SS Duplicate EAL 60 The Health of the London Borough of Ealing in the year 1969 EAL 60 Health of the London Borough of Ealing in the year 1969 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 Foreword 3 1. Vital Statistics 4 2. Infectious Diseases 7 3. Health Clinics 9 4. Day Care of Children 12 5. Care of the Unsupported Mother and her Child 13 6. Family Planning 14 7. Cervical Cytology 15 8. Midwifery 16 9. Home Nursing 17 10. Artificial Kidney Machines 18 11. Health Education 19 12. Recuperative Care 20 13. Chiropody 21 14. Tuberculosis Service 23 15. Mental Health 24 16. Home Help Service 26 17. Care of the Elderly 27 18. Immigration 28 19. School Health Service 30 20. General Environmental Health Measures 39 21. Water Supplies, Swimming Baths and Sewage Disposal 45 22. Meat Inspection and Animal Protection 47 23. Housing 48 24. Clean Air 52 25. Food Hygiene and Food and Drugs Administration 55 26. Registration of Premises used for Medical Purposes 60 27. Mortuary and Burial Arrangements 61 28. Medical Examination and Welfare of Staff 62 Tables 63-69 2 Mr Mayor, Aldermen and Councillors, There have been two developments in the health services of the Borough during the year on which I would like to comment. The first is the considerable progress which has been made towards the registration of child minders and the establishment of a satisfactory system of supervising them. I am, of course, aware of the great need for child minders in the Borough but I am anxious that this should not be an influence leading to any reduction of standards. I am confident that the dual aims of expansion and maintenance of standards can be achieved. The most important advance during the year has been the improved family planning facilities which resulted from the review carried out in 1968. These are now available at five of the Council's clinics, provided either by its own staff or by arrangements made with the Family Planning Association. In addition, a domiciliary service, clinics in association with hospital post-natal departments, and the Youth Advisory Service combined to make up a comprehensive scheme. Whilst I am sure that there is need for still further expansion in this field of maternal and child health, I feel our present service is a base from which this can satisfactorily take place. 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 1969) 297,910 Rateable value, 1st April, 1969 £24,148,363 Net product of a penny rate, 1969/70 £96,000 Live births:- Legitimate males 2,402 Females 2,399 Total 4,801 Illegitimate males 235 Females 207 Total 442 Birth-rate per 1,000 of estimated population 17.1 Illegitimate live births (per cent of total live births) 8% Still-births:- Males 28 Females 29 Total 57 Rate per 1,000 total births (live and still-births) 11 Deaths:- Males 1,802 Females 1,736 Total 3,538 Death-rate per 1,000 of estimated population 10.9 Deaths of infants under one year of age:- Legitimate males 50 Females 33 Total 83 Illegitimate males 4 Females 3 Total 7 Death-rates of infants under one year of age:- All infants per 1,000 live births 17.0 Legitimate infants per 1,000 legitimate live births 17.0 Illegitimate infants per 1,000 illegitimate live births 16.0 Neo-natal mortality rate (deaths under four weeks per 1,000 total live births) 11.0 Early neo-natal mortality rate (deaths under one week per 1,000 total live births) 11.0 Perinatal mortality rate (still-births and deaths under one week combined per 1,000 total live and still-births) 21.0 Maternal mortality (including abortion):- Number of deaths 1 Rate per 1,000 live and still-births 0.18 4 CAUSES OF DEATH Deaths 1969 Male Female Total Enteritis and Other Diarrhoeal Diseases 4 _ 4 Tuberculosis of Respiratory System 4 - 4 Other Tuberculosis, incl. late effects 2 1 3 Meningococcal infection 1 1 2 Measles - 1 1 Syphilis and its sequelae 1 - 1 Other infective and Parasitic Diseases 2 3 5 Malignant Neoplasm - Buccal Cavity 12 3 15 Malignant Neoplasm - Oesophagus 14 12 26 Malignant Neoplasm - Stomach 47 22 69 Malignant Neoplasm - Intestine 40 59 99 Malignant Neoplasm - Larynx 5 1 6 Malignant Neoplasm - Lung, Bronchus 160 44 204 Malignant Neoplasm - Breast 2 68 70 Malignant Neoplasm - Uterus - 13 13 Malignant Neoplasm - Prostate 28 - 28 Leukaemia 13 12 25 Other Malignant Neoplasms, etc. 100 114 214 Benign and Unspecified Neoplasms 6 2 8 Diabetes Mellitus 7 19 26 Avitaminoses, etc. 1 1 2 Other Endocrine etc. Diseases 3 6 9 Anaemias 2 8 10 Other Diseases of Blood, etc. - 1 1 Mental Disorders 10 17 27 Meningitis 1 2 3 Other Diseases of Nervous System, etc. 20 32 52 Chronic Rheumatic Heart Disease 13 30 43 Hypertensive Disease 35 29 64 Ischaemic Heart Disease 529 378 907 Other Forms of Heart Disease 48 108 156 Cerebrovascular Disease 137 220 357 Other Diseases of Circulatory System 79 99 178 Influenza 10 13 23 Pneumonia 114 188 302 Bronchitis and Emphysema 137 42 179 Asthma 5 3 8 Other Diseases of Respiratory System 17 15 32 Peptic Ulcer 14 8 22 Appendicitis 3 2 5 intestinal Obstruction and Hernia 4 9 13 Cirrhosis of Liver 3 5 8 Other Diseases of Digestive System 15 25 40 Nephritis and Nephrosis 11 5 16 Hyperplasia of Prostate 16 - 16 Other Diseases, Genito-Urinary System 11 12 23 Other Complications of Pregnancy, etc. - 1 1 Diseases of Skin, Subcutaneous Tissue 2 - 2 Diseases of Musculo-skeletal System 6 10 16 Congenital Anomalies 15 16 31 Birth Injury, Difficult Labour, etc. 17 7 24 5  Deaths 1969 Male Female Total Other Causes of Perinatal Mortality 11 15 26 Symptoms and Ill-defined Conditions 4 10 14 Motor Vehicle Accidents 21 11 32 All Other Accidents 21 20 41 Suicide and Self-inflicted Injuries 15 21 36 Ail Other External Causes 4 2 6 TOTALS 1, 802 1,736 3, 538 6 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 164 cases were notified during the year of which 53 were confirmed bacteriologically. In all these the organism was Shigella Sonne. FOOD POISONING 115 cases were notified of which 71 were confirmed bacteriologically. The organisms were as follows:- Salmonella Typhimurium 20 Other Salmonellae 51 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 year was 45 of which 23 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 One case was notified during the year, which was believed to have been contracted abroad. MEASLES 1,589 cases were notified during the year. ACUTE ENCEPHALITIS AND ACUTE MENINGITIS There were 10 cases of acute encephalitis and 8 cases of acute meningitis notified during the year. OPHTHALMIA NEONATORUM No cases were notified during the year. 7 POLIOMYELITIS No cases were notified during the year, this being the fifth consecutive year in which I have to report this happy state of affairs. PLAGUE No cases were notified during the year. SCARLET FEVER There were 109 cases notified during the year. SMALLPOX No cases were notified during the year. There were 51 people who arrived by air and 4 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 150 new cases of pulmonary tuberculosis and 56 new cases of nonpulmonary tuberculosis were notified. (The figures for last year were 137 and 54 respectively). TYPHOID FEVER No cases were notified during the year. PARATYPHOID FEVER During the year 3 cases of paratyphoid fever occurred. Two of the cases were in one family; a three-month-old boy and his sister aged 7 years. seven contacts were kept under surveillance and the usual exclusion measures were carried out. There were no further cases in the home. It transpired that the three-month-old boy was a "carrier". The third case was a three-month-old girl who although she became ill before the previous two cases may have been infected through contact with that family. Five contacts were kept under surveillance and no further cases developed. WHOOPING COUGH There were 46 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 16 health clinics sited to be reasonably accessible to every mother in the borough. By the end of the year the mobile clinic was being used for regular child welfare sessions at Brentham Estate, Steele Road, Acton, and Hanwell Community Centre. The clinic has proved popular with mothers who appreciate having such facilities near their homes. 