AC 439 GS EAL 50 31/10/60 The Health of Ealing in the year 1959 The Health of Ealing in the year 1959 BEING THE ANNUAL REPORT OF THE Medical Officer of Health WILLIAM G. BOOTH, M.D., B.S., D.P.H., Medical Officer of Health. Town Hall, Ealing, W. 5. Telephone: Ealing 3030. INDEX Page Section 1 - INFECTIOUS DISEASES 7 Section 2 - SANITARY CIRCUMSTANCES OF THE BOROUGH 11 Section 3 SANITARY INSPECTION 23 Section 4 - GENERAL 35 Section 5 STATISTICAL TABLES 47 Section 6 - APPENDIX REPORT OF THE DISTRICT SCHOOL MEDICAL OFFICER 53 Supplement - FOR GENERAL INFORMATION 70 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT William G. Booth M D , B.S, , D P H. I.H. Seppelt MA .M.B.J Chip, , D, P, H. G. T.H. Blackie Retired July E. Bel field Appointed July E.H. Evans C. W, Baxter E. W. Budd A. E. Pooley G. 0. Axon A.. C. Bamping N.V. Saunders L. E. Bowskill Appointed July J. A. Crisp Appointed July A, S, M. Pratt Barrister-at-Law Miss D.E. McKenzie R. S. Leggatt D. R. A. Smith Miss S. Pox Mrs. D. Barker Mrs. M. G. Byford R.M. Newbur M. L. Aldridge Appointed July R. S. Cox R. Lazzolo P. Bedley L.B, Radford E. Sheldrick Medical Officer of Health Deputy Medical Officer of Health Chief Public Health Inspector Chief Public Health Inspector Public Health Inspector " " " " " " " " " " " " " " " " " " " " " " " " " " " Chief Administrative Assistant (Part-time) Secretary to Medical Officer of Health Clerk " " Clerk and Typist Shorthand Typist Trainee Public Health Inspector Trainee Public Health Inspector Assistant Rodent Officer Rodent Operative " " Driver/Disinfector " " 5 Mr. Mayor, Aldermen and Councillors, The year 1959 has been one of consistent progress in the carrying out of the programmes laid down by the Council and I am glad to be able to report that we have had no major epidemics, nor any substantial set-backs in our work. The Clear Pood policy of the Council has been most successful in ts effect on the general outlook of traders and workers :n industry and there is little doubt that our continual propaganda through school leavers and food workers is having a substantial effect. The continued drop in Tuberculosis deaths is most satisfactory and there is every reason to hope that within a very short space of time this disease will no longer be one of any considerable concern as a public health problem. One of the major developments in Public Health throughout the whole country has been the establishment of Clean Air Zones, and since Ealing is included among the 'black areas' as far as atmospheric pollution is concerned, we have taken our full share in establishing a programme which is being implemented year by year in specified portions of the district. Every new zone is a step forward in the general picture which we must achieve as soon as possible. Details of our own schemes are included in the bulk of the Report and will, I am sure, be found of interest to members of the Council. As previously, some outline of the general health services carried out on an area basis is given, since it is the Borough Councils duty to take cognisance of all health matters within their boundary and, since the Royal Commission on the Re-Organisation of Local Government in Greater London may well affect the health services in Ealing; it is desirable that the particulars of the present services should be kept before you During 1959 we lost the services of our Chief Health Inspector, Mr G T.H Blackie, who has retired after forty years service, and who had been in the service of the Borough for thirty years. This was naturally a great loss to the Health Department, but you will be glad to know that Mr. Blackie is now in good health and is finding much pleasure in his retirement. It is a matter of extreme gratification that in the Local Government Service men of the calibre of George Blackie are giving such excellent service to the community and are prepared to devote their 6 lives to Local Authority Service. We wish him every happiness and a long life to enjoy his well earned retirement. During the year a number of developments in connection with Old People's care have been inaugurated particularly in the field of Old People s Workshops and Chiropody details of these are given in the Report. The Council are always most appreciative of the voluntary work given in the organisation of these services and I have always been most fortunate in having the fullest co operation from the bodies dealing with it. We have been hoping for some time to introduce a Rest and Treatment Centre for the elderly and we feel this might cover a need in dealing with some of the conditions which cannot at present be dealt with by General Practitioners. Through the agency of a special centre for physiotherapy and other treatments, with the backing of the Council and with the approval of the Ministry of Health, there now seems every prospect that during 1960 we may be able to make substantial progress in establishing such a Centre. It is still too early to talk of the potential that may be explored as a result of this scheme, but there would seem good grounds for attempting to try such an experiment in a Borough such as Ealing where so many experimental schemes have been tried and where so many have been successful in the past. The gaps made in the overall picture of medical services by the division of medicine into the hospital, practitioner and local authority services, need to be filled and this may well be one of the links needed to improve the present availability of treatment facilities among the elderly. The Council will, I am sure watch the progress of the experiment with great interest. May I express my appreciation of the excellent services given by all the members of the health staff during the year. I am much indebted personally to all of them. Your obedient servant, W. G. BOOTH, Medical Officer of Health. 7 SECTION 1 INFECTIOUS DISEASES CONTROL The diseases notifiable under the Public Health Act. 1936 are smallpox, cholera, diphtheria, membraneous croup, erysipelas, scarlet fever typhus, typhoid, enteric and relapsing fever. The Minister of Health has also made regulations under this Act whereby the following diseases are notifiable: plague, poliomyelitis, tuberculosis, puerperal pyrexia, ophthalmia neonatorum, malaria, dysen tery. acute primary pneumonia, acute influenzal pneumonia, measles, whooping cough, acute encephalitis and meningo coccal infection Pood Poisoning is notifiable under the provisions of the Pood and Drugs Act of 1955 and Gastroenteritis under the Milk and Dairies (General) Regulations, 1959 made under this Act. 2,844 cases of Infectious Disease were notified in the Borough during the year. Of these 6 were proved not to have suffered from the disease for which they were originally notified, reducing the corrected number of cases of Infectious Disease during the year to 2 838. DIPHTHERIA There were no cases. During the year 2 204 primary immunisations were given either at Clinics or by General Practitioners and 1.798 booster doses. 1.725 children under one year had primary immunisations which means that approximately 73% of children in their first year of life were immunised in Ealing DYSENTERY. 194 cases were notified compared with 244 in 1958. ERYSIPELAS 9 cases were notified FOOD POISONING. 37 cases were notified. The causative organism was identified in 13 cases. The higher number of notifications was due to an outbreak which occurred following a private staff party in another district but a number of the employees lived in this Borough. 8 MALARIA. No cases. MEASLES. 1,928 cases were notified compared with 985 in the previous year. Epidemics of measles usually occur every two years and 1959 was expected to be an epidemic year, MENINGOCOCCAL INFECTION Two cases were notified. OPHTHALMIA NEONATORUM Three cases occurred, all cleared up, however, without impairment to vision. PNEUMONIA. 154 cases were notified. This is almost the same as in the previous year. 61 males died and 62 females died. POLIOMYELITIS. No cases were notified. Immunisation against Poliomyelitis has continued, arrangements being made for this to be done by family doctors, at clinics, or at places of work, whichever is the most satisfactory arrangement, During the year 1,974 immunisations were given at factories by the staff of the Area Health Department. The figures for vaccination in Ealing from the beginning of the scheme until the end of the year are:- No. vaccinated with two doses Group 32,613 6 months - 15 years. 6,933 16 years - 26 years 2,275 Expectant mothers. 420 Other, (i.e ambulance staff, medical students etc ) It is estimated that 82% of children up to 15 years of age have been immunised with two doses. By the end of the year 35,221 third doses had been given. PUERPERAL PYREXIA. 37 notifications were received compared with 67 in 1958. Two occurred in home confinements and the remainder in hospitals. 9 SCARLET FEVER, 269 cases were notified against 232 in 1958. SMALLPOX. No cases occurred but 8 persons were kept under surveillance on landing from ships in which a case had been reported TUBERCULOSIS, There were 105 pulmonary notifications, 73 males and 32 females.There were 5 male non-pulmonary cases and 5 female non-puimonary cases. There were 5 pulmonary deaths and 1 non pulmonary death, in 1958 there were 10 pulmonary deaths and no non-pulmonary deaths. WHOOPING COUGH There were 80 notifications, practically the same as in the previous year. 1,240 infants were immunised against Whooping Cough in Ealing in 1959. Age Periods Deaths Pulmonary Non Pulmonary 1954 1955 1956 1957 1958 1959 1954 1955 1956 1957 1958 1959 M. F, M. F M. F M F M F. M F M F M F M. F, M. F M, F M F. Under 5 _ _ - .. - . - - - - - - 1 - - - - - - - - - 5 - 14 - - - - - - - - - - - - - - - - ~ - - - - 15 - 24 - - - 1 - - - - - - - - - - - - - - 1 - - - - 25 - 44 3 2 3 1 1 - 1 2 1 1 - - 1 - - - - - - - - 45 - 64 5 3 5 - 11 2 6 3 2 2 1 2 - 1 1 - 1 - 1 - - - - - Over 65 4 2 6 1 5 2 6 2 2 2 1 1 - - - - - - - 1 - ~ — 1 Total 12 7 4 3 17 4 13 7 5 5 2 3 - 1 3 - 1 - 2 1 - - - 1 10 TUBERCULOSIS Age Periois New Cases Pulmonary Non Pulmonary 1954 1955 1956 1957 1958 1959 1954 1955 1956 1957 1958 1959 M. F. M. F M F M. F. M. F M. F M F M F M. F M F M F M. F. Under 5 3 1 1 _ 2 1 4 1 1 2 1 2 2 _ 1 - 1 - _ 1 - - - - 5 - 14 1 2 1 1 2 5 4 1 1 1 4 - - 2 2 4 - - - - - - - 15 - 24 13 24 16 14 14 21 16 12 16 10 10 10 1 2 2 3 2 - 1 1 - 1 1 1 25 - 44 23 26 21 26 22 21 18 12 20 12 24 11 1 4 2 4 1 4 2 6 3 1 - 1 45 - 64 23 11 23 7 29 9 26 5 23 5 31 4 1 3 1 2 4 1 3 1 2 1 3 - Over 65 3 2 6 3 4 4 12 2 4 2 3 5 - 1 2 1 - - - - - 1 3 Total 66 66 68 51 73 61 80 33 65 32 73 32 5 12 10 14 8 5 6 9 5 3 5 5 11 SECTION 2 SANITARY CIRCUMSTANCES OF THE BOROUGH WATER. There are three sources of supply in the Borough. The Northolt Greenford North, Greenford Central and Greenford South Wards, most of Perivale Ward and part of Hanger Hill Ward are supplied by the Rickmansworth and Uxbridge Valley Water Company with the exception of four roads (in part) in the Perivale Ward and one road (in part) in the Hanger Hill Ward which are served by the Colne Valley Water Company The remainder of the Borough is supplied by the Metropolitan Water Board These supplies are not subject to plumbo solvent action and have been satisfactory both in quantity and quality Water from public mains is supplied to 53.343 houses with an estimated population of 182, 700 12 samples were taken from wells at 5 factories in the Borough using water from deep borings ranging in depth from 300 to 600 feet One sample was not completely satisfactory but two further samples taken from the same source proved to be satisfactory. One sample was taken from the mains supply to a private house following the receipt of a complaint and was found.to be satisfactory The fluoride content of Ealing water is in no part of the Borough above the level of 1 part per million. This is the level at which drinking water can be beneficial to dental caries. a fact which has been well demonstrated in the United States and Canada which, together with eleven other countries have water fluoridation schemes In the United Kingdom there are at present three areas where fluorine is being added to the water supply, but no report has yet been issued. The cost in the United Kingdom has varied between approximately 3½d, and 7½d per head which is indeed small compared with the cost of dental services (approximately £1 per head), DRAINAGE AND SEWERAGE The soil sewerage from the district flows to the West Middlesex Drainage Works at Mogden The surface water finds its way out of the district by the various water courses. 21 premises are still not connected to the Council's sewers. 