AC - 439 (1) EAL 51 Liberary The Health of Ealing in the year 1960 EAL 51 The Health Of Ealing in the year 1960 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 8 Section 2 - SANITARY CIRCUMSTANCES OF THE BOROUGH 12 Section 3 - SANITARY INSPECTION 24 Section 4 - GENERAL 43 Section 5 - STATISTICAL TABLES 51 Section 6 - APPENDIX : REPORT OF THE DISTRICT SCHOOL MEDICAL OFFICER 57 Supplement - FOR GENERAL INFORMATION 77 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT William G. Booth Medical Officer of Health M D, , B,S, , D.P.H. I.H. Seppelt Deputy Medical Officer of M. A., M,B., B Chir., D,P,H. Health E. Belfield Chief Public Health Inspector E.H. Evans Public Health Inspector C.W. Baxter '' '' '' E.W. Budd '' '' '' A.E. Pooley '' '' '' G. O. Axon '' '' '' A. C. Bamping '' '' '' N.V. Saunders '' '' '' L.E. Bowskill '' '' '' J. A. Crisp '' '' '' Ai S. M. Pratt Chief Administrative Assistant Barrister-at-Law (Part-time) Miss D.E. McKenzie Secretary to Medical Officer of Health D.E. Storr Appointed May Senior Clerk R. S. Leggatt Clerk D. R.A. Smith '' '' '' Miss S. Pox " Mrs. D. Barker Clerk and Typist Mrs. M.G. Byford Shorthand Typist M.L. Aldridge Trainee Public Health Inspector LH. Jones Appointed August Trainee Public Health Inspector R.S. Cox Assistant Rodent Officer R. Lazzolo Rodent Operative P. Bedley L.B. Radford Driver/Disinfector E. Sheldrick 5 Madam Mayor, Aldermen and Councillors, It is with some satisfaction that I have again to report to the Council that the general picture of health in the Borough during the past year is one of which we can be well pleased. The following basic figures give us cause for some congratulation, Infant Mortality Rate 16 per 1,000, Maternal Mortality 0.3. Anyone aware of the comparable position (Infant Mortality Rate 55 and Maternal Mortality 2.3) a generation ago (1926) will understand the significance of this in terms of human misery, apart from the cost of services provided to deal with the problems we then faced. Education of the population has undoubtedly been one of the greatest factors in the general improvement of nutrition and health amongst the community as a whole and the Council's health services have persistently and patiently pursued the path of the dissemination of knowledge on health matters through clinics, schools and house to house visitation of health visitors. These services so well established in the 30's and 40's have now been broadened into the environmental services of the Local Sanitary Authorities by the agency of the Councils staff of Health Inspectors. More and more their work has become educational, and in Ealing we have found their great value. All of them are keenly interested in the patiently progressive programme of education in the important fields of Clean Food and Clean Air, and Infectious diseases. It is indeed a token of the high standard of work done in the Clean Food field that we have a constant flow of visitors from overseas health departments to see the novel methods and materials used in your health department. I am well aware of the fact that the Public Health Committee are very appreciative of the work done in this department, and the loss that has been sustained by the reduction of senior staff by the retirement of the Chief Health Inspector and the loss of the post of Deputy Chief Health Inspector, Not only did this mean the losing of an opportunity to provide some administrative training for a chief technical officer within our own service, but also placed an extremely heavy burden upon the Chief Inspector's shoulders. This loss is still being felt, and it is hoped that the Borough Council will appreciate the desirability of making such an appointment 6 again in view of the wide field covered by the health inspectorate in a borough with a population of nearly 200,000 people, and the changes that will be necessary in the department within the next few years. One of the problems which has developed during the last year has been that of the multiple occupation of large houses, of which there are many examples in the Victorian residences of Ealing. The crippling increase in rating placed upon houses properly converted into flats has no doubt played a substantial part in the movement to let the houses in separate rooms and so avoid a revision of the rating potential. Houses with a reasonable rating can be increased five fold or more as soon as they are properly converted into self contained flats and this has no doubt been one reason for the buying of large houses and the continuing letting in multiple occupation. It should not be impossible for the rating position to be related more closely to size rather than self contained occupancy and thus encourage proper flat conversion of larger properties. The Health Inspectors have been keeping a close watch on the situation wherever our limited powers in connection with over-crowded properties are brought into play, and it is hoped that our powers will be strengthened ere long, since the influx of overseas and continental immigrants are making many problems for the department. May I take this opportunity of reminding the Council of the magnificent service being given to the community, particularly in the public health field, by the Voluntary bodies in the Borough. Meals on Wheels, Holidays for the Aged, Social Clubs, Workshops for the Elderly, Chiropody and many other philanthropic ventures are carried on in Ealing without public acknowledgment. I hope that all those people who are giving so generously of their time to help in these activities will accept my sincere thanks for the great help they are providing in the promotion of happiness for so many ageing and lonely people in Ealing. The work they are doing cannot be done by the Council themselves owing to the lack of legal powers, but we are singularly fortunate in Ealing in having so many people prepared to help this greatly needed work. 7 May I take this opportunity of thanking the Council for their consideration to the staff of the department and in their appreciation of their work, and to assure the Council of their desire to continue to give the Council as heretofore, efficient and conscientious service. Your obedient servant, W.G.BOOTH. Medical Officer of Health. 8 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, dysentery, acute primary pneumonia, acute influenzal pneumonia, measles, whooping cough, acute encephalitis and meningococcal 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. On December 1st the PublicHealth (Infections Diseases) Amendment Regulations, 1960, came into operation and provided for the notification by medical practitioners to the Medical Officer of Health of all cases of Anthrax. DIPHTHERIA. There were no cases of Diphtheria. During 1960, 2,108 children under one year of age were immunised against diphtheria. This represents approximately 78% of children in their first year of life who were immunised in Ealing. Diphtheria immunisation is now normally combined with that against whooping cough and tetanus. DYSENTERY. 261 cases were notified, an increase of 67 compared with 1959. None of these was serious in character. ERYSIPELAS. 17 cases were notified. FOOD POISONING. 20 cases were notified, and the causative organism was identified as Salmonella Typhimurium in 5 of these cases. MALARIA. There were no cases notified. 9 MEASLES. The incidence of measles was extremely low even allowing for the fact that 1980 was not an expected epidemic year. Only 50 notifications were received. MENINGOCOCCAL INFECTION. Two cases were notified. OPHTHALMIA NEONATORUM. Three cases occurred which satisfactorily cleared up. PNEUMONIA. There were 46 cases notified compared with 154 cases in the previous year. 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. The number of persons who completed a course of three injections during the year is as follows:- Children born in the years 1943 - 1960 4, 144 Young persons born in the years 1933-1942 5,463 Persons born before 1933 who have not passed their 40th birthday 2,304 Others 92 Totals 12,003 By the end of the year a total of 47,224 persons in Ealing had completed a course of immunisation against poliomyelitis. PUERPERAL PYREXIA. 63 notifications were received. 7 occurred in home confinements and the remainder in hospitals. SCARLET FEVER. 117 cases were notified. In 1959 there were 269 cases. SMALLPOX. No cases occurred but 12 persons were kept under surveillance as possible contacts of a case which arrived by air from Colombo. 10 In 1960, 1,495 infants under one year of age were vaccinated against smallpox representing approximately 55% of this age group. TUBERCULOSIS. There were 87 pulmonary notifications, 48 male and 39 female. There were 18 non-pulmonary cases, 6 male and 12 female. The pulmonary notifications continued the downward trend which has been apparent in recent years and compares with 105 notifications last year. The number of notifications of non-pulmonary cases represents a small increase over the figures of the last few years but this does not appear sufficient to be of any significance. There were 10 pulmonary deaths and 1 non-pulmonary death compared with 5 pulmonary deaths and one nonpulmonary death in 1959. WHOOPING COUGH. 258 notifications were received compared with 80 in 1959. 1,744 children under a year were immunised against whooping cough which represents 65% of this age group. 11 TUBERCULOSIS Age Periods New Cases Palmonary Non Pulmonary 1955 1956 1957 1958 1959 1960 1955 1956 1957 1958 1959 1960 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 - 2 1 4 1 1 2 1 2 - - 1 - 1 - - 1 - - - - - - 5 - 14 1 1 2 5 4 1 1 1 4 - - 3 2 4 - - - - - - - - 1 - 15 - 24 16 14 14 21 16 12 16 10 10 10 9 5 2 3 2 - 1 1 - 1 1 1 - 2 25-44 21 26 22 21 18 12 20 12 24 11 13 22 2 4 1 4 2 6 3 1 - 1 2 8 45 - 64 23 7 29 9 26 5 23 5 31 4 21 6 1 2 4 1 3 1 2 1 3 - 3 2 Over 65 6 3 4 4 12 2 4 2 3 5 5 3 2 1 - - - - - - 1 3 - - Total 68 51 73 61 80 33 65 32 73 32 48 39 10 14 8 5 6 9 5 3 5 5 6 12 Age Periods Deaths Pulmonary Non Pulmonary 1955 1956 1957 1958 1959 1960 1955 1956 1957 1958 1959 1960 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 1 1 - 1 2 1 1 - - 2 - 1 - - - - - - - - - - - 45-64 5 - 11 2 6 3 2 2 1 2 3 1 1 - 1 - 1 - - - - - 1 - Over 65 6 1 5 2 6 2 2 2 1 1 3 1 - - - - - 1 - - - 1 - - Total 4 3 17 4 13 7 5 5 2 3 8 2 3 •• 1 2 1 - - - 1 1 - 12 SECTION 2 SANITARY CIRCUMSTANCES OF THE BOROUGH WATER. There are three sources of supply in the Borough. The Northolt North, Northolt South, 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 53,770 houses with an estimated population of 183,390. 15 samples were taken from wells at 5 factories in the Borough using water from deep borings ranging in depth from 300-600 feet. Three samples were not completely satisfactory but 1 further sample taken from the same source proved to be satisfactory. The other two doubtful samples were receiving attention at the end of the year. Two samples taken from the mains supply to a school following the receipt of a complaint were found to be satisfactory. Water Samples 1960 Samples Satis factory Doubtful Unsatisfactory Wells Supply 15 10 4 1 M. W. B. Supply 2 2 - - Swimming Baths 3 3 - - 20 15 4 1 DRAINAGE AND SEVERAGE. 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. 13 RIVERS AND STREAMS. No. of inspections 332 No. of samples taken: (1) By County Engineer 24 (a) Satisfactory 8 (b) Unsatisfactory 16 (2) By Public Health Inspectors 3 (a) Satisfactory 1 (b) Unsatisfactory 2 No. of drainage defects remedied: (a) In factories 6 (b) In houses 25 (c) In shops 4 The sources of pollution can be analysed as follows:- Sinks and handbasins and baths 28 W. Cs.- Industrial Wastes 6 Soil sewers and drains 1 ATMOSPHERIC POLLUTION. Clean Air Act, 1956 - Smoke Control Areas. The Smoke Control programme approved by the Council in June, 1959, showed that it is proposed to include the whole Borough in Smoke Control Orders by 1974, covering a total of 8,781 acres and 59,280 premises. It was estimated that 8,659 premises would be included in Orders made up to the end of 1960. As the following table shows, the actual number of premises dealt with is 8,079. Preliminary surveys of two further areas are in progress. In the case of No. 5 Smoke Control Area final confirmation was held up because two objections to the Order were received from residents in the area. These objections were subsequently withdrawn after interviews with the objectors. Clean Air Act, 1956 - Section 3 - New furnaces During the year 18 notifications were received of the installation of new furnaces. The specifications were checked by the Public Health Inspectors and the Council's consultant and all were found to comply with the requirements of the Act that the plant must be capable of being operated continuously without emitting smoke when burning the correct fuel for which the plant was designed. 