I EAL 57 The Health of the London Borough of Ealing in the year 1966 EAL 57 The Health of the London Borough of Ealing in the year 1966 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: 01-567 3456 LIST OF CONTENTS Page Foreword 3 Committees and Staff 4 1. Vital Statistics 8 2. Infectious Diseases 10 3. Health Centres 13 4. Care of Mothers and Young Children 14 5. Health Clinics 15 6. Day Care of Children 18 7. Care of the Unsupported Mother and Her Child 21 8. Co-ordination of Social Services 22 9. Family Planning 23 10. Cervical Cytology 25 11. Midwifery 26 12. Health Visiting 27 13. Home Nursing 28 14. Vaccination and Immunisation 30 15. Health Education 31 16. Recuperative Holidays 32 17. Chiropody 33 18. Tuberculosis Service 35 19. Mental Health 37 20. Home Help Service 41 21. Care of the Elderly 43 22. Immigration 45 23. School Health Service 56 24. General Environmental Health Measures 72 Page 25. Water Supplies, Swimming Baths and Sewage Disposal 80 26. Meat Inspection and Animal Protection 83 27. Housing 85 28. Clean Air 91 29. Food Hygiene and Food and Drugs Administration 96 30. Registration of Premises used for Medical Purposes 103 31. Mortuary and Burial Arrangements 105 32. Medical Examination and Welfare of Staff 106 33. Medical Aspects of Council Housing 109 Tables 110 Index 131 Mr. Mayor, Aldermen and Councillors, In my previous report to you I recorded that after a period of consolidation we were in a position to proceed to the stage of improving the service and remedying deficiencies. This has indeed taken place during 1966. Improvements have been made in many parts of our existing service and at the same time various projects for the future have proceeded satisfactorily. These include a hostel for the mentally handicapped, a day club for the mentally ill, and a new day nursery. In addition, although at a preliminary stage, discussions concerning health centres have been encouraging, I look forward to continued progress next year. I would like to thank the members of those Committees of the Council concerned with its health services, together with the staff of th# department for their help during the year. Your obedient servant, I. H. Seppelt, Medical Officer of Health. MEMBERSHIP OF COMMITTEES AT 31st DECEMBER, 1966 ENVIRONMENTAL HEALTH COMMITTEE Chairman - Councillor J.F. Barlow Vice-Chairman - Councillor A.K. Schollar The Mayor (Councillor A.J. McCallum, J.P.) (ex officio) Councillor M.J. Barber CouncillorMrs. N.R. Law Councillor R.R. Clay Councillor A.W. Morbey Councillor D.J. Cousins Councillor F.R.J. Rockhill Councillor E.W.J. Everett Councillor E.J. Sheil Councillor W.G. Hill Councillor Mrs. E.M. Stephens, M.A. Councillor W.G. Lamb Councillor A.W. Surry PERSONAL HEALTH SERVICES COMMITTEE Chairman - Councillor D.J. Cousins Vice-Chairman - Councillor Miss A.J. Saunders The Mayor (Councillor A.J. McCallum, J.P.) (ex-officio) Alderman Mrs. M.T. Elliott Councillor C.C. Headey, J.P. Councillor J.F. Barlow Councillor W.G. Lamb Councillor C.B. Cripps Councillor Mrs. N.R. Law Councillor E.W.J. Everett Councillor A.W. Morbey Councillor W. Feldman, LL.B. Councillor Mrs. E.L. Prodham Councillor H.R. Hayselden 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, J.P. Vice-Chairman - Councillor J. Haigh, J.P. Alderman J. Johnston Councillor R. Hetherington Councillor F. Bavister Councillor T. W.Newson, J.P. Councillor R.A.H. Eggleton Councillor Mrs. E.L. Prodham Councillor F.G. Errington Councillor Miss A.J. Saunders Councillor S.A. Goodman Councillor P.G. Southey Co-opted Members Mrs. G. Barnes, B.A. Mrs. M.K.F.M. Summers Mr. J.H. Murray, J.P. Mrs. J. Thrift Rev. M.R. Parsons, M.A. Mr. R.F. Turnham 4 SENIOR STAFF OF THE HEALTH DEPARTMENT (as at 31st December, 1966) Medical Officer of Health and Principal School Medical Officer I.H. Seppelt, M.B., B.Chir., D.P.H. Deputy Medical Officer of Health I.O. Taylor, M.R.C.S., L.R.C.P., D.P.H. Senior Principal Medical Officer Catharine E. Hollman, M.B., B.S., D.R.C.O.G., D.P.H. Consultant Medical Officer G.E.B. Payne, M.D., B.S., 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, L.D.S., R.C.S. Miss E.S. Cosh, B.D.S. D.J. Hughes, B.D.S. Miss D.T. Matlach, L.D.S., R.C.S. Miss K.M.F. Robinson, L.D.S., R.C.S. Dental Officers • Part-time Mrs. A.H. Daniels, L.D.S. H.R. Phillips, L.D.S., R.C.S. M.J. Skillicorn, B.D.S., L.D.S., R.C.S. J.K. Chmielewski, D.C.D. et. S. (Paris) Mrs. S.A. Law, B.D.S. Orthodontists R.A.S. Tipper, L.D.S., R.C.S. - Part-time Mrs. E.G.Lindon, L.D.S., R.C.S. 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, M.A.P.H.I. G.W. Burden, M.A.P.H.I. S. Sadler, M.A.P.H.I. A.C. Bamping, M.A.P.H.I. E.W. Budd, M.A.P.H.I. D.A. Parker, M.A.P.H.I. Senior Administrative Assistant J. James COMMUNITY CARE SECTION Principal Medical Officer Margaret Heller, M.D. (Vienna)., D.C.H. Principal Mental Health Social Worker R.R.P. Mundon, R.M.N. Deputy Principal Mental Health Social Worker Z.R. Sliwinski Home Help Organiser Miss A.M. Choat 5 Community Care Section /Contd. Chest Physician - Chest Clinic H. Climie, M.D., Ch.B., D.P.H. Senior Administrative Assistant D.E. Storr SCHOOL HEALTH AND MATERNAL AND CHILD HEALTH SECTIONS Principal Medical Officer - Catharine E. Hollman, M.B., B.S., Maternal and Child Health D.R.C.O.G., D.P.H. Principal Medical Officer - Kathleen M. Hart, M.D., B.S., D.P.H. School Health Assistant Principal Medical Officer Margaret R. McDonald, M.B., B.S., D.P.H. Assistant Medical Officers - Full-time 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. Teresa J. Posmyk, M.B., B.Ch., D.P.H. Grace A.M. Webster, M.B., Ch.B., D.P.H. D.R.C.O.G. Norma C. Theobalds, M.B., B.S., M.R.C.P. (Glas.), D.C.H. Theresa Sebestyen, M.D., (Budapest), L.R.C.P., L.R.C.S., D.C.H. - Part-time Barbara A. Thomas, M.B., B.Chir., D.R.C.O.G. Sarah E. Neech, M.D. (California) M.R.C.S., L.R.C.P. Elizabeth Shindler, M.B., B.S. Hannah Mushin, M.R.C.S., L.R.C.P., D.C.H. Chief Nursing Officer - Health Miss A.M. Beck-Slinn, S.R.N., S.C.M., Visiting R.F.N., H.V.Cert. Deputy Chief Nursing Officer - Miss C.M. Gwynne, S.R.N., S.C.M., Health Visiting H.V.Cert. Senior Divisional Health Visitor Miss. J.D. McFarlane, S.R.N., S.C.M., H.V.Cert. Divisional Health Visitors Mrs. J.M. Noble, S.R.N., S.C.M., H.V.Cert. Mrs. N. Zinkin, S.R.N., S.C.M., H.V.Cert. Chief Nursing Officer - Home Nursing and Midwifery Miss H.G. Lovell, S.R.N., S.C.M. Deputy Chief Nursing Officer - Home Nursing Miss W.E. Lawrence, S.R.N., S.C.M. Deputy Chief Nursing Officer - Midwifery Miss W.E.A. Sanders, S.R.N., S.C.M. Medical Social Worker Mrs. E.A. Thome, A.I.M.S.W. Matron • Mother and Baby Home Miss M.N. Cuddiford, S.R.N., S.C.M. 6 School Health and Maternal and Child Health Sections /Contd. Supervisory Matron - Day Nurseries Miss H.L. Ogden, R.S.C.N. Senior Administrative Assistants - School Health Section P.V. Wallis Maternal and Child Health Section Miss A.I. Coyle-Williams GENERAL ADMINISTRATION SECTION Deputy Chief Administrative Assistant H.J. Reed Senior Administrative Assistant J. Burrows 7 1. VITAL STATISTICS SUMMARY OF STATISTICS Area (in acres) 13,708 Population (Census, 1961) 299,762 Population (estimated middle of 1966) 303,940 Rateable value, 1st April, 1966 £23,173,977 Net product of penny rate, 1966/67 £94,500 Live births:- Legitimate males 2,577 Females 2,536 Total 5,113 Illegitimate males 276 Females 251 Total 527 Birth rate per 1,000 of estimated population 18.6 Illegitimate livebirths(per cent of total live births) 9.3% Sti I Ibirths:- Males. 47 Females . 43 Total 90 Rate per 1,000 total births (live and still-births) 15.7 Deaths:- Males- 1,765 Females . 1,814 Total 3,579 Death-rate per 1,000 of estimated population 11.8 Deaths of infants under one year of age:- Legitimate males 50 Females 41 Total 91 Illegitimate males 8 Females 4 Total 12 Death-rates of infants under one year of age:- All infants per 1,000 live births 18.3 Legitimate infants per 1,000 legitimate live births 17.8 Illegitimate infants per 1,000 illegitimate live births 22.8 Neo-natal mortality rate (deaths under four weeks per 1,000 total live births) 13.1 Early neo-natal mortality rate (deaths under one week per 1,000 total live births) 11.0 Perinatal mortality rate (still-births and deaths under one week combined per 1,000 total live and still-births) 26.5 Maternal mortality (including abortions):- Number of deaths Nil Rate per 1,000 live and still-births Nil 8 CAUSES OF DEATH Cause of Death Deaths 1966 Total Deaths 1965 Male Female Total Tuberculosis, respiratory 6 8 14 10 Tuberculosis, other – – – 3 Syphilitic disease 1 2 3 2 Diphtheria – – – – Whooping-cough 1 – 1 1 Meningococcal infections – – – – Acute poliomyelitis – – – – Measles – – – – 1 Other infective & parasitic diseases 1 4 5 6 Malignant neoplasm, stomach 48 37 85 77 Malignant neoplasm, lung, bronchus 194 52 246 209 Malignant neoplasm, breast – 75 75 67 Malignant neoplasm, uterus – 19 19 23 Other malignant & lymphatic neoplasms 188 154 342 314 Leukaemia, aleukaemia 13 9 22 24 Diabetes 11 17 28 22 Vascular lesions of nervous system 156 258 414 368 Coronary disease, angina 465 326 791 727 Hypertension with heart disease 11 28 39 57 Other heart disease 113 191 304 346 Other circulatory disease 71 123 194 226 Influenza 1 6 7 2 Pneumonia 106 187 293 267 Bronchitis 134 40 174 201 Other diseases of respiratory system 18 13 31 34 Ulcer of stomach and duodenum 18 13 31 31 Gastritis, enteritis and diarrhoea 7 13 20 20 Nephritis and nephrosis 10 8 18 19 Hyperplasia of prostate 4 – 4 7 Pregnancy, childbirth, abortion – – – – Congenital malformations 8 14 22 30 Other defined & ill-defined diseases 112 171 283 233 Motor vehicle accidents 31 13 44 35 All other accidents 14 22 36 52 Suicide 18 11 29 36 Homicides and operations of war 5 – 5 – TOTALS 1,765 1,814 3,579 3,450 9 2. INFECTIOUS DISEASES Details of the incidence of the various notifiable infectious diseases and the action taken during the year to prevent their spread are as follows: Anthrax No cases were notified during the year. Cholera No cases were notified during the year. Diphtheria No cases were notified during the year. Dysentery This disease is usually spread by reason of faulty personal hygiene. During the year, 296 cases were notified. A number of these occurred as part of small local outbreaks. Towards the end of April, a notification was received from the Westminster City Council that a child attending an Ealing day nursery had been admitted to hospital with a diagnosis of Sonne dysentery. The 15 members of the staff and the remaining 44 children who attended the nursery were asked to submit faecal specimens. From these, a further eight children were found to be positive for this infection and were referred to their own doctors for treatment and allowed to return to the nursery only after three negative specimens had been received from each. In July, a notification of dysentery was received from a general practitioner of a two-year-old boy who attended another Ealing day nursery. Here again, faecal specimens were taken from the staff and remaining children, and another 14 cases, including a member of the staff, were discovered. After treatment by their doctors and the submission of three negative specimens all were allowed to return to the nursery. One resistant case required treatment in hospital before the stools became negative. At the end of September, the head teacher of a local school reported that a number of children were absent with symptoms of diarrhoea. Preliminary investigations by means of specimens showed that two of the children were suffering from Sonne dysentery. In view of this, a further 66 specimens were taken from the classes which contained the positive cases and a further 6 affected children were found. As the incidence of this mild but troublesome infection did not quickly abate it was decided to put into operation a regime of hand washing and disinfection of toilets and wash-basins. Each classroom was supplied with a plastic bowl and the children were made to rinse their hands in mild antiseptic three times during the school day and after any visit to the toilet. The school caretaker was instructed to swab regularly with disinfectant all lavatory seats, chains, door handles and wash-basin taps. It is considered that this routine, which has been used successfully elsewhere assisted materially in bringing the outbreak to a close. Erysipelas Nine cases were notified. 10 Food Poisoning There were 31 cases notified but only five were confirmed after bacteriological investigation. The causative agents of these were: S typhimurium (2 cases) Staph, aureus (1 case), Salmonellae - Dublin (1 case) and Salmonellae - Stanley (1 case). Infectious Hepatitis During the first full year of the Special Order which made the disease notifiable in the Borough, 58 cases were notified. One of these was fatal. Malaria There were no cases notified. Measles Measles has an interesting pattern of occurrence in that large outbreaks follow smaller ones in alternate years, and as was expected there were relatively few cases notified (1,204) during the year compared with 1965 (3,618). The explanation for this pattern is probably that many children lose during the following year a degree of immunity which they have acquired in the previous epidemic, without themselves having contracted the disease. In addition, a number of children will have been born between one 'measles year' and another and will, therefore, be susceptible. Measles is an acute virus infection which affects mainly young children, although no age group is immune. Whilst the disease itself has not changed in character in recent years, the advent of antibiotics has very much reduced the incidence of dangerous complications. It is, nevertheless, a cause of considerable distress in young children and also expensive in general practitioner time. The possibility of immunising against the disease has, therefore, been considered in recent years. In October 1964, the constituent authorities of the London Borough of Ealing, together with 15 other boroughs in various parts of the country took part in a trial organized by the Medical Research Council to test the efficiency of a vaccine against measles. Some 1,200 of the Borough's children received the vaccine and it was found that they were, depending on the type of vaccine, between five and eight times less likely to catch measles than unvaccinated children. In addition, threequarters of those who did subsequently catch measles had attacks which were less severe than usual. A small percentage of children vaccinated developed some reaction. In February, 1966, however, the Council was advised by the Ministry of Health that, although vaccines would be available to doctors who wished to use them for any of their patients, they considered it premature to embark on any programme of general measles vaccination. They considered that further studies were needed before advice could be offered on the use of this vaccine in the routine immunisation of children or on measles vaccine campaigns. The Ministry pointed out that the duration of protection is not at present known and is the subject of further study. The Council accepted this advice from the Ministry. Membranous Croup No cases were notified during the year. 11 Acute Encephalitis and Meningococcal Infection There were three cases of acute encephalitis and three cases of meningococcal infection notified during the year. Ophthalmia Neonatorum No cases occurred during the year. Plague No cases occurred during the year. Pneumonia There were 36 cases notified during the year. Poliomyelitis As in the previous year, no case of this disease was notified. There seems little doubt that this happy state of affairs owes much to the introduction of immunisation. Puerperal Pyrexia There were 38 notifications, three of which occurred in home confinements and 35 in hospital confinements. In order to make a true valuation of these figures it must be remembered that the number of births in hospital greatly exceeds home confinements and that the cases most liable to suffer from puerperal pyrexia are usually delivered in hospital. Scarlet Fever There were 126 cases notified during the year. Smallpox There were no cases during the year, although one suspected case was notified. This was seen by a smallpox consultant and diagnosed as a skin condition (papular urticaria). There were 26 people who arrived by air and seven by sea from smallpox areas without being able to produce valid certificates of vaccination. All these were kept under daily surveillance until the fourteenth day from the last day of possible contact. Tuberculosis Despite the general improvement in living standards and the efficacy of new drugs, tuberculosis remains a problem. During the year 131 new cases of pulmonary tuberculosis and 32 new cases of non-pulmonary tuberculosis were notified. Enteric or Typhoid Fever There were no cases of typhoid fever during the year. One suspected case was admitted to hospital but on investigation proved to have disseminated lupus erythematosus. Notification of a suspected case of paratyphoid fever was received and this too was unconfirmed after bacteriological investigation. Whooping-Cough There were 95 cases notified during the year. Full statistical information is set out in Table 1 at the end of this Report. 12 3. HEALTH CENTRES In my report last year I recorded that a sub-committee of the Personal Health Services Committee was shortly to begin a series of exploratory discussions with interested persons and organisations in the Borough with a view to providing health centres. These discussions took place during the year, and members of the Council met representatives of the British Medical Association, the Local Medical Committee and the Executive Council. These meetings confirmed that there is a real interest in health centres amongst practitioners in the Borough, and they were of great value in eliminating many misconceptions. It is next planned that there shall be discussions on the feasibility of health centres in specific sites, with the doctors concerned in these areas. The first two meetings will concern proposals relating to the East Acton area and the Hanwell Broadway area. 4. CARE CF 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 of the Act 1. The provision of health clinics in which ante-natal, post-natal and child welfare sessions are held. 22 2. The provision of day nurseries. 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, the Nurseries and Child-Minders Regulation Act, 1948, provides for the registration and supervision of private day nurseries and child-minders. Details of these services are contained in their individual sections. 14 5. HEALTH CLINICS The Council has 18 health clinics sited to be reasonably accessible to every mother in the Borough. At these clinics sessions are provided for ante-natal and post-natal care, child welfare, vaccination and immunisation, family planning, dental care, speech therapy, chiropody and physiotherapy. They are staffed by a medical officer, a 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, midwifery, and health visiting. Detailed accounts of the various services provided at clinics are given either below or as part of other sections of this report:- Ante-natal and Post-natal Sessions Two types of ante-natal sessions are held at clinics:- 1. Midwife's sessions, where a mother is regularly seen by the midwife who will attend her at confinement. The usual practice is for a mother to alternate a clinic attendance with a visit to her family doctor who is responsible for her ante-natal care. 2. Medical Officer's sessions. The pattern today is generally towards ante-natal care being undertaken by family doctors and hospitals. Approximately one in five mothers, however, still attend the clinic for ante-natal care by the Council's medical staff. The figures for 1966 were as follows: 1,135 mothers attended medical officers' sessions for their ante-natal care 764 mothers attended midwives' sessions for their ante-natal care 757 mothers attended ante-natal relaxation classes. The Borough is fortunate in the degree of co-ordination that has been achieved with the hospitals. An example of this is the attendance of Ealing domiciliary midwives and medical officers at regular lunch time meetings held at Perivale Maternity Hospital, where cases of clinical interest are discussed. The Council's staff much appreciate the hospital's invitation to attend these, and derive considerable benefit from them. All expectant mothers having their first babies, whoever may be undertaking their ante-natal care, are invited to take part in the ante-natal classes organised by the Council's health visitors. These provide an occasion for preparation for childbirth and infant care, and for ante-natal exercises. Post-natal sessions are held for those mothers who find it more convenient to attend the clinic than return to hospital. The purpose of these is to ensure that there are no conditions following confinement that require treatment. The number who attended in 1966 was 400. Child Welfare Sessions At these sessions, teaching in infant feeding, general care and mothercraft is given by the medical officer and the health visitor. The medical officer is responsible 15 for examining all the new babies and being concerned with feeding problems, behaviour difficulties, and the follow-up of all children needing medical supervision. 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. Apart from routine work of this sort, other important screening procedures are carried out:- 1. It is known that there is a much higher incidence of some abnormalities following certain ante-natal and post-natal conditions. A very well known example of this is, of course, german measles during pregnancy. In such cases the child is placed on an observation register kept at each clinic, and given the benefit of particularly careful surveillance. By this means it is hoped that should there be any impairment of development this is detected at the earliest stage and the child referred to a specialist unit for complete assessment. During the year, 771 children were added to the observation register, being 13.7 per cent of all live births in the Borough. The total at the end of the year was 3,225. 2. Phenylketonuria test. This test of the baby's urine is able to detect one form of mental subnormality which is correctable by diet. There were 5,659 babies tested in this way during the year, but no positive cases were detected. During the year, 14,207 children were brought to child welfare clinics. Maternal and Child Health Dental Service (Priority Dental Service) The priority dental groups comprise expectant and nursing mothers and preschool children. The figures for attendance of these groups in 1966 were:- Expectant and Nursing Mothers Examined 224 Required treatment 208 Teeth filled 761 Teeth extracted 163 Dentures provided 37 Pre-School Children Examined 1,239 Required treatment 864 Teeth filled 1,657 Teeth extracted 731 There is no doubt that all pre-school children benefit from regular dental examination, starting at the age of three years, so that defects are seen early whilst remedial action needed is minimal, and extractions avoidable. All the 16 Council's health workers coming into contact with this group press this point with parents. Reference is made elsewhere in the report to the increased dental health education programme in clinics and the health education work of the dental auxiliary. It is hoped that these measures will have a special impact on the treatment of pre-school children. 17 6. DAY CARE OF CHILDREN Pre-school Playgroups A young child's ideal environment might appear easy to attain, but in practice it is often not so. It consists of two loving parents, a home with indoor and outdoor play space, companions of the child's own age and play materials. Pre-school playgroups make an important contribution to the social education of children, particularly when the circumstances of modern living make one or more of these desirables unobtainable. It is important to recognise that they are not organised to allow mothers to go out to work, and indeed, the hours at which most operate (9.30 to 12 noon) would not allow but for the briefest period of employment. Unfortunately at present they tend to be for the children of enlightened parents, and there does seem need for greater facilities. The Council is involved in the subject of playgroups in two ways. Firstly, the Council requires pre-school playgroups to register as private day nurseries and as such they are inspected under the provision of the Nurseries and Childminders Regulation Act, 1948, with the object of safeguarding the health and welfare of the children. Secondly, the Council has decided that such groups should be encouraged, and therefore, subject to adherence to the Council's Code of Practice, playgroups in the Borough are eligible to receive financial assistance. At the end of the year there were 21 playgroups in the Borough which included 6 which were registered for the first time during the year. Of these 6 were in receipt of a Council grant. Child Minders In the not uncommon circumstances today of both parents working the problem of the care of the children is solved in a variety of ways. An au pair girl may be employed, a grandmother may care for the children, or a neighbour may help. Alternatively, children may be placed with a registered child minder, and it is in this circumstance that the Council is concerned. A child minder is defined as a person who receives into her home for reward three or more children of whom she is not a relative from more than one household for a substantial part of the day or for any longer period not exceeding six days. Under the provisions of the Nurseries and Child Minders Regulation Act, 1948, such a person is required to be registered by the Council. On receipt of an application to be a child minder an inspection is made to determine whether the premises are satisfactory, and those looking after the children are fit and proper persons. If registration is agreed then further inspections are carried out at regular intervals. At the end of the year there were 11 registered childminders in the Borough, which included 4 who were registered for the first time during the year. There are certain aspects of child minding which give cause for concern:- 1. Registration is only required by the regulations if more than two children not from the same household are minded. There would seem to be need for legislation requiring registration without any conditions if a child is minded for reward. 2. Minders may fail to notify the Authorities, and parents are not, in general, particularly concerned whether the minders are complying with the law. Illegal child minding is often detected if the health visitor is already visiting the house to see the minder's own children. If this is not the 18 case, however, she may be unaware of the situation. Efforts at enforcing the regulations also often make the health visitor's work more difficult in a household. Examples are occurring, particularly amongst immigrant families, of admission being refused to the health visitor who is too persistent in her attempts to investigate the number of children in a household. The Day Nursery Service The Day Nursery Service is provided for the care of children aged three months to five years who are in the priority group. The following circumstances constitute a priority:- 1. Where the mother is unsupported or for certain other reasons has to go out to work as an economic necessity. 2. Where home conditions are unsatisfactory from a health point of view or the mother is in ill-health. 3. Where the child is handicapped. Particularly this applies to a physical handicap, impairment of hearing or sight, or when the child is maladjusted. 4. If the parents are deaf and dumb. 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 * Training nurseries. The day nurseries are open from 7.30 a.m. to 6. p.m. Mondays to Fridays. Three of the day nurseries are recognized as training nurseries, student nursery nurses receiving their theoretical training at Chiswick Polytechnic, where they attend two days per week over two years. Four students completed their training during the year. 19 The number of staff at each nursery is determined by an overall ratio of staff/ children of 1 : 5. Charges are assessed on the family income, the maximum charge being 17s. 7d. per day per child, with the average charge much lower than this. Handicapped children over the age of two years are admitted free. During the year, 249 new admissions were made to the day nurseries, of which six children were handicapped. Six children were also placed in day nurseries in the adjacent boroughs of Harrow, Hounslow and Hillingdon; 10 children from the Hounslow area were admitted to Longcot Day Nursery. This year has seen an increase in the number of priority cases, especially for children under two years and has resulted in waiting lists for all nurseries. Lack of a day nursery in Hanwell has also thrown an added burden on the Ealing and Acton day nurseries. 