THE HEALTH AND WELFARE OF THE LONDON BOROUGH 1968 MELVILLE WATKINS, M.R.C.S., L.R.C.P., D.P.H. LONDON BOROUGH OF BARNET HEALTH & WELFARE DEPARTMENT With the Compliments of the Medical Officer of Health Gateway House, 322, Regents Park Road, Finchley, N.3. Telephone: 01-349 9121 MG 25 BAR 2 THE LONDON BOROUGH OF BARNET ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1968 MELVILLE WATKINS, M.R.C.S., L.R.C.P., D.P.H. Health and Welfare Department, Gateway House, 322 Regents Park Road, Finchley, N.3. To the Mayor, Aldermen and Councillors of the Council of the London Borough of Barnet. Mr. Mayor, Ladies and Gentlemen, I have pleasure in presenting my Report on the Health and Welfare services of the Borough for the year 1968. As in previous years the Report covers all the main facets of the Department's work. Progress in the development of establishments continues and during the year a 40-place purpose-built Rehabilitation Centre for the Blind and Physically Handicapped and a purpose-built Adult Training Centre providing 40 places were opened. It was unfortunate that due to staff recruitment difficulties a 10-place Hostel for Mentally Subnormal Children, though completed in 1968, was unable to open as planned and which meant that the earliest date when any cases could be admitted would be in early 1969. These were notable advances in the development of specific services but, whilst economic considerations have to be very much the order of the day, there is bound to be some delay in establishing a number of projects which are necessary to further the progress of the Health and Welfare day and residential services. The Council's plans however for the years ahead are realistic in their conception and whilst only limited advances have so far been made, much has been done to relieve pressures which the Department has experienced in respect of day and residential care generally. The development in 1967 of an In-Service Training Course, mainly for new recruits and covering all disciplines employed within a Health and Welfare Department, was extended so as to provide for two courses being run within a 12 month period and the second course in 1968 was planned for one morning per week spread over nine weeks and which was considered to be the necessary pattern to be adopted in future years. Invitations were extended to other Departments of the Council to nominate persons for attendance who would be particularly interested in certain aspects of the Health and Welfare services. The high standard of lectures provided by senior members of the Department's staff was extremely well received and the response from all participants confirmed the value of Local Authority staff participation in courses of this nature and which, in many instances, obviated the necessity of staff having to attend courses run by outside bodies. Another aspect of training was the introduction, in co-operation with the Education Department, of a Nursery Nurse Training Course at the Barnet College of Technology. I am confident that the establishment of such a course will do much to relieve staffing difficulties in the day nursery service and that future years will show the required number of qualified staff being available for employment. The downward trend continues in relation to live births, the corrected birth rate for Barnet this year being 13.4 per 1,000 population compared to 14.3 (1967), 14.6 (1966) and 1 15.3 (1965); there were 45 stillbirths representing a rate of 10.4 per 1,000 total live and stillbirths indicating a considerable decrease compared to 13.4 in 1967 — this is consistent with the National figure but not with Greater London which shows a slight increase from 13.3 (1967) to 13.5. Statistics in relation to infant deaths, including neonatal, early neonatal and perinatal deaths show slight increases. There was also an increase in deaths from all causes i.e. 3,732 (a corrected rate of 10.6 per 1,000 population) compared with 3,456 (10.0) for 1967, this being consistent with an increase in the National and Greater London figures. There was no serious outbreak of infectious disease during the year. In my Report for 1967, I referred to the introduction of the National Health Service (Family Planning) Act 1967 and stated that I should be dealing specifically in my next Report with the considerations to be given by the Council in regard to the implications of family planning and the Council's recommendations thereon. These are referred to in detail in the respective sections of my Report for the year under review but I would wish to highlight the fact that the introduction of a comprehensive family planning service should prove to be of immense value to society in general and it should be the means of mitigating a considerable amount of family distress and social difficulty. During 1968, considerable progress was made in attachment services to general practitioners and this form of service is in my opinion vital to the whole concept of a sound and economic domiciliary health service. General practitioners who were bensfitting by attachment services were enthusiastic in their praise for the help given. The staffing situation in 1968 showed some improvement but the administration service of the Department still needs to be strengthened and this is especially necessary when one considers the Council's forward planning for the development of the services and the responsibilities arising from the establishment of new projects. The staffing requirements of the various sections of the department were constantly under review and the appointment of senior home nurses responsible for groups of nurses and the employment of nursing auxiliaries for the first time to replace home nurses where cases did not require the full skills of a qualified nurse proved to be both economic and advantageous in ensuring that the relative degrees of home nursing were given. Homelessness as indicated in my Report for 1967 still remains a big problem and undoubtedly plans will need to be considered for providing additional units of accommodation in 1969 since the upward trend in the number of cases needing to be dealt with shows no abatement. The formative years of any virtually new Department are bound to provide periods of pressure and strain but it is with pleasure that I record my thanks once again for the assistance given by all members of the staff and acknowledge the interest and 2 skills displayed. I further acknowledge the valuable services provided by voluntary organisations operating in the Health and Social Welfare fields. Without such a form of dedicated voluntary service the Local Authority's functions would not operate with the same degree of efficiency. I should like to take this opportunity to record with deep sincerity my thanks for the support and encouragement given to me by the Chairmen, Vice-Chairmen and Members of the separate Health and Welfare Committees and, from May 1968, the Chairman, Vice-Chairman and Members of the combined Health and Welfare Committee and to acknowledge the co-operation and assistance of the Chief Officers of other Departments. M. WATKINS Medical Officer of Health 3 CONTENTS Page COMMITTEE MEMBERS, CHIEF AND SENIOR OFFICERS 7 VITAL STATISTICS 11 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES 27 ENVIRONMENTAL HEALTH SERVICES 33 MENTAL HEALTH SERVICES 69 WELFARE SERVICES 81 PERSONAL HEALTH SERVICES 89 SCHOOL HEALTH SERVICES 113 GENERAL SERVICES 127 INDEX 141 5 HEALTH AND WELFARE COMMITTEE as at 31st December 1968 Councillor (Mrs.) R. A. Freedman (Chairman) Councillor H.R. Brooks (Vice-Chairman) COUNCILLORS: E.A.E. Asker, J.P., F.C.C.S., A.B.A.A. F.J . Collisson R.J. Finigan B.Sc., (Econ.) (Mrs.) B.M.Franklin J.D. Gordon-Lee, J.P. (Mayor) J.E. Park F.C.A. J.S. Payne (Mrs.) C. Riordan B.R. Stewart LL.M. (Mrs.) M.M. Symons (Mrs.) E.R. Gibson W.C. James G.H. Jobbins (Mrs.) Clara Thubrun, M.B.E., J.P. Co-opted Member: Dr. T.J. Carter, M.R.C.S., L.R.C.P. 7 STAFF OF THE HEALTH AND WELFARE DEPARTMENT as at 31st December, 1968 M. Watkins, M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health G.C. Young, M.D., M.B., B.Ch., B.Sc., D.P.H., L.M.S.S.A. Deputy Medical Officer of Health R.C. Greenberg, M.B.B.S., D.P.H. Mary Watson, M.B., Ch.B. Principal Medical Officers Mary K. Astin, M.B., Ch.B., D.P.H. M.L. Graeme, M.A., M.B., B.Chir., D.P.H. (Resigned 28.4.68) M. McQuaid, L.R.C.P., L.R.C.S., D.P.H., (Appointed 23.9.68) Senior Medical Officers J.T. Benson, D.M.A., F.I.S.W. (Resigned 6.10.68) Chief Welfare Officer Mrs. J.M.A.W. Foulkes, S.R.N., S.C.M., H.V. Principal Nursing Officer R.L. James, L.D.S., R.C.S. Principal Dental Officer Miss E. Johnston, S.R.N., S.C.M., Q.N., H.V. Health Education Officer and Home Safety Organiser C.H. Machin, A.M.R.S.H. Principal Administrative Assistant K.J. Millen, M.R.S.H., F.A.P.H.I. Principal Public Health Inspector W.J .A. Ward, M.S.M.W.O. Principal Mental Welfare Officer 8 STATISTICS STATISTICS Area (in acres) 22,124 Population— Registrar-General's estimate Mid 1968 316.240 Number of Inhabited Dwellings, 1st April, 1968:— Houses and flats 99,574 Other properties with living accommodation 755 Rateable Value at 1st April, 1968 £22,402,216 Product of penny rate 1968/9 £89,000 LIVE BIRTHS males females total Legitimate 2,004 1,967 3,971 Illegitimate 163 159 322 2,167 2,126 4,293 Illegitimate live births per cent, of total live births:barnet 7.5 greater london 11.5 inner london 15.5 outer london 8.7 rate per 1,000 population barnet 13.6 area comparability factor 0.99 corrected rate - barnet 13.4 greater london 15.2 inner london 15.7 outer london 15.0 england and wales (provisional) 16.9 11 STILLBIRTHS MALES FEMALES TOTAL Legitimate 18 17 35 Illegitimate 3 7 10 21 24 45 Total live and stillbirths 2,188 2,150 4,338 RATE PER 1,000 LIVE AND STILLBIRTHS BARNET 10.4 GREATER LONDON 13.5 INNER LONDON 13.1 OUTER LONDON 13.7 ENGLAND AND WALES (PROVISIONAL) 14.3 INFANT DEATHS (under 1 year of age) MALES FEMALES TOTAL Legitimate 34 31 65 Illegitimate 4 1 5 38 32 70 RATE PER 1,000 LIVE BIRTHS BARNET: LEGITIMATE 16.4 ILLEGITIMATE 15.5 TOTAL 16.3 GREATER LONDON 18.6 INNER LONDON 19.8 OUTER LONDON 17.7 ENGLAND AND WALES (PROVISIONAL) 18.3 12 NEO-NATAL DEATHS (under 4 weeks of age) males females total legitimate 24 24 48 illegitimate 3 - 3 27 24 51 rate per 1,000 live births barnet: legitimate 12.1 illegitimate 9.3 total 11.9 greater london 12.8 inner london 14.0 outer london 12.1 england and wales (provisional) 12.4 EARLY NEO-NATAL DEATHS (under 1 week of age) males females total legitimate 20 22 42 illegitimate 2 - 2 22 22 44 rate per 1,000 live births barnet: legitimate 10.6 illegitimate 6.2 total 10.2 greater london 11.4 inner london 12.4 outer london 10.7 england and wales (provisional) 10.5 13 PERI-NATAL DEATHS (Stillbirths and Deaths under 1 week of age) MALES FEMALES TOTAL LEGITIMATE 38 39 77 ILLEGITIMATE 5 7 12 43 46 89 RATE PER 1,000 LIVE AND STILL BIRTHS BARNET: LEGITIMATE 19.2 ILLEGITIMATE 36.1 TOTAL 20.5 GREATER LONDON 24.7 INNER LONDON 25.3 OUTER LONDON 24.3 ENGLAND AND WALES (PROVISIONAL) 24.7 MATERNAL MORTALITY RATES (including abortion) per 1,000 total live and stillbirths BARNET 0.7 GREATER LONDON 0.4 INNER LONDON 0.6 OUTER LONDON 0.3 ENGLAND AND WALES (PROVISIONAL) 0.2 14 DEATHS FROM ALL CAUSES MALES 1,728 FEMALES 2,004 TOTAL 3,732 RATE PER 1,000 POPULATION BARNET 11.8 AREA COMPARABILITY FACTOR 0.90 CORRECTED RATE - BARNET 10.6 GREATER LONDON 11.7 INNER LONDON 12.0 OUTER LONDON 11.5 ENGLAND AND WALES (PROVISIONAL) 11.8 15 CAUSES OF, AND AGES AT, DEATH No. Cause of Death Total all ages Under 4 weeks 4 weeks and under 1 year Age in years 1 - 5 - 15 - 25 - 35 - 45 - 55 - 65 - 75 and over B3 Bacillary Dysentery, Amoebiasis 1 — — — — — — — — — — 1 B4 Enteritis and Other Diarrhoeal Diseases 4 — — — — — — — — — 2 2 B5 Tuberculosis of Respiratory Systems 7 — — — — — — 2 2 2 — 1 B6 Other Tuberculosis, incl. Late Effects 5 — — — — — — — 2 1 1 1 B17 Syphilis and its sequelae 4 — — — — — — — — 1 1 2 B18 Other infective and Parasitic Diseases 8 1 — — — — — 1 1 1 2 2 B19(l) Malignant Neoplasm — Stomach 75 — — — — — 1 2 4 15 23 30 B19(2) Malignant Neoplasm — Lung, Bronchus 201 — — — — — — 6 16 65 74 40 B19(3) Malignant Neoplasm — Breast 85 — — — — — 1 6 11 32 14 21 B19(4) Malignant Neoplasm — Uterus 30 — — — — — — — 3 14 4 9 B19(5) Leukaemia 27 — — — 1 4 1 1 4 8 4 4 B19(6) Other Malignant Neoplasms, etc. 402 — — 2 1 2 1 7 38 100 114 137 B20 Benign and Unspecified Neoplasms 9 — — — — — — — — 6 1 2 B21 Diabetes Mellitus 26 — — — — — — 2 — 5 6 13 B46(l) Other Endocrine etc. Diseases 9 — 1 — 1 1 2 — 1 — 1 2 B23 Anaemias 9 — — — — — — — — — 1 5 B46(2) Other Diseases of Blood, etc 1 — — — — — — — — 1 — — B46(3) Mental Disorders 4 — — — — 4 — — — — — 3 B24 Meningitis 4 — 1 1 — — — — — — 1 1 B46(4) Other Diseases of Nervous System, etc. 44 — — 2 2 2 1 — 6 8 8 15 B26 Chronic Rheumatic Heart Disease 32 — — — — — — 3 4 6 6 13 B27 Hypertensive Disease 84 — — — — — 1 1 2 14 19 47 B28 Ischaemic Heart Disease 927 — — — — — 5 12 52 177 248 433 B29 Other forms of Heart Disease 249 — 1 — 1 — 1 2 2 11 40 191 B30 Cerebrovascular Disease 475 — 1 — — — — 1 9 54 99 311 B46(5) Other Diseases of Circulatory System 170 — — — — 1 — 1 2 15 41 110 B31 Influenza 30 — — — — — — — — 2 5 23 B32 Pneumonia 295 1 2 2 — 2 — — 4 15 56 213 B33(l) Bronchitis and Emphysema 137 — — — —— — 1 1 6 25 38 66 B33(2) Asthma 5 — — — — — — — 1 1 1 2 B46(6) Other Diseases of Respiratory System 38 1 5 — — — — — 1 2 9 20 B34 Peptic Ulcer 19 — — — — — — — — 3 3 13 B35 Appendicitis 2 — — — — — — — 1 — — 1 B36 Intestinal Obstruction and Hernia 21 3 — — — — — — — 2 7 9 B37 Cirrhosis of Liver 12 — — — — — — — 1 5 4 2 B46(7) Other Diseases of Digestive System 34 — — — — 1 — 2 1 5 8 17 B38 Nephritis and Nephrosis 16 — — — — — — — 4 8 3 1 B39 Hyperplasia of Prostate 10 — — — — — — — — 1 2 7 B46(8) Other Diseases, Genito-Urinary System 34 — — — — — — — 1 4 9 20 B41 Other Complications of Pregnancy, etc. 3 — — — — — 2 1 — — — — B46(9) Diseases of Skin, Subcutaneous Tissue 3 — — — — — — — — — 1 2 B46(10) Diseases of Musculo-Skeletal System 18 — — — — 1 2 — 2 2 11 B42 Congenital Anomalies 21 10 7 2 — — — — — 1 — 1 B43 Birth Injury, Difficult Labour etc. 18 18 — — — — — — — — — — B44 Other Causes of Perinatal Mortality 17 17 — — — — — — — — — — B45 Symptoms and Ill-defined Conditions 5 — — — — — — — — — 2 3 BE47 Motor Vehicle Accidents 27 — — 1 4 3 1 1 1 7 3 6 BE48 All other Accidents 32 — 1 — — — 4 2 3 3 6 13 BE49 Suicide and Self-inflicted Injuries 29 — — — — 1 6 3 3 10 4 2 BE 50 All other External Causes 14 — — — — — 1 3 4 5 1 — TOTAL ALL CAUSES 3,732 51 19 10 10 19 29 62 190 640 874 1,828 16 BIRTH RATE (For the areas covered by the five constituent authorities) 17 INFANTILE MORTALITY RATE (For the areas covered by the five constituent authorities) 18 vital statistics for the past twenty years (For the areas covered by the five constituent authorities) YEAR TOTAL LIVE BIRTHS BIRTH RATE (CRUDE) TOTAL INFANT DEATHS INFANTILE MORTALITY RATE 1949 4547 14.1 93 20.5 1950 4486 13.9 78 17.4 1951 4138 13.0 97 23.4 1952 4107 12.8 85 20.7 1953 4048 12.7 78 19.3 1954 4019 12.6 78 19.4 1955 4013 12.6 83 20.7 1956 4137 13.0 67 16.2 1957 4032 12.7 80 19.8 1958 4131 13.1 57 13.8 1959 4129 13.0 100 24.2 1960 4285 13.5 74 17.3 1961 4388 13.9 91 20.7 1962 4573 14.4 84 18.4 1963 4656 14.7 82 17.6 1964 4979 15.7 74 14.9 1965 4900 15.5 62 12.7 1966 4679 14.8 62 13.3 1967 4564 14.5 73 16.0 1968 4293 13.6 70 16.3 number of deaths and death rates from tuberculosis and cancer NUMBERS RATE PER 1, 000 POPULATION MALE'S FEMALES PERSONS BARNET ENGLAND AND WALES Respiratory Tuberculosis 7 — 7 0.022 0.030 Other Tuberculosis 4 1 5 0.016 0.013 Cancer of lung and bronchus 150 51 201 0.636 0.593 Other Cancer 244 384 628 1.985 1.723 19 20 LIVE BIRTHS BY AGE AND PARITY OF MOTHER AND PLACE OF OCCURRENCE Parity of Mother Place of Delivery All Ages Under 20 Age of Mother 20 - 25 - 30 - 35 - 40 - 45 + 0 1 1,572 (96.6%) 164 (10.1%) 734 45.1%) 462 (28.4%) 145 (8.9%) 52 ( 3.2%) 14 (0.9%) 1 (0.0%) 2 43 (2.7%) 3 (0.2%) 19 (1.2%) 11 (0.7%) 9 (0.6%) — — 1 (0.0%) — — 3 12 (0.7%) — — 5 (0.3%) 3 (0.2%) 3 (0.2%) 1 (0.0%) — — — — 4 1 (0.0%) 1 (0.0%) — — — — — — — — — — — — 1,628 1 1 1,110 (84.5%) 30 (2.3%) 313 (23.9%) 464 (35.4%) 210 (16.0%) 77 (5.9%) 16 (1.2%) — — 2 63 (4.8%) — — 20 (1.5%) 25 (1.9%) 17 (1.3%) — — 1 (0.0%) — — 3 139 (10.6%) 6 (0.5%) 42 (3.2%) 69 (5.3%) 19 (1.4%) 3 (0.2%) — — — — 4 2 (0.1%) 1 (0.0%) 1 (0.0%) — — — — — — — — — — 1,314 2 1 476 (77.0%) 2 (0.3%) 72 (11.7%) 182 (29.4%) 144 (23.2%) 58 (9.4%) 18 (2.9%) — — 2 33 (5.3%) — — 4 (0.6%) 17 (2.8%) 11 (1.8%) 1 (0.2%) — — — — 3 108 (17.5%) 1 (0.2%) 16 (2.6%) 47 (7.6%) 28 (4.5%) 16 (2.6%) — — — — 4 1 (0.2%) — — — — 1 (0.2%) — — — — — — — — 618 3 1 191 (79.9%) 2 (0.8%) 19 (7.9%) 49 (20.5%) 67 (28.1%) 39 (16.3%) 14 (5.9%) 1 (0.4%) 2 7 (2.9%) — — — — 2 (0.8%) 2 (0.8%) 3 (1.3%) — — — — 3 41 (17.2%) — — 5 (2.1%) 14 (5.9%) 12 (5.0%) 9 (3.8%) 1 (0.4%) — — 4 — — — — — — — — — — — — — — — — 239 4 1 87 (90.6%) — — — — 15 (15.7%) 37 (38.6%) 21 (21.9%) 13 (13.5%) 1 (1.0%) 2 2 (2.1%) — — — — 1 (1.0%) — — 1 (1.0%) — — — — 3 7 (7.3%) — — — — 1 (1.0%) 4 (4.2%) 2 (2.1%) — — — — 4 — — — — — — — — — — — — — — — — 96 5-9 1 72 (98.6%) — 12 (16.4%) 27 (37.0%) 24 (32.9%) 7 (9.6%) 2 (2.7%) 2 — — — — — — — — — — — — — — — — 3 1 (1.4%) — — — — — — — — 1 (1.4%) — — — — 4 — — — — — — — — — — — — — — — — 73 21 Live Births by Age and Parity of Mother and Place of Occurrence (continued) Parity of Mother Place of Delivery All Ages Under 20 Age of Mother 20 - 25 - 30 - 35 - 40 - 45+ 10-14 1* 3 (100.0%) — — — — — — — 1 (33.3%) 2 (66.7%) — — 2 — — — — — — — — — — — — — — — — 3 — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — 3 15+ 1 — — — — — — — — — — — — — — — — 2 — — — — — — — — — — — — — — — — 3 — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — — Illegit 1 299 (92.9%) 87 (27.0%) 110 (34.1%) 45 (14.0%) 27 (8.4%) 23 (7.2%) 7 (2.2%) — — 2 6 (1.9%) 3 (0.9%) 1 (0.3%) 1 (0. 3%) 1 (0.3%) — — — — — — 3 11 (3.3%) 1 (0.3%) 3 (0.9%) 4 (1.3%) 2 (0.6%) 1 (0.3%) — — — — 4 6 (1.9%) 2 (0.6%) 4 (1.3%) — — — — — — — — — — 322 TOTAL 1 3,810 (88.8%) 285 (6.6%) 1,248 (29.2%) 1,229 (28.7%) 657 (15.3%) 295 (6.9%) 91 (2.1%) 5 (0.1%) 2 154 (3.6%) 6 (0.1%) 44 (1.0%) 57 (1.3%) 40 (0.9%) 5 (0.1%) 2 (0.0%) — — 3 319 (7.4%) 8 (0.2%) 71 (1.7%) 138 (3.2%) 68 (1.6%) 33 (0.8%) 1 (0.0%) — — 4 10 (0.2%) 4 (0.1%) 5 (0. 1%) 1 (0.0%) — — — — — — — — 4.293 * Place of Delivery 1. N.H.S. Hospitals 2. Non-N.H.S. Hospitals (Mainly Maternity Homes) 3. At Home 4. Other These statistics are registrations corrected for both area of usual residence of mother and date of occurrence within the calendar year as opposed to those supplied by the Registrar General which are corrected for area of residence only. 22 STILLBIRTHS BY AGE AND PARITY OF MOTHER AND PLACE OF OCCURRENCE Parity of Mother Place of Delivery All Ages Under 20 20 - Age of Mother 25 - 30 - 35 - 40 - 45 + 0 1 19 (95.0%) 3 (15.0%) 6 (30.0%) 5 (25.0%) 4 (20.0%) — — 1 (5.0%) — — 2 1 (5.0%) — — 1 (5.0%) — — — — — — — — — — 3 — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — 20 1 1 5 (85.3%) — — 1 (16.7%) 2 (33.3%) — — 2 (33.3%) — — — — 2 1 (16.7%) — — 1 (16.7%) — — — — — — — — — — 3 — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — 6 2 1 7 (87.5%) — — — — 3 (37.5%) — — 4 (50.0%) — — — — 2 1 (12.5%) — — — — 1 (12.5%) — — — — — — — — 3 — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — 8 3 1 — — — — — — — — — — — — — — — — 2 — — — — — — — — — — — — — — — — 3 — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — — 4 1 — — — — — — — — — — — — — — — — 2 — — — — — — — — — — — — — — — — 3 — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — — 5-9 1 1 (100.0%) — — — — 1 (100.0%) — — — — — — — — 2 — — — — — — — — — — — — — — — — 3 — — — — _ — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — — 1 23 Stillbirths by Age and Parity of Mother and Place of Occurrence (continued) Parity of Mother Place of Delivery All Ages Under 20 20 - Age of Mother 25 - 30 - 35 - 40 - 45 + 10-14 1 — — — — — — — — — — — — — — — — 2 — — _ — — — — — _ — — — — — 3 — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — — 15+ 1 — — — — — — — — — — — — — — — — 2 — — — — — — — — — — — — — — — — 3 — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — — Illegit 1 10 (100.0%) 2 ( [20.0%) 6 (60.0%) 2 (20.0%) — — — — — — — — 2 — — — — — — — — — — — — — — — — — 3 — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — 10 TOTAL 1 42 (93.3%) 5 (11.1%) 13 (29.0%) 13 (29.0%) 4 (8.8%) 6 (13.3%) 1 (2.2%) _ — 2 3 (6.7%) — — 2 (4.4%) 1 (2.2%) — — — — — — — — 3 — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — 45 * Place of Delivery 1. N.H.S. Hospitals 2. Non-N.H.S. Hospitals (Mainly Maternity Homes) 3. At Home 4. Other These statistics are registrations corrected for both area of usual residence of mother and date of occurrence within the calendar year as opposed to those supplied by the Registrar General which are corrected for area of residence only. PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES 27 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Legislation The Public Health (Infective Jaundice) Regulations made this disease notifiable from 15th June, 1968. This decision was taken for a number of reasons but mainly as it was believed that infectious hepatitis was increasing in incidence and because of lack of information with regard to its occurrence. From 1st October, 1968 the Public Health (Infectious Diseases) Regulations made under Section 56 of the Health Services and Public Health Act, 1968, came into operation, consolidating with amendments all previous Regulations relating to the notification and prevention of infectious disease, except the Tuberculosis Regulations of 1925. The principle changes were to make acute primary pneumonia, acute influenzal pneumonia, acute rheumatism and puerperal pyrexia no longer notifiable, whilst tetanus, yellow fever and leptospirosis became notifiable for the first time. Additionally the powers of a Medical Officer of Health to vaccinate contacts of persons suffering from smallpox have been extended to other diseases and the power of a local authority to require a person to stop work in order to prevent spread of infection are extended to permit action in cases of food poisoning. The Medical Officer of Health has been authorised to serve notices required by these Regulations with regard to measures to be taken by a local authority if and when cases of typhus, food poisoning, relapsing fever, typhoid and paratyphoid fevers occur. The Regulations also cover measures to be taken against infected rats in preventing the spread of disease and in this respect Local Authorities are empowered to take measures for destroying all rats in the district and for preventing rats from gaining access to buildings. In addition to food poisoning, the infectious diseases now to be notified to the Medical Officer of Health from 1st October, 1968 are — Acute encephalitis Acute meningitis Acute poliomyelitis Anthrax Cholera Diphtheria Dysentery (amoebic or bacillary) Infective jaundice Leprosy Leptospirosis Malaria 28 Measles Ophthalmia neonatorum Paratyphoid fever Plague Relapsing fever Scarlet fever Smallpox Tetanus Tuberculosis Typhus Whooping cough Yellow fever Notifications The fallowing Table shows the total number of corrected notifications received during the year 1968. Scarlet Fever 23 (74) Whooping cough 53 (136) Measles 334 (2694) Dysentery 71 (39) Meningococcal Infection 4 (1) Acute Poliomyelitis Paralytic — (-) Non Paralytic — (-) Diphtheria — (-) Acute Pneumonia 15 (21) Acute Encephalitis Infective — (-) Post Infectious — (-) Typhoid Fever 1 (5) Paratyphoid — (-) Erysipelas — (5) Food Poisoning 31 (70) Smallpox — (-) Tuberculosis Respiratory 109 (84) Meninges and C.N.S. — (4) Other 21 (19) Puerperal Pyrexia 72 (74) Ophthalmia Neonatorum — (2) Anthrax — (-) Cholera — (-) Plague — (-) Relapsing Fever - (-) Malaria — (-) Membranous Croup — (-) 745 (3228) Figures in parenthesis represent notifications for 1967. 