THE HEALTH OF HAMMERSMITH HAM 69 LONDON BOROUGH OF HAMMERSMITH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND DIRECTOR OF HEALTH SERVICES AND PRINCIPAL SCHOOL MEDICAL OFFICER (INNER LONDON EDUCATION AUTHORITY) FOR THE YEAR 1972 Local children seen with the Chief Dental Officer, admire the trophy presented to prize-winners at the Borough's Annual Dental Health Competition. This picture shows the Chief Chiropodist and one of his staff in the Chiropody Appliance Laboratory where special insoles, sandals and shoes are made to measure for old people with arthritic or deformed feet. The local Authority Medical Officer representative on the assessment team tests a child's hearing in the Child Development Centre at Charing Cross Hospital. (Picture by courtesy of Charing Cross Hospital) CONTENTS Page Health and Environment Committee ii Introduction vii Headquarters Staff iii Summary of Statistics x Physical and Social Conditions xviii Epidemiology A1 Environmental Health B l Personal Health C1 School Health, School Dentistry and Student Health D l Alphabetical Index D17 HEALTH AND ENVIRONMENT COMMITTEE DECEMBER, 1972 Ex-Officio: The Worshipful the Mayor Councillor Eric Hill Chairman Coucillor L.W. Stanley Vice-Chairman Councillor A. M. Norridge, B.A.(Econ.) Aldermen Sir Samuel Salmon, Kt., M.A. Mrs. A. Solomons W.C. Spiers Councillors Mrs. G. Braggins Mrs. M.L. Clarke O. Donohue Miss M. Fenelon Mrs. S. Harris M iss J.M. Hathaway A.J. Martin S.A. Matthews R. Simmerson, B.Sc.(Econ.), F.C.A. L.J. Wicks Co-opted Member Dr. O. Moses (Representing Inner London Medical Committee) STAFF ESTABLISHMENT Medical Director of Health Services, Dr. Sandy Cameron Medical Officer of Health & M.B., Ch.B., D.P.H. Principal School Medical Officer Chief Health Services Officer Dr. Clifford Jansz M.B.B.S., D.C.H., D.P.H. Principal Medical Officer Dr. John Troy M B., Ch.B., D.P.H. Senior Medical Officer Dr. Anne MacDonald M B., Ch.B., D.C.H. Assistant Senior Medical Officers Dr. Margaret Capra M B., M.R.C.S., L.R.C.P., D.P.H. Dr. Mona Gwynne-Jones M B., Ch.B. 11 Departmental Medical Officers 1 Ophthalmologist (sessional) Dental Chief Dental Officer & Patrick Fuller Principal School Dental Officer L.D.S., B.D.S. 2 Senior Dental Officers 4 Dental Officers 1 Orthodontist (sessional) 1 Dental Auxiliary 7 Dental Surgery Assistants iii Nursing Chief Nursing Officer Miss Joan Markham S.R.N., S.C.M. R.N.T., H.V., D.N.(London). Principal Nursing Officer Miss Jean Edwards S.R.N., S.C.M., H.V. 2 Area Nursing Officers 6 Nursing Officers 6 Midwives 49 Home Nursing Sisters 40 Health Visitors 4 T.B. Visitors 7 Student Health Visitors 17 School Nurses 4 Residential School Nurses 13 Clinic Nurses 2 Family Planning Nurses 20 Nursing Auxiliaries Public Health Inspectorate Chief Public Health Inspector James Collier. M.A.P.H.I. Principal Public Health Inpector Brian Denyer, M.A.P.H.I. 1 Divisional Public Health Inspector (Housing) 8 Senior Public Health Inspectors 4 Specialist/Area Public Health Inspectors 15 District Public Health Inspectors 8 Student Public Health Inspectors 6 Technical Officers Chiropody Chief Chiropodist Aubrey Carter, F.Ch.S., S.R.Ch. 1 Principal Chiropodist 10 Senior Chiropodists 4 Chiropodists Health Education Health Education Officer Vivian Searle-Jordan M.G.H.E., M.I.H E. Assistant Health Education Officer Laurence Wakeman iv Adminstrative Staff Chief Administrative Officer John Burton D.F.M. (up to November 1972) John Rozzier (appointed December 1972) Principal Administrative Officer George Nickolls 3 Senior Administrative Officers 55 Administrative and Clerical Staff Other Staff Warden and Assistant Warden at Hurlingham Lodge Hostel V.I). Welfare Officer 2 Dietitians (sessional) Superintendent & Deputy Superintendent of the Cleansing Station and Health Laundry Mortuary Superintendent CONSULTANT STAFF I he following are consulted in their professional capacities and their contributions appear later in this Report: Dr. J.L. Fluker, M.D., F R C P., Director. Special Clinic. West London Hospital. T. Mcl.achlan, D.C.M.. A.C.G.F.C., F.R.I.C., F.I.F.S.T.. M.I.(Biol.)., (Public Analyst) Dr. H. Price, M.R.C.S.. L.R.C.P., D.P.H., Consultant Physician, Fulham Chest Clinic. Dr. P. Stradling, M.D., I R.C.P., Consultant Physician, Hammersmith Chest Clinic. v HONORARY APPOINTMENTS HELD BY THE STAFF Dr. Sandy Cameron director of Health Services Chairman, Association of London Borough Medical Officers Chairman, Public Health and Education Committee, Medical Council on Alcoholism Member, Joint Working Group of Metropolitan Joint Consultative Committees Member of Council, Royal Institute of Public Health and Hygiene Member, Medical Advisory Committee, North West Metropolitan Regional Hospital Board Member, Greater London Conference on Old Peoples Welfare Co-opted Member, Inner London Local Medical Committee Trustee, Hammersmith Relief in Sickness Fund Honorary Consultant in Community Medicine, Charing Cross Group of Hospitals Mr. Patrick Fuller Chief Dental Officer Honorary Clinical Assistant, Royal Dental Hospital Miss Joan Markham Chief Nursing Officer Member, Joint Board of Clinical Studies Member, Nursing Advisory Board, British Red Cross Society Member, London Committee of the British Commonwealth Society for the Blind Member, Working Party, Disabled Living Foundation Trustee, Hammersmith Relief in Sickness Fund Divisional Nursing Officer, Hammersmith Division, British Red Cross Society Miss Jean Edwards Principal Nursing Officer Member, General Purposes Committee, Health Visitors Association Mr. Frederick Baldwin Superintendent of the Cleansing Station and Health Laundry Secretary, Hammersmith First Aid Society Miss Philippa Neil Senior Administrative Officer- Member, Hammersmith Branch of the St. John's Ambulance Association vi Old Town Hall, Fulham Broadway, S.W.6. Tel. No. 01-385 1212 The Mayor, Alderman and Councillors of the London Borough of Hammersmith Mr Mayor, Ladies and Gentlemen, MEDICAL OFFICER OF HEALTH, ANNUAL REPORT 1972 INTRODUCTORY LETTER I have the honour to present the Annual Report of the Medical Officer of Health and Director of Health Services of the London Borough of Hammersmith for the year 1972. INTRODUCTION This Report deals with the Environmental and Personal Health Services provided by the Council. In addition, and with the agreement of the Inner London Education Authority, a report on the School Health Service in the Borough during 1972, which has been submitted to the Education Authority by your Medical Officer of Health in his capacity as Principal School Medical Officer, is included. Fundamentally, the Report is concerned with the health of the residents of the Borough and the measures adopted to preserve the health of all age groups to the greatest possible extent. VITAL STATISTICS With a reduction of almost three thousand, the Registrar General's estimate of the population of Hammersmith as at mid-1972 continues the downward trend noted in recent years, not only in Hammersmith but in the Inner London Boroughs generally. The birth rate, after adjustment for the age and sex of the population, was 11.5 per 1000 of the population, and showed a reduction from the 1971 figure which was 13.9. Over the country as a whole the birth rate also fell from 16.0 per 1000 of the population in 1971 to 14.8 in 1972. The continiung need for the highest possible standard of maternal and child health care, whether provided in the home, the local authority clinic, the doctor's surgery, or the hospital, which was referred to in the Annual Report for 1971, was again evident in 1972. At 20 per 1000 live births the infant mortality rate remains too high, especially against a falling birth rate, and compares unfavourably with the national figure of 17. The infant mortality rate in Hammersmith in 1967 was 16.3 per 1000 live births at a time when the national figure was 18. Although the neonatal mortality rate at 15 per 1000 live births and the early neonatal mortality rate at 12 per 1000 total live births were both slightly reduced in 1972 as compared with 1971, the perinatal mortality rate, indicating the still-births and deaths under one week combined per 1000 total live and still-births, remained constant owing to a small increase in the still-birth rate. Although the actual number of illegitimate births fell during 1972 to 489 from 558 in 1971, the overall percentage of illegitimate births remained at 19 as against 9 for the country as a whole. The adjusted general death rate in Hammersmith in 1972 was 12.7 per 1000 of the population as compared with 14 in 1971, and was in line with the figure for England and Wales which was 12.1 Bronchial carcinoma accounted for the death of some 188 persons in Hammersmith during 1972. This figure, as well as a substantial proportion of the deaths from ischaemic heart disease, would be reduced if appropriate preventive measures were adopted. Although the role of smoking in relation to mortality under these heads in generally accepted, the consequential individual action which is so clearly called for is regrettably exceedingly slow in forthcoming. Some progress is, however, being made and may well gain momentum over the next decade. INFECTIOUS DISEASE The infectious disease record in Hammersmith during 1972 was a generally good one, with a complete absence of conditions such as diphtheria and poliomyelitis and with a reduction in the number of cases of dysentry and food poisoning which were reported. The gradual reduction in the incidence of measles since the introduction in Hammersmith in 1968 of immunisation against this disease is particularly encouraging, with the number of reported cases falling in 1972 to 214, an all-time low. The value of immunisation against diptheria, poliomyelitis, whooping cough and now measles, has been clearly demonstrated. It is, however, dependent on the percentage of the number of children who have been adequately immunised at any particular point in time, and here the co-operation of parents is essential. On our side, and in co-operation with the Borough Treasurer and Director of Financial Services, and in association with the general practitioners in the Borough, the services of the computer have been enlisted to ensure the up-to-date recording of immunisations given and to facilitate appointment making in doctors' surgeries and in clinics for children when these injections are due. Three of the four cases of typhoid which were reported during 1972 were infected overseas. The surveillance for 14 days of persons coming to Hammersmith from abroad from smallpox endemic or locally inlected areas was carried out in relation to some 39 persons during the year. vii TUBERCULOSIS Mobility of population always has implications for infectious disease, either because of its importation or because of the introduction of susceptible persons to a new community. This is particularly true of tuberculosis and the Consultant Chest Physicians at both Hammersmith and Fulham Chest Clinic refer to the effect of this on local statistics. Against this background the work of the Health Visitors in advising newcomers to Hammersmith to register with a general medical practitioner and, in particular, to have a chest X-ray is particularly significant. ENVIRONMENTAL HEALTH As part of the Authority's strategy to deal with sub-standard housing during the next decade, the public health inspectorate undertook a survey during 1972. This survey confirmed previous assessments of the situation by failing to reveal any area in the Borough which contained a number of unfit properties. On the other hand, it was estimated that there were some 17,000 sub-standard properties which required attention either by improvement or redevelopment. In an attempt to limit the overcrowding in multi-occupied houses, some 60 Direction Orders were made during the year. Quite apart from their activities in the housing field, the public health inspectorate once again in 1972 quietly and unobtrusively, ond on a day-to-day basis, made their contribution to the health of the residents of the Borough. In this connection, it is gratifying that the attendances at one of the Chest Clinics on account of bronchitis, "the English disease", is reported as having been the lowest for many years. The work undertaken by the Public Health Inspectors under the Clean Air Act must have made some contribution to this state of affairs. Constant vigilance is also necessary and is exercised in Hammersmith in relation to the possibility of lead pollution, which up to now, has proved to be of acceptable levels. Nuisance from noise and other sources detrimental to healthy living also received a great deal of attention during the year. Invaluable work continued to be carried out during 1972 by the staff at the Medicinal Baths and Treatment Centre. In contrast to 1971, there wasa welcome reduction in the number of persons requiring treatment for scabies. The infestation of rooms with fleas and bed bugs was also reduced. The Superintendent and Staff at the Centre deserve special commendation for work undertaken under difficult conditions. The health laundry, assisted bathing and the incineration of incontinence pads and dressings are all invaluable services for the infirm and handicapped and their relatives. The Health Committee are most anxious to extend the premises at Scotts Road, and meantime have taken first aid action to facilitate the conduct of the services. FAMILY PLANNING An account of the arrangements which the Council have made with the Family Planning Association for the provision of a comprehensive Family Planning Service in Hammersmith was set out in the Report for 1971. As from May 1972, the Council decided that not only advice and medical examination but also medical and other supplies should be entirely free to Borough residents. These arrangements were extended so as to include drugs and supplies prescribed by general practitioners. During the year a new clinic and Information Centre was opened in Shepherds' Bush Road, bringing the number of Family Planning Clinics in the Borough to eight. These developments were accompanied by a special Health Education campaign and, in particular, a single telephone number available for appointments at all clinics was widely publicised. The introduction of a free Family Planning Service in Hammersmith resulted in a 50% increase in clinic attendances. In so far as family planning is a public health measure designed, quite apart from its many social implications, to improve maternal and child health, it would seem logical that it should be a free service available to the vulnerable groups on the same basis as the other maternal and child health services. NURSING SERVICES During 1972 the Council approved changes in the management structure of the nursing services so as to bring the arrangements into line with the recommendations contained in the Mayston Report. The alterations made have been approved by the Department of Health and Social Security and provide a valuable link between field staff and the administration. The resultant two-way flow of information enables problems to be resolved in the light of 'grass roots' requirements. During the year a fourth hospital Health Visitor liaison scheme was arranged at the Neo-Natal Unit at Hammersmith Hospital, and further Health Visitor,/General Practitioner attachment and liaison schemes were initiated. The demands on the District Nursing Service continued to increase during the year, 18.984 additional visits being undertaken as compared with 1971. Having regard to the ageing of the population and the increased infirmity of those elderly persons being nursed at home, the District Nursing Service is emerging as one of the most important services of the National Health Service. The early transfer home of hospital patients also increases the need for skilled home nurses. As April 1974 approaches, so hospital staff are more than ever accompanying the home nursing sisters on their rounds in order to observe at first hand the problems which each day face the domiciliary nurse. CHILD HEALTH CENTRES In October 1972, the Burne Jones Clinic was reopened upon the completion of extensive alterations designed to increase the available accommodation. viii As a temporary measure the Milson Road Clinic was transferred from dilapidated premises to a temporary, well-designed, hut rather small prefabricated building pending the construction of a health centre on an adjacent site. CHIROPODY National shortage of qualified Chiropodists is now acute. At present 150 are trained each year, which barely replaces the annual wastage from this profession which, because of low pay and poor propects, loses almost as many as it trains. There is also a drain from local authority work to private practice because it is more lucrative. The solution includes more training schools for state registered chiropodists, the inauguration of training for foot hvgienists or auxiliaries to augment the work of the chiropodist by undertaking routine treatments, and most of all improved remuneration with removal of existing anomalies. A new purpose-built foot clinic was opened at Nye Bevan House to replace the old clinic at St. Dunstans. The facilities and service to the patients at this centre has been considerably improved. The increased use of the Appliance Laboratory has advanced the long-term management of foot disorders. More patients have had the special treatment they need, and it has been particularly useful in treating people with rheumatic conditions. Patients can be fitted with insulated insoles for their shoes which prevents chilling and other harmful effects of the damp and cold. ADMINISTRATION During the year the process of establishing self-contained administrative arrangements for the Health Department, to replace the central administration of the Health and Social Services, was being finalised. This entailed a great deal of additional work for the administrative staff concerned, particularly for the Chief Administrative Officer, Mr. J.E. Burton. At the end of 1972 Mr. Burton decided that his future career lay in the field of Social Services. The loss of this very able and experienced Officer was very much regretted, but sincere thanks are due to him for his excellent contribution to the work of the Health Department since its inception in 1964. A very warm welcome was extended to Mr. J. Rozzier, who succeeded Mr. Burton in the post of Chief Administrative Officer. As a result of the good relations immediately established between these two Officers, the new health administration was very smoothly and quickly finalised. CONCLUSION Sincere thanks and appreciation are expressed to the Chairman, Vice-Chairman, and Members of the Health Committee for their support and interest in the work of the Health Department during 1972. Dr. A. B. Stewart, Medical Advisor to the Greater London Council, along with his medical, dental and administrative colleagues at County Hall were once again most helpful. Gratitude is expressed to them as well as to the Public Analyst, the Consultant Chest Physicians, and the Consultant Venereologist for their cooperation and advice at all times as well as for their contribution to this Report. The medical profession, both in hospital and general practice, were also most co-operative and thanks is expressed to them as well as to the officers of the Inner London Executive Council and Local Medical Committee. The professional, administrative and other staff of the Health Department all earned very well deserved thanks for their combined efforts and hard work during 1972. A particularly heavy burden fell on those members of the staff immediately responsible for the medical, dental, nursing, environmental, chiropody, health education and administrative services and one must be particularly grateful to them for this. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your Obedient Servant, A. D. C. S. CAMERON, Medial Officer of Health and Director of Health Services ix STATISTICS AND TABLES The following statistical information relating to the Borough has been compiled from the Local and National Statistics issued by the Registrar-General in connection with population, live-births, stillbirths and deaths. The "area comparability" factors for use with crude birth and death rates contain adjustments for boundary changes and make allowances for the way in which the sex and age distribution of the local population differs from that for England and Wales as a whole. In addition, the death rate "area comparability" factors have been adjusted specifically to take account of the presence of any residential institutions in each area. When local crude birth and death rates are multiplied by the appropriate "area comparability" factor, they are comparable with the crude rate for England and Wales or with the corresponding adjustments for any other area. Area in Acres 3.995 Population: Census 1961 222,124 Census 1971 187,195 "Registrar General's Estimate mid 1972 181,880 Rating: Number of Habitable Dwellings (approx) 56,900 Rateable Value £14,039,329 Product of a penny rate (estimated) £134,500 Mortality: Number of Deaths 2,331 Deaths from Whooping Cough (all ages) Deaths from Cancer (all ages) 541 Deaths from Cancer of the Lung and Bronchus (all ages) 188 Deaths from Measles (all ages) Deaths from Enteritis and other Diarrhoeal Diseases (under 4 years of age) Death from Circulatory Diseases (all ages) 1,074 Maternal Mortality — x These mid-year figures are provisional and are subject to revision in the light of final 1971 Census figures.  Hammersmith England and Wales Total Hammersmith England and Wales Males Total Estimated mid-year home population 181,880 49,028,900 Ive births Total 1,312 1,302 2,614 725,405 Live birth rates, etc. Live births per 1,000 home population (crude rate) 14.4 14.8 Legitimate 1,070 1,055 2,125 662,907 Illegitimate 242 247 489 62,498 Area comparability factor .80 1.00 Local adjusted rate 11.5 14.8 Ratio of local adjusted rate to national rate .78 1.00 Illegitimate live births as percentage of all live births 19 9 Stillbirths Total 20 15 35 8,794 Stillbirth rate Stillbirths per 1,000 total live and still births 13 12 Legitimate 17 12 29 7,846 Illegitimate 3 3 6 948 Total live and Stillbirths Total 1,332 1,317 2.649 734,199 Legitimate 1,087 1,067 2,154 670,753 Illegitimate 245 250 495 63,446 Deaths of Infants under 1 year of age Total 26 25 51 12,494 Infant mortality rates Deaths under 1 year per 1,000 live births 20 17 Legitimate 21 19 40 11.177 Deaths of legitimate infants under 1 year per 1,000 legitimate live births 19 17 Illegitimate 5 6 11 1,317 Deaths of illegitimate infants under 1 year per 1,000 illegitimate live births 22 21 under 4 weeks of age Total 19 20 39 8,373 Neonatal mortality rate Deaths under 4 weeks per 1,000 live births 15 12 Legitimate 16 17 33 7,503 Illegitimate 3 3 6 870 under 1 week of age Total 16 16 32 7,142 Early neonatal mortality rate Deaths under 1 week per 1,000 total live births 12 10 Legitimate 14 14 28 6,365 Illegitimate 2 2 4 777 Perinatal mortalify rate Stillbirths and deaths under 1 week combined, per 1,000 total live and still births 25 22 Deaths - all ages 1,197 1,134 2,331 591,907 Death rates, etc. - all ages Deaths per 1,000 home population (crude rate) 12.8 12.1 Area comparability factor 99 1.00 Local adjusted rate 12.7 12.1 Ration of local adjusted rate to national rate 1.05 1.00 xii VITAL STATISTICS OF WHOLE DISTRICT 1965-1972 Year Population to middle of each year Registrar-General's Estimate Live Births Total Deaths Registered in the District Transferable Deaths Net Deaths belonging to the District Number Rate per 1,000 Pop. Number Rate per 1,000 Pop. Of non-residents registered inthe District Of residents not registered in the District Under 1 year of age At all ages Number Rate per 1,000 live births Number Rate per 1,000 Pop. 1 2 3 4 5 6 7 8 9 10 11 12 1965 215,240 4,433 20.16 2,251 10.5 788 995 86 19.4 2,458 11.4 1966 213,770 4,155 19.4 2,316 10.8 774 973 82 19.7 2 515 11.8 1967 211,720 3,992 18.9 2,244 10.6 783 915 65 16.3 2 376 11.2 1968 197,590 3,550 18.0 2,389 12.1 866 882 68 19.2 2,405 12.2 1969 192,810 3,414 17.7 2,438 12.6 890 857 61 18.0 2,405 12.5 1970 187,980 3,147 16.7 2,436 13.0 891 819 58 19.0 2,364 12.6 1971 184,750 2,992 16.2 2,467 13.4 873 846 64 21.0 2,440 13.2 1972 181,880 2,614 14.4 2,478 13.6 963 816 51 20.0 2,331 12.8 The following table gives the causes of death at different periods of life during 1971 in the London Borough of Hammersmith: Cause of Death Sex All Ages Under 4 wks. 4 weeks & under 1 year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over B5 Tuberculosis ol Respiratory System M 8 – – – – – – – 1 1 3 3 F 4 – – – – – – – – – – 4 B6(1) 1 ate Effects of Respiratory T.B. M – – – – – – – – – – – – F 1 – – – – – – – – 1 – – B6 (2) Other Tuberculosis M – – – – – – – – – – – – F 1 – – 1 – – – – – – – B17 Syphilis and its Sequelae M – – – – – – – – – – – – F 1 – – – – – – – – – 1 – B18 Other Infective and Parasitic Diseases M 1 – – – – – – – 1 – – – F 6 – – – – – – – 2 2 2 B19 (1) Malignant Neoplasm. Buccal Cavity Etc. M 8 – – – – – – – 1 1 3 3 F 5 – – – – – – – 1 1 1 2 B19 (2) Malignant Neoplasm. Oesophagus M 7 – – – – – – – – 3 2 2 F 3 – – – – – – – – 1 2 – B19 (3) Malignant Neoplasm. Stomach . M 30 – – – – 1 – – – 13 8 8 F 26 – – – – – – – 2 6 6 12 B19 (4) Malignant Neoplasm. Intestine M 29 – – – – – – 1 2 6 12 8 F 27 – – – – – – – 2 4 6 15 B19 (5) Malignant Neoplasm, Larynx M 1 – – – – – – – – 1 – – F 2 – – – – – – – – 1 – 1 B19 (6) Malignant Neoplasm, Lung, Bronchus M 155 – – – – – 1 – 11 45 60 38 F 33 – – – – – – – 3 8 10 12 B19 (7) Malignant Neoplasm. Breast M – – – – – – – – – – – – F 39 – – – – – 1 3 8 12 9 6 B19 (8) Malignant Neoplasm, Uterus F 18 – – – – – 1 – 5 3 6 3 B19 (9) Malignant Neoplasm. Prostate M 22 – – – – – – – – 3 5 14 B19 (10) Leukaemia M 5 – – 1 1 – – – – 2 1 – F 2 – – – – – – – – – – 2 B19 (11) Other Malignant Neoplasms M 73 – – 1 – 4 1 1 9 21 23 13 F 56 – – – 1 – – 4 3 12 15 21 B20 Benign and Unspecified Neoplasms M 5 – – – – – – – – 1 1 3 F 2 – – – – – – – – 1 1 – B21 Diabetes Mellitus M 6 – – – – – – – 1 1 2 2 F 12 – – – – – 1 – 2 – 6 3 B22 Avitaminoses, Etc M 1 – – – – – – – – – – 1 F 1 – – – – – – – – – – 1 B46 (1) Other Endocrine Etc. Diseases M 2 – – – – – – – – 2 – – F 8 – – – 2 – – – – – 1 5 B23 Anaemias M 3 – – – – – – – – – – 3 F 5 – – – – – – – – – 2 3 B46 (3) Mental Disorders M 10 – – – – 3 3 – 2 2 – – F 1 – – – – – – – – – 1 – B24 Meningitis M – – – – – – – – – – – F 1 – – – – – – – – 1 – – B46 (4) Multiple Sclerosis M 1 – – – – – – – 1 – – – F 1 – – – – – – 1 – – – – B46(5)Other Diseases of Nervous System M 9 – – – – 2 – – 1 2 3 1 F 13 – 1 – – 1 1 – 2 – 7 1 B26 Chronic Rheumatic Heart Disease M 12 – – – – 1 1 1 1 1 6 1 F 25 – – – – 1 1 2 3 8 5 5 B27 Hypertensive Disease M 13 – – – – – – – 1 5 3 4 F 21 – – – – – – 2 – 2 5 12 B28 Ischaemic Heart Disease M 335 – – – – – – 7 39 84 104 101 F 240 – – – – – – 2 1 25 62 150 B29 Other Forms of Heart Disease M 21 – – – – – – 1 2 2 10 6 F 62 – – 2 – – – – 1 3 8 48 B30 Cerebrovascular Disease M 97 – 1 – – – 3 2 5 20 36 30 F 146 – – – – – – 1 5 10 26 104 B46 (A) Other Diseases of Circulatory System M 37 1 6 12 18 F 65 – – – – – – 1 – 4 9 51 B31 Influenza M 3 – – – – – – – 1 – – 2 F 4 – – – – – – 1 – – – 3 B32 Pneumonia M 74 – 2 1 – – – – 1 6 20 44 F 115 1 2 1 – 1 – – 1 2 9 98 B33 (1) Bronchitis and Emphysema M 94 – – – – – – – 3 16 44 31 F 35 – – – – – – – 1 5 10 19 B33 (2) Asthma M 1 – – – – – – – – – 1 – F 4 – – – – – – 1 2 1 – – B 46 (7) Other Diseases of Respiratory System M 7 – 2 – – – – – – 2 3 – F 5 – – – – – – – – – – 5 B34 Peptic Ulcer M 16 – – – – – – – 2 5 5 4 F 5 – – – – – – – – – 1 4 v iii The following table gives the causes of death at different periods of life during 1971 in the London Borough of Hammersmith: Cause of Death Sex All Ages Under 4 wks. 4 weeks & under I year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over B36 Intestinal Obstruction and Hernia M 6 – – – – – – – – 1 4 1 F 8 – – – – – – 1 – – – 7 B37 Cirrhosis of Liver M 5 – – – – – – 1 2 – 2 – F 11 – – – – – – – 2 2 5 2 B46 (8) Other Diseases of Digestive System M 9 – – – – – – – 1 1 3 4 F 13 – – – – – – – 1 – 3 9 B38 Nephritis and Nephrosis M 7 – – – – – – – – 3 1 3 F 5 – – – – – – 1 – 1 – 3 B39 Hyperplasia of Prostate M 3 – – – – – – – – – 1 2 B46 (10) Other Diseases, Genito-Urinary System M 2 – – – – – – – – – 1 1 F 14 – – – – – – – 2 2 2 8 B46 (10) Diseases of Skin, Subcutaneous Tissue M – – – – – – – – – – – – F 2 – – – – – – – – – – 2 B46 (11) Diseases of Musculo-Skeletal System M 3 – – – – – – – – – 1 2 F 6 – – – – – – 1 – 1 2 2 B42 Congenital Anomalies M 8 4 1 2 – – – – – 1 – – F 10 4 1 2 – 2 – – – – – 1 B43 Birth Injury, Difficult Labour, Etc . M 11 11 – – – – – – – – – – F 13 13 – – – – – – – – – – B44 Other Causes of Perinatal Mortality M 3 3 – – – – – – – – – – F 2 2 – – – – – – – – – – B45 Symptoms and Ill Defined Conditions M 4 – 1 – – – – 1 – – – 2 F 8 – 1 – – – – – – 1 1 5 BE47 Motor Vehicle Accidents M 15 – – 1 – 3 2 – 2 1 5 1 F 14 – – – – 1 3 1 – 3 4 2 BE48 All Other Accidents M 15 1 – 2 2 4 1 1 – 2 – 2 F 11 – – – – 2 2 – – – 2 5 BE49 Suicide and Self-inflicted Injuries . M 14 – – – – 3 3 2 4 – 1 1 F 11 – – – – 1 1 1 4 2 – 2 BE50 All Other External Causes M 6 – – – – – 2 – 2 1 1 – F 11 – – – – 3 2 2 1 1 1 1 Total All Causes M 1,197 19 7 8 3 21 17 18 97 261 387 359 F 1,134 20 5 5 4 12 13 25 54 126 229 641 2,331 39 12 13 7 33 30 43 151 387 616 1000 (a) Population Once again, the Registrar-General's estimate of our population shows a decrease, the figure for 1972 of 181,880 being 2,870 less than the previous year. The actual decrease since 1955 is now 51,420 amounting to 22% The estimated population of children aged under 15 years is made up as follows: Under 1 year 2,740 1 - 4 years 8,460 5-14 years 22,300 The estimated number of people over 65 years is 25,200; of this group 9,300 are given as being over 75 years. NATURAL INCREASE OR DECREASE OF THE POPULATION DURING THE PAST 18 YEARS 1955 233,300 852 1956 230,400 940 1957 227,900 1,162 1958 224,900 1,219 1959 222,200 1,200 1960 221,250 1,615 1961 219,510 1,611 1962 218,690 1,618 1963 217,360 1,887 1964 216,940 2,100 1965 215,240 1,975 1966 213,770 1,640 1967 211,720 1,616 1968 197,590 1,145 1969 192,810 1,009 1970 187,980 783 1971 184,750 552 1972 181,880 283 (b) Births The corrected number of births was 1,312 males, 1,302 females giving a total of 2,614 compared with 2,992 in 1971. This gives an annual rate of 14.4 per thousand of the population. The actual decrease in numbers of 378 comprised a decrease of 309 legitimate births and a decrease of 69 illegitimate births. The illegitimate birth rate is just over double that for England and Wales as a whole. (c) Deaths Deaths registered during the year numbered 2,478. From this figure must be deducted 963 in respect of nonresidents transferred to their home towns. To counter-balance this must be added a total of 816 residents of the Borough who died in other parts of England. This gives a corrected figure of deaths as 2,331 comprising 1,197 males and 1,134 females. Of the outward transferrable deaths, 951 occurred in hospitals within the Borough. DEATHS FROM CANCER DURING THE PAST 18 YEARS Year Population Deaths Rate per 1,000 Pop. 1955 233,300 544 2.3 1956 230,400 498 2.2 1957 227,900 520 2.3 1958 224,900 528 2.3 1959 222,200 552 2.5 I960 221,250 562 2.5 1961 219,510 576 2.6 1962 218,690 569 2.6 1963 217,360 562 2.6 1964 216,940 602 2.8 1965 215,240 572 2.6 1966 213,770 610 2.8 1967 211,720 575 2.7 1968 