439(1) The Health of Ealing in the year 1963 EAL 54 The Health of Ealing in the year 1963 being the ANNUAL REPORT of the Medical Officer of Health I. H. SEPPELT, M.A., M.B., B.Chir., D.P.H., Medical Officer of Health Town Hall Annexe, Ealing, W.5 Telephone: Ealing 3030 EALING'S FIRST ANNUAL REPORT, 1874 INDEX Section 1 INFECTIOUS DISEASES 7 Section 2 ENVIRONMENTAL HEALTH OF THE BOROUGH ... 11 Section 3 PUBLIC HEALTH INSPECTION 29 Section 4 OLD PEOPLE'S WELFARE 43 Section 5 GENERAL 48 Section 6 STATISTICAL TABLES 50 Section 7 APPENDIX: REPORT ON SCHOOL HEALTH SERVICE 57 Supplement FOR GENERAL INFORMATION 69 PUBLIC HEALTH COMMITTEE Chairman—Councillor R. R. Clay Vice-Chairman—Councillor J. T. Bartlett Alderman Mrs. D. Gundry, j.p. Alderman Mrs. E. M. Stephens, m.a. Councillor J. J. Allsopp Councillor J. F. Barlow Councillor E. R. Bennett Councillor C. G. J. Emmins Councillor C. L. Gardner Councillor J. T. C. Hancock Councillor H. R. Hayselden Councillor A. W. Morbey Councillor H. P. Parcell Councillor P. W. Parke Councillor A. W. Surry Councillor Mrs. D. I. Williams STAFF OF THE PUBLIC HEALTH DEPARTMENT I. H. Seppelt, m.a., m.b., b.chir., d.p.h. ... I. O. Taylor, m.a., m.r.c.s., l.r.c.p., d.p.h. A. E. Pooley A. C. Bamping E. H. Evans C. W. Baxter E. W. Budd G. O. Axon N. V. Saunders L. E. Bowskill J. A. Crisp W. M. Macphail A. S. M. Pratt, Barrister-at-Law Miss D. E. McKenzie D. E. Storr D. R. A. Smith R. S. Leggatt Miss S. Fox N. M. Colwell Mrs. M. G. Byford Mrs. D. Barker Miss C. Stevens M. L. Aldridge A. Franklin R. S. Cox R. Lazzolo F. Bedley L. B. Radford E. Sheldrick Medical Officer of Health Deputy Medical Officer of Health Chief Public Health Inspector Deputy Chief Public Health Inspector Public Health Inspector 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 Chief Administrative Assistant (Part-time) Secretary to Medical Officer of Health Senior Clerk Clerk 99 99 99 Clerk and Shorthand Typist Clerk and Typist Shorthand/Typist Trainee Public Health Inspector 99 99 99 99 Assistant Rodent Officer Rodent Operative 99 99 Driver/Disinfector 99 99 4 Mr. Mayor, Aldermen and Councillors, In compiling my first Annual Report on the health of the Borough I felt it would be interesting and profitable to look back at the first Reports of my predecessors and I found this indeed to be the case. In 1874 Ealing, then with a population of 11,500 appointed Dr. C. A. Patten its first full-time Medical Officer of Health. Great prominence is given in his report to sewage disposal and water supply, subjects which are referred to in mine, but only in passing. The state of the drainage in parts of the Borough is referred to as "giving rise to considerable apprehension and alarm", whilst attention is drawn to the need for a water supply in which the population of the Borough could have full confidence. The infant mortality rate which then, as now, is taken to be one of the main indices of the state of the public's health was 114 per thousand live births, a figure regarded with satisfaction. By 1915. which was the year for which Dr. Thomas Orr submitted his first Report emphasis had shifted from the need to remedy defects of sanitation towards the need for the organization of personal health services. Dr. Orr reported that in response to the request of the Local Government Board that Local Authorities should formulate schemes for a comprehensive Maternity and Child Welfare Service he had included such a scheme in his report. In the following years this was the pattern that was, in fact, followed, and which has developed into the services in the Borough today. Dr. Orr recorded the infant mortality rate as 64 per thousand live births. Dr. W. G. Booth was appointed in 1948 and like myself was faced with widespread impending changes in Local Authority Health Services. In his case they were brought about by the National Health Service Act and were in the direction of reducing Ealing's powers in the field of health services and were consequently deplored. In my case they are brought about by the London Government Act, which aims to make Local Authority Health Services local. This is a prospect which I welcome, giving as it does an opportunity to co-ordinate the health, welfare, children's and housing services under one Council. Dr. Booth recorded the infant mortality rate as 26 per thousand live births. In my Report prominence is given to smoke control, food hygiene the care of old people and the multiple occupation of houses. The Borough's progress in smoke control is proceeding satisfactorily. I consider this a most worth-while measure of preventive medicine and it is to be hoped that the absence of large scale "smog" in recent years does not result in any decline in official or public enthusiasm for this measure. In the vital field of food hygiene Ealing's Clean Food Scheme has proved a model for many others, both in this country and abroad. It has met with considerable success, but this in no way allows for any relaxation of effort, indeed the campaign must be intensified. Within the powers available, Ealing has been one of the most progressive Boroughs in the country in its endeavours to provide old people with the high standard of service which they deserve. In this connection I would like to draw attention to the great help that the voluntary organizations in the Borough have so willingly given. 5 The multiple occupation of houses, which were never designed for the purpose, presents perhaps the most intractable health problem in Ealing, as much of the property in the Borough is a type which lends itself to such mis-use. Inspection of these premises is extremely time-consuming and requires expert staff which is never in plentiful supply. The solution lies in there being a real determination to overcome this problem combined with the most economical use of professional staff that can be arranged. My predecessors each reported a greatly reduced infant mortality rate. The figure last year in Ealing was 18.6 per thousand live births and I report it, I hope, as a figure only to be further reduced. Your obedient servant, I. H. SEPPELT, Medical Officer of Health. 6 SECTION 1 INFECTIOUS DISEASES CONTROL The diseases notifiable under the Public Health Act, 1936 are smallpox, cholera, diphtheria, membranous croup, erysipelas, scarlet fever, typhus, typhoid, enteric and relapsing fever. The Minister of Health has also made regulations under this Act whereby the following diseases are notifiable: plague, poliomyelitis, tuberculosis, puerperal pyrexia, ophthalmia neonatorum, malaria, dysentery, acute primary pneumonia, acute influenzal pneumonia, measles, whooping cough, acute encephalitis and meningococcal infection. Food poisoning is notifiable under the provisions of the Food 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 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. The problem posed by many of these conditions in the past is now much reduced, smallpox and diphtheria for example, have become a rarity, largely due to immunization, whilst scarlet fever, although still very prevalent, the type of disease now encountered bears no relation in severity to that experienced in the early part of this century. Tuberculosis has yielded to the attack of improved living conditions and chemotherapy, leaving only a hard core of cases, whilst poliomyelitis, although still able to cripple, has shown a steady decline since the introduction of immunization in 1957. Less satisfactory has been the decline in those conditions caused by faulty food hygiene and it is hoped that continued campaigning for improved standards of food hygiene will result in the near future in a reduction of gastro-enteritis of all types. In contrast to the reduction in the incidence and severity of many diseases, the great increase in international travel and its speed has produced problems of its own. This is particularly so in Ealing, where holiday makers and immigrants often spend their first few days after entering the country through London Airport. In the event of their being contacts of an infectious disease this entails a considerable amount of work in tracing them, surveillance and finally clearing them of infection. Although this is time consuming work it is an essential protective measure. DIPHTHERIA There were no cases to report. DYSENTERY Notifications showed an increase over the previous year, from 90 in 1962 to 199 in 1963. 7 ERYSIPELAS Six cases were notified. FOOD POISONING There were nine cases. In three the causative organism was Salmonella typhimurium, in one Salmonella enteritidis and in one Salmonella anatum. In the remaining four the agent was not identified. MALARIA There were no cases. MEASLES 1963 was a high incidence year and there were 2,072 notifications compared with 286 in 1962 and 3,250 in 1961. MENINGOCOCCAL INFECTION Only one case was notified. OPHTHALMIA NEONATORUM There were no cases. TYPHOID FEVER One case was confirmed in a boy of 14 years who returned with his family from a holiday in France and Spain. Laboratory investigation of other members of his family was negative. In addition arrangements were made during the year for the surveillance and laboratory investigation of a number of Ealing residents who had been in Zermatt at the time of the outbreak there. Fortunately none of these developed typhoid and laboratory investigation excluded them from being carriers. PNEUMONIA 97 cases were notified compared with 69 in 1962. POLIOMYELITIS One case was notified by a hospital. This was a boy of eight years who was diagnosed on clinical grounds only, having weakness of the muscles of one leg. PUERPERAL PYREXIA There were 57 notifications. With the exception of six all occurred in hospitals. SCARLET FEVER There were 76 notifications. 8 SMALLPOX There were no cases during the year, but there were three incidents which resulted in contacts from the East requiring services by the Health Inspectors. Three people arrived at London Airport from Karachi on the 22nd April having been in contact with a suspected smallpox case. All three had been vaccinated and were kept under surveillance. Two people arrived by air from Cairo, an endemic smallpox area. One had not been vaccinated and this was done during the time both were kept under surveillance. An employee of Ghana Airways arrived at London Airport from Cairo having lost his Vaccination Certificate. At our request he was revaccinated. TUBERCULOSIS There were 89 pulmonary notifications (61 male and 28 female) compared with 70 in 1962 (46 male and 24 female). Non-pulmonary notifications consisted of five male and six female against six female in 1962. WHOOPING COUGH There were 93 notifications. IMMUNIZATION Immunization is provided in clinics and by general practitioners in the area against the following diseases: Diphtheria Whooping Cough Tetanus Poliomyelitis Smallpox In addition immunization against tuberculosis is offered to 13-year-old school children, details of which are included in the report on the School Health Service. The schedule of immunization used in Ealing clinics is:— Age Vaccine Interval 3 months Triple antigen (Diphtheria Whooping Cough Tetanus) Four weeks or more 4 months Triple antigen Four weeks or more 5 months Triple antigen Four weeks or more 6 months Vaccination against smallpox Four weeks or more 7 months Poliomyelitis—Oral Four weeks or more 8 months Poliomyelitis—Oral Four weeks or more 9 months Poliomyelitis—Oral 16 months Triple antigen School Entry Diphtheria and tetanus booster 9 During 1963 2,206 infants under the age of one year were immunized against diphtheria. This represents an approximate acceptance rate of 75% which is satisfactory. Vaccination against smallpox was carried out on 1,580 infants under the age of one year, being approximately 51 % of the total number. This is a sharp fall compared with 1962 and is accounted for by the fact that many general practitioners have postponed vaccination from the first until the second year of life. It is to be expected therefore that the drop in the numbers of vaccination will occur during this one year only. Vaccination policy at local clinics remains unchanged as shown in the schedule above. With regard to immunization against poliomyelitis, which is now almost always by means of oral vaccine, the position has remained satisfactory. 3,598 adults and children received the primary course during 1963 and by the end of the year 67,791 persons in Ealing had completed a course of immunization since the present scheme began. 10 SECTION 2 ENVIRONMENTAL HEALTH 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 54,909 dwellings with an estimated population of 183,120. Thirty-one samples were taken from supplies derived from wells at five factories in the Borough. In these factories water is obtained from deep borings ranging in depth from 300 to 600 feet. Of these 31 samples, 16 were found to be of satisfactory quality. The remaining 15 samples consisted of 10 unsatisfactory and five doubtful samples from two factories. In the case of one factory the pipe lines were thoroughly cleansed and subsequent samples proved good. In the second case lines were similarly cleansed, with one exception where the supply line was put out of use and the supply at this point discontinued. The 15 samples of water taken from supplies provided by the Metropolitan Water Board and the Rickmansworth and Uxbridge Valley Water Company, were from four houses in multiple occupation where water for drinking purposes and for domestic use was derived from storage tanks and not direct from the rising main. In each case where doubtful or unsatisfactory results were obtained it was apparent that storage tanks had become contaminated and required thorough cleansing and covering. In one case, where investigations had been commenced in 1962, the owner decided to connect a supply for drinking purposes direct to the rising main. In all the other cases satisfactory repeat samples were obtained when thorough cleansing of the tanks had been completed. Water Samples 1963 Samples Satisfactory Doubtful Unsatisfactory Wells Supply 31 16 5 10 M.W.B. Supply 14 8 2 4 R. & U.V.W. Co. 1 1 — — 46 25 7 14 During the year the Public Health Committee considered the situation regarding premises not supplied with drinking water from a rising main. Concern was expressed over the large number of properties where drinking water was obtainable only from 11 storage tanks. Certain Council owned properties were supplied with main supplies during the year at the request of the Committee, but unfortunately no legislation exists to enable the Local Authority to require provision of a drinking water supply direct from the main. The Committee therefore referred this problem to the Association of Municipal Corporations for consideration. FLUORIDATION OF WATER SUPPLIES Early in 1963 the Middlesex County Council informed this Council that they had submitted to the Minister of Housing & Local Government for his approval a proposal to make arrangements with statutory water undertakers in Middlesex for fluoride to be added to the public water supplies to the level appropriate for the prevention of dental decay. The Ealing Borough Council decided to raise no objection to the County Council's proposal. The relationship between fluoridation and dental decay was discovered by chance many years ago at Colorado Springs in the United States where it was noted that a high fluorine level in the water produced mottling of the teeth. Despite this mottling the incidence of dental decay was much reduced. The full significance of this observation was not realised until 1946 when surveys showed that a fluorine content of one part per million in the water supply reduced dental decay by 60 % without producing mottling of the teeth. The next step was to add fluoride to water which was naturally deficient in this element. This began in various areas of the United States of America and ten years later it was apparent that the rate of dental decay in these areas had been reduced to that of areas where the natural fluorine content of the water was high. In this country relatively few areas have water with a natural fluorine content as high as one part per million. Results of dental surveys in these districts are comparable to those found earlier in the United States. As a result of this observation and the report of a mission who visited the United States to study fluoridation schemes there, pilot schemes were started in Andover, Anglesey, Kilmarnock and Watford. Before fluoridation started in these areas a survey was made in various districts with widely differing fluorine content of their water to decide the optimum level of fluorine for this Country. It was found that Slough, where the water content is normally 0.9 part per million of fluorine, gave the best results in regard to the incidence of dental decay and it was therefore decided to adopt a figure of one part per million, as in America, for all schemes in this Country. Opposition to the introduction of fluoride schemes has always been determined and vocal. It may be sufficiently convincing to most people to state that the addition of fluoride to the public water supply has the approval in this Country of both the British Dental Association and the British Medical Association. This seal of approval has only been given after the most careful consideration of the relevant facts in the belief that there can be no ill effects produced but only benefit to the community by a major reduction of the incidence of dental decay. DRAINAGE AND SEWERAGE The soil sewerage from the Borough is all eventually treated at the West Middlesex 12 Drainage Works at Mogden. Surface water in most parts of the district is drained in a separate system and is discharged largely to the River Brent and to other water courses. There are still 21 premises not connected to the Council's sewers, but these premises are mostly situated in those small areas of the Borough not yet served by main sewers. PREVENTION OF POLLUTION OF THE RIVER BRENT The Brent enters the Borough at the boundary with Wembley and Willesden and leaves the Borough at its boundary with Brentford and Isleworth, thus in its course it roughly divides the Borough into two parts. Responsibility for the prevention of pollution of the river is shared between the County Council, who are responsible for the river itself under the Rivers Prevention of Pollution Act, 1951, and the Borough Council who are responsible for preventing contamination by surface water drains which enter the river, under