AC. 43334 ack'd EAL 61 The Health of the London Borough of Ealing in the year 1970 EAL 61 The Health of the London Borough of Ealing in the year 1970 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 6 3. Health Clinics 8 4. Day Care of Children 11 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. Health Visiting 18 11. Artificial Kidney Machines 19 12. Health Education 20 13. Recuperative Care 22 14. Chiropody 23 15. Tuberculosis Service 25 16. Mental Health 26 17. Home Help Service 28 18. Care of the Elderly 29 19. Immigration 30 20. School Health Service 32 21. General Environmental Health Measures 41 1 22. Water Supplies, Swimming Baths and Sewage Disposal 47 23. Meat Inspection and Animal Protection 49 24. Housing 50 25. Clean Air 54 26. Pood Hygiene and Pood and Drugs Administration 58 27. Registration of Premises used for Medical Purposes 63 28. Mortuary and Burial Arrangements 64 29. Medical Examination and Welfare of Staff 65 Tables 66 2 Mr. Mayor, Aldermen and Councillors, This year has seen the provision of a further day nursery as well as two purposebuilt playgroups, which will go some way towards meeting the growing need for day care for socially deprived or handicapped children in the Borough. Another event of note was the start made on the immunisation of girls against German measles. Whilst it is too early to predict the success of this measure it is hoped that it will be of value in reducing the incidence of congenital defects resulting from mothers contracting this disease in early pregnancy. My report contains an account of the five cases of typhoid fever which occurred in the Borough during 1970 but this gives little idea of the amount of careful contact tracing and surveillance entailed in ensuring the containment of this disease. I would like to stress the continuing need for such infectious disease control. The last few years have seen a steady development in attachment of health visitors, home nurses and midwives to the practices of family doctors and it is pleasing to record that this has now in Ealing been completed. A noticeably more efficient working of these services is already apparent. I would like finally to take the opportunity 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 servent I.H. SEPPELT 3 1. VITAL STATISTICS SUMMARY OP STATISTICS Area (in acres) 13,708 Population (Census, 1961) 299,762 Population (estimated middle of 1970) 294,820 Rateable value, 1st April, 1970 £24,293,000 Net product of a penny rate, 1970/71 £97,000 Live births:- Legitimate males 2,487 Females 2,306 Total 4, 793 Illegitimate males 223 Females 224 Total 447 Birth-rate per 1,000 of estimated population 17.3 Illegitimate live births (per cent of total live births) 9% Still-births:- Males 32 Females 29 Total 61 Rate per 1,000 total births (live and still-births) 12.0 Deaths:- Males 1, 768 Females 1,708 Total 3,476 Death-rate per 1,000 of estimated population 11. 1 Deaths of infants under one year of age:- Legitimate males 47 Females 33 Total 80 Illegitimate males 8 Females 6 Total 14 Death-rates of infants under one year of age:- All infants per 1,000 live births 18.0 Legitimate infants per 1,000 legitimate live births 17.0 Illegitimate infants per 1,000 illegitimate live births 31.0 Neo-natal mortality rate (deaths under four weeks per 1,000 total live births) 13.0 Early neo-natal mortality rate (deaths under one week per 1,000 total live births) 12.0 Perinatal mortality rate (still-births and deaths under one week combined per 1,000 total live and still-births) 23.0 Maternal mortality (including abortion):- Number of deaths NIL Rate per 1,000 live and still-births NIL 4 CAUSES OP DEATH Deaths 1970 Male Female Total Enteritis and Other Diarrhoeal Diseases 3 1 4 Tuberculosis of Respiratory System 3 2 5 Other Tuberculosis, incl. late effects 1 2 3 Meningococcal Infection 1 – 1 Other Infective and Parasitic Diseases 3 5 8 Malignant Neoplasm - Larynx 4 – 4 Malignant Neoplasm - Stomach 31 28 59 Malignant Neoplasm - Buccal Cavity, etc. 8 2 10 Malignant Neoplasm - Lung, Bronchus 139 42 181 Malignant Neoplasm - Oesophagus 5 2 7 Malignant Neoplasm - Breast – 70 70 Malignant Neoplasm - Intestine 48 44 92 Malignant Neoplasm - Uterus – 18 18 Malignant Neoplasm - Prostate 28 – 28 Leukaemia 9 9 18 Other Malignant Neoplasms, etc. 95 103 198 Benign and Unspecified Neoplasms 7 2 9 Diabetes Mellitus 10 15 25 Other Endocrine etc* Diseases 3 1 4 Anaemias 1 8 9 Meningitis – 2 2 Mental Disorders 22 7 29 Multiple Sclerosis 5 3 8 Other Diseases of Nervous System, etc. 35 15 50 Chronic Rheumatic Heart Disease 22 30 52 Hypertensive Disease 37 32 69 Ischaemic Heart Disease 443 348 791 Other Forms of Heart Disease 66 128 194 Cerebrovascular Disease 162 247 409 Other Diseases of Circulatory System 68 97 165 Influenza 10 11 21 Pneumonia 134 197 331 Bronchitis and Emphysema 140 56 196 Asthma 9 6 15 Other Diseases of Respiratory System 18 13 31 Peptic Ulcer 17 8 25 Appendicitis 1 1 2 Intestinal Obstruction and Hernia 11 9 20 Cirrhosis of Liver 2 6 8 Other Diseases of Digestive System 17 24 41 Nephritis and Nephrosis 7 4 11 Hyperplasia of Prostate 6 – 6 Other Diseases, Genito-Urinary System 6 13 19 Diseases of Skin* Subcutaneous Tissue 1 1 2 Diseases of Musculo-skeletal System 5 14 19 Congenital Anomalies 19 12 31 Birth Injury* Difficult Labour, etc. 16 13 29 Other Causes of Perinatal Mortality 11 5 16 Symptoms and Ill-defined Conditions 5 10 15 Motor Vehicle Accidents 18 13 31 All Other Accidents 29 14 43 Suicide and Self-inflicted Injuries 18 10 28 All Other External Causes 9 5 14 TOTALS 1,768 1,708 3,476 5 2. INFECTIOUS DISEASES Details of the incidence of the various notifiable infectious diseases and the action taken during the year to prevent their spread is as follows:- ANTHRAX No cases were notified during the year. CHOLERA No cases were notified during the year. DIPHTHERIA No cases were notified during the year. DYSENTERY 117 cases were notified during the year of which 22 were confirmed bacteriologically. In 21 cases the organism was Shigella Sonne and in one case Shigella Flexner. FOOD POISONING 90 cases were notified of which 31 were confirmed bacteriologically. The organisms were as follows:- Salmonella Typhimurium 6 Other Salmonellae 25 INFECTIVE JAUNDICE The number of cases notified during the year was 48 of which 17 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 3 cases were notified during the year. In each case the disease was believed to have been contracted abroad. MEASLES 939 cases were notified during the year. ACUTE ENCEPHALITIS AND ACUTE MENINGITIS There were 8 cases of acute encephalitis and 7 cases of acute meningitis notified during the year. OPHTHALMIA NEONATORUM No cases were notified during the year. 6 POLIOMYELITIS No cases were notified during the year* this being the sixth 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 92 cases notified during the year. SMALLPOX No cases were notified during the year. There were 36 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 145 new cases of pulmonary tuberculosis and 61 new cases of nonpulmonary tuberculosis were notified. (The figures for last year were 150 and 56 respectively). TYPHOID FEVER During the year 5 cases of typhoid fever occurred. The first case was a boy aged 19 months. Investigation at his home revealed 7 other persons living there. The usual exclusion procedure was carried out. No further cases arose and the source of infection was not discovered. The second case was a 29-year-old woman who was admitted to hospital on the day she arrived in this country from India. There were no further cases. The third case was a 6-year-old girl who was admitted to hospital shortly after arriving from India. The usual investigation and exclusion measures were followed. No further cases arose and the infection was probably contracted abroad. The fourth case was an 18-month-old boy. A large number of contacts were put under surveillance. During the course of the investigation it was discovered that a relative of the patient, living in an adjoining Borough, was a carrier. There were no further cases. The fifth case was a 25-year-old man who had recently returned from a holiday in Morocco. The usual exclusion measures were followed. No further cases arose and the infection was likely to have been contracted abroad. WHOOPING COUGH There were 83 cases notified during the year. Full statistical information is set out in table 1 at the end of this report. 7 3. HEALTH CLINICS The Council has 16 health clinics sited to be reasonably accessible to every mother in the borough. At these clinics sessions are provided for ante-natal and post-natal care, child welfare, immunisation and vaccination, cervical cytology, family planning, dental care, speech therapy, chiropody and physiotherapy. They are staffed by a medical officer, a dental officer, health visitors and clinic nurses. In addition, they form the centre from which is carried out the domiciliary work of the surrounding district, namely home nursing* midwifery, and health visiting. Detailed accounts of the various services provided at clinics are given either below or as part of other sections of this report. Additional mention must be made of the Mobile Clinic which is now being used for regular Child Welfare Sessions at Steyne Road Acton, Hanwell Community Centre and the Go1f Links Estate. The Mobile Clinics' service is much appreciated particularly by those who live in isolated housing estates at some distance from one of the static clinics. It also gives valuable service in providing a clinic at points in the Borough where there would otherwise be no facilities. 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 1970 were as follows:- 475 mothers attended medical officers' sessions for their ante-natal care. 252 mothers attended midwives' sessions for their ante-natal care. 843 mothers attended ante-natal relaxation classes. 165 mothers attended post-natal sessions. CHILD WELFARE SESSIONS At these sessions, teaching in infant feeding, general care and mothercraft is given by the medical officer and the health visitor. The medical officer is responsible for examining all the new babies and being concerned with feeding problems, behaviour difficulties, and the follow-up of all children needing medical supervision. When children reach their first birthday, then and on subsequent birthdays until the age of five, they are sent an attractively designed birthday card. This contains a request for the mother to bring the child to the clinic for a " birthday check". By this means the medical officer is able to determine the developmental progress of each child and to assess if there is any departure from normal. Apart from routine work of this sort, other important screening procedures are carried out:- 8 (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 on the register at the end of the year was 1,055. (ii) Guthrie Test. Routine testing for phenylketonuria continued using the Guthrie test which is carried out on blood taken by heel prick from infants on the sixth day of life. No positive tests were obtained. During the year 13,383 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 1970 were:- EXPECTANT AND NURSING MOTHERS Examined 153 Required treatment 150 Teeth filled 395 Teeth extracted 116 Dentures provided 12 PRE-SCHOOL CHILDREN Examined 1, 042 Required treatment 745 Teeth filled 1,464 Teeth extracted 505 CO-ORDINATION AND CO-OPERATION OP HEALTH DEPARTMENT'S SERVICE WITH HOSPITAL AND FAMILY DOCTOR SERVICES During 1970 the scheme of attachment of Health Visitors, Home Nurses and Midwives to the practice of family doctors was extended to cover the whole Borough. This has been of great advantage as it means that the health teams of Health Visitor, Midwife and Home Nurse are now complete. Under this scheme all doctors whose practices are such they they have thirty families within an approximate mile radius are allocated a team. This amounts to 69% of the Borough's General Practitioners. Where it is not feasible for a practice to participate in the attachment scheme nursing services are, of course, still provided on a geographical basis. 