12 RIVERS AND STREAMS. No. of inspections 322 No. of samples taken: (1) By County Engineer 27 (a) Satisfactory 8 (b) Unsatisfactory 19 (2) By Public Health Inspectors (a) Satisfactory (b) Unsatisfactory No, of drainage defects remedied: (a) In factories 6 (b) In houses 13 The sources of pollution can be analysed as follows:- Sinks and handbasins and baths 15 W. Cs. Industrial Wastes 2 Soil sewers and drains 2 ATMOSPHERIC POLLUTION. Clean Air Act, 1956 Smoke Control Areas. The Ealing (No. 1) Smoke Control Order (referred to in the 1958 Annual Report) comes into operation on 1st July, 1960, A further Smoke Control Order was made by the Council during the year and it now awaits the Minister's confirmation. It is proposed that this Order shall come into operation on 1st October, 1960. The area covered by this Order adjoins the No. 1 Area in Northolt. A survey of premises in South Ealing for a third area was also completed and the Minister's approval in principle is awaited. An area in Greenford is at present under inspection for a fourth area. (See map on page 13) At the present rate of progress it is hoped to cover the whole of the Borough in about 15 years (See table on page 14). When Smoke Control Orders come into operation it is an offence to permit the emission of smoke from chimneys caused by the burning of other than authorised fuels. In many cases, in order to burn these fuels replacement or adaptation of existing grates will be required. Grants amounting to 7/10ths of the expenditure are available through the Council towards the cost of any adaptation which may be reasonably necessary. It should be emphasised that in order to qualify for this grant:- SMOKE CONTROL PROGRAMME AS APPROVED IN PRINCIPLE Approximate number of premises in local authority area 59,280 Acreage of local authority area 8 781, Number of premises and acreage of land in smokeless zones and smoke control areas (1) (2) (3) (4) (5) (6) (7) (8) (9) Covered by Orders made up to 31. 12.58 Estimated additions covered by Orders to be made during 1959 Estimated additions covered by Orders to be made during 1960 Estimated additions covered by Orders to be made during 1961 Estimated additions covered by Orders to be made during 1962 Estimated additions covered by Orders to be made during 1963 Final objective (the total numbers it is intended ultimately to cover) Target year for completion of programme Premises l,324 3,475 3,860 4,165 4,255 4,125 59,280 1974 Dwellings 1,303 3,364 3,800 4,070 4,085 3,970 53,610 Acres 385 617 537 509 618 677 8,781 14 15 (1) expenditure on adaptation must be incurred after confirmation of the Order but before its coming into operation; a period of at least six months, (2) it must be incurred with the written approval of the Council and adaptations must be carried out to its satisfaction, or (3) if the work is done after the coming into operation of the Older, notice must have been served by the Council r quiring the works to be done, in which case the Council may do the works in default and recover 3/10ths o ' the cost. Atmospheric Pollution Gauges Three atmospheric pollution deposit gauges together with lead peroxide instruments are sited in the Borough, One site is in Longfield Depot at the rear of the Town Hall, the second at Greenford Green Health Centre and the third at 140 Birkbeck Avenue, There is also an instrument situated in the Town Hall for the measurement of the Daily Mean Concentration of Smoke and Sulphur Dioxide., In November instruments for the measurement of the Daily Mean Concentration of Smoke and Sulphur Dioxide were installed at Eliots Green and Walpole Grammar Schools, It is gratifying to note the interest and co operation of the Headmasters and Science Teachers of these schools in this work. 1959 Deposited matter expressed as tons per square mile per month Sulphur compounds by lead peroxide method expressed as milligrams S0„/day collected by 100 sq. cm. of Batch A Pb02 Birkbeck Avenue Longfield Depot Greenford Green Birkbeck Avenue Longfield Depot Green for Green Jan. 25.58 12. 64 12.02 1.80 2.75 2.30 Feb. 9.40 16. 21 7.85 1.44 3.03 1.94 March 42.36 17. 18 11.81 1. 23 2. 18 1.58 April 16.91 12.57 9. 23 1.36 2.11 1. 22 May 60.70 13 . 04 7. 18 0.64 1.62 0.57 June 24.51 10.58 6.91 0.69 1.04 0.55 July 9. 24 3.50 7.35 0.57 0.34 0.63 Aug 6.90 7.77 3.52 0.66 1.28 0.72 Sept 6.70 10,61 4.87 1.21 2.17 1. 28 Oct. 11.11 13.64 9.60 1.32 2.47 1.66 Nov. 16.41 18.74 12.45 1.76 3.30 1.85 Dec 8.97 14.54 9.26 1.67 3.18 2.03 16 Average Monthly Concentrations of Smoke and Sulphur Dioxide 1959 Smoke in Milligrammes per 100 cubic metres Sulphur Dioxide in parts per hundred million Town Hall Eliots Green School Walpole Grammar School Town Hall Eliots Green School Walpole Grammar School Jan. 30,9 11.5 Feb. 31.17 15. 3 March 15.18 8.5 April 11.0 7.0 May 8. 0 5.4 June 6. 0 4.9 July 5. 0 3 1 Aug 4 0 3,6 Sept 10.0 5.9 Oct 13.0 8 0 Nov. 24.0 22 20 10.0 8.4 8.7 Dec 11.0 10 20 6.3 5.3 7.6 FOOD HYGIENE. The excellent co-operation between Pood Handlers and the Public Health Department; as reported in previous years, continues and again no legal proceedings were necessary to enforce the Pood Hygiene Regulations This year is the 10th anniversary of the inauguration of the Ealing Clean Pood Campaign. The campaign was introduced at a Clean Pood Exhibition when for one week exhibits by the Ministry of Pood, large industrial organisations and local concerns. together with film shows, aroused much interest. Conducted parties of school children were arranged and a visit from the B.B.C. with a subsequent broadcast commentary, gave added publicity and boosted an already satisfactory attendance even higher. Immediately following the Exhibition a Pood Hygiene booklet was issued to all traders and a free course of Pood Hygiene lectures offered. These lectures have been most popular and have been held continuously since. They are given by a Medical Officer and three different Public Health Inspectors, Interest is increased by the use of the film "Another case of Pood Poisoning" our own film strip and a flannelgraph demonstration. They are offered at any time of the day or evening to suit the audience. The Council awards a handsome Certificate of Hygiene to owners of food establishments, including canteens, if their premises are maintained in a really first-class condition and if all the members of their staff have 17 attended the course of lectures. These Certificates bear the official seal of the Council, are signed by the Mayor and are presented at a meeting of the Public Health Committee They are renewed annually, provided the standard is maintained Other features of the campaign include talks to the School Meals Service. to local women's organisations and to girls and boys of school leaving age at school. It has become appare it that personal contact is far more effective in putting over the scheme than letters, posters and so on and the D.strict Health Inspectors do invaluable work in this connection during their inspection of premises If those engaged in the food trade have a real under standing of the reasons why strict hygienic practices should be observed, then we find that they are prepared to co operate fully. Thus, when the 1955 Pood Hygiene Regulations came into force, meetings were arranged with owners and managers in the food trade to discuss this legislation. Packed houses were the rule The Clean Pood Policy of the Ealing Council is a long term one Our talks have so far been given to about 8.000 school leavers and 4 000 food workers, and 61 Certificates have been presented by the Council The campaign has already had considerable success, but this in no way allows for any relaxation. and our efforts in the future will be directed to improving still further the standard of Pood Hygiene in the Borough. During 1959. 19 lectures were given to food handlers and 97 received Certificates of Attendance upon completing the course. In addition 21 talks on Pood Hygiene were given by the Public Health Inspectors to approximately 840 school leavers at the Grammar and Secondary Modern Schools in the Borough The current holders of these 61 certificates are School Meals Service. 21 school kitchens. Factory Canteens Aladdin Industries Ltd , Western Avenue, Greenford. Hoover Ltd., Bideford Avenue: Perivale. Metal Box Co. Ltd., Wadsworth Road, Perivale. Optrex Limited, Wadsworth Road, Perivale. Sanderson A & Sons, Horsenden Lane Perivale. Taylor Woodrow, Limited, Ruislip Road, Northolt. Taylor Woodrow Services Ltd., Western Avenue, W. 5. 18 Food Factories. Quality Poods Ltd., Park Avenue, N,W. 10. - Confectionery Quality Poods Ltd., Park Avenue, N.W. 10. - Synthetic Cream Thomas & Evans Ltd., Corona Works, N.W. 10. - Mineral Waters Restaurants. Bentalls, Limited, Broadway, W.5. British Home Stores, Ltd., 104/8 Broadway, W.13. Baker's Shop, Champion Tea Co., 141 Little Ealing Lane, W.5. Confectioner, Joy Day, 5 Bond Street, W.5. Provision Merchants, J, Sainsbury Ltd., 1/4 High Street, W.5. -do- 51 Broadway, W. 5. -do- 87 Broadway, W. 13. Grocers, Champion Tea Co., 366/8 Windmill Lane, W. 5. H .Cradock Ltd,, 52/3 Manor Road, W. 13, G. & G. E. Robinson, 25 Haven Lane, W. 5. United Dairies (London) Ltd., - 11 shops, Williams Bros. Ltd., 24 Broadway, Greenford. Butchers, W. Hopkins, 48 Boston Road, W.7. R. Mathews Ltd., 165 Boston Road, W,7. G. A, Scott & Son, 2 Eastmead Avenue, Greenford. L. Shaw, 4 Mandeville Road, Northolt. L. Shaw, 6 Station Parade, Ealing Road, Northolt. Sutton & Sons, 34 Haven Green, W, 5 . -do- 7 The Green, High Street, W.5. -do- 1 Station Parade, Uxbridge Road, W, 5. 2,702 inspections of food premises were made and 533 repairs and improvements were carried out. The film-strip on Pood Hygiene made by the Council in 1954 in still in demand, a further 7 copies having been sold during the year. This makes a total of 127 copies sold. During this year we have begun work on the preparation of a new Clean Pood booklet to replace our existing one, supplies of which are now running low. It is felt that in order to have a full impact on its readers a booklet of Presentation of a Food Hygiene Certificate 21 this sort must be of the highest quality, both in material and presentation and we are aiming at this in our new booklet which it is hoped will be published early in 1960. SLUM CLEARANCE. Compulsory Purchase Orders, 1, 2 3, 4, 5, 6, 7, 8 A Compulsory Purchase Order in & 9 Vine Cottages, respect of these properties was Lower Boston load. W 7 made by the Council in April, 1959 No objection was made by the owners and the Order was confirmed by the Minister in October. 1959 Three of the houses are vacant: The remaining six are still occupied pending the adoption of a scheme for redevelopment of the Area Basement Dwellings 43 The Avenue, W 13 A Closing Order was made in respect of this property in April, 1959. The premises were empty at the time and are still vacant 47 Grange Road, W 5 The condition of the basement at this property was considered in December, 1959 An Undertaking by the owner to carry out all works necessary to render the premises fit for habitation was accepted and the work is in hand 58b Ranelagh Road, W 5 A Closing Order was made on this basement in 1952 A specification of works for rendering the premises fit was accepted by the Council and the Closing Order was determined in October, 1959 16a Drayton Green Road, A Closing Order was made on W 13 this basement in December. 1955 A specification of works for rendering the premises fit was accepted by the Council and the Closing Order was determined in October 1959 Demolition Orders 5&6MelboureCottages,The condition of these properW 7 ties was considered by the mittee in May, 1959: and an Undertaking by the owner to carry out all works necessary to render the premises fit for habitation within six months was accepted These works were completed in accordance with the Undertaking which was cancelled in December 22 BATHS AND SWIMMING POOLS. The Council's baths in Longfield Avenue contain four indoor swimming pools. The water is drawn from the mains of the Metropolitan Water Board and is supplied to the pools by continuous coagulation and filtration through four high pressure filters, combined with continuous chlorination. Tests for chlorine are applied at frequent intervals throughout each day to maintain an approved level of residual chlorine, The water in all four pools is completely circulated every four hours. There are two privately owned swimming pools in the Borough, both of which are equipped with filtration and chlorination plants. Two bacteriological tests taken during the year showed satisfactory results. PUBLIC MORTUARY. The arrangement with the Acton Council for the use of the Acton Mortuary was continued during the year 290 bodies were taken to this Mortuary and post-mortem examinations were carried out in every case, but one Arrangements were also made with the Uxbridge Council for the use of their mortuary and 38 bodies were taken to this mortuary for postmortem examination. 23 SECTION 3 SANITARY INSPECTION THE WORK OF THE PUBLIC HEALTH INSPECTORS IN 1959 I append a report to the Medical Officer of Health by the Chief Public Health Inspector giving details of the work of the Public Health Inspectors during the year. PUBLIC HEALTH ACT 1936 Inspections. Premises inspected on complaint 1,993 Other nuisances observed by Inspectors 127 Premises inspected in connection with infectious disease 905 Smoke observations 307 Houses without water supply 44 Inspections of moveable dwellings 51 Other inspections 1,854 Re-inspections 5,752 Intimation Notices served 949 Statutory Notices served 146 Letters written 1,921 Proceedings before Magistrates 3 Legal Proceedings. Public Health Act, 1936, Section 93 Non compliance with Statutory Notices In 3 cases legal proceedings were taken to enforce compliance with notices requiring the abatement of nuisances. In all the cases Orders were made by the Magistrates for the necessary work to be carried out within a stated period and costs amounted to £5.5.Od. CLEAN AIR ACT 1956 Inspections in connection with proposed Smoke Control Areas „ 3,678 FOOD AND DRUGS ACT 1955 Food Hygiene Regulations, 1955 Milk and Dairies Regulations 1949 to 1954 Complaints received 134 Inspections of Milk Purveyors Premises 91 Contravention of Regulations Inspections of Ice Cream Premises 239 24 Pood Inspections 565 Inspections of Other Pood Premises 2372 Contraventions found 369 Notices served 369 Proceedings before Magistrates 3 Samples of Milk and Cream taken 24 Samples of Ice Cream taken 96 Samples of Synthetic Cream taken 31 Samples of other foods taken 26 Samples of tea taken 263 Samples of water taken 7 Legal Proceedings, Food and Drugs Act 1955 In the following 3 cases proceedings were instituted under this Act:- 1. Ply in bread roll- £15 fine, £3.3.0d costs. 