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 Officers' 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 1969 were as follows:- 516 mothers attended medical officers' sessions for their ante-natal care. 291 mothers attended midwives' sessions for their ante-natal care. 1946 mothers attended ante-natal relaxation classes. 157 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 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:- (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, and the total at the 9 end of the year was 1,046. (ii) Guthrie Test - The "nappy test" of babies urine for phenylketonuria was superceded in November by the Guthrie blood test. This is done from a heel prick on the sixth day and so the responsibility for carrying out the test has transferred from the health visitor to the midwife. No positive tests were obtained. During the year 14,137 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 1969 were:- EXPECTANT AND NURSING MOTHERS Examined 172 Required treatment 169 Teeth filled 500 Teeth extracted 86 Dentures provided 4 PRE-SCHOOL CHILDREN Examined 1345 Required treatment 818 Teeth filled 1691 Teeth extracted 546 CO-ORDINATION AND CO-OPERATION OF HEALTH DEPARTMENT'S SERVICES WITH HOSPITAL AND FAMILY DOCTOR SERVICES During 1969 the scheme of attachment of health visitors, home nurses and midwives to the practices of family doctors was extended to cover Mattock Lane, Cherington House, Laurel House and Perivale Clinics. 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. VACCINATION AND IMMUNISATION Under Section 26 of the National Health Service Act, 1946, the Council provides vaccination and immunisation against the following diseases:- 10 Diphtheria Poliomyelitis whooping-cough Smallpox Tetanus Tuberculosis Measles The acceptance rates during the year (expressed as a percentage of total births) were:- Immunisation against diphtheria, whooping-cough and tetanus 70 Immunisation against poliomyelitis 63 Vaccination against smallpox 59 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 1179 1266 2445 Diphtheria/tetanus 592 41 633 Diphtheria 3 3 6 Tetanus 231 61 292 Poliomyelitis 2613 1281 3894 Measles 2099 937 3036 Reinforcing doses Diphtheria/whooping-cough/ tetanus 2268 817 3085 Diphtheria/tetanus 3147 564 3711 Diphtheria 3 6 9 Tetanus 312 238 550 Poliomyelitis 2862 1141 4003 Smallpox - vaccination and re-vaccination Vaccinated Re-vaccinated At clinics 3095 169 By general practitioners 1077 437 Total 4172 606 The schedule was amended this year in line with the recommendations made by the Department of Health and Social Security's Standing Advisory Committee. 11 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 46 play-groups in the borough, which included 10 which were registered for the first time during the year. Of the total, 28 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. CHILDMINDERS The registration of childminders under the revised legislation of the previous year continued and by the end of the year there were 227 registered childminders in the borough which included 193 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 ill-health. 3. where the child is handicapped. Particularly this applies to a physical handicap, impairment of hearing or sight, or when the child is maladjusted. 4. If the parents are deaf and dumb. The Council has five day nurseries with a total of 224 places, the details of which are given below:- Approved places Maximum number of places *1. 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 234 new admissions were made to day nurseries of which 18 were handicapped children. 12 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 161 unsupported mothers from Ealing, 30 from Hounslow and 39 from Hillingdon. The Council has its own mother and baby home to which the unsupported mother can be admitted, usually six weeks before confinement until 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. 13 6. FAMILY PLANNING Following a comprehensive review of the Family planning Service in the Borough increased provision in accordance with the recommendation of the Family planning Act 1967 was introduced this year, the expanded service now being:- (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 1969, 46 new patients were seen and a total of 322 visits were made to the clinic. (2) The Family Planning Association provides the following services:- (a) Sessions at Cloister Road, Northcote, Mattock Lane and Northolt Grange Clinics where the Council assists the Association by the free use of accommodation. (b) Sessions at Perivale Maternity Hospital. At all of the above sessions the Council meets the cost of women referred on medical and social necessity grounds. (c) The Family Planning Association runs 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. (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 30 patients. (e) A Youth Advisory Clinic was commenced in September and is held weekly at Mattock Lane Clinic to provide counselling and contraceptive advice for those aged 16 - 21 years. The clinic is staffed by a local authority doctor with post-graduate training in mental health, a psychiatric social worker and a Family Planning doctor and nurse appointed by the local branch of the Family planning Association. A consultant psychiatrist is available for consultation where necessary. Those persons eligible to attend must either be resident or attending a state-maintained educational establishment in the Borough. The advisory part of the service is given without charge but payment is requested for supplies. 14 7. CERVICAL CYTOLOGY This service is provided under Section 28 of the National Health Service Act, 1946. Cervical cytology facilities are 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 staffs at King Edward Memorial Hospital, Hillingdon Hospital and Central Middlesex Hospital. During the year 2,140 smears were taken. In the year two further large factories were visited when 527 women were screened, of whom 79 required surgical intervention or treatment. 15 8.MIDWIFERY In accordance with Section 23 of the National Health Service Act, the Council provides a staff of 18 midwives to undertake home confinements and to care for those mothers discharged early from hospital. The arrangement whereby this work is undertaken by the Council's own midwives in Ealing and Southall, and by Queen Charlotte's Hospital midwives in Acton, continued in 1969. 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 32 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 1965 942 4728 5670 1966 626 5039 5665 1967 599 5109 5708 1968 500 4907 5407 1969 406 4868 5274 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 conditi9ns 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:- 1965 1966 1967 1968 1969 511 718 674 679 858 16 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 47 nurses, including 3 male nurses. Patients are referred to the department either from hospitals (70%) or general practitioners (30%). The type of work ranges through short-term care of acutely ill patients, post-operative dressings and injections, the regular care of the aged and chronic sick, and finally to terminal care. The Home Nursing Service works in collaboration with two voluntary organizations. 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 3,135 articles loaned to patients during the year. The night nursing service still proves 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. During the year the establishment was increased by the addition of three nursing auxiliaries as bathing attendants. In-service training was given. 17 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 3 cases. The council had 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 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. 