LONDON COUNTY COUNCIL Report of the . County Medical Officer of Health and Principal School Medical Officer for the Year 1962 Published by the London County Council The County Hall, London,S.E.I 1963 No. 4219 4s. Od. Postage extra LONDON COUNTY COUNCIL Report of the County Medical Officer of Health and Principal School Medical Officer for the Year 1962 By J. A. SCOTT, o.b.e., m.d., f.r.c.p. county medical officer of health and principal school medical officer THE COUNTY HALL LONDON, S.E.I CONTENTS London Administrative County— Vital Statistics (Summary) page 3 Vital Statistics 4 Infectious Diseases 16 Tuberculosis 25 General Public Health 34 Scientific Branch 40 Health Service Premises 43 Care of Mothers and Young Children 47 Domiciliary Midwifery 54 Health Visiting 58 Home Nursing 59 Home Help 61 Immunisation and Vaccination 62 London Ambulance Service 66 Prevention of Illness: Care and After-Care 71 Mental Health 75 School Health Service 82 Dental Services 94 Staff 99 Finance 101 Visitors to the Department 102 Reports by the Divisional Medical Officers 103 Appendices: (a) Facts and figures from the 1961 Census 119 (b) Deafness 137 (c) Venereal diseases 144 (d) Staff of the Public Health Department 148 (e) Statistics of work carried out by the Metropolitan Boroughs 149 Index 151 2 LONDON ADMINISTRATIVE COUNTY VITAL STATISTICS, 1962 Figures in brackets are for 1961 Population: Area comparability factors: Males 1,500,000 }3,186,000 (3,180,000) Births 0.90 (0.90) Females 1,686,000 Deaths 0.97 (0.96) Number of marriages registered: 33,983 (33,579) Live births: Legitimate 53,689 (52,420) Illegitimate live births Illegitimate 8,835 (7,632) }62,524 (60,052) per cent. of total live births: 14.1(12.7) Live birth rate per 1,000 population: 19.6 (18.9) (adjusted rate 17.6 (17.0)) Stillbirths: Legitimate 848 (913) }1,054 (1,103) Illegitimate 206 (190) Stillbirth rate per 1,000 live and stillbirths: 16.6 (18.0) Total live and stillbirths: 63,578 (61,155) Deaths: Males 19,464 (19,108) }38,346 (37,915) Females 18,882 (18,807) Death rate per 1,000 population: 12.0 (11.9) (adjusted rate 11.7 (11.4)) Deaths of infants: Legitimate Illegitimate Total Under 1 month 771 (799) 182 (154) 953 (953) 1 month to 1 year 308 (295) 55 (34) 363 (329) Total under 1 year 1,079(1,094) 237 (188) 1,316 (1,282) Infant mortality rate: (per 1,000 live births) 20.1 (20.9) 26.8 (24.6) 21.0 (21.4) Neo-natal mortality rate: „ „ „ „ 14.4 (15.2) 20.6 (20.2) 15.2 (15.9) Early neo-natal mortality rate: „ „ „ „ 12.6 (13.7) 18.6 (18.3) 13.4 (14.3) Perinatal mortality rate: (per 1,000 total births) 27.9 (30.5) 40.9 (42.2) 29.8 (32.0) Maternal mortality: Rate per 1,000 Post- Other pregnancy live and abortion and childbirth Total stillbirths Deaths from sepsis 7 (14) — (—) 7 (14) Deaths from other causes 5 (4) 21 (27) 26(31) Total 12 (18) 21 (27) 33 (45) 0.52 (0.74) 3 VITAL STATISTICS* Population Table (i)— Home population †, 1953-62 (Figures in thousands) Year Mid-year estimate of population by the Registrar General, by age groups Average age (years) Total 0-4 5-14 15-24 25-44 45-64 65+ 1953 3,343 244 413 410 1,072 826 378 36.7 1954 3,322 234 425 394 1,056 827 386 36.9 1955 3,295 230 421 391 1,037 829 387 37.1 1956 3,273 229 427 384 1,018 829 386 37.1 1957 3,254 230 425 383 974 843 399 37.4 1958 3,225 231 418 387 949 843 397 37.5 1959 3,204 236 409 394 925 842 398 37.5 1960 3,194 241 403 398 905 846 401 37.6 1961 3,180 247 396 404 893 839 401 37.5 1962 M 1,500 127 193 200 447 388 145 35.8 F 1,686 121 185 222 447 450 261 39.4 3,186 248 378 422 894 838 406 37.7 † Resident civilian population, plus any British, Commonwealth or Foreign Armed Forces stationed in the area. There was a net increase of 6,000 in the estimated population from the previous year's figure; this is not necessarily a reversal of the downward trend of the past ten years but rather an adjustment of the estimate in the light of the results of the 1961 census. The main changes in the estimate are the loss of 18,000 in the school age population (5-14 years) offset by a corresponding increase at 15-24 years, as children born in the years of high fertility immediately after the war moved into the next higher age range. Fertility Table (ii)— Live births and stillbirths, 1953-62 Year Live births Stillbirths No. Rate per 1,000 population No. Rate per 1,000 total births (live and still) 1953 50,992 15.3 1,088 20.9 1954 50,745 15.3 1,029 19.9 1955 49,826 15.1 1,034 20.3 1956 52,171 15.9 1,070 20.1 1957 52,733 16.2 1,083 20.1 1958 54,152 16.8 1,102 19.9 1959 55,191 17.2 1,085 19.3 1960 57,368 18.0 1,052 18.0 1961 60,052 18.9 1,103 18.0 1962 62,524 19.6 1,054 16.6 * The statistics given are based on the latest information available from the Registrar General: instances have occurred in the past in which figures have been subsequently corrected so that data for a previous year may differ from that published in the Annual Report for that year. 4 Live births— There were 71,801 live births registered in London in the year; after correction for residence the final figure of births allocated to London was 62,524 (32,127 boys-30,397 girls), an increase of 2,472 over 1961, giving a birth rate of 19.6 per 1,000 population compared with 18-9 in 1961 and 18.0 in 1960. The post-war trend in London followed closely that for England and Wales until 1956 when the rise in the London rate preceded a similar rise in the country as a whole; in 1957 the two rates were again almost identical, but since then the crude London rate has continued to exceed the national rate by an increasing margin. The major factor contributing to the increased birth rate, both local and national, is the increased proportion of women of child-bearing age who are married (see Appendix A table (iii)). The two rates are not, however, strictly comparable because the proportion of women of child-bearing age in the population is greater in London than in England and Wales; adjusting for this difference by multiplying the crude rate by the Registrar General's area comparability factor for London births (0.90) the rate becomes 17.6. The crude birth rate for the past 12 years is shown in figure 1 below, together with the national rate and the adjusted birth rate. 5 Illegitimacy— Table (iii)— Illegitimate live births in London (A.C.) and percentages for London and England and Wales, 1953-62 Year Illegitimate live births Illegitimate live births as a percentage of total live births Ratio London/ England and Wales London A.C. England and Wales 1953 3,645 7.1 4.7 1.51 1954 3,615 7.1 4.7 1.51 1955 3,827 7.7 4.6 1.67 1956 4,434 8.5 4.8 1.77 1957 4,686 8.9 4.8 1.85 1958 5,343 9.9 4.9 2.02 1959 5,765 10.4 5.1 2.03 1960 6,530 11.4 5.4 2.11 1961 7,632 12.7 6.3 2.02 1962 8,835 14.1 6.6 2.13 The percentage of illegitimate live births has increased year by year for the past eight years in London: nationally the rise in illegitimacy has been much slower, the London percentage which was about one and a half times that for England and Wales ten years ago is currently more than twice as high. One in every seven babies born of London ' residents ' in 1962 was illegitimate and the age of the mothers of these illegitimate children is shown in table (iv) below. Table (iv)— Illegitimate live births by age of mother Age of mother (a) (years) London (A.C.) England and Wales 1961 % 1961 1962 No. % No. % 13 4 0.1 1 0.01 0.1 14 11 0.1 19 0.2 0.3 15 61 0.8 104 1.2 1.5 16 147 1.9 168 1.9 3.3 17 239 3.1 297 3.4 5.4 18 388 5.1 440 5.0 6.7 19 508 6.7 603 6.8 7.3 20-24 2,780 36.4 3,254 36.8 31.8 25-29 1,714 22.5 2,017 22.8 19.2 30-34 998 13.1 1,112 12.6 12.8 35-39 581 7.6 610 6.9 8.2 40-44 186 2.4 196 2.2 3.1 45+ 15 0.2 14 0.2 0.3 Total 7,632 100.0 8,835 100.0 100.0 (a) Cases in which the mother's age was not stated (40 in 1961, 42 in 1962) have been proportionally distributed. 6 It has been remarked in previous years that a complex of factors probably accounts for the steeper rise in London— proportionately more single women (37.0 per cent. of those aged 16-44 years in London compared with 26.9 per cent. in England and Wales), a continuous influx of unmarried women, many of whom are already pregnant, a high immigrant element in the population and the facilities which London can offer to an unmarried mother in the way of anonymity, ante-natal care and (support from moral welfare organisations.) The following table gives details of women seen by the moral welfare organisations in the 12 months ended September 1962, from which it will be seen that 940 (25.7 per cent.) were pregnant on arrival in London and that, in all, 1,565 (42.8 per cent.) were not British. It should be remembered that these components of the illegitimate births are minima; the moral welfare organisations do not deal with all unmarried mothers, though doubtless they will tend to deal with proportionately more of the non-Londoners. Table (v)— Unmarried mothers seen by moral welfare associations in London, lst October, 1961-30th September, 1962. (Figures in brackets are for 1960-1961) British (U.K.) Eire European West Indian Other Total Non-Londoners pregnant on arrival in London 506 (468) 252 (308) 59 (49) 78 (137) 45 (29) 940 (991) *Non-Londoners not pregnant on arrival in London 62 (64) 53 (49) 11 (8) 19 (40) 14 (8) 159 (169) Resident in London one year or more 1,527 (1,306) 460 (434) 104 (92) 386 (260) 84 (36) 2,561 (2,128) 2,095 (1,838) 765 (791) 174 (149) 483 (437) 143 (73) 3,660 (3,288) * Had lived in London less than 12 months before making contact with moral welfare association. The percentage of illegitimate births for the metropolitan boroughs for the years 1961 and 1962 is shown in table (vi) and range from about five per cent. in Bermondsey to 25 per cent. in Paddington. The table also shows, as at the census 1961, the percentage of the total female population who were single and aged between 16 and 44 years and the percentage of all females born outside the United Kingdom, sub-divided into those born in the Irish Republic, the West Indies, other Commonwealth countries and foreign countries or at sea. Regrettably, place of birth cannot be related to the specific female population aged 16-44 years. 7 Table (vi)— Illegitimate live births by metropolitan boroughs, 1961 and 1962 and certain population indices for 1961. Illegitimate live births as a percentage of total live births Single women aged 16-44 as a percentage of the total female population Foreign born females as a percentage of the total female population 1962 1961 Total Irish Republic (a) West Indies Other Commonwealth (b) Foreign countries, at sea and birthplace not stated (c) Division 1 Chelsea 12.3 13.6 22.2 23.2 4.7 0.6 6.1 11.8 Fulham 11.8 10.1 13.8 14.2 5.2 1.4 2.7 4.9 Hammersmith 15.7 13.5 15.2 18.8 9.0 2.6 2.3 4.9 Kensington 19.7 18.2 28.4 32.5 6.7 2.5 9.1 14.2 Division 2 Hampstead 14.6 13.7 23.8 31.7 7.0 1.1 5.6 18.0 Paddington 25.4 21.5 20.2 30.6 9.6 4.1 5.1 11.8 St. Marylebone 12.4 12.1 22.0 27.3 5.3 0.3 5.1 16.6 St. Pancras 15.5 13.4 17.2 20.6 7.5 1.2 5.2 6.7 Westminster, City of 15.4 12.8 20.9 28.1 6.9 0.2 5.3 15.7 Division 3 Finsbury 7.3 7.1 12.2 10.9 4.1 0.2 2.6 4.0 Holborn 14.9 10.6 29.5 25.4 7.4 0.4 4.9 12.7 Islington 15.8 13.9 13.4 18.7 6.3 3.1 5.3 4.0 Division 4 Hackney 17.2 15.8 11.8 14.5 2.4 4.2 1.9 6.0 Shoreditch 9.6 8.7 10.9 5.6 2.0 (d) 1.7 1.9 Stoke Newington 14.4 16.4 12.4 19.1 4.1 4.6 3.3 7.1 Division 5 Bethnal Green 10.9 9.6 10.8 6.6 2.0 0.7 1.3 2.6 City of London 10.0 25.9 26.0 14.2 3.8 (d) 2.3 8.1 Poplar 10.8 11.0 11.3 5.2 1.8 1.4 0.7 1.3 Stepney 14.8 15.3 13.3 12.5 2.9 1.4 2.3 5.9 Division 6 Deptford 13.5 11.7 10.9 7.8 2.3 2.3 1.2 2.0 Greenwich 6.6 6.6 12.8 5.6 2.0 0.4 1.3 1.9 Woolwich 6.7 5.8 10.1 4.7 1.8 0.1 1.3 1.5 Division 7 Camberwell 12.5 11.4 11.7 8.7 2.9 2.2 1.5 2.1 Lewisham 10.2 8.8 11.4 6.3 1.8 1.2 1.2 2.1 Division 8 Bermondsey 5.4 4.4 10.5 4.3 2.1 (d) 1.0 1.2 Lambeth 17.3 15.8 12.5 13.5 4.1 4.0 2.0 3.4 Southwark 9.7 9.2 10.9 7.6 3.9 0.4 1.4 1.9 Division 9 Battersea 15.5 11.1 12.0 10.4 3.2 2.7 1.6 2.9 Wandsworth 11.8 10.9 12.5 11.4 3.6 1.4 2.3 4.1 London County 14.1 12.7 14.7 15.2 4.4 1.9 3.1 5.8 (a) Including born in Ireland, part not stated. (b) Commonwealth countries, colonies and protectorates of Africa, Asia, Canada, Gibraltar, Malta, Gozo and Oceania. (c) Europe, U.S.S.R., non-Commonwealth countries of Africa, North and South America and Asia. (d) Fewer than 2,000 foreign born in the area and therefore data not tabulated. 8 Generally, where illegitimacy is high the percentage of single women is also high and conversely where illegitimacy is low the percentage of single women also tends to be lower than average. Overall, illegitimacy is higher north of the river than south and the proportion of single women and foreign born is likewise higher. The association between illegitimacy and these different attributes of the population can be expressed in mathematical terms by correlation coefficients* for each of the indices and these are shown in table (vii) below for the 1961 figures. (The City of London was excluded from these calculations because of the relatively small figures on which the indices are based.) Table (vii)— Relation between illegitimacy and certain population indices for 1961 Percentage Correlation coefficient Illegitimacy and Single women +0.447 „ „ Foreign born: Aggregate +0.699 Irish +0.587 West Indies +0.747 Other Commonwealth +0.584 Foreign countries +0.525 All the correlation coefficients shown are statistically significant but the least significant is that between illegitimacy and the percentage of single women. This would seem to indicate that there are varying degrees of proneness to illegitimacy among the population of single women living in the different boroughs of London— Opinions will vary as to the reasons for these variations which are probably due to a complex of causes such as local mores, race, religion and social class; the table deals with but one of these, the place of birth, but as indicated earlier it is the place of birth of the total female population and not that of the unmarried women of child bearing age. There is some evidence of the extent of illegitimacy by the foreign born population in the Moral Welfare Association figures (table (v)) but this is a biased sample of less than half the total illegitimate births unduly weighted by non-Londoners, especially the foreign born. An exact quantitative assessment would require an amendment to the Population (Statistics) Acts, so that the appropriate question was asked at the time of registration of birth. On this imperfect basis the degree of association of illegitimacy is greatest with the proportion of women born in the West Indies, followed by the Irish, other Commonwealth and foreign countries all of the same order; this is not wholly surprising as legal marriage is not the normal status of West Indian women (it is understood that at their 1953 census only 33 per cent. of Jamaican mothers were married, compared with a corresponding figure of 95 per cent. for mothers of children born in England and Wales in 1953). Though association is not necessarily causation and the population indices used are somewhat imperfect, there is sufficient positive indication in the figures of table (vi) to suggest that some at least of the high illegitimacy rate is accounted for by the immigrant population, quite apart from the fact that at least another 940 non-Londoners arrived in the county pregnant (see table (v)). It may well be that as and when the immigrant population becomes assimilated there may be a lessening of the amount of illegitimacy. * Correlation coefficient.— A measure of the degree of association found between two characteristics in a series of observations (on the assumption that the relationship between the two characteristics is adequately described by a straight line). Its value must lie between +1 and —1, either plus or minus 1 denoting complete dependence of one characteristic on the other and 0 denoting no association whatever between them. A plus sign shows that an upward movement of one characteristic is accompanied by an upward movement in the other; a negative sign that an upward movement of one is accompanied by a downward movement of the other. 9 Mortality The total death rate at 12.0 per 1,000 population was higher than the previous year (11.9) and slightly above the average of the last decade. Leading causes of death— The leading causes of death in London in 1962 were as follows: Deaths Rate per 1,000 population Diseases of the heart 11,956 3.75 Cancer 7,787 2.44 Bronchitis, pneumonia* 5,509 1.73 Vascular lesions of the central nervous system 3,902 1.22 Other circulatory 1,926 0.60 Violent causes 1,773 0.56 Digestive diseases 1,190 0.37 Diseases of early infancy (international classification nos. 760-776) 767 0.28 Congenital malformations (0-4 weeks) 141 Diseases of genito-urinary system 672 0.21 Other respiratory including influenza 497 0.16 Tuberculosis (all forms) 279 0.09 All other causes 1,947 0.61 Total 38,346 12.02 * Excluding pneumonia of the new born (under 4 weeks) which is included in ' Diseases of early infancy'. The ranking order of the leading causes of death has remained unchanged since 1954. Heart disease was discussed in detail in my report for 1956, cancer in 1958 and bronchitis and pneumonia in 1960. Cancer— The cancer death-rate for all ages was 2.44 per 1,000 in 1962— a very slight decrease from the previous year. Cancer is, however, largely a disease of the later half of life and in order to eliminate variations caused by a changing age/sex composition of the population rates for specific age/sex groups are shown below: Table (viii)— Cancer mortality rates per 1,000 living, 1953-62 Age and Sex 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 Males: 0-24 0.14 0.12 0.11 0.14 0.11 0.09 0.10 0.12 0.11 0.11 25-44 0.46 0.41 0.40 0.43 0.37 0.42 0.40 0.38 0.37 0.38 45-64 4.28 4.31 4.50 4.51 4.55 4.52 4.46 4.75 4.52 4.53 65+ 15.69 15.29 15.73 15.77 15.29 16.01 15.20 15.74 15.72 15.40 All Males 2.68 2.64 2.73 2.76 2.77 2.85 2.76 2.90 2.83 2.81 Females: 0-24 0.07 0.06 0.07 0.09 0.07 0.10 0.07 0.07 0.07 0.08 25-44 0.51 0.43 0.45 0.50 0.47 0.52 0.51 0.52 0.50 0.43 45-64 2.85 2.85 2.93 2.77 2.97 2.71 2.63 2.82 2.72 2.81 65+ 8.73 8.39 8.43 8.75 8.34 8.50 8.18 8.44 8.02 7.93 All Females 2.04 2.02 2.08 2.12 2.16 2.15 2.09 2.20 2.11 2.12 All Persons 2.34 2.31 2.39 2.42 2.44 2.47 2.40 2.53 2.45 2.44 10 Lung cancer— The lung has become the principal site for cancer in males and the table below shows, for three age groups, the steep rise that has occurred in the last decade together with, for comparison, the corresponding figures for females. Table (ix)— Deaths and death rates from cancer of the lung by age and sex, 1953-62 (Rates per 1,000 population) Year Age 25-44 45-64 65+ No. Rate No. Rate No. Rate Males: 1953 81 0.15 734 1.96 614 4.26 1954 64 0.12 773 2.06 625 4.34 1955 62 0.12 810 2.14 651 4.55 1956 65 0.13 853 2.25 718 5.06 1957 37 0.08 891 2.31 723 4.95 1958 52 0.11 883 2.29 786 5.46 1959 61 0.13 907 2.34 788 5.51 1960 55 0.12 958 2.46 857 5.99 1961 44 0.10 883 2.28 832 5.82 1962 37 0.08 903 2.33 860 5.93 Females: 1953 18 0.03 119 0.26 139 0.59 1954 19 0.04 137 0.30 164 0.68 1955 13 0.02 151 0.33 174 0.71 1956 13 0.03 109 0.24 154 0.63 1957 19 0.04 142 0.31 176 0.70 1958 22 0.05 124 0.27 183 0.72 1959 22 0.05 134 0.29 157 0.62 1960 26 0.06 157 0.34 190 0.74 1961 24 0.05 151 0.33 184 0.71 1962 13 0.03 153 0.34 189 0.72 It is too soon to say with any conviction but the figures for the past year or so suggest that the continuing upward trend in lung cancer in this century may have been halted in London. 11 Infant mortality Table (x)— Infant mortality, 1962 Age at death Rates per 1,000 live births Under 1 day 1 to 6 days 1 to 3 wks. 1 to 11 ninths Total under 1 yr. Early neonatal Neonatal Total infant mortality Legitimate Males 238 177 59 171 645 150 17.2 23.3 Females 169 92 36 137 434 10.0 11.4 16.7 Total 407 269 95 308 1,079 12.6 14.4 20.1 1961 426 290 83 295 1,094 13.7 15.2 20.9 Illegitimate Males 58 31 13 30 132 19.8 22.7 29.4 Females 45 30 5 25 105 17.3 18.4 24.2 Total 103 61 18 55 237 18.6 20.6 26.8 1961 99 41 14 34 188 18.3 20.2 24.6 Total legitimate and illegitimate Males 296 208 72 201 777 15.7 17.9 24.2 Females 214 122 41 162 539 11.1 12.4 17.7 Both sexes 510 330 113 363 1,316 13.4 15.2 21.0 1961 525 331 97 329 1,282 14.3 15.9 21.3 The pattern of infant mortality remains much the same as in the previous year. The trend since 1953 is as follows: Table (xi)— Infant mortality by cause, 1953-62 (Rates per 1,000 live births) Cause of death 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 Whooping cough 0.27 0.06 0.06 0.04 0.02 — 0.05 0.05 - 0.03 Tuberculosis 0.14 0.08 — — — — 0.02 0.03 0.03 — Measles 0.06 0.02 0.10 - - - - — 0.03 0.02 Bronchitis and pneumonia 4.04 2.70 3.57 3.32 2.88 3.45 3.50 3.63 3.18 3.63 Gastro-enteritis 1.27 0.43 0.48 0.35 0.42 0.31 0.27 0.16 0.30 0.37 Congenital malformations 3.41 3.51 3.43 3.70 3.96 4.51 4.75 4.32 3.94 3.68 Injury at birth 2.71 2.34 2.59 2.64 2.98 2.27 2.46 2.55 2.81 2.45 Post-natal asphyxia and atelectasis 3.90 4.06 4.32 3.66 4.17 4.08 3.59 3.63 3.61 3.63 Haemolytic disease 0.53 0.55 0.58 0.61 0.51 0.44 0.51 0.54 0.37 0.34 Immaturity 3.98 3.70 4.67 4.10 4.27 4.69 3.86 3.71 3.85 3.47 Convulsions — 0.02 — 0.02 — — — — — — Accidental mechanical suffocation 0.14 0.12 0.06 0.21 0.23 0.13 0.16 0.09 0.13 0.16 Other causes 3.40 3.04 3.35 2.55 2.56 2.60 3.26 2.77 3.10 3.28 All causes 24 21 23 21 22 22 22 21 21 21 12 Mortality— A comparison with England and Wales for both neo-natal (deaths in the first four weeks) and infant mortality (deaths in the first year) is as follows: (Rates per 1,000 live births) Year Neo-natal mortality Infant mortality London England and Wales London England and Wales 1953 16.1 17.7 23.9 26.8 1954 15.1 17.7 20.7 25.4 1955 16.7 17.3 23.2 24.9 1956 15.9 16.8 21.2 23.8 1957 16.3 16.5 22.0 23.1 1958 16.6 16.2 22.5 22.5 1959 15.7 15.8 22.4 22.2 1960 15.4 15.6 21.5 21.7 1961 15.9 15.5 21.4 21.6 1962 15.2 15.1 21.0 21.6 As regards neo-natal mortality there were 953 deaths in London; of this number 592 occurred in premature infants. An analysis of the total number of premature births by birth weight and mortality is shown in the following table. Corresponding figures of domiciliary confinements are shown in the section on domiciliary midwifery on page 57. Table (xii)— Prematurity and mortality by birth weight, 1962. Weight Number Proportion per 100 live premature infants Died within 24 hours Survived 28 days Number Per 100 live premature infants Number Per 100 live premature infants 3 lb. 4 oz. or less 579 12.0 239 41.3 233 40.2 3 lb. 5 oz. to 4 lb. 6 oz. 830 17.2 51 6.1 722 87.0 4 lb. 7 oz. to 4 lb. 15 oz. 942 19.5 26 2.8 881 93.5 5 lb. 0 oz. to 5 lb. 8 oz. 2,485 51.3 26 1.0 2,408 96.9 All premature babies 4,836 100.0 342 7.1 4,244 87.8 Perinatal mortality— Comparative rates for perinatal mortality (stillbirths and deaths in the first week of life) per 1,000 total births are given below for London and England and Wales. Year London England and Wales Year London England and Wales 1953 34.7 36.9 1958 34.3 35.1 1954 32.8 38.1 1959 32.7 34.2 1955 34.8 37.4 1960 31.2 32.9 1956 33.3 36.7 1961 32.0 32.2 1957 34.2 36.3 1962 29.8 30.8 The deaths in the first day of life are shown in table (x) on page 12. It will be apparent from the preceding section that premature babies provided the major share. The cause of stillbirth, the other component of perinatal mortality, was not known until certification was introduced on 1 October, 1960 under the Population (Statistics) Act, 1960. The following table gives the causes for 1962, but on the basis of the 1960 certificates only about two-thirds of them were certified by medical practitioners. 13 Table (xiii)— Causes of stillbirth, 1962 Code No. * Cause Male Female Number Per cent. Number Per cent. Y.30 Chronic disease in mother 27 4.9 14 2.8 Y.31 Acute disease in mother 2 0.4 3 0.6 Y.32 Diseases and conditions of pregnancy and childbirth: (1) Ectopic gestation - - - - (2) Haemorrhage 26 4.7 14 2.8 (3 and 4) Toxaemia 66 11.9 49 9.8 (5) Infection 1 0.2 2 0.4 Y.34 Difficulties in labour 57 10.3 37 7.4 Y.35 Other causes in mother 3 0.5 3 0.6 Y.36 Placental and cord conditions 168 30.1 136 27.4 Y.37 Birth injury 17 3.1 11 2.2 Y.38 Congenital malformation of foetus 52 9.4 90 18.0 Y.39 Diseases of foetus and ill-defined causes: (0-3) Diseases of foetus 22 4.0 23 4.6 (4-6) Other ill-defined or unspecified cause 114 20.5 117 23.4 Total 555 100 499 100 * International classification of causes of stillbirth. Maternal mortality— Table (xiv)— Maternal mortality, 1953-62 Year Live births and stillbirths Deaths in pregnancy or childbirth excluding abortion Postabortion deaths Total maternal deaths No. Rate per 1,000 total births 1953 52,080 21 16 37 0.71 1954 51,774 28 6 34 0.66 1955 50,860 31 8 39 0.77 1956 53,241 16 11 27 0.51 1957 53,816 15 13 28 0.52 1958 55,254 14 19 33 0.60 1959 56,276 22 12 34 0.60 1960 58,420 15 11 26 0.45 1961 61,155 27 18 45 0.74 1962* 63,578 21 12 33 0.52 *For the seventh year running none of the deaths in pregnancy or childbirth was due to sepsis; 7 of the 12 post-abortion deaths came under the category of abortion with sepsis Summary tables— Tables summarising the more important of these vital statistics, (a) by metropolitan boroughs and (b) showing the secular trend for the county, are to be found on pages 19 and 20. 14 Air pollution The table below shows for the past five winters the average levels of pollution based on the seven recording stations described in appendix B to my report for 1956. Winter averages of air pollution Average daily readings of seven volumetric recording stations Micrograms per cubic metre Winter 'Smoke' 'Sulphur dioxide' Ratio smoke/SO2 1958-1959 309 340 0.9 1959-1960 206 275 0.7 1960-1961 200 277 0.7 1961-1962 182 302 0.6 1962-1963 173 365 0.5 There has been a noticeable downward trend in the smoke index (a trend which began in 1956-57) but the sulphur dioxide figures, which showed a diminution between 1958-59 and 1960-61, increased slightly in 1961-62 and rose again in this last winter. It must be borne in mind that the figures are for the (six) winter months, including those of December 1962 and January and February 1963 when there was an exceptionally cold spell (the coldest since 1871); this in turn led to a very considerable increase in the demand for fuel for heating purposes. The sulphur pollution figures for December and January were higher than for any of the previous four winters and that for February was the highest since 1958-59. With increased fuel consumption there will be inevitably more pollution; the fact that the smoke figures were not correspondingly higher is a natural accompaniment of the Clean Air Act, 1956 in which London leads the rest of the country with 25 per cent. of the area covered by Smoke Control Orders in force. A particularly foggy incident occurred over the five days 3-7 December; the interest on this occasion was that the meteorological conditions were similar to those of the great ' smog' of December 1952. However, though the concentrations of sulphur were similar to those of 1952, the concentration of smoke was much lower. Excess mortality due to fog was estimated at 340 deaths compared with 2,000 in 1952, 480 in January 1956 and 300 in December 1957 (excluding those arising from the Lewisham rail disaster). A detailed account of this episode was given in ' The Medical Officer ' of 28 April, 1963 (109, 250-252). The weather 1962 was a year of about average temperature and sunshine with a lower than usual rainfall. However, these averages mask seasonal variations (table V 4, page 22). January and February were relatively warm and sunny, followed by a cold spring and summer with rainfall below average until August and a deficiency of sunshine, except for the month of June. December sunshine was twice the average but temperatures were low, heralding the very cold weather experienced in the following January and February. B 15 INFECTIOUS DISEASES Notifications of infectious diseases for the years 1953-1962 are shown in table V.5, page 23, those for certain such diseases by age and sex for the 13 four-weekly periods of the year 1962 are given in table V.6, page 24 and deaths from infectious diseases are included in table V.3, page 21. Diarrhoea and enteritis— There were 25 deaths under the age of two years from diarrhoea and enteritis, compared with 20 in the previous year. This represents a rate of 0.40 per 1,000 live births and shows a continuation of the low figures of recent years. Diphtheria— For the first time since notification was introduced no cases of diphtheria were reported in London during the year. Credit for this state of affairs must go partly to the diphtheria immunisation campaign and partly to the effective control measures that have been used in recent years in localities where cases were reported. Dysentery— During the year dysentery notifications rose to 2,814, compared with 1,812 in 1961. Once again there were more cases in the pre-school age group than in school children. Enteric fever— Incidence continued at a low level; no notable outbreaks occurred. Most cases in recent years have been of the sporadic kind. Influenza— The number of deaths from influenza was about the average level for a nonepidemic year. Leptospirosis— For the sixth successive year there was no case of leptospirosis reported among the Council's sewer workers. Measles— 1962 was an inter-epidemic year and there was thus a marked fall in the number of notifications from 1961. Only one death occurred during the year from measles. Ophthalmia neonatorum— There was an increase in the number of notifications from 100 in 1961 to 188 in 1962, the rate (per 1,000 registered live births) changing from 1.46 to 2.62. The increase was in the boroughs of Hampstead, Islington and Lambeth; the notifications came mainly from the principal maternity hospitals in each of these boroughs. Cases among children born to London residents totalled 108, compared with 70 the previous year; in 97 cases vision was unimpaired, nine removed and two were still under observation at the end of the year. Poliomyelitis— A continued reduction in the numbers of notifications of poliomyelitis occurred during the year. During the previous three years it had been noted that there was an unduly high proportion of cases in the 0-4 years age group; in 1962 this proportion moved back towards the previous level. Table (i)— Poliomyelitis notifications by age, 1949-62 Year 0-4 years 5-14 years 15 years and over Total No. % No. % No. % No. 1949 356 53.3 173 25.9 139 20.8 668 1950 150 34.9 149 34.6 131 30.5 430 1951 27 24.1 45 40.2 40 35.7 112 1952 95 30.7 105 34.0 109 35.3 309 1953 116 35.0 104 31.3 112 33.7 332 1954 42 33.6 41 32.8 42 33.6 125 1955 334 34.8 391 40.7 235 24.5 960 1956 88 31.5 115 41.2 76 27.3 279 1957 103 31.8 131 40.4 90 27.8 324 1958 40 37.4 36 33.6 31 29.0 107 1959 108 51.4 66 31.4 36 17.2 210 1960 52 59.8 17 19.5 18 20.7 87 1961 22 50.0 12 27.3 10 22.7 44 1962 9 39.1 5 21.8 9 39.1 23 16 As a result of scrutiny of the clinical and virological findings, a final diagnosis was made in respect of each notification. The diagnosis of paralytic poliomyelitis was made on clinical grounds, although virological confirmation was obtained in the majority of cases. A diagnosis of non-paralytic poliomyelitis was made only in cases in which poliomyelitis virus was present on the stool, or when serological evidence supported the diagnosis. Table (ii) gives an analysis of the original notifications according to the final diagnosis. Table (ii)— Final diagnosis of poliomyelitis notifications, 1962 Final diagnosis Notified as paralytic Notified as non-paralytic Total (all ages) 0-4 years 5-14 years 15+ years Total 0-4 years 5-14 years 15+ years Total Paralytic 6 3 1 16 - - - - 16 Non-paralytic — — — — 2 — 1 3 3 Not poliomyelitis 1 2 — 3 — — 1 1 4 Total 7 5 7 19 2 — 2 4 23 Of the 19 cases notified as paralytic, three proved to be not polio and of the four cases notified as non-paralytic, one was not poliomyelitis. In the 16 cases finally diagnosed as paralytic poliomyelitis, the numbers vaccinated with one, two, three or four doses of poliomyelitis vaccine and not vaccinated were as follows: Table (iii)— Vaccinal state of confirmed cases of poliomyelitis, 1962 Age Vaccinated Not vaccinated Total No. % No. % No. % (a) Paralytic cases 0-4 years - - 6 100 6 100 5-14 „ - - 3 100 3 100 15+ 2 29 5 71 7 100 Total 2 12 14 88 16 100 (b) Non-paralytic cases 0-4 years 1 50 1 50 2 100 5-14 „ — — — — — — 15+ „ 1 100 — — 1 100 Total 2 67 1 33 3 100 Of the two vaccinated cases with the paralytic form of the disease (both over 15 years of age), one had received two injections and one had had three injections. In the nonparalytic cases, one had received three injections and the other case four injections. It is estimated that by the end of the year about 70 per cent. of children aged six months14 years had received three injections or doses of poliomyelitis vaccine and 40 per cent. of the eligible schoolchildren (5-12 years) had had a fourth injection. Applying the figure of 70 per cent. to the child population at risk gives the following incidence rates for the paralytic form of the disease: Population Cases per 6 months-14 years Cases million at risk Vaccinated 417,000 — — Not vaccinated 179,000 9 50 17 B* In previous years this analysis has been made on the basis of two injections of Salk vaccine and calculated in this way the incidence rate in 1961 in the unvaccinated children was about 18 times that in the vaccinated. With the introduction of oral vaccine in early 1962 (a complete course of which comprises three doses) it is reasonable to equate three doses with three injections of Salk vaccine and recalculation of the figures for previous years (since three injections assumed worthwhile proportions) gives the following: Table (iv)— Poliomyelitis case rates, vaccinated and not vaccinated populations Year Per cent. of population 6 months-14 years vaccinated (3 injections or 3 doses) Case rates per million at risk Ratio NOT vaccinated/ vaccinated NOT vaccinated Vaccinated 1960 49 128 6 21:1 1961 56 74 NIL 8 1962 70 50 NIL 8 The last column shows that the average degree of resistance of the immunised population has become substantially greater since the introduction of third injections/doses in quantity and that the unvaccinated population has also benefited from the general lowering of the incidence of the disease, which was the purpose of the introduction of vaccination. A similar analysis of the differential incidence rates between the vaccinated and unvaccinated in the older age groups cannot be made with any degree of reasonable accuracy because the number of cases of poliomyelitis is so small and because of the difficulty in arriving at an estimate of the exposed-to-risk population of vaccinated persons with so many Londoners vaccinated elsewhere. Smallpox— There was one case of smallpox in Woolwich. The origin of this infection was not determined and no secondary cases arose. In spite of the advice of the medical officers of health that mass vaccination was inadvisable and unnecessary, large numbers of persons presented themselves for vaccination (see page 63). Whooping cough— Notifications numbered 619, a new low record. There were two deaths in the year from whooping cough. 18 Table V.l— Vital statistics—Metropolitan Boroughs and the Administrative County of London, 1962 (a) Metropolitan Boroughs Estimated home population mid 1962 Live birth rate Death rate (all causes) Infant mortality (per 1,000 live births) Death rates Notifications of infectious disease Cancer Vascular lesions of C.N.S. Heart disease Other circulatory Pneumonia Other respiratory (excluding tuberculosis) Violence Dysentery Food poisoning Measles Pneumonia Poliomyelitis Scarlet fever Whooping cough Tuberculosis Crude Adjusted Crude Adjusted Paralytic Nonpara lytic Pulmonary Nonpulmo nary Division 1 Chelsea 48,550 12.9 9.8 14.6 9.8 26 2.66 1.75 4.74 0.72 1.42 1.15 0.58 1.38 0.04 1.30 0.02 0.021 - 0.06 0.12 0.52 0.02 Fulham 110,570 17.3 17.1 12.4 11.9 26 2.58 1.50 3.59 0.75 0.67 1.17 0.52 1.25 0.47 1.49 0.09 — — 0.14 0.29 0.64 0.07 Hammersmith 108,120 21.6 20.5 11.9 12.1 22 2.63 1.17 3.60 0.53 0.68 1.10 0.52 0.41 0.20 1.78 0.20 0.009 — 0.23 0.13 0.62 0.10 Kensington 172,020 19.4 14.0 10.2 10.2 23 2.10 1.17 2.88 0.60 0.63 0.62 0.78 0.33 0.11 1.56 0.12 0.017 0.006 0.09 0.13 0.87 0.06 Division 2 Hampstead 98,240 18.1 13.8 10.7 10.7 16 2.34 0.99 3.67 0.46 0.64 0.70 0.61 0.63 0.12 1.96 0.22 - 0.010 0.20 0.17 0.44 0.11 Paddington 113,600 23.8 19.3 11.0 11.0 26 2.39 1.09 3.05 0.65 0.65 0.85 0.69 0.28 0.90 3.02 0.11 0.009 0.09 0.08 0.13 1.27 0.18 St. Marylebone 68,070 11.3 8.9 16.7 12.2 22 3.01 2.39 5.80 0.84 0.69 1.47 0.72 1.19 0.09 1.57 0.04 0.015 — 0.13 0.03 0.62 0.15 St. Pancras 124,470 20.4 18.2 11.5 11.3 23 2.40 0.97 3.31 0.52 1.00 0.96 0.71 1.74 0.41 4.72 0.29 0.008 0.008 0.19 0.11 0.84 0.12 Westminster, City of 86,110 12.2 10.2 12.0 11.8 25 2.75 1.03 3.48 0.77 0.60 0.78 0.92 0.23 0.19 1.03 0.05 - - 0.06 0.07 0.99 0.05 Division 3 Finsbury 32,540 17.6 16.0 11.9 11.7 28 2.43 1.20 3.13 0.55 1.04 1.41 0.43 1.32 1.32 5.26 1.84 - - 0.52 0.46 0.65 0.06 Holborn 20,640 9.1 6.5 13.1 13.9 69 3.44 0.92 3.25 0.78 0.78 0.82 0.82 0.34 0.10 1.07 0.10 0.048 0.048 0.05 0.10 0.78 0.05 Islington 227,870 25.4 23.4 11.3 11.0 19 2.37 1.08 3.15 0.73 0.86 1.19 0.48 1.06 0.29 5.84 0.12 0.009 — 0.29 0.22 0.98 0.09 Division 4 Hackney 163,400 23.3 21.9 11.7 12.4 20 2.50 1.05 3.69 0.70 0.61 1.21 0.41 2.45 0.13 7.27 0.15 0.006 - 0.43 0.36 0.48 0.05 Shoreditch 39,580 16.8 16.0 13.4 11.3 21 2.37 1.34 3.56 0.45 1.01 2.12 0.58 0.88 0.10 3.16 0.35 — — 0.43 0.15 0.61 0.08 Stoke Newington 52,950 24.4 21.7 10.6 12.3 18 2.12 1.00 3.64 0.53 0.62 0.93 0.40 0.47 0.17 6.59 0.06 0.019 — 0.15 0.11 0.26 0.08 Division 5 Bethnal Green 46,230 18.1 17.6 12.2 11.4 14 2.70 0.87 3.72 0.48 1.15 1.54 0.32 0.20 0.07 12.11 0.04 - - 0.80 0.43 0.43 0.13 City of London(b) 4,610 6.5 6.0 8.5 8.4 — 3.04 0.22 0.87 — 1.74 0.87 0.87 — - 0.87 0.22 - — 0.87 - 0.87 0.22 Poplar 67,340 20.8 19.8 11.5 13.0 24 2.40 1.01 3.22 0.50 0.92 1.23 0.53 0.46 0.25 3.45 0.55 — — 0.45 0.34 0.42 0.10 Stepney 90,480 20.4 18.6 12.5 12.6 18 2.37 0.88 3.68 0.56 1.35 1.68 0.53 0.34 0.11 4.84 1.05 0.011 — 0.27 0.20 1.00 0.10 Division 6 Deptford 68,980 23.1 22.6 11.7 11.8 18 2.12 1.15 3.86 0.49 0.81 1.13 0.49 1.04 0.09 1.75 0.19 - - 0.26 0.19 1.17 0.10 Greenwich 84,730 15.9 15.3 11.4 12.4 33 2.47 1.13 3.71 0.31 0.83 1.18 0.54 0.34 0.08 0.67 0.06 — — 0.39 0.15 0.34 0.05 Woolwich 148,140 15.8 15.6 10.7 11.4 19 2.11 1.03 3.51 0.53 0.87 0.77 0.52 0.02 0.01 0.45 0.49 - - 0.16 0.14 0.39 0.05 Division 7 Camberwell 173,720 20.2 19.0 11.4 11.2 24 2.49 1.17 3.34 0.64 0.97 1.00 0.48 0.64 0.15 1.94 0.23 - - 0.33 0.31 0.79 0.09 Lewisham 222,170 17.5 16.8 11.6 11.4 19 2.47 1.30 3.64 0.50 0.61 1.09 0.46 0.87 0.08 1.90 0.10 - - 0.24 0.19 0.37 0.09 Division 8 Bermondsey 51,000 17.2 16.9 11.5 11.9 15 2.57 1.04 3.47 0.86 0.45 1.14 0.55 0.90 0.63 4.69 0.16 - - 0.37 0.14 0.53 0.08 Lambeth 223,370 23.9 22.0 11.1 11.1 19 2.15 1.07 3.26 0.61 0.90 1.08 0.54 0.77 0.07 2.34 0.16 — 0.004 0.29 0.29 0.55 0.05 Southwark 86,440 19.2 17.5 14.3 12.0 21 2.65 1.23 4.86 0.71 1.10 1.53 0.60 4.40 0.28 5.36 0.65 0.012 — 0.82 0.19 0.72 0.06 Division 9 Battersea 104,020 20.9 20.7 12.9 11.9 21 2.47 1.76 3.96 0.47 0.97 1.13 0.64 0.90 0.19 1.59 0.29 - - 0.16 0.09 0.66 0.06 Wandsworth 347,810 18.2 17.5 14.4 11.2 20 2.65 1.61 5.34 0.64 0.90 0.94 0.51 0.50 0.20 2.06 0.42 0.006 — 0.31 0.16 0.50 0.04 London, 1962 3,185,770 19.6 17.6 12.0 11.7 21 2.44 1.22 3.75 0.60 0.83 1.07 0.56 0.88 0.21 2.99 0.26 0.005 0.002 0.27 0.19 0.66 0.08 London, 1961 3,179,980 18.9 17.0 11.9 11.4 21 2.45 1.25 3.62 0.64 0.76 1.06 0.53 0.57 0.25 15.00 0.37 0.009 0.003 0.43 0.36 0.74 0.08 (а) Rates are per 1,000 home population, figures in italics are based upon fewer than 20 births, deaths or notifications. (b) Including Inner and Middle Temple. 19 Table V.2— Principal vital statistics—Administrative County of London, 1953-62 Year Annual rate per 1,000 living Annual mortality per 1,000 living Annual mortality— Infant (per 1,000 live births) Maternal (per 1,000 total births) Live births Deaths (all causes) Crude rate Adjusted rate Crude rate Adjusted rate Tuberculosis Cancer Vascular lesions of C.N.S. Heart disease Other circulatory disease Influenza Pneumonia (all forms) Bronchitis Other resp. diseases Violence Infants 0—1 Diarrhoea and enteritis 0—2 Pulmonary Non-pulmonary Suicide Road accidents Other violence 1953 15.3 13.3 11.6 11.5 0.21 0.02 2.34 1.20 3.25 0.59 0.15 0.64 1.07 0.12 0.14 0.08 0.21 24 1.4 0.71 1954 15.2 13.3 10.7 10.6 0.18 0.02 2.31 1.20 3.22 0.60 0.02 0.48 0.66 0.10 0.15 0.08 0.21 21 0.5 0.66 1955 15.1 13.3 11.5 11.4 0.16 0.01 2.39 1.25 3.37 0.61 0.05 0.63 0.88 0.11 0.14 0.10 0.22 23 0.5 0.77 1956 15.9 14.0 11.7 11.7 0.13 0.01 2.42 1.27 3.46 0.59 0.04 0.67 0.96 0.11 0.15 0.10 0.22 21 0.4 0.51 1957 16.2 14.4 11.4 11.3 0.12 0.02 2.45 1.19 3.34 0.56 0.12 0.65 0.83 0.10 0.15 0.09 0.21 22 0.5 0.52 1958 16.8 15.0 11.8 11.6 0.12 0.01 2.47 1.29 3.52 0.59 0.05 0.70 0.92 0.11 0.17 0.11 0.22 22 0.4 0.60 1959 17.2 15.5 11.9 11.7 0.10 0.01 2.40 1.24 3.44 0.59 0.18 0.85 0.98 0.11 0.17 0.12 0.23 22 0.3 0.60 1960 18.0 16.2 11.4 11.2 0.07 0.01 2.53 1.28 3.51 0.57 0.01 0.65 0.70 0.11 0.16 0.14 0.20 21 0.3 0.45 1961 18.9 17.0 11.9 11.4 0.09 0.01 2.45 1.25 3.62 0.64 0.08 0.76 0.87 1.06 0.16 0.13 0.24 21 0.3 0.74 1962 19.6 17.6 12.0 11.7 0.08 0.01 2.44 1.22 3.75 0.60 0.05 0.83 0.92 0.11 0.18 0.13 0.25 21 0.4 0.52 20 Table V.3- Deaths by cause- Administrative County of London, 1962 Cause Sex 0- 1- 5- 15- 25- 45- 65- 75+ Total 1962 1961 1. Tuberculosis— respiratory M - - - 1 15 85 61 27 189 228 F — — — — 9 23 13 18 63 66 2. Tuberculosis— other M - 1 - 3 - 3 2 3 12 10 F - 2 - 1 4 3 2 3 15 14 3. Syphilitic disease M - - - 1 1 20 14 11 48 65 F - - - - 2 4 7 17 30 47 4. Diphtheria M - - - - - - - - - - F — - — — — - — — - 4 5. Whooping cough M 1 - - - - - - - 1 - F 1 - — — — — — — 1 — 6. Meningococcal infection M 6 3 - - - - - - 9 4 F 1 1 1 - - - - - 3 6 7. Acute poliomyelitis M - - - - - - - - - - F — 1 — - — — — — 1 1 8. Measles M - — 1 - - - - - 1 6 F - - - - — - - - - 5 9. Other infective, &c., diseases M 1 1 1 1 9 12 6 - 31 31 F 2 2 1 1 4 11 5 4 30 37 10. Malignant neoplasm: Stomach M - - - - 17 243 167 108 535 510 F — - — 1 10 95 117 169 392 440 11. Malignant neoplasm: Lung, bronchus M - 1 - - 37 903 609 251 1,801 1,761 F — — — 1 13 153 109 80 356 359 12. Malignant neoplasm: Breast M - - - - - 3 - 1 4 4 F - - — — 59 329 155 177 720 687 13. Malignant neoplasm: Uterus F - - - 1 28 123 73 52 277 296 14. Other malignant and lymphatic neoplasms M - 6 8 22 107 577 498 556 1,774 1,849 F 1 7 7 7 74 528 483 602 1,709 1,684 15. Leukemia, aleukemia M - 4 11 6 9 31 24 19 104 100 F — 4 6 7 9 36 22 31 115 92 16. Diabetes M — - — 1 3 19 22 23 68 73 F 2 1 — - 6 28 57 87 181 175 17. Vascular lesions of nervous system M 1 1 2 1 31 331 432 703 1,502 1,537 F - - - 3 34 289 623 1,451 2,400 2,428 18. Coronary disease, angina M 1 - - 4 139 1,558 1,314 1,230 4,246 3,810 F - - - 1 19 422 888 1,617 2,947 2,720 19. Hypertension with heart disease M - - - - 5 51 78 113 247 250 F — - — - - 31 93 252 376 418 20. Other heart disease M 5 1 2 14 59 270 329 850 1,530 1,555 F 2 1 - 11 49 216 417 1,914 2,610 2,756 21. Other circulatory disease M - - - 1 18 195 205 352 771 831 F - — 2 3 21 113 231 785 1,155 1,196 22. Influenza M 1 - 1 1 5 16 14 25 63 111 F — - - - 6 8 9 58 81 135 23. Pneumonia M 108 13 4 5 22 159 278 644 1,233 1,108 F 82 6 4 2 9 105 222 980 1,410 1,319 24. Bronchitis M 27 3 2 — 13 473 665 796 1,979 1,893 F 10 2 - 1 4 118 244 567 946 874 25. Other diseases of respiratory system M 1 3 - 1 6 88 70 59 228 221 F 4 2 - - 8 10 26 75 125 137 26. Ulcer of stomach and duodenum M — — - - 10 73 67 82 232 254 F - - - - 2 14 42 81 139 136 27. Gastritis, enteritis and diarrhoea M 15 1 - - 5 18 19 13 71 85 F 8 1 - 3 11 17 25 65 130 126 28. Nephritis and nephrosis M - — - 4 25 43 24 18 114 105 F - — 2 4 9 24 20 34 93 91 29. Hyperplasia, prostate M - - — - - 7 38 97 142 185 30. Pregnancy, childbirth, abortn. F - - — 10 23 - - - 33 45 31. Congenital malformations M 133 12 15 5 12 24 10 4 215 165 F 97 9 4 4 4 17 8 5 148 196 32. Other defined and ill-defined diseases M 460 15 12 21 69 243 200 274 1,294 1,347 F 315 10 9 14 67 256 279 693 1,643 1,626 21 Table V.3 (contd.)— Deaths by cause—Administrative County of London, 1962 Cause Sex 0- 1- 5- 15- 25- 45- 65- 75+ Total 1962 1961 33. Motor vehicle accidents M - 6 12 49 53 62 28 34 244 281 F — 6 3 19 12 32 26 54 152 133 34. All other accidents M 15 13 15 35 83 113 38 100 412 411 F 13 16 4 7 22 52 59 163 336 325 35. Suicide M - - 1 24 108 137 47 25 342 298 F - - — 18 69 105 39 16 247 224 36. Homicide, operations of war M 2 - 3 4 1 4 2 — 22 20 F 1 — — — 9 6 — 2 18 9 ALL CAUSES M 111 84 90 204 869 5,761 5,261 6,418 19,464 19,108 F 539 71 43 119 596 3,168 4,294 10,052 18,882 18,807 Table V.4— Weather during 1962 (as recorded at Kew Observatory) Month Temperature Rainfall Sunshine Mean (a) Difference from Average (b) Total Difference from Average (b) Total Difference from Average (c) °F °F ins. ins. hrs. hrs. January 41.9 +2.2 2.81 +0.85 66.1 +24.3 February 41.5 + 1.2 0.63 -0.92 67.9 +9.5 March 38.5 -4.3 1.35 -0.19 112.8 +6.1 April 47.3 -0.2 1.66 -0.05 140.7 -8.5 May 51.6 -2.0 1.56 -0.19 159.1 -38.4 June 58.5 -0.9 0.28 -1.70 261.8 +61.3 July 60.8 -1.9 2.33 -0.05 133.3 -62.2 August 60.4 -1.4 2.43 +0.19 172.8 -12.2 September 56.5 -0.9 2.84 +0.85 152.2 + 11.3 October 52.5 +2.2 2.15 -0.36 117.0 +23.8 November 44.2 0.0 1.99 -0.35 36.7 -14.5 December 36.9 -3.8 2.20 +0.04 68.3 +31.0 Year 49.2 -0.8 22.23 -1.88 1,488.7 + 31.5 (a) Average of the daily means of 24 hourly readings. (b) Average over the 80 years ended 1950. (c) Average over the 70 years ended 1950. 22 Table V.5— Notifiable infectious diseases—Annual number of notifications and numbers per 1,000 of population—Administrative County of London, 1953-1962 Year Anthrax Diphtheria Dysentery Acute encephalitis Enteric fever Erysipelas Malaria Measles Meningococcal infection Ophthalmia neonatorum Pneumonia Poliomyelitis Puerperal pyrexia Scabies Scarlet fever Smallpox Typhus Whooping cough Food poisoning Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Paralytic Non-par. Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate (a) (b) 1953 - — 11 0.003 2,639 0.789 18 0.005 45 0.013 408 0.122 89 0.027 27,046 8.09 98 0.029 161 2.76 2,434 0.728 235 0.070 97 0.029 1,712 28.72 527 0.16 3,425 1.02 — — — — 11,027 3.30 1,269 0.38 1954 1 0.0003 4 0.001 4,268 1.285 15 0.005 49 0.015 368 0.111 53 0.016 7,445 2.41 86 0.026 112 1.92 1,502 0.452 79 0.024 46 0.013 1,938 32.51 669 0.20 2,444 0.74 - — 1 0.0003 4,691 1.41 1,060 0.32 1955 — — 16 0.005 3,019 0.916 20 0.006 111 0.034 361 0.110 40 0.012 49,110 14.90 98 0.030 106 1.85 1,903 0.578 512 0.155 448 0.136 1,984 33.92 660 0.20 2,070 0.63 - - - - 4,709 1.43 1,530 0.46 1956 1 0.0003 11 0.003 6,392 1.953 54 0.016 73 0.022 297 0.091 31 0.009 9,651 2.95 94 0.029 83 1.39 1,633 0.499 183 0.056 96 0.029 1,792 29.49 703 0.21 2,198 0.67 - - - - 5,450 1.67 1,327 0.41 1957 — — 4 0.001 2,356 0.724 27 0.008 47 0.014 269 0.083 44 0.014 36,952 11.36 70 0.022 102 1.69 2,185 0.672 201 0.062 123 0.038 2,008 32.42 630 0.19 2,177 0.67 — — - — 3,982 1.22 1,189 0.37 1958 — — 38 0.012 4,502 1.396 38 0.012 42 0.013 257 0.080 10 0.003 16,664 5.17 81 0.025 132 1.99 1,735 0.538 80 0.025 27 0.008 1,680 24.85 635 0.20 2,716 0.84 — — — — 1,595 0.50 1,300 0.40 1959 — — 75 0.023 3,571 1.115 31 0.010 84 0.026 240 0.075 4 0.001 27,970 8.73 69 0.022 161 2.53 1,914 0.597 146 0.046 64 0.020 1,666 25.64 544 0.17 2,621 0.82 — — — — 1,607 0.50 1,639 0.51 1960 — — 16 0.005 5,161 1.616 23 0.007 51 0.016 229 0.072 10 0.003 8,561 2.68 71 0.022 89 1.36 882 0.276 64 0.020 23 0.007 1,416 21.20 498 0.16 1,500 0.47 1 0.0003 — — 4,794 1.50 1,229 0.38 1961 — — 28 0.009 1,812 0.570 18 0.006 32 0.010 204 0.064 26 0.008 47,620 15.00 67 0.021 100 1.46 1,174 0.369 29 0.009 11 0.003 1,486 21.27 463 0.15 1,361 0.43 1 0.0003 — — 1,146 0.36 783 0.25 1962 1 0.0003 — — 2,814 0.883 23 0.007 48 0.015 141 0.044 56 0.018 9,538 2.99 67 0.021 188 2.62 823 0.258 17 0.005 6 0.002 1,374 18.81 369 0.12 863 0.27 1 0.0003 — — 619 0.19 676 0.21 (a) Rate per 1,000 live births registered in London. (b) Rate per 1,000 total births registered in London. Table V.6—Notification of certain infectious diseases—distribution by age and date of notification—Administrative County of London, 52 weeks commencing 1 January, 1962 Fourweekly periods 1962 Dysentery Measles Meningococcal infection Pneumonia Poliomyelitis Scarlet fever Whooping cough Paralytic Non-paralytic Ages Ages Ages Ages Ages Ages Ages Ages 0-4 5—14 15+ Total 0-4 5—14 15+ Total 0-4 5—14 15+ Total 0-4 5—14 15+ Total 0—4 5—14 75+ Total 0—4 5—14 75+ Total 0—4 5—14 75+ Total 0—4 5—14 15 + Total 1— 4 M 27 9 9 45 38 18 1 57 1 1 - 2 11 4 75 90 - - 1 1 - 1 - 1 9 23 6 38 10 5 - 15 F 23 11 11 45 30 20 6 56 1 — — 1 7 7 70 84 - - - - - - - - 13 28 - 46 14 4 1 19 5— 8 M 29 14 12 57 56 44 8 109 4 1 1 6 6 5 33 44 1 — — 1 — — — — 11 23 4 38 12 4 — 16 F 29 13 30 72 57 41 5 104 3 — 1 4 6 3 30 40 1 — — 1 — — — - 16 31 5 53 20 6 - 26 9—12 m 50 43 22 115 103 59 14 176 2 — 1 3 8 3 44 55 1 — — 1 — — — — 18 41 8 67 18 3 — 21 F 48 35 33 116 78 68 16 162 1 1 — 2 2 3 31 36 - - - - - - - - 12 39 5 56 11 11 - 22 13—16 M 41 25 14 80 117 125 36 278 3 - 2 5 5 5 43 53 - - - - - - - - 16 32 7 55 12 9 — 21 F 52 30 35 117 115 99 30 246 2 1 2 5 4 1 31 36 — — 1 1 — — — - 11 33 6 50 20 14 3 37 17—20 m 51 23 21 96 112 80 31 223 2 — 1 3 5 1 15 21 - - - - - - - - 7 13 6 26 10 11 - 21 F 53 23 34 111 85 87 49 222 1 — 1 2 2 2 17 21 - - - - - - - - 10 14 1 25 15 8 1 24 21—24 M 83 52 22 160 54 54 13 122 - — 1 1 2 3 17 22 — — 1 1 — — — — 7 16 7 30 21 11 - 32 F 66 47 50 165 53 58 21 132 3 1 — 4 1 1 15 17 - - - - - - - - 7 17 - 24 16 14 1 31 25—28 m 69 41 22 133 67 62 5 134 — 1 1 2 3 4 14 21 2 1 — 3 — — — — 5 17 3 25 10 5 — 15 F 53 27 43 124 77 64 6 147 — — — — 1 1 9 11 1 - 1 2 — 2 4 11 2 18 9 11 - 20 29—32 m 24 33 17 74 141 94 6 241 2 - 2 4 2 1 11 14 1 1 - 2 — — — — 12 12 2 26 14 7 — 21 F 29 27 29 86 142 116 7 266 1 — — 1 — 1 9 10 - - - - - - 1 1 8 13 1 22 14 9 - 23 33—36 m 37 10 20 68 132 47 3 182 - - 1 1 - - 9 9 - — 1 1 — — — — 9 10 — 19 21 7 — 28 F 30 7 26 64 136 57 8 201 - - - - - 1 10 11 — 1 1 2 1 — 1 2 5 6 3 15 12 8 - 20 37—40 m 47 28 18 93 117 95 - 212 1 1 1 3 1 2 15 18 - - - - - - - - 6 13 — 19 14 8 — 22 F 36 22 33 91 109 82 3 195 — — — — 2 1 15 20 1 — 1 2 — — — — 4 9 1 14 19 14 1 34 41—44 m 59 68 32 159 262 232 4 498 1 1 2 4 — — 21 21 — — 1 1 — — — — 14 12 2 28 19 5 — 24 F 49 64 58 171 272 194 — 468 — — 2 2 1 — 16 17 - - - - - - - - 7 18 1 26 14 9 - 23 45—48 m 63 37 19 119 540 398 2 940 1 — 1 3 5 3 25 33 1 — — 1 — — — — 15 20 — 35 17 5 — 22 F 52 33 47 133 476 376 5 857 2 — — 2 1 6 23 3o — — 1 1 — — — — 12 21 1 34 22 6 1 29 49—52 m 61 67 36 165 905 627 10 1,545 1 2 — 3 3 2 33 38 1 1 1 1 1 1 1 1 11 15 — 26 15 6 — 21 F 73 55 75 204 882 593 11 1,490 1 - 1 2 6 4 42 52 1 1 1 1 1 1 1 1 16 23 1 40 18 7 - 25 Total m 641 450 264 1,364 2,644 1,935 133 4,717 18 7 14 40 51 33 355 439 6 2 4 12 — 1 — 1 140 247 45 432 193 86 — 279 F 593 394 504 1,499 2,512 1,855 167 4,546 15 3 7 25 33 33 318 385 3 1 4 8 3 - 2 5 125 263 31 423 204 121 8 333 Notes: 1. Where the total figures are in excess of the sum of the age groups, the difference is due to cases 'age not known'. 