AC. 43334 The Health of the London Borough of Ealing in the year 1968 EAL 59 The Health of the London Borough of Ealing in the year 1968 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 Forward . 3 1. Vital Statistics 4 2. Infectious Diseases 6 3. Health Clinics 9 4. Day Care of Children 13 5. Care of the Unsupported Mother and her Child 15 6. Family Planning 16 7. Cervical Cytology 17 8. Midwifery 18 9. Home Nursing 19 10. Artificial Kidney Machines 20 11. Health Education 21 12. Recuperative Care 22 13. Chiropody 23 14. Tuberculosis Service 25 15. Mental Health 27 16. Home Help Service 29 17. Care of the Elderly 30 18. Immigration 31 19. School Health Service 34 20. General Environmental Health Measures 45 1 21. Water Supplies, Swimming Baths and Sewage Disposal 52 22. Meat Inspection and Animal Protection 54 23. Housing 56 24. Clean Air 60 25. Food Hygiene and Food and Drugs Administration 64 26. Registration of Premises used for Medical Purposes 70 27. Mortuary and Burial Arrangements 71 28. Medical Examination and Welfare of Staff .. 72 Tables 73 2 Mr. Mayor, Aldermen and Councillors, This year has seen the opening of a further Day Nursery and the implementation of the much needed new legislation relating to the registration of Child Minders. In addition, there has been a comprehensive review of the Family Planning Services available in the Borough to enable us, in collaboration with the Family Planning Association, to provide a considerably improved service. This important component of maternal and child care will I am sure, be still further developed in the coming years. Finally, as a reminder of the continuing importance of infectious disease control, the measures against the outbreak of foot and mouth disease which commenced last year continued into the early months of this year. I would like to thank the members of those committees of the Council concerned with its health services together with the staff of the department for their help during the year. Your obedient servant, I.H. SEPPELT, Medical Officer of Health. 3 1. VITAL STATISTICS SUMMARY OF STATISTICS Area (in acres) . 13,708 Population (Census, 1961) 299,762 Population (estimated middle of 1968) 298,720 Rateable value, 1st April, 1968 £23,376,334 Net product of a penny rate, 1968/69 £95,356 Live births;- Legitimate males 2,485 Females 2,408 Total 4,893 Illegitimate males 249 Females 255 Total 504 Pirth-rate per 1,000 of estimated population 18.1 Illegitimate live births (per cent of total live births) 10.3% Still-births:- Males 38 Females 30 Total 68 Rate per 1,000 total births (live and still-births) 13 0 Deaths;- Males 1,781 Females 1,802 Total 3,583 Death-rate per 1,000 of estimated population 12.0 Deaths of infants under one year of age;- Legitimate males 48 Females 44 Total 92 Illegitimate males 7 Females 5 Total lfc Death-rates of infants under one year of age;- All infants per 1,000 live births 19.2 Legitimate infants per 1,000 legitimate live births 18.8 Illegitimate infants per 1,000 illegitimate live births 23.8 Neo-natal mortality rate (deaths under four weeks per 1, 000 total live births) 12.0 Early neo-natal mortality rate (deaths under one week per 1,000 total live births) 10.9 Perinatal mortality rate (still-births and deaths under one week combined per 1, 000 total live and still-births) 23.2 Maternal mortality (including abortion);- Number of deaths 4 Rate per 1,000 live and still-births . 0.73 4 CAUSES OF DEATH Deaths 1968 Male Female Total Enteritis and Other Diarrhoeal Diseases - 1 1 Tuberculosis of Respiratory System 8 2 10 Other Tuberculosis, incl. late effects 5 4 9 Whooping Cough 2 - 2 Other Infective and Parasitic Diseases - 3 3 Malignant Neoplasm - Stomach 54 21 75 Malignant Neoplasm - Lung, Bronchus 169 41 210 Malignant Neoplasm - Breast - 66 66 Malignant Neoplasm - Uterus - 20 20 Leukaemia 12 8 20 Other Malignant Neoplasms, etc. 180 184 364 Benign and Unspecified Neoplasms 5 7 12 Diabetes Mellitus 8 27 35 Avitaminoses, etc. - 1 1 Other Endocrine etc. Diseases 6 6 12 Anaemias 2 3 5 Other Diseases of Blood, etc. - 1 1 Mental Disorders 4 7 11 Other Diseases of Nervous System, etc. 29 21 50 Chronic Rheumatic Heart Disease 21 29 50 Hypertensive Disease 26 40 66 Ischaemic Heart Disease 482 374 856 Other Forms of Heart Disease 42 121 163 Cerebrovascular Disease 149 215 364 Other Diseases of Circulatory System 62 98 160 Influenza 6 16 22 Pneumonia 147 220 367 Bronchitis and Emphysema 166 54 220 Asthma 4 4 8 Other Diseases of Respiratory System 17 18 35 Peptic Ulcer 16 13 29 Intestinal Obstruction and Hernia 4 8 12 Cirrhosis of Liver 3 8 11 Other Diseases of Digestive System 10 20 30 Nephritis and Nephrosis 4 9 13 Hyperplasia of Prostate 6 - 6 Other Diseases, Genito-Urinary System 16 18 34 Abortion - 1 1 Other Complications of Pregnancy, etc. - 3 3 Diseases of Skin, Subcutaneous Tissue 2 7 9 Diseases of Musculoskeletal System 3 8 11 Congenital Anomalies 14 16 30 Birth Injury, Difficult Labour, etc. 14 14 28 Other Causes of Perinatal Mortality 11 10 21 Symptoms and Ill-defined Conditions 4 8 12 Motor Vehicle Accidents 22 12 34 All Other Accidents 21 9 30 Suicide and Self-inflicted Injuries 20 23 43 All Other External Causes 5 3 8 TOTALS 1,781 1,802 3,583 5 2. INFECTIOUS DISEASES Details of the incidence of the various notifiable infectious diseases and the action taken during the year to prevent their spread is 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 141 cases were notified during the year of which 16 were confirmed bacteriologically. In all these the organism was Shigella Sonne. ERYSIPELAS 3 cases were notified up to 1st October, 1968, when this disease ceased to be notifiable. FOOD POISONING 19 cases were notified of which 14 were confirmed bacteriologically. The organisms were as follows;- Salmonella Typhimurium 8 Other Salmonellae 6 INFECTIVE JAUNDICE This disease was made notifiable on 1st October, 1968, but infectious hepatitis has been notifiable in the borough since November, 1965. The number of cases notified during the yza.iv&& 50 cf which 15 were admitted to hospital. In conformity with the Council's control measures public health inspectors visited the households and gave advice on the appropriate hygiene measures which should be adopted and arrangements were made for the patient's linen and clothing to be disinfected by boiling or autoclaving wherever possible. MALARIA Five cases were notified during the year. In each case the disease was believed to have been contracted abroad. 6 MEASLES 722 cases were notified during the year. ACUTE ENCEPHALITIS AND ACUTE MENINGITIS There were no cases of acute encephalitis and four cases of acute meningitis notified during the year. OPHTHALMIA NEONATORUM No cases were notified during the year. PNEUMONIA 16 cases were notified up to 1st October, 1968, when this disease ceased to be notifiable. POLIOMYELITIS No cases were notified during the year, this being the fourth consecutive year in which I have to report this happy state of affairs. PUERPERAL PYREXIA 2 cases were notified up to 1st October 1968, when this disease ceased to be notifiable. PLAGUE No cases were notified during the year. SCARLET FEVER There were 131 cases notified during the year. SMALLPOX No cases were notified during the year. There were 56 people who arrived by air and 14 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 During the year 137 new cases of pulmonary tuberculosis and 54 new cases of non-pulmonary tuberculosis were notified. (The figures for last year were 142 and 49 respectively.) TYPHOID FEVER During the year one case of typhoid fever occurred. 7 This was a 14-year-old boy who came to this country from India and was admitted to hospital shortly afterwards. Investigation at his home revealed that another 10 persons were living there. The usual exclusion measures were carried out and there were no further cases. It seems likely that the infection was contracted abroad. WHOOPING COUGH There were 135 cases notified during the year. Full statistical information is set out in table 1 at the end of this report. 8 3. 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, immunisation and vaccination, cervical cytology, 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^ 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 1968 were as follows: - 789 mothers attended medical officers' sessions for their ante-natal care. 585 mothers attended midwives' sessions for their ante-natal care 648 mothers attended ante-natal relaxation classes. 227 mothers attended post-natal sessions. 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 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;- 9 (i) Particularly careful surveillance is given to children with certain ante-natal or peri-natal histories, for example, the child of a mother who has had german measles during pregnancy. An observation register is kept, to which 1,104 children were added during the year (20,6% all live births in the borough). The total on the register at the end of the year was 1, 023. (ii) Phenylketonuria test. This test of the baby's urine is able to detect one form of mental subnormality which is preventable by diet. There were 5,338 babies tested in this way during the year, but no positive cases were detected. During the year 14,147 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 pre-school children. The figures for attendance of these groups in 1968 were:- EXPECTANT AND NURSING MOTHERS Examined 42 Required treatment 42 Teeth filled 155 Teeth extracted 19 Dentures provided 7 PRE-SCHOOL CHILDREN Examined 292 Required treatment 173 Teeth filled 526 Teeth extracted 155 CO-ORDINATION AND CO-OPERATION OF HEALTH DEPARTMENT'S SERVICES WITH HOSPITAL AND FAMILY DOCTOR SERVICES During 1968 the pilot scheme of attachment of health visitors, home nurses and midwiyes to the practice of family doctors in the Ravenor Park area was extended to cover the north western part of the borough. Officers of the department serve on local maternity liaison committees and geriatric committees and the health visitor at the Day Treatment Centre also undertakes geriatric liaison duties. Links with the Central Middlesex Hospital include regular programmes of instruction for undergraduate medical students, the work of the diabetic liaison health visitor and a continuing programme of Health Education in the hospital arranged by the health education officer. Lunchtime meetings at Perivale Maternity Hospital continue to promote lively discussion and are well attended by Health Department staff. 10 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 acceptance rates during the year (expressed as a percentage of total births) were:- Immunisation. against diphtheria, whooping-cough and tetanus 69.3. Immunisation against poliomyelitis 63. 