BRE 33 AVKD LONDON BOROUGH OF BRENT REPORT of the MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1965 E. GRUNDY, M.D., M.R.C.S., D.P.H. I CONTENTS Page COMMITTEE MEMBERS, CHIEF AND SENIOR OFFICERS 2 & 3 INTRODUCTION 4 VITAL STATISTICS, INFECTIOUS DISEASES, HEALTH EDUCATION, STAFF MEDICAL EXAMINATIONS 5 PERSONAL HEALTH SERVICES 9 MENTAL HEALTH SERVICES 14 WELFARE SERVICES 20 ENVIRONMENTAL HEALTH SERVICES 25 STATISTICAL TABLES 32 REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER 55 HEALTH AND WELFARE COMMITTEE Chairman: Councillor W. L. Wilson Vice-Chairman: „ S. C. Piddington, J.P. Alderman R. W. Kettle Councillor T. Daly E. C. Meredith „ Mrs. B. De Metz A. Otten „ L. Golding, Ll.B. Councillor J. W. Buck „ Mrs. L. Lesser Mrs. N. Clark, J.P. „ Mrs. I. Manders J. Cohen „ F. K. Martin C. K. Coles „ R. Smith A. J. Cowan „ R. D. Stone Miss D. J. Cowan „ Mrs. R. Taylor, O.B.E. Health Sub-Committee Chairman: Councillor S. C. Piddington, J.P. Alderman R. W. Kettle Councillor F. K. Martin Councillor J. W. Buck „ R. D. Stone J. Cohen „ Mrs. R. Taylor, O.B.E. Miss D. J. Cowan Old People's Sub-Committee Chairman: Councillor Mrs. I. Manders Alderman R. W. Kettle Councillor F. K. Martin Councillor J. W. Buck „ S. C. Piddington, J.P. Mrs. N. Clark, J.P. „ R. Smith Miss D. J. Cowan „ R. D. Stone „ Mrs. B. De Metz „ Mrs. R. Taylor, O.B.E. Mrs. L. Lesser Co-opted Members: Mrs. J. Cowan Mrs. J. Newcombe Mr. A. Timms (a) Mrs. L. Dunbar Mrs. M. R. Wills Mr. H. King Mr. J. Shepherd (b) (a) Resigned 27.9.1965 (b) Appointed 27.9.1965 Welfare Services Sub-Committee Chairman: Councillor Mrs. N. Clark, J.P. Alderman A. Otten Councillor C. K. Coles Councillor Mrs. B. De Metz „ Mrs. L. Lesser Mrs. I. Manders „ R. Smith Mrs. R. Taylor, O.B.E. Housing and Rent Acts Sub-Committee Chairman: Councillor J. W. Buck Alderman R. W. Kettle Councillor S. C. Piddington, J.P. Councillor R. D. Stone „ Mrs. R. Taylor, O.B.E. The Leader of the Majority Party, Councillor G. B. Swannell, and the Leader of the Minority Party, Councillor E. H. Lee, J.P., are ex-officio members of all Committees and Sub-Committees. CHIEF AND SENIOR STAFF OF THE HEALTH AND WELFARE DEPARTMENT Medical Officer of Health: E. Grundy, M.D., M.R.C.S., D.P.H. Deputy Medical Officer of Health: J. P. J. Burns, M.B., B.Ch., B.A.O., D.P.H. Senior Medical Officers— School Health: C. C. A. Jansz, M B., B.S, D.C.H., D.P.H. Mental Health: Dorothea Koffman, M.D., D.P.H. Maternal and Child Health: Vacant Chief Dental Officer: A. D. Henderson, L.D.S., D.P.D. Chief Public Health Inspector: C. G. Rothwell, M.A.P.H.I., M.R.S.H. Chief of Welfare Division: C. N. Austwick, (a) (b) (c) Chief Administrative Officer: W. R. Powley, A.R.S.H. Chief Mental Welfare Officer: R. Gookin, R.M.P.A., R.M.N, (d) Superintendent Health Visitor: Miss S. M. Connor, S.R.N., S.C.M. (e) (Resigned 21.12.65) Clinical Nursing Officer: Miss M. Craggs, S.R.N., S.C.M., Q.N., M.T.D. Day Nursery Officer: Miss G. M. K. Richardson, S.R.N, (e) Home Help Organiser: Mrs. J. M. Robbins (f) (a) Diploma in Social Studies (b) Member of Society of Audiology Technicians (c) Registered Medical Auxiliary (d) Certificate in Social Work Training (e) Health Visitors Certificate (f) University Teaching Diploma in Domestic Science. LONDON BOROUGH OF BRENT Brent House, High Road, Wembley. July, 1966. To the Mayor, Aldermen and Councillors of the Borough. Mr. Mayor, Ladies and Gentlemen, In presenting the first Annual Report of the Medical Officer of Health to the London Borough of Brent, historical considerations do not offer a field in which comment can be made, the period covered by this Report indeed includes three months at the beginning of the calendar year when many of the services were still with the original Boroughs or the County Council, and only the last nine months of the year relate to the services when they were controlled by your Council. Pre-planning consequently was necessary to collect material prior to the assumption of authority of the new Borough Council. The preliminary months of the year were fully occupied and the senior staffs more than extended to suggest establishments necessary for the whole of the Department, and the earlier months of the year also barely left sufficient time for the assimilation of some 900 staff from the three authorities whose services were to be merged and the recruitment of the staff from other London local authorities who could not be assimilated. The delineation of divisions within the Department of Health and Welfare occupied much time and occasioned considerable thought and research. The organisation of the various administrative sections to help in management of the service was a tremendous task. All these most important organisational endeavours were undertaken prior to March 1965 when the new Borough Council took office. Much of this work indeed was accomplished by officers giving service to the Council beyond what can reasonably or normally be expected from them and the thanks of the Council are due for this extraordinary and very onerous service. During the transition periods, continuation of the services to residents was a prime duty of all grades in the Department, and whilst some teething troubles were experienced and a certain lack of expertise might have been evident occasionally, nevertheless the service to the public, even in the early stages of the transition, did not suffer a deterioration. Clinical work during the change of administration and the relationships of the staffs responsible for peripheral establishments with the central department were considerably altered and only by goodwill and hard work on the part of the whole of the staff from top to bottom, was it possible to accomplish a change with so little disorganisation and with such speed. The Borough Council with foresight arranged for a central administrative building to be available from which all the health services and the welfare services could be administered ; indeed, other departments of the Council are also housed in the same block of offices and this has in no small way contributed to the smooth reorganisation of service by personal contact of officers. The move into these offices, indeed, was an operation of magnitude which will not readily be forgotten by all the staff concerned. The preparation of a Ten Year Plan, which local health and welfare authorities were first asked to produce in 1962, came suddenly to the new London Borough in 1965 and involved all officers of senior grade in a very substantial task. This was accomplished, it is true, rather later than the Ministry demanded but nevertheless in time to be included in the White Paper on Development of Community Care which has now been presented to Parliament. The changes in responsibility in Brent inevitably caused grave difficulties and tremendous tasks for the new authority in making the plans which for Brent were not a revision but a new beginning, and the results were such that a special tribute is paid in the White Paper to the energy and vision of the contributing Local Authorities. Assessing the relative priorities for Capital construction in the sphere of Welfare and Health occupied the members of the Department and Committee substantially during the year. It is thought that the Ten Year Plan represents a balanced programme of extension of services during the next decade having regard to the requirements of the area and the finance which will probably be available. In forming this scheme the Committee took into account the redevelopment in areas of the town which it is envisaged will occur during the ten years, and made appropriate provision. The integration of the services which had previously not been within the sphere of local administration, the Mental Health Service and the welfare provisions entailed very much readjustment and mature consideration. The services at the end of the year are working effectively in association with the Executive Council and the hospital services. The most warm and cordial thanks are expressed to all members of the Department of Health and Welfare for the enthusiastic and almost inspired application to duty during the period of excitement when the services were first administered and during the period of plain hard work in the inaugural months. Members of the Committee, particularly the Chairman, during the first year of working have applied themselves with vigour and knowledge to the problems involved and have been a great source of strength and inspiration during these difficult months. This Report is not the work of an individual but has involved a very large number of members of the staff in the preparation of this first Annual Report, which is an original document and for which no blue print was available as a guide. My personal expression of appreciation is due to all members of the staff, particularly on this occasion those who have assisted in the compilation of the Report. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, E. GRUNDY, Medical Officer of Health. 5 SUMMARY OF VITAL STATISTICS Area 10,927 acres Population 1961 census 295,893 Population 1965—Registrar General's mid-1965 estimate 294,850 Number of structurally separate dwellings occupied (1961 census) 81,866 Number of private households (1961 census) 97,701 Rateable value (all hereditaments) 1st April 1965 £19,794,781 Product of a penny rate, financial year 1965/66 £80,022 Live births Number 6,436 Rate per 1,000 population (crude) 21.8 (adjusted) 19.9 Illegitimate live births per cent, of total live births 14.0 Stillbirths Number 117 Rate per 1,000 total live births and stillbirths 18.2 Total live and stillbirths 6,553 Infant deaths (deaths under 1 year) 128 Infant mortality rates Total infant deaths per 1,000 total live births 19.9 Legitimate infant deaths per 1,000 legitimate live births 18.8 Illegitimate infant deaths per 1,000 illegitimate live births 26.5 Neo-natal mortality rate (deaths under 4 weeks per 1,000 total live births) 13.2 Early neo-natal mortality rate (deaths under 1 week per 1,000 total live births) 11.7 Perinatal mortality rate (stillbirths and deaths under 1 week combined per 1,000 total live and still births) 29.3 Maternal mortality (including abortion) Number of deaths 3 Rate per 1,000 total live and stillbirths 0.46 Deaths 2,960 Death-rate per 1,000 population (crude) 10.0 (adjusted) 10.9 Deaths from cancer (all forms) 681 Death rate from cancer (all forms) per 1,000 population 2.3 BIRTHS In 1965, 6,436 live births were registered, giving a crude birth rate of 21.8 per thousand estimated population. The Registrar General provides area comparability factors for use with crude birth and death rates which make allowance for the way in which the sex and age distribution of the local population differs from that for England and Wales as a whole. When the local crude rates are multiplied by the comparability factor, they are comparable with the rates for England and Wales or with the corresponding adjusted rate for any other area. When the birth factor of 0.91 is applied to the crude birth rate, the standardised rate is 19.9 which is a little above the provisional rate for England and Wales, which was 18.1 per thousand population. The percentage of illegitimate live births fell slightly from 14.5 in 1964 to 14.0. This means that one in every seven babies born in Brent was illegitimate. This is about the same as for London as a whole, but twice the National figure. STILLBIRTHS 117 babies were stillborn, giving a rate of 18.2 per thousand live and stillbirths, a little above the provisional rate for England and Wales which was 15.7. 6 DEATHS The total number of deaths was 2,960, giving a crude death rate of 10.0 per thousand population. When the comparability factor is applied, the standardised rate is 10.9, a little below the provisional rate for England and Wales which was 11.5. The number of deaths from all causes is shown in Table 1. The main causes of death and rates per thousand population are shown in Table 2. Heart disease continues to be the leading cause of death, followed by cancer. Cancer of the Lung and Bronchus Cancer of the lung and bronchus continues to be the commonest cause of fatal malignant disease. 168 men and 31 women died compared with 143 men and 42 women in 1964. It is sad to see many adolescents and school children persistently smoking in the face of all the evidence of the tie-up between cigarette smoking and lung cancer, and it is to be hoped that parents will do their utmost to discourage their offspring in this, not only by their good advice, but by good example in not smoking themselves. Bronchitis. 120 men and 44 women died from bronchitis. The sex difference in number of deaths probably relates to the heavier smoking habits of middle-aged and elderly men and to a lesser extent to conditions of dust and smoke at work. MATERNAL MORTALITY There were three maternal deaths during the year, giving a rate of 0.46 per 1,000 total (live and still) births, compared with one death last year and a rate of 0.15. The provisional rate for England and Wales was 0.25. INFANT MORTALITY In 1965, 128 children died in the first year of life—75 in the first week and another 10 in the first month. There was a slight increase in the infant mortality rate from 19.5 per 1,000 live births to 19.9, which was a little above the figure for England and Wales (19.0). The perinatal mortality rate also increased slightly from 28-0 to 29-3, which again was above that for England and Wales (26.9). By Wards (Table 3) The worst wards were St. Raphael's, Brondesbury Park, Manor, Chamberlayne and Kilburn, which all had rates between 30 and 34 per 1,000 live births, but too much significance should not be placed on these figures in view of the small number involved. However, there is no doubt that an improvement in social conditions in some wards would certainly reduce the mortality. Causes of Death (Table 4) Prematurity was again the most important single factor in infant mortality; 45 premature babies died (35 per cent. of total infant deaths). Respiratory infections caused the second largest number of deaths (26). Antibiotics and improved environmental conditions have decreased the rate from this cause considerably over the past few years, but there is still room for improvement. Diarrhoea and enteritis caused 3 deaths. The steady improvement in infant care and the availability of antibiotics have decreased the rate from this cause over the past few years. In spite of the continued improvements in obstetrics, 10 children died from birth injury. The death rate due to this cause (1.6) has remained fairly constant for a number of years. Twenty-one babies died from congenital malformation; one died from other infections (peritonitis and septicaemia). PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES The declining incidence and mortality of infectious diseases such as diphtheria, scarlet fever, measles, whooping cough and typhoid in the past 50 years is a reflection mainly of improved living conditions. Better housing and nutrition, improved ventilation and smaller families have helped to increase resistance and reduce the possibilities of spread of infection. Health visitors and public health inspectors have played an invaluable role in health education and in improving hygiene. A summary of notified and confirmed cases of various diseases for 1964 and 1965 is shown in Table 5. diphtheria For the eleventh year running there were no cases of diphtheria. dysentery The number of cases confirmed (86) decreased compared with 1964 (104). There were two outbreaks of sonne dysentery, one at Gladstone Park Day Nursery and the other at Longstone Avenue Day Nursery. 31 children and staff were affected at Gladstone Park, and 24 at Longstone Avenue. The Nurseries were closed to new entrants for nearly two months until the outbreaks were cleared up. 7 food poisoning There were no outbreaks of food poisoning. The number of cases confirmed was 39 compared with 47 in 1964. measles 3,166 cases were notified compared with 1,373 in 1964. Some 2,900 of these were notified during the first half of the year, after which the number fell away sharply, only some 200 being notified during the second half of the year. meningococcal infection Three cases were notified, but one case was re-diagnosed meningitis. ophthalmia neonatorum There was no impairment of vision in the four cases of ophthalmia neonatorum. poliomyelitis It is pleasing to report that for the third year running there were no cases of polliomyelitis, which is probably the result of the steady increase in the number of people protected against the disease. puerperal pyrexia Since 1st August 1961, puerperal pyrexia applies to any "febrile condition occurring in a woman in whom a temperature of 100.4 degrees Fahrenheit has occurred within 14 days after childbirth or miscarriage". The number of cases notified (87) was less than in 1964 (129). smallpox There were no notified cases of smallpox. 76 contacts of the disease were kept under surveillance for 21 days from the last date of contact. In accordance with the International Sanitary Regulations, the signatures of doctors on 5,389 certificates of vaccination were authenticated by the department. typhoid and paratyphoid fever There were no cases of Typhoid in Brent, but 15 local residents who were contacts of a case at a Holiday Camp in Bognor were kept under surveillance for the required period. One case of Paratyphoid B in a male adult was notified. whooping cough The incidence of whooping cough decreased in 1965 compared with the previous year. The case rate was .24 per 1,000 population. HEALTH EDUCATION Health Education continues to play an essential role in the work of the Department. Concentration has been directed within the clinics, schools and the home, although posters and leaflets were distributed to libraries and other bodies during the year. Posters on varied subjects have been regularly displayed in the clinics and leaflets supporting the posters were made available to the public. Smoking and lung diseases, food diet and hygiene, immunisation, and the need for all drugs to be kept under lock and key were particularly stressed. Four clinics were able to show small displays. Mothercraft sessions continued to hold interest in the 11 clinics conducting them. Some disadvantage was felt in the loss of the services of the film projector and operator supplied by the late Middlesex County Council, but filmstrips and other visual aids were used to supplement the talks. Doctors, midwives, and nurses gave talks in addition to the health visitors. 149 classes were arranged. All home visiting professional staff continued the work of health education in the course of their visits. There were 167 talks given at 27 schools, the majority being given in the Willesden part of the Borough. Sixteen of these talks were on Smoking and lung disease and two on venereal disease. These two subjects were also introduced during other talks where applicable e.g. "Respiratory Organs", "Personal Hygiene". Previews of films "Women of Tomorrow" and "Brother for Susan" were seen by parents before being shown to the children. A new film "From Boy to Man" for the older male was approved by school staff and used in suitable schools. The film "Learning to Live" was used to great advantage in some schools, but owing to its popularity, continues to be fairly hard to book. 8 New filmstrips "Teenagers Feet" and "First Aid" were purchased as additions to the filmstrip library. Talks to new overseas students in the technical colleges on health and hygiene in Great Britain were requested and were most successful. Requests for talks from outside organisations were particularly disappointing in 1965, but this was attributed to the re-organisation of local government and the department's move from Kilburn to Wembley causing confusion to some members of the public. The matter appears to have picked up in the latter weeks and requests began to arrive for talks to be given in 1966. A course of first aid lectures was conducted for the Willesden Branch of the British Red Cross by the Senior Medical Officer. The Department was represented at the Brent Show. Photographs and coloured film loops of actual scenes in the Borough were produced and shown on a back projector. These were found to be particularly eye catching. MEDICAL ASSESSMENTS AND MEDICAL REPORTS Prior to 1st April 1965, both Wembley and Willesden Borough Council employees were required to undergo a full medical examination on appointment to the permanent staff, and 29 examinations were carried out from 1st January to 31st March. The Middlesex County Council, however, required new employees to complete a medical assessment form and, provided this was satisfactory, this met the Council's requirements. A full medical examination was only carried out if considered necessary by the Assessing Medical Officer. 291 assessments were dealt with from 1st January to 31st March. The assessment procedure has been adopted for Brent employees (except for teachers and applicants for entry to teacher training colleges), and 1,391 assessment forms were dealt with from 1st April to the end of the year. There is no doubt that this procedure results in a great saving of the time of professional staff and achieves the desired result at low cost. It is a requirement of the Ministry of Education and Science that all teachers on their first appointment and applicants for entry into teacher training colleges be medically examined. 209 teachers and 139 trainees were examined by Middlesex and Brent Medical Officers. Three members of the staff were recommended for retirement on the grounds of permanent ill-health. 