Sou 79 London Borough of Southwark ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1969 CONTENTS PAGE INTRODUCTION 3 HEALTH COMMITTEE 5 STAFF 7 VITAL STATISTICS 14 PERSONAL HEALTH SERVICES 15 COMMUNITY CARE SERVICES 33 ENVIRONMENTAL HEALTH SERVICES 60 MISCELLANEOUS 96 SCHOOL HEALTH SERVICE 101 APPENDICES 111 INDEX 117 1 Health Department, Municipal Offices, Castle House, 2 Walworth Road, S.E.1. ToThe Mayor, Aldermen and Councillors, London Borough of Southwark. Ladies and Gentlemen, I have the honour of presenting my Annual Report on the Health Services of the London Borough of Southwark for the year 1969. 1969 was an eventful year during which time we had the satisfaction of seeing some of the efforts of our earlier year's planning and hard work reach fruition. At the initial stage of planning any project, it is often difficult to envisage the many set backs likely to be encountered along the line, despite the application of the many modern planning techniques now being used. The mental health complex on the Grange Tannery site was completed during the year. This was the largest capital investment project yet undertaken by the Health Committee, and it was found necessary from time to time to amend the original planning brief to meet the changing needs within the field of mental health. The Crispin House complex provides a training centre for mentally sub-normal adults, a day centre and hostel for elderly mentally infirm and a hostel for mentally sub-normal youths. With the likelihood of changes in the not too distant future within the local authority social services, it is hoped that the firm foundation laid by the local health authority within the sphere of the social services will be appreciated by those who will be appointed responsible for their future development. During the year I was able to report on the findings of the first year's work of the pilot health survey of the general public by means of a mobile health clinic, to which I briefly referred in my last year's Annual Report. (The survey is reported fully on pages 37—45 of the report). It is evident from the interest shown at home and overseas, following the publication of my report, that much more will be heard of this very important sphere of preventive medicine in the future. Under the Government's Urban Programme, the Council was successful in its application for additional infant welfare clinic facilities. Also within the Programme, a grant of £30,000 was made available for encouraging the setting up of playgroups within the Borough, and an additional £2,000 for the salary of a Playgroup Organiser. The proposals put forward in connection with the developments within the Borough were seen by the Home Office as a pioneer scheme indicating the extent to which a local health authority might develop a full range of voluntary effort within a community in the field of pre-school 3 playgroups. Towards the end of the year there existed a strong possibility that, following the interest shown within the various Government Departments with regard to our scheme, we would be invited some time in 1970 to participate in a research project in conjunction with the National Bureau for Co-operation in Child Care. The Health Department links with the hospital service continued to develop at all levels, and the part-time attachment of a Principal Medical Officer to the Newcomen Assessment Centre, reported in my last Annual Report, has been particularly successful and illustrates just how the two branches of the National Health Service can, and should, compliment each other. Finally, 1 should like to take this opportunity of thanking Members of the Health Committee and other Committees of the Council, and all the members of the staff for their continued support during the year. I am, Mr. Mayor, Aldermen and Councillors, Your Obedient Servant, J.E. EPSOM, Medical Officer of Health and Principal School Medical Officer 4 HEALTH COMMITTEE Chairman: Councillor Mrs. C.M. Clunn Vice Chairman: Councillor R. Richards Members: Alderman W.A. Miller Councillor R.A. Gent Councillor Mrs. P.C. Cooper Councillor M.P. Mulligan Councillor C.B. Cumming Councillor A.P. Pritchett, F.S.V.A., T.D. Councillor Mrs. E.S. Daymond Councillor A.E.Smith Councillor W.L. Ellis Councillor N.H. Tertis, Councillor C.A. Farrow F.Inst.Ch., S.R.Ch., F.R.S.H. Councillor Mrs. M.G. Farrow Ex-Offico: Councillor S.R. Combes Mayor of the London Borough of Southwark Councillor J.H. O'Grady Leader of the Council Councillor H.J. Grant Leader of the Opposition Co-opted Members: Mr. H.T. Ball Mrs. A.G. Liddle Mr. J.R. Thomas Alderman W.A. Miller was Vice-Chairman; Councillors Mrs. L. Brown and the Rev. J.W. Watson were Members, and Mr. J.F. Cullingham, Mr. H. Lamborn and Dr. J.B. Quinn were Co-opted Members of the Health Committee until 21 May 1969. Members of the Health Committee represented the Council on the following organisations: Bexley Hospital Management Committee Councillor R. Richards Bird-in-Bush Welfare Centre Councillors Mrs. P.C. Cooper and Voluntary Committee Mrs. E.S. Daymond Blackfriars Settlement Councillors N.H. Tertis and the Rev. J.W. Watson Board of Governors — Guy's Hospital Alderman A.J. Kemp King's College Hospital J.F. Cullingham Camberwell T.B. Care Committee Councillors Mrs. E.S. Daymond and M.P. Mulligan 5 Cane Hill Hospital Management Committee H.G. Lamborn Family Welfare Association (Area 7) Councillor Mrs. E.S. Daymond Friends of St. Giles Association Councillor R. Richards Greater London Home Safety Council Councillor N.H. Tertis London Boroughs Training Committee Councillor N.H. Tertis National Association for Maternal and Child Welfare Councillor R. Richards National Health Service Inner H.G. Lamborn (until 27.6.69) and London Executive Council Councillor R. Richards National Society for Clean Air Councillor C.B. Cumming, Mrs. E.S. Daymond and R.C. Gent National Society of Children's Nurseries Councillor Mrs. M.G. Farrow Salomon's Welfare Centre Voluntary Councillors Mrs. L.M. Brown and Committee Mrs. P.C. Cooper South London Family Service Unit Management Committee Alderman W.A. Miller Southwark and Bermondsey T.B. Care Councillors Mrs. L.M. Brown, C.B. Cumming, Committee Mrs. E.S. Daymond and L.C. Marshall Southwark Association for the Alderman W.A. Miller (until 21.5.69) and Handicapped Councillor R Richards South West Metropolitan Regional Hospital Board — London Liaison Committee Alderman.W.AMiller Standing Conference on Atmospheric Pollution Alderman W.A. Miller St. Giles' Centre Board of Trustees Alderman W.A. Miller 6 HEALTH DEPARTMENT STAFF AT 31 DECEMBER, 1969 Medical Officer of Health and Principal School Medical Officer J.E. Epsom, M.R.C.S.(Eng.), L.R.C.P.(Lon.), D.P.H., D.I.H. Deputy Medical Officer of Health H. James, L.R.C.P., L.R.C.S., L.R.F.P.S., D.P.H. Principal Medical Officers Eileen L. Power, M.B., B.Ch., B.AO., N.U.I., L.A.R, D.P.H. Suzanne Collett, L.R.C.P., L.R.C.S., L.R.F.P.S., D.P.H. (School Health) Aileen B. Ridout, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. (M. & C.W.) Senior Medical Officer Elsie L.M. Wallace, L.R.C.P.I. & L.M., L.R.C.S.I. & L.M., D.P.H. (Staff Occupational Health & Welfare) Assistant Senior Medical Officer Sybil R. Yeates, M.B., B.S., M.RC.S., L.R.C.P. Medical Officers—9 Sessional Medical Officers—(f.t.e.)—5.9 Director, South East London General Practitioners' Centre B.H. Pentney, M.R.C.S., L.RC.P. Chief Dental Officer and Principal School Dental Officer J. Cleary, B.D.S. Dental Officers: Full-time 3. Sessional—(f.t.e.)—4.3 Dental Surgery Assistants—10 Dental Auxiliary—1 Chief A dministrative Officer A.V. Tibbitt, D.M.A., Dip.Soc.(Lon.) Deputy Chief Administrative Officer J.A. Rozzier 7 Senior Administrative Officers C. Burgess, R.A. Davies, Mrs. A. Howell, J.A. Keane, H.D. White, E.J. Wicks Administrative and Clerical Staff Full-time—132; Part-time—(f.t.e.)—6.6 Health Education and Home Safety Officer E. Clark Chief Public Health Inspector Harold Archer, F.R.S.H., F.A.P.H.J. Deputy Chief Public Health Inspector W.A. Campbell, M.R.S.H., M.A.P.H.I. Public Health Inspectors Divisional 4 Housing 1 Deputy Divisional 4 Senior Wharves 1 District 19 Wharves 3 Senior Housing 1 Senior Smoke 1 Student Public Health Inspectors 12 Technical Assistants 20 Mortuary Superintendent 1 Chief Nursing Officer Mrs. E.E. Belcher, S.R.N., M.T.D., H.V:, Q.N. Deputy Chief Nursing Officer Miss J.E. Kedge, S.R.N., S.C.M., H.V. Senior Assistant Chief Nursing Officer 1 Senior Environmental Visitor 1 Assistant Chief Nursing Officers 4 Environmental Visitors 4 Centre Superintendents 9 Superintendents, Home Nursing 2 Health Visitors 37 Deputy Superintendents Home Nursing 1 T.B. Visitors 5 District Nurses55 Student Health Visitors 15 District Nurses (S.E.N.) 8 Clinic and School Nurses 40 Student Nurses 2 Clinic Auxiliaries—(f.t.e.) 9 Nursing Auxiliaries 5 Day Nursery Staff 103 8 Chief Social Worker (Health Services) Mrs. S. Hutchings, C.S.W. Deputy Chief Social Worker (Health Services) Mrs. M.M Hill, B.Sc., A.R.M.S.W. Social Workers 6 Family Case Workers 3 Welfare Officers (Chest Clinic) 2 Chief Mental Welfare Officer Deputy Chief Mental Welfare Officer Mrs. M. Day, S.R.N., M.S.M.W.O. P. Symonds, C.S.W., M.S.M.W.O. Mental Welfare Officers Senior Occupational Therapists Part time— 15: Part time—f.t.e.— 1 Full time— 1 Joint appointment with hospitals—5 Joint appointment with St. Olave's Hospital-1 Mental Health Escort—1 Junior Training Schools Adult Training Centre Head Teachers—2 Teachers—8 Supervisors—4 Deputy Supervisors—Nil Assistant Supervisors—7 Special Care Unit Day Centres Supervisor—1 Supervisors—3 Deputy Supervisors—2 Assistant Supervisor—1 Assistant Supervisors—5 Hostels Wardens—3 Deputy Wardens—3 Assistant Wardens—1 Chief Chiropodist Chiropodists E.F. Part, M.Ch.S., S.R.Ch. Full time—5 Sessional—f.t.e.—2.0 Chief Home Help Organiser Mrs. L. Nepean Gubbins, M.R.S.H. Home Help Organisers—3: Assistant Home Help Organisers—6 Home Helps-570-f.Le.-380 Manual and Domestic Staff Staff of various categories-f.t.e.-128 9 CLASSIFICATION OF DEATHS Deaths at the subjoined ages of residents whether occurring in or beyond the District CAUSES OF DEATH Total All ages Under 4 weeks 4 weeks & under 1 year M F M F M F Enteritis and other diarrhoeal diseases 3 2 _ _ _ 1 Tuberculosis of respiratory system 9 4 _ _ _ _ Other Tuberculosis inc. late effects 7 1 _ _ _ _ Meningococcal infection 2 1 _ _ 1 _ Syphilis and its sequelae 1 5 _ _ _ _ Other infective and parasitic diseases 1 1 _ _ _ _ Malignant Neoplasm, buccal cavity etc. 5 6 _ _ _ _ _ Malignant Neoplasm, oesophagus 8 10 _ _ _ _ Malignant Neoplasm, stomach 51 34 _ _ _ _ Malignant Neoplasm, intestine 43 50 _ _ _ _ Malignant Neoplasm, larynx 8 1 _ _ _ _ Malignant Neoplasm, lung, bronchus 209 46 _ _ _ _ Malignant Neoplasm, breast _ 69 _ _ - _ _ Malignant Neoplasm, uterus _ 18 _ _ _ _ Malignant Neoplasm, prostate 25 _ _ _ _ _ Leukaemia 8 11 _ _ _ _ Other Malignant Neoplasms, etc. 77 103 _ _ 1 _ Benign and unspecified Neoplasms 4 7 _ _ _ _ Diabetes Mellitus 13. 20 _ _ _ _ Avitaminoses, etc. _ 2 _ _ _ _ Other endocrine etc. diseases 4 6 _ _ _ _ Anaemias 3 11 _ -_ _ _ Other diseases of blood, etc 1 3 _ -_ _ c _ Mental disorders 3 5 _ _ _ _ Meningitis 2 1 _ 1 1 _ Other diseases of nervous system, etc. 18 21 _ _ _ 2 Chronic Rheumatic heart disease 19 42 _ _ _ _ Hypertensive disease 23 39 _ _ _ _ Eschaemic Heart disease 432 296 _ _ _ _ Other forms of heart disease 57 92 _ _ _ _ Cerebrovascular disease 119 248 _ _ _ _ _ Other diseases of circulatory system 72 85 _ _ _ _ Influenza 11 12 _ _ 1 _ 10 WITH AGE DISTRIBUTION, 1969 AGE IN YEARS 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 & over M F M F M F M F M F M F M F M F M F 3 _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ _ _ _ _ _ _ _ 1 _ 2 1 1 _ 1 _ 3 1 1 2 _ _ _ _ 1 _ 1 _ _ _ 1 _ 3 _ 1 1 _ _ _ _ 1 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 1 _ 1 _ 3 _ _ 1 _ _ _ _ _ _ _ _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ _ _ 1 2 1 1 _ 2 3 _ _ _ _ _ _ _ _ _ _ _ 1 3 3 3 1 2 5 _ _ _ _ _ _ 1 1 1 _ 8 1 12 5 19 10 10 17 _ _ _ _ _ _ 1 _- 1 1 7 3 12 6 14 11 8 29 _ _ _ _ _ _ _ _ _ _ 1 _ _ _ 4 1 3 _ _ _ _ _ _ _ _ 1 4 _ 18 10 76 10 69 15 42 10 _ _ _ _ _ _ _ 1 _ 4 _ 13 _ 17 _ 14 _ 20 _ _ _ _ _ _ _ _ _ 3 _ 3 _ 6 _ 3 _ 3 _ _ _ _ _ _ _ _ - _ _ _ 4 _ 12 _ 8 — — _ 2 _ 1 _ _ 1 1 _ 1 1 1 1 1 5 1 3 1 _ _ 1 _ _ _ 1 2 4 10 12 27 26 20 21 16 38 _ _ _ _ _ _ -_ 2 _ 2 1 — 3 2 _ 1 _ _ _ _ _ _ _ 1 _ _ _ _ 1 2 3 6 6 4 10 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 _ _ 2 _ 1 _ _ _ _ _ _ _ _ 1 1 2 _ 3 _ _ _ 1 _ _ _ _ _ 1 _ _ 1 1 1 1 1 7 _ _ _ _ _ 1 _ — _ _ 1 _ _ 1 _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 1 1 4 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ 1 _ 1 _ 1 _ _ _ 1 _ 1 4 3 1 4 3 6 11 _ _ _ _ 1 _ 1 2 3 4 1 4 3 12 6 11 4 9 __ _ _ _ _ _ _ _ _ _ 3 1 2 4 4 7 14 27 _ _ _ _ 1 _ 1 _ 11 4 36 12 123 28 151 86 107 166 1 _ _ _ _ _ 1 _ — _ 2 3 7 3 16 12 30 74 _ _ _ _ 1 1 1 _ 2 4 7 11 26 20 35 61 47 151 _ _ _ _ _ 1 1 1 1 _ 7 1 21 6 18 22 24 54 _ _ _ _ _ _ _ 1 _ _ _ 1 .3 1 4 7 3 2 Continued overleaf 11 CLASSIFICATION OF DEATHS CAUSES OF DEATH Total All ages Under 4 weeks 4 weeks & under 1 year W F M F M F Pneumonia 161 198 2 _ 3 4 Bronchitis and Emphysema 218 60 _ _ _ _ Asthma 3 5 _ _ _ _ Other diseases of respiratory system 20 41 _ _ 6 6 Peptic ulcer 18 13 _ _ _ _ Appendicitis - 2 _ _ _ _ Intestinal obstruction and Hernia 7 10 _ _ _ _ Cirrhosis of liver 2 4 _ _ _ _ Other diseases of digestive system 9 31 _ _ _ _ Nephritis and Nephrosis 11 7 _ _ _ _ Hyperplasia of prostate 7 _ _ _ _ _ Other diseases, genito-urinary system 5 26 _ _ _ _ Abortion _ 1 _ _ _ _ Other complications of pregnancy, etc. _ 1 _ _ _ _ Diseases of the musculoskeletal system 1 11 _ _ _ _ Congenital anomalies 16 12 3 2 2 2 Birth injury, difficult labour, etc. 19 8 19 8 _ _ Other causes of perinatal mortality 2 1 2 1 _ _ Symptoms and ill-defined conditions 1 10 _ _ _ _ Motor vehicle accidents. 15 9 _ _ _ _ All other accidents 22 24 _ _ _ _ Suicide and self-inflicted injuries 27 17 _ _ _ _ All other external causes 13 3 _ _ _ _ TOTAL ALL CAUSES 1,815 1,746 27 12 15 15 12 WITH AGE DISTRIBUTION, 1969 AGE IN YEARS 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 & Over M F M F M F M F M F M F M F M F M F 4 1 _ _ _ _ 1 _ 1 1 6 3 12 10 42 29 90 150 _ 1 _ _ _ _ _ _ 1 _ 15 2 51 6 75 71 76 30 _ _ 1 _ _ _ _ _ _ _ 1 1 _ 2 _ 1 _ 1 _ 1 _ _ _ _ _ _ _ _ 1 2 4 2 4 7 5 23 _ _ _ _ _ _ _ _ _ _ 2 _ 3 4 7 2 6 7 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ _ _ 1 _ _ _ _ _ _ 1 _ 1 _ 2 _ 3 9 _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 2 _ 2 _ _ _ _ _ _ _ _ _ 1 _ 1 2 5 2 5 4 19 _ _ _ _ _ _ 1 _ 2 _ 2 _ 1 _ _ 3 5 4 _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 _ 5 _ _ _ _ _ _ _ _ _ _ _ _ _ _ 8 1 7 4 11 _ _ _ _ _ _ _ _ _ _ 1 _ _ _ _ _ _ _ _ _ _ _ _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 _ _ _ 3 1 1 _ 5 2 _ 3 _ _ _ _ 1 _ 1 1 _ 2 3 1 3 2 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 _ _ 1 8 _- _ 1 2 5 _ _ _ _ _ 1 _ 3 2 _ 3 5 2 3 _ _ _ 4 1 2 _ 2 1 4 _ 4 1 2 3 1 18 _ _ _ _ 4 _ 5 _ 2 1 4 5 6 4 6 4 _ 3 _ _ _ _ 1 _ _ _ 3 _ 2 1 2 _ 2 2 3 _ 16 3 7 7 21 5 19 13 40 37 148 99 426 211 544 401 548 943 13 VITAL STATISTICS, 1969 Area of Borough (including area covered by water) 7,115 acres Population (Registrar General's estimate mid-1969) 290,530 Number of inhabited houses 90,116 Rateable value (April, 1969) £19,093,746 Sum represented by a penny rate £73,750 Births Total Legitimate Illegitimate Live Births-Male 2,230 1,934 296- —Female 2,216 1,922 294 4,446 3,856 590 Still Births—Male 33 31 2 —Female _ 21 16 5 54 47' 7 Birth rate per 1,000 population 15.3 Number of deaths—all ages 3,561 Death rate per 1,000 population 12.3 Infantile Mortality Deaths under 1 year 69 Infant deaths per 1,000 live births 16 Maternal Mortality Deaths of women from diseases or accidents associated with childbirth, including abortion 2 Maternal death rate per 1,000 total births 0.45 Deaths from pulmonary tuberculosis 13 Death rate per 1,000 population .04 Deaths from cancer of lung and bronchus 255 Death rate per 1,000 population 0.91 Deaths from all forms of cancer 782 Death rate per 1,000 population 2.69 VITAL STATISTICS-Greater London Area and England and Wales Greater England London and Area Wales Live births per 1,000 population 15.7 16.3 Deaths per 1,000 population 11.5 11.9 Infantile mortality (deaths under 1 year) per 1,000 live births 17. 18 Maternal mortality per 1,000 total births 0.20 0.19 14- PERSONAL HEALTH SERVICES Urban Programme In February the Joint Circular from the Home Office, Department of Education and Science and Department of Health and Social Security introduced the second phase of the Government's Urban Programme making available a further £2 million for expenditure on education, housing, health and welfare, in areas of special social need. Under the Programme grant is payable through the Local Government Grants (Social Needs) Act, 1969, towards approved projects at the rate of 75%. Of the projects submitted by this Borough, the Government gave its approval to (1) the provision of infant welfare clinic facilities in the Dog Kennel Hill area (2) financial assistance, up to a total of £30,000 to aid the formation of twenty new non profit making play groups and (3) the appointment of a Playgroup Organiser whose task was to stimulate public interest in playgroups, to encourage their formation, and to maintain standards by inspection and advice. It was later ascertained that the funds allocated to the formation of new groups might also be used to assist existing ones to expand and in extreme cases to assist groups who might otherwise close because of financial difficulties. Arrangements were then made for financial help to be given under Section 65 of the Health Services and Public Health Act, 1968, and applications were encouraged from both existing and future playgroups. Surveys During the year an estimate of the day care needs of pre-school children was prepared in response to an enquiry by the Department of Health and Social Security. The existing arrangements, including day nurseries, creches, playgroups, nursery schools and classes and child-minders provide places for approximately 3,450 children. However, the unmet need, based on a 10% sample of five areas of the Borough, appeared to affect 6,000 children. Proposals for satisfying this demand by expanding the existing services over the next ten years were put forward. The special problems of increasing numbers of children living in tall blocks of fiats, of those living in overcrowded and unsatisfactory housing and of the growing immigrants child population was noted. The Department also participated in a survey of the use made of the Health Service by Commonwealth immigrants and co-operated in initial arrangements for the Southwark Community Project and the Social Action and Community Development Project. Maternity and Child Health Each of the Council's 17 health services centres provided some or all of the following services throughout the year: ante-natal, post-natal, child health, prophylaxis, creche, health education, dental care of expectant and nursing mothers and children under 5 years of age. Similar facilities were provided at two centres run by voluntary committees with grant aid from the Council. In addition, mothercraft classes were conducted by health visitors in some centres in which instruction was provided in 15 . home-making, budgeting, simple cookery and so on. Health visitors also provided health education talks and gave advice on feeding difficulties and the general management of children. An English class for immigrant mothers was also started. Clinic medical officers are primarily concerned with developmental paediatrics and a section on the handicapped and observation register can be found elsewhere in this report. Medical officers and health visitors are assisted in their tasks by clinic nurses and clinic auxiliaries. The following table indicates the volume of work carried out in health services centres during 1969: Child Health Sessions Number of children attending in 1969, born in 1969 3,802 1968 4,005 1967 4,905 Total attendances 65,754 Total sessions held 2,626 There were also 87 child health sessions held at General Practitioner surgeries at which Council staff were present Ante and post-natal sessions First attendances 102 Total attendances 363 Total sessions held 82 Facilities provided for General Practitioner Obstetricians Sessions held in Council clinics 356 Day care of children under five The Council provides day nurseries and occasional creches under Section 22 of the National Health Service Act, 1946, and has a duty under the Nurseries and Child Minders Regulation Act, 1948 (as amended by the Health Services and Public Health Act, 1968) to register and supervise persons undertaking the daily minding of children and premises in which children are received for day care. Day Nurseries There are six day nurseries in the Borough and the demand for places is such that a system of priorities governing admission is in operation (APPENDIX A). Priority is given to those children whose mothers have to go out to work through economic necessity or are unable through ill-health to care adequately for their children, and to children whose home conditions are detrimental to their health and welfare. Charges are made according to the parents' ability to pay but only a nominal charge for meals is made in respect of certain groups of children who are admitted on a part-time basis. These groups include children with a hearing defect or speech retardation and children in need of hearing environment because their parents are deaf. In addition, 16 special units to accommodate severely sub-normal children are attached to three day nurseries. Certain other handicapped children are admitted free of charge on the recommendation of a case conference. Merryfield Day Nursery was approved by the Department of Health and Social Security for training students. Where children in the highest priority groups are unable to attend a Council day nursery, approval has been obtained for the Council to contribute towards the fees of a registered child-minder, private day nursery or playgroup, after taking into account parental means on the same basis used for determining charges at the Council's nurseries. Number of day nurseries at 31 December 1969 6 Number of places 341 Number of special unit places 30 Total attendances during 1969 70,072 Total attendances at special units during 1969 3,986 Occasional Creche Creches for the minding of young children while their mothers take part in centre activities, attend clinics, visit hospital or attend to shopping and other domestic duties, are provided at five of the Council's centres, at one voluntary centre and at one church hall. One additional creche was started in a Council centre during the year but another was closed and the accommodation made available to the Save the Children Fund to run a daily playgroup. The charge at the creches is three shillings per session, abatable in necessitous cases, although no charge is made when the parent attends hospital or a centre activity. Where two or more children from one family attend, the charge is one shilling and sixpence for the second and subsequent children. Number of sessions during 1969 1,109 Total attendances during 1969 17,578 Nurseries and Child Minders Regulation Act 1948 (As amended by the Health Services and Public Health Act, 1968). Under this Act the Council has a duty to keep registers — (i) of premises in their area, other than premises used wholly or mainly as private dwellings, where children are received to be looked after for the day or for a part or parts thereof of a duration, or an aggregate duration, of two hours or longer, or for any longer period not exceeding six days; (ii) of persons in their area who for reward receive into their homes children under the age of five to be looked after as aforesaid. The amendments introduced by Section 60 of the 1968 Act considerably extend the coverage of the Act by including within the requirement to register anyone who minds children to whom she is not related for reward for at least two hours a c ay. The Act gives 17 clearer definitions of fitness of persons and premises and widens the power of local authorities to impose requirements and at the same time increases the penalties for failure to register. A considerable volume of work has fallen on visiting officers and administrative staff as a result of the extension of registration to persons receiving less than three children. This work has further increased because playgroups, which fall within the definition of premises to be registered, have increased in number so that at the end of the year 36 were open within the Borough. Registration of Premises Persons proposing to open a day nursery or playgroup are visited by a senior medical officer and a senior nursing officer who inspect the premises concerned and outline the requirements the Council would be likely to impose if registration were recommended- Applicants are also-advised-on staffing and-equipment and are notified of the need to obtain planning permission and instructions on fire precautions. At the end of the year 27 statutorily registered private nurseries and playgroups were providing places for 619 children. Child Minders As for premises above, visits of inspection are carried out by a senior medical officer and a senior nursing officer to persons who are required to register as childminders. These visits are essential not only for inspection purposes but to advise and assist the child-minder in the care of the young children under her charge. At the end of the year 102 statutorily registered child-minders were providing places for 200 children. Voluntary Child-Minders Scheme Because of the extension of the requirement to register introduced by the 1968 Act the scheme for the voluntary registration of people minding less than three children ceased, since its object of spreading supervision can now be achieved under the new Act. 18 TOTAL NUMBER OF BIRTHS-LONDON BOROUGH OF SOUTHWARK Live Births Hospital confinements 4,032 Domiciliary confinements 414 4,446 Still Births Hospital confinements 53 Domiciliary confinements 1 54 Deaths of infants in first week of life 36 Deaths of infants one week to one month 3 Deaths of infants one month to on year 30 Perinatal mortality per 1,000 total lives and stillbirths 20 Neonatal mortality per 1,000 live births 9 Infant mortality per 1,000 live births 16 DOMICILIARY MIDWIFERY SERVICE Administration of Analgesia 82.89% Cases with booked G.P. Obstetrician 97.34% No. of Midwives at end of year Full time 11 General Lying-in District 3 Doctor not booked Doctor present at delivery - Doctor not present at delivery 11 Doctor booked Doctor present at delivery 112 Doctor not present at delivery 292 No. of hospital deliveries attended by midwives on discharge before 10th day 577 5.78% of domiciliary live births were premature PREMATURITY AND MORTALITY BY BIRTH WEIGHT Deaths in 24 hours Survivors at 28 days Weight Live Prem. Births Proportion per 100 live prem. births No. Per 100 live prem. births No. Per 100 live prem. births 2 lb. 3 oz. or less 2 lb. 4 oz.