20 7. CARE OF THE UNSUPPORTED MOTHER AND HER CHILD Under Section 22 of the National Health Service Act, 1946, the Council is responsible for the care of the unsupported mother and her child. The majority of these mothers are unmarried but a few are separated or homeless. A medical social worker is employed to advise such mothers and their families of the services available to support them in planning the future for themselves and their children. The mother, her parents and sometimes the putative father are offered a personal casework service to enable them to understand something of the causes of the present situation and to prevent further social breakdown in the future. The medical social worker has a responsibility for the care of girls needing help who reside in the Borough and also, by a special arrangement, for those living in the Boroughs of Hounslow and Hillingdon. They are referred to the department's medical social worker by medical social workers in hospitals, health visitors, general practitioners, and other social workers, including the staff of the National Council for the Unmarried Mother and her Child, to whom many unmarried mothers write for help in the first instance. As the service is becoming more widely known some girls contact the medical social worker themselves or are referred by their employers or families. During the ante-natal period the medical social worker advises on employment, accommodation, finance and adoption procedure. If required she will arrange a mother and baby home booking and will co-operate with the general practitioner and the hospital where the confinement will take place. Following the delivery, while the mother is resident in the mother and baby home the medical social worker will make arrangements for adoption or alternatively help the girl to make constructive plans to keep her baby. Preventive after-care following the girl's return home is carried on wherever possible, but since a full-time social worker was not available for part of the year, little in this direction could be undertaken. During the year, the department helped 182 unsupported mothers from Ealing, 82 from Hounslow, and 80 from Hillingdon. The Council has its own mother and baby home to which the unsupported mother can be admitted, usually six weeks before confinement and for six weeks after delivery. It can accommodate 12 ante-natal patients and 14 post-natal patients and babies. The home is staffed by a matron who is a state certified midwife, a deputy matron, a part-time staff nurse, and four attendants. Ante-natal and post-natal sessions are conducted in the home every week by the Principal Medical Officer (Maternal and Child Health); all new babies are also examined regularly and a close liaison is maintained with the maternity hospitals. Ante-natal and mothercraft classes are given by the matron and, since many girls lack knowledge of the basic domestic skills, instruction in these is given as part of the normal routine of the staff. Occupational therapy classes are held weekly and the girls learn dressmaking, knitting and other handicrafts. During the year, 123 mothers were accommodated in the home and 58 of these were resident in the Borough. To date, the Council's mother and baby home has been used for the more difficult, emotionally disturbed or backward girl, and in return by arrangement with the Boroughs of Haringey and Brent the medical social worker has been able to place other girls in the homes in these Boroughs. 21 8. CO-ORDINATION OF SOCIAL SERVICES It is possible for the Council's Health, Welfare, Children's and Education Departments to be actively and concurrently involved with one family. In cases involving Council tenants with rent arrears, the Town Clerk's and Borough Treasurer's Departments will also be involved. It is the function of the Co-ordinating Committee of chief officers to ensure unified action. For this purpose a sub-committee of officers, under the chairmanship of the Principal Medical Officer (Maternal and Child Health) meets weekly to allow discussion of management of cases between the appropriate field workers. Verbal reports are received from the field workers involved and a decision made as to who will be the key worker for each family. If a social worker from either the Children's or Welfare Departments is the case worker the appropriate committee will, if necessary, guarantee the rent during the period of intensive casework. Successful casework leads to payment of the arrears and organization of the family's affairs for the future. 22 9. FAMILY PLANNING During the year the Council took important decisions in relation to its Family Planning Service as a result of Ministry of Health Circular 5/66. The existing provisions which the Council has made under Section 22 of the National Health Service Act, are as follows:- a) The Health Department provides a birth control clinic at Cherington House Clinic, Hanwell, to which local authority doctors, general practitioners and health visitors may recommend women for family planning advice on medical grounds. Two sessions are held per month with an average attendance of 20 per session. Women are advised and taught a method and issued with appliances or the Pill. Appliances can subsequently be obtained through any of the Council's health clinics by a patient who has attended the birth control clinic. In 1966 36 new patients were seen and a total of 429 visits were made to this clinic. b) Per capita payments are made to the local branch of the Family Planning Association for any women referred on medical grounds by the local authority doctors. During the year, 21 such cases were referred. c) The provision of free accommodation and free lighting, heating, cleaning, etc., in the health clinics is granted to the local branch of the Family Planning Association. d) Financial support by the donation of an annual grant to local branch of the Family Planning Association. e) Distribution of leaflets/clinic times, and details of the activities of the local branch of the Family Planning Association are made through the health clinics, health visitors, midwives, and other local health authority staff. The following improvements in the service were agreed by the Council as a result of the circular:- i Notices indicating the times and places of the voluntary clinics in the area will, in future, be prominently displayed in all health clinics. ii In future all advice and treatment, including supplies, will be provided free at clinics for women who need advice on family planning on medical grounds. iii The Council has agreed to support the local branch of the Family Planning Association in providing a domiciliary service. There is a great need to take the Family Planning service into the homes of those women who should have this help, but who, for varying reasons, fail to attend normal birth control sessions. Comparison of figures from the Council's own clinics of women referred for advice and women who actually attend shows a failure rate varying from 20% to 40% in recent years. It has been shown elsewhere that these 'failure to attend' cases can be effectively helped by a domiciliary service. Such a domiciliary service provided by the local branch of the Family Planning 23 \ Association supported by the local health authority and working with the Co-ordinating Committee of the Council could play an important part in the rehabilitation of problem families and families in temporary welfare accommodation. iv Agreement in principle has been given to the support of a Family Planning Clinic using premises at Hillingdon Hospital, as an extension of the routine post-natal clinic. This will provide for the fitting of the intra-uterine contraceptive device. v Approval was given for certain cases where, on medical grounds, another pregnancy would be detrimental to health, for a mother in the Council's mother and baby home to be given family planning advice at the Council's own clinic. By doing so it is hoped that a succession of illegitimate pregnancies and repeated admissions to the mother and baby home; can be prevented. This service will form part of the general after care of such unsupported mothers. vi The Council expressed its concern at the number of illegal abortions and illegitimate births, noted the approach of the Brook Advisory Centres to this problem, and decided to investigate this matter further. 24 10. CERVICAL CYTOLOGY This service, under Section 28, which was inaugurated at the end of last year, has developed during 1966, and 762 smears were taken. During the year two more clinics were started by the Council and facilities are therefore now available at Cherington House, Ravenor Park and Pierrepoint Road clinics. The smears are taken by a doctor on the Council's staff, and the cytological work is undertaken by King Edward Memorial Hospital. At present it is necessary for patients to be referred by their own doctor but it has been represented to me during the year that the local practitioners would prefer the service to be available by direct application to a clinic. It is hoped to arrange this in the future for all women in the age group at maximum risk (over 35 years). The general practitioner will of course, as at present, be sent the result of all smears taken of his patients. Of the 762 smears taken during the year one was positive and required further investigation. 25 11. MIDWIFERY In accordance with Section 23 of the National Health Service Act the Council provides a staff of midwives to undertake home confinements and to care for those mothers discharged early from hospital. The arrangement whereby this work is undertaken by the Council's own midwives in Ealing and Southall, and by Queen Charlotte's Hospital midwives in Acton, continued in 1966. The Council is also the supervising authority under the Midwives Act, 1951, and as such is responsible for the supervision of all midwives practising in the Borough, including those working in hospital. The Council's midwifery staff consists of a Chief Nursing Officer, (Midwifery and Home Nursing) her deputy, and the equivalent of 20 full-time midwives. Whilst working in close collaboration with general practitioners they are based on health clinics where they hold weekly ante-natal sessions. 10 of the Council's midwives are approved teachers, and are responsible for the Part II training of pupils from Hillingdon Hospital. During the year 23 pupils were trained, 3 of whom were subsequently recruited to the Council's staff. I look forward to the inauguration next year of the Part II Midwifery Training School at Perivale Maternity Hospital, for which the Council will be responsible for the district training. This, I am sure, will strengthen the already close liaison with this hospital. The number of home and hospital confinements in the area of the London Borough of Ealing over the last few years is as follows:- Year Domiciliary Hospital Total 1962 1255 4093 5348 1963 1071 4475 5546 1964 1051 4744 5795 1965 942 4728 5670 1966 626 5039 5665 The increase in the proportion of hospital confinements is clearly shown, and is in conformity with National trends. The Council has agreed with Perivale Maternity Hospital to provide nursing care and home help service for mothers discharged from hospital after 48 hours. Before arrangements are made for a mother to be accepted on this scheme the health department has to be satisfied that the home conditions are suitable, and that there will be facilities for sufficient rest on return home. The growth of this service over the last few years is shown by the figures given below:- 1962 1963 1964 1965 1966 67 151 306 511 718 26 12. HEALTH VISITING The Council's health visiting staff consists of a Chief Nursing Officer (Health Visiting) her deputy, 3 divisional health visitors, and the equivalent of 40 health visitors. They work from 16 of the Council's health clinics, each having her own district and being responsible for all the families Iiving in that area. The health visitor is in an unique position in relation to the family, in that she is often advisor to the mother during the ante-natal period. Even if this is not the case she will visit within 10 days of the baby's birth and will continue to give any support necessary to the family thereafter. Her purpose is to prevent ill health, both physical and mental, and by giving support when difficulties arise to help in the maintenance of family life. She is involved with the organization of child welfare sessions at clinics, taking relaxation and mothercraft classes, and the follow-up of handicapped children. She is active in the field of health education, including group discussions with mothers, film shows, teaching in schools and talks to various local organizations on health matters. She also works in co-operation with the family's general practitioner and with other social services in a wide variety of ways. I have referred elsewhere to the trend for the attachment of health visitors and nursing and midwifery staff to general practitioners and in my view this should be developed. During the year a pilot scheme was started by attaching one health visitor to a three doctor group practice. In this scheme she visits only the patients of this practice, instead of working in a geographical area. It is hoped that the knowledge gained by this trial will enable us to proceed smoothly with a wider attachment scheme. Five health visitor students sponsored by the Council qualified during the year and are now on the health visiting staff. Four student nurses taking the integrated course of training at Hillingdon Hospital and Chiswick Polytechnic came to the Borough for practical training, and 62 student nurses from the local hospitals came to the Borough for a few day's experience in the work of health visitors. I am very glad that the department has this opportunity to help the next generation of nurses gain a better knowledge of community services. Two health visitors took the training course in teaching methods organised by the Health Visitors Association to enable them to teach health education in schools. During the year, the following visits were made: Children under five years 60,357 Expectant mothers 2,935 School children 2,625 Elderly persons aged 65 or over 3,015 For other purposes 3,392 27 13. HOME NURSING This service is provided under Section 25 of the National Health Service Act, 1946, for sick and aged persons living in their own homes. The Council's Home Nursing staff consists of a Chief Nursing Officer (Midwifery and Home Nursing) a deputy, and a full-time equivalent of 45 nurses. 12 nurses are part-time, which is a high proportion of the total, but this works satisfactorily, and is an effective way of utilising the services of married nurses. 3 of the staff are male nurses who prove extremely useful in appropriate cases. Patients are referred to the department almost entirely from hospitals (70%) and general practitioners (20%). The type of work ranges through short term care of acutely ill patients, post operative dressings and injections, the regular care of the aged and chronic sick, and finally to terminal care. The Home Nursing Service works in collaboration with two voluntary organizations in a most effective way:- Firstly, 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 nurses willing to provide a night sitting service is kept in the department, and I am authorized to engage them for this work on behalf of the Foundation. This is a most valuable service, and during the year 17 patients were nursed in this way. Secondly, the British Red Cross Society act as the Council's agent under Section 28 of the National Health Service Act, for the loan of nursing equipment. A small charge is made to the patient to cover replacement of equipment as required, but if this is unable to be met, the charge is paid by the Council. The Health Department arranges for the transport of heavy equipment. There were 2,291 articles loaned to patients during the year. There were two developments which affected the Home Nursing Services:- 1) Whilst I have noted above that with the help of the Marie Curie Foundation we are able to provide a night nursing service for cancer sufferers,we have not up till now had such a service for other types of patient whose need is often equal, examples are those suffering from severe heart disease or strokes. Towards the end of the year an increase in establishment of 4 State Enrolled nurses has enabled us to plan such a service which it is hoped to put into operation early in 1967. This, it is worth noting, will be the first occasion that State Enrolled Nurses have been employed in the Council's nursing service, and is in conformity with Ministry wishes that the more practical parts of nursing are carried out by such staff. This should enable the State Registered Nurses to undertake the more technical duties. 2) Ministry of Health Circular 14/66 was received towards the end of the year and commends the provision of incontinence pads and protective clothing by all local authorities to an extent which ensures that they are made available for all those to whom they can be of benefit. A limited scheme is already in existence in the Borough but this is on a small scale, and restricted to persons in receipt of home nursing. The 28 Ministry is now asking local authorities to note that it is not now necessary to make this restriction. I feel this circular is most opportune as I have for some time been disturbed by the very poor state of the bedding being laundered by the Council's laundry service for the incontinent. Indeed, some articles described as draw-sheets are in fact little more than rags, and I have felt that the provision of disposable material would be far more satisfactory than washing such articles. The Personal Health Services Committee will be considering this circular early in the New Year. 29 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 (diphtheria and tetanus booster school entry (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 during the year (expressed as a percentage of total births) were:- Immunisation against diphtheria, whooping-cough and tetanus 72.1 Immunisation against poliomyelitis 69.2 Vaccination against smallpox 59.2 Full details of immunisation carried out during the year are contained in table 4. 30 Triple vaccine immunisation at Northcote Clinic 15. HEALTH EDUCATION Health Education is part of the arrangements the Council makes under Section 28 of the National Health Service Act for the prevention of illness. A substantial part of the everyday work of the department's doctors, nurses, social workers and health inspectors is educative in nature, but in addition a specific health education programme is in operation in the Borough. A divisional health visitor, with special responsibilities for health education, is in charge of the day to day work and I give below subjects which have received special attention during the year- Flameproof material In conjunction with a local store an exhibition of flameproof garments and piece goods was displayed at Northcote Clinic. This was reinforced by talks and the showing of film strips on fire prevention. Cervical Cytology To coincide with the opening of the cervical cytology clinics talks illustrated by slides were given at Mattock Lane, Ravenor Park and Avenue Road clinics. These meetings had been advertised in the local paper and were well attended. Mother and Baby Home discussions Weekly discussions were held with the mothers on health matters ranging from personal hygiene to birth control. These were illustrated by films or film strips. Co-operation with Central Middlesex Hospital Arrangements have been made for health posters to be exhibited in various departments of this hospital. This is a very welcome gesture by the hospi tal since it demonstrates an appreciation of the part played by the local authority services. In addition the health education programme in schools has developed during the year, details of this being given under the chapter headed 'School Health Service'. 31 16. RECUPERATIVE HOLIDAYS Recuperative holidays are provided under Section 28 of the National Health Service Act, 1946, at the request of general practitioners where it is felt that a patient who has recovered from a recent illness would benefit from a holiday before resuming his normal occupation. The patient must be fit to travel and not in need of medical or nursing care. The normal recuperative holiday period is two weeks and in some cases this is extended if the doctor attending the home recommends that it would be beneficial to the patient. Arrangements are made for the persons approved to stay in a home chosen from approved lists. The home must be run by a state registered nurse and a doctor is required to be available in the event of emergencies. Arrangements are made for transport to be available to and from the main line station if this is recommended by the general practitioner. The cost of the service to the patient is £5. 15s. Od. per week but the recipients may be assessed according to income if they feel unable to pay this amount. Details of arrangements made during the year are given below:- Number of applications received 100 Number of patients sent on recuperative holiday 79 Number of patients who did not avail themselves of the vacancy offered 16 Number of applications not approved 5 32 17. CHIROPODY Chiropody is provided under Section 28 of the National Health Service Act both directly by the Council and by using the British Red Cross and the Southall Old People's Welfare Association as agents. The Council has an establishment of six chiropodists, which is filled by two full-time officers, the remainder being met by private chiropodists working part-time for the Council. It is the Council's ultimate aim to provide a comprehensive chiropody service based on clinics throughout the Borough and staffed by its own chiropodists. However, the national shortage of state registered Chiropodists has meant that it has only been possible to proceed gradually with this programme. The following are eligible for the chiropody service:- a) Old age pensioners. b) Handicapped persons, i.e. registered disabled persons, holders of disablement pensions, or persons specially recommended by a doctor. c) Expectant and nursing mothers. A mother may continue to attend for one year after the birth of her baby. The service operates from certain health clinics, community centres, and old people's homes, details being contained in table 5. In addition a domiciliary service is provided. For old age pensioners attending a Council chiropodist or a Red Cross chiropodist the maximum charge is 4s. 0d., this being reduced or waived according to an assessment scale which is used by both organisations. In practice the service is free in approximately 75% of these cases. For handicapped persons the standard charge is 8s. 0d., which is also subject to assessment. In this type of case, since the person is normally working, it is usual for the full charge to be made. The service is free for expectant and nursing mothers. The Southall Old People's Welfare Association provides treatment for old age pensioners only and no charges are made. Treatment is obtained by application to the Health Department or to one of the voluntary organisations. Subsequent appointments are made at intervals recommended by the Chiropodist; normally between four and six weeks. For patients who are house-bound the domiciliary service is provided, and for those who, although not house-bound, are too incapacitated to attend a clinic session, transport by ambulance is arranged. A doctor's certificate is required for the ambulance service and for the domiciliary service provided by the Council and the British Red Cross. In the case of patients receiving the Southall Old People's Welfare Association service no certificate is required. Details of attendances for the year are shown in the following table:- 33  British Red Cross Society Southall Old People's Welfare Association London Borough of Ealing TOTAL Total number of patients 479 131 2,650 3,260 Total number of new patients 51 15 707 773 Total number of treatments at clinic 1,605 - 6,721 8,326 Total number of treatments at private surgeries - 572 572 Number of patients receiving domiciliary treatment 197 114 473 720 Number of domiciliary treatments 1,087 1,076 2,788 4,951 Expectant and Nursing mothers - - 12 12 Physically handicapped persons 7 - 39 46 The figures indicate that during the year there was an appreciable increase in the number of domiciliary treatments. In particular these provide a large proportion (approximately 50%) of the work of the voluntary association chiropodists. Less domiciliary work (20%) is undertaken by the Council's own chiropodists but this proportion too has risen in the last year. These figures may well require further investigation since they do raise important points concerning the efficiency and economics of the service. It is, of course, vital that where it is impossible for an old person to come to a clinic then a domiciliary service must be provided. It is, however, expensive both of chiropodists' time and in chiropodists' fees compared with clinic attendances. 34 18. TUBERCULOSIS SERVICE The responsibility for the Tuberculosis service in the Borough is divided between the Council and the Regional Hospital Board. The Board is responsible for the provision of treatment at chest clinics, while the Council is responsible for the visiting and welfare services under Section 28 of the National Health Service Act. The Borough is served by two chest clinics, the greater part being covered by Ealing Chest Clinic, the Southall area being catered for by Uxbridge Chest cl inic. This has resulted in there being different arrangements for the Council's service in the two catchment areas. The work in the area of Ealing Chest Clinic is undertaken by the Council's own staff, which consists of an establishment of six tuberculosis visitors, a medical social worker, and a part-time occupational therapist. The work in the catchment area of Uxbridge Chest Clinic, i.e. Southall, is undertaken by the London Borough of Hillingdon on behalf of the Council. The Borough's medical social worker does, however, attend Uxbridge Chest Clinic. As well as tuberculosis work the chest clinic undertakes the care of other chest conditions, notably cancer a of the lung and bronchitis. Details of the work during 1966 are as follows: Tuberculosis Health Visitors Acton & Ealing (Ealing Chest Clinic) Southall (Uxbridge Chest Clinic) Number of new tuberculosis cases 89 64 Number of old tuberculosis cases 4,253 1,054 Transfers into Borough 26 9 Transfers out of Borough 24 2 Number of contacts of new cases 364 419 Successful visits to tuberculosis households 4,388 1,125 Unsuccessful visits to tuberculosis households 655 25 Successful visits to other patients 487 84 Unsuccessful visits to other patients 26 7 Medical Social Worker The statistics of the cases seen by the Medical Social Worker relate only to her duties at Ealing Chest Clinic. Details of cases and action taken at Uxbridge Chest Clinic for Southall residents are included in those for the whole catchment area of that Chest Clinic, and I am not in a position to record them separately. Details of cases Cases first referred during the year 133 Total cases 323 Tuberculosis patients 189 Cancer patients 60 Bronchitis & others 74 35 The mass radiography unit of the North West Metropolitan Regional Hospital Board carried out surveys in eight sites in the borough between February and July. The health department worked closely with the unit and gave assistance in finding sites and publicising the surveys. This included approaching many of the larger firms in the borough requesting co-operation in encouraging employees to attend, and in Southall with the assistance of the Indian Workers Association, the Council distributing 2,000 leaflets in Punjabi and Urdu, giving times and details of sessions. This resulted in 31,802 people being X-rayed, of whom 30 had active pulmonary tuberculosis, and 17 cancer of the lung. A further 34 cases required to be kept under observation. 