9 PERSONAL HEALTH SERVICES CARE OF MOTHERS AND YOUNG CHILDREN A comprehensive service continues to be offered to expectant mothers by general practitioners, hospitals, and the Borough's medical and nursing staff. Health Visitors continue to follow up expectant mothers who have failed to keep their appointments at local and hospital clinics. Mothercraft often combined with relaxation classes are held in all clinics to provide help and advice to all mothers. Ante-natal Clinics Sessions Attendances Average attendance per session Ante-natal Post-natal 963 10,136 243 10.8 Cervical Cytology. Two cervical cytology clinics have been opened in the Borough during the year for the early detection of uterine cancer. One is held at Kilburn Clinic on Saturday mornings, and the other at 245, Stag Lane Clinic on Wednesday mornings. At the moment, the service is limited to symptom-free women over the age of 30, who have had several pregnancies. More and more general practitioners are making use of this valuable service. Liaison with Hospitals. The exchange of Medical Officers between the Paediatric Out-Patients' Department at the Central Middlesex Hospital and the local authority continues satisfactorily and greatly benefits both departments. CHILD WELFARE CLINICS Child welfare sessions were regularly held in the fifteen clinics in the Borough. These sessions were well attended and mothers were given help and advice on all aspects of child care by the Assistant Medical Officers and Health Visitors. A high percentage of children continued to receive vaccination against smallpox, and immunisation against the main infectious diseases. The measles vaccine trial started in 1964 was successfully completed during the year. Health education projects are displayed in all clinics. Clinic sessions Total Attendances Seen by doctor Referred elsewhere Average attendance per session 2,261 71,152 22,878 663 31.5 DENTAL SERVICE FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS OF AGE (Table 6) The Priority Dental Service was available in 11 centres in the Borough and 410 sessions were held. It must be stressed that whilst the dental health of expectant and nursing mothers shows some improvement, that of pre-school children shows little change. It is true that a slightly larger percentage of these children require no treatment, but it is alarming to find so many cases where the actual amount of treatment per mouth has greatly increased and frequently involves the upper front teeth to such an extent that even at 3 years of age little can be done to save them. Current investigations show that this to a large extent is due to the excessive use of concentrated orange juice and vitamin syrups, particularly where these are offered to infants and young children in an incorrect manner and without any attempt at oral hygiene. Further comments in the report of the Principal School Dental Officer (Page 64) indicate the results of this in later life. PREVENTION OF BREAK-UPS OF FAMILIES The Family Service Unit continues its valuable work with problem families and has now worked in the Area for the past seven years. The Council made a grant of £2,750 to the Unit during the financial year 1965/66. The overall volume of work increased considerably during 1965—eight new families were referred and the total caseload at the end of the year was 29. Maximum co-operation has existed between the Unit and members of the Department. DAY NURSERIES (Tables 7, 8, 9) The 540 approved places in the eleven Day Nurseries have been filled throughout the year. From May 31st the number of places available for Brent children in York Park Day Nursery, Hendon was reduced from 30 to 15. The demand for day nursery admission continued at a high level. The standard charge for admission remained at 17/ 6d. per day. 10 Kilburn Day Nursery was approved as a training school for N.N.E.B. students, making nine training nurseries in the Borough. Thirty-five students completed their two year period of training, and twenty-nine obtained the N.N.E.B. certificate. Recruitment for training was easier, but filling vacancies for trained nursery nurses and warders is still difficult. CARE OF THE UNSUPPORTED MOTHER AND HER CHILD (Table 10) With the breakup of the former Middlesex County Council, the service for the unsupported mother and her child was no longer centralised, and became the responsibility of each London Borough. To meet the needs of these women and children, the Council provides residential accommodation in the Belle Vue Mother and Baby Home, and the services of a Medical Social Worker. Unmarried mothers were referred to the Council's Medical Social Worker both by the Council's own staff and by moral welfare workers of all denominations. Admission to a mother and baby home was arranged at the appropriate time, until suitable arrangements could be made for them. The importance of after-care work—of ensuring that proper and permanent arrangements are made for both mother and baby—is fully realised. This needs not only experience and farsightedness on the part of the Medical Social Worker, and the staff of the mother and baby home, but a knowledge of human nature and a certain detachment from sentimentality. Close liaison with the Welfare Section was maintained in connection with the admission to homes of the homeless evicted women, either pregnant or with a young infant. In addition to the Council's own home, use was also made of the homes run by other London Boroughs who, indeed, made use of the vacancies that were available in Belle Vue Mother and Baby Home. The staffing of the Council's home presents some problems, since it is necessary to appoint reliable people even as attendants, who will be able to supervise the girls in their household tasks, and cover general supervision for short periods. During 1965 the social side of caring for the mothers and babies was carried out by one full-time Medical Social Worker, whose services are shared with the London Borough of Harrow, at an appropriate financial adjustment. FAMILY PLANNING The Council runs a family planning clinic every Monday morning at London Road Clinic. In addition, the Family Planning Association is granted the use of Pound Lane and Stag Lane Clinics one evening per week, free of charge, for holding sessions. The Council also agreed to continue the contractural arrangement previously made with the Middlesex County Council for per capita payments in respect of cases referred under Sections 22 and 28 of the National Health Service Act. INCIDENCE OF CONGENITAL MALFORMATION In accordance with the requirements of the Chief Medical Officer of the Ministry of Health, information is supplied to the General Register Office concerning congenital defects apparent at birth. A summary of notifications received and an analysis of malformations notified are shown in Tables 11 and 12. MIDWIFERY SERVICE (Table 13) The full establishment of midwives has been maintained during the year. Midwives continue to hold their own ante-natal sessions, but close liaison with general practitioners and hospitals is observed. The number of discharges from hospital within 48 hours of confinement is increasing; so far the scheme covers the Paddington and Kingsbury Hospitals only. Three part-time midwives are employed for these cases, two in the Wembley area and one in Willesden. Two of the Premix Gas Dispensers Entonox Apparatus (50% oxygen and 50% nitrous oxide) have been purchased for the use of midwives. HEALTH VISITING Health education is the health visitor's primary function. This is carried out in the clinics and during her many home visits in her capacity as adviser on the principles of health to the family as a whole. Specific health tajiks have been undertaken in schools and clinics. In addition to this, health visitors are frequently asked to give talks to various groups in the community. Sponsored students. At present four students are in training at Chiswick Polytechnic. The practical training of these students is undertaken by a new grade of staff viz. Field Work Instructors. Three health visitors undertook special training and were appointed to this grade last July. In-service training. Health visitors continue to attend lectures given by the Paediatrician at Kingsbury Maternity Hospital. Several health visitors attended two study days organised by Edgware General Hospital. 11 Refresher Courses. One health visitor attended a course at Keele University. First Effective Visits Total Effective Visits Total No Access Total Visits as School Nurse 25,812 50,749 10,810 1,425 DISTRICT NURSING This is a service which provides trained nurses to nurse the sick in their own homes. The nursing staff work in close liaison with hospitals and general practitioners so as to give the patient comprehensive nursing care. 2,766 new patients were referred during the year, and the nurses paid a total number of 142,054 visits to all patients. 867 of these visits were more than one hour's duration. At the end of the year, 1,090 cases were on the register. General Practitioner Attachment There are now four District Nursing Sisters attached to group practices. These schemes work well to the benefit of the patient and the satisfaction of the doctors and nurses. INCONTINENCE PADS The provision of incontinence pads free of charge to the incontinent patient has now been extended to cover the needs of patients where there is no district nurse in attendance. Requests come from general practitioners and other sources. A member of the District Nursing Service visits the patients to assess their needs. When patients have difficulty in disposing of soiled pads in their homes, the Council arranges for them to be collected and disposed of by incineration at the Greater London Council refuse disposal plant at Alperton. VACCINATION AND IMMUNISATION Vaccination and immunisation of children against diphtheria, tetanus, whooping cough, poliomyelitis and smallpox was undertaken by Assistant Medical Officers and by General Practitioners as set out in the following programme: — Age Immunised against 2- 6 months Diphtheria/tetanus/whooping cough 6-11 „ Poliomyelitis 13-24 „ Smallpox 18 - 21 „ Diphtheria/tetanus/whooping cough (reinforcing injection approximately one year after initial course). Further immunisation by an adsorbed vaccine against diphtheria/tetanus, and a reinforcing injection against poliomyelitis were undertaken at school entry. Under the above programme the numbers of children receiving immunisation and vaccination were as follows:— Smallpox Primary vaccination 3,058 Re-vaccinations 81 Diphtheria/tetanus/whooping cough - Primary immunisation 4,660 Re-inforcing „ 4,945 Poliomyelitis Primary inoculation 5,346 Re-inforcing „ 2,436 RECUPERATIVE HOLIDAY HOMES The authority is empowered to arrange the admission of patients recommended by general practitioners, hospitals and clinics to recuperative homes, provided their medical condition is such as to indicate that they require no form of medical or nursing care, are able to walk and dress unaided, and fit to travel by normal public transport. The arrangements are intended for patients requiring a short period of rest, fresh air and good food to complete their recovery from a recent illness or set-back in health. Patients in need of any form of medical and nursing care requiring convalescence are the responsibility of the Regional Hospital Board. During the year, the authority accepted financial responsibility for the maintenance of 150 persons in recuperative holiday homes. Of these, 127 were admitted to such homes and 23 were cancelled or withdrawn. Of the 127 cases admitted, 116 were adults and 11 were children under school age. 12 In addition, 29 school children were placed in recuperative homes under Section 48 of the Education Act, 1944. CHIROPODY The number of patients receiving treatment increased during the year and included the elderly, physically handicapped, expectant and nursing mothers and children. The majority attended the Council's clinics. Housebound elderly and handicapped persons were visited in their own homes. The chiropodists advised parents on the care of their children's feet and the wearing of suitable shoes. Patients in need of treatment were brought to the notice of the Department by doctors, health visitors, welfare workers and relatives. The chiropodist informed the Department of any help required from the Health and Welfare services. The figures set out in Table 14 include the treatments carried out by the British Red Cross Society on behalf of the Council. The Willesden Old Folks' Association administered a chiropody service on behalf of the Middlesex County Council until 31st March, and subsequently acted as agents for the Brent Council. For details see Page 24. HOME HELP SERVICE There were 1,108 applications for the service in 1965, an increase of 425 compared with the previous year. The number of cases still receiving help at the end of the year also increased from 690 to 906. Three tuberculosis cases weres helped, and help was provided free to two mothers suffering from toxaemia of pregnancy. One hundred and fifty-seven bookings were taken for confinements, but only 83 were helped, including two 48-hour discharge cases in which the help was given free. The remainder made other arrangements. There were 75 full-time equivalent home helps employed at the end of the year at an hourly rate of 4/10 3/8d. The charge to the public remained at 4/9d. Seven persons were employed as neighbourly heilps, but only three were still working at the end of the year. The Organisers made a total of 5,493 home visits. LOAN OF NURSING EQUIPMENT The Middlesex Branch of the British Red Cross Society continues to operate the loan of nursing equipment scheme on behalf of the Council. Under these arrangements a hire charge is collected from the patients by the British Red Cross Society and retained by the Society to enable it to purchase replacement equipment as required. If the patient is unable to meet the hire charge it is paid by the Council. During 1965, 2,724 articles were loaned to patients. The Council may also purchase additional equipment required to meet requests for the loan of articles on the approved list. Transport required for the collection and delivery of bulky articles is provided by the Council. During the financial year 1965/1966 the Council paid to the British Red Cross Society £647 8s. 6d. in respect of patients' hire charges. In general, the scheme is intended to facilitate simple, short-term nursing care in the patient's home. Certain items of catheterisation equipment are provided as a personal issue to paraplegic patients to enable them to care for themselves in their own homes. Other items of equipment are purchased in special cases, e.g. alternating pressure point pad units, designed to reduce the risk of the occurrence of bed soars in bedfast patients. TUBERCULOSIS (Tables 15-18) Mortality and Morbidity. There were six deaths from pulmonary tuberculosis among men and one among women with the now usual shift to the older age groups. The death rate was 2 per 100,000 population compared with a rate of 3 last year. Three of the deaths occurred in two elderly men and an elderly woman previously unknown to the health authorities. This indicates that in spite of the improvement in case finding methods, there is still a reservoir of infection among older people in the community, which holds special hazards for the young and unprotected. In view of this 'hard core' of tuberculosis infection, B.C.G. vaccination is an important preventive measure offered to all school leavers to raise their resistance to the disease. This is very necessary during adolescence when the risk of infection is higher and many new stresses have to be faced (for details of B.C.G. vaccination of school leavers see Annual Report of the Principal School Medical Officer, page 58). There was a very slight increase in notification (107) compared with the previous year (105). The number of cases of pulmonary and non-pulmonary tuberculosis on the register at the end of the year was 2,523, an increase of 13 over 1964. 13 Care and After Care. The arrangements providing for the care and after care of persons suffering from tuberculosis have continued throughout the year. The chest clinic with the physician-in-charge is the focal point. The physician is employed by the Regional Hospital Board and is a consultant in diseases of the chest. Although primarily a clinician concerned with diagnosis and treatment, he is fully aware that the prevention of the disease on the one hand and the after care of the patients on the other cannot be divorced from treatment. For this reason the physician at the chest clinic is responsible for the general supervision of the local authority's scheme to promote the after-care of patients. Experience has shown that this arrangement works smoothly and is effective. To promote this, the staff of the local authority come under the direct control of the physician for the day-to-day administration of all routine duties relating to the management and after-care of patients. Home Visiting. There were four tuberculosis visitors on the staff at the end of the year. In addition to home visiting they undertake duties at the chest clinic and act as clinic sisters at diagnostic and treatment sessions. During the year they made 1,493 visits to patients' homes. The tuberculosis visitors advise on the prevention of the spread of infection, on arrangements for care and after care, and keep all known contacts under close supervision. Included in the above figure of 1,493 visits, are those made to non-tuberculosis households, when 331 such visits were made. Welfare. The decline in the incidence of tuberculosis has had a marked effect upon the functions and duties of welfare officers attached to chest clinics. To a growing extent more and more patients suffering from non-tuberculosis chest diseases, such as chronic bronchitis and lung cancer, are being seen by the physician, and are being referred to the welfare officer, whose duties have become steadily more comparable to the general type of social-medical work undertaken by hospital almoners. The medical-social work undertaken at the chest clinic is now integrated with the hospital almoning service. It should be emphasised that this has not led to any loss by tuberculosis patients of the benefits they may receive from the authority's arrangements for their care and after care. Rehabilitation through full-time training is provided by the Ministry of Labour at their training centres. Occupational Therapy. This is the first stage in the rehabilitation of the patient. Guidance and training is given to selected patients, in their own homes, in a wide range of handicrafts. Classes are held at the Willesden Chest Clinic. The decline in the number of tuberculosis patients is naturally reflected in the work of the occupational therapist and in addition to the service to patients in the Borough, he serves patients in the London Boroughs of Ealing, Hillingdon and Hounslow. He also visits patients in the Hostel for Homeless Tuberculous Men at Twickenham. There is an appropriate financial arrangement with these authorities. One hundred and twenty-seven successful visits were made to patients' homes in Brent. There were 353 attendances at the Willesden Chest Clinic classes. Vaccination against Tuberculosis. The scheme provides for the vaccination with B.C.G. of individuals who are contacts of tuberculosis, school children aged 13 or older, students attending universities, teachers' training colleges, technical colleges or other establishments for further education. The number of persons vaccinated during the year was 2,311. For details of tuberculin testing of school children and school leavers, and B.C.G. vaccination of school leavers, see report of Principal School Medical Officer, page 58. VENEREAL DISEASES With the coming into operation of the National Health Service Act 1946, responsibility for the treatment of venereal disease was transferred to the Regional Hospital Boards. The Council, however, continue to be concerned in co-operating with the work of the venereal disease treatment clinics as regards following up persons under treatment or known or believed to be sources of infection. In this connection, the Council's Medical Social Worker attended venereal disease clinics at the Central Middlesex Hospital and her services were utilised for the purpose of tracing contacts and following up defaulters. The Medical Social Worker, under the direction of the medical officers in charge of the venereal disease clinic in Central Middlesex Hospital, assisted patients attending the clinics in meeting any social problems with which they were faced. It is impossible, in the absence of compulsory notification, to form anv estimate of the real incidence of venereal disease in the community, particularly since modern methods of antibiotic treatment and chemotherapy can be undertaken by experienced general practitioners. No information as to numbers so treated is available. 14 MENTAL HEALTH The Mental Health Community Services, which cover the needs of the mentally disordered, i.e. severely subnormal, subnormal, psychopathic and mentally ill patients, continued to run smoothly on transferral from the former Middlesex County Council to the London Borough of Brent. This borough was fortunate to have been allocated the following Centres and Hostels:— 1. Neasden Junior Training School. 2. The Day Centre for the Mentally 111, Belton Hall, Bertie Road, N.W.10. 3. The Hostel for Mentally Subnormal Working Boys, 191, Willesden Lane, N.W.10. 4. The Post-Hospital Hostel for Women, 73 Wembley Park Drive. In addition, certain uncompleted schemes were taken over, such as the proposed Hostel for 27 mentally ill men and women at 9, Willesden Lane, which is a conversion of the old Kilburn Clinic and scheduled to open in 1966. It is envisaged that patients will be referred mainly from psychiatric hospitals, but placement directly from the community will also be considered. Another incompleted scheme allocated to this borough was the adaptation of the Abadjian factory in Chapter Road, N.W.10, as an industrial rehabilitation unit. It would appear at this stage that such a scheme is going to be undesirable for a borough of this size and that it will have to be abandoned. Provision for patients could then be made with the Industrial Therapy Organisation (Thames) Ltd., at Hanwell. In July 1965, the Mental Health Social Workers moved from their separate premises in Balnacraig Avenue, Neasden, to Brent House. This made for much closer liaison with other Departments and, indeed, with the medical and administrative staff of the Health and Welfare Department. COMMUNITY CARE —MENTAL ILLNESS The care of mentally ill patients centres on the field work of social workers for which the following establishments exist: — Chief Mental Welfare Officer 1 Senior Mental Welfare Officer 1 Mental Welfare Officers 5 Mental Health Social Worker 1 In order to cover the present need it has been proposed to enlarge the establishment by 3 mental welfare officers and 2 psychiatric social workers. The activities of the mental welfare officers continued on the by now well established pattern, fulfilling the dual role of statutory officer and as a social and case worker dealing with the preventive and after-care problems, as laid down by the Mental Health Act, 1959. As their services extend to 24 hours daily the year round, they are in the unique position to respond immediately to crisis situations, where they can assist the patient, the family, and the general practitioner. After the discharge from hospital, they again pick up contact with the patient (which in many cases has indeed continued throughout the stay there), and assist in the rehabilitation period. This involves application of detailed knowledge of social work factors and the closest liaison with many social agencies. A very close link with both medical and social workers in the psychiatric units and hospitals has been forged throughout this year. Mental welfare officers regularly attend meetings and discussions at Shenley Hospital and the psychiatric units of Wembley and Central Middlesex Hospitals, as well as the Child Guidance Clinics within the area. London Borough of Brent patients can only be accepted at these hospitals, as catchment area delineations have become very rigid. It was not easy for mental welfare officers who came to this borough from other areas and who were used to dealing with the staff of various other psychiatric hospitals, to adjust speedily to new customs and methods and, indeed, criteria for admission. However, the challenge was met very well and after the initial settling-in period, new contacts had been made and the work proceeded smoothly. The Senior Medical Officer (Mental Health) holds staff meetings, where the various day-to-day problems are discussed and plans for future services are made. These meetings have become an established feature. To begin with they were structured very formally, but gradually have become quite informal, so that often they tend to take the shape of case conferences. Staff of other Departments have been invited to attend on occasion. This included child care officers whose cases not infrequently concern both Departments. Statistics relating to cases dealt with during the year under the Mental Health Act, 1959 will be found in Tables 19, 20 and 21. The Therapeutic Social Club (Gateway Club) continued with increased membership in spite of the change of the Chief Mental Welfare Officer, who is in charge of this. This Club serves a social therapeutic purpose. Its function is to provide stimuli and encouragement to those who feel isolated, apprehensive and lonely by reason of their mental illness. The Club strives to provide an atmosphere free from restraint and direction; members please themselves and choose whatever kind of recreative facility they want to, and everyone tries to encourage the other to mix, talk and play, anything in fact to lessen the inhibition that so often cripples the normal incentive and invalids the mentally ill. Encouragement is given to relatives and friends to attend. Without doubt, the Club provides a very necessary and useful purpose. Patients were placed at various local authority and mental after-care hostels, financial responsibility being borne by this London borough. Continued use was made of private accommodation by the BoardingOut Officer, whose services were shared with the London Borough of Harrow. Unfortunately, this officer resigned on 31st December 1965, and a further appointment has not been envisaged. It is proposed to continue to render this service as part of the duties of mental welfare officers. 