2. Wasp in bread - £5 fine, £2.2.0d costs. 3. Wasp in bread - £5 fine £2.2.0d.costs List of Food Premises in the Borough of Ealing Bakehouses 23 Bakers shops 54 Butchers 124 Cafes and Restaurants 147 Canteens - factory 79 Canteens - school 26 Confectioners 249 Dairies and Milk Sellers 75 Pish Fryers 23 Fishmongers 37 Greengrocers 170 Grocers 318 Ice Cream Manufacturers 3 Public Houses 64 Premises registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food 116 Premises registered for the sale of Ice Cream 388 Milk Supply, There are 85 registered distributors of milk in the Borough. During the year licences for the sale of milk under the Mi]k (Special Designations) Regulations were granted as follows:- 25  Dealer's Licences Supplementary Licences Total Tuberculin Tested Milk 51 9 60 Pasteurised Milk 62 10 72 Sterilised Milk 51 10 61 Under the provisions of the Milk (Special Designations) (Specified Area) Order 1951, all milk sold by retail in the Borough must be "designated milk," i.e. Tuberculin Tested, Pasteurised or Sterilised Milk. 24 samples of milk were taken and submitted to the Methylene Blue and Phosphatase Tests at the Public Health Laboratory, Ealing. The results were as follows:- Designation Samples Phosphatase Methylene Blue Passed Failed Passed Failed Pasteurised 17 17 - 14 3 T.T. Pasteurised 7 7 - 7 - In addition 128 samples of Pasteurised Milk from processing plants in the Borough were taken by the Officers of the County Council who are the licensing authority under the Milk (Special Designations) Regulations. Identification of Milk Bottles. The Public Health Committee gave consideration to a complaint concerning the dirty condition of a filled milk bottle delivered to a resident in the Borough This appeared to be a case for action under Article 27 of the Milk and Dairies (General) Regulations, 1959, which requires every vessel used for containing milk to be in a state of thorough cleanliness immediately before filling. The bottle was supplied by and bore the name of a multiple Dairy Company, but there was no means of proving the actual dairy premises at which the bottle had been filled, which would be a necessary part of any legal proceedings. Representations were made to the Association of Municipal Corporations that legislation should be introduced to require dairies to provide some mark of identification on their bottles which would indicate the depot at which the bottle had been filled. The Association have considered the question and are to recommend that in the next revision of the Pood & Drugs Act, it should be made an offence to sell milk in a dirty bottle. This would undoubtedly enable action to be taken in suitable cases. 26 Ice Cream. There are 388 premises in the Borough registered for the sale of ice cream It was found that their ice cream is obtained from 3 registered manufacturers in the Borough or from 5 manufacturers outside the Borough Samples from each of these manufacturers were taken once or more during the year, a total of 95 samples of ice cream and ice cream constituents being submitted for bacteriological examination The results were as follows Commodity Samples Grade Not Graded 1 2 3 4 Ice Cream Local Manufacture 74 40 26 6 2 - Ice Cream Other Manufacturers 10 2 3 3 2 - Ice lollies 11 - - - - 11 95 42 29 9 4 11 The two local samples placed in Grade 4 were followed up by an inspection of the factory and plant, and repeat samples proved to be satisfactory. The two Grade 4 samples manufactured outside the Borough were reported to the Local Authority concerned and subsequent repeat samples proved satisfactory The 11 ice lollies, though not graded were satisfactory. Ice Cream Heat Treatment Regulations 1947 -1952. There are 7 premises registered for the manufacture of ice cream but only 3 of these are in regular use. All the registered ice cream manufacturers in the Borough are equipped in accordance with the conditions laid down in the Regulations. Synthetic Cream. 31 samples of synthetic cream were taken from local manufacturers 28 were found to be satisfactory. 1 was doubtful and two unsatisfactory Repeat samples subsequently proved to be satisfactory. Inspection of Meat and Other Foods. The following foodstuffs were condemned by the Public Health Inspectors as unfit for human food in the course 27 of their inspections of the various food premises in the Borough: lbs. Beef 543 Butter 50 Cheese 42 Chickens (11) 55½ Cod fillets 49 Coned beef 800½ Dried fruit 7 Egg powder 26 Pish 2.380 Ham 17 Kidneys 14 Lamb 220 Lamb tongue 24 Liver 109½ Ox cheek 145 Ox kidneys 21½ Ox tongue 2½ Pigs cheeks 10 Pork 74 Prawns 20 Rice 42 Semolina 30 Steak & Kidney 65 Sugar 13 Tea 31,120 Turkeys 57 Foodstuffs not calculated by weight:- Assorted tins, packets, jars, cases and boxes 3,299 Articles: Chickens 19 Pig 1 Lamb 1 Tea. On the 1st January, 1959, the responsibility for sampling imported tea for adulteration and unfitness was transferred to the Local Authority from H.M. Customs and Excise. In the Borough is a large tea-packing factory and bonded warehouse to which some 2,000 cases of tea are brought direct each week. During the year 263 samples of tea were taken from this factory. 24 of them were sent to the Public Analyst, 28 who reported that 4 were unsatisfactory, and the remainder examined in the Public Health Department. As a result of these inspections it was found necessary to condemn as unfit 31120 lbs. of tea. Other Food Samples, 16 samples of English and imported fresh fruits were taken for bacteriological examination of their outer surfaces, and all proved to be satisfactory. 10 other food samples were submitted for testing after receiving complaints, and all proved to be satisfactory. These included cooked meats and meat products, smoked salmon, soda water, canned beans and canned milk. MIDDLESEX COUNTY COUNCIL ACT 1950, SECTION 11 Under this Section, 10 persons were registered during the year for the sale of food from carts, barrows, other vehicles etc. There were 51 persons on the Register at 31st December, 1959. HOUSING STATISTICS 1. Inspection of dwelling-houses during the year: (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,961 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Act, 1957 8 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 1, 105 2. Remedy of defects during the year without service of formal notices: Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 965 3. Action under Statutory Powers during the year: A - Proceedings under Sections 9, 10 and 12 of the Housing Act, 1957 (1) Number of dwelling-houses in respect of which notices were served requiring repairs (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) by Owners — (b) by Local Authority in default of owners - B - Proceedings under Public Health Act: (1) number of dwelling-houses in respect of which notices were served requiring defects to be remedied 121 29 (2) Number of dwelling houses in which defects were remedied after service of formal notice: (a) by Owners 37 (b) by Local Authority in default of owner — C Proceedings under Sections 16, 23 and 24 of the Housing Act, 1957 (1) Number of 1wel1ing-houses in respect of which Demolition Orders were made (2) Number of dwe1ling houses demolished in pursuan3e of Demolition Orders — (3) Number of houses concerning which action has been taken by the Local Authority under Section 16, and with respect to which Owners have given an undertaking that they will not be used for human habitation — D Proceedings under Sections 17, 18 and 27 of the Housing Act, 1957 (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 2 RENT ACT 1957 Part 1 - Applications for Certificates of Disrepair (1) Number of applications for certificates 40 (2) Number of decisions not to issue certificates — (3) Number of decisions to issue certificates 40 (a) in respect of some but not all defects 25 (b) in respect of all defects 15 14) Number of undertakings given by landlords under paragraph 5 of the First Schedule 32 (5) Number of undertakings refused by Local Auth— ority under proviso to paragraph 5 of the First Schedule (6) Number of Certificates issued 21 Part II - Applications for Cancellations of Certificates (7) Applications by landlord to Local Authority for cancellation of certificates 30 (8) Objections by tenants to cancellation of certificates 11 (9) Decisions by Local Authority to cancel in spite of tenants objection 3 (10) Certificates cancelled by Local Authority 22 NEW DWELLINGS, 1959 Completion figures for the 12 months period ending 31st December, 1959 were: Houses (1 bedroom) - Houses (2 bedrooms) - Houses (3 bedrooms) - Plats (Bedsitters) 30 Plats (1 bedroom) 6 Plats (2 bedrooms) 24 Plats (3 bedrooms)- 30 FACTORIES ACTS 1937 AND 1948 Part 1 of the Act 1. Inspections for the purposes of provisions as to health (including inspections made by the Public Health Inspectors): Premises Number on Register Number of Inspec- tions Written Notices Occupiers prosecuted (i) Factories in which Sec tions 1,2,3,4 and 6 are to be enforced by Local Authorities 130 13 - - (ii) Factories not included in (i) in which Section 7 is enforced by Local Auth ority 398 335 17 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out workers premises) - - - - Total 528 348 17 - . - 2. Cases in which defects were found: Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M Inspector Want of cleanliness 9 8 1 1 _ Overcrowding _ _ _ _ _ Unreasonable temperature _ _ _ _ _ Inadeouate ventilation 2 2 _ _ _ Ineffective drainage of floors _ _ _ _ _ Sanitary Conveniences: (a) Insufficient 2 _ _ 1 _ (b) Unsuitable or defective 6 6 _ _ _ (c) Not separate for sexes 1 1 _ 1 _ Other offences against the Act (not includ ing offences relating to out-workers) 11 12 1 _ _ Total 31 29 2 3 _ 31 Part VIII of the Act Outwork (Sections 110 and 111) Section 110 Section 111 Nature of Work No of out workers in August list required by Sect 110(1)(c) No. of instances of work in unwholesome premises Wearing appared: Making etc 290 - Cleaning and Washing 1 - Furniture and upholstery 3 - Artificial flowers 6 - Paper bags 5 - Making of boxes or other receptacles or parts thereof made wholly or partially of paper 6 - Carding, etc, of buttons, etc 20 - Stuffed toys 26 - Cosaques Christmas crackers, Christmas stockings, etc 55 - Lampshades 3 - Brass and Brass articles 1 - Total 416 - During 1959, 76 inspections of Outworkers premises were carried out by the Public Health Inspectors, SHOPS ACT 1950 Improvements under Section 38 of the Shops Act, 1950. relating to the health and comfort of shop workers were carried out in 126 instances; Lighting and ventilation improved 39 Heating improved 32 Sanitary accommodation improved 34 Washing facilities provided 21 PREVENTION OF DAMAGE BY PESTS ACT, 1949 The following is a summary of the work carried out by the Rodent Operatives acting under the supervision of the Chief Public Health Inspector. Complaints 847 Premises inspected 1,018 Premises found to be infested with: 1 Rats 739 2 Mice 142 Re-visits to infested premises 3,075 Pees received for treatment £661.1.0d. 32 Rodent Control in Sewers In accordance with the requirements of the Ministry of Agriculture, Fisheries and Pood (Infestation Control Division), maintenance treatments of the soil sewers in the Borough were carried out during April and October A total of 1,521 sewer manholes were dealt with and of these 365 were found to be rat infested. Poison baits were used in the infested manholes RAG FLOCK AND OTHER FILLING MATERIALS ACT,951 Seven premises in the Borough were registered under the Act and in only three of these premises is work within the scope of the Act being carried on, and in all cases only materials carrying the Certificate of the British Standards Institution are used. PET ANIMALS ACT, 1951 15 licences were renewed by the Council during the year after the premises had been inspected by the Public Health Inspector. DISINFECTION Number of houses where disinfection was carried out 62 Number of houses disinfested of vermin 5 Number of articles disinfected by steam Number of articles disinfected by formalin spray 67 Number of articles voluntarily destroyed 54 The arrangement made with the Hammersmith Metropolitan Borough Council in 1952, whereby articles to be disinfected by steam are dealt with at the Scotts Road Depot, W.12. was continued during the year. SUMMARY OF SANITARY DEFECTS REMEDIED AS A RESULT OF NOTICES SERVED AND LETTERS WRITTEN Animals - nuisances abated 9 Caravans - nuisances abated - Cesspools - cleansed - Damp proof courses inserted in walls 22 Dampness - other forms remedied 126 Drains - connected to sewer 1 Drains - cleared and cleansed 366 Drains reconstructed 46 Drains - repaired 141 Drains - new soil and ventilating pipes provided 32 Dustbins provided 168 Firegrates - repaired or renewed 56 33 Floors - sub-floor ventilation provided 32 Floors - repaired or renewed 99 Food cupboards ventilated 5 Rainwater eaves gutters, downpipes repaired 170 Refuse - accumulations removed 97 Roofs repaired 132 Sinks repaired or renewed 26 Sink waste pipes repaired or renewed 51 Staircases repaired 27 Walls and ceilings repaired or cleansed 174 Water supply reinstated 44 Water supply - draw taps fixed to main supply 4 Water closets - repaired, reconstructed or improved 87 Windows and doors repaired 125 Yards paved or repaired 26 Other defects remedied or nuisances abated 137 SUMMARY OF WORK DONE AND IMPROVEMENTS CARRIED OUT AT FOOD PREMISES Walls and ceilings repaired and cleansed 130 Floors repaired 27 Lighting and ventilation improved 50 Washing facilities provided 39 Hot water provided 47 Sinks provided 7 Storage accommodation improved 7 Water supply provided 1 Water closets cleansed or repaired 61 Refrigeration installed or improved 12 Shop heating facilities improved 32 Equipment improved 17 Other defects remedied 103 SLAUGHTERHOUSES There are no slaughterhouses in the Borough Practically no slaughtering has taken place in the Borough since 1939c Only two small private slaughterhouses have had licences since them One licence was relinquished in 1954 and the last one in June, 1958. The Slaughterhouses Act, 1958, required local authorities to submit reports on slaughterhouse facilities to the Minister of Agriculture, Fisheries and Food and the Slaughterhouse Reports (Appointed Day) Order, 1959, required these reports to be made between November, 1959, and November, 1960. 