a rate per 1,000 inspected Number inspected at 1-plus Routine Inspections 5,047 Number inspected at 1-plus Experimental Scheme Inspections — Defects A B Skin 33.3 — Eyes—Vision 101.8 — Squint 17.8 — Other 2.2 — Ears—Hearing 17.4 — Otitis Media 4.2 — Other 4.6 — Nose and Throat 41.4 — Speech 11.3 — Lymphatic Glands 5.9 — Heart 8.2 — Lungs 20.2 — Development—Hernia 6.1 — Other 11.1 — Orthopaedic—Posture 3.8 — Feet 17.4 — Other 2.8 — Nervous System—Epilepsy 4.6 — Other 1.0 — Psychological—Development 5.2 — Stability 16.2 — Abdomen 2.2 — Other—(a)Debility 2.2 (b) Enuresis 36.5 — (c) Obesity 16.2 — (d) Other 4.2 — Column "A" refers to 7-plus routine medical inspections Column "B" refers to 7-plus experimental scheme inspections 66 HEALTH EDUCATION Mr. R. W. Allen, M.A.P.H.I., Health Education Officer As it becomes better known the Health Education section becomes busier each year. With the passing years it also gains in experience and 1971 saw more effective health and home-safety education. The work of the section can briefly be described as follows: — 1. The propagation, by all appropriate means, of health and home-safety information. 2. Providing information on behalf of the Health Department. 3. Arranging in-service talks and demonstrations on topical health and safety matters. 4. Involvement in schools, especially in courses dealing with sex education and responsibility. This work has grown partly because of the raising of the school leaving age. 5. Collection, preparation and collation of material for lectures and articles. 6. Production and distribution of a quarterly twenty-four page booklet (circulation 7,500). Much information is given to students from colleges, both in and out of the Borough, to assist them with "projects" on health and home-safety. Many of those seeking information are student teachers who, in time, will be "health educators". The home safety officers continue to give advice on hazards in the home, e.g. the proper use and care of heating appliances, often when instances of misuse are referred to them by health visitors and social workers. Classes in first-aid and resuscitation continued throughout the year and well over 3,000 schoolchildren were taught the "kiss of life" before the summer holidays. 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. The anti-smoking groups have continued throughout the year. The feeling of "all being in the same boat" and being able to help each other has helped to make these groups popular. The average success rate appears to be about 50% with varying degrees of reduction among the remainder at the end of the course. Followup meetings are arranged, as there is a tendency to relapse, proving yet again the dictum "better never to have started". A new development this year was running stalls at three summer fetes. The display dealt with health and home-safety matters including demonstrations of the "kiss of life" method of resuscitation. During the school holidays talks and demonstrations were given at summer play groups. A Health Exhibition was staged for the opening of the new Jenner Health Centre, and the Section assisted the Dental Officer in a Dental Week. Again it must be emphasised that the most important function of the section is the helping of doctors, dentists, health visitors, nurses, public health inspectors and others to be health educators. The Council sponsored a new voluntary body concerned with health education. The inaugural meeting in April was addressed by the Rt. Hon. Baroness Birk, J.P., Chairman of the Health Education Council, and the new group became known as 67 the Lewisham Community Health Organisation with the Health Education Officer acting as Secretary. The constitution outlines the object as follows: To educate the general public in the safeguarding of the health of the community in the London Borough of Lewisham. In furtherence of this object the organisation will: — (a) stimulate other organisations and agencies, both statutory and voluntary, to take part in health education; (b) arrange seminars and meetings, mount displays and undertake campaigns. Meetings have since been held on health matters and a committee has been working on the production of project material for schools. The following is a summary of health education sessions of various kinds: — Table 28 Films 291 Student sessions 72 Talks by Health Education Section 332 Talks by Health Visitors and Nursing Officers 1,276 Talks by Medical Officers 120 Talks by Public Health Inspectors 41 68 CHIROPODY SERVICE Mr. B. Dalton, M.Ch.S., S.R.Ch., M.R.S.H., Chief Chiropodist At the six chiropody clinics maintained by the Council well over 6,000 persons regularly attend, on an average, four times a year each. The proportion of adult males to females being 1 : 4. There has been a small increase in the number of sessions worked as a result of a slight easing of the recruitment situation. There has been consequently a slight reduction in the interval between treatments. Even so the gap between treatments is still too long. It occasionally happens that patients have the need of an appliance and, by the end of December, 251 appliances had been made. Others require, as did 240 patients, treatment involving special techniques and equipment. There was an increase of 50% in the number of treatments given to the elderly, infirm and handicapped persons transported to various surgeries. The average appointment interval for this service was twenty weeks. Over 700 visits were made to elderly housebound persons in the postal district of S.E.4, and nearly 200 visits to those housebound but under pensionable age. The part-time clinic held at the Bathing Centre, Speedwell Street, has closed and the patients transferred to Amersham Road. Sangley Road clinic has been completely reorganised and extended to incorporate an additional appliance service which commenced towards the end of the year. During November a chiropody clinic commenced at the newly opened Jenner Health Centre in Stanstead Road. It is interesting to note that some 50% of those attending the Jenner Health Centre had not previously been receiving treatment and of that 50% about 80% were elderly. It was to this health centre that patients were transferred following the discontinuance of clinics previously organised by Lewisham Old People's Welfare Association at St. Saviour's and Stanstead Lodge. The session at Lewisham Hospital is now overbooked and owing to accommodation difficulties, the allocation of an additional session cannot be made. One of the Council's full-time chiropodists has been seconded to Deptford Central Methodist Mission pending the appointment, by the mission, of a replacement. Contact has also been maintained with Brook Lane Medical Mission. Under the Council's plan for sponsored chiropody training, one student, having Qualified, has taken up a post and another is at college. Table 29 ANALYSIS OF BOOKINGS AND ATTENDANCES AT FOOT CLINICS Clinic Total sessions Total bookings Total attendances Total failures No. of persons Per cent. attending Bathing Centre 42 237 209 28 10 65 99 597 539 58 10 111 Amersham Road 1,596 11,372 10,436 936 8 2,040 1,823 11,982 10,521 1,461 12 2,358 Downham Clinic 221 1,288 1,208 80 6 338 202 1,115 1,036 79 7 316 Jenner Clinic 29 148 143 5 3 142 Kingswear Clinic 1,058 6,483 5,855 628 10 1,389 896 5,435 4,714 721 13 1,459 Lind Clinic 339 2,042 1,975 67 3 364 318 2,173 1,834 339 15 287 Sangley Road 1,404 9,221 8,297 924 10 2,022 1,285 8,784 7,868 916 11 1,976 TOTALS 4,689 30,791 28,123 2,668 9 6,360 4,623 30,086 26,512 3,574 11 6,508 Figures for 1970 in italics 69 Table 30 STATISTICAL SUMMARY OF ATTENDANCES 1971 1970 Number of sessions 4,689 4,623 Appointment bookings 30,791 30,086 Children of or below school age 2,084 2,047 Adults: Male 5,310 4,983 Female 20,729 19,098 Total 26,039 24,081 Fee paying attendances (adults) 4,187 5,928 Free attendances (adults) 23,936 20,584 Table 31 ATTENDANCES ANALYSIS NEW