15 Post Hospital Residential Unit (73, Wembley Park Drive). This is an unstaffed hostel for six female patients recovering from mental illness. The house was made very little use of during the first part of the year. It had been the practice in the past to let a Shenley Hospital psychiatrist formulate the policy regarding the type of patient considered suitable for admission. In consequence, it had been used for adolescents only. Only two such patients were in residence from the beginning of the year up to June. At that point, I approached Shenley Hospital senior medical staff, pointing out the poor use to which this unique hostel was being put. Better liaison between hospital and local authority medical staff, together with a change of policy regarding age range of patients and source of referral (i.e. not for the exclusive use of ex-Shenley patients only) very soon led to a much improved occupancy rate. Residents are going out to work and entirely look after themselves as a family group. Recurrences of their illness do occur, but the relapse rate is not unduly high. Shenley Hospital is ever ready to accept patients back, sometimes for the week-end only, just long enough to help a woman over a difficult period. Occasionally, patients break down within a very short time of admission: it is not easy to judge accurately in advance how an apparently well person will respond to the stress of community life and change of work. Miss A.B. is a case in point: she suffers from schizophrenia and had been a patient in Shenley for many years. For almost two years prior to her discharge she had been working in a chain-store, while living at Shenley Hospital. This involved a long, daily bus journey. She seemed well suited to return to the community via the shelter of the hostel. However, she began to deteriorate slowly, with short periods of unemployment, never working for longer than three weeks anywhere. The signal for her re-admission to Shenley was when she began to behave in somewhat bizarre ways, to the discomfort of the other residents. It appeared that her breakdown was imminent and arrangements were made for her re-admission to Shenley Hospital. In contradistinction, Mrs. C.D. also an in-patient at Shenley Hospital of long standing, left the hostel, after only five weeks residency, to find herself private accommodation, and has kept well since. Most of the ladies need a considerable amount of support and on average four professional staff call regularly one evening a week each (two from Shenley Hospital and two from the Health and Welfare Department). There is no interference regarding the cleaning and general running of the hostel, but individual residents need help with personal problems—mostly connected with their employment. Patients not quite ready for work attend the Day Centre at Bertie Road, where they receive guidance and encouragement. Christmas time was a period of particular interest. Most residents went away to spend the holiday with friends or relatives. It was felt that it would be unwise to leave the two remaining alone and they were invited to Shenley Hospital as guests. This appeared a happy solution—all returned to the hostel by the New Year. The hostel was started as an experiment about three years ago, but by now it has become firmly established as a suitable stepping stone back into the community for at least some mentally ill people. Almost certainly, it will be even more in demand once the projected hostel for mentally ill patients at 9, Willesden Lane is functioning, as this will be fully staffed. A patient's return to the community can thus be envisaged in two steps: first the shelter of a staffed hostel and then residency in the more demanding family group of the unstaffed hostel, before return to her own family or full independence is achieved. The Day Centre for the Mentally 111, Belton Hall, Bertie Road, N.W.10. This Centre continues to provide excellent service to some thirty men and women who are not able as yet to return to full employment. They are referred by psychiatrists either on discharge from hospital or from out-patient clinics. It is staffed by a head occupational therapist and two occupational therapists. Cases are also accepted from contiguous local authorities, who take financial responsibility for their patients. The following report has been received from Miss Cass, head occupational therapist: — "The Centre continues to serve the same area previously covered. This year has seen the policy of occupational therapy projects outside the Centre more firmly established. Regular visits by all the staff to the psychiatric clinics of Wembley and Central Middlesex Hospitals have now been established as well as the regular visits to Shenley Hospital, keeping communication with the medical team within which we work as close as possible. Domiciliary visits this year have included patients who have needed transport to and from the Centre for a considerable length of time. In all cases this has been provided with the aim of rehabilitating the patient back to taking an active part in living and working in the community. Referred of patients. The majority of referrals are from Shenley Hospital and its associated out-patients clinics, and the psychiatric units of Wembley and Central Middlesex Hospitals. Number of patients referred January 1965—December 1965 96 (Male 40: Female 56) (8 re-admissions) Number of patients receiving treatment on December 31st 1965 44 (Male 13: Female 31) 22 with a good prognosis to return to open employment (average age 33 years). 8 housewives referred for a limited period (average age 57 years). 14 would benefit from a period of sheltered employment (average age 37 years). 16 Number of patients discharged January 1965 to December 1965 112 48 returned to work: 24 to open employment 20 housewives 2 Industrial Therapy Organisation 1 Industrial Rehabilitation Unit 1 Rantons (Brentford Adult Training Centre) 2 transferred to Welfare Service for physical disability. 1 referred to Marlborough Hill Day Centre for the Elderly Mentally 111. 1 transferred to Old People's Welfare Service. 2 referred to Mental Health Community Care. 24 admitted to Hospital (18 Shenley Hospital). 5 moved from district. 2 died. 27 discharged with no further rehabilitation programme:— 9 attended for one month (Male 3, Female 6)—average age 35 years. 7 attended over 1 month—under 3 months. 11 attended over 3 months—12 months. (Male 13, Female 6)—(average age 38 years). (16 reside in London Borough of Brent). Distribution of patients within the London Boroughs: Patients discharged 1965: London Borough of Brent 68 London Borough of Harrow 27 London Borough of Ealing 6 London Borough of Barnet 8 London Borough of Hounslow 1 London Borough of Hammersmith 1 Royal Borough of Kensington and Chelsea 1 112 Patients attending the Centre 31st December 1965: London Borough of Brent 27 London Borough of Harrow 8 London Borough of Ealing 7 London Borough of Barnet 1 London Borough of Hillingdon 1 44 Work undertaken this year within the Centre has followed the same lines as previous years, maintaining purposeful work, continuing to repair toys for the Junior Training Schools, and making toys for Christmas for the Nurseries. A new project has been started in conjunction with the W.V.S., the patients make up children's clothes from material provided by them, which are distributed to families in need. Maintenance of the Centre also provides constant work. Cooking has become a more regular feature with the increase of women patients. A small quantity of industrial assembly work has been provided from Acton Lodge Adult Training Centre. Projects outside the Centre have become an established form of occupational therapy. This year five rooms have been redecorated. Cleaning of 73, Wembley Park Drive Hostel has been undertaken about once a month. Thirty-three patients have been employed on these projects during the year:— (a) Room decoration for Old People's Welfare Association, Hampstead. Paid for by the Association. (b) Room decorated for patient recommended by mental welfare officer. Paid for by National Assistance Board. (c) Room decorated for a patient recommended by psychiatric social worker. Paid for by Queen Adelaide's Fund. (d) Room decorated for a patient recommended by mental welfare officer. Paid for by National Assistance Board. (e) Furniture decorated and repaired for 73, Wembley Park Drive Hostel. An Art Class continues to be run for one session a week. It is well attended and is one of the more valuable activities. Visits have continued to places of topical interest. The Christmas visit after a buffet lunch was again to the Ice show at Empire Pool, Wembley. A psychiatric social worker from Shenley Hospital has conducted a therapeutic discussion group which has been of great value in building up good relationships within the Centre. 17 Out posting from the Centre has continued to be developed with the patients working from the Centre within the Health Department, the garden at 73, Wembley Park Drive Hostel and the Junior Training School, Neasden in various capacities. This is a very valuable asset where the patient needs a realistic situation prior to taking open employment. Discharge of patients starts for the majority wiih the contact of the Labour Exchange through the weekly visits of the Disablement Resettlement Officer to the Centre. This enables the patients to be seen informally and they are able to discuss any problem of employment and become registered prior to attending the Labour Exchange. The majority of the twenty-two patients returned to open employment during the year were placed by the Disablement Resettlement Officer. Close contact has also been kept with the community services. Good relations have developed with the voluntary bodies and this is a great asset with the re-socialising of the patients. The Therapeutic Social Club (Gateway Club) has been regularly attended by one of the Day Centre staff every week this year. In this way patients and ex-patients have been encouraged to keep in touch. Conclusion. Group activity is of advantage to the rehabilitation of patients attending the Centre, and it will be the aim of future programmes. Those arranged for the immediate future: — (a) Cookery demonstration to a group arranged to be given by the North Thames Gas Board. (b) Beauty Counsellor to give a series of make-up demonstrations to a group. (c) Six-month group project to assist in furnishing proposed Hostel at 9, Willesden Lane. I would like to thank all the administrative staff of the Health Department for their help and understanding in the change of administration and for their understanding in accepting patients into their Department for occupational therapy." COMMUNITY CARE — SUB-NORMAL AND SEVERELY SUB-NORMAL Supervision in the Home. Over recent years it has been shown beyond doubt that the retention within the community of severely sub-normal and sub-normal persons is beneficial to the individual and his family and to the community. This end can, in many cases, only be achieved by the support of social workers. In this borough one mental health social worker and, for a small proportion of cases all mental welfare officers, look after some 500 sub-normal and severely sub-normal cases. All of them need help to a greater or lesser extent, but it appears that during the year under review some of the routine visiting has had to be less frequent than is considered desirable, as the case loads are too heavy. Some cases, particularly the educationally sub-normal school leaver on the one hand and the under 5-year-olds on the other, need intensive support as crisis situations occur relatively frequently. In the case of the adolescent, various agencies have to be contacted (Youth Employment Officer, Disablement Rehabilitation Officer, National Assistance Board) and often the employer has to be supported as well as the whole family. With the pre-school child, it is chiefly the mother who needs frequent encouragement and guidance in the handling of the child. This is particularly necessary in the absence of adequate nursery services. In consequence a large amount of time has to be given to these urgent cases. More staff is needed to give the amount of care desirable. Throughout the year the Medical Officer for Mental Health has seen cases at any one of the local authority clinics, as well as at Brent House, and home visits were made in many cases. Health Visitors are becoming aware of the advantage of making early contact with the Mental Health Section and a mutually beneficial working relationship is becoming established. For this reason, the idea of one clinic only for the whole of the area has not been considered to be in the best interest of all concerned, specifically in the case of very young children, but it may well be that a 'walk-in' type of clinic will be made available to known cases in the future. Admissions to Hospital. Leavesden Hospital, near Watford, is the only psychiatric hospital available for cases of subnormality and severe sub-normality living in this London Borough. Vacant places occur very infrequently indeed and the number on the waiting list remains woefully high. Cases admitted during 1965 4 Cases on Waiting List on 31.12.65 40 Urgent 29 Others 11 The hospital has used its vacant beds to some extent to give short term care for the relief of parents for part of the holiday period and to help in cases where critical situations arise, and also to provide the patient with surgical, medical and dental treatment. This service has proved to be of great value. Number of cases admitted for short term care during 1965: 58. Although it is very desirable for the majority of sub-normals and severely sub-normals to stay within the community, this does not apply to many of the severely sub-normal patients who suffer from additional handicaps, either emotional or physical. They require special nursing techniques and in certain cases it is quite unrealistic to expect parents and siblings to cope with patients of this kind if they feel unable to do so. For the sake of parental mental health, hospitalisation is the only answer. However, due to the lamentable shortage of hospital beds, special care units have become an established pattern of day care for such children, and this borough supports such a unit within the Neasden Junior Training School. This type of care only partially relieves the family's heavy pressure, particularly as the patients can only attend in term time. It would appear highly desirable to extend the service all the year round. 18 Guardianship and Informal Foster Care. During the year four guardianship cases were allowed to lapse. This is in accordance with the policy of the Mental Health Act, 1959. There are now no such cases for which this local authority is responsible. Informal foster care placement has continued as before. The Guardianship Society, Hove, have maintained their very helpful work in finding private homes to foster our citizens. In spite of considerable effort, it has not been possible to find private householders within this borough to take any mentally subnormal or severely sub-normal foster cases during the current year. This appears to be a reflection on public attitude to sub-normality. The Hostel for Sub-normal Working Boys, 191, Willesden Lane. This is a hostel for twelve sub-normal and severely sub-normal boys, all of whom are either in open employment or attend a Training Centre. It is staffed by a matron with 15 hours help from her husband, and an assistant matron (male). Since its opening in the Spring of 1964, this staffed hostel has had a high occupancy rate and was running smoothly by April 1st, 1965. The matron, Mrs. Sutcliffe, reports: — "With the new Authority came a change of emphasis on the type of residents admitted. Ability to work in the community, whilst still important, was no longer the prime consideration. We welcomed Dr. Koffman's suggestion that applicants for residence should be interviewed at the hostel by herself and the matron, if possible with applicants' parents at the interview. This to be followed by a medical on admittance. In this way a number of unsuitable cases were turned down and a much more satisfactory standard of residents achieved. Arrangements were made for particularly difficult cases to have specialist treatment at Leavesden Hospital, one boy having been admitted to hospital on the advice of their specialist. In June, Mr. Usher was appointed as assistant; since that time there has been a welcome improvement in staff conditions. This has enabled more time to be given to residents' leisure activities, i.e. handicrafts, gardening and elementary P.T. to give a measure of physical improvement to residents whose normal inclinations were completely sedentary. During the year, six boys have left the hostel. Two of these were welcomed back by parents who evidently had a change of heart. Two were delinquents who agreed to come here rather than remand homes, and who left when they thought that "the heat was off". One boy was discharged to Leavesden Hospital. The last boy was a confirmed wanderer ; his stay here was the longest of his career." Neasden Junior Training School. Mentally handicapped children that have been assessed as unsuitable for education at any of the schools within the Education Act, 1944, are the responsibility of the Department. Their education and training takes place at the Neasden Junior Training School. All these children are defined as "severely sub-normal". Within this category, ability varies considerably: at the top of the scale some children are able to learn the rudiments of the "three R's", while at the lowest part of the scale children, particularly those with multiple handicaps, can hardly be trained at all. These latter are cared for within the special care unit of the Neasden Junior Training School, where staff trained in nursing skills, rather than teachers, look after them. Arrangements are made for their conveyance by coaches to and from the school. This school has 78 places, 12 of which are allocated to the special care unit. Unfortunately, this is not nearly enough for the number of cases resident in this borough. A few children are allocated places at the training schools of the London Boroughs of Barnet, Harrow, Hillingdon and Hounslow, but many are on the waiting list, particularly for the special care unit. The staff consists of one supervisor, five assistant supervisors, four general duties attendants, a cook and a part-time cleaner. Although the supervisor and assistant supervisors' duties are those of specialised teachers, their own training differs from those that teach within the educational system in that they do not attend teachers' training colleges, but usually a course at the Chiswick Polytechnic arranged by the National Association for Mental Health. This is an unhappy state of affairs, as in consequence of this type of training, the salary structure in no way approaches that of qualified teachers, yet the staff's duties are mostly identical with that of teachers in certain special schools and units. Recruiting is thus a difficult problem, as it is only the exceptional person who will embark on a career which will give such poor financial reward. Happily, the present staff are devoted to their work and appear to be well settled. They are supported by twice weekly attendance of a speech therapist. In addition a psysiotherapist attends weekly to deal with spastic children in the special care unit. Once a term an eye specialist attends. It has been found that the incidence of eye defects of mentally severely sub-normal people is much higher than that for the rest of the population. Therefore, specialist attention to any likely defects of vision at frequent intervals is very important. Dr. Peter A. Gardiner, Research Fellow in Ophthalmology, continued with his survey of visual defects in mentally handicapped children, which he had begun some time ago, and issued a preliminary report, in which he concludes the following: — "The results of the report show that there is a much higher incidence of visual defect amongst mongols than amongst other mentally handicapped children. In round figures 75% of the mongols and 30% of the others had bilateral defective visual acuity sufficiently severe to make the provision of glasses a serious consideration. The actual number possessing glasses was 3, and 21 children were ordered them. Of these 21, 11 wore then constantly and happily, and 3 refused to wear them, and in 7 it is too early to assess their acceptance, but my opinion is that about 75% of these children will accept glasses. 19 The presumption is that they are obtaining visual benefit. As nearly all the conditions found were congenital, one would not expect immediate improvement in terms of visual acuity to be noticeable by the observer, even in those cases where visual acuity was obtainable, but the optical conditions now provide a clear image on the retina and the previous blurred image has been removed. The figures speak for themselves in showing that by normal standards of ophthalmic care these children have been neglected and that in the case of mongols a very high percentage have a defect of visual acuity which warrants their being regarded as a special group "at risk" regardless of their mentality or their presenting symptoms. In the case of mentally handicapped children, even more commonly than in normal young children, the symptoms of defective visual acuity are suppressed, or masked by the presence of mental defect and it is useless to use them as a guide to detecting even major visual defects. In its final form this report will show that other defects are present, such as squints, cataracts and poor vision for near work, but for the child's development and behaviour what matters most is how much he sees clearly. It is my opinion that a mentally handicapped child, even if incapable of interpreting a clear image on his retina, should not, therefore, be deprived of the opportunity to attempt this interpretation by our disregard of refractive errors present. I also think it is a pity that the teachers are not informed which children have good eyesight and which do not. The high myope in this training centre was regarded as being particularly intelligent and affectionate because she used to come up to the teacher's desk to handle the material being used. Her range of clear vision being about 9 inches, her behaviour is not surprising, but indicates her desire to see clearly, and in my opinion she makes the plea for all mentally handicapped children to be properly examined and provided for." The daily routine of more or less formal work is occasionally interrupted by outings of special educational interest: for example: this year a dairy was visited and the London Zoo. The latter particularly fired the children's imagination and, of course, the actual feat of going places has high social training as well as educational value. Children that are conveyed daily by special coach find the very fact of buying a ticket and paying out money on these outings quite a difficult exercise. The long waiting list for admission to the Neasden Junior Training School and particularly to the special care unit has made the provision of additional premises a necessity. Although a new school is to be provided in conjunction with the School for Physically Handicapped Children at Stag Lane, Grove Park, Kingsbury, I have felt that the need of these children is too urgent to await the building of this large project. Thus consideration has led to the proposal for the conversion to a special care unit of the hutted building in Balnacraig Avenue, which was vacated by the mental health social workers in July. A path is to be constructed that will link the training school with the new unit. This project should alleviate at least some of the demands made on parents whose difficult children are being looked after at home. Adult Training Centres. The age range of children attending the junior training schools is approximately from 5 to 16 years. Whenever practicable, younger children are offered a place. At the upper age limit, the young people are ready to leave the school for an adult training centre. Unfortunately, there is no such centre within this borough, and the youngsters are allocated places at centres of other local authorities, i.e. Hounslow, Hillingdon and Ealing. Because of waiting lists, a few children stay on at the Junior Training School over the age of 16 years. Coaches organised by the other boroughs run within a fairly close distance of the trainees' homes, but in certain cases a travelling distance of up to two miles to the picking-up point is expected of them. Parents have expressed their resentment of this fact, and also of the occasionally quite long journey. It would certainly be of great advantage to have an adult training centre within this borough. Trainees are taught to work more or less on factory lines, doing mostly light assembly work and also carpentry, gardening, etc. Industrial work conditions are approximated as much as possible to facilitate eventual transfer to sheltered and even open employment whenever possible. Social Club. A club for mentally handicapped teenagers is run weekly in the evenings at the Neasden Junior Training School. Parents have formed a committee which strives to offer as many activities as possible. Apart from giving the youngsters indoor entertainment such as pop record sessions, darts, etc., it has also been possible to provide a few coach outings. A mental health social worker attends as part of her duties, as it is thus possible to keep in touch with young persons and their parents more readily than by individual home visits, once they are out at work all day. Summer Camps. It has been the practice in the past to run summer camps for children attending junior training schools and adult training centre trainees, and this year four children went to Park Place Residential School near Henley-on-Thames, and thirty-seven to the permanent camp at St. Mary's Bay, Dvmchurch, Kent. It is proposed to continue this venture in future years, in conjunction with other London Boroughs. 