LEN 60 LO NDON BOROUGH OF LEWISHAM Annual report of the Medical Officer of Health 1972 LEW 60 CONTENTS Page Introduction 3 Health Committee 5 Health Staff 5 General Provision of Health Services in Area 10 Vital Statistics 15 HEALTH CENTRES 26 MATERNAL AND CHILD HEALTH 27 Health Visiting and District Nursing 27 Midwifery 28 Screening Clinic 30 Congenital Malformations 31 FAMILY PLANNING 33 LOAN SERVICE 34 DENTAL SERVICES 35 Maternal and Child Health 35 School Dental Services 37 SCHOOL HEALTH SERVICE 39 Handicapped Pupils Register 40 Deaf Register 41 School Medical Inspection 42 HEALTH EDUCATION 50 CHIROPODY SERVICE 51 1 Page INFECTIOUS DISEASES 53 Mass Radiography 56 Immunisation and Vaccination 59 Food Poisoning 60 Laboratory Facilities 61 ENVIRONMENTAL HEALTH Summary of Inspections anHi Notices Sorvorl by Public Health Inspectors 62 Factories 64 Offices, Shops and Railway Premises Act 67 Disinfection and Personal Cleansing 69 Prevention of Damage by Pests 69 Rag Flock and Other Filling Materials Act 70 Destruction of Pigeons and Foxes 70 Pet Animals Act 70 Housing Acts 71 Milk 73 Icecream 74 Food 74 Pharmacy and Poisons 77 Legal Proceedings 78 Water Supply 79 Mortuaries 83 Immigrants 83 Public Control 84 SPECIAL REPORTS Atmospheric Pollution 85 Noise - Amplified Music 88 Chest Clinics 95 Venereal Disease 97 Cervical Cytology 98 Nursing Homes 98 Suspected Case of Smallpox 99 Suspected Food Poisoning in a School 99 Advice by MOH to other Departments 101 2 TO THE MAYOR, ALDERMEN, AND OOUNCILLORS OF THE LONDON BOROUGH OF LEWISHAM I have the honour of presenting a report on Health Services in Lewisham for the year 1972. The form of this report, mainly one of statistics, is different from that of previous years. The decision to alter the format was taken in the light of pressure of work brought about by the reorganisation of the National Health Service and also to achieve some financial saving. If the report is read in conjunction with the fuller report of 1971, a few copies of which are available, an overall picture can be obtained of the health of the people of Lewisham. It is the aim of the Council to provide a continually improving health service to residents of the Borough, thus it gives me pleasure to write of extensions to the service. At New Cross Hospital child health and family planning sessions are held. I am grateful to the Governors and members of staff of Guy's Hospital who made this development possible. It has gone some way to meet the needs of an area of the borough poorly served previously. At St Catherine's Community Centre, Pepys Road, SE 4, health visitor weekly advisory sessions are held. A new dental surgery has opened at Malory School, Launcelot Road, Downham. It is encouraging to note the increased awareness and interest shown by the public in the Family Planning Service. Since the previous report, there have been increased attendances at the several clinics with a resulting increase in the number of sessions held, including a new clinic opened at Bound field Road Health Centre. The overall increase was about 10%. The chiropody service continues to expand both in the number of sessions held and those attending, but it will be necessary to continue efforts to overcome the problems of staffing and transportation. In the report for 1971, it gave me pleasure to write of the opening of the Jenner Health Centre, the first of the new comprehensive health centres programmed for the borough. The second such building will be the Honor 0k Health Centre at Turnham Road, SE 4 and should be functioning before this report is published. A further five centres of various sizes are in the planning stage. Of this number it is hoped that building work will commence during 1974 for those at Stanley Street, SE 8 and Handen Road, SE 12. Work is planned to commence during 1975 on the centres for Upper and Lower Sydenham and Bromley Road, SE 6. 3 I wish to express my thanks to Members of the Council, in particular the Chairman and Members of the Health Committee, for their support to the Health Department throughout the year. My thanks are also due to the Tavn Clerk and Chief Executive, Chief Officers of the Council and the officers of other Authorities for their assistance. Finally, I would like to express my gratitude to the staff of the Health Department whose devotion to their work is recorded in this report. 4 HEALTH COMMITTEE 1972 THE MAYOR Councillor R J Lowe CHAIRMAN Councillor S G C Hardy, BEM VICE-CHAIRMAN: Councillor A R Jinkinson Alderman P H Fletcher-Tomenius LL B Alderman 0 A Nurse Councillor G H Baker Councillor C A Cook Councillor R D Godsiff Councillor N J Gregory Councillor J C Henry Councillor Mrs D Hurren Councillor A J Newman Councillor P W Philpot Councillor D Richards Councillor Mrs A M Theobald CO-OPTED MEMBERS: Mr J B Cohen, LDS RCS Dr P Freeman, LRCS LRCP LRFPS Mr F H E Hook, FPS HEALTH DEPARTMENT AS AT 31 DECEMBER 1972 MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER, INNER LONDON EDUCATION AUTHORITY A W Tranter, MB MRCS DPH DCH MFCM DEPUTY MEDICAL OFFICER OF HEALTH T Trace, MB CH B DPH MFCM PRINCIPAL MEDICAL OFFICERS: Betty E Shortland, MB BS DPH DTMH MFCM Enid C Vincent, MB CH B DPH MFCM Daphne P Richards, MB BS DCH DPH MFCM SENIOR MEDICAL OFFICER: Vacancy 5 ASSISTANT SENIOR MEDICAL OFFICERS: 3 Full-time MEDICAL OFFICERS IN DEPARTMENT: 5 Full-time 36 sessional MGs occupying 7 full- time positions CHIEF DENTAL OFFICER AND PRINCIPAL SCHOOL DENTAL OFFICER: Clare M Leeming, BDS SENIOR DENTAL OFFICERS: Josephine M Prior, BDS G Wenicert, BDS ORTHODONTIST Honika Brazil, BDS DIP ORTH DENTAL OFFICERS: 5 full-time 4 sessional 5 Dental Auxiliaries and 18 Dental Surgery Assistants PUBLIC ANALYST: J H Shelton, FRIC CHIEF NURSING OFFICER: Dorothy M Coe, SRN RFN SCM HV C & G Technical Teachers Certificate DIP SOC DIVISIONAL NURSING OFFICER: Valerie J Buckingham, SRN RFN SCM MTD NDN CERT AREA NURSING OFFICERS: Elizabeth M Gleeson, SRN SCM HV Renee Humphries, SRN SCM DN CERT C & G Technical Teachers Rose Evans, SRN SCM DN CERT Certificate Maureen Allen, SRN SCM HV DIP SOC Diploma in Social Sciences NURSE TRAINING OFFICER: Elsie K Ford, SRN SCM HV and DN CERTS HEALTH VISITING AND SCHOOL HEALTH GROUP NURSING OFFICERS: Joan Hawkins, SRN SCM RFN HV Annie R West, SRN SCM HV (Spalding) (Central Lewisham) Rose Pedel, SRN HV Maureen 0 M Keating, SRN SCM HV (Boundfield) (Jenner) 1 Vacancy 6 CENTRE SUPERINTENDENTS: Patricia A Eskriett Mavis V Stewart, SRN HV (Kingswear) Barbara A Bridges, SRN HV (Downham) Audrey I Urwin, SRN SCM HV (Heathside) Margaret M Sammon, SRN HV and DN CERTS (Speedwell) Louise W Atkins, SRN HV (Grove Park) Marianne Shanahan, SRN SCM HV (Flower House) Anna Flemm, SRN SCM HV (Trewsbury) (Lewisham Chest Clinic) Anne Mc Garry, SRN QN CERT HVLind) SRN SCM BTA 27 Health Visitors (+13 Vacancies); 3 TB Visitors; 25 School Nurses (+4 Vacancies): 20 Clinic Nurses (+5 Vacancies); 7 Clinic Auxiliaries; 10 Trainee Health Visitors MIDWIFERY AND DISTRICT NURSING GROUP NURSING OFFICERS Ellen F Spry, SRN CMB (Part I) Dora S Pilbrow, SRN W H Carr, SRN Olive N Dawson, SRN SCM Gladys M Cruttenden, SRN Violet J Elliston, SRN Francesca Farrow, SRN 61 District Nurses (+8 Vacancies) SENIOR MIDWIVES: Margaret J Williams, SRN SCM 13 Midwives (+7 Vacancies) CHIEF CHIROPODIST IV: B Dalton, M CH S S R CH MRSH CHIEF CHIROPODISTS I: P V Rhodes, M CH S SR CH Irene E Yeomans, M CH S SR CH SENIOR CHIROPODISTS: E V Tozer, M CH S SR CH Alice Playle, M CHS SR CH L S Trister, S R CH 14 sessional chiropodists occupying 5 full-time positions; 2 Trainee Chiropodists HEALTH EDUCATION OFFICER: R W Allen, MAPHI MIHE SENIOR ASSISTANT HEALTH EDUCATION OFFICER: Muriel E Morgan, SRN SCM (Part I) ONC HV RCNT FETC (1 Vacancy) 7 ASSISTANT HEALTH EDUCATION OFFICERS: PL White, FICAP Gertrude A Kemp HOME SAFETY OFFICERS: L Selway W H Wildish CHIEF PUBLIC HEALTH INSPECTOR: A J Phillips, MAPHI ASSISTANT CHIEF PUBLIC HEALTH INSPECTORS: J H Willis, DFC DMA MAPHI R Mahoney, MAPHI J E Waring, MAPHI SENIOR PUBLIC HEALTH INSPECTORS: L J Cleverly, MAPHI W Bevan, MAPHI D W Foster, MAPHI K G Burt A G White, MAPHI ASSISTANT SENIOR PUBLIC HEALTH INSPECTORS: T W McCarthy, MAPHI R W Bradstock, MAPHI A J Thrussell, DMA MAPHI J Hills M R Chapman, MAPHI G E Fallows, MAPHI 15 Public Health Inspectors (5 Vacancies) 7 Trainee Public Health Inspectors (l Vacancy) 1 Senior Technical Assistant 17 Technical Assistants (+ 3 Vacancies) CLEANSING DISINFECTING AND BATHING STATION SUPERINTENDENT: D Walker 1 Assistant Superintendent; 12 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 8 ADMINISTRATIVE STAFF CHIEF ADMINISTRATIVE OFFICER E W Cheesman PRINCIPAL ADMINISTRATIVE OFFICERS W Fancy B Sc(Econ) DMA D M Minear, DIP SOC SENIOR ADMINISTRATIVE OFFICERS: C R Coleman, DMA ADMINISTRATIVE OFFICERS; J A W Warton. ACIS L A Stokes E A Halpin D Newland 20 Administrative Assistants; 1 Chief Officer's Personal Assistant 13 Clerical Officers; 28 Clerical Assistants (+ 2 vacancies); 8 part-time Clerical Assistants PUBLIC CONTROL INSPECTOR R Side, MISAA CONSUMER PROTECTION OFFICER Diana R Lightvving, DCA 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 3orough patients normally attend:- Lewisham, Lewisham High Street, SE 13 Lewisham Group Hospital Management Committee Grove Park, Marvels Lane, SE 12 Lewisham Group Hospital Management Cbmmittee Hither Green, Hither Green Lane, SE 13 Lewisham Group Hospital Management Cbmmittee St John's, Morden Hill, SE 13 Lewisham Group Hospital Management Committee New Cross General, Avonley Road, SE 14 Board of Governors of Guy's Hospital Children's Hospital, Sydenham, SE 26 Bromley Group Hospital Management Committee Miller Wing, Greenwich High Road, SE lOGreenwich District Hospital St Alfege's Wing, Vanbrugh Hill, SE 10 Greenwich and Deptford Group Hospital Management Committee Brook General, Shooters Hill Road, 'Woolwich Group Hospital SE 13 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 122 general practitioners serving patients in Lewisham. The numbers serving broad areas of the Borough are: Bellingham, Catford, Lewi sham, Hither Green, 35 Sydenham, Forest Hill, Brockley, 40 Deptford, 25 Blackheath, Lee, Grove Park, Downham, 22 CHEST CLINICS Deptford Chest Clinic, Harton Street, SE 8 Lewisham Chest Clinic, 1 Blagdon Road, SE 13 10 VENEREAL DISEASES CLINIC S King's College Hospital, Denmark Hill, SE 5 Miller General Wing, Greenwich District Hospital, SE 10 St John's Hospital, Morden Hill, SE 13 Dreadnought Seamen's Hospital, Greenwich, SE 10 Guy's Hospital, St Thomas Street, SE 1 St Giles' Hospital, St Giles Road, SE 5 PREMISES COMPREHENSIVE HEALTH CENTRE Name and Address Jenner 201 Stanstead Road, SE 23 Services Executive Council Services:5 Family Doctors 1 General Dental Practitioner Forest Hill Child Guidance Unit Child Health, Child Development, Family Planning, Ante-Natal, Immunisation, Health Education, Cytology, Speech Therapy, Minor Ailments, Creche, Food Sales, Specid Investigation Clinics, Slimming Group, Mothers' Club. 2 Local Authority Dental Surgeries, Chiropody Clinic. HEALTH CENTRES AND CLINICS Name and Address Amersham Road Amersham Road, SE 14 Bellingham Community Centre Bellingham Green, SE 6 Boundfield Road Community Centre, SE 6 Service Ante-Natal, Child Health, Child Development, Immunisation, Ancillary Food Sales, Special Advisory, Cytology, Special Investigation, Family Planning, Slimming Group, Mothers' Club Child Health, Immunisation, Ancillary Food Sales Child Health, Immunisation, Family Planning, Ancillary Food Sales, Cytology, Child Development, Health Education 11 Name and Address Services Central Lewisham 410 Lewisham High Street, SE 13 Deptford S T C Reginald Square, SE 8 Downham 24 Churchdown, Downham, Kent Flower House 1 Winnet House Beckenham Hill Road, SE 6 Ante-Natal, Relaxation Classes, Child Health, Immunisation, Mothercraft, Family Planning, Ancillary Food Sales, Cytology, Occasional Creche, Special Advisory, Language Classes, Slimming Group Vision Orthoptics, Minor Ailments, Ante-Natal, Child Health, Child Development, Immunisation, Family Planning, Ancillary Food Sales, Minor Ailments, Vision, Speech Therapy, Special Investigation, Social Workers Advisory Session Child Health, Immunisation, Family Planning, Ancillary Food Sales, Child Development, Health Education Grove Park Methodist Church Hall Burnt Ash Hill, SE 12 Child Health, Immunisation, Ancillary Food Sales Heathside Merton Place, SE 10 Hither Green Methodist Church Hall 53 Torridon Road, SE 6 Kingswear Dartmouth Road,^ SE 23 Lee and Blackheath Methodist Church Hall Lee Hogh Road, SE 12 Lewisham S T C 78 Lewisham Park, SE 13 Lewisham Hospital SE 13 Psycho-Prophylaxis, Family Planning, Child Health, Immunisation, Ancillary Food Sales, Speech Therapy, Mothers' Club, Slimming Group, Social Workers Advisory Session Child Health, Immunisation, Ancillary Food Sales Ante-Natal, Child Health, Immunisation, Mothercraft, Family Planning, Occasional Creche, Ancillary Food Sales, Cytology, Minor Ailments, Health Education, Screening, Slimming Group Child Health Immunisation, Ancillary Food Sales, Mothers' Club Vision, Minor Ailments, Special Investigation, Audiometry Auditory Training Unit, Orthoptics, Hearing Investigation, Special Investigation 12 Name and Address Services Lind Oxestalls Road, SE 8 Child Health, Child Development, Ancillary Food Sales, Cytology, AnteNatal, Slimming Group, Mothers' Club, Family Planning, Health Education Samuel Pepys School Wallbutton Road, SE 14 Minor ailments Speedwell Speedwell Street, SE 8 Child Health, Child Development, Immunisation, Special Investigation, Family Planning St Mary's St Mary's Church Hall Ladywell Road, SE 13 Child Health, Ancillary