I Sou 80 London Borough of Southwark ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1970 CONTENTS Page INTRODUCTION 1 HEALTH COMMITTEE 3 STAFF 5 VITAL STATISTICS 18 PERSONAL HEALTH SERVICES 22 COMMUNITY CARE SERVICES 42 ENVIRONMENTAL HEALTH SERVICES 64 MISCELLANEOUS 113 SCHOOL HEALTH SERVICE 120 APPENDICES 134 INDEX 139 Health Department, Municipal Offices, Castle House, 2 Walworth Road, SE1 6SU To The 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 1970. 1970 was a year in which the health services continued to develop and several new projects were completed. One of these projects was the Tuke Junior Training School which provided facilities for 95 sub-normal children and a special care unit for 20 mentally and physically handicapped children. The Education (Handicapped Children) Act received royal assent during the year and this new building will from 1st April 1971 be transferred to the Inner London Education Authority. The Health Committee, were aware of the high risk of flooding particularly in the northern part of the Borough, and agreed to the purchase of two dinghies as "flood aids" which would facilitate the Department's activities in the event of an emergency. As a result of a request by the Royal Society of Health, the mobile health clinic was on display at the Royal Society of Health Congress held at Eastbourne in April. The accompanying staff answered many questions raised by the delegates and numerous enquiries were later received within the Department regarding the setting-up of our scheme. The Local Authority Social Services Act received royal assent in 1970. The services the Health Committee have developed in recent years which will be transferred to the new Social Services Committee include mental health, day nurseries, playgroups and child-minders. Of course it may be some time before the new Social Services Department is in a position to accept responsibility for all the services due for transfer. 1 In September, Dr. James my deputy was appointed Medical Officer of Health for the London Borough of Bexley. While congratulating Dr. James on his welldeserved promotion, the Department was sorry to lose a stalwart whose work in developing the services following the amalgamation in 1965 was invaluable. It was also with regret that I learnt of the death, after a comparitively short illness, of Mr. T. Maxwell, former Chief Administrative Officer in the Department. Our sympathies go to Mrs. Maxwell and family. I would like to take this opportunity of thanking all the members of the Health Committee and other Committees of the Council together with members of the Health Department staff for the support given to me during 1970. I am, Mr. Mayor, Aldermen and Councillors, Your Obedient Servant, J.E. EPSOM Medical Officer of Health, and Principal School Medical Officer. 2 HEALTH COMMITTEE Chairman: Councillor Mrs. C.M. Clunn Vice-Chairman: Councillor R. Richards Members: Alderman W.A. Miller (resigned 21.9.70) Alderman J.H. Pascall (appointed 21.10.70) Councillor Mrs. L.M. Brown Councillor Mrs. P.C. Cooper Councillor C.B. Cumming Councillor Mrs. E.S. Daymond Councillor W.L. Ellis Councillor C.A. Farrow Councillor Mrs. M.G. Farrow Councillor R.C. Gent Councillor M.P. Mulligan Councillor A.P. Pritchett, T.D.,F.S.V.A. Councillor A.E. Smith Ex-Officio: Councillor N.H. Tertis, F.Inst.Ch. F.R.S.H.S.R.Ch. Councillor J.H. O'Grady Councillor R.W. Ames, M.I.E.E., F.I.E.S. Mayor of the London Borough of Southwark Leader of the Council Leader of the Opposition Co-opted Members: Mr. H.T. Ball Mrs. V. Holliday Miss A.G. Liddle Mrs. T. Soltesz Mr. J .R. Thomas Members of the Health Committee represented the Council on the following organisation:- Association of Sea & Air Port Health Authorities Alderman Miller Councillor Mrs. C.M. Clunn (from 8.12.70) Bexley Hospital Management Committee Councillor R. Richards Bird-In-Bush Welfare Centre Voluntary Councillors Mrs. P.C. Cooper and Committee Mrs. E.S. Daymond 3 Cane Hill Hospital Management Committee Dr. M.S. Kataria & Mr. H.G. Lamborn Family Welfare Association (Area 7 Committee) Councillor Mrs. E.S. Daymond Friends of St. Giles'Association Councillor R. Richards Greater London Home Safety Council Councillor N.H. Tertis National Association for Maternal and Child Welfare Councillor R. Richards National Council for Home Help Services — Executive Committee Councillor A.E. Smith National Health Service — Inner London Executive Council Councillor R. Richards National Society for Clean Air Councillors C.B. Cumming, Mrs. E.S. Daymond and R.C. Gent Salomon's Welfare Centre Voluntary Councillors Mrs. L.M. Brown and Committee Mrs. P.C. Cooper South London Family Service Unit Management Committee Councillor Richards Southwark (Camberwell) Chest Care Councillors Mrs. E.S. Daymond and Committee M.P. Mulligan Southwark (Southwark & Bermondsey) Councillors Mrs. L.M. Brown, C.B. Chest Care Committee Cumming, Mrs. E.S. Daymond & Mrs. L.C. Marshall South West Metropolitan Regional Hospital Board — London Liaison Committee Councillor R. Richards Standard Conference on Atmospheric Pollution Councillor R. Richards The Board of Governors of: Bethlem Royal & Maudsley Hospitals Mr. H.G. Lamborn Guy's Hospital Alderman A.J. Kemp, former Councillor Rowe & Alderman Mrs. I.B. Thomas King's College Hospital Mr. F.J. Francis & former Councillor Cullingham 4 HEALTH DEPARTMENT STAFF AT 31 DECEMBER, 1970 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.,F.R.S.H. Deputy Medical Officer of Health Aileen B. Ridout, M.B.,B.S.,M.R.C.S., L.R.C.P.,D.P.H. Principal Medical Officers Eileen L. Power, M.B.,B.Ch.,B.A.O.,N.U.I.,L.A.H.,D.P.H. Suzanne Collett, L.R.C.P.,L.R.C.S.,L.R.F.P.S.,D.P.H.(School Health) 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.R.C.S.,L.R.C.P. Medical Officers — 10 Sessional Medical Officers — F.T.E. — 5.3 Director, South East London General Practitioners' Centre B.H. Pentney, M.R.C.S.,L.R.C.P. Chief Dental Officer and Principal School Dental Officer J. Cleary, B.D.S. Dental Officers: Full-time - 4. Sessional - F.T.E. — 2.2 Dental Surgery Assistants - 9. Dental Auxiliary - 1. Chief Administrative Officer A.V. Tibbitt, D.M.A.,Dip.,Soc.(Lon). Deputy Chief Administrative Officer C. Burgess 5 Senior Administrative Officers Mrs. A. Howell H.D. White J.A. Keane J.W. Adams E.J. Wicks G.A. Chappelle Administrative and Clerical Staff Full-time - 125. Part-time — F.T.E. — 8.4 Health Education and Home Safety Officer E. Clark Chief Public Health Inspector Harold Archer, F.R.S.H.,F.A.P.H.I. 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 1 Senior Housing 1 Senior Smoke 1 Student Public Health Inspectors — 12 Technical Assistants — 19 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.N.,H.V. Assistant Chief Nursing Officers 3 Centre Superintendents 9 Health Visitors 45 T.B. Visitors 5 Student Health Visitors 14 Clinic and School Nurses 40 Senior Environmental Visitor 1 Environmental Visitors 4 Superintendents Home Nursing 2 Deputy Superintendents, Home Nursing 1 District Nurses 57 District Nurses (S.E.N.) 6 6 Clinic Auxiliaries — F.T.E 11 Nursing Auxiliaries 4 Midwives 9 Day Nursery Staff 99 Chief Social Worker (Health Services) Mrs. S. Hutchings, C.S.W. Deputy Chief Social Worker (Health Services) Mrs. M.M. Hill, B.Sc.,A.I.M.S.W. Social Workers 7 Family Case Workers 3 Welfare Officers (Chest Clinic) 2 Chief Mental Welfare Officer Mrs. M. Day, S.R.N.,M.S.M.W.O. Deputy Chief Mental Welfare Officer P. Symonds, C.S.W.,M.S.M.W.O. Mental Welfare Officers Full-time - 15 Part-time - F.T.E. - 0.3 Joint appointment with hospitals — 4 Trainees — 4 Senior Occupational Therapists Full-time — 1 Joint appointment with St. Olave's Hospital — 1 Mental Health Escort — 1 Junior Training Schools Head Teachers — 2 Teachers - 10 Special Care Unit Supervisor - 1 Assistant Supervisor - 3 7 Adult Training Centre Supervisors — 4 Assistant Supervisors — 6 Day Centres Supervisors — 3 Deputy Supervisors — 3 Assistant Supervisors — 5 Hostels Wardens — 3 Deputy Wardens — 3 Assistant Wardens — 4 Chief Chiropodist K. Heaton-Ward, M.Ch.S.,S.R.Ch. Chiropodists: Full-time - 6 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 - 5 Home Helps — 553 — F.T.E. — 371 Manual and Domestic Staff Staff of various categories — F.T.E. — 131 8 9 TABLE 1 CLASSIFICATION OF DEATHS WITH AGE DISTRIBUTION CAUSE OF DEATH Sex All Ages Under 4 weeks 4 Wks & under 1 year B4 Enteritis and other Diarrhoeal Diseases M 2 - 1 F 1 - 1 B5 Tuberculosis of Respiratory System M 9 - - F - - - B6(l) Late effects of Respiratory T.B. M 4 - - F 1 - - B6(2) Other Tuberculosis M 3 - - F - - - B11 Meningococcal Infection M 1 - - F 1 - - B17 Syphilis and its Sequelae M 2 - - F 6 - - B18 Other Infective and Parasitic Diseases M 2 - - F 3 - - B19(l) Malignant Neoplasm, Buccal Cavity etc. M 4 — - F 8 - - B19(2) Malignant Neoplasm, Oesophagus M 16 - - F 1 - - B19(3) Malignant Neoplasm, Stomach M 57 - - F 30 - - B19(4) Malignant Neoplasm, Intestine M 42 - - F 51 — — B19(5) Malignant Neoplasm, Larynx M 2 - - F 1 - - B19(6) Malignant Neoplasm, Lung, Bronchus M 201 - - F 44 - - B19(7) Malignant Neoplasm, Breast M - - - F 69 — — B19(8) Malignant Neoplasm, Uterus F 25 - - B19(9) Maligant Neoplasm, Prostate M 16 - - B19(10) Leukaemia M 8 - - F 5 - - 10 TABLE 1 AGE IN YEARS 1 - 4 5-14 15-24 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 & over - - - - - - - - - — — — — - — — — — — — — 1 1 1 2 1 3 - - - - - - - - - — - - - - 2 1 1 - - — — — — - — 1 — - - - 1 - - - 1 1 - - - - - - - - - — — — — 1 — - 1 1 1 — — — - - - - - - - - - - 1 - 1 - — — — — - - - 1 5 — — 1 - - - 1 - - - 1 - 1 — - - — 1 — — - — - 1 1 1 1 - 1 - - — — 3 — 4 - — - - - - 1 8 7 - - - - - - - - 1 — — — — 2 4 19 19 13 - - - - 2 2 4 7 15 — — — 1 — 3 10 17 11 - - - - 1 4 10 15 21 — — — - - — 1 1 - - - - - - - - - 1 - - - - 2 12 74 78 35 — — - 1 — 4 15 13 11 — — — — — — — — — - - 1 1 4 9 23 18 13 - - - 1 4 - 6 9 5 - - - - - 1 3 3 9 1 1 - - - 2 1 2 1 1 - - - - 2 - - 2 11 CAUSE OF DEATH Sex All Ages Under 4 weeks 4 Wks & under 1 year B19( 11) Other Malignant Neoplasms M 111 - F 102 - - B20 Benign and Unspecified Neoplasms M 3 - 1 F 5 - - B21 Diabetes Mellitus M 9 - - F 15 - - B46(l) Other Endocrine etc. Diseases M 2 - - F 7 - - B23 Anaemias M 5 - - F 9 - - B46 (2) Other Diseases of Blood, etc. M 1 — 1 F — — — B46(3) Mental Disorders M 7 - - F 9 - - B24 Meningitis M 1 — — F - ~ - B46 (4) Multiple Sclerosis M 1 - - F 2 - - B46 (5) Other Diseases of Nervous System M 17 - 1 F 20 — — B25 Active Rheumatic Fever M 1 - - F — — — B26 Chronic Rheumatic Heart Disease M 16 - - F 33 ~ - B27 Hypertensive Disease M 22 — — F 44 - - B28 Ischaemic Heart Disease M 400 — - F 262 - - B29 Other Forms of Heart Disease M 51 - - F 100 - - B30 Cerebrovascular Disease M 104 - - F 180 - — 12 AGE IN YEARS 1 - 4 5-14 15 - 24 25 - 34 35 - 44 45 - 54 55-64 65 - 74 75 & over - 2 2 1 9 10 28 32 27 ~ - 1 2 4 11 26 25 33 - — — — — — — — 2 - — - - - 2 - 2 1 - - - - - 1 2 5 1 — — — - — 1 1 3 10 - - - - - - - 1 1 - - — — — — 1 3 3 - - - - - - - - 5 2 - - - - - 1 1 5 — — — - - - - - - - - - - - - — - — - - 1 1 - 1 1 1 2 - - - - - - - 1 8 - - - — — — — - 1 — — — — — - - - - - - - — - — 1 — - — — — - - 1 1 - - 1 - 2 1 1 1 3 3 4 1 — 1 - 1 - 3 4 10 - 1 - - — — — - - — — — — — - - - - — — - - - 5 4 4 3 — 1 2 - 2 5 6 5 12 — — - - 2 3 4 8 5 - - - - - 1 6 10 27 — — 2 - 14 46 108 126 104 - - - - 1 5 28 79 149 - — — — 2 1 6 19 23 — - 1 2 1 3 3 13 77 — — 1 - - 6 20 33 44 - — 1 1 2 10 14 40 112 13 CAUSE OF DEATH Sex All Ages Under 4 weeks 4 Wks & under 1 year B46(6) Other Diseases of Circulatory System M 65 - - F 78 — - B31 Influenza M 9 — — F 20 - - B32 Pneumonia M 143 - 4 F 181 1 7 B33(l) Bronchitis and Emphysema M 164 - - F 60 — — B33(2) Asthma M 3 — - F 8 - - B46(7) Other Diseases of Respiratory System M 20 - 3 F 14 — 1 B34 Peptic Ulcer M 20 - - F 11 - - B35 Appendicitis M 2 - - F - - - B36 Intestinal Obstruction and Hernia M 4 - - F 9 - - B37 Cirrhosis of Liver M 4 - - F 2 - - B46 (8) Other Diseases of Digestive System M 8 - - F 28 - - B38 Nephritis and Nephrosis M 8 - - F 10 — — B39 Hyperplasia of Prostate M 4 - - B46(9) Other Diseases, Genito-Urinary System M 7 - - F 14 — — B40 Abortion F 1 - - B46(10 Diseases of Skin, Subcutaneous Tissue M — — — F 1 - - B46(ll) Diseases of Musculo-skeletal System M 5 - - F 9 - - 14 AGE IN YEARS 1 - 4 5 - 14 15-24 25 - 34 35 - 44 45 - 54 55-64 65 - 74 75 & over - - - - 1 5 10 28 21 - - - - 1 3 9 11 54 - - - - 1 - 1 4 3 — — — — 3 1 2 8 6 - - - - 1 5 17 25 91 - - 1 - - 4 1 25 142 — - — — 2 7 31 69 55 — - — — — 3 7 14 36 — — — — — — 2 — 1 - - - - - 2 1 3 2 — — - - - 2 6 4 5 - - - - - 1 - 3 9 - - - 1 - - 5 7 7 - - - - - 1 - 5 5 — — - - 1 - - - 1 — — — - - - - - - - - - - - - - 2 2 - - - - - - 1 2 6 — — — — — 2 1 - 1 — — — — — 1 - 1 - — — — 1 - 1 3 1 2 - - 1 - - - 2 6 19 — - — - - 2 3 1 2 - - 1 - - - 1 4 4 - - - - - - - - 4 - - - - - 1 1 2 3 - - - - 1 - 4 3 6 - 1 - - - - - - — - - - - — — — - - — — — — — — — 1 - - - - — — — — 1 4 — — — — — — — 3 6 16 CAUSE OF DEATH Sex All Ages Under 4 weeks 4 Wks & under 1 year B42 Congenital Anomalies M 21 6 5 F 16 3 5 B43 Birth Injury, Difficult Labour, etc. M 10 10 - F 7 7 - B44 Other Causes of Perinatal Mortality M 9 9 - F 8 8 — B45 Symptoms and Ill Defined Conditions M 1 - - F 7 - - BE47 Motor Vehicle Accidents M 17 - - F 15 - - BE48 All Other Accidents M 26 — 2 F 18 - 1 BE49 Suicide and Self-inflicted Injuries M 15 - — F 15 - - BE50 All Other External Causes M 11 - - F 5 - - TOTAL ALL CAUSES M 1,696 25 18 F 1,571 19 15 16 AGE IN YEARS 1 - 4 5-14 15-24 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 & over 2 - 2 2 1 1 - - 2 3 2 - - - - 2 1 - - - - - - - - - - - — — — — - - - - - - - - - - - - - - - - - - - - - - - - - - - — - - 1 - - - - - - - 1 6 - - 4 1 2 3 2 3 2 - 1 - 1 - 3 1 5 4 1 2 1 3 1 4 6 1 5 1 - 1 - - 2 4 2 7 — — 2 4 3 1 2 2 1 — — 1 - 1 1 6 4 2 1 - 3 - 2 - 1 2 2 - - - 1 - - 2 - 2 6 6 21 18 49 135 382 518 518 9 7 12 11 28 82 194 352 842 17 VITAL STATISTICS, 1970 Area of Borough (including area covered by water) 7,115 acres Population (Registrar General's estimate mid-1970) 284,690 Number of inhabited houses 88,684 Rateable Value (April, 1970) £19,068,839 Sum represented by a penny rate £72,000 Births Total Legitimate Illegitimate Live Births — Male 2,085 1,809 276 Female 1,965 1,683 282 4,050 3,492 558 Still Births — Male 23 20 3 Female 16 15 1 39 35 4 Birth rate per 1,000 population 14.2 Number of deaths — all ages 3,267 Death rate per 1,000 population 11.5 Infantile Mortality Deaths under 1 year 77 Infant deaths per 1,000 live births 19 Maternal Mortality Deaths of women from diseases or accidents associated with childbirth, including abortion 1 Maternal death rate per 1,000 total births 0.24 Deaths from pulmonary tuberculosis 14 Death rate per 1,000 population 0.05 Deaths from cancer of lung and bronchus 245 Death rate per 1,000 population 0.86 Deaths from all forms of cancer 793 Death rate per 1,000 population 2.73 18 VITAL STATISTICS - Greater London Area and England and Wales Greater London Area England and Wales Live births per 1,000 population 15.2 16.0 Deaths per 1,000 population 11.3 11.7 Infantile mortality (deaths under 1 year) per 1,000 live births 17.8 18.0 Maternal mortality per 1,000 total births 0.17 0.18 19 TABLE 2 Maternity and Child Health Services (a) Child Health Sessions Number of children attending in 1970 born in: 1970 3,390 1969 3,547 1968 - 66 4,744 Total attendances 59,216 Total sessions 2,673 Total sessions held at General Practitioner surgeries at which Council staff were present 129 (b) Ante and Post — Natal Sessions First attendances 94 Total attendances 192 Total number of sessions 60 Facilities provided for General Practitioner Obstetricians: Total number of sessions held in clinics 231 20 TABLE 3 Births Live Births Hospital confinements 3,821 Domiciliary confinements 229 4,050 Still Births Hospital confinements 37 39 Domiciliary confinements 2 Deaths of infants in first week of life 33 Deaths of infants one week to one month 11 Deaths of infants one month to one year 33 Perinatal mortality per 1,000 total live and stillbirths 18 Neonatal mortality per 1,000 live births 11 Infant mortality per 1,000 live births 17 21 PERSONAL HEALTH SERVICE Maternity and Child Welfare Each of the Council's seventeen Health Service 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 also provided at two centres run by voluntary committees with grant aid from the Council. Mothercraft classes were conducted by health visitors at some centres, in which instruction was provided in home-making, budgeting, simple cookery and so on. Health visitors also provided health education talks, gave advice on feeding difficulties and the general management of children. All health visitors keep in touch with general practitioners in their area and there is also close co-operation with the staff of Childrens and Welfare Departments and many voluntary organisations working within the Borough. Details of clinic attendances for the year are given in Table 2, page 20. Day Care of Children under 5 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 Chi ld-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. 22 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, special units to accommodate severely subnormal children are attached to three day nurseries. Certain other handicapped children are admitted free of charge on the recommendation of a case conference. Where children in the highest priority group are unable to attend one of the Council's day nurseries, 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 needs on the same basis used for determining charges at the Council's nurseries. Number of Day Nurseries at 31st December, 1970: 6 Number of places 341 Number of Special Unit places 30 Total attendances during 1970 72,808 Total attendances at Special Units during 1970 4,557 Occasional Creches Creches are provided at five of the Council's centres, at one voluntary centre and at one church hall where children are minded while their mothers are taking part in centre activities, visit hospital or attend to shopping and other domestic duties. The charge at the Creches is 15p. per session, abateable in necessitous cases. No charge is made when the parent attends hospital or takes part in the Centres activity. Where two or more children from one family attend, the charge is 7)4p for the second and subsequent child. Number of Creche attendances during 1970 1,070 Total attendances during 1970 16,718 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 a part or parts thereof of a duration, or an aggregate duration, of 2 hours or longer, or for any period not exceeding 6 days; 23 (ii) of persons in their area who for reward receive into their homes children under the age of 5 to be looked after as aforesaid. The amendments introduced by Section 60 of the 1968 Act considerably extends the coverage of the Act by including within the requirements to register anyone who minds children to whom she is not related for a reward for at least 2 hours a day. The Act gives clear definitions of fitness of persons and premises It widens the powers of Local Authorities to impose requirements and at the same time increases the penalities for failure to register. Registration of Premises Persons proposing to open a day nursery or playgroup are visited by the Deputy Medical Officer of Health or the Assistant Senior Medical Officer and the Playgroup Organiser who inspect the premises concerned and outline the requirements the Council would be likely to impose if registration were recommended. Advice is given on staffing, equipment, the need to obtain planning permission and the need to obtain instructions on fire precautions. At the end of 1970, 44 statutory registered private nurseries and playgroups were providing places for 945 children. Child Minders Visits of inspection as described above are carried out by the Deputy Medical Officer of Health or the Assistant Senior Medical Officer and the Playgroup Organiser to persons who are required to register as child minders. These visits are essential, not only for inspection purposes but to advise and assist the child minder in the care of the young children in her charge. At the end of the year the number of statutory child minders had increased to 247 (102 in 1969) providing places for 467 children (200 in 1969). Urban Programme—Playgroups I indicated in my report for 1969 that approval has been given under Phase 2 of the Urban Programme for the appointment of a Playgroup Organiser and for financial assistance, up to a total of £30,000 to aid the formation of 20 non-profit making playgroups. The Playgroup Organiser was appointed in April 1970, with the task of stimulating public interest in playgroups, encouraging their formation and maintaining standards by inspection and advice. 