5 Vaccination against smallpox 66 Full details of immunisation carried out during the year are as follows:- Type of vaccine Administered in clinics Administered by general practitioners Total Diphtheria/whooping-cough/ tetanus 3212 1446 4658 D iphtheria/tetanus 896 180 1076 Diphtheria 8 18 26 Tetanus 299 62 361 Poliomyelitis 3923 1677 5600 Reinforcing doses Diphtheria/whooping-cough/ tetanus 2592 982 3574 D iphtheria/tetanus 3767 777 4544 Diphtheria 21 17 38 Tetanus 263 110 373 Poliomyelitis 2305 1162 3467 Smallpox - vaccination and re-vaccination Vaccinated Re-vaccinated At clinics 3030 - By general practitioners 1336 288 Total 4366 288 12 4. DAY CARE OF CHILDREN PRE-SCHOOL PLAY GROUPS Pre-school play groups are now recognised as making an important contribution to the social education of children and therefore, as well as being the registering authority under the Nurseries and Child Minders Regulation Act, 1948, the Council also encourages these groups by financial assistance. At the end of the year there were 36 play-groups in the borough, which included 6 that were registered for the first time during the year. Of the total, 12 which conformed to the Council's code of practice were in receipt of a Council grant, this being one-third of the rent of the premises used, to a maximum of £100 per annum. CHILD MINDERS The Nurseries and Child Minders Regulation Act, 1948 was amended by Section 60 of the Health Services and Public Health Act, 1968. This was backed by two Departmental Circulars outlining model standards for the supervision of child minders. The main effects of the new legislation were:- (i) All persons minding children for a period of over two hours for reward are now required to register. (ii) The numbers of children minded are restricted to three children by one adult and seven children if there are two adults The legislation was introduced towards the end of the year and a start was made on the task of registration and organisation of supervision. At the end of the year there were 34 registered child minders in the borough which included 12 who were registered for the first time during the year. 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 illhealth. 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: - 13 Maximum number Approved places of places *1. Windmill Day Nursery, Windmill Lane, 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. During the year 228 new admissions were made to day nurseries of which 12 were handicapped children. The new Windmill Day Nursery was opened on 20th May, 1968, and the formal opening was on 28th June, 1968 by Dr. Thomas Oppe', F.R.C. P. , Director of the Paediatric Unit, St. Mary's Hospital Medical School. It is a purpose built single storey 50 place nursery. Bollo Bridge Day Nursery is due for replacement and a site has been obtained in Park Road North, Acton. It is hoped that work on the new building will commence early next year. 14 5. CARE OF THE UNSUPPORTED MOTHER AND HER CHILD Under Section 22 of the National Health Service Act, 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. Two medical social workers are 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 workers have 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 workers 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 workers 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 put her in touch with an Adoption Agency or alternatively help the girl to make constructive plans to keep her baby. Preventive after-care following the girl's return home is also given. During the year, the department helped 147 unsupported mothers from Ealing, 34 from Hounslow and 39 from Hillingdon. The Council has its own M)ther and B^aby Home to which the unsupported mother can be admitted, usually six weeks before confinement and six weeks after delivery. It can accommodate 12 ante-natal and 14 post-natal patients and babies. Ante-natal and mothercraft classes are given by the Matron since many girls lack the knowledge of the basic domestic skills. Occupational therapy classes are held weekly, where the girls learn dressmaking, knitting and other accomplishments. The Council's medical social workers give support in what is a very difficult time for such mothers. 15 6. FAMILY PLANNING The provisions which the Council makes under Section 22 of the National Health Service Act are as follows:- (1) The health department provides a birth control clinic at Cherington House Clinic to which doctors or health visitors can refer women on medical grounds. In accordance with circular 5/66 supplies as well as advice are now free in these circumstances. Two sessions are held per month with an average attendance of 20 per session. In 1968, 125 new patients were seen and a total of 453 visits were made to the clinic. (2) The Family Planning Association provides the following services: - (a) Sessions at Cloister Road and Northcote Clinics where the Council assists the Association by the free use of accommodation. (b) Sessions at Perivale Maternity Hospital. At all the above sessions advice is given on family planning both for medical and social reasons. The Council meets the cost of any women referred on medical grounds. During the year 22 such cases were referred. (c) The Family Planning Association run a clinic within the premises of Hillingdon Hospital in conjunction with the hospital's post-natal clinic. The Council meet the cost of the attendance of approved patients at this clinic. During the year one such patient attended. (d) A domiciliary service designed for those women who fail or who are reluctant to attend normal birth control sessions. These are usually the very women who it is most important should have advice and those for whom social workers and health visitors are giving active social support. The Council meet the cost of this service which during the year provided for 12 patients. During the year the Council carried out a comprehensive review of the family planning services available in the borough. Discussions were then commenced with the local branch of the Family Planning Association with a view to increasing the provision as recommended by the 1967 Family Planning Act, and to include the setting-up of a Youth Advisory Centre. It is hoped that these increased provisions will commence next year. 16 7. CERVICAL CYTOLOGY This service under Section 28 has developed during the year, 2,203 smears being taken compared with 1,796 last year. Cervical cytology facilities are now available at Cherington House, Ravenor Park and Pierrepoint Road Clinics. Smears are taken by a doctor on the Council's staff and the cytology work is undertaken by the laboratory staff at King Edward Memorial Hospital. During the year the age limit was lowered to 25 years to extend the service to all women at risk. In this year arrangements were made for the Council's team of doctor and nurse to carry out a screening programme in the medical suite of a large factory in the borough. 310 women were screened at fortnightly sessions over a period of four months, of whom 2 showed a positive cervical smear result, requiring further investigation. In addition, 7 women had pelvic masses requiring surgery, 13 had lumps in the breast, requiring further investigation, and 53 had some form of vaginitis, the commonest condition being a trichomonal infection. To summarise 1:4 women required treatment and 1:11 surgical intervention. These findings reveal the extent of pathology to be found in so called well women of the lower socio economic groups. There is little doubt that by taking the service to the factory, the women in turn will respond and come forward readily for screening. 17 8. MIDWIFERY In accordance with Section 23 of the National Health Service Act, the Council provides a staff of 20 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 South all, and by Queen Charlotte's Hospital midwives in Acton, continued in 1968. 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. 11 of the Council's midwives are approved teachers and during the year 30 pupils from Perivale Maternity Hospital and Hillingdon Hospital were trained. Those from the former hospital were accommodated in the Council's Pupil Midwives' Hostel, which has continued to prove popular. 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 1964 1051 4744 5795 1965 942 4728 5670 1966 626 5039 5665 1967 599 5109 5708 1968 500 4907 5407 The increase in the proportion of hospital confinements is clearly shown, and is in conformity with national trends. The Council has an agreement 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: - 1964 1965 1966 1967 1968 306 511 718 674 679 18 9. 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 46 nurses, including 2 male nurses. Patients are almost entirely referred to the department either from hospitals (70%) or general practitioners (20%). The type of work ranges through short-term care of acutely ill patients, postoperative 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. 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. I am authorized to engage nurses 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 3,452 articles loaned to patients during the year. The night nursing service inaugurated in the previous year has proved to be of great use by extending the hours of the home nursing service. Terminal patients can now receive additional care late at night or in the early morning and elderly, invalid people can be got ready to go to day centres or hospitals without haste in the mornings and can be put back to bed at a more normal hour in the evenings. 19 10. ARTIFICIAL KIDNEY MACHINES Whilst the hospital authorities are responsible for providing and maintaining the necessary equipment, local authorities are able to make arrangements for the adaptation of premises. During the year adaptations were made for one resident at a cost of £220. The Council decided that its policy would be to make such charge as is reasonable, having regard to the means of the person concerned. The type of adaptation which is necessary in these cases consists of making the walls and ceiling of the treatment room crack-proof and washable, and the floor waterproof. A sink with a good supply of water must be installed and it is also necessary to provide storage space for sterile dressings and containers of fluid. In some instances, in order to accommodate these requirements and still leave space for a bed, it is necessary to build an extension. The cost of modifications usually varies between £50 - £250. The limiting factor in the development of this service at present is not a shortage of kidney machines but the need to provide the supporting hospital accommodation and the recruitment and training of hospital medical, nursing and technical staff. The Ministry has assured the Council that it is proceeding as rapidly as possible with these arrangements. 20 11. 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, health visitors, midwives, nurses, social workers and health inspectors is educative in nature but, in addition, a specific health education programme is carried out every year In conjunction with the public relations officer and the road safety officer, a scheme involving all sections of the health department operates so that each month the programme concentrates on a particular topic appropriate to the time of the year. The complete programme was as follows:- January - Winter Ills February - Home Safety March - Nutrition April - Children's Play May - Dental Health June - Mental Health July - Summer Hazards August - Summer Hazards September - Care of Feet October - Immunization November - Preparation for Winter December - No specific subject In addition to this, films were shown at various clinics on the subject of birth control, foot health, child development, V. D. , and dental health, whilst film shows on health subjects were also given to such organisations in the borough as Townswomen's Guilds, Youth Clubs, etc. By arrangement with Central Middlesex Hospital posters were displayed in the out-patients, casualty, maternity, mass X-ray, and dental departments. This arrangement is particularly welcome since it demonstrates an appreciation by the hospital of the part that community services play. In addition, the health education programme in schools has continued during the year, details of this being given under the School Health Section. 