29 The notification of infectious diseases fell in 1968 due to a sharp diminution in the cases of measles, which amounted to 334 as against 2694 in the previous year. It is pleasing to see that no cases of either diphtheria or poliomyelitis occurred in the Borough. Dysentery In January there was an outbreak of sonne dysentery at a children's residential home when 11 cases occurred. The home was inspected, advice given on hygienic measures to prevent the spread of infection, and investigations made in an effort to determine the source of infection. A further outbreak occurred in April when 35 cases occurred in a hostel for homeless families. This was contained, but involved a considerable amount of work and was not finally resolved until June. In both outbreaks all the cases made a satisfactory recovery. Typhoid Fever One sporadic case occurred in a 30 year old Italian woman on returning from a holiday in Italy. She became ill and was admitted to Coppetts Wood Hospital on 20th September, 1968 where salmonella typhi was isolated on blood culture. Her three children who had accompanied her on holiday were tested for this 'organism but were found to be negative in this respect. It is however of interest to record that all three were found to be symptomless carriers of shigella sonnei. All known contacts were traced and the Medical Officers of Health for the areas in which they lived were notified. No related cases were found. Public Health Act, 1936, Sections 169 and 170 — Removal and Detention in Hospital of Persons Suffering from a Notifiable Disease Under this Act it became necessary to remove and detain in hospital a man suffering from open tuberculosis. The patient in question was in urgent need of treatment which he persistently refused. This man's circumstances were such that proper precautions to prevent the spread of infection were not being taken and I felt that serious risk of infection was thereby caused to other persons in the Borough; regrettably, therefore, a Magistrate's Order was obtained to compel him to submit himself for hospital treatment, but fortunately once in hospital he readily settled down. I am pleased to say that the patient responded to treatment. 30 INTERNATIONAL CERTIFICATES OF VACCINATION Three forms of International Certificates of Vaccination, namely:— smallpox, cholera and yellow fever require authentication of the signature of the doctor providing the vaccination or inoculation of persons proceeding abroad. During the year 5,742 certificates were authenticated by the Department. ENVIRONMENTAL HEALTH SERVICES 33 ENVIRONMENTAL HEALTH SERVICES An Environment which is uninfluenced by conditions inimical to health is very much taken for granted. It is therefore right to take note of the work of the Division undertaken to maintain healthy conditions in which people live, work and play. Of the basic public health services the provision of water supply, the means of sewerage and the collection and disposal of refuse are satisfactory. The inspection of premises in which food is manufactured, stored and sold or prepared for meals, coupled with an effective sampling programme does much to ensure that food is clean, unadulterated and wholesome. The extension of smoke control areas within the Borough is gradually eliminating coal smoke from the atmosphere and this is beneficial to the whole community. In 1966 the Council set 1976 as the date by which the Borough should be a complete smoke control area. In my opinion it would be a good investment in terms of good health and amenity if this date can be brought forward. Work in connection with houses is directed towards ensuring that homes are, adequate and so equipped as to be not only sound structurally but acceptable by today's amenity standards. The approach to this objective is by three avenues, namely the repair and rehabilitation of defective premises, the improvement of old but sound houses by the provision where required of a fixed bath or shower in a bathroom, a wash hand basin and hot and cold water supply, an inside W.C., a satisfactory food store, and thirdly the closure or demolition of houses which are totally unfit. The above-mentioned topics and details of other activities of the Public Health Inspectors and their supporting staff of Technical Assistants deserve further comment, and as required by the Public Health Officers' Regulations 1969 and to meet the requests of Government Departments, the following account is set down:— WATER SUPPLY The supply of water to the Borough is distributed by three companies, namely the Colne Valley Water Company, the Lee Valley Water Company, and the Metropolitan Water Board. It is satisfactory in quantity and quality. Raw water and water going into supply are regularly sampled by the companies for bacteriological and chemical examination, and the results were reported to conform to satisfactory standards of purity. The waters are not liable to plumbo solvent action. The amount of naturally occuring fluoride varies; that supplied by the Colne Valley Water Company has a content of less than 0.1 p.p.m., that supplied by the Metropolitan 34 Water Board has a content of 0.3 p.p.m., and in the case of the Lee Valley Water Company in general the content is less than 0.2 p.p.m., but there is a small source in New Barnet which has a natural fluoride content of 1.05 p.p.m., but this is rapidly diluted with water from another source having a content of less than 0.2 p.p.m. The whole district receives mains water direct and none is supplied by a permanent standpipe. FOOD Five hundred and thirty-four samples of food were submitted for analysis during the year. A table identifying the commodities and showing results is set out below. The number of samples reported as unsatisfactory was 7.7 per cent of the total submitted. Formal and Informal Samples SAMPLE FORMAL INFORMAL Satisfactory Unsatisfactory Satisfactory Unsatisfactory Almonds, Ground 3 Angelica 3 Apple Juice 1 Artificial Sweeteners 3 Baby Foods (Canned) 9 Baby Powder 1 Baked Beans 7 Blackcurrant Health Drink 7 1 Bread 2 Bread, Milk 1 Butter 6 Butter, Ghee 1 Cake Decoration (Edible) 1 Cheese 3 4 Cheese, Cream 6 3 Cheese Preparations 1 Cheese Spreads 14 2 Chewing Gum 1 Chicken Curry 5 Chili Powder 1 Chocolate Flavoured Drinks 3 Coffee 4 Cooking Fat 1 Cornmea1 1 Cough Candy 1 Cough Mixtures 2 Cream 9 Curry Powder 3 Custard Powder 2 Dental Cream 1 Digestive Pills 1 Dripping 2 35 SAMPLE FORMAL INFORMAL Satisfactory Unsatisfactory Satisfactory Unsatisfactory Egg Noodles 1 Fish Cakes and Sticks 4 Fish, Canned 3 Fish Paste 6 Flour 7 Fruit, Canned 26 1 Fruit, Dried 6 Fruit, Syrup 3 Gelatine 1 Gravy Mix and Powder 2 Ground Nut Oil 1 Hazel Nut Spread 1 Honey 1 Ice Cream Powder 2 Ice Pops 1 Jams and Marmalades 17 1 Jellies 20 1 Lard 5 Lemon Curd 4 1 Lemon Juice 1 Low Fat Spread 1 Margarine 8 Marzipan 4 Meat, Canned 12 Meat Paste 5 Meat Pies and Puddings 23 3 Meat Preparations 22 6 Milk, Channel Island 1 Milk, Evaporated 7 Milk, Dried 1 9 Milk Puddings (Canned) 1 Mince 3 6 1 Mincemeat 5 Mint Sauce 1 Mixed Peel 2 Mustard Oil 1 Olive Oil 1 Pepper 1 Pickles 1 Pie Fillings 2 Poultry, Canned 2 Puddings and Pudding Mixes 2 Rice 5 Rice, Ground 4 Salad Cream and Mayonnaise 5 Sauces 6 Sausages and Sausage Meat 38 2 Sausage Rolls 6 36 SAMPLE FORMAL INFORMAL Satisfactory Unsatisfactory Satisfactory Unsatisfactory Semolina 2 Shandy 3 1 Soft Drinks 9 Soups, Canned 9 1 Soya Flour 1 Spaghetti 1 Spices 4 Spirits 3 1 Stuffings 2 Suet 3 Sugar Confectionery 16 Tea 4 Tomatoes, Canned 12 Tomato Juice 2 Tomato Ketchup S Vanilla Essence 1 Vegetables, Canned 10 2 Vegetables, Dried 3 Vinegar 2 Y oghourt 6 2 7 8 486 33 In addition to the above samples, the following were examined in the office:— ARTICLE NUMBER OF SAMPLES Satisfactory Unsatisfactory Total Cereal 1 1 2 Confectionery 1 — 1 Cream 2 — 2 Fruit 5 1 6 Fruit, Canned 3 1 4 Ginger Beer Shandy 1 — 1 Honey — 1 1 Milk 42 — 42 Mince 36 10 46 91 14 105 37 The following comment is made regarding some of the unsatisfactory samples. Cream Cheese It is unsatisfactory to note that Full Fat Soft Cheese is still being sold by some shopkeepers as Cream Cheese in spite of the fact that the Cheese Regulations 1965 laid down specific standards of fat for all soft cheeses. Efforts are made by the staff to explain the various designations where mislabelling has been noted and shopkeepers must realise that persistent disregard of these Regulations can only lead to legal proceedings being taken against them. Beef and Hamburgers In view of the impending legislation regarding meat products, a number of informal samples of beef and hamburgers were obtained and in four cases the attention of the manufacturers was drawn to the low meat content. Steak and Kidney Pies In two instances no appreciable amount of kidney was present in the pies. The recipes used in each instance appeared satisfactory and it was concluded that inefficient mixing of the ingredients was the reason. Subsequent samples of each brand of pie were satisfactory. Table Jelly One greengage flavoured table jelly was found to contain a prohibited colouring matter. Enquiries showed that the jelly with others which were on sale in the branch of a large multiple store had some time previously been withdrawn from sale and returned to the company's central store, but in error had subsequently been reissued for sale instead of having been destroyed. Low fat yoghourt During recent years yoghourt has gained considerable popularity as an item in the daily diet of many families and that type bearing the label "low fat" has at the present time a considerable sale. Whilst there is at the present time no recognised standard for the fat content of a yoghourt so named, most authorities consider 1.5 per cent of fat to be a reasonable maximum; many low-fat yoghourts have considerably less than this. In two instances it was necessary to draw the attention of manufacturers to the descriptions used following the examination of their products. Mince Six samples of mince were found to contain sulphur dioxide preservative 38 contrary to the Preservatives in Food Regulations 1962, and legal proceedings were instituted against the butchers concerned. In five instances the shopkeeper concerned had been previously prosecuted by this Authority for a similar offence. Ice Cream The following table shows the number of samples submitted for bacteriological examination and the results:— TYPE GRADING TOTALS 1 2 3 4 Hard ice cream Premises Prepacked 12 2 — — 14 Loose 144 51 44 20 259 Vans Loose — 3 — 2 5 Soft ice cream Premises 24 10 10 19 63 Vans 1 1 — — 2 Lollies Premises All satisfactory 4 Pre-packed ice cream is of good quality and bacteriological cleanliness. Continuous attention is necessary to ensure that ice cream dispensed from cans or from extrusion units is not exposed to risk of contamination. Liquid Egg This is an important product in the baking and confectionery industry, and since the introduction of Regulations in 1964 requiring it to be Pasteurised is uniformally of good quality. Twenty-nine samples were examined and found to be satisfactory. Milk Registration, Licensing and Sampling One hundred and sixty-nine premises are registered for the sale of milk and the following licences for the sale of graded milks were.issued:— Untreated milk 53 Pasteurised milk 150 Sterilised milk 121 Ultra-Heat Treated milk 56 39 The following samples of milk were submitted for bacteriological examination:— Untreated Pasteurised Sterilised Ultra-Heat Treated No. of samples taken 49 52 4 1 Satisfactory 36 52 4 1 Failed 9 — — — Test Void 4 In addition 80 samples of raw milk were examined for the presence of brucella abortus. A further 16 samples were submitted for biological examination for the presence of tubercle bacillis. All the samples were free of such organisms. There are 10 producers of milk in the Borough. Two are in closed communities which use the milk untreated. Food Complaints One hundred and eighty-one complaints were received as to quality or soundness or the presence of foreign bodies in food of which 23 were referred to the Public Analyst for examination. In 41 cases the offence justified proceedings. In a further 12 cases the Council authorised the sending of a "warning letter". The remaining cases were dealt with by advice from the Department to the retailers or manufacturers concerned. The table below classifies the nature of the complaints. 1. Foreign bodies (a) Insects 26 (b) Metal objects 16 (c) Mercury 1 (d) Glass, stones, etc. 10 (e) Paper, wood, string, etc. 6 (f) Oil or grease 10 (g) Fabric, plastic, rubber, etc. 5 (h) Cigarette ends 2 (i) Harmless matter, e.g. burnt dough in bread 10 93 2. Quality (a) Unsoundness 6 (b) Mould growth 23 40 (c) Contamination with an outside agent 1 (d) Contents 1 (e) Rancidity 1 32 3. Damaged or Dirty containers (a) Damaged containers 3 (b) Dirty containers, e.g. milk bottles 19 22 4. Label ling or Misdescription 5 5 5. Complaints Unfounded 29 29 181 Comments on some of these complaints are given below. A couple having purchased a bag of boiled sweets on entering a cinema on a Saturday evening subsequently found that the orange flavoured sweets had a silvery coating. The factory in the North of England was traced and the discovery made that a faulty recording thermometer had permitted mercury vapour to escape and contaminate the sweets. Whilst it was reasonably certain that only one batch of orange flavoured sweets hard been affected, the supplies of these sweets of all flavours were immediately withdrawn from retailers all over the country. A rolled, but used, bandage was found in a wrapped and sliced loaf. The bandage, which was embedded in the bottom crust of the loaf, was of a different type to that used by the medical department of the manufacturing bakery concerned and its manner and point of entry to the loaf was never discovered. Lead shot in some corned beef was probably the result of the animal having been shot with a shot gun before slaughter. A complaint concerning the quality of a Welsh Rarebit raised an interesting problem. The dish had been prepared at about 2.30 p.m. on the day on which the complaint was made at the local branch of a well-known restaurant by a kitchen hand in the absence of the manageress who was having her lunch. In the absence of sufficient cheese, but not wishing to disappoint a customer, the kitchen hand substituted some mashed potato, and whilst the appearance of the finished dish was not unusual its flavour was. In the absence of any standard for such a dish and the varying recipes found in various cookery books, the staff of the restaurant was advised against any future culinary experiments. Hairclips were discovered in both milk and mineral water bottles. If such clips 41 are opened and forced into a bottle they will not fall out when the bottle is inverted during the normal washing process. Burnt dough in bread and cakes is frequently mistaken for rodent dropping, and all the complaints received alleging such contamination were found to be unfounded. It is important that shopkeepers organise a coding system for perishable foodstuffs, and ensure stock rotation in proper sequence. It is the failure to do this which is responsible for the majority of complaints about stale or mouldy goods. Food unfit for human consumption The following list sets out the foodstuffs condemned during the year:— Fresh Food Meat 2188 lbs Offal 51 lbs Fish 101 lbs Poultry 89 lbs Tinned Fruit/fruit juices 4289 Meat 393 Vegetables 3139 Fish 370 Soups 195 Milk 129 Milk puddings 489 Coffee 40 Meat puddings/pies 426 Cream 121 Unidentified 1163 Frozen Foods (in packets or cartons) Fish/fish cakes 4526 Meat 2114 Puddings/pies 552 Vegetables 3920 Fruit 617 Confectionery 3315 Poultry 712 Cheeseburgers 21 Whole dinners 17 42 Miscellaneous Preserves 25 lbs Cheese 343 packets Sauces/pickles 89 bottles Sugar 148 packets Cereals 400 packets Most was voluntarily surrendered by retailers anxious to maintain a good record for fresh produce of good marketable quality. This is one area of his work in which the Public Health Inspector has for many years been accepted as an advisor rather than as an enforcement officer. Food Hygiene The Food Hygiene (General) Regulations 1960/6 2 contain provisions as to the cleanliness of food premises and the hygienic handling of food; the construction of food premises, their repair and maintenance and the facilities to be provided. Here again, compliance with good standards is best achieved by regular visits by the Public Health Inspector in which food handlers can be advised and encouraged in good housekeeping methods. A list of food premises grouped in categories of trade is set down below containing particulars of the premises provided with wash hand basins and an adequate supply of hot and cold water, soap and towels (Regulation 16) and those provided with sinks, hot and cold water, soap, clean cloths or other cleaning and drying facilities (Regulation 19) as required by the Food Hygiene (General) Regulations, 1960. Class of Business Number at end of 1968 Number Complying with Reg. 16 Number to which Reg.19 applies Number Complying with Reg. 19[ Bakehouses and Bakers Shops 116 116 116 116 Butchers 170 170 170 170 Canteens 147 147 147 147 Confectioners 284 280 139 137 Dairies 10 10 10 10 Fishshops 74 74 73 73 Greengrocers 173 173 122 122 Grocers 333 333 331 329 Licensed Premises 175 175 165 165 Restaurants/Cafes 249 249 249 249 43 Markets There are two markets in the Borough; one owned by the Council at Burnt Oak and known as the Watling Market; operates on one day a week only. The other, privately owned, is at Barnet, and opens two days a week. Hawkers Hawkers of food and their storage premises in those areas covered by the former Middlesex County Council are required to be registered under Section 11 of the Middlesex County Council Act 1950; at the close of the year there were 73 such hawkers on the register. Poultry Inspection (1) Number of poultry processing premises within the district 1 (2) number of visits to these premises 7 (3) total number of birds processed during the year 1968 10,759 (4) types of birds processed Hens (5) percentage of birds rejected as unfit for human consumption None (6) weight of poultry condemned as unfit for human consumption None (7) The live birds are bought by individual selection from farms in Hertfordshire. Any birds which do not show a healthy live appearance are isolated, killed and, if diseased, disposed of at the farms. The processing premises consist of a building divided into two sections — for killing and for dressing. The staff engaged in the business are the proprietor, one male employee, and one female employed part-time. The birds are killed by dislocation of the neck and are not eviscerated. The carcases are immersed in a thermostatically controlled scalding tank and plucked in an electric defeatherer. They are delivered the same or the following day after slaughter to butchers in the Golders Green, Finchley, Harrow, Tottenham, Watford, Elstree and Cockfosters areas for sale in the fresh trade. As the birds are uneviscerated, inspection at the place of slaughter is limited but doubtful carcases are retained and inspected in accordance with the procedures recommended in Circular 22/61,of the Ministry of Health. Labelling of Food The Labelling of Food Order 1953 requires that foodstuffs should have informative labelling which does not mislead the purchaser. Generally all prepacked foods should 44 have on the label or wrapper the name and address of the packer or labeller or alternatively a trade mark with the words "Registered Trade Mark". There should also be a list of ingredients. A total of 654 visits were made to premises concerning the Order and 2209 labels were examined to verify the correctness of their claims. The Merchandise Marks Acts, which were repealed by the Trade Description Act 1968 on the 30th November 1968, prohibited false or misleading written trade descriptions. Four hundred and twenty-four premises were visited and the following articles of food examined for possible offences under the Acts:— Apples 395 Bacon 194 Butter 280 Currants etc 102 Honey 25 Malt products 12 Margarine 298 Meat 318 Poultry 150 Raw Cucumbers 240 Salmon and trout 18 Tomatoes 420 Legal Proceedings DATE OFFENCE FINE 8. 1.68 Sale of loaf containing nail £15 £10.10s.0d. costs 15. 1.68 Sale of mouldy loaf £10 £ 5. 0s.0d. costs 15. 1.68 Sale of loaf containing rodent dropping £10 £10.10s.0d. costs 15. 1.68 Sale of pasty containing wasp £10 £10.10s.0d. costs 14. 2.68 Sale of loaf containing pieces of glass £10 £ 7. 7s.0d. costs 8. 2.68 Sale of milk in dirty bottle £5 £ 5. 5s.0d. costs 8. 2.68 Sale of milk in dirty bottle £5 £ 5. 5s.0d. costs 22. 4.68 Sale of mouldy cake £10 £10.10s.0d. costs 6. 5.68 Sale of loaf containing flour beetles £50 £10.10s.0d. costs 24. 5.68 Sale of mince containing preservative £10 £ 8.18s.0d. costs 24. 5.68 Sale of mince containing preservative £20 £ 8.18s.0d. costs 24. 5.68 Sale of mince containing preservative £20 £ 8.18s.0d. costs 1. 7.68 Sale of mince containing preservative £30 £15.15s.0d. costs Legal Proceedings (continued) 1. 7.68 Sale of loaf containing piece of cloth £40 £15.15s.0d. costs 10. 7.68 15. 7.68 Sale of mouldy rolls Sale of sausage roll containing pin £10 £ 5. 5s.0d. costs £25 £ 5. 0s.0d. costs 21. 8.68 Sale of cake containing metal staple £10 £10.10s.0d. costs 23. 8.68 Sale of milk in dirty milk bottle £20 £ 5. 5s.0d. costs 18. 9.68 Sale of meringues containing beetle £10 £10.10s.0d. costs 23.10.68 Sale of milk in bottle containing hairclip £10 £10.10s.0d. costs 28.10.68 Sale of milk in dirty bottle £10 £ 5. 5s.0d. costs 28.10.68 Sale of meringue containing piece of glass £30 £ 5. 5s.0d. costs 28.10.68 Sale of loaf containing piece of metal foil £30 £ 5. 5s.0d. costs 4.11.68 Sale of mouldy apple slice £10 £ 7. 7s.0d. costs 11.11.68 Channel Islands milk deficient in fat Conditional discharge £10.1 Os.Od. costs 20.11.68 Sale of mouldy beef steak and kidney pie £20 £ 5. 