24 By the end of the year 10 new grant aided playgroups had opened, financial assistance had been given to prevent the closure of an existing group and to expand another group. Survey on Playgroups The department was asked by the Home Office to collaborate with the National Children's Bureau in a survey on the development of playgroups. Preliminary meetings were held with representatives from the Home Office, the Director and representatives from the National Children's Bureau and the Social Services Department. Domiciliary Midwifery To meet the needs of mothers wishing to have a home confinement 9 domiciliary midwives were employed by the Council. The Council lost the services of three midwives employed by the General Lying-in Hospital to cover a selected area of the Borough when the Hospital closed in July. The midwives visit the expectant mothers to assess the suitability of the home for domiciliary confinement or its suitability for the mother and her baby to return home to the care of the midwife 48 hours after confinement in one of the local hospitals. The number of domiciliary confinements during the year fell to 195 of which 3 were premature births and 2 were stillborn. The number of 48 hour discharges, however, rose to 624. Five of the Council's midwives are approved teachers under the Central Midwives Board second training scheme. During the year 26 pupils completed 3 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 midwives on home visits. Maternal Deaths Two deaths assigned to maternal causes or associated therewith were investigated on behalf of the Department of Health and Social Security. One of these was due to abortion. 25 TABLE 4 Domiciliary Midwifery Service Administration of Analgesia 71.04% Cases booked with G.P. Obstetrician 80.40% Number of Midwives at end of year Full time 9 General Lying-in District — Doctor not booked Doctor present at delivery — Doctor not present at delivery 4 Doctor booked Doctor present at delivery 45 Doctor not present at delivery 154 Number of hospital deliveries attended by Midwives on discharge before 10th day 624 Percentage of domiciliary live births born premature 2.11% TABLE 5 PREMATURITY AND MORTALITY BY BIRTH WEIGHT Weight Live Prem. Births Proportion per 100 live prem. births Deaths in 24 hours Survivors at 28 days No. Per 100 live prem. births No. Per 100 live prem. births 2 lb. 3 oz. or less 1 10.00 1 10.00 2 lb. 4 oz.—3 lb. 4 oz. 3 lb. 5 oz.—4 lb. 6 oz. 4 lb. 7 oz.—51b. 8 oz. 9 90.00 9 90.00 All cases 10 100.00 1 10.0 0 9 90.00 26 District Nursing The District Nursing service is provided directly by the Council only on the recommendation of the patient's general practitioner with whom the nurse works in close co-operation. (See p. 2/S Attachment of Staff to G.P.'s). Nursing auxiliaries continued to be employed to work under the direction of and carry out duties not requiring the skills of a trained nurse. The psychiatric liaison schemes with St. Olaves Hospital and the geriatric liaison schemes with the New Cross and St. Francis Hospitals continue providing a smoother transfer for patients from hospital to community care. During the year 7 students completed their district nurse training for the National Certificate of District Nursing. Many student nurses from the King's and Guy's group of hospitals accompanied the district nurses on their visits. In addition 6,606 visits were made to psychiatric patients including those to 225 new patients. 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 Health Visitor is a practitioner in her own right, detecting cases of need on her own initiative as well as acting upon referrals. The following table indicates the volume of work undertaken during 1970 by the District Nursing Service: New patients visited 3,554 Total number of visits 133,971 Nursing staff employed at 31.12.70 (f.t.e.) 63 Visits per nurse (f.t.e.) 2,127 27 The main aspects of her work are:- (1) The prevention of mental, physical and emotional ill health and its consequences in all age groups (2) The early detection of handicap and ill health and the surveyance of high risk groups (3) Identification of need and mobilisation of the appropriate resources to meet the need (4) Provision of care—this includes support during periods of stress and advice and guidance in cases of illness as well as in the care and management of children (5) 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 liaison with local hospitals continued. A Health Visitor attended King's College Hospital Diabetic Clinic and made follow-up visits to patients, giving advice on diets and general management. In October 1970 a Health Visitor was attached to the Paediatric Department of King's College Hospital to follow-up with children and families living in Southwark as does the Health Visitor attached to the Newcomen Assessment Centre at Guy's Hospital. The part of the Health Visiting Services which is measurable is shown in Table 6. Attachment of Staff to General Practitioners No further progress was possible in the attachment of nursing staff to general practitioners due to the shortage of qualified staff but the existing attachment of 3 full time health visitors and 5Vi district nurses continued. 28 Handicap and Observation Register The objects of the register are:- (1) To follow up those children who are at risk of developing a handicap because of genetic, pre-natal or post-natal history and to observe their developmental progress. (2) To ensure that all possible help is given to handicapped children and their families. (3) To obtain all necessary information to help these functions to be carried out and to assist medical research. TABLE 6 Health Visiting First visits to: Children born in 1970 4,868 Children born in 1969 5,408 Children born in 1965—1968 11,618 Total 21,894 Aged over 65 386 Mentally disordered 149 Persons discharged from hospital (other than mental hospitals) 52 Infectious diseases 138 Total of all visits made by health visitors 96,667 29 The information on which the register is based is provided by hospitals, general practitioners, domiciliary midwives, clinical medical officers and health visitors. The assistant senior medical officer decides if a child shall be included in the register and is responsible for assessing the continuing reports on a child. During 1970 visits were made to all the Infant Welfare Centres and 5,317 such reviews were made in consultation with the health visitors concerned. In addition hospital reports were requested and received on children who were under observation. Since the register was greatly extended, from 1st April 1965, over 10,000 children have been followed up. They have been removed from the register when they have been considered to be developmentally normal, retained if they needed further observation and help or transferred to the School Health Service when they were receiving formal education i.e. nursery classes or specialised schools. At 31 December, 1970 there were 3,615 children on the register, an average of 82 being added each month. The number of babies notified during the year as congenitally malformed was 86. Close liaison with the Newcomen Centre at Guy's Hospital has been maintained. Southwark bears 50% of the cost of a specialists service and provides a health visitor for the necessary follow-up for children and families in the Borough. The Deputy Medical Officer of Health conducts an assessment session at the Newcomen Centre and holds special assessment clinics at the child welfare clinics in the Borough. During the year 197 appointments were made. Reports from the Newcomen Clinic were received on all Southwark children who attended the clinic and the appropriate recommendations were carried out. (It was noted during the year that a much closer liaison was developing with the Hospitals in the area). 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. The names of such children were added to the handicapped register. 30 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 may have a damaging effect on the brain. Screening for the detection of phenylketonuria using the Guthrie test were carried out routinely on all young babies; those thought to be at special risk we retested. Prophylaxis Protection is offered in child health centres against diphtheria, whooping cough, tetanus, poliomyelitis and measles, to children below school age. Special sessions are also held in schools where necessary. In addition B.C.G. vaccination against tuberculosis of children aged 12 to 13 is carried out in schools. Vaccination may also be carried out by the family doctor and vaccines are supplied to general practitioners free of charge by the Council. Statistical information is set out in Table 7 page 38. Dental Services Although there was no marked increase in demand nevertheless the amount of treatment carried out was greater than the previous year. There were more fillings and fewer extractions for children under 5. The number of courses completed was approximately 27% higher. The amount of treatment for expectant and nursing mothers continued at the very low level at which it has been for some years past. Guy's Hospital The Guy's Dental School Mobile Clinic continued to operate in the Borough during the year. Children attending Kirkwood and Tuke Junior Training Schools and those in Special Units at three of the day nurseries were examined and treated. This most valuable work has been of great importance in the dental care of children attending these schools and it is intended that it will continue. During the year also the dental auxiliary visited the hospital schools at Evelina and Guy's Hospitals and carried out dental health education sessions which 31 were greatly welcomed by the hospital staff and which the children found most interesting. This was a new departure and one which can be of great value in preserving the dental health and hygiene of children who are obliged to spend some time in hospital. Day Nurseries All day nurseries in the Borough had a dental inspection again during the year and the figures showed that of 264 children examined 58 were in need of treatment. This figure of 22% compares with 25% in the previous year. Although it is not possible for the parents to be present nevertheless the information that their children do need treatment can be of value to them. Conversely the information that their children are dentally sound has at least relieved them of one possible source of anxiety. Statistics relating to the dental service for expectant and nursing mothers and children under 5 are set out in Table 8 page 34. 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. In my last report I referred to the publication of the Government report on the Studies and Results of 11 years of fluoridation, which confirmed yet again that fluoridation was completely safe. As long ago as 1966 the Council expressed its unqualified support for the proposal to fluoridate the water supply. Unfortunately the Metropolitan Water Board will not be able to take this action until there is a clear decision among the London Boroughs in favour of the recommendation. It is hoped that in the near future it may be possible to implement this most desirable and effective public health measure. 32 33 TABLE 7 VACCINATION AND IMMUNISATION STATISTICS FOR PERIOD1st JANUARY to 31st DECEMBER 1970 AGE 0-3 months 3-6 months 6-9 months 9-12 months 1 year 2-4 years 5-15 years TOTAL 1970 1969 Smallpox: Primary 2 6 5 3 798 1,227 190 2,231 2,213 Re-vaccination - - - - 4 38 210 252 187 Other Immunisation: Others Completed primary courses (born in) 1970 1969 1968 1967 19631966 under age 16 TOTAL 1970 1969 Triple DTP 1,085 1,785 150 42 41 9 3,112 3,366 Diphtheria/Pertussis - 6 - - - 1 7 — Diphtheria/Tetanus 9 31 7 11 184 90 332 359 Diphtheria - - - - 1 - 1 5 Pertussis - 2 - - - - 2 — Tetanus - 2 1 - 2 21 26 21 Salk - - - - - - - 3 Sabin 1,081 1,803 200 81 260 159 3,584 4,775 Measles 14 1,220 681 235 356 66 2,572 1,472 Reinforcing (booster) injections: Triple DTP 1 594 1,113 146 255 25 2,134 2,562 Diphtheria/Pertussis - 2 6 - 24 1 33 - Diphtheria/Tetanus - 25 70 24 2,222 616 2,957 2,590 Diphtheria - - - - 15 2 17 9 Pertussis - - - - 1 3 4 2 Tetanus - 1 - 2 29 60 92 114 Salk - - - - - - - 2 Sabin 10 546 906 145 2,416 1,921 5,944 4,086 TABLE 8 Maternity and Child Welfare Dental Services Children under 5 Expectant and Nursing Mothers 1970 1969 1970 1969 Inspections Number inspected 492 490 16 16 Number requiring treatment 263 255 16 16 Attendances First Visits 241 264 20 18 Subsequent Visits 448 438 36 23 TOTAL visits 689 684 56 41 Courses of treatment completed 190 157 15 3 Treatment Fillings 560 474 30 40 Extractions 129 140 8 5 General Anaesthetics 45 49 - 1 Other Treatment 294 348 40 36 Dentures Number of Patients supplied with dentures 3 - Number of Dentures supplied 4 - Number of Sessions Devoted to M.C.W. Service 1970 1969 Inspection and Treatment 98 104 Dental Health Education 18 18 TOTAL 116 122 34 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 4,762 households during the year, and 9,333 households were visited by the organising staff. The specially trained home helps worked with problem families for a total of 1631 hours and 1309 hours were given to morning and evening help cases. The Chief Home Help Organiser gave talks not only at in-service training courses within the Borough, but also at courses arranged by 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 both to the students and the local authority by provoking interest and knowledge of the services provided. 35 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. The items on issue at 31st December 1970 from the Council's stock were as follows:- (The figures in brackets show the number of items on loan at 31.12.69.) Items On loan Air rings 96 (55) Back rests 127 (45) Bed blocks 13 (28) Bed cradles 88 (24) Bed side rails 5 ( 2) Commodes 756 (710) Dunlopillo mattresses 23 (24) Easi-carri hoists 14 (17) Feeding cups 19 ( 6) Fracture boards 48 (38) Hospital beds 19 (24) Penryn hoists 45 (59) Quadruped walking aids 3 ( 4) Ripple beds 7 ( 4) Rubber bed pans 97 (35) Rubber toilet seats 17 ( 2) Tripod walking aids 12 ( 7) Urinal bottles 75 (32) Zimmer hoist 1 ( 1) Zimmer walking frames 100 (55) 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 633 (573) on loan. 36 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 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. The Social Worker for the Deaf monitored a scheme for deaf and partially hearing children to attend two of the Inner London Education Authority's play groups during school holidays. Teachers for the deaf were responsible for the children who were able to spend most of their time with normal children. Arrangements were also made for a number of young deaf children under the age of 7 years to attend a special holiday playgroup. 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. 37 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 referrels come to the caseworkers from the Borough Co-ordinating Committee's case conferences. 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 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. 38 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 Childrens Officer Vice Chairman Chef Welfare Officer Housing Manager Town Clerk Divisional Officer (Education) District Officers (G.L.C. Housing Department) Deputy Medical Officer of Health) Deputy Childrens Officer) Co-opted Members Clief 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. 39 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. 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. 40 During the course of the year the Council assumed control of the remaining clinics operated by the Family Planning Association in Council Premises. Three additional sessions were approved under the Urban Aid Programme, Phase 3, and one of these was commenced in November making a total of 8 sessions a week. 343 sessions were held during the year and 5,520 attendances made, of which 1,518 were first attendances. Per capita payments were continued in respect of Southwark residents attending Family Planning Association clinics and to the Brook Advisory Centre for unmarried persons over 16 resident in Southwark. 41 COMMUNITY CARE 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 by a medical officer from Southwark on behalf of nine other London boroughs. During the year 52 existing establishments were inspected and 16 new homes were added to the approved list. A total of 179 adults, 48 children over five years and 28 under five years were sent on a recuperative holiday. Arrangements were also made with the Inner London Education Authority on behalf of 229 children over five years and 9 children under five years. 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 principal medical officer continued to visit and advise the matrons on aspects of health, hygiene, prevention of accidents and other matters. 42 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 (see Table 9). TABLE 9 Examination of the Blind and Partially Sighted Number of examinations arranged 210 Initial examinations 71 Re-examinations 139 Number certified as blind 51 Number certified as partially sighted 154 Number found to be neither blind nor partially sighted 5 Blind certificates accepted from hospitals 27 Partially sighted certificated accepted from hospitals 21 Blind certificates accepted from other local authorities 3 Partially sighted certificates accepted from other local authorities 1 Cytological diagnosis of early uterine cancer—Well Women clinics: At these clinics each person attending has a full gynaecological examination, their blood pressure taken and a urine test. During the year 1,538 attendances were made at the 129 sessions held in the four clinics in the Borough. 669 persons were found to have no abnormality, 15 were found to have carcinoma of the cervix. 7 had some breast pathology and 681 had a gynaecological disorder. Table 10 gives details of the abnormalities found. 