439 (1) The Health of Ealing in the year 1961 EAL 52 The health of Ealing in the year 1961 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 10 Section 2 SANITARY CIRCUMSTANCES OP THE BOROUGH 13 Section 3 SANITARY INSPECTION 26 Section 4 OLD PEOPLE'S WELFARE 38 Section 5 GENERAL 46 Section 6 STATISTICAL TABLES 49 Section 7 APPENDIX : REPORT ON SCHOOL HEALTH SERVICE 57 Supplement FOR GENERAL INFORMATION 68 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.Chiro. 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 A. S. M. Pratt Chief Administrative Assistant Barrister-at-Law (Part-time) Miss D.E. McKenzie Secretary to Medical Officer of Health D.E. Storr Senior Clerk D.R.A. Smith Clerk R,S. Leggatt Miss S. Pox Mrs. M.G. Byford Clerk and Shorthand Typist Mrs. D. Barker Clerk and Typist M.L. Aldridge Trainee Public Health Inspector L,H. Jones Trainee Public Health Inspector R.S. Cox Assistant Rodent Officer R. Lazzolo Rodent Operative P. Bedley L,B. Radford Driver/Disinfector E. Sheldrick 5 Mr. Mayor, Aldermen and Councillors, In presenting the Annual Report for 1961 I have felt it desirable to take an overall picture of trends that are operating in several phases of social life in particular relationship to medical problems. The Government's decision to press forward with the re-organisation of London Local Government makes it quite clear now that we face, within the next few years, a major re-organisation of all the services in the Borough and among these of course, the health services must play an extremely important part. It is of value to you to know those problems that are facing us and the trends that are appearing out of our statistical surveys and contacts with the national health services in the Borough. In general we must be glad that our high rate of immunisation and our widely conceived services provide us with a basic machine capable of extremely efficient work no matter what administrative problems may confront us. We are fortunate in having capable officers and I have no doubt that the transition to County Borough Powers will not be as difficult as it might have been had we not previously been operating many of these services prior to 1948. There has, of course, since that time been a change in the general plan, particularly in regard to hospital services, welfare services, and the mental health services. These I think should be linked in as closely as possible with our own health services to everyone's advantage. The housing of the various public health services that will be operating together can only be considerably enhanced when the buildings from which the services will be operating are linked closely together, if possible in one unit. Since I, myself, have now been in the health service for nearly 40 years I can appreciate only too well the vital importance of close linkage of these related services under one medical control. I would strongly urge the Council to place in the hands of a capable and efficient administrative chief officer all the health services that can possibly be linked together as one unit. There should, I am sure, be no separation into other departments of such services as mental health, welfare, children's department, or basic environmental services such as Clean Air, Clean Pood and housing defects; all of these are so closely related to the work of health visitors, nurses, midwives, and the assistant medical officers of the Authority. 6 Trends in social development play a considerable part in the helpful guidance that can be given by the medical department to its Local Authority. There are two instances to which I would like to draw the attention of the Council in the body of this Report which I think might be of interest in this connection. One is the fact that the new arrangements for dental service under the National Health Service Act has produced a wealth of dental practitioners in pleasant residential areas, such as Ealing, to the detriment of other districts where there is no incentive to reside and practice. This has meant that our school dental service, which is of an extremely high standard, is not having demands upon it in the same ratio as many other less fortunate districts. There is a natural ten dency for the ordinary parent nowadays to take a child to a private dentist if one is available without diffi culty and there is therefore a curious reaction a sort of one upmanship against the local authority service, although in fact, there can be no question of the service being in any way inferior to that provided through the private dental surgeon. Again another instance of the trend of fashion and social behaviour is the recent increase, noted in 1961, of deformity of the feet of young people coming into the teenage group. What is of particular interest is that the deformity of the big toe, namely, hallux valgus, which we have noted for many years arising among the 10 to 15 year old girls, is now apparently arising to a much larger extent among the similar age group of boys. Undoubtedly this is due to the Italian style shoe which has swept the fashion conscious teenagers, and only by a determined effort to find a new approach to deal with this problem shall we be able to find means of controlling it. There are two other matters which I should like to mention, one is the Exhibition, which was held in September, and of which I am sure the Council were proud. The other is the question of the handling of the growing problem of the ageing disabled among the population. Just as the decisions taken under the National Health Service Act, 1948, caused considerable upheaval in the Health Services in Ealing, it is inevitable that the re-organisation of London, as promised by the Government, must also involve the health services in a great deal of re assessment and wide scale planning. Whilst the services were basically continued by the County Council, through 7 the same officers as previously, there has been emphasis placed centrally upon the need for bringing districts with fewer services up to the standard of those with good maternity and child welfare and educational facilities. Our own efforts to continue with some experimental and original work in conjunction with these particular services did not unfortunately meet with the approval we had hoped, but we have maintained to the best of our ability the basic experimental work and have even on occasion developed certain facets within the limitations placed upon us by the similarity of the pattern imposed by a central body upon individual areas. We can now look forward to a freedom of approach towards new ventures in co-operation among medical services in our area since these are indeed the life blood of medical progress. As the Council are well aware we have tried to inaugurate a combined service with the Hospital Board for the care of the physically disabled elderly. Since this has been undertaken outside the scope of the County Council control we have naturally had some freedom of action and have been able to use this organisation to give us a field for investigating the best practicable methods of operating a medical service for the disabled elderly without calling upon hospitals for in-patient beds. Apart from some consultant services and with help from the County Council by way of transport through the ambulance service this has been achieved. We are operating a centre which is unique in the country and does enable general practitioners to secure a service for some of their most difficult cases. The further development of our Day Treatment Centre may well come within the scope of the new arrangements of the new Ealing health services. On lines such as these we may be able to make progress in handling the enormous problems that are to be placed on our shoulders as welfare authorities in the near future. How far this type of approach may be related to mental care through the Mental Welfare Section of the new authority remains to be seen, but undoubtedly our present experiences are giving us most valuable knowledge of the necessary organisation. The great lesson that we have learned in the last year has been the impossibility of separating treatment necessary for the disabled elderly into consultant, Local Authority welfare and the General Practitioner services., together with the after-care necessary once the patients have had their period of 8 treatment at the Day Treatment Centre, It is therefore now clear that the success of these Centres must depend upon a combination of professional and technical officers working as a unit, although individually under the operational control of at least three separate Authorities. The treatment and care of the handicapped aged must be based upon a three pronged approach, each one playing a part in the overall problem of the care of the aged. It is essential that the Welfare Authority should be prepared in the future to extend to the maximum capacity its arrangements for close co-operation with the consultant services and the general practitioners and thus secure the fullest value from our Home Help, Nursing and Welfare Officers together with other Local Authority services. The full development of health services among babies and children has now become so well established and so comprehensive, particularly in view of the standard of universal education of the younger generations, that there would seem to be little more that we can do that would not be to some extent superfluous in the overall picture. What is quite certain is the need to catch up with the defects and deficiencies that have become apparent with the growth in size of the older age groups and the essential need for medical care and supervision, as this ageing group naturally tend to a high and growing incidence of defects and metabolic deficiencies. This is a problem which will face everyone in the future and we have yet to find the best solution to what is a new problem in the growing complexities of this industrial and mechanised environment. It may well be the time, in conjunction with the re-organisation of London's Health Services, to take a new look at our health plans for the changed age groupings in the population and the new health problems that are arising. It may well be that no longer do the problems of malnutrition, prematurity, neo-natal diseases and other enigmasof the new born warrant the large expenditure of time and effort that are often lavished upon comparative rarities. We should utilise our resources in medical knowledge and experience much more upon the growing and burdensome problems of the old. To keep the ageing fit and active is good medicine, is humanitarian, and probably good economics. It is hoped that you will find many matters of interest and a good deal of material for thought in the pages of this Report. You may rest assured that your staff, as a 9 whole, to whom I am extremely grateful for all that they have done during 1961, will continue to deal with the problems that are facing all of us in the highest tradition of medical care in Local Government Service in the assur ance that they have the Council's full support in their efforts. Your obedient servant, W. G BOOTH. Medical Officer of Health. 10 SECTION 1 INFECTIOUS DISEASES CONTROL The diseases notifiable under the Public Health Act, 1936 are smallpox, cholera, diphtheria, membraneous croup, erysipelas, scarlet fever, typhus, typhoid, enteric and relapsing fever. The Minister of Health has also made regulations under this Act whereby the following diseases are notifiable plague, poliomyelitis, tuberculosis, puerperal pyrexia, ophthalmia neonatorum, malaria, dysen teiy, acute primary pneumonia, acute influenzal pneumonia, measles, whooping cough, acute encephalitis and meningo coccal infection. Pood poisoning is notifiable under the provisions of the Pood and Drugs Act of 1955. Under the Milk and Dairies (General) Regulations, 1959, the occupier of premises used in the milk trade must notify the Medical Officer of Health if any of his staff are suffering from or have been in contact with any of the diseases enumerated above. In addition to these diseases the occupier of such premises has the same obligations in respect of gastro enteritis. The Public Health (Infectious Diseases) Amendment Regulations, 1960, provide for the notification of Anthrax. DIPHTHERIA. There was a case reported of a girl of 15 years who died from a throat infection. She was admitted to hospital on the 4th February with a diagnosis of acute tonsillitis. She developed quinsy on the 7th February and collapsed and died the following day. The result of a throat swab examination was inconclusive. There was considerable doubt about the diagnosis of diphtheria but in view of the Pathologist's decision to rely upon clinical evidence the case was accepted as diphtheria on the Death Certifi cate. All contacts were followed up and swabs from her family proved negative. During 1961, 2,424 children under one year of age were immunised against diphtheria. This represents approximately 84% 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. 