—3 lb. 4 oz. 3 lb. 5 oz.—4 lb. 6 oz. 4 16.67 0 0 4 16.67 4 lb. 7 oz.—5 lb. 8 oz. 20 83.33 0 0 20 83.33 All cases 24 100.00 0 0 24 100.00 Domiciliary Midwifery To meet the needs of mothers wishing to have a home confinement 11 domiciliary midwives were employed by the Council; in addition three midwives from the General Lying-in Hospital covered a selected area in the Borough. The midwives visit the expectant mother to assess the suitability of the home for domiciliary confinement, or its suitability for the mother and baby to return home to the care of the midwife 48 hours after confinement in one of the local hospitals. This year 577 mothers were able to enjoy the facilities of the early discharge scheme. To supplement clinic attendance each mother booked for home confinement received at least three home visits so that the midwife could advise on the preparation of the home and ante-natal care. In two centres, classes in the psycho-prophylactic method of relaxation were held to which ante-natal mothers who had booked either for hospital or domiciliary confinement were invited. All midwives have attended a course of instruction to enable them to assist mothers in this form of relaxation during labour. As mentioned elsewhere in this report the Guthrie test for phenylketonuria was introduced during the latter part of the year. There were 415 domiciliary confinements during the year. Of these 24 were premature births; one was stillborn. Eight of the Council's midwives are approved teachers under the Central Midwives Board second period Training Scheme. During the year 28 pupils completed three months district training. Student Nurses from Guy's Hospital doing the obstetric training course also made visits of observation to an ante-natal clinic and accompanied the midwives on home visits. We have continued the joint arrangement with the London Boroughs of Lambeth and Wandsworth of providing two non-medical supervisors to co-ordinate, on a rota basis, a 24 hour control of the midwifery services throughout the three boroughs (APPENDIX C). Maternal Deaths Two deaths assigned to maternal causes or associated therewith were investigated on behalf of the Department of Health and Social Security during 1969. One of these was due to abortion. District Nursing Section 25 of the National Health Services Act, 1946, as amended, imposes a duty on local health authorities to make provision, either directly or through a voluntary body, for the attendance of nurses on patients who require nursing in their own homes or elsewhere. The district nursing service in Southwark is provided directly by the Council. This service is provided only on the recommendation of the patient's general practitioner with whom the nurse works in close co-operation (see also page 21 "Attachment of Staff to General Practitioner"). Nursing auxiliaries were employed to work under the direction of and to carry out duties not requiring the skills of a trained nurse. The psychiatric liaison scheme with St. Olave's Hospital and the geriatric liaison schemes with New Cross and St. Francis Hospitals continue. The success of this closer 20 co-operation is shown by the smoother passage for patients when transferring from hospital to community care. During the year two student nurses completed their training. Many student nurses from both the King's and Guy's groups of hospitals accompanied the district nurses on their visits The following table indicates the volume of work undertaken in the District Nursing Service during 1969: New patients visited 3,087 Total number of visits 137,893 Nursing staff employed at the end of the year(f.t.e.) 63 Visits per nurse (f.t.e.) 2,189 Health Visiting The health visitor in the United Kingdom has been defined by the Council for the Training of Health Visitors as a nurse with a post registration qualification who provides a continuing service to families and individuals in the community. The main aspects of her work are: (i) the prevention of ill-health; (ii) the early detection of handicap and ill-health and the surveillance of high risk groups; (iii) identification of need and mobilisation of the appropriate resources to meet the need; (iv) provision of care, including advice and guidance in the care and management of children and in cases of illness; (v) health education. The work of the health visitor in these fields, including that carried out in schemes of attachment to general practitioners, is described in the appropriate sections of this report. The part of the health visiting service which is measurable is shown in the following statistics for 1969: First visits to: Children born in 1969 4 904 Children born in 1968 6,131 Children born in 1964—1967 14,401 Total 25,436 Aged over 65 479 Mentally disordered 160 Persons discharged from hospitals (other than mental hospitals) 50 Infectious diseases 46 Total of all visits made by health visitors 90,998 Attachment of Staff to General Practitioners Further progress has been made in the attachment of nursing itaff to general practitioners. In addition to the existing attachment of three full-time health visitors and 21 the equivalent of four home nurses to two group practices, a further attachment of the equivalent of one and a half home nurses was made to another practice in September, 1969. Severe limitations on the extension of these schemes is imposed by the continuing shortage of qualified staff. Furthermore, before any such scheme can be started there is need for adequate initial discussions and careful consideration of such matters as the suitability of accommodation, selection of staff and the problems arising from the overlapping of practice areas with health visitors' geographical areas. Each health visitor makes follow-up visits to those patients who live in her district and who attend the practice. She also acts as liaison officer between the general practitioner and the health visitor concerned with those who live outside her district but within the borough boundaries. All health visitors keep in touch with general practitioners in their areas and there is continuing contact between general practitioners and the home nursing service. Wherever suitable, the opportunity is taken to increase liaison with general practitioners, particularly in group practices, in preparation for further attachment schemes when the staffing situation allows. Handicapped and Observation Register Work continued on the build-up of the handicapped and observation register, with increasing exchange of information between the Department, hospitals and general practitioners. The objects of the register are:— (i) to follow up those children who are "at risk" of developing a handicap because of genetic, pre-natal or post-natal history so that there is early warning of a handicap developing (ii) to ensure care and attention for the handicapped child and his family (iii) to obtain statistical information to help the Department with its routine work and to assist medical research. Notification of- these children is received from a- number of sources, including the birth notification, the discharge notice from the hospital or domiciliary midwife, the health visitor, hospital reports and general practitioners. The term "At Risk" is used normally to describe a baby whom the midwife, general practitioner, obstetrician or hospital consultant considers may acquire a handicap, mainly because of unusual circumstances pertaining prior to, at the time of, or soon after birth. These children are medically examined at six monthly intervals and are removed either on transfer to the handicapped section of the register, or completely if they can walk, talk and are otherwise developmentaly normal. The "at risk" section of the register contained the names of 3,691 children at 31 December, 1969. A handicapped child may be defined as one who suffers from any continuing disability of body, intellect or personality which is likely to interfere with his normal growth, development and capacity to learn. Some handicaps are recognisable at birth; for example, an obvious anatomical abnormality. Others, such as deafness, blindness, metabolic disorders etc., must be deliberately looked for and discovered as quickly as 22 possible. During 1969 the number of babies notified as congenitally malformed was 69. The number of handicapped children on the register at 31 December, 1969 was 643. (See also the report on the School Health Service.) We are particularly fortunate in Southwark to have a comprehensive assessment centre for multiple handicapped children at Guy's Hospital. This centre, which is known as the "Newcomen Clinic" has been designed to supplement existing services and is concerned with young children from the age of six months when the possibility of handicaps is usually first raised, and when there is a need to assess, advise and help families. It also deals with specific cases where specialist services and knowledge are required. Among cases which are dealt with are suspected visual and auditory defects, delayed or disordered development, gross physical handicap and obscure problems of assessment and management. Two additional sessions were started during the year and one of the existing sessions is now conducted by one of this Council's Principal Medical Officers. 50% of the cost of a specialist to run the other sessions is borne by. Southwark and a health visitor is provided for the necessary follow-up with children and families from Southwark. Special follow-up sessions are held at one or two of the child health centres where the Principal Medical Officer for maternity and child health services, who is in close touch with the work of the Newcomen Clinic, is able to see the children referred by the centre. If specialist medical advice is needed for any child seen under this follow-up scheme, an immediate appointment is made for further attention at the Newcomen Clinic. Impaired Hearing in Young Children Standard screening tests for the hearing of babies and young children were carried out by medical staff with special training in this work. Any child thought to have impaired hearing was referred, with the consent of the general practitioner, to the Council's otologist for further examination and added to the handicapped register. Young children with impaired hearing who required a hearing environment and children who failed to acquire speech because their parents were deaf or because of language difficulties in the home, were, on the recommendation of the otologist, permitted to attend day nurseries for three hour sessions without charge. Phenylketonuria Phenylketonuria is a rare inborn metabolic disorder in which a baby is born without one of the essential chemicals that help to break down food for digestion: this results in one of the ingredients of most foods building up to a high level in the body, which have a damaging effect on the brain. Screening tests for the detection of phenylketonuria using "Phenistix" reagent strips were carried out routinely on all young babies; those thought to be at special risk were retested. The procedure was changed in November when the Guthrie test was introduced. This involves the taking of a blood sample and is found to give greater accuracy in detection. 23 Prophylaxis Protection is offered in child health centres against diphtheria, whooping cough, tetanus, poliomyelitis, smallpox and measles to children below school age. Special sessions are also held in schools when necessary. In addition, B.C.G. vaccination against tuberculosis of children aged 12—13 years is carried out in schools. Vaccination may also be given by the family doctor and vaccines (except B.C.G. vaccine) are supplied to general practitioners free of charge. Little progress was made with the measles vaccination programme as in March 1969 the use of the vaccine was suspended by the Department of Health and Social Security. It was not until the end of the year that supplies of vaccine of a different strain were made available. Nevertheless, 1,047 children were vaccinated in Council clinics and 425 by general practitioners. 25 TABLE 1 VACCINATION AND IMMUNISATION STATISTICS FOR PERIOD 1 JANUARY to 31 DECEMBER 1969 Age 0—3 months 3—6 months 6—9 months 9—12 months 1 year 2—4 years. 5—15 years TOTAL 1969 1968 Smallpox: Primary 3 8 9 5 718 1,301 169 2,213 3,102 Re-vaccination – – – – – 27 160 187 879 Other Immunisation: Others Completed primary 1962— under TOTAL courses (born in) 1969 1967 1967 1966 1965 age 16 1969 1968 Triple DTP 1,290 1,776 143 73 76 8 3,366 4,127 Diphtheria/Pertussis – – – – – – – – Diphtheria/Tetanus 10 49 7 20 186 87 359 341 Diphtheria 1 – – – 1 3 5 2 Pertussis – – – – – – – – Tetanus – 3 — 1 7 10 21 87 Salk 1 1 1 – – – 3 4 Sabin 1,205 2,505 299 119 374 273 4,775 4,534 Measles 1 482 458 212 291 28 1,472 4,006 Reinforcing (booster) injections: Triple DTP – 975 1,137 144 276 30 2,562 3,117 Diphtheria/Pertussis – – – – – – – – Diphtheria/Tetanus – 48 57 31 2,119 335 2,590 2,360 Diphtheria – 1 – – 7 1 9 22 Pertussis – 2 – – – – 2 – Tetanus – – 3 8 25 78 114 229 Salk – 1 – – 1 – 2 — Sabin – 303 303 86 2,026 1,368 4,086 3,167 Measles – – – – – – – – Dental Services There were somewhat fewer M.& C.W. dental sessions than in 1968 but the number of fillings per session rose from 4.2 to 5.0 and more children under five had a dental inspection. Of those inspected 52% needed treatment compared to 60% the previous year. The demand for treatment by expectant and nursing mothers continued to fall, only 16 new patients requesting treatment during the year. For the first time in 5 years there were no patients requiring the supply of dentures in this group. Dental health education is an important factor in encouraging dental care for mothers and young children and this emphasis was maintained throughout the year in the active co-operation between the Borough Health Education and Home Safety Officer and the Dental Auxiliary who devoted an increasing proportion of time to this subject including visits to welfare centres and mothers clubs. The Guy's Dental School Mobile Clinic was in use in the Borough during the year and children attending the Kirkwood Junior Training School as well as some of those in the Special Units at three of the day nurseries were examined and treated. This was a particularly important advance in making dental treatment available to handicapped children without obliging them as in the past to make long journeys to hospital. The maintenance and possible expansion of this service in the Borough is most valuable and it is hoped that this form of co-operation with the hospital service will continue to develop. A total of 216 children attending the six day nurseries in the Borough were examined during the year. Of these, 25% needed some treatment compared with 39% in the previous year. The level of dental disease seen in these very young children illustrates the widespread prevalence of early dental decay. The formation of good tooth-cleaning habits from the earliest years is of the greatest importance. The visits of the dental auxiliary to day nurseries, giving talks and demonstrations on the subject of dental health education is a valuable help in achieving this aim. Excessive sweet eating is often a problem in this age group and any attempt to reduce the intake of sticky carbohydrates is, from the point of dental health, well worth while. 26 Maternity and Child Welfare Dental Service Children under 5 Expectant and Nursing Mothers 1969 1968 1969 1968 Inspections No. inspected 490 462 16 18 No. requiring treatment 255 279 16 18 Attendances First visits 264 289 18 25 Subsequent visits 438 527 23 41 TOTAL visits 684 816 41 66 Courses of treatment completed 157 151 3 12 Treatment Fillings 474 521 40 20 Extractions 140 118 5 17 General Anaesthetics 49 52 1 4 Other treatment 348 332 36 15 Dentures No. of patients supplied with dentures 5 No. of dentures supplied 6 No. of Sessions devoted to M.C. W. Service 1969 1968 Inspection and treatment 104 130 Dental Health Education 18 24 Total: 122 154 27 Fluoridation Fluoridation is the adjustment of the fluoride content of water to one part fluoride per million parts water. This is judged to be the most effective concentration for the prevention of tooth decay. No public health measure has had as much intense study devoted to it over the past 50 years. In June 1969 the World Health Organisation adopted a resolution calling for the implementation of water fluoridation throughout the world. This resolution was passed unanimously by member states of all shades of political opinion, having been sponsored by 37 countries including the United Kingdom which was responsible for putting the proposal before the assembly. It followed an extensive and prolonged world wide investigation into the safety of fluoridation and the most careful examinations have failed to discover any injury to health. The most important development in this country during 1969 was the publication of the Government report on the Studies and Results of 11 years of fluoridation. This had been carried out in four areas of the country and the results showed that the adjustment of fluoride in the public water supply to the approved proportion had a substantial effect in reducing dental decay among children, and was also of lasting benefit to their permanent teeth. It confirmed yet again that fluoridation was completely safe. The results of this survey were studied by specialists both medical and dental and their conclusions were unanimous and were summed up in the following words. "Fluoridation is entirely effective and completely safe". The fluoride content of London water is approximately 0.3 parts per million. The proposal to fluoridate the water supply would mean that this level would be adjusted from 0.3 to 1.0 parts per million. The effect of this would be greatly to reduce the amount of new dental disease seen in school children and young children under five. The saving in expenditure and time from a proposal of this nature would in the long term be considerable. Fluoride, it must be emphasised, is a natural substance and is present in nearly all food and water. The proposal which advocates of fluoridation are making, is not to add a new ingredient to the water supply but merely to increase the proportion of something which is already present. No other single action would be of greater benefit to children's dental health. Studies have shown also that fluoridated water may be of benefit to older persons even those who no longer have dental conditions to consider as fluoride has been shown to strengthen their bones. The Council in 1966 expressed its unqualified support for the proposal to fluoridate the water supply. The fact that no progress has been possible in London is due to the lack of unanimity among all London Boroughs which prevents the Water Authority from acting on the decision of the majority. It is to be hoped that in the near future either locally or nationally it may be possible that the implementation of this most desirable and effective public health measure will be brought about. Loan of Equipment Patients being nursed at home were able to obtain nursing equipment on loan free of charge either from the Council direct or from the British Red Cross Society acting as an agent for the Council. 