43 TABLE 10 Cervical Cytology Vaginal Discharge Trichomonas Vaginitis 41 Monilia 16 Non-specific 40 Cervicitis 45 Vulvo-vaginitis (Atrophic) 1 Cervical erosion 130 Ectropion 1 Cervical polyp 24 Cystocoele and rectocoele 22 Urethral Caruncle 1 Urinary abnormalities 1 Fibroids 18 Ovarian cysts 2 Menstrual Irregularities 73 Salpingitis 1 Breast pathology 7 Thyroid enlargement 1 Post Menopausal Bleeding 10 Dual ftthology 158 Hypertension 3 Inflammatory Nuclear Change 77 Senile (Atrophic) changes 16 N.A.D. Nothing abnormal detected 669 44 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 together with a report on the physical examination are sent to the general practitioner. All persons attending the clinic for the first time are referred for a mass X-ray and if they are unable to attend on their own, transport is arranged for them. Advice is also given on maintaining standards of health and hygiene and on benefits and aids available to them. A fourth clinic was opened in November and during the year 132 sessions were held and there were 412 attendances. 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 organisation. At 1st January, 1970 there were 12 men boarded out; 4 were placed during the year, and 15 were still in care at 31 December 1970. 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 information in several languages is handed out to immigrants at sea and air ports of arrival. 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, 411 advice notes of arrivals were received and 212 "first" successful visits made. 45 Chiropody Difficulty in the recruitement of chiropodists to the Council's service continued to be experienced. In an effort to improve the situation for the future, the Council accepted the sponsorship of two trainee chiropodists at recognised chiropodial training schools. At 31st December, 1970, the number of chiropodists employed was 1 chief, 6 senior and 5 sessional (2.3 full-time equivalent). Attendance figures in respect of the 3,560 sessions held during the year at 10 different clinics are shown in Table 11. TABLE 11 Chiropody Males & Females Males Females M & F Age groups 0-4 5-14 15-64 65+ 15-64 65+ Totals Persons attending 1 23 116 806 416 3,772 5,134 Total attendances 2 71 701 4,167 2,153 19,109 26,203 46 Home Dialysis Adaptations were completed during the year at the home of a patient for whom an application for the provision of home dialysis facilities was received towards the end of 1969. Three new applications for the provision of such facilities were received during 1970; one from Guy's Hospital and two from Lambeth Hospital. One of the patients concerned was rehoused in a property suitable for adaptation and the work was completed during May but. unfortunately, the patient died four months later. Adaptations to the homes of the other two patients were still in progress at the end of 1970. Mobile Health Pilot Clinic The health screening survey of Southwark residents between the ages of 16 and 60 by means of a mobile health clinic proceeded throughout the year. The mobile clinic continued to be of considerable interest to visitors from various parts of Britain; special visits to view the clinic were also arranged for doctors from countries as far apart as America, Ceylon and Japan. On 29th January, to mark the 50th anniversary of the opening of the Salomon's Centre at Guy's Hospital, a lecture entitled "Preventive Medicine in Southwark - Present and Future" was given by me, highlighting the increasingly important role of community medicine. The film "Put to the Test" which was produced in 1969 by Granada Television for its "World in Action" series and which illustrates the work undertaken by Southwark's mobile health clinic, was shown to the invited audience and the mobile health clinic was put on display within the hospital grounds. In February, a Keystone Vision Screener was added to the clinic's equipment and this greatly facilitated the speed and accuracy with which sight testing could be carried out. Also at this stage, a routine inspection of the mobile clinic by the local Fire Prevention Officer was arranged to ensure that appropriate fire safety precautions were being taken. For one week at the end of April, the mobile health clinic was displayed at the Royal Society of Health Congress Exhibition at Eastbourne. Great interest in the clinic and its work was shown and it was estimated that more than 400 visitors, including delegates from Canada, Denmark, Germany, Holland and Japan, inspected the clinic during the period of the exhibition. 47 A dispute involving Council manual workers, including drivers, prevented the mobile health clinic from operating for a five week period during the autumn and, for four weeks towards the end of the year, the clinic's working week was reduced by half because of a shortage of medical officers. The clinic was also closed for four separate weeks at intervals throughout the year so that routine servicing and maintenance could be undertaken. Despite these interruptions to the health survey programme, 2,624 persons were examined at the clinic during 1970. 48 HEALTH EDUCATION AND HOME SAFETY The general planning of health and home safety education in this Borough is formulated by a Departmental Committee of the heads of each section and a working party with representative Health Visitors, School and Home Nurses, Day Nursery Matrons, Public Health Inspectors, etc. Thus all members of the staff who are involved in health education at administrative or field levels are enabled to participate in its basic organisation. A programme of special projects included such subjects as infectious diseases and immunisation; nuitrition; food, dental and personal hygiene; summer and winter health and accident risks. These were supplemented from time to time by publicity for various special clinics inaugurated by the Council and for particular national or local campaigns. Large scale issues of posters and leaflets were made to the Health Centres, Day Nurseries, the Area Health Offices, School Treatment Centres, notice board display sites, General Practitioners and Pharmacists in support of these various programmes, and where appropriate special teaching sessions were arranged in individual centres and schools. The section carries a stock of various visual aids which were in constant use for clinics, mothers' clubs, schools and other groups; demonstrations of this equipment were also held from time to time for the information of staff concerned. (See table 12). Smoking A long term national campaign on the health hazards of smoking organised by the Health Education Council at the end of last year, continued throughout 1970. The second phase commenced with a wide coverage of full page press advertisements which were later reproduced as posters for local support. A small pilot survey was organised at the same time to test reactions of school children to smoking. Approximately 200 boys and girls of an average age of 15 years were invited to complete a questionnaire anonymously. According to the replies 14 per cent of the female participants in girls' schools and 43 per cent of the male subjects in boys' schools admitted to smoking. In mixed schools however, the position was reversed with 27 per cent of the girls smoking and only 6 per cent of the boys. Several of the children commented that the current antismoking posters were not sufficiently 'frightening'. 49 TABLE 12 Health Education Summary of Activities: Leaflets and booklets issued 6,217 dozen Posters issued 4,636 Films (No. of screenings) 373 Projector equipment used 328 Talks: Adults Children (No. of sessions) Maternal and Child Health 127 26 Housewifery, Parentcraft 61 17 Sex Education, Personal hygiene 10 67 Nutrition, Food Hygiene 10 5 Home Safety 11 6 Dental Hygiene 7 51 Smoking, Drugs 2 23 Infectious Diseases, immunisation 1 8 Environmental health and social services 21 21 Miscellaneous 40 4 Total 290 228 Schools Summer Vacation Programmes of films and talks for children were again arranged, as in previous years, during the month of August. These sessions were held at five welfare clinics on consecutive days with a different programme for each of the lour weeks period. Whilst basically focused on health and accident prevention, the items were carefully selected to provide general interest as well as instruction and to allow active participation by the children in quiz contests, group activities and home exercise competitions on the subjects covered. Small prizes were given and 1130 children attended. 50 Mothers' Clubs These continue to function successfully in providing a valuable social link between mothers and the health clinics. The Health Education section is involved in arranging films for these programmes. Displays A Civic Exhibition was held in June as part of the Council's Summer Festival, and included a large display produced by the Health Education section, illustrating the main services of the Department. This was followed a week later by an open air fete, where a smaller version of the same display was arranged with very successful results. In September, at the request of the London College of Printing in Southwark, a display was organised as part of the Induction Course for overseas students. Particular emphasis was given to suitable clothing, nutrition, food hygiene, accident prevention and smoking. Following a lecture by a Medical Officer, students were conducted around the display by a Health Visitor. General Practitioners and Pharmacists An approach was made by the South East Metropolitan Branch of the Pharmacists' Society and the South East London Chemists' Association requesting a closer liaison with the Health Department for the exchange of information and participation in health education. This co-operation, together with that of many general medical practitioners in the Borough who accept regular despatches of health education leaflets for their waiting rooms—is most valuable and greatly appreciated. Accident Prevention A large proportion of the resources of this section is devoted to accident prevention in the home. Although detailed analyses of home accidents are not available it is encouraging to note that deaths either directly or indirectly caused by an accident have shown a slight decrease over the last three years. (See table 13). 51 52 TABLE 13 Home Accident Deaths — Southwark Residents (Deaths in which accidents in the home were the primary or contributory cause) Excluding Suicides — bracketed figures are for the year 1969 CAUSE Injuries from falls (or presumed falls) Carbon Monoxide (Gas fumes) Asphyxia Fire fumes & other causes Drug Overdose Poisoning Chronic Alcoholism Burns & Scalds Electrocution Year 1970 1970 1970 1970 1970 1970 1970 Age 76+ Group Male 4 (2) 1 — — — 1 (1) — — — — — — Female 4 (11) 1 — 1 — — — — (1) — (2) — — 66-75 Male 1 (1) — — — — — — — — — — — — Female 4 (1) — (1) — — — (1) — — — — — — 51-65 Male 2 (2) — — — (2) — — 1 — — — — (1) Female 1 (1) 1 — — — 3 — — — — — — — 36-50 Male — — — — 2 — — (1) — (3) — — — — Female 2 — — — — — — — — (2) — — — — 26-35 Male 1 — — — — — 1 — — — — — — — Female — — — — — — — — — — — — — — 17-25 Male 1 — — — 1 — 1 — — — — — — — Female — (1) — — — — 1 — — — — — — — 11-16 Male — — — — — — — — — — — — — — Female — — — — — — — — — — — — — — 6-10 Male — — — — — — — — — — — — 1 — Female — — — — — — — — — — — — — — 0-5 Male — (1) — (1) 1 — 1 — — — — (1) — — Female — — — Age unknown — — — — — — — — — — Totals M 9 (6) 1 (1) 4 (2) 4 (2) 1 (3) — (1) 1 (1) F 11 (14) 2 (1) 1 — 4 (1) — (3) — (2) — — Water Safety The Royal Society for the Prevention of Accidents state that more than three quarters of the total drowning accidents in England and Wales occur in inland waters, and the age group most at risk is the 5 — 9 year olds. Water safety publicity by posters, leaflets, talks in mothers' clubs and schools has received particular attention during the summer months but is now being extended throughout the year. There were 3 fatal drowning accidents of Southwark residents in 1970 as compared with 5 in both 1969 and 1968. (See table 14). TABLE 14 Deaths from Accidental Drowning Age Group 1970 1969 76 Male — — Female 1 — 66-75 Male — 1 Female — 1 51-65 Male 2 2 Female — — 36-50 Male — 1 Female — — Totals Male 2 4 Female 1 1 Dental Hygiene The School Dental Service of the Inner London Education Authority has again given the closest co-operation with the Health Department in promoting dental hygiene education. The help of mothers has been enlisted to encourage children in the care of their teeth; films or short talks on the subject were included in the programmes for mothers' clubs and child health clinics. Education for dental care must be aimed at the very young child, and a 'soft approach' is necessary to allay any natural apprehension about the dental surgery. To this end a cut-out card representing a large tooth brush was designed on which children filled in spaces as they completed each morning and evening toothbrushing drill. These cards had to be signed by the parent and on completion the child was presented with a certificate. 53 The I.L.E.A.'s highly professional puppet show, with the villains representing the effects of dental neglect, again visited a number of schools in November and was seen by nearly 4,500 children. Visits were also paid to two children's hospitals. Schools are also continuing the Apple Club project initiated two years ago by the purchase of apples from local dealers for resale to children in an effort to cut down consumption of sweets. MENTAL HEALTH SERVICE Co-operation was maintained during the year with all organisations concerned with mental health and, in particular, close liaison with psychiatric hospitals continued. The Psychiatric Advisory Committee to the Medical Officer of Health, consisting of four consultants from psychiatric hospitals with catchment areas in the Borough, met on two occasions during the year. Matters discussed by the committee included Housing Associations, District General Hospital Services, the five-year programme of development and expansion of services, and the Handicapped Children's Unit at Bethlem Royal Hospital. Close co-operation between the hospital and local health authority services was maintained. Two Council nurses with psychiatric training continued to work within the catchment area of St. Olave's Hospital and, at 31st December, 1970, four mental welfare officers were employed on a joint-appointment basis with various psychiatric hospitals in the area. One occupational therapist was also jointly appointed with the hospital service; she made domiciliary visits to handicapped persons, gave instruction in a number of activities and was able to arrange limited payments to patients able to undertake light industrial work in their own homes. The Deputy Medical Officer of Health and the Chief Mental Welfare Officer met members of the National Health Service Hospital Advisory Service and discussed ways of increasing co-operation between the three branches of the National Health Service, particularly so far as the effects on mentally handicapped persons were concerned. The London Boroughs of Southwark, Lambeth and Wandsworth continued satisfactorily the arrangements whereby they dealt with calls and emergencies outside normal office hours on a shared basis (see APPENDIX C). During the first ten months of the year, Southwark's male mental health escort continued to assist other Boroughs on a payment basis and undertook a total of 178 escort duties. 54 The Council approved eight medical practitioners during the year under the Mental Health (Hospital and Guardianship) Regulations, 1960, for the purpose of Section 28 of the Mental Health Act, 1958. Southwark, together with other Inner London Boroughs, continued to utilise and share the cost of maintenance by the Greater London Council of the central index. The Council's policy of encouraging mental welfare officers to become qualified was continued and two such officers returned to duty during the year having obtained the Certificate of Social Work. At various periods of the year students from different colleges were seconded to the department for supervised periods of practical training ranging from 4 weeks to 6 months. Many visitors came to the department from various parts of Britain and abroad to see the different aspects of the Mental Health Service and Establishments. Doctors, medical students, nurses and nursing students, social workers and social work students were included amongst the visitors. The Chief Mental Welfare Officer and members of her staff also visited schools and various organisations to give talks on the Mental Health Services. Mentally III Day Centres Light industrial work for local firms continued to be undertaken by mentally ill persons in need of rehabilitation who attended the Camberwell and Castle Day Centres and the Evelyn Coyle Day Centre for the elderly mentally infirm. Attendance payments were introduced for persons attending the Day Centres. At Camberwell and Castle Day Centres these payments in each case consisted of 2½p per hour for attendance, plus a merit bonus of 10p per day giving a maximum weekly payment of £1.25. For the elderly mentally infirm attending Evelyn Coyle Day Centre there was an attendance payment of 5p per day, plus a merit and ability bonus of between 1½p and 5p per day giving a weekly maximum of 50p. One of the highlights for the elderly mentally infirm was a coach outing in May to see the blossom fields of Kent. 55 Mentally Subnormal Crispin House Adult Training Centre This purpose-built centre which can accommodate 180 trainees from about 16 years of age continued into its second year of operation. The training programme, designed to provide education and general social integration, domestic science and its specific social problems, workshop training and its specific social problems, was further developed. Attendance payments were introduced at this Centre, too, and consisted of 5p daily which, together with a daily merit bonus of between 5p and 20p gave a weekly maximum of £1.25. Arrangements made with the Inner London Education Authority enabled twice-weekly Evening Classes and a Club to commence at Crispin House during March. Normal Centre staff, who received appropriate fees from the Inner London Education Authority, acted as instructors at the classes which commenced after a short tea break at the end of the Centre's normal afternoon sessions. The evening classes provided a wide range of subjects including model making handicrafts and country dancing. Hostels Dover Lodge with places for 12 subnormal girls and Gibson House accommodating 12 subnormal youths continued to provide residential facilities. The girls and youths either had outside employment during the day or attended Crispin House Adult Training Centre. A special theatre visit, followed by a party at Dover Lodge, was arranged for the girls at Christmastide; the youths also had their own Christmas celebrations. Out Patients Clinic The out-patient clinic for subnormal adults continued to be held on one afternoon at fortnightly intervals at Crispin House. The clinic was again staffed by two consultants from Darenth Park Hospital. Kirkwood Junior Training School Kirkwood Junior Training School, Kirkwood Road, S.E.15 continued in operation throughout the year. Mid-day meals for the children were again provided from Inner London Education Authority school kitchens. Special coach outings to local parks were arranged for the children accompanied by staff on five half-days and two whole days during the Summer term. 56 Tuke Junior Training School and Special Care Unit On 12th January, 1970, the new purpose-built Tuke Junior Training School and Special Care Unit, 2a Harders Road, S.E.I5 was officially opened by the Rt. Rev. David Sheppard, Bishop of Woolwich, who also unveiled a commemorative plaque. The opening ceremony was attended by the Worshipful the Mayor, the Mayoress, Mrs. Freda Corbett, M.P., members of the Council, Chairman of Health Committees of neighbouring Boroughs, Medical Officers of Health from other Inner London Boroughs, consultants from local psychiatric hospitals, general practitioners; representatives from the Greater London Council, Inner London Education Authority and Mental Health Societies; Council Chief Officers and other staff. The school's name was chosen by the Health Committee because the Tuke family were associated with those concerned in improving the conditions and treatment of persons suffering from mental illness at the end of the eighteenth century. Daniel Hack Tuke, who died in 1895, was a physician who specialised in mental health. The school provides accommodation for 95 mentally subnormal children from the age of three and 20 mentally and physically handicapped children of all ages. The nursery wing, for mentally subnormal children of 3 to 5 years old, comprises two classrooms. Each classroom has direct access to its own storeroom and to an outside paved play area. The wing has lavatory accommodation specially designed for small children, bathroom, linen store, utility room and staff toilets. The classrooms for the older mentally subnormal children are designed on similar lines; those for the 5 to 11 year olds have access to a paved external play area but, because of the limitation of site space, the classrooms for the 11 to 16 year olds are situated at first floor level. At ground floor level two larger rooms have been specially equipped; one is used for domestic instruction and the other, which has special noise dampening facilities, is used for instruction in woodwork and similar skills. The largest single space is the multi-purpose hall which is equipped with gymnastic apparatus and has direct access to outside play areas. The kitchen is equipped to provide mid-day meals by using either frozen foods or conventional cooking methods. The head teacher's room, staff room, staff cloak room and medical inspection room act as a link and a buffer zone between accommodation for the mentally subnormal, and the mentally and physically handicapped. 