18 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 concentrated on a particular topic appropriate to the time of the year. Reports were published in the local papers of the monthly topics and there was also a display of aids for the handicapped during the month of October. The complete programme was as follows:- January - Cancer Prevention February - Care of the Eyes March - Dental Health April - Home Safety May - Water Safety June - Road Safety July - Food Hygiene August - Food Hygiene September - Immunisation October - Care of Physically Handicapped November - Winter and Fire Hazards December - No specific subject In addition to this, films were shown at various clinics and to members of the staff on the subject of birth control, foot health, child development, V. P., cancer prevention 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. Talks were also given to residents of Opmar House and Amherst Lodge. 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. 19 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:- 20 Number of applications received 92 Number of patients sent on recuperative care 53 Number of patients who did not avail themselves of the vacancy offered 18 Number of applications not approved 12 Unable to obtain vacancy 6 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 serv no certificate is required. Biritish Red Cross Society Southal1 Old People's Welfare Association London Borough of Ealing Total Total number of patients 428 167 4038 4633 Total number of new patients 33 10 979 1022 Total number of treatments at clinic 647 - 8068 8715 21  British Red Cross Society Southall Old People's welfare Association London Borough of Ealing Total Total number of treatments at private surgeries 738 401 - 1139 Number of patients receiving domiciliary treatment 181 97 918 1196 Number of domiciliary treatments 935 583 4573 6091 Percentage of total work which is domiciliary 40% 59% 36% 37% Expectant and nursing mothers - - 11 11 Physically handicapped persons 14 32 46 22 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 five tuberculosis visitors is a qualified health visitor and therefore able to carry out combined duties. 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 OP CASES Cases first referred during the year 126 Total cases 301 Tuberculosis patients 163 Cancer patients 70 Bronchitis and others 68 ACTION TAKEN Referred for employment 13 Pound employment 8 Referred to Social security for maintenance 14 Referred to Social Security for bedding 1 Referred to Social Security for clothing 2 Referred to Social Security for extra nourishment 4 Referred for Housing 44 Rehoused 14 During the year the Mass Radiography Unit of the North West Metropolitan Regional Hospital Board visited 48 sites within the area and examined 26,745 workers. Twenty cases of active pulmonary tuberculosis were discovered and eight cases of lung cancer. 23 Details of the work during 1969 are as follows:- TUBERCULOSIS HEALTH VISITORS Number of new tuberculosis cases 169 Number of old tuberculosis cases 2, 164 Transfers into borough 18 Number of contacts of new cases 1, 269 Successful visits to tuberculosis households 2, 423 Unsuccessful visits to tuberculosis households 479 Successful visits to other patients 244 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 transition 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. 57 patients attended during the year. Hostels Although the borough has no hostel for the mentally ill, 23 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-sitti*ng room accommodation. 24 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 three neighbouring boroughs of Hounslow, Hillingdon and Harrow who accommodated for us 83 children during the year. Adult Training Centre There is an adult training centre in the borough at Jubilee Gardens, Southall, which provides suitable work for 60 trainees. An annexe situated in Perivale Lane to accommodate 23 trainees was opened in July of this year. This annexe, although not in ideal surroundings, nevertheless provides valuable training for those for whom no other facility is available. Liaison with the Further Education Section of the Education Department has enabled us to develop suitable individual programmes for each trainee. 38 trainees were placed at centres in neighbouring boroughs, and in addition holidays were arranged for 36 trainees. Residential Accommodation Three children are at present accommodated in other local authority hostels. The Council's own 25 place hostel was opened in June of this year. It accommodates men and women who are able to work in outside employment or attend Adult Training Centres. Hosnitals 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 13 patients were admitted informally. There is a short 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 25 16. HOWE HELP SERVICE The Home Help Service is provided by the council under Section 29 of the National Health Service Act. Pour 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 tuberculous 2, 184 Maternity 147 Others 204 pamily help 13 The establishment of home helps is 260 which is partly filled by 327 part-time and 14 full-time staff to give an equivalent of 228 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 Kelps was increased during the year to 6.59/l0d. 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. 26 The types of disability which brought patients to the Centre were as follows: Diseases of the musculo-skeletal system 50 Diseases of the cardiovascular system 14 Diseases of the respiratory system 2 Diseases of the central nervous system 68 Diseases of the alimentary system 3 No major diagnosis or senility only 12 Others 24 Total 173 The following table shows the distribution of referrals during the year from the various parts of the borough:- Hanwell, W. 7 37 Ealing, W. 13 25 Ealing, w. 5 31 Greenford 21 Northolt 12 Perivale 7 Southall 33 Acton 7 Total 173 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 3 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. During the year this was necessary in 2 cases. On most occasions persuasion succeeded in obtaining agreement to voluntary admission. 27 17. CARE OF THE ELDERLY EALING DAY TREATMENT CENTRE ASSOCIATION 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, prom Health Department housing records it is estimated that this is now in excess of 16,000, and details of admissions during 1969 are given below. Country of origin No. of Persons Number Notified Contact Established Commonwealth Countries India 796 327 Pakistan 148 46 Other Asian 31 5 Caribbean 107 48 African 308 136 Other 108 33 Non-Commonwealth Countries Europe 17 3 Other 11 3 Totals 1, 526 601(39.3%) .The ports of arrival were as follows:- Country of origin No. of Persons London Airport Other ports Commonwealth Countries India 778 20 Pakistan 136 3 Other Asian 20 8 Caribbean 98 15 African 239 85 Other 80 24 Non-Commonwealth Countries Europe 1 4 Other 7 8 Totals 1,359 167 28 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 OP PULMONARY TUBERCULOSIS - SHOWING RATE PER 1,000 OF THE POPULATIONS OP THE FORMER BOROUGHS Area 1965* 1966* 1967* 1968* 1969* 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 of 1,000 pop. No. of Cases Rate per 1,000 pop. SOUTHALL 35 0.59 51 0.86 56 1.05 56 1.05 76 1.41 ACTON 23 0.36 33 0.52 27 0.42 23 0.37 19 0.29 EALING 71 0.39 47 0.26 59 0.32 58 0.31 55 0.30 TOTALS 129 0.43 131 0.43 142 0.48 137 0.46 150 0.50 NEW CASES OF PULMONARY TUBERCULOSIS IN THE FORMER BOROUGH OF SOUTHALL SHOWING RATE PER 1,000 OF THE POPULATION Year Total cases notified Indians and Pakistanis (Based sulely on names) Others 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 1965* 35 .6 25 4. 2 10 0.2 1966* 51 . 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 1969* 76 1.4 71 4.4 5 0.01 *The rate per 1,000 is based upon an estimated "breakdown" of the total borough population. 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:- 1968 1969 Total school population 41,998 42,295 Total immigrant population in schools 8, 346 8, 568 Indians and Pakistanis 4,626 4, 856 West Indians 2, 349 2, 399 Others 1,371. 