II Sou 81 London Borough of Southwark ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1971 Page INTRODUCTION 1 HEALTH COMMITTEE 2 STAFF 5 VITAL STATISTICS 16 PERSONAL HEALTH SERVICES 18 COMMUNITY CARE SERVICES 33 ENVIRONMENTAL HEALTH SERVICES 41 MISCELLANEOUS 78 SCHOOL HEALTH SERVICE 83 APPENDICES 94 INDEX 97 Health Department, Municipal Offices, Castle House, 2, Walworth Road, SE16SU 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 1971. The Local Authority (Social Services) Act 1970 was implemented on 1st April 1971 and the new Social Services Department assumed control of the mental health, day nursery and home help services previously the responsibility of the Health Department. The Consultative Document on the Reorganisation of the National Health Service was published during the year and the department co-operated in an expert study of the detailed management arrangements for the reorganised service. These developments emphasise the need for continued close co-operation at all levels in order that client needs may be adequately met. In this connection closer liaison continued to develop with the hospitals in the area. The mobile health clinic was a focal point of interest at two important functions during 1971. In March the clinic was exhibited at the Chest and Heart Association in London. During July, the clinic was transported to Leicester where it formed part of the British Medical Association's scientific exhibition and produced a tremendous interest amongst delegates from Britain and many parts of the world. As a result of the Education (Milk) Act 1971, a scheme was approved to provide milk free of charge to children over the age of 7 years who were resident in the Borough and attending Inner London Education Authority schools, who were no longer eligible to receive milk. 1 I would like to express my gratitude to the Chairman and Members of the Health Committee in particular, and to all other Members of the Council for their support during the year. Also to the Chief Executive & Town Clerk and other Chief Officers of the Council and finally once again to the Health Department staff for their diligent work during 1971. 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 N. H. Tertis, F.Inst.Ch., F.R.S.H., S.R.Ch. Vice Chairman: Councillor Mrs. L. M. Brown Members: Alderman Mrs. F. E. Sampson Councillor L. H. Alden, B.Sc., A.K.C. Councillor F. J. Brean, F.P.S., F.R.S.H. Councillor Mrs. A. Brereton Councillor G. Byfield Councillor Miss. M. A. Cook Councillor Mrs. E. M. Dalton Councillor Mrs. E. Daymond Councillor C. A. Farrow Councillor Mrs. M. G. Farrow Councillor C. A. W. Hogben Ex-Officio: Councillor Mrs. M. Goldwin Councillor J. H. O'Grady Councillor H. J. Grant Mayor of the London Borough of Southwark. Leader of the Council Leader of the Opposition Members of the Health Committee represented the Council on the following organisations Bird in Bush Welfare Centre Voluntary Committee Family Welfare Association (Area 7 Committee) Greater London Home Safety Council National Association for Maternal and Child Welfare National Health Service—Inner London Executive Committee National Society for Clean Air Solomon's Welfare Centre Voluntary Committee Southwark (Camberwell) Chest Care Committee Councillors Mrs. Daymond and C. A. W. Hogben Councillor N. H. Tertis Councillor C. A. Farrow Alderman Mrs. F. E. Sampson Councillor N. H. Tertis Alderman Mrs. F. E. Sampson, Councillors Miss M. A. Cork and Mrs. E. Daymond. Councillor Mrs. L. M. Brown Alderman Mrs. F. E. Sampson Councillors C. A. Farrow and Mrs. M. G. Farrow 3 Southwark (Southwark & Bermondsey) Chest Care Clinic South London Family Service Unit Management Committee South West Metropolitan Regional Hospital Board—London Liaison Committee Standing Conference on Atmospheric Pollution The Board of Governors of: Bethlem Royal & Maudsley Hospital Guy's Hospital King's College Hospital Councillors Mrs. L. M. Brown, G. Byfield and Mrs. E. Daymond Councillor Mrs. Brereton Councillor Miss M. A. Cork Councillor Mrs. L. M. Brown Alderman Mrs. F. E. Sampson Councillors F. J. Brean & N. H. Tertis Councillors Mrs. M. Goldwin and N. H. Tertis 4 HEALTH DEPARTMENT STAFF AT 31 DECEMBER, 1971 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., M.F.C.M. 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., M.F.C.P. Suzanne Collett, L.R.C.P., L.R.C.S., L.R.F.P.S., D.P.H. Sybil R. Yeates, M.B., B.S., M.R.C.S., L.R.C.P. 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) Medical Officers—10 Sessional Medical Officers—F.T.E.—5.5 Director, South East London General Practitioners' Centres: B. H. Pentney, M.B.C.S., L.R.C.P. Chief Dental Officer and Principal School Dental Officer: J. Cleary, B.D.S.(Irel.), D.D.P.H., R.G.S.(Eng.) Dental Officers: Full-time 3. Sessional—F.T.E. 3.1 Dental Surgery Assistants 10. Dental Auxiliary 1 Chief Administrative Officer: B. F. Hampson, A.C.I.S. Deputy Chief Administrative Officer: E. J. Wicks 5 Senior Administrative Officers: J. A. Keane H. D. White G. A. Chappelle D.M.A. Administrative and Clerical Staff Full time—87. Part-time F.T.E.—7.6 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 Deputy Divisional 4 District 23 Senior Housing 1 Housing 1 Senior Wharves 1 Wharves 2 Senior Smoke I Student Public Health Inspectors—10 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.M., H.V. 6 Assistant Chief Nursing Officers 3 Centre Superintendents 9 Health Visitors 47 T.B. Visitors 5 Student Health Visitors 14 Clinic and School Nurses 41 Clinic Auxiliaries—F.T.E 12 Senior Environmental Visitor 1 Environmental Visitors 4 Superintendents Home Nursing 1 Deputy Superintendents, Home Nursing 1 District Nurses 52 District Nurses (S.E.N.) 7 Nursing Auxiliaries 5 Chief Social Worker (Health Services): Vacant Deputy Chief Social Worker (Health Services): Vacant Social Workers 3 Chief Chiropodist: K. Heaton-Ward, M.Ch.S., S.R.Ch. Chiropodists: Full-time—6 Sessional—F.T.E.—3.2 Manual and Domestic Staff: Staff of various categories—F.T.E.—97 7 CLASSIFICATION OF DEATHS BY CAUSE — CAUSE OK DEATH Sex All Ages Under 4 weeks 4 Wks & under 1 year. B4 Enteritis and Other Diarrhoeal Diseases M 1 – 1 F 2 — 1 B5 Tuberculosis of Respiratory System M 8 — F 1 — — B6(l) Late Effects of Respiratory T.B. M 2 F — — B6(2) Other Tuberculosis M 1 – – F 2 – — Bll Meningococcal Infection M 1 1 F 1 – 1 B17 Syphilis and its Sequelae M F 2 – — B18 Other Infective and Parasitic Diseases M 5 F 5 3 — B19( 1) Malignant Neoplasm, Buccal Cavity etc. M 8 — F 2 — — B19(2) Malignant Neoplasm, Oesophagus M 7 F 8 — — B19(3) Malignant Neoplasm, Stomach M 49 F 29 — — B19(4) Malignant Neoplasm, Intestine M 49 F 56 — — B19(5) Malignant Neoplasm, Larynx M 9 F — — — B19(6) Malignant Neoplasm, Lung, Bronchus M 207 – – F 61 — — B19(7) Malignant Neoplasm, Breast M 1 F 63 — — B19(8) Malignant Neoplasm, Uterus F 32 — — B19(9) Malignant Neoplasm, Prostate M 17 — — B19(10) Leukaemia M 7 F 7 — — 8 9 IN SEX AND AGE GROUPS AGE IN YEARS 1—4 5—14 15—24 25—34 35—44 45—54 55—64 65—74 75 & over — — — — — — — — — — — 1 — — — — — — — — — — 1 1 4 2 — — — — — — — 1 — — — — — — 1 1 — — — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — — — 1 2 1 — — — — — — — — 1 1 — — — — 1 1 1 3 2 — — — — — — — — 2 — — — — — 1 4 1 1 — — — — — — 2 2 4 — — — — — 8 14 17 10 — — — — — 2 3 8 16 — — — — 2 3 8 15 21 — — — — — 9 10 10 27 — — — — — — — 2 7 — — — — — — — — — — — — — 1 20 63 89 34 — — — — 1 5 14 18 23 — — — — — — — — 1 — — — — 2 11 18 14 18 — — — — 1 4 4 11 12 — — — — — — 2 6 9 — — — — — 1 2 3 1 — 2 — — — — 2 1 2 CAUSE OF DEATH Sex All Ages Under 4 weeks 4 Wks & under 1 year B19( 11) Other Malignant Neoplasms M 79 – – F 96 — — B20 Benign and Unspecified Neoplasms M 4 — — F 4 — — B21 Diabetes Mellitus M 7 — — F 21 — — B22 Avitaminoses, etc M 1 — — F — — — B46(l) Other Endocrine etc., Diseases M 4 — — F 4 — — B23 Anaemias M 1 F 13 — — B46(3) Mental Disorders M 6 — — F 2 — — B24 Meningitis M 2 F 2 — — B46(4) Multiple Sclerosis M 2 F 2 — — B46(5) Other Diseases of Nervous System M 14 — F 12 — — B26 Chronic Rheumatic Heart Disease M 14 — F 38 — — B27 Hypertensive Disease M 18 — — F 37 — — B28 Ischaemic Heart Disease M 447 — — F 308 — — B29 Other Forms of Heart Disease M 41 — — F 113 — 1 B30 Cerebrovascular Disease M 105 — F 220 — — B46(6) Other Diseases of Circulatory System M 54 — — F 74 — — 10 AGE IN YEARS 1—4 5—14 15—24 25—34 35—44 45—54 55—64 65—74 75 & over — — 3 2 2 8 26 21 17 1 — 1 — 7 7 23 24 33 1 1 — — — 1 1 — — — — 1 1 1 — 1 — — — — — 1 2 2 2 — — — — — — 2 5 14 — — — — — — — — 1 — — — — — — — — — — — — — 1 — 1 1 1 — — — — — — 1 1 2 — — 1 — — — — — — — — — — — — 1 1 11 — — — — — — 1 2 3 — — — — — — — 1 1 — — — — — 1 — 1 — — — — — — 1 1 — — — — — — — 1 1 — — — — — — — — 1 — 1 — — — 1 1 1 1 4 6 — — — — — 1 1 4 6 — — 1 — — 1 4 5 3 — — 1 — 2 2 8 7 18 — — — — — 3 5 8 2 — — — — — 3 4 7 23 — — 1 11 53 121 144 117 — — — — 1 12 27 92 176 — — — — 1 3 5 8 24 — — 1 — — 2 4 9 96 — — 2 — 3 5 17 35 43 — — 1 1 2 9 13 48 146 — — — — — 2 10 20 22 — — — — 1 2 3 17 51 11 CAUSE OF DEATH Sex All Ages Under 4 weeks 4 Wks & under 1 year B31 Influenza M 1 — — F — — — B32 Pneumonia M 139 2 5 F 187 1 4 B33(l) Bronchitis and Emphysema M 156 — — F 59 — — B33(2) Asthma M 5 — — F 2 — — B46(7) Other Diseases of Respiratory System M 15 — 2 F 21 — 3 B34 Peptic Ulcer M 15 — — F 14 — — B35 Appendicitis M 4 — — F 2 — — B36 Intestinal Obstruction and Hernia M 8 — — F 12 — — B37 Cirrhosis of Liver M 3 — — F 8 — — B46(8) Other Diseases of Digestive System M 13 — F 18 — — B38 Nephritis and Nephrosis M 13 — — F 10 — — B39 Hyperplasia of Prostrate M 7 — — B46(9) Other Diseases, Genito-Urinary System M 4 — — F 28 — — B40 Abortion F 1 — — B41 Other Complications of Pregnancy, etc. F 3 — — B46(10) Diseases of Skin, Subcutaneous Tissue M 1 F 2 — — B46(11) Diseases of Musculo-skeletal System M 6 —_ F 16 — — 12 AGE IN YEARS 1—4 5—14 15—24 25—34 35—44 45—54 55—64 65—74 75 & over — 1 — — — — — — — — — 1 — — — 1 5 12 33 80 — 1 — — — 2 12 29 138 — — — — 1 5 34 63 53 — — — — 1 — 4 12 42 — 1 — — — 1 1 2 — — — — — — — 1 — 1 — — — — 1 1 4 4 3 — — — — 1 1 3 1 12 — — — — — 2 2 4 7 — — — — — 2 — 4 8 — — — 1 — 1 — 1 1 — — — — — — — 2 — — — — — 1 4 3 — — — — — — 1 1 10 — — — 1 — — 1 1 — — — — — 1 — 4 1 2 — — — — — — 3 4 6 1 — — — — — 1 7 9 — — 1 — 1 2 5 1 3 — — — — 1 2 1 3 3 — — — — — — 1 1 5 — — — — 2 2 — 1 — — 1 — 5 4 17 — — — 1 — — — — — — — — 2 1 — — — — — — — — — — — 1 — — — — — — — 1 — 1 — — — — 1 — 2 1 2 — 1 — — 1 — 2 4 8 13 CAUSE OF DEATH Sex All Ages Under 4 weeks 4 Wks & under 1 year B42 Congenital Anomalies M 13 3 2 F 10 4 1 B43 Birth Injury, Difficult Labour, etc M 8 8 — F 6 6 — B44 Other Causes of Perinatal Mortality M 8 8 — F 5 5 — B45 Symptoms and Ill Defined Conditions M 1 — — F 1 — — BE47 Motor Vehicle Accidents M 17 — — F 14 — — BE48 All Other Accidents M 31 — 1 F 34 — 1 BE49 Suicide and Self-inflicted Injuries M 22 — F 15 — — BE50 All Other External Causes M 11 F 2 — — TOTAL ALL CAUSES M 1,672 21 12 F 1,687 19 12 14 AGE IN YEARS 1—4 5—14 15—24 25—34 35—44 45—54 55—64 65—74 75 & over 3 1 1 1 1 1 — 1 2 — — — 1 1 — — — — — — — — — _ — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — 1 — 3 2 1 1 2 1 3 4 — — — 1 1 7 5 1 5 2 — 4 8 5 1 4 2 1 — — 2 1 2 4 21 — — — 1 5 7 6 2 1 — — 2 — — 3 3 4 3 — — 2 1 2 2 2 2 — — — — — — 1 1 — — 6 11 14 11 41 154 372 525 505 4 7 9 4 27 84 186 368 967 15 VITAL STATISTICS, 1971 Area of Borough (including area covered by water) 7,115 acres Population (Registrar General's estimate mid-1971) 260,780 Number of inhabited houses 88,684 Rateable Value (April, 1971) £18,904,512 Sum represented by a penny rate £71,200 Births Total Legitimate Illegitimate Live Births—Male 1,935 1,628 307 Female 1,821 1,537 284 3,756 3,165 591 Still Births—Male 23 20 3 Female 19 16 3 42 36 6 Birth rate per 1,000 population 14.4 Number of deaths—all ages 3,359 Death rate per 1,000 population 12.9 Infantile Mortality Deaths under 1 year 64 Infants deaths per 1,000 live births 17 Maternal Mortality Deaths of women from diseases or accidents associated with childbirth, including abortion 4 Maternal death rate per 1,000 total births 1.05 Deaths from pulmonary tuberculosis 11 Death rate per 1,000 population 0.04 Deaths from cancer of lung and bronchus 268 Death rate per 1,000 population 1.00 Deaths from all forms of cancer 787 Death rate per 1,000 population 3.02 16 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 11.5 11.6 Infantile mortality (deaths under 1 year) per 1,000 live births 17.4 18.0 Maternal mortality per 1,000 total births 0.12 0.17 17 PERSONAL HEALTH SERVICE Maternity and Child Welfare Each of the Council's nineteen 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 Social Services Departments and many voluntary organisations working within the Borough. On 1 June 1971, a new clinic was opened at Whaddon House, Albrighton Road, S.E.22 as a sub-centre of May ward House. Services provided are two child health clinics, a mothers club and a family planning clinic. Details of clinic attendances for the year are as follows: Child Health Sessions. Total number of sessions 2,665 First attendances of children born in 1971 3,238 Total attendances (all ages) 57,746 Toddlers Sessions Total number of sessions 111 Total attendances 679 18 Ante Natal and Post Natal Sessions Ante natal and post natal sessions 38 Total attendances 85 Mothercraft and relaxation sessions 279 Total attendances 1,289 Facilities provided for General Practitioners Sessions held by G.P.s in Council Clinics Ante natal and post natal 91 Total attendances 394 Child health sessions at G.P. surgeries attended by a health visitor 208 Total attendances 4,805 Occasional Creche Creches for the minding of young children, whilst their mothers take part in centre activities, attend clinics, visit hospital or attend to domestic duties, are provided at several centres. A charge of 15p. per session is made but this is abatable in necessitous cases; no charge is made when the parent attends hospital or a centre activity. Where 2 or more children from one family attend the charge is 7|p. for the second and subsequent children. 19 TOTAL NUMBER OF BIRTHS London Borough of Southwark Actual number of births in the Authority's area during the year as notified under Section 203 of the Public Health Act, 1936 or Section 255 of the Public Health (London) Act, 1936, adjusted by any notifications transferred in or out of the area. Live Births Hospital confinements 3,625 Domiciliary confinements 131 3,756 Still Births Hospital confinements 41 Domiciliary confinements 1 42 Deaths of infants in first week of life 32 Deaths of infants one week to one month 8 Deaths of infants one month to one year 24 Perinatal mortality per 1,000 total live and stillbirths 19 Neonatal mortality per 1,000 live births 11 Infant mortality per 1,000 live births 17 Domiciliary Midwifery Service. Administration of Analgesia (89) 80.91% Cases booked with G.P. Obstetrician (109) 99.09% No. of Midwives at end of year (whole time equivalent) 8½ Doctor not booked 1 Doctor present at delivery 0 Doctor not present at delivery 1 Doctor booked 109 Doctor present at delivery 26 Doctor not present at delivery 83 No. of hospital deliveries attended by midwives on discharge before 10th day 622 Percentage of domiciliary live births (6) born premature 5.45% 20 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 life prem. births No. Per 100 live prem. births 2 lb. 3 oz. or less 0 2 lb. 4 oz.