Food Sales Spalding House 2 Spalding House Honor Oak Estate, SE 4 Ante-Natal, Child Health, Immunisation, Family Planning, Ancillary Food Sales, Vision. Minor ailments Sydenham S T C Adamsrill School Lower Sydenham, SE 26 Minor ailments Children's Hospital, SE 26 Special Investigation Sydenham London City Central Mission Wells Park Road, SE 26 Child Health, Immunisation, Ancillary Food Sales Tranquil Vale, All Saints' Hall Tranquil Vale, SE 3 Child Health, Immunisation, Creche Trewsbury Road All Saints' Parish Church Hall Trewsbury Road, SE 26 Child Health, Immunisation, Mothercraft, Health Education DENTAL SURGERIES S T C, 78 Lewi sham Park, SE 13 S T C, Downham Health Centre, Churchdown, Downham S T C, Reginald Square, SE 8 School for Dental Auxiliaries, New Cross, SE 14 Sedgehill School, Sedgehi11 Road, S E 6 Catford County S G School, Bellingham Road, SE 6 Malory School, Launcelot Road, Downham 13 CHIROPODY CLINICS Amersham Road Health Centre, SE 14 Kingsweari, Dartmouth Road, SE 23 28 Sangley Road, SE 6 Downham Health Centre, Churchdown Lind, Oxestalls Road, SE 8 Jenner, 201 Stanstead Road, SE 23 CLEANSING, DISINFECTING AND BATHING STATIONS Wearside Road, SE 13 MORTUARIES Ladywell Road, SE 13 Watson Street, SE 8 14 VITAL STATISTICS England Lewi sham and Wales AREA OF THE BOROUGH 8 ,579 acres POPULATION Census 1961 290,582 Estimate of Registrar-General at midyear 1972 262,920 49,028 ,900 RATEABLE VALUE Rateable value of the borough at April 1, 1972 £12,814,290 Estimated net product of a penny rate 1972-73 £113,800 Estimated number of separately assessed dwellings at April 1, 1972 90,561 BIRTHS Males Females Total Legitimate 1,563 1,472 3,035 662,907 Illegitimate 306 259 565 62,498 Totals 1,869 1,731 3,600 725,405 Crude birth rate per 1 000 of the estimated population 13.7 14.8 Adjusted birth rate for comparative purposes (Area comparability factor - 0.98) 13.4 14.8 Ratio of adjusted birth rate to national rate 0.91 1.0 Illegitimate live births as percentage of all live births 16.0 9.0 STILLBIRTHS Total (20 males and 15 females) 35 8,794 Rate per 1 000 live and stillbirths (males 10.6, females 8.6) 9.6 12.0 DEATHS Total 1 568 males, 1 658 females) 3,226 591 ,907 Crude death rate per 1 000 population 12.3 12.1 Adjusted death rate (Area comparability factor - 0.95) 11.7 12.1 Ratio of adjusted death rate to national rate 0.97 1.0 15 England Lewisham and Wales INFANT MORTALITY Infant deaths (all deaths of live born children under one year) Males Females Total Legitimate 38 19 57 11,177 Illegitimate 11 4 15 1,317 Totals 49 23 72 12,494 Death rate of all infants per 1,000 livebirths 20.0 17.22 Death rate of legitimate infants per 1,000 legitiate livebirths 18.8 16.9 Death rate of illegitimate infants per 1,000 illegitimate livebirths 26.5 21.1 Death rate of male infants per 1,000 male livebirths 26.2 Death rate of female infants per 1,000 female livebirths 13.3 Neonatal deaths (under 4 weeks of age) (36 males, 13 females) 49 8,373 Males per 1,000 male livebirths 19.3 Females per 1,000 female livebirths 7.5 All infants per 1,000 livebirths 13.6 11.5 Early Neonatal deaths (under 1 week of age) (32 males, 12 females) 44 7,142 Males per 1,000 male livebirths 17.1 Females per 1,000 female livebirths 6.9 All infants per 1,000 livebirths 12.2 9.8 Perinatal mortality (deaths under 1 week plus stillbirths) 79 15,936 (52 males, 27 females) Males per 1,000 live and still male 27.5 births Females per 1,000 live and still female births 15.5 All infants per 1,000 live and stillbirths 21.7 21.7 Reproductive wastage (stillbirths plus all infant deaths) 107 Males per 1,000 live and still male births 36.5 Females per 1,000 live and still female births 21.8 All infants per 1,000 live and still births 29.4 29.0 16 maternal deaths Nil Maternal deaths Maternal mortality rate per 1,000 live and stillbirths Nil 17 TOTAL DEATHS BY CAUSE AND AGE REGISTERED DURING 1972 Cruse of Death Sex All Ages Under 4 weeks 4 weeks 8. under 1 year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over B4 Enteritis and other diarrhoeal diseases M _ _ _ _ _ _ _ _ _ _ _ _ F 3 _ 1 _ _ _ _ _ 1 _ 2 _ B5 Tuberculosis of Respiratory system M 10 _ _ _ _ _ 1 _ 1 2 5 1 F 3 _ _ _ _ _ _ _ _ _ 1 2 Be (2) Other Tuberculosis M 2 _ _ _ _ _ 1 _ _ _ _ 1 F _ _ _ _ _ _ _ _ _ _ _ _ BIS Other infective and parasitic diseases M 2 _ _ _ _ _ 1 1 _ _ _ _ F _ _ _ _ _ _ _ _ _ _ _ _ B19(l) Malignant Neoplasm, Buccal Cavity etc M 3 _ _ _ _ _ _ _ 1 _ 1 1 F 1 _ _ _ _ _ _ _ _ 1 _ _ B19(2) Malignant Neoplasm, Oesophagus M 8 _ _ _ _ _ _ _ 2 2 4 _ F 5 _ _ _ _ _ _ _ _ _ _ 5 B19(3) Malignant Neoplasm, Stomach M 43 _ _ _ _ _ _ _ 2 16 14 11 F 34 _ _ _ _ _ _ _ 1 3 10 20 B19(4) Malignant Neoplasm, Intestine M 45 _ _ _ _ _ _ 2 2 15 8 18 F 40 _ _ _ _ _ _ 1 5 5 10 19 B19(5) Malignant Neoplasm, Larynx M 2 _ _ _ _ _ _ _ _ _ 2 _ F 2 _ _ _ _ _ _ _ 1 _ 2 _ B19(6) Malignant Neoplasm, Lung, Bronchus M 189 _ _ _ _ _ _ 1 16 57 62 53 F 52 _ _ _ _ _ _ 2 8 12 12 18 B19(7) Malignant Neoplasm, Breast M 2 _ _ _ 1 _ _ _ _ _ 1 1 F 90 _ _ _ _ _ _ 3 14 29 21 23 B19(8) Malignant Neoplasm,Uterus f 13 _ _ _ _ _ _ 3 1 3 _ 6 B19(9) Malignant Neoplasm,Prostate M 22 _ _ _ _ _ _ _ 1 4 6 11 18 19 TOT,\L DEATHS BY CAUSE AND AGE REGISTERED DURING 1972 Cause of Death Sex All ages Under 4 weeks 4 weeks & under 1 year 1-4 5-14 15-24 25-34 35-44 44-54 55-64 65-74 75 and over B19(l0) Leukaemia M 8 _ _ 1 _ 1 1 _ _ 1 _ 4 F 6 _ _ _ 2 _ _ _ _ 1 _ 3 B19(ll) Other malignant Neoplasms M 69 _ _ _ 1 _ 1 3 8 20 23 13 F 79 _ _ _ _ _ _ 1 7 18 19 34 B20 Benign and unspecified Neoplasms M 2 _ _ _ _ _ 1 _ _ _ 1 _ F 3 _ _ _ _ _ _ 1 _ _ 1 1 B21 Diabetes Mellitus M 6 _ _ _ 1 _ _ 1 _ 1 2 1 F 15 _ _ _ _ _ _ _ _ _ 3 12 B22 Avitaminoses, etc M 7 _ _ _ _ _ _ _ _ _ _ 7 F 13 _ _ _ _ _ _ _ _ _ 1 17 B46(l) Other Endocrine etc diseases M 1 _ _ _ _ _ _ _ _ 1 _ _ F 5 _ _ 1 _ _ _ ~ _ _ 2 2 B23 Anaemias M 2 __ _ 1 _ _ _ 1 _ _ _ _ F 4 _ _ _ 1 _ _ _ _ _ _ 3 B46(2) Other diseases of blood, etc M 1 _ 1 _ _ _ _ _ _ _ _ _ F _ _ _ _ _ _ _ _ _ _ _ _ B46(3) Mental disorders M 4 _ _ _ _ 1 _ _ _ 2 _ 1 F 1 _ _ _ _ _ _ _ _ _ _ 1 B24 Meningitis M _ _ _ _ _ _ _ _ _ _ _ _ F 2 _ 1 _ _ _ _ _ _ 1 _ _ B46(4) Multiple Sclerosis M 1 _ _ _ _ _ _ 1 _ _ _ _ F 1 _ _ _ _ _ _ _ _ 1 _ _ B46(5) Other diseases of Nervous System M 11 _ 1 2 1 _ 1 _ _ 2 1 3 F 26 _ 1 1 _ 1 2 _ _ 2 3 16 20 TOTAL DEATHS BY CAUSE AND AGE REGISTERED DURING 1972 Cause of Death Sex All Ages Under 4 weeks 4 weeks & under 1 year Age in years 1—4 5—14 15—24 25—34 35—44 45—54 55—64 65—74 75 and over B25 Active Rheumatic Fever M 1 — — — — — _ — — 1 — F — — — — — — _ — — — — — 326 Chronic Rheumatic Heart disease M 12 — — — — 1 — — — 6 3 2 F 31 — — — — — — 1 2 4 8 16 B27 Hypertensive disease M 26 — — — — — — — 1 5 6 14 F 30 — — — — — 1 _ — 1 6 22 B28 Ischaemic Heart disease M 412 — — — — 1 2 15 35 104 126 129 F 359 _ — — — — 1 2 8 19 82 247 B29 Other forms of Heart disease M 26 — — — — — — — 1 1 6 18 F 63 — — — — — 1 1 4 9 52 B30 Cerebrovascular disease M 125 — 1 — — 1 1 2 5 16 39 60 F 297 — — 1 — — 1 2 8 13 40 232 B46(6) Other diseases of circulatory system M 54 — — — — — — 2 2 8 20 22 F 86 — — — — — 1 1 — 6 20 58 B31 Influenza M 6 — _ — — — — — 2 — 2 2 F 3 — — — — — — — _ 2 — 6 B32 Pneumonia M 130 1 2 — 1 — 1 — 1 13 41 70 F 176 1 2 — — — — 1 4 9 29 130 B33(l) Bronchitis and Emphysema M 143 — — — — — 1 — 2 24 57 59 F 55 — — — — — — — 6 5 13 31 B33(2) Asthma M 3 — — — — 1 1 — — — — 1 F 4 — — — — — — — — 1 1 2 B46(7) Other diseases of respiratory system M 21 1 — — — 1 — — — 3 4 7 F 7 — 1 — — — — — — 1 1 4 21 TOT/1 DEATHS BY CAUSE AND AGE REGISTERED DURING 1972 Cause of Death Sex All Ages Under 4 weeks 4 weeks & under 1 year 1—4 5—14 15—24 25—34 35—44 45—54 55—64 65—74 75 and over B24 Peptic Ulcer M 11 — — — — _ — 2 2 3 4 F 11 — — — — — _ — 1 — 2 8 B35 Appendicitis M — — — _ — — — — — — — — F 1 — — 1 — — — — — _ — — B36 Intestinal obstruction and — Hernia M 5 1 — _ — — — — — — 1 3 F 10 — 1 — — — — — 1 — 2 7 B37 Cirrhosis of Liver M 4 — — — — — — — — 2 2 — F 3 — — — — _ _ — — 2 1 — 346(3) Other diseases of Digestive System M 9 — — — — — — — — — 4 3 F 15 — — — — — 1 — — — 3 11 B33 Nephritis and Nephrosis M 12 — — — — 1 _ — 2 1 6 2 7 — — 1 1 — — 1 — 2 1 1 B39 Hyperplasia of Prostate B46(9) Other diseases, M 7 — — — — — — — — 1 1 5 M 7 — — — — — — — — 1 1 5 urinary system B46(l0) Diseases of skin, F 14 — — — — — — 1 — — 5 8 M — — — — — — — — — — — — subcutaneous tissue F 2 — — — — — — — — * 1 1 B46(ll) Diseases of musculoskeletal system M 6 — — — — — — — — 1 2 3 F 12 — — — — — — 1 — 2 1 8 B42 Congenital anomalies M 13 7 1 — — 1 — — 1 2 1 — F 7 2 2 1 1 1 — — — — — — B43 Birth injury, difficult labour, etc M 18 18 — — — — — — 1 — — — F 5 5 — — — — — — — — — — B44 Other causes of perinatal mortality M 8 8 — — — — — — — — — — F 3 3 — — — — — — — — — — TOTAL DEATHS BY CAUSE AND AGE REGISTERED DURIMG 1972 Cause of Death Sex All ages Under 4 weeks 4 weeks & under 1 year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over B45 Symptoms and ill defined conditions M 5 _ 1 _ _ _ _ _ _ _ 1 3 F 5 _ 1 _ _ _ 1 _ _ _ _ 3 BE47 Motor vehicle accidents M 26 _ _ _ 1 3 3 1 3 3_ 7 5 F 15 _ _ 2 2 1 _ _ 2 2 4 2 BE48 All other accidents M 13 _ _ _ _ 2 4 4 3 3 _ 1 F 12 2 _ _ 2 _ 1 1 _ 2 _ 4 BE49 Suicide and self-inflicted injuries M 16 _ _ _ _ 1 6 3 1 4 1 _ F 10 _ _ _ _ 3 _ _ 3 2 2 _ BE50 All other external causes M 4 _ 1 _ _ _ 1 1 _ 1 1 _ F 2 _ _ _ _ _ _ _ 1 1 _ _ TOTAL All Causes M 11,563 36 13 4 6 15 27 37 94 326 466 544 F 1,653 13 10 8 9 7 9 23 72 154 318 1,035 HEART DISEASE The percentage of cardiovascular and atherosclerotic disease as a group has not varied much during the past ten years, as the table shows. This group of deaths, taken as a single cause, ranks above any other single cause of death among the population. 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 (g) of (f) of (h) (h) (h) (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) 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 1963 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 1972 771 193 140 1,104 166 208 3,226 34 6.5 5.2 23 LUNG CANCER Health Education was continued with the object of discouraging cigarette smoking, but is 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. LUNG CANCER MALE FEMALE Year All cancer deaths Lung cancer deaths (c) as % of (b) All cancer deaths Lung cancer deaths (f) as % of (e) (a) (b) (c) (d) (e) (f) (g) 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 l6 1972 391 189 48 322 52 16 MORBIDITY SHOWN IN INSURANCE CERTIFICATES Weekly average for period ending 1972 1971 January 25 1,339 1,209 February 22 1,056 790 March 21 971 988 April 18 740 881 May 16 816 880 June 13 718 696 July 11 713 767 August 3 690 716 September 5 651 652 October 3 820 799 October 31 971 887 November 28 1,032 895 December 26 1,362 860 Weekly average for the year 1972 990 Weekly average for the year 1971 848 24 GENERAL STATISTICS FROM 1963 Year Population Death rate * % dying under age 45 % dying under age 65 Birth rate * Maternal Death rate * Stillbirth rate Infant mortality rate ** Pulmonary Tuberculosis Notif rate II Death rate II 1963 291,180 11.7 i 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 1963 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 1972 262,920 12.3 6.7 26.8 13.7 0.0 10.0 20.0 35 5 *Per 1,000 population IPer 1,000 Registered Live and Still Births **Per 1,000 Registered livebirths IIPer 100,000 population 25 Health Centres October 1971 saw the opening of the Jenner Health Centre, the first of several centres planned for the Borough. Others in the programme for which sites have been found and are at various stages of development are shown below:- Anticipated completion date Population to be served Number of General Practitioners No of schools to be served Adolphus Stanley Streets SE 8 1975 24,000 7 12 Honor Oak 20 Turnham Road, SE 4 1973 10,000 2 5 Lee Handen Road/Burnt Ash Road, SE 12 1975 20,000 6 4 Lewisham South Bromley Road, SE 6 1976/7 20,000 7 7 Lower Sydenham Bell Green, SE 26 1976/7 20,000 8 8 Upper Sydenham Jews Walk/Wells Park Road, Kirkdale, SE 26 1977 21,000 2 6 Health Centres are also proposed for the Brockley, Catford and Central Lewisham areas. Health Centres at Grove Park and New Cross have not so far aroused sufficient general practitioner interest. 26 MATERNAL AND CHILD HEALTH Dorothy M Coe, SRN RFN SCM HV C & G Technical Teachers' Certificate, DIP SOC (Chief Nursing Officer) Valerie J Buckingham, SRN RFN SCM MTD NDN Cert (Divisional Nursing Officer) HEALTH VISITING VISITS TO HOMES Children born in 1972 5,394 Children aged under 5 9,656 Children between 5 and 16 1,181 TOTAL 16,231 Persons between 17 and 64 1,677 Persons aged 65 or over 733 Mentally disordered persons 168 Persons, excluding maternity cases, discharged from hospital (other than mental hospitals) 103 Infectious disease-chest clinic visitors 468 Households of patients with tuberculosis and other chest conditions visited by chest clinic visitors (including 32 visits by district health visitors) 1,262 Other visits (special reports on overcrowding, housing for for MOH) 202 GRAND TOTAL 20,844 SURVEYS Assistance with surveys carried out by nursing and medical staff, involving other bodies or organisations, include the following:- 1. Rubella Survey-National Surveillance of congenital rubella defects. 2. Lewisham Hospital Survey on the effects of Rhesus incompatibility. 3. National Survey of Health Development. 