28 The items on issue at 31 st December 1969 from the Council's stock were as follows (the figures in brackets show the number of items on loan at 31.12.68) Item On Loan Air rings 55 (63) Back rests 45 (59) Bed blocks 28 (25) Bed cradles 24 (35) Bed side rails 2 ( 3) Commodes 710 (680) Dunlopillo mattresses 24 (31) Easi-carri hoists 17 (23) Feeding cups 6 (14) Fracture boards 38 (38) Hospital beds 24 (28) Penryn hoists 59 (55) Quadruped walking aids 4 ( 4) Ripple beds 4 ( 7) Rubber bed pans 35 (51) Rubber toilet seats 2 ( 7) Tripod walking aids 7 (10) Urinal bottles 32 (35) Zimmer hoist 1 ( 1) Zimmer walking frames 55 (32) Fireguards were also supplied to families in need with children under 12 years of age and to necessitous elderly persons. At the end of the year there were 573 (701) on loan. Home Help Service The home help service continued to function throughout the year, but, in common with other services, only at the same level as last year due to financial stringency. Assistance was given to 4,646 households during the year, of which 4,018 were long term cases, and 9,662 visits were made by the organising staff. There was a slight increase in the number of requests for night help, and assistance for toxaemia of pregnancy and child help cases. The specially trained home helps worked with problem families for a total of 1,773 hours and 1,807 hours was given to morning and evening help cases. The fourth training course for home helps was organised, and a wider range of subjects was covered by the talks, including, at the request of the home helps one on mental health. This talk was given in one of. the Council's training centres and was followed by a tour of the premises. Resulting from this course of in-service training, ten 29 home helps were selected, for inclusion on the register of helps who attend problem families. The National Council of Home Help Services organised a competition in order to select a home help to represent Great Britain at the International Conference of Home Helps. A home help of twenty-one years standing from this Borough was among the six finalists, and represented Greater London at the Conference. The Chief Home Help Organiser gave talks not only at in-service training courses within the Borough, but also at courses arranged by the London Boroughs Training Committee for district nurses, hospital nurses, students in social work, etc. Talks were also given to members of the home help service in other authorities both in this country and on the Continent. During the year arrangements were made for students from various disciplines within the local authority framework to visit the home help offices and accompany the organisers on their visits in the district; this has been found to be most beneficial to the student and the local authority by provoking interest and knowledge of the services provided. SOCIAL WORK (HEALTH SERVICES) The Social Work Section (Health Services) is concerned with:— (a) social work arising out of school and hospital clinics and (b) intensive casework with families with multiple problems. The Social workers concerned with the School Health Service are jointly appointed by the Inner London Education Authority and the London Borough of Southwark, and have a responsibility for special investigation clinics, audiology clinics, selected eye clinics, and selected clinics at Guy's Hospital. At special investigation clinics, children are seen who suffer from enuresis, obesity and minor behaviour problems. The social workers make contact with the homes and work with the clinic doctor in dealing with the total family situation where this is appropriate. The work may be of a short or long term nature depending upon the problem and the needs of the family. At audiology clinics, the social worker is one of a team consisting of the otologist, school nurse and social worker. Close contact is maintained with the peripatetic teacher of the deaf and the staff of the schools for the deaf and partially hearing. The social workers. have continued to give support to the families of deaf children including these where the child is at Boarding school. At Guy's Hospital a full-time senior social worker continued to maintain close liaison and advised on all local authority services available for the school child and the handicapped pre-school child. The family caseworkers have been concerned with the family with multiple problems and their caseloads are purposely restricted in order that they may have the time to consider the needs of each individual member of the family and the interpersonal relationships which so often are the basis of the family's difficulties. The majority of the referrals come to the caseworkers from the Borough Co-ordinating Committee's case conferences. 30 During the year, members of the staff attended various conferences and day courses and student social workers from the London School of Economics and the School Care Committee Service, have been received in the Department for training. Arrangements were made with Chiswick Polytechnic for two students on the Certificate in Social Work course to undertake a fieldwork placement in the department with two of the family caseworkers as supervisors. The Chief Social Worker has lectured to Health Visitor Instructors on courses at Chiswick Polytechnic and to students on courses run by the London Boroughs Training Committee. Family caseworkers have also given talks to voluntary workers at settlements and schools. Two of the social workers attached to the section, work in the Borough Chest Clinics. CO-ORDINATION OF SOCIAL SERVICES The co-ordinating machinery in the Borough operates on two levels; Standing Committee and Case Conference. Matters requiring detailed examination are referred to ad hoc groups of nominated officers who report direct to the Standing Committee. The Standing Committee consists of:— Medical Officer of Health Chairman Children's Officer Vice-Chairman Chief Welfare Officer Housing Manager Town Clerk Divisional Officer (Education) District Officers, G.L.C. Housing Dept. Deputy Medical Officer of Health Co-opted Members Deputy Children's Officer Chief Social Worker (Health Services) Secretary This Committee meets on average every six weeks to consider matters which can be broadly classified as of a general and of a domestic nature, and policy concerning the social needs and well-being of the inhabitants of the Borough. Periodic reports were submitted to the Council's Social Services Co-ordinating Committee which consists of the Chairman of the Children's, Health, Housing and Welfare Committees. Case conferences were held on individual families at the requests of field-workers, and although demanding in time, are considered extremely valuable and are a means of: (a) disseminating information between a number of Social Workers involved with the same family and if possible avoiding the duplication of visits; (b) discussing future plans for any one family and to consider the introduction of an intensive family caseworker; and (c) bringing to the notice of senior officers of the Council conditions and situations which cannot be improved without changes in policy. At the bi-monthly rent arrears sub-committee, the situation of families facing court action is considered and where possible steps are taken to prevent eviction. 31 Co-operation with Hospitals and General Practitioners In order to effect close co-operation and liaison with hospital consultants and general practitioners, the following advisory committees exist to assist me on aspects of community health care in their particular field: Psychiatric Geriatric Chest Physicians Pathological General Practitioners Paediatric Obstetric and Gynaecological Venereal Disease Consultant Advisers A further committee under my chairmanship, the Community Health Service Liaison Committee of Southwark, is comprised of general practitioners and principal officers of the Health Department, whose task is to assess the value of requests from medical research groups and of health surveys and is also concerned with other health matters of a general nature affecting general practitioners and the community. Family Planning A family planning service in full implementation of the National Health Service (Family Planning) Act, 1967, continued to be provided on the following basis: (a) No charges are made for advice or examination in all cases (b) No charges are made for drugs and appliances supplied where a further pregnancy would be detrimental to health (c) Charges are made in other cases for drugs and appliances except in financially necessitous cases At the beginning of the year the service was provided through the agency of the Family Planning Association. However, in accordance with the decision to provide a direct service, the Council later assumed control of two of the clinics operating in Health Department premises. An additional session was started in one of these. In addition payment was continued to the Brook Advisory Centre on a per capita basis for unmarried persons over 16 years of age residential in Southwark. 32 COMMUNITY CARE SERVICES Recuperative Holidays Recuperative holidays are provided on medical recommendation under Section 22 and Section 28 of the National Health Service Act, 1946, for persons who, following a recent illness, are in need of rest, good food, and fresh air, but who do not require regular medical supervision or organised nursing care. The categories of patients eligible include: mothers with babies and young children; tuberculous persons; severely physically handicapped adults; old people; the chronic sick (following exacerbation of illness); other adults. Provision is made for schoolchildren under the Education Act, 1944. The majority of homes used are privately owned and offer varying standards of accommodation, hygiene and regulations. Acceptance of financial responsibility for recuperative holiday patients implies responsibility for their care and well-being and it is essential therefore that the establishments should be inspected before approval is given as a recuperative holiday home. The inspection and approval of recuperative holiday homes was carried out bv a medical officer from Southwark on behalf of nine other London boroughs. Daring the year 41 existing establishments were inspected and 15 new homes were added to the approved list. A total of 165 adults and 45 children under school age were sent on a recuperative holiday. Arrangements were made with the Inner London Education Authority on behalf of 176 schoolchildren. Advisory and Preventive Clinics for the Over-Sixties These clinics provide facilities for a general examination of elderly people, and tests are made for haemoglobin estimation, blood-pressure, urine, hearing and vision. No treatment is given but the results of the tests carried out are notified to the general practitioner concerned. Referrals are made for chest X-rays and, where appropriate, for chiropody and cervical cytology. Advice is also given on maintaining standards of health and hygiene and on benefits and aids available to them. The number of sessions held during the year was 125 and 398 persons attended. T.B. Care and After-Care — Adult Cases The Council has no hostel for tuberculous persons, but, by arrangement, uses the facilities provided by other London Boroughs or private homes or hostels run by voluntary organisations. At 1 January, 1969 there were 13 men boarded out; 4 were placed during the year, and 12 were still in care at 31 December, 1969. Medical Arrangements for Long Stay Immigrants In order to deal with some of the special problems arising from the arrival of a growing number of long term immigrants the Ministry of Health in 1965 made certain arrangements to ensure that they learned of the National Health Service and how it should be used, including registering on a list of a General Medical Practitioner in the area of intended residence and having a chest X-ray if necessary. A card, giving this 33 information in several languages is handed out to immigrants at sea and air ports of arrival, where medical inspectors or port medical officers ascertain destination addresses and notify the appropriate medical officers of health, so that follow-up visits can be made. These are carried out by health visitors or in the case of single male immigrants by a public health inspector.. During the year, 471 advice notes of arrivals were received and 258 "first" successful visits made. Nursing Homes There are two nursing homes in the Borough registered under the provisions of Part VI of the Public Health Act, 1936, and the Nursing Homes Act, 1963; neither is registered under the Abortion Act, 1967. A senior medical officer continued to visit and advise the matrons on aspects of health, hygiene, prevention of accidents and other matters. Blind and Partially Sighted During the year the Council's consultant ophthalmologist carried out examinations of blind and partially sighted persons under the provisions of Section 29 of the National Assistance Act, 1948. In addition B.D.8 certificates were received from hospitals and other local authorities. The figures for 1969 were as follows: Number of examinations arranged 190 Initial examinations 73 Pre-examinations 117 Number certified as blind 32 Number certified as partially sighted 153 Number found to be neither blind nor partially sighted 5 Blind certificates accepted from hospitals 27 Partially sighted certificates accepted from hospitals 23 Blind certificates accepted from other local authorities 6 Partially sighted certificates accepted from other local authorities Chiropody In view of the difficulty in recruiting chiropodists the Council agreed to a scheme to sponsor trainee chiropodists, and the establishment was amended to include three. In addition authority was given to alter the establishments of chiropodists to 1 chief, 8 full time senior chiropodists and 1 part time chiropodist (7 sessions). At 31 December 1969 the number of chiropodists employed was 1 chief, 5 senior and 6 sessional chiropodists (2.0 full time equivalent). The number of sessions held during the year was 3,460 and the attendances were as follows 34 Male Female Ages 0-14 5-14 15-64 65 + 15-64 65 + TOTAL Persons attending 3 33 138 816 438 3,168 4,596 Total attendances 4 120 939 4,159 1,689 17,258 24,169 Artificial Kidney Machines The first application for a patient's home to be adapted for the purpose of home dialysis was received by the Council from Dulwich Hospital in 1968. Towards the end of 1969 a second application was received, this time for a patient receiving treatment at Guy's Hospital. By the end of December, arrangements were in hand for the patient and her family to be moved from their Council home, rehoused in a nearby property with an additional bedroom and for that bedroom to be adapted for home dialysis purposes. The Mobile Health Clinic In my report for 1968 I gave a brief outline of the pilot health survey of the general public by means of a a mobile health clinic which had started operating on 18 November 1968. Now after one full year's work I am able to report more fully on the outcome of this experiment which is described in pages 37—45. It has been said in some quarters that health checks and screening techniques attract only those showing traits of neurosis. This is not our experience in Southwark since very few persons showed neurosis in this respect. People are genuinely interested in their health—the pamphlet delivered to their home and later the "chat" with the health visitor who calls, prepares the ground well. The main object is to catch diseases early and we all realise that finding a disease early has immense advantages. A recent World Health Organisation report states that present statistics indicate that more than 50% of all cancer patients could be cured if the disease were diagnosed in its earliest stages and if prompt and appropriate treatment were given.† Reading some publications giving views on the so called scientific criteria for screening and health checks, one can be completely steered away from doing simple practical things. Many clear thinking people concerned are saying that if these criteria are so why has there not been a campaign against the school health service-where regular routine examinations and tests have been carried out for over 50 years—or against the growth of occupational health services? Evaluating this and other comprehensive screening surveys where the importance of clinical history and examination have been realised and made the basis of investigation together with suitable technological aids, it would appear that in any community a substantial proportion of adult persons could be discovered who had some clinically † Early Detection of Cancer-Report of W.H.O. Expert Committee. W.H.O. Technical Report Series No.422 W.H.O. London: H.M.S.O. 1969. 35 recognised disorder which was unknown to them. I am of the opinion that a reasonable balance has to be struck in relation to the future of our work. This approach is based on the experience we have gained. Of course a whole host of minor disorders need not be searched for, but the substantial remainder have to be critically examined. Possibly a briefer but more incisive history; a shorter physical examination confining more care to the agreed hazard areas; are aspects which r ust be considered by the various Advisory Committees who helped to prepare the history and examination forms. When these procedures have been fully streamlined and assessed, we hope this work, together with any suitable newer advanced technological aids, will gradually be taken over by the general practitioner aided by the area health authorities and hospitals. We know he is a very busy man, but we feel that such an important part of medicine should be blended into his work, for which he ought to have the status and, to match it, the payment of a reasonable fee for the agreed examination and the keeping of appropriate records. I am sure there would be less shortage of general practitioners if this preventive element in general practice were introduced. It could galvanise the situation, bringing back the family doctor's rightful status and providing interesting and worthwhile work as part of his duties. Introduction The National Health Service Act, 1946 gave certain powers and duties to local health authorities, including the prevention of illness and the care and after-care of persons suffering from illness. Environmental health measures and vaccination and immnunisation have been largely responsible for the control and eradication of communicable diseases. However, the early detection and diagnosis of chronic illnesses has tended to be minimal due mainly to lack of adequate techniques. Local health authorities have helped pioneer early disease detection, particularly in the field of maternity and child welfare and in the school health service. Routine medical examinations are undertaken regularly from before birth to school-leaving age through the ante- and post-natal clinics, the child welfare service and regular school health examinations. It would be true to say that medical care is never far from the young mother and her children. The period of 16 years and over is one where, for the greater part of the population, no routine health checks are carried out—people visit their family doctor for treatment for an ailment, but very rarely has the General Practitioner the time to carry out a full medical check. In 1965 in Southwark "well-women" clinics were commenced. At these clinics a full gynaecological examination is carried out for women between the ages of 25 and 60; urine testing, blood-pressure readings and breast examinations are also carried out and cervical smears are taken. So far each year approximately one-third of women seen at "well-women" clinics were found to have some pathology. In 1967 it was decided to open advisory and preventive clinics for Southwark's over-60's age group, and since January 1968, three sessions each week have been held in various clinics in the Borough. These clinics have proved successful with the "senior citizens". 36 At mid-1969 the population of Southwark was approximately 295,000; it was estimated there were 65,000 children aged 16 and under, and 50,000 people aged 60 and over. This means approximately 180,000 were therefore between the ages of 16 and 60, or 60% of the population, who did not have the opportunity of a routine health check. As a logical extension of the introduction of "well-women" clinics, and advisory clinics for the over-60's, the Council decided to carry out a pilot health survey of the general public of the Borough aged between 16 and 60. However, before this decision was taken, much preparatory work was necessary. In 1965, following the formation of the new London Borough of Southwark, it was decided to set up advisory committees to assist in the formulation of health policies for this complex area, which comprised three former Metropolitan Boroughs and parts of two former London County Council Health Divisions and some dozen hospitals, including Guy's, the Maudsley and a large part of the catchment area of King's College Hospital. The Advisory Committees were composed of representatives of the local general practitioners and hospital consultants—the committees covered such fields as psychiatry, geriatrics, gynaecology, etc. In addition, advice was given by Professor Anderson, of King's College Hospital, and Professor Butterfield of Guy's Hospital. Informal talks were also held with the then Ministry of Health. It was decided that the best method of carrying out the survey was by means of a mobile clinic, and approval for this project was given under the Health Visitor and Social Work (Training) Act, 1962. The Survey The survey consists, for persons aged 16—60 years, of:— (1) A social history, normally taken by the health visitor before the patient's visit to the clinic, and a medical history, normally taken by the clinic nurse immediately prior to the medical examination. These histories are taken on special forms which were designed after full consultation with the Advisory Committees mentioned previously. (2) A series of tests — Haemoglobin estimation (under 80% was considered as a disability). Blood pressure Urine testing (Labstix) Vision (acuity 6/12 or less with or without glasses was considered a disability) Measurement of height and weight (more than 10% above or below ideal weight for sex, age and height according to standard tables was considered as a disability) For women over 25 there is a full gynaecological examination and a cervical smear. Arrangements have been made for all blood specimens and abnormal urine specimens to be tested at local hospitals; there is full co-operation with the hospitals in this matter. (3) A comprehensive general medical examination by the clinic doctor, and (4) X-ray of chest—attenders are referred to the frequent regular sessions of the South-East London Mass X-ray Service. 37 The purpose of these tests is to help identify those people who have health and social problems amenable to some form of treatment. It must be emphasised that no treatment is given at the clinic, but the results of all tests are notified to the general practitioner concerned. Patients are advised, where necessary, to visit their family doctor for the results of the examination. The Mobile Health Clinic The mobile health clinic is a specially fitted twenty-two foot production-line caravan built to Health Department specifications at a basic cost of £998. The caravan is fully equipped and comprises a reception/waiting room; a nurses' working area which includes a sink unit and wash-hand basin with water-heater and two changing/toilet cubicles for use by attenders; and a medical examination room for the doctor, which includes a wash-hand basin, examination couch, desk and storage facilities. Heating and hot water are provided by means of a calor gas system. Mobile Health Clinic Caravan Sketch of Lay-out The caravan is 22' long and 7'6" wide 38 The caravan is garaged each night and at weekends. It is towed by a Land Rover which is used for other departmental transport duties during the day. The driver and his assistant are responsible for internal and external cleaning and for the maintenance of electricity (battery), calor gas and water supplies. The Mobile Health Clinic is taken out of normal service for one week every three months so that servicing may be undertaken. The clinic is staffed by a medical officer (local general practitioners undertake some sessions), a clinic nurse and a clinic auxiliary. General administrative services are provided at the Health Department's main offices. The mobile health clinic visits each of the fifteen (infant welfare clinic) areas of the Borough in turn, and sites immediately convenient to the dwellings of those groups taking part are arranged approximately four weeks in advance. The clinic is based at each site usually for one week, during which 10 sessions are held. The Procedure An efficient procedure is essential in a scheme of this nature, and in order to achieve this aim and to reduce inconvenience to the attender to a minimum, an appointments system is in operation. Ten appointments are made for each session and male and female attenders are seen on separate days. It is very important that the appointment system is adhered to, because the main success of the project is that the clinic doctor has time in which to carry out a full medical examination. Following the distribution of leaflets to homes in the immediate area, the Health Visitor visits each home, gives further information if required, and books appointments on the spot. Appointments can be made also by ringing the Health Department head office, in which case the person is put in contact with the Health Visitor who is responsible for the appointments list. In view of the age group under survey, i.e. those of employable age, and the need to utilise fully the clinic by whole-time day operation, it was anticipated that the majority of those coming forward would be women. Consequently, four days in each week were reserved for female attenders and one day for male attenders. The sex distribution showed 80% female and 20% male attendances which accurately reflected the anticipated demand from the two groups. Attendance by Social Class It was particularly heartening to find that nearly 35% of attenders were from Social Classes IV and V. There is little doubt that the introduction of a Mobile Health Clinic for the screening survey has contributed to the high proportion of attendances from the lower socio-economic groups. Most other surveys elsewhere showed that persons in Groups IV and V were poor attenders. 