-3 lb. 4 oz. 2 33.33 1 100 1 20.00 3 lb. 5 oz.-4 lb. 6 oz. 0 0 0 0 4 lb. 7 oz.-5 lb. 8 oz. 4 66.67 0 0 4 80.00 All cases 6 100.00 1 100 5 100.00 Domiciliary Midwifery To meet the needs of mothers wishing to have a home confinement 8½ domiciliary midwives were employed by the Council. 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 132 of which 2 were premature births and 2 were stillborn. The number of 48 hour discharges was 622. 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 Five maternal deaths due to, or associated with, pregnancy, childbirth or abortion occurred in Southwark during 1971. Full reports on the circumstances relating to these deaths were prepared and forwarded as required to the Department of Health and Social Security. 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. Attachment of Staff to G.P.'s). Nursing auxiliaries 21 tinued 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. Olave's 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 4 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. The following table indicates the volume of work undertaken during 1971 by the District Nursing Service. New patients visited 3,075 Total number of visits 122,026 Nursing staff employed at 31.12.71 (f.t.e.) 61 Visits per nurse (f.t.e.) 2,000 In addition 5,156 visits were made to psychiatric patients including those to 148 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 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 cares of illness as well as in the care and management of children; (5) Health education. 22 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. Liaison with local hospitals continued. Health visitors continued to attend the Diabetic Clinic and Paediatric Departments at King's College Hospital and the Newcomen Assessment Centre Guy's Hospital, making follow-up visits to the children and families. The part of the health visiting service which is measurable is shown in the following statistics for 1971: First visits to: Children born in 1971 4,729 Children born in 1970 5,420 Children born in 1966-69 12,469 Total 22,618 Age 5-18 3,465 Aged over 65 831 Ante Natal 1,409 Mentally disordered 101 Handicapped children and adults 147 Persons discharged from hospital (other than mental hospitals) 50 Infectious diseases 69 Total of all visits made by health visitors 109,388 Attachment of Staff to General Practitioners Severe limitations on the extension of these schemes is imposed by the continuing shortage of qualified staff. Furthermore, before any such scheme can be started there is need for adequate initial discussions and careful consideration of such matters as the suitability of accommodation, selection of staff and the problems arising from the overlapping of practice areas with health visitors' geographical areas. However, it has been possible to maintain existing attachments to 4 group practices involving 4½ health visitors and 5½ district nurses. Each health visitor makes follow-up visits to those patients who live in her district and who attend the practice. She also acts as liaison officer between the general practitioner and the health visitor concerned with those who live outside her district but within the borough boundaries. All health visitors keep in touch with general practitioners in their areas and there is continuing contact between general practitioners and the home nursing service. 23 Wherever suitable, the opportunity is taken to increase liaison with general practitioners, particularly in group practices, in preparation for further attachment schemes when the staffing situation allows. 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. The information on which the register is based is provided by hospitals, general practitioners, domiciliary midwives, clinical medical officers and health visitors. The 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 1971 visits were made to all Infant Welfare Centres and 4,001 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. Children are removed from the register when they have been considered to be developmentally normal, retained if they need further observation and help or transferred to the School Health Service when they are receiving formal education i.e. nursery classes or specialised schools. At 31 December 1971 there were 2,860 children on the register, an average of 73 being added each month. The number of babies notified during the year as congenitally malformed was 68. 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 and Principal Medical Officers conduct an assessment session at the Newcomen Centre and hold special assessment clinics at the child welfare clinics in the Borough. Reports from the Newcomen Centre were received on all Southwark children who attended the clinic and the appropriate recommendations were carried out. 24 The Deputy Medical Officer of Health also holds an assessment session at King's College Hospital and between June and December 1971, 34 appointments were made. (Closer liaison continued to develop 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 and added to the handicapped register. Young children with impaired hearing who required a hearing environment and children who failed to acquire speech because their parents were deaf or because of language difficulties in the home, were, on the recommendation of the otologist, permitted to attend day nurseries for three hour sessions without charge. Phenylketonuria Phenylketonuria is a rare inborn metabolic disorder in which a baby is born without one of the essential chemicals that help to break down food for digestion: this results in one of the ingredients of most foods building up to a high level in the body, which have a damaging effect on the brain. Screening tests for the detection of phenylketonuria using the Guthrie test were carried out routinely on all young babies, those thought to be at special risk were retested. The Guthrie test involves the taking of a blood sample. Prophylaxis Protection is offered in child health centres against diphtheria, whooping cough, tetanus, poliomyelitis, smallpox and measles to children below school age. Special sessions are also held in schools when necessary. In addition, B.C.G. vaccination against tuberculosis of children aged 12-13 years is carried out in schools. Vaccination may also be given by the family doctor and vaccines (except B.C.G. vaccine) are supplied to general practitioners free of charge. 25 VACCINATION AND IMMUNISATION STATISTICS FOR PERIOD 1st JANUARY to 31st DECEMBER, 1971 Immunisation Completed primary courses (Born in) 1971 1970 1969 1968 19641967 Others under age 16 Total 1971 1970 Triple DTP 1072 1789 220 78 55 4 3218 3112 Diphtheria/Pertussis — — —- — 1 1 2 7 Dipht heria/Tetanus 10 36 13 6 224 181 470 332 Diphtheria — — — .—. — 4 4 1 Pertussis — 1 1 — - - 2 2 Tetanus — 4 1 1 7 42 55 26 Salk — — - — - - - - Sabin 1073 1811 237 93 285 218 3717 3584 Measles 18 1185 490 163 170 76 2102 2572 Rubella - 4 2 — 1 3242 3249 4 Reinforcing (booster) Injections Triple DTP 12 547 1194 187 253 57 2250 2134 Diphtheria/Pertussis — 3 — — 17 2 22 33 Diphtheria/Tetanus 1 21 49 32 2428 1015 3546 2957 Diphtheria — — — .—. 5 33 38 17 Pertussis — — — — 1 - 1 4 Tetanus — — 1 2 29 117 149 92 Salk — — — — - - - - Sabin 15 535 1232 221 2663 1105 5771 5944 26 REPORT OF THE CHIEF DENTAL OFFICER 1971 Borough Dental Services Maternity and Child Welfare Dental Service The number of M.&.C.W. sessions held during the year showed a 50% increase over the previous year. The treatment given rose by a comparable amount. The proportion of time of the total Dental Services of the Borough given to M.&.C.W. sessions was 5%, which is close to the national average. More than 400 children under five commenced on a course of treatment during the year and 300 of these completed their treatment. This increase was largely due to more activity in the field of dental health education. The figures also show an improvement in the ratio of fillings to extractions. At St. George's H.S.C. an experimental open session of inspection, dental health education, and instruction in oral hygiene was held jointly by the Dental Officer and the Dental Auxiliary. This session was advertised widely and produced a very good attendance of mothers interested in starting dental care for their young children. The success of this special session held once a month during the year was reflected in the increased demand for treatment of pre-school children. Junior Training Schools In April, under new legislation, the dental care of children attending Junior Training Schools became the concern of the School Dental Service. There was however no interruption in the continuity of treatment for these children. The Guy's Hospital Mobile Dental Unit continued to operate at both Tuke and Kirkwood Schools and plans were made to continue dental treatment by Borough Dental Staff when the Guy's project ended at the end of 1971. Dental Health Education Dental Health Education activity was considerable and the number of sessions devoted to this important aspect was greater than in any previous year. Talks were given and discussions on dental care were held by the Dental Auxiliary at Mothers' Clubs and Welfare Clinics as well as in the courses of visits to Day Nurseries. The amount of dental decay still seen in the youngest children makes it essential to provide information and advice to mothers on early dental care for their children. 27 MATERNITY AND CHILD WELFARE DENTAL SERVICES Children under 5 Expectant and Nursing Mothers 1971 1970 1971 1970 Inspections No. inspected 669 492 11 16 No. requiring treatment 441 263 11 16 Attendances First visits 424 241 12 20 Subsequent Visits 720 448 17 36 TOTAL Visits 1144 689 29 56 Courses of treatment completed 297 190 8 15 Treatment Fillings 759 560 23 30 Extractions 163 129 9 8 General Anaesthetics 50 45 - - Other Treatment 628 294 8 40 Dentures No. of Patients supplied with dentures - 3 No. of Dentures supplied — 4 No. of sessions devoted to M.C.W. service 1971 1970 Inspection and Treatment 150 98 Dental Health Education 45 18 TOTAL 195 116 28 Fluoridation Fluoridation is the adjustment of the fluoride content of water to one part fluoride per million parts of water. This is judged to be the most effective concentration for the prevention of tooth decay. No public health measure has had as much intense study devoted to it over the past 50 years. In June 1969 the World Health Organisation adopted a resolution calling for the implementation of water fluoridation throughout the world. This resolution was passed unanimously by member states of all shades of political opinion, having been sponsored by 37 countries including the United Kingdom which was responsible for putting the proposal before the assembly. It followed an extensive and prolonged world wide investigation into the safety of fluoridation and the most careful examinations have failed to discover any injury to health. The most important development in this country during 1969 was the publication of the Government report on the Studies and Results of 11 years of fluoridation. This had been carried out in four areas of the country and the results showed that the adjustment of fluoride in the public water supply to the approved proportion had a substantial effect in reducing dental decay among children, and was also of lasting benefit to their permanent teeth. It confirmed yet again that fluoridation was completely safe. The results of this survey were studied by specialists both medical and dental and their conclusions were unanimous and were summed up in the following words "Fluoridation is entirely effective and completely safe". The fluoride content of London water is approximately 0.3 parts per million. The proposal to fluoridate the water supply would mean that this level would be adjusted from 0.3 to 1.0 parts per million. The effect of this would be greatly to reduce the amount of new dental disease seen in school children and young children under five. The saving in expenditure and time from a proposal of this nature would in the long term be considerable. Fluoride, it must be emphasised, is a natural substance and is present in nearly all food and water. The proposal which advocates of fluoridation are making, is not to add a new ingredient to the water supply but merely to increase the proportion of something which is already present. No other single action would be of greater benefit to children's dental health. Studies have shown also that fluoridated water may be of benefit to older persons even those who no longer have dental conditions to consider as fluoride has been shown to strengthen their bones. The Council in 1966 expressed its unqualified support for the proposal to fluoridate the water supply. The fact that no progress has been possible in London is due to the lack of unanimity among all London Boroughs which prevents the Water Authority from acting on the decision of the majority. It is to be hoped that in the near 29 future either locally or nationally it may be possible that the implementation of this most desirable and effective public health measure will be brought about. Loan of Equipment Patients being nursed at home were able to obtain nursing equipment on loan, free of charge, either from the Council direct or from the British Red Cross Society acting as an agent for the Council. The items on issue at 31st December, 1971, from the Council's stock were as follows (the figures in brackets show the number of items on loan at 31.12.70):— Items No. on loan Air rings 96 (96) Back rests 147 (127) Bed blocks 44 (13) Bed cradles 133 (88) Bed side-rails 8 (5) Commodes 758 (756) Dunlopillo mattresses 26 (23) Easi-carri hoists 10 (14) Feeding cups 8 (19) Fracture boards 62 (48) Hospital beds 24 (19) Penryn hoists 57 (45) Quadruped walking aids 1 (3) Ripple beds 6 (7) Rubber bed-pans 83 (97) Rubber toilet-seats 1 (2) Tripod walking aids 14 (12) Urinal bottles 70 (75) Zimmer hoist — (1) Zimmer walking frames 135 (100) 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 679 (633) out on loan. 30 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. Hilda Lewis Unit The Bethlem Royal and Maudsley Hospital opened the Hilda Lewis Unit in August 1970, to meet the needs of severely subnormal children. The majority of children treated live in the Camberwell area. The unit undertakes the assessment of children under the age of 16 years, particularly catering for children with behaviour problems. It is a valuable addition to the provisions for these children and has enabled many children to remain within the education system. The children are admitted for short term care, as weekly boarders or attend daily. When necessary transport is provided. There is a multi-disciplinary approach, with a child psychiatrist, consultant paediatrician, community doctor, psychologist, occupational therapist, teachers, nursing and child care staff. One of my Principal Medical Officers who has an Honorary Senior Registrar appointment with the Bethlem Royal & Maudsley Hospital is in attendance at the unit. 