14 Progress of Smoke Control Programme NO. Of Smoke Control Orders Acres NO. of dwellings involved Other buildings involved Total premises covered Private Local Authority In operation 2 661 836 1,379 52 2,267 Confirmed, but not yet in operation 2 384 1, 495 970 141 2,606 Awaiting confirmation 1 167 1,421 14 58 1,493 Approved by Council for submission to Minister 1 133 6 1,682 (L.C.C.) 25 1,713 Totals 6 1,345 3,758 4,045 276 8,079 15 16 In one instance prior approval under the section was sought for the installation of new cupolas and grit arresting equipment at a foundry. The plans and specifications were examined by the Council's consultant and the application was approved. Prior approval was also given to plans and specifications for new oil fired boilers at a new fire station at Northolt. The effect of prior approval is that furnaces installed in accordance with the plans are deemed to comply with the requirements of the section. Section 10 - Heights of chimneys Under this section plans of new buildings other than residences, shops or offices, must be rejected unless the local authority are satisfied that the proposed height of the chimney will be sufficient to prevent, as far as practicable, the smoke, grit or gases from becoming prejudicial to health or a nuisance. Such plans are passed to me by the Borough Surveyor for comment on this particular aspect and in four instances during the year higher chimneys were agreed after consultation with the architects. West Middlesex Clean Air Coordinating Committee The three authorities fully represented on the Committee (Ealing, Peltham and Hayes & Hariington), were joined during the year by officer representatives from Heston& Isleworth and Southall, thus covering a contiguous area of over 28;000 acres with a total population of nearly 500,000. The Committee met three times during the year and a useful exchange of information took place, particularly on legal and administrative problems arising from the operation of Smoke Control Areas and the installation of new industrial plant with the consequent problems of heights of chimneys. There is no doubt that the formation of this Committee has been fully justified and has led to a considerable degree of uniformity of action within the area. Clean Air and Clean Food Exhibition The Public Health Committee decided to arrange a Clean Air Exhibition during 1961, in order to give the public the fullest possible information on the requirements 17 of the Clean Air Act, and to enable them to see the best types of appliance for use with approved fuels. Since it is nearly twelve years since our Clean Pood Scheme was inaugurated by the holding of an exhibition it was thought that it would be desirable to fulfil a double purpose and to hold a Clean Pood Exhibition in conjunction with the Clean Air Exhibition. The combined Exhibition will be held in the Town Hall from Wednesday, September 27th to Wednesday October 4th, 1961, that being the earliest period in which all the halls required are available at the same time. Atmospheric Pollution Gauges 1960 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 ford Green Jan. 12.84 12.67 9.16 1.16 3.90 1.39 Feb. 7,70 13.21 1004 2.66 3.83 2.15 March. 9.10 16.34 11.665 1.86 4.15 2.51 April. 10,57 8.60 7.52 1.07 2.12 1.40 May. 10.57 14.11 8.04 1.02 2.07 1.17 June. 19.31 13.44 10.54 0.77 1.65 0.77 July. 8.54 6.44 4.14 0.35 0.98 0.51 Aug. 9.94 10.27 5. 60 0.67 0.93 0.39 Sept. 11.84 10,64 4.74 1.03 1.69 1.16 Oct. 10.51 11.07 5.67 1.31 2.80 1.80 Nov. 8.70 10.24 7.54 1,14 3.28 1.91 Dec. 13.54 11,17 6.24 1,33 3.20 1.79 Average Monthly Concentrations of Smoke and Sulphur Dioxide 1960 Smoke in Milligrammes per 100 cubic metres Sulphur Dioxide in parts per hundred million Town Hall Ellots Green School Walpole Grammar School Town Hail Ellots Green School Walpole Grammar School Jan. 24 16 20 9.1 8.4 9.6 Feb. 19 17 19 9.8 8.1 9.4 March. 14 10 13 9.5 7.6 11.9 April. 9 - - 5.2 - - May. 8 5 7 8.5 4.0 6.0 June. 2.6 2.5 2.5 4.1 2.9 4.2 July. 2 2 1.6 1.4 1.7 2.0 Aug. 3 3.4 2.1 1. 5 1.3 2.5 Sept. 6.6 5.7 5.6 2.7 2.9 5.2 Oct. 12.4 14.2 12.2 6.7 7.2 8.5 Nov. 11.3 12 14.5 5.8 6.0 7.1 Dec. 22 22.3 25.5 7.8 9.5 12.3 * No returns due to Easter holidays 18 FOOD HYGIENE. The Clean Pood policy of the Ealing Council is a long term one based on regular inspections of food premises, together with talks to food handlers, school leavers and women's organisations. This lecture scheme is regarded as of vital importance and is being pursued with the same energy as during the past 11 years. There is every indication that these talks are appreciated and that they are showing beneficial results. During 1960, 37 lectures were given to food handlers and 197 received Certificates of Attendance upon completing the course. In addition 24 talks on Pood Hygiene were given by the Public Health Inspectors to approximately 960 school-leavers at the Grammar and Secondary Modern Schools in the Borough. The current holders of these 62 certificates are:- School Meals Service. 23 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. 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, The 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 The Broadway, W. 5. -do- 87 Broadway. W. 13. The Council's Food Hygiene Certificate is held in high esteem by shop keepers in the food trade and by their customers 21 Grocers, Champion Tea Co., 366/8 Windmill Lane, W.5. H. Cradock Ltd., 52/3 Manor Road, W. 13. 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. 2,464 inspections of food premises were made and 596 repairs and improvements were carried out. The film-strip on Pood Hygiene made by the Council in 1954 is still in demand, a further 11 copies having been sold during the year. This makes a total of 138 copies sold. During the year the Clean Food Booklet, which is distributed to food traders, was extensively revised. This Booklet gives an account of the principles of Pood Hygiene for all those concerned with food, but particularly shop keepers, school leavers, restaurant workers and housewives and those who handle food at home. It also gives information to food traders regarding the Council's Pood Hygiene lectures and how to gain a Pood Hygiene Certificate. It is felt that an attractive Booklet, which we hope this is, is likely to be of considerable assistance in the Clean Pood Campaign. It has been increasingly clear during the last few years that the film used for Clean Pood lectures has become very out of date. Indeed, it was made during the days of food rationing. It has therefore largely lost its impact. The provision of a replacement for this had become a necessity and the Council have agreed that negotiations should be begun to see if other interested organisations would co-operate in the production of an up-to-date colour film of high quality. The Central Council for Health Education are interested in this project and I have approached a commercial organisation in the field of sterilising fluids. This firm has itself made excellent films but the emphasis has, of course, been on advertising 22 their particular product. This restricts our use of it and I am hoping that they will be agreeable to co operate in the making of a film which reduces the advertising to an acceptable level. The forthcoming combined Clean Air and Clean Food Exhibition is referred to elsewhere in this report. SLUM CLEARANCE. Closing Order. 11 The Grove, W.5. These premises were occupied as a shop with living accommodation attached. An Undertaking was given by the owner that the premises would not be used for human habitation. Basement Dwellings 47 Grange Road, W.5. The works agreed in the owners Undertaking to render the premises fit for human habitation were completed satisfactorily. 43 The Avenue, W. 13. A Closing Order was made in April, 1959 on the basement flat at these premises. A specification of works was submitted by the owner for rendering the basement fit for habita tion and was accepted by the CouncilThe works are in hand. 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. Three samples taken for bacterial tests proved to be satisfactory. There are two privately owned swimming pools in the Borough, both of which are equipped with filtration and chlorination plants. 23 PUBLIC MORTUARY. The arrangement with the Acton Council for the use of the Acton Mortuary was continued during the year. 326 bodies were taken to this Mortuary and post-mortem examinations were carried out in every case. Arrangements were also made with the Uxbridge Council for the use of their mortuary and 38 bodies were taken to this mortuary for post-mortem examination. 24 SECTION 3 SANITARY INSPECTION THE WORK OF THE PUBLIC HEALTH INSPECTORS IN 1960 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 2,220 Other nuisances observed by Inspectors 96 Premises inspected in connection with infectious disease 600 Smoke observations 280 Houses without water supply 115 Inspections of moveable dwellings 291 Other inspections 2,119 Re-inspections 5,543 Intimation Notices served 1,039 Statutory Notices served 242 Letters written 3,173 Proceedings before Magistrates 2 Legal Proceedings. Public Health Act, 1936 Sections 75 and 93 Non-compliance with Statutory Notices In 2 cases legal proceedings were taken to enforce compliance with notices requiring the abatement of nuisances. In one case a Statutory Notice was served under Section 75 of the Public Health Act, 1936 on the owner of a house to supply a new dustbin. He appealed to the Magistrates Court on the grounds that he considered the tenant responsible. The Appeal was dismissed and the new bin was subsequently supplied by the owner. In the other case, a Nuisance Order and costs were obtained against the occupier of a caravan on land in Western Avenue, Green ford. CLEAN AIR ACT, 1956 Inspections in connection with proposed Smoke Control Areas 9,325 25 FOOD AND DRUGS ACT, 1955 Food Hygiene Regulations 1955 Milk and Dairies Regulations, 1949 to 1954 Complaints received 109 Inspections of Milk Purveyors' Premises 88 Contravention of Regulations Inspections of Ice Cream Premises 239 Pood Inspections 545 Inspections of other Food Premises 2,137 Contraventions found 218 Notices served 218 Proceedings before Magistrates 6 Samples of Milk and Cream taken 17 Samples of Ice Cream taken 78 Samples of Synthetic Cream taken 37 Samples of other foods taken 6 Samples of tea taken 944 Samples of water taken 15 Legal Proceedings Food and Drugs Act, 1955 In the following 6 cases proceedings were instituted under this Act:- Fruit fly larvae in milk - £20 fine, £5.5.0. costs. Metal screw in loaf-£10 fine, £7.7.0. costs. Glass in milk-dismissed. Foreign matter in bread-£10 fine, £2.10.0. costs. Foreign matter in orange juice-£10 fine, £6.6.0. costs. Wasp in bread-£5 fine, £3.3.0. costs. List of Food Premises in the Borough of Ealing Bakehouses 22 Bakers' shops 53 Butchers 123 Cafes and Restaurants 149 Canteens-factory 81 Canteens-school 28 Confectioners 247 Dairies and Milk Sellers 83 Fish Fryers 22 Fishmongers 34 Greengrocers 152 Grocers 310 Ice Cream Manufacturers 3 26 Public Houses 63 Premises registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food 117 Premises registered for the sale of Ice Cream 401 Milk Supply. There are 49 registered distributors of milk in the Borough. During the year licences for the sale of milk under the Milk (Special Designations) Regulations, 1960 were granted as follows:- Dealers' Licences Supplementary Licences Total Tuberculin Tested Milk 62 9 71 Pasteurised Milk 74 10 84 Sterilised Milk 53 11 64 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. 17 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 10 10 - 10 - T. T. Pasteurised 5 5 - 5 - T. T. 2 - 2 - 2 In addition 111 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, 1960. As from January 1st, 1961, the issue of licences for the sale of designated milks, passed to the Middlesex County Council. Ice Cream There are 401 premises in the Borough registered for the sale of ice cream. 27 There are only 3 registered premises in the Borough manufacturing ice cream, all are equipped in accordance with the Ice Cream (Heat Treatment) Regulations, 1959. Ice cream is obtained from these three 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 78 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 59 42 13 1 3 - Ice Cream- Other Manufacturers 10 2 1 3 4 - Ice lollies 9 - - - - 9 78 44 14 4 7 9 The 3 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 4 Grade 4 samples manufactured outside the Borough were reported to the Local Authority concerned and subsequent repeat samples proved satisfactory. The 9 ice lollies, though not graded were satisfactory. Synthetic Cream 37 samples of synthetic cream were taken from local manufacturers. 