the Public Health Act, 1936. In the case of the Brent, which before its entry in the Borough flows through industrial areas, the problem resolves itself into firstly by negotiation with the Councils of these areas to ensure that the water is clean as it enters the Borough and secondly by the action of our own Public Health Department to ensure that this state of affairs is maintained during its flow through the Borough. During 1963 the state of the water at the entry point has been much cleaner than in the previous year, when it was heavily polluted with waste oil. During the year inspection has continued in an attempt to trace and deal with unsatisfactory discharges from several water outfalls at various sites along its length. In the case of one meat processing factory, negotiations were commenced to secure satisfactory drainage to the soil sewer from a vehicle washing area where waste water and grease had formerly discharged to the surface water drainage system and thence into the river. In a second case surface water and waste water containing oil was found to be contaminating Costons Brook, a small tributary of the Brent at Greenford. The offending contaminating water is now to be diverted to the soil sewer, an improvement which should remove a source of pollution which has concerned the Department for a number of years. The results of samples taken by the County Engineer are reported to the Public Health Department. These are of two kinds, main river samples taken in mid-stream and samples taken direct from surface water sewer outfalls. It is this latter which is of particular help to us in determining wrongly connected drainage fittings causing discharges which can be corrected. Work in connection with river pollution is slow but the persistent efforts of the Inspectors of the Department over a long period continue to effect improvement. Details of the work carried out in 1963 are as follows:— No. of inspections 106 No. of samples taken by: County Engineer 14 (a) Satisfactory 3 (b) Unsatisfactory 11 13 No. of drainage defects remedied: (a) In factories 1 (b) In houses 4 (c) In shops — The sources of pollution can be analysed as follows: Sinks and handbasins and baths 4 W.Cs — Industrial Wastes 2 Soil sewers and drains — ATMOSPHERIC POLLUTION Smoke Control Areas It is satisfactory to report that progress has continued in implementing the Council's Clean Air programme which will ensure that the whole of the Borough is a Smoke Control Area by 1974. The public memory is short and the great smog of 1952 is now more than 11 years ago. At that time for anyone to question the desirability of active measures being taken against smoke pollution would have been hard to credit. To-day, however, this is far from the case and many pronouncements reach print querying the wisdom of such large expenditure for so apparently little reason. During the smog of 1952, it is estimated that 4,000 persons lost their lives. It is against a recurrence of this that smoke control programmes are directed and it is in this light that the Council's determination to proceed must be viewed. In January 1962, the Minister of Housing and Local Government approached local authorities with Circular No. 4/62 and asked them to consider whether the target dates originally set for the completion of their programmes could be brought forward. At the same time he asked for programmes for the five years 1962—1966 to be prepared. The Council accordingly gave further consideration to the matter and it was decided that the completion date could not be brought forward. It was felt that Ealing as a Borough was making as rapid progress as was feasible, particularly as by 1966, the already large number of 38,112 premises and approximately 5,940 acres which would be included, had now risen in the final estimate to 60,383 premises. During 1963, four further Smoke Control Orders were made by the Council in respect of areas Nos. 14, 15, 16 and 17, all of which were planned to come into operation during 1964. The No. 12 Smoke Control Order made in 1962 was confirmed by the Minister of Housing and Local Government in February 1963, following a public enquiry, and Smoke Control Order No. 13 also made in 1962 was confirmed by the Minister. These latter two Orders came into operation in 1963. Orders Nos. 14 and 15 made early in 1963 were confirmed later in the year and will become operative in 1964. Orders Nos. 16 and 17 made later in the year were still awaiting confirmation at the end of December. Survey work on areas Nos. 18 and 19 had been commenced before the end of the year and preliminary arrangements were also in hand for dealing with areas Nos. 20 and 21. The following table gives details of the progress of the Council's programme by the end of 1963:— 14 Progress of Smoke Control Programme No. of Smoke Control Orders Acres No. of dwellings involved Other buildings involved Total premises covered Private Local Authority In operation 13 2,614 11,935* 4,515 553 17,003 Confirmed, but not yet in operation 2 330 1,948 4 39 1,991 Awaiting confirmation 2 445 3,362 33 226 3,621 Totals 17 3,389 17,245 4,552 818 22,615 *Includes 1,682 L.C.C. properties. Borough of Ealing—Smoke Control Areas (coloured yellow) Smoke Control Order; Date of Operation: No. 1 1st July, 1960 No. 2 1st October, 1960 No. 3 1st July, 1961 No. 4 1st September, 1961 No. 5 1st November, 1961 No. 6 1st June, 1962 No. 7 1st September, 1962 No. 8 1st November, 1962 No. 9 15th November, 1962 No. 10 1st July, 1963 No. 11 1st July, 1963 No. 12 1st September, 1963 No. 13 1st November, 1963 Nos. 14 and 15 made in 1963, but to come into operation on 1st July and 1st August, 1964 respectively. Nos. 16 and 17 made in 1963, but awaiting confirmation by Minister of Housing and Local Government. Nos. 18 and 19 surveys in progress Nos. 20 and 21 next for survey Smoke Control Orders in operation in adjoining districts (coloured red) A. Urban District of Hayes and Harlington. B. Borough of Harrow. C. Borough of Acton. Proposed Smoke Control Areas in adjoining districts (coloured green) B. Borough of Harrow. C. Borough of Acton. 15 D. Borough of Willesden. E. Borough of Brentford and Chiswick. F. Borough of Southall. G. Borough of Wembley. Public Enquiry on No. 12 Smoke Control Order This Order made by the Council in 1962, was confirmed by the Minister of Housing and Local Government in February, 1963, following a Public Enquiry held at Ealing in January. It was held as the result of objections received from one householder residing in the area. The grounds of objection were briefly that the Order involved individuals and the ratepayers in unnecessary expense; that there was difficulty in obtaining smokeless fuels, which even if obtainable were added expense; and that the making of the Order was a futile measure whilst industrial plants in other areas emitted fumes and dust. The Council was represented at the Enquiry by their Assistant Solicitor and evidence was given by the Chief Public Health Inspector, representatives of the Coke Department of the North Thames Gas Board and the National Coal Board. This evidence dealt with the Council's general programme, with the supply of fuels and with particular information relevant to the area under consideration. The Minister in referring to the report of his Inspector, which he accepted, stated that the Inspector found that the area was a suitable one for smoke control; that smoke pollution was a serious social evil and that he had no doubt that the Council were in principle justified in seeking to extend the area of their district under smoke control. The presence of other forms of air pollution, which were already subject to control under existing legislation, was not in itself an argument against reducing domestic smoke. As regards the suitability of the area, smoke control was a continuing process and until it was complete it was inevitable that some householders would be under a legal obligation to avoid making smoke before their neighbours came under a similar obligation. He was also satisfied that adequate supplies of smokeless fuel would be available in the area and added that when suitable quality smokeless fuels were correctly used in modern approved appliances designed for burning them, there was no doubt that they were capable of providing efficient and economical open fire heating. Mobile Exhibition—Solid Smokeless Fuels Federation Mobile exhibition vehicles operated and staffed by the Solid Smokeless Fuels Federation visited the Borough on two occasions during the year. In July a vehicle spent three days in the area covered by the No. 15 Smoke Control Order and was visited by 185 local residents at four separate locations in the area. The vehicle used on this occasion was of a larger type than that formerly used in the Borough and contained additional examples of approved appliances. During the second visit in November one week was spent in six separate locations in the area of the proposed No. 17 Smoke Control Order and during this period, 603 local residents visited the exhibition. The Federation expressed the view that this had been one of their most successful efforts for some time. The success on this occasion was possibly due to the fact that a survey of this area was being conducted at the same time. The staff on duty were available to give advice and assistance to all who were interested in appliances 16 and fuels and on the operation of the Clean Air Act as it was likely to affect the residents in the area. Further arrangements were being made towards the end of the year for similar exhibition vehicles to visit the proposed Nos. 18, 19, 20 and 21 Smoke Control Areas during 1964. The Council is indebted to the Federation for arranging these exhibitions and for the help and advice given. All visits are heralded by advertisement in the local press and by the distribution of pamphlets to all households in the areas concerned. Publicity for Clean Air Programme As a result of the confirmation of the Nos. 12, 13, 14 and 15 Smoke Control Orders, approximately 4,000 letters were circulated to the householders in the areas concerned giving full details of the effects of the Orders and of grants available for the conversion of heating appliances. This information was given in addition to that provided by means of personal visits by the Public Health Inspectors during the initial survey of properties, and as the result of enquiries and applications for grant. Talks on the Council's Clean Air Programme and atmospheric pollution generally, were also given on several occasions to various women's organisations. These talks were illustrated with films, film strips and other visual aids and are valuable as an addition to other publicity methods used by the Council. At such talks opportunities often arise for dealing with the misunderstandings and difficulties which occur from time to time in smoke control areas. A portable display unit which illustrates the range of solid smokeless fuels and the correct operation of appliances was made available to the Council during the year by the Solid Smokeless Fuels Federation. These are now available for the information of the general public in the entrance to the Public Health Department. West Middlesex Clean Air Co-ordinating Committee The five authorities represented on the Committee (Ealing, Feltham, Hayes & Harlington, Southall and Heston & Isleworth) were joined during 1963 by representatives from Brentford & Chiswick, Acton and Ruislip—Northwood, thus covering a contiguous area of more than 40,000 acres with a total population of just over 655,000. Invitations extended to Yiewsley & West Drayton Urban District Council and to Uxbridge Borough Council to appoint representatives in order to cover the whole of the West Middlesex area included in the grouping of the new London Boroughs were declined. The Committee met on three occasions during the year when useful information on the progress of the smoke control programmes of each of the eight constituent authorities was exchanged and discussed. At the last meeting held in October it was reported that there were 54 Smoke Control Orders in operation in the combined area, covering 12,049 acres and 51,179 dwellings and 2,598 other buildings. Twelve further Orders were either confirmed but not in operation, or awaiting confirmation. Consideration was given to a wide variety of subjects ranging from such questions as the sale of solid smokeless fuels in paper bags, to the application of Sections 3 and 10 of the Clean Air Act, 1956. One meeting was addressed by the Sales Manager of the North Thames Gas Board Coke Department on the relative supply position, both present and future, of Cleanglow and Gloco. It was emphasised that the demand for Cleanglow was likely to remain in excess of production for the time being but that 17 stocks of Gloco were high at that time and that there was no danger of the supply position becoming difficult. It was felt that in future there would be an increasing tendency for the "piped" fuels such as electricity and gas to be used for domestic heating and as this trend developed there would be a corresponding reduction in the demand for gas coke. In any event technological changes in the gas making industry by the increased use of oil for carbonising and also of imported natural gas would eventually result in a decline in the production of coke at gas making plants. The difficulties being experienced in certain, smoke control Areas due to the inability of the North Thames Gas Board to cope with the amount of work involved in supplying estimates without long delays was also discussed. As a result, three officers were deputed to arrange a meeting with representatives of the North Thames Gas Board, and it is pleasing to report that at this meeting, these difficulties, which had mainly arisen because of serious staff shortages, were satisfactorily resolved. Outstanding work has since been cleared and no unusual delays are now being experienced. The work of this Committee, especially now that its activities apply to a much larger area, has led to a considerable uniformity of action, and provides a valuable opportunity for dealing with the various problems and difficulties which confront local authorities in their efforts to implement the provisions of the Act and to create smoke control areas. The Ealing representatives on this Committee are:— Councillor J. T. C. Hancock, Councillor A. W. Morbey, Chief Public Health Inspector. Supply of Fuels in Smoke Control Areas The Minister of Housing and Local Government in his Circular 7/63 published in April, gave advice to local authorities concerning the use of gas coke as open fire fuel and stated that the producers and distributors were setting up a consumer service to show householders how best to use it. The circular also dealt with the delivery of coal in smoke control areas and stated that the Coal Merchants' Federation of Great Britain had recommended its members to do everything they could to prevent bituminous coal being delivered to premises in smoke control areas. In June, following questions in the Commons, the Minister issued a further statement referring to the technological changes in the gas industry which were making increased use of oil and natural gas for the production of domestic gas supplies. These changes would lead eventually to a reduction in the supply of gas coke. The Minister indicated that in conjunction with the Minister of Power he was instituting an immediate review of current arrangements for ensuring that progress in smoke control was not impeded. The review promised by the Minister resulted in the publication of Command Paper 2231 "Domestic Fuel Supplies and the Clean Air Policy" and of his Circular No. 69/63 in December. The Minister envisaged that by 1970, there would be a shortage of open fire coke and reactive fuels suitable for use in open grates, but that there would be a surplus of fuels suitable for use in closed appliances. Adequate supplies of fuel for open grates would be available to meet the needs of existing smoke control areas, including those confirmed but not yet in operation and producers and distributors had 18 promised to do everything possible to ensure that these needs would continue to be met. In spite of all the difficulties the Minister confirmed that it was the Government's intention to encourage and facilitate vigorous action against urban smoke pollution. To do this it had become necessary to make changes in the arrangements under the Clean Air Act. For all future smoke control orders local authorities were to take full account of the local supply position to consult, at an early stage, representatives of fuel and power producers and distributors as indicated by the Minister for each region. Results of such consultations are to be reported to the Minister when any new Order is submitted. The Minister considered that the installation of openable stoves, underfloor draught fires, or fixed gas, electric storage or oil heaters should now be regarded as "reasonably necessary" works and the full expenditure on such installations should rank for grant. The increased use of stoves capable of burning hard coke which would continue in good supply should be encouraged, but the use of direct electric space heaters which adds to the difficulties being experienced by the electricity supply industry in meeting peak loads in cold weather should be discouraged. Grant for the installation of improved open grates would only continue to be payable when the local authority were informed that supplies of open grate fuel would be available for a proposed new area. Otherwise, grants would be payable for replacing such grates by other types of appliance. Attention was also drawn to certain proposed amendments to the Clean Air Act which were included in the Housing Bill then before Parliament. The effect of the advice and guidance given in the Circular and the implementation of the new grant arrangements which it authorised were considered by the Public Health Committee early in 1964, and a new list of reasonable prices for the provision of the various forms of space heating on which grant would be payable, was approved. The new arrangements were to become operative in all new areas commencing with that covered by the No. 16 Smoke Control Order. During the early months of the year, the exceptionally severe weather conditions created some difficulties with fuel supplies generally. Most householders using solid fuel found their supplies running short owing to