2. The totals of these figures will not necessarily agree with the total notifications given in table V.5 which relates to the calendar year 1962. 24 TUBERCULOSIS Notification rates of pulmonary tuberculosis were slightly lower than in 1961 and the death rates followed the same general trend. The diagram on page 26 shows the trend of notifications, deaths and numbers on the registers of chest clinics over the last decade. Deaths from non-pulmonary tuberculosis are now so few that considerable random fluctuations occur in the rates from year to year and therefore are not shown in the diagram. The number of cases on the registers is now 33,849. The 279 deaths from tuberculosis (all forms, both sexes) include 173 deaths from pulmonary disease in men aged 45 and over. Services provided—The services provided by the Council as local health authority for the care and after-care of tuberculous patients and the prevention of tuberculosis are summarised in table T.9. Care committees—The voluntary tuberculosis care committees associated with most of the 29 chest clinics in London continued their valuable work of assisting patients and their families financially or in other ways where help was not available from official sources. The Council's chest clinic welfare officers act as secretaries to these committees. B.C.G. vaccination—The numbers of children vaccinated during the year, under the Council's schemes for the B.C.G. vaccination of susceptible (tuberculin negative) child contacts of known tuberculous patients, diabetic children, thirteen-year-old schoolchildren, students at further education establishments and mentally subnormal persons at training centres, are shown in table T.ll. Preventive measures—In addition to the B.C.G. vaccination schemes, other preventive measures include the chest X-ray of all newly appointed staff who are likely to work in close and frequent contact with children, staff at the Council's training centres for mentally subnormal persons and of tuberculin reactors discovered among thirteen-year-old school children, students and others tested with a view to B.C.G. vaccination. Epidemiological investigations are made among the contacts of cases of tuberculosis notified in children, staff or residents in the Council's establishments. Similar investigations are carried out at secondary schools where the reactor rates disclosed by tuberculin surveys are significantly higher than the average for secondary schools in the area (table T.8). 25 TREND OF TUBERCULOSIS LONDON A.C. 1953-62 26 Table T.l—Tuberculosis—Statutory notifications (a) and deaths, Administrative County of London, 1953.1962 Year Pulmonary tuberculosis Non.pulmonary tuberculosis Notifications Deaths Notifications Deaths No. Annual rate per 1,000 living No. Annual rate per 1,000 living No. Annual rate per 1,000 living No. Annual rate per 1,000 living 1953 4,668 1.40 690 0.21 410 0.12 73 0.02 1954 4,231 1.27 596 0.18 410 0.12 62 0.02 1955 3,757 1.14 517 0.16 365 0.11 44 0.01 1956 3,602 1.10 423 0.13 327 0.10 32 0.01 1957 3,460 1.06 378 0.12 294 0.09 50 0.02 1958 3,103 0.96 379 0.12 305 0.10 41 0.01 1959 2,794 0.87 313 0.10 244 0.08 30 0.01 1960 2,519 0.79 235 0.07 250 0.08 34 00.1 1961 2,344 0.74 294 0.09 250 0.08 24 0.01 1962 2,092 0.66 252 0.08 245 0.08 27 0.01 (a) Excluding posthumous notifications. Table T.2—Pulmonary tuberculosis—Notification and death rates per 1,000 living by age and sex, Administrative County of London, 1953.1962 Year 0-4 5-14 Age 15-44 45 and oyer All ages M F M F M F M F M F Notification rates 1953 0.84 0.85 0.69 0.65 2.01 1.80 2.09 0.42 1.76 1.08 1954 0.64 0.55 0.48 0.55 1.79 1.71 2.02 0.41 1 60 0.99 1955 0.56 0.42 0.39 0.48 1.65 1.48 1.82 0.41 1.45 0.86 1956 0.33 0.37 0.31 0.34 1.62 1.31 2.01 0.41 1.47 0.78 1957 0.43 0.40 0.30 0.32 1.60 1.27 1.92 0.38 1.44 0.73 1958 0.39 0.33 0.30 0.27 1.49 1.03 1.89 0.32 1.37 0.60 1959 0.47 0.43 0.24 0.28 1.30 0.95 1.66 0.32 1.21 0.57 1960 0 46 0.44 0.23 0.25 1.14 0.83 1.49 0.33 1.08 0.53 1961 0 34 0.45 0.23 0.29 1.00 0.79 1.45 0.30 1.00 0.50 1962 0 34 0 38 0.16 0.27 1.04 0.60 1.26 0.24 0.95 0.40 Death rates 1953 0.02 0.03 0.00 0.00 0.12 0.1l 0.81 0.13 0.33 0.10 1954 - 0.03 - 0.01 0.07 0.10 0.74 0.12 0.28 0.09 1955 0.02 - 0.00 - 0.07 0.06 0.66 0.11 0.25 0.07 1956 — 0.02 - - 0.07 0.05 0.52 0.09 0.21 0.06 1957 — 0.009 - - 0.06 0.05 0.46 0.08 0.19 0.05 1958 - - 0.01 - 0.05 0.05 0.44 0.11 0.18 0.06 1959 0.02 0 009 - - 0.03 0.03 0.41 0.07 0.16 0.04 1960 - 0.03 - - 0.03 0.02 0.29 0.06 0.12 0.03 1961 — — 0.005 — 0.03 0.02 0.40 0.07 0.15 0.04 1962 - — — — 0.02 0.01 0.32 0.08 0.13 0.04 27 Table T.3—Non.pulmonary tuberculosis—Notification and death rates per 1,000 living by age and sex, Administrative County of London, 1953-1962 Year Age 0-4 5-14 15-44 45 and over All ages M F M F M F M F M F Notification rates 1953 0.144 0.160 0.152 0.182 0.138 0.175 0.044 0.070 0.109 0.135 1954 0.142 0.149 0.139 0.187 0.128 0.176 0.069 0.071 0.111 0.134 1955 0.110 0.116 0.140 0.121 0.140 0.189 0.042 0.037 0.105 0.116 1956 0.111 0.089 0.078 0.095 0.109 0.176 0.048 0.058 0.084 0.114 1957 0.076 0.063 0.069 0.100 0.105 0.168 0.034 0.052 0.073 0.106 1958 0.126 0.116 0.075 0.083 0.108 0.148 0.047 0.066 0.083 0.104 1959 0.050 0.043 0.063 0.040 0.103 0.130 0.055 0.041 0.076 0.076 i960 0.065 0.051 0.029 0.030 0.133 0.136 0.038 0.041 0.079 0.078 1961 0.055 0.058 0.054 0.062 0.104 0.127 0.045 0.055 0.072 0.084 1962 0.008 0.041 0.057 0.032 0.111 0.151 0.034 0.044 0.068 0.085 Death rates 1953 0.024 0.076 0.005 0.010 0.017 0.017 0.025 0.029 0.019 0.025 1954 0.025 0.018 0.005 — 0.016 0.009 0.035 0.029 0.021 0.016 1955 0.008 0.009 0.009 0.005 0.012 0.004 0.021 0.024 0.014 0.013 1956 0.009 — — — 0.009 0.004 0.023 0.014 0.012 0.007 1957 0.008 0.009 0.009 0.005 0.011 0.004 0.030 0.027 0.017 0.014 1958 — — 0.005 — 0.012 0.004 0.026 0.021 0.015 0.010 1959 0.025 0 009 0.005 — 0.009 0.001 0.011 0.017 0.011 0.008 1960 0.016 — — 0.005 0.003 0.007 0.009 0.027 0.006 0.015 1961 0.008 0.017 — 0.005 0.002 0.003 0.015 0.013 0.007 0.008 1962 0.008 0.017 - - 0.005 0.007 0.015 0.011 0.008 0.009 Table T.4—Tuberculosis—Statutory notifications by age groups, Administrative County of London, 1962 Form of tuberculosis notified Sex Number of notifications of new cases of tuberculosis Total (all ages) 0. 1. 5. 10. 15. 20. 25. 35. 45. 55. 65. 75+ Pulmonary tuberculosis M. 8 35 21 10 49 133 266 226 248 267 116 40 1,419 F. 2 44 23 27 38 102 165 99 69 61 30 13 673 Other forms of tuberculosis M. — 1 2 9 6 12 35 19 9 6 1 2 102 F. 1 4 3 3 6 21 46 28 14 6 4 7 143 All forms of tuberculosis M. 8 36 23 19 55 145 301 245 257 273 117 42 1,521 F. 3 48 26 30 44 123 211 127 83 67 34 20 816 Table T.5—Tuberculosis—Deaths in Administrative County of London, 1962 Form of tuberculosis Sex Age at death Total all ages 0— 1- 5— 15— 25— 45— 65— 75+ Pulmonary tuberculosis m. - - - 1 15 85 61 27 189 f. - - - - 9 23 13 18 63 Other forms of tuberculosis M. - 1 — 3 - 3 2 3 12 f. - 2 — 1 4 3 2 3 15 All forms of tuberculosis M. - 1 - 4 15 88 63 30 201 f. - 2 — 1 13 26 15 21 78 28 Table T.6—Statutory notification of non-pulmonary tuberculosis—Distribution according to site and age, Administrative County of London, 1962 Site of tuberculous lesion Numbers of notifications of new cases of non-pulmonary tuberculosis by age Total (all ages) 0-4 5-14 15-24 25 + Meninges and C.N.S. 2 2 1 5 10 Abdomen — 2 3 10 15 Bones and joints — 4 8 33 45 Skin and erythema nodosum 1 1 — 3 5 Peripheral glands 3 7 25 68 103 Genito-urinary — 1 7 48 56 Other sites — — 1 10 11 All sites 6 17 45 177 245 Table T.7—Patients on the registers—1953-1962 At 31st Dec. 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 Pulmonary: Males 18,475 18,897 19,300 19,715 19,946 20,308 19,553 19,380 18,759 18,153 Females 14,930 15,576 15,846 15,928 15,836 15,597 14,858 14,497 13,833 13,171 Other forms: Males 1,508 1,442 1,371 1,339 1,274 1,293 1,158 1,163 1,143 1,123 Females 1,820 1,709 1,704 1,710 1,709 1,674 1,555 1,527 1,473 1,402 Total 36,733 37,624 38,221 38,692 38,765 38,872 37,124 36,567 35,208 33,849 No. per 1,000 of population 10.9 11.3 11.6 11.8 11.9 12.1 11.6 11.4 11.1 10.6 Table T.8—Summary of investigations into tuberculosis 'incidents' at Council establishments in 1962 Establishment Notified case Children Adults Tuberculin tested Positive reactors X-rayed Abnormal X-rayed Abnormal Day school Teacher 95 18 18 - 12 - Teacher 285 47 47 1 16 — Teacher 106 1 — — 12 — Infant helper 176 3 3 — — — Pupil 40 21 21 — 12 — Kitchen helper 445 28 28 — 18 — Pupil 13 5 5 — 14 1 Total (7) 1,160 123 122 1 84 1 College Students (3) 157 122 122 - - - Student — — 23 — - — Total (2) 157 122 145 — — — Grand Total (9) 1,317 245 267 1 84 1 29 Table T.9—Summary of services provided for tuberculous patients, Administrative County of London 1958-1962 1958 1959 1960 1961 1962 Clinic registers Total on registers at the end of the year 38,872 37,124 36,567 35,208 33,849 Work of chest clinic welfare officers Patients assisted for the first time with: Beds, bedding 165 210 123 164 91 Clothing, footwear 571 558 500 421 333 Patients at the end of the year receiving: Extra nourishment 1,875 1,714 1,558 1,417 1,382 Home help service 467 465 462 412 369 Home care and treatment At the end of the year, patients: Awaiting admission to hospital 16 16 14 18 1 Under treatment in their own homes 238 143 140 123 107 Receiving attention by home nurses 368 331 283 244 201 Home visiting by tuberculosis health visitors— Total visits (including contacts) 78,953 86,680 77,861 83,585 80,756 Diversional therapy At the end of the year, patients: Attending classes at chest clinics 157 131 110 101 89 Receiving instruction in their own homes 262 200 180 150 167 Rehabilitation At the end of the year the Council was financially responsible for rehabilitants at: British Legion Village, Maidstone 30 19 11 13 18 Papworth Village Settlement, Cambridge 15 10 6 4 3 Enham-Alamein Village Centre, Andover 10 5 4 — - Barrowmore Hall, Chester 1 1 1 1 1 Sherwood Village Settlement, Nottingham — — — — 1 Correspondence courses arranged through the British Council for Rehabilitation for patients undergoing prolonged treatment at home 14 10 9 6 4 At boarding open-air schools Children convalescent from tuberculosis: At the beginning of the year 6 1 — 2 3 Admitted during the year — — 2 2 — At the end of the year 1 — 2 3 — Awaiting admission at end of year — — 1 — 1 Boarding-out of child contacts Children in nurseries and foster homes at the beginning of the year 136 94 79 53 34 Placed during the year 173 154 152 111 88 Boarded-out at the end of the year 94 79 53 34 17 Average number boarded-out at any one time 116 100 76 47 26 Boarding-out of child contacts for segregation during B.C.G. vaccination Children in nurseries and foster homes at the beginning of the year 3 9 3 2 2 Placed during the year 20 35 22 9 8 Boarded-out at the end of the year 9 3 2 2 2 Average number boarded-out at any one time 4 8 6 3 2 Hostels for homeless infective tuberculous men In residence at the beginning of the year 77 103 101 107 103 Recommendations approved during the year 81 63 74 51 76 In residence at the end of the year 103 101 107 103 98 30 Table T.10—Principal tuberculosis statistics—Metropolitan Boroughs and the Administrative County of London, 1962 Metropolitan Boroughs Estimated home population mid 1962 Pulmonary New notifications Total New notifications per 1,000 population Deaths from tuberculosis Tuberculosis deaths per 1,000 population Pulmonary tuberculosis deaths per 1,000 population aged 15 and over Number of tuberculosis cases on clinic registers at 31.12.62 Cases on register per 1,000 population Tuberculosis of Meninges and C.N.S. Other nonpulmonary tuberculosis Pulmonary Nonpulmonary tuberculosis Total deaths Total Percentage of pulmonary cases positive* during 1962 Division 1 Chelsea 48,550 25 — i 26 0.54 2 2 4 0.08 0.05 321 4.4 6.6 Fulham 110,570 71 — 8 79 0.71 4 2 6 0.05 0.04 1,235 2.5 11.2 Hammersmith 108,120 67 1 10 78 0.72 8 1 9 0.08 0.09 1,403 3.9 130 Kensington 172,020 149 1 10 160 0.93 11 1 12 0.07 0.08 1,244 3.7 7.2 Division 2 Hampstead 98,240 43 1 10 54 0.55 4 1 5 0.05 0.05 620 6.1 6.3 Paddington 113,600 144 — 20 164 1.44 9 - 9 0.08 0.10 1,230 4.2 10.8 St. Marylebone 68,070 42 — 10 52 0.76 7 2 9 0.13 0.12 746 5.9 11.0 St. Pancras 124,470 105 — 15 120 0.96 6 1 7 0.06 0.06 1,121 1.6 9.0 Westminster, City of Division 3 86,110 85 — 4 89 103 14 1 15 0.17 0.18 908 5.5 10.5 Finsbury 32,540 21 1 1 23 0.71 3 1 4 0.12 0.12 259 7.0 8.0 Holborn 20,640 16 — 1 17 0.82 3 1 4 0.19 0.16 210 6.9 10.2 Islington Division 4 227,870 224 1 19 244 1.07 13 3 16 0.07 0.07 2,415 2.4 10.6 Hackney 163,400 79 1 7 87 0.53 11 2 13 0.08 0.08 1,653 2.9 10.1 Shoreditch 39,580 24 1 2 27 0.68 9 - 9 0.23 0..30 297 8.5 7.5 Stoke Newmgton Division 5 52,950 14 — 4 18 0.34 3 — 3 0.06 0.07 720 2.3 13.6 Bethnal Green 46,230 20 — 6 26 0.56 3 1 4 0.09 0.08 701 2.5 15.2 City of London 4,610 4 — 1 5 1.08 1 - 1 0..22 0..23 66 8.1 14.3 Poplar 67,340 28 — 7 35 0.52 8 - 8 0..12 0.15 594 4.3 8.8 Stepney Division 6 90,480 90 — 9 99 1.09 12 — 12 0.13 0.17 1,238 2.4 13.7 Deptford 68,980 81 — 7 88 1.28 5 1 6 0.09 0.09 1,072 4.1 15.5 Greenwich 84,730 29 — 4 33 0.39 5 1 6 0.07 0.07 1,018 2.0 12.0 Woolwich Division 7 148,140 58 — 7 65 0.44 9 1 10 0.07 0.08 1,600 2.8 10.8 Camberwell 173,720 137 — 15 152 0.87 8 - 8 0.05 0.06 945 2.9 5.4 Lewisham Division 8 222,170 83 3 17 103 0.46 22 1 23 0.10 0.13 2,307 1.5 10.4 Bermondsey 51,000 27 — 4 31 0.61 4 - 4 0.08 0.10 657 2.2 12.9 Lambeth 223,370 122 — 10 132 0.59 22 2 24 0.11 0.13 3,367 2.0 15.1 Southwark Division 9 86,440 62 — 5 67 0.78 8 1 9 0.10 0.12 1,468 4.5 17.0 Battersea 104,020 69 — 6 75 0.72 12 - 12 0.12 0.15 972 4.5 9.3 Wandsworth 347,810 173 — 15 188 0.54 26 1 27 0.08 0.09 3,462 3.1 10.0 LONDON 3,185,770 2,092 10 235 2,337 0.73 252 27 279 0.09 0.10 33,849 3.0 10.6 *Cases whose broncho-pulmonary secretion was positive during the year (in previous years this figure has been calculated on positive cases in preceding six months). Table T.ll—B.C.G. vaccination under L.C.C. schemes in 1962 1. Day schools— No. of schools visited 343 No. of 13-year-old children at school *40,762 No. of consents *30,768 No. tuberculin tested *26,927 No. of reactors *2,367 = 8.8 per cent. No. given b.C.G. *24,954 (includes 456 absentees from 1961 visits) No. vaccinated June, 1954 to December, 1962 202,644 2. Further education establishments (colleges, etc.) No. of establishments visited during 1962 23 No. of students tested 2,147 No. of reactors 1,457 No. given b.C.G. 685 3. Residential establishments— No. of establishments visited during 1962 3 No. of children tested 99 No. of reactors 11=11.1 per cent. No. given B.C.G. 88 4. Training centres— No. of persons tested 177 No. of reactors 47 No. given B.C.G. 129 5. Notifications of tuberculosis (all forms) in 14- and 15-year-old children in 1954 82 1955 (first full year after starting B.C.G.) 45 1958 1959 38 20 1960 31 1961 26 1962 17 6. Tuberculosis contacts— No. given B.C.G. vaccination in London in 1962 4,348 No. given B.C.G. vaccination in London since inception of scheme in 1950 50,920 7. Diabetics— No. given B.C.G. in 1962 14 No. given B.C.G. since inception of scheme 93 *Divisional figures are shown in table T.I2 32 Table T.12—B.C.G. vaccination of schoolchildren in Administrative County of London, 1962—Divisional figures Division No. of 13-yearold school children Total No. of consents Alleged contacts of known cases No. of children tested and read by B.C.G. units Children not dealt with because of refusal of consent or absence Positive reactors (among (4) ) No. of negative reactors vaccinated by B.C.G. units Consents included in (2) No. Per cent. of(1) No. Per cent. (1) (2) (3) (4) (5) (6) (7) (8) (9) 1 5,856 4,509 39 4,133 1,684 28.7 468 11.3 3,647 (18 negatives not vaccinated) 2 4,415 3,484 40 3,167 1,208 27.4 417 13.2 2,736 (14 negatives not vaccinated) 3 3,144 2,144 11 1,903 1,230 39.1 225 11.9 1,670 (8 negatives not vaccinated) 4 3,073 2,421 119 2,045 909 29.6 158 7.7 1,887 5 1,500 1,012 2 847 651 43.4 54 6.4 792 (1 negative not vaccinated) 6 4,534 3,539 40 3,186 1,308 28.8 146 4.6 3,038 (2 negatives not vaccinated) 7 7,579 5,519 265* 4,350 2,964 39.1 241 5.5 4,099 (10 negatives not vaccinated) 8 5,434 4,202 93 3,683 1,658 30.5 373 10.1 3,310 9 5,227 3,938 41 3,613 1,573 30.1 285 7.9 3,319 (9 negatives not vaccinated) Totals 40,762 30,768 650 26,927 13,185 32.3 2,367 8.8 24,498 33 *Includes 183 previously given B.C.G. GENERAL PUBLIC HEALTH Housing The Council has set aside a small number of dwellings for the rehousing of families on purely medical grounds. The following table shows the cases dealt with in the past five years. 1958 1959 1960 1961 1962 Tuberculous persons Recommendations received 321 275 232 224 180 Nominated for rehousing 151 185 209 139 110 Recommendations not qualifying for rehousing 132 114 93 20 70 Under consideration at end of year 139 115 45 110 110 Persons with severe medical conditions Recommendations received 2,474 2,689 3,357 2,570 2,263 Nominated for rehousing 478 418 607 164 363 Recommendations not qualifying for rehousing 1,617 1,951 2,503 1,791 2,082 Under consideration at end of year 733 1,053 1,300 1,915 1,733 Work in connection with unfit houses during the past five years is summarised below: 1958 1959 1960 1961 1962 Slum clearance Areas represented as unfit for human habitation. 77 27 48 34 87 Houses in such areas 1,830 660 1,356 932 2,808 Areas surveyed but not represented by the end of the year 11 13 39 90 74 Houses in such areas 312 641 1,291 2,869 2,183 Public local inquiries 36 37 42 12 10 Informal hearings 2 1 1 4 — Orders confirmed (i) after inquiry or hearing 33 42 41 27 9 (ii) without inquiry or hearing (no objection received) 14 28 15 2 2 Orders not confirmed by Minister 1 3 1 — — Confirmed order quashed on appeal to High Court — — — 1 — Improvement grants Surveys following applications to the Council 119 160 1,178 309 342 Searches following applications to metropolitan borough councils 103 346 572 595 576 Dangerous structures Premises scheduled as dangerous—searches made 1,229 1,013 * * * *The functions with regard to dangerous structures were, by the London County Council (General Powers) Act, 1958, transferred to the metropolitan borough councils as from I January, 1960. Public Health Laboratory The facilities at the Medical Research Council's Public Health Laboratory at the County Hall and the close co-operation with its staff have continued to be of great value. Milk sampling The following table shows the results of tests during the year on samples taken of milk arriving in London (the figures in brackets are those for 1961): 34 Designation Tuberculin tested (Farm bottled) Tuberculin tested* Pasteurised Total Samples examined 35 (34) 4 (4) 20 (17) 59 (55) T.B. bacillus isolated - (-) - (-) N/A -(-) T.B. bacillus NOT isolated 35 (34) 4 (4) N/A 39 (38) Passed phosphatase test N/A N/A 20 (17) 20 (17) Samples from a residential school which has its own farm. Milk purchased for use in Council establishments: 1958 1959 1960 1961 1962 Liquid milk: samples taken by boroughs and county councils 947 910 589 306 310 number found to be unsatisfactory 7 11 — — — Dried milk: samples submitted to bacteriological examination 4 4 3 24* 42* No samples contained more than 100,000 organisms per gramme, nor was staphylococcus aureus solated. *Increased sampling was due to co-operation in the formulation of a British Standard for dried milk. Sanitary inspection The inspectors dealt with the following matters in Council establishments: 1958 1959 1960 1961 1962 Reports of infestation by a variety of pests 190 207 274 221 269 Visits and re-inspections involved 347 472 506 409 526 Inspections of school meals centres 375 362 341 208 242 Investigations of illness following consumption of school meals 12 7 8 11 7 Occasions when the meal was found to be the cause 3 2 2 - - Blind and partially-sighted persons During the year, 1,660 examinations—100 more than in the previous year—were made in connection with certification under the National Assistance Act, 1948 of blind or partiallysighted persons and 56 persons were found to be neither blind or partially-sighted. In addition, 434 certificates were accepted from other local authorities, hospitals and private ophthalmologists—85 more than in the previous year. The percentage of new registrations recommended to obtain treatment was 56.6 per cent. compared with 53.9 per cent. in 1961. The results of examinations of persons newly registered during the year are given in tables (i) and (ii). 35 Table (i) Number of new registrations during the year with percentage recommended to obtain treatment Age Principal cause of defective vision Total Cataract Glaucoma Retrolental fibroplasia Other conditions 0-4 years 1 - - 4 5 5-15 years 2 — — 2 4 16-64 years 12 15 — 159 186 65-74 years 57 38 — 152 247 75 years and over 179 74 — 325 578 Age not known 4 7 — 15 26 (a) Total no. of persons 255 134 - 657 1,046 (b) No. recommended to obtain treatment 170 105 - 317 592 (b) as percentage of (a) 661 78.4 - 48.2 56.6 Table (ii) Treatment recommendations in respect of newly registered persons* Treatment recommended No. of patients examined None Medical Surgical Optical Hospital supervision Early Later If general condition permits Cataract 255 85 11 47 26 17 21 106 Glaucoma 134 29 29 3 3 1 8 91 Other conditions 657 340 68 12 11 10 30 258 Total 1,046 454 108 62 40 28 59 455 *Includes cases recommended more than one form of treatment. Persons recommended to obtain treatment are re-examined at intervals after the initial registration. The number of persons re-examined for this reason in 1962 is shown in table (iii). Table (iii) Re-examination of persons recommended to obtain treatment Principal cause of defective vision Total Cataract Glaucoma Retrolental fibroplasia Other conditions No. of persons re-examined 209 71 1 316 597 No. found to have had treatment 149 67 — 216 432 Percentage treated 71.3 94.4 — 68.4 72.4 As a consequence of successful treatment 12 persons previously registered as blind were found, on re-examination, to be partially-sighted and eight persons previously certified as blind or partially-sighted were found to be improved to such an extent as no longer to justify registration. Notifications of ophthalmia neonatorum are given on page 23. 36 Registration of nursing homes Table (i)—Registration and inspection of nursing homes 1958 1959 I960 1961 1962 Registered at beginning of year 38 37 34 33 36 New homes registered — 1 — 5 1 Homes registered on change of keeper 1 2 3 1 — Registrations cancelled—voluntary closure or change of keeper 2 6 4 3 1 Registered at end of year 37 34 33 36 36 Inspections: Medical officers 41 42 35 46 45 Public health inspectors 50 63 84 122 116 Homes exempted from registration 38 38 40 37 35 Table (ii)—Accommodation in registered nursing homes at 31 December, 1962 Number of beds in homes Number of homes Maternity* Number of beds provided Mentally Others† disordered Total 25 or over 10 150 243‡ 162 555 20 to 24 6 25 83 22 130 15 to 19 8 17 100 17 134 10 to 14 8 12 87 — 99 5 to 9 2 9 6 — 15 Under 5 2 — 6 — 6 Total 36 213 525 201 939 *Each bed is registered for a maternity, medical or surgical case. †Numbers include beds for medical and surgical patients which cannot be used if a maternity patient is accommodated in the same room. ‡Number includes 33 beds registered for medical or mentally disordered cases. Invalid Meals for London The Council for many years made an annual grant under section 28 of the National Health Service Act, 1946 to Invalid Meals for London, a voluntary body providing meals for invalids and sick persons. Meals were supplied to those suffering from diseases which necessitated special diets which the recipients could not provide themselves nor obtain in an ordinary restaurant. In the great majority of cases the recipients of the meals were housebound and meals were delivered to them at their homes (in eighteen boroughs) by a transport fleet of 20 vehicles specially fitted with heated food-conveyors. Invalids living near and able to walk to the kitchens with dining-rooms attached (four out of the five) were served with meals at the restaurants. Towards the end of 1959 the Chairman of the voluntary body informed the Council that he felt unable to continue to be responsible for the work. His Executive Committee had authorised him to ask the Council to take over the service as soon as possible and, pending the completion of the necessary formalities, to make interim arrangements for the continuance of the service. The Council approved in principle the taking over of the service and, to enable the service to be maintained, approved the provision of financial and administrative assistance to Invalid Meals for London. The legal formalities were unexpectedly protracted and it was not until December, 1961 that the service was transferred to the Council. In the meantime, at the request of the metropolitan borough councils, provision had been included in the London County Council (General Powers) Act, 1961, to enable the borough councils to provide an invalid meals service or to make grants to voluntary bodies providing such a service. During 1961-62 discussions took place with the Metropolitan Boroughs' Standing Joint Committee on the future running of the service, but by the end of 1962 a final decision had still not been taken. 37 Details of the service provided is shown by the following figures: 1958/9 1959/60 1960/1 1961/2 1962/3 Meals served 167,134 172,637 180,291 196,695 202,430 Welfare Committee establishments Medical supervision of homes under the control of the Welfare Committee was continued. These homes include large and small homes for the aged and infirm, accommodation for mothers and babies, homeless families units, homes for the blind and lodging houses. There are units for lone women with a new-born baby in two of the large welfare homes, where mothers may be resident for periods up to three months. One unit provides accommodation for 18 mothers and 18 babies. The second unit originally provided places for 12 mothers and 12 babies but, due to a rise in demand, this had temporarily to be increased to 32 mothers and 34 babies by taking over accommodation which previously had been used for homeless families or old people. This accommodation was only made available to meet an emergency and the unit has now been reduced to 14 mothers and 14 babies in the original unit. Carisbrooke House is a mother-and-baby home for single girls, who are admitted for six weeks before and six to eight weeks after delivery. The Welfare Committee also have a hostel for mothers-in-work with a baby. Mothers are admitted when the baby is six weeks old and may stay until the baby reaches the age of eighteen months. In spite of the temporary reallocations of accommodation referred to above, outbreaks of infectious disease have not been a special problem in these homes. Although the two homeless families units at Norwood House closed early in January 1962 and the unit at Hillside was also closed for several months during the year, the number of homeless families received by the Welfare department remained high. The Public Health department advised on the steps to be taken to limit the spread of infectious disease, particularly Sonne dysentery and gastro-enteritis due to E. Coli. In this connection the Bacteriological Laboratory of the Public Health Laboratory Service at County Hall did invaluable work in examining the several thousands of rectal swabs collected during the year from residents admitted to the homeless families units. It is doubtful whether there has ever been any establishment, anywhere, where the laboratory has been used more intensely and for such a prolonged period in the search for potential spreaders of infection than in the homeless families units of the Council. All new admissions were vetted, those being transferred elsewhere were also tested; whenever there was a higher prevalence of bowel infection than usual widespread surveys were carried out. During the year 1,035 cases of bowel infections, which included a large proportion of symptomless carriers, and 360 cases of measles had to be removed to hospital from homeless families units. A further 430 cases (pneumonia, tonsillitis, acute appendicitis, etc.) were also transferred to hospital. The features which are of special importance in the spread of infection in these units are: (a) periodical overcrowding—it is notorious that the incidence of dysentery is highest when the occupation figures are highest; (b) the very close and intimate nature of contact between children for a large part of the time they are in the unit; (c) common feeding accommodation; (d) shared sanitary accommodation. Much has been done to stimulate the women inhabitants to a sense of responsibility for the maintenance of sanitary accommodation in good order, but responsibility of this type is patchy in distribution. It is regrettable that from the point of view of infection everyone is at the mercy of those with the lowest standards of responsibility, and there are a small number in the units at most times with very low standards of hygiene indeed. 38 As in previous years, because of their mothers' illness or other reasons, many children had to be taken into care by the Children's Officer from homeless families units. In an attempt to prevent the introduction of infection into nurseries and other residential establishments the Public Health department advised on the placing of these children, many of whom were contacts of infection up to the time of reception into care. During 1962 a total of 419 children were placed in special units because of a history of contact with infection. Of the 287 children under the age of five years, 44 (15 per cent.) developed the infection for which they were placed in special accommodation, compared with only eight cases (six per cent.) of infection amongst the remaining 132 children over the age of five years. A tendency towards this finding would be expected on general epidemiological grounds, but previous analysis of experience with child contacts also showed that there is a higher rate of infection amongst the under fives than is found amongst the children over five years of age. In the light of this experience arrangements were made during 1962 for children over the age of five years who have to be received into care from homeless families units to be received directly into children's homes, provided that reasonable observation by trained staff is maintained. So far there has been no increase in the amount of infection introduced into the children's homes which would indicate that this scheme was other than practicable. Children under the age of five years and occasionally their older siblings, who are admitted to contact accommodation have three rectal swabs examined following admission to these special units. They remain there until they have outlived the quarantine period of the infections with which they have been in contact. 39 SCIENTIFIC BRANCH The Scientific branch provides an advisory service to all departments of the Council on matters involving chemistry, physics and allied sciences. Similar service is provided, as required, to the metropolitan borough councils. In addition to statutory duties, the branch has important functions relating to health, safety and amenity. It is responsible for giving guidance on the efficient and economical use of material of all types used in the Council's service for construction, maintenance and consumption. The work is carried out in three groups of laboratories by a staff of 99. The headquarters laboratories at the County Hall cover the following main subject headings: (i) Air pollution, environmental radioactivity, ventilation. (ii) Noise and acoustics, fire precautions and investigations, industrial matters. (iii) Building materials and development work, floor maintenance, insecticides and fungicides, plastics, metals. (iv) Paint and decorative materials. (v) Fuel and boiler plant technology, heat insulation materials, drinking water, trade wastes. (vi) Detergents, laundries, swimming baths. (vii) Statutory, food, drugs, medical and general supplies. The Northern and Southern Outfall laboratories, situated at Beckton and Crossness respectively, are concerned with obtaining scientific data for the control of the sewage treatment process and ancillary plant together with research on projects potentially useful to the main drainage service. Samples totalling 66,463 were examined during 1962 in the course of analytical, experimental and research work. This record of samples does not include much of the consultative service given by the senior professional officers, which was not necessarily associated with laboratory work. A summary of the activities of the branch which have a direct or indirect application to the field of public health is given below. Full particulars are given in the annual report of the Scientific Adviser.* River Thames The condition of London's river is of special concern to the Council. In addition to effluents from the Council's own sewage treatment plants, there are sources of pollution from other sewage works, impure tributaries, trade discharges and contamination from shipping. To assess the condition of the water under varying conditions of fresh water and tidal flow, and to compare the state between seasons of the year and over periods of years, regular examinations are made involving chemical analysis of water taken from 26 points over a distance of 80 miles. The area examined extends from the upper limit of the tidal reaches at Teddington to the sludge dumping area at Black Deep in the outer estuary. The results are communicated to the Port of London Authority. The critical period is usually the summer quarter, July to September, and in 1962 a troublesome feature was the abnormally small upland flow due to reduced flow during the previous winter. Comparison with conditions over the previous ten years showed a deterioration in the dissolved oxygen content of the river in the upper tidal reaches. Despite this, there was some improvement in the region of the Outfalls, as compared with previous years, attributable to operation of new plant at the Northern Outfall Works. The incidence of sulphides in water devoid of oxygen was the lowest recorded. Sewage treatment The scientific work at both outfall works is carried out in close co-operation with the Chief Engineer, who is responsible for sewage treatment. Daily collaboration is maintained *Annual Report of the Scientific Adviser for the Year 1962, the London County Council, price 1s. 3d. 40 between our staffs and weekly conferences are held between the Scientific Adviser and the Divisional Engineer (Main Drainage), together with their senior officers, to discuss analytical results, operational practice and research projects. In addition to laboratory work undertaken to obtain the best efficiency from the treatment plant, full attention was given to matters of safety. For example, the utilisation of sludge gas involved daily safety tests at all potentially hazardous points in the digestion plant, power house and domestic boiler room. Trade waste discharges The Council exercises control under the London County Council (General Powers) Act, 1953 over industrial discharges into the London sewerage system. These discharges have increased in volume and complexity over recent years and continuous control is needed to exclude substances which would be hazardous or damage the fabric of the sewers. Detailed laboratory examinations were made on 3,630 samples of trade waste discharges, about one-third of this number being submitted by metropolitan boroughs. In consequence of these examinations, officers of the Scientific branch and of the Chief Engineer's department visited many premises to discuss with the occupiers the problems involved in treating the discharges and to give advice. A number of samples were analysed to provide data for determining' McGowan strength', so that estimates could be made of the appropriate charges to be levied under the London County Council (General Powers) Act, 1962. This Act, as from April 1964, will enable the London County Council and the metropolitan boroughs to charge for the receipt of trade waste discharges and for the London County Council to charge for the treatment of these discharges at the outfall works. Drinking water To ensure that the water supplies to Council establishments are of satisfactory quality, the Scientific branch carries out regular monthly inspections and samplings at those establishments where supplies are drawn from private wells. The water from these wells is chlorinated before use by means of automatic dosing plant. Samples of both the raw well waters and the treated waters are taken for bacteriological and chemical examination. If pollution is suspected check samples are taken at frequent intervals. At the request of the hospital management committees, the well supplies at some of the hospitals formerly under the control of the Council have continued to be regularly examined. Because of the excellent system of drinking water examination by the Metropolitan Water Board, samples are not examined direct from mains supplies but water from storage tanks is tested in many institutions to check the internal system and to ensure that tanks are periodically cleaned. Air pollution The Council continued its long-standing co-operation with the Department of Scientific and Industrial Research in investigating the incidence of air pollution, by maintaining regular observation of the degree of pollution of the atmosphere over the county. The average figure for sulphur dioxide has not shown any significant change over recent years, when seasonal fluctuations of temperature are taken into account, but in the case of smoke there has been a marked reduction reflecting the progress made by the metropolitan boroughs in implementing the Clean Air Act. By the end of the year, 25 per cent. of domestic premises in the county were using approved fuels under local Smoke Control Orders and in many other premises there was voluntary acceptance of the requirements of the Act. 41 The first week of December was notable for an exceptional meteorological fog which closely paralleled that of ten years ago. Calm conditions with temperature inversion developed on 3 December and during the next four days there were periods of dense and persistent fog when the dispersion of chimney effluents was so poor that the concentration of pollutants at ground level increased to ten times the normal winter figures. Although the concentration of sulphur dioxide approached that measured during the great fog of 1952 the general evidence was that smoke was appreciably less. Environmental radioactivity For some years the branch has undertaken experimental studies to obtain reference data on environmental levels of ionising radiation and to determine the extent of any additions arising from the numerous applications of nuclear science. Matters dealt with during the year included radiological safety in the Council's dental clinics; the safe use of radio-isotopes and X-ray apparatus in colleges; the safety of the public at exhibitions; advice to the London Fire Brigade in assessing hazards at fires involving radioactive matter. Several applications were made by hospital, industrial and laboratory users of radio-isotopes for the discharge of wastes to the sewers and suitable provisions were made. Swimming baths The Council has under its control three bathing ponds, 13 swimming baths for public use and 35 swimming baths situated at schools and institutions. Thirty-eight of the baths are equipped with complete purification plant and all the others receive some form of chlorination treatment. A careful check is kept on the condition of the water and regular visits are made by officers of the branch for inspection and testing, samples being taken for bacteriological and chemical examination. The baths with full treatment plant vary in capacity from 100,000 to 1,000,000 gallons and are emptied and refilled only once a year. During the year 500,000 people used the baths, this being a reduction on recent years due to bad weather. The minimum water clarity recorded was 21 feet and the maximum 200 feet. Noise and acoustics Measurement of the existing background noise levels was completed at nearly all of the 500 sites selected for the London Noise Survey, which is being made in collaboration with the Building Research Station of the Department of Scientific and Industrial Research and the Town Planning division of the Architect's department. The Scientific branch made measurements at additional points to obtain information about sound effects from helicopters. In connection with the Council's extensive road building schemes the noise of fast moving traffic was studied; measurements were made at sites near fly-overs, inclines, roundabouts and junctions, and where shielding has been given by shrubbery. Estimates were made of the alteration in noise level to be expected through road widening. The extent to which traffic noise is attenuated in high buildings was studied. 42 HEALTH SERVICE PREMISES Building programme In 1962, at the request of the Minister of Health, the Council, in common with all other local health authorities in England and Wales, produced a plan for the development of the health and welfare services for the ten years 1962-72. This included a health service building programme for the period which superseded the one for 1960/65 which was in existence. In preparing this new programme the Council endeavoured to formulate one which had reasonable prospects of achievement having regard to Ministerial guidance on capital expenditure and priorities, the shortage of land in the London area and the limitations which might be imposed by availability of professional and technical staff needed to build or to staff the new premises. The total cost of the schemes programmed for the ten years is of the order of £4,630,000, three-quarters of which is for the mental health and ambulance services. Details of new schemes programmed for 1963/64 are given in table (iii) and the estimated cost of the works is £907,500. About one-fifth of this cost will be met from London County Council or Metropolitan Borough Council housing capital, in respect of purpose designed accommodation for day nurseries and maternity, child welfare and school treatment centres being provided in the ground floors of new housing blocks on a rental basis. Tables (i) and (ii) show works completed in 1962 and schemes in hand at the end of 1962 from earlier programmes; table (iv) gives a list of acquisitions and leases completed in 1962. Table (i)— Works completed in 1962 Health Division Premises Work involved MATERNITY AND CHILD WELFARE 6 Burney Street, Greenwich Provision of maternity and child welfare centre in ground floor of housing block (built by Greenwich Metropolitan Borough Council). 8 Keeton's Road, St. Crispin's Estate, Bermondsey. Provision of maternity, child welfare and school treatment centre in ground floor of L.C.C. housing block. 9 Plough Road, Battersea Provision of maternity, child welfare and school treatment centre in ground floor of housing block (built by Battersea Metropolitan Borough Council). MENTAL HEALTH 6 Blackwall Lane, Greenwich Adaptation of existing building as an additional industrial training centre. 9 Putney Hill, Wandsworth Adaptation of premises as a mental health hostel. LONDON AMBULANCE SERVICE - Battersea accident ambulance station, Battersea. Replacement of building destroyed by enemy action. SCHOOL HEALTH SERVICE 4 Additional child guidance unit in Shoreditch. Conversion of standing property. PREVENTION OF ILLNESS—TUBERCULOSIS 1 Hurlingham Lodge Hostel, Fulham Improvements to kitchen and alterations to building due to road widening. 43 Table (ii)—Schemes in hand at the end of 1962from earlier programmes Health Division Premises Work involved MATERNITY AND CHILD WELFARE 2 Sumatra Road welfare centre, Hampstead. Extension to existing building to provide additional facilities. 3 Barnsbury Estate, Islington New maternity, child welfare and school treatment centre in L.C.C. housing block to replace unsatisfactory premises. 5 St. John's Parish Estate, Poplar Provision of maternity, child welfare and school treatment centre in housing development. 6 Abbey Estate, Woolwich New maternity, child welfare and school treatment centre in housing block to replace temporary welfare centre on L.C.C. estate. 8 Benson Home, Sancroft Street, Lambeth. Replacement in converted accommodation for unsatisfactory centre. 8 Loughborough Estate, Lambeth New maternity, child welfare and school treatment centre to replace unsatisfactory premises. 9 Stormont Road, Battersea New maternity, child welfare and school treatment centre to replace unsatisfactory premises. DAY NURSERY 1 St. Quintin, Kensington Extension to existing building to provide additional places. 1 Additional day nursery in North Kensington area. Conversion of standing property if acquired. 3 Additional day nursery in South West Islington area. Inclusion in new housing block under consideration. 4 Sun Babies day nursery, Shoreditch Improvements to heating and sanitary facilities. 9 Sisters Avenue day nursery, Battersea Replacement nursery or extension of lease. MENTAL HEALTH 6 Maze Hill, Greenwich New junior training centre to replace unsatisfactory premises. 7 Brockley Rise, Lewisham New mental health hostel. 8 Draper Street, Southwark New day centre for the mentally ill to be constructed in L.C.C. housing development. SCHOOL HEALTH 4 Shoreditch Health Centre, Shoreditch Improvements to provide additional dental surgery accommodation. PREVENTION OF ILLNESS—TUBERCULOSIS 3 Cromwell Lodge Hostel for tuberculous men, Hornsey. Annexe for occupational therapy. LONDON AMBULANCE SERVICE - Streatham accident ambulance station, Wandsworth. Provision of petrol pumps and hard standing. — Oval accident ambulance station, Lambeth. Rebuilding to accommodate additional ambulances. — South Western general ambulance station, Lambeth. Provision of workshops and extra garage space. - South Eastern general ambulance station, Deptford. Improvements to access, service bay and lighting. - Russell Square accident ambulance station, Holborn. Adaptation and reconstruction. 44 Table (iii)—Programme for 1963-64 Health Division Premises Work proposed 1 Grove House day nursery, Fulham Acquisition of freehold and subsequent improvements. 1 Latymer day nursery, Kensington Replacement in connection with road development scheme. 1 Maternity, child welfare and school treatment centre, Walmer Road, Kensington Replacement in new L.C.C. housing block for two unsatisfactory centres. 