AC 93334 / EAL56 The Health of the London Borough of Ealing in the year 1965 EAL 56 The Health of the London Borough of Ealing in the year 1965 being the ANNUAL REPORT of the Medical Officer of Health and Principal School Medical Officer I. H. SEPPELT, M.A., M.B., B.Chir., D.P.H., Medical Officer of Health and Principal School Medical Officer Town Hall Annexe Ealing, W.5 Telephone: Ealing 3456 LIST OF CONTENTS Page COMMITTEES AND STAFF 4 FOREWORD 11 1. VITAL STATISTICS 12 2. INFECTIOUS DISEASES 14 3. HEALTH CENTRES 19 4. CARE OF MOTHERS AND YOUNG CHILDREN 20 5. HEALTH CLINICS 21 6. DAY CARE OF CHILDREN 25 7. CARE OF THE UNSUPPORTED MOTHER AND HER CHILD 27 8. CO-ORDINATION OF SOCIAL SERVICES 28 9. FAMILY PLANNING 29 10. CERVICAL CYTOLOGY 30 11. MIDWIFERY 31 12. HEALTH VISITING 33 13. HOME NURSING 34 14. VACCINATION AND IMMUNISATION 36 15. HEALTH EDUCATION 38 16. RECUPERATIVE HOLIDAYS 39 17. CHIROPODY 40 18. CHEST CLINICS 42 19. MENTAL HEALTH 44 20. HOME HELP SERVICE 49 21. CARE OF THE ELDERLY 52 22. IMMIGRATION 56 23. SCHOOL HEALTH SERVICE 58 24. SCHOOL CLINICS 59 25. SCHOOL DENTAL SERVICE 71 26. GENERAL PUBLIC HEALTH MEASURES 74 27. HOUSING 83 28. FOOD HYGIENE AND FOOD AND DRUGS ADMINISTRATION 88 29. MEAT INSPECTION AND ANIMAL PROTECTION 96 30. CLEAN AIR 99 31. WATER SUPPLIES AND SEWAGE DISPOSAL 106 32. REGISTRATION OF PREMISES USED FOR MEDICAL PURPOSES 108 33. MORTUARY AND BURIAL ARRANGEMENTS 110 34. MEDICAL EXAMINATION AND WELFARE OF STAFF 111 TABLES 113 GRAPHS 137 INDEX 140 3 MEMBERSHIP OF COMMITTEES AT 31st DECEMBER, 1965 ENVIRONMENTAL HEALTH COMMITTEE Chairman—Councillor J. F. Barlow Vice-Chairman—Councillor A. K. Schollar The Mayor (Councillor D. J. Cousins, J.P.) (<ex-officio) Alderman G. W. Reynolds, M.P. Councillor M. J. Barber Councillor R. R. Clay Councillor E. W. J. Everett Councillor W. G. Hill Councillor W. G. Lamb Councillor Mrs. N. R. Law Councillor A. W. Morbey Councillor F. R. J. Rockhill Councillor E. J. Sheil Councillor Mrs. E. M. Stephens, M.A. Councillor A. W. Surry PERSONAL HEALTH SERVICES COMMITTEE Chairman—Councillor A. J. McCallum Vice-Chairman—Councillor Miss A. J. Saunders The Mayor (Councillor D. J. Cousins, J.P.) (<ex-officio) Alderman Mrs. M. T. Elliott Alderman A. Scott Councillor J. F. Barlow Councillor C. B. Cripps Councillor W. Feldman, LL.B. Councillor H. R. Hayselden Councillor C. C. Headey, J.P. Councillor W. G. Lamb Councillor Mrs. N. R. Law Councillor A. W. Morbey Councillor Mrs. E. L. Prodham Councillor A. K. Schollar Co-opted Members Dr. M. B. Clyne Dr. M. Murray Non-Council Members in an advisory capacity Miss M. M. Bark (appointed in her capacity as Matron, King Edward Memorial Hospital) Dr. E. I. Boxer (nominated by Middlesex Local Medical Committee) Miss M. Hillier (appointed in her capacity as Matron, Perivale Maternity Hospital) Mrs, W. E. Riddell (nominated by Ealing Association for Mental Health) Mr. A. Shotts (nominated by Middlesex Local Dental Committee) Mr. S. Simons (nominated by Middlesex Local Pharmaceutical Committee) EDUCATION (SPECIAL SERVICES) SUB-COMMITTEE Chairman—Alderman Mrs. M. Lorde Vice-Chairman—Councillor J. Haigh, J.P. Alderman J. Johnston Alderman A. Scott Alderman W. A. Whitbread, J.P. Councillor F. Bavister Councillor R. A. H. Eggleton Councillor F. G. Errington Councillor S. A. Goodman Councillor A. W. Morbey Councillor T. W. Newson, J.P. Councillor Mrs. E. L. Prodham Councillor P. G. Southey Co-opted Members Mrs. G. Barnes, B.A. Mr. J. H. Murray, J.P. Rev. M. R. Parsons, M.A. Mr. R. F. Turnham Mrs. Rex White 4 STAFF OF THE HEALTH DEPARTMENT (as at 31st December, 1965) Medical Officer of Health and Principal School Medical Officer I. H. Seppelt, M.A., M.B., B.Chir., D.P.H. Deputy Medical Officer of Health I. O. Taylor, M.A., M.R.C.S., L.R.C.P., D.P.H. Principal Medical Officers Kathleen M. Hart (School Health), M.D., B.S., D.P.H. Margaret Heller (Mental Health) M.D. (Vienna), L.R.C.P., L.R.C.S., L.R.F.P.S., D.C.H. Catharine E. Hollman (Maternal and Child Health), M.B., B.S., M.R.C.S., L.R.C.P., D.R.C.O.G., D.P.H. Consultant Medical Officer G. E. B. Payne, M.D., B.S., M.R.C.S., L.R.C.P., D.P.H. Chief Administrative Assistant K. F. Maplesden DENTAL SECTION Chief Dental Officer and Principal School Dental Officer L. C. Mandeville, L.D.S., R.C.S. Senior Dental Officer Miss I. M. M. Cameron, L.D.S., R.C.S. Dental Officers—Full-time J. C. Robertson Miss E. S. Cosh J. Finmark D. J. Hughes Miss D. T. Matlach Miss K. M. F. Robinson Dental Officers—Part-time Miss A. H. Daniels H. R. Phillips M. J. Skillicorn S. A. Khan J. K. Chmielewski Orthodontists R. A. S. Tipper Mrs. E. W. Lindon {Part-time) Other Dental Staff—Establishment 1 Dental Auxiliary 1 Senior Dental Surgery Assistant 13 Dental Surgery Assistants 3 Orthodontic Dental Surgery Assistants 5 ENVIRONMENTAL HEALTH SECTION Chief Public Health Inspector A. E. Pooley, M.A.P.H.I. Deputy Chief Public Health Inspector M. Dowie, M.A.P.H.I. Divisional Inspectors R. W. McDonald G. W. Burden S. Sadler A. C. Bamping E. W. Budd D. A. Parker Supervisory Meat Inspectors W. G. Collam J. R. Glover D. F. W. Rands Other Staff—Establishment 29 Public Health Inspectors 8 Authorised Meat Inspectors 3 Technical Assistants 1 Assistant Rodent Officer 4 Rodent Operatives 1 Senior Meat Inspector's Assistant 2 Meat Inspector's Assistants 4 Trainee Meat Inspectors 6 Trainee Public Health Inspectors 1 Senior Driver/Disinfector 5 Driver/Disinfectors COMMUNITY CARE SECTION Principal Mental Health Social Worker R. R. P. Mundon Deputy Principal Mental Health Social Worker Z. R. Sliwinski Other Mental Health Staff—Establishment 1 Casework Supervisor 1 Senior Mental Health Social Worker 8 Mental Health Social Workers Adult Training Centre 1 Supervisor Instructor 3 Instructors 6 COMMUNITY CARE SECTION—continued Home Help Organiser Miss A. M. Choat Other Home Help Staff—Establishment 6 Assistant Organisers Equivalent of 260 Full-time Home Helps Chest Clinic Chest Physician H. Climie, M.D., Ch.B., D.P.H. Other Chest Clinic Staff—Establishment 1 Welfare Officer 5 T.B. Health Visitors 1 Occupational Therapist (Part-time) Mortuary 1 Mortuary Keeper 1 Mortuary Attendant Chiropody—Establishment 4 Chiropodists SCHOOL HEALTH AND MATERNAL AND CHILD HEALTH SECTION Assistant Medical Officers Margaret F. Fry, M.B., B.Ch., B.A.O., D.C.H. R. D. Gross, M.D., D.P.H., D.T.M. & H. Margaret R. McDonald, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Teresa J. Posmyk, M.B., B.Ch., D.P.H. Grace A. M. Webster, M.B., Ch.B., D.P.H., D.Obst.R.C.O.G. Norma C. Theobalds, M.B., B.S., M.R.C.P.(Glos.), D.C.H. Chief Nursing Officer—Health Visiting Miss A. M. Beck-Slinn Deputy Chief Nursing Officer—Health Visiting Miss C. M. Gwynne Senior Divisional Health Visitor Miss J. D. McFarlane Divisional Health Visitors Mrs. J. M. Noble Mrs. N. Zinkin Other Staff—Establishment 50 Health Visitors 12 Clinic Nurses 5 Student Health Visitors Chief Nursing Officer—Home Nursing and Midwifery Vacancy 7 SCHOOL HEALTH AND MATERNAL AND CHILD HEALTH SECTION—continued Deputy Chief Nursing Officer—Home Nursing Miss W. E. Lawrence Deputy Chief Nursing Officer—Midwifery Miss W. E. A. Sanders Other Staff—Establishment 45 Home Nurses 22 Midwives Medical Social Worker Mrs. M. E. Seager Mother and Baby Home Matron Miss M. N. Cuddiford Other Staff—Establishment 1 Deputy Matron 1 Nurse 4 Attendants 1 Night Duty Attendant 1 Cook/Housemother 1 Handyman Day Nurseries (5) Supervisory Matron Miss H. Ogden Matrons Miss J. Webster Mrs. L. Rawes Mrs. E. Collins Miss P. Bell Miss G. Houlton Other Day Nursery Staff—Establishment 5 Deputy Matrons 5 Wardens 28 Nursery Nurses 8 Nursery Students 5 Cooks 8 Domestic Assistants Medical Auxiliaries, etc.—Establishment 1 Senior Speech Therapist 3 Speech Therapists 3 Physiotherapists 1 Orthoptist (Part-time) 3 Audiometricians Domestic Staff Employed in Clinics—Establishment 4 Caretakers 1 Stoker/Porter 12 Cleaners 8 ADMINISTRATIVE AND CLERICAL STAFF Deputy Chief Administrative Assistant H. J. Reed Senior Administrative Assistants Community Care Section D. E. Storr Environmental Health Section J. Burrows Maternal and Child Health Section Miss A. I. Coyle-Williams School Health Section P. V. Wallis General Administration Section J. James Other Administrative and Clerical Staff—Establishment Administrative Assistants 13 Secretaries 2 Clerical Assistants 18 Clerks 54 Shorthand-Typists 8 9 Foreword 7th December, 1966. Mr. Mayor, Aldermen and Councillors, I have the honour to submit the first Annual Report of the Medical Officer of Health of the London Borough of Ealing. The former Municipal Boroughs of Acton, Ealing and Southall were amalgamated to form the London Borough on the 1st April, 1965, and this Report covers the period from that date until the end of the year. As was expected, this time has been largely taken up with consolidating the Environmental Health Services of the Municipal Boroughs with the Personal Health Services which passed to the new Borough from Middlesex County Council. This has now been achieved and we are in a position to proceed to the stage of improving the services and remedying deficiencies. I have endeavoured to make this first Annual Report a comprehensive account of the Borough's Health Services. This I trust will be of value not only to the Council but also to others in the Borough engaged in the various parts of the National Health Service. Local health services in Ealing are now really local, and it is important that their extent should be known. I would, in conclusion, like to thank the members of those Committees of the Council concerned with its health services, together with the staff of the department, for their help in what would otherwise have been a much more difficult year. Your obedient servant, I. H. SEPPELT, Medical Officer of Health. 11 1. VITAL STATISTICS SUMMARY OF STATISTICS Area (in acres) 13,708 Population (Census, 1961) 299,762 Population (estimated middle of 1965) 303,660 Rateable value, 1st April, 1965 £23,003,684 Net product of a penny rate, 1965/66 (estimated) £92,500 Live births:— Legitimate males 2,593 Females 2,431 Total 5,024 Illegitimate males 274 Females 254 Total 528 Birth-rate per 1,000 of estimated population 18.3 Illegitimate live births (per cent of total live births) 10.5% Still-births:— Males 49 Females 32 Total 81 Rate per 1,000 total births (live and still-births) 14 Deaths:— Males 1,728 Females 1,722 Total 3,450 Death-rate per 1,000 of estimated population 11.4 Deaths of infants under one year of age:— Legitimate males 50 Females 39 Total 89 Illegitimate males 4 Females 6 Total 10 Death-rates of infants under one year of age:— All infants per 1,000 live births 17.8 Legitimate infants per 1,000 legitimate live births 17.7 Illegitimate infants per 1,000 illegitimate live births 18.9 Neo-natal mortality rate (deaths under four weeks per 1,000 total live births) 11.9 / Early neo-natal mortality rate (deaths under one week per 1,000 total live births) 10.4 Perinatal mortality rate (still-births and deaths under one week combined per 1,000 total live and still-births) 24.7 Maternal mortality (including abortion):— Number of deaths Nil Rate per 1,000 live and still-births Nil 12 CAUSES OF DEATH Cause of Death Deaths, 1965 Total Deaths 1964* Male Female Total Tuberculosis, respiratory 5 5 10 9 Tuberculosis, other 1 2 3 1 Syphilitic disease 1 1 2 4 Diphtheria — — — — Whooping cough 1 — 1 — Meningococcal infections — — — — Acute poliomyelitis — — — — Measles 1 — 1 — Other infective and parasitic diseases 1 5 6 6 Malignant neoplasm, stomach 52 25 77 82 Malignant neoplasm, lung, bronchus 178 31 209 190 Malignant neoplasm, breast — 67 67 66 Malignant neoplasm, uterus — 23 23 16 Other malignant and lymphatic neoplasms 156 158 314 362 Leukaemia, aleukaemia 10 14 24 22 Diabetes 9 13 22 18 Vascular lesions of nervous system 141 227 368 402 Coronary disease, angina 433 294 727 663 Hypertension with heart disease 18 39 57 73 Other heart disease 132 214 346 346 Other circulatory disease 95 131 226 198 Influenza — 2 2 4 Pneumonia 104 163 267 261 Bronchitis 152 49 201 187 Other diseases of respiratory system 17 17 34 27 Ulcer of stomach and duodenum 21 10 31 27 Gastritis, enteritis and diarrhœa 7 13 20 18 Nephritis and nephrosis 11 8 19 9 Hyperplasia of prostate 7 — 7 15 Pregnancy, childbirth, abortion — — — 1 Congenital malformations 12 18 30 29 Other defined and ill-defined diseases 91 142 233 263 Motor vehicle accidents 26 9 35 49 All other accidents 27 25 52 52 Suicide 19 17 36 42 Homicides and operations of war — — — 1 Totals 1,728 1,722 3,450 3,443 *A11 three former Boroughs. 13 2. INFECTIOUS DISEASES The prevention of spread of infectious disease is achieved by a system of notification of cases and the subsequent control of cases and contacts. NOTIFICATIONS The following diseases are notifiable in the London Borough of Ealing:— (1) Under the Public Health Act, 1936, medical practitioners are required to notify smallpox, cholera, diphtheria, membranous croup, erysipelas, scarlet fever, typhus, typhoid, enteric and relapsing fever. (2) The Minister of Health has also made regulations under the Public Health Act whereby also notifiable are plague, acute poliomyelitis, tuberculosis, puerperal pyrexia, ophthalmia neonatorum, malaria, dysentery, acute primary pneumonia, acute influenzal pneumonia, anthrax measles, whooping cough, acute encephalitis and meningococcal infection. (3) Under a Special Order made by the Council during the year and confirmed by the Minister of Health, infectious hepatitis is also notifiable. (4) Food poisoning is notifiable under the provisions of the Food and Drugs Act, 1955. (5) 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. CONTROL It might be thought that with the lessening in incidence and severity of many infectious diseases that there would be a corresponding decrease in importance of this aspect of the work of a Health Department. This, however, is not the case. It is true that many diseases have altered radically over the last 30 years, smallpox and diphtheria for example being now a rarity, and scarlet fever, whilst still fairly common, has become a mild disease. Although I consider there is a great need for some re-thinking on the necessity for control measures for certain diseases, in general constant attention must still be paid to measures of control if a satisfactory position is to be maintained. The principle of control of a serious infectious disease is that as soon as a notification is received a detailed picture of the patient's movements, immediately prior to and during his illness, must be built up in the shortest possible time. The purpose of this is to compile a list of contacts so that they may be traced and kept under surveillance until it is certain that they have not been infected. It may be necessary to restrict their movements during this time if they are in any way a potential cause of spread. This measure is always of importance, but where a contact is employed in the food trade or with young children it is doubly so, since these are circumstances which possess the potential for extensive spread. In the case of intestinal diseases, contacts may become carriers and although symptomless themselves carry and can pass on the infecting organisms. Laboratory testing is required to determine when they are no longer a danger, and surveillance must continue until this is so. 14 The great increase in interchange of populations and the speed with which air travel enables this to take place has increased the need for control of infectious disease and at the same time adds to the difficulty of accomplishing this. ANTHRAX This is a disease sometimes contracted by those who work with animals and animal products. During the year, the Ministry of Health drew attention to the value of vaccination against anthrax for workers exposed to special risks of contracting the disease. The workers mainly concerned are those in establishments such as tanneries, glue, gelatine, soap, and bone-meal factories, and woollen mills who regularly handle certain raw materials. Investigation revealed that there were no factories within the Borough where such workers were employed but, nevertheless, action was taken to advise local general practitioners of the desirability of anthrax vaccination in certain cases and the facilities available. DIPHTHERIA No cases occurred during the year. It was, however, necessary to take action in respect of a possible contact of the disease, a traveller from Pakistan who arrived here on business and was notified to us as having been in contact with a colleague suspected of having diphtheria. Arrangements were made for him to be restricted to his home and for laboratory tests to be carried out. The results of these were negative. DYSENTERY This is a disease which usually betokens faulty personal hygiene. Fortunately, there was no major outbreak, but the notification of 235 isolated cases is higher than one would wish. Three persons in food premises within the Borough, who were contacts of Sonne dysentery, were excluded from work until laboratory tests had shown them to be free from infection. Compensation was paid by the Council for loss of earnings. ERYSIPELAS Eleven persons were notified as suffering from this infectious skin condition. FOOD POISONING Twenty-seven cases of food poisoning were notified during the year, of which only three were confirmed by bacteriological examination. In all of these three cases the organism was salmonella typhimurium. Although the number of cases is small there is no ground for complacency since it seems likely that this illness is much more widespread than the notification figures would suggest. Many cases, I suspect, remain unrecognised, the symptoms being of a mild nature and not leading the person involved to seek medical advice. A one-year-old child was discovered to be a carrier of salmonella typhimurium. She was kept under surveillance over a period of four months until tests showed she was free from infection. An account will later be given of the Borough's Clean Food campaign, and it is here I am confident that the solution to the problem of food poisoning lies. INFECTIOUS HEPATITIS This disease became notifiable in the former Borough of Southall on the 1st October, 1964, following the occurrence of a considerable number of cases in the district 15 during the preceding year. In view of the amalgamation it was necessary to decide whether to allow the Order to lapse or extend it to cover the whole of the new borough. The Council decided that, in view of the lack of knowledge of the incidence of this disease in the community and of the efficacy of the control measures, the opportunity to endeavour to remedy this should not be lost. It accordingly made an Order under Section 147 of the Public Health Act, 1936, declaring Infectious Hepatitis to be a notifiable disease in the London Borough of Ealing. The Minister of Health confirmed the Order, which became operative on the 1st November, 1965, and will continue in force for a period of three years from that date. The decision as to what information should be collated and what control measures should be adopted were taken after consultation with the Medical Research Council and are in conformity with World Health Organization practice. They can be summarized as follows:— (1) A Public Health Inspector visits the household to give advice on the appropriate hygiene measures which should be adopted. (2) Arrangements are made for the patient's linen and clothing to be disinfected by boiling or autoclaving whenever possible. (3) Contacts are not excluded from work, with the exception of school meals workers who, if they have a case in the family, are excluded from work for one month. (4) In the event of any contact being an expectant mother, a protective injection of gamma globulin is offered subject to the discretion of the patient's own doctor. It is thought that this substance gives a measure of protection, and trials of its efficacy are at present being conducted by the Medical Research Council. Ealing cases will form part of this trial. Thirteen notifications were received during the period from the 1st November until the end of the year. MALARIA There were no cases notified. MEASLES This disease characteristically has a high incidence in alternate years. 1965 was a "high incidence " year and 3,618 notifications were received. MENINGOCOCCAL INFECTION One case, a child aged five years, was notified. The patient was treated in hospital and made an uneventful recovery. OPHTHALMIA NEONATORUM This disease has in the past been responsible for much blindness in the newborn and it is satisfactory to know that no cases occurred during the year. PNEUMONIA Forty-one cases were notified during the year. This disease is one of those which the advent of antibiotics has made so much more amenable to treatment, and less grave in outlook than formerly. POLIOMYELITIS No cases were notified during the past year. It is most gratifying to be able to make a nil return of a disease which has been responsible in the past for much 16 death and disability. There seems no doubt that the major reason for this state of affairs is the introduction of immunisation in 1957, and its acceptance by the general public. PUERPERAL PYREXIA There were 42 notifications, six cases occurring in home confinements and 36 in hospital confinements. It must be borne in mind that the percentage of hospital confinements considerably exceeds that of home confinements, and includes the cases most liable to suffer from puerperal pyrexia. SCARLET FEVER There were 124 cases. Not very long ago this disease was responsible for filling many beds in infectious disease hospitals. It is now a much milder condition, partially due to antibiotics, but at least in part probably due to some natural decline in virulence of the organism. With the exception of one case, all were nursed at home. SMALLPOX There were no cases notified during the year. Sixteen people arrived by air and 15 by sea from smallpox areas without being able to produce valid certificates of vaccination. All were kept under daily surveillance until the fourteenth day from the last day of possible contact. TUBERCULOSIS Although this disease has been partly affected by improved living conditions and the discovery of new drugs, there is still no cause for complacency since during the year 129 cases of pulmonary tuberculosis were notified and 42 cases of non-pulmonary tuberculosis. TYPHOID FEVER Although chemotherapy has markedly reduced the fatality rate of this intestinal disease the occurrence of a case must still be regarded with concern. The ultimate cause of all cases is a human source of infection and outbreaks take two possible forms:— (1) Those in which infection is passed directly from patient to contact. Such outbreaks usually include only a small number of persons. (2) Those where water or food supplies have been contaminated producing an explosive outbreak, involving large numbers of people. There were in Ealing three cases notified, all of which, fortunately, fell within the first category. The first was a woman, aged 24 years, who was immediately admitted to hospital. Investigation at her home revealed that another 12 people were living there and that four of them were employed in food premises. These food handlers were excluded from work and young children were excluded from school. Investigation led to the belief that the infection was likely to have originated from a carrier, but the source was not identified. No other case occurred as a result of this case. The second case was that of a boy, aged 2-J- years, who was admitted to a general hospital with a provisional diagnosis of broncho-pneumonia, but on a diagnosis of typhoid being made he was transferred to an isolation hospital. All home contacts were traced and it was found, in addition, that the patient had recently been cared for by a foster-mother whilst his mother was in hospital for a confinement. All contacts of this household were also traced. Several adult contacts of this case were 17 B employed in various capacities in the food trade and were excluded from their employment. Also excluded from normal duties were two of the Council's health visitors and two of its child care officers, all of whom had been in contact with one or other of the households concerned during the relevant period. No secondary cases occurred. The source of the infection was undoubtedly the child's father, who is a known carrier of the disease. He has received a course of drug treatment in an attempt to clear him of this condition, and a check is kept on him to ensure that he is not employed in the food trade at any time. The third case was a student, aged 16 years, who became ill after returning from a holiday in France with her family. She was admitted to hospital where typhoid fever was confirmed. The contacts of this case were mostly her school friends who were traced and excluded from school until proved free from infection. It is almost certain that in this instance the disease was contracted whilst on the Continent. In addition to these cases occurring in the Borough we were concerned with the contacts of cases occurring elsewhere. The first incident concerned two men who were employed within the Borough in a food factory who had been in contact with a case of typhoid fever elsewhere. They were excluded from work for a period of one month. During the autumn we were informed of a confirmed case of typhoid fever in a holiday camp, where, amongst the guests, were 54 Ealing residents. Every contact was visited and advised of the situation and their family doctors given relevant information. Routine surveillance was undertaken and a number of food handlers and school children were excluded. Full statistical information is set out in Table 1 at the end of this report. 18 3. HEALTH CENTRES The provision of Health Centres was an integral part of the National Health Service when first planned. Such centres were to be provided by local authorities and from them would function their own services, together with general practitioner, general dental, pharmaceutical and hospital specialist or other out-patient services. Although Section 22 of the Act made it a duty to provide Health Centres, in practice few have materialized. I am aware of the many difficulties which would have to be surmounted before a centre could be provided in the Borough, but I feel that the prize merits the effort. Over the next 10 years the Council will need to replace many of its health clinics and it has adopted the following plan in respect of this:— "Health Clinics (providing only Local Authority services) should be replaced by Health Centres (providing Local Authority and General Practitioner services). It may be that the general practitioners in the catchment area of a clinic about to be replaced are reluctant at that stage to co-operate in such a scheme. In this case land should be set aside and the design of the building should be such that it allows later addition of accommodation suitable for use by general practitioners." With this resolution in mind, a sub-committee of the Personal Health Services Committee will shortly begin a series of exploratory discussions with interested persons and organizations in the Borough. I am hopeful that they will reveal a willingness to enter into partnership with the Council in the provision of a first centre. 19 4. CARE OF MOTHERS AND YOUNG CHILDREN Mothers and young children constitute a priority group of the community for which the local health authority provides a comprehensive service of medical and social care, the extent of which, under the National Health Service Act, 1946, is as follows:— Section 1. The provision of health clinics in which ante-natal, post- natal and child welfare sessions are held 2. The provision of day nurseries 22 3. The care of the unsupported mother and her child 4. The provision of family planning facilities 5. A domiciliary midwifery service 23 6. A health visiting service 24 7. Vaccination and immunisation 26 8. The provision of cervical cytology 28 9. Home help service 29 and, in addition, under the Nurseries and Child-Minders Regulation Act, 1948, the registration of private day nurseries and child minders. It is these services which over the years have done so much in reducing the infant and maternal mortality rate from the high level of half a century ago. The need for even further improvement remains. Details of the services are contained in their individual sections. 20 5. HEALTH CLINICS There are 18 health clinics in the Borough situated with the aim that every mother should be within pram-pushing distance of one of them. The range of the Council's services for the mother and child provided at these clinics includes sessions for ante-natal and post-natal care, child welfare, immunisation and vaccination, family planning, dental care, speech therapy, chiropody and physiotherapy. The health clinics are staffed by a medical officer, dental officer, health visitors and clinic nurses. In addition, they form the centre from which is carried out the domiciliary work of the surrounding district, namely, home nursing and midwifery and the visiting of children at home by health visitors. Of the Borough's 18 clinics, seven are purpose built, the remainder being conversions, carried out with varying success. Seven clinics are scheduled for replacement in the next 10 years, and I have already given my views on their replacement. Detailed accounts of the various services provided at clinics are given either below or as part of other sections of this report. A complete timetable of clinic sessions appears as Table 2. ANTE-NATAL AND POST-NATAL SESSIONS The arrangements provided for ante-natal care in this country at present are sometimes found confusing. Thus a mother may have her baby at home or in hospital and in each case her ante-natal care may be undertaken either by her family doctor or by one of the Council's medical officers at a health clinic—four possible combinations. In practice in Ealing the majority of mothers either have hospital confinements with the ante-natal care undertaken by their family doctor, or have home confinements with the ante-natal care shared between the family doctor and the midwife who will undertake the delivery. The lack of sufficient obstetric beds in the Ealing district necessitates very careful consideration by the medical officer of the medical and social factors in each case before any patient can be booked for a hospital or home confinement. As, however, a well-established relationship exists between the clinic staff and the obstetric units in the area and the criteria for allocation of hospital beds is well understood by all concerned, few booking difficulties are encountered. Once the decision is made, the patient is booked at a hospital, or with the midwife for delivery, and continues to attend the ante-natal sessions at regular prescribed intervals. All expectant mothers having their first babies are invited to take part in the ante-natal classes organized by the health visitors as a preparation for childbirth and in infant care. These are very popular and help to dispel the fear of having a baby. Following delivery, mothers return to the clinics for their post-natal examination as an alternative to going back to the hospital. The figures for attendance in 1965 were as follows:— 2,209 patients attended the clinics for their ante-natal care 401 patients attended the clinics for their post-natal care 820 expectant mothers attended the ante-natal classes. 21 CHILD WELFARE SESSIONS As part of the general arrangements for the care of mothers and children the Council provides child welfare clinics at which teaching in infant feeding, general care and mothercraft are given by the medical officer and the health visitor. The medical officer is responsible for examining all the new babies and being concerned with feeding problems, behaviour difficulties, and the follow-up of all children needing medical supervision. Should a baby develop severe and prolonged feeding difficulties, accommodation in a residential mothercraft training home can be arranged for the mother and child. When children reach their first birthday, then and on subsequent birthdays until the age of five, they are sent an attractively designed birthday card. This contains a request for the mother to bring the child to the clinic for a "birthday check". By this means the medical officer is able to determine the developmental progress of each child and to assess if there is any departure from normal. An important item in the work undertaken at child welfare sessions is the keeping of the Observation Register. It is known that certain factors in the ante-natal and post-natal history of a child place that child "at risk" of developing an abnormality or handicap, and for such children an observation register is kept at each clinic. The medical officer keeps children on this register under surveillance and examines them where possible at regular intervals in a systematic way, e.g., by performing the Sheridan hearing test at the age of six months. Should any impairment of development be detected the child is referred to a specialist unit for a complete assessment. "At risk" children who are not brought to the clinic are observed at home by the health visitors. During the year, 906 children were added to the Observation Register, being 15 per cent, of all births in the Borough. The total at the end of the year was 2,454. A register of all babies born with a congenital malformation is kept. This information is obtained from the Notification of Birth. During the year, 71 cases were notified and they fell into the following categories:— Central Nervous System Anencephalus 4 Encephalocele 1 Arnold Chiari malformation 1 Hydrocephalus 1 Meningocele 2 Spina Bifida 4 Ear Minor defect 1 Alimentary System Cleft palate 4 Hare lip 1 Oesophageal atresia 1 Diaphragmatic hernia 1 Uro-Genital System Hypospadias 1 Defect of kidney 1 Other defects 3 Limbs Dislocation of hip 2 Polydactyly 1 Talipes 25 Other defects 13 22 Other Malformations Mongol 4 Another screening procedure which is carried out at child welfare sessions is the phenylketonuria test. It has been discovered that one form of mental sub-normality is due to an abnormality in the way the baby's body deals with certain constituents of his food. The effects of this faulty "chemistry" can be overcome by an appropriate diet, providing the disorder is detected in time. Detection is by means of a simple test of the baby's urine at the age of three weeks, and is carried out in Ealing by the clinic nurses at the child welfare sessions, and by the health visitors when making home visits. 