I the Health of Ealing EAt £2. the Health of Ealing Annual Report 1971 Design by Architectural Division/Technical Services Group IH Seppelt MA MB BChir DPH Medical Officer of Health and Principal School Medical Officer Town Hall Annexe Ealing W52BY telephone 01-567 3456 FOREWORD Mr. Mayor, Aldermen and Councillors. 1971 has been characterized by a steady increase in the volume of work undertaken by existing services rather than by innovation. As such, it has been an extremely busy time and I would like to thank both the members of those committees of the Council concerned with its health services together with the staff of the department for their help during the year. Your obedient servant. Medical Officer of Health. LIST OF CONTENTS FOREWORD 1. Vital Statistics 2. Infectious Diseases 3. Vaccination and Immunisation 4. Co-ordination and co-operation between Health Department's Service, and Hospital and Family Doctor Services 5. Infant Welfare 6. Health Centres 7. Family Planning 8. Well-woman Clinic 9. Midwifery 10. Home Nursing 11. Health Visiting 12. Renal Dialysis 13. Health Education 14. Chiropody 15. Chest Clinic 16. Care of the Elderly 17. Immigration 18. School Health Service (including Dental Service) 19. General Environmental Health Measures 20. Water Supplies, Swimming Baths, and Sewage Disposal 21. Meat Inspection and Animal Protection 22. Housing 23. Clean Air 24. Food Hygiene and Food and Drugs Administration 25. Registration of Premises used for Medical Purposes 26. Public Control Measures 27. Mortuary and Burial Arrangements 28. Medical Examination and Welfare of Staff TABLES 1 VITAL STATISTICS Area (in acres) 13,708 Population (Census, 1961) 299,762 Population (estimated middle of 1971) 300,580 Rateable value, 1st April, 1971 £24,975,000 Net product of 1p rate, 1971/72 £236,000 SUMMARY OF STATISTICS LONDON BOROUGH OF EALING ENGLAND AND WALES 1965 1970 1971 1971 Live births:- Legitimate 5,024 4,793 4,686 717,491 Illegitimate 528 447 444 65,674 Birth-rate per 1,000 of estimated population 18.3 17-3 16.6 16.0 Illegitimate live births (per cent of total live births) 10.5% 9% 9% 8% Still-births 81 61 61 9,898 Rate per 1,000 total births (Live and stillbirths) 14 12 12 12 Deaths 3,450 3,476 3,506 567,345 Death-rate per 1,000 of estimated population 11.4 11.1 11.0 11.6 Deaths of infants under one year of age:- Legitimate 89 80 79 12,140 Illegitimate 10 14 12 1,586 Death-rates of infants under one year of age:- All infants per 1,000 live births 17.8 18 18 18 Legitimate infants per 1,000 legitimate live births 17.7 17 17 17 Illegitimate infants per 1,000 illegitimate live births 18.9 31 27 24 Neo-natal mortality rate (deaths under four weeks per 1,000 total live births) 11.9 13 12 12 Early neo-natal mortality rate (deaths under one week per 1,000 total live births) 10.4 12 9 10 Perinatal mortality rate (still-births and deaths under one week combined per 1,000 total live and still-births) 24.7 23 21 22 Maternal mortality (including abortion):Number of deaths Nil Nil 2 132 Rate per 1,000 live and still births Nil Nil 0.4 0.2 CAUSES OF DEATH Deaths 1971 Male Female Total Enteritis and Other Diarrhoea 1 Diseases 4 3 7 Tuberculosis of Respiratory System 4 2 6 Other Tuberculosis, including late effects 2 — 2 Whooping Cough 1 — 1 Meningococcal Infection 1 — 1 Other Infective and Parasitic Diseases 1 2 3 Malignant Neoplasm — Larynx 2 1 3 Malignant Neoplasm — Stomach 35 37 72 Malignant Neoplasm — Buccal Cavity, etc. 6 4 10 Malignant Neoplasm — Lung, Bronchus 180 52 232 Malignant Neoplasm — Oesophagus 11 7 18 Malignant Neoplasm — Breast — 67 67 Malignant Neoplasm Intestine 39 47 86 Mai ignant Neoplasm — Uterus — 26 26 Malignant Neoplasm — Prostate 20 — 20 Leukaemia 13 12 25 Other Malignant Neoplasms, etc. 89 110 199 Benign and Unspecified Neoplasms 2 2 4 Diabetes Mellitus 9 23 32 Other Endocrine etc. Diseases 5 9 14 Avitami noses — 1 1 Anaemias 2 6 8 Other Diseases of Blood — 2 2 Mental Disorders 31 7 38 Multiple Sclerosis 2 5 7 Other Diseases of Nervous System, etc. 26 17 43 Chronic Rheumatic Heart Disease 20 36 56 Hypertensive Disease 28 27 55 Ischaemic Heart Disease 517 353 870 Other Forms of Heart Disease 50 119 169 Cerebrovascular Disease 160 254 414 Other Diseases of Circulatory System 81 102 183 Influenza 1 1 2 Pneumonia 103 195 298 Bronchitis and Emphysema 116 43 159 Asthma 2 5 7 Other Diseases of Respitatory System 15 6 21 Peptic Ulcer 6 9 15 Appendicitis - 3 3 Intestinal Obstruction and Hernia 5 17 22 Cirrhosis of liver 2 6 8 Other Diseases of Digestive System 13 21 34 Nephritis and Nephrosis 8 4 12 Hyperplasia of Prostate 9 - 9 Other Diseases, Genito-Urinary System 6 13 19 Abortion – 1 1 Other Complications of Pregnancy – 1 1 Diseases of Skin, Subcutaneous Tissue – 3 3 Diseases of Musculo-skeletal System 8 11 19 Congenital Anomalies 9 22 31 Birth Injury, Difficult Labour, etc. 16 12 28 Other Causes of Perinatal Mortality 3 8 11 Symptoms and Ill-defined Conditions 3 9 12 Motor Vehicle Accidents 24 13 37 All Other Accidents 25 16 41 Suicide and Self-inflicted Injuries 13 15 28 All Other External Causes 4 7 11 TOTALS 1,732 1,774 3,506 2 INFECTIOUS DISEASES Anthrax No cases were notified. Cholera No cases were notified. During the latter half of the year there were outbreaks of cholera in several countries and as a result ports of entry into Britain demanded valid certificates of vaccination from persons arriving from those places. 322 persons arriving by air and 23 by sea who failed to provide valid certificates were kept under surveillance for 5 days. Diphtheria No cases were notified. Dysentery 69 cases were notified, 24 of which were confirmed bacteriologically. The organism shigella sonnei was found in 20 cases and shigella flexner in 4 cases. Encephalitis (Acute) Three cases were notified. Food Poisoning Notifications were received for 72 cases, 43 were confirmed bacteriologically divided as follows: Salmonella Typhimurium 12 Other SaImoneIlae 31 Infective Jaundice During the year 72 cases were notified. In co-operation with the London Boroughs of Hounslow and Richmond together with the West and South Middlesex hospitals the Council participated in a pilot research scheme to:- 1. Assess the prevalence of endemic clinical hepatitis in an open urban community. 2. Form detailed knowledge of the clinical pictures of these disorders by a total population study in a clearly defined geographical area. 3. Correlate the different clinical types of hepatitis with associated immunological data such as hepatitis associated with australic antigen. 4. Investigate as far as possible the epidemiological factors with particlar regard to the spread and severity of these illnesses in the community. A detailed questionnaire was completed in each case which involved more than 150 visits by the Public Health Inspectors. This research scheme will continue for three years, and the results will be published in due course. Leptospirosis No cases were notified. Malaria One case was notified which was contracted abroad. Measles 1,039 cases were notified. The corresponding figures for the last three years were:- 1968 722 1969 1588 1970 932 The figures seem to indicate that, as the consequence of routine immunisation, the former two-year cycle of the disease tends to become less pronounced. Meningitis (Acute) 9 cases were notified. Ophthalmia Neonatorum 5 cases were notified. Paratyphoid Fever There were three cases notified. The first case was a 21 year old student who had been on holiday to Morocco. Shortly after his return to this country he was admitted to hospital. No other case occurred and it would appear that the infection was contracted whilst he was abroad. The second case was a 7 year old girl who became ill after returning from a holiday in India and was subsequently admitted to hospital. There were no other cases and it appears that the infection was contracted abroad. The third case was a 20 year old woman who became ill ten days after arriving in this country on holiday from India. No other cases arose and it seems that the infection was contracted abroad. Plague No cases were notified. Poliomyelitis No cases were notified. Relapsing Fever No cases were notified. Scarlet Fever 90 cases were notified. Smallpox No cases were notified. 57 persons arrived by air who were unable to produce valid certificates of vaccination and they were kept under surveillance for 16 days after possible contact. Tetanus No cases were notified. Tuberculosis During the year 124 cases of pulmonary tuberculosis and 69 cases of non-pulmonary tuberculosis were notified (the figures for last year were 145 and 61 respectively). Typhoid Fever One case of typhoid fever was notified in an 11 year old boy. The usual control measures were instituted and a large number of contacts traced. Pupils in the same class as the patient, teachers and fellow passengers on school buses were excluded until considered free from possible infection. Before he became ill the boy had stayed with a family in the Midlands. Investigations in this household were made and a carrier was found. Although the visit was made several weeks before the symptoms arose there seems little doubt that the boy was infected during that time. Typhus No cases were notified. Whooping Cough There were 69 cases notified. Yellow Fever No cases were notified. Full statistical information is set out in Table 1 at the end of this report. 3 VACCINATION AND IMMUNISATION Under Section 26 of the National Health Service Act 1946, the Council provides immunisation against the following diseases:- Diphtheria Whooping-Cough Tetanus Measles Poliomyelitis Tuberculosis Rube I la During the year, the Department of Health advised that smallpox vaccination be dropped from the routine immunisation schedule, and in this Borough it has been decided to carry out smallpox vaccination by request only. During the year, rubella vaccine has been offered to 13year-old girls and the Department of Health has not so far advised that the age group be extended. STATISTICAL DETAILS OF IMMUNISATION carried out during the year are as follows:- TYPE OF VACCINE ADMINISTERED IN CLINICS ADMINISTERED BY GENERAL PRACTITIONERS  Diphtheria/Whoopi ng-Cough/Tetanus 2773 1685 4458 Diphtheria/Tetanus 599 59 658 Diphtheria 2 2 4 Tetanus 171 39 210 Pol iomye litis 3396 1734 5130 Measles 3081 961 4042 Rubella 1330 211 1541 REINFORCING DOSES Diphtheria/Whooping-Cough/Tetanus 184 532 716 Diphtheria/Tetanus 2369 512 2881 Diphtheria 7 5 12 Tetanus 234 203 437 Poliomyelitis 2040 1573 3613 SMALLPOX - VACCINATION AND RE-VACCINATION VACCINATED RE-VACCINATED AT CLINICS 2272 79 BY GENERAL PRACTITIONERS 913 475 TOTAL 3185 554 B.C.G. VACCINATION AT AGE 13 (THIS IS TO PROTECT AGAINST TUBERCULOSIS). TOTAL 2571 4 CO-ORDINATION AND CO-OPERATION BETWEEN HEALTH DEPARTMENT'S SERVICE. AND HOSPITAL AND FAMILY DOCTOR SERVICES The scheme of attachment of Health Visitors, Home Nurses and Midwives has continued, and all Health Visitors and Home Nurses, and four fifths of the domiciliary midwives are now attached to general practices. In view of the number of the practices, the nursing personnel need to be attached to several, and this requires wide mileage coverage which is not economic in time and transport. However, the service given to the patients is considered to be an improved one, and the over-all advantages far outweigh the disadvantages. It is not feasible for some practices to participate in this scheme, and in such cases the nursing services are still provided on a geographical basis. Officers of the department serve on local maternity liaison committees, and the Health Visitor at the Ealing 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. Perivale Hospital continues to provide lunch-time meetings which are attended by the domiciliary midwives and other Health Department staff. 5 INFANT WELFARE The Council has sixteen Health Clinics sited to be reasonably accessible to most mothers in the Borough. Sessions are provided at these clinics for ante-natal and post-natal care, child welfare, immunisation, cervical cytology, family planning, dental care, speech therapy, chiropody and physiotherapy. They are staffed by a medical officer, health visitors, clinic nurses, clerical staff and in many cases a dental officer and dental nurse. Some clinics have visiting specialist staff. In addition, they form the centre from which is carried out the domiciliary work of the surrounding district, namely home nursing, domiciliary midwifery and health visiting. Details of the various services provided at clinics are given below, or as part of the sections of this report. At child welfare sessions teaching in infant feeding, general care and mothercraft is given by the staff. The medical officer is responsible for examining all new babies, giving advice in the problems of the pre-school child, and the follow-up of all children requiring medical supervision. A mobile clinic continues to be used and now provides regular child welfare sessions, at Steele Road, Acton, the Brentham Estate, Hanwell Community Centre and the Golf Links Estate. The mobile clinic provides facilities where the static clinics are at some distance. Mothers are encouraged to bring their children aged 1 to 4 years for "birthday checks" and this enables the medical officer to determine the developmental progress of each child and to assess any departure from normal. Apart from routine work of this nature, other screening procedures carried out include:- (i) The particularly careful surveillance which is given to children with certain ante-natal, peri-natal and family histories - for example, the child of a mother who has had rubella during pregnancy. An observation register is kept for this purpose. (ii) The Guthrie Test. Testing fa phenylketonuria continued, using the Guthrie method which is carried out on blood taken by heel prick from infants on the eighth day of life. The blood specimens are sent to Great Ormond Street Hospital for testing. No positive tests were obtained in 1971. During the year, 5801 children were brought to child welfare clinics. 6 HEALTH CENTRES The Council's health centre programme is as follows:- Commencement of Building Site Financial Year 1971/72 Church Road, Hanwell. Financial Year 1972/73 Within CPO Area 28 Acton. Financial Year 1973/74 Present site of Greenford Green Clinic. Church Road, Hanwell - Tenders have gone out and it is anticipated that building will commence in the Spring of 1972. It will provide facilities for four general practitioners together with a full range of local authority services including dental. On its completion Cherington House Clinic will close. CPO Area 28 - Discussions with general practitioners have continued during the year and it is hoped that a final decision on the number willing to participate will be made early in 1972. The precise location within the area of the Compulsory Purchase Order has yet to be decided. Greenford Green - It is proposed to replace the existing clinic by a purpose built health centre. Discussions on this project have however not yet commenced. 7 FAMILY PLANNING The Council's Family Planning Service is provided both directly and by the Family Planning Association acting as its agents in accordance with the National Family Planning Agency Scheme. In July the Department of Health and Social Security issued Circular 36/71 which requests local authorities to inform the Department about the services which they are providing and the plans that they have for developing them. It also stresses the importance of domiciliary services and the role of family planning in the prevention of illegitimate births and abortions. Following receipt of this circular a review of the Council's services was commenced and as an interim measure the Council decided in November to change its arrangements with the Family Planning Association. Until then the Council had operated Application 6 of the Agency Scheme which meant that it met the cost of both consultation and supplies to "medical cases" only. These are defined as women whose health in the opinion of the examining doctor would be expected to suffer by the increased medical, physical and social burdens placed on them by pregnancy. In November the Council adopted Application 5 which means that in addition it now meets the cost of consultation in all cases. At the same time the Council's direct service which had previously been restricted to "medical cases" was made available to all women who desire family planning. The services now provided are as follows:- LOCAL AUTHORITY 1. The health division hold a clinic on alternative weeks at Cherington House Clinic, Hanwell. Details of attendance, during the year are shown in the table belcw. 2. A Youth Advisory Clinic is held weekly at Mattock Lane Clinic to provide counselling and contraceptive advice for those aged 16-21 years. It is staffed by a doctor and nurse experienced in adolescent problems whilst a doctor with post-graduate training in mental health and a senior psychiatric social worker are available for consultation where necessary. Those persons eligible to attend must either be resident or be attending a state maintained educational establishment in the Borough. Attendances are shown in the table below. CHERINGTON HOUSE BIRTH CONTROL CLINIC, 1971 NO. OF SESSIONS NEW CASES TOTAL ATTENDANCES AVERAGE ATTENDANCE PER SESSION 24 35 283 11.8 YOUTH ADVISORY CLINIC, 1971 SESSIONS NEW CASES TOTAL VISITS 49 88 317 FAMILY PLANNING ASSOCIATION The North West London Branch of this Association holds sessions in Council health clinics and in hospitals serving the Borough. The Council and the hospitals concerned provide free use of premises, and as already described the Council meet the cost of certain of those who attend. It also meets the cost of those seen by the domiciliary service. 