4. Spina--bifida survey. In addition, surveys have been held by Health Department staff on the state of immunisation of age groups, etc. 27 DOMICILIARY MIDWIFERY Births The rate declined by 11.9% from the previous year 4,151 in 1971; 3,653 in 1972. Domiciliary Confinements There were 260 in 1971 and 144 in 1972 a fall of 44.5%. Seventeen emergency deliveries, booked for hospital were born before arrival of the ambulance. Domiciliary Liaison Scheme Deliveries totalled 183 compared with 102 in 1971, an increase of 79.4%. Planned Early Transfer Scheme There were 1,101 cases; a decline of 14.7%. Planned 829 District transfers 22 Unplanned 250 (22.7%) The change in the proportion of irregular discharges is negligible but it still remains a problem. Ante-Natal Care Attendances increased by 21.3% 4,604 in 1971; 5,599 in 1972. Home Visits for Ante-Natal Care and Assessment declined by 33% 6,038 in 1971; 4,046 in 1972. Post Natal Visits declined by 24% 14,082 in 1971; 11,689 in 1972. Staffing During the year there was a considerable degree of staff changes. At the beginning of the year there were 17 midwives in post but by 31 December 1972 there were only 12. Recruitment has been difficult. Pupil Midwife Training (a) Lewisham Hospital Part II training January-May 1972 16 pupils completed the course Single period integrated training commenced in January and the first group commenced domiciliary experience in May. 14 pupils received domiciliary experience and a further 7 are still working on the district. 28 (b) Greenwich District Hospital Part II training 5 pupils completed the course and two are still in training. Patients booked for domiciliary confinement and subsequently admitted to hospital with the following conditions:- Ante partum haemorrhage 2 Pre-eclamptic toxaemia 3 Kidney infections 1 Early rupture of membranes 6 Delay in first stage 3 Malpresentations 2 Post maturity 4 Retained placenta 1 Post partum haemorrhage 1 Secondary post partum haemorrhage 2 25 Babies admitted to hospital with the following conditions:- Born at home Born in Hospital Total Failure to feed and thrive 1 2 3 Vomiting and passage of blood per rectum 1 3 4 Abnormality of alimentary tract 1 1 Diarrhoea and De-hydration 1 1 Pyloric stenosis 1 1 Respiratory tract infection and abnormalities 2 2 Jaundice and infection of cord 1 1 Socio-medical problems 1 1 Prematurity 1 1 8 7 15 29 RATES OF ATTENDANCE AND REFERRAL: PERCENTAGES OF ATTENDERS FOUND TO HAVE DEFECTS: ADULT SCREENING CLINIC (January 72-December 72) No of sessions held No of attenders Average attendance per session Persons referred Persons found to have defects No % of attenders No % of attenders Men 33 231 7 161 70% 90 39% Women 43 275 6 187 68% 122 44% ANALYSIS OF DEFECTS BY TEST OR SYSTEM: ADULT SCREENING CLINIC (January 72-December 72) No of attenders Total No of defects found No of defects in each group Hearing defect Vision defect (untreated) Obesity Urine abnormality Respiratory abnormality . Hyper Itension Blood abnormality Breast abnormality Pelvic abnormality Abnormal smear No of defects 21 25 13 9 4 44 5 - - - Men 231 121 % of all defects 17% 20% 11% 7% 3% 36% 4% - - - 1 No of defects 16 34 10 4 4 52 12 2 30 1 Women 275 165 % of all defects 10% 21% 6% 2% 2% 31% 7% 1% 18% 1% 30 CONGENITAL MALFORMATIONS During the year a total of 74 children were reported, which figure represents 2.05 per cent of total live births in the Borough CONGENITAL MALFORMATIONS REPORTED 0.1 Anencephalus 4 0.4 Hydrocephalus 7 0.5 Microcephalus 1 0.6 Other specified malformations of brain or spinal cord 6 0.8 Spina bifida 7 Total: Central Nervous System – 25 1.8 Accessory auricle 1 1.9 Other specified malformations of ear 2 Total: Eye and Ear – 3 2.1 Cleft lip 3 2.2 Cleft palate 4 2.4 Tracheo-oesophageal fistula, oesophageal atresia and stenosis 2 Total: Alimentary System – 9 3.0 Unspecified malformations of heart and circulatory system 2 3.9 Specified malformations of heart and circulatory system 8 Total: Heart and Circulatory System – 10 4.9 Other specified malformations of respiratory system 1 Total: Respiratory System – 1 5.0 Unspecified malformations of urino-genital organs 1 5.2 Undescended testicle 1 5.3 Hydrocele 2 5.7 Hypospadias, epispadias 3 5.9 Other specified malformations of urino-genital organs (includes pseudohermaphroditism) 1 Total: Urino-genital System – 8 6.0 Polydactyly 10 6.2 Reduction deformity hand or arm 1 6.4 Unspecified reduction deformity of limbs 1 6.5 Talipes 13 6.6 Congenital dislocation of hip 1 26 Total: Limbs - 7.1 Malformations of skull or face bones 3 3 Total: Other parts of Musculo-skeletal System – 8.3 Pigmented naevus 1 8.4 Other specified malformations of skin including ichthyosis congenita 2 8.9 Exomphalos, omphalocele (excluding umbilical hernia) 1 Total: Other Systems – 4 9.0 Other and unspecified congenital malformations 2 9.6 Down's syndrome (mongolism) 3 9.9 Multiple congenital malformations not specified 1 Total: Other Malformations – 6 95 31 CONGENITAL MALFORMATIONS REPORTED: BY PARITY Parity Number of Children 0 28 1 17 2 12 3 7 4 5 5 1 6 2 10 1 11 1 74 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 ILEA. The number arranged during 1972 was as follows:- 1972 Expectant and Nursing Mothers 16 Other Adults 116 Psychiatric patients 9 Accompanied Children - Unaccompanied Children (ILEA Scheme) 95 BLIND AND PARTIALLY SIGHTED PERSONS 121 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 52. This certification facilitates the prevision of the Council's welfare services. 32 FAMILY PLANNING DOMICILIARY SERVICE 1972 Number of doctor sessions held 151 Number of nurses sessions held 101 Number of new patients registered with Domiciliary Family Planning Service during the year 48 Number of re-visits by Medical Officer 328* Number of re-visits by Medical Officer and Nurse 2* Number Of re-visits by Nurse. 370* Number of visits by patient to clinic. 178 Total consultations throughout the year. 873 * Includes new patients. CLINIC SERVICES 1972 Number of clinics 13 Number of clinic sessions held 1,618 Number of doctor sessions held 2,291 Number of cytological smears taken 4,053 Number found to be positive 86 Clinic New Patients First Visit This Year ReDeat Visits Necessitous Amersham Road 377 876 2,048 364 Boundfield Road 11 12 6 10 Central Lewisham 602 2,010 3,755 536 Downham 250 526 1,139 150 Flower House 325 973 1,498 154 Heathside 128 282 536 98 Jenner 259 408 773 226 Lewisham Hospital 668 1,796 2,454 615 Lind 144 359 718 110 Louise House 820 2,679 4,526 459 New Cross Hospital 24 25 15 17 Spalding House 266 681 1,062 170 Speedwell 189 354 958 228 Speedwell-Youth Advisory (FPA) 53 160 327 6 TOTALS: excluding Youth Advisory 4,063 10,981 19,488 3,137 GRAND TOTALS 4,116 11,141 19,815 3,143 1971 (3,734) (8,812) (17,243) (2,387) 33 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 Equipment No. issued during At 31 December 1972 Total stock held on stock register No on loan 1972 1971 Air Rings 45 47 125 118 Back Rests 111 91 226 218 Bed Cradles 97 79 252 234 Bed Pans 57 58 166 131 Commodes 461 403 1,155 1,145 Cot Beds 7 1 10 7 Easi-Carry Hoists 4 10 25 22 Easi-Carry Hoist Slings 5 10 31 21 Fireguards 65 27 265 265 Fracture Boards 42 32 184 166 Hospital Beds with Pulley 15 17 40 25 Inflatable Toilet Seats 5 12 25 16 Mattress (Dunlopillo) 2 2 23 22 Mattress (Hair) 23 17 39 30 Mattress Covers 45 22 88 68 Penrhyn Bed Lifts 23 16 62 53 Ripple Beds 20 14 16 14 Rubber Sheets (6ft x 3ft) 105 62 301 270 Sorbo Rings 44 41 73 60 Tripod Walking Sticks 25 12 72 72 Urinals (Glass) 74 43 141 115 Zimmer Walking Frames 139 119 315 298 Wheelchairs 87 62 137 131 TOTALS 1,501 1,197 3,771 3,501 34 DENTAL SERVICES Mrs C M Leeming, BDS (Lond) Chief Dental Officer and Principal School Dental Officer DENTAL SERVICES FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS A. ATTENDANCES AND TREATMENT Number of Visits for Treatment During Year 1971 1972 1971 1972 Children 0-4(incl) Expectant and Nursing Mothers First Visit 670 849 8 40 Subsequent Visits 1,403 1,448 35 115 Total Visits 2,073 2,297 43 155 Number of Additional Courses of Treatment other than the First Courses commenced during year 78 96 - 2 Treatment provided during the year- Number of Fillings 1,530 1,589 32 134 Teeth Filled 1,396 1,476 28 116 Teeth Extracted 276 289 4 19 General Anaesthetics given 70 103 2 4 Emergency Visits by Patients 69 112 - 12 Patients X-Rayed 11 13 2 29 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 474 669 12 27 Teeth Otherwise Conserved 203 190 - - Teeth Root Filled - - 2 8 Inlays - - 2 3 Crowns - - 1 4 Number of Courses of Treatment Completed During the Year 403 447 7 26 B. INSPECTIONS 1971 1972 1971 1972 Number of Patients given First Inspections During Year A 180 233 D 7 12 Number of Patients in A and D above who required treatment B 163 204 E 6 12 Number of Patients in B and E above who were offered treatment C 163 204 F 6 11 35 C. SESSIONS Number of Dental Officer Sessions (ie Equivalent Complete Half-Days) Devoted to Maternal and Child Health 1971 1972 For Treatment 278.5 326.1 For Health Education 105.0 120.0 36 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 Authirity, based on returns supplied by the dental clinics: 1.97.2 1971 School Roll 46,418 45,874 Number of sessions: Inspection 234.7 217.0 Ordinary treatment 5,119.9 4,440.4 General anaesthetic 80.7 70.1 Orthodontic 381.4 340.8 Health education 226.9 101.7 Total sessions 6,043.6 5,170.0 Inspections-Number of children given: First inspection at school 29,996 28,378 First inspection at clinic 3,479 2,801 Percentage found to require treatment 60.2 60.3 Reinspection at school or clinic in 1972 691 740 Percentage found to require treatment 84.5 80.9 Visits for treatment: Number of first visits 10,672 8,827 Number of subsequent visits 27,274 23,868 Total visits 37,946 32,695 Emergencies 1,718 1,316 Additional courses commenced 1,913 1,608 Number did not attend 17,038 11,207 Treatment given: Number of fillings: In permanent teeth 17,634 15,438 In temporary teeth 10,112 9,789 Number of extractions (excluding orthodontics): Of permanent teeth 771 651 Of temporary teeth 2,683 2,815 Number of other operations (prophylaxis, X-rays, inlays, crowns, etc) 19,238 14,221 Courses of treatment completed 6,871 5,593 Orthodontics: Number of new cases 157 117 Number of removable appliances fitted 307 349 Number of fixed appliances fitted 4 15 Number of orthodontic extractions: In permanent teeth 279 466 In temporary teeth 69 227 Sessional averages: 1972 1971 First visits 1.9 1.8 Subsequent visits 4.9 4.9 Emergencies 0.3 0.3 Did not attend 3.1 2.3 Fillings; In permanent teeth 3.2 3.2 In temporary teeth 1.8 2.0 Extractions: Of permanent teeth 0.2 0.2 Of temporary teeth 0.5 0.6 Ratio of permanent teeth filled to permanent teeth extracted 19.6 20.1 Ratio of temporary teeth filled to temporary teeth extracted 3.4 3.1 38 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 a joint use by the Authority and the Borough Council of professional staff, premises and equipment. The Medical Officer of Health is a Principal School Medical Officer of the Inner London Education authority for the area and responsible to that authority for the day to day running of the service. The standard of health of the school children of the Borough has continued to be satisfactory. There was a rise in the number of children attending schools in the Borough and on 31 December 1972, the number was 46,591. The system of routine medical examination was continued, ensuring that children were seen on entry to Infant, Junior and Secondary Schools, and in the year preceding school leaving. In addition school doctors have carried out special medical examinations, in school and in the home, where various health problems have given rise to anxiety on the part of parents or teachers. School doctors are able to make recommendation for placement in special schools, for tuition in the home and for transport to and from school. Examinations have also been carried out for children who undertake part-time employment, or are going away on school journeys. Sessions have been held in schools for immunisation against diphtheria, tetanus, polio, rubella and tuberculosis (BOG). 39 OBSERVATION/hANDICAP REGISTER SCHOOLCHILDREN Type of School No attending Day School No attending Boarding School Total Physically handicapped 73 12 85 Delicate 120 30 150 Blind 1 4 5 Partially sighted 32 3 35 Deaf 37 13 50 Partial hearing 39 5 44 Maladjusted 83 86 169 Autistic 6 3 9 ESN-school 714 74 788 school (severe) 147 3 150 school (special care) 29 3 32 Community Home - 5 5 Other Special School - - - Total Special Schools 1.231 241 1.522 Ordinary schools 1,051 1 1,052 In Hospital/hospital school 46 Home tuition 15 YEAR OF BIRTH OF SCHOOLCHILDREN ON OBSERVATION/HANDICAP REGISTER Year of Birth No of school children 1958 254 1959 198 1960 195 1961 234 1962 253 1963 197 1964 135 1965 147 1966 133 1967 105 1968 50 1969 5 1,956 Number on register 2,689 40 CHILDREN ATTENDING SPECIAL SCHOOLS OR UNITS (Special School/Unit Age Range 2 years to 16+ years) Type of School/Unit Day Boarding Total Deaf 40 10 (3 weekly) 50 Partially hearing 38 - 38 Partially hearing with additional handicap 1 1 2 Physically handicapped 2 - 2 Physically handicapped with additional handicap - - - Deaf/Blind - 1 1 Delicate - - - ESN 11 - 11 Maladjusted - - - Others ESN (Severe) School 1 Early Care Unit - Residential Care 5 Total Number of Children on register: 339 Under School Age: 6 41 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 46,418 as at May 1972. 