LONDON BOROUGH OF BRENT MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER E. GRUNDY, M.D.. M.R.C.S., D.P.H. CONTENTS Page COMMITTEE MEMBERS, CHIEF AND SENIOR OFFICERS 2 INTRODUCTION 4 VITAL STATISTICS, INFECTIOUS DISEASES. HEALTH EDUCATION, STAFF MEDICAL EXAMINATIONS 5 PERSONAL HEALTH SERVICES 9 MENTAL HEALTH SERVICES 16 WELFARE SERVICES 21 ENVIRONMENTAL HEALTH SERVICES 26 STATISTICAL TABLES 33 REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER 59 COMMITTEE MEMBERSHIP—MUNICIPAL YEAR 1969/70 HEALTH AND WELFARE COMMITTEE The Mayor, Alderman Mrs. R. G. N. Taylor, O.B.E., is an ex-officio member of all Committees and SubCommittees Chairman: Councillor Miss D. Cowan Vice-Chairman: Councillor Mrs. A. M. Newland Alderman A. Otten Councillor Mrs. L. Dunbar Councillor Mrs. J. Bowen „ Mrs. D. Francis „ Mrs. K. Bowtell „ L. Golding, LL.B. „ Mrs. P. Brothers „ T. Goudie, LL.B. „ C. Coles „ E. McDonald „ G. R. Cadogan-Ogg „ O. Stone „ A. J. Cowan „ R. Stone „ M. Curley „ Mrs. G. Tookey „ Mrs. B. De Metz „ H. Tucker „ W. Dromey 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: Peggy Snow, 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, F.R.S.H., M.A.P.H.I. 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: Mrs. E. H. Simmonds, S.R.N., S.C.M. (e) Clinical Nursing Officer: Miss D. A. Hunter, S.R.N., S.C.M., S.R.F.N., Q.N. (e) (retired 18.8.69) Miss M. Wetherell, S.C.M. (appointed 25.8.69) 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 of Recognition 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, 1970. To the Mayor, Aldermen and Councillors of the Borough. Mr. Mayor, Ladies and Gentlemen, This report surveys in some detail the activities of the Department during the year and it would detract from the content if a summary were to be given in the foreword. It remains, therefore, for me only to say that the report itself is not the work of one individual but the work of many in the Department and it is my privilege to express gratitude to colleagues within the Department who have so conscientiously helped. We are also indebted to other members of the staff who have given nothing but the best advice and assistance when any request has been made. Thanks are due also to the Mayor, the Chairman of the Committee and to all Members of the Council for their continued support, guidance and advice during the year. 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 1969—Registrar General's mid-1969 estimate 281,530 Number of structurally separate dwellings occupied (1961 census) 81,866 Number of private households (1961 census) 97,701 Rateable value (all hereditaments) 1st April, 1969 £20,608,965 Product of a penny rate, financial year 1969/70 (estimated) £81,850 Live births Number 5,485 Rate per 1,000 population (crude) 19.5 Rate per 1,000 population (adjusted) 17.6 Illegitimate live births per cent. of total live births 14.7 Stillbirths Number 77 Rate per 1,000 total live births and stillbirths 13.8 Total live and stillbirths 5,562 Infant deaths (under 1 year) 105 Infant mortality rates Total infant deaths per 1,000 total live births 19.1 Legitimate infant deaths per 1,000 legitimate live births 17.7 Illegitimate infant deaths per 1,000 illegitimate live births 27.3 Neo-natal mortality rate (deaths under 4 weeks per 1,000 total live births) 12.9 Early neo-natal mortality rate (deaths under 1 week per 1,000 total live births) 10.6 Perinatal mortality rate (stillbirths and deaths under 1 week combined per 1,000 total live and still births) 24.3 Maternal mortality (including abortion) Number of deaths 4 Rate per 1,000 total live and stillbirths 0.72 Deaths 2,913 Death-rate per 1,000 population (crude) 10.3 Death-rate per 1,000 population (adjusted) 11.4 Deaths from cancer (all forms) 674 Death rate from cancer (all forms) per 1,000 population 2.4 BIRTHS In 1969, 5,485 live births were registered, giving a crude birth rate of 19.5 per thousand estimated population compared with a rate of 20.1 in 1968. 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 0.90 is applied to the crude birth rate the standardised rate is 17.6 which is above the provisional rate for England and Wales, which was 16-3 per thousand population. There were 807 illegitimate live births, i.e. 14.7 per cent. of total live births, a very slight decrease compared with last year (14.8 per cent.). STILLBIRTHS Seventy-seven babies were stillborn, giving a rate of 13.8 per thousand live and stillbirths, above the provisional rate for England and Wales which was 13.0. DEATHS The total number of deaths was 2,913 giving a crude death rate of 10.3 per thousand population. When the comparability factor is applied, the standardised rate is 11.4, a little below the provisional rate. 6 for England and Wales which was 11.9. 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. Diseases of the circulatory system (active rheumatic fever, heart disease, hypertensive disease, cerebrovascular disease, etc.) continue to be the leading cause of death with a rate of 2.4, and respiratory diseases (influenza, pneumonia, bronchitis and emphysema, asthma, etc.) with a rate of 1.4. Infectious Diseases Five men died from tuberculosis of the respiratory system. There were no deaths among women. This is a great improvement compared with last year when nine men and two women died from the disease (see page 14). There were no deaths from any other notifiable disease. Cancer of the Lung and Bronchus Once again cancer of the lung and bronchus continues to be the commonest cause of fatal malignant disease. 158 men and 44 women died compared with 148 men and 31 women in 1968. The Department of Health and Social Security, with the assistance of the Health Education Council Ltd., continued its campaign on smoking and health. The Department co-operated by distributing a considerable amount of literature to school, youth clubs and other organisations, and 11 talks were given in schools to 614 pupils. Bronchitis and Emphysema 116 men and 49 women died from bronchitis and emphysema compared with 118 men and 42 women in 1968. The sex difference in numbers of deaths is probably related to the heavier smoking habits of middle-aged and elderly men and to a lesser extent conditions of dust, smoke and fumes at work. Abortion and Other Complications of Pregnancy There were four maternal deaths giving a rate of 0.72 per 1,000 (live and still) births, compared with two deaths and a rate of 0.34 in 1968. The provisional rate for England and Wales was 0.19 per 1,000 live and stillbirths. Motor Vehicle Accidents Thirty-eight residents died as a result of accidents involving motor vehicles (26 males, 12 females). All other Accidents Twenty males and 16 females died as a result of other accidents, the commonest causes being falls at home and at work, carbon monoxide poisoning, burns and asphyxia due to fires, and drowning. Suicides Eighteen men and 18 women committed suicide (see page 17). INFANT MORTALITY In 1969, 105 children died in the first year of life—58 in the first week and another 13 in the first month. There was a slight decrease in the infant mortality rate compared with 1968, from 23.4 per 1,000 live births to 19.1, which was above the provisional figure for England and Wales (18.0). The perinatal mortality rate (stillbirths and deaths under one week combined per 1,000 live and stillbirths) decreased from 29.5 to 24.3, above the provisional figure for England and Wales which was 23.0. Causes of Death (Table 3) The main cause of infant mortality was birth injury, difficult labour and other anoxic and hypoxic conditions. Twenty-seven babies died in the first week of life and one in the second. Twenty babies died of other causes of perinatal mortality. Nineteen of these deaths were due to prematurity. Influenza, pneumonia, and other diseases of the respiratory system caused eighteen deaths. Antibiotics and improved environmental conditions have decreased the number of deaths from these causes considerably over the past few years. Last year, I said "it is pleasing to report that there were only two deaths from enteritis and diarrhoeal diseases compared with six in 1967". This improvement continued; there was only one death in 1969. There is no doubt that the work done by the health visitors educating mothers, particularly immigrant mothers many of whose standards of infant care and feeding leave a great deal to be desired, has contributed to this low death rate. There were 24 deaths from congenital anomalies, one due to a motor accident, one from carbon monoxide poisoning (fire fumes) and one cot death, a child of one day. PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Improved conditions of housing and general standard of living, together with modern medicine and vaccines have played an important part towards better health and reduction in number of notifiable diseases in the Borough. Health Visitors and Public Health Inspectors have played an invaluable role in health education and in improving hygiene, and where a disease has been notified prompt action and advice has no doubt prevented it from becoming widespread. A summary of notified and confirmed cases for 1968 and 1969 is shown in Table 4. Diphtheria There were no cases in the Borough during 1969. 7 Dysentery The number of confirmed cases (113) was considerably more than in 1968 (33). On many occasions, several members of one family were found to be infected. However, these were sporadic incidents, the various families were not connected in any way and there was no evidence of a common source of infection. All cases were followed up in the normal manner until free from infection. Food Poisoning Fifty confirmed cases and their contacts were dealt with during the year. Where food handlers were involved they were excluded from work or given other duties. The number of confirmed cases increased compared with last year (35) mainly due to an outbreak following a wedding reception in Cricklewood when 36 guests were affected, 17 of them being Brent residents. The causative organism was Salmonella enteritidis, phage-type 8. It was not possible to identify the food concerned as none was left over for bacteriological examination, but the suspected food was chicken. An enteric infection occurred at the Kingsbury Maternity Hospital where one baby died as a result. Twenty-one mothers and 20 babies were at risk. Three mothers and six babies were found to be symptomless carriers. The causative organism was Salmonella Chester. Precautions were taken to prevent the spread of the infection and the hospital was closed from the middle of January to the 20th February. Measles There was a decrease in the number of cases notified (970) compared with 1968 (1,367) and with 1967 (2,564). Measles vaccine was introduced in May 1968 and this probably accounts for the decrease in the number of cases notified. Poliomyelitis There were no cases in the Borough this year. Smallpox There were no cases in the Borough, but 59 people were put under routine surveillance after arriving from endemic areas abroad without valid vaccination certificates. Typhoid and Paratyphoid Fever One case of typhoid fever was confirmed. He was a man of 22 years who left an address in Brent on the 8th May for a holiday in India. He returned on the 19th June and was admitted to the Willesden General Hospital on the 21st June as a typical infective hepatitis case with jaundice. Between seven and ten days later he developed a high pyrexia. Blood cultures were taken and as soon as organisms were discovered he was placed on barrier nursing. When the organisms were identified as Salmonella typhi he was transferred to Neasden Hospital. Contacts were kept under strict surveillance. There were no other cases in the Borough but 36 persons were kept under routine surveillance after they had returned to the Borough from endemic areas abroad or had been contacts of confirmed cases in other Boroughs. There were no cases of paratyphoid fever. Whooping Cough There was a marked decrease in the number of confirmed cases (37) compared with last year (111). Ophthalmia Neonatorum There was no impairment of vision in the six confirmed cases. Infective Jaundice Details of the 33 cases notified as suffering from this disease were sent to the North London Blood Transfusion Centre of the National Blood Transfusion Service. The information enables the Service to delete the patient's name from the panel if he or she is a donor and to defer the call-up of close contacts for six months. In addition, it may enable the Service to stop a recent donation from being used clinically or included ia a pool of plasma. Particular attention has been focused on the transmission of jaundice by the use of contaminated syringes or needles by persons who administer drugs intravenously by self-injection, and the occurrence of cases of jaundice has led to the detection of foci of drug addiction. When information is obtained by the Public Health Inspectors that a person suffering from infective jaundice is a drug addict, the Mental Health Division is informed. HEALTH EDUCATION The aim of health education is to help people strive towards better health and to regard a healthy, happy mind and body as a valuable asset to living. The Department's health education programme is based mainly on lectures illustrated by films, filmstrips and other visual aids. Assistant medical officers, dental officers, health visitors, chiropodists and public health inspectors gave 164 talks in 24 Brent schools. Outside groups accepted 56 talks, clubs and associations, and professional bodies, 39. Mothercraft classes, which included films and instructional demonstrations numbering 478 were held in clinics mostly by health visitors and midwives. 8 Many requests were received from factories, commercial firms, organisations, general practitioners, shop-keepers, teachers, students and members of the public for posters and literature. The major demand was for material on smoking and lung cancer, but that for drug abuse, etc., showed a marked increase during the year. In September, the North West Metropolitan Regional Hospital Board's Mass Radiography Unit visited Willesden, and an extensive advertising campaign was conducted on their behalf. Public response was most gratifying and 12,297 people were x-rayed. National campaigns on smoking and lung cancer, immunisation and influenza were supported, and new literature and posters were distributed throughout the Borough. In addition, the Department organised local campaigns on the care and use of oil heaters, and personal hygiene. A large exhibit depicting the Department's many activities was displayed at the "Welcome to Citizenship" held in the Town Hall in April. This was enjoyed by the 400 or so young people who attended and many questions were put to the professional staff who were in attendance. A representative display was shown in the Civic Services tent at the Brent Show held in September. MEDICAL ASSESSMENTS AND MEDICAL REPORTS New entrants to the Council's service are required to complete a medical assessment form. The forms are scrutinized by an assessing medical officer and, if considered necessary, further information is obtained from the entrant's general practitioner or a hospital, and/or a medical examination carried out. During the year, 1,964 assessments were dealt with. Further information was obtained from general practitioners in 18 cases and from hospitals in 13 cases. It was not necessary to carry out any medical examinations. Eight medical examinations were carried out on behalf of other local authorities. Five medical examinations were carried out on behalf of other Departments of the Council where the Chief Officer considered it necessary before granting an extension of service. Six members of the staff were recommended for retirement on the grounds of permanent ill health. It is a requirement of the Department of Education and Science that all teachers, on their first appointment, and applicants for entry to Teacher Training Colleges, be medically examined. 137 teachers and 200 trainees were examined by Assistant Medical Officers. 9 PERSONAL HEALTH SERVICES HEALTH CENTRE DEVELOPMENT Completion of the Chalkhill Heath Centre, which will be the first provided by the Council, was delayed and it was impossible for the premises to be handed over in the year under review. The delay was caused by a fire on site and structural strengthening required by the new regulations for system built premises. The doctors intending to practise in the Centre remain keen and interested, meeting together each six weeks to discuss problems of commissioning. The Craven Park Health Centre project continues and the present expected date of completion is late 1970. These two health centres will permit group practice in two important areas of the town and the concept of co-ordination between the Local Authority Services and family doctors will become more readily possible in these areas. This is in accordance with modern thinking in the Health Service, CARE OF MOTHERS AND YOUNG CHILDREN Under Section 22 of the National Health Service Act, 1946, it is the duty of the local health authority to make arrangements for the care, including dental care, of expectant and nursing mothers and of children under 5 years of age who are not attending primary schools maintained by the local education authority. Child Welfare and Ante-Natal Clinics The 15 health clinics continue to offer comprehensive personal service for ante-natal and post-natal mothers and the care of their children. The constant aim is preventive and educational. Every effort is made to encourage parents to avail themselves of the services for prophylaxis arranged at all clinics. The smaller number of births has probably resulted in the decreases in attendances at some clinic sessions during the year. Child Health Clinics Clinic sessions Total Attendances Seen by doctor Referred elsewhere Average attendance per session 2,327 56,416 19,758 728 24.2 Ante-natal Clinics Sessions Attendances Average attendance per session Ante-natal Post-natal 880 4,005 109 4.6 Mothercraft Classes There has been less demand for relaxation and mothercraft classes in some areas of the Borough as a result of more mothers attending classes provided by hospital ante-natal departments. Unfortunately the special psycho-prophylaxis class held at Kilburn Square Clinic for ante-natal mothers closed during the year due to lack of trained personnel. This adversely affected the numbers attending ante-natal sessions. Cervical Cytology Cervical cytology sessions were held at Stag Lane Clinic on Wednesday mornings, and Kilburn Square Clinic on Saturday mornings. Patients attending the birth control clinics at London Road, Kilburn Square, and Stonebridge Clinics are given this facility if required. There was an increase in the number of tests done—1,642 patients attended during the year compared with 1,289 in 1968. Nurseries and Child Minders Regulation Act, 1948 As Amended by the Health Services and Public Health Act, 1968 As anticipated the amendment to the 1948 Act by Section 60 of the Health Services and Public Health Act resulted in an almost overwhelming increase in applications for registration as child minders. 369 persons were registered at the end of 1969, but many more applications were made and several withdrew after the initial visit. There are 45 registered playgroups in the Borough. DENTAL SERVICE FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS OF AGE (Table 5) Report of the Chief Dental Officer Probably due to the impact of dental health education generally and to the tendency of tooth conscious parents to seek dental inspection and treatment for their children at an earlier age, a smaller percentage of teeth are being lost in under-five children. It is also pleasing to note that fewer first attendances are for 10 emergency treatment. It is unfortunate, however, that so many parents who are well aware of the value of a correct diet medically and dentally, and equally well aware of the dangers of cariogenic foodstuffs, permit the consumption of such items with little regard for oral hygiene and seem content to leave it to the dental profession to repair the ensuing damage to the teeth. It cannot be over-emphasised that the dentist can only repair caries damage, not cure it. PREVENTION OF BREAK-UP OF FAMILIES Families in need of extra or specialised support remain an urgent priority group. Work in depth is undertaken in co-operation with officers in other departments. Families in need of long-term intensive support and guidance are referred by all agencies and departments to the Family Service Unit, each request being channelled through the Health Visiting Service. During 1969, seven new cases were accepted by the Unit for such intensive case work, no cases were closed, and the case load at the end of the year was 45 families. The office of the Brent Branch was transferred to the Methodist Church Hall, 2, Tavistock Road, Harlesden. The Council made a grant of £4,000 to the Unit in the financial year 1969/70, and also a grant of £100 towards the cost of the removal from 8, Neasden Lane to Harlesden. DAY NURSERIES (Tables 6 and 7) The demand for admission to the Council's twelve day nurseries has continued at a high level. The standard charge remained at 17/6d. per child per day with a minimum charge of 1/- per day. Sixteen students completed their two-year period of training and all obtained the N.N.E.B. Certificate. Five nursery nurses attended a two-week Course for qualified and experienced nursery staff at Chiswick Polytechnic. Two matrons attended the Annual Conference of the National Association of Nursery Matrons. On 17th January, 1969, three day nursery projects were approved by the Home Office for inclusion in the first Phase of the Urban Programme which expires on 31st March, 1970, viz. Vale Farm Nursery Phase II—improvement of toilet and cloakroom facilities for children aged 1—5, replacement of solid fuel boilers by gas fired, and enlargement of kitchen at an estimated cost of £12,500; Mortimer Road — improvement of washing and cloakroom facilities for children, improvement of staff toilet accommodation, building of new playroom, and re-wiring at a cost of £11,070; Princes Avenue—provision of additional cloakroom and improvement of existing toilet and cloakroom accommodation for children aged 1—5, and provision of covered play space at a cost of £7,420. The work at Mortimer Road and Princes Avenue commenced in April and was completed in October, and that at Vale Farm commenced in July and will be completed early in 1970. New admissions were discontinued prior to the commencement of the works, and in the case of Vale Farm and Mortimer Road the registers were slowly run down, staff vacancies were not filled, and the nurseries were closed whilst the works were in progress. The remaining staff were temporarily transferred to fill vacancies in other Nurseries. The building of the 50-place nursery within the Neighbourhood Centre Scheme at the junction of Harlesden Road and Longstone Avenue was delayed owing to difficulties experienced by the lowest tenderer. The Council decided to invite new tenders for the whole Scheme and eventually work commenced on 18th August, 1969, and is due for completion in June 1971. The estimated cost of the nursery is £48,900 and furniture £7,000. The Council at their meeting in November approved proposals submitted by the Borough Architect for the provision of a 50-place nursery in the Chalkhill Redevelopment Area at an estimated cost of £54,250 including furniture. The proposals were submitted to the Department of Health and Social Security for cost limit approval. CARE OF THE UNSUPPORTED MOTHER AND HER CHILD (Table 8) Residential accommodation for ante- and post-natal periods is provided by the Council in "Bellevue" Mother and Baby Home which accommodates 12 mothers and 12 babies. Use was also made of similar homes run by other local authorities and voluntary organisations. The services of a Medical Social Worker are provided to deal with cases referred from many quarters for help, which includes counselling and advice, where necessary hostel placement before and after delivery, and, most important, after-care for both mother and child. The services of the Medical Social Worker are shared with the London Borough of Harrow. "Bellevue" was full for most of the year. There was a slight decrease in admissions although the average length of stay during the post-natal period increased from 34 days in 1968 to 40 days in 1969. The average length of stay during the ante-natal period was 30 days which is in line with most other mother and baby homes. The trend for the year under review seems to have been for mothers to keep their babies, especially in the cases where they spent the six week post-natal period in a mother and baby home. However, some mothers wanted their babies fostered directly from hospital pending adoption, and these arrangements were made. 11 FAMILY PLANNING There was a considerable expansion of the family planning service in 1969. Each of the three Council clinics offering the service commenced a second session—London Road on 9th May, Stonebridge on 2nd June, and Kilburn Square on 23rd June. The sessions now held are: — London Road Clinic Administered by Council — two mornings Kilburn Square Clinic „ „ „ — morning and afternoon Stonebridge Clinic „ „ „ — morning and afternoon Stag Lane Clinic „ „ F.P.A. — evening Neasden Clinic „ „ „ — evening Pound Lane Clinic „ „ „ — evening One Tree Hill Clinic „ „ „ — morning and evening At the beginning of the year, the Council decided that oral contraceptives should be supplied on social grounds at Council Clinics. This decision was implemented on 1st April, and the charge determined by the general principle of cost price plus 10%. Free supplies are prescribed for patients in receipt of Social Security Benefit. The Borough of Brent is in the area administered by the North West London Branch of the Family Planning Association and the clinic premises listed above are provided free of charge to the Association for holding sessions. A grant of £300 was made to this Branch in 1969/70. In addition, Brent patients who are referred to clinics administered by other Branches of the Association have consultation fees and supplies, other than oral contraceptives, paid for by the Council. The number of referrals was reduced as a result of the extra sessions commenced in Brent during the year. INCIDENCE OF CONGENITAL MALFORMATION In accordance with the requirements of the Chief Medical Officer of the Department of Health and Social Security, information is supplied to the Registrar General concerning congenital defects apparent at birth. A summary of notifications received and an analysis of malformations notified are shown in Tables 9 and 10. MIDWIFERY SERVICE (Table 11) There are 16 full-time and four part-time midwives on the establishment. The number of full-time midwives has been maintained during the year. Three part-time midwives were employed, the vacancy is not being filled for the time being. A scheme for attaching midwives to general practitioners' surgeries was introduced during the year and four midwives are now attached. The scheme is working satisfactorily. Midwives who are not attached hold their own ante-natal sessions observing close liaison with general practitioners, obstetricians and hospital services. Ante-natal care includes classes in preparation for childbirth, use of analgesics, i.e. gas and air, trilene and pethilorfan. Sterilised maternity outfits are provided for all mothers who have home confinements, and a modified pack is provided for early discharges from hospital. The Maternity Medical Services Co-operation Card is used between midwives and general practitioners. Its purpose is to ensure that each member of the team is aware of the attention given to patients by other members. Refresher Courses Five midwives attended refresher courses during the year to comply with Section G.l of the Rules of the Central Midwives' Board which require every practising midwife to attend a residential refresher course every five years. Pupil Midwives A total of 23 pupil midwives were accepted for Part II district training from St. Mary's Hospital, Harrow Road, W.9 and Central Middlesex Hospital. As a result of the continuing decline in domiciliary bookings with its adverse effect on the training of pupils, i.e. insufficient cases to meet the requirements of the Central Midwives' Board, a revised scheme of training was approved by the Board. As from 1st November, 1968, the number of cases delivered by pupils was reduced from ten to six. An additional four patients to be delivered within the hospital during the intern part of the training. In addition to complying with the Rules of the Board, a programme of talks and visits was arranged extending over the 13 week period of domiciliary training. At the request of the Board the programme was planned to give pupils a broad outline of community care, with a composite picture of the work of the Local Authority as it affects community care generally and the maternity services in particular. 