2 Mental health hostel, Lancefield Street, Paddington New purpose-built hostel for sub-normal men in work. 2 Adult training centre (men), St. Pancras New centre to replace two unsatisfactory centres. 3 Junior training centre, Basire Street, Islington Purpose built training centre to replace unsuitable centre. 5 Maternity, child welfare and school treatment centre, Leopold Street, Stepney Replacement in new L.C.C. housing block as part of redevelopment scheme. 6 Adult training centre (women), Greenwich Replacement of unsatisfactory centre in converted property. 6 Maternity, child welfare and school treatment centre and child guidance unit, Garland Road, Woolwich. Redevelopment of site at present containing prefabricated welfare centre. 6 Rusthall Lodge maternity, child welfare and school treatment centre, Woolwich Appropriation and adaptation to give improved facilities. 6 Maternity and child welfare centre, Avery Hill Estate, Woolwich Purpose designed annexe to new tenants' clubroom to provide improved facilities for Estate. 6 Maternity, child welfare and school treatment centre, William Barefoot Drive, Woolwich Replacement in new housing block of two substandard centres in church halls. 7 Wyndham day nursery, Camberwell Replacement of unsatisfactory nursery in new L.C.C. housing block. 7 Maternity, child welfare and school treatment centre, Dartmouth Road, Lewisham Replacement in new L.C.C. housing block of two unsatisfactory centres. 9 Child guidance unit, York Road, Battersea Additional purpose-built unit. 9 Day nursery, Upper Tulse Hill, Wandsworth Replacement in new L.C.C. housing block for unsatisfactory nursery. 9 Day nursery, maternity and child welfare and school treatment centre, Wandsworth Replacement of unsatisfactory premises in new buildings—site under negotiation. - Two mental health hostels New provision to meet demand. Sites under consideration. LAS South Eastern general ambulance station, Deptford Re-organisation and improvement of staff accommodation. LAS Brook general ambulance station, Greenwich Re-organisation and improvement of operational facilities and staff accommodation. LAS LAS Headquarters, Waterloo Road, Lambeth Improvements. LAS South Western general ambulance station, Landor Road, Lambeth Re-organisation and improvement of staff accommodation. LAS North Western general ambulance station, St. Pancras Replacement necessitated by hospital redevelopment scheme. LAS Arsenal accident ambulance station, Woolwich Replacement necessitated by road redevelopment scheme. 45 Table (iv)—Acquisitions and leases completed Health Division Property Interest obtained MATERNITY AND CHILD WELFARE 1 Fulham school treatment centre, 18 Bagley's Lane, Fulham Renewal of 7-year lease. 2 Hampstead Wells welfare centre, Christchurch Hill, Hampstead Completion of 21-year lease for premises previously rented. 2 St. Pancras school treatment centre, 26 Prince of Wales Road, St. Pancras. Completion of 10-year lease for premises previously rented. 2 Hallfield Estate welfare centre, Pickering House, Paddington Leasehold completed for new centre in borough housing block. 4 West Hackney welfare centre, St. Paul's Church, Evering Road, Stoke Newington Burney Street welfare centre, Burney Street, Greenwich Alteration of leasehold to allow for additional use. Completion of 60-year lease for new centre in borough housing block. 8 John Dixon welfare and school treatment centre, Keeton's Road, Bermondsey Indefinite tenancy from Housing Committee for new premises in L.C.C. housing block. 9 St. Christopher's welfare and school treatment centre, Plough Road, Battersea Completion of 60-year lease for new centre in borough housing block. 9 Putney Health Centre, 2 Clarendon Drive, Wandsworth. Completion of 99-year lease. DAY NURSERY 3 St. Margaret's, 10 Cambridge Road, Battersea Acquisition of freehold of premises previously leased. MENTAL HEALTH 3 Basire Street, Islington Freehold site acquired for erection of training centre. 6 Woodland Crescent, Greenwich Appropriation of freehold site for erection of training centre. 6 15 Park Vista, Greenwich Freehold acquired of premises to be converted for use as training centre. PREVENTION OF ILLNESS—TUBERCULOSIS 9 Wandworth chest clinic, Wandsworth Municipal Buildings, Wandsworth Completion of 7-year sub-lease of accommodation at Wandsworth Municipal Buildings. PREVENTION OF ILLNESS—INVALID MEALS 1 155 Munster Road, Fulham Acquisition of freehold of premises used by Council as kitchen. 46 CARE OF MOTHERS AND YOUNG CHILDREN The main features of the Council's services for care of mothers and young children remained as in previous years. Day-to-day administration of the services is the responsibility of the nine divisional health committees; details are given in the reports of the divisional medical officers. Changes in centres during the year are reported in the section on health service premises. Maternity and child welfare Particulars of sessions and attendances are given in the following table: Table (i)—Clinics for mothers and young children 1958 1959 1960 1961 1962 Ante-natal, post-natal and combined clinics: Number at end of year 112 111 109 109 108 Sessions per month 799 797 793 787 803 Ante-natal: First attendances 25,673 23,905 25,455 27,560 28,293 Total attendances 134,684 129,731 133,062 140,790 135,760 Percentage of pregnant women attending an ante-natal clinic 45 42 43 45 44 Post-natal: Number of women attending during the year 3,714 3,524 3,369 2,859 2,335 Child welfare clinics: Number at end of year 179 179 179 178 174 Sessions per month 1,991 1,957 2,034 2,057 2,081 Attendances under 1 year First 49,229 49,610 50,202 54,393 57,038 Total 611,057 606,042 578,250 599,930 600,436 Attendances over 1 year 177,283 152,627 163,845 169,023 166,401 Attendances at special toddlers clinics (not included in above) 38,940 38,361 37,533 38,203 37,790 Percentage of infants attending a centre at least once in the first year of life 88 89 88 90 90 General practitioner obstetricians—Following the principles laid down by the Maternity Services (Cranbrook) Committee for improving co-ordination, co-operation and exchange of information among the three branches of the maternity services, there was considerable extension in eight of the Council's health divisions of the arrangements whereby general practitioner obstetricians are given free use of the Council's ante-natal clinics to see patients booked for maternity medical services. In the remaining division it was arranged to put the scheme into practice on 1 January, 1963. In this connection table (ii) on page 54 is informative. The success of the Council's domiciliary midwives in encouraging mothers to book a general practitioner obstetrician for their confinement is reflected in the reduced number of mothers shown as attending the Council's clinics for their post-natal care in the above table, as most of them go to the doctor's own surgery for these examinations. Family planning—Advice on family planning is provided for married women for whom further pregnancy would be detrimental to health. 1958 1959 1960 1961 1962 Attendances at sessions provided by the Council First 1,011 975 945 899 1,034 Total 4,392 4,260 4,337 4,226 4,423 Women referred by the Council to Family Planning Association 702 705 741 641 595 47 National welfare foods Average weekly issues 1958 1959 1960 1961 1962 National dried milk (tins) 15,791 15,328 13,817 11,647 10,562 Cod-liver oil (bottles) 3,620 3,469 3,442 2,623 1,709 Vitamin tablets (packets) 2,736 2,775 2,837 2,109 1,196 Orange juice (bottles) 31,360 30,412 28,864 18,514 11,315 NOTE: The following charges applied as from 1.6.61: Cod-liver oil—1s. a bottle (previously free). Vitamin tablets—6d. a packet (previously free). Orange juice—1s. 6d. a bottle (previously 6d. a bottle). Day accommodation for children Table (ii)—Day nurseries and child minders At 31 December 1958 1959 1960 1961 1962 day nurseries: Maintained 76 75 74 73 73 Grant-aided 5 4 4 4 4 Total 81 79 78 77 77 Places: under 2 years 1,690 1,693 1,649 1,623 1,623 2-5 years 2,631 2,499 2,420 2,394 2,387 Total 4,321 4,192 4,069 4,017 4,010 council's child minder scheme (Voluntary registration): Child minders registered 824 875 989 861 810 Children minded 973 1,039 1,187 993 961 nurseries and child-minders regulation act, 1948: Private day nurseries registered (including part-time nurseries) 59 60 59 69 78 r ' Places 1,742 1,620 1,595 1,840 1,927 Child minders registered 141 167 202 210 221 No. of children authorised to be minded 781 939 1,023 1,088 1,265 Occasional creches—These creches provide for the children of mothers attending a clinic or class on the premises and also give occasional relief to mothers who, for various reasons such as visits to hospitals, shopping, laundering and other domestic duties, wish to be relieved of their young children for two or three hours during the day; they also present an opportunity for an only child to associate with other children of similar age. At 31 December a total of 111 sessions a week was being held, providing for 1,870 childattendances weekly. Prevention of break-up of families A case-work consultant was appointed in April, the first appointment of its kind by a local health authority. The recruitment of family case workers continued during the year and by 31 December thirteen were employed. In addition, eighteen selected social workers engaged in social work in connection with the school health service were each allocated up to three families. As in previous years, the Council made a grant to Family Service Units in London towards the cost of their work with families in difficulties. The grant for 1962/63 amounted 48 to £17,690, divided equally between the Health and Children's Committees. A grant of £1,000 was made, as in the previous year, to the Family Welfare Association as a contribution towards their work with families with problems. The arrangements for the co-ordination of social services within each division vary in detail, but broadly follow a similar pattern. In each division there is a co-ordinating committee which meets at regular intervals under the chairmanship of the Divisional Medical Officer, the Area Children's Officer in each division acting as Vice-Chairman. In some divisions the committee meets quarterly and is concerned only with policy; in one division the main committee is a case-work conference, while in other divisions casework is done by an intermediate committee meeting at monthly or fortnightly intervals. Consultations between health visitors, social workers and voluntary workers at field level are everywhere the rule. Families are reported to the co-ordinating committees, not only by public health staff, but also by Children's, Education, Housing and Welfare departments, as well as by hospital consultants and general practitioners. In spite of all the work which is being done, however, explosive and unforeseeable conditions arise in the family situation which no department is in a position to prevent and which, from time to time, bring families before the Courts. Schemes for early discharge of mothers from maternity hospitals Emergency Bed Service admissions to maternity hospitals in London have continued to rise, although more than half of the women who had to be so admitted were known well in advance to be in need of hospital confinement on social grounds; in some instances there were added risks because of age and parity. Emergency Bed Service maternity admissions, Administrative County of London 1960 1961 1962 January—June 867 1,027 1,230 July—December 874 1,094 932 Year 1,741 2,121 2,162 No particular reason is known for the marked reduction in admissions in the second half of 1962, but it seems probable that the Council's participation in agreed schemes for early discharge of maternity patients (see below) was a contributory factor. In an attempt to relieve the situation, bed-booking bureaux have been established in the two hardest pressed areas in north-west London and nine hospitals in various parts of the county were operating schemes at the end of the year, in association with the Council, for the early discharge of selected maternity patients 48 hours after delivery. In each scheme an agreed number of mothers and babies may be discharged each month, these numbers being sufficient to take the pressure off the hospital wards. Mothers, if they agree, are selected for 48-hour discharge by the consultant obstetrician as early as possible during pregnancy. A report on the home conditions is provided by the domiciliary midwife and the general practitioner obstetrician is asked to accept responsibility for the care of the mother and baby. Seven part-time midwives were recruited, to provide the reports on home conditions and to nurse mothers and babies discharged home under the schemes. In consideration of these facilities the hospitals concerned usually undertake to admit a small number of patients each month for delivery and full term post-natal nursing, who would otherwise have been referred for admission to hospital under the Emergency Bed Service procedure. In practice the success of the scheme varies in different divisions. In the north west of the county, for example, where the Emergency Bed Service pressure is highest, the social conditions of the mothers often make early discharge impossible. 49 Detection of children suffering from phenylketonuria As a result of the routine testing of babies to detect phenylketonuria, a rare inborn metabolic disorder which can give rise to mental defects, one child was found to be affected and was admitted to hospital where it received treatment and was making good progress at the end of the year. Children ' at risk ' There has been a gradual re-orientation of the work of clinic doctors and health visitors during the past few years towards the special care of babies born with physical and mental handicaps. Registers of all handicapped children as well as of all children at risk of congenital handicap, based on notification from the hospital maternity and domiciliary midwifery services, have now been set up. This procedure is fully described in the article on deafness (Appendix B). In division 2, an analysis made of the results of the follow-up of babies on the ' at risk ' register for the first eighteen months has shown that 919 cases of defect, amounting to some seven per cent, of the live births, have been found in the period. This is an indication that the work involved is very well worth while. Fifty-four per cent, of the children on the 'at ‘risk’ register were tested by 'stycar' test and on first testing eight per cent, of these were found not be satisfactory (about four per cent, of the children 'at risk'). On subsequent testing about a half of the children found not to be satisfactory proved to have normal hearing and the remainder were referred to the audiology unit for investigation. Among the children 'at risk' the following additional defects were found before six months of age: Talipes Eye (cataract) Mongol Abnormal external genitals Hare lip or cleft palate Congenital heart Cerebral palsy Achondroplasia Multiple deformities Meningocele and spina bifida Abnormality of feet Voluntary work In January 1962 the Minister of Health issued circular 2/62 which, in inviting local authorities to complete plans complementary to ' A Hospital Plan for England and Wales ' in respect of (a) the prevention of illness and (b) care in the community for which they were responsible, drew attention to the part that was already being played by voluntary organisations and suggested that voluntary effort had not reached its full potential. This was followed in April by circular 7/62, in which local authorities were asked to consider how their arrangements for co-operation with voluntary organisations could be improved or extended. A meeting was accordingly held in July, at which members of the Health and Welfare Committees discussed with representatives of the British Red Cross Society, Family Service Units, the Family Welfare Association, the Invalid Children's Aid Association, the London Council for Social Service, the St. John's Ambulance Brigade and Association and Women's Voluntary Service the place of voluntary effort in the health and welfare services. It was recognised that London is particularly well served by voluntary bodies which, along with individual volunteers, assist the Council and the people of London in many fields. A number of suggestions were made for possible development which, at the end of the year, were under consideration by the organisations concerned. 50 Residential establishments for young children in care Private residential establishments and those under the management of the Children's Committee are visited regularly by the Council's medical officers, who advise on hygiene and child health. A register is maintained of physically and mentally handicapped children and individual case histories are regularly reviewed by a senior medical officer, so that the need for special education or long-term care can be anticipated. Adoption and boarding out Children in care who are being considered for adoption or boarding-out are medically examined by a doctor, who supplies a written report of the examination on the form provided by the Council. This, in turn, is scrutinised by a medical officer in the Public Health department and the Children's Officer is advised on the child's suitability on medical grounds for boarding-out or adoption. Should a report reveal a medical defect or handicap in the child, the Children's Officer is also advised on any particular medical need. Where there is a history of inheritable disease in the natural parents, the Children's Officer is advised of this and a medical officer interviews the prospective adopters, with whom he discusses the implications of the probability of the child's inheritance of disease or defect. The number of children referred to me for advice by the Children's Officer and the decisions reached are shown below: 1958 1959 1960 1961 1962 1. Adoption cases: Suitable for adoption 167 228 267 257 289 Suitable for adoption subject to certain conditions 2 1 2 32 43 Unsuitable for adoption but suitable for boarding out 17 5 21 13 5 Withdrawn by Children's Officer 3 2 1 9 4 Under consideration at 31 December 1 2 5 4 5 190 238 296 315 346 2. Boarding out cases: Suitable for boarding out 320 290 447 438 483 Withdrawn by Children's Officer 3 3 6 5 1 Under consideration at 31 December 1 3 7 7 3 324 296 460 450 487 3. Unsuitable for either adoption or boarding out 3 1 — 1 1 TOTAL 517 535 756 766 834 Care of the unmarried mother and her child Moral welfare associations—Financial assistance totalling £15,574 was given during the year to the five large moral welfare associations of the major religious denominations: £ London Diocesan Council for Moral Welfare 8,387 Southwark Diocesan Association for Moral Welfare 5,937 Westminster Catholic Social Welfare Committee 600 Southwark Catholic Rescue Society 500 Jewish Board of Guardians 150 The two Church of England organisations (the London Diocesan Council 'Wei-Care' and the Southwark Diocesan Association) together employ a total of 26 outdoor workers, each of whom has her own particular area and works from a local office. Grants to these 51 two associations covered a large proportion of the salaries and expenses of the outdoor workers. The work of the Westminster Catholic Social Welfare Committee (Crusade of Rescue) is somewhat differently arranged; the first interview and the plans for the mother are dealt with at the association's central office, mainly by voluntary workers. When the question of adoption arises, this is dealt with by a social worker of the Crusade of Rescue. The Southwark Catholic Rescue Society interviews the mothers at a central office where the girl is seen by a social worker. The Jewish Board of Guardians also maintain a central office. When financial assistance for maintenance is needed the matter is referred to the Welfare department of the Council. Pregnant girls of school age living south of the Thames are helped principally by the children's special workers attached to the divisional school care organisation of the Education Officer's department; north of the Thames this work is done by the children's voluntary moral welfare associations, which are grant-aided through the Children's Committee. The Children's department and the adult voluntary moral welfare associations also deal with a number of cases. Mother and baby homes—Voluntary organisations provide most of the mother and baby homes in London, supported by grants in aid from the Council under the National Health Service Act, 1946. A total of £11,743 (including £1,920 for special works) was paid during the year to the 16 homes receiving grant and the number of expectant and nursing mothers admitted to these homes was 1,599. One mother and baby home is maintained by the Welfare department together with two other units within their larger homes. A marked upward trend in the percentage of illegitimate births in London over the last eight years has been commented on in this report (see page 6). There has also been an increase in the number of illegitimate pregnancies among girls under school-leaving age and girls still receiving full-time education. The care of these young mothers presents special problems and I have previously reported that, following a conference of departments and voluntary bodies concerned, it was arranged for a mother and baby home in South London administered by the Church Army to be made available for the sole use of young expectant mothers in receipt of full-time education, who would be referred by the Children's Officer. Girls are admitted to the home as soon as pregnancy has been diagnosed. A full-time teacher is provided by the Education Committee and a special per capita maintenance rate is paid by the Children's department, which co-operates closely with the staff of the home. An obstetrician in the maternity unit of a local hospital has undertaken the full maternity care of the girls admitted to this home and they are all admitted to the hospital for delivery. A consultant psychiatrist visits the home every two weeks and holds informal discussion groups with the mothers. During the year 22 girls under 16 years of age were admitted to the home. Of the 25 babies born in the year to young girls, ten were placed with a view to adoption, eight remained with the mother or have since been re-united, six were placed in residential nurseries and there was one still-birth. One mother had a severe mental breakdown and had to be transferred with her baby to hospital. She subsequently fully recovered and returned to her own country with her baby. Staffing—The voluntary committees of mother and baby homes have experienced increasing difficulties in recruiting resident staff. A trained nurse, often with midwifery qualifications, has in the past been appointed as matron in most homes with a trained nurse as her deputy. The present organisation of maternity services in London, however, is such that experience in midwifery is no longer an essential qualification for the matron. Because of this situation, coupled with a shortage of trained nurses interested in this field of work, a number of homes have now appointed an experienced nursery nurse as matron; this has worked well. Some homes have employed non-resident nurses or nursery nurses as assistant staff. 52 Special grants totalling £9,750 have been approved towards the cost of modernisation and improvements at two mother and baby homes. One of these homes, which carried out excellent work for many years in small and inconvenient premises in London, has moved to a larger home outside the county which is being completely adapted and modernised to provide accommodation for 22 girls and 13 babies. A second home, with large institutional wards each for 16-20 girls, is to be completely modernised; the improvements will necessarily reduce the total accommodation available by a few places. Child protection In six health divisions the visiting of foster children under the Children Act, 1958 and the inspection of the premises in which these children are living is undertaken for the Children's Officer by health visitors, who are designated as ' child protection visitors In these divisions the number of children supervised by child protection visitors on 31 March, 1962 was 516. During the year one successful application was made to a Juvenile Court to have a foster child removed from the care of a foster mother because of unfitness. The child was received into care by the Council. Marriage guidance Grants totalling £8,000 for the year ending 31 March, 1963 were made to the London Marriage Guidance Council, the Catholic Marriage Advisory Council and the Family Discussion Bureau. 53 DOMICILIARY MIDWIFERY The duty to provide adequate domiciliary midwifery service is discharged through the Council's own midwives and those employed by district nursing associations and hospitals. Table (i)—Staff District midwives employed at 31 December by 1958 1959 1960 1961 1962 The Council 87 89 94 94 100 (+ 7 part-time) District Nursing Associations (including supervisory staff) 48 45 46 43 46 Hospitals 40 46 43 40 37 175 180 183 177 190 In addition, 64 independent midwives practised during the year compared with 50 in 1961. The use of the Ambulance Service switchboard for routeing night calls has enabled revised relief arrangements to be made, under which the midwives receive an extra 17½ hours off duty each month. Table (ii)—Domiciliary confinements attended and institutional deliveries nursed at home. 1958 1959 1960 1961 1962 Doctor present Doctor not present Doctor present Doctor not present Doctor present Doctor not present Doctor present Doctor not present Doctor present Doctor not present (a) Doctor not booked L.C.C. 201 2,899 232 2,761 178 2,197 83 1,069 61 708 D. N. A. 75 1,577 58 1,360 47 1,193 39 716 9 359 Hospital district 23 1,693 41 1,574 – – – – – – 299 6,169 331 5,695 225 3,390 122 1,785 70 1,067 6,468 6,026 3,615 1,907 1,137 (6) Doctor booked L.C.C. 1,135 1,966 1,340 2,405 1,563 2,848 2,237 3,759 2,608 4,238 D. N. A. 182 389 194 505 280 692 339 1,010 501 1,561 Hospital district 144 225 132 313 202 1,745 302 1,666 344 1,607 1,461 2,580 1,666 3,223 2,045 5,285 2,878 6,435 3,453 7,406 4,041 4,889 7,330 9,313 10,859 Total 10,509 10,915 10,945 11,220 11,996 (c) No. of institutional deliveries attended by midwives on discharge before the tenth day 1,012 1,141 1,463 1,954 2,187 Grand total 11,521 12,056 12,408 13,174 14,183 Domiciliary confinements increased by 776 over 1961 and institutional deliveries discharged home before the tenth day showed an increase of 233. The figures of early discharges include (i) cases sent into hospital during labour from the domiciliary midwifery service on account of some abnormality and returned for nursing by a domiciliary midwife (this has long been a normal practice); (ii) cases accepted after 48 hours in accordance with pre-arranged schemes with certain maternity hospitals (see page 49). It will be seen that there has been a steady increase, from 4,041 in 1958 to 10,859 in 1962 (i.e. almost double), in the number of home confinements booked by general practitioners for the provision of maternity medical services. If hospital district cases are excluded the number has been almost trebled. Also, in about one-third of the cases where a doctor has been booked he attends the confinement. Table (iii)—Confinements by age and parity Age Total confinements Parity 0 1 2 3 4 and over Not known Under 20 No. 538 210 253 69 6 – – % 1.7 2.1 0.6 0.1 — — 20-29 No. 7,779 673 3,258 2,308 1,029 509 2 % 5.6 27.2 19.2 8.5 4.3 0.0 30-39 No. 3,474 54 745 1,020 812 843 % 0.5 6.2 8.5 6.8 7.0 — 40 and over No. 197 2 20 32 45 98 _ % 0.0 0.2 0.3 0.4 0.8 — Not known No. 8 – 2 4 1 – 1 % — 0.0 0.0 0.0 — 0.0 Total No. 11,996 939 4,278 3,433 1,893 1,450 3 % 7.8 35.7 28.6 15.8 12.1 0.0 Percentages are of the total confinements. On grounds of parity, 1,450 (12.1 per cent.) of mothers delivered by domiciliary midwifery services should have been delivered in hospital, but this was not possible either because beds were not available at the time the mother came for her ante-natal care or because the patient herself (69 instances) refused hospital booking. The peri-natal mortality rate for the domiciliary midwifery service (table(iv)) was 11.2 per thousand total births. The stillbirth rate in the domiciliary midwifery service was 7.0 per thousand total births, compared with 8.1 for England and Wales (1961). However, an analysis of peri-natal mortalities and stillbirths, according to age and parity, does seem to show that primiparae under 20 years of age delivered at home are at greater risk of peri-natal mortality or of a stillbirth than other mothers delivered at home. This conclusion is based on small numbers but does suggest a review of the priority for hospital admissions in this respect, so far as the maternity services in London are concerned. 55 Table (iv)—Stillborn and peri-natal mortality rates by age and parity Age Parity Number of confinements (a) Number of births Stillbirth rate (b) Neonatal deaths in first 7 days Perinatal mortality rate (b) Live births Stillbirths Total births Under 20 years 0 210 (1) 205 5 210 23.8 4 42.9 1 253 252 — 252 — 3 11.9 2 75 75 — 75 — — — 3 + — — — — — — — All 538 (1) 532 5 537 93 7 22.3 20-29 years 0 673 (1) 665 4 669 60 4 120 1 3,258 (12) 3,252 13 3,265 40 15 8.6 2 2,308 (7) 2,305 8 2,313 3.5 8 6.9 3+ 1,538 (5) 1,529 9 1,538 5.9 4 8.5 All 7,777 (25) 7,751 34 7,785 4.4 31 8.3 30-39 years 0 54 (1) 53 1 54 18.5 — 18.5 1 745 (3) 742 6 748 8.0 — 8.0 2 1,020 (5) 1,012 11 1,023 10.8 3 13.7 3 812 (1) 800 12 812 14.8 5 20.9 4+ 843 (5) 830 10 840 11.9 2 14.3 All 3,474 (15) 3,437 40 3,477 11.5 10 14.4 40 years and over 0 2 2 — 2 — — — 1 20 (2) 21 1 22 45.5 — 45.5 2 32 31 1 32 31.3 — 31.3 3 45 45 — 45 — 1 22.2 4 31 31 — 31 — — — 5+ 67 63 3 66 45.5 2 75.8 All 197 (2) 193 5 198 25.3 3 40.4 Age or parity not stated 10 10 — 10 — — — Grand Total 11,996 (43) 11,923 84 12,007(c) 7.0 51 11.2 (a) Number of confinements with twins shown in brackets. (b) Hates per 1,000 total births. (c) There were 32 abortions and miscarriages not shown in the table. 56 Table (v)—Premature live births 1958 1959 I960 1961 1962 Number 482 555 517 525 474 Per cent. of live births 4.6 5.1 4.7 4.7 4.0 Particulars of domiciliary premature live births are set out below. The difference between the total (528) shown in this table and the number (474) quoted above represents the number of cases attended by doctors and midwives independently of the Council's domiciliary midwifery service. Table (vi)—Domiciliary births—prematurity and mortality by birth weight 1962 Weight Number Proportion per 100 live premature infants Deaths in 24 hours Survivors at 28 days Number Per 100 live premature infants Number Per 100 live premature infants 3 lb. 4 oz. of less 38 7.2 13 34.2 20 52.6 3 lb. 5 oz. to 4 lb. 6 oz. 66 12.5 4 61 60 90.9 4 lb. 7 oz. to 4 lb. 15 oz. 75 14.2 3 40 71 94.7 5 lb. to 5 lb. 8 oz. 349 66.1 5 1.4 340 97.4 All cases 528 100 25 4.7 491 93.0 These figures, especially those relating to infants surviving at 28 days, compare favourably with those for all live premature infants born in the administrative county during 1962 (see table (xii), page 13). Midwives Act, 1951 Notifications received of intention to practise as a midwife: 1958 1959 1960 1961 1962 1,160 1,285 1,404 1,447 1,502 In accordance with section G of Rules of the Central Midwives Board, 124 midwives in the county attended a refresher course during the year. Fees to medical practitioners called in by midwives in emergency: 1958 1959 1960 1961 1962 Number of claims 2,626 2,653 2,350 1,291 711 The decline in medical aid claims by general practitioners is a direct result of the encouragement given to every woman having home confinement to book a doctor as well as a midwife. 57 HEALTH VISITING Home visits 1958 1959 1960 1961 1962 Expectant mothers: First 24,131 22,940 24,013 26,531 28,574 Revisit 23,213 23,161 22,546 23,934 24,410 Percentage of notified live and still-births 42 40 41 43 44 Stillbirths 979 960 1,024 849 769 Children under 1: First 53,557 53,224 55,226 60,995 67,829 Revisit 176,428 173,932 168,669 172,964 180,893 Children 1-5 368,845 372,622 369,122 379,793 375,543 Care of old people 13,331 14,366 14,350 14,772 15,526 Miscellaneous 80,978 80,948 80,026 86,971 80,422 Unsuccessful 100,648 101,503 104,014 111,958 117,113 TOTAL 842,110 843,656 838,990 878,767 891,079 58 HOME NURSING Details of the work done by the 25 voluntary grant-aided district nursing associations who act as agents for the Council are given below: Table (i)—Staff (numbers employed at 31 December)* 1958 1959 1960 1961 1962 State registered nurses 506 512 517 495 510 State enrolled assistant nurses 33 34 34 35 36 Total number of nurses employed 539 546 551 530 546 Male nurses (included above) 41 39 39 38 40 Full-time equivalent of nurses employed† 496 507 508 492 509 Students 65 78 27 64 32 Male students (included above) 6 6 — 2 4 * Exclusive of supervisory staff. † Excluding staff on annual leave. Table (ii)—Types of case nursed and visits paid Type of case Number of patients nursed % Average number of visits to each patient Total visits Medical 37,196 80.4 34 1,263,343 Surgical 5,551 12.0 40 220,656 Infectious diseases 85 0.2 5 446 Tuberculous 918 2.0 50 45,908 Maternal complications 1,403 3.0 6 8,307 Others 1,110 2.4 27 30,334 46,263 1000 34 1,569,004 The total visits for 1960 and 1961 were 1,690,084 and 1,601,860 respectively. Table (iii)—Types of treatment and location Visits for At patients' home Elsewhere (e.g., Nurses' Homes) Total visits % Injections only 524,824 22,013 546,837 35 Injections plus other treatment 88,715 499 89,214 6 Other treatment only 931,654 1,299 932,953 59 1,545,193 23,811 1,569,004 100 The proportion of visits for 'injection only' fell during the year by one per cent., compared with reductions in 1961,1960 and 1959 of two, four and five per cent. respectively. Table (iv)—Long-term cases {i.e., those visited more than 24 times during year) Number Percentage of total patients nursed 9,011 19.5 The percentage of long-term cases shows a decrease of 1.3 per cent. on the previous year. 59 Table (v)—Age distribution of patients Age No. of patients % 0-4 years 1,943 4 5-64 years 17,706 38 65 years and over 26,614 58 46,263 100 There were fewer patients than in 1961 (49,137) and the proportion of patients aged 65 years and over increased by two per cent; there was a similar increase in 1961. Table (vi)—Nursing treatments and case load 1958 1959 1960 1961 1962 Number of completed treatments 53,359 49,299 43,118 41,010 37,489 Number of patients being nursed at end of year 12,099 11,352 11,118 10,898 11,233 Average case load per equivalent whole-time effective* nurse at end of year 24 23 24 22 24 * Allowing for holidays and sickness. 60 HOME HELP Statistics of the service provided during the last five years are shown in the following tables. 1958 1959 1960 1961 1962 New applications dealt with 17,704 18,459 18,168 18,096 17,085 Applications deferred or refused because home helps were not available 25 13 23 18 14 Number of households assisted 34,600 36,056 38,031 38,546 38,461 Details of households assisted 1958 1959 1960 1961 1962 Maternity 1,601 1,823 1,913 1,785 1,642 Tuberculosis 777 710 692 647 547 Chronic sick 28,851 29,943 31,602 32,215 32,744 Early morning and evening help 197 200 244 257 238 Child help (resident) 6 20 8 24 12 Night help for chronic sick 55 40 28 17 17 Special help (problem families) 119 110 116 112 109 Miscellaneous 2,944 3,210 3,428 3,489 3,152 34,600 36,056 38,031 38,546 38,461 In the scheme for free home help service to women suffering from toxaemia of pregnancy, assistance was given to 78 cases (included above), amounting to 3,864 hours of service. Staff details 1958 1959 1960 1961 1962 Home helps employed at end of year 3,529 3,706 3,830 3,896 4,040 Equivalent of whole-time staff* 2,033 2,150 2,242 2,164 2,192 Hours worked during the year 4,651,500 4,919,200 5,129,000 5,059,064 5,064,696 * Excluding staff on annual and sick leave. 61 IMMUNISATION AND VACCINATION For the first time since 1957 there has not been an increase in the number of children given a primary course of diphtheria immunisation in the calendar year of birth. The administration of triple antigen (diphtheria, tetanus and pertussis) decreased by 10,819 (primary and booster courses). On the other hand, the number of persons vaccinated or re-vaccinated against smallpox reached the record figure of 611,137, of which 321,695 were dealt with in the Council's clinics. During the year the vaccination of young children against poliomyelitis was done increasingly by vaccine taken orally; in the age-group 1958—62 more than twice as many doses were given of Sabin vaccine as of Salk. Oral vaccine is now available to adults up to the age of 40 years. Diphtheria, tetanus, whooping cough— Table (i) 1958 1959 1960 1961 1962 Diphtheria immunisation: Primary course— Born in same year 10,644 14,102 20,203 20,990 20,852 Born in previous four years 23,301 26,125 28,980 32,276 22,054 Total under 5 33,945 40,227 49,183 53,266 42,906 Age 5-14 4,742 5,022 7,648 14,490 12,902 Reinforcing doses 38,725 33,237 40,511 87,758 44,472 Immunity index 1-4 years 69.9 70.6 74.1 82.2 87.3 Tetanus immunisation 15,092 32,531 48,605 60,298 46,963 Whooping cough vaccination 34,133 38,917 48,539 54,064 42,637 The number of children referred to in table (i) who received multiple antigens is as follows: Table (ii) 1958 1959 1960 1961 1962 Diphtheria/whooping cough 7,623 4,925 1,536 722 215 Diphtheria/whooping cough/tetanus 15,092 32,382 46,650 52,927 42,108 Diphtheria/tetanus — 42 1,734 5,860 2,435 The falling off in the number of children receiving the triple antigen may very well be the result of mothers keeping their babies away from welfare centres during the smallpox scare early in the year. The arrangements for the booster dose to be given at about 15 months of age were bound up with those for giving the third injection of poliomyelitis (Salk) vaccine at about the same time. With the introduction of a poliomyelitis vaccine to be taken orally and the discontinuance of the third injection, parents seemed disinclined to bring forward their children for the diphtheria, etc., booster dose. New arrangements have been made for parents to be given a direct reminder of the need for, and importance of, this booster dose. 62 Smallpox— Table (iii) 1960 1961 1962 Primary vaccinations: Under 1 year 23,057 30,482 36,406 One year 2,135 3,568 12,036 2-4 years 1,259 1,937 20,876 5-14 years 808 1,186 74,080 15 years or over 1,072 1,372 115,662 Total 28,331 38,545 259,060 Given by— l.C.C 20,583 29,913 150,157 general practitioners 7,748 8,632 108,903 Re-vaccinations: Under 1 year 44 63 8 One year 22 31 200 2-4 years 113 185 11,405 5-14 years 455 556 73,000 15 years or over 2,940 3,024 267,464 Total 3,574 3,859 352,077 Given by— l.C.C 1,598 1,715 171,538 general practitioners 1,976 2,144 180,539 Population 3,194,000 3,180,000 3,186,000 Percentage vaccinated 0.9 1.2 8.1 Percentage re-vaccinated 0.1 0.1 11.1 The large number of vaccinations in 1962 arose from reports concerning two smallpox cases in London in the early part of the year. Experience has shown that in such circumstances the disease can be controlled by the vaccination of close contacts of cases. Mass vaccination, besides having no effect on the cause of the outbreak, results in the primary vaccination of a large number of adolescents and adults, among whom complications are more likely to occur than in infants. For these reasons the public were advised not to seek vaccination, but so great was the public alarm that large numbers flocked to their doctors and to the Council's clinics. The result in terms of complications was as expected. During the year 21 cases of generalised vaccinia were reported and eight cases of post-vaccinal encephalitis—all recovered. In addition, five cases of eczema vaccinatum were reported in unvaccinated persons accidentally infected by contact with vaccinated persons. 63 Poliomyelitis—The number of persons who have received protection against poliomyelitis is as follows: Table (iv) Salk Sabin 1962 Since commencement of scheme 1962 Since commencement of scheme Primary vaccination:* Born in 1958-62 15,527 489,496 35,448 47,738 1943-57 10,451 12,290 1933-42 Londoners 8,631 183,245 7,677 7,677 Others 1,146 48,541 348 348 1932 or earlier (under 40) Londoners 14,230 84,430 10,442 10,442 Others 1,884 17,711 705 705 Other (over 40) 1,175 15,321 746 746 Total 53,044 838,744 67,656 67,656 Given by— L.C.C 32,262 599,532 56,222 56,222 general practitioners and hospital doctors 20,782 239,212 11,434 11,434 Booster doses† 3,463 102,272 13,508 13,508 Given by— L.C.C 1,475 84,085 12,095 12,095 general practitioners and hospital doctors 1,988 18,187 1,413 1,413 * Those who have received a third injection of Salk or three doses of Sabin. t Those who have received a fourth injection or a fourth dose of vaccine orally. Yellow fever vaccination—The numbers of persons vaccinated were: Table (v) 1960 1961 1962 Clinic No. 1. (Hospital for Tropical Diseases) 10,571 9,297 9,550 (Shipping Federation Clinic, King George V Dock) 809 2,762 2,937 Clinic No. 2. (Unilever House) 1,249 1,173 1,263 Clinic No. 3. (West London Centre) 4,031 3,682 4,055 16,660 16,914 17,805 Administrative and clerical procedures—Vaccination and immunisation procedures are changing as more knowledge becomes available and new materials are brought into use. As an examination of the department's immunisation and vaccination procedures was last made in 1954, it was considered that a further investigation was due. In 1960 a public health departmental committee was appointed to investigate the administrative and clerical procedures relating to immunisation and vaccination, under the chairmanship of Dr. Ian Taylor, Principal Medical Officer (Epidemiology). An interim report was issued in 1961 and a final report in 1962. I accepted the Committee's recommendations, which were passed to the nine health divisions for the necessary executive action. Those affecting the schools have been implemented with the active co-operation of the Education Officer. Some of the more important recommendations were: (i) The institution of a systematic follow-up by special letter of all children who had not commenced a course of immunisation against diphtheria, tetanus and whooping cough by the time they were four months old, with a further reminder, if necessary, 64 at nine months. Individual reports from health visitors to be called for in respect of those children who had failed to commence a course of immunisation by the time they were 12-13 months old. (ii) The importance of maintaining immunity by giving a booster dose at about 15 months of age to be emphasized by sending a reminder to the parent to bring the child to the welfare centre for such booster dose, in addition to an appointment being made on the child's personal immunisation record card (see page 58 of my report for 1961). (iii) In regard to the second booster dose due at about age five, special arrangements to be made for health visitors to call at the home of the child just before the time that he is due to commence attendance at school (from four and a half years of age upwards) to see the parents and to persuade them to bring the child to a welfare centre for the second booster dose before the child commences school attendance. To reinforce her request, the health visitor to leave with the parents a letter from the divisional medical officer, inviting the child to be taken to a welfare centre for the appropriate prophylactic measure before starting school. Concurrently, head teachers to be invited to co-operate in persuading the parent to arrange for the child to have the appropriate antigen before commencing school, by handing to the parent applying for a child's admission to school a printed copy of a letter from the medical officer of health pointing out the wisdom of having the child fully protected before school life begins. To supplement these arrangements an annual review to be made of the immunisation state of each child in a primary school, following which parents will be invited to give their consent to any necessary prophylactic procedure or to take the child to the family doctor. (It is hoped that as a result of annual reviews there will be every prospect that the child, on entering secondary school, will be adequately protected against diphtheria, tetanus and poliomyelitis.) Parental consent is always sought when a child needs immunisation, it having been assumed that a minor 'in law' would need such consent before an injection could be given. Consideration has been given to raising the age at which it would be necessary to approach parents for their consent. Having regard to the varying situations where a person under 21 years of age is legally accepted as being capable of coming to a decision, it has been decided, in regard to vaccination and immunisation, to continue to require written parental consent only in the case of infants and children still at school and those adolescents who have left school but who have not reached their sixteenth birthday. e 65 LONDON AMBULANCE SERVICE The tables below show some aspects of the work of this Service and of its agency and supplementary services in 1962. Table (i) indicates that the number of patients dealt with by the accident section, 1,990 more than in 1961, continue to increase; that 39,324 fewer patients were carried by the general section and 4,777 more by the agency and supplementary services. The decrease in the total number of patients carried is a little less than four per cent. or, on average, considerably less than one patient per hospital per day. The total number of general section patients conveyed includes a number travelling long distances who make the major part of their journey by rail; the Service moved about 25,000 such patients to and from London railway termini. Most of these patients were conveyed at the request of other authorities; only 6,537 patients travelled under arrangements originated by this Service. Table (i)—Work performed by the directly provided service and by the agency and supplementary services, including both general and accident section work 1958 1959 I960 1961 1962 Patients: Accident Section 94,079 99,834 103,497 108,235 110,225 General Section 991,263 1,009,128 1,033,909 1,008,539 969,215 Total—directly provided service 1,085,342 1,108,962 1,137,406 1,116,774 1,079,440 Joint Committee 24,382 26,582 32,593 31,701 31,349 Hospital Car Service 201,161 193,523 189,337 183,231 188,365 West Ham C.B.C. 409 496 338 331 326 Total—agency and supplementary services 225,952 220,601 222,268 215,263 220,040 Total patients 1,311,294 1,329,563 1,359,674 1,332,037 1,299,480 Journeys: Accident Section 99,188 104,983 109,551 114,953 117,020 General Section 482,863 488,336 488,422 480,978 476,081 Total—directly provided service 582,051 593,319 597,973 595,931 593,101 Joint Committee 9,710 10,250 10,877 10,858 10,456 Hospital Car Service 70,724 69,672 58,441 61,294 66,704 West Ham C.B.C. 403 489 335 329 324 Total—agency and supplementary services 80,837 80,411 69,653 72,481 77,484 Total journeys 662,888 673,730 667,626 668,412 670,585 Mileage: Accident Section 495,913 524,009 556,390 605,904 618,075 General Section 3,982,374 3,980,327 3,960,964 3,928,746 3,908,580 Total—directly provided service 4,478,287 4,504,336 4,517,354 4,534,650 4,526,655 Joint Committee 394,145 411,823 441,468 435,851 427,119 Hospital Car Service 1,224,817 1,212,580 1,207,439 1,191,201 1,271,863 West Ham C.B.C. 4,953 5,121 4,061 3,850 3,543 Total—agency and supplementary services 1,623,915 1,629,524 1,652,968 1,630,902 1,702,525 Total mileage 6,102,202 6,133,860 6,170,322 6,165,552 6,229,180 66 LONDON AMBULANCE SERVICE, 1947-62 GENERAL SECTION, INCLUDING AGENCY AND SUPPLEMENTARY SERVICES From 1955 onwards the figures of patients conveyed are based on the Ministry of Health definition of a patient which differs somewhat from that formerly used by the Council. E* 67 Table (ii)—General section 1958 1959 1960 1961 1962 Average mileage per patient 4.02 3.94 3.83 3.89 4.0 Average mileage per journey 8.25 8.15 8.11 8.17 8.2 Patients carried per 100 journeys 205 207 212 210 208 Table (iii)—Accident section Year Number of calls received Ambulance not required Average time to incident (in minutes) Average time from incident to hospital (in minutes) 1958 99,188 7,746 6.5 5.7 1959 104,983 8,640 6.6 6.2 1960 109,551 9,644 6.8 6.4 1961 114,935 10,350 7.0 6.2 1962 117,020 10,420 7.0 6.5 NOTES—1. These numbers include some urgent parturition cases and patients removed by general section ambulances when passing the scene of an accident. 