11 DYSENTERY These notifications decreased to 127 compared with 261 in 1960. Again they were all of a very mild type which cleared up within a few days. ERYSIPELASo Six cases were notified. FOOD POISONING. Of the 15 cases notified the causative organism was identified as Salmonella typhimurium in 5 cases. In 7 the cause was unknown and the remaining 3 proved not to be cases. MALARIA, One case occurred in a man of 37 years who was an airline pilot. MEASLES, 1961 was an epidemic year and there were 3,250 cases notified. MENINGOCOCCAL INFECTION, One case was notified. OPHTHALMIA NEONATORUM, Two cases were notified. Both cleared up without impairment to vision. PARATYPHOID FEVER, One case occurred in a boy of 15 years following his return from holiday in Spain with a school party. Faeces examinations were carried out on all the members of the party with negative results. PNEUMONIA, 70 cases occurred compared with 46 in the previous year. POLIOMYELITIS, There were two confirmed cases. The first was a man aged 30 years with facial paralysis following a tonsillectomy operation and the second was a girl of 9 years with non-paralytic poliomyelitis. 12 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 - 1961 2,610 Young persons born in the years 1933 - 1942 1,160 Persons born before 1933 who have not passed their 40th birthday 4,309 Others 321 Total 8,400 By the end of the year a total of 55,624 persons in Ealing had completed a course of immunisation against poliomyelitis. PUERPERAL PYREXIA. 44 notifications were received. With the exception of one all occurred in hospitals. SCARLET FEVER Cases showed a marked decrease, 67 against 117 in 1960 and 269 in 1959. SMALLPOX. Eight persons were kept under surveillance as possible contacts of cases which arrived by air from Pakistan. In 1961, 2,079 infants under one year of age were vaccinated against smallpox representing approximately 74% of this age group. TUBERCULOSIS. There were 93 pulmonary notifications, 64 male and 29 female. This compared with a total of 87 notifications in 1960 of which 48 were male and 39 female. There were 6 male and 4 female non-pulmonary notifications. The figures for 1960 were the same in regard to males but there were 12 female non-pulmonary notifications in that year. There were 7 pulmonary deaths and no non-pulmonary deaths compared with 10 pulmonary deaths and one non-pulmonary death in 1960. WHOOPING COUGH. Only 51 notifications of whooping cough were received compared with 258 in the previous year. 13 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 53,772 houses with a population of 183,151 (1961 Census). Seventeen samples were taken from supplies derived from wells at 5 factories in the Borough. In these fac tories water is obtained from deep borings ranging in depth from 300 600 feet. Two samples were not completely satisfactory, and two repeat samples taken from one source were also doubtful. After advice and treatment of storage tanks and supply pipes, further samples taken from the two sources in question proved to be satisfactory. A sample taken from a storage tank in a private house by the Metropolitan Water Board, following a complaint was of satisfactory quality. Water Samples 1961 Samples Satisfactory Doubtful Unsatisfactory Wells Supply 17 13 4 - M.W.B. Supply 1 1 - - 18 14 4 - DRAINAGE AND SEWERAGE The soil sewerage from the district flows to the West Middlesex Drainage Works at Mogden. Surface water finds its way out of the district by the various water courses. There are still 21 premises not connected to the Council's sewers, mainly because they are in areas not yet served by a main sewer. 14 RIVERS AND STREAMS. No. of inspections 55 No. of samples taken by: County Engineer 19 (a) Satisfactory 9 (b) Unsatisfactory 10 No. of drainage defects remedied: (a) In factories 2 (b) In houses 8 (c) In shops 2 The sources of pollution can be analysed as follows:- Sinks and handbasins and baths 11 W.Cs Industrial Wastes 1 Soil sewers and drains ATMOSPHERIC POLLUTION. Clean Air Act 1956 Smoke Control Areas. The Smoke Control programme approved by the Council in June, 1959, showed that it was 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 12,824 premises would be included in Orders made up to the end of 1961. The actual number of premises dealt with during the year under review was 10,741, somewhat short of the target. This was due in the main to the fact that Order No. 9 was not ready for submission to the Council until after the end of the year. Smoke Control Orders Nos. 1 and 2 became operative in 1960, Nos. 3, 4 & 5 became operative in 1961, and Nos. 6, 7 & 8 made in 1961 were either confirmed or awaiting confirmation by the Minister of Housing and Local Government. Survey work on Area No. 9 had been completed by the end of the year and a survey of No. 10 was in progress. Preliminary arrangements were also in hand for dealing with areas Nos. 11 and 12. During the year the Council made a Variation Order for Smoke Control Area No. 1 in order to exempt from the operation of Section 11 of the Act, the boiler plant at a school premises. Modifications had been made to the mechanical underfeed stokers and the Council's consultant was satisfied that the emission of smoke from the boiler chimney had been reduced to an acceptable minimum. The following table gives details of the progress of the Council's programme:- 15 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 5 1,212 3,752 2,363 251 6,366 Confirmed, but not yet in operation 2 359 2 , 581* 420 66 3,067 Awaiting confirmation 1 175 1 277 - 31 1,308 Totals 8 1,746 7,610 2,783 348 10,741 * Includes 1 682 L.C.C. properties. 16 Borough of Ealing No. 1 Smoke Control Order - came into operation 1.7.60 No. 2 Smoke Control Order - came into operation 1.10.60 No. 3 Smoke Control Order - came into operation 1,7.61 No. 4 Smoke Control Order - came into operation 19.61 No. 5 Smoke Control Order - came into operation 1.11.61 No. 6 Smoke Control Order made - to come into operation 1.6.62 No. 7 Smoke Control Order made - to come into operation 1.9,62 No. 8 Smoke Control Order made - awaiting Minister's confirmation Nos. 9 & 10 - Survey in progress Nos. 11 & 12 - Next areas for Survey A. Smoke Control Areas in Hayes B. Smoke Control Area in Harrow C. Suggested Smoke Control Area in Willesden D. Suggested Smoke Control Areas in Acton E. Suggested Smoke Control Areas in Brentford & Chiswick P. Suggested Smoke Control Areas in Southall 17 18 Clean Air Act 1956 Section 3 New furnaces During the year 15 notifications were received in accordance with Section 3 of the Act of the intention to install new furnaces at various industrial and commercial premises in the Borough. Every effort was made in these cases to obtain full information as to the proposed plants, and in some cases the Council's consultant was called upon for his opinion. Section 3 provides that all new furnaces installed should be capable, as far as practic able, of being operated continuously without emitting smoke when burning fuel of a type for which the furnace was designed. Clean Air Act 1956 Section 3 Prior approval No applications for prior approval under the Section were received or dealt with during the year. Clean Air Act 1956 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 oranuisance. Such plans are passed to me by the Borough Surveyor for comment on this par ticular aspect and in three instances during the year higher chimneys were agreed after consultation with the architects concerned. It is to be regretted that this is the only provision in the Clean Air Act for reducing the harmful effects of gases from chimneys. As the Section only applies where plans have to be submitted in accor dance with building byelaws it follows that buildings which are exempt from byelaw control are also exempt from the provisions of this Section. The Section makes no provision for requiring a higher chimney when a small furnace with a low chimney is replaced by a different type of furnace with much more heavily polluted flue gases. West Middlesex Clean Air Co-ordinating Committee The three authorities fully represented on the Com mittee (Ealing, Peltham and Hayes & Harlington), were joined during 1960 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. 19 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. One meeting of the Committee, in September, was held at Ealing in conjunction with the combined Clean Air and Clean Pood Exhibition. At this meeting a discussion on Supplies of Solid Smokeless Fuels now and in the future, was introduced by representatives of the Society of Coal Merchants, the North Thames Gas Board, and the Coal Utilisation Council. The National Coal Board film, "Arthur clears the Air" was also shown to members of the Committee. 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. Atmospheric Pollution Gauges 1961 Deposited matter expressed as tons per square mile per month Sulphur compounds by lead peroxide method expressed as milligrams so /day collected by 100 sq„ cm. of Batch A Pb02 Birkbeck Avenue Longfield Depot Greenford Green Birkbeck Avenue Longfield Depot Greenford Green Jan 12. 27 9.90 7. 54 1.71 3.56 2.35 Feb 7.04 7.00 4.94 1.44 3.28 2.10 March 12.14 18.14 5.20 1.16 2.41 1.44 April 5.40 8.57 3.74 0.93 2.30 1.13 May 9.34 7.37 5.69 0.64 1.45 0.68 June 12.71 7.20 5.60 0.68 1.23 0.55 July 11.87 9.04 6.17 0.65 1.03 0.41 Aug 4.60 5.27 11.87 0.57 1.29 0.43 Sept 9. 17 11.91 7.87 0.87 1.87 1.03 Oct 7.24 6.67 4.14 0.82 1.87 1.07 Nov 7.00 8.74 6.67 1.40 2.86 1.76 Dec 8.24 9.84 4.77 1.79 5.55 2.42 Average Monthly Concentrations of Smoke and Sulphur Dioxide 1961 Smoke in Milligrammes per 100 cubic metres Sulphur Dioxide in parts per hundred million Town Hall Eliots Green School Walpole Grammar School Town Hall Eliots Green School Walpole Grammar School Jan. 14. 2 13.7 17.0 8. 2 6.2 7.0 Feb. 10. 1 8.4 10.0 7.8 4.9 5.8 March 22. 8 * 18.5 9.7 * 9.3 20 1961 Town Hall Eliots Green School Walpole Grammar School Town Hall Eliots Green School Walpole GrammarobhihE School Smoke and Sulphur Dioxide in microgrammes per cubic metre April % 46.6 54.3 % 135.2 149.6 May 30.0 36.1 26.2 124.8 75.5 106.5 June 35.0 21.7 22.9 101.2 96.1 57.9 July 27.4 11.6 17.2 148. 1 76.6 76.9 Aug. 21.0 * * 88.3 * * Sept. 3000 47.0 45.0 % 197.0 170.0 Oct. % 76.0 52.0 % 106.0 130.2 Nov. % 120.2 135.7 % 238.8 309.9 Dec. % 190.4 208.3 % 358.2 365.7 * School holidays / Faulty apparatus Clean Air and Clean Food Exhibition A combined Clean Air and Clean Food Exhibition was held at the Town Hall from 27th September to the 4th October. It is twelve years since Ealing's Clean Food campaign was launched with an Exhibition. and although a Clean Air Exhibition was held in the Northolt area at the time this was declared a smoke control area, the public in the Borough as a whole have not had an opportunity to learn about this important subject. It therefore seemed appropriate that a combined exhibition should be held. The Victoria Hall, the Queens Hall and the Princes Room were all used for the purpose. The Clean Air section was in the Victoria Hall, the various exhibitors con structing their own stands, subject to the Public Health Department's overall approval. A large number of concerns exhibited including the National Coal Board, the Coal Utilisation Council, the North Thames Gas Board, the Southern Electricity Board and the Esso Petroleum Co. The Public Health Departmens s stand included an automatic Question and Answer device which proved particularly effective in providing the public with information. Pre recorded replies by the Medical Officer of Health were given to twenty questions relating to atmospheric pollution and its prevention. In addition full details of the Council's smoke control programme were available, together with examples of the way routine pollution measurements are taken regularly in the Borough. The Clean Food Exhibition was held in the Queens Hall where it was decided that a more effective lay out could be achieved by a single co-ordinated plan by a firm of Exhibition Fitters. The result I think, justified this decision. The firms which exhibited were J.Lyons and Co., the Southern Electricity Board, Prestcold,Benham & Sons, (Reproduced by kind permission of "Middlesex County Times") CLEAN AIR EXHIBITION Dialling for Clean Air information (Reproduced by kind permission of "Middlesex County Times") CLEAN AIR EXHIBITION An interested young audience learns the principles of under-floor heating (Reproduced by kind permission of "Middlesex County Times") CLEAN FOOD EXHIBITION A Public Health Inspector explains one aspect of the comprehensive work of the Public Health Laboratory Service (Reproduced by kind permission of "Middlesex County Times") CLEAN FOOD EXHIBITION The common fly incriminated as a spreader of disease 21 Cooper McDougall & Robertson, Rentakill, the North Thames Gas Board, Domestos, Marks and Spencers Ltd., F.H. Rowse Ltd., Bentalls Ltd., and T. Wall & Sons. The Public Health Department's stand concerned itself with the Council's Clean Pood Campaign and Pood Hygiene Certificate Scheme. The Public Health Laboratory Service also provided a stand dealing fully with the bacteriological aspect, and we were fortunate on many occasions in having Dr. Betty Hobbs demonstrating this. The opening ceremony was performed by J.W. Barter Esq., Member of Parliament for Ealing North, and a large number of specially invited visitors and representatives of the Exhibitors attended a small reception which enabled them and the Council's representatives to meet. Throughout the week, in addition to casual visitors, it was arranged that parties could attend by appointment, and we were particularly glad when these consisted of Ealing school children. The total number who visited the Clean Pood section was 3,531 and the Clean Air section was 3,304. All visitors received a copy of the Exhibition brochure. Every effort had been made to make it informative and I think we succeeded in this. It is very difficult to evaluate the full effects of such an Exhibition, but I feel confident that many of the visitors now have a much clearer understanding of the Council s aims and intentions in these two spheres of public health work. FOOD HYGIENE The. Clean Food 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 12 years. There is every indi cation that these talks are appreciated and that they are showing beneficial results. During 1961, 22 lectures were given to food handlers and 88 received Certificates of Attendance upon completing the course. In addition 27 talks on Pood Hygiene were given by the Public Health Inspectors to approximately 990 school-leavers at the Grammar and Secondary Modern Schools in the Borough. Food Hygiene Certificates. The current holders of these 58 certificates are:- 22 School Meals Services 23 school kitchens. Factory Canteens, Aladdin Industries Ltd., Western Avenue, Greenford. Hoover Ltd., Bideford Avenue, Perivale. Hoover Ltd., Wadsworth Road, Perivale. Metal Box Co. Ltd., Wadsworth Road, Perivale. Optrex Limited, Wadsworth Road, Perivale. A. Sanderson & 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 Restaurants, Bentalls, Limited, The Broadway, W.5. British Home Stores, Ltd., 104/8 Broadway, W.13. 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. Multiple Store. Marks & Spencer Ltd., 92/94 Broadway, W.13. Grocers. Champion Tea Co.,366/8 Windmill Lane, W.5. H. Cradock Ltd.,52/3 Manor Road, W. 13. United Dairies (London) Ltd., - 10 shops Williams Bros. Ltd., 24 Broadway, Greenford. Butchers, R. Mathews Ltd., 165 Boston Road, W.7. G.A. Scott & Son, 2 Eastmead Avenue, Greenford. L0 Shaw, 6 Station Parade, Ealing Road, Northolt. Sutton & Sons, 34 Haven Green, W. 5. -do- 1 Station Parade, Uxbridge Road, W.5. 2,064 inspections of food premises were made and 528 repairs and improvements were carried out. The film-strip on Pood Hygiene made by the Council in 1954 is still in demand, a further 8 copies having been sold during the year. This makes a total of 144 copies sold. (Reproduced by courtesy of Hoover Ltd.) EALING CLEAN FOOD SCHEME Food Hygiene Lecture 23 During the year the Clean Pood Booklet, which is distributed to food traders, was again 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. HOUSING ACT, 1957 Closing Orders, 45 The Avenue, W.13. 28 South Ealing Road, W.5. 43 The Avenue, W.13. 36 Lower Boston Road, W.7. 97 The Grove, W.5. A Closing Order under Sec. 18(1) of the Act was made in respect of the basement flat at this property in January, but this was determined in May on completion of a specification of works which had been approved by the Council. A Closing Order under Sec. 18(1) of the Act was made in respect of a flat over the shop at this property in February. A Closing Order in respect of the basement flat at this property, made in 1959, was determined on completion of a specification of works approved by the Council. A Closing Order in respect of the basement flat at this property, made in 1956, was determined on completion of a specification of works approved by the Council. The Council approved a specification of works in respect of the basement flat at this property, for which a Closing Order had been made in 1958. The Closing Order was subsequently determined on completion of the work. 24 47 The Avenue, W.13. A specification of works and an undertaking not to relet submitted by the owner of these premises in respect of the basement flat were accepted by the Council in October, Underground Room Regulations Revised Regulations for Underground Rooms were made by the Council under Section 18 of the Housing Act. 1957, in May and the Minister of Housing and Local Government gave his consent to these Regulations in November. The Regulations were to come into operation on the 1st January, 1962. PUBLIC HEALTH ACT, 1961. This Act,mainly intended to amend the provisions of the Public Health Act, 1936, relating to building byelaws and trade effluents, and also public health matters formerly dealt with in local Acts, came into force in October. The Council immediately had under consideration the exercise of their new powers under Section 74 of the Act relating to nuisance caused by the congregation of pigeons and other birds in the built up areas, about which com plaints had been received. In the absence of statutory powers prior to the passing of this Act, there was very little that could be done about this problem in Ealing. At the end of the year preliminary investigations into the activities and methods of several firms specialising in the work of pigeon control were still proceeding. 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 completely circulated in all four pools every four hours. The treatment plant provides for flocculation with alum and soda ash prior to filtration, combined with continuous marginal chlorination of the water as it is drawn from the pools and as it is returned. Tests are made at frequent intervals each day to maintain a satisfactory level of residual chlorine. There are two privately owned swimming pools in the Borough, both of which are equipped with filtration and chlorination plants. They were not in use however during 1961. 25 PUBLIC MORTUARY, There being no Public Mortuary in this Borough, existing arrangements continued with the Acton Council for the use of the Acton Mortuary. 346 bodies were taken there and post mortem examinations carried out in every case. Arrangements were also made with the Uxbridge Council for the use of their mortuary and 18 bodies were taken to this mortuary for post-mortem examination. 26 SECTION 3 SANITARY INSPECTION THE WORK OF THE PUBLIC HEALTH INSPECTORS IN 1961 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 Inspectionso Premises inspected on complaint 2,019 Nuisances observed by Inspectors 64 Premises inspected in connection with infectious disease 552 Stooke observations 227 Houses without water supply 45 Inspections of moveable dwellings 313 Other visits 1,805 Re-inspections 5,013 Intimation Notices served 878 Statutory Notices served 183 Letters written 777 Proceedings before Magistrates 2 Legal Proceedings. Public Health Act, 1936, Sections 39 and 93 Non-conpliance with Statutory Notices In 2 cases legal proceedings were taken to enforce complaince with Notices requiring the abatement of Nuisances. In one case an Order was made by the Magistrates for the necessary work to be carried out under Section 39 of the Public Health Act, 1936 within a stated time with a fine of £3 and costs of £2.2.0d. In the other case a Nuisance Order and costs of £3.3.0d. were obtained against the occupier of a caravan. CLEAN AIR ACT, 1956 Inspections and visits in connection with proposed Smoke Control Areas 6,854 FOOD AND DRUGS ACT, 1955 Food Hygiene Regulations, 1955 Milk and Dairies Regulations, 1949 to 1954 Complaints received 103 Inspections of Milk Purveyors, Premises 70 PUBLIC HEALTH INSPECTION Routine inspection of a beer cellar 27 Contravention of Regulations Inspections of Ice Cream Premises 200 Pood Inspections 553 Inspections of other Food Premises l,794 Contraventions found 203 Notices served 202 Proceedings before Magistrates 10 Samples of Ice Cream taken 79 Samples of Synthetic Cream taken 36 Samples of other foods taken 22 Samples of tea taken 740 Samples of water taken 18 Legal Proceedings, Food and Drugs Act, 1955 In the following 8 cases proceedings were instituted under this Act: Insects in bread - Pined £5, Costs £1.1.0. Metal in sausages Pined £5, Costs £2.2.0. Mouldy apple pie - Case dismissed. Mouldy steak and kidney pie - Fined £5. Mouldy pie Pined £5 Costs £5. 5.0. Mouldy chicken and veal pie Pined £5. Foreign matter in milk - Fined £5, Costs £5.5,0. Cigarette end in doughnut Fined £10, Costs £15.l5.0. In the following 2 cases proceedings were instituted under the Food Hygiene (General) Regulations, 1960:- Sale of Hot Dogs from mobile tricycle - convicted on 8 summonses - Total fines £56. Boiling hams in W.C. Compartment - Fined £10. List of Food Premises in the Borough of Ealing Bakehouses 21 Bakers' shops 52 Butchers soman sir 120 Cafes and Restaurants 155 Canteens - factory 81 Canteens - school 24 Confectioners 244 Dairies and Milk Sellers 90 Pish Fryers 23 Fishmongers 32 Greengrocers 147 Grocers 302 Ice Cream Manu. 3 Public Houses 64 28 Premises registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food 118 Premises registered for the sale of Ice Cream 05 Milk Supply There are 49 registered distributors of milk in the Borough, As from 1st January, 1961, the issue of licences under the Milk (Special Designations) Regulations, I960, for the sale of designated milks, passed to the Middlesex County Council and 117 samples of milk were taken in the Borough by officers of the Middlesex County Council. Ice Cream, There are 405 premises in the Borough registered for the sale of ice cream. There are only 3 registered premises in the Borough manufacturing ice cream, and 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. A total of 79 samples from these manufacturers was taken during the year, and submitted for bacteriological examination. The results were as follows:- Commodity Samples Grade Not Graded 1 2 3 4 Ice Cream - Local Manufacturers 70 48 18 - 4 - Ice Cream - Other Manufacturers 2 - 2- - - Ice lollies 7 - - - - 7 79 48 20 -- 4 7 The 4 local samples placed in Grade 4 were followed by an inspection of the factory and plant, and repeat samples proved to be satisfactory. The 7 ice lollies, though not graded were satisfactory. Synthetic Cream A total of 36 samples of synthetic cream was taken from local manufacturers. All were found to be satisfactory. PUBLIC HEALTH INSPECTION Routine sampling of Ice Cream 29 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 Boroueh;- lbs. Apples 400 Apricot Pulp 10 Apricots 10 Bacon 146 Beef 891 Carrots 16 Chicken 57 Chuck Steak 95 Corned Beef 18 Eggs (frozen) 322 260 Ham 71 Jellied Veal 25 Kidney 15 Larob 55 Liver 113 Luncheon Meat 4 Milk Powder 64 Mutton 77 Ox Tongue 6 Pork 112 Potatoes 224 Sprouts 4 Tea 57,800 Tongue 67 Veal 42 Foodstuffs not calculated by weight: Assorted tins9 packets and . jars .. .« .. .. .. 43561 Articles: Loaves of bread .. 66 Trays of peaches .. 55 Teao The examination and sampling of tea, taken over from HoMe. Customs & Excise in 1959. continued throughout the year. 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 initialte 30 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 Pood & Drugs Act, 1955, and the Public Health (Imported Pood) Regulations, 1937. During 1961¬, 740 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. 3. Lead is another known contaminant of tea but none of our samples has shown this to be present in excess. Of the 740 samples taken by the Inspector during the year, 26 were of doubtful quality after the initial tests were carried out and were referred for further examination to the Public Analyst. He reported that 8 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. Some consignments of tea certified as unfit are res 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. In other cases such tea is blended with large quantities of other good tea on the advice of the analyst, and samples of the resultant product have proved to be satisfactory. Other Food Samples Twenty-two other food samples were submitted for testing after receiving complaints and all but one proved 31 to be satisfactory. These included: Cereals (2 samples). Ale (2)9 Luncheon Meat (2), Frankfurter Sausages (10), Lard (1), Meat Pies (2), Gravy (1, Cheese (1). The unsatisfactory sample was one of milk and the vendor was summoned and fined as reported elsewhere. MIDDLESEX COUNTY COUNCIL ACT, 1950, SECTION 11 Under this Section, 4 persons were registered during the year for the sale of food from carts, barrows, other vehicles etc. There were 35 persons on the Register at 31st December, 1961. HOUSING STATISTICS 1. Inspection of dwelling-houses during the year: (1) Total number of dwelling-houses inspected for housing defects (under Public Hhouses (included under sub-head (1) above) which were inspected and recorded under the Housing Act, 1957 7 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found nott be in all respects reason ably fit for human habitation 1,096 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 . 