AC 45553 HARR 33 London Borough of Harrow Annual Report AND Mexican Officer off Health AND Principal School Medical Officer FOR THE YEAR 1966 WILLIAM CORMACK, M.B., Ch.B., D.P.H. London Borough of Harrow Annual Report OF THE Medical Officer of Health AND Principal School Medical Officer FOR THE YEAR 1966 WILLIAM CORMACK, M.B., Ch.B., D.P.H. CONTENTS Page Introduction 7 Statistics and Social Conditions of the Area 15 Personal Health Services 27 Health Education 45 Mental Health Services 49 Welfare Services 63 Children's Services 77 General Services 83 Infectious Diseases 89 Environmental Health Service 101 School Health Service 127 LONDON BOROUGH OF HARROW HEALTH COMMITTEE as at December 1966 His Worship the Mayor (ex officio) The Deputy Mayor (ex officio) Councillor W. E. Jones, A.M.A.S.E.E. (Chairman) Councillor D. H. J. Hart (Vice-Chairman) Councillor Mrs. A. M. Carey Councillor Mrs. M. M. Haslam Councillor A. C. Cocksedge Councillor N. G. Hines Councillor B. M. Cohen Councillor C. F. J. Low, F.S.S. Councillor Mrs. E. E. Davies Councillor I. W. Mackay, LL.B Councillor G. Davies, S.R.N., R.M.N., B.T.A. Councillor D. S. O. Smith, F.A.C.C.A. Councillor A. J. Eckert Councillor Barry Turner Councillor E. W. H. Feakins Councillor R. J. Whtitome, A.C.I.I. Councillor H. I. Harris Councillor W. E. N. Wormald Representing Middlesex Local Medical Committee Dr. H. T. Foot WELFARE COMMITTEE His Worship the Mayor (ex officio) The Deputy Mayor (ex officio) Alderman H. Grainger (Chairman) Alderman Mrs. I. M. Potts, M.B.E. (Vice-Chairman) Councillor K. W. Childerhouse, B.SC.(Econ.) Councillor E. J. Harkett Councillor Mrs. J. M. Debell Councillor H. I. Harris Councillor A. J. Eckert Councillor M. D. Hartley Hill Councillor Mrs. S. R. Edgeworth Councillor Mrs. N. Rees Councillor E. W. H. Feakins Councillor Ben Turner, A.C.C.S. Councillor W. E. N. Wormald CHILDREN'S COMMITTEE His Worship the Mayor (ex officio) The Deputy Mayor (ex officio) Councillor Mrs. D. A. Nott Cock, S.R.N., S.C.M., F.R.S.H. (Chairman) Councillor Mrs. M. M. Haslam (Vice-Chairman) Councillor B. M. Cohen Councillor Mrs. N. Rees Councillor G. Davies, S.R.N., R.M.N., B.T.A. Councillor D. B. Rouse Councillor Mrs. D. I. Edwards Councillor W. A. Tackley Councillor Ben Turner, A.C.C.S. 7 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH Health, Welfare & Children's Department, Hanover House, Lyon Road, Harrow, Middlesex. To His Worship the Mayor, Aldermen and Councillors of the London Borough of Harrow. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Annual Report on the Health and Sanitary Conditions of the district and on the health, welfare and children's services provided by the Borough for the year 1966. In line with the pattern set by the Council's decision in 1965 to combine the Health, Welfare and Children's Services of the Borough the process of amalgamating the three services into one composite department continued in 1966. The National Health Service Act of 1946 has been criticised because with it evolved the tripartite arrangement of Hospital Services, General Medical Services and the Local Authority Services which in the beginning all seemed to work in water-tight compartments with little liaison between them. With the passing of the years, there is much evidence of a "coming together" of these three services, much to the benefit of the public for whose assistance they were designed. In a similar way a tripartite system seemed to exist within the Local Authority Services in that various aspects of the social services were split up between the Health, Welfare and Children's Services. Fundamentally all three services were dealing with the same unit, i.e. the family. It seemed logical, therefore, that the "coming together" theme should be pursued even further by combining these three services into one charged with the task of promoting Family Care and achieving the same objectives with economies both in staff" and effort. It soon became evident that the personnel of the three services, who in the past had each tended to "plough their own (jealous?) furrow" in their speciality, were realising that other allied services had a part to play in the common task of family care. During the year there has been ample evidence of the case in which liaison can be established and co-operation over an agreed course of action can be achieved in a combined Health, Welfare and Children's Department. It is submitted that this combination of effort must only be to the ultimate benefit of the public in general and prove that the Council made a wise decision in April 1965. Finally the amalgamation of the Borough's services should undoubtedly prove helpful in the general task of trying to integrate even further the Hospital, General Medical and Local Authority Services. 8 In pursuit of this integration, liaison schemes whereby the Health Visitors attend the paediatric departments of Edgware General and Kingsbury Maternity Hospitals and the geriatric wards at Roxbourne Hospital continued during the year. The out-patient psychiatric clinic set up in collaboration with the North West Regional Hospital Board at the Caryl Thomas Clinic has proved to be of tremendous value to all concerned. Finally, in the liaison field, a start was made during the year to "attach" members of the borough nursing staff to general practitioners working in group practices. In an urban area this last scheme is fraught with difficulties associated with such things as availability of staff, distribution of doctors' patients, willingness to co-operate and generally must of necessity, be restricted to doctors working in a group. However, a start has been made and plans for expansion were under consideration during the year. Several new projects were completed and brought into use during the year. In April the new clinic was opened at Tenby Road. This clinic was built to provide clinic facilities in the Stanmore South Ward and replace those previously provided in All Saints Church Hall. Although very grateful to the Church authorities for permitting the use of their hall, it could not be considered as really suitable for clinic purposes. Finding a suitable site proved to be an extremely long drawn out and difficult task but eventually a site alongside the assembly hall in Tenby Road was allocated and building work commenced in 1965. All services are provided at the clinic and as the assembly hall is used as a luncheon and social club for elderly, plans are being considered to run an advisory health clinic in the neighbouring clinic building which the old people could easily attend. Whyteways, a new designated Home for the Elderly in Brookshill, Harrow Weald, was also completed during the year. This home provides accommodation for 60 elderly people and by the end of the year 27 were in residence—the admission rate having once again to be geared to the number of staff available. The third project was the opening in September of the transition class at Tanglewood. This class of 20 places is run in conjunction with the Junior Training School for mentally-handicapped children. It serves several purposes such as taking cases at present on the waiting list for Uxbridge Adult Training Centre and also taking children from the senior class at the Junior Training School so allowing admissions lower down the school from the waiting list of younger children. The transition class concentrates on basic social training with the idea of enabling the older children to become more independent than in the past and acts as a maturing phase between the rather "sheltered" academic life of the school to the full day's work under factory conditions of the centre. In line with the development plan for health and welfare services, work commenced in August on the new Residential Home for the Elderly at Sancroft Road, Harrow Weald and completion of this project is 9 expected towards the end of 1967. In addition, plans were finalised for three other projects—the Adult Training Centre, the Day Centre for younger mentally ill and the Assessment Unit for Pre-School Children at the Junior Training School and it is hoped that a start may be made on these projects in 1967. The general trend during the year was one of inauguration, expansion and improvement in services to the public. A cervical cytology clinic was opened at the Caryl Thomas Clinic, a new social club for the handicapped was started at the Presbyterian Church Hall, Station Road, Harrow, chiropody sessions for the elderly were increased and arrangements made for the Family Planning Association to move from their rather cramped quarters at Elmwood Avenue Clinic to the more spacious and better situated Caryl Thomas Clinic in Headstone Drive. Progress was made under the Clean Air Acts during the year when Smoke Control Orders No. 10 and 11 became effective in July and December respectively and in addition the Minister of Housing and Local Government confirmed Orders No. 12 and 13 to come into operation in 1967. A varied programme of health education topics was conducted throughout the year. The personnel of all sections collaborated with the Health Education Officer on projects both of a general nature and others designed for specific groups. More details are given in the main report but mention must be made here of two outstandingly successful projects, viz. the Mental Health Week held in June and the pilot Dental Health Exhibition for schools run for two weeks in November. The interest shown as a result of these two projects was more than rewarding and thanks and congratulations are due to all concerned with their promotion. With the introduction of many new staff into the Health, Welfare and Children's Department during the year, it was considered that arrangements should be made to start training staff by organising an in-service training course which could be attended by members from all sections of the Department. The Establishment Committee readily agreed and a start was made in October 1966 with the preliminary course initially consisting of two ten-week terms. Senior staff of the Mental Health Section readily agreed to give lectures which were supplemented by outside lecturers and also by the showing of specialised films. The course proved very popular with about 50-60 members of staff attending. Consideration of the infectious diseases notified during the year reveals three main points of interest. Eleven cases of enteric fever occurred and from the investigations carried out by the Department in collaboration with the Public Health Laboratory, the infection in all cases was obviously acquired abroad. Secondly there was a slight rise from 20 to 28 in the number of cases of whooping cough notified. Diagnosis of this condition is usually on clinical grounds and few are confirmed by laboratory investigation. Cases occurred in previously immunised children and 10 the problem was to know whether the organism of whooping cough was actually involved or some other infective agent. This matter became the subject of an investigation carried out by the Public Health Laboratory Service and along with other districts the Department is co-operating in this research. Thirdly it is pleasing to note the decline in the number of cases of tuberculosis notified during the year. In January the Council adopted a recommendation that arrangements be made for the addition of fluoride to the water supplies of the Borough. This was submitted to the Colne Valley and Rickmansworth and Uxbridge Valley Water Companies who both replied to the effect that until such time as all local health authorities within their respective statutory areas of supply were in agreement over fluoridation, no action was possible. The position was unchanged at 31st December, 1966. The disagreeable habit of inconsiderate members of the public of dumping rubbish in any convenient open space still unfortunately persisted during the year. The various departments of the Council concerned with the clearing up of these eyesores did their utmost to cope with the problem but it was most disheartening to see a site—only recently cleared —"full to the brim" again after only a short period of time. A joint report from the Departments concerned was under consideration by the Council and it is expected plans for future action to deal with the problem will be forthcoming early in 1967. Following the settling down period of 1965, the School Health Services made steady progress in routine services during 1966. Even though there was an increase in the school population of 654 to a figure of 26,723 the improvements in the previous year's staffing resulted in an increase in the actual numbers of school children receiving a medical and dental inspection. The fact that out of the large number of children inspected only 18 or 0.2% were considered to have an unsatisfactory physical condition is worthy of note and probably gives an indication of the general good standard of health among local school children. Routine medical inspections were confined to the usual three age groups—Entrants, Intermediates, i.e. during first year in secondary school and Leavers, i.e. last year in school. Mention was made in the report for 1965 of introducing a pilot scheme for a fourth medical inspection at the age of 7-8 years using the "selective" medical technique but unfortunately due to other commitments, this aim was not achieved. Every endeavour will be made to try out the scheme during 1967. The importance of the detection of defects in any child at the earliest possible moment in life is now well appreciated. The whole idea being to mobilise as soon as possible all services for the treatment and care of the handicapped child and the support of the family in general. Many agencies are involved in this task—Health, Education and Welfare with perhaps more emphasis on one particular service, depending on the age of the child at any given time. During the school life of such a child, the School 11 Health and the Education services are deeply committed in their endeavours to assure the child receives the type of education most suited to his or her disability. During the year a joint circular was issued by the Minister of Health and the Secretary of State for Education and Science inviting education, health and welfare authorities to review their arrangements for the care of physically and mentally handicapped children and to join with other authorities in a review of aspects of common concern to ensure that optimum services are provided for handicapped children and their families at all times. This review was conducted and a joint report from the Education and Health and Welfare Departments issued. The report reviewed present practices within the Borough and indicated suggested improvements in the services for the handicapped child. On behalf of all the staff of the Health, Welfare and Children's Department, I would like to express thanks to the Chairman and Committee members of the various committees for their interest, support and encouragement during the year and, at the same time, acknowledge with grateful thanks the ready help and co-operation of my colleagues and their respective staffs in other departments. Finally my sincere thanks are due to all members of the Department for their able and willing assistance during 1966. I have the honour to be, Your obedient Servant, WILLIAM CORMACK, Medical Officer of Health Principal School Medical Officer. STATISTICS AND SOCIAL CONDITIONS OF THE AREA 15 STATISTICS AND SOCIAL CONDITIONS OF THE AREA General Statistics Area in acres 12,500 Population (Registrar General's estimate) 208,730 Estimated number of inhabited houses 67,463 Rateable value £11,587,322 Sum represented by a penny rate £47,162 Vital Statistics Live Births:— Male Female Total Legitimate 1,583 1,398 2,981 Illegitimate 86 94 180 Total 1,669 1,492 3,161 Live Birth rate per 1,000 population 15.1 Adjusted Live Birth rate 15.4 Birth Rate for England and Wales 17.7 Illegitimate live births per cent of total live births 5.7 Stillbirths:— Male Female Total Legitimate 25 19 44 Illegitimate 4 3 7 Total 29 22 51 Still Birth rate per 1,000 Live and Still Births 15.9 Total Live and Still Births 3,212 Still Birth rate for England and Wales 15.4 Infant Deaths Cunder 1 year of age) Male Female Total Legitimate 17 15 32 Illegitimate 5 1 6 Total 22 16 38 Infant mortality rate per 1,000 live births 12.0 Legitimate Infant mortality rate per 1,000 legitimate live births 10.7 Illegitimate Infant mortality rate per 1,000 illegitimate live births 33.3 Infant mortality rate for England and Wales 19.0 16 Neo Natal Deaths (under four weeks of age):— Male Female Total Legitimate 12 12 24 Illegitimate 3 0 3 Total 15 12 27 Neo-natal mortality rate per 1,000 live births 8.6 Neo-natal mortality rate for England and Wales 12.9 Early Neo-natal mortality rate (first week) per 1,000 live births 6.6 Peri-natal mortality rate per 1,000 live and still births 22.5 Maternal Mortality:— Maternal deaths Nil Maternal mortality rate per 1,000 live and still births Nil Maternal mortality rate for England and Wales 0.26 Deaths:— Male Female Total 1,077 957 2,034 Death rate per 1,000 population: Crude Death Rate 9.7 Comparability Factor 1.05 Adjusted Death Rate 10.2 Death rate for England and Wales 11.7 Population The estimated mid-year population was 208,730 which, in spite of a natural increase in population—excess of births over deaths—of 1,127 was 870 lower than the figure calculated for 1965. The number of occupied houses and flats rose by 609 to 67,463. Births The total number of births during the year was 3,161 (1,669 male and 1,492 female). 