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: 31 (a) No charges are made for advice and consultation in all cases. (b) No charges are made for drugs and appliances supplied where a further pregnancy would be detrimental to health. (c) Charges are made in other cases for drugs and appliances except in financially necessitous cases. At the commencement of the year 8 sessions were being provided from 6 centres. Four additional sessions commenced during the year, one in March, one in May and two in November. All the additional sessions qualify for a 75% grant under the Urban Aid Programme. In October a domiciliary service was started under the Urban Aid Programme comprising 5 medical officer and 5 nurse sessions. Liaison visits were made to general practitioners and local hospitals. A total of 35 patients were visited in their homes. 502 clinic sessions were held during the year and a total of 6,903 visits was recorded including 2,243 first visits. 1,088 new patients were seen. Per capita payments were continued in respect of Southwark residents attending Family Planning Association clinics and the Brook Advisory Centres for unmarried persons over the age of 16. 32 COMMUNITY CARE SERVICES 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 fifth clinic was opened in November and during the year 211 sessions were held and there were 738 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 organisations. At 1 January, 1971 there were 15 men boarded out; 1 was placed during the year, and 8 were still in care at 31 December, 1971. 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, 308 advice notes of arrivals were received and 126 "first" successful visits were made. Nursing Homes There are two nursing homes in the Borough registered under the provisions of Part IV of the Public Health Act, 1936, and the Nursing Homes Act, 1963; neither is registered under the Abortion Act, 1967. A senior medical officer continued to visit and advise the matrons on aspects of health, hygiene, prevention of accidents and other matters. 33 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. Number of examinations arranged 204 Initial examinations 61 Re-examinations 143 Number certified as blind 45 Number certified as partially sighted 157 Number found to be neither blind nor partially sighted 2 Blind certificates accepted from hospitals 34 Partially sighted certificates accepted from hospitals 10 Blind certificates accepted from other local authorities 1 Partially sighted certificates accepted from other local authorities — Chiropody In April 1971 under the Local Authority Social Services Act 1970, which directed that all chiropody services operated by the Council should become the responsibility of the Health Department, chiropody services to the extent of 9 sessions per week previously operated by the ex Welfare Department were transferred to the Health Department. The establishment was increased to 1 chief chiropodist, 9 senior chiropodists and part time chiropodists equivalent to 6 sessions. As at 31 December 1971 the number of chiropodists employed was 1 chief chiropodist, 6 senior chiropodists full time and 8 sessional chiropodists (3.2 full time equivalent). In addition 3 trainee chiropodists were being sponsored by the Council. The number of sessions held during the year was 4,194 and the number of attendances was 29,835. Home Dialysis Three patients were provided with home dialysis facilities in Southwark during 1971. Two of these patients had their existing homes adapted and the other was rehoused in a vacant, previously adapted property. New applications for home dialysis facilities were received during 1971 in respect of three patients. At that time, a vacant, adapted flat was available in the northern area of the Borough but all three patients refused to accept the flat for rehousing purposes. At the end of 1971 the adaptation of one existing home was being carried out while the other two patients were still waiting for accommodation suitable for rehousing and adaptation to become available. 34 Maternal Deaths Five maternal deaths due to, or associated with, pregnancy, childbirth or abortion occurred in Southwark during 1971. Full reports on the circumstances relating to these deaths were prepared and forwarded as required to the Department of Health and Social Security. Mobile Health Clinic There was an overall reduction of attendances for examination at the Mobile Health Clinic during 1971. Total attendances for the year were 1901. This reduction was partly due to loss of working time attributable to demonstrations, visits by representatives from outside local authorities and organisations and the inability to obtain medical officers for some sessions. Bad weather, particularly freezing and wet winter spells caused a decline in the number of attenders. Considerable interest in the Mobile Health Clinic continued to be shown by other local authorities and the medical profession generally. The film "Put to the Test" produced to illustrate the various aspects of the Clinic's work remained in demand for showing to other local authorities, medical and allied organisations. A short period of evening sessions was organised during the year in an effort to provide an opportunity for those persons, particularly males, who are at work during the daytime to attend for examination. Attendances at these sessions were good but difficulties were experienced both in securing the assistance of medical officers during the evenings and in keeping within the limits of the length of working day allowed to the drivers by the Road Transport Act. The Mobile Health Clinic was a focal point of interest at two important functions during 1971. In March the Clinic was exhibited at the Chest and Heart Association Annual Conference in London. During July, the Clinic was transported to Leicester where it formed part of the British Medical Association's Scientific Exhibition and produced a tremendous interest amongst delegates from Britain and many parts of the world. 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 1,348 attendances were made at the 144 sessions held in the four clinics in the Borough. 399 persons were found to have no abnormality, 6 were found to have carcinoma of the cervix, 12 had some breast pathology and 856 had other gynaecological disorders, which are summarised as follows:— 35 Trichomonas Vaginitis 10 Monilia 3 Non-Specific 40 Cervicitis 82 Vulvo-vaginitis (Atrophic) 2 Cervical erosion 85 Ectropion 10 Cervical polyp 17 Vulval warts 1 Lipomatic of Labia 1 Cystocoele and rectocoele 9 Urethral Caruncle 9 Urinary abnormalities 7 Fibroids 4 Ovarian cysts 6 Menstrual irregularities 86 Salpingitis 3 Breast pathology 12 Abdominal mass 1 Thyroid enlargement 2 Post menopausal bleeding 3 Inflammatory nuclear change 74 Senile (atropic) changes 51 Nothing abnormal detected 399 Hypertension 14 Dual Pathology 336 Slimming Clinic In view of the growing demand for health education in dealing with the problem of obesity it was agreed to set up a slimming clinic as a limited pilot project under the supervision of a staff medical officer. This clinic commenced at the beginning of October, for ladies only and has had a good response from the public in the short time it has been operating. 36 HEALTH EDUCATION A Departmental Working Party of Health Visitors, School and Home Nurses, Public Health Inspectors and other members of the staff involved in health education at field level have met each month during the year. New posters, leaflets, films and various visual aid items were assessed for their suitability for welfare clinics, mothers' clubs, junior and senior schools and general publicity. A monthly programme of special projects was formulated including food and dental hygiene, immunisation, nutrition and home safety, supplemented by supporting publicity for national camppaigns and the Council's special clinics. Posters and leaflets were issued to school treatment centres, clinics, nurseries, area health offices, information centres, notice board sites, general practitioners and pharmacists. Special teaching sessions were arranged at individual schools and centres, for which a stock of visual aids—film strips, flannelgraphs, wall charts, models and other equipment—was in constant demand. During the year several demonstrations of this equipment and other facilities offered by the section were arranged for new members of the staff. A special sub-committee was formed during the year to consider the publication of leaflets etc., to meet particular local needs. One of the more urgent recommendations was for an advisory leaflet on head lice, in view of the growing incidence of this condition amongst schoolchildren. Smoking: Full support was given locally for the Health Education Council's Smoking and Health Campaign, which included television "shorts" and full page advertisements in the national press later reproduced as posters. In a circular from the Department of Health and Social Security, published in January, the Secretary for State announced that warning notices of the dangers to health from smoking would be printed on all cigarette packets and advertisements and requested local authorities to support anti-smoking publicity at local level. He also drew attention to the dangerous risks of smoking for pregnant women. Full scale publicity on this subject was maintained throughout the year with particular emphasis at ante-natal clinics, mothers' clubs and schools. Schools Summer Vacation: 1715 children attended the sessions of films and talks held daily at five welfare clinics throughout August. This was nearly six hundred more than in 1970. The films are carefully selected to illustrate a health or safety theme in terms of general interest to young children and are supplemented by short talks, group exercises and home competitions on the theme for each week. The subjects for this year's sessions included food and dental hygiene, nutrition, vandalism, litter, safety and local community services. 37 Mothers' Clubs: These clubs encourage young mothers to continue attendances at welfare clinics where they can meet informally and discuss problems in general terms. The Health Education Section assisted in presenting suitable films for these programmes. Displays: Several small displays were arranged during the year, including family planning, nutrition and weight control which were used in various clinics and schools. The display organised in 1970 as part of the London College of Printing Induction Course for overseas students was repeated this year. A preliminary lecture given to the students by a medical officer included advice on such subjects as suitable clothing, nutrition, food hygiene, smoking, venereal disease and accident prevention which were given special emphasis in the display. Dental Hygiene: This subject has again been stressed in health education activities particularly in regard to young children where the standard of dental health still causes concern. The Dental Section designed an attractive birthday card which is sent to all children on reaching the age of three years, to encourage them and their parents in the proper care of the teeth. Postal Franking: Health and accident prevention slogans are franked on the envelopes of all outgoing mail. These include immunisation, dental and food hygiene, fire prevention to which were added slogans on Well Women Clinics and Smoking and health. Sex Education: The number of talks given in schools on various aspects of this subject was higher than for any other subject. In most cases they were given as a series which included personal hygiene, reproduction, birth control and sexually transmitted infections. Home Safety: The Health Education Section devotes much of its activities to home safety and the programme of projects includes an accident hazard appropriate to each season. Special attention has been given to publicity on fire prevention, water safety, and the safe disposal of old medicines and disused refrigerators; the latter had been the cause of several fatal accidents to children in various parts of the country, and was the subject of a special warning issued by the Ministry of Housing and Local Government at the end of 1970. An analysis of the deaths of Southwark residents where an accident in the home was either a primary or contributory cause of death is given in the following table. Whilst the total figures show very little change from 1970, an appreciable increase will be noted in the number of cases involving injuries from falls amongst the elderly. 