197,590 581 2.9 1969 192,810 571 3.0 1970 187,980 537 2.9 1971 184,750 593 3.2 1972 181,880 541 3.0 xv (d) Infant Mortality The number of deaths of infants under one year of age during the year was 51, giving a mortality rate per 1,000 live births of 20. This represents a 23% increase over the 1967 figure of 16.3. infant mortality - 1972 AND PREVIOUS 17 YEARS Year Live Births Deaths of Infants Deaths of Infants per 1,000 Live Births 1955 3,408 97 28.4 1956 3,545 84 23.7 1957 3,674 95 25.8 1958 3,792 81 21.4 1959 3,821 94 24.6 1960 4,075 91 22.3 1961 4,119 74 18.0 1962 4,280 101 23.6 1963 4,564 97 21.2 1964 4,467 102 22.8 1965 4,433 86 19.4 1966 4,155 82 19.7 1967 3,992 65 16.3 1968 3,550 68 19.2 1969 3,414 61 18.0 1970 3,147 58 19.0 1971 2,992 64 21.0 1972 2,614 51 20.0 (e) MATERNAL MORTALITY 1972 AND PREVIOUS 17 YEARS Year Number of Deaths Pregnancy, Childbirth, Abortion Number of Live Births Maternal Death Rate for 1,000 Live Births 1955 4 3,408 1.17 1956 – 3,545 – 1957 3 3,674 0.82 1958 3 3,792 0.79 1959 2 3,821 0.52 1960 1 4,075 0.25 1961 1 4,119 0.24 1962 3 4,280 0.7 1963 – 4,564 – 1964 – 4,467 – 1965 2 4,433 0.45 1966 1 4,155 0.24 1967 4 3,992 1.0 1968 3 3,550 0.8 1969 1 3,414 0.29 1970 2 3,147 0.63 1971 1 2,992 0.33 1972 – 2,614 – xvi !1A\ INFANT MORTALITY RATE - ENGLAND & WALES, AND VARIOUS OTHER COUNTRIES Deaths under 1 year per 1,000 live births 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 England and Wales 25 24 23 23 22 22 22 22 21 20 19 19 18 18 18 18 18 Scotland 30 29 29 28 28 27 26 27 26 24 23 23 21 21 21 21 20 Northern Ireland 32 29 29 28 28 27 27 27 27 26 25 26 23 24 24 23 23 Irish Republic 37 36 33 35 32 30 30 27 27 27 25 25 25 21 21 19 18 Australia 22 22 21 20 22 20 19 20 20 19 18 18 18 18 18 18 17 Canada 31 32 31 30 28 27 27 27 26 25 24 23 22 21 19 19 * Chile 121 113 117 127 120 127 116 121 111 114 107 108 100 82 87 75 * Denmark 25 25 23 22 22 22 22 20 19 19 19 17 16 16 15 14 14 France 39 36 34 32 30 27 26 26 26 23 22 22 17 17 20 18 17 Italy 49 48 50 48 45 44 40 41 40 36 36 34 33 32 30 29 29 Netherlands 20 19 17 17 17 17 16 15 14 15 14 14 13 13 13 13 12 New Zealand 22 19 20 19 20 20 19 20 20 19 20 18 19 20 17 17 16 Sweden 17 17 17 16 16 16 16 15 15 14 13 12 13 * 12 11 11 United States of America 27 26 26 26 26 26 25 26 25 24 25 23 22 22 21 20 19 *Figures not yet available PHYSICAL AND SOCIAL CONDITIONS The London Borough of Hammersmith covers an area of 3,995 acres, bounded on the South by the Thames, on the North by Brent, to the East by Kensington and Chelsea, and to the West by Ealing and Hounsiow. The subsoil in the Northern section of the Borough is mainly clay, whilst in the South there is a layer of some twenty feet of gravel over blue clay. There is a variation of approximately 120 feet in elevation from the river to the Northern boundary whilst the lowest point is 13 feet above sea level. There are more than 1,000 factories of varied nature within the Borough and most trades are represented. This development is undoubtedly due to the excellent water, road, and rail transport facilities available. Of equal importance to the industrialist and the resident alike are the comprehensive passenger transport services of the area which, for eighteen hours a day provide train and bus schedules to most parts of London and to surrounding districts. The Borough is easily accessible to London Airport. Hammersmith has all the usual amenities for recreation and relaxation. There are swimming baths at Lime Grove and North End Road, whilst Bloemfontein Road has an open-air swimming pool measuring 150 feet by 75 feet. The Southern boundary formed by the Thames stretches for four miles around two bends. Whilst industry occupies a considerable proportion of this frontage, it is gradually being decreased as the Council's policy of opening up access to the river continues. The Malls, together with Furnival Gardens at Hammersmith and Bishops Park at Fulham provide pleasing promenades available to all as the Surrey bank is relatively open retaining to some extent a rural aspect. The river itself is used by various rowing clubs and schools and, of course, stages the Oxford and Cambridge Boat Race and the Head of the River Race each spring. Onlookers as well as participants have a very wide choice as the Borough is unique in housing three Football League Clubs; Chelsea at Stamford Bridge; Fulham at Craven Cottage and Queens Park Rangers at Loftus Road, Shepherd's Bush. The White City Stadium stages national and international athletics. Both the Queens Club and Hurlingham Club stage major tennis tournaments, whilst the latter club claims the distinction of being the home of croquet. Olympia attracts thousands from all over the country to its famous exhibitions and shows, whilst the B. B.C. Television Centre in Wood Lane, the Lime Grove Studios and the Television Theatre in Shepherd's Bush providing entertainment for millions are household names. Parks and open spaces are provided within the Borough. Approximately 204 acres are maintained by the Borough Council. The G.L.C. maintains Wormwood Scrubs (190 acres). There are eight Public Libraries within the Borough with over 53,800 registered readers borrowing some 2,000,000 books each year. A full reference information service is provided at the two main Libraries. In addition, over 19,000 gramophone records covering all facets are available for loan. Finally, advice and assistance is maintained to the public at all times of the day and night throughout the year by means of the emergency service available on telephone no. 748 8588. xviii A. EPIDEMIOLOGY EPIDEMIOLOGY Notification of Infectious Disease A total of S60 cases of infectious disease were notified during the year and of these 118 cases were removed to hospital. INCIDENCE OF INFECTIOUS DISEASE Measles There was again a decrease in the number of cases from 283 (1971) to 214. Dysentry There was a slight increase in the number of cases notified, but infections involving school children continued. Food Poisoning There was a definte decrease in the number of cases from 93 (1971) to 31. The different phase typings identified were as follows:- Salmonella Agona 1 Enteritidis 7 Gloucester 1 Ibadan 1 Stormont 1 Typhimurium 9 The remaining infections were due to unknown causes. Typhoid There were four notified cases of typhoid, all being admitted to hospital. All contacts were proved to be clear. Paratyphoid There were three notified cases of paratyphoid, all being admitted to hospital. All contacts were proved to be clear. Smallpox No case of smallpox was notified during the year. Notifications were received from Health Authorities at Ports and Airports concerning 47 persons who had arrived in the country from abroad without a valid certificate of vaccination. Of these 35 were from areas where smallpox is endemic, 12 from locally infected areas. All, with the exception of eight persons who were untraceable, were placed under surveillance for 14 days from the date of their arrival. INTERNATIONAL CERTIFICATES OF VACCINATION AND INOCULATION Arrangements continued for the authentication by the Medical Officer of Health of the signatures of doctors on certificates of vaccination and inoculation for travellers from this country going abroad, as required by the International Sanitary Regulations. During the year ending on 31st December, 1972 a total of 6,365 certificates were authenticated. BACTERIOLOGICAL EXAMINATIONS During the year 4,724 specimens were sent to the Public Health Laboratory for bacteriological examination. A1 NOTIFICATIONS OF INFECTIOUS DISEASE 1st January 1972 - 31st December 1972 DISEASE 0-1 1 2-4 5-14 5-242 25-44 45-64 65+ Total Cases Removed to Hospital s Measles 14 26 80 89 2 3 - - 214 8 - Dysentery 5 2 18 60 4 19 5 - 113 7 - Scarlet Fever - 1 4 10 3 - - - 18 - - Whooping Cough 2 1 5 3 - - - - 11 1 - Infective Jaundice - - 1 2 22 25 5 2 57 34 1 T.B. Resp. - - 1 8 10 31 13 14 77 33 1 Non-Resp. - - 1 - 1 5 5 1 13 4 - Acute Meningitis 1 2 - 5 2 1 - - 11 11 1 Paratyphoid - - - - 1 2 - - 3 3 - Typhoid - - - 1 2 - 1 - 4 4 - Encephalitis (Post infectious) - - - - 1 - - - 1 1 - Opthalmia Neonatorum 1 - - - - - - - 1 1 - Food Poisoning - 1 5 6 9 5 4 1 31 - - Malaria - - - - 3 3 - - 6 6 - TOTAL 23 33 115 184 60 94 33 18 560 118 3 SUMMARY OF NOTIFICATIONS DURING THE PERIOD 1ST JANUARY 1972-31ST DECEMBER 1972 FORMAL NOTIFICATIONS NUMBER OF PRIMARY NOTIFICATIONS OF NEW CASES OF TUBERCULOSIS Age 0 1 2-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75+ Respiratory Males - - 1 1 2 - 8 10 14 7 6 9 - Females - - - 3 2 1 1 5 2 - 1 - 5 Non-Respiratory Males - - - - - - - 2 2 - 2 - - Females - - 1 - - - 1 1 - 1 1 - 1 CASES NOTIFIED AND DEATHS - PAST TEN YEARS YEAR NUMBER OF CASES NOTIFIED Total NUMBER OF DEATHS NUMBER OF CASES ON REGISTER OF NOTIFICATIONS Pulmonary Non-Pulmonary 1963 117 27 144 22 2,584 1964 121 14 135 11 2,570 1965 116 33 149 3 2,282 1966 89 19 108 15 2,007 1967 91 12 103 15 1,833 1968 90 16 106 56 1,810 1969 92 29 121 10 1,623 1970 76 17 93 8 1,574 1971 73 21 94 17 1,536 1972 77 13 90 13 1,450 Average number of cases notified for the past 10 years 1963/72 (inclusive) 114.3 Average number of deaths for the 10 years 1963 72 (inclusive) 17.0 A 2 TABLE. OF NOTIFICATIONS OF INFECTIOUS DISEASES SINCE 1965 DISEASE TOTALS NOTIFIED IN: 1965 1966 1967 1968 1969 1970 1971 1972 Anthrax - - - - - - - - Cholera - - - - - - - - Diphtheria - - - - - - 2 - Dysentery 94 258 75 62 130 74 138 113 Encephalitis, Acute Infective 1 - - 1 - - - - Encephalitis. Acute Post-Infective - - 1 - 1 - - 1 Erysipelas 6 10 9 - - - - - Food Poisoning 25 29 34 35 107 86 93 31 Infective Jaundice - - - 35 57 80 63 57 Leprosy - - - - - - - - Leptospirosis - - - - - - - - Malaria 1 - 4 1 - 2 7 6 Measles 1,907 1,233 1,075 496 410 624 283 214 Meningitis. Acute 7 3 3 7 9 7 15 11 Opthalmia Neonatorum 2 5 - 6 - - 3 1 Paratyphoid Fever - - 1 6 - - - 3 Plague - - - - - - - - Pneumonia 24 8 7 7 - - - - Poliomyelitis, Acute Paralytic - - - 1 - - - - Poliomyelitis, Acute Non-Paralytic - - 1 - - - - - Puerperal Pyrexia 65 50 24 23 - - - - Relapsing Fever - - - - - - - - Scabies 8 - - - - - - - Scarlet Fever 43 29 38 77 31 24 29 18 Smallpox - - - - - - - - Tetanus - - - - - - - - Tuberculosis, Pulmonary 116 89 91 90 92 76 73 77 Tuberculosis, Non-Pulmonary 33 19 12 16 29 17 21 13 Typhoid Fever - 1 3 4 1 3 2 4 Typhus - - - - - - - - Whooping Cough 49 122 126 87 15 60 51 11 Yellow Fever - - - - - - - - TOTALS 2,381 1,856 1,504 954 882 1,057 780 560 A3 B. ENVIRONMENTAL HEALTH B. ENVIRONMENTAL HEALTH THE STAFF The establishment of Inspectors consists of a Chief Public Health Inspector, Principal Public Health Inspector, 1 Divisional Public Health Inspector, 8 Senior Inspectors, 2 specialist and 2 Area Inspectors, 14 District Inspectors, 8 Student Inspectors and 4 Technical Assistants. There was a considerable shortage of staff in post throughout the year related directly to the fact that more and more local authorities outside London pay comparable salaries with better and more congenial working conditions and without the wear and tear associated with commuting. There would appear to be little likelihood of the situation improving until the salary differential which previously existed between London and the provinces is restored. Meanwhile, the staffing difficulties make it extremely difficult to maintain the desired standard of service. NEW LEGISLATION The Housing Finance Act, 1972 altered the Qualification Certificate procedure to enable landlords to obtain a Qualification Certificate providing the qualifying conditions were met, irrespective of when additional amenities had been provided. The appeal provisions where a tenant was unwilling to accept improvements were changed so that the Court should no longer take into account the means or resources of the tenant but should consider in particular any disadvantages to the tenant resulting from the works, what accommodation is available to the tenant while the works are carried out and the age and health of the tenant. The removal of consideration of means or resources of the tenant relates to the other financial provisions of the Act with regard to rent rebates and rent allowances whereby tenants of limited means are able to obtain assistance in the payment of a fair rent. Other provisions in the Act relating to general decontrol of controlled tenancies over a period up to 1st July 1975 will result in the abolition of rents which are too low to give the landlord the ability to maintain his property in a reasonable condition. The general decontrol provision has also had a bearing on the number of applications for Qualification Certificates received during the latter part of the year. HOUSING Preferential Rehousing on Medical Grounds During the year 1477 applications for rehousing on medical grounds were referred to the Housing Manager for assessment, but in only 27 cases were the applicants actually rehoused. Applications were graded as below:- a) Special Category 36 b) 25 points 361 c) 15 points 694 d) 10 points 340 e) No priority on medical grounds 46 Total 1477 B1 Housing Inspection House to house inspections were continued in the Greyhound Road Study Area. During the year 437 properties in this area were inspected and classified for report in the Greyhound Road (east) report dated 5th June 1972 and the Greyhound Road (west) interim report dated 22nd August 1972. Inspections were still proceeding in this western area at the close of the year. Inspections were also carried out in the Moore Park Road General Improvement Area and, to a lesser extent, in the Masbro Road General Improvement Area, in order to encourage as much improvement of the houses in these areas as possible. In the Moore Park Road area a procedure was adopted whereby warning letters were sent to the owners of unimproved properties indicating that the Council were prepared to use their powers of compulsory purchase in General Improvement Areas if improvements were not put in hand in the immediate future. This procedure has resulted in considerable response. In addition to the work in the Programmed Study Areas and the General Improvement Areas, a quick survey was carried out in the Crisp Road Area as a G.L.C. site had become available and it was felt that if there were a sufficient number of linked unfit houses in the immediate vicinity, clearance/procedure could be considered. This did not prove to be the case but the information gained will prove useful in the wider context of the Fulham Reach Study. In June, two Compulsory Purchase Orders were made in relation to 36 unfit properties in Greyhound Road and Chelmsford Street and were subsequently submitted to the Department of the Environment for confirmation. During the year I Closing Order was made with regard to a part of a dwelling; none was made relating to whole houses and I was determined. Also during the year I demolition order was made and the house was demolished. During August, in repsonse to the Government's request for housing surveys to be carried out and for local authorities to formulate housing strategies designed to eliminate sub-standard housing during the next 10 years, a sample survey of the Borough was carried out in order to establish the number of unfit and substandard houses. The information obtained did not add greatly to local knowledge of conditions in the Borough but did confirm the figures previously obtained in the Borough housing study and the G.L.C. house condition survey of 1967, it being shown that there are some 17,000 sub-standard properties requiring positive treatment by means of redevelopment or improvement. Inspections of houses in multiple occupation in Study Areas, General Improvement Areas and also in those areas of high density occupation programmed for such action have proceeded throughout the year but, due to the priority given to other work the volume of inspections did not reach that of previous years when other commitments were less demanding. A policy is being pursued of limiting the occupation of multi-occupied houses by making Direction Orders with an eventual fall in occupation and improvement of the houses to form self-contained dwellings having full amenities. Multiple occupation will continue but the evils attaching thereto of inadequate and shared facilities, coupled with gross overcrowding should gradually be eliminated. Some sixty Direction Orders were made during the year in this connection. Towards the end of the year the practice of carrying out works in default relating to Notices under Section 16, Housing Act, 1961 (provision of means of escape in case of fire from houses in multiple occupation) was instituted and thirty three such cases were forwarded for such action. It is, however, anticipated that due to the already heavy commitments of the Direct Labour Building Organisation, considerable delay will necessarily arise in the completion of these works. Due to this it is expected that the matter will be reviewed in 1973 to ascertain whether such work should be carried out by outside contractors. One Control Order was made during the year in connection with a multi occupied house in appalling condition, the Council taking over the property and rehousing the tenants prior to implementing a scheme of rehabilitation.In the event the property was subsequently acquired by the Council and the Control Order procedure lapsed. Three Management Orders were made on houses where parts of the houses in common use were in such condition as to warrant this action. HOUSES IN MULTIPLE OCCUPATION 1965 1966 1967 1968 1969 1970 1971 1972 Premises Inspected 36 253 309 913 718 401 430 337 (244 lettings) (412) (804) (3150) (1868) (1423) (1021) (801) Where informal action taken 10 253 215 768 494 304 79 186 Where ho further action taken 5 Nil 94 145 224 97 351 3 Where formal action taken 13 17 85 43 192 223 92 191 TOTAL INSPECTIONS 314 991 1815 3722 3530 4115 2431 1352 The assessment of applications for Improvement Grants has formed a considerable part of the department's work. During the year 799 Improvement Grant applications were processed and 939 were recommended tor approval. The latter figure is higher due to applications received in the preceding year being processed during 1972. B 2 Very lew tenants seem to avail themselves of their ability, contained in Section 19 of the Housing Act, 1964 to initiate improvements to their dwellings where the owner has failed to respond to their requests. This department dealt with only four applications under Section 19 during the year, of which three were found to be capable of improvement. The probable reasons for the dearth of applications are:- (a) A frequently unjustified fear as to security of tenure. (b) Uncertainty about the amount of rent increase which may result from obtaining improvements. It is intended during 1973 to pursue the question of publicity on Section 19, Housing Act, 1964 in order to bring forward those tenants who are interested in improvements and inform them fully as to their rights and the consequences which may be involved. The Housing Section in particular has suffered during 1972 from a shortage of staff, but has managed to carry out all those specific tasks which were assigned to it. There has, however, not been the ability to pursue the inspection of houses in multiple occupation with the vigour required, nor to work ahead with area surveys in order to provide information relating to the programming of action with regard to sub-standard housing. Housing Act, 1969 — Qualification Certificates The Housing Act 1969 introduced the procedure whereby dwellings occupied by controlled tenants could, if certain qualifying conditions were met, be brought out of control and converted into regulated tenancies subject to "Fair Rents". If was estimated in 1969 that there were between 2,500 and 3,000 controlled tenancies in the Borough and it was anticipated that after an initial surge the number of applications would diminish in successive years. This has proved to be the case as 137 applications for Qualification Certificates were received in 1972 against 1,495 in 1970 and 605 in 1971. During the year 225 applications were granted and 40 were refused, the higher number being accounted for by applications from the previous year being carried over for decision. Rent Acts, 1957/8 Applications under the above Acts during the past seven years have been as follows:- 1966 1967 1968 1969 1970 1971 1972 For Certificates of Disrepair: number received 7 1 4 3 3 21 1 number granted 4 1 2 1 1 - - For Revocation of Certificates number received - 4 2 2 1 2 - number granted 2 1 2 1 2 - Undertakings given by Landlord: number accepted 3 1 - 1 2 2 Housing List The Housing Manager has kindly supplied the following details:- Number of persons rehoused on medical grounds 27 Number of all new Council dwellings erected during the year and the appropriate figures for the following table 238 (1) Number of families rehoused by the Borough in new flats and houses since the war 6,020 (2) Number of families rehoused by the Borough in rebuilt houses since the war 28 (3) Number of families still living in pre-fabricated dwellings 74 (4) Number of families on the waiting list at the end of the year. 5,652 B3 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 1 Registration and Inspections The number of newly registered premises has increased slightly this year, whilst the overall number of employees has risen by almost a third. This considerable increase has been due partially to the nationalisation of the Post Office, but in the main to the acceptance from the Factory Inspectorate of the British Broadcasting Corporation premises in the Borough. A full-time Section is responsible for the administration of the Act and its Regulations as in previous years. The 1971 temporary reduction of the Section's staff to one Senior Public Health Inspector has unfortunately continued throughout 1972. In July the officer who had held this appointment for three years resigned, and although the post was filled internally as speedily as possible an unavoidable situation arose in the the newly appointed inspector was required, because of overall staff shortage, to divide his time between his previous unfilled post and his Offices and Shops responsibilities for nearly three months. These factors are reflected in a considerable reduction in the number of inspections made during the year. Due to the great difficulty in recruiting Public Health Inspectors in London, after repeated advertising, it has become necessary to rearrange the staffing structure of the Section to one Senior Public Health Inspector and two Technical Assistants. It is hoped that these latter posts will be filled during the first months of 1973 which will result in a corresponding increase in the number of initial and follow-up inspections carried out over the forthcoming year. The routine street by street inspections on the scale of previous years has obviously not been possible during 1972. The resources of the Section have therefore been concentrated on the important matters of the investigation of accidents, reported contraventions of the Hoists and Lifts Regulations, complaints regarding unsatisfactory working conditions generally and the inspection of newly registered premises. As in previous years premises are also inspected before a licence under the Betting, Gaming and Lotteries Act is issued to ascertain whether objections should be made regarding the requirements of the Offices, Shops and Railway Premises Act. 2 Accidents During 1971 a circular letter was sent to all registered premises notifying employers of their obligation under the Act to report accidents. The number of notifications received this year have consequently increased, althouth the figure is still below that which was anticipated having regard to the total number of employees in registered premises. It is proposed to re-circularise all firms to again draw attention to their obligations under the Act, and to reinforce this with direct advice and instruction during visits by inspectors. A total of 57 accidents was reported during the year, only five of which it was considered necessary to investigate. In three of these case formal warning was given. The following table shows the primary cause and the type of premises in which the accident occured:- ANALYSIS OK REPORTED ACCIDENTS Primary Cause Class of Workplace Catering Establishments Total Investigated Offices Shops Wholesale/ warehouses Machinery 1 — 1 — 2 2 Transport — — 3 — 3 2 Falls 8 10 4 3 25 1 Stepping/ Striking 2 — — — 2 — Handling Goods 1 5 3 3 12 — Struck by tailing object — 4 — — 4 — Fires — — — 1 1 — Electricity — — — — — — Hand tools — 1 — 1 2 — Not otherwise specified 4 — 1 1 6 — 57 5 Once again it can be seen that falls of all kinds constitute the largest group of accidents of which only one was of a serious nature. This particular accident involved a fall from a flat roof on which handrails have since been erected. An accident at a local bank is of particular interest and has involved liaison with the Factory Inspectorate Engineering Department. In this case a bank clerk broke a bone in his wrist when he accidentally operated a printing machine whilst his hand was under the printing head. This was possible because of the lack of shrouding of the dual switches enabling them to be operated with the hip and forearm rather than both hands. The manufacturers have now produced a modification for the machine and the bank in question have made arrangements for this to be fitted. B4 3 Hoists and Lifts Regulations 1968 A large number of engineers reports were received again this year detailing a wide variety of faults, the main offenders being the breweries where the lack of adequate enclosures remains a prominent factor. The failure to remedy this particular problem by informal means will no doubt result in the Local Authority considering the advisability of taking legal proceedings to secure compliance with the requirements of the Regulations. 4 General Apart from the failure, by brewers to enclose the cellar hoists in their premises, as commented on above, no exceptionally bad conditions have been encountered. The British Broadcasting Corporation premises have been found to be of a very high standard due to a great extent to the awareness of the Management of their responsibilities under the Act and their desire to obtain even higher standards than those legally required. At the television centre for instance where there are approximately 6,500 employees, it was only found necessary to comment upon three matters, two relating to lighting and one to ventilation. Bearing in mind the size of the premises and its round the clock use, these standards have reached a remarkably high level. B5 B6 THE OFFICES, SHOPS AND RAILWAY PREMISES ACT 1963 Annual report under section 60 to the Secretary of State for the Environment for the year ended 31st December 1972 LONDON BOROUGH OF HAMMERSMITH TABLE A REGISTRATIONS AND GENERAL INSPECTIONS Class of premises Number of premises newly registered during the year Total number of registered premises at end of year Number of registered premises receiving one or more general inspections during the year (1) (2) (3) (4) Offices 13 630 79 Retail shops 4 990 120 Wholesale shops, warehouses 2 54 2 Catering establishments open to the public, canteens 4 265 33 Fuel storage depots NIL NIL NIL TOTALS 23 1,939 234 TABLE B NUMBER OF VISITS OF ALL KINDS (INCLUDING GENERAL INSPECTIONS) TO REGISTERED PREMISES 660 TABLE C ANALYSIS BY WORKPLACE OF PERSONS EMPLOYED IN REGISTERED PREMISES AT END OF YEAR Class of workplace Number of persons employed (1) (2) Offices 18,651 Retail shops 5,924 Wholesale departments, warehouses 833 Catering establishments open to the public 2,419 Canteens 578 Fuel storage depots Total 27,505 Total: Males 13,610 Total: Females 13,895 TABLE D - EXEMPTIONS M,c. Line No. Class of premises (1) No. of exemptions current at end of year (2) During the year M/c. Line No. No. of exemptions | No. of applications Appeals to Court against refusal to grant or extend an exemption or against the withdrawal of an exemption newly granted (3) extended (4) expired or withdrawn (5) refused (6) opposed by employees (7) No.made (8) No.allowed (9) Part I-Space (sec. 5(2)) 1 Offices 1 2 3 Retail shops 2 Wholesale shops, warehouses 3 4 Catering establishments open to public, canteens N — 1— L 4 5 Fuel storage depots 5 Part II—Temperature (sec. 6) 11 Offices 11 12 Retail shops 12 13 Wholesale shops, warehouses 13 14 Catering establishments open to public, canteens N— 1— L 14 15 Fuel storage depots 15 Part III—Sanitary Conveniences (sec. 9) 21 Offices 21 22 Retail shops 22 23 Wholesale shops, warehouses 23 24 25 Catering establishments open to public, canteens N — 1— L 24 Fuel storage depots 25 Part IV—Washing Facilities (sec. 10(1)) 31 Offices 31 32 Retail shops 32 33 Wholesale shops, warehouses 33 34 Catering establishments open to to public, canteens N — 1— L 34 35 Fuel storage depots 35 TABLE E - PROSECUTIONS Prosecutions instituted of which the hearing was completed in the year Section of Act or title of Regulations or Order (1) No. of informations laid (2) No. of informations leading to a conviction (3) NIL NIL NIL • No. of persons or companies prosecuted NIL No. of complaints (or summary applications) made under section 22 NIL No. of interim orders {ranted NIL TABLE F-STAFF Mo. of inspectors appointed under section 52 (1) or (5) of the Act 1 whole-time, and 14 public health inspectors devoting part of their time Mo. of other staff employed for most of their time on work in connection with the Act 1 r*> 2C Drainage During the year 711 plans were submitted to the Health Department and a total of 3848 inspections were made in connection with supervision of drainage works. FACTORIES ACT, 1961 The following is a table in the form prescribed by the Secretary of State for Employment and Productivity on the administration of the Factories Act, 1961 dealing with factories, both mechanical and non-mechanical, and outwork. 1. Inspection Number on Register Inspections Number of Written Notices Occupiers Prosecuted (i) Factories in which Sections 1,2,3,4, and 6 are to be enforced by Local Authorities 157 5 _ _ (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority. 