1, 313 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 1969 show an improvement on previous years. 29 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) 9& years (junior school) and 14 - 1454 years (senior school leavers). The total school population at the end of the year was 42,295 and the details of examinations carried out are as follows:- First age group 4,813 Second age group 3, 132 Third age group 3,510 11,455 Classification of general condition: Satisfactory 11,327 98.89% Unsatisfactory 128 1. 11% Defects requiring treatment found at routine medical inspections: Skin 324 Vision 703 Squint 98 Hearing 32 Middle ear 164 Nose and throat 113 Speech 58 Enlarged glands 21 Heart 20 Lungs 46 Hernia 15 Orthopaedic: Postural 32 Feet 106 Epilepsy 10 30 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 in 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 16,323 Schools visited 139 Children with hearing loss 622 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 1969 34,199 examinations were carried out, 350 cases of infestation were found representing 0.96% of the children examined. Vision Testing Vision testing is carried out normally on five occasions during the child's school life, namely at five, seven, nine, twelve and fourteen years of age. Three of these examinations are linked with the routine medical examination, and school nurses make special visits to school for the other two. In special schools vision testing is carried out annually. 31 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 clincs 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 124 Laurel House 421 Avenue Road 1, 085 Mattock Lane 603 Cherington House 836 Northcote 613 Cloister Road 194 Northolt Grange 446 Greenford Green 190 Perivale 316 Islip Manor 386 Pierrepoint Road 602 Jubilee Gardens 562 Ravenor Park 841 King Street 383 Trinity Way 229 Asthma Clinics Special sessions for children suffering from asthma and bronchitis are held at 4 of the Council's clinics where group therapy is given under the guidance of a physiotherapist. These children have not developed good breathing habits and breathing exercises have been found to reduce the attacks of asthma and bronchitis. Asthmatic attacks understandably give rise to parental anxiety which often unfortunately cause the child to be 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 1,345 attendances were made. Chiropody Clincs 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. 32 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, most of this work has been taken over by clinic nurses. Details of attendances during 1969 are:- Verrucae Other chiropody New cases 632 125 Re-examinations 3,704 911 Total 4,336 1,036 Speech Therapy Clinics The following types of defect were encountered during the year:- Dyslalia (confusion of articulation) 335 Delayed development of speech and/or language 74 Aphasia or dysphasia (absence or disorder of speech and/'or language due to neurological causes) 23 Anarthria or dysarthria (neuro-muscular disorders of muscles of articulation) 7 Aphonia or dysphonia (disorders of voice) 8 Cleft Palate 12 Stammer 57 Dysenia (articulatory defect arising from hearing loss) 7 523 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 Islip Manor Clinic - Dr. M. Billinghurst, M.B., B.S., D.O.M.S. 1 session per month Ravenor Park Clinic - Dr. M. Billinghurst 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 our clinics and the local hospitals, and any operative or other treatment required can be readily obtained without a break in continuity. The figures for attendance are as follows:- 33 New cases 749 Re-attendances 2,473 Total 3,222 Glasses prescribed 300 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 12 550 Ravenor Park 89 456 Total 101 1,006 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. 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 1969 are:- New cases 189 Re-attendances 681 Total 870 Physiotherapy is provided at the following clinics:- Greenford Green Ravenor Park Mattock Lane Northcote Islip Manor 34 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, Southall. Details of the work carried out during the year are as follows:- Referrals Number of cases on waiting list at December, 1968 81 Number of cases referred to Centre during 1969 480 Number of cases seen by Psychiatrists during 1969 359 Number of cases seen by other Officers 1969 33 Cases withdrawn 1969 103 Number of cases awaiting at December, 1969 82 Recommendations by Psychiatrists Treatment or remedial teaching 159 Placed in residential school for maladjusted 37 Placed in day school for maladjusted Aston 13 Newlands 13 26 Placement in residential schools for the maladjusted Number of children awaiting placement at 31st December, 1968 7 Number of children recommended during the year 11 Children placed 37 Awaiting placement at 31st December, 1969 22 Recommendations for psycho-therapy or remedial treatment Cases awaiting treatment at 31st December, 1968 11 Recommendations for treatment 159 Discharged during year 39 Treatments during year 131 Awaiting treatment at 31st December, 1969 39 Of the 393 children referred to the centre for intelligence testing 263 were boys and 130 were girls. HANDICAPPED CHILDREN The following table sets out, in their various categories, the number of handicapped pupils as at 31st December, 1969:- 35 Category of Pupils In Special Day Schools In Special Residential Schools In maintained Primary and Secondary Schools Not at School In Independent Schools  M P M P M P M P M P M F Blind _ 2 2 2 _ _ 1 2 _ _ 3 6 Partially sighted 8 9 _ _ _ _ _ _ _ _ 8 9 Deaf 5 8 4 2 _ _ _ 1 _ _ 9 11 Partially deaf 21 15 4 2 _ 1 _ 3 _ _ 25 21 E.S.N. 160 110 24 6 31 20 10 3 _ _ 225 139 Epileptic _ _ 1 3 _ _ 2 - _ _ 3 3 Maladj usted 59 21 104 38 11 4 5 1 — _ 179 64 Physically handicapped 30 29 4 7 _ 1 8 6 _ 1 42 44 Defective speech 6 3 _ _ _ _ 7 5 _ _ 13 8 Delicate 30 11 10 5 3 1 2 _ _ _ 45 17 Totals 319 208 153 65 45 27 35 21 _ 1 552 322 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. 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 11.7+1 dental auxiliary dental officers was employed. 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 inspection during 1969 55% of school pop. Pound to require treatment 63% Sessions devoted to inspection 3.8% Dental Treatment The figures for dental treatment during the year were:- 36 Total visits to clinics 28,073 Teeth filled 20,767 Teeth extracted 7,281 General anaesthetics 2,863 Emergencies 1,465 Sessions devoted to treatment 4,600 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 1969. A review of the results will be in the next edition of the Health of the Schoolchild. 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-instructec 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. 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 Teaching courses at Chiswick Polytechnic. School Leavers' Course Southall Grammar Technical School held a further school leavers' course in July, and the Health Department was invited to assist. Members of Health Department gave lectures and the course ended with a series of discussion groups and an open forum. 37 SCHOOLGIRL MOTHERS 6 cases were referred to the School Health Service during the year of which 3 girls did not return to school after their confinements. 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 precise 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 for 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 year was three. There is a total of 86 children of school age in junior training schools. RECUPERATIVE CARE Under Section 48 or the Education Act, arrangements are made on the recommendation of a doctor for convalescent holidays, without charge, for school children. During 1969 recuperative care was arranged for 23 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 £5.15.0d. per week for the mother and up to £3.3.0d. for the children. 