increased heating demands and distributors were hard put to keep pace with their deliveries, which were hampered by road conditions and frozen stocks in the depots. The problem was therefore largely that of delivery rather than of supply. A limited scheme for supplying small quantities of prepacked coal and smokeless fuel to old persons and families, where there were very young children, who were unable to obtain supplies quickly was operated by the Department. This scheme was made possible through the generosity of the Mayor's Christmas Fund, which enabled the scheme to be financed. By this means 87 households were assisted and in some cases more than one delivery was made. In almost every case the cost of the fuel supplied was recovered and the Mayor's Fund reimbursed. "Homefire" A new fuel known as "fiuidised char binderless briquettes", but to be sold under the name "Homefire" was authorised during 1963 for use in smoke control areas. This fuel was being produced in the Birch Coppice plant by the National Coal Board 19 in limited quantities but there were plans for expanding its production. As far as is known this fuel was not available in Ealing during the year. New furnaces During the year 78 notifications were received in accordance with Section 3 of the Clean Air Act, 1956 of the intention to instal new furnaces at various domestic, commercial and industrial premises in the Borough. In many of these cases further enquiries were made to obtain fuller information about proposed installations and as to the type of fuel and chimneys to be used. In certain instances the Council's consultant was asked for his opinion and efforts generally resulted in agreement being reached in the planning stages on modifications and improvements designed to provide more efficient operation and dispersal of flue gases. Section 3 of the Act provides that all new furnaces installed should be capable, as far as practicable, of being operated continuously without emitting smoke when burning fuel of a type for which the furnace was designed. Prior Approval One application for prior approval under Section 3 of the Act in respect of an oilfired central heating boiler for a new Old People's Home, was received during the year. Certain modifications to the proposals were made and accepted and the application was finally approved. Heights of Chimneys Plans of new or extended buildings submitted to the Borough Engineer and Surveyor and passed to the Department for comment are dealt with in accordance with Section 10 of the Clean Air Act whenever they show that it is proposed to construct chimneys for carrying flue gases from the building. During 1963, fifteen such plans were examined and in seven cases it was necessary to offer criticisms which resulted in amendments being made to the plans to provide more satisfactory chimney heights. In one instance it was recommended that a plan for an extension to an existing industrial building should be rejected. This building was to include large boilers for raising process steam and for central heating and the chimneys proposed were considered to be totally inadequate in height for the plant concerned. Satisfactorily amended plans submitted later were approved by the Council under Section 10. Comments on the unsatisfactory scope of Section 10 of the Act has been made in previous years. This section deals with the height of industrial chimneys, but as it only applies when plans have to be submitted in accordance with building bye-laws any buildings exempt from bye-law control are also exempt from the provisions of this section. It is to be hoped that there will in the near future be amendments to this section to remedy this anomaly. Smoke from Bonfires A large number of enquiries received from householders in smoke control areas concerning the burning of garden rubbish prompted the production of an explanatory leaflet which has been issued whenever necessary. Several complaints about bonfires were dealt with during the year. In all cases the offenders were seen by the Public 20 Health Inspector for the district concerned. There were no cases where repetition of nuisances arose which called for statutory action. The information given in the leaflet is as follows:— CLEAN AIR ACT, 1956 Smoke from Bonfires 1. Smoke from bonfires causes severe distress to sufferers from respiratory and certain other diseases, and may give rise to serious nuisance to those who wish to rest or to dry laundry in their gardens. It also tends to nullify the beneficial effects obtained by the reduction in domestic smoke resulting from the operation of Smoke Control Orders. 2. Bonfires are not specifically prohibited by the Clean Air Act, even in Smoke Control Areas, but Section 16 of the Act provides that such smoke shall, if it is a nuisance to the inhabitants of the neighbourhood, be deemed to be a statutory nuisance for the purpose of Part III of the Public Health Act, 1936. Offenders may be liable to a penalty not exceeding ten pounds. 3. It is always advisable to come to an understanding with neighbours before bonfires are started, so that they are not annoyed unnecessarily on account of the smoke produced. 4. Occupiers of premises, both in Smoke Control Areas and elsewhere, are urged to observe the following simple conditions, before lighting fires in the open:— (a) Never light a bonfire unless you are satisfied that weather conditions and wind direction are such that smoke will be carried away from your neighbours' windows and gardens. Ensure that there is no laundry drying in any adjoining gardens. (b) Only use material which is dry enough to enable it to be burned quickly and with a minimum of smoke. (c) Never leave a fire to smoulder for long periods. (d) Do not burn grass cuttings and other soft vegetable waste which is difficult to dry. This should be buried or composted. (e) Exclude all oily rags, rubber and other materials likely to produce heavy or pungent smoke. (f) Choose the site for your bonfire carefully having due regard for those living nearby. 5. Generally speaking, bonfires which smoulder away and smoke for long periods, especially when wind and weather conditions are unfavourable, are those most likely to give rise to complaint, and are those which might be dealt with as nuisances in accordance with Section 16.of the Clean Air Act, 1956. 6. It will be seen that if the above-mentioned simple rules are followed in all cases no annoyance will be caused to neighbouring properties and there will be no need for any formal action to be taken by the Council to deal with nuisances. 21 Measurement of. Atmospheric Pollution The Council maintains standard deposit gauges and lead dioxide candles at Birkbeck Avenue, Greenford, and at Longfield Depot at the rear of the Town Hall. These gauges and candles provide information which is of local interest only and serve to indicate the level of pollution in the immediate areas concerned. The deposit bowls and candles are changed monthly and the results are determined by a private analyst. In addition there are three sets of equipment which provide daily measurements of smoke and sulphur dioxide by the volumetric system. These are located at the Town Hall, at Eliots Green Grammar School, Northolt, and at Walpole Grammar School, Ealing. The results obtained from these instruments are submitted to the Warren Spring Laboratory of the Department of Scientific and Industrial Research. Early in the year the Director of the Laboratory informed the Council that it had been decided to include in the national survey, all towns in England and Wales with a population of more than 100,000. The Council's existing arrangements for the measurements of smoke and sulphur dioxide fulfilled all their requirements. Ealing would therefore be included in the list of representative towns for the purpose of analysing the results to give a comprehensive picture of airborne pollution throughout the country. The tables and graphs in the following pages give details of the monthly results from the deposit gauges and lead dioxide candles, and the monthly average, which is the means of the "daily average" figures for smoke and sulphur dioxide, obtained from the volumetric apparatus. The photographs of the deposit gauge, the lead dioxide candle, and the daily volumetric apparatus, which appear on the graphs, are 'Crown Copyright' and are published by permission of the Director of Warren Spring Laboratory of the Department of Scientific and Industrial Research. Dark Smoke from Industrial Premises The adoptive Section 47 of the Middlesex County Council Act, 1961, was brought into force in the Borough, by special resolution of the Council, and took effect as from 1st September, 1962. This Section prohibits the emission of dark smoke from any industrial premises in the district and provides penalties for contraventions. The Section does not apply to smoke emitted from any chimney of a building or from a chimney to which Section 1 of the Clean Air Act, 1956, applies, nor to dark smoke accidentally or inadvertently emitted if all practicable steps have been taken to prevent or minimise the emission of such smoke, nor to premises controlled under the Alkali, etc., Works Regulations Act, 1906. With these exceptions, the Section will prove most useful in dealing with conditions which might arise, especially in smoke control areas, from the burning of large quantities of waste material in the open, and closes a serious loophole in the provisions of the Clean Air Act. Several occasions have arisen where the attention of possible offenders has been drawn to the Section, but no formal action has so far been necessary. This Section is much stronger in its effect than Section 16 of the Clean Air Act, 1956, which makes it necessary for the local authority to prove that a nuisance is being caused to the inhabitants of the neighbourhood, where smoke, other than that dealt with in other Sections of the Act, is produced. 22 Deposit Gauges and Lead Dioxide Instruments (Monthly analysis) 1963 Deposited matter expressed as tons per square mile per month Sulphur compounds by lead dioxide method expressed as milligrams SO3/day collected by 100 sq. cm of Batch A Pbo2 Birkbeck Avenue Longfield Depot Birkbeck Avenue ield Depot/ Jan. 12.34 8.67 4.10 6.50 Feb. 20.58 14.44 1.40 5.30 March 23.91 22.58 1.40 3.10 April 19.78 17.34 M0 2.70 May 18.98 12.94 0.73 1.40 June 28.75 17.21 0.55 1.20 July 23.71 20.88 0.34 1.80 August 13.64 11.47 0.37 0.90 Sept. 16.11 13.97 0.71 1.50 Oct. 18.53 14.40 0.77 1.80 Nov. 18.78 17.77 0.92 3.30 Dec. 16.71 15.04 1.40 3.30 Average for year 19.32 15.56 115 2.73 Average Monthly Concentrations of Smoke and Sulphur Dioxide (Daily Volumetric Instruments) Smoke in Microgrammes Sulphur Dioxide in Microgrammes 1963 per cubic metre per cubic metre Town Hall Eliots Green School Walpole Grammar School Town Hall Eliots Green School Walpole Grammar School Jan. 173.6 176.2 242.3 488.5 382.5 483.3 Feb. 217.4 172.4 219.8 335.9 449.2 491.8 March 50.8 49.3 46.2 332.0 147.2 142.3 April 89.5 * * 271.0 * * May 30.4 17.2 27.3 119.4 69.7 79.4 June 25.2 12.3 22.7 97.0 50.1 86.7 July 22.2 25.4 16.4 93.3 74.6 102.2 August. 32.6 ♦ * 114.6 * * Sept. 52.8 49.5 57.8 139.9 130.5 208.0 Oct. 71.6 45.2 53.3 187.6 119.6 120.3 Nov. 100.4 100.2 112.1 252.9 184.7 180.0 Dec. 187.7 104.4 195.6 359.9 298.6 371.8 Average for year ... 87.8 74.8 99.3 232.6 190.6 226.5 *School holidays. 23 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 14 years. There is every indication that these talks are appreciated and that they are showing beneficial results. During 1963 lectures were given to food handlers and 145 received Certificates of Attendance upon completing the course. In addition 17 talks on food hygiene were given by the Public Health Inspectors to approximately 680 school-leavers at the Grammar and Secondary Modern Schools in the Borough, and 19 lectures were given to women's organisations. Since the inception of the Food Hygiene Scheme in 1949, 597 lectures have been given and 2,627 food traders and food handlers have completed the courses which have been arranged and all have been supplied with Certificates of Attendance. In addition there have been 308 talks to school leavers at the Grammar and Secondary Modern Schools and in the 13 years since this part of the scheme was commenced approximately 12,090 children have attended. A total of 57 talks have also been given to various women's organisations. Food Hygiene Certificates The current holders of these 59 certificates are:— School Meals Service 25 school kitchens. Staff Canteens Aladdin Industries Ltd., Western Avenue, Greenford. Bentall's Ltd., The Broadway, W.5. 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, Ltd., Ruislip Road, Northolt. Taylor Woodrow Services Ltd., Western Avenue, W.5. F. H. Rowse Ltd., Broadway, W.13. Food Factories Quality Foods Ltd., Park Avenue, N.W.10.—Confectionery. Quality Foods Ltd., Park Avenue, N. W.10.—Synthetic Cream. Restaurants Bentall's Ltd., The Broadway, W.5. F. H. Rowse, Ltd., Broadway, W. 13. Confectioner Joy Day, 5 Bond Street, W. 5. 24 Provision Merchants J. Sainsbury Ltd., 1/4 High Street, W.5. J. Sainsbury Ltd., 51 The Broadway, W.5. J. Sainsbury Ltd., 87 Broadway, W.13. Multiple Store Marks & Spencer Ltd., 92/94 Broadway, W.13. Grocers Champion Tea Co., 366/8 Windmill Road, W.5. H. Cradock Ltd., 52/3 Manor Road, W.13. United Dairies (London) Ltd., 7 shops. Williams Bros. Ltd., 24 Broadway, Greenford. Butchers R. Mathews Ltd., 165 Boston Road, W.7. G. A. Scott & Son, 2 Eastmead Avenue, Greenford. L. Shaw, 6 Station Parade, Ealing Road, Northolt. Sutton & Sons, 34 Haven Green, W.5. Sutton & Sons, 1 Station Parade, Uxbridge Road, W.5. 2,010 inspections of food premises were made and 408 repairs and improvements were carried out. The film-strip on food hygiene made by the Council in 1954 is still in demand, a further six copies having been sold during the year, bringing the total number of copies so far sold to 161. During the year the Clean Food Booklet, was again widely distributed amongst food traders. This booklet gives an account of the principles of food 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 food hygiene lectures and describes the conditions under which Food Hygiene Certificates are issued. This booklet has been of considerable assistance in the Clean Food Campaign. New film—"The Poisoners" A new food hygiene film in colour entitled "The Poisoners" was completed towards the end of the year and was presented to the Public Health Committee of the Council. This film was produced by the Council with advice and assistance from the Medical Director of the Central Council for Health Education and with a financial contribution from Messrs. Domestos, Ltd., makers of detergents and sterilizers. The film is now being used in conjunction with other films and film strips in the lectures given by Public Health Inspectors as part of the Council's Clean Food Scheme. HOUSING ACTS Clearance Area Programme The Council's programme which was drawn up in 1956, included proposals to deal with approximately 120 premises to which another 21 properties have been added as a result of more recent inspections. Action in the earlier years resulted in the clearance or compulsory purchase of a large number of these houses but at the end of 1963, 25 44 premises included in the proposals were still occupied and remained to be dealt with in this manner or by other means. Some progress has however been made in achieving the Council's objective of ensuring that certain houses should not again be used for human habitation. Details of this are as follows:— 2-6 Melbourne Cottages, These and other adjoining premises were acquired Hanwell, W.7. privately for development of the site, and have now been demolished. 1-23 Adelaide Cottages, Hanwell, W.7. 7, 8, 9 and 10 Church Place, Ealing, W.5. 2-6 Farm Cottages, Hanger Lane, W.5. No. 4 Adelaide Cottages became vacant as the result of the elderly tenant being rehoused by the Council. The owners gave an undertaking not to re-let this house, nor any others which became vacant. In addition to No. 4, Nos. 3, 6, 18 and 19 were also vacant at the end of the year. These properties, two of which were vacant were purchased by the Council and will eventually be demolished to provide a site suitable for re-development. These premises were to be purchased by a statutory undertaker and the site redeveloped. Certain occupiers were rehoused with assistance from the Council. Regulations for Underground Rooms 16 Eaton Rise, An undertaking by the owner to carry out certain works Ealing, W.5. to make the basement accommodation fit for human habitation was accepted by the Council. Arrangements were to be made by the Council to provide temporary accommodation for the occupants to enable the work to proceed. 53a Mattock Lane, W.13. A Closing Order in respect of the basement accommodation was made by the Council during the year. The accommodation had recently been vacated by the tenant and no rehousing problem arose. Houses in Multiple Occupation—Housing Act, 1961 I am glad to be able to report that a satisfactory start has been made in tackling the problem of houses in multiple occupation, using the increased powers which are provided by the Housing Act, 1961. Though doubtless there are very many areas in London presenting greater problems than Ealing, there is nevertheless a very considerable amount of property in the Borough used for this purpose. Inspection of premises commenced towards the latter end of 1963, and a total of 74 houses were inspected. The fact that houses are in multiple occupation, if not already known to the Department, is normally brought to our attention by the Town Planning and Housing Departments of the Council. The procedure then is that preliminary enquiries are made to establish the ownership of the premises, the pattern of occupation, and the length of time this pattern has 26 existed. If the multiple occupation is of recent inception or if the Borough Surveyor's Town Planning Section is investigating the case no further action is taken by the Department until the need for Town Planning action has been decided. This procedure is most important as it is obviously undesirable to seek the improvement of premises where a proper right of use in multiple occupation does not exist. When it is plain that Town Planning action will not be prejudiced a detailed inspection is made of those premises where facilities and conditions are seen to require improvement. An inspection is also made with a representative of the Middlesex County Council Fire Brigade upon whose report the requirements under Section 16 of the Act are based. Informal notices are then served on the owner or person having control of the premises requesting the provision of such additional facilities and improvements in the means of escape in case of fire as appear necessary having regard to the number of persons in occupation. Regular reports are made to the Public Health Committee and the service of formal notices under Sections 15 and 16 of the Housing Act, 1961 is authorised where necessary. Authority is also obtained at the same time for the execution of the required works in the event of the owners default and for the recovery of the costs. Liaison with the Housing and Town Planning sections of the Borough Surveyor's Department is close and much valuable advice and assistance has been given to the Department by the Chief Fire Prevention Officer of the Middlesex County Council and his staff, and I would like to record my gratitude for this. It is too early at this stage to take stock of the effectiveness of our efforts to improve the standard of these premises. What is already clear, however, is that it will require much time consuming work over many years before it can be said that the problem in the Borough is under strict control. 