57 The two classrooms of the special care wing are separated by large sliding doors which can be opened to form one very large free teaching area. These classrooms have direct access to outside play areas with an external store for outdoor equipment. Also, there are specially equipped lavatories, bathroom, utility room and linen store in this wing of the school. Central heating and domestic hot water is provided by two gas-fired boilers, natural ventilation is provided to all areas by windows and roof lights and forced ventilation is available in the kitchen. The school is equipped with a fire alarm system with call points and sirens which give a very clear warning above background noise. A separate fire main and hose reels are positioned so that any part of the school can be easily and quickly reached. Normal school activities were commenced at the beginning of the Spring Term, 1970; the children and staff were transferred from Peckham Junior Training School and Derwent Special Care Unit both of which closed permanently at the end of 1969. Short Term (Residential) Care Short term care arrangements for subnormal and severely subnormal persons, children and adults, continued to be made during 1970. Unfortunately, one of the residential homes, of which considerable use had been made in previous years, closed in February and this added to the difficulties experienced in securing suitable residential vacancies for short term care. Places provided at Council expense at local health authority, voluntary and privately maintained homes numbered 67; this was 57 fewer than in 1969. In addition, 22 short term care places were provided in hospital and 27 at Hilda Lewis House, an assessment unit opened on 1st April, 1970, under the auspices of Bethlem Royal Hospital. Transport In addition to the day-to-day transport facilities provided as part of the mental health services to take adults and children to and from the training centre, day centres, junior training schools and special care unit, numerous special transport arrangements were made during the year. On one occasion six children were taken to, and returned from, St. Leonards-on-Sea Sussex, for a two week holiday arranged by Southwark Society for Mentally Handicapped Children and many journeys were made in connection with long term and short term care placements. A departmental car was permanently available for use by mental welfare officers and occupational therapists. 58 The Radio Taxi Service administered by the London Borough of Lambeth was no longer available after August 1970. Alternatively arrangements were made for a radio taxi service to be available to Southwark mental welfare officers in cases of emergency outside normal office hours. During the early part of the year discussions took place with representatives of the London Ambulance Service in an effort to improve the service and reduce delays in the provision of ambulances for transporting mentally disordered patients to hospital in emergency and taking physically and mentally handicapped children to and from the special care unit each week for hospital physiotherapy treatment. Difficulties were experienced during a five week period in the autumn when a dispute involving Council and Inner London Education Authority manual workers including drivers, severely disrupted transport facilities. Meals normally provided by Inner London Education Authority School Kitchens could not be made available to Camberwell and Castle Day Centres, the Junior Training Schools and Special Care Unit. Parents were requested to provide their children with suitable packed lunches and special arrangements were made for mid-day meals to be provided at the Day Centres. Although some parents were able to take their children to, and collect them from, the special care unit, others were unable to do so and had to keep their children at home during this period. A number of the elderly mentally infirm persons were unable to travel to the Evelyn Coyle Day Centre during the dispute. Attenders at the adult training centre and junior training schools continued to be transported by hire coaches; these transport arrangements were unaffected. Transfer of Responsibility for Education of Mentally Handicapped Children The Education (Handicapped Children) Act, 1970, which received the Royal Assent on 23rd July, 1970, provided for the transfer of responsibility for the education of mentally handicapped children from local health authorities to local education authorities. The Secretary of State for Education and Science subsequently determined that the transfer of responsibility should take place on 1st April, 1971. Accordingly, close liaison and consultation with the Inner London Education Authority on the services, establishments and staff to be transferred was commenced and maintained during 1970. Towards the end of the year the head teachers of Kirkwood Junior Training School and Tuke Junior Training School and Special Care Unit attended meetings organised by the Inner London Education Authority to discuss various aspects of the change over. 59 Statistical information on the Mental Health Service is given in Tables 15 - 18. TABLE 15 Number of referrals during year Referred by Mentally Ill Mentally Handicapped and Severely Mentally Handicapped Under 16 Over 16 Under 16 Over 16 Totals M F M F M F M F General Practitioners 1 — 46 58 — — 1 — 106 Hospitals — 1 85 144 1 — 9 2 242 Local Education Authority 1 1 6 4 31 21 21 17 102 Police and Courts — — 10 7 — 2 — — 19 Others* 1 1 187 236 23 5 18 5 476 Totals 3 3 334 449 55 28 49 24 945 * Includes relatives, neighbours, Ministry of Social Security Reception Centres, other local authorities, etc. SUMMARY OF ACTION TAKEN IN RESPECT OF NEW CASES Admitted to hospital: Informally 24 Compulsorily: M.H. Act, 1959, Section 25 (for observation) 83 Section 26 (for treatment) 4 Section 29 (emergency admission for observation) 82 Other 11 Afforded community care 466 Given advice only 390 Total 1,060 60 TABLE 16 NUMBER OF PERSONS RECEIVING COMMUNITY CARE at 31st DECEMBER 1970 Type of Care Mentally Ill Elderly Mentally Infirm Mentally Handicapped and Severely Mentally Handicapped Totals Under 16 Over 16 M F M F M F M F Attendance at day centres, training — — — — — — — — — centres and special units 42 35 8 27 69 48 54 70 353* Home training 5 13 — — — — — 5 23 Residence in homes, hostels, etc. — — — — — — — — — Local authority (Dover Lodge) — — — — — — — — — Other — — — 11 — — 6 8** 25 Formal guardianship — — — — — — — 2 2 S.W. visits (awaiting admission to hospital — — — — — — — — — for long term res. care) — — — — — — — — — Totals 47 48 8 38 69 48 60 85 403 * Plus 34 Junior and 1 Adult patients from other Boroughs (and including 15 juniors and 1 Adult attending other Boroughs' centres). ** Plus 2 persons included below under formal guardianship. 61 TABLE 17 NUMBER OF MENTALLY HANDICAPPED AND SEVERELY MENTALLY HANDICAPPED 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) 23 7 8 8 46 In homes, hostels, etc. 28 4 13 15 60 Totals 51 11 21 23 106 TABLE 18 ESTABLISHMENTS AND NUMBER OF PLACES Number of Establishments Number of Places Totals Mentally Ill Elderly Mentally Infirm Mentally Handicapped and Severely Mentally Handicapped Junior Adult Under 16 Over 16 Under 16 Over 16 Training centres 2 1 — — — 175 180 355 Special units (in day nurseries) 3 — — — 29 — 29 Day centres 2 — 80 — — — 80 Hostels (Dover Lodge) 1 — — — — 13 13 (Gibson House) 1 — _ — 12 12 (Evelyn Coyle) 1 — — — — 12 12 Totals — 80 — 204 217 501 62 TABLE 19 ENVIRONMENTAL HEALTH SERVICES Number of complaints received 8,577 Inspections: Nuisance inspections 8,653 Re-inspections 10,909 House-to-House 114 Overcrowding 156 Offensive trades 12 Factories and workplaces 564 Outworkers' premises 38 Verminous premises and persons 939 Common lodging houses 81 Conveniences, public and private 408 Pet animal premises 59 Hairdressers and barbers 90 Rent Act, 1957 9 Miscellaneous inspections 8,324 Infectious diseases 1,542 Infectious diseases, visits to contacts and re-inspections 1,223 Drainage (new buildings): Inspections 4,723 Tests applied 2,020 Drains constructed 1,395 Drainage (existing buildings): Inspections 2,891 Tests applied 929 Drains found defective 130 Drains totally reconstructed 125 Drains repaired or partially reconstructed 465 Offensive Trades Type of Business Number of Register Fat extractors 2 Manure manufacturer 1 Skin dressers 5 Fellmongers 3 Glue and size manufacturer 1 Sixteen inspections of these premises were made 63 ENVIRONMENTAL HEALTH SERVICES Common Lodging Houses There are seven common lodging houses in the Borough, four for women and three for men. 81 inspections were made during the course of the year. Hairdressers and Barbers During the year 90 inspections were made to the 237 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 15 sites in the Borough. The estimated total number of pigeons frequenting these sites was 4,400 and 3,169 were caught. Pet Animals Act, 1951 Twenty premises are registered under this Act and 59 inspections were made during the year. Pharmacy and Poisons Act, 1933/41 There are 134 persons included in the Council's list of sellers of Part II poisons: 51 inspections were made. Registration of Food Premises Under the provisions of Section 16 of the Food and Drugs Act, 1955, 41 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 219 inspections of these premises were made. Bakehouses There are 33 bakehouses in use and 61 inspections were made during the year. Sewerage and Sewage Disposal All houses in the Borough are connected to the main drainage system. The sewage passes to the Greater London Council's main sewers thence to sewage disposal works outside the Borough. 64 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:- CamberweII: Front 118,000 gals. Rear 118,000 gals. Dulwich: Front 118,000 gals. Second Class 88,600 gals. Bermondsey Central: First Class 150,000 gals. Second Class 73,125 gals. Rotherhithe 220,000 gals. Manor Place: First Class 157,000 gals. Second Class 164,000 gals. Small 48,000 gals. Sixty one samples of bath water were submitted for examination with the following results:- B. Coli Not found in 50 mls 61 Found in 10 mls — Bacteria per ml. No growth 34 Under 5 9 5-50 12 50 - 75 2 Over 75 4 Free chlorine 0.5 p.p.m. or less 24 0.6 to 1 p.p.m. 18 1.0 to 1.5 p.p.m. 10 1.5 to 2 p.p.m. 7 2 to 5 p.p.m. 2 Over 5 p.p.m. — 65 METROPOLITAN WATER BOARDER EXAMINATION DEPARTMENT AVERAGE RESULTS OF THE CHEMICAlMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH SOUTHWARK Milligrammes per litrss otherwise stated) Description of the Sample Number of Samples Day of the month Ammoniac? Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO4 4 hrs at 27°C. B.O.D 5 days at20°C Hardness (total) CaC03 Hardness (noncarbonate) CaO>j esium as M Potassium as K Chloride as CI Phosphate as P04 Silicate as SiO2 Sulphate as S04 Natural Fluoride as F Surfaceactive ma terial as Manoxol OT Turbidity units Colour (Burgess units pH value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (11 ) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) River Thames — derived 363 0.026 0.083 4.8 1.02 274 79 5? 5.6 40 2.7 9 70 0.20 0.03 0.1 11 7.9 570 Honor Oak 4 0.045 0.015 0.3 0.07 306 51 15 0.50 0.4 5 7.4 520 Mernot Abbey 3 0.015 0.021 0.8 0.12 244 22 16 0.50 0.3 6 7.3 480 BACTERIOLOGICAL RESULTARLY AVERAGES Water supplied to Londough of Southwark Source of Supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count E scherichia coli count Number of samples Agar plate count per ml. Coliform count E. coli count 20-24 hours at 37° C. 3 days at 22° C. Per cent, samples negative in 100 ml. Count per 100 ml cent. mles gative in 0 ml. Count per 100 ml. 20-24 hours at 37°C. 3 days at 22°C. Per cent, samples negative in 100 ml. Per cent. samples negative in 100 ml. River Thames — derived 8,259 31.9 37.91 17.3 3 58 4.7 3,710 8.0 99.92 99.97 Honor Oak 60 0.1 4 96.67 0.1 0 0 — 59 0.1 18 100.0 100.0 Merton Abbey 8 0.1 3 100.0 — 0 0 - 8 0.0 3 100.0 100.0 66 67 Chloramine 0.5 p.p.m. or less 48 0.6 to 1 p.p.m. 10 1.0 to 1.5 p.p.m. 2 1.5 to 2 p.p.m. 1 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 2506. 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 1970. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after the analytical results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. 68 (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, 1970, was 284,690. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride is being added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2 (a) The supply was derived from the following works and pumping stations:- River Thames — derived water via Hampton, Walton and Surbiton Works, and some 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. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not plumbosolvent. 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. INFECTIOUS DISEASES The requirements relating to the notification to the Medical Officer of Health of certain diseases are contained in Sections 47 to 49 of the Health Services and Public Health Act, 1968 and the Public Health (Infectious Diseases) Regulations 1968, and in addition to food poisoning the following infectious diseases are required to be notified to the Medical Officer of Health:- Acute encephalitis Acute meningitis Acute poliomyelitis Ophthalmia neonatorum Paratyphoid fever Plague 69 Anthrax Cholera Diphtheria Dysentery (amoebic or bacillary) Infective Jaundice Leprosy Leptospirosis Malaria Measles Relapsing fever Scarlet fever Smallpox Tetanus Tuberculosis Typhus Whooping cough Yellow fever The fee payable in respect of a notification is 25p and books of notification certificates may be obtained on application to the Medical Officer of Health. Details of all notifications received and the age groups affected are given in Tables 20 to 22. REPORT ON GENERAL FOOD POISONING OUTBREAK (1) (a) Food Causing Outbreak Minced Chicken (b) Agent Causing Outbreak Sal. Indiana (2) Cases Forming Outbreak Which Occurred on 19th December 1970 Notified — 8 Otherwise ascertained — 13 Total — 21 Fatal — — 70 TABLE 20 Notification of Infectious Diseases Disease 1968 1969 1970 Scarlet Fever 112 125 79 Whooping cough 257 37 200 Acute poliomyelitis and acute polio encephalitis 2 — — Measles 556 2,115 1,802 Diphtheria — — — Dysentery 195 201 192 Meningoccal infection 6 13 7 Paratyphoid fevers — 2 1 Food poisoning 157 168 110 Tuberculosis Respiratory system 130 148 110 Other forms 12 14 10 Malaria — — — Ophthalmia neonatorum 1 2 5 Acute gastro enteritis 2,031 1,755 1,222 Infective jaundice 13 43 184 71 TABLE 21 NOTIFICATION OF INFECTIOUS DISEASES 1970 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 1 7 14 48 6 3 _ — — 79 Whooping cough 25 44 51 77 2 1 - - - - - 200 Measles 96 428 557 671 32 16 2 - - - - 1802 Diphtheria - - - - - - - - - - - - Dysentery 17 37 20 28 11 25 22 15 7 4 6 192 Meningoccal infection 3 - - 2 - 1 - 1 - - - 7 Acute encephalitis — infective Paratyphoid — - - - - 1 - - - - - 1 Food poisoning 1 8 4 10 7 23 12 15 14 7 9 110 Tuberculosis — Respiratory 1 1 3 7 22 18 25 19 14 110 Other forms — — — 1 — 1 2 1 - — 4 9 Meninges & CHS - - - 1 - - - - - - - 1 Ophthalmia neonatorum 5 5 Acute gastro enteritis 113 180 97 128 69 199 124 104 103 66 39 1222 Infective jaundice - 10 6 69 42 17 28 5 5 2 - 184 Total 261 715 750 1035 172 294 212 159 154 98 72 3922 TABLE 22 FOOD POISONING - INCIDENTS AND CASES Causative Agent GENERAL OUTBREAKS FAMILY OUTBREAKS TOTAL Total No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks « No. of cases notified or ascertained or U tv/\ Ulv CASES notified or ascertained No. of Outbreaks and sporadic cases columns (1 + 3+5) No. of cases columns (2+4+5) 1 2 3 4 5 6 7 S. typhimurium _ — — — 8 8 8 Other Salmonellae 1 21 — — 11 12 32 CI. welchii - - - - - - - Staph, aureus — — — — — — — Other causes — — — — — — — Cause Unknown — — — — 85 85 85 TOTAL 1 21 - - 104 105 125 73 (3) Clinical Features (i) Average internal ingestion to onset: 24 — 48 hours. (ii) Main symptoms: Stomach pains, vomiting and diarrhoea. (iii) Severity of illness: In 5 cases moderately severe, others mostly mild. (iv) Duration of illness: Most cases were normal after 2-3 days but faecal specimens have continued to be positive for Sal. Indiana in some cases. (4) Results of Laboratory Investigations (Summary) Cases Sal. Indiana isolated from faeces in all cases. Food Handlers . Investigation carried out by London Borough of Food Samples Hackney (see para. 6) Other (5) Origins and Preparation of Food Causing Outbreak See para. 4 (6) Place at Which Food Causing Illness was Consumed Shoreditch Town Hall, Old Street, E.C.I. (Turkish-Cypriot Wedding Party) Estimated number of persons at risk - 250 approx. (7) Probable Origin of Infection Minced Chicken, forming part of a meal of minced chicken and salad. Public Health Act, 1961 — Section 41 Under the provisions of the above Act, 27 persons engaged in the food trade were requested to discontinue their employment for varying periods with a view to preventing the spread of a notifiable infectious disease. Compensation for loss of earnings was made in those cases where such loss was sustained. 