5,587 babies were screened during the year and no positive cases were detected. All expectant mothers attending the ante-natal sessions are also screened by this test as it is now certain that affected pregnant women can influence their unborn children adversely unless kept on a special diet. 2,209 expectant mothers were screened and one positive case was detected. This expectant mother was referred to the special unit at Great Ormond Street Hospital for confirmation of the condition, and was placed on the special diet until delivered in St. Thomas's Hospital. Her baby is now being followed up by Great Ormond Street Hospital and it is hoped that the mother's special diet during pregnancy will have had a beneficial effect upon the baby's mental development. Child welfare sessions remain popular and show high attendance rates. The work demonstrates adaptation to changing needs in that the emphasis is moving away from the "well baby" to that of providing screening tests, developmental examinations and counselling on the emotional and social needs of young children. During the year, 13,568 children were brought to the child welfare clinics, and one mother and baby were admitted to a residential home for training in mothercraft. MATERNITY AND CHILD HEALTH DENTAL SERVICE (Priority Dental Service) Details of the staffing and availability of this service are contained in the section of my report dealing with the School Dental Service since approximately 90 per cent, of the work of the Council's Dental Service is concerned with school children. The same facilities are, however, also available to two priority groups:— (1) Expectant and nursing mothers. (2) Pre-school children. The figures for attendance in 1965 were as follows:— Expectant and nursing mothers Examined 250 Required treatment 190 Teeth filled 620 Teeth extracted 215 Dentures provided 16 Pre-school children Examined 1,161 Required treatment 701 Teeth filled 1,700 Teeth extracted 565 23 Mr. L. C. Mandeville, the Council's Chief Dental Officer, comments as follows:— The proportion of eligible mothers who seek treatment at the dental clinics is small since the majority these days have regular treatment from private practitioners. There is, however, still a significant number of mothers who neglect their teeth. Some agencies of ante-natal care are more zealous than others in coaxing their patients to have dental treatment. Thus we receive a substantial number of requests from Hammersmith Hospital in respect of mothers from the Acton area, and the hospital has a good follow-up system to ensure that patients do attend. The percentage of mothers who are provided with dentures (6 per cent.) is gratifyingly low, as is the average of teeth requiring extraction per patient (less than one tooth per patient). The condition of pre-school children's teeth varies widely. Overall we see more children who do not need treatment (42 per cent.), and of the rest, whilst there are some who have a large number of teeth which cannot be saved, an increasing proportion are being brought for treatment in time to save the teeth. As the figures given above show, more than three times as many baby teeth are filled than extracted, and this is a gradually improving figure. Dental treatment for these small pre-school children is very time consuming and is a field where the trained dental auxiliaries, from the school at New Cross Hospital, would have especial value. It is hoped that we will be allocated one of these young ladies next year, and so be able to take part in this interesting experiment. As encouraging evidence of the increasing awareness of mothers of the importance of dental health in children of all ages, we have had several requests during the year to give talks on dental matters to Young Wives Groups and similar organizations. 24 (Facing p. 25) Constructive play at Longcot Day Nursery. 6. DAY CARE OF CHILDREN THE DAY NURSERY SERVICE The Day Nursery Service is provided by the Council for the day care of children aged three months to five years, whose family or home circumstances prevent normal care in their own homes. The circumstances governing admission to a day nursery are as follows:— (a) Where the mothers are unsupported, e.g., unmarried, widowed, divorced, separated or deserted, and who must of necessity go out to work. (b) Where the home conditions are in themselves unsatisfactory from a health point of view. (c) Where mothers, by reason of their own ill-health or absence from the home, are incapable of undertaking the full care of their children. (d) Where the child itself is mentally or physically handicapped and in particular is deaf, or partially deaf, partially sighted, or has deaf and dumb parents. (e) Where the child is maladjusted. (f) Where the mother is compelled to go to work as an economic necessity because the father is unemployed or has a low income, provided the mother is employed for at least 30 hours per week. If, at any one time, all children coming within the above priority categories have been accommodated, children of two years and over can be admitted where both parents are working, on the understanding that the place will be forfeited should a priority case need to be admitted The Council has five day nurseries with a total of 224 places, the details of which are given below:— Approved places Maximum number of places *1. Stanhope Day Nursery, Mansell Road, Greenford 50 60 *2. Culmington Road Day Nursery, 17, Culmington Road, Ealing, W.13 40 48 *3. St. Dunstan's Day Nursery, Friars Place Lane, Acton, W.3 45 54 4. Longcot Day Nursery, Newton Grove, W.4 54 65 5. Bollo Bridge Day Nursery, 169, Bollo Bridge Road, Acton, W.3 35 42 The day nurseries are open from 7.30 a.m. to 6 p.m. Mondays to Fridays. Each nursery is approved by the Ministry of Health for a definite number of places to which 20 per cent, is added to give a "maximum" number of places. This 20 per cent, allows for emergency admissions, e.g., mother going into hospital, and is offset against the fact that it is unlikely for the total number of children on the register to attend every day. Three of the day nurseries are recognized as Training Nurseries and these are marked with an asterisk. Student nursery nurses receive their theoretical training at Chiswick Polytechnic, attending two days per week over two years. 25 Admissions to the day nurseries and the day-to-day supervision of the service is carried out by the Superintendent Matron. Each nursery is staffed by a matron, a deputy matron, a nursery warden, nursery nurses, and in the training nurseries by student nursery nurses. The number of staff at each nursery is determined by an overall ratio of staff/children 1 : 5. Charges are assessed on family income. The maximum charge is 17s. 6d. per day per child, though the average charge is much lower than this. Handicapped children are admitted free. During the year, 220 new admissions were made to the day nurseries, of which 11 children were handicapped. Thirteen children were also placed in the adjacent Boroughs' day nurseries of Harrow, Hounslow and Hillingdon; 15 children from the Hounslow area were admitted to Longcot Day Nursery. A total of four students were trained in the year. This year has seen an increase of priority cases, especially for children under two years, and for deaf children recommended for admission by the Audiology Unit at Heston, and has resulted in long waiting lists for all nurseries. Lack of a day nursery in Southall has also thrown an added burden on the Ealing and Acton day nurseries. REGISTRATION OF PRIVATE DAY NURSERIES AND CHILD MINDERS Private day nurseries and child minders are required to be registered and inspected by the Council under the provisions of the Nurseries and Child-Minders Regulation Act, 1948, with the object of safeguarding the health and welfare of the children. A child minder is defined as a person who receives into her home for reward three or more children for the substantial part of the day or up to six days; a private day nursery is defined as premises where children are received other than a private dwelling, e.g., church hall, for a similar length of time. On receipt of an application to be a child minder or to open a day nursery a visit is made by the Principal Medical Officer (Maternal and Child Health) and the Superintendent Matron of Day Nurseries to satisfy themselves that the premises are fit for a nursery and that the persons employed in looking after the children are fit and proper persons, as required by the Council's own specified standards. Registration being completed, the Superintendent Matron carries out further inspections at regular intervals. The Council has decided to register pre-school play groups under the Act and these are similarly inspected. Any allegations that an unregistered person is minding three or more children, or that a daily minded child is not receiving adequate care, are promptly investigated and dealt with. During the year:— Number of child minders inspected 7 Number of private day nurseries inspected 15 Number of new child minders registered 1 Number of new private day nurseries registered 4 Number of complaints of inadequate child minding investigated 5 In September, an application was received for financial assistance towards the establishment of a Multi-Racial Pre-School Play Group in Southall, the aim of which is to assist the integration of the Indian community situated in that part of the Borough. Following detailed discussion between members of the Council and many interested bodies supporting the project, the Council approved financial support being given. The project will be regarded as a pilot scheme in the first instance and will be reviewed after a reasonable period. 26 (Facing p. 27) The nursery at the Mother and Baby Home. 7. CARE OF THE UNSUPPORTED MOTHER AND HER CHILD The Council is charged with the care of the unsupported mother and her child under Section 22 of the National Health Service Act, 1946. This it carries out by the provision of a mother and baby home to which an unsupported mother can be admitted during her pregnancy and again after confinement in a nearby hospital, and by the employment of a medical social worker who gives the necessary support concerning services needed for this type of patient. The unsupported mothers are, in the main, unmarried girls though a few may be married but homeless. They are referred to the Department's medical social worker by health visitors, midwives, child care and welfare officers, general practitioners, medical social workers in hospitals, moral welfare workers and the staff of the National Council for the Unmarried Mother and her Child to whom many girls in trouble write for advice. The medical social worker is responsible for the care of girls needing help who reside in the Borough, and also by a special arrangement for those girls living in the Boroughs of Hillingdon and Hounslow. Her duties are many and varied. During the ante-natal period she helps with finding suitable temporary employment, arranges a booking in the Council's Mother and Baby Home, or one organized by a voluntary association, advises about claims for maternity grants, National Assistance, and gives information in general terms about adoption. Following the birth of the baby, and usually whilst the unsupported mother is resident in the Mother and Baby Home, the medical social worker makes arrangements for adoption of the baby if the mother so wishes, or should the mother wish to keep her baby, finds work and accommodation where the mother can have the baby with her, or places the baby with a fosterparent until such time as the mother can look after the baby herself. During the year, the medical social worker interviewed and helped 186 unsupported mothers from Ealing, 111 from Hounslow and 96 from Hillingdon. The Council's Mother and Baby Home has accommodation for 12 ante-natal unsupported mothers and for 14 post-natal mothers and their babies. The Home is staffed by a matron who is a state certified midwife, a deputy matron, a staff nurse, four female attendants and three domestic staff. Unsupported mothers can be admitted to the Home at any stage of pregnancy but usually enter six weeks before delivery and remain a further six weeks after delivery. They are delivered in the obstetric units of the neighbouring hospitals with whom a very close liaison is maintained; an ante-natal and post-natal session is conducted every week in the Home by the Principal Medical Officer (Maternal and Child Health), obviating where possible the need for long and tiring journeys to the hospitals; all new babies are also examined on admission to the Home. Ante-natal and mothercraft classes are given by the Matron-in-Charge and, as many of the unsupported mothers lack the knowledge of normal domestic skills, an occupational class is held weekly by an occupational therapist during which baby clothes, lampshades, trays, dolls and suchlike are made. A course of health and good grooming lectures conducted by the Health Education Officer over several weeks also proves very popular. 125 mothers were accommodated in the Home during the year, of whom 45 lived in the Borough. There is a need for a voluntary association to take a general interest in the Home. Apart from the many ways in which an organization could be of service, such a link with the community would undoubtedly play a valuable part in assisting the mothers with the many problems of successful rehabilitation. It is hoped that in the near future an organization of this kind might offer its services. 27 8. CO-ORDINATION OF SOCIAL SERVICES In the very early months of the new Borough the need became apparent for the co-ordination of its social services, and a co-ordinating committee of officers was formed with myself as Chairman. Members of the committee include the Chief Education Officer, the Chief Welfare Officer, the Children's Officer, the Borough Treasurer and the Borough Solicitor. The initial matter dealt with has been problem families, particularly council tenants in rent arrears. The committee is working as follows:— (1) The co-ordinating committee itself decides what recommendations regarding policy it will make to the appropriate committee of the Council. (2) A sub-committee meets weekly for the purpose of holding case conferences to decide the best way to help individual families. The field workers concerned in each department attend and normally one particular officer is assigned to undertake the care. The purpose of this arrangement is the avoidance of overlap. I feel that this committee has made an encouraging start. In the first six months, 75 families have been discussed and plans for rehabilitation formulated. The work will be facilitated when a Central Register of families with children at risk has been organized. When it is in operation any department which is aware of such a family will notify the Central Register and when three such notifications are received the family will be considered at a case conference. 28 9. FAMILY PLANNING Under Section 22 of the National Health Service Act, 1946, the Council has a duty to make available family planning advice to women to whom a further pregnancy would be detrimental to health. In Ealing this service is provided in two ways. A birth control clinic is held twice a month at Cherington House Clinic to which patients are referred on medical grounds by general practitioners, medical officers and health visitors. The clinic is staffed by a doctor specially trained in family planning methods and by a clinic nurse who instructs the patient. The mothers who attend are taught a suitable method of birth control and are seen subsequently every six months. Twenty patients are seen on an average at each session. During the year, 45 new patients were seen and there was a total of 432 visits. In addition, the Department works in conjunction with the Family Planning Association, the Council's Principal Medical Officer in charge of Maternal and Child Health being a co-opted member of the local branch of the Association. Under Section 28 of the National Health Service Act, 1946, as amended by the Local Government Act, 1958, the Council makes a grant of £100 to the local branch of the Family Planning Association, and under the provisions of Section 63 of the National Health Service Act, 1946, allows the use of health clinic premises by this Society for four sessions per week without charge. Finally, suitable patients are referred to the birth control clinics organized by the Association and for these the Council pays standard fees according to the advice given. Two patients were so referred in the year. 29 10. CERVICAL CYTOLOGY Negotiations between the Council and the Regional Hospital Board during the year led to submission of amended proposals under Section 28 of the National Health Service Act, 1946, to the Ministry of Health to set up a clinic for the taking of cervical smears for diagnostic cytological examination. These proposals were approved and in December a cervical smear clinic was established at Cherington House Clinic. A letter was sent to all the general practitioners who practise in the Borough inviting them to refer patients to this clinic for screening. The patients referred must live in the Borough and be aged 35 years and over, this being considered the age group at maximum risk. The smears are taken at the clinic by a doctor and sent for assessment to the pathological laboratory at King Edward Memorial Hospital. The results are sent back to the clinic and a copy is forwarded to the patient's general practitioner. There is no charge for this service. Although started on a small scale, there is every hope of expansion of the service at an early date when more technicians have been trained and are employed by the hospital. 30 (Facing p. 31) One of the Council's midwives in her new uniform. 11. MIDWIFERY Section 23 of the National Health Service Act, 1946, makes it the duty of the Council to ensure that there are sufficient certified midwives in its area to deliver women in their homes, and for this purpose the Council operates a domiciliary midwifery service in Ealing and Southall. Home confinements in the Acton area are conducted on behalf of the Borough by midwives from Queen Charlotte's Hospital under a long-standing agreement with the Board of Governors of that Hospital. A further duty of the Council under the Midwives Act, 1951, makes it the Council's responsibility to supervise all midwives practising in its area. The Council's midwifery staff consists of the Chief Nursing Officer (Midwifery and Home Nursing), Deputy Chief Nursing Officer (Midwifery), and 21 full-time and two part-time midwives. The Principal Medical Officer (Maternal and Child Health) is the Medical Supervisor of Midwives and the Chief Nursing Officer the Non-Medical Supervisor. The midwives are grouped in pairs, are allocated districts based on the health clinics and conduct weekly ante-natal sessions. They work closely with the general practitioners and three of them attend ante-natal sessions held at the general practitioners' surgeries. For a home confinement case the midwife, in conjunction with the family doctor, carries out the ante-natal care, conducts the delivery and attends each mother for 10 days after delivery. She then hands over the follow-up care to the health visitor. Maternity packs containing sufficient equipment and dressings for labour and for a period of 10 days afterwards are issued without charge to all patients having a home confinement. TEACHING Twelve of the midwives are recognized as teaching midwives by the Central Midwives Board, and during the year trained pupil midwives taking their Part II Midwifery at Hillingdon Hospital. All midwives attend lunch-time staff meetings held weekly at Perivale Maternity Hospital whenever possible. 48-HOUR DISCHARGE SCHEME The Council operates a planned 48-hour discharge scheme for maternity cases in conjunction with neighbouring hospitals and with some of the London teaching hospitals. Provided the home circumstances are adequate, and this is carefully assessed by the midwife during the ante-natal period, maternity patients are discharged home after delivery and two days in hospital to the care of three of the Council's midwives who are specially recruited to provide this service. This arrangement helps to overcome the effects of the shortage of obstetric beds in the area, in that high risk patients are admitted to hospital for delivery and discharged home within a few days. The essential support of the Home Help Service has been readily available throughout the year and has functioned smoothly and well. The Brentford and Chiswick parts of the Hounslow Borough are also covered by Ealing midwives for this service, for which the Council is reimbursed. RECRUITMENT Recruitment of midwives presents problems. The Council has therefore taken a series of steps to make working conditions in the Borough as attractive as possible. 31 It was felt, for example, that the uniform should be modernized and brought up to date. Representatives of the midwives, together with senior health department staff and the tailor, worked together and designed a new top coat, and a dress and jacket to match, made in a washable drip-dry material. This uniform, together with the new Air Hostess styled cap, were exhibited at the Professional Nurses and Midwives Conference at Seymour Hall, London, in the autumn, and were well received. Another example is the provision of transport. All midwives have a car allowance and where they are unable to purchase a car a Council-owned Mini may be provided. The grouping of midwives in pairs so that optimum off duty can be arranged has also proved popular. Night calls are routed through the telephone control at King Edward Memorial Hospital to ensure that only the midwife on duty is disturbed. A final example concerns housing. The Council requires its midwives to live in a particular district and therefore provides housing. This in many instances is in accommodation of such a standard as to be incidentally an aid to recruitment. Number of home deliveries 945 Number of 48-hour planned discharge patients (23 from Brentford and Chiswick area)511 Number of pupil midwives who have completed district training in the area during the year as part of a Part II midwifery course 65 Number of midwives who attended compulsory refresher courses 4 32 (Facing p. 33) A health visitor advises a mother of a young family in her home. 12. HEALTH VISITING The Health Visiting Service is operated by the Council under Section 24 of the National Health Service Act, 1946, for which it employs a Chief Nursing Officer (Health Visiting), a Deputy Chief Nursing Officer (Health Visiting), a Senior Divisional Health Visitor, two Divisional Health Visitors, 33 full-time health visitors and four part-time health visitors. Twelve clinic nurses are also employed to assist the health visitors with some of their routine work in the clinics and at school. A health visitor is a state registered nurse who has midwifery experience (either the full qualification of a midwife or Part I Certificate of the Central Midwives Board, or a three months' approved obstetric course), and has also received the Certificate in Health Visiting after a further one year's training at a recognized centre. Each health visitor works from one of the Council's health clinics and has charge of a district. She is the health educator, the all purpose medico-social worker to all the families in her area, and frequently acts as the liaison officer between the general practitioners and the social and welfare services. She is in addition the school nurse to all the schools in her district under the School Health Service. She is responsible for advising on the health and general well-being of all children under school age, either in their homes or at child welfare sessions held at the clinics, for organizing ante-natal classes for expectant mothers, for the follow-up of handicapped children and for the home visiting of the aged. One of the Divisional Health Visitors is charged with the organization and co-ordination of health education carried out by the health visitors, which includes poster displays in clinics, group discussion with mothers, film shows, teaching in schools and evening talks to various local organizations on health matters. Under the new regulations for the training of health visitor students, four of the health visitors received in-service training during the year to qualify as Fieldwork Instructors. They, themselves, in turn were responsible for the training of the five Council sponsored health visitor students and one independent student. One other health visitor took the training course in teaching methods organized by the Health Visitors' Association to enable her to teach in schools. The Chief Nursing Officer (Health Visiting) attended a week's administrative course held in London by the London Boroughs Training Committee. 33 During the year, the following visits were made:— Children under five years 19,541 Expectant mothers 1,917 School children 927 Elderly persons aged 65 or over 3,120 Visits for other purposes 1,152 c 13. HOME NURSING Section 25 of the National Health Service Act, 1946, charges the Council with the duty of providing a home nursing service for patients in their own homes. For this purpose the Council employs a Chief Nursing Officer (Midwifery and Home Nursing), a Deputy Chief Nursing Officer (Home Nursing), and 38 full-time home nurses of whom three are male nurses, and 11 part-time home nurses. All the home nurses have the state registered nurse qualification, and the majority have additional district nurse training. The services of a home nurse are available from 7.30 a.m. to 9.30 p.m. every day. Each home nurse is attached to one of the groups based on six of the health clinics in the Borough and works under the direction of the general practitioner. Three home nurses were assigned Borough-owned cars during the year and the others were given a car allowance for use with their own cars, as mobility is essential to cover the day's work. Patients are recommended for home nursing by general practitioners, medical social workers in hospitals and by the Council's own staff such as health visitors and welfare officers. The types of illness which are nursed at home fall into four main categories, namely:— (1) Patients requiring short-term care, e.g., post-operative cases requiring daily dressings and/or injections. (2) Chronically sick patients requiring long-term care, e.g., paraplegic or hemiplegic patients, diabetics requiring regular injections. (3) Elderly patients with chronic multiple disorders. (4) Terminal cancer patients. More and more elderly patients are now nursed at home and the home nurse plays an important part in keeping them in the community and out of hospital. The Council acts as the local agent for the Marie Curie Foundation which provides, without charge, day and night assistance to patients with terminal cancer. A register of state registered and state enrolled nurses willing to nurse such patients, and persons with nursing experience willing to act as “sitters in” is kept in the department. The Foundation also pays for medical appliances, equipment, and special items of diet for such patients where necessary. During the year, six nurses were seconded for three months to take the district nursing course at Chiswick Polytechnic and all were successful in obtaining their National Certificate of District Training. Three other home nurses attended refresher courses organized by the Queen's Institute of District Nursing and the Deputy Chief Nursing Officer (Home Nursing) attended a conference entitled “A New Look at Home Care”. On the 5th November, Miss W. E. Lawrence, Deputy Chief Nursing Officer (Home Nursing) and Mrs. J. H. Waldron (Home Nurse) were presented with Long Service Badges of the Queen's Institute by Her Royal Highness Princess Alexandra at the Fishmongers Hall, City of London. Number of patients nursed in the year 3,636 Number of visits made to patients 108,332 Number of patients helped by the Marie Curie Foundation 13 LOAN OF NURSING EQUIPMENT A function of the Council is the loan of nursing equipment for the care of the sick 34 and bedridden patients at home. This is provided under Section 28 of the National Health Service Act, 1946, and is operated on behalf of the Council by the Middlesex Branch of the British Red Cross Society. Under these arrangements, a hire charge is collected from the patients by the British Red Cross Society and is retained by the Society to enable it to purchase new or replacement equipment as required. Should the patient be unable to meet the hire charge it is paid by the Council. From time to time the Council purchases additional equipment at the request of the Red Cross Society; the Council is also responsible for providing transport for bulky articles to and from the patient's home. 2,746 articles were loaned to patients during the year. INCONTINENCE PADS The provision of pads for incontinent patients at home can be made under Section 28 of the National Health Service Act, 1946. The Council operates a scheme whereby incontinence pads and polythene bags for their disposal are issued free of charge for a limited period of time on the request of a general practitioner or as part of the home nursing service; long term provision is not thought necessary as there is a Council laundry service for such cases. NURSES AGENCIES ACT, 1957 No new agencies were registered during the year. A re-registration was received in respect of the one existing agency but this closed down early in the year. 35 14. VACCINATION AND IMMUNISATION Under Section 26 of the National Health Service Act, 1946, the Council provides vaccination and immunisation against the following diseases:— Diphtheria Poliomyelitis Whooping Cough Smallpox Tetanus Tuberculosis The schedule of immunisation used in the clinics for infants and young children is the following:— Age Vaccine 3 months Diphtheria, whooping cough and tetanus 1st injection 4 months Diphtheria, whooping cough and tetanus 2nd injection 5 months Diphtheria, whooping cough and tetanus 3rd injection 6 months Poliomyelitis 1st dose 7 months Poliomyelitis 2nd dose 8 months Poliomyelitis 3rd dose Soon after first birthday Smallpox vaccination 16 months Diphtheria, whooping cough and tetanus Booster 5 years or school entry Diphtheria and tetanus Booster Poliomyelitis Booster 10 years Diphtheria and tetanus Booster Medical officers and health visitors use every opportunity, during their course of work, to encourage parents to have their children protected by immunisation and vaccination. The acceptance rates for immunisation against diphtheria, whooping cough and tetanus, and for immunisation against poliomyelitis are reasonably satisfactory. There is less willingness to accept vaccination against smallpox. In view of the interchange of population to-day and the speed with which air travel makes this possible, it remains most important to obtain a population, a high percentage of which has been vaccinated in infancy. When localized outbreaks of smallpox occur, the Borough's general practitioners and the health clinics are overwhelmed with requests but, alas, the demand vanishes with the last case notified. Full details of immunisation carried out during the year are contained in Table 3. B.C.G. VACCINATION B.C.G. vaccination provides a large measure of protection against tuberculosis. Under Section 28 of the National Health Service Act, the School Health Service arranges an annual programme of visits to senior schools, both maintained and private, for the purpose of administering B.C.G. vaccination. A team comprising a medical officer, nurse, and clerk carry out the visit. The age of 13 years is selected as the most suitable time to vaccinate, and parents 36 The acceptance rate during the year (expressed as a percentage of total births) was:— Percentage 73.4 Immunisation against diphtheria, whooping cough and tetanus .. Immunisation against poliomyelitis 71 Vaccination against smallpox 52.8 of children in this age group are provided with full information concerning the proposed protective measures and are invited to give their consent in writing. It is necessary to carry out a preliminary skin test to see if the child has a naturally acquired immunity and this is done at the first of two visits made to each school. On the second visit the test is read and negative reactors are given B.C.G. Positive reactors are referred to the chest clinic for an X-ray examination to eliminate the slight possibility of active infection. In the case of the smaller private schools where there are not sufficient pupils to justify a visit, a session is arranged at the Town Hall, and this provides further opportunity to invite any absentees from other sessions to attend. The programme usually covers a period of three months and commences soon after the schools re-assemble after the Christmas vacation. There is an increasing requirement from employers for junior staff to produce a certificate of vaccination against tuberculosis, and this trend is welcomed, as no doubt it will have a beneficial effect on the acceptance rate, when it is realized that such certificates are required before some appointments can be made. 37 15. HEALTH EDUCATION This work is undertaken under Section 28 of the National Health Service Act, 1946, which permits the local authority to make arrangements for the purpose of the prevention of illness. Although specific arrangements are made to deal with situations which achieve a temporary extra importance, such as the campaign which precedes the introduction of a new vaccine, health education is basically a continuing and painstaking process. It thus forms a large part of the work of the doctors and health visitors and other members of the Health Department staff. A divisional health visitor has been appointed to assist in the co-ordination and development of health education in the clinics and schools. A number of health visitors have taken a special training in order to obtain the "Teaching Methods in Health Education" certificate of the Health Visitors' Association. Aids to health education which are widely used include posters advising on the importance of immunisation, home safety, the effect of smoking on health and the care of the teeth. All clinics run classes for expectant mothers who are instructed in breathing and relaxation in preparation for child birth. The film “To Janet—A Son” is shown at evening discussion groups to which both prospective parents are invited. In addition, advice and information is given to the expectant mother about her own health and how she can best deal with her baby when it arrives. An increasing number of talks is being given to school children on preparation for life ahead and sex education. At the other end of the scale, talks on health in later years are given to groups in local firms as part of a pre-retirement course. Special attention is given to the immigrant population in the Southall area. This includes visual displays and film strips on subjects of general health importance and talks on matters such as food hygiene. Special mothercraft classes are held for immigrant mothers. VENEREAL DISEASE Instruction on the dangers of venereal disease remains important and necessary. A film strip entitled “Venereal Disease” is shown to selected groups of secondary school girls and followed by discussion. SMOKING The problem of smoking and the health hazards that it entails will probably be solved only by preventing succeeding generations of school children from taking up the habit. Films such as “Smoking and You” and “The Smoking Machine” are shown in some secondary modern schools and are followed by discussions. It is hoped to show one of these films in junior schools in the near future. Apart from our own clinics, sites used for anti-smoking posters include all public libraries, youth clubs, an employment exchange and a number of general practitioners' surgeries. HOME SAFETY Home Safety remains of great importance, particularly to the very young and the elderly. The Royal Society for the Prevention of Accidents has inaugurated a Home Safety Area Council to which this authority agreed to belong and the Chairman of the Personal Health Services Committee and a Principal Medical Officer of the Health Department have been appointed as representatives to serve on this Council. 38 (Facing p. 38) Health education for senior schoolgirls. 