CASES Age groups Number attending clinics 1971 1970 0-4 5 5 5-15 351 379 Males 16-65 342 387 Females 16-60 1,034 939 Males over 65 940 1,224 Females over 60 3,649 3,574 Physically handicapped—Males 14 Females 25 TOTAL 6,360 6,508 - - 70 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 Measles Acute meningitis Ophthalmia neonatorum Acute poliomyelitis Paratyphoid fever Anthrax Plague Cholera Relapsing fever Diphtheria Scarlet fever Dysentery (amoebic or bacillary) Smallpox Food poisoning Tetanus Infective jaundice Tuberculosis Leprosy Typhoid fever Leptospirosis Typhus Malaria Whooping cough Yellow fever NUMBER OF NOTIFIED CASES (Corrected for revised diagnosis) during the year 1971 with comparative figures for the nrevious six vears. Table 32 Diseases Cases notified 1971 1970 1969 1968 1967 1966 1965 Anthrax — — — — 1 — 1 Diphtheria — — — — — — — Dysentery 18 59 137 46 90 152 159 Encephalitis (acute) 1 — — 1 — — — Enteric or typhoid fever 1 1 1 2 3 1 1 Infective jaundice 33 46 47 21 — — — Food poisoning 16 40 36 20 22 34 20 Malaria 3 4 1 1 — — — Measles 1,181 1,521 1,787 799 2,561 2,017 3,014 Meningococcal infection 28 27 24 16 — 3 1 Ophthalmia neonatorum — — 2 1 5 3 3 Poliomyelitis (acute) 1 — — — — — — Scarlet fever 120 96 86 105 174 82 161 Tuberculosis 100 127 107 132 116 148 157 Whooping cough 68 110 32 146 130 169 108 TOTALS 1,570 2,031 2,260 1,290 3,102 2,609 3,625 71 72 Table 33 NOTIFICATIONS OF INFECTIOUS DISEASES IN 1971 SHOWING SEX AND AGE GROUPS M F M F 2- 4- 5- 10- 15- 25- 45- 65 + Total Disease Under 1 1- M F M F M F M F M F M F M F M F M F Acute Encephalitis 1 — — — — — — — — — — — — — — — — — — — 1 — Dysentery 1 — 2 1 2 1 — 1 1 1 — — 1 2 1 2 — 2 — — 8 10 Food Poisoning 2 — — 2 — 1 — — 1 1 — 1 1 3 — 2 1 1 — — 5 11 Infective Jaundice — — - — 1 — — — 4 6 9 4 1 3 2 3 — — — — 17 16 Malaria — — — — — — — — — — — — — — 2 1 — — — — 2 1 Measles 25 31 83 77 171 170 95 77 203 211 9 12 3 7 — 6 — 1 — — 589 592 Meningococcal infection — — 3 1 — 1 1 2 7 2 2 — 2 5 — 2 — — — — 15 13 Poliomyelitis — — — — — — — — — — — — — — — 1 — — — — — 1 Scarlet Fever — 1 1 2 3 7 8 9 24 41 8 7 3 4 2 — — — — — 49 71 Tuberculosis — — — — 1 — — — 1 1 2 1 4 9 20 9 22 7 15 8 65 35 Typhoid — — — — — — — — — — — — — — — — — — — — — 1 Whooping Cough 20 7 — 4 5 2 1 5 5 16 1 — — — 1 — — 1 — — 33 35 Table 34 TUBERCULOSIS NOTIFICATIONS AT AGES Age Periods New cases notified Respiratory Non-Respiratory Totals M F M F M F 0- - - - - - - 1- - - - - - - 2- 1 - - - 1 - 5- 1 1 - — 1 1 10- 2 — - 1 2 1 15- 1 2 - — 1 2 20- 3 4 - 3 3 7 25- 6 5 1 — 7 5 35- 13 2 - 2 13 4 45- 8 2 - 1 8 3 55- 13 2 1 2 14 4 65- 11 1 - 2 11 3 75+ 3 4 1 1 4 5 TOTALS 62 23 3 12 65 35 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: — During 1971 1,875 new patients were seen at the Clinic, these comprised 954 men, 781 women and 140 children. In addition 5,751 patients were sent for X-ray examination by their General Practitioners. The total attendances at the Clinic for the year were 18,010. The number of new notifications of Tuberculosis in the Lewisham part of the Borough was 53, this is the lowest recorded figure. Of this number 45 attended the chest clinic (29 men, 13 women and 3 children). Ten of these Tuberculosis cases were born outside the British Isles. B.C.G. vaccination was given to 159 contacts. For the last three months of 1971 we had only one Health Visitor owing to illness, and therefore the total number of visits done by our Health Visiting Staff during the year is considerably down, being 1,519. Among the large variety of chest diseases investigated by the Clinic there were 124 cases of asthma. With regard to carcinoma of the lung, 112 new cases were diagnosed, 24% of these were women who comprised an undue proportion of the younger age group patients. Further grave news in this disease is the figure of 8% operability in this year's cases. 73 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: — Despite threats of extinction, the Deptford Chest Clinic still continues to prosper and the attendance figures have, in fact, increased during 1971 despite an attempt to reduce the numbers. Thus the total attendances went up from 5,358 to 5,744 and the total number of new patients from 1,330 to 1,350. Most of the latter consisted of consultations by general practitioners, cases sent to me for an opinion on the chest for the most part. The total number of cases of tuberculosis on the Deptford Register has decreased from 969 to 862. Of these, the deaths of cases on the Tuberculosis Register was down from 31 to 18 in 1971. There were 44 newly diagnosed cases of tuberculosis, 23 of whom had tuberculosis germs in the sputum when first seen. This is less than 1970 but still quite a large number of new cases of tuberculosis. Deptford has been the seat of a number of striking changes in the last few years, as a result of wholesale destruction of older housing properties and the replacement of these old houses by large blocks of new flats, often in skyscraper form, reminiscent in parts of New York's Manhattan area. These housing changes have had marked secondary effects on the tuberculosis cases in the area as many of them have become rehoused elsewhere, not always in Deptford. No less than 80 cases left the area last year compared with 69 in 1970. I have also been going through the Tuberculosis Register in detail and decided that many of the previous sufferers can now be regarded as having recovered from tuberculosis. Some years ago, before the powerful drug treatments for tuberculosis were introduced, it would have been unthinkable to remove so many cases from the Register as recovered, but last year I was able to remove no less than 40 cases. Despite systematic home visiting by the tuberculosis visitors, however, there are still a number of cases who manage to apparently disappear and become lost from sight. Where cases of tuberculosis occur in Carrington House, contact is not infrequently lost with individuals. Consequently Carrington House continues to occupy a good deal of my time as far as tuberculosis is concerned.. Tuberculosis is still the main reason for which I am consulted about these men. When found, most of the tuberculous cases in this lodging house are of severe degree and need admission to hospital forthwith and many months of treatment. I am pressing the Mass X-ray authorities to increase the number of times that they visit this house with their equipment. I understand the visits may be increased to three-monthly before long. My firm impression is that, quite apart from chest diseases among the inmates of Carrington House, there is a quite extraordinary amount of illness and decrepitude among the people there. Most of the men are single, unattached elderly males, not skilled in the art of looking after themselves as far as health matters are concerned. There would seem to be a need for daily attendance by a medical practitioner at the house, and there is, of course, considerable scope for social welfare activities. I understand these are already being attended to systematically and in a way which is unbelievable compared with the state of affairs which existed some years ago at this house, but much remains to be done. I am still collecting data about heavy tobacco smokers, narticularly those addicted to cigarettes. In 1971 I see there were 108 males and 61 females who were smoking more than 20 cigarettes each day regularly, sometimes as much as 30 or even 40 or more cigarettes daily. The threat to health from such a practice is quite incalculable and the money expense to the smoker must make quite a big hole in the family budget. As a result of this and other factors, bronchitis is still a great problem in this part of the Thames Estuary. Many patients who attend here obviously 74 increase their symptoms by the large amount of tobacco which they persist in smoking. I do my best to dissuade them from this. I am still amassing data with regard to smokers between the ages