36 Action taken Referred for employment 14 Found employment 4 Referred to Social Security for maintenance 30 ,, bedding 1 ,, clothing 4 ,, extra nourishment 16 19. MENTAL HEALTH The legislation under which the mental health services of the Borough operate is the Mental Health Act, 1959, which aims to move the emphasis away from hospital towards community care and when hospital treatment is essential to provide this on a voluntary admission basis. The services are divided into those dealing with the mentally ill and those dealing with the mentally subnormal. The past year has been one of improvement and expansion of the facilities for both types of patient. MENTAL ILLNESS Social Work The social work for the mentally ill is carried out by the department's 11 mental health social workers. Mental health social workers may be obtained during working hours by contacting the health department and in cases of emergency after office hours general practitioners can contact the duty officer through the control service at King Edward Memorial Hospital. Progress has been made during the year in two important fields. Firstly, a start has been made in improving the training of staff, both by in-service courses and by secondment. One mental health social worker has commenced a year's course and arrangements have been made for a senior psychiatric social worker, who shares her time equally between the mental health service and the Child Guidance Clinic, to act as case work supervisor. This has made it possibl e to provide newly engaged officers with improved training and supervision. In addition, one mental health social worker has attended regular sessions at the Drug and Alcoholic Unit of St. Bernard's Hospital. It is only by the provision of training and supervision that the intentions of the Mental Health Act can ultimately be implemented. The second development concerns co-operation with the psychiatric hospitals for this area. The consultant psychiatrist at Springfield who is in charge of admissions to that hospital from the Ealing area has paid regular visits to the mental health section and monthly conferences have taken place. In addition, better mutual understanding of the work of the hospital and the local authority has been achieved by including a short period of training at Shenley and Leavesden Hospitals for mental health social workers. Social and Therapeutic Centre In July the Council gave approval to a scheme to provide a social and therapeutic centre in an adapted premises in Windmill Lane, Greenford, The Centre, the object of which is to assist patients to make the transition between hospital and life in the community, will be opened in 1967. It will accommodate between 25 and 30 people and consist of two elements - a therapeutic centre, which patients will attend daily, and a social club, which will be open mainly in the evenings. Attendance at the therapeutic centre will be on the recommendation of a psychiatrist, whilst those attending the club will be referred by their general practitioners, hospitals and the Council's mental health social workers. In addition to helping those who have been in-patients, it is planned that the Centre will undertake preventive work and avoid the necessity of many admissions to hospital. 37 Hostels At present the Borough has no hostel for the mentally ill but 23 patients are living either in other local authorities hostels or those run by various voluntary organisations. Hospitals Ealing is served by three psychiatric hospitals. These are:- Springfield Hospital, Upper Tooting - Ealing area Shenley Hospital, St. Albans - Acton area St. Bernard's Hospital, Southall - Southall area In addition, Central Middlesex and West Middlesex Hospitals have small psychiatric units to which patients can be admitted for observation or short term treatment. It is to be hoped that in the future reorganisation of the hospital catchment areas can be arranged toeliminatethe use of hospitals which are some distance outside the Borough boundaries. Voluntary Associations The Ealing Association for Mental Health has continued to be active. It runs a weekly bus service to Springfield Hospital to facilitate the visiting of patients and it organises shopping expeditions for in-patients. During the Mental Health Week in June the Association arranged for displays of work by patients to be shown in clinici and other Council establishments. MENTAL SUBNORMALITY Subnormal patients are referred to the department through many agencies. Some are ascertained uhder Section 57 of the Education Act as being unable to benefit by education in school, whilst others are referred on leaving a school for educationally subnormal children if they are in need of supervision. Others are notified to the mental health section by health visitors, general practitioners or hospitals. All new cases are seen by a Principal Medical Officer and a recommendation made as to the best way of caring for them. Supporting visits are then made by mental health social workers and two clinics are held monthly for parents who need help and advice. The Principal Medical Officer also holds discussion groups for parents of mentally handicapped children and arrangements have been made through the Kennedy Galton Centre at Harperbury Hospital for certain parents to be given genetic counselling. Small numbers of very young mentally handicapped children now attend play groups or are admitted to day nurseries. This greatly assists parents and relieves much of the strain in caring for a handicapped child during the day. In addition, the presence of a mentally handicapped child in a group of normal children leads to better mutal understanding. It is proposed to investigate to what extent these numbers can be increased without throwing an undue strain on the staff. Junior Training Schools There are at present no junior training schools in the Borough and arrangements are made for children to be placed in schools belonging to neighbouring local authorities as follows: 38 Junior Training School Number Attending London Borough of Hounslow The Isleworth Junior Training Centre, Bridge Road, Isleworth, 60 The Hanworth Junior Training Centre, Bear Road, Feltham. 2 London Borough of Hi! ling don The Hi 11 ingdon Junior Training Centre, Harlington Road, Hil 1 ingdon. 24 London Borough of Harrow The Harrow Junior Training Centre, Whittlesea Road, Harrow, 9 London Borough of Brent Neasden Junior Training Centre, Neasden Lane, London, N.W. 10 1 All junior training schools arrange holiday camps during the summer for suitable children. Adult Training Centre There is one adult training centre in the Borough and this is situated in Jubilee Gardens, Southall. It is for 60 trainees and is open from 9 a.m. to 5 p.m. daily. Work is obtained from local firms on a contract basis and includes assembling electrical and television parts and trimming rubber components for motor vehicles. Trainees are also instructed in general gardening work and several have obtained work in the past as nurserymen. Three trainees were successfully placed in employment during the year. Every effort is made to simulate the conditions of open industry, trainees being required to clock on and off, and monetary award systems operate. Similarly, the mid-day meal, which is prepared on the premises, is purchased in the canteen as in industry. Also trainees living within two miles of the Centre are expected to travel there by themselves, transport being provided for those who live at a greater distance. Travelling alone is a valuable training in itself but the purpose of insistence on this is sometimes misunderstood. Holidays are arranged for all suitable people attending adult training centres. The London Borough of Hounslow was responsible for arranging two camps during August and September, each for a period of 10 days at which a total of 17 Ealing trainees attended. 39 In conjunction with the Education Department, arrangements are in hand for an important innovation, namely the appointment to the Centre of a part-time teacher for three sessions per week. This will enable trainees to continue their basic education after leaving junior training schools, particular emphasis being placed on practical matters such as telling the time, learning money values and shopping. Residential Accommodation Two patients were accommodated in hostels belonging to other local authorities and three in hostels run by voluntary organizations. During the year, the Ministry of Health approved plans for a hostel to be built on the Brenthill Nursery site in Hanwell. This wil I provide 25 places for men and women who are able to work in open industry or attend adult training centres. This should be opened in 1968 and will remedy a deficiency in the Council's services. Hospitals The Borough is entirely within the catchment area of Leavesden Hospital at Abbots Langley, near Watford, which accommodates both severely subnormal children and adults. During the year, 18 patients were admitted to hospital, of these 15 were admitted informally. Obtaining hospital care remains a problem, particularly when the disability is so great that the only satisfactory solution is permanent care in hospital. The waiting list of such cases is 30 and many of these have been waiting for years. Short term admission is easier to obtain and does provide a measure of relief for the famili es. It is at present the Council's policy that advantage should be taken of the availability of short term care placements in the hospital caring for the severely subnormal and if provision cannot be obtained in this way then by placement in private establishments. During the year, arrangements were made through the hospital for short term care of up to eight weeks for 32 patients and two patients were accommodated in private establishments. Voluntary Organizations The Ealing Society for Mentally Handicapped Children is also an active organization and, amongst its activities, it provides a sitters-in service to enable parents of severely subnormal children to leave them at home under supervision. The Society is also planning to build a youth centre on land provided by the Council. Statistical information on the work of the mental health service is contained in tables 6 and 7. 40 20. HOME HELP SERVICE The Home Help Service is provided by the Council under Section 29 of the National Health Service Act. Four types of service are provided:- 1) The Standard Service This provides help in acute illness, at home confinements, for tuberculosis cases, and for the chronic sick and aged. The major part of the case load is composed of the chronic sick. 2) Family Help Service This is to support the family when the mother is either temporarily absent from home, or due to fecklessness or some other reason is unable to cope with her family duties. The family help service may be residential or non-residential. 3) The Good Neighbour Service This is an arrangement by which regular help is given by a neighbour working under the Home Help scheme. 4) The Night Service This operates from 11 p.m. to 7 a.m. to give relief to the family of seriously ill patients. The case load of the service during the year was as follows:- Types of patients assisted No. Chronic sick, aged and tuberculosis 2,453 Maternity 230 Others 224 Family help 1 The establishment of home helps is 260 which is partly filled by 329 parttime and 11 full-time staff to give an equivalent of 208 full-time home helps. Recruitment has always been a problem, and during the year a re-organization of the service was agreed by the Personal Health Services Committee, which it is hoped will begin to have a beneficial effect next year. The re-organization is designed to ensure the most efficient utilization of the limited labour available by the modernization of methods. At the same time it is intended to increase the flexibility of the service to meet the future needs not only of the health department, but of the allied social service departments of Welfare and Children. The following measures have been agreed:- 1) The creation of posts of Home Assistants at a higher grade of salary so that a nucleus may be formed of the most capable home helps, to undertake the more difficult cases and control the other home help staff where occasion arises. It is hoped that this promotion structure 41 will provide an incentive to the best of our existing staff to remain in the service. 2) More favourable rates of pay to all grades of home helps to bring their remuneration on a par with comparable posts in industry. In particular, the salary of the Family Helps has been considerably raised in recognition of the particularly arduous nature of their duties. 3) The formation of a Mobile Home Help Unit. This is to be staffed by a male home help/driver and a team of home helps equipped with modern cleaning apparatus. This will allow them to visit a large number of premises for short periods for intensive cleaning. 4) Arrangements are to be made to overcome the recruiting problem by bringing home helps from areas where they can be most easily recruited to areas where they are particularly needed. It has always been one of the difficulties that the need has been greatest in those areas where recruitment is most difficult. Inadequacies of public transport in the Borough have prevented the use of the services of many women who would otherwise be prepared to be home helps. It is hoped that by providing our own transport we will overcome this difficulty. 42 21. CARE OF THE ELDERLY Ealing Day Treatment Centre Association The Ealing Day Treatment Centre for the daily care and treatment of elderly is supported by donations from local organizations and a grant from the Council under Section 136 of the Local Government Act, 1948. The Centre is for 20 patients, and is staffed by a Sister-in-Charge and nursing staff. The services available include a full medical examination by the Centre's geriatrician, physiotherapy, occupational therapy and chiropody. The number of patients attending during the year was 132 which is a slight increase compared to last year. The average duration of stay was 9.8 weeks which compared with 9.7 weeks last year. The types of disability which brought patients to the Centre were as follows:- Diseases of the musculoskeletal system 36 Diseases of the cardiovascular system 26 Diseases of the respiratory system 7 Diseases of the central nervous system (includes: hemiplegia 33) 39 Diseases of the alimentary system 2 No major diagnosis or senility only 16 Others 6 132 As before, referrals have been mostly from areas nearest to the Centre but a welcome change has been the marked increase in referrals from Southall. a welcome change has been the marked increase in referrals from Southall. The following table shows the distribution of referrals during the year from the various parts of the Borough:- Hanwell, W.7. 29 Ealing, W.13 27 Ealing, W.5 24 Greenford 12 Northolt 12 Perivale 1 Southall 25 Acton 2 In my report last year I referred to the lack of follow-up facilities. I am glad to record that during the year this has been remedied. Firstly an extension to the building was brought into use in November, which includes a physiotherapy room and a day room for 12 patients. This has enabled us to provide a follow-up clinic whereby patients who have been discharged are seen periodically at the Centre for re-assessment and continued rehabilitation. Secondly, in September a Geriatric Visitor was appointed to visit the homes of those patients who had been discharged. In this way it is hoped that any signs of deterioration will be seen early so that the patient may again be referred to the Centre for exam ination and possible re-admissinn. 43 In previous years I have referred to difficulties with the Ambulance service, and I am glad to report this year that, despite a continuing shortage of staff, it has been able to provide us with much better transport facilities for patients. Social activities are of great benefit to the patients. The usual summer outing took place, on this occasion being 1to* Eastbourne. Harvest Festival gifts were received from the children of Oaklands School and a carol concert was given by the choir of St. Thomas's Church, Hanwell, at an entertainment attended by the Mayor and Mayoress. Financial assistance was given to the Association by the Hanwell Carnival and Fete Society and by Aladdin Industries. The Association is grateful for all these examples of interest shown by the local community. The members of the Association for 1966 were:- President The Worshipful the Mayor of Ealing (Councillor D.J. Cousins) Chairman Councillor A.J. McCallum Vice-Chairman Councillor Miss A.J. Saunders Council Councillors Barlow, Mrs. Law, Morbey Representatives and Mrs. Prodham. Ealing Division, British Red Cross Society Mrs. D.M. Collins. Ealing Division, St. John Ambulance Brigade Mr. G. Hosking Ealing Division of the Women's Royal Voluntary Service Miss E. Tippetts Ealing Division of the British Medical Association Drs. Barbara Bailey, C.A. Osborn and F.H. Scoones. Fuel for the Elderly The Department maintains a small stock of bagged fuel for delivery to elderly persons when their usual service breaks down. Normally the cost is met by the recipient. In necessitous cases the Mayor will consider meeting the cost from his fund. Difficulties with fuel supplies are usually brought to our notice by Health Visitors, Home Nurses, Home Helps, or Old People's organizations. During the year 17 bags of fuel were delivered to 9 elderly people. Persons in need of Care and Attention The Council has powers under Section 47 of the National Assistance Act, 1948, to remove persons in need of care and attention to hospital or other suitable place. I am glad to report that during last year this was only necessary in two instances. On all other occasions persuasion succeeded in obtaining agreement to voluntary admission. 44 22. IMMIGRATION There are immigrants of many nationalities in the Borough; Indian, Pakistani, West Indian, Polish, Irish, and one family each from Persia, Thailand and Fiji. Most of these integrate easily into the community and present no particular problem, and it is only the concentration of Asian immigrants in the Southall part of the Borough which calls for special help. It is largely with them that this section of my report is concerned. For some years this area has formed an attractive target for immigrants from India and Pakistan. It has the advantage of close proximity to London Airport with many different types of work available. Indians form the majority of immigrants in Southall and most of them are Punjabi Sikhs but a small number come from Kenya. There is a small percentage of Pakistanis,estimated to be in the region of 10% of the Asian population. There is a local belief that the arrival of Indian immigrants began with one Indian ex-soldier who sought and obtained work from his former British officer, by then working in,a nearby rubber factory. During 1950/51 the wages and standard of living obtainable attracted some of this Indian's friends and relatives who in turn influenced other compatriots. Finding it difficult to rent accommodation they gradually purchased many houses of the gabled Victorian villa type south of the Uxbridge Road. By 1961 the census showed there to be 1,780 Indian or Pakistani immigrants. The 1966 census, a 10% sample, does not give the populations of the former boroughs separately but it shows an estimated total Indian and Pakistani population in the whole Borough of 9,327. Since that Census there has been a further influx of immigrants, some coming as additional separate families or parts of families, and others to join relatives who were already established in the area. These immigrants can mainly be placed into three categories: 1) Permanent The immigrant who comes to Southall, obtains a local job, buys a house, settles down, and is inclined to remain there with his family. 2) Originally temporary, but remaining permanently It is a traditional obligation to supply accommodation to relatives and friends when they arrive in this country and this tradition is practised frequently. Some immigrants taking advantage of this system find employment in the area and eventually find permanent homes of their own in Southall, Hill ingdon or adjoining districts. 3) In transit This group also takes advantage of the traditional obligation, but stay with friends or relatives in Southall for only a short period before moving off to other parts of the country. A great number find employment in industry in the Birmingham area and others in the brick-fields of Bedford. 45 The immigrants coming under categories 2 and 3 make it difficult for an accurate assessment of numbers to be made unless a complete Census is taken. From Health Department housing records, however, it is estimated that the total Asian population is now in excess of 11,000. NOTIFICATION OF ARRIVAL AND MEDICAL EXAMINATION A Commonwealth citizen who wishes to work and settle down in the United Kingdom must first obtain a Ministry of Labour voucher. Applicants for vouchers are placed in one of two categories:- 'A' For application by employers in this country who have specific jobs to offer particular Commonwealth citizens; and 'B' For applications by Commonwealth citizens without a specific job to go to but with certain professional qualifications. There is a statutory right that the wife and the children, under 16 years of age can accompany or follow an immigrant to this country without they themselves possessing a voucher. All voucher holders are given a medical examination at the port of entry, 99% of these being X-rayed. A large number of arrivals, however, are relatives of immigrants already established in this country and are not compelled to have medical examinations. All voucher holders are notified to the health department of the local authority into whose area they are proceeding. These immigrants are visited by health visitors who inform them of the medical facilities available, advise them to register with a general practitioner, and encourage them to have a chest x-ray if this has not already been done. The figures for notifications in 1966 are given below:- Country of Origin No. of Persons Number Notified Contact Established Commonwealth Countries India 404 289 Pakistan 73 64 Other Asian 42 35 Caribbean 211 194 African 33 19 Other 30 4 Non-Commonwealth Countries Europe 33 26 Other 25 6 Totals 851 647 (74.7%) 46 The ports of arrival were as follows:- Country of Origin No. of Persons London Airport Other ports Commonwealth Countries India 380 24 Pakistan 72 1 Other Asian 32 10 Caribbean 167 44 African 33 . Other 21 9 Non-Commonwealth Countries Europe 1 32 Other 15 10 Totals 721 130 TYPES OF WORK AVAILABLE The majority of Asian immigrants are engaged on manual work in factories, most of them being semi-skilled or unskilled. Many of these are employed in food factories, others work for London Transport or are self-employed in various forms of trade mainly within their own community. A few are employed in office work. The industrialization of the Southall area may not be apparent to the passing traveller as it consists of smaller type factories, mainly away from main roads and in the area immediately south of the railway. It is true to say that many of the unskilled and labouring jobs taken by Asian immigrants would not otherwise be filled by the indigenous population. A small proportion have found employment of a higher grade, in the post office, at London Airport or as school teachers, but nevertheless a large number of welleducated immigrants are doing manual work in factories and are frustrated by this fact. A proportion of the female population also goes out to work but no statistics are available as to the percentage involved. LANGUAGE PROBLEMS The majority of Indian immigrants come to this country with no knowledge of the English language. Fortunately, however, there is usually one person, often the landlord of a multi-occupied house, who can speak English and this is useful in making contact. The staff of the health department includes the full time equivalent of VA Indian interpreters, an Indian health visitor, and a Kenyan public health inspector. In addition we have an English medical officer, a health visitor and clerk who speak various Indian dialects. These officers between them enable us to communicate in Hindi, Punjabi, Urdu and Gujrati. As the language most commonly spoken is Punjabi, a course of lectures given by a member of the teaching staff of Ealing Technical College was arranged and 47 attended by 15 medical, nursing and administrative staff of the department. The lectures aimed to give an outline knowledge of the Punjabi language and general information on the customs of the country. Indian names present a difficult problem as there is no system comparable to that used in this country, 'Singh' and 'Kaur' are Sikh titles which denote male and female respectively and may appear at the end of other names or in between other names. Surnames may be similar to our own or may be given as the name of a village from which the person comes. It is thus possible for members of the same family to have different surnames. The titles of 'Singh' and Kaur' are so common as to be a source of great confusion and appear to be best omitted when possible. At Clinics,in order to avoid such confusion, Indians attending are asked for their 'family' name. If this is not forthcoming at the first visit they are told that no name will be recorded on the card until they can give the information required. Health visiting cards made out for new births have the name omitted if the family name is not given on the birth notification. When a copy of the birth registration card is received, this is sent to the clinic and in most cases it contains the family name. As a result of this system, no names of 'Singh' or 'Kaur' have been recorded at Clinics for the last two years. HEALTH EDUCATION Language difficulties are responsible for many of the problems of health education. The usual media are ased but there is an emphasis on pictures as many of the immigrants are illiterate. At local clinics filmstrips are shown to mothers attending the ante-natal, welfare and immunisation sessions, and explained with the help of interpreters. The subjects included are hygiene in the home, prevention of accidents, care of oil heaters, prevention of tuberculosis, immunisation, vaccination and dental care. A single concept projector has been purchased. This is similar to a television in appearance, the pictures being produced from a continuous loop of film. Any part of this can be repeatedly shown in order to emphasize the message. This apparatus is particularly useful in health education amongst immigrants where repetition is the main way of making the point. Demonstrations are also given. The subjects include the preparation of bottle feeds and simple diets, the latter being of particular importance since the Indian diet is low in protein. Leaflets in Hindi and Urdu are available at clinics^on the subjects of tuberculosis, food preservation, general hygiene, the laying of rat poison and the correct use of oil heaters. During the first half of 1966, the Mass X-ray Unit of the North West Metropolitan Regional Hospital Board visited the Borough and extra sites were used in the Southall area to encourage a full attendance. Leaflets printed in Hindi and Urdu were distributed at the Dominion Cinema, Southall. 10,438 persons attended this mass X-ray, which is considered by the Unit to be a good response. 