850 67 5 _ (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises). _ _ _ _ 1007 72 5 _ 2. Cases in which Defects were Found. N umber of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector by H.M. Inspector Want of cleanliness (S.I) _ _ _ _ _ Overcrowding (S.2) _ _ _ _ _ Unreasonable temperature (S.3) _ _ _ _ _ Inadequate ventilation (S.4) _ _ _ _ _ Ineffective drainage of floors (S.6) _ _ _ _ _ Sanitary conveniences (S.7) _ _ _ _ _ (a) Insufficient _ _ _ _ _ (b) Unsuitable or defective _ _ _ _ _ (c)Not separate for sexes _ _ _ _ _ Other offences against the Act (not including offences relating to outwork). _ _ _ _ _ B8 3. Outwork Section 110 Section 111 No. of Outworkers in August list required by Section 110/1 (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel 132 _ _ _ _ _ Curtains 4 _ _ _ _ _ Furniture and Upholstery 5 _ _ _ _ _ Jewellery 42 _ _ _ _ _ Artificial flowers 15 _ _ _ _ _ Paper Bags 7 _ -_ _ _ _ Paper Boxes 3 _ _ _ _ _ Carding of Buttons etc. 9 _ _ _ _ -_ Lampshades 4 _ _ _ _ _ Stuffed Toys 10 _ _ _ _ _ Brass Manufacture 1 _ _ _ _ _ Electrical Goods 1 _ _ _ _ _ Artist 1 _ _ _ _ _ Packaging 2 _ _ _ _ _ 236 _ _ _ _ _ B9 SANITARY INSPECTION The sanitary conditions of the Borough were subject to routine inspection and investigations were made into 1924 complaints received. Particulars of the visits made by the public health inspectors together with the number of preliminary and statutory notices served and complied with are set out below: PUBLIC HEALTH INSPECTORS' TOTALS OF WEEKLY SUMMARY SHEETS, 1972 TOTAL INSPECTIONS TOTAL REVISITS TOTAL NOTICES SERVED TOTAL NOTICES COMPLIED WITH HOUSING Housing Act 1957 367 40 1 House to House 1634 65 Housing Defects 3005 3654 604 499 H.M.O. 337 1015 377 53 Overcrowding 122 Re-Housing Applications 1 Rent Act 2 Moveable Dwellings 6 Drainage 3742 106 Refuse accommodation Housing Act, 1969 3228 149 5 FOOD PREMISES Bakers 94 2 6 Bakehouses 30 1 Butchers 133 1 5 1 Chemist 55 Confectioners 70 8 F. Fish 55 11 3 Wet Fish 30 1 Grocers 526 10 8 2 Greengrocers 77 — 2 Ice-cream 61 Milk Vendor 79 Provisions 36 Caterers 780 24 64 4 Markets 177 Contd.. B10  TOTAL INSPECTIONS TOTAL REVISITS TOTAL NOTICES SERVED TOTAL NOTICES COMPLIED WITH Licensed Premises 113 6 4 1 Sampling 420 LICENCES Hairdressers & Barbers 12 Club Licensing 20 1 Pharmacy & Poisons 18 Pet Animals 12 Animal Boarding 1 Rag & Flock 1 Milk Processing Depots 51 VARIOUS Factory (M) 67 Factory (Non M) 5 Outworkers Offices, Shops etc. 309 213 179 7 Factory (Food) 48 4 Noise 309 Public Urinals 15 Fireguard Regulations 1 Consumer Protection Act 25 Infectious Disease 199 Rats & Mice 298 Pigeons 38 Clean Air 265 24 Miscellaneous 2226 16 3 TOTALS 19100 5350 1261 568 In addition 4009 abortive visits were made where access was not obtained. 1047 Statutory Notices were served and 809 complied with during the year. These figures do not include 191 Statutory Notices and 26 complied with under Ss. 15 and 16, Housing Act 1961; nor 82 Statutory Notices of Intention and 67 Direction Orders served under Sec. 19 of the same Act. B 11 RODENT CONTROL Rat complaints showed a marked reduction this year, probably due to more effective control over the sealing of disused drains on demolition sites. Mice complaints, however, have again increased, although the percentage increase is reducing. The mouse problem would appear to affect the whole country, but is most acute in urban areas. At the request of the Ministry of Agriculture, Fisheries and Food, a survey was carried out during the year by the London Boroughs to ascertain just how great the problem is. Statistics from this survey will be available next year. If the mouse population is to be controlled, having regard to the lack of a fully effective poison, a more concentrated form of control would appear to be required. It is possible that only the widespread use of block control, coupled with a vigorous and intensive public relations campaign to reduce harbourage and improve notification and treatment by occupiers themselves will succeed in stemming the increase in infestation by mice. The following table summarises the work of the Rodent Control Staff in 1972:- Type of Property Non-agricultural 1. Number of properties in district 66,138 2. a) Total number of properties (including nearby premises) inspected following notification 2,979 b) Number infested by (i) rats (ii) mice 545 2,434 3. a) Total number of properties inspected for rats and/or mice for reasons other than notification 55 b) Number infested by (i) rats (ii) mice _ _ PIGEONS Complaints with respect to pigeons continue at a more or less constant level and are actioned by a private contractor employed by the Council, who provides a quick and effective service with the result that some thousands of pigeons are removed from the neighbourhood each year. Despite this, however, due possibly to topping up of the local flocks from other nearby areas where eradication measures are not actively pursued, the numbers of pigeons in the area do not noticeably decrease. Occasions still arise where misguided and often very zealous pigeon lovers encourage the birds to congregate by providing large quantities of food. It is possible, with some of these people, to explain the extent of the nuisance the birds cause and to prevail upon them to desist from feeding them, but this is not often the case. There is no doubt that the efforts made by the Council to lessen the nuisance caused are well worthwhile and, although it is not possible to talk of eradicating pigeons from this particular area, they are at least kept within reasonable limits and areas where specific nuisance is caused receive prompt and effective treatment. B12 DISEASES OF ANIMALS ACT 1950 Services Carried On Behalf Of The London Borough Of Hammersmith 1972 Fox's Pel Stores, Railway Approach 18 visits Fox's Pet Stores. Cinema Extension 18 visits Ellis' Stores. Railway Approach 17 visits Shepherds Bush Market 14 visits North End Road Market 12 visits These visits were mainly concerned with the sale of pet animals and poultry and on the whole the premises and livestock were in satisfactory condition. On one occasion the shop at Cinema Extension had live poultry for sale. Advice was given to the owner and such sales were stopped. Psittacosis or Ornithosis Order 1953 In February investigations were carried out at Fox's Pet Stall concerning a budgerigar which died within one hour of purchase. The carcase of the bird was collected and sent for tests and meanwhile sales of other birds on the premises were stopped. The tests proved negative for psittacosis and permission was given for sales to be resumed. All the other birds had remained healthy and a replacement was made for the dead bird. Orders - Ministry of Agriculture, Fisheries and Food Animals (Miscellaneous Provisions) Order 1957 The following were received and advertisements placed in the 'Daily Telegraph' as necessary:Newcastle Disease (England and Wales) Order 1971 Brucellosis (Eradication Areas) Orders Brucellosis (Area Eradication) Orders Diseases of animals (Approved Disinfectants) Order 1972 Diseases of Animals (Approved Disinfectants) (Amendment) Order 1972 Tuberculosis (Compensation) Amendment Order 1972 Diseases of Animals (Miscellaneous Fees) Order 1972 Live Poultry (Restrictions) Amendment Order 1972 Foot and Mouth Disease (Infected Areas) (Vaccination) Order 1972 Foot and Mouth Disease (Infected Areas) Special Orders Nos. 1-4 1972 Swine Vesicular Disease (Infected Areas) Special Orders Nos. 1-5 1972 Live Poultry (Restrictions) Order 1971 The International Poultry Show was held in September at Olympia and this was visited and all livestock, quarters, and food was inspected. A licence had previously been issued for the holding of this Show. Performing Animals (Regulation) Act 1925 Visits were made to the B.B.C. studios in May and August concerning the use of animals in productions. The animals concerned were six pigeons and a dog. These were supplied by reputable trainers and everything was found to be satisfactory. Pharmacy and Poisons Act, 1933 Pharmacy and Medicines Act, 1941 The names and addresses of 86 retailers were entered on the Council's list of persons entitled to sell poisons under part II of the above Acts. Many of these persons are food retailers and in some instances the poisons sold are only household disinfectants, but a careful watch is kept on commodities sold under proprietary names containing other poisons mentioned on the list. No action was necessary in respect of any offences under the Acts. Pet Animals Act, 1951 Fourteen applications for licences were received and granted during the year. All premises were kept under observation. Animal Boarding Establishments Act, 1963 One application for a licence was received and granted during the year. The premises were kept under observation. Caravan Sites and Control of Development Act, 1960 Land may not be used as a site for movable dwellings unless a site licence is held. A site licence may have such Conditions attached as the Council "see fit" with respect to the number and class of caravans to be kept on the site, the space between such dwellings, fire protection and the securing of adequate water supplies and sanitary facilities. There arc two licensed sites within the Borough, run by private concerns, having standings for two and five caravans respectively. LICENCES AND REGISTRATION B13 Hairdressers and Barbers Under Section 21 of the Greater London Council (General Powers) Act, 1967 as from the appointed day no person shall carry on the business of a hairdresser or barber on any premises in the Borough unless he/she is registered in respect of those premises by the Borough Council. (The appointed day for the London Borough of Hammersmith was 1st April, 1968). • By the end of the year 173 premises were registered. All new applicants are asked to display on their premises, in addition to the statutory requirements of certificate or registration and byelaws, a copy of their price list. SUMMONSES Proceedings instituted during the year- Public Health Acts 67 Food and Drugs Act, 1955 and Regulations made thereunder 145 SEWERAGE The main sewers and the sewerage disposal system in London are the responsibility of the G.L.C. Rainwater and soil sewage are carried in the same sewers, but the arrangements for Hammersmith are not yet adequate inasmuch that some basements in the Borough are liable to flooding from time to time when heavy storms cause the sewers to be surcharged. WATER SUPPLY / am indebted to Dr. E. Windle Taylor, Director of Water Examination for the Metropolitan Water Board who kindly supplied the following report: 1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1972. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after the analytical results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1972, was 181,880. (ii) No houses were permanently supplied by stand-pipe. (d) No artificial fluoride is being added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations:- River Thames-derived water from the Thames Valley group of stations. No new sources of supply were instituted and therewere no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not plumbo-solvent. It should, however, be appreciated that all types of water, pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. B14 METROPOLITAN WATER BOARD - WATER EXAMINATION DEPARTMENT AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO LONDON BOROUGH OF HAMMERSMITH DURING 1972. Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMn04 4 hrs at 27° C BOD 5 days at 20°C Hardness (total) CaC03 Hardness non carbonate CaC03 Magnesium as Mg Sodium as Na Potassium as K Chloride as CI Phosphate as P04 Silicate as SiO2 Sulphate as SO4 Natural Fluoride as F Surfaceactive material as Manoxol OT Turbidity units Colour (Burgess units) pH value Elec trical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) River Thamesderived 364 0.031 0.069 6.9 1.06 - 274 82 5.0 24.5 5.5 35 2.8 10 58 0.15 0.02 0.1 13 7.9 570 METROPOLITAN WATER BOARD — Water Examination Department. BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1972. WATER SUPPLIED TO THE LONDON BOROUGH OF HAMMERSMITH. BEFORETREATMENT AFTER TREATMENT Agar plate count per ml. Coliform count Escherichia coli count Agar plate count per ml. Coliform count E. coli count Source of supply Number of samples 20-24 hours at 37°C. 3 days at 22° C. Per cent samples negative in 100 ml. Count per 100 ml. Per cent samples negative in 100 ml. Count per 100 ml. Number of samples 20-24 hours at 37°C. 3 days at 22° C. Per cent samples negative in 100 ml. Per cent samples negative in 100 ml. River Thames-derived 8087 42.3 41.94 10.2 56.76 4.0 3891 10.0 99.85 99.97 B 15 CLEAN AIR Smoke Control Generally Since the Borough completed its Smoke Control Programme in 1967, steady progress has been made in reducing the level of pollution from smoke and sulphur dioxide. Based on the readings of the three atmospheric pollution recording stations situated in the north, central and south of the Borough respectively, the average concentrations of smoke for 1972 were 28 microgrammes per cubic metre (1971 - 35 microgrammes per cubic metre) and sulphur dioxide 81 microgrammes per cubic metre (1971 - 158 microgrammes per cubic metre). This downward trend has been accentuated by the increasing use of gas which has a negligible sulphur content, and the lighter fuel oils with a low sulphur of below 1%. The number of coal fired plants still in operation have continued to decline and can now literally be counted on one hand. Even coke fired installations are being replaced by gas or oil. The number of gas fired installations being installed both for domestic and non-domestic use has increased, in some cases even replacing oil. However, the very large installations such as the power station and hospitals continue to use heavy oil. Fulham Power Station The changeover from coal to oil firing which commenced in 1970, was completed in 1972 and there has been a marked reduction, since the changeover in the emissions of smoke. The power station uses a heavy oil, but with a sulphur content of about 1% which is low for a fuel of this type. Charing Cross Hospital (Fulham) The new Charing Cross (Fulham Hospital), which was commissioned in 1970 has brought about a great improvement in the area, but is still experiencing'teething troubles' from the heating plant and it is hoped that these will be brought to a satisfactory conclusion early in the new year. Emissions of Smoke Many complaints are received from the public regarding the emissions of smoke from industrial, commercial, office blocks and public buildings, especially as domestic consumers have to burn authorised fuels smokelessly. The clean air legislation does allow for the emissions of smoke under certain conditions such as lighting-up from cold and meeting sudden demands of steam due to fluctuating loads, etc. Provided these do not exceed the Dark Smoke Permitted Period Regulations, 1958, these emissions are quite lawful, although extensive black smoke is not permitted by the Act. However, all smoke emissions should be reported for investigation by this department, though it may well be that in some cases they are within the permitted limit. Sometimes emissions of steam are mistaken for white smoke. Demolition Sites and Domestic Bonfires It is quite a common sight to see bonfires on demolition sites, creating a nuisance owing to the lack of supervision on the site. Although legislation does permit the burning of rubbish on site, under controlled conditions, there is no excuse for the clouds of smoke and fly ash that result and complaints of this nature should be reported for investigation. Another source of complaint is the domestic garden bonfire which is not to be encouraged as it does tend to affect neighbours in close proximity, but if causing a nuisance it can be dealt with under existing legislation. Incineration The use of incineration as a method of trade refuse disposal has proved rather disappointing as regards the smoke and smut emissions that do frequently occur. In some cases the incinerator has been overfilled and forced beyond its capacity with the result that the plant cannot cope and unnecessary smoke emissions occur. I his is usually due to the carelessness of the incinerator operatives and the shortsightedness on the part of management who have underestimated the amount of refuse to be disposed of so that the existing incinerator is really too small for the task at hand. This is an uneconomic policy as the plant is subject to greater heating stresses affecting the refractory brickwork and the incinerator and tends to wear out quickly resulting in its replacement in a comparatively shorter time. Other incinerators do not seem to be able to burn smokelessly the plastic content of the refuse which has increased considerably over the last few years. If the smoke problem from incinerators is not to get out of hand, radical changes in design are necessary and in some cases alternative methods of refuse disposal may have to be used. It would appear essential that for smokeless incineration to be effective, the following guide lines should be borne in mind:- (1) Always have plant large enough to cope with existing load and any foreseeable future load. (2) Always use trained staff to operate the plant as per manufacturers instructions. This is not easy to achieve as the labour available is often unskilled and cannot always be closely supervised. (3) The plastic content of the refuse should be kept to a minimum unless the plant can adequately cope with plastics. The rule should be to burn a little at a time. B16 Lead in the Atmosphere Great interest was aroused early in the year arising from a circular letter from the department of Health and Social Security to all Medical Officers of Health in December 1971 regarding the health hazards from extensive emissions of lead in food, water, soil and the atmosphere. With the atmosphere very much in mind, because young children and pregnant mothers are more susceptible than the average male population to lead toxicity, in February 1972 the Government's Alkali Inspector was requested to inspect the only two lead industrial plants in Hammersmith known to be engaged in the manufacture and assembly of battery plates for car batteries. In March 1972 the Inspector reported that tests carried out at both plants revealed the lead content to be well below the threshold limit of 0.2 milligrammes percubic metre, so that the health hazard was minimal. The owner of these plants is currently negotiating for alternative sites outside the Borough, and all operations ceased in December 1972. The premises are now used only for storage and distribution. However, although these particular emissions of lead did not constitute a hazard to health, it is proposed in 1973 to monitor samples of the soil and especially the atmosphere as it is k nown that a source of lead in the atmosphere emanates from the lead content of petrol which is emitted from the exhaust system of motor vehicles. CLEAN AIR ACT. 1956 Notification to Install New Furnaces—Section 3(3) Oil fired furnaces 5 Gas fired furnaces 7 12 Application for Prior Approval to the Installation of New Furnaces Section 3(2) Applications received 8 Applications approved 8 CLEAN AIR ACT, 1968 Grit and Dust Emissions—Section 2(4) Number of contraventions received 5 Application for Approval of Chimney Heights—Section 6 Applications received 8 Applications approved 7 Applications refused 1 AIR POLLUTION PROBLEMS Source of Pollution No. of Contraventions Recorded Smoke from chimneys 30 Smoke from demolition sites and bonfires 25 Smuts from chimneys 8 Grit, dust and fume emissions 5 Odours from combustion processes 2 'Watchdog' Activities In all cases complaints are investigated. Quite often verbal intimation is sufficient to abate the nuisance. Where necessary, this is followed up by written notification. Emphasis must be always on achieving a reduction in air pollution on a permanent basis with the maximum of voluntary co-operation as well as by statutory enforcement. Visits to the offending premises to discuss the problems with management, including the tendering of advise, often result in the replacement of obsolescent plant and the adoption of new techniques and methods of smokeless combustion. These methods, perhaps not so spectacular, are just as effective in the long run. Another silent service is the approval of new plant and chimneys before installation to ensure that smokeless combustion and operation can be achieved in practice and not just on the drawing board. However, the best 'watchdog' of all is the public whose interest in achieving clean air can always be measured by the number of complaints received. B17 Conclusion It is now 20 years since the infamous London smog of 1952 which helped to kill 4,000 people. The advent of the Clean Air Acts and the implementation of the Council's phased Smoke Control Programme has brought about a great improvement in the Borough. Yet there is no room for complacency. Attention should now be focussed on the other sources of pollution such as the products of combustion from motor vehicles, especially the unburnt and partially burnt hydrocarbons, including the lead containing aerosol emitted with the exhaust fumes as lead is added to petrol as an anti-knock agent. If these pollutants can be monitored now, then data will be readily available should any hazard to health arise either from direct sources or as a cumulative effect. It is calculated that 22,000 vehicles daily use the Hammersmith Broadway which alone is food for thought. Not withstanding this, on aesthetic grounds alone there is a good case for reducing the toxicity of exhaust fumes from motor vehicles. B18 INSPECTION AND SUPERVISION OF FOOD Number of Premises where Food is Sold, Stored and Prepared in 1972 Bakehouses (level) 23 Bakers' retail shops 49 Biscuit Manufacturers 1 Butchers 111 Cafes & Restaurants 275 Canteens & Clubs 216 Chemists 63 Chocolate Manufacturers 1 Confectioners 314 Fishmongers (wet & fried) 58 Fruiterers & Greengrocers 125 Fruit Drinks (bottling) 2 Grocers & Provisions 343 Ice Cream Manufacturers 3 Honey Refiner I Jellied Eels & Pies (manufacture & sale) 6 Milk Processing Depots 2 Off Licences 107 Public Houses 154 Sweet Manufacturers 3 Wholesale Food Stores 45 Wine Bottling 2 TOTAL: 1,904 B 19 FOOD AND DRUGS ACT 1955 Unsound Food Condemned in 1972 Tons. Cwts. Lbs. BISCUITS 32 BUTTER 45 CEREAL 2 13 CHEESE 2. 7 46 CONDIMENTS 5 8 CONFECTIONERY 10 18 FISH (FRESH) 1. 1 25 FISH (TINNED) 1 79 FLOUR 85 FRUIT (DRIED) 17 FRUIT (FRESH) 7. 7 80 FRUIT (JUICE) 15 28 FRUIT (TINNED) 3. 18 98 HAM (TINNED) 9 32 MEAT (FRESH) 7. 19 108 MEAT (TINNED) 2 110 MEAT PATE 1. 2 67 MILK POWDER 34 NUTS 3 33 OFFAL 1. 3 104 PASTRY 28 POULTRY 4 94 PRESERVES 6 46 SAUSAGES 17 SOUP (TINNED) 2 SUGAR 7 TOMATOES (TINNED) 4 7 VEGETABLES(FRESH) 10. 11 51 VEGETABLES (TINNED) 7 35 TOTAL 39. 8. 5 B20 Unsound Frozen Food Condemned Tons. Cwts. Lbs. BEEFBURGERS 7. 73 CHICKEN PIES 24 CHIPS 3. 12 CREAM CAKES 70 DESSERTS 2. 85 FISH 16. 34 FISH CAKES 108 FISH FINGERS 6. 69 FRUIT JUICE 77 ICE CREAM 1. 32 MEAT 6. 77 MEAT PIES 3. 8 OFFAL 5. 84 PASTRY 3. 63 PORKBURGERS 27 POULTRY 17. 3 RISSOLES 1. 79 SAUSAGES 27 SAUSAGE ROLLS 17 VEGETABLES 19. 11 TOTAL 4. 17. 84. B21 FOOD COMPLAINTS During the year 113 complaints were received from members of the public in connection with food purchased in the Borough. The following summary shows the action taken after full investigation in each case:- 1 ? mould in can of chopped ham and pork Sulphur staining - no action 2 ? condition of walnuts Cheap nuts of low quality - no action 3 Chicken and brussels tops caused throat sensation No evidence to support complaint 4 Chocolates out of condition No action 5 Sale of rancid butter Imported. Min. of Agriculture, Fisheries & Food informed. 6 Bunround with piece of string Legal Proc. Absol. Discharge £5 costs 7 Misleading fruit pie label Not considered misleading 8 Piece of metal in frankfurter sausages Imported. Referred to Min. of Agriculture, Fisheries & Food 9 Unsound condition of packet of crumpets £25 fine £10 costs. 10 Glass in jar of instant coffee Unable to confirm product sold as alleged. 11 Use of dirty 1/3rd pint milk bottle Legal proceedings. £25 fine £5 costs. 12 Foreign matter in pork chipolata sausages Legal proceedings. £25 fine £7 costs. 13 Mouldy condition of cheddar cheese £30 fine £5 costs. 14 Chocolate eclairs suspected of causing food poisoning No action 15 Cornish Pasty contaminated with hair No action 16 Mouldy condition of bread rolls Fined £25 £5 costs. 17 Metal in lunch £50 fine £20 costs. 18 Dirty pint milk bottle No action 19 Sale of mouldy processed cheese £10 fine £5 costs. 20 Sale of mouldy cheese £20 fine £5 costs. 21 Piece of wood in tin of blackberries Legal Proc. £20 fine £5 costs. 22 Sale of mouldy chicken spread Legal Proc. £60 fine £5 costs. 23 Dirty pint milk bottle £75 fine £5 costs 24 Unsatisfactory condition of chocolate-coated toffees Referred for legal proceedings 25 Lobster curry contained prawn or shrimps Advice given 26 Pint bottle of milk contained wrapping No action paper from tobacco 27 Sale of mouldy corned beef Referred to London Borough in which sale occurred 28 Sale of mouldy pineapple tidbits Wholesalers advised 29 Imported canned tomatoes contained erroneous label Referred to Ministry of Agriculture, Fisheries and Food 30 Sale of mouldy sliced wheatmeal loaf Retailers fined £20 Costs £10.50 31 Sale of unsound deep freeze chipped potatoes No action 32 Grapefruit juice alleged to cause sickness No action B22 33 Sale of french bread not of quality demanded No action 34 Unpleasant flavour of bread pudding Referred for legal proceedings 35 Bar of chocolate nibbled by mice Legal proceedings. £40 fine £8 costs. 36 Foreign matter in loaf of bread No action 37 Brown bread roll contained dark matter Legal Proc. £75 fine £5 costs. 38 Sale of mouldy "take & bake" loaf £15 fine £5 costs. 39 Foreign matter (? tobacco) in sliced white loaf Legal Proc. £50 fine £5 costs. 40 Breakfast food contained insect Producers notified 41 Salted peanuts contained foreign matter Legal proceedings. Producers given absolute discharge. Council awarded £5 costs. 42 Sausages served in meal contained plastic Legal Proc. £20 fine £5 costs. 43 Sale of mouldy ham & tomato sandwich Cautionary letter to retailer 44 Foreign matter in can of pork shoulder and ham Referred to Min. of Agriculture, Fisheries & Food. 45 Cheese roll contained hair Legal Proc. £15 fine £5 costs. 46 Unpleasant taste and smell from flour Advisory letter to complainant 47 Sale of rancid butter Warning issued to retailers 48 Foreign matter in ham & egg pie Legal Proc. £25 fine £5 costs. 49 Fly eggs and larvae in sausages Legal proceedings. £15 fine £5 costs. 50 Can of mutton contained metal Referred to Government of Country of origin 51 Sale of mouldy wrapped sliced loaf Referred for legal proceedings. 52 Sliced loaf contained dark matter Bakers notified 53 Sale of mouldy loaf Legal proceedings authorised; not instituted. Witness disappeared. 54 Blacks specks in milk bottle Legal proceedings. Fine £25 Costs £10 55 Milk cap in pint milk bottle Legal proceedings. Fine £25 Costs £10 56 Insect in packet of biscuits No action. 57 Mouldy condition of soft cheese Legal proceedings. Fine £25 Costs £5 58 Sale of chocolates out of condition Legal proceedings. Fine £25 Costs £5 59 Sale of mouldy loaf No action. • 60 Stale condition of pork pies Retailer cautioned 61 Sale of mouldy fruit malt loaf No action. 62 Sour condition of double cream Legal proceedings. Case dismissed 63 Mouldy condition of french sliced loaf Legal proceedings. Fine £5 Costs £2 64 Piece of metal in toffee No action. 65 Mouldy condition of large sliced white loaf Legal proceedings. Fine £10 Costs £11.50 66 Mouldy condition of loaf No action 67 Foreign matter in large sliced loaf Referred for legal proceedings B23 68 Sale of mouldy apricot pie Legal proceedings. Fine £25 Costs £5 69 Sale of mouldy sliced white loaf No action 70 Sale of sliced loaf containing insect Legal proceedings authorised, but unable to trace witness. 71 Sale of mouldy sausage rolls Legal proceedings. Fine £20 Cost £26.41 72 Use of unclean 1 /3rd pint milk bottle No action. 73 Loaf contained discoloured matter Producers notified. 74 Sale of unsound can of peas No action 75 Sale of unsound Scotch egg Legal proceedings. Fine £15. Costs £7 76 Sale of unsound orange squash Bottlers notified. 77 Excessively salty condition of canned salmon Referred to Government of country of origin. 78 Sale of unsound beefburger No action 79 Custard powder contained mouse Referred to London Borough wherein sale took place 80 Foreign matter in 1 pint bottle of milk No action 81 Undesirable side effects of antiseptic mouthwash No action. 82 Dirty condition of bottle of milk Legal proceedings. Fine £25 Costs £5 83 Deep-frozen fish tasted sour No action. 84 Larva in biscuits Producers informed. 85 Sale of mouldy blackcurrant & apple pie Complaint withdrawn. 86 Yoghurt was off - unfit to eat Legal proceedings. Fine £50 Costs £5 87 Sale of large sliced loaf containing cigarette packet Legal proceedings. Fine £15 Costs £5 88 Sale of unfit bacon boiling joints No action 89 Cigarette end in can of pineapple rings Referred to Government of country of origin. 90 Pint bottle of milk contained cap in milk No action 91 Sale of mouldy steak & kidney pudding Legal proceedings. Fine £25 Costs £5 92 Pint bottle of milk unclean No action 93 Chocolate biscuits contained "bloom" No action 94 Sour condition of steak & kidney pie Legal proceedings. Fine £25 Costs £9.30 95 Stale condition of malt loaf No action 96 Cream crackers damaged by mice Legal proceedings. Fine £60 Costs £10 97 Breakfast cereal contained moth No action 98 Unfit condition of canned raspberries No action 99 Milk adulterated with water? No action. 100 Stale condition of rye crispbread Legal proceedings. Fine £25 Costs £5 101 Sale of unsound pork chops Legal proceedings. Fine £15 Costs £5 102 Unsatisfactory condition of full cream No action evaporated milk 103 ? condition of beefstock with gravy No action B24 104 Sale of mouldy crumpets Legal proceedings. Fine £50 Costs £5 105 ? type of meat sold as chicken Satisfactory. No action. 106 Sour condition of chocolate dairy dessert Legal proceedings. Fine £25 Costs £5 107 ? chicken in cooked chicken and rice Satisfactory product 108 Dirty milk bottle No action 109 Insect in packet of wheatgerm No action 110 Mouldy condition of chocolate fudge cake No action 111 Chocolate raisins contained a stone Legal proceedings. Fine £20 Costs £5 112 Pork luncheon meat had catty odour Referred to producers 113 Piece of metal in bar of chocolate Producers notified. List of Premises Registered under Section 16, Food & Drugs Act, 1955. Ice cream Manufacturers 3 Ice Cream Sales Only 4 Confectioners selling Ice Cream 207 Restaurants selling Ice Cream for consumption off premises 23 Grocers selling Ice Cream 118 Fruiterers & Greengrocers selling Ice Cream 12 Off Licence premises selling Ice Cream 14 Bakers selling Ice Cream 2 Hairdressers selling Ice Cream 2 Fried Fish Shops selling Ice Cream 1 386 Butchers preserving meat/and/or manufacturing sausages 58 Grocers & Provision dealers preserving meat 28 Caterers preserving meat 3 Fishmongers curing fish 20 Food factories manufacturing sausages and preserved food 4 113 Grind Total. 499 B25 ICE CREAM Ice Cream is manufactured at two premises in the Borough. During the year thirty-two samples were taken lor bacteriological examination and the Methylene Blue Test by the Public Health Laboratory Services. The Methylene Blue Test is recommended by the Department of Health as a guide for ascertaining the bacteriological cleanliness of ice cream. The time taken to decolourise the Methylene Blue is recorded, and the samples graded as follows:- Provisional Grade Time Taken to Decolourise Methylene Blue 1 4 hours or more 2 2½ hours or more 3 ½ to 2 hours 4 less than half an hour The thirty-two samples were placed in the following grades:- Grade No. of Samples 1 11 2 4 3 6 4 11 Milk Supplies There are two Milk processing Depots in the Borough, one of which is given over almost completely to the production of milk products. In the case of the one where milk is processed, the assembly of the milk -just over 100,000 gallons per day is as heretofore by road tanker and rail tanker. In this depot there are four H.T.S.T. pasteurising plants in which milk is heated to, and retained at, a temperature of 161 degrees F. for fifteen seconds, and then cooled to below 50 degrees F. in accordance with the Milk (Special Designation) Regulations. During the year experiments were carried out with a semi-portable refrigerated blower unit for connecting to bulk milk bottle transporters in order that milk for transport to distribution depots in London, should leave the plant at a temperature of 40 degrees F., such milk being transferred to refrigerated storage at the distribution depots. The introduction of this type of low temperature to insulated vehicles, was successful, and by the end of the year it was intended to bring the number of the refrigerated units for vehicle cooling, up to six. An interesting feature of work at this plant is that between 4 and 500,000 bottles per week are needed to replace bottles not returned through disapearance or breakage or rejection, because of misuse by the public. At the milk products plant the processing of cream and the manufacture of yoghurt continue apace, and bacteriological and chemical samples were taken from each of the above establishments. 