74 DETAILS OF FOOD POISONING DUE TO SALMONELLAE OTHER THANS. TYPHIMURIUM Type of Salmonellae Indiana 1 21 — — — 1 21 Panama — — — — 1 1 1 Infantis — — — — 1 1 1 Reading — - - - 5 5 5 San Diego — — — — 2 2 2 Enteriditis — — — — 2 2 2 TABLE 23 SALMONELLA INFECTIONS (NOT FOOD BORNE) INCIDENTS AND CAUSES Causative Agent GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC CASES notified or ascertained TOTAL No. of Outbreaks 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 outbreaks No. of cases notified or ascertained 1 2 3 4 5 6 7 S. typhimurium 6 6 6 Other Salmonellae - - - - - - - TOTAL - - - — 6 6 6 75 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 WorkScabies and Vermin Vermin Scabies Male Female Infants Male Female Infants Southwark cases 1911 159 128 145 134 88 treatments 1911 159 128 345 253 135 Lambeth cases 108 79 55 64 73 54 treatments 108 79 55 100 130 105 Schoolchildren (male and female) cases 1129 257 treatments 1129 441 Total treatments 3569 1509 Disinfection and Disinfestation of Premises Domestic dwellings (rooms) 3,045 Public conveniences 12 Public buildings, Institutions 35 Articles treated 35,072 Disinfection following infectious disease Rooms treated 27 Library books treated 21 Incontinent Laundry Service Weight of articles laundered 115,078 lbs. Bathing of Aged Persons (No. of Baths) Baths at home 14,575 Baths at disinfecting stations 696 76 MORTUARY Bodies brought to Southwark Mortuary:From hospitals in: Southwark Lambeth 272 491 763 From private addresses in: Southwark Lambeth Lewisham Recovered from River Thames 272 491 1 764 10 1,537 Bodies brought from hospitals and institutions:- Southwark Guy's Hospital Evelina Hospital Maudesley St. Giles' Hospital St. Francis Hospital Dulwich Hospital St. Olaves Hospital Catholic Nursing Institute Lambeth Lambeth Hospital South Western Hospital St. Thomas' Hospital King's College Hospital Belgrave Hospital South London Hospital for Women Weir Hospital Brixton Prison Post mortems without Inquest with Inquest 107 2 3 56 48 41 14 1 101 21 23 330 4 8 1 3 1.332 205 1,537 77 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 284,690. The majority of commercial premises and office blocks are concentrated in the north part of the Borough. Registrations and Inspections New registrations were made of 190 premises of which 110 were offices and 62 retail shops. The total number of registered premises at the end of the year was 3,848, an increase over the previous year of 49. 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. The total number of general inspections made was 1,688 and the total visits made to registered premises was 4,565. An analysis of infringements found and remedied following visits to the various classes of registered premises is shown in Table 25. It was necessary to send 140 written notices of requirements under the Act of which 117 had been complied with at the end of the year. As in previous years, many of the improvements obtained and comparatively minor infringements rectified were achieved following discussions with occupiers of registered premises. It is considered that over the years a steady improvement in conditions has taken place and regular inspections have, in the main, ensured that such improvements as have been obtained are maintained. Inspections of premises are made by the Public Health Inspectors and Technical Assistants under the supervision of the Inspectors. The statistical information which has already been supplied to the Department of Employment is shown in Table 24. Operation of the General Provisions of the Act The analysis of contraventions found and remedied shows a pattern similar to previous years in that cleanliness, provision of thermometers, provision of first aid materials, and failure to display an abstract of the Act were the matters most frequently needing attention. 78 TABLE 24 OFFICES, SHOPS AND RAILWAY PREMISES ACT 1963 INSPECTION OF PREMISES TABLE “A" REGISTRATIONS AND GENERAL INSPECTIONS (1) Class of Premises (2) Number of premises registered during the year (3) Total number of regi stered premi se s at the end of year (4) Number of registered premises receiving a general inspection during the year Offices 110 1.373 409 Retail Shops 62 1,767 952 Wholesale shops, warehouses 13 300 126 Catering Establishments open to the public, canteens 5 400 200 Fuel Storage Depots — 8 1 Totals 190 3,848 1,688 TABLE “B" : NUMBER OF VISITS OF ALL KINDS BY INSPECTORS TO REGISTERED PREMISES - 4,565 (l) Class of Workplace (2) Number of persons employed Offices 23,494 TABLE "C" Retail Shops 6,503 ANALYSIS OF Wholesale departments, warehouses. 2,481 PERSONS EMPLOYED Catering establishments open to the public 1,705 IN REGISTERED Canteens 342 PREMISES BY Fuel storage depots 28 Total: 34,553 " UKKr LALlj Total Males: 19,634 Total Females: 14,919 79 TABLE 25 OFFICES, SHOPS AND RAILWAY PREMISES ACT 1963 ANALYSIS OF INFRINGEMENTS FOUND AND REMEDIED DURING INSPECTIONS OF OFFICES AND SHOP PREMISES DURING 1970 Offices Shops Wholesale Warehouse Catering Premises Canteens Fuel Storage Total Fnd. Rem. Fnd. Rem. Fnd. Rem. Fnd. Rem. Fnd. Rem. Fnd. Rem. Fnd. Rem. Cleanliness 66 41 120 84 11 14 34 24 7 7 1 239 170 Overcrowding 4 4 — 1 _ _ _ _ _ 4 5 Heating 5 5 8 6 5 3 6 2 24 16 Provision of Therm ... 90 59 109 57 14 8 13 6 _ 226 130 Ventilation 6 8 10 18 2 2 11 7 „ _ 29 35 Lighting 32 29 40 34 11 6 11 8 1 1 _ _ 95 78 Insufficient sanitary accommodation 9 1 1 1 2 4 _ 12 6 Insufficient washing facilities 3 1 5 _ 1 4 5 _ 13 6 Deficient sanitary accommodation 36 29 85 57 9 6 8 7 1 _ 139 99 Hot water/warm water required 27 15 24 15 5 I 3 6 59 37 Other deficient washing accommodation 9 6 23 24 4 1 8 2 2 2 46 35 Drinking water 1 1 _ _ i 1 Clothing accommodation 2 4 10 9 2 3 4 17 17 Seating facilities — _ 1 _ __ 3 3 _ 3 4 Eating facilities Hoists and lifts 10 7 _ 3 1 _ 1 13 9 Dangerous machinery... 3 2 4 3 6 3 13 8 Floors and staircases 28 22 34 57 17 13 5 2 84 94 First Aid 89 64 145 107 20 19 35 19 6 6 _ 295 21 5 Abstract not displayed 154 115 204 113 16 15 21 12 4 4 - 399 259 Totals 574 413 822 587 126 92 164 108 23 24 2 - 1711 1224 INFORMAL NOTICES SERVED 57 68 11 2 1 1 140 INFORMAL NOTICES COMPLIED WITH 46 58 8 3 1 1 117 80 The incidence of these infringements requiring attention during the year was: Found Remedied Cleanliness 239 170 Provision of thermometers 226 130 Provision of first aid materials 295 215 Abstract not displayed 399 259 In general, the contraventions of the Act were related not so much to the lack of basic amenities but rather to their maintenance, repair and cleanliness. Hoists and Lifts Under the Offices, Shops and Railway Premises (Hoists and Lifts) regulations 1968, copies of examination certificates relating to hoists and lifts are forwarded to the local authority. Examination of the lifting apparatus is made in the case of adverse reports and written notices of works required are sent to the occupier of the premises concerned. The majority of adverse reports related to manual hoists in licensed premises. The most common defects were worn ropes, broken and worn platform guide shoes, failure to make safe working loads and no proper enclosure of the apparatus at cellar level. No particular difficulty has been experienced in getting the necessary works carried out except that there has on occasions been some delay with regard to the provision of caged enclosures due apparently to the heavy demand for this specialised kind of work. The assistance, advice and co-operation afforded by H.M. Factory Inspectorate is, as has been in previous years, greatly appreciated. Legal Proceedings Despite the success in obtaining compliance with the requirements of the Act by informal means, it does sometimes become necessary to institute legal proceedings where frequent visits and written notices have not succeeded. Three occupiers of retail shops were prosecuted during the year with the following results: 81 1. Absence of artificial lighting to sanitary accommodation Abstract of Act not displayed Contents of first aid box not maintained to required standard 2. Absence of handrail to staircase Abstract of Act not displayed Contents of first aid box not maintained to required standard 3. Thermometer not provided Abstract of Act not displayed Worn and holed floor covering Worn treads and nosings of wooden staircase Fine £3 £3 £3 £2 £2 £2 £2 £2 £2 £2 Costs £2 £2 £2 Notification of Accidents During the year, 44 accidents were notified and 34 were the subject of investigation. This is the lowest number of accidents reported since the formation of the London Borough of Southwark, but unfortunately one accident was fatal. This related to a male employee at a warehouse who sustained fatal injuries following a fall from a loading bay. Discussions took place with the management of the Company concerned regarding preventive measures to be taken. A full report on this fatal accident was sent to the Deputy Superintending Inspector of Factories. An analysis of reported accidents is shown in Table 26 and it will be seen that falls of persons and the handling of goods, as has been experienced in previous years, are the most common causes of accidents. In 1970, falls of persons accounted for 13 of the accidents reported and handling of goods for 14. It is evident from the investigations carried out that many of the accidents were due to carelessness or monetary lack of attention on the part of employees and would not have been prevented by any reasonable precautions. The opportunity is always taken when visits are made to registered premises to advise occupiers on means of accident prevention. In commenting on the number of accidents reported during the year, whilst some satisfaction can be obtained from the low number, it is felt that this may not possibly present a true picture. Whilst the larger business concerns are well 82 TABLE 26 REPORTED ACCIDENTS ANALYSED - WORKPLACES AND ACTION TAKEN Workplace Number Fatal Reported Non-fatal Number Investigated Prosecution Formal Warning Informal Advice No Action 1970 1969 1968 1970 1969 1968 1970 1969 1968 1970 1969 1968 1970 1969 1968 1970 1969 196X 1970 1969 1968 Offices — — — 6 6 15 3 4 3 – – – – – – 1 2 2 2 2 1 Retail Shops - - - 17 25 33 15 19 9 – – – 2 – – 3 8 7 10 11 2 Wholesale Shops, Warehouses 1 — — 18 12 27 13 8 8 – – – – 1 – 4 2 6 9 5 2 Catering Establishments open to the Public, Canteens — — — 3 9 6 3 5 1 — — — 1 — — — — 1 2 5 — Fuel Storage Depots — — — — — — — — — — — — — — — — — — — — — Totals 1 — — 44 52 81 34 36 21 - - - 3 1 - 8 12 16 23 23 5 83 TABLE 27 REPORTED ACCIDENTS - ANALYSIS BY CAUSE Cause Offices Retail Shops Wholesale Shops, Warehouses Catering Establishments open to the Public, Canteens Fuel Storage Depots 1970 1969 1968 1970 1969 1968 1970 1969 1968 1970 1969 1968 1970 1969 1968 Machinery 1 1 2 6 – 1 Transport 3 2 1 1 Fall of persons 2 4 10 6 11 16 3 5 7 2 2 - - - - Stepping on or striking against object or Person 1 1 – 4 4 1 1 2 – – 1 – – – – Handling Goods 3 – 4 1 7 3 9 4 9 1 2 3 – — – Struck by falling object – – – – – 1 2 – – 1 1 – – – Fires and explosions – – – – – – – – – – – – – – – Electricity – – – 1 – – – – – – – – – – – Use of hand tools - - - 3 2 5 2 - 1 – 1 — - — — Not otherwise specified - 1 - 2 - 2 - - 3 - 1 2 - - - Totals 6 6 15 17 25 33 19 12 27 3 9 6 - - - 84 aware of the requirements as to accidents there is no doubt that many of the smaller undertakings are unaware of their responsibilities under the Act. It may be that publicity at a national level in support of the efforts made at local level would help to rectify this. An analysis of reported accidents is contained in Table 27. TABLE 28 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 377 100 – – (ii) Factories not included in (i) in which Section 7 is enforced by the local authority 1,637 464 17 1 (iii) Other Premises in which Section 7 is enforced by the local authority (excluding out-workers premises) 58 76 – – Total 2,072 640 17 1 85 DEFECTS FOUND Particulars Number of cases in which defects were found Number of defects in which prosecutions were instituted Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of cleanliness (S.l) – Overcrowding (S.2) — - - - - Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors(S6) - - - - - Sanitary conveniences (S.7) — Insufficient 6 4 — 4 1 Unsuitable or defective 21 19 — 8 — Not separate for sexes 2 2 - — - Other offences — — — — — (not including offences lating to home work) - - - - - Total 29 25 - 12 1 OUTWORKERS Nature of Work Number of Outworkers in August lists as required by Section 133(l)(c) Artificial flowers 12 Cardboard boxes 10 Carding of buttons 12 Jewellery 7 Lampshades 7 Showcards 14 Wearing apparel 99 Total 161 There were no instances of work in unwholesome premises and it was not necessary to servyce any notices or institute proceedings. 86 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) 14,816 (b) Number of Inspections made for the purpose 27,815 (2) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 467 (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 1,480 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 1,029 (1) Proceedings under Housing Act, 1957:— (a) Number of houses made fit after service of formal notices (Sections 9, 16 and 18) (i) By owners 17 (ii) By local authority in default of owners 1 (b) Houses demolished as a result of formal or informal procedure under Section 17 2 (c) Houses closed in pursuance of an undertaking given by the owners under Section 16 1 (d) Closing Orders on parts of buildings (Section 18) 26 (e) Undertakings not to use parts of buildings for human habitation accepted 4 (0 Closing Orders made under Section 17(3) Nil (g) Demolition Orders determined and Closing Orders substituted under Section 26 Nil (h) Closing Orders made under Section 17 (1) 36 (i) Closing Orders determined 1 (j) Closing Orders revoked and Demolition Orders made Nil (k) Number of houses included in representations (Section 42) 385 87 (2) Houses in Multiple Occupation — Housing Acts, 1961-64:- (a) Number of premises found to require action 296 (b) Number of premises at which conditions were remedied as a result of informal action 375 (c) Number of premises requiring formalaction 74 (d) Number of Directions given 38 (e) Number of Directions revoked Nil (0 Number of Directions varied Nil (g) Number of Management Orders made 33 (h) Number of Management Orders revoked 3 (3) Housing Act, 1964:- (a) Number of Control Orders under Section 73 Nil (b) Number of Control Orders revoked under Section 86(2) Nil (4) Housing Act, 1969 — Qualification Certificates Applications received 492 granted 216 deferred or refused 276 Applications for Provisional Certificates received 4 granted 4 (5) Proceedings under Public Health Acts:- „ (a) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 770 (b) Number of dwelling-houses in which defects were remedied after service of formal notices:- (i) By owners 725 (ii)By local authority in default of owners 96 Housing Inspections No. of Inspection Clearance areas 3,303 Individual unfit houses Section 9 363 Section 16 271 Parts of premises — Section 18 328 Houses in multiple occupation 713 Re-inspections (all sections) 3,275 Total inspections ... 8,253 88 Legal Proceedings — Public Health Act, 1936: Nuisance Orders made 16 Summonses withdrawn (work completed) 12 RENT ACT, 1968 Applications for Certificates of Disrepair Number of applications for certificates 1 Number of decisions not to issue certificates — Number of decisions to issue certificates:- (a) in respect of some but not all defects 1 (b) in respect of all defects — Number of undertakings given by landlords 1 Number of undertakings refused — Number of certificates issued — Applications for cancellations of Certificates of Disrepair Applications by landlords for cancellation 1 Objections by tenants to cancellation — Decisions to cancel in spite of tenants objections — Certificates cancelled 1 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 1970, 2,175 visits were made to applicants' homes as well as visits of investigation (to hospitals, relatives, etc.) and 2,090 recommendations were made to the Housing Department. ATMOSPHERIC POLLUTION - CLEAN AIR ACTS 1956/68. Smokeless Fuel The winter of 1969-70 brought to light the scarcity of solid smokeless fuels in certain parts of the country. Included in the areas of scarcity was Inner London, and particularly the South Bank Boroughs and it was with some misgiving as to the availability of solid smokeless fuels that we entered into 1970. 89 In Circular 63/70 from the Minister of Housing and Local Government, local authorities were invited to submit Suspension Orders to the Minister for his consideration. Orders of this type, if confirmed, permitted the sale and delivery of coal within operative smoke control areas. By the beginning of November, the Council had received confirmation from the Minister for the suspension of thirteen specified Smoke Control Orders. This, in effect, meant that some 25,000 premises in 1,280 acres were released from smoke control and some 40% of all controlled premises allowed to burn bituminous coal between the period 7th November, 1970 and 31st March, 1971. The oncoming winter of 1970/71 turned out to be comparatively mild, and therefore, a regional fuel crisis was fortunately averted. Fuel Oil and Sulphur-dioxide Local air pollution by sulphur-dioxide resulting from the burning of fuel oils with high sulphur content, has for many years been of some concern. Industry and commerce have at all times been persuaded — without any legal backing — to fire new furnaces with a low sulphur content oil. In practice, this means the burning of oil of 35 seconds viscosity. This is a gas oil with a sulphur content not greater than 1% by weight of the fuel. At their meeting in April, the Health Committee recommended that all Council establishments, as a Public Health measure, should use 35 seconds oil in their boiler furnaces and final approval of this far-reaching policy decision was endorsed later. It is indeed an exemplary and progressive decision which will, in time, improve the air quality not only of the local environment, but also that of Inner London. Additional legislation in the form of the 1968 Clean Air Act increased the umbrella of air pollution control in the specific areas of:— (a) Chimney height of new furnaces (b) Emissions of grit, dust and fumes from furnaces and (c) Dark smoke from open-air incineration on industrial and trade premises. 