38 39 HOME ACCIDENT DEATHS—1970, 1971—Southwark. residents (Registered to December 31 st) (Deaths in which accidents in the home have been primary or contributory cause) CAUSE Injuries from falls (or presumed falls) Carbon Monoxide (Gas fumes) Asphyxia Fire fumes & other causes Drug overdose Poisoning Burns and Scalds Electrocution YEAR 1970 1971 1970 1971 1970 1971 1970 1971 1970 1971 1970 1971 Age Group 76+ Male 4 2 1 — — — 1 1 — — — — Female 4 11 1 — 1 — — 1 — 1 — — 66-75 Male 1 1 - - - - - - - - - - Female 4 3 - - - - - - - - - - 51-65 Male 2 - - 1 - - - 2 - 2 - - Female 1 1 1 - — 1 3 - - - - - 36-50 Male - - - - 2 - - 3 - - - - Female 2 - - - - - - - - - - - 26-35 Male 1 1 - - - - 1 - - - - - Female - - - - - - - - - - - - 17-25 Male 1 - - 1 1 - 1 - - - - - Female — — — — — - 1 — — — — — 11-16 Male - 1 - 1 - 1 - - - - - - Female - - - - - - - - - - - - 6-10 Male - - - - - - - - - - 1 - Female - - - - - - - - - - - - 0-5 Male - - - - 1 1 1 - - - - - Female — - — 1 - 3 - — — — — — Totals: Male 9 5 1 3 4 2 4 6 - 2 1 - Female 11 15 2 1 1 4 4 1 — 1 - — Summary of Activities Leaflets and Booklets issued 6,043 dozen Posters issued 3,763 Films (No. of screenings) 348 Projector equipment used 272 Talks Adults Children (No. of sessions) Maternal and Child Health 165 46 Housewifery, parentcraft 53 14 Sex Education, Personal Hygiene 20 81 Nutrition, Food Hygiene, Weight Control 50 9 Accident Prevention 30 18 Dental Hygiene 13 40 Infectious diseases, Immunisation 10 2 Smoking, Drugs, Alcoholism 5 5 Social Services 42 12 Miscellaneous 47 7 TOTAL 435 234 40 ENVIRONMENTAL HEALTH SERVICES Number of complaints received 8,463 Inspections: Nuisance inspections 7,543 Re-inspections 7,908 Overcrowding 69 Offensive trades 22 Factories and workplaces 924 Outworkers premises 128 Verminous premises and persons 580 Common lodging houses 124 Conveniences, public and private 228 Pet animal premises 75 Hairdressers and barbers 70 Rent Act, 1968 15 Miscellaneous inspections 9,642 Infectious diseases 729 Infectious diseases, visits to contacts 271 Drainage (new buildings) Inspections 3,634 Tests applied 2,204 Drains constructed 1,655 Drainage (existing buildings) Inspections 3,779 Tests applied 1,118 Drains found defective 380 Drains totally reconstructed 212 Drains repaired or partially reconstructed 499 Offensive Trades Type of Business Number of Register Fat extractors 2 Manure manufacturer 1 Skin dressers 5 Fellmongers 3 Glue and size manufacturer 1 Twenty-two inspections of these premises were made. 41 Common Lodging Houses There are seven common lodging houses in the Borough, four for women and three for men. 124 inspections were made during the course of the year. Hairdressers and Barbers During the year 70 inspections were made. There are 239 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 sixteen sites in the Borough. The estimated total number of pigeons frequenting these sites was 3,600 and 2,566 were caught. Pet Animals Act, 1951 Eighteen premises are registered under this Act and 75 inspections were made during the year. Pharmacy and Poisons Act, 1933 There are 134 persons included in the Council's list of sellers of Part II poisons: 119 inspections were made. Registration of Food Premises Under the provisions of Section 16 of the Food and Drugs Act, 1955, 47 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 244 inspections of these premises were made. Bakehouses There are 22 bakehouses in use and 67 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. 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 42 set out below: Camberwell Front 118,000 gals. Camberwell Rear 118,000 gals. Dulwich Front 118,000 gals. Dulwich Second Class 88,600 gals. Bermondsey Central First Class 150,000 gals. Bermondsey Central Second Class 73,125 gals. Rotherhithe 220,000 gals. Manor Place First Class 157,000 gals. Manor Place Second Class 164,000 gals. Manor Place Small 48,000 gals. Seventy-one samples of bath water were submitted for bacteriological and chemical examinations. In some cases the free chlorine was low but the water was of satisfactory chemical and bacteriological standard. During the year arising from the transfer of some of the Greater London Council Parks and Open Spaces to the Council, three open air swimming baths were transferred namely those in Southwark Park, Peckham Rye and Mary Harmsworth Park. Arrangements were made for periodical sampling to be undertaken. 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 1971. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. 43 METROPOLITAN WATER BOARD.TER EXAMINATION DEPARTMENT AVERAGE RESULTS OF THE CHEMICAUMINATION OF WATER SUPPLIED TO THE LONDON BOROUG1 SOUTHWARK Milligrammes per litiess otherwise stated) Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMn04 4 hrs at 27°C B.O.D. 5 days at 20°C Hardness (total) CaC03 Hardness (noncarbonate) CaC03 Mag nesiutm as M Potassium as Chloride as CL Phosphate as PO4 Silicate as Si02 Sulphate as SO4 Natural Fluoride as F Surfaceactive material as Manoxol OT Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) River Thames- derived 364 0.029 0.084 6.1 1.04 — 281 90 55 5.1 34 2.3 10 64 0.15 0.02 0.1 13 7.8 580 Honor Oak 3 0.065 0.011 0.2 0.05 - 293 53 15 0.45 0.0 6 7.2 530 BACTERIOLOGICAL RESULIYEARLY AVERAGES Water supplied to the Londoough of Southwark Source of Supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count 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. cent. Counples perative 100 in ml. Count per 100 ml. Number of samples 20-24 hours at 37°C. 3 days at 22°C. Per cent, samples negative in 100 ml. Per cent, samples negative in 100 ml. River Thames-derived 8,154 53.9 40.37 12.2.91 5.1 3,901 8.4 99.51 99.97 Honor Oak 62 0.0 7 87.10 0.4.71 0.2 63 0.2 19 100.0 100.0 44 45 (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, 1971, was 259,982. (ii) No house were permanently supplied by standpipe. (d) No artificial fluoride was added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2 (a) The supply was derived from the following works and pumping stations:— River Thames-derived, also small quantities of well water from Honor Oak and Merton Pumping stations. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are not considered to be plumbo-solvent. [t 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 All medical practitioners are required to notify the Medical Officer of Health, on certificates which are provided free of charge, of any of their patients who, in their opinion, are suffering from any of the following infectious diseases:— Acute encephalitis Ophthalmia neonatorum Acute meningitis Paratyphoid fever Acute poliomyelitis Plague Anthrax Relapsing fever Cholera Scarlet fever Diphtheria Small-pox Dysentery (amoebic or bacillary) Tetanus Food poisoning Tuberculosis Infective jaundice Typhoid fever Leprosy Tyhpus Leptospirosis Whooping cough Malaria Yellow fever Measles 46 Acute Gastro Enteritis The order made by the Council requiring acute gastro enteritis to be made a notifiable disease in the Borough expired on 29th January, 1971. Since the making of this Order the Health Services and Public Health Act, 1968 came into operation as did the Public Health (Infectious Diseases) Regulations, 1968. These Regulations consolidated into one instrument all existing Regulations relating to the notification and prevention of infectious diseases. Whilst the notification of acute gastro enteritis has served a useful purpose, the Public Health (Infectious Diseases) Regulations contain adequate provisions for suitable measures to be taken for preventing the spread of infection arising from conditions which the notification of acute gastro enteritis was envisaged would bring to my notice. It was therefore agreed that no new Order be made requiring the notification of acute gastro enteritis. Notifications of Infectious Diseases Disease 1968 1969 1970 1971 Scarlet fever 112 125 79 75 Whooping cough 257 37 200 78 Acute poliomyelitis and acute polio encephalitis 2 — — — Measles 556 2,115 1,802 410 Diphtheria — — — — Dysentery 195 201 192 66 Meningococcal infection 6 13 7 10 * Pneumonia (acute primary and acute influenzal) 29 — — — Paratyphoid fevers — 2 1 — *Erysipelas 5 — — — Food poisoning 157 168 110 68 Tuberculosis Respiratory system 130 148 110 75 Other forms 12 14 10 11 Malaria — — — — Puerperal pyrexia 69 — — — Ophthalmia neonatorum 12 5 3 Acute gastro enteritis 2,031 1,755 1,222 85 †lnfective jaundice 13 43 184 107 †Notifiable as from 15th June 1968 *Ceased to be notifiable from 1st October 1968. 47 48 NOTIFICATION OF INFECTIOUS DISEASES 1971 Age Distribution of Notifications Disease Under 1 Year 1-2 3-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65 & Over Total All Ages Scarlet Fever — 4 20 40 6 4 — 1 — — — 75 Whooping Cough 7 19 19 32 — — — 1 — — — 78 Measles 36 130 131 93 14 4 2 — — — — 410 Dysentery 3 11 5 9 4 5 10 3 5 5 6 66 Meningococcal Infection — — 2 1 — 1 5 — — 1 — 10 Food Poisoning 3 3 — 7 3 16 14 4 6 6 6 68 Tuberculosis: Respiratory 1 — — — 2 6 11 5 14 16 20 75 Other Forms - - - - - 2 1 3 1 1 3 11 Ophthalmia Neonatorum 3 - - - - - - - - - - 3 Infective Hepatitis — 2 2 32 19 17 15 6 4 9 1 107 Acute Gastro Enteritis 10 16 3 7 2 18 13 9 3 3 1 85 TOTAL 63 185 182 221 50 73 71 32 33 41 37 988 49 TABLE 1 FOOD POISONING—INCIDENTS AND CASES 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 — - - - 5 5 5 Other Salmonellae - - - - 5 5 5 CL. welchii - - - - - - - Staph, aureus - - - - - - - Other causes — - - — — — — Cause Unknown - - - - 58 58 58 TOTAL — — — — 68 68 68 DETAILS OF FOOD POISONING DUE TO SALMONELLAE OTHER THAN S. TYPHIMURIUM Type of Salmonellae Indiana - - - - 4 4 4 Java - - - - 1 1 1 TABLE II 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 - - - - 2 2 2 Other Salmonellae0 — — — — 3 3 3 TOTAL — — — — 5 5 5 DISINFECTING STATIONS There are two disinfecting stations in the Borough situated at: King James Street, S.E.1 The Neckinger, S.E.I6 Summary of Work Scabies and Vermin Vermin Scabies Male Female Infants Male Female Infants Southwark cases 1,310 210 164 167 220 53 treatments 1,310 210 164 295 429 94 Lambeth cases 73 61 60 44 51 30 treatments 73 61 60 69 78 52 Schoolchildren (male and female) cases 1,298 224 treatments 1,701 362 Total treatments 3,308 872 Disinfection and Disinfestation of Premises Domestic dwellings (rooms) (i) Vermin 1,818 (ii) Other infestations 978 Public conveniences 18 Public buildings, Institutions 58 Articles treated 25,800 Disinfection following infectious disease Rooms treated 39 Incontinent Laundry Service Number of articles laundered 149,615 Bathing of Aged Persons (No. of Baths) Baths at home 17,349 Baths at disinfecting stations 1,784 MORTUARY Bodies brought to Southwark Mortuary: From hospitals in Southwark 263 From hospitals in Lambeth 479 742 From private addresses in Southwark 389 From private addresses in Lambeth 386 775 Recovered from River Thames 1 1,518 50 Bodies brought from hospitals and institutions: Southwark Guy's Hospital 128 Evelina Hospital 3 Catholic Nursing Institute 9 St. Giles' Hospital 43 St. Francis Hospital 33 Dulwich Hospital 35 St. Olaves Hospital 7 Royal Eye Hospital 3 Maudesley Hospital 1 All Saints 1 Lambeth Lambeth Hospital 67 South Western Hospital 20 St. Thomas' Hospital 24 King's College Hospital 342 South London Hospital for Women 21 Weir Hospital 1 Belgrave Hospital 1 Brixton Prison 3 Post mortems without Inquest 1,289 with Inquest 229 Cremation Certificates The Medical Officer of Health is the Medical Referee for the Council's crematorium at Honor Oak. Three other medical staff act as Deputy Medical Referee. No body may be cremated until the Medical Referee (or deputy) has signed the necessary authority after examination of the appropriate forms and medical certificates. During the year the number of cremation certificates signed was 2,686. 51 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 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 259,982. The majority of commercial premises and office blocks are concentrated in the north part of the Borough. Registrations and Inspections New registrations during the year totalled 213, of which 129 were in respect of offices and 59 retail shops. The total number of registered premises at the end of the year was 4,042, an increase over the previous year of 194. All newly registered premises are given a general inspection as soon as possible after registration. The total number of general inspections made was 2,113 and total visits made to registered premises amounted to 6,020 an increase of 1,455 over the previous year. Inspections are made by the Public Health Inspectors and Technical Assistants under the supervision of the Inspectors. An analysis of the infringements found and remedied by class of premises is given in Appendix II. The statistical information which has already been supplied to the Department of Employment is given in Appendix I. It is pleasing to record the continued high degree of co-operation received from the great majority of occupiers of registered premises during the course of inspections, investigations and in carrying out necessary works. Much that has been achieved in the way of remedial measures has been done by discussion with occupiers. It becomes increasingly evident that awareness on the part of the occupiers of registered premises that regular inspections are made does have some bearing upon the reduction in the more serious types of contraventions of the Act and these formed a comparatively small proportion of the matters requiring attention. Operation of General Provisions of the Act The analysis of infringements found and remedied (Appendix II) shows that the following matters were found to be those most frequently needing attention:— Found Remedied Abstract of Act not displayed 397 245 Provision of first aid materials 360 204 Cleanliness 293 204 Defective floors and staircases 235 102 Deficient sanitary accommodation 233 113 Absence of thermometers 230 145 52 The overall number of infringements recorded during the year was 2,247, an increase of 536 compared with the previous year. Many were either of a minor nature or basically due to lack of maintenance, cleanliness and repair and were resolved informally. Legal Proceedings Legal proceedings were instituted in one case only, these arising from the notification of an accident due to the use of a gravity-feed slicing machine in a wholesale food warehouse. Offence Fine Costs Failure to fence a dangerous part of certain £10 £2 machinery namely, a food slicing machine in that the transparent plastic guard extending over part of the feed chute was not in position. Notification of Accidents During the year, 70 accidents were notified and investigations were made into 58 of these. An analysis of these accidents, both by location and cause, is given in Appendix III. The predominant causes of accidents are shown to be (i) falls of persons and (ii) handling of goods, which accounted for 28 and 16 accidents respectively during 1971. In fact, these two causes have consistently been the main reasons for notifiable accidents since the Act came into operation. Following an investigation into an accident arising from the use of a gravity-feed slicing machine in a wholesale food warehouse, legal proceedings were instituted which are referred to above. Whilst every opportunity is taken to advise occupiers of registered premises of accident prevention measures, it is only too obvious that many are due to carelessness or temporary lack of concentration on the part of the individual. The Department of Employment has asked local authorities to comment particularly on the following matters:— Mechanical Handling of Goods Most of the registered premises using mechanical handling equipment such as belt and roller conveyors, fork lift trucks etc. have been visited during the year. The use of this equipment is, of course, largely limited to warehouses and no particular problems have been encountered as the occupiers seemed to be well aware of the necessary safety measures. 