5s.0d. costs 25.11.68 Sale of rye loaf containing a rivet £5 £ 2. Os.Od. costs 25.11.68 Sale of loaf in mouldy condition £2 £ 2. Os.Od. costs 9.12.68 Sale of mince containing preservative £35 £14.14s.0d. costs 9.12.68 Sale of mince containing preservative £20 £14.14s.0d. costs National Pesticide Survey During the year an interim report was issued on the operation of the National Scheme to determine the extent of pesticide residues in foodstuffs sold in England and Wales. The period covered by the report was 1st August 1966 — 31st July 1967. In the first year the sampling work involved was shared by 233 authorities and the scheme was so designed that the results would be capable of statistical examination. It was pointed out in the report that it was important to realise that it was only an interim one covering only the results obtained in the first year and before it had been possible to make any statistical examination. Attention was also drawn to the fact that there is always the possibility that the pattern of results may change materially from one year to the next and that there can thus be no finality in this kind of investigation. The report said that "the results for the first year indicate that there is no evidence of contamination sufficiently serious to be of significance to public health in the short term. None of the samples revealed gross contamination. In setting up the scheme the Association of Public Analysts had in mind the possibility of samples being contaminated sufficiently to justify follow-up enquiries regarding specific batches or sources of food. In fact, only one or two of the samples analysed have been found to indicate the need for 45 special action of this kind. On the other hand, a large proportion of the samples examinee contained traces of pesticides, and in such samples the amounts, though too small to attract any doubt as to the fitness of the food for human consumption, were sometimes larger than had been expected for that particular pesticide or for that particular kind of food. The results of surveys in subsequent years will be of great interest and should do much to reveal any definite trend." CLEAN AIR Smoke Control Areas Impetus has been maintained in the smoke control programme and the table on page 4' shows the position at the 31st December 1968. It will be seen that 55,104 dwellings are covered by Orders in operation, but the benefits of clean air affect a much wider sector of the community and this can be gauged from the map on page 48. Because national electricity generating capabilities had improved the Minister of Housing and Local Government decided during the year to allow once again grant for for the supply and fitting of direct heating electric fires in Smoke Control Areas. Since December 1964 only electric storage heaters had qualified for grant. Atmospheric Pollution Information about smoke and sulphur in the atmosphere is obtained from apparatus at the Town Hall, East Barnet, Branch Library, Edgware, offices at 308 Regents Park Road, N.3., the Town Hall, Friern Barnet, and Branch Library in Golders Green. The particulars are sent to the Warren Spring Laboratory of the Ministry of Technology for assessment, and the results are included in the national survey of air pollution which the Ministry is conducting. The Clean Air Act 1968, which will become operative by Orders establishing "appointed days" in respect of various provisions, contains a section enabling the Local Authority to determine the height of chimneys of all classes of buildings, thus rectifying an omission from the Clean Air Act 1956 which excluded blocks of flats, offices and schools from control as to chimney heights. I have written before on the advantages of district heating schemes using one specially designed chimney discharging fumes at high level instead of a large number of low independent chimneys serving individual properties. It was gratifying to note that the Council have decided to have a considerable part of the Grahame Park development heated by such a scheme and have approved a boiler installation using light fuel oil with an output of 72 million B.Th.U's and a chimney height of 120 ft. This height was a finally agreed compromise after much consultation with the Borough Engineer and Surveyor, Borough Architect, Borough Planning Officer and the Greater London Council to satisfy health needs, constructional problems and visual amenity. 46 47 TABLE A SMOKE CONTROL ORDER DATE MADE DATE CONFIRMED DATE IN OPERATION ACREAGE NC. OF DWELLINGS OTHER PREMISES Orders made by London Borough of Barnet and Constituent Authorities As at 31st December 1967 9,432 50,433 3,009 London Borough of Barnet (No. 6) (Mill Hill and Edgware) 18-8-67 8-11-67 1-7-68 282 2,244 87 London Borough of Barnet (No. 7) (Friern Barnet and Muswell Hill) 18-12-67 29-3-68 1-10-68 377 2,427 121 London Borough of Barnet (No. 8) (Childs Hill and Cricklewood) 30-8-68 5-12-68 1-7-69 164 1,327 131 London Borough of Barnet (No. 9) (North Finchley) 18-10-68 27-2-69 1-9-69 341 3,147 316 London Borough of Barnet (No. 10) (Colindale and West Hendon) SURVEY IN PROGRESS - (393) - (2,692) - (148) TOTAL 1,164(393) 9,145(2,692 ) 655(148) GRAND TOTAl 10, 596 59,578 3,664 Acreage of Borough 22,124 Approximate number of premises (all types) 115,750 HOUSING Provision of Housing Accommodation During the year the number of purpose-built housing units provided by construction was 274. One unit of housing accommodation only was acquired from a private owner, the Council having discontinued its previous policy in this connection for financial reasons. A total of 434 families had been rehoused by 31st December. By December all the remaining persons in the West Hendon Housing Area, the largest of the redevelopment areas included in the Council's programme, had been allocated tenancies thereby permitting demolition to be completed. In all, 101 families were rehoused from Housing Areas during the year. Pressure continued to remain high on the type of accommodation suitable for elderly persons unable to climb stairs and, wherever necessary, the Borough Housing Officer seeks my views on the Medical aspects of such cases. Despite the progress in rehousing, the number of persons applying to the Council for accommodation continued to increase, it being noteworthy that a high proportion of these were young married couples unable to find private accommodation in the Borough within their means. At the end of the year a total of 5581 applications were registered. I am indebted to the Borough Housing Officer for the above information on the progress made by the Council during the year in providing housing. Houses in Multi-occupation The Housing Acts 1961 and 1964 provide power to deal with unsatisfactory living accommodation in houses let in lodgings or occupied by more than one family. In this connection in October 1965 the Council adopted comprehensive standards in respect of facilities and amenities to be applied in such houses. There are many houses in the Borough which are let in lodgings or occupied by varying numbers of families; the former often of the bed-sitting room type which if well maintained help to fulfill a housing need not otherwise satisfied. There are some clearly defined and well established sectors, namely in parts of Cricklewood, Childs Hill and Golders Green, where concentrations of multi-occupied houses are found. There are also many such houses "concealed" throughout the Borough and it is often in these properties that the most adverse conditions exist. 188 houses in multiple occupation were inspected in detail and 90 have been equipped and repaired so as to make them suitable for the number of individuals or families in occupation. In one house in East Finchley which could not physically be 49 provided with adequate facilities an Order was made limiting the occupants to a number appropriate to the services available. One most important matter namely, the need of means of escape from fire, calls for comment and special emphasis. In the houses inspected there had been an almost total neglect to carry out work to provide means of escape from fire, regardless of the number of persons at risk. The hazard from fire in older type properties occupied by several families is much increased by the multiplicity of means of cooking, space heating, and the sometimes inexpert additions to electrical circuits. Much can be done to limit the spread of fire by making doors and partitions fire resisting and to check the spread of flame and smoke by fire stops and smoke screens. The Code of Practice of the Greater London Fire Brigade for means of escape in the case of fire at houses in multiple occupation is applied, and 55 houses have been modified to such standards. Leaflets printed both in English and a number of foreign languages are distributed when necessary drawing attention to the added risk of fire when paraffin heaters are used and when supplies of paraffin are stored inside a house. Clearance Areas During the year Orders were confirmed by the Minister of-Housing and Local Government, each without modification, in respect of the three clearance areas which had been represented to the Council under Part III of the Housing Act 1957 during 1967. Rehousing of the tenants was completed in respect of the area at East Finchley (ten houses) and that at Lodge Lane, North Finchley (four houses), but was still outstanding in respect of The Burroughs, Hendon (six houses). Individual Unfit Houses A total of twenty-seven dwellings were reported during the year as being unfit for human habitation and incapable of repair at reasonable cost. In three cases the making of Demolition Orders was appropriate but in the remaining twenty-four instances it was necessary to make Closing Orders, as the dwellings were not capable of demolition in isolation. In consequence of this action, together with that which had been commenced in previous years, sixteen unfit houses were demolished and forty-three dwellings were made the subject of Closing Orders. Thirty-two families comprising in all a total of sixty-nine persons vacated unfit properties. In three instances the tenants found themselves suitable alternative accommodation; in all other cases rehousing was undertaken by the Council. Five Closing Orders which had been made during previous years were determined. In each case the property could be accepted as having a reasonable future life, the 50 owner agreed to install full standard amenities as part of the rehabilitation scheme, and the five properties were adapted so as to provide ten units of accommodation. Slum Clearance and Redevelopment Satisfactory progress was maintained in dealing appropriately with the 144 properties which had been included in the Council's Slum Clearance Programme for the five year period 1966 to 1970, and by the end of the year 10 only still remained in respect of which action required to be initiated. Twenty-seven dwellings which were found to be unfit as a result of normal routine inspections were also dealt with. From experience gained since the amalgamation of constituent authorities on 1st April, 1965 some twenty dwellings are revealed as unfit and incapable of repair at reasonable cost during each year. Outside the areas which the Council have already designated under Part V of the Housing Act 1957 for comprehensive redevelopment during the next five years there are no localities of unfit housing. The problem of unfitness remains confined to individual houses or small groups of properties which can be conveniently dealt with by closure, demolition or clearance under Parts II and III of the Housing Act 1957. However, following upon a "locality survey" which had already been completed during 1967 in respect of properties in the immediate vicinity of a group of houses included in the Slum Clearance Programme and others already the subject of Closing Orders, the Council designated a further Part V Housing Area at Cromwell Road, Muswell Hill. The area, which is almost wholly residential in character, was providing accommodation for some 115 families at the time of the original survey. Improvement of Houses The House Purchase and Housing Act 1959 and the Housing Acts 1961 and 1964 place a duty upon the local authority to make grants towards the cost of improving older houses which still have a reasonable life and which presently lack amenities in the form of hot water supply, a fixed bath or shower, wash hand basin, inside water closet, a proper food store. As a matter of policy, older type houses are inspected and when found to be suitable for improvement information and advice is proffered to owners in the hope that they will undertake improvement with the aid of grants available. In twenty-two cases a favourable response was received and improvement schemes were carried out or put in hand. Compulsory Improvement During 1966 the Council had agreed, as a pilot scheme, to designate Prospect Road, Childs Hill, as an Improvement Area under Part II of the Housing Act 1964. 51 This comprised one complete road of thirty-eight terraced houses, identical in type, and constructed so as to lend themselves readily to improvement to the full standard. Situated immediately adjacent to an area scheduled for redevelopment it was visualised that integration of the two areas would ultimately achieve overall environmental improvement. By the end of 1968 all the tenanted houses in the area had been improved to provide full standard amenities, and apart from two houses occupied by old age pensioners the owner-occupied houses had been similarly dealth with or arrangements were in hand for the carrying out of the work. During the year a second Improvement Area comprising 91 tenanted houses at Brent Terrace, Cricklewood, was designated. Originally constructed to provide housing accommodation for railway employees, the properties had passed into private ownership. Agreement was reached with the owners at the outset to proceed with a phased programme of improvement in order to achieve completion of the work within two years; all the houses to be retained for renting. By the end of the year the work was proceeding and a pattern of improvement established. . Consideration was also given to a third area of 136 houses in Campion, Needham, Johnston and Midland Terraces, Cricklewood, which like Brent Terrace had been a British Rail estate and now acquired by a private property Company. Before designation as an Improvement Area could be made the owners gave an undertaking to the Council to carry out complete modernisation of properties as they became vacant and to improve to the full standard the remaining houses including those where the sitting tenants were desirous of purchasing for owner/occupation. This undertaking was accepted on the understanding that every effort would be made to complete the work in two years, and by the end of the year this was well in hand. Indications are that within the next twelve months the compulsory provisions of the Housing Act 1964 relating to the area improvement will be repealed by new legislation, and it will be necessary to revert to "improvement by persuasion", a policy first suggested by the Minister in 1962. Whilst it is accepted that certain of the procedures laid down in the present Act are cumbersome and time consuming, it is felt that with an element of dedication on the part of the officers concerned the improvement area provisions in the Housing Act 1964 could have provided a very useful weapon in the war against sub-standard housing conditions in many districts. Section 19 of the Housing Act 1964 enables the tenant of a house which is outside an Improvement Area to make representation to the Council to take action to secure the provision of satisfactory amenities at his house. The initial approach must come from the tenant and it is discouraging to find how little the provision is used. No representations were received during the year. The works necessary in respect of two cases outstanding from the previous year were satis.factorily completed. 52 Overcrowding The following details refer to the known cases of statutory overcrowding dealt with during the year. (a) Number of dwellings known to be overcrowded at end of year 15 Number of families in occupation 17 Number of persons in occupation 80 (b) Number of new cases reported 14 (c) Number of cases relieved 9 Number of persons concerned 38 The existing standards were first introduced in 1935 when, compared with earlier standards, they were considered to be high. However, after more than thirty years they can no longer be regarded as satisfactory in the light of modern living conditions. When assessing housing needs in respect of applications for housing accommodation, the Council therefore maintains a more realistic approach by awarding "points" on an ascending scale according to the degree of insufficiency of proper bedroom accommodation. During the year the Department was actively concerned with an increasing number of applications for Council housing, in some cases supported by medical certificates, referred by the Housing Department for special consideration on medical grounds, sanitary circumstances, and alleged overcrowding. I wish to record that each application made for Council housing accommodation which was supported by the Department on public health grounds received the fullest consideration by the Borough Housing Officer. Common Lodging Houses There are no common lodging houses in the Borough. Rent Acts The Rent Acts which amongst their many provisions allow the holder of a controlled tenancy to seek an abatement of his rent when his accommodation is not being maintained in a satisfactory state of repair having regard to its age, character and locality, continued to be little used, largely it is felt because to the average tenant the essential procedure is lengthy and involved. The following details indicate the number of applications for Certificates of 53 Disrepair and Revocation received and the action taken during the year. Applications for Certificates of Disrepair (1) Number of applications for certificates 4 (2) Number of decisions not to issue certificates 1 (3) Number of decisions to issue certificates (a) in respect of some but not all defects 2 (b) in respect of all defects 1 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 1 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule — (6) Number of Certificates issued 2 Applications for Cancellation of Certificates (7) Applications by landlords to Local Authority for cancellation of certificates 1 (8) Objections by tenants to cancellation of certificates — (9) Decisions by Local Authority to cancel in spite of tenants' objections — (10) Certificates cancelled by Local Authority 1 Housing Statistics 1. Inspection of Dwelling Houses (i) (a) Total number of dwellings inspected for housing defects (under Public Health or Housing Acts) 3147 (b) Number of inspections made for the purpose 5866 (ii) Number of dwellings found to be unfit for human habitation 31 (iii) Number of dwellings (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably f it for human habitation 1135 54 (iv) Number of dwellings surveyed in existing Housing Areas and designated under Part V of the Housing Act 1957 in connection with the Council's negotiations for acquisition 25 (v) Number of dwellings inspected in connection with proposed Improvement Areas and Improvement Grants Scheme 385 2. Remedy of Defects during the year without service of formal notices: Number of defective dwellings rendered fit in consequence of informal action 335 3. Action under statutory powers during the year (a) Proceedings under Sections 9 and 10 of the Housing Act 1957 (i) Number of dwellings in respect of which notices were served requiring repairs NIL (ii) Number of dwellings which were rendered fit after service of formal notices: (a) By owners NIL (b) By Local Authority in default of owners NIL (b) Proceedings under Public Health Acts: (i) Number of dwellings in respect of which notices were served requiring defects to be remedied 36 (ii) Number rendered fit (a) By owners 23 (b) By Local Authority in default of owners NIL (c) Proceedings under Sections 16 & 17 of the Housing Act 1957 (i) Number of dwellings in respect of which Demolition Orders were made 1 (ii) Number of dwellings demolished in pursuance of Demolition Orders 5 (iii) Number of dwellings in respect of which Closing Orders were made 26 (iv) Number of dwellings closed in pursuance of Closing Orders 23 55 (v) Number of dwellings in respect of which undertaking accepted under Section 16(4) NIL (vi) Number of dwellings in respect of which Closing Orders were determined under Section 27(2) 10 4. Houses in multiple occupation - Housing Act 1961 (i) Number of properties made suitable for occupation by number of occupants accommodated (Section 15) 90 (ii) Number of properties provided with means of escape from fire (Section 16) 55 5. Compulsory improvement — Housing Act 1964 Number of dwellings in improvement areas improved to the full standard 20 Number of dwellings outside improvement areas improved to the full standard — Section 19 2 CARAVANS Under the Caravan Sites and Control of Development Act 1960, there are three sites licensed in the Borough. One licence is for a single site at Brookhill, Stanmore, and the other two licences are for sites on either side of the Barnet By Pass at Stirling Corner for 137 caravans. Conditions annexed to the licences provide, inter alia, for the provision of water supply, drainage, sanitation and washing facilities and refuse disposal. Periodical inspections are made to check compliance with these conditions. Itinerant caravan dwellers who from time to time halt on verges of the main roads which traverse the Borough present problems, both in respect of unsatisfactory conditions created by their business activities and socially by reason of their totally sub-standard existence. Arising from the Ministry of Housing and Local Government Circular No.49/68 on gypsies and other travellers and Part II of the Caravan Sites Act 1968, an investigation into the need and possibility of providing a camp site for gypsies and other travellers is under consideration. 