48 HOUSING AND GENERAL HYGIENE Housing presents a great problem to the Asian immigrant both by reason of low availability and high cost. Thus most of the houses available to the Asians are in multiple occupation. Elsewhere in this Report a full account of this subject is given and indicates that dwelling houses are of two kinds; those which can be satisfactorily adapted for multiple occupation, and those that cannot. Unfortunately the houses in Southall occupied by immigrants largely fall into the latter category. Broadly speaking, general hygienic standards in the area are satisfactory. There are of course some exceptions to this but it must be remembered that extremes may be found in all areas. From time to time there are complaints about the dumping of rubbish in back gardens and in rear alleys. These are always investigated and rubbish removed by the Borough Surveyor, in accordance with an arrangement between the two departments. Infestations of mice in houses in the area occupied by Asian immigrants are fairly common, and it is thought that this may be due to the habit of storing flour and other cereals in bulk and to the failure of the occupiers to lodge early complaints in the proper quarter. INFECTIOUS DISEASE It is fair to say that the problems of infectious disease presented by Asian immigrants are somewhat exaggerated in the publ ic mind. Certain diseases, however, are a cause of concern to the health department and these are dealt with below. Smallpox Owing to the speed of international travel, it is possible for a person to be in contact with a case of smallpox on one day and to arrive in the Borough of Ealing on the next. There is a requirement that immigrants from countries where smallpox is endemic shall bring with them evidence of recent vaccination. Some of the vaccination certificates, however, are suspect as it is known that there is a trade in certificates given without the person undergoing vaccination. A small number of immigrants arrive in this country without a valid vaccination certificate and these are vaccinated at the port of entry and notified to the local authority of the area to which they are proceeding. There they are kept under surveillance until such time as there is no danger of the disease developing. During the period from the 1st April, 1965 to the present time there has been no confirmed case of smallpox in the Borough. The major factor in preventing an outbreak of smallpox arising from an imported case will always be a high vaccination state in the indigenous population of this country. Typhoid Fever Outbreaks of typhoid fever are generally traced back to carriers who although in normal health are capable in infecting others. Immigrants are intrinsically no more prone to be carriers than the indigenous population, but because they have had greater opportunity to have been in contact with the disease there is a higher proportion of carriers amongst them. All known carriers are kept under surveillance and are prevented from being employed in the food trade or water undertakings, this being the way extensive spread can occur. 49 Tuberculosis It is sometimes thought that tuberculosis is widely imported into this country by Asian immigrants. It seems as likely, however, that Asians are a susceptible population who more commonly contract the disease after their arrival here. It must also be borne in mind that a level in excess of the present rate for Asians was found in the indigenous population not so many years ago. This responded to the measures that were taken and there is no reason why the same success cannot be achieved with the immigrant population. Given below are certain figures relating to tuberculosis in the borough over the last five years. Although the number of cases is obtained from official notifications, the rates in different parts of the borough since 1965 are calculated from estimated populations. Similarly for the whole of the period under review the calculation of the differing incidence in the immigrant and indigenous population is based on estimates of the size of these communities. Nevertheless they are sufficiently accurate to give a broad indication of the pattern of tuberculosis in the borough. NEW CASES OF PULMONARY TUBERCULOSIS - SHOWING RATE PER 1,000 OF THE POPULATIONS OF THE FORMER BOROUGHS Area 1962 1963 1964 965* 966* No.of Cases Rate per 1,000 pop. No.of Cases Rate per 1,000 pop. No.of Cases Rate per 1,000 pop. No.of Cases Rate per 1,000 pop. No.of Cases Rate per 1,000 pop. SOUTHALL 59 1.09 76 1.40 83 1.45 35 0.59 51 0.86 ACTON 69 1.06 64 0.98 50 0.77 23 0.36 33 0.52 EALING 70 0.38 89 0.49 47 0.26 71 0.39 47 0.26 TOTALS 198 0.65 229 0.75 180 0.59 129 0.43 131 0.43 NEW CASES OF PULMONARY TUBERCULOSIS IN THE FORMER BOROUGH OF SOUTHALL SHOWING RATE PER 1,000 OF THE POPULATION Total cases notified Indians & Pakistanis (Based solely on names) Others Year No. of Cases Rate per 1,000 popula tion No.of Cases Rate per 1,000 of estimated population No. of Cases Rate per 1,000 of estimated population 1962 59 1.1 14 7.9 45 0.9 1963 76 1.4 24 8.0 52 1.0 1964 83 1.5 34 7.5 49 0.9 1965* 35 .6 25 4.2 10 0.2 1966* 51 .9 33 3.6 18 0.4 * 1965 and 1966. The rate per 1,000 for these years is based upon an estimated 'breakdown' of the total Borough population. 50 Venereal Disease It has been observed that new cases of gonorrhoea in males are proportionately higher among Asians. There is a need for health education in this respect. Any community whose structure consists of a large number of men without their families can be expected to have a high venereal disease rate. The immigrant community in Southall in its early days was of such a structure. Latterly the arrival of families is producing a more normal structure, and with this a fall in the venereal disease rate can be anticipated. MATERNAL AND CHILD HEALTH The Clinic Service The bulk of the Asian population attends Northcote Clinic, Southall, which is the nearest to the main Asian housing area. Substantial numbers however attend other clinics in Southall and are represented at all clinics in the Borough. The presence of a high proportion of Asian immigrants among attenders slows down the pace of the work undertaken due to language difficulties, confusion about names and also problems of unpunctuality. The Asian concept of time differs from that of the Northern European races; not only do they have difficulty in keeping appointments at the right time of day, but they become confused over the days of the week and the weeks of the month. In general, immigrants are anxious to secure the maximum benefits available to their children and, in their eagerness, do not clearly distinguish the different roles of the members of the clinic staff but endeavour to ask an opinion on the same subject from everyone that they meet there. Problems of communication require adjustment on the part of the clinic staff who need to become used to receiving intimate details of a female patient's medical history from her husband and to talk to him about her as a child might be talked about, rather than in the way an adult European woman would expect. Although language barriers have been broken down by the appointment of interpreters the health visitors are still handicapped in their dealings with Asian mothers as they are unable to establish the same degree of rapport that they would obtain by direct communication. The level of discussion is thus more simple than that which obtained with the English population. It is not possible to discuss emotional difficulties in the mother or the finer psychological points of child management through an interpreter. English Mothers There is a tendency for English mothers in Southall to think that all our efforts are being devoted to the immigrants. In order to remove this impression it is intended to set Northcote Clinic aside for them at regular intervals for talks, discussions and demonstrations. English speaking immigrant mothers will be welcome but the invitations are being extended to the 'minority mothers' first. Maternity Services The home conditions in Asian households are generally unsuitable for domiciliary confinement because of lack of space and facilities. During 1966, there were 424 Asian babies born, of which only two were born at home.The reasons for hospital bookings were medical in 98 cases and social in 324. 51 The normal pattern of ante-natal classes used in the Borough is unsuitable for the Southall Asians. They find lying on the floor in groups undignified and do not in any case see the need for ante-natal exercises. Some progress in teaching preparation for child-birth is, however, being made by one of the Indian health visitors. Health Visiting The health visitor can wield great influence, providing the family is visited as soon as possible after arrival in this country. She is able to explain the facilities available from local and national authorities and can sort out health problems about which the family is concerned. There is little chance of influencing Asian immigrants at the port of arrival as they are naturally excited and possibly worried at this time, and it is in their own homes that they are most susceptible to advice. If however the visit is unduly delayed, and this means a gap of perhaps seven to ten days, it is possible that the family will have moved to another area often without leaving an address and are thus 'lost'. Family Planning A family planning clinic is held at Northcote Clinic weekly and the average attendance is 15, of which about half are Asians. The choice of method is an individual matter and no distinct racial pattern is evident. Apart from the language difficul ty, which is overcome by the services of interpreters, the presence of a high proportion of Asians does not present any particular problem. With financial assistance from the Council the Family Planning Association opened a clinic in Hillingdon Hospital premises. It is anticipated that Asian mothers will make use of this following their post-natal examinations. Day Care of Children I have noted elsewhere in this report that there are certain aspects of child minding which give cause for concern and this is particularly so in the case of immigrant children. Both illegal minding and unsatisfactory minding falling within the present law are common. Supervision and control, however, is difficult to enforce. Often the minder does not know the full names and addresses of the children being minded and if health visitors persist in probing, admission is refused at subsequent visits. The rapid transfer of the children to other families within the house or next door will guard against follow up visits made by other authorized staff. The health and safety of these minded children are the main worries of the department, but such practices as leaving toddlers all day in prams or cots without toys or play materials are also a cause for concern. The more enlightened mothers use play-groups, of which there are a large number of well managed examples in the Borough. Many of these have children of all nationalities in them, but of particular interest is the multi-racial play group held at Southall Community Centre. This was started with support from the Council with the definite object of fostering integration. This group keeps an equal number of places for IndianandEuropeanchildren, and aims to teach the children at an early age something of each other's way of life. Home Nursing Service Because of difficulties experienced in arranging for immigrants to stay at home on specific times and days in order to receive injections from home nurses, a special service for ambulant patients is provided at Northcote Clinic. This has proved to be 52 a satisfactory arrangement and there has been an average attendance of 16 patients at each of the two weekly sessions held. Treatment by injection is a more popular form of therapy with Indians than it is with Europeans. SCHOOL HEALTH The immigrant school child population of the whole Borough at the end of the year was as follows: Total school population 38,706 Total immigrant children 5,054 Indians and Pakistanis 2,670 West Indians 1,439 Others 945 The immigrant school child population produces a variety of problems, and solving these is made harder by the fact that their parents do not usually attend routine medical inspections. This is especially the case where in order to avoid a high concentration in any one school the children are dispersed at considerable distance from their homes. A random sample taken from two schools in Southall revealed that for Asian children only 45% of the parents were present compared with 93% of other children. In three schools in Northolt and Acton only 5% of the parents of Asian children attended compared with 72% of parents of other children. In order to overcome this difficulty some experimental routine medical inspection sessions for 'dispersed' children in reception classes are planned to be held at Northcote Clinic. This will have the added advantage of enabling an interpreter to be present, which would not be possible with examinations taking place at various widely scattered schools. Routine medical inspection of these children since the amalgamation has not shown anything untoward, but there is a need to make specific surveys to verify that this is indeed the case. Immigrant parents are usually keen to ensure that their children miss as little school as possible, and it is sometimes difficult to dissuade them from sending children to school when they are unwell, or from returning them to school before they have completely recovered from an illness. There is difficulty too in convincing parents that infestations require to be taken seriously, and that children should remain at home until they have been cleared. A survey in a small number of schools during the year indicated that the immigrant school population does have a higher rate of infestation than the indigenous, (1.29% compared with .54%). It must be borne in mind however that a level in excess of that at present found amongst the immigrants, was general not so many years ago, and I see no reason why within a short time there should not be a universal low incidence. As part of the Council's tuberculosis prevention service all immigrant children are Heaf tested on admission to school. There is a high number of positive reactors amongst them which means one of three things; either that they have been immunised against tuberculosis - a common practice in India and Pakistan, or that they have been in contact with tuberculosis, or that they have themselves suffered from the disease. It is difficult to ascertain whether past immunisation is the cause, due to language difficulty and therefore positive reactors are referred to the chest clinic for investigation. The figures for the year are as follows: 53  Immigrants Others Total Number tested 321 1,281 1,602 Number found positive 175 39 214 Percentages of number tested found positive 54.52 3.04 13.36 During 1966 two Asian immigrant children were found to have active tuberculosis, and since 1960 a total of five. The position regarding educational subnormality in immigrant children is not clear cut. The percentage of educationally sub-normal children in the Borough as a whole is 0.7% and the percentage in Asian children is estimated as 0.4%. It is difficult to draw valid conclusions from these figures since it is possible that they are not referred for special education on account of their language difficulty but are retained in normal schools for instruction in the English language. It may well be that difficulty in distinguishing between language difficulty and backwardness results in a longer period of normal school being necessary before the two are differentiated. If there is uncertainty on this point, it is the practice in Ealing schools to give Asians the benefit of the doubt. In contrast, West Indian children have more than double the average percentage of educationally sub-normal pupils. The situation here, however, is different in that although they are English speaking, they have not had the same educational facilities in their country of origin. There is little evidence of any major psychiatric problem in the immigrant children, but there is, however, an unhappy tendency towards the isolation of the nonEnglish speaking mother from her family. The father and children eventually learn to speak English but the mother may not, particularly if she does not go out to work. In the long term this could be an undesirable trend as the mother may eventually be cut off from the school and unable to take part in any decisions made about her child. DENTAL HEALTH The pattern of dental disease in the children is not dissimilar from that of European children. Indeed, overall, they seem to have rather less caries, probably because their diet contains a lower proportion of sugar. There is a need for improvement however in the standard of oral hygiene. The immigrant mothers offer a rather different clinical picture from the same group of young English women. Whilst a large number of the immigrants are cariesfree because of their rather different dietetic habits, paradontal disease of an advanced nature and its precursor, salivary calculus, are a common occurrence. This all too often leads to premature teeth loss. It is of interest that the number of immigrant mothers referred to the Southall dental clinics by general medical practitioners is a much higher proportion than in any other part of the Borough. Orthodontic treatment for immigrant children presents certain unusual aspects. Firstly, as always, communication is difficult and it is a problem to make the parent understand what is involved. Parents often willingly give their consent to orthodontic treatment but it is only later that it becomes obvious that they have really failed to 54 understand that their personal involvement and co-operation is of great importance. Secondly, the facial pattern of the immigrant differs from that of Europeans, especially among the people of African origin, and the orthodontist has to be very alert to these difficulties and to modify any preconceived notions about the ideal facial and dental pattern accordingly. Although the average immigrant's attitude to appointment keeping is rather lackadaisical, both children and mothers make co-operative and grateful patients. MENTAL HEALTH The impression is that the incidence of mental illness among Asian immigrants is no higher in proportion to that amongst the remainder of the population. We do not however have any figures to confirm this because of lack of uniformity in referrals. During the year ended 31st December, 1966, 941 patients were referred, of which 47 were Indians or Pakistanis and 23 were West Indians. It is suspected that mentally ill relatives are contained longer within their own community than is the case with English people. When mental illness is found, it may present florid and bizarre symptoms not usually seen in our culture. During the year ended 31st December, 1966, there were 61 severely sub-normal children referred, of which 7 were Indian or Pakistani, and 4 were West Indian. 55 23. SCHOOL HEALTH SERVICE During the year a comprehensive review of the School Health Service in the Borough took place, and the resultant recommendations were accepted by the Education (Special Services) Sub-Committee at the end of the year. They aim to achieve a closer integration of the teaching, child guidance, and school health staff, and to increase the effectiveness of the various components of the school health service. In addition they include a 10 year programme of improvement of school medical room facilities and the starting of a pilot scheme of selective medical examination. It is hoped that during the course of next year a substantial start will have been made in implementing these recommendations. Routine School Medical Inspection At the present time a minimum of three examinations are carried out during a child's school life, these being at the ages of 5 years (infant school entrants) 9½ years (junior school) and 14 - 14½ years (secondary school leavers). The total school population at the end of the year was 38,706 and the details of the examinations carried out are as follows: First age group 3,895 Second age group 3,269 Third age group 3,314 10,478 Classification of general condition: Satisfactory 10,452 - 99.75% Unsatisfactory 26 - .25% Defects requiring treatment found at routine medical inspection: Skin 161 Vision 510 Squint 62 Hearing 44 Middle ear 32 Nose and throat 97 Speech 62 Enlarged glands 3 Heart 12 Lungs 39 Hernia 6 Orthopaedic: Postural 13 Feet 106 Epilepsy 8 One of the changes recommended by the review was that there should be a pilot scheme of selective medical examination, a system which has been introduced in many areas. It consists of omitting the intermediate examination, since it is considered that the provision of general practitioner and hospital services, combined 56 with the general increase in health of the population, has reduced the need for routine medical inspection. It is felt that selective medical examination allows more time to be given to those children who really need assistance, by reducing the time spent in the relatively unprofitable examination of fit children. The system involves parents of children of this age group filling in a questionnaire, and the school medical officer assessing whether an examination is indicated. In addition to the questionnaire, such selection methods as referral by teachers, weekly visits to the school by the school nurse, and attendance by the school doctor at physical education classes are used. It should be emphasized that such schemes are not economical of doctor and nurse time, and nor are they intended to be. The object is to provide a better service for children who are actually in need of it. I look forward with interest to the outcome of this scheme in Ealing. School Medical Rooms As part of the review of the service the facilities provided for school medical rooms were assessed and the results are summarized below: Group 1 Schools with designated medical rooms in which satisfactory arrangements exist 31 Group 2 Schools with medical rooms with some defect 22 Group 3 Schools without medical rooms, but where arrangements are reasonably satisfactory 6 Group 4 Schools without medical rooms, and where arrangements are not satisfactory 43 Group 5 Schools where no medical facilities are available and inspection is carried out at a clinic 7 Total 109 A 10 year programme of improvement has been agreed. SCREENING PROCEDURES An important adjunct to the routine inspection of children is the frequent visiting of schools by nursing or medical auxiliary staff for the purpose of screening large numbers of children for defects. Such visits are made for the following purposes: 1) Audiometry 2) Foot Health 3) Head Inspections 4) Vision Testing Audiometry This is devised to detect even a slight loss of hearing at the earliest possible opportunity. The first test is carried out shortly after admission to school and thereafter at two to three yearly intervals. Any loss of hearing is reported to the school doctor who will examine the child to exclude some minor or temporary condition. 57 Should he suspect some more serious cause of deafness the child is referred either to his own doctor, to the ear, nose and throat consultants, who hold sessions at the Council's clinics, or to the audiology unit at Heston. The figures for testing during the year were: Children tested 13,959 Schools visited 96 Children with hearing loss 514 Children referred to specialist 134 Foot Health The special sessions for foot inspections at schools have been discontinued due to lack of staff. This is much to be regretted since the regular inspection of children's feet for early defects and the opportunity this gives to spread propaganda emphasizing the need for wearing of sensible shoes is of the greatest value. These inspections will be resumed as soon as possible, meanwhile, foot examination is of course part of the routine medical inspection. Head Inspections The Council's policy of inspection of children's heads for infestation is that examination takes place at six monthly intervals except that, where a junior or secondary school has been entirely free from infestation for two years, further examinations take place less frequently at my discretion. During 1966, 48,071 examinations were carried out, 413 cases of infestation were found representing 0.86% of the children examined. Vision Testing Vision testing is carried out normally on five occasions during the child's school life, namely at five, seven, nine, twelve and fourteen years of age. Three of these examinations are linked with the routine medical examination, and school nurses make special visits to school for the other two. Defective colour vision could influence the choice of career and, for this reason, colour vision testing is carried out in junior and senior schools. SCHOOL CLINICS The following school clinics are provided: General Asthma Chiropody Foot Health Advisory Speech Therapy Ophthalmic Orthopaedic Ear, Nose and Throat Child Guidance General School Clinics To these clinics any parent or teacher may refer a child whose health or progress 58 at school is causing concern. They also provide the school medical officer with a further opportunity to investigate any defect noted at routine medical examinations at school. Sessions are held at each of the Council's clinics at least once a week. Attendances during the year were: Avenue Road 613 Abbey Parade 128 Laurel House 338 Brentside 106 Mattock Lane 507 Cherington House 772 Northcote 514 Cloister Road 119 Northolt Grange 435 Greenford Green 138 Peri vale 260 Islip Manor 309 Pierrepoint Road 471 Jubilee Gardens 156 Ravenor Park 743 King Street 420 Trinity Way 215 Asthma Clinic Special sessions for children suffering from asthma and bronchitis are held at five of the Council's clinics, where group therapy is given under the guidance of a physiotherapist. These children have not developed good breathing habits and breathing exercises have been found to reduce the attacks of asthma and bronchitis. Asthmatic attacks understandably give rise to parental anxiety which often unfortunately cause the child to be over clothed, over protected, and to have unnecessary limitations placed on his activities. At the Asthma Clinic parents are advised on the best needs of an asthmatic child. During the year, 1045 attendances were made. Chiropody Clinics In so far as school children are concerned, chiropody is almost exclusively the treatment of verrucae. This persistent and widely spread condition among school children is a type of wart which forms on the sole of the foot and if untreated becomes very painful. The treatment, although not difficult, is time-consuming. Six sessions a week are held at clinics throughout the Borough. Details of attendances during 1966 are:- New cases seen 342 Re-examinations 2,720 Total attendances 3,062 Foot Health Advisory Clinics These are complementary to the screening procedure for feet already mentioned, and have similarly had to be discontinued due to staff shortage. Speech Therapy Clinics It will be readily appreciated that defective speech, even of a minor degree, by virtue of its interference with communication presents considerable difficulty in the education of a child. 59 As in the case of all handicaps, the aim is to discover this before school life begins..This is usually achieved since, if a toddler's speech is not developing normally, he is generally brought by his mother to a Child Welfare Clinic. It may be, however, that a child does reach school age with defective speech, in which case he will probably be referred by his teacher or be discovered at the initial medical examination. The child is then seen by one of the Council's medical officers who has particular experience in this field. A full investigation will be carried out to ensure that the correct diagnosis is that of defective speech, and is not complicated by such features as deafness or low intelligence, both of which can first come to light as a 'speech defect'. The child will then be referred to one of the Council's speech therapists, sessions being held at most clincs. Should a child's speech defect be of such a severe nature as to interfere with his education-, he may be admitted to Brentside Speech Class which is at Brentside Infants' School. This is a special class within an ordinary school and caters for up to 10 pupils at ages ranging from approximately four to seven years. Two speech therapists attend the class for a total of four sessions per week. The children are treated individually and tape recordings are made regularly as a record of 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. This class has been very successful in helping children to enter or return to normal school with greatly improved speech. Diagnosis The following types of defect were encountered during the year:- 1) Simple and multiple defects of articulation (Dyslalia) 289 2) Delayed or absent speech (Developmental aphasia and dysphasia) 36 3) Delayed speech associated with mental subnormality (Aphasia) 2 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) 4 7) Stammering 47 8) Lisp 4 9) Cleft palate 3 10) Sigmatism 14 11) Slow development 8 Total 417 Ophthalmology Clinics Ophthalmic sessions are carried out in the Borough as follows: Avenue Road Clinic Dr. B. Bradley, M.D., D.O.M.S. Mattock Lane and Northcote Clinics Dr. Marie A. Woodhouse, M.B., B.S., D.O. Ravenor Park Clinic Dr. Margaret Billinghurst, M.B., B.S., D.O.M.S. 60 Dr. Billinghurst and Dr. Woodhouse were newly appointed during the year and commenced their duties in April and May respectively. Sessions are held weekly at Avenue Road and at the remaining clinics a double session is held on alternate weeks. Dr. Bradley and Dr. Billinghurst are members of the staff at Central Middlesex Hospital and Dr. Woodhouse is a member of the staff at King Edward Memorial Hospital. There is thus a close link between our clinics and the local hospitals and any operative or other treatment required can be readily obtained without a break in continuity. The figures for attendance are as follows: New cases seen 630 Re-attendances 1,902 Total attendances 2,532 Glasses prescribed 859 In addition to the consultant sessions, an orthoptic clinic at Avenue Road functions for four sessions a week. An additional orthoptic clinic at Ravenor Park started on the 8th November, 1966, and is held every other week. The figures for attendance are: New cases Total Number of attendances at clinic No. referred back to Ophthalmic Surgeon Avenue Road 16 407 32 Ravenor Park 11 17 1 32 424 33 Orthopaedic Service Orthopaedic sessions are carried out in the Borough as follows: Mattock Lane Clinic Monthly Mr.J.A. Cholmeley, F.R.C.S. Ravenor Park Clinic Alternate Weeks Northcote Clinic Monthly Mr. P.I. Busfield, F.R.C.S. Mr. Cholmeley is an Orthopaedic Surgeon to the Royal National Orthopaedic Hospital and its branch at Stanmore, and Mr. Busfield is an Orthopaedic Consultant at Hillingdon Hospital. Hospital facilities which include operative treatment, x-ray, provision of appliances and pathological investigations, are, therefore, freely available to the children attending our clinics and who thus remain under the same consultant surgeon throughout their treatment. Admission to hospital can be arranged promptly and subsequently follow-up by consultant and physiotherapist at the local clinic does not involve undue travelling. 