48 Hour Discharges 469 patients were discharged from hospital before the 10th day. The majority were planned for early discharge, others were accepted on account of emotional disturbances and domestic difficulties, and a number took their own discharge. Three part-time midwives are employed for the nursing of early discharges. 12 HEALTH VISITING The staff position improved as five sponsored students, who successfully completed a course of training and obtained the Health Visitor's Certificate, were appointed to the established staff. Five more sponsored students are attending the current course. At the end of 1969, there were 39 health visitors in post covering 43 areas. Their work is varied and exacting. They attend all clinic and school health sessions, but the majority of their time is spent giving advice and help to persons in their own homes. First Effective Visits Total Effective Visits Total No. Access Total Visits as School Nurse 21,052 42,368 9,538 2,562 Schemes for attaching health visitors to general practitioners' surgeries are difficult to implement owing to restricted staff and financial resources, but plans for attachment have remained a subject for discussion. However, liaison schemes between general practitioners and health visitors have been encouraged and arrangements were made for three more health visitors to have regular contact with general practitioners, making a total of seven involved in such schemes. Attachment to hospital Diabetic and Geriatric Units are well established and continue on an even tenor despite changing personnel. Closer co-operation between local authority and hospital staffs continued with sharing of study days in the hospitals. Two health visitors attended lectures and paediatric rounds at Kingsbury Maternity Hospital. Two health visitors attended a non-residential Refresher Course at St. Gabriel's College, London University, one attended a non-residential Course at Chiswick Polytechnic, and one attended a residential Course at St. Catherine's College, Liverpool. The Superintendent Health Visitor attended a follow-up weekend Seminar on Management at Warwick University, and the Deputy attended a Course for Supervisors of Child Minders at Chiswick Polytechnic. DISTRICT NURSING Under Section 25 of the National Health Service Act, 1946, it is the duty of every local health authority to provide nurses for persons who require nursing in their own homes. The establishment of nurses (48 plus two State Enrolled Nurses) was increased by one full-time male officer. The nurses work in close liaison with general practitioners and hospital staff. Facilities have been given for senior student nurses in general training to accompany the Council's nurses on their rounds. Seven part-time bathing attendants are employed. They work under the close supervision of the trained nurses, and attend the elderly and infirm patients who require semi-nursing care over a long period, thus allowing the trained nurses to give more time to the acutely ill and surgical patients. 2,452 new patients were referred during the year, and the nurses paid a total of 120,944 visits to all patients. 5,086 visits were paid by bathing attendants. At the end of the year, 1,374 cases were on the register. General Practitioner Attachments Nine new attachments were started during the year making a total of 16 operating in the Borough. The scheme works well to the satisfaction of the doctors and nurses, resulting in better community care for the patients. 2,050 treatments were given in general practitioners' surgeries under the group attachment schemes. Training and Refresher Courses Five nurses attended the District Nurse Training Course at Chiswick Polytechnic. They were all successful and obtained the National Certificate of the Department of Health and Social Security. One State Enrolled Nurse attended Chiswick Polytechnic for the special course in District Nurse Training for State Enrolled Nurses working on the District. Two nurses attended refresher courses to comply with the Department of Health and Social Security's recommendation that all home nurses should attend such courses every five years. Disposable Equipment The use of pre-sterilised and disposable equipment, which materially improves efficiency and safety, continued. Marie Curie Memorial Foundation Help is given by this Foundation to terminal cases of carcinoma nursed at home. Night nurses were provided for 20 patients during the year, thus enabling relatives to have some rest during the most difficult and trying periods. Two patients were provided with the loan of ripple beds (alternating pressure beds) by a medical equipment firm on behalf of the Foundation. INCONTINENCE PADS Incontinence pads are provided by the Council free of charge to all incontinent patients who require them, whether or not there is a Home Nurse in attendance. Requests for pads are received from general practitioners, hospitals, social workers and others. 76,250 pads were issued in 1969. 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. 13 VACCINATION AND IMMUNISATION Vaccination and immunisation of children against diphtheria, tetanus, whooping cough, poliomyelitis, smallpox and measles was undertaken by Assistant Medical Officers at the Council's clinic and by General Practitioners, as set out in the following programme:— During the first year of life Diphtheria/tetanus/whooping cough and oral poliomyelitis vaccine (first dose) Diphtheria/tetanus/whooping cough and oral poliomyelitis vaccine (second dose) Diphtheria/tetanus/whooping cough and oral poliomyelitis vaccine (third dose) During the second year of life Measles vaccination Smallpox vaccination At five years of age or school entry *Diphtheria/tetanus and oral poliomyelitis vaccine or *Diphtheria/tetanus/poliomyelitis vaccine Smallpox re-vaccination * re-inforcing immunisation Under the above programme the numbers of children receiving immunisation and vaccination were as follows:— Smallpox Primary vaccination 2,944 (2,924) Re-vaccination 512 (380) Diphtheria/tetanus/ whooping cough Primary immunisation 3,896 (3,402) Re-inforcing 1,991 (3,904) Poliomyelitis Primary immunisation 4,325 (3,870) Re-inforcing 3,345 (2,893) Measles Primary vaccination 2,374 (2,771) (Figures for 1968 in brackets) The routine vaccination of children against measles during the second year of life had to be discontinued during the latter part of the year owing to a shortage of vaccine, resulting in a decrease in the number of vaccinations in 1969 compared with 1968. The sharp fall in the number of children receiving diphtheria/tetanus/whooping cough re-inforcing injection is due to the existing vaccination and immunisation schedule which removes the necessity for the re-inforcing or booster dose previously given at the age of 18 months. RECUPERATIVE HOLIDAY HOMES The Council is empowered as part of its powers in the prevention of illness, for care and aftercare under Section 28 of the National Health Service Act, 1946, to arrange for the admission to recuperative homes of patients recommended by general practitioners, hospitals and clinics, 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 1969, the Council arranged and accepted financial responsibility for the placement of 51 persons in recuperative holiday homes, and of these 33 were admitted to such homes and 18 cancelled or withdrew. A further 34 applications were received, but were declined as not falling within the scope of the scheme. In addition, 19 school children were placed in recuperative holiday homes under Section 45 of the Education Act, 1944. CHIROPODY (Table 12) The chiropody service provided by the Council for the elderly, the physically handicapped, expectant and nursing mothers, and children under school age, continued during the year with no slackening in demand. 4,299 patients were treated compared with 3,767 in 1968. The service, which has been free since November 1967, was provided in the main by three full-time and three part-time chiropodists employed by the Council, partly by arrangement with seven private chiropodists, and partly by arrangement with the British Red Cross Society. Where treatment could not be given in a health clinic or a private chiropodist's surgery, because of the patient's age or disability, arrangements were made for a chiropodist to visit the patient's home. Chiropody treatment for school children was provided under the Education Act, 1944 (see page 62). HOME DIALYSIS Ministry of Health Circular 2/68 of the 4th January, 1968, informed local health authorities that adaptations for the installation of kidney machines could be carried out under Section 28 of the National Health Service Act, 1946, and that the Minister approved the making by the Council of such charges for this service as the Council considered reasonable having regard to the means of the person concerned. Hospital Authorities are responsible for providing the machinery and the running costs. 14 An application was received from King's College Hospital for a room to be adapted in the home of a man aged 55 years suffering from renal failure. The Council approved the adaptation, and the necessary work was carried out at a cost of £378. As the patient was receiving Social Security Benefit, he was not required to contribute towards the cost. Another application was received from the Home Dialysis Unit of the Charing Cross Group of Hospitals in respect of a woman aged 45 years. The Council at their meeting in November decided to take no action in this case, but following representations and further medical evidence from the Hospital it was agreed that the adaptation should be carried out. The estimated cost of the work is £335 and it will be commenced in January 1970. HOME HELP SERVICE There were 1,053 applications for the service in 1969, and the number of cases receiving help at the end of the year increased from 1,160 to 1,201. Two tuberculosis cases were helped, and help was provided free to one mother suffering from toxaemia of pregnancy. Seventy-three bookings were taken for home confinements but only 40 of these were helped, the remainder making other arrangements. The maximum charge to the public remained at 6/9d. per hour, but this charge was under review at the end of the year. The rate of pay of Helpers was increased from 5/9⅝fd. per hour to 6/4fd. per hour from 29th September, and this probably helped recruitment as the establishment of 95 full-time equivalent Home Helps was reached at the end of the year. An average full-time equivalent of 90.5 was maintained throughout the year. Ten persons were employed as Neighbourly Helps. The Organisers made a total of 6,121 home visits. LOAN OF NURSING EQUIPMENT The Middlesex Branch of the British Red Cross Society through its Divisions at Willesden and Wembley continues to operate the loan of nursing equipment scheme on behalf of the Council. Under these arrangements a hire charge is collected from the patient 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 1969, 2,421 articles were loaned to patients and hire charges amounting to £1,053 17s. 6d. were paid by the Council to the Society. The Council arranges transport for the collection and delivery of bulky articles. In general, the scheme is intended to facilitate simple short-term nursing care in the patient's home. Certain items of catheterisation equipment may be provided as a personal issue to paraplegic patients to enable them to care for themselves in their own homes. Other items of equipment may be purchased in special cases. TUBERCULOSIS (Tables 13—16) Mortality and Morbidity Five men died from respiratory tuberculosis, but there were no deaths among women. This is an improvement compared with last year when nine men and two women died from the disease. There was one death in the age group 35-44 years, two in the group 45-54 years, one in the group 55-64 years and one in the aged 75 and over group. Three of the men were previously unknown to the health authorities. This indicates that 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 tuberculous infection, B.C.G. vaccination is an important preventive measure offered to all school leavers to raise their resistance to the disease. (For details of B.C.G. vaccination of school leavers see Report of Principal School Medical Officer, page 61). Care and After Care The same provisions for the care and after care of patients, as have obtained in previous years, continued with Willesden Chest Clinic, Pound Lane as the focal point of the chest services, although a small number of Brent patients are also treated at Harrow and Edgware Chest Clinics. The Regional Hospital Board employs the Physician-in-Charge at Willesden Clinic. As a consultant in chest diseases, he is primarily clinically engaged with diagnosis and treatment, but he is also vitally concerned with prevention and after care. For this reason, the Physician has general responsibility for this Authority's measures for ensuring the after care of patients and this arrangement has stood the test of time well. To the same ends, the arrangements also provide for the Physician-in-Charge to have direct control of Council staff at the Clinic who are involved with the after care of patients. Occupational Therapy The services of a full-time occupational therapist have in recent years been shared with the London Boroughs of Ealing and Hounslow. As these two Authorities have indicated that they are now able to make their own arrangements for this work to be done, the sharing arrangements have been terminated. The services of the occupational therapist are now fully utilised by this Department but in the main in the Welfare Division. The practice has evolved of having chest patients registered as physically handicapped so that their therapy needs are met as part of the general caseload, both as regards guidance and training in handcrafts at home as well as placement, where suitable, in sheltered work centres. Vaccination against Tuberculosis B.C.G. vaccination is provided for persons who are tuberculosis contacts, school children aged 13 years and over as well as students attending Universities, Teacher Training Colleges and other further educational establishments. 15 Home Visiting At the end of the year four tuberculosis visitors were employed. Although their prime function is visiting patients' homes to advise on methods to overcome the spread of infection, to explain care and after care facilities and to closely supervise all known contacts, they also have duties at the Chest Clinic, including acting as Clinic Sister during diagnosis and treatment sessions. Home visits during the year totalled 1,457, of which 228 were to households proving to be non-tuberculous. VENEREAL DISEASE Responsibility for the treatment of venereal disease rests with Regional Hospital Boards. Local health authorities, however, co-operate with the venereal disease Treatment Centres 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 the venereal disease clinic at the Central Middlesex Hospital and her services were utilised for the purpose of tracing contacts, following up defaulters, and assisting patients attending the clinic in meeting any social problems with which they were faced. The majority of Brent residents attended Central Middlesex Hospital and St. Mary's Hospital, W.2., but to preserve anonymity some patients present themselves at clinics far removed from their homes. The disease is not notifiable, but the number of new cases attending for treatment at various Centres in 1969 is shown in Table 17. The incidence of the disease continues to cause concern. 16 MENTAL HEALTH (Tables 18—20) MENTAL ILLNESS Community Care and the Social Workers The social work team was augmented by the appointment of a Deputy Chief Mental Health Social Worker. An additional senior mental health social worker post, included in the revised establishment, had not been filled despite intensive advertising. This difficulty in attracting appropriately qualified staff is due largely to the reluctance of this authority to enter into competition with others in bidding in the form of salary scales for the services of scarce qualified senior professionals. One mental health social worker and our sole trainee mental health social worker both succeeded in gaining places of the few available on the Certificate in Social Work Course. Both these social workers have been seconded by the Council for their training. It remains to be seen whether, with existing salary and career prospects for mental health social worker staff in this Department, we will be able to retain the services of these officers when they return from their courses. The increased establishment as fixed in 1968 only just enables the basic mental health needs of the community to be met. In order to plan an effective preventive mental health programme, a substantial increase in the number of mental health social workers is vital. To make the best of existing limited facilities, certain social work management techniques have been introduced. Although initial referrals are taken from any source, social work services are provided only after a critical examination of the referral by the senior social work staff. Individual case loads are controlled and supervised to ensure the most efficient use of scarce resources. Thus, the number of effective interventions, where such are actually necessary, has increased. A re-evaluation of "agency acceptance" criteria, with Seebohm in mind, has enabled the mental health social work staff to evolve into a family social work service. Liaison with hospitals serving Brent has been immeasurably improved. A mental health social worker is attached, for liaison purposes, to each consultant psychiatrist's team. This arrangement, together with the use made of the psychiatric adviser to the Section, has enabled a meaningful relationship to develop between the hospitals and local authority mental health services. Individual social workers have represented the Mental Health Division at various professional conferences, both nationally and locally. The demand by various voluntary and statutory social service agencies for senior mental health social workers to give talks and lectures, has increased. This is considered a valuable service which the social workers perform out of office hours. Although there are two mental health social workers specialising in social work for the mentally subnormal, all the mental health social workers have mixed case loads of the mentally ill and the mentally subnormal. Still in the field of subnormality, a discussion group for parents of subnormal children was held once-weekly throughout the year. This group, organised and taken by mental health social workers, was an invaluable though limited in size forum in which professional officers and their clients benefitted mutually from meaningful exchanges. If the social services of the future are not to become too remote from the public they serve, such discussion groups should be widely encouraged. However efficient the mental health services may have developed, mental illness caused by social breakdown can only be checked and even prevented by a concerted attack on all the causes of social depression and deprivation by a comprehensive social work agency and not in isolation by mental health workers alone. There are high hopes that the proposed unified Social Services Department to be set up on the enactment of the Seebohm recommendations and the proposed new management techniques to be adopted by the Council will go a long way towards providing this comprehensive approach. Boarding-Out Scheme Contrary to expectations, this scheme got off the ground only slowly. It proved very difficult to recruit suitable landladies in spite of intensive advertising. One of the reasons seemed to be that the public's fears of the "Mental Illness" label are by no means allayed and that the stigma of such an illness is still very much a reality. We have a long way to go yet before people will no longer view illnesses of the mind with great suspicion. The few cases who were placed have been quite successfully so, and slowly a list of landladies is being built up. Financially the scheme is proving less costly than had been anticipated as ex-patients' earnings are often on average high enough to meet practically the whole of the boarding charge and few have to be subsidised. Those out of work are drawing social security benefit and do not therefore require the Council's financial support. "Brentholme" Hostel, 9 Willesden Lane, N.W.6 Regretfully I have to report that there has been, once more, a change of Superintendent at this hostel. Fortunately it has not proved too difficult on this occasion to recruit suitable staff as there were several quite satisfactory applicants. It would appear that for no apparent reason resident posts of this kind have become more attractive to reasonably well-qualified persons. It still seems to be the position nationally that recurrent staff changes will continue to take place in mental after care hostels until such time as there exists a proper career structure—and this Borough is not unfortunately an exception. It is to be hoped that a certain degree of specialization will evolve, leading eventually to relevant qualifications as more courses become available at various colleges. The hostel has functioned very well in spite of these staff changes and bed occupancy has been high, no more than a very few vacancies occurring at any time so that over two dozen men and women were accommodated throughout the year in this 27 bed hostel. There has also been a fairly rapid turnover of most patients but it had to be accepted that a very small number could not be discharged within the few months' period expected of most. 17 The Hostel, 73 Wembley Park Drive This small unstaffed unit for six ladies is continuing to function most satisfactorily. This year it has been possible to prevent a re-admission to Shenley Hospital of the one patient suffering from a relapse by her transfer for a three week period to "Brentholme" Hostel. The skilled attention by the staff there enabled this patient to return speedily to her place at the unstaffed unit and back to work without suffering the distress of a hospital admission. In this way, the two hostels complement each other admirably in their services to the mentally ill in the community. Registered Residential Homes (Ealon House, N.W.6) This remains the only voluntary hostel within Brent. It is registered in accordance with Section 37, National Assistance Act, 