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 on its return. The Baths Manager makes tests at frequent intervals each day to ensure that a satisfactory level of residual chlorine is maintained. In addition 75 samples were taken by the Department during the year and sent for bacteriological examination. Of these 75 samples 68 were found to be entirely satisfactory. The seven doubtful samples consisted of six taken very early in the season, and of one taken in November. It is understood that the Council has taken preliminary steps to replace the present chlorinating equipment with more modern machinery. A private swimming pool operated by a local industrial firm in Greenford was sampled on two occasions during the year and results were satisfactory. 27 PUBLIC HEALTH ACT, 1961—DESTRUCTION OF PIGEONS Section 74 of this Act gives local authorities power to deal with nuisances caused by the congregation of pigeons and certain other birds in built-up areas. The arrangement whereby the Council exercised these powers by employing a specialist firm to deal with such infestations of pigeons in various areas in the Borough, and which was commenced in 1962 was continued in 1963. A new contract for 12 months was entered into in April. A total of 3,173 pigeons was destroyed during the year, and the work resulted in a very marked improvement in many sites in the Borough where previous infestations had been heavy and had caused serious nuisance and inconvenience from roosting and fouling. Particular attention was given to a number of railway bridges, notably those in the Perivale and West Twyford areas. The methods used were mainly trapping and shooting with the occasional use of repellents, and all the work was carried out in accordance with the Protection of Birds Act, 1954, and to the satisfaction of the Royal Society for the Prevention of Cruelty to Animals and the local police. The use of narcotics was excluded, owing to the difficulties associated with the recovery of narcotised birds in such a built-up area. PUBLIC MORTUARY As there is no Public Mortuary in this Borough, existing arrangements continued with the Acton Borough Council for the use of the mortuary at Acton. The number of bodies taken there was 388 and post-mortem examinations were carried out in all cases. Similar arrangements were also continued with the Uxbridge Borough Council for the use of their mortuary and 69 bodies were dealt with at Uxbridge and post-mortem examinations made. 28 (Reproduced by kind permission of 'Middlesex County Times') PIGEONS ON HAVEN GREEN An attractive sight in such surroundings but these birds cause great damage and nuisance to buildings. SECTION 3 PUBLIC HEALTH INSPECTION THE WORK OF THE PUBLIC HEALTH INSPECTORS IN 1963 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 is as follows:— PUBLIC HEALTH ACT, 1936 Inspections Premises inspected on complaint 1,982 Nuisances observed by Inspectors 85 Premises inspected in connection with infectious disease 623 Smoke observations 113 Houses without water supply 109 Inspections of moveable dwellings 170 Pet Animals Act, 1951 29 Cinemas and Music and Dancing Licences 53 Shops Act 33 Chiropodists and Special Treatment 17 Schools 51 Public Health Laundry Service 96 Licensing Act (W.C. Accommodation) 16 Noise Abatement Act 11 Brent Pollution 106 Rent Act, 1957 94 Other inspections and visits 1,639 Reinspections 4,620 Informal Notices 538 Letters sent 3,196 Statutory Notices served 825 Proceedings before Magistrates 3 Legal Proceedings Public Health Act, 1936 Non-compliance with Statutory Notices Three summonses were issued in respect of two premises for non-compliance with Notices served under Sections 39 and 93 of the Public Health Act, 1936. In the case of one premises a 28 day Nuisance Order was made in connection with Section 93 and a fine of £5 was imposed for non-compliance with the Section 39 Notice. Costs of £3 3s. Od. were awarded to the Council. In the second case a 28 day Nuisance Order was made for non-compliance with a Notice served under Section 93 of the Act and £3 3s. Od. costs were awarded to the Council. 29 CLEAN AIR ACT, 1956 Inspections and visits in connection with Smoke Control Areas 8,681 FOOD AND DRUGS ACT, 1956 Food Hygiene (General) Regulations, 1960 and 1962 Milk and Dairies (General) Regulations, 1959 Complaints received 184 Food Inspections 461 Inspections of Food Premises 2,010 Contraventions found 288 Informal notices given 288 Proceedings before Magistrates 4 Samples of Ice cream taken 102 Samples of synthetic cream taken 34 Samples of other foods taken 14 Samples of tea taken 717 Samples of domestic water taken 46 Samples of swimming bath water taken 77 Legal Proceedings Food and Drugs Act, 1955 The initial enthusiasm which members of the public frequently show in complaining to the Department about the sale of articles of food which are either unfit, or which contain extraneous articles, often wanes considerably when they are asked if they are willing to give evidence in Court. In cases where a purchaser is unwilling to assist in this manner, it is almost invariably impossible to institute legal proceedings which have any chance of being successful. Every complaint is investigated in detail, however, and appropriate action is taken to draw attention in the proper quarters to any contraventions which have taken place. Difficulties also arise in the case of complaints about dirty milk bottles, as evidence must be obtained as to the location of the plant where the bottling has taken place, and any proceedings must be commenced in the area of the bottling plant. In the absence of any requirement for the name and address of the plant to be recorded on the bottle cap, such evidence is, in most instances, difficult to obtain and to draw the attention of the dairy firm to the fact that a dirty bottle has been used for the sale of milk is the only course open to the Council. During 1963 two successful prosecutions for the sale of food articles which were not of the nature, substance or quality demanded by the purchaser were taken under this Act:— (a) Sale of bread found to be mouldy— fined £10 with £5 5s. Od. costs. (b) Sale of bread containing foreign matter— fined £10 with £6 6s. Od. costs. Food Hygiene (General) Regulations, 1960 In two cases proceedings were instituted under these Regulations with the following results:— 30 (a) Sale of hot dogs from a mobile vehicle— operator found guilty on three charges and conditionally discharged for twelve months. Costs of £2 2s. Od. were awarded. (b) Sale of hot dogs from mobile vehicle— operator found guilty and fined £8 Os. Od. on each of eight charges and £8 Os. Od. on each of the three charges for which the defendant was convicted but conditionally discharged under (a) above. Costs of £10 10s. Od. were awarded. List of Food Premises in the Borough of Ealing Bakehouses 17 Bakers' shops 49 Butchers 115 Cafes and Restaurants 162 Canteens—factory 86 Canteens—school 32 Confectioners 236 Dairies and Milk Sellers 112 Fish Fryers 22 Fishmongers 32 Greengrocers 140 Grocers 272 Hotels and Licensed Clubs 50 Ice Cream Manufacturers 3 Public Houses 62 Premises registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food 114 Premises registered for the sale of ice cream 387 Milk Supply There are 71 registered distributors of milk in the Borough. The issue of licences under the Milk (Special Designations) Regulations, 1960, is now the responsibility of the Middlesex County Council and during the year 93 samples of milk were taken in the Borough of Ealing by officers of the County Council. Ice Cream There are 387 premises in the Borough registered for the sale of ice cream. There are only three 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 five manufacturers outside the Borough. A total of 102 samples from these manufacturers was taken during the year and sumbitted for bacteriological examination. 31 The results were as follows:— Commodity Samples Grade Not Graded 1 2 3 4 Ice Cream— (Local Manufacturers) 63 35 20 3 5 - Ice Cream— (Other Manufacturers) 28 4 12 6 6 - Ice Lollies— (Local Manufacturers) 9 - - - - 9 Ice Lollies— (Other Manufacturers) 2 - - - - 2 102 39 32 9 11 11 The five local samples placed in Grade 4 were followed by an inspection of the factory and plant, and repeat samples proved to be staisfactory. The six samples of ice cream in Grade 4 taken from products manufactured outside the Borough, were followed up with the firms concerned, and subsequent samples proved to be satisfactory. The 11 samples of ice lollies were reported upon satisfactorily, but were not placed in the grades used for ice cream. Synthetic Cream A total of 34 samples of synthetic cream was taken during the year and all were from local manufacturers. In all cases except one reports from the laboratory indicated that the samples were of excellent or satisfactory quality. Inspection of Meat and Other Foods The following foodstuffs were condemned by the Public Health Inspectors as unfit for human consumption and were surrendered for destruction: lbs. Almonds 7 Bacon 7 Beef 681 Cereal 2 Cheese 59 Corned beef 4 Dough 648 Edible fats 485 Fish 56 Flour 1,540 Kidney 14 Lamb 62 32 SAMPLING OF SYNTHETIC CREAM FOR BACTERIOLOGICAL EXAMINATION. Liver 14 Meat Extract 6 Mutton 29 Offal 378 Pork 71 Preserves 67 Sausages 15 Semolina 7 Steak 586 Veal 101 Tea and Tea Sweepings 25,450 Foodstuffs not calculated by weight: Assorted tins, packets and jars 6,895 Tea The examination and sampling of tea, taken over from H.M. 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, quantities of tea are delivered direct from the docks. The initial point of inspection in this country is therefore at the bonded warehouse. This places on the Council the responsibility of inspecting this tea to ensure that it is fit for human consumption, in accordance with the provisions of the Food & Drugs Act, 1955, and the Public Health (Imported Food) Regulations, 1937. During 1963, 717 samples 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 by foreign matter. Experience has shown that teas originating from certain countries are more likely to be contaminated than others and therefore greater attention is given to these. Of the 717 samples taken during the year 70 were found to be of doubtful quality after initial tests had been carried out and were then referred for further examination to the Council's analyst. He reported that 29 samples were from consignments of tea considered to be unfit for human consumption mainly on account of the presence of excessive quantities of metallic dust. Some consignments of tea certified as unfit were re-exported under guarantee, usually to Holland, for industrial purposes. The Medical Officers of Health for the Port of London and the Port of Rotterdam were notified to enable them to check this procedure. Of the 29 samples reported upon adversely by the analyst, 15 samples were from consignments which he considered could be blended with larger quantities of other good tea. Further samples of the resultant product were taken in all cases and the final blend was found to be satisfactory. It is interesting to note that the samples taken during the year represented total consignments of 96,267 cases of tea of which 61, or 0.06%, were found to be completely unfit for use for human consumption and 261 cases or 0.27% were recommended for blending under supervision with other good tea so that they did not form more than 5 % of the final blend. 33 Other Food Samples Fourteen other food samples were submitted for laboratory examination following complaints and all were found to be satisfactory. These samples included cooked meats, canned fruit, canned meat, packeted cereal, water ice, and a variety of packed frozen foods. SUMMARY OF WORK DONE AND IMPROVEMENTS CARRIED OUT AT FOOD PREMISES Clothing accommodation provided or improved 6 Equipment improved or cleansed 37 First Aid equipment provided or improved 7 Floors repaired and floor coverings improved 40 Food storage accommodation improved 12 Hot water provided or restored 29 Hygiene Notices provided 13 Lighting and ventilation improved 16 Protective clothing provided or improved 1 Refrigeration installed or improved 9 Refuse bins provided or renewed 19 Refuse removed 22 Sinks provided or renewed 22 Tables and working surfaces made impervious 5 Walls and ceilings repaired or cleansed 105 Washing facilities provided or improved 7 Water closets cleansed, repaired or lighted 16 Water supply provided or improved 5 Other defects remedied 37 MIDDLESEX COUNTY COUNCIL ACT, 1950, SECTION 11 Under this Section, four persons were registered during the year for the sale of food from carts, barrows, other vehicles, etc., bringing the total number on the Register at 31st December, 1963 to 34. HOUSING STATISTICS 1. Inspection of dwelling-houses during the year: (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,529 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Act, 1957 25 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 8 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 958 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 742 3. Action under Statutory Powers during the year: 34 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 105 (2) Number of dwelling-houses in which defects were remedied after service of formal notice: (a) by Owners 49 (b) by Local Authority in default of owner 9 C—Proceedings under Sections 16, 23 and 24 of the Housing Act, 1957 (1) Number of dwelling-houses in respect of which Demolition Orders were made (2) Number of dwelling-houses demolished in pursuance of Demolition Orders (3) Number of houses concerning which action has been taken by the Local Authority under Section 16, and with respect of which Owners have given an undertaking that they will not be used for human habitation 1 D—Proceedings under Section 17, 18 and 27 of the Housing Act, 1957 (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit - CARAVAN SITES AND CONTROL OF DEVELOPMENT ACT, 1960 MIDDLESEX COUNTY COUNCIL ACT, 1944 An application for a site licence in respect of the use of a caravan at a Sports Ground in Northolt was granted for a period of six months expiring on the 6th December, subject to certain conditions. A further application for renewal of this licence was received in December and this was granted for a further period of twelve months on the same conditions. The problem posed by itinerant or gypsy caravan dwellers continued during last year and in the two months at the end of the year a slight increase in numbers occurred. The Council were without a Gypsy Warden from the 13th October until a new warden commenced duties on the 1st January, 1964. The warden continued to patrol the Borough at frequent intervals and to tow caravans off Corporation land and road verges and to assist the owners of private land on which caravans were being parked without permission. 35 On the 9th January, 1963 another conference was held between the Middlesex County Council and representatives of County Districts and since then the County Council have investigated the possibility of finding a suitable piece of land for the establishment of a caravan site in the north and west of the County and have held discussions with officers of the County District. The County Council have stated that from the County Planning Officer's initial investigation only three localities seemed at all possible in the County but each of the authorities was of the opinion that there was not sufficient problem to warrant the provision of an itinerant caravan site and that there was no suitable site within the district concerned for that purpose. All the officers of other authorities which might be said to be affected by itinerants expressed the same view. Having regard to the views of the authorities concerned that there was no suitable site and to the fluctuating numbers of caravanners in the County, the County Planning Committee decided to take no further action to find a site until a further survey had been carried out on a common date to be fixed by the Ministry. The Ministry have expressed disappointment that the County Council did not propose to take any action to provide a site but the County Planning Committee at a meeting on the 5th December, 1963 considered the matter again and felt that it would be unwise to provide a site in opposition to the wishes of local authorities. The Committee decided to take no action to find a permanent site until a further survey on a date to be fixed by the Ministry has been carried out. Work of blocking off Council and privately owned sites in the Borough which caravanners are apt to park on was started at the end of the year and is hoped to be completed in 1964. During the year it was suggested that Hayes & Harlington U.D.C. might share the cost and services of the Borough Council's Gypsy Warden and an agreement to this effect was reached whereby Hayes & Harlington pay three-sevenths of the total cost of the warden's appointment and the warden spends an equivalent time carrying out duties for the U.D.C. Often however a position is reached where the Council's warden can do nothing to move gypsies. This is when they park on the highway or on lay-bys which are part of the highway. Once the warden has towed the caravans off Corporation or private land he has no authority to force them to move on as the matter is then one for the police. The police in their turn are often in a difficult position in these cases because although the offenders may be summoned for obstruction and may neglect to pay their fines, if any warrant is executed and the occupier is sent to prison for failure to pay fines then the wife and children of the caravan occupier are left usually on a lay-by near the highway and the local authority and the gypsy warden are still presented with the same problem. Some caravan dwellers have expressed the opinion that they are as content to be summoned and brought before the Magistrates in the Ealing area as they are to have it happen elsewhere, and it may be that they regard the amount of fines which they have to pay as being in the nature of rent for the part of the highway which they occupy. SLAUGHTER OF ANIMALS ACTS, 1933/1944 A licence to slaughter animals in accordance with the provisions of these Acts was issued during the year to an officer of the R.S.P.C.A. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 This new Act received the Royal Assent in July 1963, and came as a result of the Gowers Committee Report of 1949. The recommendations of that Report were only partially enacted in the Offices Act of 1960, which was a private members' bill. This 36 Act was never brought into operation and was in fact repealed by the new Act. The purpose of the new Act is to set standards for the health, welfare and safety of employees in shops, offices and railway premises, who will be protected for the first time by legislation of this type. It is estimated that the provisions of the Act will apply to over 3,000 premises in the Borough. The Act, or designated parts of it are to be brought into effect on day, or days appointed by the Minister of Labour, but by the end of 1963, no Orders had been made. Discussions about the manner in which the Act would be implemented were commenced towards the end of the year. RADIOACTIVE SUBSTANCES ACT, 1960 This Act concerns itself with the control of the keeping and use of radioactive materials and the accumulation and disposal of wastes. As from the appointed day, which had been fixed as 1st December, 1963, persons who keep or use radioactive material are, unless specifically exempted, required to register with the Minister of Housing and Local Government and to obtain authorisation from him for its accumulation or disposal. During 1963, notifications were received from the Minister that he had granted Certificates of Registration under Section 1 of the Act in respect of eight premises in the Borough of Ealing. In all cases, enquiries were made by the District Public Health Inspectors to provide information about methods of control and safety measures. Although the Council has no responsibility in this matter it was felt that some details should be available locally. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 This Act received the Royal Assent during the year and came into operation on the 1st January, 1964. Three applications for licences for premises in the Borough to which this Act applies were received in 1963. As a result of inspection of the premises certain recommendations were made to the owners to carry out modifications. Licences were granted in all three cases. COMMON LODGING HOUSES There are no common lodging houses in the Borough. RENT ACT, 1957 Part I—Applications for Certificates of Disrepair (1) Number of applications for certificates 22 (2) Number of decisions not to issue certificates 1 (3) Number of decisions to issue certificates:— (a) in respect of some but not all defects 8 (b) in respect of all defects 13 (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 4 Part II—Applications for Cancellations of Certificates (7) Applications by landlord to Local Authority for cancellation of certificates 3 (8) Objections by tenants to cancellation of certificates 1 (9) Decisions by Local Authority to cancel in spite of tenants' objection - (10) Certificates cancelled by Local Authority 11 37 NEW DWELLINGS, 1963 Completion figures for the 12 months period ending 31st December, 1963 were: Bed/sitting room flats 15 Flats (1 bedroom) 9 FACTORIES ACT, 1961 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 96 6 1 - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authority 401 260 32 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — —. — — Total 497 266 33 — 2. Cases in which defects were found: Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 9 9 — —. — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors 1 1 — — — Sanitary Conveniences: (a) Insufficient 3 4 .— — —- (b) Unsuitable or defective 5 6 — — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to outworkers) 7 14 — — — Total 25 34 — — — 38 RODENT CONTROL IN SEWERS telescopic device for laying baits in deep manholes. Part VIII of the Act Outwork (Sections 133 and 134) Nature of Work Section 133 Section 134 No. of out-workers in August list required by Sect. 133 (1) (c) No. of instances of work in unwholesome premises Wearing apparel: Making, etc 161 — Artificial Flowers 3 — Feather sorting 1 — Paper bags 7 — Carding, etc., of buttons, etc 26 — Stuffed toys 19 — Cosaques, Christmas stockings, etc 89 — Lampshades 3 — Brass and brass articles 1 — Woodwork 1 - Jewellery 36 — Total 347 — During the year 64 inspections of Outworkers' premises were carried out by the Public Health Inspectors. SHOPS ACT, 1950 Improvements under Section 38 of the Shops Act, 1950, relating to the health and comfort of shop workers were carried out as follows:— Lighting improved 72 Sanitary accommodation improved 57 Temperature improved 72 Washing facilities provided or improved 68 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 794 Premises inspected 1,012 Premises found to be infested with: 1. Rats 881 2. Mice 124 Re-visits to infested premises 3,679 Fees received for treatment £738 12s. Od. 39 RODENT CONTROL IN SEWERS The 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 again in operation in the Borough in 1963. In the areas selected for treatment during the year 297 sewer manholes were treated with this poison in March, and again in July and October. The Department's Rodent Operatives were able to undertake this treatment which is one of the more important aspects of their work, without assistance from the Borough Surveyor's staff as was necessary with pre-baiting and baiting methods using warfarin and other substances. As only one visit on each of the three occasions was made to each manhole, it was not possible to assess the results of the treatment at the time. Experience in previous recent years has proved the effectiveness of fluoracetamide, but as a check, 122 of the 297 manholes previously dealt with during the year were test-baited in November. Of these 122 manholes there were only seven where partial takes were recorded and these were then treated with warfarin and finally test-baited and found clear. It has now become standard practice where several complaints of rat infestations are received in a small area, not the subject of a current maintenance treatment, to place fluoracetamide baits in sewer manholes in the immediate vicinity. There is always a marked decline in the number of complaints in areas where sewer treatments are undertaken, which proves the value of this work in built-up areas. There is no doubt that such work should be organised on as wide a basis as possible. 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. In all cases only materials carrying the Certificate of the British Standards Institution are used. PET ANIMALS ACT, 1951 Licences in respect of 12 premises were renewed by the Council during the year. Routine visits of inspection were made by the Public Health Inspectors to these premises on 29 occasions during the year. NUISANCES CAUSED BY DEMOLITION WORKS The development of vacant sites and the increased amount of private building which is now in hand in the Borough has resulted in large scale demolition of many of the older houses in Ealing. Demolition work of this type frequently gives rise to serious nuisances from dust and noise, and smoke from bonfires which, because of the very nature of the work, are difficult to minimise or control. In a number of cases inteø vention by the officers of the Department has produced improvements in methods used and in the damping down of material prior to its loading into the vehicles used for its removal from the site. In other cases water sprays have been used to reduce dust nuisances caused by the felling of large sections of brickwork and masonry. The new powers contained in Section 29 of the Public Health Act, 1961, which enable local authorities to serve notices on demolition contractors to take certain action whilst carrying out the work, do not, unfortunately include any provisions to safeguard adjoining residents against dust, noise and smoke and it is therefore necessary to use other powers to deal with these matters. The Association of Municipal Corporations which was approached on this problem felt that it would not be possible to secure the passing of legislation giving further powers, so soon after the enactment of the Public Health Act, 1961. 40 (Reproduced by kind permission of 'Middlesex County Times') DEMOLITION WORK IN PROGRESS Houses of this age have passed their useful life but demolition brings problems of noise and dust nuisance difficult to combat. NOISE NUISANCES Certain powers for dealing with noise nuisances contained in the Middlesex County Council Act of 1944, have been strengthened by those of the Noise Abatement Act of 1960, which provide that noise or vibration which is a nuisance shall be a statutory nuisance for the purposes of the Public Health Act, 1936. The Act of 1960 also limits the hours during which a loudspeaker may be used in a street and prohibits its use altogether for certain purposes. No proceedings under this Act were necessary during the year, but 19 complaints about noises of various kinds were received in the Department. These complaints varied from noise arising from the use of a mechanical shovel to that from an extractor fan in a restaurant, but were mainly concerned with factory processes and machinery. All complaints were investigated by the Public Health Inspectors and informal action was normally successful in securing improvements and a little more thought on the part of some firms and individuals for the comfort and well-being of those living in adjoining houses. DISINFECTION AND DISINFESTATION Number of houses where disinfection was carried out 74 Number of houses disinfested of vermin 26 Number of articles disinfected by steam 12 Number of articles disinfected by formalin spray 206 Number of articles voluntarily destroyed 5 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 20 Baths provided or renewed 11 Caravans—nuisances abated 28 Cesspools—cleansed 1 Damp proof courses inserted in walls 10 Dampness—other forms remedied 134 Drains—connected to sewer 2 Drains—cleared and cleansed 285 Drains reconstructed 25 Drains repaired or improved 115 Drains—new soil and ventilation pipes provided 38 Dustbins provided 86 Firegrates—repaired or renewed 51 Floors—sub-floor ventilation provided or improved 23 Floors—repaired or renewed 62 Food cupboards provided, ventilated or improved 4 Gutters and downpipes repaired or renewed 188 Land fenced 11 Lighting (natural and artificial) provided or improved 29 Refuse accumulations removed 120 41 Roofs repaired 177 Sinks and wash-hand-basins repaired or renewed 42 Sink and other waste pipes repaired or renewed 35 Staircases repaired 43 Ventilation improved 14 Walls and ceilings repaired 122 Walls and ceilings cleansed or redecorated 68 Water supply reinstated 109 Water supply—service pipes and fittings repaired or renewed 53 Water supply—draw taps fixed to main supply 3 Water supply—hot water service provided or repaired 23 Water closets—repaired, reconstructed or improved 104 Water closets—additional accommodation provided 16 Windows and doors repaired 130 Yards paved or repaired 19 Other defects remedied or nuisances abated 136 42 (Reproduced by kind permission of the 'Middlesex County Times') THE MAYOR AND MAYORESS OF EALING AT THE OPENING OF THE NORTHOLT WORK CENTRE SECTION 4 OLD PEOPLE'S WELFARE OLD PEOPLES' LIAISON COMMITTEE This Committee is representative of the Council and those voluntary organisations receiving grants from the Borough Council under the National Assistance Act. it meets annually for the purposes of co-ordinating the running of the services of these organisations for the year. The voluntary associations are able to bring to the notice of the Council any difficulties they have encountered during the year, any proposals they may have for extending their services during the coming year and a statement of their future financial requirements. Its recommendations are then referred to the Public Health Committee. This committee has functioned very satisfactorily in providing a method of making an overall assessment of the need and ways of meeting needs. The Members of the Committee for 1963 were: Councillor Clay (Chairman) Councillor Barlow Councillor Bartlett Councillor Emmins Councillor Hayselden Councillor Parcell. and the following representatives of organisations. Mrs. D. M. Collins, British Red Cross Society. Mrs. E. M. Doughty. British Red Cross Society. Mrs. G. Duponchel, Ealing Committee for the Employment and Recreation of Elderly Citizens. Mrs. M. Hill, Ealing Committee for the Employment and Recreation of Elderly Citizens. Mr. L. Ward, Greenford Philanthropic Society. Mr. F. W. Tomlin, Greenford Philanthropic Society Miss E. Tippetts, Women's Voluntary Service. Mrs. H. W. Corey, Women's Voluntary Service. WORK CENTRES During the year the Borough's three Work Centres, administered by the Ealing Committee for the Employment and Recreation of Elderly Citizens, have continued to provide daily employment for a large number of elderly people of retirement age. The Northolt Work Centre moved from the Parkway Room to the Northolt Memorial Hall on the 26th June and the opening of the Centre was kindly carried out by the Worshipful the Mayor, on Monday, 1st June. The move has been of great benefit as the Northolt Centre can now accommodate 48 persons, whereas before the maximum number was 23. In addition there is adequate storage space, one of the essential features of any satisfactory centre. The two other Centres are:— Territorial Drill Hall, Churchfield Road, West Ealing The Methodist Church Hall, Ruislip Road, Greenford. 43 The West Ealing Centre employs approximately 50 people and the Greenford Centre 33. There is therefore a total of 131 places available throughout the Borough. The work done has again been diverse and includes the following:— Assembling and packing ball point pens. Making Manilla folders. Assembling Soap cartons. Packing tablets of soap. Collating circulars and inserting them in envelopes. Assembling and packing curtain wires. Making padded coat hangers. Collating catalogues Repairing industrial overalls and gloves. Packing balloons and balloon pumps. Affixing labels to lids of shaving bowls. While the work at the Centres is of course subsidised, nevertheless ll/5d. was recovered for every £1 paid in wages. This compares with last year's figure of ll/4d. Although this shows little change it may be remembered that the weather at the beginning of the year was extremely severe and attendances consequently dropped at that time. During the year plans were submitted to the Public Health Committee for the provision of a pre-fabricated timber building in Ravenor Park to replace the present use of the Methodist Church Hall. When built this will enable the Greenford Work Centre to have a great deal more working space and adequate storage facilities. This year, for the first time, each Centre held its own Christmas Party and these occasions were thoroughly enjoyed by the old people. The Ealing Committee is represented at the Employment Fellowship Annual General Meeting and plans were made during the year for an improved display of the work done at the Ealing Work Centres to be shown at the meeting early in 1964. The display was designed by Mr. J. A. Crisp, Public Health Inspector, and a photograph of it is included in this report. MEALS ON WHEELS SERVICE The Meals on Wheels Service in the Borough is supplied jointly by the British Red Cross Society and the Women's Voluntary Service. During the year the number of meals distributed was as follows:— British Red Cross Society 15,645 Women's Voluntary Service 9,460 Total number of meals 25,105 B.R.C.S. w.v. s. Normal number of meals served per week 320 200 Normal number given 2 meals per week 17 58 Normal number given 3 meals per week 32 — Normal number given 4 meals per week 1 3 Normal number given 5 meals per week 34 — 44 EALING WORK CENTRES DISPLAY FOR THE EMPLOYMENT FELLOWSHIP ANNUAL GENERAL MEETING In addition to this total supplied to the home, the British Red Cross Society and Women's Voluntary Service between them have supplied up to 20 meals a day for persons attending the Ealing Day Treatment Centre. The meals are cooked in the kitchens of each Society and taken by van in heated containers to where they are required. There is no doubt that one good meal a day is of great assistance to those old people who, through physical or mental disability, are unable to cook adequate and wholesome meals for themselves. It is not putting it too strongly to say that a service of this nature could prevent the physical deterioration which often follows a diet of bread and butter and tea, which is all many old people are able or willing to prepare EALING DAY TREATMENT CENTRE The Ealing Day Treatment Centre has continued to provide facilities of the greatest value in the care and treatment of the elderly disabled. Patients attend daily from 9 a.m. to 5.30 p.m. and the treatments available include physiotherapy, occupational therapy and chiropody. In addition patients have a routine hearing test and have their eyes examined by an ophthalmologist. Apart from physical treatments special attention is paid to raising the morale of those who are lonely and lack social contacts. Following a visit to the Camden Road Medical Rehabilitation Unit a programme of daily exercises to music has been started and it has been found that this is of great benefit to patients' morale. Naturally, not all patients are able to carry out all the exercises but they do those that they can, and enjoy the community feeling that the daily sessions produce. A report on the Day Treatment Centre was published last year by The Lancet and reproduced in the 1962 Annual Report, and following this there was an increase in the number of visitors from all parts of the world to see the work that is being done. They included a group of American Public Health doctors, a Delegation from Iran and a group of Swedish Doctors and Welfare Workers. Visitors generally appeared most interested and often expressed the view that they would like similar facilities for treating their own elderly handicapped. 