858 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 143 (2) Number of dwelling-houses in which defects were remedied after service of formal notice: (a) by Owners 90 (b) by Local Authority in default of owner 10 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 32 (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 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determinedthe tenement or room having been rendered fit 4 THE CARAVAN SITES AND CONTROL OF DEVELOPMENT ACT, 1960 One application for permission to retain a caravan at the rear of club premises was refused during the year and steps taken to secure its removal. In one other case a site licence in respect of the use of a caravan in the rear garden of a private house was issued for a period of one year. Town Planning permission in this case had been given by the Minister of Housing and Local Government following an appeal. The main problem concerning caravans remained in dealing with the itinerant or gipsy type caravan dwellers who encamp on any available vacant plot of land, on road verges and service roads and other available sites. The problem is not a new one but it has intensified as Northolt and adjoining areas have become built up and the number of sites available to the caravan dwellers has become more and more restricted. Many of the families of caravan dwellers have been in the neighbourhood for several generations, their names having been repeated many times over the years on notices served by Inspectors. During the last few years they have been harassed by the Warden employed by the Council to keep them away from Council owned land and whenever possible Abatement Notices under Section 93 of the Public Health Act, 1936 have been served on the occupiers of the caravans. During 1961, 45 such notices were served, but it was only possible in one case to obtain a hearing for a successfully served summons. This procedure is slow and difficult owing to the time lags which inevitably occur between service of notice, service of summons and date of hearing. Pines and costs, when imposed are light and are no real deterrent to the offenders, but are merely regarded as part of the natural hazards of this way of life. In the early part of the year, in addition to the regular families, there was an PUBLIC HEALTH INSPECTION Dry Rot in Hanwell 33 influx of new caravans with Irish families, and they were no improvement:, as visits to the sites occupied by them clearly showed. The problem became so acute that the Council set up a special Caravan Trespassers Committee. As a result, concentrated efforts were made to enclose Council-owned land in the affected areas with suitable fences and to persuade the private land owners to erect new, and repair existing fences and gates and to take other suitable action to secure their land. Abatement Notices were served on caravan occupiers on every possible occasion. By the early part of the summer, practically all sites used had been cleared and the remaining few offenders were under control and kept on the move by the Warden. When the majority of the caravans had left, the sites were found to be littered with refuse of all kinds in tremendous quantities. This was removed by the Council and the areas disinfected by the staff of the Public Health Department. RENT ACT, 1957 Part I - Applications for Certificates of Disrepair (1) Number of applications for certificates 21 (2) Number of decisions not to issue certificates - (3) Number of decisions to issue certificates (a) in respect of some but not all defects 13 (b) in respect of all defects 8 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 15 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule - (6) Number of Certificates issued 5 Part II - Applications for Cancellations of Certificates (7) Applications by landlord to Local Authority for cancellation of certificates 4 (8) Objections by tenants to cancellation of certificates - (9) Decisions by Local Authority to cancel in spite of tenants objection - (10) Certificates cancelled by Local Authority 4 NEW DWELLINGS, 1961 Completion figures for the 12 months period ending 31st December, 1961 were: Houses (1 bedroom) Houses (2 bedrooms)- Houses (3 bedrooms) - Flats (Bedsitters) - Flats (1 bedroom) 36 Flats (2 bedrooms) 109 Flats (3 bedrooms) - 34 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 87 11 - - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authority 427 310 11 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 514 321 11 - 2. Cases in which defects were found: Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.Mo Inspector By H.M. Inspector Want of cleanliness 9 7 - 1 - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors - - - - - Sanitary Conveniences: (a) Insufficient 1 1 - 1 - (b) Unsuitable or defective 8 8 - - - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to out-workers 1 1 - - - Total 19 17 - 2 - 35 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. 290 1 Cleaning and Washing - - Furniture and upholstery 2 - Artificial flowers 6 - Paper bags 6 - Making of boxes or other receptacles or parts thereof made wholly or partially of paper 4 - Carding., etc. of buttons, etc. 40 - Stuffed toys 27 - Cosaques, Christmas crackers, Christmas stockings, etc. 147 - Lampshades 4 - Brass and Brass articles 2 - Woodwork 2 - Total 530 1 During the year, 337 inspections of Outworkers premises were carried out by the Public Health Inspectors, and an informal notice was sent to the occupier of one private dwelling-house. SHOPS ACT, 1950 Improvements under Section 38 of the Shops Act, 1950, relating to the health and comfort of shop workers were carried out as follows:- Lighting and ventilation improved 52 Heating improved 27 Sanitary accommodation improved 36 Washing facilities provided 16 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 956 Premises inspected 1,126 Premises found to be infested with: 1. Rats 914 2. Mice 201 Re-visits to infested premises 3,476 Pees received for treatment £837.8.0d. 36 Rodent Control in Sewers A new system of rodent control in sewers recommended by the Ministry of Agriculture, Fisheries and Food with the use of fluoracetamide as a direct poison bait was carried out in five areas of the Borough in March and October. Maintenance treatments had previously been made with warfarin, a system which entails at least three visits to every manhole treated. The use of fluoracetamide is very much simpler than warfarin as only one visit to each manhole is required with a consequent saving of labour and transport. It does however mean that with the use of fluoracetamide no direct evidence is available at the time as to the efficiency with which the system operates. It was however, proposed to carry out a further full scale treatment with warfarin in 1962 as a control measure. Persistent maintenance treatments of the sewers in the Borough have now been carried out over a very long period with increasingly satisfactory results so far. 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. PET ANIMALS ACT, 1951 16 licences were renewed by the Council during the year after the premises had been inspected by the Public Health Inspectors. DISINFECTION Number of houses where disinfection was carried out 143 Number of houses disinfested of vermin 72 Number of articles disinfected by steam 32 Number of articles disinfected by formalin spray 151 Number of articles voluntarily destroyed 138 The arrangement made with the Hammersmith Metropolitan Borough Council in 1952, whereby articles to be disinfected by steam are dealt with at the Scotts Road Depot. W.12, was continued during the year. SUMMARY OF SANITARY DEFECTS REMEDIED AS A RESULT OF NOTICES SERVED AND LETTERS WRITTEN Animals - nuisances abated 10 Caravans - nuisances abated 92 37 Damp proof courses inserted in walls 8 Dampness - other forms remedied 129 Drains - cleared and cleansed 520 Drains reconstructed 14 Drains - repaired 171 Drains - new soil and ventilating pipes provided 21 Dustbins provided 116 Firegrates - repaired or renewed 57 Floors - sub-floor ventilation provided 2 Floors - repaired or renewed 50 Food cupboards ventilated 2 Rainwater eaves gutters, downpipes repaired 121 Refuse - accumulations removed 83 Roofs repaired 134 Sinks repaired or renewed 28 Sink waste pipes repaired or renewed 46 Staircases repaired 11 Walls and ceilings repaired or cleansed 161 Water supply reinstated 45 Water supply - draw taps fixed to main supply 4 Water closets - repaired, reconstructed or improved 75 Windows and doors repaired 119 Yards paved or repaired 24 Other defects remedied or nuisances abated 207 SUMMARY OF WORK DONE AND IMPROVEMENTS CARRIED OUT AT FOOD PREMISES Walls and ceilings: repaired and cleansed 235 Floors repaired 39 Lighting and ventilation improved 24 Washing facilities provided 8 Hot water provided 11 Sinks provided 18 Storage accommodation improved 8 Water supply provided 1 Water closets cleansed or repaired 38 Refrigeration installed or improved 5 Shop heating facilities improved 5 Equipment improved 5 Other defects remedied 116 First Aid Equipment provided 2 Clothing accommodation provided 2 Water heater repaired 3 Accumulations of refuse removed 4 Yard paving repaired 4 38 SECTION 4 OLD PEOPLES WELFARE In recent years the problem of caring for the growing number of old people has become of increasing importance. The Ealing Borough Council has, I consider, in its endeavour to meet this problem, set as high a standard as any in the country. It has been anxious at all times to use its statutory powers to the full, both in providing services directly and by contributing to voluntary organisations in the Borough. Ealing too is fortunate in the response it has always had from its voluntary organisations to requests for help. As work for old people is becoming of greater significance, I have decided that a section of my Annual Report shall be devoted to an account of the Care of Old People in the Borough. In addition to the services provided locally, those administered by the Middlesex County Council have been included. I look forward to the time when the Borough Council will be able to incorporate these in a comprehensive and truly local service for old people. I have long held the opinion that in a Borough of the size of Ealing the proper provider of such a service is the Borough Council. In my capacity as Joint Area Medical Officer for the part of Middlesex which includes Ealing I have endeavoured to link such services as the Home Help Service, Home Nursing, Health Visiting and Chiropody to those directly under my jurisdiction as Medical Officer of Health. An account of these will be given elsewhere in the Report but it is convenient here to emphasise how a great percentage of their work is now concerned with old people. 