1971 1972 Routine inspections: Number inspected 17,799 16,720 Number found not to warrant examination (7 plus 'specials scheme') - - Percentage of No inspected of: Parent present 57.3 60.2 Care Committee present 38.1 35.9 % vaccinated against smallpox 68.0 65.4 % immunised against diphtheria 93.8 94.1 % immunised against whooping cough 89.0 89.4 % vaccinated against poliomyelitis 92.8 93.5 Physical condition unsatisfactory 0.2 0.0 Referred for treatment of defects 16.1 16.8 Referred for treatment of defects other than vision 8.9 9.7 Non-routine inspections: (i) Specials 5,323 5,852 (ii) Re-inspections 6,029 6,200 TOTAL (i) and (ii) 11.352 12,052 No of routine inspections as percentage of school roll 38.8 36.0 No of non-routine inspections as percentage of school roll 24.7 26.0 42 ROUTINE MEDICAL INSPECTIONS - DEFECTS Number of children noted for treatment or observations expressed as a rate per 1,000 inspected 1971 1972 Number inspected 17,799 16,720 Defects * Skin T 14.50 15.61 O 12.53 13.52 Eyes-(a) Vision T 79.39 80.32 (b) Squint O 32,87 36.42 T 11.35 13.76 (c) Other O 4.66 3.89 T 2.42 4.25 O 1.01 1.79 Ears-(a) Hearing T 3.65 9.21 O 7.53 7.60 (b) Otitis T 1.74 3.35 Media O 3.20 3.05 (c) Other T 2.13 0.42 O 1.35 0.96 Nose and Throat T 5.73 6.16 O 28.65 25.96 Speech T 4.33 3.59 O 7.14 7.30 Lymphatic Glands T 0.34 0.84 O 6.80 6.94 Heart T 3.37 3.65 O 5.11 5.93 Lungs T 11.29 12.86 O 8.98 9.16 Developmental (a) Hernia T 1.63 2.15 O 4.49 5.02 (b) Other T 1.97 2.57 O 6.01 3.59 Orthopaedic-(a) Posture T 0.62 0.24 O 2.64 2.03 (b) Feet T 4.55 5.62 O 12.47 10.83 (c) Other T 2.58 3.05 O 2.08 3.05 Nervous System-(a) Epilepsy T 2.36 2.63 O 1.52 1.44 (b) Other T 0.56 0.60 O 0.90 0.78 Psychological-(a) Development T 0.73 1.14 O 3.88 4.07 (b) Stability T 2.25 2.51 O 10.51 12.03 Abdomen T 0.62 0.72 O 0.90 0.20 43 1971 1972 Other-(a) Debility T 0.45 0.30 O 0.67 0.90 (b) Enuresis T 9.16 11.30 O 19.44 21.41 (c) Obesity T 5.06 5.03 O 9.94 12.44 (d) Other T 2.31 3.23 O 0.34 0.90 *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. 44 PERSONAL HYGIENE The appended table relates to surveys undertaken and also indicates action taken with verminous cases found as a result of the surveys: 1. Comprehensive Surveys: 1971 1972 (a) Number examined 22,943 38,729 (b) Number (occasions) found verminous 85 419 (c) Percentage found verminous 0.37 1.08 2. Selective Surveys: (a) Number examined 13,115 21,905 (b) Number (occasions) found verminous 306 463 (c) Percentage found verminous 1.69 2.11 3. (a) Total times vermin found (l(b) + 2(b)) 391 882 (b) Total percentage found verminous (3(a) as percentage of l(a) + 2(a)) 0.95 1.45 (c) Number of individual pupils found verminous 331 343 (d) Percentage of individual pupils found verminous (of school roll) 0.81 0.75 4. Action taken with verminous cases: (a) Advice and/or Lorexane 355 823 (b) Further action 36 59 (c) 4(b) expressed as a percentage of 4(a) 10.14 7.17 Analysis of.4(b) cases-referrals of hardcore cases to bathing centres Voluntary attendances at bathing centres: Number of pupils 36 59 Number of statutoxy notices issued - -- Number cleansed at centres following statutory notices: Voluntarily - - Compulsorily - - Emphasis is placed on children Joeing 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. 45 NON-ROUTINE MEDICAL INSPECTIONS Type of Inspection 1972 1971 Re-inspections 6,200 6,029 Bathing centre inspections-scabies 4 - -other 3 20 Employment certificates 622 636 Theatrical children 43 16 School journeys 3,668 3,311 Recuperative holidays-pre-departure 16 24 -on return - - Secondary School annual surveys - - Candidates for higher awards 35 25 Nautical school entrants - - Outward bound courses 5 4 Infectious disease investigation 250 - TB contacts - - Boarding schools for the Delicate-pre-departure 1 2 -on return - - Handicapped pupils-statutory examination 64 113 -periodic special defect examinations 638 637 Research investigations and enquiries 1 - 5,350 4,788 SPECIALS-At request of:- Head teacher-child's name entered in special book 81 121 -others 161 147 School nurse-following health survey 79 84 -others 12 8 Divisional (Education) Officer 17 28 District Care Organiser or Care Committee 18 12 Parent 88 86 School medical officer 42 44 498 530 OTHERS:- Accident on school premises 1 - Boxing-reference from schools, ABA or similar association — — 46 For free travel - - References (i) connected with remedial exercises - - foot classes - - (ii) by gymnast or physiotherapist -- - Referred by-hospital - - -speech therapist - - -general practitioner - - Miscellaneous 8 5 4 5 TOTAL OF ALL NON-ROUTINE MEDICAL INSPECTIONS 12,052 11,352 47 i ROUTINE MEDICAL INSPECTIONS-VISION This table is a statement of the visual equity of pupils whose vision was tested at routine medical inspections, divided into those not wearing and those wearing glasses, together with the proportions rioted for treatment or observation. 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 Treatment Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls 1971 3.968 8,747 87.2 34.2 4.2 4.7 2.9 3.7 2.9 3.3 3.3 3.6 1.4 1.9 0.9 1.9 3.5 5.8 3.0 1972 8,630 3,024 36.4 85.1 4.9 4.2 3.1 3.5 3.2 3.9 2.9 3.4 1.5 1.9 1.2 l.8 3.3 5.7 8.0 43 DEFECTS NOTED AT 7-PLUS ROUTINE MEDICAL INSPECTIONS IN 1972 Number of children noted for treatment and observation expressed as a rate per 1,000 inspected 1971 1972 Number inspected at 7-plus Routine Inspections 5,047 4,893 Defects Skin 33.3 32.9 Eyes-Vision 101.8 116.1 Squint 17.8 17.6 Other 2.2 6.5 Ears-Hearing 17.4 18.6 Otitis Media 4.2 8.4 Other 4.6 1.6 Nose and Throat 41.4 35.4 Speech 11.3 9.4 Lymphatic Glands 5.9 7.4 Heart 8.2 7.5 Lungs 20.2 22.7 Development-Hernia 6.1 7.4 Other 11.1 8.2 Orthopaedic-Posture 3.8 2.2 Feet 17.4 14.7 Other 2.8 6.1 Nervous System-Epilepsy 4.6 4.5 Other 1.0 0.8 Psychological-Development 5.2 7.8 Stability 16.2 17.8 Abdomen 2.2 1.6 Other-(a) Debility 2.2 1.6 (b) Enuresis 36.5 39.4 (c) Obesity 16.2 16.1 (d) Other 4.2 4.5 49 HEALTH EDUCATION Mr R W Allen, MAPHI MIHE Health Education Officer Talks by Health Education Division 416 Films 367 Student Sessions 28 Talks by Medical Officers (involving Health Education Section) 120 Talks by Public Health Inspectors 29 Talks by Health Visitors and Nursing Officers 11256 A one-day symposium on Health Education in Schools with an exhibition of material and help available to teachers in the area was well attended in March. The Section is gradually increasing the aid it can give to schools on all aspects of health education and home safety. At the end of the year it was decided to appoint an extra health educator to specialise in subjects concerning inter-personal relationships and responsibility in relationships between the sexes. 50 CHIROPODY SERVICE Mr B Dalton, MChS SRCh MRSH, Chief Chiropodist At the six Chiropody clinics maintained by the Council the number of persons regularly attending increased by nearly 20% to 7,572. These people attend nearly four times annually. The proportion of males to females is 1:4. In the last year there has been a 15% increase in the number of sessions, totalling 5,416. The provision of appliances is now arranged from Sangley Road, where last year 190 were made. Patients often require the use of special techniques and equipment; 168 such treatments were provided at Amersham Road. The number of handicapped persons attending still continues to strain the limited transport facilities available. The average appointment interval of over 16 weeks is still far too long for these persons. 628 patients were transported to the clinics, under three times during the year. 1,266 domiciliary visits were made to 390 elderly persons in the postal districts of SE 4, 8, 14, 15 and 16; 154 such visits were made to 32 persons of under pension age throughout the Borough, 40% of whom suffer from Multiple Sclerosis. 254 'once only' domiciliary visits were made to persons awaiting the transport service. An additional session has been commenced at Lewisham Hospital. The Deptford Central Methodist Mission have now appointed a chiropodist and visits by the Council's Chiropodists have also been made to Brook Lane Medical Mission. A paper on the various types of Verrucae encountered clinically has been published and a follow-up paper is in hand. Two talks were given on foot health, one to an over 60's club and the other to a young mothers' club. Under the Council's plan for sponsored training, two students are at present attending college, and applications have been received to attend next year. 51 ANALYSIS OF BOOKINGS AND ATTENDANCES AT CHIROPODY CLINICS Clinic Total Sessions Total Bookings Total Attendances Total Failures Per Cent No of Persons Amersham Road 1,606 (1,596) 11,731 (11,372) 10,451 (10,436) 1,280 (936) 11 (8) 2,343 (2,040) Downham 236 (221) 1,981 (1,288) 1,809 (1,208) 172 (80) 8.5 (6) 354 (338) Jenner 528 (29) 4,058 (148) 3,615 (143) 443 (5) 10 (3) 790 (142) Kingswear 1,037 (1,058) 6,409 (6,483) 5,799 (5,855) 610 (628) 9 (10) 1,392 (1,339) Lind 278 (339) 1,872 (2,042) 1,795 (1,975) 77 (67) 4 (3) 339 (364) Sangley Road 1,731 (1,404) 10,624 (9,221) 9,629 (8,297) 995 (924) 9 (10) 2,354 (2,022) Totals 5,416 (4,689) 36,675 (30,791) 33,098 (28,123) 3,577 (2,668) 8 (9) 7,572 (6,360) Figures for 1971 in brackets STATISTICAL SUMMARY OF ATTENDANCES 1972 1971 Number of Sessions 5,416 4,689 Appointment Bookings 36,675 30,791 Children of or below school age 2,348 2,084 AdultsL Male 6,429 5,310 Female 24,321 20,729 TOTAL 30,750 26,039 Fee paying attendances (adults) 6,537 4,137 Free attendances (adults) 24,213 23,936 ATTENDANCES ANALYSIS Age Groups Number attending Clinics 1972 1971 0-4 13 5 5-15 420 351 Males 16-65 439 342 Females 16-60 1,210 1,034 Males over 65 1,131 940 Females over 60 4,305 3,649 Physically handicapped: Males 24 14 Females 30 25 TOTAL 7,572 6,360 52 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 Healths- Acute encephalitis Acute meningitis Acute poliomyelitis Anthrax Cholera Diphtheria Dysentery (amoebic or bacillary) Food poisoning Infective jaundice Leprosy Leptospirosis Malaria Measles Ophthalmia neonatorum Paratyphoid fever Plague Relapsing fever Scarlet fever Smallpox Tetanus Tuberculosis Typhoid fever Typhus Whooping Cough Yellow fever NUMBER OF NOTIFIED CASES (Corrected for revised diagnosis) during the year 1972 with comparative figures for the previous six years. Diseases Cakes notified 1972 1971 1970 1969 1968 Anthrax — — — — — Diphtheria - - - - — Dysentery 19 13 59 137 46 Encephalitis (acute) 2 1 — - 1 Enteric or Typhoid fever 1 1 1 1 2 Infective jaundice 39 33 46 47 21 Food poisoning 6 16 40 36 20 Malaria 5 3 4 1 1 Measles 420 1,181 1,521 1,787 799 Meningococcal infection 31 28 27 24 16 Ophthalmia neonatorum 1 — — 2 1 Poliomyelitis (acute) — 1 — — — Scarlet fever 75 120 96 86 105 Tetanus 1 — - - - Tuberculosis 103 100 127 107 132 Whooping cough 18 68 110 32 146 TOTALS 721 1,570 2,031 2,260 1,290 53 54 NOTIFICATIONS OF INFECTIOUS DISEASES IN 1972 SHOWING SEX AND AGE GROUPS Under 1 1- 2- 4- 5- 10- 15- 25- 45- 65+ Total Disease M F M F M F M F M F M F M F M F M F M F M F Acute Encephalitis - - - - - - 1 - - 1 - - - - - - - - - - 1 1 Dysentery - - - 1 1 4 2 - 2 1 - - 1 - 4 2 1 - - - 11 8 Food Poisoning - - 1 - - - - - - - - - 1 2 - - 1 1 - - 3 3 Infective Jaundice - - - - - 1 - 1 2 3 - 2 6 4 6 3 3 3 3 2 20 19 Malaria - - - - - - - - - - - - 2 - 1 1 1 - - - 4 1 Measies 14 5 29 20 45 54 33 29 99 82 3 3 - 2 - 2 - - - - 223 197 Meningococcal infection 1 - - - 2 - - - 7 4 - - 6 1 4 4 1 - 1 - 22 9 Ophthalmia neonatorum - 1 - - - - - - - - - - - - - - - -- - - - 1 Scarlet Fever - 1 - - 7 4 3 6 17 22 4 6 1 4 - - - - - - 32 43 Tetanus - - - - - - - - - - - - - - - 1 - - - - - 1 Tuberculosis - - - - - - - - - - 1 - 4 3 23 14 32 6 15 5 75 28 Typhoid - - - - - - - - - - - - - - 1 - - - - - 1 - Whooping Cough 2 1 1 1 2 1 1 - 2 5 1 1 - - - - - - - - 9 9 TUBERCULOSIS NOTIFICATIONS AT AGES Age Periods New cases notified Respirarory Non-Respiratory Totals M F M F M F 0- - - - - - - 1- - - - - - - 2- - - - - - - 5- - - - - - - 10- 1 - - - 1 - 15- 1 - 1 - 2 - 20- 2 3 - - 2 3 25- 10 5 1 5 11 10 35- 11 4 1 - 12 4 45— 15 4 - - 15 4 55— 17 1 - 1 17 2 65— 11 1 - 3 11 4 75+ 4 1 - - 4 1 TOTALS 72 19 3 9 75 28 55 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 1972, on which the following tables are baseds- TOTALS EXAMINED Men 4,204 Women 3,677 7,881 ABNORMALITIES DETECTED Total numbers of proved cases (a) Tuberculous Men Women Total Cases requiring close supervision or treatment 16 1 17 Cases requiring occasional supervision 4 3 7 Cases previously known requiring close supervision or treatment 13 — 13 Cases previously known requiring occasional supervision 4 1 5 Still under investigation - - - F Failed to attend follow-up — — — TOTAL 37 5 42 (b) Non-tuberculous Carcinoma of lung 4 2 6 Malignant neoplasms other than carcinoma of lung — — — Other non-tuberculous abnormalities (see attached) 30 29 59 Still under investigation - - -- Failed to attend follow-up 1 - 1 TOTAL 35 31 66 TOTALS-all abnormalities 72 36 108 56 ANALYSIS OF 'OTHER NON-TUBERCULOUS ABNORMALITIES' Borough of Lewisham-Year 1972 Men Women Total Non-malignant neoplasms - 1 1 Lymphadenopathies, excluding sarcoids - - - Sarcoids - - - Congenital Cardio-vascular abnormalities - - - Acquired Cardio-vascular abnormalities 8 5 13 Pneumoconiosis without PMF - - - Pneumoconiosis with PMF - - - Pneumonitis 6 7 13 Chronic Bronchitis and emphysema 5 - 5 Bronchiectasis - 1 1 Diaphragmatic and Oesophageal abnormalities 1 1 2 Spontaneous pneumothorax - - - Miscellaneous abnormalities 6 3 9 Previously known abnormalities 4 11 15 TOTALS 30 29 59 58 BOROUGH OF LEWISHAM, JANUARY-DECEMBER 1972, 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 Total Regular Services for Local Authorities and GP referrals 2,663 2,711 5,374 2 1 3 1 3 4 Firms and Establishments - - — - — — - - - Contacts 652 195 847 — - — 1 - 1 Hospitals, Colleges, etc 279 472 751 - - - - - - Prisons, Homes and Hostels 381 93 474 12 - 12 1 — 1 Small Community Visits 229 206 435 2 - 2 1 - 1 TOTALS 4,204 3,677 7,881 16 1 17 4 3 7 IMMUNISATION AND VACCINATION Type of