1948 as applied by Section 19, Mental Health Act, 1959 and run by the Jewish Welfare Board. Regular inspections are made by the Senior Medical Officer and I can report that gradually this hostel is successfully mobilizing an increasing number of residents back into a realistic work situation. The general standards are excellent. Day Centre for the Mentally III, Belton Hall, Bertie Road, N.W.10 In line with up-to-date occupational therapy practice, activities at the Centre in 1969 have tended more towards an orientation to the development of wider interests and self reliance in the patients and not only on creating work situations The number of referrals (92) and discharges (70) during the year approximated closely to the figures for 1968 (89 and 69 respectively). As in years past the position has arisen on a number of occasions that the facilities provided at the Centre do not meet the specific needs of a particular patient referred for admission. In these instances it has not proved possible to accept the referral. A prefabricated extension to the premises, the need for which is reflected in some of the projects and activities mentioned below, was completed in May at a cost of approximately £1,000 including furniture and fittings. The Monday Afternoon Social Club for the elderly mentally ill which had heretofore functioned at "Brentholme" Hostel, transferred to the new extension and continued to provide for a membership of 16. For the benefit of patients and to encourage mutually helpful involvement, arrangements were made to entertain ten housebound elderly people, introduced by the W.R.V.S., to a Christmas dinner party. The programme in other respects has followed the pattern of previous years including such things as group undertaking of decorating; furniture and toy repairs and dressmaking; gardening; cooking; some routine assembly work; typing and duplicating; physical activities, e.g. swimming and tennis; social activities including visits, play readings and discussions; art. The work of the occupational therapist staff is supplemented by other professional workers including the visiting consulting psychiatrist, mental health social worker (conducting a weekly therapeutic discussion group) and the Disablement Resettlement Officer to advise on employment problems, further training and rehabilitation arrangements. Clubs for the Mentally III The two clubs run in the Borough for the mentally ill continued in successful operation during 1969. These are the "Gateway Club" which is held at Willesden Day Centre on Tuesday evenings and which follows purely social pursuits and the "Do-it-Yourself Club" held at the same venue on Thursday evenings and which has as its main aim helping members to develop hobbies and other active interests so as to widen and enrich what might otherwise be somewhat restricted lives. Both these clubs operate with the support of occupational therapist and mental health social worker staffs. Day Care for the Elderly Mentally III As in previous years, the needs of this large group of patients are partially met by the few places (ten) allocated to Brent at the Harrow Day Centre for the Elderly Mentally Infirm. These provisions do not anywhere near meet the total needs among the aged and it is with much regret that I had to accept the Council's decision that on financial grounds, extension of this much needed service would have to be postponed, despite pressing needs, in the present situation. Shenley Hospital Professional relations between the community mental health and hospital staffs continue to be excellent. Some far-reaching changes, however, are going to take place in the near future as the whole policy regarding such very large psychiatric hospitals has come under review. Gradually it is intended that such institutions should disappear when more small, acute psychiatric wards attached to district general hospitals become freely available. It is to be hoped that the optimistic view that modern treatment methods supported by good community services will be substantiated and result in fewer and fewer chronically ill patients, so that the doors of empty old "chronic wards" can then be locked from the outside forever. League of Friends of Shenley Hospital The Brent Branch have generously contributed towards comforts of ex-Shenley patients in the community. Christmas parcels for the residents at 73 Wembley Park Drive and contributions of money for Christmas activities at the "Gateway" Social Club and "Brentholme" Hostel were greatly appreciated by patients and residents. The Brent Samaritans The Director, the Rev. Keith Johnson has furnished the following:— "In 1969, our activity increased considerably. This was largely due to the fact that our hours of work were extended. The Centre is now manned from 7 p.m. until 7 a.m. the following day, in place of 18 the previous four hours only operation. We have recorded 250 new clients in the past year, many of whom were quickly helped and needed no further lengthy befriending. On the other hand, a fair proportion of those people we have befriended, have needed our attention for a period of months rather than weeks. Now we run our own training classes locally, which means that more volunteers are becoming available. However, our strength remains at about 60, with a constant trickle of people moving out and away from us. Consequently, it is vital that we find more volunteers generally, and more especially people who can offer time during the day, so that we can eventually provide a 24-hour service. Although our work may be quantitively restricted compared with that of other branches we know that we do ease the load that would otherwise fall on St. Stephen's and Harrow Branches; while qualitatively, we claim high standards. Many other branches are envious of the links we have with Dr. Dominian at the Central Middlesex Hospital where we have regular seminars with him, and also with the Brent Council Mental Health Department. In the local papers one reads regularly of people who commit suicide; unhappily these people never came to us and by and large we deal with more people who are unhappy for many reasons rather than those at the brink of suicide. None the less, we are sure that we perform a necessary function in enhancing the well-being of the community and in preventing many a tragic occurrence." Approved Medical Practitioners There are no changes during the year in the list of doctors approved for the purposes of Section 28, Mental Health Act, 1959. Drug Abuse and Dependence For some years past, the Mental Health Division has been alert to this problem and became actively engaged in this specific field of social work by opening in 1966 a "Walk-in Clinic" at Monks Park, Wembley, the purpose of which was to give advice to young people dependent upon drugs. Subsequently, the Probation Officers in the Bjrough approached the Department with the suggestion of forming a joint special task unit to combat the increasing wave of drug abuse among young people. As a result a Committee was formed and a group of involved professional workers undertook to serve. Permission was given to use Kilburn Square Clinic as a "Centre" where young people dependent on drugs and many on probation could be seen and their needs, psychiatrically and socially assessed. Thus professionally staffed the centre fulfilled a unique and very necessary function in the field of social medicine. Unfortunately this service has suffered a temporary setback in the year under review because of the departure of the psychiatrist to a post outside the Borough and of the loss of the services of the general medical practitioner owing to indisposition and pressure of work in his own practice. Both these doctors gave their services unstintingly and voluntarily. Because it was not possible to obtain voluntary professional replacements, financial provision has now been made for the services of a psychiatrist and general practitioner on the basis of one paid session per week on a selected evening at Kilburn Square Clinic. The doors of the centre should therefore soon be open again to these less fortunate members of our community. The Department has never been complacent about the dangers of drug abuse among our young people and is aware that it prevails to some degree in the Borough but we have insufficient data as to the actual size of the problem because of the difficulties of identifying those in need. It is true to say that some young people are experimenting with drugs but it is equally true to say that fortunately only a very small percentage of youngsters go beyond the experimental stage to actual drug habituation. It should not be assumed that because of the temporary closure of Kilburn Square Centre other work on drug abuse in the Borough has been neglected — far from it in fact; the Department is actively engaged in serving the needs of those dependent upon drugs not only by advice and support, but also, when necessary, arranging psychiatric consultation and treatment. A large part of the work the Department puts into the problem of drugs is largely and rightly of a preventive nature and includes lectures to school and youth groups, discussions and generally the dissemination of as much useful information as possible. An example of this kind of effort was when quite recently a major industrial firm in the Borough invited the attendance of a speaker from the Department to talk on the subject of drug abuse to apprentices in their factory. These efforts are finding an appreciative and responsive audience among young people who may be susceptible to the temptations of drugs. As a realistic and practical Department we are aware of the limitations and the possible dangers of over-presentation of preventive material, but we do our best to inform and educate whenever and wherever suitable opportunity arises. MENTAL SUBNORMALITY Community Care—Support in the Home The introductory remarks to the section of this Report dealing with mental illness from the aspects of social worker involvement in community care has pertinence in major part to the support of the subnormal and his family. Leavesden Hospital During the year under review, public attention became focused on hospitals for the subnormal and severely subnormal, and, for the first time it seemed, and due to disclosures as to the conditions prevailing in many of these institutions, public awareness became alerted. This led to the Minister's setting up investigating bodies to visit and collate information about conditions generally, available facilities and shortcomings, all with a view to the government's making a full reappraisal of the situation and of the necessity for extra funds being allocated to improve matters. These investigating teams, quite rightly, found much of which to be severely critical in our subnormality hospitals. 19 As was to be expected in this comprehensive survey, Leavesden Hospital came under close scrutiny. The professional staff there welcomed these investigations and gladly opened doors to representatives of the press and television. It was felt that nothing but good could come of using the mass media to bring home to the public the shortcomings in at least some of those facilities that modern management could be expected to provide for patients. Now steps are being formulated for quite substantial improvements to take place at Leavesden in the near future. Apart from the attention being directed to the rather bleak hospital buildings, a rigorous policy change in regard to discharges back into the community of rehabilitated patients is being pursued. The hospital doctors are pressing for patients to be returned to community life as soon as possible and are also seeking to find ways and means of returning to the community long-stay patients who have been allowed to linger on in hospital for want of somewhere else for them to go. These measures coupled with a more stringent admission policy are aimed at the alleviation of at least some of the scandalous overcrowding which has been accepted complacently by our society for far too long. The stricter admission criteria, are not always easily accepted by our mental health social workers, who may be called on for lack of a hospital bed to support quite considerable hardship cases in totally unsuitable home conditions. It is to be hoped that more hospital placements for those in need of such will gradually become more readily available as further hostel provision is made in Brent. It is foreseen that as progress in that direction becomes reality ready exchanges should become possible, so that for any patient admitted to hospital for care, nursing and training, a rehabilitated patient can be discharged to hostel accommodation. Short term care placements in hospital were arranged as in previous years, with Leavesden as usual catering for the largest number of such cases. Guardianship and Informal Foster Care It remained the position during the year that it was not necessary to make use of the Mental Health Act provisions in regard to the placing of any person in guardianship. Informal foster care placements for the severely subnormal with various voluntary organisations, privately-run homes or foster parents continued on the same lines as in previous years, i.e. about 50 persons were so placed at any one time. The position with regard to availability of such places has not noticeably improved and it remains true that much more needs to be done by local authorities themselves in the implementation of their powers under the Act to provide hostel accommodation for the subnormal and severely subnormal. This Council's one such hostel for males is referred to in the following paragraph. A hostel for 15 females estimated to cost £73,000 figures in the Capital Works Programme for 1970/71. The usual arrangements for short term care either in hospital or elsewhere were put into effect during the year so as to give parents some respite from the constant caring for retarded children at home, to allow for family holidays or to meet some special situation or emergency in the family. Sixty-seven such placements were made in hospitals and eight residentially elsewhere. "Homelea" Hostel, 191 Willesden Lane, N.W.6 The resignation of the Superintendent and her husband unfortunately broke continuity in the care that ideally it had been hoped to provide in this hostel for 12 subnormal working boys. Replacement of this staff proved extremely difficult, partially due to the fact that it was felt to be unwise once more to engage a married couple both in full time post. In a small, family type home like this it is tempting to take on parentsubstitute staff but the arrangements for off-duty periods are very complicated as a couple invariably wish to be away simultaneously. The appointment of a temporary superintendent helped to bridge the gap but as several boys were discharged during the latter half of the year, no urgency was attached to filling the vacancies and a waiting list was allowed to accrue. Observations made elsewhere in this report regarding the recruitment and retaining of staff in residential posts in mental after-care hostels, apply equally in hostels for subnormals. More training provisions will have to be made available and general conditions of service must be improved. At this hostel, staff quarters are hardly either suitable or attractive, making for additional difficulties in getting good staff. It may well be that early financial provision must include for major structural alterations for the benefit of staff. Kingsbury Junior Training School Expectations outlined in the 1968 Report regarding the future of training facilities for severely subnormal children were only partially realised. Transfer of establishments to education authorities has not yet taken place and the responsibility for them will rest with the health authorities a little longer than was anticipated. However, the new school at Kingsbury was completed by the middle of the year and officially opened by His Worship the Mayor in November. Within a very few weeks of the move from the old building at Neasden it became evident how much new purpose-built and fully equipped premises affected the children advantageously. It had, of course, been anticipated that a well-designed establishment would greatly further these children's educational achievements but the speed with which this occurred was quite unexpected. It had become at last possible to attract well qualified staff, not only because of the lure of a brand new school but also because of a very much better pay structure than that which had obtained till then. By the end of the year the new establishment appeared to have already settled into a good working routine. It need hardly be mentioned that the parents are delighted with the many and varied educational facilities now available to their children. 20 Neasden Special Care Unit Although the new Kingsbury Junior Training School incorporates a 36-place Special Care Unit it was essential not to lose the use of the 24-place unit, originally part of the Neasden Junior Training Centre, but housed in an adapted separate building. Unhappily, this Borough still has need of provision additional to that at the Kingsbury Unit alone as the proportion of multiple-handicapped children in Brent appears to be rather higher than the national average. The Neasden Unit, divorced from its former close integration as part of the old Training Centre had to become an independent establishment and the new staff set-up there is headed by a Matron. The arrangement has so far proved very satisfactory and staff and children have settled well. The Holiday Centre As in previous years, a summer school was run during August for the benefit of some children and parents alike. This time it was possible before the new school acutally became operational to use the premises of the new Kingsbury Junior Training School, with all its added facilities and attractions, including both indoor and outdoor paddling pools. Summer Holiday Camps Once more this Borough owes appreciation to adjoining authorities for including in their summer holiday camp arrangements Brent trainees who attend their adult training centres. This Department was able to help with the provision of escorts and the cost of such holidays for 20 trainees was subsidised by the Council on the basis of individual assessment. Separate arrangements were made at a holiday camp in Devon for a two week stay for the residents of "Homelea" Hostel, all on similar financial terms. Adult Training Centre Approximately 80 Brent trainees continued to make use of places provided at Acton Lodge, Brentford, Southall and Uxbridge Adult Training Centres by the Boroughs of Hounslow, Hillingdon and Ealing. With the evacuation of the premises at Neasden by the Junior Training School on its transfer to Kingsbury, the building was put to use from September as had been planned, as a temporary Adult Training Centre. The 50 places provided were quickly taken up by those awaiting training. It is to the credit of the new staff at the Centre that within a very short time many and divers training facilities were got under way and generally a most auspicious start made in this, the first centre of its kind in the Borough. Simultaneously with these developments in 1969, planning progress continued on the proposed new permanent Adult Training Centre at Stonebridge. At the end of the year, finalized proposals for submission for loan sanction were nearing completion. The project embodies the conversion of the existing Stonebridge Health Clinic and the building of extensions thereto, all at an estimated cost of £100,000 and to provide for 120 trainees.. Social Clubs for the Mentally Subnormal Two such clubs, both sponsored by voluntary bodies, continued in successful operation during the year, viz:— The "Bonanza Club" (by the Brent Society for Mentally Handicapped Children) in the hall at Kingsbury Junior Training School each Saturday afternoon; and The "Neasden Teenagers' Club" (by the Parents' Association) in the Gibbons Social Centre. The Brent Society for Mentally Handicapped Children (Willesden and Wembley Areas) Apart from the function referred to above, the Society has continued its very valuable work in support of the persons and families it was formed to serve, where necessary in liaison with officers of the Department. It is with great appreciation that I have to record that in addition to providing a sum of £1,000 for extra outdoor sports equipment and an internal communications system at Kingsbury Junior Training School, the Society further undertook at a cost of almost £400 the conversion of a small storeroom into a kitchen for the more convenient preparation of meals required for children in the Special Care Unit at the School. 21 WELFARE SERVICES TEMPORARY ACCOMMODATION At the beginning of the year, short stay accommodation was provided for 56 families in four hostels (91, Dartmouth Road, "Rosmoyne", Harrow Road, 54, Winchester Avenue, and 9/11, Nicoll Road), in eleven houses purchased by the Council in advance of requirements in Redevelopment Areas, and in three houses loaned by the Ministry of Transport which were purchased by the Ministry for eventual demolition in connection with the Neasden Underpass Scheme. In addition, emergency accommodation with its own cooking and personal cleansing facilities was provided for 15 persons at 91, Dartmouth Road. A domestic science leader from the London Council of Social Service ran a home making group one day per week at the hostel in Dartmouth Road. During the year, the group had an average attendance of seven mothers who were given instruction in sewing, cooking, household budgeting, etc. In addition, a playgroup leader from the Save the Children Fund attended the hostel five mornings a week. The sessions are of great benefit to the children and mothers, who are given guidance on methods of play and the caring of their children. After considerable delay, due to the vendor's difficulty in obtaining alternative accommodation, the purchase of 13, Nicoll Road was finally completed on 3rd September. The property will be adapted to accommodate five families and it is estimated that repairs and adaptions will cost £3,000. On 17th January, 1969, the Home Office agreed to the expenditure of £80,000 under Phase I of the Urban Development Programme for the purchase and adaptation of houses for homeless families. Four properties were appropriated from other Committees viz. 81 and 95, Hartland Road, N.W.6 from Education, 240, Willesden Lane, N.W.6 from Housing, and 61 Lancelot Road, Wembley, from Planning, and at the end of the year negotiations were in progress for the purchase of 60, Brondesbury Villas, N.W.6 and "Braemar House", 169, Ealing Road, Wembley. In addition, four further houses purchased in advance of requirements in Redevelopment Areas were handed over to the Department during the year, and 13 further houses were loaned by the Ministry of Transport. On 1st January, 1968, 56 families (comprising 30 men, 56 women and 170 children) were in temporary and emergency accommodation. During the year, 80 families were admitted and 38 discharged, leaving 98 families (55 men. 98 women and 299 children) in residence at the end of the year. Of the families discharged, 16 were re-housed by the Council, two were re-housed by other local authorities, and 20 found their own accommodation. Several voluntary organisations provided accommodation including Ladyholme Company Ltd., Provident Row Night Refuge and Home, Ambridge House Foundation, and the Salvation Army. Despite an increase in the accommodation provided and also the fact that more families have been re-housed by the Council, the problem continues to grow. Illegal and legal evictions increased, and although some landlords have been prosecuted and fined for illegally evicting families, they have not been obliged to take them back and the families remain homeless. It has also become more difficult for families to find private unfurnished accommodation for themselves as the extra security given to tenants in unfurnished property has encouraged landlords to stop letting this type of accommodation. RESIDENTIAL ACCOMMODATION The total number of beds provided under Section 21 (1) (a) of the National Assistance Act, 1948 is 517, allocated as shown below:— Beds Coplands 62 Men and Women Courtfield 44 Men and Women Freeland Roa 47 Women Hillcrest 100 Men and Women Ithell Court 40 Men and Women Kenton Grange 34 Men and Women Kingsbury Manor 23 Women Mardale 18 Women Shepperton Court 71 Men and Women Roberts Court 50 Men and Women Wren Park 28 Women During the year, 121 women and 40 men were admitted to the Council's homes on a permanent basis, and on 31st December, 1969, 89 women and 26 men 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 a further 220 residents in voluntary and other local authority homes. The short stay scheme, which enables relatives or friends to have a holiday and an elderly person a change of routine, continued to operate throughout the year. Six beds for women and four for men were retained in three of the Wembley Homes. Twenty-seven men and 62 women were accommodated under the scheme, the average stay being 19 days. The conversion of the coke fired boilers at "Kingsbury Manor" to oil firing was completed in January at a cost of £859, and a similar conversion at "Mardale" was completed during November at a cost of £1,800. The building of a 50 bed home within the Neighbourhood Centre Scheme at the junction of Harlesden Road and Longstone Avenue was delayed owing to difficulties experienced by the lowest tenderer. The Council decided to invite new tenders for the whole Scheme and eventually work commenced on the 18th August, 1969, and is due for completion in June, 1971. It is estimated that the building and fees will amount to £115,200 and furniture to £10,500. 