75% of those helped by the Home Help Service were old people and nearly 60% of those attended by the Home Nursing Service were over 65 years of age, whilst chiropody provided under the National Health Service Act is almost entirely for old people. The Health Visitors too have been redeployed to assist with the care of old people and have some 500 in Ealing under their surveillance. Cooperation between the Health Visitors and the Borough's Public Health Inspectors is close and forms a most useful combination. The Royal Commission on Local Government recommended that all these services should be unified under the Borough Councils and that to these should be added the function of the Welfare Department with its residential (Reproduced by kind permission of "Middlesex County Times") A HOME HELP AT WORK IN THE BOROUGH Many of the elderly of the Borough could not continue to live in their own homes without the assistance of the Home Help Service MEALS ON WHEELS SERVICE Hot meals being placed in heated containers at the start of a lunch-time tour 39 accommodation, I view this prospect with optimism and feel confident that such an arrangement will provide a service that will meet the needs of the aged in future years. MEALS ON WHEELS. The Meals on Wheels service which covers the whole of the Borough of Ealing has continued its useful work. The total number of hot meals supplied by the British Red Cross Society and Women's Voluntary Service during the year was 24,417. The British Red Cross Society provided meals two to five times weekly in the Ealing and Hanwell area. Approximately 79 old people were given meals each week and the total number of meals supplied was 15,100. The rest of the Borough, namely, Greenford, Perivale and Northolt, was supplied by the Women's Voluntary Service. The number receiving two meals a week was approximately 80 and the total number of meals provided during the year was 9,317. Both the British Red Cross Society and Women's Voluntary Service cook their meals centrally in their respective kitchens. The cooked meals are then transferred to charcoal heated containers which are delivered by van. It will be appreciated that in a large Borough like Ealing, where the distances involved are great, that considerable effort is required to ensure that meals are hot on delivery. Notwithstanding this difficulty hot meals of a high standard are provided. In addition to the domiciliary service they provide, the British Red Cross Society and the Women's Voluntary Service have co-operated to provide twenty meals a day on week-days for the Day Treatment Centre since it opened in June. The manner in which these two organisations have co-operated and adapted their service to meet this increased need is most gratifying. OLD PEOPLE'S WORK CENTRES. The beneficial work of the Borough's two Work Centres, organised by the Ealing Committee for the Employment and Recreation of Elderly Citizens continued in 1961. The West Ealing Centre which is in the Drill Hall, has 60 workers when at full capacity, and the Greenford Centre which is at Ravenor Park Pavilion has 28 workers when at full capacity. As in all Centres one of the biggest 40 problems is obtaining work and we have been fortunate during the year in receiving a wide variety. The list below gives some idea of the versatility of the workers in the Centres. Enclosed many thousands of circulars for three different firms. Applied "2d. off" selotape labels to cartons. Collated Instruction Manuals and leaflets for Electronic firms. Strung 64,000 labels. Assembled Ball Point pens. Packed combs. Separated plug parts, "Jigged" Badges ready for plating. Trimmed Polythene. Needlework of various kinds. Made plush balls for a toy firm. Piled bakelite parts. Made many thousands of Manilla Polders. Cut out swimming suit emblems. Packed swimming suits. Packed soap. Sorted screws. Made padded coat-hangers. Made curtains. Strung washers for plating. The average age of the workers varies between the two Centres, being over 70 in West Ealing and the late 60's in Greenford. This one would expect of course from the nature of the two different parts of the Borough. The beneficial effect of these Centres on those who attend has been mentioned often in earlier reports and these previous observations continue to be amply confirmed. No small part of the value of these Centres is the sense of comradeship and such activities as the Christmas Party and the "Thrift Club" are examples of this. The Christmas Party was spent at the Town Hall Pantomime followed by a meal in the Nelson Room. We are grateful for the help received from several local firms, private individuals and the Ealing Rotary Club, who all assisted in various ways. During the year Mrs. Corbyn, the Secretary, found it necessary to advise the Committee that although able to continue in this capacity, she will be unable to continue working as Supervisor. It has been decided that a (Reproduced by kind permission of "Middlesex County Times") OLD PEOPLE'S WORK CENTRES The West Ealing Centre EALING DAY TREATMENT CENTRE Physiotherapy 41 full time salaried Organiser be engaged with a part time Supervisor for each Centre. The proposed Northolt Work Centre has not yet come into being, but it is hoped that this will be the case in 1962, so that this part of the Borough can have the advantage of this service, EALING DAY TREATMENT CENTRE. For the past several years in my Annual Report I have recorded the progress of the efforts to inaugurate the Day Treatment Centre. I am now glad to record that the Centre opened in June and by the end of the year had established itself as a valuable component of the Council's service for old people. The Centre is run by the Ealing Day Treatment Centre Association, with Alderman Mrs. L, Stowell as its Chairman. The Committee consists of six members of the Ealing Borough Council, three representatives of the West Middle sex 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 Women's Voluntary Service. The Mayor of Ealing agreed 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. have provided and erected a very suitable building rent free for five years, and Honeywell Brown Controls have provided the necessary electrical equipment. Glaxo Laboratories Limited have made a generous grant towards the equipping of the Centre, and the British Bath Company have supplied on loan a bath especially designed for use by old people. The site of the Centre is in Green Lane, Hanwell, W. 7. The building caters for 20 people and has a fully equipped surgery for use by visiting General Practitioners, a Treatment Room, well supplied with physiotherapy equipment, and a Day Room. The bathroom has a specially designed bath incorporating aids for the crippled and infirm. The Centre has a full time staff of three, consisting of a Sister, an Assistant Nurse and a clerk. The consultants and medical auxiliaries are either on a voluntary or sessional basis. The patients are brought to the Centre at approximately 9 a.m. daily Monday to Friday inclusive, and taken home at about 4 p.m. 42 This experimental scheme it is thought is probably the first in this country where a medical practitioner can refer a patient to a Centre for daily care and treatment under his own supervision. Whilst it is rather too early to make a firm forecast for the future I feel that the first six months working of this Centre has indicated that there is a real need for a service of this sort and that it has the potential for development into a service of the greatest value. Members of the Day Treatment Centre Association for 1961 Alderman Mrs. L. Stowell, O.B.E. Chairman Councillor Barlow „ Brewster - Vice-Chairman " Clay " Miss Lawford " Reeves Borough Council Dr. Barbara Bailey Dr. Osborn Dr. Scoones General Practitioners Mrs. Collins - British Red Cross Society Mr. Love - St. John Ambulance Brigade Miss Tippetts - Women's Voluntary Service LAUNDRY SERVICE FOR THE INCONTINENT. This most useful service has continued during 1961. Whilst it is for the incontinent of all ages, in practice, as would be expected, the great majority of those receiving help are elderly. It represents an answer to what would otherwise be an insoluble problem as commercial laundries are not in a position to accept soiled linen of this nature. 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 Women's 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. (Reproduced by kind permission of "Middlesex County Times") HOLIDAYS FOR OLD PEOPLE A holiday party organised by the Women's Voluntary Service, waiting to enter the coach at the beginning of their holiday 43  1956 1957 1958 1959 1960 1961 NO. of new cases dealt with during the year 78 70 56 67 83 69 No. of cases remaining at end of year 47 39 38 39 42 34 No, of cases that died 26 48 35 31 48 30 No. of cases removed to hospital 28 14 22 41 30 22 No, of cases where other arrangements were made 5 4 2 3 16 Total number of articles dealt with 36,755 44,466 36,723 59,004 48,847 34,727 Total number of collections 3,086 3,333 2,766 4,822 2,954 3,058 Average number of articles per collection 11.9 13.3 13.3 12.2 16.5 11.0 HOLIDAYS FOR OLD PEOPLE, The Women's Voluntary Service and the Greenford Philanthropic Society, with the aid of grants from the Borough Council, again arranged for elderly people to have a holiday by the sea. The Women's Voluntary Service took 240 to Bexhillon-Sea, and the Greenford Philanthropic Society's party, consisting of 48 disabled and blind people, went to Ramsgate. This annual holiday is something to which many old people look forward and is of great mental benefit to them. DAY CLUB FOR OLD PEOPLE, An interesting project was proposed by the Women's Voluntary Service during the year in the provision of a Day Club for Old People and the Borough Council offered a site off the Greenford Road for the establishment of a Club. This building, it is hoped, will house the central kitchen for the Women's Voluntary Service "Meals on Wheels" service, a hall where the old people can have meals and hold social activities, such as whist drives, and a Club room. It seems likely that a grant towards the erection of the building will be given by the King George VI Foundation Committee and the Borough Council have approved the idea in principle. NATIONAL ASSISTANCE ACT, 1948, Section 47. This section provides for the removal to a suitable hospital or other place of persons who: 44 (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, once again, not been necessary to use these powers during the year, which is a source of satisfaction in that their use represents a failure of our services. I do not feel that the compulsory removal of an old person from his home, however unsatisfactory that home may be. is ever very likely to be a solution leading to a happy last few years. As a general rule old people are happiest when managing independently for them selves. An essential pre requisite of happiness in any Old Persons Home is to convince the old person that the time has come for him to accept the offer of a vacancy in such a home. OLD PEOPLE'S LIAISON COMMITTEE This Committee was formed in January. 1959, when it was felt that the partnership between the activities of the Borough Council for Old People's Welfare and those voluntary organisations which were running services on the Council's behalf under Section 31 of the National Assistance Act, would function even more smoothly if a joint Committee were formed. Here, the Council members would be given an opportunity to explain their overall plan for Old People's Welfare to the voluntary organisa tions and at the same time the representatives of these organisations would have the opportunity to bring their various difficulties to the notice of the Council. In this way it was hoped that there would be a unified and co-ordinated policy. These hopes have been entirely justified and the Liaison Committee met on the 15th November when the progress of work for 1961 was considered and plans formulated for its continuance in 1962. Committee Members: Alderman Mrs. L. Stowell, O.B.E. Chairman Councillor J.P. Barlow J.T. Bartlett " H.G. Brewster " R.R. Clay " D.J. Cousins Council Representatives 45 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. P. W. Tomlin Mr. L. Ward Greenford Philanthropic Society Mrs. H. W. Corey Miss E. C. Tippetts Women's Voluntary Service 46 SECTION 5 GENERAL ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT. There are 24 establishments registered in the Borough. In addition four exemptions were granted in respect of establishments run by members of the Chartered Society of Physiotherapists. One application for a licence was refused on the grounds that the applicant did not possess the technical qualifications required by the Council. An appeal to the Ealing Magistrates Court against this decision was dismissed but subsequent appeal to the Middlesex Quarter Sessions was allowed and the Council was instructed to register this applicant. On the 1st July, 1961, an Order brought into operation certain provisions of the Professions Supplementary to Medicine Act, 1960. 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. The provisions of the Act, which were brought into operation during the year were the establishment of this Council and of the Boards for the various professions. Ealing has long endeavoured to ensure that the qualifications of Chiropodists in private practice in the Borough are as high as those who are employed by the County Council in its clinics and by hospitals in the Borough under the National Health Service Act. It does not seem reasonable, in my opinion, that persons having chiropody from private chiropodists should be receiving it from a person whose qualifications are not sufficient to enable him to get employment in the National Health Service. 47 It is to be hoped that the newly constituted Board for the Profession of Chiropody will state unequivocally what they consider to be adequate training and qualifications, and that it will then by no longer necessary for the Borough Council to take this upon itself. HEALTH EDUCATION, Health Education is an integral part of most aspects of the everyday work of a Health Department. During the year, however, a major effort was made in the combined Clean Air and Clean Pood Exhibition which is described elsewhere in this Report. Whilst continued day to day effort is necessary, a stimulus of this sort is of great value. NATIONAL ASSISTANCE ACT, 1948. Section 50 Burial of the Dead. Two burials were carried out for which the Council accepted financial responsibility. In one of these burials the total cost was recovered and in the other a claim to the Ministry of Pensions has not yet been settled. REGISTRATION OF NURSING HOMES There are 8 Nursing Homes in the Borough, with a total number of 167 beds. They are registered by the Borough Council under the Public Health Act, 1936, and are inspected regularly in order to ensure that as high a standard as possible is maintained. 