39 Table 1. Attendance in Social Class Groups Social Class Social Class Definition Mobile Health Clinic Approximate Distribution in Southwark I Upper and professional classes Higher administrative and professional occupations and business directorships 37(1.2%) 1.6% II Intermediate between Social Classes I and III-Persons responsible for initiating policy; persons without this responsibility but with some responsibility over others 544(17.2%) 7.7% III Skilled workers -Skilled workers with a special name, special responsibility and adaptability 1,341 (42.4%) 52.6% IV Intermediate between Social Classes III and V-Semi-skilled or persons doing manual work requiring no great skill or training but who are doing it habitually and in a particular industry 584(18.5%) 21.9% V Unskilled workers 516(16.3%) 16.2% Unclassified Persons with occupations unknown; unemployed single women and widows 138(4.4%) 3,160(100.0%) 100.0% N.B. With the exception of those included as "Unclassified", all women were classed according to their husbands' occupation or, if this was not known, according to their own occupation. 40 The Results (See Tables 5, 6 and 7 Pages 44,45) The survey commenced on 18th November, 1968, and by the end of the first year 3,160 persons had attended the Mobile Health Clinic. During this time periodic reviews of administrative and clinical procedures were undertaken and improvements effected where necessary. Discounting gynaecological disorders, there were no significant differences in the incidence of illness between males and females, although there were differences in pattern. The incidence for all groups showed that only 120 men and 363 women out of the 3,160 were free from disability; the remaining 2,677 patients had one, or more, disability. Of those 2,677 it was ascertained that 875 were either receiving treatment for the disability presented or were suffering from a disability of a sufficiently minor nature not to warrant referral to their general practitioner. Nevertheless, 1,802 persons were referred to their family doctor for further investigation and possible treatment. Seven cases of pro-invasive cervical cancer, one active case of pulmonary tuberculosis and one confirmed case of carcinoma of the breast are included among the major disorders detected. Special Interim Surveys During the year two "special" surveys were undertaken within the programme. The first was a preliminary analysis of the results of the first 1,000 persons to attend, the main purpose of which was to identify emerging trends and to review administrative and clinical procedures. The second survey was carried out over an eight-day period at the end of September, 1969, following the receipt of a grant from Granada Television Ltd. A television film unit visited the clinic at a selected street; 172 persons attended for examination during this special survey period. The programme shown by Granada Television on 13th October, 1969, in its "World in Action" series, illustrated the whole sequence of events: the attendances and examinations at the clinic, referral to the general practitioners, and for the case of malignant disease, the hospital consultation, details of the operation, result and prognosis. Follow-up Survey In order to ascertain what proportion of patients actually received treatment, were placed under observation or were referred to a hospital or specialist by their General Practitioners, it was necessary for follow-up information to be obtained. This was a large and difficult exercise. No less than 115 Southwark General Practitioners were involved and it was necessary to cause a minimum of inconvenience to them and to consume as little as possible of their time. In most cases appointments were made for Medical Officers of the Health Department to visit the General Practitioners' surgeries to obtain the information and, in this connection, the co-operation of the General Practitioners was very much appreciated. For this survey a 25% sample of the total number of patients referred to their General Practitioners was followed-up; thus efforts were made to obtair information on 451 of the 1,802 patients referred to their own doctors. The results of th s work are given in Tables 2,3 and 4 (Page 42). 41 Finance The cost per person attending is very difficult to assess exactly, because of the multi-disciplinary staff used in part-time capacities, but below are given headings with approximate figures in each section of costing: — Approximate Estimate of Costs from November 1968 to November 1969 £ Transport, including capital repayment 1,745 Repairs and maintenance 88 Insurance 6 Mobile Health Clinic staff salaries 3,948 Estimated cost of administrative and clerical services, including salaries, provided at head office 2,720 Fuel (calor gas) 21 Furniture and fittings 21 Operational equipment 79 Medical requisites 230 Cleaning materials 5 Total 8,863 The average cost is, therefore, approximately £2.15s.0d., for each person attending. Private agencies running comprehensive health checks charge a £25—£30 fee. 42 Table 2. Attendance Results Total % Number of patients who attended G.P. as requested 405 89.8 Number of patients: no confirmation of attending G.P.; G.P. retired, ill health, holidays, patient moved away etc. 46 10.2 Total number of patients selected for follow-up survey 451 100.0 Table 3. Findings Total % Number of Mobile Health Clinic (MHC) findings already known to G.P. 442 53.4 Number of MHC findings not previously known to G.P. but confirmed by him/her 313 37.8 Number of MHC findings not confirmed by G.P. 73 8.8 Total number of MHC findings in respect of the survey patients 828 100.0 Table 4. Further Care Arrangements of Patients Total Arrangements % For observation by G.P. 147 30.0 For treatment by G.P. 236 48.2 For referral to hospital or specialist by G.P. 107 21.8 Total number of further care arrangements 490 100.0 43 Provisional Findings Reported to G.Ps 16-40 Years 41 Years + Totals % age of Patients M F M F Table 5 - Disability Groups Cardiovascular High Blood Pressure 33 60 45 199 337 10.6 Murmur (for observation and investigation by GP/Hospital) 3 34 5 40 82 2.5 Others, e.g. Pulse, Signs of Failure, etc. 2 11 5 18 36 1.1 Respiratory 0 54 23 62 149 4.7 Digestive Disorders 83 197 91 199 570 18.0 Orthopaedic Conditions 17 87 31 247 382 12.0 Eye Disorders Vision Defects 29 142 68 209 448 14.1 Eye Diseases 16 18 15 29 78 2.5 Teeth and Gums 51 145 42 125 363 11.5 Nose and Throat 21 29 10 18 78 2.5 Ear and Hearing 13 69 37 113 232 7.3 Gynaecological Disorders — 439 — 499 938 29.6 Genito-Urinary 12 3 3 21 39 1.3 Nervous Disorders Neurological 8 26 10 27 71 2.2 Psychiatric 14 297 15 190 516 16.3 Weight Disorders Overweight (10% and above ideal weight) 127 416 105 350 998 31.6 Underweight (10% and below ideal weight) 24 201 32 157 414 13.1 Varicose Veins 15 109 42 170 336 10.6 Tuberculosis — — — 1 1 .03 Miscellaneous Hernia 4 7 8 7 26 .8 Skin 25 97 26 71 219 6.9 Endocrine 1 14 — 17 32 1.0 Breast (including carcinoma) – 15 – 14 29 .9 Blood Abnormal Hb — 60 1 63 124 3.9 Abnormal Other — 3 1 4 .1 Urinary Abnormalities Protein 3 11 3 4 21 .7 Glucose 1 1 3 9 14 .4 Blood 3 22 2 10 37 1.2 Infection — 5 — 7 12 .4 Cervical Smear Suspicious of malignancy — 3 — 3 6 .2 Positive for malignancy - 3 4 7 .2 Totals 515 2,578 622 2,884 6,599 44 16—40 Years 41 Years + Totals % age of Patients M F M F Table 6 - Incidence of Illness Patients free from disability 77 265 43 98 483 15.3 Patients with single disability 126 497 81 223 927 29.3 Patients with multiple disability 136 691 165 758 1,750 55.4 Totals 339 1,453 289 1,079 3,160 100.0 Table 7 - Sex and age distribution of attenders 339 1,453 289 1,079 3,160 100.0 Cytological diagnosis of early uterine cancer—“Wett Women” Clinics At the clinics, a full gynaecological examination is carried out, urine tests are made and vaginal as well as cervical smears are taken. The results of all tests carried out are sent to the general practitioner concerned. A total of 1,807 women attended the 141 sessions held at the five clinics in the Borough and of these 1,240 women were found to have no abnormalities; 18 were found to have carcinoma of the cervix, 3 had some breast pathology and 546 had other gynaecological disorders which are summarised as follows:— Vaginal discharge Trichomonas Vaginitis 35 Monilia 12 Non-specific 33 Cervicitis 123 Vulvo-vaginitis (Atrophic) 5 Cervical erosion 146 Ectropion 12 Cervical polyp 34 Bartholin's cysts 1 Cystocoele and rectocoele 12 Urethral Caruncle 1 Urinary abnormalities 6 Fibroids 20 Ovarian cysts 2 Menstrual Irregularities 36 Thyroid enlargement 2 Haemorrhoids 2 Post Menopausal Bleeding 6 Dual Pathology 3 Hypertension 11 Inflammatory Nuclear Change 40 Senile (atrophic) changes 4 45 HEALTH EDUCATION & HOME SAFETY A Departmental Committee, comprising heads of each section of the Department, and a Working Party with representatives of Health Visitors, School and Home Nurses, Public Health Inspectors, Day Nursery Matrons, Dental Auxiliary and Play Group Organiser have met regularly throughout the year to decide general policies and activities. The following basic programme of projects was formulated: — January Smoking, Fire & Winter safety February, Dental & Personal Hygiene March Fire April, Care of feet Safety May, June Food Hygiene for Pre-school immunisation Baby July, Summer Health Summer August Leisure & Play accident Preparation for school risks September Scalds, Poisoning October to Winter family Fire & Winter safety December Health (including fireworks and Christmas accidents) This programme was supplemented throughout the year by such subjects as Infectious Diseases, Immunisation, Nutrition, Diet, Maternal and Child Health and also by various special campaigns, all of which were supported by publicity posters and leaflets issued to all health clinics, school treatment centres, area health offices, day nurseries, general practitioners and group practice attachments, official notice boards and also offices of other departments of the Council, including the Public Libraries. Several original posters and leaflets have been produced for local services such as the Mobile Health Clinic, Well Women's Clinic, Advisory and Preventive Clinics for "over sixties", and Family Planning clinics and articles on health and home safety have been written for the Council's "Civic News" magazine which has a circulation of approximately 200,000 copies. Visual aids e.g. films and film strips, projection apparatus, flannelgraphs, teaching charts and equipment were provided for display and talks for clinics, mothers' clubs, schools and various other groups. 46 Smoking Following a spate of evasive publicity that smoking was a wasteful expense and an untidy nuisance, the new Health Education Council embarked on a long term national campaign, reverting to an emphasis on the health risks of smoking. The Health Department co-operated fully with continuous local publicity and educational talks and films for adults and children. Health authorities face two formidable problems on this subject: firstly to interpret to the growing ranks of juvenile smokers the risks of serious illness or death in later years which to early teenagers may seem too remote to worry about, and secondly to impress upon adults their responsibilities, by persuasion and example, to encourage children to heed this advice. Venereal Disease There has been a tendency in the past to relegate publicity on the subject to obscure corners of public conveniences. The increase in this disease has resulted in a much more open attitude, and it was decided to design and print a large poster prominently displaying the addresses and times of local treatment clinics. These posters were exhibited throughout the borough on public notice boards and in all Council offices, and a wide distribution of leaflets was maintained throughout the year. Special attention has been given to the inclusion of venereal disease in talks and films on sex education for adult and adolescent groups. Dental Hygiene The Health Department and the School Dental Service of the Inner London Education Authority have co-operated closely in dental hygiene education for children. This subject remains one of the most important targets in health education and a number of projects were undertaken during the year. Through the kind co-operation of Colgate Palmolive Ltd., packs containing tooth paste, tooth brush and a beaker inscribed with the dental health rules in verse were distributed to young children in day nurseries and attending dental clinics. The Oral Hygiene Service also kindly gave permission for the illustration of their "Fuzzy Bunny" leaflets to be reproduced on a card as a painting competition with the best answer to the question "How do you keep your teeth clean?", which evoked an encouraging response. An excellent I.L.E.A. puppet theatre with dolls representing the "goodies and baddies" of the dental scene visit 39 infant schools, and was also featured in special sessions during the school summer holidays referred to later. Dental health education on more adult lines has also been undertaken continuously with-talks at senior schools and mothers' clubs, for there is a serious danger that if children are allowed to eat too many sweet sticky foods—often as a substitute for a cooked breakfast—all the efforts and expense devoted to the dental education of children may be nullified. 47 Child Minding This was the subject of another special campaign during the year, and was directed both to minders, as a warning of their obligations for registration and observance of the various requirements, and also to mothers to ensure that child minders having care of their children were properly registered. This publicity included another specially designed poster and leaflet. Home Safety Accidents in the home continue to impose upon the medical and nursing services a serious strain which, to some extent, must be regarded as potentially avoidable. Carelessness, ignorance and faulty manufacture of goods all contribute to accidents, and the need for sustained education in this field is a high priority which has been maintained by continuous publicity throughout the year on the numerous hazards which threaten all ages. The following information from the London Fire Brigade shows an increase in fire calls in the Borough compared with the previous year, although these figures do not indicate any degree of severity but an encouraging decrease in oil heater fires. 1968 1969 Fires in premises (excluding following) 1,571 2,120 Chimney and grass fires 202 233 Oil heater fires 50 39 During 1969 the Department of Health and Social Security drew attention to the increasing extent of hospital treatment which was becoming necessary to deal with cases of acute poisoning. The accidental drug overdose is only part of this situation; many cases occur through medicines or poisonous domestic substances being easily accessible to young children, and to toxic liquids stored in wrongly labelled bottles or in cabinets together with medicines. Poisonous plants also present a risk to the town child who is unfamiliar with their properties. Water safety In a communication to local authorities the Secretary of State expressed concern at the many hundreds of people drowned each year. Seventy five per cent of those fatalities occur in inland waters and this aspect is of particular significance in Southwark which is intersected by the Surrey Canal. A publicity campaign was maintained throughout the summer to warn both mothers and children of the danger of playing near the Canal and stressing the importance of learning to swim. The following table shows deaths of Southwark residents, registered up to the end of 1969, in which home or drowning accidents were either the primary or a contributory cause of death. 48 49 CAUSE Injuries from falls (or presumed falls) Carbon Monox = (Gas fumes) Asphyxia Fire fumes & other causes Drug poisoning Burns & Scalds Electrocu tion Drowning 1968 1969 1968 1969 1968 1969 1968 1969 1968 1969 1968 1969 1968 1969 Age Group 76 + Male 3 2 1 Female 7 11 1 2 66-75 Male 1 1 1 Female 3 1 1 1 1 51-65 Male 3 2 1 2 2 1 2 2 Female 1 1 1 36-50 Male 1 2 1 1 1 Female 1 26-35 Male 1 1 1 Female 1 17-25 Male 1 1 Female 1 11-16 Male Female 6-10 Male 1 Female 1 0- 5 Male 1. 1 1 2 1 1 Female 1 Age unknown 1 Totals Male 8 6 4 1 4 2 5 2 1 1 1 4 4 Female 13 14 1 1 1 1 1 1 2 1 1 Summer School Vacation The programmes arranged for children in past years during the August school holidays was repeated in 1969 and again proved extremely popular and successful. Previously, these have taken the form of a selection of films on health or safety interspersed with entertainment items shown at four of the health centres with a change of programme on each of the four weeks. This year, a special sub committee was formed to try to extend the scope of the educational content whilst avoiding direct formalised teaching. Quiz contests and home exercises on poster drawing, scrap books, etc. were organised and small prizes awarded. About 1,100 children attended these sessions. Mothers' Clubs Mothers' clubs are now operating at Health Centres in the borough, and a great deal of excellent work is contributed by Health Visitors to encourage young mothers to attend these meetings with their children. Programmes of talks, films and demonstrations are arranged, often with special items for the benefit of the children. Whilst fundamentally educational, the aim is to provide programmes of general interest in a social atmosphere which will encourage mothers to remain in close contact with the centre and the Health Visitor. In-service Training A two-day course was arranged in co-operation with the Health Education Council at the end of October, covering a wide range of problems under the title of "Health and Marriage". Members of the staffs of the Health, Welfare and Children's Departments attended the course and presented several interesting reports from the useful group discussions. A series of eight weekly training sessions for Home Helps was also arranged by the Chief Home Help Organiser between March and May. These courses included lectures by Health Visitors, District Nurses and Public Health Inspectors, designed to give a practical knowledge of fundamental food hygiene, diet and nutrition, accident prevention etc. Displays An open air display illustrating the functions of the Health Department was mounted at Belair, the Council's recreation ground at Dulwich, in connection with a summer festival in June. A large quantity of leaflets on health and safety was issued on this occasion and numerous interested enquiries were made by visitors, many of them young people. 50 Summary of activities: Leaflets and booklets issued 9,487 dozen Posters issued 6,617 Films (No. of screenings) 306 Projector equipment used 210 Talks: Adults Children (sessions) Maternal & Child Health 77 83 Housewifery 61 6 Venereal diseases, sex education, family planning, etc 44 83 Nutrition, food hygiene 14 4 Home safety 15 11 Dental hygiene 2 91 Smoking, drugs 38 Infectious diseases, immunisation 2 6 Environmental health, social services, etc 54 16 Totals 269 338 MENTAL HEALTH SERVICE Co-operation with all organisations concerned with mental health was fully maintained during the year. The Psychiatric Advisory Committee to the Medical Officer of Health met on three occasions. Matters discussed by the Committee, consisting of four consultants from hospitals with catchment areas in the Borough, included facilities in the community for the mentally subnormal, psychiatric hostel accommodation, provisions for seriously disturbed adolescents, clinic facilities for subnormal patients, the Council's Five-Year Plan for mental health establishments and the Grange Tannery Project mentioned later in this report. Close liaison between hospital and local health authority after care services also continued and five mental welfare officers were employed on a joint appointment basis with psychiatric hospitals in the area. Two council nurses with psychiatric training continued to work within the catchment area of St. Olave's Hospital. In conjunction with the hospital these nurses attended case conferences, learned the patients' needs and were able to visit the patients' homes and ensure that the prescribed treatment was carried out. There was further co-operation with the hospital service in the continued joint appointment of an occupational therapist who made home visits and gave instructions in a number of activities; limited payments may be made to patients able to undertake light industrial work in their own homes. 51 Joint arrangements between the London Boroughs of Southwark, Lambeth, and Wandsworth for dealing on a shared basis with calls and emergencies outside normal office hours continued most satisfactorily (see APPENDIX C). The male mental health escort employed by Southwark continued to assist other Boroughs on a payment basis and a total of 221 escort duties were undertaken by him. During the year, eight Medical Practitioners were approved by the Council under the Mental Health (Hospital and Guardianship) Regulations, 1960, for the purpose of Section 28 of the Mental Health Act, 1959. The Greater London Council continued to maintain the central index of mentally disordered pefsons. Southwark, together with other Inner London Boroughs, utilized the index and shared the cost of its maintenance. Departmental officers concerned with mental health attended appropriate conferences and meetings during the year. The Council continued its policy of encouraging mental welfare officers to become qualified; one mental welfare officer returned to duty during July having obtained the Certificate in Social Work and one commenced a one-year course in September. In addition, two mental welfare officers continued their period of secondment for the whole of the year. The students detailed below were seconded to the Department for supervised practical training and they stayed for various periods ranging from 2 weeks to 7 months at different times during the year: 1 Bedford College 4 Croydon Technical College 1 Hillcroft College 1 Keele University 3 London School of Economics (Social Administration) 6 North West Polytechnic 1 Regent Street Polytechnic Many visitors were welcomed from various parts of the British Isles and from abroad to see the different aspects of the mental health services and establishments. Some were short visits of inspection and others were longer and more detailed periods of observation. Included among the visitors were doctors, medical students, nurses and nursing students, social workers and students. In addition, talks about the mental health service were given by the Chief Mental Welfare Officer and some of her staff at schools in the Borough and to a variety of voluntary and statutory organisations. Grange Tannery A most important project in the field of mental health was completed during the year and brought into functional operation in June. This was the Grange Tannery project in the Bermondsey area of the Borough. The complex was officially opened on 8 October 1969, by the Rt. Hon. R. Mellish, P.C., M.P., K.S.G. Amongst those who attended the ceremony were the Worshipful the Mayor, The Mayoress, Mr. S. Silkin, M.P., Members of the Council, Chairmen of Health Committees from neighbouring Boroughs, Medical Officers of Health from other Inner London Boroughs, general practitioners, representatives from the Department of Health and Social Security, industrial firms who supply work to the Centres, and Mental Health Societies; and Council Chief Officers and other staff. 