22 The "Friends of Hillcrest", a voluntary association of local residents, was formed in January 1968 to provide extra amenities for the residents. Outings and musical evenings are arranged, presents given to the residents on birthdays and at Christmas, and a fully equipped ladies' hairdressing salon and a putting green for men have been provided. An amplifier, speakers and a microphone have been purchased to facilitate the entertainments programme, and sufficient funds have been raised for a sun lounge to be erected early in 1970. There are similar voluntary associations giving invaluable help at "Courtfield" and "Kenton Grange". WELFARE OF THE BLIND AND PARTIALLY SIGHTED Blind Persons On 31st December, there were 527 persons on the register. There were 45 new cases (excluding re-certifications and transfers from other areas) during the year. The majority of referrals for registration came from hospitals. The classification of blind persons by age groups and at age of onset of blindness are shown in Tables 21 and 22. Ninety of those registered suffer from additional physical and/or mental handicaps. Four children are under five years of age. Of the eight children of school age, four attend special schools, the remainder are unsuitable for education at school. Four young men between 16 and 20 years of age continued their education. One hundred and eight persons were in full employment, and an analysis of their occupations is shown in Table 23. Four hundred and three persons were unemployable or unavailable for work. Of these, 50 were in residential accommodation provided by local authorities, two in other Homes, and 13 were in hospital for extended periods. Domiciliary visits to both blind and partially sighted persons were made by social workers with an average case load of 144. Individual teaching was given in both Braille reading and writing, Moon type reading, and typewriting. Three handcraft classes were held weekly in the afternoons, seven evening classes organised by the Education Committee and eight social clubs offered variety of occupation. Free transport facilities to classes and clubs continued to be provided by the Council. At the Brent Show on 13th and 14th September, an exhibition, competition for handcrafts, and sale of goods made by blind and other physical handicapped persons, were staged. Ninety-five wireless sets were issued on behalf of the British Wireless for the Blind during the year bringing the total issued to 291. The rental of talking book machines issued by the British Talking Book Service for the Blind was paid by the Council in respect of 167 readers; 25 were issued during the year. Various Braille and Moon magazines were circulated free. Two hundred and six free aids, e.g. typewriters, watches, electric shavers, alarm clocks, pingers, bread cutters, etc. were issued. One hundred and forty-two applicants applied for assisted holidays. Fifty-eight were directly arranged by the Council, and 43 persons who arranged private holidays and 41 who stayed with relatives or friends received financial aid from the Council. Partially Sighted Persons On 31st December, there were 192 persons on the register. There were 27 new cases (excluding re-certifications and transfers from other areas) during the year. Five persons were transferred to the blind register. The classification of partially sighted persons by age groups is as follows: — Under 5 years Nil 5—15 20 16—20 13 21—49 41 50—64 25 65 and over 93 Of the 20 children of school age, 17 attend special schools, two attend other schools, and one remains at home. Five of those in the 16—20 age group are still at school. Of 50 persons "near and prospectively blind" (aged 16 and over), 13 were employed and 37 incapable or not available for work. Of 50 persons mainly "industrially handicapped" (aged 16 and over), 43 were employed, two are undergoing training, and five are not available for employment. Sixty-seven persons mainly over 65 years requiring "observation" only, and unemployable or unavailable for work, constitute the remainder. WELFARE OF THE HANDICAPPED There were 266 new registrations during the year, and on 31st December 1,259 persons were on the register. Of these, 31 were deaf with speech, 98 deaf without speech, 29 were hard of hearing, and 1,101 were in the general classes. Details of registrations, an analysis of disabilities, and occupational grouping of the general classes are shown in Tables 24, 25, and 26. Domiciliary visits made by social workers, with an average case load of 252, enabled general assistance to be given, and ensured regular contact with the handicapped person and the family. Close liaison with statutory and voluntary bodies, along with allied services was maintained. 23 General Classes of Handicapped Persons Sixty-seven persons continued normal employment in open industry, 38 worked in sheltered industry and 29 practised some form of home industry. Nine hundred and sixty-seven, including nine children under 16 years of age, were unemployable or unavailable for work. Fifty-three of these were maintained in residential homes. The Work Centre at Church Lane, N.W.10, supervised by two Industrial Works Organisers and an Assistant, continued to offer part-time occupation of a rehabilitative character to 35 persons. Light assembly work was obtained from local factories. In February 1969, the Ministry of Housing and Local Government issued loan sanction in the sum of £18,750 which enabled the Council to secure the former Civil Defence Headquarters in Carlton Avenue East for use as a rehabilitation/work centre until such time as the premises are required for the extension of the adjoining telephone exchange. A scheme for the adaptation of the premises, including estimates of cost, was approved by the Department of Health and Social Security in July. Tenders for the works were invited in October, and the lowest tender of £8,678 was accepted by the Council which together with fees of £1,500 and equipment of £2,200 amounted to £12,378. The works commenced early in January 1970, and in due course the Centre at Church Lane will be transferred to these premises. The demand for aids and gadgets continued; these are issued on free loan, and are invaluable in assisting the handicapped person. Three hundred and thirty-three aids such as metal walking frames, hoists, pick-up sticks, special knives and forks, can openers, etc., were issued. One hundred and ten applications for adaptations to the home received approval, e.g. provision of ramps, handrails, ground floor toilet accommodation, etc. Two hundred and eighteen applicants applied for assisted holidays. One hundred and three were directly arranged by the Council. One party, under the supervision of social workers, spent a fortnight in August at The Little Oyster Holiday Camp, Isle of Sheppey and another spent a week in September at Gibsons Holiday Camp, Bracklesham Bay. Fourteen severely handicapped persons went to Crabhill House, South Nutfield, run by the Women's Royal Voluntary Service Winged Fellowship. The Jewish Association for the Physically Handicapped, and the Shaftesbury Society also provided holidays for those requiring orthopaedic designed homes which make full provision for severe disabilities. Most homes are situated within easy reach of the sea, or in the country. Families are encouraged to arrange a united holiday privately, and 63 applicants were assisted. Thirtyeight handicapped persons who stayed with relatives or friends received financial aid from the Council. Further education evening classes in choral, cookery, dancing, drama and pottery were provided by the Education Committee received an increasing response. Closer integration between all classes of handicapped persons has developed voluntarily through these shared interests. British Red Cross workers continued to teach crafts weekly at two handcraft classes held during the afternoon at 170/172 High Road, Willesden, and St. John's Church Hall, Wembley. Four Social clubs continued to be run by voluntary organisations. The Spastics Society donated a Challenge Cup to be presented annually for the best handcraft article made by a physically handicapped person (other than the blind) in competition held at the Welfare Exhibition stand at the Brent Show. The Council continued to provide free transport facilities, including the use of specially adapted coaches with rear tail hoists to accommodate wheel chairs, and adapted minibuses designed for easy access and comfort. Four special coaches were loaned free of charge to the Willesden Association for the Welfare of the Handicapped for their annual outing to Sunbury-on-Thames on 21st June. A number of handicapped were conveyed to and from the Brent Show on 13th and 14th September, Additional transport facilities were provided for summer outings. Deaf and Hard of Hearing Persons Help has been afforded to the deaf and hard of hearing both in the social and employment field. One hundred and twenty-nine congenitally deaf and twenty-nine hard of hearing are on the register. Most of the hard of hearing are affected due to accident after birth. The greater number in both categories are between the ages of 16—49; many of whom were gainfully employed. In the field of employment, the closest co-operation is maintained between the Department of Employment and Productivity and the Council, in seeking to provide suitable and appropriate work. There are two Clubs in the vicinity of Brent, meeting fortnightly; the Queensbury Deaf/Dumb Club, and the Wembley and Willesden groups of the Middlesex and Surrey League for the Hard of Hearing, run by voluntary committees. The Council provides transport to the latter. Close liaison has been maintained with voluntary organisations such as the Royal Association in Aid of the Deaf and Dumb, the South East Regional Association for the Deaf, and the Middlesex and Surrey League for the Hard of Hearing, to all of which the Council makes a grant, and also the Royal National Institute of the Deaf concerned with general welfare and training of officers at the College of Deaf Welfare. 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 three private old persons' homes on the register—22, St. Gabriel's Road, N.W.2, accommodating 16 men and women; 28, Sedgecombe Avenue, Kenton, accommodating nine women and two men; and 39, Sedgecombe Avenue, Kenton, accommodating seven women and one man. The London Transport Executive (Retired Employees) Housing Association maintains a voluntary home at 100, Forty Avenue, Wembley. During the year the Home was extended and the number of elderly men accommodated was increased from 30 to 53. 24 The Royal London Society for the Blind maintains a residential club for 14 blind men at 63, Christchurch Avenue, N.W.6, and a similar establishment for 14 blind women at 32, The Avenue, N.W.6. The Royal National Institute for the Deaf maintains a hostel for 16 deaf youths at 11, Forty Avenue, Wembley. All 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 Council to remove to an Institution a person in need of care and attention; an Order for removal is given 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 by the provision of additional services such as home help, home nurse and meals-on-wheels to avoid the necessity of statutory action. 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 movable property of 23 residents who were admitted to hospital when it became apparent that no other suitable arrangements were being made. In four 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 23 residents was in store in the annexe of "Mardale" Residential Home. 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 37 persons during the year. Twenty-three of these were residents of the Council's residential homes. WELFARE SERVICES FOR THE ELDERLY IN THE COMMUNITY The Council continued to provide various services for the elderly under the National Assistance Act 1948 (Amendment) Act, 1962, broadly defined as the provision of meals, and recreation in the home and elsewhere. Eleven luncheon clubs operated during 1969, and 60,492 meals, prepared by the School Meals Service, were served in the clubs at a charge of l/3d. The meals-on-wheels service continued to be run in conjunction with the Women's Royal Voluntary Service, deliveries being made on two or three days per week. Seven vehicles are in use on the service on peak delivery days. 38,410 meals were delivered in 1969, at the same charge of 1 / 3d. Considerable difficulty was experienced during the year due to sickness in staffing the kitchen at the Kensal Rise Senior Club where meals are prepared for delivery in the Willesden area. The meals for the Wembley area are supplied by the School Meals Service. Once again the three full-time social centres in the Borough—the Willesden Green and Kensal Rise Senior Clubs and the "49" Club—have had successful years, a varied programme of social activities having been arranged by the respective House Committees. The Council also provided premises for two full-time clubs for men in the Wembley area—the Barham Park and Kingsbury Veterans' Clubs. During 1969, arrangements were made for pensioners to have two weeks' holiday at three south coast resorts. Six hundred and eighty-two pensioners participated in the scheme at an all-in charge of £4 to each applicant. In addition, the Council made grants to 76 persons towards the cost of privately arranged holidays or to persons going on group holidays organised by bodies other than the Council. The Department also arranged two summer holidays for elderly ladies with the Women's Holiday Fund. As in previous years a grant of £50 was made towards the cost of holidays for elderly Brent patients in Shenley Hospital. More than 40 afternoon clubs operate in the Borough, and during the winter months the Council, through the Entertainments Department, arranged monthly concerts for the majority of these Clubs. In addition, a series of variety matinees were presented at the Town Hall free of charge to pensioners. Free transport was arranged from the more outlying areas of the Borough. Several clubs received grants to help pay the rent of the premises and to help with additional Christmas expenses. The Council continued to make available welfare foods, such as Complan, Horlicks, Ovaltine, Bovril, Marmite and tea at reduced prices. These are sold at and delivered to 35 clubs and clinics in the Borough. Sales amounted to almost £5,100. In August, an outing was arranged to Bray-on-Thames for just over 60 elderly housebound people. Transport was arranged by the Council and the old people were conveyed from and to their homes. Council transport also conveyed non-ambulant members to and from seven old people's clubs. At Christmas the Council, in conjunction with the Brent Christmas Comforts Fund for Old People, distributed 1,689 food parcels to those most in need over 70. In addition, the Department supplied to various organisations and schools within the Borough, the names of 140 persons who would not otherwise have received a parcel. The Council also made a grant of £60 to the South Kilburn Old Folks' Fund to help them supply parcels to pensioners in the Carlton and Kilburn Wards of the Borough. 25 The Medical Officer of Health continued to act as local representative for such charitable organisations as Wireless for the Bedridden Society, the Steiner Charity, which makes free radio and television sets available to the bedridden and housebound, and for the National Society for Cancer Relief in payment of weekly allowance to elderly patients. The Department's Social Workers concerned with old people's welfare continued their numerous visits to help and advise, and to assess the need for the various services. They were also available at various centres for interviewing elderly people. OLD PEOPLE'S CLINICS Thirty-five clinic sessions for elderly citizens resident in the Borough were held at the Neasden Clinic, Balnacraig Avenue, N.W.10, during the year. Seventy-five cases were seen, 18 of whom were new cases, and they made 204 attendances (48 men and 156 women). The majority travelled unaccompanied to the Clinic by public transport. Even the cold, wet weather during the winter months did not deter many from attending the sessions. This is even more note-worthy when it is realised that 15 men and 25 women were in the age group 80—90. One spritely man in his early nineties attended regularly. Rheumatism, in its many manifestations, was most prevalent during the year especially in the late autumn and early winter months as indeed were colds with irritating coughs. Influenza attacks were troublesome at the beginning and end of the year. However, thanks to prudence at the onset of symptoms in the form of early retirement to bed, warmth and sweet beverages coupled with skilled attention as necessary from their medical practitioners, they overcame the infection and were soon up and about again even though their convalescence was protracted. A few developed severe bronchitis and pneumonia and required urgent admission to hospital. The doctor and nurse in attendance at the sessions were consulted about various social and health problems. The vast majority of those attending bought food and vitamin supplements at the Clinic. The following referrals were made during the year: — No. of Patients To Social Worker for visits 24 To Council Chiropodist 10 For Council aided holiday 7 To Council Physiotherapist 5 To Housing Manager 3 For admission to Residential Home 3 For admission to Luncheon Club 1 For admission to Senior Club 3 To Home Help Organiser 5 To Department of Health & Social Security 2 VOLUNTARY SERVICES FOR THE AGED The Women's Royal Voluntary Services continued to give invaluable help in the day-to-day operation of the meals-on-wheels service and at six of the luncheon clubs. At the other luncheon clubs, voluntary and essential help was given by members of the League of Jewish Women and private individuals, many of whom have continued to do this work for many years since the inception of the various clubs. There is a shortage of voluntary helpers in the luncheon clubs, and it is hoped that it may be possible to recruit additional helpers in 1970. The Wembley and Willesden Divisions of the British Red Cross Society continued their many and varied services during 1969 including visiting, chiropody, escorting on holidays and outings, and the loan of wheel-chairs and nursing equipment. There are many afternoon clubs for the elderly run by voluntary organisations such as the League of Jewish Women (Friendship Clubs for the Jewish Elderly), the British Red Cross Society (Evergreen Clubs), the W.R.V.S. (Darby and Joan Clubs), the National Federation of Old Age Pensions Associations, Community Associations, Churches and private groups. Much voluntary work is done at these clubs and many additional activities, apart from regular weekly meetings, are arranged. LAUNDRY SERVICE FOR THE INCONTINENT AGED A laundry service for the incontinent elderly continues to be administered by the Council. The articles are laundered at Neasden Hospital by arrangement with the Central Middlesex Group Hospital 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 hospital, doctors, home nurses and relatives. The service enables patients, who might otherwise have to be admitted to hospital, to be nursed at home and more beds are thus available for urgent cases. It was greatly appreciated by the patients and their relatives. The service frequently operates in conjunction with the issue of free incontinence pads. No. of Old People Using Laundry Service On register Admitted to On register 1.1.69 New Cases Died Hospital Discontinued 31.12.69 65 43 17 6 23 62 26 ENVIRONMENTAL HEALTH SERVICES SANITARY CIRCUMSTANCES OF THE AREA WATER The Metropolitan Water Board, the Colne Valley Water Company together with the Rickmansworth and Uxbridge Water Board 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 various undertakings. SEWAGE AND DRAINAGE Most of the sewage from the Willesden area of the Borough is discharged into the Greater London Council main sewers, and all that from the Wembley area together with 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. REFUSE DISPOSAL The Borough Engineer and Surveyor's Department deals with the provision of dustbins. House refuse is collected weekly and trade refuse as often as required at an agreed charge. The Greater London Council is responsible for the disposal of refuse by controlled tipping and by separation and incineration. SWIMMING BATHS The Borough Engineer and Surveyor 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 ensure breakpoint chlorination is installed at each pool. 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 Capacity pass through filters, etc. (gallons) (hours) Granville Road Baths 145,000 4 Gladstone Park Swimming Pool 500,000 6 Willesden Sports Centre Swimming Pools (3) 532,000 6½ Kingsbury Swimming Pool 464,000 4½ Vale Farm Swimming Pool 400,000 5 Two hundred and seventy-four samples were taken, of which 11 were unsatisfactory. (See Public Health Laboratory service page 30). When samples were found to be unsatisfactory, immediate investigations were made and the various causes remedied. SANITARY INSPECTION OF THE AREA Details of inspections carried out are shown in Table 27. Two inspectors were engaged on special surveys in smoke control areas. Demolition and Closing Orders Demolition Orders were made in respect of property at 50 and 52 Greyhound Road, N.W.10; and Closing Orders were made in respect of 2 Bramshill Road, N.W.10 (ground floor), and 8 Union Road, Wembley (whole house). The Closing Order was determined in respect of 8 Union Road, Wembley, subject to satisfactory completion of the Schedule of Works. Slum Clearance and Area Development The High Court action concerning the South Kilburn (Extended) Area C.P.O. 1 was heard in the High Court in October, 1967. The Judge dismissed the appeal against the Order initiated by certain property owners in the area comprising 417 premises and redevelopment is now proceeding. 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. Forty-six notices under Section 15, Housing Act, 1961, requiring the provision of additional amenities and 69 directions under Section 19 of the Act to overcome overcrowding in houses in multiple occupation were served. During 1967, the Department assumed responsibility for the provision of means of escape from fire in dwelling houses under Section 16 of the Housing Act, 1961. One notice was served during the current year. 27 Overcrowding There has been little change in the extent of overcrowding which still remains prevalent. The Housing Manager has kindly supplied the details of overcrowding in the area, which have been based mainly on statements of housing applicants (Table 28), and also details of new dwellings constructed during the year (Table 29). Applicants to the Council for mortgage for the purchase of a house, can submit a medical certificate or a certificate of overcrowding in support of the application. These certificates are assessed and information given to the Borough Treasurer to assist in discriminating at the medical level. Housing on Medical Grounds Each medical certificate and all medical evidence provided in support of an application for rehousing, is submitted for assessment, and points may be granted up to a maximum of five in respect of a medical claim. The medical part of the evidence is carefully examined and, in order to achieve uniformity, the whole of these assessments are made by one individual officer. It is possible for the Medical Officer to recommend a separate bedroom if requisite and in case of exceptionally severe illness a recommendation may be made that the case is brought to the immediate attention of the Committee. During the year, 962 cases were considered and awarded points, where appropriate, on medical grounds. In addition, 209 applications for transfer on medical grounds were dealt with. Notices Served under the Public Health Acts, 1936 and 1961, and Housing Acts, 1957 and 1961 The large number of statutory notices served was maintained (Table 30). 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 31. Rent Act, 1957 Details of the applications received and the certificates issued up to the end of the year are shown in Table 32. Work in Default The Department assumes responsibility for carrying out work when owners do not comply with the requirements of Statutory Notices served under the Housing, Public Health and various other Acts. Housing Act, 1969 The above-mentioned Act which came into force on 25th August, 1969, provided wider powers for the provision of grants for improvement and conversion of property for private owners and housing associations. It also provided powers for the conversion of controlled tenancies to regulated tenancies and dwellings where (a) the standard amenities have at all times since the commencement of the Act been provided for exclusive use of its occupants and (b) any of the standard amenities previously lacking were provided by means of works begun before the commencement of the Act, and (c) where it is also in good repair. The Health and Welfare Department are responsible for the work involved in determining whether or not a certificate shall be issued or refused. When a certificate is issued, the Landlord is enabled to apply to the Rent Officer for a fair rent to be fixed for the dwelling. From the commencement of the Act until the end of the year 433 applications were received and whilst the principal object of the Act seemed to be the improvement of dwellings with grant aided assistance where necessary, the applications received, except for a very small percentage, related to those premises where the amenities are already in existence. CLEAN AIR The No. 6 (Willesden Green) Smoke Control Order came into operation on 1st August, 1969, and there are now 24 Orders operative as shown in Table 33. Volumetric analysis of sulphur dioxide and measurement of smoke concentration continued at Kilburn Senior High School and at the G.P.O. Research Station. Fifty-five notifications of new boiler plant were received in accordance with Section 3 of the Clean Air Act, 1956, and the heights of 20 new chimneys were determined. The proprietor of a greengrocer's shop in Kingsbury was prosecuted under the Clean Air Act, 1956 in respect of nuisance from bonfires. He was ordered to cease the nuisance in seven days and the Council were awarded £5 costs. INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES The Food Hygiene (General) Regulations, 1960, prescribe standards for the preparation, storage and sale of food, and since the earlier Regulations of 1955 came into force there has been a steady improvement in hygiene in the production and sale of food. In January, 1967, The Food Hygiene (Market, Stalls and Delivery Vehicles) Regulations, 1966, came into operation with the object of bringing the hygiene of stalls to the standard required in premises. Provision is made, however, for the vendors of certain low-risk foods, e.g. fruit and vegetables, to be exempted from the need to carry full washing facilities if these are available nearby, and ten stallholders have qualified for certificates of such exemption. 