16. RECUPERATIVE HOLIDAYS This service is provided under Section 28 of the National Health Service Act, 1946, for the benefit of people who have had a recent illness and who their doctor considers to be in need of a recuperative holiday before resuming their normal occupations. They must be fit to travel and not in need of medical or nursing care. Arrangements are made for patients to stay at a home chosen either from one approved by a local authority outside the Greater London area or one in the King Edward's Hospital Fund directory. The initial holiday period is for two weeks but in some cases an extension of one or two weeks is granted if the doctor attending the home recommends this as being beneficial to the patient. The homes must be run by state registered nurses and a doctor is required to be available in the event of emergencies. The cost of the service to the patient is £5 15s. a week, but the recipient is assessed according to income if he feels unable to pay this amount. The Council provides transport to and from main line stations if this is recommended by the general practitioner. The figures detailed below give the number of patients for whom arrangements were made during the year:— Number of applications received 119 Number of patients sent on recuperative holiday 94 Number of patients who were not able to avail themselves of vacancy offered 22 Number of applications not approved 3 39 17. CHIROPODY This service is operated under Section 28 of the National Health Service Act, 1946, in conjunction with the British Red Cross Society and the Southall Old People's Welfare Association. It is provided at most of the local authority's clinics and some community centres; in addition, visits are made to old people's homes. The establishment of the service is four full-time chiropodists. This is made up of one full-time chiropodist and seven who work on a sessional basis. The Chiropody Service is for:— (a) Elderly people (i.e., persons of pensionable age—women over 60 years and men over 65 years). (b) Handicapped persons (persons of any age who are registered disabled persons having a disablement pension or who are specially recommended on account of some physical handicap). (c) Expectant and nursing mothers (a mother may continue to attend for one year after her baby is born). The maximum charge for old age pensioners is 4s. according to the assessment of income, but in the majority of cases there is no charge. For handicapped persons, the standard charge is 8s. and for expectant and nursing mothers no charge is made. Persons requiring treatment are asked to complete an application form and to submit this to the Health Department. An appointment is then made for them to attend a health clinic for treatment. Subsequent appointments are given as requested by the chiropodist, the average return period being eight weeks. If a person is unable to attend a clinic, a medical certificate must be obtained from his general practitioner recommending either conveyance to a clinic by ambulance or a domiciliary visit by a chiropodist. Attendances for the year were as shown in the following table:— British Red Cross Society Southall Old People's Welfare Association London Borough of Ealing Totals Total number of patients 485 274 2,182 2,941 Total number of new patients 79 21 635 735 Total number of treatments at clinics and private surgeries 2,504 490 6,435 9,429 Number of patients receiving domiciliary treatment 189 194 352 735 Number of domiciliary treatments 982 820 1,756 3,558 Expectant and nursing mothers — — 8 8 Physically handicapped persons 4 30 34 These figures show an increase on previous years due both to the combining of 40 the three former Boroughs and to the wider knowledge of the service through old people's clubs and other organizations. Treatment is given at the following places:— Health Clinics: Avenue Road 43-47, Avenue Road, Acton, W.3 Brentside Westcott Crescent, Hanwell, W.7 Cherington House Cherington Road, Hanwell, W.7 Cloister Road Cloister Road, Acton, W.3 Greenford Green Wadham Gardens, Greenford Islip Manor Eastcote Lane, Northolt Laurel House 283, Windmill Road, Ealing, W.5 Mattock Lane 13, Mattock Lane, Ealing, W.5 Northcote Avenue Northcote Avenue, Southall Perivale Horsenden Lane South, Perivale, Greenford Ravenor Park Oldfield Lane, Greenford Trinity Way Trinity Way, East Acton, W.3 Surgeries: 120, Uxbridge Road, Hanwell, W.7 Private; used by the British Red Cross Society 234, Northfield Avenue, Ealing, W.13 50, Minterne Avenue, Norwood Green Private; used by the Southall Old People's Welfare Association 3, Church Avenue, Southall 114, Uxbridge Road, Southall Community Centre: Manor House, Church Road, Northolt Old People's Homes: Kolbe House, Hanger Lane, Ealing, W.5 Torkington House, Creswick Road, Acton, W.3 The Almshouses, Church Gardens, Ealing, W.5 Northolt House, Haydock Avenue, Northolt Bethany Eventide Homes, North Common Road, Ealing, W.5 “Green Haven” , Montpelier Road, Ealing, W.5 Hanwell House, Boston Road, Hanwell, W.7 “ Southfield,” 22, Mount Park Road, Ealing, W.5 “ Greenfield,” 1, Courtfield Gardens, Ealing, W.5 Ealing Day Treatment Centre: Green Lane, Hanwell, W.7 41 18. CHEST CLINICS This Borough is served by two Chest Clinics. The major part, which comprises the former Ealing and Acton area, is within the catchment area of Ealing Chest Clinic, situated in Green Man Passage, W.13. The Southall area is catered for by the Uxbridge Chest Clinic, which is situated in High Street, Uxbridge. The local authority is directly responsible for the welfare work of the chest clinic and, although the chest physician is employed by the Regional Hospital Board, part of his salary is paid by the Council. The staff employed by the Council include the welfare officer, the tuberculosis visitors, an occupational therapist and a clerk. The clinics are open at the following times:— Ealing Chest Clinic: Monday a.m. Children 12 noon—12.30 p.m. X-ray p.m. Children Evening Adults Tuesday a.m. Adults 12 noon—12.30 p.m. X-ray p.m. Bronchitis Evening Adults Wednesday a.m. Adults 12 noon—12.30 p.m. X-ray p.m. Ante-natal session (X-ray only) Thursday a.m. Adults 12 noon—12.30 p.m. X-ray Friday a.m. Adults 12 noon—12.30 p.m. X-ray p.m. Children (tuberculosis testing and B.C.G. vaccination) Uxbridge Chest Clinic: Monday a.m. (1st, 3rd, 5th of every month) Children 11.30 a.m.—12 noon X-ray p.m. Old case clinic Evening (2nd and 4th week of every month) Workers' clinic Tuesday a.m. Old case clinic New case clinic 11.30 a.m.—12 noon X-ray p.m. Observation clinic Evening (1st week of month) Workers' clinic Wednesday a.m. Old case clinic New case clinic 11.30 a.m.—12 noon X-ray p.m. X-ray contact clinic 42 Table 2 Tuberculosis Welfare Officer Acton and Ealing Number of cases dealt with during 1965 as follows: Tuberculous patients 250 Cancer patients 47 Bronchitics and others 72 369 Number of new cases 123 Number referred to Welfare Officer for employment 18 Number for whom employment was found 12 Number referred to National Assistance Board: For maintenance 37 For bedding 1 For clothing 2 For extra nourishment 14 54 43 19. MENTAL HEALTH The Mental Health Services of the Borough are divided into those for the mentally sub-normal and those for the mentally ill. The legislation which covers these services is the 1959 Mental Health Act, the aim of which was to move the emphasis from hospital care towards care in the community, and to provide hospital treatment when required on a voluntary basis whenever possible. There has been, therefore, in the last year both a National re-orientation and a local re-organization in progress at the same time. Most health services which passed to the Borough on re-organization had been administered by the Middlesex County Council on an Area basis and the boundary of the London Borough of Ealing was coterminous with the County Council Area. Thus it found itself with all the essential components of a Health Service. The exception to this rule was in the field of Mental Health which the County Council organized on a County wide basis, disregarding Area boundaries. On re-organization, as far as mental health provisions within the Borough were concerned, Ealing found itself, by chance, among the less favoured. Compensation for this in the form of user rights in establishments in the neighbouring Boroughs has enabled the services to continue without disruption and these user rights will continue for the next five years. I consider that, although this is satisfactory in the short term, planning should be directed towards providing a complete basic service within the Borough boundary. SERVICES FOR THE MENTALLY SUB-NORMAL The main components of a Mental Health Service for the sub-normal are these:— (1) Social work to give the necessary support for mentally sub-normal persons living within the community. (2) A junior training school for children from 3½-16 who are unable to attend schools run by the Education Department. (3) An adult training centre for the training of sub-normal persons after school leaving age. (4) Hostels to enable sub-normal patients to live in the community. (5) Voluntary organizations to support the statutory services. (6) Hospital facilities for those unable to live within the community. SOCIAL WORK Sub-normal and severely sub-normal persons may come to the knowledge of the mental health services in several ways. Some are ascertained under Section 57 of the Education Act, 1944, as being unable to benefit by education in a normal school. Others have been ascertained under Section 34 of the Education Act as requiring special education at a school for the educationally sub-normal, and are placed under supervision when they leave there at the age of 16. Many others, before formal ascertainment, are known to the service from their early days. Every new case which comes to the attention of the service is investigated by the Principal Medical Officer in the patient's own home, and a recommendation made as to the best way of caring for the handicapped person in the community. Frequent home visits are made by the mental health social workers with the object of supporting the family to the maximum extent. This enables many patients, who would not 44 otherwise be able to live within the community, to manage this successfully. At the end of the year, 497 sub-normal and severely sub-normal persons were benefiting from this form of community care. Of these, a substantial number of school leavers and young adults are able to obtain, and maintain, work in open industry. At the end of the year, two patients were under the guardianship of the Borough and 31 patients were in informal foster care in homes run by voluntary organizations and in private foster homes. Three children in residential accommodation are receiving tuition at their Home pending placements being found for them in a junior training school. Towards the end of the year, special clinic sessions were arranged for mentally sub-normal children and adults. The purpose of these clinics is to give parents an opportunity to discuss problems with the Principal Medical Officer and the mental health social worker. Attendance is by appointment and there are at present two clinics in operation. One of these is held at Ravenor Park Clinic on the second Wednesday in each month, starting at 10.30 a.m., and a second is held at Mattock Lane Clinic on the third Wednesday in each month, starting at a similar time. The Borough has an establishment of 11 mental health social workers. At the time of re-organization there was in the London area a local shortage of such staff, which resulted in many of those due to be transferred to Ealing obtaining positions elsewhere before the proposed date of transfer. 1965 was therefore spent in building and training a team of workers, and establishing a relationship with other social services both within the Department and without. This process will take many years to complete. JUNIOR TRAINING SCHOOLS Those children who are unable to benefit by a formal school education are placed, whenever possible, in a junior training school. Here the accent is on handwork and the children are taught to develop their manual dexterity and skills to the fullest possible extent. Activities will include drawing, painting, rug making, embroidery, simple carpentry, physical education and music. As there is no junior training school within the Borough, arrangements were made for children to be placed in training schools in neighbouring authority areas. Places were taken up as follows:— Isleworth Junior Training School 55 Hillingdon Junior Training School 24 Harrow Junior Training School 10 Neasden Junior Training School 1 Hanworth Junior Training School 2 Arrangements were made for five children to attend a holiday camp at Henley organized by the London Borough of Hillingdon. ADULT TRAINING CENTRE The Council has an Adult Training Centre at Jubilee Gardens for 60 trainees. The aim of the Centre is to train those attending to function at their highest possible level of skill whether that involves work within the centre or in outside employment. In this way trainees become more independent and are enabled to lead as full and active a life as possible. Experience has shown that trainees can efficiently operate machinery and turn out a high standard of product which years ago would have been considered beyond their powers. Work is undertaken for local firms on a contract basis, and includes the drilling of metal components and the assembling of electrical and television parts. The trainees are also taught general gardening work and several have left to go into 45 nurseries. In order to simulate conditions in open industry a clocking-on system is in operation. The Centre is open for 40 hours a week. A mid-day meal is prepared on the premises and the trainees have to pay for this daily. A monetary award system is in operation, and trainees are paid a weekly figure ranging from 8s. to £2 according to their diligence, ability and application. Transport is provided to convey the trainees to and from the Centre, and every effort is made to pick them up as near to their homes as possible. In some cases they are expected to travel a short distance to a collecting point, and this, it is found, is often of considerable help in their training. The number of trainees successfully placed in employment during the year was seven. Employment was found for a further four trainees, but not accepted by the parents. As in the case of children attending the Junior Training Schools, arrangements were made with a neighbouring borough for adult trainees to go away to the seaside for a summer holiday. The London Borough of Hounslow took responsibility for this adult camp, and 27 went to St. Mary's Bay. Although I feel that the service provided by this Centre is of a high order, the premises are far from ideal, being in a hutted building. It is to be hoped that this will be remedied in the not too distant future. HOSTEL ACCOMMODATION The Borough has no hostel accommodation of its own but it is hoped to build one with 26 places (13 male and 13 female) on a site in Hanwell during 1966. Plans have been prepared and submitted to the Ministry of Health. It is necessary at present to use accommodation provided by neighbouring Boroughs, and this authority has one severely sub-normal male in a hostel run by the London Borough of Hillingdon and two patients in a hostel for sub-normal males administered by the London Borough of Brent. In addition, two male school leavers have been placed in a National Association for Mental Health Hostel for the Maladjusted. VOLUNTARY ASSOCIATIONS The Ealing Society for Mentally Handicapped Children provides a “sitter-in” service intended to enable parents to leave their child at home under suitable supervision. It is limited to children and adults who are severely sub-normal, and the maximum time allowed to any one family is 10 hours a week in term time, and 15 hours during school holidays. The procedure for obtaining a " sitter-in " is as follows:— (1) An application form must be completed and sent to the Welfare Secretary of the local Society for Mentally Handicapped Children. (2) A member of the Association will then visit the family and determine the number of hours that can be given, the charge per hour and the period for which the service is required. (3) The application form is then sent to the Medical Officer of Health for approval. HOSPITALS The Borough of Ealing is fortunate in that it lies entirely within the catchment area of one hospital for sub-normal children and adults, Leavesden Hospital at Abbots Langley, near Watford. However, as this hospital also serves four other boroughs, it is not always possible to obtain quickly permanent placements for urgent cases. 46 At the end of the year, there was a waiting list of 29 persons for permanent hospital care. During the year, 14 patients were admitted to hospital. The following table shows the categories into which these admissions fell:— Informal admissions 11 Mental Health Act, 1959, Section 26 Nil Mental Health Act, 1959, Section 25 1 Mental Health Act, 1959, Section 60 2 Total 14 Temporary care is easier to obtain and can usually be arranged so that parents of sub-normal patients may be given a measure of relief from the often difficult work of caring for them. This is especially necessary for those urgent cases which are on the hospital priority waiting list. During the year, arrangements were made for 33 patients to be sent to Regional Hospital Board hospitals for periods of up to eight weeks, and a further six patients were accommodated in privately managed establishments when hospital care could not be immediately arranged. SERVICES FOR THE MENTALLY ILL The principal features of a service for the mentally ill living in the community are:— (1) Social work to give the necessary support for the mentally ill living within the community. (2) Social centres for the mentally ill. (3) Hostels to act as a transitory stage for the mentally ill to return from the hospital into the community. (4) Voluntary organization to support the statutory services. (5) Hospital facilities for those either temporarily or permanently unable to live within the community. SOCIAL WORK The mental health service is in the immediate care of a Principal Medical Officer. The establishment of 11 mental health social workers already mentioned provides for duties both with the mentally handicapped and the mentally ill. The work of the mental health social worker with the mentally ill can be divided into two main parts. He has, firstly, in co-operation with doctors who are specially approved for this purpose, a number of statutory duties in connection with the legal aspects of compulsory admission of patients to hospital. He often helps too with the admission of voluntary patients. Secondly, the mental health social worker gives support to patients and their families at all times. The services of a mental health social worker can be obtained during working hours by contacting the Health Department, and at other times, as an emergency, by a doctor contacting the emergency control at King Edward Memorial Hospital. SOCIAL CENTRES There is at present no social centre in the Borough except for a small club run by the Ealing Association for Mental Health. Such a centre is essential and accordingly provision has been made for it in the ten year plan. Its facilities would be available for patients attending the Industrial Therapy Organisation unit and their friends and relatives, as well as for patients living in the community and their friends and relatives. The amenities at such a 47 centre would include therapeutic activities as well as the usual ones found in any other club. HOSTELS There is at present no hostel in the Borough but provision has been made for this in the ten year plan. There are at present 29 Ealing patients in hostels outside the Borough. In some instances the ability of a mentally ill person to live in the community can be maintained and his admission or re-admission to hospital avoided, if a suitable alternative to unsatisfactory home environment or living conditions can be offered. Accommodation in a hostel or similar sheltered environment is also valuable where a discharged patient still needs supervision and help before returning completely to ordinary life. Again, where a mentally ill person is living at home, it can ease the tensions of the family and be beneficial both for him and for his relatives if he can be accommodated away from home temporarily. VOLUNTARY ASSOCIATIONS Voluntary associations in the Borough play an important part in the rehabilitation of the mentally ill. The Industrial Therapy Organisation (Thames) Limited, whose factory is situated in Elthorne Park Road, Hanwell, trains suitable ex-hospital patients for work in factory conditions. A small wage is paid to the trainees, and they are helped financially by the National Assistance Board until such time as permanent placement, if possible, can be obtained for them in open industry. During the year, the Ealing Association for Mental Health has been active in many ways. These have included running a weekly bus service to Springfield Hospital to facilitate the visiting of patients by their relatives, and in organizing shopping expeditions for in-patients. Premises have been acquired, which it is hoped to use as a hostel for up to six women who have recently been discharged from hospital and are not yet ready to re-settle fully into the community. Homes administered by the Mental After-Care Association have been of value in placing patients who require a measure of residential care. HOSPITALS Patients from Ealing may be admitted to three psychiatric hospitals. These are:— Shenley Hospital, St. Albans Acton area Springfield Hospital, Upper Tooting Ealing area St. Bernard's Hospital, Southall Southall area In addition, Central Middlesex Hospital and West Middlesex Hospital have small psychiatric units to which patients may be admitted for short periods for observation and treatment. It will be seen that there is much to be done before one can be satisfied with the services in the Borough for the mentally handicapped and the mentally ill. The areas, however, are favourable. A pattern of co-operation with the local hospitals is rapidly being built up. However, working in collaboration with three main psychiatric hospitals, two of which are well outside the Borough boundary, is not ideal. It is hoped that the many problems arising out of a reorganization of these hospital catchment areas will be resolved and that the one hospital within the Borough will be able to provide all necessary services. Ealing is fortunate in its voluntary organizations concerned with Mental Health, and finally I feel the Council is most sympathetic to this branch of its services. Statistical information relating to the work of the Mental Health Service is contained in Tables 4, 5 and 6. 48 20. HOME HELP SERVICE This service is provided under Section 29(1) of the National Health Service Act, 1946, which as amended by the Mental Health Act, 1959, allows a local health authority to make such arrangements as the Minister of Health may approve for providing domestic help for households where there is illness, an expectant mother, an aged person, or a child not over compulsory school age. TYPES OF SERVICE There are four types of service provided in the Borough. (1) The Standard Home Help Service. (2) The Family Help Service:— (a) Residential. (b) Non-residential. (c) Problem Family. (3) The Good Neighbour Service. (4) The Night Service. (1) The Standard Home Help Service This is provided in the following circumstances:— (a) Acute illness—Sudden illness or accident, usually a short-term case. (b) Home confinements—Expectant mothers are normally given ten days' assistance from the date of the baby's birth, but this may be increased on a recommendation from the doctor or midwife attending the case. (c) Tuberculosis—These are usually long-term cases. The number of hours required is recommended by the chest physician and is provided in collaboration with the tuberculosis welfare officer. (id) Chronic sick and aged—This group comprises the largest number of cases and the service is usually only terminated by death or admission of the patient to hospital or welfare home. (2) The Family Help Service This service was designed to support a family either when the mother was temporarily absent or when she was unable to manage and required guidance. It avoids the necessity of taking children into care and falls into three categories:— (a) Residential Service—For families with two or more children, where the mother is temporarily away from home. The home help takes the place of the housewife, and acts as a temporary mother to the family. (b) Non-Residential Service—In cases where the mother is absent, the family help takes the responsibility for the home during the day-time with the father or a relative taking control at night. (ic) The Problem Family Service—This is given if the mother, owing to fecklessness, mental disability or some other reason, is unable to cope with the normal domestic duties. Family help is employed in order to teach the mother to manage her household affairs. 49 D (3) The Good Neighbour Service This was inaugurated to assist elderly or chronically disabled persons by utilizing the services of neighbours who, although not wishing to become home helps, are prepared to give some assistance on a regular basis. The "good neighbour" attends patients at times when assistance is needed, e.g., first thing in the morning and last thing at night. (4) The Night Service This service was started to relieve a family of some of the burden of helping a seriously ill patient during the night. The home help is in attendance to assist the patient from 11 p.m. to 7 a.m. This service is usually only given on alternate nights, except in special circumstances. CASE LOAD OF THE SERVICE Over the last five years there has been a gradual increase in the call on the service. Set out below are details of the types of patients assisted during the year:— Maternity 255 Tuberculosis 31 Chronic sick and aged 2,283 Acute illness 244 Family help 1 2,814 The number of patients receiving assistance at the end of the year was 1,740. The chronic sick represent by far the largest load on the service and the overwhelming majority of these are elderly. The provision of a service to these patients is very expensive of home help time. The home help who attends this type of case works in close collaboration with the home nurse, the patient's general practitioner, the health visitor and the welfare officer, all of whom may be concerned in some way. The number of maternity cases assisted has remained fairly constant over the past three years. The home help attending this type of case works in conjunction with the midwife. PROCEDURE FOR OBTAINING A HOME HELP The request for the services of a home help may be made by the patient, his relatives, family doctor, welfare officer, children's officer, or by one of the Health Department staff. In all cases a doctor's supporting certificate must be obtained. The Home Help Service is under the immediate supervision of an Organiser and six Assistant Organisers. When a request for help is received the patient is visited and an assessment is made of the requirements. The applicant then completes a form agreeing to pay the full cost of the service, or to be assessed. Provision for payment is contained in Section 29(2) of the National Health Service Act, 1946, which reads "A local health authority may, with the approval of the Minister, recover from persons availing themselves of the domestic help so provided such charges (if any) as the authority consider reasonable, having regard to the means of those persons In Circular 100/48, the Minister indicated the extent to which he approved the making of charges for certain articles or services provided under the National Health Service Act. The Council decided to make charges for various services and articles, including the Home Help Service. The present standard rate is 4s. 9d. per hour, but approximately 70 per cent. of those receiving help are given a free service. 50 Details of the cost of the services are as follows:— Maternity cases—An hourly rate is charged if less than 36 hours' help is given during the period but a variable lump sum is charged if more is required. Early discharge cases receive a free service. Night Service—Standard rate. Good Neighbour—Charges are made according to the work done up to a maximum of £2 a week. Family Help—Residential: full rate £9 12s. 6d. a week. Non-residential: full rate £9 12s. 6d. a week. Problem family: standard rate. Toxaemia of pregnancy cases—Free service. Tuberculosis cases—As for standard cases, with extra allowances if the patient is assessed. The establishment of home helps is 260. This is partly filled at present by 334 part-time helps which is the equivalent of 202.4 full-time workers. Adding to the strain produced by this shortage of staff is an increasing demand for the service. The result of this has been that the time which can be devoted to individual patients has become less and less adequate. It means also that in the event of a sudden influx of acute cases there have to be cancellations and alterations to the service at much shorter notice than is desirable. The Council at the moment is considering alterations to the service and it is hoped that in the future more home helps will be employed and the service further stabilized. 51 21. CARE OF THE ELDERLY The care of the elderly is both a national and a local problem. It is estimated that the number of persons aged 65 and over will have risen to nearly million by 1982. This represents an increase in numbers of one-third over a 20-year period. Of these elderly people, the numbers aged 75 and over will proportionately exceed those in the 65-74 age group. The immense strain that is thrown upon local resources and services can be estimated from these figures. Many agencies assist in supporting the elderly in their homes. The local authority provides home helps, health visitors, welfare officers, a laundry service for the incontinent, a chiropody service and a meals-on-wheels service. Local voluntary organizations arrange holidays and outings, supply clothing, food and coal for the needy, and provide radio sets for the housebound. There are clubs in all parts of the Borough and many of these have a visiting service for their sick members. The sturdy independence of many of our elderly citizens is something in which we can take pride. Nevertheless, this sometimes leads to difficulties in bringing help where it is required. One of the problems lies in ascertaining at an early stage those who are in need of the various services. It is here that the health visitor has a large part to play, by knowing and understanding the problems of her district. More and more of her time is now being spent in helping the elderly. Also of value is the Ealing Day Treatment Centre described below, to which persons in need of investigation, treatment and general care are referred by or through their general practitioners. Apart from specific treatment and rehabilitation, the Centre serves as a focal point for ascertaining the elderly disabled and for bringing them the help which the local health authority services can give. A steady expansion of services and excellent liaison with other local authority departments, hospitals, doctors and social agencies are required in the future if the problem of the care of our elderly people is to be conquered. EALING DAY TREATMENT CENTRE ASSOCIATION The Ealing Day Treatment Centre Association was formed in 1960 to establish a Centre where the elderly of the Borough could be taken for daily care and treatment under the supervision of their general practitioner. This experimental scheme was thought to be the first of its type in this country and was made possible by donations from local firms and a grant from the former Ealing Borough Council under Section 136 of the Local Government Act, 1948. The building was erected and opened in May, 1961. The London Borough of Ealing has continued this support. The voluntary organization functions in co-operation with other agencies working for the good of the elderly in the Borough, such as the Welfare Department which provides aids recommended by the occupational therapist at the Centre and mealson-wheels. There is also a close liaison with the home helps, health visitors, home nurses and welfare officers who are all helping to keep the elderly in the community. Members of the Committee for 1965-66 were:— Councillor A. J. McCallum (Chairman) Councillor Miss A. J. Saunders (Vice-Chairman) Councillor J. F. Barlow Councillor Mrs. N. R. Law Councillor A. W. Morbey Councillor Mrs. E. L. Prodham 52 (Facing p. 52) Morning exercises for the elderly at the Day Treatment Centre. Dr. Barbara Bailey Dr. C. A. Osborn Dr. F. H. Scoones Mrs. D. M. Collins (British Red Cross Society) Miss E. Tippetts (Women's Voluntary Service) One vacancy (St. John Ambulance Brigade) The Town Clerk, the Medical Officer of Health, the Borough Treasurer and the Borough Architect act as honorary officers to the Association in their respective professional capacities. During the year, the Centre has continued to provide facilities for the care and treatment of the elderly disabled. Patients attend on a daily basis from 9 a.m. to 5.30 p.m., and those who are unable to travel to the Centre by themselves are taken by ambulance. Patients are accepted only on the recommendation of their own general practitioner and referrals should be made to the Honorary Medical Adviser, Town Hall Annexe, Ealing, W.5. On their first attendance, all patients are medically examined by a geriatrician and treatment where necessary is prescribed. A wide variety of services is available and includes physiotherapy, occupational therapy and chiropody. In addition, injections and dressings are undertaken by the nursing staff. During the early part of the patient's stay at the Centre, routine eye-testing by an eye specialist and investigation of any hearing loss by an ear, nose and throat specialist are arranged. Apart from these physical treatments, every endeavour is made to raise the morale of the patients and to ensure that those who are lonely and lacking in social contact are rehabilitated in social relationships. The Centre was used to capacity during the year when 118 patients were admitted, 28 of these having attended previously at some time since the Centre opened in 1961. The average age of the patients was 75. The main disabilities which brought the patient to the Centre were as detailed in the following table:— Diseases of the musculoskeletal system 31 Diseases of the cardiovascular system 22 Diseases of the respiratory system 2 Diseases of the central nervous system 33 (includes: hemiplegia 26 disseminated sclerosis 2 Parkinson's disease 4) Diseases of the alimentary system 7 Diseases of the eye 4 No major diagnoses or senility only 7 Others 12 Total 118 This pattern of illness does not differ significantly from that found in previous years. The distribution of referrals during the year from various parts of the Borough were as follows:— Hanwell, W.7 35 Ealing, W. 13 30 Ealing, W.5 16 Greenford 7 Northolt 14 Perivale 1 Southall 14 Acton 1 53 It will be seen that most patients come from the area closest to the Centre and that the facilities which the Centre has offered in the past have, I am glad to report, speedily become known and been used by the practitioners of Southall. On the other hand, few patients have been referred from Acton, presumably owing to the greater distance which has to be travelled. Transport has again proved a major difficulty during the year. This is despite co-operation from the ambulance service whose difficulties can be appreciated. Unfortunately, the time of the Centre's needs coincides with the maximum demand on the ambulance service generally, that is, in the early morning and late afternoon. This has resulted in patients arriving late in the morning with a consequent shortening of the working day and leaving at irregular times in the afternoon, which is unsettling for them. In addition to the normal routine of the Centre, there have been, as usual, some special outside activities for the benefit of the patients. An outing to Eastbourne was arranged during the summer and a party of 34 expressed their great appreciation of this trip. At Christmas, the now traditional party was held and the choir from St. Thomas' Church sang carols and entertainment was provided by an accordionist and a drummer. Harvest Festival gifts were received from Oaklands Junior School and each person attending the Centre at that time was given a parcel of fruit and groceries. Gratitude is due to all those who have helped in these social activities. There is no doubt at all that the old people derive very great pleasure from them. The Centre has again been helped by a generous donation from the Hanwell Carnival and Fete Society and a cheque for £460 was presented to the Chairman for the general use of the Association. At the end of 1965, the Centre was approaching the completion of the first five years of its existence. Intended originally to be experimental in purpose, there now seems no doubt that the Centre will continue in its present form. One of the difficulties in the past has been that of following-up patients when they have been discharged from the Centre back to their own homes. The criticism has been made that it is possible for patients returned into an unsatisfactory environment to deteriorate after a successful course of treatment and so to lose what they had gained. Plans are now afoot for the building of an extension to the present Centre which would serve as a follow-up clinic and in this way a routine check could be kept on the mental and physical condition of patients who had been discharged from the Centre after a period of treatment there. SOILED LINEN CLEANSING SERVICE This service, which was started in Ealing in 1952 under Section 84 of the Public Health Act, 1936, provides a regular collection of soiled clothing and bed linen for laundering. A public health inspector is required to certify on behalf of the Medical Officer of Health that articles are in so filthy a condition as to render their cleansing, purification or destruction necessary in order to prevent injury or danger of injury to the health of any person in the premises. The work is undertaken by two driverdisinfectors with the co-operation of the Baths Laundry Service for the Ealing and Southall area and Neasden Hospital for the Acton area. Application for the service should be made to the Medical Officer of Health and no charge is made to the applicant. Laundry is collected and delivered twice weekly in containers provided by the Health Department. The work of washing and ironing the articles collected from the Acton area is carried out entirely by Neasden Hospital but, in Ealing, the driver-disinfectors assist the laundry staff by sorting and marking the soiled articles prior to washing and ironing by the laundry staff. 