180 of these births were illegitimate, giving a percentage of total births of 5.7. Total number of live and still births 3,212 Local births 658 (a) domiciliary confinement 657 (b) nursing home confinement 1 2,581 birth notifications were transferred from other districts, being mostly births occurring to Harrow mothers in hospitals in Middlesex or in London. The birth rate was 15.1 per 1,000 population, which when corrected by the application of the Registrar General's area comparability factor, gives a birth rate of 15.4 as compared with the birth rate of 17.7 per 1,000 population for England and Wales. 17 Congenital Malformations Information concerning congenital malformations or abnormalities apparent at birth was collected and supplied to the Registrar General. The following is a summary and analysis of the information received during the year. Incidence of Congenital Malformations A. Summary of Notifications (i) Number of notifications received during the year 85 (ii) Number of births included in (i) above 78 (iii) Number of still births included in (i) above 7 (iv) Total number of malformations notified as apparent at birth 93 (v) Number of children with multiple malformations 7 B. Analysis of Malformations Notified Code Number Number of cases Code Number Number of cases 0 Central Nervous System 5 Uro-genital System .1 Anencephalus 1 .0 Defects of uro-genital NOS 1 .4 Hydrocephalus 4 .8 Spina Bifida 9 .6 Hypospadias 5 .9 Intermediate sex 1 1 Eye, Ear .6 Defects of ear NOS 1 6 Limbs .1 Defects of lower limbs NOS 3 2 Alimentary System .0 Defects of alimentary system NOS 1 .3 Polydactyly 3 .4 Syndactyly 3 .1 Cleft lip 2 .5 Dislocation of hip 2 .2 Cleft palate 2 .6 Talipes 33 .3 Heatus hernia 2 .8 Other defects of hands.. 1 .4 Tracheo-oesophageal fistula 1 .9 Other defects of pelvic girdle and lower limb 1 .7 Anal atresia 2 .9 Other defects of alimentary system 1 7 Other skeletal .9 Other generalised defects of skeleton 1 3 Heart and Great Vessels 8 Other systems .0 Congenital Heart disease NOS 3 .3 Vascular defects of skin and subcutaneous tissues 3 .9 Exomphalus 1 9 Other Malformations .0 Congenital Malformations NOS 1 .6 Mongolism 4 Still Births 51 still births were registered during the year, giving a still birth rate of 15.9 per 1,000 live and still births, which compares favourably with the rate of 15.4 for the country as a whole. 18 Infant Mortality During the year, 38 (22 male and 16 female) infants living in the district, or born to mothers ordinarily resident here, died under one year of age. This was an increase of five on the figure for 1965 and with 3,161 live births gives an infant mortality rate of 12.0 as compared with that of 10.0 in 1965. The rate for England and Wales was 19.0. Twenty-seven, or approximately seventy per cent of these infant deaths occurred during the first four weeks of life, giving a neo-natal mortality rate of 8.6 per thousand live births. Twenty-one of these neo-natal deaths occurred during the first week of life, prematurity being the main cause of death. These early neo-natal deaths, combined with the still births give a peri-natal mortality rate of 22.5 per thousand live and still births compared with a rate of 19-4 for 1965. Maternal Mortality No deaths occurred during 1966 due to causes associated with pregnancy and childbirth. Deaths The total number of deaths of residents of the Borough was 2,034, giving a death rate of 9.7 per 1,000 population. Liability to death varies at different ages and also between the sexes. Accordingly, to offset the effect of these variations and so produce a rate which can be used for comparison purposes with other districts in the country as a whole, the Registrar General calculates for each district a comparability factor which, when applied to the crude death rate of 9.7, gives an adjusted death rate of 10-2, which then compares with the death rate of 11.7 per 1,000 population for England and Wales. The main causes of death were as follows:— 1. Diseases of the circulatory system 755 2. Cancer 457 3. Vascular diseases of the central nervous system 265 843 deaths registered were of people over 75 years of age, i.e. 41 % of the total deaths registered in the district. Deaths from Cancer In 1966 the number of deaths from cancer was 250 males and 207 females. Deaths from lung cancer decreased by 22 to a total of 133 for the year, or a rate per 100,000 of 63.73. Seventy-two per cent of these deaths occurred in the age group 55-75 years. Measures to bring the association of cigarette smoking with lung cancer to the attention of the public continued during the year. 19 Deaths from Accidents Motor vehicle and other accidents caused the deaths of 52 residents during 1966. Again in the classification of other accidents 43 per cent of the deaths occurred in the elderly age group. All members of the staff are aware of these problems and every opportunity is taken to advise on home safety measures during the course of the many domiciliary visits paid during the year. Deaths from Suicide Eighteen people committed suicide during 1966, an increase of one compared with the figure for 1965. Deaths from Infectious Diseases There were nine deaths from tuberculosis during 1966, with once more a nil return in the case of whooping cough, measles and acute poliomyelitis. TABLE I Summary of Vital Statistics 1942-1966 Estimated Civilian Population Birth Rate per 1,000 Population Death Rate per 1,000 Population Infant Mortality Rate—Deaths under 1 year per 1,000 Neonatal Mortality Rate—Deaths under 1 month per 1,000 Maternal Mortality Rate per 1,000 live and still births Still Birth Rate per 1,000 live and still births 1942 195,100 16.6 9.3 31.5 - 1.50 24.1 1943 191,660 18.2 9.1 38.0 - 2.57 28.0 1944 185,090 18.1 9.3 34.8 - 0.56 33.6 1945 191,710 16.0 9 0 32.2 - 1.26 29.1 1946 210,890 18.0 8.6 31 0 - 0.75 30.0 1947 215,930 17.7 8.5 24.0 - 1.00 23.2 1948 218,700 14.7 8.4 28.8 - 0.60 20.9 1949 220,300 13.9 8.5 20.7 - 1.60 20.9 1950 222,300 12.8 8.9 13.6 - 1.30 21.6 1951 220,000 13.1 9.5 22.1 - 1.00 23.9 1952 219,000 13.1 8.7 21.7 - 1.30 18.2 1953 217,900 12..5 8.8 16.9 - 0.30 24.5 1954 217,700 12.6 8.2 16.7 11.3 0.70 20.0 1955 217,100 12.7 8.9 17.6 12.0 0.35 17.8 1956 216,200 12.9 8.8 21.1 16.7 0.70 20.4 1957 215,000 12.9 9 0 14.0 9.7 0.30 21.9 1958 214,300 13.2 9.3 17.0 13.5 0.70 16.3 1959 213,700 13.7 9.7 15.0 11.6 Nil 14.4 1960 214,370 14.5 9.4 18.6 14.4 0.32 18.2 1961 209,580 14.7 10.2 18.1 12.6 0.30 14.7 1962 209,600 15.5 10.4 22.5 17.6 Nil 13.4 1963 209,520 15.2 10.4 16.3 11.9 Nil 16.6 1964 210,250 15.9 9.3 12.2 8.1 Nil 12.1 1965 209,600 15.8 9.7 10.0 7.6 0.59 12.5 1966 208,730 15.1 9.7 12.0 8.6 Nil 15.9 20 TABLE D Comparative Vital and Mortality Statistics for the Borough of Harrow and for England and Wales for years 1956-1966 Year Birth Rate Death Rate Infant Mortality Rate Harrow England and Wales Harrow England and Wales Harrow England and Wales 1956 13.1 15.6 10.5 11.7 21.1 23.7 1957 13.2 16.1 10.5 11.5 14.0 23.1 1958 13.5 16.4 11.1 11.7 17.0 22.6 1959 14.1 16.5 11.5 11.6 15.0 22.2 1960 14.9 17.1 11.1 11.5 18.6 21.9 1961 15.3 17.4 11.9 12.0 18.1 21.4 1962 16.1 18.0 12.1 11.9 22.5 20.7 1963 15.5 18.2 11.2 12.2 16.3 21.6 1964 16.2 18.4 10.0 11.3 12.2 30.0 1965 16.1 18.1 10.1 11.5 10.0 19.0 1966 15.4 17.7 10.2 11.7 12.0 19.0 TABLE III Deaths of Harrow Residents during 1966 Registrar General's Return Cause of Death Males Females Total 1. Tuberculosis, respiratory 5 3 8 2. Tuberculosis, other — 1 1 3. Syphilitic disease 2 2 4 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal Infections — 1 1 7. Acute Poliomyelitis — — — 8. Measles — — — 9. Other infective and parasitic diseases 2 5 7 10. Malignant neoplasm, stomach 25 21 46 11. Malignant neoplasm, lungs, bronchus 108 25 133 12. Malignant neoplasm, breast 1 44 45 13. Malignant neoplasm, uterus —- 11 11 14. Other malignant and lymphatic neoplasms 116 106 222 15. Leukaemia, aleukaemia 7 9 16 16. Diabetes 5 2 7 17. Vascular lesions of nervous system 99 166 265 18. Coronary disease, angina 291 182 473 19. Hypertension with heart disease 9 14 23 20. Other heart disease 59 82 141 21. Other circulatory disease 47 71 118 22. Influenza — — — 23. Pneumonia 61 53 114 24. Bronchitis 78 24 102 25. Other diseases of respiratory system 6 7 13 26. Ulcer of stomach and duodenum 14 10 24 27. Gastritis, enteritis, diarrhoea 5 8 13 28. Nephritis and nephrosis 8 3 11 29. Hyperplasia of prostate 4 — 4 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformations 14 5 19 32. Other defined and ill-defined diseases 69 74 143 33. Motor vehicle accidents 14 5 19 34. All other accidents 16 17 33 35. Suicide 12 6 18 36. Homicide and operations of war — — — Total 1,077 957 2,034 21 TABLE IV Causes of Deaths (Males) at various ages, 1966 Cause of Death All Ages Under 4 weeks 1 month to 1 year 1- 5- 15- 25- 35- 45- 55- 65- 75- 1. Tuberculosis, respiratory 5 — — — — — — 1 — 3 — 1 2. Tuberculosis, other — — — — — — — — — — — — 3. Syphilitic disease 2 — — — — — — — — — 1 1 4. Diphtheria — — — — — — — — — — — — 5. Whooping Cough — — — — — — — — — — — — 6. Meningococcal infections — — — — — — — — — — — — 7. Acute Poliomyelitis — — — — — — — — — — — — 8. Measles — — — — — — — — — — — — 9. Other infective & parasitic diseases 2 — 1 — — — — — — — 1 — 10. Malignant neoplasm, stomach . . 25 — — — — — — 1 2 7 9 6 11. Malignant n'plsm, lungs, bronchus 108 — — — — — — 1 13 47 28 19 12. Malignant neoplasm, breast 1 — — — — — — — — 1 — — 13. Malignant neoplasm, uterus — — — — — — — — — — — — 14. Other malignant and lymphatic neoplasms 116 — — — — 1 1 2 5 32 38 37 15. Leukaemia, aleukaemia 7 — — — — — 2 — 1 1 2 1 16. Diabetes 5 — — — — — — — — 1 1 3 17. Vascular lesions of nervous system 99 — — — — — — 2 6 17 29 45 18. Coronary disease, angina 291 — — — — — — 4 28 80 111 68 19. Hypertension with heart disease 9 — — — — — — — — 1 4 4 20. Other heart disease 59 — — — — — — — 3 10 12 34 21. Other circulatory disease 47 — — — — — — 1 4 12 8 22 22. Influenza — — — — — — — — — — — — 23. Pneumonia 61 1 3 1 — — — — 1 5 15 35 24. Bronchitis 78 — — — — — — — 2 21 30 25 25. Other diseases of respiratory system 6 — — — — — — 1 — 2 — 3 26. Ulcer of stomach and duodenum 14 — — — — — — — 1 4 4 5 27. Gastritis, enteritis, diarrhoea 5 — 1 — — — — — 1 — 2 1 28. Nephritis and nephrosis 8 — — — — — 2 2 — 1 1 2 29. Hyperplasia of Prostate 4 — — — — — — — — 1 — 3 30. Pregnancy, childbirth, abortion — — — — — — — — — — — — 31. Congenital malformations 14 6 2 2 1 1 — — — 1 1 — 32. Other defined & ill-defined diseases 69 8 — 1 — 3 — 2 6 10 20 19 33. Motor vehicle accidents 14 — — 1 1 3 1 3 2 2 — 1 34. All other accidents 16 — — 3 2 3 — 1 2 — — 5 35. Suicide 12 — — — — — — — 3 5 3 1 36. Homicide and operations of war — — — — — — — — — — — — Total 1077 15 7 8 4 11 6 21 80 264 320 341 22 TABLE V Causes of Death (Females) at various ages, 1966 Cause of Death All Ages Under, 4 weeks month to 1 year 1- 5- 15- 25- 35- 45- 55- 65- 75Over 1. Tubercolusis, respiratory 3 — — — — — — 1 — 1 — 1 2. Tuberculosis, other 1 — — — — — — — — — — 1 3. Syphilitic disease 2 — — — — — — — 1 — 1 — 4. Diphtheria — — — — — — — — — — — — 5. Whooping Cough — — — — — — — — — — — — 6. Meningococcal infections 1 — — — — — — — — — 1 — 7. Acute Poliomyelitis — — — — — — — — — — — — 8. Measles — — — — — — — — — — — — 9. Other infective & parasitic diseases 5 — — — — — 2 — — 2 1 — 10. Malignant neoplasm, stomach .. 21 — — — — — — — — 5 4 12 11. Malignant n'plsm, lungs, bronchus 25 — — — — — — 2 — 9 12 2 12. Malignant neoplasm, breast 44 — — — — — — 2 8 17 8 9 13. Malignant neoplasm, uterus 11 — — — — — — 1 2 3 2 3 14. Other malignant and lymphatic neoplasms 106 — — 1 — — — 3 10 27 25 40 15. Leukaemia, aleukaemia 9 — — 1 1 — — — 1 3 1 2 16. Diabetes 2 — — — — — — — — — 1 1 17. Vascular lesions of nervous system 166 — — — — — 1 — 3 12 35 115 18. Coronary disease, angina 182 — — — — — — 1 3 30 58 90 19. Hypertension with heart disease 14 — — — — — — — — 2 1 11 20. Other heart disease 82 — — — — — — — — 7 8 67 21. Other circulatory disease 71 — — — — — — — 4 8 12 47 22. Influenza — — — — — — — — — — — — 23. Pneumonia 53 — 1 — — — — 1 — 1 9 41 24. Bronchitis 24 — — — — — — — 3 — 6 15 25. Other diseases of respiratory system 7 — — — — — — — — 1 3 3 26. Ulcer of stomach and duodenum 10 — — — — — — — 1 — 2 7 27. Gastritis, enteritis, diarrhoea 8 — 1 — — — — — 1 — — 6 28. Nephritis and nephrosis 3 — — — — — — — — — — 3 29. Heperplasia of Prostate — — — — — — — — — — — — 30. Pregnancy, childbirth, abortion — — — — — — — — — — — — 31. Congenital malformations 5 3 — — 1 1 — — — — — — 32. Other defined & ill-defined diseases 74 9 1 — 1 1 — 4 6 7 23 22 33. Motor vehicle accidents 5 — — — — — — 1 — 3 1 — 34. All other accidents 17 — 1 — 1 — — 2 1 6 2 4 35. Suicide 6 — — — — — — 2 3 1 — — 36. Homicide and operations of war — — — — — — — — — — — — Total 957 12 4 2 4 2 3 20 47 145 216 502 23 TABLE VI Deaths of Harrow Infants under 1 year of age, 1966 Causes of Death AGE Under 1 day 1-7 days 1-2 weeks 2-3 weeks 3 weeks to 1 month Total under month 1-3 months 3-6 months 6-9 months 9-12 months Total under I year Broncho Pneumonia — — — — — — 3 1 2 — 6 Asphyxia 1 1 — — — 2 1 — — — 3 Congenital Heart Disease 2 — 1 1 4 — — — — 4 Prematurity 7 4 1 — — 12 — — — — 12 Atelectasis 1 1 — — — 2 1 — — — 3 Acute Virus Encephalitis — — — — — — — — — 1 1 Cerebral Haemorrhage — — — — — — 1 — — — 1 Congenital Malformation — 2 — — 3 — 1 — — 4 Rhesus Incompatibility 1 1 — — — 2 — — — — 2 Meningitis — — — 1 — 1 — — — — 1 Peritonitis Hirschsprings Disease — — — 1 — 1 — — — — 1 Total 10 11 2 3 1 27 6 2 2 1 38 TABLE VII Pulmonary Tuberculosis; Cancer of Lung and Bronchus Deaths with Rate per 100,000 Population, 1956-1966 Year Population Deaths/Pulmonary Tuberculosis Deaths/Lung Cancer Number Rate per 100,000 Number Rate per 100,000 1956 216,200 13 6.01 81 37.47 1957 215,000 12 5.58 97 45.12 1958 214,300 8 3.73 82 38.27 1959 213,700 6 2.80 104 48.67 1960 214,370 10 4.66 135 62.98 1961 209,580 9 4.29 130 62.03 1962 209,600 5 2.38 133 68.22 1963 209,520 4 1.91 109 52.07 1964 210,250 10 4.75 132 62.73 1965 209,600 5 2.39 155 73.95 1966 208,730 8 3.83 133 63.73 PERSONAL HEALTH SERVICES 27 PERSONAL HEALTH SERVICES These services are provided under Part III of the National Health Service Act of 1946. Section 22 — Care of Mothers and Young Children Ante-natal