2. Some accident calls are answered by vehicles from general stations, usually when an ambulance from the nearest accident station is not available. Table (iv)—Accident section—Source of calls 1958 1959 1960 1961 1962 Public and L.C.C. staff 68,134 72,793 76,705 81,755 84,261 Police 15,468 16,430 16,505 16,753 16,396 Midwives* 714 420 326 339 307 Doctors 6,815 7,092 7,522 7,964 8,549 Hospitals 2,032 2,021 2,186 2,045 1,933 Railway officials 3,030 2,931 2,896 2,868 2,654 Local calls† 870 923 893 788 827 London Fire Brigade 928 1,067 1,055 789 596 Out county 1,206 1,306 1,463 1,634 1,497 Total calls 99,188 104,983 109,551 114,935 117,020 * Fewer calls for gas-and-air analgesia apparatus because of the introduction of trilene apparatus which is portable by midwives. † Made personally at ambulance stations. Vehicles—By the end of the year 199 of the new type Austin ambulances were in service in replacement of Daimlers. Many modifications and improvements to the original prototype were carried out and research continued into the possibility of further improvement. The vehicle strength at 31.12.62 was: Large ambulances 250 Single stretcher, sitting case ambulances 61 Sitting case cars 30* Ambulance coaches 6 Mobile control unit for major accidents 1 Tenders 2 350 * Including four cars for the use of visiting officers. 68 Buildings—A new accident ambulance station was brought into operation at Battersea Rise in May and was officially opened by the Chairman of the Health Committee on 1 November. The station accommodates three ambulances engaged on normal emergency and general work and is also used as a training station (see paragraph on ' Training'). Five of the six general ambulance stations are accommodated in buildings erected over 60 years ago and a programme is in progress for modernising these buildings and improving the staff amenities. As the first stage in this programme, improvements to the administrative and operative staff accommodation were carried out during the year at the Eastern ambulance station. Abnormal weather conditions—Severe weather conditions were experienced at both the beginning and the end of the year. There was severe frost in January and February, causing many difficulties for the accident section; 611 casualties were removed on 1 January and 633 on 26 February, approximately double the normal figures. Dense fog was experienced during the three days 4 to 6 December and this again placed a severe strain on the Service; many crews willingly worked exceptionally long hours, driver/attendants had to lead their ambulances on occasions and 288 fog flares were used. In this period 1,243 emergency calls were answered. Although the number of general service removals fell because of the cancellation of out-patient attendances, there was a considerable increase in the number of general cases taken to hospital suffering from respiratory diseases and 206 cylinders of oxygen were used for the relief of bronchial and other patients. Rail strikes—On 29 January there was a strike on the London Underground railways. This resulted in exceptionally heavy traffic in central London and great difficulty was experienced in getting patients to and from hospital. Hospital authorities co-operated by cancelling non-essential journeys but nevertheless patients were subjected to unprecedented delays; for example, one ambulance took an hour to travel from Guy's hospital to Headquarters in Waterloo Road—a distance of little more than a mile. There was a strike on the main line railways on 3 October and, in anticipation of traffic chaos in central London, hospitals were asked to reduce their requests for ambulance transport as much as possible. In fact, little difficulty was experienced on this occasion although, of course, journeys involving rail transport were cancelled. Many of the admissions, discharges and treatments not carried out because of strikes and weather conditions were merely postponed and the carry-over work imposed some strain on the resources of the Service. Radio control—Radio control was extended to the vehicles operating from the Eastern ambulance station. Hospital casualty services—The Platt report envisaged the provision of a limited number of accident centres providing comprehensive facilities for the treatment of all types of casualties and the closure to ambulance-borne casualties of other hospitals. The first step in implementing this scheme in London was taken in May, when Guy's hospital was designated as the accident centre for an area of south-east London. Staff—The service is under the supervision of an Officer-in-Charge and is staffed by 33 administrative and clerical staff, 77 ambulance control clerks and 880 uniformed supervisory and operative staff. Training—The Service training scheme was re-organised during this year to provide for new entrants four weeks theoretical and practical training, including first aid, and, in addition, at least four weeks operational training at an accident ambulance station. At this operational training station, eight trainee crews on rotary shifts man three accidentequipped, radio-controlled ambulances. A personal instructor, with the rank of Station 69 Officer, is attached to each crew; he accompanies them on all calls to observe performance and, after completion of each call, to instruct and advise on techniques and conduct. The marked improvement in the ability and confidence of new entrants after this intensive training has fully justified the scheme. Award of resuscitation certificates—Three drivers were awarded the Royal Humane Society's resuscitation certificate during the year. Meritorious service medal—The Chairman of the Council presented the Council's Ambulance Service Meritorious Service Medal and the Royal Humane Society's testimonial on vellum to an ambulance driver in recognition of his courageous action in attending a severely injured man who had fallen under an Underground electric train. First aid and diagnosis competition—For the second successive year the London Ambulance Service team won the Buxton International Trophy for first aid and diagnosis in the international competition organised by the Casualties Union. Safe driving—Seventy per cent. of the drivers who entered the National Safe Driving Competition held by the Royal Society for the Prevention of Accidents in 1961 gained awards, 16 per cent. were disqualified and 14 per cent. were accounted for by resignations and by exemption owing to prolonged sickness. Civil Defence The most significant event in Civil Defence was the reorganisation of the Corps, effective from 1 October, which introduced new obligations of service for different classes of volunteers. The emphasis is now on establishing more intensive training and achieving higher standards of performance. As a result of the first stages of re-organisation, the strength of the Ambulance and First Aid Section fell from 1,895 to 1,310 at 31 December, due largely to the inability of some volunteers to accept the new training commitments. There were 443 enrolments during the year. The following training courses were held during the year: New entrants 3 Officer selection 3 First aid 8 Officer training 1 Ambulance section—part 15 Driving and maintenance 11 Ambulance section—part 2 13 There was a considerable increase in exercise training. The code name ‘Leader’ has been given to exercises promoted by the London Ambulance Service primarily for Ambulance and First Aid Section personnel and five such ' Leader' exercises were held. The largest of these involved the deployment of an ambulance column—100 vehicles and about 330 personnel. Section personnel participated in 20 exercises in all. An internal competition among teams from the Ambulance and First Aid Section proved of great value. After a total of 694 hours instruction by the British School of Motoring, 27 volunteers passed the Ministry of Transport driving test. In addition, qualified volunteers were given driving practice on various types of ambulance and others visited the Council's accident ambulance stations to see casualty work at first hand. 70 PREVENTION OF ILLNESS: CARE AND AFTER-CARE Chiropody The following tables show the attendances at the Council's foot clinics since 1958, with an analysis according to age groups: New cases and attendances Year New cases Attendances Staff at the end of the year (in terms of whole units) 1958 6,994 172,005 44.2 1959 7,074 169,847 46.2 1960 9,405 186,735 57.7 1961 10,379 196,788 55.6 1962 8,575 192,500 57.7 Analysis in age groups of treatment given at clinics Group 1958 1959 1960 1961 1962 Children 0-4 years 100 137 129 117 78 5-14 years 6,381 6,390 7,062 6,599 6,549 Males 15-64 years 14,805 14,442 14,766 14,076 12,237 65 years and over 15,435 15,410 17,613 19,675 20,106 Females 15-59 years 59,217 56,581 57,980 55,237 49,957 60 years and over 76,067 76,887 89,185 101,084 103,573 Total 172,005 169,847 186,735 196,788 192,500 Recuperative holidays Admissions to recuperative holiday homes 1958 1959 1960 1961 1962 Expectant and nursing mothers 111 123 109 95 80 Other adults 2,289 2,457 2,175 2,183 2,137 Children under 5 not at school 575 571 512 479 439 School and nursery school children 2,507 2,597 2,357 2,138 2,089 5,482 5,748 5,153 4,895 4,745 The Council maintains a recuperative holiday home at Littlehampton, Sussex, for 36 children from 3 to 8 years of age and leases another home at Bognor Regis, Sussex, for 44 children from 8 to 15 years old. Children who could not be accommodated in these homes, and all adults, have been placed in homes under private ownership or maintained by voluntary organisations. Roland House, Littlehampton was used exclusively for children from homeless families in Welfare department establishments for the first 14 weeks of 1962. During this period 229 children were given a recuperative holiday. Health education A very full description of the health education work of the department was given in my annual report for 1961. 71 Smoking and health—Considerable interest was taken during the year in the subject of smoking and health. The Council was closely associated with the planning and other arrangements for a closed-circuit colour television programme of live scientific demonstrations and discussions relayed from the County Hall to a centre in London. The programme, sponsored by the Central Council for Health Education, was watched by 2,400 senior London pupils and their teachers. As an experiment, advisory sessions have been organised at the East Islington welfare centre, Drayton Park, N.5 to assist smokers who wish to give up the habit. A working party was set up by the Education Officer, with representatives of the Education, Public Health and Children's departments and teachers, to review the situation in schools and to consider what further steps should be taken to warn children of the dangers of smoking, to discourage them from smoking and to prevent the formation of the smoking habit. It was thought necessary to have some reinforcement of the staff connected with health education. The contribution which the two mobile units set up by the Central Council for Health Education could make in London is small and for this reason the Council decided to set up its own mobile unit on an experimental basis. The capital cost of the unit is about £800 and the annual running costs are estimated at £2,500. The programme of visits by the unit to schools, welfare centres etc. will be linked with local publicity drives and the co-operation of local organisations, both statutory and voluntary, will be sought. It is proposed to provide a second unit if experience justifies it. Campaigns and exhibitions—A stand on safety in the home, fire prevention and means of escape from fire was again mounted at the Ideal Home Exhibition, Olympia. Demonstrations on the stand of mouth-to-mouth resuscitation proved a popular attraction. An exhibition on ante-natal care was staged at County Hall. At the end of the year, proposals were made for more extensive routine publicity over the home counties area on the need for routine immunisation. Other subjects proposed for attention were dental health and venereal disease. Health education talks—The following tables show the variety and volume of talks and discussions arranged by the field staff. Films and filmstrips continued to be widely used in these activities. The department's own library met 979 requests for filmstrips and provided 150 of the total of 655 films shown. Talks given by health visitors in schools at the invitation of head teachers ranged over a variety of subjects and numbered over 4,000. Health education talks—1962 Table (i)—Speakers Divisions 1 2 3 4 5 6 7 8 9 Total Medical officers – 75 9 – – – 3 – 2 89 Nursing officers – – – – – – 1 — — 1 Health vistors and school nursing sisters 606 1,077 316 279 399 898 734 103 265 4,677 Domiciliary midwives 5 17 9 1 3 — 16 — — 51 Teachers/instructors 87 134 — 112 59 — 43 — — 435 Other Council officers 7 – – – – – 8 2 — 17 Lecturers from outside the Council's service—Nursing – 1 – – – – 2 2 – 5 Other 6 30 25 7 9 – 89 23 – 189 Total 711 1,334 359 399 470 898 896 130 267 5,464 72 73 Table (ii)—Subjects of talks and attendances Divisions 1 2 3 4 5 6 7 8 9 Total Talks Attendances Talks Attendances Talks Attendances Talks Attendances Talks Attendances Talks Attendances Talks Attendances Talks Attendances Talks Attendances Talks Attendances Care of mothers and young children 595 4,435 945 7,162 314 2,556 224 2,067 350 3,637 844 9,615 559 5,437 87 718 246 2,422 4,164 38,049 Care of older children — — 84 655 2 51 — — 3 30 — — 17 219 — — 2 28 108 983 General family health topics 23 394 51 474 15 89 5 118 16 192 5 121 35 414 5 70 13 134 168 2,006 Environmental hygiene — — 13 105 — — — — 1 7 1 17 – – – – – – 15 129 Infectious diseases and prophylaxis 8 84 27 176 1 6 — — 13 112 24 280 22 255 5 46 2 11 102 970 Prevention of accidents 13 99 46 310 3 31 — — 8 66 15 148 27 344 4 58 — — 116 1,056 Smoking and lung cancer 6 103 12 93 2 130 – – – – – – 9 149 — — — — 29 475 Cancer education (other than above) – – – – – – – – 2 16 – – – – – – – – 2 16 Mental health 8 42 4 46 1 7 — — 2 13 — — 2 19 1 18 1 15 19 160 First aid 11 41 10 84 1 10 — — 2 20 — — 18 275 2 32 — — 44 462 Other 47 559 142 1,534 20 206 170 3,151 73 641 9 138 207 2,958 26 418 3 59 697 9,664 Total 711 5,757 1,334 10,639 359 3,086 399 5,336 470 4,734 898 10,319 896 10,070 130 1,360 267 2,669 5,464 53,970 Table (iii)—Audience groups Divisions 1 2 3 4 5 6 7 8 9 Total Expectant mothers 560 803 257 271 287 882 539 82 219 3,900 Mothers, mothers' clubs, etc. 113 515 99 127 183 15 339 38 46 1,475 Parent/teacher associations — - 1 — — — — — — 1 Schools* — — 2 — — — 3 — — 5 Day continuation classes 30 15 — — — — — — — 45 Voluntary organisations 8 1 — 1 — 1 15 10 2 38 Total 711 1,334 359 399 470 898 896 130 267 5,464 * Lectures by medical officers. 74 MENTAL HEALTH SERVICES An account of the historical development of the mental health services in London and the implementation of the Mental Health Act, 1959 was given in my report for 1961, (Appendix A). The year has shown a steady expansion of the facilities available for persons suffering from mental disorder, but it is realised that much more remains to be done on community care generally and especially in the provision of residential accommodation. However, the Council's first residential hostel for mentally ill persons and its first day special care unit for mentally sub-normal children aged 5-16 years were opened during the year, thus marking further milestones in the progress of the mental health service. Training centres To meet an increasing demand for places in south-west London, a new centre for 40 sub-normal and severely sub-normal older girls and women opened in Wandsworth in September. In November, 20 extra places for older boys and men living in north-west London were made available by increasing the accommodation of a centre in Kensington. At the end of the year there were 23 training centres providing 1,455 places (755 in nine junior centres, 335 in six centres for older boys and men—including 110 places in two industrial centres, 365 in eight centres for older girls and women) and 34 persons were awaiting entry. Industrial work, with income shared between the trainees taking part, continued alongside other training activities at most adult centres. As an experiment, in one centre paid laundry work for the Council's service was introduced. The two industrial centres produced goods valued at £2,225 for use in the Council's service and as a result of a larger turnover it was possible to increase the ex-gratia payments made to the trainees in these centres to three shillings a day. Special care units—The first special care unit in Council premises was brought into use in March in a specially adapted part of the Bethnal Green training centre. This provides accommodation for twelve sub-normal boys and girls, aged between 5-16 years, who are also severely physically handicapped or of such restless or aggressive behaviour that they cannot be accepted for admission to an ordinary junior training centre. Due to a more generous staffing ratio (one assistant supervisor and two attendants under the general direction of the centre supervisor), the special care unit enables the children to be given a greater amount of individual attention. Attendances were very good and the results achieved most encouraging. All the children showed a significant improvement and in the case of two of them this was sufficient to warrant their consideration for early transfer to an ordinary junior centre. Provision has been made in planning new junior training centres for the inclusion of a special care unit and the practicability of adding further units to existing centres was being actively considered at the end of the year. The Council approved the payment to the Friends of the Centre for Spastic Children of a contribution of 90 per cent. of the net annual cost of maintaining a special care unit for sub-normal multi-handicapped spastic children at the Cheyne Walk Centre, Chelsea. This unit, which was opened in November, provides for eight to twelve of these severely handicapped children between the ages of 2 and 7 years. Home teaching—At the end of the year home tuition was being provided for 43 mentally sub-normal persons who were unable through physical handicap to attend training centres. 75 Rehabilitation, training and occupation of mentally ill persons Day centres for the mentally ill—A second day centre, in Shoreditch, was opened by the Council in December for chronic mentally ill persons. Its purpose is to prevent further deterioration by providing a meeting place and some occupational and educational interests, to relieve relatives from the care of patients for a few hours daily and to provide the opportunity for patients to discuss and receive advice on personal problems and difficulties from the Council's social workers who are based in the same building. The centre accommodates up to 20 persons and was being fully used at the end of the year. The number on the register of the Council's day rehabilitation centre at Clifton Lodge, Hackney, which provides accommodation for up to 40 persons, had risen from 26 at the end of 1961 to 37 by December 1962. The day rehabilitation centres of the Institute of Social Psychiatry at Blackfriars and Southwark, towards the running costs of which the Council makes a 90 per cent. grant, were well used and 36 and 40 patients, respectively, were attending the centres at the end of the year. Financial assistance was also given to the Psychiatric Rehabilitation Association, towards the maintenance costs of a day centre for chronic mentally ill persons in Hackney and to the authorities of Trinity Church, Poplar, in connection with a day centre in East India Dock Road for older patients discharged from the day hospital at St. Clement's hospital. Day hospitals—Co-operation with hospital authorities in the provision of occupational therapy and social worker services at psychiatric day hospitals continued. During the year the Council was associated in this respect with day hospitals set up by Bexley hospital management committee at Castlewood hospital, Woolwich; by the Paddington Group hospital management committee in Torquay House, Harrow Road, W.9; and by Westminster hospital at Vincent Square, S.W.1. The day hospital at St. Olave's hospital, also assisted in a similar way by the Council, continued to function during the year. Psychiatric social clubs—In addition to the five psychiatric social clubs organised directly by the Council and the eight run by the Institute of Social Psychiatry, the Council gives financial assistance to clubs run by hospitals and other voluntary organisations. A new development during the year was the payment of grants to the Hampstead Council of Social Service, in respect of a club for mentally disordered persons and to the Royal Free hospital, towards the running expenses of a social therapeutic club for psychiatric patients which functions as a link between hospital treatment and complete independence from medical care. This is a field in which considerable expansion can be expected in future years. Occupation and instruction in the home—The experiment of using in two divisions the part-time services of an occupational therapist, previously employed solely on work with tuberculosis persons, in the home teaching and occupation of mentally ill patients was considered to have been successful. Arrangements were made for the experiment to be continued for a further year and to be extended to other divisions wishing to partake in it. The scheme provides positive activity for home-bound patients, which acts as an incentive towards rehabilitation and is aimed at preventing further deterioration. Furthermore, it provides a link through the visiting therapist with the outside world and support for the relatives. Residential accommodation Council hostels—The Council's first hostel for mentally ill persons, which opened in Putney for the reception of residents on 30 July 1962, provides accommodation in a converted residence for 23 men and women between approximately 18 and 60 years. The hostel is to cater for those persons who require a period of sheltered accommodation to help establish themselves in employment and in the community while recovering from 76 mental illness; this includes the temporary care of patients from the community in circumstances where a period of support away from the home surroundings might prevent a more serious breakdown. Admissions are on a trial basis of normally one month; during that time and, indeed, throughout the period of hostel stay, very active rehabilitation is often necessary by the warden and the social worker to help the residents in the process of readjustment. There were 17 persons in residence on 31 December. During the year 28 girls were resident at the Council's Dover Lodge hostel, Lewisham, for mentally sub-normal girls and nine remained in residence at the end of the year. This compares with 29 and eight respectively in 1961. Tenders for the erection of a purpose-built hostel in Lewisham have been received and work is due to start early in 1963. Arrangements were nearing completion for the acquisition or appropriation of sites for the erection in Paddington of a hostel for employable subnormal males requiring long-term care and in Greenwich of a hostel for long-stay mentally disordered children. The search for sites for further hostels for mentally disordered persons was continuing at the end of the year. Voluntary organisations—Hostels and homes maintained by voluntary organisations and private persons continued to be used for both mentally ill and mentally sub-normal patients; several additional establishments were approved for this purpose. At the end of the year the Council was maintaining 152 mentally ill patients at a number of voluntary homes and hostels, including those owned or sponsored by the Mental After-Care Association and the S.O.S. Society, and 128 mentally sub-normal persons in various establishments, including convents and other training establishments run by religious communities, placings through the Guardianship Society of Brighton and at hostels established by the National Association for Mental Health. Short-term care—The provision of short-term care for mentally sub-normal persons in hospitals or private homes approved by the Council's medical staff continues to grow. During the year 580 persons were placed under these arrangements for periods normally not exceeding eight weeks (compared with 427 in 1961). These facilties help to relieve for short periods the strain of home care of children and adults by parents and relatives, many of whom do not wish to place them in hospital or elsewhere on a long-term basis. Hostel for alcoholics—Financial assistance, based on 90 per cent. of net running costs, was continued to the West London Mission in respect of a hostel in Lambeth for male alcoholics. The selection of residents for the hostel takes into consideration both the need for rehabilitation and employment prospects. During the year 164 men were admitted; 38 from prison, 26 from Magistrates' Courts, 38 from hospitals and 62 from welfare organisations, general practitioners or clinics. Of the 162 men discharged during the year, about half were considered to have been successfully rehabilitated. Recuperative holidays for psychiatric patients—During the year recuperative holidays of two to three weeks were arranged for 125 persons recovering from psychiatric illness. Community care The number of mental health social workers was increased during the year from 81 to 102 (whole time equivalent) to meet the growing demands of the service. The integration of the work has been to some extent hampered by the need for mental welfare officers to serve on weekend and night rota duties and by changes of staff, but has gone ahead slowly and fairly steadily. There were 7,241 persons receiving community care at the end of 1962 compared with 6,053 for the previous year. The total number of mentally disordered persons referred to mental health social workers increased from 8,258 (1961) to 9,801 (1962). Links with the catchment area hospitals were improved and strengthened during the year, assisted in some divisions by the development of the day hospitals. 77 Guardianship—Four persons were admitted to the guardianship of the Council during the year and at the end of 1962 the total number in the guardianship of the Council was 39. Samaritan service—The Council made a grant, subject to review by 1964, to the Camberwell Samaritans towards the cost of employing a psychiatric social worker to organise the Samaritans' social work and help with the social training of a corps of 'befrienders' for persons faced with social problems. Staff training Two mental welfare officers were accepted for the Mental Health course, two for the two-year 'Younghusband' course and two for the one-year course at the Institute for Social Work Training. These six officers were seconded on salary. One deputy divisional mental welfare officer returned during the year after successfully completing the Mental Health course. A number of students from these courses spend varying periods with the divisional mental health teams as part of their practical work training. Seminars for mental welfare officers were arranged by the medical staff of St. Clement's hospital and several of the Council's staff were able to attend. By the end of the year a close link for staff training purposes had developed between division 7 and the Maudsley hospital. The majority of mental welfare officers have voluntarily attended one or more relevant conferences, lectures and/or part-time courses during the year. Statistics Statistical tables dealing with the work of the mental health service during 1962 are set out below with comparative figures for 1961 in italics. Table (i)—Source of referral of all cases Mentally ill Subnormal and severely subnormal Total 1962 Total 1961 With a view to hospital admission Community care No. % No. % No. % No. % No. % Psychiatric hospital or ward 589 9.4 812 37.5 Psychiatrist at general ward 328 5.2 28 1.3 149 11.1 2,558 26.2 1,927 23.3 Non-psychiatric referrals from hospitals 576 9.2 76 3.5 Psychiatric out-patient clinic or day hospital 221 3.5 118 5.4 62 4.6 401 4.1 221 2.7 Non-psychiatric hospital outpatient - - - - General practitioner 2,393 380 169 7.8 19 1.4 2,581 26.3 2,468 29.9 Police or court 670 10.7 13 0.6 23 1.7 706 7.2 777 9.4 Patient or relative 450 7.2 235 10.8 93 6.9 778 7.9 Landlord or neighbour 267 4.2 - - - - 267 2.7 Education officer 796 12.6 168 7.8 678 50.5 2,510 25.6 2,865 34.7 Health visitor 65 30 67 5.0 National Assistance Board 63 2.9 252 18.8 Miscellaneous 421* 19.4) Total 1962 6,290 100.0 2,168 1000 1,343 100.0 9,801 100.0 Total 1961 5,750 1,408 1,100 8,258 8,258 100.0 *Includes other departments of L.C.C., other local authorities, government departments and welfare associations. 78 There was an overall increase in total referrals during 1962, from 8,258 to 9,801; mentally ill persons referred with a view to hospital admission increased by 540, mentally ill persons for community care by 760 (a 50 per cent. increase) and subnormal patients by 243. The principal sources of referral were, for the first category, general practitioner; for the second psychiatric hospitals (referrals from this source more than doubled in 1962, from 398 in 1961 to 812); and for subnormal patients, the education service. Table (ii)—Initial action and final disposal of mentally ill persons referred to mental welfare officers with a view to removal to hospital Initial action Final disposal No. % No. % Informal admission 1,123 (899) 17.9 (15.6) 2,806 (2,306) 44.5 (40.1) Compulsory admission: For observation (sec. 25) 989 (903) 15.7 (15.7) - - - - Emergency admission for observation (sec. 29) 2,017 (1,841) 32.2 (31.9) - - - - For treatment (sec. 26) 136 (116) 2.2 (2.0) 489 (497) 7.8 (8.6) By police (sec. 136) 139 (232) 2.2 (4.0) — — — — Court order 208 (147) 3.3 (2.6) 209 (156) 3.3 (2.7) Absent from hospital without leave (sec. 40) 7 (3) 0.1 (0.1) 10 (5) 0.2 (0.1) Psychiatric out-patient clinic or day hospital 198 (170) 3.1 (3.0) 199 (170) 3.2 (3.0) General ward for physical care 59 (43) 0.9 (0.8) 79 (66) 1.3 (1.2) Community care from general practitioner, Welfare dept., etc. 204 (109) 3.2 (1.9) 205 (110) 3.3 (1.9) Other cases, including no further action 1,210 (1,287) 19.2 (22.4) 2,275* (2,314) 36.1 (40.2) Not known — — — — 18 (126) 0.3 (2.2) 6,290 (5,750) 100.0 (100.0) 6,290 (5,750) 100.0 (100.0) *Includes 977 (935) discharged after a period of observation and 80 (68) deaths. The pattern of action taken on referral and the final disposal of these patients remains much the same as in 1961, except that there were proportionately more cases admitted informally than in 1961 both on initial action and on final disposal. This aspect is dealt with in more detail in table (iii). Table (iii)—Hospital admissions dealt with by mental welfare officers informally or under sees. 25, 26 and 29 of the Mental Health Act, 1959 Initial disposal to hospital Final disposal to hospital Under 65 years 65 years and over Total Under 65 years 65 years and over Total No. % No. % No. % No. % No. % No. % Informal admission 840 (668) 24.0 (22.0) 283 (229) 37.1 (32.4) 1,123 (897) 26.4 (23.9) 2,184 (1,783) 82.6 (80.0) 622 (515) 95.2 (91.3) 2,806 (2,298) 85.1 (82.2) Compulsory admission: For observation (sec. 25) 762 (685) 21.8 (22.5) 227 (215) 29.8 (30.5) 989 (900) 23.2 (24.0) - - - - - - - - - - - - Emergency admission (sec. 29) 1,774 (1,583) 50.6 (52.1) 243 (250) 31.8 (35.4) 2,017 (1,833) 47.2 (49.0) - - - - - - - - - - - - For treatment (sec. 26) 126 (103) 3.6 (3.4) 10 (12) 1.3 (1.7) 136 (115) 3.2 (3.1) 458 (447) 17.4 (20.0) 31 (49) 4.8 (8.7) 489 (496) 14.9 (17.8) Total 3,502 (3,039) 100.0 (100.0) 763 (706) 100.0 (100.0) 4,265 (3,745) 100.0 (100.0) 2,642 (2,230) 100.0 (100.0) 653 (564) 100.0 (100.0) 3,295 (2,794) 100.0 (100.0) 79 In numbers practically all categories shown in table (iii) increased but proportionately there were more informal admissions on initial disposal to hospital than in 1961—24.0 compared with 22.0 per cent. for those under 65 years and 37.1 compared with 32.4 per cent. for those aged 65 years and over. Compared with 1961, final disposal showed proportionately fewer patients retained in hospital under compulsion—17.4 compared with 20.0 per cent. for persons under 65 years and 4.8 compared with 8.7 per cent. for old people aged 65 years and over. In my report for 1961 I commented on the high proportion of old people admitted to hospital in the first instance under the compulsory sections of the Mental Health Act. An investigation of this aspect during a part of 1962 showed that of the compulsory admissions of old people 62 per cent. had been seen by a psychiatrist before admission. The reasons given for requesting compulsory admission were—because of the disturbed state of the patient 91.7 per cent.; because of delay in admission which would otherwise have occurred 4.6 per cent.; that the patient was known to the hospital and unacceptable informally 3.7 per cent. Table (iv)—Disposal of cases referred specifically for community care (a) Suffering or suspected to be suffering from mental illness No. 1961 No. 1962 % % Hospital care: Informal admission 32 2.3 81 3.7 Compulsory admission 6 0.4 36 1.7 Psychiatric out-patient clinic or day hospital 20 1.4 62 2.9 Community care of mental health service 1,113 79.1 1,656 76.3 Other community care, e.g., Welfare or Children's dept., general practitioner, probation officer, etc. 61 4.3 84 3.9 No further action 176 12.5 249 11.5 No. of persons involved 1,408 100.0 2,168 100.0 (b) Mentally subnormal and severely subhormal No. 1961 1962 % No. % Hospital care 49 4.5 71 5.3 Community care of mental health service: Residential home, hostel, convent, etc. 36 926* 84.1 451 1,078* 80.3 Attendance at training centre 102j 77 Receiving visits from mental welfare officer 904 1,054 Other types of community care 30 33 Other community care, e.g., Welfare or Children's depts., general practitioner, probation officer, etc. 22 2.0 51 3.8 No further action 86 7.8 143 10.6 Miscellaneous 17 1.6 — — 1,100 100.0 1,343 100.0 *Number of persons; some cases are being visited as well as receiving some other form of care. With both mentally ill and subnormal persons the pattern of care for patients referred during 1962 remains similar to that of the previous year. At the end of the year 2,211 (1,321) mentally ill persons and 5,030 (4,732) mentally subnormal or severely subnormal were receiving some form of community care. Table (v) analyses the various types of care being given, from which it will be seen that 6,897 (5,724) persons were being visited by mental health social workers, 341 (304) were being provided with residential accommodation and 1,496 (1,430) were receiving training at day centres or in their own homes. 80 Table (v)—Persons receiving community care at 31.12.62 Type of care received Mentally ill Mentally subnormal or severely subnormal Grand total Under 16 years Over 16 years All ages No. % No. % No. % Residential home, hostel, convent, etc 185 (165) 27 2.0 65 1.8 92 (72) 1.8 277 (237) Boarded out — 5 0.4 59 1.6 64 (67) 1.0 64 (67) Home training (13) 20 1.5 23 0.6 43 (40) 0.9 43 (53) Attendance at day centres 133 (85) — — — — — — 133 (85) Attendance at social clubs for mentally ill* 132 (67) — — — — — — 132 (67) Training centres for subnormal and severely subnormal — 708 520 675 18.4 1,383 (1,292) 27.5 1,383 (1,292) Receiving visits from m.w.o. or p.s.w. 2,018 (1,132) 1,317 96.8 3,562 97.1 4,879 (4,592) 96.9 6,897 (5,724) Other types of community care 82 (12) 30 2.2 114 3.1 144 (52) 2.9 226 (64) †No. of persons involved 2,211 (1,321) 1,361 (1,306) 3,669 (3,426) 5,030 (4,732) 7,241 (6,053) *Some patients who are not included were attending clubs which receive financial or other help from the Council. †Some persons were receiving more than one type of service. SCHOOL HEALTH SERVICE Pupils on school rolls—In January, 1963 there was a total of 417,320 pupils on the day school roll; 231,934 in primary schools, 174,835 in secondary schools, 2,052 in nursery schools, 8,146 in special schools and 353 in hospital schools. In January, 1962 there were 422,622 pupils on the roll. Medical inspection Details of medical inspections during 1962 are summarised and compared with those for earlier years in the tables below. Since 1958 periodic general medical inspections have been analysed by year of birth to conform with Ministry of Education requirements, but to facilitate annual comparisons the year of birth has been turned into 'age' (by subtracting year of birth from year of inspection) in the tables throughout this section of the report. The Council's revised scheme for the medical inspection of schoolchildren came into operation on 1 January, 1959 and one effect was to make the intermediate periodic inspections a year later in the child's school life. It will be seen from the following table that intermediate inspections now are each spread over two age-groups because the school year begins in September. The number of children seen at periodic general medical inspections in 1962 was 39.3 per cent of the school roll, compared with 38.7 per cent. in 1961 and 35.2 per cent in 1960. It is of interest that of the 11,339 special inspections, over half were requested by head teachers, over a quarter by school health visitors and over one-tenth by parents. An experimental procedure for medical inspections was introduced during 1962 into selected schools. The routine examination of the seven to eight years age group was suspended to allow more time for the examination of selected children considered to be in need of particular attention. It is too early to assess the full value of the scheme. Periodic general medical inspections Age groups 1960 1961 1962 No. % No. % No. % 4 and less 7,674 5.1 7,939 4.9 7,995 4.9 5 27,435 18.2 28,558 17.4 28,647 17.4 6 7,511 5.0 8,314 5.1 8,972 5.5 7 9,744 6.5 9,356 5.7 9,039 5.5 8 19,322 12.8 20,684 12.6 20,783 12.7 9 3,227 2.1 4,204 2.6 5,843 3.6 10 1,897 1.3 2,078 1.3 2,109 1.3 11 10,549 7.0 10,096 6.2 10,416 6.3 12 19,634 13.0 20,148 12.3 18,992 11.6 13 4,884 3.2 6,103 3.7 6,280 3.8 14 9,418 6.2 10,277 6.3 8,152 5.0 15 and over 29,495 19.6 35,841 21.9 36,828 22.4 150,790 100.0 163,598 100.0 164,056 100.0 82 Non-routine medical inspections 1960 1961 1962 Reinspections 80,631 74,618 73,794 Secondary school reviewals 1,785 1,908 1,994 Other non-routine inspections (see next table) .. 50,648 48,380 46,682 Total 133,064 124,906 122,470 Total inspections 283,854 288,504 286,526 Analysis of non-routine medical inspections Nature of inspection Number inspected 1960 1961 1962 Bathing centre inspections—scabies 79 28 23 Bathing centre inspections—other 92 128 31 Employment certificates 5,288 5,264 4,226 Licences for theatrical employment 447 468 399 School journeys 21,032 21,409 20,556 Recuperative holidays—prior to holiday 1,188 1,075 952 —on return 396 53 69 Candidates for higher awards 47 34 50 Nautical school entrants 111 149 159 Outward Bound and Adventure courses 157 159 183 T.B. contacts 58 30 7 Boarding schools for the delicate— Pre-departure inspections 246 130 133 On return 85 45 38 Other handicapped pupils— Statutory examination 944 1,072 1,175 Periodic special defect examination 5,490 5,126 5,795 Research investigations and enquiries 383 186 339 36,043 35,356 34,135 Specials, at request of: Head teacher—special book 1,659 1,618 1,572 —other 4,854 4,585 4,496 School nurse—after health survey 1,722 1,208 1,076 —other 1,539 1,401 1,819 Divisional officer (Education) 888 895 716 District care organiser or care committee 725 642 485 Parent 1,669 1,488 1,175 13,056 11,837 11,339 All other non-routine inspections 1,549 1,187 1,208 Total 50,648 48,380 46,682 Pupils found to require treatment at periodic general medical inspections (excluding dental and infestation) Age groups inspected For defective vision (excluding squint) For other conditions Total individual pupils 4 and less 25 635 658 5 244 2,164 2,375 6 141 816 935 7 620 768 1,316 8 1,454 1,389 2,711 9 418 453 831 10 165 169 320 11 1,052 566 1,543 12 2,012 1,110 2,976 13 643 350 950 14 858 279 1,099 15 and over 3,976 1,087 4,910 11,608 9,786 20,624 83 Defects noted at routine medical inspections—The overall percentage of children referred for treatment of a defect was 12.6 in 1962 compared with 12.3 in 1961. The comparative percentages for sex and age are shown in the following table. The percentage referred for vision defects has increased from 6.6 in 1960 to 7.1 in 1962; for other defects it has increased slightly from 5.8 in 1961 to 6 0 in 1962. The increase in vision defect is mainly confined to the girls and is particularly evident in the 12-, 13- and 14-year old age groups. Vision defects are dealt with in more detail in a later paragraph. For all defects in the age groups containing the largest numbers (viz. 5, 8, 12 and 15) a marked increase over the 1961 figures was apparent in boys and girls aged 12 and a less marked one in girls aged 15 and over; for the 12-year old boys and girls aged 15 and over this was attributable solely to an increase in vision defects; whereas for the 12-year old girls this was caused by an increase both in vision defects and, to a lesser extent, in defects other than vision. Percentage of children noted for treatment Age and sex All defects Vision defects Defects other than vision 1960 1961 1962 1960 1961 1962 1960 1961 1962 4 and less Boys 9.6 9.3 8.6 0.5 0.4 0.3 9.3 9.0 8.3 Girls 8.3 7.6 7.9 0.3 0.4 0.3 8.0 7.3 7.6 5 Boys 9.2 8.6 8.6 0.5 0.5 0.8 8.7 8.2 8.0 Girls 7.9 7.5 7.9 0.7 0.7 0.9 7.3 6.9 7.1 6 Boys 12.5 11.8 11.3 2.1 1.3 1.6 10.8 10.8 9.8 Girls 10.7 9.4 9.5 2.0 1.5 1.5 9.0 7.9 8.3 7 Boys 15.2 15.4 15.0 6.6 7.0 6.4 9.2 9.0 9.4 Girls 150 13.9 14.1 7.6 7.2 7.4 8.2 7.2 7.5 8 Boys 140 13.5 13.7 7.2 7.0 7.0 7.5 7.0 7.3 Girls 13.5 12.8 12.4 7.3 7.5 7.0 6.7 5.9 6.0 9 Boys 13.7 14.0 14.3 7.3 7.1 6.4 7.1 7.9 8.4 Girls 13.3 14.0 14.1 7.5 8.1 7.9 6.2 6.3 7.0 10 Boys 16.0 15.5 15.4 8.7 8.9 7.0 7.8 7.4 9.3 Girls 15.5 14.2 14.9 9.0 9.4 8.7 7.4 5.7 6.7 11 Boys 13.3 12.8 12.4 9.1 8.4 8.1 4.6 4.8 4.9 Girls 17.3 16.4 17.2 11.3 11.6 12.1 6.9 5.4 6.0 12 Boys 130 13.4 14.3 8.3 8.8 9.8 5.2 5.1 5.1 Girls 15.3 15.4 17.2 9.8 10.4 11.4 6.2 5.8 6.6 13 Boys 13.4 12.0 13.0 8.7 8.5 8.8 5.2 3.9 4.7 Girls 16.3 15.0 17.5 11.0 10.7 11.9 6.2 4.9 6.6 14 Boys 12.1 12.1 11.7 8.9 9.4 9.0 3.5 3.1 2.9 Girls 13.2 14.5 15.5 10.2 10.7 12.2 3.7 4.6 4.0 15 and over Boys 11.4 12.2 11.8 8.9 9.7 9.5 2.8 2.9 2.6 Girls 14.3 14.3 14.9 10.7 11.6 12.1 4.2 3.3 3.3 Total Boys 12.1 12.0 12.0 6.1 6.4 6.4 6.3 6.0 6.0 Girls 12.9 12.6 13.2 7.1 7.5 7.8 6.4 5.6 5.9 Total Both sexes 12.5 12.3 12.6 6.6 6.9 7.1 6.3 5.8 6.0 note: A child can be noted as requiring treatment of vision and another defect, hence the percentage requiring vision treatment plus the percentage requiring treatment of other defects exceeds the percentage referred for treatment of all defects. The following table shows the percentage of children of all ages noted for treatment or observation of the defects listed for the years 1960 to 1962. These percentages remain fairly stable over the period. Enlarged tonsils and adenoids, orthopaedic defects and external eye diseases all show a continued decline. Defective hearing and enuresis have increased over the last year. 84  1960 1961 1962 Numbers examined 150,790 163,598 164,056 Percentages Skin diseases 1.22 1.19 1.14 External eye diseases 0.56 0.54 0.48 Defective hearing 0.85 0.90 0.99 Otitis media 0.56 0.51 0.49 Enlarged tonsils and adenoids 4.28 3.95 3.72 Defective speech 0.88 0.87 0.89 Enlarged cervical glands 0.68 0.63 0.66 Heart and circulation 0.83 0.87 0.86 Lung disease (not T.B.) 1.38 1.21 1.25 Orthopaedic defects 3.93 3.52 3.31 Defects of nervous system 0.43 0.43 0.43 Psychological defects 1.02 1.08 1.06 Anaemia 0.12 0.12 0.11 Enuresis 1.80 1.77 1.96 A child can be noted for more than one defect. The following table shows the sources of referral for special medical inspections and the value of such referrals judged from the number of defects found. Defects found at special medical inspections—1962 Head teacher School health visitor Referred by: Divisional officer (Education) Care committee Parent Number of pupils seen 6,068 2,895 716 485 1,175 Number of defects found 2,740 1,611 141 170 611 Number of defects per 1,000 pupils: Skin diseases 28 54 4 2 17 Defective vision 108 556 18 52 67 External eye diseases 22 39 1 6 20 E.N.T. conditions 80 115 29 33 100 Orthopaedic defects 37 58 14 12 39 Defects of nervous system 37 16 8 14 14 Psychological defects 338 30 25 49 66 Enuresis 26 42 4 33 46 Speech defects 59 20 1 4 22 Nutritional defects 17 34 1 35 17 All other defects 139 177 89 109 111 Attendance of parents and care committee representatives at periodic inspections—As in previous years, the percentage of medical inspections at which a parent is present decreases as children get older. The overall percentage was 49.2, slightly higher than in 1961 when it was 48.6 per cent. Care committee representatives attended 86.3 per cent. of all periodic general inspections. In the infant and junior school age groups the figure was over 90 per cent. but only about 80 per cent. in the secondary school age groups. This was due, no doubt, to the fact that care committees do not function in all secondary schools. 85 Attendance of parents and care committee representatives Age Group Number of pupils inspected Parent present % Care committee representatives present at inspection % 4 or less 7,995 92.1 80.6 5 28,647 87.7 93.7 6 8,972 79.3 95.7 7 9,039 73.4 93.8 8 20,783 70.9 95.3 9 5,843 63.8 94.8 10 2,109 52.3 95.3 11 10,416 38.2 76.2 12 18,992 31.1 82.9 13 6,280 25.3 82.3 14 8,152 8.9 83.4 15 and over 36,828 7.6 76.5 Physical condition of pupils The percentage of pupils whose condition was classified as satisfactory and unsatisfactory and the percentage who were noted as requiring treatment or observation on account of nutrition during 1962 are set out below, with similar figures for the four preceding years. This table suggests a continuous improvement over the five years, but the steadying of the percentage noted with a nutrition defect may mean that the end of this improvement is near. Physical condition Satisfactory Unsatisfactory % % Nutrition defect noted for Treatment Observation % % 1958 98.1 1.9 0.5 0.6 1959 98.8 1.2 0.2 0.5 1960 99.0 1.0 0.2 0.5 1961 99.2 0.8 0.2 0.4 1962 99.4 0.6 0.2 0.4 As indicated in my report for 1959, the newly introduced basis of tabulation by years of birth permits the comparison of samples of children of the same age group and is analogous to a ' follow-up ' survey. The last four years' figures are: 86 Percentage unsatisfactory physical condition Year of birth 1959 Year of examination 1962 1960 1961 1944 0.6 — — — 1945 0.9 0.4 — — 1946 1.3 0.6 0.4 — 1947 1.3 0.8 0.4 0.3 1948 1.2 0.9 0.6 0.3 1949 2.9 0.9 0.6 0.5 1950 20 2.2 0.6 0.5 1951 1.2 1.6 1.7 0.4 1952 1.4 1.1 1.5 0.9 1953 2.4 1.8 1.0 0.9 1954 1.4 1.8 1.2 0.8 1955 1.4 1.2 1.8 0.9 1956 - 10 0.7 0.8 1957 — — 0.8 0.6 1958 and later - — — 0.8 School meals and milk The Ministry of Education asked for a return for a typical day of the total number of (i) day school children who had school dinners and (ii) children who had school milk. The day selected for the census was 25 September or the nearest normal school day thereto. The figures are set out below with those for 1961 in brackets. Number of Number who took Type of school children school dinners present On payment Free Total % Secondary 165,861 99,416 7,499 106,915 64.46 (173,329) (103,139) (7,470) (110,609) (63.81) Primary 205,032 111,522 12,703 124,225 61.48* (205,994) (109,150) (12,382) (121,532) (59.00) Special 5,640 4,424 1,149 5,573 98.81 (5,585) (4,411) (1,098) (5,509) (98.64) Nursery 1,634 868 79 947 96.34† (1,509) (870) (87) (957) (99.17) 378,167 216,230 21,430 237,660 63.45‡ (386,417) (217,570) (21,037) (238,607) (61.75) *Percentage of 202,064 children, as 2,968 children attended half time and did not have dinners. †Percentage of 983 children, as 651 children attended half time and did not have dinners. ‡Percentage of 374,548 children. The Ministry was informed that 308,095 children in Council maintained schools took milk on the selected day(s) compared with 316,826 in September 1961. Of 29,030 children present in independent schools, 21,662 had milk under the scheme. The percentages for the several types of school for the corresponding days were: 1958 1959 1960 1961 1962 Secondary 71.45 69.23 66.05 63.12 61.08 Primary 97.52 96.82 96.32 96.51 96.01 Day special 98.44 98.83 98.47 99.18 97.32 Nursery 98.78 98.64 98.51 98.67 97.86 Boarding 98.78 98.12 98.51 97.52 98.41 Independent 77.10 76.67 74.60 77.66 74.62 Vision Visual acuity standards expressed as percentages of the numbers of children whose eyes were tested are set out in the following table. For children not wearing spectacles the highest rate of referral for treatment is at age under 7 (entrants), but this is because vision testing at this young age is not general and tends to be confined to those in whom there is a suspicion of defective vision. In general the referral rate for treatment is fairly consistent throughout the age range, i.e., development of defective vision is progressive with age, since those found to have defective vision at earlier examination and provided with spectacles will be excluded from this side of the table at subsequent examinations. For children already wearing spectacles the proportions referred for treatment increase with age, doubtless for correction of refraction. Of the children medically inspected 0.6 per cent. were noted for treatment of squint, the same as in the past three years. The percentage ranged from 1.2 in the entrant group to 0.1 in the leaver group. 