244 premises were registered for the sale of milk and the number of licences in force at the end of the year were as follows:- Pasteurised 218 Sterilised 191 Un-treated 106 Ultra heat treated 145 The following table shows the results of bacteriological samples of milk taken from the processing plants, distributors and automatic vending machines. Class of Milk No. tested Phosphatase Test Methylene Blue Test Turbidity Test Passed Failed Passed Failed Passed Failed Pasteurised 35 35 _ 31 _ _ _ Sterilised 1 _ _ (4 void) _ 1 _ B26 ANNUAL REPORT OF THE PUBLIC ANALYST During the year 1972, 1126 items of food and drugs were examined. Of these 16 samples were taken formally, 1012 informally, and the remaining 98 articles were submitted as the result of complaints. The number adulterated or about which adverse comment was made was 187. The incidence of criticisms may be classified as follows:- Number Number examined adulterated Milk 44 Milk Bottles 12 12 Other Food 1057 175 Drugs 13 Last year 58 complaints were received and of these 55 were thought to be justified, while this year 98 complaints were received of which 82 were considered justified. Judging by the type of complaint received the public are more likely to take exception to dirt in any form than to such things as misleading labels and most of the adverse comments on extraneous matter were the result of complaints by members of the public, although a few samples submitted for general examination were also found to be unsatisfactory in this respect. Twelve milk bottles contained dirt of one type or another showing that they had not been properly washed and your analyst is firmly of the opinion that, so long as mechanical decrating of empty milk bottles without inspection before washing is continued, so long will this type of complaint be a common one. The types of dirt included empty tobacco packets, milk bottle caps, soot form foreworks or candles, building rubble, and the remains of very mouldy milk residues. A can of evaporated milk purchased by a complainant together with two unopened controls was submitted as the complainant alleged when she opened her one it was bad; the milk in all the cans contained lumps resembling sludge due to faulty sterilisation. Some double cream tasted bitter due to decomposition caused by proteolytic bacteria, the sample having been sold when it was over a week out of date, and a whipped cream contained 114 million organisms per gramme growing at 22°C. A packet of butter was very badly contaminated with mould on the exterior, and while another butter submitted was thought to be rancid according to taste, no chemical sign of rancidity could be detected. Three complaints were received regarding cheese, and in every case the cheese was very mouldy and, as it all originated from the same factory, it was obvious that the factory must have been badly contaminated. A cottage cheese was also mouldy on receipt, coloured matter present in a cheddar cheese was due to mould, and a cheese spread had an unpleasant odour and a very bitter taste due to the action of proteolytic bacteria. A yogurt had a vinegary smell due to its being old stock and fermentation had consequently been carried too far. Some ham and pork, was thought to be mouldy but the so-called mould was sulphur stain and was really insufficient to justify a complaint, whereas a smoked ham roll had been improperly cured and the odour was typical of such ham. A ham and tomato sandwich had been sold when it was mouldy. Dyed human hair found in a cornish pasty was embedded in the pie filling and had minute fragments of food attached, and an animal hair 1½" long was found in a cheese roll, but suspected cats hairs in a cooked chicken and rice meal were embryonic feathers which should have been removed, and the description of the product as "Chicken and Rice" was incorrect when there was more rice than chicken present. Many mature eggs and a few larvae of some type of fly were found in a packet of pork and beef chipolatas. A larva found in some crispbread biscuits was identified as that of the Codling moth. Four live and one dead larvae of the Dermestidae family were found in a packet of breakfast food, although no sign of ingress or exit to the packet by a beetle could be detected by careful examination of the inner paper lining and three control packets submitted at the same time were satisfactory, but another breakfast cereal contained one live larva and five dead moths. A dead insect and a number of pieces of black burnt pieces of wheat germ were found in some wheat germ from which it appeared probable that the insect had been heated. Some rice contained several dead weevils and also pieces of weevils. Complaint was made regarding the condition of some walnuts. There were a large quantify of broken nuts present, some bad and attacked by maggots, and they appeared to have been gathered before being completely ripe and had been im-properly dried. A dried fruit salad described as "Finest Foods" contained a live and a dead weevil, while the fruit itself was of poor quality, the prunes being over dried, and as the packet was 5 per cent deficient in weight it was possible it had dried out even further since packing. In the case of a steak and kidney pie the meat was decomposing before it was cooked, but a steak and kidney pudding was contaminated with three varieties of mould, penicillium, Aspergillus glaucus, and Monilia sitophilia due to insufficient precautions during manufacture. Some Scotch eggs were submitted because of a sour taste and the high microbiological counts showed that they were unfit for consumption. A can of peas possessed a fermented odour but the bacteriological counts were satisfactory, and it was probable that the peas had been left standing in their cans for some time before being sterilised. A tomato paste was thought to be bad and the empty can was submitted together with a control unopened sample. The interior of the empty complaint can was badly corroded as was that of the control can and the tin content of the unopened sample was 400 parts per million, whereas no food ought to contain more than 250 parts per million of tin. An orange squash in a plastic bottle was submitted because of its swollen condition and examination of this and two others as controls showed that the complaint and one of the controls were badly contaminated with B27 yeasts, although the second control bottle was satisfactory. Crumpets suspected of causing food poisoning were submitted, but although examination showed they were unfit for sale, when received, the symptoms suffered by the complainant were inconsistent with those of food poisoning. I wo pieces of string, of the type commonly used for sewing flour bags were present in a ham and egg pie, and a bun round contained a piece of string which had been cooked in it. Some canned pineapple tidbits were mouldy dut to the tool marking on the tin being too deep causing the can to leak, and a cigarette end found in another can of pineapple slices was not a type of cigarette normally sold in Great Britain indicating that it had been in the can before sealing. A piece of wood, submitted with an empty can which had contained blackberries, was thoroughly impregnated with colour derived from blackberries, and must have been in the juice for some considerable time. A piece of plastic material was found in some beef sausages, and a stone weighing 0.75 of a gramme was found in a packet of chocolate raisins purchased from a slot machine. A piece of wire found in a can of frankfurters was pitted due to corrosion and had doubtless been cooked when the can was sterilised. A portion of a wire nail stated to have been found in a bar of chocolate showed traces of adherent chocolate. A piece of solder was found in some corned mutton, and a piece of metal in a can of pork and ham showed carelessness in the factories concerned. A complaint was received about a piece of metal found in a toffee, but as the offending material was a tooth stopping, it was surprising that the complainant did not realise he had lost the stopping when eating the toffee; some metallic matter in shelled peanuts was found to consist of iron with oil doubtless due to gear oil from machinery, while another packet of peanuts contained a piece of very oily thin paper, probably used in the factory for filtering or cleaning purposes, and a piece of glass found in a jar of coffee had no doubt broken from a similar jar due to an accident in the filling chain. A complaint of an unusual deposit found in a tea cup consisted essentially of tea dust, and it is probable that tea had been measured from a large container using this cup and that the cup had then been used for a cup of tea without being washed. The black material in pork chipolatas consisted of carbonaceous matter, although it was impossible to suggest how this had gained access in manufacture, and some potato chips, which were the subject of a complaint, were found on examination to consist of one third of diseased potato which should have been removed before frying. A pork luncheon meat was received because of a "Catty" odour which was due to contamination of the lacquer solvent used for the tinplate and subsequent inadequate stoving of the lacquered tinplate, and in the case of a complaint that a can of salmon was too salty, it was found that the salt in the liquid surrounding the fish was 15.6 per cent and on the drained fish 8.2 per cent, whereas the normal salt content of canned salmon ranges from 0.7 to 1.5 per cent, so that an accident must have happened with this can. The contents of a box of chocolates submitted as a complaint were found to be in a very bad condition, but no sign of cocoa moth or larvae could be detected, and it was thought the condition was caused by the chocolates being stored in too warm a place. Another box in a very bad condition was obviously old stock and was believed to be at least eight years old. Likewise the bloom on some chocolate biscuits consisted of a "fat" bloom, which may have been due either to faulty manufacture or long storage under unsuitable conditions. A complaint was received regarding the amount of fruit in an apple pie,and, although your analyst thought sufficient fruit was present, the illustration on the carton was considered misleading because it showed a nicely browned pie whereas when the pie was cooked according to the directions it browned at the edges and left a white centre. A margarine complied with chemical tests, but had a most objectionable flavour due to the use of improperly refined oil, and was reported as inferior, whilst some cooking fat also possessed an unpleasant taste and odour, but in this case the taste was due to rancidity, which could be shown by chemical tests. Some chocolate coated marshmallow biscuits were thought to have caused sickness, and, while the flavour was unpleasant, examination proved them to be safe for consumption, although it was thought the manufacturers had used a rancid milk product in the preparation of the marshmallow portion. The rancid flavour of some chocolate coated toffees, and the soapy flavour of a sponge cake mix were due to the use of improperly refined fat, but the unpleasant flavour of some bread pudding was due to contamination with a small quantity of synthetic detergent. A sample of frankfurters contained total meat only 59.4 per cent, being 20 per cent deficient in meat, but the follow-up sample contained 73.7 per cent and was therefore only 1.5 per cent deficient, while another different make contained only 67.4 percent meat, and some pork sausages contained only 61.09 percent of meat being 6 per cent deficient, but again the follow up sample contained 66.5 per cent which is satisfactory. I he total meat on some baconburgers with baked beans was only 58.9 per cent, whereas it was considered that the lowest meat standard for a baconburger should be that of a frankfurter w hich when in a can must be not less than 70 per cent of meat. Moreover owing to the small quantity of baconburgers, the product should, in any case, have been described as a "Ready Meal", but it was not. I wo samples of meat spread contained only 56.1 percent and 58.4 percent of meat respectively whereas the Fish and Meat Spreadable Products Regulations 1968 requires not less than 70 percent of meat, and a sample of pork cured in spiced brine was made up essentially of pieces of pig tail, so that it should have been described as "pork tail". A cream contained 48.2 per cent of fat and 3.8 per cent of solids not fat, indicating that the solids not fat on the original milk were only 7.1 per cent. Two soured creams were incorrectly labelled, since soured cream is a B28 compound food and the ingredients should have been declared as "cream culture"; one of them was also 12 per cent deficient in fat. A processed cheese with ham contained 60.9 per cent of water after removal of the ham, whereas the maximum permitted water content is 60 per cent. A Goat's milk medium fat cheese contained 53 percent of fat calculated on the dry matter and was therefore really a full fat cheese, but two samples of goat's milk yogourt contained respectively only 7.2 and 7.3 percent of solids not fat. and 3.03 and 2.96 per cent of fat, whereas goats milk normally contains over 4 percent of fat and 9 per cent of solids not fat. Another goat's milk yogurt contained only 2.97 percent of fat instead of 3.2 per cent as claimed and it was also stated to be prepared from "Zimbabwe yogurt" which should have read "goat's milk yoghourt". A follow-up sample of the same product contained 3.52 per cent of fat. A lobster curry was made with cooked peeled shrimps and not lobster, and a product described as "I una Fish with Garnish" contained only 12 per cent of tuna fish together with 88 percent of garnish, which included carrots, cauliflower and black olives none of whose presence was declared. The illustration on the label of a stuffed pork roll showed a considerable amount of salad not in the pack. A jar of curry paste was leaking and separated on receipt so that it was impossible to determine the edible oil. It should, however, have been labelled "stir before use", - and the declaration "spices" instead of curry or a list of spices, contravened the Labelling of Food Order 1953 and the Labelling of Food Regulations 1970, and a curry sauce mix showed an illustration of rice and vegetables which should have been labelled "serving suggestion" or "rice and vegetables required". The fat on a creamed milk pudding was only 2.56 per cent, although it was stated to be made with fresh milk indicating that the milk had not been properly stirred in the holding container. A ready to eat jelly contained 4 pieces of pineapple in an orange flavoured jelly, although the illustration on the lid was that of an orange, and one saw nothing about pineapple until the list of ingredients wasexamined, while a quince jelly was reported as inferior because the fruit content was only 20 to 23 instead of 40 percent. Two cans of apricots described as "solid pack" showed drained weights of only 62 and 64 percent, which are far from solid packs and the interiors of the cans were not lacquered. An apricot jam contained only about 23 per cent of fruit, but the Preserves Regulations allow such a product to be claimed as satisfactory because the fruit stones had been removed. A pineapple juice contained less than 80 per cent of fruit juice indicating the addition of water, and a whole lemon drink contained only 7.8 percent of lemon juice, whereas citrus drinks must contain not less than 10 per cent of potable citrus fruit. Some Campden Tablets, a preservative for fruit, were at least 15 per cent deficient in sulphur dioxide, doubtless due to their being old stock and oxidised. Some grapefruit segments contained 190 parts per million of tin and, if kept for some time before using, the quantity of tin would have exceeded the legal 250 parts per million. It is regretted that not all fruit canners yet use lacquered cans which would obviate this trouble. Some Moong beans contained a number of foreign seeds, all from leguminous plants but not proper moong beans. The Howard mould counts on samples of tomato puree and canned tomatoes were 56 and 52 per cent respectively whereas this should not be more than 40 per cent on tomato puree and 20 per cent on canned tomatoes. A sample of rice was reported as inferior because it contained small particles of dirt which would probably be removed if the rice was washed, but which looked objectionable, and some cloves were of poor quality and contained 4 per cent of stalks so that they were reported as inferior. Two samples of Devon custard were stated to be prepared from "Fresh milk, sugar, edible starch, flavouring, colouring" whereas they had been prepared with a mixture of whole milk and separated milk. Similarly a sample of milk chocolate sandwich biscuits were coated with chocolate made with skimmed milk powder. Two samples, submitted as "Cocoa Beans", were identified as a variety of the common bean, Phaseolus communis, but this particular variety is sometimes known as the "Coco", not "Cocoa" bean. An ingredient of Hamburgers with onion and gravy was described as "soya isolate" which must be properly described. Two samples of canned hot dog sausages were not of the size expected of a hot dog sausage, and should have been described as chipolatas or cocktail sausages, while a product labelled "Meatballs with Spaghetti and Tomato Sauce" was satisfactory, but should have been labelled "Meat Balls in Tomato Sauce with Spaghetti". The label of a Beef Curry with Rice was misleading as the rice was missing and the word "with" should be replaced by "for". Two cans of mackerel were stated to be in "Natural Oil" instead of "in natural juice", as there was more watery fish liquor than oil present. The words "Irish Moss" on a health drink were in letters six times the height of "Health Drink", as though the product was really Irish Moss. Three samples of sterilised cream were not properly labelled as "sterilised Cream". A product described as "Won I on Soup" consisted fundamentally of a type of pasta, and no soup was present, while another was described as chicken stock, but consisted essentially of salt, sodium glutamate and hydrolysed vegetable protein. The principal ingredient of a main course soup was chicken stock, but "Chicken stock" can mean anything or nothing, and an oxtail soup stated to be made with "good meaty oxtail, beef, red wine, onions and spices" B29 contained only an insignificant quantity of oxtail. Three different crispbread products all had labels showing various salads and sometimes cheese and butter not inside the packs; two samples of sterilised cream showed illustrations of fruit salads with cream poured on them, and a can of meat tuna bore an illustration of salad not in the pack. There was an illustration of cakes w ithout the words "cooking suggestion" on the wrapper of a margarine; an illustration of peaches with a topping, with the words "just add milk and whisk" on a carton of topping, without any peaches in the pack, and another on a Sage and Onion Stuffing Mix with a large turkey with tomatoes and various other vegetables, but showing very little stuffing. The ingredients of some canned mixed vegetables were not declared on the label in the order in which they were present, and a steak sauce and a grill sauce were incorrectly labelled both as regards the description of the ingredients mentioned and because other ingredients were omitted from the list. Three cream desserts contained cream but this was not declared among the ingredients. Various other lists of ingredients on labels were incorrect, as for example:- On the label of a beef stew the words "Beef Stew" were not in the same size print as "Seasoning Mix" and the illustration showed a stew with a lot of beef in it, not present in the pack. A mushroom gravy mix was misdescribed since the words "Mushroom gravy" stood out but the word "mix" was not obvious nor should it have been described as gravy since the word "gravy" implies a liquid which derives most of its flavour from meat, whereas this product contained neither meat extract nor animal fat. Some canned artichokes contained 11.9% artichokes and 57.7% of potatoes, so that they should have been described as "Potatoes with Artichokes", while some canned okra contained 1.09 per cent of salt and was therefore in dilute brine, without being so labelled. A wine v inegar was satisfactory, but the label bore no name and address of the manufacturer, importer, or packer. The description "Starch reduced slices made with wholemeal flour" was misleading because starch reduced products cannot be made with wholemeal flour unless other ingredients are added to reduce the starch, and if the starch is reduced by removal of starch from the wholemeal Hour then it is no longer wholemeal flour, l ikewise a product described as "Popcorn" was not popcorn, but was corn for popping. A jar of melon preserve contained 16 ozs. but the label claimed only 12 ozs. whilst a jar of marmalade contained 11b. as stated on the lid, while the main label declared 15 ozs. only. Various samples of drinks and the water taken from the tap of a dispenser were submitted following a complaint. The water had not only been boiled causing a precipitate of calcium carbonate, but it was also coloured brown due to contamination by traces of one of the substances used. Further samples of water from the tap were submitted together with the drinkmaster, but in your analyst's opinion it was the design of the drinkmaster that was at fault. Food Legislation 1972. This year has been a busy one for new and proposed legislation and also for various proposals regarding food directives, which will result from our entry into the European Common Market. What these latter will mean eventually is not yet known so it is unnecessary to comment on them at the present time. The Trade Descriptions Act 1972 was passed to cover omissions from the Trade Descriptions Act 1968 and requires goods to be marked with their country of origin, doing away with the mark "foreign produce" except in the case of mixed goods including generally foods such as mixed fruit or tea which may be derived from more than one country. The Poisons Act 1972 results from the passing of the Medicines Act 1968 and arranges for the control of the sale of poisons when the Medicines Act comes into full operation. Practically the whole of the Pharmacy and Piosons Act will now be repealed in so far as it affects Local Authorities. The Labelling of Food (Amendment) Regulations 1972 were issued largely because of weaknesses discovered in the 1970 Regulations and both sets of regulations came into force at the same time, 1st or 3rd January, 1973. Since the 1970 Regulations occupy 48 pages and the Amendment Regulations a further 14 pages it would have been an advantage to all concerned if revised regulations could have been issued embodying the amendments. In your analyst's opinion the continued exemption of catering packs from labelling control is a matter requiring urgent attention at the present time. More and more manufacturers are beginning to realise the advantages of labelling their products as catering packs in order to avoid regulations, but the products are being sold in the retail markets. The Lead in Food (Amendment) Regulations. This amendment has been issued in order to reduce the quantity of lead to 0.5 parts per million in food as consumed by infants. It results from the discovery that the lead content of canned infants foods was excessive and was helping to cause mild lead poisoning in infants. The Bread and Flour Amendment Regulations 1972. These regulations were issued in September and came into force in November. They permit the addition of azodicarbonamide and L-cysteine hydrochloride to flour and allow iron to be added as citrate or sulphate to flour instead of reduced iron. They also permit Vitamin B1, nicotinamide, and nicotinic acid to be used in any form complying with the requirements of the British Pharmacopoeia. Date Marking of Food. There has been considerable discussion in recent years about the necessity or advisability of prepacked foods being marked with their date of manufacture, date of packing, date before which they should be sold, or with other useful guidance for the purchaser. This is a matter of greatest importance both to the public and to the manufacturer and the Foods Standards Committee's report points out that the present laws are ineffective in preventing the sale of stale or otherwise unacceptable foods. The B30 report also says that the voluntary marking by manufacturers will not be sufficiently rapid to bringabout the necessary changes so that some form of legislation must be introduced, and recommends that foods should be divided into various categories with different types of markings so that the manufacturer or packer should be able further to decide which type he wishes to adopt, whether, for example, the mark should state the date of packing, the date by which sale should be effected or the date by which the food should be eaten, bearing in mind the desire to bring our food laws into line with international legislation generally. The final recommendation is that food manufacturers should be invited to comment on the report and that the Committee should then, with the Ministers' agreement, consider these and make a further report to the Ministers - a recommendation which must be heartily supported, as there is often a feeling that after the issue of a report, political influences are able to shape the final legislation. At the same time it has to be remembered that the date marking of foods, especially perishable foods, is not the final solution. More information must be given about storage conditions and care must be taken to see that these conditions are complied with before sale, even if one cannot control those which the housewife will subsequently employ. Antioxidants in Foods. The Food Additives and Contaminants Committee were asked to review theexisting regulations and therefore requested comments by the end of August, but their report has not so far been issued. Colouring Matter in Foods. Proposals were made so as to bring British Food colours into line with those used generally on the continent. Emulsifiers and Stabilisers. The Food Additives and Contaminants Committee issued a further report and the main point of interest is that it proposes a large number of specifications for various emulsifiers and stabilisers. These specifications are generally good and to be recommended, but it must always be remembered that foods imported from abroad may be made with ingredients, which do not comply with our specifications and that as it is impossible to check on these, it may place the home manufacturer at a disadvantage. Offals in Meat Products. The Food Standards Committee has issued a report on the use of offals in meat products. This would extend the use of offal in meat products, but the recommendations are contradictory in that in one place it is proposed that all offal should be described by its anatomical name and the proposal is then qualified by suggesting that offal should be described either by its anatomical name or by the word "offal". Naturally the manufacturer will use whichever word suits his purpose the better. Preservatives in Food. The Food Additives and Contaminants Committee issued a report reviewing the Preservatives in Food Regulations 1962, but your analyst finds it difficult to follow the reasoning in the report and it is possible that much of the report would have been different if the members of the Committee had studied the Final Report of Departmental Committee on the use of Preservatives and Colouring Matters in Food issued by the Ministry of Health in 1924. Some of the new proposals are extremely practical as, for example, the granting of permission to add preservatives to products such as fruit yoghurts, fruit ices, etc. If preserved fruit may be used initially it seems only a matter of commonsense to allow the same quantity of preservative in a final product containing unpreserved fruit as would be obtained from the use of preserved fruit initially. The committee appear to have missed their way, however, when discussing tomato paste and tomato puree. In par. 34 they suggest that fruit and fruit pulp and tomato paste and puree should be brought into line. In par. 63(e) it is further recommended that tomato pulp, paste or puree should be allowed to contain 800 p.p.m. of benzoic acid as an alternative to para-hydroxybenzoates and in par. 121 that no preservatives should be permitted in canned tomatoes. Tomato pulp, paste and puree are invariably canned and should be kept refrigerated after opening so that is is difficult to see why they need any preservative. In this respect they are entirely different from other fruit pulps, which are generally shipped unsterilised. The Food Standards Committee Report on Vinegars. The report on vinegars is dated 1971, but was not issued to the public until 1972. Whilst agreeing with most of the conclusions of the report one regrets the lack of historical knowledge of the Committee. It is suggested that the earliest method of preparing vinegar was from crab apples, whereas knowledge about vinegar goes back some 5,000 years or more to Egypt, a country which is too hot for the growth of crab apples. Mention is also made of the legal history of vinegar, but there is no mention of the fact that a blacking maker in the 1830’s required a vinegar manufacturer's licence because he used wood v inegar in the only blacking sold at that time, a water blacking. It will be well, however, for vinegars to be sold under their correct descriptions now that technology has improved and has made this possible and most people will approve the suggestion that vinegars should be sold as malt vinegar, cider vinegar, wine vinegar, spirit vinegar, grain vinegar or artificial vinegar. The only drawbacks are that it is suggested that malt vinegar need not be made from more malt than is necessary to convert starch to sugar and some wine dealers may be hurt because much of the real vin aigre, as vinegar was formerly known and from which the word vinegar is derived, cannot be sold because it will have too little acetic acid in it, the fermentation having been stopped by the combination of alcohol and acetic acid. An interesting memorandum was issued by the Department of Health and Social Security on the processing of large canned hams. The memorandum is useful and instructive, but it is a pity that when the Ministry of Agriculture. Fisheries and Food