and post-natal clinics were held for the benefit of expectant mothers at fourteen centres throughout the Borough. Consideration of the numbers making use of these facilities compared with the number of births during the year again illustrate the present day trend of ante-natal care moving away from the clinic towards either the hospital and/or the general practitioner's surgery. The planned early discharge of maternity patients permitting delivery in hospital and discharged to own home after 48 hours is popular with mothers and probably has some bearing on the decrease in attendances at ante-natal clinics. To counter-balance this decrease in ante-natal attendances at the clinics, there has been an increase in the number of "preparation" classes held by appointment at ten centres. Thirteen classes giving instruction in mothercraft and antenatal relaxation are held each week. Each course lasts between 8/9 weeks and starts during the fifth month of pregnancy. The weekly haematology clinic is held every Thursday afternoon at the Caryl Thomas Clinic, Headstone Drive. This clinic provides a central point for taking blood specimens from expectant mothers referred from other clinics or direct from general practitioners. The Pathological Department at Edgware General Hospital obliges with immediate tests and reports on all specimens. Appointments from the haematology clinic can be made by telephoning the clinic :- TEL.: 427 4484. Advice on the feeding, hygiene and general management of the infant is made available at eighteen centres where child welfare and clinic sessions are held. These sessions have a great educational value and judging by the number of mothers attending with their children, are very much appreciated. The guidance, encouragement and education of the young nursing mother, in congenial surroundings has much to recommend it and may be said to be the main function of a child welfare clinic. Special toddlers' sessions are also held where mothers of older children are seen by appointment. Here the mother has ample opportunity to discuss with the clinic staff the general developmental progress of her child. Facilities for vaccination and immunisation are available at all child welfare sessions. The following table gives the number of children attending infant welfare and toddlers' sessions from 1962 to 1966. Year Number of Children Attending Clinics 1962 8,651 1963 9,381 1964 10,527 1965 11,647 1966 12,224 28 Care of the Unsupported Mother and her Child This type of case presents many problems, many of which can be very difficult to resolve. There is no set pattern for dealing with them— each case being considered in the light of all circumstances and the best solution possible worked out in the interests of the mother and child. Many social work agencies can be involved and they all work in collaboration with the Medical Social Worker engaged specifically to deal with such problems and whose services are shared with the London Borough of Brent. During 1966, 94 applications for help were received from expectant mothers and 56 entered Mother and Baby Homes. Of the remaining 38, 21 mothers decided to keep their babies and returned home from hospital. One mother had a still-birth and another made her own private arrangements for adoption. One mother preferred to care for her baby in her own home until he was placed by an Adoption Society. Five girls did not pursue their initial applications and probably left the area; one au pair girl returned to her own country. The remaining eight mothers asked for their babies to be placed with foster mothers from hospital pending adoption. These arrangements were made but only one baby was placed in the Harrow area. There would appear to be a great dearth of approved short term private foster mothers in Harrow and this necessitates babies being placed, often quite a distance, away from the mother's home area. As the mother has to take her baby to the Adoption Society for interview and again for hand-over when adopters have been chosen, the extra travelling involved can cause difficulties and hardship. The demand for fostering from hospital is increasing and is sought mainly by the professional girl and by families of the very young expectant mother, often a school girl, whom it is felt would have great difficulty in taking an objective view of the future of her child should she have to care for him for any length of time. In certain circumstances this type of fostering can be an enormous help to a mother in coming to a decision but it is not the answer for every unmarried mother. Day Nurseries There are two day nurseries in the Borough providing accommodation for 110 children aged 0-5 years for whom nursery provision is required on health grounds. These nurseries are at:— (a) Headstone Drive, Wealdstone 50 place (b) Walton Avenue, South Harrow 60 place 29 Demand for places is high and admission is determined by a system of priorities. In certain cases where it is considered attendance at a day nursery would be beneficial to progress, certain handicapped children are admitted without charge. The present categories are deaf, partially deaf, children of deaf and dumb parents where talking environment is desirable, children showing behaviour problems and finally for suitable physically handicapped children. Training facilities are available at the Headstone Drive Nursery for students seeking the qualification of the National Nursery Examination Board. Each year the number of applicants for training far exceeds the posts available. Nurseries and Child Minders Regulation Act Private day nurseries and child minders are registered under the Nurseries and Child Minders Regulation Act. On receipt of requests for registration, arrangements are made for the applicant(s) to be interviewed by a Medical Officer at the home or premises where it is proposed to carry out the daily care of children. This gives an opportunity of assessing the applicant's qualifications and suitability to carry out this type of work and also to discuss the standards which the Council would require in order to effect registration. Following registration, periodic visits are made by a Medical Officer to all premises and in addition visits are made by health visitors to ensure that the conditions of registration are being observed and in general to give advice on the well being of the children. The numbers registered at the end of the year were as follows:— (i) Child Minders 22 (ii) Private Day Nurseries 22 Priority Dental Service There was a substantial increase over the previous year in the number of pre-school children attending for treatment. A total of 440 new cases were seen compared with 246 new cases in 1965. This improvement reflects the close co-operation between the Welfare Clinics and the Dental Clinics. The tendency is gratifying as experience shows that children receiving treatment at an early age usually continue as patients after reaching school age. There was a fall in the number of expectant and nursing mothers attending for the first time. The total being 59 compared with 74 in 1965. Marriage Guidance The Marriage Guidance Council have a local office in the Borough. This is at 88/98 College Road, Harrow, Tel.: 427 8694. 30 Family Planning In Circular 5/66 the Minister of Health urged local health authorities to review the present arrangements for family planning advice and treatment in their area and suggested ways in which, in co-operation with Family Planning Association and other bodies, the local services might be further developed for the welfare of their citizens. The Borough continued to carry out general education in family planning matters as authorised under existing powers. The service includes lectures and discussions in the Health Education Programme, supplemented by talks and discussions by the medical, health visiting, home nursing and midwifery staff in their day to day contact with mothers in the clinics and also during the course of home visiting. In addition, suitable posters are exhibited at all the Borough clinics. Arrangements were also made with the Family Planning Association whereby certain clinics were made available, without charge, to the Association to hold family planning sessions. These sessions were held at the Elmwood Avenue and Alexandra Avenue Clinics until November 1966 when due to the tremendous expansion in the services arrangements were made to transfer the sessions at Elmwood Avenue to the more commodious and more centrally situated Caryl Thomas Clinic in Headstone Drive. The present sessions are as follows:— Caryl Thomas Clinic Monday evening Headstone Drive, Wednesday afternoon Wealdstone. Wednesday evening Alexandra Avenue Clinic Alexandra Avenue, Tuesday morning. South Harrow. The Borough accepts financial responsibility for patients referred by Council Medical Officers for contraceptive advice and treatment on medical grounds. Section 23 — Midwifery The domiciliary midwife working in liaison with the general practitioner obstetrician provides ante-natal supervision of mothers expecting to be confined at home. The ante-natal care includes instruction in the use of analgesia apparatus—gas and air and trilene. Sterilized maternity packs are available to all, except those who have booked a hospital bed for their confinement. A special small emergency pack is used in cases of early discharge from hospital. The establishment of midwives during the year was fifteen full-time and two part-time. During the year two midwives resigned one emigrating to Canada and the other to the United States of America. Recruitment was carried out by advertising through the normal channels and in fact applications far outnumbered vacancies. 31 The midwives work in groups of four and have a duty rota system which has worked well to the mutual benefit of patients and midwifery staff. Emergency night calls are dealt with extreme efficiency through the switchboard at Harrow Hospital. Attendances during the year:- Total domiciliary bookings 913 Home confinements 657 Emergency admissions to hospital 163 Discharged to the district 83 The 83 patients returned to the care of booked domiciliary midwives. Planned Early Discharge of Maternity Patients This scheme continues to be run by two full-time and one part-time midwife. The scheme works well and is popular with the mothers concerned. Patients are received from the following hospitals:- Kingsbury, Edgware, Bushey, Queen Charlotte's, The Middlesex and University College. No adverse effects to any mother or child have been observed. Cases:— Booked and discharged 283 Booked and not discharged 106 Unbooked discharges 44 Standard Ante-Natal Co-operation Card These cards continue to be proved their worth and are in continuous use by general practitioners and midwives. The card, recommended by the Maternity Services (Cranbrook) Committee ensures that each member of the obstetric team is aware of the attention given by other members. It is retained and produced by the patient at every ante-natal examination until the final post-natal examination when it should be passed to her general practitioner for inclusion in her medical records. Training Nineteen pupil midwives from Bushey Maternity Hospital were attached to a Department for completion of midwifery training. Each pupil works with a teaching midwife who supervises their domiciliary training in preparation for Part II of the Examination of the Central Midwives Board. The pupils receive practical instruction on the district and as a stimulus to interest, have lectures on public health matters, together with visits to such places as the Colne Valley Water Works and a dairy farm. 32 Four midwives attended Post-Certificate Refresher (G.I.) Courses as required by the rules of the Central Midwives Board. Flying Squad Services of the Flying Squad were requested by the domiciliary midwives on three occasions during the year. The response was immediate and this service is very much valued and appreciated. Care of Premature Babies—Portable Incubator These incubators are held at main ambulance depots and are used for the transport of small or sick infants under good conditions of warmth and humidity with the addition of oxygen if required. No calls were made on this service during the year. Liaison with Group Practices In November 1966, a pilot scheme was started at a Group Practice working in the Edgware district of the Borough. In this scheme the midwives working in this area take it in turns to attend the ante-natal clinic which is held at the surgery of the Group Practice once weekly. This scheme appears to be working well and the advantages can be summarised:— (1) the patient is seen by a doctor and midwife on her attendance at the clinic (2) the doctor and midwife are able to confer readily when necessary (3) the patient has only to attend one centre (4) the patient benefits psychologically from the close co-operation between doctor and midwife (5) the possibility of conflicting advice is diminished (6) liaison between doctor and midwife is enhanced. This scheme appears to be excellent but for the midwife to be fully occupied during clinic time, it is desirable that the Group Practice concerned should be a sufficiently large unit. Notification of Intention to Practice Twenty-three midwives notified their intention to practice within the Borough as is required under the Rules of the Central Midwives Board. Twenty-two of these were domiciliary midwives. Section 24 — Health Visiting During the year 1966 the health visiting establishment remained static as three resignations due to retirement were offset by the appointment of three Student Health Visitors who completed their training in 33 July, 1966. Two had been sponsored by the Borough and one had completed the integrated course at the Hammersmith Hospital. Two further student Health Visitors were recruited for the sponsored training scheme and they commenced their training in September 1966. Clinic nurses are attached to all clinic centres to relieve the health visiting staff of the more routine clinic duties and also some of the duties under the school health service. Their services are extremely useful and much appreciated. Training of Health Visitors The new syllabus for the training of Health Visitors has been used for the second year and two Senior Health Visitors appointed as Field Work Instructors have been supervising and training pupil Health Visitors in the practical skills of health visiting. In order to strengthen this Field Work Instruction team, a third Health Visitor attended a special 10-day course at the Chiswick Polytechnic. Student Health Visitors from other authorities have also been trained in Harrow. The Senior Health Visitor appointed as Group Adviser has supervised the young Health Visitors for a period of three months after completion of their training. She has also been the instructor to groups of nurses who have visited the area from the Middlesex, Edgware General and Mount Vernon Hospitals. Discussions have been arranged in the hospitals following observation visits to the local health authority and the Group Adviser has attended these discussions as representative and adviser. One Health Visitor attended a refresher course during the year and a second Health Visitor completed and passed the examination of a parttime teaching course arranged and conducted throughout the year by the Health Visitors' Association. All Health Visitors and clinic nurses attended a successful In-Service training course arranged by the mental health section to study the subject of mental subnormality. Preparation for Confinement Arrangements were made for all the Health Visitors to attend a series of lectures in relaxation given by the Chief Physiotherapist at Edgware General Hospital. The aim was to introduce a method of preparation for childbirth which would be common to hospital and local health authority clinics and thus avoiding confusion to patients. Two courses of six lectures were given to the health visiting staff. Discussion Groups All Health Visitors attended case discussions in groups of eight once a month for a period of six months under the guidance of Dr. Tonnesmann, a Psychiatrist. A particular family or families were used for discussion in a group situation. 