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 38 Sickness Pay Scheme (Servants) 144 Gunnersbury Park Joint Committee Employees 8 190 The Council has amended the Sickness Pay Scheme so that staff who would previously have been excluded from benefit due to some particular condition may now be 48 passed with reservations. These employees are paid for all absences due to conditions other than the disability specified at their examination. The results of the inations have been as follows: No. examined Passed without reservation Passed with reservations 144 115 29 The conditions for which these reservations have been made are as follows:- Bronchitis 1 Colitis 2 Deformed hands and defective vision 1 Epilepsy 2 Genito-urinary disease 2 Heart disease 3 Hernia 3 Hernia and deformed feet 1 High blood pressure 1 Mental illness 2 Middle ear disease 1 Migraine 2 Peptic ulcer and bronchitis 1 Recent injuries 2 Spinal disease 2 Tuberculosis 1 Tuberculosis and middle ear disease 1 Varicose veins 1 49 SECTION 6 STATISTICAL TABLES SUMMARY OF STATISTICS Area (in Acres) 8,781 Population (Census. 1961) 183,151 Population (estimated middle of 1961) 182,970 Rateable Value, 1st April. 1961 £3,798,000 Net Product of a Penny Rate, 1961/62 (Est.) £15,530 Live Births:- Legitimate Males 1,377, Females 1,296. Total 2,673 Illegitimate Males 98, Females 87, Total 185 Birth-Rate per 1,000 of Estimated Population 12 Illegitimate Live Births (per cent of total live births) 6.5% Still-Births:- Males 14, Females 23, Total 37 Rate per 1,000 total Births (Live and Still Births) 13 Deaths:- Males 1,050, Females 967, Total 2,017 Death-Rate per 1,000 of Estimated Population 11 Deaths of Infants under one year of age:- Legitimate Males 31, Females 12, Total 43 Illegitimate Males 1, Females -, Total 1 Death-Rates of Infants under one year of age:- All Infants per 1,000 Live Births 15 Legitimate Infants per 1,000 Legitimate Live Births 16 Illegitimate Infants per 1,000 Illegitimate Live Births 5.4 Neo-natal Mortality Rate (deaths under four weeks per 1,000 total live births) 13 Early Neo-natal Mortality Rate (deaths under one week per 1,000 total live births) 11 Perinatal Mortality Rate (still births and deaths under one week combined per i,000 total live and still births) 24 Maternal Mortality (including Abortion) 1 Rate per 1,000 Live and Still Births 0.34 50 INFANT MORTALITY. There were 44 deaths of infants under one year of age in 1961 making an infant death rate of 15 per thousand live births (16 in 1960). Of the 44 deaths, 38 occurred within the first month of life and of these, 32 were within the first week and 23 within the first day of birth. The first 24 hours of life appears therefore to be the most dangerous, but for those who survive the first 4 weeks, the risks are nowadays small. By far the most frequent cause of infant death is still prematurity; 19 babies died of this in 1961. Pour of these were stated to be associated with maternal toxaemia of pregnancy and this may well have been the precipitating factor in other cases. Further knowledge on the prevention and cure of toxaemia may be needed before the prematurity rate is appreciably reduced. Many cases of premature birth still remained unexplained. Congenital abnormalities formed the next most frequent cause of death after prematurity. There were 7 deaths from this cause in 1961 (13 in 1960). The number shows no increase in Ealing over the years despite the reputed danger from radiation. Four babies died of atelectasis failure of the lungs to expand at birth and 2 from asphyxia at birth. Three deaths were due to Rhesus incompatibility. There were 5 deaths from infection and these were all infections of the lung. It is of interest to compare the deaths from infections of all types and from prematurity and congenital malformation in babies under 1 year of age in Ealing in the years 1917, 1931 and 1961:- 1917 1931 1961 Total births 1,064 1,817 2,895 Total infant deaths 67 84 44 Deaths from all types of infections in babies under 1 year 37 27 5 Prematurity 7 19 19 Congenital malformation 5 9 7 51 Cases of Infectious and Other Notifiable Diseases notified in the Borough Disease 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 Smallpox - - - - - - - - - - - - Diphtheria 3 2 - - 1 - - - - - - 1 Scarlet Fever 294 203 402 238 287 108 159 95 232 269 117 67 Enteric Fever (including Paratyphoid) 5 3 2 3 5 7 - 1 - - 1 1 Puerperal Pyrexia 24 38 70 61 54 44 71 77 67 37 63 44 Pneumonia: Primary 173 162 100 157 152 135 113 72 94 97 30 37 Influenzal 6 38 28 74 52 56 48 99 57 57 16 33 Acute Poliomyelitis 42 10 21 13 5 61 46 2 2 - - 2 Meningococcal Infection 9 2 - - 6 3 2 2 3 2 2 1 Malaria 4 1 1 3 1 1 - - 1 - - 1 Dysentery 24 542 179 132 225 149 193 252 244 194 261 127 Erysipelas 24 17 26 18 18 12 12 13 19 9 17 6 Tuberculosis: Pulmonary 209 210 211 205 132 119 134 113 97 109 89 93 Non-Pulmonary 41 24 29 20 17 24 13 16 8 10 18 10 Ophthalmia Neonatorum 3 6 - - 2 2 2 5 6 3 3 2 Measles 1,016 3, 296 993 2, 558 132 2, 422 726 1,854 975 1,928 50 3,250 Whooping Cough 274 550 77 491 116 156 67 131 85 90 258 51 Food Poisoning 23 86 26 31 78 36 26 20 18 39 20 15 Totals 2, 174 5, 190 2, 165 4, 004 1,284 3, 335 1,612 2,752 1,908 2, 844 945 3,741 52 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 SmallFox DiFhtheria 1 Scarlet Fever 67 Enteric Fever (including FaratyFhoid) 1 FuerFeral Fyrexia 44 Fneumonia: Frimary 37 Influenzal 33 Acute Foliomyelitis 2 Food Foisoning 12 Meningococcal Infection 1 Disease Malaria 1 Dysentery 116 ErysiFelas 6 Tuberculosis: Fulmonary 93 Non-Fulmonary 10 OFhthalmia Neonatorum 2 Measles 3,250 WhooFing Cough 51 Total 3,727 Infectious and Other Notifiable Diseases Classified in Age GrouFs Scarlet Fever WhooFing Cough Foliomyelitis Measles DiFhtheria Dysentery Meningococcal Infection Faralytic Non-Faralytic M F M F M F M F M F M F M F M F Numbers originallynotified 22 45 23 28 – – – – 1,720 1, 530 – 1 64 63 – 1 FINAL numbers after correction Under 1 year 2 1 4 1 – – – – 42 40 – – 4 3 – – 1 - 2 1 - 3 - - - - 146 110 - – 4 2 – – 2 - 1 3 5 4 - - - - 195 189 - – 2 4 – _ 3 - - 5 2 5 - - - - 235 185 – – 2 1 – – 4 - 3 3 2 4 - - - - 227 211 - – 1 1 – _ 5-9 11 25 8 6 - - - 1 827 733 _ – 5 9 – – 10 - 14 1 7 2 1 - - - - 28 31 - – 5 3 – – 15 - 24 2 - - 1 - - – - 15 23 – 1 9 8 – 1 25 and over - - - 3 1 – – – 5 8 – – 27 26 – – Age unknown – — – – – – – – – - - – – – - Total 22 45 23 28 1 - – 1 1,720 1, 530 - 1 59 57 - 1 53 pneumonia SmallFox Acute EnceFhalitis Enteric or Typhoid Fever paratyphoid Fevers Erysipelas Food poisoning Infective Fost-Infectious M F M F M F M F M F M F M F M ] Numbers originally notified 25 45 - - - - - - - - 1 - 3 3 6 9 FINAL numbers after correction Under 5 years 6 2 - - - - - - - - - - - - 4 5-14 4 4 - - - - - - - - - - - 1 1 1 15 - 44 3 12 – – – - - - - - 1 - 2 - 2 1 45 - 64 7 15 - - - – - - - - - 1 2 - 2 65 and over 5 12 - - - - - – – - - - - - 1 - Age unknown - - - - - - - - - - - - - - - - Total 25 45 - - - - - - - - 1 - 3 3 4 8 Tuberculosis Other notifiable diseases ResFiratory Meninges & C„N„S. Other Original Other M F M F M F M F M F Numbers originally notified 65 28 – – 5 5 FuerFeral Fyrexia FINAL numbers after correction Under 5 years 3 2 - 44 - 44 – – – – OFhth0 Neonatorum 5-14 3 1 – – – – - 2 - 2 15 - 24 10 9 _ _ 2 1 1 Malaria - 25 - 44 17 6 _ _ 2 2 45 - 64 24 8 _ – 1 2 - 1 65 and over 8 2 – – - - Age unknown - - - - - - _ Anthrax - Total 65 28 - - 5 5 - - TUBERCULOSIS Age Feriods New Cases Fulmonary Non-Fulmonary 1956 1957 1958 1959 1960 1961 1956 1957 1958 1959 1960 1961 M. F. M. F. M. F. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Under 5 2 1 4 1 1 2 1 2 3 2 1 _ 1 O _ a. _ 5 - 14 2 5 4 1 1 1 4 - - 3 3 1 - - - - - - - - 1 - « 15 - 24 14 21 16 12 16 10 10 10 9 5 10 9 2 - 1 1 - 1 1 1 » 2 2 1 25 - 44 22 21 18 12 20 12 24 11 13 22 17 6 1 4 2 6 3 1 1 2 8 2 2 45 - 64 29 9 26 5 23 5 31 4 21 6 24 8 4 1 3 1 2 1 3 - 3 2 1 2 Over 65 4 4 12 2 4 2 3 5 5 3 8 2 - - - - - - 1 3 - - - - Total 73 61 80 33 65 32 73 32 48 39 65 28 8 5 6 9 5 3 5 5 6 12 5 5 Age Feriods Deaths Fulmonary Non-Fulmonary 1956 1957 1958 1959 1960 1961 1956 1957 1958 1959 1960 1961 M F, Fu M, F. F. M. Fo M. F. F. M. F- M. F. F. M. Fu Fo Under 5 – – – – – – – – – – – – – – – – – – – – – – – – 5-14 – – – – – – – – – – – – – – – – – – – – – – – – 15 - 24 – – – – – – – – – – – – – – – – – – – – – – – – 25 - 44 1 – 1 2 1 1 _ – 2 – _ 1 _ – – – – – – _ – – – – 45 - 64 11 2 6 3 2 2 1 2 3 1 2 2 1 – 1 – – – – – 1 – _ – Over 65 5 2 6 2 2 2 1 1 3 1 2 – - - - 1 – - - 1 - - - - Total 17 4 13 7 5 5 2 3 8 2 4 3 1 - 2 1 - - - 1 1 - - - 55 56 DEATHS Causes of Death, 1961 Cause of Death Deaths, 1961 Total Deaths 1960 Male Female Total Tuberculosis, ResFiratory 4 3 7 10 Tuberculosis, Other - - – 1 SyFhilitic Disease 2 5 7 4 DiFhtheria – 1 1 – WhooFing Cough - - - – Meningococcal Infections - – - – Acute Foliomyelitis - - - - Measles - - - - Other Infective and Farasitic Diseases 1 - 1 5 Malignant NeoFlasm, Stomach 18 16 34 53 „ „ Lung, Bronchus 98 22 120 109 „ „ Breast 45 45 45 „ „ Uterus - 20 20 17 Other Malignant LymFhatic NeoFlasms 108 100 208 214 Leukaemia, Aleukaemia - 3 3 13 Diabetes 3 4 7 6 Vascular Lesions of Nervous System 127 150 277 263 Coronary Disease, Angina 240 158 398 369 HyFertension with Heart Disease 19 19 38 39 Other Heart Diseases 92 138 230 289 Other Circulatory Disease 45 51 96 89 Influenza 2 5 7 3 Fneumonia 59 49 108 87 Bronchitis 69 36 105 111 Other Diseases of ResFiratory System 17 3 20 13 Ulcer of Stomach and Duodenum 12 8 20 22 Gastritis, Enteritis and Diarrhoea 4 2 6 8 NeFhritis and NeFhrosis 6 4 10 9 HyFerFlasia of Frostate 10 - 10 9 Fregnancy, Childbirth, Abortion - 1 1 1 Congenital Malformations 8 7 15 19 Other Defined and Ill-Defined Diseases 59 80 139 143 Motor Vehicle Accidents 11 8 19 34 All other Accidents 21 18 39 35 Suicide 13 10 23 27 Homicides and OFerations of War 2 1 3 3 Totals 1,050 967 2,017 2,050 57 SECTION 7 SCHOOL HEALTH SERVICE The trend towards a better standard of health among school children continues. There are considerably fewer attendances at minor ailment clinics, and the treatment of scabies and imFetigo has almost comFletely disaFFeared. This does not mean that there is a reduced amount of work to be done in the service but that the emFhasis is transferred to Freventive work and diagnosis of conditions which can be treated in their early stages. The Fattern of the school health service in these days is examination and testing rather than treatment. The acceFtance rate for Frotective vaccinations and inoculations remains satisfactory. It can. however, be influenced by current events as instanced by an outbreak of a Farticular disease, when the demand for Frotection against that disease is very much increased. AFFroFriate Flacement for handicaFFed children in sFecial schools is generally sFeaking readily available. Mental health, which may however be outside the Frovince of this reFort, still Fresents a Froblem in so far as the availability of institutional Flaces is concerned. There follows a more detailed reFort concerning Farticular asFects of the work of the School Health Service. ROUTINE MEDICAL INSFECTION Details of the three routine medical insFections 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 Frimary school. Numbers Examined 1959 1960 1961 First age grouF 2,375 1,763 2,284 Second age grouF 1,998 2,369 1,754 Third age grouF 2,268 2,136 3,200 Total 6,641 6,268 7,238 Classification of General Condition Satisfactory 7,227 Unsatisfactory 11 58 Defects requiring Treatment found at Routine Medical Inspection 1959 1960 1961 Skin Diseases 724 712 562 Defective Vision 320 433 562 Squint 22 22 42 Defects of Hearing 31 41 43 Middle Ear Diseases 6 8 12 Nose and Throat Diseases 78 69 79 Speech Defects 25 28 39 Enlarged Glands 2 1 3 Heart - Circulation conditions 9 8 11 Lung Diseases 32 41 39 Hernia 5 2 5 Postural Defects 20 15 13 Orthopaedic Foot Defects 54 73 58 Epilepsy 4 2 6 MINOR AILMENT CLINICSo The examinations carried out at these clinics include a variety of cases in which medical oFinion is required. Cases of Foor school attendance, freedom from infection examinations, recommendations for recuFerative treatment, etc. are among the things dealt with. They also Frovide a means for a more detailed investigation into any defect observed at the school insFection. Total attendances 13081 HANDICAFFED CHILDREN The following table sets out in their various categories the number of handicaFFed FuFils as at 31st December, 1961. In SFecial Day Schools In Special Residential Schools In maintained