has stopped the use of the word "ham" for shoulders another department continues to use the word without qualification. This Mr. Mayor, Ladies and Gentlemen will be my last Annual Report and I would like to offer my thanks to the Council and to the previous Councils of the Borough of Fulham for their trust and help during the forty years it has been my privilege to serve them. Thomas McLachlan. Public Analyst. B31 HAMMERSMITH ANNUAL REPORT - 1972 Number Examined Number Adulterated Formal Informal Complaint Total Formal Informal Complaint Total Angelica 1 1 Baby Talcum Powder 1 1 Beverages Chocolate 2 2 Malt 4 4 Biscuits 3 1 4 1 1 2 Bread, rolls, crispbread and sandwiches 7 18 25 3 16 19 Bread pudding I 1 1 1 Cakes 1 2 3 2 2 Cake, pudding and pastry mixes 24 24 3 3 Campden Tablets 2 2 1 1 Cereals Baking powder 1 1 Barley 1 1 Breakfast 8 3 11 2 2 Corn 3 3 1 1 Custard and blancmange powders 4 4 Flour 6 1 7 Matzo Meal 2 2 Rice 13 13 2 2 Semolina 2 2 Trahanas 1 1 Wheat Germ 1 1 2 1 1 Cheese 1 Goats Milk 1 1 1 Hard 2 4 6 4 4 Soft 6 1 7 1 1 Spread 8 8 2 2 Cocktail Savouries 4 4 1 Coffee 4 1 5 1 Confectionary 11 8 19 6 6 Convenience Meals 15 15 3 3 Cream 51 2 53 8 2 10 Cream, soured 2 2 2 2 Cream, imitation 1 1 1 1 Crumpets 1 1 Custard, prepared 2 2 2 2 Dessert Mixes 8 8 Desserts Prepared 14 14 3 3 Dietetic Foods 6 6 1 1 Edible Fats Butter 14 2 16 2 2 Cooking fat 1 4 5 1 1 Corn Oil 1 1 Dripping 1 1 Lard 8 8 Margarine 18 18 2 2 Spread, low fat 1 1 1 Eggs, Scotch 1 1 2 1 1 Essence, rum 1 1 Fish Canned and bottled 24 1 25 4 1 5 Cooked 2 2 1 1 Frozen 5 5 Paste 6 6 B32  Number Examined. Number Adulterated Formal Informal Complaint Total Formal Informal Complaint Total Fish contd. Pate 2 2 Salted 1 1 Spread 5 5 Fruit Bottled and canned 30 3 33 4 3 7 Dried 11 11 2 2 Dumpling 1 1 Fritters 1 1 Glace 1 1 Juice 16 2 18 1 1 Peel 2 2 Pie Filling 4 4 Gelatine 1 1 Ginger, crystallised Gravy Mixes 1 1 7 7 1 1 Herbs, dried 4 4 Ice Cream 9 9 Infant Food 11 11 Jellies 4 4 1 1 Macaroni products 8 8 Meat Black Puddings 2 2 1 1 Canned 63 6 69 5 5 10 Chicken 1 2 3 1 1 Fresh 21 21 Frozen 10 10 4 4 Hamburgers and Faggots 5 5 1 1 Paste and spread 1 14 15 1 1 2 Pate 4 4 Pies 16 3 19 3 3 Pork Brawn 1 1 Puddings 7 1 8 1 1 Sausages 3 44 6 53 1 5 4 10 Sausage rolls 3 3 Suet 2 2 Milk Bottles 12 12 12 12 Buttermilk 1 1 Condensed 5 5 Dried 9 9 Evaporated 7 1 8 1 1 Fresh 43 1 44 Long Life 1 1 Separated 2 2 Topping 1 1 Mustard, prepared 3 3 Nuts 1 11 3 15 3 3 Peanut butter 1 1 Pickles 3 3 Pies, apple 2 2 2 2 Pizza 1 1 Preserves Jam 9 9 2 2 Jelly 3 3 1 1 Lemon Curd 1 1 Marmalade 6 6 1 1 Mincemeat 4 4 B33  Number Examined Number Adulterated Formal Informal Complaint Total Formal Informal Complaint Total Puddings. Fruit 2 2 Milk 7 7 1 1 Sponge 5 5 1 1 Ravioli 2 2 Rennet 1 1 Rose Coco Beans 1 1 2 1 1 2 Salad Cream 13 13 Sauce 27 27 3 3 Sauce Mixes 7 7 1 1 Sea grass 1 1 Seasoning Mixes 3 3 1 1 Soft Drinks 1 19 1 21 3 1 4 Soft Drink Powder 4 4 Soup Canned 12 12 3 3 Cubes and powder 22 22 1 1 Spices Caraway 1 1 Cinnamon 1 1 Cloves 1 1 1 1 Curry 3 3 Mixed 1 1 Minced 1 1 Nutmeg 1 1 Pepper 3 3 Pimentos 1 1 Spirits Gin 2 2 Vodka 1 1 Whisky 1 1 2 Spread Savoury 8 8 Sweet 2 2 Stuffing mix 1 1 1 1 Sugar 4 4 Syrup 1 1 Tea Cup 1 1 1 1 Tea 1 8 9 Tea, prepared 2 2 Tomatoes Canned 15 15 1 1 Juice 3 3 Paste and puree 1 6 1 8 2 1 3 Vegetables Canned 38 1 39 4 1 5 Dried 8 8 1 1 Fresh 1 1 Juice 2 2 Pate 2 2 Pickled 4 4 Potato Chips 1 1 1 1 Vegetarian Products 2 2 Vinegar 2 2 1 1 Water from heater 1 1 1 1 Yeast extract 2 2 Yoghurt 2 18 1 21 1 2 1 4 B34  Number Examined Number Adulterated Formal Informal Complaint Total Formal Informal Complaint Total Drugs Antiseptics 1 1 2 Calcium Tablets 1 1 Energy Tablets 2 2 Health Salts 1 1 Rose Hip Syrup 2 2 Stomach Tablets 1 1 Tonic Capsules and Tablets 4 4 Carried forward 16 1000 97 1113 4 101 82 187 TOTAL 16 1012 98 1126 4 101 82 187 Report on Examination of Beads Following the report in the Public Press towards the end of May 1972, that certain necklaces made from beads were formed from seeds containing poison, the owners of the necklaces made from beads took them in to Police Stations and to the Health Department for checking purposes. The seeds found in the necklace examined in Bristol, which gave rise to the national publicity, were the fruit of the Abrus precatorius vine found mainly in Africa, Asia and Mexico. Eighteen necklaces composed of beads were handed in to the Health Department and all were examined by the Council's Public Analyst, fifteen of which were found to contain one or more types of poisonous seed. Of the remainder, two were found to contain non poisonous seeds and one of these has been returned to the owner. The second one has, at the request of the owner, been destroyed. In the case of the last remaining necklace, because no authority has been able to identify the seeds, a specimen has been sent to the Government Chemist in Nigeria to see if they can be classified there. All owners of necklaces handed in were advised of the result of the examination. Authorisation for destruction of all those containing poisonous sees was received. B35 MARKETS There are seven markets in the Borough five of which are street trading sites. In two of the street trading sites the number of stalls is one only. The street trader is a source of attraction to a large number of people still, although in some respects there seems to be a slight change in the type of goods sold. During the year the re-development of the north side of King Street began with the demolition of property to the west of Bradmore Lane. The effect of this on the street traders in Bradmore Lane had been foreseen and, following the demolition of Lawson's premises, the site was concreted and with the co-operation of the traders, arrangements were completed for the termination of trading in Bradmore Lane and for the temporary re-location of trading on to the site in Hammersmith Grove where Lawson's premises had stood. LICENSING ACT 1964 Part two of the Act deals with the sale of intoxicating liquor in club premises which must be registered with The Clerk to the Justices for the Sessions Area in which the clubs are situated. The Local Authority or Police may object to the registration or renewal of registration of any premises considered to be not suitable or convenient, and the Department is able to comment on the public health and food hygiene aspects of such club premises. In particular, where new applications are being made for registration, it is usually possible to have incorporated in the provisions, suggestions made by the Department thereby making any objections to registration unnecessary. This arrangement worked satisfactorily during the year and in no case was it necessary to recommend objection to registration. OTHER REGULATIONS Fertilisers and Feeding Stuffs Act 1926 Fertilisers and Feeding Stuffs Regulations 1960-1964 Under the above, the seller of soil fertilisers or cattle or poultry feeding stuffs is required to furnish a statutory statement as to the name and contents of the material as listed in Schedule 1 of the Regulations, and a local authority in enforcing the legislation may take samples for analysis. During the year the only known seller of loose animal feeding stuff ceased to trade therein. No samples were taken during the year. Rag Flock and Other Filling Materials Act, 1951 Rag Flock and Other Filling Materials Regulations, 1971 The above Act and Regulations deal with the licensing and registration of premises where filling materials for use in upholstered articles are made or used, with a view to securing the use of clean fillings. There are five premises registered in the Borough and although no samples of filling materials were taken during the year the premises were satisfactory. Consumer Protection Act, 1961 Nightdresses (Safety) Regulations, 1967 These regulations impose requirements to prevent or reduce risk of death or personal injury in relation to nightdresses and no person may sell or have in his possession for sale a nightdress not complying with the Regulations. During the year seven samples were taken and unsatisfactory reports were received in respect of three of these. Communications were sent in each case with a view to righting the discrepancy. The Toys (Safety) Regulations, 1967 These Regulations prohibit the use of celluloid in toys other than ping pong balls and impose restrictions in relation to the paint which may be used on toys, laying down a maximum content in respect of lead, arsenic, soluble antimony, barium, cadium and chromium. During the year twenty-one samples of toys were purchased and all were found to comply with the Regulations. Oil Heaters Regulations, 1966 These Regulations relate to warning notices and the standard of performance of oil heaters and although it is found that new heaters generally are in good condition second-hand heaters are more likely to contravene the Regulations. It becomes more and more difficult to find second-hand oil heaters exposed for sale. During the year two heaters were submitted for examination but in neither case was it found necessary to proceed. The Electric Blankets (Safety) Regulations, 1971 These Regulations came partly into operation on the 1st January, 1972 and fully into operation on the 1st September, 1972. The Regulations broadly require electric blankets to bear the appropriate certification mark or otherwise to comply with the requirements of the relevant British Standard. All the electric blankets examined by the end of the year had been found to bear the appropriate certification mark. The Cooking Utensils (Safety) Regulations, 1972 The above Regulations impose requirements in relation to the kitchen utensils used for the cooking of food, the effect of which is to restrict to an upper limit of 20 parts in 10,000 parts the lead content of the tin or other metallic coating used on the surface of the utensil designed to come into contact with the food. These Regulations will come into operation on the first of April 1973. B 36 National Assistance Act, 1948 National Assistance (Amendment) Act 1951 Removal to Hospital of Persons in Need of Care and Attention Under the provisions of the above Acts, application may be made to a Court of Summary Jurisdiction for an Order for the compulsory removal to hospital of persons in need of proper care and attention. It was not found necessary to take action under these Acts in respect of any person in the Borough during the year. In all cases, it was possible to find a solution in other ways, usually by co-operation with the family doctor and the provision of ancillary services. National Assistance Act, 1948 - Section 50 Burial or Cremation of the Dead During the year 22 burials were carried out by the Council. PUBLIC BATHS AND WASH-HOUSES The Metropolitan Water Board supply is used for both baths and the pool. The water is chlorinated, given alkali treatment and filtered by way of continuous circulation. Samples of water were taken for analysis and all were reported satisfactory. In addition, frequent checks are made by the staff at the baths, particularly when a lot of people are using them. The public baths and wash-houses in Lime Grove, Shepherd's Bush and North End Road, Fulham, provide facilities for bathing, swimming and laundry work. For bathing there are private hot baths or shower cubicles, and towels, soap, bath cubes and shampoos are supplied at a small cost. There are concessionary rates for children, and old age pensioners are entitled to free baths on certain days. In the public wash-houses, fully automatic machinery is provided for washing and spin drying. There are also facilities for ironing. There are two swimming baths at Lime Grove and three at North End Road, only the smaller ones being open all the year round. The larger ones are available during the summer, as during the winter they are converted into public halls which may be hired for meetings, concerts, wrestling, dancing, badminton and bowls. BLOEMFONTEIN ROAD OPEN AIR BATHS This pool is open during the summer for swimming and sunbathing. During the summer season, checks are also made on the various paddling pools in the parks. LABORATORY FACILITIES Bacteriological examination of food is carried out by the Public Health Laboratory Service, County Hall, S.E. 1. and occasionally by the Royal Institute of Public Health. The Public Health Laboratory Service is also available to doctors for bacteriological examination - throat swabs, intestinal specimens, and so on. The necessary swabs and outfits for the laboratory can be obtained from the Environmental Health Section who provide a Monday to Friday daily service to County Hall, with collection points in various parts of the Borough. B37 CORONER S COURT AND PUBLIC MORTUARY These buildings which are situated in a central part of the Borough within easy reach of the excellent travel facilities in Hammersmith Broadway are the property of the Council. The Coroner's Court and ancillary offices are leased to the Greater London Council who are responsible for this aspect of the service. The Court Room is well equipped with adequate accommodation for Jury, Press and public in addition to Counsel and Officials. Microphones are provided for the Coroner and Witnesses with an amplifier to ensure that all speech is clearly audible throughout the Court. Linked to this system is a tape recorder for use by the Coroner. Offices are provided for the Coroner and his officers with adequate waiting rooms and toilet facilities. The public mortuary and post-mortem room are provided by the local authority under Section 198 of the Public Health Act, 1936. There are two purpose built-refrigerators providing accommodation for eighteen bodies, which are more then adequate to cover normal needs in the mortuary. A viewing room is also provided where relatives through a specially designed glass screen can view the deceased. This room is furnished with flowering plants by the Parks Department. The post-mortem room is equipped with four tables of special design incorporating elbow operating taps and foot operated sluicing mechanisms with drainage ducts that can readily be cleared. An independent gas boiler provides very hot water to meet all requirements and an electrically operated air conditioning unit ensures a satisfactory temperature both summer and winter. Offices are provided for both the Pathologist and Mortuary Superintendent with toilet facilities. A reciprocal agreement operates with the neighbouring borough of Ealing during the absence of either Superintendent due to leave or sickness. Bodies are routed to the Acton mortuary or vice-versa and a nominal fee of £2 per body is either received or paid. During the year 851 bodies were received at the mortuary, an increase of 117 on the previous year. The following is a summary for the year:- Bodies in respect of Hammersmith By order of Coroner 745 Total By arrangements of Health Department (i.e. from Council homes for the elderly, etc.) 7 Bodies in respect of Ealing 58 Bodies in respect of Wandsworth 41 851 No. of Post-Mortem examinations Hammersmith cases 745 Ealing cases 58 Wandsworth (employing own staff) 41 844 No. of Inquests held at Coroner's Court Hammersmith cases 92 Ealing cases 64 B38 STAFF MEDICAL EXAMINATIONS All applicants for employment with the Council are required to complete a detailed questionnaire which is considered by the Principal Medical Officer who then decides whether a medical examination is necessary. Medical examinations, however, are still carried out in the following cases: 1. Personnel in contact with children 2. Cases of prolonged sickness 3. Personnel for extension of service 4. All food handlers Chest X-Rays are required for all staff joining the Council. Tribute must once again be paid to the general practitioners and hospital specialists who supply essential information in so many cases. With their specialised knowledge given so willingly, doubtful cases are properly assessed to the mutual benefit of both the Borough and the staff. Statistical information is given below: Staff Medical Questionnaires & Medical Examination - 1 Jan. until 31 Dec. 1972 New Applicants Questionnaires received 1555 Questionnaires satisfactory 1202 Applicants withdrawn or not offered post 155 Questionnaires not completed 46 Medically examined new applicants 152 Total 1555 Medical Examinations Satisfactory 215 Not satisfactory 22 Suitable for employment subject to review 48 Total 285 Extended Service Examined and recommended for Extension of Service Total 13 13 Retirement on Medical Grounds Examined and recommended for retirement (including three domiciliary visits) 24 Total 24 TOTAL MEDICAL EXAMINATIONS 322 Special Requests Recommended as fit to return to work 19 Recommended as fit for light duties for limited period 4 Recommended as fit for the work in which they are employed 21 Recommended as fit for part-time employment 23 Recommended as fit for heavy vehicle driver 5 Total 72 Reviews Examined and now satisfactory 21 Examined and further review recommended 28 Examined and new review recommended 48 Examined and recommended to retire 7 Total 104 Examined at Hammersmith for other Boroughs 11 Examined elsewhere for Hammersmith 2 Examined at Annesley for Annesley House, Southsea 8 Examined at Hammersmith for Annesley House, Southsea 12 Total 33 Chest X-ray examinations at Hammersmith Hospital 498 Chest X-ray examinations at Hammersmith Hospital (repeat) 33 Chest X-ray examinations at S.W.L. Mass Radiography Units 319 Chest X-ray examinations at other hospitals & mass X-ray Units 315 Total 1165 B39 Specialist and general practitioner's letters 43 Stool examinations 25 Child adoptions 31 Children free from infection 19 Flu vaccine injections 314 Total 432 Employees Retired on grounds of Permanent Ill-Health Arthritis 2 Bronchitis 1 Heart Disease 3 Hypertension 3 Psychiatric 8 Slipped Disc 1 Various 6 Total 24 Candidates who Failed Medical Examinations for Employment with the Council Arthritis 2 Chest Conditions 1 Heart Disease 1 Hypertension 3 Psychiatric 8 Slipped Disc 4 Others 1 Total 20 B40 MEDICINAL BATHS AND TREATMENT CENTRE General This year it is pleasing to report that there was a drop in both the number of infested properties and in the cases of scabies, although the latter is still remaining above the annual post-war average. There were two serious disruptions to the working of the unit during the year. The first occurred in February when the supply of electricity was either halted or reduced causing a loss of activity for considerable periods. The second occasion was in September when supplies of steam and hot water were shut down for almost two weeks owing to essential boiler repairs at Lime Grove baths. This was partially relieved by operating a restricted laundry serivce for incontinent people at Fulham Baths. The neighbouring Royal Borough of Kensington and Chelsea also helped by making available facilities for personal cleansings and treatments, whilst head treatments were carried out at the Scotts Road centre by using hot water from an immersion heater. During the period from January 1966-July 1972, evening staff were working to wash fouled laundry and linen from Council establishments, which relieved the heavy pressure of work the following day. In the summer it was decided to purchase 601b. capacity washers because these would not only cope with the present heavy demands but would also allow for the future growth of the service. Two new 251b. hydro-extractors were also of great benefit and there is now no hold-up of articles which have passed through the washing machines. It is anticipated that a general purpose ironing machine will be installed in 1973 which should increase productivity even further. Another useful addition to the Centre was the hoist erected in one of the bathrooms to aid the staff in lowering certain disabled patients into the water. In September a start was made to redecorate the area around the disinfector and one of the bathrooms on which a damp resistant paint was experimentally used. Nursing and health visiting students, doctors and public health inspectors have been some of the visitors to view the work of the Scotts Road Centre during the year. CLEANSING AND TREATMENT OF PERSONS 1. Scabies As mentioned earlier, this has been the first year since 1964 to show a fall in attendance for the treatment of scabies, with 451 people treated as against 620 cases in 1971. 2. Impetigo This infection is commonly associated with head lice and five individuals were treated in 1972, the first cases at the Centre since 1968. 3. Flea Infestation Two people were treated for this condition. 4. Pediculosis It was agreed that children could be sent to Scotts Road for head cleansings if the journey obviated the crossing of busy road junctions. This may considerably increase the number of cleansings at the Centre, but should make little difference in the overall total within Hammersmith. The attendances for this school group were 50% up on the 1971 figures, adult attendance increased by 39% whilst the number of infants seen was quadrupled. The considerable fall in the number of cleansings for body lice is mostly due to the closing of a large hostel which provided inexpensive accommodation in the locality. 1972 PED. CAPITIAS PED. PUBIS PED. CORPORIS Males Females Males Females Males Females Ind. Tre. Ind. Tre. Ind. Tre. Ind. Tre. Ind. Tre. Ind. ###] Adults 25 25 66 72 55 82 14 19 35 39 1 2 School Age 73 87 80 119 Under Five 35 39 46 54 No Fixed Abode 2 2 36 44 1 1 From hostels 19 21 Totals 135 153 192 245 55 82 14 19 90 104 2 3 (Ind = Individuals) (Tre = Treatments) B41 Disinfestation There was a decrease in the number of treatments given in this section, 1,537 rooms being dealt with as opposed to 1,866 in 1971. Infestation with fleas and bed bugs continues to be the largest problem in this area. Disinfestation of Property Nuisance Number of Visits Rooms Fumigated Ants 60 129 Bed Bugs 170 451 Beetles 52 123 Cockroaches 45 126 Fleas 153 588 Lice 6 8 Other Pests 43 112 Total 529 1537 In addition, help was rendered in 109 complaints of wasps, and 11 visits paid to dry articles which had been subjected to water damage. Disinfection This is mostly confined to dealing with requests following terminal non-infective illness. Spraying is usually carried out to reassure what is generally a distressed relative. A total of 52 visits in respect of 118 rooms were made, and 16 visits made in respect of 26 rooms where there had been possible infection. Assisted Bathing This bathing service is for the benefit of the old and infirm usually at the request of social workers or general practitioners. The patients are collected and returned to their homes by Borough transport. Because it is such a time-consuming service it has to be restricted but those patients who receive it are very appreciative. A total of 18 patients with an average age of 68.8 years received 465 baths. The infirmities included hemiplegia, arthritis, multiple sclerosis and poliomyelitis. The Station Superintendent who is a State Registered Nurse, keeps a strict watch on these patients during bathing. The Health Laundry In trying to cope with the most pressing needs of the present demand, the working conditions continue to be hampered by lack of space. Requests have had to be restricted and priority is given to acute cases who are often waiting for a hospital bed. In addition, the number of articles laundered for the Old Peoples' Homes has risen with the increase of incontinent persons resident in the Homes. No commercial laundry would provide such a regular twice weekly service to launder fouled linen, including its collection and delivery, as Scotts Road is able to do and, in future, with larger accommodation it is hoped to provide an even better service. Incontinence Pads and Dressings The provision of disposable paper pads and sheets is a logical extension of a laundry service for incontinent people, and collection and incineration of these substances has become an accepted part of the work of the Centre. As fewer homes now have open fires, the burning of this fouled material is not always possible, and no doubt the number of collections made will increase in future. Collections are usually made three times a week from the Old Peoples' Homes and twice a week from other cases, special arrangements being made regarding acute cases and home dialysis. In 1971 300 collections were made, whilst in 1972 the total exceeded 1200. Incontinent Section-Yearly Summary 1966 1967 1968 1969 1970 1971 1972 No. of cases on 1 Jan. 180 198 218 211 199 151 201 New cases started during year 226 191 171 153 149 195 269 Cases removed from register 208 171 178 165 197 145 244 Cases continuing on 31 Dec. 198 218 211 199 151 201 226 No. of collections 11229 11508 11692 10693 9547 10335 10698 No. of articles laundered 134564 133857 140303 130578 117186 121701 120108 B42 Laundry Service for Council Establishments and Other Organisations A total of 55,136 articles, not including fouled linen, were laundered during the year plus between 8,000 and 9,000 towels and items of protective clothing used in the course of duties at Scotts Road. Steam and Chemical Sterilisation Demand for this service is mainly from the Borough's own establishments and Fulham Hospital: 1. Steam Sterilisation of Bedding, Clothing & Soft Furnishings: No. of Collections No. of Articles Fulham Hospital 166 866 West London Hospital 25 179 Stamford House 135 1499 Butterwick House 11 100 From private dwellings 38 176 Other collections 13 19 TOTAL 388 2839 2. Formaldehyde Sterilisation of Clothing and Accessories: No. of Collections No. of Articles Fulham Hospital 36 257 Hurlingham Lodge 82 6038 Stamford House 19 278 Other Collections 8 22 TOTAL 145 6595 3. Steam Sterilisation of Clothing for Verminous Persons & for Certain Cases of Scabies 268 such people had their clothing sterilised. SUMMARY OF WORK CARRIED OUT IN THE LAST TWO YEARS AND THE PERCENTAGE INCREASE/DECREASE 1971 TO 1972 BREAKDOWN OF DUTIES YEAR %-age 1971 1972 LAUNDRY FROM PRIVATE HOMES Collections 10335 10698 + 3.5 Number of articles 121701 120108 - 1.6 LAUNDRY FROM COUNCIL ESTABLISHMENTS Number of articles 62392 55136 - 11 PERSONAL CLEANSING/TREATMENTS Scabies: Number of persons 620 451 - 27.3 treatments 1136 827 - 27.2 Pediculosis: Number of persons 480 488 + 1.7 cleansings 609 606 - 0.5 PROPERTY DISINFECTED/DISINFESTED Number of properties 714 597 - 16.4 rooms 1907 1681 - 11.9 B43 STERILISATION OF ARTICLES Loads steam treated 677 636 - 6.1 formaldehyde disinfected 104 145 + 28.3 ASSISTED BATHING OF AGED AND INFIRM Number of persons 17 18 +5.9 bathings 271 465 + 71.6 AID TO OTHER LOCAL AUTHORITIES Number of persons 422 446 + 5.7 attendances 712 699 - 1.8 STATISTICAL SUMMARY FOR HAMMERSMITH 1967 1968 1969 1970 1971 1972 HEALTH LAUNDRIES: Incontinent Section 133,857 140,303 130,578 117,186 121,701 120,108 Departmental Section 56,512 42,431 53,458 57,078 62,392 55,136 Total of all articles laundered 190,369 182,734 184,036 174,264 184,093 175,244 BATHING OF AGED AND INFIRM: Number of persons assisted 18 18 17 15 17 18 Number of cleansings 291 308 261 241 271 465 PERSONAL CLEANSING AND TREATMENT: Pediculosis Individuals 305 291 267 336 480 488 Treatments 439 391 343 434 609 606 Scabies Individuals 463 468 519 527 620 451 Treatments 907 795 787 882 1,136 827 Other dermatological conditions Individuals 20 19 7 17 7 Treatments 41 - 21 12 17 7 SPRAYING OF PROPERTY: Number of premises 386 446 543 654 714 597 Number of rooms 763 973 1,391 1,565 1,907 1,681 STEAM & CHEMICAL STERILISATION OF BEDDING. CLOTHING. ETC: Number of collections 272 385 364 358 398 533 Number of articles 8,029 9,736 10,914 11,304 11,151 9,434 FOR OTHER LOCAL AUTHORITIES PERSONAL CLEANSING: Individuals 394 361 350 523 422 446 Treatments 584 604 588 840 712 699 B44 C. PERSONAL HEALTH THE PERSONAL HEALTH SERVICE In England and Wales the Personal Health Services of the Local Health Authorities (i.e. the Councils of Counties-and County Boroughs) are provided under Sections 21-29 of the National Health Service Act 1946, as amended by the Health Services and Public Health Act, 1968. A similar position obtains in the case of the London Borough Councils with the exception that Section 27, which deals with the provision of an ambulance service, is administered as one service throughout Greater London by the Greater London Council. CO-ORDINATION OF SERVICES Co-ordination and co-operation of the Local Health Authority's services with the hospital and family doctor services were continued during the year. There was consultation between the three services at Maternity Liaison Committees and during the year many visits of observation were made to personal health establishments. Visitors included students of nursing, medicine, dietetics, nutrition, home economics, social and hospital administration and student tutors. Nursing Officers continue to teach student nurses at Fulham/Charing Cross, West London, Royal Masonic and Hammersmith Hospitals. The ways in which domiciliary staff co-operated with the other two branches of the Health Service are described in the following paragraphs on particular services. HEALTH CENTRES The National Health Service Act 1946, made it aduty (which for various reasons has not been insisted upon) for every Local Health Authority to provide, equip and maintain, to the satisfaction of the Minister, premises which shall be called "Health Centres" at which facilities shall be available for all or any of the following purposes: General medical, dental or pharmaceutical services, services of the Local Health Authority, services of specialists and health education, and "a local Health Authority shall to the satisfaction of the Minister provide staff for any Health Centre provided by them". In July, 1965, the Minister of Health asked for information on the Council's long-term plans-for the development of the Health and Welfare Services. The period for which information was required was the 10 years from 1st April, 1966 -31st March, 1976; and in addition, information in the year 1965/66 was requested. It was, therefore, essential to forecast the demands and needs of the various services to decide how they could best be met for the future. It was felt that the needs of the Borough could best be served by Group Health Centres for the practice of preventive medicine and for the promotion of the mental and physical health of the family. These Centres would provide all or most of the following: Accommodation for General Practitioners Maternity and Child Health facilities School Treatment Centre Information/Advice Centre Additional Special Clinics as necessary (Example: geriatric/chiropody) There are obvious advantages to both the public and staff in having these services in one building. A full description was given in my Annual Report for 1968 of the first Health Centre opened in the London Borough of Hammersmith. This Centre provides accommodation for five General Practitioners and a number of Local Authority clinics. Co-operation between the two branches of the services remains excellent. CARE OF MOTHERS AND YOUNG CHILDREN Under Section 22 of the National Health Service Act 1946 it is the duty of every Local Authority to make arrangements for the care (including particularly dental care) of expectant and nursing mothers and of children who have not attained the age of five years and are not attending primary schools maintained by a Local Education Authority. Maternity and Child Health Service Notification of births ensures that the