34 Health Education Talks were given to groups of mothers, youth clubs, old people's clubs and church organisations during the year. As in previous years, fathercraft classes were arranged at the Caryl Thomas Clinic for groups of fathers. The course consists of three lectures in preparation for the new duties of the husbands in the management of the young child, for cases of emergency in the home and a fuller understanding of pregnancy and the birth of the baby. Film evenings were arranged in three clinics during the year for expectant mothers and their husbands—fourteen such evenings were arranged. In addition, classes were arranged for school leavers in Home Making and Health and Personal Hygiene. The aim of the classes is to help girls to realise more fully their responsibilities as future wives and mothers. Classes in child care in preparation for the Duke of Edinburgh's Gold Medal Award were given in Downer Grammar School. The schools concerned in this programme were Blackwell Secondary, Roxeth Manor Secondary, Heriots Wood Grammar and Heathfield College. Research Projects In conjunction with general practitioners, the Department has been co-operating with the Public Health Laboratory at Colindale in a survey to investigate the serotypes currently responsible for cases of whooping cough and also to study the relation between serotypes isolated from patients and those present in current vaccines. Previous research work had suggested that the whooping cough vaccines may be less effective than in former years, because there may have been a change in the antigenic structure of the epidemic strain organism. More than 4/5 strains of Bordetella pertussis now being isolated in this country are of serotype 1, 3. Most of the pertussis vaccine used until recently contained mainly antigens 1 and 2 and little antigen 3. Before 1958 strains of serotype 1, 3 were rarely isolated. The main objectives of this survey were as follows:— (1) to identify the serotypes of Bordetella pertussis responsible for cases of whooping cough in the United Kingdom and when a patient has been previously vaccinated to determine whether the serotype isolated, was represented in the vaccine. (2) To determine if cases considered clinically to be whooping cough may be caused by other agents. General practitioners were asked to report suspected cases of whooping cough to the Department by telephone with the minimum of delay. These cases were then visited by nursing staff from the Department 35 in order to take pernasal swabs of the patient and pre-school household contacts. At the same time record cards were completed. These swabs were then passed to Colindale for the necessary laboratory investigations. Investigation was still in progress at the end of the year. Liaison Schemes with Hospitals A Health Visitor continued to attend the Paediatric Department at Edgware General Hospital. She informs the Health Visitor concerned of any difficulties in the progress and rehabilitation of child patients receiving care from the hospital and the local authority. This scheme continues to be valuable to both services. The liaison scheme with Kingsbury Maternity Hospital has continued. Two Health Visitors attend for a series of four weeks, the lectures and ward teaching rounds as well as the At Risk clinic conducted by Dr. Barrie of the Paediatric Department of the Charing Cross Hospital Group. A rota system has been worked out and all Health Visitors attended during the year. A very much closer working relationship has thus been established through this scheme. The third scheme for liaison between the district and the geriatric wards at Roxbourne Hospital has continued to work well. Student Visits to the District Programmes were arranged for groups of students to observe the various activities in the local health authority field. These groups included students from nurses' training schools at the Middlesex, Edgware General and Mount Vernon Hospitals, a nursing administration student from Trinidad, student health visitors and social workers from various training schools and several groups of scholars from secondary schools in the neighbourhood. Work of the Health Visitor All health visiting staff were fully committed during the year with consultative and advisory work in the clinics and in the home. Their field of work spreads through all age groups but with an ageing population the numbers of the visits to the elderly is undoubtedly on the increase— these rose from 757 in 1965 to 1,141 in 1966. Section 25 — Home Nursing The home nursing staff consisting of 23 nurses equivalent to 22 whole time staff, worked in liaison with the general practitioners to provide nursing care for the acute and chronic sick in their homes. During the year, the nurses paid a total number of 60,183 home visits. (1) Total number of persons nursed during the year 2,061 (2) Number of persons under 5 years old at first visit 40 (3) Number of persons 65 years or over at first visit 1,386 (4) Total number of visits made during the year 60,183 (5) Number of visits of over one hour's duration 1,663 (6) New cases referred during the year 1,465 36 Type of illness involving the above visits Category Male Female Total Medical 584 1,290 1,874 Surgical 85 76 161 Infectious diseases 1 1 2 Tuberculosis 5 6 11 Maternal complications — 13 13 Total 675 1,386 2,061 It will be seen that although the service involves the nursing care of all age-groups, by far the greatest number of cases lie in the elderly group suffering from chronic ill-health. These visits are usually to provide general nursing care and are visits which cannot be hurried. In addition to the nursing attention, the visits also have a therapeutic social value for patients and relatives. Certain routine nursing duties are on occasions taken over by the St. John's Ambulance Brigade and the British Red Cross. This assistance is greatly appreciated. Training The Deputy Supervisor of Home Nurses attended a course on Civil Defence at the Civil Defence Training College. Incontinence Pads In accordance with the Minister of Health's Circular 14/66, incontinence pads are now issued on a much wider scale to patients of all categories who suffer from incontinence. Requests are mainly received from general practitioners and hospitals. The overall demand for this service has shown a steady increase with 13,080 pads being issued during the year. Incontinent Pants and Interlinings These items are now being provided on a Doctor's request for the incontinent aged. They have proved very successful. Thirty-six pants were issued in 1966. Incontinent Laundry Service This service helps with the problem of nursing the incontinent patient at home and the assistance of Edgware General Hospital in organising the service is much appreciated. The number of recipients of this service appears to have stabilised at approximately twelve patients. 37 Disposable Equipment Disposable syringes, gloves, masks, caps and razors are used throughout the home nursing service. These items undoubtedly assist and guarantee sterility of equipment for the nurse in her work in domiciliary practice. Marie Curie Foundation—Day and Night Nursing Service The Foundation nurses continue to provide a much appreciated nursing service in terminal cases of malignancy. Two nurses are on the roll and they have dealt with twenty-six patients throughout the year. The majority of requests for the service has been for night duty work. Student Visits on the District Students from Edgware, Harrow, The Middlesex and Mount Vernon Hospitals visited the department and accompanied the Home Nurses on domiciliary visits. This is part of the training programme and enables them to see at first hand some of a local health authority's services. Section 26 — Vaccination and Immunisation No changes were made in the immunisation schedules during the year and every opportunity was taken by the health staff to advise parents of the importance of ensuring that all children were fully protected against smallpox, diphtheria, whooping cough, tetanus and poliomyelitis. Facilities for vaccination and immunisation were as usual made available at all clinics in the Borough and, of course, can be obtained through the general practitioner service if so desired. The following tables show the numbers of children under sixteen who completed vaccination or immunisation during 1966. The figures compare favourably with those for 1965. Vaccination against smallpox during 1966 Age at date of vaccination Total Under 1 year 1 year 2-4 yrs. 5-15 yrs. Smallpox Primary vaccination 96 1,686 546 112 2,440 Re-vaccination — — 11 235 246 38 Immunisation against Diphtheria/Whooping Cough/Tetanus/Poliomyelitis Year of birth Others under Age 16 Total 1966 1965 1964 1963 19591962 Diphtheria Primary course 1,109 1,360 127 54 46 13 2,709 Reinforcing dose — 685 1,228 179 1,624 61 3,777 Whooping Cough Primary course 1,090 1,357 128 48 29 5 2,657 Reinforcing dose — 648 1,187 162 818 31 2,846 Tetanus Primary course 1,109 1,360 127 54 57 79 2,786 Reinforcing dose — 685 1,229 181 1,626 129 3,850 Poliomyelitis Primary course 565 1,984 220 116 210 66 3,161 Reinforcing dose — 70 127 49 2,262 115 2,623 Section 28 — Prevention of Illness, Care and After Care Chiropody A chiropody service is provided by the Borough for the treatment of expectant mothers, handicapped persons and the elderly. Valuable assistance is also given in this service through arrangements made with the British Red Cross who in addition to providing facilities at centres also have a service for treating the home bound. The demand for chiropody services is an ever increasing one and it is pleasing to note that by recruitment it was possible to raise the nineteen sessions each week at the beginning of the year to a total of thirty-six each week by the end of the year. Patients unable to travel by public transport can be collected by the ambulance car service. Unfortunately, due to heavy demands on the ambulance service, severe delays can occur in picking up patients again for their return journey home. In order to try and overcome this problem, a modified service was instituted using the Borough's own transport as and when it could be spared from other health and welfare commitments. 39 Details of attendances for the year 1966:— Category of Patient New Cases, first attendance Old Cases, first attendance Reattendances Total Elderly persons 495 820 5,966 7,281 Physically handicapped 6 11 46 63 Expectant and nursing mothers 4 4 19 27 School children 63 18 212 293 Others 7 3 19 29 Total number of treatments 7,693 Number of sessions 1,394 During the year 1966 the local branch of the British Red Cross carried out 1,691 treatments, 1,031 which were domiciliary. Recuperative Holidays During the year arrangements were made for the placement of patients in suitable recuperative holiday homes. This service is restricted to those people recovering from a recent acute illness, no longer in need of nursing treatment and only requiring rest, fresh air and good food to complete their treatment. Recommendations were received from hospitals and general practitioners. Sixty-eight applications were received and suitable holidays arranged for 49 patients—of this number 46 were adults and 3 school children. In 19 cases the arrangements were cancelled at the patient's request. The 3 school children were recommended under Section 48 of the Education Act 1944. Cervical Cytology Following the Council's agreement in March 1966 to start a pilot scheme for the taking of cervical smears to assist in the early diagnosis of cancer of the womb, steps were taken to amend the proposals pursuant to Section 28 of the National Health Service Act, 1946. These steps involved consultations with the appropriate Hospital Management Committee, the Middlesex Executive Council and the Local Medical Committee. All approvals were eventually obtained by September and in October in Circular 18/66 the Minister of Health issued a general approval under Section 28 to the making of arrangements in obtaining cervical smears for cytological investigations. Arrangements were then finalised for the first session to be held in January 1967 at the Caryl Thomas Clinic, Headstone Drive. 40 Loan of Nursing Equipment The British Red Cross Society continued to operate the scheme for the loan of nursing equipment. This equipment helps in the nursing of patients in their own homes. A small hire charge is made but in cases where the patient is unable to pay the hire charge, it is paid by the Borough. Monies collected are used to purchase replacement equipment as required. In addition additional equipment is purchased by the Borough to meet requests for loan of articles on the approved list. Number of articles loaned during the year 1,217 The Red Cross depot is at 39 Sheepcote Road, Harrow—Telephone 01-427 8788. Tuberculosis The Borough is served by two clinics:— (1) the Harrow Chest Clinic, Station Road, Harrow (Chest Physician Dr. R. Grenville-Mathers) covering the main part of the district, and (2) the Edgware Chest Clinic, Edgware Hospital (Chest Physician Dr. H, J. Trenchard) which includes in its catchment area the small remaining part of the Borough in the Edgware District. Care and After Care The treatment, the preventive, and the after care services for this disease are all inter-related and in order to achieve the best results must of necessity work in close liaison. For this reason the arrangements for this service continue to be centred on the two chest clinics under the general supervision of the physician in charge. The services provided include general welfare, home visiting, occupational therapy and vaccination against tuberculosis. Welfare The advisory services of a Welfare Officer are available to all patients. This Officer is mainly concerned with the many medical-social problems that can and do arise in households as a result of a case or cases of tuberculosis occurring there. Latterly with the fall in the incidence of tuberculosis, more cases with other chest complaints—chronic bronchitis and lung cancer—are being seen at the clinic. These cases also have many social problems and are helped by the welfare services. Financial advice, rehabilitation and training, recuperative holidays, extra nourishment, etc. —are all included in the welfare officers sphere of work. During the year one patient was admitted to the Rehabilitation Unit, British Legion Industries, Preston Hall, Maidstone. 41 Home Visiting During the year 2,217 home visits were made by the tuberculosis visitors attached to the clinics. Their work includes advice on the home care of patients, the encouragement of known contacts to attend the clinic for X-Ray and medical supervision and general advice on care and after-care arrangements. They also act as clinic sisters at diagnostic and treatment sessions in the Chest Clinics. Occupational Therapy Occupational therapy in the home and in the clinic plays a part in the rehabilitation of patients. The services of a therapist are available for two sessions each week. B.C.G. Vaccination Vaccination against tuberculosis (B.C.G.) is offered to contacts of known cases of tuberculosis, thirteen-year-old school children and students of further education establishments. The numbers vaccinated during the year 1966 were as follows:— Contact Scheme 332 School Children and Students 1,681 The total number of persons on the tuberculosis register for the district on 31st December, 1966 was 2,075 as compared with 2,174 on 31st December, 1965. Advisory Clinic for the Elderly The weekly advisory clinic for the elderly held at the Broadway Clinic, Wealdstone, continued during the year, offering advice on personal health problems, diet, accident prevention and Social Welfare. Any patient found on examination to have a condition requiring attention is referred, with a letter, to his own medical practitioner. Twenty new cases were seen during the year. The total number on the register was 56 and a total of 228 visits were made during the year. Problems of every variety were discussed and appropriate advice given. Nine cases were referred to their general practitioners. Venereal Disease Responsibility for the treatment of venereal disease is vested in the Regional Hospital Boards and facilities are available at various hospitals in the region—Central Middlesex and Hillingdon. Many of the London teaching hospitals also offer treatment facilities. The special services Medical Social Worker dealing with the care of the unsupported mother and child, is also responsible for the follow-up of defaulters from the venereal disease clinic at Central Middlesex Hospital and is also concerned in contact tracing and assisting patients with their resulting social problems. 