52 The area of the site, on which there had been a Tannery for over 200 years, was 1.36 acres. The only building remaining was a four-storey block constructed in 1941 the the structure of which, although damaged by fire and vandalism, was sound. The new development comprised three separate units or houses: Crispin House The remaining four-storey factory block was especially modified for use as a training centre for mentally subnormal adults. The Centre, known as Crispin House, can accommodate 180 trainees from about 16 years of age. The purpose of the centre is to stimulate social, manual and intellectual developments, training being organised into three groups to achieve this aim, namely: Education and general social integration Domestic science and its specific social problems Workshop training and its specific social problems One floor of the building has been allocated to each of these activities. The first floor workroom is equipped with light industrial machinery and tools; industrial firms supply the work for which they pay an agreed rate. The competitive urge is fostered not only to increase production but also to stimulate the team spirit. Trainees on the second floor attend Education Classes where they are given talks under the general heading of communication, independence, and social integration. The talks are illustrated with pictures, practical demonstrations and, where possible, visits to shops, cafes, municipal buildings and other suitable places of interest. Domestic science training is undertaken on the third floor. Here a demonstration flat is incorporated where trainees can be taught laundering, cleaning, cooking, serving meals and table manners. A room equipped with sewing machines is used for instruction in "make-do and mend", knitting and sewing. Whilst most of these are practical lessons, the "Three R's" are involved in shopping for the cookery class, the weighing of ingredients and dress-making, The mezzanine floor, which has been added to the orignal strueture, The mezzanine floor, which has been added to the original structure, incorporates the trainees' quiet and recreation room together with the medical room and staff room. The clerical and administrative staff for the group of buildings also have offices on this floor. The main entrance hall is at ground floor level. The lower ground floor houses the dining room which is large enough to accommodate all the trainees at one sitting. The dining room is served direct from the central kitchen by way of the servery counter. The kitchen serves both this dining room and the one used by the elderly mentally infirm in Evelyn Coyle House. Evelyn Coyle House Evelyn Coyle House incorporates a day centre and hostel for elderly mentally infirm persons. Both wings of the building are at lower ground floor level in common with Crispin House. Up to 40 persons can be employed on light work in the large workroom of the day centre. Some of those attending the day centre are temporarily 53 unable to reside in their own homes for various reasons and the short-stay hostel provides 12 single bed-sitting rooms for these people. Both those attending the day centre and those housed in the hostel are able to relax in the sitting room and take their meals in the separate dining room. Also provided are bathrooms, showers, medical room and hair-dressing room. There is a two-bedroomed flat for the resident warden and a self-contained bed-sitting room which enables a staff member to act as temporary relief for the warden. Gibson House This building provides hostel accommodation for 12 mentally subnormal youths, each having his own bedroom. There is a communal sitting room, dining room, and recreation room. The young people living here either have outside employment or undergo daily training at Crispin House. As at Evelyn Coyle House, there is a two-bedroom flat for the resident warden and a bed-sitting room for the staff member on relief duty. General Morning, evening, and weekend meals are supplied to the two hostels from their own kitchens, all week day lunches being provided from the central kitchen in Crispin House. The central kitchen can also provide light refreshments for evening social activities held in the main dining room of Crispin House. Gardens between the Houses provide pleasant surroundings to the buildings and help to give each House its own identity. Staff A total of 31, including three administrative and clerical staff are on the establishment of the centre and hostels. The manager at Crispin House and the supervisor at Evelyn Coyle House Day Centre are responsible for ensuring that an adequate and continuous supply of work is available. They also advise on the organisation of the workshops, problems arising from the work, the selection of admissions for employment and their discharge. Each hostel has its own warden, deputy warden and assistant warden; the day centre at Evelyn Coyle House has a supervisor and assistants; Crispin House has a manager together with supervisors and assistant supervisors. MENTALLY ILL Day Centres The Camberwell and Castle Day Centres continued to function for those mentally ill persons in need of rehabilitation. Work undertaken at these centres was mainly of a light industrial nature for various firms in the area. The Page's Walk Day Centre for the elderly mentally infirm was closed and the work and persons attending were transferred to the new purpose-built facilities provided at Evelyn Coyle House described earlier in this report. 54 MENTALLY SUBNORMAL Special Clinics Because of the greater availability of various forms of consultation, the special clinics held at welfare centres were discontinued so that from June onwards these special advisory clinics for subnormal children no longer formed a part of the Department's Mental Health Service. Benhill Adult Training Centre The adult training centre held in the Parish Hall, Benhill Road, S.E.5. continued to function for the first half of the year. At the end of June the trainees and staff were transferred to the new purpose-built adult training centre at Crispin House mentioned previously. Out-Patient Clinic An interesting development was the commencement of an out-patient clinic for subnormal adults. The clinic, staffed by two consultants from Darenth Park Hospital, is held at Crispin House on one afternoon at fortnightly intervals. Each consultant medically examines one subnormal adult whose parents and mental welfare officer may be present. After the examination the consultants discuss the cases with the staff concerned; health department medical officers, mental welfare officers and centre staff attend and participate in these discussions. Girls' Hostel The Dover Lodge Hostel for subnormal girls continued to function. Occupation of the twelve available places was not fully maintained throughout the whole of the year, however, despite the provision of places for other boroughs at agreed rates of payments. Junior Training Schools Kirkwood Junior Training School in Kirkwood Road, S.E.15. and Peckham Junior Training School held in the Congregational Church Hall, Studholme Street, S.E.15. continued to function throughout the year. Peckham Junior Training School closed permanently at the end of the Autumn Term, however, and arrangements were well in hand at the end of the year for the transfer of all equipment, staff and children to the new purpose-built Tuke Junior Training School and Special Care Unit in time for the commencement of the Spring Term, 1970. By arrangement with the Inner London Education Authority speech therapists continued to visit the junior training schools thus benefitting those subnormal children suffering from speech defects. Special Care Unit Derwent Special Care Unit situated in the Dulwich area of the Borough continued to provide a much needed service. However, the Unit closed on 17 December, 1969, in readiness for its transfer to Tuke Junior Training School and Special Care Unit in time for the commencement of the Spring Term, 1970. 55 Short Term (Residential) Care During the year, short term care arrangements were made for a variety of reasons for subnormal and severely subnormal persons, children and adults. Ten places were provided in hospital and 124 places were provided at the Council's expense at Local Health Authority, voluntary and privately maintained establishments. In addition, 27 recuperative holidays on medical grounds following recovery from recent acute illness were provided for mentally ill persons. Social A ctivities The Borough participated again in the organised training centre holiday scheme organised by the London Borough of Hammersmith on behalf of the Inner London Boroughs. Nine Southwark children and adults enjoyed the two weeks holiday in May on the coast at Dymchurch, Kent. In addition to social clubs run by voluntary organisations, a social club for subnormal persons continued to be held weekly throughout the year at the St. Giles' Church Hall, Benhill Road, S.E.5. A weekly club was also held at the Castle Day Centre for mentally ill persons attending that centre and the Camberwell Day Centre. Both clubs were organised by Council staff and sessional fees were paid to the club leaders by the Council. Grants Grants and payments were made to the other bodies and voluntary organisations listed below in respect of services provided for the mentally disordered: Blackfriars Settlement Work Centre Helping Hand Organisation St. Giles' Centre Talbot Settlement National Association for Mental Health National Society for Mentally Handicapped Children Cane Hill Hospital Management Committee-Havil Street Club. Transport Trainees attending the adult training centre and children attending the junior training schools continued to be transported daily from and to pick-up points near their homes by the use of contract hire coaches. The Council's own mini-buses continued to transport from and to their own homes children attending the special care unit and elderly mentally infirm persons attending the Evelyn Coyle Day Centre. 56 STATISTICS FOR YEAR ENDED 31 DECEMBER 1969 TABLE I NUMBER OF REFERRALS DURING YEAR Referred by Mentally 111 Subnormal Severely Subnormal Under 16 16 & over Under 16 16 & over Under 16 16 & over M F M F M F M F M F M F Total General Practitioners 2 1 73 86 - - - - - - - - 162 Hospitals 1 - 119 173 1 4 - 2 1 - - - 301 Local Education Authority - - - 2 26 22 21 4 8 1 - - 84 Police and Courts - - 24 22 - 2 1 - - - 49 Others* - 1 169 219 17 6 7 11 9 1 - - 440 Totals 3 2 335 502 44 34 29 17 18 2 - - 1,036 *Includes relatives, neighbours, Department of Health and Social Security Reception Centres, other local authorities, etc. TABLE II SUMMARY OF ACTION TAKEN IN RESPECT OF NEW CASES Admitted to hospital: Informally 45 Compulsorily: M.H. Act, 1959, Section 25 (for observation) 74 Section 26 (for treatment) 13 Section 29 (emergency admission for observation) 81 Other 12 Afforded community care 527 Given advice only 284 Total 1,036 57 TABLE III NUMBER OF PERSONS RECEIVING COMMUNITY CARE at 31st DECEMBER 1969 Type of Care Mentally III Elderly Mentally Infirm Subnormal and Severely Subnormal Totals Under 16 Over 16 M F M F M F M F Attendance at day centres 42 39 7 23 _ _ 111† Attendance at training centres _ _ _ 59 45 69 63 236* Home training 9 16 _ _ _ _ 8 5 38 Residence in homes, hostels, etc. Local authority (Dover Lodge) _ _ _ _ _ _ 8 7‡ 15 Other 13 24 - - 3 6 9 19** 74 Attendance at special units - - - - 24 12 - - 36 Formal- guardianship _ _ _ _ _ _ _ 3 3 S.W. visits (awaiting admission to hospital for long term res. care) _ 4 3 _ 7 Totals 64 79 7 23 90 66 94 97 520 Plus 11 patients from other Boroughs •Plus 1 Junior patient from another Borough (and 1 Adult attending other Boroughs' centres). |Plus 4 persons from other Boroughs "Plus 2 persons included below under formal guardianship TABLE IV NUMBER OF SUBNORMAL AND SEVERELY SUBNORMAL PERSONS AFFORDED SHORT-TERM RESIDENTIAL CARE Under 16 Over 16 Totals M F M F In N.H.S. Hospitals (arranged by mental health staff) 3 3 1 7 In homes, hostels, etc. 52 13 15 18 98 Totals 55 16 16 18 105 TABLE V ESTABLISHMENTS AND NUMBER OF PLACES Number of Establishments Number of Places Totals Mentally III Elderly Mentally Infirm Subnormal and Severely Subnormal Junior Adult Under 16 Over 16 Under 16 Over 16 Training centres 2 1 _ _ _ 84 180 264 Special units (in day nurseries) 3 _ _ _ _ 29 _ 29 Day centres _ 3 _ 80 40 _ _ 120 Hostels (Dover Lodge) — 1 _ _ _ _ 13 13 Gibson House — 1 — — — _ 12 12 Evelyn Coyle - 1 - - - - 12 12 Totals - 80 40 113 217 450 59 ENVIRONMENTAL HEALTH SERVICES Number of complaints received 7,859 Inspections: Nuisance inspections 8,504 Re-inspections 12,217 Overcrowding 150 Offensive trades 32 Factories and workplaces 512 Outworkers premises 290 Verminous premises and persons 972 Common lodging houses 97 Conveniences, public and private Pet animal premises 66 Hairdressers and barbers 149 Rent Act, 1957 19 Miscellaneous inspections 8,204 Infectious diseases 1,812 Infectious diseases, visits to contacts and re-inspections 1,419 Drainage (new buildings) Inspections 4,107 Tests applied 1,915 Drains constructed 1,470 Drainage (existing buildings) Inspections 2,696 Tests applied 1,043 Drains found defective 259 Drains totally reconstructed 202 Drains repaired or partially reconstructed 490 Offensive Trades Number Type of Business of Register Fat extractors 2 Manure manufacturer 1 Skin dressers 5 Fellmongers 3 Glue and size manufacturer 1 Thirty-two inspections of these premises were made. 60 Common Lodging Houses There are seven common lodging houses in the Borough, four for women and three for men. 97 inspections were made during the course of the year. Hairdressers and Barbers During the year 149 inspections were made to the 236 registered premises in the Borough. Feral Pigeons. Under licences granted by the Ministry of Agriculture, Fisheries and Food, narcotic treatment against feral pigeons was carried out at twelve sites in the Borough. The estimated total number of pigeons frequenting these sites was 2,845 and 2,296 were caught. Pet Animals Act, 1951 Nineteen premises are registered under this Act and 66 inspections were made during the year. Pharmacy and Poisons Act, 1933 There are 138 persons included in the Council's list of sellers of Part II poisons: 119 inspections were made. Registration of Food Premises Under the provisons of Section 16 of the Food and Drugs Act, 1955, 102 premises are registered for the purpose of preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale. During the year 324 inspections of these premises were made. Bakehouses There are 39 bakehouses in use and 54 inspections were made during the year. Sewerage and Sewage Disposal All houses in the Borough are connected, ta the main drainage system. The sewagepasses to the Greater London Council's main sewers thence to sewage disposal works outside the Borough. Swimming Baths There are five public swimming baths in the Borough with a total of ten pools. The water is supplied by the Metropolitan Water Board and details of capacity are set out below: Camberwell Front 118,000 gals. Camberwell Rear 118,000 gals. Dulwich Front 118,000 gals. Dulwich Second Class 88,600 gals. Bermondsey Central First Class 150,000 gals. 61 Bermondsey Central Second Class 73,125 gals. Rotherhithe 220,000 gals. Manor Place First Class 157,000 gals. Manor Place Second Class 164,000 gals. Manor Place Small 48,000 gals. Fifty eight samples of bath water were submitted for bacteriological and chemical examinations and found to be satisfactory. Cremation Certificates The Medical Officer of Health is the Medical Referee for the Council's crematorium at Honor Oak. Three other medical staff act as Deputy Medical Referee. No body may be cremated until the Medical Referee (or deputy) has signed the necessary authority after examination of the appropriate forms and medical certificates. During the year the number of cremation certificates signed was 2,595. Water Supply I am indebted to Dr. E. Windle Taylor, Director of Water Examination, Metropolitan Water Board, for the following report regarding the Board's supply to the area of the London Borough of Southwark. 1. (a) The supply was satisfactory both as to quality, and quantity throughout 1969. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1969, was 290,530. (ii) No house were permanently supplied by standpipe. (d) No artificial fluoride was added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations:— River Thames-derived, also small quantities of well water from Honor Oak and Merton Pumping stations. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. 62 (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are not considered to be plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. Surveys carried out between 1966 and 1968 on analyses of water from consumers' premises confirmed this statement. 63 METROPOLITAN WATER BOARD- AVERAGE RESULTS OF THE CHEMICAL THE LONDON BOROUGH Milligrammes per litre Description of the Sample Number of Samples Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO, 4 hrs at 27°C. B.O.D. 5 days at 20°C. Hardness (total) CaCO3 Hardness non carbonate CaCO3 Magnesium as Mg. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Thames-derived 371 0.024 0.083 4.4 1.05 282 79 5 South of Riverf 4 0.045 0.021 0.2 0.10 292 43 _. Honor Oak 4 0.005 0.017 0.2 0.08 252 38 ._ BACTERIOLOGICAL RESULTS Water supplied to London Source of supply BEFORE TREATMENT Number of samples Agar plate count per ml. Coliform count 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Count per 100 ml. Thames-derived, South of Rivert 8,196 66.5 _ 39.79 19.0 Honor Oak 81 0.0 3 97.53 0.1 Merlon 19 23 10 100.0 _ 3 Hampton, Surbiton & Walton 64 WATER EXAMINATION DEPARTMENT EXAMINATION OF WATER SUPPLIED TO OF SOUTHWARK (unless otherwise stated) Sodium as Na Potassium K Chloride as C1 Phosphate asP04 Silicate as SiOj Sulphate as S04 Natural Fluoride as F Surface active material as Manoxol OT Turbidity units Colour (Burgess units) PH value Electrical Conductivity (micromhos)   (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) 24.0 5.4 32 2.1 9 58 0.25 0.02 0.1 11 7.9 550 17 0.50 0.5 9 7.3 480 73 0.50 0.4 4 7.4 430 - YEARLY AVERAGES Borough of Southwark AFTER TREATMENT Escherichia coli count Agar plate count per ml. Coliform count E. coli count Per cent. samples negative in 100 ml. Count per 100 ml. Number of samples 20-24 hours at 37°C. 3 days at 22°C. Per cent, samples negative in 100 ml. Per cent, samples negative in 100 ml. 53.97 7.0 3,698 12.9 _ 99.89 100.0 100.0 - 81 0.1 11 100.0 100.0 100.0 - 19 0.2 2 100.0 100.0 65 INFECTIOUS DISEASES All medical practitioners are required to notify the Medical Officer of Health, on certificates which are provided free of charge, of any of their patients who, in their opinion, are suffering from any of the following infectious diseases. Acute encephalitis Acute gastro enteritis Acute meningitis Acute poliomyelitis Anthrax Cholera Diphtheria Dysentery (amoebic or bacillary) Food poisoning Infective jaundice Leprosy Leptospirosis Malaria Measles Ophthalmia neonatorum Paratyphoid fever Plague Relapsing fever Scarlet fever Small-pox Tetanus Tuberculosis Typhoid fever Typhus Whooping cough Yellow fever Notifications of Infectious Diseases Disease 1967 1968 1969 Scarlet fever 1.56 112 125 Whooping cough 170 257 37 Acute poliomyelitis and acute polio encephalitis — 2 — Measles 2,881 556 2,115 Diphtheria — — — Dysentery 231 195 201 Meningococcal infection — 6 13 Pneumonia (acute primary and acute influenzal) 37 29 — Paratyphoid fevers — — 2 Erysipelas 8 5 — Food poisoning 64 157 168 Tuberculosis Respiratory system 149 130 148 Other forms 19 12 14 Malaria 1 — — Puerperal pyrexia 122 69 — Ophthalmia neonatorum 2 1 2 Acute gastro enteritis 1,064 2,031 1,755 Infective jaundice — 13 43 66 67 NOTIFICATION OF INFECTIOUS DISEASES 1969 Age Distribution of Notifications. Disease Under 1 Year 1-2 3-4 5-9 10-14 15-24 24-35 35-45 45-55 55-65 65+ Total all ages Scarlet fever - 10 30 64 16 3 2 _ _ _ — 125 Whooping cough 4 9 12 11 _ _ _ 1 _ _ _ 37 Measles 130 571 636 699 49 15 13 2 _ _ _ 2,115 Diphtheria _ _ _ _ _ _ _ _ _ _ _ _ Dysentery 11 38 46 53 9 10 15 8 4 4 3 201 Meningoccal infection 1 3 1 3 3 1 _ _ _ _ 1 13 Acute encephalitis-infective _ _ _ _ _ _ _ _ _ _ _ _ Food poisoning 6 9 6 14 13 34 28 18 18 9 13 168 Tuberculosis- Respiratory 1 _ 1 1 3 10 19 31 29 24 29 148 Other forms _ 2 _ 1 1 1 4 2 _ 1 2 14 Meninges & Cns. _ _ _ _ _ _ _ _ _ _ _ Ophthalmia neonatorum 2 _ _ _ _ _ _ _ _ _ _ 2 Acute gastro enteritis 171 241 195 253 184 234 152 113 90 68 54 1,755 Infective jaundice _ _ 2 6 6 12 8 3 2 2 2 43 Paratyphoid _ _ _ _ 1 1 _ _ _ _ _ 2 Total 326 883 929 1,105 285 321 241 178 143 108 104 4,623 68 TABLE I FOOD POISONING-INCIDENTS AND CASES Causative Agent GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC CASES notified or ascertained TOTAL No. of Ou tbreaks and sporadic cases columns (1+3+5) TOTAL. No. of cases columns (2+4+5) No. of separate outbreaks No. of cases notified or ascertained No. of separate ou tbreaks No. of cases notified or ascertained 1 2 3 4 5 6 7 S. typhimurium _ _ _ _ 2 2 2 Other Salmonellae — — — — 15 15 15 CI. welchii — — — — — — — Staph, aureus — — — — — — — Other causes — — — — — — — Cause Unknown — — _ — 151 151 151 TOTAL — — — — 168 168 168 DETAILS OF FOOD POISONING DUE TO SALMONELLAE OTHER THAN S. TYPHIMURIUM Type of Salmonellae Stanley — _ _ _ 1 1 1 Brandenbourg — _ — 2 2 2 Un-named _ _ _ _ 3 3 3 Virchol _ _ _ _ 1 1 1 Newpor _ _ 7 7 7 Enteriditis - - 1 1 1 TABLE II SALMONELLA INFECTIONS (NOT FOQD BORNE) INCIDENTS AND CAUSES Causative Agent. GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC CASES notified or ascertained TOTAL No. of Ou tbreaks and sporadic cases columns (1+3+5) TOTAL No. of cases columns (2+4+5) No. of separate ou tbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained 1 2 3 4 5 6 7 S. typhimurium _ _ _ _ 4 4 4 Other Salmonellae _ _ _ _ 13 13 13 TOTAL - - - - 17 17 17 DISINFECTING STATIONS There are two disinfecting stations in the Borough situated at: King James Street, S.E.I The Neckinger, S.E.16 Summary of Work Scabies and Vermin Vermin Scabies Male Female Male Female Southwark cases 1.789 191 192 210 treatments 1,789 191 370 382 Lambeth cases 44- 61 69 78 treatments 41 61 122 140 Schoolchildren (male and female) cases 729 363 treatments 729 613 Total treatments 2,559 1,627 Disinfection and Disinfestation of Premises Domestic dwellings (rooms) Public conveniences 27 Public buildings, Institutions 41 Articles treated 28,535 Disinfection following infectious disease Rooms treated 44 Library books treated 115 Incontinent Laundry Service Number of articles laundered 117,602 Bathing of Aged Persons (No. of Baths) Baths at home Baths at disinfecting stations MORTUARY Bodies brought to Southwark Mortuary: From hospitals in Southwark 229 From hospitals in Lambeth 448 677 From private addresses in Southwark From private addresses in Lambeth 448 From private addresses in Greenwich 1 873 Recovered from River Thames 5 1,555 69 Bodies brought from hospitals and institutions: Southwark Guy's Hospital 52 Evelina Hospital 2 Newington Lodge 5 Catholic Nursing Institute 2 St. Giles' Hospital 64 St. Francis Hospital 52 Dulwich Hospital 32 St. Olaves Hospital 18 Royal Eye Hospital 1 Maudesley Hospital 1 Lambeth Lambeth Hospital 124 South Western Hospital St. Thomas' Hospital Kings' College Hospital 229 South London Hospital for Women 14 Weir Hospital 1 Annie McCall Hospital 1 Brixton Prison 3 Post mortems without Inquest 1,349 with Inquest 206 OFFICES, SHOPS AND RAILWAY PREMISES ACT 1963 Introduction The Borough covers an area of 7,115 acres and extends from the south side of the River Thames to the Crystal Palace. The estimated mid-year population was 290,530. The majority of commercial premises and a large number of office blocks are concentrated in the north of the Borough. Substantial redevelopment schemes are either in hand or in the planning stage. Registrations and Inspections Registrations New registrations were made of 149 premises, 103 fewer than in the previous year and the total number of premises registered at the end of the year was 3,799. It was found that in a large proportion of new businesses, particularly shops, the occupier seemed unaware of his responsibilities under the Act. It may well be that periodical publicity directed to new businesses would be of advantage. The Public Health Inspectors are continually on the look out for new premises which may be subject to the provisions of the Act. 70 The number of persons employed in retail shops has decreased considerably which is probably due in some measure to the tendency for retail shops to change to self-service trading with a subsequent reduction in persons employed. Inspections All newly registered premises are given a general inspection as soon as possible after registration and all registered premises have had at least one general inspection. It is anticipated that it will be possible to ensure that all registered premises are given a general inspection every 18 months to 2 years. Re-inspections are carried out at periodical intervals particularly where requirements under the Act have been brought to the attention of the occupiers. Written notices are given where necessary but, as has been found in previous years, many improvements have been achieved following discussions with the occupiers. It is interesting to note that very few complaints were received from employees. The total number of general inspections made during the year was 1,826 and the total number of visits to all registered premises 4,937 compared with 1,240 and 3,847 respectively for 1968. The number of infringements found and remedied was 1,743 and 1,489 respectively compared with 1,025 and 735 for 1968. Details are given in Table D. The statistical information required to be submitted annually to the Department of Employment and Productivity is shown in Tables A, B and C. The inspection of premises is carried out by the Public Health Inspectors and Technical Assistants under the supervision of the Inspectors. Operation of the General Provisions of the Act Cleanliness (Section 4) This continues to be one of the more common shortcomings and 307 instances were found warranting attention. Of those, 226 were satisfactorily resolved during the year. Overcrowding (Section 5) Four instances of overcrowding were encountered and two remedied. Most occupiers and employees seem to be well aware of the requirements of the Act in this respect. Temperature and Ventilation (Sections 6 and 7) There were comparatively few instances of inadequate heating and in most cases effective remedial measures were taken. The lack of thermometers continues to be a common failing and action was taken in respect of 186 premises. 