116 patients were admitted during the year, which is a slight increase on the previous year's figure of 104. Of these patients, 15 were being admitted for the second time and five for the third time. Many of these patients have more than one disability, but taking the main diagnosis, usually that which brings the patient to the Centre in the first place, they were classified as follows: Arthritis and allied complaints 32 Neurological diseases (including hemiplegia 17, Parkinson's Disease 4, Disseminated Sclerosis 5) 29 Diseases of the cardiovascular system 18 Diseases of the respiratory system 4 No major ailment, or senility only 20 Others (including diabetes) 13 This pattern shows no significant differences from that of the previous year. The average age remained high at 75. The districts from which patients attended were: Hanwell, W.7 28 Ealing, W.13 26 Ealing, W.5 34 45 Northolt 12 Greenford 15 Ealing, N.W.10 1 When the patients leave the Centre after their course of treatment every effort is made to supply them with services which will help to support them at home. These include the provision of meals under the Meals on Wheels scheme, the services of a Home Help if necessary and contact with various social clubs. The problem of followup visiting remains a difficult one. Unfortunately, the health visiting staff of the area is insufficient to cope with this problem and efforts have been made to find a suitable number of voluntary visitors. Some progress has been made in this direction. The members of the Committee of the Ealing Day Treatment Centre Association for 1963 were:— Councillor R. R. Clay (Chairman) Councillor J. T. Bartlett (Vice-Chairman) Alderman Mrs. D. Gundry Councillor J. F. Barlow Councillor E. R. Bennett Councillor Mrs. D. I. Williams Dr. Barbara Bailey Dr. C. A. Osborn Dr. F. H. Scoones Mrs. D. M. Collins—British Red Cross Scoiety Mr. L. G. Love—St. John Ambulance Brigade Miss E. Tippetts—Women's Voluntary Service NATIONAL ASSISTANCE ACT, 1948 Section 47 This section provides powers for the compulsory removal to hospital or other place of persons who:— (ia) are suffering from grave chronic disease 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. Once again it was not necessary to take action under this section during the past year. Many old people were visited following reports received from General Practitioners, Home Helps, Health Visitors, etc. Where an old person is unwilling to enter a hospital or home voluntarily it has often been found possible to give sufficient support through the good offices of the Home Help Section, the Meals-on-Wheels service and the Home Nursing service. This enables the person's home to be brought up to a reasonably satisfactory state of hygiene and comfort. Many of the old people visited would undoubtedly receive more adequate care in an Old Person's Home, but one is naturally reluctant to use compulsory powers of removal in any but extreme cases. A great deal however can be done by persuasion and explanation. DAY CLUB FOR OLD PEOPLE For some time the Women's Voluntary Service has been considering building a 46 day club for old people on a site off the Greenford Road. Architects have now been employed to submit plans to the Borough Council for Bye-law and Town Planning consent and these should be ready in early 1964. The main purpose of the building will be to provide day-club facilities for the elderly and a kitchen large enough to prepare meals for club members and for the meals on wheels service. The full capacity of the kitchen is planned to provide 400 meals per day. HOLIDAYS FOR OLD PEOPLE Holidays for the elderly are arranged by the Women's Voluntary Service and the Greenford Philanthropic Society, supported by grants from the Borough Council. This valuable service provides both mental and physical recreation for those who would otherwise be unable to have a holiday. During the year the Women's Voluntary Service took 240 people to Bexhill-on-Sea, and the Greenford Philanthropic Society took an increased number of 50 to Ramsgate. Many letters of application have been received from the old people. SOILED LINEN CLEANSING SERVICE This service provides for the collection and washing of soiled linen from households where an incontinent person is being cared for. The service is provided by the Public Health Department in co-operation with the Baths Laundry Service. Applications for this service should be made to the Medical Officer of Health. Laundry is collected and delivered on Mondays and Thursdays and there is no charge to the applicant. I should like to acknowledge the continued help given by the Catholic Women's Guild in repairing worn linen and clothing. The table below shows the use made of this service during the past six years. 1958 1959 1960 1961 1962 1963 No. of new cases dealt with during the year 56 67 83 69 86 92 No. of cases remaining at end of year 38 39 42 34 41 38 No. of cases that died 35 31 48 30 42 30 No. of cases removed to hospital 22 41 30 22 31 32 No. of cases where other arrangements were made 2 3 16 3 33 Total number of articles dealt with 36,723 59,004 48,847 34,727 38,211 32,968 Total number of collections 2,766 4,822 2,954 3,058 3.041 2,899 Average number of articles per collection 13.3 12.2 16.5 11.0 12.6 11.37 LEAFLET OF SERVICES AVAILABLE As it was considered that the widest publicity should be given to the services available to the elderly in the Borough it was decided to produce, for distribution, a leaflet giving all the available information. The lay-out of the leaflet was kindly designed by students at the Ealing Technical College and School of Art. 16,000 copies were printed and distributed through the Ministry of Pensions Offices. The leaflet gives details of the most important services obtainable and judging by the number of additional copies required it would seem that it is of real value to the aged and those working for them. 47 SECTION 5 GENERAL ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT There are at present the following establishments in the Borough:— Chiropody only Chiropody and Special Treatment Massage only Physiotherapy only Osteopathic 9 11 1 2 1 During the year the Boards set up under the Provisions Supplementary to Medicine Act, 1960 have compiled their registers of those who are considered to be suitably qualified and entitled to use the designation "State Registered". It is to be hoped that the object of the Act, to provide for medical auxiliaries a guarantee of training and status, will be achieved. In respect of chiropody, I feel that Ealing has played some small part in this by the effort we have made to enforce standards in the Borough. NATIONAL ASSISTANCE ACT, 1948 Section 50—Burial of the Dead Ten burials were carried out during the year. In four instances the total cost was recovered, and in three part of the cost. The remaining three had to be written off as irrecoverable. REGISTRATION OF NURSING HOMES The Nursing Homes Act, 1963, came into operation in May, 1963. The main effect of the Act is to make it a requirement that all Nursing Homes in the Borough be registered with the Council. Under the previous legislation (Public Health Act, 1936) homes run by voluntary organisations on a non-profit making basis were exempt from registration. A secondary effect of the Act is to lay down standards which can be enforced. These are contained in The Conduct of Nursing Homes Regulations, 1963, and refer to the provisions of facilities and services generally. Efficient nursing care must be provided by day and night by a sufficient number of suitably qualified and competent staff. Accommodation must be reasonable, clean and in good repair and equipment and treatment facilities suitable for the type of patients received. There are provisions to limit the number of persons received into Nursing 48 Homes and the registration authority is empowered to prosecute for offences against the regulations. The total number of Homes now required to be registered by the Council is 10, with a total number of 296 beds. Although not previously required to register, there have been two non-profit making Homes in the Borough who elected to do so in the past. They did this because they felt that inspection by the Council assisted them in maintaining a high standard. The following is a list of Nursing Homes in the Borough. Alexian Brothers Nursing Home, Twyford Abbey, Twyford Abbey Road, N. W. 10. Carlton Nursing Home, 1 Carlton Road, Ealing, W.5. Cranborne Nursing Home, 105 & 107, Cowper Road, W.7. The Lady Margaret Nursing Home, 87 Mattock Lane, W.5. Methuen Nursing Home, 13 Gunnersbury Avenue, W.5. Nuffield Nursing Home, Hanger Lane, Ealing, W.5. Old Court Nursing Home, 19 Montpelier Road, Ealing, W.5. St. Anthony's Nursing Home, 40 Mount Park Road, W.5. St. David's Home, Castlebar Hill, Ealing, W.5. Servite House, Queens Walk, Ealing, W.5. MEDICAL EXAMINATIONS There are two classes of candidate for medical examination, those who seek permanent appointments in administrative, technical and clerical positions and those who are admissible to the Sickness Pay Scheme of the National Joint Industrial Council for Local Authorities Non-Trading Services. The latter scheme enables some employees to be accepted with reservations as to conditions for which sickness pay is granted when otherwise they would fail the examination. The following examinations were carried out during the year:— Administrative, Technical and Clerical staff 54 Sickness Pay Scheme (Servants) 87 Gunnersbury Park Joint Committee Employees 4 145 The Sickness Pay Scheme examinations may be further classified as follows:— No. examined Passed without reservation Passed with reservations 87 76 11 The conditions for which reservations were made were:— High Blood Pressure 3 High Blood Pressure and Varicose Veins 1 Hernia 1 Hernia and Varicose Veins 1 Mental Illness 4 Tuberculosis 1 49 SECTION 6 STATISTICAL TABLES SUMMARY OF STATISTICS Area (in Acres) 8,781 Population (Census, 1961) 183,151 Population (estimated middle of 1963) 183,120 Rateable Value, 1st April, 1963 £12,184,819 Net Product of a Penny Rate, 1963/64 (Est.) £50,000 Live Births:— Legitimate Males 1,385 Females 1,374 Total 2,759 Illegitimate Males 134 Females 111 Total 245 Birth-Rate per 1,000 of Estimated Population 16.4 Illegitimate Live Births (per cent of total live births) 8.2% Still-Births:— Males 28 Females 18 Total 46 Rate per 1,000 total Births (Live and Still Births) 15 Deaths:— Males 1,169 Females 1,131 Total 2,300 Death-Rate for 1,000 of Estimated Population 12.5 Deaths of Infants under one year of age— Legitimate Males 34 Females 15 Total 49 Illegitimate Males 5 Females 2 Total 7 Death-Rates of Infants under one year of age:— All Infants per 1,000 Live Births 18.6 Legitimate Infants per 1,000 Legitimate Live Births 17.8 Illegitimate Infants per 1,000 Illegitimate Live Births 28.5 Neo-natal Mortality Rate (deaths under four weeks per 1,000 total live births) 11.3 Early Neo-natal Mortality Rate (deaths under one week per 1,000 total live births) 11.7 Perinatal Mortality Rate (still-births and deaths under one week combined per 1,000 total live and still births) 24 Maternal Mortality (including Abortion) Rate per 1,000 Live and Still Births Nil 50 Cases of Infectious and Other Notifiable Diseases notified in the Borough Disease 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 Smallpox — —. — — — — — — — — — — Diphtheria — — 1 — — — — — — 1 — — Scarlet Fever 402 238 287 108 159 95 232 269 117 67 98 76 Enteric Fever (including Paratyphoid) 2 3 5 7 _ 1 — — 1 1 2 1 Puerperal Pyrexia 70 61 54 44 71 77 67 37 63 44 49 57 Pneumonia: Primary 100 157 152 135 113 72 94 97 30 37 45 68 Influenzal 28 74 52 56 48 99 57 57 16 33 24 29 Acute Poliomyelitis 21 13 5 61 46 2 2 — — 2 — 1 Meningococcal Infection — — 6 3 2 2 3 2 2 1 1 1 Malaria 1 3 1 1 — — 1 — — 1 — — Dysentery 179 132 225 149 193 252 244 194 261 127 90 199 Erysipelas 26 18 18 12 12 13 19 9 17 6 7 6 Tuberculosis: Pulmonary 211 205 132 119 134 113 97 109 89 93 70 89 Non-Pulmonary 29 20 17 24 13 16 8 10 18 10 6 11 Ophthalmia Neonatorum — — 2 2 2 5 6 3 3 2 1 — Measles 993 2,558 132 2,422 726 1,854 975 1,928 50 3,250 286 2,072 Whooping Cough 77 491 116 156 67 131 85 90 258 51 19 93 Food Poisoning 26 31 78 36 26 20 18 39 20 15 7 11 Totals 2,165 4,004 1,284 3,335 1,612 2,752 1,908 2,844 945 3,741 705 2,714 51 The number of cases of infectious disease originally notified sometimes varies due to changes of diagnosis and the following table is therefore given to show the final numbers after correction. Disease Disease Smallpox — Malaria — Diphtheria — Dysentery 199 Scarlet Fever 76 Erysipelas 6 Enteric Fever (including Paratyphoid) 1 Tuberculosis: Pulmonary 89 Puerperal Pyrexia 57 Non-pulmonary 11 Pneumonia: Primary 68 Ophthalmia neonatorum — Measles. 2,072 Influenzal 29 Whooping Cough 93 Acute Poliomyelitis 1 Total 2,712 Food Poisoning 9 Meningococcal Infection 1 52 Infectious and Other Notifiable Diseases Classified in Age Groups Scarlet Fever Whooping Cough Poliomyelitis Measles Diphtheria Dysentery Meningococcal Infection Paralytic Non-Paralytic M F F M F M F M F M F M F M F M Numbers originally notified 48 28 44 49 — — — 1 1,070 1,002 — — 92 107 — 1 FINAL number after correction: Under 1 year — — 1 1 — — — — 29 32 — — 5 2 — 1 1— 2 — 2 4 — — — — 114 86 — — 2 1 — — 2— 5 — 2 5 — — — — 164 142 — — 3 5 — — 3— 6 2 3 8 — — — — 122 127 — — 4 1 — — 4— 2 3 6 9 — — — — 158 153 — — 4 1 — — 5—9 26 19 16 18 1 — — — 464 436 — — 15 11 — — 10—14 3 2 12 4 — — — — 17 20 — — 7 4 — — 15—24 3 2 2 — — — — — 2 6 — — 16 23 — — 25 and over 1 — — — — — — — — — — — 36 59 — — Age unknown — — — — — — — — — — — — — — — — Total 48 28 44 49 1 — — — 1,070 1,002 — — 92 107 — 1 53 54 Pneumonia Smallpox Acute Encephalitis Enteric or Typhoid Fever Paratyphoid Fevers Erysipelas Food Poisoning Infective PostInfectious M F M F M F M F M F M F M F M F Number originally notified 50 47 — — — — — — 1 — — — 4 2 4 7 FINAL numbers after correction: Under 5 years 7 3 — — — — — — — — — — — — — — 5—14 5 3 — — — — — — 1 — — — — — — 1 15—44 10 16 — — — — — — — — — — 1 1 3 2 45—64 22 15 — — — — — — — — — 3 1 1 2 65 and over 6 10 — — — — — — — — — — — — — — Age unknown — — — — — — — — — — — — — — — — Total 50 47 — — — — — — 1 — — — 4 2 4 5 Tuberculosis Other Notifiable Diseases Respiratory Meningitis & C.N.S. Other Original Other M F M F M F M F M F Numbers originally notified 61 28 — — 5 6 — Puerperal Pyrexia 57 FINAL numbers after correction Under 5 years 2 1 — — — — 57 — 5—14 2 2 — — — — Ophth. Neonatorum 15—24 4 6 — — 1 1 25—44 20 9 — 3 2 Malaria 45—64 24 5 __ 1 2 65 and over 9 5 — — — 1 Total 61 28 — — 5 6 Anthrax TUBERCULOSIS Age Periods NEW CASES Pulmonary Non-Pulmonary 1958 1959 1960 1961 1962 1963 1958 1959 1960 1961 1962 1963 M F M F M F M F M F M F M F M F M F M F M F M F Under 5 1 2 1 2 — — 3 2 1 — 2 1 — — — — — — — — — — — — 5—14 1 1 4 — — 3 3 1 1 1 2 2 — — — — — — — — — — — — 15—24 16 10 10 10 9 5 10 9 6 3 4 6 __ 1 1 1 — 2 2 1 — 1 1 25—44 20 12 24 11 13 22 17 6 14 13 20 9 3 1 1 2 8 2 2 — 1 3 2 45—64 23 5 31 4 21 6 24 8 19 5 24 5 2 1 3 __ 3 2 1 2 2 1 2 Over 65 4 2 3 5 5 3 8 2 5 2 9 5 — — 1 3 — — — — — 3 — 1 Total 65 32 73 32 48 39 65 28 46 24 61 28 5 3 5 5 6 12 5 5 — 6 5 6 Age Periods DEATHS Pulmonary Non-Pulmonary 1958 1959 1960 1961 1962 1963 1958 1959 1960 1961 1962 1963 M F M F M F M F M F M F M F M F M F M F M F M F Under 5 — — — — — — — — — — — — — — — — — — — — — — — — 5—14 — — — — — — — — — — — — — — — — — — — — — — — — 15—24 — — — — — — — — — — — — — — — — — — — — — — — — 25—44 1 1 — — 2 — — 1 — — — 2 — — — — — — — — — — — — 45—64 2 2 1 2 3 1 2 2 4 1 4 1 — — — — — — — — — — — — Over 65 2 2 1 1 3 1 2 2 1 6 — — — — — — — — — — — 1 — Total 5 5 2 3 8 2 4 3 6 2 10 3 — — — 1 1 — — — — 1 1 — 55 DEATHS Causes of Death, 1963 Cause of Death Deaths, 1963 Total Deaths 1962 Male Female Total Tuberculosis, Respiratory 10 3 13 8 Tuberculosis, Other 1 — 1 1 Syphilitic Disease — — — 9 Diphtheria — — — — Whooping Cough — — — — Meningococcal Infections — — — — Acute Poliomyelitis — — — — Measles — — — — Other Infective and Parasitic Diseases 3 5 8 1 Malignant Neoplasm, Stomach 24 21 45 52 „ „ Lung, Bronchus 106 19 125 104 „ „ Breast — 42 42 49 „ „ Uterus — 20 20 15 Other Malignant Lymphatic Neoplasms 109 84 193 207 Leukaemia, Aleukaemia 9 7 16 7 Diabetes 5 8 13 14 Vascular Lesions of Nervous System 119 178 297 225 Coronary Disease, Angina 274 196 470 464 Hypertension with Heart Disease 12 19 31 24 Other Heart Diseases 105 173 278 240 Other Circulatory Disease 39 61 100 99 Influenza 1 4 5 7 Pneumonia 86 90 176 132 Bronchitis 102 48 150 126 Other Diseases of Respiratory System 14 11 25 16 Ulcer of Stomach and Duodenum 3 3 6 17 Gastritis, Enteritis and Diarrhoea 5 5 10 11 Nephritis and Nephrosis 5 5 10 4 Hyperplasia of Prostate 4 — 4 13 Pregnancy, Childbirth, Abortion — — — 1 Congenital Malformations 9 11 20 17 Other Defined and Ill-defined Diseases 71 78 149 129 Motor Vehicle Accidents 17 9 26 22 All other Accidents 24 14 38 33 Suicide 11 17 28 17 Homicides and Operations of War 1 — 1 — Totals 1,169 1,131 2,300 2,064 56 SECTION 7 SCHOOL HEALTH SERVICE I wish to thank the Area Medical Officer for enabling me to give an account of the work of the School Health Service in Ealing for the year. The very severe winter conditions made it necessary to close some schools for short periods due to the freezing of the water supply to the lavatories but it is satisfactory to report that the health of the children appeared to be unaffected by the exceptionally long and intense cold weather. Several outbreaks of winter vomiting occurred. This condition which occurs only during winter months is of unknown origin but may be caused by a virus. The striking features of this condition are the rapid onset and equally rapid recovery. The main symptom is of course vomiting and less frequently