health visitor service is available and offered to all regardless of social need; but those who are in need are identified early and given special attention. Because the numbers are small, personal contact can be achieved with every mother. The mobility of the population, however, means that case loads are constantly changing, and personal communication with field workers both within this Borough and in other boroughs is vital. Ante-natal care is still provided on a tripartite basis - by hospitals, general medical practitioners and the local health authority. The important thing is to ensure that every mother receives adequate medical and social care and that health education is available to all. C1 Mothers attend at child health centres with infants from the age of two weeks for the purpose of getting advice from health visitors and clinic doctors about mothercraft and care of their children, and for routine developmental examinations by the clinic medical officers. Mothers may attend as often as they wish but are invited to attend for routine developmental examinations at six monthly intervals until their children are two years of age. Thereafter, they should attend at least once yearly for medical examination. As required, children are referred for further developmental examinations to the Borough^ Developmental Clinics held at selected child health centres where they are seen by specialists in developmental paediatrics, who refer then to assessment centres, if necessary, or continue to keep them under supervision. Other services available for children at the centres include routine prophylaxis against diphtheria, whooping cough, tetanus, poliomyelitis and measles, as well as creche facilities (at two centres). For mothers, ante-natal, and post-natal, and cervical cytology and family planning clinics, and health education are provided. Mothers and families know the health centres as a focal point where they can contact the health visitor and visit at intervals for consultation with the clinic medical officers. Clinic medical officers are primarily concerned with developmental paediatrics and a section on the handicapped and observation register can be found elsewhere in this report. Medical officers and health visitors are assisted in their tasks by clinic nurses. There are eight Maternity and Child Health Centres in the Borough, together with a purpose-built Health Centre as shown below: Becklow Gardens, Becklow Road, W12. Burne Jones, North End Road, W14. Glenthorne Road, 48 Glenthorne Road, W6. Greyhound Road, 90-92 Greyhound Road, W6. Milson Road, 1-3 Milson Road, W14. Parsons Green, 5/7 Parsons Green, SW6. Wandsworth Bridge Road, 170 Wandsworth Bridge Road, SW6. Westway, The Curve, W12. The Grove Health Centre, 95 Goldhawk Road, W12. These centres provide between them the following services: Ante-natal Cytology Creches Dental Care for expectant and nursing mothers and children under 5 Family Planning Child Health Mothers' Groups Mothercraft Parentcraft Post-natal Relaxation Vaccination and Immunisation for children under 5 In 1972 attendances at the Child Health Centres (including attendance at the Grove Health Centre) of children up to 5 years of age totalled 31,098 (43,328). Priority Dental Treatment Dental treatment is provided for expectant and nursing mothers and children under five years; the attendances being 22 and 553 respectively. The service is provided in conjunction with that for school children, combined use being made of the staff and premises. Screening for Phenylketonuria All new-born babies have a screening test at the age of six days, using the Guthrie method, for the detection of phenylketonuria. This is normally carried out in hospital on babies born in hospital and by domiciliary midwives on children born at home and on those babies discharged from hospital before six days. This test is used to detect the presence of phenylketones in the blood which result from a metabolic disorder which if left untreated may lead to mental subnormality. Positive cases can be referred to hospital for treatment and development is then normal. C2 Well-Baby Clinics Held at General Practitioners' Surgeries In addition to the Child Health Sessions at the Council's Maternity and Child Health Centres, four Health Visitors attended Well-baby Sessions held in General Practitioners' surgeries. A General Practitioner also conducts a well-baby clinic for his own patients in one of the Council's Maternity and Child Health Centres. Cervical Cytology Screening Service (Prevention of Illness, C are and After-Care, Health Services and Public Health Act 1968, Section 12) Women of any age who live or work in Hammersmith may attend for cytology screening and are actively encouraged to do so by Health Visitors. Some excellent publicity leaflets and posters have been provided by the Women's National Cancer Control Campaign and the Health Education Council. A limited number of appointments are made for each session so that in addition to the smear test each patient has a urine examination, a full gynaecological examination, and examination of the breasts to screen for early breast cancer. Our doctors instruct each woman on how to examine her own breasts and there is time also for discussion of marital problems if required. The family doctors are informed of all results, whether negative or positive, and patients are invited to have a second test after 5 years. The Council also participates in the National Recall Scheme whereby women are offered a further test after a five year interval. Some general practitioners in the Borough prefer to provide a cervical cytology service themselves but the majority advise and encourage their patients to attend the Council's clinics. During 1972, 162 (137) sessions were held at which 1,203 (918) attendances were made. Facilities were offered to all women regardless of their age group to take advantage of this test. In addition, letters were sent to all firms in the Borough inviting women employees to attend our clinics, or offering to provide a service at the place of employment, provided a sufficient number of individuals wished to take advantage of this, and provided adequate facilities were available. 15 special sessions were held in 1972 accordingly at places of employment. HANDICAPPED CHILDREN Of recent years considerable attention has been focussed on the needs of the handicapped child and his family. A child may be handicapped by reason of some congenital abnormality or deformity as a result of disease or injury in early life or of adverse emotional and environmental conditions. There is a tendency for handicaps to be multiple. The same pathological process that causes a physical handicap may also lead to an intellectual one. A child with impaired physical or mental development may also suffer from emotional deprivation, over protection and lack of opportunity in his home environment to develop his potential. The emotional needs of handicapped children - the longing for love which a physically unattractive child so badly needs, the self-awareness which he must learn at a very early age, or the frustration at lack of ability which is expressed in temper tantrums - these are problems for the family. The whole family must be involved, but when the daily regime of a young child is considered it is the mother who bears the greatest burden. The mother will need help in understanding that when the other siblings have outstripped the handicapped child in agility, performance and control of bodily functions, this one will continue to need the care usually bestowed on a baby. She will also need to learn, and this is a difficult lesson, that a handicapped child must also be subject to the ordinary rules of social behaviour. He must be allowed and encouraged to do things for himself such as feeding and dressing. He must learn to accept "no" without resorting to temper tantrums or even fits in an attempt to get his own way. The local authority, the hospital and general practitioner service and voluntary organisations all have a part to play in meeting the needs of handicapped children and their families. The early diagnosis of and treatment of the condition is a medical responsibility. Support of the family in the home by provision of material help and advice on day to day management is a role undertaken by the health visitors or social workers, while early training and education may be undertaken by nursery nurses or nursery teachers. For any satisfactory service a team approach is essential. No matter who provides the help it must be co-ordinated. There must be full assessment of the family's immediate needs and of the child's potential. The parents must be given a realistic prognosis and helped to accept it by counselling on a long term basis. As a first step in the co-ordination of the services for handicapped children, the Health Department maintains a register to encourage the early identification of handicaps to ensure follow up by regular review, to arrange for appropriate management and treatment, and where necessary to ascertain for special education. Children may be placed on the register because of congenital abnormalities notified at birth, or because of failure to make normal progress in any sphere of development whether this is due to physical or mental handicap or adverse emotional or environmental conditions. The service for handicapped children has two main objectives. One is to provide the necessary help to the child and his family from an early age so that he shall learn to live with the handicap, to adjust to it and ultimately to become an independent member of the community. The other is to prevent handicaps developing: to identify and treat deviations from the normal before all the secondary disadvantages, emotional disturbance, educational failure and social maladjustment have overwhelmed him and turned him into an unacceptable, unsuccessful, unhappy misfit. Sufficient time is allowed for full examination and assessment of the child's immediate needs and as far as possible of his future requirements and potential. Placement may be recommended in a special unit or day nursery in order to provide training by skilled staff and an opportunity for the child to play and learn with C3 others. Health visitors and social workers are encouraged to attend at the same times as their families, and parent counselling on a long term basis is provided. Observation and Handicap Register. Babies that are considered to be at risk of developing a handicap by reason of adverse factors occurring during pregnancy, labour or the lying-in period, are entered on the Observation Register. The Register is scrutinised at regular intervals by a Medical Officer so that the child's progress and development may be kept under review. Should a handicap become evident the child's name is then transferred to the Handicap Register. HANDICAP AND OBSERVATION REGISTER (0-5 YEARS OLD) YEAR OFBIRTH 1972 1971 1970 1969 1968 TOTAL NERVOUS SYSTEM Epilepsy - - - 2 - 2 Cerebral Palsy - - - 1 - 1 Neuro Muscular - - - - - - Spina Bifida 4 - 1 1 - 6 Other congenital 1 1 - - - 2 Other acquired 1 1 1 - - 3 EYE, EAR Blind - - - _ _ _ Partially sighted 2 1 - - 1 4 Deaf - 1 - - - 1 Partially hearing - - - - 1 1 ALIMENTARY SYSTEM Cleft palate, hare lip 1 2 1 - - 4 Oesophageal stricture - - - - - - Colostomy - - 1 1 - 2 Other 1 2 1 - - 4 CARDIO-VASCULAR SYSTEM Congenital 5 5 6 1 - 17 Acquired - - - - - - RESPIRATORY SYSTEM Fibro cystic - - - - - - Bronchiectasis - - - - - - Severe Asthma - - 1 4 1 6 Other - - - 1 - 1 URO GENITAL SYSTEM Congenital 3 5 1 - - 9 Nephritis - - - 1 - 1 Nephrosis 2 - - - - 2 Other acquired - - 1 - - 1 LIMBS Limb abnormality 6 4 4 3 - 17 Kyphoscoliosis - - - - - Other congenital - - 1 - - 1 Other acquired - - - - - - BLOOD DISEASES Haemophilia - 1 - - - 1 Abnormal Haemoglobin 2 - 1 2 - 5 Leukaumia - - - - - - Punpura - - - - - - METABOLIC Diabetis . - - - - - Other I 1 - - - 2 OTHER HANDICAPS Skin diseases - - 1 - - 1 C4 YEAR OF BIRTH 1972 1971 1970 1969 1968 TOTAL MENTALLY SUBNORMAL E.S.N. - 1 1 4 1 7 S.S.N. 1 - - - 3 4 PSYCHIATRIC Maladjusted - - - - 1 1 Autistic/psycotic - - . - - - Mongols 2 4 2 - - 8 Socio-Medical 1 1 1 1 - 4 Multiple Handicaps 2 5 3 5 - 15 IN CARE - 4 2 3 - 9 OBSERVATION 416 289 181 99 30 1,015 TOTALS 451 328 211 129 38 1,157 SCHEME FOR REPORTING CONGENITAL MALFORMATIONS The scheme rests on information being sent to the Medical Officer of Health by the doctor or midwife notifying a birth (as required by Section 203 of the Public Health Act 1936) of any malformation of the child observable at birth. The Medical Officer of Health is required to return to the Director and Registrar General a standard form for every child living in his area in whose case he has received information of a malformation observed at birth. In 1972, 49 Congenital Malformations were n'otified regarding 41 children. Notification was made as follows: 1972 Congenital Malformations Central nervous system 12 Eye and Ear 3 Alimentary system 4 Heart and circulatory system 2 Respiratory system 2 Urino-genital system 4 Limbs 19 Other parts of musculoskeletal system - Other systems 2 Other malformations 1 49 VACCINATION AND IMMUNISATION Vaccination and Immunisation are provided jointly by the general medical practitioner and local health authority services under Section 26 of the National Health Service Act 1946. Every local health authority is required under the Act to make arrangements with medical practitioners for the vaccination of persons in the area of the authority against smallpox, and immunisation against diphtheria. The Minister of Health subsequently approved immunisation against whooping cough, poliomyelitis, tetanus and measles as well as vaccination against anthrax of workers in specified industries, but there are no such workers known to beat risk in the Borough. Authorisation has also been received for vaccination against rubella for girls between their eleventh and fourteenth birthdays. Later, the Secretary of State accepted the advice of the Joint Committee on Vaccination and Immunisation which concluded that with the changes in the prevalence of smallpox in the countries overseas and the diminishing likelihood of the occurrence of outbreaks in this country, smallpox vaccination need not now be recommended as a routine procedure in early childhood. However, travellers to and from areas of the world where smallpox is endemic or countries where eradication programmes are in progress should still be protected by recent vaccination. Protection is offered in child health centres against diphtheria, whooping cough, tetanus, poliomyelitis, and measles, to children below school age. At appropriate ages a card is sent to each child, inviting him to be immunised either by his family doctor or by attendance at a clinic, and a leaflet giving information about immunisation accompanies it. C5 Publicity for immunisation procedures continued in all clinics and in general practitioners' surgeries during the year, in the form of posters and leaflets which were varied from time to time. The following tables show details of the numbers of persons protected against diphtheria, tetanus, whooping cough, smallpox, poliomyelitis and measles during 1972. TABLE I Completed Primary Courses - Number of Persons under age 16. YEAR OF BIRTH Others under Age 16 Total Type of Vaccine or dose. 1972 1971 1970 1969 1965-68 1. Quadruple B.T.P.P. - - - - - - - - 2. Triple B.T.P. 122 1,213 199 29 21 2 1,586 3. Diphtheria/Pertussis - 4 - - 9 3 16 4. Diphtheria/Tetanus 6 109 30 12 137 23 317 5. Diphtheria - 19 2 - - - 21 6. Pertussis 1 13 5 - - - 19 7. Tetanus - 4 - - 2 38 44 8. Salk - - - - - - - 9. Sabin 120 1,345 212 36 191 98 2,002 10. Measles 31 974 422 83 84 14 1,608 11. Lines 1+2+3+4+5 (Diphtheria) 128 1,345 231 41 167 28 1,940 11. Lines 1+2+3+6 (Whooping cough) 123 1,230 204 29 30 5 1,621 13. Lines 1+2+4+7 (Tetanus) 128 1,326 229 41 160 63 1,947 14. Lines 1+8+9 (Polio) 120 1,345 212 36 191 98 2,002 No. given by Borough Medical Officers 3,459 No. given by General Practitioners 2,154 C6 TABLE 2 Reinforcing doses - Number of persons under age 16 Type of Vaccine or dose YEAR OF BIRTH Others under age 16 Total 1972 1971 1970T 1969 1965-68 1. Quadruple D.T.P.P. - - - - - • - 2. Triple DTP. - 128 165 72 49 10 424 3. Diphtheria/Pertussis - 1 1 - 46 3 51 4. Diphtheria/Tetanus - 7 25 15 1,347 133 1,527 5. Diphtheria - - 2 - 2 1 5 6. Pertussis - - - - - - - 7. Tetanus - - 1 1 12 257 271 8. Salk - - - - - - - 9. Sabin - 140 177 47 1,472 518 2,354 10. Lines 1+2+3+4+5 (Diphtheria) - 136 193 87 1,444 147 2,007 11. Lines 1+2+3+6 (Whooping cough) - 129 166 72 95 13 475 12. Lines 1+2+4+7 (Tetanus) - 135 191 88 1,408 400 2,222 13. Lines 1+8+9 (Polio) - 140 177 47 1,472 518 2,354 No. given by Borough Medical Officer 3,334 No. given by General Practitioners 1,298 TABLE 3 SMALLPOX Number of Persons Vaccinated or revaccinated during year ended 31st December 1972 Age at date of Vaccination Vaccinated Revaccinated 0-3 months - - 3-6 2 - 6-9 4 - 9-12 7 - 1 year 85 - 2-4 79 10 5-15 69 182 TOTAL 246 TOTAL 192 No. given by Borough Medical Officers 125 No. given by General Practitioners 313 C7 International Certificates of Vaccination Three forms of International Certificates of Vaccination have been prescribed, namely, for smallpox, cholera and yellow fever. Yellow fever vaccination must, for international and technical reasons, be carried out at centres designated by the Government, and International Certificates of Vaccination against yellow fever are supplied at those centres. Vaccination against any disease other than yellow fever may be performed by a person's own doctor. The International Certificate against smallpox and cholera must be obtained by the traveller himself and taken to the doctor for completion. These forms are usually obtainable, free of charge, from the company arranging the traveller's transport, or from the Department of Health and Social Security. If the vaccinator is not an authorised user of an approved stamp, the person vaccinated must have the certificate staped by the local authority in whose area the vaccinator practises. As in previous years, very many International Certificates were stamped in this Department authenticating the signature of the vaccinator. EXAMINATION OF BLIND AND PARTIALLY-SIGHTED PERSONS Arrangements were made for the domiciliary examination and re-examination of persons with a view to their inclusion on the Register of Blind and Partially Sighted kept by the Borough's Welfare Services. Inclusion on the Register entitles a person to extra benefits from the Department of Health and Social Security and to the full range of services provided by the Social Services Department. During 1972 the examinations continued to be carried out by the Consultant Ophthalmologist, Miss. J.M. Dollar, F.R .C.S.,. In addition certificates are accepted from other Local Authorities, Hospitals, and private Ophthalmologists, and fees paid where appropriate. The following are details of work carried out during the year: 1972 1971 Number of domiciliary examinations during the year 21 (18) Number of domiciliary re-examinations during the year 35 (65) Number of certificates accepted from other Local Authorities, Hospitals, and private Ophthalmologists 63 (65) MEDICAL ARRANGEMENTS FOR LONG-TERM STAY IMMIGRANTS Advice of arrival of long-stay immigrants is received from ports and airports. Health visitors then get in touch with them, give them information about the Health Services, persuade them to register themselves and their dependents with general medical practitioners, and have chest X-rays where these are appropriate. Country where Passport issued Immigrants Notified Visits Total Successful Unsuccessful Commonwealth Countries 535 337 198 535 Non-Commonwealth 15 8 7 15 TOTALS 550 345 205 550 C8 FAMILY PLANNING The Council continued to implement the provisions of the National Health Service (Family Planning) Act 1967, through the Agency of the Family Planning Association. The Council reviewed the scheme in April and decided that a totally free scheme (including a domiciliary service) should be provided for men and women. Plan 4 of the Family Planning Agency scheme was therefore adopted; this came into effect during May and provides for free consultation and supplies to all Hammersmith residents, the Council meeting the cost on a per capita basis. Under the previous scheme (Plan 5) consultation had been given.without charge to applicants but contraceptive supplies were chargeable except in cases of medical need or social hardship, where the cost was met by the Council. The following table lists the Family Planning Clinics held within the Borough and sets out figures of new patients and attendances. Figures for the previous year are given in brackets. It is apparent that the inception of free and comprehensive service in May has since resulted in a 50% increase in new cases: Statistics Clinic New Clients Including FPA Transfers Total Visits Cytology Becklow Gardens 251 (241) 1078 (837) 75 (143) Glenthorne Road 358 (210) 1516 (1039) 203 (283) Greyhound Road 197 (151) 1021 (978) 133 (142) The Grove 191 (206) 841 (826) 140 (143) Parsons Green 854 (802) 4292 (3291) 723 (758) West London Hospital 627 (602) 3207 (3140) 220 (395) Westway 198 (109) 408 (408) 161 (100) Shepherds Bush 641 - 1172 - 276 - TOTAL 3,316 (2,321) 13,535 (10,519) 1,931 (1,964) The age classification of individual clients dealt with at Family Planning Clinics is set out below:- Age Group Full Service (including free supplies) Under 20 614 20 - 24 1455 25 - 29 845 30 - 34 200 Over 35 202 TOTAL 3316 The Family Planning Association opened a new clinic and information centre at 160, Shepherds Bush Road, W.6. during May, making a total number of eight clinics covering the Borough. Domiciliary cases numbered 62 to whom a total of 430 visits were made. A considerable number of Hammersmith residents attended Family Planning Association Clinics elsewhere in London, these too were paid for by the Council. The Council also decided to meet the cost of Family Planning prescriptions issued by general practitioners and dispensed at Family Planning Clinics. By the end of the year 778 prescriptions had been issued. In addition, free supplies had been issued at these Clinics, on demand, to 101 persons, under arrangements approved by the Council. C9 The aim of a Family Planning policy must be to reduce the incidence of illegitimacy, other unwanted pregnancies and abortions. It is too soon yet to assess the full effect of Family Planning in Hammersmith. However, the illegitimacy rate is dealt with elsewhere in this Report and I give below the figures for abortions to Hammersmith residents since 1968: 1968 293 1969 578 1970 928 1971 1,153 1972 1,240 The relevant tables of abortions by grounds, marital status and age for 1971 and 1972 are as follows: Year Total Number Single Married Others Under 16 16 19 20 34 35 44 45 and over Not stated 1971 1,153 808 254 91 18 163 852 89 3 28 1972 1,240 841 289 110 16 174 922 108 2 18 CIO COMMUNITY NURSING SERVICE Health Visiting In common with other Inner London Boroughs the Department had great difficulty in recruiting staff during the year. Promotion, retirement, marriage and other domestic commitments reduced the Health Visiting establishment to 33 out of a possible total of 40 by the end of the year. In spite of these shortages the Department has managed to achieve yet another Health Visitor liaison scheme, this time with the Neo-Natal Unit at Hammersmith Hospital, bringing the regular Health Visitor/hospital liaison schemes to a total of 4. In addition, the link with general practitioners has been extended to include a further Health Visitor attachment in the W. 14 area. As the doctors at this latest practice intend moving to new premises in 1974 this could prove a most successful attachment providing the staffing situation improves. A total of 10 Health Visitors are now fully attached to general practice and a further 2 operate a liaison scheme. During the year a new pattern of nursing management was introduced, with the appointment of 6 middle managers. Four are concerned with preventive medicine, covering Health Visiting Staff, and School and Community Nurses within a specified geographical area. The remaining two Nursing Officers are managers in the district nursing field. All these officers provide a valuable link between the field staff and the administration. Information flows both ways to the benefit of all, allowing problems to be dealt with at the grass roots. In 1972 five students sponsored by the Borough successfully obtained their Health Visiting Certificates, and a further 7 were sponsored for the course beginning in September. As in previous years the staff have willingly assisted in providing observational experience for student nurses and midwives from local hospitals, as well as pre and post graduate students from many other disciplines. A total of 129 non-nursing visitors were seen in the Department, many coming from the developing countries overseas. Health Visitors have been seconded to Refresher Courses and other In-Service Training on a variety of subjects. In addition, the Department mounted a two-day Conference in October at Fulham Town Hall on "Family Planning" at which the Family Planning Association provided interesting speakers. At this Conference places were also made available for Midwives together with Home and Hospital Nursing Staff. Clinics After being closed for nine months for major alterations Burne Jones Clinic re-opened in October. The increased accommodation now available means that ante-natal, cytology and family planning sessions can also be held there. In December, Milson Road Clinic moved into a temporary structure a short distance away, while plans for the new Health Centre can go ahead on the original site. Although, it is not permanent, the new building is well designed and a great improvement on the old clinic. One disadvantage of the limited space available though, is that it is impossible to increase the scope of work as the Department would like. Specialist Health Visiting Service In addition to the general Health Visiting establishment there are 3 extra staff who work exclusively with patients from the chest clinics. All those suffering from Tuberculosis are visited at home at least once, and those with other respiratory complaints are visited when and if necessary. Most of the latter group visited are those afflicted with carcinoma, particularly in the terminal stages. When this occurs the specialist Health Visitor will call frequently, perhaps every day, and should the patient require admission to a terminal home, she will arrange this together with any additional assistance from charitable organisations if necessary. The hospital ward for chest patients is sited near to the Chest Clinics which enables in-patients to be frequently seen by the specialist Health Visitors as well. All patients receiving anti-tuberculous chemotherapy are supervised by the Chest Clinic, or at the District Nurses Clinic or occasionally at the patient's place of work if an occupational health scheme operates. To ensure adequate supervision is maintained, attendances are checked each week. In addition, a Clinic staffed by one of these Health Visitors and a Radiographer, to screen those who have been in contact with tuberculous patients is held once a week. Screening measures undertaken include skin-testing and X-ray followed by B.C.G. vaccination if required. Midwifery During the year full maternity services were provided for patients whether they were delivered at home or in the general practitioner unit(s) at 3 hospitals. Women booked for hospital confinement were increasingly interested in being discharged home early where they are nursed by a domiciliary midwife until the tenth day when responsibility is transferred to the Health Visitor. The Borough's Midwives have increased their participation in the parentcraft and relaxation classes conducted at the Child Health Centres. During the year one partularly popular class dealing with therapeautic excercises for post-natal mothers was started at Greyhound Road Clinic. Pupil Midwives from Queen Charlotte's Hospital continued to receive practical experience of domiciliary work and the wider aspects of community care. School Nursing The School Nurses have benefitted from the appointment of the four Nursing Officers referred to earlier. As C11 each of them have close contact with one quarter of the staff they have dealt with problems as they arise as well as generally improving communications. Their function has been particularly helpful in supporting new and inexperienced members of staff. This is relevant to the present situation, whereby the School Nursing workforce is mainly composed of young married women whose length of service will probably be limited. The amount of travelling time spent by each School Nurse was cut down because the geographical areas they serviced were reorganised during 1972. In addition, the number of minor ailment clinics held in the Borough was reduced in September, following the trends in other authorities, thus allowing better use of the School Nurses' time. Home Nursing 1972 made very heavy demands upon the District Nursing Sisters, partly because of the early discharge policy undertaken by most hospitals, which caused an increase in each case load. This resulted in staff being unable to give as much time and attention to patients as they would have wished. Again, more hospital staff, medical students, dieticians and psychiatric nurses have accompanied the District Nursing Sisters on their rounds and it is pleasing that these visitors have felt the experience was most worthwhile, indeed many expressed the wish to return at a later date. In order to further mutual understanding of nursing problems, whether in hospital or in the community, an exchange visit was arranged with nursing staff from the Charing Cross Hospital Group. These nurses spent a week with the Borough's District Nursing Sisters visiting patients at home, gaining insight into the many difficulties posed by nursing the sick at home. The District Sisters then spent a week in turn with their hospital colleagues, to keep abreast of modern therapeutic techniques, enabling them to give appropriate care to patients on their discharge to the community. The Department now provides practical experience for students undertaking the four year integrated SRN/Health Visiting/ District Nursing course at Hammersmith Hospital, Surrey University and Chiswick Polytechnic. These students seem to thoroughly enjoy the experience gained in the Borough, and have taken a keen interest in involving some of the District Sisters in group discussions with their Tutors on return to hospital. The extended nursing service at night continues to give extra care to those who are very ill, but again, the demand for this service is growing, necessitating the careful assessment of requests before extra visits are arranged. Special nursing equipment is loaned to patients at home and this is arranged by the District Nursing Sisters. Altogether, 1972 was a very busy but progressive year for the District Nursing Service. Number of Patients Treated During 1972. Under 5 5-64 65 & Over Total 106 1453 4162 5721 Total visits, including baths = 146,794. C I 2 TUBERCULOSIS Hammersmith Chest Clinic The mildness of the last few winters, and the accumulative effects of the Clean Air Act, may be partly responsible for recent satisfying