34 After consultation with neighbouring local authorities and with the various trade organisations and trade unions concerned, the Council resolved to inform the Minister that there is no actual or anticipated need for the provision of slaughterhouse facilities in the Borough. 35 SECTION 4 GENERAL MEALS ON WHEELS The entire Borough is covered by a Meals on Wheels service to deliver hot meals to old people who have difficulty ir providing them for themselves Meals are cooked centra ly and delivered by van in heated containers In the Eeling and Hanwell area this is operated by the British Red Cross Society. Meals are delivered from two to five Limes weekly and the number of old people served is 70 The total number of meals delivered last year was 13,533. In the Greenford, Perivale and Northolt areas the service is operated by the Womens Voluntary Service A paid Cook is now employed, but the rest of the work, i e. preparing vegetables, driving the van. delivery of meals and washing up is done by voluntary workers It is now possible to provide special meals for those on restricted diets. The number of old people being so helped at the end of the year was 72, each receiving two meals per week, The total number of meals delivered last year was 6,558 CHIROPODY There has been a Chiropody Service for the elderly in the Borough since 1956. and it has been operated by the British Red Cross Society since February, 1958 This has been done with the assistance of a grant from the Borough Council to the British Red Cross Society under Section 31 of the National Assistance Act. The scheme has functioned extremely satisfactorily and a large number of old people receive treatment through out the Borough. At present Chiropody is available as follows:- Clinics. Cherington House. Cherington Road, Hanwell, W.7. Greenford Green, Wadham Gardens, Greenford Islip Manor, Eastcote Lane, Northolt. Laurel House, Windmill Road. Ealing, W. 5. Mattock Lane, 13 Mattock Lane, Ealing, W. 5. ommunity Centres. Northolt Manor House, Church Road, Northolt, Greenford. 36 Northfields - 71 Northcroft Road, Ealing, W.13. Perivale - Horsenden Lane South, Perivale, Greenford. Almshouses. St Mary's Almshouses, Church Gardens., Ealing, W. 5. old People's Home. Greater Ealing Old People's Home, Northolt House. Haydock Avenue, Northolt. Private Surgeries. 120 Uxbridge Road, Hanwell, W.7. 234 Northfield Avenue, West Ealing, W.13. 25b Church Road, Hanwell, W.7. 129a Greenford Avenue, Hanwell. W. 7. 49 Little Ealing Lane, Ealing, W. 5. In addition, treatment is given in their homes to housebound patients There is a considerable demand for this service but it has been possible to avoid a waiting list. The charge to the patient is 2/6d. for attention to both feet where necessary. The total attendances were as follows:- Total number of individual patients 463 Total number of treatments 2,778 Number of patients receiving domiciliary treatmen180 Number of domiciliary treatments 1,080 In April of this year the Minister of Health announced that he was now prepared to approve proposals by Local Health Authorities who wished to establish, or where one already existed, to extend a Chiropody Service as part of their arrangements for the prevention of illness under Section 28 of the National Health Services Act. It was suggested that in the early stages priority should be given to the elderly, physically handicapped and expectant mothers. While of course welcoming any extension of Chiropody for old people in Ealing it is to be hoped that this County wide provision of Chiropody will not, in practice, mean a levelling down resulting in a reduction of the service in Ealing to make it conform to a general pattern. In addition, it is particularly to be hoped that there will be no increase in the small charge that we have striven to maintain. Ealing Chiropody Service 37 OLD PEOPLE'S WORK CENTRES. There are now 2 Work Centres in the Borough organised by the Ealing Central Aid Committee for the Employment and Recreation of Elderly Citizens. West Ealing Centre moved to larger premises in January and by the end of the year employed 31 women and 9 men, 6 of the workers being over 80 and the average age 73. There is sufficient space for another 30 workers if enough work can be obtained West Ealing's work has consisted of packing and mounting Greeting Cards on to showcards (one order being for 100,000). stringing labels, making quilted linings for nightdress cases and repairing Home Help overalls and bed linen from an hotel Also many hundreds of Ball Point Pens were assembled and carded; and plastic coathangers were carded and put into polythene bags, December was a particularly busy month, the following being West Ealing's output:- 119,760 leaflets inserted into envelopes for a publicity firm. 23,040 Ball Point Pens assembled. This Centre had a day's outing during the Summer to Bognor for which the workers saved weekly during the previous three months. Two of the old folk who met at the Centre. married in August and a party was held in their honour and a gift presented to them from the workers in the presence of the Mayor and Mayoress. The new Greenford Centre was opened in the Bowls Pavilion at Ravenor Park in June and by the end of the year there were 29 workers with an average age of 69. The oldest is 88. This Centre is now practically full, and is run by a paid organiser assisted by voluntary helpers. They had some good pre-Christmas orders for packing Fairy Lamps and pasting labels on to shaving bowls and other work undertaken including pasting gussets and pockets on to Manilla Files. There is no doubt of the good effect of the Work Centre Scheme on the workers, many of whom have been advised by their Doctors to come to the Centre It is very rewarding to see how after a short time they so often lose a mood of depression and thoroughly enjoy the work. HOLIDAYS FOR OLD PEOPLE. During the year holidays for old people were arranged 38 by the Womens Voluntary Service and the Greenford Philanthropic Society. On May lst; 200 old people went to Bexhill on Sea in the Womens Voluntary Service party each old person contributing a nominal sum of £1 towards the cost of the holiday. The Greenford Philanthropic Party numbered 34 old people, including some blind and infirm. They travelled in a party accompanied by trained Social Workers who remained with them to care for them while they were on holiday. At Ramsgate coach trips and theatre outings were arranged. There is no doubt that these holidays are of the utmost benefit to the old people and it is fortunate that these two voluntary organisations between them are able to cover the entire Borough and maintain the good liaison which exists between them. PROPOSED REST AND TREATMENT CENTRE We have been hoping for some time to introduce a Rest and Treatment Centre for the Elderly and during 1959 considerable progress has been made with this scheme It may be useful therefore if an account is given of the purposes of this proposed Centre. On the coming into being of the National Health Service thirteen years ago. the responsibility for the medical and welfare services of the country became tripartite The Regional Boards were given control of the Hospitals, County Councils were made responsible for the welfare and personal health services and District Councils remained responsible for environmental health It is perhaps in the care of old people, more than in any other field that the liaison and co operation between the various branches of the health and welfare services has been shown to be inadequate to the situation There are of course schemes outside the rigid divisions laid down by the National Health Service Act and the National Assistance Act which endeavour to help old people who would otherwise deteriorate Thus, at the Cowley Road Hospital, Oxford, a "Day Hospital" has been organised for cases discharged from the Geriatric Unit They attend one to five days a week and receive occupational therapy, physiotherapy, medical supervision and a mid day meal Those helped in this way have been mentally confused old people needing considerable care and attention. 39 Another approach to the problem has been in Twickenham, where a clinic for the elderly has been started with the idea of examining apparently healthy old people in order to detect incipient defects and remedy them before they become a disability. A further example is the Rutherglen Consultative Health Centre for Elderly People, where there is integration with hospital, local authority, general practitioner and voluntary services for old people in the local auth-ority" s premises. The Medical Officer of Health makes a social assessnent of the case and examines the old person in consultation with the Geriatrician. The old people are subsequently kept under medical surveillance, and chiropody and physiotherapy services are made available to them. As Medical Officer of Health I am continually being approached for assistance by General Practitioners with regard to their elderly patients In my experience the sort of cases I am asked to assist are those which do not seem to be in unequivocal need either of hospital care or admission to Old People s Home and yet do not seem to be living successfully at home Of course the Home Nursing and Home Help Services are of inestimable value in tackling this problem, and as a Borough we have done much to augment these statutory services. Thus, under Section 31 of the National Assistance Act, in partnership with voluntary organisations we provide a Meals on Wheels Service Holidays for Old People, a Chiropody Service and Work Centres for the Elderly Despite this, I still find that there is a certain type of old person who does not appear to be successfully helped at present by our services This is the housebound old person who is perhaps severely crippled by arthritis, is rarely visited and whose morale is low and whose zest for living has gone. This type of old person is often living alone and even if living with relatives is uncared for during the day when they are out at work I have given careful consideration to the needs of these old people and to possible means of meeting them and I feel that a Day Rest and Treatment Centre may well prove a solution. The idea is that these patients would be recommended by their doctor and brought by ambulance daily to the Centre. Here they would receive chiropody and physiotherapy and would be visited for treatment by their own doctor. A hot lunch would be provided by the Meals on Wheels Service. This medical and 40 ancillary treatment however, would play only a part. The companionship and sense of return to the community would go far to restore their morale which would in turn doubt less benefit their physical condition We already have an example of this in the remarkable success of our Work Centres in the mental and physical rehabilitation of old people who attend them It is envisaged that an old person would attend for one month and would then it is hoped be sufficiently rehabilitated to remain at home for many months Re-admission might be necessary at a later date The General Practitioners in the area have given support to this proposal and at a meeting in January, 1959, their representatives attended and discussed methods of implementing the scheme. With regard to the practical measures to bring it into operation we have made considerable progress. On the financial side the Borough Council have allocated a substantial grant for 1959 and for 1960 and the Minister of Health has given his approval to this In addition two industrial concerns in the Borough have been generous in their offers of help We have an