36 were found to be satisfactory; 1 was doubtful. A repeat sample 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 of their inspections of the various food premises in the Borough:- lbs. Bacon 18 Beef 902½ Beef Sausages 24 28 lbs. Beef & lamb trimmings 16 Cheese 14 Chicken 189% Corned beef 42 Currants 45 Dripping 90 Eggs (frozen) 30 Pish 154 Flour 179 Ham 66½ Hearts 22 Jam 29 Kidneys 55 Lamb 185 Liver 32 Loganberries 1 Melts 85 Mutton 114 Oatmeal 22 Ox heart 14 Ox tongue 2½ Plums 9 Pig offal 28 Pork 252½ Pork Luncheon Meat 6 Prunes 270 Rabbit 18 Steak 104 Suet ¼ Sultanas 13 Tea 115,168 Tea sweepings 3,042 Tripe 30 Turkey 12 Veal 12 Foodstuffs not calculated by weight:- Assorted tins, packets and jars 39212 Articles: Chickens 8 Steak & kidney pies 2 Pork pies 2 Apple Pies 3 29 Tea For very many years the sampling of tea on importation, for the detection of adulteration and unfitness, was carried out by H.M. Customs & Excise, but this was discontinued from 1st January, 1959. The powers and duties of Port Health Authorities, Food and Drugs Authorities and other Local Authorities to inspect food for adulteration and unfitness remained unaffected, H.M. Customs and Excise connection with this work dates from the latter years of the last century. At that time, it appears, there was special concern as to impurities in Chinese tea and the work of checking it was no doubt laid to that Department because, inter alia, tea was then a major revenue producer and already extensively examined for Customs purposes. Nowadays the revenue interest in it has much declined as most tea imported is admitted free of duty. There is a very large tea packing factory and bonded warehouse in the Borough to which, by arrangement with the Commissioners of Customs & Excise, large quantities of tea are delivered direct from the docks. The initial point of inspection in this Country is therefore at the bonded warehouse. This places on the Council the responsibility of inspecting this tea to ensure that it is fit for human consumption, in accordance with the provisions of the Food & Drugs Act, 1955, and the Public Health (Imported Food) Regulations, 1937. During 1960. 939 samples of tea which were representative of all consignments received at the warehouse were taken by the District Public Health Inspector. This entailed three to four visits a week to the warehouse for routine testing for unfitness or adulteration with foreign matter. Experience has now shown that teas originating from certain Countries are more likely to be contaminated than others and therefore greater attention is given to these. The main forms of contamination of tea have been found to be: 1. Metallic dust and mineral matter, this apparently occurring during the processes of collection and preparation of the tea. 2. Moulds, which arise where the tea has become damp during transport to this Country. Their presence adversely affects the quality and flavour of the tea. 30 3. Lead is another known contaminant of tea but none of our samples has shown this to be present in excess. Of the 939 samples taken by the Inspector during the year, 175 were of doubtful quality after the initial tests were carried out and were referred for further examination to the Public Analyst. He reported that 95 samples were from consignments of tea considered to be unfit for human consumption mainly because of the presence of excess quantities of magnetic metallic dust. Tea that has been certified as unfit is re-exported under guarantee, usually to Holland, for industrial purposes. The Medical Officers of Health for the Port of London and the Port of Rotterdam are notified to enable them to check this procedure. Many of these teas could be blended with large quantities of other good tea and the analyst would regard the resultant product as satisfactory. A fairly large amount of the time of an Inspector has been taken up by this work but I feel that as we have now become responsible for this testing it must be carried out in the thorough way in which other foodstuffs are controlled. Other Food Samples. Six other food samples were submitted for testing after receiving complaints and all proved to be satisfactory. These included cooked meats, confectionery and cabbage water. MIDDLESEX COUNTY COUNCIL ACT, 1950, SECTION 11 Under this Section, 1 person was registered during the year for the sale of food from carts, barrows, other vehicles etc. There were 38 persons on the Register at 31st December, 1960. 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) 2, 244 (2) Number ot dwellmg-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Act, 1957 2 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 1,251 Public Health Inspector engaged in Tea Testing 33 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 891 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 118 (2) Number of dwelling-houses in which defects were remedied after service of formal notice: (a) by Owners 78 (b) by Local Authority in default of owner 8 C - Proceedings under Sections 16, 23 and 24 of the Housing Act, 1957 (1) Number of dwelling-houses in respect of which Demolition Orders were made (2) Number of dwelling-houses demolished in pursuance 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 1 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 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Houses in Multiple Occupation. In common with most authorities in the London Area, we are finding an increasing tendency for houses in the Borough to be let to a number of families without proper conversion into self-contained units. Many of the larger houses lend themselves particularly to this type of occupation, but smaller houses also are being used in this way, owing largely to the influx of numbers of immigrants from the Commonwealth and from Ireland. In addition to overcrowding there arise problems of providing adequate and suitable facilities such as water closets, sinks and cookers for each separate family. 34 Sections 36 and 90 of the Housing Act, 1957, contain provisions designed to deal with these problems. Section 90 gives a local authority power to fix the number of persons who can occupy a room for sleeping purposes in houses let in lodgings or occupied by more than one family. Section 36 enables a local authority to require the pro vision of suitable amenities. In default of executing such works the owner may choose to reduce the number of occupants in the house. This option to obtain possession against the occupiers makes the section difficult to apply in some cases. Most of the families occupying these houses are unlikely to be favourably placed on the Council's housing list, not having lived in the Borough long enough. Any abrupt legal action in such a case would possibly create an even greater hardship. Informal action has in the long run been successful in many cases. The Act does not itself lay down specific standards to be applied to these houses. The Metropolitan Boroughs Standing Joint Committee has suggested a code of practice for general use in the Metropolitan area and the Council have resolved to use this as a guide for the time being and to ask the Middlesex Borough and District Councils Association to consider standards for use by Middlesex authorities, with a view to securing uniformity of action throughout the County. This is still under consideration. An important fact about overcrowding in general, is that it is not always realised that the overcrowding clauses of the Housing Act, 1957, are not so restrictive as might be thought in fixing the total number of occupants for a dwelling-house. With its standard of two units per room, with allowances for smaller rooms and with children between 1 year and 10 years of age counting as half units, the average five roomed house has a permitted number of 8½ units. All living rooms and bedrooms have to be included in arriving at the permitted number. Our larger houses, with a dozen or more habitable rooms, can legally house quite large numbers of people, especially with children. We receive quite a number of complaints alleging overcrowding, which on investigation are found not to be justified on the legal standard. Have we become so used to houses being occupied by small families that a fully occupied house calls for adverse comment and complaint? Admittedly, the official standard might not be thought to be a good one, but there would have been no point in an unduly severe legal standard which was not capable of attainment for some years to come. (Reproduced by kind permission of "Middlesex County Times") Roadside Gipsy Encampment in Ealing 37 THE CARAVAN SITES AND CONTROL OF DEVELOPMENT ACT, 1960 This Act came into force on 29th August, 1960. Its objects are to control the location of caravan sites and to improve conditions on sites. It is an offence, punishable by a fine of up to £100, for anyone to permit land to be used as a caravan site without a site licence. The Council have delegated to the Public Health Committee the powers relating to site licences, but these can only be issued if the planning authorities first give planning permission. If that permission is given, a site licence cannot be refused, but will impose conditions to secure that sites are properly laid-out, equipped and maintained. There are certain exemptions from these requirements such as travelling showmen, agricultural and building site workers and sites with occasional and limited use. It was found that nine sites were in use in the Borough and applications in respect of these are being considered by the planning authorities. It does not appear that the Act will be of much assistance in dealing with our main problem, that of the itinerant or gipsy type caravan dweller who encamps on any available plot of land, road verges, etc. The habits of these people are only too well known and are a constant cause of complaint. Our only legal remedy is in establishing a statutory nuisance under the Public Health Acts, but the nomadic nature of these people makes the correct service of notices and summonses a virtual impossibility. Formal and informal action by the Public Health Inspectors over past years, under powers contained in the Ealing Corporation Act, 1905, has led to practically all available privately owned land in the Greenford and Northolt areas being fenced as a protection against the entrance of these caravans. The Council employ a warden to keep Council owned land free and the constant harassing of these caravan dwellers by the warden and the Public Health Inspectors, who work in close co-operation, has met with a reasonable degree of success. Towards the end of the year, however, there were signs that the problem was likely to be intensified along road verges, unused service roads, etc. owing, no doubt, to the still further restricted availability of suitable land in West Middlesex. RENT ACT, 1957 Part I Applications for Certificates of Disrepair (1) Number of applications for certificates 24 (2) Number of decisions not to issue certificates 38 (3) Number of decisions to issue certificates (a) in respect of some but not all defects 14 (b) in respect of all defects 10 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 16 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule (6) Number of Certificates issued 8 Part II - Applications for Cancellations of Certificates (7) Applications by landlord to Local Authority for cancellation of certificates 12 (8) Objections by tenants to cancellation of certificates 1 (9) Decisions by Local Authority to cancel in spite of tenants objection (10) Certificates cancelled by Local Authority 11 NEW DWELLINGS, 1959 Completion figures for the 12 months period ending 31st December, 1960 were: Houses (1 bedroom) - - Houses (2 bedrooms) - - Houses (3 bedrooms) - 62 Flats (Bedsitters) - 18 Flats (1 bedroom) - 22 Flats (2 bedrooms) - 55 Flats (3 bedrooms) - - FACTORIES ACTS, 1937 AND 1948 Part I 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 Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1,2,3,4 and 6 are to be enforced by Local Authority 79 2 - - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authority 431 325 15 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 510 327 15 - 39 2. Cases in which defects were found: Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Pound Remedied Referred To H. M. Inspector By H.M. Inspector Want of cleanliness 12 7 - - Overcrowding » - - - - Unreasonable temperature - - - - - Inadequate ventilation 3 2 - - - Ineffective drainage of floors - - - - - Sanitary Conveniences; (a) Insufficient 3 3 - 3 - (b) Unsuitable or defective 7 7 - 2 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to out-workers) 4 3 - 1 - Total 29 22 - 6 - Part VIII of the Act Outwork (Sections 110 and 111) Nature of Work Section 110 Section 111 No. of out-workers in August list required by Sect. 110(1)(c) No of instances of work in unwholesome premises Wearing apparel: Making, etc. 300 - Cleaning and Washing 1 - Furniture and upholstery 2 - Artificial flowers 6 - Paper bags 10 - Making of boxes or other receptacles or parts thereof made wholly or partially of paper 6 - Carding, etc. of buttons, etc. 42 - Stuffed toys 30 - Cosaques, Christmas crackers, Christmas stockings, etc. 43 - Lampshades 3 - Brass and Brass articles 1 - Woodwork 1 - Total 445 - 40 During the year, 234 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 158 instances: Lighting and ventilation improved 54 Heating improved 29 Sanitary accommodation improved 51 Washing facilities provided 24 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 770 Premises inspected 1,104 Premises found to be infested with: 1. Rats 886 2. Mice 161 Re-visits to infested premises 3,317 Pees received for treatment £692.6.0d. A Statutory Notice was not complied with and the work was done by the Council in default. Rodent Control in Sewers Maintenance treatments of soil sewers in the Borough were carried out during May, but the second treatment which should have been done in November had to be postponed because of acute staff shortages in the sewers department. 