61 Referrals to these clinics are usually from routine medical inspection at schools, the general school clinic, family doctors and a small number from other hospitals. The figures for attendance during 1966 are given below:- New cases 241 Re-attendances 553 794 Physiotherapy is provided at the following clinics: Greenford Green Ravenor Park Mattock Lane Northcote Islip Manor Ear, Nose and Throat Service Ear, nose and throat sessions are carried out at Ravenor Park and Mattock Lane on alternate weeks by Mr. R.M. Savage, F.R.C.S., (Edin.) D.L.O. and the figures for attendance during the year were:- New cases 136 Re-attendances 335 Medical treatment 210 Operative treatment 67 There is an arrangement by which children requiring operative treatment for tonsils and adenoids can be admitted to the Royal Hospital, Richmond. Children whose hearing defect cannot be rectified by treatment are referred to the Audiology Unit at Heston where the otologist assesses the degree of hearing loss in regard to the child's ability to receive education. He may recommend admission to a special school and he may recommend provision of a commercial hearing aid, for which the Council assumes financial responsibility. It has been argued that these consultant services are a duplication of those provided at hospital out-patients departments and there is a danger that in the near future these services, other than ophthalmic services, may be discontinued. There are, in my opinion, strong reasons in favour of their retention and these reasons are:- 1. Children should be regarded as a priority class. 2. As such, the services available to them should be easily accessible and the waiting time both for appointments and during attendance at the clinic should be reduced to a minimum. The Council's clinics are able to provide these favourable circumstances. 3. The consultants attending the Ealing clinics are in sympathy with the concept of a preventive specialist service. This has resulted in an integration of their work with the screening services provided by the Council's medical and nursing staff. It would be much regretted if these services, built up over many years, were discontinued. 62 CHILD GUIDANCE The Consultant Psychiatrist to the Child Guidance Centre is Dr. Portia Holman, M.D., F.R.C.P., D.P.M., who is, together with her two registrars, an officer of the North West Metropolitan Regional Hospital Board, the remaining staff are Council officers of the Education Department. The service is conducted from the main clinic at Madeley Road, Ealing, and from 3 sub-clinics. Avenue Road, Acton, Northolt Grange and Villiers Road, Southall. Details of the work carried out during the year are given below:- Referrals Number of cases on waiting list at 31st December, 1965 77 Number of cases referred to Centre during 1966 328 Number of cases seen by the Psychiatrists during 1966 315 Number of cases on waiting list at 31st December, 1966 90 Recommendations by Psychiatrists Treatment or remedial teaching or follow-up 227 Residential school for maladjusted 26 Residential school for educationally sub-normal 2 Day school for educationally sub-normal (or training centre) 6 Day school for maladjusted Aston 9 Newlands 11 20 Infant assessment classes 8 Other day schools or classes 7 Miscellaneous 19 Placement in residential schools for the maladjusted Number of children awaiting placement at 31st December, 1965 9 Number of children recommended during the year 26 Children placed 22 Recommendations withdrawn 4 Awaiting placement at 31st December, 1966 9 Recommendations for psycho-therapy or remedial treatment Cases awaiting treatment at 31st December, 1965 17 Recommendations for regular treatment 217 Recommendations for follow-up only 10 227 Discharged during year 58 Treatments during year 137 Awaiting treatment at 31st December, 1966 49 Of the 328 children referred to the centre 212 were boys and 116 were girls, details of their age range, level of intelligence and school attended are given below: 63 64 Parents and their children obtain the services of a Child Guidance Clinic either by asking for an appointment on their own initiative, or as a result of a referral which may be from a wide variety of sources; these include head teachers, school medical officers, general practitioners, the Youth Employment Bureau and the Juvenile Court. HANDICAPPED CHILDREN The object of the School Health Service in relation to the handicapped child is to ensure that the handicap interferes as little as possible with the child's education. Section 34 of the 1944 Education Act requires the Council to ascertain children likely to need special education at the age of 2 years, but the procedure in the Borough is that medical officers and health visitors report handicapped children to the School Health Service at the earliest age they become known to them. By this means we have a fairly complete record of all disabled children in the Borough in advance of the time when we are required to assist them. When such a child approaches school age he is examined by the school medical officer who decides whether he should be classified as handicapped in the statutory sense. If this is the case the child is 'ascertained' as in need of special education. Various types of special education are available including special classes at ordinary schools, home tuition, or education at special schools. The Borough's own special schools and classes are as follows:- Brentside Speech Class Reference has already been made to this class at Brentside Infant's School for ten children aged four to seven years who have speech defects of such a severe nature as to interfere with education. Day Schools for the Maladjusted These consist of Aston, a junior school at 1 Aston Road, Ealing for 25 children, and Newlands, a senior school within the curtilage of Oldfield School, for 25 children. The school health services available to these schools are in general the same as for ordinary schools with certain additions. These extra facilities consist of a routine medical examination annually instead of at the usual intervals, and the attendance of a psychiatric registrar for one session every fortnight. Day Schools for Educationally Subnormal Children These are Belvue and Acton Schools. Belvue School is a purpose built school in Northolt, providing places for 180 children. It was opened in September, 1966 and its first pupils were, in the main, those transferred from the former Talbot School in Southall. Acton School is for 40 children. The additional school health facilities available to these schools are an annual medical examination and the visit of a speech therapist three times a week. Residential Schools for Maladjusted Boys East Quinton School at Seaford is for 32 junior boys and Red House School near Reigate is for 33 senior boys. In each case, the children are under the medical care of a local practitioner who visits the school once a week and as often as otherwise required. Each child is examined, as a routine, once a term. A psychiatrist. Dr. M. Main, attends both schools once a month and a psychologist visits twice weekly. The following table sets out, in their various categories, the number of handicapped pupils as at 31st December, 1966. Category of pupils In Special Day Schools In Special Residential Schools In maintained Primary and Secondary Schools Not at School Total M F M F M F M F M F Blind 1 4 3 2 - - - _ 4 6 Partially sighted 4 9 . . . _ _ _ 4 9 Deaf 3 5 5 2 - - - . 8 7 Partially deaf 16 3 2 3 2 1 . _ 20 7 Educationally sub-normal 112 70 21 11 24 20 157 101 Epileptic - 1 . 3 _ _ . _ 4 Maladjusted 41 15 77 19 13 5 1 - 132 39 Physically handicapped 37 18 3 7 6 5 1 46 31 Defective speech 10 1 - - - - - - 10 1 Delicate 30 10 14 7 5 2 - - 49 19 Total 254 136 125 54 50 33 1 1 430 224 66 SCHOOL DENTAL SERVICE The School Dental Service has the following functions:- 1. The routine dental inspection of children at school. 2. Ensuring that any necessary dental treatment is received, either from the Council's own dentists or by attendance at a private dentist. 3. Dental Health Education. Dental sessions are held at 13 of the Council's clinics. The establishment of dental staff includes 14 dental officers and 18 surgery assistants. For the major part of the year the actual number of officers in employment was the full time equivalent 10.4 dental officers and 13.4 surgery assistants. This is a more satisfactory picture than is usually presented and is reflected in the figures given below for dental inspection and treatment. However, the uncertainty of maintaining a sufficiently high level of staffing makes the provision of a stable service extremely difficult. Patients and parents not unnaturally much prefer continuity, and expect to see the same dental surgeon regularly. The most successful clinics in the Borough are those where this has been the case. It was, therefore, disappointing to receive the resignation of two of our dental officers at the end of the year. This in no way reflects on the facilities and working conditions we are able to offer our dental staff, since these are in general of a high order, but is the result of being in a very competitive market. National salary scales for local authority dentists are ungenerous in relation to the rewards in private practice and as long as this continues to be the case recruitment will be difficult. Dental Inspection The figures for dental inspection during the year were as follows:- Routine dental inspections during 1966 83% of school population Found to require treatment 62% Sessions devoted to inspection 4.7% This is a markedly higher percentage of pupils inspected compared with last year when the figure was 66%. Dental Treatment The figures for dental treatment during the year were:- Total visits to clincs 28,854 Teeth filled 22,264 Teeth extracted 6,127 General anaesthetics 2,548 Emergencies 1,386 Sessions devoted to treatment 3,651 Dental Health Education During the year a dental auxiliary from the New Cross School began work at Ravenor Park Clinic where she undertakes a limited range of treatment under strict dental supervision. Equally, if not more important is her health education work for which she has been specially trained. The experiment so far has been very successful, and she has given talks and film shows on dental care to children at school and 67 at school dental inspections. Her efforts have been well received and favourably commented on by head teachers. During the year, an inspection of the Council's dental services was carried out by a Dental Officer of the Department of Education and Science. He was in general satisfied with the service, but drew attention to the variation in standard of accommodation and equipment, the low percentage of dental inspections, the need to use surgery assistants less on clerical duties, and the absence of x-ray units in some clinics. The Council's plans for the dental service already coincide with the various recommendations of the Inspector, with the exception of the provision of increased x-ray facilities. At present x-ray facilities are available at four clinics which are staffed by experienced officers. Increasing these facilities could lead to the installation of expensive equipment which was not fully used, and which might have to be operated by officers whose experience was limited. PREVENTiON OF INFECTIOUS DISEASE The School Health Service, in conjunction with the Council's other health services, is responsible for the control of all infectious disease in schools. In practice those which most frequently call for action are as follows: 1) Gastro-intestinal infections The most usual infection is dysentery, which is not uncommon in schools, and in the case of infants schools it is usually difficult to control. The type of disease, however, is rarely serious, although it is usually confused in the minds of parents with much more serious types of dysentery. Reference is made to an outbreak of this condition in an infants school earlier in this report. The routine food hygiene work of the department continued during the year. Of the 50 school kitchens in the Borough 17 have been awarded the Food Hygiene Certificate of the Clean Food Scheme. 43 kitchen and serving staff attended courses of nine lectures given by public health inspectors. 2) Winter Vomiting This is a disease characterized by a sudden onset of nausea, vomiting and giddiness. It is thought to be a virus condition and probably spread by droplet infection. An outbreak occurred at two schools during the year, involving approximately 78 children. 3) Infectious Hepatitis The London Borough of Ealing is one of the few areas in the country where this disease is notifiable. In the event of a case being notified in a school-chi Id, class contacts are offered gamma globulin, which is a serum extract which gives some measure of protection against the disease. Six cases were notified in five schools during the year, and a total of 58 children were given gamma globulin. None of these children subsequently developed infectious hepatitis. 4) Tuberculosis The School Health Service is actively concerned in preventing tuberculosis. On the child's entry into school, subject to the parent's 68 consent, a tuberculosis skin test is carried out and the children with a positive reaction are referred to the chest clinic for x-ray to exclude active disease. At the age of 13, parents are again invited to allow the child to have a tuberculosis skin test and if the reaction is negative, showing that the child has not yet acquired a natural immunity, a protective vaccination called B.C.G. is given. The figure for B.C.G. vaccination in 1966 were:- Number of children tested 2,420 Number of children vaccinated 2,161 Number of children positive 214 On notification of a case of active pulmonary tuberculosis in a school-child, an investigation is carried out on all school contacts. In the case of young children it takes the form of giving the skin test and a subsequent x-ray at the chest clinic, of those who give a positive reaction. The skin test is omitted for older children and adults and all are offered an x-ray. There were 4 cases of pulmonary tuberculosis notified in school children during the year, and investigations on the above lines were carried out. Regulations as to Infectious Disease These Regulations are based on current Ministry of Health policy and set out the types of infectious disease together with exclusion periods. All head teachers have a copy. HEALTH EDUCATION IN SCHOOLS In addition to the everyday work of the School Health Service, which is largely educative in nature, health visitors have for many years been playing an active part in a specific health education programme in operation in the Borough. In order to equip themselves for this work, two health visitors have attended a course extending over 42 weeks on 'Modern Methods of Health Education'. The programme is as follows:- 1) A series of talks to senior girls on all aspects of preparation for adult life. The course consists of 12 one hour lessons and the subjects include sex education, venereal disease and the harmful effects of smoking. Ten senior schools participated in this programme. During the year 120 talks were given to 315 children. 2) A series of talks to junior schools, consisting of two or three lessons of one hour, on anatomy and physiology, particularly in relation to changes at puberty. Ten junior schools are participating. During the year 30 talks were given to 500 children. 3) In infants schools health education is confined to talks on dental hygiene, illustrated by visual aids and a 'Noddy' film. This is now largely undertaken by the recently appointed dental hygienist. During the year 2 talks were given to 474 children. 69 4) Talks to school leavers on food hygiene are given by public health inspectors. During the year 10 talks were given to 400 children. A total of 28 out of 132 schools in the Borough now have health education programmes as follows:- No. of Schools with Schools in Health Education Borough Programmes Secondary Girls 9 7 Secondary Boys 9 4 Secondary Mixed 13 5 Juniors 49 10 Infants 50 2 Junior & secondary mixed 2 INDEPENDENT SCHOOLS The School Health Service is not generally available to children attending non-maintained schools, although Section 78 of the Education Act, 1944, provides for the extension of all or part of the service to such schools, subject to agreement between the proprietors and the local authority. There are certain facets of the School Health Service, however, in which private schools are included. They are:- 1) The consultant orthopaedic, ear, nose and throat, ophthalmology and psychiatric services are available to all school children since the consultants are officers of the Regional Hospital Board working under the National Health Service Act which does not differentiate between state-maintained and non-state-maintained school children. 2) Under Section 28 of the National Health Service Act the Council is responsible for providing immunisation against infectious disease, including B.C.G. vaccination, to all school children.During 1966, 330 children attending private schools were immunized against tuberculosis by the School Health Service. 3) Section 34 of the Education Act requires that all children in the Borough needing special educational treatment should be the responsibility of the Council. The last requirement has given the Education Committee some concern since during the year it was asked to assume responsibility for two children aged 15 years and 14 years respectively needing special education abroad. These handicapped children had, until shortly before the request been unknown to the School Health Service. The Council's medical staff can only be in a really satisfactory position to advise on the merits of such request if they have had an opportunity to observe such children from an early stage in their school careers. Following the review of the School Health Service, the possibility is being investigated of extending it at least in some measure to private schools. SCHOOLGIRL MOTHERS Until a few years ago the pregnant schoolgirl was a sufficiently rare occurrence to call for no special consideration by the Health Department other than that given to any unsupported mothers. In my review of the School Health Service 70 I drew attention to an increase in this problem and the need for an enquiry into the completeness of the Council's service for schoolgirl mothers. This will proceed during next year. CHILDREN UNABLE TO BENEFIT FROM EDUCATION AT SCHOOL Under Section 57 of the Education Act children who are so mentally handicapped that they are unable to benefit by education at school are referred to the Council's Mental Health Service for further care. There is no arbitrary 'score' which decides the issue, but the generally accepted standard is as follows:- The purpose of this is to ensure that if suitable they shall receive alternative training at junior training schools. The number of children who were assessed as unable to benefit from education during the year was three. There is a total of 98 children of school age in Junior Training Schools. RECUPERATIVE HOLIDAYS Under Section 48 of the Education Act arrangements are made on the recommendation of a doctor, for convalescent holidays for school children. No charge is made. During 1966, recuperative holidays were arranged for 34 school children. Normal schooling Education at a school for the above 75 educationally sub-normal Unable to benefit from education 75 - 50 below 50 71 24. GENERAL ENVIRONMENTAL HEALTH MEASURES NUISANCES AND COMPLAINTS During the year, 5,988 complaints were received, the main categories of complaint being as follows:- Housing defects 1,404 Dustbins and refuse 773 Drainage 790 Animals 27 Insects and wasps 212 Food 348 Smoke emissions and bonfires 178 Overcrowding and multiple occupation 120 Noise 120 Rats and mice 1,562 Miscellaneous 454 5,988 Action taken as a result of complaints resulted in 4,289 initial inspections of premises of all types and the service of 1,510 informal notices under the Public Health Acts and allied legislation. This informal action generally brought a satisfactory response and most requirements of the notices were dealt with in a reasonable time by the persons responsible. It was necessary, however, to serve 533 statutory notices in cases where action to remedy defects was not readily forthcoming and in the case of 13 premises, legal proceedings were taken. Of these 13 cases, 3 were adjourned to enable owners to carry out the works, and Nuisance Orders were made in the remaining 10 cases. Total costs payable to the Council amounted to £55. 3. Od. A total of 4,580 repairs and improvements were carried out as a result of informal and formal action under the Public Health and Housing Acts. The most numerous items involved were the cleansing and repair of 1,015 drains and water closets, abatement of dampness in 373 cases, the removal of 343 accumulations of refuse and the repair of 337 walls and ceilings. DESTRUCTION OF PIGEONS - Public Health Act, 1961 The contract with a firm specialising in the destruction of pigeons was renewed and the continuation of this work resulted in the destruction of 2,847 feral pigeons. The usual pattern of behaviour of pigeons is for them to roost in belfries, etc., during the night and to perch on roofs or gather in open spaces during the day. Larger numbers can, therefore, be caught by night with relative ease, but trapping in daylight has to be confined to the early morning if adverse public reaction is to be avoided. CARAVAN SITES AND CONTROL OF DEVELOPMENT ACT, 1960 One application for the renewal of a site licence for the use of a caravan on a sports ground was granted for a period of one year, expiring on 31st March, 1967. The illegal occupation of open land and service roads in the extreme western edge of the Borough as camping sites by gipsies and other itinerant travellers continued to present problems. Several sites available in earlier years became 72 inaccessible owing to housing development schemes in the favoured areas and the problem has therefore been reduced considerably in extent. The district public health inspectors again co-operated with the Council's warden and in 16 instances served notices under Section 93 of the Public Health Act, 1936, requiring the removal of caravans within 24 hours in order to abate nuisances caused by lack of sanitary accommodation and depositing of refuse. RENT ACT, 1957 The number of applications for certificates of disrepair from tenants of properties still under control remains small. The following tabl e gives details of action during the year. Part I - Applications for Certificates of Disrepair 1. Number of applications for certificates 21 2. Number of decisions not to issue certificates 1 3. Number of decisions to issue certificates - a. in respect of some but not all defects 12 b. in respect of all defects 8 4. Number of undertakings given by landlords under paragraph 5 of the First Schedule 9 5. Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule 6. Number of certificates issued 13 Part II - Application for Cancellation of Certificates 7. Applications by landlords to Local Authority for cancellation of certificates 7 8. Objections by tenants to cancellations of certificates 4 9. Decisions by Local Authority to cancel in spite of tenants' objection 1 10. Certificates cancelled by Local Authority 4 RADIOACTIVE SUBSTANCES ACT, 1960 Persons who keep or use radioactive material, unless specifically exempted, are required to be registered by the Minister of Housing and Local Government, who authorises the accumulation or disposal of such material. The Minister notifies local authorities of any Certificate of Registration which he issues. During the year, two notifications were received in respect of newly registered premises, and four notifications in respect of premises where revised certificates had been issued. One certificate was withdrawn. In all these cases, visits were made to the premises concerned to obtain information about safety precautions and other measures of control. Although the Council has no special responsibility for control, such visits were made to ensure that some detailed information was available locally in case of accident. At the end of the year, 20 premises within the Borough were registered under the Act. 73 INSPECTION OF FACTORIES AND OUTWORKERS' PREMISES - Factories Act, 1961 This act and various regulations made under it places on local authorities the responsibility for the enforcement of provisions relating to cleanliness, overcrowding, temperature, ventilation, drainage of floors and sanitary conveniences in respect of any factory where mechanical power is not used, and the provisions concerning sanitary conveniences in powered factories. In accordance with Section 8 of the Act, a register of all factories in the Borough is kept and at the end of the year 1,119 premises were registered. Routine inspections were carried out at 430 factory premises and, although a number of defects were found, most of these were remedied during the year and in no case was it found necessary to institute proceedings. Section 133 of the Act required occupiers of factories to notify local authorities of the names and addresses of persons employed by them in their own houses when they are engaged on certain classes of work. 61 visits of inspection were made to outworkers' houses and in all cases conditions were found to be satisfactory. Statistical information is given in Tables 8, 9, and 10. COMMON LODGING HOUSES There are no common lodging houses in the Borough. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 At the end of the year, 11 premises in the Borough were registered under this Act, which is designed to secure the use of clean filling and lining materials in upholstered articles, and other articles which are stuffed or lined. Conditions were found to be satisfactory in all cases. THE NOISE ABATEMENT ACT, 1960 Noise Complaints The number of complaints received during the year about alleged noise nuisances was 119. This figure is an increase of 17% above the number of complaints received during 1965 and again points to the greater reaction of the general public to the whole problem of noise. The complaints referred to noise from commerce and industry, noisy neighbours, traffic, road drills and the keeping of animals. As would be expected from the mixed development of parts of the Borough, approximately half of the complaints related to noise from factories or commercial premises. Of these it was found that about 65% could be held to be nuisances. In the case of the compl aints about noise from other sources, the position was reversed, and only 35% were found to be justified. Once again, the Council did not require to use formal statutory action to achieve the necessary reductions in noise emissions. In the autumn, the attention of the Public Utility companies was drawn to the number of complaints being received in the department regarding excessive noise from road drills and pointing out that the Borough Engineer and Surveyor had undertaken to equip the Council's drills with the appropriate noise converters or muffles. The response to this appeal was generally favourable, although one company pointed out that there was a loss of efficiency with some types of muffle. It was noticed 74 over the latter months of the year that there was an increase in the use of converters and muffles by contractors, with a satisfactory decrease in nuisance. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 This Act is designed to raise standards of working conditions in offices, shops, warehouses, canteens, catering establishments and fuel storage depots so as to promote the health, welfare and safety of the employees. At the end of the year, 2,964 premises were registered by the Council under this Act, there having been 204 additions to the register, and 56 deletions. There were still some areas of the Borough which had not been fully surveyed by the end of 1966, and it cannot be said that the register was fully accurate or complete. Inspection of premises to which the Act applied continued at a very satisfactory pace with 1,607 general inspections and a total of 2,802 visits of all kinds. With the appointment of an additional full-time technical officer in October it was possible to intensify the extent of registration and reinspection by the end of the year. Although there were some difficulties with a number of occupiers who were intially reluctant to comply with the requirements of the Act, there was a general acceptance of the Council's requirements for securing compliance. Occupiers are responsible for notifying accidents to their employees which result in absences of three days or more from normal work. During 1966, 108 accidepts were reported - an increase of 11 over the figures for 1965. A leaflet giving details of the regulations relating to accidents was sent out to occupiers with all correspondence relating to their premises because it was felt that many accidents were still not being notified!. Fortunately there were no fatal accidents during the year, but there was one prosecution in a case where serious injury was caused to an employee who fell through an unguarded trap door in a shop floor. There were two contraventions of Section 16 of the Act. The opening of the trap door was not securely fenced and steps leading to the basement were not provided with handrails or handholds. The magistrate found both charges proved and imposed total fines of £30 with 20 guineas costs. The following table gives an analysis of reported accidents according to their primary cause: 75 Primary Cause Adults 18 & over Young persons under 18 Total M F M F Non-power machinery in motion 1 1 Power machinery in motion 3 3 6 Vehicles moved by power 1 1 2 Vehicles moved by non-power 1 1 Falls on or from stairs 3 5 8 Falls on or from ladders 1 5 6 Other falls from one level to another 9 3 1 13 FalIs on same level 5 12 1 3 21 Stepping on or striking object or person 2 5 1 8 Handling goods 9 7 3 19 Struck by falling object 1 2 1 4 Use of hand tools 4 1 1 1 7 Fire 1 2 3 Electrical 1 1 Lifts and hoists 5 1 2 8 Totals 46 48 8 6 108 A second successful prosecution taken under the Act concerned shop premises occupied by a furniture retailing firm. There were six offences relating to the absence of thermometers, absence of hot and cold running water, dirty store and wash room, absence of a handrail or handhold to the staircase to the first floor, a defective sanitary convenience and the absence of an adequate first aid box. The company occupying the premises pleaded guilty to all charges and was fined a total of £120 with 10 guineas costs. During the year, the Council received two applications for exemption from the requirements of Section 24 of the Act relating to the provision of first aid boxes on the grounds that first aid rooms were to be provided. In one case a satisfactory room had been prepared and equipped and the application was granted. The second application related to a newly constructed warehouse and office building, in which a specially designed first aid suite had been contructed but, as work had not been completed at the end of the year, consideration of the application was deferred. One application for exemption from the requirements of Sections 9 and 10. relating to sanitary conveniences and washing facilities, was received and granted for a period of six months. One exemption granted in 1965 under Sections 9 and 10 lapsed during the year when the premises changed hands. The following tables summarize the work done under the Act during the year:- 76 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 53 815 277 Retail shops 128 1880 1087 Wholesale shops, warehouses 14 104 98 Catering establishments open to public, canteens 9 161 145 Fuel storage depots - 4 - Totals 204 2964 1607 No. of visits of all kinds by Inspectors to registered premises 2,802 Analysis of persons employed in registered premises by workplace:- Class of workplace Number of persons employed Offices 13,412 Retail shops 10,759 Wholesale departments, warehouses 1,580 Catering establishments open to public 1,339 Canteens 183 Fuel storage depots 54 Total 27,327 Total males 12,840 Total females 14,487 77 Contraventions remedied Items No. of Improvements Premises cleansed 137 Overcrowding abated 10 Temperature improved 52 Thermometers provided 119 Ventilation provided or improved 40 Lighting improved 23 Windows and skylights cleaned 6 Lighting apparatus repaired 8 W.C. accommodation increased 21 Washing facilities increased (basins) 50 Hot and cold water provided 80 Soap provided 19 Towels provided 19 Drinking water provided 6 Drinking vessels provided 2 Accommodation for clothing provided or improved 53 Facilities for drying clothing provided 14 Sitting facilities provided or improved 31 Meal facilities provided or improved 14 Floors, stairs, passages, etc., repaired 48 Handrails provided 21 Staircase guards provided 11 Machinery guarded 47 First aid boxes provided or refilled 157 Fairs and Circuses The Council gave consideration during the year to the question of sanitary conveniences at fairs and similar events. It was decided that strict conditions should be specified in the Council's contracts with showmen, and this decision was implemented during the Fair Season this year. These include provisions relating to the number, type, lighting, condition and location of trailers used as sanitary conveniences. The Agreement also detailed arrangements which were to be made to ensure that regular emptying and cleansing of closets could be carried out by the Borough Engineer and Surveyor's Department. Fairs were held on Ealing Common, in Acton Park, and at Northolt, and frequent inspections showed compliance with the conditions imposed. Food stalls were numerous on the sites and the standard of hygiene was found to be reasonable. DISINFECTION AND DISINFESTATION The amount of work connected with disinfestation for the eradication of bed bugs continues to decline and heavy infestations are now rarely found. Disinfestation measures were taken in 89 houses, following complaints of bed bugs and other insects. 78 Nearly 400 items were disinfected by formalin spray, and these were mainly articles of clothing despatched to various European countries by relatives and friends. Import of such clothing to certain countries is only permitted on production of a certificate of disinfection. Routine terminal disinfection of 133 houses, after cases of illness, was carried out, mainly as a result of special requests from the occupiers. Articles disinfected by steam are dealt with at the Cleansing Station at Scott's Road, W.12., by arrangement with the London Borough of Hammersmith; but it was only necessary to use these facilities on one occasion during the year. PREVENTION OF DAMAGE BY PESTS ACT, 1949 The following is a summary of the work carried out by the rodent operatives:- Complaints received 1,562 Premises inspected 1,949 Premises found to be infested with: 1) Rats 847 2) Mice 452 Re-visits to infested premises 4,978 Fees received for treatment £1,904 RODENT CONTROL IN SEWERS During the year, approximately 2,000 sewer manholes were baited with fluoracetamide for controlling rats in the sewers in accordance with the recommendations of the Ministry of Agriculture, Fisheries and Food. The initial treatment of the Borough has almost been completed and the information gained over the last two years, together with improved methods of recording infestations and increased transport facilities, will enable the operatives to deal more effectively with both sewer and surface infestations. BYELAWS RELATING TO HAIRDRESSERS On 1st September, new byelaws as to hairdressers and barbers, made under Section 77 of the Public Health Act, 1961, came into force in the Borough. Copies of the byelaws were sent to approximately 250 hairdressers and barbers and, by the end of the year, 69 premises had been inspected. These inspections were normally combined with inspection under the Offices, Shops and Railway Premises Act, 1963. At all the premises inspected, any defects found were dealt with either under the Act or the byelaws. 79 25. WATER SUPPLIES, SWIMMING BATHS AND SEWAGE DISPOSAL WATER SUPPLIES Four water undertakings supply the Borough with mains water. 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 Surburban Water Company supplies the whole of Dormers Wells and Northcote Wards, the remainder of Waxlow Manor Ward and part of Glebe Ward. The Metropolitan Water Board supplies all other areas of the Borough not already mentioned. These public supplies have been satisfactory in quality and quantity and are not subject to plumbo-solvent action. Water from public mains was supplied to 89,524 dwellings with a mid-1966 estimated population of 303,940. Private supplies are derived from welIs at 11 factories in the Borough. In these factories water is obtained from deep borings ranging in depth from 300 to 600 feet. Of 32 samples of water from these wells submitted for bacteriological and chemical examination during the year, two were found to be unsatisfactory. After thorough cleansing and sterilization of supply pipes repeat samples proved to be satisfactory. As a result of complaints, nine samples of tap water from public supplies were taken, three of which proved to be unsatisfactory. In these cases, storage tanks had become contaminated. After the tanks had been thoroughly cleaned and properly covered, satisfactory repeat samples were obtained. Water Samples, 1966. Samples Satisfactory Doubtful Unsatisfactory Well supplies 32 30 - 2 Public supplies 9 6 - 3 Totals 41 36 - 5 FLUORIDATION OF WATER SUPPLIES In the latter part of 1965 the Council considered the advice given in Ministry of Health Circular 15/65 on the subject of fluoridation and passed a resolution in which it approved the addition of fluoride to the public water supplies in the Borough. Water undertakers serving the Borough were notified of the Council's decision,and, in accordance with the Minister's approval under Section 28 of the National Health Service Act, 1946, were asked to make the necessary arrangements. In an area such as Greater London with its 33 local health authorities and with public water supplies provided by eight separate water undertakings, agreement on fluoridation by all parties concerned has proved difficult. The problem was considered by the London Boroughs Committee in May 1966, when it was reported that an approach had been made to the Minister of Health with a view to the introduction 80 of legislation enabl ing fluoridation of water supplies to be directed nationally. The Council supported the views of the London Boroughs Committee. The Minister, however, remained of the opinion that every possible step should be taken to secure fluoridation by the use of existing powers and that the taking of further powers at present would be premature. Attempts are still being made to secure agreement amongst all local authorities in the area. SWIMMING BATHS The Council has four indoor public swimming pools at Ealing, two indoor pools at Acton and an outdoor pool and paddling pool at Southall. At four of the Council's schools there are swimming pools and there is also a pool at one direct grant school. A local industrial firm operates an outdoor swimming pool at its sports ground at Greenford and a private swimming pool is provided for the residents of a privately owned housing estate. The Department took samples of water from each pool at regular intervals throughout the year and these were submitted for bacteriological examination. A total of 415 samples was taken of which only eight were unsatisfactory. In the latter cases repeat samples were found to be acceptable and advice was given where necessary. The results are given below:- No. of Pools Satisfactory samples Unsatisfactory samples Total samples Public baths 8 289 - 289 School baths 5 94 5 99 Private baths 2 24 3 27 Totals 15 407 8 415 The Council's analyst also carried out detailed chemical and bacteriological examination of swimming bath water at intervals with the following results:- No. of Pools Satisfactory samples Unsatisfactory samples Total samples Public baths 8 67 1 68 School baths 5 15 2 17 Private baths 1 4 1 5 Totals 14 86 4 90 81 The unsatisfactory sample from the public bath was obtained at a time when the plant was undergoing repair. The unsatisfactory results from the schools were due to the presence of B coli Type II, and the dichloramines, permanganate value and albuminoid nitrogen being too high. The reason for the unsatisfactory result from the private bath was that the pH value was too low. When these results were notified to the appropriate authorities, the necessary action was taken so as to ensure that satisfactory samples were obtained. DRAINAGE AND SEWERAGE The Greater London Council is responsible for the treatment of soil sewage at its Disposal Works at Mogden and Barking. The surface water drainage, where it is not combined with soil drainage, is discharged to water courses or the River Brent. 30 premises, not connected to the main sewers, are drained to cesspools or septic tank installations and four premises have pail closets. 82 26. MEAT INSPECTION AND ANIMAL PROTECTION MEAT INSPECTION REGULATIONS The large factory slaughterhouse at Acton is engaged in the slaughtering and processing of pigs by a moving line system dealing with approximately 327 carcases an hour. The Council maintains a staff of authorised meat inspectors and assistants to carry out the provisions of the Meat Inspection Regulations, 1963, as amended by the Meat Inspection (Amendment) Regulations, 1966. These amending Regulations came into operation in September and provide further measures necessary to bring about full inspection of all home-killed meat before it leaves the slaughterhouse. They empower local authorities to fix the times at which slaughtering may take place in any private slaughterhouse; prohibit the removal of meat from a slaughterhouse until it has been inspected and stamped and make certain changes in the inspection procedure in the principal Regulations. With the change in the detailed inspection of pigs as required by these Regulations, it was found necessary to increase the inspection team to 10. The work still remained exacting and tiring but, with 12 authorised meat inspectors, it was possible to commence a system of rest days in October when summer leave had finished. This resulted in a reduction in the amount of overtime worked and an appreciation of this facility by the staff concerned. The Slaughterhouse (Hygiene) (Amendment) Regulations, 1966, were made in October and will come into operation in February, 1967. They prohibit the retention in a slaughterhouse of any carcase of an animal slaughtered elsewhere unless special conditions are complied with; limit, except where an authorised officer gives his consent, and subject to certain conditions, to 72 hours the period which any animal intended for slaughter may be kept in a slaughterhouse; impose an obligation on an occupier of a slaughterhouse to keep the lairage clean; and prohibit the use of wiping cloths in dressing of carcases but until 1st November, 1968 a wiping cloth may be used on any carcase or offal, if it is sterilised before use, and used on only one carcase and its associated offal before resterilisation. Tables 15 and 16 give details of meat inspection carried out during the year. POULTRY INSPECTION There are no poultry processing and packing premises in the Borough. DISEASES OF ANIMALS ACT, 1950 The Borough remained free of notifiable diseases throughout the year. No prosecutions or official cautions under the Act were made. In August and September foot and mouth disease occurred in Northumberland, whilst an isolated outbreak was notified in West Sussex. In neither instance was the Borough involved in any licensing procedure. Mr. J. A. Morris, M.R.C.V.S., continued in his duties under the Act at Southall Market, and authorised 52 market sales under the Regul ation of the Movement of Swine Order, 1959, and issued 574 movement licences authorising 12,548 pigs to be moved out of the market. Of 22 vehicles inspected, no contraventions were found. 83 DISEASES OF ANIMALS (WASTE FOODS) ORDER, 1957 Five plants are still in operation and are working satisfactorily. SLAUGHTER OF ANIMALS ACT, 1958 Four new applications for licences were received and approved whilst 13 applications for renewal of existing licences were received and granted. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 Four applications for the renewal of licences were received and granted. The premises concerned were inspected on five occasions during the year. PET ANIMALS ACT, 1951 Licences in respect of 20 premises were renewed and one new application for a licence was received and granted. The number of routine visits made was 37. RIDING ESTABLISHMENTS ACT, 1964 A licence in respect of one establishment was renewed and one new application was received and a licence granted after reports from the Council's veterinary adviser. Routine visits were made on 16 occasions. 84 27. HOUSING The principal housing work of the department is concerned with unfit houses and houses in multiple occupation. UNFIT HOUSES a) Clearance Areas The following progress was made during the year in connection with the Council's programme for 1965 - 1970 which has been submitted to the Minister Qf Housing and Local Government:- 1 - 9 (consecutive) Vine Cottages, Demolition completed Lower Boston Road, W.7 1 - 23 (consecutive) Adelaide Cottages, W.7 Demolition completed 18 - 26 (evens) Church Road, W.7 Remaining two families to be rehoused early 1967. 1 - 6 (consecutive) Williams Passage; Compulsory Purchase Order made. 1 / 26 (consecutive) Green Man Lane, Confirmed after public inquiry, and 1,3,5 & 7 St. John's Road, W.13 Some families rehoused. 1-14 Buckingham Terrace and Compulsory Purchase Order made. 1,2 and 3 Clearview Cottages, Public inquiry held. Southall. 89 - 99 (odds) High Street, Clearance Order made. & 1,2,3,8c 4 Park View Road, Southall Public inquiry held. b) Individual Unfit Houses and Parts of Houses 139B The Grove, W.5 Closing Order made, and premises vacated. 92 and 94 Boston Road, W.7 Demolition Orders made, and some tenants rehoused. 3 and 5 Norwood Road, Southall. Demolition Orders made. 15, 17, 27,and 29 Norwood Road, Remaining occupants rehoused Southall. following Demolition Orders made in 1964 and premises demolished. 8 Green Man Lane, W.13 Premises vacated following Closing Order made in 1965. 145/147 Boston Road, W. 7 Demolished following Closing Order made in 1934, in respect of No. 145. 85 c) Underground Rooms New regulations for the London Borough, made in 1965, were confirmed by the Minister of Housing and Local Government in 1966. The following action was taken during the year in respect of underground rooms at the premises listed:- 83 Church Road, W.3 (Basement) Closing Order made and tenant rehoused. Premises later made fit and Order determined except in respect of one room approved for storage. 11a Hardwicke Road, W.4 Closing Order made and tenant (Basement) rehoused. 55 Mount Avenue, W.5. Premises made fit and Closing Order (Basement) made in 1956 fully determined. HOUSES IN MULTIPLE OCCUPATION The powers available to the Council for use i n connection with houses in multiple occupation are as follows:- 1) Housing Act, 1957, Section 90, Abatement of Overcrowding. This empowers the Council to prosecute when the 'permitted number' for a house or part of a house in multiple occupation is exceeded. The legal standari is laid down in Section 77, and in the 6th Schedule of the Act, and it is related to the number of available living rooms and bedrooms, and their respective floor areas. The number of persons permitted is calculated in terms of equivalent adults, children under one year being disregarded, and children between 1 and 10 years counted as half an equivalent adult. 2) Housing Act, 1961, Section 19 - Directions. Under this Section the Council may give a Direction limiting the number of individuals, who in the Council's opinion should occupy a house in multiple occupation. A Direction does not require the surplus occupants to leave immediately but it is an offence to allow further individuals to take up residence, or to replace any who leave, until the number has been reduced to below that fixed by the Direction. 3) Housing Act, 1961, Sections 15 and 16 (Improvement to Amenities and means of escape from fire) Under Section 15 certain additional facilities may be required to be provided in houses in multiple occupation according to the Council's standards. The improved amenities include ventilation, water supply, sanitary conveniences, and facilities for storage of food. Under Section 16 improvements of means of escape from fire can be required, the code of practice followed being that laid down by the Greater London Council. 4) Housing Acts, 1961 and 1964, Registration Schemes Local Authorities may submit schemes for the registration of houses in multiple occupation for the approval of the Ministry of Housing and Local Government. 86 5) Housing Act, 1961, Section 12 Contains the power to make an Order applying a Code of Management of any house in multiple occupation. 6) Housing Act, 1964 - Control Orders This empowers the Council, short of becoming the actual owners, completely to control the house. There are in general, two types of houses in the Borough in multiple occupation: 1) Large several storied Victorian houses, often standing in their own grounds. Such properties are capable of providing satisfactory accommodation for several families providing the necessary adaptation is carried out. The Council in these circumstances therefore use the legislation that requires such increased amenities to be provided, i.e. Section 15. 2) Small terraced or semi-detached houses, built usually after the turn of the century. These commonly have two rooms and a kitchen on the ground floor, and three bedrooms and sometimes a bathroom on the first floor. Many of these have one W.C. only on the ground floor, but some do have an additional W.C. on the first floor level. No amount of increased amenities can make such property satisfactory for multiple occupation, and it is therefore not the Council's policy to require the provision of improvements. To do so would be, in effect, to sanction unsatisfactory multiple occupation. In this type of property, therefore, the Council's policy is to make Directions under Section 19, with the object of reducing the number of occupants. In addition on any type of property the Council uses Section 90 of the Housing Act, 1957 (Abatement of Overcrowding) and Section 16 of the Housing Act, 1961, (Improvement of means of escape from fire). The Council has not made any Control or Management Orders, the procedure laid down being extremely involved. There is, however, one Management Order which was made by the former Municipal Borough of Ealing which is still in force. Nor has the Council submitted a scheme for registration of houses in multiple occupation. It has felt that whereas licensing prior to use might be of value, powers which merely provided for registration once such misuse had begun, would not be helpful in dealing with the problem. General Legal position The existing powers for dealing with houses in multiple occupation are unsatisfactory and inadequate in certain respects, the main deficiencies being as follows:- 1) The fines imposed by the local Magistrates Court when cases for contraventions of Directions are heard are normally small and it is suspected that they are regarded by some owners as being part of their overhead expenses in letting their houses to an excessive number of individuals. Once the Council has prosecuted for a contravention no further action can be taken so long as the same individuals remain the house. If there were to be a daily penalty for a continuing offence this would act as a strong deterrent and 87 would eventually result in a considerable thinning down of the number of individuals living in the area. 2) A house in multiple occupation is one which is occupied by members of more than one family or which is let in lodgings. There is however, a lack of precise definition in the Housing Acts of the term 'family'. This has always caused difficulty which has been accentuated by a recent interpretation by the Court of Appeal in the case of the Royal Borough of Kensington and Chealsea v. Holm. Until a more positive definition of 'family' can be established the Council will continue to have difficulty especially in houses occupied by Asian immigrants. It is is found that there is an almost indefinite degree of inter-relation between individual families in a house owing to the customs of the communities from which they come and the fact that they frequently originate from the same villages. 3) Any scheme of registration similar to that envisaged by the Housing Acts 1961 and 1964, or to the scheme operating in Birmingham under the Birmingham Corporation Act, 1966, would not help to solve the housing problem in Southall. The normal exemption of a house with up to two families or up to four lodgers would certainly take many of the houses in Southall out of such a scheme completely. All these deficiencies have been considered frequently by the Environmental Health Committee and the Council, and representations have been made from time to time to the Minister of Housing and Local Government. At the end of the year an interview with the Ministry of Housing and Local Government was being sought with a view to obtaining more extensive powers to deal with houses in multiple occupation. Details of action taken to enforce the provisions of the Housing Acts relating to houses in multiple occupation are given i n the following tables: 88 Houses in multiple occupation - action taken Totals for years 1963-1965 1966 Totals Acton Ealing Southall Acton Ealing SouthaII Directions given (Section 19 Housing Act 1961) 1 3 835 7 32 149 1,027 Prosecution for contravention of Directions - - 7 - - 66 73 Notices to improve facilities and means of escape from fire (Sections 15 and 16 Housing Act, 1961) 24 22 58 50 - 154 Overcrowding notices (Section 90 Housing Act 1957) 1 - 20 1 1 6 29 Prosecution for contravention of overcrowding notices - - 93 - . 2 95 Notices requiring information as to occupants (Section 19 Housing Act 1961) . 2 947 - 3 383 1,335 Prosecution for failure to supply information - - 7 - _ 1 8 Prosecutions for false information - - - . . 1 1 Control Orders made (Housing Act 1964) - - - - _ _ . Management Orders made (Section 12 Housing Act 1961) - 1 - - - - 1 Total visits and inspections of houses in multiple occupation during 1966 2,857 Overcrowding - Section 90 of the Housing Act, 1957 Number of dwellings overcrowded at end of year 20 Number of families occupying these houses 58 Number of individuals living in these houses 229 Number of new cases overcrowding reported during the year 8 Overcrowding relieved during the year (a) Number of cases 20 (b) Number of individuals involved 102 89 Of the 66 prosecutions for contraventions of the terms of direction given under Section 19 of the Housing Act, 1961, 63 were successful. Fines amounting to £587. 