87 Age group Boys Not wearing spectacles Wearing spectacles 6/6 6/9 6/12 or worse Referred for treatment 6/6 6/9 6/12 or worse Referred for treatment Under 7 78.4 11.3 7.7 10.3 0.9 0.7 1.0 1.0 7 78.6 11.3 6.4 6.3 1.2 0.9 1.6 0.9 8 81.3 9.0 5.7 5.5 1.4 1.1 1.5 1.6 9 81.0 8.8 5.8 5.2 1.6 1.2 1.6 1.3 10 82.6 6.9 5.6 6.0 1.7 1.2 2.0 1.3 11 81.3 5.5 5.5 5.7 3.9 1.5 2.3 2.5 12 79.5 5.5 6.5 6.5 3.9 2.2 2.4 3.4 13 81.4 5.4 5.9 5.8 4.0 1.5 1.8 3.0 14 80.8 4.3 5.6 5.4 4.4 2.2 2.7 3.7 15 and over 77.4 4.6 6.1 5.5 6.4 2.6 2.9 4.1 Total 79.5 6.5 6.0 5.9 3.9 1.9 2.2 2.8 Girls Age group Not wearing spectacles Wearing spectacles 6/6 6/9 6/12 or worse Referred for treatment 6/6 619 6/12 or worse Referred for treatment Under 7 78.3 11.4 7.6 11.7 0.9 0.9 0.9 1.0 7 77.4 11.8 6.6 6.6 1.4 1.4 1.4 1.5 8 80.2 9.8 5.5 5.7 1.5 1. 1.6 1.5 9 79.9 9.3 5.8 6.1 1.9 1.4 1.7 1.9 10 79.3 9.3 5.8 7.0 2.0 1.6 2.0 2.0 11 75.7 6.9 6.9 7.6 5.0 2.7 2.8 4.6 12 76.7 6.9 6.4 7.3 4.6 2.8 2.6 4.2 13 75.5 7.0 7.5 7.8 4.2 3.0 2.8 4.1 14 75.2 5.6 5.8 6.7 5.7 4.0 3.7 5.6 15 and over 74.2 4.9 5.8 6.3 7.6 4.2 3.3 5.8 Total 76.5 7.3 6.2 6.8 4.6 2.8 2.6 3.9 note: The percentages of children referred for treatment differ slightly from those quoted in the defects for treatment table on page 83 in which the percentages were based on the number of children medically inspected. Personal hygiene The hygiene inspection of each child once a term was replaced in January 1959 by an annual comprehensive health survey of each pupil, plus such additional health surveys as may be thought necessary or desirable at selected individual schools or departments. Also, from January 1960, the use of Lorexane No. 3 shampoo was brought into use throughout the county under a revised cleansing scheme. However, since the type of action to be taken in any particular case is at the discretion of the school nurse/health visitor concerned, in the light of her knowledge of the family, it was decided that from 1 January 1961 no attempt need be made to distinguish between 'first' and 'second' notices and that the distinction between 'verminous heads', 'nits only', and 'other verminous cases' be also discontinued. 88 Health surveys—The number of comprehensive health surveys conducted in 1962 was four per cent less than that conducted in 1961. There was a decrease of 16 per cent. in the number of selective health surveys. No. found Pupils found to be verminous No. examined verminous % of No. examined Annual comprehensive health surveys* 309,897 2,577 0.83 (323,800) (2,899) (0.90) Additional health surveys* 158,678 2,911 1.83 (189,216) (3,327) (1.77) *1961 figures in brackets. To assess the comparative level of infestation amongst schoolchildren, only the findings for comprehensive health surveys (each child seen once a year) can be compared with the former hygiene inspections (each child seen once a term). As will be seen in the following table, the percentage found to be verminous at comprehensive surveys has shown a continuous decline over the years 1959 to 1962, which is largely due to the introduction in 1960 of Lorexane No. 3. shampoo. Percentage found to be verminous Hygiene inspections Comprehensive health surveys 1955 1956 1957 1958 1959 1960 1961 1962 1.35 1.26 1.25 1.27 1.25 0.93 0.90 0.83 The number of individual children found to be verminous during 1962 was 3,119, a reduction of 975 from the number in 1961. Fewer selective health surveys were made, which may account in part for the reduction, but the fact that the percentage found verminous (occasions) at these selective health surveys has increased from 1.77 in 1961 to 1.83 in 1962 suggests that the surveys have tended to be confined to those schools where the need is greatest. Details of the work done under the cleansing scheme are shown below. The emphasis of the cleansing scheme as now carried out is on the children being cleansed by the parents at home, where any other verminous members of the family may, in the privacy that the home affords, also use the Lorexane No. 3 shampoo, hence eradicating a possible source to the child of recurring infestation. To about seven per cent. of the number found verminous (occasions) at comprehensive and selective surveys the issue of advice alone was necessary; to about 75 per cent. a tube of Lorexane No. 3 shampoo was given. The number of statutory notices issued was 93, an increase of 31 over the number issued in 1961. (320 such notices were issued in 1960). Cleansing scheme 1958 1959 1960 1961 1962 Advice notice only issued N/A N/A 2,381 575 405 Advice notice with Lorexane No. 3 N/A N/A 6,552 4,488 4,087 Number of pupils referred for further action N/A N/A N/A 1,204 996 Pupils attending bathing centre voluntary 5,527 4,552 1,628 735 758 Statutory cleansing notices issued 964 764 320 62 93 Pupils cleansed after service of statutory notice: Voluntarily 240 259 84 18 12 Compulsorily 628 458 197 37 81 Total 868 717 281 55 93 Bathing centres—The number of cases of infestation with vermin treated at bathing centres showed a reduction of 12 per cent. compared with 1961 and the number of treatments a reduction of 12 per cent. There can be little doubt that these reductions are directly attributable to the introduction of Lorexane. 89  1958 1959 1960 1961 1962  Scabies Pupils treated 768 660 637 514 458 Vermin Pupils treated 7,473 7,025 3,441 2,265 1,983 Treatments needed 13,647 11,799 4,345 2,764 2,422 Impetigo Pupils treated 1,478 1,187 1,020 1,033 903 Ringworm New cases 22 20 10 7 6 Employment of schoolchildren Medical examinations were carried out divisionally of 4,226 children with a view to the issue of employment certificates and 399 medical examinations were carried out at the County Hall in respect of employment under licence in public entertainments. Choice of employment The percentage of school leavers advised against particular forms of employment was 13.3 per cent. of those inspected, the same as that for 1961. For boys the figure rose from 14.2 per cent. in 1961 to 14.6 per cent. but for girls it fell from 12.3 per cent. to 11.9 per cent. As in recent years, normally acute vision headed the list of contra-indications followed by colour vision (boys only) and heavy manual work: Contra-indications Boys Girls Occupations involving: Heavy manual work 272 176 Sedentary work 14 13 Indoor work 14 13 Exposure to bad weather 141 145 Wide changes of temperature 92 73 Work in damp atmosphere 115 107 Work in dusty atmosphere 186 130 Much stooping 49 48 Work near moving machinery 105 85 Prolonged standing, much walking or quick movement from place to place 251 227 Normally acute vision 1,942 1,928 Normal colour vision 541 7 Normal use of hands 24 13 Work requiring freedom from damp hands and skin defects 37 27 Handling or preparation of food 35 34 Normal hearing 85 71 note: An individual may be noted for two or more contra-indications. Infectious diseases in schools When a pupil is absent from school and the cause is either known or suspected to be due to infectious disease, the head of the school notifies the divisional medical officer and the borough medical officer of health. These notifications are uncorrected for diagnosis but form the best available index of the trend of infectious disease in the school community; they are the only figures available in respect of diseases which are not statutorily notifiable. When the number of cases of infectious disease reported from a particular school indicates the possibility of an outbreak, special visits are made by a school health visitor and, if necessary, by a school doctor, in order to investigate the situation and take whatever control action is necessary. 90 The numbers of cases of infectious diseases reported during 1962 and the preceding years are given below: 1958 1959 1960 1961 1962  Chicken-pox 8,901 5,399 8,357 5,895 8,332 Dysentery, diarrhoea or enteritis 1,170 1,148 1,557 669 988 German measles 2,549 1,325 631 3,891 12,332 Impetigo 265 192 194 187 193 Influenza N/A N/A 229 127 183 Jaundice 11 19 253 493 274 Measles 5,045 9,326 2,544 14,343 2,875 Mumps 2,778 3,788 8,783 2,338 1,677 Ophthalmia and conjunctivitis 319 264 299 536 645 Ringworm (scalp) 13 13 8 10 10 Ringworm (body) 38 46 51 26 19 Scabies 61 57 76 78 59 Scarlet fever 1,251 1,264 721 634 526 Sore throat and tonsillitis 994 1,299 905 1,416 911 Whooping cough 485 508 1,454 395 245 Prophylaxis—The new system of recording medical inspection findings by years of birth permits an analysis of the percentage of school pupils, according to age, who have received prophylaxis, based on the findings at periodic general medical inspections. These figures may be compared with the separate estimates, prepared for the Ministry of Health, given on pages 62, 63 and 64. % % % % Number of vaccinated immunised immunised vaccinated Age group pupils against against against against inspected smallpox diphtheria whooping poliomyelitis cough 4 or less 7,995 80.4 89.5 85.9 82.9 5 28,647 76.1 86.0 79.7 81.0 6 8,972 69.9 79.5 70.1 72.8 7 9,039 71.1 85.5 72.4 77.8 8 20,783 71.2 89.4 73.3 80.4 9 5,843 68.6 83.3 67.4 74.8 10 2,109 65.6 68.1 50.1 60.9 11 10,416 71.4 87.6 58.6 80.2 12 18,992 67.5 89.4 50.0 77.7 13 6,280 61.3 84.8 43.5 74.3 14 8,152 65.5 84.8 47.6 73.3 15 and over 36,828 72.3 88.5 44.8 77.3 The increases in the percentages vaccinated against smallpox (compared with 1961) are doubtless a consequence of the outbreak of smallpox at the end of 1961 and the beginning of 1962. Medical treatment of schoolchildren Treatment statistics—The number of sessions, new cases and total attendances at schoolchildren's clinics during 1962 (including sessions held in hospital premises) were as follows: Type of clinic Sessions New cases Attendances  Minor ailments (nurse) 16,683 41,127 340,480 Minor ailments (doctor) 2,023 18,724 Special investigation 2,113 2,053 14,507 Dental 27,337 66,558 214,850 Vision 4,723 26,548 70,371 Orthoptic 1,710 1,051 5,893 Ear, nose and throat 579 2,198 5,435 Audiology 384 1,618 3,363 Rheumatism (supervisory) 104 45 752 Enuresis 113 120 648 91 Handicapped pupils New assessments—During 1962 the numbers of new assessments of pupils for special educational treatment were as follows: Day Boarding Blind — 2 Partially sighted 37 1 Deaf and partially hearing 49 6 Delicate 387 226* E.S.N. 835 99 Epileptic — 4 Maladjusted 419 249 Physically handicapped 134 16 Speech defect l,20† 25† Dual/multiple defect — 76 *Including diabetic and E.S.N./delicate. †Including pupils attending special schools for other defects. Special educational provision—At the end of 1962 special educational treatment was being provided for over 12,000 pupils (London and out-county). The following table shows the main categories of handicap and numbers of London pupils receiving full-time special education: Day special schools Boarding special schools Non-council boarding schools, hostels, foster-homes, etc. Council's hospital special schools and groups Total  Blind — 61 38 — 99 Partially sighted 238 — 11 — 249 Deaf and partially hearing 284* 36 112 — 432 Physically handicapped 850 73 69 205 1,197 Delicate 1,345 159 87 — 1,591 Educationally subnormal 3,467 608 125 — 4,200 Epileptic† — — 21 — 21 Maladjusted 231 354 383 27 995 Dual/multiple defect — 26 — — 26 6,415 1,317 846 232 8,810 *Includes 109 pupils in partially hearing units. †A number of epileptic children (apart from those in ordinary school) are placed in schools for the delicate, physically handicapped or educationally subnormal. Educationally subnormal pupils—Section 57 of the Education Act, 1944 (as amended by the Mental Health Act, 1959) deals with the examination and reporting to the local health authority of children who are considered unsuitable for education at school, the review of cases previously reported to the local health authority and the cancellation of the report where the child on re-examination is found to be suitable for education at school. Details of the number of children dealt with under this section are as follows: Section 57 (as amended)—Unsuitable for education at school: 1959 1960 1961 1962 Children not in any school 86 84 100 133 Children in ordinary schools 6 — 3 3 Children in special schools 97 57 68 72 Children receiving home tuition under section 56 of the Education Act, 1944 1 — 1 — 190 141 172 208 Section 51A—Review of cases: 1961 1962 Number reviewed 20 27 Still considered unsuitable for education at school 16 19 Cancellation of report 4 8 92 Routine audiometer testing—The numbers of children given 'rapid-sweep' audiometer tests during 1962 are as follows: Pupils given screening tests 56,249 Pupils failing screening tests given pure tone tests 3,653 Pupils failing pure tone tests referred to otologists 1,501 Speech therapy—By the end of the year 257 sessions a week were being held, 157 in 51 clinics and 100 in special schools. During the year 1,232 pupils were ascertained as requiring speech therapy, whilst 524 were discharged from treatment and 187 ceased to attend. The number of pupils under treatment at the end of the year was 2,541, whilst 304 were on the waiting list. Child guidance units—Two new units—at Hoxtow and Roehampton—were opened in May, 1962. Details of the work done during the year at the seven child guidance units maintained by the Council follow: Patients At 1 January, 1962 On waiting list: At 31 December, 1962 On waiting list:  (a) awaiting first interview 165 (a) awaiting first interview 207 (6) interviewed and awaiting treatment 78 (b) interviewed and awaiting treatment 115 In attendance: In attendance: (a) active 392 (a) active 387 (b) under review* 429 (6) under review* 471 During 1962 During 1962 Applications received 973 Applications withdrawn 215 Cases closed 642 2,037 2,037 *Some cases are kept 'under review' for a time after active treatment has ceased; others are closed as soon as active treatment has ceased, any further visits, etc., being regarded as 'follow up'. Student health scheme The student health service was started at Barrett Street technical college at the beginning of the 1960/61 session (see page 112 of my report for 1960). In 1961 it was decided to extend the scheme to the City of Westminster and Brixton day colleges. The following table gives statistics of the work done in 1962: Barrett Street College City of Westminster College Brixton College  No. of new students under 19 years returning questionnaires 191 200 278 No. invited for interview after scrutiny of completed questionnaire 56 66 27 No. of students seen by doctor: (a) following invitation—first attendances 56 24 23 —subsequent attendances 18 26 11 (b) voluntary—first attendances 81 32 66 —subsequent attendances 38 20 37 — 193 — 102 — 137 No. of students referred for treatment 69 35 34 No. of doctor's sessions 30 27 19 No. vaccinated against smallpox 297 Nil 250 No. X-rayed—mobile unit 407 Nil — 93 DENTAL SERVICES The Chief Dental Officer and Principal School Dental Officer reports as follows: School dental service Table (i)—Staff and sessions 1958 1959 1960 1961 1962  Dental officers Number employed (i) full-time 42 35½* 36½* 36½* 33½* (ii) part-time 97 94 84 72 68 Total 139 129½ 120½ 108½ 101½ Full-time equivalent (i) School service 72.5 64.4 64.6 60.9 58.9 (ii) M & CW service 6.3 6 4.9 4.8 4.8 Total 78.8 70.4 69.5 65.7 63.7 Establishment (temporary) 95 95 95 95 95 Weekly sessions School service (i) by full-time dental officers 437 364 373 361 338 (ii) by part-time dental officers 361 355½ 337½ 308½ 300½ Total 798 719½ 710½ 669½ 638½ M & CW service (i) by full-time dental officers 41 29 31 32 34 (ii) by part-time dental officers 28 37½ 22½ 20½ 18½ Total 69 66½ 53½ 52½ 52½ Grand Total 867 786 764 722 691 *'½' full-time officer accounted for by appointment of half-time Assistant Chief Dental Officer A study of dental graphs and tables given in this report reveals a reduction under nearly all headings, when compared with previous years. The reduction in staff (table (i)) of the equivalent of two full-time dental officers was not of itself sufficient to account for the general shrinkage; certain other trends and events also had an impact. NUMBER OF INSPECTION SESSIONS AT SCHOOLS The considerable reduction in the number of inspections held in schools is attributable mainly to the introduction, in divisions 1 and 9, of an experimental alternative to inspections in schools by dental officers. This experiment consisted of endeavouring to ascertain, by issue of special handbills, the proportion of parents who would 'contract in' to use the school dental service and of those who would 'contract out' by expressing their preference to make private arrangements for their children's dental welfare. Not all of those 'contracting in' responded when offered appointments in due course at a school treatment centre and it is unlikely that all who 'contracted out' did indeed obtain treatment as they intended. On the latter point liaison was formed during the year with the London Executive Council, in an endeavour to ascertain the numbers who indeed obtained their desired treatment in the general dental service. Trends which were revealed appeared to indicate that many children fell between the two services (general dental service and school dental service), but no firm figures were ascertained during the year. Research and enquiries were actively conducted throughout the year and will continue. 95 NUMBER OF TREATMENT SESSIONS The graph of treatment sessions shows the continuance of the steady decline since the peak year of 1957. The explanation lies in the declining demand on the service, resulting from the alleged drift towards use of the general dental service. During 1962 it was no longer necessary to conduct an urgent recruitment campaign and, in fact, recruitment of staff became once more a matter of selection. Another important sequel to the falling demand was ability to permit a much fuller measure of revisional treatment for children who had been rendered dentally fit. This essential form of dental care for the developing mouth is established as routine in most 'private' and general dental service practices; because of overwhelming previous demands on school dental services, until last year it has had to be virtually prohibited in the treatment centres. Without revisional treatment much of the benefit to children from dental treatment is lost and it is a matter for professional satisfaction that, although fewer children may have been treated, for many more than formerly the treatment in 1962 was of a rising standard. For the sixth successive year this improvement in standard is reflected in table (iii);—the ratio of permanent teeth extracted to permanent teeth filled was almost 1 to 10, an improvement to view with some satisfaction but not complacency. 96 Table (ii)—School dental service: Attendances and treatments 1958 1959 1960 1961 1962  Number of inspection sessions held at schools 1,952 2,177 2,473 2,514 2,092 Number of children inspected at schools by dental officers 196,573 215,637 244,630 246,803 212,597 Number found to require treatment 144,050 152,131 165,439 161,277 137,853 Percentage requiring treatment 73.5% 70.5% 67.6% 65.3% 64.8% Additional number inspected at centres 36,067 27,576 23,229 19,778 17,580 Total number found to require treatment 180,117 179,707 188,668 181,055 155,433 Total cases treated 97,300 82,448 77,781 69,470 66,558 Attendances 298,342 267,781 256,983 237,411 220,639 Ordinary treatment sessions 31,322 29,637 29,006 28,060 26,638 General anaesthetic sessions 1,431 1,180 1,049 922 699 Temporary teeth extracted 58,223 46,461 42,343 35,286 29,147 Permanent teeth extracted 19,342 14,973 14,467 11,072 8,947 Temporary teeth restored by fillings 40,994 39,861 38,164 37,533 40,091 Permanent teeth restored by fillings 122,558 110,934 109,586 100,755 89,130 Fillings in temporary teeth 43,176 42,656 40,996 40,350 43,935 Fillings in permanent teeth 136,811 125,053 124,821 115,294 101,534 Other operations: temporary teeth 54,884 49,109 43,889 38,682 40,493 permanent teeth 64,995 61,835 63,835 57,641 51,009 General anaesthetics 30,861 24,367 21,753 18,101 14,125 Cases for whom immediate treatment was completed 10,566 9,414 8,407 5,317 4,364 Cases discharged as dentally fit 66,990 54,474 50,584 45,003 40,011 Table (iv)—School dental service: Orthodontic sessions 1958 1959 1960 1961 1962  Number of special orthodontic sessions 282 229 237 254 422 Number accepted at special orthodontic sessions 199 138 152 171 275 Number accepted at routine sessions 474 371 401 470 227 Number referred to hospitals 186 279 154 154 237 Total number of patients accepted or referred 859 788 707 795 739 97 g Table (iii)—School dental service: Average number of permanent teeth restored for each permanent tooth extracted 1953 .. 4-69 1954 .. 5-32 1955 .. .. 7-39 1956 .. 6-50 1957 .. 6-41 1958 .. .. 6-34 1959 .. .. 7-41 1960 .. .. 7-57 1961 .. 910 1962 .. .. 9-96 Orthodontics Orthodontic treatment continued for another year to be somewhat stultified, but some improvement was effected by the allocation of an additional four sessions a week specifically for this work. The allocation was, however, at the expense of a similar number of sessions for routine treatments. Table (iv) shows this increase in sessions and numbers referred, but unfortunately an even greater fall in numbers treated by staff generally at routine sessions. Correction of malocclusions is a time-consuming form of dental treatment requiring the application of special knowledge and skill and is therefore difficult to develop to meet all requirements. My thanks are expressed to the four hospitals which assist the Council in this work (St. Alfege's, King's College, Royal Dental and the Eastman Dental) and it is gratifying to note some increase in their acceptance figures for the year. Maternity and child welfare dental service Dental services in boarding schools and residential establishments As might be expected, there was little change in the maternity and child welfare dental service (table (v)) and the services provided at boarding schools and residential establishments. All requests for treatment were met, however, in the former service and in the latter some improvement was made at several establishments for more regular and systematic dental attention than in the previous year. Table (v)—Maternity and child welfare patients: Attendances and treatments 1958 1959 1960 1961 1962  Number of sessions 3,135 2,764 2,592 2,300 1,908 Number of appointments offered 34,740 30,456 27,368 23,864 19,158 Attendances—by appointment 24,691 21,995 19,651 16,500 12,958 —other 1,539 1,122 1,060 894 553 Silver nitrate treatment 5,065 4,415 5,858 5,718 4,141 Fillings 11,491 10,031 8,716 7,399 5,976 Extractions 5,873 5,114 4,513 3,624 2,619 Dentures supplied—new full 422 380 351 327 151 —new partial 685 649 468 485 240 Number made dentally fit 5,014 4,784 4,165 3,255 2,507 Table (vi)—Breakdown of table (v) separating nursing or expectant mothers from children under five—1962 Total Nursing or expectant mothers Children (under 5)  Number of sessions 1,908 — — Number of appointments 19,158 11,075 8,083 Attendances—by appointment 12,958 7,152 5,806 —other 553 185 368 Silver nitrate treatment 4,441 753 3,388 Fillings 5,976 3,237 2,739 Extractions 2,619 1,669 950 Dentures supplied—new full 151 151 — —new partial 240 240 — Number made dentally fit 2,507 883 1,624 Dental auxiliary experiment In 1962 the first batch of two-year trained dental auxiliaries were passed out by the General Dental Council training school at Deptford and five—of six originally contracted for—took up duty with the Council in September. The auxiliaries were posted to appropriate twin-surgery treatment centres under the direct control and supervision of full-time dental officers. The scope of treatment permitted by law to be given by dental auxiliaries is restricted and there was difficulty in selecting requisite numbers of suitable patients to keep the new type of surgery staff fully occupied. Towards the end of the year it was evident that of the 25,000 school children allocated in 1961 for inspection and treatment by the staff and pupils of the Deptford training school, many had not received attention. These matters and many other details relating to this experiment were under active consideration at the end of the year. 98 STAFF The following statement shows the number of staff employed in the Public Health department at the end of the year (part-time staff are expressed as whole-time equivalents). The principal officers of the department at that date are shown in Appendix E. Location Types of staff' Central office Divisional offices and establishments Other establishments Total (a) (b) Administrative and clerical (including ambulance control clerks) 245 638 79 962 Medical officers (c) 28 154 — 182 Dental officers 2 62 64 Scientific branch staff 36 19 55 Inspectors IS — — 15 Medical auxiliaries (d) 34 148 17 199 Social worker grades (e) 24 379 13 416 Nursing and midwifery staff 10 1,813 246 2,069 Ambulance service operational staff — — 842 842 Manual workers, home helps, domesti grades, telephonists, etc 9 3,358 16 3,383 Totals 403 6,552 1,232 8,187 99 (a) Including divisional health offices, home help offices, welfare centres, school treatment centres, training centres for the mentally sub-normal, etc. (b) Including residential schools and nurseries, Welfare department homes, recuperative holiday homes, ambulance stations, outfall works laboratories, central dental laboratory. (c) There are 136 visiting medical officers employed at residential establishments on a part-time basis whom it is not possible to compute in terms of whole-time staff. They have therefore been omitted from the table. (d) Including physiotherapists, speech therapists, dental surgery assistants, dental technicians. (e) Including psychiatric social workers, mental welfare officers, welfare officers (chest clinics), social workers (health services) etc., and workers in allied fields (e.g. home help organisers). Appointments and retirements—On 30 April, Mr. R. H. J. Stronge, Establishment Officer of the department since 1948, retired on reaching the age of 65, his place being taken by Mr. T. A. Wright, previously Administrative and Establishment Officer of the Parks department. Mr. W. H. Joyce, Principal Clerk of Division C of the department retired on 12 April and was succeeded by Mr. C. W. Shaddick. Miss L. Berry, Divisional Nursing Officer, retired on 30 October, her position being taken by Miss M. V. Naunton. Miss E. Beattie, Divisional Nursing Officer, left the Council's service on 16 June on appointment as Principal Nursing Officer, S.S.A.F.A.; she was succeeded by Miss E. A. Evans. Medical examinations—Numbers of medical examinations of staff for various purposes, with the result of the examination, follow: 1958 1959 I960 1961 1962 Candidates fit for appointment 7,531 7,399 8,252 11,106 11,236 Candidates unfit for permanent appointment 401 343 250 560 584 Referrals (ill-health) 6,719 7,252 8,032 8,156 9,245 Permanently unfit to carry out their ordinary duties 323 331 418 641 548 Advice given (without examination) 1,621 1,595 1,034 1,386 1,111 Eligibility for spouse pensions 24 29 66 87 80 Staff casualties 315 309 289 863 1,058 Candidates for out-county authorities 100 111 84 121 104 Candidates examined for the Council by out-county medical officers of health 138 111 102 72 125 G* Food handlers—During the year 489 food handlers were referred for investigation because they had been in contact with or had suffered from certain infectious diseases. Bacteriological examination was arranged where appropriate. 1958 1959 1960 1961 1962 Contacts 137 167 205 118 114 Ill 266 302 419 307 375 Allowed to resume work after examination or fixed period of exclusion 388 451 578 406 444 Resigned, retired or died 9 8 23 16 28 Excluded from work and referred to own doctor for treatment 6 10 23 3 17 The 17 cases referred to their doctor had been lound to have the following microorganisms: Condition Organism isolated Discharging ears convalescent Pyocyaneus and Proteus Discharging ears convalescent Staphylococcus aureus Discharging ears convalescent Staphylococcus aureus and Staphylococcus pyogenes Discharging ears convalescent Staphylococcus pyogenes Dysentery contacts (2) Shigella sonnei Dysentery convalescents (5) Shigella sonnei Enteritis convalescent Salmonella typhimurium Enteritis convalescent Shigella sonnei Gastro-enteritis convalescent Shigella sonnei Vomiting convalescents (2) Shigella sonnei Vomiting convalescent Salmonella typhimurium 100 FINANCE Capital—The total capital expenditure on the health services of the Council in the year ended 31 March, 1962 was £49,764, details of which are as follows: £ Ambulance stations—acquisition, erection, adaptation and equipment 12,160 Day nurseries—transfer to revenue account 861 (Cr.) Health centres—adaptation and equipment 2,186 Maternity and child welfare centres—acquisition, erection and equipment 279 Hostel and training centres—acquisition, erection and equipment 36,000 £49,764 Maintenance—The gross cost of the various services in 1961/62—including central administrative and debt charges—and the contributions recovered from recipients of the services were: Service Cost Amount recovered in contributions £ £ Ambulance 1,421,069 — Day nurseries 1,107,682 151,976 Domiciliary midwifery 293,966 — Foot clinics 112,277 11,403 General health (including health education) 65,940 — Health centres 42,779 — Health visiting 411,510 — Home nursing 570,863 — Home help 1,432,460 75,427 Maternity and child welfare 962,653 88,570 Mental health 545,252 22,938 Prevention of illness, including care and after-care of tuberculosis 405,462 15,440 School health 1,110,979 — Vaccination and immunisation 268,015 — 8,750,907 365,754 The net cost of the services, before allowing for Government grant, expressed in terms of ate in the £ was 18d. VISITORS TO THE DEPARTMENT During the year 570 visitors were received through the central office—of whom 407 came from overseas. The Minister of Health paid an informal visit to Pakenham House welfare centre in division 8. Individual overseas visitors included the Minister of Health for Eastern Nigeria, the head of local government in Western Nigeria, the Minister of Health and Home Affairs, Queensland, Australia, a chief medical officer of the World Health Organisation, a member of the Oslo Board of Health, the Mayor of Bombay, the Paramount Chief of the Moyamba district of Sierra Leone, a member of the Japanese Parliament, the head of the Foreign Relations section of the Ministry of Social Welfare in Indonesia and the Secretary to the Governor of the Punjab; also 39 doctors, 21 local government officers, 24 social workers, 19 nurses, one university director, 12 teachers, two journalists, four speech therapists, one architect, one hospital administrator and six students. Parties included doctors and psychologists from the U.S. President's Panel on Mental Retardation, Foreign Service students from Laos, members of a Belgian Women's Organisation, students from Africa and Asia, German social workers,' Cento 'representatives, social workers from Malaya, doctors from the International Children's Centre in Paris, a party of doctors from the 'Medical World' International conference and delegates of the World Organisation for Childhood Education. Altogether visitors were received from 53 overseas countries. Other visitors were received at divisional offices, Woodberry Down health centre, the London Ambulance Service headquarters and the Council's training centres for mentally subnormal children. The health centre was visited by 1,049 people, 256 from overseas and 793 (711 students) from the United Kingdom; the Ambulance Service headquarters received 191 visitors and training centres 537 visitors, including 432 students. Facilities were again provided for medical, nursing and social science students to study the health services. Courses of visits of observation and talks were arranged for post-graduate students preparing for the Diploma in Child Health and the Diploma in Public Health. Members of the department's nursing staff gave talks to student nurses at hospitals and programmes were arranged to enable 3,883 of these students to gain practical experience. Talks by members of the staff and/or visits of observation and periods of attachment were also arranged for students from the following training centres: Health visitor students Other students (medical, nursing, teaching and social science) Battersea College of Technology Battersea College of Technology Royal College of Nursing Dr. Barnardo's Home Training School University of London (Institute of Froebel Educational Institute Education) King Edward's Hospital Fund for London— University of Southampton Course for Overseas Hospital Administrators London Probation Service National Children's Home Staff Training College National Society for Mentally Handicapped Speech therapy students Children National Society for the Prevention of Cruelty Speech Therapy Training School of the to Children West End Hospital for Neurology North-Western Polytechnic Queen's Institute for District Nursing The Oxford House, Bethnal Green University of LondonInstitute of Education London School of Economics and Political Science University House, for St. Bartholomews Hospital Womens Public Health Officers Association 102 REPORTS BY THE DIVISIONAL MEDICAL OFFICERS (A statistical summary of work done in the divisions will be found at the end of this section.) DIVISION 1, comprising the boroughs of Chelsea, Fulham, Hammersmith and Kensington Dr. Bertha E. A. Sharpe reports: Prophylaxis—The occurrence in London and elsewhere of a number of cases of smallpox led to a greatly increased demand from the public for vaccination, despite the Ministry of Health's statement that there was no necessity for mass vaccination in London. The regular evening and Saturday morning sessions, where prophylaxis of all kinds is available, were extended by increasing the numbers of doctors and other staff on duty and lengthening the sessions. Additional evening sessions were also arranged. As far as possible attendance was restricted to adults and school children; mothers with children under five years of age were encouraged to attend their usual welfare centres where additional staff and sessions were provided. Large quantities of vaccine were provided for general practitioners. During the March quarter 24,750 vaccinations were performed at the Council's centres and 21,000 by general practitioners in the division. In July an intensive campaign was launched to provide school children in the division with a reinforcing fourth dose of poliomyelitis vaccine, as advised by the Ministry of Health and 2,500 children between the ages of five and 14 years were given this additional protection. Oral (Sabin) vaccine was introduced and proved to be very popular. During 1961 courses of active tetanus immunisation were made available for persons who had received an emergency dose of anti-toxin in hospital and in nine months 80 such courses were given. In 1962 the number of persons who availed themselves of this form of protection rose to 363. Maternity and child welfare—To reduce the time spent by clinics in trying to book maternity beds for women needing hospital confinement on medical or social grounds, a divisional bed bureau was established. This has produced highly satisfactory results. Of 917 cases referred to the bureau in the last six months of 1962, a hospital bed was found for 841 (92 per cent.). The 76 for whom no booking could be arranged, and who perforce had to be referred for admission under the Emergency Bed Service procedure, were all social cases, mostly attending clinic for the first time at a late stage of pregnancy. Beds were found for all cases referred to the bureau on medical grounds. Towards the end of the year facilities were offered to general practitioner obstetricians to attend midwives sessions at the Council's welfare centres to see their own booked maternity patients and, by agreement, those of other practitioners. The scheme will start early in 1963, with 25 general practitioner obstetricians participating at seven welfare centres. In October a weekly evening paediatric session was established at Lancaster Road welfare centre at the instigation of the Notting Hill Council of Social Service. This was an experiment for six months, in the first instance, to meet the needs of any working mothers who were unable to bring their children to the normal daytime infant welfare sessions. The medical officer, Dr. Gans, gives his services and the Council provides accommodation and other staff. Health education—This forms a regular part of the activities at welfare and school treatment centres and of health visitors seeing mothers and children in their homes. A wide variety of topics is covered but during 1962 special emphasis was placed on directing public attention to the hazard of lung cancer from smoking and to the fire risks associated 103 with the use of oil heaters. This was done in conjunction with campaigns organised by the borough councils in the division, by the display of posters and distribution of leaflets at welfare centres, etc. and by arranging talks and film shows to mothers attending centres. In November support was given to an anti-poisoning campaign launched by Fulham Borough Council. More classes were held at welfare centres during the year for expectant mothers, their husbands and parents of young children. Record numbers attended and at some of the mothercraft classes more than 70 expectant mothers and husbands were present. Chiropody—In February an additional foot clinic was opened at the Hammersmith Borough Council's medicinal baths. The borough council kindly granted the necessary facilities without charge but this Council staffed and equipped the clinic. In September the number of sessions was increased from two to three a week. The full number of sessions authorised for the Council's clinics is 100 a week but owing to illness and the difficulty in recruiting chiropodists the average number held was about 87 weekly. In addition, facilities are provided through the Old People's Welfare organisations, with financial assistance from the Council, and by the Chelsea School of Chiropody. Day nurseries—There was no significant change in the number of children attending the Council's day nurseries. Shortages of nursing staff and assistants have imposed heavy strains on the nursery staffs and on several occasions have made it necessary to restrict admissions. The grouping of children in 'families', including all ages, has been extended with marked success wherever the layout of the premises and the staff available has made this possible. Increasing use has been made of the day nurseries for the care of children with handicaps or behaviour problems. Improvements were carried out to a number of nurseries, including the installation of gas-fired central heating and reorganisation of the laundry at Eridge House day nursery, Fulham. Extensive alterations were carried out at Cheyne Hospital nursery to allow the Cheyne Hospital Spastic Unit additional space. The whole of the second floor was vacated and the nurses' home was surrendered on expiration of the lease in September. Limited accommodation for resident staff was provided but it is no longer possible to accept resident students for training. Occasional creches—This service was extended by additional sessions and remains very popular. Special investigation clinics—A new clinic was opened in May at Westway maternity and child welfare centre, to serve the White City area. Parents and children had previously had to travel either to Fulham or Kensington, which for many involved a long walk and two bus journeys. The sessions were originally held on alternate weeks, but by the end of the year the steady increase in attendances indicated that a weekly session would soon have to be arranged. Bathing centres—The Kensington Borough Council bathing centre was closed in May for rebuilding and temporary arrangements were made for the cleansing of school children to be carried out at the Hammersmith medicinal baths; facilities are also provided at Sedlescombe Road treatment centre, Fulham. Considerable success has been achieved through the health education activities of health visitors and school nurses and by the free distribution of ' Lorexane' shampoo but the need for bathing centre facilities still remains, especially in North Kensington where many houses and rooms are in multiple occupation and washing facilities are minimal and shared by other families. Child guidance—The Earls Court child guidance unit was completely redecorated and additional accommodation made available for the registrar and the day hospital. 104 Mental health—This year has been a period of consolidation with some progress in the field of community care. Closer contact has been established with many general practitioners and with the hospitals but shortages and fairly frequent changes of staff have imposed limitations. Day accommodation is provided at four training centres and at the unit for severely sub-normal infants at Grove House day nursery, Fulham. An average of five children attended this unit daily and they showed considerable all-round improvement. It is very gratifying to see the way those attending the training centres respond. Activities at College Park centre for older girls have been extended to laundry work, which has proved very popular. Both the girls and their parents appreciate the fact that the girls are following useful occupations for which they receive some financial reward. Throughout the year the part-time services of an occupational therapist, already employed with tuberculous patients, were made available for giving occupation and instruction to mentally ill persons in their own homes. Two or three patients at a time receive the service, but the field is obviously limited and the scheme may be regarded as still in an experimental stage. Prevention of break-up of families—Divisional co-ordinating committee meetings and intermediate case conferences have been held regularly throughout the year. Cases have been referred by general practitioners, probation officers and almoners, as well as from Council departments. Full co-operation has been received from bodies outside the Council, especially from the National Assistance Board and borough council housing departments, who refer families with children who are in arrears of rent. The continued cooperation of the N.S.P.C.C. is greatly appreciated. Liaison with other bodies—Regular meetings were held with the medical officers of health of the metropolitan boroughs in the division. The Council continued to be represented on the local maternity liaison committee of the Chelsea and Kensington hospital management committee. Professor McClure Browne of the obstetrics and gynaecology departments at Hammersmith hospital held a meeting for doctors doing ante-natal work for the Council and Dr. C. W. Kesson, consultant paediatrician at the Victoria Hospital for Children, arranged talks for health visitors and for medical officers. A discussion group led by Dr. Felix Brown, Medical Director of the Earls Court child guidance unit, continued to be well attended by child welfare doctors and health visitors. A meeting of hospital almoners, superintendents of district nursing associations and representatives of other local voluntary bodies with divisional staff was held to focus attention on the services the Council provides. Topics discussed included services available to prevent the reception of children into care, the mental health community care services and facilities for invalid meals. Two meetings were held in Fulham and in North Kensington to acquaint general practitioner obstetricians in the area with the offer by the Council to provide facilities and premises, without charge, for them to see their own booked patients and by agreement those of other general practitioners. DIVISION 2, comprising the boroughs of Hampstead, Paddington, St. Marylebone, St. Pancras and the City of Westminster Dr. H. L. Oldershaw reports: Maternity and child welfare—The number of women receiving ante-natal care at the Council's clinics shows a steady increase, despite the fact that more general practitioner obstetricians are providing care for expectant mothers in their surgeries. The three evening ante-natal sessions for expectant mothers at work were again well attended. 