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. 9 VACCINATION AND IMMUNISATION Under Section 26 of the National Health Service Act, 1946, the Council provides vaccination and immunisation against the following diseases:- Diphtheria Poliomyelitis Whooping-cough Smallpox Tetanus Tuberculosis Measles Rubella (German measles) Infection with rubella (German measles) during the first three months of pregnancy may give rise to serious congenital defects in the baby. A vaccine to prevent the disease has been manufactured and was made available during 1970 through the Department of Health and Social Security. In the first instance vaccination has been offered to girls aged thirteen years. It is hoped to extend the age group during 1971. The vaccination consists of a single injection. It is too early at this stage to give a confident prediction of the likely degree of success,, but a substantial protection is hoped for. It will, however, be some years before statistical proof becomes available. Pull 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 2,455 1,893 4,348 Diphtheria/tetanus 505 82 587 Diphtheria 3 2 5 Tetanus 138 45 183 Poliomyelitis 2,963 1,948 4,911 Measles 4,006 1,335 5,341 Rubella 281 46 327 Reinforcing doses Diphtheria/whooping-cough/ tetanus 326 525 851 Diphtheria/tetanus 2,617 551 3,168 Diphtheria 10 3 13 Tetanus 247 218 465 Poliomyelitis 2,818 1,029 3,847 Smallpox - vaccination and re-vaccination Vaccinated Re-vaccinated At clinics 3,074 239 By general practitioners 1,302 518 Total 4,376 757 10 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. During the year under the urban aid programme two local authority play groups were opened. They were pre-fabricated buildings and are situated one in Southall and one in West Ealing. They aim to cater for children aged 2^ to 5 years who are considered to be socially deprived and they also admit a small number of handicapped children. Twentyfive places are available at each group and there are separate morning and afternoon sessions. At the end of the year there 61 play groups in the borough, which included 15 registered for the first time during the year. Of the total 29 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 continued and by the end of the year there were 436 registered childminders in the borough which included 209 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 239 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 11  Approved places Maximum number of places 4. Longcot Day Nursery, Newton Grove, W.4 54 65 *5. Hanbury Day Nursery, Park Road North. Acton, W.3 50 60 *Training Nurseries. During the year 236 new admissions were made to day nurseries of which 9 were handicapped children. The new Hanbury Day Nursery which replaces Bollo Bridge Day Nursery received children from 12 January 1970 and was formally opened by the Mayor on 3 June 1970. This is a purpose-built single-storey fifty-place nursery. There has been favourable comment in the Architectural Press and the Department of Health and Social Security are making use of it as a place for visitors who wish to keep up with the developments in this field. The staff find the new nursery a very satisfactory place to work in and altogether it seems to be a successful project. Building commenced during the year on a further Day Nursery which is situated in Hambrough Road, Southall. 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 until 1 April 1970 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 129 unsupported mothers from Ealing and 30 from Hounslow and 13 from Hillingdon. The London Borough of Hillingdon withdrew from arrangements on 1 April 1970. The Council has its own Mother and Baby Home to which an unsupported mother may be admitted for a period, usually six weeks before confinement and until six weeks after delivery. The demand for places in the Home has declined in recent years. This has enabled us to provide a less institutional type of care. To this end the available accommodation has been converted into bed-sitting rooms in which the mothers are able to look after their babies in their own room rather than having to leave them in a communal nursery in the Home. I have no doubt that this "rooming-in" enables much more personal care to be provided which must be in the interests of both the mother and her baby. 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 these 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 has continued, the expanded service now being:- (1) The health department provides a birth control clinic at Cnerington 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 16 per session. In 1970, 47 new patients were seen and a total of 393 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 and Queen Victoria Hospital, W.7. 1509 new patients attended the above clinics during the year making a total of 3832 patients attending. At all of the above sessions the Council meets the cost of women referred on medical and social 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 33 patients. (e) A Youth Advisory Clinic 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. During the year 62 new patients attended making a total of 75 attending. 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, and during the year 4 business premises were also visited. 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 2514 smears were taken and the findings were as follows:- Twelve smears were either positive or suspect and were referred for further investigation to gynaecological out-patients. investigation to gynaecological out-patients. In addition the following abnormal conditions were discovered and appropriate action taken. Trichomonal Infections 58 Monilial Infections 15 Cervical Polypus 44 Abnormal vaginal bleeding 100 Pelvic mass 46 Breast examinations are undertaken at the same time and 117 women were referred for further investigation. Blood pressure is also taken routinely. It is of interest to record that the analysis of the results from the Cervical Cytology Clinics were published in "The Lancet" under the name of Dr. Barbara Thomas, one of the Council's Medical Officers who undertook this work. 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 1970. 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. 13 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 1966 626 5, 039 5, 665 1967 599 5, 109 5, 708 1968 500 4,907 5, 407 1969 406 4,868 5, 274 1970 345 4, 926 5, 271 The Council has an agreement with Perivale Maternity Hospital to provide nursing care and home help service for mothers discharged from hospital after 48 hours. Before arrangements are made for a mother to be accepted on this scheme the health department has to be satisfied that the home conditions are suitable, and that there will be facilities for sufficient rest on return home. The growth of this service over the last few years is shown by the figures given below:- 1966 1967 1968 1969 1970 718 674 679 858 879 INTEGRATED MIDWIFERY WITH PERIVALE MATERNITY HOSPITAL During the year an integrated midwifery scheme between Perivale Maternity Hospital and the London Borough of Ealing was started. The domiciliary midwives and their pupils will undertake the delivery of a certain number of patients in the hospital. These patients are selected by a consultant obstetrician from those already booked for a hospital confinement and discharge at 48 hours. This will allow for a continuity of care provided by the midwife in the ante-natal and post-natal periods. 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 and 3 nursing auxiliaries as bathing attendants. 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 12 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 3,222 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. 17 10. HEALTH VISITING All Local Authorities have a duty under Section 24 of the National Health Service Act, 1946, to provide a health visiting service. For this the Borough employs a Chief Nursing Officer (Health Visiting), three Divisional Health Visitors and forty-three Health Visitors. Twenty Clinic Nurses and four interpreters act as auxiliaries to this service. STAFF TRAINING Five sponsored students successfully completed their training and joined the staff in September. Four more are currently training at recognised colleges. Two Divisional Health Visitors attended Management Courses during the year, and the practice of sending Health Visitors on refresher courses at regular intervals was continued. In addition, staff were kept well informed of new trends and modern concepts appertaining to their work by in-service training. This included a course in conjunction with the midwives on psychoprophylaxis, and a series of speakers from Hammersmith Hospital on modern methods of treatment of the newborn. VISITORS TO THE BOROUGH The year brought increased demands for Health Visitors to have representatives and students from varied disciplines to observe their work. To co-ordinate this service a Health Visitor was selected to plan such programmes in addition to her normal duties. Throughout the year 103 students visited clinics in the Borough, some coming from abroad to study aspects of community health in this country. HEALTH EDUCATION Teaching in various types of groups and schools continued. The principle that Health Visitors teaching in senior schools must have an additional teaching certificate was maintained. At present there are five Health Visitors with teaching certificates and three Health Visitors are currently attending Chiswick Polytechnic for the City and Guilds Teaching Certificate. Mothercraft and psychoprophylaxis classes are held in the majority of clinics weekly. The majority of a Health Visitor's work is still home visiting, incorporating the wider concepts of health education and social advice to the whole family. Her main work is in the prevention of physical, emotional and mental ill health, early detection of ill health, recognition of needs and the appropriate resources available. VISITS BY HEALTH VISITORS Children under five years of age 24,825 Elderly 3,745 Mentally Handicapped 231 Discharged from hospital 483 Other visits 5,196 CLINIC NURSES During the year there was an increase of two State Registered Nurses to the clinic nurse establishment. This was to undertake additional work involved through an increased school population and further clinic sessions. The Clinic Nurse takes much of the routine work off the shoulders of the Health Visitors. They do this by taking part in the whole range of the Council's Clinic Services. 