598 manholes were treated in May, of which 65 were found to be rat infested. In an effort to overcome future difficulties of this kind the Council have purchased manhole cover lifting equipment which will cut down the amount of labour required. They have also agreed to the new system recommended by the Ministry of Agriculture of using fluoroacetamide as a direct poison bait. RAG FLOCK AND OTHER FILLING MATERIALS ACT. 1951 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. 41 PET ANIMALS ACT, 1951 15 licences were renewed by the Council during the year after the premises had been inspected by the Public Health Inspectors. There was one new application and the licence was issued. DISINFECTION Number of houses where disinfection was carried out 113 Number of houses disinfested of vermin 52 Number of articles disinfected by steam 20 Number of articles disinfected by formalin spray 257 Number of articles voluntarily destroyed 62 The arrangement made with the Hammersmith Metropolitan Borough Council in 19523 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 10 Caravans-nuisances abated 7 Cesspools-cleansed Damp proof courses inserted in walls 9 Dampness-other forms remedied 107 Drains-connected to sewer Drains-cleared and cleansed 442 Drains reconstructed 43 Drains-repaired 207 Drains-new soil and ventilating pipes provided 47 Dustbins provided 156 Firegrates repaired or renewed 95 Floors-sub-floor ventilation provided 29 Floors-repaired or renewed 110 Food cupboards ventilated 8 Rainwater eaves gutters, downpipes repaired 186 Refuse-accumulations removed 101 Roofs repaired 227 Sinks repaired or renewed 40 Sink waste pipes repaired or renewed 77 Staircases repaired 30 Walls and ceilings repaired or cleansed 187 Water supply reinstated 115 Water supply-draw taps fixed to main supply 5 Water closets repaired, reconstructed or improved 91 Windows and doors repaired 198 42 Yards paved or repaired 37 Other defects remedied or nuisances abated 174 SUMMARY OF WORK DONE AND IMPROVEMENTS CARRIED OUT AT FOOD PREMISES Walls and ceilings repaired and cleansed 158 Floors repaired 45 Lighting and ventilation improved 22 Washing facilities provided 12 Hot water provided 27 Sinks provided 14 Storage accommodation improved 21 Water supply provided Water closets cleansed or repaired 25 Refrigeration installed or improved 6 Shop heating facilities improved Equipment improved 23 Other defects remedied 138 First Aid Equipment provided 3 Clothing accommodation provided 1 Water heater repaired 2 43 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 in providing them for themselves. Meals are cooked centrally and delivered by van in heated containers. In the Ealing and Hanwell area this is operated by the British Red Cross Society. Meals are delivered from two to five times weekly and the number of old people served is 75. The total number of meals delivered last year was 14,000. In the Greenford, Perivale and Northolt areas the service is operated by the Womens Voluntary Service. 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 7,488. 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 under Section 31 of the National Assistance Act. The scheme has functioned extremely satisfactorily and a large number of old people receive treatment throughout 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. Community Centres Northolt-Manor House, Church Road, Northolt, Greenford. Northfields-71 Northcroft Road, Ealing, W. 13. Perivale-Horsenden Lane South, Perivale, Greenford. Almshouses St. Mary's Almshouses, Church Gardens, Ealing, W.5. 44 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, 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 465 Total number of treatments 2,000 Number of patients receiving domiciliary treatment 284 Number of domiciliary treatments 1,200 In April of this year the County Council formulated its policy with regard to a Chiropody Service which it is to run under Section 28 of the National Health Service Act. The County Council decided to replace the existing scheme, run by the British Red Cross Society, by a scheme employing County Council Chiropodists working at Clinics. It has been arranged that there shall be a gradual run down9 the British Red Cross Society agreeing not to accept new patients, but to refer requests to the Area Health Office. It is hoped that this transition will work smoothly. However,, certain difficulties have already arisen* Whereas the charge has, until now been 2/6d. for both feet, the charge under the new scheme is 8/-. Although it is true that this is reduced, and even waived in necessitous cases, difficulty has been experienced in explaining the reason for the increased charges to those patients who are now having to pay them. The second difficulty which has arisen is in respect of domiciliary treatments. These represented a large proportion of the British Red Cross Society service and are not available under the County Council's scheme. Although it is appreciated that domiciliary treatment is expensive 45 the alternative of giving treatment to housebound old people by taking them to clinics in ambulances does not commend itself to me. The Ealing Borough Council have given a grant to cover the existing service until March, 1961, but it is anticipated that thereafter the County Council scheme will be functioning and the need for a grant from the Borough Council will cease, OLD PEOPLE'S WORK CENTRES There are two Work Centres in the Borough organised by the Ealing Committee for the Employment and Recreation of Elderly Citizens, At present there are 40 workers at the West Ealing Centre and 25 at the Greenford Centre, The South West Middlesex Hospital Management Committee are negotiating for the use of the Drill Hall as a temporary out-patients department during building operations at King Edward Memorial Hospital. This would necessitate alternative accommodation for this Centre and various approaches have been made. It is hoped to increase the numbers of workers gradually but there are limiting factors, the two most important of these being the need to find more voluntary helpers to supervise the work and the ever present difficulty of finding suitable work. Northolt Workshop In January it was decided that a third workshop should be opened in Northolt so that the old people living in that area could benefit from this scheme. Various sites were visited and it was decided that the Northolt Memorial Hall was the most suitable. The Trustees of the Memorial Hall were approached with a request that the Council be allowed to administer the Trust and grant a lease to the Ealing Committee for the Employment and Recreation of Elderly Citizens. It is hoped that alterations can be made and the Workshop opened early next year, HOLIDAYS FOR OLD PEOPLE During the year holidays for old people were arranged by the Womens Voluntary Service and the Greenford Philanthropic Society. The Womens Voluntary Service party consisted of 240 old people who were taken to Bexhill-on-Sea for one week's holiday. The Greenford Philanthropic Society party numbered 45 old people, who were taken in two parties, for a week's holiday to Ramsgate. 46 These holidays are of great benefit. I have no doubt that an old person can often be kept in good health and even out of hospital by a timely holiday of this nature. PROPOSED REST AND TREATMENT CENTRE During the year plans have gone ahead for a Rest and Treatment Centre for the elderly and an inaugural meeting to form a voluntary organisation to administer the scheme was held in July. An Association called the Ealing Day Treatment Centre Association was formed with Alderman Mrs* L. Stowell as its Chairman. The Committee consisted of six members of the Ealing Borough Council9 three representatives of the West Middlesex Division of the British Medical Association and one representative from each of three voluntary organisations in the Borough, namely the British Red Cross, St. John Ambulance Brigade and the Womens Voluntary Service. The Mayor of Ealing was asked to become President. The scheme has been made financially possible by contributions to the Association from various sources. The Council have made a grant, Messrs. Taylor Woodrow Ltd. are providing and erecting a very suitable hut rent free for five years, and Honeywell Brown Controls are providing the necessary electrical equipment. Glaxo Laboratories Limited have made a generous grant towards the equipping of the Centre, and the British Bath Company have offered to loan a bath specially designed for use by old people. During the year various sites have been under consideration, several of which have had to be abandoned in the end,due to one or other difficulty. Finally in October a plot of land in Green Lane, Hanwell, was offered to the Association and accepted. Building Byelaw approval has been received for the erection of this building and it is hoped that Town Planning approval will be to hand early in the New Year so that the scheme can commence by the middle of 1961. Committee Alderman Mrs, L. Stowell, 0.B.E. Alderman Mrs, E.M. Stephens Councillor J.F. Barlow Councillor H.G. Brewster Councillor G.W. Hill Councillor Miss J.I. Lawford Council Representatives Dr. Barbara Bailey Dr. C. A. Osborn Dr. F.H. Scoones West Middlesex Division of the British Medical Association Mrs. D. M. Collins Mr. G.E. Hoskings Miss E.C. Tippetts British Red Cross St. John Ambulance Brigade Womens Voluntary Service 47 OLD PEOPLE'S LIAISON COMMITTEE. This Committee, which consists of representatives of the Public Health Committee and those voluntary organisations which run services with grants from the Council under Section 31 of the National Assistance Act. met on 8th November this year. It again proved most useful in giving the Council members a chance to explain their overall plan for old people's welfare to the voluntary organisations and at the same time gave the representatives of the voluntary organisations the opportunity to bring their various difficulties to the notice of the Council. The representatives for the year were as follows:- Committee Members: Alderman Mrs. L. Stowell, 0. B.E. Chairman Councillor J.F. Barlow Councillor J.T. Bartlett Councillor H.G. Brewster Councillor J. Fullwood Councillor B.H. Silverman Council Representatives Mrs. D.M. Collins Mrs. E.M. Doughty British Red Cross Society Mrs. H. Corbyn Mr. L.R. Feltham Ealing Committee for the Employment and Recreation of Elderly Citizens Mr. F. W. Tomlin Mr. L. Ward Greenford Philanthropic Society Mrs. H.W. Corey Miss E.C. Tippetts Womens Voluntary Service LAUNDRY SERVICE FOR TOE INCONTINENT This service has continued its useful work during 1960. Arrangements have remained unchanged during the year, namely collections twice weekly by public health transport and an initial cleansing by the Health Department's Driver/Disinfectors. Subsequent laundering is in the Baths Laundry, separately from its normal work. The Catholic Womens Guild has very kindly continued to undertake the auxiliary service of repairing worn garments and bed linen. The following table shows the use made of the service during the last six years. 