38 20. GENERAL ENVIRONMENTAL HEALTH MEASURES NUISANCES AND COMPLAINTS During the year, 6,782 complaints were received, the main categories of complaint being as follows:- Housing defects 1,240 Dustbins and refuse 585 Drainage 1,242 Animals, etc. 70 Insects and wasps 355 Pood 392 Smoke emissions and bonfires 207 Overcrowding and multiple occupation 195 Noise 152 Rats and mice 1,989 Miscellaneous 355 6,782 Action taken as a result of complaints resulted in 7,803 inspections of premises of all types and the service of 1,256 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 832 statutory notices in cases where action to remedy defects was not readily forthcoming and in the case of 18 premises, legal proceedings were necessary, involving the service of 21 summonses. Of these 21 cases, 5 were withdrawn before the hearings on compliance, and in 3 cases agreed costs were paid to the Council. Nuisance Orders were made in 10 cases and defendants ordered to pay costs, and fines and costs were imposed in 3 other cases. No nuisance order was made in one case as the work was done before the hearing, but costs of £10 were granted. Non-compliance with a notice requiring information as to ownership led to a fine and costs being imposed. The remaining case was adjourned sine die. Total fines imposed amounted to £30 and costs to £93.12s.0d. The owners of 4 houses in Acton appealed to the Magistrates against a notice served requiring drainage works. The appeal was disallowed and an order was made apportioning the cost of the works. A total of 3,849 repairs and improvements were carried out as a result of informal and formal action under the Public Health and Housing Acts. The most numerous items involved were the cleansing and repair of 1,106 drains and water closets, abatement of dampness in 393 cases, the removal of 375 accumulations of refuse and repair of 283 walls and ceilings, and 243 roofs. 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 3,390 feral pigeons. 39 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 normally resulted in a satisfactory removal of the vehicles within a short time. There is no doubt that without this degree of control, the caravans would create a nuisance by remaining for long periods on sites which are quite unsuitable for camping. RENT ACT, 1957 The number of applications 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 5 (2) Number of decisions not to issue certificates - (3) Number of decisions to issue cert ificates:- (a) in respect of some but not all defects 3 (b) in respect of all defects 2 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 1 (5) Number of undertakings refused by Local Authority under proviso of paragraph 5 of the First Schedule - (6) Number of certificates issued 5 Part 11 - Application for Cancellation of Certificates (7) Application by landlords to Local Authority for cancellation of certificates 1 (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 1 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. One new premise was registered during the year to bring the total in the borough to 24. INSPECTION OF FACTORIES AND OUTWORKERS' PREMISES - FACTORIES ACT, 1961 This Act and various regulations made under it place on local authorities the responsibility for the enforcement of provisions relating to cleanliness, overcrowding, temperature, ventilation, drainage of floors in respect of any factory where mechanical 40 power is not used, and the provisions concerning sanitary conveniences in all factories. During the year, 247 premises were inspected and at the end of the year there were 1,312 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 homes. 38 visits of inspection were made and conditions were found to be satisfactory. Statistical information concerning the Factories Act is given in tables 2, 3 and 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 12 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 150 a decrease of 2% 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 49% of the complaints referred to noise coming from industrial and commercial premises and that about 51% of these were valid complaints. Of the complaints of noise from other sources, about 53% were complaints which could be supported by the Department. The number of complaints about noise from road drills decreased slightly. In a few cases it was 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, 78 were abated without having to use statutory action, 54 were held not to be nuisances although in most cases efforts were made to achieve a reduction of noise at source. 18 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, 3,096 premises were registered by the Council under this Act, there having been 201 additions to the register, and 153 deletions. Inspection of premises to which the Act applied continued at a very satisfactory pace with 1,718 general inspections and a total of 3,640 visits of all kinds. 41 Occupiers are responsible for notifying accidents to their employees which result in absence of three days or more from normal work. During 1969, 113 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 3 _ _ _ 3 Non-power machinery in motion _ 1 _ _ 1 Vehicles moved by power 5 2 _ - 7 Vehicles not moved by power 1 - - - 1 Palls on or from stairs 1 6 1 2 10 Palls on or from ladders - 1 _ _ 1 Other falls from one level to another 10 2 - 12 Palls on same level 5 10 - - 15 Stepping on or striking object or person 5 6 - 1 12 Handling goods 22 7 1 - 30 Struck by falling object 8 3 - - 11 Use of hand tools 4 1 2 - 7 Not specified 2 1 - - 3 Totals 66 40 4 3 113 Prosecutions During 1969 there were six successful prosecutions for a variety of offences under the Act and Regulations made under it, and one case was withdrawn. The total fines in these cases amounted to £255.0.0d. and costs of £50.10.0d. were awarded to the Council. Registrations and General Inspections Class or 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 73 775 333 Retail shops Wholesale shops, 93 1,974 1,185 warehouses 10 108 72 Catering establishments open to public, canteens 24 236 127 Fuel storage depots 1 3 1 Totals 201 3, 096 1,718 No. of visits of all kinds by inspectors to registered premises - 3,640 42 Analysis of persons employed in registered premises by workplace Class of workplace r of persons employed Offices 13,045 Retail shops 10, 002 Wholesale departments, warehouses 2,502 Catering establishments open to public 1,769 Canteens 144 Fuel storage depots 18 Total 27,480 Total males 12,550 Total females 14,930 Contraventions remedied Items No. of Improvements Premises cleansed 393 Overcrowding abated 5 Temperature improved 27 Thermometers provided 138 Ventilation provided or improved 115 Lighting improved 27 Lighting apparatus repaired 11 W.C. accommodation increased 12 Washing facilities increased (basins) 32 Hot and cold water provided 98 Drinking water provided 1 Drinking vessels provided 1 Accommodation for clothing provided or improved 26 Facilities for drying clothing provided 6 Sitting facilities provided or improved 3 Floors, stairs, passages etc. repaired 99 Handrails provided 18 Staircase guards provided 16 Machinery guarded 40 First aid boxes provided or refilled 280 Window skylights cleaned 4 Soap and towels provided 2 FAIRS AND CIRCUSES Pairs 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. Pood stalls were numerous on the sites and standards here were also found to be reasonable. 43 DISINFECTION AND DISINFESTATION The amount of work connected with disinfestations for the eradication of bed bugs continues to be small and heavy infestations are now rarely found. Disinfestation measures were taken in 85 houses, following complaints of bed bugs and other insects. 976 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 productions of a certificate of disinfection. Routine terminal disinfection of 327 houses, after cases of illness, was carried out, mainly as a result of special requests from the occupiers. 