53 Enforcement Related to Class of Premises No particular difficulties have been experienced in enforcing the requirements of the Act other than in relation to the requirements of the Hoists and Lifts Regulations in certain licensed premises regarding the enclosure of liftways, particularly those associated with crate hoists. Fortunately, these difficulties were resolved and arrangements are in hand for the necessary works to be carried out. Generally speaking, the recommendations contained in the statutory lifts and hoists examination reports are dealt with promptly. In addition, some occasional reluctance on the part of occupiers of warehouses to register has been experienced but this was resolved by personal delivery of O.S.R. I and completion on the spot. Safe Use of Food Slicing Machines The leaflet "The Safe Use of Food Slicing Machines" issued by the Department of Employment appears to have been reasonably well received and generally to have led to greater awareness of the need for care in the use of these machines. It is felt, however, that a more continuous and greater impact would be achieved by the production nationally of a warning poster, on the lines shown in page 9 of the leaflet, which could be fixed near the machine as a constant reminder to take care. The assistance, advice and co-operation afforded by H.M. Factory Inspectorate during the year have been of great help and are much appreciated. 54 55 APPENDIX I TABLE "A" REGISTRATIONS AND GENERAL INSPECTIONS (1) (2) (3) (4) Class of Premises Number of Premises registered during the year Total number of registered premises at the end of year Number of registered premises receiving a general inspection during the year Offices 129 1,545 771 Retail Shops 59 1,774 1,100 Wholesale shops, warehouses 12 304 84 Catering Establishments open to the public, canteens 12 410 158 Fuel Storage Depots 1 9 — TOTALS 213 4,042 2,113 TABLE "B" NUMBER OF VISITS OF ALL KINDS BY INSPECTORS TO REGISTERED PREMISES—6,020 (1) (2) Class of Workplace Number of persons employed TABLE "C" ANALYSIS OF PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE Offices 24,843 Retail Shops 6,327 Wholesale departments, warehouses 2,480 Catering establishments open to the public 1,722 Canteens 330 Fuel storage depots 36 Total 35,738 Total Males 20,628 Total Females 15,110 56 APPENDIX II Analysis of Infringements Found and Remedied During Inspections of Offices and Shop Premises During 1971 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 99 71 173 112 15 15 4 4 2 2 - - 293 204 Overcrowding 4 — — — — — — — 4 Heating 4 4 19 7 1 4 4 2 2 - — 30 17 Provision of Thermometer 97 60 121 79 10 3 2 3 230 145 Ventilation 21 11 11 3 1 1 3 3 2 2 38 20 Lighting 20 24 46 20 2 2 2 2 1 1 71 49 Insufficient sanitary accommodation 4 2 5 2 7 6 2 2 18 12 Insufficient washing facilities 25 20 46 35 3 7 7 7 4 4 85 73 Deficient sanitary accommodation 80 29 139 76 11 5 2 2 1 1 233 113 Hot water/warm water required 15 7 34 16 4 4 8 8 3 3 64 38 Other deficient washing accommodation 14 1 36 21 3 2 - - - - - - 53 24 Drinking water — 1 — — — 1 1 2 2 3 4 Clothing accommodation 3 1 13 4 10 9 4 4 30 18 Seating Facilities 1 3 2 _ 4 2 Eating Facilities 1 1 - 2 - Hoists and lifts 14 6 3 - 1 31 26 43 33 Dangerous machinery — 1 14 11 6 2 29 16 - - - — 49 30 Floors and staircases 83 32 134 56 11 7 5 5 2 2 - - 235 102 First Aid 120 71 213 119 17 8 9 5 1 1 360 204 Abstract not displayed 158 103 210 125 19 11 9 5 1 1 — — 397 245 TOTALS 762 444 1221 687 104 69 133 106 27 27 — — 2247 1333 INFORMAL NOTICES SERVED 83 172 16 21 1 - 293 INFORMAL NOTICES COMPLIED WITH 29 82 11 15 1 — 138 57 APPENDIX III REPORTED ACCIDENTS — WORKPLACES AND ACTION TAKEN Workplace Number Fatal Reported Non-Fatal Number Investigated Prosecutions Formal Warning Informal Advice No Action 1971 1970 1969 1971 1970 1969 1971 1970 1969 1971 1970 1969 1971 1970 1969 1971 1970 1969 1971 1970 1969 Offices - - - 23 6 6 22 3 4 - — — 2 — - 7 1 2 13 2 2 Retail Shops - - — 29 17 25 21 15 19 - - - 1 2 - 8 3 8 12 10 11 Wholesale Shops, Warehouses - - - 14 3 9 12 3 5 1 — 1 1 — 1 - - 9 2 5 Catering Establishments open to the Public, Canteens — 1 — 3 18 12 2 13 8 - - - - - 1 1 4 2 1 9 5 Fuel Storage Depots - — - 1 — 1 - - - - - - - - - - - 1 — — TOTALS — 1 — 70 44 52 58 34 36 1 — — 4 3 1 17 8 12 36 23 23 58 APPENDIX III (continued) REPORTED ACCIDENTS — ANALYSIS BY CAUSE CAUSE Offices Retail Shops Wholesale Shops, Warehouses Catering establishments open to the Public, Canteens Fuel Storage Depots 1971 1970 1969 1971 1970 1969 1971 1970 1969 1971 1970 1969 1971 1970 1969 Machinery 1 — - — - 1 2 — - 1 — 1 — - — Transport 1 - - - - - - 2 1 - - - - - - Fall of Persons 12 2 4 11 6 11 3 3 5 1 2 2 1 - - Stepping on or striking against object or person 4 1 1 1 4 4 — 1 2 — — 1 — — — Handling Goods 3 3 — 7 1 7 6 9 4 - 1 2 — - - Struck by Falling Object 1 - - 5 — — 2 2 — — — 1 — — — Fires and Explosions - - - - - - - - - - - - - - - Electricity - - - - 1 - - - - - - - - - - Use of Hand Tools — — — 4 3 2 — 2 — 1 — 1 — - - Not Otherwise Specified 1 — 1 1 2 — 1 — — — - 1 — - - TOTALS 23 6 6 29 17 25 14 19 12 3 3 9 1 — — 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 242 54 3 2 (ii) Factories not included in (i) in which Section 7 is enforced by the local authority 1,671 818 79 - jii) Other Premises in which Section 7 is enforced by the local authority (excluding outworkers premises) 51 52 Total 1,964 924 82 2 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 (S.6) Sanitary conveniences (S.7)— - - - - - Insufficient 4 3 Unsuitable or defective 76 45 7 1 Not separate for sexes 2 1 - - 1 Other offences (Not including offences relating to home work) — — — — — Total 82 49 — 7 2 59 OUTWORKERS Nature of Work Number of Outworkers in August lists as required by Section 133(l)(c) Brushes 16 Cardboard boxes 11 Jewellery cases 9 Lampshades 21 Showcards 13 Wearing apparel 114 Artificial flowers 3 Total 187 There were no instances of work in unwholesome premises and it was not necessary to serve any notices or institute proceedings. HOUSING—INSPECTIONS, PROCEEDINGS, ETC. Inspection of Dwelling-Houses during the Year: (1) (a) Total number of dwelling-houses inspected for housing fects (under Public Health or Housing Acts) 14,60 (b) Number of Inspections made for the purpose 28,512 (2) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 471 (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 2,109 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 . 1,035 (1) Proceeding under Housing Act, 1957:— (a) Number of houses made fit after service of formal notices (Sections 9, 16 and 18) (i) By owners6 (ii) By local authority in default of owners 3 (b) Demolition orders made under Section 17 3 (c) Houses closed in pursuance of an undertaking given by the owners under Section 16 17 60 (d) Closing Orders on parts of buildings (Section 18) 54 (e) Undertakings not to use parts of buildings for human habitation accepted 25 (f) Closing Orders made under Section 17(3) (g) Demolition Orders determined and Closing Orders substituted under Section 26 (h) Closing Orders made under Section 17(1) 55 (i) Closing Orders determined 5 (j) Closing Orders revoked and Demolition Orders made (k) Number of houses included in representations (Section 42) 298 (2) Houses in Multiple Occupations—Housing Acts, 1961-64:— (a) No. of premises found to require action 55 (b) No. of premises at which conditions were remedied as a result of informal action 3 (c) No. of premises requiring formal action 55 (d) No. of Directions given 17 (e) No. of Directions revoked 4 (f) No. of Directions varied (g) No. of Management Orders made 28 (h) No. of Management Orders revoked 7 (3) Proceedings under Public Health Acts: (a) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,988 (b) Number of dwelling-houses in which defects were remedied after service of formal notices: (i) By owners 553 (ii) By local authority in default of owners 76 Housing Inspections No. of Inspections Clearance areas 2,990 Individual unfit houses Section 9 307 Section 16 510 Parts of premises—Section 18 241 Houses in multiple occupation 652 Re-inspections (all sections) 3,614 Miscellaneous Inspections 2,747 Total inspections 11,061 61 Legal Proceedings—Public Health Act, 1936:— Nuisance Orders made 20 Summonses withdrawn (work completed) 18 Housing Act, 1969 Applications for Qualification Certificates Granted 56 Deferred 76 Refused 94 Granted after previous refusal or deferment 49 Applications for Certificates of Provisional Approval: Granted 16 Refused 8 MEDICAL PRIORITIES FOR REHOUSING When applicants for rehousing submit medical assessment forms 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 and as a result of these investigations 2,258 recommendations were made to the Housing Department. ENVIRONMENTAL VISITING The environmental visitors made a total of 4,148 visits during the year. These included visits for the following reasons: medical rehousing, flood warning, over 60's clinics, hospitals, relatives, sick staff etc. CLEAN AIR ACTS 1956 and 1968 Smoke Control Orders Two Smoke Control Orders were made during the year with the operative date of 1st December 1972 in each case. Details of the Orders are as follows: No. 27 (Camberwell Green) No. 28 (Friary Road) Area 166 acres 264 acres Industrial and Commercial Premises .. 190 162 Privately owned dwellings 3,052 4,647 Local authority owned dwellings 500 443 Other premises 161 95 62 The position with regard to the Borough as a whole at the end of the year was as follows: Acres Premises Total for Borough 6,981 123,175 Covered by Orders operative on 31st December 1971 4,652 68,543 Covered by Orders made but not operative 430 8,642 Target year for completion 1975/76 Industrial Survey It has been proposed for some time to have an up-to-date record and appraisal of all industrial furnaces in the Borough, the main drawback has always been staff difficulties. In-service training of the present technical assistants has enabled a start to be made on such a survey. Nevertheless, it must be recognised that the survey can only be a 'surface' survey as opposed to one in depth. The latter can only be accomplished with adequately qualified and experienced Public Health Inspectors or assistants with specialised technical knowledge. The survey has so far provided certain useful information. For example, of the 2,000 industrial visits made by the end of the year, 325 furnaces were recorded as being industrial, i.e. with a rating of 55,000 Btu.s and above: 150 of the 325 furnaces were oil-fired, with 105 of that total on low sulphur oil. Gas-firing accounted for 132 furnaces while only 36 were on solid fuel. Grit and Dust Control and Measurement Two new Regulations were made during the year, both relating to the control of grit and dust. The Clean Air (Emission of Grit and Dust from Furnaces) Regulations 1971 were made on 1st February 1971 and controlled emission from both new and existing furnaces. For new furnaces, the effective date was 1st November 1971 and for existing furnaces, alas, 1st January 1978. In the Clean Air (Measurement of Grit and Dust from Furnaces) Regulations of 1971, the operative date was 15th March 1971. Height of Chimneys Fourteen formal applications were approved for chimney height. In all the applications, prior consultations for suitable heights were obtained by the applicant before submission. 63 There is still further need to control the height of chimneys served by furnaces with ratings below the present minimum legal rating of 1J million Btu.s. Furnaces Seventeen applications relating to the installation of furnaces were approved. A high degree of co-operation was received from the applicants with regard to the use of oil of low viscosity and sulphur content where applicable. Demolition Bonfires The drive on the control of demolition bonfires continues and it is anticipated that the much needed stricter legislation may be available soon. Sulphur in Oils It is highly desirable that fuel burning oils be restricted to those of low sulphur content. Much voluntary co-operation is being experienced at present in this field. Students All final year Student Public Health Inspectors receive intensive lectures in preparation for their examination. In addition, several local schools and Training Colleges have sent students to attend talks on air pollution. Legal Proceedings After repeated warnings were found to be ineffective, it was necessary to institute legal proceedings against a manufacturing firm for the emission of dark smoke. A plea of guilty was entered by the firm and a fine of £20 on each of two summonses was imposed with costs of £5. Summary of Inspections Complaints received and investigated (i) Industrial 239 (ii) Non-Industrial 760 Smoke observations 407 Smoke Control Areas 3,354 Industrial premises 2,080 Miscellaneous 3,502 Approval of furnaces 17 Approval of chimney heights 14 64 NOISE The following is a summary of complaints relating to noise nuisance indicating source of alleged nuisance and action taken: (a) Noise and Vibration Industrial Premises Commercial Premises Roadworks, Demolition etc. Domestic Premises *Other Total Complaints received 21 31 17 44 2 115 Cases complained of 23 31 23 30 2 109 Cases investigated 23 31 19 30 1 104 Nuisances confirmed 19 26 17 21 - 83 Nuisances remedied informally 18 21 16 18 - 73 Abatement notices served 1 - 1 — - 2 Prosecutions - - - - - - *goods deliveries, refuse collections etc. (b) Loudspeakers on Highway One complaint was received of noise nuisance from a loudspeaker operating on the highway and this was resolved informally. (c) Complaints of Noise Sources Exempt from Proceedings under Noise Abatement Act 1960 Operations of Statutory undertakers: 7 Traffic Noise: 2 Most of the complaints of noise refer to the noisy machinery and roadworks. A high degree of success has been achieved in abating nuisances by informal means such as discussion with commercial and industrial management. PREVENTION OF DAMAGE BY PESTS ACT, 1949 1 Total number of properties in district 123,175 2 (a) Total number of properties inspected following notification ... 