105 Lack of sufficient hospital beds for maternity patients continued to present a problem. A clearing house system has been set up in the division to help expectant mothers, particularly those whose home conditions did not permit a domiciliary confinement, and for whom their local clinic had failed to find a maternity bed. During 1961 the divisional 'bed bureau' handled 724 cases and was able to find beds for 498 mothers. In 1962 the number dealt with was almost the same (726) but pressure for maternity beds throughout the London area was so great that only 399 were found beds. The remainder were referred, where possible, to the domiciliary midwifery service or to the Emergency Bed Service for hospital admission when in labour. In March the Hallfield child welfare centre was opened in accommodation on the ground floor of a block of flats on the Paddington Borough Council's Hallfield Estate. The centre provides for the needs of the new estate and surrounding district and made it possible to cease the use of two church halls for maternity and child welfare sessions. Following discussions between representatives of the Council and St. Mary's hospital, staff and students from the hospital will take part in the work of this new centre. Prophylaxis—The first weeks of 1962 were overshadowed by the diagnosis of a case of smallpox in St. Pancras. Fortunately no secondary cases resulted in the division, although there was another case in London and others elsewhere in the country. To satisfy the enormous public demand for protection extra clinic sessions were held, including lunchtime clinics at Caxton Hall to cater for people working in the West End. At the height of the demand, in the week ending 20 January, 17 extra sessions were held, including five evening sessions. Some idea of the extent of the demand for vaccination, both primary and revaccination, can be seen by the fact that in the first quarter of the year 49,738 persons were vaccinated in Council clinics, whereas in the last quarter, when demand had resumed its normal level, the number had fallen to 851. The Sabin type of oral poliomyelitis vaccine was introduced and by the end of the year some 7,000 persons had completed a course of three doses; in addition, doses were given to complete courses started with Salk vaccine. An intensive effort was made during the spring to ensure that all school children in the division had the opportunity to receive complete courses of vaccination, including a fourth dose where appropriate. The administration of measles antigen was started experimentally at one clinic, under the auspices of a research team from University College hospital. School health—In July responsibility for the administration of St. Pancras school treatment centre passed from the hands of the voluntary committee which had already given up its treatment centre at Somers Town in 1960. Now, after fifty years of valuable service in the field of school health, the voluntary committee asked the Council to undertake the running of its last remaining centre. Prevention of break-up of families—The extremely valuable work in connection with the prevention of neglect and ill-treatment of children in their own homes has continued to increase. During the year 87 families came before the divisional co-ordinating machinery as presenting particularly difficult problems. Intermediate case conferences continued to be well attended by both statutory and voluntary agencies. The largest number of referrals again came from health visitors but outside agencies referred a number of families. During the year the divisional mental welfare officer became a member of the divisional co-ordinating committee; this has proved a most effective link as a number of the families discussed are already well known to the mental health section. At the end of 1962 there were two full-time case workers in the division and three social workers undertaking part-time case work with difficult families. Mental health—The pressure for compulsory admissions continued high throughout the year. 106 The establishment (under the auspices of the hospital authorities) of day hospitals showed that such hospitals could provide a focal point for community care. The staff of the hospitals and the local authority worked in close co-operation. A psychiatric social worker was attached to the Paddington day hospital, attending meetings and case conferences there on two mornings a week. In addition, the mental welfare workers referred patients to the day hospital. Agreement in principle was reached with the hospital authorities that a psychiatric social worker should attend Westminster hospital, but implementation awaited the appointment of staff for this purpose. In the latter part of the year a scheme was put into operation to provide occupational therapy for mentally ill patients in their own homes. Up to three sessions a week, formerly allocated for the instruction of tuberculosis patients by a diversional therapist, were allotted for this purpose. Staff shortages caused some delay in putting the scheme into operation but it is now working well. DIVISION 3, comprising the boroughs of Finsbury, Holborn and Islington Dr. W. G. Harding reports: Maternity and child welfare—Arrangements which enabled Mr. Gordon Bourne, obstetric consultant, St. Bartholomew's hospital, to conduct an ante-natal session at Leage Street welfare centre, Finsbury, from May established a valuable link between the hospital, the community and the personal health services. General practitioner obstetricians are welcome to attend at the sessions in order to carry out examinations of their own booked cases in association with the midwife, and Mr. Bourne is available for consultation. In accordance with the recommendations of the Maternity Services (Cranbrook) Committee and the policy agreed by the Local Medical Committee for London, progress was made with the scheme under which general practitioner obstetricians who wished to do so carry out ante- and post-natal examinations at fixed times in co-operation with the midwife in the Council's maternity and child welfare centres. Only one general practitioner obstetrician practises in the borough of Holborn and he started to see his own booked cases at the Province of Natal centre in June. In November all general practitioner obstetricians practising in the boroughs of Finsbury and Islington were invited to a meeting. The meeting decided in principle to try the scheme on the basis that general practitioner obstetricians who wish to work at a particular centre and who attend a sufficient number of cases in the catchment area would form a centre rota, while others who deal with small numbers could attend the centre on an ad hoc basis by arrangement with the midwife. It was also decided to draw up provisional rotas for further consideration by the general practitioner obstetricians interested in the scheme. At the end of the year 19 general practitioner obstetricians in 14 partnerships had expressed a wish to participate and rotas were being prepared. Health education: smoking advisory sessions—Although the recommendation by the Royal College of Physicians in their report on smoking and health that the Government might investigate the values of anti-smoking clinics brought no lead from the Government, it was thought worthwhile to try out advisory sessions in division 3 under section 28 of the National Health Service Act, 1948. Keen interest had been shown in such a project by Dr. Wallace Craig, chest physician, Islington chest clinic, Dr. V. Freeman, borough medical officer of health, Islington, the Islington Youth Committee and the divisional staff. It was possible, therefore, to undertake this as a co-operative health education project to which the local health authority, hospital service and the public health department of a metropolitan borough council contributed. The Health Committee approved advisory sessions being started, on an experimental basis, at East Islington welfare centre for adults who wished to give up smoking; weekly evening sessions (5.30-7.30 p.m.) have been held there since November. General 107 practitioners were informed of the arrangements and invited to refer patients; the medical director of the mass X-ray unit located at the East Islington welfare centre undertook to draw the attention of persons visiting the unit to the advisory sessions and to distribute requests for appointments to those interested; other referrals were expected from chest clinics and self-referrals, although not sought, were accepted. Applicants attend the sessions by appointment. A full-time medical officer attends the sessions regularly and assistance is given by senior nursing staff, health visitors and social workers in the division. Dr. Freeman and his staff and Dr. Wallace Craig, together with his colleagues, also participate actively in the sessions. All new patients are received and interviewed by a doctor and most of them are then referred to a series of group sessions. As the sessions had run for less than two months by the end of the year it was too early to give any reliable evaluation of results but the following figures in respect of the first seven sessions to 31 December 1962 are of some interest: No. offirst attendances 64 Total attendances. 256 No. attending One session Two sessions Three sessions Four sessions Five sessions 64 36 25 10 1 Sources of referral General practitioners 27 Self referrals 17 Chest clinics 5 Other (friends, relatives, television, Mass radiography unit 5 health visitors)10 64 It is not intended to use the advisory sessions as a major part of the educational campaign directed towards those who attend school. It is considered that this group should be tackled primarily within the schools by the combined efforts of teachers and members of the school health service. Apart from individual consultations in schools talks were given and films shown in some of the senior schools but these efforts are still considerably handicapped by the shortage of good visual aid material, especially of films of a technical standard sufficiently high to hold the attention of such sophisticated audiences. The divisional medical officer attended a meeting of the Islington Borough Youth Committee which expressed a lively interest in propagating any efforts designed to curb juvenile smoking; although all youth clubs in the borough were circulated, however, there was practically no response. Prophylaxis—The replacement of Salk vaccine by oral Sabin vaccine was welcomed; staffing of poliomyelitis immunisation sessions was simplified and a series of special sessions, including some in the early evenings, was arranged for adult workers. The initial response from the public was good. Later, Press reports of restrictions on the use of live attenuated virus vaccine in the United States and Canada had an adverse effect on attendances. Although the use of Sabin vaccine continued there was no general publicity to sustain the demand for immunisation by adults nor, fortunately, were there any poliomyelitis incidents in the division. These factors were associated with a steady fall in the number of adults seeking immunisation. Meanwhile, a combined antigen was released which incorporates killed polio vaccine together with diphtheria, tetanus and pertussis antigen. Such a vaccine may have attractive advantages over the separate administration to infants and young children of triple antigen and poliomyelitis vaccine. Trials of the quadruple vaccine commenced in divisions 3 and 6, involving 100 children in each division, with the aim of assessing the effectiveness of the vaccine by: (a) determining the antibody response to the primary course and a booster dose; (b) measuring the degree of intestinal immunity to polio virus and relating this to the antibody level and 108 (c) recording the results of any exposure to pertussis and poliomyelitis. This involves the collection and examination of blood samples and specimens of faeces at planned intervals from all children in the trial. A part-time medical officer took charge of the field work in the division. It will be some time before these trials are fully evaluated. Premises—An annexe at Cromwell Lodge hostel, providing a workshop for occupational therapy and an office for the two occupational therapists who run a domiciliary service for tuberculous persons, was completed by the end of the year. It is hoped that the workshop will stimulate more residents of the hostel to take up occupational therapy. Home help service—While the number of persons receiving help at the end of the year was 2.5 per cent less than at the end of 1960 the number of home helps, expressed as the equivalent of whole time workers, fell in the same period by 13.8 per cent. This was due to increasing difficulty in recruiting sufficient women of the required calibre to make good the losses due to resignations. The result was that the number of hours of service which could be allocated had fallen in all three home help areas to an extent that was barely adequate for the needs of many patients, especially the aged. In five years the service given, expressed in average hours per patient per week, gradually fell from 3.8 to 3.01 in the southern area; from 4.7 to 2.86 in the central area; and from 4.5 to 3.08 in the northern area. It was evident, therefore, that special measures would have to be taken to increase the flow of recruits so as to restore the level of service provided to an average of four hours service a patient each week. An intensive recruiting campaign was therefore planned for the new year. Mental health—The work of building up the community mental health service has gone steadily on throughout the year. The field of subnormality has continued to claim a considerable share of workers' time and interest. Close contact has been maintained with the North London Society for Mentally Handicapped Children, which continues to render admirable service to children suffering from severe subnormality and to their families. At the end of the year a new advisory clinic for young retarded children was opened at the East Islington child welfare centre. The Elfrida Rathbone committee, on which the divisional mental welfare officer serves, has worked in close co-operation to give social support to the families of subnormal children and particularly also to school leavers. A special interest has been maintained in homeless subnormal young men and women. A privately run hostel in the area is giving considerable assistance with men and boys and a number of hostels and employers are helping young women who not infrequently turn up at the office without warning, complete with baggage. In the field of mental illness the part played by the mental health team community services has been consolidated and closer contacts are being forged with the psychiatric hospitals. There has been a considerable shortage of senior staff with a continuity of service, owing to the overriding needs of the night and off-duty rota which must be maintained on a county-wide basis. A psychiatric social worker who joined the team in the autumn is now making an increasingly important contribution to the service; it is hoped to open a psychiatric social club and also a temporary day centre in the near future. The number of cases referred to the mental health section for help and support is steadily increasing. A part-time occupational therapist was appointed to visit mentally ill patients in their own homes; this has been found to be a much appreciated service which is capable of further development. DIVISION 4, comprising the boroughs of Hackney, Shoreditch and Stoke Newington. Dr. S. King reports: Maternity and child welfare—The number of births occurring in the division continues to increase; attendances at ante-natal sessions were considerably higher than in 1961, 109 necessitating a number of additional sessions. Visits by health visitors to expectant mothers and to children under one year of age also were much higher than previously. Arrangements were completed during the year for several general practitioner obstetricians to have the free use of ante-natal clinic facilities at welfare centres to see their booked maternity patients in co-operation with district domiciliary midwives, thus enabling the expectant mother to see her doctor and the midwife with whom she is booked at one and the same visit. It is hoped to extend these arrangements in 1963. Day nurseries—The demand for day nursery places continues and attendances at the seven day nurseries in the division were maintained at a high level. Occasional creches—These continue to serve a useful purpose at five of the centres, at an average of eighteen sessions per week. Prevention of break-up of families—The divisional co-ordinating committee held seven meetings during 1962. There were 16 intermediate case conferences at which 67 families were discussed; over a quarter of these were referred by the housing department on account of rent arrears. Families referred for discussion by borough council housing departments numbered thirteen, compared with one during 1961. Two family case workers were employed whole-time, and one part-time, during the year; they were responsible for intensive work with a total of 31 families. In addition, health visitors made a total of 2,159 visits to families in special need and trained home helps were provided to 13 households. Prophylaxis—To deal with the sudden demand for vaccination which followed the outbreaks of smallpox early in the year, it was necessary to arrange ad hoc sessions all day and in the evenings for a period of approximately three weeks. Private doctors were also inundated with requests for protection. During the first quarter of the year over 43,000 vaccinations and re-vaccinations were given at Council clinics. The number of vaccinations and re-vaccinations during 1962 at clinics and by general practitioners in the division totalled over 64,000—an unprecedented number—and over 2,000 international certificates were issued. In April, oral (Sabin) poliomyelitis vaccine was introduced for routine vaccination against poliomyelitis. Child guidance units—Two units now function in the division, the Hoxton child guidance unit opening in May at the Hoxton treatment centre. The medical director holds four sessions each week and a psychiatric social worker and an educational psychologist are employed full-time. There is no doubt the work of the unit will expand and it is anticipated that in 1963 the services of a child psychotherapist will be required. The child guidance unit at Woodberry Down health centre, established ten years ago, continues to be very busy, attracting not only patients but students and many visitors. Mental health—Community care services for the mentally ill continue to expand; social activities developed during the year include an evening art group each week at the Woodberry Down health centre and a weekly evening social club and a group for music appreciation at the Shoreditch health centre. Mental welfare staff give freely of their spare time to organise and attend meetings of these groups. In addition, at the Shoreditch health centre, a day centre was opened early in December for twenty chronically ill patients who, though ineligible for admission to Clifton Lodge day rehabilitation centre, are considered to be suitable for and in need of this kind of help. A full-time supervisor is in charge and admissions are arranged under the supervision of the divisional mental welfare officer. Very simple industrial work is provided, together with outings organised by the supervisor. A waiting list is already building up. The Psychiatric Rehabilitation Association—a voluntary organisation—receives a grant from the Council towards the cost of a day centre for approximately ten patients, held three days weekly in accommodation at the Hackney Downs Baptist Chapel. 110 An open day was held at Clifton Lodge day rehabilitation centre, to which officers of interested voluntary and statutory organisations and firms providing work for the patients were invited. This experimental unit for 40 patients is well attended and there has been no lack of suitable industrial work. The weekly evening social club continues and is much appreciated. Fifty children, of whom 20 were new cases, attended the special advisory clinic for mentally backward children under five years of age which is held weekly at the Shoreditch health centre. Woodberry Down health centre—Adaptations within the premises have provided additional office space for the Area Children's Officer and additional accommodation for the expanding child guidance unit. Loan of home nursing equipment—This scheme continues to be in demand and items on loan include special beds for heart cases, Dunlopillo mattresses, hoists, commodes and outdoor and indoor wheel-chairs. Chiropody—The average number of sessions held weekly increased from 70 to 73. DIVISION 5, comprising the boroughs of Bethnal Green, Poplar and Stepney and the City of London Dr. G. O. Mitchell reports: Mental health—The work in the mental health field increased during the year. The social side developed rapidly and many patients were introduced to clubs and evening institutes; some churches also showed interest in the work. Contacts with a number of firms resulted in about 24 patients being placed in work; lodgings were found for a few but this is a real problem in such a congested area. Temporary residential care was provided for a number of weeks whenever needed for the mentally subnormal and proved to be of real benefit to the recipients and their relatives. The day hospital which functions at St. Clement's hospital was of immense value to the division during the year. This unit is primarily for elderly persons who are also mentally ill—the average age of the patients attending in 1962 was 68. The occupational therapy provided proved both interesting and helpful; it is encouraging to know that of the 60 patients discharged during the year, 30 were considered to have improved and 29 of these were able to return to their own homes. Late in the year a social club was formed at the day hospital and reports so far indicate that this is yet another successful development in this field. On the completion of works of adaptation, the Bethnal Green training centre opened in January as a centre for older girls and in March a 'special care unit' was opened at this centre to deal with the more severely mentally and physically handicapped children. The divisional special advisory clinic for mentally backward children under five years of age was attended by 42 children, of whom nine were new patients. Prophylaxis—Following the announcement of the first case of smallpox in Bradford during the second week of January there was a heavy and increasing pressure from the public for immediate vaccination; this pressure was further increased with the diagnosis of cases at Woolwich and Hornchurch. Many requests were received from employers for sessions to be organised for the mass vaccination of their employees and from certain firms for vaccination of particular groups of workers. Special sessions were arranged for the vaccination of dockers and also for a number of delegates from Bradford who were inspecting wool warehouses in Millwall Docks. Altogether, nearly 100 additional day-time and evening sessions were held in addition to the extension of existing vaccination sessions. At all sessions during the emergency period of almost five weeks nearly 14,000 persons were vaccinated, of these nearly 10,000 returned a week later for the inspection of their vaccinations. In addition, more than 20,000 doses of vaccine were issued to general 111 practitioners for their patients and to doctors at business houses, hospitals, etc., in the division. It was possible to recruit extra doctors from the general practitioners both in and outside the division but the resources of the nursing and clerical staffs were stretched to the limit; assistance was received from the local office of the children's department in staffing the evening sessions. All the staff concerned—medical, nursing and clerical— responded magnificently to the emergency. Since 1958, when both the need and the public demand for vaccination against poliomyelitis were high, the City of London Corporation has provided facilities at the Guildhall for the Council to hold lunch time vaccination sessions, sometimes as many as four a week, for the eligible day time population of the City. The decline in demand for immunisation led to the termination of the sessions in 1962; over 90,000 doses of vaccine were given during the four years in which they operated. Health education—Activities have continued to expand. Mothers' clubs were formed at five centres, four meeting during the afternoon and one in the evening; all mothers in the area covered by each centre were invited to join and no attempt was made to encourage a selected group. Programmes have included outside speakers on a wide variety of subjects, all allied to health, and films and filmstrips were followed by lively discussion. Evening film shows to invited audiences of parents, grandparents, general practitioners and hospital nursing staff were very successful. In Bethnal Green it was necessary to obtain the use of a large public hall to accommodate the numbers attending and in Poplar 127 people attended one evening session. In the Limehouse area a health visitor participated in the activities of a church mothers' club. Occasional creche—In May an occasional creche was opened at the Mary Hughes centre, to accommodate the children of women attending the weekly meeting of a mothers' club at the centre. Chiropody—Serious difficulty was experienced in recruiting chiropodists to work in east London and the service consequently languished far behind that provided in all other divisions. Although approval was given in October 1961 to an increase of three sessions a week, it was not until September 1962 that it was possible to bring these additional sessions into being, so increasing the total sessions from nine to twelve a week. The demand for the service was very heavy, particularly among older people and central recruitment of chiropodists was introduced in an effort to secure an increase in the service in the East End. Prevention of break-up of families—The divisional co-ordinating committee continued to meet quarterly to discuss the various aspects of co-operation and liaison with other departments and outside agencies. During the year 34 intermediate case conferences were held, at which 102 families were considered, many of these having been referred by the Housing department as being at risk of eviction because of rent arrears. The volume of work in connection with problem families seems to increase steadily and will make increasing demands upon the time of case workers and other field workers. Despite staff shortages, 14 families were helped during the year with intensive case-work. Day nurseries—A marked decline in the demand for day nursery places in the division was apparent from 1951 to 1955; the position then remained fairly static until 1959, since when the downward trend has been even more pronounced and the indications are that the decline is continuing. DIVISION 6, comprising the boroughs of Deptford, Greenwich and Woolwich Dr. F. R. Waldron reports: Premises—A new maternity and child welfare centre on the ground floor of a block of flats erected by the borough council in Burney Street, Greenwich, was opened in October. This centre absorbed sessions in a church hall and a prefabricated building in the area served. 112 Maternity services—Pressure on hospital maternity beds continues and of necessity some women, especially in Deptford, have to be referred to the Emergency Bed Service. During the year arrangements were made for the early discharge of pre-selected cases in the Greenwich and Deptford areas which has helped to ease the position slightly. Mental health—The case conference discussion groups continued to meet under the leadership of consultant psychiatrists. The Woolwich group now hold their meetings at Castlewood day hospital which opened in mid-year. Prophylaxis—In October a trial of quadruple vaccine was commenced, sponsored by the Medical Research Council. This will continue for a year and, if successful, will reduce the number of visits to clinics or doctors needed to complete immunisation. It will also avoid the difficulties inherent in the storage and distribution of oral Sabin vaccine. B.C.G. Vaccination—The B.C.G. team visited all secondary schools in the division. Of the 3,186 children skin tested, 3,040 tubercular negative children were given B.C.G., while 146 children were referred for X-ray. Chiropody—There was great difficulty in maintaining a full service during the year; instead of a maximum of 171 sessions per week in the division an average of 130 had to be accepted. Every effort was made to meet the demand of priority classes but at times the waiting period had of necessity to be longer than desirable. Credit is due to the staff who made every attempt to deal with the problem. Prevention of break-up of families—The co-ordinating committee continued to meet regularly to consider policy and subjects of common concern as well as measures to help particular families, the allocation of social case workers and of specially trained home helps. In addition, 36 intermediate case conferences were held, at which a number of departments of the Council and the majority of other statutory and voluntary agencies in the area took part. Home helps—An increase in demand, most marked in the Woolwich and Plumstead areas, was noted. With the completion of the Abbey Wood estate this area has reached the stage when a strengthening of the supervisory staff has become necessary and measures wore put in hand to achieve this. Where large numbers of home helps are employed a minor increase in the sickness rate added to increased demand in the community for the same reason may produce difficulties. On the whole a high standard is maintained, due to the efforts of the organisers and the willing co-operation of the home helps. Smallpox—Following the confirmation of a case of smallpox in Woolwich on 24 January arrangements were made for the opening of 30 vaccination sessions. On 26 January all children attending a school where there were two contacts of the case were vaccinated. Facilities were extended during the week following, when all normal sessions at centres (except ante-natal) were open to the public. In all 120 sessions were held at 27 centres. By Saturday, 10 February, 51,227 children had been vaccinated at school and 50,057 of the general public at the special sessions. It is estimated that, including those by general practitioners, a total of 130,000 vaccinations were carried out. Doctors, health visitors, all members of the staff and many voluntary helpers worked unceasingly during this crisis which, considering the stress and the many difficulties of supply and transport involved, was an amazingly smooth operation due entirely to the co-operation and unselfishness of all concerned. DIVISION 7, comprising the boroughs of Camberwell and Lewi sham Dr. Ann Mower White reports: Prophylaxis—The occurrence of cases of smallpox in London, although none occurred in Camberwell or Lewisham, resulted in an intensified demand for vaccination both at the Council's clinics and at general practitioners' surgeries. In the Council's clinics priority 113 H was given to unvaccinated children under five years of age and the re-vaccination of young persons under 18 years of age who had not been re-vaccinated during the previous years. Adults who had been in contact with suspected cases were given primary vaccination on request, after the attendant risks had been explained. With mounting publicity and the occurrence of a case in another nearby division, demand for adult vaccination became insistent. This demand was met by holding extra evening sessions and by increasing the turn-over at existing sessions. The division helped the borough medical officers of health in the supply of vaccine to general practitioners and a week-end service was provided for this purpose. In April, oral (Sabin) poliomyelitis vaccine was introduced for persons in the priority groups. During the September quarter, the 100,000 mark was passed for persons completing primary courses of poliomyelitis vaccination in the division. Pre-school play groups—This new private venture in the minding of pre-school children showed some growth in the division. Although the play groups do not as a rule come within the provisions of the Nurseries and Child-Minders' Regulation Act, 1948, they voluntarily sought the advice of the Council's officers on standards, hygiene and child care. School treatment centres—An appreciable fall in attendances at minor ailment sessions held at school treatment centres was noted. As a result of this a number of sessions were reduced in duration and one centre, that at Cobourg School, was closed. Dover Lodge hostel for girls—During the year visits were paid by members of the divisional health committee, who were able to suggest some improvements which contributed to the comfort of the girls; the committee also received quarterly reports on the hostel. The reports showed that there was a happy atmosphere in the home. The girls' jobs were carefully selected by the mental welfare officer and the warden; several employers took a friendly interest in the girls' work and in the life of the hostel. The girls continued to attend and benefit from evening classes in dressmaking, basketry and physical training. They enjoyed badminton and church youth club activities, with their own regular Thursday 'pop' record evening as a popular feature of the week. The position of second assistant warden was filled early in the year, this completing the supervisory staff of warden and part-time warden (joint appointment of wife and husband) and two assistant wardens. Regular case conferences were held at the hostel between the principal medical officer for mental health, the divisional medical officer, and the deputy divisional mental welfare officer. At these, all aspects of the girls' health and welfare were discussed. This proved a valuable method of giving help and guidance to the warden. For routine medical attention the girls were on the list of the local general practitioner. Occupational therapy—A qualified occupational therapist was employed part-time (six sessions per week) from October. Her time was mainly spent in visiting the mentally ill housebound patients in their homes and providing them with various types of occupation. Besides the normal forms of therapy, such as basket work, rug making, the making of lamp shades, etc., she also helped the patients in dressmaking and cookery. The main aims were to rehabilitate patients as far as possible back to a normal life and work and to provide those unable to work with interests and occupation. The work should prove to be of great benefit to the patients. General practitioner obstetricians—Discussions took place with the general practitioner obstetricians attending expectant mothers resident in the division, with a view to giving effect to the principles laid down by the Maternity Services (Cranbrook) Committee. They were offered the free use of the Council's ante-natal clinics to see their own booked maternity patients and, by agreement, those of other doctors. This allowed a group of doctors to attend at a centre in rotation and to see each other's patients. As a result of the discussions, agreement was reached for a team of doctors to attend one session a week at Spalding House welfare centre, Honor Oak Estate; other teams planned to operate early in 1963. 114 South-East London General Practitioners Centre—Progress at the centre has continued; there has been a steady increase in new patients and the number of doctors using the centre has risen from 106 to 129. There have been a number of visitors to the centre, parties as well as individuals. In addition to post-graduate discussions and meetings, which have continued, a party of 30 medical students from London hospitals were given short talks by the general practitioners and consultants attached to the centre. DIVISION 8, comprising the boroughs of Bermondsey, Lambeth and Southwark Dr. W. H. S. Wallace reports: Premises—The divisional health office moved into new premises in Castle House, 2 Walworth Road, S.E.I, early in the year. The new building is part of the Council's Elephant and Castle scheme and also accommodates the Area Children's office, the District Housing office, the Youth Employment bureau and part of the Comptroller's department. This association with other departments, in particular the Children's department, has provided an excellent opportunity of achieving most valuable co-operation between the services. The public, also, have the convenience of having so much of the Council's public services available together. The John Dixon maternity and child welfare and school treatment centre was opened by the Mayor of Bermondsey in June. The centre, named after the first medical officer of health for Bermondsey, has been incorporated in the ground floor of a block of flats and offers a full range of services, including chiropody sessions. This new centre has afforded an excellent opportunity to offer facilities to general practitioner obstetricians practising in the area to see their patients at the ante-natal clinic. The arrangements have been most successful. Health education—Mothers' clubs have been established at three of the main centres in the division and have been most successful. Afternoon meetings are held at Tulse Hill and evening meetings at Norwood and Loughborough centres. Lectures, demonstrations and discussions on health and related topics have proved of great interest and value. The shop window in Brixton has continued to prove a valuable asset for the display of health education material. The health visitors have done valuable work in arranging the window displays. Regular sessions for teaching road safety to young children are being held in conjunction with the Southwark Borough Council Road Safety Committee at the Health Services Department and Sutherland House. These have proved most valuable and have been well attended by the parents with young children in the district. Occasional creches—During the year the existing service of 17 sessions at four welfare centres was increased by three sessions and an additional five sessions were started at two other centres. In addition, three sessions were started in association with Guy's hospital, the hospital authorities providing accommodation at the Charterhouse Girls' Club and the Council supplying a nursery assistant to look after the children. Prophylaxis—During the year there was considerable public alarm as a result of the cases of smallpox that were reported in parts of the country. This resulted in a great demand for vaccination against smallpox by people of all ages. The staff are to be congratulated on the way in which they met the enormous amount of extra work that fell on many of the clinics. The introduction of the oral poliomyelitis vaccine proved successful and a large proportion of young children are now receiving the vaccine. The evening and Saturday morning clinics which had been introduced in previous years to meet the great demand for poliomyelitis vaccination continued but were all closed by the end of the year. 115 H* School health service—The number of children referred for treatment from school medical inspections continues to decrease. This is partly due to the improvement in health of the school children and partly due to the fact that many mothers prefer to take their children to their family doctor. There has been an increase in the numbers of children attending the special investigation clinics at John Dixon and Stockwell centres; this is in part due to the fact that many secondary school girls prefer the opportunity offered at these clinics of consulting a woman doctor. Particular attention has been given to tracing all cases of deafness in school children and to ensuring that all children suffering from any degree of deafness were included on the deaf register. The number on the register rose from 124 in 1961 to 167 in 1962. Handicapped children—A register has been compiled of all handicapped children in the division under five who are so handicapped that it appears they are likely to need special educational facilities when they reach the age of five. The register is made up from information received from health visitors and all cases are kept carefully under review to ensure that treatment and assistance is being given and to arrange in good time for educational provision. This register has proved most valuable; there were about 180 children on it during the year, about two-thirds of whom were mentally handicapped. Prevention of break-up of families—The work of the divisional co-ordinating committee has been steadily increasing. Five meetings of the full committee and 64 intermediate case conferences were held during the year. A total of 243 notifications were received of tenants who were being considered for eviction because of rent arrears—72 from the L.C.C. Housing department and 171 from the borough councils. There would appear to be a growing tendency towards irresponsibility in payment of rent among problem and potential problem families and it has often been very difficult to prevent evictions. There are about 200 families at present on the co-ordinating committee files; 55 of these are receiving casework from the Family Service Unit (39 families), the Children's department intensive caseworker (14 families) and the Public Health department case consultant (two families). The work of giving assistance to the remaining families falls on the health visitors and social workers in the division. DIVISION 9, comprising the boroughs of Wandsworth and Battersea Dr. J. T. R. Lewis reports: Maternity and child welfare—St. Christopher's welfare centre, a purpose built centre incorporated in a Battersea Borough Council block of flats, was formally opened in July. The centre, which replaces two welfare centres accommodated respectively in an old school and in public baths and a school treatment centre in a converted shop, provides a full range of maternity, child welfare and school treatment services, with a total of no less than 42 sessions weekly. Patmore infant welfare centre was opened in March, in the tenants' clubroom on the Council's Patmore Estate, for one infant welfare session a week and a session held at a public baths was discontinued. Three occasional creches, where mothers can leave their children for a morning or an afternoon, were added to the existing provision. Chiropody service—A foot clinic for one session weekly was started in the area of the Argyle and Ackroyden Estates, Wimbledon Park Side. Prophylaxis—The sudden increased demand by the public in the early part of the year for protection against smallpox was met by the opening, to the extent necessary, of special sessions at conveniently situated centres. 116 Accidents in the home—Display units dealing with home safety, from the Council's stand at the Ideal Home Exhibition at Olympia, were exhibited at various public libraries in the division. Mental health service—Community care services for the mentally ill established in 1961 were developed further. The psychiatric social club started in April 1961 at Tooting is a flourishing and successful venture, with attendances of between 40 and 50 on the one evening in the week and a second club was started at Putney health centre. The scheme for giving occupation and instruction in their homes to mentally ill persons was extended to eight sessions a week. A meeting was arranged in April, which some 200 persons attended, to bring before people engaged in public life and social work the altered approach to mental health and the facilities available in the division. Chellow Dene residential hostel was opened in July, with accommodation for 23 men and women who require a period of sheltered accommodation to help them to establish themselves in employment and in the community as a whole after recovery from mental illness. To meet the increased demand for training centre places for older girls a new centre with 40 places, Newlands training centre, Tooting, was opened in September. The Clapham industrial training centre for older boys and men got into its stride and made in quantity articles such as duckboards, children's swings, sleeve ironing boards, tabletennis bats and bundled firewood. Handicapped children—Arrangements were made for a part-time unit, known as the Roehampton child guidance unit, to commence at the William Harvey welfare centre. To provide for more centrally located facilities for the young partially deaf child, a parttime auditory training centre has been established at Wandsworth school treatment centre. 117 School health service—The number of children referred for treatment from school medical inspections continues to decrease. This is partly due to the improvement in health of the school children and partly due to the fact that many mothers prefer to take their children to their family doctor. There has been an increase in the numbers of children attending the special investigation clinics at John Dixon and Stockwell centres; this is in part due to the fact that many secondary school girls prefer the opportunity offered at these clinics of consulting a woman doctor. Particular attention has been given to tracing all cases of deafness in school children and to ensuring that all children suffering from any degree of deafness were included on the deaf register. The number on the register rose from 124 in 1961 to 167 in 1962. Handicapped children—A register has been compiled of all handicapped children in the division under five who are so handicapped that it appears they are likely to need special educational facilities when they reach the age of five. The register is made up from information received from health visitors and all cases are kept carefully under review to ensure that treatment and assistance is being given and to arrange in good time for educational provision. This register has proved most valuable; there were about 180 children on it during the year, about two-thirds of whom were mentally handicapped. Prevention of break-up of families—The work of the divisional co-ordinating committee has been steadily increasing. Five meetings of the full committee and 64 intermediate case conferences were held during the year. A total of 243 notifications were received of tenants who were being considered for eviction because of rent arrears—72 from the L.C.C. Housing department and 171 from the borough councils. There would appear to be a growing tendency towards irresponsibility in payment of rent among problem and potential problem families and it has often been very difficult to prevent evictions. There are about 200 families at present on the co-ordinating committee files; 55 of these are receiving casework from the Family Service Unit (39 families), the Children's department intensive caseworker (14 families) and the Public Health department case consultant (two families). The work of giving assistance to the remaining families falls on the health visitors and social workers in the division. DIVISION 9, comprising the boroughs of Wandsworth and Battersea Dr. J. T. R. Lewis reports: Maternity and child welfare—St. Christopher's welfare centre, a purpose built centre incorporated in a Battersea Borough Council block of flats, was formally opened in July. The centre, which replaces two welfare centres accommodated respectively in an old school and in public baths and a school treatment centre in a converted shop, provides a full range of maternity, child welfare and school treatment services, with a total of no less than 42 sessions weekly. Patmore infant welfare centre was opened in March, in the tenants' clubroom on the Council's Patmore Estate, for one infant welfare session a week and a session held at a public baths was discontinued. Three occasional creches, where mothers can leave their children for a morning or an afternoon, were added to the existing provision. Chiropody service—A foot clinic for one session weekly was started in the area of the Argyle and Ackroyden Estates, Wimbledon Park Side. Prophylaxis—The sudden increased demand by the public in the early part of the year for protection against smallpox was met by the opening, to the extent necessary, of special sessions at conveniently situated centres. 116 Accidents in the home—Display units dealing with home safety, from the Council's stand at the Ideal Home Exhibition at Olympia, were exhibited at various public libraries in the division. Mental health service—Community care services for the mentally ill established in 1961 were developed further. The psychiatric social club started in April 1961 at Tooting is a flourishing and successful venture, with attendances of between 40 and 50 on the one evening in the week and a second club was started at Putney health centre. The scheme for giving occupation and instruction in their homes to mentally ill persons was extended to eight sessions a week. A meeting was arranged in April, which some 200 persons attended, to bring before people engaged in public life and social work the altered approach to mental health and the facilities available in the division. Chellow Dene residential hostel was opened in July, with accommodation for 23 men and women who require a period of sheltered accommodation to help them to establish themselves in employment and in the community as a whole after recovery from mental illness. To meet the increased demand for training centre places for older girls a new centre with 40 places, Newlands training centre, Tooting, was opened in September. The Clapham industrial training centre for older boys and men got into its stride and made in quantity articles such as duckboards, children's swings, sleeve ironing boards, tabletennis bats and bundled firewood. Handicapped children—Arrangements were made for a part-time unit, known as the Roehampton child guidance unit, to commence at the William Harvey welfare centre. To provide for more centrally located facilities for the young partially deaf child, a parttime auditory training centre has been established at Wandsworth school treatment centre. 