of 13 and 25 years. My present impression is that teenage smokers are not so numerous as the popular press would have us believe. Often in the early twenties smoking increases considerably during the tensions of this period of life, by which time a habit may be formed which is almost impossible to break in later life without a considerable exercise of will power. How much better it would be if these heavy smokers did not start smoking at all, but before this could happen I feel that civilised life must find better and healthier outlets for its young people than at the present time. Some individuals seem to smoke to show off that they have attained adult years, but in my view they would be better able to prove this by mature behaviour in other ways. MASS RADIOGRAPHY UNIT I am indebted to Dr. J. M. Morgan, the director of the unit, for information of work done in the Borough during 1971, on which the following tables are based:— Table 35 TOTALS EXAMINED Men 5,434 Women 5,353 10,787 ABNORMALITIES DETECTED Total numbers of proved cases (a) Tuberculous Men Women Total Cases requiring close supervision or treatment 11 2 13 Cases requiring occasional supervision 2 — 2 Cases previously known requiring close supervision or treatment 5 1 6 Cases previously known requiring occasional supervision 3 — 3 Still under investigation — — — Failed to attend follow-up — — — TOTAL 21 3 24 (b) Non-tuberculous Carcinoma of lung 12 2 14 Malignant neoplasms other than carcinoma of lung — — — Other non-tuberculous abnormalities (see attached) 45 40 85 Still under investigation — — — Failed to attend follow-up — — — Unfit for investigation — — — TOTAL 57 42 99 TOTALS—all abnormalities 78 45 123 75 ANALYSIS OF "OTHER NON-TUBERCULOUS ABNORMALITIES" Table 36 Borough of Lewisham—Year 1971 Men Women Total Non-malignant neoplasms 1 6 7 Lymphadenopathies, excluding sarcoids 1 — 1 Sarcoids 1 2 3 Congenital Cardio-vascular abnormalities — I 1 Acquired Cardio-vascular abnormalities 8 10 18 Pneumoconiosis without P.M.F — — — Pneumoconiosis with P.M.F — — — Pneumonitis 7 4 11 Bronchitis and emphysema group 5 2 7 Bronchiectasis 2 — 2 Diaphragmatic hernia group — 2 2 Spontaneous pneumothorax group 2 1 3 Other miscellaneous abnormalities 11 2 13 Previously known abnormalities 7 10 17 TOTALS 45 40 85 PROPHYLAXIS Immunisation against the following diseases was offered at health centres and schools—diphtheria, whooping cough, tetanus, poliomyelitis, smallpox, measles, tuberculosis and rubella. 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 diptheria, whooping cough, tetanus, measles, rubella and smallpox vaccine. Smallpox vaccination. Following circular CM012/71 dated 28.7.71 from the Department of Health and Social Security, smallpox was discontinued as a routine measure in August 1971 but advised for certain special groups such as travellers to and from countries where smallpox is endemic or where eradication programmes are in progress and for health service staff who may come into contact with patients. 76 Table 37 BOROUGH OF LEWISHAM, JANUARY - DECEMBER, 1971, ALL UNITS Numbers Examined Cases of Tuberculosis requiring treatment or close supervision Cases of Tuberculosis requiring occasional supervision Men Women Total Men Women Total Men Women  Regular Services for Local Authorities and G.P. referrals 3,178 2,868 6,046 2 1 3 1 — 1 Firms and Establishments 145 156 301 — — — — — — Contacts 7 99 106 — — — — — — Hospitals, Colleges, etc. 781 836 1,617 — 1 1 1 — 1 Prisons, Homes and Hostels 290 114 404 7 — 7 — — — Small Community Visits 1,033 1,280 2,313 2 — 2 — — — TOTALS 5,434 5,353 10,787 11 2 13 2 — 2 77 Table 38 IMMUNISATION AND VACCINATION Type of vaccine or dose Primary course completed Year of birth Others under age Total 16 yrs. 1971 1970 1969 1968 1964-67 Diphtheria 216 2,585 595 123 426 226 4,171 Whooping Cough 211 2,537 584 108 160 35 3,635 Tetanus 216 2,585 595 122 426 226 4,170 Polio 137 2,541 590 140 516 307 4,231 Measles 25 873 802 232 257 55 2,244 Rubella — — — 1 — 2,961 2,962 Reinforcing dose Diphtheria 10 177 245 147 3,235 1,178 4,992 Whooping Cough 10 154 214 51 891 168 1,488 Tetanus 10 180 248 150 3,240 1,291 5,119 Polio 8 75 83 38 3,125 686 4,015 Smallpox Vaccination Age at date of vaccination Total Months Years 0-3 3-6 6-9 9-12 1 2-4 5-15 Vaccination 10 13 16 21 770 762 118 1,710 Re-vaccination — — — 1 13 57 268 339 PERCENTAGE OF CHILDREN BORN IN 1969 AND VACCINATED BY 31.12.71 Lewisham England Diphtheria 76 80 Whooping Cough 74 78 Poliomyelitis 74 80 78 FOOD POISONING Table 39 FOOD POISONING CASES General Outbreaks Family Outbreaks Sporadic Cases Total Total Causative agent No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained i Notified or ascertained No. of outbreaks am sporadic cases columns (1+3 + 5) i No. of cases columns (2+4 + 5) 1 2 3 4 5 6 7 S. Typhimurium — — — — 3 3 3 Other Salmonellae — — — — 10 10 10 Cause unknown — — — — 3 3 3 Total — — — — 16 16 16 DETAILS OF FOOD POISONING DUE TO SALMONELLAE OTHER THAN S.TYPHIMURIUM Type of salmonella 1 2 3 4 5 6 7 Panama — — 5 5 5 Stanley — — — — 1 1 1 Group B — — — — 1 1 1 Group D — — — — 1 1 1 Brandenburg — — — — 1 1 — Infantis GPCI — — — — 1 1 1 Salmonella infection, not food borne—Nil. LABORATORY FACILITIES The following represents work carried out by the Southern Group Laboratory on behalf of the Council during 1971:— Table 40 Specimens Number Remarks Faeces 446 Negative 1 Salmonella Derby 5 Salmonella Typhimurium 15 Salmonella Panama 2 Salmonella Indiana 3 Salmonella Heidelberg 1 Salmonella Brandenberg 13 Shigella sonnei 2 Salmonella Infantis 1 Salmonella Virchow 3 Bacteria Coli Type 0111 1 Bacteria Coli Type 0125 1 Bacteria Coli Type 0126 1 Poliomyelitis Type 2 Widal 2 Negative Water 10 Milk 25 Ice-cream and other foods 118 TOTAL 650 79 ENVIRONMENTAL HEALTH Mr. A. J. Phillips, M.A.P.H.I., Chief Public Health Inspector The detailed summary of inspections shows that the total number of visits paid by the public health inspectors and technical assistants rose by nearly 15,000 from 44,690 to 59,560 due to some extent to the filling of some outstanding vacancies. Complaints accounted for 6,790 visits compared with 5,539. Inspections of drainage rose from 2,987 to 4,272. Visits to houses in multi occupation numbered 2,503 compared with 781 last year. Visits to houses regarding improvement grants rose from 1,571 to 2,789. There was also an increase of 1,500 visits to offices and shops. Housing Considerable repairs and improvement of houses were achieved by the consideration of applications for Qualification Certificates under the Housing Act, 1969. 505 applications were received compared with 774 in the previous year. In 97 cases this included the provision of additional amenities as a result of an improvement grant. 518 certificates were issued compared with 325 last year. Close liaison was maintained with the Rent Officers in this work. Two Clearance Areas involving 155 houses and 457 persons were declared during the year. Further surveys of possible improvement areas were carried out. There was an increase from 121 to 206 in the applications for improvement grants but the number of standard grants fell from 583 to 294. 45 Special Grants were dealt with compared with 14. Improvements completed during the year rose from 239 to 337. A scheme for the registration of houses in multiple occupation came into force on the 1st September and at the end of the year 195 premises had been registered. 