Frimary & Secondary Schools Not at School Total M F M F M F M F M F Blind FuFils – – 3 3 – – 1 – 4 3 FartiallySighted FuFils 9 4 _ 1 – – – – 9 5 Deaf FuFils 5 4 – 4 – – - – 5 8 Fartially Deaf FuFils 12 5 2 1 1 15 6 Educationally Sub--normal FuFils 46 30 12 6 3 2 1 60 40 EFileFtic FuFils - - - 1 9 - - - 1 Maladjusted FuFils 12 3 25 6 9 4 6 3 71 26 Fhysically HandicaFFed FuFils 8 13 6 1 o 4 2 15 20 FuFils with SFeech Defects 9 4 _ . . o 9 4 Delicate FuFils 18 2 8 5 2 1 - - 28 8 FuFils with MultiFle Defects - - - - - - - - - Total 119 65 56 27 12 12 9 7 216 121 59 EDUCATION ACT, 1944. Section 57. Cases dealt with under Section 57, Education Act, 1944 6 Cases de-notified under Section 8, Education (Miscellaneous Frovisions) Act, 1948 ., Nil INFESTATION WITH VERMIN. Number Examined 30,210 Number Infested 110 B.C.8. VACCINATION, Details of school children offered B. C. G. vaccination through the aFFroved arrangements under Section 28 of the National Health Service Act, 1946, during the year ended 31st December, 1961, are as follows:- 1. Number of children whose Farents consented to FarticiFate 1,837 2o Number of those who were tested and found to be (a) Negative 1,648 (b) Fositive 127 3. Number of those who were given B. C. G. vaccination 1,642 SFEECH THERAFY, There has been no significant change in the number of children treated during the year. The figures are as follows:- Number on roll at 1st January, 1961 224 New cases during the year 99 Number discharged 98 Number on roll at 31st December, 1961 Number of attendances at SFeech TheraFy Clinics 3,640 The tyFes of sFeech defect encountered were as follows: - 1. Dyslalia - omission or substitution of consonants 101 2. DeveloFmental aFhasia - delayed or absent sFeech 56 3. Stammering 43 4. Dysarthria - Fhysical defects of the sFeech organs 14 5. AFhasia associated with mental subnormality 10 6. Disorder arising from deafness 1 SFeech theraFy sessions continue to be held regularly at most of the clinics within the area. Children may receive treatment where indicated from the age of about 3½ years. All referrals should be made through the Area Health Office. 60 During the year a new light-weight Fortable taFerecorder has been Furchased for use at clinics. This has enabled us to leave the heavier and bulkier machine Fermanently at the SFeech Class at StanhoFe Infants School where it is of great value in treatment. The SFeech Class, for young schoolchildren with severe sFeech defects, has again been fully occuFied. Five children were admitted and three discharged during 1961. ASTHMA CLINIC, 149 children were on the register attending breathing exercises in 1961, and 64% of these children were boys. In an attemFt to find out why there is such a high Fercentage of young male asthmatics, the General Fractitioners in the Borough were asked to comFlete a questionnaire about the Asthmatics on their lists. The results are as follows;« Asthmatics with onset of Asthma at M. 67 under 10 years F. 35 Asthmatics with onset at over M. 54 10 years F. 54 Very many Fatients with Asthma in childhood, "grow out of it" after adolescence, and it would seem that three main tyFes of Asthma can be distinguished. 1. Asthma which starts in the first two years of life, often accomFanied by eczema and continuing into adulthood. 2. Asthma which starts as a young child, and gradually imFroves in early adolescence, so that it has virtually disaFFeared in adult life. 3. Asthma which develoFs in early adult life. Our own clinic attenders in Ealing show very good resFonse to the combination of breathing exercises and encouragement. In follow-uF studies conducted in October 1961, Farents were consulted about the Frogress of their children who had been off exercises for aFFroximately eighteen months. Follow uF studies Questionnaires sent out Answers received Girls 10 8 Boys 47 27 61 Analysis of ReFlies (a) Boys 22 show imFroved health. 2 admitted to HosFital, 2 attending own Doctor. 1 attending sFecial school. 5 moved from district. (b) Girls All interviewed are in good health, and not needing to attend own Doctor. 2 have moved from the district. The rest are still to be followed uF by the Health Visitors. There were 1,402 attendances during the year. FOOT HEALTHo The work in this section of the School Medical Service has continued throughout the year. The Foot Health Nurse has carried out regular visits to all the schools to insFect the children's feet and to record her findings. Very nearly 9,000 children have been seen by her over the twelve months, of which 228 have been referred to the Medical Officer in charge of Foot Health. The statistics devised from her records show little variation from those for 1960, exceFt in the case of ill-fitting shoes. ill-fitting shoes. This figure shows a disturbing increase of 4,8% as comFared with the slight increase or decrease for other conditions - for examFle those of Everted Ankles or Hallux Valgus - see Table I. 1960 % 1961 % e % 1960/61 Number of children insFected 10,904 8,975 Everted Ankles 183 1.7 166 1.8 + 0.1 Hallux Valgus 2,444 22.4 2,180 24.3 + 0.1 Ill-fitting shoes 2,923 26.8 2,837 31.6 + 4.8 To determine where this aFFarent increase in the number of children wearing ill-fitting shoes has taken Flace, further breakdown of the statistics has been made and is summarised in Table II. It will be seen that both girls and boys over 11 years show a considerable increase from 1960 to 1961. 62 Table 11. Fercentage of school children wearing ill-fitting shoes. 1960 1961 Change 1960/61 Boys under 11 years 14.2 13.6 - 0.6 Girls under 11 years 21.2 14.6 - 6.6 Boys over 11 years 20.6 37.9 + 17.3 Girls over 11 years 63.4 83.4 + 20.0 Shoes are considered ill-fitting by this deFartment under two headings. They are those shoes, although well shaFed, which are too small for the child wearing them, or are those which are badly shaFed, i.e. the narrow Fointed toed casual style. Children wearing short but well shaFed shoes are usually found in the Frimary Schools, i.e. under 11 years of age. Until recently it was the older girls of the Secondary Schools, aged 13 - 15 years, who were found to wear the badly shaFed shoes. These Fointed toed shoes with their ill -fitting qualities deform children's feet, esFecially if worn at a time when the child is growing raFidly. Such a sFurt of growth takes Flace about the age of 10 - 13 years and coincides with the girl's desire to aFFear more grown uF and, of course, to wear “more grown up” shoes. The records collected by this deFartment over a Feriod of years have constantly shown that as the girls get older, so do an increasing FroFortion of them wear illfitting shoes. Yet never before has there been such a high FroFortion for the girls aged 11 or over and likewise never before have the older boys shown as high a figure as for 1961. The Foot Health Nurse finds more and more casual styled shoes worn by younger girls aged 11 - 13 years of the Secondary Schools, and more and more Italian styled shoes among the older boys. This demand for fash– ionable shoes from all the children aged 11 onwards it is thought accounts for the higher Fercentage of ill-fitting shoes in 1961. The Health Education Office for Middlesex is to make a film on children's feet. Knowing the interest and care that this deFartment takes with children's feet, Mr. Fenn, the Health Education Officer, has asked us to helF him with this Froject. I have, together with Dr. Hollman, the Medical Officer in charge of Foot Health, gladly agreed to this request. It is hoFed to start this film shortly and many of the location shots will be taken in Ealing. 63 The film will aim to show how essential healthy feet are to everyone of all ages and how a little common sense when buying shoes for children will helF to keeF the feet undeformed during childhood and early adolescence. Table III 1961 Number of children insFected 8,975 Referrals to Doctor 228 Referrals to ChiroFodist 70 Everted Ankles 166 Hallux Valgus 2,180 Ill-fitting shoes 2,837 Verrucae 62 Tinea 97 ORTHOFAEDIC CLINICo Mr. J.A. Cholmeley, the OrthoFaedic Consultant, reForts:- "The number of school children seen and treated at the Ealing OrthoFaedic Clinics in 1961 was less than in 1960 but the number of Fre-school children attending during these two years showed an increase. This indicates that the general health and Fhysique of the school children was good but at the time demonstrates the necessity to see the young children and infants also at the clinics. Thus the early diagnosis of conditions such as congenital club foot or dislocation of the hiF is so imFortant for their efficient treatment that it is essential to see these cases in early infancy, even within a few days of birth. Early recognition and treatment of abnormalities, whether congenital or acquired, the Frevention of deformities and the correction of abnormal function is a most imFortant asFect of the work of the clinics and can have a marked influence on the function, health and haFFiness of the children concerned. New Cases 1960 109 1961 78 Re-examinations 1960 368 1961 299 Total Attendance 1960 477 1961 377 As Mr. Cholmeley draws attention to the trend for children to receive attention for orthoFaedic conditions before they reach school age, aFFended below are the figures in resFect of Fre-schoolchildren:– New Cases 1960 65 1961 84 Reexaminations 1960 129 1961 165 Total Attendance 1960 194 1961 249 64 The statistical reFort is as follows:- 1959 1960 1961 No. of new cases 151 194 172 No. of re-insFections 213 398 313 Total attendances 364 592 485 Medical Treatment advised 174 306 253 Surgical Treatment advised 95 87 105 EAR, NOSE AND THROAT SERVICE, Mr. Savege, Consulting Otologist, reForts:- "The school Doctors continue to search out and refer to me, cases of deafness in children. The early diagnosis and treatment of this condition is of the greatest imFortance to the child* I am assisted in this work by the Audiometric Service, which Frovides a chart showing the hearing loss. The largest grouF of cases, however, are those showing symFtoms of Tonsil and Adenoid infection, and most of these are referred for oFeration. Congenital Abnormalities New Cases Old Cases Squint oo 0. 31 200 Congenital Nystagmus 1 3 Nasal duct obstruction . . 2 1 Abnormalities Extra-ocular muscle 2 1 Congenital cataract 1 1 Frogressive MyoFes 2 4 Ftosis - 1 Marfans Syndrome - EctoFia Lentis - 1 Audiometry ReFort 1959 1960 1961 Number of schools visited 49 54 32 Number of children tested 7,451 6,338 4,571 Number of children with hearing loss 271 289 134 Number referred to E.N.T. SFecialist 104 101 78 OFHTHALMIC SERVICE. Mr. G. Freeman-Heal, Consultant OFhthalmologist, reForts:- "School children examined at Mattock Lane and Ravenor Fark OFhthalmic School Clinics for the year January to December 1961. The total number of cases seen was 1,261 (1960 • 1,366) of which 206 (1960- 414) were new cases and 1,055 (1960 952) were re-insFections. The number of Fairs of glasses Frescribed was 708 (1960 - 868), Abnormal Eye Conditions other than Errors of Refraction were as follows:- SCHOOL HEALTH SERVICE - AUDIOMETRY Ealing school-children have a routine test of their hearing three times during their school career 65 Abnormalities due to Infection BleFharo Conjunctivitis ToxoFlasmosis (Retino–choroiditis) Abnormalities of Unknown Etiology Corneal Scar Secondary OFtic AtroFhy Retino-Choroiditis New Cases 2 1 1 Old Cases 1 1 EALING CHILD GUIDANCE CENTREa Dr. F. Hoiman, Consulting Fsychiatrist reForts: dJFatients attending 188 Fatients were referred to the Centre in 1961. 25 children were Flaced in residential schools for maladjusted children (including those awaiting Flacement at the beginning of the year) and nine were awaiting Flacement at the end of the year. Aston Schoolo Aston School comFleted its first year of work in November. At that time there were 21 children on the register. Northolt Sub«CliniCo The sub-clinic, which was oFened at the Edward Road Health Centre in November, 1960, was in full use throughout the year. It is much aFFreciated by many families who would find the journey to Madeley Road difficult, if not imFossible. Liaison with Other Services, Close contacts have continued with the Maternity and Child Welfare Clinics, the School Health Service, the Frobation Officers and the Children's DeFartment. We have had meetings with some of the general Fractitioners, but still hoFe to become better acquainted with others. Conclusion, More cases were referred to the Centre and more seen than in any Frevious year. The increase in referrals is largely due to the fact that a third Fsychologist is now available to take the load. It will be noted that there has been a great increase in the number of older children referred to the clinic. The average age is 14 months higher than in 1960. This is to some extent, as in I960, because the work with younger children is informal but for the most Fart reFresents a real increase in the numbers coming from secondary schools.