56 INSPECTIONS AND COMPLAINTS Some 5817 complaints and requests for services were investigated and, where possible, defects or unsatisfactory conditions were remedied. The following table shows the nature and number of inspections made to ensure that people live and work in healthy surroundings, and that food is manufactured or prepared under hygienic conditions and sold in premises properly equipped. Housing Public Health and Housing Acts 6,749 Multiple Occupation 1,131 Other housing visits 1,422 9,302 Clean Air Observations 324 Surveys, proposals and claims 5,191 Other clean air visits 8,984 14,499 Food Premises Bakehouses and bakers shops 132 Butchers 305 Dairies and Milkshops 54 Grocers 383 Ice Cream 89 Restaurants, Cafes 384 School Meals Kitchens and Canteens 349 Stalls 132 Unsound Food 180 Other food premises visits 563 2,571 Factories Powered/non-powered 787 Sites 18 Outworkers 136 941 Offices, Shops and Railway Premises 2,635 Drainage Drainage and Plumbing Works 1,640 Cesspools 704 2,344 Infectious Diseases 1,752 57 Animals Pet Shops 51 Riding Establishments 12 Boarding Establishments 3 Diseases of Animals Act 130 Others 16 212 Miscellaneous Visits Accommodation roads/Passages 77 Noise nuisance 539 Accumulations of Rubbish 1,255 Hairdressers 20 Caravans 115 Watercourses 349 Not classified 1,295 3,650 37,906 Of the 2007 informal notices served 1255 were complied with and 83 statutory notices were required, and of these 52 had been complied with at the end of the year. LOCAL LAND CHARGE ENQUIRIES These referred to enquiries from the Town Clerk concerning outstanding Notices, the progress of Housing Schemes and Smoke Control Areas in relation to all types of property in the Borough, in pursuance of the provisions of the Land Charges Act 1925. The necessary searches were made and information supplied in respect of 8,802 properties. NOISE The Noise Abatement Act 1960 makes noise or vibration which would amount to a nuisance at Common Law a statutory nuisance which can be dealt with according to the procedure in Part 3 of the Public Health Act 1936. The Act does not apply to noise or vibration caused by aircraft or by statutory undertakers in the exercise of their powers. During the year 99 complaints were received; the majority relating to noise from business or industrial activity and the remainder from domestic or social causes. There are no specially noisey industrial processes and the most intractable cases arise from business uses or light industrial activity in smaller factories or workshops which are intermingled with or adjoining houses. 58 In the case of legal proceedings in respect of noise or vibration caused in the course of trade or business it is a defence to prove that the best practicable means have been used for preventing and counteracting the effect of noise or vibration and so long as this built-in defence is available an element of annoyance from noise may have to be accepted particularly in areas which are not wholly residential. Complaints are investigated promptly but some require numerous visits at night time as well as during the day and it is sometimes difficult to obtain a solution to or amelioration of noise nuisance without what may seem to a complainant, unreasonable delay. Although it is not always possible to reduce noise to a level which satisfies complainants there is a good degree of co-operation from business firms. SHOPS AND OFFICES The Offices, Shops and Railway Premises Act 1963 and a number of Regulations made thereunder regulate working conditions in offices and shops. Public Health Inspectors and Shops Inspectors of the Town Clerk's Department, collaborate in these measures to secure the health, safety and welfare of persons employed in such premises. The Town Clerk is responsible for the registration procedure and the publication of an Annual Report to the Minister of Labour. The following is an extract from the Report, setting out the number of premises registered, an analysis of persons employed and the number of general inspections made:— Table A — Registrations and General Inspections Class of premises No. of premises Total registered premises at end of year Registered premises receiving a general inspection Offices 53 760 159 Retail shops 154 2167 896 Wholesale shops, warehouses 3 59 7 Catering establishments open to the public, canteens 37 239 26 Fuel storage depots — 4 - TOTALS 247 3229 1088 Table B — Number of Visits of all kinds by Inspectors to Registered Premises 4223 59 Table C — Analysis of Persons Employed in Registered Premises by Workplace Class of workplace No. of persons employed Offices 12243 Retail shops 8803 Wholesale departments, warehouses 1448 Catering establishments open to the public 1550 Canteens 193 Fuel Storage depots 22 TOTAL 24259 Total Males 11527 Total Females 12732 FACTORIES AND WORKPLACES The Local Authority is responsible for enforcing the provisions of the Factories Act 1961 and associated Regulations, in respect of cleanliness, overcrowding, temperature, ventilation, drainage of floors, and sanitary conveniences in factories where no mechanical power is used, and the provisions as to sanitary conveniences only in factories in which power is used. The following tabulated report in the form specified by the Ministry of Labour shows the number of factories registered, the number of inspections made and defects found and remedied. Premises Number on Register NUMBER OF Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Section 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 72 84 11 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 604 703 53 — (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 25 18 — — TOTAL 701 805 64 60 Cases in which defects were found:— Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.1) 4 3 - 1 - Overcrowding (S.2) — - - - Unreasonable temperature (S.3) 1 1 - - - Inadequate ventilation (S.4) 7 4 - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 1 - - - - (b) Unsuitable or defective 30 14 - 7 - (c) Not separate for sexes - - - - Other offences against the Act (not including offences relating to Outwork) 53 31 1 2 - TOTAL 96 53 1 10 - OUTWORKERS Section 133 of the Factories Act 1961 requires the occupier of a factory to notify to the Local Authority the names and addresses of persons employed in their own homes. There are 136 outworkers so notified engaged in the following trades:— Wearing apparel 89 Household linen 2 Curtains and furniture hangings 1 Furniture and upholstery 2 Brass and brass articles 7 Artificial flowers 6 Making of boxes, etc. 17 Soft toys 2 Chocolates and sweetmeats 3 Cosaques, Christmas stockings etc 1 Lamp shades 6 The Public Health Inspectors made 136 visits to such premises. No unsatisfactory conditions were noted. 61 RAG FLOCK AND OTHER FILLING MATERIALS The Rag Flock and Other Filling Materials Act 1951 and Regulations prescribe standards of cleanliness of filling materials used in the manufacture of bedding, toys, baby carriages and other articles of upholstery and the registration of premises where the work is carried out. The regulations also prescribe the form of records to be kept showing the amounts etc. of filling materials used. Five premises registered under the Act were inspected and found to be satisfactory. SWIMMING POOLS AND BATHS Whilst the indoor swimming pool at Finchley is generally available throughout the whole of the year, the season for the three open air pools at Finchley, Hendon and Mill Hill is from the end of April to the middle of September. All pools are equipped with modern filtration and chlorination plants. During 1968 there were 355,850 visitors to the pools including 77,624 school children. Nine schools have teaching pools provided either by the Education Authority or by Parent Teacher Associations. There is also one privately owned pool which is open to the public. Samples taken by the Public Health Inspectors from the pools, additional to the daily checks made by the operating staffs, show that a generally high standard of bacteriological purity was maintained. There are also three public slipper baths in the Borough, and during the year 22,465 persons attended the baths. At prescribed times, old age pensioners may have the free use of washing facilities at certain establishments. SANITARY CONVENIENCES There are 29 male and 27 female public conveniences adjoining the highways and 37 male and 37 female conveniences within the curtilage of the Council's parks and open spaces. Seventy-eight of these conveniences have free hand washing facilities including eight installations of an improved type of hand washing and drying machine. A specialist firm was employed during the year to carry out a thorough cleansing of the public conveniences adjoining the highways. It is intended that such a cleansing should occur each year and that the service should be extended to-cover conveniences in the Council's parks and open spaces. 62 SEWERAGE AND SEWAGE DISPOSAL There have been no changes in sewerage and sewage disposal during the year. Works in constructing a relief surface water sewer in Devonshire Road was being carried out to alleviate flooding in part of the Mill Hill drainage area from Sanders Lane to a point of outfall into the watercourse which flows through Hendon Park Cemetery and Crematorium. It is anticipated that this relief surface water sewer will be functioning about the middle of 1969. Outfall sewers and on site sewers are also being constructed within the Grahame Park drainage area to serve a catchment of approximately 880 acres and to deal with a peak flow of 305 cusecs during times of normal storm, with outfall into the Silk Stream near Colindeep Lane Junction with Rushgrove Avenue. REFUSE COLLECTION AND DISPOSAL Domestic refuse is collected by directly employed labour from every premises in the Borough at weekly intervals. One bin of trade refuse is also collected free of charge from each business premises weekly, whilst additional collections are made and/ or additional refuse removed under agreement, an appropriate charge being made. There is a special collection service for the removal of old furniture, garden and builders' rubbish, etc., payment for which is made at the time of collection. Disposal is undertaken by the Greater London Council at two main disposal sites, these being at Brent Terrace, N.W.2. (by incineration) and Summers Lane N.12., where it is transferred to other road vehicles for transport to a tipping site outside the Borough. Salvage collection and disposal averages 30/35 tons per week, comprising mixed papers, fibre board, newsprint, carpet and mixed rags. ANIMALS Protective legislation to secure the well-being of cats and dogs, animals sold for pets, and horses hired out for riding is provided for in the undermentioned Acts, and at the end of the year the following licences were in force, namely:— Animal Boarding Establishments Act 1963 3 Pet Animals Act 1951 20 Riding Establishments Act 1964 10 63 The Public Health Inspectors are "authorised officers" for enforcing the provisions of the Diseases of Animals Act 1950 and the numerous orders made thereunder. There is one establishment, licensed by the Ministry of Agriculture, Fisheries and Food, for the detention of cats and dogs under quarantine following importation to this country. 107 dogs were received during the year and kept under observation to check on the presence and isolation of the animals for the required periods. Farm records of the movement of cattle, sheep, goats and pigs on or off the premises are periodically checked. The records show that the average numbers of stock held were:— Cattle 1006 Pigs 2546 Sheep 46 Goats 2 Poultry 23141 Fifteen licences were in force at the end of the year permitting the use of plant for boiling waste foods for animal feeding. Cleanliness and adequate cooking of such wastes are essential to prevent the spread of animal disease. The Borough fortunately did not have any cases of Foot and Mouth Disease during the outbreak which originated in 1967, but, with the whole of the country, was subject to the restrictions of a Controlled Area, and during the period, November 1967 to February 1968 , 63 licences were issued for the movement into the Borough of 53 cattle, 98 sows and 3,200 pigs. In October a suspected case of Foot and Mouth Disease outside the Borough required the posting of notices on various roadsides to mark the boundary of the area under restrictions. A trainee working on a local farm was a possible contact with the suspected animals and until the matter was cleared up, no movements in and out of the farm were permitted. The restrictions were lifted in 24 hours. Mr. J.R. Stockman M.R.C.V.S., continued to act on a consultancy basis to assist in the inspection of animals and premises where necessary. RODENT CONTROL The Prevention of Damage by Pests Act 1949 places on the occupier of land the onus of ridding his premises of rats and mice, but the Council provides a service which is free in the case of private property, and chargeable on a "time plus cost of materials and overhead expenses" basis in respect of business and other premises. The work is carried out by a trained staff of rodent operatives and in accordance with the recommendations of the Ministry of Agriculture, Fisheries and Food. 64 Treatment of sewers to reduce the level of infestation is carried out three times a year, and is preceded by test baiting. Fluoracetamide, a dangerous poison, is used and the work is carried out by a specialist firm under contract. The arrangements for this work and its supervision are made with the co-operation of the Borough Engineer and Surveyor. The following table summarises the work carried out and is in the form required by the Ministry of Agriculture, Fisheries and Food. Properties other than Sewers Type of Property Non-Agricultural Agricultural 1. Number of properties in the district 117,537 41 2. (a) Total number of properties (including nearby premises) inspected following notification 2,944 8 (b) Number infested by (i) Rats 2,126 3 (ii) Mice 649 - 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 385 4 (b) Number infested by (i) Rats 218 - (ii) Mice 5 - The Rodent Operatives made 14,426 visits during the year. DISINFECTION AND DISINFESTATION Facilities for steam disinfection and disinfestation, and for the personal cleansing of verminous persons remain the same as for previous years. The treatment of females and young children is done under the supervision of a woman attendant specially employed. Requests for advice and assistance in dealing with insect pests increase in number and range over a wide variety. Many of these insects are of no public health significance, but steps are taken to assist in all enquiries. Again, thanks are due to the Director of the Department of Entomology of the Natural History Museum for the helpful co-operation of his experts in the identification of numerous insects. During the year 64 requests for the hire of a squirrel trap were received. 65 "Wild" or "feral" pigeons are now a widespread pest, and the problem of reducing them in number is made intractable by the well meant but misplaced kindness of people who regularly provide food at all seasons. A charge is made for disinfection and disinfestation, with the exception of terminal disinfection carried out after a notifiable disease and the cleansing of verminous persons. The following table shows the work done by the Disinfectors:— Disinfection Rooms 67 Articles 258 Disinfestation Ants 30 Bugs 26 Cockroaches 17 Beetles 8 Fleas 31 Lice — Scabies 4 Leatherjackets 1 Flying maggots 1 Silver fish 3 Drying Processes Premises 4 Articles 6 MORTUARIES The public mortuary serving the Borough is situated in the North Circular Road, N.3., adjacent to the Disinfecting Station. In the course of the year 522 bodies were received in the mortuary. EXHUMATIONS Licences issued by the Home Office for the removal of human remains under the Burial Act 1857 state, inter alia, "It is considered advisable that the Medical Officer of Health should be notified whenever such a licence is granted in order that he may be in a position to take any action that may be necessary in the interests of public health." Fourteen exhumations were carried out during the year and, where appropriate, were observed by a Public Health Inspector, to ensure compliance with the conditions in the licence. 66 MENTAL HEALTH SERVICES MENTAL HEALTH SERVICES Because of the Government restrictions on Capital Expenditure it was necessary for the Council to review it's capital programme which resulted in the postponement of major building projects during 1968. Despite the setback it is encouraging that during 1970/71 the development of the mental health services will include 150-place adult training centre, a 24-place hostel for male and female subnormal adults, and a 60-place rehabilitation workshop. Particular energy has been concentrated to further improve existing services and ensure progress in the field of care and rehabilitation both of the mentally ill and mentally retarded. The Mentally Subnormal Subnormal and severely subnormal cases under Local Authority care increased by 9% and at the end of the year there was a total of 486 receiving such care. Visiting of children under 16 years of age and their families is undertaken by the Health Visitor in co-operation with the Social Worker. The care of those over the age of 16 and their families is carried out by the Mental Health Social Worker. Children leaving Schools for the Educationally Subnormal are followed up by a Social Worker, in co-operation with the Youth Employment Officer, with a view to securing suitable employment or failing that arranging further education or vocational training. It is essential that practical relief be given to the families from the continual care of the subnormal member and short term care is arranged through private placements, but where individual nursing care is needed this is arranged (whenever possible), through the psychiatric hospital. Harperbury Hospital Despite the virtual full stop on permanent admission because of the need to reduce overcrowding and improve the service for patients already in hospital, mutually helpful liaison with Harperbury Hospital continues. The Principal Medical Officer for Mental Health continues to hold the port time post of Hon. Assistant Psychiatrist for 3 sessions a week at the hospital. Proposals are in hand for student nurses to spend part of their training period in various rrental health establishments which will further the links already made and enable insight with the various aspects of Local Authority community care. 69 Junior Training Schools The two Junior Training Schools have had a successful year; emphasis has been given in seeking new teaching techniques and encouraging social competence through outside activities. An excellent film has been made by the staff of Hendon Junior Training School showing the whole range of school work and also some of the brilliantly organised extra mural activities such as a youth hostelling weekend at Windsor. The Prime Minister announced in the House of Commons in November that the decision had been taken to transfer the responsibility for the education of severely subnormal children from Health to the Education Services. This change will undoubtedly necessitate substantial re-organisation to effect a smooth transfer and minimise any possible disruption to the children. No decision has yet been made regarding the future care of those severely handicapped children in the special care units attached to the Junior Training Schools. Early settlement of the date of transfer is not only important in the interests of the children but also in future planning and legislation is anticipated during 1969. An important problem related to the transfer of responsibility, which has not been clarified, is the question of residential care of children who need to be away from their homes but do not need psychiatric hospital placement. Residential Care This Council, has continued to maintain patients in a variety of homes. The number of patients in informal foster care in homes or hostels run by voluntary organisations was 50 in 1968, an increase of 9 over the previous year. Additionally 43 children and adults received periods of short term care. A small but important contribution to residential care of child patients was made by the completion during the year of a 10-place home for mentally disordered children at "Harwood", 55 Christchurch Avenue, North Finchley, N.12. Fieldways Adult Training Centre It has been particularly encouraging to see that some trainees who were very disturbed in other placements have improved to a considerable extent at this Centre and also some progress has been made in the placement of trainees in outside employment. Hendon Adult Training Centre This new purpose-built Centre for 40 mentally subnormal adults and young people 70 was completed and opened at the end of the year. It is intended that the programme in this Centre shall be an experimental one and it is hoped that some lessons will be learnt which could be applied in the two 150-place adult training centres which the Council are proposing to build in the 10-Year Plan. Residential Care of Adult Subnormals The demands for residential placement for adults who do not need hospital admission naturally grows yearly as parents become elderly or die. The Council has continued to make private placements as often as possible but, appreciating the increasing difficulty of obtaining such placements, plans have been made for two 24-place hostels for trainable adult mentally subnormal young men and women and it is hoped that one of these will be included in the earliest possible building programme when the present financial restrictions are lifted. Mental Illness This Borough is fortunate in having close co-operation not only with its catchment hospital, Knapsbury, but also with the general and teaching hospital psychiatric units in Greater London. This allows for greater flexibility in the arrangements for treatment of residents of this Borough. Relationships are particularly constructive with the Marlborough Day Hospital, St. John's Wood, and the psychiatric unit of the Middlesex Hospital, St. Luke's-Woodside, Muswell Hill. The envisaged run down of the population of the general psychiatric hospitals has not yet had a great impact on the community services but much greater demands both on capital expenditure for buildings and on manpower will be made with increasing momentum in future years. This is quite obvious since the future government policy is for a substantial amount of psychiatric work to be done at units attached to District General Hospitals with a rapid turn over of patients. The Mental Health Social Workers continue to operate from Ravenscroft House, Wood Street, Barnet but, during the year, there have been changes in organisation designed to meet the need for comprehensive social work structure capable of coping with the changing conditions under which the field staff now work and with all the new aspects of, and approaches to, the problems of mental illness and subnormality. The Mental Welfare Officers' statutory duties and obligations under the Mental Health Act 1959 to act in psychiatric emergencies, are still covered by a 24 hour night and day, throughout the year, emergency service. However, it has been clearly demonstrated that emergency work can be markedly diminished by skilful and regular social work allied to early psychiatric referral. Because of the complexity of the service the Field Workers need to be fully experienced and qualified in social work. Progress is being made in the recruitment of qualified 71 staff and of the secondment of staff already in post to courses of training for the Certificate in Social Work. With the unification of all Social Workers under one roof, it has been possible to build up a comprehensive supervision structure in which all staff have the opportunity for consultation with one another and each being under the supervision of a senior officer. In a report of this nature it is only possible to give an outline of the organisation which has been built up, but the foregoing gives basic aspects. Passing from organisation to operation, the following brief details will give some indication of the wide range of work covered by the present day Mental Welfare Officer. Cases of Mentally III Persons referred