vaccine or do se Primary course completed Year of Birth Others under age 16 yrs Total 1972 1971 1970 1969 1968 -65 Diphtheria 147 2,341 528 84 505 97 3,702 Whooping Cough 144 2,303 510 76 125 7 3,165 Tetanus 147 2,340 528 84 504 97 3,700 Polio 108 2,327 523 93 412 125 3,588 Measles 5 759 721 95 153 11 1,744 Rubella - - - - - 1,332 1,332 REINFORCING DOSE Diphtheria 1 85 146 35 3,216 644 4,127 Whooping Cough 1 66 135 26 514 84 826 Tetanus 1 83 146 35 3,435 720 4,420 Polio 1 52 77 57 3,255 938 4,380 SMALLPOX VACCINATION Age at date of Months vaccination Years Total 0-3 3-6 6-9 9-12 1 2-4 5-15 Vaccination 2 2 4 9 55 65 153 290 Re-vaccination - - - - - 16 114 130 PERCENTAGE OF CHILDREN BORN IN 1970 AND VACCINATED BY 31.12.72 Lewisham England Diphtheria 76 81 Whooping Cough 74 79 Poliomyelitis 72 80 60 FOOD POISONING FOOD POISONING CASES Causative agent GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC CASES TOTAL No of outbreaks and sporadic cases columns (1+3+5) TOTAL No of cases columns (21+4+5) No of separate outbreaks No of cases notified or ascertained No of separate outbreaks No of cases notified or ascertained Notified or ascertained 1 2 3 4 5 6 7 S.Typhimurium - - - - - - - Other Salmonellae - - - - 4 4 4 Cause unknown - - - - 2 2 2 TOTAL - - - - 6 6 6 DETAILS OF FOOD POISONING DUE TO SALMONELLAE OTHER THAN S.TYPHIMURIUM Type of salmonellA 1 2 3 4 5 6 7 Stanleyville - - - - 1 1 1 Group B - - - - 2 2 2 Group C - - - - 1 1 1 Salmonella infection, not food borne - Nil LABOR/TORY FACILITIES The following represents work carried out by the Southern Group Laboratory on behalf of the Council during 1972:- Specimens Number Remarks Faeces 465 Negative 2 Salmonella Montevideo 2 Salmonella Typhimurium 6 Salmonella Stanleyville 63 Shigella sonnei 4 Salmonella Virchow 2 Group B 1 Group C Water 4 Milk 30 Ice-cream 54 Other foods 78 TOTAL 711 62 SUMMARY OF INSPECTIONS BY PUBLIC HEALTH INSPECTORS AND VISITS MADE BY TECHNICAL ASSISTANTS Reasons 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 - - - - - 1 - 1 - - - 4 21 1 29 3 - - 60 Clean Air Act - 47 - - 154 177 - - - 1 2 4 2 - 230 46 - - 663 Clearance Areas - 4 1 - 654 - - - - - - - - - 26 9 - - 694 Complaints - 349 5 - 5,974 111 3 19 3 13 42 97 37 7 558 136 44 7 7,405 Consumer Protection Act - 5 1 - 10 - - - - - 1 2 1 - 69 - 6 - 95 Drainage - 147 8 - 2,960 126 6 4 1 - 68 121 37 7 525 552 8 34 4,604 Fish Curing - 9 - - - - - - - - - - - - - - - - 9 Fish Frying - 42 - - - - - - - - - 64 - - - - - - 106 Food Poisoning - 3 - - 122 - - - - - 1 - 15 1 12 - - 1 155 House to House - - - - 1,410 - - - - - - - - - - - - - 1,410 Houses in Multiple Occupation - - - - 4,550 - - - - - - - - - - - - - 4,550 Housing Act 1957,Section 9 - - - - 51 - - - - - - - - - - - - - 51 Housing Act 1961,Section 16 - - - - 302 - - - - - - - - - - - - - 302 Ice-cream - 121 - - - 2 - 4 4 - - 6 - 2 8 - 28 - 175 Improvement Area - - - - 951 - - - - - - - - - 39 - - - 990 Improvement Grant - - - - 4,491 - - - - - - - - - - - - - 4,491 Infectious Diseases - - - - 453 - - - - - 1 4 4 - 36 - - - 498 Infestation - 41 1 - 427 - - 1 2 1 7 41 7 2 98 9 - - 637 Milk - 76 - - - - 5 7 3 - - 1 - - - - - - 92 Mortgages - - - - 571 - - - - - - - - - - - - - 571 Notice of Builder - 16 - - 341 - - - - - 3 23 11 - 45 201 - 3 643 Offices, Shops and Railway Premises Act - 924 26 - - 55 73 49 54 7 227 424 - 32 : 1,412 - 1 294 3,578 OSR Accidents - 32 - - - - - 5 1 - 1 1 - - 2 - - - 42 Outworkers - - - - 83 - - - - - - - - - - - - - 83 Pharmacy and Poisons net - 45 6 - - - 1 10 1 - - - - 2 60 - - - 125 Pressed, Potted and Pickled Food - 10 - - - - - 2 - - - 3 - - - - 2 - 17 63 SUMMARY OF INSPECTIONS BY PUBLIC HEALTH INSPECTORS AND VISITS MADE BY TECHNICAL ASSISTANTS Reasons for Visit Type of Premises Animal Boarding Establishments Food Shops Chemi sts 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 Qualification Certificates - - - - 899 - - - - - - - - - - - - - 899 Rag flock etc Act - - - - - - - - - - - - - 7 - - - 7 Rent Acts - - - - 8 - - - - - - - - - - - - 8 Rodent Control - 173 6 - 975 6 5 8 8 8 20 68 11 5 267 72 1 1 1,634 Sampling - 268 1 - - 5 1 60 - 1 5 16 2 19 64 - 89 - 531 Sausage Manufacturer - 15 - - - - - - - - - - - - - - - 15 Unsound Food - 358 3 1 142 9 - 64 - 2 5 53 83 207 28 - 1 2 958 Flid Hygiene ~ 1321 23 - 28 36 6 55 52 4 364 980 31 25 60 - 990 21 3,996 Housing Applications - - - - 394 - - - - - - - - - - - - 394 Registered Premises 1 116 3 - - 598 141 9 10 19 23 49 - - 34 - 4 - 1,007 Immigrants - - - 274 - - - - - - - - - - - - 274 Miscellaneous 1 140 4 1 1,517 83 4 7 14 30 48 80 37 12 1,597 128 14 40 3,757 Re-visits - 1,054 29 - 17,573 822 30 18 42 24 38 141 31 117 2,521 784 10 173 23,407 totals 2 5,316 117 2 45,314 2,031 275 323 195 110 856 2 1,182 330 i 439 7,727 1,940 1,198 576 68,933 SUMMARY OF NOTICES SERVED Informal notices: Public Health Act 1936 372 Offices, Shops and Railway Premises Act 1963 152 Total 524 Statutory notices: Public Health Act 1961 117 Public Health Act 1936 157 Housing Act 1961 379 Byelaws 26 Factories Act 1961 15 GLC (General Powers) Act 8 Housing Act 1957 8 Total 710 factories Section 7 of the Factories Act 1961, requiring the provision of sufficient and suitable sanitary conveniences is enforced by the Council in all factories, whether mechanical power is used in the factory or not. The provisions of sections 1,2,3,4 and 6 relating to cleanliness, overcrowding, the maintenance of a reasonable temperature, the securing of adequate ventilation of workrooms and the furnishing of adequate means of draining floors where wet processes are carried on, are enforced by the Council in factories in which mechanical power is not used. The provisions of section 7 are also applied to certain building operations and works of engineering construction, etc. A local authority is required to keep a register of factories where it is responsible- for the enforcement of any of the provisions mentioned above. Close co-operation is maintained with HM 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 HM inspectors. HM 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; 64 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 45 22 - - (ll)Factories not included in (i) in which section 7 is enforced by the local authority i 650 2,009 15 (iii)Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) - - - - TOTAL 695 2,031 15 - CASES IN WHICH DEFECTS WERE FOUND Defects No of defects Prosecutions instituted Found Remedied Referred To HM Inspector By HM Inspector Want of cleanliness(Sl) - - - - - Over crowding(S2) - - - - - Unreasonable temperature(S3) - - - - - Inadequate ventilation(S4) - - - - - Ineffecive drainage of floors(S6) - - - - - Sanitary conveniences(S7): (a) insufficient - - - - - (b) unsuitable or defective 14 14 - 4 - (c) not separate for sexes 1 1 - - - Other offences against the Act (not including offences relating to outwork) - - - - - TOTAL 15 15 - 4 - 65 OUTWORKERS Under Section 133 of the Factories Act 1961, the occupier of every factory and every contractor employed by him must keep lists showing the names and addresses of all outworkers directly employed by him and of the places where they are employed. He must send to the Council in February and in August of each year, copies of those lists showing all outworkers so employed by him during the preceding six months. Section 134 of the same Act empowers the Council by notice in writing to the occupier or any contractor employed by him to prohibit the employment of any persons as home workers in premises which the Council regard as injurious or dangerous to health. The Home Work Order 1911, specified the kinds of work to which these two sections apply. The types of work consist mainly of wearing apparel and textiles, the making of paper bags, boxes, brushes, baskets, artificial flowers, metal fittings, etc. The following is a list of such occupations:- Trade Outworkers employed Wearing apparel 103 Lace 2 Box making 1 Leather goods 4 110 The inspectors made 83 visits during the year. No adverse comments were made. OFFICES, SHOPS AND RAILWAY PREMISES ACT 1963 During 1972, 49 offices were registered for the first time compared with 76 in the previous year but at the end of the year showed an increase of 4. Although 112 retail shops were registered for the first time during the year compared with 140 in 1971, the final figure at the end of the year showed a drop from 1,212 to 1,194. The number of registered premises inspected in 1972 was 1,531 compar with 1,575 in 1971 and the total number of visits made during the year fell slightly from 5,683 to 5,389. The number of staff employed was 14,709 compared with 15,135. The number of items requiring attention showed an increase of 30 in 1972. The figures shown below indicate that a poor standard of cleanliness was the most common defect. This related principally to the decorative condition of the room behind the shop, staircase, lobbies and water closets. In very few cases was it necessary to call attention to the cleanliness of the shop itself. The condition of floors and staircases also accounted for quite a number of the defects and these related to defective floor covering, absence of satisfactory handrails arid staircase sometimes impeded by stock. Other items requiring most attention were deficient or insufficient washing facilities, the absence of a proper first aid box and deficient and insufficient sanitary accommodation. Poor standard of cleanliness 100 Deficient and insufficient washing facilities 63 Absence of a thermometer 33 Absence of a proper first aid box 50 Deficient and insufficient sanitary accommodation 46 Condition of floors and staircases 85 Abstract of the Act not displayed 21 Insufficient lighting 30 Insufficient ventilation 11 Insufficient heating 7 absence of drinking water 2 Lack of facilities for drying clothes 1 Dangerous machinery 5 Lack of seating facilities 1 There were more accidents reported in 1972 (88 compared with 70) but most were fortunately of a minor character. 46 of the accidents were fully investigated and advice was given to avoid a repetition. The inspection and repair of lifts and hoists were continued satisfactorily during the year. It is difficult to specify instances of exceptionally good or bad standards but it could be said that the standard of most of the multiple stores is always very good and every attention is given to the requirements of the Act. In no instance was it necessary to invoke Section 22. 67 REGISTRATIONS AND GENERAL INSPECTIONS Class of promises 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 49 525 258 Retail shops 112 1,194 932 Wholesale shops, warehouses 4 69 32 Catering establishments open to the public, and canteens 36 289 309 Fuel storage depots - - - TOTALS 201 2,077 1,531 PERSONS EMPLOYED IN REGISTERED PREMISES BY WORK PLACE Class of work place Number of persons employed (1) (2) Offices 5,156 Retail Shops 7,021 'Wholesale departments, warehouses 1,255 Catering establishments open to the public 1,223 Canteens 117 Fuel storage depots - Total 14,772 Total Males 8,577 Total Females 6,195 68 DISINFECTION AND PERSONAL CLEANSING Details of the work carried out during the year are as follows:- Rooms disinfected or disinfested 1,448 Articles disinfected or disinfested 8,793 Verminous children cleansed 719 Verminous adults cleansed 598 Treatment for scabies, children 658 Treatment for scabies, adults 442 Articles cleansed 89,025 Domiciliary bathing 644 Collection and delivery of laundry (bundles.) 6,614 Collection of placentae 72 Collection of bad food 31 Collection of soiled dressings, bedpans, etc 2,013 WASPS, HORNETS AND THE LIKE Under the provisions of Section 6 of the Local Government (Financial Provisions) Act 1963, the Council provides a service to assist residents to eradicate wasps, hornets and the like. During the year 196 wasps nests were dealt with. In a number of cases it was not possible to deal with the nests because of their inaccessibility. PREVENTION OF DAMAGE BY PESTS ACT 1949 The following table shows rat and mice destruction carried out by pest operatives during 1972:- Type of Property Local Authority Dwe11ing houses (including council houses) All other (including business premises) Total Properties inspected as a result of (a) notification 37 2,918 329 3,284 (b) survey 186 - 186 (c) otherwise - — — Total inspections 37 3,104 329 3,470 Properties inspected which were found to be infested by_; (a) Rats - major — — — (b) - minor 13 755 85 853 (c) Mice - major — - - (d) - minor 15 738 88 841 Infested properties treated 28 1,493 173 1,694 Retreatments 79 2,446 337 2,862 'Block' control schemes carried out 8 involving 126 premises 69 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. One premises is registered for the use of filling materials for upholstery purposes. Samples of these materials proved satisfactory on examination. DESTRUCTION OF PIGEONS AND FOXES The pigeon catchers, who are employed on a part-time basis, investigated complaints and paid regular visits to badly affected sites, such as railway bridges and churches. Some 2,174 birds as well as many eggs and nests were destroyed by the Council employees, in addition to which 339 birds were disposed of by Contractors. The feeding of pigeons, by the general public is a 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, and during 1972, 19 foxes were destroyed. PET ANIMALS ACT 1951 During the year 22 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. 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, MRCVS. REGISTRATION OF HAIRDRESSERS The number of hairdressing establishments registered under the Greater London Council (General Powers) Act 1967, is 209. 