7. Od. were imposed in these 63 cases, and a total of £169. 1. Od. costs awarded to the Council. The fines ranged from £5 to £25, and the costs from £2. 2. 0. to £5. 5. 0. In two cases of failure to abate overcrowding following the service of notices under Section 90 of the Housing Act, 1957, the magistrates imposed total fines of £35. O.Od. with £4.4.0d. costs to the Council. For failure to give information contrary to Section 170 of the Housing Act, 1957 in one case, and for giving false information in another case, there were fines of £3. O.Od. and £10. O.Od. respectively with costs to the Council of £1.1.Od. and £2. 2.0d. 90 28 CLEAN AIR The Council's policy of establishing Smoke Control areas to cover the whole Borough by 1972 was continued and during the year four further Orders were made. These related to Areas Nos. 26, 27, 28 and 29 covering 825 acres and including 4,970 dwellings and 145 other buildings. Of these Orders Nos. 26 and 27 were confirmed by the Minister of Housing and Local Government and come into operation on 1st June and 1st July, 1967, respectively. Orders Nos. 28 and 29 were submitted to the Minister and were awaiting confirmation at the end of the year. Order Nos. 21, 22, 23 24 and 25 made in 1965 became operative during 1966. Surveys of Areas Nos. 30 and 31 were aImost complete at the end of the year and pretiminary work on Areas Nos. 32 and 33 had been commenced. Figures which indicate progress made in this Borough compared with Greater London and the total 'black areas' of the whole country are given in the following table: 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' 517,740 24.13 2,926,810 35.66 Greater London 173,240 52.97 1,537,980 58.03 London Borough of Ealing. 8,349 60.92 59,173 58.89 The following table and map give details of progress made in Ealing up to 31st December, 1966: 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 42 7524 44,451 6,921 2,686 54,058 Confirmed but not yet in operation 2 537 1,500 679 24 2,203 Awaiting confirmation 2 288 2,529 262 121 2,912 Totals 46 8349 48,480 7,862 2,831 59,173 91 London Borough of Ealing - Smoke Control Areas (coloured yellow on map) Smoke Control Orders Year of operation Acton Nos. 1 - 9 Ealing Nos. 1-17 Southall Nos. 1 - 5 1960 - 1964 Acton Nos. 10 & 11 Ealing Nos. 18, 19 & 20 Southall No. 6 1965 Ealing Nos. 21, 22, 23, 24 & 25 1966 Ealing Nos. 26 & 27 Made and confirmed in 1966 but not coming into operation until 1st June and 1st July, 1967, respectively. Ealing Nos. 28 & 29 Made in 1966, but awaiting confirmation by the Minister of Housing and Local Government. Ealing Nos. 30 & 31 Surveys almost complete. Ealing Nos. 32 & 33 Surveys in progress. Smoke Control Areas in adjoining districts. Areas where Smoke Control Orders are in operation are shown in red on the map, and areas where Orders are proposed for future years are shown in green. London Boroughs. A. Harrow. B. Brent. C. Hammersmith. D. Hounslow. E. Hillingdon. 92 Yellow - Smoke Control Areas in the London Borough of Ealing. Red - Smoke Centre Areas in adjoining districts. Green - Proposed Smoke Control Areas in adjoining distncii. PUBLICITY FOR CLEAN AIR PROGRAMME The delivery of circular letters advising householders of the effect of newly confirmed Smoke Control Orders continued and preliminary surveys of proposed smoke control areas were carried out. The arrangement with the Solid Smokeless Fuels Federation for a series of visits each year also continued during 1966 and an exhibition van spent four separate periods of six days in the Borough visiting areas where Smoke Control Orders were proposed. Advance publicity of these visits was arranged by circular letter in the usual way. In general, householders have much information available to them and few difficulties arise on this account. GRANT ARRANGEMENTS A further circular (No. 25/66) revising the Minister of Housing and Local Government's scale of appliance cost limits was issued on 3rd June, 1966. The Council adopted the new limits. A letter was received from the Minister during July advising that, on account of the continued run down in gas coke supplies, local authorities in the Greater London Area should no longer assume that smokeless fuel supplies for open fires could be met wholly by gas coke. The Minister advised that grant could be paid in future Smoke Control Areas for the replacement of improved open fires by appliances capable of burning hard coke or by other approved appliances burning gas, electricity or oil. Satisfactory replies from fuel producers having been received for all Smoke Control Areas up to and including No. 29 the Council decided to implement the new arrangement in respect of Order No. 30 onwards. SUPPLIES OF FUELS IN SMOKE CONTROL AREAS No local fuel supply difficulties were encountered although some particular fuels need to be ordered well in advance of requirement to ensure availability. NEW FURNACES Notifications of the installation of new boilers in domestic, commercial and industrial premises totalled 119 during 1966. The oil-fired glass melting furnace installed last year and referred to in the 1965 report proved successful and the company concerned will allow its registration under the Alkali etc., Works Order, 1966, to lapse as it will no longer be manufacturing or using producer gas. Smoke emission will thus be much reduced. PRIOR APPROVAL No formal applications were received but consultation continued on all applications of which the Department became aware and modifications were frequently agreed before work commenced. 93 HEIGHTS OF CHIMNEYS Applications under the Building Regulations, 1965, in respect of new chimneys totalled 84, a considerable increase over last year's total of 19. This increase was partly accounted for by the greater emphasis given to chimneys and flues in the Building Regulations by comparison with the former Building Byelaws. New oil-fired warm air heaters for factories, warehouses and garages are proving popular and also contributed to the increase. The full fume arrestment plant for the British Bath Works, Greenford, was commissioned late in the year after some delays due to late delivery of equipment and unforeseen difficulties in supporting the new equipment on the existing cupolas. Regular use of the new plant had not commenced by the end of the year but the commissioning trials suggested that a considerable improvement will be achieved which will be most welcome in the neighbourhood surrounding the works. MEASUREMENT OF AIR POLLUTION The six daily volumetric instruments for measuring smoke and sulphur dioxide in the air and the six deposit gauges (including one operated by the North Thames Gas Board) for monitoring local emissions were maintained in operation during the year. The complete results for the year are given in Tables 11, 12 and 13. The overall figures for the daily volumetric instruments show average reductions, compared with 1965, of 25% in the amount of smoke and 12% in the amount of sulphur dioxide in the air. The reduction in the amount of smoke is not quite so great as that noted between 1964 and 1965, but the reduction in sulphur dioxide is three times greater than that observed between those two years. The deposit gauge figures, which are subject to irregular fluctuations due to varying weather conditions, show an overall rise in deposit of 16%. The trend lines, obtained from using five year moving averages, show slight rises for the stations at Bashley Road, Acton, Birkbeck Avenue, Greenford, and Longfield Depot and decreases at the other stations. The dieselisation of the Western Region engines would appear to have had a marked effect on the gauge at Park Avenue, Southall, as this gauge has given successively lower deposits over the past five years. CONTRAVENTIONS OF SMOKE CONTROL ORDERS No formal action was necessary during 1966 to enforce Smoke Control Orders. Advice was given in several cases where minor contraventions were observed. DARK SMOKE FROM INDUSTRIAL PREMISES Waste burning in the open remained the usual cause of complaint i n this case but no formal action was required. SMOKE FROM INDUSTRIAL CHIMNEYS There were 47 complaints of smoke from industrial chimneys and 422 observations were made by the inspectors during 1966. Smoke emission from oil-fired plant is commonly quickly overcome by adjustment of controls but incinerators burning variable materials and often with unskilled attendants are a more difficult problem. Even a costly incinerator with adequate draught control and an afterburner has been found to emit smoke if the combustion chamber is over-loaded. 94 Co-operation with the Council's Consultants and with the National Industrial Fuel Efficiency Service continued and was most helpful i n difficult cases. CLEAN AIR INFORMATION SERVICE This service continued to be a valuable source of technical information and advice. The Principal of the College of Fuel Technology which provides the service is available in a consultative capacity at short notice which is of great help if an unusual process is under discussion. 95 29. FOOD HYGIENE AND FOOD AND DRUGS ADMINISTRATION CLEAN FOOD SCHEME The Council's Clean Food campaign was continued during the year, 14 lectures being given to a total of 85 food handlers, and certificates of attendance awarded to those who completed the courses. In addition, two lectures were given by public health inspectors to 80 members of women's organisations, and 10 to approximately 400 children approaching school leaving age in secondary schools. 56 Food Hygiene Certificates awarded to school meals canteens and other food premises were renewed for a further year. Four further copies of the Council's Clean Food film strip were sold to other local authorities. INSPECTION OF FOOD PREMISES A total of 4,011 visits was made to the 2,282 premises in the Borough and 2,077 improvements were effected as a result of these visits. It was not found necessary to take any legal proceedings under the Food Hygiene (General) Regulation 1960, in respect of these visits as the traders concerned all responded to informal notification of the works required. Table 14 gives details of food premises in the Borough. MILK AND DAIRIES (GENERAL) REGULATIONS) 1959 During the year, 15 persons were registered as distributors of milk in accordance with the provisions of Regulation 8. There remained on the register at the end of the year one dairy and 159 distributors of milk in respect of 228 separate premises. One pasteurising and bottling plant ceased operation. The one dairy still operating in the Borough has up-to-date bottle washing equipment, and 38 samples of washed bottles taken at random from the bottling plant immediately before the filling machine were found on bacteriological examination to be satisfactory. In spite of all the precautions taken by dairy firms 16 complaints were received from members of the public concerning the sale of milk in dirty bottles or in bottles containing foreign bodies. There were nine prosecutions during 1966 for such offences. One case was dismissed but in the remaining cases the magistrates convicted and imposed fines and awarded costs to the Council. It is unfortunate that milk bottles are frequently misused by the public so that adequate cleansing is made difficult and often impossible by the normal bottle washing system. THE MILK (SPECIAL DESIGNATION) REGULATIONS, 1963 and 1965 During the year, 15 new Dealer's (pre-packed Milk) Licences were issued, and on 31st December, 1966, 158 distributors and one pasteuriser, involving 224 premises, were on the licence register. Informal samples of miIk taken for chemical analysis, to ensure that the samples were genuine and reached the required standards for fat and milk solids other than fat, were also examined by the tests prescribed for designated milks. All samples examined were found to satisfy these tests, as shown in the following table:- 96 Food & Drugs Act, 1955 - inspection of milk bottling plant Class of Milk No.of samples Phosphatase test Methylene Blue test Turbidity Test Colony Count test Passed Failed Passed Failed Passed Failed Passed Failed Pasteurised 50 50 — 50 — — — — — Steril ised 12 — — — — 12 — — — Untreated 11 — — 11 — — — — — Ultra Heat Treated 3 — — — — — — 3 — Totals 76 50 — 61 — 12 — 3 — RAW MILK SUPPLIES- BRUCELLA ABORTUS The only farm engaged in milk production in the Borough lies on the boundary adjoining the London Borough of Hillingdon. The sampling of raw milk for examination and for the detection amongst other things of brucella abortus organisms was carried out by officers of that Borough. This is a convenient arrangement for both authorities, since all milk produced at the farm was sent for treatment at a milk processing plant in Hillingdon. ICE CREAM During the year, 14 premises were added to the register for the sale and storage of ice cream, leaving a total at the end of the year of 524 premises registered for sale and storage and five premises for manufacture. Throughout the year, routine inspections at regular intervals were made to manufacturers' premises to ensure compliance with the requirements of the Food Hygiene and Ice Cream (Heat Treatment) Regulations. Systematic sampling of ice cream and ice lollies was carried out, details of which are as follows: 97 Commodity No.of Samples Methylene Blue Grade Not graded Grades I & II Satisfactory Grade III doubtful Grade IV unsatisfactory I II III IV Ice cream (local manufacturers) 249 203 19 15 12 — 222 15 12 Ice cream (other manufacturers) 41 14 3 7 17 — 17 7 17 Ice lollies (local manufacturers) 42 — — — — 42 42 — — Ice lollies (other manufacturers) 10 — — — — 10 10 — — Totals 342 217 22 22 29 52 291 22 29 The table above includes: Ice cream samples from vans. 7 6 — 1 — — 6 1 — Soft ice cream samples. 34 6 4 7 17 — 10 7 17 Most of the unsatisfactory samples were from soft ice cream dispensing machines. These machines require very careful cleaning and sterilizing at the end of each day, but the need for this was not always appreciated by the operatives. Visits by inspectors were made in order to improve the standard and this resulted in more satisfactory samples being obtained. IMITATION CREAM There are two manufacturers of this product in the Borough. Imitation cream is used largely by the confectionery trade and is produced by an emulsion of edible oils or fats with water, and the mixture is then pasteurised. The bacteriological examination of 77 samples was made and all were found to be satisfactory. The two producers concerned continued to maintain a high standard of hygiene and quality control. LIQUID EGG (PASTEURISATION) REGULATIONS, 1963 There are no pasteurising plants in the Borough and no samples of liquid egg were taken from any other premises. 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:- 98 Lbs. Meat and meat products 2,982 Fish and fish products 1,660 Flour and confectionery 363 Fruit and vegetables 1,027 Groceries 2,458 Foodstuffs not calculated by weight: Assorted tins, packets, jars, bottles, articles, casks and boxes 41,174 IMPORTED FOOD REGULATIONS - EXAMINATION OF TEA The examination and sampling of tea taken over from H.M. Customs and Excise in 1959 continued during 1966. Imports of teas from all parts of the world arrived at a large tea blending and packing factory in Greenford and came direct from the London docks without inspection on landing. This places on the Council the responsibility of ensuring that these teas are fit for human consumption in accordance with the provisions of the Food and Drugs Act, 1955, and the Public Health (Imported Food) Regulations, 1937. During the year, a total of 655 samples which were representative of all consignments received at the factory was taken. Experience over the last few years has shown that greater attention must be paid to teas from certain areas, and sampling is therefore selective. Of these 655 samples, 30 were found to be of doubtful quality after initial tests had been carried out locally and were referred to the Council's analyst for more detailed examination and report. The samples taken during the year were from a total stock of 54,210 cases received at the factory direct from the docks. REGISTRATION OF HAWKERS OF FOOD AND THEIR FOOD PREMISES In accordance with the requirements of Section II of the Middlesex County Council Act, 1950, seven hawkers were registered during the year leaving a total of such traders on the register at the end of the year at 48. Each of these traders was notified in writing of the principal provisions of the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966, due to come into operation on 1st January, 1967, and advised to contact the Health Department if there was any doubt as to their responsibility under these Regulations. PREMISES REGISTERED FOR PREPARATION OF SAUSAGES AND PRESERVED FOODS Five premises were registered in accordance with Section 16 of the Food and Drugs Act, 1955, during the year, at the end of which there were 181 premises on the Council's register. SAMPLING OF FOOD AND DRUGS - CHEMICAL ANALYSIS Food and Drugs samples are examined by the Council's Public Analyst, Mr. W.B. Chapman, B.Sc., F.R.I.C., and his Deputy, Mr. E.H.W.J. Burden, B.Sc., F.R.I.C. They are both officers of the Scientific Branch of the Greater London Council, and an annual block payment is made by the borough to cover these services. The analytical work is carried out in laboratories which are staffed and equipped to undertake a wide 99 variety of investigations. Apart from food and drugs these include water pollution and sewage treatment, sampling of water from swimming pools, air pollution, ventilation, noise and vibration, fire precautions, petroleum, fertilizers and feeding stuffs, radiochemistry and general supplies and services. Some years ago the Ministry of Health recommended that the level of food and drugs sampling should be approximately three samples per 1,000 population per annum. During the year, exactly 1,000 samples comprising 11 formal and 989 informal samples of food and drugs were taken and submitted to the Public Analyst for examination, and it will be noted that this is in accordance with the Ministry recommendation. Of the 1,000 samples examined, 65 were found to be unsatisfactory. Cases worthy of mention where compositional standards were not satisfied included a marmalade prepared according to a special formula which failed to meet the minimum requirements for sugar; formalin and mint tablets affected by long storage; canned fish containing prohibited preservatives; vitamin tablets which failed to satisfy fully the B.P. requirements in respect of disintegration; and meat pies, sausages and hamburgers all with low meat 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. Manufacturers in other cases agreed to examine their methods in order to bring their products up to at least minimum requirements. LABELLING OF FOOD ORDER Samples of food and drugs subjected to chemical analysis were also scrutinised to determine whether or not they complied where necessary with the requirements of the Labelling of Food Order, 1953. Irregularities in labelling were discovered in 67 instances and in all cases the attention of manufacturers and packers or importers was drawn to the infringements. In the majority of cases arrangements were made to print new labels for stocks immediately or undertakings were accepted that new labels would be designed and used as soon as existing stocks became exhausted. A summary of the irregularities found is as follows:- Incorrect or inadequate description 6 No name and address 11 Incorrect or inadequate list of ingredients 10 No list of ingredients 19 Misleading statements 7 Use of generic terms 8 Inadequate size of printing 5 Unsatisfactory dosage directions 1 BACTERIOLOGICAL EXAMINATION OF OTHER FOODS A total of 320 samples of various types of food was submitted to the laboratory for bacteriological examination including 211 samples of frozen sea foods released from the port without examination and 48 cans of meat packed and processed at canneries in the district. Consumer complaints of articles of food, and specimens obtained in the investigation of suspect cases of food poisoning and other infections numbered 14 but no harmful organisms were found on examination. The seven unsatisfactory samples of sea foods led to re-processinq of the product before release. A summary of the results is given in the following table: 100 Food Satisfactory Unsatisfactory Total samples Sea foods 204 7 211 Fish 7 — 7 Canned meats 48 — 48 Raw meat 1 — 1 Milk powder 1 — 1 Other foods (including meal specimens) 15 — 15 Milk bottles 44 — 44 Totals 320 7 327 FOOD COMPLAINTS Food articles purchased by members of the public were the subject of 139 complaints received by the Health Department and all were thoroughly investigated. Twenty-two of the articles were submitted to the Public Analyst for his opinion. Complaints of particular interest included such articles as a biscuit containing a human hair 5½ inches long, yoghurt containing iron oxide, jars of cream containing glass, a currant bun with an imbedded bandage, a sponge cake containing a cigarette end and a cake fouled by bird droppings. Full or empty bottles of milk were found to contain mould, sand and cement, and traces of animal hairs. In all 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. There were a number of cases where bread was found to contain grease, mould, rubber, a nail and a cigarette end. Prosecutions were taken in 30 cases, of which 28 were successful, fines ranging from £20 to £3 being imposed, and totalling £269. 10s. Od. with £176. 10s. Od. costs to the Council. PESTICIDES SURVEY During the year, the Council agreed to participate in a systematic survey to detect traces of pesticides in common foods. A number of local authorities are taking part in the scheme, which has been prepared by the Association of Public Analysts in consultation with the Ministry of Agriculture, Fisheries and Food. The sale and use of pesticides in this country is controlled by a Government voluntary scheme but this, of course, only covers home produced food. The control of pesticides in countries from which food is imported varies considerably. This survey will make it possible for an assessment to be made of the present extent of pesticides on a variety of foods and could be of considerable assistance in deciding the need for any further action. The number and type of food samples to be taken by each food and drugs authority participating in the scheme was agreed in advance. In this Borough a total of six samples was purchased before the end of the year. The food articles concerned were specified types of tomatoes, apples, potatoes, currants, white bread and rice. All samples were examined for traces of D.D.T., other organo-chlorine and organo-phosphorus 101 compounds and also for metal. The only sample showing a significant amount of pesticide was the currants, with a D.D.T. content of one part per million. The analyst considered that this was not unduly high and did not represent a health hazard. 102 30. REGISTRATION OF PREMISES USED FOR MEDICAL PURPOSES Nursing Homes Nursing homes are required to be registered with the local authority under Section 190 of the Public Health Act, 1936, and at the end of the year, seven nursing homes were registered with a total of 262 beds. During the year, alterations were made to one of the homes so that two extra patients could be accommodated. Visits are regularly made to all nursing homes to ensure that they maintain satisfactory standards. Details of nursing homes registered by the Council are given below:- The Lady Margaret Nursing Home, 87 Mattock Lane, W.5 17 beds Male and female - Geriatric chronic sick and medical. Methuen Nursing Home, 17 beds 13 Gunnersbury Avenue, W.5 Female - chronic sick and medical Old Court Nursing Home, 19 Montpelier Road, W.5 14 beds Male and female - medical and surgical. St. Anthony's Nursing Home, 40 Mount Park Road, W.5 15 beds Male and female - chronic sick and medical St. David's Home, Castlebar Hill, W.5 59 beds Ex-servicemen - non-profit making, Roman Catholic, taking all denominations. Disabled. Servite House, Queen's Walk, W.5 42 beds Male and female - non-profit making, chronic sick and disabled. Twyford Abbey Nursing Home, Twyford Abbey Road, N.W. 10 98 beds Males - Non-profit making organisation. Roman Catholic, taking all denominations. Chronic sick and geriatric. Establishments for Massage and Special Treatment The Council requires all persons operating an establishment for massage or special treatment to be registered under Part XII of the Middlesex County Council Act, 1944. All establishments are inspected annually to ensure that they are satisfactory. Byelaws made under the Act state that the licensed person must exhibit a complete scale of all fees or charges, keep records of people employed at the establishment, and keep particulars of cases treated. There is a total of 31 establishments used by licensed persons in the Borough as follows: 103 Chiropody only 13 Chiropody and special treatment 12 Massage only 1 Massage and special treatment 2 Physiotherapy only 2 Osteopathy 1 Boards were set up under the Professions Supplementary to Medicine Act, 1960, and registers were complied of those medical auxiliaries considered to be suitably qualified. People registered are entitled to use the designation 'state registered'. Inspection of Old People's Homes All old people's homes in the Borough must be registered with the Council. On behalf of the Chief Welfare Officer, these homes are now regularly inspected by a medical officer and a public health inspector. Their reports and recommendations are passed to the Chief Welfare Officer. 104 31. MORTUARY AND BURIAL ARRANGEMENTS Public Mortuary The public mortuary is situated in Petersfield Road, Acton, W.3, and has a capacity for 40 bodies. The Council is responsible for providing mortuary accommodation when death occurs in the Borough in certain circumstances. These are firstly, when death follows an accident, and secondly, when the cause of death is unknown and the Coroner decrees that a post mortem examination shall be carried out by a Home Office Pathologist. 616 bodies of residents from the following areas were taken to the mortuary. Ealing 534 Hillingdon 26 Hammersmith 7 Harrow 7 Hounslow 7 Brent 4 Richmond-upon-Thames 3 Others 28 Total 616 One full-time mortuary attendant is employed and arrangements are made with the London Borough of Hammersmith for bodies to be received there when he is absent for any reason. Burial or Cremation of the Dead - National Assistance Act, 1948, Section 50. Burials and cremations of the dead are arranged by the Council when relatives of a deceased person are unable to afford the cost of a burial, or when no relative can be found, and no previous provision has been made by the deceased. The Council is required to make these arrangements if the death takes place within the Borough, whether or not the home address is within that area. Application is made to the Ministry of Social Security and the appropriate death grant obtained, and any monies due from insurance policies on the life of the deceased are taken by the Council to offset the cost of the burial or cremation. Any balance remaining after meeting burial costs is passed to relatives if any are found. There were 14 such burials and two cremations carried out during the year. 105 32. MEDICAL EXAMINATION AND WELFARE OF STAFF The medical suite in the Town Hall Annexe now consists of three rooms, the plan to add one further room having been implemented during the year. It is now, therefore, possible to provide the full range of facilities which were intended, the suite being used for the following purposes:- 1. As a first aid and rest room. 2. For the vaccination and immunisation of staff. 