28 Public Health Inspectors inspect food premises and stalls (Table 34) regularly and give verbal or serve 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). For contravention of the Regulations of 1960 and 1966, legal proceedings were authorised by the Council with the following results:- Hawkers (a) Two contraventions—Fined £15.0.0 £7.7.0 costs. Premises (a) Two contraventions—Fined £35.0.0 £5.5.0. costs Persons (a) One contravention—Fined £7.0.0 £2.2.0 costs. (b) One contravention—Fined £5.0.0. £1.1.0 costs. (c) One contravention—Fined £5.0.0 £2.2.0 costs. (d) One contravention—Fined £5.0.0 £1.0.0 costs. (e) One contravention—Conditional Discharge—£1.0.0 costs. (f) One contravention—Fined £10.0.0 £2.2.0 costs. (g) One contravention—Fined £10.0.0 £2.2.0 costs. INSPECTION OF POULTRY There is no slaughtering of poultry carried out in the Borough, but some nine thousand ready-plucked table-birds are eviscerated and dressed at one hundred and thirty shop premises every week, considerably more, of course, immediately before Christmas. Of close on half-a-million carcases dressed per annum, by far the greatest proportion are broilers, perhaps ten per cent are turkeys (principally at Christmas and Easter) one per cent made up of culls, ducks and geese. The number of visits made to premises in connection with poultry dressing was 166. Disease appears to be rare in the birds reaching the shops in this Borough and no birds were condemned. With the great number of birds being dressed at so many establishments, often at irregular times, it is not practicable to institute a system of poultry inspection to cover all carcases and apart from spotchecks the Department relies on the butchers to retain carcases of which they had any doubt for examination by the Inspectors. 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). Nineteen applications for registration were received during the year, 13 in respect of ice-cream and six in respect of preserved food premises, and they were all granted. 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 41). EDUCATION IN FOOD HYGIENE Lectures illustrated with film shows, filmstrips and bacteriological cultures were given to school leavers and other interested groups. FOOD UNFIT FOR HUMAN CONSUMPTION Twenty-three cwts. nineteen lbs. of meat inspected by the Public Health Inspectors was found to be unfit for human consumption and was dealt with as trade refuse. SLAUGHTERHOUSE There is one private slaughterhouse licensed in the Borough and two slaughtermen are licensed to work in it. Particulars of inspections, carcases inspected and condemned are shown in Table 38. THE LIQUID EGG (PASTEURISATION) REGULATIONS, 1963 There is no plant engaged in the pasteurisation of liquid egg in the Borough, but local use of this product is high owing to the presence of a large biscuit and cake manufacturer. In fifteen bakeries large and small, the annual consumption is some fifteen hundred tons, of which only two tons are imported. Nine samples submitted to the alpha-analase test were found to be satisfactory and inspections of confectionery bakehouses revealed no use of bulk egg from unauthorised sources. 29 CONTAMINATED AND UNSOUND FOODS One hundred and twenty complaints about foodstuffs were received from members of the public (Table 39). They alleged souring or decomposition, mouldiness, or the presence of dirt or foreign bodies including insects. Nine of these complaints, although made in good faith, were found on professional examination of the foods to be not justified; four were referred to other local authorities for attention; and it was decided to take no action in 32 others. Of the remaining 75 cases, the Council decided to send 57 warning letters and to prosecute in 18 cases. The results of the prosecutions heard were: — (1) Foreign matter in loaf of bread—fined £25. £5.5.0 costs. (2) Insect in bread roll—fined £10. £5.5.0 costs. (3) Plaster fibres in loaf of bread—fined £20. £6.6.0 costs. (4) Mouldy loaf—Owner left district, case not proceeded with. (5) Unsound fish—fined £25. £15 costs. The remaining 13 were carried over to 1970. SAMPLING OF FOOD AND DRUGS 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. 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 foods must, however, by the Labelling of Food Order, 1953 and Labelling of Food Regulations, 1967 bear the 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. Five hundred and sixty-one visits of inspection for the general purpose of checking the accuracy of marking and labelling food exposed for sale were made, and first warnings were given in 12 instances. Composition of Food Of 635 samples taken, 91 were submitted to the Public Health Laboratory for bacteriological examination, 413 to the Public Analyst (11 taken formally), and 131 were examined in the Department (Table 40). With regard to the labelling contraventions, undertakings were received to amend all four labels. Of the samples adversely reported upon as to composition, four resulted in the local stock being returned to wholesalers, in three cases new recipes were adopted by the manufacturers, one led to prosecution, and warnings were given in the remaining 19 cases. The prosecution resulted in the defendants being fined £10 for failing to label canned food correctly, and the Council being awarded £6.6.0 costs. MILK AND DAIRIES REGULATIONS The Borough is a specified area in which it is permissible only to sell milk to which a special designation is applied, i.e. pasteurised, sterilised, ultra-heat treated or untreated. Assuming that the consumption of milk in the Borough conforms to the national average, some 214,000 pints are sold daily. The amount of untreated (Kedassia) milk is less than 12 pints per day. There is no bottling plant in the Borough, but there are 272 persons registered as distributors, all being licensed as dealers in pre-packed milk to which the special designations apply. Samples of milk were submitted for bacteriological examination and compositional analysis, with the results shown in Table 41. REGISTRATION OF HAWKERS Hawkers of food, and premises used by them for storage accommodation, must be registered with the Council (Section 11 of the Middlesex County Council Act, 1950). One hundred and eleven hawkers are on the current register (38 selling fruit and vegetables, 33 mobile canteens and hot dog vendors, 22 selling ice-cream, six fish, two cooked poultry, two groceries, six fish and chips, one bread and confectionery and one selling milk drinks). Twelve were newly registered during the year and one discontinued trading. Some hawkers are also licensed street traders at fixed sites, but the majority are itinerant, many appearing in the Borough only when events of national or international importance take place at Wembley Stadium. At such times there is also an influx of unregistered hawkers, and reference has already been made on this page to prosecutions for lapses in food hygiene in this connection. Many more cases would have been taken but for misleading information being given by individuals as to their names and addresses. In a number of cases, addresses were found on subsequent enquiry to be false and in other instances the court officers were unable to serve summonses. 30 PUBLIC HEALTH LABORATORY SERVICE (Table 41) Bacteriological specimens (swabs from sore throats, faeces from intestinal infections, cough plates and post natal swabs from whooping cough cases, etc.) are examined by the Public Health Laboratory Service at the Public Health Laboratory at Neasden Hospital or Central Middlesex Hospital. Specimens delivered to the Health and Welfare Department and the Health Clinics were collected and taken to the Laboratory at 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 three or four showed a reduction compared with last year. The number of swimming bath water samples reported as being below the very high standard normally achieved also showed a reduction compared with last year. Early in 1970 all specimens and samples of milk, etc., will be examined at the Public Health Laboratory at Central Middlesex Hospital only as the Neasden Hospital Laboratory will be closed down. 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 42 and 43, 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. 166 were employed during the year, the largest number (103) altering and making clothing. Public Health Inspectors inspected these workers' homes, which were all found to be satisfactory (Table 44). NOISE NUISANCE Public Health Inspectors made 864 visits (including 15 at night) under the Noise Abatement Act, 1960 and the Public Health Act, 1963, in connection with 191 complaints of nuisance caused by noise or vibration from factory processes, launderettes, compressors, noisy animals, commercial deliveries and ice cream vendors. Of the complaints received, 77 were in respect of industrial premises, 70 in respect of commercial premises (including ice cream vendors) and 44 domestic. 171 nuisances were abated, and one was still being dealt with at the end of the year. An ice cream vendor was prosecuted for contravening Section 2 of the Noise Abatement Act. He was convicted and fined £5 with £2.2.0 costs. 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 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 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. During the year, two new businesses were registered and one registered business was discontinued leaving eight premises on the register, two of which are outworkers premises. Three samples were taken during the year, the results of which were satisfactory. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 The Act came into force on the 1st August, 1964 and with certain exceptions applies to retail shops, offices, wholesale premises and warehouses, catering establishments and canteens, fuel storage depots 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 45. Public Health Inspectors are broadly speaking responsible for enforcing the general provisions of the Act in offices, food shops, wholesale premises and warehouses, catering establishments open to the public and canteens in the Borough. The remainder of premises for which the Council is responsible are inspected by the Shops Inspectors. The total number of general inspections made is shown in Table 46 and the defects found and remedied in Table 47. As the contraventions found were either complied with or were being dealt with, no prosecutions were instituted by the Council during 1969. 31 Under Section 46 of the Act the Council have powers to grant an exemption in respect of the requirements regarding room space for employees, temperature, provisions of sanitary conveniences and the provision of running water for washing facilities. No application for exemption from the requirements was made during the past year. On the 28th May, 1969 regulations came into operation imposing requirements as to the construction, maintenance and examination of hoists and lifts in all premises to which the Act applies. Six lifts were reported to the Council where defects were found needing immediate attention. All six were immediately made safe to use. Employers are required to notify to Local Authorities accidents to employees which cause the death of the injured person or disables him for more than three days from doing his usual work. There were no fatal accidents but 48 non fatal accidents were notified, and an analysis of their causation and injuries sustained is shown in Table 48. Thirty-four of the accidents were investigated but no prosecutions were instituted. Three employers received formal warning, ten informal advice and no action was necessary in the remaining cases. 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, four new licences were granted and 39 were renewed. All the applicants are suitable persons to hold licences and their premises were found to be satisfactory. RODENT CONTROL A new rodent officer was appointed at the beginning of the year. This was considered to be an opportune time, having regard to the difficulty of maintaining a full establishment of rodent operators, to reorganise the administration and work of the Section for the purpose of securing maximum efficiency. It became expedient to terminate all contracts in business premises and to cease treating mice infestations in private dwellings except in special circumstances, e.g. old age pensioners, etc., and recurring infestations. Letters giving detailed instructions on methods of rodent elimination were sent to all who complained of mice, and business premises were visited by the rodent officer who determined the extent and type of infestation and advised on methods of control and referred the matter to the Public Health Inspector for such action as was found to be necessary. In large urban areas such as Brent, the natural habitat of the predominent species, i.e. the brown rat, is the sewer, and rats emerge from the sewer via broken and defective drains to the surface where they forage for food. To discover defects in drains, smoke tests are applied to determine whether or not rats are present in a drain. Manholes within the curtilage of dwellings are inspected and where necessary baits are laid in the manholes. During the current year, 1,840 manholes were inspected and defects were found in 435 and action was taken to have these defects remedied. During the industrial dispute when refuse collection was interrupted, 826 visits were paid to 67 temporary refuse dumps. One thousand, one hundred and twenty-seven complaints were received of rats and 89 additional infestations were found by rodent operators making a total of 1,216 complaints and initial visits. 3,648 revisits were made for treatment. Three hundred and forty-four initial visits were made following complaints of mice and four further infestations were found by the rodent operators making a total of 348. 1,044 visits were made for treatment. Two hundred and fifty-six complaints of rat infestations were found to be mice infestations and advice was given by the rodent officer on methods of treatment. CONTROL OF WILD PIGEONS During the year, the ten railway bridges in the Borough, for which there is a contract for the exterminating of pigeons, were kept under surveillance. Regular systematic treatment by the Contractor, under the supervision of a Senior Public Health Inspector, resulted in 305 birds being destroyed. UNCLEANLINESS AND SCABIES (Table 49) Treatment for scabies, lice and nits continued at Stonebridge Clinic. Compared with 1968, there has been an increase in the number of cases treated for scabies (89 in 1968 to 156 in 1969), the increase being mainly among children aged 5—15 years. The number of cases treated for lice and nits increased slightly from 41 in 1968 to 52 in 1969. 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. 32 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 50). 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. The number of verminous premises treated remains very small when considered in relation to the total number of premises in the Borough, and calls for no special comment. There was a considerable increase in the number of wasps nests treated compared with 1968. PUBLIC MORTUARY During the year, Home Office pathologists performed post mortem examinations on 766 bodies in the Town Hall Mortuary, followed by an inquest in 176 cases. All the inquests were held by the Coroner in accommodation provided by the London Borough of Barnet at Avenue House, East End Road, Finchley, N.3. The Mortuary was constructed in 1959/60, and contains a refrigerated chamber for nine bodies, two post mortem tables, waiting room, viewing room and offices for the pathologist and mortuary superintendent. In addition to the mortuary superintendent, a full-time attendant is employed . 33 TABLES Table 1 CAUSES OF DEATH Males Females Total B.l Cholera - - - B.2 Typhoid fever - - - B.3 Bacillary dysentery and amoebiasis - - - B.4 Enteritis and other diarrhoeal diseases 1 1 2 B.5 Tuberculosis of respiratory system 5 - 5 B.6 Other tuberculosis, incl. late effects 3 1 4 B.7 Plague - - - B.8 Diphtheria - - - B.9 Whooping cough - - - B.10 Streptococcal sore throat and scarlet fever - - - B.l 1 Meningococcal infection - - - B.12 Acute poliomyelitis - - - B.13 Smallpox - - - B.14 Measles - - - B.15 Typhus and other rickettsioses - - - B.16 Malaria 1 - 1 B.17 Syphilis and its sequelae 1 - 1 B.18 Other infective and parasitic diseases 5 - 5 B.19(l) Malignant neoplasm, buccal cavity, etc 5 4 9 B.l9(2) Malignant neoplasm, oesophagus 11 7 18 B.19(3) Malignant neoplasm, stomach 39 22 61 B.l9(4) Malignant neoplasm, intestine 33 46 79 B.l9(5) Malignant neoplasm, larynx 4 1 5 B.l9(6) Malignant neoplasm, lung, bronchus 158 44 202 B.l9(7) Malignant neoplasm, breast - 63 63 B.19(8) Malignant neoplasm, uterus - 20 20 B.l9(9) Malignant neoplasm, prostate 21 - 21 B.19(10) Leukaemia 7 6 13 B.19(11) Other malignant neoplasms 88 95 183 B.20 Benign and unspecified neoplasms 3 9 12 B.21 Diabetes mellitus 19 12 31 B.22 Avitaminoses and other nutritional deficiency - 2 2 B.46(l) Other endocrine, etc., diseases 6 6 12 B.23 Anaemias 1 6 7 B.46(2) Other diseases of blood, etc 1 1 2 B.46(3) Mental disorders 3 11 14 B.24 Meningitis 1 2 3 B.46(4) Other dieases of nervous system, etc 17 21 38 B.25 Active rheumatic fever - - - B.26 Chronic Rheumatic heart disease 19 31 50 B.27 Hypertensive disease 29 39 68 B.28 Ischaemic heart disease 408 258 666 34  Males Females Total B.29 Other forms of heart disease 50 64 114 B.30 Cerebrovascular disease 119 212 331 B.46(5) Other diseases of the circulatory system 63 72 135 B.31 Influenza 12 12 24 B.32 Pneumonia 81 105 186 B.33(l) Bronchitis, emphysema 116 49 165 B.33(2) Asthma 4 7 11 B.46(6) Other diseases of the respiratory system 10 11 21 B.34 Peptic ulcer 15 8 23 B.35 Appendicitis - 1 1 B.36 Intestinal obstruction and hernia 7 7 14 B.37 Cirrhosis of liver 2 7 9 B.46(7) Other diseases of digestive system 8 14 22 B.38 Nephritis and nephrosis 6 5 11 B.39 Hyperplasia of prostate 6 - 6 B.46(8) Other diseases of the genito-urinary system 7 15 22 B.40 Abortion - 2 2 B.41 Other complications of pregnancy, etc. - 2 2 B.46(9) Diseases of skin and subcutaneous tissue - 2 2 B.46(10) Diseases of musculoskeletal system 3 8 11 B.42 Congenital anomalies 13 17 30 B.43 Birth injury, difficult labour, etc 14 14 28 B.44 Other causes of perinatal mortality 15 5 20 B.45 Symptoms and ill-defined conditions 3 6 9 BE.47 Motor vehicle accidents 26 12 38 BE.48 All other accidents 20 16 36 BE.49 Suicide and self-inflicted injuries 18 18 36 BE.50 All other external causes 6 1 7 TOTAL 1,513 1,400 2,913 Table 2 MAIN CAUSES OF DEATH AND RATES PER 1,000 POPULATION Cause No. Rate per 1,000 population Diseases of the circulatory system (active rheumatic fever, heart disease, hypertensive disease, cerebrovascular disease, etc.) 1,364 4.8 Malignant neoplasms 674 2.4 Diseases of the respiratory system (influenza, pneumonia, bronchitis and emphysema, asthma, etc.) 407 1.4 Violent deaths (motor vehicle accident, all other accidents, suicides and self-inflicted injuries, all other external causes) 177 0.4 Other causes 351 1.3 TOTALS: 2,913 10.3 35 Table 3 INFANT MORTALITY - CAUSES Neonatal 1-12 months Total Enteritis and other diarrhoeal diseases - 1 1 Infective and parasitic diseases 1 1 2 Malignant neoplasms - 2 2 Diseases of blood 1 - 1 Meningitis 2 1 3 Diseases of nervous system - 1 1 Influenza - 1 1 Pneumonia 1 12 13 Other diseases of respiratory system - 4 4 Intestinal obstruction and hernia 1 - 1 Other diseases of digestive system - 1 1 Congenital anomalies 16 8 24 Birth injury, difficult labour and other anoxic and hypoxic conditions 28 - 28 Other causes of perinatal mortality 20 - 20 Motor vehicle accidents - 1 1 All other accidents 1 1 2 TOTALS : 71 34 105 Table 4 INFECTIOUS DISEASES 1969 (1968 in brackets) Notified Confirmed Diphtheria - (-) - (-) Dysentery 116 (35) 113 (33) Food Poisoning 76 (55) 50 (33) Infective Jaundice 33 (52) 33 (51) Malaria 2 (1) 2 (1) Measles 970 (1,367) 970 (1,367) Meningococcal Infection 5 (6) 5 (5) Ophthalmia Neonatorum 6 (4) 6 (4) Scarlet Fever 68 (83) 68 (83) Typhoid Fever 1 (2) 1 (2) Whooping Cough 37 (111) 37 (111) Table 5 PRIORITY DENTAL SERVICE Expectant and Nursing Mothers Children under 5 Number examined 164 867 Number required treatment 149 540 Number of new cases commenced treatment 146 537 Dentally fit 83 340 Extractions 36 331 Fillings 410 1,428 Scaling and gum treatment 69 28 Silver nitrate dressings - 55 Dentures 17 - Number of attendances 470 1,447 36 Table 6 DAY NURSERIES: ATTENDANCES Nursery Approved places Children on register at 31.12.69 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 20 35 4,665 6,228 43 Evefield 25 25 16 34 3,321 7,113 41 Gladstone Park 25 25 25 21 5,463 4,887 41 Kilburn 25 25 18 39 4,038 6,895 43 Longstone Avenue 25 25 26 28 5,483 5,963 45 Mortimer Road 25 25 8 18 136 567 9 Princes Avenue 25 25 8 28 692 4,578 21 Vale Farm 25 25 - - 13 1,994 10 Villiers Road 25 25 8 32 1,785 6,014 31 Wesley Road 15 25 12 30 1,976 5,764 30 William Dunbar 25 25 16 38 5,297 5,524 42 Shoot-up Hill 25 25 19 29 4,854 5,725 42 TOTALS: 290 300 176 332 37,723 61,252 398 Table 7 DAY NURSERIES: WAITING LIST Nursery 1.1.69 31.12.69 Essex Road 28 12 Evefield 14 4 Gladstone Park 15 15 Kilburn 27 29 Longstone Avenue 64 44 Mortimer Road 31 15 Princes Avenue 23 1 Vale Farm 48 50 Villiers Road 35 9 Wesley Road 24 14 William Dunbar 23 17 Shoot-up Hill 7 7 TOTALS: 339 217 Table 8 MOTHER AND BABY HOME —"BELLEVUE", WILLESDEN LANE Total number of beds 12 Total number of cots 12 Average length of stay—ante-natal 30 days Average length of stay—post-natal 40 days Total number of women admitted during the year 59 (excluding re-admissions after confinement) Number of admissions for which Council accepted financial responsibility 48 Number of cases sent to mother and baby homes other than "Bellevue" during year:- Expectant mothers 60 Post-natal cases 37 CONGENITAL MALFORMATIONS Table 9 Summary of Notifications (i) Number of notifications received during year 79 (ii) Number of live births included in (i) above 67 (iii) Number of stillbirths included in (i) above 12 Macerated Nil Others 12 (iv) Number of children with multiple malformations 13 Table 10 Analysis of Malformations Notified Code No. Classification Number of cases Code No. Classification Number of cases 0 Central Nervous System 6 Limbs .1 Anencephalus 6 .0 Polydactyly 8 .8 Spina bifida 8 .1 Syndactyly 1 .4 Hydrocephalus 3 .5 Talipes 22 .5 Microcephalus 2 .9 Unspecified limb malformations 5 1 Eye and Ear .1 Anophthalmos and microthphalmos 1 7 Other parts of Musculo-skeletal System .0 Unspecified malformations of eye 1 .2 Malformations of spine 1 .0 Other malformations of musculoskeletal system 1 .8 Accessory auricle 1 .9 Other specified malformations of ear 1 8 Other systems .6 Unspecified malformations of ear 2 1 Other malformations of face and neck 2 .9 Exomphalos, omphalocele 1 2 Alimentary system .2 Other unspecified malformations of muscles, skin and fascia 1 .1 Cleft lip 3 .2 Cleft palate 2 7. Rectal and anal atresia 1 9 Other malformations 3 Heart and Great Vessels .0 Unspecified congenital malformations 1 .9 Specified malformations of heart and great vessels 1 .6 Down's syndrome 2 5 Urino-genital system .7 Hypospadias, epispadias 12 .2 Undescended testicle 3 .3 Hydrocele 1 Table 11 MIDWIFERY SERVICE Deliveries attended: — Doctor not booked, doctor present 1 Doctor not booked, doctor not present 24 Doctor booked, doctor present 103 Doctor booked, doctor not present 151 Number of home booked cases transferred to hospital before confinement 36 Cases in which analgesia was administered:- Gas and air 19 Trilene 169 Pethilorfan 94 Number of times Emergency Transfusion Service used — Visits paid:- Ante-natal 3,654 During labour 488 Nursing domiciliary confinements 4,289 Nursing institutional discharges 2,880 Clinic Sessions Attended:- Ante-natal 823 General practitioners' clinics 77 Relaxation 42 Mothercraft 39 Number of cases in which medical aid was called by midwife 15 38 Table 12 CHIROPODY SERVICE Number of persons treated during the year. By Local Authority By British Red Cross Society Total Elderly Persons 3,997 218 4,215 Expectant and Nursing Mothers 28 - 28 Children under 5 22 - 22 Others (Physically handicapped who are not old age pensioners) 34 - 34 Total 4,081 218 4,299 Number of treatments