32 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 1,989 Premises inspected 1,883 Premises found to be infested with - (a) rats 973 (b) mice 791 Re-visits to infested premises 7,244 Pees received for treatment £1,851 Rodent Control in Sewers During the year, approximately 2,725 sewer manholes were baited with fluoracetamide for controlling rats in the sewers in accordance with the recommendations of the Ministry of Agriculture, Fisheries and Pood. INSPECTION OF HAIRDRESSING ESTABLISHMENTS 233 premises have been placed on the register and 115 were inspected in 1969. Premises have, on the whole, been found to be satisfactory, and only minor deficiencies discovered. 44 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 plumbo-solvent action. water from public mains was supplied to 91,859 dwellings with a mid-1969 estimated population of 297,910. 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 83 samples of water from these wells submitted for bacteriological and chemical examination during the year 15 were found to be unsatisfactory and 1 doubtful. After thorough cleansing and sterilization of supply pipes, repeat samples proved to be satisfactory. As a result of complaints, 10 samples of tap water from public supplies were taken and 1 proved unsatisfactory. Water Samples, 1969 Samples Satisfactory Doubtful Unsatisfactory Well Supplies 83 67 1 15 Public Supplies 10 9 - 1 Totals 93 76 1 16 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. Private swimming pools are provided for the residents of a housing estate, and at a modern block of flats. The Department took samples of water from each pool at regular intervals throughout the year and these were submitted for bacteriological examination. A total of 180 samples was taken of which only 6 were unsatisfactory. In the latter cases repeat samples were found to be acceptable and advice was given where necessary. The results are as follows:- 45  Number of pools Satisfactory samples Unsatisfactory samDles Total samples Public baths 11 87 2 89 School baths 5 77 2 79 Private baths 2 10 2 12 Totals 18 174 6 180 The Council's analyst also carried out detailed chemical and bacteriological examination but had a free chlorine content which was too high. Number of pools Satisfactory samples Unsatisfactory samples Total samples Public baths 11 101 101 School baths 5 33 1 34 Private baths 2 - - - Totals 18 134 1 135 The one unsatisfactory sample was 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. 37 premises are not connected to main sewers, 27 are drained to cesspools or septic tanks and the remaining 10 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. 46 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 Southall Market Mr. J.A. Morris, M.R.C.V.S., continued in his duties under the Act at Southall Market and authorised 52 market sales under the Regulation of the Movement of Swine Order, 1959, and issued 630 movement licences authorising 15,201 pigs to be moved out of the market. Of 32 vehicles 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 16 applications for renewal of existing licences were received and granted. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 4 applications for the renewal of licences were received and granted. The premises concerned were inspected on 6 occasions during the year. PET ANIMALS ACT, 1951 Licences in respect of 22 premises were renewed. The number of routine inspections was 66. 47 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 29 Haven Green and 1 Haven Lane Clearance Order made and about to be submitted to Minister. 2-20 (evens) Beaconsfield Road, 14-38 (evens) and 13-31 (odds) Gladstone Road, W.4 Compulsory Purchase Order made and submitted to Minister. 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. Compulsory Purchase Order made in 1967. Public Inquiry held. Confirmed by Minister of Housing and Local Government. Rehousing of occupants commenced. 1-21 (odds) and 2-26 (evens) Richard's Cottages, W. 3. ) Compulsory Purchase Order made and Public Inquiry held. Confirmation by Minister still awaited. 1-8 (consecutive and 11-16 (consecutive) Nelson Place and 17-27 (odds) and 43-49 (odds) Steyne Road, W.3. Clearance Order made in 1968 confirmed by Minister of Housing and Local Government, following Public Inquiry. Rehousing of occupants commenced. (b) Individual Unfit Houses and Parts of Houses 28 Lancaster Road, W.7. 1 & 3 Spooners Mews, W. 3. Tenants rehoused following Closing Orders made in 1968. 25 Castlebar Mews, W.5. Closing Order made; premises vacant. 13, 15 & 17 Haven Lane, W.5. Closing Orders made in 1965 and 1967 but determined following completion of rebuilding of Nos. 13-19 Haven Lane. 26 Castlebar Mews, W.5. 69 Hammond Road, Southall (Ground Floor 126 Hammond Road Southall 27 Kirchen Road, w.13. Closing Orders made and tenants rehoused. 23 Shirley Gardens (Ground Floor and First Floor Flats Closing Orders made and tenants awaiting rehousing. 37 Boston Road, W.7. House demolished following Demolition Order made in 1968. 116 Argyle Road, W.13. Considered by Health Committee, making of Demolition Order deferred; premises vacant. 48 (c) Underground Rooms The following action was taken during the year:- 8 Drayton Green Road, W. 13 (Basement) 7 Cumberland Park, W.3 (Basement) 33 The Mall, W. 5 (Basement) Closing Orders made and tenants rehoused. 29 Acacia Road, W.3 (Basement) Closing Order made; premises vacant. 1 & 2 Laurel Bank Villas Lower Boston Road, W. 7 (Basements) Closing Orders made; no rehousing necessary. 38a Lower Boston Road, W.7 (Basement) Informal undertaking given by owner not to relet pending redevelopment HOUSES IN MULTIPLE OCCUPATION Details of action taken over last seven 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. 49 Action taken Totals for years 1963-1968 1969 Total Acton Ealing Southall Acton Ealing Southall Directions given (Section 19 Housing Act, 1961) 17 79 1278 9 26 122 1531 Prosecution for contravention of Directions - - 99 - 1 24 124 Notices to improve facilities and means of escape from fire (Sections 15 and 16 Housing Act, 1961) 219 188 6 129 144 3 689 Prosecution for failure to comply with notices served under Sections 15 and 16 of Housing Act, 1961 - 2 - 2 1 - 5 Overcrowding notices (Section 90 Housing Act, 1957) 5 2 34 2 1 14 58 Prosecution for contravention of overcrowding notices - - 96 - _ 2 98 Notices requiring information as to occupants (Section 19 Housing Act, 1961) 13 79 1911 9 26 255 2293 Prosecutions for failure to supply information as to occupants 2 4 26 - - 1 33 Prosecutions for false information _ - 1 _ - - 1 Prosecution for failure to supply information as to ownership 2 - - 2 - - 4 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 1969 — 3855 50 Details of overcrowding under Section 90 of the Housing Act, 1957:- Number of dwellings overcrowded at end of year 6 Number of families occupying these houses 19 Number of individuals living in these houses 79 Number of new cases of overcrowding reported during the year 17 Overcrowding relieved during the year - (a) Number of cases 11 (b) Number of individuals involved 68 Of the 25 prosecutions for contraventions of the terms of Directions given under Section 19 of the Housing Act, 1961, 24 were successful and 1 case was withdrawn on payment of costs. Pines, totalling £360 were imposed and a total of £82.10.0d. costs awarded to the Council. Pines ranged from £5 to £50 and costs from £2.10.0d. to £5. Subsequently one case was taken to Middlesex Quarter Sessions where an appeal against conviction was allowed. There was one prosecution for failure to supply information as to occupants, contrary to Section 19 of the Housing Act, 1961, which resulted in a fine of £5 and costs of £2. There were three 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. In the other two cases fines totalling £25 were imposed and £9 costs awarded to the Council. Two summonses were withdrawn on payment of £4.4.0d. costs when the new owners gave an undertaking to carry out works required by Sections 15 and 16 Housing Act, 1961. Two cases of obstructing Public Health Inspectors resulted in a fine of £5 and £2.2.0d. costs in one case, the other was later withdrawn when access to the premises was allowed. 