to the Mental Welfare Service (see statistical tables — Page 77) The total number of such cases was 1,078, an increase of 3½% on the 1967 figures. Whereas in previous years the main source of referrals was the General Practitioner it will be noted that referrals from "other sources" now account for the major proportion. This is indicative of the widening area of contact as under this heading are those referred by Health Visitors, Social Welfare Officers, and other Social Work Agencies, Voluntary bodies, Government Departments i.e. Social Security, etc. Of the total cases referred 497 were later admitted to psychiatric hospital, 176 of this number being admitted informally. Admission under Sections 25, 26, 29 and 60 of the Act amounted to 321 compared to 303 in 1967. The use of emergency powers under Section 29 of the Mental Health Act, 1959, continues to decrease and now represents 14% of the total cases referred as compared with 20% in 1967. During the year 5,196 visits were made to Mentally 111 Persons and 493 visits to Subnormal Persons giving a total of 5,689 visits by Mental Welfare Officers. Friern Hospital, New Southgate Cases from the London Borough of Barnet area are no longer admitted to Friern Hospital but, by reason of the fact that the hospital is situated within the Borough boundaries, Mental Welfare Officers are liable to be called in for statutory duties in relation to patients in that hospital and during the year under review 61 such cases were dealt with. 72 Experimental Day Centre for the Mentally Infirm Elderly. Park House Hostel, East Finchley, N.2. The Day Centre was open on Tuesdays and Thursdays throughout the year and, from November, additionally on Wednesday of each week. At the 102 sessions of the centre during 1968 the average attendance was 9 persons and at each session at least one Mental Welfare Officer was present. During next year it is hoped to extend the Centre to four days per week which will be practically the limit for this experimental project. Mention should be made of the fact that a paper on the work done at the Centre was presented by the Principal Medical Officer (Mental Health) and one of the Senior Mental Welfare Officers at the 7th International Congress on Mental Health in London in August. Park House Hostel This 30 place hostel is primarily intended for 15 persons of each sex on a short-stay basis on discharge from psychiatric hospital although, in a few instances, admissions have been direct from the community where it is considered that a short-term admission will prevent breakdown and/or possible admission to hospital. During the latter part of 1968 an increased amount of Social Work support was given with the introduction of a team approach to the running of the Hostel. Therapeutic Social Clubs The three Clubs: Park House, The Links and York Park continued to function with varying degrees of success. However, changes in hospital catchment areas and housing developments in some parts of the Borough makes its necessary for the organisation of the social clubs to be reviewed and it is proposed to do this during the coming year. Napsbury Hospital Mental Welfare Officers are authorised by the Hertfordshire County Council to act with regard to Borough residents who are, for the time being, in psychiatric hospitals in that County; 40 such cases were dealt with during the year. Mental Welfare Officers continue to attend Ward Meetings, Case Conferences etc., in the Hospital to develop close co-operation between hospital and Community Care Services. The question of notification of discharges from the Hospital to the Local 73 Authority Mental Health Section is still not resolved but it is hoped that 1969 will bring this about. Drug Dependency This important subject and the type of programme devised in this Borough to deal with it was briefly described in last year's report. The development of this programme in 1968 continued particularly having regard to the interest shown by the Department of Education and Science. Further meetings in schools and with youth groups were personally undertaken by the Principal Medical Officer for Mental Health. In August a two day Conference for Head Teachers of secondary schools and Principals of Colleges was held. The programme was designed to cover problems of drug addiction among young persons and included lectures on: "Drugs of Dependency — Their Use and Abuse". "Legal and Social Aspects of Drug Abuse". "Signs, Symptoms and Social Consequences with particular reference to the problem of the 'Drop-out' ". "The Emotional Disturbance in Adolescence associated with the risk of Drug Dependency". Each lecture was followed by small group discussion and time was allowed for reporting back and speakers' answers. Subsequently a series of six morning seminars for 30 teachers and assistant lecturers were held. It must be emphasised that the aim of the seminars was not to make teachers into diagnosticians of drug addiction but rather to make them more sensitive to those disturbances of adolescence that make youngsters a possible prey to drugs and most particularly those young people who are at serious risk because of death of parents, break up of home or by some other special crisis in their lives. Further programmes of this kind will be undertaken when the work already done has been properly evaluated. The Dangerous Drugs Act, 1967 and The Dangerous Drugs (Notification of Addicts) Regulations 1968 and Dangerous Drugs (Supply to Addicts) Regulations 1968, came into force during the year. This legal machinery tightened up the supplies of dangerous drugs from medical sources and was associated with the opening of the drug addiction centres in various hospitals primarily to deal with the management of heroin addicts. A close liaison has been built up with those units where patients from the Borough are being treated and joint measures of prevention and after care in the field of drug dependency are under active cons ideration. 74 Mental Health Week, 1968 The third and final week in the series promoted by the National Association for Mental Health and the National Society for Mentally Handicapped Children, was held during the week 9th—15th June. The theme "Targets for Tomorrow", was designed to cover the five areas in the mental health field most needing support and improvement. Staff of the Mental Health Division and Health Education Section in conjunction with the Friern Barnet Association for Mental Health, organised a one day conference designed to provide an opportunity for active participation by the youth of the Borough and to enable the discussion of all aspects of mental health. The conference was held in the Borough's Youth Centre and 250 youth clubs were invited to attend. It was an all day conference consisting of lectures, films and group discussions. Speakers were carefully chosen to represent the varied areas of the mental health field and it was felt it had been a successful and informative conference. Voluntary Bodies The year cannot pass without again extending sincere thanks to the enterprising voluntary associations whose organisation of functions and provision of additional amenities for the mentally handicapped in the Borough has greatly assisted the staff of the various establishments. 75 Number of persons under Local Health Authority care at 31st December, 1968 Mentally 111 Elderly Mentally Infirm Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (ID (12) (13) (14) (15) (16) (17) (18) (19) 1. Total number 2 1 107 126 16 41 2 10 5 107 78 56 49 97 84 781 2.Attending workshops, day centres or training centres (including special units) 3 4 6 16 9 4 25 17 48 37 43 43 255 3 Awaiting entry to workshops, day centres or training centres (including special units) 1 1 1 5 10 1 4 23 4 Receiving home training 5 Awaiting home training 6 Resident in L.A. home/hostel 3 3 7 Awaiting residence in L.A. home/hostel 8 Resident in other home/hostel 15 12 9 7 8 3 18 7 76 9 Boarded out in private household 1 1 10 Attending day hospital 2 8 10 11 Receiving home visits and not inc. in lines 2-10 (a) suitable to attend a training center 7 16 5 18 46 (b) others 2 1 77 87 5 7 2 1 74 56 1 2 40 35 390 76 77 Cases of Mentally III Persons referred to Mental Welfare Officers during 1968 REFERRED BY:- UNDER 16 YEARS 16 YEARS AND OVER TOTAL MALE FEMALE MALE FEMALE GENERAL PRACTITIONERS 1 3 145 284 433 HOSPITALS, on discharge from IN PATIENT TREATMENT 24 41 65 HOSPITALS, after or during OUT PATIENT or DAY TREATMENT 25 45 70 LOCAL EDUCATION AUTHORITY 2 2 POLICE AND COURTS 1 30 26 57 OTHER SOURCES 1 2 167 281 451 TOTAL 3 5 391 679 1,078 Persons Under Mental Welfare Officers' Care At 31.12.68 MENTALLY ILL ELDERLY MENTALLY INFIRM SUBNORMAL TOTAL Under 16 years 16 years & over Male Female Male Female Male Female Male Female 2 1 109 126 16 41 185 181 661 WELFARE SERVICES WELFARE SERVICES The Council provides a wide-range of Services under the National Assistance Act 1948 which extend to the care and well-being of persons in the community who by reason of age, physical disability, homelessness or other circumstance are in need of such care. Residential Accommodation The pressing needs of a number of senior citizens of the Borough is recognised in the provision of accommodation for the elderly in seven Residential Homes. Care and attention is provided by experienced staff. The extent of the demand for residential accommodation for the elderly is reflected in the size of the Waiting List which is in the region of 150. Work has been started on the new Meadowside, a replacement for the Home of a similar name. Fifty persons will be accommodated there. Work has also started on Merrivale, a 60-bed Home for both sexes, which is the first of the replacement buildings for Redhill House, scheduled to close in 1970. The number of persons accommodated at 31st December 1968, was 406. In addition 49 persons for whom the Council is financially responsible were accommodated in 81 Name of Home No. of Beds Disposition Beach Lodge, 66 Hendon Lane, N.3. 32 Female The Cedars, Richmond Road, New Barnet. 38 Mixed The Leys, Barnet Lane, Elstree. 47 Female Morton Lodge, Ashfield Road, Southgate, N.14 50 Mixed Redhill House, Burnt Oak Broadway, Edgware. 210 Mixed Storth Oaks, 1 Downage, Hendon, N.W.4. 31 Mixed Woodhill House, Kentish Lane, Essendon, Herts. 41 Mixed other Local Authority Homes. During the year, 145 people were admitted to the Council's Homes: 82 persons were discharged to hospitals and a total of 69 deaths occurred in the Homes. Short-stay accommodation was provided for 26 elderly persons so that relatives who normally cared for them were able to take a holiday. Extensive improvements were effected in various forms at Woodhill House, The Leys and Redhill House. A Handicraft Instructor attends the Homes and provides handicraft instruction to those residents who wish to receive such instruction. Outings to the coast and the countryside are also arranged. Additional outings, lunches, theatre parties etc., are provided by voluntary organisations. The Council appreciates the interest in, and the contribution made, by these organisations towards the welfare of the elderly. Registered Homes for the Elderly and Handicapped There are 52 Registered Homes for the Elderly and Handicapped in the Borough. A total of 881 persons were admitted to these Homes during the year; i.e. 677 to Homes run by Voluntary Organisations, and 204 to Private Homes. Four additional Homes were registered during the year and five registrations were cancelled in the same period. Homeless Families Temporary Accommodation for Homeless Families is provided in two Hostels maintained for this purpose. Kelvedon, 27 Woodside Avenue, Finchley, N.12 accommodates 12 families, and Redhill Lodge, Burnt Oak, Edgware provides accommodation for 25 families. Both Hostels were in full occupation throughout the year, an indication of the extent of the problem of homelessness. In addition to the Hostels, a Reception Unit was opened at Redhill House during the.year. With the co-operation of the Borough Housing Officer, a four-family-unit is being prepared for occupation at 2 Edward Road, New Bamet. Approval has been obtained from the Department of Health and Social Security for the building of The Croft, a 12-family-unit, with separate accommodation for the Warden. The Council again determined that a minimum of 15 families from the Hostels would be rehoused and, in accordance with this policy, twenty-two families were placed in accommodation by the Borough Housing Officer during the year. The Elderly Community Services are provided at a number of Centres throughout the Borough. 82 Claremont Clinic A Day Centre for 15 elderly people commenced activities during the year. The Centre functions on Tuesday and Thursday of each week enabling housebound elderly people to be collected from their homes, and enjoy the facilities at the Centre. Health Visitors have given support to the venture which has proved most successful. Etchingham Park Centre, Finchley The popularity of this Centre continues. Day care is provided for 15 elderly houseboundpersons, enabling the members of their families, who normally care for them, to follow their own occupations. A Work Centre, catering for 35 active elderly persons, also operates and adds to the value of the service provided. Finchley Work Centre This Centre is organised by the Finchley Guild of Social Service and provides a most worthwhile and interesting service for elderly persons in the East Finchley area. Meals on Wheels The service in the Borough continues to be organised by the Women's Royal Voluntary Service and 53,670 meals were delivered during the year. Not all parts of the Borough receive a five-day service but there has been an increase in the number of meals provided since last year, and the ultimate aim is a daily service in all areas of the Borough. Luncheon Clubs operated by the Women's Royal Voluntary Services and other associations, play an important and supportive role in caring for the needs of the elderly. During the year a total of 14,935 meals were served in different areas of the Borough. In addition, Social Welfare Officers continue to play a large part, and with other Officers of the Department and those of voluntary bodies, advise on the wide range of available activities and services. Services for the Blind, Deaf and Physically Handicapped Blind and Partially-Sighted Persons The total number of persons registered at the 31st December 1968 was made up as follows:— 83 Eight of the registered blind persons are employed in sheltered conditions in Workshops for the blind, and an equal number of Blind Homeworkers are engaged in occupations ranging from physiotherapy to knitting. It is pleasing to report that 71 persons were employed under ordinary conditions in occupations such as telephone operators. A total of 22 males and 48 females were added to the Blind Register during the year. Qualified Social Welfare Officers for the Blind are employed to promote their general social welfare, arrange occupational and recreational facilities and ensure that those able to benefit from training and rehabilitation, are given the opportunity to do so. The partially-sighted register totals 162 persons. Handicraft classes for the blind and partially-sighted are held in different parts of the Borough each week. Dancing and Cookery classes form a feature of other activities. Forty-seven persons participated in the Council's Assisted Holiday Scheme. The Deaf and Hard of Hearing The Welfare Officer for the Deaf undertakes case work on behalf of persons registered Deaf and /or Hard of Hearing and advises other Social Workers of their special problems with which he has knowledge. Contact is maintained with the "Hard of Hearing" Groups at Barnet and Hendon which continue to flourish under active leadership. Physically Handicapped Persons This group of persons includes spastics, epileptics, sufferers from multiple sclerosis, muscular dystrophy, arthritis, poliomyelitis and other permanent disabilities. The number on the Council's Register of Physically Handicapped Persons at 31st December 1968 was 1,451 — when split into age groups the following figures emerge:— Under 16 years of age 16 Aged 16 years to 64 years 550 Aged 65 years and over 885 84 1,451  Male Female Total Under 5 years of age - - - Aged 5 to 15 years 9 7 16 Aged 16 to 20 years 4 5 9 Aged 21 to 64 years 86 84 170 Aged 65 years and over 135 346 481 234 442 676 The Work Centre at Heriot Road continues to operate successfully, attendance of up to 30 persons daily is maintained. The output of work has increased to the benefit of those attending. The new Rehabilitation Centre at Deansbrook Road, Edgware, was opened during the year and is providing a useful service for the physically handicapped. At the moment approximately 30 persons attend the Centre daily, most of whom are conveyed by Council transport. The British Red Cross Society operates weekly craft classes at Edgware, Hendon, Finchley and High Barnet. During school term a choral class is held in North Finchley. Transport to these classes is provided by means of the Council's specially-adapted vehicles. During the year 135 persons availed themselves of the Council's Assisted Holiday Scheme for the physically-handicapped. Social Welfare Officers visit the physically handicapped frequently and offer advice and guidance on the many problems of these persons. The case work undertaken by these Officers provides intensive support for the physically handicapped of the Borough. During the year 460 aids to daily living were issued on free loan and 93 adaptations effected to the properties of those who need assistance to maintain independence at home. Miscellaneous The Council has a duty to protect the movable property of persons admitted to hospital, residential or other accommodation under order of the Court where there appears danger of loss or damage to such property. Action was taken in five cases during the year. The Department accepts gift furniture which is distributed to persons in need and is particularly useful in assisting families rehoused from the Homeless Families Units. Voluntary Organisations The valuable contributions made by the many voluntary organisations with the Borough is much appreciated; all are concerned with the well-being of those who need support in the Community. The Council is continuing its policy of assisting these organisations in their work by means of financial and other support where needed. 85 PERSONAL HEALTH SERVICES PERSONAL HEALTH SERVICES Existing Clinic Provision Full information in respect of the Council's clinics and the key to the services provided, is set out in a table to be found on page 108. Co-ordination and Co-operation with Hospital and General Practitioner Services All midwives are attached to General Practitioner/Obstetricians and during the year General Practitioners were approached and discussed the possible attachment and allocation of health visitors and home nurses to their group practices and partnerships. Doctors in a group of four Practices led the way by having a health visitor in their premises and from the knowledge and experience gained in this situation a relationship was built up in many other parts of the Borough. It was rewarding to find, when introducing home nurses to the General Practitioners, how often the Practitioners showed an eagerness to also have a health visitor attached as soon as possible. By 1st October, after careful preparation, all home nurses were attached, and this closer association has led to the more effective use of staff. Student visitors from the Bamet General, Edgware General, Harperbury and Middlesex Hospitals were welcomed to observe health and welfare services. A closer link with Harperbury Hospital was gained, as student nurses were given lectures on community care of the handicapped and were able to visit some of the families of these patients. The attendance of staff at the Paediatric Units at Edgware General and Bamet General Hospitals has proved invaluable. One health visitor spends one morning a week at the Premature Baby Unit, Maternity Unit and Children's Ward at Barnet General Hospital. Another health visitor attends the Ante-Natal Unit at Edgware General Hospital once weekly. These visits help the staff to know their hospital colleagues better and give a more complete service to the family. The liaison with Edgware General Hospital, Geriatric Department, is now well established and is clearly appreciated by that Department, health visitors and patients. Health Visiting Some aspects of the health visitor's work began to change. The family unit was benefitting from her wider knowledge gained through a close working relationship with General Practitioners, and age groups not previously well known to the health visitor were rapidly constituting an important part of her work. Consultation, and group work with young mothers were replacing the routine weighing sessions in Child Welfare Clinics. 89 Health visitors continued to form discussion groups with mothers of young children, and mothercraft and relaxation classes provided a valuable link with ante-natal mothers. Fathers were included where some health visitors were able to hold\further discussions in the evenings. During the year, child care students spent two or three days at a time with health visitors, observing their work. Home Visiting Cases First Effective Total Effective No. Access Visits at request of G.P. or Hospital Expectant Mothers 1073 1765 404 - Children born in: 1968 4783 10864 2760 - 1967 4744 9706 2024 - 1963 - 66 7239 14726 2838 — Persons aged 65 or over 2180 5896 835 1030 Mentally disordered 182 570 95 89 Persons discharged from hospital (other than mental hospitals) 315 394 49 271 Households — Tuberculous 282 533 202 - Households — other infectious diseases 70 89 19 - Other visits as Health Visitors 1218 2681 286 - Total as Health Visitor - 47224 9512 1390 Cases seen as School Nurse - 1863 428 - Prevention of Homelessness - (Problem Families) Two Family Case Workers continued to carry out intensive case work with problem families. Families at risk of homelessness were successfully helped and those re-housed from temporary accommodation by the Borough Housing Officer under the Council's scheme were given support by social workers of the Department. 