offer from one of a sum which I consider would be sufficient for the equipment of the premises and from another we have the loan of a suitable hut free of charge, for the use of the experiment for five years As to the provision of a site, there is an excellent site available in Greenford on land belong ing to the Council. The paid staff would consist of a Sister-in Charge a nurse, a secretary, a part-time physiotherapist and domestic help The annual cost of this, together with services is likely to be about £3.000 The County Ambulance Service would be able, it is believed. to transport the old people from their homes to the Centre. To summarize., the object of this Day Centre is the rehabilitation of old people who are housebound, to prevent their admission to hospital and thereby it is hoped, to make their lives happier This work can only be done if it is directly related first to the work of the General Practitioners for their own patients who are in the Centre and secondly to other services provided by the Borough Council such as Meals on Wheels, Holidays for Old People, and Chiropody, The scheme is a pilot one for five years, by which time it should be quite clear whether this method of approach to the problem is successful. In order to form a close link in the chain of organisation, it is suggested that practitioners from Greenford, 41 Hanwell and Ealing be appointed to the voluntary body needed to implement the scheme OLD PEOPLE'S LIAISON COMMITTEE. The work of the Health Committee, has of course, during the last few years been increasingly concerned with the Care of Old People and it follows from this that there has been increasing co-operation with the voluntary organisations in the Borough without whose assistance much of the work of this nature would not be possible In November, 1958 it was decided that there was a need for a meeting between representatives of the Public Health Committee and those voluntary organisations who were running services which were receiving grants from the Council under Section 31 of the National Assistance Act. The Old People's Liaison Committee was therefore formed, its purpose being to ensure that the needs and difficulties of the voluntary organisations could be clearly brought to the Council's notice and at the same time the feelings of the Council on present and future plans for services for old people could be explained to the voluntary organisations. The Committee has met as and when required and has been most successful in achieving the object for which it was constituted. The representatives for 1959/60 were as follows:Public Health Committee: Councillor D. J. Cousins (Chairman) Aldermen! Mrs D. Gundry Mrs LStowell Councillors; J. T.Bartlett B.H. Silverman W.E.Wood Womens Voluntary Services: Miss E. Tippetts Mrs. H.W. Corey British Red Cross Society (Ealing): Mrs. E.M. Doughty Mrs. R. Chamberlain Ealing Central Aid Society - (Ealing Central Aid Committee for the Employment and Recreation of Elderly Citizens): Mr. L.R, Feltham Mrs. H.Corbyn. Greenford Philanthropic Society: Mr.F. W.Tomlin, Mr.L.Ward 42 LAUNDRY SERVICE FOR THE INCONTINENT. This Service has continued its useful work during 1959 The Laundry Service in Ealing was inaugurated in 1952 It operates under Section 84 of the Public Health Act. 1936, and Section 42 of the Middlesex County Council Act, 1956, Cases are recommended to the Medical Officer of Health by general practitioners, home nurses, home helps, etc Each case is then visited by a Public Health Inspector and the patient is given an explanatory leaflet. Collection and delivery is twice weekly, (Mondays and Thursdays) and this is done by Public Health transport Washable aluminium bins, complete with lid and strap, are provided by the Health Department The laundry is done in the Baths Laundry at the rear of the Town Hall, Existing buildings were converted at the beginning of the scheme Although the Baths Laundry is used, washing from this service is done entirely separately from the normal washing of the Baths Laundry The initial sorting hosing and disinfection is carried out by two driver/disinfectors employed by the department and the actual washing is then carried out by employees of the Baths Laundry under the supervision of the Baths Manager All articles are washed, dried and ironed before return The Catholic Women's Guild very kindly arranges for a panel of helpers to repair worn garments and bed linen. This auxiliary service is essential to the Laundry Service and their help in this respect is most appreciated. The following table shows the growth of the service since 1954 1954 1955 1956 1957 1958 1959 No, of cases dealt with during the year 66 84 78 70 56 67 No, of cases remain ing at end of year 47 44 47 39 38 39 No. of cases that died 28 39 26 48 35 31 No of cases removed to hospital 24 39 28 14 22 41 No of cases where other arrangements were made 8 7 5 4 2 3 Total number of articles dealt with 25,097 34 259 36,755 44,466 36,723 59,004 Total number of collections 2, 500 3,347 3,086 3, 333 2,766 4,822 Average number of articles per collection 10.0 10. 2 11. 9 13.3 13.3 12.2 The Mauyor of Eating ansd Members of the Eating Borough Council wish you a very happy birthday , long life , good health and every happiness. Ealing Birthday Card for a One Year Old 45 It is estimated that the cost is approximately 10/per collection The scheme is designed to cope with a maximum of 45 patients and the demand is such that this number is usually being catered for. Although not confined to old people, in fact, the majority requiring this service are elderly We have found over the years that this is probably the most appreciated health service which the Borough provides, since it is impossible for relatives to cope with this type of soiled linen. It is almost impossible for any commercial laundry to undertake the work, and the value of the service to relatives is inestimable. MASSAGE AND SPECIAL TREATMENT ESTABLISHMENTS. One new licence was issued during the year and there were 24 establishments at the end of the year. Pour exemptions were granted to members of the Chartered Society of Physiotherapists. NURSING HOMES. These were inspected as usual and no new homes were registered. HEALTH EDUCATION. During 1959 the Council inaugurated an effective health education scheme. This was the sending of Birthday Cards to children under school age The card, which is attractively designed and different for each birthday, carries a message of greeting from the Mayor, In addition there is enclosed a letter to the children's parents from the Medical Officer of Health bringing to their notice the wide range of health services which are available in the Borough. such as the prevention of Air Pollution, The Clean Pood Campaign and the Maternity and Child Welfare Services. It then draws particular attention to the Child Welfare Clinic services available, giving their location and times. together with an invitation to bring the child for a birthday medical examination An example of the Ealing cards is shown on page 44. NATIONAL ASSISTANCE ACT, 1948. Section 47. This section provides for the removal to a suitable hospital or other place of persons who: (a) are suffering from grave chronic diseases or being aged, infirm or physically incapacitated are living in insanitary conditions, and 46 (b) are unable to devote to themselves, and are not receiving from other persons, proper care and attention. It has fortunately not been necessary to use these powers this year In all instances either the assistance of the Home Help, Home Nursing. Health Visiting and Laundry Services have proved successful in keeping the old person satisfactorily at home or persuasion has succeeded in obtaining agreement to admission to hospital or Old Persons Home when necessary Section 50 - Burial of the Deaic. Five burials were carried out for which the Council accepted financial responsibility In three of these the total cost was recovered from the estate of the deceased, in one part of the cost and in the remaining burial it was not possible to recover any of the cost MEDICAL EXAMINATIONS. Candidates for permanent appointment to the Council's service are required to pass a medical examination on appointment as are manual staff for admission to the Sickness Pay Scheme of the National Joint Industrial Council for Local Authorities Non-Trading Services During the year the following examinations were carried out:- Administrative, Technical and Clerical Staff 41 Sickness Pay Scheme (Servants) 139 Gunnersbury Park Joint Committee Employees 3 Total 183 13 of the above were rejected for the following causes:- Bronchitis 2 Cardiovascular disease 4 Hernia 2 Mental disorder 5 2 of the above were provisionally rejected, but will be reviewed in one year, for the following causes:- Deformed feet 1 Gastric Ulcer 1 One case, which had been provisionally rejected during 1958, was reviewed during 1959 and rejected due to Bronchitis. 47 SECTION 5 STATISTICAL TABLES SUMMARY OF STATISTICS Area (in Acres) 8,781 Population (Census, 1951) 187,323 Population (estimated middle of 1959) 182,700 Rateable Valine, 1st April, 1959 £3,665,334 Net Product of a Penny Rate, 1959/60 (Est*) £14,936 Live Births: - Legitimate Males, 1,294 Females, 1.241 Total 2P535 Illegitimate Males, 88 Females, 71 Total 159 Birth Rate per 1,000 of Estimated Population 14.74 Still Births:- Males, 20 Females, 18 Total 38 Rate per 1,000 total Births (Live and Still Births) 24.67 Deaths:- Males, 1,028 Females, 954 Total 1,982 Heath Rate per 1,000 of Estimated Population 10.85 Deaths of Infants under one year of age: Legitimate Males, 25 Females, 16 Total 41 Illegitimate Males, 2 Females, 2 Total 4 Death-Rate of Infants under one year of age;- All Infants per 1,000 Live Births 16.7 Legitimate Infants per 1,000 Legitimate Live Births 16.17 Illegitimate Infants per 1,000 Illegitimate Live Births 25.16 Deaths from Diseases and Accidents of Pregnancy and Childbirth:From Sepsis - None From other Causes - None 48 Cases of Infectious and Other Notifiable Diseases notified in the Borough Disease 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 Smallpox - - - - - - - - - - - - Diphtheria 13 16 3 2 - - 1 - - - - - Scarlet Fever 204 176 294 203 402 238 287 108 159 95 232 269 Enteric Fever (including Paratyphoid) 3 8 5 3 2 3 5 7 1 Puerperal Pyrexia 25 27 24 38 70 61 54 44 71 77 67 37 Pneumonia: Primary 189 163 173 162 100 157 152 135 113 72 94 97 Influenzal 6 10 6 38 28 74 52 56 48 99 57 57 Acute Poliomyelitis 10 34 42 10 21 13 5 61 46 2 2 - Meningococcal Infection 2 14 9 2 - - 6 3 2 2 3 2 Malaria 2 4 1 1 3 1 1 1 Dysentery 7 23 24 542 179 132 225 149 193 252 244 194 Erysipelas 32 13 24 17 26 18 18 12 12 13 19 9 Tuberculosis: Pulmonary 206 205 209 210 211 205 132 119 134 113 97 109 Non-Pulmonary 27 32 41 24 29 20 17 24 13 16 8 10 Ophthalmia Neonatorum - 5 3 6 - 2 2 2 5 6 3 Measles 1.379 1 450 1.016 3 296 993 2, 558 132 2,422 726 1 854 975 l,928 Whooping Cough 383 303 274 550 77 491 116 156 67 131 85 90 Food Poisoning — 21 23 86 26 31 78 36 26 20 18 39 Totals 2 492 2.503 2, 174 5. 190 2,165 4, 004 1. 284 3,335 ls 612 2,752 1. 908 2.844 49 The number of cases of infectious disease originally notified sometimes varies due to changes of diagnosis and the following table is therefore given to show the final numbers after correction. Disease Disease Smallpox Diphtheria Scarlet Fever 269 Enteric Fever (including Paratyphoid) Puerperal Pyrexia 37 Pneumonia. Primary 97 Influenzal 57 Acute Poliomyelitis Food Poisoning 37 Meningococcal Infection 2 Malaria Dysentery 194 Erysipelas 9 Tuberculosis: Pulmonary 105 Non-Pulmonary 10 Ophthalmia Neonatorum 3 Measles 1,928 Whooping Cough 90 Total 2,838 50 Infectious and Other Notifiable Diseases Classified in Age Groups Scarlet Fever Whooping Cough Poliomyelitis Measles Diphtheria Dysentery Meningococcal Infection Paralytic Non-Paralytic M F M F M F M F M F M F M F M F Numbers originally notified 142 127 49 41 - 981 947 _ _ 75 119 - 2 FINAL numbers after correction Under 1 year - - 6 6 - - - - 26 30 - - - 14 - 1 1 - 4 2 7 3 - - - - 88 86 - - 6 3 - — 2 - 9 12 6 7 - - - - 111 106 - - 4 7 - - 3 - 13 6 3 3 - - - - 112 102 - - 6 5 - - 4 - 21 8 2 - - - - - 128 138 - - 7 5 - - 5-9 80 83 18 16 - - - - 487 452 - - 9 14 - ~ 10 - 14 13 10 3 6 - - - - 21 21 - - 10 13 - - 15 - 24 1 6 2 - - - - - 4 10 - - 7 16 ~ — 25 and over 1 - 2 - - - - - 4 2 - - 26 42 ~ 1 Age unknown - — - - — - - - - - - - - - - Total 142 127 49 41 - - - - 981 947 - - 75 119 - 2 51 Pneumonia Smallpox Acute Encephalitis Enteric or Typhoid Fever Paratyphoid Fevers Erysipelas Food Poisoning Infective Post-Infectious M P M P M F M F M F M F M F M F Numbers originally notified 83 71 - - - - - - - - - - 3 6 22 17 FINAL numbers after correction Under 5 years 5 7 - - - - - - - - - - - - 1 - 5-14 14 14 - - - - - - - - - - - - - 15 - 44 17 14 - - - - - - - - - - - 1 8 9 45 - 64 33 22 - - - - - - - - - - 3 4 9 7 65 and over 14 14 - - - - - - - - - - - 1 3 - Age unknown - - - - - - - - - - - - - - - - Total 83 71 - - - - - - - - - - 3 6 21 16 Tuberculosis Respiratory Meninges & C.N.S. Other M F M P M F Numbers originally notified 74 35 _ 5 5 FINAL numbers after correction - - - - - Under 5 years 1 2 - - - - 5-14 4 - - - - - 15 - 24 10 10 - - 1 1 25 - 44 24 11 - - - 1 45 - 64 31 4 - - 3 - 65 and over 3 5 - 1 3 Age unknown - - - - - - Total 73 32 - - 5 5 Other notifiable diseases