42 Section 29 — Home Help Service This service was again heavily committed during the year providing assistance in the home for a total of 1,411 cases. Again the heaviest demand came from the elderly but cases of home confinement and acute illness of the mother with a young family receive special priority. The average number of home helps employed was one full-time and 74 part-time, being an equivalent of 43 full-time home helps. Assistance was given as follows during the year:— Maternity cases 203 Acute illness 354 Chronic sick and Tuberculosis 116 Mentally disordered 9 Aged and infirm 729. Total 1,411 Neighbourly Help Scheme During the year, fourteen neighbourly helps were engaged to provide assistance to fourteen cases. In these cases the aid of a friendly neighbour is enlisted to keep a watchful eye and at the same time carry out a certain amount of helpful tasks in the home of an elderly or chronically disabled person. Arrangements are usually made for the help to call several times a day for short periods, helping out by lighting fires, preparing a meal, doing some shopping or some other household chore, but most important of all, keeping in contact with the patient. This scheme works well and neighbours are sometimes more willing to do this work for a person they know rather than join the general home help service. On the other hand, the old person concerned usually knows the neighbour quite well and thus an amicable liaison is more easily established. HEALTH EDUCATION 45 HEALTH EDUCATION Health Education is an essential part of any preventive service, which will fall short of achievement unless supported by informed public opinion. In England and Wales this function is shared by the Ministry of Health, mainly through the mass media of the press, radio, television and posters, and by local authorities at local level. Much of the work of the Council's Health Department is related directly or indirectly to health education and those engaged in field work have a unique opportunity to integrate education in their person to person dealings with the general public. In certain fields, however, this is supplemented by special programmes as in the case of Mothercraft classes at maternity and child welfare clinics and food hygiene talks to food handlers. Other priorities affecting the general public are cancer education and dental health. Talks are available on all aspects of health from a team of speakers from all sections of the Department and audiences vary from school children where specialist talks may supplement the school curriculum, to old people's clubs who invariably present a most enthusiastic audience. In between are youth organisations, women's clubs and church groups, all of whom are often surprised to learn what can and is being done by the various sections of the Department. Attention is also given to in-service training and regular staff meetings are arranged, often with invited speakers to keep personnel up to date with developments in their particular field. An example is a most successful course of 10 lectures on "Mental Subnormality" arranged by the Mental Health Section for Doctors, Health Visitors, Nurses and Social Workers, who, judging by their attendance figures, are only too keen to increase their knowledge and to learn from the experience of other sections. Student Health Visitors, Midwives and Nurses are also given an insight into the working of the Department. In November a most successful pilot Dental Health Scheme was organised covering some 5,400 school children of the age groups from infants to school leavers in seventeen school departments, the staff of whom were most co-operative. A talk and demonstration with audience participation was followed by a suitable film and question time. It was revealed that many children were unaware of even the correct way to clean their teeth and there is no doubt that such programmes have a considerable impact especially with the younger children. 46 During Mental Health Week an exhibition was staged in cooperation with the Granada Cinema featuring the services and establishments maintained by the Council. This revealed that many visiting the exhibition had little concept of changing policy on mental health within the community, which to be successful needs a greater increase in tolerance and understanding from the general public. It is encouraging to report that the greatest increase in talks to local organisations have been in those dealing with mental health. The fourteen film evenings on child-birth arranged for expectant mothers and their husbands were well attended and very few expressed any misgivings at having seen this preview of their coming "ordeal"— again there is no doubt that the informed husband, for whom additional fathercraft classes are held, can be a source of great comfort to his wife during pregnancy and the post-natal period. The theme of the exhibition at the Delegate Conference was that of "Home Safety" to which the Gas and Electricity Industries contributed stands. Industry is assuming an increasing role in both industrial health and industrial safety and at least one local company are well in the forefront of this field. The exhibit was later transferred to the exhibition organised by the Harrow Chamber of Trade during Civic Week. Campaigns were also organised featuring smoking and health; immunisation—there being still some parents who fail to take advantage of the protection available to their children. Whilst most people must be aware of the association of lung cancer with heavy smoking, fewer are aware of its significance in cardio-vascular disease and chronic bronchitis. In the field of community health, a further clean air week and exhibition was held at Cecil Park Clinic and mobile exhibitions visited those areas about to become smoke controlled. Excluding courses in schools and mothercraft classes, a total of 134 talks were given involving the Department personnel. Health education needs must vary in content and method depending on the type of community involved. If vital statistics, in the improvement of which health education is playing a proportionately increasing role, are any indication, Harrow, whose figures compare with any in the country, would appear to be a well informed community. With a pre-dominance of the higher socio-economic groups in Harrow this should be so, compared for example, with a society having a higher proportion of immigrants— perhaps a greater problem in Harrow is not that of ignorance but of the dangers of excess. MENTAL HEALTH SERVICES 49 MENTAL HEALTH SERVICES The Council's community mental health service continued to expand during the year. The Principal Medical Officer, Mental Health, who already sits on the hospital's Medical Advisory Committee, was appointed to the Leavesden Hospital Management Committee to serve for a period of three years, and the Chief Mental Welfare Officer was co-opted on to the Committee of the League of Friends of Shenley Hospital. The arrangement whereby a Mental Health Clinic is held every Thursday afternoon at the Caryl Thomas Clinic, Headstone Drive, continued to operate satisfactorily as did the arrangement whereby the mental welfare officer 'on call' out of office hours is called out by the duty telephonist at Harrow Hospital. One of the highlights of the year was Mental Health Week, 5th—11th June, 1966. This Week was held with the encouragement of the Minister of Health, and the active co-operation of all the voluntary bodies concerned in the mental health field. The National Association for Mental Health and the National Society for Mentally Handicapped Children as the bodies primarily concerned have undertaken to promote a Mental Health Week in 1968 to mark the International Congress on Mental Health to be held in London in August of that year on behalf of the World Federation for Mental Health. In order to experiment with the best way to conduct such a Week in 1968, arrangements were made to hold preliminary weeks in 1966 and 1967. The general theme of the Week this year was"Mental Health—Your Concern". With the co-operation of the voluntary societies in this field, i.e. the National Society and the Harrow Society for Mentally Handicapped Children, the League of Friends of Shenley Hospital and the Friends of Leavesden Hospital, together with both Shenley and Leavesden Hospitals, the following events were held within the Borough and neighbouring districts:— An exhibition, open to the public featuring the work carried out by the local authority, hospital and voluntary societies, was held at the Granada Theatre, Sheepcote Road, Harrow. This was opened by His Worship the Mayor on Tuesday, 7th June. A folksong/church service with the "Ambassadors" for all mentally handicapped children and parents was held at St. Alban Church on 5th June. A folk music concert at the Brent Town Hall with Julie Felix on 10th June. 50 Open days were held at the three mental health establishments run by the local authority, and open evenings were held at the two social clubs run by the Borough's mental health staff. The Harrow Society for Mentally Handicapped Children also held an open afternoon at their Peter Pan Club, which meets every other Saturday at the Assembly Hall, Rayners Lane. In addition, Leavesden Hospital was open to the public each afternoon from Monday, 6th June to Friday, 10th June, and Shenley Hospital also showed parties of people over the hospital during the week. Leaflets were printed giving details of the problems to be faced both nationally and locally, and also detailing the programme of events for the Week, which were distributed to the public. Excellent coverage in the local press was given to the Week which resulted in numerous enquiries from people and voluntary organisations offering help and also seeking advice. Community Care—Mental Illness The number of patients actually under care on 31st December, 1966 was 388—(see Table I). Table III gives details of the number of cases dealt with by the social workers from 1st January—31st December, 1966. Table IV gives details of cases referred during the year. The Mental Welfare Officers, in addition to their statutory duties under the Mental Health Act, 1959, also help in the arranging of informal admissions to hospital, they also give help and advice to patients, relatives and friends at all times. Close collaboration continues to be maintained with the doctors and staff of Shenley Psychiatric Hospital, general practitioners and all other social work agencies. Arrangements were also made for a number of patients to be admitted to hospital during the course of the year for short term care in order to give their relatives some respite and/or to enable them to have a holiday. Hostels Tanglewood Hostel—During the year 30 patients were admitted to this hostel and 30 patients were discharged, of which 15 returned to hospital, 11 returned home and 4 went to other accommodation. At the end of the year there were 19 patients in residence. Whilst in previous years by far the largest number of cases referred for admission have come from Shenley Hospital, in 1966 just over 50% of the cases were referred by mental welfare officers and other agencies. The main criteria for admission continues to be that those patients referred should be capable of working in the community. 51 Frequent discussions, both formal and informal, continue to take place between the medical and social work staff of both Shenley Hospital and this Authority regarding the patients' problems and their future placement. Approximately 41 visitors were shown over the hostel during the year. Non-Maintained Hostels.—During the year 9 patients were placed in other local authorities or voluntary associations hostels as it was felt to be in the patients best interests to do so. At 31st December, the number of patients still so placed was 7. Boarding-Out Scheme—Under this Scheme those mentally disordered patients who are considered suitable for such accommodation are found suitable lodgings or foster homes. However, the Social Worker responsible for the operation of the Scheme resigned in December, 1965, and it was, therefore, decided that the mental welfare officers should take over the responsibility for finding suitable accommodation for those patients recommended under this Scheme. At the beginning of the year there were only two patients from Harrow boarded out in this way and during 1966 only one patient was actually placed in such accommodation and three were discharged, of these, one was re-admitted to Shenley Hospital, one was transferred to a Council flat, and the Ministry of Social Security took over financial responsibility for the third case. At the end of the year there were no cases placed under this Scheme for whom the local authority was financially responsible. Day Centre for the Elderly Mentally III.— During the year 117 patients (80 women and 37 men) were referred for admission to this Centre. Of this total 38 were referred by general practitioners, 7 by mental hospitals, 30 by social workers, 31 by general hospitals and 11 from other sources. The number of patients discharged from the Centre during the year totalled 44, of which 16 were admitted to mental hospitals, 14 to general hospitals, 3 to welfare homes, 7 refused to attend after a short time, 4 improved or left the district. Also during the same period 7 patients died. Eight patients from the London Boroughs of Brent and Barnet were admitted to the Centre. The number of patients on the register at 31st December, 1966, was 53 (19 men and 34 women), and 6 patients were awaiting admission. In order that consultant psychiatrists, general practitioners, social workers, etc., can have some degree of privacy when interviewing patients at this centre, one of the workrooms was partitioned off" during the year to form a Treatment/Interview room. Prior to this work being carried out such interviews or treatment took place in the Supervisor's Office, workrooms or dining room. 52 Once a month a local Clergyman holds a short service during the lunch time for the patients attending the Centre, after which he spends the remainder of the afternoon with the patients. During the year a tape recorder was presented for use at the Centre by the Ward Trust. During the year 99 people were shown over this Centre, including visitors from America and Trinidad. Day Centre for the Younger Mentally Ill.