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. 70 HOUSING ACT 1957-PART 2 No of cases or notices served Section 9(l) Houses found unfit 1 Section 9(la)Houses requiring substantial repair 7 Section 10 Default of sections 9(1) and 9(la) - Section 16 Undertaking to carry out work - Section 16 Undertakings not to use for habitation Section 17 Demolition Orders made 3 Section 17 Closing orders made in lieu of demolition orders 36 Section 18 Closing orders on basements 25 Section 18 Closing orders on other parts 7 Section 24 Demolition orders revoked Section 27 Closing orders determined 5 Section 28 Closing orders converted to demolition orders 2 HOUSING ACT 1957 - PART 3 Number Section 42 Clearance areas declared 4 Dwellings in these areas 117 Persons in occupation 213 Unfit houses demolished in areas declared during 1972 and in previous years 432 REGISTRATION OF HOUSES IN MULTIPLE OCCUPATION INFORMATORY AND REGULATORY SCHEME 1970 In September 1971 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. REGISTER OF HOUSES IN MULTIPLE OCCUPATION No registered under Part I 467 No registered under Part II 9 No removed from the Registers: Part I - Part II — No refused registration (Part II only) — No registered containing: 3 Households 210 4 Households 147 5 Households 46 6 Households 32 7 Households 14 8 Households 13 9 Households and over 14 71 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 17 Section 14 Formal management notices served 14 Section 15 Formal notices served for amenities 176 Section 16 Formal notices served for means of escape 290 Section 19 Directions made 18 Housing Act 1964 Section 73 Control orders made - Section 73 Control orders in force 2 Section 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 - Section 60 Closing orders made on parts of houses - HOUSING FINANCE ACT 1972 - QUALIFICATION CERTIFICATES Number Applications for provisional certificates 40 Provisional certificates issued 65 Qualification certificates issued 35 Application for qualificltion certificates 143 Refusal to issue qualification certificates 8 Qualification certificates issued 159 HOUSING ACT 1964 - SECTION 19-REPRESENTATION BY TENANT Number of representations during year 6 Number of improvement notices served 5 Number of undertakings given - 72 HOUSING ACT 1969 - GRANTS Number of Approved Dwellings Completed Improvement (discretionary)grants 422 226 Standard grants 277 242 Special grants (number of houses) 34 21 *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 1972:- Applications for certificates 4 Decisions not to issue certificates 1 Decisions to issue certificates 5 Undertakings given by landlords to repair 1 Undertakings refused for special reasons - Certificates of disrepair issued 5 Applications by landlords for cancellation of certificates - Objections by tenants to cancellation - Certificates cancelled - MILK THE MILK AND DAIRIES (GENERAL) REGULATIONS 1959 At the end of the year there were 225 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 31 December 1975, were issued during the year as follows:- Licences issued during 1972 Total licences issued for sale of untreated milk 3 52 for sale of pasteurised milk 29 250 for sale of sterilised milk 15 185 for sale of ultra heat treated milk 12 128 73 ANALYSIS OF MILK During the year under review 73 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 Ice-cream is submitted to the Public Health Laboratory for bacteriological examination. The ice-cream is graded according to the tine 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 ice-cream it is recommended officially that judgement should be based on a series of samples and that too much attention should not be paid to the result of an individual sample. It is suggested that over a six-monthly period, at least 50 per cent of a vendor's samples should fall into grade 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 ice-cream were submitted for bacteriological examination with the following results:- Samples % Grade I 31 43 Grade II 13 13 Grade III 9 13 Grade IV 19 26 TOTAL 72 100 In general, grades I and II are satisfactory, while grades III and IV may indicate some defects in manufacture, handling or storage, Such cases are followed up and advice given. FOOD GENERALLY OTHER BACTERIOLOGICAL SAMPLES Cream 19 Mi1k 34 Shellfish 2 Meat 38 Miscellaneous 15 Total 103 74 ADULTERATION The number of samples taken during the year under the Foods and Drugs Act was 704. After examination the public analyst reported that 17 samples were adulterated, below standard or insufficiently described by label. This accounts for 2.4 per cent of all samples submitted. SAMPLES ANALYSED Articles Examined Adulterated Formal Informal Formal Informal Foodstuffs 2 391 — 10 Milk and cream - 106 - 3 Other drinks - 49 - 1 Drugs and medicines - 4 - - Miscellaneous - 152 - 3 TOTALS 2 702 - 17 DEFICIENCIES FOUND IN SAMPLES Article Formal or Informal Adulteration or irregularity Action taken Apple puree Informal Contained excessive lead withdrawn from sale by manufacturers. Grillburgers Informal Irregular labelling Public Analyst has withdrawn his comments. Chopped ham Informal Deficient in meat Further sample satisfactory. Butter Informal Contained excess water Further sample satisfactory. Fresh milk concentrate Informal No provision exists for the sale of this product in the condensed milk regulations Newcastle CB negotiating a test case. Further action pending result. Steak pie Informal Deficient in meat Further sample taken. Ground cinnamon Informal Contained excess copper Letter to manufacturer. Boned chicken in jelly Informal Deficient in meat Further sample takenletter to importer. Chopped ham and pork Informal Deficient in meat Letter to manufacturer. 75 Article Formal or Informal Adulteration or irregularity Action taken Hot dog sausages Informal Deficient in meat Letter to importers. Smoked salmon Informal Confusing label Letter to manufacturer. Cream,double pasteurised Informal Sample contained fat in amount corresponding to whipping cream Labelling to be investigated. Cream,real. Devon Informal Sample contained fat in amount corresponding to whipping cream Labelling to be investigated. Vinegar Informal Sample was one of non-brewed condiment Retailer notified. Vinegar essence Informal Sample was a coloured solution of acetic acid, and was incorrectly labelled Label checked with manufacturers. Boned chicken in Jelly Informal Sample was deficient in meat Letter to manufacturer. Jaffa orange juice Informal Can showed signs of corrosion Further sample found to be sound. 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 poisonings- Bread (3) Blackberries Milk (2) Soup Figs Tinned cream Chicken Milk bottle Rice Cheese Beef Milk Powder Peanuts Tinned Tomatoes Rissoles Tinned Pineapples Peas FOOD COMPLAINTS Food complaints numbering 236 were received from members of the public during the year. In 9 instances legal proceedings were taken under the Food and Drugs Act, resulting in fines totalling £253. 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. Type of premises Number of premises Number provided with wash-hand basins Number with facilities for washing food and equipment Grocers and multiple grocers 301 301 301 Greengrocers 127 125 not applicable Bakers 84 84 34 Butchers 142 142 142 Confectioners 299 299 not applicable Catering Establishments 390 390 390 Fish shops 27 27 27 Fried fish shops 54 54 54 Public houses 163 163 163 Off licences 87 87 not applicable PHARMACY AND POISONS The names of 12 persons were entered on the Council's list of persons entitled to sell poisons in Part II of the poisons list and the names of 106 persons previously registered were retained on the register. 125 visits were paid by the public health inspectors in connection with the granting and renewal of the licences. 77 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 24 cases of legal proceedings for infringement of various Acts, as followsi- Number of cases Fines Costs £ £ Food and Drugs Act 1955 9 253 72 Public Health Acts 2 - 8 Housing Act 1961 7 205 50 Public Health (Recurring Nuisances) Act 1969 2 20 13 Byelaws (Noise) 2 20 10 Byelaws (Drainage) 2 2 3 TOTAL 24 500 156 REGISTRATION OF FOOD PREMISES New registrations in 1972 and the total, including previous years, are shown in the table below:- Type 1972 Total Sale and storage of ice-cream 21 546 Manufacture of ice-cream - 15 Fish frying - 54 Fish curing - 16 Preparation or manufacture of sausages 3 118 Preparation or manufacture of potted, pressed, pickled or preserved food 3 205 UNSOUND FOOD Approximately 85 tons of food were surrendered as unfit for human consumption and dealt with by the Council's food inspectors. This included meat, fruit-pulp, fish, vegetables, etc. Some of the spoiling was caused by refrigerator breakdowns. 78 CONTINENTAL GOODS DEPOT, HITHER GREEN Imports of perishable food from the Continent through the Continental Freight Depot continues, and a small amount of food, mostly meat, has been exported. We are concerned insofar as unfit food or meat, without proper documents, may be imported, in which case we have to ensure that it is either destroyed, not used for human consumption or re-exported. It may be necessary to contact wholesalers and various local authorities if it is intended for distribution elsewhere. The amount of unfit food was small. Totals for the year are shown in the table:- Country of origin Tonnage imported Spain 143,614 Italy 18,533 France 12,343 Algeria 601 Hungary 26 Total 175,117 WATER SUPPLY I am indebted to Dr E Windie 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 1972:- 1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1972. (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 carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the RegistrarGeneral's estimates at 30 June 1972, was 262,920. (ii) No houses were permanently supplied by standpipe. 79 (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 the Thames Valley group of works. Weil water from Bexley, Darenth, Deptford, Merton (occasionally)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. 80 18 AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH OF LEWISHAM DURING 1972 Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs from KMn04 4 hrs at 27°C BOD 5 days at 20°C Hardness (total) CaC03 . Hardness (non-carbonate) CaC03 Magnesium as Mg Sodium as Na Potassium as K Chloride as CI Phosphate as P04 Silicate as Si02 Sulphate as S04 Natural Fluoride as F Surface-active material as Manoxol OT C02 Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) River Thames - derived 364 0.031 0.069 6.9 1.06 - 274 32 5.0 24.5 5.5 35 2.8 10 58 0.15 0.02 - 0.1 13 7.9 570 Bexley 4 0.007 0.016 7.1 0.14 - 320 76 4.0 34 - 23 - - - 0.11 - 34 0.0 3 7.1 580 Darenth 4 0.000 0.015 5.9 0.12 - 268 43 2.8 31 - 17 - - - 0.11 - 31 0.1 2 7.3 500 Deptford 4 0.007 0.014 8.2 0.10 - 378 144 8.5 36 - 48 - - - 0.15 - 36 0.0 2 7.2 750 Merton 1 0.070 0.016 0.5 0.04 - 244 24 13.0 - - 23 - - - 0.40 - - 1.3 22 7.3 450 Wilmington 4 0.006 0.015 9.5 0.26 - 290 53 3.5 33 - 25 - - - 0.10 - 33 0.0 1 7.2 550 82 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES 1972 WATER SUPPLIED TO THE LONDON BOROUGH OF LEWI SHAM BEFORE TREATMENT AFTER TREATMENT Source of supply Number of Samples 20-24 hours at 37° C 3 days at 22° C Coliform Per cent samples negative in 100 ml count Count per 100 ml Escherichia coli count Aqar plate Coliform E coli count 3er ml count count Per cent samples negative in 100 ml Count per 100 ml Number ®f 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 8,087 42.3 - 41.94 40.2 56.76 4.0 3,891 10.0 - 99.85 99.97 Bexley 50 0.1 11 99.54 - 100.0 - 253 0.2 27 100.0 100.0 Darenth 251 2.3 20 100.0 - 100.0 - 254 0.7 42 100.0 100.0 Deptford 241 0.1 46 97.93 0.5 99.59 - 247 0.0 43 100.0 100.0 Merton Abbey 1 - - 100.0 - 100.0 - 1 5.7 - 100.0 100.0 Wilmington 229 1.1 40 99.13 - 100.0 - 234 0.1 25 98.72 100.0 MORTUARIES, BURIALS AMD 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:- Lewisham Mortuary Deptford Mortuary Total Bodies received from hospitals etc 892 591 1,483 Others 371 274 645 Totals 1,263 865 2,128 MEDICAL ARRANGEMENTS FOR LONG-STAY IMMIGRANTS At ports of arrival long-stay immigrants, both Commonwealth and alien, are referred to medical inspectors and given a pamphlet printed in languages which they are likely to understand. This is to encourage them to register with a medical practitioner in their place of residence so that he can arrange for them to go to a mass radiography unit, a chest clinic or a hospital for X-ray. The Health Department is notified of the names and addresses of immigrants entering the Borough with the object of ensuring that at an early date the immigrants are made aware of how to use the Health Service. An important aim of the department is to secure by persuasion that those from countries with a high incidence of tuberculosis have an X-ray of the chest as soon as possible. The following table, based on returns made to the Department of Health and Social Security, shows the number notified to the department during 1972, 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. Country Number of Immigrants Number of first successful visits (a) Commonwealth Countries Carribean 133 84 India 23 8 Pakistan 4 1 Other Asian 60 29 Africa 115 74 Other 25 15 (b) Non-Commonwealth Countries European 7 2 Other 6 2 TOTALS 373 215 63 PUBLIC CONTROL Shops Act 1950 and Young Persons (Employment) Act 1938 No of inspections carried out 1,300 No of infringements detected 200 Massage Establishments: LCC (General Powers) Act 1920 No of establishments licensed 13 Employment Agencies: LCC (General Powers) Act 1921 No