Original Other M F M F Puerperal Pyrexia - 37 - 37 Ophth. Neonatorum - 3 - 3 52 DEATHS Causes of Death 1959 Cause of Death Deaths, 1959 Total Deaths 1958 Male Female Total Tuberculosis, Respiratory 2 3 5 10 Tuberculosis. Other - 1 1 Syphilitic Disease - - - 2 Diphtheria - - - - Whooping Cough - - - - Meningococcal Infections - - - - Acute Poliomyelitis - - - - Measles - - - - Other Infective and Parasitic Diseases 2 2 4 1 Malignant Neoplasm Stomach " " Lung, Bronchus 32 28 60 52 89 15 104 94 Breast - 38 38 45 " " Uterus - 10 10 ?0 Other Malignant Lymphatic Neoplasms 84 97 181 187 Leukaemia, Aleukaemia 8 6 14 7 Diabetes 4 8 12 15 Vascular Lesions of Nervous System 90 176 226 248 Coronary Disease, Angina 213 128 341 320 Hypertension with Heart Disease 10 18 28 50 Other Heart Diseases 90 131 221 253 Other Circulatory Disease 47 29 76 73 Influenza 14 15 29 1 Pneumonia 61 62 123 87 Bronchitis 101 40 141 140 Other Diseases of Respiratory System 17 4 21 21 Ulcer of Stomach and Duodenum 15 8 23 23 Gastritis, Enteritis and Diarrhoea 5 2 7 4 Nephritis and Nephrosis 4 9 13 15 Hyperplasia of Prostate 11 - 11 21 Pregnancy, Childbirth, Abortion - - - Congenital Malformations 13 4 17 15 Other Defined and 111-Defined Diseases 65 80 145 134 Motor Vehicle Accidents 22 6 28 25 All other Accidents 12 23 35 27 Suicide 17 10 27 17 Homicides and Operations of War - 1 1 - Totals 1,028 954 1,982 1,907 53 SECTION 6 SCHOOL HEALTH SERVICE The statistics relating to the School Health Service reveal no unexpected trends. The reduced attendance at Minor Ailment Clinics are accounted for partly by a change of procedure. The practice of referring all cases of verruca tc a medical officer has been discontinued. Straightforward cases are now referred directly to the Chiropodist for treatment, thus reducing the attendance at Doctor's Minor Ailment Clinics Another factor is an increasing tendency on the part of working mothers to take children to General Practitioners' evening sessions rather than suffer a loss of income by taking time off from work to attend day-time sessions at local Authority clinics. The increased head infestation figures do not truly represent a worsening of the condition in this respect, Apart from a few problem families, in nearly all cases, the figures relate to children moving into the district. We discover and promptly deal with the condition, but having done so, must record the fact, MINOR AILMENT CLINICS, The examinations carried out at these clinics include a variety of cases in which medical opinion is required. Cases of poor school attendance, freedom from infection examinations, recommendations for recuperative treatment, etc., are among the many things dealt with They also provide a means for a more detailed investigation into any defect observed at the school inspection, Attendances at Minor Ailment Clinics 1957 1958 1959 9,951 9,996 5,040 C.G. VACCINATION Details of school children offered B.C.G. vaccination through the approved arrangements under Section 28 of the National Health Service Act, 1946f during the year ended 31st December, 1959 are as follows:- 1. Number of children whose parents were approached regarding participation in the scheme 6,230 2. Number of children whose parents consented to participate 3,935 54 3. Number of those who were tested and found to be (a) negative 3,503 (b) positive 194 4. Number of those who were given B.C.G. vaccination 3,503 ROUTINE MEDICAL INSPECTIONS Details of the three routine medical inspections carried out in schools are set out below. These are normally carried out during the first and last years at school and at the last year in primary school. Numbers Examined 1958 1959 First age group 2, 050 2,375 Second age group 2,419 1,998 Third age group 1, 991 2,268 Total 6,460 6,641 Classification of General Condition Satisfactory 6,629 Unsatisfactory 12 6,641 Defects requiring Treatment found at Routine Medical Inspection 1957 1958 1959 Skin Diseases 738 846 724 Defective Vision 349 438 320 Squint 10 26 22 Defects of Hearing 53 114 31 Middle Ear Diseases 24 8 6 Nose and Throat Diseases 86 141 78 Speech Defects 12 28 25 Enlarged Glands 5 2 2 Heart - Circulation conditions 2 7 9 Lung Diseases 52 74 32 Hernia 5 - 5 Postural Defects 23 32 20 Orthopaedic Foot Defects 48 68 54 Epilepsy - - 4 ASTHMA CLINIC. The general work of the bronchial asthma clinic continued on the revised lines provisionally started in 1958 when it was decided to start a detailed enquiry into the causation of bronchial asthma and chronic bronchitis in childhood. The enquiry was limited to those children who had been referred to the clinic for a course of remedial breathing exercises. 55 Some of the results obtained from the investigations are issued herewith in the form of an interim report based on the information collected between 1958 and 1959 inclusive. 109 bronchial asthmatic children (aged 3-16 years), 55 children with chronic bronchitis (aged 4-16 years), and a control group of children who suffered from neither of these illnesses (aged 5-16 years) were critically examined, In view of the small number of children in this survey the results now presented must be accepted with certain qualifications. It cannot be assumed that these results are representative of those which might have been obtained if it had been possible to examine ten or a hundred times the actual number of cases used. Table 1 The Constitution of the Cases Attending the Bronchial Asthma Clinic from 1958 - 1959 1958 1959 Bronchial Asthmatic Children 50% 64%Y Chronic Bronchitic Children 32% 32% Children with Chest Deformities 18%X 4% (X) The rather high number of cases with chest deformities referred to the clinic in 1958 was probably due to the fact that the Assistant Medical Officers referred all types of "chesty children" for treatment. They had been advised that a special survey was to be started during that year. Some of the children with chest deformities did not, however, appear to have either chronic bronchitis or bronchial asthma. (Y) The increase in the number of cases of bronchial asthma in 1959 is explained by a spill-over of the cases who started treatment in 1958. Table 2 The Incidence of Asthma and Chronic Bronchitis in Males and Females and the Composition of the Control Group Males Females Bronchial Asthmatic Children 71.56% 28.44% Bronchial Asthmatic Adults (Z) 66.67% 33.33% Chronic Bronchitic Children 52.73% 47.27% Control Group of Children 53.42% 46.58% (Z) A small survey was carried out on adult asthmatics (16-22 years of age) who were former patients attending the clinic. 56 The Following Interesting Facts emerged from a preliminary Study of the Results of the Survey (1) Of 2,003 children who had dental gas in 1958, 20 clinic asthmatics and 17 clinic bronchitics presented no anaesthetic problems (2) No adverse reactions were reported from poliomyelitis immunisations given to the bronchial asthmatics, of whom 38% had varying degrees of eczema (3) The effects of tonsillectomy seemed beneficial only in cases of chronic bronchitis. (4) Almost 50% of the asthmatic children had a positive skin reaction to mixed pollens, yet only 19% of them had a personal history of Hay Fever This suggests that skin tests for pollen are of no great value in the type of case normally referred to the clinic (5) The majority of the bronchial asthmatics (45%) showed a tendency to have their worst attacks in winter, although 30% had attacks at any time The main pre cipitating cause of the attacks of asthma were given as being due to anxiety, excitement, or head colds Often the causation was a combination of the above factors. On the other hand the adult asthmatics (50%) stated that their worst attacks occurred at any time and only 21% stated these attacks were worse in winter The majority claimed that head colds often triggered off their attacks although anxiety was listed as the next most common factor Several adults also mentioned specific allergic factors such as dusts, pollens, and feathers etc., whereas few of the children were thus affected (6) It was noted that 6% of the asthmatic children had attended the Child Guidance Clinic compared with 9% of the bronchitics and 2% of the control children (7) Just over 4½ times as many asthmatic adults were using some form of inhaler compared with the children attending the clinic. (8) On a superficial examination, the results of intelli gence tests on a group of asthmatic children compared with matched group of non-asthmatic children appeared to show little difference Hitherto, it was popularly believed that asthmatic children were on average more intelligent than the non-asthmatics It was, however, noted from the school attendance records of the above Asthma Clinic Asthma Clinic 61 children that the asthmatics missed more schooling in a year than did the control group. (9) Prom an analysis of a special investigation into the neurotic tendencies exhibited by all the children in the survey, the following information was obtained. For the purpose of this survey symptoms of maladjust ment as listed in the Underwood Report were regarded as neurotic tendencies and the table shows how often these tendencies occurred in the three categories. Table 3 Percentage of Children with No Neurotic Tendencies., and those with Neurotic Teniencies 1 5, and 6 or Over Nil 15 6 or over Bronchial Asthmatic Children 0 44% 56% Chronic Bronchitic Children 4% 53% 43% Control Group of Children 8% 66% 26% As previously stated a detailed mathematical assessment of the results has not yet been completed with respect to any of the above-mentioned findings. It does, however, seem that the asthmatics present a greater number of neurotic tendencies than do the controls At the same time, however, it is noted that the bronchitic children had a much higher instance of neurotic tendencies than the control group, (10) An attempt was made to gauge the clinical response to breathing exercises after six months treatment, Estimations offered are the result of observation, and the opinion of both the parents concerned and the physio-therapist. They appear in Table 4. Table 4 Degree of Clinical Improvement After Six Months Great Improvement Moderate Improvement Little Improvement Bronchial Asthmatic Children 25% 66% 9% Chronic Bronchitic Children 49% 44% 7% The above figures suggest that the bronchitics normally respond quicker to treatment than do asthmatics. Asthma is, however, a capricious, often a long-term, illness to treat in view of its complicated origin. The clinical response to remedial breathing exercises so far noted has, however, been most encouraging., The total attendances at the clinic in 1958 were 2,157, and in 1959 1,951. 62 REPORT ON THE SCHOOL DENTAL SERVICE IN EALING During the year the School Dental Service has continued under the same conditions of uncertainty as have been referred to in recent previous reports. Increases of salary have been made to both dental officers and dental attendants and whilst these increases have apparently not materially affected recruitment of staff, nevertheless the position in this area is better than that in those adjacent. Part-time officers are very definite in their preference for working in the clinics which have the most modern equipment and the actual process of improvement must continue if we are to attract the best dental officers. The majority of part-time dental officers who are also in private practice are now using air turbine dental engines in their own practices and convinced of the efficiency of this type of apparatus, they press for the provision of similar equipment in the clinics. We hope to start using such equipment in 1980, but it will take some time to re-equip all surgeries. The demand for treatment does not abate and it is satisfying that the proportion of conservation treatment to extraction continues to rise steadily. This readiness on the part of parents and patients to accept the treatment proposed by the dental officers demonstrates the increasing awareness of parents of the need for dental health, and the readiness with which children accept the relatively small amount of pain and discomfort of modern dental techniques. Unfortunately it is the experience of all dental officers that there is an increasing incidence of dental decay amongst school children. This not only affects those who have failed to seek treatment, but those who have had regular treatment as well and the rate of deter ioration in some mouths and the constant vigilance that is required of the dental surgeon places a great strain on limited resources. There is no doubt at all that this higher incidence of caries and rapid progress of the disease is due to the increasing consumption of sweetmeats and "sticky carbohydrate" foods. Limited dental health propaganda directed to improving our dietetic habits does not seem to be making much impact. Still our greatest hope for reducing the onset of caries seems to be the fluoridation of domestic water supply. This is a measure of preventive medicine which has proved itself in many parts of the world in spite of intense opposition. 