figures. The total attendances dropped, from the usual of just over 23,000 to 20,584 in 1971 and 19,711 in 1972, the lowest for many years. New attendances were 681, there being a particularly welcome drop in new cases of bronchitis from 197 in 1971 to 90 this year. The figure for new cases of lung cancer, however, was 57: about the average of the fluctuating figures for the last 7 years. There is unlikely to be any remarkable change in this situation while the present attitude to cigarette smoking continues. In 1970 attention was drawn to an encouraging drop in the figures for tuberculosis; but a warning was given that this could not necessarily be interpreted as a trend. Such caution has been justified for there has now been a sharp rise in the new tuberculosis notifications. This is almost entirely due to cases in immigrants to this country who, in fact, yielded two-thirds of the notifications in 1972. The figure for the indigenous population has remained remarkably static recently: around 23 for the last 7 years. Details of the tuberculosis figures are given in Tables I and II and Figure I. The services provided from the Clinic have remained unchanged. Newer drug treatments for tuberculosis are proving remarkably effective and cause much less upset to the patients, who usually only need to leave work for 3 or 4 weeks. Treatment for the tobacco-induced diseases - bronchitis and lung cancer - is, on the other hand, miserably unsatisfactory. The only hope here is prevention: cure is, at present, impossible. My sincere thanks to the Clinic staff for their continued loyal and cheerful co-operation. TABLE I Tuberculosis Figures 1972 No. of cases notified: Pulmonary 57 Non-pulmonary 12 Total 69 Deaths 0 No. of cases on register 31.12.72 Pulmonary 692 Non-pulmonary 264 Total 956 TABLE II Nationalities of Newly-Notified Cases of Tubercolosis: 1972 Asian 24 English 23 Irish 9 West Indian 6 African 3 European 1 Japanese 1 New Zealander 1 Cypriot 1 total 69 C I 3 PI 3 Fulham Chest Clinic The year under review shows little change in the overall size of the problem and its clinical and bacteriological manifestations. However, during the last few years the social pattern of the disease has changed so that a considerable proportion of the notified cases occur in individuals born overseas. This year 10 of the 29 pulmonary cases were immigrants (34.4%) which, however, shows a fall from 1971 with 19 out of 37 notifications (51.3%) in this category. The majority of these patients were not discovered at the port of entry. For the first time in some years the notification of males has occurred in the under 20's; fortunately, there were no notifications of females under 30. The total number of female notifications is low -7(16) All the deaths, 13 male and 3 female, occurred in the 56+ age groups which conforms to the pattern of recent years. During the current year, we have been joined by the Mass X-Ray Unit under their director, Dr. F. Nash. This joint use of the existing premises has worked in a satisfactory manner for both units. (Nos. in brackets refer to 1971). Summary of Statistics - Fulham Chest Clinic Table 1 No. of New Patients Attending- 1972 1971 Non-Tuberculous Chest Cases 69 (96) New Contacts of Notified Cases 61 (32) New Notifications Transferred In 14 (21) No. of Clinic Attendances- Notified cases of tuberculosis 461 (469) Contacts of tuberculosis 136 (91) Other chest diseases 910 (1066) No. of New Notifications of Tuberculosis in Fulham Chest Clinic Area- Pulmonary Tuberculosis in area 29 (32) Non-Pulmonary Tuberculosis 2 (5) No. of Patients Removed from T.B. Register as DECEASED- Pulmonary Tuberculosis 16 (12) Non-Pulmonary Tuberculosis Nil (1) No. of Visits by Health Visitors 755 (933) No. of Patients X-rayed 1051 (967) No. of B.C.G. Vaccinations 85 (89) No. of Notified cases of Tuberculosis on the Register at 31st December, 1972 512 (523) C 1 5 Table 2 New Notification in Age Groups Age Males Females 1972 1971 1972 1971 6-15 years Nil (1) Nil (2) 16-25 years 4 (4) Nil (5) 26 - 35 years 4 (3) Nil (3) 36 - 45 years 5 (4) 2 (1) 46 - 55 years 5 (4) Nil (5) 56 - 65 years 1 (3) Nil Nil Over 65 years 5 (2) 5 Nil 24 (21) 7 (16) Table 3 Deaths Males Females 56 - 65 years 1 Nil Over 65 years 12 3 13 3 HURLINGHAM LODGE HOSTEL Hurlingham Lodge is a hostel for ambulent, infective, tuberculous men, one of three similar establishments in Inner London, the others being in the London Boroughs of Islington and Lambeth. H urlingham Lodge provides accommodation for those who do not require nursing but need the security of a home with regular good meals, clean laundry and sympathetic companionship. It is also to the advantage of the community that, as far as possible, these infective tuberculous people are segregated from the dangers of close and frequent contact with those who might be susceptible to contracting the disease. Residents who are fit to work are encouraged to find employment through the Disablement Resettlement Officer in the local office of the Department of Employment. They are also encouraged to join the list of a local general practitioner who visits the hostel regularly and, in addition, maintains health surveillance of the staff. A Senior Medical Officer from the staff of the Director of Health Services also visits the hostel. Recommendations for admission are received from the Chest Physicians at Chest Clinics in the London Boroughs and from hospitals in and outside London. The Medical Officer of Health of the Borough in which the patient was formerly resident is asked to accept financial responsibility, and residents are requested to contribute towards their maintenance, according to their means. Admissions are arranged as and when vacancies occur. The condition of residents is reviewed periodically to establish the need for continued residence. There is accommodation for 28 at the hostel and at the end of 1972 there were a couple of men awaiting admission. C 16 THE HEALTH EDUCATION SERVICE The purpose of the Health Education Service is to provide Borough residents with educational programmes on personal, environmental and social health topics. In 1972 the main campaign activities highlighted specific health and social services run by the Council so that the public could make even better use of them. The programmes gave extensive coverage to Immunisation, Family Planning and Services for the Under 5's, using mobile exhibitions sited at Fulham Broadway, Hammersmith Town Hall, Bishops Park and a number of schools and colleges. This was reinforced by articles in the press, lectures, demonstrations, film shows, posters and leaflets. As health education is a continuous process other supplementary "reminder" campaigns were being conducted alongside the main exercises. Themes included Cervical Cytology, Mental Health, Water Safety, Diabetes, Epilipsy, Food Hygiene and Social Drinking. The continuous Anti-Smoking Campaign brought many callers to the Exhibition requesting further information and help to give up the habit. When the Council decided to provide a completely free Family Planning Service the Family Planning Campaign was extended and also accompanied by a Press conference. Much emphasis was placed during the year on combating Sexually Transmitted Infections. Offices, factories and public houses were encouraged to display notices publicising a telephone number which, when dialled, automatically gave the caller information about venereal diseases and local clinic session times. At the Hammersmith show the Health Education Exhibit and continuous film shows were visited by many people of all ages and it is hoped that the event will be an even greater attraction in the forthcoming year. The publication "Social Drinking and You" is now in its third edition and a new publication, "The Star of Good Eating" produced in conjunction with the Borough Dietitian has been published to give information about sensible diets. The quarterly Bulletin designed for multi-disciplinary interests in health teaching covers topical health trends and developments and is now circulated to over 1,500 individuals and educational establishments. Organised groups visiting the "Design for Living" Exhibition at 2-6 Fulham Broadway have increased this year; local students undertaking health project work have particularly made use of the audio-visual aids, programmed learning material and appropriate displays on view at the Exhibition. Many schools, colleges and societies from all parts of Britain have sent parties to the Exhibition and other attenders have included overseas visitors on study courses in health education. The continuing expansion and up-dating of the audio/visual library, means that project teachers in the vicinity are now loaned additional tapes, film strips and overhead projection transparencies. Such new equipment is also essential to further the work of professional staff concerned with teaching health subjects to the community. C 17 RENAL DIALYSIS Arrangements for patients to carry out renal dialysis in their own homes first commenced in this Borough in April 1969. Patients with diseased or non-functioning kidneys accumulate waste products in the blood and renal dialysis is the method needed to clear the blood of these products. The patient is connected to the kidney machine, sometimes three times a week, for as long as 10 hours. Experience has shown that patients carrying out dialysis at home do better than those returning to hospital for the treatment. Travelling to a hospital centre can be both time consuming and exhausting and dialysis at home enables the patient to do a full week's work and lead a normal family life. More importantly, it reduces the risk of infection to the patient himself and to other patients and staff in a hospital dialysis unit. The demand for renal dialysis is increasing, and to meet this demand it is essential for patients to be trained to carry out the procedure in their own homes so that the hospital staff can treat and train more patients. In some instances a room in a patient's home is adapted to accommodate the dialysis equipment, but in others it is housed in a Portakabin in the garden of the house. This latter method is sometimes more satisfactory from the point of view of the family as it leaves more living accommodation for them. The cost of converting the property or supplying the Portakabin is met by the Council, but the dialysis equipment is supplied by the hospital authorities. During the year, arrangements were made for three patients to dialyse themselves in their homes. One patient and his family were rehoused in Council property as the flat he was living in was inadequate to meet the necessary requirements. A room in the house was then adapted for the purpose. The other 2 patients lived in their own property which they were buying on a mortgage and, again, suitable rooms were adapted to house the dialysis machines. By the end of the year, arrangements were being made for a further 2 patients to undergo renal dialysis at home. WEST LONDON HOSPITAL—MARTHA & LUKE CLINIC During the year 1972 the total number of cases seen in the department were 18,747 as opposed to 18,898 in 1971. This is the first time in 10 years in which no increase has been registered but it is doubtful if this signifies any substantial reduction or change in the trend of the conditions treated here. The waiting room and reception facilities provided were inadequate to deal with the enormous influx of patients who often had to stand in crowded conditions, and this undoubtedly deterred a number of people from attending. The total number of cases from Hammersmith was 6,281 and this showed a decrease of 509 over the previous year, but this was offset by the more peripheral boroughs. The total number of cases of infectious syphilis seen in the clinic was 136 with a further 97 of latent syphilis. This is virtually unchanged from recent years. The corresponding figures for Hammersmith were 45 and 37; the number of cases of gonorrhoea were 2,652. 825 of which were from Hammersmith which shows a welcome reduction. A marked improvement in the laboratory services for the diagnosis of this condition in women coupled with intensive and highly efficient methods of contact tracing may have contributed to this welcome result but it is too soon to draw any firm conclusion. The incidence of all other conditions continues to rise and the problem of non-specific genital infection has now become a major one and much improved research is required before any solution is likely to be achieved. In conclusion it seems that the rapid increase in previous years is mercifully tending to slow down. Shortage of staff continues to be a major problem although efforts are being made to ameliorate this difficulty. THE CHIROPODY SERVICE DURING 1972 The development of the Chiropody Service is hampered by the acute national shortage of State Registered Chiropodists. The situation is so serious that other methods of expanding the workforce must be considered. One possible method, for instance, would be to train foot hygenists or auxiliaries to augment the work of the Chiropodist by undertaking the more simple routine treatments. Under a scheme of this nature, such treatments would, of course, be supervised by qualified Chiropody staff. Since the work of the Chiropodist is no luxury, but makes a vital contribution to the health of the community, there is need for more training schools to increase the number of qualified personnel. The present rate of producing 150 newly trained Chiropodists each year is so inadequate that it barely replaces the annual wastaige from the profession, which because of low pay and poor career prospects, loses almost as many as it trains. In addition, the more lucrative work of private practice adds to the drain of staff from local health departments. All these factors contribute to the difficulties of developing the Chiropdy service to deal with unmet need in the community. In Hammersmith during the latter part of 1972 the Section had to cope with severe staffing problems. The sad death of Mr. Astley, a senior member of staff, has been a great loss to the service. A further full-time and two sessional staff resigned, two of whom decided to leave the profession completely. These latter events resulted in a diminished establishment and regretfully weakened the efficiency of the service. The decision of the Council to raise the establishment from 14 to 16 full-time staff as from 1 st April 1973 was welcomed, together with the introduction of full-time clerical assistance from 1st September 1972. The C 18 complete staff consists of the Chief Chiropodist, responsible for the overall organisation, one principal, six senior, seven sessional and one contractual Chiropodist. I he Chief Chiropodist organises the service at eight clinics, nine old people's residential homes, and one convent, and in addition, arranges the transport and domiciliary service. T he transfer of the Chiropody Clinic from St. Dunstan's School Treatment Centre to the purpose-built clinic at Nye Bevan House, St. Thomas' Way, S. W.6., was welcomed by all. Whilst this does not necessarily mean an increase in the number of patients seen, the district served has now got better facilities and an improved service. The Appliance Laboratory The opening of the Chiropody Appliance Laboratory, attached to the Chiropody Clinic at 706 Fulham Road, S.W.6. in early 1970 has brought considerable advances in the long term management of foot disorders. Its use has enhanced the comfort and mobility of many patients and has enabled others to receive and enjoy more protracted treatment. This has resulted in more people having the special treatment they need. At the Laboratory many patients suffering from rheumatic diseases are now fitted with excellent insulating material insoles for their shoes, which prevent chilling and other harmful effects of the damp and cold. Platform-Soled Shoes On a topical note, the wearing of the new fashionable rigid platform shoes which do not allow for the normal rocking movement of the foot during walking, is asking for trouble in the future. Surely the service should be geared to prevent deformities all too frequently occurring in the young. Foot Health Education and a School Chiropody Service would, undoubtedly, be an important step in the right direction. Statistics Persons Treated 1972 1971 Aged 60 and over 6,229 5,815 Physically handicapped or other disabled people under 65 years 28 54 Expectant mothers 2 1 Others (non-priority) 317 493 Total 6,576 6,363 Totals of treatments given 29,517 28,970 Domiciliary (included in total) 4,383 3,844 Domiciliary new cases 495 387 NURSING HOMES Local Health Authorities have a duty to register and inspect Nursing Homes established in their areas, in accordance with the provisions of the Public Health Act, 1936, the Nursing Homes Act, 1963 and Mental Health Act, 1959. There are no registered Mental Nursing Homes or Maternity Homes in the Borough, but two general Nursing Homes are registered, one for 32 chronically sick patients and the other for 266 medical and surgical patients. The latter has been approved by the Secretary of State for Health and Social Security, under the Abortion Act, 1967 as a place for treatment for the termination of pregnancy. MENTAL HEALTH ACT, 1959—APPROVAL OF MEDICAL PRACTITIONERS Section 28 of the Mental Health Act, 1959, provides that where an application is to be made for a person to be detained in hospital (or received into guardianship) by reason of mental disorder, one of the two medical practitioners making the necessary recommendations shall have been approved for this purpose by the Local Health Authority as having special experience in the diagnosis or treatment of mental disorder. Although the majority of local authority functions exercised under the Mental Health Act were assigned to Social Services Committees in 1971 by the Local Authority Social Services Act, 1970, it remains the duty of the Council, as Local Health Authority, to consider applications by medical practitioners seeking approval under Section 28 of the Act. In so doing, the Council must consult at least two members of the local advisory panel appointed for this purpose by the Regional Hospital Board, as to the experience of the applicant. At the end of the year nine doctors were listed as approved by the Council, for this purpose. C19 D. SCHOOL HEALTH ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER INNER LONDON EDUCATION AUTHORITY (HAMMERSMITH), ON THE SCHOOL HEALTH SERVICES The Inner London Education Authority is responsible for the school health service, but by virtue of an agreement required by Section 32 ofthe London Government Act, 1963 there isjointuse by the Authorityand the Borough of professional staff, premises and equipment. The Director of Health Services is the Principal School Medical Officer of the Inner London Education Authority for the area and is responsible to that Authority for the day to day running of the service. The co-operation of the Medical Adviser's department of the Inner London Education Authority, the local Divisional Education Officer and Head Teachers of the schools in the Borough has been much appreciated throughout the year. Pupils on Day School Rolls I n December, 1972 there was a total of 26,959 on the day school roll attending 46 primary schools (including full and part-time nursery classes), 15 secondary schools; 3 nursery schools and 9 special schools. There were also 2 units for partially-hearing children, one in a primary and one in a secondary school. Routine Medical Inspections As a routine, all pupils in nursery schools and nursery classes were medically inspected on admission and annually thereafter, or as necessary. Each pupil was also examined by the school nurse each term in which a medical inspection was not carried out. School nurses visited weekly, but made more frequent visits in emergencies. Other children were medically examined as soon as possible after admission to infants' schools. The next routine medical examination took place after the pupils were transferred to secondary school. Pupils were again seen as early as possible in the term before the one by the end of which they would reach Statutory school leaving age. A medical report to the Careers Service was completed at this examination for pupils who intended to leave school at 16 years of age. Pupils who were still in attendance after attaining 16 years of age were inspected as early as possible in the term prior to that in which they would be leaving school, when a medical report to the Careers Service was completed. Special school pupils were also seen at least once a year by the school doctor, specialist or consultant, as appropriate. Routine medical examinations are performed by medical officers working in either a full-time or part-time capacity. Whenever the necessity arises the family doctor is consulted about the results of the examination, and parents are invited to attend, so that any matters relating to the child's health may be discussed without delay. Much valuable information is also obtained from the school nurses, the Care Committee workers and the teaching staff. Immunization records receive special scrutiny and, if indicated, the attention of the parents is directed towards completing the immunization schedule, particularly with regard to the prevention of diphtheria, poliomyelitis, tetanus and tuberculosis. Control of infection and infestation is facilitated by means of the medical inspections and the health surveys made by the school nurses. In this respect, examination of children before a school journey is of proven value. Relatively frequent medical examinations take place at the schools for the handicapped. Specially approved medical officers examine educationally subnormal children. Although the emphasis rests upon the educational status of these children, any physical abnormality is carefully assessed, for the successful treatment of a physical defect may well enhance the child's prospects of securing gainful employment after leaving school. Behaviour problems in children of all ages continue to present difficulties. To solve a behaviour problem is often an exacting task, demanding intensive application of medical and educational resources. Special Medical Examinations Any pupil about whose well-being (physical or mental) the parents, school nurse, care committee or teaching staff were in doubt, and pupils whose performance raised doubts concerning their physical or mental fitness for whom special educational treatment might be necessary, were brought before the school doctor by head teachers. The Education Officer also requested that certain children be examined at times other than the normal routine examinations. Re-Inspections School doctors re-inspected 8,813 (8,884) children who had been referred for treatment or observation. Special Recommendations by School Doctors School doctors sometimes made special recommendations (e.g. position in class because of hearing and vision limitations, restrictions of physical training activities) and head teachers or other responsible teachers saw that they were carried out. They were also asked to ensure that children with defective vision wore spectacles prescribed for them and children with hearing aids used them. D 1 Employment of School Children During 1972 190 (209) examinations were carried out on school children of 13 years of age and over who were employed part-time delivering milk, newspapers, in shops, etc. These examinations were carried out within 14 days of the commencement of their employment and every 12 months thereafter. This was to ensure that such employment was not prejudicial to their health and physical development and would not render them unfit to obtain proper benefit from their education. School Journey Medical Examinations. Before children went away for a school journey, the school nurses checked their medical records and arranged for any treatments to be given which might be needed to make them fit to go, referring them to the school doctor if necessary. Any information regarding the child's physical condition mentioned on the parental consent form and about medicine or tablets being taken was also passed on to the medical officer. The type of journey was, of course taken into consideration. Strenuous expeditions might be too much for delicate children, children with plantar warts might not be able to walk far and other children might present special problems. 1,381 (1,542) children were examined by a school doctor within 96 hours of departure to make sure that they had not been in contact with infectious disease and to determine whether they were fit to go. One of the accompanying teachers was available for the school doctor to discuss any restriction which should be placed on the activities of any of the children. This reduced risks not only to individual children but to the party as a whole. The table below is an analysis ot routine and non-routine medical inspections (excluding Dental and Health Surveys) :- School Roll: December 1972 26,959 1971 (27,694) Routine Inspections 10,111 (9,472) Percentage of Numbers inspected where - Parent present 60.9 (59.3) Care Committee present 65.3 (69.0) Physical condition unsatisfactory 0.5 (0.7) Referred for treatment of defects 18.5 (20.2) Referred for treatment of defects other than vision 10.2 (9.5) Non-Routine Inspections (1) Specials 1,524 (1,640) (2) Re-Inspections 8,813 (8,884) TOTAL -(1) & (2) 10,337 10,524 Analysis of Non-Routine Medical Inspections Re-Inspections 8,813 (8,884) Bathing Centre Inspections - Scabies 4 (-) Bathing Centre Inspections - Other 9 (39) Employment Certificates 190 (209) Theatre Children 76 (75) School Journeys 1,381 (1,542) Recuperative Holidays - Pre-departure 99 (72) D2 Analysis of Non-Routine Medical Inspections (cont.) Secondary School Annual Surveys - (-) Candidates for Higher Awards 6 (10) Boarding Schools for the Delicate - Pre-departure 35 (53) Boarding Schools for the Delicate - On Return 4 (1) Outward Bound Courses 54 (13) Handicapped Pupils - Statutory Examination 98 (119) Handicapped Pupils - Periodic Special Defect Examination 129 (161) Research Investigations and Enquiries 5 (1) 2,090 2,295 Special Inspections made at request of: Head Teacher - child's name entered in special book 96 (144) Head Teacher - Others 519 (604) School Nurse - following Health Survey 24 (68) School Nurse - others 200 (124) Divisional (Education) Officer 90 (79) District Care Organiser or Care Committee 27 (35) Parent 184 (168) School Medical Officer 384 (418) Sub-Total 1,524 (1,640) Others Referred by Hospital - (3) Accident on School Premises - (-) Miscellaneous 3 (-) Referred by Speech Therapist 1 (-) Sub-Total 4 (3) TOTAL of all Non-Routine Medical Inspections 12,431 (12,822) D3 Analysis of defects found at Routine Medical Inspections (Number of children noted for treatment or observation expressed as a rate per 1,000 inspected). Number inspected: 10,111 (9,472) Defects - Skin T 8.60 (9.92) O 16.52 (19.11) Eyes (a) Vision T 96.33 (120.78) O 84.46 (74.11) \ (b) Squint T 10.78 (12.04) O 5.64 (6.23) (c) Other T 1.68 (2.01) O 1.38 (2.01) Ears (a) Hearing T 12.66 (9.61) O 7.71 (8.02) (b) Otitis Media T 2.77 (3.06) O 4.75 (6.02) (c) Other T 0.59 (1.06) O 0.89 (0.63) Nose and Throat T 9.69 (8.97) O 44.01 (43.39) Speech T 11.77 (6.23) O 15.03 (10.87) Lymphatic Glands T 1.48 (1.06) O 20.27 (22.49) Heart (Congenital) T 3.46 (3.27) O 10.98 (11.51) Bronchitis T 2.43 (7.07) O 8.66 (15.10) Developmental (a) Hernia T 1.38 (1.48) O 2.87 (3.27) (b) Other T 2.27 (3.17) O 6.33 (6.86) Orthopaedic (a) Posture T 2.87 (1.27) O 8.70 (5.70) (b) Feet T 4.05 (2.74) O 20.67 (19.21) (c) Other , T 2.47 (2.74) O 4.75 (5.28) Nervous System (a) Epilepsy T 3.76 (1.79) O 1.48 (1.79) (b) Other T 2.57 (1.27) O 0.69 (2.22) Psychological (a) Development T 6.23 (3.80) 0 7.81 (9.40) (b) Stability T 8.41 (5.70) 0 24.13 (29.46) Obesity T 6.43 (4.12) O 21.56 f (23.12) D4 Abdomen T 0.30 (1.27) O 1.48 (2.53) Other Debility T 1.58 (1.27) O 4.75 (4.75) Enuresis T 12.86 (11.40) O 36.69 (38.43) Other T 8.11 (7.71) O 10.78 (10.14) I - I reatment O = Observation (N.B. A child can be noted for more than one defect). Vision The following table is a statement of the visual acuity of pupils whose vision was tested at routine medical inspections divided into those not wearing and wearing glasses, together with the proportion noted for treatment or observation. (Expressed as percentages of the numbers of children whose eyes were tested). 6/6 6/9 6/12 or worse Noted for Treatment A. Not Wearing Glasses Boys 79.7(77.5) Girls 75.6(75.6) Boys 8.6(9.6) Girls 11.5(9.8) Boys 5.7(6.6) Girls 6.3(6.9) Boys 6.3(7.8) Girls 7.2(8.7) B. Wearing Glasses 2.3(2.6) 2.1(2.5) 2.0(2.1) 2.1(2.7) 1.7(1.7) 2.4(2.6) 4.4(5.3) 4.8(6.6) Number Tested Boys 4,281 (3,720) Wearing Spectacles Girls4,216 (4,268) Special Educational Problems Many school children present complex problems of learning difficulties and behaviour. Close co-operation with all agencies involved in the solution of these problems helps with educational placement and provision of help to the children, school staff and children's parents. The agencies involved include teaching staff, school doctors, educational psychologists, social workers, education welfare officers, probation officers, schoolcare organisers, psychiatrists, etc. Placement of children in residential schools is the responsibility of the specialist staff at County Hall. Handicapped Pupils At the end of 1972 special educational treatment was being provided for 1,133 (1,152) children. The following table shows the categories of handicaps and number of pupils receiving special education in day schools in the London Borough of Hammersmith. These schools serve much of the West of London and accordingly many of the pupils are not residents of Hammersmith. Type of Handicap Delicate Partially-sighted Deaf Partially-hearing Physically Handicapped Educationally Subnormal School Wood Lane School John Aird School Ackmar Road School Units in - (1) Holman Hunt School (2) Hammersmith County School and Christopher Wren School Queensmill School Elizabeth Burgwin School 179 104 78 28 4 47 186 (1971) (182) (123) (72) (20) (4) (47) (184) D5 Educationally Subnormal Wedgwood School Educationally Subnormal St. Huberts School Educationally Subnormal (Severe) Granville Sharp School MaJadjusted (including unit for 5 Autistic Children). Northcroft School 188 160 75 84 1,133 (187) (173) (75) (85) M52) (30 pupils are accommodated at Palingswick Hostel for diabetic children and attend day schools in the neighbourhood). Educationally-Subnormal Children Under Section 34 of the Education Act, 1944, it is the duty of a Local Education Authority to discover which children over the age of two years require special educational treatment as handicapped pupils. Of the various categories of handicapped pupils, the educationally-subnormal is the largest. 139 (156) pupils were examined under this Section on account of a disability of the mind or any other condition which might necessitate special educational treatment. 104 (100) children were examined for suspected disability of the mind and of these 53 (49) were recommended as fit to continue to attend ordinary school, 69 (93) were recommended for placement in a school for educationally-subnormal pupils, and 5 (3) were recommended for Community Care. The remaining 12 (11) were examined because of their physical handicaps. 