of agencies licensed 33 Nurses Agencies Act 1957 No of agencies licensed 2 Theatrical Employers Registration Acts 1925/28 No of registrations 16 Explosives Act 1875 and 1923/Fireworks Act 1961 No of premises registered 160 No of inspections carried out 200 No of infringements detected 20 Dog Licences Counterfoils of dog licences issued from Post Offices 9,800 Refreshment Houses Acts 1860 to 1969 No of refreshment houses licensed 9 Night Cafes: GLC (General Powers) Act 1968 Mo of late night cafes registered 14 84 ATMOSPHERIC POLLUTION - MOTOR VEHICLE EXHAUSTS - LEAD This report follows a question at Council by Councillor E Richards, in reply to which the Chairman of the Health Committee agreed to a referral to the Health Committee. Lead is found in the atmosphere in inorganic form. Apart from the dust around old smelting works and special cases such as the burning of car batteries, the main source of this pollutant is the combustion of organic lead compounds which are commonly added to petrol as 'anti knock' agents. Lead is readily absorbed into the blood stream when inhaled and less readily when eaten. It is deposited in all organs but particularly bones. A normal acceptable blood level is 30 microgrammes/lOO ml but in industry levels of up to 60/100 ml are accepted with a maximum allowable concentration of 80/100 ml of blood. Symptoms of poisoning arise at blood levels above 80 per 100 ml. Cn 21 December 1971, Sir George Godber, Chief Medical Officer to the Department of Health and Social Security, wrote to all Medical Officers of Health about possible hazards to health from excessive amounts of lead in food, the atmosphere, water and soil. The letter followed a discussion by a group of experts on the available. information of the hazards in Britain. With regard to lead in the atmosphere, he reports that it is in extremely small concentrations and the only reason for giving it special attention is that, inhaled, pollutants may be more completely absorbed than the same pollutants after being eaten. Investigations amongst persons specially exposed to atmoshperes affected by heavy motor traffic show no evidence of excessive amounts of lead in the blood. Some recent investigations suggest that lead derived from the combustion of petrols with added lead is firmly attached to carbon particles of a sufficient size to explain why excessive absorption does not take place. The expert group did not think there was a general hazard from this source at the present levels of emission. He also reports on the possibility of high concentrations of lead in dust and soil near to old lead smelters in one area of East London. On three occasions outbreaks of lead poisoning have been reported amongst children exposed at home to excessive concentrations of lead in dust and perhaps in fumes from burning old battery cases. Whilst there is no evidence directly obtained on the level of lead contamination in the atmosphere of the Borough of Lewisham, a certain amount of corroborative evidence is available from the London area to confirm the Chief Medical Officer's opinion. The conditions which produce the worst pollution by vehicle exhausts are; calm weather, high traffic density congestion (causing stop-go 85 traffic flow) and narrow roads lined by continuous high buildings. The degree of pollution may be expected to be similar at places in this country wherever these conditions prevail. A report was made by the Chairman of the General Purposes Committee of the Greater London Council on 22 February 1971 following a detailed report by the Scientific Adviser to the GLC. The levels found were not considered a danger to health. In the House of Commons on 3 August 1971 (Hansard column 273-274) the Secretary of State for the Environment listed the surveys being carried out or sponsored by various Government Departments and research councils. Those applicable to atmospheric lead included:- 1. Vehicle exhaust pollutants including lead at Reading (Road Research Laboratory and Warren Springs Laboratory). 2. Measurements of airborne lead and other exhaust components at two points in London, one with heavy traffic and one away from traffic. (Medical Research Council Air Pollution Unit). 3. Measurement of lead content of soil near busy roads (Road Research Laboratory). 4. Study of lead levels in plants and small animals near busy roads (Monks Wood Experimental Station). 5. Study of differing lead levels in the blood of two groups of professional drivers working in London one in daytime and one at night (Medical Research Council Air Pollution Unit). Other surveys cover pollution from industry and tips, and surveys of lead in food are being carried out by the Ministry of Agriculture, Fisheries and Food. The Medical Officer of Health for Islington in his Annual Report of 1970 lists lead levels in the atmosphere. He suggests that these levels should be considered in conjunction with the Technical Report of California Standards for Ambient Air Quality (State of California I960) which suggested an estimated standard of six microgrammes per cubic metre as a permissible maximums- AVERAGE LEAD CONTENT IN MICROGRAMMES PER CUBIC METRE OF AIR 1963 1969 1970 January 1.3 1.18 0.71 February 0.9 0.89 0.57 March 0.85 0.48 0.64 April 0.85 0.54 0.83 May 0.74 0.47 0.65 June 0.49 0.36 0.50 July 0.52 0.46 0.95 August 0.20 0.41 0.84 September 0.21 0.70 0.75 October 1.04 1.58 1.10 November 1.14 0.77 0.97 December 1 .05 0.58 1.50 36 A consultant at The Hospital for Sick Children, Great Ormond Street, has been contacted and points out that the problem of lead poisoning due to eating lead is much the major problem. Dr B Gans, consultant paediatrician, at Lewisham Hospital, states that standards of normal levels of lead in the blood are not known, that most children he has checked had a level of 20 microgrammes per 100 ml of blood, and that no one would consider treating a case with a blood level below 60. He also pointed out that much of this lead arises from eating lead rather than from inhalation. A series of articles in 'Chemistry in Britain' and the 'New Scientist and Science Journal' have proposed that lead from 'anti knock petrol' is a growing and serious hazard in Britain. One of the main points used was a graph showing the increase in lead found in snow in Greenland. A reply to these articles gave the full details which showed annual fluctuations but no trend to increase between the years 1946 to 1965. In Command 4373 'The tection of the Environment' the then Secretary of State for Local Government and Regional Planning (May 1970) said: 'There is no evidence that cars add significantly to the lead which occurs naturally in the soil or in the vegetable food we eat. The Government will nevertheless continue to keep this matter under review'. In reply to a suggestion to the Scientific Adviser of the GLC that Lewisham might be used for the purpose of testing the atmosphere for lead, he regretted that the limited resources he could allocate to the investigation of vehicle fumes were fully engaged and that he is unable to undertake measurements in Lewisham. CONCLUSION 1. There is no evidence that lead poisoning is a particular hazard in Lewisham. 2. Lead poisoning is likely to occur in certain specific areas and it wguld only be by analysis in those areas that the risks of poisoning could be predicted. 3. Unless areas of special hazard can be identified in Lewisham the most sensitive indication of increasing danger will be obtained by observing those areas where there is a special hazard. 87 AMPLIFIED MUSIC This report is presented at the request of the Chairman following a question at the last Council Meeting by Councillor & Richards. The question referred to research at youth clubs in the West Ridirg and the findings that 'in almost every case the noise of amplified music is above a safe level' and asked whether a similar situation exists in Lewisham and what steps might be taken to protect the hearing of Lewisham's youth? R W Fearn, Principal Lecturer in Environmental Physics at Leeds Polytechnic reported the investigations into sound levels made at ten youth clubs and stated 'The above article only draws attention to the widespread presence of damaging noise levels in clubs,' and referred to the need for measurements of hearing loss. In 1971 a working party of the Noise Advisory Council produced a report on the Noise Abatement Act of 1960 and made recommendations aimed at strengthening the working of the Act and possibly as the basis of a new Noise Abatement Act. Noise has been defined as unwanted sound and may cause disturbance, annoyance, be a nuisance or be dangerous to hearing. The former categories could be grouped under neighbourhood noise and the latter as noise potentially dangerous to health. (a) Neighbourhood Noise refers to those noises which may cause disturbance and annoyance to the general public in their homes and going about their lawful occasions. It is dealt with by the Noise Abatement Act and includes:- human noise arising from lack of consideration for others such as noisy parties, loud speakers, slamming of car doors etc; noise from entertainments, sports and advertising; noise from machinery, plant and equipment in buildings, noise from demolition, construction and roadworks and noise from factories. (b) Noise dangerous to hearing refers to that noise which is potentially dangerous to health and includes:- noise in factories and offices and shops (where regulations are made) and noise of machinery and equipment such as road drills, lathes, rivetters, sand blasters etc. Other noises may be harmful such as bomb explosions, gunfire and accidental explosions. (c) A further category includes those which may be a nuisance and also potentially hazardous such as:- aircraft noise, which is dealt with by the Civil Aviation Act 1968, and the British Airports Authority Act 1965 and motor vehicle noise, which is governed by the Road Traffic Acts. 88 Mr R W Fearn in his report refers to the need to keep sound levels below a rating of N85 which is 85 decibels. Some normal levels found in this country are Countryside 25 decibels Quiet bedroom 35 decibels Road noise 40 to 79 decibels Conversation 60 decibels Busy general office 65 decibels Back seat of car at 40 mph 75 decibels Unmuffled road drill at 50 ft 85 decibels Alarm clock (at 3 ft) 88 decibels Heavy diesel lorry (at 20 ft) 88 decibels Lathe 86-95 decibels Mechanical saw 100-110 decibels Sand blasting . 118 decibels Rivetting 130 decibels Jet aircraft (taking off at 25 yds) 140 decibels A decibel is a unit on a logarithmic ratio of measurement based on a reference level which is the threshold of hearing. Thus a zero decibel level is the quietest sound which can be heard by the normal human ear and an increase of three decibels is the minimum change which is likely to be distinguished without the opportunity of direct comparison. Similarly, because it is a logarithmic scale a change of ten decibels represents a doubling of the loudness in subjective terms. Measurement of noise is a complex and difficult problem. In assessing the potential danger of noise, the intensity, the varieties of pitch and the duration of exposure all need to be taken into account. In industry, levels of exposure which should not be exceeded, are laid down as guidelines. Unfortunately, there are individuals whose hearing may be damaged more easily. In general, however, exposure to levels above 130 decibels can be considered as hazardous to hearing irrespective of the duration of exposure or of the composition of the noise. Mr Fearn's readings gave maximum levels of 115 decibels and at this level for the non-sensitive person it is necessary to assess the composition of the noise, the duration of exposure and the frequency of exposure. A small number of well documented studies have failed to show any definite damage to hearing of rock and roll or pop musicians. This may be due to:- (a) the breaks in the noise during the session, 89 (b) the limited time to which people are exposed to potentially hazardous levels at one sitting, (c) the relatively infrequent occasions to which youngsters are able to expose themselves to this hazard, and (d) the variation in octave bands which occur at discotheques and pop sessions. It is obviously a matter of concern particularly as the long term effects are not known. Again, if any of the above factors change adversely, a more serious situation could develop. Action under the Noise Abatement Act can be taken if the noise produced is shown to be a nuisance to the general public ie those not attending. The most important measures that can be taken to control a potentially hazardous situation is by means of health education, advice to organisers and performers on sound levels, length of sessions, frequency of breaks in the music and the wearing of hearing protectors by the performers and the advice of the public health inspector trained in the use of sound measurement. It is known that Mr Fearn is continuing to be interested in this subject. It is suggested that the Medical Officer of Health should keep the matter under review, reporting as necessary. 