90 Battersea 'B' Power Station In July, 1970, a newspaper report disclosed that washing of the flue gases on 'B' Power Station was to be discontinued for an experimental period of two years. The power station is within two miles, as the crow flies, from this Borough. It was estimated that, with certain winds, the unwashed flue gases with their heavy sulphur dioxide gas load would either pass over or be deposited in this Borough. Formal notification was received from Central Electricity Generating Board of their intentions. The Council, by resolution, referred to the London Borough's Association their objection to the discontinuance of flue gas washing by the Central Electricity Generating Board. Legal Proceedings It was found necessary to prosecute a local firm for repeated smoke emissions in August. At the Court hearing, the Magistrate imposed a total fine of £40 on both summonses plus £5 costs. Health Education From June 8th — 13th, an exhibition of inter-departmental activities was on view at the Civic Centre, Old Kent Road. The Clean Air Stand attracted much interest and many questions from a cross-section of the general public. A number of local organisations and schools continue to request talks on air pollution. This Council's nomination for a seat by ballot on the Clean Air Council for .the.South East Division, resulted in the Council's Senior Public Health Inspector (Atmospheric Pollution) being elected. Summary of Inspections 1 Number of Complaints (a) Industrial (b) Non-Industrial Total 2 Number of Inspections (a) S.C. Areas (b) Smoke Nuisances (c) Industrial Premises (d) Other Visits Total Visits 279 495 774 6,225 599 606 8,821 16,251 91 3 Number of Smoke Observations 316 4 Approval of Furnaces (Sec3(2) Clean Air Act, 1956) 16 5 Approval of Heights of Chimneys (Sec.6 Clean Air Act, 1968) 13 Smoke Control Orders During the year the No. 26 (Peckham Central) Smoke Control Order, 1970 was confirmed, the operative date being 1st July, 1971. This Order applies to an area of 215 acres which includes 4,197 dwellings and 220 industrial and commercial premises. The position with regard to Smoke Control Orders at the end of the year was as follows:- Subject to operative Orders 3,157 acres Subject to temporary suspension of Orders 1,280 acres Subject to Order confirmed but not yet operative 215 acres 4,652 It is anticipated that the remaining areas of the Borough totalling 2,329 acres will be subject to Smoke Control Orders by 1975/76. PREVENTION OF DAMAGE BY PESTS ACT, 1949 1 Total number of properties in district 122,279 2 (a) Total number of properties inspected following notification 4,582 (b) Number infected by (i) rats 2,201 (ii) mice 2,244 3 (a) Total number of properties inspected for rats and/or mice for reasons other than notification 105 (b) Number infested by (i) rats 58 (ii) mice 47 92 The following table shows the work of the rodent control staff:- Domestic Premises Business Premises Rats Mice Rats Mice Complaints received 1,741 1,583 570 684 Visits by investigators 1,741 260 570 684 Visits by rodent operatives 10,214 12,522 3,214 3,424 Number of premises cleared 1,150 1,475 498 688 FOOD AND DRUGS ACT 1955 During the year, 1,684 formal and 277 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 Raspberry powder Informal Artificial product containing no raspberries Labels revised Sylvasun tablets Formal Slight deficiency of stated vitamin content Formal warning. Old stock withdrawn from sale Blackcurrent drink Informal Contained no blackcurrent Labels revised Milk gums Informal Contained no milk fat Formal sample satisfactory Austrian smoked cheese Informal Incorrectly labelled Taken up with manufacturers Chocolate party cup sweets Informal Stale and rancid Foreign produce stock surrendered Smoked processed cheese Informal Contained excess water Taken up with importers Orange drink Informal Contained non-permitted cyclamate sweetner Old stock - use of cyclamate discontinued Rose syrup Informal Incorrectly labelled Labels revised 93 Marzipan Formal Contained 4% of groundnuts Foreign produce Taken up with importers Canned milk top Informal Deficient in fat Taken up with manufacturers Apple and raspberry jam Informal Contained excess preservative Taken up with manufacturers Apricot chutney Informal Incorrectly labelled and contained excess preservative Return to country of origin Grapesoda Informal Incorrectly labelled Labels revised Almond drink Informal Incorrectly labelled and contained no almonds Labels revised Syrup of roses Informal Contained mould growth Foreign produce Taken up with importers Curry powder Informal Incorrectly labelled Labels revised Pork sausages Formal Contained undeclared preservative Formal warning Beef sausages Formal Contained undeclared preservative Formal warning Pork sausages (2) Informal Contained undeclared preservative Formal samples satisfactory Beef sausages Informal Contained undeclared preservative Formal sample satisfactory Pure wet sugar Informal Incorrectly labelled, consisted of raw sugar and molasses Foreign produce Taken up with importers Low calorie orange drink Informal Contained non-permitted cyclamic acid sweetner Old stock Cyclamates no longer used Enriched white bread Informal Enrichment not specified Taken up with manufacturers 94 Butter Formal Contained slight excess of water Formal warning Haldi Informal Incorrectly labelled. Should be described as Turmeric Powder Old Stock Labels revised Fruit yoghurt Informal Incorrectly labelled Taken up with manufacturers Canned tomatoes Informal Contained excess tin and internal corrosion Formal warning Batter mix Informal Contained prohibited emulsifying agent Taken up with manufacturers Legal action taken following complaints made by members of the public: Offence Result Fine Costs Sale of mouldy loaf Dismissed. Held that there was reasonable doubt that loaf was sold in condition alleged. Sale of yoghurt in state of active fermentation £15 £5 Sale of loaf of bread containing piece of string £10 £2 Sale of loaf of bread containing metal washer £20 £5 Sale of bread pudding containing a match stick £10 £2 Sale of bottle of milk containing a piece of glass £20 £5 Sale of bottle of milk of unusual taste and smell £40 £5.25 Sale of larvae infested chocolate £20 £2 Sale of loaf of bread contaminated with machinery lubricant £20 £5 Sale of yoghurt with sour smell and taste £20 £5 Sale of loaf of bread containing a winged insect £5 £2 Sale of loaf of bread contaminated with oily matter £5 £3 95 Offence Result Fine Costs Sale of sausages containing small pieces of metal £25 £5.25 Sale of tin of beans containing a caterpillar £10 £2 Sale of mouldy loaf of bread Dismissed. Held that there was reasonable doubt loaf sold in condition alleged. Sale of yoghurt in state of fermentation Absolute discharge £5.25 Sale of loaf of bread contaminated with oily matter £40 £5.25 Sale of mouldy sausage rolls £10 £2 Sale of tin of chopped ham and bacon in state of decomposition £5 £2 Sale of loaf of bread containing strip of brown paper £20 £5.25 Sale of loaf of bread containing piece of metal £35 £5.25 Sale of loaf of bread containing a spider £20 £3.15 Sale of ground almonds containing insect webbing £20 £3 Sale of mouldy meat pies £15 £5 Sale of porage oats infested with larvae £10 £2 Sale of mouldy meat pies £5 £2 Sale of cake containing a cigarette filter £10 £5 Sale of mouldy apple pie £5 Sale of larvae infested chocolate £10 £3.15 Sale of mouldy meat pie £5 Sale of yoghurt in state of fermentation £5 £3.15 Sale of mouldy loaf of bread £60 £3.15 Sale of bottle of milk containing mould £20 £5 96 Sale of sausages in a state of decomposition £15 £5 Sale of mouldy cornish pasty £10 £5 In addition, 38 warning letters were issued in respect of complaints made by members of the public. Milk distributors and sampling There are 462 registered milk sellers in the Borough. Licences to expire on 31 December 1971, were issued as follows:- For sale of untreated milk 41 For sale of pasteurised milk 208 For sale of sterilised milk 168 For sale of ultra heat treated milk 45 One hundred and one samples of milk were submitted for chemical analysis and two were found to be unsatisfactory. Seventy-one samples were submitted for bacteriological examination and of these 2 failed the methylene blue test. These unsatisfactory samples were discussed with the distributors concerned and subsequent samples were found to be satisfactory. Ice Cream Forty-one samples of ice cream were examined with the following results: Methylene Blue Grading Soft Ice Cream Other Ice Cream Grade 1 (satisfactory) 6 11 Grade 2 (sub-standard) 2 2 Grade 3 (unsatisfactory) 8 4 Grade 4 (unsatisfactory) 1 7 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 Analysis One hundred and one samples were submitted for chemical analysis. Two were found to be unsatisfactory and the matter was taken up with the producers. 97 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 121 premises. The following table shows the number of visits made by the public health inspectors to the various types of food premises:- Bakehouses 61 Bakers and confectioners 200 Butchers 450 Cooked and preserved meat shops 219 Dairies and milkshops 179 Fishmongers, friers and curers 273 Food factories 858 Ice cream premises 183 Public houses 567 Restaurants, canteens, etc 1,772 Street markets 667 Street traders' food stores 88 Wholesale food dealers 335 Other food premises 828 Legal Proceedings Result Nature of Business Offence Fine Costs Cafe Failure to provide suitable and sufficient wash hand basin (Regulation 16(1)) £20 £5 Failure to provide adequate supply either of hot and cold water or hot water for the wash basin (Regulation 16(2)) £5 Failure to provide adequate supplies of soap, nailbrushes and towels (Regulation 16(3)) £5 Failure to provide suitable and sufficient sinks for washing food and equipment (Regulation 19( l)(a)) £20 98 Failure to provide adequate supply of hot and cold water or hot water to the sinks (Regulation 19(1 )(b)) £5 Failure to provide adequate supplies of soap and clean cloths for the sinks (Regulation 19( 1 )(d)) £5 Restaurant Failure to provide adequate supply either of hot and cold water or hot water for the wash basin (Regulation 16(2)) £5 £2 Failure to keep sinks clean (Regulation 19(l)(c)) £5 Failure to keep food room clean and in good repair (Regulation 23(1)) £5 Accumulation of refuse in food room (Regulation 24) £5 Cafe Food exposed to risk of contamination (Regulation 5) — — Failure to keep articles and equipment clean and in good order, repair and condition (Regulation 6(1)) - - Failure to keep sanitary conveniences clean and in efficient order (Regulation 14(l)(a)) £3 £2 Failure to provide notice as to washing of hands after use of sanitary conveniences (Regulation 14(5)) £3 - Failure to provide adequate supply of nailbrushes and towels (Regulation 16(3)) - - 99 Failure to keep wash hand basins clean (Regulation 16(4)) Failure to keep structure of food room clean and in good order, repair and condition (Regulation 23(1)) - - N.B. In certain of these summonses the Court declined a fine as the matters which were the subject of the had been remedied. to impose summonses Cafe Failure to keep articles and equipment clean and in good order, repair and condition (Regulation 6(1)) £7 £2 Failure to keep sanitary convenience clean and in efficient order (Regulation 14(1 )(a)) £3 Failure to provide notices as to washing of hands after use of sanitary conveniences (Regulation 14(5)) £3 Failure to provide adequate supply either of hot and cold water or hot water for the wash basin (Regulation 16(2)) £3 Failure to provide adequate supply of soap, nailbrushes and towels (Regulation 16(3)) £3 Failure to provide first aid equipment (Regulation 17) £3 Failure to provide adequate supply of hot and cold water or hot water to the sinks (Regulation 19(l)(b)) £3 100 Failure to provide suitable and sufficient means of ventilation to a food room (Regulation 21) £3 Use of food room communicating directly with a sleeping room (Regulation 22(2)) £3 Failure to keep structure of food room clean and in good order, repair and condition (Regulation 23(1)) £3 Cafe Failure to keep articles of equipment clean and in good order, repair and condition (Regulation 6(1)) £5 £5 Failure to keep sanitary conveniences clean and in efficient order (Regulation 14(l)(a)) £5 Failure to provide notices as to washing of hands after use of sanitary convenience s (Regulation 14(5)) £5 Failure to provide suitable and sufficient locker accommodation (Regulation 18) £5 Failure to provide suitable and sufficient means of ventilation to a food room (Regulation 21) £5 Cafe Failure to keep sanitary conveniences clean and in efficient order (Regulation 14(l)(a)) £10 £2 Failure to provide suitable and sufficient lighting for sanitary conveniences (Regulation 14(2)) £2 101 Failure to provide adequate supply either of hot and cold water or hot water for the wash basin (Regulation 16(2)) £5 Failure to provide adequate supplies of soap, nailbrushes and towels (Regulation 16(3)) £2 Failure to provide adequate supply of hot and cold water or hot water to the sinks (Regulation 19(l)(b)) £2 Failure to keep sinks clean and in efficient order (Regulation 19(l)(c)) £2 Failure to keep structure of food room clean and in good order, repair and condition (Regulation 23(1)1 £5 Legal Proceedings Result Nature of Business Offence Fine Costs Itinerant Vendor Contravention of Regulation 13(1) of the Food Hygiene (Markets Stalls and Delivery Vehicles) Regulations 1966 (did carry on a food business without displaying the address at which the vehicle was garaged or kept) £3 £2 Contravention of Regulation 16(2) of the Food Hygiene (Market Stalls and Delivery Vehicle's) Regulations 1966 (did fail to provide and maintain at every wash basin an adequate supply of hotwater at a suitably controlled temperature) £3 102 Contravention of Regulations 16(3) of the Food Hygiene (Market Stalls and Delivery Vehicles) Regulations 1966 (did fail to provide supplies of soap or other detergent or nail brushes etc. at or near the wash basin used by persons engaged in handling food) £3 Contravention of Regulation 17 of the Food Hygiene (Market Stalls and Delivery Vehicles) Regulations 1966 did fail to provide first aid equipment for the use of persons engaged in handling food) £3 Food delivery vehicle Contravention of Regulation 4 of the Food Hygiene (Markets Stalls and Delivery Vehicles) Regulations 1966 made under Section 13 of the Food and Drugs Act 1955 (did in the course of a food business use a delivery vehicle which was insanitary and in such a condition that the food was exposed to the risk of contamination) £40 £10 Contravention of Regulation 5(1) of the Food Hygiene (Markets etc.) Regulations 1966 (did in the course of a food business use a delivery vehicle which was not kept clean and was not in such good order and repair as to enable it to be effectively cleaned) £10 Contravention of Regulation 6(1) of the Food Hygiene (Markets etc.) Regulations 1966 (did fail to keep clean articles or equipment with which food comes into contact or is liable to come into contact in the course of a food business. £10 103 Contravention of Regulation 9 of the Food Hygiene (Markets etc.) Regulations 1966 (being a person who was engaged in the handling of open food other than raw vegetables did not, whilst so engaged, wear sufficient clean and washable overclothing £10 Contravention of Regulation 13 (l)(a) of the Food Hygiene (Markets etc.) Regulations 1966 (did use a delivery vehicle in the carrying on of a food business which did not have displayed conspicuously and legibly upon it the name and address of the person carrying on that business) £2 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 and meat products 14 19 1 4 Canned meat 48 16 — 19 Fish — 9 — 19 Fruit and vegetables 173 16 1 5 Miscellaneous foodstuffs 52 7 1 10 Miscellaneous canned goods 100 8 - 8 Total 390 16 1 9 FOOD HYGIENE (MARKETS, STALLS AND DELIVERY VEHICLES) REGULATIONS, 1966 Regular inspection of street markets are undertaken by the Public Health Inspectors and 667 such inspections were made during the year, mostly at weekends when the markets are at their busiest. Twenty-seven certificates of exemption from certain requirements of the Regulations were granted to street traders. 104 IMPORTED FOOD CONTROL THE IMPORTED FOOD REGULATIONS, 1968 FOOD AND DRUGS ACT, 1955 The following samples were submitted for bacteriological examination during 1970:- Egg products 596 Frozen prawns and shellfish 1,730 Second grade cheese 334 Frozen chicken 100 Canned meats 33 Desiccated coconut 18 Miscellaneous 8 Total 2,819 The following samples were submitted for chemical examination:Frozen liquid egg for alpha-amylase test 2,097 Routine chemical examination: Canned fruit and juice 537 Dried fruit 173 Canned meat 158 Canned vegetable 62 Canned fish 130 Canned tomatoes 76 Tomato puree 51 Tea 238 Butter and fats 51 Lard 96 Nuts 88 Cheese 15 Miscellaneous 343 2,018 Total number of chemical samples 4,115 105 106 BACTERIOLOGICAL EXAMINATION OF EGG PRODUCTS, 1970 Country of origin Type of egg product Quantity examined Number of samples taken Number of samples positive Quantity of contaminated egg T C Q L T C Q L Australia Frozen albumen 482 10 0 0 355 - China Frozen albumen 51 12 0 0 54 - Dried whole egg 20 0 0 0 10 - Poland Frozen albumen 34 9 0 0 46 - Dried whole egg 10 3 0 0 9 - U.S.A. Dried albumen 32 9 0 0 107 4 1 15 0 0 (Released for heat treatment) Yugoslavia Frozen albumen 25 8 0 0 15 1 7 8 0 0 (Released for heat treatment) Totals 656 11 0 0 596 5 9 3 0 0 The following types of Salmonellae were isolated during routine sampling of egg products during 1970:- Country of Origin Organism No. of samples U.S.A. Salmonella albany 1 Salmonella braenderup 3 Yugoslavia Salmonella enteritis 1 5 The Liquid Egg (Pasteurisation) Regulations, 1963 There are two egg pasteurising plants operating in the borough, 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 for B. Coli and plate count, in addition to the alpha-amylase test, are carried out. 374 samples of pasteurised home produced liquid egg were taken from the plants for alpha-amylase test, the results of which were satisfactory, and, of the imported frozen whole egg examined during the year, only 0.005% failed the test. 107 The Liquid Egg (Pasteurisation) Regulations, 1963 There are two egg pasteurising plants operating in the borough, 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 for B. Coli and plate count, in addition to the alpha-anylase test, are carried out. 374 samples of pasteurised home produced liquid egg were taken from the plants for alphaamylase test, the results of which were satisfactory, and, of the imported frozen whole egg examined during the year, only 0.005% failed the test. 108 SAMPLING OF FROZEN WHOLE EGG, 1970 Country of origin Quantity imported Number of samples taken Number of samples failed test Quantity of unsatisfactory egg Remarks T C Q L T C Q L Australia 1164 2 0 0 467 - Resampled and submitted to Colindale Laboratory. Found to be satisfactory. 30 10 0 0 29 4 (Yolk) China 600 0 0 0 145 - Czechoslovakia 1 1 Sample tin only Holland 4 0 0 0 4 - New Zealand 549 5 0 0 220 - Poland 201 1 0 0 174 - Romania 62 10 0 0 20 - South Africa 1284 15 0 0 571 - Yugoslavia 2 0 0 0 2 2 2 0 0 0 Re-pasteurised Totals 3898 3 0 0 1633 7 2 0 0 0 New Zealand Second Grade Cheese 334 samples of New Zealand Second Grade Cheese were submitted for bacteriological examination during 1970 with the following results:— Coagulase-positive staphylococci Number of samples Less than 500 per gram 310 500 — 50,000 per gram 16 50,000 — 500,000 per gram 6 Over 500,000 per gram 2 334 Brand with counts in excess of 500,000 per gram were destroyed. The remainder of the cheese was allowed to go for processing. OTHER IMPORTED FOODSTUFFS—ROUTINE CHEMICAL EXAMINATION The following action was taken as the result of chemical analysis:— Food Examined Apricots (dried) Result of examination Found to contain Sulphur Dioxide in excess of 2,000 parts per million Action taken Returned to country of origin Chicken meat (cooked) Found to consist of paste containing 73.5% meat Importer advised to re-label as "Chicken Meat Paste". Grapefruit juice (canned) Analysis indicated that juice had been diluted Released for manufacturing purposes only Groundnuts in shell (4 consignments) Found to contain Aflatoxin — "High" and "Very High" categories Detained Herring in jelly (canned) Label printed entirely in foreign language Warning letter to importer Melon cubes in syrup Found to have tin content in in excess of 250 parts per million Warning letter to importer 109 Orange segments (canned) Excessive tin contamination Destroyed Parmesan cheese Label found to be incorrect Warning letter to importer Pate de lievre Label printed entirely in foreign language Warning letter to importer Pate de marrons confits Label printed entirely in foreign language and no indication given of ingredients Released for catering purposes only Peanuts (flaked) (2 consignments) Found to contain Aflatoxin — "Medium category" Detained Processed cheese (canned) Found to be deficient in fat and label incorrect Detained Soy sauce Found to contain 200 parts per million Benzoic Acid Re-exported Tomatoes (canned) Found to contain lead in excess of 2 parts per million Warning letter to importer Tomato paste (canned) Howard Mould content in excess of 50% Detained 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 1,000,000, the importer was warned that the shellfish should be used immediately after defrosting. Samples taken from two consignments of Pakistani Raw Freshwater Prawns were found to contain Salmonella typhi-murium, Salmonella aba, Salmonella beaudesert and Salmonella newport. These prawns were re-exported. Samples taken from a consignment of Malaysian Raw Prawns were found to contain Salmonella paratyphi B and Salmonella weltevreden. The batch containing S. paratyphi was destroyed and the remainder re-exported. Samples taken from other consignments of Malaysian Prawns were found to contain Salmonella lexington (2) and Salmonella weltevreden (1). All these prawns were re-exported. 