18 11. ARTIFICIAL KIDNEY MACHINES Under Section 28 of the National Health Act the local authority is able to make arrangements for a suitable room within a private dwelling to be adapted for the installation of a Home Dialysis Unit. The equipment is installed and supervised by the hospital authorities. The authority can raise charges for the adaptations and such charges are made in accordance with the Council's assessment procedure. One new patient was referred during the year bringing the number having home dialysis in the Borough to 8. 19 12. HEALTH EDUCATION Health Education is part of the arrangements the Council makes under Section 28 of the National Health Service Act for the prevention of illness. A substantial part of the everyday work of the department's doctors, health visitors, midwives, nurses, social workers and health inspectors is educative in nature but, in addition* a specific health education programme is carried out every year. In conjunction with the Public Relations Officer and the Road Safety Officer, a scheme involving all sections of the Health Department operates so that each month the programme concentrates on a particular topic appropriate to the time of the year. The staff of the Health Education office now consists of a Health Education Officer and Technical Assistant. Decisions on the food health campaigns are taken by the Health Education Advisory Panel. Members of this panel represent the Health, Dental, Inspectorate, Safety, Education and Public Relations Departments. The monthly health education programmes are discussed and wherever applicable each department takes some part. The public relations officer ensures press coverage of many events. LEAFLETS AND PUBLICATIONS PRODUCED DURING 1970 "Happy Families" - a leaflet on family planning in English, Punjabi and Hindi. "Your Childrens Feet" - leaflet for parents of school children produced at the request of Head Teachers. "Calling All Women" - leaflet on cervical cytology with tear off card addressed to Town Hall requesting appointment for a test. "Now Wash Your Hands" - adhesive label for W. C.s in shops and industrial premises. "Venereal Diseases" - adhesive label for public lavatories, public houses and industrial enterprises and colleges giving addresses where treatment can be obtained. "The Work of the Day - a set of slides showing various facets of the work Treatment Centre" of the Day Treatment Centre. ORGANISATIONS RECEIVING SPEAKERS Parent-Teacher organisations Young Wives Clubs Parents of handicapped children St. Johns Ambulance Brigade Day Treatment Centre School teaching staff Townswomens Guild College and university students and student nurses. The Health Education Officer, health visitors and public health inspectors continued to lecture on a variety of subjects in secondary and primary schools. The health visitors also continue to do a great deal of health education in the clinics with mothers. One of the most successful items was the Southall Grammar and Technical School Leavers Course, where a team of speakers from the Health Department attended to give lectures on all aspects of their work. A great deal of help is now being given to schools in the way 20 of provision of Health Education material both visual and written. A special occasion was the health education display which was mounted at Acton Technical College inaugural session. IN-SERVICE TRAINING (a) A session on health education is held quarterly for the pupil midwives. (b) Quarterly film meetings are held for health visitors and medical officers with the presentation of new or specialist films. (c) A series of tapes and slides on psychological medicine in the setting of family practice was shown to the Mental Health Social Workers. Among subjects discussed were The Anatomy of Melancholy, Adolescence - conflict and confrontation, The Housebound Housewife, Menopause and Retirement and Old Age - sans everything. OTHER ACTIVITIES A survey was carried out in six schools on the effectiveness of a new educational film about feet called "The Five" in conjunction with the audio-visual communication department of the British Medical Association. A six-week course for childminders was held at Jubilee Gardens Clinic. This took place one morning a week and the children were cared for while the minders attended the lectures which were given by health visitors and one Head Teacher and Playgroup Leader. Subjects discussed on this course were: 1. Recordkeeping and home arrangements 2. Signs of illness 3. Home Safety 4. Growth, development, diet 0-2 years 5. Growth, development, diet 2-5 years 6. Film - Terrible 2's and Trusting 3's 7. Play material - social growth 8. Preparation for school - childrens problems on starting school. A successful family planning campaign was held in February in conjunction with the Family Planning Association. Film shows were held at selected clinics: there were poster displays and publicity in the local paper. Mrs. Pauline Crabbe of the Race Relations Board addressed a large meeting of health visitors, doctors and social workers on the subject of 'The Immigrant, The Unmarried Mother and Family Planning'. With the knowledge of the importance of play in a child's development, displays were mounted in many clinics during May of toys suitable for children from 0-5 years of age. The national press commented on this. There was a very successful and extremely well-attended meeting and film show arranged for the parents of mentally handicapped children. Refreshments were provided and keen interest was shown in a bookstall of suitable literature as well as in the display of toys especially chosen to help in these childrens development. Many organisations were supplied with leaflets and posters, apart from clinics, libraries and general practitioners. These included schools and colleges, hospitals, business premises, youth clubs and scout organisations. Over 100 film shows were held during the year for a variety of audiences on drugs, smoking, V D, family planning and dental care. Advice is given to the very many students who contact the department. We are gradually building up a library of film strips on health subjects and have now over 130 in stock, together with 17 16mm films which are used extensively whenever the staff give lectures. 21 13. 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 £10-50 per week but the recipients may be assessed according to income if they feel unable to pay this amount. Details of arrangements made during the year are given below:- Number of applications received 99 Number of patients sent on a recuperative holiday 60 Number of patients who did not avail themselves of the vacancy offered 34 Number of applications not approved 3 Unable to obtain vacancy 2 22 14. 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 20p, 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 40p, 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. Cross. In the case of patients receiving the Southall Old People's Welfare Association service no certificate is required. British Red Cross Society Southall Old People's Welfare Association London Borough of Ealing Total Total number of patients 435 160 3, 107 3, 702 Total number of new patients 6 _ 929 935 Total number of treatments at clinic 373 _ 8,550 8, 923 23 British Red Cross Society Southall Old People's Welfare Association London Borough of Ealing Total Total number of treatments at private surgeries 653 395 1,048 Number of patients receiving domiciliary treatment 156 98 1,282 1,536 Number of domiciliary treatments 724 250 7,700 8,674 Percentage of total work which is domiciliary 42% 39% 47% 46% Expectant and nursing mothers _ — 7 7 Physically handicapped persons 5 _ 71 76 24 15. TUBERCULOSIS SERVICE The responsibility for the tuberculosis service in the borough is divided between the Council and the Regional Hospital Board. The Board is responsible for the provision of treatment at chest clinics, while the Council is responsible for the visiting and welfare services under Section 28 of the National Health Service Act. 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. Details of the work during 1970 are as follows:- TUBERCULOSIS HEALTH VISITORS Number of new tuberculosis cases 176 Number of old tuberculosis cases 3,543 Transfers into borough 19 Number of contacts of new cases 1,187 Successful visits to tuberculosis households 3,725 Unsuccessful visits to tuberculosis households 864 Successful visits to other patients 495 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 101 Total cases 253 Tuberculosis patients 147 Cancer patients 59 Bronchitis and others 47 ACTION TAKEN Referred for employment 8 Pound employment 6 Referred to Social Security for maintenance 13 Referred to Social Security for bedding 2 Referred to Social Security for clothing 7 Referred to Social Security for extra nourishment 8 Referred for Housing 46 Rehoused 8 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. 25 16. MENTAL HEALTH The Council is responsible under the Mental Health Act, 1959, for the provision of community care for the mentally ill and mentally subnormal. One may, therefore, consider mental disability under these two separate headings. MENTAL ILLNESS Social Work The mentally ill living in the community require support which is provided by a team of Mental Health Social Workers who are also responsible for the statutory provisions required for the compulsory admission of patients to hospital. A twenty-four hour service is provided and outside office hours contact may be made through the switch-board at King Edward Memorial Hospital. A useful feature of the arrangements is two joint appointments of social workers with Springfield Hospital and similarly with Leavesden Hospital. These joint appointments ensure a close liaison between the hospitals and the community from which they draw their patients. Greenford Mental Health Centre This Centre provides a period of rehabilitation for patients who are making the sometimes difficult transition from hospital to community. Close links have been forged with the Disablement Resettlement Officer and the Industrial Therapy Organisation in order to deal adequately with matters of employment and rehabilitation. During the past year thirty-five new admissions were made to the Health Centre. Hostels The borough has no hostel for the mentally ill and it makes use of the facilities provided by other Authorities and by Voluntary Organisations. At the end of the year thirty patients were accommodated in this way. Ealing Association for Mental Health provides bed-sitting rooms for three persons who have been recently discharged from hospital but are 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) and St. Bernard's Hospital (Southall area). The difficulties which are caused by having three different hospital catchment areas in the borough have been referred to in previous years. It is hoped that future plans will overcome these problems. MENTAL SUBNORMALITY Advisory and Diagnostic Services Sessions are held by the Principal Medical Officer (Mental Health) and by a Consultant Psychiatrist. Evening discussions with parents and home visits by the Principal Medical Officer are also valuable, and the Mental Health Social Workers play a further part. Pre-School Provision The day nurseries and playgroups admit some of the