54 Infra-red therapy at the Day Treatment Centre. (Facing p. 54) The amount of laundry dealt with in the areas during 1965 is given below:— Ealing and Southall Acton Total Number of new cases dealt with during the year 85 62 147 Number of cases remaining at end of year 42 29 71 Number of cases died 23 23 46 Number of cases removed to hospital 17 12 29 Total number of articles dealt with 24,507 12,745 37,252 Total number of collections 2,787 1,582 4,369 Help is given in the Ealing area by the Catholic Women's Guild in repairing torn and worn linen and clothing, which is greatly appreciated. FUEL FOR THE ELDERLY AND SICK A small quantity of coke or coal is available to the elderly and sick when they are unable to obtain fuel from their usual retailers. This stock of fuel was made available by the Mayor of Ealing, who advances money from his Fund. Many elderly people on fixed incomes are unable to build up a stock of coal to last them through the winter and suppliers are often not in a position to deliver just when it is required. A charge of 4s. is made for a 28 lb. bag and, if the applicant is able to pay, this money is then repaid into the Mayor's Fund. Requests for assistance are usually received through home helps, health visitors and old people's organizations. Fewer calls were made on this service during the winter, possibly because the weather was less severe than in other years. PERSONS IN NEED OF CARE AND ATTENTION Under Section 47 of the National Assistance Act, 1948, the Council has powers compulsorily to remove to hospital or other place, persons who are:— {a) suffering from a 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. Before taking action compulsorily to remove a person to hospital or other place, every endeavour is made to keep him in his own home by supplying supporting services such as those provided by home helps, home nurses and the meals-on-wheels service. In some cases, however, the service is refused or insufficient in that constant care is necessary and, although the patient does not wish to go to hospital, it is considered to be in his own interest and often for reasons of his own safety that he should do so. A great deal, however, can be done by persuasion and explanation and compulsory removal is carried out in only a tiny fraction of those cases which are referred. Only when satisfied that there is no other way of keeping the person in a reasonable state of hygiene and comfort is a court order for compulsory removal sought. During the past year, it was necessary to remove two persons to hospital. 55 22. IMMIGRATION are in the Borough various immigrant communities from Commonwealth other countries but it is the Indian and Pakistani community in the Southall who are in need of most assistance from the Health Department. This unity numbers approximately 10,000 persons. Special efforts have been made Health Department to assist them and to ensure that they know and make the various health services. ???guage can, of course, prove a difficult barrier and, in order to overcome this, apartment employs two interpreters and one Indian health visitor. In addition, ???gements are in hand for a course of instruction in Punjabi, the commonest of Indian dialects spoken, for officers who are working with the Indian community, arrangements are to commence early in 1966 and will consist of instruction I working hours to a group of about 15 medical, nursing and administrative Apart from the object of gaining a rudimentary knowledge of the language, it bed that the lectures will include some information on Indian customs and ???e. Such background knowledge is, I feel, of great help to the Department's ???n working in full sympathy with the community. ails of all new immigrants proceeding to the Borough are notified to the Health treatment by the authorities at the port of arrival. On receipt of such information ??gements are made for a health visitor to call. The purpose of this visit is to ???n immigrants of the medical facilities available to them and the necessity of ling registered with a general practitioner. Details of the visits that have been in this respect are as follows:— April to December, 1965 Notification from port authorities of country from which immigrant arrives Number of advice notes received from port authorities Number of successful visits paid by health visitors to new immigrants Commonwealth countries: Caribbean 172 136 India 254 217 Pakistan 44 35 Other Asian 20 16 Africa 11 8 Other 40 13 Non-Commonwealth countries: Europe 90 66 Other 13 11 Total 644 502 special service is given to immigrant school children. Head teachers of all ???ls notify this Department, at our request, of entrants who are immigrants. A n??? visitor then visits the school and carries out a tuberculosis skin test on the ???en. Those shown to be susceptible are offered B.C.G. immunisation, a dure described elsewhere in this report. immigrant community makes full use of the clinical services and is appreciative 56 (Facing p. 56) An Indian family attends Northcote Clinic. of the help given. Health education is an important part of the work done for them and includes the showing of film strips dealing with such items as hygiene in the home, prevention of accidents in the home, care of oil heaters, the prevention of tuberculosis, immunisation and vaccination, and dental care. In addition, for display in clinics, posters have been prepared on which the written matter is in Punjabi. These posters deal with similar subjects to the film strips but also include instruction about infants' feeding and nutrition, children's clothing and the care of feeding utensils. Leaflets also are distributed in Punjabi and Urdu in matters of general and food hygiene, e.g., the importance of this method is demonstrated when rat-baiting is being carried out in the area. Pamphlets are distributed in the appropriate languages, giving a warning that the bait should not be interfered with. Demonstrations are given on the preparation of food for infants and toddlers, emphasis being placed on the need for high protein and iron-containing foods of which the Indian population has a particular need. Apart from help at clinics, a great deal of advice is given to those who call at the Town Hall for information, particularly by the public health inspectors in relation to housing matters. On specific instances liaison is maintained with representative bodies such as the Indian Workers' Association and the Pakistani Welfare Association. 57 23. SCHOOL HEALTH SERVICE The purpose of the School Health Service can be simply stated. It is to provide such health measures as are necessary to ensure that every child benefits to the full from his education. I will shortly be submitting a report to the Education Committee containing my recommendations for the improvement of the service in Ealing, and I have therefore confined the present report to an outline of the services. ROUTINE MEDICAL INSPECTION All children in the Borough's schools are examined on at least three occasions in their school life. This is when they enter an infants class, in the last year as a junior, and finally in their last year at a senior school. The examinations, apart from a few exceptions, take place at school where sessions are arranged for between 15 and 20 children to be seen. Parents are encouraged to be present and a high proportion attend for the infant and junior examinations. The school nurse tests the child's vision and weighs and measures him, whilst the medical officer carries out a general examination and is able to give to the parent advice on every aspect of the child's health and the effect this may have on his education. Details of the three routine medical inspections carried out in schools are set out below. Numbers examined—1965 First age group 3,931 Second age group 3,548 Third age group 3,078 Classification of general condition Satisfactory 10,541 Unsatisfactory 16 Defects requiring treatment found at routine medical inspection Skin disease 148 Defective vision 496 Squint 54 Defects of hearing 64 Middle ear diseases 21 Nose and throat diseases 142 Speech defects 42 Enlarged glands 2 Heart-circulation conditions 22 Lung diseases 31 Hernia 7 Postural defects 11 Orthopaedic foot defects 84 Epilepsy 11 58 24. SCHOOL CLINICS Children examined at school inspection who require further advice or treatment may be referred to one of the undermentioned clinics:— General school Ophthalmic Ear, nose and throat Orthopaedic Speech therapy Foot health Chiropody Asthma Child guidance The ear, nose and throat, orthopaedic, ophthalmic and child guidance clinics are conducted by consultants, appointed and remunerated by the Regional Hospital Board. They may be regarded as extra-mural out-patient departments of the hospitals but sited for the convenience of parents and children in our local clinics. Children are referred only with the consent of the family doctor. The asthma clinic and the foot health clinic are conducted by medical officers of the Health Department. Treatment at the chiropody and the speech therapy clinics is carried out by the appropriate medical auxiliary. GENERAL SCHOOL CLINICS Children are referred to a school clinic when more detailed examination of defects and problems discovered at routine medical examinations is required. Also seen at school clinics are children referred by teachers and parents between regular school inspections, and those requiring treatment for minor ailments. Total attendances .. .. .. 5,829 OPHTHALMIC Ophthalmic sessions were carried out at Mattock Lane and Ravenor Park Clinics by Mr. J. G. Freeman Heal, M.D., D.O.M.S. Changes in staff occurred at the other clinics, Dr. Orr-Ewing at Northcote Clinic being succeeded in September by Dr. Westlake on a locum tenens basis. Mr. Mangat's sessions at Avenue Road Clinic were taken over by Dr. Bradley in December. The whole question of the provision of an efficient ophthalmic service was the subject of discussions with the North West Metropolitan Regional Hospital Board and I am optimistic that a completely satisfactory service will be in operation in 1966. The figures given below illustrate the volume of work in this field. New cases 396 Re-inspections 1,296 Total attendances 1,692 Glasses prescribed 571 I would like, on her retirement, to express my appreciation to Dr. Orr-Ewing who worked for many years in the Southall area where I know she was held in high esteem. I would also like to express my thanks to Mr. Freeman Heal who, after 25 years' service at Mattock Lane and Ravenor Park Clinics, will have retired from the School Health Service by the time this report is published. Mr. Freeman Heal writes that, in the retrospect of something over a quarter century, there is first the notable fact of the great improvement in general in children's 59 health and nutrition and, in particular, flowing from this, the greatly diminished incidence of ophthalmic infections and constitutional disorders such as phlyctenular conjunctivitis. Secondly, the high proportion of children who suffer from squint and amblyopia, a congenitally installed disorder of largely unknown or theoretical etiology, notoriously resistant to cure by present day therapeutic measures. Thirdly, the great repugnance of children to the wearing of glasses, epitomised by the young lady of 12 who declared that she would not wear glasses because if she did she would lose her boy-friend. Report on school children examined at Mattock Lane and Ravenor Park School Clinics for the year 1965 The total number of cases seen was 904, of which 227 were new cases and 677 were re-inspections. The number of pairs of glasses prescribed was 474. Abnormal eye conditions other than errors of refraction were as follows:— New cases Old cases Congenital abnormalities: Squint 32 124 Congenital nystagmus 3 3 Ptosis 2 2 Cataract 2 1 Occlusion nasal duct 1 — Defective extra-ocular muscles 1 1 Absence of punctum — 1 Malignant myopia 1 — Ectopia lentis—Marfans syndrome 1 — Abnormalities due to infection: Toxoplasmosis — 2 Toxocara macular degeneration 1 — Conjunctivitis 1 — Meibomian cyst 1 — Blepharitis 1 1 Hordeolum 2 — Abnormalities due to trauma: Cataract 1 — Corneal nebula 1 — Abnormalities of unknown etiology: Optic neuritis 1 — Ophthalmic sessions are carried out at the following Clinics: Avenue Road Wednesday a.m. Northcote Thursday p.m. Ravenor Park Tuesday a.m. Mattock Lane Wednesday a.m. Keystone School Vision Screener The Keystone Vision Screener, a relative innovation, was used in eye testing during the year, both during routine medical inspections and vision screening of the 7 + age groups at schools in the Hanwell, West Ealing and Southall areas. The apparatus was used exclusively by two school nurses, who now have considerable experience in its operation and prefer this method to previous methods of eye testing. The advantages are that lighting and distance are fixed. The former is a variable quantity in all schools, even under good conditions, and the latter 60 (Facing p. 60) Sight-testing with a visual screening apparatus. (Facing p. 61) A hearing-test at school. quantity may vary slightly even with the greatest care. The recall rate following an unsatisfactory test has been considerably lessened, and this has also cut unnecessary referrals for specialist opinion. The examination by this method is a comprehensive one, allowing for testing of far and near vision, depth perception, muscle balance and colour vision. Even so, the total time taken by an experienced operator is very little more than that taken when the Snellen eye card is used. The children tested appear to be enthusiastic over the test, and show very much more interest and concentration. The disadvantages are, firstly, that the age groups below the age of seven find more difficulty in concentration and results here were not clear enough to permit the routine usage of the apparatus and, secondly, that the apparatus weighs one stone and is bulky, with the consequent necessity for the operator to have transport. However, it is considered that the advantages far outweigh the disadvantages, and that for the first time accurate eye testing may be done in schools for the 7 + age group. EAR, NOSE AND THROAT Ear, nose and throat clinics are held at Ravenor Park and Mattock Lane by Mr. R. M. Savege, F.R.C.S., D.L.O., who has observed that during the year the present attitude to the operations of tonsillectomy and adenoidectomy is a more carefully selective one than the almost universal application of surgery as treatment for most ear, nose and throat symptoms 30 years ago. The widespread use of antibiotics, mainly in the oral form, by the general practitioner, has, in many cases, obviated the need for recourse to surgery and tided the child over the period of maximum sensitivity to infections, i.e., the first two years at school. Paediatricians have tended to support the view that tonsillectomy and adenoidectomy are rarely necessary, and many are reluctant to refer cases, except in extreme circumstances. Ear, nose and throat surgeons appear to think there is still a definite place for the operation and that the injudicious use of antibiotics may lead to the masking of, e.g., ear conditions and to irreversible hearing loss. Finally, there is still a definite place for the operation of tonsillectomy and adenoidectomy, but candidates, in most cases, are more carefully selected than in former times. The statistical report again shows an increase in the number of cases in each category, but the clinical pattern remains much the same as before. More cases of slight deafness have been picked up by audiometric tests, but have been cleared up quickly by medical treatment or removal of tonsils and adenoids. New cases 173 Re-inspections 410 Total attendances 583 Medical treatment advised 296 Surgical treatment advised 114 Referred by school medical officer. When arranged by the Authority these are carried out at Richmond Hospital. Sessions are held alternate weeks at Ravenor Park and at Mattock Lane on Thursday afternoons. ORTHOPAEDIC Orthopaedic sessions are held at three clinics within the Borough, namely, at Mattock Lane, Ravenor Park and Northcote. The sessions held at Mattock Lane and Ravenor Park are carried out by Mr. J. Cholmeley, F.R.C.S., the orthopaedic consultant to the Royal National Orthopaedic Hospital and to its branch at Stanmore. The session held at Northcote Clinic is carried out by Mr. P. I. Busfield, F.R.C.S., who is consultant orthopaedic surgeon to Hillingdon Hospital. 61 Mr. Cholmeley reports that attendances at his consultant clinics and for any physiotherapy that is ordered were very good throughout the year. This appears to indicate an appreciation, both by general practitioners and by the parents, of the facilities offered at the clinics as regards diagnosis and treatment of orthopaedic conditions. Midwives, too, are glad to make use of the immediate appointments which the clinics are able to offer for very young infants with orthopaedic defects. Admission to hospital when surgery is required can be arranged promptly and subsequent follow-up by the surgeon and the physiotherapist is at the clinic within easy reach of the child's home. A few requests for physiotherapy come from teaching hospitals and local hospitals for their child patients, but unfortunately not so many as we should like. Mr. Busfield reports that the average number of patients seen at his clinics during 1965 was 18. During the first half of the year, only one session every two months was held at Northcote Clinic, but an increase in the waiting list made it necessary to hold a clinic every month in the second half of the year. Ninety per cent. of the children attending have minor orthopaedic defects such as flat feet and knock knees with associated poor gait. Operative treatment when required for the more serious conditions is arranged at Hillingdon Hospital. Physiotherapy is provided at Northcote Clinic for four sessions a week and at Jubilee Gardens Clinic for two sessions a week. Most treatments consist of foot exercises, manipulation and re-education in walking. Electrical apparatus when required for treatment is available at Northcote Clinic only. In Acton, there is no orthopaedic clinic, but the area is well served by local hospitals with orthopaedic departments. School Health Maternal and Child Health New cases 100 112 Re-inspections 318 170 418 282 The times of the orthopaedic sessions are as follows:— Once a month at Mattock Lane Wednesday p.m. Alternate weeks at Ravenor Park Tuesday a.m. Once a month at Northcote Monday p.m. Physiotherapy is provided at seven clinics:— Cloister Road Greenford Green Jubilee Gardens Mattock Lane Ravenor Park Islip Manor Northcote SPEECH THERAPY The speech therapy staff comprises:— 1 full-time senior speech therapist. 2 full-time speech therapists. 2 speech therapists working four sessions per week each. Clinics There are 18 clinics in the Borough, 16 of which are used for one or more speech therapy sessions per week. Steele Road and Perivale are the only two clinics not used for this purpose. 62 System of Referral Children are referred for speech therapy from various sources, including health visitors, heads of schools, child guidance clinics, hospitals, general practitioners and routine school medical inspections. All children referred for speech therapy are first seen by the medical officer who is in charge of the service, and who holds clinic sessions alternately at Ealing, Acton and Southall. A hearing test is carried out routinely before the child is seen by the medical officer, and at the examination particular reference is paid to the functions of lips, tongue and palate and the condition of tonsils and adenoids. Any behaviour problems are noted and such investigations necessary are initiated. Diagnosis The following types of defect were encountered during the year:— (1) Simple and multiple defects of articulation (Dyslalia) 258 (2) Delayed or absent speech (Developmental aphasia and dysphasia) 40 (3) Delayed speech associated with mental subnormality (Aphasia) 15 (4) Disorder arising from deafness (Dyseneia) 1 (5) A neuromuscular defect of the speech organs (Dysarthria) 9 (6) Disorder of phonation and/or resonance (Dysphonia) 6 (7) Stammering 58 Total 387 Treatment Treatment is individual, but sometimes children are seen in a group. The latter is preferred for the pre-school child who is unused to mixing with other children or for the child who is very self-conscious about his speech. In the group, he meets other children with similar difficulties. At school age, the children are usually treated individually once weekly. If a child needs more treatment, the therapist will arrange this. Treatment of children at special schools is carried out by a speech therapist attending the school for this purpose. Three sessions per week are given at Talbot School and one at Acton Special School. School Visiting This is one of the primary methods of screening. The speech therapist visits the schools of the Borough once a year; she makes an appointment with the head teacher who, prior to her visit, collects the names of any children about whose speech he is doubtful. The speech therapist then examines the child at school and decides whether he needs treatment. Home Visiting If a child repeatedly fails appointments or attends too irregularly to benefit from treatment, arrangements are made for a health visitor to call on the parent or guardian and enquire about the non-attendance. The speech therapist sometimes finds it necessary to visit a family herself to obtain a fuller picture of the case. Speech Class A special class for speech defective children is held at a normal infants school, the school being Brentside School, Hanwell. The class caters for up to 10 pupils with severe speech defects. The majority of the children who have passed through the class have been severely dyslalic or aphasic. There has been an occasional dysphonic child. The ages range from approximately four to seven years. An intelligence quotient assessment is carried out on all candidates and they are 63 not accepted unless their intelligence is within the normal range. Hearing, as in all children with defective speech, is also tested beforehand. The purpose of the class is to form a sheltered environment for children who would be unable to benefit from a formal education owing to their inability to communicate with the teacher or with other children. These children have a social problem as well as an educational one and, as the class is small, they are able to benefit from the individual attention they receive. Parents are frequently asked to visit the class so as to keep in contact with the work that is being done. Two speech therapists attend the class for four sessions per week altogether. The children are treated individually and a tape recording is made regularly once a month as a record of the child's progress. Also, a written speech analysis is made once a term. The class teacher and speech therapists work closely together and speech work is incorporated into every aspect of learning, the work being adapted to the individual need of each child. Regular case discussions take place. The average length of stay is about three terms. Many of the children have started speech therapy before entering the class and continue attending the speech clinic after leaving. Most children are able to take up places in normal school on leaving this class. FOOT HEALTH The former Borough of Ealing had for many years provided a Foot Health Service for children as part of the School Health Service. This consisted of a systematic inspection of children's feet carried out by the foot health nurse in schools, together with clinics where children and their parents could obtain advice from Dr. Catharine Hollman, the medical officer in charge, about the care of growing feet and the choice of shoes. The foot health nurse has continued her inspections in schools in the old Ealing area of the London Borough and this year has seen 8,181 children. She referred 72 of these children to the foot clinics for further advice and treatment. As yet, the Foot Health Service has not been extended to the Acton and Southall areas, as it is expected that the Department of Education and Science will, in the near future, issue a recommendation for the setting up of a Foot Health Scheme for school children by each local authority, and it was felt wise to defer extension until this is received. The film " 52 Small Bones " is of considerable value in foot health education, and the demand for the film which was directed by Dr. Hollman in 1963 has been good, and many copies have been sold in this country and abroad. It obtained the Gold Award from the B.M.A. Annual Film Competition and this was received by Dr. Hollman and Mr. C. E. Read (Cameraman) in July at a ceremony at B.M.A. House. It is pleasing to note that, of all the award winning films, "52 Small Bones" was the only one chosen for showing at this presentation. Dr. Hollman was asked to lecture in Cambridge in June at a General Practitioners' Refresher Course, and attended and spoke at the Annual Conference of the British Boot and Shoe Institution held at Buxton in November. She has also attended meetings of the Foot Health Advisory Panel of the B.M.A., of which she is a member. Foot inspections Children inspected 8,181 Referrals to doctor 72 Referrals to chiropodist 33 Verrucae 27 Defective shoes 1,294 Everted ankles 49 Hallux valgus 1,078 Tinea 36 64 CHIROPODY Chiropody treatment is provided free of charge for children attending maintained schools in the London Borough of Ealing. Most children who require chiropody treatment are suffering from verrucae. This condition is contagious but treatment at a series of weekly visits is effective. The application for treatment arises very largely from the foot health inspections carried out at schools but a few cases are also referred by general practitioners and parents. Recruitment to the service does present problems and our present establishment of four is filled by one full-time and seven part-time chiropodists. Chiropodists are appointed by the Department for duties shared between both the school clinics and clinics for the treatment of the aged and disabled patients. Sessions for school children are held at Avenue Road Clinic on Thursday mornings, Cherington House Clinic on Tuesday afternoons and Thursday mornings, Greenford Green Clinic on Thursday mornings, Mattock Lane Clinic on Tuesday afternoons, Northcote Clinic on Thursday afternoons and Ravenor Park Clinic on Wednesday afternoons. During the year, there was a total attendance of 2,961, including 453 new cases. THE ASTHMA CLINIC This clinic was set up to provide advice and treatment for children suffering from respiratory disease. A physiotherapist carries out weekly sessions at each of five clinics distributed over the Borough, and a medical officer supervises the work and examines the children on a rota of one clinic every month. Children are referred by other medical officers, paediatricians or general practitioners. Close liaison is maintained between doctors, parents and head teachers. Many children develop respiratory symptoms in early infancy often in association with the onset of teething. The consequent difficulty in breathing is one of the most distressing things for parents to watch and patterns of over-anxiety may be established early. Some children develop classic asthma/eczema syndrome in the pre-school years and these can be helped by breathing exercises as young as three years of age. The support and reassurance of the medical officer is helpful at this stage. For most children, however, trouble begins when they start school and are exposed to a new bacterial-viral environment. Explanations of the use and necessity of the cough reflex are necessary, and advice is required on the balance between coddling and over-exposure and between educational needs and the prevention of spread of infection. Advice too on problems of education and future occupation is given. Many children require intensive indoctrination before they can break the habit of breathing through their mouths, and others need help in mastering the art of blowing their noses. Exercises can be conducted in groups, or individually. All children are encouraged to do their exercises regularly at home, but this requires constant reminders by both the medical officer and the physiotherapist. Respiratory disease is one of the commonest health hazards of adult life in this country, and opportunities for health education on the effects of smoking will occur in the course of treatment. The nature of the disease processes of asthma is still imperfectly understood, and research into the sex incidence of asthma and bronchitis has been undertaken at the Asthma Clinic. The effects of such environmental factors as atmospheric pollution and pollen count have also been studied. 65 E ENURESIS Bed-wetting is a common complaint about which assistant medical officers are frequently consulted and one that is distressing both to parents and child. The age at which a child becomes dry at night varies considerably, and the reason for this is that maturation of the nerves which enable voluntary control to take over from reflex action may take place over a fairly wide age range; in fact, medical officers are far less concerned than parents in the earlier years. It is usual, however, for a child to be dry by the time he enters school and, if this has not come about by then, medical advice is sought—usually at the first routine examination in school. In a proportion of cases, simple instruction to the parents in the management of the child, particularly stressing the necessity to avoid punishment and emotional involvement is sufficient to clear the matter. In a proportion of cases, drugs may be of value in treatment, in which circumstances parents would be referred to their family doctor. A further form of therapy is by means of the electric alarm apparatus and a number of these machines is held in the Health Department and issued on loan at the request of medical practitioners or assistant medical officers. The apparatus works on the principle that the smallest amount of urine passed during the night completes an electrical circuit which is powered by a low-voltage battery. This sets off the alarm which wakens the child who can rise and attend to his needs. In this way, a child is conditioned to remain continent whilst he is asleep. Children who are selected for this form of treatment are normally over the age of seven years and are carefully selected for their suitability. Children who are bedwetting because of anxiety or emotional distress are not normally considered as suitable, and in all cases treatment is with the knowledge and consent of the child's general practitioner. On receiving a request for the loan of the alarm apparatus, a specialist health visitor arranges to visit the home and demonstrate its use to the parents. A standard sheet of instructions is also left in case any difficulty should arise, together with the health visitor's personal card, so that she may be contacted if necessary. Progress cards are supplied to record the wet and dry nights, and there is provision also for recording the size of the wet patch as an additional guide to progress made. A second visit is usually made one week later to ensure that the machine is being used correctly. The parent is advised not to discontinue the use of the machine until there has been a three week period without a wet night. If, however, a child requests to have the machine removed because he feels confident that he no longer needs it, then the parent is encouraged to let him try. If he happens to relapse, then the use of the machine can be continued for a further period. A further home visit is paid after six months to ascertain that progress has been maintained. During the year, the apparatus was loaned to 65 children. The great majority of these children became dry or were improved after a single course of treatment. CHILD GUIDANCE Child guidance services are available at three points in the Borough, at Madeley Road Centre and at Avenue Road and Northolt Grange Clinics. The service to children in Southall prior to the amalgamation was provided by Dr. Levinson of the Hounslow Child Guidance Clinic but, from April, 1965, Dr. Portia Holman, M.D., F.R.C.P., D.P.M., of the Ealing Child Guidance Clinic, accepted all referrals from Southall, although Dr. Levinson continued for a while the treatment of children referred to him before 1st April, 1965. The service of the whole Borough is now under the supervision of Dr. Holman, who reports: 66 Patients attending 366 children were referred to this centre in 1965 and 64 were brought forward from the waiting list at the time of amalgamation. Of these 430 children, 285 were seen by the full clinic team, 68 were dealt with without being seen by a psychiatrist and 77 were awaiting diagnosis at the end of the year. Recommendations made at Diagnostic Interviews Mention should, I feel, be made of two children of secondary school age who, on our recommendation, spent a period in an adolescent in-patient unit. Both seemed extremely ill when first seen, but both made complete recoveries in a short time. This makes us wish that it were easier to get in-patient treatment for disturbed children and adolescents. We can think of several others whose recovery would probably have been more rapid had in-patient care been available. Aston School Seven children seen at the Centre were admitted to Aston School for the maladjusted during the year, five to the primary department and two to the secondary. Two were transferred from primary to secondary and the totals at the end of the year were— Primary 23 Secondary 24 Three were awaiting admission. In view of the rapid growth of the secondary department, it was decided towards the end of the year to separate the primary and secondary departments into two schools. A headmaster of the secondary school was appointed as from 1st January, 1966. Changes of Staff Changes of staff were numerous during the year. The Centre lost two psychiatric social workers at the end of 1965, and also part of the time of another, who was appointed as Senior Casework Supervisor, and divides her time between the Mental Health Service and the Child Guidance Service. As part of her duties she will undertake the supervision of trainees in both departments. The lack of psychiatric social workers makes it unlikely that the service will be all we could wish in 1966. Future developments There is still much to do on the preventive side of child guidance. When we have something nearer to our complete establishment we hope to be able to work out developments. We now have two flourishing assessment classes for infants and hope for further development in the diagnosis and educational treatment of young school children. Table 1 1. Analysis of work Number of cases referred to the Centre in 1965 366 Number of cases brought forward from 1964 waiting list 64 Number of these cases dealt with by the psychiatrists 285 Number dealt with without being seen by a psychiatrist 68 Number remaining on waiting list for interview in 1966 77 67 Table 1—continued 2. New cases seen at the Centre in 1965 Number of new cases seen by psychiatrists 285 Recommendations made at diagnostic interviews:— (a) Treatment or remedial teaching or follow-up 201 (b) Residential school for maladjusted 21 (c) Residential school for educationally sub-normal children 4 (d) Day school for educationally sub-normal children (or training centre) 5 (e) Aston School 10 (f) Infant assessment classes 15 (g) Other day schools or classes 5 (h) Adolescent in-patient unit 2 (i) Miscellaneous 22 Table 2 Analysis of all cases attending (a) Regular treatment and remedial teaching cases taken on in 1965 108 (b) Carried over from 1964 or earlier (including those on waiting list) 64 Discharged from regular treatment or remedial teaching in 1965 68 Cases current on 31st December, 1965 97 Awaiting treatment on 31st December, 1965 17 Table 3 Analysis of intelligence 314 children tested in 1965 (204 boys and 110 girls) Intelligence quotient range Under 70 70-79 80-89 90-99 100-109 110-119 24 24 39 66 55 43 120-129 130-139 140-149 150-159 160-169 170-179 21 8 1 1 1 1 (Unable to obtain result: 30) Table 4 Age of 314 children Under 2 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1 11 13 13 25 29 26 30 28 30 23 25 26 21 9 2 2 (Average age: 9) Pre-School Primary Secondary Modern Secondary Grammar Private Special 37 168 67 15 21 6 Regular sessions are held at Avenue Road Clinic all day on Mondays, and at Northolt Grange Clinic all day Tuesdays and Fridays, and at Madeley Road Centre Wednesdays and Thursdays. These are augmented by additional sessions carried out where and when required. HANDICAPPED CHILDREN Section 34 of the Education Act, 1944, requires every local education authority to ascertain which children in its area require special educational treatment. Children 68 so ascertained may be placed in either day or residential special schools. Normally, a day school is recommended, but residential schooling is indicated when there is no suitable school within travelling distance of the child's home or when there are domestic difficulties at home or the home background is considered unsuitable. The following table sets out in their various categories the number of handicapped pupils as at 31st December, 1965. In Special Day Schools In Special Residential Schools In Maintained Primary and Secondary Schools Not at School Totals M. F. M. F. M. F. M. F. M. F. Blind 1 — 3 3 — — 1 1 5 4 Partially-sighted 5 9 — 2 — — — — 5 11 Deaf 3 3 4 4 — — — — 7 7 Partially deaf 14 5 2 3 — — — — 16 8 Educationally subnormal 115 69 14 8 11 6 1 2 141 85 Epileptic — 1 2 3 — — — — 2 4 Maladjusted 40 14 64 21 9 8 1 — 114 43 Physically handicapped 34 18 5 6 2 1 1 2 42 27 Defective speech 5 — — — — — — — 5 — Delicate 30 8 21 11 4 2 1 — 56 21 Multiple defects — — — — — — — — — — Totals 247 127 115 61 26 17 5 5 393 210 The Borough is responsible for five special schools:— Aston (Junior and Senior Departments) Day school for maladjusted boys and girls. Red House Residential schools for maladjusted boys. East Quinton Talbot Road Day schools for educationally subnormal boys and girls. Acton Special School TUITION OTHER THAN AT SCHOOL Section 56 of the Education Act, 1944, gives power for the local education authority to provide education other than at school. Under this section, arrangements may be made for tuition in the child's own home; usually as a temporary measure only, until a vacancy in a special school has been obtained. Children may also receive education while in hospital, if their stay is prolonged. Handicapped children over two years old and under the age of five years may be admitted to one of the Council's day nurseries, when it is considered to be in the child's interests. Children who are deaf or maladjusted benefit particularly from being in this environment. 