1. The sessions held are as follows Cloister Road Clinic, Acton. - 4 sessions per week (3 double doctor) - includes weekly session for I.U.D. and monthly sessions for marital difficulties). Perivale Maternity Hospital, -2 sessions per week Peri vale (includes one session for I.U.D.) Northcote Clinic, Southall -1 session per week, (double doctor) Mattock Lane Clinic, Ealing -2 sessions per week (1 double doctor) Northolt Grange Clinic, -1 session per week Northolt Queen Victoria Hospital, -1 session per week HanwelI 2. In addition, a further weekly session is held at Hillingdon Hospital at the same time as the postNatal clinic. This provides a service for those hospital patients who live in the Southall area of the Borough, the normal arrangements being for them to attend once at Hillingdon, and then to be transferred to Northcote Clinic. Separate figures for Ealing residents who attend at the hospital session are not available. 3. A domiciliary service is avai lable and is designed for those women who fail or who are reluctant to attend clinic sessions. These are usually the very women who it is most important should have advice. FUTURE DEVELOPMENT Family Planning is becoming an increasingly important part of the Council's maternity and child health service and should be seen not as a project in isolation but as complementary to the other parts of that service which aim to improve the quality of domestic life. The present review is being conducted on the principle that expansion should be directed towards ensuring that:- 1. facilities are evenly spread throughout the Borough. 2. at those clinics where the pressure is greatest there shall be additional sessions or relief provided by additional sessions at neighbouring clinics. 3. there is a sufficient increase in sessions to permit publicity. 4. special provision is made for those groups who do not readily attend family planning clinics. family planning association sessions 1971 new patients total no. of patients no. of attendances clinic sessions doctor sessions cervical cytology 1914 4631 10997 573 707 2096 domiciliary services. 1971 new patients old patients 28 15 8 WELL-WOMAN CLINIC This service is provided under Section 28 of the National Health Service Act 1946. Facilities are available at Ravenor Park. Cherington House and Pierrepoint Road Clinics. Business and industrial premises are also visited. Women are seen by a doctor on the Council's staff and a history is obtained, breast, abdominal and pelvic examinations made and a cervical smear taken from the neck of the womb for microscopic examination. This examination is carried out by the laboratory staff at King Edward Memorial Hospital, Hillingdon Hospital and the Central Middlesex Hospital. During the year, 1633 first examinations were made, 453 of these in the four business and industrial premises visited. 453 recall examinations were undertaken on women first examined 3-4 years ago and a further 297 repeat examinations made, usually on the advice of the cytologist. The initial findings shQwed:- CLINICS FACTORIES 3-4 YEAR RECALLS TOTAL Number examined 1180 453 453 2086 Repeats 297 — 297 Trichomonal Infection 47 16 5 68 Monilial Infection 17 4 4 25 Cervical Polyp 15 8 5 28 Abnormal Vaginal Bleeding 47 1 18 66 Pelvic Mass 16 5 6 27 Positive or Suspicious Smear 9 4 – 13 Breast Abnormality 42 5 10 57 Follow up of women having possible major pathology is not yet complete though six of those having suspicious or positive smears have been found not to have cancer. However, seven having suspected breast abnormalities were found to have cancerous lesions and received treatment. 9 MIDWIFERY In accordance with Section 23 of the National Health Service Act 1946, the Council provides a staff of 17 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 Southall and Ealing, and by Queen Charlotte's Hospital midwives in Acton, continued in 1971. The Integrated Midwives Scheme with Perivale Maternity Hospital started in 1970 was also continued, whereby selected mothers found suitable for earlv discharge were delivered in Perivale Maternity Hospital by domiciliary midwives. This has been very successful and both the mothers and the midwives have found this service valuable. The growth of this service is shown by the following figures:- 1970 - 27 1971 - 100 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. 10 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. It will be noted that the domiciliary birth rate has continued to fall. This follows the Peel Report, which stressed that confinements should take place in hospital. All midwives undertake planned early discharges, and there were 536 of these during 1971. The number of home and hospital confinements in the area of the London Borough of Ealing over the last few years is as folfows:- Year Domiciliary Hospital Total 1967 599 5,109 5,708 1968 500 4,907 5,407 1969 406 4,868 5,274 1970 345 4,926 5,271 1971 202 5,005 5,207 The teaching programme for the pupil midwives has continued to be of great value and has enabled them to have an insight into all aspects of community care provided by the Council. This extended Community Care course is designed to partially take the place of the reduced domiciliary deliveries, and trains them to give advice on such matters as family planning. The range of duties of the midwives has extended and an evening class for expectant multiparae has been well attended. The mothers are taught psycho-prophylaxis, with mothercraft talks being given jointly with the health visitors. Overleaf is a photograph taken for the Department of Health and Social Security, to be used nationally for recruitment to the midwifery profession. The photograph shows a midwife at work in the Borough. ANTE-NATAL AND POST-NATAL SESSIONS: Two types of ante-natal sessions are held at clinics:- 1. Midwives' Sessions where a mother is regularly seen by the midwife who wiII attend her at confinement. During this time the expectant mother may visit her general practitioner or, if thought necessary, the hospital ante-natal department. 2. Medical Officers' Sessions Most mothers today are attended by their general practitioner or the hospital ante-natal department. However, there are a number of medical practitioners in the area who do not provide ante-natal care and the Council's medical officers supervise these cases. The figures for 1971 were as follows:- Mothers attending medical officers' sessions for their ante-natal care367 Mothers attending midwives' sessions for their antenatal care 181 Mothers attending ante-natal relaxation classes 855 Mothers attending post-natal sessions 177 "BATHING THE NEW BABY" 10 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 establishment for Home Nursing staff consists of the equivalent of 49 full-time State Registered Nurses and State Enrolled Nurses and includes two male nurses. There are also the equivalent of three full-time nursing auxiliaries some of whom work part-time and whose duties are assisting with the bathing of the elderly frail in their own homes. This is of invaluable assistance to the Home Nursing team. Patients are referred to the department by general practitioners. The type of work continues to range through short-term care of acutely ill patients, post-operative dressings, injections, regular care of the chronic sick and terminal care. The Home Nursing Service works in collaboration with two voluntary organisations. 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 authorised to engage nurses for this work on behalf of the Foundation. This is a most valuable service and during the last year six patients were nursed in this way. Secondly, the British Red Cross Society acts 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. During 1971, the Home Nursing Service dealt with the fol lowing:- Total number of patients during year:- 2922 Total number of visits:- 120,519 The night nursing service still proves of great use by extending the hours of the Home Nursing Service from 7 p.m. to 7 a.m. It works in the same way as the day service and is a visiting rather than a sitting-in service. The number of patients and visits made by the Night Service during 1971 were:- Number of patients 134 Number of visits made 4,233 New staff have continued to attend Chiswick Polytechnic for District Nursing training and 2 were successful in the examination. Refresher courses and practical work instructor courses have also been attended by four members of the staff, and proved beneficial. 11 HEALTH VISITING All Local Authorities have a duty under Section 24 of the National Health Service Act, 1946, to provide a health visiting service. The Council's establishment for Health Visiting staff consists of the equivalent of 43 full-time Health Visitors, 22 Clinic Nurses, together with 3 Interpreters. The statutory function of Health Visitors is the care of mothers and young babies and this is carried out by means of home visits, consultations at clinics and group discussions with parents until the child is five years of age. During the year, 1872 infant welfare sessions were held in clinics, and 800 other clinic sessions were devoted to the care of mothers and young children. The major part 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 deviations from the norm, recognition of needs and the appropriate resources available. VISITS BY HEALTH VISITORS Children under five years of age 47236 The Elderly 4850 Mentally Handicapped 143 Discharged from hospital 237 Other visits 13340 STAFF TRAINING Five sponsored students successfully completed their training and joined the staff in September, and six more are currently training at recognised colleges. The practice of sending Health Visitors on refresher courses at regular intervals was continued, and staff were kept well informed of new trends and modern concepts appertaining to their work by in-service training. HEALTH EDUCATION Teaching in various types of groups and schools continued and the principle that Health Visitors teaching in senior schools must have an additional teaching certificate was maintained, four Health Visitors at present holding this qualification. CLINIC NURSES Clinic Nurses continued to take much of the routine work off the shoulders of the Health Visitors, by taking part in the whole range of the Council's Clinic Services. 12 RENAL DIALYSIS Under Section 28 of the National Health Service Act, the local authority can adapt a room in a private house to enable a Home Dialysis unit to be installed. The unit enables those persons who have inadequate kidney function to clear impurities from the blood-stream, and to live a normal life. The alternative is to spend many hours attached to a machine in hospital, and home dialysis is much preferred by patients. Adaptation includes rendering walls and floors impervious to water, installing power points, plumbing-in hot and cold water supply, and providing drainage, sink unit, and storage space. The Council is authorised to recover from the patient the whole or part of the cost according to means revealed by an assessment procedure. The hospital authorities install and service the equipment, which is provided on loan. I am glad to report that three machines have been withdrawn from Ealing patients following successful transplant operations, and five are in current use, two of which were installed during the year. 13 HEALTH EDUCATION Health Education, which is the Council's responsibility under Section 28 of the National Health Service Act, is part of the everyday work of all doctors, nurses, dental officers, public health inspectors, and other staff of the Health Division. To assist them by the provision of material and expertise the Council have a Health Education Section consisting of a Health Education Officer, a Technician and an Assistant. Involvement with this work however extends beyond the Council's Health Services, and a Health Education Advisory Panel regularly meets under the chairmanship of one of the Council's Principal Medical Officers. It is attended by officers of the Education Department and the Council's Road Safety, Industrial Safety and Public Relations Sections. This panel decides on future health education activity for the Borough and how the various departments should give support to each month's special campaign. The programme of these for 1971 was as follows:- January - Home Safety for small children * February - Family Planning March - Smoking April - Venereal Disease May - Importance of Play in Child Development June - July Water Safety - Clean Food August September - Immunisation October - Mental Health November - Dental Health A particularly important field for health education is of course in schools and this is carried out both by the Health Education Officer and by certain specially trained health visitors. The widely ranging syllabus includes child development, sex education, venereal disease, and hazards to health such as smoking and drugs. It also includes advice on the care of feet and teeth and an outline of the National Health Service. Such health education is given in 15 of the 52 Primary Schools and in 12 of the 34 Secondary Schools. I regard it as a most important facet of the School Health Service and it is to be regretted that the staffing position prevents extension of the work to all schools in the Borough. Other activities of note include in-service training to Health and Social Services staff, and this year Dr. Mills, Geriatrician at Central Middlesex Hospital, and Professor Huntingford, Obstretician at St. Mary's Hospital, have given lectures which were particularly appreciated. The Health Education Section is active in the production of special leaflets, for example a nutritional leaflet in three languages, and also in the production of posters. In connection with anti-smoking campaigns close liaison is maintained with Central Middlesex Hospital and special anti-smoking posters have been supplied to the hospital for display there. In turn. Dr. Keith Ball, Cardiologist at that hospital, spoke to students at Southall Technical College on the dangers of smoking. During the year a Servision Slide Projector was acquired. This in appearance is similar to a television set but shows slides with synchronized tape and is a most useful piece of new equipment. 14 CHIROPODY This service, which is provided under Section 28 of the National Health Service Act, is provided in part by the Council, and in part by the British Red Cross Society and the Southall Old Peoples Welfare Association. It is hoped that eventually all Chiropody services will be directly run by the Council. The difficulty in obtaining chiropodists prepared to work either full-time of part-time in the Council's clinics is making this goal difficult to achieve, although the figures indicate that we are moving to this end. reason all patients who are able to do so are encouraged to attend the suitably equipped clinics where many more treatments can be given per hour; ambulance service is provided for those unable to travel by public transport. The maximum charge for the service is 20p which has remained unaltered for over ten years and the income limits which qualified for free service have also remained unaltered. With increased pensions all incomes now exceed the figure which qualified for free service - thus all new patients are required to pav the nominal maximum charge . The cost to tne Council for a domiciliary visit is 125 pence plus administrative costs. British Red Cross Society Southall Old People's Welfare Association London Borough of Ealing Total Total number of patients 392 177 3648 4217 Total number of new patients 11 — 1051 1062 Total number of treatments at clinic 395 — 94 60 9855 Total number of treatments at private surgeries 513 381 — 894 Number of patients receiving domiciliary treatment 168 77 1527 1772 Number of domiciliary treatments 672 321 7441 8434 Percentage of total work which is domiciliary 42% 39% 45% 44% Expectant and nursing mothers — — 3 3 Physically handicapped persons 4 — 42 46 15 CHEST CLINIC The responsibility for the work of the Chest Clinic in the borough is divided between the Council and the Regional Hospital Board. The Board is responsible for the provision of treatment, 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, W13, 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 1971 are as follows:- Number of new tuberculosis cases 164 Number of old tuberculosis cases 3,415 Transfers into borough 8 Numbers of contacts of new cases 1,092 Successful visits to tuberculosis households 3,948 Unsuccessful visits to tuberculosis households 738 Successful visits to other patients 540 Medical Social Worker The statistics of the cases seen by the Medical Social Worker relate only to cases under the care of Ealing Chest Clinic. Those attending Hillingdon Hospital are seen by the Medical Social Worker there. Details of Cases Cases first referred during the year 107 Total cases 237 Tuberculosis patients 113 Cancer patients 54 Bronchitis and others 70 Action Taken Referred for employment 5 Found employment 3 Referred to Social Security for maintenance 19 Referred to Social Security for bedding 1 Referred to Social Security for clothing — Referred to Social Security for extra nourishment 5 Referred for Housing 32 Rehoused 5 During the year the Mass Radiography Unit of the North West Metropolitan Regional Hospital Board visited various sites within the area and examined 23,000 workers. 