—The younger patients from Harrow still continue to travel to the Day Centre run by the London Borough of Brent at Belton Hall, Bertie Road, Willesden, N.W.10. During 1966 the total number of patients referred to this centre was 9. At the end of the year the number of patients from Harrow actually in attendance there was 5. Advice was received from the Minister of Health during the year that he had agreed to include this Authority's project for a similar 30 place centre being included on the list of schemes for which he hoped to be able to recommend loan sanction during 1968/69. It is envisaged that such a centre will cater for the needs of two main groups of mentally ill patients:— (a) Hospital long stay patients on discharge. (b) Unemployed persons residing in the community. The Centre will be the first step towards rehabilitation and resocialisation, thus encouraging patients towards a full community life by providing a work situation for them. To this end group activities would be arranged to encourage the patients to return, if possible, to work in the community. A wide range of crafts will be available as well as art classes, music, drama and mime to foster movement and communication. As the need arises patients will be seen by a Social Worker and the Disablement Resettlement Officer and a decision reached regarding future placement in one of the following:— (i) Industrial Resettlement Unit. (ii) Industrial Therapy Organisation Thames Ltd. (iii) Industry or Commerce. Mental Nursing Homes.—There is one mental nursing home within the Borough which is registered with this Authority and accommodates 47 patients. This home has been visited during the year and found to be satisfactory. Community Care—Mentally Subnormal The total number of subnormal and severely subnormal patients under community care at the end of the year was 341, 161 females and 180 males. (Table II.) The number of cases referred for care during the year was 60 (Table IV.) 53 Table III. gives details of the number of cases dealt with by the social workers during the year. Close liaison is maintained with the maternity and child welfare service, and all cases referred to the department under 5 years of age are continued to be visited by the Health Visitors after initial visits by the Principal Medical Officer and Mental Health Social Worker. Every assistance continues to be given to relatives with any problems they may have concerning the patients. Guardianship.—This Authority at present has no cases placed under guardianship. Informal Foster Care.—Nineteen patients were placed in private homes under Informal Foster Care, 5 of these are placed in foster homes within the Borough. The total number of cases still under such care at the end of the year was 19. Admissions to Hospitals.—Five patients were admitted to hospital for permanent care, all of which were informal admissions. At the end of the year there were only 3 patients awaiting admission to hospital. Temporary Care.—25 requests were received during the year for patients to receive short term care, in order to give families some respite from their care. Of these, 18 were placed in hospitals, the remainder in private homes or hostels. Harrow Junior Training School.—The total number of children on the register at the beginning of 1966 was 106. This figure included 14 children from Hillingdon, 8 from Ealing, 6 from Brent, 2 from Barnet, 1 from Houndslow and 1 from Croydon — the last four cases being children placed under informal foster care within the Borough by their respective Authorities. Mentally handicapped children remain at this School until their sixteenth birthday, when they are transferred to an Adult Training Centre and from then on are expected to play their part in an industrial working programme where the emphasis is on commercial production. Although in the early 1950s this more realistic approach to the possibility of a mentally handicapped young person being able to do a worth-while day's work under sheltered factory conditions for which a wage packet was received at the end of the week was welcomed, it is now realised that if these young people are to continue to live in the community a much wider basic social training must be provided, as well as teaching them how to work. Experience has shown that many of these young people are not mature enough at 16 to move from the rather sheltered "academic" life of the Junior Training School to a full day's work under factory conditions, where the emphasis must be put on speed and output if assembly and contract work are to be delivered on time. Many of them are only just beginning to take an interest in elementary 3-R work, in simple cookery, sewing and domestic work, and it is this basic social training 54 towards personal independence that often decides whether elderly parents can continue to look after the subnormal child at home or whether they will reluctantly have to ask for a hospital bed. At present there is no Adult Training Centre in the Borough and young people from Harrow have to travel by coach each day to Uxbridge, where there is a waiting list of children. Because of this, and because there were children in the senior class at the Junior Training School who were ready for a fuller programme of social training, Committee approval was obtained in January, 1966 to the Borough setting up a Transition Class until such time as it is possible for the Authority to have its own purposebuilt Aduh Training Centre. This class serves several useful purposes. Cases who were on the waiting list for the Uxbridge Adult Training Centre, and a number of children in the senior class at the Junior Training School were admitted to this twenty place Transition Class which was opened in the Autumn of 1966 and held in the games room at the rear of Tanglewood Hostel, Common Road, Stanmore. This made it possible for places to be made available lower down the School for the 14 children of 7 years of age and under who were awaiting admission. Instead of an abrupt transition from school to a full working day, an imaginative programme of basic social training was started, enabling the older children to become more independent than in the past and experience gained from this experimental pilot scheme will prove invaluable in planning the new Adult Training Centre. The curriculum includes all types of domestic training for both boys and girls as the hostel is used for practical teaching purposes. Most of the residents of the hostel are out at work all day so that the children's mid-day meal is taken in the residents' dining room. The garden and grounds offer scope for games and physical activities as well as simple gardening and maintenance, and the resident's laundry is large enough for a small class and the toilet and washing facilities are adequate for these 20 children who are roughly between the ages of 14 and 18. A supply Supervisor originally based at the Junior Training School has been placed in charge of this experiment and has an Assistant Supervisor and a General Duties Assistant helping her. The system of monetary awards in operation at the Adult Training Centre has not been instituted, as this class is regarded as an extension of the Junior Training School and in no way a sheltered workshop. Classes are held from 9.30 a.m. to 3.30 p.m., Monday to Friday, and there are the usual primary school holidays in the district. At the end of the year there were 109 children on the School's register—97 attending the School and 12 the Transition Class. These figures include 33 children from other Authorities. Orderlies.—There are 3 Orderlies employed at the School. These are senior girls who show an aptitude for domestic work or for work in the nursery class with the babies and who have elected to stay on in preference 55 to being automatically transferred to an Adult Training-Centre. They are paid monetary awards of up to £1 10s. 0d. per week, in the same way as the trainees at the Centre. Summer Outings and School Journeys.—During the Summer Term two parties of children, accompanied by members of the staff, visited the Lido at Ruislip. The outing proved a great success as it held both educational and social training value, as indeed do all similar outings and school journeys in which the children participate. At the end of the academic year, it was felt that the parents of all the children would appreciate a written annual report by the class teacher and the Headmistress on their child's progress. This was warmly welcomed by the parents. Open days or open evenings are also held once a term in order to give parents an opportunity of visiting the classrooms and discussing any problems with the staff of the school. Visitors.—During the year over 90 visitors were shown over the school including a number of people from overseas. Formation of Parent-Teachers Association.—In order to obtain greater co-operation and liaison between the parents and teachers at the School, in March, 1966, it was decided to form a Parent-Teacher Association, the objects of the Association being:— (a) greater co-operation on questions such as the training of retarded children between parents and staff. (b) The organisation of various social events for both children and their parents. (c) The raising of money to provide additional amenities for the School. Adult Training Centres.—The older subnormal patients from Harrow continue to attend other local authorities centres. These establishments are open from 9.0 a.m. — 5.0 p.m. Mondays to Fridays, inclusive and light industrial work is undertaken for local firms on a contract basis. In addition, the trainees are also taught gardening. Mid-day meals are provided for which the trainees pay daily. At the end of the year the number of patients from Harrow attending such centres was 47 (21 women and 26 men). Forty-four of whom were in attendance at the London Borough of Hillingdon's centre at Uxbridge. Annual Camps.—A party of 44 children and staff from the Harrow Junior Training School under the leadership of Dr. R. Fidler, Principal Medical Officer, Mental Health, attended a successful summer holiday camp at the National Society for Mentally Handicapped Children's holiday home 'Pirates Springs', Near Dymchurch, Kent, from 28th July to 12th September, 1966. The adult camps were again held at St. Mary's Bay, Dymchurch, Kent—the girls' from 19th-30th August, 1966, and the boys' from 30th August-9th September, 1966, and 20 patients from Harrow attended. 56 These camps not only allow parents to take a well deserved holiday but also afford a valuable period of practical training for the mentally handicapped person. Social Clubs.—The two social clubs held in the Games Room, Tanglewood, Common Road, Stanmore, on Monday and Wednesday evenings continue to flourish. The Monday club for subnormal patients over the age of fifteen years has an average weekly attendance of forty members. Several interested young people help at the club and they propose to form a League of Friends with the object of raising money to provide among other things outings of a socio-educational nature. Club leadership will however continue to be provided by the members of the Mental Health staff. The Wednesday Club membership has slowly increased. All persons suffering from loneliness or recovering from a psychiatric illness are encouraged to attend, not only to pursue their own interests but also to partake in group activities. As with the Monday Club it is hoped to promote outings and journeys to places of cultural interest. There are also plans for the club to publish its own magazine. Leadership continues to be provided by the Mental Health Staff. Students.—During 1966 fifteen students from various Universities and Colleges were received into the Department for practical experience in the Mental Health field. Courses.—In July 1966 a very successful refresher lecture was held on "New Developments in the Teaching of Number Concepts to Mentally Subnormal Children," at which in addition to staff from the Harrow Junior Training School, staffs from neighbouring Training Schools also took part, some 70 people in all attending. In view of the success of this project and with the introduction of many new staff into the Department during the year it was felt that the time was appropriate to organise an in-service training course which could be attended by staff from all sections of the Department. Some 60/70 members of the staff attended including social workers from the Mental Health and Welfare fields, Health Visitors, Midwives, staff from the Junior Training School and other establishments. A series of 10 lectures were held in the Autumn/Winter of 1966 on "Mental Subnormality". Senior staff co-operated by giving lectures which were augmented by the engaging of outside lecturers and the hiring of specialised films. This course proved extremely successful and at the end of the year arrangements were in hand for this series of lectures to be followed up early in 1967 by a course of lectures on "Mental Illness". Research Projects.—During the year this Authority along with other local authorities co-operated with (a) Leavesden Hospital in a research project carried out under the direction of Professor Penrose and (b) with 57 Professor Elek and Dr. Stern of St. George's Hospital on Serological Investigations into the Possible Virus Aetiology of Mental Deficiency. The results of these two projects are not yet known. TABLE I Mentally Ill Patients under Local Authority Care at 31st December, 1966. Mentally Ill Elderly mentally infirm Total Under age 16 Aged 16 and over Total M. F. M. F. M. F. 1. Number of patients under care at 31st December, 1966 3 6 107 221 337 18 33 51 2. (a) Attending day training centre — — 2 3 5 15 30 45 Awaiting entry thereto — — — — — — — — (6) Resident in a residential training centre — — — — — — — — Awaiting residence therein — — — — — — — — (c) Receiving home training — — — — — — — — Awaiting home training — — — — — — — — (d) Resident in L.H.A. home/ hostel — — 9 2 11 — — — Awaiting residence in L.H.A. home/hostel — — — — — — — — Resident at L.H.A. expense in other residential homes/hostels — — 4 4 8 — 1 1 Resident at L.H.A. expense by boarding out in private household — — — — — — — — Receiving home visits and not included (a) to (d) 3 6 92 212 313 3 2 5 3. No. of patients in L.H.A. area on waiting list for admission to hospital at 31.12.66: In urgent need of hospital care — — — — — — — — Not in urgent need of hospital care — — — 12 12 — — — 4. No. of admissions for temporary residential care (e.g. to relieve the family) during 1966: To N.H.S. Hospitals — — 1 — 1 8 9 17 Elsewhere — — — 3 3 6 — 6 58 TABLE II Subnormal and Severely Subnormal Patients under Local Authority Care at 31st December, 1966 Subnormal Severely Subnormal Under age 16 Aged 16 and over Total Under age 16 Aged 16 and over Total M. F. M. F. M. F. M. F. 1. Number of patients under care at 31st December 1966 31 18 77 72 198 41 34 31 37 143 2. (a) Attending day training centre 16 7 11 15 49 24 27 13 7 71 Awaiting entry thereto 1 — 2 — 3 8 4 1 1 14 (b) Resident in a residential training centre — — 1 1 2 2 — 1 — 3 Awaiting residence therein — — — — — — — — — — (c) Receiving home training — — — — — — — — — — Awaiting home training — — — — — — — — — — (d) Resident in L.H.A. home/ hostel — — 2 1 3 — — — — — Awaiting residence in L.H.A. home/hostel — — — — — — — — — — Resident at L.H.A. expense in other residential homes/hostels — — 3 6 9 2 — 1 3 6 Resident at L.H.A. expense by boarding out in private household 4 3 3 2 12 4 — 2 1 7 Receiving home visits and not included (a) to (d) 10 8 55 47 120 1 3 13 25 42 3. No. of patients in L.H.A. area on waiting list for admission to hospital at 31.12.66: In urgent need of hospital care — — — — — 2 — — — 2 Not in urgent need of hospital care 1 — — — 1 — — — — — 4. No. of admissions for temporary residential care (e.g. to relieve the family) during 1966: To N.H.S. Hospitals — — 5 1 6 5 3 3 1 12 Elsewhere 1 — 2 1 4 1 2 — — 3 59 TABLE III Work of Mental Welfare Officers and Mental Health Social Workers. 