very young mentally handicapped children which relieves the strain on parents who normally have to look after their handicapped children during the day. 26 Junior Training Schools There is at present no Junior Training School in the borough and eighty-two children were accommodated for us by the neighbouring boroughs of Hounslow, Hillingdon and Harrow during the past year. It is hoped that Ealing's own special school will be completed in 1971, and the arrangements with the other Authorities will then be phased out. Adult Training Centre The Adult Training Centre at Jubilee Gardens, Southall, with its annexe in Perivale Lane, provides useful work for eighty-three trainees. Liaison with the Further Education Section of the Education Department has enabled us to develop suitable individual programmes for each trainee. A further forty trainees were placed in Centres belonging to neighbouring boroughs by arrangement with them. During 1970, summer holidays were arranged for thirty-six trainees. Residential Accommodation The Brenthill Hostel provided accommodation for twenty patients who were able to work in outside employment or attend the Adult Training Centre. During the year six shortstay patients were also admitted and five trainees were able to return to their own homes. Hospitals The borough is entirely within the catchment area of Leavesden Hospital, near Watford, which accommodates both severely subnormal children and adults. Although there is a short waiting list it was found possible to admit informally seven patients during the year. Short-term admission is easier to obtain and provides a welcome measure of relief for some families who are under considerable stress. Voluntary Organisations The Ealing Association for Mental Health and the Ealing Society for Mentally Handicapped Children are two Voluntary Organisations performing valuable service in the community and a close relationship is maintained with them. Cases referred during year 1970 Ex General Practitioners 392 " Hospitals 196 99 Local Education Authorities 11 " Police and Courts 19 Other Sources 213 TOTAL 831 Patients receiving supportive visits 1,877 " attending Day Centres/Schools 228 " in residence 75 " awaiting admission 37 TOTAL 2,217 27 17. HOME HELP SERVICE The Home Help Service is provided by the Council under Section 29 of the National Health Service Act. Four types of service are provided:- (1) The Standard Service This provides help in acute illness, at home confinements, for tuberculosis cases, and for the chronic sick and aged. The major part of the case load is composed of the chronic sick. (2) Family Help Service This is to support the family when the mother is either temporarily absent from home, or due to inadequacy or some other reason is unable to cope with her familj duties. The family help service may be residential or non-residential. (3) The Good Neighbour Service This is an arrangement by which regular help is given by a neighbour working under the Home Help scheme. (4) The Night Service This operates from 11 p.m. to 7 a.m. to give relief to the family of seriously ill patients. The case load of the service during the year was as follows:- Types of patients assisted No. Chronic sick, aged and tuberculosis 2,713 Maternity 108 Others 189 Family help 11 The establishment of home helps is 260 which is partly filled by 338 partrtime and 14 full-time staff to give an equivalent of 219 full-time home helps. The basic rate payable to Home Helps was increased during the year to 39p per hour. This increase did not improve recruitment. A mobile squad is used to deal with long neglected homes which are sometimes only brought to our notice when a patient has to be admitted to hospital. 28 18. CARE OF THE ELDERLY EALING DAY TREATMENT CENTRE ASSOCIATION The types of disability which brought patients to the Centre were as follows:- Diseases of the musculo-skeletal system 66 Diseases of the cardiovascular system 17 Diseases of the respiratory system _ Diseases of the central nervous system 56 Diseases of the alimentary system 1 No major diagnosis or senility only 3 Others 10 Total 153 The following table shows the distribution of referrals during the year from the various parts of the borough:- Hanwell, W.7 28 Ealing, W. 13 20 Ealing, W. 5 18 Greenford 26 Northolt 24 Perivale 1 Southall 23 Acton 13 Total 153 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 14 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 1 case. On most occasions persuasion succeeded in obtaining agreement to voluntary admission. 29 19. 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 1970 are given below. Country of origin No. of Persons Number Notified Contact Established Commonwealth Countries India 642 412 Pakistan 128 46 Other Asian 51 19 Caribbean 75 45 African 355 124 Other 117 3 Non-Commonwealth Countries Europe 22 1 Other 22 1 TOTALS 1, 412 651 46. 1% TUBERCULOSIS Given below are figures relating to tuberculosis over the last five years showing the differing incidence in the immigrant and indigenous population in the three main parts of the borough. It must be emphasized that these rates are calculated from estimated populations, and the incidence in Asians is gauged from the names of those notified. I consider, however, they are sufficiently accurate to give a broad indication of the pattern of tuberculosis in the borough. NEW CASES OF PULMONARY TUBERCULOSIS - SHOWING RATE PER 1,000 OF THE POPULATION ACCORDING TO THE AREAS OF THE FORMER BOROUGHS Area 1966 1967 1968 1969 1970 No. of Cases Rate per 1, 000 pop. No. of Cases Rate per 1, 000 pop. No. of Cases Rate per 1, 000 pop. No. of Cases Rate per 1, 000 pop. No. o f Cases Rate per 1,000 pop. SOUTHALL 51 0.86 56 1. 05 56 1.05 76 1. 41 46 0. 87 ACTON 33 0. 52 27 0. 42 23 0.37 19 0. 29 30 0. 48 EALING 47 0. 26 59 0. 32 58 0.31 55 0. 30 69 0. 26 TOTALS 131 0.43 142 0. 48 137 0. 46 150 0. 50 145 0. 49 30 NEW CASES OP PULMONARY TUBERCULOSIS IN THE FORMER BOROUGH OP SOUTHALL SHOWING RATE PER 1,000 OP THE POPULATION Year Total cases notified Indians and Pakistanis (Based solely 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 1966 51 0.9 33 3.6 18 0.4 1967 56 1. 1 41 3.4 15 0. 4 1968 56 1. 1 43 3. 1 13 0.3 1969 76 1.4 71 4.4 5 0. 01 1970 46 0.8 34 1.9 12 0. 4 N.B. 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:- Total school population 44,712 Total immigrant population in schools 10,169 31 20. 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 - 14^ years (senior school leavers). The total school population at the end of the year was 44,712 and the details of examinations carried out are as follows:- First age group 5,032 Second age group 3,923 Third age group 3, 347 12,302 Classification of general condition: Satisfactory 99.16% Unsatisfactory 0.84% Defects requiring treatment found at routine medical inspections: Skin 334 Vision 823 Squint 118 Hearing 105 Middle ear 160 Nose and throat 121 Speech 93 Enlarged glands 16 Heart 30 Lungs 47 Hernia 16 Epilepsy 15 Orthopaedic: Postural 15 Feet 125 SELECTIVE MEDICAL EXAMINATION During the year a pilot scheme of selective medical examinations was carried out and the results will be analysed during the next year. Instead of automatic examination of children at three fixed times in their school life selective assessment consists of a continual watch by teacher, school nurse and school doctor for any children who may show signs of incipient physical illness or behaviour problems. 32 Contact is also made with the parents and they are asked to complete a questionnaire about their child's health. Those children who are considered to have physical or behaviour problems are then the only children examined. It must be emphasized that such a scheme will not reduce the total work-load, indeed the opposite is found to be the case. Many consider it, however, a more profitable use of time in that only children who have a need to be examined are in fact examined. 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 frequest 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 14,982 (355 re-tests) Schools visited 151 Children with hearing loss 716 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 1970, 50,284 examinations were carried out, 451 cases of infestation were found representing 0.69%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. 33 Defective colour vision could influence the choice of career and, for this reason, colour vision testing is carried out in junior and senior schools. SCHOOL CLINICS The following school clinics are provided:- General Asthma Chiropody Speech Therapy Ophthalmic Orthopaedic Child Guidance. General School Clinics To these clinics any parent or teacher may refer a child whose health or progress at school is causing concern. They also provide the school medical officer with a further opportunity to investigate any defect noted at routine medical examinations at school. Sessions are held at each of the Council's clinics at least once a week. Attendances during the year were:- Abbey Parade 149 Laurel House 473 Avenue Road 1,154 Mattock Lane 858 Cherington House 1,357 Northcote 724 Cloister Road 219 Northolt Grange 496 Greenford Green 237 Perivale 528 Islip Manor 454 Pierrepoint Road 641 Jubilee Gardens 497 Ravenor Park 975 King Street 230 Trinity Way 308 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 1,065 attendances were made. Chiropody Clinics In so far as school children are concerned, chirpody is almost exclusively the treatment of verrucae. This persistent and widely spread condition among school children is a type of wart which forms on the sole of the foot and if untreated becomes very painful. The treatment, although not difficult, is time consuming. Sessions are held at six clinics throughout the borough. 34 Owing to a shortage of chiropodists and because most of the work on childrens' feet consists of the treatment of a single verruca most of this work has been taken over by clinic nurses. Details of attendances during 1970 are:- Verrucae Other chiropody New cases 425 149 Re-examinations 2,156 1,150 Total 2,581 1,299 Speech Therapy Clinics The following types of defect were encountered during the year:- Dyslalia (confusion of articulation) 458 Delayed development of speech and/or language 113 Aphasia or dysphasia (absence or disorder of speech and/or language due to neurological causes) 26 Anarthria or dysarthria (neuro-muscular disorders of muscles of articulation) 7 Aphonia or dysphonia (disorders of voice) 9 Cleft Palate 17 Stammer 81 Dysenia (articulatory defect arising from hearing loss) 5 Total 716 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:- 35 First attendances 739 Re-attendances 2, 175 Total 2,914 Glasses prescribed 326 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:- Total Number New Cases ^ ^ of attendances Avenue Road 24 467 Ravenor Park 3 124 Total 27 591 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. 