325 formal notices were served under the Housing Act, 1961, in respect of houses in multi occupation for lack of amenities and the proper means of escape in the case of fire. Public Health Acts There was a slight increase in the informal notices under the Public Health Act 1936, 402 being served compared with 374 but the formal notices fell from 221 to 176. There was an increase from 117 to 190 in the formal notices under the Public Health Act, 1961. The notices related chiefly to defective roofs and gutters, ceiling plaster and floors, dampness and the repair of defective window frames. Factories For the first time for several years the number of factories in the Borough rose from 654 to 694 and the visits to these premises rose sharply from 1,409 to 2,293 but in only 49 cases was it necessary to serve formal notices. It was also surprising to find an increase in the number of outworkers from 91 to 134; of this number 123 were engaged in the making of clothing in their own homes. Food There was a reduction of some 14,000 tons in the imports at the Continental Depot. Samples were taken for pesticide residues and for prohibited dyes and preservatives. Importers were informed of incorrect or misleading labelling. The unsound food surrendered by shopkeepers fell from 256 to 188 tons. The breakdown of refrigerating plants was again responsible for a considerable amount of this. The number of bacteriological samples taken was 152 which included 46 samples of ice cream. 80 All were satisfactory except for 17 ice cream samples which were graded III and IV. This does not show much improvement on last year and is to be regretted. 210 complaints were investigated during the year. 846 samples were submitted to the Public Analyst and 22 were found to be adulterated. The meat content was low in a number of meat products and this was taken up with the wholesalers and manufacturers. Offices and Shops There was a reduction of 120 in the number of registered premises at the end of the year. This was accounted for by a reduction in the number of retail shops. There was a reduction of nearly 500 in the staff employed. The number of accidents fell from 75 to 70. The conditions did not continue to improve and where in 1970 it was necessary to call attention to the poor standard of cleanliness in 38 cases, it is regretted that the figure rose to 71 in 1971. Many of the other defects also showed a considerable increase. Rodent Control The number of properties inspected for rats and mice during the year fell from 4,215 to 3,908. This was due to a silght fall in rat and mice infestation. It will be seen from the graphs in the report that whilst the rat infestation continued a downward trend throughout the year the mice infestation showed an upward trend again in the last two quarters of the year. It was necessary to carry out 3,252 re-treatments compared with 3.645. Five Block Control Schemes involving 178 premises were carried out. Disinfection and Personal Cleansing The number of rooms disinfected rose sharply from 1,949 to 2,942 but the articles disinfected fell from 26,569 to 22,334. Articles cleansed also fell from 87,837 to 81,470. Verminous children cleansed rose from 648 to 686 but adults fell from 733 to 652. The figures for scabies continued to rise for both children and adults. During 1971 it was necessary to treat 1,331 children and 855 adults for scabies compared with 1,108 and 728 the previous year. It is hoped that in next year's report it will be possible to show a reduction in these figures. 81 Table 41 SUMMARY OF INSPECTIONS BY PUBLIC HEALTH INSPECTORS AND VISITS MADE BY TECHNICAL ASSISTANTS Reason for Visit Type of premises Animal Boarding Establishments Food Shops Chemists Common Lodging Houses Dwelling Houses Factories Hairdressers Multiple Stores Off Licences Pet Shops Public Houses Restaurants and Cafes Schools Wholesale Shops and Warehouses Other Types of Premises Sites Markets, Stalls, etc. Offices Totals Canteens — — — — — 5 — 16 — — 1 1 66 — 69 2 — — 160 Clean Air Act — 6 — — 106 252 — — — — — — — 1 357 51 — 3 776 Clearance Areas — — — — 423 — — — — — — — — — — — — — 423 Complaints — 188 3 5 5,585 134 16 19 6 4 28 36 13 18 557 155 14 9 6,790 Consumer Protection Act — 52 3 — 13 3 — — 1 — — — — — 246 — — — 318 Drainage — 110 4 — 2,591 130 7 — 2 — 113 106 30 3 434 708 1 33 4,272 Fish Curing — 10 — — — — — — — — — 6 — — 1 — — — 17 Fish Frying — 29 — — — — — — — — — 50 — — 1 — — — 80 Food Poisoning — — — — 182 — — — — — — 3 1 — 47 — — — 233 House to House — — — — 563 — — — — — — — — — — — — — 563 Houses in Multiple Occupation — — — — 2,503 — — — — — — — — — — — — — 2,503 Housing Act, 1957, Section 9 — — — — 95 — — — — — — — — — — — — — 95 Housing Act, 1961, Section 16 — — — — 221 — — — — — — — — — — — — — 221 Icecream — 98 — — 1 14 — — 7 — — 2 — — 3 — — — 125 Improvement Area — — — — 1,070 — — — — — — — — — 20 — — — 1,090 Improvement Grant — — — — 2,989 — — — — — — — — — — — — — 2,989 Infectious Diseases — — — — 442 — — — — — — 3 8 1 74 — — — 528 Infestation — 79 — 4 213 4 — 4 — 1 17 29 — 1 38 12 — — 402 Milk — 101 — — 3 — 1 — 2 — 1 — — — 1 — — — 109 Mortgages — — — — 1,062 — — — — — — — — — — — — — 1,062 Notice of Builder — 18 1 — 336 — — — 1 — 33 8 1 2 20 169 10 — 599 Offices, Shops and Railway Premises Act 2 719 25 1 — 116 134 20 28 4 170 189 — 32 2,117 1 1 233 3,792 O.S.R. Accidents — 8 — — — 1 — — 1 — 2 — — 2 3 — — — 17 Outworkers — — — — 87 — — — — — — — — — — — — — 87 Pharmacy and Poisons Act — 52 13 — — — — 13 — — — — — 1 61 — — — 140 Pressed, Potted and Pickled Food — 2 — — — — — 1 — — — — — — 2 — — — 5 Qualification Certificates — — — — 1,657 — — — — — — — — — — — — — 1,657 Rag Flock etc. Act — — — — — — — — — — — — — — 1 — — — 1 Rent Acts — — — — 16 — — — — — — — — — — — — — 16 Rodent Control — 88 2 — 583 7 3 1 — 1 11 68 13 7 198 75 — — 1,057 Sampling — 279 1 — 5 8 — 28 — 1 4 18 8 12 44 — 5 — 413 Sausage Manufacturer — 15 — — — — — — — — — — — — — — — — 15 Unsound Food — 243 1 — 95 3 — 64 1 — 5 17 43 78 51 — — 1 602 Food Hygiene 3 1,283 12 1 34 44 3 52 29 1 376 769 54 23 151 — 815 1 3,651 Housing Applications — — — — 270 — — — — — — — — — — — — — 270 Registered Premises 1 74 — — — 898 171 4 1 29 2 63 — 4 22 — — — 1,269 Immigrants — — — — 244 — — — — — — — — — 36 — — — 280 Miscellaneous — 107 4 1 1,269 178 13 5 5 16 16 29 29 13 1,604 175 1 140 3,605 Re-visits 1 605 13 — 15,094 496 57 2 11 11 71 135 35 67 2,299 642 6 83 19,628 Totals 7 4,166 82 12 37,752 2,293 405 229 95 68 850 1,532 301 265 8,457 1,990 853 503 59,860 82 Table 42 SUMMARY OF NOTICES SERVED Informal notices: Public Health Act, 1936 402 Offices, Shops and Railway Premises Act, 1963 147 Total 549 Statutory notices: Public Health Act, 1961 190 Public Health Act, 1936 176 Housing Act, 1961 325 Byelaws 31 Factories Act, 1961 49 G.L.C. (General Powers) Acts 2 Total 773 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 cooperation 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 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 46 27 — — (ii) Factories not included in (i) in which section 7 is enforced by the local authority 648 2,266 49 — (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) — — — — TOTAL 694 2,293 49 — 83 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 (SI) — — — — — Overcrowding (S 2) — — — — — Unreasonable temperature (S3) — — — — — Inadequate ventilation (S 4) — — — — — Ineffective drainage of floors (S6) — — — — — Sanitary conveniences (S7): (a) insufficient 1 1 — 1 — (b) unsuitable or defective 8 8 — 8 — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to outwork) — — — — — TOTAL 9 9 — 9 — 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 123 Lace 9 Box making 2 134 The inspectors made 87 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. 