44 cases of inadequate ventilation were found and some difficulty was experienced in achieving satisfactory remedies, particularly in retail shops. 71 Lighting (Section 8) Lighting standards generally in registered premises are considered to be of a reasonable standard but in some cases there was difficulty in obtaining satisfactory standards. Sanitary Accommodation and Washing Facilities (Sections 9 and 10) When inspections were made, the emphasis continued to be placed on maintenance of fittings, cleanliness and the general state of repair of the sanitary accommodation and washing facilities. Only 17 cases of insufficient sanitary accommodation were found and in 15 of those additional facilities were provided and' in 63; cases improvement of washing facilities was obtained. Floors and Staircases (Section 16) There was a marked increase in the number of instances where floors and staircases needed attention —156 compared with 52 the previous year. The majority of defects was due to worn floor coverings and in view of the likelihood of accidents, particular emphasis was placed on obtaining improvements. Dangerous Machinery (Sections 17, 18 and 19) In 34 cases it was found necessary to advise occupiers of inadequate fencing of machinery. First Aid Materials (Section 24) First aid materials were found to be inadequate or not provided in 268 premises and this continues to be a common cause for action. Notification of Accidents (Section 48) 52 accidents were notified and 36 were considered to warrant investigation. It is pleasing to note that this is the lowest number reported since the formation of the London. Borough of Southwark. The most common form of accident reported continues to be of falls of persons and, as mentioned earlier, particular regard is giveTi to the needfor the maintenance of floors and floor coverings. An analysis of reported accidents is given in Tables E and F. Display of A bstract of the Act (Section 50) This is yet another common failing in registered premises. 311 cases were found where the abstract was not displayed. However, verbal notice was usually sufficient to remedy omissions. Offices, Shops and Railway Premises (Hoists and Lifts) Regulations 1968 These regulations which came into operation in 1969, are welcomed. It became evident towards the end of the year when Examination Reports were received that manual hoists, particularly those in licensed premises, were frequently found to be in need of maintenance. Occupiers were advised during inspection, following receipt of Examination Reports of the general requirements of the Regulations particularly those 72 dealing with regular examination by competent persons. As is the practice adopted by H.M. Factory Inspectorate, written communications were sent to all occupiers following receipt of an unsatisfactory report. Conclusion It is considered that steady progress continues to be made in obtaining higher standards in registered premises. It is pleasing to note that enforcement of the requirements of the Act has to a large extent been achieved by discussion with and advice given to occupiers and without recourse to legal proceedings and, in the majority of cases, to written notices. The continued advice and assistance afforded by H.M. Factory Inspectorate is greatly appreciated. 73 TABLE A REGISTRATIONS AND GENERAL INSPECTION (1) Class of Premises (2) Number of premises registered during the year. (3) Total number of registered premises at end of year (4) Number of registered premises receiving a general inspection during the year Offices 62 1,304 473 Retail shops 56 1,794 1,052 Wholesale shops, warehouses 16 297 123 Catering establishments open to the public, canteens 15 396 178 Fuel storage depots - 8 - Totals 149 3,799 1,826 TABLE B Number of visits of all kinds by Inspectors to Registered Premises 4,937 TABLE C ANALYSIS OF PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE (1) (2) Class of Workplace Number of Persons Employed Offices 19,285 Retail shops 13,534 Wholesale departments, warehouses 2,585 Catering establishments open to the public 1,727 Canteens 340 Fuel storage depots 28 Total 37,499 Total males 20,862 Total females 16,637 74 75 TABLE D ANALYSIS OF INFRINGEMENTS FOUND AND REMEDIED DURING INSPECTIONS OF OFFICES AND SHOP PREMISES DURING 1969 Offices Retail Shops Wholesale Departments/ Warehouses Catering Premises Canteens Fuel Storage Depots Total Fnd. Rem. Fnd. Rem. Fpd. Rem. Fnd. Rem. Fnd. Rem. Fnd. Rem. Fnd. Rem. Cleanliness 52 58 138 84 15 10 90 62 12 12 _ _ 307 226 Overcrowding 2 1 1 1 1 — — — — — — — 4 2 Heating 2 2 14 14 2 2 11 7 — — — — 29 25 Provision of Thermometer 46 50 102 98 ?9 4 8 11 — _ — — 186 163 Ventilation 3 — 22 18 4 1 13 7 2 2 _ 44 28 Lighting 22 17 43 33 10 3 16 11 2 2 _ — 93 66 Insufficient sanitary accommodation 6 5 6 10 3 - 2 - - - - - 17 15 Deficient sanitary accommodation 19 18 69 93 7 7 16 11 — - - — 111 129 Insufficient washing facilities 1 3 18 6 12 1 4 - - — - - 35 10 Hot water/warm water required 10 13 31 33 6 13 10 6 - - — - 57 65 Other deficient washing accommodation 6 4 45 33 3 2 19 14 — — — 73 53 Drinking water — — — — — — — — — — — — — — Clothing accommodation 2 5 9 7 2 — 2 — — — — — 15 12 Seating facilities — — 1 2 1 — — — _ — — — 2 2 Eating facilities — — 1 2 — — — — — — — — 1 2 Dangerous machinery 2 1 25 18 2 — 5 1 — — — — 34 20 Floors and staircases 34 31 86 99 19 21 17 12 — — — — 156 163 First-aid 78 80 129 127 21 23 39 19 1 — — _ 268 249 Abstract not displayed 87 84 170 143 19 13 33 17 2 2 — — 311 259 TOTALS 372 372 910 821 156 100 285 178 20 18 — — 1,743 1,489 There were 292 Informal Notices served and 171 were complied with during the year. 76 TABLE E REPORTED ACCIDENTS ANALYSED-WORKPLACE AND ACTION TAKEN Reported Non-fatal Number Investigated Formal Warning Informal Advice No Action Class of Workplace 1969 1968 1967 1969 1968 1967 1969 1968 1967 1969 1968 1967 1969 1968 1967 Offices 6 15 13 4 3 — — — — 2 2 — 2 1 — Retail shops 25 33 37 19 9 14 — — — 8 7 5 11 2 9 Wholesale Depts./Warehouses 12 27 21 8 8 — 1 — — 2 6 — 5 2 — Catering Establishments/ canteens open to the public 9 6 18 5 1 4 - - - - 1 2 5 — 2 Fuel Storage Depots - - - - — — - — - — — - — Total 52 81 89 36 21 18 1 — - 12 16 7 23 5 11 There were no fatal accidents reported and no prosecutions 77 TABLE F REPORTED ACCIDENTS ANALYSED BY PRIMARY CAUSE Class of Workplace Total Primary Cause Offices Retail Shops Wholesale Depts./ Warehouses Catering Establishments/ Can teens open to the public Fuel Storage Depots 1969 A* B* 1969 A*B» 1969 A* B* 1969 A* B* 1969 A* B* 1969 A* B* Machinery - 1 3 1 1 5 _ 8 1 1 — 2 - - - 2 10 11 Transport — — 2 — 3 — 1 1 5 — — — — — — 1 4 7 Falls of persons 4 10 5 11 14 12 5 6 3 2 — 8 — — — 22 30 28 Stepping on or striking against object or person 1 — — 4 2 4 2 1 2 1 — 1 — — _ 8 3 7 Handling goods — 4 2 7 4 7 4 7 5 2 3 2 — — — 13 17 16 Struck by falling object — — 1 — 1 1 — — 2 1 1 2 — — — 1 3 6 Fires and explosions — — — — — — — — — — — — — — — — — — Electricity — — — — — — — — — — — — — — — — — — Use of hand tools — — — 2 5 7 — 1 — 1 — — — — — 3 7 7 Not otherwise specified 1 — — — 2 1 — 3 3 1 2 3 — — — 2 7 7 Total 6 15 13 25 32 37 12 27 21 9 6 18 — — — 52 81 89 A* 1968 B* 1967 FACTORIES ACTS, 1961 INSPECTIONS Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by local authorities 435 131 — — (ii) Factories not included in (i) in which Section 7 is enforced by the local authority 1,719 344 — — (iii) Other Premises in which Section 7 is enforced by the local authority, (excluding out-workers premises) 59 37 — — Total 2,213 512 — — DEFECTS FOUND Particulars Number of cases in which defects were found Number of defects in which M prosecutions were instituted Found Remedied Referred toH.M. Inspector Referred' by H.M. Inspector Want of cleanliness (S. 1) _ _ _ _ Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary conveniences (S.7)- lnsufficient 6 4 — 2 — Unsuitable or defective 41 32 - 6 — Not separate for sexes 2 — — 2 — Other offences — — — — — (Not including offences relating to home work) — — —- — — Total 49 36 - 10 - 78 OUTWORKERS Nature of Work Number of Outworkers in August lists as required by Section 133 (1) (c) Cardboard boxes 42 Carding of buttons 15 Lampshades 27 Showcards 10 Wearing apparel 196 Total 290 There were no instances of work in unwholesome premises and it was not necessary to serve any notices or institute proceedings. HOUSING-INSPECTIONS, PROCEEDINGS, ETC. Inspection of Dwelling-Houses during the Year: (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 13,710 (b) Number of Inspections made for the purpose 28,029 (2) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 304 (3) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 3,186 Remedy of Defects during the Year without Service of Formal Notices: Number of defective dwelling-houses rendered fit in consequence of informal action by the local authority or their officers 1,532 (1) Proceeding under Housing Act, 1957: - (a) Number of houses made fit after service of formal notices (Sections 9, 16 and 18) (i) By owners 3 (ii) By local authority in default of owners 1 (b) Houses demolished as a result of formal or informal procedure under Section 17 10 (c) Houses closed in pursuance of an undertaking given by the owners under Section 16 7 (d) Closing Orders on parts of buildings (Section 18) 30 (e) Undertakings not to use parts of buildings for human habitation accepted 3 79 (f) Closing Orders made under Section 17(3) (g) Demolition Orders determined and Closing Orders substituted under Section 26 (h) Closing Orders made under Section 17( 1) 37 (i) Closing Orders determined 4 (j) Closing Orders revoked and Demolition Orders made (k) Number of houses included in representations (Section 42) 217 (2) Houses in Multiple Occupations-Housing Acts, 1961-64:— (a) No. of premises found to require action 144 (b) No. of premises at which conditions were remedied as a result of informal action 1 (c) No. of premises requiring formal action 140 (d) No. of Directions given 67 (e) No. of Directions revoked 1 (f No. of Directions varied (g) No. of Management Orders made 38 (h) No. of Management Orders revoked — (3) Housing Act, 1964:- (a) No. of Control Orders under Section 73 Nil (b) No. of Control Orders revoked under Section 86(2) Nil (4) Proceedings under Pu blic Health Acts: (a) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2,054 (b) Number of dwelling-houses in which defects were remedied after service of formal notices: (i) By owners 826 (ii) By local authority in default of owners 104 Housing Inspections Clearance areas Individual unfit houses Section 9 Section 16 Parts of premises—Section 18 Houses in multiple occupation Re-inspections (all sections) Miscellaneous Inspections Total inspections . No. of Inspections 2,312 594 210 417 609 3,086 3,173 10,401 80 Legal Proceedings-Public Health Act, 1936:— Nuisance Orders made 19 Summonses withdrawn (work completed) 21 RENT ACT, 1957 Applications for Certificates of Disrepair Number of applications for certificates 2 Number of decisions not to issue certificates Number of decisions to issue certificates: (a) in respect of some but not all defects 2 (b) in respect of all defects 1 Number of undertakings given by landlords Number of undertakings refused Number of certificates issued 2 Applications for cancellation of Certificates of Disrepair Applications by landlords for cancellation 4 Objections by tenants to cancellation Decisions to cancel in spite of tenant's objection Certificates cancelled 4 MEDICAL PRIORITIES FOR RE-HOUSING When applicants for re-housing submit medical certificates in support of their applications, the Medical Officer of Health assesses the degree of priority to be awarded in each case. This involves considerable investigation, including visiting the applicant's present accommodation. These duties are undertaken by the Council's environmental visitors under the supervision of a senior medical officer. During the year 3,144 visits were made to applicants' homes as well as 843 other visits of investigation (to hospitals, relatives, etc.) and 2,127 recommendations were made to the Housing Department. CLEAN AIR ACTS 1956 and 1968 Smoke Control Areas At the end of the year the total number of operative Smoke Control Orders was 25 covering 4,437 acres and 63,981 premises. No new Smoke Control Orders were made during the year but the surveys for the proposed No.26 (Peckham Central) were completed with a view to the Order being made early in 1970. In addition, surveys commenced for two further Smoke Control Areas and the target for completion of the Borough is 1976. Installation of Furnaces Eight applications for prior approval to the installation of furnaces were approved. It is fitting to report that a high degree of co-operation was received from the applicants in connection with suggestions made to them regarding the use of oil of low viscosity and sulphur content. 81 Smoke Nuisances Investigation into 512 complaints of smoke nuisance were made and of this number 198 related to industrial sources. It was not found necessary to institute any legal proceedings and where nuisances were substantiated, abatement was secured by informal action. Burning of refuse by demolition contractors was a frequent source of complaint. Clean Air Act 1968 Additional responsibilities arose from the Clean Air Act 1968 relating mainly to the control of open incineration on trade and business premises, chimney heights, and the emission of grit, dust and fumes. Eight applications were received in respect of chimney heights and in three cases alterations were required. There were 16 cases of recorded grit and dust emissions which were resolved informally. Health Education As in previous years, the subject of atmospheric pollution has figured prominently in-talks given by the Public Health Inspectors to schools and other organisations. Summary of Inspections Complaints investigated 512 Smoke Observations 275 Smoke Control Areas 11,473 Industrial Inspections 583 Miscellaneous Inspections 5,158 PREVENTION OF DAMAGE BY PESTS ACT, 1949 1. Total number of properties in district 122,747 2. (a) Total number of properties inspected following notification 4,367 (b) Number infested by (i) rats 2,163 (titmice 2,057 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 95 (b) Number infested by (i) rats 62 (ii)mice 33 The following table shows the work of the Rodent Control Staff: Domestic Premises Commercial Premises Rats Mice Rats Mice Complaints received 1,653 1,459 625 630 Visits by investigators 1 612 355 655 667 Visits by rodent operatives 10,924 11,877 3,284 3,294 Number of premises cleared 1,115 1,415 715 771 82 FOOD AND DRUGS ACT 1955 During the year, 245 formal and 1,924 informal samples were submitted for analysis. Details of unsatisfactory samples and action taken are as follows: Sample Formal or Informal Result of Analysis Action Taken Chopped pork Informal Contaminated with lead Taken up with manufacturers. Cultured buttermilk Inform al(2) Incorrectly labelled Taken up with manufacturers. Strawberry flavour syrup Informal Incorrectly labelled Taken up with manufacturers. Labels reprinted. Strawberry flavour syrup Informal Excess of sulphite preservative Formal sample satisfactory. Syrup of creosote Informal Incorrectly labelled Taken up with manufacturers. Labels reprinted. Ground nut oil Informal Incorrectly labelled Taken up with facturers. Labels printed- Canned goulash Informal Incorrectly labelled Taken up with manufacturers. Labels reprinted. Cooking butter Informal (2) Formal (1) Slightly rancid Taken up with manufacturers. Sausages, beef Informal (1) Formal (1) Preservatives not declared Formal sample taken. Prosecution, fine £5. chipolatas Formal 8% deficient in meat Taken up with manufacturers. Subsequent sample satisfactory pork Formal 13% deficient in meat content Re-sampled,satisfactory pork Informal Preservatives not declared Formal sample satisfactory. Corned beef Informal Contained 45% cereal filler Product withdrawn from sale Cherries, canned Informal Small hole in can No further action. Contents sound. 83 Sample Formal or Informal Result of Analysis Action Taken (continued...) Blackcurrants, canned Informal Slight corrosion No further action. Contents sound Blackcurrant health drink Informal Contained pieces of wax Formal sample satisfactory. Olive oil Informal Excessive acidity Formal sample satisfactory. Apricot chutney Informal Incorrectly labelled and excessive preservatives Consignment returned to Australia Devon cheese Informal Incorrectly labelled Re-labelled and subsequent sample satisfactory. Cooked meat pies Informal 25% deficient in meat Taken up with manufacturers. Almond drink Informal Contained no almond Taken up with manufacturers. Carrots, canned Informal Contained fungus Taken up with manufacturers. Pork luncheon meal I Informal Incorrectly labelled Taken up with manufacturers. Labels reprinted. Chopped pork and ham Informal Incorrectly labelled Taken up with manufacturers. Labels reprinted. Fruit laced wine Informal Incorrectly labelled Taken up with manufacturers. Labels reprinted. Strawberry cream soda Informal (1) Formal (1) Incorrectly labelled Taken up with manufacturers. Labels reprinted. Curry powder Informal Incorrectiy labelled Taken up with manufacturers. Labels reprinted. Sangria alcoholic drink Informal Incorrectly labelled Taken up with manufacturers. Labels reprinted. Compound codeine tablets Informal Incorrectly labelled Taken up with manufacturers. Labels reprinted. 84 Sample Formal or Informal Result of Analysis Action Taken (continued...) Rose syrup Informal Incorrectly labelled Taken up with manufacturers. Labels reprinted. Kola champaign Informal Dfccription likely to mislead Taken up with manufacturers. Labels reprinted. It will be seen that the majority of the samples subject to adverse reports related to labelling requirements which were resolved with the manufacturers concerned. Legal proceedings taken as a result of complaints made by members of the public where food was sold to the prejudice of the purchaser: — Offence Result Fine Costs Crumpet containing metal shavings Conditional Discharge £5.5.0. Mouldy beef pies £10. 0.0. £2.0.0. Mouldy loaf £25. 0.0. £5.0.0. Dirty bacon £10. 0.0. £2.0.0. Loaf containing dirty dough £15. 0.0. £2.0.0. Pork pie containing a piece of metal £10. 0.0. £2.0.0. Carton of sour milk £10. 0.0. £2.0.0. Mouldy loaf £25. 0.0. £3.3.0. Loaf contaminated by oil £30. 0.0. £3.0.0. Loaf contaminated by oil £30. 0.0. £6.6.0. Jam containing wood shaving £10. 0.0. £3.0.0. Pease pudding containing a piece of wire £ 5. 0.0. £2.0.0. Beef roll containing live maggots £15. 0.0. £3.3.0. Loaf containing a piece of cardboard £ 5. 0.0. £5.5.0. Mouldy loaf of bread £ 5. 0.0. £5.0.0. Mouldy fruit pie £ 5. 0.0. £5.0.0. Mouldy meat pudding £25. 0.0. £5.0.0. Ant infested"chocolate £ 5: 9:0. f-ULQ.. Mouldy chicken pie £20. 0.0. £5.5.0. Mouldy steak pie £10. 0.0. £2.0.0. Mouldy meat pattie £10. 0.0. £5.0.0. Result Offence Fine Costs Mouldy jam sandwich £20. 0.0. £5.0.0. Loaf of bread containing a nail £25. 0.0. £5.0.0. Nut ring containing larvae webbing Proceedings against retailer not pursued. Council awarded £15.15.0. costs against wholesaler. In addition, 30 warning letters were issued following complaints made by members of the public. Milk distributors and sampling There are 427 milk sellers in the Borough. Licences to expire on 31st December 1970, were issued as follows: For sale of untreated milk 34 For sale of pasteurised milk 308 For sale of sterilised milk 313 For sale of ultra heat treated milk 84 Ice cream Fifty-six samples of ice cream were examined with the following results: Methylene Blue Grading Soft Ice Cream Other Ice Cream Grade 1 (satisfactory) 18 23 Grade 2 (sub-standard) 3 1 Grade 3 (unsatisfactory) 4 1 Grade 4 (unsatisfactory) 2 4 Samples of milk for chemical and bacteriological examination were obtained from milk distributors in the Borough and also from schools and day nurseries with the following results: No. of samples Satisfactory Unsatisfactory Chemical examination 64 64 — Bacteriological examination 76 70 6 The six unsatisfactory samples which failed the Methylene Blue Test were taken up with the distributors concerned and subsequent samples were found to be satisfactory. 86 Where unsatisfactory reports are received further samples are obtained before any further action is taken. In the cases reported, further samples were found to be satisfactory. Chemical A nalysis Twenty-five samples were submitted for examination and found satisfactory. FOOD HYGIENE (GENERAL) REGULATIONS, 1960 All food premises were inspected and during the year written notices of requirements under the Regulations were given in respect of 145 premises. The following table shows the number of visits made by the public health inspectors to the various types of food premises: Bakehouses 54 Bakers and confectioners 389 Butchers 664 Cooked and preserved meat shops 324 Dairies and milkshops 286 Fishmongers, friers and curers 430 Food factories 882 Ice cream premises 374 Public houses 797 Restaurants, canteens, etc 2,135 Street markets. 