48  1955 1956 1957 1958 1959 1960 No of cases dealt with during the year 84 78 70 56 67 83 No of cases remaining at end of year 44 47 39 38 39 42 No, of cases that died 39 26 48 35 31 48 No of cases removed to hospital 39 28 14 22 41 30 No of cases where other arrangements were made 7 5 4 2 3 Total number of articles dealt with 34,259 36,755 44,466 36,723 59,004 48„847 Total number of collections 3,347 3,086 3,333 2,766 4,822 2,954 Average number of articles per collection 10.2 11.9 13.3 13.3 12.2 16.5 MASSAGE AND SPECIAL TREATMENT ESTABLISHMENTS Twenty-four establishments remained registered at the end of the year, and four exemptions were granted to members of the Chartered Society of Physiotherapists. One application for registration was refused because the applicant did not possess the technical qualifications required by the Council. During the year Parliament passed The Professions Supplementary to Medicine Act. 1960, but this has not yet come into operation. The Act provides for the establishment of Boards to promote a high standard of professional education and conduct for Chiropodists, Dietitians, Medical Laboratory Technicians, Occupational Therapists, Physiotherapists, Radiographers and Remedial Gymnasts, These Boards will have the function of maintaining a Register of those who have attended courses of training approved by the Board, or in the case of existing practitioners those who are considered suitably qualified by reason of practical experience before the appointed day. Registered persons will be entitled to use the title of State Registered Chiropodist etc. A Council for Professions Supplementary to Medicine is to co-ordinate and supervise the activities of the Boards, At present the Borough Council is responsible for registration of establishments for Massage and Special Treatments under the Middlesex County Council Act, 1944, and may refuse to license all those who do not possess such technical qualifications as may be reasonably 49 sary. Doubtless, therefore, the decision of these Boards as to suitable qualifications will be of great assistance to the Council in its administration of this provision of the Middlesex County Council Act. NURSING HOMES These were inspected as usual and no new homes were registered, HEALTH EDUCATION The Council have been particularly active this year in the field of Health Education, A revised Clean Pood Booklet has been published arrangements are going ahead for a combined Clean Air and Clean Food Exhibition and negotiations have begun for the production of a new Clean Food Film, In addition there has been an increasing interest in Health Education in schools. Mention of all these items is made elsewhere throughout this report. NATIONAL ASSISTANCE ACT 1948 Section 4? 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 (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 Dead. Seven burials were carried out for which the Council accepted financial responsibility. In two of these burials the total cost was recovered and in the remaining five the cost was irrecoverable. 50 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 62 Sickness Pay Scheme (Servants) 126 Gunnersbury Park Joint Committee Employees 6 194 During the year the Council have amended the Sickness Pay Scheme so that staff who would previously have been excluded from benefit due to some particular condition may now be passed with reservations. These employees are paid for all absences due to conditions other than the disability specified at their examination. This arrangement appears to have worked satisfactorily during the year. The results of the examinations have been as follows:- Passed without Passed with reservation reservations 126 100 26 The conditions for which these reservations have been made are as follows:- Arthritis Bronchitis High Blood Pressure (5) Epilepsy and Dental Sepsis Eye injury Hernia (2) Heart Disease and Hernia Mental illness (2) Middle ear disease Miscellaneous conditions likely to require surgical operations in the near future (4) Peptic ulcer Peptic ulcer and skin disease Skin disease Recent severe internal operation Torn cartilage Tuberculosis Varicose Veins 51 SECTION 5 STATISTICAL TABLES SUMMARY OF STATISTICS Area (in Acres) 80781 Population (Census, 1951) 187,323 Population (estimated middle of 1960) 183,390 Rateable Value, 1st Aprils 1960 £3,712,498 Net Product of a Penny Rate, 1960/61 (Est.) £15,400 Live Births:° Legitimate Males 1,356, Females 1,241, Total 2,597 Illegitimate Males 82, Females 79 Total 161 Birth-Rate per 1,000 of Estimated Population 15 Still-Births:- Males 21, Females 26, Total 47 Rate per ls000 total Births (Live and Still-Births) 17 Deaths:> Males 1,046, Females 1,001, Total 2,047 Death-Rate per 1,000 of Estimated Population 10,9 Deaths of Infants under one year of age:- Legitimate Males 23, Females 19, Total 42 Illegitimate Males 2, Females Total 2 Death Rate of Infants under one year of age:- All Infants per 1,000 Live Births 16 Legitimate Infants per 1,000 Legitimate Live Births 16 Illegitimate Infants per 1,000 Illegitimage Live Births 12 Deaths from Diseases and Accidents of Pregnancy and Childbirth;- From Sepsis - None From other Causes - 1 Death-Rate per 1,000 Live Births 0.36 52 Cases of Infectious and Other Notifiable Diseases notified in the Borough Disease 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 Smallpox – – – – – – – – – – – – Diphtheria 16 3 2 - 1 • - • - Scarlet Fever 176 294 203 402 238 287 108 159 95 232 269 117 Enteric Fever (including Paratyphoid) 8 5 3 2 3 5 7 1 1 Puerperal Pyrexia 27 24 38 70 61 54 44 71 77 67 37 63 Pneumonia: Primary 163 173 162 100 157 152 135 113 72 94 97 30 Influenzal 10 6 38 28 74 52 56 48 99 57 57 16 Acute Poliomyelitis 34 42 10 21 13 5 61 46 2 2 Meningococcal Infection 14 9 2 - - 6 3 2 2 3 2 2 Malaria - 4 1 1 3 1 1 - 1 • Dysentery 23 24 542 179 132 225 149 193 252 244 194 261 Erysipelas 13 24 17 26 18 18 12 12 13 19 9 17 Tuberculosis: Pulmonary 205 209 210 211 205 132 119 134 113 97 109 89 Non-Pulmonary 32 41 24 29 20 17 24 13 16 8 10 18 Ophthalmia Neonatorum 5 3 6 - 2 2 2 5 6 3 3 Measles 1,450 1,016 3,296 993 2, 558 132 2,422 726 1.854 975 it, 928 50 Whooping Cough 303 274 550 77 491 116 156 67 131 85 90 258 Food Poisoning 21 23 86 26 31 78 36 26 20 18 39 20 Totals 2,503 2,174 5.190 2,165 4, 004 1, 284 3,335 1,612 2,752 1,908 2,844 945 53 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 Malaria Diphtheria Dysentery 247 Scarlet Fever 116 Erysipelas 17 Enteric Fever (including Tuberculosis: Paratyphoid) 1 Pulmonary 87 Puerperal Pyrexia 63 Non-Pulmonary 18 Pneumonia: Ophthalmia Neonatorum 3 Primary 30 Measles 50 Influenzal 16 Whooping Cough 258 Acute Poliomyelitis - Food Poisoning 15 Total 922 Meningococcal Infection 1 54 Infections 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 60 57 124 134 – – – – 27 23 – – 134 127 – 2 PINAL numbers after correction Under 1 year 1 – 6 13 – – – – – – – – 6 6 – – 1 - 1 1 15 10 – – – – 1 3 – – 6 6 – – 2 - 4 3 14 15 – – – – 3 5 – – 8 9 – – 3 - 4 3 11 11 – – – – 7 3 – – 6 5 – – 4 - 10 4 9 15 - - - – 3 2 - - 10 2 – 1 5-9 33 36 48 46 - - - – 11 7 - - 25 17 - - 10 - 14 4 7 15 17 – - – 1 3 - - 12 16 - - 15 - 24 - 3 1 3 – – – – - - - - 14 12 - - 25 and over 2 O 5 4 – – – – - - - - 37 50 - - Age unknown o a ° – – – – - - - - - - - - Total 59 57 124 134 – – - – 27 23 - - 124 123 - 1 55 Pneumonia Smallpox Acute Encephalitis Enteric or Typhoid Fever Paratyphoid Fevers Erysipelas Food Poisoning Infective Post-Infectious M F M F M F M F M F M F M F M F Numbers originally notified 21 25 - - - - - - - 1 - - 9 8 10 10 FINAL numbers after correction Under 5 years 4 2 - - - - - - - - - - - 2 - 5 » 14 5 1 - - - - - - - - - - - - 1 15 - 44 3 5 - - - - - - - - - - 1 1 1 5 45 - 64 4 9 - - - - - - - - - - 7 7 1 3 65 and over 5 8 - - - - - - - 1 - - 1 2 o Age unknown - - - - - - - - - - - - - - - - Total 21 25 - - - - - - - 1 - - 9 8 6 9 Tuberculosis Respiratory Meninges & C.N. S. Other M F M F M F Numbers originally notified 49 40 - - 6 12 FINAL numbers after correction Under 5 years - - - - 5-14 - 3 - - 1 - 15 - 24 9 5 - - - 2 25 - 44 13 22 - - 2 8 45 - 64 21 6 - - 3 2 65 and over 5 3 - - o - Age unknown - - - - - - Total 48 39 - - 6 12 Other notifiable diseases Original Other M F M F Puerperal Pyrexia - 63 - 63 Ophth. Neonatorum - 3 - 3 56 DEATHS Causes of Death 1960 Cause of Death Deaths, I960 Total Deaths 1959 Male Female Total Tuberculosis, Respiratory 8 2 10 5 Tuberculosis, Other 1 – 1 1 Syphilitic Disease 4 – 4 – Diphtheria – – – – Whooping Cough – – – –– Meningococcal Infections – – – – Acute Poliomyelitis – – – – Measles – – – – Other Infective and Parasitic Diseases 2 3 5 4 Malignant Neoplasm, Stomach 29 24 53 60 Lung0 Br onchus 89 20 109 104 Breast – 45 45 38 Uterus – 17 17 10 Other Malignant Lymphatic Neoplasms 108 106 214 181 Leukaemia Aleukaemia 6 7 13 14 Diabetes 2 4 6 12 Vascular Lesions of Nervous System 108 155 263 226 Coronary Disease, Angina 225 144 369 341 Hypertension with Heart Disease 17 22 39 28 Other Heart Diseases 114 175 289 221 Other Circulatory Disease 41 48 89 76 Influenza – 3 3 29 Pneumonia 44 43 87 123 Bronchitis 86 25 111 141 Other Diseases of Respiratory System 10 3 13 21 Ulcer of Stomach and Duodenum 11 11 22 23 Gastritis, Enteritis and Diarrhoea 3 5 8 7 Nephritis and Nephrosis 6 3 9 13 Hyperplasia of Prostate 9 – 9 11 Pregnancy,, Childbirth, Abortion – 1 1 – Congenital Malformations 7 12 19 17 Other Defined and ill-Defined Diseases 64 79 143 145 Motor Vehicle Accidents 26 8 34 28 All other Accidents 11 24 35 35 Suicide 13 14 27 27 Homicides and Operations of War 2 1 3 1 Totals 1,046 1,004 2,0501 1,982 57 SECTION 6 SCHOOL HEALTH SERVICE The figures relating to the School Health Service do not reveal any unexpected alteration in the normal pattern. Probably the best general guide to health of the school child is the proportion of children found to be in an unsatisfactory condition compared with those who are in a satisfactory state of health. The percentage this year is ,36. The handicapped school child requiring special educa tional facilities can now be placed without undue delay. Although it has long been acknowledged that Health Education carried out in schools by Health Visitors is of value, recently Head Teachers in Ealing have become increasingly interested in the idea. This is encouraging, for to be of value this service must have been requested by a school rather than pressed upon it. The work has been done in one Ealing school for the last five years but it has been extended recently and courses are now given in four Secondary Modern Girls Schools. It is felt3 not least by the Health Visitors doing this work, that apart from a wide knowledge of health matters a grasp of the technique of Health Education is essential if the interest of young listeners is to be held. We have therefore made it a rule that all Health Visitors in Ealing doing this work should hold the Woman Public Health Officers Certificate in Teaching Methods in Health Education. The purpose is essentially preparation for adult life and includes the following:- Physical and emotional development in adolescence. Courtship and Marriage. Budgeting. Parentcraft (the physical and mental development of children and their care). Prevention of accidents. Meaning of good health. Human relations (stressing the idea that all are members of a community, having responsibility to and for others). The response, both of Head Teachers and the girls themselves has shown that the courses are appreciated and suggests that there is a wider scope still for this work. 58 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.9 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 1958 1959 1960 90 996 5,040 5,185 B.C»G. VACCINATIONo Details of school children offered B.C.G. vaccination through the approved arrangements under Section 28 of the National Health Service Act9 1946, during the year ended 31st December, I960, are as follows:- 1. Number of children whose parents consented to participate 2,143 2. Number of those who were tested and found to be (a) negative 1,784 (b) positive 135 3. Number of those who were given B. C. G. vaccination 1;784 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 1960 First age group 2.050 2,375 1,763 Second age group 2,419 1,998 2,369 Third age group 1,991 2,268 2,136 Total 6,460 6,641 