20 WELFARE SERVICES TEMPORARY ACCOMMODATION It is the Council's responsibility to provide temporary accommodation for persons who, owing to sudden or unforeseen circumstances, are rendered homeless (Section 21(l)(b) National Assistance Act, 1948). The standard charge per family is £2, but those who cannot afford to pay this amount are assessed according to the Council's scheme. The minimum charge is £1 per family. The charge covers the use of a room, electricity for lighting, and water services including a reasonable supply of hot water for domestic purposes. The Council provides three hostels. The hostel at 91 Dartmouth Road is for women and children only, with accommodation for 16 women and 36 children. In addition, there is a communal emergency room providing accommodation for 3 women and up to 15 children. A resident warden is employed. In 1963, a committee was formed on the basis of a League of Friends and was named "Friends of 91". Plans are well advanced for the provision of a playroom in the garden incorporating a covered sand pit. The "Friends of 91", with financial help from the Willesden Round Table, are providing the prefabricated building, and the Council is providing the site and floor slabs, lining to the internal walls and ceiling, rainwater drainage, painting, heating and lighting. There is an outside playground for use in fine weather and a play group has been established for children between the ages of 2 and 5 years. This group is supervised by a leader who attends three days a week from 10.30 a.m. to 12.30 p.m. during school term time. The hostel at 9/11 Nicoll Road is also under the supervision of a resident warden. Accommodation is provided for 9 families including accommodation for 2 husbands and 28 children. The problem of providing a satisfactory fire escape has been solved, the work costing £1,240. The third hostel, "Rosmoyne", 642 Harrow Road, Wembley occupies a very pleasant position on the fringe of Barham Park, and the accommodation for 5 families is reserved entirely for married couples and their children. There is no warden in residence, but the warden at Nicoll Road attends once a week to supervise cleaning arrangements. During the year, 49 families were admitted to the hostels. Thirteen families were re-housed, 8 by the Council and 5 by other local authorities. RESIDENTIAL ACCOMMODATION The total number of beds provided under Section 21(l)(a) of the National Assistance Act, 1948, is now 466, allocated as shown below: — Beds Coplands 62 Men and Women Courtfield 44 Men and Women Freeland Road 47 Women Hillcrest 100 Men and Women Ithcll Court 39 Men and Women Kenton Grange 34 Men and Women Kingsbury Manor 23 Women Mardale 18 Women Shepperton Court 71 Men and Women Wren Park 28 Women "Courtfield", the new purpose built home at Church Hill, Harefield, was opened in May 1965. In December, the annexe at "Mardale" was closed due to inadequate heating and the 8 men accommodated there were transferred to "Courtfield". The annexe is now used for the storage of property under Section 48 of the National Assistance Act. During the year 51 men and 128 women were admitted to the Council's homes, and on 31st December 4 men and 27 women were on the waiting list for admission. In addition to the old people accommodated in the above homes, the Council is responsible for the maintenance of another 177 residents in voluntary and other local authority homes. Sixteen men and 32 women were admitted to short stay accommodation during the year. WELFARE OF THE BLIND AND PARTIALLY SIGHTED Blind On 31st December, there were 525 persons on the register. There were 35 new cases (excluding recertifications and transfers from other areas) during the year. The classification of blind persons by age groups and at age of onset of blindness are shown in Tables 22 and 23. One hundred and twenty-three of the registered blind persons suffer from additional physical and/or mental handicaps. Of the children under 5 years of age, four are at home with parents and one attends the Spastic Centre, Cheyne Walk, S.W.3. The nine children of school age attend special schools for the blind, and a girl of 16 attends the Royal Normal College, London. Two men are undergoing professional/university training in London at the Kennington College and the Royal National Institute for the Blind Training College. One girl obtained a Bachelor of Divinity Degree. One hundred and twenty-three persons were in full employment, and an analysis of their occupations is shown in Table 24. Forty-one persons were in accommodation provided by local authorities, 7 were in other residential voluntary homes and 17 were in hospital. 21 Two persons were sent by the Council on a 13-week Social Rehabilitation Course arranged by the Royal National Institute for the Blind at their Torqu ay Centre. Five Social Workers are employed to assist the blind and partially sighted. Braille and Moon type reading were taught either at home or at classes. Five handicraft classes were held weekly in the afternoons, and negotiations are in progress to rent three further premises with a view to starting additional classes in 1966. The social worker also arranged various social activities and suitable training for persons of working age. The six social clubs run by voluntary associations continue to be held either weeky (one club), fortnightly (4 clubs), or monthly (one club) and were much appreciated. Social workers and welfare assistants attend four of the clubs to give assistance. During the year, 63 assisted holidays were arranged for the blind and partially sighted. A total of 244 wireless sets have now been issued free on behalf of the British Wireless for the Blind Fund, and 74 talking book machines on behalf of the Nuffield Talking Book Library for the Blind. The contract with a local firm for the maintenance and repair of the wirelless sets was continued. In May, the Council decided to pay the annual subscription of £3 for all blind persons being in need of and receiving a talking book machine. Partially Sighted On 31st December, there were 170 persons on the register. There were 33 new cases (excluding recertifications and transfers from other areas) during the year. Eight persons were transferred to the blind register. The classification of partially sighted persons by age groups is as follows: — Under 5 years 1 5-15 21 16 - 20 15 21 - 49 33 50 - 64 26 65 and over 74 Of the 21 children of school age, one is at Lower Place School for the physically handicapped, 16 at special schools for the partially sighted, two at ordinary schools, and one is uneducable. Three young people in the 16-20 age group are still at school. Of 40 persons "near and prospectively blind" (aged 16 and over), 11 are employed, one is available for work, and 28 are not available or not capable of work. Of 47 persons "industrially handicapped", 41 are employed, 3 are available for work, and 3 are not available or not capable of work. Fifty-eight persons require "observation only". WELFARE OF THE HANDICAPPED On 31st December, there were 817 persons on the register. Details of registrations and an analysis of disabilities of the general classes are shown in Tables 25 and 26. Home visits were made by five social workers who maintained close liaison with the handicapped person and the family. There was also close co-operation with voluntary agencies to improve the social life of the handicapped. The demand for aids and gadgets continued. One hundred and thirty-six personal aids, e.g. pick-up sticks, special knives and forks, can openers, etc., and 57 larger aids, e.g. metal walking aids, hoists, cantilever tables, etc., were issued. Eighteen adaptations to property, e.g. construction of downstairs toilets, ramps, handrails, widening of doors, etc., were carried out, in order to assist the handicapped to lead a more independent life. At the Work Centre, Church Lane, N.W.10, 32 handicapped people were employed on outwork obtained from local factories. This light assembly work was supervised by an Industrial Works Organiser who also delivered and collected homework from 11 housebound handicapped persons. Seventy-one persons went on holidays to specially adapted holiday homes run by Dorincourt Estates, the Donkey Clubs, the W.V.S., the British Epilepsy Association, the Shaftesbury Society and lewish Welfare Board; to special guest houses; or to boarding houses, relatives or friends. Payment towards the holiday was made on an assessment basis. Private escorts or British Red Cross Society escorts were arranged as necessary. British Red Cross workers continued to teach crafts at the two Handicraft Classes. They were held one afternoon a week at 170/172, High Road, Willesden, and 563, High Road, Wembley. Two choral classes and a drama class met weekly and were well attended. Transport was provided by the Council where necessary. Four social clubs, run by voluntary organisations, catered for the special needs of handicapped persons, including a club for the deaf and dumb in Queensbury. At the beginning of the year, the Council had one specially adapted coach for transporting the handicapped to clubs, classes, etc., but this transport was insufficient. An additional coach and two minibuses were purchased which enabled more people to take advantage of the facilities available. 22 REGISTRATION OF DISABLED PERSONS' OR OLD PERSONS' HOMES Section 37 of the National Assistance Act, 1948, requires disabled persons' and old persons' homes to be registered by the Council. There are two private old persons' homes registered by the Council: — 22, St. Gabriels Road, N.W.2. 28, Sedgecombe Avenue, Kenton. These homes are inspected at regular intervals and a high standard is maintained. REMOVAL TO SUITABLE PREMISES OF PERSONS IN NEED OF CARE AND ATTENTION Section 47 of the National Assistance Act, 1948, permits the removal to an institution of a person in need of care and attention by the Council; an Order for removal is made by a court of summary jurisdiction, but seven clear days' notice of an intended application must be given. The National Assistance (Amendment) Act, 1951, permits immediate removal provided the Medical Officer of Health and another registered medical practitioner certify that it is in the interests of the person to remove him without delay; the Order in this case can be made either by a court of summary jurisdiction or by a single justice having such jurisdiction. The amending Act modifies the period from three months to three weeks for a person to be detained in the first instance. Several cases were investigated during the year, but it was possible to make them comfortable in their own homes by the provision of additional services such as home help, home nurse, meals-on-wheels and no further action was necessary. TEMPORARY CARE AND PROTECTION OF PROPERTY In accordance with Section 48 of the National Assistance Act, the Department undertook responsibility for the care and protection of the movable property of 11 residents who were admitted to hospital or residential accommodation where it was apparent that no other suitable arrangements were being made. In 14 other cases, the Department was able to discharge its duties by arranging for relatives or friends to assume responsibility and to indemnify the Council accordingly. At the end of the year, the property of 17 residents was in store in the annexe of "Mardale" residential home. The Council decided to use the annexe for storage purposes after it was closed for residential purposes in December due to inadequate heating. Two properties were secured for protection and no further action was required. Proceedings were commenced for the Borough Treasurer to be appointed as agent under Receivership Orders in two cases where the persons concerned were deemed to be unable to manage their own affairs. BURIAL OF THE DEAD In accordance with the provisions of section 50 of the National Assistance Act, 1948, arrangements were made for the burial or cremation of 46 persons during the year. 28 of these were residents of the Council's residential homes. WELFARE SERVICES FOR THE ELDERLY IN THE COMMUNITY Prior to 31st March 1965, many of the welfare services for the elderly in the community, such as luncheon clubs, meals-on-wheels, full-time clubs, holidays, outings for the housebound, sale of welfare foods and distribution of Christmas gifts, were organised and administered by Wembley Old People's Welfare Committee and Willesden Old People's Welfare Committee, with financial support from their respective Borough Councils. From 1st April, these services were taken over by the Council. Two full-time social centres for the elderly—Willesden Green and Kensal Rise Senior Clubs—entered their fifth year of successful operation, the former in adapted and the latter in purpose-built premises. Each Senior Club has an enrolled membership of 500, who pay a nominal membership fee of l/0 d. per year. The amenities provided include rooms for billiards, television, hobbies, reading and spacious main club rooms for meals, refreshments, whist-drives, concerts and other entertainments. In the Wembley area, Council finance supports two full-time centres providing similar amenities, but for men only, at Barham Park and Kingsbury Veterans' Clubs, in premises provided by the Council. Eight luncheon clubs have in recent years been established in the Willesden part of the Borough at William Dunbar Community Centre, Kilburn; Harley Hall, Harlesden; St. Michael's Church Hall, Knatchbull Road ; Neasden Methodist Church Hall; Anson Hall, Cricklewood; Scout Hall, Streatley Road, Kilburn; and the Willesden Green and Kensal Rise Senior Clubs. A ninth club, the first in the Wembley area, was opened in November, at the New Hall, Ealing Road, and on the three days the club functions attendances soon reached the 80/90 mark. Two-course meals, prepared in school meals kitchens, are served at a charge of 1 /3d. and 35,270 meals were served in the nine clubs in 1965. The meals-on-wheels service continued to be operated in conjunction with the Women's Voluntary Services, deliveries being made on 2 or 3 days per week in five vehicles. Meals are prepared at Kensal Rise Senior Club Kitchen for the Willesden area, and from the school meals organisation for the Wembley area, 26,593 meals being delivered in 1965 at the same charge of 1 /3d. 23 The assisted holiday scheme for elderly people to go for a fortnight to the seaside during off-peak months was extended to include those in the Wembley part of the Borough. Five hundred and sixteen such holidays were arranged during the year at a charge of £4 each to the applicants, and a further 11 through the Women's Holiday Fund. Through this Fund 12 holidays were also arranged at Christmas for elderly women who live alone. For the elderly who can get out, more than 40 afternoon clubs operate in the Borough. During the winter some 30 of them enjoy monthly concerts provided by the Council through the Entertainments Department. In addition, for the first time this year a series of 5 variety matinees was organised at the Town Hall. Several hundred pensioners have attended these, those from the more outlying areas being provided with free transport. A small number of the clubs received financial assistance from the Council to pay for the rent of their premises and to help with Christmas arrangements. The sale of welfare foods at reduced prices was extended during the year. Complan, Horlicks, Ovaltine, Bovril, Marmite, and tea, are sold and delivered regularly to 26 clubs, clinics and other centres, and annual sales amount to close on £3,000. In August and September, 3 outings into the Country were organised for about 150 housebound elderly people, including a number confined to wheelchairs. Special tail-lift coaches, minibuses and cars were provided by the Council, and on each occasion a number of cars were also provided by voluntary drivers. In September, a programme of regular weekly visits by minibus was initiated to get small numbers of elderly housebound to Willesden Green and Kensal Rise Senior Clubs. At Christmas, 1,842 food parcels were distributed among those over 70. This was made possible in part by gifts in kind and cash donations of £372 from various local organisations, the rest of the cost being provided by the Council. In the Carlton and Kilburn Wards, a further 588 parcels were distributed by the Luke Old Folk's Fund. In October, substantial gifts of packaged foods from Harvest Festival offerings at local schools were distributed with the meals-on-wheels. The Medical Officer of Health acts as local representative for the Wireless for the Bedridden Society, which has 24 radio sets on loan to elderly people in the Borough ; to the Steiner Foundation, which has made available 29 television sets, licensed and maintained ; and to the National Society for Cancer Relief in the payment of weekly allowances to a number of elderly patients. Cases of hardship due to lack of fuel in cold weather were helped from emergency supplies kept by the Council for the purpose. Facilities for interviewing elderly people to help them with a wide variety of problems were maintained during the year, and the Department's Social Workers visited elderly people in their own homes to assess and help with a diversity of problems. OLD PEOPLE'S CLINICS Two Geriatric Clinics are held weekly, one at Neasden Clinic, Balnacraig Avenue, N.W.10, from 9 a.m. to 12 noon on Mondays, and the other at Mortimer Road Clinic, Mortimer Road, N.W.10, from 9 a.m. to 12 noon on Wednesdays. A doctor and nurse are in attendance. All senior citizens can come to these clinics to discuss their physical and mental health, and their social problems. Transport is arranged for those who find difficulty in getting to the clinic. Friendly cooperation has been maintained with family doctors who are informed after each session of their patients' visits. Communications with hospitals are made as and when required, and correspondence with statutory and voluntary bodies is initiated when necessary. The wide range of services which the Council provides e.g. home help, domiciliary visits by health visitors and social workers, aids to assist mobility and adaptations in the home, clubs, meals-on-wheels, domiciliary bathing, holiday scheme, short and long stay residence in old people's homes, chiropody, physiotherapy and home nursing, are explained at the clinic sessions, and those required are provided. Housing is very important in the lives of everyone and the elderly are no exception. Their accommodation is discussed, advice given, and help provided where possible. Food supplements are sold at reduced prices and these have proved highly popular. Physiotherapy is available at the Neasden Clinic, and chiropody is provided at both clinics. During 1965, 79 sessions were held. Altogether 107 patients attended (70 for the first time), and they made a total of 325 attendances. The majority of patients were in the 70 - 80 year age group. A very large percentage were women. VOLUNTARY SERVICES FOR THE AGED Apart from those services for the elderly in the community which were taken over by the Council on 1st April and which are referred to in the previous section, certain services continued to be operated by voluntary organisations, in some instances with financial support from statutory sources. The Willesden Old Folk's Association continued to run the '49' Club which was the first of the five full-time Clubs for the elderly in the Borough. In February it celebrated its thirteenth anniversary. The running expenses were partly met by a grant from the Council. 24 Since 1960, the same Association has acted as agents for the Middlesex County Council under Section 28 of the National Health Service Act 1946, in administering a chiropody service for the elderly. The service, which has been complementary to that provided by the health authority at the clinics, was provided through five chiropodists in private practice. The treatment is free to old people in receipt of supplementary pensions from the National Assistance Board, and to single persons whose income does not exceed £5 per week, or married couples not exceeding £8 per week. Otherwise a charge of 2/0d. for treatment of one foot, or 4/0d. for both, is made. A total of 6,245 treatments were given in 1965 at a cost of £2,718 of which £2,624 was recovered by the Association by way of grants from the County Council to 31st March, and from Brent Council over the remainder of the year. A limited amount of chiropody treatment was also made available for the elderly through the Wembley and Willesden Divisions of the British Red Cross Society. The Society also afforded assistance in providing on loan wheelchairs and nursing equipment, and in placing elderly persons requiring some degree of care and attention in its holiday homes. The majority of afternoon clubs for the elderly, which organise many social activities for their members in addition to regular meetings, are run by such voluntary organisations as the League of Jewish Women (Friendship Clubs for the Jewish elderly), the Women's Voluntary Services (Darby and Joan Clubs), the British Red Cross Society (Evergreen Clubs), the National Federation of Old Age Pensions Associations, Community Associations, Churches and private groups. The luncheon clubs provided by the Council are entirely staffed by voluntary workers and much voluntary work is also carried out in the five full-tim e centres in the Borough. Various organisations, including Youth Clubs, as well as private persons, participated in arrangements for visiting the elderly who live alone, and in offering help with shopping, gardening, decorating and other chores. LAUNDRY SERVICE FOR THE INCONTINENT AGED The laundry service for the incontinent elderly is administered by the Council under Section 31 of the National Assistance Act. The articles are laundered at Neasden Hospital by arrangement with the Central Middlesex Management Committee and at Colindale Hospital under a similar arrangement with the Hendon Group Hospital Management Committee. Transport is provided by the Borough Council. Patients are referred by hospitals, doctors, council nurses and relatives. The service enables patients who would be admitted to hospital to be nursed at home and more beds are available for urgent cases. It was greatly appreciated by the patients and their relatives. No. of Old People using the Laundry Service On register 1.1.65 New Cases Died Admitted to Hospital Discontinued On register 31.12.65 56 49 19 12 19 55 25 ENVIRONMENTAL HEALTH SERVICES SANITARY CIRCUMSTANCES OF THE AREA WATER The Metropolitan Water Board and the Colne Valley Water Company supply Brent with water. These supplies are not subject to plumbo-solvent action and have been satisfactory both in quantity and quality. All dwelling houses and flats have a piped supply direct from the mains and there were no complaints of any contamination during the year. Frequent bacteriological and chemical examination of the water is carried out by the Metropolitan Water Board and Colne Valley Water Company. SEWAGE AND DRAINAGE Most of the sewage of the borough is discharged into the Greater London Council main sewers, but a small amount from the Park Royal area is discharged into the West Middlesex Main Drainage system. The arrangements for sewage disposal are adequate and also those for sewerage with minor exceptions due to local flooding associated with severe storms. Three schemes which were approved in 1963 were completed during 1964. REFUSE DISPOSAL The Borough Engineer's Department deals with the provision of dustbins. Refuse is disposed of by controlled tipping at Yiewsley and by a separation and incineration plant at Alperton, house refuse is collected weekly and trade refuse as often as required at an agreed charge. SWIMMING BATHS The Borough Engineer has kindly supplied the following information in respect of the five swimming baths in the borough. The water for filling the baths is obtained from the mains supply. It is regularly chlorinated and plant of sufficient capacity to insure breakdown conditions is installed at each bath. The capacity of each bath and the time taken for the whole of the water to pass through the filters and treatment plant is as follows:— Time taken for water to pass through filters, etc. (hours) Capacity (gallons) Granville Road Baths 145,000 4 Gladstone Park Swimming Pool 500,000 11 King Edward's Recreation Ground Swimming Pool 350,000 6½ Kingsbury Swimming Pool 400,000 4½ Vale Farm Swimming Pool 464,000 5 297 samples were taken, of which 4 were unsatisfactory. Swimming bath Samples taken Unsatisfactory Granville Road 130 3 Gladstone Park 52 — King Edward's Park 61 — Kingsbury 34 1 Vale Farm 20 — SANITARY INSPECTION OF THE AREA Details of inspections carried out are shown in Table 27. Four inspectors were engaged on special surveys: three on the smoke control areas, and one onRachman-type problems. Demolition and Closing Orders (Table 28) Two closing orders and two demolition orders were made during the year. Slum Clearance and Area Redevelopment During the year, three slum clearance areas were dealt with, the largest being the South Kilburn Redevelopment (Extended Area). This Area was declared as a clearance area by the Willesden Borough Council in February 1964. 