69 CHILDREN UNABLE TO BENEFIT BY EDUCATION Cases dealt with under Section 57 of the Education Act, 1944. Section 57 relates to children who are so mentally handicapped that they are unable to benefit by education either at normal or a special school for educationally sub-normal pupils. These children are referred to the Council's mental health service 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 psychiatric hospitals, or remain at home in the care of their parents. The decision to refer children in this way is always reluctantly taken and whenever possible only after a trial period at one of the special schools for educationally sub-normal pupils. During the year, the number of cases so dealt with was five. INFESTATION Section 54 of the Education Act, 1944, requires that the authority should ensure the cleanliness of children in attendance at maintained schools and is empowered itself to cleanse infested children. During 1965, with a school population of approximately 37,000 children, 32,976 examinations were carried out, 246 cases of infestation being found (0.7 per cent.). All cases are followed up by the health visiting staff until satisfactorily cleansed. Facilities are available to the parents through the clinics, where a cleansing preparation is available and the staff advise how the condition should be treated, or use may be made of the Hammersmith Cleansing Station. Regular supervision at the various schools is based on the known need, the overall pattern in the Borough being fairly constant. The contributing cause to this continuing problem would appear to be a well-known core of problem families who require constant supervision. 70 (Facing p. 71) Polishing teeth at conclusion of dental treatment. 25. SCHOOL DENTAL SERVICE The School Dental Service has the following functions:— (1) Routine dental inspection of children at school. (2) The provision of treatment or the ensuring that children found to have defective teeth attend private dentists. (3) Dental health education. The service functions from all but five of the Council's clinics and is in the charge of the Chief Dental Officer who has an establishment of 13 dental officers, two of whom are orthodontists. We are at present unfortunately three dental officers below establishment. As a result, seven clinics are run on a full-time basis and six part-time (varying from eight sessions a week to three sessions a week). In four clinics, two surgeries are working part of the week when the orthodontist as well as the dental officer is in attendance. DENTAL INSPECTION The aim is to inspect all children at school at least once a year, but shortage of staff has prevented this being achieved. The figures for inspection during the year were:— Number of inspections 25,052 Percentage of school children inspected 66 Number found to require treatment 13,375 TREATMENT The parents of approximately 50 per cent. of children found to need treatment elect to have this done by the School Health Service, the remainder preferring their private dentist. The figures for treatment during the year were:— Total visits to clinics 30,115 Teeth filled 19,288 Teeth extracted 5,225 General anaesthetics given 2,481 Emergencies 1,186 Ratio of permanent teeth filled/extracted 16.6 to 1 An important branch of treatment is orthodontics for the correction of abnormalities of position of teeth. Details of orthodontic treatment during the year were as follows:— Cases completed 233 Number of removable appliances fitted 465 The Council has arranged with the London Borough of Richmond for the use of the Teddington Dental Laboratory. DENTAL HEALTH EDUCATION The great majority of this work is done by the dental officers at the chairside in the course of their everyday work. In addition to this, however, special schemes 71 are organized, the best example of which is the showing of a “Noddy” film at schools. This understandably makes considerable impact on the children which it is hoped can be maintained by other measures throughout their school life. Mr L. C. Mandeville, Chief Dental Officer, reports:— “The success of a dental service may be judged not by the number of teeth filled or extracted, but by the number that do not require this attention. Beneficial effects in this direction can be achieved by a greater public awareness of the importance of diet in the prevention of dental caries. The damaging effects of a largely carbohydrate diet, especially when combined with inadequate tooth cleaning, and the advantages of proteins, fruit and vegetables as exercising and cleansing foods for the teeth, are subjects of long term dental health education which are being actively pursued. The correct mental attitude towards the prevention of dental decay is of considerable importance. There is much evidence of a growing positive attitude of self help by adults, including parents, but too many people think of dental decay as an inevitable minor disability which requires one regularly to visit the dentist in order to have it put right, and that there is little that one can do about this state of affairs, beyond perhaps cleaning the teeth. Perhaps the most effective weapon available at present, and one which again depends on an active change in social attitudes, is fluoridation of domestic water supplies. The Borough Council by giving its support for fluoridation has helped to make its realization more likely, although of course the necessity for general agreement within the area supplied by one particular water concern means that fluoridation is still a long way from reality. An encouraging trend in the last eight years has been the appreciable increase in the number of five-year-old school entrants found to have caries-free first teeth. Probably one child in six is now in this desirable condition as against one in 10 previously, but there are still many whose teeth are in a very poor state indeed when they enter school. If the dental staffing position permits it is hoped during 1966 to carry out a pilot investigation of the dietary habits of the group of five-year-olds who show no signs of dental decay. The results of such a survey may well provide a further background of information from which parents of very young children can be advised about their offspring's teeth. The percentage of children inspected and found to require treatment (53 per cent.) is approximately the figure that has been observed in the area for several years now, but it will be appreciated it does not take account of the amount of treatment required by each child. The ratio of permanent teeth filled to permanent teeth extracted because they could not be saved (16.6 to 1) is a good figure and has risen steadily over past years. Modern techniques make possible the saving of many more teeth. Such techniques usually involve greater expenditure of time on individual teeth, but it is essential that the treatment given to our patients is of the highest standard. Staff are encouraged to attend post-graduate courses so as to become conversant with advances in technique, but the number of suitable courses is limited. The orthodontic service is still much in demand and, with ever increasing public transport fares, parents are appreciative that such treatment can usually be obtained fairly near to home. It is impossible to arrange for orthodontic service at all dental clinics because of the need for specialized apparatus as well as staff, but with four orthodontic surgeries in the Borough the cover is very adequate. Provision of modern equipment not only makes for efficient working but is essential if the right kind of staff is to be attracted. The teaching hospitals are equipped with the most up-to-date apparatus, and young dental surgeons are usually not prepared to put up with apparatus that does not conform to the highest standards. 72 less, it is difficult to decide to put in costly items of equipment, dental units, etc., in clinics which we are hoping will be replaced in the foreseeable future, and which would be better in every way if they started off completely new. In addition, some items like air-turbine engines have developed so rapidly since their inception that those of the original design are almost as dated in comparison with the most recent ones, as the electric engine was to the first generation of air turbines. Thus, the programme of replacement of major items of dental equipment is a continuous one, rather like repainting the Forth Bridge." 73 26. GENERAL PUBLIC HEALTH MEASURES The work of the Environmental Health Section of the Department is organized under the Chief Public Health Inspector in six main Divisions, two of which deal with general district work and the remaining four with Meat Inspection, Housing, Clean Air and Food and Drugs respectively. Each Division is under the immediate control of a Divisional Public Health Inspector, and there are also sub-divisions dealing with rodent control, work under the Offices, Shops and Railway Premises Act, 1963, and general duty transport with disinfection and disinfestation. The duties are briefly as follows:— General Divisions—Investigation of general complaints and nuisances observed; infectious disease and food poisoning enquiries; drainage; water supplies; disinfection and disinfestation; river pollution; routine inspection of factories, outworkers' premises, certain food premises and offices and shops; caravans; industrial and domestic smoke emissions; Rent Act applications; schools; unsound food; swimming baths; rodent and pigeon control. Meat Inspection Division—Meat inspection at slaughterhouse; enforcement of slaughterhouse and slaughtering legislation; Diseases of Animals Act; sale and movement of animals from Southall market; pig-keeping; licensing of slaughtermen; pet animals; boarding of animals; riding establishments. Housing Division—Slum clearance; individual unfit houses; underground rooms; overcrowding; houses in multiple occupation; mortgage enquiries. Clean Air Division—Implementation of clean air programme and work in connection with new and existing smoke control orders; measurement of atmospheric pollution; notification and prior approval of new furnaces; chimney heights; building plans. Food Division—Sampling of food and drugs; registration of milk purveyors; milk special designation licences; registration of premises for ice cream and preserved foods; bacteriological examination of milk, ice cream, imitation cream, well-water and miscellaneous foods; inspection of certain food premises; consumer food complaints; food hygiene and clean food scheme. NUISANCES During the year, 5,241 complaints were received, and the vast majority of these concerned housing defects and nuisances which were investigated by inspectors of the General Divisions. Action taken as a result of these complaints resulted in 4,337 initial inspections of premises of all types and the service of 1,222 informal notices under the Public Health Act and other allied legislation. In most cases, the requirements of these informal notices were dealt with in a reasonable time by the persons responsible, but it was also necessary to serve 297 statutory notices. In the case of nine premises, legal proceedings were taken by the Council in order to achieve results which could not be obtained by less formal methods and details of these are given in Table 7. DESTRUCTION OF PIGEONS—PUBLIC HEALTH ACT, 1961 Section 74 of the Public Health Act, 1961, enables local authorities to take steps to abate or reduce any nuisance, annoyance or damage caused by the congregation of house doves, pigeons, starlings or sparrows in built-up areas, provided the work 74 (Facing p. 74) Domestic premises requiring cleansing. (Facing p. 75) The same premises as in the previous photograph—the paper sacks contain accumulations of refuse. is carried out humanely and so as not to contravene the provisions of the Protection of Birds Act of 1954. The Council accordingly entered into a contract with a firm specializing in bird control and, during 1965, work under the contract resulted in the destruction of 3,698 feral pigeons. A special treatment was carried out at Southall Gas Works where a heavy infestation of pigeons had built up in a group of large derelict buildings which have since been demolished. Unfortunately, many birds were dispersed when certain buildings were demolished and before control operations were completed, and the problem of reducing their numbers over a much wider area will be much more difficult and time consuming. The contractor relied entirely on trapping and shooting methods, with the occasional use of repellent materials, the employment of narcotics having so far been avoided. There are, however, a number of sites where the future use of narcotized baits may be considered practicable, especially in areas where birds feed in the day-time, and where it would be difficult to reduce their numbers by other means. All the work was carried out strictly in accordance with the provisions of the Protection of Birds Act, 1954, and to the satisfaction of both the Royal Society for the Prevention of Cruelty to Animals and the local police. CARAVAN SITES AND CONTROL OF DEVELOPMENT ACT, 1960 One application for the renewal of a site licence for the use of a caravan at a sports ground was granted for a period of one year expiring on 31st December, 1965. Visits by gipsies and other types of itinerants continued to present problems. Almost all the land in the Borough has now been built on or is adequately fenced, and caravans were often parked on the highways, usually on service roads, and nuisance was caused by the absence of sanitary accommodation and the deposit of rubbish. Every effort is made by the district public health inspectors, in co-operation with the Council's warden, to obtain early information of such nuisances. Notices under the Public Health Act are then served. In most cases this caused the removal of the vans within the specified period of 24 hours. In six cases it was necessary to apply for a summons, but only four were actually served and, as a result of proceedings in the magistrates' court, fines of £1 and costs of £1 1s. were imposed in each case. A survey was carried out to record details of all the caravans, accompanying vehicles, and their occupants as they came into the Borough, and it is hoped that the information obtained will be useful for identification purposes. 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 — (3) Number of decisions to issue certificates— (a) in respect of some but not all defects 13 (b) in respect of all defects (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 14 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule — (6) Number of certificates issued 7 75 Part II—Applications for Cancellation of Certificates (7) Applications by landlord to Local Authority for cancellation of certificates 7 (8) Objections by tenants to cancellation of certificates 2 (9) Decisions by Local Authority to cancel in spite of tenants' objection — (10) Certificates cancelled by Local Authority 5 In November, the owner of 144, Southfield Road, W.4, made an application to Brentford County Court for cancellation of an outstanding Certificate of Disrepair, which was opposed by the tenant. The District Public Health Inspector gave factual evidence concerning a defective sanitary fitting which was the cause of the dispute. The application was refused. RADIOACTIVE SUBSTANCES ACT, 1960 This Act is concerned with the control of the keeping and use of radioactive materials and the accumulation and disposal of wastes. As from 1st December, 1963, the appointed day, persons who keep or use radioactive material, unless specifically exempted, have been required to register with the Minister of Housing and Local Government and to obtain authorization from him for its accumulation or disposal. During 1965, notifications were received from the Minister that he had granted Certificates of Registration in respect of four premises within the Borough and revised Certificates of Registration in respect of four. In all cases, enquiries were made by the District Public Health Inspector to provide information about control methods and safety measures. Although the Council has no responsibility for control, such visits are made to ensure that some detailed information is available locally. Nineteen premises within the Borough are registered under the Act. INSPECTION OF FACTORIES AND OUTWORKERS' PREMISESFACTORIES ACT, 1961 A total of 363 inspections of factory premises, mainly in connection with the provision and maintenance of adequate sanitary accommodation, was made in 1965, with 194 visits to domestic premises occupied by factory outworkers. Statistical information as requested by the Minister of Labour is given in Tables 8, 9 and 10 on pages 122 and 123. COMMON LODGING HOUSES There are no common lodging houses in the Borough. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Twenty-five premises in the Borough are registered under the Act, one new premises having been added during the year. In all cases, only materials carrying the Certificate of the British Standards Institution are used. THE NOISE ABATEMENT ACT, 1960 The Nuisance of Noise Noise, being unwanted sound, implies nuisance. People differ a good deal in the extent to which noise disturbs them, and their state of health, occupation at the moment, and so on, will cause any one individual to vary his reaction to noise at different times. These factors combine to produce, in all types of general noise problems, a sometimes substantial minority of people who are disturbed by conditions which the majority consider quite reasonable. The reaction of different people to 76 the same noise climate may vary from complete indifference to a state of mind bordering on desperation. The possibility of a minority disturbance of this sort may have to be accepted in any general solution of a noise problem, simply because the economic factors may restrict the solution to something less than complete insulation. Noise has been held to be a nuisance if it is an inconvenience materially interfering with the ordinary physical comfort of human existence according to plain, sober and simple notions among people. The main problem of assessing whether or not a noise constitutes a nuisance is due to the different reactions of people to noise and to the lack of any legal standard. The Wilson Committee on Noise in its final report suggested, as a very tentative estimate, that the noise level in a bedroom, at night, in a busy urban area, should not exceed 35 dBA (decibels—"A" scale) for more than 10 per cent. of the time, nor exceed 50 dBA during the day. The Building Research Station has given a simplified procedure for assessing public reaction to industrial noise in a mixed residential and industrial area. This method, which was referred to in the Wilson Report, suggests that, if the noise outside the complainant's house exceeds 50-55 dBA, complaints could be expected. The International Standards Organization has recommended the use of certain criteria which would suggest that the acceptable level at certain frequencies would be 35 dBA. The first and last recommendations refer to noise levels within the building and the Building Research Station's figure, when adjusted to make allowances for this, is 35-40 dBA. Noise Measurement There is, unfortunately, no instrument which will react to noise in the same manner as the human ear. The simple noise level meter will show the overall sound pressure level in decibels at the moment of use. As the "A" scale is said to compare most closely with the loudness level of the noise, the sound pressure level in dBA is used to make a rough assessment of the overall sound pressure level at any place. This single figure reading can, however, be misleading as it gives only the overall sound pressure level and this overall level is the sum of the noise levels in all the octave bands. The degree of annoyance varies with the frequency of the noise as well as with the loudness, high frequency noises being rated as more annoying than low frequency noises of the same overall loudness, and percussive noises more annoying than steady noises. Because of these facts, a single dBA reading can give a false impression of the value of a noise. A noise with a marked high frequency component could give a relatively low overall level reading on the "A" scale, whereas readings of the sound pressure levels in the various octave bands would show this high frequency component very clearly and would give a clear indication of the annoyance likely to be caused by the noise in question. Data of this nature can only be obtained by employing rather more sophisticated equipment than is at present available in this Department. Noise Complaints During 1965, 102 noise complaints were received in the Department. This figure is greatly in excess of the total number of complaints received by the three Boroughs prior to amalgamation and does point to a greater reaction by the public to the ever growing noise problem. The complaints varied from noise from traffic on the M.4 motorway to noisy animals. Just over half of them concerned noise from factories or other industrial premises and just under half of the total complaints were held to be nuisances. The investigation of a noise complaint takes a considerable time and often involves the inspector in a fair measure of work late at night and in the early hours of the morning. 77 Although authority for statutory action had to be obtained in a number of cases, no formal proceedings were required, as the makers of noise invariably work closely with the inspectors when nuisances are drawn to their attention. The high cost of noise reduction is illustrated by the fact that one large firm in the Borough had to spend over £30,000 in reducing the noise emitted from its factory premises. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 At the end of 1965, a total of 2,816 premises were registered under this Act. During the year, 172 premises were added to the register and in 29 cases, where the Act no longer applied, the premises were deleted. The register is not yet complete as there are still some parts of the Borough where complete inspections have not yet been possible. It is hoped that this position will improve in the near future. The general inspection of premises continued, and it was found that the attitude of the occupiers of shops and offices was usually most co-operative when contraventions of the Act and its regulations were drawn to their notice. Employees as a whole welcomed the operation of the Act, although there were cases where some seemed willing to accept unsatisfactory conditions without protest or complaint. A total of 97 accidents, fortunately none of a serious nature, were reported during the year. It would appear that a number of accidents are not reported and a leaflet giving details of the regulations relating to accidents is enclosed in all initial letters to occupiers. The following table gives the analysis or the accidents according to their primary cause:— Primary cause Adults 18 and over Young persons under 18 Total Males Females Males Females Non-power machinery in motion — 1 — — 1 Machinery in motion under power 1 2 — 1 4 Vehicles moved by power 4 — — — 4 Falls on or from stairs 4 4 — 2 10 Falls on or from ladders 2 2 — — 4 Other falls from one level to another 3 — 2 — 5 Falls on same level 2 12 — 1 15 Stepping on or striking object or persons 2 7 — 9 Handling goods 13 8 3 — 24 Struck by falling object 3 4 — — 7 Use of hand tools 9 — — — 9 Not otherwise specified 2 3 — — 5 Totals 45 43 5 4 97 One prosecution under the Act was taken relating to an accident which had occurred in 1964, in which a youth of 17 employed in a supermarket had the top of his right fore-finger severed whilst cleaning a power-operated gravity slicing machine. The case was taken under Section 18(1) of the Act which states that no young person employed to work in premises to which this Act applies shall clean any machinery used as, or forming part of, the equipment of the premises, if so doing exposes him 78 to risk of injury from a moving part of that or adjacent machinery. The magistrates found the case proved and imposed a fine of £25 with £5 5s. costs against the company. During the year, seven applications were received for exemptions from various sections of the Act. Of these, four were granted (two with a time limit of 12 months), two were deferred pending completion of work and one was refused. One of the four exemptions granted was subsequently revoked as the requirements of the Act were not fully met. During November, a special survey of lighting was made at the request of the Ministry of Labour. This showed that, as would be expected, older properties had poorer lighting, both artificial and natural, than modern ones. Modern offices and shops generally were well lit, but the pattern of illumination was not always in line with the occupational pattern of the building. It was particularly noticeable that selling areas in shops were reasonably well lighted, but that stores, packing rooms, etc., were poorly lighted and corridors and stairs were often badly lighted. Certain specified statistics, together with a more detailed report on the operation of the Act in the Borough, were submitted to the Minister of Labour at the end of the year in accordance with the Annual Reports Order made under the Act. The statistical details given in this report, together with a summary of contraventions remedied, are as follows:— Contraventions remedied Items Number of improvements Premises cleansed 69 Overcrowding abated 7 Temperature improved 45 Thermometers provided 75 Ventilation provided or improved 25 Lighting improved 23 Windows and skylights cleaned 11 Lighting apparatus repaired 17 W.C. accommodation increased 3 Washing facilities increased (basins) 17 Hot and cold water provided 31 Soap provided 19 Towels provided 19 Drinking vessels provided 6 Accommodation for clothing provided or improved 29 Facilities for drying clothing provided 2 Sitting facilities provided or improved 21 Meal facilities provided or improved 5 Floors, stairs, passages, etc., repaired 18 Handrails provided 5 Machinery guarded 2 First-aid boxes provided or refilled 97 79 Table A Registrations and General Inspections Class of premises No. of premises registered during year Total no. registered at end of year No. of general inspections Offices 36 765 142 Retail shops 119 1,799 724 Wholesale shops, warehouses 10 95 33 Catering establishments open to public, canteens 7 153 36 Fuel storage depots — 4 1 Totals 172 2,816 936 Table B Number of visits of all kinds by inspector to registered premises—2,259. Table C Analysis of persons employed in registered premises by workplace Class of workplace Number of persons employed Offices 12,097 Retail shops 10,338 Wholesale departments, warehouses 1,484 Catering establishments open to public 1,311 Canteens 177 Fuel storage depots 54 Total 25,461 Total males 11,790 Total females 13,671 Table D Exemptions Two applications for exemption from the provisions of Section 9 were received during the year and both were granted. One application for exemption from the provisions of Section 10(1) was received during the year and was refused. Four applications for exemption to provide first aid boxes because of the provision of first aid rooms were received; two exemptions were granted, one was later revoked. The remaining two applications were deferred pending satisfactory construction, equipment and staffing of the rooms to the Council's satisfaction. 80 Table E Prosecutions There was one prosecution during the year, details of which are given in Table 7. Table F Inspectors Number of inspectors appointed under Section 52(1) or (5) of the Act:— (a) Public Health Inspectors (part-time) 27 (b) Technical assistant (full-time) 1 Number of other staff employed for most of their time on work in connection with the Act 1 FAIRS AND CIRCUSES For the second year, a large fair was held on Ealing Common during August; other fairs were held in Acton Park, W.3, and at Yeading Lane, Northolt. A circus visited the area during the year and performances were given at Northolt. Inspections were carried out to enforce compliance with the Food Hygiene Regulations and, with a few exceptions, the food stalls were found to be in a reasonable condition and most were provided with hot water. Difficulties were encountered in securing suitable temporary sanitary accommodation; the facilities provided by the showmen were generally inadequate, poorly constructed, inadequately lighted and screened, and frequently insufficient in number. The emptying of the various types of closets provided was undertaken by the Council, but complaints were received that the accommodation was misused and insanitary. There is no doubt that the most satisfactory solution to this problem would be the provision, by the Council, of suitable mobile conveniences which could be towed to the various sites as required, and I am pleased to report the Council is now giving this proposal its consideration. DISINFECTION AND DISINFESTATION Number of houses where disinfection was carried out 17 Number of houses disinfested of vermin 41 Number of articles disinfected by steam 7 Number of articles disinfected by formalin spray 325 Number of articles voluntarily destroyed 14 Number of wasps' nests destroyed 215 Articles disinfected by steam were dealt with at the Cleansing Station at Scotts Road, Shepherds Bush, W.12, by arrangement with the London Borough of Hammersmith. PREVENTION OF DAMAGE BY PESTS ACT, 1949 The following is a summary of the work carried out by the rodent operatives:— Complaints received 1,460 Premises inspected 1,675 Premises found to be infested with:— (1) rats 1,251 (2) mice 402 Re-visits to infested premises 4,988 Fees received for treatment £1,671 8s. 6d. 81 RODENT CONTROL IN SEWERS The treatment of sewers for controlling rodents continued during the year, and a total of approximately 1,500 sewer manholes was treated with fluoracetamide as recommended by the Ministry of Agriculture, Fisheries and Food. The efficiency of this method can be illustrated by the fact that, on the day after treatment had been carried out in one small area, several complaints were received to the effect that dead rats with green faces had been found on the road and in gardens, the colour of the bait used being green. This incident led to the discovery of a hitherto unsuspected fracture in the drain in one of the houses in the area. BYELAWS The Council had under consideration during the year the need for making new byelaws in matters concerned with Environmental Health, and for revoking existing byelaws made by former authorities and which only applied in the areas for which they were originally made. It was found, not unexpectedly, that a general reorganization in this field was necessary in order to provide uniformity over the Borough. Matters dealt with included byelaws relating to the keeping of animals, offensive trades, common lodging houses, tents, vans and sheds and similar structures, barbers and hairdressers. At the end of the year, necessary steps had been taken to obtain confirmation of the new byelaws and it is hoped that these will come into operation during 1966. Other matters remain to receive similar attention as time permits. 82 27. HOUSING The function of the Housing Division is, in the main, to deal with unfit properties (either individually or as clearance areas), houses in multiple occupation, and overcrowding. Details of prosecutions under the Housing Acts and the annual housing statistics required by the Ministry of Housing and Local Government are given in Tables 11 and 12 on pages 124 and 125. CLEARANCE AREA PROGRAMME During the year, the Council submitted to the Minister of Housing and Local Government a slum clearance programme for the five-year period 1965-1970 in which it proposed to deal with 222 properties by taking action under Part III of the Housing Act, 1957. The total number of houses included some where formal and private action had already been commenced with a view to the rehousing of the occupants and the clearance of the sites. The slum clearance problem in Ealing is less than in certain other areas of London and the provinces, and action in earlier years by the three former Boroughs has done much to reduce the total stock of unfit properties which remain. Satisfactory progress was made in 1965 and the following action was taken:— 1-23 (consec.) Adelaide Cottages, Hanwell, W.7 The rehousing of the remaining families in occupation of these unfit houses was completed by the Council towards the end of the year in accordance with an agreement with the owners. It is anticipated that the site will be cleared early in 1966. 