110 BACTERIOLOGICAL EXAMINATION OF FROZEN SHELLFISH, 1970 Country of origin Type No. of Samples taken Viable counts at 37°C. Less than 100.000 100,0001.000,000 More than 1,000,000 Australia Raw prawns 18 Brazil Cooked prawns 2 2 Canada Cooked prawns 27 25 2 Crab meat 4 Ceylon Cooked prawns 1 1 Raw prawns 9 Chile Cooked prawns 29 29 China Cooked prawns 36 18 14 4 Raw prawns 90 Cuba Raw prawns 4 Denmark Cooked prawns 21 16 2 3 Formosa Cooked prawns 166 153 13 Raw prawns 4 Lobster meat 2 Hong Kong Cooked prawns 60 16 38 6 Raw prawns 25 Lobster meat 13 India Raw prawns 9 Indonesia Raw prawns 2 Japan Cooked prawns 162 158 4 Crab meat 6 Lobster meat 14 Malaysia Cooked prawns 172 101 60 11 Raw prawns 399 Salmonella organisms found in 5 samples Lobster meat 10 Mexico Cooked prawns 2 2 Pakistan Raw prawns 290 Salmonella organisms found in 4 samples Senegal Raw prawns 8 Thailand Cooked prawns 4 4 Raw prawns 3 U.S.A. Cooked prawns 130 102 24 4 Crab meat 8 Totals (Cooked (Raw 812 918 626 157 29 111 112 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 3 2 0 Beans 1 3 3 26 Cheese 1 1 20 5 18 2 0 Chestnuts 20 13 0 0 Cocoa beans 1 16 0 0 Coconut 2 0 0 Egg products 11 3 0 0 2 22 Fruit 1 15 0 0 Fruit (canned) 40 7 2 0 Fruit (dried) 11 5 0 0 17 0 0 Ginger 18 0 0 Groundnuts 25 5 2 10 132 9 0 0 Lentils 4 5 0 0 Meat 1 0 1 0 Meat (canned) 1 0 0 0 51 1 0 23 Offals 9 8 0 0 Onions 15 5 2 0 Peas I 0 0 13 3 0 3 5 Potatoes 3 12 0 0 Prawns (frozen) 18 5 0 4 5 13 0 0 Shrimps (dried) 7 0 0 0 Tapioca 2 3 0 0 Tomato Puree 20 0 0 0 Vegetables 14 0 0 Vegetables (frozen) 35 4 0 0 Various 13 2 2 0 Totals 49 1 2 23 17 5 0 23 182 19 0 4 196 7 2 17 73 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. MISCELLANEOUS ADOPTION AND BOARDING-OUT The number of medical reports received from the Children's Officer in 1970 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 the Deputy Medical Officer of Health for possible medical contra-indications to the intended arrangements and, where necessary, additional information is sought from hospitals and general practitioners. During the year, 14 children were considered suitable for adoption and 20 for boarding-out. Similar recommendations were made on 12 prospective adopters. However, 2 prospective adopters were considered medically unsuitable to adopt children. In addition, 51 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. CHILDREN'S AND WELFARE COMMITTEE 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 principal medical officer exercised general medical supervision of the establishments and gave special attention to short-stay accommodation for homeless families. SOUTH EAST LONDON GENERAL PRACTITIONER S CENTRE This report covers the fifth full year since the Centre became the responsibility of the London Borough of Southwark. I — General The number of general practitioners using the Centre has increased from 304 in 1969 to 311. The work at the Centre continues to show a marked increase in volume. Negotiations with the I.L.E.A. for extra space have been successful and a section of the boat building room has been acquired. Detailed plans are to be drawn up for the utilisation of this space and re-organisation of other rooms. 113 Visits Apart from the usual visits by nurses from King's College Hospital and Guy's Hospital, visitors to the Centre have included twenty-five Southwark Social Workers, seventy Spanish Medical Students and thirty Dutch doctors from the Educational Interchange Council, doctors from Japan, China and Canada and architectural students. Meetings Six lunch time meetings of general practitioners held within this period were well attended. A series of afternoon meetings were held at which eight Tyne Tees films of broadcasts to medical audiences were reviewed on behalf of the British Medical Association to select films to be purchased for their circulation library. Several lunch time meetings on the subject of "Battered Babies" were held at the Centre, attended by representatives from the Welfare Department, Metropolitan Police, N.S.P.C.C., King's College Hospital, Guy's Hospital and local general practitioners. The meetings were very satisfactory and will now be continued on a larger scale at King's College Hospital. The South East London Obstetric Society, the South London Faculty of the Royal College of General Practitioners and the "Psychiatric Club" have continued with their evening meetings and regular meetings of the Medical Staff Committee and the House Committee have also taken place. II — Medical Well Women Clinics The total attendances for 1970 were 560 as compared with 591 in 1969. The number of cervical smears taken at the Centre by general practitioners was 222. Work in the Various Departments The volume of work carried out during the year is shown in Tables 29 and 30 on page 115. 114 115 TABLE 29 South East London G.P. Centre — Volume of work carried out Jan.—Mar. Apr.—June July—Sept. Oct.—Dec. Total Patients seen: 2,794 3,037 2,522 2,480 10,833 Number of Investigations, Treatments etc. 5 ,377 5,695 4,591 4,621 20,284 TABLE 30 South East London G.P. Centre - Work in the various departments Period Path.Lab. X-ray E.C.G. Allergy Nursing Minor Ops. Total Investigations Total Attendances Jan.—Mar. 1,780 1,363 346 51 1,832 5 5,377 2,794 Apr—June 2,239 1,399 359 33 1,654 11 5,695 3,037 July—Sept. 1,820 1,044 295 28 1,388 16 4,591 2,522 Oct—Dec. 1,624 1,125 319 32 1,514 7 4,621 2,480 Total 7,463 4,931 1,319 144 6,388 39 20,284 10,833 These figures do not include attendances at 'Well Women' Clinics The approximate findings on routine screening tests for the year are as follows: Abnormal blood pressures: 2.1% Albumin in urines 1.8% Sugar in urines 4% In each group the figures are higher than shown in other screening surveys and indicate an economic method of identification in population. Since the Pathology Department at King's College Hospital has had its SMA 12 automatic pathology facilities, routine biochemistry has been performed on patients attending for blood tests. We are grateful to Professor Gray for allowing this opportunity for research. Patients' problems dealt with by the Health Visitor are not included in the overall volume of work carried out. In the future it is hoped to increase the number of Health Visitors based at the Centre. Education The post graduate education programme has continued successfully and in addition to the usual lunch-time meetings, six afternoon lectures were arranged for practitioners by Dr. T.A. Johns of King's College Hospital. They were all very well attended. Undergraduate Education An undergraduate course was arranged for Miss L. Pipoly, a medical student from the Department of Environmental Health of the University of Cincinatti. The course ran from the 8th July to 14th August and included attachments to general practitioners, a programme with the Southwark Health Department and attendances at ward rounds and out-patient clinics connected with the Paediatric Department at Guy's Hospital. Miss Pipoly felt that this course proved to be very worthwhile. 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. Table 31 on page 117 gives details of this work. 116 TABLE 31 Staff Medicals Officers Manual Workers Questionnaires received and scrutinised 651 1,320 Medical examinations of staff: After scrutiny of questionnaires 182 566 Full Medicals (Nursing staff etc.) 171 - Full Medicals (for heavy goods vehicle licences) - 76 Staff called up for review 56 243 Staff absent from duty owing to sickness 137 775 Domiciliary visits to sick staff 12 39 TABLE 32 Number of patients on chest clinics registers at 31 December 1970 Pulmonary 1,847 Non-Pulmonary 258 New cases notified: Pulmonary 103 Non-Pulmonary 14 Deaths from tuberculosis 11 Contacts given B.C.G. Vaccination 240 Number of cases having domiciliary help at 31 December 1970: Home helps 5 District nurses 22 Home visits by health visitors 4,549 Patients in receipt of extra nourishment 16 Patients assisted for the first time with: Bed or bedding 12 Clothing or footwear 53 Diversional theraphy — patients attending weekly classes 72 117 CHEST CLINICS There are three Chest Clinics in the borough, situated at Bermondsey Health Centre, the Health Services Department Larcom Street and St. Giles Hospital. The Council reimburses the hospital service a proportion 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 in the form of milk, butter and eggs was given to necessitous cases on the recommendation of the Chest Physicians. 16 cases were assisted, compared with 24 in 1969. The voluntary care committees continued to provide assistance with items such as clothing, bedding and holidays to patients who did not qualify for extra assistance from the statutory services. Statistics relating to work undertaken at the chest clinics are set out in Table 32 on page 117. DEVELOPMENT OF VOLUNTARY EFFORT Every endeavour was made to use voluntary assistance during 1970, 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 Centres for the Mentally 111 Cane Hill Psychiatric Social Club, Havil Street, S.E.5. St. Giles' Centre Talbot Settlement — Wednesday Club 118 Prevention of Break-up of Families South London Family Service Unit Family Welfare Association 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 & Child Welfare National Association of Child Welfare Voluntary Hostels. FINANCE Expenditure The net revenue expenditure for 1970/71 was £1,762,109; the amount recovered in contributions and charges was £312,312, including reimbursement of the cost of the school health service (£165,406) and the Government Grant of half the cost of the Port Health Administration (£16,641). 119 120 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. 121 The Inner London Education Authority is responsible for the School Health Service, but by virtue of an agreement required by Section 32 of the London Government Act, 1963, there is joint use by that 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 is responsible to that Authority for the day-to-day running of the School Health Service. The School Population There were a greater number of children attending schools in this Borough than in any other Inner London Borough. The number of children on the roll of the Borough's schools was 49,624. This shows an increase of about 300 over the previous year's total. TABLE 33 SCHOOL HEALTH SERVICE — Medical Examinations Medical Inspections Examinations: Routine examinations at ages 5, 7, 11 and during the last year at school 18,069 Non-routine examinations 11,913 Examinations to ascertain fitness for employment 376 Statutory Examinations. Children examined under Sections 34 and 57 of the Education Act, 1944 146 As a result of these examinations the following recommendations were made:- Admissions to Boarding E.S.N. Schools 6 Admissions to Day E.S.N. Schools 91 Admissions to Junior Training Schools 3 Admissions to Open Air School 1 To remain at ordinary school with special educational help Decision deferred 42 3 122 TABLE 34 SCHOOL HEALTH SERVICE - Clinic attendances Vision Clinics. Sessions 387 Total attendances 3,830 Number of new cases 833 Errors of refraction or squint 3,285 Other eye defects 13 Spectacles ordered 1,325 Audiology Clinics Sessions 81 Total attendances 844 Number of new cases 325 Special Investigation Clinics Sessions 395 Total attendances 2,056 Number of new cases 244 Minor Ailments Sessions — Medical Officer — Nursing Sister 1,689½ Total attendances 11,597 Number of new cases seen by Medical officer — Number of new cases seen by nursing sister 2,208 Number of new cases per 1,000 school population 44 Cases treated Athletes foot, verrucae, skin diseases, eye and ear defects, bruises, lacerations etc 2,208 123 TABLE 35 SCHOOL HEALTH SERVICE - Prophylaxis Diphtheria — Primary Courses 163 Booster Doses 815 Measles — Poliomyelitis Primary Courses 250 Booster Doses 2,497 B.C.G. Mantoux tested 5,243 Vaccinated 4,604 Mantoux positive 292 Percentage of School Population Immunised:- Southwark I.L.E.A. Diphtheria 89.9% 88.9% Whooping Cough 86% 82.1% Poliomyelitis 87.8% 88.5% Smallpox 66.7% 69.1% TABLE 36 SCHOOL HEALTH SERVICE - School Nursing School Nursing Health Surveys: Comprehensive — Total number examined 34,627 Percentage found verminous 1,48% Selective — Total number examined 14,942 Percentage found verminous 3,36% Audiometry Number of children given sweep tests 9,580 Number of children given pure tone tests 488 Number of children referred to otologist 243 124 TABLE 37 SCHOOL DENTAL SERVICE TOTAL SCHOOL ROLL 49,600 1970 1969 Inspection 258 180 Ordinary Treatment 2,944 2,877 General anaesthetic 68 54 Orthodontic 35 42 Health Education 311 325 Total Sessions 3,616 3,478  1970 970 Inspection: number of children given First inspection at school 24,994 17,000 First inspection at clinic 3,719 4,106 Percentage found to require treatment 52.8 57.1 Re-inspection at school or clinic 2,013 1,958 Percentage found to require treatment 86.7 86.0 Percentage of school Roll inspected 58.0 43.0 Visits for treatment: Number of first visits 5,291 4,879 Number of subsequent visits 12,551 13,079 Total visits 17,842 17,958 Emergencies 471 477 Additional courses commenced 1,726 1,547 Number did not attend 7,254 8,502 125 TABLE 37 (continued) 1970 70 Treatment given: Number of fillings: In permanent teeth 10,579 10,349 In temporary teeth 6,471 6,110 Number of extractions: of permanent teeth 537 551 of temporary teeth 2,667 2,428 Number of other operations (prophylaxis, X-rays, inlays, crowns, etc.) 7,475 7,391 Courses of treatment completed 4,818 4,188 Orthodontics: Number of new cases 15 24 Number of removable appliances fitted 16 35 Number of fixed appliances fitted 3 1 Number of cases referred to Hospital Consultant 5 5 Sessional averages: First visit: 1.7 1.6 Subsequent visits 4.1 4.4 Emergencies 0.2 0.2 Did not attend 2.4 2.9 Fillings: In permanent teeth 3.5 3.5 In temporary teeth 2.1 2.1 Extractions: of permanent teeth 0.2 0.2 of temporary teeth 0.9 0.8 Ratio of permanent teeth filled to permanent teeth extracted 16.6 to 1 15.5 to 1 Ratio of temporary teeth filled to temporary teeth extracted 2.1 to 1 2.2 to 1 126 Schools The total number of schools in Southwark was 138. This total is comprised of the following:- County Schools Junior and Infants combined 15 Infants 30 Juniors 30 Secondary 15 Voluntary Schools Junior and Infants combined 20 Infants 5 Juniors 4 Secondary 11 Nursery Schools 3 Special Schools for the Educationally Sub-normal children 4 for Maladjusted Children 1 738 The number of Nursery Classes in the Borough increased from 25 to 35 in 1970. With the opening of a Partially hearing Unit at John Ruskin School in 1970, the number of Partially Hearing Units in the Borough was increased to 2. Medical Inspections There was a total of 18,069 Routine Medical Inspections, during 1970, of Southwark school children. These routine Medical Inspections are carried out at least four times in each pupil's school life: at entry into Infant School, Junior School, Secondary School and also in the last year at School. Children in Nursery Schools are seen annually. In addition to Routine Medical Inspections, there were 11,960 re-inspections and other Non-routine Medicals carried out. These are arranged at the request of Medical Officers, Headteachers, School Nurses, the Divisional Education Welfare Officer, or parents. Children on the Observation and Handicapped Register are seen at regular intervals and their educational requirements are re-assessed accordingly. 127 Children whose school attendance is a problem are visited at home to evaluate the reasons for their non-attendance. The Medical Officers, the Teachers and the Care Committee Workers work in close liaison to help these children. The reasons for their non-attendance are varied but may be social, physical or emotional difficulties. Statutory Examinations A total of 146 children were examined under the Sections 34 and 57 of the Education Act 1944 for assessment of possible need of E.S.N. schooling. This total was 21% lower than the previous year. Of the children examined, 24% were recommended to continue at ordinary schools but with extra remedial help. A greater number of children, than in previous years, (who were referred by either the Head Teachers or the Principal Medical Officer to the Educational Psychologists) were found to require short term educational help only. The close co-operation and liaison between the Medical Officers and the Educational Psychologists have proved to be very beneficial to the children. School Health Social Work There has been little change in the structure and responsibilities of the Social Workers in the School Health Service. They have been working particularly with families attending the Special Investigation Clinics, and with families with deaf children. One Social Worker was attached to the School Health Clinic of the Royal Eye Hospital, and another acted as a Liaison Officer between the paediatric and children's psychiatric services of Guy's Hospital, and the Local Authority School Health Services. The use of these Social Workers in these capacities proved a great help to the functioning of the services involved. The Social Worker for the Deaf monitored a successful scheme for deaf and partially hearing children at two of the Inner London Education Authority's playgroups for normal children during school holidays. These were held in ordinary schools where teachers of the deaf were responsible for each group. Hence deaf children were, for the majority of the time, integrated with normal children but could appeal to the teachers of the deaf when necessary. A group of young deaf children (under 7) attended a special holiday playgroup. The Inner London Education Authority arranged transport. 128 The Social Worker for the deaf attended the sessions of the otologist at the Partially Hearing Units. He established a close relationship with both the teacher for the deaf and the Principal Medical Officer (School Health) for the supervision of children on the Deaf Register. Prophylaxis During 1970 the immunisation drive against Diphtheria, Tetanus and Poliomyelitis was increased. In certain schools, where the immunisation status was unsatisfactory, children were immunised in the schools. Polio vaccinations were administered simultaneously with the School Medical Examinations. The 1970 B.C.G. Programme has been very successful. 5,243 children were Mantoux tested. This covers the school population in their 13th year and absentees from the previous year. A total of 292 (i.e. 5.5%) of those children tested were found to be Mantoux positive. However, approximately half of these had already previously received a B.C.G. vaccination. 