84 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 During 1971, 76 offices were registered for the first time compared with 53 in the previous year and at the end of the year showed an increase of 19. Although 140 retail shops were registered for the first time during the year compared with 101 for 1970, the final figure at the end of the year showed a drop from 1,348 to 1,212. The last of the fuel depots closed during the year. The number of registered premises inspected in 1971 was 1,575 compared with 1,487 for 1970 and the total number of visits made during the year rose from 5,268 to 5,688. The number of staff employed fell from 15,602 to 15,135. The number of items requiring attention showed an increase in 1971 but this may partly be due to the greater number of visits made. The figures shown below indicate that a poor standard of cleanliness was the most common defect, followed closely by deficient and insufficient washing facilities and the absence of a thermometer. Table 46 Poor standard of cleanliness 71 Deficient and insufficient washing facilities 63 Absence of a thermometer 55 Absence of a proper first aid box 48 Deficient and insufficient sanitary accommodation 46 Condition of floors and staircases 42 Abstract of the Act not displayed 22 Insufficient lighting 18 Insufficient ventilation 8 Insufficient heating 6 Absence of drinking water 4 Lack of facilities for drying clothes 3 There were less accidents reported in 1971 (70 compared with 75) and most were fortunately of a minor character; 33 of the accidents were fully investigated. None of the accidents was due to a food slicing machine and it would seem that the staff are showing a greater awareness of the need for care and this may well be due to the leaflet, "The Safe Use of Food Slicing Machines". Further repairs were carried out during 1971 on lifts and hoists and this confirms the value of the regulations dealing with these. Table 47 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 76 521 330 Retail shops 140 1,212 933 Wholesale shops, warehouses 7 71 28 Catering establishments open to the public, and canteens 20 275 282 Fuel storage depots — — 2 TOTALS 243 2,079 1,575 85 Table 48 PERSONS EMPLOYED IN REGISTERED PREMISES BY WORK PLACE Class of work place Number of persons employed (1) (2) Offices 5,331 Retail Shops 7,378 Wholesale departments, warehouses 999 Catering establishments open to the public 1,339 Canteens 88 Fuel storage depots — Total 15,135 Total Males 8,502 Total Females 6,633 DISINFECTION AND PERSONAL CLEANSING Details of the work carried out during the year are as follows:— Table 49 Rooms disinfected or disinfested 2,942 Articles disinfected or disinfested 22,334 Verminous children cleansed 686 Verminous adults cleansed 652 Treatment for scabies, children 1,331 Treatment for scabies, adults 855 Articles cleansed 81,470 Domiciliary bathing 778 Collection and delivery of laundry (bundles) 12,604 Collection of placentae 419 Collection of bad food 91 Collection of soiled dressings, bedpans, etc. 1,817 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 271 wasps nests were dealt with on this basis. In a number of 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, 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. 86 PREVENTION OF DAMAGE BY PESTS ACT, 1949 The following table shows rat and mice destruction carried out by pest operatives during 1971:— Table 50 Type of Local authority Property Dwelling houses (including council houses) All other (including business premises) Total Properties inspected as a result of (a) notification 29 3,290 466 3,785 (b) survey — 120 3 123 (c) otherwise — — — — Total inspections 29 3,410 469 3,908 Properties inspected which were found to be infested by:— (a) Rats—major — — — — (b) —minor 6 726 132 864 (c) Mice—major — — — — (d) —minor 16 817 142 975 Infested properties treated 22 1,543 274 1,839 Retreatments 68 2,673 511 3,252 "Block" control schemes carried out 5, involving 178 premises RODENT CONTROL The incidence of infestation during the year was normal and no special comment is called for. A statistical analysis of infestation over the past six years is illustrated in the following two graphs which show the number of premises dealt with by quarters. The incidence of rat infestation has not changed much, but, as is clearly shown by the trend line there has been quite a steep rise in the number of mice infestations up to the end of March, 1970, before the number began to fall. However, the fall appears to be only temporary as the latest figures show that there is every indication that the incidence is rising again and may well exceed the peak reached in 1970 by March, 1972. Each of the premises about which a complaint of rodent infestation has been made or is suspected of being infested receives an average of 2.7 visits per week (3.0 visits for rats and 2.3 visits for mice per week). It takes an average of 5.7 visits to deal with a rat complaint and 4.4 visits for a complaint of mice over an average period of two weeks. A few infestations take considerably longer than this to clear up. The figures quoted do not apply to places where there is need for treatment over a continuous period, such as river banks, railway cuttings and sewers, all of which are dealt with as a matter of course by the rodent operatives or sewermen. 87 88 89 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 AND FOXES The complaints received during 1971 showed, as in previous years, that the two worst affected sites were in Forest Hill and Catford. These were treated by contractors and 87 birds were destroyed at the Forest Hill site and 475 at the Catford site. The pigeon catchers, who are employed on a part-time basis, investigated the remainder of the complaints and paid regular visits to badly affected sites, such as railway bridges and churches. Some 2,842 birds as well as many eggs and nests were destroyed. The feeding of pigeons by the general public is still a great problem and if this diminished there is no doubt that the number of birds would be reduced. The pigeon catchers also investigate complaints of foxes which are now more frequently seen in Lewisham and during 1971, 18 foxes were destroyed. PET ANIMALS ACT, 1951 During the year 24 premises were licensed as pet shops. In the main, the sale of pets at these premises consists of cage birds and tropical and coldwater fish. In general it has been found that pets are kept for sale under conditions which do not call for any particular comment and in no case has it been found necessary to attach special conditions for any licence which has been issued. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 Under the above Act, no person may keep a boarding establishment for animals (i.e. dogs or cats) except under the authority of a licence granted by the local authority for the area in which the establishment is situated. One such licence was granted during the year. RIDING ESTABLISHMENTS ACT, 1964 There is one licensed riding establishment in the Borough. This is inspected and supervised by the Council's Veterinary Officer, Mr. G. S. Wiggins, M.R.C.V.S. ATMOSPHERIC POLLUTION 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. 90 Table 51 ATMOSPHERIC CONDITIONS IN 1971 January February March April May June July August September October November December Average or actual Temperature—1 Mean C 5.3 5.0 5.7 8.1 12.1 13.5 17.5 16.4 13.7 11.7 6.1 6.9 10.2 Rainfall Total2 in. 2.46 0.31 1.74 1.53 2.39 4.42 0.54 2.55 0.71 2.03 1.93 0.73 21.34 Per cent, of averages 124 33 112 79 145 299 40 149 29 94 106 35 104 Sunshine—1 Daily mean hrs. 1.48 2.88 3.53 3.83 7.79 5.61 7.70 4.99 5.88 4.93 3.44 1.02 4.42 Per cent, of average 99 127 97 72 122 79 121 82 124 157 194 80 113 Wind—1 NE/E/SE % 26 19 25 66 44 25 33 18 33 24 3 23 28 S/SW/W % 58 52 43 20 36 44 35 61 31 55 51 58 45 NW/N/Calm % 16 29 32 14 20 31 32 21 36 21 46 19 27 Atmospheric pollution Creekside Depot Water insol. matter tpm 21.49 19.30 22.13 30.54 26.23 27.23 16.08 16.88 11.50 10.58 64.77 32 67 24.95 Water sol. matter tpm 11.89 5.65 7.66 2.95 6.98 9.55 17.05 8.35 6.18 6.30 17.50 6.77 8.90 Lewisham Town Hall— Smoke, daily average * 115 111 71 63 57 41 57 51 81 93 117 118 81 Sulphur, dally average * 217 221 175 203 183 100 152 99 173 112 176 202 168 Valentine Court— Smoke, daily average * 63 56 28 30 23 12 21 18 40 38 54 50 36 Sulphur, daily average * 198 198 141 159 177 90 141 67 146 85 94 77 131 Deptford Town Hall— Smoke, daily average * 78 111 78 93 75 53 44 41 68 56 73 Closed 70 Sulphur, daily average * 260 282 207 262 257 125 195 118 228 142 183 down 205 Creekside— Smoke, daily average * 102 95 59 62 49 33 41 41 74 70 92 100 68 Sulphur, daily average * 251 238 199 240 235 128 191 112 211 134 172 211 194 Weather Summary Mainly Mild Changeable Changeable Dull, cold and dry Sunnier than average Very cool much heavy rain Sunny but some heavy thunder storms Very changeable some heavy rain Long dry and sunny spells Warm with dry and sunny spells Much sunnier than average Very mild duller and drier than average 91 Notes— 1Kew; 2Lewisham; tpm: Tons per square mile per month; *microgrammes per cubic metre REGISTRATION OF HAIRDRESSERS The number of hairdressing establishments registered under the Greater London Council (General Powers) Act, 1967, is 216. 