63 It is to be hoped that the experimental schemes at present being carried out in Britain will soon be followed by a much broader national scheme. EAR, NOSE AND THROAT SERVICE. Mr R. Savege, Consulting Otologist, reports: With the almost total disappearance of cases of chronic middle ear suppuration- the emphasis is now upon the early diagnosis and treatment of deafness in children Very offen, cases of minor degrees of deafness, particularly unilateral deafness, are unsuspected by the parents, until discovered at routine examination by the school doctors, and then tested by the audiometer Early discovery is important, as good hearing is essential in the child's education and conduct, but also because treatment can usually restore the hearing to normal, and prevent the development of chronic deafness The rising generation can look forward to better hearing in their lives than could many of their parents. The statistical report relating to the general work of the Far, Nose and Throat Clinic is as follows: 1959 (1958) No. of new cases 151 (145) No. of re-inspections 213 (292) Total attendances 364 (437) Medical Treatment advised 174 (230) Surgical treatment advised 95 (99) Audiometry Report An additional part time Audiometrician was appointed during the year to assist the Audiometrician A new transistor pure tone audiometer was purchased. This machine has facilities for testing bone conduction deafness, and this proves of great help in picking out cases of nerve deafness. The Audiometrician was given the opportunity during the year of attending a special course at the Heston School for the Deaf The age groups tested as a routine in schools are 6-7 years, 9- 10 years, and 13-14 years. 1958 1959 Number of schools visited 32 49 Number of children tested 5,498 7,451 Number of children with hearing loss 193 271 Number referred to E.N.T. Specialist 53 104 64 FOOT HEALTH. 11,184 children have had their feet inspected this year by the Foot Health Nurse, and 297 have been seen together with their parents by the Medical Officer in charge of the special foot clinic. In addition the Health Visitors and Clinic Nurses have visited each school every term and carried out foot hygiene inspections. The incidence of verrucae (plantar warts) was .8% and tinea (athlete's foot) was 1,5%. Children with verrucae are asked to see their General Practitioner for treatment or to attend one of the two chiropodists employed by the School Health Service The treatment is painless and thorough. The children are asked to keep the verrucae covered with plaster from the time that they are diagnosed and to refrain from swimming until the wart is eradicated, so as to minimise the chance of spreading the infection to other children. The two school chiropodists treated 635 children this year. The Medical Officer and Foot Health Nurse at the Foot Clinics are constantly asked to recommend suitable shoes for children, and it is of course, necessary to know what shoes and what standard of fitting are available in the shoe shops of the Area, A survey of all the shops selling children's shoes in Ealing was made and the results have been published in the British Medical Journal A questionnaire was used in each of the 39 shops selling children's shoes, but because of some inaccuracies in completion, the final analysis was made on 25 shops. All 25 shops studied were found to stock a well designed shoe, rounded toe and straight inner border in a lace-up or bar style- but only 11 shops had the necessary range of three width fittings or more, which is essential to fit the majority of children's feet. For children of 3-11 years the stocks were good, but poor for the age of 11-15 years, particularly for girls. Stocks of larger shoes, of size 7 and over, were also limited. Shoes out of stock were usually obtained in one week, which seems unnecessarily long, yet all the shops stocked the inferior girls shoe known as the "casual". The worst type of casual shoe with pointed toe, and low cut sides and front was found in 17 shops. These shoes have to be "short fitted" in length, narrow in width and use the toes as a "digital wedge" in order to stay on the foot. These shoes are very popular and sell well to the fashion conscious girl. The standard of shoe fitting for children varied from shop to shop, but on the whole was inadequate. The Shop Assistants were usually trained by the Manager, and in only 4 shops was the training done by the firm making the shoes None of the assistants attended a shoe fitting course as provided by a Technical College Eight shops admitted to allowing untrained assistants to fit children's shoes at busy periods The few shops that employed an x-ray machine found it of little value in shoe fitting. The overlip of price ranges clearly demonstrated that all well designed children's shoes could be multifitting, and yet reasonably priced Foot Inspection - Defects Total number examined ll,184 Referred to Medical Officer 297 Referred to Chiropodist 105 .9% Verrucae 96 .8% Defective shoes 1,840 16,4% Everted Ankles 202 1,8% Hallux Valgus 2;385 21.2% Tinea 172 1.5% Number of children treated by the two chiropodists 635 ORTHOPAEDIC CLINIC Mr, J.A. Cholmeley, the Orthopaedic Consultant reports:- During 1959 there has been no reduction in the atten dances at the Ealing Orthopaedic Clinic either for exam ination or treatment, although there are no longer the number of fresh cases of poliomyelitis that used to occur only a few years ago. Of the new cases seen during the year over a third have been concerned with the feet of school children some, but by no means all. are related to ill fitting and bad design of shoes There has been a recent outcry in the medical press on the type of shoes worn by the adoles cent girl Some of those attending the Orthopaedic Clinic wear shoes that are too narrow, too short and too pointed but many adolescent girls have feet adult size and can only get the adult type of shoe Apart from this they often dress like young adults and wish to wear a corres ponding type of shoe similar to their mothers, many of whom must therefore share the blame. The young man of to-day is now taking to the pointed shoe and it will be 66 interesting to see whether the incidence of foot trouble in the adolescent boy will now increase - I rather doubt it, providing the shoes are long enough. HANDICAPPED CHILDREN. The following table sets out in their various categories the number of handicapped pupils as at 31st December, 1959. In Special Day Schools In Special Residential Schools In maintained Primary & Secondary Schools Not at School Total B G B G 3 G B G B G Blind Pupils - - 3 1 - - 1 1 4 2 Partially- Sighted Pupils 7 3 - - - - - 1 7 4 Deaf Purils 3 4 2 1 - - - - 5 5 Partially Deaf - - - - - - - - - - Pupils 5 4 4 1 3 2 - 2 12 9 Educationally Sub normal Pupils 35 30 16 8 3 5 2 3 56 46 Epileptic Pupils - - = 1 - - 2 - 2 1 Maladjusted Pupils - - 40 22 7 5 1 - 48 27 Physically Han dicapped Pupils 9 13 4 3 6 5 3 3 22 24 Pupils with Speech Defects - - - - 9 3 - - 9 3 Delicate Pupils, 7 3 12 5 6 3 1 - 26 11 Pupils with Multiple Defects - - - - - - - - - - Total 66 57 81 42 34 23 10 10 191 132 OPHTHALMIC SERVICE. Mr, G. Freeman-Heal, Consultant Ophthalmologist; reports:- Report on School Children examined at Mattock Lane and Ravenor Park School Clinics for the year January to Decemher, 1959. The total number of cases seen was 1,483 (1958 1,574) of which 462 (1958 470) were new cases and 1,021 (1958 1,103) were re-inspections. The number of pairs of glasses prescribed was 961 (1958 - 927), Abnormal Eye Conditions other than Errors of Refraction were as follows:- Congenital Abnormalities New Cases OH Cases Squint 71 186 Congenital Nystagmus 3 2 Nasal Duct Obstruction 3 1 Abnormalities Extra Ocular Muscle 1 1 Congenital Cataract 2 2 Progressive Myopia 3 3 Ptosis 2 1 67 Abnormalities fine to Infection New Cases Oli Cases Mucocele 1 - Styes 2 - Meibomian Cysts 3 - Abnormalities due to Trauma Rupture of suspensory ligament of lens 1 - Abnormalities of Unlcnown Etiology Pigmentary disturbance at maculae 1 - Central Retino-Choroiditis - destruction of maculae 1 - Optic Atrophy 3 - SPEHCH THERAPY, The past year has again been a busy one for the Speech Therapy Department The figures are as follows:- Number on roll at 1st January, 1959 216 New cases during the year 109 Number discharged 111 Number on roll at 31st December, 1959 214 Number of attendances at Speech Therapy Clinics 4,071 Thus while the total number of children under treatment has remained stable, there has been a wide turnover of cases. The frequency of the various types of speech defect has shown little variation and the percentages encountered are as shown below % (1) Dyslalia Missing or missing out of consonants 48,6 (2) Stammering 15.4 (3) Developmental aphasia - Delayed or absent speech 20.5 (4) Dysarthria - Defects due to disorders of the muscles of articulation 11.7 (5) Aphasia associated with mental deficiency 3.7 (6) Disorder arising from deafness .5 Parents generally are less critical of their children s speech than are other people and a large number of new case referrals are still received from teachers. Many of these children have never spoken well and could have at least begun treatment before reaching school age. Some defects in fact can be entirely eliminated before the child starts school thus obviating the need for regular absences in order to attend clinics. In general any child aged three years and six months whose speech does not seem entirely normal for his age 68 should be seen by a Speech Therapist and treatment if indicated can be instituted from then on. It is hoped that an increasing number of parents of young children will take advantage of the expert advice available to them. The Speech Class at Stanhope Infants School continues to prove of great value in catering for children with more severe speech defects,, Accommodation is provided for about ten pupils and during the past year there have been five new admissions and three diseharges EALING CHILD GUIDANCE CENTRE. Dr. P Holman. Consulting Psychiatrist, reports:- 152 Ealing patients were referred to the Centre in 1959, This figure hardly differs from that of 1958 Fewer cases were withdrawn before investigation at the Centre, This is more satisfactory than in previous years. It is impossible to avoid some wastage when, for example, families remove from the area; parents become ill, or the child makes a spontaneous recovery 22 children were placed in Residential Schools in the course of the year. The frequency of different types of cases and of different symptoms changes little year by year. The average I.Q is exactly the same this year as last: the average age has gone down by one month (not a significant change). There is little change in the ratio of primary to secondary children coming to us. Although there is an apparent drop in the number of pre-school children referred, this is much more than balanced by the large number of young children now seen informally by the Psychiatrists and Psychiatric Social Workers in the Maternity and Child Welfare Clinics. Only one new case referred by the Probation Officers was seen during the year, though several old cases who had come to us in this way continued to take up a disproportionate amount of our time There was a further slight rise in the number of children placed in schools for maladjusted children. It is noticeable that more than two thirds of these are children of secondary school age, for whose special educational treatment there is little day school provision. 69 There were more changes in staff in 1959 than for several years and longer gaps between resignations and replacements The six months' gap between Dr. Ogden's departure and Dr. Harrold's arrival meant fewer cases treated, a damaging interruption of treatment for many children and a long wait for a diagnostic interview for others. EDUCATION ACT 1944, Sections 57(3 „ 57(4) and 57(5). Cases dealt with under Section 57, Education Act, 1944: Sub-Sect ion 3 11 Sub-Section 4 - Sub-Section 5 4 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act, 1948 MEDICAL EXAMINATION OF TEACHERS. Number of Teachers examined as to fitness for appointments 50 INFESTATION WITH VERMIN. Number Examined 31,268 Number Infested 109 70 SUPPLEMENT - FOR GENERAL INFORMATION HEALTH SERVICES PROVIDED BY THE LOCAL HEALTH AUTHORITY In Middlesex the Local Health Authority under the National Health Service Act is the Middlesex County Council, They have formed ten areas in the county, Ealing and Acton forming Area No 7 In Ealing the local administration is carried out at the Town Hall, Ealing, MATERNITY AND CHILD WELFARE CLINICS Regular sessions for expectant mothers are held at 9 Health Clinics by doctors and midwives, Arrangements are made for blood testing, chest Xray and for distribution of iron and vitamins. Mothers are also given the opportunity of attending ante natal exercises and mothercraft classes. During the year 1,816 expectant mothers attended clinics in Ealing Advice to mothers on the care of their children is given at Health Clinics by doctors and health visitors, children are weighed at each attendance and a careful watch kept on all aspects of the children's progressWelfare and other foods are distributed During the year S;481 children attended clinics in Ealing, The following are the addresses of the Maternity and Child Welfare Clinics in Ealing. There are 20 Health Visitors in Ealing In addition to the clinic work home visiting to advise mothers on the care of their children forms a useful link with the Clinic Ante-Natal Clinics (Interview by Appointment) Artiress Times Abbey Parade. North Circular Road Tues mornings Ealing, W. 5 Brentside Westcott Crescent, Thurs. mornings Hanwell, W. 7 Cherington House, Cherington Road, Mon Tues mornings Hanwell, W. 7 Greenford Green. Wadham Gardens, Tues Pri mornings. Greenford Islip Manor, Eastcote Lane, Mon. Wed mornings Northolt. Laurel House, Windmill Road, Wed. Thurs mornings Ealing, W. 5, Mattock Lane, 13 Mattock Lane, Mon. Wed Pri Ealing, W. 5 mornings. Perivale, Horsenden Lane, Greenford Wed. mornings. Ravenor Park, Oldfield Lane, Mon Thurs mornings. Greenford 71 Child Welfare Clinics Address Times Abbey Parade North Circular Road, Tues-Fri. 2 4p.m, Ealing, W. 5 Brentside, Westcott Crescent, Thurs. 