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 1970 are:- New cases 99 Re-attendances 387 Total 486 Physiotherapy is provided at the following clinics:- Greenford Green Ravenor Park Mattock Lane Jubilee Gardens Islip Manor CHILD GUIDANCE Dr. Portia Holman retired on December 31st 1969 having been director of the Child Guidance Clinic for many years, and was replaced by two part-time Consultant Psychiatrists. Dr. Robin Benians took up his duties on 24th July and Dr. Sonia Holmes on the 1st September. In addition to their work at the Child Guidance Clinic, Dr. Benians is responsible for assessing and preparing psychiatric reports on children admitted to the 36 Council's reception home, and Dr. Holmes visits the day special schools, and holds weekly discussion groups for the field staff of the Children's and Health Departments. There were also changes in the psychiatric cover for the residential special schools. Following the resignation of Dr. Maine, Dr. Masani was appointed to advise the staff of Red House and East Quinton Schools. 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, 1969 82 Number of cases referred to Centre during 1970 478 Number of cases seen by Psychiatrists during 1970 389 Number of cases seen by other Officers 1970 23 Cases withdrawn 1970 118 Number of cases awaiting at December, 1970 86 Recommendations by Psychiatrists Treatment or remedial teaching 147 Placed in residential school for maladjusted 32 Placed in day school for maladjusted Aston 7 Newlands 11 18 Placement in residential schools for the maladjusted Number of children awaiting placement at 31st December, 1969 15 Number of children recommended during the year 11 Children placed 32 Awaiting placement at 31st December, 1970 15 Recommendations for psycho-therapy or remedial treatment Cases awaiting treatment at 31st December, 1969 39 Recommendations for treatment 147 Treatments during year 112 Awaiting treatment at 31st December, 1970 26 Of the 373 children referred to the centre for intelligence testing 245 were boys and 128 were girls. HANDICAPPED CHILDREN 37 The following table sets out, in their various categories, the number of handicapped pupils as at 31st December, 1969:- Category of Pupils In Special Day Schools In Special Residential Schools In maintained Secondary Schools Not at School In Independant Schools Total M F M F M F M F M F M F Blind - 2 1 2 - 1 4 Partially sighted 8 10 - - - - - - - - 8 10 Deaf 5 12 3 3 - - 1 1 - - 9 16 Partially deaf 17 12 5 3 - - - 3 - 1 22 19 E.S.N. 159 116 27 11 44 28 14 6 - - 244 161 Epileptic - 1 1 4 1 - 1 - - - 3 5 Maladjusted 63 16 96 39 17 13 6 2 - - 182 70 Physically handicapped 33 26 2 5 3 - 8 9 - 3 46 43 Defective speech 9 1 - - - - 11 7 - - 20 8 Delicate 28 10 11 4 4 4 4' 1 - - 47 19 Totals 322 206 146 71 69 45 45 29 - 4 582 355 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 were held at 13 of the Council's clinics and at the end of the year 11 full-time dental officers were employed and two part-time officers being the equivalent of 8/10 of a full-time officer. There was also one dental auxiliary. Though the total of 11 /10 appears to have changed very little from 1969 the situated is quite markedly different as we now have only one part-time dental officer doing five sessions a week (the remaining /10 being a part-time orthodontist). In 1969 we had the services of five part-time officers. The present level of dental time staffing should be adequate to ensure a high standard of treatment for those parents who opt for treatment by the School Dental Service. Dental Inspections The figures for dental inspection during the year were as follows:- Routine dental inspections during 1970 71.6% of school population Pound to require treatment 67. 2% Sessions devoted to inspection 6.6% Dental Treatment The figures for dental treatment during the year were:- 38 Total visits to clinics 26,780 Teeth filled 21,711 Teeth extracted 6, 909 General anaesthetics 2,458 Emergencies 1, 144 Sessions devoted to treatment 4, 226 In March the School Dental Service was inspected by a dental officer of the Department of Education and Science. In the subsequent report which was received recommendations were made, amongst other things, as to equipment, forms of consent for treatment and improvement in natural lighting in one clinic. Most of the recommendations were already in hand before the report was received and the structural undertakings to improve lighting will be undertaken in 1971. In discussion during the visit we were urged to inspect more children at school and try not to devote as much time to re-inspecting children during the year for "check-ups". Many parents expect their children to be seen regularly during the year and hope that appointments will be sent at four to six monthly intervals for "check-ups". Except for children who are very caries-prone, the responsibility for appointments for re-inspection has had to be left to parental request and not sending for the children at regular intervals as a matter of course* It is a pity that we cannot have the same service for recall appointments as many private practitioners do but they only treat a proportion of children in their practices. Even so 13% of children treated for a first course had subsequent courses of treatment during the year and the routine inspections during 1970 show an increase of 31% over 1969. Altogether 1970 was a year of progress for the dental service particularly as a far greater measure of stability has been attained and it is hoped that this will be maintained. DENTAL HEALTH EDUCATION One aspect of the dental auxiliaries' work in dental health education, which has been found to be especially useful, is to give individual instruction at school dental inspections to those children whose dental hygiene is inadequate. These lessons are followed up after a couple of weeks to see what improvement has resulted. Our one auxiliary can only cover a limited area of activity, and her effort has to be used where the need seems greatest. Accordingly, among others, the children attending special schools have seemed especially in need of this extra care. Children do not seem to lack toothbrush and paste, this is now rarely the case, but they are too lax and ill-instructed in using them. PREVENTION OP 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. 39 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 the Health Department gave lectures and the course ended with a series of discussion groups and an open forum. SCHOOLGIRL MOTHERS 7 cases were referred to the School Health Service during the year of which 5 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 83 children of school age in junior training schools. RECUPERATIVE CARE Under Section 48 of the Education Act, arrangements are made on the recommendation of a doctor for convalescent holidays, without charge, for school children. During 1970 recuperative care was arranged for 27 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. 40 21. GENERAL ENVIRONMENTAL HEALTH MEASURES NUISANCES AND COMPLAINTS During the year, 7,953 complaints were received, the main categories of complaint being as follows:- Housing defects 1,411 Dustbins and refuse 893 Drainage 1, 209 Animals, etc. 66 Insects and wasps 364 Pood 364 Smoke emissions and bonfires 237 Overcrowding and multiple occupation 63 Noise 151 Rats and mice 2,836 Miscellaneous 180 Action taken as a result of complaints resulted in 8,964 inspections of premises of all types and the service of 1,321 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 628 statutory notices in cases where action to remedy defects was not readily forthcoming and in the case of 25 premises, legal proceedings were necessary, involving the service of 26 summonses. Of these 26 cases, 8 were withdrawn before the hearings on compliance, and on payment of agreed costs to the Council. Nuisance Orders were made in 10 cases and defendants ordered to pay costs, and fines and costs were imposed in 2 other cases. In three other cases no orders were made as the works were completed before the hearings, but costs were granted. One case was withdrawn due to the summons being wrongly served but the work was subsequently completed. Another case was adjourned sine die to allow the work to be done. The Council carried out works in default of the owner in the last case and the summons was withdrawn. Total fines imposed amounted to £65 and costs to £123.10. A total of 4,384 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 1,016 drains and water closets, abatement of dampness in 297 cases, the removal of 610 accumulations of refuse and the repair of 287 walls and ceilings, and 196 roofs. DESTRUCTION OP PIGEONS - PUBLIC HEALTH ACT, 1961 The contract with a firm specialising in the destruction of pigeons was continued and work carried out resulted in the destruction of 3,726 feral pigeons. CARAVAN SITES AND CONTROL OP 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 41 roads in the Western Avenue and Yeading Lane areas. His co-operation with the local police resulted, in most cases, in a satisfactory removal of the vehicles within a short time. There is no doubt that without this degree of control, the caravans would remain for long periods on sites which are quite unsuitable for camping, with consequent creation of nuisance. REFUSE COLLECTION During the latter part of the year whilst the manual workers were on strike arrangements were made by the Chief Officer, Works, for refuse to be collected on certificate of the Chief Public Health Inspector. 120 such collections were made and also 4 cesspools emptied. As a result of this action no health hazards arose. RADIOACTIVE SUBSTANCES ACT, 1960 Persons who use radioactive material, unless specifically exempted, are required to be registered by the Minister of Housing and Local Government, who notifies local authorities. A visit is then made by the public health inspector to obtain detailed information concerning safety precautions so that such information is available locally in the event of an accident. Two new premises were registered during the year to bring the total in the borough to 26. INSPECTION OP FACTORIES AND OUTWORKERS' PREMISES - FACTORIES ACT, 1961 This Act and various regulations made under it places on local authorities the responsibility for the enforcement of provisions relating to cleanliness, overcrowding, temperature, ventilation, drainage of floors and sanitary conveniences in respect of any factory where mechanical power is not used, and the provisions concerning sanitary conveniences in powered factories. During the year, 124 premises were inspected and at the end of the year there were 1,441 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. 121 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 8 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 151. The complaints again referred to noise from industry, commerce, neighbours, road traffic, road drills, and the practice sessions of “pop” groups. 42 On investigation, it was found that approximately 61% of the complaints referred to noise coming from industrial and commercial premises and that about 40% of these were valid complaints. Of the complaints of noise from other sources, about 51 were complaints which could be supported by the Division. The number of complaints about noise from road drills increased slightly probably because of extensive work carried out by one of the public utility companies, but in only a few cases was it noted that silencers or mufflers were not in use and in these instances the mufflers were soon fitted when attention was drawn to the deficiency. Of the total number of complaints, 70 were abated without having to use statutory action, 64 were held not to be nuisances although in most cases efforts were made to achieve a reduction of noise at source. 