7.83 Street traders' food stores 247 Wholesale food dealers 417 Other food premises 1,679 Legal Proceedings Nature of Business Offence Fine Costs Café Regulation 14(2) Convenience not suitably lighted or kept clean £5.0.0. £5.0.0. Regulation 14(5) No notice requesting washing of hands after using the convenience £3.0.0. Regulation 16(1) No wash basin for use of those engaged in handling food £5.0.0. Regulation 17 No sufficient first aid equipment available for those handling food £3.0.0. Regulation 19(1) No adequate supply of hot water in sink for washing equipment £5.0.0. 87 Legal Proceedings Nature of Business Offence Fine Costs (contd...) Regulation 23(1) a Premises not kept in such good order as to enable them to be Cafe effectively cleaned Regulation 8 Failure to take steps to protect £3.0.0. food from contamination Regulation 23(1 )a £40.0.0. £10.0.0. Premises not kept in such good order as to enable them to be effectively cleaned £10.0.0. Regulation 24 Accumulation of refuse in food rooms £10.0.0. Unsound Food The following quantities of foodstuff were on examination found to be unfit for human consumption and were destroyed or disposed of for purposes other than human food: Tons Cwts. Qrs. Lbs. Meat 5 2 2 21 Canned meat and meat products 51 14 0 4 Fish ... — 3 28 Fruit and vegetables 216 10 3 6 Miscellaneous foodstuffs 132 14 0 8 Canned goods 113 4 3 3 Total 519 7 1 14 FOOD HYGIENE (MARKETS, STALLS AND DELIVERY VEHICLES) REGULATIONS, 1966 All street markets in the Borough are regularly inspected by the Public Health Inspectors and 783 such inspections were made during the year, in the main at the weekend. In addition 247 inspections were made on street traders' food stores. Nine certificates of exemption from certain requirements of the Regulations were granted to street traders. 88 IMPORTED FOOD CONTROL THE IMPORTED FOOD REGULATIONS, 1968 FOOD AND DRUGS ACT, 1955 The following samples were submitted for bacteriological examination during 1969: Egg products 860 Frozen prawns and shellfish 1,167 Second grade cheese 295 Dessicated coconut 3 Total 2,325 The following samples were submitted for chemical examination: Frozen liquid egg for alpha-amylase test 2,524 Routine chemical examination: Canned fruit and juice 445 Dried fruit 92 Canned meat 121 Canned vegetables 48 Canned fish 91 Canned tomatoes 68 Tomato puree 16 Tea 266 Butter and fats 53 Lard 80 Nuts 41 Cheese 40 Miscellaneous 269 1,622 Total number of chemical samples 4,146 The Liquid Egg (Pasteurisation) Regulations, 1963 There are two egg pasteurising plants operating in the horaugh both, of which combine the process of egg pasteurisation with that of egg breaking and the freezing of liquid egg; the plants are high temperature short time with inplace cleaning. Each plant is equipped with its own laboratory in which tests required by the Egg Marketing Board of those companies under contract to them are carried out. These tests include B. Coli and plate count in addition to the alpha-amylase test. 338 samples of pasteurised home produced liquid egg were taken from the plants for alpha-amylase test, the results of which were satisfactory. No particular difficulties were met with during the sixth year of the operation of the Regulations. The home production appeared to-be quite satisfactory and only 0.84% of the imported frozen whole egg failed the alpha-amylase test. 89 SAMPLING OF FROZEN WHOLE EGG FOR ALPHA-AMYLASE TEST Country of origin Quantity imported No. of samples taken No. of samples failed Quantity of unsatisfactory egg T C Q L test T C Q L Australia 2,517 12 0 0 910 13 43 14 0 0 (Returned to Australia) China 3,214 6 0 0 798 1 21 9 0 0 (Repasteurised) New Zealand 125 0 0 0 52 — Poland 15 5 0 0 5 — Rumania 276 0 0 0 91 — South Africa 1,589 5 0 0 668 - Totals 7,737 8 0 0 2,524 14 65 3 0 0 In addition, 405 control samples were taken from the two pasteurisation plants in the Borough as follows: — British Egg 338 Chinese Egg 58 Polish Egg 7 Spanish Egg 2 405 All these samples were found to be satisfactory. 91 BACTERIOLOGICAL EXAMINATION OF EGG PRODUCTS Country of origin Type of egg product Quantity examined No. of samples taken No. of samples positive Quantity of contaminated egg T C Q L T C Q L Australia Frozen albumen 158 9 0 0 114 — Frozen yolk 20 0 0 0 23 — Dried whole egg 2 16 0 0 4 — China Frozen albumen 378 0 0 0 246 — Dried whole egg 11 0 0 0 15 — Denmark Dried albumen 12 10 0 0 36 — Holland Dried whole egg 16 0 0 0 42 — Liquid whole egg 81 5 0 0 100 Poland (Sugar preserved) Frozen albumen 148 15 0 0 172 5 6 2 0 0 (Re-exported) U.S.A. Dried albumen 29 13 0 0 72 2 2 4 0 0 (Re-pasteurised) Yugoslavia Frozen albumen Miscellaneous 34 0 0 0 17 19 Totals 892 8 0 0 860 7 8 6 0 0 The following types of Salmonellae were isolated during routine sampling of egg products during 1969:— Country of Origin Organism No. of samples Poland Salmonella worthington 4 Arizona group 1 U.S.A. Salmonella thompson 2 7 New Zealand Second Grade Cheese 295 samples of New Zealand second grade cheese were submitted for bacteriological examination during 1969 with the following results: — Coagulase-positive staphylococci Not found Less than 500 per gram 500—50,000 per gram 50,000—500,000 per gram Over 500,000 per gram No. of samples 15 277 2 1 NIL 295 Other Imported Foodstuffs - Routine Chemical Examination The following action was taken as the result of chemical analysis: — Food Examined Result of Examination Action taken Apricots (dried) Label found to be incorrect. Released with warning to importer. Chopped beef (canned) Contained only 80% meat instead of not less than 90%. Released with warning regarding future consignments. Cod Roe (smoked) Label found to be incorrect. Released with warning to-importer. Confectionery Found to contain prohibited colouring matter. Returned to country of origin. Fruit cocktail Found to contain little or no cherries. Released with warning to importer. Fruit juices (canned) Fermentation and mould growth. Returned to country of origin. Glace fruits Found to contain prohibited colouring matter. Destroyed. Haricots verts Label found to be incorrect. Released with warning to importer. Macaroni Label printed entirely in foreign language. Released with warning to importer. 92 Mustard spread Label printed entirely in foreign language. Released with warning to importer. Soup (dehydrated) Label found to be incorrect. Released with warning to importer. Spinach puree Label found to be incorrect. Released with warning to importer. Tarragon leaves. Label printed entirely in foreign language. Released with warning to importer. Tea Found to contain excess lead. Released for blending. Tomato ptwee- Found to have excessive mould content. Refeasecf for visual and chemical investigation only. 93 BACTERIOLOGICAL EXAMINATION OF FROZEN SHELLFISH, 1969 Country of origin Type No. of Samples taken V anable con ntr at 3 7°C Less than 100,000 100,0001,000,000 More than 1,000,000 Australia Raw prawns 10 Cooked prawns 4 4 Brazil Raw prawns 4 Canada Cooked prawns 63 50 10 3 Crab meat 4 4 Lobster meat 2 2 Canned lobster 7 Chile Cooked prawns 36 36 China Raw prawns 44 Cooked prawns 75 66 7 2 Crab meat 2 2 Lobster meat 2 Cuba Raw prawns 76 Cyprus Cooked prawns 2 2 Formosa Cooked prawns Lobster meat 88 1 80 1 8 Hong Kong Raw prawns 57 Cooked prawns 31 22 8 1 Crab meat 2 2 Lobster meat 2 1 1 Indonesia Raw prawns 13 Lobster meat 2 Japan Cooked prawns 113 110 3 Crab meat 32 27 5 Kenya Raw prawns 1 Korea Raw prawns 2 Malaysia Raw prawns 120 Cooked prawns 13 6 5 2 New Zealand Raw prawns 4 Pakistan Raw prawns 287 Salmonella organisms found in 5 samples Persia Raw prawns 1 Senegal Raw prawns 3 South Africa Cooked prawjis 3 3 Thailand Raw prawns 12 Trinidad Raw prawns 7 U.S.A. Cooked prawns 38 38 Crab meat 4 4 Totals 1,167 455 52 8 Consignments of cooked Shellfish showing viable counts in excess of 1,000,000 were detained. Where a consignment showed a viable count of between 100,000 and 1,000,00(J, the importer was warned that the shellfish should be used immediately after defrosting. A sample taken from one consignment of Pakistani Raw Prawns was found to contain Salmonella paratyphi B; 131 Cartons were destroyed and the remainder re-exported. Samples taken from other consignments were found to contain Salmonella augustenborg (1), Salmonella v rchow (1) and Salmonella butantan (2). All these prawns were re-exported. 94 DISPOSAL OF UNSOUND OR CONTAMINATED FOOD Commodity Disposed of for purposes other than human food Released under supervision of other local authority Re-exported Destroyed T C Q L T C Q L T C Q L T C Q L Bacon 2 3 0 0 11 19 0 0 19 2 0 Beans 5 16 1 17 44 7 2 0 Butter 67 7 1 5 Casings 6 1 0 Cheese 2 19 2 16 3 16 0 18 Cocoa 1 0 0 Coffee 21 13 0 8 3 0 0 Egg products 80 11 0 0 19 3 2 0 3 10 Fish (canned) 18 0 0 Fruit 7 2 0 Fruit (canned) 49 8 0 0 Fruit juice 5 0 0 0 (canned) Kangaroo meat 33 18 0 24 Meat 25 8 0 22 Meat (canned) 18 6 2 12 69 16 1 17 Milk powder i 16 0 0 Nuts 12 11 2 6 21 6 0 25 5 0 0 0 Onions 18 0 0 Peas 2 19 2 8 Prawns 60 19 1 10 10 10 0 0 Rice 7 2 1 17 Tapioca 17 0 0 Tea 30 4 0 0 3 10 0 0 2 18 0 0 Tomato puree 18 0 0 Vegetables 2 3 0 0 Vegetables 0 0 (frozen) 12 17 Various 13 4 0 0 Totals 116 1 3 21 199 14 2 15 168 12 0 22 169 15 1 17 66 consignments of imported food were detained and subsequently were released for re-export, manufacture and treatment, animal feeding or destruction, all with the necessary safeguards. 95 MISCELLANEOUS ADOPTION AND BOARDING-OUT The number of medical reports received from the Children's Officer in 1969 relating to prospective adopters increased, while those relating to children proposed for adoption and boarding out continued at the same level as in the previous year. These reports are examined by a senior medical officer for possible medical contra-indications to the intended arrangements and, where necessary, additional information is sought from hospitals and general practitioners. During the year, 25 children were considered suitable for adoption and 29 for boarding-out. Similar recommendations were made on 32 prospective adopters. However, 1 child was considered medically unsuitable for adoption and 4 prospective adopters were considered medically unsuitable to adopt children. In addition, many enquiries were carried out at the request of the Children's Officer for information appertaining to initial applications from persons wishing to adopt or foster a child. CHILDRENS AND WELFARE COMMITTEES ESTABLISHMENTS Part-time visiting medical officers hold appointments at residential nurseries, and at large and small homes for children, the aged and infirm, homeless family units etc. A senior medical officer exercised general medical supervision of the establishments and gave special attention to short-stay accommodation for homeless families. THE SOUTH EAST LONDON GENERAL PRACTITIONER'S CENTRE The number of general practitioners using the Centre has increased from 287 in 1968 to 304 and the volume of work carried out at the Centre has shown an upward trend especially in the area of investigations. From 1st March a routine screening service was instituted for every patient attending the Centre comprising of details of height and weight, blood pressure and urine tests. The observations which have proved most useful were made known to the general practitioners and are much appreciated by them. This service is being continued. The "Tine Test" for tuberculosis is now included on the list of investigations undertaken. Visits The interest in the functions of the Centre continued to attract visitors from this country and abroad. Among the visitors were groups of nurses from Guy's and King's Hospitals, architects and students, health visitors' study groups, and twelve Dutch general practitioners who attended a routine lunch time general practitioner session. In addition medical and nursing officers from the Department of Health and Social Security visited the Centre in connection with the preparation of a comprehensive report on health centres. 96 Meetings There have been regular meetings of the House Committee and these are followed by interesting talks on the various aspects of their work by senior officers of the Health Department. Lunch time meetings of general practitioners continued to be held during the year with very good attendances and afternoon film-strips were shown including one giving instruction on 'Home Dialysis'. It is interesting to note that these meetings are now recognised as one half session for general practitioner post-graduate payment. Evening meetings have included those of the South East London Obstetric Society, the South London Faculty of the Royal College of General Practitioners and the "Psychiatric Club" which, under the auspices of the Inner London Education Authority, arranges seminars on child guidance topics for doctors and social workers. In view of the retirement of Dr. G.S.R.Little, Chairman of the Medical Staff Committee a general meeting was held in November of the practitioners using the centre. Dr. H.O'Brien was elected as Chairman and Dr. I.W.Crown succeeded him as Secretary. The following general practitioners were also elected to serve on the Committee: Dr. E.Almeida, Dr. C.Bhatt, Dr. J.Byles, Dr. S.M.F.Cure, Dr. D.Fletcher, Dr. G.Harris, Dr. C.Josephs, Dr. L.Kwasny, Dr. T.Madden, Dr. Z.Nowiak and Dr. S.D.Moss. The volume of work carried out during the year in the various departments (excluding figures of the "Well Women" Clinics) was as follows:- Period Path. Lab. X-ray E.C.G. Allergy Nursing Minor Ops. Total Investigations Total Attendances Jan.-Mar. 1,644 1,332 324 32 676 5 4,013 2,777 Apr.—June 1,857 1,244 334 29 1,956 12 5,432 2,782 July-Sept. 1,488 1,050 276 18 1,332 13 4,177 2,429 Oct.-Dec. 1,583 1,030 281 79 1,273 13 4,259 2,292 Total 6,572 4,656 1,215 158 5,237 43 17,881 10,280 17,882 investigations compared with 14,052 in 1968 shows a substantial increase largely due to the routine screening tests now carried out at the Centre. The approximate findings on routine screening tests for the last 6 months of the year were: — Abnormal blood pressures 1.33% Albumin in urines 1.7% Sugar in urines 33% 97 Social Medicine The number of patients referred to health visitors continues to increase but the numbers dealt with are not included in the overall volume of work carried out. Education The response to postgraduate education has increased considerably this year due to the more frequent luncheons and the introduction of afternoon meetings. Undergraduate Education Regrettably the studentships offered to two students from Charing Cross Hospital under the Sir Halley Stewart Trust were not accepted because of difficulties involving grants from their own local authority. It has become clear that it is difficult for students to fit a twelve week attachment to general practice into their very full curriculum and consideration is being given to revising the form of this type of undergraduate education in consultation with the Deans of the Medical Schools. STAFF MEDICAL EXAMINATIONS A senior medical officer,, with nursing assistance-, is responsible for the medical examination of new entrants to the staff and in certain circumstances of sick personnel. The following table gives details of this work. Officers Manual Workers Medical questionnaires received and scrutinised 655 1,086 Medicals of staff after scrutiny of questionnaires 160 621 working with children 188 —■ sewerman etc. — 12 absent from duty owing to sickness 81 415 absent due to sickness (special survey) 41 541 called up for review 32 144 CHEST CLINICS The three chest clinics in the Borough are situated at St. Giles' Hospital, Bemondsey Health Centre, and the Health Services Department, Larcom Street: the two latter clinics have the same Tuberculosis Care Committee. The Council reimburses the hospital service a portion of the chest physicians' salary and provides health visitors, social workers, occupational therapists and administrative staff. Advice and assistance were given to patients with personal, domestic, occupational and hygiene problems. Domiciliary visits were made and extra nourishment (milk, butter and eggs) was given to necessitous cases on the recommendation of the chest physician: 24 cases were assisted compared with 17 in 1968. 98 I am pleased to report that no occasion arose during the year on which it was found necessary to board out children because of infection in their homes or in the absence of parents receiving residential treatment for tuberculosis. During the year voluntary care committees continued to give valuable assistance by providing items such as clothing, bedding, and holidays to patients who would not qualify for "extras" from the statutory services. Number of patients on chest clinic registers at 31.12.69: Pulmonary 2 046 Non-Pulmonary 267 New cases notified: Pulmonary 146 Non-Pulmonary 15 Deaths from tuberculosis 16 Under special treatment at home Contacts given B.C.G. vaccination 293 Cases having domiciliary help: (a) Home helps 13 (b) District nurses 8 Home visits by health visitors 4,860 Patients in receipt of extra nourishment 24 Patients assisted for the first time with: Bed or bedding 4 Clothing or footwear 44 Diversional therapy: Patients attending weekly classes 72 Patients instructed at home DEVELOPMENT OF VOLUNTARY EFFORT Every endeavour was made to use voluntary assistance during 1969, and during the year, grants were made to the following: Maternity and Child Welfare Service Bird in Bush Welfare Centre Brook Advisory Centre Family Planning Association Salomons Centre, Guy's Medical School Chiropody Bermondsey Medical Mission Camberwell Old People's Welfare Association King George VI Memorial Club 99 Centres for the Mentally III Cane Hill Psychiatric Social Club, Havil Street, S.E.5. St. Giles' Centre Talbot Settlement-Wednesday Club Prevention of break-up of families Family Welfare Association South London Family Service Unit Various Blackfriars Settlement Occupational Work Centre British Red Cross Society Catholic Nursing Institute Central Council for Health Education Chest and Heart Association Invalid Children's Aid Association National Association for Mental Health National Association for Maternal and Child Welfare National Society for Mentally Handicapped Children FINANCE Assessments and Charges In June the London Boroughs Association revised their advice regarding the calculation of charges and their abatement in appropriate circumstances by means of assessment scales, and their detailed recommendations were later adopted by the Borough's Health Committee. Expenditure The approximate net revenue expenditure for 1969/70 was £1,521,540; the amount recovered in contributions and charges, including reimbursement of the cost of the school health service (£143,080) and the Government Grant of half the cost of the Port Health Administration (£15,950), was approximately £263,630. 100 ANNUAL REPORT ON THE SCHOOL HEALTH SERVICE IN THE SOUTHWARK AREA J. E. EPSOM, M.R.C.S., L.R.C.P., D.P.H., D.I.H. PRINCIPAL SCHOOL MEDICAL OFFICER (SOUTHWARK) AND J. CLEARY, B.D.S. PRINCIPAL SCHOOL DENTAL OFFICER SCHOOL HEALTH SERVICE, Castle House, 2 Walworth Road, S.E.I. 101 The Inner London Education Authority is responsible for the School Health Service, but by virtue of agreement required by Section 32 of the London Government Act 1963, there is joint use by the Authority and the Borough Council of professional staff, premises and equipment. The Medical Officer of Health is the Principal School Medical Officer of the Inner London Education Authority for the area and responsible to that Authority for the day-to-day running of the service. School Roll There were more children attending schools in this Borough than in any other Inner London Borough, in May 1969 there were 49,350 children in the roll of the 109 County and Voluntary schools in the Borough. Medical Inspections Routine Medical Inspections were carried out at ages 5, 7, 11 and during the last year at school. Non-routine examinations were arranged as follows:— (a) At the request of the Divisional Education Officer because of poor school attendance. (b) At the request of the Head Teacher because of some physical defect or poor school progress. (c) By the School Medical Officer following a hospital report or to review the progress of a handicapped child. (d) By the school nurse as a result of a survey or school visit. Statutory Examinations Despite the change in procedure in the previous year , the marked decrease noted in the number of children formally examined under the provisions of Sections 34 and 57 of the Education Act, 1944, was not maintained. The total rose almost to its former level. The largest increase was in those referred to E.S.N. schools, both boarding and day. Those remaining at ordinary school with special help also increased. The figures for statutory examinations do not include 14 children referred to-the Medical Adviser of the Inner London Education Authority for pre-school assessment. Prophylaxis 1. Measles Vaccination Little progress was made with the measles vaccination programme as, in March 1969, the use of the vaccine was suspended by the Department of Health and Social Security. 2. Diphtheria Immunisation and Poliomyelitis Vaccination. The review of the immunisation against diphtheria and vaccination against poliomyelitis continued. The percentage of Southwark schoolchildren who have been protected against Poliomyelitis has remained steady although the Diphtheria figure has fallen very slightly. The average for the whole of Inner London has risen during the year. 102 Diphtheria Poliomyelitis Southwark 89.0 86.3% I.L.E.A. Area 88.1 87.6% 3. B.C.G. Vaccination against tuberculosis was offered to all children in the 12—13 age group. Handicapped Register The review of handicapped children is now a well established part of the School Health Service. During the year a Principal Medical Officer visited the schools with an Assistant Nursing Officer to discuss the problems of these children with school nurses and Head Teachers. The Senior Assistant Medical Officer continued her regular visits to Thurlow Park Day School for Physically Handicapped Children. She worked in co-operation with the social workers of the Invalid Children's Aid Association who are involved with these children and often undertook home visits for her. The close co-operation with the Welfare Department and Youth Employment Service continued and I was represented at the South Bank Employment Committee's Handicapped Young Persons Sub-Committee. Student Health Service The advisory student health service continued at the London School of Printing, the Southwark College for Further Education and the Camberwell School of Arts and Crafts. The visiting medical officers work in close co-operation with the College staff. National Child Development Study The second follow-up of children involved in the original survey, that is those born between 3rd and 9th March 1958, was begun towards the end of the year on behalf of the Study group. Health Visitors interviewed parents and, where possible, completed home reports. Hearing tests were arranged at their schools for the children involved, audiology reports were obtained and medical examinations were conducted at special sessions. Preparation of reports on the completed cases was in hand at the end of the year, prior to their despatch to the Study group. Health Education A total of 338 talks were given by members of the staff on a wide range of subjects, including the following:- Accident prevention — Anatomy and biology — Ante natal and child care — Dental care — Environmental Health and Social Services — Family planning and sex education (including venereal diseases) — Housewifery and parenthood — Infectious diseases and immunisation — Nutrition, infant feeding and food hygiene — Personal Hygiene, general health and first aid — Smoking, drugs and alcoholism. Secondary schoolchildren were invited to observe the work at Day Nurseries, 103 Welfare Centres and Mothers' Clubs. The Health & Home Safety programme arranged for groups of children was held this year at four health services centres throughout August with films, group participation exercises and competitions. As usual, the programme was changed each week. The number of children attending rose to approximately 1,100. Social Work (Health Services) The Social Work Section (Health Services) is concerned with (a) social work arising out of school and hospital clinics and (b) intensive casework with families with multiple problems. The Social Workers concerned with the School Health Service are jointly appointed by the Inner London Education Authority and the London Borough of Southwark, and have a responsibility for special investigation clinics, audiology clinics, selected eye clinics, and selected clinics at Guy's Hospital. At special investigation clinics, children are seen who suffer from enuresis, obesity and minor behaviour problems. The social workers make contact with the homes and work with the clinic doctor in dealing with the total family situation where this is appropriate. The work may be of a short or long term nature depending upon the problem and the needs of the family. At audiology clinics, the social worker is one of a team consisting of the otologist, school nurse and social worker. Close contact is maintained with the peripatetic teacher of the deaf and the staff of the schools for the deaf and partially hearing. The social workers have continued to give support to the families of deaf children including those where the child is at boarding school. At Guy's Hospital a full-time senior social worker continued to maintain close liaison and advised on all local authority services available for the school child and the handicapped pre-school child. During the year, members of the staff attended various conferences and day courses and student social workers from the London School of Economics and the School Care Committee Service, have been received in the Department for training. Arrangements were made with Chiswick Polytechnic for two students on the Certificate in Social Work course to undertake a fieldwork placement in the department with two of the family caseworkers as supervisors. The Chief Social Worker has lectured to Health Visitor Instructors on courses at Chiswick Polytechnic and to students on courses run by the London Boroughs Training Committee. Family caseworkers have also given talks to voluntary workers at settlements and schools. 