4,604 children were vaccinated with B.C.G. This comprises a 92.5% acceptance rate of the pupils requiring to be vaccinated. Student Health Service This service has continued to be provided for the London School of Printing the Camberwell School of Art, the Walbrook College, and the Southwark College for Further Education. The Medical Officers concerned gave introductory lectures to students, especially from Overseas, to assist on the difficult transitional period of adjustment to student life in England. Full time students, who were new entrants, were given the opportunity of a medical check-up. The attendance rate for these check-ups was very encouraging. Other students were seen by the Medical Officer at regular sessions. This was arranged by either self-referral, or referral by Social Workers or lecturers. 129 The majority of the problems that arose were found to be of an emotional nature caused by the various stresses of student life (e.g. Examinations, sex, separation from home, etc). Referrals were made, where necessary, to a psychiatric hospital, a local general hospital, or a Family Planning Clinic. All referrals were made in consultation with the Student's General Practitioner. All students were strongly advised to register with a General Practitioner on entry to the College. Health Education An increasing number of teaching sessions in Schools have been arranged at the request of head teachers. Nursing staff are invited to cover health education subjects included in courses to C.S.E. level, as members of a teaching team. A closer liaison between heads of departments in senior schools is developing, and advice is frequently sought and supplied. Regular health education teaching is being carried out in all E.S.N. schools and is becoming established in a greater number of Primary Schools. A total of 208 talks were given by Health Visitors and School Nurses on a wide range of subjects, including the following:- Parent Craft Child development Ante-natal and child care Environmental Health and Social Services Sex education Family planning Venereal diseases Nutrition for the family Food hygiene Infectious diseases and immunisation Personal hygiene General health First aid Smoking, drugs and alcoholism A variety of visual aids were used to illustrate the talks. 130 The Health Education Programme for School children were held at five centres during August. Changes in the films, group activities and competitions, were made each week. The total number of children that attended was 1130. Much of the individual work produced by the children was of a high standard. Report of the Principal School Dental Officer 1970 During 1970 as part of the increased volume of school dental inspections a large number of secondary school children were seen. It is interesting to observe that the percentage of these older children who required dental treatment (42%) was less than for school children in the Borough as a whole (53%). This tendency increased with age and it was noted that in the sixth forms and upper forms of secondary schools the numbers in need of dental treatment had fallen considerably. The majority of secondary school children now appear to have regular dental treatment. Many of them avail of the facilities provided by the General Dental Services and have become regular attenders at their family dentist. There is no doubt that quite a few of these children have their introduction to dentistry in our school clinics and from this the habit of continuing dental care is established. The only point on which there may be some doubt is that some of them showed lack of care in oral hygiene. To these children the importance of frequent tooth brushing had not been conveyed as clearly as the importance of regular visits to the dentists. It would indicate therefore the value of dental health education and the teaching of methods of preventive dentistry in secondary schools. If the level of oral hygiene can be brought to the same standard as the restoration of cavities in teeth, there is every hope that children will leave school in increasing numbers with their mouths in good condition and free of any dental defects. Inspection and Treatment A total of 25,000 children were inspected at school and in all 58% of the school roll received dental inspection either at school or at the clinic. This was the highest figure attained since the resumption of annual school inspections in 1966. The trend towards less treatment being necessary continued. The percentage of those needing treatment was again lower than in the previous year. 131 Visits for treatment were approximately the same as in 1969. There was again a fall in the number of broken appointments per session. This is an encouraging sign and will perhaps permit an extension in the number of children treated per session in future years. Due to the increased demand following on the rise in school inspections, there were more general anaesthetic sessions this year and the number of extractions also increased. Fewer orthodontic cases were seen this year as the post of Orthodontist became vacant in May and was not filled until November. Staff During 1970 two full time dental officers joined the staff replacing several part-time staff who left. These changes were largely due to a rather higher number than usual of newly qualified dental surgeons joining the school service for a period of between three and six months. Although this does lead to some administrative difficulties, nevertheless the impact of newly qualified officers on the service has many advantages. Ideally one would hope that it would be possible to retain these recruits for at least a year. In this way changes of staff are kept to a minimum and the children become accustomed to being treated by the same dental officer. The position with regard to dental surgery assistants was reasonably satisfactory. The quality of our dental surgery assistants work is very high but there is great difficulty in attracting suitable applicants to fill vacancies because of the low pay scales compared to those obtained in the general dental service. A further difficulty is the fact that young applicants are deterred by the age-related scale which prevents the employing authority making any allowance for previous experience in this work. Premises and Equipment During the year an additional surgery, equipped for a dental auxiliary, was brought into use at 475, Lordship Lane. Extensive structural alterations and decorations were carried out at this clinic which brought about a marked improvement in its general appearance as a dental suite. The I.L.E.A. mobile dental clinic was again in use at Redriff and Langbourne Schools, providing treatment facilities for children who would otherwise have had long and difficult journeys to the nearest clinic. 132 Courses Two dental surgery assistants attended the evening course held by the City College of Further Education and were successful in the subsequent examination for the National Certificate. Classes for this course were held at St. George's Health Services Centre. During the year courses attended by dental officers included one on the subject of Preventive Dentistry at the British Dental Association Headquarters in London, a refresher course at Oxford in September, one on the care of handicapped children at Guy's Hospital and one on the latest advances in drugs at Mount Vernon Hospital, Northwood. Visitors to the Borough during the year included Dr. E.V. Castillo, the Deputy Director of Dental Services for the Phillipines who was in the country on a W.H.O. Fellowship and was most interested in the dental services in the Borough. Dental Health Education Throughout the year the programme of dental health education continued with various activities at different schools in the Borough. At one school a Dental Health Summer Fair was organised by one of the dental surgery assistants. This was a great success and enabled the children to make the learning of the dental health lesson an interesting procedure. The I.L.E.A. Dental Health Puppet Show again visited the Borough during November and 31 schools and a total of 4,470 children received dental health education in an amusing and entertaining way. The Puppet Show was also taken to two childrens hospitals. Although a number of schools being supplied with apples decided to leave the "Apples for Schools" scheme, it was very encouraging to see that many of these schools were contacting local shops and buying apples directly for resale to the children during break time. This was a tangible result of the efforts over previous years of dental health education. Children were becoming accustomed to buying apples at school break time instead of biscuits and sweets and therefore one small step forward in improving both their dental health and possibly their general health also had been taken. A description of the scheme operating in Southwark schools was featured in the display of the General Dental Council at the Royal Society of Health Congress at Eastbourne in April. The dental auxiliary carried out most of the dental health education work during the year. This involved much visiting of schools and also a considerable amount of ingenuity and hard work which went into the preparation for the 133 ferent visits. It is not always the same display which appeals to children of different ages. The making of models and the preparation of posters and suitable talks are all part of the work of the dental auxiliary in this most important field of prevention. 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. 134 Mental Health Training Centres Crispin House (Adult) Kirkwood (Junior) Tuke (Junior) Day Centres Castle Camberwell Special Care Unit Tuke (Junior) Hostels Dover Lodge Evelyn Coyle Gibson House Mortuary S.E. London G.P. Centre Home Help Offices Bermondsey Health Centre Lordship Lane Town Hall Offices H.Q. Castle House Area 1 Area 2 Area 3 Area 4 137 49 Grange Walk, S.E.1 Kirkwood Road, S.E.15 2a Harders Road, S.E.15 Hampton Street, S.E.17 Benhill Road, S.E.5 2a Harders Road, S.E.15 Wood Vale, S.E.23 49a Grange Walk, S.E.1 12 The Grange, S.E.1 Tennis Street, S.E.1 St. Mary's Road, S.E.15 Grange Road, S.E.1 20/22 Lordship Lane, S.E.22 Peckham Road, S.E.5 2 Walworth Road, S.E.1 Larcom Street, S.E.17 Spa Road, S.E.16 29 Peckham Road, S.E.5 20/22 Lordship Lane, S.E.22 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.1 (telephone number 703 6363). Outside Office Hours (including week-ends 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 week-ends 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 week-ends). 138 APPENDIX B HEALTH DEPARTMENT ESTABLISHMENTS Maternity and Child Welfare Centres Amott Bermondsey Health Centre Bird-in-Bush Consort Denmark Hill Health Services Dept, John Dixon Kingswood Lordship Lane Mayward House Redriff St. George's Health Services Centre Salomon's Silverlock Sumner Road Sutherland House Townley Villa Street School Treatment Centres Bermondsey Health Centre Camberwell Camberwell Sub-Centre Gordon Road Health Services Dept. John Dixon Lindley Lordship Lane Redriff School St. George's Health Services Centre Amott Road, S.E.15 Grange Road, S.E.1. Old Kent Road, S.E.15 Consort Road, S.E.15 Blanchedowne, S.E.5 Larcom Street, S.E.17 6/8 Drummond Road, S.E.16 Bowen Drive, S.E.21 475 Lordship Lane, S.E.22 Benhill Road, S.E.5. Redriff Road, S.E.16 151/152 Blackfriars Road, S.E.1 Guy's Hospital, S.E.1. 3 Warnden Street, S.E.16 Basingstoke House, S.E.I5 Sutherland Square, S.E.17 Townley Road, S.E.22 Villa Street, S.E.17 Grange Road, S.E.1 Addington Square, S.E.5 Comber Grove School, S.E.5 Gordon Road, S.E.15 Larcom Street, S.E.I7 6/8 Drummond Road, S.E.16 163 Commercial Way, S.E.15 475 Lordship Lane, S.E.22 Redriff Road, S.E.16 151/152 Blackfriars Road, S.E.1 135 Day Nurseries Bishops House Dog Kennel Hill Lympstone Merryfield Queen's Road Whitstable Disinfecting and Cleansing Stations King James' Street, S.E.1 Neckinger, S.E.16 District Nurses Benson Home Bermondsey Peckham Road Foot Clinics Amott Bermondsey Health Centre Bird-in-Bush Caroline Gardens Health Services Department John Dixon Lordship Lane Peckham Road St. George's Health Services Centre Silverlock Creche Bird-in-Bush Consort Road Kingswood St. George's Health Services Centre St. Peter's Church Hall Sumner Sutherland House Townley Kennington Park Place, S.E.1 1 Dog Kennel H1ll, S.E.22 Lympstone Gardens, S.E.15 Sultan Street, S.E.5 St. Mary's Road, S.E.15 Stevens Street, S.E.1 Sancroft Street, S.E.1 1 108 Grange Road, S.E.1 29 Peckham Road, S.E.5 Amott Road, S.E.15 Grange Road, S.E.1 Old Kent Road, S.E.15 Asylum Road, S.E.15 Larcom Street, S.E.17 Drummond Road, S.E. 16 475 Lordsh1p Lane, S.E.22 29 Peckham Road, S.E.5 151/152 Blackfrlars Road, S.E.1 3 Warndon Street, S.E.16 616 Old Kent Road, S.E.15 S.E.15 Bowen Drlve, S.E.21 151/152 Blackfrlars Road, S.E.1 Dulwich Common, S.E.21 Basingstoke House, Sumner Road, S.E.15 Sutherland Square, S.E.17 Townley Road, S.E.22 136 INDEX Abortion Act, 1967 42 Accidents in the home 52 Notification 83-85 Prevention 51 Adoption and Boarding out 113 Advisory Committees 40 Advisory and Preventive Clinics 45 Analysis of food and drugs 93 Water 68 Ice cream 97 Artificial Kidney Machines 47 Atmospheric Pollution 89 Smokeless Fuel89 Fuel oil. 90 Sulphur dioxide90 Battersea 'B' Power Station 91 Legal proceedings 91 Smoke control orders 92 Attachment to G.P.s 28 Audiology 37,119 Bacteriological examinations eggs 106,107 food 93 milk 97 shell-fish 111 water 66,67 Bakehouses 64 Barbers & hairdressers 64 Bathing of Aged Persons 76 Baths personal cleansing 76 swimming 65 B.C.G. vaccination of schoolchildren 124,129 Births 21 Blind and Partially sighted persons 43 Boarding-out 113 British Red Cross Society-loans, home nursing Equipment 36 Cancer 18,43 Case conferences 38, 39 Cervical cytology 43,114 Cheese 109 Chest clinics 117, 118 Child-minders 23,24 Child welfare centres 22 Children & Welfare Committees Establishments 113 Chiropody 46,118 Clean Air Act, 1956, 1968 89,91,92 Cleansing stations 76 Clearance areas 88 Closing Orders 87 Common Lodging Houses 64 Community care 42,61 Compensation - loss of earnings 74 Confinement 21,25 Co-operation with doctors and hospitals 40 Co-ordinating Committee 38,39 Co-ordination of social services 39, 40 Creches - occasional 137 Cremations68 Cytology - cervical 43, 44 Day centres 137 Day nurseries 136 Rules for admission 134 Council 32 Private 24 Deaf children 30,37,128 Death causes of 12-17 classification 10,11 infant 18, 19 maternal 18,19,25 rates 18 tuberculosis 18 Dental service 31 Hygiene 53,54 maternity and child welfare 31,34 schoolchildren 133 Development of voluntary effort 118 Diabetic Clinic 28 Diphtheria Immunisation 33,124,129 Disinfection and disinfestation 76 Displays 51 Disposal of unsound food 109, 112 District nursing 27,136 Domiciliary midwifery service 26 Drainage 63 Early discharge of maternity patients 25 Egg products 107 Emergency arrangements 138 Environmental Health Services 63,64 Establishments 62 Eye Clinics 43,47 Factories Act, 1961 85 Family caseworkers38 Family Planning 40,41 Family Planning Act, 1967 40,41 Feral Pigeons 64 Finance 119 Fireguards, loan of 36 Fluoridation 32 Food & Drugs Act, 1955 92-96,105 139 Food hygiene regulations 98-101, 102-104 imported 105, 106, 109, 110 poisoning 70,73 premise 64 routine examination 105 sampling 93 unsound & legal proceedings 98,104 Foot clinics 136 Geriatric liaison 40 Guthrie Test 31 Gynaecological disorders 44 Handicapped and Observation Register 29, 30 Handicapped children 29,59,60 pupils 127 Health Committee 3,4 education and home safety 28,49,50,91, 129,130 service establishments 135 surveys 124 visiting 26-28 Health Services and Public Health Act, 1968 22 Hoists and Lifts 81 Home bathing service 76 Home Dialysis 47 Home help service 35,137 Home nursing 25,27 Home nursing equipment, loan of 36 Home safety 49 Houses in multiple occupation 88 Housing Inspection of dwelling houses 87,88 Proceedings - Public Health Acts 87 Proceedings - Housing Aet, 1957, 69 87 Ice-Cream sampling 97 Illegitimate births 18 Immigrants - medical arrangements 45 Immunisation and vaccination 31,129 Imported food Regulation, 1968 105 lncomtinent laundry service 76 Infant mortality 18 Infant welfare clinics 22, 135 sessions 22 Infectious Diseases 69, 70 Inner London Education Authority School Health Service Inquests 77 Junior Training Schools 56-58 Legal proceedings 81,82,89 Loan of fireguards horrif nursing equipment 36 Maternal mortality 18,19,25 Maternity and child welfare centres 135 services 20,34,118 Measles 33,69,70,71, 124 Medical examination of staff 116, 117 inspection of schoolchildren 127 priorities for rehousing 89 treatment of schoolchildren 122 Mental Health service Act, 1958 54,55,60,137 Hospital and Guardianship Regulations, 1960 55 community care 42, 61 day centres 55 junior training schools 56,57,59 residential accomodation 56,58 short-term care58 social clubs 56 special care units 57,59 staffing 54 Midwifery service 138 Milk sampling 97 Miscellaneous 113,114 Mobile Health Pilot Clinic 47,48 Mortuary 77, 137 Mothercraft 22 Mothers Clubs 51 National Health Service Act, 1946 22 Neo-natal mortality 21 Newcomen Centre 28, 30 Notifiable diseases 69-72 Notification of infectious diseases 71,72 Nurseries & child-minders Regulations Act 23 Nursing Homes 42 Observation (At Risk) & Handicapped Register 29, 30 Offensive trades 63 Office, Shops and Railway Premises Act, 1963 78, 79,80 Outworkers registration 86 instruction 86 Perinatal mortality 21 Paripatetic teacher of the deaf 37 Personal cleansing stations 76 Personal health services 24,25 Pest control 92 Pet Animals Act, 1951 64 140 Pharmacy and Poisons Act, 1933 64 Phenylketonuria 31 Pigeons 69 Playgroups 24 Poliomyelitis vaccination 70,71,124,129 Populatio 18 Port Health Administration 45 Post mortem examination 77 Premature births 26 Prevention of Damage by Pests Act, 1949 92, 93 Preventive Medicines 45 Prophylaxis 31, 129 Psychiatric liaison 27,128 Puppet shows 54 Recuperative holidays 42 Registration of premises 64 Rent Act, 1957 89 Residential accomodation (Mental Health) 59, 62 Rodent control 93 Samples food and drugs 108 ice cream 97 milk 97 water 66,67 Sanitary circumstances of the area 63 Scabies and vermin 76 School dental service 125,126,131,132 School Health service 122,123,128,129 School nursing service 124 School population 127,128 School summer vacation programme 50 Sewerage and sewage disposal 64 Shellfish 111 Smallpox vaccination 33,124 Smoke control 92 Smoking 49,50 Social Work (Health Services) 37,38 South-East London General Practitione's 113, 115, Centre 137 Special advisory clinics 40,45 Special care units (mental health) 137 Special Investigation Clinic 37 Staff 5 Staff - attachment of 28 Staff medical examinations and questionaires 11.6,117 Statutory examination 128 Stillbirths 18,21 Student Health service 129,130 Surveys 124 Swimming baths 65 Tetanus immunisation 33 Tuberculosis care and after-care 45 chest clinics 39,118 deaths 10, 18 notifications 70,71 Typhoid fever 69,71,72 Unsound food 112 Urban programme — Playgroups 24 Vaccination and immunisation 33 Vermin and scabies 76 Verminous premises 76 Vision testing 43 Vital statistics 18,19 Voluntary effoer - Development 118 Voluntary organisations 118 Water safety 5 3 Water supply 68 Water supply, fluoridation of 32 Welfare & Children's Committees' 113 Establishments 113 Well women clinics 114 Whooping cough immunisation 31 141 Printed and Published by London Borough of Southwark