17 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, 3,258 premises were registered by the Council under this Act, there having been 249 additions to the register, and 87 deletions. Inspection of premises to which the Act applied continued at a very satisfactory pace with 1,852 general inspections and a total of 3,152 visits of all kinds. Occupiers are responsible for notifying accidents to their employees which result in absences of three days or more from normal work. During 1970, 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 6 - - - 6 Power machinery at rest 1 - - - 1 Vehicles moved by power 1 - - - 1 Vehicles moved by power in motion 7 2 - - 9 Falls on or from stairs 3 5 1 - 9 Falls on or from ladders 1 2 - - 3 Other falls from one level to another 4 3 - - 7 Falls on same level 7 8 1 - 16 Stepping on or striking object or person 6 7 - - 13 Handling goods 9 8 - - 17 Struck by falling object 15 5 - - 20 Use of hand tools 6 - 3 - 9 Fire - 2 - - 2 Totals 66 42 5 - 113 43 Prosecutions During 1970 there were 3 successful prosecutions for a variety of offences under the Act and Regulations made under it. The total fines in these cases amounted to £140 and costs of £30 were awarded to the Council. Registrations and General Inspections Class of Premises No. of premises newly registered during year Total No. registered at end of year No. of registered premises receiving one or more general inspections during the year Offices 132 888 411 Retail shops 98 2,007 1, 237 Wholesale shops, warehouses 8 115 95 Catering establishments open to public, canteens 11 245 109 Fuel storage depots - 3 - Totals 249 3, 258 1. 852 No. of visits of all kinds by inspectors to registered premises - 3,152 Analysis of persons employed in registered premises by workplace Class of workplace Number of persons employed Offices 15,863 Retail shops 9,986 Wholesale departments, warehouses 2,668 Catering establishments open to public 1,828 Canteens 149 Fuel storage depots 18 Total 30,512 Total males 14,548 Total females 15,964 Contraventions remedied Items No. of Improvements Premises cleansed 345 Overcrowding abated 3 Temperature improved 10 Thermometers provided 83 Ventilation provided or improved 82 44 Items No. of Improvements Lighting improved 29 Lighting apparatus repaired 6 W.C. accommodation increased 9 Washing facilities increased (basins) 33 Hot and cold water provided 67 Drinking water provided 1 Accommodation for clothing provided or improved 22 Sitting facilities provided or improved 6 Floors, stairs, passages etc., repaired 145 Handrails provided 24 Staircase guards provided 23 Machinery guarded 39 First aid boxes provided or refilled 198 Windows and skylights cleaned 3 Soap provided 2 Towels provided 2 Meal facilities provided or improved 11 PAIRS AND CIRCUSES Fairs were held during the year at Ealing Common, Acton Park, and at Northolt. The Council now have as standard in any agreement with fairmen clauses requiring satisfactory sanitary arrangements. These include provisions relating to the number, type, lighting, condition and location of trailers used as sanitary conveniences, and resulted in a satisfactory standard being maintained during the year. Pood stalls were numerous on the sites and standards here were also found to be reasonable. DISINFECTION AND DISINFESTATION The amount of work connected with disinfestations for the eradication of bed bugs continues to decline and heavy infestations are now rarely found. Disinfestation measures were taken in 84 houses, following complaints of bed bugs and other insects. 35 items were disinfected by formalin spray, and these were mainly articles of clothing despatched to various European countries by relatives and friends. Import of such clothing to certain countries is only permitted on production of a certificate of disinfection. Routine terminal disinfection of 217 houses, after cases of illness, was carried out, mainly as a result of special requests from the occupiers. 12 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 2,730 Premises inspected 2,836 Premises found to be infested with:- (a) rats 951 (b) mice 1,246 45 Re-visits to infested premises 5,487 Pees received for treatment £1,789 There has been a considerable increase in the number of complaints concerning both rats and mice, with a significant increase particularly in the number of infestations of mice found and treated. This increase in mice is not peculiar to Ealing, but is common throughout London and many other parts of the country and is mainly due to a growing resistance to mice against Warfarin and a lack of other safe and suitable poisons which are available for use. Infestations of mice are now more difficult to eradicate and longer periods of treatment such as an increase in the number of revisits has become necessary. With the work of the rodent control staff being directed to deal with these current needs, activities in other spheres have been reduced, particularly in connection with the control of rodents in sewers. However the Council has now agreed to an increase in staff and transport during the next two years, and arrangements to resume a full programme of regular treatment of the sewers will now become possible. INSPECTION OP HAIRDRESSING ESTABLISHMENTS 227 premises have been placed on the register and 89 inspections were made in 1970. Premises have, on the whole, been found to be satisfactory, and only minor deficiencies discovered. 46 22. WATER SUPPLIES, SWIMMING BATHS AND SEWAGE DISPOSAL WATER SUPPLIES Pour water undertakings supply the borough with mains water. The Colne Valley Water Company supplies small parts of Perivale and Horsende, Wards. The Rickmansworth and Uxbridge Valley Water Company supplies the remainder of Perivale and Horsenden Wards, part of Waxlow Manor Ward and the whole of Ravenor, Mandeville and West End Wards. The South West Suburban Water Company supplies the whole of Dormers Wells and Northcote Wards, the remainder of Waxlow Manor Ward and part of Glebe Ward. 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 92,937 dwellings with a mid-1970 estimated population of 294,820. 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. 54 samples of water from these wells submitted for bacteriological and chemical examination during the year were all satisfactory, although 3 had a high iron content due to internal rusting of supply pipes; this condition was subsequently remedied. As a result of complaints, 13 samples of tap water from public supplies were taken all of which proved satisfactory. Water Samples, 1970 Samples Satisfactory Doubtful Unsatisfactory Well Supplies 54 54 - - Public Supplies 13 13 - - Totals 67 67 - - 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, a modern block of flats and at a sports club. Samples of water from each pool were taken at regular intervals throughout the year and submitted for bacteriological examination. A total of 194 samples was taken of which only 4 were unsatisfactory. In the latter cases repeat samples were found to be acceptable and advice was given where necessary. The results are as follows:- 47  Number of pools Satisfactory samples Unsatisfactory samples Total samples Public baths 11 84 2 86 School baths 5 58 - 58 Private baths 3 48 2 50 Totals 19 190 4 194 The Council's analyst also carried out detailed chemical and bacteriological examination of swimming bath water at intervals with the following results:- Number of pools Satisfactory samples Unsatisfactory samples Total samples Public baths 11 94 - 94 School baths 5 21 - 21 Private baths 3 3 1 4 Totals 19 118 1 119 The unsatisfactory sample was found to be acceptable on bacteriological examination but had a free chlorine content which was 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 are served by chemical or pail closets. FLUORIDATION OP 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. 48 23. 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 OP 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 51 market sales under the Regulation of the Movement of Swine Order, 1959, and issued 552 movement licences authorising 14,281 pigs to be moved out of the market. Of 53 vehicles inspected, no contraventions were found. DISEASES OF ANIMALS (WASTE POODS) ORDER, 1957 Three plants are still in operation and are working satisfactorily. SLAUGHTER OP ANIMALS ACT, 1958 17 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 13 occasions during the year. PET ANIMALS ACT, 1951 Licences in respect of 25 premises were renewed. The number of routine inspections was 48. 49 24. HOUSING UNFIT HOUSES (a) Clearance Areas The following progress was made during the year in connection with the Council's programme for 1965 - 1970 2-20 (evens) Beaconsfield Road and 14-38 (evens) and 13-31 (odds) Gladstone Road, W. 4. Compulsory Purchase Order made in 1969 confirmed by Secretary of State for the Environment following Public Inquiry. 1-21 (odds) and 2-26 (evens) Richards Cottages, W. 3. Compulsory Purchase Order made in 1969 confirmed following Public Inquiry. Rehousing of occupants nearing completion. 29 Haven Green and 1 Haven Lane, W.5. Clearance Order submitted but negotiations for improvement and reconditioning in progress. 6-13 (consecutive) Oldham Terrace, 1-14 (consecutive) Mill Hill Terrace, 1-7 (consecutive) Princes Terrace and 1 & 2 Priory Cottages, Princes Terrace, W.3. Compulsory Purchase Order confirmed in 1968 after Public Inquiry. Rehousing of occupants nearing completion and 14 properties demolished. 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 confirmed in 1968. Rehousing of occupants nearing completion and 29 properties demolished. 63-89 and 63a-89a (odds) Dudley Road, Southall. ) Compulsory Purchase Order made in 1967 and confirmed in 1968. Rehousing of occupants completed and premises demolished. 1-8 (consecutive) and 11-16 (consec- utive) Nelson Place and 17-27 (odds) and 43-49 (odds) Steyne Road, W.3. Clearance Order confirmed in 1968. Rehousing of occupants nearing completion and 4 properties demolished. (b) Individual Unfit Houses and Parts of Houses 139B The Grove, W. 5. Closing Order made in 1966 determined on demolition and reconstruction. Ground floor and first floor flats 23 Shirley Gardens, W. 7. Closing Order made in 1969; tenants rehoused. Carfield Lodge, Gladstone Road, W. 4, Ground floor flat, 120 Hammond Road, Southall, 48B Mattock Lane, W. 5, 38A St. Dunstans Road, W. 7. Closing Orders made and tenants rehoused. 116 Argyle Road, W. 13. No further action taken on proposed Demolition Order following completion of works to make premises fit. 50 (c) Underground Rooms The following action was taken during the year:- 5 Cumberland Park, W.3. Closing Order made, occupants awaiting rehousing. 