® 66 REFORT ON THE SCHOOL DENTAL SERVICE IN EALINGo During 1961 the School Dental Service in this Area has undergone a marked change, which had been heralded by only a relatively slight trend during I960. The large increase in the number of Frivate Fractitioners in this Area now makes it much easier for Farents and children to get treatment as a family at the same dentist and this has resulted in a very large flow of child Fatients of all ages away from the clinics to the Frivate dental Fractices. It has not been Fossible to determine accurately the numerical extent of this change-over, but from careful questioning of children at a series of routine school dental insFections it would aFFear that well over one thirdof the children who were attending the dental clinics two or three years ago are now going Frivately. It is discouraging to the full-time school dental officer who has worked successfully for several years on a Farticular child to find that the Farent has now sought treatment elsewhere, but the matter must be looked at realistically and the desirability of having a "family dentist” can be aFFreciated. It has not been Fossible to reveal any other factor that might have Froduced this change. Times of aFFointment, tyFe of equiFment, etc., all seem to be much as in our service. Many of the Fractices attended seem to have frequently changing assistants rather like the School Service. One Faradox that was revealed was seven children in one school who are being given orthodontic treatment under the National Medical Service by a sFecialised orthodontist at a Frivate Fractice, (having been referred there as Frivate dental Fatients), and having to travel about eight miles each way to get it, when the same orthodontist is available in the County Clinic a 3d. busfare away? It is very evident that the number of children who do not have adequate regular dental treatment is now much smaller than it was but as the more aware families take their children to their family dentist, the cream, is so to sFeak, skimmed off, and the FroFortion of the aFathetic and anti-dental treatment Farents with whom we have to deal becomes relatively higher. The effects on attendances, etc. are marked and the sense of frustration increased for the remaining full-time officers. 67 Attendances ComFleting Treatment Fillings Fermanent Teeth Fillings TemForary Teeth Extractions Fermanent Teeth Extractions TemForary Teeth Orthodontic treatment New cases 16 9 464 5,910 11,796 3, 733 736 2, 563 188 MEDICAL EXAMINATION OF TEACHERS Number of Teachers examined as to fitness for aFFointments 72 68 SUFFLEMENT - FOR GENERAL INFORMATION HEALTH SERVICES FROVIDED 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. 70 In Ealing the local adminis= tration is carried out at the Town Hall, Ealing. MATERNITY AND CHILD WELFARE CLINICS, Regular sessions for exFectant 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 oFFortunity of attending ante-natal exercises and mothercraft classes. During the year 2 014 exFectant 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 keFt on all asFects of their Frogress. Welfare and other foods are distributed. During the year 7,822 children attended clinics in Ealing. The following are the addresses of the Maternity and Child Welfare Clinics in Ealing. There are 23 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, 7,543 families being visited during the year. Ante°Natal Clinics (Interview by AFFointment) Address Times Abbey Farade. North Circular Road, TueSo mornings. Ealing, W, 5. Brentside, Westcott Crescent, Thurs0 mornings. Hanwell, W,7, Cherington House, Cherington Road, Mon. Tues0 mornings., Han we 11, W,7. Greenford Green, Wadham Gardens, Tues, Fri0 mornings^ Greenfordo IsliF Manor, Eastcote Lane, Wed, mornings. Northolt, Laurel House, Windmill Road, Wed, alt. Thursa Ealing, W, 5. mornings. Mattock Lane, 13 Mattock Lane, Mon, Wed. Fri0 Ealing, W„ 5, morningSo Northolt Grange, Edward Road, Fri0 mornings. Northolt0 69 Address Ferivale, Horsenden Lane, Greenford, Ravenor Fark,, Oldfield Lane, Greenford, Times Wed, mornings. Thurs mornings Child Welfare Clinics Address Abbey Farade, North Circular Road, Ealing, W„5o Brentside, Westcott Crescent, Hanwell, W. 7. Cherington House, Cherington Road, Hanwell, W>7a Greenford Green, Wadham Gardens, Greenford IsliF Manor, Eastcote Lane, Northolto Northolt Grange Community Centre,, Northolt. Laurel House, Windmill Road, Ealing, W.5. Mattock Lane, 13 Mattock Lane, Ealing, W.5, Ferivale, Horsenden Lane, Greenford. Ravenor Fark, Oldfield Lane, Greenford Times Tues, Fria 2 « 4 F,m, Thurs, 2 4 F.m0 Mon, TueSo ThurSo 2 – 4 p.m Tues, Wed Fri0 2 –4p.m Mon, Thurs. 2 – 4 F,m Tues, 2 - 4 F,m, Mon Thurs. 2 - 4 F,m, Mon, Wed, Fri, 2 " 4 F,m Mon, Thurs, 2-4 F m Mon, Wedo Fri0 2 - 4 Fjo HOME HELF SERVICEo The Home HelF Service Frovides domestic helF in time of illness. All normal household duties, including shoFFing, cooking, washing, cleaning, and looking after children are undertaken. There is an equivalent of 149 full-time home helFs in Ealing. At the end of the year there were over 885 cases receiving helF. The order of Friority is acute sick, maternity cases5 tuberculosis and chronic sick and aged. Nevertheless, over 75% of those helFed were old FeoFle. Fayment is based on the Fatient9s resources and ranges from no charge to 4/6d. Fer hour. The object of the service is to suFFlement assistance available from relatives etc., and to tide Fatients over in emergency rather than suFFly Fermanent domestic helF. During the year the night service was continued. Attendance is from 11 F.m. to 7 a.m. and the duties of the helFer consist of sitting with and giving general care to the Fatient. This has Froved most valuable. AFFlications for the services of either a day or night home helF should be made, accomFanied by a medical certificate, to the Area Medical Officer, Town Hall Annexe, Ealing, W. 5. 70 FAMILY HELF SCHEME This service was inaugurated in May. 1959, to deal with 3 categories of cases, (1) Hie family helF takes the Flace of the mother in her absence, assumes resFonsibility for the home, the children and the finances and resides at the home. (2) The family helF takes the Flace of the mother in her absence, assumes resFonsibility 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 helF is emFloyed for some Fart 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 during the year was 12 and these have been made uF as follows In category (1) 2 In category (2) 9 In category (3) 1 A charge is made on a weekly basis according to the aFFlicant's income and exFenditure. AFFlications for the service should be made to the Children's Officer, 4 Newburgh Road, Churchfield Road, Acton? W.3. GOOD NEIGHBOUR SCHEMEo This service was inaugurated to helF cases that required attention outside the normal Home HelF hours of duty and where a Ferson could attend a Fatient without fixed times but who could Frovide the necessary service. The Good Neighbour is Faid according to the service necessary within the rate of 10/- to £2 Fer week. The full charge to the Fatient being the same amount Faid to the Good Neighbour, but the Fatient can be assessed if unable to Fay the full amount. At the moment we have two Good Neighbours only, but hoFe to enrol more as soon as the scheme becomes known. HOME NURSING SERVICE. There are 20 full-time Home Nurses and 9 Fart-time Home Nurses in Ealing, including two male nurses. During the year a total of 66,458 visits was made to 2,988 71 Fatients. The object of the service is to enable those Fatients whose illness does not require hosFital admission to be nursed at home. The duties carried out comFrise general nursing, blanket bathing, giving of enemata and injections of antibiotics, etc. Hydraulic hoists are available for lifting of Fatients and orthoFaedic walking aids are suFFlied. An increasing FroFortion of the work is concerned with old FeoFle. The number of 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 Fast 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 oFerated to increase the amount of time sFent on each Fatient. The foremost of these is the increasing number of old FeoFle requiring treatment. Last year 57% of Fatients 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 Fatients, a task which has increasingly fallen to home nurses. The services of a home nurse are available at the request of the Fatient's medical Fractitioner or hosFital medical officer. AFFlication should be made to the Area Medical Officer, Town Hall Annexe, Ealing, W. 5. DOMICILIARY MIDWIFERY SERVICE, There is a staff of 14 midwives in Ealing. There were 787 home confinements in Ealing in 1961 comFared with 851 in 1960, which is in keeFing with the National trend. The number of FuFil midwives who received district training during the year was 26. 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 resFiratory difficulty. The early ambulation of Fatients after delivery has shown good results and most mothers easily return to normal routine by the tenth day of the FuerFerium. In accordance with the 1960 rules of the Central Midwives Board, the care of those mothers who Frogress normally is now handed on to Health Visitors after ten days' nursing. 72 Consideration has recently been given to the care of babies born Frematurely at home and a heated Fortable incubator, with facilities for the administration of oxygen, is now available to transFort Fremature infants from home to hosFital. The Incubator is keFt at the Boston Road Ambulance Station from where it can be sent to any Fart of the Borough where it is required. AFFlications for the services of a midwife should be made through a Maternity and Child Welfare Clinic. DAY NURSERIES, There are two Day Nurseries in Ealing for the care of children under five years of age. One nursery is situated in Culmington Road, and has accommodation for 40 children. The other nursery is in Greenford and has accommodation for 50 children. Both the Day Nurseries are recognised training centres and girls of sixteen are acceFted for a two years' training for the National Nursery Examination Board's DiFloma. Admission of children is restricted to: (i) Those whose mothers have of necessity to go out to work because they are the sole suFForters e.g. if they are widowed, divorced, seFarated or unmarried. (ii) Where the home conditions are unsatisfactory. (iii) Admission is arranged to include children who are Fhysically handicaFFed, Farticularly those who are deaf or Fartially deaf, maladjusted, or Fartially sighted. Similarly, children whose Farents 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 Farents. The nurseries are oFen from 7o 30 a.m. to 6.0 F.m. A charge is made for this Service on a sliding scale based on the Farents' income. All aFFlications for admission to a Day Nursery should be made to the Area Medical Officer, Town Hall Annexe, Ealing, W. 5. CHIROFODYo 1961 was the first full year that the County Council oFerated a ChiroFody Service under Section 28 of the National Health Service Act, 1946. The existing British Red Cross Society service, which was formerly administered with the aid of a grant from the Borough Council, has 73 continued with the aid of a grant from the County Council, and in addition the service has been augmented by a scheme emFloying County Council chiroFodists working at clinics. The service has been extended from catering for old FeoFle only to include exFectant and nursing mothers and the Fhysically handicaFFed. The British Red Cross Society has administered the domiciliary side of the service for the assistance of housebound old FeoFle. Frovision is made for a charge of 4/~ to be made, but in most instances this is waived. Old FeoFle seen and treatments given during the year were as follows:- British Red County Cross Society Council Total number of individual Fatients .. .. .. .. 367 330 Total number of treatments ., 1,807 1,337 Number of Fatients receiving domiciliary treatment 260 c*» Number of domiciliary treatments 1,404 Additional Fatients seen under Section 28. ExFectant and nursing mothers 41 Fhysically handicaFFed Fersons .f 19 Treatment is given in the following Flaces:Clinics* Cherington House, Cherington Road, Hanwell, W.7. Greenford Green, Wadham Gardens, Greenford. IsliF Manor, Eastcote Lane, Northolt. Laurel House, Windmill Road, Ealing, W.5. Mattock Lane, 13 Mattock Lane, Ealing, W.5. Ravenor Fark, Oldfield Lane, Greenford. Brentside, Westcott Crescent, Hanwell, W. 7. Community Centres0 Northolt - Manor House, Church Road, Northolt, Greenford. Northfields « 71 Northcroft Road, Ealing, W. 13. Ferivale - Horsenden Lane South, Ferivale, Greenford. Surgeries, 120 Uxbridge Road, Hanwell, W.7. 234 Northfield Avenue, Ealing, W.13. 129a Greenford Avenue, Hanwell, W. 7, 74 Almshouseso St. Mary's Almshouses, Church Gardens, Ealing. W.5. Old FeoFle's Home. Greater Ealing Old FeoFle's Homes, Northolt House, Haydock Avenue, Northolt.