117 Statistical summary 1962—health divisions Health division 1 2 3 4 5 6 7 8 9 Total Health division 1 2 3 4 5 6 7 8 9 Total Estimated population—mid 1962 439,260 490,490 281,050 255,930 208,660 301,850 395,890 360,810 451,830 3,185,770 Foot clinics Births and associated mortality Sessions 4,344 1,156 3,505 3,820 487 6,348 2,536 3,269 1,939 27,404 Live births 8,214 8,821 6,559 5,762 4,118 5,276 7,397 7,869 8,508 62,524 Total attendances 30,907 7,430 24,597 28,392 3,399 48,982 14,609 21,263 12,921 192,500 Rate per 1,000 population 18.7 18.0 23.3 22.5 19.7 17-5 18.7 21.8 18.8 19.6 Deaths under 1 month 145 152 100 80 55 82 113 102 124 953 Day nurseries Rate per 1,000 live births 17.7 17.2 15.2 13.9 13.4 15.5 15.3 130 14.6 15.2 Number of places at 31 Dec. 627 975 349 379 275 55 279 634 437 4,010 Total attendances 138,851 217,806 80,488 87,413 52,747 11,371 61,121 143,305 89,876 882,978 Deaths All ages 5,126 5,900 3,238 3,008 2,515 3,352 4,551 4,300 6,356 38,346 Child minders Rate per 1,000 population 11.7 12.0 11.5 11.8 12.1 11.1 11.5 11.9 141 120 Statutorily registered 31 Dec. 29 17 20 18 7 51 43 2 34 221 Children minded (authorised no.) 168 97 105 66 42 296 237 18 236 1,265 Health visiting Voluntarily registered 31 Dec. 127 150 98 53 55 109 116 90 12 810 Effective visits 107,670 119,967 69,733 63,926 57,959 76,343 87,690 110,596 80,040 773,924 Children minded 214 134 97 65 69 129 137 101 15 961 Staff at 31 Dec. W/T equivalents 57 60 40 44 32 45 51 55 60 444 Home help Welfare centres Households attended 4,360 4,913 2,934 4,358 3,075 3,809 5,632 4,593 4,787 38,461 Children— Households attended per 1,000 population 9.9 10.0 10.4 17.0 14.7 12.6 14.2 12.7 10.6 12.1 Sessions 2,793 3,870 2,894 1,804 2,096 2,898 2,975 3,098 2,610 25,038 Total attendances 85,317 119,153 84,278 64,223 63,108 84,206 97,832 97,288 109,222 804,627 Age 0-1: first attendances % of live births 89 90 92 100 87 96 92 88 89 91 Home nursing Total visits 214,966 225,289 129,670 119,031 111,273 196,534 188,661 200,776 182,804 1,569,004 Expectant mothers— Visits per 1,000 population 489 459 461 465 533 651 477 556 405 493 Sessions 1,583 1,646 1,277 471 343 1,266 1,615 697 743 9,641 First attendances 4,443 5,335 4,584 2,101 562 2,381 3,385 2,996 2,519 28,306 School health service % of live and still-births Medical inspection, routine, special, Total attendances 20,454 23,553 20,532 9,242 4,237 15,771 17,479 14,211 13,798 139,277 reinspection 35,441 30,123 28,295 21,161 25,653 32,992 37,746 31,184 42,372 284,967 Health surveys 81,794 85,420 53,198 27,276 36,081 99,278 55,139 44,952 71,438 554,576 Prophylaxis Hospital/specialist clinics— Poliomyelitis (L.C.C. and general practitioners)— New cases 4,059 3,729 3,609 2,258 2,882 3,394 3,461 2,773 3,632 29,797 Total attendances 7,650 10,318 12,825 6,212 6,945 8,017 8,284 8,576 12,872 81,699 Salk vaccine Primary course (3 injections)— Dental services born 1958-62 1,821 2,133 1,131 1,799 1,196 1,078 2,016 2,716 1,637 15,527 Schools— born 1943-57 849 1,633 618 1,694 860 576 1,064 1,590 1,567 10,451 New cases 7,827 8,102 6,565 10,143 6,595 5,080 5,450 6,589 10,182 66,533 born 1933-42 933 2,252 648 826 1,539 552 819 1,179 1,029 9,777 New cases per 1,000 population 187 185 201 314 227 123 103 138 182 176 born 1932 or earlier and under 40 years 1,238 3,460 942 1,337 2,026 1,321 1,656 2,248 1,886 16,114 age 5-14 Total attendances 25,772 30,123 20,495 29,082 20,341 16,320 19,003 23,193 30,695 215,024 over 40 years 166 374 40 102 11 249 179 — 54 1,175 Maternity and child welfare— Total 5,007 9,852 3,379 5,758 5,632 3,776 5,734 7,733 6,173 53,044 First treatment 609 446 299 856 153 146 76 227 149 2,961 Fourth injection 637 543 253 73 210 301 603 257 586 3,463 Total attendances 2,434 2,245 2,427 3,309 881 711 273 724 507 13,511 Sabin vaccine Primary course (3 doses)— born 1958-62 5,161 4,092 5,439 2,979 2,309 3,937 3,643 3,517 4,371 35,448 born 1943-57 1,517 1,581 1,480 824 2,412 936 1,082 1,522 936 12,290 born 1933-42 1,765 1,009 1,552 448 871 690 631 534 525 8,025 born 1932 or earlier and under 40 years 2,144 1,144 2,089 455 1,191 1,382 1,047 805 890 11,147 over 40 years 227 163 120 17 9 76 99 — 35 746 Total 10,814 7,989 10,680 4,723 6,792 7,021 6,502 6,378 6,757 67,656 Fourth dose 2,967 3,256 1,111 505 1,780 1,009 1,391 1,091 398 13,508 Smallpox—Vaccinations 21,573 32,146 21,637 29,883 25,462 53,057 28,980 28,302 18,020 259,060 Re-vaccinations 40,206 69,805 23,670 34,629 18,049 76,024 31,740 29,474 28,480 352,077 Diphtheria—Primary course 6,236 5,318 5,329 4,682 3,198 3,993 5,141 5,964 6,020 45,881 Reinforcing injections 7,846 4,630 3,452 4,172 3,891 4,841 3,926 5,885 4,338 42,981 Whooping cough—Primary course 5,156 4,928 5,215 4,456 2,762 3,769 4,926 5,547 5,878 42,637 Reinforcing injections 3,578 2,358 3,075 2,325 1,431 2,657 2,969 2,684 2,961 24,038 Tetanus—Primary course 6,639 5,216 5,374 4,754 3,384 3,973 5,183 6,069 6,371 46,963 Reinforcing injections 4,585 2,980 3,321 2,727 1,943 3,161 3,465 3,593 3,326 29,101 118 I APPENDIX A FACTS AND FIGURES FROM THE 1961 CENSUS Publication of the 1961 Census Report for the County of London provides an opportunity to review the facts and figures that form the basis of the rates and indices which appear in the annual report of a Medical Officer of Health, as well as providing some data on the manifold social characteristics of the population. The census in this country is on a de facto basis and relates to persons present on census night, 23/24 April. This means that the population figures quoted are reduced by the number of London residents absent from their homes on census night and increased by the number of visitors to London. Adjustment of these figures will not be possible until publication of the Report on Usual Residence; information as to occupation, work place and migration (which was on a 10 per cent, sample basis) will not be available until publication of that report. Population Table (i) is a summary of the age and sex constitution of the population of London A.C. (with the exception of North Woolwich the area proposed for the twelve inner boroughs of the Greater London Council and the City of London) for the year 1961 with corresponding figures from the two previous censuses of 1931 and 1951 (there was no census in 1941— the only break in the decennial series since 1801) and a comparison of proportions with England and Wales for 1961. The 1931 population of 4,397,000 fell to a post-war figure in 1951 of 3,348,000 and in the ten years since there has been a gradual average annual decline of 0.45 per cent. per year to 3,200,000 in 1961. Figure 1 on page 121 depicts this change by age and sex over the ten years 1951-61. The main changes are fewer children of infant age (0-4 years) and fewer persons in the age group 25-44 years with more young men and women age 15-24 years, 225,000 young men compared with 188,000 and 244,000 young women compared with 230,000 in 1951. Part of these changes is brought about simply by the passage of time, e.g. the survivors of the post-war 'bulge' having moved into the 5—14 and early 15-24 years age groups; part is due to the multiple action of slight fluctuations in the death rate, the fall until 1955 and subsequent rise in the birth rate and, overshadowing the rest during the whole of the decade, net outward migration. As is evident from the diagram, parents and young children have moved out and there has been an influx of young people into London. This pattern of migration has been common in London for three and a half centuries and is the main reason for the fact that in comparison with England and Wales the London population contains proportionately fewer children and more adults age 15-44 years. Details of the 1961 population (total persons) for the metropolitan boroughs within the county are shown in table A.(i) in the annex; table A.(ii) gives more detail of persons of pensionable age together with a very useful statistic of the number living alone (13.4 per cent, males and 29.4 per cent. females). Table A.(iv) gives a borough comparison of 1951 with 1961 and the percentage change on an annual basis: only four boroughs, Kensington, Hampstead, Stoke Newington and Wandsworth, showed gains in population. Proportionately, the net loss in population has been greatest in the boroughs of St. Pancras, Westminster, Holborn, Shoreditch, Bethnal Green, Bermondsey, Southwark and Battersea (excluding the City of London). The column 'by births and deaths' shows the proportionate change arising from the interaction of these two factors—the natural increase or decrease; in only three boroughs, St. Marylebone, Holborn and Wandsworth and in the City of London did deaths exceed births. During the decade, therefore, the average annual rate of net outward migration is arrived at by subtracting from the net loss the natural increase—thus for the county net outward migration becomes 0.90 offset by a natural increase of 0.46, leaving a residual net loss of 0.45. 119 Table (i)—Age and sex constitution of the population London A.C. Census 1931, 1951 and 1961 Population in thousands Distribution per thousand 1931 1951 1961 1931 1951 1961 England and Wales 1961 PERSONS All ages 4,397 3,348 3,200 1,000 1,000 1,000 1,000 0- 4 297 271 223 68 81 70 79 5-14 650 384 398 148 115 124 149 15-24 837 418 469 190 125 147 132 25-44 1,334 1,101 897 302 329 280 262 45-64 957 802 835 218 239 261 258 65-74 231 253 238 53 76 74 77 75-84 80 104 118 18 31 37 37 85 and over 11 15 22 3 4 7 6 MALES All ages 2,044 1,566 1,524 1,000 1,000 1,000 1,000 0- 4 150 139 114 73 89 75 84 5-14 327 195 203 160 125 133 159 15-24 395 188 225 193 120 148 137 25-44 605 541 453 297 344 297 270 45-64 437 361 395 214 231 259 255 65-74 98 101 90 48 64 59 64 75-84 29 37 38 14 24 25 27 85 and over 3 4 6 1 3 4 4 FEMALES All ages 2,353 1,782 1,676 1,000 1,000 1,000 1,000 0- 4 147 132 109 62 74 65 75 5-14 323 189 195 137 106 116 142 15-24 442 230 244 188 129 146 127 25-44 729 560 444 310 315 264 254 45-64 520 441 440 221 247 263 259 65-74 133 152 148 57 85 88 88 75-84 51 67 80 22 38 48 46 85 and over 8 11 16 3 6 10 9 As mentioned earlier, since about 1750 London has attracted ' foreigners ', ranging from those born in other parts of the United Kingdom to those genuinely foreign born. Unfortunately, the number of London born residents will not be known until publication of the Report on Usual Residence so that, at present, the number of immigrants from other parts of the United Kingdom cannot be assessed—in 1951 it was 27 per cent. As regards those born outside the United Kingdom, this country has traditionally been generous in its acceptance of foreigners either as refugees or as persons seeking employment. Over the years this unrestricted entry to the country has been modified by Alien's Restriction Acts beginning in 1914 and more recently by the Commonwealth Immigrants Act, 1962. Nevertheless, there is now in this country, in London in particular, a considerable number of persons who were not born in the United Kingdom—in London they number 506,913 (16 per cent.); of 120 Figure 1 POPULATION AGE DIAGRAMLONDON A.C. CENSUS 1951 AND 1961 The size (area) of the block for each age group represents the proportion of the total population in that group 121 these, 131,703 were from the Irish Republic (another 9,236 from Ireland, part not stated), 186,896 from Commonwealth countries, Colonies and Protectorates and 176,642 from Foreign countries, born at sea or birthplace not stated. Table (ii) gives details of place of birth for 1951 and 1961, together with the proportions per 1,000 of the enumerated population. Table (ii)—Birthplace of population, London A.C. Census 1951 and 1961 with proportions per 1,000 enumerated Number enumerated Distribution per 1,000 enumerated 1951 1961 1951 1961 Males Females Males Females Males Females Males Females England 1,343,392 1,527,680 1,206,665 1,346,944 858 857 792 804 Wales 25,878 33,538 21,299 27,138 17 19 14 16 Scotland 30,275 32,705 29,883 29,821 19 18 20 18 Northern Ireland 8,367 8,500 10,850 10,352 5 5 7 6 United Kingdom part not stated - - 4,947 5,672 - - 3 3 Irish Republic 39,073 50,822 62,539 69,164 25 29 41 41 Ireland part not stated 2,492 2,417 4,593 4,643 2 1 3 3 Isle of Man and Channel Islands 1,364 1,810 1,066 1,370 1 1 1 1 Commonwealth, colonies and protectorates 33,471 31,504 (a)102,849 (a)84,047 21 18 (a)067 (a)50 Foreign countries, at sea and birthplace not stated 81,576 93,118 (b)79,668 (b)96,974 52 52 (b)52 (b)58 Total 1,565,888 1,782,094 1,524,359 1,676,125 1,000 1,000 1,000 1,000 3,347,982 3,200,484 (a) † Africa 12,989 8,564 9 5 Canada 2,762 2,664 2 2 Asia 36,103 26,452 24 16 Oceania 4,672 7,036 3 4 Gibraltar, Malta and Gozo 3,735 2,870 2 2 British Guiana and West Indies 38,405 32,118 25 19 (b) †Europe 43,883 61,025 29 36 Africa 3,270 2,929 2 2 America, North and South 4,676 5,380 3 3 Asia 5,725 5,162 4 3 U.S.S.R. 4,757 5,367 3 3 At sea . 266 186 0 0 † Excluding visitors, those with birthplace not stated and country of birth with fewer than 50 enumerated. The proportion not born in the United Kingdom has increased from 101 per 1,000 for both males and females in 1951 to 164 per 1,000 for males and 153 for females in 1961. Principally the increase has been in persons born in the Irish Republic and in the West Indies; similar details for the year 1961 in the metropolitan boroughs are given in table A.(iii). Persons born in the Irish Republic are more frequent in the north and west, the boroughs of Hammersmith, Hampstead, Paddington and St. Pancras; immigrants from the Commonwealth, mainly Asian and West Indian, are more frequent in the boroughs of Kensington, Paddington, St. Pancras, Islington, Stoke Newington and Lambeth; foreign 122 born immigrants, mainly European, are more frequent in the boroughs of Chelsea, Kensington, Hampstead, Paddington, St. Marylebone, Westminster and Holborn. In all, there were proportionately more persons not born in the United Kingdom north of the river than south, notably in the boroughs of Kensington, Hampstead, Paddington and Westminster, where about one-third of the population were not of United Kingdom origin. Fertility Details of births in London have been given annually in this report. The diagram on page 5 shows how the crude birth rate from 1951 to 1961 has exceeded that for England and Wales, with the exception of the years 1952 and 1953, but that when corrected for the proportion of women of child bearing age in the population the fertility of London women is lower than the national experience. The proportion of women age 15-44 years in London was 41.0 per cent. compared with 39.2 in England and Wales; in 1951 the corresponding percentages were 44.4 and 41.4 respectively. However, this adjustment has no regard to the proportion of married women, who in London give rise currently to some 86 per cent, of births, and the following table shows the proportion of women ever married for the years 1931, 1951 and 1961, together with the corresponding proportions for England and Wales in 1961. Table (iii)—Proportion of women ever married Percentage of all women in age group specified London A.C. Census 1931, 1951 and 1961 Age 1931 1951 1961 England and Wales 1961 16-19 1.9 6.2 8.9 8.2 20-24 23.1 44.5 45.9 59.1 25-34 61.3 76.0 74.7 88.4 35-44 76.3 80.7 83.7 91.2 There was a dramatic change over the twenty years 1931-51, when the proportion of young women married under age 20 years increased three times and the proportion under 24 years doubled. This span of twenty years covered a period of turbulent social history; from the economic depression of the early 1930's, through the greatest war in history with active involvement of the citizen population, to the early post-war period of shortages and priorities, all accompanied by vast social change of which earlier age at marriage was but one facet. The trend towards marriage at an earlier age has continued in the past decade though at a slower pace; the percentage of women married in London was at the census, 8.9 per cent. at ages 16-19 years, 45.9 per cent. at ages 20-24 years, 74.7 per cent. at ages 25-34 years and 83.7 per cent. at ages 35-44 years. However, with the exception of ages under 20, all these proportions are lower than the national ones, which means there are proportionately more unmarried women of child bearing years in London than there are nationally. The following figures are the numbers of single women in London's population: Age 16-19 81,784 20-24 73,050 25-34 55,816 35-44 36,371 This higher proportion of single women in London has a bearing on the illegitimacy rate, a matter of some concern in recent years, see page 61. Mortality Figure 2 on page 124 depicts, for males and females separately, the death rates by age and sex for periods of three years centred on the censuses of 1931, 1951 and 1961. From infancy to old age in all three periods the rates for males are higher than those for females. 123 Figure 2 CHANGES IN DEATH RATES BY AGE GROUPS, 1931-1961, LONDON A.C. RATE PER 1,000 POPULATION (UNDER1 YEAR PER 1,OOO LIVE BIRTHS) 124 There was a striking decline in mortality up to middle age between 1931 and 1951; in the past ten years there has been a further but much smaller decline, more pronounced in females than in males (at ages 15-24 years the male death rate in 1961 slightly exceeded that for 1951). At older ages, though there has been a decline over the 30 years, the difference between males and females is even more evident than at younger ages; the male rates in 1951 at ages 65+ years showed hardly any change on 1931, whereas the corresponding female rates showed a substantial fall and the differences between 1961 and 1951 are proportionately greater for females than for males. Infant mortality is mentioned separately below. In children (1-4 and 5-14 years) the big reduction in mortality has been due to the fall in deaths from infectious diseases, particularly diphtheria, respiratory diseases and tuberculosis. With young adults (15-24 years) the fall in mortality has largely been accounted for by far fewer deaths from tuberculosis and the respiratory diseases; the increase between 1951 and 1961 in males of these ages, though slight, is accounted for by increased deaths due to violence, mainly deaths from motor vehicle accidents. At ages 25-44 years there has been a reduction in mortality from tuberculosis, the respiratory diseases and in females, between 1931 and 1951, far fewer deaths in childbirth. Beyond age 44 years the fall in mortality, which is proportionately much smaller than at earlier ages, has been largely due to fewer deaths from tuberculosis and respiratory causes and at extreme old age to increased longevity, particularly with females. Particular aspects of the changes in mortality have been given in previous annual reports. Appendix A in 1955 gave a review of mortality in this century; appendix A in 1954 gave a review of lung cancer and since 1958 a table dealing with this has been given annually in this series of reports; special reference in the section on mortality was made to heart disease in 1956, to cancer in 1958, and to bronchitis and pneumonia in 1960. Figure 3 on page 126 dealing with infant mortality shows, for the same three periods as in figure 2, the striking change that has taken place in this field in the space of thirty years, especially in the first twenty of them. (From a figure of 64 infant deaths per 1,000 live births centred on 1931 to 25 in 1951 and to a rate of 21 currently.) The main causes for this improvement were dramatic falls in mortality from the infectious diseases, respiratory diseases, gastro-enteritis and immaturity. Housing Housing and health go hand-in-hand; the association of poor housing and poor health is well recognised. The census provides a stock-taking of the housing available and the uses to which it is put and, whilst figures may not have any qualitative expression, judicious use of suitable housing indices in juxtaposition provides measures from which can be gauged the adequacy or otherwise of the way in which the population is housed. The housing data is not seriously affected by the de facto aspect of the census, except that when related to households information is restricted to households present on census night. An explanation of the terms used in the census and in the discussion that follows is given in the footnote. Housing definitions. A dwelling means a building or part of a building which provides separate living quarters. Normally this is a private dwelling-house or flat with a front door of its own. The instructions to the census enumerators were that accommodation should only be counted as a dwelling if access to the main door was by means of an admission staircase or landing; if it could only be reached through the quarters occupied by another household, including a hall, it was not to be counted as a separate dwelling. A room was defined as any covered space surrounded by walls, doors or windows which was used for living, eating or sleeping and included rooms available for these purposes but not actually in use; the instructions to the enumerators were that landings, lobbies, recesses, closets and bathrooms, store rooms, shops, offices and warehouses should not be included in the number of rooms and that kitchens, kitchenettes or sculleries should only be counted as rooms if meals were regularly eaten there. (There was a slight difference between 1931 and 1951 in this last respect; in 1931 all kitchens so described were counted in the number of rooms but its practical effect is not thought to be sufficiently material to impair intercensal comparison.) A household was defined as ' A household comprises one person living alone or a group of persons living together, partaking of meals prepared together and benefiting from a common housekeeping." 125 Figure 3 CAUSES OF INFANT MORTALITY, 1931-1961, LONDON A.C. RATE PER 1,000 LIVE BIRTHS * The 1931 figure for immaturity includes some deaths assigned in 1951 and 1961 to congenital malformations, injury at birth and post-natal asphyxia. 126 With these definitions in mind the basic housing details for the years 1931, 1951 and 1961 are shown in table (iv) below: Table (iv)—Structurally separate dwellings, rooms and households London A.C. Census 1931, 1951 and 1961 1931 1951 1961 Dwellings— Occupied 730,628 798,840 917,395 Vacant 18,302 22,078 20,439 748,930 820,918 937,834 RoomsOccupied 4,251,754 3,843,184 4,010,914 Wholly vacant 96,412 82,281 95,749 4,348,166 3,925,465 4,106,663 Rooms per occupied dwelling 5.8 4.8 4.4 Households in occupation on census night 1931 1951 1961 Number % Number % Number % Persons per household present on census night 1 155,132 13.0 220,476 19.7 252,621 22.8 2 280,393 23.6 328,156 29.3 334,483 30.2 3 261,414 22.0 256,792 22.9 223,707 20.2 4-5 324,601 27.3 253,141 22.6 235,862 21.3 Over 5 168,490 14.1 62,145 5.5 60,457 5.5 Total 1,190,030 100.0 1,120,710 100.0 1,107,130 100.0 Number of persons in these households 4,122,639 3,161,901 3,024,585 Number of rooms occupied 4,198,292 3,801,320 3,929,715 Average number of persons per room 0.98 0.83 0.77 Households sharing accommodation 63% 47.8% 29.9% The total stock of structurally separate dwellings has increased over the past thirty years; by 10 per cent. in the twenty years 1931-51 and by 14 per cent. in the ten years 1951-61. (The period 1931-51 included the war years when there was extensive damage to residential property.) The number of rooms within the dwellings has, however, changed: in 1951 there were some 422,000 fewer rooms than in 1931 and between 1951 and 1961 the number of rooms increased by only four per cent. compared with the 14 per cent. increase in dwellings, with consequent changes in the index of rooms per occupied dwelling—from 5.8 in 1931 to 4.8 in 1951 and to 4.4 in 1961. There has, of course, been much rebuilding in London over the thirty years (some 78,000 houses have been demolished under slum clearance schemes by the London County Council and the metropolitan borough councils) and considerable conversion of existing premises and extensive new housing developments by both local authorities and private developers. In all these schemes the trend has been to produce a greater opportunity for households to have accommodation of their own; as evidenced by the fall in the proportion of households sharing accommodation—from two in every three sharing in 1931 to one in two in 1951 and one in three in 1961. If housing standards can be crudely expressed by the average number of persons per room, there has been a marked improvement from 0.98 in 1931 to 0.83 in 1951 and to 0.77 in 1961. This reduction in the average has operated with minor variations throughout the entire range of household sizes. There has been a significant change in household sizes, 127 especially between 1931 and 1951; there are now many more single person households than there were thirty years ago and fewer large households. This is not necessarily due to smaller families (the current trend is for family size to increase slightly), but possibly to more of the larger families splitting into separate households, doubtless owing to the lessening pressure of living accommodation and change in economic circumstances. Table A.(v) shows the more important of these housing statistics for each of the metropolitan boroughs for the years 1951 and 1961. This table, which brings together households and (structurally separate) dwellings, is perforce limited to dwellings occupied. Overall the percentage of shared dwellings as opposed to households has declined from 25.9 per cent. in 1951 to 12.9 per cent. in 1961; boroughs in which the percentage of shared dwellings has at least halved over the ten years were in the north-west, Fulham, Hampstead, St. Marylebone, St. Pancras and Westminster; in the north-east, Shoreditch, Stoke Newington, Poplar and Stepney; in the south-east, Deptford, Greenwich, Woolwich, Camberwell and Southwark and in the south-west, Wandsworth. The two boroughs with the largest percentage of shared dwellings in 1961 were Islington (33 per cent.) and Hackney (27 per cent.); both of these boroughs have a problem of large Victorian type houses now in multiple occupation. Overall the number of households in occupation on census night has fallen by only one per cent.; Kensington, Hampstead, Stoke Newington and Wandsworth show the biggest proportionate increases and St. Pancras, Westminster, Bethnal Green, the City of London, Deptford, Bermondsey and Southwark the biggest proportionate decreases. There is more sharing of accommodation north of the river than south; north London is older than the south and has more old property in multiple occupation, this is especially so in Islington and Hackney for the reasons referred to earlier. The density of occupation (persons per room) has not changed very much over the ten years, either overall or in individual boroughs and there has been no increase in this index figure in any one borough; with the index of percentage of persons at more than 1½ per room, though the overall figure shows a proportionate decline of a similar order to the index of persons per room, increases in this index figure compared with 1951 were recorded in the following boroughs: Hammersmith, Kensington, Paddington, Islington, Hackney, Stoke Newington, Stepney, Deptford, Camberwell, Lambeth and Battersea. As regards housing standards other than spatial, table A.(vi) in the annex shows by boroughs the proportion of households sharing or entirely without the domestic household arrangements which are nowadays considered essential. (Similar information was first obtained in the census of 1951 but the questions then asked were slightly different from those of 1961, so that exact comparison between the two sets of data is not possible; hence figures for 1961 only are shown.) The overall proportion of households without exclusive use of a stove and kitchen sink was 7.1 per cent., the proportion sharing use of a piped cold water supply within the building was 7.3 per cent. and households entirely without averaged 0.2 per cent. Access to piped hot water was a new question in 1961 and is a modern amenity becoming increasingly desirable if not essential [improvement grants under the Housing (Financial Provisions) Acts, 1958 and 1959 make provision for this and for fixed baths and indoor water closets]; 4.7 per cent. of households were described as sharing and 36.6 per cent. as entirely without; i.e. of all households in London 58.7 per cent. have exclusive use of this amenity. The proportion of households sharing a fixed bath was 18.6 per cent. and 30.5 per cent. were entirely without; the extent of sharing was about the same as in 1951 but the proportion entirely without shows a considerable reduction on the 1951 figure of 44 per cent. Similarly, the figure 30.2 per cent. sharing a water closet shows a decline from the 1951 figure of 35 per cent.; the figure of 0.7 per cent. entirely without a water closet refers to households without a water closet within the building or attached to it, i.e. separated from the dwelling. As with the indices of shared accommodation, the indices of these shared and absent household arrangements are worse north of the river than south: Islington has high figures for sharing or being without all the arrangements shown; Kensington and Paddington have a much higher than average percentage without exclusive use of stove and sink (flatlet houses); St. Pancras, Finsbury and Stepney have high 128 proportions sharing a piped cold water supply; St. Pancras, Finsbury, Hackney, Shoreditch, Bethnal Green, Poplar, Stepney, Deptford, Southwark and Battersea show relatively high proportions without access to a piped hot water supply and the same boroughs have high figures for percentage without a fixed bath; Kensington, Paddington, and St. Pancras have high proportions for the sharing of a water closet. 129 Table A.(i)—Population by age, Census 1961, metropolitan boroughs Total population (Census 1961) Age—years 0-4 5-14 15-24 25-44 45-64 65-74 75-84 85+ Division 1 Chelsea 47,256 2,475 4,424 7,242 13,108 13,036 3,998 2,423 550 Fulham 111,791 7,116 12,525 16,139 29,629 31,906 9,097 4,615 764 Hammersmith 110,333 7,668 12,417 17,573 30,959 29,074 8,245 3,795 602 Kensington 171,272 10,305 14,325 33,387 55,028 40,213 11,191 5,571 1,252 Division 2 Hampstead 98,844 5,544 8 807 16,946 30,402 25,584 7,199 3,643 719 Paddington 116,923 7,743 10,436 19,072 36,834 30,289 8,278 3,649 622 St. Marylebone 69,045 2,626 4,937 9,536 18,672 22,451 6,976 3,198 649 St. Pancras 124,855 8,644 13,608 19,122 36,526 32,209 9,533 4,433 780 Westminster, City of 85,735 3,690 6,568 12,390 24,560 27,013 7,768 3,193 553 Division 3 Finsbury 32,887 2,736 4,634 4,187 9,586 8,076 2,428 1,049 191 Holborn 22,008 988 1,678 3,668 6,699 6,323 1,783 763 106 Islington 228,345 18,850 28,234 34,341 67,040 55,379 15,340 7,760 1,401 Division 4 Hackney 164,766 12,488 20,783 23,413 44,829 44,351 12,201 5,761 940 Shoreditch 40,455 3,047 6,895 5,233 11,216 9,520 2,805 1,476 263 Stoke Newington 52,301 4,243 6,920 7,916 15,107 13,067 3,269 1,519 260 Division 5 Bethnal Green 47,078 3,684 6,576 6,072 12,909 12,101 3,673 1,773 290 City of London 4,767 151 266 764 1,123 1,874 413 159 17 Poplar 66,604 5,278 10,369 9,648 18,517 15,876 4,414 2,199 303 Stepney 92,000 7,349 13,002 13,051 26,298 22,640 6,466 2,773 421 Division 6 Deptford 68,829 5,196 9,340 9,887 18,487 17,902 4,865 2,733 419 Greenwich 85,546 5,746 12,479 12,816 22,493 22,100 6,153 3,128 631 Woolwich 146,603 10,102 23,050 19,319 37,792 38,735 11,379 5,264 962 Division 7 Camberwell 175,304 12,952 25,423 24,727 47,514 44,599 12,373 6,570 1,146 Lewisham 221,753 15,614 31,176 30,193 58,194 59,030 17,553 8,334 1,659 Division 8 Bermondsey 51,860 3,905 7,780 6,748 14,308 13,172 3,778 1,881 288 Lambeth 223,763 18,232 29,445 31,770 63,473 55,726 15,986 7,793 1,338 Southwark 86,249 7,037 12,839 11,445 23,717 21,523 6,069 3,121 498 Division 9 Battersea 105,870 7,928 13,825 15,061 28,512 27,838 7,767 4,127 812 Wandsworth 347,442 22,333 45,389 47,425 93,253 93,437 27,528 14,988 3,089 London County 3,200,484 223,670 398,150 469,091 896,785 835,044 238,528 117,691 21,525 130 131 Table A.(ii)—Persons of pensionable age, Census 1961, metropolitan boroughs Age—years Total Number living alone Percentage living alone 60-64 65 -74 75-84 85 and over F M F M F M M F M F M F Division 1 Chelsea 1,746 1,327 2,671 750 1,673 135 415 2,212 6,505 273 2,187 12.3 33.6 Fulham 3,601 3,431 5,666 1,461 3,154 211 553 5.103 12,974 658 3,957 12.9 30.5 Hammersmith 3,171 3,194 5,051 1,211 2,584 156 446 4,561 11,252 608 3 379 13.3 30.0 Kensington 4,931 3,771 7,420 1,454 4,117 232 1,020 5,457 17,488 914 5,393 16.7 30.8 Division 2 Hampstead 3,215 2,428 4,771 1,057 2,586 158 561 3,643 11,133 545 3,623 15.0 32.5 Paddington 3,506 3,123 5,155 1,162 2,487 149 473 4,434 11,621 843 4,130 19.0 35.5 St. Marylebone 3,019 2,515 4,461 1,023 2,175 186 463 3,724 10,118 548 3,177 14.7 31.4 St. Pancras 3,659 3,623 5,910 1,415 3,018 231 549 5,269 13,136 927 4,663 17.6 35.5 Westminster, City of 3,229 3,008 4,760 1,070 2,123 154 399 4,232 10,511 712 3,557 16.8 33.8 Division 3 Finsbury 1,028 951 1,477 344 705 47 144 1,342 3,354 267 1,224 19.9 36.5 Holborn 766 714 1,069 265 498 28 78 1,007 2,411 179 834 17.8 34.6 Islington 6,141 5,898 9,442 2,463 5,297 365 1,036 8,726 21,916 1,479 7,309 16.9 33.4 Division 4 Hackney 4,976 4,651 7,550 1,874 3,887 273 667 6,798 17,080 884 5,145 13.0 30.1 Shoreditch 1,121 1,043 1,762 451 1,025 71 192 1,565 4,100 312 1,333 19.9 32.5 Stoke Newington 1,343 1,228 2,041 500 1,019 66 194 1,794 4,597 245 1,383 13.7 30.1 Division 5 Bethnal Green 1,505 1,404 2,269 584 1,189 84 206 2,072 5,169 362 1,797 17.5 34.8 City of London 167 192 221 69 90 5 12 266 490 21 89 7.9 18.2 Poplar 1,771 1,775 2,639 762 1,437 94 209 2,631 6,056 380 1,775 14.4 29.3 Stepney 2,533 2,684 3,782 1,046 1,727 145 276 3,875 8,318 550 2,495 14.2 30.0 Division 6 Deptford 1,884 1,973 2,892 927 1,806 110 309 3,010 6,891 355 2,026 11.8 29.4 Greenwich 2,402 2,431 3,722 1,116 2,012 181 450 3,728 8,586 351 1,917 9.4 22.3 Woolwich 4,259 4,572 6,807 1,870 3,394 309 653 6,751 15,113 592 3,254 8.8 21.5 Division 7 Camberwell 4,765 4,556 7,817 2,057 4,513 310 836 6,923 17,931 875 5,230 12.6 29.2 Lewisham 6,683 6,839 10,714 2,844 5,490 494 1,165 10,177 24,052 839 5,230 8.2 21.7 Division 8 Bermondsey 1,513 1,405 2,373 632 1,249 84 204 2,121 5,339 346 1,856 16.3 34.8 Lambeth 6,237 6,087 9,899 2,501 5,292 332 1,006 8,920 22,434 1,160 6,738 13.0 30.0 Southwark 2,320 2,336 3,733 997 2,124 143 355 3,476 8,532 628 2,952 18.1 34.6 Division 9 Battersea 3,068 2,828 4,939 1,251 2,876 194 618 4,273 11,501 532 3,372 12.5 29.3 Wandsworth 10,624 10,363 17,165 4,630 10,358 715 2,374 15,708 40,521 1,547 9,732 9.8 24.0 London County 95,183 90,350 148,178 37,786 79,905 5,662 15,863 133,798 339,129 17,932 99,757 13.4 29.4 Table A.(iii)-Birthplace of population, Census 1961, metropolitan boroughs Boroughs NUMBERS RATE PER 1,000 ENUMERATED Boroughs Birthplace Birthplace England Wales Scotland Northern Ireland United Kingdom (part not stated) Irish Republic Ireland (part not stated) Isle of Man and Channel Islands Commonwealth countries, Colonies and Protectorates Foreign countries, at sea and birthplace not known Total England Wales Scotland Northern Ireland United Kingdom (part not stated) Sub-total U.K. Irish Republic Ireland (part not stated) Isle of Man and Channel Islands Commonwealth countries, Colonies and protectorates Foreign countries, at sea and birthplace not known Total London A.C. 2,553,609 48,437 59,704 21,202 10,619 131 703 9,236 2,436 186,896 176,646 3,200,484 798 15 19 7 3 842 41 3 1 58 55 1,000 London A.C. Chelsea 33,548 1,015 1,632 404 207 1,871 145 78 3,162 5,194 47,256 710.0 21.5 34.5 8.5 4.4 778.9 39.6 3.0 1.7 66.9 109.9 1,000 Chelsea Fulham 89,562 2,130 2,214 804 395 5,537 350 97 5,335 5,367 111,791 801.2 19.1 19.8 7.2 3.5 850.8 49.5 3.1 0.9 47.7 48.0 1,000 Fulham Hammersmith 81,238 2,577 2,261 1,082 430 9,972 715 82 6,414 5,562 110,333 736.3 23.4 20.5 9.8 3.9 793.9 90.4 6.5 0.7 58.1 50.4 1,000 Hammersmith Kensington 102,668 3,854 5,410 1,646 626 10,378 818 248 21,963 23,661 171,272 599.4 22.5 31.6 9.6 3.7 666.8 60.6 4.8 1.4 128.2 138.2 1,000 Kensington Hampstead 61,027 2,351 2,702 862 403 6,420 425 87 8,283 16,284 98,844 617.4 23.8 27.3 8.7 4.1 681.3 65.0 4 . 0.9 83.8 164.7 1,000 Hampstead Paddington 70,379 2,955 2 954 1,182 538 10,332 928 140 13,193 14,322 116,923 601.9 25.3 25.3 10.1 4.6 667.2 88.4 7.9 1.2 112.8 122.5 1,000 Paddington St. Marylebone 46,005 1,483 2,115 574 371 2,975 251 80 4,237 10,954 69,045 666.3 21.5 30.6 8.3 5.4 732.1 43.1 3.6 1.2 61.4 158 6 1,000 St. Marylebone St. Pancras 89,843 2,214 3,043 1,312 519 8,799 804 97 10,066 8,158 124,855 719.6 17.7 24.4 10.5 4.2 776.4 70 5 6.4 0 8 80 6 65.3 1,000 St. Pancras Westminster, City of 54,461 2,079 3,617 1,031 425 4,888 336 1326 5,262 13,510 85,735 635.2 24.2 42.2 12 0 50 718.6 57.0 3.9 1.5 61.4 157.6 1,000 Westminster, City of Finsbury 27,802 477 564 203 46 1,359 73 24 1,075 1,264 32,887 845.5 14.5 17.1 6.2 1.4 884.7 41.3 2.2 0.7 32.7 38.4 1,000 Finsbury Holborn 14,725 515 742 250 93 1,229 76 29 1,492 2,857 22,008 669.1 23.4 33.7 11.4 4.2 741.8 55.8 3.5 1.3 67.8 129.8 1,000 Holborn Islington 173,434 2,763 3,837 1,694 780 14,114 826 103 21,880 8,914 228,345 759.6 12.1 16.8 7.4 3.4 799.3 61.8 3.6 0.5 95.8 39.0 1,000 Islington Hackney 135,666 1,454 1,604 633 642 3,668 244 42 11,456 9,357 164,766 823.4 8.8 9.7 3.8 3.9 849.6 22.3 1.5 0.3 69.5 56.8 1,000 Hackney Shoreditch 37,270 279 357 149 158 794 42 9 702 695 40,455 921.3 6.9 8.8 3.7 3.9 944.6 19.6 1.0 0.2 17.4 17.2 1,000 Shoreditch Stoke Newington 39,840 621 779 314 172 2,047 156 36 4,813 3,523 52,301 761.7 11.9 14.9 6.0 3.3 797.8 39.1 3.0 0.7 92.0 67.4 1,000 Stoke Newington Bethnal Green 42,824 318 392 165 49 874 58 4 1,207 1,187 47,078 909.7 6.8 8.3 3.5 1.0 929.3 18.6 1.2 0.1 25.6 25.2 1,000 Bethnal Green City of London 3,805 104 167 54 5 223 3 3 119 284 4,767 798.3 21.8 35.0 11.3 1.0 867.4 46.8 0.6 0.6 25.0 59.6 1.000 City of London Poplar 60,703 429 621 273 93 1,143 62 13 2,030 1,237 66,604 911.4 6.4 9.3 4.1 1.4 932.6 17.2 0.9 0.2 30.5 18.6 1,000 Poplar Stepney 75,396 818 1,249 487 314 2,563 264 29 5,481 5,399 92,000 819.5 8.9 13.6 5.3 3.4 850.7 27.9 2.9 0.3 59.6 58.6 1.000 Stepney Deptford 60,680 676 793 391 235 1,755 124 41 2,891 1,243 68,829 881.6 9.8 11.5 5.7 3.4 912.0 25.5 1.8 0.6 42.0 18.1 1,000 Deptford Greenwich 77,736 1,116 1,292 419 206 1,604 92 63 1,593 1,425 85,546 908.7 13.0 15.1 4.9 2.4 944.1 18.8 1.1 0.7 18.6 16.7 1,000 Greenwich Woolwich 134,182 1,895 2,162 696 384 2,440 170 102 2,462 2,110 146,603 915.4 12.9 14.7 4.7 2.6 950.3 16.6 1.2 0.7 16.8 14.4 1,000 Woolwich Camberwell 153,532 1,941 2,389 827 547 4,794 320 101 7,473 3,380 175,304 875.9 11.1 13.6 4.7 3.1 908.4 27.3 1.8 0.6 42.6 19.3 1,000 Camberwell Lewisham 200,668 2,584 2,951 925 548 3,792 194 185 5,726 4,180 221,753 904.9 11.7 13.3 4.2 2.5 936.6 17.1 0.9 0.8 25.8 18.8 1,000 Lewisham Bermondsey 48,240 318 424 149 109 975 54 11 595 985 51,860 930.2 6.1 8.2 2.9 2.1 949.5 18.8 1.0 0.2 11.5 19.0 1,000 Bermondsey Lambeth 181,466 3,204 3,910 1,571 593 9,068 556 187 15,679 7,529 223,763 811.0 14.3 17.5 7.0 2.7 852.5 40.5 2.5 0.8 70.1 33.6 1,000 Lambeth Southwark 76,066 812 1,359 596 220 3,460 279 48 1,856 1,553 86,249 881.9 9.4 15 8 69 2.6 916.6 40.1 3.2 0.6 21.5 18.0 1,000 Southwark Battersea 89,839 1,578 1,668 481 421 3,198 254 78 5,396 2,957 105,870 848.6 14.9 15.8 4.5 4.0 887.8 30.2 2.4 0.7 51.0 27.9 1,000 Battersea Wandsworth 291,004 5,877 6,496 2,028 1,090 11,431 617 293 15,055 13,551 347,442 837.7 16.9 18.7 5.8 3.1 882.2 32.9 1.8 0.8 43.3 39.0 1,000 Wandsworth Table A.(iv)—Population and intercensal variations, 1951-1961, metropolitan boroughs Population Intercensal increase or decrease (—) Amount Percentage per year 1951-1961 1951 1961 1951-1961 Net By births and deaths (a) By migration (b) Division 1 Chelsea 50,957 47,256 3,701 0.75 0.08 0.83 Fulham 122,064 111,791 10,273 0.87 0.36 — 1-24 Hammersmith 119,367 110,333 9,034 0.78 0.58 - 1-36 Kensington 168,160 171,272 3,112 0.18 0.66 - 0-48 Division 2 Hampstead 95,131 98,844 3,713 0.38 0.49 - 0-11 Paddington 125,463 116,923 8,540 0.70 0.78 - 1-48 St. Marylebone 75,821 69,045 6,776 0.93 0.39 - 0-53 St. Pancras 138,377 124,855 13.522 1.02 0.60 - 1-62 Westminster, City of 99,048 85,735 13,313 1.43 0.13 — 1-55 Division 3 Finsbury 35,370 32,887 2,483 0.72 0.89 - 1-61 Holborn 24,810 22,008 2,802 1.19 0.04 - 1-15 Islington 235,632 228,345 7,287 0.31 0.78 — 1 09 Division 4 Hackney 171,342 164,766 6,576 039 0.52 - 0-91 Shoreditch 44,871 40,455 4,416 1.03 0.40 - 1-42 Stoke Newington 49,136 52,301 3,165 0.62 0.72 - 0 10 Division 5 Bethnal Green 58,353 47,078 11,275 2.11 0.57 - 2-68 City of London 5,324 4,767 557 1.09 0.46 - 0-63 Poplar 73,579 66,604 6,975 0.99 0.64 - 1-63 Stepney 98,858 92,000 6,858 0.71 0.69 — 1 40 Division 6 Deptford 75,495 68,829 6,666 0.92 0.41 - 1-33 Greenwich 89,846 85,546 4,300 0.49 0.50 - 0 99 Woolwich 147,891 146,603 1,288 0.09 0.36 - 0-45 Division 7 Camberwell 179,777 175,304 4,473 0.25 0.52 - 0-77 Lewisham 227,576 221,753 5,823 0.26 0.38 - 0-64 Division 8 Bermondsey 60,640 51,860 8,780 1.55 0.57 - 2-12 Lambeth 230,240 223,763 6,477 0.28 0.71 - 1 00 Southwark 97,221 86,249 10,972 1.19 0.49 — 1-67 Division 9 Battersea 117,140 105,870 11,270 1.00 0.51 - 1-51 Wandsworth (c) 330,467 347,442 16,975 0.50 0.06 0 56 London County 3,347,956 3,200,484 147,472 0.45 0.46 - 0 90 (a) Births exceed deaths except where prefixed by a negative sign. (b) Net change column increased by excess of births over deaths; where the reverse applies the migration column is decreased by the excess of deaths over births. (c) Figures relate as nearly as possible to the area as constituted in 1961; there was a small change in boundary between London and Surrey Administrative Counties on 1 April, 1957. 134 135 Table A.(v)—Housing of private households, Census 1951 and 1961, metropolitan boroughs Structurally separate dwellings occupied Households Density of occupation Number V.of 1951 % of dwellings shared Number % of 1951 % of households sharing a dwelling % of one person households Persons per room % of persons at more than 1½ per room 1951 1961 1951 1961 1951 1961 1951 1961 1951 1961 1951 1961 1951 1961 Division 1 Chelsea 15,008 16,292 109 11.1 9 0 18,426 17,756 96 28.2 25.8 31.4 36.1 0.75 0.68 10.3 8.2 Fulham 28,549 34,156 120 38.6 16 2 43,184 41,423 96 60.4 32.4 18.9 23.0 0.84 0.76 13.1 10.4 Hammersmith 26,229 28,915 110 30.7 16.0 38,909 37,553 97 54.0 36.6 18.8 22.8 0.90 0.83 15.8 16.0 Kensington 41,390 47,521 115 16 5 10 7 60,718 64,545 106 43.7 38.6 32.3 36.4 0.82 0.80 17.1 18.5 Division 2 Hampstead 22,116 30,545 138 26.8 9 9 35,970 38,698 108 55.5 31.9 28.6 33.7 0.80 0.75 12.9 11.5 Paddington 24,320 30,294 125 32.3 16 5 46,559 45,804 98 65.0 47.5 31.2 36.0 0.88 0 84 18.8 20.9 St. Marylebone 22,762 26,196 115 7.8 2 6 26,961 26,606 99 22.6 10.6 31.5 35.9 0.76 0.68 9.6 7.0 St. Pancras 29,146 35,016 120 33.9 14 0 48,865 44,201 90 61.1 34.1 27.5 28.9 0.93 0.85 17.2 15.4 Westminster, City of 24,491 29,358 120 10.7 3 4 32,449 29,737 92 33.0 14.6 34.9 36.8 0.76 0.69 11.0 7.6 Division 3 Finsbury 8,702 9,262 106 25.0 15.6 12,416 11,526 93 48.1 33.4 23.4 23.6 0.96 0.88 16.1 14.6 Holborn 6,644 5,954 90 5.6 6.0 7,498 6,418 86 16.5 17.3 31.8 35.2 0.92 0.81 14.8 11.6 Islington 44,543 50,827 114 49.1 33.0 81,793 80,980 99 72.9 58.9 20.3 23.0 0.92 0.87 15.8 17.7 Division 4 Hackney 39,560 41,760 106 35.7 27.3 57,654 57,713 100 56.7 48.3 14.8 18.7 0.85 0.79 9.4 11.4 Shored itch 10,840 12,127 112 24.9 9.3 14,412 13,443 93 44.1 19.2 17.0 19 0 0.98 0.88 17.7 13.6 Stoke Newington .. 10,330 14,784 143 42.1 14.0 16,717 18,225 109 65.2 31.2 17.3 20 0 0.86 0.83 10.1 12.8 Division 5 Bethnal Green 15,632 14,464 93 221 13.7 19,775 16,668 84 38.9 260 17.5 20.6 0.92 0.84 14 .3 12.4 City of London 1,456 1,320 91 0.7 0.4 1.466 1,225 84 1.4 1.3 22.5 21 3 0.77 0.68 6.5 3.3 Poplar 17,806 18,897 106 24.5 10.6 22,563 21,128 94 41.1 21.0 13.7 16 2 0.93 0.82 16.0 12.2 Stepney 24,895 26,524 107 17.8 7.7 30,295 29,219 96 33.0 17. 6 17.0 200 0.94 0.86 16.1 16.2 Division 6 Deptford 17,749 19,564 110 35.4 15.5 25,162 23,069 92 55.5 29. 3 15.1 17.4 0.81 0.74 9.3 10.4 Greenwich 21,348 24,608 115 19.1 8.5 26,397 26,772 101 3.1 17.1 11.1 13.7 0.83 0.73 11.0 7.0 Woolwich 39,960 45,001 113 12.1 5.1 45,366 46,972 104 23.0 10.2 10.3 12.5 0.73 0.68 6.1 3 8 Division 7 Camberwell 41,188 53,322 129 36 2 8.5 59,121 58,382 99 56.4 17.6 15.3 178 0.80 0.75 9.2 9.7 Lewisham 58,417 65,046 111 19 7 10.5 72,100 72,922 101 35.5 21.3 11.0 14.0 0.77 0.70 8.3 5.9 Division 8 Bermondsey 15,567 15,470 99 20.3 12.7 19,132 17,468 91 35.6 23.7 15.4 19.1 0.93 0.85 15.1 12.3 Lambeth 55,192 62,287 113 26.5 14.2 76,666 75,707 99 47.8 30.6 17.3 20.1 0.83 0.79 11.7 12.1 Southwark 23,082 24.540 106 25.4 12.4 32,052 28,900 90 46.7 26.8 19.8 20.9 0.93 0.86 15.2 13 8 Division 9 Battersea 27,274 29,059 107 35.7 20.4 39,080 36,427 93 56.0 37.6 15.5 19.4 0.81 0.75 10.4 11.2 Wandsworth 84,644 104,286 123 21.9 9.4 109,004 117,643 108 40.1 21.2 15.3 19.1 0.75 0.71 7.9 7.5 London a.C. 793,840 917,395 115 25.9 12.9 1,120,710 1,107,130 99 47.8 29.9 19.7 22.8 0.83 0.77 12.2 11.5 Table A.(vi)—Households sharing or entirely without household arrangements, Census 1961, metropolitan boroughs Number of households (a) Households without exclusive use of stove and sink per cent. Piped cold water (b) per cent. Piped hot water per cent. Fixed bath per cent. Water closet (c) per cent. S N S N S N S N Division I 17 9 0.4 Chelsea 17,756 3.9 4.5 0.1 3.5 20.2 11.3 16.6 Fulham 41,423 6.0 6.1 0.2 6.0 39.6 22.2 33.3 270 0.6 Hammersmith 37,553 9.2 9.2 0.2 7.0 40.2 24.6 29.5 34.6 0.9 Kensington 64,545 11.3 8.4 0.3 7.0 22.1 33.1 14.6 41.7 0.7 Division 2 Hampstead 38,698 9.3 9.7 0.2 10.3 21.1 35.9 10.8 38.0 0.6 Paddington 45,804 12.2 9.6 0.3 5.8 36.6 32.6 26.9 45.3 0.8 St. Marylebone 26,606 4.8 6.9 0.3 2.5 19.4 13.2 17.7 22.2 0.6 St. Pancras 44,201 9.2 10.0 0.3 4.3 49.0 19.1 39.9 44.3 1.0 Westminster, City of 29,737 6.7 9.1 0.2 5.0 26.5 20.6 19.3 27.0 0.4 Division 3 Finsbury 11,526 7.9 12.8 0.4 1.3 56.5 6.1 55.7 37.4 0.8 Holborn 6,418 6.9 8.5 0.3 2.3 36.3 7.5 35.4 21.1 1.1 Islington 80,980 11.5 11.6 0.3 6.3 57.4 25.6 45.4 54.0 0.8 Division 4 Hackney 57,713 7.3 6.8 0.1 4.6 44.7 17.9 41.7 39.3 0.5 Shoreditch 13,443 8.4 9.0 0.8 0.8 42.4 1.5 42.4 24.9 0.8 Stoke Newington 18,225 7.1 7.1 0.2 6.8 39.6 29.2 29.0 40.3 0.6 Division 5 Bethnal Green .. 16,668 6.0 7.4 0.2 0.8 49.9 2.8 55.3 28.9 0.3 City of London 1,225 0.9 6.9 0.1 2.5 12.8 1.7 19.2 8.2 0.6 Poplar 21,128 6.6 6.2 0.3 1.0 52.5 3.2 51.3 31.5 0.6 Stepney 29,219 8.0 10.9 0.8 1.1 54.2 2.2 56.6 26.1 2.0 Division 6 Deptford 23,069 6.7 6.5 0.2 4.0 48.7 18.0 44.1 34.9 0.6 Greenwich 26,772 3.9 4.1 0.1 2.6 31.6 8.7 27.4 15.9 0.5 Woolwich 46,972 3.7 3.5 0.1 2.3 21.2 5.1 20.7 9.0 0.5 Division 7 Camberwell 58.382 4.5 5.4 0.2 3.4 40.9 14.6 36.6 26.8 0.7 Lewisham 72,922 3.6 3.5 0.1 4.6 20.9 15.5 11.8 14.6 0.3 Division 8 Bermondsey 17,468 4.6 4.6 0.2 1.0 40.6 2.1 48.7 26.8 0.8 Lambeth 75,707 7.5 8.1 0.2 5.1 39.9 20.4 28.6 28.2 0.8 Southwark 28,900 6.7 8.7 0.1 1.1 56.1 3.4 59.3 25.4 0.7 Division 9 Battersea 36,427 6.6 6.2 0.2 5.2 47.0 20.1 40.7 26.5 0.6 Wandsworth .. 117,643 4.7 4.8 0.1 6.1 23.7 21.2 16.7 19.5 0.4 London A.C. 1,107,130 7.1 7.3 0.2 4.7 36.6 18.6 30.5 30.2 0.7 S = sharing N = entirely without, but see below (a) Households present on census night; i.e. restricted to households of which at least one member was present at census. (b) Refers to a tap within the building; piped water from a tap in an open yard or a public standpipe is shown in column N. (c) Refers to a water closet within the building or attached to it; a water closet separated from the dwelling is shown in column N. 136 APPENDIX B DEAFNESS Historical Background—The history of provision for deaf children in London, as elsewhere, shows some unusual and interesting features in comparison with the traditional pattern of development in the work of other handicaps. There are few instances where a long period of slow progress has been followed by such revolutionary changes in every aspect within a comparatively short time. For many years the full implications of the disability were not understood by the community, with the result that public sympathy and action were slow to be aroused. The suspicious attitude of the deaf themselves—engendered by the nature of the condition—did not encourage investigation and experiment. Major progress could not be made until the medical and technological advances of the past 25 years took place. At first the voluntary organisations led the way by the establishment in 1792 of the first British institution for the training of deaf children. This was the Asylum for the Deaf and Dumb in the Old Kent Road. In 1872 the local education authority, which was the London School Board, undertook responsibility and set up its first class for deaf pupils two years later. Parliamentary legislation followed, in the form of the Elementary Education (Blind and Deaf Children) Act, 1893, which laid down the duty of the school authority to make provision for blind and deaf pupils and gave power to enforce attendance, which was compulsory, for deaf children from seven to sixteen years. This tying of the age of entrance to seven years meant that children who were already retarded in relation to others of the same age were held back a further two years. Many authorities, including London, did in fact admit children younger than seven to schools for the deaf. However, the age of compulsory attendance was not lowered to five years until 1937. When the London County Council took over the London School Board's function as education authority in 1904 there were ten schools for the deaf or special classes in ordinary schools, two boarding schools and one boarding school for deaf pupils who had an additional handicap. Although its provision was often in advance of legislation, the Council's approach to the care of the deaf child reflected the national attitude. Little medical information about the causes of congenital deafness was available and the field of acquired deafness was largely unexplored from both the preventive and curative angles. A child's hearing was seldom questioned unless it did not develop speech at the normal time or came from a family in which there was a known history of deafness. Sometimes the child was thought to be mentally retarded, particularly the hard-of-hearing child who gave evidence of being able to hear some sounds but who could not fully comprehend or reproduce normal speech. The severely deaf child was regarded as a deaf mute and effort was directed towards enabling him to make the best of his inescapable fate as a dumb adult. The difficulty of communication tended to lead the deaf to form a narrow community within the normal body of society. Assisted by voluntary organisations they had a variety of social pursuits amongst themselves; certain types of selected employment were available; intermarriage was common. The hearing world was regarded with suspicion and the protective cover of the group was comforting. Early hearing aids were cumbersome and of limited use, but there were no hearing aids, even of this type, for children. The development of the thermionic valve and later of the transistor led to the production of the modern compact powerful aid, which enables every remnant of useful hearing to be employed and is of such small size and light weight that it is suitable for a young baby. The International Congress on Deafness held in London in 1925 stressed the importance of adequate hearing in relation to education. This precept was behind the routine audiometric testing of schoolchildren begun by the London County Council in 1930. (In this the Council was in advance of the recommendations of the Commission of Enquiry in 1938.) 