19 South Ealing Road, W.5. (Basement) Closing Order made in 1964 determined on completion of works. HOUSES IN MULTIPLE OCCUPATION Details of action taken over the last 7 years in connection with houses in multiple occupation in the area which is now the London Borough of Ealing are given below. Action taken 1970 Totals Acton Ealing Southall Directions given (Section 19 Housing Act, 1961 8 15 104 127 Prosecution for contravention of Direction — 2 11 13 Notices to improve facilities and means of escape from fire (Sections 15 and 16 Housing Act, 1961) 185 208 11 404 Prosecution for failure to comply with notices served under Sections 15 and 16 of Housing Act, 1961 6 7 — 13 Overcrowding notices (Section 90 Housing Act, 1957) — — 8 8 Prosecution for contravention of overcrowding notices — — — — Notices requiring information as to occupants (Section 19 Housing Act, 1961) 12 22 251 285 Prosecutions for failure to supply information as to occupants _ — — 33 Prosecutions for false information — — — — Prosecution for failure to supply information as to ownership 3 1 _ 4 Control Orders made (Housing Act, 1964) — — — — Management Orders made (Section 12 Housing Act, 1961) — — — 1 Total visits and inspections of houses in multiple oocupation during 1970 3,712 51 Details of overcrowding under Section 90 of the Housing Act, 1957:- Number of dwellings overcrowded at end of year Number of families occupying these houses Number of individuals living in these houses Number of new cases of overcrowding reported during the year Overcrowding relieved during the year - 11 27 135 8 (a) Number of cases 7 94 (b) Number of individuals involved The 12 prosecutions for contraventions of the terms of Directions given under Section 19 of the Housing Act, 1961, were all successful. Pines, totalling £210, were imposed and a total of £45 costs awarded to the Council. Pines ranged from £5 to £40 and costs from £2 to £18. There were also 4 proceedings for failure to comply with notices under Section 170 of the Housing Act, 1957, requiring information as to ownership. Two cases were withdrawn when the information was given and in one case costs of £3.15 were paid to the Council. One case was dismissed and in another case fines totalling £12 were imposed and £10 costs awarded to the Council. There were 11 prosecutions for failure to comply with notices served under Sections 15 and 16 of the Housing Act, 1961. 10 of which were successful, one case being withdrawn when the work was done. Pines totalling £454 were imposed and £86 costs awarded to the Council. There was one appeal to County Court against service of a notice under Section 16 of the Housing Act, 1961, which was dismissed. A fine of £3 was imposed and £3 costs awarded to the Council in a case where a Public Health Inspector was obstructed. IMPROVEMENT GRANTS The staff carrying out Improvement Grant functions under the Housing Acts from 1954 onwards were transferred to the Inspectorate with effect from 1st June, 1970. The decision to transfer these functions was influenced by the coming into operation in August, 1969, of the Housing Act, 1969, which radically altered the financial basis of grant calculation and introduced the Qualification Certificate procedure by means of which owners of rent controlled dwellings could apply to the Rent Officer for the registration of fair rents and the conversion of controlled tenancies to regulated ones. Landlords following this procedure required a qualification certificate stating that the dwelling was provided with all the amenities prescribed by the Act, was fit for human habitation and in good repair having regard to, its age, character and locality. By December, 1969, about 900 applications for Qualification Certificates had been received but because of staff difficulties little progress had been made in inspecting the properties although an adequate administrative procedure had been built up. By December, 1970, the number of applications for Qualification Certificates had risen to 1,883. By steady work throughout the year, mainly with the assistance of the District Public Health Inspectors, 278 Qualification Certificates were issued following completion of necessary works of repair by the owners. A further 1,380 premises had been inspected following which some applications were withdrawn and the remainder were awaiting completion of work before Certificates could be issued. 52 During 1970, 181 Improvement Grants were approved totalling £90,206 in grant value. This compares with 77 approvals totalling £28,427 in value for 1969. This increase is accounted for by the greater interest on the part of property owners (not only owner/occupiers) as the result of the more attractive grant aid now available. A grant can be up to £1,000 per dwelling and up to £1,200 if work is carried out on the third floor or above in any building. 58 Standard Grants to the value of £7,503 were approved in 1970 as against 77 totalling £9,092 in value for 1969. The number of Standard Grant applications may be expected to decline because an Improvement Grant which may include grant aid for essential repairs is generally more attractive. The technical staff is also responsible for house to house surveys in areas under consideration by the Chief Officer, Town Planning. One such survey of the Acton Town Centre Study Area was commenced late in 1970. Each house is inspected and a full report made giving the present pattern of use, cost of repairs and necessary improvements and estimated future life following repair and improvement. The Chief Officer, Town Planning, uses the information obtained in formulating proposals for consideration by the Council and also by the public. MEDICAL ASPECTS OP COUNCIL HOUSING Many persons who have applied for Council housing or who wish for a transfer from one Council house to another require special consideration by reason of illness or disability suffered by a member of the family. Such consideration can only be given if a doctor's letter or certificate is furnished. These certificates are usually forwarded in the first place to the Housing Manager who then seeks advice on the medical implications, at the same time forwarding any relevant information that is to hand in his division. 53 25. CLEAN AIR The Council's policy of establishing Smoke Control areas to cover the whole borough by 1972 was continued during the year and 4 further Orders were made. These related to Areas Nos. 49-52 inclusive covering 552 acres, including 3,214 dwellings and 731 other buildings. Orders Nos. 48 and 51 were confirmed to come into operation on 1.6.71 and 1.7.71 respectively and Orders Nos. 49, 50, 52 and 33 (Variations) Order were awaiting confirmation at the end of the year. Orders Nos. 45-47 made in 1969 also became operative in 1970. A survey of Areas Nos. 53 and 54 was completed. This finishes the survey of the borough. Because of the anticipated shortage of solid smokeless fuel during the winter 1970/71, an order was made by the Council and confirmed by the Minister to come into operation on 11th November, 1970, suspending the following Smoke Control Orders from that date until 31st March, 1971:- Acton Nos. 1 - 11. Ealing Nos. 3, 5, 14, 15, 16, 17, 22, 23, 31, 34, 37, 41, 42, 44 and 47. 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. The Orders referred to are those which have been confirmed or which are awaiting confirmation by the Minister. Position at 31st December 1970 Region No. of acres covered by Staoke Contro 1 Orders Percentage of total “black area” acreage so covered No. of premises covered by Staoke Control Orders Percentage of total "black area" premises so covered Whole Country “black areas” 824,072 46. 5 4,367,628 56. 2 Greater London 241,192 73. 8 2, 143,310 81. 2 London Borough of Ealing 12,791 93. 3 96,930 96.4 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 85 12,075 76,616 10,227 4, 214 91, 057 Confirmed but not yet in operation 2 501 2, 796 5 119 2, 920 Awaiting confirmation 4 428 4,055 197 768 5, 020 Totals 91 13,004 83,467 10,429 5, 101 98,997 Suspended 11.11.70 31.3.71 26 3, 722 31,653 2, 846 1, 860 36,359 Totals at 31.12.70 65 9, 282 51,814 7, 583 3, 241 62,638 London Borough of Ealing - Smoke Control Areas (coloured yellow on map) SMOKE CONTROL ORDERS YEAR OP OPERATION Acton Nos. 1-11 1960 - 1965 Ealing Nos. 1-20 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 1970 Ealing Nos. 38 - 40 Made in,1969 and confirmed in 1970 but not coming into operation until 1971. Ealing No. 51 Made and confirmed in 1970 but not coming into operation until 1971. Ealing Nos. 33 (variation) 49, 50, 52 Made in 1970 but awaiting confirmation by the Ministry of Housing and Local Government. Ealing Nos. 53 and 54 Survey complete. 55 MEASUREMENT OP AIR POLLUTION Daily volumetric instruments for measuring smoke and sulphur dioxide in the air ana deposit gauges for monitoring local emissions were maintained in operation during the year. The overall figures for the daily volumetric instruments show an average reduction compared with last year of 24% in the amount of smoke and 26% in the amount of sulphur dioxide in the air. The deposit gauge figures show an overall 15% increase in airborne particles. 57 26. FOOD HYGIENE AND FOOD AND DRUGS ADMINISTRATION CLEAN POOD SCHEME The council's Clean Pood campaign was continued during the year. 14 lectures being given to a total of 276 food handlers, and certificates of attendance awarded to those who completed the courses. In addition, 8 lectures were given by public health inspectors to 185 members of women's organisations, and 11 lectures to 450 school children approaching school leaving age in the secondary schools. 4 filmstrips were sold to other local authorities. INSPECTION OP POOD PREMISES A total of 1,517 visits was made to food premises in the borough, and 1,085 improvements effected as a result. 8 prosecutions for flagrant contravention of the Pood Hygiene (General) Regulations, 1960, were taken during the year, involving 87 summonses. Pines totalling £1,257 and costs of £83 were awarded to the Council on 85 counts and two summonses were dismissed. Table 5 gives details of the number of food premises in the borough according to particular category of use. THE POOD HYGIENE (MARKETS. STALLS & DELIVERY VEHICLES) REGULATIONS, 1966 One certificate of exemption from the provisions of the Regulations relating to water supply and washing facilities was granted by the Council during the year, as satisfactory alternative facilities were available in adjoining premises. There was one successful prosecution during the year for two contravention of the Regulations. Pines totalling £17 were imposed and £5 costs awarded to the Council. MILK AND DAIRIES (GENERAL) REGULATIONS, 1959 During the year, 39 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 165 distributors of milk in respect of 240 premises. 