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 obtained. 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. 51 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 six further Orders were made. These related to Area Nos. 43-48 inclusive covering 1,289 acres, including 10,258 dwellings and 283 other buildings. Orders Nos. 41-47 were confirmed to come into operation on 1.9.69, 1.10.69, 1.11.69, 1.12.69, 1.6.70, 1.7.70 and 1.8.70 respectively and Order No. 48 was awaiting confirmation at the end of the year. Orders Nos. 38-42 made in 1968 also became operative in 1969. A survey of Area No. 51 was completed and preliminary work on Nos. 49 and 50 had commenced. (The re-arrangement of the sequence was due to projected redevelopment plans). 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 1969 Region No. of acres covered by Smoke Control Orders Percentage of total "black area" ac re a g e so covered No. of premises covered by Smoke Control Orders Percentage of total "black area" premises so covered Whole Country "black areas" 757,897 42.72 4,086,025 52.54 Greater London 229,847 70.28 2,031,757 76.97 London Borough of Ealing 12,238 89.27 92,985 92.54 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 61 11,478 71,815 9,664 4,046 85,525 Confirmed but not yet in operation 3 597 4,801 563 168 5,532 Awaiting confirmation 1 163 1,896 3 29 1,928 Totals 65 12,238 78,512 10, 230 4,243 92,985 52 London Borough of Ealing - Smoke Control Areas (coloured yellow on map). SMOKE CONTROL ORDERS YEAR OP OPERATION Acton Nos. 1-11 Ealing Nos. 1-20 1960 - 1965 Southall Nos. 1-6 Ealing Nos. 21 - 25 1966 Ealing Nos. 26 - 30 1967 Ealing Nos. 31 - 37 1968 Ealing Nos. 38 - 44 1969 Ealing Nos. 45 - 47 Made and confirmed in 1969 but not coming into operation until 1970. Ealing No. 48 Made in 1969 but awaiting confirmation by the Ministry of Housing and Local Government. Ealing No. 51 Survey complete. 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 increase compared with last year of 10% in the amount of smoke and of 3% in the amount of sulphur dioxide in the air. The deposit gauge figures show an overall 36% reduction in airborne particles. 53 Yellow - Smoke Control Areas In the London Borough of Ealing Red - Smoke Control Areas In adjoining districts Green - Proposed Smoke Control Areas in adjoining districts 25. FOOD HYGIENE AND FOOD AND DRUGS ADMINISTRATION CLEAN FOOD SCHEME The Council's Clean Pood campaign was continued during the year, 15 lectures being given to a total of 74 food handlers, and certificates of attendance awarded to those who completed the courses. In addition, 6 lectures were given by public health inspectors to 150 members of women's organisations, and 16 lectures to 640 school children approaching school leaving age in the secondary schools. 5 filmstrips were sold to other local authorities. INSPECTION OF FOOD PREMISES A total of 2,280 visits were made to premises in the borough, and 2,007 improvements effected as a result of these visits. Seven prosecutions for contraventions of the Food Hygiene (General) Regulations, 1960, were taken during the year. Fines ranging from £80 to £279 were imposed the total being £959 with costs of £65 awarded 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 Ten 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. It was necessary to prosecute one stallholder during the year for six contraventions of the regulations. A fine of £30 was imposed and costs of £7 awarded to the Council. MILK AND DAIRIES (GENERAL) REGULATIONS, 1959 During the year, 35 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 141 distributors of milk in respect of 255 premises. 12 samples of washed bottles were taken at random from a bottling plant at one dairy, which were all satisfactory. 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 14 conplaints were received from members of the public concerning the sale of milk in dirty bottles containing foreign bodies. There was one prosecution involving a fine of £15 and costs of £6. THE MILK (SPECIAL DESIGNATION) REGULATIONS, 1963 AND 1965 During the year 36 new dealer's (pre-packed milk) licences were issued, and 141 distributors and 2 pasteurisers, involving 237 premises were on the register at the end of the year. Informal samples of milk taken for chemical analysis, to ensure that the samples 55 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 Pail Pass Fail Pass Pail Pass Pail Pasteurised 47 47 - 47 - - - - - Sterilised 13 - - - - 13 - - - Ultra Heat Treated Totals 5 - - - - - - 5 - 65 47 - 47 - 13 - 5 - RAW MILK SUPPLIES - BRUCELLA ABORTUS There is only one farm engaged in milk production in the borough. As a result of a 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 1969. A total of 10 samples was taken and all were found to be negative for this organism by the ring test. ICE CREAM During the year 9 premises were added to the register for the sale and storage of ice cream, leaving a total at the end of the year of 498 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 Pood Hygiene and Ice Cream (Heat Treatment) Regulations. Systematic sampling of ice cream and ice lollies was carried out, details of which are as follows:- 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) 197 145 25 21 6 . 170 21 6 Ice Cream (other manufacturers) 79 49 9 12 9 . 58 12 9 Ice Lollies (local manufacturers) 21 . . . . 21 21 . . Ice Lollies (other manufacturers) 17 ._ . . . 17 17 . . Totals 314 194 34 33 15 38 228 33 15 56 The table on the previous page also includes:- Commodity Number of Samples Methylene Blue Grade Grades I & II satisfactory Grade III doubtful Grade IV unsatisfactory I II III IV Ice Cream samples from vans 54 24 10 11 9 34 11 9 Soft ice cream samples 62 32 10 13 17 42 13 7 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. Visits by inspectors were made in order to improve the standard and this resulted in more satisfactory samples being obtained. IMITATION CREAM The remaining manufacturer ceased production during the year. Imitation cream is used largely by the confectionery trade and is produced by an emulsion of edible oils or fats with water, and the mixture is then pasteurised. The bacteriological examination of 31 samples was made and all were found to be satisfactory. SURRENDER OF UNSOUND MEAT AND OTHER FOODS (EXCLUDING MEAT AT SLAUGHTERHOUSE) The following foodstuffs were condemned by the public health inspectors as unfit for human consumption and were surrendered for destruction:- lbs. Meat and meat products 2,407 Fish and fish products 559 Fruit and vegetables 1,465 Groceries 444 Total 4,875 Foodstuffs not calculated by weight Assorted tins, packets, jars, bottles, articles, casks and boxes 35,402 REGISTRATION OF HAWKERS OF FOOD AND THEIR FOOD PREMISES In accordance with the requirements of Section 11 of the Middlesex County Council Act, 1950, 16 hawkers were registered during the year leaving a total of such traders on the register at the end of the year at 49. PREMISES REGISTERED FOR PREPARATION OF SAUSAGES AND PRESERVED FOODS One premises was registered in accordance with Section 16 of the Food and Drugs Act, 1955, during the year, at the end of which there were 168 premises on the Council's register. 57 SAMPLING OF FOOD AND DRUGS - CHEMICAL ANALYSIS Pood and drugs samples are examined by the Council's Public Analyst, Mr. W.B. Chapman, B.Sc., P.R.I.C., and his deputy Mr. E.H.W.J. Burden, B.Sc., P.R.I.C. They are both officers of the Scientific Branch of the Greater London Council, and an annual block payment is made by this Council to cover the cost of the services provided. 