137 At the congress Dr. Alfred Eicholz, Chief Medical Officer of the Board of Education, urged the prevention of deafness by attention to one of the most frequent causes of acquired deafness in children, namely, 'running' ears. Developments in drug therapy have led to a decrease in the diseases which produce otorrhoea and to fewer chronic cases among those which still occur. School medical officers are alert to the need for early and effective treatment for aural sepsis. Educationalists experimented with various methods of teaching the deaf child to communicate and the schools changed from finger spelling to lipreading and oralism. It was recognised, too, that the partially hearing child required different techniques of instruction from the severely deaf child and the London County Council was the first authority to initiate special units for these children. The first partially deaf (now called partially hearing) unit was established by the Council in 1947. Audiometry—In order to establish a standard test for the routine assessment of schoolchildren's hearing, the Council introduced gramophone audiometry in 1930. Prior to this, arbitrary methods of testing were used; for example, the whisper test and the watch tick. The advantages of the gramophone audiometer were (a) 40 children could be tested at one time, (b) it was an objective test, (c) it did stress the area of hearing for speech. On the other hand, it could only be used for children who could write down what they heard, so that the children had to be of sufficient intelligence and educational attainment, i.e., about seven years. By 1939 specially trained school nursing staff were carrying out audiometric testing of all seven year old children in the Council's schools. The children who failed this initial test were given a further test and the failures of this second test were referred to one of the Council's otologists. Pure tone audiometry was first used at County Hall in the 1930's in order to test children referred to the Council's consultant otologist for consideration for special education. A wider range of frequencies could be tested and, as the ability to take down dictation was not involved, children who did not know their letters could be tested. By 1957 pure tone sweep testing was substituted for gramophone audiometry in all the Council's divisions. All children of five years were required to be tested and it is now hoped shortly to repeat this test during the child's period in secondary school. In 1962 a number of light-weight transistorised portable pure tone audiometers were purchased for the use of school nursing staff in charge of audiometry in each of the nine divisions. The numbers of children given' rapid-sweep ' audiometer tests during 1962 are as follows: Pupils given screening tests 56,249 Pupils failing screening tests given pure tone tests 3,653 Pupils failing pure tone tests referred to otologists 1,501 Pupils found to have impaired hearing 76 Perhaps the most important development in the treatment of child deafness was the realisation of the urgency of early diagnosis and guidance for mother and infant during the vital early years when the normal development of speech takes place. After the first three years of life the acquisition of speech becomes progressively more difficult. Pioneers in this revolutionary approach were Miss Edith Whetnall, Director of the Audiology Unit, Royal National Throat, Nose and Ear Hospital, Sir Alexander and Dr. Irene Ewing, Department of Education, Manchester University and Dr. Mary Sheridan, Medical Officer, Ministry of Health. The 'at risk' register—In the maternity and child welfare services of the Council, during the past few years, the work of clinic doctors and health visitors has been re-orientated towards the early diagnosis of congenital handicaps. These handicaps, both physical and mental, can be divided into two groups. Firstly, those which are obvious at birth; secondly, handicaps which have to be deliberately sought for during the first year of life because the baby is in the 'at risk' category. The diagnosis of deafness as early as possible is obviously of major importance. 138 CUP AND SPOON TEST AGE 5 months SCREENING TESTS FOR HEARING PAPER TEST AGE 5 months VOICE TEST 3ft "pth pth" AGE 7 months PAPER TEST 3ft AGE 7 months RATTLE TEST AGE 10£ months CUP AND SPOON TEST AGE IIJ months SEVEN TOY TEST 10 feet " Show me the car" AGE 2 years SEVEN TOY TEST 10 feet " Show me the ship " AGE 2 years The Silent Children Hugh Myddelton School for the Deaf 1911 MODERN NURSERY SCHOOL FOR THE DEAF Frank Barnes Primary School 1953 DEAF AID EQUIPMENT Old Kent Road School for the Deaf 1958 PERCUSSION BAND Ackmar Road School for the Deaf 1962 (Daily Telegraph photo) Registers of all babies with congenital handicaps, as well as registers of all babies ' at risk' are being set up in each health division. The 'at risk' register must be compiled from notifications, sent by the hospital maternity services and the domiciliary midwifery service, of factors occurring in the pre-natal, peri-natal and post-natal periods. For this purpose a 'notification of discharge' form for mothers and babies has been introduced by the Council which provides a list of factors which can be ringed as appropriate. The current list of factors suggesting child may be at special risk are as follows:— Genetic: Family history of deafness, blindness, etc. Pre-natal: Rubella or other virus infection in first 16 weeks of pregnancy Blood incompatibilities (e.g. Rhesus sensitization) Hyperemesis Ante-partum haemorrhage Severe illness necessitating chemotherapy or major surgery in early months of pregnancy X-ray other than chest X-ray Thyrotoxicosis Diabetes Toxaemia of pregnancy Other complications of pregnancy, e.g., pyelitis Any psychiatric illness during pregnancy Peri-natal: Prolonged or difficult labour Birth weight under 4 lb. or gestation under 36 weeks Birth asphyxia Prolonged poor sucking Post-natal: Jaundice Convulsions Respiratory distress, cyanotic attacks Any congenital abnormalities Not all maternity hospitals have as yet accepted the form; in some instances a copy of the discharge letter sent to the family doctor is still in use. All medical officers in the Council's services have been given the opportunity to attend training courses in standard screening tests for hearing for young children and Stycar testing sets have been provided in all the Council's clinics. Health visitors have made home visits to encourage mothers to bring babies who have been included in the 'at risk' register for screening tests at critical periods during the first two years of life. In some divisions these screening tests are carried out at special sessions, in others they are done as part of the normal work of the child welfare session. When a hearing loss is suspected, the baby is referred either to one of the Council's otologists or to hospital. Transistorised hearing aids are provided and auditory training is given by peripatetic teachers of the deaf in the Council's clinics. A reviewing medical officer has been appointed in each division to supervise the registers and to plan any special medical or social services which may be necessary. If deafness is confirmed, the child's name is transferred to the deaf register. Children under three years of age whose speech development is not progressing can be admitted to a day nursery free for three hours daily. These, on recommendation of the otologist, include children of deaf parents who need a hearing environment; children who appear to have a hearing loss, but whose deafness has not been confirmed; and some children whose hearing loss is not so severe as to require admission to a nursery class for the deaf. It is hoped that by these measures, in due course, many cases of congenital deafness will be diagnosed during the first year of life. 139 The deaf register—In 1961 a register of all children with impaired hearing was established in each of the nine divisions. The primary object was to ensure prompt and efficient pursual of effective treatment and to keep a close watch on the progress of such children attending ordinary or special school. A number of ancillary aims were envisaged, such as the compilation of statistical data and the co-ordination of all those working with children with impaired hearing. In each division a medical officer and a social worker were specially designated to be in charge of the register. The doctor is, where possible, the school medical officer for the school for the deaf or the partially hearing unit. The social worker attends all otologist's sessions, whether in the audiology unit or in the school. A home report is obtained for every child on the register and this report is specifically geared to provide information on the factors bearing on the handicap, e.g., hearing environment in the home, attitude of parents, language spoken in the home. In this way a complete picture of the child as a member of a family is obtained. This information is just as vital when making a recommendation for specialised training as is knowledge of the child's intelligence, the amount of useful hearing and the possible existence of another handicap. One of the major achievements of the work has been to render all those dealing with children 'hearing' conscious. The deaf register. Table (i)—Children on deaf register at 31.12.62 1,727 Table (ii)—New eases* from all sources (Council and non-Council) added to register during 1962 Type of hearing defects Congenital 171 Acquired 204 Uncertain or unknown 56 431 *Includes children already receiving treatment which became known to the Council only during 1962. Table (iii)—London children receiving full-time special education as deaf or partially hearing pupils at 31.12.62 Day special schools 284* Boarding special schools 36 Non-Council boarding schools 112 432 * Includes 109 pupils in units for the partially hearing. Table (iv)—Children on deaf register at 31.12.62 in Training centres 11 Public boarding schools 1 Reception centres 1 13 All the above aged five years or over. 140 Table (v)—Children on deaf register at 31.12.62 not included in tables (iii) and (iv) Aged 0-4 Aged 5 and over Receiving auditory training Receiving auditory training In nursery class in 'ordinary' day school or' ordinary' nursery school; in 'ordinary' day nursery; at home but attending audio logy centre for auditory training only; at home and receiving auditory training at home 77 In ' ordinary ' day schools and special schools or units (day or boarding) for handicaps other than one of hearing; at home but attending audio logy centre for auditory training only 199 With supervision by peripatetic teacher With supervision by peripatetic teacher In 'ordinary' day nursery 4 In 'ordinary' day schools and special schools or units (day or boarding) for handicaps other than one of hearing 95 No special treatment No special treatment In nursery class in 'ordinary' day school or 'ordinary' nursery school; at home under review only 23 In 'ordinary' day schools and special schools or units (day or boarding) for handicaps other than one of hearing 876* In long stay hospital, hospital school or special unit 2 In long stay hospital, hospital school or special unit 5 With other supervision In Children's department establishment (long stay) 1 * Although requiring no special treatment, their progress is kept under review. Audiology services—The Council's audiology services vary in type in different areas. In some districts the unit is provided wholly by the Council. In three divisions, hospitals provide otologists and premises, while the Council is responsible for the teacher of the deaf, social worker and educational psychologist. In two areas experimental association of the audiology unit with the school for the deaf is taking place. Sessions are held weekly at County Hall by the Council's consultant otologist, who sees children referred for specialist opinion. A peripatetic teacher of the deaf was appointed in 1955. It was visualised that her work would be mainly with the very young child so that she could help the child both directly and through the parents to acquire speech during the important early years. She was also expected to supervise the educational progress of children who had moved from partially hearing units to ordinary school, so that any inability to cope on the part of the child could be detected before too much ground had been lost. Children with a moderate degree of hearing loss who can manage in ordinary school with the help of a hearing aid require instruction in its use, as do their parents; the teacher of the deaf visits the child's school periodically to advise the teachers on the child's special needs and to keep a check on his progress. Lectures and demonstrations have been given by the peripatetic teachers to various groups, such as day nursery staff, health visitors, student teachers. The Council has provision for ten peripatetic teachers of the deaf and the future needs are under review. One of the most rewarding aspects of the teacher's work has been the development of the Parent Teacher Association of Children Receiving Auditory Training. This body, in addition to the usual valuable functions exercised by like associations, directs its experience towards assisting new parents to tackle their problems. When a new child is admitted for auditory training it is paired with a child of similar background, age, hearing ability and cause of deafness. Both parents of the child who has had training, and is succeeding, visit the new family and help all members with the benefit of their own personal experience. Provision of hearing aids—Whilst the provision of hearing aids is the responsibility of the National Health Service, the standard Medresco aid, which is the only one available 141 under the National Health Service, is sometimes considered by otologists to be less suited to the needs of individual children than one or other of the commercial aids available on the market. In December, 1953 the Health Committee approved the purchase of commercial aids for children when the medical officer considered that the Medresco aid was unsuitable. Accordingly, whenever the medical officer is satisfied, on medical and educational grounds after three months' trial, that a commercial aid is of benefit to a child its purchase is authorised. The schools—For children with a severe hearing loss the Council has established four primary special schools and one secondary special school. These schools provide a range of small, well balanced classes which permit a greater amount of individual teaching. In each of the special primary schools there is a nursery department equipped to deal with children from the age of two years who need special training before continuing in the primary school for the deaf or before proceeding to one of the units for partially hearing children. These nursery classes are taught by qualified teachers of the deaf and give the younger child every opportunity of attaining a high oral standard. The schools for the deaf are equipped with excellent group hearing aids in every classroom, except for the nursery departments. In the latter, a loop induction system has been installed and this system is also available in every other classroom in addition to the group aid. Tape recorders, gramophones, wireless receivers, auditory trainers and audiometers are also provided. Soundtreating of a very complete type is being carried out in all schools. There are four partially hearing units in primary schools for hearing children and secondary education for partially hearing children is provided at two partially hearing units attached to comprehensive schools. The principle obtaining in these units is that, while special training by teachers of the deaf using modern equipment including group hearing aids is essential, partially hearing children should be integrated into hearing classes so that they may learn with their hearing companions and adjust themselves socially to a hearing society. There are teachers of the deaf in all these units. For children in schools for the deaf and in the primary units for the partially hearing it was thought that it would be beneficial to have an extra teacher who could give special help to individual children. The Council therefore appointed an extra teacher for individual auditory training in each of the schools for the deaf and the primary units for partially hearing. Auditory training units are supplied for use by the teachers. The Council's boarding special school, Rayners, provides for the needs of partially hearing children suffering from additional handicaps. As this school until recently catered for deaf, as well as partially hearing children, there are still a few very deaf children there who will remain until they leave the school at the age of sixteen years. Some children are placed in non-Council boarding establishments for children with impaired hearing. In November 1962, the Council agreed that the London School Plan should be amended in so far as it related to provision for plans in day special schools for handicapped children. The proposed future plan for the education of children with impaired hearing in London makes a number of changes. Children below the age of five will be in units for the partially hearing, instead of being in schools for the deaf. There will, of course, be teachers of the deaf with them, so that they will receive the special approach required from the teacher of the deaf, yet be able to learn a normal social way of life from being in contact with normal children; normal in this sense meaning children with normal hearing. Those who can hear anything will also have the benefit of hearing more normal speech patterns and generally there will be greater motivation towards the use of speech whenever possible. There will be an additional primary partially hearing unit and two more partially hearing units in secondary schools. The secondary units, to be opened in September 1963, will have, in addition to the completely integrated groups of children, a small group who will need to remain as a single group with a teacher of the deaf and go into normal classes for selected subjects, such as art, handwork, games, etc. 142 The deaf school leaver—Deaf and partially hearing school leavers are given information about careers, advice about suitable employment, are assisted in finding it and followed through at work by specialist officers of the Council's youth employment service. The degree of hearing loss suffered by deaf and partially hearing school leavers is a considerable handicap in employment. Nevertheless, these children are satisfactory workers and employers speak highly of them. Girls leaving special schools during the past year entered clerical work, copy typing, office machine operating, various branches of the needle trades and in a few cases factory work. One girl having obtained nine 'O' level passes in the G.C.E. examination, including physics and chemistry, was placed as a scientific assistant in the Civil Service. Boys leaving during the same period obtained varied employment, three as apprentices in furriery, lithographic artistic work and silversmithing respectively; others are receiving training in electric motor repair, textile printing, tailoring, optical work, clerical work in the offices of accountants and quantity surveyors. Successful also are boys employed in the manufacture of leather and plastic goods, woodwork and metalwork. The question of further education for children with impaired hearing is at present under review by the Education Officer. The future prospects for these children are bright. London's silent children are beginning to speak. 143 APPENDIX C VENEREAL DISEASE The Council's powers—The Council's present work in this field was first undertaken during the last war, when a Defence Regulation (33B) provided for the compulsory treatment of venereal disease in certain circumstances. The Regulation was repealed with effect from the end of 1947 and since then no statutory power has existed whereby sufferers from infectious venereal disease can be compelled to undergo treatment. A Private Member's Bill introduced in the House of Commons sought to restore the provisions formerly contained in Defence Regulation (33B), but the Second Reading, due in October 1962, did not take place. As a local health authority the Council has permissive powers, under section 28 (1) of the National Health Service Act, 1946, to make arrangements for the prevention of illness and the care of persons suffering from illness. Within the scope of these arrangements and with the consent of the Ministry of Health the Council co-operates, when requested to do so, with the work of venereal disease treatment centres situated within the county. In addition, the Council increasingly is drawing attention to venereal disease in its health education programmes. The extent of the problem—Venereal disease is not a notifiable disease but the growing extent of the problem in London is illustrated in table (i). The figures show the numbers of new cases treated in London out-patient clinics where, on average, 83 per cent, of the patients are resident within the county. The slight drop in the figures for 1962 is encouraging but its significance cannot be assessed until information for 1963 indicates whether or not the improvement has been maintained. Table (i)—Treatment of venereal disease at London out-patient clinics Year New cases Total attendances Syphilis S. Chancre Gonorrhoea Total venereal cases Total non-venereal cases M. F. M. F. M. F. M. F. M. F. M. F. 1953 720 401 88 4 6,I'J3 1,546 6,911 1,951 17,615 6,121 220,316 102,365 1954 651 340 64 2 5.816 1,422 6,531 1,764 17,875 6,304 219,258 100,554 1955 625 400 77 6 5,916 1,457 6,618 1.863 18,735 7,056 221,381 103,815 1956 691 493 72 4 7,468 1,718 8,231 2,215 19,802 7,468 222,695 101,034 1957 701 562 78 2 8,943 2,003 9,722 2,567 20,554 8,102 223,821 97,149 1958 733 490 66 3 10,619 2,307 11,418 2,800 21,906 8,857 215,934 89,407 1959 799 493 93 — 11,722 2,599 12,614 3,092 24,013 9,179 229,368 88,232 1960 908 410 68 2 13,077 2,905 14,053 3,317 26,494 10,647 240,303 96,113 1961 1,067 563 47 — 13,573 2,906 14,687 3,469 28,081 11,824 253,806 93,398 1962 1,060 533 52 2 12,225 2,533 13,337 3,068 27,360 11,939 243,078 87,860 For 1962, and with the co-operation of the London out-patient clinics, most of the new cases were further classified into age groups and an analysis by birthplace was made. This additional information is set out in table (ii). 144 Table (ii)—Analysis ofpatients dealt with for the first time during 1962 at London out-patient clinics Age groups Males* Females* Total mates and females* la lb 2a 2b 3a 3b 4 5 6 7 8 9 Total la lb 2a 2b 3a 3b 4 5 6 7 8 9 Total la lb 2a 2b 3a 3b 4 5 6 7 8 9 Total Syphilis 0 to 15 1 1 2 1 5 2 1 1 4 3 — — — — — 1 3 — — 1 1 9 16 1 1 2 — — — — — — 2 — — — — 4 3 — — — — — — 2 — — — — 5 17 2 — — — — — — 4 — — — 1 7 3 7 10 5 — — 11 — — — 1 17 18 and 19 3 — — — — — 1 14 2 1 21 17 1 14 1 33 20 2 28 1 2 1 54 20 to 24 58 — 12 1 12 1 1 86 10 6 5 8 200 78 2 2 19 5 2 108 136 14 1 12 1 3 105 15 8 5 8 308 25 to 29 85 — 8 3 13 5 78 7 18 10 13 240 94 1 2 21 7 4 ? 131 179 9 3 13 7 99 14 22 12 13 371 30 and over 136 1 15 2 28 — 9 259 20 26 25 18 539 126 — 2 — 2 — 4 74 13 11 4 3 239 262 1 17 2 30 — 13 333 33 37 29 21 778 286 1 35 6 53 1 17 443 37 52 41 41 1,013 322 — 5 — 2 — 9 138 26 17 6 4 529 608 1 40 6 55 1 26 581 63 69 47 45 1,542 Gonorrhoea 0 to 15 3 1 1 7 1 13 7 14 21 10 1 — — — 1 21 1 — 34 16 8 — — 1 — — 3 28 — 2 — 3 45 2 21 1 — 1 3 28 10 — — 1 — — 3 49 1 2 1 6 73 17 31 — — — 4 — 22 66 1 9 4 3 140 12 — — — — 1 4 79 2 5 4 2 109 43 — — — 4 1 26 145 3 14 8 5 249 18 and 19 155 — 7 — 23 — 85 289 32 29 11 3 634 50 3 ? 16 303 26 14 5 9 428 205 7 3 25 101 592 58 43 16 12 1,062 20 to 24 1,156 1 145 25 168 8 496 1,339 243 203 106 50 3,940 152 1 14 4 2 2 22 679 64 58 13 9 1,020 1,308 2 159 29 170 10 518 2,018 307 261 119 59 4,960 25 to 29 989 1 209 15 147 3 289 1,180 169 140 118 57 3,317 103 — 6 — 1 — 12 276 36 20 6 1 461 1,092 1 215 15 148 3 301 1,456 205 160 124 58 3,778 30 and over 1,055 149 11 180 1 203 1,645 172 135 139 70 3,760 87 — 3 2 1 — 16 263 35 15 10 3 435 1,142 — 152 13 181 1 219 1,908 207 150 149 73 4,195 3,397 2 511 52 522 12 1,099 4,554 617 518 379 186 11,849 413 1 23 9 6 3 70 1,635 164 112 39 27 2,502 3,810 3 534 61 528 15 1,169 6,189 781 630 418 213 14,351 Other conditions 0 to 15 34 1 2 96 2 3 138 125 1 6 213 6 3 1 1 356 159 1 1 8 309 8 3 1 4 494 16 4 — 1 1 1 — 11 92 1 9 1 3 124 13 1 2 2 154 3 ?. 4 5 186 17 2 1 3 13 246 4 11 5 8 310 17 33 — 4 1 5 — 40 191 6 7 5 8 300 42 1 1 1 — 1 5 359 6 9 4 5 434 75 1 5 2 5 1 45 550 12 16 9 13 734 18 and 19 111 1 18 4 50 2 107 826 33 38 29 21 1,240 166 — 11 6 6 2 25 989 62 81 19 22 1,389 277 1 29 10 56 4 132 1,815 95 119 48 43 2,629 20 to 24 965 3 235 51 299 21 698 3,333 244 389 180 154 6,572 513 36 11 33 1 74 2,376 190 778 103 57 3,672 1,478 3 ?7i 6? 332 22 772 5,709 434 667 283 211 10,244 25 to 29 1,090 354 33 393 8 517 2,806 225 315 71 170 6,122 474 2 64 5 20 41 1,164 102 134 37 29 2,072 1,564 2 418 38 413 8 558 3,970 327 449 748 199 8,194 30 and over 1,548 4 255 30 448 11 395 6,088 350 406 263 219 10,017 565 16 3 23 9 70 1,724 112 153 42 35 2,752 2,113 4 271 33 471 20 465 7,812 462 559 305 254 12,769 3,785 9 867 120 1,196 42 1,770 13,432 861 1,164 689 578 24,513 1,898 3 130 26 84 13 223 6,979 481 660 210 154 10,861 5,683 12 997 146 1,280 55 1,993 20,411 1,342 1,824 899 732 35,374 *Analysis by birthplace. la West Indies (coloured persons), lb West Indies (white persons). 2a Africa (coloured persons). 2b Africa (white persons). 3a Asia (.coloured persons). 3b Asia (white persons). 4 Greece, Cyprus or Malta. 5 United Kingdom. 6 Eire. 7 Europe. 8 All other. 9 Not known. Total 51,267 Not classified 4,437 55,704 145 Already many national and local studies have provided confirmation of the increase in the incidence of the venereal diseases and offered statistical evidence from which valid conclusions may be drawn. The figures given in table (ii) add to the information available on these matters, but the purpose of this report is not so much to interpret them as to indicate what the Council is doing and hopes to do to combat venereal disease. It would be appropriate to mention here that all the statistical evidence should be treated with caution. It is well known, for example, that some persons who become infected repeatedly use different names and different clinics thereby creating an imbalance between 'new cases' and 'personsConversely, treatments by private practitioners and self medication conceal a volume of infection which it is difficult to assess, but which has been estimated as about a quarter of that dealt with in out-patient clinics. In addition, it should be remembered that available evidence suggests that the majority of immigrants are first infected after arrival in this country. Contact tracing—The following-up of persons to ensure completion of treatment and the tracing of those known or believed to be sources of infection is an activity which the Council shares with the hospital authorities. In this field specially-appointed Council welfare officers participate with almoners and other hospital and clinic staff in the work of contact tracing. In addition, the Council's officers endeavour to trace contacts referred by the medical services of the Armed Forces and from local health authorities outside London. An analysis of this work is given in table (iii). Table (ii)—Tracing of contacts of patients Analysis of work undertaken by Council's welfare officers 1958 1959 1960 1961 1962 Contacts referred by hospitals, medical services of the Armed Forces and by local health authorities 297 246 282 188 160 Insufficient information for following-up 191 102 91 33 11 Contacts brought to treatment 43 57 72 67 57 Contacts traced but not brought to treatment 3 7 13 15 4 Contacts not traced 60 80 106 73 88 In addition the female welfare omcers attended clinics at St. Paul s, St. Mary s, St. Thomas and London hospitals and at H.M. Prison, Holloway and followed-up persons defaulting in attendance at these clinics. A record of patients completing treatment and of defaulters has also been kept. Table (iii)—Number of patients completing treatment and of defaulters 1958 1959 1960 1961 1962 Syphilis—patients completing treatment— Males 631 579 526 572 507 Females 554 508 434 362 359 patients not completing treatment— Males 870 672 677 776 682 Females 292 336 431 390 389 Gonorrhoea—patients completing treatment— Males 5,237 4,941 5,700 7,800 5,398 Females 1,165 1,199 1,334 1,269 1,129 patients not completing treatment— Males 4,128 4,900 6,536 8,085 4,929 Females 1,161 1,312 1,485 1,550 1,237 It is accepted that the spread of venereal disease, particularly gonorrhoea, can be closely associated with prostitutes who, for obvious reasons, usually the possible curtailment of their activities, are reluctant to attend for treatment. It is because of this that the Council's welfare officers mainly concern themselves with tracing women contacts of men who have become infected. Special qualities are called for if success is to be achieved in this difficult work and at present four full-and one part-time women officers are employed; an experienced 146 male officer is available as required. One of the women officers works full-time from Holloway Prison while the remainder work in co-operation with the clinics at St. Mary's, St. Paul's, St. Thomas's, the Eastern, the London and the Royal Free hospitals. Having no statutory powers enabling them to compel contacts to attend for examination, the welfare officers must rely solely on a tactful approach, the establishment of confidence and an ability to prove to contacts that examination and, if necessary, treatment are essential. This can be a time-consuming and unrewarding task, often best approached by appealing to a client's self-interest in the maintenance of her health; any approach on moral and reformative grounds is unlikely to succeed. Whatever future advances may occur in the methods of treating venereal disease, its prevention and eventual eradication will depend, while immunisation is impracticable, upon the gradual reduction of the sources of infection and here health education has an important part to play. The role of health education—Health education for school children and for the students of further education establishments is a matter for the Council's Education Officer and his Chief Inspector in considering the revision of the Council's pamphlet on sex education in schools in order to bring it up to date in the light of modern conditions. There are also proposals to form a Standing Committee of teachers, doctors and others interested in health education, to consider ways in which schools could be helped to continue and to expand health education. The problem of venereal disease will be one of the first matters to be considered by this new Committee. An Advisory Panel on Health Education was set up in the Public Health department in 1954. The members are selected from senior medical and nursing staff at the central office and the nine health divisions and include a divisional administrative officer. The problem of health education in venereal diseases for adolescents is being carefully studied by the panel. The measures taken must be carefully planned if adverse reactions in parents, teachers or the children themselves are to be avoided. The subject itself must be introduced to children as part of a wider campaign of education in citizenship rather than as an isolated subject. There is at present a serious lack of suitable films, film strips, posters and leaflets designed as teaching aids for different age levels. Such material is needed for group discussions with staff, parents and young adults as well as for school children, but a film which is admirable for one group may be quite unsuitable for others. New and appropriate sites for the display of posters and leaflets, so that they reach a wider public, must be sought in consultation with medical officers of health of the metropolitan boroughs and the Home Counties and such consultations are already taking place. Health departments through their health education services can however play only a minor though important role in the prevention of the great moral problems of promiscuity, illegitimacy and venereal diseases. These great issues must be tackled nationally on a much broader front. 147 APPENDIX D STAFF OF THE PUBLIC HEALTH DEPARTMENT AT 31 DECEMBER, 1962 Medical Officer of Health and Principal School Medical Officer J. A. Scott Deputy Medical Officer of Health and Deputy Principal School Medical Officer A. B. Stewart Senior Principal Medical Officer M. MacGregor Administrative Officer D. J. B. Cooper Principal Medical Officers Maternity and child welfare Dorothy F. Egan School health G. D. Pirrie Epidemiology Ian Taylor Tuberculosis W. Hartston Mental health C. W. J. Ingham Staff medical examinations R. Cove-Smith Chief Dental Officer and Principal School Dental Officer W. Ritchie Young Chief Nursing Officer Evelyn Robinson Scientific Adviser S. G. Burgess Establishment Officer T. A. Wright Principal Clerks G. Berridge G. M. Howes Principal Clerk and Statistician C. W. Shaddick Officer-in-Charge, London Ambulance Service F. A. Richardson Chief Inspector J. C. Clancey Principal Social Worker (Health Services) Frances C. K. Gregson Principal Mental Welfare Officer Olive K. Bowtell Senior Officers of the Divisions Division Divisional Medical Officer Divisional Administrative Officer Divisional Nursing Officer 1. Bertha E. A. Sharpe T. A. Stone Joan A. Surr 2. H. L. Oldershaw N. A. Woodruff Esther A. Evans 3. W. G. Harding N. B. Chapman Margery D. Butler 4. S. King J. C. Minter Lilian E. Arrow 5. G. O. Mitchell E. L. Hannant Elizabeth J. Early ^ 6. F. R. Waldron L. M. Longhurst Margaret V. Naunton 7. Ann Mower White F. L. Clark Kathleen L. Sewell 8. W. H. S. Wallace D. E. Armstrong Bessie Thom 9. J. T. R Lewis R. E. Haymes Winifred M. Winch 148 APPENDIX E Statistics of the administrative work carried out by the Metropolitan Borough Councils in 1962. Borough DWELLINGS CLEARANCE AREAS Housing Act, 1957, Part III DWELLING HOUSES Inspections Repaired as a result of informal action Defects remedied after service of format notice Houses closed in pursuance of owners' undertaking Persons displaced Demolition Orders made Persons displaced Closing Orders made in lieu of Demolition Orders Persons displaced Closing Orders determined Closing Orders revoked and Demolition Orders made Houses demolished as a result of formal or informal procedure Persons displaced Rooms dosed Undertakings accepted Erected by Borough Council Erected by other persons Total number in the Borough Unfit houses Other houses Houses excluded from Clearance Orders (no longer unfit for human habitation—Section 24) Initial visits on complaint With a view to action under Part II of the Housing Act, 1957 Other reasons Re-inspections Underground rooms Other rooms Underground rooms Other rooms Demolished Persons displaced Demolished Persons displaced Public Health (London) Act, 1936 Housing Act, 1957 Number Persons displaced Number Persons displaced Number Persons displaced Number By owners By local authority By owners By local authority Division 1 Chelsea — 64 16,703 — — — — — 633 — 3,905 8,227 95 48 — — — — — — — — — — — — — — — — — — — — Fulham 24 54 34,268 24 34 — — 2 1,403 286 1,170 4,089 1,390 621 9 — 1 — — — — 3 7 5 — — — 1 3 — — — — — Hammersmith 11 29 28,040 52 295 38 † — 2,210 245 3,651 7,189 991 397 — 2 — — — — — 3 — 15 — — — 3 — 1 — — — — Kensington 40 98 41,353 — 224 — 14 — 2,396 1,313 7,341 25,577 593 283 6 6 2 — — 4 — 1 5 — — 10 27 91 9 — — 17 — — Division 2 Hampstead 11 140 24,364 — — — — — 704 14 14,657 8,883 641 105 — 20 2 — — — — — — 2 — 31 37 3 7 1 4 — — — Paddington 82 599 38,336 66 117 23 4 — 2,798 361 3,470 14,378 461 265 5 — — — — — — 1 — 95 — — — 60 25 10 — — — — St. Marylebone — 199 25,059 31 82 — — — 809 151 84 1,609 348 61 — 1 — — — 1 2 — — 9 — 1 3 — — — — 1 — — St. Pancras 395 50 29,774 19 83 — — — 2,730 180 2,540 10,256 1,110 1,124 13 25 2 Westminster, City of 204 140 28,215 2 7 — — — 621 256 3,190 6,809 238 4 — — — — — 1 5 — — 7 — — — 19 11 1 1 — — — Division 3 Finsbury 37 173 9,438 113 87 — — — 735 11 4,702 9,957 298 31 3 — — — — — — 2 — 11 — 6 — 3 2 — — — — — Holborn 21 25 5,973 — — — 89 47 1,759 866 74 11 — — — — — — — — — — 1 2 4 — — — — — — Islington 162 244 47,288 49 73 2 2 — 4,519 154 2,097 17,152 1,175 771 19 — — — — 2 4 11 160 83 — 20 — 21 60 8 32 2 — — Division 4 Hackney 369 186 42,664 — 485 — — — 2,248 298 980 16,322 107 1,411 27 — — — — — — 2 6 3 — 3 — 84 41 29 t — — — Shoreditch 230 19 12,200 — 6 — — — 1,382 307 5,560 4,357 678 68 — — — 37 72 1 2 1 5 — — 10 12 7 — 2 1 1 — — Stoke Newington 64 26 12,226 1,168 126 3,100 4,214 164 122 7 — — — — — — — — 4 — — — 4 — — — 7 — — Division 5 Bethnal Green 12 162 14,590 115 81 12 12 — 1,934 2,084 6,248 5,064 1,139 429 12 — — — — — — — — — — — — — — — — — — — City of London — — 1,021 — — — — 10 — 3 20 6 — — — — — — — — — — — — — — — — — — — — Poplar 56 697 18,150 29 113 — — — 1,546 462 2,985 6,754 949 315 — — — — — 9 39 — — — — 6 26 9 5 — — 3 1 — Stepney 258 512 26,004 4 10 — — — 5,466 252 3,092 4,585 119 1,050 90 — — — — 3 — 3 7 — — 5 7 9 — — — — — — 1 Division 6 Deptford 109 266 18,402 — — — — — 1,107 — 4,125 12,332 382 174 — — — — — — — — — — — — — — — — — — — — Greenwich 74 166 24,825 1,836 14 6,720 8,555 355 96 9 — — — — — — — — — — — — — — — — — — — Woolwich 392 304 45,460 66 459 14 43 — 974 156 8,472 5,430 599 — 215 — — — — — — 6 19 6 — 3 7 5 8 Division 7 Camberwell 238 442 44,874 24 203 — — — 4,574 121 24,382 11,696 475 1,449 2 6 — — — — — — — — — — — — — — — — — — Lewisham 191 513 65,758 2 — 1 — 1,956 12 15,149 14,105 396 264 18 5 — 1 — 1 — 1 — 10 — 3 4 — — 3 — — — — Division 8 Bermondsey 231 45 15,318 137 56 9 4 — 1,652 2 2,789 13,620 629 132 1 — — — — — — 1 4 — — — — 2 4 — — — — — Lambeth 305 310 72,939 46 66 34 81 — 2,010 23 10,018 9,209 751 727 81 3 — — — — — — — — — — — 1 2 — — — — — Southwark 148 187 25,167 30 131 2 t — 1,870 43 10,727 4,709 923 625 61 — — 1 5 4 13 1 — 1 — 32 47 5 7 11 6 23 17 — Division 9 Battersea 32 115 29,054 61 169 76 99 — 2,287 146 6,442 9,825 447 346 8 1 — — — — — 1 10 1 — 2 — 6 8 2 — — — — Wandsworth 316 589 120,921 27 28 22 7 — 5,103 17 17,163 16,871 833 279 8 — — — — 1 — 2 3 5 — 2 2 5 1 — — 1 — — LONDON 4,012 6,354 918,384 895 2,811 232 267 2 56,770 7,081 176,521 262,660 16,366 11,208 594 69 7 39 77 27 65 49 226 298 — 135 174 431 193 97 44 61 18 — tIncluded in the previous ' persons displaced' column. 149 APPENDIX E Borough DWELLING HOUSES Water supply to tenement houses P H (London) Act 1936 AIR POLLUTION CLEANSING AND DISINFECTION LICENSED OR REGISTERED PREMISES PUBLIC HEALTH INSPECTORS Housing Act 1961—Houses in multiple occupation Overcrowding abated Section 90, Housing Act 1957 Complaints Observations Intimation notices served Nuisance notices served Prosecutions Smoke Control Orders confirmed Adults cleansed Children cleansed Premises disinfected Premises disinfested Establishment Employed at end of year Assistants employed at end of year Licensed slaughterhouses Other offensive trades Common and Seamen's Lodging Houses Dairies and milk shops Ice cream premises Closing Orders substituted for Demolition Orders Management Orders made Neglect of proper standards of management made good Additional services or facilities provided Houses provided with means of escape from fire Directions made to reduce or remedy overcrowding At home At cleansing station Male Female Total Male Female Total Houses provided with supply Prosecutions Convictions Number Persons displaced Number Persons displaced Number Persons displaced By owners By local authority By owners By local authority By owners By local authority Number Persons displaced Number of houses Persons displaced Number Persons displaced Number of houses Persons displaced Number Persons displaced Number Persons displaced Number Persons displaced Division 1 Chelsea — — — — — — — — — — — — — — — — — — — — — — — 80 30 — — — 1 — 43 14 305 294 — — — 56 112 8 6 2 8 — — — Fulham — — — — 2 — — — 2 — — — — — — — 1 3 1 2 2 — — 37 81 — — — 1 — 31 1 41 380 — — — 124 226 14 11 — 11 3 — 3 Hammersmith — — — — — — — — — — — — — — — — — — — — 3 — — 58 29 5 — — 1 — 307 102 38 432 — — — 130 250 12 9 1 10 2 — 2 Kensington — 2 — — — — — — — — — — — — — — — — — 4 — — 47 24 — — — 1 13 160 158 191 530 — — — 202 382 19 15 — 15 2 — 2 Division 2 Hampstead — — 6 — — — — — 7 — — — — — — — 4 13 — — 7 — — 64 130 — — — 1 — 17 1 118 135 — — — 72$ 257 14 13 1 14 2 1 3 Paddington — — — — — — — — — — — — — — — — — — — — 9 — — 97 117 4 3 — — 69 74 54 47 619 — — — 144 211 17 14 — 14 2 — 2 St. Marylebone — — — — — — — — — — — — — — — — — — — — 21 — — 84 76 19 — — 1 — 809 200 54 236 — 1 2 72 220 15 10 3 13 2 — 2 St. Pancras — — — — — — — — — — — — — — — — — — — — — — — 68 80 7 — — 1 — 570 93 79 561 — — — 256 254 20 20 — 20 — — — Westminster, City of — — — — — — — — — — — — — — — — — — — — 1 — 54 584 — — — 4 — 470 2 180 313 — — 2 136 263 22 21 1 22 4 — 4 Division 3 Finsbury — — — — — — — — — — —— — — — — — — — 1 3 6 — — 38 505 2 — — 1 — 88 4 112 335 — — 1 133 154 10 10 — 10 2 — 2 Holborn — — — — — — — — — — — — — — — — — — — — — — — 31 178 1 — — 2 61 161 12 197 111 — 5 2 75 143 5 5 — 5 — — — Islington — — — — — — — — — — — — — — — — — — — — 4 1 1 57 263 34 — — 4 192 213 286 357 1,099 1 11 — 357 557 33 23 2 25 1 — 1 Division 4 Hackney — — — — — — — — — — — — — — — — — — — — — — — 66 142 14 1 1 2 — 88 46 463 348 — 5 1 215§ 454 20 18 — 18 3 — 3 Shoreditch — — — — — — — — — — — — — — — — — — — — — — — 6 134 10 — — — — 7 — 15 339 — 1 — 78 110 9 8 — 8 3 — 3 Stoke Newington 34 14 1 — — 2 — 17 5 16 59 — 1 — 50 106 7 7 — 7 — — — Division 5 Bethnal Green — — — — — — — — — — — — — — — — — — — — — — — 29 31 — — — 1 308 28 1 1 438 — 2 — 93 133 9 9 — 9 1 — 1 City of London — — — — — — — — — —— — — — — — — — — — — — — — 76 91 9 — — * — 1,067 — 2 16 — — 1 25 78 19 19 — 19 3 — 3 Poplar — — — — — — — — — — — — — — — — 1 52 1 52 — — — 54 61 1 — — 1 — 36 5 50 1,780 — 1 3 106 199 9 8 — 8 4 — 4 Stepney — — — — — — — — — — —— — — — —— — — — 6 19 4 — — 58 247 — 2 — 1 82 369 22 23 359 — 19 5 230 315 18 14 — 14 3 — 3 Division 6 Deptford — — — — — — — — — — — — — — — — — — — — — — — 12 504 — — — 1 908 665 48 75 338 — — 1 101 201 8 7 — 7 2 — 2 Greenwich — — — — — — — — — — — — — — — — — — — — — — — 21 85 — — — 2,019 1,372 53 58 1,313 — — — 112 239 10 9 1 10 2 — 2 Woolwich — — — — — — — — — — — — — — — — — — — — — — — 12 75 — — — 1 — 25 166 201 219 1 1 — 117 315 18 16 1 17 2 — 2 Division 7 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Camberwell 1 — — — — — — — — — — — — — — — — — — — — — — 74 255 — — 2 1 — 81 145 22 674 — 3 1 226 538 21 19 1 20 3 — 3 Lewisham — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 38 104 212 149 — — — 126 355 20 18 — 18 4 — 4 Division 8 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Bermondsey — — — — — — — — — — — — — — — — — — — — — — — 13 100 — — — 1 1 49 12 10 350 — 8 1 119 221 11 10 — 10 — — — Lambeth — — — — — — — — — — — — — — — — — — — — — — — 225 266 14 — — — 87 50 170 624 — 1 — 276 603 21 16 1 17 2 — 2 Southwark — — — — — — — — — — — — — — — — — — — — — — — 12 193 10 — — 1 — 702 426 50 1,684 — 2 6 145 304 20 13 1 14 4 — 4 Division 9 Battersea — — — — — — — — — — — — — — — — — — — — — — — 13 211 4 — 1 1 — 188 301 1,001 140 — 2 — 134 280 16 11 1 12 2 — 2 Wandsworth — — — — — — — — — — — — — — — — — — — — — — — 151 283 1 — — 1 — 46 7 218 234 — — — 325‡ 723 22 22 — 22 2 — 2 LONDON 1 — 9 — 2 — — 9 — — — — — — — 14 68 12 91 85 1 1 1,575 4,789 136 6 4 40 3,653 7,808 2,318 4,306 14,109 2 63 26 4,235 8,203 447 381 16 397 60 1 61 150 *The whole of the City of London is a Smokeless Zone under the City of London (Various Powers) Act, 1954. %One prosecution. §Two prosecutions. INDEX Page Accidents in the home 72,138 Acoustics 42 Adoption of children 51 Air pollution .. 15,41 Alcoholics, hostels for 77 Ambulance service 66 Ante-natal care 47, 72 ' At risk register 50,138 Audiology 141 Audiometry 93 Bathing centres 89 B.C.G. vaccination 25, 32 Births 3 Blind persons 35 Boarding out of children 51 Building programme 43 Cancer 10 Care committees 25,85 Care of mothers and young children 47 Child guidance 93 help 61 minders 48 protection 53 welfare 47 Children at risk 50,138 Chiropody 71 Civil defence 70 Cleansing scheme 89 Community care of the mentally ill and the sub-normal 77 Voluntary work 50 Co-ordinating committees, social services 49 Creches, occasional 48 Dangerous structures 34 Day centres for the mentally ill 76 nurseries 48 Deaf register 140 Deafness 137 Deaths 3,10,21,123 Dental auxiliaries 98 services 94 Diarrhoea and enteritis 16 Diphtheria 16,62 District nursing associations 59 Divisional medical officers' reports 103-117 statistical summary 118 Domiciliary midwifery 54 Drinking water 41 Dysentery 16 Educationally sub-normal pupils 92 Emergency Bed Service, maternity admissions 49 Employment of schoolchildren 90 Enteric fever 16 Environmental radioactivity 42 Exhibitions, health education 72 Expectant and nursing mothers 47 151 Page Families, prevention of break-up 48 Family planning 47 Family Service Units 48 Family Welfare Association 49 Fertility 4, 123 Finance 101 First aid competition 70 Food handlers100 Foot clinics 71 General Practitioner obstetricians 47 Guardianship of the mentally sub-normal 78 Handicapped pupils 92 Health education 71,147 surveys of pupils 89 visiting 58 Hearing aids 14 defects, in young children 137 Home help 61 nursing 59 safety 72 teaching of mentally ill 76 Hospital confinements, scheme for early discharge 49 Hospitals, admission of mentally ill 80 Hostel, for alcoholics for the mentally ill 75, 76, 77 Housing 34,125 Illegitimacy 3,6 Immunisation 62, 91 Improvement grants 34 Industrial training centres 75 Infant mortality 3, 12, 125 Infectious diseases 16, 23, 24, 90 Influenza 16 In-service training 69, 78 Invalid meals 37 Leptospirosis 16 Live births 3, 4, 5 London Ambulance Service 66 Lung cancer 11 Marriage guidance 53 Marriages 3 Maternal mortality 3, 14 Maternity and child welfare 47 dental service 98 Maternity beds, use on social grounds 49 Meals, children 87 invalid 37 Measles 16 Medical inspection of pupils 82 Medical treatment of pupils 91 Mental health services 75 statistics 78 Meritorious service medal 70 Metropolitan borough councils 149 Midwifery service 54 Midwives Act 57 INDEX—continued. Page Milk sampling 34 school 87 Moral welfare associations 7, 51 Morning and evening helps 61 Mortality 3, 10, 13, 123 Mother and baby homes 52 National welfare foods 48 Neo-natal mortality 3, 13 Night helps 61 Noise measurements 42 Nurseries, day 48 residential 51 Nursing home registration 37 Occasional creches 48 Ophthalmia neonatorum 16 Orthodontics 97 Perinatal mortality 3,13,55 Personal hygiene of pupils 88 Phenylketonuria 50 Physical condition of pupils 86 Poliomyelitis 16, 64 Population 3,4,119 Premature babies 13, 57 Premises 43 Problem families 48 Prophylaxis 62, 91 Psychiatric day hospitals 76 social clubs 76 Public health laboratory 34 Radioactivity 42 Recuperative holidays 71,77 Rehabilitation of the mentally ill 76 Rehousing 34 Residential accommodation for the mentally ill 75, 76 establishments for young children 51 Resuscitation certificates, award 70 River Thames 40 Safe driving awards 64 Safety in sewers 41 Samaritan service 78 Sanitary inspection 35 Page School care committees 85 dental service 94 health service 82 meals 7,87 medical inspections 82 treatment centres 91 Scientific branch 40 Sewage treatment 40 Slum clearance 34 Smallpox 18,63 Smoking and health 72,107 Social work in mental health service 77 Social services, co-ordinating committees 49 South East London General Practitioners' Centre 115 Spastic children units 75 Special care units 75 educational provisions 92 home helps 61 Speech therapy 93 Staff 99, 150 training 69, 78 Stillbirths 3, 4, 14, 55 Student health scheme 93 Swimming baths 42 Tetanus 62 Trade waste discharges 41 Training centres 75 Training, staff 69, 78 student health visitors 102 Tuberculosis 251 care committees 25 1 contact scheme 30 1 Unmarried mothers 7, 51 1 Vaccination 62, 91 Venereal disease 144 Vision tests 87 Visitors 102 Vital statistics 3, 4, 19, 20 Voluntary work 50 Water sampling 41 Weather 15, 22 Welfare Committee establishments 38 Welfare foods 48 Whooping cough 18,62 Woodberry Down health centre 1ll Yellow fever 64 Young children in care 51 References to local activities in the sphere of chiropody, health education, mental health education, home making courses, problem families, prophylaxis, etc., will be found in the divisional medical officers' reports, pages 103-117. 152 Printed for London County Council Supplies Department by Waterlow &. Sons Limited, (71733) 11/63 114538