32 cases of active pulmonary tuberculosis were discovered and 73 cases of lung cancer. 16 CARE OF THE ELDERLY EALING DAY TREATMENT CENTRE The Centre, supported by an annual grant from the Council and by voluntary contributions, continued to play an important part in the provision of services to the aged and infirm. All patients are recommended by their general practitioners, and the object of the Centre is to carry out a fulI medical and social assessment and provide all measures necessary for rehabilitation. On referral, a visit is made to the old persons home by the Geriatric Health Visitor, so that as much as possible is known of the patient before admission. Transport to the Centre is provided by the Ambulance Service and attendance is usually daily for up to three months. After discharge, periodic attendance for a day is the normal procedure, whi 1st the geriatric visitor maintains contact with the old person at home. By this it is possible to check that satisfactory progress is being maintained and if this is not the case, to arrange readmission. The following table shows the distribution of referrals during the year from the various parts of the Borough:- Hanwell W7 30 Ealing W13 26 Ealing W5 20 Greenford 23 Northolt 13 Perivale 3 Southall 23 Acton 10 Total: 148 The types of disability which brought patients to the Centre were as follows:- Diseases of the musculo-skeletal system 62 Diseases of the cardiovascular system 7 Disease of the respiratory system 4 Diseases of the central nervous system 64 Diseases of the alimentary system — No major diagnosis of senility only 5 Others 6 Total: 148 I would like again to thank the Friends of Ealing Day Treatment Centre for the interest and support which they have continued to give. During the year they presented the Centre with a very advanced type of physiotherapy couch which has proved to be a very great benefit to the patients. During the year the Centre continued to attract many interested visitors from home and overseas. 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. These powers are only exercised in the last resort and only one such removal occurred during the year. All other removals were on a voluntary basis. 17 IMMIGRATION POPULATION STATISTICS There are immigrants of many nationalities in the Borough but the community which poses particular problems and calls for particlar help is the Asian one in Southall. It has never been felt that we have an accurate knowledge of the numbers of these immigrants as we are forced to rely on various sources of information which can only give an indication. Some assistance is provided by the 1971 census and the 1966 10% census, whilst notification from ports of entry, school child population, housing records, and a survey carried out by the health visitors do in combination enable a calculation to be made. From these sources it is estimated that there are now in excess of 20,000 Asian immigrants in Southall and its adjacent areas. NOTIFICATION Notification is received from ports of entry concerning immigrants who are said to be proceeding to addresses in the Borough. On receipt of this information a health visitor endeavours to make contact with a view to giving advice regarding the importance of registration with a local general practitioner. The opportunity is taken to advise on a variety of other matters such as for example the need to seek school placement. In some cases the port authorities draw attention to a medical condition requiring investigation and in these circumstances the health visitor will initiate any necessary action. Whilst every effort is made to establish contact only half of the immigrants are found at the addresses given and in some cases even the street names given do not exist in Ealing. Details of admissions in 1971 were as follows:- Details of admissions in 1971 were as follows:- Country of origin No. of Persons Number Notified Contact Established Commonwealth Countries India 573 405 Pakistan 116 29 Other Asian 64 26 Caribbean 53 38 African 434 193 Other 68 28 Non-Commonwealth Countries Europe 17 4 Other 29 5 TOTALS 1354 728 (53.8%) MATERNAL & CHILD HEALTH Mothers in the immigrant community are commendably anxious to take advantage of the Maternal and Child Health services and are receptive to the advice given. to them. It has however resulted in a great increase in the work load at Northcote Clinic for which it has been very difficult to cater in view of the limited size of these premises. Details of the attendances over the last seven Health services and are receptive to the advice given years are as follows:- Clinic 1965 1966 1967 1968 1969 1970 1971 Northcote 4828 6250 7907 7848 6908 6777 6899 INFECTIOUS DISEASE It is fair to say that the problems of infectious disease presented by Asian immigrants are somewhat exaggerated in the public mind. Nevertheless there are three diseases which constitute a considerable work load and do give rise to a certain amount of concern:- 1. Smallpox Owing to the speed of international travel it is possible for a person to be in contact with a case of smallpox on one day and to arrive in the Borough of Ealing on the next. There is a requirement that immigrants from countries where smallpox is endemic shall bring with them evidence of recent vaccination. Some of the vaccination certificates, however, have in the past been suspect, as it is known that there is a trade in certificates which are given without the person concerned undergoing the procedure of vaccination. A small number of immigrants arrive in this country without a valid vaccination certificate and these are vaccinated at the port of entry and notified to the local authority of the area to which the immigrants are proceeding, where they are kept under surveillance until such time as there is no danger of the disease developing. There have been no cases since the formation of the London Borough although each year there are 4-6 suspected cases which require consultation with a smallpox consultant. Incidence of these has remained constant and suspected cases commonly occur when smallpox is reported in countries abroad. 2. Typhoid Fever The same observations about rapid travelling as described under Smallpox apply to Typhoid Fever. Since the formation of the London Borough there has been a total of 15 confirmed cases of which 12 were in Asian immigrants, 2 in returning English holiday makers and 1 in a person who had never been out of of this country. 3. Tuberculosis It is sometimes thought that Tuberculosis is widely imported into this country by Asian immigrants. It seems more likely however that Asians are a susceptible population who contract the disease after their arrival here. The table given below shows that Asians do constitute an unduly high proportion of notifications in relation to their numbers and that the number of notifications from the Southall area is unduly high in relation to its population. The work load on the Tuberculosis Health Visiting service is corresponding great. Details of notifications for the last six years are as consultation with a smallpox consultant. Incidence follows:- Year New cases of Tuberculosis Indians & Pakistanis based on names Acton & Ealing al I Total Pul. Non-Pul. 1965 171 129 42 42 113 58 1966 163 131 32 52 91 72 1967 191 142 49 69 104 87 1968 191 137 54 92 103 88 1969 206 150 56 122 99 107 1970 206 145 61 94 120 86 1971 193 124 69 116 87 106 INSPECTORATE As far as the Inspectorate is concerned the following are the problems which face it in Southall:- 1. Housing The houses occupied by the immigrants in Southall are mainly of the small semi-detached or terraced types with 2 rooms and kitchen on the ground floor, and 3 rooms on the first floor. Many of these houses have only one W.C. although some have two W.C.'s and a bathroom. No amount of increased amenities can make such houses suitable for multiple occupation and it has therefore not been the policy of the Council so far to require improvements to facilities and to the means of escape from fire under Sections 15 & 16 of the Housing Act 1961. To do so would be in effect, to sanction multiple occupation in unsuitable premises which were originally intended, and are still suitable, for single family occupation only. In such houses, therefore. Directions are given under Section 19 of the Housing Act with the object of achieving a gradual or "painless" reduction in the number of occupants. The houses in the main are over occupied rather than overcrowded, but Section 90 of the Housing Act 1957 is applied in those cases where statutory overcrowding is found to exist. In Southall 57 such overcrowding cases have been dealt with in the last 9 years, compared with only 10 in all other parts of the Borough. The effect of the Council's policy of giving Directions cannot be calculated properly without a full-scale survey of all the premises involved (ie. about 1600) but the general impression is that the average number of individuals and households living in the houses is diminishing slowly as more and more immigrants purchase houses in the district or elsewhere. This may be due in part to the Council's application of Section 19 but there is no accurate method of assessing this. The effect in any event is that immigrant families from Southall are now spreading more and more into other parts of this and adjoining Boroughs. Statistical details of action under the Housing Act are given in the section of this report dealing with Housing. Improvement Grants There appears to be no serious problem as far as Improvement Grants are concerned. The immigrant population is becoming well aware of the grants which are available and apart from difficulties of communication which can generally be overcome, the applications take their normal course. No grants are made available where multiple occupation exists in order to avoid conflict with action under Section 19. A recent enquiry from the President of the.Sikh Church concerning improvement grants generally was answered with literature and an invitation to discuss the matter in more detail, but this has not been pursued. In a few cases where applications are made for grant aid for extra bedroom space, a child or other member of the family is expected to arrive in this country. Approval is delayed in these cases until the entry documents have been issued and there is a useful liaison for this purpose with the Home Office Immigration Section. This is not a real problem, but is expensive in terms of time and effort. Clean Air There are no real problems of enforcement of the provisions of Smoke Control Orders. Whilst it is necessary to issue formal warnings to the indigenous population for burning unauthorised fuel it has been found that immigrants from warmer climates do not in general use solid fuels as a means of heating. Most use paraffin heaters but an increasing number are installing gas or electric heating, so that paraffin heating tends to be replaced as the immigrants become established. Paraffin heating is generally associated with low income, but unfortunately gives rise to greater fire hazards, especially as the average number of occupants per house is high. Separate fire statistics are not maintained by the London Fire Brigade in respect of Southall. The average number of fires in the whole Borough since 1965, caused by paraffin heaters has been about 30 per year. 4. Food Hygiene There are approximately 160 food premises in Southall controlled by immigrant traders. There have been about 15 prosecutions under the Food Hygiene Regulations. The premises tend to be untidy and disorderly and routine cleaning is often neglected. Overstocking is a common fault, particularly with larger stocks of grain than most traders would consider sufficient for current needs, and this leads to spillage, bad handling and rodent infestations. Evidence of rodents does not seem to provoke the same feeling of repugnance which is generally common in white people. The use of oil for culinary purposes in restaurants and sweet kitchens produces much greasing of surrounding structures and equipment and special attention to cleaning, layout, materials and ventilation is necessary. The difference in standards of life may be exemplified by the use of the W.C. If a squat type of W.C. is not provided then the same position is adopted for a pedestal type. Water in a bottle or jug is used for cleaning instead of paper. These habits and customs lead to problems which have also been the subject of a number of complaints from factories and other premises in the Borough where there is a mixed staff of Asians and others. Food hygiene control in these cases is difficult and visits of inspection which must include an element of food hygiene education can be protracted and must be on a more frequent basis than elsewhere. Constant activity in this sphere is producing results, and it is really a matter of staff availability. 5. General Public Health Measures One of the major problems concerns the widespread accumulations of refuse in Southall in gardens, on most vacant pieces of land and in rear access alleyways. The Chief Officer, Works, is advised in writing of all accumulations which require removal on public health grounds and does his best to clear them, but quite plainly he is often embarrassed by the number of requests from this Division which outnumber those from all other parts of the Borough. Immigrant landlords do not always comply readily or satisfactorily with notices served under the Public Health Acts. Problems of language sometimes occur and it is possible that this may be used as an excuse for delay. In general there is a tendency to promise anything with little possibility of real achievement. Certain properties (Hammond Road for example) are of a poor standard but on the whole, apart from over occupation, rodent infestations and food storage, houses occupied by Asians compare favourably with others. Complaints from other local residents about these houses are mainly about refuse, cooking smells and alleged over crowding. 6. Rodent Control The main difficulties arise because of a failure on the part of immigrants to report infestations at an early stage. When complaints are received the subsequent inspections often reveal serious infestations which are then more difficult to clear and much more time is required. A block control treatment conducted in one part of Southall revealed many infestations which were not reported at all. Here again there are difficulties of communication. Many rooms are found to be locked and in others shift workers are asleep and treatment cannot be completed easily. Special appointments are frequently not kept. Food storage seems to take place in several rooms of a house and not just in the kitchen or larder. Rice and other cereals are stored in bulk with uncleared spillages which only tends to encourage rats and mice. Refuse accumulations aggravate the problem and the introduction of the plastic sack method of refuse storage and collection has not helped. These are often filled with household wastes and dumped in alleyways with resultant spillages which provide ample food sources for rodents. At the present time approximately 115 infestations are under treatment in the Southa 11 area. Shops Acts Difficulty in communication is again a major problem. Three main offences against the Shops Acts relate to trading after prescribed hours, non-observance of the weekly early closing day, and illegal Sunday trading. Much time is spent endeavouring to explain the requirements of the Acts to traders but prosecutions result when all else fails. There have so far been 33 cases against immigrants and 7 against other traders in the Southall area. Some complaints arise from the habits of the Asians of using their shop premises as venues for social intercourse. This has the effect of the shop lights remaining on long after closing hours and persons being seen to enter and remain in the shop, although sales are not necessarily taking place. Enforcement in these circumstances is difficult. Many shops are exempted from the provisions of the Offices, Shops & Railway Premises Act, 1963 because only self-employed persons or employers relatives are engaged. The Act prescribes the relationships which apply and these are restricted and it is often difficult to explain this in cases where the occupier regards any person of his own race as his close relation for this purpose. DENTAL SERVICES In the Southall area the estimated figures for immigrant attendances at King Street and Northcote Clinics are now approximately 50% of total attendances, having risen from approximately 35% in the last two years. This high figure is in part due to the fact that in addition to catering for those children attending schools in their catchment area these clinics have to deal with an increasing number of children from other clinics in the Borough for extraction under general anaesthesia. The purpose of this referral is that the children can attend the clinic nearest their home and thus make it easier for parents to accompany them, an essential prerequisite to the administration of general anaesthesia. It also minimises the distance the child has to travel home after general anaesthetic, an important consideration when dealing with parents who rarely have their own transport. Although, except when general anaesthesia is being administered, the presence of a parent is not essential it is always highly desirable. This is particularly the case in primary school children and these, as a consequence of dispersal, are at present treated at clinics at a distance from their homes. This means that parents find it difficult to accompany the child to the clinic and the dental officer does not therefore have the benefit of a proper medical history and does not have an opportunity to explain the nature and necessity of treatment to parents. Other problems consequent upon dispersal are the difficulty in obtaining the parents' signature on the consent form and the problems associated with the fact that after treatment the child is unable to return home until the bus leaves school at 3.30 p.m. In order to minimise these difficulties arrangements have been made for Welfare Assistants from the schools to accompany the children to the clinic. This has however thrown strain on the limited number of Welfare Assistants available. 