21 12. RECUPERATIVE CARE Recuperative care is 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 period of recuperative care before resuming his normal occupation. The patient must be fit to travel and not in need of medical or nursing care. The normal recuperative care 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 a main line station if this is recommended by the general practitioner. The cost of the service to the patient is £5. 15s. 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 104 Number of patients sent on a recuperative holiday 74 Number of patients who did not avail themselves of the vacancy offered 23 Number of applications not approved 6 Unable to obtain vacancy 1 22 13. 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. 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. Od. , 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. Od. , 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 provide 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 chiropodists, which, in practice, is 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:- 23  British Red Cross Society Southall Old People's Welfare Association London Borough of Ealing Total Total number of patients 550 198 3,059 3,807 Total number of new patients 25 12 1, 037 1,074 Total number of treatments at clinic 620 - 8,557 9,177 Total number of treatments at private surgeries 752 395 - 1,147 Number of patients receiving domiciliary treatment 180 75 717 972 Number of domiciliary treatments 853 597 4,546 5,996 Percentage of total work which is domiciliary - 60% 34% 36% Expectant and nursing mothers - - 15 15 Physically handicapped persons 20 - 32 52 24 14. 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, whilst the Council is responsible for the visiting and welfare services under Section 28 of the National Health Service Act. Because of the Hospital Committee's Catchment Areas, patients residing in Ealing and Acton are referred to the Ealing Chest Clinic, Green Man Passage, W.13, whilst those living in Southall are referred to the chest clinic at Hillingdon Hospital for investigation and treatment. In the long term it is the Council's policy to integrate the tuberculosis visiting service with the health visiting service. Indeed, tuberculosis visitors as such are no longer being trained and eventually this designation will disappear. At present, however, only one of the Council's six tuberculosis visitors is a qualified health visitor and therefore able to carry out combined duties. Details of the work during 1968 are as follows:- TUBERCULOSIS HEALTH VISITORS Number of new tuberculosis cases 175 Number of old tuberculosis cases 4,192 Transfers into borough 30 Number of contacts of new cases 1,088 Successful visits to tuberculosis households 3,927 Unsuccessful visits to tuberculosis households 1,060 Successful visits to other patients 627 MEDICAL SOCIAL WORKER The statistics of the cases seen by the Medical Social Worker relate only to cases under the care of Ealing Chest Clinic. Those attending Hillingdon Hospital are seen by the Medical Social Worker there. DETAILS OF CASES Cases first referred during the year 151 Total cases 359 Tuberculosis patients 189 Cancer patients 70 Bronchitis and others 100 ACTION TAKEN Referred for employment 14 Found employment 10 Referred to Social Security for maintenance 22 Referred to Social Security for bedding 1 Referred to Social Security for clothing 4 Referred to Social Security for extra nourishment 11 Referred for Housing 65 Rehoused 22 25 During the year the Mass Radiography Unit of the North West Metropolitan Regional Hospital Board visited 11 factories and offices within the area and examined 7, 935 workers. Five cases of active pulmonary tuberculosis were discovered and four cases of lung cancer. 26 15. MENTAL HEALTH The Council is responsible under the Mental Health Act, 1959, for the provision of community care for the mentally ill and the mentally subnormal. MENTAL ILLNESS Social Work A large part of the support which the mentally ill living in the community require is provided by the borough's 11 mental health social workers who are also responsible for certain legal aspects of the compulsory admission of patients to hospital. A 24-hour service is provided. During the year a consultant psychiatrist from Springfield Hospital was appointed for one session per fortnight to advise mental health social workers. Greenford Mental Health Centre This centre has continued to provide a period of rehabilitation for patients making the sometimes difficult transit from hospital to community life. Close links have been established with the Disablement Resettlement Officer and the Industrial Therapy Organisation who deal with matters of employment and rehabilitation. 49 patients attended during the year. Hostels Although the borough has no hostel for the mentally ill, 28 patients are living in other local authority hostels and those run by voluntary organisations. The Ealing Association for Mental Health provides bed-sitting rooms for six women recently discharged but not yet ready to settle in the community. Hospitals Ealing is served by three psychiatric hospitals;- Springfield Hospital, Upper Tooting - Ealing Area Shenley Hospital, St. Albans - Acton Area St. Bernard's Hospital, Southall - Southall Area I have in previous reports referred to the difficulties caused by this division and by the long journey to two of the three hospitals. Voluntary Organisations The Ealing Association for Mental Health has continued its valuable activities which include a bus service to Springfield Hospital, shopping expeditions for in-patients, and the organisation of the local Mental Health Week. Note has already been made of the Association's bed-sitting room accommodation. 27 MENTAL SUBNORMALITY Advisory and Diagnostic Services These include sessions held by the Principal Medical Officer and special occasional sessions by a consultant psychiatrist. Evening discussions with parents and home visits by medical officers are also valuable. The mental health social workers have their part to play, and the day nurseries and play groups admit some of the very young mentally handicapped children which relieves the strain on those who would normally look after them during the day. Junior Training Schools. There are at present no junior training schools in the borough although a site has been agreed for the future building of Ealing's own junior training school. At present we have to thank the four neighbouring boroughs of Hounslow, Hillingdon, Harrow and Brent who accommodated for us 88 children during the year. Adult Training Centre There is one adult training centre in the borough at Jubilee Gardens, Southall, which provides suitable work for 60 trainees. Liaison with the Further Education Section of the Education Department has enabled us to develop suitable individual programmes for each trainee. Needlework is also available, if appropriate. 39 trainees were placed at centres in neighbouring boroughs, and in addition holidays were arranged for 37 trainees. Residential Accommodation Three patients are at present accommodated in other local authority hostels. The Council's own 25 place hostel now nearing completion on the Brenthill Nursery site will be ready for occupation early in 1969. It will accommodate men and women who are able to work in outside employment or attend Adult Training Centres. 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 25 patients were admitted informally. There is a long waiting list for permanent care. Short term admission is easier to obtain and provides a measure of relief for some families. Voluntary Organisations. The Ealing Society for Mentally Handicapped Children has a wide range of activities and conducts a youth centre on land provided by the Council. 28 16. 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 inadequacy 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 2,595 Maternity 247 Others 212 Family help 10 The establishment of home helps is 260 which is partly filled by 349 part-time and 12 full-time staff to give an equivalent of 227 full-time home helps. Due to the Prices and Incomes Policy it was still not possible fully to implement the reorganisation recommended in previous reports. The basic rate payable to Home Helps was increased during the year to 5s 9½d. per hour. This increase did not noticeably improve recruitment. The mobile squad introduced in late 1967 has been in use throughout the year and proved itself a valuable addition to the service. 29 17. CARE OF THE ELDERLY EALING DAY TREATMENT CENTRE ASSOCIATION The types of disability which brought patients to the Centre were as follows:- Diseases of the musculoskeletal system 52 Diseases of the cardiovascular system 19 Diseases of the respiratory system 1 Diseases of the central nervous system 61 Diseases of the alimentary system 5 No major diagnosis or senility only 5 Others 16 Total 159 The following table shows the distribution of referrals during the year from the various parts of the borough:- Hanwell, W. 7 20 Ealing, W.13 24 Ealing, W. 5 26 Greenford 23 Northolt 22 Perivale 8 South all 24 Acton 12 Total 159 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 organisations. During the year fuel was delivered to 2 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 the year this was not necessary. On all occasions persuasion succeeded in obtaining agreement to voluntary admission. 30 18. IMMIGRATION There are immigrants of many nationalities in the borough but the community which calls for particular help is the Asian one in the Southall area. From Health Department housing records it is estimated that this is now in excess of 14, 000 and details of admission of voucher holders during 1968 are given below. This year the number of children accompanying the adult was noted. Country of origin No. of persons Number Notified Contact Established Commonwealth Countries India 959 886 Pakistan 110 85 Other Asian 47 24 Caribbean 111 89 African 203 153 Other 101 31 Non-Commonwealth Countries Europe 25 19 Other Totals 14 6 1, 570 1,293(82.3%) The ports of arrival were as follows Country of origin No. of persons London Airport Other ports Commonwealth Countries India 918 41 Pakistan 110 - Other Asian 44 3 Caribbean 109 2 African 63 140 Other 75 26 Non-Commonwealth Countries Europe 5 20 Other 5 9 Totals 1,329 241 31. TUBERCULOSIS Given below are figures relating to tuberculosis over the last five years showing the differing incidence in the immigrant and indigenous population in the three main parts of the Borough. It must be emphasized that these rates are calculated from estimated populations, and the incidence in Asians is gauged from the names of those notified. I consider, however, 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 1964 1965* 1966* 1967* 1968* Area 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 83 1. 