given during the year. By Local Authority By British Red Cross Society Total In Clinics 11,034 769 11,803 In patients' homes 5,249 466 5,715 In old peoples' homes 2,116 - 2,116 In chiropodists' surgeries 3,329 - 3,329 Total 21,728 1,235 22,963 Number of local authority clinic sessions 1,706. Table 13 TUBERCULOSIS: NEW CASES AND DEATHS BY AGE GROUPS (Deaths in brackets-figures under non-respiratory include deaths from late effects) Age groups New Cases Respiratory Non-respiratory Male Female Male Female Under 1 - (-) - (-) - (-) - (-) 1 to 4 - (-) - (-) - (-) - (-) 5 to 9 3 (-) - (-) - (-) 1 (-) 10 to 14 1 (-) - (-) - (-) 1 (-) 15 to 19 2 (-) 2 (-) 1 (-) 20 to 24 - (-) 3 (-) 2 (-) 3 (-) 25 to 34 2 (-) 3 (-) 3 (-) 2 (-) 35 to 44 8 (1) 4 (-) 1 (-) 4 (-) 45 to 54 5 (2) 4 (-) 1 (-) 2 (-) 55 to 64 5 (1) 1 (-) - (-) 1 (1) 65 and upwards 1 (1) 1 (3) - (-) Totals: 27 (5) 15 (-) 10 (3) 15 (1) 39 Table 14 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 - - - - 1,106 896 (b) Persons who were given X-ray examination only - - - - 2,074 1,684 Number of persons found to be tuberculous during the year, including new contacts shown below 88 50 21 33 109 82 Number of new contacts seen for the first time during the year and included above (a) Contacts who were given a full medical examination - - - - 207 141 (b) Contacts who were given X-ray examination only - - - - 183 183 Number found to be tuberculous 7 5 - - 7 5 Number of cases not on the register but who are under observation at the chest clinic - - - - 317 220 40 Table 15 TUBERCULOSIS: NOTIFIED CASES AND DEATHS Year Population New Cases Deaths Cases on Register Pulmonary Nonpulmonary All forms Pulmonary Other Tuberculosis including late effects All forms Pulmonary Nonpulmonary All forms 1965 294 850 107 27 134 7 3 10 2,169 354 2 523 1966 294,450 75 36 111 5 4 9 2,221 390 2,611 1967 293,370 60 15 75 12 2 14 2,128 389 2,517 1968 284,460 51 37 88 11 5 16 1,941 411 2,352 1969 281,530 42 25 67 5 4 9 1,848 426 2,274 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 Other Tuberculosis including late effects All forms 1965 294,850 36 9 45 2 1 3 1966 294,450 25 12 37 2 1 3 1967 293,370 20 5 25 4 1 5 1968 284,460 18 13 31 4 1 5 1969 281,530 15 9 24 2 1 3 Table 17 VENEREAL DISEASE Treatment Centre Number of new cases in 1969 Totals all Venereal Conditions Syphilis Gonorrhoea Other Venereal Conditions Primary and Secondary Other St. Thomas' Hospital, S.E.1 69 - - 8 61 Central Middlesex Hospital, N.W.10 1,288 6 81 254 947 Westminster Hospital, S.W.l 30 - - 8 22 St. Mary's Hospital, W.2 1,117 11 9 258 839 Seamen's Hospital, Greenwich 2 — — 1 1 Moorfields Eye Hospital, E.C.l 7 — 1 1 5 TOTALS 2,513 17 91 530 1,875 41 Table 18 MENTAL HEALTH Patients under Local Authority care at 31st December, 1969 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, 1969 - - 138 221 359 155 85 195 177 612 2 Attending training centre or day centre 3 Awaiting entry thereto - - 16 4 21 5 37 9 88 45 58 50 241* 4 Receiving home training - - - - - - - - - - 5 Awaiting home training - - - - - - - - - - 6 Resident in L.A. home/hostel - - 8 14 22 - - 5 - 5 7 Awaiting residence in L.A. home/hostel - - - - - - - - - - 8 Resident at L.A. expense in other homes/hostels - - 5 7 12 17 4 6 11 38 9 Resident at L.A. expense by boarding out in private household - - 2 5 7 3 - 5 5 13 10 Attending day hospitals - - - - - 1 - - - 1 11 Receiving home visits and not included in lines 2-10 - - 103 167 270 46 36 120 111 313 No. of patients in L.A. area on waiting list for admission to hospital at 31.12.69 In urgent need of hospital care - - 4 7 11 6 3 1 - 10 Not in urgent need of hospital care - - - - - 20 11 9 1 41 No. of admissions for temporary residential care (e.g. to relieve the family) during 1969 to N.H.S. Hospitals - - - - - 29 27 2 10 68 Elsewhere - - - - - 1 2 - 1 4 * Includes patients attending centres administered by other local authorities. 42 Table 19 Number of Patients Referred During Year Ended 31st December, 1969 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 1 4 113 171 289 - - - - - Hospitals, on discharge from in-patient treatment - - 27 51 78 4 3 - 3 10 Hospitals, after or during out - patient or day treatment 47 92 139 2 4 - - 6 Local education authorities - - - - - 8 1 9 4 22 Police and courts 1 1 17 26 45 - - 1 - 1 Other sources - - 196 227 423 11 8 6 - 25 Total 2 5 400 567 974 25 16 16 7 64 Table 20 Work of Mental Welfare Officers and Mental Health Social Workers (a) Mental Illness: Visits made by mental welfare officers and interviews with clients (home and office) 5,332 Compulsory admissions to psychiatric hospitals by mental welfare officers 206 Informal admissions to psychiatric hospitals by mental welfare officers 132 (b) Mental sub-normality: Visits and interviews by mental health social workers 1,809 WELFARE OF THE BLIND Table 21 Classification of Registered Blind Persons by Age Groups Age Group No. Under 5 4 5 - 15 8 16 - 20 6 21 - 29 22 30 - 39 19 40-49 39 50-59 65 60 - 64 51 65-69 43 70 - 79 127 80-84 65 85 - 89 41 90 and over 37 Total 527 43 Table 22 Age at Onset of Blindness Age Group No. Birth 70 1 — 15 51 16 — 20 17 21—29 24 30 — 39 25 40-49 42 50-59 55 60 — 64 40 65 — 69 45 70-79 92 80-84 31 85 — 89 15 90 and over 5 Unknown 15 Total 527 Table 23 Analysis of Occupations of Blind Persons Occupation No. Masseurs and Physiotherapists 2 Teacher of Languages 1 Teacher of Music 1 Social Worker to the Blind 1 Business Managers 2 Typists, Shorthand Typists 9 Braille Copyists, Proof Readers 2 Clerical Workers 2 Telephone Operators 8 Shop Manager 1 Shop Assistant 1 Machine Tool Operators 6 Fitters and Assemblers 6 Boxers, Fillers, Packers 7 Warehousemen, Storekeepers 2 Knitters (machine) 5 Mattress Makers 8 Basket Makers 7 Chair Seaters 2 Brush Maker 1 Piano Tuners 7 Craftsmen and Production Process Workers 9 Labourers 8 Domestic/Canteen Workers, Cleaners 4 Launderer, Dry Cleaner 1 Miscellaneous Workers 5 Total 108 44 WELFARE OF THE HANDICAPPED Table 24 Registrations Age Sex Number of persons on register at 31st December, 1969 Number of persons whose names were added to the register during the year ended 31st December, 1969 Deaf with speech Deaf without speech Hard of hearing General Classes Total Deaf with speech Deaf without speech Hard of hearing General Classes Total Under 16 M 2 3 - 4 9 2 - - 1 3 F - - - 5 5 - 1 - 1 2 16-29 M 1 23 2 30 56 - 2 1 9 12 F 1 11 2 17 31 1 3 1 1 6 30-49 M 4 18 - 59 81 1 2 - 7 10 F 4 15 1 71 91 - 2 1 16 19 50-64 M 3 8 3 126 140 - - - 34 34 F 7 12 2 190 211 1 - - 36 37 65 or over M 1 5 7 165 178 - - 2 49 51 F 8 3 12 434 457 - - 3 89 92 Total 31 98 29 1.101 1,259 5 10 8 243 266 45 Table 25 General Classes-Analysis of Disabilities Disability Age Total Under 16 16-29 30-49 50-64 65 and over Amputations 1 - 3 11 38 53 Arthritis and rheumatism - - 21 98 337 456 Congenital malformations and deformities 1 - 1 3 3 8 Diseases of digestive and genito-urinary systems - - 2 2 6 10 Diseases of the heart or circulatory systems - 2 - 30 62 94 Diseases of the respiratory system (other than tuberculosis) - 1 3 29 42 75 Diseases of the skin - - - - 1 1 Injuries of the head, face, neck, thorax, abdomen, pelvis or trunk - - 1 1 5 7 Injuries or diseases (other than tuberculosis) of the upper and lower limbs, and of the spine 1 2 8 13 39 63 Organic nervous diseases, epilepsy, poliomyelitis, multiple sclerosis 9 44 86 185 168 492 Neuroses, psychoses and other nervous and mental disorders - - 1 1 3 5 Tuberculosis (respiratory) - - 1 2 - 3 Tuberculosis (non-respiratory) - - 2 3 2 7 Diseases and injuries not specified above - 1 5 19 29 54 Total 12 50 134 397 735 1,328* * This figure includes those handicapped persons who suffer from dual or multiple disabilities. 46 Table 26 General Classes—Occupational Grouping Groups Age Total Under 16 16-29 30-49 50-64 65 and over (a) Handicapped persons (other than ** children) who though possibly needing training for some new occupations are capable of work under ordinary industrial conditions - 7 22 32 6 67 (b) Handicapped persons (other than ** children) who are incapable of work under ordinary industrial conditions but who are mobile and capable of work in sheltered workshops 4 10 24 38 (c) Handicapped persons (other than ** children) who are incapable of work under ordinary industrial conditions and who are insufficiently mobile for work in sheltered workshops but who are capable of work at home - 2 9 18 29 (d) Handicapped persons (other than children) who are incapable of, or not available for work - 34 89 242 593 958 (e) Handicapped persons who are children under the age of 16 years and whose needs are likely to be met under other enactments but for whom the local authority have a general responsibility under Section 29 of the Act 9 - - - - 9 Total 9 47 130 316 599 1,101 **Actual number of persons employed within these categories. SANITARY INSPECTION OF THE AREA Table 27 Inspections and Visits by Public Health Inspectors Public Health Act Dwellings—inspected 2,945 Dwellings—re-inspected 7,789 Visits re accumulations 2,308 Visits re Vermin 314 Visits re improper keeping of animals 103 Other nuisances including rats 1,072 Other Visits 1,480 Housing Acts House-to-house—inspections 39 House-to-house—re-inspections 528 Individual houses—inspected 70 Individual houses—re-inspected 154 Houses in multiple occ.—inspected 346 Houses in multiple occ.-—re-inspected 1,746 Basement rooms inspected 27 Overcrowding visits 222 Imp. and standard grant inspections 240 Houses inspected—special surveys 74 Other Visits 960 47 Rent Act Dwellings—inspected 97 Dwellings—re-inspected 33 Other Visits 46 Factories Act Power factories—inspected 1,585 Power factories—re-inspected 266 Non-power factories—inspected 62 Non-power factories—re-inspected 3 Outworkers' rooms inspected 199 Other visits—building sites 17 Basement bakehouses, etc. Food and Drugs Act Premises—inspected 6,290 Premises—re-inspected 2,580 Visits re unsound food 208 Visits re contaminated food 147 Formal and informal sampling 300 Visits re labelling of food 228 Visits re Merchandise Marks Act 440 Clean Air Act Boiler plant inspected 61 Premises inspected in SCAs 2,192 Other visits in SCAs 21 Visits re nuisance from smoke, etc 1,055 Smoke observations 158 Offices and Shops Act General inspection—office 1,090 General inspection—-retail shop 1,039 General inspection—wholesale/warehouse 158 General inspection—catering establishment 243 General inspection—fuel storage depot 1 Re-inspections 370 Other Visits 147 Infectious Disease Cases investigated 523 Contacts followed up 806 Food poisoning enquiries 167 Other visits 414 Miscellaneous Aged persons 44 Attendance at Court or Inquiries 100 Drainage inspections 1,689 Massage, etc. establishments inspected 67 Noise nuisance investigations 864 Places of entertainment inspected 95 Rag, flock, etc. premises inspected 10 Unsuccessful visits 4,804 All other visits 1,666 Food Hawkers 418 Table 28 Overcrowding (a) Dwellings overcrowded at the end of the year 1,218 (b) Overcrowding relieved during the year 240 (c) Dwelling houses which have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Not known (d) (i) Council houses found to be overcrowded at end of year 42 (ii) Persons 47 (e) Section 80, Housing Act, 1957—licences issued 2 48 Table 29 New Dwellings 1969 Houses Flats Dwellings built by private builders (excluding those built by the police authorities) 23 50 Built by local authority 62 351 Applicants on Council's waiting list 31.12.69 7,916 Table 30 Notices Served (including Housing Survey) Intimation notices served 724 Intimation notices complied with 554 Statutory notices served (Public Health Act, 1936) 1,023 Statutory notices complied with (Public Health Act, 1936) 922 Statutory notices served (Public Health Act, 1961) 66 Statutory notices complied with (Public Health Act, 1961) 66 Statutory notices served (Shops Act, 1950) — Statutory notices complied with (Shops Act, 1950) — Statutory notices served (Prevention of Damage by Pests Act, 1949) 30 Statutory notices complied with (Prevention of Damage by Pests Act, 1949) 24 Statutory notices served Housing Act, 1957 (Section 9) 7 Statutory notices complied with Housing Act, 1957 (Section 9) 1 Statutory notices served Housing Act, 1961 (Section 15) 46 Statutory notices complied with Housing Act, 1961 (Section 15) 28 Statutory notices served Housing Act, 1961 (Section 16) 1 Non-compliance with statutory notices referred to Town Clerk (Public Health Act, 1936, Section 93) 163 Referred for work to be carried out in default of owners 91 Table 31 Nuisances Abated and Improvements Effected Dwelling Houses, Water Supply and Service New cisterns provided 2 Cisterns repaired/renewed 80 Cisterns cleansed/covered 7 Draw taps placed on mains 3 Water supply re-instated 9 Drainage and Sewerage W.C.'s—pans and traps renewed 37 W.C.'s—cleansed/repaired 193 W.C.'s—add. accom. provided 3 W.C.'s—ventilation improved 9 Drains—reconstructed — Drains—examined, tested, exposed 6 Drains—cleared, repaired 123 Soil pipes or vent shafts repaired 37 New soil pipes or vent shafts fixed 6 Disconnecting traps or chambers inserted - New manhole covers 10 49 Other Defects Brickwork repaired/ repointed 126 Dampness remedied— D.P. course 331 Dampness remedied— others 38 Exterior paintwork repainted 5 Fireplaces/ranges repaired or renewed 10 Flooring and other woodwork rep./ren. 344 Floor (solid) repaired 33 Floors— add. vent, provided Food stores— ventilation provided 23 Gutters, R.W.Ps., waste pipes repaired 478 Overcrowding abated 20 Plastering repaired/renewed (rooms) 475 Refuse accumulations removed 13 Roofs repaired /renewed 368 Sinks— additional provided 48 Sinks— repaired/renewed 62 Flues repaired 1 Staircases, passages— cleansed 5 Staircases, passages— repaired 17 Walls and ceilings— cleansed 316 Walls and ceilings— repaired 133 Windows repaired 553 Other defects 445 Courts, Forecourts, Yards Nuisances abated 10 Paving repaired/ relaid 38 Accumulations removed 319 Verminous Articles and Premises Premises disinfested 6 Articles disinfested/ destroyed — Animals Nuisances abated — Offices and Shops Ventilation— provided and/or maintained 33 Temperature— reasonable prov./ maintained 15 W.C.'s— cleansed/repaired 28 W.C.'s— add. acc. provided — Lighting— suitable and sufficient provided 39 Other nuisances abated 349 Miscellaneous Nuisances abated 5 Smoke nuisances abated 4 Hot water provided in dwelling house 149 Cookers 17 Baths „ „ „ „ 6 Food store „ „ „ „ 26 Cold water „ „ „ „ 30 50 Table 32 Rent Act 1957 Certificates of Disrepair Applications (Form I) received and investigated 11 Agreed and proposal to issue Certificate of Disrepair (Form J) served 11 Refused — Undertakings (Form K) received from landlords 6 Accepted 6 Refused — Certificate of Disrepair (Form L) issued 5 Applications received for cancellation of Certificates of Disrepair (Form M) — Table 33 CLEAN AIR Area No. Date of operation Acreage No. of dwellings No. of other premises Willesden No. 1 1. 6.59 48.5 627 73 Willesden 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 Brent No. 1 1. 7.66 505 3,929 414 Brent No. 2 1.12.66 201 2,879 170 Brent No. 3 1. 8.67 460 4,292 108 Brent No. 4 1.12.67 306 4,322 329 Brent No. 5 1. 7.68 662 4,593 235 Brent No. 6 1. 8.69 230 4,279 421 Total — 6,9553 62,910 4,154 51 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 28 28 28 28 Bread and Confectionery 63 63 63 63 Dairy 6 6 6 6 Butcher 170 170 170 170 Grocer and General Store 346 346 346 346 Fishmonger and Fish Fryer 62 62 62 62 Cafe and Restaurant 229 229 229 229 Greengrocer and Fruiterer 175 175 175 175 Ice Cream and Sweet Shop 328 328 191 191 Food Stall 111 — — — Public House 67 67 67 67 Works Canteen 142 142 142 142 School Canteen 78 78 78 78 Food Factory 18 18 18 18 Other Food Premises 78 78 68 68 Totals 1,901 1,790 1,643 1,643 Inspections and Revisits Inspections: 6,290 Revisits: 2,580 Total: 8,870 Table 35 Premises unsatisfactory on 31.12.68 160 Unsatisfactory during the year 796 Premises made satisfactory during year 722 Unsatisfactory 31.12.69 234 Table 36 FOOD PREMISES: DEFECTS REMEDIED Defects Outstanding at 31.12.68 Found during the year Total Remedied during year Outstanding at 31.12.69 1. Inadequate lighting and ventilation 12 14 26 12 14 2. Inadequate washing facilities 90 182 272 149 123 3. Inadequate refuse storage 36 167 203 158 45 4. Unsatisfactory or insufficient sanitary accommodation 65 129 194 101 93 5. Inadequate storage accommodation 58 61 119 60 59 6. Defective walls, ceilings or floors 140 192 332 161 171 7. Dirty walls, ceilings or floors 141 337 478 316 162 8. Inadequate first aid materials 41 85 126 79 47 9. Unsatisfactory conditions 28 23 51 20 31 10. Any other defects 136 246 382 214 168 Totals 747 1,436 2,183 1,270 913 52 Table 37 FOOD PREMISES: REGISTRATION Premises on register 31.12.68 Applications received Applications granted Applications refused Premises removed from register during 1969 Total on register at 31.12.69 (1) Sale and storage of ice cream 632 13 13 - 12 633 | 643 (2) Manufacture of ice cream 10 — — - — 10 (3) Manufacture of preserved food 216 6 6 — 29 193 Table 38 SLAUGHTERHOUSE Carcases Inspected and Condemned Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 57 - - 363 - Number inspected 57 — — 363 — All diseases except tuberculosis and cysticerci:— Whole carcases condemned — — — — - Carcases of which some part or organ was condemned 13 - - 26 - Percentage of the number inspected affected with disease other than tuberculosis and cysticerci 22.8 - - 7.2 - 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 - — — - - 53 Table 39 CONTAMINATED FOOD COMPLAINTS Foodstuff Dirt or Foreign Bodies Insects Mould Souring or other unfitness Bread and flour confectionery 13 4 16 5 Milk, cream and yogurt 10 (1) 3 (2) 1 5 Meat and meat products — 4 8 8 (2) Canned foods 3 — — 2 Bottled foods — — 1 3 Cereals — 1 — — Pies 1 — 2 2 (1) Cheese — — 1 1 Butter and margarine 1 — — — Wines and beer — — — 1 Sweets 2 3 — 2 Fruit and vegetables 2 4 2 3 Beverages — 1 — 1 (1) Fish — 2 — 2 (2) TOTALS 32 22 31 35 Figures in brackets indicate complaints not confirmed. Table 40 SAMPLING OF FOOD AND DRUGS Articles Total procured Unsatisfactory Labelling Composition Milk 2 - 1 Milk (condensed and dried) 5 — 1 Creams and yogurt 11 — — Meat and meat products 68 — 4 Meat pies 28 — — Butter, margarine and fats 9 — 2 Bread, flour and cereals 36 — 1 Fish and fish pastes 12 — — Cakes, biscuits, mixtures and fillings 9 — 1 Fruit juices, syrups and soft drinks 12 — 1 Spirits, wine, beer 16 — 1 Coffee, tea and beverages 31 — 1 Sweets and chewing compounds 17 — 1 Fruit and vegetables 83 3 6 Curries, spices and flavourings 24 — 1 Vinegar, pickles and sauces 42 1 1 Cheese and spreads 15 — 1 Jams, jellies and preserves 10 — 1 Drugs 46 — 2 Soups and mixes 12 1 TOTALS 488 4 27 54 Table 41 BACTERIOLOGICAL EXAMINATION OF MILK, ICE CREAM AND WATER Milk examinations—25 Schools Pasteurised Dealers' premise s U.H.T. Total Pasteurised Sterilised Samples 4 16 4 1 25 Satisfactory 4 14 4 1 23 Unsatisfactory — 2 — — 2 Ice cream examinations— 58 Grade 1 Grade 2 Grade 3 Grade 4 Total 42 6 4 6 58 Water examinations—274 Domestic supplies Swimming pools Paddling pool Total Samples 268 6 274 Satisfactory — 259 4 263 Unsatisfactory - 9 2 11 FACTORIES Table 42 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 23 65 1 - Factories not included above in which section 7 is enforced by the local authority 967 1,851 63 - Other premises in which section 7 is enforced by the local authority (excluding outworkers premises) 8 18 - - Total 998 1,934 64 — 55 Table 43 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) 1 1 - - — Overcrowding (sec. 2) — — — — — Unreasonable temperature (sec. 3) — — — — — Inadequate ventilation (sec. 4) 5 5 — — — Ineffective drainage of floors (sec. 6) 2 2 — — — Sanitary conveniences (sec. 7) (a) Insufficient 2 1 — — — (b) Unsuitable or defective 87 78 — — — (c) Not separate for sexes 1 — — — — Other offences against the Act (not including offences relating to outworkers) 4 3 — — — Total 102 90 — — — Table 44 Outworkers e of Work No. of outworkers in August list No. of instances of work in unwholesome premises Notices served Wearing apparel (making, etc.) 103 - - Handbags 11 — — Making of boxes or other receptacles or parts thereof made wholly or partially of paper 5 - - Christmas crackers 6 - — Brass articles 5 - — Stuffed toys 6 - — Brush making 1 - — Packeting or boxing of buttons, pins, etc. 3 - — Ladies' Belts 7 - — Fancy Goods 3 - — Millinery 6 - — Lampshades 8 - — Wigs 1 - — Metal Boxes 1 - — Artificial Flowers - - Total 166 - — There were no cases of default in sending lists to the Council, and there were no prosecutions. 56 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Table 45 Registration of Premises and Analysis of Persons Employed Class No. of premises registered during the year Total No. of registered premises at end of year No. of persons employed Offices 46 768 13,446 Retail Shops 25 687 3,933 Wholesale shops, warehouses 6 76 1,901 Catering estabs. open to the public, canteens 4 175 1,789 Totals 81 1,706 21,069 Males 10,604 Females 10,465 Table 46 Inspections and Visits Class No. of registered premises receiving general inspection during the year Number of visits of all kinds Offices 757 2,532 Retail Shops 680 Wholesale shops, warehouses 74 Catering estabs. open to the public, canteens 174 Total 1,685 57 Table 47 Defects and Unsatisfactory Conditions Found and Remedied Section Unsatisfactory conditions or defects Outstanding 1968 Found 1969 Remedied during the year 4 Premises in a dirty state 5 32 32 5 Overcrowding — 1 1 6 Temperature Unreasonable 8 24 29 Lack of room thermometer 5 26 27 7 Ventilation — 8 8 8 Lighting 1 3 4 9 Sanitary Conveniences Unsuitable and insufficient 3 5 6 Lack of artificial lighting 7 3 10 Other nuisances 8 38 38 10 Washing facilities insufficient and unsuitable 5 49 50 11 Adequate supply of drinking water and hot water 0 2 12 Accommodation for clothing — 3 3 13 Seating facilities — 1 1 14 Seats for sedentary work — 1 1 15 Eating facilities for shop employees 1 — 1 16 Floors, passages and stairs not soundly constructed, properly maintained or kept free from obstruction or slippery substance 3 27 27 17 Dangerous parts of machines not properly fenced 4 11 15 22 Dangerous practices and conditions — 2 1 24 First Aid— General Provisions 16 54 61 50 Information for employees, Lack of 18 67 78 • Other nuisances — 15 15 Total 84 372 410 Table 48 Accidents Reported 1969 Class of Premises Total Offices Retail Shops Wholesale Shops and Warehouses Catering Establishments and Canteens 1. No. of Accidents Reported 9 24 9 6 48 2. No. of Accidents Investigated 6 20 4 4 34 3. Action taken: (a) Formal warning — 2 1 — 3 (b) Informal Advice 2 6 1 1 10 (c) None 7 16 7 5 35 4. Causation: (a) Machinery — — 2 1 3 (b) Transport — 1 — - 1 (c) Falls of Persons 6 7 2 - 15 (d) Stepping on or striking against object or persons 1 1 (e) Handling goods 1 8 4 2 15 (f) Struck by falling objects — 1 — - 1 (g) Fires and explosions — — — 1 1 (h) Electricity — — — - - (i) Use of Hand Tools — 6 - - 6 (j) Not otherwise specified 1 1 1 2 5 5. Injuries sustained: (a) Fractures and dislocations 1 2 - 1 4 (b) Sprains and strains 2 3 4 2 11 (c) Internal injury — — - - - (d) Open wounds/surface injury — 9 3 1 13 (e) Bruising and crushing 5 8 2 1 16 (f) Amputation — — - - - (g) Burns — - - 1 1 (h) Poisoning 1 1 - 2 (i) Other injuries — 1 - — 1 58 Table 49 UNCLEANLINESS AND SCABIES New cases treated Attendances Scabies Lice and nits Total Scabies Lice and nits Total Children under 5 years 32 6 38 41 6 47 Children 5-15 years 52 32 84 59 42 101 Adults Men 30 6 36 39 6 45 Women 42 8 50 51 9 60 Total 156 52 208 190 63 253 Table 50 DISINFESTATION (a) Verminous Premises: Council properties 20 Private properties 56 Total 76 (b) Verminous Rooms: Council properties 62 Private properties 170 Total 232 (c) Clothine and bedding materials: (i) disinfected 7 (ii) disinfested 2 (d) Miscellaneous: Ants 1 Silver Fish 1 Wasps nests 198 Plaster Beetles 1 59 REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR 1969 To The Mayor, Aldermen and Councillors of the Borough. 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 A. M. P. Snow, m.b., b.s., m.r.c.s., l.r.c.p., d.c.h., d.p.h. Assistant School Medical Officers R. Aaronson, m.d. (Vienna) J. Bean, m.b., b.ch. (resigned 26.10.69) P. A. Garrard, m.b., b.s., m.r.c.s., l.r.c.p. A. J. Gower, m.b., ch.b., d.c.h. F. X. Letellier, m.r.c.s., l.r.c.p., d.p.h. O. J. Macdonald, m.d., m.b., ch.b. (from 6.10.69) H. E. McNamara, m.d., (Toronto), d.r.c.o.g., d.p.h. L. Morris, m.b., b.s. C. Sayal, m.b., b.s., d.c.h., d.p.h. G. Walshe, m.b., b.ch., b.a.o., d.c.h. (from 8.12.69) Z. Vellani, m.b., b.s., m.r.c.s., l.r.c.p., d.r.c.o.g. Chief Dental Officer A Henderson, l.d.s., d.p.d. (u.st.and) School Dental Officers Miss S. Broady, b.d.s. Miss C. A. Brown, b.d.s. Mrs. H. Collins, l.d.s., r.c.s., b.d.s. P. Grimer, b.d.s. Mrs. D. Mailer, l.d.s., r.f.p.s. (Glas.) Mrs. J. Mans, l.d.s. Mrs. M. Perera, l.d.s. J. A. Rejman, l.d.s., r.c.s. (Eng.), b.d.s. Mrs. G. Segal, l.d.s., r.c.s. Mrs. A. Sowa Dr. E. Velden, m.d. (Vienna), l.d.s. Dr. W. Wierzbicki, m.d. (Bologna), 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. Miss R. Malik, l.d.s., r.c.s. (Eng.), b.d.s. Dental Auxiliary Mrs. J. Zucker, Eastman Dental Hospital Cert. 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. Education Psychologists D. Ganley, b.a. (Hons.) Dr. V. P. Varma, ph.d. A. Rigby, b.a. (Hons.) Speech Therapists Miss J. A. Brewer, l.c.s.t., l.a.m.d.a. (resigned 29.8.69) Miss A. Elvins, l.c.s.t. Miss V. S. Hunt, l.c.s.t. (resigned 23.9.69) Miss S. Oliver, l.c.s.t. Mrs. J. M. Shinkfield, l.c.s.t. Mrs. Sunshine, m.c.s.t. (from 17.12.69) Mrs. Williams, l.c.s.t. Physiotherapists Mrs. H. J. Amery, s.R.Ph. (resigned 30.6.69) Mrs. B. Cottis, m.c.s.p. Mrs. M. Gilbert, m.c.s.p. Mrs. I. B. Johnson, s.r.p., m.c.s.p. (from 1.1.69) Mrs. P. MacArthur, m.c.s.p. Miss P. Patel, m.c.s.p. (from 5.11.69) Mrs. D. V. Bell Audiometricians Mrs. D. Pursey Mrs. A. Taylor, s.r.n. Administrative Officer B. H. Lovett Hospital Board Consultants attending School Clinics Orthopaedic -J. Cholmeley, f.r.c.s. K. Nissen, f.r.c.s. Audiology L. Fisch, f.r.c.s. Ophthalmic - B. R. Medlycott, m.b., 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. 