26 The Area covering approximately 20 acres, comprised 417 properties, 328 of which were considered to be unfit for human habitation and 89 were considered fit, these are of necessity included so that the redevelopment of the whole area can be proceeded with according to a properly phased programme. The Ministry of Housing and Local Government held a Public Inquiry, which commenced on the 8th November, 1965, and continued for five weeks until the 10th December 1965. During this time, 296 objections were heard in relation to 237 properties. The objectors mounted a massive attack on the Council and its officers; it is understood that the Inquiry lasted longer than any other and there was the largest ever number of objectors. The inspection of the properties by the Inspector from the Ministry of Housing and Local Government followed the Public Inquiry, and the Council are now awaiting the Minister's decision. In June 1965 the Brent Borough Council made a Clearance Area of Malvern Place and part of Malvern Road ; this area comprises 23 unfit houses and was dealt with at the same Public Inquiry. A further Area comprising part of Cambridge Road and the whole of Rudolph Road, involving 17 unfit properties was also dealt with and confirmed by the Minister after a Public Inquiry. In addition to this work, surveys were commenced in the Nicoll Road Area and the Lower Place Industrial Area C.D.A., which are not already in Council ownership. Approximately 80 houses are involved in the latter area. House-to-House Inspection and Multiple Occupation House-to-house inspection was carried out during the year. Although hampered by shortage of staff and the difficulty of carrying out 'work in default', a great deal of work was done in combating multiple occupation to secure the provision of amenities and general repair. This is a most time-consuming project and many additional public health inspectors would have to be recruited before any appreciable inroads into the problem could be made. 83 notices under section 15, Housing Act, 1961, requiring the provision of additional amenities, and 112 directions under section 19 of the Act to overcome overcrowding in houses in multiple occupation were served. Overcrowding There has been little change in the extent of overcrowding which still remains acute. The Housing Manager has kindly supplied the details of overcrowding in the area, which have been based mainly on statements of housing applicants (Table 29), and also details of new dwellings constructed during the year (Table 30). Notices served under the Public Health Acts, 1936 and 1961, and Housing Acts, 1957 and 1961 There was a decrease in the number of statutory notices served during the year, compared with 1964 (Table 31). No management orders under section 12, Housing Act, 1961, were served during the year. Nuisances abated and improvements effected A summary of nuisances abated and improvements effected in dwelling houses is shown in Table 32. Rent Act, 1957 Details of the applications received and the certificates issued up to the end of the year are shown in Table 33. CLEAN AIR The Clean Air Act, 1956, came into operation on the 1st June 1958, and further progress has been made in the establishment of Smoke Control Areas provided for in the Act. Three Smoke Control Areas became operational as follows:— No. 10 (St. Andrew's) covering 310 acres with 2,226 dwellings, and 54 commercial and other premises was confirmed by the Minister of Housing and Local Government on the 18th November 1964 and came into operation on the 1st November 1965. No. 11 (Barham) covering 279 acres with 2,162 dwellings and 176 commercial and other premises was confirmed by the Minister on the 18th November 1964 and came into operation on the 1st November 1965. No. 7 (Brondesbury Park) covering 409 acres with 5,042 dwellings and 214 commercial and other premises was confirmed by the Minister on the 21st May 1965 and came into operation on the 1st December 1965 27 The Orders now in operation are as follows: — Area No. Date of operation Acreage No. of dwellings No. of other premises Willesden No. 1 1. 6.59 48.5 627 73 Wiillesden No. 2 1.10.60 271 2,351 143 Willesden No. 3 1.11.61 380 5,057 450 Willesden No. 4 1.10.62 210.8 3,667 421 Willesden No. 5 1.11.63 355 4,192 121 Willesden No. 6 1.11.64 144 3,496 213 Willesden No. 7 1.12.65 409 5,042 214 Wembley No. 1 1.10.61 299 1,377 26 Wembley No. 2 1.10.62 265 758 82 Wembley No. 3 1.10.62 148 564 40 Wembley No. 4 1.10.62 119 1,137 7 Wembley No. 5 1.10.62 158 1,017 37 Wembley No. 6 1.10.63 163 853 19 Wembley No. 7 1.10.63 391 997 96 Wembley No. 8 1.10.63 398 831 155 Wembley No. 9 1.11.64 243 2,262 150 Wembley No. 10 1.11.65 310 2,226 54 Wembley No. 11 1.11.65 279 2,162 176 TOTAL 4,591.3 38,616 2,477 The Brent No. 1 (Tokyngton) Smoke Control Order covering 505 acres with 3,929 dwellings and 414 commercial and other premises was confirmed by the Minister on the 28th December 1965 and will become operational on the 1st July 1966. The Council have approved the following programme of Smoke Control Areas providing for two Areas annually until 1971 when three Areas will become operational and the whole Borough will be a Smoke Control Area. 1966 Brent No. 2 Kilburn 1967 Brent No. 3 Kingsbury Brent No. 4 Mapesbury 1968 Brent No. 5 Preston Brent No. 6 Willesden Green 1969 Brent No. 7 Sudbury Brent No. 8 Dudden Hill 1970 Brent No. 9 Queensbury Brent No. 10 Dollis Hill 1971 Brent No. 11 Brentside Brent No. 12 Stonebridge Brent No. 13 South Kilburn The volumetric analysis of SO2 and measurement of smoke concentration has continued at six stations. The station at the Willesden Health Department offices has been transferred to Kilburn Grammar School. Eleven notifications of new boiler plants were received in accordance with the provisions of Section 3 of the Clean Air Act and the heights of new chimneys were determined in 10 cases. INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES The Food Hygiene (General) Regulations, 1960, prescribe standards for the preparation, storage and sale of clean food. There has been a marked improvement in hygiene in the production and sale of food since the Food Hygiene Regulations, 1955, came into force. Public Health Inspectors inspect food premises and stalls (Table 34) regularly and serve verbal or written notice to improve the standards of food hygiene. Improvements in some premises are still either in progress or arrangements are being made for them to be carried out (Tables 35 and 36). The proprietors of three food stalls were prosecuted for contraventions of the Food Hygiene Regulations, with the following results: — (a) Ten contraventions: All proved—fined £104.0.0d. with £10.10.0d. costs. (b) Seven contraventions: All proved—fined £99.0.0d. with £7.7.0d. costs. (c) One contravention: Proved—fined £2.0.Od. with £1.0.0 costs. PREMISES WHERE FOOD IS PREPARED Premises which manufacture or sell ice-cream or prepare or manufacture sausages, potted, pressed, pickled or preserved foods, including cooked meat or fish intended for sale, must be registered by the Council. If the Council refuses or cancels a registration, the owner can appeal first to them and if unsuccessful to a court of summary jurisdiction. (Table 37). Premises where ice-cream is manufactured are kept under close supervision. Most of the ice-cream sold in the borough is manufactured outside the district, and is usually pre-packed. The ice-cream reaches a high standard of purity. (Table 40). 28 EDUCATION IN FOOD HYGIENE Lectures illustrated with film shows, filmstrips and bacteriological cultures were given to school leavers. FOOD POISONING It is pleasing to report that there was no outbreak of food poisoning in the borough. This is probably a reflection of the great improvement in handling, preparation, storage and sale of food. There was a decrease in the number of individual cases of food poisoning notified. FOOD UNFIT FOR HUMAN CONSUMPTION One ton 9 cwt. of meat, fish and other food inspected by the Public Health Inspectors was found to be unfit for human consumption. All the food was dealt with as trade refuse by the Borough Engineer's Department and deposited on the controlled refuse tip. SLAUGHTERHOUSE There is one private slaughterhouse licensed in the Borough. This was discontinued during the last War and was brought back into operation in 1952. Particulars of inspections, carcases inspected and condemned are shown in Table 38. CONTAMINATED FOOD Sixty-three specimens of contaminated food were dealt with by the Department. They included foreign bodies in milk (11), dirty bottles of milk (7), foreign matter in bread (11), mould in a cheese sandwich, in a loaf of bread, in canned meat (4), in meat pies (2), in cakes (2), in sausages (2), in canned food (2), and in yoghurt, other foreign bodies in cheese, sausage (2), bacon (2), meat pies (3), fish (3), sandwiches, boiled sweets, cakes, soft drinks (2), canned food (2), and pepper. A further sixteen complaints were of food alleged to be unsound for some other reason. Six other complaints were considered to be not justified. Of the 79 cases, in only 39 was the evidence sufficient to warrant action and of these, the Council resolved to issue 35 cautions and prosecute in four instances. Three cases had not been heard by the end of the year. In the remaining one the defendant was fined £5.0.0d. with £2.2.0d. costs for failure to cleanse a milk bottle. SAMPLING OF FOOD AND DRUGS Composition of Food. The Council became a food and drugs authority on 1st April 1965 and by the provisions of the Food and Drugs Act, 1955, the medical officer of health and the public health inspectors are by virtue of their appointments, authorised officers for the purposes of the Act, including the procuring of samples. The former County Analyst was appointed Public Analyst to the London Borough of Brent. The assumption of new duties by the existing officers of the two former Boroughs, now constituting the London Borough has resulted in a programme of sampling for the part of the first year which has to a large extent been exploratory, and details of the samples procured for submission to the Public Analyst are shown in Table 39. The unsatisfactory samples consisted of foods which were either the subject of a questionable description or foods where the retailer failed to make it clear to the purchaser that an inferior article was offered. It was considered appropriate to prosecute in only one case where a fine of £10,0.0d. was imposed with £5.0.0d. costs. Marking and Labelling of Food. Whilst it is not at present a requirement at law to identify by a label the type or variety of an open food, any misdescription can be a contravention of the Food and Drugs Act. Certain packeted or canned food must, however, by the Labelling of Food Order, 1953 bear a name of the food, its ingredients, and the name and address of the packer or a registered trade mark. Again, some imported foods must, when exposed for sale, carry an indication of their origin in accordance with the Merchandise Marks Acts and Orders made thereunder. Visits of inspection for the general purpose of checking the accuracy of marking and labelling food exposed for sale have been made on 960 occasions, and first warnings given in 113 instances. In addition 18 samples were taken for examination in the Department. In one case, after warnings, legal proceedings were instituted resulting in a fine of £5.0.0d. being imposed with £6.6.0d. costs (failure to mark imported apples as "Foreign"). MILK AND DAIRIES REGULATIONS The Borough is a specified area in which may be sold only milk to which a special designation is applied, i.e. Pasteurised, Sterilised, Ultra-heat-treated (since October 1965) and Untreated. (The latter designation was introduced in 1963 when tuberculosis in milch cattle was virtually eradicated in this country). 29 When the Borough became a food and drugs authority in April 1965, the function of administering the Milk (Special Designation) Regulations was returned to the local authority after five years during which the Middlesex County Council had acted in thematter. Only one pasteurising bottling plant remains operative in the district, but there are 244 persons registered as distributors, all licensed dealers in pre-packed milk to which special designations apply. Assuming that the consumption of milk in the Borough conforms to the national average, some 214,000 pints of milk are sold daily. The amount of untreated milk is less than 50 pints per day. A new designation for milk which is sterilised by a short time-high temperature method (one second at 270°F) was authorised during the year—"Ultra-Heat-Treated". None is produced in the Borough but 36 licenses were issued to dealers in milk treated in this manner. Inspections of dairies 43 Samples examined bacteriologically 90 Samples examined for fat content 34 Complaints of dirty bottles or foreign bodies in milk 18 REGISTRATION OF HAWKERS Hawkers of food and premises used by them for storage accommodation must be registered by the Council (section 11 of the Middlesex County Council Act, 1950). Eighty-six hawkers are registered (31 selling fruit and vegetables, 30 selling "hot dogs", 13 ice-cream, 4 fish, 2 mobile canteens, 2 cooked poultry, 2 bread and confectionery, 1 groceries, and 1 selling milk drinks). Fourteen were newly registered during the year. Three hawkers were prosecuted for failing to register and for contraventions of the Food Hygiene (General) Regulations, 1960. Eighteen summonses were found proved and resulted in the imposition of fines totalling £205 with £18.17.0d. costs to the Council. PUBLIC HEALTH LABORATORY SERVICE (Table 40) Bacteriological specimens (swabs from sore throats, faeces from intestinal infections, cough plates and post-nasal swabs from whooping cough cases, etc.) are examined by the Public Health Laboratory Service at the Central Public Health Laboratory, Colindale, and at the branch laboratory at Neasden Hospital. Specimens delivered to the Health and Welfare Department and the Health Clinics are collected and taken to the laboratory in Neasden Hospital. A report by telephone is given to the doctor as soon as possible, followed by a written report. Samples of milk, ice-cream and water are sent by public health inspectors. The percentage of ice-cream samples graded 2, 3 or 4 was almost the same as last year. There was one unsatisfactory sample of milk. This was taken from a vending machine and was probably due to faulty stock rotation. Four samples of water from swimming baths were found to be unsatisfactory due to the breakdown of plant. Further samples were satisfactory. About 1,450 tons of bulk liquid egg is used annually in the seventeen bakeries in the Borough. With the exception of approximately 40 tons, which is imported from Australia and Poland, it is produced and pasteurised in this country. Twelve samples were taken in accordance with the Liquid Egg (Pasteurisation) Regulations, 1963, and were found to be satisfactory. FACTORY INSPECTION The Council supervise sanitary conveniences in all factories and, in addition, cleanliness, overcrowding, temperature, ventilation and drainage of floors in non-power factories. Details of inspections and notices served, defects found and remedied are given in Tables 41 and 42. Basement Bakehouses In 1963, one Certificate of Suitability was issued to the occupier of a basement bakehouse in accordance with the provisions of Section 70 of the Factories Act, 1961. During the year the premises ceased to be used as a bakehouse. Outworkers and Homeworkers In February and August of each year, factory owners send to the local authority lists of names and addresses of all persons who have worked at home for them during the previous six months on certain jobs. 202 were employed during the year, the largest number (136) altering and making clothing. Public Health Inspectors inspected these workers' homes, which were all found to be satisfactory (Table 43). NOISE NUISANCE The Borough Council deals with noise nuisances under the Noise Abatement Act, 1960, which repealed the noise nuisance section of the Middlesex County Council Act, 1944. It provides that noise and vibration which are nuisances are offences under the Act. It is no longer necessary for a doctor to have to decide whether there is danger or injury to health. 30 Public Health inspectors have made day and night observations to determine whether complaints of noise nuisance were justified or not. 82 complaints were received during the year, of which 28 were in respect of noise from industrial premises, 30 in respect of commercial premises and 24 domestic. 74 complaints were abated, but 8 were still being dealt with at the end of the year. The Council authorised the employment of the Greater London Council Scientific Division to advise on a difficult case of noise from machinery. The noises objected to by complainants were wide and varied, and included those from factory processes, car delivery and repairs, unloading of milk churns, loudspeakers, 'beat groups', and inconsiderate neighbours. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 The Rag Flock and Other Filling Materials Act, 1951, and Regulations of 1961, specify standards of quality and cleanliness for certain filling materials which are used in the manufacture of upholstered articles. Premises in which such materials are manufactured must be registered with the Council, and premises which are used for the storage of such materials only must be licensed by the Council. Premises where the business of upholstering, stuffing or lining of bedding, toys and baby carriages is carried on must be registered, the statutory fee being £1.0.0d. The Act does not cover the re-making of an article, and consequently the standards of quality and cleanliness do not apply to articles being repaired. There are now seven premises on the register, six of which are in Willesden and one in Wembley. Formerly there were twelve in Willesden, but six of these which were outworkers have ceased business. There were two in Wembley, but one of these now uses foam filling only. Five samples of filling materials were taken and submitted to the Analyst. Three of these were found to be satisfactory, but the fourth was found to have an excessive trash content. The sample was repeated and on this occasion the trash content was found to be satisfactory but the dust content was high. Since these matters related to quality rather than cleanliness and were not of a serious nature, a warning letter was sent to the manufacturers. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 The Act virtually came into full force on the 1st August, 1964, and with certain exceptions applies to retail shops, offices, wholesale premises and most warehouses, catering establishments and canteens, fuel storage premises and certain railway premises. The exceptions are premises where only self-employed persons work, businesses in which only immediate relatives of the employer are employed, and other premises where not more than 21 man-hours weekly are normally worked. Employers are required to register their premises and the number registered during the year together with the number of persons employed is shown in Table 44. The general requirements of the Act deal with matters affecting the safety, health and welfare of employees, and covers cleanliness; overcrowding; temperature; ventilation; lighting; sanitary conveniences; washing facilities; drinking water; accommodation for clothing; seating arrangements; eating facilities in shops; cleaning machinery and fencing exposed parts; training and supervision of persons working at dangerous machines; prohibition of heavy work; first aid; penalisation of dangerous acts and interference with equipment; dangerous conditions and practices; and construction and maintenance of floors, passages and stairs. H.M. Factory Inspectorate is responsible for enforcing the general provisions of the Act in offices and shops in factories; railway premises and offices; premises owned or occupied by the Crown; and premises occupied by County Councils, local fire and police authorities, and probation committees. The responsibility for the remainder of premises falls to the Council, and in Brent this responsibility has been delegated to shops inspectors and public health inspectors. Broadly speaking, public health inspectors inspect offices, food shops, wholesale premises, warehouses and catering establishments open to the public, and canteens, and shops inspectors inspect the remainder. The total number of general inspections made is shown in Table 45, and the defects found and remedied in Table 46. Under Section 46 of the Act the Council have power to grant an exemption in respect of the requirements regarding room space for employees, temperature, provision of sanitary conveniences and provision of running water for washing facilities. Exemption from the requirement to supply running water may be given either for a specified period or indefinitely; exemption from any other requirements must be for a period only, not exceeding two years. To obtain an exemption certificate it is necessary to satisfy the enforcing authority that it is not reasonably practicable to comply with the statutory requirement or requirements from which exemption is sought. The Council need to know precisely what trouble and cost would be involved in meeting the requirements and what other practical difficulties exist. An appeal against an authority's refusal to grant an exemption can be made to a magistrates' court. One application for exemption from the requirements of providing a sanitary convenience and running water for washing facilities was received, but this was refused on the grounds that it was practicable to install the necessary facilities. The applicant did not appeal. Employers are required to notify accidents to employees which cause the death of the injured person or disables him for more than three days from doing his usual work. 53 non-fatal accidents were notified; an analysis of their causation is shown in Table 47. Each accident was investigated and, if necessary, advice given to prevent a recurrence. Enforcing authorities have power to prosecute in any case of infringement of the Act or Regulations. However, during the first year or two of the operation of the Act it is best to proceed by way of advice and warning and no prosecutions have yet been instituted by the Council. 31 ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT The registration of establishments for massage and special treatment is a function of the Borough Council under Part XII of the Middlesex County Council Act, 1944. During the year six new licences were granted and 39 were renewed. All the applicants are suitable persons to hoild licences and their premises were found satisfactory. RODENT CONTROL Rodent control, as approved by the Ministry of Agriculture and Fisheries (Infestation Branch) has been carried out in the properties below: — Business premises 309 Borough Council properties 46 Private dwellings 1,342 1,697 The cost of disinfestation of business premises viz. £1,474 15s. 7d. was recovered from the occupiers. The service is free to occupiers of private dwellings. In July, the Council decided that, owing to the difficulty of recruiting staff, contracts with business premises in the Willesden part of the area (there were no such contracts in Wembley) be not renewed, and therefore these contracts will have lapsed by the end of May 1966. Rodent control in the Council's sewers is carried out by the Borough Engineer's Department. Where surface rat infestation is due to faults in the connections of the house drains with the sewer, the Borough Engineer's Department arranges for the opening of the pavement. CONTROL OF WILD PIGEONS The contract entered into by the former Wembley Borough Council for the extermination of pigeons from railway bridges was renewed for the year ending 31st March 1966. The Council decided to make provision in the estimates for 1966/67 for the extension of the contract to include railway bridges in the former Willesden part of the area, making a total of ten bridges in the Borough. UNCLEANLINESS AND SCABIES (Table 48) Treatment for scabies, lice and nits has been carried out at Stonebridge Clinic. As compared with 1964, there has been an increase in the number of children under 5 years of age and adults treated for scabies, and an increase in the number of children up to 15 years of age treated for lice and nits. However, the numbers treated are still small, and there is no evidence of a significant increase in the prevalence of these conditions among the population. DISINFESTATION The Public Health Inspectors inspect verminous premises and supervise the work of disinfectors employed by the Council (section 83 of the Public Health Act, 1936) (Table 49). There was a decrease in the work compared with the previous year. The Council provide transport for clothing and bedding requiring disinfection and disinfestation (section 84 of the Public Health Act, 1936). The Council's employees disinfect and disinfest rooms, and collect and deliver the clothing and bedding. PUBLIC MORTUARY On 1st April, two mortuaries were transferred to the Council, viz. the Willesden Borough Council's mortuary in Kilburn, and the Wembley Borough Council mortuary at the rear of the Town Hall. The Kilburn mortuary was built last century, but was modernised and enlarged in 1961 at a cost of £3,000. It contains a refrigerated chamber for six bodies and two separate post mortem tables, together with waiting room, viewing room, toilet accommodation and offices. There is also a Coroner's Court in the curtillage, which is seldom used (twice in 1964, once in 1965). The Town Hall mortuary was constructed in 1959/60, at a cost of £16,300. It contains a refrigerated chamber for nine bodies and two separate post mortem tables, together with waiting room, viewing room, toilet accommodation and offices. The Mortuary Attendant at the Town Hall Mortuary resigned in August. The premises were closed temporarily and all bodies were then received into the Kilburn mortuary. Complaints were made by the Coroner and his Pathologist that the Kilburn mortuary was inadequate and that geographically it was unsatisfactory. After very careful consideration, the Health and Welfare Committee recommended that the Kilburn Mortuary be closed and in future all bodies be received into the Town Hall mortuary. This recommendation was agreed by the Council and the decision was put into effect on the 2nd December, 1965. During the year post mortems were performed on 765 bodies, followed by an inquest in 109 cases. These inquests were held either at Hendon or Finchley. 