45 35 0. 59 51 0. 86 56 1.05 56 1. 05 ACTON 50 0. 77 23 0. 36 33 0. 52 27 0. 42 23 0. 37 EALING 47 0. 26 71 0. 39 47 0. 26 59 0. 32 58 0. 31 TOTALS 180 0. 59 129 0. 43 131 0. 43 142 0. 48 137 0. 46 NEW CASES OF PULMONARY TUBERCULOSIS IN THE FORMER BOROUGH OF SOUTHALL SHOWING RATE PER 1, 000 OF THE POPULATION Total cases notified Indians and Pakistanis (Based solely on names) Others Year No. of Cases Rate per 1, 000 of estimated population No. of Cases Rate per 1, 000 of estimated population No. of Cases Rate per 1, 000 of estimated population 1964 83 1. 5 34 7. 5 49 0. 9 1965* 35 0.6 25 4. 2 10 0.2 1966* 51 0. 9 33 3. 6 18 0. 4 1967* 56 1.1 41 3.4 15 0. 4 1968* 56 1.1 43 3. 1 13 0. 3 * 1965, 1966, 1967 and 1968 The rate per 1,000 for these years is based upon an estimated "breakdown" of the total borough population. 32. SCHOOL HEALTH The number of immigrant school children at the end of the year in relation to the total school child population was as follows:- Total school population 41,998 Total immigrant population in schools 8,346 Indians and Pakistanis 4,626 West Indians 2,349 Others 1,371 As part of the Council's tuberculosis prevention service the heaf testing of all immigrant children on admission to school has continued and the figures for 1968 compared with the previous year are as follows:- Immigrants Others Total 1967 1968 1967 1968 1967 1968 Number tested 266 366 1350 2614 1616 2980 Number found positive 179 230 60 80 239 3110 Percentages of number tested found positive 67.29 62. 87 4. 44 3. 05 14.79 10.40 33. 19. SCHOOL HEALTH SERVICE ROUTINE SCHOOL MEDICAL INSPECTION At the present time in the London Borough of Ealing 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) years (junior school) and 14 - 14½ years (senior school leavers). The total school population at the end of the year was 41,998 and the details of examinations carried out are as follows:- First age group 4,455 Second age group 3,621 Third age group 3,199 11,275 Classification of general condition: Satisfactory 11,189 = 99.24% Unsatisfactory 86 = 0.76% Defects requiring treatment found at routine medical inspections: Skin 289 Vision 675 Squint 77 Hearing 147 Middle ear 211 Nose and throat 119 Speech 47 Enlarged glands 12 Heart 13 Lungs 63 Hernia 6 Orthopaedic: Postural 33 Feet 103 Epilepsy 9 34. SELECTIVE MEDICAL EXAMINATIONS As the final pattern of school re-organisation has not yet emerged, it has been decided to hold in abeyance this type of medical examination for a further year. SCHOOL MEDICAL ROOMS The gradual improvement in facilities of school medical rooms has continued as fast as the financial situation has allowed. 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) Head Inspections (3) Vision Testing Audiometry This is devised to detect even a slight loss of hearing at the earliest possible opportunity which in certain cases may be before the child attends school. Normally 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. Should he suspect some more serious cause of deafness the child is referred either to his own doctor, to a hospital ear, nose and throat consultant, or to the audiology unit at Heston. The figures for testing during the year were:- Children tested 9,764 Schools visited 121 Children with hearing loss 370 Children referred to specialist 149 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 1968 52,829 examinations were carried out, 549 cases of infestation were found representing 0. 96% of the children examined. 35. 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. In special schools vision testing is carried out annually. 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 Speech Therapy Ophthalmic Orthopaedic Child Guidance General School Clinics To these clinics any parent or teacher may refer a child whose health or progress 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:- Abbey Parade 107 Laurel House 378 Avenue Road 724 Mattock Lane 509 Cherington House 648 Northcote 469 Cloister Road 165 Northolt Grange 468 Greenford Green 171 Perivale 220 Islip Manor 479 Pierrepoint Road 520 Jubilee Gardens 672 Ravenor Park 688 King Street 317 Trinity Way 211 Asthma Clinics 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 36. 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 ofter unfortunately cause the child to be overclothed, overprotected, 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 1,126 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. Sessions are held at six clinics throughout the borough. Owing to a shortage of chiropodists and because most of the work on childrens' feet consists of the treatment of single verruca, clinic nurses took over this work in July. Nurses at almost every clinic in the Borough are now involved in this aspect of foot health. Details of attendances during 1968 are:- Verrucae Other chiropody New cases 581 335 Re-examinations 1,891 1,858 Total 2,472 2,193 Speech Therapy Clinics The following types of defect were encountered during the year:- Dyslalia (confusion of articulation) 220 Delayed development of speech and/or language 87 Aphasia or dysphasia (absence or disorder of speech and and/or language due to neurological causes) 7 Anarthria or disarthria (neuro-muscular disorders of muscles of articulation) 5 Aphonia or dysphonia (disorders of voice) 7 Cleft Palate 11 Stammer 60 37. Dyseneia (articulatory defect arising from hearing loss) 5 402 Ophthalmology Clinics Ophthalmic sessions are carried out in the borough as follows:- Avenue Road Clinic - Dr. B Bradley, M. D. , D. O. M. S. 1 session per week Mattock Lane Clinic - Dr. L. H. Macfarlane, M. D. , B. S. , D. P. H. , D. O. M. S. 1 session per week Jubilee Gardens Clinic - Dr. L. H. Macfarlane) 2 sessions per month Dr. J. Anderson ) 2 sessions per month Islip Manor Clinic - Dr. M. Billinghurst, M. B. , B. S. , D. O. M. S. 1 session per month Ravenor Park Clinic - Dr. M. Billinghurst, M. B. ,B. S. ,D. O. M. S. 3 sessions per month The Ophthalmologists working in the Ealing Clinics are all on the staff of local hospitals, and there is thus a close link between out 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 767 Re-attendances 2,801 Total 3,568 Glasses prescribed 730 In addition to the consultant sessions an orthoptic clinic at Avenue Road functions for seven sessions a fortnight and at Ravenor Park there are three sessions a fortnight. The figures for attendance are:- New Cases Total Number of attendances Avenue Road 20 551 Ravenor Park 67 516 Total 87 1,067 38. 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 at the Royal National Orthopaedic Hospital and its branch at Stanmore, and Mr. Busfield is an Orthopaedic Consultant at Hillingdon Hospital. During the year the North West Metropolitan Regional Hospital Board reported that Mr. Cholmeley would retire from his appointment in the National Health Service on the 31st October but they were prepared to offer him a locum tenens engagement to cover the Ealing clinics. It is, however, the Board's policy to discontinue local authority consultant clinics as soon as the appropriate hospital department is able to accept the additional load. This is to be regretted since these clinics have been of considerable benefit to local residents. The hospital link has enabled such facilities as operative treatment, x-ray, provision of appliances and pathological investigations to be freely available to children attending our clinics who have remained under the same consultant surgeon throughout their treatment. Admission to hospital has also been able to be arranged promptly and the subsequent follow-up by the consultant and physiotherapist at the local clinic has avoided undue travel. Referrals to these clinics usually follow from routine medical inspection at schools, from the general school clinic, from family doctors and a small number from other hospitals. The figures for attendance during 1968 are:- New cases 198 Re-attendances 686 Total 884 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 were carried out at Ravenor Park and Mattock Lane clinics on alternate weeks by Mr. R. M. Savage, F. R. C. S. (Edin. ),D. L. O. , for the first six months of 1968 and figures for attendance during that time were:- New Cases 77 39. Re- attendances 294 Medical treatment 152 Operative treatment 29 Mr. Savage retired from the service of the Regional Hospital Board on the 30th June, 1968 and, in conformity with the policy already described above, no new consultant was appointed to cover the Ealing clinics. From the 1st July all children requiring ear, nose and throat consultant services were referred to their general practitioners or with their consent, to a hospital ear, nose and throat department. 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 full time Registrar and part-time clinical assistant, an officer of the North West Metropolitan Hospital Board. The remaining staff are council officers of the Education Department. The service is conducted from the main clinic in Madeley Road, Ealing and from three sub clinics at Avenue Road, Acton; Northolt Grange, Northolt; and Villiers Road, South all. Details of the work carried out during the year are as follows:- Referrals Number of cases on waiting list at December, 1967 105 Number of cases referred to Centre during 1968 435 Number of cases seen by Psychiatrists during 1968 299 Number of cases seen by other Officers 59 Cases withdrawn 85 Number of cases awaiting at December, 1968 97 Recommendations by Psychiatrists Treatment or remedial teaching 164 Placed in residential school for maladjusted 34 Placed in day school for maladjusted Aston 8 Newlands 20 28 Placement in residential schools for the maladjusted Number of children awaiting placement at 31st December, 1967 10 Number of children recommended during the year 31 Children placed 34 Awaiting placement at 31st December, 1968 7 40. Recommendations for psycho-therapy or remedial treatment Cases awaiting treatment at 31st December, 1967 31 Recommendations for treatment 155 Discharged during year 11 Treatments during year 164 Awaiting treatment at 31st December, 1968 11 Of the 337 children referred to the centre for intelligence testing 211 were boys and 126 were girls. HANDICAPPED CHILDREN The following table sets out, in their various categories, the number of handicapped pupils as at 31st December, 1968. Category of pupils In Special Day Schools In Special Residential Schools In maintained Primary and Secondary Schools Not at School Totals M F M F M F M F M F Blind 1 4 3 2 - - - - 4 6 Partially sighted 5 5 - 1 1 1 - - 6 7 Deaf 6 8 5 2 - - - 1 11 11 Partially deaf 20 6 3 4 1 - - 2 24 12 Educationally subnormal 146 111 31 9 19 11 2 6 198 137 Epileptic - - 1 2 1 - 1 - 3 2 Maladjusted 52 18 108 28 5 1 3 - 168 47 Physically handicapped 42 31 3 7 - - 4 4 49 42 Defective speech 7 3 - - - - - - 7 3 Delicate 31 9 10 2 4 3 1 2 46 16 Totals 310 195 164 57 31 11 11 15 516 283 SCHOOL DENTAL SERVICE Mr. L. C. Mandeville, L. D.S. , R. C. S. , Principal School Dental Officer, reports as follows: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. 