18 SCHOOL HEALTH SERVICE (INCLUDING DENTAL SERVICE) MEDICAL EXAMINATIONS At least three examinations during a child's school life are carried out in the London Borough of Ealing. The ages at which these examinations are carried out are at age 5 6 years (school entrants) age 9-10 years (junior school) and 14-15 years (senior school leavers) The total school population at the end of 1971 was 45,462 and the details of the examinations carried out are as follows:- First age group 4727) Total: Second age group 3714) 12413 Third age group 3972 ) Classification of general conditions:- Satisfactory 12303 Unsatisfactory 110 Defects noted at routine Medical Inspections are as follows:- Skin 606 Vision 1311 Squint 253 Hearing 337 Middle Ear Disease 391 Nose and throat 723 Speech 253 Enlarged glands 244 Heart 190 Lungs 259 Hernia 40 Epilepsy 43 Orthopaedic:- PosturaI 115 Feet 448 SELECTIVE MEDICAL EXAMINATION During 1971 a pilot scheme of selective medical examinations was started in four selected schools by two medical officers. This was carried out in the second age group, and a questionnaire was sent to each parent about their child's health. Only children with a known physical or behaviour problem were examined. Such a scheme requires close co-operation between the head teacher, school nurse and school doctor. Following analysis the following points were made:- (a) Much time was spent in administrative arrangements. (a) The questionnaire was lengthy. (c) Local knowledge of the children was inadequate in areas where there had been a high staff turnover. (d) The method was unsatisfactory where there were immigrant children. Attendance of parents was low probably because children are "bussed" to schools at some distance from their homes. (e) It was felt that the scheme had been worthwhile but that further work on it was necessary, widening its field of operation. SCHOOL MEDICAL ROOMS Unfortunately, the progress in school medical rooms has not been as rapid as had been hoped. However, when the new school plan has been implemented it is hoped that this matter will then be dealt with. SCREENING PROCEDURES These procedures are done in addition to the routine inspection of children by nursing or medical auxiliary staff, for the purpose of screening large numbers of children for defects. Visits are made for the following pur poses:- 1) Audiometry 2) Head inspections 3) Vision testing (1) Audiometry This is devised to detect even slight hearing loss. It is carried out when possible, during the child's first year in school, and thereafter at three yearly intervals. Any hearing loss is reported to the School Medical Officer, so that minor or temporary conditions may be excluded before further referral is made, either to the child's general practitioner or to the Audiology Unit at Heston. The figures for tests carried out during the year were:- Children tested 14975 Schools visited 80 Children with hearing loss 1114 Not all those children showing hearing loss were severely affected and most were helped by treatment. (2) Head Inspections Ignorance of infestation by the public is distressing and it seems that all too few parents regularly check their children's heads these days. As a consequence, emergency inspections and contact tracing have increased. During 1971, 50,489 examinations were carried out and 515 cases of infestation were found, representing 1% of chi Idren examined. (3) Vision Testing Vision testing is carried out normally on five occasions diring the child's school life: at approximately five, seven, nine, twelve and fourteen years of age. Three of these examinations are linked with the routine medical inspections, and school nurses make special visits to school for the other two. Colour vision is checked once during the chi Id's school life, as a defect may influence the choice of career. Procedures (1) and (3) are carried out more frequently in special schools, as are routine medical inspections. SCHOOL CLINICS The following school clinics are provided:- General Asthma Chiropody Speech Therapy Ophthalmic Orthopaedic Child Guidance The work done at these clinics is described below. General School Clinics To these clinics any parent or teacher may refer a child whose health or progress at school is causing concern. Sessions are held at each of the Council's clinics at least once a week. Abbey Parade Laurel House Avenue Road Mattock Lane Cherington House Northcote Cloister Road Northolt Grange Greenford Green Peri vale Islip Manor Pierrepoint Road Jubilee Gardens Ravenor Park King Street Trinity Way These clinics provide a greater measure of privacy than is normally possible at school and the medical officer can give more time to a discussion with parents. Asthma Clinics Special sessions for chi Idren suffering from bronchitis and asthma are held at four of the Council's clinics, where children are treated by a physiotherapist. The treatment is aimed at improving healthy habits, which assists in reducing attacks of asthma and bronchitis. At the Asthma Clinic parents are advised on the best needs of an asthmatic child. Chiropody Clinics In so far as school children are concerned, chiropody is almost exclusively the treatment of verrucae. This persistent and contagious condition is prevalent amongst school children and is a type of wart, which forms usually on the sole of the foot and if untreated becomes painful. The treatment, though not difficult, is time consuming. Chiropodists remain in short supply and most of the work in children's feet consists of treatment of single verrucae. This work is done almost entirely by clinic nurses. Details of attendances during 1971 are:- New cases 1110 Re-examinations 4214 Total 5324 Speech Therapy Members of the medical profession, the schools, and the general public are becoming increasingly aware of the value and scope of speech therapy, so that despite the addition of an extra full time speech therapist on the establishment, it is increasingly difficult to meet the demand for this service. The following types of defect were encountered during the year:- Dyslalia 714 Retarded language development 100 Mental subnormality 10 Stammer 117 Dysenia 13 Dysphonia Nil Dysarthria 4 Others: Cleft palate 24 Dysphasia 1 Aphasia 1 Total: 984 Ophthalmology Clinics Ophthalmic Clinics are carried out in the Borough as follows:- Avenue Road Clinic - weekly Dr B Bradley, M.D. d.o.m.s. Mattock Lane Clinic - weekly . Dr L H Macfarlane Jubilee Gardens Clinic - m.d. d.P.H. d.o.M.s. fortnightlv Islip Manor Clinic - monthly Dr m Billinghurst Ravenor Park Clinic-three m.B. B.S. D.O.m.S. monthly The ophthalmologists working in the Ealing Clinics have a link with the local hospitals, and any operative or other treatment may be obtained without a break in continuity. Dr Macfarlane retired from the Council service in September 1971 and permission was obtained for an increase in sessions to deal with the increased referrals. Attendances during the year were:- First attendances 483 Re-attendances 1866 Total 2349 Glasses prescribed 712 In addition to the ophthalmic consultant sessions, an orthoptic clinic at Avenue Road functions for seven sessions a fortnight and at Ravenor Park for three sessions a fortnight. The figures for attendance are:- New Cases Total Number of Attendances Avenue Road 18 375 Ravenor Park 10 219 Total 28 594 Orthopaedic Clinics Orthopaedic sessions are carried out in the Borough as follows:- Mattock Lane Clinic - Monthly) Ravenor Park Clinic -Alternate) Mr J A Cholmeley weeks F.R.C.S Northcote Clinic - Monthly Mr P I Busfield F.R.C.S. Referrals to these clinics come from routine medical inspections at schools, general school clinics, welfare clinics, family doctors and a few from hospital. The figures for attendance during 1971 were:- New cases 52 Re-attendances 134 Total 186 Physiotherapy is provided at the following clinics:- Greenford Green Ravenor Park Mattock Lane Jubilee Gardens Islip Manor CHILD GUIDANCE The main clinic is at Madeley Road, Ealing, and there are three sub-clinics at Avenue Road, Acton, Northolt Grange, Northolt and Villiers Road, Southall. Dr Robin Benians and Dr Sonia Holmes are part-time Consultant Psychiatrists at the Clinics. In addition to the Child Guidance Clinic work, they are responsible for preparing psychiatric reports for juvenile courts on children admitted to the Council's reception centre, for giving advice to the field staff of the ChiIdren's and Health Departments, and have sessions at the day and residential special schools. Referrals No. of cases seen by Psychiatrists 266 " " " " other MedicaI Officers 156 Total cases ascertained Boys 189 Girls 66 Total 255 Placed in Day Schools Boys 60 Girls 19 Total 79 Placed in Residential Schools Boys 105 Girls 39 Total 144 Waiting Placement Boys 24 Girls 8 Total 32 Schools for the Maladjusted Day Cavendish School - a 50 place school for 7 - 11 year old pupils which replaced Aston in September 1971. Newlands School - a 45 place school for 11+ - 16year old pupils. Springhallow - a 16 place unit for non-communica- ting children of all ages with provision fa the teaching of Autistic children which opened in September 1971. Residential East Quinton School - a 44 place school for 7 - 11 year old pupi Is. Red House School - a 30 place school for 11+ - 16 year old pupi Is. HANDICAPPED CHILDREN The table below sets out, in various categories, the number of handicapped pupils, as at 31 December 1971. Category of Pupils Special Day Schools Special Residential Schools Maintained Secondary Schools Not at School In Independent Schools TOTAL M F M F M F M F M F M F Blind — 2 1 1 — — — — 1 1 2 4 Partial ly Sighted 4 8 — — — — — — — — 4 8 Deaf 7 11 2 4 — — — — 1 — 10 15 Partially Deaf 17 13 3 3 — 4 — 1 3 3 23 24 E.S.N. 174 128 28 14 43 26 — — 2 4 247 173 Epileptic — 1 3 4 — — — — — — 3 5 Maladjusted 60 19 105 39 23 7 — — 1 1 189 66 Physical ly Handicapped 35 25 4 8 2 2 3 4 6 45 44 Defective Speech 11 2 1 — — — — — 10 7 22 9 Delicate 24 8 9 7 3 3 — — 3 2 39 20 PREVENTION OF INFECTIOUS DISEASE The School Health Service, in conjunction with the Council's other health services, is responsible for the control of all infectious diseases in schools. Although many infectious diseases are less severe than in years past some of them remain a problem. Diseases such as gastro-enteritis require much work to prevent and control them. Outbreaks of vomiting (winter vomiting) occur yearly and the cause remains unknown. Fortunately the illness clears quickly. The practice concerning infectious diseases in schools is based on the current policy of the Department of Education and Science. The regulations set out the types of infectious disease together with exclusion periods. All head teachers have a copy. These regulations were amended by the Department of Education and Science in Autumn 1971 and a further booklet is being prepared for distribution to head teachers for guidance. SCHOOLGIRL MOTHERS Only one case was referred to the School Health Service during 1971. The girl returned to school after her confinement. 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 1971 recuperative care was arranged for 37 school chi Idren. Where a mother has been ill, arrangements can be made for her to be sent away with her children. In those cases, the mother and any children under school age, are assessed according to the family income and a charge made. SPECIAL SCHOOL FOR THE MENTALLY HANDICAPPED From the appointed day (1st April 1971) the procedure for determining a child as ineducable has ceased to be used. Children who would have been considered for determination under Section 57 of the Education Act 1944 come under the provisions which apply generally to those requiring special educational treatment and in particular Section 34 of the Act. Until September 1971 the London Borough of Ealing had no special school for the mentally handicapped and children were accommodated for us by the neighbouring boroughs of Hounslow, Hillingdon and Harrow. In September 1971 Mandeville School, a special school for mentally handicapped children opened and a gradual transfer of children into the school began. This school has a Special Care Unit attached to it with 24 places for children with severe physical as well as mental handicaps. Children are admitted from the age of 3 years. At the end of the year 126 mentally handicapped children attended the following schools:- Borough of Ealing - Mandeville Special School 71 St. Raphaels Convent 1 Borough of Hounslow - Oaklands Special School 47 Hanworth " " 2 Borough of Hillingdon - Moorcroft Special School 4 Borough of Harrow - Whittlesea " " 1 126 PROVISION OF MILK IN SCHOOLS The Education (Milk) Act 1971 and the subsequent Regulations which brought its provisions into effect on the 1st September empowered the Council to provide free milk only to the following categories of pupils in maintained schools:- (a) Pupils in special schools, ie those for the maladjusted, physically handicapped, delicate, blind, deaf, etc. (b) Pupils in other maintained schools up to the end of the summer term after they attain the age of 7. (c) Other pupils in primary schools and junior schools in all-age and middle schools where a school medical officer certified that the pupil's health requires that he should be provided with milk at school. It is only the children falling within category (c) above (approximately 16,200) which require further consideration and plans have been made to identify those who are most likely to require free mi Ik and arrange for their medical examination as soon as possible. I consider the following should be given priority for examination:- (a) Those on the Health and Social Services 'At Risk' Register: placed there because they come from problem families (approximately 1,200). (b) Children noted at Routine Medical Inspection as unsatisfactory, mainly under weight and delicate children (approximately 50). (c) Ascertained handicapped children attending ordinary junior schools instead of being placed in special schools (details not readily obtainable but numbers are not significant.) (d) Children in junior schools receiving free school meals (approximately 1,500). (e) Children referred by parents, teachers, general practitioners, or social workers (approximately 200 to date). The total number of children in all these groups together amounts to some 3,000 but it must be noted that there is probably considerable overlapping within the groups. For example it is likely that a large number of those on the 'At Risk' Register will be receiving free school meals. It is not however possible to estimate the extent of this. It is also not possible to estimate the number of parents who will accept the offer of a medical examination for their child. Arrangements have been made for additional medical, nursing and clerical staff to undertake these examinations which it is hoped will be commenced early in the new year. Following the initial medical examinations there will be a recurring yearly commitment albeit on a reduced scale but the extent of this will only be apparent after the initial examinations have been completed. SCHOOL DENTAL SERVICE Miss KM F Robinson LDS RCS, Principal School Dental Officer, reports as follows:- The School Dental Service has the responsibility of providing a routine dental inspection of all children at school, and ensuring that any treatment necessary is received either from the Council's dental officers or by attendance at a general dental practitioner. A further function is the provision of dental health education. The Service operates from 12 of the Council's clinics. five of which have two surgeries so that the additional orthodontic and dental auxiliary services may be provided. The establishment for dental staff is 13 dental officers, two of whom are orthodontists, and 1 dental auxiliary. During the year, staffing has presented some difficulty, two clinics being without a dental officer, one for 3 months and the other for 6 months, due to difficulty in recruitment. This resulted in a reduction of the total treatment figures, which was reflected in the annual statistical returns. The position has now been resolved and at present 9 full-time and 2 part-time dental officers are