there is diarrhoea as well. Children may be apparently quite well on arrival at school and a few hours later be prostrate. Recovery is usually complete in one or two days. Although it is difficult to produce accurate figures, as winter vomiting is a condition which can easily be confused with similar ones, it is probable that some 600 children were absent from school at some time during the winter. Over 15 schools in the area reported sizeable outbreaks; two of them in fact reported numbers of over 100 affected. At Little Ealing Infants school there were 101 absences and at Cardinal Wiseman Mixed Secondary School there were 188 absences. Probably no school escaped entirely. ROUTINE MEDICAL INSPECTIONS Details of the three routine medical inspections carried out in schools are set out below. These are normally carried out during the first and last years at school and at the last year in primary school. Numbers Examined 1961 1962 1963 First age group 2,284 2,071 2,438 Second age group 1,754 1,989 2,017 Third age group 3,200 3,246 1,965 Total 7,238 7,306 6,420 Classification of General Condition Satisfactory 6,402 Unsatisfactory 18 Defects requiring Treatment found at Routine Medical Inspection 1961 1962 1963 Skin Diseases 562 445 478 Defective Vision 562 699 686 Squint 42 36 43 Defects of Hearing 43 135 97 Middle Ear Diseases 12 10 12 Nose and Throat Diseases 79 127 148 Speech Defects 39 45 51 Enlarged Glands 3 5 — Heart—Circulation conditions 11 24 12 Lung Diseases 39 38 46 Hernia 5 2 11 Postural Defects 13 18 30 57 Orthopaedic Foot Defects 58 113 126 Epilepsy 6 2 1 MINOR AILMENT CLINICS These clinics are used for the treatment of minor ailments in school children. They are also of value in the more detailed examination of defects and problems discovered at routine medical examinations at school, and those referred by teachers and parents between regular school inspections. Total attendances 528 HANDICAPPED CHILDREN The following table sets out in their various categories the number of handicapped pupils as at 31st December, 1963. In Special Day Schools In Special Residential Schools In maintained Primary & Secondary Schools Not at School Total M F M F M F M F M F Blind Pupils — — 3 2 — — 1 — 4 2 Partially-sighted Pupils 4 7 — 1 — — — — 4 8 Deaf Pupils — 2 2 3 — — — — 2 5 Partially Deaf Pupils 9 4 — 1 4 — — — 13 5 Educationally sub-normal Pupils 47 31 7 8 17 10 — — 71 49 Epileptic Pupils — — — 1 — — — 1 — 2 Maladjusted Pupils 33 11 44 14 6 3 1 1 84 29 Physically Handicapped Pupils 8 11 6 2 1 — 1 — 16 13 Pupils with Speech Defects — — — — 4 2 — — 4 2 Delicate Pupils 18 3 8 4 6 2 1 — 33 9 Pupils with Multiple Defects — — — — — — —— — — —— Total 119 69 70 36 38 17 4 2 231 124 EDUCATION ACT, 1944 Section 57 Cases dealt with under Section 57, Education Act, 1944 12 Section 57 relates to children who are so mentally handicapped that they are unable to benefit by education either at normal school or a special school for educationally sub-normal pupils. These children are referred to the mental health authorities for further care. Dependent on the degree of disability they may be admitted to training establishments where the emphasis is on manual skills rather than academic subjects, admitted to mental hospitals or remain at home in the care of their parents. The decision to refer a child to the mental health authorities is always reluctantly taken and whenever possible only after a trial period at one of the special schools for E.S.N, pupils. INFESTATION WITH VERMIN Number Examined 23,331 Number Infested 84 58 B.C.G. VACCINATION Details of school children offered protection against tuberculosis by B.C.G. vaccination through the approved arrangements under Section 28 of the National Health Service Act, 1946, during the year ended 31st December, 1963, are as follows:— 1. Number of children whose parents consented to participate 1,733 2. Number of those who were tested and found to be (a) Negative 1,446 (b) Positive 57 3. Number of those who were given B.C.G. vaccination 1,446 SPEECH THERAPY The Speech Therapy Department has had another busy year and the number of children referred has risen slightly. The year's figures are as follows:— Number on roll at 1st January, 1963 203 New cases during the year 93 Number discharged 71 Number on roll at 31st December, 1963 225 Number of attendances at Speech Therapy Clinics 2,625 The types of speech defect treated follow the established pattern:— 1. Dyslalia—omission or substitution of consonants 125 2. Development aphasia—delayed or absent speech 52 3. Stammering 34 4. Dysarthria—physical defects of the speech organs 5 5. Aphasia associated with mental subnormality 7 6. Disorder arising from deafness 1 7. Dysphonia 1 Speech therapy sessions are held at nearly all the Ealing clinics and treatment may be started where appropriate from about three and a half years of age. The Speech Class which caters for up to ten pupils with severe speech defects, has settled in to its new premises at Brentside Infants' School under the care of a new teacher, Mrs. I. Matyiaszek. During the year four children were admitted and six discharged. ASTHMA CLINIC Unfortunately, the work of the Asthma Clinic this year has been hampered by the absence of a Physiotherapist since Mrs. B. J. Kane left in September, 1963. A skeleton service has been continued by the physiotherapists who do orthopaedic work, but the anxious enquiries of parents have left us in no doubt about the need to continue a regular service of breathing exercises. During the year there were 707 attendances. FOOT HEALTH In 1962 the Health Education Department of the Middlesex County Council decided to make a film on the care of children's feet and asked for the help of this department. 1963 has seen the completion of this film. Directed by Dr. C. Hollman, photographed by Mr. Read, the technical assistant to the County's Healty Education Department, and with much advice from Dr. W. G. Booth, the film was in fact 59 finished in time to have its "premiere" in the Town Hall before Dr. Booth retired in October. The film was made primarily for use in schools in Middlesex and in particular for girls aged 10 to 12 years, but subsequent experience has shown that it is popular with younger children and also with parents. The film is called "52 Small Bones" which is the actual number of bones in any one pair of feet. It is in colour, lasts for 20 minutes, and has a music and sound commentary. From the very first the aim was to devise an attractive beginning and end, and to let the pictures tell the story as much as possible. The film starts by showing feet in action in many places as for example, a policeman on point duty, a window cleaner climbing his ladder, children paddling on the beach, and goes on to show that because of splashing vehicles, dirty pavements, broken milk bottles and other hazards, shoes have to be worn in this country. It contrasts the perfect feet of people living in the warmer parts of the world who wear no shoes, with foot deformity developing in girls of this country. It shows by diagrams and action shots, the anatomy and function of the human foot and how the latter is impeded by wearing high-heeled shoes. Interwoven among the facts is the story of two girls, Jane and Mary, who grow up together. Jane has a sensible mother who is seen taking the right sort of care of her daughter's feet. Mary's mother, however, is foolish and ruins her daughter's feet by letting Mary wear a pair of shoes for far too long a period so that they become too small for her, and later by allowing her to wear pointed casuals before she is 10 years old. Consequently by the age of 15 years Mary is found leaving a party long before Jane, as her feet are "killing" her, and the film goes on to predict that Mary will suffer a great deal in later life from her deformed feet. The film ends with a wedding, and a plea for the very best care of children's feet at all times. "52 Small Bones" has been well received so far, and there have been several enquiries about hiring or purchasing a copy of the film. This is very encouraging, for it is hoped that by this means the principles of good foot care should spread beyond Ealing and Middlesex to other parts of the country. The routine work of this department during the year is detailed in the following table:— Children inspected 5,593 Referrals to Doctor 93 Referrals to Chiropodist 55 Verrucae 46 Defective shoes 1,552 Everted ankles 83 Hallux Valgus 1,210 Tinea 44 ORTHOPAEDIC CLINIC Mr. J. A. Cholmeley, the Orthopaedic Consultant reports:— "The figures of attendances remain amazingly steady in all groups. Apart from statistics I do welcome the opening of the new orthopaedic department at Ravenor Park. It says a lot for the good temper and efficiency of all concerned that there was no falling off in the work done in the temporary accommodation while the rebuilding of the clinic was being carried out. 60 I look forward to the day when the Mattock Lane Clinic is rebuilt. The wooden hut in the garden has been used for over a quarter of a century for treatments by the physiotherapists and others. In this day and age it is out of place in an efficient borough such as Ealing; in addition with the new high closely surrounding buildings, it is becoming both dank and overlooked." During the year attendances were as follows:— Pre-School Children New Cases Re-examinations Total Attendance 1962 1963 1962 1963 1962 1963 75 82 178 178 253 260 School Children New Cases Re-examinations Total Attendance 1962 1963 1962 1963 1962 1963 69 75 260 235 329 310 EAR, NOSE AND THROAT SERVICE Mr. R. Savege, Consulting Otologist, reports "The figures for the year show a gradual diminution in each category, which can, I think, be taken as evidence that the general Ear, Nose and Throat health of the school child is improving." The statistical report is as follows:— 1961 1962 1963 Number of new cases 172 141 120 Number of re-inspections 313 319 237 Total attendances 485 460 357 Medical Treatment advised 253 199 114 Surgical Treatment advised 105 77 67 Audiometry Report 1961 1962 1963 Number of schools visited 32 57 48 Number of children tested 4,571 6,242 5,090 Number of children with hearing loss 134 183 156 Number referred to E.N.T. Specialist 78 84 59 OPHTHALMIC SERVICE Mr. G. Freeman-Heal, Consultant Ophthalmologist reports:— "The total number of cases seen was 925 (1962-907) of which 230 (1962-145) were new cases and 695 (1962-762) were re¬inspections. The number of pairs of glasses prescribed was 529 (1962-527)". Abnormal Eye Conditions other than Errors of Refraction were as follows:— Congenital Abnormalities New Cases Old Cases Squint 38 160 Congenital Nystagmus — 3 Ptosis — 1 Cataract — 2 Absence of punctum — 1 61 Occlusion of nasal duct 1 1 Defective extra-ocular muscles 2 — Progressive Myopia — 1 Persistent pupillary membrane 1 — Abnormalities due to Infection Sub-acute Conjunctivitis 1 — Retinitis (Toxoplasmosis) 1 — Blepharitis 1 — Meibomian Cyst 1 — Abnormalities due to Trauma Cataract — 1 Abnormalities of Unknown Etiology Macular Degeneration 1 1 ENURESIS SCHEME Nocturnal enuresis (bed-wetting) is a common and distressing condition among school-children. One effective form of treatment is by electric buzzer apparatus and the Area Health Department has for some years provided a scheme for the distribution of such apparatus to the parents of affected children. A number of machines are available for loan, free of charge, on receipt of a medical recommendation. A report giving details of the working of the scheme and the results obtained has recently been published by Dr. Taylor, Deputy Medical Officer of Health of Ealing and Assistant Medical Officer, Middlesex County Council and is reproduced below by kind permission of the Editor of The Medical Officer. A SCHEME FOR THE TREATMENT OF ENURESIS BY ELECTRIC BUZZER APPARATUS By L O. Taylor, M.A., M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officer, Area 7, (Ealing and Acton), Middlesex Methods for the treatment of nocturnal enuresis by electrical devices have been known for nearly 60 years. A number of devices have been available for private purchase or hire from commercial firms, but only in recent years has this form of treatment gained the general recommendation of the medical profession. Encouraged by reports of the successful treatment of large series of patients both in paediatric practice (Wickes, 1958) and in general practice (Gillison and Skinner, 1958), it was decided to establish a scheme for the distribution and use under supervision of electrical buzzer apparatus in the administrative health area of Ealing and Acton in the county of Middlesex. The area has a total population of approximately 250,000 and a school child population of some 30,000. Originally a small number of manufactured machines were purchased. The high price of these and reports of a home-made buzzer (Metcalfe 1959) led us to design and produce apparatus of our own with a consequent saving in running costs. This apparatus is described below. 62 TREATMENT OF ENURESIS BY ELECTRICAL BUZZER APPRARATUS WIRING CIRCUIT The scheme began in June, 1959. Since that time little has been reported of the use of electric buzzers by local authority health departments although they are probably being widely used by school and enuresis clinics. It is hoped, therefore, that a description of a scheme not based on local clinics will be of interest to other L.A. workers in this field. Administration The service is based on the area health office in Ealing and is in the immediate charge of the Deputy Superintendent Health Visitor who carries out all the necessary visiting herself. Referrals are received at the area office on a standard form from assistant medical officers or by letter from general practitioners. It is the concern of the doctor referring the child to carry out the necessary physical examination and to test the urine. When an apparatus is available the health visitor arranges to visit the home and demonstrate the use of the machine. A standard sheet of instructions is also left in case any difficulty should arise. Progress cards are supplied so that wet and dry nights may be recorded and as a guide to progress the time and size of the wet patch. The parents of the child are advised not to discontinue use of the apparatus until there has been a three-week period without wetting. The health visitor calls again at the home after one week to see that the apparatus is being used correctly. Her next visit will be some three to four weeks after this and if the child is not then dry further visits will be made at appropriate intervals. All children are visited again at an interval of between six months and one year after the buzzer has been removed. In addition by reason of her other duties the health visitor will have contact with many families outside these routine visits. The Apparatus We were fortunate in having a member of the staff who volunteered to design, make and keep in repair the requisite number of machines. It was found that 12 machines were necessary to avoid a waiting list. The wiring circuit is shown in the diagram (Fig. 1). The machine is housed in an Oxo or similar tin and the components required are a G.P.O. type relay, 6-volt dry battery, buzzer, light, switch, two yards of twin flex, and two crocodile clips. The cost of these components is about 21s. There is no charge to the patient. Experience has shown that the machine must be of robust construction with all wiring joints firmly soldered. Mats or pads used in conjunction with the machine are available in various patterns. Foil mats were used at first, but experience showed that these were liable to tear and we are now using the wire net type which proves more durable. Results At the time of writing 100 children have completed their treatment and have had a follow-up visit at least six months afterwards. This group comprised 62 boys and 38 girls. Their ages are given in Table I. 63 Table I Age 5-7 8-9 10-11 12-13 14-15 Males 22 10 15 10 5 Females 17 3 10 4 4 Total 39 13 25 14 9 When the buzzers were removed the children were either dry for a period of three weeks or thought unlikely to show improvement or further improvement. The results are shown in Table II. Table II Dry Improved Wet Males 34 15 13 Females 30 2 6 Total 64 17 19 Of the 100 children treated 64 had become dry. A further 17 were improved and 19 had made no improvement. Taking the dry and improved groups together a favourable response was found in 81 of the cases. Of the 19 children who were still wet when the buzzers were removed seven were five years old and the others were spread evenly over the age range up to 11 years old. While it is almost impossible to decide why a particular child has not responded to treatment the health visitor felt that a number of adverse factors could be identified. These were:— (a) Where both parents were working. This seemed to be associated with a lack of interest and supervision. Mothers had less time to give to their children's problems and were understandably less willing to get up at night when the alarm went off. (b) Parents of low intelligence. (c) Where a parent had himself or herself been an enuretic and grown out of it without or despite treatment. The assumption was that the child would do the same. This attitude had of course not prevented advice from being sought in the first place, but in the absence of a rapid cure was a bar to persistence in treatment. (d) Where a child was a very heavy sleeper. (e) Where a child showed evidence of laziness in other directions. (f) Where the child was of very anxious personality. At the follow-up visit at least six months later 11 of the dry children were found to have relapsed, as shown in Table III. 64 Table III Still Dry Relapsed Males 26 8 Females 27 3 Total 53 11 Of these, eight were boys and three were girls. Their ages ranged from 7 to 15 years. Relapses occurred for a variety of reasons, sometimes after a cold or some domestic excitement, School examinations coincided with some relapses and one child became wet again on leaving school to start work. The original improved and wet groups showed little change at follow-up although many had by then begun treatment by other methods. Of the 17 improved children 15 had maintained their improvement and two were more wet. The group of 19 wet children showed 17 who had remained wet and two who had improved. Discussion Having one health visitor in charge of a scheme such as this enables her to build uj& a considerable experience