41. 3. Dental Health Education. Dental sessions are held at 13 of the Council's clinics. The establishment of dental staff is 14 dental officers. At the end of the year a full time equivalent of 8. 9/10ths dental officers was employed. This is fractionally lower than that shown in the 1967 report. As in previous years, there has been a difficulty in recruiting adequate numbers of dental officers. This has been especially marked in the Northolt part of the borough and is presumably due to communication difficulties. Lack of stability and continuity in the service does, more than any other factor, cause parents and patients to seek treatment elsewhere and even to make no arrangements at all. Dental Inspections The figures for dental inspection during the year were as follows:- Routine dental inspections during 1968 49.8% of school pop. Found to require treatment 50.7% Sessions devoted to inspection 4.1% The percentage of pupils inspected last year was 56. 2%. Dental Treatment The figures for dental treatment during the year were:- Total visits to clincis 23,221 Teeth filled 16,700 Teeth extracted 5,749 General anaesthetics 2,543 Emergeneies 1,412 Sessions devoted to treatment 3,526 Specialist orthodontic treatment for "straightening" the teeth (overcrowding, malformation of jaws and teeth, etc.) is available at four of the dental clinics, and in parts of the Borough private practitioners also like to refer children for the opinion of our orthodontists. The selection of patients who will maintain the proper degree of interest and co-operation over a period of two years or more is vital as the treatment is quite expensive of time and material. "Wastage" of patients, usually through declining interest and lack of co-operation in wearing their appliances, is less than 2%, which is well below figures quoted in other parts of the country. In 1948 the Ministry of Education started a quinquennial survey of dental caries in 5 to 12 year old children in seven local authorities. Southall was one of the areas which was concerned in the Middlesex part of the survey, and at each survey since that date Miss Cameron has been the dental officer who has carried out the survey here, and she has continued with the survey in 1968. A review of the results will be in the next edition of the Health of the Schoolchild. 42. Dental Health Education One aspect of the dental auxiliaries' work in dental health education, which has been found to be especially useful, is to give individual instruction at school dental inspections to those children whose dental hygiene is inadequate. These lessons are followed up after a couple of weeks to see what improvement has resulted. Our one auxiliary can only cover a limited area of activity, and her effort has to be used where the need seems greatest. Accordingly, among others, the children attending special schools have seemed especially in need of this extra care. Children do not seem to lack toothbrush and paste, this is now rarely the case, but they are too lax and ill instructed in using them. 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. Outbreak of Typhoid Fever A 14 year old boy attending one of the council schools was diagnosed as suffering from typhoid fever on the 23rd December 1967. He had last attended school on the 15th December and 34 class pupils and teachers were excluded from school until they were shown to be free from infection by laboratory tests. Obtaining the necessary specimens proved difficult as the school was closed for Christmas holidays and the teachers in particular were dispersed. Consequently, none of the teachers and only 12 of the children had been cleared by the commencement of term on the 9th January, but all were subsequently cleared. 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 Health Visitors now undertake regular sessions of Health Education in both junior and senior schools. Those involved with senior school talks have been on day-release courses in Health Education Teaching at Chiswick Polytechnic. School Leavers' Course Southall Grammar Technical School held its first school leavers' course for 90 pupils in July, and the Health Department was invited to assist. Members of the Health Department gave lectures and the course ended with a series of discussion groups and an open forum. SCHOOLGIRL MOTHERS 8 cases were referred to the School Health Service during the year of which three girls did not return to school after their confinements. 43. 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 Intelligence Quotient 'score' which decides the issue, but the generally accepted standard is as follows:- I. Q. 'Score' Normal schooling above 75 Education at a school tor the educationally sub-normal 75 - 50 Unable to benefit from education below 50 The purpose of this is to ensure that, if suitable, the children shall receive alternative training at junior training schools. The number who were assessed as unable to benefit from education during the was three. There is a total of 88 children of school age in junior training schools. RECUPERATIVE CARE Under Section 48 of the Education Act, arrangements are made on the recommendation of a doctor for convalescent holidays, without charge, for school children. During 1968 recuperative care was arranged for 34 school children. Where a mother has been ill, arrangements can be made for her to be sent away with her children, In these cases the mother and children under school age are assessed according to the family income and a charge made which is up to £5.15. 0. per week for the mother and up to £3. 3. 0. for the children. 44. 20. GENERAL ENVIRONMENTAL HEALTH MEASURES NUISANCES AND COMPLAINTS During the year, 6,341 complaints were received, the main categories of complaint being as follows:- Housing defects 1,270 Dustbins and refuse 518 Drainage 1,344 Animals, etc. 36 Insects and wasps 235 Food 341 Smoke emissions and bonfires 207 Overcrowding and multiple occupation 175 Noise 154 Rats and mice 1,699 Miscellaneous 362 6,341 Action taken as a result of complaints resulted in 6,925 inspections of premises of all types and the service of 1,699 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 634 statutory notices in cases where action to remedy defects was not readily forthcoming and in the case of 19 premises, legal proceedings were necessary, involving the service of 21 summonses. Of these 21 cases, 7 were withdrawn before the hearings on compliance, and on payment of agreed costs to the Council. Nuisance Orders were made in 9 cases and defendants ordered to pay costs, and fines and costs were imposed in 4 other cases. In the remaining case, a Public Health Inspector was granted an entry warrant as a result of obstruction on the part of an occupier. Total fines imposed amounted to £33. and costs to £66. 3s. Od. The owner of a house in Acton appealed to the Middlesex Quarter Sessions against conviction and fines imposed during 1967, for failure to comply with a Nuisance Order. In this case the original fine of £50. was reduced to £5. and costs of £10. 10s. Od. cancelled. A total of 3,519 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 957 drains and water closets, abatement of dampness in 331 cases, the removal of 263 accumulations of refuse and the repair of 329 walls and ceilings, and 317 roofs. 45. 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 5,277 feral pigeons. CARAVAN SITES AND CONTROL OF DEVELOPMENT ACT, 1960 The Council's warden continued to deal with gipsies and other travellers who entered the borough from its western boundaries and parked their vehicles on service roads in the Western Avenue and Yeading Lane areas. His co-operation with the local police resulted, in most cases, in a satisfactory removal of the vehicles within a short time. There is no doubt that without this degree of control, the caravans would remain for long periods on sites which are quite unsuitable for camping, with consequent creation of nuisance. Two licences for caravans with planning permission were renewed during the year. RENT ACT , 1957 The number of applicantions for certificates of disrepair from tenants of properties still under control remains small. The following table gives details of action taken during the year. Part 1 - Applications for Certificates of Disrepair (1) Number of applications for certificates 11 (2) Number of decisions not to issue certificates - (3) Number of decisions to issue certificates:- (a) in respect of some but not all defects 6 (b) in respect of all defects 3 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 5 (5) Number of undertakings refused by Local Authority under proviso of paragraph 5 of the First Schedule - (6) Number of certificates issued 4 Part 11 - Application for Cancellation of Certificates (7) Applications by landlords to Local Authority for cancellation of certificates - (8) Objections by tenants to cancellations of certificates - (9) Decisions by Local Authority to cancel in spite of tenant's objection - (10) Certificates cancelled by Local Authority - 46. RADIOACTIVE SUBSTANCES ACT, 1960 Persons who use radioactive material, unless specifically exempted, are required to be registered by the Minister of Housing and Local Government, who notifies local authorities. A visit is then made by the public health inspector to obtain detailed information concerning safety precautions so that such information is available locally in the event of an accident. Two new premises were registered during the year to bring the total in the borough to 23. 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. During the year, 236 premises were inspected and at the end of the year there were 1,276 on the register. In no case was it found necessary to institute proceedings to remedy the defects found. The Council is also responsible for the inspection of the houses of outworkers, i. e. persons employed by factories in their own house. 55 visits of inspection were made and conditions were found to be satisfactory, except in one case. Statistical information concerning the Factories Act is given in tables 2, 3 & 4. 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. Inspections were made on 9 occasions when conditions were found to be satisfactory in all cases. NOISE ABATEMENT ACT, 1960 Complaints of alleged noise nuisance received during the year totalled 154 an increase of 50% on the number for the previous year. The complaints again referred to noise from industry, commerce, neighbours, road traffic, road drills, and the practice sessions of "pop" groups. On investigation, it was found that approximately 56% of the complaints referred to noise coming from industrial and commercial premises and that about 63% of these were valid complaints. Of the complaints of noise from other sources, about 60% were complaints which could be supported by the Department. 