104 School Roll - (May) 49,350 Medical Inspections Sessions attended by Medical Officer Ordinary Schools 1,361 E.S.N. Schools 231 School Journey Medicals 73½ Further Education 75 National Child Development Survey 29 Examinations Routine examinations at ages 5, 7, 11 & during the last year at school 17,859 Non-routine examinations 12,308 Examinations to ascertain fitness for employment 374 Statutory Examinations Children examined under Sections 34 & 57 of the Education Act 1944 194 As a result of these examinations the following recommendations were made:— Admissions to Boarding E.S.N. Schools 10 Admissions to Day E.S.N. Schools 117 Admissions to Day Schools for the Physic ally Handicapped 1 Admissions to Junior Training Schools 4 Admissions to Open Air Day School 2 To remain at ordinary school with special educational help 59 Referred to The Medical Adviser l.L.E.A. for reassessment 1 Decision deferred Clinic Attendances Vision Clinics Sessions 415 Total attendances 4,182 Number of new cases 1,031 Errors of refraction or squint 3,526 Other eye defects 16 Spectacles ordered 1,530 Audiology Clinics Sessions 78 Total attendances 799 Number of new cases 260 Special Investigation Clinics Sessions 377 Total attendances 2,294 Number of new cases 320 105 Minor Ailments Sessions — Medical Officer Nursing Sister 1,720 Total attendances 11,871 Number of new cases seen by medical officer Number of new cases seen by nursing sister 2,430 Number of new cases per 1,000 school population 49 Cases treated Athletes foot, verrucae, skin diseases, eye & ear defects, bruises, lacerations etc. 2,430 Prophylaxis Diphtheria — Primary Courses 153 — Booster Doses 327 Measles — - Poliomyelitis — Primary Courses 190 — Booster Doses 1,196 B.C.G. — Mantoux tested 5,810 — Vaccinated 5,036 — Mantoux positive 354 School Nursing Health Surveys:- Comprehensive — Total number examined 34,505 — Percentage found verminous 1.47% Selective — Total number examined 13,526 — Percentage found verminous 2.91% Audiometry Number of children given sweep tests 9,587 Number of children given pure tone tests 585 Number of children referred to otologist 283 Report on the Principal School Dental Officer Over the past five years the percentage of children at school dental inspections found to need treatment has shown a steady fall. This pattern has been observed not only in Southwark but throughout the Inner London area. Unfortunately this does not necessarily indicate a fall in the level of dental disease, but rather a greater awareness on the part of parents of the importance of dental care, and a more extensive use of the facilities for treatment. More children are having regular dental treatment and are starting to attend at an earlier age. The amount of treatment for children has increased not only in the school dental service but also in the general dental service. Dental health education has no doubt contributed to this improved state of affairs but, in the long term, prevention is not only better but less costly than cure. The best way to deal with dental disease is as far as possible to prevent it happening. One of the most effective and positive n eans of 106 achieving this objective is to adjust the level of the fluoride in the public water supply to that which has been found to be of greatest benefit to children's teeth. Orthodontics A considerable number of children with irregular and unsightly teeth can benefit from orthodontic advice. In many cases treatment may be unnecessary or may be no more than the judicious extraction of overcrowded teeth. For the more complicated cases appliances are needed. Any orthodontic service however should be under the control and supervision of a qualified and experienced orthodontist. The appointment of a sessional orthodontist early in 1969 was a step forward in the development of the service in the Borough. Sessions were held each week at Bermondsey Health Centre and children were referred from all other clinics for consultation and treatment. It was hoped to increase the number of sessions per week as the service expanded. Dental officers in the other clinics were enabled to treat the simpler cases under the supervision of the Orthodontist. Inspection and Treatment School inspections fell during the year to 43% of the school roll. This was because of the need to deal with the increased demand for treatment arising from the expansion of dental inspections during the previous two years. Until additional surgeries are available, thereby enabling more staff to deal with the demand for treatment, the target of an annual school dental inspection for all children will not be reached. Visits for treatment were up by 5% over the previous year. More children were opting for school dental treatment and the number of broken appointments per session fell from 3.1 to 2.9. There was a considerable increase in the number of fillings in permanent teeth and for every permanent tooth extracted, fifteen were filled. Gas sessions were down by 30% and there was a continuing decrease in the percentage of those seen in school who required treatment. Premises and Equipment The modernisation of equipment in the existing dental clinics was completed during the year. The furnishings of waiting rooms and surgeries were also improved and as far as equipment and furniture are concerned, the standard of the Borough dental surgeries compares favourably with any in the school dental service. No new surgeries were opened during the year, as owing to unforeseen difficulties the provision of additional surgery accommodation at Bermondsey Health Centre was delayed. Discussions continued during the year to bring into use the rooms in two of our largest secondary schools. These rooms had been intended for use as dental surgeries when the schools were first built but had since been used for other purposes. There are many advantages to having dental surgeries in large schools, particularly in the saving of pupil's time and the elimination of broken appointments. As well as this, the presence of dental staff in the school helps children to accept dental care as a natural procedure and they are more likely to continue to have regular dental attention after they leave school. 107 Staff The staff situation remained good during 1969 and although one full time dental officer retired and one resigned the vacancies were filled by the appointment of sessional dental officers, a number of whom were recent graduates of Guy's Dental School. In December the post of Senior Dental Officer was filled with the appointment of Mr. A. Longden. The Chief Dental Officer completed the one year course and was successful in obtaining the diploma in Dental Public Health of the Royal College of Surgeons. Two members of the staff attended the annual conference of the British Dental Association at Bournemouth in June. One dental officer attended a Course on Child Dental Health at the London Hospital and other courses attended included one on organisation for Public Dental Officers in November and a Conference on Dental Health organised by the General Dental Council. Four dental surgery assistants attended a one day course on Dental Radiography. Visitors to the Borough during the year included the Dental Adviser of the I.L.E.A. who in January visited all the Borough Clinics. In October four students on the Dental Public Health Course spent a full day in the Borough and observed the Dental Services in operation. Other visitors included Dr. Snyman, the Director of the Johannesburg Coronation Dental Infirmary. Dental Health Education In the early part of the year a painting competition was held in all the clinics in the Borough in connection with dental health. There was a most encouraging response and at the judging and prize giving which was held at the end of term at St. George's Health Services Centre, over 200 people attended including parents, children and others interested. The programme commenced with a puppet show on dental health followed by the prize giving by Pierre the Clown. In September and October the I.L.E.A. Health Educator and the Borough Dental Auxiliary combined in touring 40 infant schools with the I.L.E.A. Dental Health Puppet Show. The response from pupils was striking and in many cases schools followed up the puppet show by having either an essay or painting competition based on what they had seen and remembered. At the end of the year a Christmas project was held at St. George's Centre during which Santa Claus gave each child a tube of toothpaste and a packet of nuts and crisps. As well as these activities, the usual visits to schools were made by the dental auxiliary and the total number of sessions given to dental health education rose by over a third compared with the previous year. 108 1969 ANNUAL STATISTICS SCHOOL DENTAL SERVICE TOTAL SCHOOL ROLL 49,350 1969 1968 Number of sessions: Inspection 180 208 Ordinary Treatment 2,877 2,839 General anaesthetic 54 85 Orthodontic 42 — Health Education 325 234 Total sessions: 3,478 3,366 1969 1968 Inspection: number of children given: First inspection at school 17,000 19,782 First inspection at clinic 4,106 4,952 Percentage found to require treatment 57.1 58.9 Reinspection at school clinic 1,958 2,240 Percentage found to require treatment 86.0 77.3 Percentage of school Roll inspected 43.0 50.0 Visits for treatment: Number of first visits 4,879 4,788 Number of subsequent visits 13,079 12,285 Total visits 17,958 17,073 Emergencies 477 427 Additional courses commenced 1,547 1,520 Number did not attend 8,502 9,155 Treatment given: Number of fillings: In permanent teeth 10,349 8,521 In temporary teeth 6,110 6,090 Number of extractions: of permanent teeth 551 497 of temporary teeth 2,428 2,381 Number of other operations (prophylaxis, X-rays, inlays, crowns, etc.) 7,391 5,388 Courses of treatment completed 4,188 4,836 109 1969 1968 Orthodontics: Number of new cases 24 25 Number of removable appliances fitted 35 12 Number of fixed appliances fitted 1 1 Number of cases referred to Hospital Consultant 5 19 Sessional averages: First visits: 1.6 1.6 Subsequent visits 4.4 4.2 Emergencies 0.2 0.1 Did not attend 2.9 3.1 Fillings: In permanent teeth 3.5 3.0 In temporary teeth 2.1 2.1 Extractions: of permanent teeth 0.2 0.2 of temporary teeth 0.8 0.8 Ratio of permanent teeth filled to permanent teeth extracted 15.5:1 14.9:1 Ratio of temporary teeth filled to temporary teeth extracted 2.2:1 2.2:1 110 APPENDIX A RULES FOR ADMISSION TO THE COUNCIL'S DAY NURSERIES 1. The first priority for admission shall be given equally, subject to the other rules, to the children (including adopted children) of: (a) mothers who are widows, separated or divorced wives, or wives whose husbands are totally disabled or in prison or unmarried mothers, provided they are maintaining an independent home and are employed at least 35 hours a week including meal times; (b) parents where the mother is in ill-health and cannot care adequately for the children, or during the mother's confinement; (c) parents who are living in housing conditions detrimental to health, or where other environmental factors are such that it is desirable for the health of the child that it should be admitted to a day nursery; and (d) widowers or where the mother has left the home. 2. The second priority for admission shall be given, subject to the other rules, to the children of parents where, because the father is unemployed or his earnings are so low, the mother is compelled to go to work as an economic necessity and is employed at least 35 hours a week, including meal times, provided the joint net income of the parents as calculated in accordance with approved rules does not exceed £10 a week. 3. Vacancies not required for children in the first and second priority classes shall be offered to other children in a third priority class whose parents are both working if able to do so (the mother being employed for at least 35 hours a week, including meal times), and whose joint net income, as calculated in accordance with approved rules, exceeds £10 a week. 4. In assessing applications for all admissions an overriding consideration shall be that the parent(s) is/are unable to make satisfactory arrangements for the care of the children. 111 APPENDIX B HEALTH DEPARTMENT ESTABLISHMENTS Maternity and Child Welfare Centres Amott Amott Road, S.E.I5. Bermondsey Health Centre Grange Road, S.E.I. Bird-in-Bush Old Kent Road, S.E.I5. Consort Consort Road, S.E. 15. Denmark Hill Blanchedowne, S.E.5. Health Services Dept. Larcom Street, S.E. 17. John Dixon 6/8 Drummond Road, S.E.16. Kingswood Bowen Drive, S.E.21. Lordship Lane 475 Lordship Lane, S.E.22. Mayward House Benhill Road, S.E.5. Redriff Redriff Road, S.E. 16. St. George's Health Services Centre 151/152 Blackfriars Road,S.E.I. Salomon's Guy's Hospital, S.E.I. Silwood Alpine Road, S.E. 16. Sumner Road Basingstoke House, S.E. 15. Sutherland House Sutherland Square, S.E. 17. Townley Townley Road, S.E.22. Villa Street Villa Street, S.E. 17. School Treatment Centres Camberwell Addington Square, S.E.5. Camberwell Sub-Centre Comber Grove School, S.E.5. Gordon Road Gordon Road, S.E. 15. Redriff School Redriff Road, S.E. 16. St. George's Health Services Centre 151/152 Blackfriars Road, S.E.I. Bermondsey Health Centre Grange Road, S.E.I. Health Services Dept. Larcom Street, S.E. 17. John Dixon 6/8 Drummond Road, S.E. 16. Lindley 163 Commercial Way, S.E. 15. Lordship Lane 475 Lordship Lane, S.E.22. Day Nurseries Bishops House Kennington Park Place, S.E.I 1. Dog Kennel Hill Dog Kennel Hill, S.E.22. Lympstone Lympstone Gardens, S.E. 15. Merryfield Sultan Street, S.E.5. Queen's Road St. Mary's Road, S.E. 15. Whitstable Stevens Street, S.E.I. 112 Disinfecting and Cleansing Stations King James'Street S.E.I. Neckinger S.E. 16. District Nurses Benson Home Sancroft Street, S.E. 11. Peckham Road 29 Peckham Road, S.E.5. Bermondsey 108 Grange Road, S.E. 1. Foot Clinics Rotherhithe 1 Thaxted Court, Abbeyfield Rd., S.E. 16. Amott Amott Road, S.E. 15. Bermondsey Health Centre Grange Road, S.E.1. Bird-in-Bush Old Kent Road, S.E. 15. Health Services Dept. Larcom Street, S.E. 17. John Dixon Drummond Road, S.E. 16. Lordship Lane 475 Lordship Lane, S.E.22. Peckham Road 29 Peckham Road, S.E.5. Caroline Gardens Asylum Road, S.E. 15. St. George's Health Services Centre 151/152 Blackfriars Road, S.E.I. Creche St. Peter's Church Hall Dulwich Common, S.E.21. Consort Road S.E. 15. Kingswood Bowen Drive, S. E. 21. Sutherland House Sutherland Square, S.E. 17. Townley Townley Road, S.E.22. Bird-in-Bush 616 Old Kent Road, S.E.15. Sumner Basingstoke House, Sumner Rd.,S.E. 15. St. George's Health Services Centre 151/152 Blackfriars Road, S.E.I. Mental Health Training Centres Crispin House (Adult) 49 Grange Walk, S.E. 1. Kirkwood (Junior) Kirkwood Road, S.E. 15. Peckham (Junior) Studholme Street, S.E. 15. Day Centres Castle Hampton Street, S.E. 17. Camberwell Benhill Road, S.E.5. Special Care Unit Derwent 56 East Dulwich Grove, S.E.22. 113 Hostel Dover Lodge Wood Vale, S.E.23. Evelyn Coyle 49a Grange Walk, S.E. 1. Gibson House 12 The Grange S.E.I. Mortuary Tennis Street, S.E. 1. S.E. London G.P. Centre St. Mary's Road, S.E. 15. Home Help Offices Bermondsey Health Centre Grange Road, S.E.I. Town Hall Peckham Road, S.E.5. Lordship Lane 20/22 Lordship Lane, S.E.22. Offices H.Q. Castle House 2 Walworth Road, S.E.I. Area 1 Larcom Street, S.E. 17. Area 2 Spa Road, S.E. 16. Area 3 29 Peckham Road, S.E.5-. Area 4 20/22 Lordship Lane, S.E.22. 114 APPENDIX C EMERGENCY ARRANGEMENTS FOR HEALTH DEPARTMENT SERVICES During Office Hours All emergency calls, except those for the domiciliary midwifery service, are made to the headquarters offices, Castle House, 2 Walworth Road, S.E.I (telephone number 703 6363). Outside Office Hours (including weekends and public holidays). All emergency calls are made to the Lambeth Town Hall, Brixton Hill, S.W.2 (telephone number 274 7722). Domiciliary Midwifery Service All emergency calls both by day and by night—including weekends and public holidays-are made to Lambeth Town Hall, S.W.2 (telephone number 274 7722). District Nursing Service can be obtained by telephoning 735 1335, between 8.00 a.m.— 10.30 p.m. daily (including weekends). 115 ■ ' INDEX Abortion Act, 1967 20, 34 Cremations 62 Accidents in the home 48, 49 Cytology-cervical 45 Adoption and boarding-out 96 Advisory Committees 32, 37 Advisory and preventive clinics 33, 37 Day centres 54 Analysis of food and drugs 83 Day nurseries Analysis of water 62 Council 16,111 Analysis of ice cream 86 Private 18 Ante-natal clinics 15, 16,112 Deaf children 23,105 Artificial kidney machines 35 Death Assessment charges for services 100 causes of 10, 12 Audiology 23,105 classification 10, 12 infant 14 maternal 14 rates 14 Bacteriological examinations tuberculosis 14 eggs 90, 91 Dental service food 89 maternity and child welfare 26, 27 milk 86 schoolchildren 107-110 shell-fish 94 Development of voluntary effort 99 water 62 Diphtheria Immunisation 25,102,106 Bakehouses 61 Disinfection and disinfestation 69,113 Barbers & hairdressers 61 Disposal of unsound food 95 Bathing centres 69 District nursing 20,113,115 Bathing of Aged Persons 69 Domiciliary midwifery service 19,115 Baths statistics 19 personal cleansing 69 Drainage 60 swimming 61 B.C.G. vaccination of schoolchildren 103 Births 19 Blind and partially sighted persons 34 Early discharge of maternity patients 20 Boarding-out 96 Egg products 91 Emergency arrangements 115 Case conferences 30, 31 Environmental Health Services 60 Cervical cytology 36 Establishments 112 Charges and assessments for services 100 Chest clinics 98 Factories Act, 1961 78 Child-minders 18 Family caseworkers 30 Child welfare centres 15,112 Family Planning 32, 46 Children & Welfare Committees' Family Planning Act, 1967 32 Establishments 96 Feral Pigeons 61 Chiropody 34, 99,113 Finance 100 Clean Air Act, 1956, 1968 81, 82 Fireguards, loan of 29 Cleansing stations 69,113 Fluoridation 28, 62 Clearance areas 80 Food & Drugs Acts 83, 89 Closing Orders 80 Food Common Lodging Houses 61 hygiene regulations 87-88 Community care 33 imported 89-94 Confinement 19, 20 poisoning 68 Co-operation with doctors and hospitals 32 premises 61 Co-ordinating Committee 31 sampling 83-94 Co-ordination of social services 31 unsound & legal proceedings 70, 83-88 Creches-occasional 17,113 Foot clinics 34, 99,113 117 Hairdressers & barbers 61 Mental health service Handicapped and Observation community care 58,113 Register 16, 22,103 day centres 53,113 Handicapped junior training schools 53,105,113 children 16, 22 residential accommodation i 51, 56 pupils 103 short-term care 56, 59 Health Committee 5 social clubs 56 Health special care units 55 education and home safety 15, 26, 46 staffing 51 48, 82,103 statistics 57 108 Midwifery service 20,115 service establishments 112 Milk sampling 86 surveys 106 Miscellaneous 96 visiting 21 Mobile health clinic 35 Health Services and Mortuary 69 Public Health Act, 1968 15 Home bathing service 69 Home help service 29,114 Home nursing 20 Home nursing equipment, loan of 28 Neo-natal mortality 19 Home safety 48 Notifiable diseases 66 Houses in multiple occupation 80 Notification of infectious diseases 66 Housing Nurseries & Child-Minders Regulation Inspection of dwelling houses 79 Act. 16 Proceedings-Public Health Acts 79 Nursing Homes 34 Proceedings-Housing Act 1957 79 Observation (At Risk) & Handicapped Register 22 Ice-Cream sampling 86 Occasional creches 113 Illegitimate births 14 Offensive trades 60 Immigrants-medical arrangements 33 Office, Shops and Railway Premises Immunisation and vaccination 25,102,106 Act, 1963 70 Imported food 89-94 Outworkers 79 Incontinent laundry service 69 Infant mortality 14 Infant welfare Perinatal mortality 19 clinics 112 Personal cleansing stations 69 sessions 16 Personal health services 15 Inner London Education Authority- Pest control 82 School Health Service 101 Pet Animals Act, 1951 61 Inquests 70 Pharmacy and Poisons Act, 1933 61 Phenylketonuria 23 Pigeons 61 Playgroups 18 Junior training schools 55,105,113 Poliomyelitis vaccination 24,102,106 Population 14 Laundry service 69 Post mortem examinations 70 Legal proceedings 81 Premature births 19 Loan of fireguards 29 Prevention of Damage by Pests Act, home nursing equipment 28 1949 82 Prophvlaxis 24, 25,102 106 Maternal mortality 14, 19 Pupils on school rolls 102,105 Maternity and child welfare centres 15,112 services 15, 99 Measles 24, 66 Medical Recuperative holidays 33 examination of staff 98 Relaxation classes 20 inspection of schoolchildren 105 Removal of remains of deceased priorities for rehousing 81 persons 69 treatment of schoolchildren 105 Rent Act, 1957 81 118 61 Residential accommodation Swimming baths 69 (Mental Health) 56 Rodent control 82 Tetanus immunisation 24 Tuberculosis Samples care and after-care 33 food and drugs 83 chest clinics 98 ice cream 86 deaths 14 milk 86 notifications 66 water 64 Typhoid fever 66 Sanitary circumstances of the area 46 Scabies & vermin 69 School dental service 106,109 Unsound food 88 School health service 101 School nursing service 106 School population 102 Vaccination and immunisation 24,102,106 Sewerage and sewage disposal 61 Venereal disease 47 Shellfish 94 Vermin & scabies 69 Smallpox vaccination 24 Verminous premises. 69 Smoke control 81 Vision testing 105 Social Work (Health Services) 30,104 Vital statistics 14 South-East London General Practitioner's Voluntary effort-Development 99 Centre 96 Voluntary organisations 99 Special advisory clinics 32, 37 Special care units (mental health) 55 Staff 17 Water supply 62 Staff-attachment of 32 Water supply, fluoridation of 28, 62 Staff medical examinations 98 Welfare & Children's Committees' Statistics, vital 14 establishments 96 Stillbirths 14 Well women clinics 36, 45 Surveys 106 Whooping cough immunisation 24 119 Printed and Published by London Borough of Southwark