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. 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 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 1969 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 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. When the 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, 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) Houses 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 conditions 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 92 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, 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 HousingAct, 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, is 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 power 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. (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 52 HOUSING ACT, 1957—PART 2 No. of cases or notices served Section 9(1) Houses found unfit 4 „ 9(la) Houses requiring substantial repair 20 „ 10 Default of sections 9(1) and 9(la) 1 „ 16 Undertaking to carry out work 2 „ 16 Undertakings not to use for habitation 1 „ 17 Demolition Orders made 7 „ 17 Houses demolished under demolition orders 6 „ 17 Closing orders made in lieu of demolition orders 14 „ 18 Closing orders on basements 8 „ 18 Closing orders on other parts 7 „ 24 Demolition orders revoked — „ 27 Closing orders determined 8 „ 28 Closing orders converted to demolition orders — 93 Table 53 HOUSING ACT, 1957 —PART 3 Number Section 42 Clearance areas declared 2 Dwellings in these areas 155 Persons in occupation 457 Unfit houses demolished in areas declared during 1971 and in previous years 216 Table 54 HOUSING (FINANCIAL PROVISIONS) ACT, 1958 No. of houses inspected No. of houses made fit Section 43 Council mortgages 522 308 REGISTRATION OF HOUSES IN MULTIPLE OCCUPATION INFORMATORY AND REGULATORY SCHEME 1970 In September the Council in exercise of their powers under Section 22 of the Housing Act, 1961 as amended by Section 70 of the Housing Act, 1964 and Section 58 of the Housing Act, 1969 and extended by Section 64 of the said Act of 1969 introduced a scheme for the registration of houses in multiple occupation which has two objects. A To give the Council information as to houses in multiple occupation in the Borough. B To prevent any increase in multiple occupation except under conditions specifically approved by the Council. This scheme applies to any house occupied by more than two households or apart from one household (if any) is occupied by more than four persons. Already the information being gathered under the scheme is proving of great assistance to the public health inspectors in dealing with this type of property. Table 55 REGISTER OF HOUSES IN MULTIPLE OCCUPATION No. registered under Part I 195 No. registered under Part II — No. removed from the Register: Part I — Part II — No. refused registration (Part II only) — No. registered containing: 3 Households 81 4 „ 62 5 „ 25 6 „ 15 7 „ 3 8 „ 5 9 and over 4 94 Table 56 HOUSING ACTS 1957 - 1969 — HOUSES IN MULTIPLE OCCUPATION Housing Act, 1957 Number Section 90 Overcrowding notices served - Housing Act, 1961 Section 12 Management orders made 8 „ 14 Informal management notices served - „ 14 Formal management notices served 4 „ 15 Informal notices served for amenities 2 „ 15 Formal notices served for amenities 136 „ 16 Informal notices served for means of escape 6 „ 16 Formal notices served for means of escape 185 „ 19 Directions made 12 Housing Act, 1964 Section 73 Control orders mad - „ 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 57 HOUSING ACT, 1969 —PART 3 — QUALIFICATION CERTIFICATES Number Section 44(2) Applications for provisional certificates 97 „ 44(2) Provisional certificates issued 86 „ 46(3) Qualification certificates issued 22 „ 44(1) Applications for qualification certificates 408 „ 45(2) Qualification certificates issued: R.V. £90 or more 230 R.V. under £90 102 „ 55 Exemption certificates issued to tenants 1 95 Table 58 HOUSING ACT, 1969 —GENERAL IMPROVEMENT AREAS During year Total to date Number of areas declared 2 2 Grants in General Improvement Areas During the Year A pproved Improvement grants for conversions (resultant dwellings) 8 Improvement grants for individual dwellings 62 Standard grants - Special grants - Table 59 HOUSING ACT, 1964 —SECTION 19 — REPRESENTATION BY TENANT Number of representations during year 15 Number of improvement notices served 6 Number of undertakings given — Table 60 ♦HOUSING ACT, 1969 —GRANTS Number of A pproved Dwellings Completed Improvement (discretionary) grants .. 206 100 Standard grants .. 294 222 Special grants (number of houses) .. 30 15 •Including cases approved under old Acts and those in general improvement areas. RENT ACT, 1957 The following table shows the applications for certificates of disrepair dealt with during the year 1971: — Table 61 Applications for certificates 5 Decisions not to issue certificates — Decisions to issue certificates ... ... 3 Undertakings given by landlords to repair — Undertakings refused for special reasons — Certificates of disrepair issued 2 Applications by landlords for cancellation of certificates ... 2 Objections by tenants to cancellation 1 Certificates cancelled 1 96 MILK The Milk and Dairies (General) Regulations 1959 At the end of the year there were 206 persons registered for the distribution of milk from the premises within the Borough. There are no premises in the Borough used as dairies. Milk (Special Designations) Licences Licences to expire on 31st December, 1975, were issued during the year as follows:- Table 62 Licences issued during 1971 Total licences issued for sale of untreated milk 3 49 for sale of pasteurised milk 55 221 for sale of sterilised milk 35 170 for sale of ultra heat treated milk 18 116 Analysis of Milk During the year under review 37 samples of milk were submitted to the public analyst by the Council's inspectors none of which was deficient in milk solids. ICE-CREAM 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 46 samples of icecream were submitted for bacteriological examination with the following results:— Table 63 Samples % Grade I 19 41 Grade II 10 22 Grade III 10 22 Grade IV 7 15 TOTAL 46 100 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. 