employed, being a full-time equivalent of 10 2/10. A full-time dental auxiliary continues to assist the dental officer at one of the clinics. During the year, two senior members of the staff. Mr L C Mandeville. Principal School Dental Officer, and Miss I Cameron, Senior Dental Officer, retired from local authority service. Both Mr Mandeville and Miss Cameron had been concerned with the School Dental Service over a number of years, and they will be very much missed by all members of the staff. DENTAL INSPECTION The figures for dental inspections during the year were as follows :- Number of routine dental inspections 1971 20,243 Percentage of children inspected 45,45% Number found to require treatment 15,534 Sessions devoted to inspection 199 DENTAL TREATMENT Total Visits to clinics 25,587 Number of teeth filled 20,798 Teeth extracted : total 6.562 Teeth extracted in orthodontic treatment 525 General anaesthetics 2,187 Emergencies 1,281 Sessions devoted to treatment 3,600 Although there has been little change in the percentage of children found to require treatment, observed in the Borough for a number of years, there has been a reduction in the amount of treatment required by each child. The ratio of permanent teeth filled to permanent teeth extracted is a good figure, and has risen steadily over past years. It is also encouraging to note, as the following tables show, that in the last 3 years, the number of deciduous extractions has continued to fall in the younger age groups, and that the number of general anaesthetics required for all age groups has been reduced. TABLE 1 DECIDUOUS EXTRACTIONS 5-9 years 10-14 years 15 years + 1969 4595 1426 111 1970 4365 1309 111 1971 3689 1251 115 TABLE 2 GENERAL ANAESTHETICS 5-9 years 10-14 years 15 years + 1969 1980 796 87 1970 1775 620 63 1971 1404 522 39 DENTAL HEALTH EDUCATION It is recognised that dental health education in the schools plays a large part in increasing an awareness of the importance of dental health, and an interest in maintaining it. Dental health education forms an important part of the work of the dental auxiliary, who, wherever possible, has accompanied the dental officer on school inspections to give a talk on dental health in conjunction with a suitable film, and to demonstrate various aspects of dental hygiene. An encouraging trend in the last few years has been the appreciable increase in the number of five-year-old school entrants found to have caries-free deciduous teeth. There remains however a disappointingly high number of children whose teeth are in a very poor state indeed on school entry, and it is to this younger section of the school population, and the parents, that the greatest efforts in dental health education are directed. 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 1971 were:- EXPECTANT AND NURSING MOTHERS: Examined 109 Required treatment 104 Teeth filled 192 Teeth extracted 50 Dentures provided 32 19 GENERAL ENVIRONMENTAL HEALTH MEASURES Nuisances and Complaints During the year 7,596 complaints were received,the main categories being as follows:- Housing defects 1,127 Drainage 825 Refuse and dustbins 676 Animals 71 Insects 307 Food 291 Smoke emissions and bonfires 131 Overcrowding and multiple occupation 81 Noise 223 Rats and mice 3,591 Miscellaneous 273 As a result of these complaints 9,406 inspections and 11,207 reinspections were made of premises of all types and 1,318 informal notices were served under the Public Health Acts and allied legislation. It was found that in general this informal action brought a satisfactory response and that the necessary works were completed within a reasonable time. However, it was necessary to serve 663 statutory notices in cases where action to remedy defects was not readily forthcoming and these resulted in the taking of legal proceedings in 25 cases. Two cases were withdrawn before the hearings on completion of the works and on payment of agreed costs to the Council. Twenty Nuisance Orders were made and the defendants ordered to pay the costs. In two cases fines were imposed and costs granted for non-compliance with Nuisance Orders. A fine was imposed in the remaining case for failure to comply with a notice served under Section 56 of the Public Health Act 1936. The total amount of fines imposed was £170 and costs £1,743. The informal and formal action taken under the Public Health and Housing Acts resulted in 5,080 repairs and improvements being carried out, including the cleansing and repair of 881 drains and water closets, the abatement of dampness in 411 cases, the removal of 519 accumulations of refuse, the repair of 560 walls and ceilings and 340 roofs. Radioactive Substances Act 1960 The Department of the Environment maintains a register of persons authorised to use radioactive materials and notifications of new registrations are passed to the Council. A Public Health Inspector then visits the premises to obtain information regarding safety precautions so that such details are available locally in the event of an accident. Three new premises were registered during the year bringing the total in the borough to 24. Factories Act 1961 This Act and the various regulations made under it places on the Council certain responsibilities regarding the inspection of factories and outworkers premises. The Council is responsible for enforcing the provisions relating to sanitary conveniences in all factories and those concerning cleanliness, overcrowding, temperature, ventilation, and drainage of floors in any factory where mechanical power is not used. During the year 53 premises were inspected and at the end of the year there were 1,102 on the register. Where defects were found they were remedied after informal action. A register of persons employed by factories in their own homes, ie. outworkers is maintained by the Council and 120 visits were made to their houses to ensure that the work was being carried on under hygienic conditions. Tables 2-4 give the statistical information for the year. Caravan Sites and Control of Development Act 1960 The difficulties in dealing with gipsies and other travellers who park on service roads and other land in the northern parts of the borough continued to present a problem. However, the vigilance of the Council's Warden and co-operation of the police resulted in the satisfactory removal of the vehicles in most cases. Without this degree of control no doubt the caravans would remain for long periods on these unsuitable sites which are without sanitary conveniences and with the consequent dumping of rubbish which creates a nuisance. Common Lodging Houses There are no common lodging houses in the Borough. Rag Flock and Other Filling Materials Act, 1951 This Act and its accompanying regulations are designed to secure the use of clean filling and lining materials in upholstered and other articles which are stuffed or lined. At the end of the year 6 premises in the Borough were registered under the Act. Inspections were made of these premises on 9 occasions and conditions were found to be satisfactory in all cases. Noise Abatement Act 1960 Complaints of alleged noise nuisance made during the year totalled 233. Not only was this the highest number received - 54% above last year's figure - but the percentage of valid complaints, 86%, was greater than in any previous year. Noise from industrial and commercial premises gave rise to 162 complaints - 69% of the total - whilst the remaining 71 complaints were split almost equally between those about noisy neighbours and the miscellaneous group which includes road drills, road traffic, noisy animals, etc. By the end of the year, 164 of the complaints had been resolved without statutory action, one following statutory action, 33 were not considered to be nuisances, although in most cases some reduction of noise was achieved, and 35 complaints were still being investigated. The latter related to noise from nine different premises and in each case work was being carried out to reduce the noise emissions. The case which required statutory action related to an old established factory in the Greenford area which, early in the year, changed from a one shift system to two shifts in order to increase production. This action immediately resulted in complaints from local residents about noise and vibration. Numerous visits to the district were made by the inspectors concerned, including visits during the night and in the early morning. The assistance of staff from the Greater London Council Scientific Branch was obtained in order to evaluate the effects of the vibrations noted during the visits. Following the investigation, an Abatement Notice relating to the vibrations was served on the occupiers of the factory. As the nuisance continued, a case was taken in the Magistrates Court where a Nuisance Order was made restricting working time to the 12 hours between 6.30 a.m. and 6.30 p.m. The company appealed against this Order but the Middlesex Quarter Sessions dismissed the appeal. At the hearings in both Courts, valuable technical evidence was given by officers of the Greater London Council, by the Divisional and District Public Health Inspectors concerned and by a number of local residents. Aircraft Noise Although this subject is outside the local authority's sphere of operations, because of complaints which appeared in the local press and as the borough is overflown by some of the flight paths serving London Airport, monitoring of aircraft noise was carried out on a number of occasions during the year. The Wilson Report on Noise (Cmnd 2056) discussed the effects of aircraft noise at considerable length and defined the units used both to measure the noise and to assess its degree of annoyance. The unit used for measurement is the Perceived Noise Decibel (PNdB). For all practical purposes, this is obtained by adding 13dB to the reading obtained on the ordinary noise level meter on the 'A' weighting scale (dBA), this being the unit normally used for recording noise levels. To assess the nuisance caused by aircraft noise, a composite measure, the Noise and Number Index (NNI), is defined to take into account the average peak noise level and also the number of aircraft heard in a specific time. This index is then related to the results of a social survey carried out in 1961 when it was found that a Noise and Number Index of 30 was deemed to cause little annoyance, 44 caused moderate annoyance and 55 and above was very annoying. In Ealing during August, aircraft noise was monitored for 29 hours spread over a period of five days in the Recreation Ground, Southall. During the period a total of 1,067 movements were noted, the highest reading obtained was 99PNdB and the average peak noise level was 83 PNdB, giving Noise and Number Indices for each of the five days of 43, 32, 34, 38, and 30. A similar exercise at the same site in October 1967, recording the noise made by 376 planes, gave a higher result of 104 PNdB and an average peak noise level of 89 PNdB, giving N.N.I.'s on this occasion of 26, 44, 38, 26, and 19. Later in the same month when flight path 060M was in use, monitoring was carried out for short periods on two days in Elthorne Park which is almost directly under this occasionally used flight path. These observations extended over a period of seven hours on the two days and noted the movement of 75 aircraft, the highest peak was 105 PNdB and the average peak level was 96 PNdB, giving N.N.I.'s of 36 and 42 for the two days. Noise levels at this site in May 1968, gave a highest peak of 113 PNdB with an average peak level of 108 PNdB giving an N.N.I. of 42. It would appear that the average peak noise levels have decreased at both sites but the annoyance factor has increased slighly in Southall. At both sites the moderate annoyance level is almost reached at times but neither site has reached the very annoying level which resulted in the Heathrow Sound Insulation Grant Scheme. Public Health Act, 1961 - Destruction of Pigeons The contract with a firm specialising in pigeon control work was continued, resulting in the destruction of 3,147 feral pigeons. Disinfection and Disinfestation The number of properties found infested with bed bugs was not large but fleas caused an increase in the disinfestations carried out during the year. Disinfestation measures were taken in 215 houses involving 776 rooms. The importation of clothing and other articles into certain countries in Europe is only permitted on production of a Certificate of disinfection. Before a certificate is issued the articles are sprayed with formalin and 77 items were so treated. Eight houses and other premises were disinfected after cases of illness and 14 articles were destroyed. Offices, Shops and Railway Pemises Act 1963 The number of small shopkeepers in the borough is on the decline as an increasing number of supermarkets are opened. A large number of shops have been given over to employment agencies, travel agents, banks, building societies and betting shops. "Take-away" food shops and "Cash and Carry" warehouses are also new and growing activities. The conversion of former factory buildings to wholesale and "Cash and Carry" shops causes some difficulty because such items as drinking water, wash hand basins and proper ventilation are not provided before the premises are opened. This state of affairs causes unnecessary disturbance and additional expenditure to bring the working conditions up to standard. At the end of the year 3362 premises were registered under the Act there having been 209 additions and 105 deletions. During the year 2114 general inspections and 4825 visits of all kinds were made to premises under the Act. The guarding of dangerous machinery still presented many problems especially with imported items of equipment which had inadequate safety devices. Some operators do not seem aware of the dangers in using inadequately guarded machines as they often put safety devices out of action and remove guards for ease of working. Considerable attention was given during the year to the use of food slicing machinery in food premises and the leaflet "The Safe Use of Food Slicing Machines" was supplied in appropriate cases. The total number of accidents reported was 116 and 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 Non power driven machinery 1 — — — 1 Power driven machinery in motion 2 1 — — 3 Power machinery at rest 4 — — — 4 Vehicles in motion not moved by power 3 1 — — 4 Vehicles in motion moved by power 7 3 — — 10 Falls on or from stairs 3 3 — — 6 Falls on or from ladders 4 1 — 1 6 Other falls from one level to another 5 — — -— 5 Falls on same level 3 12 — — 15 Stepping on or striking object or person 10 4 — 1 15 Handling goods 10 6 1 — 17 Struck by falling object 13 5 — — 18 Use of hand tools 6 2 — — 8 Fire — 2 — — 2 Not specified 1 1 — — 2 Totals 72 41 1 2 116 Prosecutions There were five successful prosecutions during the year. In the first case the occupier of the premises pleaded guilty to nine offences including dirty waI Is and ceilings in the W.C. and wash room, an accumulation of rubbish, dirty W.C. pan and wash basin, absence of a supply of hot or warm running water and absence of a first aid box. He was fined £85 with £2 costs. The second case was for three offences including inadequate ventilation, and absence of a supply of hot or warm running water. A fine of £35 was imposed with £6 costs. A third case was taken after an accident in which an employee alleged she fell because of a damaged carpet. The defendants pleaded guilty and were fined £5 with £5 costs. In the fourth case the defendant was charged with failure to provide conveniently accessible sanitary conveniences and a supply of hot or warm running water.He was fined £20 and £2 costs. A fifth summons was withdrawn on payment of agreed costs of £5. This related to the failure to supply hot or warm running water but the work was completed before the hearing. 