4,866 (b) Number infested by (i) rats 1,966 (ii) mice 2,757 3 (a) Total number of properties inspected for rats and/or mice for reasons other than notification 143 (b) Number infested by (i) rats 57 (ii) mice 86 65 The following table shows the work of the Rodent Control Staff: Domestic Premises Commercial Premises Rats Mice Rats Mice Complaints received 1,482 2,080 541 763 Visits by investigators 1,482 298 541 763 Visits by rodent operatives 9,265 14,330 3,304 4,063 Number of premises cleared 897 1,639 404 749 FOOD AND DRUGS ACT, 1955 During the year, 233 formal and 1,402 informal samples were submitted for analysis 66 Details of unsatisfactory samples and action taken are as follows: Sample Formal or informal Result of Analysis Action Taken Canned Butter (2) Informal Slightly rancid Taken up with manufacturers Canned Blackcurrants Informal Incorrectly labelled Stocks withdrawn from sale for re-labelling Low Calorie Lemon Drink Informal Incorrectly labelled Taken up with manufacturers Cheese Food Dressing Informal Incorrectly labelled Taken up with manufacturers— label reprinted Scotch Steak Mince Informal Contained non-permitted preservative Formal sample taken Scotch Steak Mince Formal Contained non-permitted preservative Legal proceedings Fine £10, Costs £5 Sweet Martini Formal Deficient of 14% of alcohol stated to be present Legal proceedings Fine £10, Costs £2 Cinzano Bianco Formal Deficient of 4% of alcohol stated to be present. Legal proceedings Fine £10 Baked Beans Informal Can bore no label Legal proceedings Fine £10, Costs £5 Tomato Soup Informal Can bore no label Legal proceedings Fine £10 Soft Ice Cream Informal Deficient in fat and milk solids Advice to retailer Beef Sausages (4) Informal Contained undeclared preservative Advice to retailer Milk Formal Small amount of extraneous matter Taken up with bottlers Stewed Steak with Gravy Informal 10% deficient of meat Taken up with manufacturers Cough Mixture Informal Incorrectly labelled Label reprinted Rose Cordial Informal Incorrectly labelled Old Stock. Taken up with manufacturer Pineapple filled chocolate Informal Contained non-permitted preservative (sorbic acid). Taken up with importers. Foreign produce Cherry filled chocolate Raspberry filled chocolate Curry Sauce Mix Informal Incorrectly labelled Taken up with manufacturers Camembert Cheese Informal Incorrectly labelled Stock withdrawn from sale Citrus blossom water Informal Incorrectly labelled Formal sample satisfactory It will be seen that many of the samples subject to adverse reports related to labelling requirements which were resolved with the manufacturers concerned. Legal proceedings taken as a result of complaints made by members of the public where food was sold to the prejudice of the purchaser:— Offence Result Fine Costs Mouldy loaf (4) (1) £10 £2 (2) £20 £5 (3) £10 £2 (4) £25 £20 Loaf containing a metal bolt £10 £2 Loaf containing pieces of cardboard £25 £2 Loaf containing a sewing needle £20 £10 Loaf containing dried paint film £25 £5 Mouldy meat pie (5) (1) £25 £2 (2) £25 £5 (3) £25 £5 (4) £3 £2 (5) £2 — 67 Pie containing split pin £30 £2 Mouldy table jelly £15 £2 Mouldy custard tarts £20 £5 Orange drink containing mould growth £25 £5 Ham sausage decomposing £25 £5 Oats infested by insects £10 £8 Biscuits infested by insects (2) (1) £10 £10 (2) £10 — Luncheon meat infested by blowfly eggs £20 £2 Fried fish containing rodent excreta £25 £5 Pasty containing adhesive dressing £10 £7 Veal, maggot infested £25 £5 Steak and kidney pie containing a piece of tile £25 £5 In addition 37 warning letters were issued relating to food complaints made by members of the public. Milk distributors and sampling There are 470 milk sellers in the Borough. Licences to expire on 31st December 1975, were issued as follows: For sale of untreated milk 41 For sale of pasteurised milk 167 For sale of sterilised milk 207 For sale of ultra heat treated milk 45 Samples of milk for chemical and bacteriological examination were obtained from milk distributors in the Borough and also from schools and day nurseries with the following results: No. of samples Satisfactory Unsatisfactory Chemical examination 83 83 — Bacteriological examination 58 56 2 The two unsatisfactory samples which failed the Methylene Blue Test were taken up with the distributors concerned and subsequent samples were found to be satisfactory. 68 Ice Cream Forty five samples of ice cream were examined with the following results: Methylene Blue Grading Soft Ice Cream Other Ice Cream Grade 1 (satisfactory) 17 9 Grade 2 (sub-standard) 5 2 Grade 3 (unsatisfactory) 5 2 Grade 4 (unsatisfactory) 5 — Where unsatisfactory reports are received further samples are taken before any action is decided upon. In the cases reported subsequent samples proved satisfactory. Chemical Analysis Fifty-six samples were submitted for examination. All proved satisfactory with one exception where there was a deficiency in fat and milk solids. Following advice given to the producer a subsequent sample was found to be satisfactory. FOOD HYGIENE (GENERAL) REGULATIONS, 1970 Food premises were inspected and during the year written notices of requirements under the Regulations were given in respect of 343 premises. The following table shows the number of visits made by the public health inspectors to the various types of food premises: No. of premises No. of inspections Bakehouses 22 67 Bakers and confectioners 85 346 Butchers 183 396 Cooked and preserved meat shops 22 244 Dairies and milkshops 470 336 Fishmongers, friers and curers 66 120 Food factories 80 427 Greengrocers 188 203 Grocers and Provisions 332 562 Ice cream premises 375 263 Public houses 403 852 Restaurants, canteens, etc 583 2,035 Street markets 21 661 Wholesale food dealers 34 463 Other food premises 127 341 69 Legal Proceedings Nature of Business Offence Fine Costs Food canning factory Dirty articles of equipment (Regulation 6) £3 — Failing to protect food from risk of contamination £3 — (Regulation 8) Dirty condition of sanitary convenience (Regulation 14) £3 — Absence of notice requesting washing of hands after use of toilet £3 — (Regulation 14) Absence of wash hand basin, soap, towels and nailbrush £3 — (Regulation 16) Absence of cupboard or locker accommodation £3 — (Regulation 18) Dirty equipment for washing food and equipment £3 — (Regulation 19) Insufficient means of lighting £3 — (Regulation 20) Dirty condition of food storage room £3 — (Regulation 23) Dirty condition of food preparation and canning room £3 £2 (Regulation 23) These proceedings were taken under the Food Hygiene (General) Regulations 1960 which were revoked as from 1st March 1971. FOOD HYGIENE (MARKETS, STALLS AND DELIVERY VEHICLES) REGULATIONS, 1966 All street markets in the Borough are regularly inspected by the Public Health Inspectors and 661 such inspections were made during the year, in the main at the weekend. In addition 147 inspections were made on street traders' food stores. Three certificates of exemption from certain requirements of the Regulations were granted to street traders. 70 Legal Proceedings Nature of Business Offence Fine Costs Hot dog stall Not wearing clean clothing £5 £5 (Regulation 9) No name and address on stall £5 - (Regulation 13(l)(a)) Wash hand basin not provided £5 - (Regulation 16(1)) No supply of hot water for wash hand basin £5 - (Regulation 16(2)) No sink at stall £5 - (Regulation 18(a)) No supply of hot water for a sink £5 - (Regulation 18(b)) 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 3 8 2 21 Canned meat and meat products 8 6 0 20 Fish 2 1 2 0 Fruit and vegetables 149 3 3 15 Miscellaneous foodstuffs 73 10 1 5 Canned goods 103 12 1 10 Total 340 2 1 15 IMPORTED FOOD CONTROL THE IMPORTED FOOD REGULATIONS, 1968 FOOD AND DRUGS ACT, 1955 The following samples were submitted for bacteriological examination during 1971:— Egg Products 485 Frozen Prawns and Shellfish 825 Second Grade Cheese 64 Other Cheese 15 Canned Meats 29 Miscellaneous 9 Total 1,427 71 The following samples were submitted for chemical examination:— Frozen Liquid Egg for alpha-amylase test 522 Routine Chemical Examination: Canned Fruit and Juice 566 Dried Fruit 126 Canned Meat 96 Canned Vegetables 46 Canned Fish 137 Canned Tomatoes 54 Tomato Puree 55 Tea 114 Butter and Fats 59 Lard 108 Nuts 112 Cheese 53 Miscellaneous 426 1,952 Total Number of Chemical Samples 2,474 The Liquid Egg (Pasteurisation) Regulations, 1963 There is one egg pasteurising plant operating in the borough, which combines the process of egg pasteurisation with that of egg breaking and the freezing of liquid egg. The plant is high temperature short time with inplace cleaning. The 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. 105 samples of pasteurised home produced liquid egg were taken from the plant for alpha-amylase test and all were found to be satisfactory. One sample of imported German Preserved Liquid Egg Yolk was taken and found to be satisfactory. 72 SAMPLING OF FROZEN WHOLE EGG, 1971 Country of Origin Quantity imported No. of samples taken T. C. Q. L. Australia 300 8 0 0 102 China 505 0 0 0 137 Holland 4 4 0 0 4 New Zealand 125 0 0 0 48 Poland 110 0 0 0 107 Totals 1,044 12 0 0 398 OTHER IMPORTED FOODSTUFFS The following action was taken as the result of chemical analysis:— Food Examined Result of Examination Action Taken Crab Meat Found to contain added flavouring (monosodium glutamate) Letter to importer Green Beans Found to contain added flavouring (monosodium glutamate) Letter to importer Groundnut Kernels Found to contain Aflatoxin—"High" and "Medium" Categories Consignments detained Honey Contained 9% sucrose (Unnaturally high) Letter to importer Horseradish Sauce Found to contain excess Sulphur Dioxide Sampled at request of importer Italian Dressing Found to contain non-permitted preservative Detained Mineral Water Stated to contain .0017Kg of iron but no iron present Letter to importer Mustard Found to contain excess Sulphur Dioxide Letter to importer Tartar Sauce Found to contain non-permitted preservative Detained Tomato Paste Excessive Howard Mould Count Detained Twelve letters were sent to importers in respect of labelling offences. 73 BACTERIOLOGICAL EXAMINATION OF FROZEN SHELLFISH, 1971 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 13 Brazil Cooked prawns 3 3 0 0 Canada Cooked prawns 53 51 2 0 Lobster meat 5 Chile Cooked prawns 29 28 1 0 China Raw prawns 9 Denmark Cooked prawns 16 16 0 0 Formosa Cooked prawns 59 55 4 0 Raw prawns 3 Hong Kong Cooked prawns 40 21 19 0 Raw prawns 3 India Cooked prawns 2 1 1 0 Indonesia Cooked prawns 10 6 4 0 Japan Cooked prawns 13 13 0 0 Kuwait Raw prawns 4 Malaysia Cooked prawns 291 143 118 30 Raw prawns 80 Pakistan Raw prawns 52 U.S.A. Cooked prawns 137 135 2 0 Totals Cooked 653 472 151 30 Raw 169 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. 3 samples of home produced prawns were taken and found to be satisfactory. 74 New Zealand Second Grade Cheese 64 samples of New Zealand second grade cheese were submitted for bacteriological examination during 1971 with the following results:— Coagulase-positive staphylococci No. of samples Less than 500 per gram 56 500-500,000 per gram 1 Over 500,000 per gram 7 64 Brands with counts in excess of 500,000 per gram were destroyed. The remainder of the cheese was allowed to go for processing. First Grade Cheese 11 samples of New Zealand first grade cheese and 4 samples Czechoslovakian Cheddar Cheese were submitted and found to be satisfactory. 75 76 BACTERIOLOGICAL EXAMINATION OF EGG PRODUCTS, 1971 Country of Origin Type of Egg Product Quantity Examined No. of Samples taken No. of Samples Positive Quantity of Contaminated Egg T C Q L T C Q L Australia Frozen Albumen 286 10 0 0 211 1 1 11 2 0 China Frozen Albumen 10 0 0 0 8 — Czechoslovakia Dried Whole Egg 45 18 0 0 27 — New Zealand Dried Whole Egg 1 0 0 0 2 — Poland Dried Whole Egg 20 0 0 0 17 — Frozen Albumen 25 0 0 0 22 — U.S.A. Dried Albumen 59 3 0 0 148 4 1 5 0 0 West Germany Dried Albumen 53 7 0 0 47 — Frozen Albumen 8 0 0 0 3 — Totals 508 18 0 0 485 5 2 16 2 0 The whole of the contaminated egg was released for heat treatment. The following types of Salmonellae were isolated during sampling of egg products during 1971:— Country of origin Organism No. of samples Australia Salmonella typhi-murium 1 U.S.A. Salmonella blockley 1 Salmonella st. paul 2 Salmonella thompson 1 5 77 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 4 2 0 Butter 5 9 l 0 Casings 8 0 0 Cheese 7 11 0 0 46 11 0 0 19 12 3 16 Chestnuts 95 19 2 6 Coconut 6 1 0 Coffee 1 0 0 0 Egg products 7 4 2 0 Fish 1 17 0 0 Fruit 31 11 0 0 Fruit (dried) 4 10 2 0 5 3 0 20 Fruit and fruit juice (canned) 86 9 3 26 Gravy base 10 0 0 Groundnuts 76 15 0 0 40 0 0 0 Lentils 3 16 0 3 Meat 2 2 2 6 8 18 0 0 1 6 3 4 Milk (canned) 57 13 1 8 Milk powder 111 14 0 0 Pasta 4 5 0 0 Peas 3 2 0 0 Peppers 14 0 0 Prawns (frozen) 42 18 0 0 5 2 0 Tomato puree 17 1 0 0 Turmeric 14 0 0 Various 28 16 2 18 Totals 198 4 0 6 20 4 3 0 156 10 0 0 339 11 2 17 58 consignments of imported food were detained and were subsequently 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 Social Services Department in 1971 relating to prospective adopters and 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 17 children were considered suitable for adoption and 20 for boarding out. Similar recommendations were made on 14 prospective adopters. In addition, 45 enquiries were carried out at the request of the Social Services Department for information appertaining to initial applications from persons wishing to adopt or foster a child. SOCIAL SERVICES ESTABLISHMENTS Part-time visiting medical officers hold appointments at residential nurseries, and at large and small homes for children, the aged and infirmed, homeless family units etc. A senior medical officer exercise general medical supervision of the establishments and gave special attention to short-stay accommodation for homeless families. THE SOUTH EAST LONDON GENERAL PRACTITIONERS' CENTRE This report covers the sixth full year since the Centre became the responsibility of the London Borough of Southwark. I—General The number of general practitioners who have used the Centre increased from 311 in 1970 to 321. During this period work commenced on the conversion of the space provided by the boat room and the Centre's section has now been partitioned from the remainder of the space to be used by the Deptford Evening Institute. Work is now at a standstill pending negotiation for a somewhat longer lease of the additional accommodation but it is hoped that the alterations planned will be completed in the very near future to ease the congestion in certain departments of the Centre. The work at the Centre shows a slight decrease in volume largely due to the shortage of staff that has existed in the pathology laboratory. 78 Visits The Centre has received a variety of visitors throughout this period including the usual groups of student nurses from Guy's Hospital and King's College Hospital, sixteen girls from Friern Road Secondary School, a visit of Swedish students arranged through Bede House Association, German Civil Servants and American students. We have also received a visit from the B.B.C. 'Nation Wide' television team who made a short film on the function of the Centre and the history of the Peckham Experiment. Meetings During the year four general practitioners' luncheons were arranged. Films were shown and lectures given by Consultants from local hospitals and the meetings were very well attended. The Annual General Meeting of the British Medical Association was held in June when Mr. Andrew Cruikshank was the speaker and the usual meetings took place of the South East London Obstetric Society, the South London Faculty of the Royal College of General Practitioners, the Psychiatric Club, the Centre's Medical Staff Committee and the House Committee. II—Medical (a) Well Women Clinics The total attendances for 1971 were 455 as compared with 560 in 1970. The number of cervical smears taken at the Centre by general practitioners was 126. (b) The volume of work carried out during the year is shown in the following tables. Jan.-Mar. Apr.-June July-Sept. Oct.