90 Care of Mothers and Young Children Notification of Births Number of births in the London Borough of Barnet during 1968 as adjusted by inward and outward transfers:- (i) Live Births (a) Domiciliary 316 (b) Institutional 3944 4260 (ii) Still Births (a) Domiciliary — (b) Institutional 40 40 4300 Ante-Natal and Post-Natal Clinics Ante-Natal and post-natal clinics are provided at 11 clinics and the following tables show the numbers of ante-natal, post-natal, relaxation and mothercraft clinic sessions held Ante-Natal Clinics (Combined with Post-Natal) Clinics No. of sessions held Total No. of Attendances Average attendance per session Ante-Natal Post-Natal Oak Lane 49 217 19 4.8 Torrington 48 235 23 5.4 Central Hendon 30 122 2 4.1 Childs Hill 44 164 — 3.7 Mill Hill 49 314 9 6.6 Watling 24 46 1 2.0 West Hendon 50 602 — 12.0 Holly Park 47 63 10 1.6 Oakleigh Road 51 10 - 0.2 Edgware 46 152 1 3.3 Sutton Road 52 306 15 6.2 TOTALS 490 2231 80 4.7 91 Attendance at combined Mothercraft and Relaxation Clinics Combined Mothercraft and Relaxation No. of Sessions Held Total No. of Attendances Average Attendance per session Oakleigh Road 47 97 2.1 Mill Hill 43 417 9.7 Chi Ids Hill 36 91 2.9 Edgware 53 221 4.2 Watling 16 54 3.4 West Hendon 36 188 5.2 Central Hendon 46 195 4.2 Oak Lane 39 103 2.6 Torrington 94 652 6.9 Sutton Road 40 57 1.4 East Barnet 10 46 4.6 Vale Drive 38 272 7.2 Broadfields 4 11 2.8 TOTAL 502 2404 4.8 Congenital Malformations From January 1964 information has been collected about congenital defects by local health authorities and since that time 261 cases of malformation have been notified in respect of children born to parents normally resident within the area of the London Borough of Barnet. A classified breakdown of this figure is given below. The names of all children suffering from congenital malformation are added to the Observation Register to ensure that they are examined at the appropriate time and that treatment is given where required. 92 Defect Number of cases Central Nervous System Anencephalus 10 Hydrocephalus 10 Other specified malformations of brain or spinal cord 2 Spina bifida 10 32 Eye and Ear Accessory auricle 1 1 Alimentary System Cleft lip 23 Cleft palate 9 Hiatus hernia 1 Tracheo-oesophageal fistula 1 Rectal and anal atresia 3 Other specified malformations of intestinal tract 2 39 Heart and Great Vessels Specified malformations of heart and great vessels 3 3 Respiratory System Malformations of nose 1 Other specified malformations of respiratory system 1 Unspecified malformations of respiratory system 1 3 Urino-Genital System Extrophy of bladder 14 Malformations of male external genitalia 4 Malformations of female vagina and external genitalia 2 20 Limbs Polydactyly 1 93 Limbs — continued Syndactyly 2 Reduction deformity hand or arm 1 Reduction deformity leg or foot 21 Unspecified reduction of limbs 6 Talipes 11 Congenital dislocation of hip 81 Unspecified malformations of upper limb or shoulder 1 Unspecified malformations of leg or pelvis 7 Unspecified limb malformations 2 133 Other Parts of Musculoskeletal System Other malformations of musculoskeletal system (including congenital hernias) 1 Malformations of skull or face bones 6 Malformations of spine— scoliosis curvature — lordosis, not otherwise stated 3 Chondrodystrophy 1 11 Other Systems Branchial cleft, cyst or fistula; pre-auricular sinus 1 Other malformations of face and neck 4 Other unspecified malformations of muscles, skin and fascia 1 Pigmented naevus 1 7 Other Malformations Conjoined twins 1 Down's syndrome (mongolism) 8 Multiple congenital malformations not specified 3 12 261 * * Of this number 28 had multiple defects 94 Child Welfare Centres The following table shows the sessions held and attendances at each of the Child Welfare clinics: Clinics No. of Sessions Total Attendance Average Attendance No. of cases seen by A.M.O. No. of cases referred elsewhere Infant Welfare Sessions Claremont 50 993 19.9 454 9 Colindale 50 2064 41.3 717 _ Edgware 100 2969 29.7 1048 2 Broadfie Ids 54 2333 43.2 796 _ Watling 82 1179 14.4 484 — Central Hendon 151 4684 31.0 2111 6 West Hendon 103 2515 24.4 913 8 Childs Hill 102 4661 45.7 1857 1 St. Barnabas 53 2194 41.4 660 18 Holders Hill 34 981 28.9 437 7 Mill Hill 102 3083 30.2 1356 — Sanders Lane 25 793 31.7 309 _ Torrington 102 3748 36.7 1334 _ Oak Lane 154 3729 24.2 1838 5 Essex Park 7 257 36.7 88 _ Etchingham Park 97 2938 30.3 1152 — Oakleigh Road 55 1791 32.6 733 — Holly Park 52 1391 23.9 773 — Sutton Road 52 2013 38.7 848 - St. Marks 11 262 23.7 145 1 St. Stephens 50 1477 29.5 664 5 Osidge 153 4086 26.7 1571 3 Quaker Hall 17 209 12.3 70 2 Vale Drive 51 1263 24.6 766 14 East Barnet 100 3163 31.6 1484 6 Dollisfield 23 477 20.7 254 10 Sessions without a doctor Dollisfield 27 300 11.1 _ — Holly Park 33 227 6.9 _ — Inglis Barracks 49 1063 21.7 — — Oak Lane - - - - - Holders Hill 10 306 30.6 _ — St. Barnabas 51 722 14.2 _ — St. Marks 13 339 26.1 — — Sanders Lane 25 524 20.9 _ — Mill Hill 3 53 17.7 - - Vale Drive 2 16 8.0 _ — St. Stephens 1 20 20.0 — — Central Hendon 1 83 11.6 - - Toddlers Sessions Sutton Road 1 13 13.0 13 — Watling 5 49 9.8 49 — Oak Lane 39 538 13.8 451 Claremont 1 21 21.0 13 — Holly Park 2 22 11.0 22 — Oakleigh Road 2 12 6.0 12 - Developmental Clinics Broadfie Ids 5 38 7.6 38 — Mill Hill 5 69 J3.8 55 - Holly Park 3 4 1 .3 18 — East Barnet 3 _ — 8 — St. Barnabas 42 321 7.6 435 - Childs Hill 14 55 3.9 85 — Vale Drive 9 16 1.8 22 - Oakleigh Road 1 10 10 0 10 - TOTALS 2177 60074 27.6 24093 97 95 Number of children who attended during 1968 Born in 1968 3851 Bom in 1967 3581 Born in 1963/66 4485 11917 Mothers Discussion Groups Discussion groups were in operation at the end of the year at the Vale Drive, Torrington Park, Brunswick Park (Osidge), Mill Hill and Childs Hill Clinics. Midwifery The trend towards hospital confinements has increased with a marked decrease in domiciliary confinements. The number of home deliveries conducted by the domiciliary midwives was 316 and medical aid was summoned in 22 cases. Apart from these deliveries there were 520 early discharges from hospital on a planned scheme and assessments were made in all cases prior to confinement and early discharge, by midwives employed especially for this work. Pupil midwives from Edgware General and Bushey Maternity Hospitals received their Part II district training under the Department's approved midwifery teachers. Six pupils resided with midwives and the remainder were accommodated at the Nurses Home, Gervase Road, Edgware, in the charge of a Senior Midwife. This Home was modernized during the year — hand basins were put in four of the six bedrooms, a large kitchen was provided and central heating installed. Difficulty had been experienced in obtaining private accommodation for pupils in training. Arrangements were made for 4 midwives to attend statutory refresher courses. All "Trilene" machines were replaced by "Entonox" machines in accordance with Department of Health and Social Security policy. Home Nursing During the year four Senior Home Nurses were appointed and home nurses were divided into four groups. The employment of nursing auxiliaries to blanket bath patients showed, over a nine month period, a considerable saving in skilled home nursing time, and eight nursing auxiliaries were appointed to fill home nurse vacancies. The Senior Home Nurse introduces new staff, supports other staff, is responsible for the supervision and work load of the nursing auxiliaries and is given other minor administrative duties to gain experience and provide a career structure for this service. 96 No. of cases nursed 3801 No. of patients under 5 at first visit 93 No. of patients 65 or over at first visit 2604 Marie Curie Memorial Foundation This voluntary society, for which the Authority acts as agent, has provided 13 terminal cases with night nursing service to assist relatives in caring for them. Loan of Nursing Equipment The British Red Cross Society continues to act as agent of the Authority in providing for the loan of nursing equipment apart from large items, such as hoists, special beds and ripple mattresses, which are purchased or hired by the Authority. A small loan charge is collected by the Society towards the replacement of equipment, except in hardship cases where the charge is paid by the Council. Incontinence Pads and Clothing In suitable cases recommended by General Practitioners or home nurses, the free provision of incontinence pads and clothing helps greatly where patients are being nursed at home by relatives. Pads and clothing are available at all main clinics; 85,200 pads were issued during the year and 580 waterproof pants and linings. Home Help Service A syllabus has been drawn up for a course of training at the Barnet College of Further Education which suitable home helps will attend on a day release basis. It is hoped that the scheme will be in operation by September next year. Recruitment improved during the year, although it still did not reach a satisfactory level. In seeking the services of suitable staff the Authority is at a disadvantage in having to compete against the higher rates of pay offered by private employers. The following shows the type of assistance given during the year:— Number of cases Aged 65 or over on first visit during year Age under 65 in 1968 Total Chronic sick or Tuberculosis Mentally Dis ordered Maternity Others 1575 150 18 109 549 2401 97 Neighbourly Help Service 51 Neighbourly helps were employed at the end of the year and were providing assistance to 51 households. Day Nurseries During the year the three day nurseries remained adequately staffed, for although there was a considerable turnover of staff, replacements were obtained without difficulty. The 165 approved places were filled with children in the priority categories. In a few cases, where it was considered to be beneficial, the children of families at risk of homelessness were admitted for temporary periods, free of charge. Day Nursery No. of approved places Children on Register at 31st December 1968 Attendances for the year Average daily attendances 0-2 2-5 0-2 2-5 York Park 60 9 47 2769 8757 45.2 Kingswood 50 6 47 2078 8779 42.6 Wood Street 55 12 38 2183 8442 41.7 TOTALS 165 27 132 7030 25978 129.5 Nursery Nurses Training Negotiations continued with the Department of Health and Social Security and the Nursery Nurses Examination Board regarding the introduction of a nursery nurse training course at Barnet College of Further Education, and this course commenced in September. A total of 26 college based students were selected for the first year of training and the Health and Welfare Department was asked to nominate a representative for the Selection Panel. Lectures on health aspects were covered by two members of the Department. Private Day Nurseries and Registered Child Minders The number of applications for registration continued to grow steadily throughout the year and from November, in accordance with the Health Services and Public Health Act, 1968, applications for the registration of child minders receiving one or two children were considered. 98 Clinics for the Elderly A total of 55 sessions were held at West Hendon and Watling (Edgware) clinics and 1201 attendances made. Chiropody As I pointed out in previous Annual Reports, there is an ever-increasing demand for chiropody treatment and, whilst the Council's directly operated scheme continues to expand, the inability to recruit sufficient staff militates against this being as effective a service as is needed. It is hoped that with an increase in the Council's staff establishment and subject to chiropodists being available, it will be possible to provide a directly operated chiropody scheme in the areas of the Borough where the Hertfordshire County Council's scheme of treatment by chiropodists in private practice or domiciliary visits still continues. The chiropody service is supplemented by work undertaken on behalf of the Authority by various voluntary bodies and this has proved to be a valuable adjunct to the Council's directly operated service. Category Persons provided with Treatment Directly by the Authority (including those treated by private chiropodists on behalf of the Authority) Through arrangements with Voluntary Organisations Elderly persons Physically handicapped Expectant and Nursing Mothers School children Children under 5 years TOTALS 2837 25 10 18 2 2892 790 790 Recuperative Holiday Homes Recommendations for holidays were received from General Practitioners, Hospitals and medical staff of the Department and during the year 82 persons were admitted to recuperative holiday homes. There were also 36 applications approved but later withdrawn. Registration of Nursing Homes The 16 Nursing Homes, named below, are registered with the Borough in accordance 99 with the provisions of the Public Health Act, 1936, the Nursing Homes Act, 1963 and Part 3 of the Mental Health Act, 1959 and were regularly inspected during the year. Name and Address No. of Beds St. Mary's Maternity & Medical Nursing Home, 5 Maternity 46 Sunny Gardens Road, N.W.4. 6 Surgical/Medical/Chronic Brent Nursing Home, 4-6 Heather Gardens, N.W.ll. 32 Medical/Chronic "Cartref", 196 Watford Way, N.W.4. 2 Chronic Edgware Nursing Home, 36—38 Orchard Drive, Edgware. 13 Medical/Chronic "Clovelly", 81 Torrington Park, N.12. 14 Medical/Chronic Arkley Lawn Nursing Home, Arkley, Barnet, Herts. 26 Medical/Chronic Ellern Mede Nursing Home, Totteridge Common, N.20. 34 Chronic Preston Lodge Nursing Home, 38 Station Road, New Barnet, Herts. 16 Medical/Chronic Braeside House Nursing Home, 76 Park Road, New Barnet, Herts. 9 Medical/Chronic Highwood House Nursing Home, Highwood Hill, Mill Hill, N.W.7. 21 Medical/Chronic Bedford House, Hammers Lane, Mill Hill, N.W.7. 23 Chronic Convent of St. Mary at the Cross, Hale Lane, Edgware. 48 Incurable Orthopaedic (Female) Manor House Hospital, (The Industrial Orthopaedic Society) North End Road, N.W.ll. 139 Medical/Chronic Stuart House, 66 West Heath Road, N.W.3. 8 Chronic The National Kidney Centre, 1 Fairholme Gardens, N.3. 3 Northumberland House Mental Nursing Home, 237 Ballards Lane, N.3. 30 Mental 100 Nurses' Agencies The four nurses' agencies: Harley Nurses, Rupert House, Stonegrove, Edgware. The Hertford Nurses Bureau, 45 Manor Road, Barnet. The Finchley Nurses Co-operation, 24 Eton Avenue, N.12. Nul-Sal Agency, 335 Long Lane, N.2. were inspected during the year and their licences renewed. Priority Dental Services The number of expectant and nursing mothers and children under 5 years of age receiving dental treatment at clinics continued to decline due to the greater number of patients seeking free treatment from their own private dental practitioners. Attendances and Treatment Children under 5 Expectant and Nursing Mothers First Visit 643 117 Subsequent Visits 763 214 Total Visits 1406 331 Number of additional courses of treatment commenced 27 9 Treatment Provided: Number of fillings 1175 236 Teeth filled 995 209 Teeth extracted 211 53 General Anaesthetics 104 1 Emergency visits 40 20 Patients X-rayed 6 32 Patients treated by scaling etc. 26 120 Teeth otherwise conserved 348 _ Teeth root filled _ 1 Inlays/Crowns — 1 Number of courses of treatment completed during the year 353 54 Prosthetics Patients supplied with full upper or full lower (first time) 9 Patients supplied with other dentures 28 Number of dentures supplied 37 101 Anaesthetics General anaesthetics administered by Dental Officers 3 Inspections: Children under 5 Expectant and Nursing Mothers Number of patients given first inspections 573 82 Number of patients who required treatment 297 66 Number of patients who were offered treatment 297 66 Number of Dental Officers sessions devoted to maternity and child welfare patients 212 T uberculosis The Borough is served by two chest clinics, i.e. Edgware Chest Clinic (attached to Edgware General Hospital) Chest Physician — Dr. H.J. Trenchard, and Barnet Chest Clinic (attached to Barnet General Hospital) Chest Physician — Dr. J.G. Hounslow. The Department's health visitors and T.B. visitors continued to carry out social visiting and act as liaison between the patients and the Chest Physicians. 1. Number of cases of tuberculosis under treatment or supervision at 31st, December, 1968:— Respiratory N on-Re spiratory Men Women Children Total Men Women Children Total 1800 1342 183 3325 64 77 6 147 2. Number of cases of respiratory tuberculosis (whether notified or not) included under Section 1 above which were new to the clinics (but excluding transfers from other clinics) during the year ended 31st December, 1968:— * Classification Non-Bacteriologically Confirmed Bacteriologically Confirmed Men Women Children Total Men Women Children Total Group I 25 21 91 0 137 10 6 - 16 Group II 10 3 - 13 12 4 - 16 Group III 5 2 1 8 10 3 1 14 Totals 40 26 92 0 158 32 13 1 46 0Includes 82 school children found tuberculin positive under school scheme and who had not previously received B.C.G. 102 3. Number of cases of non-respiratory tuberculosis included in 1 above, new to the clinics (but excluding transfers from other clinics) during the year ended 31st December, 1968:— Men Women Children Total 8 14 3 25 4. Number of cases included in I above, whose broncho-pulmonary secretion was positive during the year — 51 * The three sub-divisions of new respiratory cases are estimated as follows from the standard P.A. film. Group I Total area of disease not exceeding one third of one lung in aggregate. Group II Total area of disease not exceeding two thirds of one lung in aggregate. Group III Total area of disease exceeding (including miliary disease) two thirds of one lung in aggregate. Tuberculosis pleural effusions, pleural thickening, lung involvement and enlarged hilar glands are placed in Group I. The Care of the Unsupported Mother The Authority has one Mother and Baby Home, Guilford House, where 14 ante-natal and 14 post-natal beds with 14 cots are provided. No deliveries take place in the Home. Of the 112 referrals to the department, 43 were admitted to Guilford House. 19 were admitted to other Local Authority Homes and 50 were not admitted; also 65 cases were admitted to Guilford House from other Local Authorities. Family Planning A clinic and domiciliary service continued to be offered through facilities provided by the Family Planning Association. In June, the Council decided to implement the Family Planning Act, 1967 by providing a comprehensive family planning service for residents of the Borough through the medium of the Family Planning Association, who would act as the Council's full agent; the service to include the following provisions:— a) that in all medical cases advice, examination, prescriptions and supplies be given free of charge. 103 b) that in all non-medical cases advice, and examination be given free of charge but that the appropriate charge be made to these persons for prescriptions and supplie: subject to the abatement by the Council of such charge in accordance with the the appropriate assessment scales in cases of financial hardship, and that the Family Planning Association be responsible for the collecting of amounts and charges so made. c) that advice be given on request to unmarried persons under 21 years of age withou the necessity of prior consent of the parent/guardian to be obtained. d) that treatment be given to unmarried persons between 16 and 21 years of age only in cases where prior consent of the parent/guardian has been obtained. e) that the arrangements approved by the Council in February, 1967, for the provision of a domiciliary Family Planning Service in the Borough be continued. f) that the General Practitioner concerned be consulted in all cases in which oral contraceptives are proposed to be supplied or prescribed or an intra-uterine contraceptive appliance is proposed to be fitted. Cervical Cytology This service continued during the year at Torrington, Childs Hill, East Barnet and Watling Clinics and in April a fifth clinic was started at Vale Drive, Barnet. In May, further clinics were established at West Hendon and Oak Lane (Finchley). Fortnightly sessions were held at the clinics and all women who attended had a full examination of the breasts, abdomen and pelvis. 1608 Patients attended for the first time during the year and in every case the patient and her doctor were notified of the result of the test; there was one positive result and the patient was referred through the General Practitioner to a Gynaecologist for further investigation. Clinic No. of Sessions held New Cases Total No. of attendances Average attendance per session Torrington 26 2 94 327 12.6 Childs Hill 25 289 319 12.8 East Barnet 26 257 297 11.4 Watling 44 490 496 11.3 West Hendon 11 100 100 9.1 Oak Lane 10 139 146 14.6 Vale Drive 17 139 144 8.5 TOTAL 159 1608 1829 11.5 104 Vaccination and Immunisation Immunisation in Childhood Early in the year the single schedule of immunisation in childhood, recommended by the Joint Committee on Vaccination and Immunisation of which the Authority was notified by the Ministry of Health in December 1967 as advance information, was put into effect by the medical staff of the Department. The new procedures include vaccination against measles and make several important modifications affecting the minimum age at which immunisation against diphtheria/tetanus and pertussis and poliomyelitis should preferably begin, the spacing doses in the basic course of immunisation against these diseases and the spacing of subsequent re-inforcing doses. It is desirable that the basic course of immunisation against diphtheria, tetanus, pertussis and poliomyelitis, which consists of three doses of diphtheria, tetanus, and pertussis (triple) vaccine and, concurrently, three doses of oral poliomyelitis vaccine, should be completed by about the first birthday or as early as possible thereafter, consistent with the recommended spacing of the doses. The age at which the first dose is given is important and so are the intervals between doses. The desirable intervals between the doses of the basic course are six weeks between the first and second doses and six months or more between the second and third doses. These intervals offer optimum protection from three doses and render unnecessary the giving of a re-inforcing dose during the second year of life. These recommended procedures were confirmed by the receipt, in August, of Ministry of Health Circular 29/68 which also included a revised list of vaccinations and immunisations and associated fees for the purpose of determining payments due to General Practitioners. Statistical tables of the immunisation of persons under the age of 16 are given below:— Table 1. Completed Primary Courses Type of vaccine or dose Year of Birth Others under age 16 TOTAL 1968 1967 1966 1965 1961-64 1. Quadruple D.T.P.P. _ _ _ _ _ 2. Triple D.T.P. 309 1546 143 20 98 35 2151 3. Diphtheria/Pertussis — 7 — — — - 7 4. Diphtheria/Tetanus 30 219 31 8 91 61 447 5. Diphtheria — — 1 — — — 1 6. Pertussis — 1 3 — — — 4 7. Tetanus _ 1 1 — 9 386 397 8. Salk _ — — — — — — 9. Sabin 280 1782 209 59 207 108 2645 10. Measles 19 467 579 470 1256 212 3003 11. Total immunised against Diphtheria (Lines 1-2-3-4-5) 346 1772 175 28 189 96 2606 12. Total immunised against Whooping Cough/Pertussis (Lines 1-2-3-6) 309 1554 146 20 98 35 2162 13. Total immunised against Tetanus (Lines 1-2-4-7) 346 1766 175 28 198 482 2995 14. Total immunised against Polio (Lines 1-8-9) 280 1782 209 59 207 108 2645 105 Table 2. — Re-inforcing Doses Type of vaccine or dose Year of Birth Others under age 16 TOTAL 1968 1967 1966 1965 1961-64 1. Quadruple D.T.P.P. _ 2. Triple D.T.P. 779 114 8 104 494 97 2622 3. Diphtheria/Pertussis — 1 37 38 4. Diphtheria/Tetanus _ 126 245 56 1994 1115 3536 5. Diphtheria — — — 2 19 129 150 6. Pertussis — — — _ — — — 7. Tetanus — — — 1 28 907 936 8. Salk — - — — - — 9. Sabin — 799 1200 116 2313 2219 6647 10. Measles — — — — - — — 11. Total immunised against Diphtheria (Lines 1-2-3-4-5) - 905 1393 163 2544 1341 