47 The number of complaints about noise from road drills increased slightly probably because of extensive work carried out by one of the public utility companies, but in only a few cases was it noted that silencers or mufflers were not in use and in these instances the mufflers were soon fitted when attention was drawn to the deficiency. Of the total number of complaints, 91 were abated without having to use statutory action, 52 were held not to be nuisances although in most cases efforts were made to achieve a reduction of noise at source. 10 cases were still under investigation at the end of the year. 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, 3, 048 premises were registered by the Council under this Act, there having been 412 additions to the register, and 450 deletions. Inspection of premises to which the Act applied continued at a very satisfactory pace with 1,371 general inspections and a total of 2, 965 visits of all kinds. Occupiers are responsible for notifying accidents to their employees which result in absences of three days or more from normal work. During 1968, 111 accidents were reported. The following table gives an analysis of reported accidents according to their primary cause. Primary Cause Adults 18 and over Young Persons under 18 Total Males Females Males Females Power machinery in motion 2 2 1 - 5 Power machinery at rest - 1 - 1 2 Vehicles moved by power 5 - - - 5 Vehicles at rest 2 - - - 2 Falls on or from stairs - 6 - - 6 Falls on or from ladders 1 3 - - 4 Other falls from one level to another 3 2 - 1 6 Falls on same level 5 8 - - 13 Stepping on or striking object or person 3 7 - - 10 Handling goods 26 16 4 - 46 Struck by falling object 2 2 1 - 5 Use of hand tools 4 - 2 - 6 Fire 1 - - - 1 Totals 54 47 8 2 111 48. Prosecutions During 1968 there were six successful prosecutions for a variety of offences under the Act and Regulations made under it, and two further cases were withdrawn. The total fines in these cases amounted to £295. 0. Od. and costs of £98.14s. Od. were awarded to the Council. Registrations and General Inspections Class of Premises No. of premises newly registered during year Total No. registered at end of year No. of registered premises receiving one or more general inspections during the year Offices 112 733 394 Retail shops 238 1,987 803 Wholesale shops, warehouses 19 104 59 Catering establishments open to public, canteens 43 222 115 Fuel storage depots - 2 - Totals 412 3, 048 1,371 No. of visits of all kinds by inspectors to registered premises - 2, 965 Analysis of persons employed in registered premises by workplace Class of workplace Number of persons employed Offices 12,266 Retail shops 10,067 Wholesale departments, warehouses 2,397 Catering establishments open to public 1,712 Canteens 144 Fuel storage depots 9 Total 26,595 Total males 11,984 Total females 14,611 49. Contraventions remedied Items No. of Improvements Premises cleansed 173 Overcrowding abated 4 Temperature improved 23 Thermometers provided 79 Ventilation provided or improved 42 Lighting improved 13 Lighting apparatus repaired 2 W. C. accommodation increased 10 Washing facilities increased (basins) 31 Ho.t and cold water provided 72 Drinking water provided 1 Drinking vessels provided 1 Accommodation for clothing provided or improved 19 Facilities for drying clothing provided 4 Sitting facilities provided or improved 3 Floors, stairs, passages etc. repaired 41 Handrails provided 26 Staircase guards provided 8 Machinery guarded 33 First aid boxes provided or refilled 159 Window skylights cleaned 1 FAIRS AND CIRCUSES Fairs were held during the year at Ealing Common, Acton Park, and at Northolt. The Council now have as standard in any agreement with fairmen clauses requiring satisfactory sanitary arrangements. These include provisions relating to the number, type, lighting, condition and location of trailers used as sanitary conveniences, and resulted in a satisfactory standard being maintained during the year. Food stalls were numerous on the sites and standards here were also found to be reasonable. DISINFECTION AND DISINFESTATION The amount of work connected with disinfestations for the eradication of bed 50. bugs continues to decline and heavy infestations are now rarely found. Disinfestation measures were taken in 30 houses, following complaints of bed bugs and other insects 220 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 187 houses, after cases of illness, was carried out, mainly as a result of special requests from the occupiers. 120 articles were disinfected by steam at the Cleansing Station at Scott's Road, W. 12. by arrangement with the London Borough of Hammersmith. PREVENTION OF DAMAGE BY PESTS ACT, 1949 The following is a summary of the work carried out by the rodent operatives:- Complaints received 1699 Premises inspected 1951 Premises found to be infested with:- (a) rats 907 (b) mice 605 Re-visits to infested premises 5794 Fees received for treatment £1621 Rodent Control in Sewers During the year, approximately 2880 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. INSPECTION OF HAIRDRESSING ESTABLISHMENTS In September of 1966 new Bye-laws came into operation concerning Hairdressers and Barbers. These were made under Section 77 of the Public Health Act, 1961. Since then 233 premises have been placed on our register and 82 were inspected in 1968. Premises have, on the whole, been found to be satisfactory, and only minor deficiencies discovered. 51. 21. 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 plumbosolvent action. Water from public mains was supplied to 91,189 dwellings with a mid-1968 estimated population of 298,720. Private supplies are derived from wells at factories in the borough. In these factories water is obtained from deep borings ranging in depth from 300 to 600 feet. Of 87 samples of water from these wells submitted for bacteriological and chemical examination during the year 7 were found to be unsatisfactory and 2 doubtful. After thorough cleansing and sterilization of supply pipes, repeat samples proved to be satisfactory. As a result of complaints, 26 samples of tap water from public supplies were taken and 6 proved unsatisfactory. Water Samples, 1968 Samples Satisfactory Doubtful Unsatisfactory Well Supplies 87 78 2 7 Public Supplies 26 20 - 6 Totals 113 98 2 13 SWIMMING BATHS The Council has public swimming baths at Ealing , Acton, Southall and Northolt. In addition, at four of the Council's schools there are swimming pools, and there is also a pool at one direct grant school. A private private bath 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. 52. A total of 249 samples was taken of which only 9 were unsatisfactory. In the latter cases repeat samples were found to be acceptable and advice was given where necessary. The results are as follows:- Number of pools Satisfactory samples Unsatisfactory samples Total samples Public baths 11 109 1 110 School baths 5 97 3 100 Private baths 1 34 5 39 Totals 17 240 9 249 The Council's analyst also carried out detailed chemical and bacteriological examination of swimming bath water at intervals with the following results:- Number of pools Satisfactory samples Unsatisfactory samples Total samples Public baths 11 102 1 103 School baths 5 30 1 31 Private baths 1 6 - 6 Totals 17 138 2 140 The two unsatisfactory samples were found to be acceptable on bacteriological examination but had free chlorine contents which were too high. 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. 38 premises are not connected to main sewers, 28 of which are drained to cesspools or septic tanks. The remaining 10 are served by chemical or pail closets. FLUORIDATION OF WATER SUPPLIES In 1965 the Council approved the addition of fluoride to the public water supplies in the Borough. It has still not been possible to implement this decision as unanimity between the Greater London local health authorities has not been reached and the Government has not introduced legislation. 53. 22. 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, 1956, as amended by the Meat Inspection (Amendment) Regulations, 1966. POULTRY INSPECTION There are no poultry processing and packing premises in the borough. DISEASES OF ANIMALS ACT, 1950 Outbreak of Foot-and-Mouth Disease On the 18th November, 1967. the Minister of Agriculture, Fisheries and Food made a special Order declaring the whole of England and Wales to be a Controlled Area which meant that no movement of animals could take place except under licences issued by local authorities under the Diseases of Animals Act. This Order was finally revoked on 13th February 1968. Special arrangements were made for licences to be issued for the movement of pigs into a large slaughterhouse inside the borough, and with special routes, where necessary, to avoid travel through Infected Areas. Licences were refused for movements from Infected Areas, all of which were plotted on maps, as and when Infected Area Orders were made by the Minister. The Council's duties included the checking and collection of licences on the arrival of animals at the slaughterhouse, the ante-mortem inspection of the animals the cleansing and disinfection of all vehicles and the disposal of straw and refuse. Whilst the Order was in operation 6,268 licences were issued involving the movement of 145, 094 pigs and the cleansing and disinfection of 3,244 vehicles. The weekly market, held on Wednesdays at Southall, was also subject to special licence conditions, with separate licences under the Order required for all inward and outward movements. Special conditions included the requirement that all animals brought to the market were to be sent to a slaughterhouse and not permitted to return to the farms from which they originated, and also the requirement that they be slaughtered within 36 hours of arrival at a slaughterhouse. Visits were also made to all animal stockholders in the Borough to advise them about the restrictions and also as to the need for the proper boiling of waste food. Southall Market Mr. J. A. Morris, M. R. C. V. S. , continued in his duties under the Act at Southall Market and 54. authorised 49 market sales under the Regulation of the Movement of Swine Order, 1959, and issued 489 movement licences authorising 9,672 pigs to be moved out of the market. Of 57 vechicles inspected, no contraventions were found. DISEASES OF ANIMALS (WASTE FOODS) ORDER , 1957 Three plants are still in operation and are working satisfactorily. SLAUGHTER OF ANIMALS ACT, 1958 17 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 10 occasions during the year. PET ANIMALS ACT , 1951 Licences in respect of 22 premises were renewed. The number of routine inspections was 31. 55. 23. HOUSING UNFIT HOUSES (a) Clearance Areas The following progress was made during the year in connection with the Council's programme for 1965 - 1970 1-14 (consecutive) Buckingham Terrace and and 1,2 & 3 Clearview Cottages, Southall. 89-99 (odds) High Street and 1, 2, 3 & 4 Park View Road, Southall. 6-13 (consecutive) Oldham Terrace, 1-14 (consecutive) Mill Hill Terrace, 1-7(consecutive) Princes Terrace and 1 & 2 Priory Cottages, Princes Terrace, W. 3. 1-9 (consecutive) Oak Street, 20-24 (consecutive) Baker's Lane, 1 & 2 Grove Place, 1-4 (consecutive) Paddock Place, 27-37 (odds) Baker's Lane, 26-60 (evens) Baker's Lane, W.5. and 17a & 17-23 (odds) The Grove, W.5. 