-Dec. Total Patients seen 2,957 2,530 2,507 2,361 10,155 Number of Investigations, Treatments, etc. 5,575 4,924 4,631 4,571 19,691 Work in various departments Period Path. Lab. X-ray E.C.G. Allergy Nursing Minor Ops. Jan.-Mar. 1,934 1,301 371 37 1,913 9 Apr.-June 1,739 1,142 340 30 1,660 13 July-Sept. 1,755 981 271 28 1,575 21 Oct.-Dec. 1,498 1,122 333 66 1,532 20 TOTAL 6,926 4,546 1,315 161 6,680 63 79 (c) The approximate findings on routine screening tests for the year were as follows:Abnormal blood pressures: 2.1 % Albumin in urines: 2.48% Sugar in urines: 0.56% (d) The Sir Halley Stewart Trust kindly donated a defibrillator machine for emergency resuscitation in the theatre. This donation, amounting to £379, will enable general practitioners to carry out general anaesthetics where desired and at a meeting of the Medical Staff Committee in January it was agreed that a letter should be circulated to all general practitioners stating the correct procedure to be carried out whilst using a general anaesthetic to ensure the highest level of safety possible. (e) There are now two health visitors based at the Centre, but patients' problems dealt with by the health visitors are not included in the overall figure. Undergraduate Education Undergraduate courses were arranged for two students, Miss Carol Huseman and Mr. David Olian, from the Department of Environmental Health of the University of Cincinatti. Each student carried out an eight week attachment including visits to the Health Department, local general practitioners' surgeries and attendance at Guy's Hospital paediatric clinics. Both students found the programme arranged very informative. Postgraduate Education In addition to the general practitioners' lunch-time meetings, eight very successful postgraduate afternoon meetings were arranged by Dr. T. A. Johns of King's College Hospital. STAFF MEDICAL EXAMINATIONS A senior medical officer, with nursing assistance, is responsible for the medical examination of new entrants to the staff and in certain circumstances of sick personnel. The following table gives details of this work. Officers Manuals Questionnaires received 691 1,239 Questionnaires scrutinised 219 559 Medical examinations:— Full medicals after scrutiny of questionnaires 160 155 Staff absent from duty through sickness 120 694 Staff called up for review 71 234 Domiciliary visits to sick staff 13 29 80 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 Chest Clinic situated at Bermondsey Health Centre transferred to St. Olave's Hospital on 23 August, 1971. The Council 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. 12 cases were assisted, compared with 16 in 1970. 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 the following table. Number of patients on chest clinics registers at 31 December, 1971. Pulmonary 1,786 Non-pulmonary 264 New cases notified: Pulmonary 73 Non-pulmonary 12 Deaths from tuberculosis 11 Contacts given B.C.G. Vaccination 188 Number of cases having home nursing service at 31 December, 1971: 5 Home visits by health visitors 4,603 Patients in receipt of extra nourishment 12 Patients assisted for the first time with: Bed or bedding 13 Clothing or footwear 63 Diversional therapy—patients attending weekly classes: 81 DEVELOPMENT OF VOLUNTARY EFFORT Every endeavour was made to use voluntary assistance during 1971, 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 Various British Red Cross Society Central Council for Health Education Chest and Heart Association National Association for Maternal and Child Welfare Marie Curie Memorial Foundation FINANCE Expenditure Despite the additional cost (£23,738) of the introduction of the School Milk Scheme in October, 1971, total expenditure for 1971/72 was lower than in the previous year because of the transfer on 1st April, 1971, to the Social Services Department, of the functions relating to day nurseries, mental health, home help, recuperative holidays, etc. The approximate net revenue expenditure for the year was £1,063,220; the amount recovered in contributions and charges was approximately £258,640, including re-imbursement of the cost of the School Health Service (£176,209) and the Government Grant of half the cost of the Port Health Administration (£16,989). 82 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.(Irel.), D.D.P.H., R.G.S.(Eng.) PRINCIPAL SCHOOL DENTAL OFFICER SCHOOL HEALTH SERVICE, Castle House, 2 Walworth Road, SE1 6SU. 83 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 Of the Inner London Boroughs, Southwark has the highest school population. The number of children on the roll of the Borough's schools is 49,895. This shows an increase of approximately 200 over the previous year's total. Schools The total number of schools in Southwark is 108. This total is comprised of the following:— County Schools: Primary 48 Secondary 15 Voluntary Schools: Primary 25 Secondary 11 Nursery Schools: 2 Special Schools: for Educationally Subnormal children 4 for Severely Educationally Subnormal children 2 for Maladjusted children 1 108 34 of the primary schools have separate departments for infant and junior children, and each department has its own head teacher. During 1971 the number of Nursery Classes in the Borough increased from 35 to 40 of which seven are full time Classes. There are 2 Partially Hearing Units attached to primary schools in the Borough. Medical Inspections During 1971, 18,231 children were examined at routine school medical inspections. These routine inspections are carried out 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. 84 In addition to Routine Medical Inspections, 9,815 re-inspections and non-routine inspections were undertaken. 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 re-assessed accordingly. Children whose school attendance is a problem are visited at home to evaluate the reasons for their non-attendance. The Medical Officers, Teachers, Education Welfare Officers and 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. The Education (Handicapped Children) Act, 1970 The Education (Handicapped Children) Act, 1970, which came into effect on 1st April 1971, made provision for the transfer of responsibility for the education of severely mentally handicapped children from Local Health Authorities to Local Education Authorities. The two junior training schools in the borough were transferred to the Inner London Education Authority on 1st April and re-classified as schools for severely subnormal children. During the year 140 children were on roll at the schools. Tuke School, the opening of which was described in my last report, is purpose built and has a special care unit for the children who are both severely physically and mentally handicapped or severely mentally handicapped and disturbed. Statutory Examinations 92 children were examined under Section 34 of the Education Act 1944, to assess their need for special schooling. This figure was 36% lower than the previous year. Of the children examined, 25 were recommended to remain at ordinary schools with special remedial help. The Education (Milk) Act, 1971 Following the implementation of the Education (Milk) Act, 1971, the provision of free milk for pupils in primary schools, over the age of 7 years ceased from 1st September, 1971. Milk is, however, provided for any child for whom it was recommended on medical grounds. 128 children (0.25%) of the school population have been recommended for milk. 85 Prophylaxis Rubella One of the most important advances in the field of prophylaxis is the provision of rubella vaccine to afford protection against the risk of contracting rubella (German measles) during pregnancy, because of the possible affect on the unborn child. In 1970 the Department of Health and Social Security announced that rubella vaccine would be made available for the immunisation of girls between their 11th and 14th birthdays. Early in 1971 a vaccination programme was arranged for all secondary girls schools and by the end of the year 2,898 girls had been protected. B.C.G. 5,282 children were Mantoux tested. 4,648 were vaccinated, 356 found to be Mantoux positive and referred to their local Chest Clinic for X-ray, 278 failed to attend for the result of their Mantoux test. Diphtheria and Tetanus 143 primary courses of Diphtheria and Tetanus immunisation were given at School Medical examinations and 762 children were given re-inforcing doses. Poliomyelitis 171 children were given primary courses of poliomyelitis immunisation and 697 re-inforcing doses were given. 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. Medical Officers gave introductory lectures to students, especially from Overseas, to assist in the difficult transitional period of adjustment to student life in England. The visiting medical officers hold regular sessions at which new entrants are given the opportunity of a medical check up. All students are encouraged to consult the medical officers with their problems. Lecturers and social workers may also refer students for medical advice. 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.). 86 All students are strongly advised to register with a General Practitioner on entry to the College. Health Education The programme of teaching sessions in Schools arranged at the request of head teachers was continued. Nursing staff covered health education subjects included in courses to C.S.E. level, as members of the teaching team. The closer liaison between heads of departments in senior schools; the nursing staff and Health Education Section continued. Talks given by Health Visitors and School Nurses included the following subjects:— 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. The Health Education Programmes arranged at five centres during August were most successful. 1,715 children saw films selected to illustrate a health or safety theme in terms of interest to young children, supplemented by short talks, group exercises and competitions on the theme for the week. Screening of Schoolchildren s urine for the early detection of Urinary Tract Infection During 1971 the school health services of Southwark and Lambeth co-operated with King's College Hospital in a survey on the early detection of renal disease. As the incidence of renal disease in boys is much lower than in girls the research was concentrated on school girls. In Southwark 4 primary and 3 secondary schools were asked to take part. Parents who agreed to allow their daughters to participate were asked to complete a simple medical questionnaire. A urine specimen was then obtained during school medical inspection and this was tested at the hospital laboratory. In all cases 87 where positive results were obtained a further sample was tested and the child's General Practitioner informed. In the event of two positive results the child was referred to hospital for further examination. 907 children took part in the survey. 815 negative results were obtained. Of the remaining 92 positive results 29 girls were referred to hospital for further investigations. SCHOOL HEALTH SOCIAL WORK It is a matter of great concern to the School Health Social Work Department, that due to depletion of staff, for various reasons, it has not been possible to undertake the normal volume of preventive social work with the families of school children, at a time when it is abundantly clear that there is an ever increasing need. When the Social Services Act came into being on 1st April, 1971, the Principal School Health Social Worker and the three family caseworkers moved over to Social Services. Two long serving social workers later retired and as it has not been possible to replace the liaison social worker at Guy's Hospital, they have lost a valuable link with the preventive services provided by the Inner London Education Authority. The Social Worker for the Deaf was sadly missed by many families as well as colleagues working with the deaf, when he left to go abroad. The two young social workers who joined the School Health Service this year have made a noble effort to continue the work at the Partial Hearing Units and the Play Group projects which he pioneered, as well as covering the work from four special investigation clinics. When the Deputy Principal School Health Social Worker left at the end of September, only one of the original team remained, who in optimistic mood commenced an Extra Mural Course at London University! In spite of all these setbacks, the special investigation clinics have continued to treat children suffering from enuresis, obesity and minor behaviour problems. This has been made possible by the excellent co-operation of the School Nursing Staff whose expert knowledge, close contact with the families of school children and deep concern for preventive medicine, has always been a vital contribution to the work of the team. 88 Medical Inspections Examinations Routine examinations at aged 5, 7, 11 and during the last year of school 18,231 Non-routine examinations 13,036 Examinations to ascertain fitness for employment 258 Statutory Examinations Children examined under Section 34 of the Education Act, 1944 95 As a result of these examinations the following recommendations were made:— Admissions to Boarding E.S.N. Schools 1 Admissions to Day E.S.N. Schools 62 To remain at ordinary school with special educational help 25 Referred to Educational Psychologist 3 Referred for Child Guidance 1 Vision Clinics Sessions 304 Total Attendances 3,264 Number of new cases 963 Errors of refraction 1,660 Other eye defects 114 Spectacles ordered 1,121 Audiology Clinics Sessions 76 Total attendances 784 Number of new cases 281 Special Investigation Clinics Sessions 374 Total attendances 1,790 Number of new cases 284 Minor Ailments Sessions Nursing Sister 1,722 Total attendances 12,093 Number of new cases seen by nursing sister 2,125 Number of new cases per 1.000 school population 45 89 Cases treated Athletes foot, verrucae, skin diseases, eye and ear defects, bruises, lacerations etc. 2,119 B.C.G. Mantoux tested 5,282 Mantoux positive 356 Vaccinated 4,648 Diphtheria Primary Courses 143 Reinforcing doses 762 Poliomyelitis Primary Courses 171 Reinforcing doses 697 Rubella 2,898 90 LONDON BOROUGH OF SOUTHWARK SCHOOL DENTAL SERVICE REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER, 1971 It is interesting to reflect at the end of the first five year period of the Borough School Dental Service, on some of the trends and changes in the patterns of dental demands and treatment. The number of sessions held increased over this period of five years by 25%. This increase was largely due to an expansion of the inspection service beginning in 1966, which resulted in over 56% of the school population being inspected in 1971 compared with 17% in 1966. Dental Health Education was another theme which showed considerable change during this time. The development of the I.L.E.A. dental health unit together with the appointment of dental auxiliaries in the borough has resulted in a more sophisticated and intensive approach to this most important aspect of the service. The amount of treatment given has also expanded. The number of fillings has risen by approximately 15% and the number of extractions of permanent teeth has fallen by 20%. Average attendances have remained fairly steady during this time and the number of courses of treatment completed annually has increased by approximately 10%. The most significant figure possibly is that which shows the percentage of children seen at school requiring treatment. This has fallen slowly but steadily year by year and is now approximately 55%. This pattern is reflected in other parts of Inner London and is no doubt a result of the extended treatment facilities and also of the Dental Health Education carried out by the I.L.E.A. and the individual Boroughs. Inspection and Treatment The same number of sessions as last year were held. The number of Dental Health Education sessions showed a fall but this was balanced by an increase in the ordinary treatment sessions. There was a slight increase in first visits and a fall in the number of broken appointments. The figure of first visits is a very important one as it reflects the proportion of the school population who attend for treatment. Therefore this figure indicated the extent to which the School Dental Service is making inroads on the amount of dental disease present in schoolchildren. Although there has been a slight rise this year in the number of first visits this is no cause for complacency as it is essential to increase this figure until all children who are found at school inspection to need treatment have not only been given the opportunity of having it but have also been persuaded to avail of this service. The increase in orthodontic activity this year was due to the fact that during 1971 we had the services of our sessional orthodontist who has been dealing with the backlog of treatment remaining from the previous year. The amount of orthodontic treatment showed a welcome increase although there is still much scope for expansion in this field. 