1 (3) was recommended for boarding open-air school, 5(1) for day open-air school, 6 (2) for day school for the physically handicapped and 0 (3) for home tuition. 17(12) children were examined because of severe subnormality. Of these 10(6 children were recommended to attend an E.S.N. (Severe) School, and 2(3) were recommended for special care in an annexe of the school. 5(3) were recommended for Community Care only. Handicapped School Leavers When handicapped young people leave school, any further care will be arranged by the Social Services Department. At present the school medical records and case files are not transferred directly to this department for various reasons, including the difficulties regarding confidentiality. Much of the correspondence on these records and files has been exchanged on the understanding that it was "Doctor to Doctor". However, I feel that it is important that these young people be brought to the attention of the Social Services Department. 1 therefore introduced a system whereby my school medical officers endeavour to supply the Social Services Department with a very brief summary of each handicapped young person who has left or will leave school. These forms are completed by the school medical officer during the last term that the young person is at school in our area. The case history of those children who are resident in our area but who are placed in either boarding schools or schools in other areas will be summarized by the school medical officer from school medical records and case files which are obtained from the other authorities concerned. With regard to handicapped children in our schools who are not resident in our area, a summary is not completed, but all these case files, plus school medical records, are forwarded to the Principal School Medical Officer concerned. I am sure that this new scheme is proving to be a further means of benefit to our community. Personal Hygiene An annual comprehensive survey of each pupil is carried out together with such additional health surveys as are thought necessary or desirable at selected individual schools. Details of the work done under the cleansing scheme are shown below. The emphasis of the cleansing scheme is on the children being cleansed by the parent at home where other verminous members of the family may, in the privacy that the home affords, also use the Lorexane No. 3 shampoo distributed by the school nursing department and thus eradicating a possible source of recurring infestation to the child. It is the practice for the school nurse, prior to the commencement of school term, to visit families with a record of infestation to ensure that the children are clean and fit to return to school. This practice has continued to be of considerable value. Findings at Health Surveys School Roll - December, 1972 26,959 (27,694) 1. Comprehensive Surveys (a) Number examined 22,452 (24,135) (b) Number (occasions) found verminous 357 (259) (c) Percentage found verminous 1.59 (1.07) D6 2. Selective Surveys (a) Number examined 12,503 (11,543) (b) Number (occasions) found verminous 436 (427) (c) Percentage found verminous 3.49 (3.70) 3. (a) Total times vermin found (1(b) + 2(b)) 793 (686) (b) Total % found verminous (3(a) as % of 1(a) + 2(a)) 2.27 (1.92) (c) Number of individual pupils found verminous 588 (441) (d) % of individual pupils found verminous (of school roll) 2.14 (159) 4. Action taken with verminous cases: (a) Advice and/or Lorexane 589 (498) (b) Further action 206 (188) (c) 4(b) expressed as a % of 4(a) 35.09 (37.75) Analysis of 4(b) cases - referrals of hardcore cases to bathing centres Voluntary attendance at bathing centres - Numberofpupils 206 (512) N umber of staturory notices issued - (-) 5. Communicable Disease Surveys Number examined for - Athlete's Foot (-) Plantar Warts - (-) Dysentry - (-) Other communicable diseases 527 (1,572) Infectious Diseases in Schools When a pupil is absent from school and the cause is either known or suspected to be due to infectious disease, the Head of the School notifies the Principal School Medical Officer. These notifications are uncorrected for diagnosis, but form the best available index of the trends of infectious diseases in the school community; they are the only figures available for diseases which are not statutorily notifiable. community; they are the only figures available for diseases which are not statutorily notifiable. The following is a table of the infectious diseases notified by Heads of schools in 1972. Cerebro-Spinal Meningitis 5 (5) Pulmonary T uberculosis (Primary) 1 (2) Chicken Pox 261 (328) Ringworm (Scalp) 1 (3) Diphtheria - (I) Ringworm (Body) 4 (13) Dysentry, Diarrhoea or Enteritis 72 (85) Scabies 20 (29) German Measles 118 (105) Scarlet Fever 11 (20) Influenza 120 (2) Sore Throat 3 (4) Impetigo 13 (19) Tonsilitis 9 (28) Jaundice 3 (11) Typhoid Fever and Paratyphoid Fever - (1) Measles 131 (103) Whooping Cough 4 \ (16) Mumps 239 (73) Other Sickness 12 (29) Ophthalmia & Conjunctivitis 11 (2) D7 A close watch is maintained on the incidence of infectious disease in schools and in this context I am indebted to the teaching staff for supplying early information about illness in the schools, and to the general practitioners, medical officers, public health inspectors and health visitors for co-ordinating the investigation and management of cases and contacts. Prophylaxis Action has been taken to increase the number of school children protected against infectious diseases. The following table shows the percentage of school children of all ages inspected who were reported to have been immunised against:- (a) Smallpox 69.0 (67.9) (b) Diphtheria 91.5 (90.5) (c) Whooping Cough 81.1 (78.9) (d) Poliomyelitis 92.3 (91.6) Vaccination Against Rubella In accordance with Circular 11/70 from the Department of Health and Social Security, arrangements were made for vaccination of girls attending Hammersmith schools who were in their fourteenth year of life. The object was to ensure that as many girls as possible are offered protection against Rubella by vaccination before reaching child-bearing age because of the known association of certain foetal abnormalities with Rubella infection in pregnancy. The scheme commenced during the Autumn term of 1970 and despite initial difficulties due to delay in the supply of vaccine, 417 girls were vaccinated by the end of the first year out of an estimated potential total of 1,000. The exercise continued immediately on resumption of school in the Spring term of 1972. Ultimately vaccination will be offered to all girls between their 11th and 14th birthdays. The total number of girls vaccinated against Rubella in 1972 was 1,273 (1,291). B.C.G. Vaccination of Scholchildren The vaccination of children against tuberculosis with B.C.G. (Bacillus Calmette-Guerin) was first introduced in London schools in 1954 and has now become a routine procedure. This is normally carried out every year in the autumn and spring terms and this protective measure is offered to all eligible children aged 13 years +. Children whose skin tests show a negative result and who have not been subject to tuberculous infection are vaccinated; children showing a positive result are referred to the Chest Physicians for X-Ray and any further necessary investigation and treatment. 1. No. of children tuberculin-tested 2,933 (2,313) 2. No. of children found positive to test 534 (558) 3. No. of children positive to test who were X-rayed 335 (270) 4. No. of children found negative to test 2,212 (1,585) 5. No. of children vaccinated 2,202 (1,580) Kecuperative Holidays Arrangements are made under the Education Act, 1944, for recuperative holidays, without charge to the parents, for school children in need of rest, fresh air and good food. The total number of children from Hammersmith schools who went on a recuperative holiday during 1972 was 147 (211). Vision Clinics There are three Vision Clinics in the Borough at Fulham Treatment Centre, Bagleys Lane, S.W.6., at St. Dunstan's Treatment Centre, W.6. and at Hammersmith School Treatment Centre, 103 Shepherds Bush Road, W.6. The Ophthalmologists are officers of the South West Metropolitan Regional Hospital Board and, by arrangements made through the I.L.E.A., undertake a total of 8 or 9 sessions a week. Referrals to the Clinic mainly arise from school medical inspections and an Optician is in attendance to deal with prescriptions for glasses at the parent's discretion. I ne lollowing summarises the work carried out at the Clinics during the year:- Number of sessions 315 (357) Number of new cases 834 (1,004) Total attendances 3,187 (3,713) Errors of refraction and squints 615 (1,269) D8 Other eye defects (-) Spectacles ordered 569 (685) Weekly orthoptic sessions are also held at the Fulham and St. Dunstan's Treatment Centres and the following work was carried out at the Clinics during the year:- N umber of sessions 95 (85) Number of new cases 53 (57) Total Attendances 187 (213) Minor Ailments Centres Minor ailments of school children are treated at five Treatment Centres in the Borough. The following is a statement for the year under report: - Sessions: Medical Officer 25 (35) Nursing Sister 1,203 (1,475) Total Attendances 16,679 24,200 Defects treated:- Athlete's Foot 342 (405) Verrucae 952 (1,002) Ringworm - Body 1 (10) Impetigo 13 (21) Other skin diseases 325 (464) Eye disease 92 (124) Ear diseases 17 (42) Miscellaneous bruises etc. 1,612 (1,962) Special Investigation Clinics Special investigation clinics were held for children suffering from obesity, enuresis and early emotional problems. The school doctor could refer children to these clinics where advice was given and emotional problems and management discussed with parents. These clinics are run on an agency basis by the I.L.E.A. and have the assistance of a social worker and a school nurse who work in close co-operation with the School Care Organiser in the Education Department and with the School Medical Officer. 189 (169) new patients attended the five Special Investigation Clinics, total attendances 1,493 (1,496) were made and 103 (105) children were discharged. Audiometry Hearing loss may be detected not only by clinical examination but also by the use of audiometers (machines which provide an accurate assessment of the hearing defect). Routine audiometry forms part of the health examination of school entrants, and pre-school children are tested whenever possible. The tests are performed by school nurses with special experience in the use of the apparatus. An audiometry test is employed as a preliminary measure in the investigation of educational subnormality as a deaf child of normal intelligence may sometimes give the impression of being educationally subnormal. Audiometry is of particular value in investigating learning difficulties which are sometimes found to be due to a relatively slight degree of defective hearing. Audiology Clinics A total of 137 (125) new cases attended the audiology clinics in the Borough. Most of the children who come to the clinics are given a preliminary "sweep test" by a school nurse. Some are discharged after treatment, others are referred to hospital for minor surgery, but many have a slight but permanent hearing loss. The peripatetic teacher of the deaf and the social worker attached to the clinics ensure that the effects of the handicap are minimised. 240 (234) total attendances were made at the Clinics and 53 (63) children were discharged. Hospital Appointments 439 (465) children were referred from school medical examinations for specialist opinion. The general practitioners were consulted on all these and, with their approval, 419 (436) were referred through the School D9 Health Service. Some practitioners preferred to make their own arrangements for the treatment of 20 (29) children. Health Education in Schools At the request of head teachers, health visitors continue to provide health education in schools on the following topics:- Fulham County School First Aid, Parentcraft & Social Services Gilliat School Nursery Nursing Hammersmith County School Social Services Hurlingham School First Aid, Parentcraft, Health Hygiene, "Careers Convention". Student Health Service A preventive and advisory Student Health Service began in October, 1966, for students of the West London College and was extended in 1968 to include students at the Hammersmith College for Further Education. Dr. Margaret Capra, a full-time Medical Officer on the Staff, who conducts the Service has continued to receive great co-operation and help throughout the year from the Principals of the Colleges and their staffs. A summary of the arrangements has been given in my previous Annual Reports. 1 he following is a statistical summary of the work carried out during 1972; West London Collece Art and Building Hammersmith College Total number of sessions: 27 (27) 25 (25) Clerical sessions 2 (2) 2 (D Consultation sessions 25 (25) 13 (23) Number of students medically examined 1 (2) 38 (3) Number of students advised 40 (38) 73 (14) Referred to Chest X-ray - (-) - (-) Referred to Hospital - (1) 1 (1) Referred to General Practitioner 11 (6) 13 (21) Referred to Dentist - (-) 1 (-) Referred to Optician 1 (-) 1 (-) Referred to Psychiatrist 2 (1) - (-) Referred to Social Worker 3 (-) 1 (1) Handicapped Register The review of handicapped children is now a well established part of the School Health Service. This Register is scrutinised at regular periods by a Medical Officer so that each child's progress and development may be kept under review. The following table is an analysis of the cases placed on the Register:- DIO HANDICAP AND OBSERVATION REGISTER TOTAL = 2,132 SCHOOL CHILDREN AND YOUNG PERSONS LP TO 21 YEARS AGE 5-16 AGE 16-21 TOTAL Epilepsy 112 42 154 Cerebral Palsy 21 1 22 Neuro-Muscular 13 5 18 Spina-Bifida 21 1 22 Nervous System Defects 36 3 39 Blind & partially Sighted 40 - 40 Other Eye Defects 14 5 19 Deaf & Partially Hearing 177 23 200 Speech Defects 43 3 46 Alimentary System 47 3 50 Heart Defects 71 10 81 Fibro Cystic 7 - 7 Asthma 151 8 159 Other Respiratory Defects 29 2 31 Uro-Genital Defects 33 3 36 Limb Abnormalities & Defects 70 10 80 Blood Diseases 26 1 27 Diabetes 45 18 63 E.S.N. 339 31 370 E.S.N. (Severe) 64 5 69 Mongols 28 1 29 Backward 39 - 39 Maladjusted 177 19 196 Autistic 16 3 19 Socio-Medical 20 - 20 Multiple 34 4 38 Dual 45 3 48 Other 20 1 21 Observation 189 - 189 1,927 205 2,132 D11 Social Work (School Health Service) The Social Work Section (School Health Service) is concerned with:- (a) social work arising out of school and hospital clinics and (b) intensive casework with families with multiple problems. The Social Workers concerned with the School Health Service are jointly appointed by the Inner London Education Authority and The London Borough of Hammersmith and have a responsibility for special investigation clinics, audiology clinics, etc. At special investigation clinics, children are seen who suffer from enuresis, obesity and minor behaviour problems. The social workers make contact with the homes and work with the clinic doctor in dealing with the total family situation where this is appropriate. The work may be of a short or long term nature depending upon the problem and needs of the family. At audiology clinics, the social worker is one of the team consisting of the otologist, school nurse and social worker. Close contact is maintained with the peripatetic teacher of the deaf and staff of the schools for the deaf and partially hearing. The social workers have continued to give support to the families of deaf children including those where the child is at boarding school. Sanitary conditions in schools All school premises are inspected annually by the medical staff who offer advice concerning the sanitary conditions and standards of hygiene. Reports concerning defects are passed on to the Divisional Officer of the l.L.E.A. for attention. Conclusion 1 should like to take this opportunity of expressing my sincere thanks to Dr. C.C. A. Jansz, Deputy Principal School Medical Officer, who has been immediately responsible throughout the year for the work set out in this Report. 1 would also like to thank Mr. P.T. Fuller, Principal School Dental Officer and all the Staff of the School Health Services for their hard work and support throughout the year. National Tuberculin Survey by the Medical Research Council As part of the National Tuberculin Survey, the Medical Research Council conducted tests in the following Hammersmith Schools:- Schools No. of Children Tested Melcombe Infants 89 Halford Infants 91 Gilliatt Secondary 90 Miles Coverdale Primary 73 London Oratory Secondary 142 Langford Infants 72 Henry Compton Secondary 107 St. Clement Danes Secondary 111 The results of these tests were as follows:- A. Primary School Children Total No. of Children Tested 325 Total No. of Children with a reaction of 5 mm or more to PPDS 12 Percentage of Children with a reaction of 5 mm or more to PPDS 3.69% B. Secondary School Children Total No. of Children Tested 450 Total No. of Children with a reaction of 5 mm or more to PPDS 24 Percentage of Children with a reaction of 5 mm or more to PPDS 5.33% D12 THE SCHOOL DENTAL SERVICE ANNUAL REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER Since September 1971 the Borough has had the full time use of an I.L.E.A. dental caravan. This is a fully equipped mobile dental surgery which goes to schools.and provides dental treatment on the premises. The dental caravan is used mainly for treating children at Special Schools but also visits some primary schools which are rather distant from the fixed clinics. Experience has shown that this is a very efficient way of providing dental treatment and is a great convenience for many parents who would have difficulty in taking their children for treatment during normal working hours. A further difficulty is the high level of absence at Special Schools because of sickness, which results in many failed appointments when treatment is being given at fixed clinics. The use of the dental caravan largely eliminates failed appointments and also reduces any further loss of school time through having to visit the dentist. An important advantage from the use of the dental caravan is that the dental staff become part of the school for several weeks at a time and most children readily accept visiting the dental caravan as merely a part of their normal school life. It is hoped to open a dental surgery in the Hammersmith County School in the next few months which will provide dental treatment for both Hammersmith County and Christopher Wren Schools. So far there has been little provision of dental facilities at schools except in rural areas as it has always been assumed that in towns children can travel to fixed clinics without difficulty. In view of the ever increasing need for mothers to work and the increased cost of public transport it may well be that schools should be provided with dental facilities whenever practicable. Dental Inspections During the year 13,163 children were inspected at schools and clinics and of these 53% required treatment. It is regretted that only 48% of the school population was inspected compared with 61% the previous year. The main reason for this decline was the high turnover of staff which inevitably results in a disruption of the programme of school inspection. Priority has been given to inspecting nursery schools, special schqpls and primary schools. Staffing The dental staff on 31st December, 1972 was:(1971 in brackets) Staffing Chief Dental Officer Senior Dental Officers Full time Dental Officers Orthodontist (part-time) Dental Auxiliary Dental Surgery Assistants 1 (1) 2 (1) 3 (4) 1 (1) 1 (1) 7 (7) The past year has been a very difficult one for maintaining a full establishment of staff. In common with many professions there is a high demand for dental staff which leads to a high turnover as staff are able to move to jobs in other areas offering better working conditions and less difficulty in obtaining housing. During the year the dental auxiliary and a dental surgery assistant left and were replaced after considerable difficulty. In addition the senior dental officer, a full time dental officer, and the orthodontist left and were only replaced after repeated advertising. Approval was given to a second post of senior dental officer which helps to create a better career structure within the service. Postgraduate Courses Dental Officers have attended courses on preventive dentistry, children's dentistry and on the care of handicapped children. Mr. Jackson, Senior Dental Officer, attended the British Dental Association conference at Swansea. The dental auxiliary attended the I.L.E.A. in-service training course for dental auxiliaries. A new type of course was started by the I.L.E.A. in conjunction with staff from the Royal Dental Hospital. This is an essentially practical course in children's dentistry and was attended by Mr. Pradham. It is hoped that these in-service courses will continue on a regular basis so that all dental officers will have the opportunity of attending. In October the Chief Dental Officer commenced the course for the Diploma in Dental Public Health. This course is designed to train Dental Officers in the broad field of public dental health. Dental Health Education The Ronson Dental Health Trophy was awarded this yearto Wood Lane Schoolfor their enthusiastic work in designing posters for dental health. The I.L.E.A. puppet show visited many of the primary schools and was very well received. Pierre the clown made a return visit to the Borough and visited over thirty schools and nurseries. The major part of the work of dental health education is done by the dental auxiliary in visiting schools and teaching children in the classrooms. In addition a vital part of dental health education is the individual D13 approach of the dentist at thechairside when the child attends for treatment. More and more emphasis is being given to teaching oral hygiene with the use of disclosing tablets to show the child where plaque collects on the teeth and how to remove it. Most children in their first year at school have been given dental health packs as an introduction to the sch'ool dental service. It is hoped that it will be possible to continue this scheme in future years. Premises and Equipment Every effort is being made to maintain a high standard of hygiene. All surgeries have been washed down thoroughly and several have been redecorated. A programme of re-equipping surgeries has been started which will permit and encourage seated dentistry. The surgery at St. Dunstan's School Treatment Centre was the first to be re-equipped. It is hoped to continue this programme in future years thus enabling the School Dental Service to attract good dental officers. Statistics The amount of treatment being provided has increased this year despite a reduction in the total number of sessions worked. It is particularly encouraging to report an increase in the amount of work carried out each session. In particular the number of children attending for treatment and completing their treatment has increased markedly. In order to show the changing pattern of work a new range of treatment is shown under the heading "prevention" as it is felt that proper recognition must be given to this aspect of dentistry. It is essential however that a proper balance is kept between prevention and treating established dental disease. Conclusion This has not been an easy year for the dental staff particularly as the reorganisation of the health services looms ever nearer. This has inevitably created an atmosphere of uncertainty and unease as to the future. It is indeed a tribute to all the dental staff that despite this uncertainty they have made every effort to improve the service. In addition a high turnover of staff tends to have an unsettling effect on the other staff. I am most grateful to all the dental staff for their excellent work throughout the year. Finally I wish to thank the Dental Adviser of the I.L.E.A. and all the staff for their support and guidance throughout the year. D14 Appendix - School Dental Service - Statistics 1972 Sessions 1972 1971 1970 Sessions for Treatment 2174.3 2174.9 2027.6 Inspections 109.8 144.5 108.8 Orthodontics 178.0 109.0 92.0 General Anaesthetics 9.1 14.1 11.2 Dental Health 150.5 311.7 129.0 Total 2621.7 2754.2 2368.6 Inspections Pupils inspected at School 11031 14591 9585 Clinics 2132 2302 2197 % inspected 47.8% 61% 44.4% % requiring treatment 52.8% 53.5% 56.0% % accepting treatment 54% 55.6% 51% Re-inspections 1360 1048 758 Visits 1st visits 4065 3405 3133 Subsequent visits 9287 7911 7886 Total 13352 11316 11019 Failed appointments 5408 4633 5201 Treatment Fillings in permanent teeth 7902 7572 6789 Fillings in deciduous teeth 5535 5819 4252 Permanent teeth extracted 262 338 376 Deciduous teeth extracted 948 1290 1263 G.A. administered 117 204 149 Pupils X-rayed 579 509 383 Teeth otherwise conserved 757 238 211 Teeth root filled 12 16 5 Crowns 34 53 41 Courses of treatment completed 3857 3285 2825 Prevention Prophylaxis 2230 1663 1255 No. given dental health instruction 2619 1150 774 Topical fluorides 558 223 10 Orthodontics Number of new cases 44 33 54 Number of appliances fitted 87 58 84 D15 DENTAL CARE IN THE MATERNITY & CHILD HEALTH HEALTH SERVICE Despite the rather unsettled staffing position, all day nurseries and many playgroups were inspected. Less children were inspected than in the previous year but as many attended for treatment and a much higher proportion completed their course of treatment. The number of expectant and nursing mothers has been steadily declining for many years but there was a marked increase in the number being treated this year. This may well be because the increasing efforts being made to encourage pre-school children to attend for treatment has also encouraged their mothers to attend. The puppet show visited some day nurseries and was very well received. Pierre the clown also visited day nurseries for the first time. It is hoped to repeat both of these methods of dental health education in the future. The dental auxiliary has also continued visiting day nurseries and playgroups and some ante natal clinics to give talks and show films on dental health education. Maternity & Child Welfare Dental Statistics 1972 Children aged 0-4 years Expectant and Nursing Mothers Inspections 1972 1971 1970 1972 1971 1970 1st inspections 1048 1387 914 42 22 27 No. requiring treatment 441 635 344 42 22 21 Visits 1st visits 243 240 179 39 19 21 Subsequent visits 329 435 345 71 55 40 Total visits 572 675 524 110 74 61 Treatment Fillings 482 703 489 134 74 46 Teeth filled 419 579 449 113 63 40 Extractions 26 49 38 12 8 2 Patients X-rayed 1 1 1 16 14 3 Prophylaxis 219 177 98 32 16 13 Teeth otherwise conserved 45 25 36 - - . Courses of treatment completed 172 157 137 30 13 13 1972 1971 1970 Number of sessions for MCW. 137.0 145.0 108.9 D16 INDEX Page Animal Boarding Establishments Act 1963 B13 Animals Act 1950, Diseases of B13 Animals Act 1951, Pet B13 Animals (Miscellaneous Provisions) Order 1957 BI3 Animals (Regulations) Act 1925, Performing BI3 Bathing. Assisted Baths & Wash-Houses, Public Beads. Examination of Blind & Partially Sighted Persons. Examination of C8 Burial & Cremation of the Dead Caravan Sites & Control of Development Act 1960 BI3 Cervical Cytology C3 Chiropody C18 Clean Air B16 Clean Air Act 1956 BI7 Clean Air Act 1968 B17 Cleansing & Treatment of Persons B41 Community Nursing Cll Congenital Malformations, Scheme for Reporting C5 Consumer Protection Act 1961 B36 Cooking Utensils (Safety) Regulations 1972 B36 Coroner's Court & Public Mortuary B38 Dental Care. Maternity & Child Health C2 Disinfection B42 Disinfestationaaaa B42 Disinfestation of Property B42 Dysentery A1 Electric Blankets (Safety) Regulations 1971 B36 Factories Act 1961 B8 Family Planning C9 Fertilisers & Feeding Stuffs Act 1926 B36 Fertilisers & Feeding Stuffs Regulations 1960 to 1964 B36 Flea Infestation B4I Food & Drugs Act 1955 B20 Food & Drugs Act 1955 - Registered Premises B25 Food Complaints B22 Food - Inspection & Supervision B19 Food Poisoning A1 Fulham Chest Clinic C15 Hairdressers & Barbers B14 Hammersmith Chest Clinic C13 Handicapped Children C3 Health Centres C1 Health Education CI7 Health Laundry B42 Health Visiting Cll Home Nursing CI2 Houses in Multiple Occupation B2 Housing B1 Housing Act 1969 - Qualification Certificates B3 Housing Finance Act 1972 BI Housing Inspection B2 Hurlingham Lodge Hostel C16 Ice Cream B26 Immigrants, Medical Arrangements C8 Impetigo B41 Incontinence Pads B42 Infectious Diseases A1 Laboratory Facilities B37 Laundry Services B43 Licensing Act 1964 B36 Live Poultry (Restrictions) Order 1971 BI3 D17 Markets B36 Maternity & Child Health Service CI DI6 Measles AI Medicinal Baths & Treatment Centre B 41 Mental Health Act - Approval of Medical Practitioners CI9 Midwifery Cll Milk Supplies B26 Mothers & Children, Care of CI Nightdresses (Safety) Regulations 1967 B36 Nursing Homes C19 Offices Shops & Railway Premises Act 1963 B4 Oil Heaters Regulations 1966 B36 Paratyphoid A1 Pediculosis B4I Personal Health Service CI Pharmacy & Medicines Act 1941 B13 Pharmacy & Poisons Act 1933 B13 Phenylketonuria C2 Pigeons BI2 Psittacosis or Ornithosis Order 1953 B13 Public Analyst, Annual Report of B27 Public Health Inspectorate Bl Rag Flock & Other Filling Materials Act 1951 B36 Rag Flock & Other Filling Materials Regulations 1971 B36 Rehousing on Medical Grounds Bl Removal of Persons in Need of Care & Attention B37 Renal Dialysis C18 Rent Act 1957 B3 Rodent Control BI2 Scabies B4I School Dental Service D13 School Dental Service - Dental Health Education DI3 School Dental Service - Dental Inspections D13 School Dental Service - Postgraduate Courses D13 School Dental Service - Premises & Equipment DI4 School Dental Service - Staff D13 School Dental Service - Statistics D14 School Health Service D1 School Health Service - Audiology D9 School Health Service - Audiometry D9 School Health Service - B.C.G D8 School Health Service - Educationally Sub-Normal Children D6 School Health Service - Employment of School Children D2 School Health Service - Handicapped Pupils D5 School Health Service - Handicapped School Leavers D6 School Health Service - Health Education in Schools D10 School Health Service - Hospital Appointments D9 School Health Service - Infectious Diseases in Schools D7 School Health Service - Minor Ailment Clinics D9 School Health Service - Personal Hygiene D6 School Health Service - Prophylaxis D8 School Health Service - Recuperative Holidays D8 School Health Service - Routine Medical Inspections D1 School Health Service - Rubella Vaccination D8 School Health Service - Sanitary Conditions in Schools DI2 School Health Service - School Journey Medicals 2 School Health Service - Social Work DI2 School Health Service - Special Educational Problems D5 School Health Service - Special Investigation Clinics D9 School Health Service - Special Medical Examinations Dl School Health Service - Special Recommendations Dl School Health Service - Vision Clinics D5 School Nursing Cll Sewerage BI4 Smallpox AI Staff Medical Examinations B39 Steam & Chemical Sterilisation B43 Student Health Service DI0 D18 Toys (Safety) Regulations 1967 B36 Tuberculin Survey D12 Tuberculosis C13 Tuberculosis. Summary of Notifications A3 Typhoid AI Vaccination & Immunisation C5 Vaccination & Inoculation Certificates A1 Venereal Disease - Martha & Luke Clinic, West London HospitalCI8 Water Supply B14 Well-Babv Clinics at G.P. Surgeries C3 D 19