2 4p.m. Hanwell, W. 7 Cherington House, Cherington Road Mon-Tues. Thurs. Hanwell, W. 7 2 - 4 p.m. Greenford Green. Wadham Gardens, Tues-Wed. Fri. Greenford 2 - 4 p.m Islip Manor, Eastcote Lane Mon-Thurs. 2 4 p.m. Northolt Northolt Grange Community Centre; Tues 2-4 p.m. Northolt Laurel House. Windmill Road Mon-Thurs. 2-4 p.m. Ealing, W. 5 Mattock Lane, 13 Mattock Lane. Mon-Wed. Thurs. Fri. Ealing, W. 5 2-4 p.m. Perivale, Horsenden Lane, Greenford Mon-Thurs 2 4p.m. Ravenor Park, Oldfield Lane, Mon-Tues. Wed. Fri. Greenford 2-4 p.m. DOMICILIARY MIDWIFERY SERVICE There is a staff of 12 midwives in Ealing. There were 725 home confinements in Ealing in 1959 compared with 740 in 1958 This decrease of 15 on last year is the first fall in home confinements since 1955. An account of a survey of home confinements in Ealing is given at the end of this report All midwives are trained in the use of Trilene and gas & air Analgesia for mothers in labour, and in the use of small oxygen cylinders should any baby have respiratory difficulty The number of pupil midwives who received district training during the year was 18. The Rota system for midwives, which was begun in Ealing in September 1958, continued to work satisfactorily during 1959 The long hours of duty both actual working time and on call" time has,, throughout the country, made the recruitment of midwives difficult The rota system is designed to overcome this objection and give midwives the maximum possible time when they are completely free from responsibility The Borough has been divided up into six areas, each of which has two midwives allocated to it, one midwife being on duty for the whole area and her opposite number being off duty. The rota works over two weeks and is as follows;- 72 1st Week On ^uty: 8 a m. to 3 p m for 6 days during the week Off duty: One period of 24 hours during the week, i e. from 6 am one day to 6 am the next day 2nd Week On duty 2 p.m. to 6 a.m for 4 days except on opposite midwife's day off when she will be on duty for 24 hours Off duty: Friday 6 am,. to Monday 6a.m. This system has resulted in the working and "on call" hours being reduced from 132, before the institution of the rota, to 85½ hours weekly. The effect of this is, of course, that during her time on duty the midwife is even more fully engaged than under the previous system. It has, however, been popular with the midwives and an entirely satisfactory service can be given to the public. Applications for the services of a midwife should be made through a Maternity and Child Welfare Clinic. HOME NURSING SERVICE. There are 23 full-time Home Nurses and 8 part-time Home Nurses in Ealing, including two male nurses. During the year a total of 73,387 visits was made to 3,561 patients. The object of the service is to enable those patients whose illness does not require hospital admission to be nursed at home. The duties carried out comprised general nursing, blanket bathing, giving of enemata and injections of antibiotics, etc. Hydraulic hoists are available for lifting of patients and orthopaedic walking aids are supplied. An increasing proportion of the work is concerned with old people. The services of a home nurse are available at the request of the patient's medical practitioner or hospital medical officer. Application should be made to the Area Medical Officer, Town Hall, Ealing, W. 5. HOME HELP SERVICE. The Home Help Service provides domestic help in time of illness. All normal household duties, including shopping, cooking, washing, cleaning, and looking after children are undertaken. There is an equivalent of 126 full-time home helps in Ealing, At the end of the year there were over 829 cases receiving help. The order of priority is acute sick, maternity cases, tuberculosis, and chronic sick and aged. Nevertheless, over 80% of those helped were old people. Payment is based on the patient's resources and ranges from no charge to 4/- per 73 hour. The object of the service is to supplement assistance available from relatives etc,, and to tide patients over in emergency rather than supply permanent domestic help. During the year the night service was continued, Attendance is from 11 p.m. to 7 a. m, and the duties of the helper consist of sitting with and giving general care to the patient. This has proved most valuable. Applications for the services of either a day or night home help should be made, accompanied by a medical certificate, to the Area Medical Officer, Town Hall, Ealing, W. 5. FAMILY HELP SCHEME. This service was inaugurated in May, 1959, to deal with 3 categories of cases. (1) The family help takes the place of the mother in her absence, assumes responsibility for the home, the children and the finances and resides at the home. (2) The family help takes the place of the mother in her absence, assumes responsibility for the home, the children and the finances in the day time only, but is non-resident, the father or other relative takes over at night. (3) The family help is employed for some part of the day to assist and advise the mother who, although resident with her family, requires to be taught how to manage her household affairs and to budget sensibly. The total number of cases dealt with since the inception of the service is five and these have been made up as follows:- One in category (1) Three in category (2) One in category (3). A charge is made on a weekly basis according to the applicant's income and expenditure. Applications for the service should be made to the Children's Officer, 4 Newburgh Road, Churchfield Road, Acton, W.3. DAY NURSERIES, There are two Day Nurseries in Ealing for the care of children under five years of age. One nursery is situated in Culmington Road, and has accommodation for 40 children. The other nursery is in Green ford and has accommodation for 50 children. Both the Day Nurseries are recognised 74 training centres and girls of sixteen are accepted for a two years' training for the National Nursery Examination Board's Diploma. Admission of children is restricted as a genera] rule to those whose mothers need to go out to work, although there are exceptions such as during a mother's illness, or on a doctor's recommendation for the sake of the child's health. Children under two years of age are only admitted if the mothers are the sole supporters, e.g, divorced, separated or unmarried, or if the home conditions are unsatisfactory. The nurseries are open from 7.30 a.m. to 6,0 p.m. A charge is made for this Service on a sliding scale based on the parents income. All applications for admission to a Day Nursery should be made to the Area Medical Officer, Town Hall, Ealing, W. 5. Reprinted from The Medical Officer by kind per mission of the Editor THE PATTERN OF DOMICILIARY AND INSTITUTIONAL CONFINEMENTS IN EALING, 1958 By Margaret McDonald, M B., B,S. Assistant Medical Officer, Area No. 7. , Middlesex County Council This survey was prompted by an increase in the demand for domiciliary midwives in Ealing, The numbers of domiciliary and institutional births and the totals in the years 1952-58 inclu sive are shown in Table I Table I Year Domiciliary Births Institutional Births Total Births 1952 488 2, 006 2,494 1953 470 1, 987 2,457 1954 498 1, 860 2,358 1955 448 1, 921 2,369 1956 546 2, 026 2,572 1957 6 27 2, 079 2,706 1958 740 1, 948 2,688 The Borough of Ealing has a population of 183, 000 The Area is served by the Obstetric Departments of two general hospitals and a mater nity hospital: the Central Middlesex has 79 mater nity beds, the West Middlesex 80 beds, and the Perivale Maternity Hospital 52 beds. In 1958 there were ten domiciliary midwives in Ealing, although this number has since been increased to 13 The residential area consists mainly of private houses and flats, 46,979 in number, and there are some Council estates.' containing 6 135 houses and flats a total of 53.114 dwellings Domiciliary Midwifery Service 77 The health visitors were asked to interview and complete a questionnaire in respect of each woman in their district who had been confined in 1958, and with whom they came into contact during January to March 1959. There were 899 women interviewed, 390 being primigravidae and 499 being multigravidae The information obtained is analysed in Table II Table II Primigragidae 390 Confired at By choice Not by choice Home 20 10 Hospital 338 22 Multigravidae 499 Home 194 63 Hospital 196 46 Primigravidae All those who had their confinement at home (although they would have preferred hospital) said they enjoyed having their babies athome (10), However, half of those who had asked to have their babies at home (22), but had been advised to go to hospital, still wished they had been confined at home Multigravidae Among those who both wished for, and had confinement in hospital (196), only five had had opportunity for comparison, and gave the reason for their preference as freedom from domestic worry Amongst the 63 women who had asked for hospital and had been unable to get a bed, 32, on reflection, preferred home because they were with the family and had more personal attention. Six women would have preferred home if they could have obtained adequate and inexpensive domestic help Twenty five women still preferred hospital giving their reasons as (a) more rest (6) (b) freedom from domestic worries (7) (c) more security (5), and (d) vague reasons (7) DISCUSSION The statement that six people would have pre ferred a home confinement if they could have obtained adequate and inexpensive domestic help raises the question of the added expense to the mother of having her confinement at home Possibly there were many more mothers to whom this question of expense was a material factor in choosing to have the confinement in hospital A reasonable estimate of this additional cost is: - £ s d. Home Help (Cranbrook Report Appendix V East Suffolk County Council Estimate, 1956) 11 10 0 Pood for mother 2 10 0 Heating, lighting, etc 1 10 0 Additional linen 2 0 0 Extras; soap, bowls, etc 10 0 18 0 0 78 Towards this expenditure the mother receives a home confinement grant of £5 The Reading Borough Council gave their estimate (1956) for Home Help at £6.6s 7d In Ealing the average Home Help charge made to mothers in assessed cases for the financial year ending 31st March, 1959, was £4 per case This estimate concerns those whose income is so low that they know they will get the Home Help at a diminished rate Those who are asked to pay the full rate of 4s per hour either make other arrangements, or have a Home Help for a few days only. The Cranbrook Committee state that "the home confinement grant, at present £5, was we thought unlikely to cover the cost of food (which in hospital was provided free), minor equipment and the additional home help that the mother confined at home was likely to require We consider that with the changing value of money the amount of the home confinement grant should periodically be reviewed," In 1946, the Population Investigation Committee and the Royal College of Obstetricians and Gynaecologists combined to make an inquiry into the social and economic factors of childbearing All the women delivered in a single week were interviewed, and the Borough of Ealing was invited to participate in this inquiry In urban areas throughout the country, 46 per cent of confinements took place in institutions, but, in 1948, 78 per cent of Ealing mothers were confined in institutions. In the Cranbrook Report some witnesses suggested that every woman who wishes to have her baby in hospital should be allowed to do so, other witnesses thought that every woman should be actively encouraged to have her baby in hospital, while a third source stressed that there were important physical and psychological advantages in the normal confinement taking place at home. The Cranbrook Committee recommended that sufficient maternity beds should be provided for a national average of 70 per cent of all confinements to take place in hospital In Ealing 73 per cent. of the total births in 1958 were in hospital. If a hospital bed had been provided for every patient who had asked for one, 76 per cent of those interviewed would have been confined in hospital SUMMARY (1) Eight hundred and eighty-nine women who had been confined in 1958 were interviewed and a questionnaire completed by the health visitors 607 chose to have a hospital confinement, although 73 had to have a home confinement; 68 had a hospital confinement, but not by choice; leaving 214 confined at home by choice (2) All 10 of the primigravidae, and 38 out of 63 of the multigravidae who had been obliged to have their confinements at home, decided, on retrospect, that they really preferred to do so. Financial implications may well have been the deciding factor in their first choice. .