63-89 and 63a-89a (odds) Dudley Road, Southall. 1-8 (consecutive) and 11-16 (consecutive) Nelson Place and 17-27 (odds) and 43-49(odds) Steyne Road, W. 3. Remaining occupants rehoused and premises demolished following Compulsory Purchase Order made in 1966. Remaining occupants rehoused and premises demolished following Clearance Order made in 1966. Compulsory Puchase Order made in 1967, confirmed after Public Inquiry. Rehousing of occupants commenced. Compulsory Purchase Order made in 1967. Public Inquiry held. Confirmation by Minister of Housing and Local Government still awaited. Compulsory Purchase Order made in 1967, confirmed after Public Inquiry. Rehousing of occupants commenced. Clearance Order made and submitted to Minister of Housing and Local Government. (b) Individual Unfit Houses and Parts of Houses 110 Western Road, Southall. Closing Order made and tenant rehoused. 28 Lancaster Road, W. 5. Closing Order made; tenant awaiting rehousing. 87 York Road, W. 3. (2nd floor) Closing Order made but later determined following completion of works. 5 Castlebar Mews, W. 5. Closing Order made and tenant rehoused. 56. 30 Harewood Terrace, Southall Closing Order made and tenant rehoused. 37 Boston Road, W. 7 1 & 3 Spooner's Mews, W. 3 Green Man Lane, W. 13 Demolition Order made and tenant rehoused. Closing Orders made; tenants awaiting rehousing. Closing Order made in 1965 determined on completion of works. (c) Underground Rooms The following action was taken during the year:120 Boston Road, W. 7 (Basement) 65 Uxbridge Road, W. 7 (Basement) 46A Windsor Road, W. 5 (Basement) 75 Mattock Lane, W. 5 (Basement) Closing Order made in 1967 determined on completion of works. Closing Order made and tenant rehoused. Undertaking given in 1964 not to use for human habitation cancelled on completion of works. Closing Order made in 1964 partially determined on completion of works. HOUSES IN MULTIPLE OCCUPATION Details of action taken over the last six years in connection with houses in multiple occupation in the area which is now the London Borough of Ealing are given on the next page. 57. Action taken Totals for years 1963-1967 1968 Totals Acton Ealing Southall Acton Ealing Southall Directions given (Section 19 Housing Act, 1961 9 40 1072 8 31 206 1374 Prosecution for contravention of Directions - - 89 - - 10 99 Notices to improve facilities and means of escape from fire (Sections 15 and 16 Housing Act, 1961) 138 129 - 81 59 6 413 Prosecution for failure to comply with notices served under Sections 15 and 16 of Housing Act, 1961 - 2 - - - - 2 Overcrowding notices (Section 90 Housing Act, 1957) 3 1 27 2 1 7 41 Prosecution for contravention of overcrowding notices - - 96 - - - 96 Notices requiring information as to occupants (Section 19 Housing Act, 1961) 4 40 1626 9 39 285 2003 Prosecutions for failure to supply information as to occupants - - 14 - 3 2 19 Prosecutions for false information - - 1 - - - 1 Prosecution for failure to supply information as to ownership - - - 2 - - 2 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 1968 2665 58. Details of overcrowding under Section 90 of the Housing Act, 1957:- Number of dwellings overcrowded at end of year 4 Number of families occupying these houses 11 Number of individuals living in these houses 55 Number of new cases of overcrowding reported during the year 10 Overcrowding relieved during the year (a) Number of cases 10 (b) Number of individuals involved 132 Of the 10 prosecutions for contraventions of the terms of Directions given under Section 19 of the Housing Act, 1961, 9 were successful and 1 case was dismissed. Fines, totalling £104, were imposed in these 9 cases and a total of £35. 14s. Od. costs awarded to the Council. Fines ranged from £2 to £25 and costs from £2. 2s. Od. to £10. 10s. Od. There were 5 prosecutions for failure to supply information as to occupants, contrary to Section 19 of the Housing Act, 1961, which resulted in total fines of £14 and costs of £9. 9s. Od. One of these cases was withdrawn on payment of the Council's costs, and on compliance with the notice prior to the hearing. There were also two prosecutions for failure to comply with notices under Section 170 of the Housing Act, 1957, requiring information as to ownership. One case was withdrawn when the information was given and in the second case costs of £6. 6s. Od. were awarded to the Council, but no fine imposed. 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. 59. 24. CLEAN AIR The Council's policy of establishing Smoke Control areas to cover the whole borough by 1972 was continued during the year and seven further Orders were made. These related to Areas Nos. 36-42 inclusive covering 1,269 acres, including 11,706 dwellings and 469 other buildings. Orders Nos. 35-40 were confirmed to come into operation on 1. 10. 68, 1. 12. 68, 1. 12. 68, 1. 6. 69, 1. 7. 69 and 1. 8. 69 respectively and Orders Nos. 41 and 42 were awaiting confirmation at the end of the year. Orders Nos. 31-35 made in 1967 also became operative in 1968. A survey of Area No. 43 was completed and preliminary work on Nos. 44 and' 45 had 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:- Position at 31st December 1968 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" 698,201 38.28 3,756,149 48.31 Greater London 213,164 65. 18 1,910,632 72.39 London Borough of Ealing 10,949 79. 80 82,444 82. 06 60. Progress of Smoke Control Programme in Ealing No. of Smoke Control Orders Acres No. of dwellings No. of other buildings Total Premises Private Local Authority In operation 54 10,108 60,850 8,839 3,607 73,296 Confirmed but not yet in operation 3 597 4,851 419 210 5,480 Awaiting confirmation 2 244 3,424 101 143 3,668 Totals 59 10,949 69,125 9,359 3,960 82,444 London Borough of Ealing - Smoke Control Areas (coloured yellow on map). SMOKE CONTROL ORDERS Acton Nos. 1 - 11 Ealing Nos. 1-20 Southall Nos. 1-6 Ealing Nos. 21 - 25 Ealing Nos. 26 - 30 Ealing Nos. 31 - 37 Ealing Nos. 38 - 40 Ealing Nos. 41 - 42 Ealing No. 43 YEAR OF OPERATION 1960 - 1965 1966 1967 1968 Made and confirmed in 1968 but not coming into operation until 1969. Made in 1968 but awaiting confirmation by the Ministry of Housing and Local Government. Survey complete. 61. Yellow - Smoke Control Areas in The London Borough of Filling. Red - Smoke Control Areas in adjoining districts. Green - Proposed Smoke Control Areas in adjoining districts. MEASUREMENT OF AIR POLLUTION Daily volumetric instruments for measuring smoke and sulphur dioxide in the air and deposit gauges for monitoring local emissions were maintained in operation during the year. The overall figures for the daily volumetric instruments show an average reduction compared with last year of 1% in the amount of smoke but an increase of 8% in the amount of sulphur dioxide in the air. The deposit gauge figures show an overall 19% increase in solid deposit in the air. 63. 25. FOOD HYGIENE AND FOOD AND DRUGS ADMINISTRATION CLEAN FOOD SCHEME The Council's Clean Food campaign was continued during the year, 15 lectures being given to a total of 298 food handlers, and certificates of attendance awarded to those who completed the courses. In addition, 10 lectures were given by public health inspectors to 227 members of women's organisations, and 16 lectures to 649 school children approaching school leaving age in the secondary schools. 15 filmstrips were sold to other local authorities. INSPECTION OF FOOD PREMISES A total of 3, 640 visits was made to 2,551 premises in the borough, and 1,705 improvements effected as a result of these visits. Two prosecutions for flagrant contravention of the Food Hygiene (General) Regulations, 1960, were taken during the year. In the first case the proprietor of a cafe was convicted on 38 summonses and was fined £76 and costs of £7 7s. were awarded to the Council. In the second case a cafe proprietor was summonsed on 18 counts, one of which was withdrawn. On the remaining 17 counts he was convicted and fined £85 with £52. 10s. costs to the Council. Table 5 gives details of the number of food premises in the borough according to particular category of use. THE FOOD HYGIENE (MARKETS, STALLS & DELIVERY VEHICLES) REGULATIONS, 1966 Six certificates of exemption from the provisions of the Regulations relating to water supply and washing facilities were granted by the Council during the year, as satisfactory alternative facilities were available in adjoining premises. MILK AND DAIRIES (GENERAL) REGULATIONS, 1959 During the year, 22 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 two dairies and 163 distributors of milk in respect of 243 premises. 47 samples of washed bottles were taken at random from a bottling plant at one dairy, of which 46 were found to be satisfactory and one unsatisfactory. The second dairy is mainly concerned with the pasteurising and packing of cream in plastic containers. In spite of all the precautions taken by dairy firms 19 complaints were received from members of the public concerning the sale of milk in dirty bottles containing foreign bodies. There were 2 prosecutions involving total fines of £25 and costs of £11 11s. 64. THE MILK (SPECIAL DESIGNATION) REGULATIONS, 1963 AND 1965. During the year 22 new dealer's (pre-packed milk) licences were issued, and 149 distributors and 2 pasteurisers, involving 228 premises were on the register at the end of the year. Informal samples of milk 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:- Class of milk No. of Samples Phosphatase Test Methylene Blue Test Turbidity Test Colony Count Test Pass Fail Pass Fail Pass Fail Pass Fail Pasteurised 43 43 -- 43 -- - - - - Sterilised 7 - - - - 7 - - - Untreated - - - - - - - - - Ultra Heat Treated 3 - - - - - - 3 - Totals 53 43 - 43 - 7 - 3 - RAW MILK SUPPLIES - BRUCELLA ABORTUS There is only one farm engaged in milk production in the borough. As a result of a request from the Public Health Laboratory Service, sampling of raw milk for the detection of brucella abortus organisms was carried out directly from the farm during 1968. A total of 33 samples was taken and all were found to be negative for this organism by the ring test ICE CREAM During the year 11 premises were added to the register for the sale and storage of ice cream and two for manufacture leaving a total at the end of the year of 533 premises registered for sale and storage and seven 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: - 65. Commodity Number 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) 277 163 55 43 16 - 218 43 16 Ice Cream (other manufacturers) 44 19 10 4 11 - 29 4 11 Ice Lollies (local manufacturers) 24 - - - - 24 24 - - Ice Lollies (other manufac turers) 19 - - - - 19 19 - - Totals 364 182 65 47 27 43 290 47 27 The above table includes:- Ice Cream samples from vans 30 17 6 2 5 - 23 2 5 Soft ice cream samples 66 30 13 6 17 - 43 6 17 The largest proportion of 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 is still one manufacturer 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 mixtures is then pasteurised. The bacteriological examination of 67 samples was made and all were found to be satisfactory. The producer concerned continued to maintain a high standard of hygiene and quality control. 66. 