1st January—31st December, 1966. (a) Mental Illness Visits made by mental welfare officers 6,448 Compulsory Admissions 115 Informal Admissions 185 (b) Mental Subnormality Visits to those under community care by mental welfare officers and mental health social workers 1,434 TABLE IV Number of Patients Referred During Year Ended 31st December, 1966. Referred by Mentally III Subnormal and severely subnormal Under age 16 Aged 16 and over Total Under age 16 Aged 16 and over Total M. F. M. F. M. F. M. F. General Practitioners — 1 92 161 254 — — — — — Hospitals, on discharge from Inpatient treatment — — 26 36 62 2 2 1 1 6 Hospitals, after or during outPatient or day treatment — 2 75 115 192 3 1 — — 4 Local Education Authorities 4 — 3 — 7 8 3 3 4 18 Police and Courts 2 — 19 16 37 — — — — — Other sources 2 — 119 225 346 15 13 2 2 32 TOTAL 8 3 334 553 898 28 19 6 7 60 WELFARE SERVICES 63 WELFARE SERVICES I think it is generally accepted that once a service has been provided the demand for that service increases and progression and expansion must follow. This is certainly the case in the field of Welfare and since my last annual report improvements and planning have resulted in a far wider section of the community being able to avail itself of the necessary services to relieve distress and strengthen its ability to function as normally as possible. This has been achieved in spite of staffing and other setbacks, such as the postponement of certain projects proposed in the 10 year plan due to National economic difficulties. Significant progress has been maintained with regard to the services for the handicapped and the introduction of an elderly persons' register has proved very useful. The addition of another residential home, Whyteways, opened in September, did much to reduce the waiting list of persons requiring residential care. Facilities too for homeless families were strengthened by the provision of extra hostel accommodation for seven families made available in June. The trend of expansion was also evident in the field of blind welfare. Provision of Temporary Accommodation for Families rendered homeless It was the original intention of the National Assistance Act 1948 that accommodation of a temporary nature should only be provided for families rendered homeless by such causes as fire, flood, etc. This service has now been extended to provide help for families whose need has arisen through a variety of causes. Assistance is given in many ways and relatively few families actually require accommodation. Social Work Financial mismanagement and desertion are frequently the causative factors, whilst overcrowding and mental strain is likely to develop where relatives have had to provide shelter. Families which have actually become homeless have often lost their initiative and sense of responsibility. Most authorities maintain that the longer the causative factors have existed the more unrewarding and time consuming will be the social workers' task of rehabilitation. Consequently efforts are more productive when directed towards families who have not actually become homeless. In many instances, visits by the social worker to landlords and relatives result in some measure of agreement and eviction is prevented. In addition the better understanding obtained results in a lessening of tension for all concerned. On other occasions, preventive measures are indicated when, for example, a family is beginning to fall into arrear with their rent. On 64 these ocassions the social worker has worked closely with the family in order to obtain a more realistic use of the money available and ensure that the payment of rent is regarded as a priority. All families in hostel accommodation are visited regularly and efforts are made to encourage them to pursue any course which may provide a solution to their problems. At the same time as the social worker advises on the immediate problem of accommodation, attempts are made to identify and then eradicate the causative factors. In June an additional social worker was appointed to work exclusively with families in the Council's temporary accommodation and with families in financial difficulties and possibly threatened with eviction. This service proved to be most valuable and in many cases the advice and help given, together with approaches to landlords, resulted in eviction being postponed. During the extra time thus gained and with the assistance of the social worker, some families managed to solve their problems. Towards the end of the year, preventive work with Council tenants was extended and from September onwards officers attended the Rent Arrears Sub-Committee of the Housing Committee. 22 cases were referred and by the end of the year six of those families were out of debt and regularly paying their way; two had moved away from the district whilst in only one case was no progress made. Accommodation Towards the end of 1965 work commenced on two houses in Headstone Road in order to adapt them to accommodate 7 homeless families. The houses were ready for occupation in June when the first family was admitted. Table I gives details of the 80 applications for temporary accommodation received during the year, whilst Table II shows details of the causation and solutions for the individual families' problems. TABLE I Action taken Number of Families Provided with temporary accommodation 12 Children taken into care by Children's Committee 4 Found accommodation elsewhere 32 Application withdrawn 3 Advised 29 Total 80 65 TABLE II Details of Cases Details of cases referred No. of families No. of families accommodated (temporary) No. of families accommodated elsewhere Advised Applications withdrawn Children accommodated by Childrens Department Evicted by Court Order Arrears of rent 11 6 2 1 2 — Arrears of mortgage 5 1 1 2 1 — Possession required by landlord 5 — 2 3 — — Unauthorised tenants 2 — 2 — — — Evicted other than by order of court Arrears of rent 2 — — 2 — — Possession required by landlord 14 1 7 5 1 Unauthorised tenants 4 1 1 2 — — Bankruptcy 2 — 2 — — — Overcrowding 2 — 1 1 — — Domestic dissension 23 1 9 11 — 2 Service tenancy expired 6 1 4 1 — — No fixed abode 1 — — 1 — 1 Fire 1 1 — — — — Tenancy voluntarily given up 2 — 1 — — 1 Totals 80 12 32 29 3 4 Welfare Services for the Handicapped Handicapped persons in Harrow may avail themselves of a wide range of services and their welfare is the concern of four social workers. They visit the handicapped in their own homes and by developing good relationships are able to discuss with them their various problems and so arrive at ways of enabling them to come to terms with their disabilities and lead as independent a life as possible within their capabilities. To assist them to this end the Borough provides aids of all descriptions and 114 were issued by December. They ranged from extending shoelaces and specialised cutlery to bed hoists, walking aids and easy chairs with devices designed to help a handicapped person get into the standing position when required. In order to increase the degree of independence of handicapped persons within their own homes it is often necessary to make minor adaptations such as installing a handrail for a bath or toilet or staircase. Less frequently, 66 major alterations are required and these range from the construction of a ramp to the provision of a downstairs shower and toilet. 13 major and minor adaptations of homes were completed during the year. The Work Centre for handicapped persons continued to be fully attended by those who are unable to work in open employment or under sheltered conditions. There is a waiting list for new members. Here for 3 hours a day, light assembly work is done for 5 days a week and workers can earn up to £1 19s. 1 Id. per week. Transport is provided by the Borough and the special coach equipped with a power operated ramp, which was purchased last year, has given invaluable service. For those unable to attend the Centre, work is provided at their homes. With the co-operation of the British Red Cross Society a weekly handicraft class is held attended on an average by 55 handicapped persons. Social activities play an important part in the lives of handicapped persons and, apart from a weekly dancing class and a choral class held twice a week which are wholly organised by the Borough, grants of £847 18s. Od. have been made to seven voluntary bodies to provide social and recreational facilities for handicapped Harrow residents. However, these generally specialise in a particular form of disability and, during the year it became apparent that there was a need for a Social Club to which handicapped persons, whatever their disability, could attend. In July, the Council approved the formation of such a Club to be held in the hall generously offered by the Trinity Presbyterian Church. The Club was named "The Happy Circle" and was an immediate success. In previous years, holiday arrangements were made for small groups of 2-6 handicapped people to go to guest houses at different resorts. As there were many drawbacks to sending small groups, it was felt that considerable advantage might be gained by sending a large party. Consequently, 42 handicapped persons accompanied by six helpers were welcomed at an hotel on the South Coast. I am pleased to be able to report that the holiday was very successful and that, as anticipated, companionship proved an outstanding feature. Communal events were provided and everyone in the hotel was encouraged to join the coach trips, outings and evening entertainments. This again was much appreciated as was the excellent food and comfort. A total of 78 handicapped persons were sent on holiday during the year and various establishments were used, some catering especially for handicapped persons. I am indebted to the volunteers who undertook the escort duties and thus enabled handicapped persons to have a pleasant holiday. 67 On the 1st January 1966, there were 456 handicapped persons on the register and the position at 31st December 1966 is shown in the table below:— Handicapped Persons Numbers on Register on 31st December 1966 Children under 16 years Persons aged 16—64 Persons 65 and over Total Deaf with speech Male — 5 — 5 Female 1 1 2 4 Deaf without speech Male — 3 1 4 Female — 3 2 5 Hard of hearing Male — 6 7 13 Female — 6 14 20 General Classes Male — 134 54 188 Female 7 147 138 292 Total 8 305 218 513 Residential Homes for the Aged At the beginning of the year, eight residential homes were available in the Borough giving accommodation for 331 persons. An additional designated home for 60 persons was completed during the year and the first resident admitted in September. Plans initiated by the former County Council and inherited by the Borough were finalised during the year and building work commenced in August for a further home situated in Sancroft Road. This designated home will accommodate 54 persons and is scheduled for completion in 1968. The following table gives details of the Homes run by the Borough:— Residential Homes Name and Location of Home Type of Home No. of Beds Male or Female 79 Bessborough Road, Harrow Non-designated 20 Females Breakspear House, Harefield Designated 71 Females Coleshill House, Amersham Non-designated 46 Females Haydon Hill, Bushey Designated 44 Males Knightscote, Harefield Designated 50 Mixed Willerton, Weybridge Non-designated 30 Females The Retreat, Eastcote Non-designated 18 Females Vernon Lodge, Harrow Designated 52 Mixed Whyteways, Harrow Weald Designated 60 Mixed 391 68 The demand for residential accommodation for those in need of care and attention which cannot otherwise be provided increased steadily during the year and the waiting list rose from 99 to 103 despite the admission of 141 persons. During the last few years, the tendency has been for the average resident seeking admission to suffer from a greater degree of physical or mental handicap than was the case previously. This has led to considerable problems within the homes themselves and if the trend continued it will mean that staffing ratios will have to be reviewed. Another factor which became apparent during the year was that more beds than necessary were being reserved for men. Consequently, the number of male beds was reduced. A number of homes administered by voluntary organisations also admitted Harrow residents and, where appropriate, the Borough becomes financially responsible for those residents under the provisions of Section 26 of the National Assistance Act 1948. 30 such persons were admitted to voluntary homes during 1966. In previous years, the short stay scheme was confined largely to admitting elderly persons for short periods during the summer months whilst their relatives went on holiday. By so relieving pressures and tensions many elderly persons were enabled to stay in their own homes amongst their relatives for as long as possible. However, during the year, this service was extended to include any elderly person in need and a small number of beds were retained solely for this purpose. 39 such admissions were arranged during the year. It is hoped that this, coupled with the full support from the other services will delay or entirely prevent permanent residential care. Examples of other agencies and services which are fully utilized are:—district nurses, home helps, meals-on-wheels, luncheon clubs, social clubs, chiropody. Health visitors play a big part in their care and in addition to dealing with other problems give advice on health matters such as diet. Through their good relationship with statutory and voluntary bodies such as the Ministry of Social Security and church organisations, the section's social workers are able to arrange financial and other help for those in need. Companionship is very often the root cause underlying the need for admission for residential care. The organising officer for the Harrow Old People's (Voluntary) Committee arranges for friendly visits to those in need. In these and every other way preventive measures and community care are forming an increasing aspect of the section's function and it is a service which will be expanded as rapidly as possible. 