6,268 Classification of General Condition Satisfactory 6,245 Unsatisfactory 23 6,268 (Reproduced by kind permission of "Middlesex County Times") Health Education in a Secondary Modern Girls' School (Reproduced by kind permission of "Middlesex County Times") Health Education in a Secondary Modern Girls' School 63 Defects requiring Treatment found at Routine Medical Inspection 1958 1959 1960 Skin Diseases 846 724 712 Defective Vision 438 320 433 Squint 26 22 22 Defects of Hearing 114 31 41 Middle Ear Diseases 8 6 8 Nose and Throat Diseases 141 78 69 Speech Defects 28 25 28 Enlarged Glands 2 2 1 Heart - Circulation conditions 7 9 8 Lung Diseases 74 32 41 Hernia - 5 2 Postural Defects 32 20 15 Orthopaedic Foot Defects 68 54 73 Epilepsy •» 4 2 ASTHMA CLINIC A variety of different types of breathing disability continue to be presented at the Asthma Clinic. Some cases are emotional in origin, some are infective and some allergic; many are a combination of all three causes. The greatest seasonal incidence of conditions necessitating absence from school occurs in December and January, which coincides with maximal air pollution. In May and June, when air pollution is low, but there are high concentrations of fungus spores and pollens, absences from school by children attending the Asthma Clinic are very similar to those by normal control children. The interesting thing is that all these different types of chest trouble respond so well to simple encouragement and re-assurance, and regular breathing exercises, REPORT ON THE SCHOOL DENTAL SERVICE IN EALING The general pattern of the School Dental Service in Area 7 during the year 1960 has followed the same trends as in previous years. Part time dental officers have come and gone and the usual anomaly of officers leaving just as they are beginning to understand the requirements of the service has continued. Whilst the transient part-timers enable us to meet something of the demand for treatment, the lack of continuity, and the uncertainty of the parents and patients as to who is to do the treatment leads to a lack of confidence and interest. Part time officers who remain with us and have regular commitments, and who are in effect "permanent dental officers" are the ones who do the most valuable work. 64 One part time orthodontist, who had been with us seven years, left during August owing to ill health and as it has not been possible to replace him we have a considerable waiting list for orthodontic treatment. There seems little likelihood of securing more orthodontic help until the sessional remuneration is raised to a figure commensurate with that in the hospital service. The process of modernising the equipment in the dental surgeries has continued and 2 air-turbine dental engines have been installed during the year and are proving very popular with patients as causing much less discomfort in cavity preparation than conventional equipment. In the central part of Ealing there has been an increase in the number of dental practitioners over the past few years and many more children are now receiving complete treatment privately. If this trend should continue, as evidenced at school dental examinations, it should be possible to re-dispose our available forces to deal with some of the considerable arrears of inspection and treatment that exist in other districts of the Borough, But we are always faced with the difficulty that part time officers are reluctant to travel towards the Western boundaries of the borough unless they live fairly near. Atten dances Completing Treatment Fillings Perm anent Teeth Fillings Temporary Teeth Extractions Permanent Teeth Extractions Temporary Teeth Orthodontic treatment New cases 17,339 6,065 12 , 290 3,517 800 2,878 99 EAR NOSE AND THROAT SERVICE Mr, Savege, Consulting Otologist, reports:- Many of the children attending this clinic, are referred because of some degree of hardness of hearing, detected by the School Doctors and confirmed by the Audiometrician, In most cases, the condition is the result of infected adenoids, causing eustachian obstruction and catarrh. Fortunately, treatment, in some cases surgical and in others, conservative - restores the hearing to normal. The statistical report relating to the general work of the Ear, Nose and Throat Clinic is as follows:~ 65 1959 1960 Number of new cases 151 194 Number of re-inspections 213 398 Total attendances 364 592 Medical treatment advised 174 306 Surgical treatment advised 95 87 Audiometry Report 1958 1959 1960 Number of schools visited 32 49 54 Number of children tested 5 498 7 451 6,338 Number of children with hearing loss 193 271 289 Number referred to E.N,T. Specialist 53 104 101 FOOT HEALTH We have during the year continued our comprehensive system of foot inspections and the figures reveal a very consistent pattern. The cases of verrucae remain pretty much the same as in previous years, the condition responds to treatment, but it can be very time consuming necessitating return visits to chiropody sessions. Our efforts to persuade the senior schoolgirls to adopt a more sensible type of footwear have proved unavail ing and in the opinion of the school nurse carrying out inspections, no less than 2,438 children were found to be wearing shoes which were in some respects unsatisfactory. Hitherto the wearing of unsatisfactory shoes has been largely confined to the senior girls, but with the introduction of J,Italian*' style shoes for boys we may find that the incidence of Hallux Valgus will increase. There has already been a slight increase but it is too early to decide whether this is related to the extended use of shoes with pointed toes. The figures given below relate to the special foot inspections carried out at all schools and does not include foot-skin defects found at routine medical examinations. Foot Inspection - Defects Total number examined 10,929 Referred to Medical Officer 234 Referred to Chiropodist 122 Verrucae 102 Defective shoes 2,438 Everted Ankles 189 66 Hallux Valgus 2,557 Tinea 136 Number of children treated by the chiropodists 592 During the year a report was published by one of my Assistant Medical Officers of a survey of retail shoe shops in the Borough. We have long realised that not only must school children be persuaded of the need for suitable shoes but these must be readily available in the shops. The survey which deals with this problem has been reproduced below by kind permission of the Editor of "The British Medical Journal". SHOES FOR CHILDREN A Survey of Retail Shoe Shops in the Borough of Ealing By Catherine Hollman, MCBD,ObsteR C,0 G=„ Assistant Medical Officer, Middlesex County Council Area No; 7, Doctors and health workers can readily describe suitable designs of children's shoes which promote the growth of healthy feet, but are these shoes in fact to be obtained in the shops? Parents tell of the difficulty experienced in finding shoes of correct style and size, but how true is this? and to what extent can the blame be with the manufacturers for not making such shoes, or with the retailers for not stocking them? If the retailers have them, do they stock a sufficient range of sizes and fittings? How often do the retailers stock other girls' shoes of inferior design as, for example, the fashionable casual style? Again, if well-designed shoes are stocked in the shoeshops, is it the fitting by the assistants that is at fault? Can it be that the poorly designed shoes are cheaper than the well-fitting ones? To try to find the answer to some of these questions, an inquiry, by means of a questionary, was made in the Borough of Ealing during the period January-June, 1958, Ealing has long been concerned about the damage done to children's feet by ill-fitting shoes, and has produced much valuable and original research in the past 10 yearso Surveys carried out by Dr, D A, Craigmile in Ealing revealed the incidence and variety of foot defects in children, many of which are known to cause foot pain in adults* The Ealing Contributory Shoe Scheme clearly showed that many of these acquired foot defects can be cured or improved by well-fitting shoes alone, At the present time in this area a foot health nurse visits the schools, inspects the children's feet3 and records her findings,. Children with early foot defects and in need of advice are asked to attend the foot clinics at which the particular problem can be discussed with the parents* Ealing can thus be regarded as having a high standard of foot care In this inquiry the visits to the shoe~shops were carried out by the foot health nurse and myself only in order to keep the personal error as small as possible. The questionary was completed in each case by one of us in the shop at the time of the interview with the manager, who was on the itfiole most interested and helpful Occasionally the manager thought he should 67 first seek permission to answer the questions from his employer, in which case the questionary was left with him for completion and was subsequently collected or returned by post. A list of footwear retailers in the Ealing area was obtained from the Public Health Inspectors Department, Out of 49 shops selling shoes, 39 sold children's shoes Of these 39 shops 3 were multiple stores - for example, Woolworths Some of these 39 shops were branch shops of one particular firm, but as their stocks of shoes were found to differ with the individual manager's choice, they were counted as separate shops in this survey In two shops the managers were unwilling to cooperate In 15 shops the questionary had to be left with the manager concerned; of these, four were never recovered though a letter of reminder was sent, and in eight cases the questionary was incomplete or inaccurate. These were discarded and the final analysis was made with the results from 25 shops At the time of the questionary (mid-year, 1958) the population of Ealing was 183,000, and the number of children aged 1-15 years was estimated at 34,000, Description of Questionary The questionary was devised in the form of a series of questions, followed by the possible answers, of which the pertinent answer was ringed by the questioner in each ,ase For example: (1) Do you stock shoes with rounded toes and straight inner borders? ....Yes /No, (2) Are all or some or none of your assistants trained to fit children9s shoes? The questionary was in seven main parts. Part I - This ascertained whether suitable children's shoes were stocked and, if so, whether they were in half-sizes and width-fittings, How many width-fittings? Were these shoes of a lace-up style or bar-instep style,* or both? Were they stocked for toddler aged 1 - 3 years, infant aged 3-7 years, junior aged 7-11 years, and senior aged 11 - 18 years? Were these shoes stocked in large sizes - that is, size 7, 8, 9, and 10 for boys and girls? Part II - Besides these well shaped shoes, what other styles for girls were stocked in the shop? That is, did the shop stock (1) double ankle-bar, (2) high-cut casual, (3) low-cut casual shoes? Part III - Did the shop recommend or sell only one make of shoe, or several? Part IV - Did the shop carry a stock of the good shoes with (a) half-sizes and (b) width fittings in all, or some, or none of the shoes? The manager was then asked to show a narrow-fitting shoe (10c child's shoe) and a large-size shoe (8 girl's shoe) asacheck of the shop's stock at the time of the survey. Could the shop obtain shoes out of stock in one day, two or three days, one week, or several weeks? Did they try to do this? Part V - Pour shoes were specified and the prices asked. For example, a request was, "Qiote the price of size 5 toddler's shoe in brown leather and composition sole," 'Bar instep style denotes a shoe with a strap across the instep 68 Part VI - In this shop do all or some or none of the assistants fit children's shoes during busy periods? By whom are the assistants trained? Do they attend a refresher course of training once„ or periodically, or never? Part VII - Did the shop employ an x- ray machine for fitting if so. did they rely on it a great deal or a small amount when fitting children's shoes Results Part I Table I shoes the results of Part i of the questionary All 25 shops stocked a well shaped shoe that is, with rounded toe and straight inner border Of these, 17 shops had half sizes in all these shoes and five had half-sizes in some of them Fifteen shops stocked width-fittings in all these shoes two stocked width fittings in only some of these shoes. Yet of the 17 shops with these shoes in width-fittings, only four stocked four width-fittings3 seven stocked three width-fittings0 and six stocked two width fittings A