6346 12. Total immunised against Whooping Cough/Pertussis (Lines 1-2-3-6) - 779 1148 105 531 97 2660 13. Total immunised against Tetanus (Lines 1-2-4-7) — 905 1393 161 2516 2119 7094 14. Total immunised against Polio (Lines 1-8-9) - 799 1200 116 2313 2219 6647 B.C.G. Vaccination against Tuberculosis To enable the B.C.G. vaccination of school children to be integrated into the latest schedule of immunisation, the age at which this protection is offered was advanced by one year with the necessary adjustment being carried out during the course of the year. School children and students were vaccinated at school and at establishments for further education by the Department's medical staff and contacts of tuberculosis were vaccinated at Chest Clinics in the Borough. Young immigrants arriving in the Borough during the year were offered a tuberculin test; where the result was positive arrangements were made for further investigation and supervision at a Chest Clinic. Tuberculin Test and B.C.G. Vaccination No. of persons vaccinated through the Authority's approved arrangements under Section 28 of the National Health Service Act (a) CONTACTS (i) No. skin tested 230 (ii) No. found positive 37 (iii) No. found negative 193 (iv) No. vaccinated 150 106 (b) SCHOOL CHILDREN AND STUDENTS (i) No. skin tested 3145 (ii) No. found positive 379 (iii) No. found negative 2603 (iv) No. vaccinated 2585 Whooping Cough Vaccination The Authority continued to co-operate in the investigation by the Public Health Laboratory Service of the sero-types currently responsible for cases of Whooping Cough. Smallpox Vaccination There were no reports of cases of generalised vaccinia or post-vaccinal encephalomyelitis or death from any other complications of vaccination. Smallpox Vaccination Persons aged under 16 Age at date of Vaccination Number of persons vaccinated or re-vaccinated Number Vaccinated Number Re-Vaccinated 0— 3 months 17 — 3— 6 months 14 — 6— 9 months 28 — 9—12 months 78 — 1 year 2039 - 2— 4 years 329 125 5—15 years 96 539 TOTALS 2601 664 107 CLINIC PREMISES Main Clinics Clinic Sessions (See Key Table on page 109) Brunswick Park Road, N.ll. I.W.C. D OPH SP C.S.C. Town Hall, Hendon, N.W.4. C.S.C. A/N OPH ORT D CHIR I.W.C. A/NE-M/C SP Garth Road, N.W.2. C.S.C. DV I.W.C. C SP CHIR A/N A/NE-M/C D 149 East Barnet Road, Barnet I.W.C. A/NE-M/C C.S.C. D C SP Holly Park, N.ll. D DV I.W.C. CHIR C.S.C. T SP A/N Hartley Avenue, N.W.7. SP DV D CHIR I.W.C. A/NE-M/C C.S.C. A/N Oak Lane, N.2. SP A/N D C I.W.C. T C.S.C. CHIR OPH A/NE-M/C Oakleigh Road, N.20 I.W.C. A/NE-M/C C.S.C. A/N DV T Sutton Road, N.10 I.W.C. T C.S.C. A/NE-M/C A/N DV SP Torrington Park, N.12. I.W.C. CHIR C.S.C. A/NE-M/C A/N C SP Vale Drive, Barnet SP DV D C I.W.C. ORT C.S.C. A/NE-M/C OPH 36 Cressingham Road, Burnt Oak CHIR OPH A/NE-M/C SP A/N D C I.W.C. T C.S.C. C.E. York Road, N.W.9. SP c D C.E. I.W.C. CHIR C.S.C. A/NE-M/C A/N Claremont Way, N.W.2. I.W.C. T Approach Road, Edgware SP CHIR I.W.C. A/NE-M/C C.S.C. A/N C Other Premises Etchingham Park Road, N.3. I.W.C. CHIR St. Andrew's Church Hall, Lynford Gardens, Edgware I.W.C. DV A/NE-M/C 108 Other Premises (continued) St. Stephen's Hall, I.W.C. Bells Hill, Barnet Dollisfield, Totteridge Lane, I.W.C. N.20. United Free Church Hall, I.W.C. Sanders Lane, N.W.7. St. Barnabas Church Hall, I.W.C. DV Cranbourne Gardens, N.W.ll. St. Mark's Hall, I.W.C. Woodville Road, Barnet Congregational Church Hall I.W.C. Colin Close, N.W.9. St. Mary Magdalen Church Hall I.W.C. Holders Hill Road, N.W.4. KEY TABLE I.W.C. Infant Welfare Clinic C.S.C.Consultative School Clinic A/N Ante-Natal Clinic C.E. Clinic for Elderly OPH Ophthalmic SP Speech Therapy A/NE Ante-Natal Exercises only M/C Mothercraft only A/NE-M/C Combined Ante-Natal Exerciscs and Mothercraft ORT Orthoptic D Dental CHIR Chiropody DV Development Clinic T Toddlers Clinic C Cervical Cytology S.I.C Special Investigation Clinic 109 SCHOOL HEALTH SERVICE SCHOOL HEALTH SERVICE Introduction The continuation of regular medical inspections for those children in attendance at Local Authority Schools has been maintained; any treatment needed being available at clinics or readily and freely obtainable through facilities provided under the National Health Service Act, 1946. In accordance with the duty laid on the School Health Services of the Local Educatioi Authority, to ascertain which children in their area require special educational treatment, during the year, 83 children were reported to the Authority as suffering from a disability requiring some form of special educational treatment. The School Health Service continues in its endeavour to co-ordinate available services to the benefit of the handicapped children in the Borough. School Population The school population continued to increase during the year and the following table shows the position at 31st December, 1968. Schools No. of Pupils 89 Primary Schools 23,770 19 Secondary Modern and Bilateral Schools 10,478 14 Grammar Schools 7,693 1 Residential Special School (E.S.N.) 176 2 Day Special Schools (E.S.N.) 243 42,360 Periodic Medical Inspections The policy of the Authority for the routine medical inspection of school entrants and leavers together with an intermediate examination during the last year at the primary school has continued. Assistant Medical Officers are encouraged to maintain a close contact with the schools and Head Teachers are aware that any problems they have may be discussed with the Medical Officers. 113 The following table shows the number of children inspected by years of birth and the state of their physical condition:— Year of Birth Number of Pupils Inspected Physical Condition of Pupils Inspected Satisfactory Unsatisfactory 1964 & later 286 286 — 1963 2,149 2,147 2 1962 1,752 1,752 - 1961 457 456 1 1960 237 236 1 1959 194 193 1 1958 1,336 1,336 - 1957 1,855 1,853 2 1956 667 665 2 1955 283 283 - 1954 2,012 2,011 1 1953 & earlier 1,139 1,139 - TOTAL 12,367 12,357 10 Percentage of pupils inspected whose physical condition was found:— Satisfactory 99.92% Unsatisfactory 0.08% Medical Treatment Details of treatment (excluding uncleanliness and dental disease) of pupils attending maintained primary and secondary schools (including arsery and special schools), whether provided directly by the Council or arranged for through other agencies, are contained in the Tables of statistics which follow this section of this Report. Ophthalmic Clinics There are five school ophthalmic clinics operating in clinics dispersed throughout the whole of the Borough and an orthoptic service is provided at two of these clinics. As the Ophthalmologists working in the school ophthalmic service are employed by the North West Metropolitan Regional Hospital Board they also work in hospital. Therefore, any eye examinations which can be undertaken outside hospital can be carried out in the Authority's clinics with a resultant saving in time and journeys for both children and parents. The obvious advantage of this system is in its promotion of early diagnosis and supervision of children with defective vision. Audiometry Three routine hearing tests are carried out during the school life of children in schools 114 in the Borough by two Audiometer Operators who also deal with those children suspected of having a hearing loss. The following Table shows the number of pupils whose hearing has been tested: — Sweep tests 9,597 Re-tests 806 Special tests 799 Re-tests 159 Audiology Those children requiring further investigation for a loss of hearing are referred to one of the audiology units established in the London Borough of Haringey and the London Borough of Brent. The Peripatetic Teachers for the Deaf attached to the units visit those children in schools in this Borough who are in the care of the units and require supervision or training. The demand for a Peripatetic Teacher to supervise children in school, and at home, who are in the care of Consultants at various London Hospitals still exists. Unfortunately, although the Local Authority agreed to the appointment of a Peripatetic Teacher of the Deaf to care for these children for whom adequate help is not available, it has not yet been possible to fill the post. During the year 13 children were provided with hearing aids and at the end of the year 85 school children and 10 children under school age (6 of whom were attending the Local Authority Day Nurseries) were known to have hearing aids. Child Guidance Service In July a Child Guidance Service was established in the Borough under the joint administrative responsibility of the Chief Education Officer and myself. Dr. A.D. Black was appointed by the North West Metropolitan Regional Hospital Board as the Consultant Child Psychiatrist for three sessions a week in the Local Authority Clinics at:— 304, Regents Park Road, Finchley, N.3. and The Health Centre, Vale Drive, Barnet, Herts. 115 Prior to the establishment of the Authority's service arrangements were made for children to be seen at Child Guidance Clinics held at:— The Child Guidance Training Centre The Hampstead Child Therapy Clinic The Tavistock Clinic University College Hospital Working in close conjunction with the Child Guidance Service the Authority opened the Diagnostic Unit, Smith's Field, East End Road, N.3. for the education of children with severe learning problems, certain minor or severe behaviour problems. The link between the Unit and the full facilities of the Child Guidance Service being through the Senior Educational Psychologist. Speech Therapy The speech therapy service in the London Borough of Barnet has an establishment of five speech therapists who work within the school health service at clinics and special schools in the district. The speech therapists are responsible for the diagnosis and treatment of speech and language disorders. These may arise from organic or emotional problems resulting in the inability of the patient to communicate either adequately or intelligibly. The therapists however cannot concentrate all their attention on the treatment of the specific speech disorder alone, and must look for all the possible causes of speech defect, be they psychological or physiological. The abilities of the patient in all language concepts must be assessed before an adequate diagnosis can be reached, advice to parents proffered and the correct treatment implemented. While the therapists are themselves capable of dealing with most aspects of such an assessment, to obtain a complete assessment they must of course rely on colleagues in other departments, such as the Educational Psychologists, for help in respect of their own specialties. The therapists are indeed grateful for the co-operation they have always received from these departments. i The age of the children seen in the speech therapy clinics ranges from three years to school leaving age although the majority of children who receive regular treatment are between the ages of five and seven years. Some may, however, be referred as early as two and a half years old, if there is any cause for concern. Indeed, therapists would prefer referrals at an early age, not necessarily for the purposes of regular therapy but to give advice and guidance to parents thus alleviating any anxiety and avoiding the possibility of lengthy treatment in the future. 116 Children with speech and language disorders are generally referred to the speech therapist by the school medical officers following medical examinations, although the therapists themselves, following school visits, often have children referred to them by the Head Teachers. The following is a list of the types of disorders treated by the therapists. Disorders of Articulation. Dyslalia, dyseneia, dysarthia and articulation defects due to structural abnormalities such as a cleft palate. Disorders of Language. Developmental dysphasia and retarded language development, the latter being very common particularly amonst children in special schools. Indeed it is also felt that some disorders of arciculation are closely linked with retarded language development. At this stage it may be pointed out that speech therapists are aware of the growing problem of language difficulties amonst Immigrant children who are faced with the problems of learning a new language. Disorders of Voice. Dysphonia or impairment of voice such as excessive nasality and puberphonia (failure in development of the normal adult voice). Disorders of Speech Fluency. Most well known is that of stammering. Not so well known is the disorder of non fluency most common amon g children of pre-school age. This is often, and wrongly, diagnosed as stammering. However, if it is incorrectly handled it can often prove to be the fore-runner of a stammer. In closing it must be mentioned that while it is possible, following the Seebohm Report, that the format of the service and the present role of the speech therapist will change, the aims will not. These are to offer advice and treatment where necessary to those patients who are handicapped by speech and language disorders. Handicapped Pupils Section 34 of the Education Act, 1944, makes it a duty of the Local Education Authority to ascertain what children in the area require special educational treatment and to provide such treatment. The various categories of handicapped pupils are defined by The School Health Service and Handicapped Pupils Regulations, 1959, as follows:— Blind Epileptic Partially Sighted Maladjusted Deaf Physically Handicapped Partially Hearing Delicate Educationally Subnormal Children suffering from Speech Defects Special educational treatment being provided either in special school or, otherwise, by special methods appropriate to the handicap of the particular child. 117 The following Table shows the Number of handicapped pupils as at 31st December, 1968 Special Day Schools Special Residential Schools Maintained Primary & Secondary Schools Independent Schools Not at School Total b. g- b. g- b. g- b. g- b. g- b. g. Blind _ 2 6 2 - - - - - 6 4 Partially Sighted 3 4 — _ 1 2 1 _ 4 7 Deaf 2 3 2 5 — — — — 3 — 7 8 Partially Hearing 8 8 1 - 2 1 - 1 2 1 13 11 Delicate 8 2 7 7 - - 3 - - - 18 9 Educationally Subnormal 97 68 23 6 2 1 - - 2 — 124 75 Epileptic - - 4 - - - - - - - 4 — Maladjusted 4 1 39 14 8 3 3 1 2 2 56 21 Physically Handicapped 24 11 10 6 3 1 - - 4 5 41 23 Speech Defects - - - 1 — — — - — — — 1 Total No. Handicapped Pupils 146 99 92 41 16 8 6 3 13 8 273 159 Special Transport to School Section 55 of the Education Act, 1944, allows for the provision of transport to facilitate the attendance of pupils at school and, during the year, special transport was recommended on medical grounds for 35 children attending ordinary schools. The length of time for which the transport was required varied according to the needs of the individual cases Home Tuition During the year 12 children were recommended home tuition, under Section 56 of the Education Act, 1944, for varying periods in accordance with their disability. SCHOOL HEALTH SERVICE STATISTICAL TABLES PUPILS FOUND TO REQUIRE TREATMENT AT MEDICAL INSPECTION (excluding dental disease and infestation with vermin) Year of birth For defective vision (excl. squint) For any of the other conditions recorded Total Individual Pupils 1964 and later 2 13 14 1963 76 148 214 1962 83 148 218 1961 22 39 59 1960 16 19 32 1959 12 17 28 1958 127 146 244 1957 164 150 293 1956 78 57 123 1955 32 16 42 1954 269 138 364 1953 & earlier 147 69 201 TOTAL 1,028 960 1,832 118 PERIODIC INSPECTIONS Defect Code No. Defect or Disease Entrants Leavers Total incl. all other age groups Special Inspections 4 Skin T O T O T O T O 24 70 26 24 100 141 4 3 5 Eyes: (a) Vision 180 434 385 131 1028 831 123 128 (b) Squint 60 24 10 6 104 49 3 6 (c) Other 6 7 2 2 19 31 2 — 6 Ears: (a)Hearing 43 151 20 17 91 237 22 71 (b) Otitis media 8 48 2 3 15 68 _ 1 (c) Other 3 8 3 1 10 12 - — 7 Nose & Throat 27 156 7 25 43 230 16 6 8 Speech 67 65 4 3 100 88 26 10 9 Lymphatic Glands 1 27 1 - 4 34 - 1 10 Heart 4 55 8 15 17 103 3 2 11 Lungs 11 73 8 18 30 143 2 4 12 Developmental: (a) Hernia 9 11 - 2 12 18 1 2 (b)Other 7 106 2 - 37 162 9 13 13 Orthopaedic: (a) Posture 1 20 17 29 86 87 3 2 (b) Feet 13 44 29 31 80 119 3 6 (c) Other 5 26 3 10 14 50 1 2 14 Nervous System: (a)Epilepsy 1 11 3 3 9 31 1 (b) Other 9 1 1 22 - 1 15 Psychological: (a) Development _ 25 2 8 4 64 2 10 (b)Stability 2 53 2 14 14 122 6 6 16 Abdomen 1 11 - 3 3 21 - - 17 Other 50 130 52 43 191 297 21 35 *T — requiring Treatment 0 — requiring Observation 119 TREATMENT OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (including Nursery and Special Schools) GROUP 1: Eye Diseases (e.g. blepharitis, conjunctivitis), Defective Vision and Squint (a) External & other, excluding errors of refraction & squint No. of cases known to have been treated 8 (b) Errors of refraction, including squint 2,526 TOTAL: 2,534 (c) No. of pupils for whom spectacles were prescribed 881 GROUP 2: Diseases and Defects of Ear, Nose and Throat Received ope rative treatment for: (a) Diseases of the ear - (b) Adenoids and Chronic Tonsilitis 36 (c) Other nose and throat conditions 7 Received other forms of treatment - TOTAL: 43 Total No. of pupils in schools who are known to have been provided with hearing aids: (a) in 1968 13 (b) in previous years 72 GROUP 3: Orthopaedic & Postural Defects No. of pupils known to have been treated in clinics or at out-patients departments - GROUP 4: Diseases of the skin (excluding uncleanliness) Ringworm (i) scalp 1 (ii) body - Scabies 13 Impetigo 10 Other skin diseases - TOTAL: 24 GROUP 5: Child Guidance Treatment No. of pupils treated at Child Guidance Clinics 266 GROUP 6: Speech Therapy No. of pupils treated by speech therapists 561 GROUP 7: Other Treatment given: (excl. B.C.G. vaccination) (a) Minor ailments 26 (b) Convalescent treatment under School Health Service arrangements 30 TOTAL: 56 Education Act 1944 - Section 57 Cases dealt with under Section 57, Education Act, 1944 3 Cases de-notified under Section 57(a) Education Act, 1944 Nil 120 REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER When considering the Dental Health of a child, one tends to underestimate the damage which can be caused by poorly aligned teeth. In general terms poorly aligned teeth form the basic of orthodontic treatment. The causes of teeth being irregular are many and varied. These causes are looked for by the Dental Surgeon and attempts to eliminate them are constantly being made. When, however, the teeth are not normally positioned in the mouth, the proper cleaning of the teeth can be difficult, which leads to eventual loss. This makes orthodontic treatment a very vital part of dentistry. The more regular form of the dental arch, does much to eliminate food particles between teeth, and thus reduces gum disease. The progress of some gum diseases is such that premature loss of teeth occurs. As much of this kind of disease can be prevented by orthodontic treatment, it is important that this treatment should have a firm place in our School Dental Service. With this in mind consideration is being given to increase further this service within the Borough. In July 1968 the Cressingham Road Dental Clinic, in common with the rest of that Clinic, closed down for alterations. Dental Surgery No.2 at Mill Hill Clinic was used as a base for operations, and the Dental Surgeon carried out her duties for Cressingham Road Clinic from Mill Hill. During the year the Quinquennial Survey was conducted in the Borough. The full result of this is shown on Page 123. A Pre-School Children's Nutritional Survey was carried out by the Department of Health and Social Security. The results of this will be made known at a later date. Equipment An X-Ray machine and a new cabinet were added to the equipment at Watling Clinic. Dental Laboratory The Dental Laboratory continued to supply the various apparatus required by the dental surgeries and in addition prosthetic work for the London Borough of Enfield and Haringey; with regard to the latter however this discontinued in September, 1968. 121 Ages 5-9 Ages 10-14 Ages 15 & over Total Attendances & Treatment: First visit 4091 3173 692 7956 Subsequent visits 6217 7347 2241 15805 Total visits 10308 10520 2933 23761 Additional courses of treatment commenced 353 182 60 595 Fillings in permanent teeth 3094 6789 2572 12455 Fillings in deciduous teeth 7186 638 7824 Permanent teeth filled 2460 5983 2079 10522 Deciduous teeth filled 5874 552 6426 Permanent teeth extracted 83 472 137 692 Deciduous teeth extracted 1438 781 2219 General anaesthetics 1014 386 44 1444 Emergencies 318 153 31 502 Prosthetics: Pupils supplied with full upper or full lower (first time) Pupils supplied with other dentures (first time ) 2 4 7 13 Number of dentures supplied 2 4 7 13 Number of pupils X-rayed 738 Prophylaxis 1794 Teeth otherwise conserved 3420 Number of teeth root filled 78 Inlays 25 Crowns 116 Courses of treatment completed 6060 Orthodontics: New cases commenced during year 303 Cases completed during year 107 Cases discontinued during year 72 No. of removable appliances fitted 484 No. of fixed appliances fitted 67 Pupils referred to Hospital Consultant 5 [Anaesthetics General anaesthetics administered by Dental Officers 50 122 Inspections: a. First inspection at school No. of pupils 31019 b. First inspection at clinic No. of pupils 2389 No. of a. and b. found to require treatment 13784 No. of a. and b. offered treatment 13784 c. Pupils re-inspected at school or clinic 1094 No. of c. found to require treatment 601 Sessions: Sessions devoted to treatment 4640 Sessions devoted to inspection 241 Sessions devoted to Dental Health Education 137 Quinquennial Survey of Dental Caries in School Children 12 year old children (i) No. of children examined Hendon Finchley 500 120 (ii) No. of children showing no D.E.M. Permanent Teeth 16 3 (iii) No. of children D.E.F. Permanent Teeth Found 3064 647 (iv) No. of children D. Permanent Teeth Found 694 175 (v) No. of children E. Permanent Teeth Extracted 315 364 (vi) No. of children F. Permanent Teeth Filled 2055 408 (vii) The Percentage of children showing no D.E.F. 3.2% 2.5% (viii) Average No. of D.E.F. Teeth per child examined 6.12 4.29 GENERAL SERVICES GENERAL SERVICES Health Education The need for education in health matters is no less essential today than it was in the Dark Ages, when life was "nasty, brutish and short". Indeed, man has not yet reached that highest state of well-being that might have been expected from such rapid changes in environment and in medical knowledge. The sicknesses of yesterday have been largely mastered, only to be replaced by others, most of which are avoidable by the individual himself. The gap between health knowledge and health practice, however, appears to be widening. Education in health, therefore, is of prime importance, and the staff of the Health Education Section of the Department is aware of the responsibility it holds to make every effort to improve the general level of personal and community health through a programme of education. Health Education in School Recent years have seen increased awareness of the importance for all children of the feeling of stability, goodwill and enjoyment that accompanies the satisfaction of their physical, mental and social needs — for all are involved. With this in mind, staff of the local health authority, i.e. Health Visitors, Health Education Officers and others participated in health education programmes in schools. In Primary Schools, the children are helped to an understanding of health and the functions of their bodies, ways in which they can maintain good functioning and the abuses or neglect which will prevent good health. The approach in Secondary Schools is somewhat different. The concern of health education with the physical and emotional changes of adolescence are self-evident. Whilst there is still as much need for strengthening of good habits, there is also a need to influence the pupils to make proper use of the new forces which are at work in them, and prepare them for adult life. Most of the schools, where Health & Welfare Department staff were teaching health subjects, had a full year's programme, whilst a few asked for shortened programmes or occasional talks. The subjects covered included the effects of smoking, alcohol and drugs on physical, mental and social life, education for family life (covering sex education, childbirth and child care), human relationships and mental and social health. 