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 libs Meat and meat products 1,884 Fish and fish products 382 Fruit and vegetables 1,157 Groceries 1,107 Foodstuffs not calculated by weight Assorted tins, packets, jars, bottles, articles, casks and boxes 44,437 REGISTRATION OF HAWKERS OF FOOD AND THEIR FOOD PREMISES In accordance with the requirements of Section 11 of the Middlesex County Council Act, 1950, 4 hawkers were registered during the year leaving a total of such traders on the register at the end of the year at 44. PREMISES REGISTERED FOR PREPARATION OF SAUSAGES AND PRESERVED FOODS Two 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 180 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 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, fertilisers 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 800 samples comprising 17 formal and 783 informal samples of food and drugs were taken and submitted to the Public Analyst for examination, which is in accordance with the Ministry recommendation. Of the 800 samples examined, 43 were found to be unsatisfactory. There were several cases which are worthy of mention, where compositional standards and other similar requirements were below the specified minima. Sampling of dried milk revealed one product containing 7. 4% of moisture which is in excess of the 5% permitted by the Dried Milk Regulations, 1965. Legal proceedings were taken and a fine of £30 imposed and costs of £3. 3s. Od. were awarded to the Council. Informal sampling 67. of minced beef at a butcher's shop revealed the presence of sulphur dioxide which is not permitted by the Preservatives in Food Regulations, 1962. A subsequent formal sample was also proved on analysis to contain sulphur dioxide as a preservative, contrary to the Regulations, and legal proceedings were taken. The Magistrates imposed a fine of £15 and awarded £5. 5s. Od. costs to the Council A successful prosecution followed the sale of sausage meat deficient in meat content, resulting in a fine of £20 and the award of £8. 8s. Od costs to the Council. Sampling of certain imported foods also revealed the presence of a preservative, Benzoic acid, which is not permitted in this country in specified foods. The food articles concerned were egg, vegetable and fish products, all of which had been imported from Germany where the use of this preservative is permitted. Consultations were held with the importers concerned, resulting in agreement being reached on future importations. The difficulty which importers face in attempting to comply with the multiplicity of food legislation would be eased if general international standards could be agreed and adopted. The Colouring Matter in Food Regulations, 1966, do not apply to drugs. It is Considered , however, that in general, drugs intended for internal use should not contain colouring matter which is specifically prohibited in foods. Sampling of one drug revealed the presence of a colouring matter, Rhodamine B, which is not permitted in food. In this case the manufacturer was co-operative and agreed to discontinue the use of this colour and replace it with one which is acceptable under the Regulations. 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, and the labelling provisions of other Regulations Irregularies in labelling were discovered in 84 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:- BACTERIOLOGICAL EXAMINATION OF OTHER FOODS In addition to the bacteriological examination of particular types of foods referred to in earlier paragraphs of this report, 82samples of frozen seafoods of a wide variety were submitted to the laboratory. The samples were from consignments imported into the Borough and released from the Port of London without examination Articles of food which were the subject of consumer complaints numbered 2 but no harmful organisms were found on examination Incorrect or inadequate description No name and address Incorrect or inadequate list of ingredients 9 12 6 15 7 25 4 6 No list of ingredients Misleading statements Use of generic terms Inadequate size of printing Incorrect statutory declaration 68. A bacteriological examination of pet food sold in this Borough was made. Seventy-four samples of raw and processed food were obtained, of which eleven (fifteen per cent.) were unsatisfactory in that pathogenic organisms were found. The traders were informed in each case so that adequate precautions could be taken to prevent cross contamination from the raw food to cooked or processed food and to the handlers. FOOD COMPLAINTS Food articles purchased by members of the public were the subject of 159 complaints received by the Health Department and all were thoroughly investigated. 27 of the articles were submitted to the Public Analyst for his opinion. Complaints of particular interest included such articles as a jar of honey containing glass, a steak and kidney pie containing a piece of hide, a tin of prunes containing a strip of steel and a nail, and several loaves of bread with such articles as screws and nails. Prosecutions were taken in 14 cases, all of which were successful, fines ranging from £20 to £10 being imposed and totalling £260 with £96 12s. costs to the Council. PESTICIDES SURVEY The Council continued 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 6 samples was purchased before the end of the year. The food articles concerned were specified types of pears, lettuce, pork, bacon, pork sausages and infant meat food. No sample showed a significant amount of pesticide. 69. 26. 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, eight nursing homes were registered with a total of 275 beds. Visits are regularly made to all nursing homes to ensure that they maintain satisfactory standards. 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 29 establishments used by licensed persons in the borough as follows:- Chiropody only 12 Chiropody and special treatment 6 Massage only 2 Massage and special treatment 1 Physiotherapy and special treatment 1 Osteopathy 3 Beauty treatment 4 Boards were set up under the Professions Supplementary to Medicine Act, 1960, and registers were compiled of those medical auxiliaries considered to be suitably qualified. People registered are entitled to use the designation "state registered". 70. 27. 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. 658 bodies of residents from the following areas were taken to the mortuary:- Ealing 547 Hillingdon 14 Richmond upon Thames 17 Hounslow 32 Other London Boroughs 32 Other areas 16 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, and he in turn accepts Hammersmith bodies in the absence of their mortuary attendant. 71. 28. MEDICAL EXAMINATION AND WELFARE OF STAFF MEDICAL ASSESSMENTS Total number of questionnaires assessed for fitness for employment 3,175 Number of medical examinations required following questionnaire assessment 338 Number of failures as a result of medicals following questionnaire assessment 12 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 1968 was as follows:- Vaccination against smallpox 51 Immunisation against typhoid fever 9 Immunisation against typhoid/tetanus 40 Immunisation against tetanus 12 112 FIRST AID During the year 890 attendances for treatment were made. 72. 73. Table 1 INFECTIOUS AND OTHER NOTIFIABLE DISEASES CLASSIFIED IN AGE GROUPS Numbers originally notified Scarlet Fever Whoopingcough Measles Dysentery Acute Meningitis Malaria M F M F M F M F M F M F 66 65 66 69 381 341 75 66 4 - 5 - Final numbers after correction Under 1 year 3 - 8 6 17 11 3 2 _ - _ - 1 - 2 - 2 5 38 48 13 3 - - - - 2 - 5 3 9 7 52 51 2 4 - - - - 3 - 4 9 8 13 61 50 4 6 - - - - 4 - 7 9 11 6 72 59 - 3 - - - - 5-9 32 35 21 26 126 112 10 11 3 - 1 - 10 - 14 4 6 6 2 3 6 2 5 - - 3 - 15 - 24 9 1 - 2 8 3 8 6 1 - - - 25 and over - 1 - 2 1 - 32 25 - - 1 - Age unknown " 1 1 ■" 3 1 1 - - - - Total 66 65 66 69 381 341 75 65 4 - 5 - 74. Table 1 continued *Pneumonia up to 1. 10. 68 Typhoid Fever Erysipelas up to 1.10 68 Food Poisoning M F M F M F M F Numbers originally notified 6 10 1 - 1 2 7 12 Final numbers after correction: Under 5 years - - - - - - 2 3 5 - 14 2 - 1 - 1 -- 1 3 15 - 44 3 4 - - - - 2 3 45 - 64 1 1 - - - - - - 65 and over - 3 - - - 2 - - Age unknown - 2 - - - - - - Total 6 10 1 - 1 2 5 9 75. Table 1 continued Tuberculosis Infective jaundice ^Puerperal pyrexia up to 1.10. 68 Pulmonary Meninges and central nervous system Other M F M F M F M F - Numbers originally notified 83 54 - - 23 30 34 16 2 Under 5 years 4 9 _ _ _ - - _ - 5-14 2 2 - - 1 1 13 7 -- 15 - 24 7 13 - - 4 9 11 8 2 25 - 44 33 17 - - 17 16 6 1 - 45 - 64 22 8 - - - 2 4 - - 65 and over 13 3 - - - 2 - - - Age unknown 2 2 - - 2 - - - - Total 83 54 - - 24 30 34 16 2 There were no cases of acute encephalitis, anthrax, cholera, diphtheria, leptospirosis, ophthalmia neonatorum, plague poliomyelitis relapsing fever smallpox tetanus, typhus and yellow fever. *The following diseases ceased to be notifiable as from 1st October, 1968 - acute influenzal pneumonia, acute primary pneumonia, acute rheumatism, erysipelas, membranous croup and puerperal pyrexia. Table 2 FACTORIES ACT 1961 - PART 1 Inspections for the purposes of provisions as to health (inspections made by public health inspectors). Premises (i) Factories in which sections 1. 2, 3 4 and 6 are to be enforced by local authorities Number on Register Number of Inspections Written Notices Occupiers prosecuted 12 3 1 - (ii) Factories not included in (i) in which section 7 is enforced by the local authority 1257 233 39 - (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 7 10 - - Total 1276 246 40 -- 76. Table 3 FACTORIES ACT. 1961 - PART 1 Cases in which defects were found Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred ToH.M. Inspector By H.M Inspector Want of cleanliness 11 11 - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation 1 1 - - - Ineffective drainage of floors - - - - - Sanitary conveniences: - - - - - (a) Insufficient - - - - - (b) Unsuitable or defective 24 24 - 9 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to outwork) 6 6 - - - Total 42 42 - 9 - 77. Table 4 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(l)(c) Wearing apparel: Making, etc. 84 Artifical flowers 6 Cosaques, Christmas stockings, etc. 105 Umbrellas, etc 3 Paper bags 2 Furniture and upholstery 1 Total 201 During the year, 55 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. 78. 79. Table 5 LIST OF FOOD PREMISES IN THE LONDON BOROUGH OF EALING Category of premises No of premises No. complying with Reg. 16 (Wash-hand basins, etc. ) No. to which Reg 19 applies (Sinks, etc ) No. complying with Reg. 19 (Sinks, etc. ) Bakehouses 31 31 31 31 Bakers' shops 76 76 - - Butchers 189 189 189 189 Cafes and restaurants 298 298 298 198 Canteens (industrial) 217 217 217 217 School kitchens and dining centres 102 102 102 102 Confectioners 374 374 - - Dairies 2 2 2 2 Food factories and stores 78 78 78 78 Food stalls 66 16 2 2 Fish fryers 39 39 39 39 Fishmongers 36 36 36 36 Greengrocers 212 212 175 175 Grocers 414 414 297 297 Hotels, nursing homes and old people's homes 59 59 59 59 Ice cream manufacturers 7 7 7 7 Licensed premises and clubs 299 299 299 281 Hawkers 44 14 9 9 Totals 2,543 2,463 1,838 1,800 1