lace up style of shoe was common to all 25 shops, but 19 also stocked a bar-instep style, These well-shaped Table I - Details of Well-shaped Shoes in 25 shops Good shoe stocked No of Shops 25 Half-sizes all 17 Some 5 Width-fittings All 15 Some 2 NOc of width-fittings 4 4 3 7 2 6 Lace-up style 25 Bar-instep style 19 Age 1 " 3 years 15 3-7 years 21 7 - 11 years 23 11 - 18 years 14 Large Sizes B G Boys Girls 7 7 14 11 8 8 8 7 9 9 5 0 10 10 2 0 shoes were well stocked for infant age range (3 - 7 years) and junior age range (7 - 11 years)0 but less so for toddler age range (1-3 years)„ and only 14 shops had these shoes for age range 11-18 years The range of large sizes in these shoes was very poor, particularly for girls. Parts II and III-Table ii shows how many shops stocked other inferior designs of girls" shoes= All 25 stocked a high-cut casual style and 17 shops stocked the lowcut casual style, Eight shops stocked one make of shoe, Yet of these eight shops only four carried an adequate range of half-sizes and three width-fittingSc Table II - Details of Badly Designed Girls' Shoes in 25 Shops No, of Shops Double ankle-bar 7 High-cut casual 25 Low-cut casual 17 One make stocked 8 69 Part IV - Table III shows the extent of the stock of well-made shoes in the 25 shops Only six shops stocked half-sizes in all their well-shaped shoes, and 15 shops stocked half-sizes in some of these shoes. Five shops had three width-fittings or more in ail their stock of well-shaped shoes, Twelve shops had width fittings in some of the well-shaped shoes, but only five of these stocked three or more width fittings Table III Number of Shops Having a Comprehensive Stock of Half Sizes and Width Fittings, and Time Taken to Obtain Shoes Out of Stock Half-sizes in All No of Shops 6 Some 15 None 4 Width-fittings in All 5 Some 12 None 8 Able to show 10c shoe 12 Girls 8 8 Time to obtain shoes out of stock 2-3 days 3 1 week 19 2-3 weeks 2 No which did this 22 On asking to see two selected shoes as a check on the stock of the shop at the time of the visit0 only 12 shops could show a narrow-fitting child's shoe, size 10c, and only eight could show a large-size girl's shoe, size 8 Nineteen shops took one week to obtain shoes out of stock, three shops took only two or three days, Twenty-two shops tried to obtain shoes out of stock for their customers. Part V« Four children's shoes were described to obtain the price. The results showed two basic price ranges The more expensive range was that in which the shoes had width-fittings In the cheaper range the shoes had no width-fittings These results are analysed in Table IV. Table IV Details of Price Range of Four Specified Shoes According to Whether Width-fittings were Stocked Shops with Width-fittings Shops with No Width-fittings Size 5 toddlers 14s« 6d.-21se9d. 8s0 Od. -15s. 1ld, 12% brown leather, composition sole 24s, lid.-37s, 6d 21s, 9d. -26s, 9d, 1254 brown leather, leather sole 26s. lid. -43s, 6d, 21s, 9d. -27s, lid. 7 boys0 brown leather, crepe rubber sole 31s, lid. °55s,Od, 26s. 9d. -39s. 6d, Part VI - Table V shows that out of the 25 shops, 14 allowed all their assistants to fit children9s shoes, eight allowed only some of their assistants to do so, and one shop had one assistant only who did the fitting of children's shoes; 16 shops trained all their assistants to fit children's shoes, and six trained some of them. Eight shops allowed untrained assistants to fit children's shoes at busy periods, The training in 16 shops was done by the manager and by a firm in four shops None of the 25 shops sent their assistants to a 70 shoe-fitting training course, Eleven shops gave their assistants refresher courses in shoe-fitting from time to time, but nine never did. Table V - Details of the Fittings of Children's Shoes in 25 Shops No, of Shops Fitting by assistants All 14 Some 8 None 1 Whether trained All 16 Some 6 Untrained assistants fitting in busy periods 8 Training by Manager 16 Firm 4 Course 0 Refresher course Periodically 11 Once 1 Never 9 X-ray machine used 8 Value of machine Great 0 Little 8 Part VII - Eight shops used an x-ray machine for fitting, but they all agreed it was of little value, Discussion Though there are many criteria that can be used to define a well-designed shoe0 only two were used in this survey, A suitable children's shoe was defined as having a rounded toe and a straight inner border. All the 25 shoe-shops stocked such a shoe, Other surveys have shows that to fit a high proportion of children's feet there must be at least three width-fittings to every half-size (Craigmile, 1953), The Somerset survey, carried out with the cooperation of CI arks shoe firm, stated that with their multi-fitting range of shoes, 92% of girls and 87% of boys could be properly fitted in winter, and 98% of girls and 95% of boys with summer sandals (County Medical Officer, Somerset, 1953), The Satra House Research Report (RR98), "'Dimensions of Children's Feet," showed that a range of five width-fittings would cover 95% of children's feet and three width-fittings 91% of children's feet This Ealing survey shows how poor is the stock of width-fittings in the shoe-shops, for less than half of them stocked three or more widthfittings. Though well-designed shoes were found to be adequately stocked for the age-group 3-11 years, fewer shops catered for the 11 - 18 age-group. This infers that men's and ladies' styled shoes are usually sold to this age-group, A very poor stock of shoes of the larger sizes was found in the shops. This obviously adds a further difficulty to the parents of children with big feet, and, in the case of girls, encourages the purchase of a ladies9 style shoe Inferior Styles of Girls' Shoes - A girl's shoe is made to look "pretty" or "fashionable" by altering the basic details of a well-designed shoe in one of the following ways: (a) The site of the strap in a bar-instep style is changed from the side of the shoe to the back, doubled, and fastened by a button across the front of the instep, The toe shape remains unchanged,, but because of the 71 inadequate grip of the double strap at the instep the shoe fits poorly. Luckily, this double-ankle-bar style is a dying fashion, but it can still be found in the toddler age-group Seven shops stocked this style. (b) The toe shoe is altered by curving the inner border of the shoe inwards to meet the outer border at a point of varying degree The straight inner border and generous rounded toe shape are thus lost. The upper of the shoe is made to fit tightly across the metatarsal arch of the foot, and this, plus the "digital wedge* effect described by Haines and McDougall (1954), keeps the shoe applied to the foot. This design of shoe is much in favour with parents of older girls and with the shoe-fitters Twenty-five shops stocked this style of shoe. (c) It is surely true to say that the low-cut casual style of shoe has no residual good features of design at all. These shoes have pointed toes, low-cut sides, and low-cut fronts They stay on the foot because they are "short-fitted" in length, narrow in width, and use the toes as a ''digital wedge," Seventeen shops stocked such a shoe. The results of this survey show how often the shoe-shops cater for the fashion-conscious girl by stocking these casual shoes. These sell well, and can be shown to parents when the shop itself has not got the correct fitting in a well-shaped shoe, or when the parents want a more grown-up style, or when the girl is allowed to choose her own shoes. Eight shops stocked and recommended one make of shoe. Yet of these only four had the adequate range of half-sizes and three width-fittings to cover accurate fitting of children's feet. Size of Stock - The results as expressed in Table III show how poor was the extent of the stock of wellshaped shoes Only 12 shops could show a narrow-fitting child's shoe, and only eight could show a large size for girls The present custom of selling children's and adult shoes together from any one shop limits the size of the stock The retailers claim that in order to stock a comprehensive range of half-sizes and three width-fittings in children's shoes, their shops would have to be enormous There is an obvious need for the establishment of shoe-shops in which only children's shoes will be sold and where a sufficient range of sizes and width-fittings can be stocked However, even with the existing system of selling children's shoes, the size of the stock would be relatively unimportant if the time taken to obtain shoes not in stock was one or two days. This survey shows, however, that the usual time to obtain these shoes is one week, which is far too long an interval Shoes out of stock could be obtained in 48 hours if the manufacturers were contacted immediately. Price Range of Four Specified Shoes - The prices quoted by the managers had, of course, a wide range, but on analysis were found to fall into two groups The more expensive were those of shoes with widthfittings, but the two price-ranges show an overlap, clearly demonstrating that all shoes for children could be multi-fitting and yet reasonably priced. Fitting of Children s Shoes - The fitting of any shoe is a skill requiring training and experience, and particularly is this true with children's shoes Many firms have their own foot-gauges, which are very useful, but in addition a trained assistant should be able to fit by hand. 72 Table V shows that the training of shop assistants is not nearly good enough. Much selling of children's shoes takes place unfortunately on a Saturday, when the shops are very busy; some shops employ young unskilled girls on that day as a source of extra help. In fact, eight managers admitted that they allow untrained assistants to fit children's shoes in busy periods- The training of assistants was found to be usually done by the managers themselves,, Only four shops used training by a shoe firm, and none of the 25 shops sent their assistants to a training course in shoe-fitting Less than half the shops allowed their assistants to attend a refresher course. Only a third of the shops used x-ray machines, and all agreed that these machines were of little use in the fitting of children's shoes, Summary A survey of 25 shops selling children's shoes is described, All the shops were found to stock welldesigned shoes for children. Very few shops, however, stocked a comprehensive range of half-sizes and three width-fittings in these shoes, and such a range is essential to fit the majority of children's feet, Only half the shops kept these shoes for children of 11« 18 years. Stocks of larger shoes, of size 7 and over0 were also limited. Yet all 25 shops stocked the inferior-styled girls' shoe known as the "casual,w There was an unnecessary time-lag in obtaining shoes out of stock Adequate training of shop assistants in the art of fitting children's shoes was lacking The few shops that employed an x-ray machine found it of little value in shoe-fitting, It was shown that all well-designed children's shoes could be multi-fitting and yet be reasonably priced. The need to establish shops \diich sell only children's shoes is discussed, ORTHOPAEDIC CLINICo Mr* JeAe Cholmeley, the Orthopaedic Consultant., reports:- The number of cases seen and treated at the orthopaedic clinics varies very little although a change in the type of case seen is occurringe Fortunately the number of recent cases of poliomyelitis is now very small but there is no decrease in tlie number of cases of cerebral palsy. There are, of course9 a large number of minor conditions as occur in all out-patient departments. For many of these all that is needed is advice as to suitable footwear and minor adjustments to boots and shoes in order to reduce excessive and uneven wear. This not only often improves the function of the children but is of economic benefit to their parents. Letters are written to the general practitioners of all patients referred to the orthopaedic clinics, with whom therefore we are building 73 up a most desirable liaison. As a result of this3 children are also referred direct to the clinics by general practitioners for advice and treatment. HANDICAPPED CHILDREN The following table sets out in their various categories the number of handicapped pupils as at 31st December, 1960. Category In Special Day Schools In Special Residential Schools In maintained Primary & Secondary Schools Not at School Total B G B G B G B G B G Blind Pupils « o 3 2 O 1 4 2 PartiallySighted Pupils 7 5 1 1 8 6 Deaf Pupils 5 4 « 2 - = - - 5 6 Partially Deaf Pupils 8 4 2 1 1 1 2 12 7 Educationally Sub-normal Pupils 39 26 14 8 4 4 5 5 62 43 Epileptic Pupils » 1 1 1 1 