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. During the year, 800 samples comprising 15 formal and 785 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, 86 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. Informal sampling of minced beef at a butcher's shop revealed the presence of sulphur dioxide which is not permitted by the Preservatives in Pood 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 £25 and awarded £6.6.0d. costs to the Council. A successful prosecution followed the sale of palm oil containing more than the permitted amount of lead, contrary to the Lead in Pood Regulations, 1961; a fine of £25 was imposed and £10 costs were awarded to the Council. Sampling of yoghourt revealed the presence of preservatives, sorbic and benzoic acid, which are not permitted in this country in specified foods. The preservative had been added to the puree used to flavour the yoghourt. The Preservatives in Pood Regulations are at present under review by the Pood Additives and Contaminents Committee and as a result it is possible that these preservatives may be permitted in the fruit used for yoghourt manufacture. An interesting point arose out of the sampling of flour. Most flours are required to contain added chalk in order to replace calcium lost during milling. Objection was taken to a sample which contained more chalk than the permitted maximum. It was found that the millers experience difficulty in complying with the Bread and Flour Regulations, 1963. This matter was referred to the Local Authority in whose area the mill is situated. 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 Pood Order, 1953, and the labelling provisions of other Regulations. Irregularities in labelling were discovered in 86 instances and in all cases the attention of manufacturers and packers or importers was drawn to the infringements. In the majority of cases arrangements were made to print new labels for stocks immediately or undertakings were accepted that new labels would be designed and used as soon as existing stocks became exhausted. A summary of the irregularities found is as follows: Incorrect or inadequate description 13 No name and address 11 Incorrect or inadequate list of ingredients 5 No list of ingredients 17 Misleading statements 8 Use of generic terms 22 Incorrect statutory declaration 10 58 BACTERIOLOGICAL EXAMINATION OF OTHER FOODS In addition to the bacteriological examination of particular types of foods referred to in earlier paragraphs of this report, 85 samples 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 submitted for bacteriological examination which were the subject of consumer complaints numbered 2 but no harmful organisms were found. A bacteriological examination of pet food sold in this Borough was made. 37 samples of raw and processed food were obtained, of which 3 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 161 complaints received by the Department and all were thoroughly investigated. 3 of the articles were submitted to the Public Analyst for his opinion. Complaints of particular interest included such articles as rubber in butter a beetle (foreign in origin) in a tin of imported spaghetti, a metal nut in ice cream, lead pellet in can of evaporated milk and a loaf of bread with a cigarette end and another with a matchstick. Prosecutions were taken in 17 cases, 16 of which were successful, fines ranging from £5 to £25 being imposed and totalling £247 with £101.7.0d. costs to the Council. 59 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, 10 nursing homes were registered with a total of 325 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 33 establishments used by licensed persons in the borough as follows:- Chiropody only 11 Chiropody and special treatment 8 Massage only 1 Massage and special treatment 5 Physiotherapy only 1 Physiotherapy and special treatment 1 Osteopathy 2 Beauty treatment 2 Sauna 2 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". 60 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 703 bodies of residents from the following areas were taken to the mortuary:- Ealing 492 Hillingdon 48 Richmond uponThames 3 Hounslow 22 Other London Boroughs 100 Other areas 38 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. 61 28. MEDICAL EXAMINATION AND WELFARE OF STAFF MEDICAL ASSESSMENTS Total number of questionnaires assessed for fitness for employment 3,225 Number of medical examinations required following questionnaire assessment 351 Number of failures as a result of medicals following questionnaire assessment 8 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 1969 was as follows:- Vaccination against smallpox 110 Immunisation against typhoid fever 12 Immunisation against typhoid/tetanus 38 Immunisation against tetanus 8 168 FIRST AID During the year 882 attendances for treatment were made. 62 63 Table 1 INFECTIOUS AND OTHER NOTIFIABLE DISEASES CLASSIFIED IN AGE GROUPS Scarlet Fever Whoopingcough Measles Dysentery Acute Meningitis Malaria M F M F M F M F M F M F Numbers originally notified 60 49 26 20 815 775 78 89 5 4 _ 1 Final numbers after correction: Under 1 year – 1 5 3 34 39 2 3 1 1 – – 1 - 3 1 – 1 115 89 5 5 – - - — 2 - 3 2 5 4 133 114 6 3 - - - – 3 - 10 6 3 3 103 107 3 3 1 - - – 4 - 7 4 5 5 120 124 5 2 - - - – 5 - 9 26 25 7 3 289 281 19 9 2 - – – 10 - 14 2 7 – 1 8 8 6 8 - 1 - – 15 - 24 6 3 - – 7 6 11 16 – – - - 25 and over 2 – 1 - 5 4 16 35 – 2 - - Age unknown 1 – — — — 3 3 4 - - - 1 Total 60 49 26 20 814 775 76 88 4 4 – 1 64 Table 1 continued Acute Encephalitis Paratyphoid Fever Pood Poisoning M F M F M F Numbers originally notified 6 4 1 2 50 65 Pinal numbers after correction: Under 5 years 1 – 1 1 7 7 5-14 2 3 - 1 7 4 15 - 44 3 1 - - 11 10 45 - 64 - - - - 1 7 65 and over - - - - 2 3 Age unknown - — — - 4 8 Total 6 4 1 2 32 39 65 Table 1 continued Tuberculosis Infective jaundice Pulmonary Meninges and central nervous system Other M F M F M F M F Numbers originally notified 88 65 – – 21 36 28 19 Pinal numbers after correction: Under 1 year 1 - - – – – – – 1 - - – - - 1 – – - 2 - 4 4 - - - - - - – 5-9 3 - - - - - - 4 10 - 14 1 5 - - - 1 - – 15 - 19 2 8 - - 3 3 6 2 20 - 24 5 14 - – 4 3 8 1 25 - 34 19 12 - - 6 10 5 4 35 - 44 13 12 - - 3 5 2 3 45 - 54 9 3 - - - 3 - 1 55 - 64 20 3 - - - 2 2 1 65 - 74 5 3 - - 2 1 1 - 75 and over 2 1 - - 1 4 - 2 Age unknown 4 1 – – – 4 2 1 Total 88 62 - – 20 36 26 19 There were no cases of anthrax, cholera, diphtheria, leptospirosis, ophthalmia neonatorum, plague, poliomyelitis, relapsing fever, smallpox, tetanus, typhus, typhoid and yellow fever. FACTORIES ACT, 1961 - PART 1 Inspections for the purpose of provisions as to health (inspections made by public health inspectors). Premises Number on Register Number of Inspections Written Not ices Occupiers prosecuted (i) Factories in which sections 1, 2, 3, 4 and 6 are to be enforced by local authorities 12 5 – – (ii) Factories not included in (i) in which section 7 is enforced by the local authority 1293 236 31 – (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 7 6 – – Total 1312 247 31 – 66 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 To H.M. Inspector By H.M. Inspector Want of cleanliness 7 7 – – – Overcrowding – – – – – Unreasonable temperature – – – – – Inadequate ventilation 1 1 – – – Ineffective drainage of floors – – – – – Sanitary conveniences: (a) Insufficient – – – – – (b) Unsuitable or defective 56 56 – 30 – (c) Not separate for sexes 2 2 – – – Other offences against the Act (not including offences relating to outwork) 25 25 – – – Total 91 91 – 30 – 67 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. 85 Artificial flowers 5 Cosaques, Christmas stockings, etc. 107 Umbrellas, etc. 3 Paper bags 2 Furniture and upholstery 1 Total 203 During the year, 38 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. 68 69 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 29 29 29 29 Bakers' shops 74 74 – Butchers 184 184 184 184 Cafes and restaurants 294 294 294 294 Canteens (industrial 221 221 221 221 School kitchens and dining centres 118 118 118 118 Confectioners 360 360 – – Dairies 2 2 2 2 Pood factories and stores 74 74 74 74 Pood stalls 65 19 2 2 Pish fryers 39 39 39 39 Fishmongers 34 34 34 34 Greengrocers 206 206 169 169 Grocers 391 391 288 288 Hotels, nursing homes and old people's homes 91 91 91 91 Ice cream manufacturers 6 6 6 6 Licensed premises and clubs 199 199 199 199 Hawkers 49 16 9 9 Totals 2,436 2, 357 1,759 1,759