60 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. Mortimer Road Clinic, Mortimer Road, N.W.10. 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, Mortimer Road 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 and Mortimer Road Clinics. SCHOOL HYGIENE Under Section 54 of the Education Act, health and cleanliness surveys are undertaken by the School Nurse. Regular inspections of the children are made in school, and talks, films and film strips are used to encourage an interest in personal hygiene and appearance. A cleansing service is provided at the Stonebridge Health Clinic for the treatment of scabies and for disinfestation. Total number of examinations 19,220 Total number of individuals found to be infested for the first time during the year 174 Number of individual pupils in respect of whom cleansing notices were issued under Section 54(2) of the Education Act 1944 105 Number of individual pupils in respect of whom cleansing orders were issued under Section 54(3) of the Education Act 1944 — WORK OF THE HEALTH VISITOR AND SCHOOL NURSE The Health Visitor and School Nurse are concerned especially in maintaining good health amongst school children. This is done by carrying out routine heal.h surveys, preparing for and assisting the School Medical Officers with medical inspections. Contact is made with Heads of Schools and a link with the families and homes of the pupils is fostered. The Health Visitors' special skill of health teaching is offered to all schools and many members of staff participate in health programmes. 61 PROTECTION OF SCHOOL CHILDREN AGAINST TUBERCULOSIS Vaccination against tuberculosis continued to be offered to 13-year-old pupils attending both maintained and independent schools. After the parent's consent has been obtained a simple skin test is administered to determine whether or not the child needs protection. If the skin reacts to the test it usually means the child has developed some immunity, but all such cases are investigated at the Mass X-ray Unit or Chest Clinic. During 1969, the testing of school entrants normally at the age of five years was continued throughout the Borough. In all cases where a reaction was noted the child was referred to the Chest Clinic. The table below gives the number of children tested and vaccinated:— Leavers (i) Number of children whose parents were approached 2,865 (ii) Number of children tested 2,102—73.4% (iii) Number of those in (ii) negative to Heaf Tests 1,801—85.7% (iv) Number of those in (iii) B.C.G. vaccinated 1,784—99.1% (v) Percentage of Vaccination to (i) above 62.3% Entrants (i) Number skin tested 3,764 (ii) Number positive 361— 9.6% (iii) Number negative 3,368—89.5% CONVALESCENT TREATMENT Twenty children were recommended for recuperative holidays under Section 28 of the National Health Service Health Act, 1946, for which the Education Authority accepted responsibility These arrangements are made on the recommendation of the School Medical Officer or General Practitioner in respect of children who have been found to be in poor health or suffering from a disability for which a holiday is considered to be an essential part of the recuperative treatment. In no way are they intended to provide annual holidays for children whose parents are unable to do so. Details of illness and length of stay are given below:— Diagnosis No. of Children Length of Stay Asthma and Bronchitis 1 2 weeks Debility 5 „ Diabetes 1 „ Eczema 1 „ Emotional instability 1 „ Frequent upper respiratory infections 1 „ Physically handicapped 7 „ Sprained left hip 1 „ Tonsilitis 2 „ Total 20 AUDIOMETRY The routine testing of pure tone audiometer of every school childs hearing continued. A "sweep" test is carried out in the first instance in the school, normally at the ages of 6, 9 and 13 years, failures are retested at clinics under more favourable conditions. Children failing the second test are then referred to School Medical Officers for further investigation. The establishment of operators was increased by one part time operator during the year. This was necessary because of additional sessions at the Audiology Unit where an operator is required and the increasing number of immigrant children being admitted to school who through language or other difficulties take longer to test. Special cases (for example children who fail to develop proper speech, fail without apparent reason to make progress at school) were tested at the clinics 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, the figures for 1968 in brackets. 62 Audiometry: Children Tested Routine Age Group 1st Tests Retests Failures Totals Both Ears One Ear Right Left Up to 7 years 4,422 (4,586) 143 (142) 78 (86) 63 (62) 65 (82) 206 (230) Intermediate 4,026 (3,684) 180 (259) 43 (48) 35 (37) 32 (43) 110 (128) Leavers 3,043 (1,730) 60 (69) 25 (17) 19 (20) 15 (13) 59 (50) Totals 11,491 (10,000) 383 (470) 146 (151) 117 (119) 112 (138) 375 (408) Specials All Ages 1st Tests Retests Failures Totals Both Ears One Ear Right Left Totals 1,110 (1,053) 296 (277) 178 (193) 96 (95) 125 (140) 399 (428) CHIROPODY The demand for chiropody for school children remains fairly consistently high as a result of parents having become increasingly foot conscious over recent years. As usual, many school children attended the clinic for treatment for plantar warts, and more boys suffered with chilblains and clawing toes, no doubt due to wearing stretch socks. The incidence of verrucae showed some increase. Hallux valgus was again less common than in the past few years as shoes are a slightly better shape. On the whole, children's feet were in a much better condition and mothers now demand that the feet are measured each time they buy new shoes. Chiropody— School Children Treated 1969 School or Clinic New Cases 1st Attendance this year of old cases Re-attendance Total Kilburn Square 55 15 224 294 London Road 38 8 147 193 Monks Park 5 2 30 37 Mortimer Road 24 6 97 127 Neasden Clinic 36 15 279 330 Stag Lane Library 31 20 146 197 Stonebridge 79 23 205 307 Pound Lane 5 8 43 56 Totals 273 97 1171 1541 63 SPEECH THERAPY Due to a number of resignations of therapists for various reasons, a serious staff shortage has been experienced this year and the treatment of many children has been interrupted. Waiting lists have lengthened for the same reason and at some clinics it has been impossible to arrange sessions at all. The Special Schools too have been affected although the one exception was the Grove Park Special School where perhaps the need is greatest. It is to be hoped that the situation will improve in the coming year. HANDICAPPED CHILDREN AND SPECIAL SCHOOLS blind children At the end of 1969 there were six children, all of them boys, placed in residential schools for the blind. There were three children at Dorton House, Sevenoaks, one at Condover Hall, Shropshire, one at Sunshine House, Sussex and one at Worcester College, Worcester. partially sighted children Unlike the previous group of children who are all boys the partially sighted children consisted of eleven boys and seven girls. At the end of 1969 they were all placed at day schools in the Inner London Education Authority. There were 17 children at John Aird School and one girl at New River School. deaf children At the end of 1969 there were 13 boys and seven girls ascertained as deaf. Four of these boys were of pre-school age and placed in Brent Day Nurseries. These children were seen regularly at the Day Nursery by the peripatetic teacher of the deaf. Ten of the school children were placed at Heston Day School for the Deaf in Hounslow and Blanche Nevile Day School at Tottenham and one girl was at Ackmar Day School in the Inner London Education Authority. The remaining five children are at residential schools, one each at Nuffield Priory School, St. Thomas' School, Basingstoke and Tewin Water School and two children at the Royal School for the Deaf in Margate. partially hearing children Children in Brent who are ascertained as partially hearing are placed in partially hearing classes attached to ordinary schools in the Heston and Tottenham areas where these classes are supervised from the schools for the deaf in these areas. It has always been felt that the journey for Brent children and particularly for the very young was long and tiring and a decision of the Education Committee this year to establish two partially hearing classes attached to Kingsbury Green School has been most welcome and timely. An increasing number of children requiring special education as partially hearing either on a long term basis or for shorter periods has occurred during the last few years and consequendy children have had to wait for places at Tottenham and Heston. It is hoped that these two classes in Brent will be equipped and staffed and ready to admit pupils in 1970. At the end of 1969 there were 35 children, 15 boys and 20 girls, ascertained as partially hearing, six of these were of pre-school age and attended Brent Day Nurseries. Eleven of the children attended partially hearing classes in the Heston area (London Borough of Hounslow) and eight children in the Tottenham area (London Borough of Haringey). There were two children in the partially hearing unit of Haverstock Hill Day School in the Inner London Education Office area. There were four children placed at residential school, at the Royal School for the Deaf, Margate. There were a number of partially hearing children who managed in ordinary classes in Brent schools. These children have hearing aids and their progress was supervised by the peripatetic teachers of the deaf who visit them at school. These children were seen regularly by the consultant otologist at Neasden Audiology Unit in consultation with the peripatetic teacher of the deaf and if these children were found to be experiencing difficulties in class, transfer to partially hearing units was arranged. It will be very satisfactory to have our own partially hearing classes so that these transfers can be arranged within the Borough. educationally sub-normal children Woodfield Day Special School It was planned in 1968 to increase the provision in 1969 for children requiring special education because of learning difficulties as the numbers of these children in the Borough had increased very consider ably, particularly in the senior age groups. This increase was partly due to the actual increase in the number of school children in Brent and it is estimated that about L% of children havs learning difficulties and may require special education. Also there was an increase ii the number of older immigrant children in Brent, many of whom for various reasons presented learning difficulties. The Junior and Senior Sections of the school at Woodfield were to be separated, the former being transferred to the Manor School in The Avenue, Broidesbury, the seniors remaining at Woodfield. Due to the delays in the building alterations at the Manor School the opening in September 1969 was postponed and both the Head Teachers of the Junior and Senior Sections of the school had to manage their separate schools in Woodfield until the end of 1969. 64 At the end of 1969 there were 36 Juniors and 149 Seniors in Woodfield and 30 children on the waiting list for admission. During the year 37 children left the school, the majority of these reaching school leaving age at 16 and the others either as removals to other areas or schools in other districts. Three children reached a scholastic standard which enabled them to return to ordinary school. Children are only admitted to Woodfield Special School after careful consideration both educationally and medically. A full assessment is made by the Educational Psychologist on referral of a child either by the Head Teacher or other source and this is followed by a full medical examination when all the information from the Head Teacher, the Educational Psychologist, and medical specialist, if involved, is considered before making a decision concerning the child's need for special education. Following admission to Woodfield School the staff and Head Teacher periodically review the children's progress and refer for further assessment those children they consider may be suitable for transfer to ordinary school again or to other special education. The health of the children at Woodfield is carefully supervised both by regular medical examinations and by special examination at the request of the Head Teacher or pupil's parents. For any further treatment or investigation referrals are made to General Practitioners or to Consultants at Hospitals with the General Practitioner's permission. Children are referred to the Local Authority Eye, Dental, Orthopaedic, Ear, Nose and Throat or Audiology Clinics and these provide an excellent service for detection and treatment of defects. Many of the children at Woodfield have speech defects and the speech therapist attended the school for six sessions a week. The School Nurse attended the school regularly and gave health education talks to the children. Other Special Day and Residential Schools Thirty-three Brent children attend other Day Schools for Educationally Sub-Normal Children at Montfort House, Golders Green, Oak Lodge School in East Finchley, the Shaftesbury School in Harrow, Marjorie Kinnon School in Bedfont, Hedgewood School, Hayes, Northway School, Barnet and St. Hubert's School and Holly Court in the Inner London Education Authority. There are 15 Brent children placed at residential special schools, 11 boys at Swaylands School. Penshurst and four girls at Clay Hill House Hostel, Enfield. There were 13 Brent children placed in independent residential schools. epileptic pupils The majority of children with epilepsy remain in ordinary schools and their seizures are well controlled by modern medication. Occasionally however these children suffer from frequent and more serious fits and require supervision during the day that is not possible at ordinary schools. Sometimes these children may be placed at day schools for delicate children or at Grove Park School for physically handicapped children when the fits are associated with a physical handicap. On occasion admission may be arranged temporarily to Grove Park School while medication brings the seizures under control and the child subsequently returns to ordinary school. Residential school is arranged for children with more serious difficulties. At the end of 1969 there were four epileptic children at Grove Park School and four children placed residentially at Lingfield Hospital School in Surrey. One child was receiving home tuition. maladjusted children The number of children at the end of 1969 ascertained as maladjusted had risen since the previous year from a total of 113 to 150, This number did not include all the children who attended our two Day Special Schools for Maladjusted Children (Barretts Green and Vernon House) as many were placed there informally. Sixty-nine of the 150 ascertained children were placed at Residential Schools for Maladjusted Pupils and at independent Residential Schools accepting maladjusted children. A number of children who were thought to be mildly maladjusted were placed at Brent's Residential School, Tylney Hall. Barretts Green School The children attending Barretts Green School are of secondary school age and at the end of 1969 there were 15 boys and girls on roll, many of whom were seriously disturbed and required considerable individual attention. The school will accommodate 40 pupils and it is likely that in the next year this number will be reached. With the increase in the number of staff and pupils during the year the provisions for a full curriculum became easier and by the end of 1969 a wider range of activities was provided. Vernon House School This school is situated in Willesden Lane and originally housed the Willesden Education Offices. The building has been extensively adapted to accommodate 40 children o f primary school age who have behaviour difficulties which are interfering with their learning abilities in ordinary schools. At the end of 1969 one classroom of ten children was still being occupied by the Special Infants Class but this is expected to be transferred to the Manor School in 1970. The extra classroom is badly needed as there is a waiting list of children requiring placement at Vernon House. By the time these children have been referred for problems of maladjustment they are very much in need of help and waiting for a place adds to their difficulties and creates a greater problem in their management when they are admitted. 65 At the end of 1969 there were 30 pupils on roll in Vernon House and ten children in the Special Infants Class. There were 13 children on the waiting list and during the year 14 children were admitted and ten left. Of the ten leavers five returned to ordinary school at secondary age and three other children were transferred to special schools for maladjusted. The other two children left the district. Special Infants Class in Vernon House School This class provides places for ten children of infant age who because of a variety of difficulties which interfere with learning would find the ordinary class at primary school impossible to contend with. At the end of 1969 there were 17 children awaiting a place in this class and when this group of children is moved to the Manor School a second class is expectedto be established. Regular reviews were made of the progress of the children in this special class and only after full educational, psychological, and medical assessment were decisions reached about the children's future schooling. Regular medical examinations were carried out at both Vernon House and Barretts Green School and the school nurses visited periodically. Monthly case conferences were held at both schools with the staff of the school, the child guidance team and the school doctor together with representatives from other departments involved in the children's care. physically handicapped children Grove Park School The delightful buildings and surroundings of this School have provided an ideal setting for the teaching of handicapped children. The School throughout 1969 was full and there was a waiting list of children for admission. At the end of 1969, there were 123 children in the School, 76 of these Brent children. Lower Place School and then Grove Park School have always accepted a certain number of children from adjacent boroughs and at the end of 1969, there were 47 children from Barnet, Ealing and Harrow. The School is an all-age school and most of the 22 new admissions during 1969, were in the younger age group but there were a few more in the older age group this year, many of them immigrant children. It is always encouraging to report that children have returned to ordinary school and of the 30 children who left during the year, five were able to join ordinary classes, 16 left at school leaving age and the remaining leavers either transferred to other special schools or moved to another area. The pattern of disabilities in pupils attending has changed greatly in recent years. While there are still some 34 children with cerebral palsy we now have few with defects resulting from infections such as poliomyelitis, rheumatic heart disease, chronic chest and bone diseases and kidney disease. With the modern advances in surgery more children survive who have congenital abnormalities and this in particular has affected the children born with spina bifida and we had at the end of 1969, in Grove Park School, 14 children with this abnormality, whereas ten years ago only one or two such children attended the school. Other congenital abnormalities are in greater number in the School and usually these are multiple in nature. As a result of this change, handicaps tend to be more extensive and multiple and this creates greater problems for the teaching staff resulting in the need to reduce the size of classes. Whereas it was possible to teach 20 children in one class, now this number must be reduced to enable each child to have the attention required. Associated with this change in the type of handicap seen in schools for the physically handicapped has arisen the more serious problem of placement in work on leaving school. Changes have taken place in industry leading to greater mechanisation and automation with the result that fewer jobs are available for children with any handicap and particularly the physically handicapped child. The solution to this problem can only be met at Government level with the production of a wellformulated and planned national policy for the employment of the handicapped and most particularly the young school leaver. Plans were considered for the establishment of a nursery class at Grove Park and this is very seriously needed. The type of child now being admitted to school, as previously mentioned, because of congenital abnormalities has very often been immobilized since birth and has never had an opportunity of experiencing the normal activities of ordinary children. If this child is not admitted until the age of five it may well have missed some of the most valuable experiences of early childhood unless we can provide this in a special nursery. The provision of this nursery is a priority in the care of the handicapped child. Regular medical examinations were carried out at the School during 1969, and the children were periodically assessed concerning their progress and the need for any further special treatment. Close liaison was maintained with specialists in charge of the children at the various London hospitals. Vision and hearing are regularly tested and a consultant opthalmologist visits the School twice a term. The orthopaedic consultant attended the School several times a term and any corrective surgery required was carried out at the Stanmore Orthopaedic Hospital. The children from the two special classes with hearing handicaps and other partially hearing children in the School were supervised at Neasden Audiology Unit by the consultant otologist. Three full-time physiotherapists provided treatment in the large physiotherapy department and the adjacent hydrotherapy pool. Children who were able also visited the swimming baths with the School. The School Nurse who is in full-time attendance at the School is supported by welfare assistants who help with the care of the children. This work can be very heavy as many of the children are seriously handicapped and require considerable attention. 66 Residential Schools for Physically Handicapped Children There were two children placed in residential schools, one at St. Michael's, Eastcote and the other at Tylney Hall near Basingstoke. children with speech defects There were, at the end of 1969, 781 boys and 274 girls who suffered from a speech defect and were receiving speech therapy. 771 of these children attended Brent Primary and Secondary day Schools and seven Independant Day schools. 277 of the children were under five years of age. No speech defects are included in this group arising from deafness. delicate and diabetic children At the end of 1969 there were 39 boys and 16 girls ascertained as in need of special schooling in this group. Twenty-one of the children attended day schools amongst which were John Keats and Wood Lane Schools in the Inner London Education Authority and Hazelbury School in the London Borough of Enfield Two children were placed as delicate at Grove Park School. The residential schools attended by the 31 children placed out of London include Tylney Hall, Nr. Basingstoke, Suntrap School, and St. Patricks School, Hayling Island, St. Dominies School, Surrey, Elmers Court, Lymington, Park Place, Henley-on-Thames, Port Regis School, Broadstairs, St. Stephens School, Kent. One child was placed at Palingswick Diabetic Hostel, Hammersmith. RETURN OF HANDICAPPED PUPILS, YEAR ENDED 31st DECEMBER, 1969 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 8 — — — 6 — Partially-Sighted Pupils 13 6 2 — 11 7 Deaf Pupils 13 7 1 — 13 7 Partially Deaf Pupils 16 15 — 5 15 20 Delicate Pupils 30 12 13 5 39 16 Diabetic Pupils Educ. Sub-Normal Pupils 125 102 17 21 129 119 Epileptic Pupils 10 1 — 1 10 1 Maladjusted Pupils 87 26 20 8 119 31 Physically Handicapped Pupils 33 27 5 5 34 25 Pupills with Speech Defects 727 255 124 46 781 274 Pupils with Multiple Defects 36 27 4 2 37 24 Totals 1,098 478 186 93 1,194 524 Grand Totals 1,576 279 1,718 0\ RETURN OF HANDICAPPED PUPILS, YEAR ENDED 31st DECEMBER, 1969 Distribution 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 - - 6 - - - - - - - 6 - Partially-Sighted Pupils 11 7 - - - - - - - - 11 7 Deaf Pupils 5 6 4 1 — — — — *4 — 13 7 Partially Deaf Pupils 8 13 3 1 3 1 - - *i *5 15 20 Delicate Pupils 9 3 23 8 6 4 — 1 i — 39 16 Diabetic Pupils Edu. Sub-normal Pupils 88 83 18 5 13 15 10 **16 - - 129 119 Epileptic Pupils 3 1 4 — 2 — — — †1 — 10 1 Maladjusted Pupils 21 3 29 — 32 10 37 18 — — 119 31 Physically Handicapped Pupils 26 21 2 - 4 2 - - *2 §2 34 25 Pupils with Speech Defects - - - - 596 175 6 1 179 98 781 274 Pupils with Multiple Defects 28 19 5 3 1 2 2 — *1 — 37 24 Totals 199 156 94 18 657 209 55 36 189 105 1,194 524 Grand Totals 355 112 866 91 294 1,718 * Attending Day Nursery. ** 1 girl placed in private School by parents, † eceiving home tuition by parents. § 1 girl in Day Nursery. 