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 107 969 425 Retail shops 73 2005 1309 Wholesale shops, warehouses 20 133 272 Catering establishments open to public, canteens 8 251 105 Fuel storage depots 1 4 3 Totals 209 3362 2114 No. of visits of all kinds of inspectors to registered premises - 4825 Analysis of persons employed in registered premises by workplace Class of Workplace Number of persons employed Offices 18091 Retail shops 9885 Wholesale departments, warehouses 3028 Catering establishments open to public 1909 Canteens 146 Fuel storage depots 23 Total 33082 Total Males 15979 Total Females 17103 Contraventions Remedied Items No. of Improvements Premises cleansed 315 Overcrowding abated 2 Temperature improved 6 Thermometers provided 91 Ventilation provided or improved 66 Windows and skylights cleaned 16 Lighting improved 11 Lighting apparatus repaired 12 W.C. accommodation increased 10 Washing facilities increased (basins) 10 Soap and towel provided 19 Hot and cold water provided 61 Drinking water provided 1 Accommodation for clothing provided or improved 15 Sitting facilities provided or improved 1 Meal facilities provided or improved 1 Floors, stairs, passages etc., repaired 155 Handrails provided 29 Staircase guards provided 34 Machinery guarded 29 First aid boxes provided or refilled 271 Facilities provided for dying clothing 3 Prevention of Damage by Pests Act 1948 The following is a summary of the work carried out by the Rodent Operatives:- Complaints received 3,591 Premises inspected 3,693 Revisits to infested premises 12,022 Fees received for treatment £1,874 Number of Infestations Outstanding at 31.12.70 New Infestations Found During Year Infestations Cleared During Year Number of Infestations Outstanding at 31.12.71 Rats Mice Total Rats Mice Total Rats Mice Total Rats Mice Total 125 228 353 620 1,357 1,977 610 1,164 1,774 135 421 556 The increase in the number of complaints about rodents noted last year continued unchecked and by September it had become apparent that the staff increases of two men and one vehicle authorised for this year and another two men and one vehicle approved in principle for the following year would be inadequate to cope with the growing number of infestations - mostly mice - which were being found. In January, the staff was dealing with 353 infestations. By September the figure had risen to 487 and at the end of the year had reached 556. Because the work load had risen above the capabilities of the existing staff of six operatives, in November the Council approved the immediate appointment of five additional operatives, bringing the establishment up to eleven. It is hoped that when the new establishment has been filled, the staff should be able to cope adequately with both surface and sewer infestations. Fairs Fairs were held at Ealing Common, Acton Park and at Northolt during the year. At Ealing Common there was some deterioration in the condition of the temporary sanitary accommodation provided and although some improvements were effected on the site it has been found necessary to amend the conditions in the form of agreement for the use of Council land on future occasions in order to secure a higher standard. There were a number of food stalls on the sites and warnings were given concerning some contraventions of the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966. Summer Camp for Overseas Visitors Early in june 1971 the Greater London Council granted permission to Christian Action for the use of part of the Wormwood Scrubs open space known as Old Oak Common as a temporary camp for overseas visitors. Wide publ icity was given to this decision in the national press where it was suggested that up to 2,000 young foreign visitors were to be accommodated on the site. The Council viewed the project with some concern and after discussions with the G. L.C. and all other interested parties it was made clear that planning permission and a licence under Section 269 Public Health Act 1936 were required. Eventually, planning permission was granted, and a licence was issued for a period ending 3rd September 1971 limiting the number of visitors to 554. Strict conditions were imposed relating to the site management, density and space, sanitary accommodation and washing facilities, water supply, sale and preparation of food, refuse storage and disposal, medical facilities and the control of noise. The site was made available on 21st June and the first 25 visitors arrived on the 23rd June. The visitors were accommodated in marquees hired by the organisers, Double-bunk beds, blankets and cotton sleeping bags were supplied and light refreshments were available from a mobile canteen. Further marquees were erected as the number of visitors increased and the highest number on any one day was reached on the 27th August when 467 were accommodated. The majority of visitors provided their own sleeping bags, and a few slept in small tents of their own. The total number of visitors was 8,000 of whom 1,600 were females. The average length of stay was 2½ nights. Good sanitary accommodation and washing facilities including showers were available in the existing G.L.C. changing room on the site and a Camp Warden with a volunteer staff maintained the facilities in a satisfactory condition. Visits were made on a daily basis by the Public Health Inspectors who maintained close liaison with the Warden and no major problems were encountered. The camp was well organised and managed and no complaints were received from local residents after the camp site was opened. "SUMMER CAMP FOR OVERSEAS VISITORS" 20 WATER SUPPLIES, SWIMMING BATHS, AND SEWAGE DISPOSAL Water Supplies All parts of the borough are supplied with mains water serving 93,697 dwellings with an estimated mid 1971 population of 299,450. The supplies are satisfactory in quality and quantity and are not subject to plumbo-solvent action. They are derived from four water undertakings:- 1. The Colne Valley Water Company which supplies small parts of the Peri vale and Horsenden Wards. 2. The Rickmansworth and Uxbridge Valley Water Company which supplies the remainder of the Perivale and Horsenden Wards, part of Waxlow Manor and the whole of the Ravenor, Mandeville and West End Wards. 3. The South West Suburban Water Company which supplies the remainder of Waxlow Manor Ward, the whole of Dormers Wells and Northcote Wards and part of Glebe Ward. 4. The Metropolitan Water Board which supplies those parts of the borough not mentioned above. Ten samples of tap water were taken as a result of complaints but they all proved to be satisfactory on examination. At several factories in the Borough water is obtained from deep borings ranging in depth from 300 to 600 feet. Sixty one samples of water taken from these wells were submitted for bacteriological and chemical examination with satisfactory results. Water Samples 1971 Source No. of Samples Satisfactory Doubtful Unsatisfactory Well Supplies 61 61 — — Public Supplies 10 10 — — Totals 71 71 — — Swimming Baths The Council provide public swimming baths at Ealing, Acton, Southall and Northolt. Four of the Council's schools have swimming pools, in addition to one at a direct grant school. Residents of a housing estate and a modern block of flats have private swimming pools as does a sports club. Throughout the year samples were taken at regular intervals from each pool and submitted for bacteriological examination. 205 samples were taken and only 7 proved to be unsatisfactory. Advice was given on necessary measures to improve matters, and repeat samples were found to be acceptable. Swimming Bath Samples Number of pools Satisfactory samples Unsatisfactory samples Total samples Public baths 11 114 2 116 School baths 5 49 — 49 Private baths 3 40 5 45 Totals 19 203 7 210 Detailed chemical and bacteriological examinations were also carried out at regular intervals by the Council's Analyst with the following results:- Number of pools Satisfactory samples Unsatisfactory samples Total samples Public baths 11 108 1 109 School baths 5 25 - 25 Private baths 3 2 - 2 Totals 19 135 1 136 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 part of the borough is connected through the West Middlesex Main Drainage Scheme to the soil sewerage treatment works at Mogden which are operated by the Greater London Council. Effluent from parts of Acton, which is combined soil and surface water, passes through another G.L.C. system to a works at Barking, Essex. The River Brent and other water courses take the surface water drainage where it is not combined with soil sewers. There are 37 premises not connected to main sewers, 27 are drained to cesspools or septic tanks and the remaining 10 are served by chemical or pail closets. 21 MEAT INSPECTION AND ANIMAL PROTECTION Meat Inspection Regulations The large factory slaughterhouse at Acton is engaged in the slaughtering and processing of pigs. A moving line method of carcase dressing is in operation which deals with approximately 327 carcases in an hour. Working under these conditions is exacting and tiring. The Council, therefore, has a staff of twelve authorised Meat Inspectors operating a rota system with three assistants, the Public Health Inspectors being called on at holiday times or whenever there is a depletion of staff through sickness. The provisions of the Meat Inspection Regulations are enforced to ensure that no diseased or insound meat reaches the consumer. Tables 5-7 give details of meat inspection carried out during the year. Poultry Inspection There are no poultry processing and packing premises in the Borough. Diseases of Animals Act 1950 The borough remained free of notifiable disease throughout the year and no outbreaks occurred elsewhere which involved the Council in any licensing procedure. Mr J A Morris M.R.C.V.S.,continued 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 593 movement licenses allowing 14,169 pigs to be moved out of the market. Diseases of Animals (Waste Foods) Order 1957 Three plants are still in operation and working satisfactorily. Visits of inspection were made on 24 occasions. Slaughter of Animals Act 1958 Applications for renewal of existing licences were received and granted in 15 cases. One new application for a licence to slaughter animals was also granted. Animal Boarding Establishments Act 1963 Two applications for renewal of licences were received and granted. Inspections of the premises concerned were made on 25 occasions during the year. Pet Animals Act 1951 Licences in respect of 22 premises were renewed and one new application was granted. Visits were made to the premises involved on 203 occasions. 22 HOUSING Unfit Houses (a) Clearance Areas The following progress was made during the year in connection with the Council's programme for 1965-70. 2-20 (evens) Beaconsfield Compulsory Purchase Order Road & 14-38 (evens) and made in 1969, confirmed 13-31 (odds) Gladstone in 1970 by Secretary of Road, W4 State for the Environ- ment. Rehousing of occupants proceeding. 1-21 (odds) and 2-26 (evens) Compulsory Purchase Richards Cottages, W3 Order made in 1969 confirmed in 1970. Rehousing of occupants nearing completion and 11 houses demolished. 29 Haven Green and 1 Clearance Order sub- Haven Lane, W5 mitted but negotiations for improvement and repair still in progress. 1-9 (consec) Oak Street, Compulsory Purchase 20-24 (consec), 26-60 Order made in 1967 (evens) and 27-37 (odds) confirmed in 1969. Bakers Lane, 1-4 (consec) Rehousing of occupants Paddock Place, 17A and completed and all 17-23 (odds) The Grove, properties demol ished. and 1 and 2 Grove Place, W5. 1-8 (consec) and 11-16 Clearance Order made (consec) Nelson Place, in 1968 confirmed in and 17-27 (odds) and 1969. Rehousing of 43-49 (odds) Steyne Road, occupants completed W3. and all properties demolished. 1-14 (consec) Mill Hill Complusory Purchase Terrace 6-13 (consec) Order made in 1967 Oldham Terrace 1-7 (consec) confirmed in 1968. Princes Terrace 1 and 2 Rehousing of occupants Priory Cottages, W3 completed and all properties demolished. (b) Individual Unfit Houses and Parts of Houses 49 Mattock Lane, W5 Demolition Order made and some tenants rehoused. Basement, 5 Cumberland Occupants rehoused Park, W3 following Closing Order made in 1 970. Ground floor flat, 69 Closing Orders made Hammond Road, Southall. in 1969 determined on Ground floor flat, 23 completion of works. Shirley Gardens, W7 First floor flat, 23 Shir ley Gardens, W7 Ground floor flat, 120 Closing Orders made Hammond Road, Southall in 1970 determined on 48B Mattock Lane, W5 completion of works. Part Basement, 29 Birkbeck Road, W3 Second floor flat, 5 Heathfield Road, W3 ) Closing Orders made , 2 and 3 Haven Place, W5 and tenants rehoused. 39 Featherstone Terrace, Southall 34 Boston Road, W7 1 and 2 Essex Park Mews, W3. The Bungalow, Springdale, Demolition Order made, Uxbridge Road, Southall tenant rehoused, and premises demolished. 33A The Grove, W5 Closing Orders made 3 Essex Park Mews, W3 and tenants awaiting 12 Burlington Mews. W3 rehousing. 6 Essex Park Mews, W3 Closing Order made: premises vacant 7 Essex Park Mews, W3 Action on proposed 13 Burlington Mews, W3 Closing Orders Rose Cottage, Ranelagh eferred pending Mews, W5 decisions on owners' proposals. Houses in Multiple Occupation The aim of the Council's policy with regard to houses occupied by persons who do not form a single household is to control excessive numbers of individuals in occupation, to reduce gross overcrowding and, in suitable cases to improve the conditions and amenities available and means of escape from fire. The powers used in the main by the Council are derived from the following:- (a) Housing Act 1957, Section 90 - which is used to abate overcrowding when the "permitted number" for a house or part of a house in multiple occupation is exceeded. (b) Housing Act 1961, Section 19 - this empowers the Council to give a Direction limiting the number of individuals or householders who may occupy the house. A Direction does not require the surplus occupants to leave immediately but it is an offence to allow the number of individuals or householders occupying the house to increase to a number above the limit specified or to replace any who leave before the number has been reduced below that fixed. (c) Housing Act 1961, Section 15 - the Council has fixed a standard which requires the provision of certain facilities, and if these are not available a notice may be served under this Section. The facilities required include ventilation, water supply, sanitary conveniences, washing facilities, preparation and storage of food. (d) Housing Act 1961, Section 16 - improvements in the means of escape from fire are required in accordance with the code of practice laid down by the Greater london council. Details of action taken over the last 8 years in connection with houses in multiple occupation in the area which is now the London Borough of Ealing are given below. Action Taken Totals for years 1963 - 1970 1971 Totals ACTON EALING SOUTHALL ACTON EALING SOUTHALL Directions given (Section 19 Housing Act 1961) 34 120 1504 4 12 86 1,760 Prosecutions for contravention of Direction — 3 134 — — 14 151 Notices to improve facilities and means of escape from fire (Sections 15 and 16 Housing Act 1961) 533 540 20 366 341 7 1,807 Prosecutions for fai lure to comply with notices served under Sections 15 and 16 Housing Act 1961 8 10 4 5 27 Overcrowding notices (Section 90 Housing Act 1957) 7 3 56 — — 1 67 Prosecutions for contravention of overcrowding notices — — 98 — — — 98 Notices requiring information as to occupants (section 19 Housing Act 1961 34 117 2417 29 40 324 2,961 Prosecutions for failure to supply information as to occupants 3 4 27 1 — — 35 Prosecution for false information — — 1 — — — 1 Prosecutions for failure to supply information as to ownership 7 1 — — — — 8 Management Order made Section 12 Housing Act 1961) — 1 — — - - 1 Total visits and inspections of houses in multiple occupation during 1971 — 5,480 The following table gives details of action taken during the year under Section 90 of the Housing Act 1957. Number of dwellings overcrowded at end of year 3 Number of families occupying these houses 12 Number of individuals living in these houses 49 Number of new cases of overcrowding reported during the year 1 Overcrowding relieved during the year — (a) Number of cases 9 (b) Number of individuals involved 91 The fourteen prosecutions for contraventions of the Directions given under Section 19 of the Housing Act 1961 were all successful. Fines totalling £275 were imposed and a total of £78 costs awarded to the Council. Six prosecutions for fai lure to comply with notices served under Sections 15 and 16 of the Housing Act 1961 were also successful. Fines totalling £410 were imposed and £131 costs awarded to the Council. There was one prosecution for failure to carry out works required by Sections 15 and 16 after a previous conviction. A fine of £100 was imposed and £10 costs awarded to the CounciI. Three appeals to Quarter Sessions against convictions for offences under Sections 15 and 16 were dismissed. In one case the fines were reduced from £1 00 to £10 and in the other two additional costs totalling £80 were awarded. In one case under Section 19 (9) of the Housing Act 1961 for failure to supply information as to occupants a fine of £5 was imposed with £2 costs plus £4 interpreters fee. Improvement Grants The number of Improvement Grants approved during the year increased substantial ly from the 181 totalling £90,206 in 1970 to 309 totalling £232,844. Standard grants increased from 58 totalling £7,503 in 1970 to 69 totalling £8,633. These grants are not expected to vary greatly in number but improvement grants will certainly continue to rise sharply in number and value as a result of publicity and to some extent of increases in wages and cost of materials due to inflation. This increased work has been dealt with by a staff which has been under strength since 1970 due to difficulty in filling vacancies. In anticipation of the London House Improvement Campaign planned for April/May 1972, the appointment of additional staff has been approved and a reorganisation recommended which it is hoped will enable applications to be dealt with more expeditiously. Survey Work The Acton Town Centre Survey continued to occupy the Improvement Grant Staff during the year and despite the increase in work already mentioned was substantially complete by the end of the year. Qualification Certificates 617 Qualification Certificates were issued during the year following the completion of repairs by owners. A further 663 premises had been inspected and were awaiting completion of repairs and 250 applications were withdrawn or refused during the year. The majority of these inspections were carried out by the District Public Health Inspectors, and the remainder by Improvement Grant Staff. Certificates of Provisional Approval and Qualification Certificates necessary where rent controlled dwellings lack the standard amenities prescribed by the Housing Act 1969 are often applied for at the same time as grant aid is sought towards the cost of the work. 52 Qualification Certificates were issued upon completion of the improvement and repair works and a further 240 cases had been provisionally approved and await completion of the work. 17 applications were withdrawn or refused for various reasons. All applications of this type are in respect of tenanted properties and the interest of property owners and managing agents demonstrates the encouragement given by the grant aid available. London House Improvement Campaign This campaign sponsored by the Department of the Environment, is planned to take place in April and May 1972 and is intended to encourage and expedite the improvement of the existing housing stock. The participation by this Council in the campaign was considered towards the end of the year and it is expected that this will take the form of making show houses available to the general public, together with a large-scale programme of local advertising and publicity to supplement the general publicity in London by the Department of the Environment. Medical Aspects of Council Housing Applicants for Council accommodation, or those who wish to transfer from one Council house to another, often require special consideration because of the disability or illness of some member of the family. Before such consideration can be given it is necessary for a medical certificate to be furnished and these are usually sent to the Housing Manager. He then seeks advice on the medical implications and forwards any relevant information that he has already obtained. After assessment additional points may be awarded or a special report presented to the Housing Committee. 