3. For the medical examination of staff and candidates for employment. First aid and rest room The requirements of the Offices, Shops and Railway Premises Act, 1963 include the provision of first aid boxes in office premises, but exemption may be granted where a properly maintained first aid room is in operation. It was decided that a first aid room for use by members of the staff of all departments in the Town Hall would be the most satisfactory arrangement. Equipment is such as to satisfy the requirements of the Act and a state registered nurse is available at all times. When required, a medical officer of the department is available to see casualties. During the year, a total of 672 attendances for treatment was made at the medical suite. Cases included minor injuries incurred at work such as sprains, cuts and splinters in the hand, and illness varying in degree from headaches and colds to a sudden heart attack. It is not intended, nor is it possible, with the limited facilities available, to carry out more than first aid, those patients appearing likely to require treatment or continued supervision are referred to their own general practitioners. Vaccination and Immunisation of Staff Vaccination against smallpox and immunisation against typhoid fever and tetanus are offered to members of the health department staff who are at risk. The number of vaccinations and immunisations carried out during 1966 is as follows:- 1. Vaccination against smallpox 157 2. Immunisation against typhoid fever 5 3. Immunisation against typhoid/tetanus 42 4. Immunisation against tetanus 11 Total 215 Medical Examination of staff Prior to their appointment, all staff complete a medical questionnaire. From the information given by the candidate, it is decided whether or not a medical examination is required in order to determine his fitness to carry out the duties of the appointment. A medical examination is always necessary for candidates taking certain appointments; these include residential staff in children's homes and staff at special risk. 106 such as those employed for driving motor vehicles and those whose duties involve working at heights. Employees with a history of illness who are candidates for admission to the manual workers Sickness Pay Scheme are also examined. It is Council policy that, as far as possible, complete exclusion from the scheme shall be avoided, and accordingly in the majority of cases, candidates are accepted subject to benefit not being payable for absence due to any specified disability from which they were suffering at the time of examination. As a requirement of the Department of Education and Science, all 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 college of education, attend for a medical examination. Certain candidates are required to attend for a chest x-ray unless they have written evidence of a satisfactory x-ray resul t during the twelve months preceding their appointment. Staff who come into this category are those whose work in schools or otherwise involve contact with groups of children, those who cook or serve food and those employed as home helps. At the request of the Chief Officer concerned, a medical examination is arranged for any staff about whom there is doubt as to their medical fitness to continue employment. 107 Questionnaire Assessments 1. Total number of questionnaires assessed for fitness for employment 3,042 2. Total number of medical examinations required following questionnaire assessment 174 3. Total number of failures as a result of medicals following questionnaire assessment 4 Staff requiring medicals as a routine 1. Total number of medical examinations for fitness for employment 688 a) Total number of officers and manual workers examined: Officers 54 Manual 162 b) Total number of teachers examined for Department of Education and Science 238 c) Total number of student teachers examined 234 2. Total number of these candidates found unfit: 1 Manual Workers Sick Pay Scheme 1. Total number of manual workers Sickness Pay Scheme questionnaire assessments 1,390 2. Total number of medical examinations for Sickness Pay Scheme following questionnaire 114 3. Total number of candidates failed 3 a) Following medical after questionnaire 2 b) Following routine medical 1 4. Total number of candidates with 'exclusions' 30 a) Following medical after questionnaire 23 b) Following routine medical 7 Examinations at the request of Chief Officers 1. Total number of employees examined for fitness to continue employment 14 2. Total number of employees found unfit for continued employment 13 33. MEDICAL ASPECTS OF COUNCIL HOUSING Many persons who have applied for Council housing or who wish for a transfer from one Council house to another require special consideration by reason of illness or disability suffered by a member of the family. Such consideration can only be given if a doctor's letter or certificate is furnished. These certificates are usually forwarded in the first place to the Housing Manager who then seeks advice from the health department on the medical implications, at the same time forwarding any relevant information that is to hand in his own department. A medical certificate alone does not always give sufficient information about a particular case and a visit to the family concerned may be required by a medical officer, health visitor, mental health social worker or public health inspector. Over 100 visits were made in this way by members of the staff during the year. In addition, such visits often bring to light circumstances which lead to the supply of other health department services or referral to another department of the Council in order to help the tenant apart from his housing need. After assessing the case, the medical officer may recommend the award of a limited number of points on medical grounds, which are added to the general points total of the applicant. In many cases this is sufficient to ensure that the applicant receives consideration within a short time. In cases where the general points total is too low for a medical points addition to make any difference and where, by reason of the medical circumstances, there is great hardship to the persons involved the application may be referred to the appropriate housing sub-committee for discussion and decision. The figures for the year are as follows: Number of housing applications 264 Number of cases reported to Committee 24 Number of re-housing applications 179 Other cases 30 Total number of cases 473 109 TABLE 1 ESTABLISHMENT OF THE HEALTH DEPARTMENT (as at 31st December, 1966) Number on Establishment Number on Strength MEDICAL STAFF Senior Principal Medical Officer 1 1 Principal Medical Officer 2 2 Assistant Principal Medical Officer 1 1 Medical Officer 12 6 Consultant Medical Officer of Health 1 1 ADMINISTRATIVE STAFF Chief Administrative Assistant 1 1 Deputy Chief Administrative Assistant 1 1 Senior Administrative Assistant 4 4 Administrative Assistants 15 15 Secretaries 2 2 Clerical Assistants 21 18 Clerks 49 47 Shorthand Typists 10 9 DENTAL STAFF Chief Dental Officer 1 1 Senior Dental Officer 1 1 Dental Officers 10 6 10/11 Orthodontists 2 1 3/11 Dental Auxiliary 1 1 Senior Dental Surgery Assistant 1 1 Dental Surgery Assistants 13 101/2 Orthodontic Dental Surgery Assistants 3 2½ PUBLIC HEALTH INSPECTORATE Chief Public Health Inspector 1 1 Deputy Chief Public Health Inspector 1 1 Divisional Public Health Inspectors 6 6 Supervisory Meat Inspectors 3 3 Public Health Inspectors 28 15 Authorised Meat Inspectors 12 11 Trainee Meat Inspectors 5 3 Trainee Public Health Inspectors 6 6 Technical Assistants 4 4 Assistant Rodent Officer 1 1 Rodent Operatives 4 4 Senior Meat Inspector's Assistant 1 1 Meat Inspector's Assistants 2 2 Senior Driver/Disinfector 1 1 D r i ver/D i s i nf ect ors 5 5 110 Number on Establishment r on Strength SOCIAL WORKERS Principal Mental Health Social Worker 1 1 Deputy Principal Mental Health Social Worker 1 1 Casework Supervisor 1 1 Mental Health Social Workers 9 5 Trainee Mental Health Social Workers 2 1 Medical Social Workers 3 1 HOME HELP STAFF home Help Organiser 1 1 Assistant Home Help Organisers 7 7 Home Helps (full-time equivalent) 260 218 HEALTH VISITORS AND CLINIC NURSES Chief Nursing Officer (Health Visiting) 1 1 Deputy Chief Nursing Officer (Health Visiting) 1 1 Senior Divisional Health Visitor 1 1 Divisional Health Visitors 4 2 Health Visitors 49 44 6/11 Clinic Nurses 12 * 16 8/11 Student Health Visitors 5 5 Geriatric Visitor 1 1 NURSING AND MIDWIFERY STAFF Chief Nursing Officer (Home Nursing and Midwifery) 1 1 Deputy Chief Nursing Officer (Home Nursing) 1 1 Deputy Chief Nursing Officer (Midwifery) 1 1 Home Nurses 45 44 Midwives 22 19 MEDICAL AUXILIARIES Audiometricians 3 3 Chiropodists 4 4 Orthoptist (part-time) 1 1 Physiotherapists 3 1 6/11 Senior Speech Therapist 1 1 Speech Therapists 3 3 DAY NURSERY STAFF Supervisory Matron 1 1 Matrons 5 5 Deputy Matrons 5 5 Wardens 5 1 Nursery Nurses 28 23 Nursery Students 8 8 Cooks 5 5 Domestic Assistants 9 9 111  Number on Establishment Number on Strength CLINIC STAFF Interpreters 2 1¼ Clinic Caretakers 4 4 Clinic Stoker/porter 1 1 Clinic Cleaners 12 12 CHEST CLINIC STAFF Chest Physician 1 1 Welfare Officer 1 1 Tubercglosis Health Visitors 5 4 Occupational Therapist (part-time) 1 1 MOTHER AND BABY HOME STAFF Medical Social Workers 3 1 Matron 1 1 Deputy Matron 1 1 Nurse 1 1 Attendants 4 4 Night Duty Attendant 1 1 Cook/Housemother 1 1 Assistant Cook 1 1 Handyman 1 1 ADULT TRAINING CENTRE STAFF Supervi sor/l nstructor 1 1 Instructors 4 4 Cook-in-Charge 1 1 Assistant Cook 1 1 Coach Guides 2 2 MORTUARY STAFF Mortuary Keeper 1 1 Mortuary Attendant 1 - * Includes 4 8/11 held against Health Visitor establishment. 112 TABLE 2 INFECTIOUS AND OTHER NOTIFIABLE DISEASES CLASSIFIED IN AGE GROUPS Scarlet Fever Whoopingcough Measles Dysentery Meningococcal infection M F M F M F M F M F Numbers originally notified 63 63 37 58 614 603 146 150 2 1 Final numbers after correction: Under 1 year - - 7 10 32 29 7 5 - _ 1 - 3 - 5 4 83 72 8 8 - _ 2 - - 1 3 8 97 93 11 7 1 - 3 - 3 5 7 7 83 77 6 4 - - 4 - 11 10 3 7 121 119 10 10 - _ 5 - 9 31 35 9 16 186 204 23 30 - - 10 - 14 6 4 2 5 5 5 11 9 1 _ 15 - 24 5 4 - 1 - 2 16 16 _ _ 25 and over 2 1 - - 2 1 50 59 - 1 Age unknown 2 3 1 - 2 1 2 2 - - Total 63 63 37 58 611 603 144 150 2 1 113  Pneumonia Acute encephalitis Paratyphoid fevers Erysipelas Food Poisoning Infective Post infectious M F M F M F M F M F M F Numbers originally notified 18 18 3 1 4 5 13 18 Final numbers after correction: Under 5 years 2 - - - - - - - - - - 1 5 - 14 4 4 2 - - - - - 1 - - - 15 - 44 5 5 1 - - - - - 1 2 1 1 45 - 64 4 7 - - - - - - 1 2 2 - 65 and over 2 2 - - - - - - 1 1 - - Age unknown 1 - - - - - - - - • • - Total 18 18 3 - - - - - 4 5 3 2  Tuberculosis Infectious Hepatitis Puerperal pyrexia Pulmonary Other M F M F M F F Numbers originally notified 91 43 12 20 40 18 38 Final numbers after correction: Under 5 years 2 4 - 1 2 1 - 5 - 14 2 2 - - 10 5 - 15 - 24 9 13 1 7 11 5 17 25 - 44 39 17 4 8 8 5 16 45 - 64 27 6 5 1 6 1 - 65 and over 9 1 - - 3 1 - Age unknown - - 2 3 - - 5 Total 88 43 12 20 40 18 38 There were no cases of anthrax, diphtheria, enteric or typhoid fever, malaria, ophthalmia neonatorum, poliomyelitis, smallpox, and tuberculosis of the meninges and central nervous system. TABLE 3 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. (S.C.) †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. A.N. Sp. Meds. whn. req. Dental Dental Orthod. †B.C.C. †Polio Dental Orthod. Sp. Thpy. Chir. (O.A.P.) Dental Sp. Thpy. Sp. Meds. whn. req. Dental A.N. IMM. Tuesday P.M. G.S.C. C.W. IMM. Vacc. Dental Mid. A.N. 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 flMM. Sp. Thpy. Dental Wednesday P.M. Dental Dental A.N. Chir. (O.A.P.) IMM. C.W. IMM. †Polio 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. Chir. (S.C.) G.S.C. IMM. Vacc. Dental Orthopt. Chir. (S.C.) †B.C.C. Dental Orthod. C.C. Dental Orthod. Dental Dental Orthod. Thursday P.M. Dental Sp. Thpy. 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. Chir. (O.A.P.) Friday A.M. Dental Sp. Thpy. Dental Chir. (O.A.P.) G.S.C. †P.N. Dental A.N. Ex. flMM. Orthod. 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 Dental C.W. (no Dr.) Orthod. *IMM. Chir. (O.A.P.) C.W. Dental Physio. †Chir. (O.A.P.) C.W. Sp. Thpy. C.W. Dental 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; B.C.C.—Birth control clinic; P.N.—Post-natal; C.C.—Cervical Cytology; Men. Hlth.—Mental Health; Home Num. injns.—Home Nursing injections; occ.—occasional; *—monthly; †—alternate weeks. 116 TABLE 3 CLINIC SESSIONS /Contd. 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. Chir. (S.C.) C.W. Physio. •Orthop. Dental Orthod. G.S.C. C.W. Sp. Thpy. C.W. Sp. Thpy. Physio. Dental C.W. (no Dr.) *Polio C.W. IMM. Vacc. Tuesday A.M. Sp. Thpy. Dental tPolio Dental A.N. Ex. Dental A.N. IMM. Vacc. Home Nurse. injns. Chir. (O.A.P.) (occ.) tOrthop. tOphthal. Dental Chir. (O.A.P.) Physio. Sp. Meds. whn. req. B.C.C. Tuesday P.M. Sp. Thpy. Dental Mid. A.N. Dental Physio. 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.) *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. Chir.(S.C.) 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 C.C. Physio. Dental A.N. C.C. 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. 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. tOphthal. †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.) 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; 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; †—alternate weeks. 117 VACCINATION AND IMMUNISATION OF PERSONS UNDER AGE 16 COMPLETED DURING THE YEAR Sub-Table 1 - Completed Primary Courses diphtheria, whooping-cough, tetanus and poliomyelitis Type of vaccine Administered in clinics Administered by general practitioners Totals Diphtheria/whooping-cough/ tetanus/pol iomyelitis - 112 112 Diphtheria/whooping-cough/ tetanus 3,217 1,389 4,606 Diphtheria/tetanus 312 16 328 Diphtheria 1 1 2 Whooping-cough — 2 2 Tetanus 399 32 431 Poliomyelitis - Salk — 142 142 Poliomyelitis - oral 3,585 1,362 4,947 Sub-Table 2 - Reinforcing doses Diphtheria/whooping-cough/ tetanus/pol iomyel itis - 40 40 Diphtheria/whooping-cough/ tetanus 2,450 898 3,348 Diphtheria/Tetanus 3,303 313 3,616 Diphtheria 110 8 118 Tetanus 483 30 513 Poliomyelitis - Salk — 306 306 Poliomyelitis - oral 2,085 846 2,931 Sub-Table 3 - Smallpox - vaccination and re-vaccination Vaccinated Re-vaccinated At clinics 3,090 15 By general practitioners 1,375 159 Totals 4,465 174 118 TABLE 5 CHIROPODY TREATMENT Treatment is given at the clinics shown in Table 3 and also at the following premises:- Surgeries: Private: used by the British Red Cross Society 120 Uxbridge Road, Hanwell, W.7 234 Northfield Avenue, Ealing, W.13 50 Minterne Avenue, Norwood Green. Private: used by the Southall Old Peoples 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, E.5 'Greenfield', 1 Courtfield Gardens, Ealing, W.13. Ealing Day Treatment Centre Green Lane, Hanwell, W.7 119 031 TABLE 6 MENTAL HEALTH - PATIENTS UNDER LOCAL AUTHORITY CARE AT 31ST DECEMBER 1966 Mentally ill Subnormal and severely subnormal Under age 16 Aged 16 and over Elderly Mentally infirm Total Under age 16 Aged 16 and over Total M F M F M F M F M F 1. Number of patients under care at 31st December, 1966 1 3 362 575 3 4 948 79 67 201 164 511 2. a) Attending day training centre Awaiting entry thereto _ _ 7 3 _ _ 10 56 42 58 51 207 - - - - - - - 19 16 2 5 42 b) Receiving home training Awaiting home training _ _ _ _ - - - _ - - - - - - - - - - - - - c) Resident in L.H.A. home/hostel _ 3 1 _ _ 4 2 2 4 Awaiting residence in L.H.A. home/ hostel - - - - - - - - - - - - Resident at L.H.A. expense in other homes/hostels - - 11 8 - - 19 1 3 1 6 11 Resident at L.H.A. expense by boarding out in private household - - - 1 - - 1 2 1 11 3 17 d) Receiving home visits and not included in (a) to (c) 1 3 341 562 3 4 914 4 9 132 103 248 3. Number of patients in L.H.A. area on waiting list for admission to hospital at 31.12.66 In urgent need of hospital care - - - - _ - _ 3 4 - 2 9 Not in urgent need of hospital care - - - - - - - 7 11 - 4 22 4. Number of admissions for temporary residential care (e.g. to relieve the family) during 1966 - To N.H.S. hospitals - - _ - 3 4 7 14 5 5 8 32 Elsewhere - - - - - - - - 1 1 - 2 It should be noted that it is possible for persons to be included in more than one of the categories listed under items 2 (a) to (d) IZl TABLE 7 MENTAL HEALTH - NUMBER OF PATIENTS REFERRED DURING YEAR ENDED 31ST DECEMBER, 1966 Referred by Mentally ill Subnormal and severely subnormal Under age 16 16 and over Total Under age 16 16 and over Total M F M F M F M F General practitioners - - 125 218 343 - - - - - Hospitals, on discharge from in-patient treatment - - 35 42 77 - - - 2 2 Hospitals, after or during outpatient or day treatment - 3 36 41 80 2 1 - - 3 Local education authorities - - 2 3 5 2 2 4 1 9 Police and courts - - 16 16 32 - - - - - Other sources - - 93 115 208 22 16 5 5 48 Total - 3 307 435 745 26 19 9 8 62 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 16 27 1 - ii) Factories not included in (i) in which section 7 is enforced by the local authority. 1,096 391 38 - iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises). 7 12 - Total 1,119 430 39 - 122 TABLE 9 FACTORIES ACT, 1961 - PART I Cases in which defects were found Particul ars No. of cases in which defects were found No. of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 5 6 - 2 - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation 3 2 - - - Ineffective drainage of floors 1 - - - - Sanitary conveniences: a) insufficient 11 5 - 7 - b) unsuitable or defective 18 6 - 2 - c) not separate for sexes 4 2 - * - Other offences against the Act (not including offences relating to outwork) 14 12 * - - Total 56 33 - 11 - 123 TABLE 10 FACTORIES ACT, 1961 - PART VIII (SECTIONS 133 and 134) Outwork Nature of work Section 133 No. of out-workers in August list required by section 133 (1) (c) Wearing apparel: Making, etc. 95 Artificial flowers 3 Carding, etc., of buttons, etc. 2 Cosaques, Christmas stockings, etc. 170 Lampshades 1 Brush making 1 Furniture and upholstery 2 Total 274 During the year, 61 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. 124 TABLE 11 AVERAGE MONTHLY SMOKE CONCENTRATIONS (microgrammes per cubic metre) Daily volumetric instruments 1966 Acton Lane Chase Road Eliots Green School Friars Place Lane Town Hall Annexe Walpole Grammar School January 101 60 78 187 178 - February 51 73 24 59 66 51 March 68 75 24 51 59 42 Winter average (Oct. 1965 March 1966) 85 73 54 97 103 57 April 78 74 57 71 43 May 28 55 15 27 32 27 June 22 42 - 19 29 33 July 17 36 12 18 19 11 August 33 35 - 26 30 - September 51 61 15 47 48 29 Summer average (April 1966 September 1966) 38 50 14 32 38 29 October 42 55 38 37 59 40 November 57 76 - 65 71 74 December 72 64 101 54 58 59 Average for year, 1966 52 59 38 54 60 41 year, 1965 71 74 58 67 73 59 125 TABLE 12 AVERAGE MONTHLY SULPHUR DIOXIDE CONCENTRATIONS (microgrammes per cubic metre) Daily volumetric instruments 1966 Acton Lane Chase Road Eliots Grn. School Friars Place Lane Town Hall Annexe Walpole Grammar School January 297 373 288 253 425 - February 193 251 168 200 266 192 March 193 269 233 180 267 178 Winter average (Oct. 1965 March, 1966) 247 315 224 242 315 237 April 227 258 216 274 181 May 124 175 79 145 173 101 June 97 143 - 88 136 155 July 83 101 44 95 104 65 August 101 131 - 103 134 - September 149 178 131 137 153 - Summer average (April - September, 1966) 130 164 85 131 162 125 October 129 234 137 129 198 134 November 229 283 - 235 276 206 December 241 297 180 182 270 161 Average for year, 1966 172 224 157 164 223 153 year, 1965 192 264 183 191 224 183 TABLE 13 AVERAGE MONTHLY INSOLUBLE DEPOSIT (milligrammes per square metre per day) Deposit gauges 1966 Bashley Road Birkbeck Avenue Hortus Road Longfield Depot Park Avenue White Street * January 149 251 74 119 6 14 February 172 412 90 88 65 108 March 218 172 134 256 108 29 Winter Average (Oct. 1965 March, 1966) 139 175 77 119 54 45 April 121 122 68 371 _ 50 May 128 265 68 518 57 68 June 178 314 131 154 41 84 July 330 314 62 137 79 - August 113 65 47 291 82 23 September 134 175 234 225 82 23 Summer Average (April - September, 1966) 167 209 102 283 68 50 October 111 118 42 64 73 7 November 169 187 65 304 52 38 December 70 150 56 78 43 7 Average for year, 1966 158 212 89 217 63 41 * maintained by North Thames Gas Board. 127 128 TABLE 14 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 31 31 31 31 Bakers' shops 73 73 - - Butchers 167 167 167 167 Cafes and restaurants 264 264 264 264 Canteens (industrial) 176 176 176 176 School kitchens and dining centres 107 107 107 107 Confectioners 342 342 - - Dairies 1 1 1 1 Food factories and stores 57 57 47 47 Food stalls 47 - - - Fish fryers 34 34 34 34 Fishmongers 36 36 36 36 Greengrocers 181 181 167 167 Grocers 419 419 298 298 Hotels, nursing homes and old peoples homes 53 53 53 53 Ice cream manufacturers 5 5 5 5 Licensed premises and clubs 225 225 225 225 Hawkers 47 - - - TOTALS 2,265 2,171 1,611 1,611 129 TABLE 15 Pigs carcases and offal inspected and condemned in whole or in part (Figures in column (2) in each year indicate the rate per 1,000 carcases inspected) 1963 1964 1965 1966 (D (2) (1) (2) (1) (2) (1) (2) 1. No. killed 568,310 - 557,914 - 576,649 - 592,805 - 2. No. inspected 568,910 - 558,486 - 577,229 - 593,399 - 3. Dead on arrival or died in pens 4. All diseases except T.B. 600 0.90 572 1.02 580 1.05 594 1.01 a) Whole carcases condemned 1,058 1.90 1,236 2.20 1,777 3,10 2,238 3.77 b) Carcases of which some part or organ condemned 49,645 87.10 132,384 226.80 170,418 294.90 218,014 367.30 5. Tuberculosis a) Whole carcases condemned 34 0.059 12 0.021 10 0.019 3 0.005 b) Carcases of which some part or organ condemned 19,991 35.14 23,618 42.27 31,728 54.88 17.442 29.39 6. Total carcases condemned 1,092 1.92 1,248 2.24 1,787 3.21 2,241 3.77 7. Total heads condemned 12,463 21.91 15,405 27.59 17,776 30.78 18,490 32.84 8. Total weight of plucks (lungs, livers, hearts, lights) condemned in lbs. 126,435 221.70 392,291 702.50 519,022 899.10 736,275 1240.70 9. Total weight of mesenteries, stomachs and intestines condemned in lbs. 137,340 241.00 153,030 280.30 227,720 394.50 263,710 444.40 10. Total weight carcases condemned (tons) 99.30 0.17 112.95 0.20 150.40 0.26 195.35 0.32 11. Total weight of parts or organs condemned (tons) 253.25 0.45 352.35 0.63 496.90 0.86 726.55 1.22 12. Total weight condemned in tons 352.55 0.62 465.35 0.83 647.30 1.12 921.90 1.54 TABLE 16 ANALYSIS OF DISEASES AND CONDITIONS OF WHOLE CARCASES CONDEMNED Figures in column (2) in each case indicate the rate per 1,000 whole carcases condemned) Figures in column (3) in each case indicate the rate per 1,000 carcases inspected) (D (2) (3) Total number inspected 593,399 - - Dead on arrival 323 144.2 0.54 Died in pens 271 120.9 0.46 Pyaemia 572 255.4 0.96 Septicaemia 311 138.8 0.52 Acute diffuse septic pleurisy and peritonitis 287 128.1 0.48 Acute diffuse septic pleurisy 170 75.9 0.29 Advanced anaemia 4 1,78 0.0067 Extensive bruising - - - Pathological emaciation 9 4.02 0.015 Fever 130 58.03 0.22 Acute septic mastitis - - - Jaundice 21 9.37 0.035 Enteritis — - - Acute septic pneumonia 6 2.68 0.01 Uraemia 8 3.57 0.013 Generalised oedema 16 7.14 0.026 Leukaemia 4 1.78 0.0067 Melanosis 2 0.09 0.0038 Septic erysipelas 3 1.34 0.005 Moribund 1 0.04 0.0019 Tumours - malignant 4 1.78 0.0067 Acute septic pericarditis - - - Multiple septic arthritis 84 37.5 0.14 Tuberculosis 3 1.34 0.005 Septic Metritis 8 3.57 0.013 Damaged in dressing 4 1.78 0.0067 Toxaemia - - - Total 2,241 130 Page Adult Training Centre 39 Air pollution, measurement of 94, 125 Animal Boarding Establishments Act, 1963 84 Animal protection 83 Ante-natal sessions 15 Anthrax 10 Asthma clinic 59 Audiometry 57 B.C.G. vaccination 69 Birth control sessions 23 Birthday cards 16 Births and birth rate 8 British Red Cross Society 28, 33 Burial of dead 105 Caravan sites 72 Care and attention, persons in need of 44 Care of mothers and young children 14 Care of the elderly 43 Cervical cytology 25 Chest clinics 35 Child guidance clinics 63 Child minders 18 Child welfare sessions 15 Chimneys, heights of 94 131 Page Chimneys, industrial, smoke from 94 Chiropody 33, 59, 119 Cholera 10 Circuses 78 Clean Air 91 Clean Air Information Service 95 Clean Air Programme, publicity for 93 Clean Food Scheme 96 Clearance area programme 85 Clinics 15, 116 Common lodging houses 74 Council housing, medical aspects of 109 Cremation of dead 05 Croup, membranous 11 Day care of children 18 Day nurseries 19 Dead, burial or cremation of 105 Deaths and death rate 8, 9 Dental service 16, 67 Deposits, insoluble, in the atmosphere 127 Diseases of Animals Act, 1950 83 Diseases of Animals (Waste Foods) Order, 1957 84 Diphtheria 10 Disinfection and disinfestation 78 Drainage and Sewerage 82 Dysenterv 10, 68 132 Page Ealirig Day Treatment Centre 43 Ear, nose and throat clinics 62 Early discharge scheme (maternity cases) 26 Elderly, care of 43 Encephalitis 12 Enteric fever 12 Environmental Health measures 72 Erysipelas 10 Establishment of Health Department 110 Factories Act, 1961 74, 122 Fairs 78 Family Help Service (Home Help) 41 Family planning 23 Fluoridation of Water Supplies 80 Food and Drugs administration 96 Food and drugs, chemical analysis of 99 Food and drugs, sampling of 99 Food complaints 101 Food hygiene 96 Food hygiene certificates 96 Food poisoning 11 Food premises, inspection of 96, 128 Food, surrender of unsound 98 Foods, bacteriological examination of 100 Foot health 58 133 Page Fuel for the elderly 44 Fuel, supply of, in Smoke Control Areas 93 Furnaces, new 93 Good Neighbour Service (Home Help) 41 Grant arrangements - appliances in Smoke Control Areas 93 Hairdressers and Barbers, Byelaws 79 Handicapped children 65 Hawkers, registration of, and premises 99 Health centres 13 Health education 31, 69 Health visiting 27 Hepatitis, infectious 11,68 Holiday camps (Mental Health) 39 Home Help Service 41 Home Nursing Service 28 Hostel accommodation (Mental Health) 38, 40 Houses in multiple occupation 86 Houses, unfit 85 Housing 85 Ice cream 97 Imitation cream 98 Immigration 45 Immunisation 30, 118 Immunisation of staff 106 134 Page Incontinence pads 28 Infectious diseases 10, 113 Infectious hepatitis 11,68 Infested children 58 Junior training schools 38 Liquid Egg (Pasteurisation) Regulations, 1963 98 Loan of nursing equipment 28 Malaria 11 Manual Workers' Sickness Pay Scheme, admission to 107 Marie Curie Foundation 28 Massage and Special Treatment, establishments for 103 Maternal mortality 8 Measles 11 Meat Inspection Regulations 83 Meat, surrender of unsound 98 Medical examination of staff 106 Medical social workers 21, 35 Meningococcal infection 12 Mental health 37, 120 Mental illness 37 Mental sub-normality 38 Midwifery Service 26 Milk Regulations 96 Mobile exhibition - Solid Smokeless Fuels Federation 93 135 Page Mortuary, public 105 Mother and Baby home 21 Neo-natal mortality rate 8 Night Service (Home Help) 41 Noise Abatement Act, 1960, 74 Nuisances 72 Nurseries and Chi Id-Minders Regulation Act 18 Nursing equipment, loan of 28 Nursing homes 103 Observation Register 16 Offices, Shops and Railway Premises Act, 1963 75 Old People's Homes, inspection of 104 Ophthalmia neonatorum 12 Ophthalmic clinics 60 Orthopaedic clinics 61 Osteopathy 104 Outworkers' premises 74, 124 Overcrowding - Housing Act, 1957 86 Perinatal Mortality Rate 8 Persons in need of care and attention 44 Pesticides Survey 101 Pet Animals Act, 1951 84 Phenylketonuria Screening 16 136 Page Physiotherapy 15, 62 Pigeons, destruction of 72 Plague 12 Pneumonia 12 Poliomyelitis 12 Population 8 Post-natal sessions 15 Pre-school Playgroups 18 Preserved foods, premises registered for preparation of 99 Prevention of Damage by Pests Act, 1949 79 Priority Dental Service 16 Puerperal pyrexia 12 Queen Charlotte's Hospital 26 Radioactive Substances Act, 1960 73 Rag Flock and Other Filling Materials Act, 1951 74 Rateable Value 8 Recuperative holidays 32,71 Rent Act, 1957 73 Riding Establishments Act, 1964 84 Rodent control in sewers 79 Routine medical inspections 56 Sausages, premises registered for preparation of 99 Scarlet fever 12 School clinics 58 School Dental Service 67 137 School Health Service 56 Sewage disposal 82 "Sitters-in" service 40 Slaughter of Animals Act, 1958 84 Smallpox 12 Smoke and sulphur dioxide in the atmosphere 94, 125 Smoke Control Areas 92 Smoke Control Orders, contraventions of 94 Smoke, dark, from industrial premises 94 Smoke from industrial chimneys 94 Social and therapeutic centre (Mental Health) 37 Social services for problem families, co-ordination of 22 Soiled linen cleansing service 29 Solid Smokeless Fuels Federation - mobile exhibition 93 Special Schools 66 Special Treatment, establishments for Massage and 103 Speech class 60, 66 Speech therapy 59 Staff, medical examinations and welfare of 106 Staff, vaccination and immunisation of 106 Still-births 8 Swimming baths 81 Tea, examination of 99 Tuberculosis 12, 35, 68 Tuberculosis Visitors 35 Tuberculosis Medical Social Worker 35 138 Page Typhoid fever 12 Underground rooms 86 Unsupported mothers 21, 70 Vaccination 30, 118 Vision testing 58 Vital statistics 8 Water supplies 80 Whooping cough 12 Winter vomiting 68 139 Printed by the London Borough of Ealing