7, 8, 9 & 10, Church Place, Ealing, W.5 These unfit properties, which were acquired by the Council in 1963 and from which the remaining occupants had been rehoused, were demolished in 1965. 2-6 (consec.) Farm Cottages, Ealing, W.5 These unfit houses, purchased by a statutory undertaking in 1964, and from which certain families had been rehoused with assistance from the Council, remained vacant during 1965, but not demolished as expected. 18-26 (even numbers) Church Rd., Hanwell, W.7 The area in which these five properties are situated was declared to be a clearance area in 1964, and a Compulsory Purchase Order made by the Council in 1965 resulted in certain objections and a local public inquiry. The Order was later confirmed by the Minister of Housing and Local Government. Rehousing of the occupants and demolition of the houses is expected to take place in 1966. 1-6 (consec.) Williams Passage 9-26 (consec.) Green Man Lane 1, 3, 5 & 7 St. John's Rd., West Ealing, W.13 An official representation was submitted to the Council in June and the area in which these 28 properties are situated was declared to be a clearance area. The Council also decided to make a Compulsory Purchase Order. The Minister advised the Council to declare the properties as two separate clearance areas in view of some " grey " land in the centre of the site and arrangements were made for new representations to be made early in 1966. 83 1-9 (consec.) Vine Cottages, Lower Boston Rd., W.7 The remaining families were rehoused from these cottages in a clearance area which was the subject of a Compulsory Purchase Order made in 1959. Demolition of the houses is to take place in 1966. INDIVIDUAL UNFIT HOUSES AND PARTS OF HOUSES 13 & 15 Haven Lane, Ealing, W.5 Closing Orders made. Both houses vacant. 17 & 19 Haven Lane, Ealing, W.5 Negotiations for rehousing the tenants were commenced with the owners, with a view to the improvement of the whole site occupied by 13-19 Haven Lane. 37 Avenue Rd., and 8 Green Man Lane, W.13 Closing Orders made but rehousing of tenants still awaited. 22, 24, 26 & 30 South Ealing Rd., W.5, and 144 Closing Orders made in respect of the living accommodation at the rear of and over shops at these premises. Uxbridge Rd., W.7 All tenants rehoused by Council. 150 Uxbridge Rd., Hanwell, W.7 Tenant rehoused by Council following acceptance of informal undertaking not to relet living accommodation over a shop at these premises. 92 Colville Rd., W.3 15 & 17 Norwood Rd., Southall Closing Order made and tenant rehoused. Tenant of 15 Norwood Road rehoused following Demolition Orders made in 1964 in respect of both properties. Demolition not possible until tenant of 17 Norwood Road is rehoused. 23 & 25 Norwood Rd., Southall Tenants rehoused following Demolition Orders made in 1964, and the premises demolished. 27 & 29 Norwood Rd., Southall Tenant of 27 Norwood Road rehoused following Demolition Orders made in 1964 in respect of both properties. Demolition not possible until tenant of 29 Norwood Road is rehoused. 19 & 20 Featherstone Terrace, Southall Brook House, Hayes Bridge, Southall Both premises demolished following making of Demolition Orders and the rehousing of tenants in 1964. Tenant rehoused following a Closing Order made in 1963. REGULATIONS FOR UNDERGROUND ROOMS Regulations made by the former Boroughs of Acton and Ealing in accordance with Section 18 of the Housing Act, 1957, remained in force in the areas for which they were originally made, but the Council decided to make new Regulations for the London Borough. Confirmation was still awaited from the Minister of Housing and Local Government at the end of the vear. 84 The following properties were dealt with during 1965:— 9 Lothair Rd., W.5 A Closing Order made in 1954 in respect of the basement accommodation was determined on completion 83 Church Rd., W.3 of works of repair and improvement. Information concerning persons having an interest in these premises was difficult to obtain but " time and place" notices were eventually served to enable the condition and future use of the basement accommodation to be considered early in 1966. 14 Argyle Rd., W.13 Closing Order in respect of the basement accommodation made and tenant rehoused by Council. HOUSES IN MULTIPLE OCCUPATION The aim of the Council's policy with regard to houses let in lodgings or occupied by members of more than one family is to control excessive numbers of individuals in occupation, to reduce gross overcrowding, and in suitable cases to improve conditions and the amenities and means of escape in case of fire available to those families who are obliged to live in such houses in face of a continuing housing shortage in the London area. The Council's powers relating to houses in multiple occupation are derived mainly from Part II of the Housing Act, 1961, and fall into four main groups as follows:— (i) Section 12 of the Act contains the power to make an order applying the code of management prescribed in the Housing (Management of Houses in Multiple Occupation) Regulations, 1962, to any house which, or part of which, is let in lodgings, or which is occupied by members of more than one family, if the house appears to the Council to be in an unsatisfactory state because of failure to maintain proper standards of management. This power is designed to deal with really squalid conditions and the Minister of Housing and Local Government has advised that it should be applied only to houses manifestly in need of improvement. Section 14 of the Act gives the local authority power to require work to be carried out which is necessary to comply with the requirements of the Management Regulations. (ii) Sections 15 and 16 of the Act contain power to require an adequate provision of any of the following essential facilities—natural and artificial lighting, ventilation, water supply, personal washing facilities, drainage and sanitary conveniences, facilities for storage, preparation and cooking of food and for the disposal of waste water, installations for space heating or for the use of space heating appliances, and provision of means of escape in case of fire. In the early part of the year, the Council adopted a standard of amenities for the purposes of Section 15, and this standard has been applied in the main to houses of the larger type which, apart from a lack of certain facilities and a degree of disrepair and overcrowding, were more suitable for this type of occupation. In appropriate cases, informal notices were also served under Section 16 of the Act, requiring improvements to the means ot escape in case of fire. Requirements listed were based on the recommendations of the Fire Prevention Officer of the Greater London Council, or on the Code of Practice drawn up by that Council and now agreed by the London Boroughs Committee (iii) Section 18 of the Act contains powers to enable local authorities to carry out works in default and to recover the cost reasonably incurred where a notice under Sections 14, 15 or 16 has not been complied with. Also, the Housing Act, 1964, gives power to prosecute for non-compliance in lieu of executing work in default. It was not necessary to carry out any works in default during the year and there were no prosecutions. (iv) Section 19 of the Act enables the local authority to make a Direction setting a limit to the number of occupants who should live in a house in multiple occupation having regard to the availability of the basic services and facilities specified in Section 15, and to ensure that the number of individuals in occupation does not exceed that limit, or that where it does any other individuals are not permitted to take up residence in the house when any vacancies occur. The Act contains many other supplementary and miscellaneous powers for dealing with houses in multiple occupation, and Section 90 of the Housing Act, 1957, gives the Council power to deal with overcrowding. In practice it has been found that the most effective and widely applicable Sections were 15, 16 and 19. There are, however, certain drawbacks even with the application of these Sections in that many landlords tend to regard the fines imposed by the 85 magistrates in successful prosecutions for contraventions of Directions made under Section 19 as "business expenses and also the Acts contain no powers for making the persistent disregard of a Direction a continuing offence. A further prosecution can only be taken if different individuals are involved. There seems little likelihood that Section 19 will be amended in the near future to close this obvious deficiency in the legislation available. The Council will, I am sure, be watching with interest the effect of the implementation of the Birmingham Corporation Act, 1965, which gives that authority power to require the registration of existing houses in multiple occupation and the prior registration of houses which it was proposed to use for multiple occupation. The Act contains no more effective method of dealing with established multiple occupation than existing general legislation, but it will enable the Birmingham Corporation to exercise greater control over proposed use and to require works in advance of occupation and to fix limits as to the number of individuals and families who should live in the houses. Penalties for contraventions of the Act are severe. It would seem that the Act is in the nature of an experiment which could possibly be used nationally when the Minister has had time to study its effect and usefulness. 86 Action taken during the year to enforce the provisions of the Housing Acts relating to houses in multiple occupation in this Borough is summarized in the table which follows:— Directions given during the year 255 Prosecutions for contravention of Directions 7 Total number of Directions in force at end of year 839 Informal notices to improve facilities and means of escape in case of fire 46 Overcrowding notices 21 Prosecutions for contravention of overcrowding notices 24 Notices requiring information as to occupants 540 Prosecutions for failure to supply information 4 Prosecution for obstruction of public health inspector 1 Total number of visits and inspections 2,304 OVERCROWDING—HOUSING ACT, 1957 The following table gives details of action taken during the year to deal with the abatement of overcrowding:— (a) (1) Number of dwellings overcrowded at end of year 32 (2) Number of families dwelling there in 98 (3) Number of persons dwelling therein 526 (b) Number of new cases of overcrowding reported during year 35 (c) (1) Number of cases of overcrowding relieved during year 19 (2) Number of persons concerned in such cases 93 (d) Particulars of any case in which dwelling-houses have again become overcrowded after the local authority has taken steps for the abatement of overcrowding — (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report — MORTGAGE ENQUIRIES If multiple occupation is involved, the Greater London Council requires persons, who apply to that authority for mortgages, to obtain statements from local authorities of any additional facilities or other work which may be required under the Housing Act, 1961. This results in many enquiries from solicitors acting for prospective purchasers and entails the inspection of premises, and subsequent visits to check the occupation and progress of work required. In all cases where inspections showed that there may have been contraventions of the Town and Country Planning Act the particulars were referred to the Borough Engineer and Surveyor. MEDICAL ASPECTS OF APPLICATIONS FOR COUNCIL HOUSING Many applications for council housing or a transfer from one council house to another deserve special consideration by reason of the illness or disability of the tenants. Such consideration is only given if medical evidence from general practitioner, hospital or other medical source is furnished. These certificates are sent in the first place to the Housing Manager who then asks for my advice on the medical aspects involved. He, at the same time, forwards any relevant information that is to hand in his own department. It is not always possible for a proper assessment of the medical aspects of a housing application to be made from written evidence and in many cases a visit and further report is undertaken by a health visitor, a public health inspector or a medical officer. After an assessment of the case, the medical officer may recommend the award of a limited number of points on medical grounds and these are added to the general points total of the applicant. Cases of extreme urgency may be referred to the appropriate Housing Sub-Committee for discussion and a decision. In addition to the award of medical points in this way, the investigation of housing circumstances often leads to the supply of other Health Department services which benefit the tenant. The medical points scheme began in October, 1965, and, in the three months of the year during which it has been in operation, the following number of assessments were made:— Number of cases where medical points were given 67 Number of special reports to Committee 7 Number of applications by council tenants for re-housing on medical grounds 57 Number of other applications 7 Total number of cases 138 87 28. FOOD HYGIENE AND FOOD AND DRUGS ADMINISTRATION The Food Division is concerned with food production and sale, food handling and the hygiene of food premises, the bacteriological and chemical quality of foods and drugs, labelling requirements and the licensing and registration provisions of the Food and Drugs Act, 1955. The Division is also responsible for the application and enforcement of all Orders, Regulations and Standards relating to food. CLEAN FOOD SCHEME The Council is pursuing a Clean Food policy and, during 1965, 26 lectures were given to a total of 155 food handlers and 103 certificates of attendance were awarded to those who completed the courses. In addition, seven lectures were given by public health inspectors to 240 members of women's organizations and other groups. FOOD HYGIENE CERTIFICATES These certificates are awarded in respect of those school meals canteens, and other food premises in the Borough, where the standard of construction and hygiene is of a high order, and where members of the food handling staff have attended the courses of lectures in food hygiene organized by the Council. All certificates are renewed annually subject to new members of the staff attending the lectures and having passed a chest X-ray examination. The lecture scheme is now conducted with a series of three talks by public health inspectors in each course dealing with food poisoning and food infections, personal hygiene and hygiene of premises, and ending with a talk on the law relating to food and food handling. All talks are illustrated with flannelgraph, film-strips, coloured slides and films, and are normally followed by a period for questions and general discussion. At the end of the year, certificates of hygiene were held for the following premises:— School Meals Service Kitchens at 25 schools 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. A. Sanderson & Sons, Horsenden Lane, Perivale. Taylow 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. 88 Confectioner Joy Day, 5 Bond Street, W.5. 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's Tea Co. Ltd., 366-8 Windmill Road, W.5. H. Cradock Ltd., 52-3 Manor Road, W.13. United Dairies (London) Ltd.—six shops. Williams Brothers Ltd., 24 Broadway, Greenford. Butchers R. Matthews 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. INSPECTION OF FOOD PREMISES Food premises in the Borough number more than 2,000 and routine inspection was carried out during the year as vigorously as availability of staff would permit, with a total of 2,772 visits of inspection and 1,108 revisits. A summary of the work done and improvements carried out (total 1,451) at food premises during 1965 following these inspections is given in Table 13. The results have confirmed that it is good policy to send an informal letter to the trader concerned whenever contraventions of the Food Hygiene Regulations are found on inspection, in order to give him a reasonable opportunity of carrying out the necessary works. By following this procedure it was only necessary to resort to legal proceedings on two occasions (see Table 14 for details). Table 15 on page 128 gives details of the numbers of food premises in the Borough It also shows the various categories of premises and information as requested by the Ministry of Health concerning the proportion of such premises which comply with the requirements of Regulations 16 and 19 of the Food Hygiene (General) Regulations, 1960, dealing with the provision of wash-hand basins and sinks. MILK AND DAIRIES (GENERAL) REGULATIONS, 1959 During the year, 35 persons were registered as distributors of milk in accordance with the provisions of Regulation No. 8, and at the end of the year there remained on the register two dairies and 152 distributors of milk, in respect of 221 separate premises. The Regulations provide, amongst other things, that it shall be an offence for any milk bottle to be used for containing milk unless it is in a state of thorough cleanliness immediately before use. The two dairies now operating in the Borough both have up-to-date bottle washing equipment in use, and nine samples of washed bottles, taken at random from the bottling plants at these premises immediately before the filling machine, were found on bacteriological examination to be satisfactory. Complaints were received from members of the public on 11 occasions during the 89 year concerning the sale of milk in dirty bottles or in bottles containing foreign bodies. There were four prosecutions taken by the Council during 1965 for such offences, and in all cases the magistrates convicted and imposed fines and awarded costs to the Council. Many of the complaints, and all of the prosecutions, were in respect of bottles dealt with at dairies outside the Borough. It is indeed unfortunate for the dairy trade that many customers fail to rinse bottles before returning them to their retailers, and also frequently put them to improper use. This necessitates the utmost vigilance on the part of the managements at milk bottling plants to ensure that such bottles are not released in an unsatisfactory condition. THE MILK (SPECIAL DESIGNATION) REGULATIONS, 1963 AND 1965 During the year, eight new Dealer's (Pre-packed Milk) Licences were issued for the period ending on 31st December, 1965, and towards the end of the year two Dealer's (Pasteuriser's) Licences and 151 Dealer's (Pre-packed Milk) Licences, which involved 217 premises, were renewed for the five year period ending 31st December, 1970. The Dealer's (Pre-packed Milk) Licences renewed were in respect of the use of the following special designations:— "Pasteurised" 149 "Untreated" 87 " Sterilised " 110 "Ultra Heat Treated " 1 The Amendment Regulations of 1965 which came into operation on 1st October, 1965, authorized the use of the special designation "Ultra Heat Treated " in respect of milk produced by a special method which ensures satisfactory keeping quality over a long period. Only one dairy firm applied for a licence to retail this product in the Borough from licensed premises in another area. The informal samples of milk taken for chemical analysis, to ascertain whether they were genuine milks and reached the standards for fat and milk solids other than fat, were also examined by the tests prescribed in these Regulations. Reports on these samples were all satisfactory as shown in the following table:— Class of milk Number of samples Phosphatase test Methylene Blue test Turbidity test Colony Count test Pass Fail Pass Fail Pass Fail Pass Fail Pasteurised 47 47 — 47 — — — — — Sterilised 6 — — — — 6 — — — Untreated — — — — — — — — — Ultra Heat Treated — — — — — — — — — Totals 53 47 — 47 — 6 — — — ICE CREAM At the end of the year, 524 premises in the Borough were registered in accordance with Section 16 of the Food and Drugs Act, 1955, for the sale and storage of ice cream and five premises were registered for manufacture. There were 10 new premises registered for sale and storage during the year. Routine visits of inspection of manufacturers' premises were carried out at regular 90 The preponderance of the unsatisfactory samples was from soft ice cream dispensing machines. These machines are complicated pieces of equipment requiring very careful cleaning and sterilising at the end of each day, and the need for great care in operating them was not always appreciated by those responsible. Repeated visits by inspectors were made whenever necessary in order to investigate unsatisfactory results and to educate operators in methods of sterilization. Further sampling produced more satisfactory results in most cases. IMITATION CREAM Imitation cream is produced by emulsifying edible oils or fats with water, and is used largely in the confectionery trade. There are two manufacturers of this product in the Borough. During the year, 80 samples were taken for bacteriological examination, and all were satisfactory except one. The standards and quality maintained by the two producers at their premises were extremely high. 91 intervals throughout the year to ensure compliance with the requirements of the Food Hygiene and the Ice Cream (Heat Treatment) Regulations. Sampling of ice cream and of ice lollies was also carried out systematically and details of samples taken and results of examination are given below. Commodity Number of samples Methylene Blue Grade Not graded Grades I and II satisfactory Grade III doubtful Grade IV unsatisfactory I II III IV Ice cream (local manufacturers) 232 205 21 3 3 — 226 3 3 Ice cream (other manufacturers) 64 25 14 5 20 — 39 5 20 Ice lollies (local manufacturers) 38 — — — — 38 37 — 1 Ice lollies (other manufacturers) 10 — — — — 10 10 — — Totals 344 230 35 8 23 48 312 8 24 The above table includes: Ice cream samples from vans 11 3 5 1 2 — 8 1 2 Soft ice cream samples 28 7 5 3 13 — 12 3 13 SURRENDER OF UNSOUND MEAT AND OTHER FOODS (excluding meat at slaughterhouse) The following foodstuffs were condemned by the public health inspectors as unfit for human consumption and were surrendered for destruction:— lbs. lbs. Apples and other fruit 4,902 Ham 66 Bacon 359 Meat 3,591 Biscuits 372 Offal 90 Black pudding 4 Pickles 1,200 Cheese 59 Potatoes and other vegetables.. 8,520 Confectionery 224 Poultry 494 Corned beef 8 Preserves 54 Dried fruit 2 Rabbit 20 Edible fats 193 Sausages 415 Fish 402 Sugar 2 Flour 33 Veal and ham pie 4 Garlic 84 Foodstuffs not calculated by weight—assorted tins, packets and jars, etc. 36,380 In addition, 7,302 lbs. of tea was found to be unfit for human consumption and was reblended under supervision so that it did not form more than 5 per cent. of the final product. IMPORTED FOOD REGULATIONS—EXAMINATION OF TEA Imports of teas from all parts of the world arrived at a large tea blending and packing factory in Greenford, and approximately 10 per cent. of stocks received during the year came direct from the London docks without inspection on landing. This placed on the Council the responsibility of sampling and examining the consignments to ensure that they were fit for use for human consumption in accordance with the provisions of the Public Health (Imported Food) Regulations, 1937. The remaining 90 per cent. of stocks received at the factory arrived from bonded warehouses in London and had already been subject to inspection by other local authorities. During the year, 624 samples from total consignments of 80,841 cases, received at the factory without prior inspection, were taken by public health inspectors and examined for evidence of unfitness and contamination by foreign substances. Experience has shown that teas from certain growing areas of the world are more likely to be contaminated than others and sampling was therefore selective. Of the 624 samples examined locally only 14 were found to be of doubtful quality and these were referred to the Council's Analyst for more detailed examination and report. Of the 14 samples examined by him, only one was unsatisfactory and this was from a consignment of 47 cases containing excessive amounts of metallic dust. Contamination of these 47 cases was such that the tea was blended under supervision with other good teas so that it did not form more than 5 per cent. of the final blend. The blending machinery itself includes suitably placed magnets which extract much of the metallic content whenever this is present. Samples of the resultant product were found on examination to be satisfactory. The amount of tea found to be unsuitable for use without special arrangements affecting the blending was only 0.058 per cent. of the total quantity examined, and this represented the lowest percentage achieved since sampling and inspection by the local authority was commenced in 1949, when the duties were taken over by the former Municipal Borough of Ealing from H.M. Customs and Excise. 92 BACTERIOLOGICAL EXAMINATION OF OTHER FOODS During the year, 172 samples of foods of varying types were submitted to the pathological laboratory for bacteriological examination. The foods concerned included 82 samples of sea foods of the frozen imported variety, taken from consignments received in the Borough from overseas. Sampling was carried out as a routine on receipt of advice from the port health authority that consignments had been released without inspection at the port. Sampling of canned meats included 43 cans of meat packed and processed at food canneries in the district. Consumer complaints concerning suspected articles of food, and specimens obtained in the investigation of suspected cases of food poisoning and other infections accounted for 27 of the remaining samples. In these latter categories no harmful organisms were found on examination. A summary of results of sampling is given in the following table:— Food Satisfactory Unsatisfactory Total samples Sea foods 77 5 82 Fish 3 — 3 Canned meats 43 — 43 Raw meat 3 2 5 Milk powder 3 — 3 Other foods (including meal mens) 27 — 27 Milk bottles 9 — 9 Totals 165 7 172 REGISTRATION OF HAWKERS OF FOOD AND THEIR PREMISES Section 11 of the Middlesex County Council Act, 1950, which had been brought into operation by the former Ealing and Southall Borough Councils, was extended to apply to the whole of the London Borough as from 1st January, 1966. The Section requires that no person other than a person keeping open shop for the sale of food shall sell or offer or expose food for sale on any cart, barrow, or other vehicle, or any basket, pail, tray or other receptacle unless he is registered with the local authority of the district in which the food is sold, or offered, or exposed for sale. Premises used in connection with the storage of any food to be sold in this manner must also be registered. A total of 32 such registrations where persons were still in business were effective at the end of 1965, four new traders having been added during the year. PREMISES REGISTERED FOR PREPARATION OF SAUSAGES AND PRESERVED FOODS Section 16 of the Food and Drugs Act, 1955, provides that no premises shall be used for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale unless registered for the purpose by the local authority. At the end of the year, there were 180 premises on the Council's register where the various preparation processes were being carried on, three new premises having been added during the year. 93 LIQUID EGG (PASTEURISATION) REGULATIONS, 1963 No samples of liquid egg were taken during the year. There are no pasteurising plants in the Borough. SAMPLING OF FOOD AND DRUGS In addition to its functions as a "local authority" under the Food and Drugs Act, 1955, the Council assumed the duties of a "food and drugs authority" on the 1st April, 1965, the latter duties having been performed formerly by the Middlesex County Council. In order to carry out its food and drugs responsibilities the Council was required to appoint a Public Analyst, and completed negotiations with the Greater London Council for the appointment of Mr. W. B. Chapman, B.Sc., F.R.I.C., as Public Analyst, and Mr. E. H. W. J. Burden, B.Sc., F.R.I.C., as Deputy Public Analyst. Both officers are members of the staff of the Department of the Scientific Adviser of the Greater London Council. An annual block payment is made by the Council for the analytical work carried out in the laboratories which are staffed and equipped to undertake a wide variety of investigations. Apart from food and drugs these include water pollution and sewage treatment, sampling of water from swimming pools, examination of building materials for construction and maintenance, air pollution, ventilation, noise and vibration, fire precautions, petroleum, fertilizers and feeding stuffs, radiochemistry, and general supplies and services. During the last nine months of 1965, 18 formal and 605 informal samples of food and drugs were taken and submitted to the Public Analyst for examination. The rate of sampling now reached (approximately three samples per 1,000 population per annum) is that recommended by the Ministry of Health. Details of the variety of samples taken and the number shown to be adulterated or irregular are given in Table 16 on page 129. CHEMICAL ANALYSIS OF FOOD AND DRUGS Of the total of 623 samples of food and drugs taken or purchased in the Borough during the year in accordance with the Food and Drugs Act, 1955, and submitted to the Public Analyst for examination, 88 were found to be unsatisfactory. Infringements of the many Regulations relating to food were mostly of a minor character, and 50 were concerned with various labelling irregularities which are given in detail in Table 17 on page 131. Cases worthy of mention where compositional standards were not satisfied included angelica containing a prohibited colouring agent; dried milk containing excess moisture; weights of individual drug tablets more variable than was expected; unsatisfactory packaging of ground nutmeg resulting in absorption of volatile oils and loss of flavour; meat pasties, meat pies, sausages and hamburgers all with low meat content; prunes containing a prohibited preservative, and canned cream with low fat content. All unsatisfactory results were discussed with the manufacturers and importers concerned. In some cases, where commodities had been imported, all available stocks were withdrawn and returned to the country of origin. In other cases, manufacturers agreed to examine their methods in order to bring their products up to at least minimum requirements. In the examination of samples of meat which were found to contain excess mercury, consideration was given to the level of mercury in meat which could be regarded as free from any danger to health. This tentative standard was then applied in the production of the meat concerned in order to remove all reasonable doubts of risk to human health in its use as a food. FOOD COMPLAINTS During the year, 137 complaints about articles of food purchased by members of the public were received in the Health Department, and all were examined and 94 investigated. Of these articles, 18 were submitted to the Public Analyst for his opinion. Articles of food involved included a number of cases of bread found to contain foreign bodies such as cotton sacking, string, poppy seeds and feathers. Full or empty bottles of milk were found to contain such items as mould, sand and cement, potato peelings, a steel wool pad, clay and soil, and traces of petrol. In all these cases there was evidence that the bottles had passed through the normal bottle washing process, from which it was concluded that the foreign bodies were present in the bottles at the time of filling at the dairy premises. Other articles of food concerned included ice cream containing excreta, chewing gum wrapper in canned soup, chilli powder diluted with corn meal, green dye in sausages, and metal in toffee. Details of 20 legal proceedings concerning the sale of unsound food or food "not of the nature, substance or quality demanded by the purchaser" are given in Table 14 on page 127. 95 29. MEAT INSPECTION AND ANIMAL PROTECTION This Division is responsible for the administration of the Meat Inspection Regulations, 1963, and for the Diseases of Animals Act, 1950, and other legislation which controls slaughterhouse operations, together with inspection and licensing of pet animals shops, riding establishments and animal boarding establishments. The legislation covering control of operations at a slaughterhouse governs licensing, hygiene, prevention of cruelty, anaesthesia, inspection, administration, slaughtering and notifiable disease. The object of meat inspection is to ensure that no diseased or unsound meat reaches the consumer. Any failing on the part of the inspectorate could result in the transmission of disease to man. Other aspects of the work of the meat inspection division referred to in this report relate to duties under the Diseases of Animals Act and to various minor pieces of legislation which are designed to improve the handling of animals. MEAT INSPECTION REGULATIONS The factory slaughterhouse of T. Wall & Sons, Ltd., Atlas Road, Acton, is engaged in the slaughtering and processing of pigs and is the largest of its kind in the country. In order to carry out the provisions of the Meat Inspection Regulations, 1963, a staff of eight authorized meat inspectors and three assistants, together with a Supervisory Inspector in charge, was employed daily throughout the year from Monday to Friday with occasional Saturday morning duty. The moving line method of carcase dressing is in operation and, with a speed of approximately 327 carcases an hour, staff have found this type of meat inspection exacting and tiring, and difficulty has been experienced in the past in attracting public health inspectors to this particular type of work. In order to overcome this difficulty the former Acton Council started a training scheme for authorized meat inspectors to release its public health inspectors for other duties. On the 1st April, 1965, four authorized meat inspectors were transferred to the staff of the London Borough together with four students under training. The staff necessary to complete the meat inspection team was drawn from the Public Health Inspectorate on a rota system, working an early and late shift. In May, the student meat inspectors were successful in their qualifying examination and were appointed authorized meat inspectors, and a staff of eight authorized meat inspectors became operative. Public health inspectors since then have only been required for duty when authorized meat inspectors were absent on holiday or through sickness. There were four further student meat inspectors under training at the end of the year, and when they are qualified it is hoped that this will enable the amount of overtime being worked by the meat inspectorate to be reduced. This I consider important as I am sure that a high standard of inspection cannot be maintained if the shifts worked are excessively long. The need for constant vigilance in meat inspection was illustrated during July and August when batches of pigs from two farms were received and on post-mortem examination showed signs of a toxic condition in certain organs. The carcases were detained and bacteriological and chemical examinations were carried out by the Council's Analyst and the Ministry of Agriculture, Fisheries and Food. Their reports indicated that the animals were affected by mercurial poisoning and were unfit for human food. The source of the mercury was found to be due to the inclusion of washed seed barley in the feed meal supplied to the two farms. The 96 (Facing p. 96) Inspection of pigs at a meat factory. . 