32 TABLES Table 1 DEATHS Causes: Males Females Total 1. Tuberculosis (respiratory) 6 1 1 2. Tuberculosis (other) 3 — 3 3. Syphilitic disease 2 2 4 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis — — — 8. Measles — — — 9. Other infective and parasitic diseases 6 3 9 10. Malignant neoplasm, stomach 46 30 76 11. Malignant neoplasm, lung bronchus 68 31 199 12. Malignant neoplasm, breast 1 60 61 13. Malignant neoplasm, uterus — 22 22 14. Other malignant and lymphatic neoplasms 163 160 323 15. Leukaemia, aleukaemia 9 14 23 16. Diabetes 9 16 25 17. Vascular lesions of nervous system 127 223 350 18. Coronary disease, angina 396 221 617 19. Hypertension, with heart disease 6 21 27 20. Other heart disease 66 135 201 21. Other circulatory disease 65 108 173 22. Influenza — 1 1 23. Pneumonia 85 85 170 24. Bronchitis 120 44 164 25. Other diseases of respiratory system 22 9 31 26. Ulcer of stomach and duodenum 12 10 22 27. Gastritis, enteritis and diarrhoea 8 10 18 28. Nephritis and nephrosis 4 7 11 29. Hyperplasia of prostate 11 — 11 30. Pregnancy, childbirth, abortion — 3 3 31. Congenital malformations 18 12 30 32. Other defined and ill-defined diseases 122 133 255 33. Motor vehicle accidents 28 12 40 34. All other accidents 29 16 45 35. Suicide 17 20 37 36. Homicide and operations of war 1 1 2 TOTAL 1,550 1,410 2,960 33 Table 2 MAIN CAUSES OF DEATH AND RATES PER 1,000 POPULATION Cause No. Rate per 1,000 population Heart disease and other diseases of circulatory system 1,018 3.5 Malignant neoplasms 681 2.3 Vascular lesions of nervous system 350 1.2 Respiratory diseases (influenza, pneumonia, bronchitis, etc.) 366 1.2 Violent deaths (motor vehicle accidents, other accidents, suicides and homicide) 124 0.4 All other cases 421 1.4 TOTALS: 2,960 100 Table 3 Infant Mortality: —by Wards Ward Number of deaths Rate Queensbury — Nil Kingsbury 2 9.1 Kenton 2 10.4 Sudbury 4 19.0 Preston 2 8.8 Chalkhill 1 4.6 Barham 5 17.5 Tokyngton 2 8.7 Alperton 8 28.3 Brentwater 4 25.3 Church End 5 21.2 Gladstone 3 24.2 Cricklewood 1 4.3 Willesden Green 8 23.0 Mapesbury 5 16.5 St. Raphael's 5 30.1 Roundwood 6 18.6 Brondesbury Park 8 34.8 Stonebridge 6 18.9 Manor 9 33.7 Chamberlayne 6 32.3 Harlesden 8 26.1 Kensal Rise 5 16.1 Queens Park 7 24.7 Kilburn 12 31.9 Carlton 4 15.2 128 19.9 34 Table 4 Infant Mortality—Causes Neo- Natal 1—12 Months Total Rate Respiratory 5 21 26 4.0 Diarrhoea and Enteritis 1 2 3 .5 Other infections — 1 1 .2 Congenital malformations 9 12 21 3.2 Prematurity 44 1 45 7.0 Injury at birth 10 — 10 1.6 Other causes 16 6 22 3.4 All causes 85 43 128 19.9 Table 5 INFECTIOUS DISEASES 1965 (1964 in brackets) Notified Confirmed Diphtheria - (-) - (-) Dysentery 104 (153) 86 (140) Erysipelas 11 (11) 11 (11) Encephalitis, acute - (2) (2) Food poisoning 39 (49) 39 (47) Malaria - (-) - (-) Measles 3,166 (1,373) 3,162(1,373) Meningococcal infection 3 (2) 2 (1) Ophthalmia neonatorum 4 (1) 4 (1) Paratyphoid fever 1 (1) 1 (1) Pneumonia 65 (79) 65 (79) Poliomyelitis and polioencephalitis - (-) - (-) Puerperal pyrexia 87 (129) 87 (129) Scarlet fever 94 (167) 94 (167) Smallpox - (-) - (-) Typhoid fever - (-) - (-) Whooping cough 71 (163) 71 (163) Table 6 PRIORITY DENTAL SERVICE Expectant and Nursing Mothers Children under 5 Number examined 336 1,082 Number required treatment 303 678 Number of new cases commenced treatment 293 653 Dentally fit 170 430 Extractions 436 458 Fillings 961 1,419 Scaling and gum treatment 136 — Silver nitrate dressings — 389 Dentures 69 — Number of attendances 1,214 1,614 35 Table 7 Day Nurseries: Attendances Nursery Approved places Children on register at 31.12.65 Attendances for the year Average daily attendances 0—2 years 2—5 years 0—2 years 2—5 years 0—2 years 2—5 years Essex Road 25 25 25 27 2,544 5,845 33 Evefield 25 25 14 36 4,025 5,993 39 Gladstone Park 25 25 24 28 5,144 5,178 41 Kilburn 25 25 20 37 3,755 8,188 47 Longstone Avenue 25 25 23 24 5,110 6,051 44 Mortimer Road 25 25 24 26 5,548 6,131 46 Princes Avenue 25 25 23 34 3,701 7,699 45 Vale Farm 25 25 27 26 5,878 5,993 45 Villiers Road 25 25 19 30 4,756 5,349 40 Wesley Road 15 25 11 30 2,656 5,998 34 William Dunbar 25 25 23 36 5,605 6,040 46 TOTALS: 265 275 233 334 48,722 68,465 460 Table 8 Day Nurseries: Waiting List Position at: Nursery 1.1.65 31.12.65 Essex Road 29 19 Evefield — 6 Gladstone Park 45 51 Kilburn 27 30 Longstone Avenue 21 31 Mortimer Road 67 77 Princes Avenue 6 4 Vale Farm 27 33 Villiers Road 53 41 Wesley Road 11 45 William Dunbar 44 34 TOTALS: 330 371 Table 9 Day Nurseries: Priorities Nursery Unsupported Mothers Medical Reasons Bad Housing Low Income Total on Register Essex Road 30 8 5 8 51 Evefield 23 2 6 12 43 Gladstone Park 26 9 10 12 57 Kilburn 37 4 2 8 51 Longstone Avenue 33 4 3 12 52 Mortimer Road 50 2 — 1 53 Princes Avenue 23 14 1 17 55 Vale Farm 44 3 — 11 58 Villiers Road 29 2 6 8 45 Wesley Road 30 3 3 6 42 William Dunbar 34 10 6 8 58 York Park 9 — 2 4 15 TOTALS: 368 61 44 107 580 36 Table 10 MOTHER AND BABY HOME —"BELLE VUE", WILLESDEN LANE Total number of beds 12 Total number of cots 12 Average length of stay—ante-natal 3-3/7 weeks Average length of stay—post-natal 7 weeks Total number of women admitted during the year (excluding re-admissions after confinement) 115 Number of admissions for which Council was responsible 47 Number of cases sent by Council during year to mother and baby homes other than "Belle Vue":— Expectant mother 133 Post-natal cases CONGENITAL MALFORMATIONS Table 11 Summary of Notifications (i) Number of notifications received during year 74 (ii) Number of live births included in (i) above 63 (iii) Number of stillbirths included in (i) above 11 (iv) Total number of malformations notified as apparent at birth 74 (v) Number of children with multiple abnormalities 14 Table 12 Analysis of Malformations Notifeid Code No. Classification Number of cases Code No. Classification Number of cases 0 Central Nervous System 5 Uro-genital system Nil notified .1 Anencephalus 6 .4 Hydrocephalus 3 .6 Other defects of brain 2 6 Limbs .8 Spina bifida 6 .1 Defects of lower limbs 13 .5 Dislocation of hip 2 1 Eye, ear .6 Talipes 15 .5 Other defects of eye 1 .8 Other defects of hand 4 .6 Defects of ear 1 .9 Other defects of ear 1 7 Other skeletal .9 Other generalised defects of skeleton 1 2 Alimentary system .1 Cleft lip 6 .2 Cleft palate 4 8 Other systems .6 Hirschsprung's disease 1 .3 Vascular defects of skin, subcutaneous tissues, and mucous membranes (including lymphatic defects) 2 3 Heart and Great Vessels Nil notified .9 Exomphalos 2 4 Respiratory system .8 Defects of mediastinum 1 .9 Other defects of respiratory system 1 9 Other malformations .0 Congenital malformations NOS 2 37 Table 13 MIDWIFERY SERVICE Deliveries attended:— Doctor not booked, doctor present 12 Doctor not booked, doctor not present 59 Doctor booked, doctor present 277 Doctor booked, doctor not present 415 Number of home booked cases transferred to hospital before confinement 124 Cases in which analgesia was administered: — Gas and air 84 Trilene 462 Pethilorfan 288 Number of times Emergency Transfusion Service used 14 Visits paid:— Ante-natal 6,027 During labour 1,350 Nursing domiciliary confinements 12,846 Nursing institutional discharges 656 Clinic Sessions Attended:— Ante-natal 664 General practitioners' clinics 11 Relaxation 45 Mothercraft 49 Number of cases in which medical aid was called by midwife 121 Table 14 CHIROPODY New cases 1st Attendance of old cases Re-attendances Total Elderly persons 137 8 5,504 5,649 Physically handicapped 2 — 34 36 Expectant and nursing mothers 36 — 63 99 Others 5 — 10 15 School children 169 24 1,070 1,263 Domiciliary 15 2 1,682 1,699 Total 364 34 8,363 8,761 38 Table 15 TUBERCULOSIS: NOTIFIED CASES AND DEATHS Year Population New Cases Deaths Cases on Register Pulmonary Nonpulmonary All forms Pulmonary Nonpulmonary All forms Pulmonary Nonpulmonary All forms 1964 296,030 105 18 123 8 6 14 2,174 336 2,510 1965 294,850 107 27 134 7 3 10 2,169 354 2,523 Table 16 TUBERCULOSIS: CASE RATE AND DEATH RATE Year Population New Cases Rate per 100,000 Population Deaths Rate per 100,000 Population Pulmonary Nonpulmonary All forms Pulmonary Nonpulmonary All forms 1964 296,030 35 6 41 3 2 5 1965 294,850 36 9 45 2 1 3 39 Table 17 TUBERCULOSIS: NEW CASES AND DEATHS BY AGE GROUPS (Deaths in brackets) Age groups New Cases Respiratory Non-respiratory Male Female Male Female Under 1 - (-) - (-) - (-) - (-) 1 to 4 5 (-) 3 (—) - (1) — (—) 5 to 9 2 (-) 3 (—) 1 (-) — (—) 10 to 14 3 (-) — (—) - (-) 1 (—) 15 to 19 1 (-) 2 (—) 2 (-) — (—) 20 to 24 8 (-) 4 (—) 4 (-) 1 (—) 25 to 34 15 (-) 12 (—) 1 (-) 7 (—) 35 to 44 11 (1) 11 (—) 2 (-) 2 (—) 45 to 54 4 (1) 1 (—) (1) 2 (—) 55 to 64 12 (1) 2 (—) 1 (-) 1 (—) 65 and upwards 6 (3) 2 (1) - (1) 2 (—) Totals: 67 (6) 40 (1) 11 (3) 16 (—) Table 18 TUBERCULOSIS: SUMMARY OF WORK OF WILLESDEN CHEST CLINIC Pulmonary Nonpulmonary Total M F M F M F Total number of persons examined for the first time during the year, including new contacts shown below. (a) Persons who were given a full medical examination — — — — 1,068 798 (b) Persons who were given X-ray examination only — — — — 2,476 1,979 Number of persons found to be tuberculous and formally notified during the year, including new contacts shown below 84 49 6 20 90 69 Number of new contacts seen for the first time during the year and included above (a) Contacts who were given a full medical examination — — — — 251 234 (b) Contacts who were given X-ray examination only - - - - 274 282 Number found to be tuberculous 5 11 — — 5 11 Number of cases not on the register but who are under observation at the chest clinic - - - - 209 141 40 Table 19 MENTAL HEALTH Patients under Local Authority care at 31st December, 1965. Mentally ill Sub-normal and severely sub-normal Under age 16 Aged 16 and over Total Under age 16 Aged 16 and over Total M F M F M F M F 1 Number of patients under care at 31st December, 1965 - - 136 232 368 96 61 175 169 501 2 (a) Attending day training centre - - 6 17 23 55 35 42 55 187* Awaiting entry thereto — — — — — 8 16 8 6 38 (b) Resident in a residential training centre - - - - - 1 - - - 1 Awaiting residence therein — — — — — — — — — - (c) Receiving home training - - - - - - - - - - Awaiting home training — — — — — — — — — — (d) Resident in L.A. home/hostel - - - 6 6 - - 1 - 1 Awaiting residence in L.A. home/hostel - - - - - - - - - - Resident at L.A. expense in other residential homes/ hostels - - 4 5 9 2 2 1 5 10 Resident at L.A. expense by boarding out in private household - - 1 6 7 9 1 5 4 19 (e) Receiving home visits and not included in (a) to (d) - - 126 199 325 21 7 118 99 245 3 No. of patients in L.A. area on waiting list for admission to hospital at 31.12.65 In urgent need of hospital care - - - - - 15 10 - 4 29 Not in urgent need of hospital care - - - - - 4 5 2 — 11 4 No. of admissions for temporary residential care (e.g. to relieve the family) during 1965 To N.H.S. Hospitals - - - - - 21 12 2 17 52 Elsewhere - - - - - 3 1 1 1 6 * Includes patients attending centres administered by other local authorities. 41 Table 20 Number of patients referred during year ended 31st December, 1965. Mentally ill Sub-normal and severely sub-normal Under age 16 Aged 16 and over Total Under age 16 Aged 16 and over Total M F M F M F M F General practitioners — — 224 524 748 2 1 — — 3 Hospitals, on discharge from in-patient treatment - - 56 44 100 - - 2 1 3 Hospitals, after or during out - patient or day treatment - - 8 11 19 4 - - 1 5 Local education authorities — — — — — 7 7 5 9 28 Police and courts — — 3 5 8 - - - - - Other sources — — 32 27 59 8 — 1 — 9 Total - - 323 611 934 21 8 8 11 48 Table 21 Work of Mental Welfare Officers and Mental Health Social Workers. (a) Mental Illness: Visits made by mental welfare officers 1,575 Compulsory admissions to psychiatric hospitals by mental welfare officers 146 Informal admissions to psychiatric hospitals by mental welfare officers 196 (b) Mental sub-normality: Visits to those under Council's community care by mental welfare officers and mental health social workers 1,069 WELFARE OF THE BLIND Table 22 Classification of Registered Blind Persons by Age Groups. Age Group No. Under 5 4 5 — 15 9 16 — 20 7 21—29 14 30 — 39 19 40 — 49 46 50 — 59 80 60 — 64 47 65—69 53 70 — 79 103 80 — 84 47 85 — 89 59 90 and over 37 Total 525 42 Table 23 Age at Onset of Blindness. Age Group No. Birth 66 1 — 15 53 16 — 20 18 21 — 29 21 30 — 39 30 40 — 49 42 50 — 59 53 60 — 64 38 65 — 69 40 70 — 79 85 80 — 84 39 85 — 89 20 90 and over 5 Unknown 15 Total 525 Table 24 Analysis of Occupations of Blind Persons. Occupation No. Masseurs and Physiotherapists 2 Teacher of Languages 1 Teacher of Music 1 Social Workers to the Blind 2 Kiosk Manager 1 Business Organiser 1 Typists, Shorthand Typists 7 Braille Copyist 1 Braille Proof Reader 1 Telephone Operators 13 Shop Manager 1 Shop Assistants 2 Machine Tool Operators 2 Fitters and Assemblers 9 Packers 7 Store Keeper 1 Knitters (Hand and Machine) 13 Mattress Makers 8 Basket Makers 9 Chair Setters 3 Brush Maker 1 Piano Tuners 9 Craftsmen and Production Process Workers 13 Labourers 2 Domestic/Canteen Workers, Cleaners 9 Miscellaneous Workers 4 Total 123 43 WELFARE OF THE HANDICAPPED Table 25 Registrations Children under 16 Persons aged 16-64 Persons aged 65 and over Total Deaf with speech Male 10 8 2 20 Female 8 7 6 21 Deaf without speech Male 7 66 3 76 Female 4 34 3 41 Hard of Hearing Male Nil 1 2 3 Female Nil Nil 5 5 General Classes Male 2 178 79 259 Female 3 190 199 392 Total 34 484 299 817 Table 26 General Classes—Analysis of Disabilities Disability No. Amputations 37 Arthritis and rheumatism 204 Congenital malformations and deformities 12 Diseases of Digestive and Genito-urinary systems 20 Diseases of the heart or circulatory systems 49 Diseases of the respiratory system (other than tuberculosis) 39 Diseases of the skin 1 Injuries of the head, face, neck, thorax, abdomen, pelvis or trunk 12 Injuries or diseases (other than tuberculosis) of the upper and lower limbs, and of the spine 46 Organic nervous diseases, epilepsy, poliomyelitis, disseminated sclerosis 279 Neuroses, phychoses and other nervous and mental disorders 15 Tuberculosis (respiratory) 3 Tuberculosis (non-respiratory) 6 Diseases and injuries not specified above 26 Total 749* * This figure includes, those handicapped persons who suffer from dual or multiple disabilities. 44 Table 27 INSPECTIONS AND VISITS BY PUBLIC HEALTH INSPECTORS Public Health Act Dwellings—inspected 2,179 Dwellings—re-inspected 5,404 Visits re accumulations 187 Visits re Vermin 393 Visits re improper keeping of animals 67 Other nuisances including rats 1,747 Other Visits 1,157 Housing Acts House-to-house—inspections 242 House-to-house—re-inspections 1,041 Individual houses—inspected 246 Individual houses—re-inspected 317 Houses in multiple occ.—inspected 291 Houses in multiple occ.—re-inspected 2,016 Basement rooms inspected 85 Overcrowding visits 128 Imp. and standard grant inspections 126 Houses inspected—special surveys 133 Other Visits 1,195 Rent Act Dwellings—inspected 37 Dwellings—re-inspected 84 Other Visits 30 Factories Act Power factories—inspected 1,400 Power factories—re-inspectcd 310 Non-power factories—inspected 105 Non-power factories—re-inspected 9 Outworkers' rooms inspected 223 Other visits—building sites 104 Basement bakehouses, etc. Food and Drugs Act Premises—inspected 4,858 Premises—re-inspected 1,912 Visits re unsound food 135 Visits re contaminated food 182 Formal and informal sampling 203 Visits re labelling of food 115 Visits re Merchandise Marks Act 418 Clean Air Act Boiler plant inspected 124 Premises inspected in SCAs 6,477 Other visits in SCAs 137 Visits re nuisance from smoke, etc. 821 Smoke observations 849 Offices and Shops Act General inspection—office 317 General inspection—retail shop 572 General inspection—wholesale/warehouse 37 General inspection—catering establishment 107 General inspection—fuel storage depot 0 Re-inspections 394 Other Visits 419 Infectious Disease Cases investigated 253 Contacts followed up 416 Food poisoning enquiries 153 Other visits 134 Miscellaneous Aged persons 85 Attendance at Court or Inquiries 182 Drainage inspections 2,407 Massage, etc. establishments inspected 51 Noise nuisance investigations 888 Places of entertainment inspected 107 Rag, flock, etc. premises inspected 93 Unsuccessful visits 4,425 All other visits 2,260 Food Hawkers 149 45 SANITARY INSPECTION OF THE AREA Table 28 Demolition and Closing Orders Housing Act, 1957 (Sections 17 and 18) Demolition Orders, section 16, Housing Act, 1957. 182 Villiers Road 56 Malvern Road Closing Orders, sections 17 and 18, Housing Act, 1957. 48 Winchester Avenue (basement) 95 Carlton Vale (ground floor) Table 29 Overcrowding (a) Dwellings overcrowded at the end of the year 845 (b) Overcrowding relieved during the year 49 (c) Dwelling houses which have again become overcrowded after the local authority have taken steps for the abatement of overcrowding no information (d) (i) Council houses found to be overcrowded at end of year 50 (ii) Families 50 (iii) Persons 250 approx. (e) Section 80, Housing Act, 1957—licences issued Nil Table 30 New Dwellings, 1965 Houses Flats Rebuilds Dwellings built by private builders (excluding those built by the police authorities) 65 87 - Built by local authority — 36 — Applicants on Council's waiting list at 31.12.65 6,209 Table 31 Notices served (including Housing Survey) Intimation notices served 593 Intimation notices complied with 491 Statutory notices served (Public Health Act, 1936) 982 Statutory notices complied with (Public Health Act, 1936) 912 Statutory notices served (Public Health Act, 1961) 64 Statutory notices complied with (Public Health Act, 1961) 56 Statutory notices served (Shops Act, 1950) — Statutory notices complied with (Shops Act, 1950 — Statutory notices served (Prevention of Damage by Pests Act, 1949) 20 Statutory notices complied with (Prevention of Damage by Pests Act, 1949) 22 Statutory notices served (Middlesex County Council Act, 1956) 85 Statutory notices complied with (Middlesex County Council Act, 1956) 84 Statutory notices served Housing Act, 1957 (Section 9) 40 Statutory notices complied with Housing Act, 1957 (Section 9) 57 Statutory notices served Housing Act, 1961 (Section 15) 83 Statutory notices complied with Housing Act, 1961 (Section 15) 92 Non-compliance with statutory notices referred to Town Clerk (Public Health Act, 1936, section 93) 130 Referred to Borough Engineer for work to be carried out in default of owners (203 work done by Borough Engineer) 222 46 Table 32 NUISANCES ABATED AND IMPROVEMENTS EFFECTED Dwelling Houses, Water Supply and Service New cisterns provided 3 Cisterns repaired/renewed 54 Cisterns cleansed/covered 6 Draw taps placed on mains 2 Water supply re-instated 28 Drainage and Sewerage W.C.'s—pans and taps renewed 35 W.C.'s—cleansed / repaired 154 W.C.'s—add. accom. provided 1 W.C.'s—ventilation improved 6 Drains—reconstructed 2 Drains—examined, tested, exposed 13 Drains—cleared, repaired 200 Soil pipes or vent shafts repaired 36 New soil pipes or vent shafts fixed 16 Disconnecting traps or chambers inserted 6 New manhole covers 16 Other Defects Brickwork repaired/repointed 121 Dampness remedied—D.P. course 102 Dampness remedied—others 207 Exterior paintwork repainted 22 Fireplaces/ranges repaired or renewed 23 Flooring and other woodwork rep./ren. 272 Floor (solid) repaired 13 Floors—add. vent. provided 6 Food stores—ventilation provided 2 Gutters, R.W.Ps., waste pipes repaired 274 Overcrowding abated 0 Plastering repaired/renewed (rooms) 404 Refuse accumulations removed 37 Roofs repaired/renewed 320 Sinks—additional provided 43 Sinks—repaired / renewed 22 Flues repaired 3 Staircases, passages—cleansed 8 Staircases, passages—repaired 3 Walls and ceilings—cleansed 107 Walls and ceilings—repaired 61 Windows repaired 492 Other defects 262 Courts, Forecourts, Yards Nuisances abated 9 Paving repaired/relaid 80 Accumulations removed 116 Verminous Articles and Premises Premises disinfested 3 Articles disinfested/destroyed 1 Animals Nuisances abated 4 Offices and Shops Ventilation—provided and/or maintained 1 Temperature—reasonable prov./maintained 1 W.C.'s—cleansed /repaired 7 W.C.'s—add. acc. provided 8 Lighting—suitable and sufficient provided 7 Other nuisances abated 50 Miscellaneous Nuisances abated 8 Smoke nuisances abated 6 Noise 4 Hot water provided in dwelling house 130 Cookers „ „ „ „ 17 Baths „ „ „ „ 3 Food store „ „ „ „ 16 Cold water „ „ „ „ 25 47 Table 33 Rent Act, 1957 Certificates of Disrepair Applications (Form I) received and investigated 10 Agreed and proposal to issue Certificate of Disrepair (Form J) served 10 Refused Nil Undertakings (Form K) received from landlords 6 Accepted 6 Refused Nil Certificate of Disrepair (Form L) issued 3 Applications received for cancellation of Certificates of Disrepair (Form M) 16 Granted 10 Refused 6 Table 34 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES Types of Food Premises No. Food Hygiene (General) Regulations, 1960 No. fitted to comply with Reg. 16 (provision of wash-hand basins) No. to which Reg. 19 applies (facilities for washing food and equipment) No. fitted to comply with Reg. 19 Baker 27 27 27 27 Bread and Confectionery 64 64 64 64 Dairy 10 10 10 10 Butcher 178 178 178 178 Grocer and General Store 489 489 489 489 Fishmonger and Fish Fryer 64 64 64 64 Cafe and Restaurant 193 193 193 193 Greengrocer and Fruiterer 194 194 194 194 Ice Cream and Sweet Shop 358 358 191 191 Food Stall 86 — — — Public House 74 74 74 74 Works Canteen 167 167 167 167 School Canteen 67 67 67 67 Food Factory 12 12 12 12 Other Food Premises 170 170 130 130 Totals 2,153 2,067 1,860 1,860 Inspections and Revisits Inspections: 4,911 Revisits: 1,552 Total: 6,463 Table 35 Premises unsatisfactory on 31.12.64 35 Unsatisfactory during the year 686 Premises made satisfactory during the year 486 Unsatisfactory on 31.12.65 235 48 Table 36 FOOD PREMISES: DEFECTS REMEDIED Defects Outstanding at 31.12.64 Found during the year Total Remedied during year Outstanding at 31.12.65 Inadequate lighting and ventilation 0 23 23 20 3 Inadequate washing facilities 8 230 238 190 48 Inadequate refuse storage 3 112 115 84 31 Unsatisfactory or insufficient sanitary accommodation 9 162 171 115 56 Inadequate storage accommodation 5 93 98 45 53 Defective walls, ceilings or floors 15 456 471 362 109 Dirty walls, ceilings or floors 16 545 561 328 233 Inadequate first aid materials 1 76 77 44 33 Unsatisfactory conditions 2 22 24 13 11 Any other defects 24 62 86 60 26 TOTALS 83 1,781 1,864 1,261 603 Table 37 FOOD PREMISES: REGISTRATION Premises on register 31.12.64 Applications received Applications granted Applications refused Premises removed from register during 1965 Total on register at 31.12.65 (1) Sale and storage of ice cream 562 7 6 1 568 578 (2) Manufacture of ice cream 10 - — — - 10 (3) Manufacture of preserved food 214 3 3 — — 217 (4) Fish curing 1 — — — — 1 49 Table 38 SLAUGHTERHOUSE Carcases Inspected and Condemned Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 47 - - 338 - Number inspected 47 — — 338 - All diseases except tuberculosis and cysticerci:— Whole carcases condemned - - - - - Carcases of which some part or organ was condemned - - - 1 - Percentage of the number inspected affected with disease other than tuberculosis and cysticerci - - - 3 - Tuberculosis only:— Whole carcases condemned - - - - - Carcases of which some part or organ was condemned - - - - - Percentage of the number inspected affected with tuberculosis - - - - - Cysticercosis:— Carcases of which some part or organ was condemned - - - - - Carcases submitted to treatment by refrigeration - - - - - Generalised and totally condemned - — — — - Table 39 Sampling of Food and Drugs Articles Total procured Unsatisfactory Milk (various) 34 (3) 1 Milk (condensed) 21 (1) — Cream 23 (6) — Ice cream 21 (4) — Meat and meat products 94 (30) 3 Butter and margarine 37 (27) — Bread, flour and cereals 17 (1) — "Buttered" bread 13 6 Cakes and biscuits 22 (1) 12 Fruit juices, syrups and soft drinks 28 3 Spirits 12 (7) 1 Coffee 7 (2) — Sweets and chewing compounds 36 4 Fruit and vegetables 25 (7) 1 Curries, spices and flavourings 21 1 Vinegar, pickles and sauces 16 (22) — Cheese and spreads 11 (1) — Jams, jellies and preserves 7 — Drugs 5 (12) — Miscellaneous 6 (3) TOTALS 456 (117)* 32 * Figures in parenthesis are samples taken by officers of the Middlesex County Council during January— March 1965. 