90 MEASUREMENT OF NOISE (a) In Places of Entertainment No Date and time Distanceof meter from sound Meter reading Other noise Effect on ear 1 24.10.72 9.00-10.00 pm 20 feet 95 decibels in Bar, 104 in Discotheque Conversation Defening impossible to carry on conversation 2 25.10.72 9.00-9.30 pm 10 feet 108 decibels Minimum during the period -100 Conversation, singing Deafening conversation possible with difficulty 3 31.10.72 9.00-10.00 pm 15 feet 104 decibels maximum. Most of the time 95 Conversation Some live music. Singing Very loud conversation possible with difficulty 4 2.11.72 8.30-9.00 pm 15 feet 102 decibels maximum. Most of the time 97 Conversation Very loud conversation possible but difficult 5 2.11.72 9.20-10.00 pm 15 feet 96 decibels maximum. Most of the time 90 Conversation Not very loud. Conversation possible 6 3.11.72 7.45-8.40 pm 15 feet Maximum 93 decibels in Bar, 99 in hall. Most of the time 90 Conversation Not very loud. Conversation possible in both cases 7 6.11.72 9.00-10.30 pm 15 feet > 97 decibels maximum. Most of the time 90 Conversation Moderate conversation possible 91 (b) From Traffic BLACKHEATH HILL 6.11.72 8.20-9.00 am NEW CROSS ROAD 8.11.72 8.45-9.10 am LEWISHAM HIGH STREET 9.11.72 8.35-9.10 am Background noise 84 , . Background noise 78 Background noise 84 Bus (old type) 93 Motor cycle 86 Mini car 94 Motor cycle 92 Bus (new type) 86 Bus (old type) 91 Coach 92 Diesel lorry 89 Diesel lorry 99 Container lorry 100 Coach 87 Container lorry 92 Trailer lorry 100 Haulage lorry (laden) Baker's van 97 Tipper lorry 94 ' Haulage lorry (unladen) 88 Haulage lorry 92 Sports car 92 Bus (old type) 87 Food lorry 101 Haulage lorry (diesel) 98 Motor Cycle 100 Cement mixer 94 Trailer lorry (heavily laden) 100 BLACKHEATH HILL 2.11.72 12.00-12.40 pm NEW CROSS ROAD 3.11.72 12.15-12.50 pm LEWISHAM HIGH STREET 6.11.72 12.20-1.00 pm Background noise 85 Background noise 82 Background noise 84 Container lorry 99 Bus (old type) 87 Bus (old type) 93 Cement mixer 98 Haulage lorry 88 Skip lorry 97 Sports car 97 Trailer lorry 91 Sand lorry 97 Bus (old type) 95 Motor cycle 88 Trailer lorry (heavily laden) 100 Sand lorry 100 Tipper lorry 91 Open lorry 95 Haulage lorry 98 Cement mixer 87 Sports car 96 Motor cycle 97 Sports car Coach 89 88 92 BLACKHEATH HILL 3.11.72 5.00-5.45 pm NEW CROSS ROAD 7.11.72 4.50-5.30 pm LEWISHAM HIGH STREET 8.11.72 5.15-5.45 pm Background noise 80 Background noise 81 Background noise 76 Container lorry 86 Petrol tanker 92 Bus (old type) 84 Trailer lorry 87 Bus (new type) 87 Sports car 92 Sports car 86 Bus (old type) 91 Coach 83 Haulage lorry 88 Cattle lorry 92 Diesel trailer 87 Bus (old type) 84 Haulage lorry (diesel) 89 Diesel lorry (heavily laden) 86 Motor cycle 85 Haulage trailer 88 Haulage lorry 85 ' Coach 84 Continental container lorry 101 Tarmac lorry and trailer 87 The details of readings taken on the 124 bus route during last summer are repeated as requested. Readings taken in ground floor front room of 49 Sandhurst Road, Catford 11.00 am - 6.6.72 Background noise 44 124 Buses 56 61 61 36 Buses 72 56 58 60 Vans and lorries 53 60 56 62 58 Cars 54 52 48 50 Readings taken in ground floor front room of 317 Torridon Road, Catford 11.30 am - 6.6.72 Background noise 46 124 Buses 63 60 Vans and lorries 63 64 70 58 62 Cars 60 54 and less 93 Readings taken in ground floor front room of 317 Torridon Road, Catford 8.30 am - 7.6.72 Background noise 54 124 Buses 64 64 68 Cars 56 55 59 54 and less Readings taken in parked car in Sandhurst Road with windows open 4.30-5.00 pm - 5.6.72 Background noise 60/65 124 Buses 80 34 90 100 99 36 Buses 80 88 Heavy lorries 96 85 Vans 78 77 75 . 82 84 Cars 86 71 82 73 80 77 01 83 81 37 78 94 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 1972, 1,733 new patients attending the Chest Clinic comprised of 391 men, 737 women and 105 children. General Practitioners also sent 5,832 patients for X-ray; the total attendance for medical care at the Clinic during the year was 17,400. The number of new Notifications of Tuberculosis remained the same as for 1971 viz 53. There are now 395 patients on the Tuberculosis Register. In addition during the year 07 new patients were seen with healed Tuberculosis. , BCG was given to-134 child contacts. a large variety of chest diseases were seen at the Chest Clinic, the bulk comprising chest infections, pleurisy, bronchitis and asthma. Again there were over 100 new cases of cancer of the lungs, with only a 10fa operable rate. 95 CHEST CLINIC, DEPTFORD I am indebted to Dr J P Rigby for the following report concerning the Chest Clinic at Harton Street, of which he is consultant physicians- The main feature of 1972 was a continuing decline in pulmonary tuberculosis in the Deptford area. Doubtless this is due to gradual eradication by energetic treatment following discovery by chest X-rays surveys and prevention by the giving of BCG vaccination to pre-school leaving children at the age of thirteen in London. There is, however, still some new tuberculosis found mainly in Carrington House, the largo Common Lodging House here. The response there to the periodic X-ray surveys has played its beneficial part and has been increased by inducements to individuals to attend the Unit. The Deptford Chest Clinic continues to survive nut is due for demolition before long. It will, however, rise like a Phoenix from the ashes and move elsewhere, either to the Miller General Hospital or the Greenwich District Hospital, where it is hoped that the patients will continue to be adequately followed up. The Deptford Chest Clinic has been worth its weight in gold to this locality as, since its inception in 1928 on this site, the Clinic has been the main means of getting rid of tuberculosis in Deptford. Many people will miss the Clinic which has done noble work. The detection and treatment of lung cancer remains one of the main occupations of this Clinic at the present time. Many cases of chest diseases and bronchitis are seen and treated along with other conditions. During 1972 fresh cohorts of heavy cigarette smokers of both sexes were seen and they were urged to reduce their smoking in order to improve their chest condition in this relatively polluted urban atmosphere. If anything, the men are the heaviest smokers, but in these days of liberation, the women are catching them up. 96 97 VENEREAL DISEASE NUMBER OF NEW CASES IN THE YEAR Treatment Centre Totals All Conditions Syphilis Gonorrhoea Other Conditions 1972 1971 1970 1969 1968 1972 1971 1970 1969 1968 1972 1971 1970 1969 1968 1972 1971 1970 1969 1968 Middlesex Hospital 184 147 87 93 79 2 1 3 4 - 15 14 12 10 20 167 132 72 79 59 Greenwich District Hospital 604 534 488 423 397 17 8 12 3 7 143 165 159 129 101 444 361 317 291 289 London Hospital 124 ; 182 120 118 122 3 5 1 3 3 16 38 28 26 34 105 139 91 89 85 St Thomas's Hospital 268 213 178 160 84 2 -- 2 2 1 35 37 34 31 13 231 176 142 127 70 St John's Hospital 710 856 754 560 591 7 13 11 4 9 113 154 153 102 119 590 689 590 454 463 Dreadnought Seamen's Hospital 309 314 225 220 177 6 5 3 3 2 72 81 53 73 40 231 228 169 144 135 St Giles' s Hospital 322 329 229 219 166 1 3 3 4 1 72 91 54 40 34 249 235 172 175 131 TOTALS 2,521 2,575 2,081 1,793 1,616 38 35 35 23 23 466 580 493 411 361 2017 1,960 1,553 1,359 1,232 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. 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 GP with abnormalities or positive smear result Well-women Cytology Clinics 1,517 191 Adult Screening Clinics 275 31 Family Planning Clinics 4,053 86 TOTAL 5,845 308 NURSING HOMES 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. The total number of beds provided is as follows: For chronic cases 54 For medical cases 14 For surgical cases (including 9 for abortions) 14 For expectant and nursing mothers (plus 8 cots) 22 Total (plus 8 cots) 104 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. 93 SUSPECTED CASE OF SMALLPOX On Saturday 30 July 1972 a general practitioner reported to the duty medical officer a case of chicken-pox where owing to the unusual distribution of the rash he wished to exclude the possibility of smallpox. Visits were made to the patient, a West Indian, by two members of the Health Department medical staff, and it was decided to call in the Area Smallpox Consultant. The patient had come to this country in 1959 and had not left it since. He had been vaccinated against smallpox in childhood, and probably also in 1959. There was no known contact with any recent arrivals from endemic areas abroad, nor with any cases of chickenpox. Specimens were taken by the Consultant for investigation at Colindale Public Health Laboratory, but it was felt that the case was probably one of chickenpox, and no other measures were taken, apart from confining the patient and his wife to the house. Early test results 36 hours later indicated that the case was not smallpox, and this was confirmed five days later. SUSPECTED FOOD POISONING IN A SCHOOL A sudden outbreak of an illness characterised by bouts of abdominal pain, vomiting and in some cases diarrhoea, occurred at Downderry Infants School, Downham, over the period 22 to 27 March 1972, The head teacher, three other teachers, seventy-six children and one school meals worker were affected, of whom fifty-six children and the four members of the teaching staff were taken ill during the night of 22/23 March, the remaining cases occurring in decreasing frequency over the next four days. The illness was comparatively mild and of short duration, lasting for twenty-four hours or less and in no case was hospital admission necessary. In view of the sudden onset of a large number of cases at one time, it was first necessary to exclude the possibility of a food or waterborne outbreak. Investigation failed to show any conclusive pattern in this respect and no single meal or item of food or drink appeared to be common to all patients; many of the children did not have their meals at school and of the staff who had a school dinner on 22 March, some had chosen a different meal from the menu from that served to the children. The meals for Downderry Infants School are prepared at the main kitchens at Churchdown School, which also provide meals for Churchdown School itself and for Downderry Junior School, as well as other schools in the area; no similar outbreaks occurred at these establishments. The kitchens were inspected and the staff questioned regarding recent illness etc., but no significant factors emerged. 99 Other possible bacterial causes were also considered in addition to food poisoning, although the clinical picture was not really suggestive of these possibilities. Public Health Inspectors visited fifty-eight homes of patients in the district and made relevant enquiries. Thirty-three samples of faeces and one sample of vomit were obtained from patients and sent for bacteriological tests, together with specimens of school milk and the specimen school meal from 22 March which had been retained in the kitchen according to the usual practice in ILEA schools. The water supply to this school was also analysed bactericlogically and chemically by the Metropolitan Water Board. All bacteriological and chemical tests carried out proved to be negative. Six samples of faeces were sent for virology tests and results were negative. However, this did not exclude a viral origin to the outbreak, as it is only occasionally that the causative virus can be isolated in occurrences of this sort. Further enquiries in neighbouring schools and among the general public in the area revealed that a number of sporadic cases of similar symptomatology had occurred in the district over the past few weeks. It was finally concluded that the outbreak was probably viral in origin although no fully satisfactory theory had been propounded to explain the occurrence of such a large number of cases simultaneously. No further cases were reported after 27 March 1972. The Medical Officer of Health acknowledges with thanks the cooperation of the ILEA, the Metropolitan Water Board, the staffs of the Southern Region Public Health Laboratory at Hither Green Hospital, and of the Virology Department at County Hall. Family doctors in the district were circularised with information throughout and details were also given informally to the Department of Health. 100 ADVICE BY MEDICAL OFFICER OF HEALTH TO OTHER DEPARTMENTS Medical advice from the Health Department is sought by other departments of the local authority for a variety of reasons including the health of children and adults, hygiene matters in Council establishments, and environmental factors affecting health. 1. Advice to Social Services Department (a) Adoption Medical assessments of children for adoption in 1972 43 including; Number examined by local authority doctor 43 Medical examinations of prospective adopters 94 Investigations into medical records of hospitals and family doctors on natural parents, and preliminary enquiries with medical hostories of prospective adopters 63 All assessments and reports are scrutinised by a Principal Medical officer who advises the adoption subcommittee on all medical aspects of adoption. (b) Fostering Medical examinations of children prior to fostering 24 Medical reports on prospective foster parents 68 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 The responsibility for arranging recuperative holidays is that of the Social' Services Department. Advice on medical recommendations has been provided in 404 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, eg 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. 101 2. 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 30 per week (average) (ii)applicants for transfer 20 per week (average) Special Medical Recommendations made 1972s 160 3. Advice to the Town Clerk and Chief Executive's Department (a) Mew 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 1972 1,296 Number of medical examinations carried out 308 (b) Existing Staff Medical advice is requested for various reasons, eg 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 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. 102 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. 103