23 CLEAN AIR Due to a national shortage of solid smokeless fuel 40% of the Council's smoke control orders were suspended between November 1970 and March 1971. No significant increase in air pollution levels was noted as a result of this suspension, largely because of the mild winter and the continuing reduction in the number of solid fue I burning appliances. The provision of those orders remaining in force were rigorously enforced as it was felt that the progress in clean air already achieved would be jeopardised should the widespread use of bituminous coal occur. Despite efforts to give maximum publicity to the suspensions and orders remaining in force, sales of coal did occur and four merchants were prosecuted and fined for delivering and selling unauthorised fuel. Fines totalling £20 and costs of £18 were imposed. A large industrial firm was prosecuted and fined £20 with costs of £5 for two separate offences relating to the burning of rubbish in an incinerator within a smoke control area. A second firm was prosecuted under the Public Health (Recurring Nuisance) Act 1969. A fine of £20 was imposed with £5 costs and a Nuisance Order made requiring the provision of arrestment plant to eliminate the emission of particles of carbon black. Five smoke control orders became operative in 1971, and the last two, Ealing Nos.52 and 53, which have been confirmed, will operate from 1st July 1972. The borough Region No. of acres covered by smoke control orders Percentage of total "black area" acreage so covered No. of premises covered by smoke control orders Percentage of total "black area" premises so covered Whole country "black areas" 896,561 50.6 4,695,561 60.4 Greater London 260,582 79.7 2,266,946 85.8 London Borough of Ea ling 13,708 100.0 101,262 100.0 Progress of Smoke Control Programme in Ealing No. of Smoke Control Orders Acres No. of Dwellings No. of other Bui Idings Total premises Private Local Authority In operation 69 12866 81533 11282 5038 97853 Confirmed but not yet in operation 2 842 2871 95 443 3409 Tota Is 71 13708 84404 11377 5481 101262 will then have smoke control orders covering the entire area, although a few exemptions concerning property awaiting demolition will remain. The first order(SouthaII No.1) was made on 25th November 1958. confirmed by the Minister of Housing and Local Government on 21st June 1959 and came into operation on 1st May 1960. Since that time the programme has proceeded steadily, with a few disappointing setbacks due to financial difficulties and shortage of fuel, and is now virtually complete with a total of 71 separate orders. The benefits of clean air, many of which are already manifest in the borough, include an increase in measurable sunlight which in turn increases plant growth and improves the condition of the soil. The effects will also be felt in a general improvement in the psychological and social consequences of life in a cleaner environment as well as in general health due to a reduction in the respiratory diseases associated with air pollution. The cost of repairs to buildings due to corrosion of stone and metals will be reduced as well as that of domestic cleaning as a result of the improved atmospheric conditions. Figures which indicate progress made in this borough compared with Greater London and the total "black areas" of the country as a whole are given in the following table:- London Borough of Ealing - Smoke Control Areas (Coloured yellow on map) Smoke Control Orders Year of Operation Acton Nos 1-11) Ealing Nos 1 -20) 1960 - 1965 SouthalI Nos. 1-6) Ealing Nos. 21 -25 1966 Ealing Nos. 26 -30 1967 Ealing Nos. 31 -37 1 968 Ealing Nos. 38 - 44 1969 Ealing Nos. 45 -47 1970 Ealing Nos. 48 - 51 -54 1971 and 33 (variation) Ealing No.52 Made in 1970 confirmed in 1971 but not coming into operation until 1972. Ealing No.53 Made and confirmed in 1971 but not coming into operation until 1972. Measurement of Air Pollution Daily volumetric instruments for measuring smoke and sulphur dioxide in the air and deposit gauges for monitoring local emissions were maintained in operation during the year. The overall figures for the daily volumetric instruments show an average reduction compared with 1970 of 5% in the amount of smoke and 7% in the amount of sulphur dioxide in the air. The deposit gauge figures show an overall 16% increase in airborne particles. Yellow - Smoke Control Areas in the London Borough of Ealing Red - Smoke Control Areas in adjoining districts Green Proposed Smoke Control Areas in adjoining districts 24 FOOD HYGIENE AND FOOD AND DRUGS ADMINISTRATION Clean Food Scheme In the furtherance of the Council's Clean Food Campaign 17 lectures were given to a total of 322 food handlers; certificates of attendance were awarded to those who completed their course. Twelve lectures were given to 470 secondary school children approaching leaving age and the Public Health Inspectors also lectured to 9 women's organisations with 193 members. Copies of the filmstrip "Food Poisoning" were still available for sale to local authorities and other interested bodies. It is interesting to note that although this film strip was made in 1954 it is still popular and in regular demand and 222 copies have been sold, many of them to health education bodies overseas. Inspection of food premises A total of 4,551 visits, including re-inspections, was made to food premises in the borough and as a result 2839 improvements were effected including 428 items of equipment cleansed, 275 floors repaired, 291 tables and working surfaces made impervious, 437 walls and ceilings cleansed and 109 water closets repaired. Seven prosecutions for contraventions of the Food Hygiene (General) Regulations 1960 were taken during the year. One case involved the service of 22 summonses for offences including dirty premises as a whole, dirty equipment, dirty shelving, absence of soap or towel, absence of first aid equipment, defective and dirty floors, accumulations of refuse in food rooms and flaking paintwork. The defendant was fined a total of £370 with £20 costs. A second case was for offences involving insanitary condition of kitchen, dirty equipment, dirty shelving, food not protected from contamination, unfit food not kept separate, dirty protective clothing, absence of supply of hot water, absence of first aid box, and dirty walls, floors and ceilings. Fines totalling £190 were imposed with £10 costs. In a third case, 12 offences occurred involving premises in a dirty condition generally, food stored so as to involve risk of contamination, floor covering defective and dirty, sanitary convenience communicating directly with a food room and dirty shelving. £390 in fines were imposed with £25 costs. A fourth defendant was summonsed on two occasions for a total of twelve offences, including floors in filthy condition, food open to contamination especially to rodent excreta, waIIs and ceilings dirty, WC communicating directly with a food room and used as storage and absence of wash hand basin. He was fined a total of £410 with £30 costs. The sixth and seventh cases were less flagrant and fines of £10 were imposed in each case with costs totalling £3. A certificate of exemption was granted under Regulation 17 of the Food Hygiene (General) Regulations 1970 relating to water supply as alternative faci lities were available in nearby premises. Table eight gives details of the number of food premises in the borough according to the particular category of use. Food Hygiene (Market Stalls and Delivery Vehicles) Regulations 1966 There were 4 prosecutions during the year for 13 contraventions of the Regulations: Three cases were successful and fines tota I ling £120 were imposed with £20 costs. The fourth case was dismissed by the Magistrates because the evidence given showed that the defendant was not actually trading at the time the alleged offence took place; costs of £10 were given against the Council. Milk and Dairies (General) Regulations 1959 In accordance with the provisions of Regulation 8, 22 persons were added to the register of distributors of milk. At the end of the year two dairies and 192 distributors of milk at 221 premises were left on the register. One of the dairies operates a standard pasteurising and bottling plant, and eighteen washed bottles taken at random before being filled with milk were found on bacteriological examination to be satisfactory. At the second dairy the plant is designed for the pasteurisation of cream which is packed only into special disposable plastic containers. In spite of the precautions taken by dairy firms in general, complaints were received on 14 occasions from members of the public regarding milk in dirty bottles or with foreign matter therein. Two prosecutions were taken, one for fragments of glass in a bottle of mi Ik and the other for selling miIk in a dirty bottle. Fines of £30 were imposed with £12 costs. Milk (Special Designation) Regulations 1963 and 1965 Twenty-two new dealers (prepacked milk) licences were issued making 192 distributors and 2 pasteurisers with 257 premises on the register at the end of the year. Samples taken to ensure that they were genuine and reached the required standards for fat and mi Ik solids other than fat were also subjected to the prescribed tests for designated milk with the following satisfactory results:- Designation No. of Samples Phosphate Test Methylene Blue Test Turbidity Test Colony Count Test Pass Fail Pass Fail Pass FaiI Pass Fail Pasteurised 44 44 — 44 — — — — — SteriIised 15 — — — — 15 — — — Untreated — — — — — — — — — Ultra Heat Treated 7 — — — — — — 7 — TOTALS: 66 44 — 44 — 15 — 7 — Raw Milk Supplies As a result of a request from the Public Health Laboratory Service, the sampling of raw mi Ik for the detection of brucella abortus was continued at the only farm in the borough engaged in milk production. Eighteen samples were taken and submitted to the ring test which proved to be negative in all cases. Ice Cream Five premises were registered for the sale and storage of ice cream and one for manufacture bringing the totals at the end of the year to 483 premises for sale and storage and 9 for manufacture. Routine inspections were made at regular intervals of the manufacturers premises to ensure compliance with the Food Hygiene (General) and Ice Cream (Heat Treatment) Regulations. Systematic sampling of ice cream and ice lollies was carried out with the following results:- Commodity Number of Methylene Blue Grade Not Graded Grades I or II Satisfactory Grade II Doubtful Grade IV Unsatisfactory Samples I II III IV Ice Cream (Local Manufacturers 208 151 27 7 23 — 178 7 23 Ice Cream (Other Manufacturers) 40 25 2 5 8 — 27 5 8 Ice Lollies (Local Manufacturers) 26 — — — — 26 26 — — Ice Lollies (Other Manufacturers) 10 — — — — 10 10 — TOTALS 284 176 29 12 31 36 241 12 31 "The figures given in the table above include the following samples obtained from itinerant traders and from soft ice cream dispensing machines." Ice Cream Samples from Vans 32 20 2 7 3 - 22 7 3 Soft Ice Cream samples 49 34 4 3 8 - 38 3 8 Soft ice cream samples invariably provide a large proportion of unsatisfactory samples as the need for very careful cleaning and sterilising of the equipment at the end of the day is not always appreciated. More satisfactory samples are normally obtained after advice is given by the Public Health Inspectors. Registration of Hawkers of Food and their Storage Premises In accordance with the requirements of Section 11 of the Middlesex County Council Act 1950, 9 hawkers were registered leaving a total of such traders on the register at the end of the year of 38. Before registration is recommended a careful inspection is made of the vehicle to be used and of the storage premises. The main categories of business involved are greengrocery, grocery, shellfish, ice cream and "hot dogs". Registration of Premises for the Preparation of Sausages and Preserved Foods At the end of the year there were 151 premises on the register there having been no new premises registered during the year. Surrender of Unsound Meat and Other Foods (excluding meat at Slaughterhouse) The following foodstuffs were condemned by the Public Health Inspectors as being unfit for human consumption and they were surrendered for destruction. lbs Meat and meat products 2918 Fish and fish products 315 Fruit and vegetables 7534 Groceries 489 11256 Foodstuffs not calculated by weight assorted tins, packets, jars, bottles, articles, casks and boxes. 37070 Chemical Analysis of Food & Drugs Analytical work is carried out by the Greater London Council's Scientific Branch, two of whose officers have been appointed as this Council's Public Analyst and Deputy Public Analyst respectively. The laboratory is able to undertake other work apart from food and drugs including water pollution, sewage treatment, water from swimming pools, air pollution, ventilation, noise, vibrations, fire precautions, petroleum, fertilisers, feeding stuffs, radiochemistry, general supplies and services. During the year 800 samples, comprising 14 formal and 786 informal samples of food and drugs were taken in accordance with the recommendations of the Department of Health and Social Security. Forty-four of the 800 samples were unsatisfactory and some are worthy of particular mention. (a) The jelly decoration on one of the items in a packet of small iced cakes contained Blue VRS which is a non-permitted food colour. This decoration was found to have come from an initial experimental batch which had been released as a result of an oversight. A sample from a subsequent batch was found to be satisfactory. (b) Many claims are made for health foods which are sufficiently vague as to be misleading. However, where specific claims are made that food contains vitamins or minerals the amounts must be as shown on the label and stand up to a laboratory check. It was found that a blackcurrant drink contained only 65 mg per fluid ounce of vitamin C whereas the label claimed that it contained a minimum of 150 mg per fluid ounce. The manufacturer undertook to amend his claim accordingly. (c) The label of a diabetic chocolate stated that it contained 130 mg per ounce of calcium whereas on examination it was found that only 80 mg per ounce were present. In this case the manufacturers had omitted to add an ingredient but promised to adopt a stricter quality control in order to prevent a recurrence. Labelling of Foods Those foods and drugs which are subjected to chemical analysis are also examined to ensure that the labels comply with the provisions of the Labelling of Foods Order 1953 and allied legislation. During the year 107 instances of irregularities in labelling were found and the attention of the manufacturers, importers or packers was drawn to the infringements. Undertakings were accepted that new labels would be printed. Incorrect or inadequate description 28 No name and address 4 Incorrect or inadequate list of ) ingredients or no list of ) ingredients) 31 Misleading statements 10 Use of generic terms 24 Inadequate size of printing 1 Incorrect claim of mineral content 9 Food Complaints 178 complaints were received from members of the public regarding articles of food all of which were thoroughly investigated. The Public Analyst was asked for his opinion on 24 of the items. Complaints of particular interest included a piece of wire in a can of rhubarb, a bolt in a tin of salmon, a bullet in a can of tomatoes, a pork pie containing a bolt and washer and a loaf with part of a slicing blade embedded in it. Many complaints refer to foods containing mould, often due to poor stock rotation and advice is given in all cases. Nine firms were prosecuted as a result of the investigation of consumers' complaints and fines totalling £185 and costs of £54 were imposed. Beer Glasses Bacteriological examination was carried out with regard to beer glass washing in a representative selection of public houses. The tests were carried out by rinsing the glasses in a Ringers Solution which is sterile. The results varied from a plate count of 30,000 organisms per ml to nil. Glass washing in public houses has been given special attention and landlords, where necessary, have been instructed in the best methods of washing and use of sterilants. A further survey showed that this information was being accepted and the results achieved were more satisfactory. 