in a comparatively short time. This is of value in understanding the problems of enuretic children and the attitudes of their parents. Some parents, particularly those of low intelligence, require a great deal of encouragement to persevere with the use of the apparatus or indeed to start using it at all. An advantage over a clinic service is that the apparatus is installed and demonstrated in the place where it is to be used. This has been found reassuring to parent and child and most helpful in ensuring co¬operation. The amount of visiting required from the health visitor has not been so much that it could not be fitted in with her other duties. New cases have been referred at the rate of about three per month and each has required an average of about five visits. This works out at less than one enuresis visit per working day and although a wide area is covered it is possible to arrange many visits to fit in with other work. In a suburban area with a school child population of 30,000 the work involved does not seem to be too heavy an additional burden for someone willing to accept a specialised role of this nature. Making the machines within the department reduces the expense considerably. Certainly it is necessary to have a member of the staff with the requisite electrical knowledge and a willingness to give time to the project. The apparatus, however, is a relatively simple affair and can be assembled from its components in about one hour. Repairs can be speedily effected without having to send machines away and it is possible to build and keep sufficient machines in service to prevent a waiting list. The children referred have contained a large proportion in the youngest age group probably because awareness of the easy availability of the apparatus had led to its employment as soon as a child was considered to be an established enuretic. Although five years is thought an early age for this type of treatment and this group 65 had a relatively higher number of failures it is interesting to note that those children who did become dry did not figure among the relapses at follow¬up. The results generally seem to be satisfactory in that a favourable response within a short time was obtained in 81 per cent of the children treated. Allowing for children who relapsed into wetness and those who failed to maintain an improvement the overall response at follows-up was favourable in 68 per cent with a cure rate of 53 per cent. Despite some limitations the electric alarm seems likely to remain a popular treatment by reason of offering a cure or improvement to a majority within a comparatively short time. Summary A scheme has been described for the treatment of enuresis by means of the electric buzzer apparatus in a local authority area with a school child population of 30,000. The apparatus is constructed and serviced by a member of the area health office staff. The machine is demonstrated in the child's home by a senior health visitor who also does the follow¬up visits. Follow¬up visits at least six months after the end of treatment showed that 68 per cent of the children had responded favourably, 53 per cent being completely dry. Acknowledgements I wish to express my thanks to Dr. G. S. Wigley, County Medical Officer of Health, Middlesex, for permission to publish this article and to Dr. W. G. Booth, Joint Area Medical Officer, Area No. 7, Middlesex County Council, for his encouragement and advice during its preparation. I am also indebted to Miss C. M. Gwynne, Deputy Superintendent Health Visitor, who has carried out all the visiting and kept careful records, and to Mr. P. V. Wallis, Administrative Officer, who has designed and made the machines and supplied the electrical details. I wish to thank also those of my colleagues who have made helpful comments and criticisms. (Any expression of opinion in this article is that of the author and does not necessarily reflect the views of the Middlesex County Council.) References Wickes, I. G. (1958): Treatment of persistent enuresis with the electric buzzer. Arch. Dis. Child, 33, 160-4. Gillison, T. H., and Skinner, J. L. (1958): Treatment of nocturnal enuresis by the electric alarm. Brit. Med. ii, 1268-72. Metcalfe, J. B. (1959): "Do-it-yourself" enuresis alarm. Ibid ii, 1488. EALING CHILD GUIDANCE CENTRE Dr. P. Holman, Consultant Psychiatrist, reports that 189 patients were referred to the Centre in 1963, which is little different from the number the previous year (168). It is gratifying to be able to report that there has been an increased interest taken in the work of the Centre by the medical, educational and social services, the resultant 66 co¬operation with other workers being most rewarding. The number of urgent cases has continued unchanged whilst the proportion of young children seen has increased. The average age, nine years and two months, is the lowest for six years and the number of pre¬school children attending the clinic is the highest in the Centres records. There has been a corresponding increase in the number dealt with informally. These are satisfactory features as the staff of the Centre are always anxious to work with young children and their parents as this is truly preventive. ASTON SCHOOL Twelve children were admitted to Aston Primary School during the year (including four awaiting admission at the end of 1962). One child was awaiting admission at the end of 1963. The secondary department opened in September 1963 with seven children from the primary school and three recommended by the Child Guidance Clinic. We are very pleased to record the opening and successful first term of the secondary department which is fulfilling a most valuable function. REPORT ON THE SCHOOL DENTAL SERVICE IN EALING Mr. L. Mandeville, the Area Dental Officer reports:— "There was some dislocation of the Service in the beginning of the year owing to the inadequate temporary accommodation at Ravenor Park and continuing part-time staff changes at Mattock Lane. In the late summer the picture changed radically with the opening of the new and greatly admired dental suite at Ravenor Park and the appointment of two young ladies, Miss Matlach and Miss Preece, as full time dental officers. Modernisation of premises and equipment always leads to a rapid increase of patients of all ages and groups. Parents and the older children particularly expect the Dental Surgery to be modern and such equipment as air turbine dental engines are part of the public image of dental efficiency. Absenteeism continues to be a problem at some clinics and vigorous measures are being taken to try to reduce this. It would appear that absenteeism is not confined to the Dental Service and it is strange that parents do not appreciate the cost of wasted time when appointments are not kept. The demand for orthodontic treatment continues to increase and it is a tribute to our Orthodontists that a number of requests are received from private practitioners for treatment of their private-patient school children. Gratifying evidence of a change of attitude to dental health is that a number of schools have modified their "tuck shop" arrangements and are now selling apples instead of less desirable foodstuffs at mid-morning and mid-afternoon breaks. There is increasing public interest in dental health and fluoridation of public water supplies especially. A number of requests from various local groups for talks by the staff on these subjects have been received. A proper understanding by the public of the issues involved will lead to acceptance of and probably a demand for fluoridation of water supplies. 67 Although one full-time dental officer is due to retire next year, it is hoped that a period of stability and expansion has now begun for the School Dental Service in Area 7. Attendances Completing Treatment Fillings Permanent Teeth Fillings Temporary Teeth Extractions Permanent Teeth Extractions Temporary Teeth Orthodontic Treatment New Cases 15,112 5,005 9,723 3,744 406 170 3,582 MEDICAL EXAMINATION OF TEACHERS Number of Teachers examined as to fitness for appointments 69 68 SUPPLEMENT—FOR GENERAL INFORMATION HEALTH SERVICES PROVIDED BY THE LOCAL HEALTH AUTHORITY In Middlesex the Local Health Authority, under the National Health Service Act, is the Middlesex County Council. They have formed ten areas in the county, Ealing and Acton forming Area No. 7. I wish to thank the Area Medical Officer for enabling me to give an account of these services. MATERNITY AND CHILD WELFARE Ante-Natal Clinics Regular sessions for expectant mothers are held at the health clinics by doctors and midwives. Arrangements are made for blood testing, chest X-rays and for distribution of iron and vitamins. Mothers are also given the opportunity of attending ante-natal exercises and mothercraft classes. During the year 2,125 expectant mothers attended clinics in Ealing. Child Welfare Clinics Advice to mothers on the care of their children is given at Health Clinics by doctors and health visitors. There are seven medical officers and 24 health visitors engaged in this work in Ealing. Children are weighed at each attendance and a careful watch kept on all aspects of their progress. Welfare and other foods are distributed. In addition to the clinic work, home visiting by health visitors forms a useful link with the clinics. During the year 7,532 children attended clinics in Ealing. Ante-Natal Clinics (Interview by Appointment) Address Times Abbey Parade, North Circular Road, Ealing, W.5. Tues. mornings Brentside, Westcott Crescent, Hanwell, W.7 Thurs. mornings Cherington House, Cherington Road, Hanwell, W.7. Mon. mornings Greenford Green, Wadham Gardens, Greenford Mon. mornings Islip Manor, Eastcote Lane, Northolt Wed. mornings Laurel House, Windmill Road, Ealing, W.5 Wed., alt. Thurs. mornings Mattock Lane, 13 Mattock Lane, Ealing, W.5 Mon. Wed. Fri. mornings Northolt Grange, Edward Road, Northolt Fri. mornings Perivale, Horsenden Lane, Greenford Wed. mornings Ravenor Park, Oldfield Lane, Greenford Thurs, mornings Child Welfare Clinics Address Times Abbey Parade, North Circular Road, Ealing, W.5 Tues. Fri. 2—4 p.m. Brentside, Westcott Crescent, Hanwell, W.7 Thurs. 2—4 p.m. Cherington House, Cherington Road, Hanwell, W.7 Mon. Tues. Thurs. 2—4 p.m. Greenford Green, Wadham Gardens, Greenford Tues. Wed. Fri 2—4 p.m. Islip Manor, Eastcote Lane, Northolt Mon. Thurs. 2—4 p.m. Northolt Grange, Edward Road,Northolt Tues. Fri. 2—4 p.m. Laurel House, Windmill Road, Ealing, W.5 Mon. Thurs. 2—4 p.m. 69 Mattock Lane, 13 Mattock Lane, Ealing W.5 Mon. Wed. Fri. 2—4 p.m. Perivale, Horsenden Lane, Greenford Mon. Thurs. 2—4 p.m. Ravenor Park, Oldfield Lane, Greenford Mon. Tues. Wed. Fri. 2—4 p.m. HOME NURSING SERVICE There are 20 full-time Home Nurses and eight part time Home Nurses in Ealing, including two male nurses. During the year a total of 83,026 visits was made to 2,531 patients. The object of the service is to supply nursing care for those whose illness can be as well treated at home as in hospital. An increasing amount of the work is concerned with the elderly in helping to keep them in the community. Day and night nursing assistance is now available for patients with terminal carcinoma through the Marie Curie Foundation who will also provide grants for extra nourishment, etc. These services have been greatly appreciated. The services of a home nurse are available at the request of the patient's medical practitioner or hospital medical officer. Application should be made to the Area Medical Officer, Town Hall Annexe, Ealing, W.5. DOMICILIARY MIDWIFERY SERVICE There is a staff of 14 midwives in Ealing. There were 708 home confinements in Ealing in 1963 compared with 846 in 1962. The number of pupil midwives who received district training during the year was 20. Patients suitable for home confinement are those who, it is expected, will have an uncomplicated delivery and whose home circumstances are satisfactory. Because of the extra demand for maternity hospital beds a part-time domiciliary midwife has been appointed to nurse midwifery patients who can be discharged from hospital 48 hours after delivery. These patients are very carefully selected and are discharged only if both mother and baby are fit. This arrangement has reduced the number of maternity patients who have to be admitted to hospital through the emergency bed service. A heated portable incubator, with facilities for the administration of oxygen, is available to transport premature infants from home to hospital. The incubator is kept at the Boston Road Ambulance Station from where it can be sent to any part of the Borough where it is required. Applications for the services of a midwife should be made through a Maternity and Child Welfare Clinic. HOME HELP SERVICE The Home Help Service provides domestic help in time of illness. All normal household duties, including shopping, cooking, washing, cleaning, and looking after children are undertaken. There is an equivalent of 155 full-time home helps in Ealing. 70 At the end of the year there were over 965 cases receiving help. The order of priority is acute sick, maternity cases, tuberculosis and chronic sick and aged. Nevertheless, over 75% of those helped were old people. Payment is based on the patient's resources and ranges from no charge to 4s. 9d. per hour. The object of the service is to supplement assistance available from relatives, etc., and to tide patients over in emergency rather than supply permanent domestic help. During the year the night service was continued. Attendance is from 11 p.m. to 7 a.m. and the duties of the helper consist of sitting with and giving general care to the patient. This has proved most valuable. Applications for the services of either a day or night home help should be made, accompanied by a medical certificate, to the Area Medical Officer, Town Hall Annexe, Ealing, W.5. Family Help Scheme This service is designed to deal with three categories of cases. (1) The family help takes the place of the mother in her absence, assumes responsibility for the home, the children and the finances and resides at the home. (2) The family help takes the place of the mother in her absence, assumes responsibility for the home, the children and the finances in the day time only, but is non-resident. The father or other relative takes over at night. (3) The family help is employed for some part of the day to assist and advise the mother who, although resident with her family, requires to be taught how to manage her household affairs and to budget sensibly. The total number of cases dealt with during the year was 12 and this has been made up as follows:— In category (1) 3 In category (2) 1 In category (3) 2 A charge is made on a weekly basis according to the applicant's income and expenditure. Applications for the service should be made to the Children's Officer, Denmark House, Denmark Road, Ealing, W.13. Good Neighbour Scheme This service is to help cases that require attention outside the normal Home Help hours of duty. The Home Help who acts as a good neighbour attends a patient without fixed times so that assistance is given when needed. The Good Neighbour is paid according to the time involved up to a maximum of £2 a week the full charge to the patient being the same amount paid to the Good Neighbour but this can be reduced if the patient is unable to meet the full sum. At the moment we have seven Good Neighbours. It will be appreciated that it is not a job which is taken on lightly, implying as it does considerable responsibility for the patient. It also means that the Good Neighbour commits herself to being available during evenings and nights. The scheme has proved most helpful in cases where a suitable Good Neighbour who lives nearby has been prepared to undertake this work. 71 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 16 are accepted for a two years' training for the National Nursery Examination Board's Diploma. Admission of children is restricted to:— (i) Those whose mothers have of necessity to go out to work because they are the sole supporters, e.g. if they are widowed, divorced, separated or unmarried. (ii) Where the home conditions are unsatisfactory. (iii) Admission is arranged to include children who are physically handicapped, particularly those who are deaf or partially deaf, maladjusted, or partially sighted. Similarly, children whose parents are deaf or dumb and who would therefore lack the normal talking environment in the home, are admitted. In all these instances there is no charge to the parents. The nurseries are open from 7.30 a.m. to 6 p.m. A charge is made for this service on a sliding scale based on the parents' income. All applications for admission to a Day Nursery should be made to the Area Medical Officer, Town Hall Annexe, Ealing, W.5. CHIROPODY The County Council operate a Chiropody Service under Section 28 of the National Health Service Act in conjunction with the British Red Cross Society. Provision is made for a charge of 4s. to be made, but in most instances this is waived. Treatment given during the year was as follows:— British Red County Cross Society Council Total number of new patients 274 403 Total number of treatments 1,514 2,682 Number of patients receiving domiciliary treatment 186 68 Number of domiciliary treatments 1,119 247 Expectant and nursing mothers — 11 Physically handicapped persons —7 The service is provided at most of the Local Authority clinics, and some community centres, in addition visits are made to old people's homes. Where necessary ambulance transport can be provided. Treatment is given in the following places:— Clinics Cherington House, Cherington Road, Hanwell, W.7. Greenford Green, Wadham Gardens, Greenford. Islip Manor, Eastcote Lane, Northolt. 72 Laurel House, Windmill Road, Ealing, W.5. Mattock Lane, 13 Mattock Lane, Ealing, W.5. Ravenor Park, Oldfield Lane, Greenford. Brentside, Westcott Crescent, Hanwell, W.7. Community Centres Northolt—Manor House, Church Road, Northolt, Greenford. Northfields—71 Northcroft Road, Ealing, W.13. Perivale—Horsenden Lane South, Perivale, Greenford. Surgeries 120 Uxbridge Road, Hanwell, W.7. Private Surgeries at which the British 234 Northfield Avenue, Ealing, W.13. Red Cross conduct some sessions 129a Greenford Avenue, Hanwell, W.7. under the Middlesex scheme. Old People's Homes Northolt House, Haydock Avenue, Northolt. Kolbe House, Hanger Lane, W.5. Servite House, Queens Walk, W.5. St. Mary's Almshouses, Church Gardens, Ealing, W.5. Ealing Day Treatment Centre Green Lane, Hanwell, W.7. 73