Maladjusted Pupils 7 3 49 18 8 5 2 66 26 Physically Handicapped Pupils 8 12 4 ,» 1 3 4 7 17 22 Pupils with Speech Defects Delicate Pupils 15 2 8 7 8 2 3 2 3 - 8 28 3 11 Pupils with Multiple Defects - - - - - - - • - Total 89 56 81 38 24 19 17 14 211 127 OPHTHALMIC SERVICE, Mr. G. Preeman-Heal9 Consultant Ophthalmologist., reports:~ The total number of cases seen was 1,366 (1959 - 1,483) of which 414 (1959 - 462) were new cases and 952 (1959 1,021) were re-inspections* The number of pairs of glasses prescribed was 868 (1959 - 961). Abnormal Eye Conditions other than Errors of Refraction were as follows: - Congenital Abnormalities Squint Congenital Nystagmus Nasal duct obstruction Abnormalities Extra-ocular muscle Ptosis New Old Cases Cases 48 159 1 3 3 1 2 1 1 74 Abnormalities doe to Infection New Cases Old Cases Conjunctivitis 3 – Meibomian cyst 3 – Blepharitis 1 – Mucocele - 1 Abnormalities of Unknown Etiology Retinitis a 2 Herniation of orbital fat 1 – SPEECH THERAPY – There has been a slight but not significant rise in the number of children under treatment during the past year. The figures are as follows:- Number on roll at 1st January, 1960 214 New cases during the year 87 Number discharged 77 Number on roll at 31st December, 1960 224 Number of attendances at Speech Therapy Clinics 3,711 The types of speech defect were classified as follows:- (1) Dyslalia - Mixing or missing out of consonants 126 (2) Developmental aphasia - Delayed or absent speech 43 (3) Stammering 32 (4) Aphasia associated with mental subnormality 12 (5) Dysarthria - Defects due to disorders of the muscles of articulation 10 (6) Disorder arising from deafness 1 Speech therapy may be begun, when necessary, at the age of three and a half years and any child of this age or older whose speech appears to be abnormal or backward for his age should be referred for an opinion. Referrals are made to the Area Health Office from School Medical Officers,, General Practitioners, School Teachers and Educational Psychologists. Each child is medically examined at his first attendance and any necessary investigations e.g. hearing tests are arranged. Speech therapy sessions are held regularly at most of the clinics within the area for the individual treatment of children. Some pre-school children are best treated in a group and such play-groups are held at the Mattock Lane and Ravenor Park clinics. 75 The Speech Class at Stanhope Infants School continues to cater for 10 pupils with severe speech defects and all the available places have been kept filled since its inception in 1954. A further 4 pupils were admitted during the year and 6 were discharged. EALING CHILD GUIDANCE CENTRE Dr. P. Holman, Consulting Psychiatrist reports:- 126 patients were referred to the Centre in 1960: 26 fewer than last year. The total number of patients attending for some form of treatment was 219 (18 more than in 1959) and 59 cases were "under supervision". 17 children were placed in residential schools in 1960. Members of the Child Guidance Clinic have continued to work with health visitors towards the prevention of mental ill-health in pre-sehool children. We have, as in the pastc had close but informal contacts with school medical officers, the Area Children's Officer and her staff, probation officers, education welfare officers and others. It is now generally agreed that co-operation with other welfare services for children is as important a part of the Child Guidance Clinic's task as its direct work with parents and children. We hope to increase our contacts with other services in the new year. The cases referred to us continue to be the same types and to come in almost the same proportion as in previous years. The average I. Q. of children referred to the Centre continues to be 5 points above the national average, whilst the average age has increased a little. This is accounted for in part. by seeing fewer pre-school children in the Clinic as more are seen informally or discussed with health visitors by psychiatric social workers, and in part. it is due to a real increase in referrals of children of secondary school age. Nine referrals came in 1960 from grammar schools and included two pupils of seventeen. There is inevitably an increased tendency to maladjustment in adolescence and we are glad to be able to help this age group. Aston School, Mr. R, B. Laslett took up his appointment as headmaster in May. Two teachers (Miss Banks and Miss Steptoe) and the necessary non teaching staff were appointed shortly 76 afterwards. Unfortunately. it was only possible to move into the building, (even then far from ready) in November. Up to that time Mr. Laslett and his staff had had a class of twelve children at North Ealing School. These twelve settled in well at Aston which will be building up its numbers in the next few terms. It is already giving most valuable help in the resettlement of unhappy and difficult children. The opening of Aston School is a most important aid in helping difficult and unhappy children of primary school age. The increasing number of secondary school children coming to us suggests the need for a comparable development for their benefit. EDUCATION ACT 1944 Sections 57(3). 57(4) and 57(5). Cases dealt with under Section 57. Education Act, 1944: Sub-Section 3 8 Sub-Section 4 Sub-Section 5 3 Cases de-notified under Section 8. Education (Miscellaneous Provisions) Act, 1948 The sections referred to above are those that were in operation prior to the amendments to this Act made by the Mental Health Act. MEDICAL EXAMINATION OF TEACHERS Number of Teachers examined as to fitness for appointments 39 INFESTATION WITH VERMIN Number Examined 31,636 Number Infested 68 77 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 10 Health Clinics by doctors and midwives. Arrangements are made for blood testing, chest X-ray and for distribution of iron and vitamins. Mothers are also given the opportunity of attending ante-natal exercises and mothercraft classes. During the year 2,666 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 their progress. Welfare and other foods are distributed. During the year 6,861 children attended clincis 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. 8,623 families being visited during the year. Ante-Natal Clinics (Interview by Appointment) Address Times Abbey Parade. North Circular Road, Ealing, W. 5. Tues. mornings. Brentside, Westcott Crescent, Hanwell. W. 7. Thurs. mornings. Cherington House, Cherington Road, Hanwell, W. 7. Mon. Tues, mornings, Greenford Green, Wadham Gardens, Greenford, Tues, Pri. mornings, Islip Manor, Eastcote Lane, Northolt. Wed, mornings. Laurel House, Windmill Road, Ealing, W.5. Wed, Thurs. mornings. Mattock Lane. 13 Mattock Lane, Ealing, W. 5. Mon. Wed. Pri. mornings. Northolt Grange, Edward Road, Northolt. Pri. mornings. 78 Address Times Perivale, Horsenden Lane, Greenforde Wed, mornings. Ravenor Park, Oldfield Lane, Greenford, Mon, Thurs. mornings. Child Welfare Clinics Address Times Abbey Parade. North Circular Road, Ealing, W. 5. Tues. 2 - 4 p.m. Brentside. Westcott Crescent, Hanwell. W. 7. Thurs. 2 - 4 p.m. Cherington House, Cherington Road, Hanwell, W. 7. Mon. Tues. Thurs, 2-4 p.m. Greenford Green. Wadham Gardens, Greenford. Tues. Fri. 2 - 4 p.m. Islip Manor, Eastcote Lane, Northolt, Mon., Thurs. 2 - 4 p. m. Laurel House, Windmill Road, Ealing, W. 5. Mon. Wed. Thurs. 2 - 4 p. m. Mattock Lane, 13 Mattock Lane, Ealing, W, 5» Mon. Wed. Thurs. Fri. 2-4 p.m. Northolt Grange, Edward Road, Northolt. Tues. pri. 2 - 4 p.m. Perivale, Horsenden Lane, Greenford, Mon. Thurs. 2- 4 p.m. Ravenor Park, Oldfield Lane, Greenforde Mon. Tues. Wed. Pri. 2 - 4 p.m. In December, the new Northolt Grange Clinic came into operation. There has long been a need for a clinic in this area where there is a Council estate of 1,379 houses as well as 838 private dwellings. Provision of a clinic was under consideration as long ago as 1948, but until now we have had to suffice with an improvised clinic held in a Community Centre in the area. In addition to provisions for ante-natal and infant welfare sessions the Clinic has facilities for dental treatment, including orthodontics. A Child Guidance Clinic is incorporated. I am confident that the provision of this Clinic will enable us to give a much better service to the families in the area. DOMICILIARY MIDWIFERY SERVICE. There is a staff of 12 midwives in Ealing. There were 851 home confinements in Ealing in 1960 compared with 725 in 1959, which is in keeping with the National trend. The number of pupil midwives who received district training during the year was 25. All midwives are trained in the use of Trilene and gas and air Analgesia for mothers in labour, and in the use of small oxygen cylinders should any baby have 79 respiratory difficulty. The early ambulation of patients after delivery has shown good results and most mothers easily return to normal routine by the tenth day of the puerperium. In accordance with the 1960 rules of the Central Midwives Board, the care of those mothers who progress normally is now handed on to Health Visitors after ten days' nursing. Following the recommendations of the Cranbrook Maternity Services Committee a Maternity Liaison Committee based on Perivale Maternity Hospital held an inaugural meeting in April. Matters of mutual interest to the three branches of The Midwifery Service were discussed. in particular the criteria for hospital booking and methods of exchange of information. This resulted in the introduction of a co-operation card on which both the doctor and the midwife report findings at examinations made. The card is kept by the patient so that it is available at any time and in particular when labour starts. In addition, local clinical meetings to which midwives and general practitioner obstetricians are invited have been introduced and the one held in 1960 was interesting and instructive. Applications for the services of a midwife should be made through a Maternity and Child Welfare Clinic. 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 867 cases receiving help. The order of priority is acute sick. maternity cases. tuberculosis and chronic sick and aged. Nevertheless, over 84% of those helped were old people. Payment is based on the patient's resources and ranges from no charge to 4/- per 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 80 certificate. to the Area Medical Officer. Town Hall Annexe. 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 11 and these have been made up as follows:- In category (1) 2 In category (2) 8 In category (3) 1 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 Iras accommodation for 40 children The other nursery is in Greenford and has accommodation for 50 children. Both the Day Nurseries are recognised 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 to:- (i) Those whose mothers have of necessity to go out to work because they are the sole supporters e. g. if they are widowed, divorced, separated or unmarried. (ii) Where the home conditions are unsatisfactory. 81 (iii) Admission has now been extended to include children who are physically handicapped. particularly those who are deaf or partially deaf. maladjusted, or partially sighted. Similarly, children whose parents are deaf or dumb and who would therefore lack the normal talking environment in the home. are admitted. In all these instances there is no charge to the parents. 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 Annexe, Ealing, W. 5. HONE 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 67,241 visits was made to 1,799 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 comprise 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 number of patients nursed and visits made has continued to fall each year since 1947. but this fact must be viewed in the light of the changing character of the work involved. The introduction of drugs which in the past have been given by injection and which now can be administered orally means that treatment frequently does not require a visit by a nurse. However, several factors have operated to increase the amount of time spent on each patient. The foremost of these is the increasing number of old people requiring treatment. Last year 57% of patients were over 65 years of age and this, together with the increasing number suffering from cardio-vascular disabilities has resulted in the need for lengthier visits. A further time consuming, although rewarding task, is the rehabilitation of disabled patients, a task which has increasingly fallen to home nurses. 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 Annexe, Ealing, W.5.