127 Below are details of school courses which were undertaken during the year. Primary Schools: 10—11 year old pupils Full year's courses 9 One or two term courses 1 Short courses 2 Secondary Schools: 13—15 year old pupils Full year's courses 7 Occasional talks 3 Grammar Schools: 16—18 year old pupils Occasional talks 3 Special Schools: (Educationally Subnormal, Junior Training Schools) Short courses 2 Health Education in Clinics Parentcraft Classes in relaxation and parentcraft for expectant mothers continued during the year in many clinics. These were undertaken by Health Visitors, supported by the Health Education Section. In support of these classes, the film "To Janet — A Son?" was shown on alternate months in the evenings for expectant mothers and their husbands at two parts of the Borough. Mothers and Toddlers Groups The purpose of these groups is to enable mothers to get together to discuss a variety of subjects and problems concerned with the well-being of the family, together with other items of interest, giving them an opportunity of making friends and sharing experiences. Health topics feature continuously in the arranged programmes. Clinics for the Elderly These clinics serve a good purpose in that not only are the old folks 'screened' by the Doctor, but also that they are able to meet together for mental stimulation in which matters concerning their health are frequently introduced. Support in the form of films and other aids and help was maintained by the Health Education Section. 128 Health Education in other Organisations Talks or discussions in small groups are of tremendous importance in health education, since the effect is more likely to be successful in changing attitudes and inculcating new habits. During the year, talks to a wide variety of groups and organisations within the community were given and a synopsis is given below. Groups requesting talks Youth Organisations, Clubs etc. 59 Young Wives Groups, Women's and Men's Organisations 32 Parent/Teacher Associations 5 Old People's Clubs 13 Synopsis of subjects covered Health and Welfare Services 20 Health of the Elderly 10 Home Safety 44 Smoking and Health 9 Personal Health 5 Child Growth and Development 11 Drug Use and Abuse 3 Food Hygiene 7 General Publicity A monthly programme of health subjects for general distribution was arranged with posters and leaflets being sent to all Borough establishments. Special publicity was given to Safety with fireworks and Christmas safety. Many requests for health education material came from various sections of the community, namely teachers, leaders of organisations and students in training. Displays and Exhibitions Window displays and exhibitions were assembled on the themes given below. March The Services of the Department June Mental Health July Home Safety Gateway House, 322 Regents Park Road, N.3. Mental Health Week Youth Conference Finchley Carnival 129 August The Services of the Department October Safety with fireworks Friern Barnet Summer Show Gateway House, 322 Regents Park Road, N.3. and Town Hall, Friern Barnet Campaigns Dental Health Campaign in Primary Schools In October almost all primary schools in the Borough had a visit by Pierre, the clown, organised by this Section. Visiting six or eight schools a day, Pierre put across an instructive yet amusing lesson in dental health. Every child received painting sheets, an Apple Club badge and an apple. This schedule covered two weeks and was most popular with the schools. The aim of this campaign was to stimulate interest in dental health, the intention being to follow up with more intensive teaching of the subject the following year. In-Service Training in Health Education Students and staff taking courses are frequent visitors to the Health Education Section, seeking help in projects which their course requires of them and where possible, assistance is given. Film reviews were arranged from time to time. A course in Psycho-Physical preparation for childbirth was arranged for Health Visitors and Midwives. Home Safety There is a continued need for education in the dangers within the home and the ways in which these can be overcome. Both local and national statistics prove that as one cause of home accidents is eradicated, another one takes its place. Many of these are caused by a constant flow of new articles appearing on the market which are found to be unsafe, or by hazards in the home, but the majority are caused by the human factor. 130 Education in safety at home, bearing in mind the need to guard the very young and the old, continued and increased. General Publicity Posters and leaflets supporting the quarterly campaigns of RoSPA were distributed. Special emphasis was made at Guy Fawkes Night and at Christmas. Training and Talks Talks to various groups and organisations were undertaken. Many of these were to youth groups, i.e. Girl Guides, Scouts, Cubs and Brownies, Girls Brigade and youth clubs. Others included mothers' groups, old people's groups and influencial groups such as St. John's and Red Cross. Talks on Home Safety were given in schools and frequently in the courses of health teaching given by Health Visitors. Campaigns Disposal of Medicines Campaign A campaign urging the public to turn out their cupboards and return old medicines and tablets to their local chemist was held for two weeks in April. Some of the pharmacists in the boroough agreed to participate by receiving a 'dump box' for use in their shop, in which was placed the returned material. This was collected for disposal by the Health Education Staff. In order that the effort may be evaluated, the material was weighed and the tablets counted; some 22, 000 tablets were destroyed emphasising not only the danger that lurks in the cupboards and drawers of the homes in our community, but also the wastage. It is considered that the effort was worth while if only one child or other person was saved from accidental poisoning. Finchley Carnival and Friern Barnet Summer Show This year, at the Finchley Carnival, a float was entered in the procession, the theme being 'The facts about home accidents'. It showed the need to guard the young and old. At both events a display was mounted and free literature disseminated and a children's competition was again organised. This attracted a large number of children on both occasions in spite of the weather and it is considered that many children were made aware of the hazards at home. Displays The occasion of Guy Fawkes' Night is always fraught with apprehension, knowing 131 the danger it hazards. Consequently displays were mounted in the windows of Gateway House, 322 Regents Park Road, N.3 and at the Town Hall, Friern Barnet. A small display was also arranged for a series of talks on home safety at St. John's Ambulance Brigade at Edgware. Barnet Civic News A series of 'Home Safety Tips' appeared in the Bi-monthly issues of the Barnet Civic News. These featured the cartoon drawings of 'Safety Sam' by a young cartoonist, providing a humourous illustration to the serious message to be conveyed. SPECIAL INVESTIGATION CLINIC During 1968 the number of patients referred to the Special Investigation Clinic continued to increase. The majority of the referrals were because of severe nocturnal enuresis, and the remainder were due to diurnal enuresis or encopresis. The mode of treatment if orientated on the lines of Learning Theory and Behaviour Therapy and the figures shown give evidence of the success of this approach. The relapse rate for the year 1968 was 25%, which is somewhat lower than is generally accepted for this therapy. Two research psychologists are attached to the clinic on a voluntary basis and investigations are proceeding on medico-social variants in relation to enuresis, and application of high — low tone conditioning techniques. Other studies being undertaken are of personality assessment and preventive mental health and the value of overlearning to reduce relapse. The main percentage of referrals are via the medium of the school health service, but in each case the general practitioner is contacted before a patient is appointed. There is now also a tendency for some of the general practitioners to make their own referrals direct to the clinic. Statistics year ending 31st December, 1968 BOYS GIRLS TOTAL No. of new patients seen: Under 5 4 1 5 5-9 108 52 160 10 & over 21 12 33 133 65 198 132 Statistics — continued BOYS GIRLS TOTAL Total attendances 826 361 1187 No. of 1st appointment failures 38 34 72 Total appointment failures 339 182 521 Referrals: Under 5 17 4 21 5-9 97 67 164 10 & over 33 15 48 Total 147 86 233 Discharged Cases 93 55 148 (Of these, discharged for second time) 4 3 7 Relapsed Cases Discharged 1967: 3 3 Discharged 1968: 22 15 37 Total 25 15 40 Total Sessions: 110 Total Appointments: 1708 Average appointed number /sessions: 16 ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT The total number of establishments registered at the end of the year under Part XII of the Middlesex County Council Act, 1944, was 27. PERSONS IN NEED OF CARE AND ATTENTION Provision is made under Section 47 of the National Assistance Act 1948 as amended by the National Assistance (Amendment) Act 1951 for securing the necessery care and attention in hospital or other place, e.g. residential accommodation provided under Part III of the Act, for persons who are infirm or suffering from a serious chronic disease and who are unable to give themselves sufficient care nor are receiving it from other sources. Fortunately, it was not necessary to apply the statute in respect of any case during the year. 133 BURIAL AND CREMATION Under Section 50 of the National Assistance Act 1948 it is the duty of the local authority to cause to be buried or cremated the body of any person who has died in or been found dead in the area, in any case where it appears to the authority that no suitable arrangements for the disposal of the body have been or are being otherwise made. The expenses incurred may be recovered from the estate of the deceased persons, by death grant subject to the contribution conditions being satisfied, or from any person who for the purposes of the Act was liable to maintain the deceased person immediately before his death. Nine cremations or burials were carried out during the year. CREMATION CERTIFICATES The Medical Officer of Health, Deputy Medical Officer of Health and a Senior Medical Officer are appointed Medical Referees under the Cremation Acts 1902 and 1952. During the year 962 certificates were examined and approved, this being an increase of 215 over the previous year. DOMICILIARY LAUNDRY SERVICE This service is available to assist families to care for the elderly, or to nurse chronically sick people of any age at home. The cleansing and laundering of soiled linen and clothing is carried out by the Hendon Group Hospital Management Committee at Colindale Hospital. A once a week collection and delivery is dealt with by the Department. At the end of the year 28 persons were receiving assistance. MEDICAL ASSESSMENTS AND EXAMINATIONS (STAFF HEALTH SERVICE) During 1968 discussions continued to take place in regard to the inauguration of a Staff Health Service and it is hoped that during 1969 a scheme will be implemented on the following lines: (a) The service would be operated by the Medical Officer of Health. (b) All employees, other than casual employees engaged for limited periods, would be medically assessed before commencing employment. 134 (c) Medical assessment of any employee would be obtainable by a Chief Officer at any time from the Medical Officer of Health (in normal circumstances within one week of request). (d) Chief Officers would refer to the Medical Officer of Health for a report and recommendation on (i) any employee who had been absent through sickness for periods aggregating to more than three months in any period of twelve months; (ii) any employee frequenty absent for short periods of sickness, especially such where the submission of Medical Certificates was not required. (e) In all cases where employees are to be medically examined by the service, the employee's own General Practitioner would be advised and invited to attend the examination or submit any relevant information. (f) The closest liaison would be established between employees' General Practitioners and the service. Given below are statistics in respect of medical assessments and examinations carried out during the year:— No. of medical forms assessed 2013 No. of medical-examinations — Barnet 57 — other authorities 14 No. of medical examinations carried out under Ministry of Education Circular 249/52:- (a) Teachers' first appointments 101 (b) Entrants to Training College 310 Eight medical assessments were carried out in respect of staff with prolonged absence due to illness and with a view to ascertaining whether or not they were fit to undertake the duties of their posts, or to be subject to early retirement. In six cases it was found that the staff should be subject to premature retirement on the grounds of permanent ill health. In connection with the operation of the Disabled Persons' Employment Acts 1944 and 1958, eight persons were medically examined and found suitable for registration as disabled persons. DEPARTMENTAL SPECIAL TRANSPORT During the year the Council's fleet of transport, required for conveying the elderly and 135 physically handicapped and blind persons to Craft and Choral Classes, Day and Work Centres etc., comprised six twelve-seater vehicles and one twenty-four-seater, all vehicles being provided with tail lifts. It is hoped that in 1969, three other vehicles will have been delivered and which will enable transport to be provided at the required level and in respect of rapidly developing services. As in previous years, I would again pay tribute to the excellent service received through the medium of the Borough Engineer & Surveyor's Department and acknowledge the cooperative and understanding manner in which both drivers and escorts of the special vehicles perform their duties. TRAINING COURSES During 1968 a wide variety of training courses, refresher courses, study days etc. were made available to the staff of the Department. The London Boroughs Training Committee continued to be prominent in arranging courses and study days for midwives, district nurses, school nurses and social workers. Courses and study days attended by staff inter alia embraced the following subjects:— Diploma in Public Health Diploma in Municipal Administration Social Work Course leading to the National Certificate Diploma Course for Teachers of Mentally Handicapped Children Refresher Course for Teachers of Mentally Handicapped Children Mental Subnormality Course for Head Teachers of Junior Training Schools Course for staff of Adult Training Centres Spastics Developmental Paediatrics Assessment of Hearing Loss in Children Assessment of Handicapped Children Screening tests for eye defects Maternal and Child Welfare Refresher Course District Nurse Training Field Workers' Course Case presentation for Health Visitors Midwives' Refresher Course Preparation for Childbirth Geriatrics Course for Matrons and Wardens of Old People's Homes Policy and Management of Residential Care Public Health Noise 136 Insect Control Imported Food Regulations Fuel oil firing Speech Therapy Refresher Course Epilepsy Drug taking in School Children Health Education Nursery Wardens' Course Illegitimacy Women, Family and Work STUDENT ATTACHMENTS The Department continued to provide facilities for a wide variety of student attachments and references to such attachments are made elsewhere in the Report. I would, however, draw attention to the fact that student nurses from the Friern Hospital Nurse Training School were afforded training by way of lectures and periods of observation of community care. This type of placement has enabled student nurses to understand the need for cohesion between the community and hospital services. One interesting visit made to the Department during the year was that of a member of the Department of Social Affairs, Sudan, who wished to be given knowledge of the services and administrative set-up for a combined Health and Welfare Department. The visitor was appreciative of all that she saw and was told, and which would be of benefit to her in her work in the Department of Social Affairs, Sudan. EMERGENCY CALL SERVICE The authority's Emergency Night and Weekend Telephone Service, which provides for emergencies arising in all Departments of the Council, has continued to operate with a high degree of efficiency and some indication of the importance of this service, which insofar as this Department is concerned inter alia deals with emergency calls for midwives, social welfare officers and mental welfare officers, is that in respect of the latter, 176 calls were made. 137 INDEX INDEX PAGE A Adult Training Centres 70 Animals 63 Ante-Natal Clinics 91 Atmospheric Pollution 46 Audiology 115 Audiometry 114 B BCG Vaccination 106 Births and Birth Rates 11, 17, 20, 21, 91 Blind and Partially Sighted 83 British Red Cross Society — loan of equipment 97 Burial and Cremation 134 C Cancer 19 Caravans 56 Care of Mothers and Young Children 91 Care of the Unsupported Mother 103 Cervical Cytology 104 Chest Clinics 102 Child Guidance Service 115 Child Minders 98 Child Welfare Centres 95 Chiropody 99 Clean Air 46 Clearance Areas 50 Clinics for the Elderly 83, 99, 128 Clinic Premises 89, 108 Clinic Sessions and Attendances 95 Committee Members 7 Common Lodging Houses 53 Complaints — Environmental Health 57 Compulsory Improvement Areas 51 Congenital Malformations 92 Contents 5 Cremation Certificates 134 D Day Centres for the Elderly 83 Day Centres for the Mentally I11 73 Day Nurseries 98 Day Nurseries, Private and Registered Child Minders 98 Deaf and Hard of Hearing 84 Deaths and Death Rates 12,13,14,15,16,18,19 Dental Laboratory 121 Dental Services, Priority 101 Dental Services, School 121 Disinfection and Disinfestation 65 Domiciliary Laundry Service 134 Drug Dependency 74 Dysentery 29 E. PAGE Elderly Persons 82 Emergency Call Service 137 Enuresis 132 Environmental Health Services 33 Establishments for Massage and Special Treatment 133 Exhumations 66 F Factories and Work Places 60 Family Planning 2, 103 Food 34 Food — Complaints 39 Food Hygiene 42 Food Samples, Formal and Informal 34 Food Unfit for Human Consumption 41 Friern Hospital 72 G General Practitioner — Staff Attachments 2, 89 General Services 127 Gift Furniture 85 H Handicapped Pupils 117 Harperbury Hospital 69 Hawkers 43 Health Education 127 Health Visitors 89 Health and Welfare Committee 7 Holiday Homes — Recuperative 99 Homes for the Elderly and Handicapped 81, 82 Home Help Service 96 Home Nursing 96 Home Safety 130 Home Tuition — School Children 118 Home Visiting 90 Homelessness 2, 82, 90 Hospital and General Practitioner Services 89 Hostels — Mental Health 70, 73 Houses — Compulsory Improvement 51 Houses in Multiple Occupation 49 Housing 49 Housing Accommodation 49 Housing Statistics 54 I Ice Cream 38 Immunisation and Vaccination 30, 105 Improvement Areas 51 Incontinente Pads and Clothing 97 Incontinent Laundry Service 134 Individual Unfit Houses 50 Infectious Diseases 27 141 PAGE In-Service Training Course 1 Inspections — Environmental Health 57 International Certificates of Vaccination 30 J Junior Training Schools 70 L Labelling of Food 43 Land Charges 58 Laundry Service 134 Legal Proceedings 44 Liquid Egg 38 Loan of Nursing Equipment 97 M Marie Curie Memorial Foundation 97 Markets 43 Massage and Special Treatment 138 Meals on Wheels 83 Medical Assessments and Examinations 134 Medical Inspections and Treatment (Schools) 113, 114 Mental Health — Residential Care 70, 71 Mental Health Services 1, 69 Mental Health Week 75 Mental Illness 71 Mental Subnormality 69 Mentally I11 Persons 72 Merchandise Marks 44 Midwifery 96 Milk — Registration, Licensing and Sampling 38 Mortuaries 66 Mother and Baby Home 103 Mothercraft and Relation Clinics 92 Mothers' Discussion Groups 96 N Napsbury Hospital 73 Neighbourly Help Service 98 Noise 58 Nursery Nurse Training 98 Nurses' Agencies 101 Nursing Homes, Registration 99 O Offices and Shops 59 Ophthalmic Clinics 114 Outworkers 61 Overcrowding 53 P Personal Health Services 89 Persons in Need of Care and Attention 133 Pesticide Survey 45 Physically Handicapped Persons 84 Post-Natal Clinics 91 Poultry Inspection 43 Prevalence and Control of Infectious and Other Diseases 27 Prevention of Homelessness (Problem Families) 90 PAGE Protection of Property 85 Psychiatric Hospitals 69,73 Q Quinquennial Survey of Dental Caries in School Children 123 R Rag, Flock and Other Filling Materials 62 Recuperative Holiday Homes 99 Refuse Collection and Disposal 63 Relaxation and Mothercraft Clinics 92 Rent Acts 53 Residential Accommodation — Welfare Services 81 Residential Care — Mental Health 70, 71 Rodent Control 64 S Sanitary Conveniences 62 School — Special Transport 118 School Children — Home Tuition 118 School Dental Service 121 School Health Service 113 School Medical Inspection and Treatment 113,114 School Population 113 Sewarage and Sewage Disposal 63 Shops and Offices 59 Slum Clearance and Redevelopment 51 Smallpox Vaccination 107 Smoke Control Areas 46 Social Work — Mental Health 71 Special Investigation Clinic 132 Speech Therapy 116 Staff 2, 8 Staff Health Service 134 Staff Training 1,136 Statistics — Housing 54 Mental Health Service 76,77 School Health Service 118,119,120 Vital 11,19 Stillbirths 12,22,23 Student Attachments 137 Swimming Pools 62 T Temporary Accommodation 82 Therapeutic Social Clubs 73 Transport 135 Tuberculosis 19, 29, 102 Tuberculosis BCG Vaccination 106 Typhoid Fever 29 V Vaccination and Immunisation 30, 105 Vital Statistics 1, 11,19 Voluntary Organisations 3, 75,85 W Water Supply 33 Welfare Services 81 Whooping Cough Vaccination 107 142 ■ V Printed and Pulished by Barnet London Borough Council