91 Staff and Courses During the year one dental officer attended a course at Cardiff on the subject of dental treatment of handicapped children. A course on children's dentistry at the Royal Dental Hospital in September was also attended. There were a number of staff changes during the year, the most notable of which was the resignation of our senior dental officer Mr. A. Longden, who left in January to take up his new appointment as Principal School Dental Officer in the Royal Borough of Kensington & Chelsea. Mr. Longden's new post reflects credit not only on himself but also on the work which he has done in the Borough of Southwark. The senior dental officer position remained vacant until in November, Miss N. O. Ekanayake, who has been with us since the inception of the Borough, was appointed to the vacancy. Miss Ekanayake's particular interest is in the dental care of handicapped children and in this respect it was intended that she should take over responsibility for treatment of mentally handicapped children at the Junior Training Schools when the Guy's Dental School project finished at the end of the year. Premises and Equipment The main item of interest in this field during 1971 was the opening of the new surgery at Bermondsey Health Centre. This was a notable event as it represented the first completely new surgery in the Borough, previous new surgeries having been replacements of older premises. The new surgery had been adapted from an existing room in the dental suite in the Bermondsey Health Centre and with new equipment and renovation of the room itself an attractive and well lighted surgery has been produced. Our newly appointed second Dental Auxiliary commenced treatment sessions at the new surgery towards the end of the year and it was hoped that this service for the younger children of the Bermondsey area would expand as time went on. As a result of this the orthodontic sessions were moved to St. George's Health Service Centre at Blackfriars Road. St. George's is more accessible being better served by Public Transport and therefore more convenient for children and parents coming from other clinics in the Borough. Dental Health Education During the two weeks that the I.L.E.A., mobile clinic was at Langbourne School, talks and lessons on the subject of dental health were given to all the children. This was an effective way of combining dental treatment with dental health education. At one of the senior girls schools all the first year girls were involved in a practical lesson during the Autumn term. Under the direction of the dental auxiliary a number of experiments in various methods of tooth cleaning and the effects of different foods on teeth were carried out. As well as these special projects regular dental health education was continued throughout the Borough's schools in 1971. 92 1971 ANNUAL STATISTICS SCHOOL DENTAL SERVICE TOTAL SCHOOL ROLL 49,895 1971 1970 Number of sessions: Inspection 253 258 Ordinary Treatment 3,082 2,944 General anaesthetic 57 68 Orthodontic 77 35 Health Education 153 311 Total Sessions 3,622 3,616 1971 1970 Inspection: number of children given: First inspection at school 24,921 24,994 First inspection at clinic 3,012 3,719 Percentage found to require treatment 56.0 52.8 Reinspection at school or clinic 1,440 2,013 Percentage found to require treatment 82.8 86.7 Percentage of school Roll inspected 56.0 58.0 Visits for treatment: Number of first visits 5,514 5,291 Number of subsequent visits 12,233 12,551 Total visits 17,747 17,842 Emergencies 461 471 Additional courses commenced 1,266 1,726 Number did not attend 6,833 7,254 Treatment given: Number of fillings: In permanent teeth 9,330 10,579 In temporary teeth 6,786 6,471 Number of extractions: Of permanent teeth 438 537 Of temporary teeth 2,477 2,667 93 Number of other operations (prophylaxis, X-rays, inlays, crowns, etc.) 6,908 7,475 Courses of treatment completed 4,444 4,818 Orthodontics Number of new cases 56 15 Number of removable appliances fitted 66 16 Number of fixed appliances fitted 5 3 Number of cases referred to Hospital Consultant 2 5 Sessional averages: First visits: 1.7 1.7 Subsequent visits: 3.8 4.1 Emergencies 0.1 0.2 Did not attend 2.1 2.4 Fillings: In permanent teeth 2.9 3.5 In temporary teeth 2.1 2.1 Extractions: Of permanent teeth 0.2 0.2 Of temporary teeth 0.8 0.9 Ratio of permanent teeth filled to permanent teeth extracted 18.3 to 1 16.6 to 1 Ratio of temporary teeth filled to temporary teeth extracted 2.5 to 1 2.1 to 1 APPENDIX A HEALTH DEPARTMENT ESTABLISHMENTS Maternity and Child Welfare Centres Amott Amott Road, S.E.15 Bermondsey Health Centre Grange Road, S.E.1 Bird-in-Bush Old Kent Road, S.E.15 Consort Consort Road, S.E.15 Denmark Hill Blanchedowne, S.E.5 Health Services Department Larcom Street, S.E.17 John Dixon 6/8 Drummond Road, S.E.16 Kingswood Bowen Drive, S.E.21 Lordship Lane 475 Lordship Lane, S.E.22 Mayward House Benhill Road, S.E.5 94 Redriff Redriff Road, S.E.16 St. George's Health Services Centre 151/152 Blackfriars Road, S.E.1 Salomon's Guy's Hospital, S.E.1 Silverlock 3 Warndon Street, S.E.16 Sumner Road Basingstoke House, S.E.15 Sutherland House Sutherland Square, S.E.17 Townley Townley Road, S.E.22 Villa Street Villa Street, S.E. 17 Whaddon House 2-3 Whaddon Hse, Dog Kennel Hill, S.E.22 School Treatment Centres Bermondsey Health Centre Grange Road, S.E.1 Camberwell Addington Square, S.E.5 Camberwell Sub-Centre Comber Grove, S.E.5 Gordon Road Gordon Road, S.E.15 Health Services Department Larcom Street, S.E.17 John Dixon 6/8 Drummond Road, S.E.16 Lindley 163 Commercial Way, S.E.15 Lordship Lane 475 Lordship Lane, S.E.22 Redriff School Redriff Road, S.E.16 St. George's Health Services Centre 151/152 Blackfriars Road, S.E.1 Disinfecting and Cleansing Stations King James' Street S.E.1 Neckinger S.E.16 District Nurses Benson Home Sancroft Street, S.E.11 Peckham Road 29 Peckham Road, S.E.5 Bermondsey 108 Grange Road, S.E.1 Foot Clinics Amott Amott Road, S.E.15 Bermondsey Health Centre Grange Road, S.E.1 Bird-in-Bush Old Kent Road, S.E.15 Caroline Gardens Asylum Road, S.E.15 Health Services Department Larcom Street, S.E.17 John Dixon Drummond Road, S.E.16 Lordship Lane 475 Lordship Lane, S.E.22 Peckham Road 29 Peckham Road, S.E.5 Silverlock 3, Warndon St., S.E.16 St. George's Health Services Centre 151/152 Blackfriars Road, S.E.1 95 Creche Bird-in-Bush 616 Old Kent Road, S.E.15 Consort Road S.E.15 Kingswood Bowen Drive, S.E.21 St. George's Health Services Centre 151/152 Blackfriars Road, S.E.1 St. Peter's Church Hall Dulwich Common, S.E.21 Sumner Basingstoke House, Sumner Road, S.E.15 Sutherland House Sutherland Square, S.E.17 Townley Townley Road, S.E.22 Mortuary Tennis Street, S.E.1 S.E. London G.P. Centre St. Mary's Road, S.E.15 Offices H.Q. Castle House 2 Walworth Road, S.E.1 6SU Area 1 Larcom Street, S.E.17 Area 2 Spa Road, S.E.16 Area 3 29 Peckham Road, S.E.5 Area 4 20/22 Lordship Lane, S.E.22 APPENDIX B 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 weekends and public holidays). All emergency calls are made to the Lambeth Town Hall, Brixton Hill, S.W.2 (telephone number 274 7722). Domiciliary Midwifery Service All emergency calls both by day and by night—including weekends and public holidays—are made to Lambeth Town Hall, S.W.2 (telephone number 274 7722). District Nursing Service can be obtained by telephoning 735 1335, between 8.00 a.m.— 10.30 p.m. daily (including weekends). 96 INDEX page Abortion Act, 1967 33 Accidents in the home 39 Adoption and Boarding out 78 Advisory and Preventive Clinics 33 Analysis of food and drugs 66-77 Air Pollution 62 Industrial Survey 63 Grit and Dust Control 63 Sulphur in Oils 64 Furnace 64 Inspections 64 Legal proceedings 64 Smoke control orders 62 Attachment to G.P.'s 23 Audiology 89 Bacteriological examinations: eggs 71,76 food 75 milk 68 shell-fish 71, 74 water 44,45 Bakehouses 42, 69 Barbers and Hairdressers 42 Bathing of Aged persons 50 Baths: Personal cleansing 50 swimming 42 B.C.G. vaccination of schoolchildren 86 Births 16,20 Blind and Partially sighted persons 34 British Red Cross Society-loans home Nursing Equipment 30 Cancer 16,35 Cervical cytology 35 Cheese 75 Chest clinics 81 Child-health 18 Child welfare centres 18 Chiropody 34 Clean Air Act, 1956, 1968 62, 63, 64 Cleansing stations 95 Clearance areas 61 Community Health Service Liaison Committee 31 Community Care 33 Confinement 20 Co-operation with doctors and hospitals 31 Creches - occasional 19,96 Cremations 51 Cytology - cervical 35,36 Deaf children 25 page Death: cause of 8-15 Classification 8-15 Infant 16, 17 Maternal 16, 17, 21 rates 16 tuberculosis 16 Dental service: Health Education 27 Hygiene 38 maternity and child welfare 27, 28 schoolchildren 91 Statistics 93,94 Development of voluntary effort 82 Diphtheria Immunisation 25, 26, 90 Disinfecting stations 50,95 Disinfection and disinfestation Displays 38 Disposal of unsound food 77 District nursing 21 Liaison with Hospitals 22 Domiciliary midwifery service 20, 21 Drainage Early discharge of maternity patients 21 Egg products 74,76 Emergency arrangements 96 Environmental Health Services 41, 77 Factories Act, 1961 59 Family Planning 18,31,32 Family Planning Act, 1967 31 Feral Pigeons 42 Finance 82 Fireguards, loan of 30 Fluoridation 29 Food: hygiene regulations 69,70 imported 71-74 poisoning 49 premises 69 routine examination 69,71,72,73,74,75 sampling 66, 67, 68 unsound & legal proceedings 77 Food & Drugs Act, 1955 66 Foot clinics 95 Guthrie Test 25 Gynaecological disorders 35 Handicapped and Observation Registar 24, 25 Health Committee 3, 4 Health Department establishments 94-96 97 INDEX—contd. page Health Education 37-40 home safety 37,38 postal franking 38 service establishments 38 sex education 38 talks/activities 40 Health visiting 22 Hilda Lewis Unit 31 Home Bathing service 50 Home dialysis 34 Home nursing 21,22 Home nursing equipment, loan of 30 Home safety 38 Houses in multiple occupation 61 Housing: Inspection of dwelling houses 60,61 Proceedings - Public Health Acts 61,62 Proceedings - Housing Act, 1957, 1961-64 & 1969 60,61,62 Ice-Cream sampling 69 Immigrants - medical arrangements 33 Immunisation and vaccination 26, 86 Imported Food Regulations, 1968 71 Incomtinent laundry service 50 Infant mortality 16 Infant welfare: clinics 18,94,95 sessions 18, 19 Infectious Diseases 46, 47, 48 Inner London Education Authority School Health Service 83 Inquests 51 Junior Training Schools 27 Legal Proceedings 53, 62 Loan of equipment 30 fireguards 30 home nursing equipment 30 Maternal mortality 16,25 Maternity and child welfare: centres 94 services 18,19,82 Measles 25,26,46-48 Medicals: examination of staff 80 inspection of schoolchildren 84 priorities for rehousing 62 Midwifery service 21,96 Milk sampling 68 Miscellaneous 78 Mobile Health Clinic 35 page Mortuary 50 Mothercraft 18, 19 Mothers Club 38 Neo-natal mortality 20 Newcomen Centre 24 Noise 65 Notifiable diseases 46,47 Notification of infectious diseases 47, 48 Nursing Homes 33 Observation (at risk) & Handicapped Registar 24,25 Occasional crede 19 Offensive trades 41 Office, Shops and Railway Premises Act, 1963 52-54 Registration/Inspection 52,55,59 Persons employed 55 Infringements/defects 52, 56, 59 Reported accidents 53,57,58 Outworkers 60 Perinatal mortality 14,20 Personal health services 18 Pest Control 65,66 Pet Animals Act, 1951 42 Pests Acts, 1949 65,66 Pharmacy and Poisons Act, 1933 42 Phenylketonuria 25 Poliomyelitis vaccination 25,86,90 Population 16 Port Health Administration 33 Post mortem examination 51 Premature births 21 Prevention of Damage by pests Act, 1949 65 Preventive Medicines 33 Prophylaxis 25, 26, 86 Registration of food premises 42 Rodent control 65,66 Samples: food and drugs 66, 67, 68 ice cream 69 milk 68 water 44,45 Sanitary circumstances of the area 41 Scabies and vermin 50 School dental service 91-94 School Health Service 83-90 School nursing service 87 School population 84 School summer vacation 37 Sewerage and sewage disposal 42 98 INDEX—contd. page Shellfish 74 Slimming clinic 36 Smallpox vaccination 25 Smoke control 62 Smoking 37 Social Work (Health Services) 88 South-East London General Practitioners Centre 78, 79 Staff 5 Staff - attachment of 23 Staff medical examination and questionaire 80 Statutory examination 85 Stillbirths 16 Student Health service 86, 87 Swimming baths 64 Tetanus immunisation 26,86 Tuberculosis: care and after-care 33 page Chest clinics 81 Deaths 8 notifications 46,47 Typhoid fever 46,47 Unsound food 77 Vaccination and immunisation 26, 86 Vermin and scabies 50 Verminous premises 58 Vision testing 34 Visiting medical officers 78 Vital statistics 16,17 Voluntary organisations 82 Water supply 43 Water supply, fluoridation of 29 Well Women clinics 72 Whooping cough immunisation 25 99 Printed by W. 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