97 Table 64 FOOD GENERALLY Other Bacteriological Samples Cream 20 Milk 29 Shellfish 12 Meat 27 Miscellaneous 18 Total 106 Adulteration The number of samples taken during the year under the Foods and Drugs Act was 846. After examination the public analyst reported that 22 samples were adulterated, below standard or insufficiently described by label. This accounts for 2.6 per cent. of all samples submitted. Table 65 Samples Analysed Articles Examined Adulterated Formal Informal Formal Informal Foodstuffs 1 545 18 Milk and cream — 88 — — Other drinks — 60 — 1 Drugs and medicines — 34 — 1 Miscellaneous — 118 — 2 TOTALS 1 845 — 22 98 Table 66 Non-genuine Samples Article Formal or informal Adulteration or irregularity Action taken Sweet lolly Informal Contained excessive lead. Stocks withdrawn, letter to importers. Sausage roll Informal Deficient in meat. Subsequent samples found genuine. Peeled plum tomatoes Informal Contained excessive lead. Subsequent formal sample genuine. Beefburgers Informal Deficient in meat. Further samples satisfactory. Beefburgers Informal Deficient in lean meat. Further samples satisfactory. Shandy Informal Deficient in proof spirit. Further samples taken (no legal standard). Shandy Informal Deficient in proof spirit. Further samples taken (no legal standard). Shandy Informal Deficient in proof spirit. Further samples taken (no legal standard). Lambs tongues in jelly Informal Deficient in meat. Letter to manufacturers. Minced beef with onions and gravy Informal Deficient in meat. Letter to manufacturers. Boned chicken in jelly Informal Deficient in meat. Letter to manufacturers. Thyme Informal Contained excessive lead. Letter to manufacturers. Sage Informal Contained excessive lead. Letter to manufacturers. Hot dog sausages Informal Deficient in meat. Letter to importers. Apple juice spread Informal Incorrectly labelled. Letter to importers. Crab paste Informal Deficient in crab. Letter to manufacturers. Butter crinkle biscuit Informal Contained fat other than butter fat. Trade agreements pending Butter Osborne biscuit Informal „ „ Butter Crumble biscuit Informal „ „ Cheese Informal Incorrectly labelled. No action taken. Polymur Informal Incorrectly labelled. Letter to manufacturers. Lunch tongues Informal Incorrectly described and deficient in meat. Letter to manufacturers. In addition to those submitted to the public analyst for routine examination, the following were submitted because of complaints received or as a result of enquiries into cases of food poisoning:— Meat (6) Fried Chips Bread (3) Tinned fish Milk (2) Marmalade Chicken (2) Gari Vodka Toy rattle Baby food Fruit juice Pastry Eggs Milk powder (2) Crumpet Can lid Shandy Tinned peas Suppositories Liquid paraffin 99 Food Complaints Food complaints numbering 210 were received from members of the public during the year. In 20 instances legal proceedings were taken under the Food and Drugs Act, resulting in fines totalling £175. 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 67 Type of premises Number of premises Number provided with wash-hand basins Number with facilities for washing food and equipment Grocers and multiple grocers 297 297 297 Greengrocers 132 126 not applicable Bakers 84 84 84 Butchers 143 143 143 Confectioners 318 318 not applicable Catering Establishments 382 382 382 Fish shops 29 29 29 Fried fish shops 51 51 51 Public houses 163 163 163 Off licences 88 88 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 Borongh:- Table 68 Licensed stallholders selling food 85 Unlicensed stalls on private forecourts or elsewhere 10* Shellfish stalls on private forecourts 13* Mobile grocery shops 10* *These figures are approximate and vary throughout the year. PHARMACY AND POISONS The names of three 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 116 persons previously registered were retained on the register. 119 visits were paid by the public health inspectors in connection with the granting and renewal of the licences. 100 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 33 cases of legal proceedings for infringement of various Acts, as follows:— Table 69 Number of cases Fines Costs £ £ Food and Drugs Act, 1955 20 175 54.00 Public Health Act, 1936 7 10 63.35 Housing Act, 1961 3 — 36.15 Offices, Shops & Railway Premises Act, 1963 3 12 3.00 Total 33 197 156.50 REGISTRATION OF FOOD PREMISES New registrations in 1971 and the total, including previous years, are shown in the table below:— Table 70 Type 1971 Total Sale and storage of icecream 6 529 Manufacture of icecream — 15 Fish frying 2 55 Fish curing — 17 Preparation or manufacture of sausages — 115 Preparation or manufacture of potted, pressed, pickled or preserved food 3 202 UNSOUND FOOD Approximately 188 tons of food were surrendered as unfit for human consumptior and dealt with by the Council's food inspectors. This included meat, fruit-pulp. fish, vegetables, etc. Some of the spoiling was caused by refrigerator breakdowns. CONTINENTAL GOODS DEPOT, HITHER GREEN Imports of perishable food from the Continent through the Continental Freight Depot continues, and a small amount of food, mostly meat, has been exported. We are concerned insofar as unfit food or meat, without proper documents, may be imported, in which case we have to ensure that it is either destroyed, not used for human consumption or re-exported. It may be necessary to contact wholesalers and various local authorities if it is intended for distribution elsewhere. The amount of unfit food was small. 101 Totals for the year are shown in the table:— Table 71 Country of origin Tonnage imported Spain 126,807 Italy 32,777 France 20,399 Algeria 866 Germany 12 Israel 11 Total 180,872 WATER SUPPLY 1 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 1971:— 1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1971. (b) 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 the analytical results are found to be satisfactory. The quality control from these laboratories is carricd 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. (c) (i) The Board has no record of the number of structually separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1971, was 264,800. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride is being added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations:- River Thames-derived water from Hampton, Kempton Park, Surbiton and Walton works. Well water from Bexley, Darenth, Deptford, and Wilmington 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 on the attached sheets. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not 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. 102 Table 72 AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIES TO THE LONDON BOROUGH OF LEWISHAM DURING 1971 Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO 4 hrs at 27°C B.O.D. 5 days at 20°C Hardness (total) CaCO, Hardness (non-carbonate) 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 364 0.029 0.084 6.1 1.04 - 281 90 5 23.5 51 34 2.3 10 64 0.15 0.02 0.1 13 7.8 580 Bexley 5 0.011 0.019 6.0 0.09 - 308 74 - - - 23 - - - 0.10 - 0.0 3 7.2 570 Darenth 4 0.009 0.021 6.2 0.11 - 285 60 - - - 21 - - - 0.10 - 0.0 1 7.2 550 Deptford 4 0.009 0.020 6.5 0.11 - 367 128 - - - 42 - - - 0.15 - 0.1 2 7.2 740 Wilmington 4 0.020 0.029 9.0 0.19 - 295 74 - - - 28 - - - 0.14 - 0.0 1 7.4 560 103 Table 73 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1971 WATER SUPPLIES TO THE LONDON BOROUGH OF LEWISHAM Source of supply BEFORE TREATMENT AFTER TREATMENT Agar plate count per ml. Coliform count Escherichia coli count Agar plate count per ml. Coliform count E. coli count Number of samples 20-24 hours at 37°C. 3 days at 22°C. Per cent samples negative in 100 ml. Count per 100 ml. Per cent, samples negative in 100 ml. Count per 100 ml. Number of samples 20-24 hours at 37°C. 3 days at 22°C. Per cent samples negative in 100 ml. Per cent samples negative in 100 ml. River Thames—Derived 8,154 53.9 — 40.37 12.2 54.91 51 3,901 8.4 — 99.51 99.97 Bexley 263 0.1 8 100.0 — 100.0 — 254 0.1 12 100.0 100.0 Deptford 214 3.4 52 99.07 0.1 99.53 — 216 0.1 18 100.0 100.0 Darenth 250 0.0 14 99.20 — 100.0 — 256 0.0 4 100.0 100.0 Wilmington 248 0.8 74 97.18 0.2 100.0 — 245 0.3 13 99.18 100.0 104 MORTUARIES, CREMATIONS, BURIALS AND EXHUMATIONS Mortuaries The two public mortuaries situated in the Borough serve other areas as well as Lewisham. The number of bodies received during the year is shown below:— Table 74 Lewisham Mortuary Deptford Mortuary Total Bodies received from hospitals etc. 678 526 1,204 Others 510 295 805 Totals 1,188 821 2,009 Cremations and Burials The following statistics relating to cremations and burials are for the year 1st April, 1971 to 31st March, 1972:— Table 75 Cemetery No. of burials Hither Green 956 Grove Park 234 Ladywell 57 Brockley 61 Total 1,308 There were 1,740 cremations carried out at Hither Green Crematorium after certifications by the Medical Officer of Health or