24 samples of washed bottles were taken at random from a bottling plant at one dairy, of which 23 were found to be satisfactory and one unsatisfactory. The second dairy is mainly concerned with the pasteurising and packing of cream in plastic containers. In spite of all the precautions taken by dairy firms 14 complaints were received from members of the public concerning the sale of milk in dirty bottles containing foreign bodies. There were 2 prosecutions involving total fines of £55 and costs of £15. THE MILK (SPECIAL DESIGNATION) REGULATIONS, 1963 AND 1965 During the year 39 new dealer's (pre-packed milk) licences were issued, and 151 distributors and 2 pasteurisers, involving 225 premises were on the register at the end of the year. Informal samples of milk taken for chemical analysis, to ensure that the samples were genuine and reached the required standards for fat and milk solids other than fat, were also examined by the tests prescribed for designated milks. All samples examined were found to satisfy these tests, as shown in the following table:- 58 Class of milk No. of Samples Phosphatase Test Methylene Blue Test Turbidity Test Colony Count Test Pass Fail Pass Fail Pass Fail Pass Fail Pasteurised 44 44 - 44 - - - - - Sterilised 14 - - - - 14 - - - Untreated - - - - - - - - - Ultra Heat Treated 4 - - - - - - 4 - Totals 62 44 - 44 - 14 - 4 - RAW MILK SUPPLIES - BRUCELLA ABORTUS There is only one farm engaged in milk production in the borough. As a result of a request from the Public Health Laboratory Service, sampling of raw milk for the detection of brucella abortus organisms was carried out directly from the farm during 1970. A total of 18 samples was taken and all were found to be negative for this organism by the ring test. ICE CREAM During the year 18 premises were added to the register for the sale and storage of ice cream and one for manufacture leaving a total at the end of the year of 508 premises registered for sale and storage and 9 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 o f Samples Methylene Blue Grade Not Graded Grades I & II satisfactory Grade III doubtful Grade IV unsatisfactory I II III IV Ice Cream (local manufacturers) 184 126 26 14 18 - 152 14 18 Ice Cream (other manufacturers) 57 31 12 5 9 43 5 9 Ice Lollies (local manufacturers) 9 - - - - 9 9 - - Ice Lollies (other manufacturers) 15 - - - - 15 15 - - Totals 265 157 38 19 27 24 219 19 27 59 The aforementioned table includes:- Ice Cream samples from vans 29 15 5 3 6 - 20 3 6 Soft ice cream samples 46 28 11 1 6 - 39 1 6 The largest proportion of unsatisfactory samples were from soft ice cream dispensing machines. These machines require very careful cleaning and sterilizing at the end of each day, but the need for this was not always appreciated by the operatives. Visits by inspectors were made in order to improve the standard and this resulted in more satisfactory samples being obtained. SURRENDER OP 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 4,931 Pish and fish products 484 Fruit and vegetables 16,555 Groceries 1,217 Total 23,187 Foodstuffs not calculated by weight Assorted tins, packets, jars, bottles, articles, casks and boxes 58,668 Milk 2,334 gallons REGISTRATION OP HAWKERS OP POOD AND THEIR POOD PREMISES In accordance with the requirements of Section 11 of the Middlesex County Council Act, 1950, 6 hawkers were registered during the year leaving a total of such traders on the register at the end of the year at 29. PREMISES REGISTERED FOR PREPARATION OP SAUSAGES AND PRESERVED POODS No new premises were registered under Section 16 of the Food and Drugs Act, 1955, during the year, at the end of which there were 165 premises on the Council's register. SAMPLING OF FOOD AND DRUGS - CHEMICAL ANALYSIS Food and drug 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 the borough to cover these services. The analytical work is carried out in laboratories which are staffed and equipped to undertake a wide variety of investigations. Apart from food and drugs these include water pollution and sewage treatment, sampling of water from swimming pools, air pollution, ventilation, noise and vibration, fire precautions, petroleum, fertilisers and feeding stuffs, radiochemistry 60 and general supplies and services. Some years ago the Ministry of Health recommended that the level of food and drugs sampling should be approximately three samples per 1,000 population per annum. During the year, exactly 800 samples comprising 14 formal and 786 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, 40 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. Samples of coffee concentrate and cooking oil which are sold in pressurised containers, were found to contain lead considerably in excess of the legal maximum of 2 parts per million. The packers of the coffee concentrate are to determine the lead content after flushing with nitrogen before pressurising and a period of storage. Production of the oil which was used as a non-stick frying aid, was discontinued. The Soft Drinks Regulations prescribe a minimum of 57 parts per million of quinine sulphate B.P. to be contained in tonic water. Sunlight tends to decompose quinine; therefore manufacturers should not allow stocks to become outdated. A sample of tonic water had a low quinine content due to decomposition and it was shown to be over a year old. LABELLING OP POOD 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 84 instances and in all cases the attention of manufacturers and packers or importers was drawn to the infringements. In the majority of cases arrangements were made to print new labels for stocks immediately or undertakings were accepted that new labels would be designed and used as soon as existing stocks became exhausted. A summary of the irregularities found is as follows:- Incorrect or inadequate description 14 No name and address 11 Incorrect or inadequate list of ) 39 ingredients or ) no list of ingredients ) Misleading statements 4 Use of generic terms 10 Inadequate size of printing 1 Incorrect claim of mineral content 3 BACTERIOLOGICAL EXAMINATION OP OTHER POODS In addition to the bacteriological examination of particular types of foods referred to in earlier paragraphs of this report 83 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. One consignment which was contaminated with Salmonella Welterreden was not released for sale. Articles of food which were the subject of consumer complaints numbered 4 but no harmful organisms were found on examination. 61 POOD COMPLAINTS Pood articles purchased by members of the public were the subject of 171 complaints all of which were thoroughly investigated. 38 of the articles were submitted to the Public Analyst for his opinion. Complaints of particular interest included a tin of spaghetti containing an insect of Mediterranean origin, two tins of salmon, one containing a spider and another containing a fish hook, and a steak and kidney pie containing a piece of metal. Prosecutions were taken in 13 cases, fines ranging from £10 to £40 being imposed and totalling £260 with £66 costs to the Council. One case was dismissed and another withdrawn on a plea of warranty. 62 27. REGISTRATION OF PREMISES USED FOR MEDICAL PURPOSES NURSING HOMES Nursing homes are required to be registered with the local authority under Section 190 of the Public Health Act, 1936, and at the end of the year, eight nursing homes were re registered with a total of 275 beds. Visits are regularly made to all nursing homes to ensure that they maintain satisfactory standards. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT The Council requires all persons operating an establishment for massage or special treatment to be registered under Part XII of the Middlesex County Council Act, 1944. All establishments are inspected annually to ensure that they are satisfactory. Byelaws made under the Act state that the licensed person must exhibit a complete scale of all fees or charges, keep records of people employed at the establishment and keep particulars of cases treated. There is a total of 33 establishments used by licensed persons in the borough as follows:- Chiropody only 10 r Chiropody and special treatment 7 Massage only 2 Massage and special treatment 7 Physiotherapy 1 Physiotherapy and special treatment 1 Osteopathy 2 Beauty treatment 3 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". 63 28. 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. 618 bodies of residents from the following areas were taken to the mortuary:- Ealing 476 Hillingdon 7 Richmond upon Thames 5 Hounslow 17 Other London Boroughs 106 Other areas 7 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. 64 29. MEDICAL EXAMINATION AND WELFARE OF STAFF MEDICAL ASSESSMENTS Total number of questionnaires assessed for fitness for employment 3, 163 Number of medical examinations required following questionnaire assessment 316 Number of failures as a result of medicals following questionnaire assessment 5 Number of persons undergoing medical examination other than by questionnaire assessment 982 On the 1st February, 1970, the Road Safety Act of 1967 requiring a special medical examination for drivers of heavy goods vehicles came into operation. During the year, 46 Council drivers were examined prior to the renewal of their licences. VACCINATION AND IMMUNISATION OP STAPP 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 92 Immunisation against typhoid fever 34 Immunisation against typhoid/tetanus 61 Immunisation against tetanus 20 207 FIRST AID During the year 714 attendances for treatment were made. 65 99 Table 1 INFECTIOUS AND OTHER NOTIFIABLE DISEASES CLASSIFIED IN AGE GROUPS Scarlet Fever Whoopingcough Measles Dysentery Acute Meningitis M F M . F M F M F M F Numbers originally notified 49 43 35 48 481 455 56 63 4 3 Final numbers after correction Under 1 year - - 4 7 19 20 1 - - 2 1 - - 1 2 1 52 43 3 2 - - 2 - 1 1 4 4 59 53 2 4 - - 3 - 3* 2 5 5 56 61 3 6 - - 4 - 9 5 6 5 91 71 1 1 - - 5-9 28 26 12 24 185 188 12 8 2 - 10 - 14 6 5 - 1 5 9 5 2 - 1 15 - 24 1 2 1 - 8 7 6 6 - - 25 and over 1 - 1 1 4 4 20 28 2 - Age unknown - 1 - - 3 1 2 5 - - Total 49 43 35 48 482 457 55 62 4 3 79 Table 1 continued Typhoid Pever Pood Poisoning Malaria M F M F M F Numbers originally notified 3 2 50 40 3 - Pinal numbers after correction: Under 5 years 2 _ 9 3 _ - 5-14 - 1 2 1 - - 15 - 44 1 1 8 2 2 - 45 - 64 - - 1 1 1 - 65 and over - - - 1 - - Age unknown - - 3 - - - Total 3 2 23 8 3 - 89 Table 1 continued Tuberculosis Infective jaundice Pulmonary Meninges and central nervous system Other M F M F M F M F Numbers originally notified 85 64 - - 32 31 27 23 Pinal numbers after correction: Under 1 year - — - - - - - 1 - - 1 — - - - - - 2 - 4 2 1 - - - - - 1 5-9 2 2 - - - 3 1 10 - 14 2 1 - - 2 2 1 1 15 - 19 5 4 - - 1 2 1 2 20 - 24 8 13 - - 4 4 2 2 25 - 34 10 13 - - 10 9 11 4 35 - 44 10 7 - - 4 6 4 3 45 - 54 21 8 1 - 2 4 3 1 55 - 64 11 3 - - 1 2 2 2 65 - 74 8 4 - - 3 - - - 75 and over 1 3 - - 1 1 - 1 Age unknown 2 3 - — 2 - - 3 Total 82 63 1 - 30 30 27 21 There were no cases of anthrax, cholera, diphtheria, leptospirosis, ophthalmia neonatorum, plague, poliomyelitis, relapsing fever, smallpox, tetanus, typhus, or yellow fever. Table 2 FACTORIES ACT 1961 - PART 1 Inspections for the purposes of provisions as to health (inspections made by public health inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which sections 1, 2, 3, 4 and 6 are to be enforced by local authorities 12 3 1 - (ii) Factories not included in (i) in which section 7 is enforced by the local authority 1. 422 121 39 - (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 7 - - - Total 1, 441 124 40 -- 69 Table 3 FACTORIES ACT 1961 - PART 1 Cases in which defects were found Particulars 9 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 1 1 - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors - - - - - Sanitary conveniences: (a) Insufficient 1 1 - - - (b) Unsuitable or defective 10 9 - 10 - (c) Not separate for sexes 1 1 - - - Other offences against the Act (not including offences relating to outwork) 3 3 - - - Total 16 15 - 10 - 70 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(1)(c) Wearing apparel: Making, etc. 30 Artificial flowers 3 Cosaques, Christmas stockings, etc. 54 Car Accessories 2 Handbags 3 Fasteners 3 Fishing Rods 1 Wigs 1 Tapestry 1 Lampshades 1 Total 99 During the year, 121 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. 71