25 REGISTRATION OF PREMISES USED FOR MEDICAL PURPOSES NURSING HOMES Section 190 of the Public Health Act, 1936, requires nursing homes to be registered with the local authority. At the beginning of 1971 ten nursing homes were in operation and they had a combined total of 355 beds. Both medical and surgical facilities are available. Three nursing homes were licensed to carry out abortions under the Abortion Act 1967 and the maximum number of beds available was75. Inspections are made every six months by officers of the Health Division to ensure that as high a standard as possible is maintained. Further information about local nursing homes and their residential charges may be obtained from the Health Division, on request. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT In accordance with the provisions of Part XII of the Middlesex County Council Act 1944, the Council requires the registration of all persons and premises where there is an establishment for massage and special treatment. The establishments are inspected annually to ensure that they are satisfactory and comply with the requirements of the Council's byelaws which state that a complete scale of all fees and charges must be exhibited, records kept of persons employed and particulars of cases treated. A total of 30 establishments are used by licensed persons in the Borough as follows:- Chiropody only 10 Chiropody and special treatment 7 Massage only 2 Massage and special treatment 3 Physiotherapy and special treatment 1 Osteopathy 2 Beauty treatment 3 Sauna baths 2 26 PUBLIC CONTROL MEASURES The Shops Acts and Licensing Section of the Inspectorate deals with a wide variety of public control and licensing measures. Some of these have close associations with the health aspect of the general work of the Division. Shops Acts 1950 - 1965 Young Persons (Employment) Act 1938 Children and Young Persons Act 1933 These Acts are mainly concerned with the closing hours of shops in the evenings, on Sundays and on earlyclosing days; intervals for meals; conditions and hours of employment of young persons in wholesale and retail trades, hotels, transport undertakings and other employments; also adults employed in retail shops on Sundays. Routine inspections of all premises covered by the Acts were carried out. A total of 3,690 visits were made by the Inspectors during the year and 910 infringements were dealt with by informal action. There were 33 prosecutions -23 for Sunday trading offences. 4 for offences against evening closing hours and 6 for early closing day offences. Fines totaIling £187 were imposed with £76 costs. Visits under these Acts were combined with those made under the Offices, Shops & Railways Premises Act and other Acts. Consumer Protection Acts 1961 and 1971 Under this Act the Secretary of State is empowered to make regulations imposing requirements in respect of any class of goods to prevent or reduce risk of death or personal injury. Regulations have been made in respect of heating appliances (fireguards), oil heaters, nightdresses. stands for carry-cots, toys, and the colour coding of mains leads attached to domestic electrical appliances. The Regulations impose amongst other things requirements for construction and testing. Routine inspections were carried out at all retail outlets. including secondhand shops and certain articles were purchased for testing. In addition, two markets in the Borough were visited weekly, also the majorit, of jumble sales. As a result 124 unsatisfactory heating appliances were destroyed. The Toys (Safety) Regulations prohibit the use of celluloid in toys and prescribe the proportion of metallic poisons which may be used in any paint applied to toys. During the year 25 toys were sent for analysis, and it was found in three cases that the prescribed proportion of lead was exceeded. The paint on two imported toy tomahawks had an excessive lead content but legal proceedings were not taken as the firms concerned with distribution of these toys had gone out of business. In an endeavour to prevent the sale of unsuitable toys, distributors in the Borough were asked to submit for analysis any suspect toys which they have in stock before they sell them, and Inspectors checked the warehouse stocks regularly. As a result a brush and comb set from Yugoslavia was found to contain paint having a high lead content and this consignment was destroyed by the wholesaler. During the year 1,123 inspections were made under the various Regulations. Late Night Refreshments Houses Act 1969 and The Greater London Council (General Powers) Act 1968 Part VIII - Night Cafes The Council has adopted Part Vll lof the Greater London Council (General Powers) Act 1968 for the registration of premises as Night Cafes which are open after 11 pm. and issues licences under the Late Night Refreshment Houses Act for those premises wishing to remain open for refreshments between the hours of 10 pm and 11 pm. Four premises are registered as Night Cafes and 28 are licensed as late night refreshment houses. Night inspections were made during the year and there was one prosecution for failure to have a licence. A fine of £10 with £5 costs was imposed. During the year 233 inspections were made and 14 cautions given for infringements of these Acts. Pharmacy & Poisons Act 1933 This Act permits persons other than pharmacists to have their names entered on the Council's list permitting them to sell poisons listed in Part II of the Poisons List. These poisons are commonly found in household use such as ammonia, disinfectants containing phenols, horticultural and gardening preparations, hair preparations and photographic materials. There are 180 premises entered on the list and there were 391 inspections of these premises during the year. 31 cautions were given for infringements of the Act. Middlesex County Council Act 1956 - Part V Street Trading There are 29 designated street trading sites for which licences are granted for the sale of fruit and vegetables, refreshments, flowers and newspapers. The Street Trading Inspector supervises the use of these sites and deals with unauthorised street trading. 4,807 inspections were made during the year and 66 cautions were given. There were 35 prosecutions and fines totalling £900 with costs of £150 were imposed. Income from the licensing of street trading sites during the year amounted to £2,334. Fertiliser & Feeding Stuffs Act 1926 Nine samples of fertilisers were taken during the year, two of which were found to be below standard. No action could be taken as the retailers in each case could submit that they had taken all reasonable precautions against committing the offence. The facts were passed to the Inspector for the area in which the goods were imported. Explosives Acts 1875 & 1923 167 licences were issued during the year. 250 inspections were made and 22 cautions given for infringements of the Act. Particular attention was given to the safe handling, display and keeping of fireworks and the storage of high explosives used for industrial purposes. General There are a number of other functions which involve the control and the issue of licences, permits or registration, ie. dog, game and employment agency licences, scrap metal dealer registration, amusement with prizes permits, etc. . . In all cases routine inspections were carried out during the year. 27 MORTUARY AND BURIAL ARRANGEMENTS The public mortuary at Petersfield Road, Acton, has a capacity for 40 bodies. The Association of Municipal Corporations Health Committee recently considered the section of the Broderick Report on Death Certification and Coroners, which is specifically concerned with mortuaries and facilities for post-mortem examinations. The Committee, while expressing no firm opinion at this stage, were inclined to the view that, after re-organisation of the National Health Service in 1974, the provision of new mortuaries should be an NHS responsibility, and that mortuaries should be part of, or sited very close to. hospitals with main pathology departments. During the year, 590 bodies of former residents from the following areas were taken to the mortuary: Ealing 489 Hillingdon 5 Richmond 6 Hounslow 9 Other London Boroughs 65 Other areas 16 One full-time attendant is employed, and during his absence from duty, bodies are admitted to Hammersmith Mortuary. This is a reciprocal arrangement. 28 MEDICAL EXAMINATION AND WELFARE OF STAFF In accordance with the Offices, Shops, and Railway Premises Act, 1963, there is a first-aid centre in the Town Hall Annexe. In the three-roomed suite are facilities for simple first-aid, and for the examination of casualties. A State Registered Nurse is avai lable throughout the working day. Persons entering the Counci I's service are required to fill in a medical questionnaire. Unless this shows a clear history of good health or minor illnesses only, a medical examination is necessary. Vaccination and immunisation of those staff who might be exposed to a serious infectious disease by reason of their employment, eg. Public Health Inspectors and nursing staff, receive protective injections at the appropriate intervals. Appointments are made on behalf of the National Blood Transfusion Service for members of staff who are willing to give blood. There is always a good response and blood is taken on the Town Hall premises. The following figures indicate the volume of work which passes yearly through this department:- MEDICAL ASSESSMENTS Total number of questionnaires assessed for fitness for employment — 3148 Number of medical examinations required following questionnaire assessment = 501 Number of failures as a result of medical examination following questionnaire assessment — 9 Number of persons undergoing medical examination other than by questionnaire assessment _ 1142 Number ctf Heavy Goods Vehicle Drivers medical examinations — 77 Number of people attending for routine three- yearly chest x-ray in accordance with Ministry Regulations — 2299 VACCINATION AND IMMUNISATION OF STAFF Number vaccinated against smallpox — 82 Number immunized against typhoid fever = 76 Number immunized against typhoid/tetanus — 142 Number immunized against tetanus = 41 SICK STAFF Number reporting sick during year — 1170 BLOOD DONORS Appointments made for volunteers =107 251 Number suitable and who donated -219 TABLE 1 INFECTIOUS AND OTHER NOTIFIABLE DISEASES CLASSIFIED IN AGE GROUPS MEASLES DYSENTERY SCARLET FEVER ACUTE MENINGITIS WHOOPING COUGH M F M F M F M F M F Number originally notified 501 538 37 34 43 47 3 6 38 41 Final numbers after correction: Under 1 year 23 30 2 2 1 1 5 6 1- 47 51 — 2 1 1 — — 1 3 2- 59 50 2 1 1 2 — — 2 3 3- 67 60 2 — 3 4 — 1 4 5 4- 85 108 2 — 7 6 — — 3 5 5-9 204 211 5 2 20 24 — 1 11 15 10 - 14 10 15 5 — 5 1 — — 1 — 15-24 2 9 6 9 2 6 2 — — 1 25 and over 1 4 11 13 3 2 — 3 — 2 Age unknown 3 — 1 4 1 1 — — 1 1 TOTAL 501 538 36 33 43 47 3 6 28 41 TABLE 1 - continued TUBERCULOSIS PULMONARY MENINGES AND CENTRAL NERVOUS SYSTEM OTHER INFECTIVE JAUNDICE M F M F M F M F Numbers originally notified 65 59 1 1 34 36 45 27 Final numbers after correction: Under 1 year 1 — — — — — — — 1 - — — — — — — — — 2-4 1 — — — — — 3 2 5-9 3 1 — — — — 2 5 10 - 14 — 3 — — 1 — 3 6 15 - 19 8 5 — — 3 3 6 2 20 - 24 1 11 — 1 12 10 11 4 25 - 34 12 13 — — 9 6 10 4 35 - 44 9 8 1 — 1 5 3 1 45-54 6 5 — — 3 5 5 1 55-64 10 5 — — 1 4 — — 65 - 74 12 4 — — 2 1 — — 75 and over 2 2 — — — — — — Age unknown — 2 — — — 1 2 2 TOTAL 65 59 1 1 32 35 45 27 There were no cases of anthrax, cholera, diphtheria, leptospirosis, plague, poliomyelitis, relapsing fever, smallpox, tetanus, typhus or yellow fever. TABLE 1 - continued Acute encephalitis Paratyphoid Fever Ty phoid Fever Food Poi soning Malaria Infective Postinfectious M F M F M F M F M F M F[/$$$] Numbers originally notified 1 1 1 — 1 2 1 — 39 33 — 1 Final numbers after correction: Under 5 years — — — — — — — — 9 5 — — 5 — 14 1 1 1 — — 1 1 — 4 2 — — 15 - 44 — — — — 1 1 — — 2 7 — 1 45 - 64 — — — — — — — — 3 1 — — 65 and over — — — — — — — — — — — Age unknown — — — — — — — — 5 5 — — TOTAL 1 1 1 - 1 2 1 - 23 20 - 1 TABLE 2 FACTORIES ACT 1961 - PART 1 Inspections for the purpose of provisions as to health (inspection 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 LocaI Authorities 8 2 — — (ii) Factories not included in (i) in which section 7 is enforced by the Local Authority 1,087 51 5 — (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers premises). 7 — — TOTAL 1,102 53 5 — TABLE 3 FACTORIES ACT 1961 — PART 1 Cases in which defects were found Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied To H.M. Inspector Referred by H.M. Inspector Want of cleanliness — — — — — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors — — — — — Sanitary conveniences — — — — — (a) Insufficient — — — — — (b) Unsuitable or defective 7 7 — 7 — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to outwork) 2 2 — — — TOTAL 9 9 — 7 — 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.) 87 Artificial flowers 4 Cosaques, Christmas stockings, etc. 97 Jewellery 26 Millinery 3 Handbags 4 Fasteners 2 Wigs 1 Tapestry 1 Lampshades 1 Total 226 During the year 120 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. TABLE 5 CARCASES AND OFFAL INSPECTED AND CONDEMNED IN WHOLE OR IN PART - 1971 Pigs 1. Number kiIled 485.118 2. Number inspected 485.566 3. Dead on arrival or died in pens 450 4. All diseases except Tuberculosis: Whole carcases condemned 1,487 Carcases of which some part was condemned 20,179 Percentage of the number inspected affected with disease other than Tuberculosis 4,16% 5. Tuberculosis only: Whole carcases condemned 25 Carcases of which some part was condemned 12,434 Percentage of the number inspected affected with Tuberculosis 2.56% 6. Cysticercosis: Carcases submitted to treatment by refrigeration - Carcases of which some part or organ was condemned - Generalised and totally condemned - The total weight of meat and offal surrendered was:- Tons Cwts. Qtrs. lbs. Carcases 128 14 1 17 Parts & Organs 431 16 0 12 Total 560 10 2 1 TABLE 6 NUMBER OF PIGS' CARCASES INSPECTED DURING 1971 WITH ANALYSIS OF SURRENDERS ON ACCOUNT OF DISEASE Month Pigs Inspected Parts Condemned Carcases Heads Collars Fore Qtrs. H ind Qtrs. Legs Skins Hocks Flares Pieces of pork (lbs.) Plucks (lungs, I ivers, hearts) (lbs.) Messeries. (Stomachs & i ntest i nes) (lbs.) January 41,927 158 1,034 2 - - 817 44 - 364 6,028 23,148 21,750 February 37,919 162 1,025 5 - - 542 39 - 123 5,568 19,987 18,760 March 45.925 122 1,186 2 - - 700 26 - 191 7,670 26,786 21.370 April 40,826 120 1,128 - - - 752 65 - 238 6,288 30,176 21.370 May 40,360 141 1,125 3 - - 679 17 - 189 5,675 26,768 21,030 June 45,688 127 1,225 1 - - 751 31 1 283 6,214 29,922 26,060 July 43,646 183 1,296 3 - - 646 15 - 212 4,161 32,188 21,600 August 40,549 131 1,097 1 - - 643 29 - 207 3,996 31,631 19,400 September 41,244 101 1,242 2 - - 552 48 2 187 4,409 35,322 21,330 October 35,128 98 1,131 1 - - 477 21 - 255 4,820 25,489 15.570 November 37,416 85 1,309 3 - - 518 38 - 190 4,974 26.599 19,360 December 34,938 84 1,145 1 - - 434 54 - 157 4,354 26.766 15,110 Totals 485,566 1*512 13*943 24 - - 7,511 427 3 2,596 64,157 334,792 242,710 TABLE 7 ANALYSIS OF DISEASES AND CONDITIONS OF WHOLE PIG CARCASES CONDEMNED - 1971 Total number inspected 485,566 Dead on arrival 221 Died in pens 229 Diseases and conditions listed in Schedule 2, Meat Inspection Regs. 1963 Anaemia (advanced) 1 Bruising (extensive and severe) 10 Emaciation (pathological) - Fever 46 Jaundice 7 Melanosis (generalised) - Metritis (acute septic) 1 Oedema (generalised) 7 Peritonitis (acute septic) 185 Pleurisy (acute diffuse septic) 5 Pneumonia (acute septic) 12 Pyaemia (including multiple abscesses) 595 Septicaemia or toxaemia 67 Swine erysipelas (acute) - Tuberculosis (generalised) 25 Tumours:- (a) malignant with secondary growths 2 (b) multiple - Uraemia 2 Other Conditions Leukaemia - Moribund 9 Damaged in dressing 1 Arthritis (multiple septic) 87 TOTAL 1,512 TABLE 8 LIST OF FOOD PREMISES IN THE LONDON BOROUGH OF EALING Category of Premises No. of premises No. complying with Reg. 16 (Wash-hand basins, etc.) No. to which Reg 19 applies (Sinks, etc.) No. complying with Reg. 19 (Sinks, etc.) Bakehouses 29 29 29 29 Bakers' shops 73 73 — — Butchers 184 184 184 184 Cafes and restaurants 293 293 293 293 Canteens (Industrial) 243 243 243 243 School kitchens and dining centres 120 120 120 120 Confectioners 327 327 — — Dairies 2 2 2 2 Food factories and stores 98 98 98 98 Food stalIs 69 19 2 2 Fish fryers 41 41 41 41 Fishmongers 34 34 34 34 Greengrocers 182 182 145 145 Grocers 360 360 263 263 Hotels, Nursing Homes and Old People's Homes 96 96 96 96 Ice Cream manufacturers 9 9 9 9 Licensed premises and clubs 310 310 310 292 Hawkers 38 8 8 8 Totals 2508 2428 1877 1859