68 TYLNEY HALL SCHOOL Tylney Hall School caters for mildly maladjusted and mildly delicate boys whose handicap is such that they do not require psychiatric support or medical treatment. In other words, so far as maladjusted boys are concerned this is not a school for those who are seriously disturbed but for those whose maladjustment is so mild that often the change in environment in itself provides most beneficial results. Provided there is room the school may also accommodate some ordinary boarders. The school is housed in a late nineteenth century family mansion (formerly belonging to the Rotherwick family) standing in some 100 acres of pleasant Hampshire countryside. It is about seven miles from Basingstoke, twelve miles from Reading and forty-five miles from London. There are extensive playing fields, tennis courts and a swimming pool. The normal classrooms and craft rooms are supplemented by a library, a hall (the original ballroom), a gymnasium and recreation rooms for leisure time activities. The non-teaching staff includes full-times supervisors who, in conjunction with the teachers, are responsible for the welfare of the boys out of school hours. Catering is dealt with by a superintendent who, with matron and other staff, is also responsible for the boys' general welfare. In broad terms the curriculum followed is designed to meet the needs of boys in secondary modern schools. Since the classes are small a good deal of individual and group work is possible. Every advantage is taken of the rural surroundings and craft-work, rural studies, gardening, etc., play an important part in the school programme. The boys as appropriate take the normal C.S.E. and/or R.S.A. Examinations. The after-school activities include such things as The Young Farmers' Club, Scouts, a cycling club, craft clubs, Judo, and week-end camping during the summer. Visits are made to such places as Winchester, Southampton and Reading. The boys sleep in small dormitories, varying from three to twelve beds in size. Meals are served in the large dining hall on small tables and are supervised by members of the staff. Special attention is paid to the needs of delicate children. There is a resident school nurse and the school doctor is always available. The boys attend local churches according to their denomination and clergy visit the school regularly. There are normally two or three visiting days a term and parents are informed of the arrangements directly by the school. The usual school holidays are taken at home including long half-term holidays. The maximum number of boys to be accommodated is 130. NEASDEN AUDIOLOGY UNIT During 1969 Neasden Audiology Unit continued to provide a diagnostic, follow-up and supervisory service for children with hearing difficulties in the Boroughs of Brent, Harrow and part of Barnet. The number of referrals to the Unit has continued to rise and during the year 1969, 450 children were seen and of these 165 were new patients. Of the new children seen 71 were pre-school age and a common cause of their referral was failure to develop speech. This delay in speech development was not often found to be due to a hearing defect but was found commonly in association with a child's poor environment, lacking stimulation and deprived of adequate maternal care. These children often showed slow development in spheres other than speech. With both parents working long hours many of the children had suffered frequent changes of child minder with consequent damage to their emotional, social and on occasion, their physical development. For both the hearing handicapped and the disadvantaged child, as described above, nursery placement is vital and these children have, where possible, been placed in Brent Day Nurseries so that they may have the skilled and understanding care given by staff there. This has resulted in a general all-round improvement in many of the children. Immigrant children found to be deaf or partially hearing whose language is not English have presented a considerable problem. Some of school age on arrival in this country have had little schooling in their own countries and no early auditory training and they are faced with the tasks of adjusting themselves to the use of their new hearing aid and of learning English, while at the same time hearing another language at home. The problem is equally difficult for the newly diagnosed very young child who is just commencing to use words and whose mother can only speak one language and whose teacher of the deaf must give auditory training in English. These mothers are encouraged to learn English but this is not always very easy for them. Because of the lengthening waiting list for consultations at the Audiology Clinic, special screening sessions were arranged again in 1969 enabling a preliminary estimate to be made of the child's difficulties and treatment started, a further appointment being given for a later date when fuller investigations were made. At the moment it is only possible for two sessions to be held at the Audiology Unit, one by the Consultant Otologist Dr. Fisch and one by the Senior Medical Officer. The majority of referrals require follow-up at varying intervals from six weeks to a year and the work that has accumulated over the six years since the Unit's establishment is considerable. During the year the work of supervision of children with hearing aids and those with a more moderate loss in ordinary schools, together with the auditory training of pre-school children in their homes or in the day nurseries has increased and the caseload carried by our two peripatetic teachers of the deaf became much too large. An increase in the establishment was granted and a further peripatetic teacher of the deaf is being sought. Brent children who are deaf and partially hearing and who require special schooling attend schoi Is in Heston and Tottenham. We are looking forward to the commencement of the partially hearing unit in Brent when our partially hearing children will not have to travel such long distances to school. During the year a one-way observation window was installed in the Audiology Clinic together with an inter-communication system allowing the small room adjacent to the consulting room to be used by visitors. This has been in constant use and we are very pleased to have visitors to the Unit who are working with children who mav have hearing difficulties. 69 SCHOOL DENTAL SERVICE Report of the Principal School Dental Officer The question of fluoridation of public water supplies was again considered by the Council during the year and again turned down, this time by a very much larger majority. Questioning of parents, however, at school inspections and at treatment sessions reveals that of those who know what fluoridation means, a majority would welcome the adoption of this measure. It is pleasing to note that few children leave school with an unhealthy mouth, but the number of fillings in the mouth of the average school leaver is still on the increase. Emphasis must therefore continue to be on prevention and in this context dental health education is being linked to a greater degree with school inspections when children and parents can be reached simultaneously. CHILD GUIDANCE SERVICE Prepared by Mr. C. Graham, b.sc., Chief Educational Psychologist Organisation of the Service At the end of the year the waiting lists were a little lower than at the beginning, 314 children to be seen by one of the psychologists (compared with 340 at the end of 1968) and 94 to be seen by one of the psychiatrists (compared with 116 at the end of 1968). This means that there is a waiting period before a child's case is investigated, but this is probably about the same as found in Child Guidance Services in other parts of the country. Naturally urgent cases are always given priority and these tend to be children where reports are needed for the Juvenile Court or children excluded from school where reports are needed for school placement purposes. The Service continues to be organized geographically into the Kingsbury Child Guidance Centre in Church Lane serving the Wembley area, and the Kilburn Child Guidance Centre in Brondesbury Villas serving the Willesden area. The Educational Psychologists in the School Psychological Service deal with problems, usually more of a learning nature, from the schools and the whole team in the Child Guidance Centres deals with the more deep-seated emotional problems of children referred from any source. Referrals There were just 1,000 children referred during 1969 (compared with 919 in 1968), and this can be subdivided as follows:— Kingsbury Kilburn Total School Psychological Service 111 518 629 Child Guidance Centres 170 201 371 Total 281 7l9 1,000 Clearly the main pressures come from school referrals from the Willesden side of the Borough. With a Brent school population of 40,000, the referrals make up 2½% of the total school population. This is not excessive when it is considered that the Service deals with any problem of an emotional or learning nature. As can be seen from Table 2, of the referrals to the Child Guidance Centres, about a third come from medical sources, about a quarter from the schools and about a fifth from parents themselves. Table 1 shows the usual preponderance of boys in the referrals, but the proportion is not now quite as great as 2:1 as found in previous years. Altogether 270 children during the year received some form of individual help for varying periods of time, sometimes as often as an hour twice a week, sometimes as infrequently as half an hour once in two months. About half the number of children receiving regular help were seen by one of the two psychiatrists, the remainder were seen largely by the psychotherapists. The number of children seen regularly has increased greatly year by year viz:— 1965: 146 1967: 173 1969: 270 1966: 162 1968: 182 The same high proportion (62%) of the Child Guidance Centre referrals are for behaviour problems, usually where the child makes life difficult for the teacher or parent. Naturally many of these require investigation but the dual plea made in previous annual reports needs making again. First, there is little that the Child Guidance Service has to offer if parents do not, or will not, see the problem and are not co-operative. Secondly, the preponderance of this type of referral should not detract from the referring of the less difficult but equally important type of child where withdrawn, sensitive, nervous and psychosomatic difficulties require investigation. The age distribution (Table 4) is much the same as previous years. It is the hope of the Child Guidance personnel that children be referred at as early an age as possible. The 52 children referred at age 14+ present particular difficulties, and many of these were referred for the first time, but should have been referred at an earlier stage. Staff and Premises The staffing position has been more settled in 1969. The total establishment is filled except for a few sessions of psychotherapists. Miss Villiers began as full-time P.S.W. during the latter part of the year, taking the place of Miss Bardram who left in the earlier part of the year. Mrs Hutten and Miss Dickeson joined the Service as parttime P.S.W's. Miss Michaelides took the place of Mrs. Garner as a clerical assistant. 70 The employment of so many sessional workers is useful in that the more people there are, the more professional viewpoints that can be voiced, however, it does present administrative difficulties. At Kilburn, for example, there are ten people filling by sessional work the establishment of four for P.S.W's and Psychotherapists. At Kilburn there are 18 persons (five of whom are full-time) sharing the ten rooms available. At Kingsbury there are 14 persons (four of whom are full-time) sharing seven rooms. Kingsbury will be using the rooms on the ground floor of the Church Lane building when the Maternity and Child Welfare Clinic moves out. There are no immediate plans to alleviate the pressure on space at the Kilburn Centre. During the year Mr. Graham was granted three months' study leave, and Mr. Rigby was absent for two months on sick leave. Immigration At the beginning of 1969 Brent's school population consisted of 27% immigrants, largely children from the West Indies. There seems little doubt that a higher proportion of these children present problems of learning and behaviour which impinge on the Child Guidance Service. Many immigrants, particularly of Secondary School age, arrive in this country with low educational attainments. Many, because of their long separation from their parents combined with adjustment to a new urban environment, exhibit behaviour problems, often of an "acting out" aggressive nature. There has been some recent national publicity concerning the number of West Indian children designated E.S.N, and placed in Special Schools. In Brent there are nearly double the proportion of immigrant children in E.S.N, schools as compared with the proportion in ordinary schools. This is the same proportion as found in I.L.E.A. Special Schools. Children are not transferred to Special Schools lightly. Full psychological and medical assessments are made on each child. All such children score in the bottom 2% of their age group in both ability and scholastic attainment tests. However, it is quite likely thrft "intelligence tests" of any type do not adequately measure the ability of immigrant children. Exclusions from School During 1969 there were 31 formal exclusions from Brent schools, compared with 23 in 1968. The numbers were made up as follows:— Boys Girls Total Infant 6 0 6 Junior 12 3 Secondary 7 15 22 Total 14 17 31 The number of exclusions of boys is about the same as last year but the number of girls has doubled, and now exceeds the number of boys excluded. As can be seen, about half the children excluded from school are secondary girls. Of the 31 children excluded, 24 were of immigrant origin. Of the 31 children, nine were returned to the same school, ten were transferred to a different normal school, three were transferred to E.S.N. Special Schools and nine were placed in Maladjusted Special Schools. Provision of Special Schools and Classes Vernon House Primary Day School and Barretts Green Secondary Day School are dealing with maladjusted pupils in the Borough. Both have 40 places. At the end of the year the Special Infants Class at Vernon House moved into the new Manor Primary E.S.N. School, thereby allowing more places for maladjusted pupils. The schools for maladjusted children must not be regarded as dumping grounds for discipline and delinquency problems in the ordinary schools. Admission to these schools is dealt with by consultation amongst the Child Guidance Service, the School Health Department and the headteachers. Particularly for Barretts Green Secondary School, children are put forward in their last year at school, and where they have never been referred before. Few of such cases can be helped by a school transfer, and, in any case, it would be quite unfair to expect the staff of Barretts Green School to deal with such problems. The six Remedial Reading Classes dealt with 206 children during the year (155 boys and 51 girls). This preponderance of boys is usual for such classes. Liaison with other Agencies Each month at Kilburn the School Medical Officers attend for a case conference with the Child Guidance staff. Each month, Dr. Graf and Mr. Graham spend an afternoon at a case conference at the Barretts Green Reception Centre. The Brent Consultation Centre as a walk-in-service for adolescents has probably relieved the pressure of the older cases that might have been referred to ths Child Guidance Service. In conclusion, the Child Guidance Service is most grateful to Mr. Wyeth and the Education Department, and Dr. Grundy and the Health Department for their close co-operation. 71 CHILD GUIDANCE CENTRES Table 1. Referrals Number of cases referred to the Centre in 1969 (145 girls, 226 boys) 371 Number of cases brought forward from 1968 waiting list 116 487 Number of new cases dealt with by psychiatrist and team 272 Number of cases investigated by Educational Psychologist and P.S.W. or withdrawn before full investigation 121 487 Cases remaining on waiting list at 31.12.69 94 Number of cases seen for regular treatment 270 Number of cases recommended for residential placement 26 Table 2. Sources of Referrals M.O.H. and School Medical Officers (20%) 74 Headteachers and Educational Psychologists (28%) 105 General Practitioners (13%) 49 Hospitals (2%) 6 Probation Officers and Juvenile Courts (2%) 5 Parents (19%) 73 Children's Department (6%) 21 Others (10%) 38 371 Table 3. Reasons for Referral 1. Nervous Disorders (11%) (a) Fears and anxieties 29 (b) Inhibited behaviour 4 (c) Depression 6 2. Behaviour Disorders (43%) (a) At home 91 (b) At school 45 (c) Predominantly aggressive 23 3. Habit Disorders (12%) (a) Enuresis (wetting) 22 (b) Involuntary movements 4 (c) Sleep disturbance 8 (d) Speech disorders 9 (e) Head banging 3 (f) Encopresis (soiling) 1 4. Psychosomatic (2%) Asthma, Eczema, etc. 8 5. Anti-social behaviour (19%) (a) Stealing 43 (b) Non-attendance at school 26 (1%) 6. Psychotic behaviour 4 7. Educational difficulties (12%) Backwardness and retardation in school work 45 371 Table 4. Age Distribution of Referrals Under 5 years 41 12 years 27 5 years 26 13 years 39 6 years 24 14 years 34 7 years 36 15 years 15 8 years 34 Over 15 years 3 9 years 33 371 10 years 32 11 years 27 72 SCHOOL PSYCHOLOGICAL SERVICE Table 5. Reason for Referral to Psychologist Backwardness 220 Assessment for Medical Officer of Health 72 Behaviour difficulties 113 Assessment for allocation to schools 13 E.S.N. School Leavers 24 442 Table 6. Disposal of School Psychological Service Cases Recommendation for Remedial Reading Class 82 Recommendation for Special School 62 Recommendation to Medical Officer of Health 67 Advice to schools 68 Referral to Child Guidance Centre 46 Cases to be reviewed 68 Recommendation to Chief Education Officer 33 Advice to parents 13 Notification under 57(3) as severely subnormal 3 442 Table 7. Waiting List for Psychologists at 31.12.69 School Psychological Service 220 Cases for Review 56 Cases for testing in Child Guidance Centres 38 314 Table 8. Unattached Classes Numbers Attending Remedial Reading Classes in 1969 Bridge Remedial Teacher: Mrs. Zurawski Boys Girls Total Primary 11 5 16 Secondary 12 2 14 Total 23 7 30 Granville Remedial Teacher: Mr. Lovell Boys Girls Total Primary 34 14 48 Secondary 2 - 2 Total 36 14 50 Mora Remedial Teacher: Miss Kiverstein Boys Girls Total Primary 14 6 20 Secondary 9 3 12 Total 23 9 32 73 Lower Place Remedial Teacher: Mrs. Richmond Boys Girls Total Primary 14 2 16 Secondary 9 5 14 Total 23 7 30 Sudbury Remedial Teacher: Mrs. Scott Boys Girls Total Primary 13 5 18 Secondary 12 1 13 Total 25 6 31 Kingsbury Green Remedial Teachers: Mrs. Hyams (half time) Mrs. Ghaleb (half time from 17.11.69) Miss Marriot (half time until 30.9.69) Boys Girls Total Primary 14 4 18 Secondary 11 4 15 Total 25 8 33 PROVISION OF SCHOOL MEALS AND MILK Milk Free milk was supplied during 1969/70 to all children in maintained primary and special schools. The result of a census taken on a day in September 1969 showed that 22,218 children received one third pint. Of children present on that day, this amounted to 98% of infants, 90% of juniors and 88% of pupils in special schools. Children of primary age in non-maintained schools are also supplied with free milk. About 1,050 bottles per day were provided during 1969/70. School milk is pasteurised and the supplying dairies are supervised by the Medical Officer of Health. Meals Meals are served to maintained schools in 88 different premises. The average number provided to pupils on each school day during 1969/70 was 26,900 and during holidays, 360 per day. Cost of School Meals and Milk Total expenditure on school meals and milk for 1969/70 was estimated at £865,790 and income from payments and other sources at £350,660. This gives a net expenditure of £515,310 chargeable on the rates The Report is the work of many members of the Department and will be of interest to Members, disclosing to them the extent and scope of the School Health Service. Your Obedient Servant, E. GRUNDY, Principal School Medical Officer. APPENDIX 75 MEDICAL INSPECTION AND TREATMENT Number of pupils on registers of maintained primary, secondary, special and nursery schools 41,234 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) 1965 and later 443 443 6 19 19 1964 2,335 2,321 14 71 102 164 1963 1,314 1,297 17 34 51 80 1962 332 322 10 24 21 45 1961 1,485 1,444 41 84 76 147 1960 541 536 5 38 38 70 1959 962 936 26 44 39 83 1958 1,720 1,702 18 81 93 158 1957 620 619 1 32 37 62 1956 213 211 2 6 6 11 1955 527 524 3 18 29 43 1954 and earlier 1,674 1,660 14 45 65 104 Total 12,166 12,015 151 483 576 986 Col. (3) total as a percentage of Col. (2) total 98.74% Col. (4) total as a percentage of Col. (2) total 1.24% 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 1,693 Number of Re-inspections 1,609 Total 3,302 Table C. Infestation with Vermin • Notes:—All cases of infestation, however slight, are included in Table C. The numbers recorded at (b), (c) and (d) 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 19,220 (b) Total number of individual pupils found to be infested 174 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 105 (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act. 1944) – 76 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 32 Errors of refraction (including squint) 1,758 Total 1,790 Number of pupils for whom spectacles were prescribed 650 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 5 (b) for adenoids and chronic tonsillitis 30 (c) for other nose and throat conditions — Received other forms of treatment 15 Total 50 Total number of pupils in schools who are known to have been provided with hearing aids: (a) in 1968 5 (b) in previous years 32 Table C. Orthopaedic and Postural Defects Number known to have been treated (a) Pupils treated at clinics or out-patients departments 624 (b) Pupils treated at school for postural defects 6 Total 630 Table D. Diseases of the Skin Number of pupils known to have been treated Ringworm (a) Scalp ... — (b) Body ... — Scabies ... 52 Impetigo ... 4 Other skin diseases ... 12 Total 68 77 Table E. Child Guidance Treatment Number known to have been treated Pupils treated at Child Guidance Clinics 487 Table F. Speech Therapy Number known to have been treated Pupils treated by speech therapists 451 Table G. Other Treatment Given Number known to have been dealt with (a) Pupils with minor ailments 1,503 (b) Pupils who received convalescent treatment under School Health Service arrangements 19 (c) Pupils who received B.C.G. vaccination 1,784 (d) Other than (a), (b) and (c) above Please specify : Lungs (Breathing Exercises) 32 Psychological (Stability) 102 (Development) 6 Developmental (Hernia) 5 Total: (a) —(d) 3,451 78 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 19 15 28 62 6 O 241 100 227 568 26 5 Eyes—a. Vision T 118 56 272 446 106 O 341 251 486 1,078 68 b. Squint T 30 3 24 57 2 O 90 10 77 177 3 c. Other T 5 7 6 18 — O 24 7 49 80 1 6 Ears—a. Hearing T 6 3 14 23 46 O 165 44 131 340 48 b. Otitis Media T 5 1 5 11 — O 158 21 119 298 — c. Other T — — 5 5 9 O 71 8 77 156 17 7 Nose and Throat T 23 6 29 48 10 O 525 68 327 920 19 8 Speech T 36 2 20 58 39 O 104 18 65 187 10 9 Lymphatic Glands T 1 — 5 6 1 O 272 20 185 477 18 10 Heart T 10 1 4 15 — O 109 14 67 190 — 11 Lungs T 8 6 6 15 5 O 163 24 133 320 15 12 Developmental—a. Hernia T 6 1 7 14 — O 103 11 74 188 2 b. Other T 3 — 7 10 6 O 130 9 132 271 19 13 Orthopaedic—a. Posture T 11 12 22 45 4 O 63 55 153 271 2 b. Feet T 21 20 82 123 18 O 141 57 237 435 58 c. Other T 7 11 6 24 27 O 58 21 59 138 20 14 Nervous System—a. Epilepsy T 2 — 5 7 — O 15 4 27 46 1 b. Other T — 1 — 1 — O 13 1 16 30 2 15 Psychological—a. Development T 1 4 2 7 2 O 63 13 86 152 24 b. Stability T 43 41 63 147 54 O 403 88 494 985 148 16 Abdomen T — — — — — O 58 29 87 174 1 17 Other T 225 36 402 663 26 O 58 47 94 199 430 T = Pupils found to require treatment. O = Pupils found to require observation. 79 SCHOOL DENTAL SERVICE Number of Pupils on the Register of Maintained Primary and Secondary Schools including Nursery and Special Schools in January 1969 as in Form 7, 7m and 11 Schools 41,234 Attendances and Treatment Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First visit 3,526 2,452 736 6,714 Subsequent visits 6,566 7,544 2,473 16,583 Total visits 10,092 9,996 3,209 23,297 Additional courses of treatment commenced 515 610 186 1,311 Fillings in permanent teeth 2,442 7,471 3,515 13,428 Fillings in deciduous teeth 7,695 770 — 8,465 Permanent teeth filled 3,081 6,317 2,929 12,327 Deciduous teeth filled 6,731 699 — 7,430 Permanent teeth extracted 187 599 164 950 Deciduous teeth extracted 2,618 706 — 3,324 General anaesthetics 1,018 385 39 1,442 Emergencies 261 133 50 444 Orthodontics Number of Pupils X-rayed 788 Prophylaxis 1,136 Teeth otherwise conserved 437 Number of teeth root filled 33 Inlays 1 Crowns 15 Courses of treatment completed 6,014 Cases remaining from previous year 134 New cases commenced during year 132 Cases completed during year 58 Cases discontinued during year 55 No. of removable appliances fitted 285 No. of fixed appliances fitted 43 Pupils referred to Hospital Consultant 34 80 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) — 13 6 19 Number of dentures supplied — 13 6 19 INSPECTIONS (a) First Inspection at school. Number of Pupils 16,659 (b) First Inspection at clinic. Number of Pupils 5,681 Number of (a) + (b) found to require treatment 12,691 Number of (a) + (b) offered treatment 12,290 (c) Pupils re-inspected at school clinic 2,178 Number of (c) found to require treatment 1,442 Sessions Sessions devoted to treatment 4068.5 Sessions devoted to inspection 225.5 Sessions devoted to Dental Health Education 11.5