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114
after the fulfilment of their contractual obligations following qualification. The
number of certificated health visitors increased during the year from 346 to 365.
An attempt of a different kind to alleviate the shortage of certificated health
visitors was introduced when the Council instituted a new grade of " clinic nurse."
These officers who are qualified nurses, but not qualified health visitors, are employed
on some of the clinic work in maternity and child welfare centres, thus enabling health
visitors to devote more time to home visiting. They are also engaged on work in
vaccination and immunisation clinics.
Co-operation
with borough
councils
Co-operation between the Council and the metropolitan borough councils in the
administration of London's public health services continued during 1951. Almost
all the borough medical officers of health take part in the administration of the
Council's personal health services, and under an agreement reached during the year the
Council pays 25 per cent. of their salaries in recognition of their work on its behalf.
Complementary arrangements are not yet on such a large scale, but during the year
two more assistant medical officers of the Council were seconded part-time for duty
as deputy borough medical officers of health. By the end of the year such secondments
were in force in three boroughs, viz., Finsbury, Fulham and Islington.
Tripartite
appointments
Important though these developments were, they were overshadowed by the
unique experiment designed for the Council's Health Division No. 9, comprising the
metropolitan boroughs of Battersea and Wandsworth. The opportunity to attempt
a really close integration of the health and environmental services in this area was
afforded by the coincidence of the retirement of both borough medical officers of
health. Consultation between the three authorities concerned, and with the Ministry
of Health, culminated in the appointment of one officer to be the Council's divisional
medical officer and medical officer of health for the two boroughs. Thus, for the first
time in the history of London government, immediate control of all the public health
services in a wide area (total population over 400,000) became the responsibility of
one medical officer, himself responsible to three authorities. The officer appointed
to this post was Mr. J. T. R. Lewis, M.D., D.P.H., formerly medical officer of health
and school medical officer of West Bromwich. Two other medical officers were appointed
to assist Dr. Lewis in his work for the Council and to deputise for him as
medical officer of health in each borough. Although this scheme did not actually
commence to operate before the end of the year and hence cannot be reviewed in this
report, it is certain that it will be watched with critical interest, coupled with the
hope that it may prove of great benefit to the efficiency of the public health services
in the area.
Staff medical
examination*
The number of references to the department for medical examination or advice
concerning the health of staff or the fitness of candidates for appointment was 12,455,
compared with 12,361 in 1950; 200 members of the staff were found to be permanently
unfit for further duty with the Council and 191 candidates were found unfit for appointment.
Reciprocal arrangements with provincial authorities for the examination locally
of new entrants were continued. Provincial medical officers of health arranged for
the examination of 15 entrants to the Council's service and the Council's medical
officers examined 25 persons for provincial appointments.
The Council's staff medical examiners made 95 home visits to examine members
of the staff who were unable to travel, compared with 74 during 1950.
Sewer
workers
Arrangements made for the ascertainment and the treatment of leptospirosis
among the Council's sewer workers have been continued. There was a reduction in
the incidence of the disease among London sewer workers during the war years,
possibly associated with the cessation of building operations in the sewers. Since
the war there have been two or three cases a year and despite a slight increase in the
last two years the incidence remains reasonably low.