50 Table 40 Bacteriological examination of milk, ice cream and water Milk examinations—80 Dealers' premises Total Pasteurised Untreated Sterilised Samples 65 3 12 80 Satisfactory 64 3 12 79 Unsatisfactory 1 — — 1 Ice cream examinations—83 Grade 1 Grade 2 Grade 3 Grade 4 Total 50 5 12 16 83 Water examinations—312 Domestic supplies Swimming pools Paddling pool Total Samples 4 297 11 312 Satisfactory 4 293 11 308 Unsatisfactory — 4 — 4 FACTORIES Table 41 On register and inspections No. on register Inspections Written notices Occupiers prosecuted Factories in which sections 1, 2, 3, 4 and 6 are to be enforced by local authority 79 86 1 - Factories not included above in which section 7 is enforced by the local authority 875 1,724 63 - Other premises in which section 7 is enforced by the local authority (excluding outworkers premises) 8 14 - - Total 962 1,824 64 - Table 42 Defects found Found Remedied Referred No. of cases in which prosecutions were instituted To H.M. Inspector By H.M. Inspector Want of cleanliness (sec. 1) 35 32 - - - Overcrowding (sec. 2) — — - — — Unreasonable temperature (sec. 3) — — - — — Inadequate ventilation (sec. 4) — — - — — Ineffective drainage of floors (sec. 6) — — - — - Sanitary conveniences (sec. 7) (a) Insufficient 1 1 - - - (b) Unsuitable or defective 26 22 - - - (c) Not separate for sexes 2 2 - - - Other offences against the Act (not including offences relating to outworkers) — — - - - Total 64 57 - - - 51 Table 43 Outworkers Nature of Work No. of outworkers in August list No. of instances of work in unwholesome premises Notices served Wearing apparel (making, etc.) 136 - - Household linen 1 - - Handbags 7 - - Making of boxes or other receptacles or parts thereof made wholly or partially of paper 7 - - Carding, etc. of buttons, etc. 6 - - Stuffed toys 10 - - Lampshades 2 - - Brush making 1 - - Lace making 1 - - Hosiery 2 - - Ladies' Belts 5 - - Fancy Goods 2 - - Millinery 4 - - Furrier 1 - - Wigs 1 - - Metal Boxes 1 - - Shoes 5 - - Total 202 - - There were no cases of default in sending lists to the Council, and there were no prosecutions. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Table 44 Registration of Premises and Analysis of Persons Employed (Figures in brackets relate to premises registered with Shops Inspectors) Class No. of premises registered during the year Total No. of registered premises at end of year No. of persons employed Offices 96 (22) 616 (71) 10,743 (992) Retail Shops 176 (331) 605 (1,335) 3,886 (6,006) Wholesale shops, warehouses 5 (-) 42 (—) 781 (-) Catering estabs. open to the public, canteens 19 (-) 127 (-) 1,638 (—) Totals 296 (353) 1,390 (1,406) 17,048 (6,998) Males 8,614 (2,423) Females 8,434 (4,575) Table 45 Inspections and Visits Class No. of registered premises receiving general inspection during the year Number of visits of all kinds Offices 317 1,887 Retail Shops 572 Wholesale shops, warehouses 37 Catering estabs. open to the public, canteens 107 Total 1,033 52 Table 46 Defects and Unsatisfactory Conditions Found and Remedied Section Unsatisfactory conditions and defects Outstanding 1964 Found 1965 Remedied during the year 4 Premises in a dirty state 3 9 10 5 Overcrowding 3 (a) 2 (a) 1 Temperature 6 Unreasonable 1 18 15 Lack of room thermometer 14 20 27 8 Lighting Nil 1 1 9 Sanitary Conveniences Unsuitable and insufficient 11 44 (b) 33 Lack of artificial lighting 2 10 8 10 Washing facilities insufficient and unsuitable 18 26 (c) 24 11 Adequate supply of drinking water not provided Nil 1 1 12 Accommodation for clothing Nil 3 3 13 Seating facilities Nil 2 2 14 Seats for sedentary work Nil 1 1 15 Eating facilities for shop employees Nil 1 1 16 Floors, passages and stairs not soundly constructed, properly maintained or kept free from obstruction or slippery substance 1 29 19 17 Dangerous parts of machines not properly fenced 2 5 3 24 First Aid and General Provisions 11 59 58 50 Information for employees, Lack of Nil 31 19 (a) The overcrowding was found in premises in use on 31st July 1964 and therefore the space standards do not apply until 1st August 1967. (b) 19 defects not required to be remedied until Sanitary Convenience Regulations 1964 come into force on 1st January 1966. (c) 20 defects not required to be remedied until Washing Facilities Regulations 1964 come into force on 1st January 1966. Table 47 Analysis of Reported Accidents Cause Offices Retail Shops Wholesale Shops, Warehouses Catering establishments open to the public, canteens Machinery - 3 3 - Transport - 3 2 - Falls of persons 2 7 6 - Stepping on or striking against object or person 1 4 1 - Handling goods — 3 2 2 Struck by falling object — 4 — — Fires and Explosions — — — — Electricity 1 — — — Use of Hand Tools — 4 - - Not otherwise specified 1 4 — — TOTALS 5 32 14 2 Table 48 Uncleanliness and Scabies New cases treated Attendances Scabies Lice and nits Total Scabies Lice and nits Total Children under 5 years 13 13 26 23 14 37 Children 5-15 years 2 44 46 8 53 61 Adults Men 17 4 21 27 4 31 Women 10 2 12 16 2 18 Total 42 63 105 74 73 147 53 Table 49 DISINFESTATION (a) Verminous premises: Council properties 18 Private properties 40 Total 58 (b) Verminous rooms*: Council properties 36 Private properties 87 Total 123 *Some rooms are treated more than once. (c) Clothing and bedding materials: (i) disinfected 5 (ii) disinfested 6 (d) Miscellaneous: Ants 2 Wasps Nests 65 Report of the Principal School Medical Officer For the Year 1965 55 REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1965 To The Mayor, Aldermen and Councillors of the Borough. Mr. Mayor, Ladies and Gentlemen, This Report presents a record of activities in the School Health Service of the Borough of Brent during the first year of its operation, indeed the statistical part of the Report includes figures from January to March 1965 when, in fact, the Middlesex County Council still continued as Local Education Authority. One of the most formidable tasks has been the smooth acceptance of responsibility by all personnel in the Service, and it is indeed reassuring to record that the transfer of function occurred expeditiously and effectively. The continuation of the routine medical inspection of the age groups in the schools of the Borough has been maintained, and is still thought to be of substantial value, although it will be noted that exploration has occurred in the examination of selected groups in lieu of the routine inspection in certain schools. If this could be perfected it might represent the most profitable use of professional staffs. It is, however, completely dependent on the co-operation between medical officer and teacher, which is the aim of the School Health Service, always directed towards the benefit of the pupil. Ascertainment of handicapped children continued. The placement of those handicapped, in appropriate schools, a new responsibility, taxed the technical knowledge and experience of the staff to a considerable extent. Selecting the school most appropriate to the attainments of some of the more severely handicapped represents a task which requires expertise and skill beyond the average. The Audiology Unit continued to function and provided service for the partially hearing in the school population, both of Brent and neighbouring boroughs, enabling these children to obtain full benefit from the education offered in school. Hearing aids were supplied and, in order to ensure that these were kept in reasonable condition and were in fact being used, a peripatetic teacher visited the schools from time to time to discuss problems with the school teachers. The School Dental Service continued to provide its most valuable contribution to the health of the children and the report by the Principal Schools Dental Officer reveals the extent of this service. The Report which is the work of many members of the Department, could be read advantageously by all the staff of the Council and it is presented to members for attention. Your Obedient Servant, E. GRUNDY, Principal School Medical Officer. 56 STAFF OF THE SCHOOL HEALTH SERVICE Principal School Medical Officer E Grundy, m.d., m.r.c.s., d.p.h. Deputy Principal School Medical Officer J. Burns, m.b., b.ch., b.a.o., d.p.h. Senior Medical Officer C. C. A. Jansz, m.b., b.s., d.c.h., d.p.h. Assistant School Medical Officers R. Aaronson, m.d., Vienna. J. Bean, m.b., b.ch. C. Dunsby, m.b., b.ch., b.a.o. E. S. Harper, m.b.,, ch.b., d.obst., r.c.o.g., d.c.h. A. E. Harvey, m.b., ch.b., d.c.h. E. H. Johnson, m.b., b.s. Punjab, c.p.h. M. King, m.r.c.s., l.r.c.p., d.p.h. F. X. Letellier, m.r.c.s., l.r.c.p., d.p.h. H. E. McNamara, m.d. Toronto, dip.obst., r.c.o.t., d.p.h. C. Sayal, m.b., b.s., d.c.h., d.p.h. M. H. Snape, m.r.c.s., l.r.c.p., d.c.h., m.b., b.sc. A. M. P. Snow, m.r.c.s., l.r.c.p., d.c.h., m.b., b.s. Chief Dental Officer A. Henderson, l.d.s., d.p.d. (u.st.and) School Dental Officers Miss S. Brody, b.d.s. Mrs. H. Collins, l.d.s., r.c.s., b.d.s. I. Erdman, d.m.d. Berlin, m.d. Berlin, g.d.c. London P. Grimer, b.d.s. Mrs. D. Mailer, l.d.s., r.f.p.s. (Glas.) Miss R. Malik, l.d.s., r.c.s. (Eng.), b.d.s. J. A. Rejman, l.d.s., r.c.s. (Eng.), b.d.s. A. Ritchie, b.d.s. (Lond.) Mrs. G. Segal, l.d.s., r.c.s. Mrs. A. Sowa M. Tonkin, l.d.s., r.c.s. Dr. E. Velden, m.d. Vienna, l.d.s. Dr. W. Wierzbicki, m.d. Bologno, Cert, of Dentistry (Poland) Orthodontists Mrs. E. Carvalho, l.d.s., r.c.s. Mrs. B. Lowenberg, l.d.s., d.orth., f.d.s., r.c.s., b.d.s. Dental Auxiliary Miss S. M. Gale, Cert of Proficiency Psychiatrists (Part time) Dr. A. K. Graf, m.d., d.p.m., p.m.c. Dr. M. Friedman, m.b., ch.b., d.p.m. Chief Educational Psychologist C. Graham, b.sc., a.b.p.ps. Educational Psychologists Mrs. M. Dunne, b.sc. Mrs. C. Steen, b.sc. Speech Therapists Mrs. T. Abrahams, l.c.s.t. Miss. A. Elvins, l.c.s.t. Miss S. M. Griffiths, l.c.s.t. Miss K. James, l.c.s.t. Miss J. Stavenhagen, l.c.s.t. Physiotherapists Miss A. S. E. Downing, m.c.s.p. Mrs. M. Gilbert, m.c.s.p. Mrs. M. Townsend, m.c.s.p. Audiometricians Mrs. D. Pursey Mrs. A. Taylor, s.r.n. Administrative Officer B. H. Lovett Hospital Board Consultants attending School Clinics: Orthopaedic J. Cholomley, f.r.c.s. K. Nissen, f.r.c.s. Audiology - - - L. Fisch, f.r.c.s. Ophthalmic - - B. R. Medlycott, m.b., b.s., d.o.m.s. M. C. Da Silva, l.m.s. (Ceylon), d.o.m.s. (Lond.), d.o. (Oxon.) E.N.T. P. Carter, f.r.c.s. 57 PARTICULARS OF CLINICS HELD The following clinics are provided by the Education Committee for the treatment of defects found at School Medical Inspections; attendance thereat is by appointment arranged by the School Medical Officer. Minor Ailments Kilburn Square Clinic, 91, Kilburn Square, N.W.6. Pound Lane Clinic, Pound Lane, N.W.10. Neasden Clinic, Balnacraig Avenue, N.W.10. Stonebridge Clinic, Hillside, Harrow Road, N.W.10. London Road Clinic, London Road, Wembley. Perrin Road Clinic, Perrin Road, Sudbury. One Tree Hill Clinic, Bridgewater Road, Alperton. Stag Lane Library Clinic, Stag Lane, Kingsbury, N.W.9. College Road Clinic, College Road, Wembley. Dental Kilburn Square, Pound Lane, Neasden, Stonebridge, London Road, Perrin Road, One Tree Hill, Stag Lane Library, College Road Clinics. Stag Lane Clinic, 245, Stag Lane, Kingsbury, N.W.9. Orthodontics Sudbury Orthodontic Clinic, Perrin Road, Sudbury, Kilburn Square and Pound Lane Clinics. Child Guidance - Kilburn Child Guidance Clinic, 22, Brondesbury Villas, N.W.6. Kingsbury Child Guidance Clinic, Church Lane, Kingsbury, N.W.9. Speech Therapy - Kilburn Square, Pound Lane, Neasden, Stonebridge, London Road, College Road, Stag Lane Library, One Tree Hill Clinics. Orthopaedic Stonebridge and Stag Lane Library Clinics. Physiotherapy Kilburn Square, Pound Lane, Neasden, Stonebridge, London Road and Stag Lane Library Clinics. Ophthalmic Kilburn Square, Pound Lane, Stonebridge and Stag Lane Library, Monks Park Clinic, Monks Park, Wembley. Orthoptics Pound Lane, Stag Lane Library and Monks Park Clinics. Audiology Neasden Audiology Unit, Neasden Clinic. Ear, Nose and Throat Kilburn Square, Pound Lane and Stonebridge Clinics. Chiropody Kilburn Square, Pound Lane, Stonebridge, Neasden, Monks Park, London Road, Stag Lane Library Clinics. MEDICAL INSPECTION IN SCHOOLS The system of routine medical inspections is as follows: Primary, Secondary Modern and Grammar Schools. (1) Entrants i.e. Children admitted for the first time to a maintained school, normally at the age of 5 years. (2) 7-8 year old i.e. Children in their first year at a Junior School. (3) Intermediate i.e. Children in their last year at a Primary School. (4) Final Leavers i.e. Children in their last year of attendance at maintained Secondary School. (5) Special Cases i.e. Children of other ages with possible defects and whom the Head Teachers and parents wish the Medical Officer to see. A total of 12,054 were examined of whom 11,935 were found to be in a satisfactory medical condition. 3,972 special inspections and 2,543 re-examinations were carried out. Age grouping and defects found at the above inspections can be found in Statutory Tables 1, 2 and 3 in the appendix. 58 SCHOOL HYGIENE Section 54 of the Education Act 1944 empowers the local education authority to cause examinations of the person and clothing of pupils attending maintained schools. Inspections are carried out by the School Nurses in school. The finding of slight infestation leads to an issue of an informal letter to the parents setting out a method of treatment and offering a supply of cleansing material (emulsion). Steel combs are sold or loaned where necessary. The appropriate formal notices are sent to parents of children previously found to be verminous. Endeavours are made by the School Nurse to contact the parents personally to emphasise that infestation may be a family complaint and not limited to the school child. A cleansing department is provided at Stonebridge Clinic for the treatment of scabies and occasionally deals with other verminous children. Total number of Examinations 18,263 Total number of individuals found to be infested for the first time during the year 256 Number of individual pupils in respect of whom cleansing notices were issued under Section 57/2 Education Act 1944 76 Number of individual pupils in respect of whom cleansing orders were issued Nil WORK OF HEALTH VISITOR AND THE SCHOOL NURSE The major part of the work of the Health Visitor/School Nurse is concerned with routine school medical inspections and surveys. During 1965, the routine vision testing of school entrants was introduced and is carried out at the pre-medical inspections conducted by the Health Visitor/School Nurse. A close liaison is maintained with the teaching staff and in many cases the nurse's knowledge of particular families proved helpful when dealing with problems of teaching or attendance. Considerable assistance is given to the programme of health education in some schools in the Borough and it is hoped to extend the work in the near future. PROTECTION OF SCHOOL CHILDREN AGAINST TUBERCULOSIS B.C.G. vaccination is offered to school children between their thirteenth and fourteenth birthdays and as the scheme operates under Section 28 of the National Health Service Act is not confined to children attending maintained schools but is also available to those of appropriate age attending independent schools. The method adopted consists of a simple skin test usually in one arm to find out if a child needs protection. If the skin reacts to the test it usually means that the child has developed some immunity, but all such cases are investigated at the mass X-ray unit or chest clinics. If the skin does not react to the test the child is unprotected and B.C.G. vaccination is offered. In addition all school entrants are tested and where a reaction is noted the child is referred to the chest clinics. The table below gives number of children tested and vaccinated. LEAVERS (i) Number of children whose parents were approached 3,109 (ii) Number of children from (i) whose parents consented 2,669—86% (iii) Number of those in (ii) negative to Heaf Gun Tests 1,975—74% (iv) Number of those in (iii) B.C.G. vaccinated 1,966—99.5% (v) Percentage of vaccination to (i) above 63% ENTRANTS (i) Number skin tested 2,164 (ii) Number positive 192—8.9% (iii) Number negative 1,916—88% CONVALESCENT TREATMENT Section 28 of the National Health Service Act 1946 permits a local health authority to arrange recuperative holidays for persons for whom a holiday is considered necessary after a recent illness. A charge is normally made for this service but in the case of school children the Education Authority accepts responbility. During the year holidays for 29 school children were arranged at convalescent homes situated by the sea and in the country. 59 AUDIOMETRY This scheme provides for the routine testing by pure-tone audiometer of every schoolchild's hearing three times during their school life, normally at the ages of 6, 9 and 13 years. A "sweep" test is carried out in the first instance in school and failures are then retested at clinics under more favourable conditions. Children failing a second time are then referred to the School Medical Officers for further investigation. Special cases (e.g. children who fail to develop proper speech, fail without apparent reason to make progress at school) are also tested at the request of Medical Officers, Speech Therapists, Educational Psychologists and Head Teachers. A table showing the numbers dealt with during the year is given below. Audiometry: Children Tested Routine. Age Group 1st Tests Re-tests Failures Totals Both Ears One Ear Right Left Up to 7 years 3,443 161 74 44 67 185 Intermediate 2,421 102 29 29 32 90 Leavers 2,748 111 30 26 19 75 Totals 8,612 374 133 99 118 350 Specials. All ages 1st Tests Re-tests Failures Totals Both Ears One Ear Right Left Totals 1,078 400 171 100 87 358 CHIROPODY In the school health service foot education is being developed very extensively with emphasis on preventive work. Film strips are shown and talks given in Schools as there is no doubt that the great majority of foot conditions begin in childhood, and evidence of future defect can be seen sometimes at quite an early age, for example Hallux Valgus, and hammer toe. Verrucae, corns, fungus infections, and nail troubles are common, but apart from the early treatment of foot disorders, one of the greatest needs of the young, is an understanding of the importance of foot hygiene, and good shoe fitting. Children could thus be brought to adolescence with healthy, strong feet, and should they later treat them badly, the well cared for foot, would withstand ill-usage and resist the deformities from which so many young adults suffer at the present time. Advice on shoe fitting is given at school talks and always, after these visits by the Chiropodist to the schools, many children come to the Clinics for treatment for foot troubles from which they had not realised they suffered. There is no doubt that there is plenty of scope for development in the education of young people in the care of their feet, which being hidden are often neglected. During the year 193 pupils made 1,263 attendances at foot clinics details of which are given below. School Clinic New Cases 1st Attendance this year Re-attendance Total Kilburn Square 23 1 158 182 London Road 24 4 133 161 Monk's Park 6 - 79 85 Mortimer Road 15 - 115 130 Neasden 37 8 298 343 Stag Lane (Library) 23 10 159 192 Stonebridge 41 1 128 170 TOTAL 169 24 1,070 1,263 60 SPEECH THERAPY During the past twelve months, the speech therapy service in the London Borough of Brent has been extended, so that there are now five therapists working on a full-time basis. This means that all the major clinics and special schools are catered for to some degree. Reports on Work in the Clinics 1. Kilburn, Neasden, Pound Lane and Stonebridge:— All the above clinics make fairly adequate provision for speech therapy. The individual working conditions could perhaps be improved in certain of them, but generally the service is well established. Long waiting lists at Neasden and Kilburn indicate the real need for speech therapy. The predominating age range among the patients, is five to seven years ; although a lot of pre-school children are being referred at Neasden. Articulatory defects are prominent, as well as a fairly large group of language problems among the immigrant children at Kilburn. 2. London Road, College Road, One Tree Hill and Stag Lane Library:— Again a reasonably adequate service is being maintained at these clinics, where particularly good connections are being built up with the local schools. A great many children are in need of treatment, and a long waiting list exists at London Road Clinic. Here it is already apparent that extra sessions are needed. But these seem impossible to arrange in view of the limited accommodation. Generally a wide variety of disorders are treated, with emphasis on a number of stammerers. The preponderance of this difficulty within the area seems linked with the increase in pressures and high standards among the families. Reports from Special Schools 1. Lower Place Physically Handicapped School:— Two speech therapists work at the school for a total of seven sessions per week. Approximately twenty children are seen, but several of these receive two or three treatments per week. A variety of cases is dealt with. These include delayed speech development, cleft palate, dysphasia and dyslalia. All are associated with an accompanying physical handicap. Despite extremely good co-operation with teaching staff, the working conditions are still inadequate; as a room is shared with the physiotherapists, whose treatment obviously produces a lot of distractions and noise. 2. Wood field School:— Speech therapy has been improved during the past six months since the reorganisation of the service under one therapist. However if conditions are to be ideal, the present four sessions could be extended still more. There is a long waiting list and a heavy case load, comprised of children with more complex problems than merely an intellectual one. This means that they should be receiving 'three times a week' treatment, which at the moment is impossible. Conclusions It appears that at the moment a fairly adequate speech therapy service is being run in Brent. Obviously, change will have to be made in subsequent years, in order that the service shall keep in line with the apparent increase in the need for this type of treatment. However, the therapists would like to stress that they are particularly grateful for many facilities already provided. Regular meetings are held during school holidays, and the recent reorganisation of programmes has resulted in a decrease in the amount of travelling during working hours. Both these features make for a more full and varied treatment programme. Clinic or School No. of cases dealt with during the year School children Pre-school children College Road 21 1 Kilburn Clinic 65 7 Pound Lane Clinic 50 7 Stonebridge Clinic 62 1 Lower Place special school for physically handicapped pupils 25 - Neasden Clinic 34 4 Woodfield Special School for E.S.N. 13 — London Road 40 11 Stag Lane Library 52 3 One Tree Hill 11 1 TOTALS 373 35 61 HANDICAPPED PUPILS The Education Act 1944, places on local education authorities the duty of ascertaining handicapped pupils residing in their areas and of providing for the special educational treatment of such children. The Minister defined the several categories of pupils requiring special educational treatment in the School Health and Handicapped Pupils Regulations 1953 (as amended) as follows:— Blind Epileptic Partially Sighted Maladjusted Deaf Physically Handicapped Partially Hearing Children Suffering from Speech Defects Educationally Sub-Normal Delicate During the year 301 such children were ascertained and placed at the two Day Special Schools in the Borough or at Day and Residential Special Schools maintained by the Inner London Educational Authority or other London Boroughs. It was also necessary to place children at approved independent schools and at schools run by voluntary associations. On the 31st December special education was being provided for 1,294 handicapped pupils—details of their category and placement are given in the adjoining table. The Middlesex County Council in 1959 gave approval to the attendance at Day Nurseries of handicapped children under the age of five years who may be recommended for such admission. The Brent Borough Council have agreed to the continuation of the scheme. No charge is made to the parents in these cases. RETURN OF HANDICAPPED PUPILS (YEAR ENDED 31st DECEMBER, 1965) Ascertainment Category No. of ascertained Cases known 1st day of year No. of New Cases ascertained during year No. of ascertained Cases known last day of year B G B G B G Blind Pupils 6 1 1 — 7 1 Partially-Sighted Pupils 8 7 3 — 9 7 Deaf Pupils 8 4 1 1 8 6 Partially Deaf Pupils 10 4 3 3 13 8 Delicate Pupils 26 13 9 7 22 9 Diabetic Pupils Educ. Sub-Normal Pupils 114 80 18 16 113 74 Epileptic Pupils 2 — 2 — 3 — Maladjusted Pupils 59 18 21 6 69 17 Physically Handicapped Pupils 42 23 7 4 31 18 Pupils with Speech Defects 611 230 103 53 615 221 Pupils with Multiple Defects 45 24 8 — 27 16 Totals 931 404 176 90 917 377 Grand Totals 1,335 266 1,294 62 RETURN OF HANDICAPPED PUPILS (YEAR ENDED 31st DECEMBER, 1965) Distribution (as at last day of Year) Category In Special Day Schools In Special Residential Schools In maintained Primary and Secondary Schools In independent Schools Not at School Totals B G B G B G B G B G B G Blind Pupils - - 7 1 - - - - - - 7 1 Partially-Sighted Pupils 9 7 - - - - - - - - 9 7 Deaf Pupils 6 3 2 2 - — — — - 1 8 6 Partially Deaf Pupils 8 5 1 - 1 - - - 3 3 13 8 Delicate Pupils 4 2 17 7 1 — — — — — 22 9 Diabetic Pupils Edu. Sub-normal Pupils 98 66 10 3 4 5 - - 1 - 113 74 Epileptic Pupils — — 1 — — — — — 2 — 3 — Maladjusted Pupils 1 1 14 3 20 2 34 11 — — 69 17 Physically Handicapped Pupils 25 15 2 1 — 1 3 — 1 1 31 18 Pupils with Speech Defects - - - 1 504 152 11 - 100 68 615 221 Pupils with Multiple Defects 19 12 5 3 — — 2 — 1 1 27 16 Totals 170 111 59 21 530 160 50 11 108 74 917 377 Grand Totals 281 80 690 61 182 1,294 63 WOODFIELD SPECIAL DAY SCHOOL FOR EDUCATIONALLY SUB-NORMAL PUPILS This school is in a modern building of rather unusual design, situated in pleasant surroundings on the banks of the Welsh Harp Reservoir. During the year, there were 38 admissions and 41 discharges from this school of 200 pupils. In addition, two children were transferred to the new Catholic School that opened at Golders Green. As a result the waiting list for Woodfield diminished, and by the end of the year, it was possible to admit a pupil needing this kind of education, without any delay. Routine medical inspections were carried out a year after admission, between the ages of 12 and 13 and prior to a child leaving school. 