97 G matter was immediately referred to the local inspector under the Fertiliser and Feeding Stuffs Act. Fortunately, this particular batch had only been supplied to the two pig breeders mentioned above and was then withdrawn. The Council co-operated during the year in a national Tumour Survey in food animals, and specimens of tumours found during meat inspection were submitted to Professor W. F. H. Jarrett at Glasgow University. Tables 18 and 19 on pages 132 and 133 give details of the total numbers of carcases inspected during the year, and an analysis of carcases and parts surrendered on account of disease. DISEASES OF ANIMALS ACT, 1950 The Borough remained free of notifiable disease throughout the year. No prosecutions or official cautions under the Act were made. Mr. J. A. Morris, M.R.C.V.S., was appointed an inspector under the Act and commenced duties on behalf of the London Borough at Southall Market in June. This market is held on Wednesdays for the sale by auction of horses and pigs, and under the Regulation of the Movement of Swine Order, 1959, 39 market sales were authorized, and 422 Movement Licences, involving 9,260 pigs, were issued for animals to be moved out of the market. Fifty-three vehicles were inspected and no contraventions were found. Under the Markets (Protection of Animals) (Amendment) Order, 1965, the Minister of Agriculture, Fisheries and Food must approve the covered accommodation provided in markets for calves, cows and pigs exposed for sale and held awaiting removal. The owner and occupier of the Southall Market was advised of his obligation to make the necessary application for approval in accordance with the Order. DISEASES OF ANIMALS (WASTE FOODS) ORDER, 1957 Ten premises are licensed under this Order. During the year, 54 routine visits were made to the smallholdings concerned. At the end of the year, only five of the plants were still in operation and all were found to be working satisfactorily and in accordance with the requirements of the Order. SLAUGHTER OF ANIMALS ACT, 1958 Two new applications for licences to slaughter animals were received during the year. These were granted after the competency of the applicants had been confirmed. Twelve applications for the renewal of existing licences were received and these were granted. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 Four applications for the renewal of licences under this Act were granted during the year. Routine visits to these premises were made on nine occasions by public health inspectors. PET ANIMALS ACT, 1951 Licences in respect of 22 premises were renewed during the year and routine visits of inspection were made by the public health inspectors to these premises on 52 occasions. 98 RIDING ESTABLISHMENTS ACT, 1964 This Act came into force on 1st April, 1965. Two applications for licences to keep riding establishments were received. Upon reports from the Council's Veterinary Officer, licences were granted in both instances, although one licence was issued on condition that certain works of improvement would be carried out within six months. Routine visits of inspection were made on 24 occasions by public health inspectors during the year. 99 30. CLEAN AIR Air pollution in this country comes from many sources and takes many forms. It includes not only smoke, gases, dust and grit from chimneys, smoke from locomotives and ships, exhaust gases from internal combustion engines, but also the fumes, gases and products of chemical works and industrial processes, and airborne dust from other sources. Legislation has existed for many years for the control of the emission of fumes and smoke from certain chemical and industrial processes but no comprehensive legislation for the control of smoke from domestic sources existed until the passing of the Clean Air Act in 1956. The problem of air pollution, and in particular smoke, has been the subject of much study and research and a large volume of technical knowledge is now available. In addition to the work of public authorities, various other bodies, notably the National Society for Clean Air, have long been active in publicising the evils of pollution and promoting measures of abatement. Following the great London "Smog " of December, 1952, which resulted in the deaths of some 4,000 people, a Committee on Air Pollution under the chairmanship of Sir Hugh Beaver, was set up "to examine the nature, causes and effects of air pollution and the efficacy of present preventive measures; to consider what further preventive measures are practicable; and to make recommendations". This committee reported its findings in November, 1954, and, in 1956, the Clean Air Act came into being. The smoke and sulphur dioxide which are produced by the combustion of coal, oil and other products are harmful to health, damage vegetation, blacken and damage the fabric of buildings, paintwork, ironwork and add considerably to our laundry bills. The Beaver Committee estimated that the national cost of air pollution amounted to some £250 million annually. The establishment of Smoke Control Areas under the Clean Air Act is one of the most important methods of reducing air pollution, as recent estimates suggest that over 80 per cent, of smoke pollution is due to house chimneys. Progress in the setting up of Smoke Control Areas in this Borough has been growing steadily since 1959, and it is gratifying to note that we are now in a slightly better position than Greater London as a whole, and certainly much more advanced in our programme than the total " black areas " of the country. Comparative Region No. of acres covered by Smoke Control Orders Percentage of total " black area " acreage so covered No. of premises covered by Smoke Control Orders Percentage of total " black area " premises so covered Whole country ("black areas") 427,415 20.3 2,504,870 30.5 Greater London 149,670 45.8 1,350,560 51.2 London Borough of Ealing 7,524 54.8 54,058 53.8 100 figures for the whole country, Greater London, and the London Borough of Ealing are set out in the table (page 99) and these relate to the position on 31st December, 1965. SMOKE CONTROL AREAS The amalgamation of the three Boroughs provided an opportunity to re-examine the original clean air programmes and to combine them into a new scheme which should result in the Borough being completely covered by Smoke Control Orders by 1972, this date being some two years ahead of the original completion date. During 1965, five new Smoke Control Orders were made by the Council. These related to Areas Nos. 21, 22, 23, 24 and 25 covering 1,511 acres, and including 8,250 dwellings and 404 other buildings. Of these Orders, Nos. 21 and 22 were confirmed by the Minister of Housing and Local Government and come into operation on 1st July, 1966, and 1st August, 1966, respectively. Orders Nos. 23 and 24 were submitted to the Minister and were awaiting confirmation at the end of the year, and Order No. 25 was about to be submitted for confirmation. During 1965, the following Orders became operative: Acton Nos. 10 and 11, Ealing Nos. 18, 19 and 20, and Southall No. 6. Surveys of Areas Nos. 26 and 27 were nearing completion at the end of the year and the preliminary work on Areas Nos. 28-31 had been commenced. The following table and map give details of the progress made up to the end of 1965:— Progress of Smoke Control Programme No. of Smoke Control Orders Acres No. of dwellings No. of other buildings Total premises Private Local Authority In operation 37 6,013 36,717 6,405 2,282 45,404 Confirmed but not yet in operation 2 636 3,510 109 125 3,744 Awaiting confirmation 3 875 4,224 407 279 4,910 Totals 42 7,524 44,451 6,921 2,686 54,058 ERRATUM For the map showing the position with regard to Smoke Control see facing p. 107. 101 London Borough of Ealing—Smoke Control Areas (coloured yellow on map) Smoke Control Orders Date of Operation Acton Nos. 1, 2 and 3 1960 Ealing Nos. 1 and 2 Southall No. 1 Acton No. 4 1961 Ealing Nos. 3, 4 and 5 Southall No. 2 Ealing Nos. 6, 7, 8 and 9 1962 Southall No. 3 Acton Nos. 5, 6 and 7 1963 Ealing Nos. 10, 11, 12 and 13 Southall No. 4 Acton Nos. 8 and 9 1964 Ealing Nos. 14, 15, 16 and 17 Southall No. 5 Acton Nos. 10 and 11 1965 Ealing Nos. 18, 19 and 20 Southall No. 6 Made and confirmed in 1965 but to come into Ealing Nos. 21 and 22 operation on 1st July and 1st August, 1966, respectively. Ealing Nos. 23, 24 and 25 Made in 1965, but awaiting confirmation by Minister of Housing and Local Government. Ealing Nos. 26 and 27 Surveys in progress. Ealing Nos. 28 and 29 Next for survey. Smoke Control Orders in operation in adjoining districts (coloured red on map). A. London Borough of Harrow. C. London Borough of Hammersmith. E. London Borough of Hillingdon. Proposed Smoke Control Areas in adjoining districts (coloured green on map). A. London Borough of Harrow. B. London Borough of Brent. C. London Borough of Hammersmith. D. London Borough of Hounslow. E. London Borough of Hillingdon. PUBLICITY FOR CLEAN AIR PROGRAMME As a result of the confirmation of the Ealing Nos. 19, 20, 21 and 22 and the Acton Nos. 10 and 11 Smoke Control Orders, approximately 8,000 letters were circulated to householders in the areas concerned, giving them full details of the effect of the Orders and of grant aid available for the conversion of heating appliances. In addition, approximately 11,000 visits were made by officers of the Department in areas being surveyed with a view to the making of new Smoke Control Orders. These visits were either to make personal contact with occupiers or to leave reply-paid questionnaires, asking for information about existing heating methods. At these visits, occupiers were given a leaflet which explained that a Smoke Control Order affecting their methods of heating would be made by the Council in the near future. 102 Talks on the Council's Clean Air Programme and atmospheric pollution generally were also given on several occasions to various organizations. These talks were illustrated with films, film strips and other visual aids, and were valuable as an addition to other publicity methods. A portable display unit which illustrated the range of solid fuels and the correct operation of appliances was made available by the Solid Smokeless Fuels Federation. This unit was on view throughout the year for the information of members of the general public making enquiries at the Department. In February, the former Borough of Ealing participated in an Exhibition staged by the North Thames Gas Board at the Town Hall, which extended over a period of 12 days and was attended by nearly 2,200 visitors. An exhibition stand staffed by officers of the Department was used to publicise the Council's programme, the effects of atmospheric pollution, and the grant system. The exhibition was opened by the Mayor of Ealing who referred to the efforts being made by the Council to deal with air pollution in the Borough. Arrangements were made with the Solid Smokeless Fuels Federation for mobile exhibitions demonstrating modern solid fuel space, and water heating appliances and fuels, to visit proposed Smoke Control Areas. A total of 2,856 persons visited the vans which spent four separate periods of six days in the Borough in Smoke Control Areas Nos. 22, 23, 24, 25 and 27. Area No. 26 is to be visited during 1966 since it contains very few private houses, the great majority of the properties being owned by the Council. The residents are therefore less in need of advice and information as the necessary adaptations to fire grates are carried out by the Council. Visits by these exhibitions are a most useful method of advance publicity in proposed Smoke Control Areas. The Department distributes circular letters in the area immediately prior to the date of the visit so that the local residents are informed of the place where the vehicle may be found on any given day. The Federation supports this publicity with advertisements in the local press, and the Department is indebted to it for the valuable assistance given during the year. GRANT ARRANGEMENTS With the object of cutting down the volume of administrative work and so helping to speed up the establishment of Smoke Control Areas, the Minister of Housing and Local Government issued Circular No. 51/65 on 28th June. This Circular laid down a scale of cost limits for the various types of appliances which he considered to be "reasonably necessary" replacements for existing appliances in Smoke Control Areas and clarified the procedures under some of the previous circulars. The Council adopted the new schedule of prices. Circular No. 77/65 issued on 31st December, 1965, further simplified the procedures for submitting estimates and final costs for Smoke Control Areas. SUPPLY OF FUELS IN SMOKE CONTROL AREAS The Ministry Circular No. 13/65 issued on 17th March drew the attention of local authorities to the fact that any increase in the availability of solid smokeless fuels would relate only to some of the specially reactive premium fuels, and that owners and occupiers in Smoke Control Areas should continue, for grant purposes, to have freedom of choice between appliances using solid fuel, gas, off-peak electricity and oil. In October, the Minister of Power issued a White Paper on Fuel Policy. This described, with the necessary background information, the principles which should govern a co-ordinated national fuel policy and the machinery and measures whereby the Government proposed to secure and maintain such a policy. With regard to the 103 impact of fuel policy on clean air policy it was stated that, although solid smokeless fuels from the gas industry had decreased since the publication of the White Paper on Domestic Fuel Supplies and Clean Air Policy in December, 1963, the National Coal Board and private producers had announced plans to make substantial increases in the production of open-grate premium fuels. The Board also expected to increase the availability of hard coke for use in domestic closed appliances up to the level forecast in that White Paper. In addition, there were plentiful supplies of non-solid smokeless fuels, gas, off-peak electricity and oil. All these together should be fully sufficient to maintain progress with the clean air policy. Returning nearer home, no local difficulties were experienced in obtaining supplies of solid smokeless fuels, only in a few isolated instances where supplies of a particular fuel were not available within a reasonable time. FUELS AUTHORIZED FOR USE IN SMOKE CONTROL AREAS The Smoke Control Areas (Authorized Fuels) (No. 2) Regulations, 1965, which came into operation on 13th December, added a new fuel called "Multiheat" to those previously declared to be "authorized fuels This fuel was originally to be known as "Phurnacine" and as such had been declared an authorized fuel by regulations made earlier in the year but later revoked. This new fuel, produced by the National Coal Board in Cardiff, is a high quality, smokeless boiler fuel, based on the mild heat treatment of briquettes made mainly from anthracite small coal. It is designed mainly for boilers but is also suitable for burning in most types of room heaters. The National Coal Board expected that production would be at the rate of 110,000 tons a year by the end of the winter of 1965-66. NEW FURNACES Notifications of intention to install new boilers in domestic, commercial and industrial premises totalled 103 during 1965. A noticeable feature was the preponderance of gas-fired installations for domestic premises. Out of 69 notifications for this type of premises, 55 related to gas-fired boilers. One particular notification was of interest—that of an oil-fired regenerative glassmelting furnace. Similar furnaces operated by the company concerned over a number of years have been fired by producer-gas, and have given rise to smoke emission at the time of regeneration. It is expected that the new oil-fired furnace will overcome this particular emission. PRIOR APPROVAL There were no formal applications for prior approval. Much consultation, however, arises out of notifications of proposed new furnaces and the submission of plans for new chimneys, and gives good opportunities to press for modifications. HEIGHTS OF CHIMNEYS Building Byelaw applications involving new chimneys numbered 19 during the year, of which eight required amendment before approval. Gradual improvement in the understanding of the principles underlying the safe dispersal of flue gases is becoming noticeable, and architects and heating engineers frequently discuss a proposed boiler and flue before making formal application under the Byelaws. Particular cases of interest were the new chimney forming part of the full fume arrestment apparatus to be installed at the British Bath Works during 1966, and the chimney for the glass-melting furnace before-mentioned. The Bath Works chimney will reach 125 ft. and, when completed and operational, the equipment should effect 104 a considerable improvement in the level of atmospheric pollution in the neighbourhood of the works. In the case of the glass works, the chimney will be 131 ft. high and is designed with a removable constriction at the outlet so as to maintain a suitable efflux velocity with one bath working. When a second bath is brought into commission the constriction will be removed. This adaptation was made following representations from the Department and is a good illustration of the benefits of notification and consultation. The well-known weakness of the Act concerning boilers and chimneys for shops and offices, to which Section 10 of the Act does not apply, has not yet been remedied. MEASUREMENT OF ATMOSPHERIC POLLUTION Shortly after the amalgamation of the three Boroughs, consultations were held with representatives of the Warren Spring Laboratory, Ministry of Technology, to establish the number and siting of the various instruments necessary to give adequate information as to atmospheric pollution in the Borough. It was decided that this object could best be obtained as follows:— (1) By retaining five standard deposit gauges at Bashley Road, Acton; Longfield Depot, Ealing; Birkbeck Avenue, Greenford; Hortus Cemetery, Southall; and Park Avenue, Southall. These are for monitoring local emissions in the vicinity of the sites and for measuring local fall-out of larger particles. (2) By continuing the use of six volumetric instruments at Acton Lane, Acton; Friars Place Lane, Acton; Chase Road, Acton; Town Hall Annexe, Ealing; Eliots Green Grammar School, Northolt; and Walpole Grammar School, Ealing. The function of these is to measure smoke and sulphur dioxide in the atmosphere. (3) The eventual establishment of a new volumetric instrument at Northcote Clinic, Southall. This regrouping resulted in the reduction of the former volumetric sites by one and the abolition of all the lead peroxide sites. The modern daily volumetric instrument gives a more reliable and useful figure for atmospheric sulphur. Examination of former figures for the lead peroxide instruments which have now been discontinued shows that the amount of sulphur in the air in the past few years has been decreasing steadily at all the sites with the exception of the one used at Longfield Depot; the trend line of this station, obtained by using a five-year moving average, shows a slow rise. The standard deposit gauge figures follow a similar pattern with the exception of those at Bashley Road and Longfield Depot, both of which show a slight rise over the past three years. As the volumetric instruments have not been in use for such long periods as the other types, it is not possible to establish reliable trends but, from the information available, it appears that the amount of smoke in the air each day is getting less whilst the amount of sulphur dioxide is increasing slightly. The monthly averages of the daily figures for smoke and sulphur dioxide obtained from the six volumetric instruments are shown graphically in the first three diagrams on pages 137 and 138. The monthly analysis of insoluble deposits from the deposit gauges is shown in the last three diagrams on pages 138 and 139. (The White Street, Southall, deposit gauge is operated by the North Thames Gas Board.) The complete results for the year are given in Tables Nos. 20, 21 and 22 (immediately preceding the graphs) on pages 134, 135 and 136. 105 It will be noted that the smoke and sulphur dioxide figures follow a fairly regular pattern, the highest daily concentrations being obtained in the winter with the lowest in the summer. The standard deposit gauges, however, give very irregular results due to the fact that the weather conditions can have a considerable effect on the deposit. High winds will bring to the gauges road dust, dust from nearby building sites, and leaves and small twigs from trees, these latter often rotting in the course of a month pass down into the collecting bottle and so form part of the insoluble deposit. CONTRAVENTIONS OF SMOKE CONTROL ORDERS Minor contraventions of the provisions of Smoke Control Orders continue to occur occasionally in domestic premises due to misunderstandings. These normally result in no formal action, as occupiers readily comply with Orders when the position is explained to them. DARK SMOKE FROM INDUSTRIAL PREMISES The adoptive Section 47 of the Middlesex County Council Act, 1961, which applies in the whole of the Borough, again proved useful during the year and several warnings were given, although no formal action was necessary. Contravention of this provision, which deals with smoke other than from chimneys, commonly arises from the burning of waste in the open. SMOKE FROM INDUSTRIAL CHIMNEYS Seventy-eight complaints regarding the emission of smoke from industrial chimneys were received, and 512 observations were carried out by the inspectors during the year. In most cases, where an emission of dark smoke or black smoke was observed, the cause was found to be due to faulty adjustment or maintenance of controls on oil-fired furnaces and a remedy was quickly applied in many cases; smoke emission from hand-fired incinerators, however, was sometimes more difficult to overcome. The Council's Consultants and the National Industrial Fuel Efficiency Service were called upon to assist and advise in a few cases, where firms were found to be persistent offenders and where special problems were involved. Complaints were also received about smoke from hot-blast cupolas, producer gas plants and a power station, and these were notified to the District Alkali Inspector of the Ministry of Housing and Local Government. CLEAN AIR INFORMATION SERVICE The Council pays an annual fee for membership of the Clean Air Information Service, which is operated by the College of Fuel Technology. This entitles the Council to a regular supply of technical information on all aspects of combustion engineering and atmospheric pollution. In addition, the College acts through its Principal as the Council's consultant in these matters, and the officers of the Department have received much help in dealing with the many technical matters which arise in the administration of the Clean Air Act. This is most valuable when unusual processes are under consideration as, for instance, the new chimney for the glass melting furnace mentioned under the paragraph on chimney heights. 106 31. WATER SUPPLIES AND SEWAGE DISPOSAL WATER SUPPLIES The whole of the Borough is fortunately supplied with mains water, there being four public sources. The Colne Valley Water Company supplies small parts of Perivale and Horsenden Wards. The Rickmansworth and Uxbridge Valley Water Company supplies the remainder of Perivale and Horsenden Wards, part of Waxlow Manor Ward and the whole of Ravenor, Mandeville and West End Wards. The South West Suburban Water Company supplies the whole of Dormers Wells and Northcote Wards, the remainder of Waxlow Manor Ward and part of Glebe Ward. All other areas of the Borough not already mentioned are supplied by the Metropolitan Water Board. These public supplies are not subject to plumbo-solvent action and have been satisfactory both in quantity and quality. Water from public mains was supplied to 88,901 dwellings with a mid-1965 estimated population of 303,660. Thirty-six samples for bacteriological examination and chemical analysis were taken from private supplies derived from wells at 11 factories in the Borough. In these factories, water is obtained from deep borings ranging in depth from 300 to 600 feet. Of these 36 samples, one proved to be unsatisfactory but, after thorough cleansing and sterilization of supply pipes, repeat sampling proved to be satisfactory. Forty-eight samples of tap water from public supplies were taken, of which 15 were unsatisfactory. In most of these cases, storage tanks had become contaminated and all were thoroughly cleaned and properly covered. Satisfactory repeat samples were obtained when all necessary works had been completed. Water Samples, 1965 Samples Satisfactory Doubtful Unsatisfactory Well supplies 36 35 - 1 Public supplies 48 33 2 13 Totals 84 68 2 14 SWIMMING BATHS The Council is responsible for the maintenance of four indoor public swimming pools at Ealing, two indoor pools at Acton and one outdoor pool and a paddling pool at Southall. In addition, there are swimming pools at four Education Department schools in the Borough for which the Council is now responsible and at one direct grant school. A private outdoor swimming pool is operated by a local industrial firm at its sports ground at Greenford. Samples of water from each pool were taken by the Department at regular intervals when they were in use, and were submitted for bacteriological examination. From a total of 346 samples, 12 were found to be unsatisfactory, but further samples taken 107 after investigation proved acceptable. Results of sampling are given in the following table:— Number of pools Satisfactory samples Unsatisfactory samples Total samples Public baths 8 281 3 284 School baths 5 39 7 46 Private bath 1 14 2 16 Totals 14 334 12 346 DRAINAGE AND SEWERAGE The greater part of the soil sewerage system of the Borough is connected to the West Middlesex Main Drainage Scheme and treatment is carried out at the Greater London Council's Drainage Works at Mogden. In parts of Acton, the soil and surface water drainage is combined, and the sewers are connected to the Greater London Council's system with an outfall to the Works at Barking, Essex. Surface water drainage, where not combined with the soil sewers, is discharged to the River Brent and other water courses. There are 31 premises not drained to main sewers; 11 are connected to septic tank installations; 19 to cesspools and 1 club pavilion is provided with pail closets. PREVENTION OF POLLUTION OF THE RIVER BRENT Responsibility for the prevention of pollution of the River Brent is now shared by the Greater London Council and this Borough. The Greater London Council's Department of Public Health Engineering administers the Rivers Pollution Act, 1951, in an area comprising the districts previously within the boundaries of the former London County Council, the whole of Middlesex and part of Surrey. This Borough is responsible for preventing contamination by surface water drains. The work involved in tracing sources of pollution is often difficult and takes a considerable time. As a result of reorganization and the shortage of staff, the number of inspections has been reduced but improvements continue to be effected. During the year under review, 54 inspections were carried out, and seven wrong connections in houses were diverted to soil sewers. 108 32. REGISTRATION OF PREMISES USED FOR MEDICAL PURPOSES NURSING HOMES Nursing homes are required to be registered by the Council under Section 190 of the Public Health Act, 1936. At the end of 1965, the number of nursing homes registered was seven, with a total number of 259 beds. During the year, one new home was registered; two homes closed (one becoming an old people's home), and a third ceased to accept maternity cases because of the difficulty in obtaining midwives. All the homes were regularly inspected by a medical officer during the year and they were found to have maintained a satisfactory standard. Inspections are also carried out in conjunction with the Fire Prevention Officer to ensure that adequate safety precautions are provided against the risk of fire. Under the Nursing Homes Act, 1963, the Minister of Health made regulations entitled "The Conduct of Nursing Homes Regulations ", which laid down enforceable standards relating to facilities and services. They require that efficient nursing care should be given day and night by qualified and competent staff, and that adequate heating, lighting and ventilation should be provided. Provisions are made to limit the number of patients admitted to nursing homes, and accommodation must be sufficient and treatment facilities suitable for the type of patient received. The Act also repealed Section 192 of the Public Health Act, 1936, which enabled certain homes and institutions, not run for profit, to be exempt from registration. The following is a list of registered nursing homes in the Borough, giving information regarding the type of patient admitted to each home:— The Lady Margaret Nursing Home, 87, Mattock Lane, W.5 Methuen Nursing Home, 13, Gunnersbury Avenue, W.5 Old Court Nursing Home, 19, Montpelier Road, W.5 St. Anthony's Nursing Home, 40, Mount Park Road, W.5 St. David's Home, Castlebar Hill, W.5 Servite House, Queen's Walk, W.5 Twyford Abbey Nursing Home, Twyford Abbey Road, N.W.10 Elderly male and female—Chronic and medical. Female only—Chronic and medical. Male and female—Medical and surgical. Facilities for operations. Male and female—Chronic and medical. Disabled ex-Servicemen only—Non-profit making organization. Roman Catholic, taking all denominations. Male and female, all ages—Chronic physically disabled. Non-profit making organization. Males only—Chronic and geriatric. Nonprofit making organization. Roman Catholic, taking all denominations. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT The Borough requires all persons setting up establishments for massage and special treatment to be registered under Part VII of the Middlesex County Council Act, 1934. Bye-laws made under the Act allow the Borough to refuse to license people who do not possess appropriate technical qualifications. The person licensed has to exhibit a scale of fees and keep records of people 109 employed and particulars of cases treated. Part VII of the Act was adoptive and the former Boroughs of Ealing and Southall decided to enforce it. New bye-laws are in the course of being submitted to the Secretary of State for approval and from April, 1966, establishments in all parts of the Borough will be required to register. The following figures of establishments relate only to the Ealing and Southall areas. Chiropody only 12 Chiropody and special treatment 12 Massage only 1 Physiotherapy only 2 Osteopathy 1 There are also two chiropodists registered who carry out home visits only. All premises are inspected annually by public health inspectors to ensure that they are satisfactory. Under the Professions Supplementary to Medicine Act, 1960, Boards were set up and registers compiled of those medical auxiliaries considered to be suitably qualified. People registered are entitled to use the designation "State Registered ". It is also the duty of the Boards to prepare and maintain a register of the names, addresses and qualifications of all persons who are entitled to be registered by the Board, in accordance with the provisions of the Act. The Chiropodists Board was appointed in January, 1962, and has published its first register of people who applied for registration before 30th June, 1963. The Physiotherapists Board was appointed in January, 1962, and the first register to be published by the Board contained the names of all who applied for registration before 31st March, 1963. 110 33. MORTUARY AND BURIAL ARRANGEMENTS PUBLIC MORTUARY The public mortuary, which is capable of accepting up to 40 bodies, is situated in Petersfield Road, Acton, W.3, and, although the former catchment areas were the Boroughs of Acton, Ealing, Southall and Brentford and Chiswick, it now only serves those who die in this Borough. Bodies are taken to the mortuary from accidents and all cases where the cause of death is unknown and the coroner decrees that a post-mortem examination should be carried out. Autopsies are carried out in the mortuary by a pathologist. The number of bodies taken to the mortuary for the period 1st January to 31st March, 1965, was 82. From 1st April to 31st December, a total of 486 bodies was taken to the mortuary, of residents from the following areas:— Ealing 397 Hillingdon 39 Hounslow 21 Richmond-upon-Thames 3 Others 26 Total 486 One full-time mortuary attendant is employed. BURIAL OR CREMATION OF THE DEAD—NATIONAL ASSISTANCE ACT, 1948—SECTION 50 The Council is empowered to arrange for burials or cremations in those circumstances where relatives of a deceased person are unable to afford the cost of a burial and where no previous provision has been made or where no relative can be found. The Council is also required to arrange for the burial of a deceased person, if requested to do so, provided that the death takes place within the Borough, whether or not the home address is within that area. Application is made to the Ministry of Pensions and National Insurance and the appropriate death grant is obtained to offset the cost, to the Council, of the burial or cremation. Any monies found or insurance policies on the life of the deceased are subsequently taken by the Council and any excess after meeting burial costs is passed to relatives. Two undertakers have acted for the Borough, one in Acton and one in Ealing, but the Council has decided that, in 1966, one undertaker will be appointed for the Borough. Five burials were carried out during the year and one cremation. Ill 34. MEDICAL EXAMINATION AND WELFARE OF STAFF The Medical Suite at the Town Hall Annexe at present comprises two rooms. An adjoining room will be made available early in 1966, when it will be used for the following purposes:— (1) as a first aid and rest room; (2) for medical examination of staff; (3) for vaccination and immunisation of staff. FIRST AID AND REST ROOM Section 24 of the Offices, Shops and Railway Premises Act, 1963, requires that first aid boxes, equipped to certain specifications according to the number of staff employed, shall be provided for all office premises, but, where a first aid room is maintained and arrangements exist for securing the immediate treatment in that room of persons who become ill or suffer injury, exemption from the requirement to supply first aid boxes may be given. It was decided, therefore, to provide a first aid room for use by members of the staff of all departments situated at the Town Hall. The Suite has now been equipped in such a way to satisfy the requirements of the Act relating to a first aid room and is staffed by two nurses, one part-time and one full-time, both of whom are state registered. A medical officer is available for consultation when necessary. Application has been made for exemption from the requirements of the Act relating to first aid boxes, and it is anticipated that this will be granted. During the first few weeks in which the Medical Suite was being used for first aid purposes 19 patients attended for treatment, most cases being of minor injury or illness such as cuts and headaches. MEDICAL EXAMINATION OF STAFF All staff are required to complete a medical questionnaire before appointment. From the information given, it may be decided that the candidate is fit to carry out the duties of the appointment, or it may be considered necessary for the candidate to be given a medical examination to determine his fitness. Certain staff, however, always require medical examination. Included in this category are staff at special risk (such as those employed for driving motor vehicles and those whose duties involve working at heights) and all residential staff in children's homes. Employees with a history of illness who are for admission to the Manual Workers' Sickness Pay Scheme are examined to assess whether they should be excluded from the benefits of this scheme when suffering from that particular illness. Thus those who might otherwise completely fail to qualify for admission to the scheme can be granted sick pay when absent as a result of other conditions. Medical examinations are also carried out as required by the Department of Education and Science for teachers not previously employed as such by a local education authority in the United Kingdom, and all students residing in the Borough who are for admission to a teachers' training college. Depending on the nature of work, some candidates are required to attend for a chest X-ray unless they can produce written evidence of a satisfactory X-ray result during the preceding twelve months. Staff in this category are those who work in 112 schools or otherwise come into contact with groups of children, those who handle food and those who work as home helps. In addition to medical assessment of staff on appointment, any Chief Officer who has doubts as to the medical fitness of a member of staff to continue his employment refers the matter to me. Seven such referrals took place during the year. The table below shows the number of examinations made between April, 1965, and the end of the year:— Total number of medical questionnaires received 2,039 Number of candidates not requiring examination because the answers to the medical questionnaires were satisfactory 1,338 Number of candidates examined as a result of assessment of their medical questionnaires; or upon requests from heads of other departments of the Council, including requests from the Chief Education Officer on behalf of the Department of Education and Science for the examination of teachers; or upon requests from teachers' training colleges on behalf of the same Department for the examination of students:— Non-Manual Staff Manual Staff Teachers Students 156 158 217 170 701 Number of candidates found unfit for initial or continued employment (the candidates suffered from one of the following: neurosis, cardiac condition, pulmonary condition, Parkinson's disease, thyrotoxicosis and gastric ulcer, diabetes with complications, arthritis) 14 VACCINATION AND IMMUNISATION OF STAFF During the year, it was decided to offer vaccination against smallpox and immunisation against typhoid fever and poliomyelitis to all personnel of the Health Department, and to encourage particularly those who might be at special risk. These would include medical officers, dental staff, public health inspectors, driver/ disinfectors, nursing staff including day nursery staff, and certain administrative staff, all of whom would be liable to be involved in the event of an outbreak of a serious infectious disease. Similarly, it was considered necessary to have on record a complete picture of the immunisation state of the Department's staff, and all staff were asked to record details of immunisations they had received and to indicate their willingness to accept further protection. In accordance with current opinion, it was decided to offer immunisation against typhoid fever to any member of the staff intending to holiday abroad. This could, if wished, be combined with protection against tetanus. The programme was started towards the end of the year with immunisation against poliomyelitis. The number of staff not already protected was small as protection had been accepted over the past few years. Some 25 members of the staff received oral vaccine. The programme will continue in 1966 when courses of vaccination against smallpox and typhoid will be started. 