deputy as Crematorium Referee. One exhumation took place at a Council cemetery during the year. MEDICAL ARRANGEMENTS FOR LONG.STAY IMMIGRANTS At ports of arrival long-stay immigrants, both Commonwealth and alien, are referred to medical inspectors and given a pamphlet printed in languages which they are likely to understand. This is to encourage them to register with a medical practitioner in their place of residence so that he can arrange for them to go to a mass radiography unit, a chest clinic or a hospital for X-ray. The Health Department is notified of the names and addresses of immigrants 105 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 Department of Health and Social Security, shows the number notified to the department during 1971, and the number of successful visits made. Unsuccessful visits occur where the immigrant has moved out of the Borough and has left no forwarding address. Table 76 Country Number of Immigrants Number of first successful visits (a) Commonwealth Countries Caribbean 132 96 India 25 9 Pakistan 13 6 Other Asian 41 32 Africa 60 33 Other 16 5 (6) Non-Commonwealth Countries European 25 11 Other 2 1 TOTALS 314 193 INDEX Page Advice by M.O.H. to other departments 30 Animal Boarding 90 Ante-Natal Care 33 Anti-fly Campaign 86 Area of Borough 12 Atmospheric Pollution 90 Bacteriological Samples 98 Bathing of Elderly People 35 Births and Birthrate 12 Blind and Partially sighted persons 49 Borough, description of 9 Burials 105 Cervical Cytology 28 Chest Clinics 73 Chiropody Service 69 Clean Air 90 Cleansing, Personal 86 Clearance Areas 92 Closure or demolition of unfit houses 93 Congenital malformations 48 Continental Goods Depot 101 Council Mortgages 93 Cremations 105 Deaf Register 60 Deaths and Deathrate12 Deaths by Cancer 16 Deaths by cause and age 14 Demolition and Closing Orders 93 Demolition or Closure of unfit houses 93 Dental Service, Maternal and Child Health 55 Dental Service, Schools 56 Dental Services 53 Dental Services, Accommodation 53 Deptford Chest Clinic 74 Developmental Paediatrics 25 Disinfection and Personal Cleansing 86 District Nursing 35 District Nursing, Geriatric Liaison Scheme 35 District Nursing, staff recruitment and training 36 Domiciliary Confinements 32 Early Discharge Scheme 33 Early Neonatal deaths 13 Emergency Services 29 Environmental Health 80 Exhumation 105 Page Factories 83 Family Planning 49 Flies 86 Food 98 Food Complaints 100 Food Hygiene (General) Regulations 1960 100 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966 100 Food Poisoning79 Food Premises, registration 101 Food Samples 98 Foxes 90 General Provision of Health Services 9 General Statistics from 1962 17 Geriatrics 22 Geriatric Liaison Scheme 35 Hairdressers 92 Handicap Register 59 Health Centres 18 Health Education 67 Health Visiting 38 Heart Diseases 15 Hepatitis 28 Houses in Multiple Occupation 94 Housing 92 Housing Act 1969—Grants 96 Housing Act, Management Orders 95 Housing Act, Provision of means of escape 95 Icecream 97 Immigrants 105 Immunisation and Vaccination 78 Improvement Areas % Improvement Work 93 Infant Mortality 13 Infant Mortality 26 Infectious Diseases 71 Infective Hepatitis 28 Laboratory Facilities 79 Legal Proceedings 101 Lewisham Chest Clinic 73 Loan Service 52 Loans for House Purchase 93 Local Sickness 16 Lung Cancer 16 107 INDEX—continued Page Markets, Stalls and Delivery Vehicles 100 Mass Radiography Unit 75 Maternal Deaths 13 Mice 87 Midwifery Service 32 Midwifery Training 33 Milk 97 Morbidity shown in insurance certificates 16 Mortuaries 105 Neo-natal deaths 13 Nursing Homes 29 Observation/Handicap Register 59 Offensive Trades101 Offices, Shops and Railway Premises 85 Outworkers 84 Paediatrics 25 Perinatal Mortality 13 Pet Animals 90 Pharmacy and Poisons 100 Phenylketonuria 34 Pigeons 90 Poliomyelitis 26 Population 12 Premature Babies 34 Prevention of Damage by Pests 87 Prophylaxis 76 Psychiatry 21 Psychogeriatrics and Psychiatrics 39 Public Health Inspectors, summary of inspections 82 Public Health Inspectors, summary of notices served 83 Pupil Midwife Training 33 Qualification Certificates 95 Page Rag, flock and other filling materials 90 Rateable Value 12 Rats and Mice 87 Recuperative Holidays 49 Registration of Hairdressers 92 Rent Act 96 Repair of unfit houses 92 Representation by Tenant 96 Reproductive Wastage 13 Riding Establishments 90 Rodent Control 87 School Dental Service 56 School Health Service 57 School Medical Inspections 61 Schoolchildren, Personal Hygiene 63 Screening Clinic (Louise House) 46 Screening for Phenylketonuria 34 Sickness, Local 16 Slaughterhouses and Slaughterers 101 Smoke Control 90 Special Reports21 Stalls 100 Stillbirths 12 Surveys 46 Tuberculosis 73 Unsound Food 101 Venereal Disease 23 Vision, School Medical Inspections 65 Vital Statistics 12 Wasps, Hornets and the like 86 Water Supply 102 108 TABLES No. Subject Page 1. Causes of death by age groups 14 2. Heart and circulation mortality 15 3. Cancer deaths 16 4. Morbidity shown in insurance certificates 16 5. General statistics from 1962 17 6. Venereal Disease—new cases in the year 24 7. Developmental Paediatrics—clinic attendances 25 8. Health Visiting 46 9. Screening Clinic—attendance and referral 47 10. Screening Clinic—analysis of defects 47 11. Congenital malformations 48 12. Congenital malformations by parity 49 13. Recuperative holidays 49 14. Family Planning, Council's domiciliary service 51 15. Family Planning Association, clinics 51 16. District Nursing loan equipment 52 17. Dental Service, maternal and child health 55 18. Dental inspection of schoolchildren 56 19. Observation/Handicap register, schoolchildren by type of school 59 20. Observation/Handicap register, schoolchildren by year of birth 59 21. Deaf register, schoolchildren 60 22. Routine inspections of schoolchildren 61 23. Routine inspections of schoolchildren—defects 62 24. Personal hygiene of schoolchildren 63 25. Non-routine medical inspection of schoolchildren 64 26. Routine inspections of schoolchildren—vision 65 27. Comparison of Defects noted at "Special" medical inspections of schoolchildren 66 28. Health Education, film shows, talks, etc 68 29. Chiropody—analysis of bookings and attendances 69 30. Chiropody—summary of attendances 70 31. Chiropody—attendances by age groups 70 32. Notified cases of infectious diseases 71 33. Notification of infectious diseases by sex and age 72 34. Tuberculosis, notifications 73 35. Mass Radiography 75 36. Mass Radiography, non-tuberculous abnormalitIes 76 37. Mass Radiography, surveys 77 38. Immunisation and Vaccination 78 39. Food Poisoning 79 40. Laboratory facilities 79 41. Public Health Inspectors, summary of visits 82 42. Summary of notices 83 43. Factory inspections 83 44. Factory defects 84 45. Outworkers 84 46. O.S.R. Items requiring attention 85 47. O.S.R. Registrations and inspections 85 48. O.S.R. Persons employed 86 109 TABLES—continued No. Subject Page 49. Disinfection and Personal Cleansing 86 50. Rodent Control 87 51. Atmospheric conditions 91 52. Housing Act, 1957—Part II 93 53. Housing Act, 1957—Part III 94 54. Housing (Financial Provisions) Act, 1958 94 55. Houses in Multiple Occupation—register 94 56. Houses in Multiple Occupation—Housing Acts, 1957-1969 95 57. Qualification Certificates 95 58. General Improvement Areas 96 59. Housing Act, 1964—Representation by tenant 96 60. Housing Act, 1969—Grants 96 61. Rent Act, 1957 % 62. Milk (Special Designations) Licences 97 63. Grading of icecream 97 64. Other bacteriological samples 98 65. Samples analysed 98 66. Non-genuine samples 99 67. Food Premises, washing facilities 100 68. Inspections of markets, stalls and delivery vehicles 100 69. Legal proceedings 101 70. Registration of food premises 101 71. Continental Goods Depot, tonnage imported 102 72. Water, chemical analysis 103 73. Water, bacteriological samples 104 74. Bodies received in mortuaries 105 75. Burials 105 76. Immigrants 106 110 / A *o\ /■ 'A L!B".,.nY