72 children were examined during the year, and the general standard of health and hygiene were found to be high. No formal health education talks were given but the teaching staff stressed the ideas of health and hygiene whenever an opportunity occurred. Attendances at eye and dental clinics were arranged, at the Medical Officer's request, through the school, and special transport took pupils from the school to the appropriate clinic. A Speech Therapist continued to visit the school and gave individual instructions to those pupils who were referred to her. A number of pupils had reading difficulties and there were remedial reading classes formed at the latter part of the year. There was an improvement in the physical activities at the school. The football team was re-started during this year and a cricket team built up. LOWER PLACE SCHOOL FOR PHYSICALLY HANDICAPPED PUPILS This Day School for Physically Handicapped Pupils is in Barretts Green Road, Harlesden. During the year this school contained 90 pupils (26 left the school and 26 were admitted). The pupils had the advantage of individual attention due to the small classes and could progress at a rate suited to their ability and physical handicap. Medical inspections were usually held once a fortnight and all pupils were seen routinely every six months. A full time school nurse was employed at the school. A Consultant Ophthalmologist held sessions at the school and an Orthoptist visited the school when required. A Consultant Orthopaedic Surgeon visited the school regularly to supervise those children with orthopaedic defects. Two full time Physiotherapists worked under his directions at the school. Selected children were taken regularly by the Physiotherapists to a swimming class at nearby baths. Admissions 1965 Borough in which children reside No. of new recommendations read. during the year No. of children admitted during the year No. of children on waiting list at 31.12.65 Brent 17 17 — Barnet 3 3 — Ealing 3 3 — Harrow 2 2 — Hounslow 1 1 — Total 26 26 — NEASDEN AUDIOLOGY UNIT This unit is situated within the Neasden Health Clinic and consists mainly of a sound-proofed medical examination room and sound-proof room for audiometry. During the year under review improvements were made in the sound-proofing by further treatment to the walls, a better system of double glazing and the installation of a silent ventilating system that could deliver hot or cold air. The unit serves the needs of Brent and the neighbouring Boroughs of Harrow and Barnet. In 1965 69 children were seen from Harrow, 90 from Barnet, 131 from Brent. Due to the large number of referrals the waiting list was long but cases needing priority were seen within a fortnight. Efforts to obtain extra specialist sessions at the unit were unsuccessful during this year, but firm arrangements were made for extra sessions to commence from the 1st April, 1966. 64 The majority of children seen at the unit were referred by local authority medical officers following a hearing loss discovered at routine Stykar testing or routine audiometry. Some children were referred by paediatricians and a small number by general practioners. Children requiring hearing-aids were referred to St. Mary's Hospital, Paddington, W.2 for the supply and fitting of Medresco hearing-aids. Some children required special types of hearing-aid (e.g. post aural) that were only available commercially. These hearing-aids were obtained for them by the responsible local authority through the Neasden Unit at a special price. Children fitted with hearing-aids were given auditory training by the peripatetic teacher of the deaf, who was present with the child at the diagnostic and the follow up sessions at the unit. Deaf or partially hearing children who needed special education were placed at residential schools or at day schools at Heston and Tottenham. It is hoped to have a partially hearing unit within the new school for physically handicapped pupils that is now under construction in the Borough. SCHOOL DENTAL SERVICE Report of Principal School Dental Officer It is now fairly generally accepted that most children, once introduced to dentistry, tend to become regular patients either of the Local Authority Dental Service or of general practitioners under the National Health Services but the main trouble is that frequently by the time the first treatment is requested (often emergency treatment) considerable damage has already been done to the primary teeth and even to the permanent teeth. (See report of Chief Dental Officer page 9). A very large majority of children leaving school have acquired the habit of receiving regular dental attention from one source or another and only a very small number present neglected mouths. This however, offers no grounds for complacency as the results of earlier neglect are all too apparent in the large number of missing teeth and massive restorations. It is essential, therefore, that dental health education should be directed intensively to expectant and nursing mothers and their co-operation enlisted in caring for their children's teeth with professional assistance from the time when the child has teeth. If every child were to have regular dental inspections and treatment from the age of two, the child would accept this as routine with great benefit to himself and to his dentist and many would be able to go through life with healthy mouths. The fact that children of tender age could not attend without a parent, would also be beneficial insofar that many parents with previously neglected mouths might themselves be persuaded or even shamed into accepting dental treatment. Dental health education should also be directed at the 8-11 age group, where we have the highest incidence of dental decay due mainly to two factors. One, the failure of the parents to see that they arrive at this age with sound mouths. Two, the fact that the child can now purchase for himself sweets, ices, biscuits and other substances harmful to the teeth and consume them at the wrong times (between meals) without supervision and without adequate safeguards ; for example, mouth rinsing or tooth cleaning either with a brush or a soft cleansing food such as an apple, carrot, celery, etc. Details of attendances at school clinics and treatment given can be found in the statutory table in the appendix. CHILD GUIDANCE SERVICE Prepared by Mr. C. Graham, B.SC., Chief Educational Psychologist. Organisation of the Service. The Service is divided into the School Psychological Service, and the Child Guidance Centres. All referrals coming from the headteachers are seen first in the schools by one of the psychologists under the aegis of the School Psychological Service. Headteachers are encouraged to refer all children falling into the bottom 2% of an age range in educational attainment, so that remedies might be applied. Each psychologist has the responsibility for referrals from particular schools. If the problem is one which warrants a full Child Guidance psychiatric investigation, the child is referred to the Child Guidance Centre. As will be seen from Table 6, of the 405 children seen in the School Psychological Service, 71 (18%) were referred to the Child Guidance Centre. Referrals coming from other sources, e.g. School Medical Officers and General Practitioners are dealt with by the whole Child Guidance team. The Psychiatric Social Workers deal largely with the parents and other social agencies, the Educational Psychologists deal with the educational and intellectual assessment of the child and link up with the schools, and the Psychiatrists give a psychiatric diagnosis and link up with medical colleagues. The Kilburn Child Guidance Centre in Brondesbury Villas deals with referrals from Willesden, and the Kingsbury Child Guidance Centre in Church Lane deals with referrals from Wembley. There has been no change ill this arrangement since the formation of Brent in April 1965. 65 If, after full investigation, it is considered that the child would benefit from treatment, and the parents are fully agreeable and co-operative about this, then the child attends usually for an hour a week to see a psychotherapist or, in some cases, another team member. It will be seen from Table I that 146 children attended for weekly treatment. Type of Referral. The School Psychological Service is heavily pressed with referrals from the schools. Referrals from the schools are often not seen until some months have elapsed because of shortage of staff. Many of these referrals are children who have arrived in this country fairly recently, and who present severe learning problems and behaviour problems. With children from a different cultural background it is extremely difficult to assess potential ability, as they tend to do poorly on our ability tests. However, from all practical purposes, if a Secondary School child is illiterate, he needs special attention which cannot often be given in an ordinary school. Hence, the Woodfield Special School, and the Remedial Reading Classes have a high proportion of immigrant children. Of the Child Guidance referrals, just over half are from medical sources and these are evenly divided between local authority and other medical agencies, as can be seen from Table 2. It is perhaps not always widely enough realised by referral agencies that, because it is felt that a child "should see a psychiatrist" or "needs treatment" that help cannot be given unless the parents themselves realise this and want help. It is discouraging, and wasteful of valuable time, to offer appointments to parent and child which are not kept because basically the parent does not want help. Staff. The increased establishment of a further Educational Psychologist, as agreed from September, 1965, would help the School Psychological Service enormously. Unfortunately, a suitably qualified candidate has not come forward, and we still have this vacancy. Five sessions of psychotherapist time is still unfilled due to lack of suitable applicants. A half-time P.S.W. post has also remained unfilled since Mrs. Hicklin left in early October. Dr. Graf, Consultant Psychiatrist at Kilburn, and Dr. Friedman, Consultant Psychiatrist at Kingsbury, both feel that the appointment of a whole-time Psychiatric Registrar or Senior Registrar to be shared by the two Centres is necessary due to pressure of psychiatric referrals. So much time is spent on seeing new referrals that little time is left for preventive work in the community. This appointment could be made by the Regional Hospital Board at the request of the Local Education Authority. Premises. The Kingsbury Child Guidance Centre, although new and purpose-built, has insufficient rooms for the work undertaken. One room from the Maternity and Child Welfare Clinic on the ground floor has been transferred to Child Guidance use, but still more room is necessary. The possibility of additional building on the site is being investigated by the Borough Architect. The Kilburn Child Guidance Centre has been decorated internally during the year. Residential Placement. During the year 35 children were ascertained as maladjusted and recommendations were made that they be placed in residential schools. This is advised only when placement away from home and the day school is necessary. It is disconcerting, however, to find that at the end of the year there were 20 still on the waiting list for placement, and a quarter of these had waited longer than three months. Many of these children present real difficulties to the day school, and urgent placement is usually necessary. Unattached Classes. The Day Maladjusted Unit which is planned for the old Willesden Education Office in Willesden Lane is an urgent need, and it is hoped that this will open in September, 1966. The Language Class at Mora Junior School was increased from half-time to full-time in September 1965. It deals with two groups each of a dozen children who attend for a half-day every day. At the end of the year there were 42 children who were on the waiting list for the Language Class. It will take a very long time indeed for these to be admitted. There is need for a further Language Class. Contact with other Agencies. There is close co-operation with the Health Department. School Medical Officers attend a monthly conference at Kilburn, and Mental Health Officers attend regular conferences at Kingsbury. We are called upon to address groups, such as Parent-Teacher Associations, and various social groups in the Borough. We are always ready to do this. We take a large part in the training of professional workers. Psychologists, psychotherapists and social workers spend continuous periods doing practical work at the Centres as part of their training and we have many visits from students. Conclusions. More accommodation in the Kingsbury Child Guidance Centre, the appointment of a full-time medical registrar, and the establishment of a further language class would assist the service considerably. We are grateful to both Mr. Wyeth and the Education Office staff, and Dr. Grundy and the School Health Service staff for co-operation and help in what is a hard pressed service. 66 CHILD GUIDANCE CENTRES Table 1. Referrals Number of cases referred to the Centres in 1965 (126 girls, 212 boys) 338 Number of cases brought forward from 1964 waiting list 30 368 Number of new cases dealt with by Psychiatrist and team 243 Number of cases investigated by Educational Psychologist and P.S.W. or withdrawn before full investigation 62 Cases remaining on waiting list at 31.12.65 63 368 Number of cases seen for regular treatment 146 Number of cases recommended for residential placement 35 Table 2. Sources of Referrals M.O.H. and School Medical Officers (26%) 89 Headteachers and Educational Psychologists (17%) 57 General Practitioners (18%) 62 Hospitals ( 8%) 28 Probation Officers and Juvenile Courts ( 2%) 8 Parents (16%) 53 Children's Department ( 6%) 19 Others ( 7%) 22 338 Table 3. Reasons for Referral 1. Nervous Disorders (13%) (a) Fears and anxieties 26 (b) Inhibited behaviour 17 2. Behaviour Disorders (35%) (a) At home 66 (b) At School 25 (c) Predominantly aggressive 27 3. Habit Disorders (20%) (a) Enuresis (wetting) 28 (b) Encopresis (soiling) 7 (c) Involuntary movements 12 (d) Sleep disturbances 11 (e) Speech disorders 11 4. Psychosomatic ( 5%) Asthma, Eczema, etc. 17 5. Anti-social Behaviour (17%) (a) Stealing 31 (b) Non-attendance at school 28 6. Educational Difficulties (10%) Backwardness and retardation in school work 32 338 Table 4. Age Distribution of Referrals Under 5 years 38 11 years 22 5 years 31 12 years 27 6 years 30 13 years 14 7 years 42 14 years 24 8 years 27 15 years 11 9 years 32 Over 15 years 6 10 years 34 338 67 SCHOOL PSYCHOLOGICAL SERVICE Table 5. Reason for Referral to Psychologists Backwardness 158 Assessment for allocation to schools 98 Behaviour difficulties 55 Assessment for Medical Officer of Health 76 E.S.N. School Leavers 18 405 Table 6. Disposal of School Psychological Service Cases Recommendation to Chief Education Officer on suitable education 80 Recommended for Remedial Reading Centre 60 Recommended for Special School 28 Cases to be reviewed 48 Advice to Schools 49 Recommendation to Medical Officer of Health 34 Advice to Parents 10 Recommended for Special Infants' Class 20 Notification under 57 (4) as severely subnormal 5 Referred to Child Guidance Centre 71 405 Table 7. Waiting List for Psychologists at 31.12.65 School Psychological Service 122 Cases for Review 38 Cases for testing in Child Guidance Centres 20 180 Table 8. Unattached Classes Numbers attending during 1965 REMEDIAL READING CLASSES Bridge Remedial Teacher: Mrs. Zurawski Boys Girls Total Primary 17 7 24 Secondary 16 - 16 Total 33 7 40 Granville Remedial Teacher: Mr. Edmonds (until 30.5.65) Mr. Lovell (from 7.9.65) Boys Girls Total Primary 17 6 23 Secondary 19 6 25 Total 36 12 48 Mora Remedial Teacher: Miss Phillips (from 7.9.65) Boys Girls Total Primary 7 3 10 Secondary 7 3 10 Total 14 6 20 68 Sudbury Remedial Teacher : Miss Kemsley (from 7.9.65) Boys Girls Total Primary 9 6 15 Secondary — — — Total 9 6 15 Kingsbury Green Remedial Teachers: Miss Marriot (half time) Mrs. Brand (half-time from 21.9.65) Boys Girls Total Primary 16 — 16 Secondary 10 — 10 Total 26 - 26 Stonebridge Special Infants' Class Teacher: Mrs. Gillespie Boys Girls Total 17 6 23 Mora Language Class Teacher : Miss Romanowicz (until 23.7.65) Miss Russell (from 7.9.65) Boys Girls Total Primary 11 5 16 Secondary 9 4 13 Total 20 9 29 APPENDIX 70 MEDICAL INSPECTION AND TREATMENT Number of pupils on registers of maintained primary, secondary, special and nursery schools 35,669 Part I.—Medical Inspection of Pupils attending Maintained Primary and Secondary Schools (including Nursery and Special Schools) Table A Periodic Medical Inspections Age Groups inspected (by year of birth) No. of Pupils who have received a full medical examination Physical Condition of Pupils Inspected Pupils found to require treatment (excluding dental diseases and infestation with vermin) for defective vision (excluding squint) for any other condition recorded at Part II Total individual pupils Satisfactory Unsatisfactory No. No. (1) (2) (3) (4) (5) (6) (7) 1961 and later 513 513 - 22 38 51 1960 2,345 2,320 25 82 159 218 1959 1,043 1,032 11 37 94 117 1958 326 322 4 16 36 50 1957 1,446 1,426 20 84 106 178 1956 407 406 1 41 33 72 1955 850 834 16 28 60 81 1954 1,349 1,335 14 87 107 183 1953 595 592 3 32 59 85 1952 153 152 1 10 28 38 1951 691 682 9 43 44 86 1950 and earlier 2,336 2,321 15 132 225 333 Total 12,054 11,935 119 614 989 1,492 Col. (4) total as a percentage of Col. (2) total 99.01% to two places of decimals. Col. (4) total as a percentage of Col. (2) total 0.99% Table B. Other Inspections Notes:—A special inspection is one that is carried out at the special request of a parent, doctor, nurse, teacher or other person. A re-inspection is an inspection arising out of one of the periodic medical inspections or out of a special inspection. Number of Special Inspections 3,972 Number of Re-Inspections 2,543 Total 6,515 Table C. Infestation with Vermin Notes:—All cases of infestation, however slight, should be included in Table C. The numbers recorded at (b), (c) and (d) should relate to individual pupils, and not to instances of infestation. (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 18,263 (b) Total number of individual pupils found to be infested 256 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54) (2) (Education Act. 1944) 76 (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54) (3) (Education Act, 1944) Nil 71 Part II. Defects found by Periodic and Special Medical Inspections during the year Defect Code No. (1) Defect or Disease (2) Periodic Inspections Special Inspections Entrants Leavers Others Total 4 Skin T 18 49 43 110 13 O 145 114 120 379 176 5 Eyes—a. Vision T 143 174 297 614 89 O 272 269 516 1057 55 b. Squint T 25 1 18 44 4 O 54 21 60 135 5 c. Other T 8 4 14 26 - O 27 15 43 85 22 6 Ears—a. Hearing T 33 42 75 150 37 O 147 30 133 310 48 b. Otitis Media T 6 — 5 11 2 O 109 14 52 175 9 c. Other T 1 3 5 9 9 O 47 9 45 101 21 7 Nose and Throat T 35 14 39 88 15 O 489 64 342 895 34 8 Speech T 60 8 30 98 15 O 96 13 55 164 24 9 Lymphatic Glands T 4 - 5 9 1 O 188 6 114 308 10 10 Heart T 4 3 1 8 - O 66 31 54 151 5 11 Lungs T 7 3 3 13 - O 118 35 32 235 15 12 Developmental—a. Hernia T 5 - 4 9 - O 54 7 36 97 6 b. Other T 6 3 16 25 4 O 129 38 138 305 20 13 Orthopaedic—a. Posture T 19 39 50 108 6 O 49 58 106 213 11 b. Feet T 43 79 121 243 27 O 97 56 127 280 22 c. Other T 9 15 9 33 6 O 55 57 67 179 9 14 Nervous System—a. Epilepsy T 1 - 4 5 1 O 8 11 9 28 2 b. Other T - 2 1 3 1 O 22 7 20 49 3 15 Psychological—a. Development T 4 1 14 19 - O 57 15 68 140 23 b. Stability T 15 3 22 40 20 O 308 122 358 788 42 16 Abdomen T 2 2 1 5 2 O 30 17 50 97 11 17 Other T 227 56 289 572 41 O 32 39 81 152 61 72 TREATMENT OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (Including Nursery and Special Schools) Table A. Eye Diseases, Defective Vision and Squint Number of cases known to have been dealt with External and other, excluding errors of refraction and squint 58 Errors of refraction (including squint) 2,685 Total 2,743 Number of pupils for whom spectacles were prescribed 896 Table B. Diseases and Defects of Ear, Nose and Throat Number of cases known to have been dealt with Received operative treatment: (a) for diseases of the ear — (b) for adenoids and chronic tonsillitis 81 (c) for other nose and throat conditions 6 Received other forms of treatment 83 Total 170 Total number of pupils in schools who are known to have been provided with hearing aids:— (a) in 1965 8 (b) in previous years 52 Table C. Orthopaedic and Postural Defects Number known to have been treated (a) Pupils treated at clinics or out-patients departments 748 (b) Pupils treated at school for postural defects — Total 748 Table D. Diseases of the Skin Number of pupils known to have been treated Ringworm (a) Scalp - (b) Body — Scabies — Impetigo 2 Other skin diseases 108 Total 110 Table E. Child Guidance Treatment Number known to have been treated Pupils treated at Child Guidance Clinics 368 73 Table F. Speech Therapy Number known to have been treated Pupils treated by speech therapists 373 Table G. Other Treatment Given Number known to have been dealt with (a) Pupils with minor ailments 985 (b) Pupils who received convalescent treatment under School Health Service arrangements 29 (c) Pupils who received B.C.G. vaccination 1,966 (d) Other than (a), (b) and (c) above Please specify: Lungs (Breathing Exercises) 90 Psychological (Stability) 70 „ (Development) 10 Total: (a) —(d) 3,150 SCHOOL DENTAL SERVICE Number of Pupils on the Register of Maintained Primary and Secondary Schools including Nursery and Special Schools in January 1966 as in Forms 7, 7m and 11 Schools 35,669 Attendances and Treatment Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First visit 3,795 2,592 724 7,111 Subsequent visits 6,591 7,254 2,009 15,854 Total visits 10,386 9,846 2,733 22,965 Additional courses of treatment commenced 539 353 99 991 Fillings in permanent teeth 3,073 7,071 2,838 12,982 Fillings in deciduous teeth 7,011 597 7,608 Permanent teeth filled 2,597 6,316 2,437 11,350 Deciduous teeth filled 6,462 546 7,008 Permanent teeth extracted 137 517 148 802 Deciduous teeth extracted 2,470 713 3,183 General anaesthetics 945 382 43 1,370 Emergencies 190 115 35 340 74 Number of Pupils X-rayed 509 Prophylaxis 1,068 Teeth otherwise conserved 1,214 Number of teeth root filled 49 Inlays 3 Crowns 18 Courses of treatment completed 5,123 Orthodontics Cases remaining from previous year 995 New cases commenced during year 232 Cases completed during year 125 Cases discontinued during year 59 No. of removable appliances fitted 271 No. of fixed appliances fitted 17 Pupils referred to Hospital Consultant 18 Prosthetics 5 to 9 10 to 14 15 and over Total Pupils supplied with F.U. or F.L. (first time) — — — — Pupils supplied with other dentures (first time) 2 6 7 15 Number of dentures supplied 2 6 8 16 Anaesthetics General Anaesthetics administered by Dental Officers — Inspections (a) First Inspection at school. Number of Pupils 24,435 (b) First Inspection at clinic. Number of Pupils 3,281 Number of (a) + (b) found to require treatment 14,517 Number of (a) + (b) offered treatment 13,434 (c) Pupils re-inspected at school clinic 1,541 Number of (c) found to require treatment 901 Sessions Sessions devoted to treatment 3,444 Sessions devoted to inspection 339 Sessions devoted to Dental Health Education 61.5 Sessions devoted to X-Rays 80 DEANER PRINTERS LTD. (T.U.), LONDON ;