113 TABLES Table 1 infectious and other notifiable diseases classified in age groups Scarlet fever Whooping cough Poliomyelitis Measles Diphtheria Dysentery Meningococcal infection Paralytic Non-paralytic M F M F M F M F M F M F M F M F Numbers originally notified 58 68 36 25 – – – – 1,930 1,688 – – 136 118 – 1 Final numbers after correction: Under 1 year 1 2 6 4 – – – – 82 69 – – 4 4 – – 1– 3 2 7 1 – – – – 193 167 – – 10 3 – – 2– 3 2 1 2 – – – – 251 266 – – 7 7 – – 3– 4 8 7 3 – – – – 300 263 – – 4 6 – – 4– 14 17 5 10 – – – – 331 279 – – 4 2 – – 5–9 25 27 11 4 – – – – 748 601 – – 17 14 – 1 10–14 6 7 – 1 – – – – 16 32 – – 6 8 – – 15–24 1 2 – – – – – – 4 6 – – 17 17 – – 25 and over – – – – – – – – 5 5 – – 52 50 – – Age unknown – – 1 – – – – – – – – – 2 1 – – Total 57 67 38 25 – – – – 1,930 1,688 – – 123 112 – 1 114 Table 1—continued INFECTIOUS AND OTHER NOTIFIABLE DISEASES CLASSIFIED IN AGE GROUPS—Continued 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 Numbers originally notified Final numbers after correction: Under 5 years 21 20 – – – – – – 1 2 – – 5 6 15 12 4 2 – – – – – – – – – – – – 1 – 5–14 3 2 – – – – – – 1 – – – – – – 1 15–44 6 4 – – – – – – – 2 – – 1 2 – – 45–64 7 5 – – – – – – – – – – 4 4 1 – 65 and over 1 7 – – – – – – – – – – – – – – Age unknown – – – – – – – – – – – – – – – – Total 21 20 – – – – – – 1 2 – – 5 6 2 1 115 Table 1—continued infectious and other notifiable diseases classified in age groups—Continued Tuberculosis Infectious hepatitis Puerperal pyrexia Pulmonary Meninges and central nervous system Other M F M F M F M F F Numbers originally notified 99 33 1 1 15 27 13 10 42 Final numbers after correction: Under 5 years 3 1 – – – – 1 – – 5–14 – – – – 2 2 5 4 – 15–24 9 3 – – 5 3 1 1 16 25–44 33 15 1 1 7 13 5 4 26 45–64 36 8 – – 1 3 1 1 – 65 and over 16 5 – – – 4 – – – Total 97 32 1 1 15 25 13 10 42 There were no cases of ophthalmia neonatorum, malaria or anthrax. Table 2 clinic sessions Abbey Parade Avenue Road Brentside Cherington House Cloister Road Greenford Green Islip Manor Jubilee Gardens King Street Monday A.M. Dental G.S.C. Dental Orthopt. †Chir. (O.A.P.) Speech Therapy Dental A.N. Dental Orthod. G.S.C. Dental A.N. IMM. A.N. Ex. G.S.C. Dental Monday P.M. Dental Polio C.W. Dental Orthopt. †Chir. (O.A.P.) Sp. Thpy. Dental C.W. Dental Dental A.N. Ex. G.S.C. Dental C.W. IMM. †Vacc. Sp. Thpy. Dental *Polio Tuesday A.M. Sp. Meds. whn. req. Dental Dental Orthod. †B.C.C. †Polio Dental Orthod. Physio. Sp. Thpy. Chir. (O.A.P.) Dental Sp. Thpy. Physio. (Asthma) Sp. Meds. whn. req. Dental A.N. IMM. Tuesday P.M. G.S.C. C.W. IMM. Vacc. Dental Mid. A.N. Chir. (S.C.) C.W. Dental Orthod. Dental Orthod. C.W. *IMM. C.W. Mid. A.N. C.W. Sp. Thpy. Dental C.W. Wednesday A.M. Dental Ophthal. A.N. Ex. Dental Polio Dental A.N. Ex. Orthod. Dental Chir. (O.A.P.) Physio. G.S.C. A.N. Dental Polio tIMM. Sp. Thpy. Dental Wednesday P.M. Dental A.N. Dental A.N. Chir. (O.A.P.) IMM. C.W. IMM. fPolio G.S.C. Mid. A.N. Dental Chir. (O.A.P.) Orthod. Sp. Thpy. Dental Physio. Mid. A.N. *Polio Dental Mid. A.N. Thursday A.M. Sp. Thpy. Chir. (S.C.) G.S.C. IMM. Vacc. Dental Orthopt. Chir. (S.C.) tB.C.C. Dental Orthod. C.C. Dental Orthod. Chir. (S.C.) Dental Physio. Dental Orthod. Chir. (S.C.) Thursday P.M. Dental Dental Orthopt. C.W. Sp. Thpy. Dental Orthod. C.W. Dental Orthod. Dental Chir. (O.A.P.) A.N. Ex. Mid. A.N. G.S.C. Dental C.W. A.N. Ex. Dental Orthod. Friday A.M. Dental Sp. Thpy. Dental Chir. (O.A.P.) G.S.C. tP.N. Dental A.N. Ex. tIMM. G.S.C. A.N. Dental Orthod. Physio. Dental †Chir. (O.A.P.) Sp. Thpy. G.S.C. A.N. IMM. *Vacc. Sp. Thpy. Dental Friday P.M. C.W. (no Dr.) Dental Sp. Thpy. A.N. Dental Dental Orthod. Dental C.W. (no Dr.) Orthod. *IMM. Chir. (O.A.P.) C.W. Dental Physio. tChir. (O.A.P.) C.W. Sp. Thpy. C.W. Dental Saturday A.M. KEY: Orthopt.—Orthoptic; Sp. Thpy.—Speech Therapy; G.S.C.—General School Clinic; Orthop.—Orthopaedic; Chir.—Chiropody; Physio.—Physiotherapy; whn. req.—when required; Orthod.—Orthodontic; Ophthal.—Ophthalmic; E.N.T.—Ear, Nose and Throat; Sp. Meds.—Speech Medicals; C.W.—Child Welfare; IMM.—Immunisation; Vacc.—Vaccination; A.N.—Ante-natal; A.N. Ex.—Ante-natal exercises; Chir. (O.A.P.)—Chiropody (Old Age Pensioners); Chir. (S.C.)—Chiropody (School Children); Mid. A.N.—Midwives Ante-natal; F.P.—Family Planning; B.C.C.—Birth control clinic; P.N.—Post-natal; C.C.—Cervical Cytology; Men. Hlth.—Mental Health; Home Nurse, injns.—Home Nursing injections; occ.—occasional; *—monthly; f—alternate weeks; J—Mental Health (occasional— evening). 116 Table 2—continued clinic sessions—continued Laurel House Mattock Lane Northcote Northolt Grange Perivale Pierrepnt. Road Ravenor Park Steele Road Trinity Way Monday A.M. †Chir. (O.A.P.) Sp. Thpy. Dental A.N. Polio Physio. Dental Chir. (O.A.P.) Dental A.N. Ex. †Polio Sp. Thpy. Physio. G.S.C. IMM. Dental Dental Monday P.M. G.S.C. C.W. tChir. (O.A.P.) Dental A.N. Ex. C.W. C.W. Physio. *Orthop. Dental G.S.C. C.W. Sp. Thpy. C.W. Sp. Thpy. Physio. Dental Jsee below C.W. (no Dr.) *Polio C.W. IMM. Vacc. Tuesday A.M. Sp. Thpy. Dental †Polio Dental A.N. Ex. Dental A.N. IMM. Vacc. Home Nurse. injns. Chir. (O.A.P.) (occ.) tOrthop. Ophthal. Dental Chir. (O.A.P.) Physio. Sp. Meds. whn. req. F.P. Tuesday P.M. Sp. Thpy. Dental Chir. (S.C.) Mid. A.N. Dental Physio. Dental Mid. A.N. A.N. Ex. G.S.C. C.W. Vacc. C.W. IMM. *Polio Physio. Dental Chir. (O.A.P.) C.W. B.C.C. (Evening) Wednesday A.M. Dental Chir. (O.A.P.) †IMM. *Vacc. Physio. Chir. (O.A.P.) Ophthal. *Men. Hlth Dental C.W. Dental A.N. Ex. A.N. IMM. G.S.C. A.N. IMM. Sp. Thpy. *Men. Hlth Dental A.N. Ex. Sp. Thpy. Dental Wednesday P.M. Dental Mid. A.N. Physio. *Orthop. C.W. Chir. (O.A.P.) Sp. Thpy. Chir. (O.A.P.) Dental A.N. Ex. Mid. A.N. C.W. Chir. (S.C.) C.W. Dental B.C.C. (afternoon and evening) Thursday A.M. Dental A.N. Sp. Thpy. Dental G.S.C. A.N. G.S.C. Dental Chir. (O.A.P.) Polio Sp. Thpy. Dental Physio. Dental A.N. G.S.C. A.N. Thursday P.M. Dental C.W. †E.N.T. Dental A.N. Ex. IMM. F.P. (1.302.30) Physio. Ophthal. Chir.(S.C.) Dental Dental Mid. A.N. G.S.C. C.W. Vacc. Physio. Dental †E.N.T. Mid. A.N. Sp. Thpy. C.W. IMM. Vacc. C.W. (no Dr.) Friday A.M. Dental A.N. Ex. Physio. A.N. †Ophthal. †Ophthal. Dental Home Nurse. injns. Dental C.W. Polio Polio †Chir. (O.A.P.) G.S.C. A.N. Ex. Dental Dental Friday P.M. Dental C.W. (no Dr.) †Chir. (Red Cross) Physio. C.W. Dental C.W. G.S.C. A.N. IMM. C.W. Dental C.W. †Chir. (O.A.P.) Chir. (O.A.P.) Saturday A.M. *Chir. (Red Cross) *IMM. KEY: Orthopt.—Orthoptic; Sp. Thpy.—Speech Therapy; G.S.C.—General School Clinic; Orthop.—Orthopaedic; Chir.—Chiropody; Physio.—Physiotherapy; whn. req.—when required; Orthod.—Orthodontic; Ophthal.—Ophthalmic; E.N.T.—Ear, Nose and Throat; Sp. Meds.—Speech Medicals; C.W.—Child Welfare; IMM.—Immunisation; Vacc.—Vaccination; 3 A.N.—Ante-natal; A.N. Ex.—Ante-natal exercises; Chir. (O.A.P.)—Chiropody (Old Age Pensioners); Chir. (S.C.)—Chiropody (School Children); Mid. A.N.—Midwives Ante-natal; F.P.—Family Planning; B.C.C.—Birth control clinic; P.N.—Post-natal; C.C.—Cervical Cytology; Men. Hlth.—Mental Health; Home Nurse, injns.—Home Nursing injections; occ.—occasional; *—monthly; t—alternate weeks; J—Mental Health (occasional— evening). 117 Table 3 vaccination and immunisation of persons under age 16 completed during the year Table 1—Completed Primary Courses, Diphtheria, Whooping Cough, Tetanus and Poliomyelitis Type of vaccine or dose Year of birth Total 1965 1964 1963 1962 19581961 Others under age 16 Quadruple 26 23 2 2 1 – 54 Triple 2,030 2,486 425 103 77 22 5,143 Diphtheria/tetanus 39 43 46 52 176 159 515 Diphtheria – 3 1 – – – 4 Tetanus – – – 3 86 530 619 Poliomyelitis—Salk 30 81 16 8 12 7 154 —Sabin 732 3,180 574 187 291 171 5,135 Table 2—Reinforcing Doses 1965 1964 1963 1962 19581961 Others under age 16 Total Quadruple – 5 12 3 4 3 27 Triple – 1,461 1,077 77 490 80 3,185 Diphtheria/tetanus – 32 43 39 2,050 1,124 3,288 Diphtheria – – 2 1 52 292 347 Tetanus – – – – 206 311 517 Poliomyelitis—Salk – 61 57 40 290 134 582 —Sabin – 17 37 24 2,402 226 2,706 General practitioners carried out 29-7 per cent. of the immunisation. Table 3—Smallpox—Vaccination and Re-vaccination Age at date of vaccination Number vaccinated Number re-vaccinated 0- 3 months 37 – 3- 6 months 109 – 6- 9 months 332 – 9-12 months 239 – 1 year 1,685 – 2- 4 years 466 30 5-15 years 109 86 Total 2,977 116 118 Table 4 work of mental health social workers for ten months to 31 st december, 1965 Mental illness Subnormal Total Visits to patients' homes 2,766 303 3,069 Visits to patients in hospital 314 16 330 Visits to patients in places of employment, etc. 117 56 173 Office interviews 133 17 150 Total visits and interviews 3,330 392 3,722 Compulsory admissions to psychiatric hospitals by mental health social workers .. 217 1 S.25 2S.60 220 Informal admissions to psychiatric hospitals arranged and conducted by mental health social workers 162 11 173 Total admissions to hospitals 379 14 393 Total number of referrals from all sources (new and old cases) 1,719, of which 187 were stand-by calls. Table 5 mental health—number of patients referred during ten months ended 31st december, 1965 Referred by –16 16+ Total M. F. M. F. General Practitioners – – 116 171 287 Hospital on discharge from in-patient treatment – – 139 288 427* Hospital during or after out-patient or day treatment – – 15 31 46 Local education authorities – – – 2 2 Police and courts – – 27 28 55 Other sources 1 2 82 111 196 Total 1 2 379 631 1,013 * Includes 171 after-care cases sent by Middlesex Divisions on change-over. 119 Table 6 mental health—patients under london borough of ealing care at 31ST december, 1965 Mentally 111 –16 16+ Total M. F. M. F. Number of patients under care at 31st December, 1965 4 5 256 463 728 Attending day training centre – – 7 3 10 Awaiting entry thereto – – – – – Resident in a residential training centre – – – – – Awaiting residence therein – – – – – Receiving home training – – – – – Awaiting home training – – – – – Resident in London Borough of Ealing home/ hostel – – 1 4 5 Awaiting residence in London Borough of Ealing home/hostel – – – – – Resident at London Borough of Ealing expense in other residential home/hostel – – 5 5 10 Resident at London Borough of Ealing expense by boarding out in private household – – – 1 1 Number of patients in London Borough of Ealing area on waiting list for admission to hospital in urgent need – – – 5 5 Not in urgent need – – 5 22 27 Number of admissions for temporary residential care (e.g., to relieve the family) to N.H.S. hospitals – – 11 17 28 Elsewhere – – – – – 120 Table 7 legal proceedings under public health act, 1936, and offices, shops and railway premises act, 1963. Proceedings were instituted in respect of non-compliance with statutory notices served in accordance with the provisions of the Public Health Act, 1936, and for an infringement of the Offices, Shops and Railway Premises Act, with the following results:— Premises Offence Result 67/71, Broadway, W.13. Contravention of section 18(1) of the Offices, Shops & Railway Premises Act, 1963, relating to an accident. Fined £25, £5 5s. costs 39, Antrobus Road, W.4. Failure to permit inspector to enter. Warrant to enter granted under section 287, Public Health Act, 1936. Caravans at Northolt (4 separate cases). Non-compliance with notice served under section 93, Public Health Act, 1936. Fined £1 & £1 Is. costs in each of 4 cases. 30, Hessel Road, W.13. Non-compliance with notice served under section 93, Public Health Act, 1936. Fined £5. £2 2s. costs. 28 day Nuisance Order. 30, Hessel Road, W.13. Non-compliance with notice served under section 93, Public Health Act, 1936. Fined £5. £2 2s. costs. 28, Carlyle Road, W.5. Non-compliance with notice served under section 93, Public Health Act, 1936. 28 day Nuisance Order. Parkside, The Vale, W.3. Non-compliance with notice served under section 93, Public Health Act, 1936. Costs £6 6s. 28 day Nuisance Order. 121 Table 8 factories act, 1961—part I Inspections for the purposes of provisions as to health (including inspections made by 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 authorities 46 16 1 – (ii) Factories not included in (i) in which section 7 is enforced by the local authority 966 347 28 – (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) – – – – Total 1,012 363 29 – Table 9 factories act, 1961—part I 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 6 10 6 1 _ Overcrowding – – – – – Unreasonable temperature – – – – – Inadequate ventilation 2 1 1 – – Ineffective drainage of floors 1 2 – – – Sanitary conveniences: (a) insufficient 4 2 – 1 – (b) unsuitable or defective 18 12 – 13 – (c) not separate for sexes – – – – – Other offences against the Act (not including offences relating to outwork) 9 14 2 – – Total 40 41 9 15 – 122 Table 10 factories act, 1961—part viii (sections 133 and 134) Outwork Nature of work Section 133 No. of outworkers in August list required by section 133 (1) (c) Wearing apparel—making, etc. 31 Paper bags 34 Stuffed toys 8 Total 73 During the year, 194 inspections of outworkers' premises were carried out by the public health inspectors. There were no cases of default in sending lists to the Council under section 133 of the Act and no instances of work in unwholesome premises under section 134. 123 Table 11 legal proceedings under the housing acts The following table gives particulars of prosecutions in connection with houses in multiple occupation:— Premises Offence Result 54, Argyll Avenue, Southall Contravention of a Direction under section 19, Housing Act, 1961 Fined £3, £2 2s. costs. 1, Milford Road, Southall „ „ Fined £5, £2 2s. costs. 70, Hambrough Road, Southall „ „ Fined £3, £2 2s. costs. 19, Beaconsfield Road, Southall „ „ Fined £15, £2 2s. costs. 6, Alexandra Avenue, Southall „ „ Fined £5, £2 2s. costs. 48, Alexandra Avenue, Southall „ „ Fined £20, £2 2s. costs. 44, Avenue Road, Southall „ „ Fined £15, £2 2s. costs. 126, West End Road, Southall Contravention of Notice under section 90, Housing Act, 1957, requiring abatement of overcrowding Fined £8, £2 2s. costs. 92, Northcote Avenue, Southall „ „ Fined £5, £2 2s. costs. 73, Oswald Road, Southall „ „ Fined £20, £2 2s. costs. 115, Woodlands Road, Southall „ „ Fined £10, £2 2s. costs. 79, Woodlands Road, Southall „ „ Fined £40, £8 8s. costs. (4 summonses) 50, West End Road, Southall „ „ Fined £30, £6 6s. costs. (3 summonses) 72, Beresford Road, Southall „ „ Fined £40, £8 8s. costs. (4 summonses) 22, West End Road, Southall „ „ Fined £30, £6 6s. costs. (3 summonses) 137, Hambrough Road, Southall „ „ Fined £3, £2 2s. costs. 82, Clarence Street, Southall „ „ Fined £3, £2 2s. costs. 87, Ranelagh Road, Southall „ „ Fined £4, £6 6s. costs. (4 summonses) 61, Abbotts Road, Southall Failure to return statement of occupants under section 19(9), Housing Act, 1961 Fined £3, £1 1s. costs. 77, Saxon Road, Southall „ „ Fined £3, £1 1s. costs. 7, Grange Road, Southall „ „ Fined £5, £2 2s. costs. 100, West End Road, Southall „ „ Fined £5, £2 2s. costs. 3, Shackleton Road, Southall Housing Act, 1957, section 160—obstruction for refusing access for inspection Fined £5, £3 3s. costs. 124 Table 12 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) 4,337 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Act, 1957 140 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 12 (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 1,118 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 its officers 780 3. Action under statutory powers during the year: A—Proceedings under sections 9, 10 and 12 of the Housing Act, 1957: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 17 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) by owners 60 (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 289 (2) Number of dwelling-houses in which defects were remedied after service of formal notice: (a) by owners 187 (b) by local authority in default of owners 84 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 4 (3) Number of houses concerning which action has been taken by the local authority under section 16, and in respect of which owners have given an undertaking that they will not be used for human habitation – 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 11 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 1 125 Table 13 summary of work done and improvements carried out at food premises Clothing accommodation provided or improved 47 Equipment improved or cleansed 134 First Aid equipment provided or improved 72 Floors repaired and floor coverings improved 83 Food storage accommodation improved 43 Hot water provided or restored 81 Hygiene Notices provided 165 Lighting and ventilation improved 51 Protective clothing provided or improved 5 Refrigeration installed or improved 28 Refuse bins provided or renewed 74 Refuse removed 93 Sinks provided or renewed 30 Tables and working surfaces made impervious 75 Walls and ceilings repaired or cleansed 220 Washing facilities provided or improved 55 Water closets cleansed, repaired or lighted 88 Water supply provided or improved 12 Other defects remedied 95 Total 1,451 126 Table 14 legal proceedings under the food and drugs act and regulations made under the act The following table gives details of prosecutions in cases involving the sale of unsound food, food articles containing foreign bodies, the use of dirty milk bottles, and of the use of food premises in contravention of the Food Hygiene Regulations. Offence Result Mould in steak and kidney pie Fined £30, costs £15 15s. Dust and dirt in milk Fined £5, costs £5 5s. Nail in bread Fined £5, no costs. Mould in steak and kidney pie Fined £10, costs £5 5s. Metal bolt in ground almonds Absolute discharge after plea of guilty. Metal tag in steak and kidney pie Fined £5, costs £3 3s. Brass rivet in bread Fined £5, costs £3 3s. Algae growth in milk Fined £10, costs £5 5s. Foreign body in ice cream Fined £10, costs £5 5s. Maggots in bacon Fined £15, costs £3 3s. Mould in pork pie Fined £20, costs £5 5s. Nail in bread Fined £20, costs £5 5s. Dirty milk bottle Fined £10, costs £10 10s. Ball-point pens in beer Absolute discharge. Defendant ordered to pay £21 costs. Decomposing bacon containing larva Case dismissed. Council ordered to pay £10 10s. costs. Bacon joint containing maggots Fined £10, costs £5 5s. Cigarette end in bread roll Fined £20, costs £6 6s. Bread containing bird excreta and feathers Fined £10, costs £6 6s. Dirty milk bottle Fined £20, costs £6 6s. Tea containing insect Fined £5, costs £5 5s. Contraventions of Food Hygiene Regulations at 46, Manor Road, W.13 (8 summonses) Fined £80, costs £10 10s. Contraventions of Food Hygiene Regulations at 31, Greenford Avenue, W.7 (7 summonses) Fined £130, costs £22 1s. 127 Table 15 list of food premises in the london borough of ealing Category of premises No. of premises No. complying with Reg. 16 No. to which Reg. 19 applies No. complying with Reg. 19 Bakehouses 25 25 25 25 Bakers' shops 75 72 – – Butchers 188 176 188 188 Cafes and restaurants 235 224 235 235 Canteens (factory) 184 184 184 184 Canteens (office) 13 13 13 13 Canteens (schools) 54 54 54 54 Confectioners 357 314 – – Dairies 2 2 2 2 Food factories 25 25 25 25 Food warehouses 10 10 – – Food stalls and storage premises 26 6 – – Fish fryers 34 29 34 34 Fishmongers 42 28 42 42 Greengrocers 217 204 178 163 Grocers 486 461 326 317 Hotels 8 8 8 8 Ice cream manufacturers 5 5 5 5 Licensed premises and clubs 83 83 83 83 Licensed premises serving main meals 60 60 60 60 Nursing homes 8 8 8 8 Totals 2,137 1,991 1,470 1,446 128 Table 16 number of samples procured and examined in 1965 Nature of sample No. examined No. adulterated (or otherwise giving rise to irregularity) Formal Informal Formal Informal Alcoholic drinks – 5 – – Arrowroot – 1 – – Beverages – 2 – – Biscuits – 3 – – Bread and bread/butter – 11 – 2 Cake and cake decorations – 20 – 3 Canned fish – 25 – 3 Canned fruit – 9 – 1 Canned meat – 19 – 2 Canned vegetables – 20 – 5 Cereals – 11 – – Cheese – 9 – 2 Chocolate preparations – 2 – – Coffee – 21 – 1 Colourings – 10 – 2 Cornflour – 1 – – Cream – 8 – 2 Custard powder – 3 – – Dried fruit – 22 – 5 Dried herbs – 5 – – Drugs – 19 – 1 Fats – 26 – 3 Fish – 3 – 1 Fish paste – 17 – – Fish preparations – 9 – – Flavourings – 11 – – Flour – 6 – – Fruit preparations 1 32 1 5 Gelatine and jelly – 10 – 1 Honey – 5 – – Ice cream – 4 – – Meals – 11 – 5 Meats – 4 – 1 Meat paste – 3 – – Meat pie – 16 – 2 Meat preparations 9 27 – 10 Milk – 53 – – Milk powder – 2 – 2 Nuts – 12 – – Oils – 3 – 2 Pickles – 4 – 3 Preserves – 5 – – Puddings – 4 – 1 Saccharin – 1 – – continued overleaf 1 129 Table 16—continued number of samples procured and examined in 1965—Continued Nature of sample No. examined No. adulterated (or otherwise giving rise to irregularity) Formal Informal Formal Informal Salad cream and sandwich spread – 5 – – Sauces – 10 – 1 Sausages 7 23 – 6 Soft drinks – 13 – 1 Soups – 10 – 2 Spices 1 15 – 3 Spirits – 6 – 4 Suet – 1 – – Sugar confectionery – 11 – 1 Tea – 6 – – Treacle – 1 – – Vegetable extract – 1 – – Vinegar – 5 – 1 Yoghurt – 4 – 3 Totals 18 605 1 87 130 Table 17 labelling irregularities A number of infringements of the labelling requirements were noted as follows:— Incorrect or inadequate description Cake decorations (2) Vinegar Palm oil No name or address Cake decorations (2) Inadequate address Salted cod cutlets Sardines (2) Moussaka Plum pudding Pork chipolatas Raisin cordial Sarmi Incorrect or inadequate list of ingredients Antipasto Cake decorations (2) Chewing gum Cochineal Glace cherries Pickles (4) Prunes Soup Vindaloo paste Ice lolly Mixed fruit Frankfurters Yoghurt Sauce Bolognese Mixed peel Macedoine Yogfruit Cake fruit mixture Oxtail flavour soup block Sabat Maahn (whole urd) No label attached \ / Crystallised fruit Incorrect common or usual name Herb, butter and cheese spread Mushroom, butter and cheese spread Vodka (2) Incorrect declaration of fat content Dried milk Inadequate declaration of preservatives Pork chipolatas Inadequate declaration of proof spiritMisleading claims Gin Scotch whisky Casserole steak Instant coffee Inadequate cautionary notice Dried milk All labelling infringements found were taken up with the manufacturers or importers concerned and in almost every case a satisfactory agreement was reached as to the use of labels which complied with the requirements of the Labelling of Food Order. In some cases, available stocks were withdrawn. 131 Table 18 carcases and offal inspected and condemned in whole or in part—1965 Pigs 1. Number killed 576,649 2. Number inspected 577,229 3. Dead on arrival or died in pens 580 4. All diseases except Tuberculosis— Whole carcases condemned 1,777 Carcases of which some part or organ was condemned 170,418 Percentage of the number inspected affected with disease other than tuberculosis 29.83% 5. Tuberculosis only— Whole carcases condemned 10 Carcases of which some part or organ was condemned 31,728 Percentage of the number inspected affected with tuberculosis 5.50% 6. Cysticercosis— Carcases of which some part or organ was condemned – Carcases submitted to treatment by refrigeration – Generalised and totally condemned – The total weights of meat and offal surrendered were:— Pork Tons cwts. qrs. lbs. 1,787 carcases 150 8 0 21 202,146 parts 496 18 1 8 Total 647 6 2 1 132 133 Table 19 NUMBER OF PIGS' CARCASES INSPECTED AT T. WALL & SONS LTD. SLAUGHTERHOUSE DURING 1965 WITH ANALYSIS OF SURRENDERS ON ACCOUNT OF DISEASE Month Pigs inspected Parts condemned Carcases Heads Collars Fore quarters Hind quarters Legs Skins Hocks Flares Pieces of pork Plucks (lungs, livers, hearts, lights) Weight of mesenteries, stomachs and intestines lbs. lbs. January 44,183 101 1,543 — — — 1,968 14 17 613 9,287 8,749 21,250 February 42,048 108 1,409 1 2 — 1,309 19 39 617 9,588 11,106 17,610 March 50,426 108 1,650 — 2 — 1,771 18 50 841 9,783 10,551 21,570 April 45,998 113 1,199 — — — 1,495 31 63 613 10,338 8,209 15,010 Mav 50,030 157 1,347 — — — — 1,621 20 55 720 11,963 6,966 17,220 June 47,788 145 1,174 — — — — 1,427 27 38 797 10,509 10,686 17,920 July 50,325 220 1,276 — — — — 1,252 30 47 723 10,413 11,304 15,390 August 50,788 233 1,424 — — — 1,196 19 47 862 8,617 9,280 17,790 SeDtember 52,219 162 1,447 — — — — 1,818 45 45 1,085 11,122 12,022 22,780 October 47,328 146 1,669 — — — 1,611 33 12 981 13,330 10,285 21,410 November 47,201 118 1,529 — — 1 1 1,530 57 8 746 12,778 11,091 16,620 December 48,895 176 2,109 — — — 2,316 64 19 829 13,867 14,924 23,150 Totals 577,229 1,787 17,776 1 5 1 19,314 377 440 9,427 131,595 125,173 227,720 Table 20 AVERAGE MONTHLY SMOKE CONCENTRATIONS (microgrammes per cubic metre) Daily volumetric instruments 1965 Acton Lane Chase Road Eliots Green School Friars Place Lane Town Hall Annexe Walpole Grammar School January 115 127 66 90 94 102 February 112 117 145 115 119 145 March 103 101 75 112 96 105 April 59 69 64 53 54 18 May 44 71 6 32 50 29 June 25 48 18 27 28 15 July 24 34 15 18 41 16 August 33 36 * 33 29 * September 48 52 46 42 48 28 Summer average— (April-September) 39 52 30 34 42 21 October 116 115 95 114 128 65 November 117 73 83 97 108 78 December 59 44 24 74 83 48 Average for year 71 74 58 67 73 59 * Closed for school holidays. 134 Table 21 AVERAGE MONTHLY SULPHUR DIOXIDE CONCENTRATIONS (microgrammes per cubic metre) Daily volumetric instruments 1965 Acton Lane Chase Road Eliots Green School Friars Place Lane Town Hall Annexe Walpole Grammar School January 237 334 203 216 296 177 February 242 345 311 310 267 241 March 285 385 214 233 290 208 April 197 355 244 177 226 217 May 119 205 101 140 123 102 June 94 112 117 107 104 91 July 86 115 70 71 138 64 August 128 158 * 124 157 * September 116 158 99 102 160 99 Summer average— (April-September) 123 184 126 120 151 115 October 336 410 254 352 389 408 November 276 315 223 255 280 256 December 189 274 176 210 262 153 Average for year 192 264 183 191 224 183 * Closed for school holidays. 135 Table 22 AVERAGE MONTHLY INSOLUBLE DEPOSIT Deposit gauges (milligrammes per square metre per day) 1965 Bashley Road Birkbeck Avenue Hortus Road Longfield Depot Park Avenue White Street* January 139 78 37 49 89 20 February 198 11 35 200 38 t March 131 11 63 222 73 95 April 102 305 173 309 323 80 May 204 206 54 320 93 33 June 35 64 101 201 184 32 July 173 452 78 180 223 31 August 163 187 77 185 t 31 September 146 170 31 196 67 t Summer average— (April-September) 137 231 86 232 178 41 October 81 56 50 90 38 47 November 121 93 † 105 82 62 December 92 67 39 55 26 9 Average for year 132 142 67 176 112 44 * Maintained by North Thames Gas Board. t Gauge damaged. 136 137 138 t—' U) VO INDEX Page Adult training centre 45 Animal Boarding Establishments Act, 1963 97 Animal protection 96 Ante-natal sessions 21 Anthrax 15 Asthma clinic 65 Atmospheric pollution, measurement of 104 Audiology Unit 26 B.C.G. vaccination 36 Birth control sessions 29 Birthday cards 22 Births and birth rate 12 Brent, River, prevention of pollution of 107 British Red Cross Society 35, 40 Burial of dead 110 Byelaws—Environmental Health 82 Caravan sites 75 Care and attention, persons in need of 55 Care of mothers and young children 20 Care of the elderly 52 Cervical cytology 20, 30 Chest clinics 42 Child care officers 26 Child guidance clinics 66 Child minders 26 Child welfare sessions 22 Children unable to benefit by education 70 Chimneys, heights of 103 Chimneys, industrial, smoke from 105 Chiropody 21,40,65 Chiropody clinics 41,65 Cholera 14 Circuses 81 Clean air 99 Clean Air Information Service 105 Clean Air Programme, publicity for 101 Clean Food Scheme 88 Clearance area programme 83 Clinic nurses 20, 34 Clinics 21,116 Common lodging houses 76 Council housing, medical aspects of applications for 87 Cremation of dead 110 Croup, membranous 14 Day nurseries 20, 25 Dead, burial or cremation of 110 Deaths and death rate 12 Dental care 21,23,71 140 INDEX—con tinued Page Dental service 23,71 Deposits, insoluble, in the atmosphere 104, 136 Diseases of Animals Act, 1950 97 Diseases of Animals (Waste Foods) Order, 1957 97 Diphtheria 14,36,113 Disinfection and disinfestation 81 Drainage (Sewerage) 106 Dysentery 14,113 Ealing Day Treatment Centre 52 Ear, nose and throat clinics 61 Early discharge scheme (maternity cases) 31 Egg Regulations 94 Elderly, care of the 52 Elderly people 40, 52 Encephalitis 14,113 Enteric fever 14,113 Enuresis 66 Erysipelas 14,113 Factories, inspection of 76 Fairs 81 Family case worker 29 Family Help Service (Home Help) 49 Family planning 20, 29 Food and Drugs administration 88 Food and drugs, chemical analysis of 94 Food and drugs, sampling of 94 Food complaints 95 Food hygiene 88 Food hygiene certificates 88 Food poisoning 15,113 Food premises, inspection of 89 Food, surrender of unsound 91 Foods, bacteriological examination of 93 Foot health clinic 64 Foster care, informal 44 Fuel for the elderly and sick 55 Fuel, supply of, in Smoke Control Areas 102 Fuels authorized for use in Smoke Control Areas 103 Furnaces, new 103 Gammaglobulin 16 Gastro-enteritis 14 General practitioners 19, 24, 29, 36, 39,40, 52, 56 Good Neighbour Service (Home Help) 50 Grant arrangements—appliances in Smoke Control Areas 102 Guardianship 45 Handicapped children 68 Hawkers, registration of, and premises 93 Health centres 19 Health education 38 141 INDEX—continued Page Health visitors 21, 33, 36, 38, 52, 63, 66, 70 Hepatitis, infectious16,115 Holiday camps (Mental Health) 47 Home Help Service 20, 49 Home nurses 34 Home safety 38 Hostel accommodation (Mental Health) 46 Houses in multiple occupation 85 Houses, unfit 84 Housing 83 Ice cream 90 Imitation cream 91 Immigration 56 Immunisation 20,36 Immunisation of staff 11l Incontinence pads 35 Infectious diseases14,113 Infested children 70 Junior training schools 45 Keystone School Vision Screener 60 Liquid Egg (Pasteurisation) Regulations, 1963 94 Loan of nursing equipment 35 Malaria 14,16 Manual Workers' Sickness Pay Scheme, admission to1ll Marie Curie Foundation 4 Massage and Special Treatment, establishments for108 Maternal mortality 12 Maternity and Child Welfare Dental Service 23 Maternity packs 31 Measles 13,14,16,113 Meat inspection 95,133 Meat Inspection Regulations 96 Meat, surrender of unsound 92 Medical examination of staff 1ll Medical inspections, routine 58 Medical social workers 27 Meningococcal infection 13, 14, 16, 113 Mental health 44 Mental illness 47 Mental sub-normality 44 Midwives 31 Milk Regulations 14, 90 Mobile exhibition—Solid Smokeless Fuels Federation 102 Moral welfare workers 27 Mortgage enquiries 86 Mortuary, public 110 Mother and baby home 27 Multi-Racial Pre-School Play Group 26 142 INDEX—continued Page Neo-natal mortality rate 12 Night Service (Home Help) Noise 76 Noise Abatement Act, 1960, The 76 Nuisances 74 Nurseries and Child-Minders Regulation Act 26 Nurses Agencies Act, 1957 35 Nursing equipment, loan of 35 Nursing homes 108 Observation Register 22 Offices, Shops and Railway Premises Act, 1963 78 Old age pensioners 40 Ophthalmia neonatorum 14, 16 Ophthalmic clinics 59 Orthopaedic clinics 61 Osteopathy 109 Outworkers'premises 76,123 Overcrowding—Housing Act, 1957 86 Perinatal Mortality Rate 12 Persons in need of care and attention 55 Pet Animals Act, 1951 97 Phenylketonuria Screening 23 Physiotherapy 21 Pigeons, destruction of 74 Plague 14 Pneumonia 13,14,16,114 Poliomyelitis13,14,16,36,113 Population 12 Post-natal sessions 21 Preserved foods, premises registered for preparation of 93 Prevention of Damage by Pests Act, 1949 81 Priority Dental Service 23 Problem families 49 Public Health Inspectors 54, 74, 86, 92, 96 Public Health measures, general 74 Public Health Regulations 92 Puerperal pyrexia 14,17,115 Queen Charlotte's Hospital 31 Radioactive Substances Act, 1960 76 Rag Flock and Other Filling Materials Act, 1951 76 Rateable Value 12 Recuperative holidays 39 Relapsing fever 14 Rent Act, 1957 75 Riding Establishments Act, 1964 98 Rodent control in sewers 82 Rooms, regulations for underground 84 Routine medical inspections 58 143 INDEX—continued Page Salmonella typhimurium 15 Sausages, premises registered for preparation of 93 Scarlet fever 14,17,113 School clinics 59 School Dental Service 71 Sewage disposal 106 Sheridan hearing test 22 " Sitters-in" service 46 Slaughter of Animals Act, 1958 97 Smallpox 14,17, 36, 114 Smoke and sulphur dioxide in the atmosphere 99,104,137 Smoke Control Areas 99 Smoke Control Orders, contraventions of 105 Smoke, dark, from industrial premises 105 Smoke from industrial chimneys 105 Smoking 38 Social services for problem families, co-ordination of 28 Soiled linen cleansing service 54 Solid Smokeless Fuels Federation—mobile exhibition 102 Special Schools 67, 69 Special Treatment, establishments for Massage and 108 Speech class 63 Speech therapy 21,62 Speech therapy clinics 62 Staff, medical examinations and welfare of 1ll Staff, vaccination and immunisation of 112 Statistics 12 Still-births 12 Swimming baths 106 Tea, examination of 92 Ten Year Development Plan 19, 48 Tetanus 36 Toxaemia of pregnancy 51 Training (Day) Nurseries 25 Tuberculosis 13,14,17,36,115 Tuberculosis Visitors 43 Tuberculosis Welfare Officer 43 Tuition other than at school 69 Tumour Survey in food animals 97 Typhoid fever 14,17, 18, 114 Typhus 14 Unsupported mothers 20 Vaccination 20, 36 Vaccination of staff 1ll Venereal disease 38 Vital statistics 12 Water supplies 72 Whooping cough 14,36,113 144 » Printed for the London Borough of Ealing by Harrison & Sons Ltd., London