69 Inspection of Private and Voluntary Residential Accomodation The duty for inspecting private and voluntary establishments under the National Assistance Act 1948 was also assumed by the Borough on its formation The following table gives details of the three voluntary and nine private homes which are situated within the Borough. Address Telephone No. Name of Owner Private 134 Pinner Hill Road, Pinner 866-7957 Mrs. Gandy 4 Maxted Park, Harrow 422-2043 Mr. & Mrs. Crodzicki 14 Hindes Road, Harrow 427-7659 Mrs. Mclnerney Mrs. Goslett Royston Lodge, Oakleigh Road, Hatch End 428-5550 "Westlands", South Hill Avenue, Harrow 422-2987 Mrs. Esselmont "Clavering", Royston Grove, Hatch End 428-4223 Mr. D. Smith 59 Moss Lane, Pinner 866-5804 Mr. D. Smith "Greenways", 633 Uxbridge Road, Pinner 866-3563 Mr. Ralph De Marco (Proprietor) Convent of Our Lady of Lourdes, Oxhey Lane, Harrow 428-4077 Convent of Our Lady of Lourdes Voluntary Valley Field, Mount Park Road, Harrow 422-9172 Middlesex Association for the Blind Pinner House, Church Lane, Pinner 866-0122 Harrow Homes for the Aged Priory Close, Common Road, Stanmore 950-1812 Wembey Eventide Homes Ltd. Protection of Movable Property The safeguard of personal property of patients in hospital or residential Homes is a responsibility undertaken by the Borough under Section 48 of the National Assistance Act, and during the period 18 cases were dealt with and property in two cases was stored by the Borough. Welfare Services for the Blind and Partially Sighted During the year, the three home teachers caring for the needs of the blind and partially sighted persons made 2,923 home visits and provided 303 handcraft and 148 Braille or Moon lessons. In addition, through their agency voluntary organisations are able to assist in many ways. The home teachers also run a handcraft class and organised a sale of work at Hanover House. The standard of workmanship was high and very little was left unsold at the end of the sale. 70 The Middlesex Association for the Blind organised a Handcraft Exhibition open to all blind persons in the new London Boroughs. This took place in May and there were 23 entries from Harrow. Of these 13 received awards as follows:— 3 first prizes, 4 second prizes, 2 third prizes and 4 highly recommended. During the period under review, fortnightly handcraft classes were arranged as well as courses in dancing, horticulture and cookery. These were well attended, as were the various social functions organised by the local club for the blind. Financial assistance was provided and arrangments made to enable 58 blind persons to have an enjoyable holiday. They were accompanied by 16 guides without whom the holiday would have been impossible. The Royal National Institute for the Blind provide wireless sets for the blind and these are, for the most part, mains sets. It was decided this year to change these for transistor battery sets in order to ease the maintenance problem created by the difficulty in getting parts for the old sets. This transition has commenced and will be completed as soon as possible. The Ministry of Labour, in association with various blind welfare agencies, operate a scheme whereby workers who are able to work as home workers or in sheltered work-shops have their weekly earnings augmented to nationally approved levels. Under this scheme further financial assistance is given with regard to equipment and in the case of sickness. The Borough is responsible for the payment of these fees. On 31st December, 1966, there were 423 persons on the register and Table I is a summary of the changes which have taken place during the year; Table II illustrates the occupations and accommodation of those registered as blind or partially sighted: Tables III and IV show the age at registration of blind and partially sighted cases. Table V gives details of the diagnoses of those registered as either blind or partially sighted. TABLE I Blind Partially-sighted Total M. F. Total M. F. Total No. on register 1 Jan., 1966 131 193 324 25 52 77 401 No. of cases transferred in 7 8 15 — 2 2 17 No. of new cases added 15 33 48 3 12 15 63 No. of P/S transferred to Blind register 2 5 7 —2 —5 —7 No. of cases transferred out 5 5 10 1 1 2 12 No. of deaths 19 20 39 1 6 7 46 No. on register 31.12.66 131 214 345 24 54 78 423 71 TABLE II Blind Partially-sighted Total Total Residential Acc'dation Blind Homes 24 61 1 6 Local Authority Homes 13 3 Private Homes 10 l Geriatric Units 14 l Employment Unemployed 221 272 43 64 Employed in open industry 34 21 Sheltered workshops 6 — Home workers 11 — Education (a) University 2 12 — 8 (b) Schools 2 — (c) Special schools 5 8 (d) Sunshine Homes — — (e) At home (under 4 years) 3 Grand Totals 345 78 TABLE m New Registrations—Age at Registration—Blind 0 1 2 3 5 510 11- 15 1620 2129 3039 4049 5059 6064 6569 7079 8084 8589 90 + unkown Total M. - - 1 - - 1 1 - - 1 1 - - 1 6 2 2 1 - 17 F. 1 - 3 11 11 7 s - 38 Total - - 1 - - 1 1 - - 1 1 1 - 4 17 13 9 6 - 55 New Registrations—Age at date of Registration—Partially Sighted 0—1 2—4 5—15 16—20 21—49 50—64 65 + Total M. — — — — 1 — 2 3 F. — — — — — 2 10 12 Total — — — — 1 2 12 15 72 TABLE V Diagnostic Details of New Cases Registered in 1966 Cause of Disability Cataract Glaucoma Retrolental Fibroplesia Myopia Others Total No. of cases registered during the year in respect of which Para 7(c) of Form B.D.8 recommends :— (a) No treatment 4 4 5 37 50 (b) Treatment (medical, surgical or optical) 6 6 — 1 7 20 Voluntary Services The membership of Harrow Old People's Voluntary Committee is drawn from voluntary organisations interested in promoting the welfare of old people. It was set up in April 1950 at the instigation of the former Urban District Council, following a circular letter from the Ministry of Health making suggestions for developing co-operation between local authorities and local voluntary organisations. On the assumption of their new powers, the Borough recommended that to avoid confusion the title of the Harrow Old People's Welfare Committee be changed to the Harrow Old People's (Voluntary) Committee. Three members of the London Borough were appointed to this voluntary committee which receives a monetary grant from and reports to the Welfare Committee of the Borough. The Voluntary Committee functions through three sub-committees: Meals Service; Workrooms; and Home Visiting Service. It was agreed that the day to day management of these services would be the responsibility of the Voluntary Committee who would advise and make recommendations to the Council. (i) Meals Service: (a) Luncheon Clubs: There are four luncheon clubs in the Borough. Daily, on Mondays to Fridays, hot midday meals are cooked in a central kitchen and served in three halls:— the Belmont and North Harrow Assembly Halls and the South Harrow Baptist Church. In addition, at Tenby Road, meals are cooked and served on the premises. Associated Social Clubs have been organised so that not only can the elderly benefit from a wholesome meal but also attend social gatherings. (b) Meals-on-Wheels Service: Inaddition to supplying the Assembly Halls, the central kitchen prepares hot midday meals which are served to housebound people in their own homes through the "Meals-on-Wheels Service". Three vans are used and staffed by members of the W.R.V.S. 73 (ii) Home Visiting Service: Many elderly residents are visited regularly in their own homes by voluntary workers. Besides bringing friendship and companionship they also encourage a feeling of "being wanted" and help to dispel loneliness and depression. The elderly are often unaware of the services available and in many instances these voluntary workers have been able to alert the statutory services to problems readily capable of solution. It is a pity that this voluntary service is undermanned and many more helpers are urgently required. (iii) Workrooms: The Central Workroom at "Palmerston Centre", Palmerston Road is open da'ly Mondays to Fridays whilst Coles Crescent Communal Room, South Harrow is open mornings only, five days a week. At these units a wide variety of industrial work is undertaken. This service is being extended as rapidly as opportunity allows and it is hoped to open further units in the near future. CHILDREN'S SERVICE 77 CHILDREN'S SERVICES 1966 is the first complete year of which the Children's Department in Harrow has functioned under the direction of the Committee of the Borough of Harrow. There have been no staff changes during this period amongst the Child Care Officers, but one of the administrative staff left to study for the Social Studies Diploma. During the year there were 398 enquiries from parents, relatives and guardians about 661 children, which resulted in 94 being received into care, and 108 were discharged home again. Seven Fit Person Orders were made by the Courts investing the Borough with the responsibility of bringing up the child until he/she attains eighteen years of age, unless the Order, at the request of the parents or guardian, has been revoked before that date. There were no cases of cruelty or negligence endangering the health or life of any child during that period reported to this department. 88 children were supervised by this department during the probationary period required by the Adoption Act 1958 pending the adoption. Seventeen children were committed to the Approved Schools by the Courts. After care work requested from the Approved Schools, whose duty it is to appoint the After Care Officer, was made for the after care to be carried out by this department for six boys. The Parents Advisory Clinic has proved to be a great support and is most excellent. Of 79 parents who approached us during this period, 26 were referred to Dr. Tonnesman who directed some to the Child Guidance Clinic, and others to Mental Hospitals, but a greater number continued supervision by the Children's Department. It was necessary for only one child to be brought before the Court. The help that can be g;ven to children in their own homes under the Children and Young Persons Act, 1963, Section 1, has revealed that poverty is not the most pressing problem in keeping a family together, rather especially in Harrow where the Welfare Department is so able to deal with pending evictions and so often stave them off. The main problem appears to be the inability of parents to control their children, largely due to unhappy marriages or co-habitation, and general lack of principles and self-discipline, which, of course, prevents them making a satisfactory home for their family. Children placed with foster parents by their own parents and supervised under the Children's Act, 1958, numbered 73. Foster parents during this year have given loving and efficient care to the children, and returns which cover the period from 1st April 1965 to 31st March 1966, revealed the fact that Harrow, equally with another London Borough, had the highest boarding out figure amongst the London Boroughs, i.e. 70%. In addition to caring for young children who need care, both short and long term, foster parents have tackled difficult teenagers and have shown great insight and initiative. 78 Meetings between the Children's Officers of the London Boroughs have proved to be of great practical value. Case conferences within the Borough's services have also been very helpful, but as the offices are now adjacent and the staff so well known to each other, the conferences are replaced by an even swifter action of personal consultation between members of the staff concerned. At Christmas it was possible for the Children's Home at 229 The Heights to be closed, and 7a Gaylor Road remained opened in cases of emergencies, but all the children went away for the actual Christmas weekend. During the summer holidays the staff and children of 7a Gaylor Road went away for a seaside holiday, whilst the staff and children of 229 The Heights remained at home, taking day trips. In addition holidays were arranged for several of the children. There has been no change in the Staff of the Children's Homes, there being the same housemothers and deputies as were there when the Homes were opened: 7a Gaylor Road, on the 8th September 1956, and 229 The Heights on the 13th April 1957. Several sites were considered for the erection of a Reception Unit, but for varying reasons a suitable one was not obtained. The relationship between the Probation Department and the Juvenile Court continues to be a very close and cordial one and it is of great assistance to this department. The inner departmental relationships are excellent. The Children's section receives close co-operation and helpful advice from all the departments of the service which it has to call upon in varying circumstances. Home Office Circular 137/1966 In order to ensure that doctors examining children on the Authority's behalf were aware of the need to report fully on each child's condition, the Secretary of State in Home Office Circular No. 137/1966, asked Local Authorities to review their arrangements for the provision of medical reports on children in care. As a result, suitable amendments were made in the forms of report, so that information was included of any abnormality, injury or apparent injury found during the examination, whatever the alleged cause and however unimportant it may seem clinically. 79 Statistics for the Period 1st January to 31st December 1966 Children in Care, Received into Care and Ceasing to be in Care Children in the care of Harrow on 1st January 1966 98 Children received into care during the period 94 Children committed to care during the period 7 Children who ceased to be in care during the period 108 Children in care on 31st December 1966 91 Children in the care of other local authorities, Supervision Authority Harrow: During the period 23 On 31st December 1966 8 Number of children concerning whom enquiries were made 661 Children for whom parents sought advice as being beyond control 79 Brought before the court 2 Received into care 1 Reasons for Acceptance of Children into Care Death of mother, father unable to care for children 2 Deserted by mother, father unable to care for children 7 Mother's confinement 18 Short-term illness of mother 47 Mother receiving treatment for mental illness 1 Long-term illness of mother 1 Child illegitimate and mother unable to provide 7 Family homeless because of eviction 6 Family homeless through a cause other than eviction 2 Unsatisfactory home conditions 1 Fit Person Orders 7 Other reasons 2 Total 101 Number of families involved: 59. Children Act 1958—Child Protection Children supervised: During the period 73 On 31st December 1966 29 Adoption Act 1958 Childien under supervision pending adoption: During the period 88 On 31st December 1966 17 Adoption Orders granted 74 GENERAL SERVICES 83 GENERAL SERVICES Nursing Homes These are private establishments which provide accommodation for various types of patients. Section 187 of the Public Health Act 1936 requires that these homes shall be registered with the local health authority. Additional powers for supervision are exercised under the Mental Health Act 1959, and the Nursing Homes Act 1963. The following table sets out the particulars of the various homes registered at the end of the year, with details of ownership and their accommodation:— Beds Type of Case Bermuda House, Mount Park, Harrow. Mrs. A. M. Elphick Mr. A. E. Elphick 13 Medical or Chronic Beverley Maternity Home, 170 Whitchurch Lane, Edgware. Miss C. Dear 2 2 Maternity Chronic Bowden House Clinic, London Road, Harrow-on-the-Hill. Bowden House Nursing Home Association Ltd. 47 Mental Brockenhurst Nursing Home, 82/84 Hindes Road, Harrow. Mrs. T. O'Donnell 11 Chronic Calvary Nursing Home, Sudbury Hill, Harrow. Mother Superior 48 Medical or Chronic Heywood Nursing Home, London Road, Stanmore. Mrs. M. Guyatt 4 1 Medical Maternity Hillmede Nursing Home, 3 Lansdowne Road, Harrow. Mrs. D. M. Woodman 11 Chronic St. Michael's Nursing Home, 11 Hindes Road, Harrow. Mrs. T. O'Donnell 8 Medical or Chronic Establishments for Massage and Special Treatment All persons in the district wishing to carry on an establishment for massage or special treatment are required by Section 355 of the Middlesex County Council Act 1944 as amended by the Local Law (North West London Boroughs) Order 1965, to obtain a licence from the District Council authorising them to do so. Before approving the licensing of any premises, the Council requires to be satisfied about the general suitability for the work to be carried out in it and also about the equipment. Those in whose name the premises are licensed have to comply with the bye-laws relating to the conduct of these premises. Licences are renewed annually. It is the premises which are licensed and anyone who carries on similar treatment not at any premises but at the homes of patients does not need to be licensed. At the beginning of the year 28 establishments were licensed and at the end of the year the number licensed was 26, there being two deletions due to retirement from practice. 84 (National Assistance Act 1948—Section 47) Section 47 of this Act enables the Court on the application of the Medical Officer of Health to grant an order for the removal of a person in need of care and attention to a welfare home or hospital. Seven clear days notice of an intended application must be given but the National Assistance (Amendment) Act 1951 permits immediate removal provided the Medical Officer of Health and another registered Medical Practitioner certify that it is in the interests of the person to remove him without delay. Under the Amending Act the period for which a person can be detained in the first instance is three weeks. These Acts are usually invoked in the case of a person who (a) is suffering from grave chronic disease or, being aged, infirm or physically incapacitated, is living in insanitary conditions and (b) is unable to devote to himself and is not receiving from others proper care and attention. In practice, every effort is made to solve the problem by using the Home Help Service, the Home Nursing Service and the help provided by voluntary bodies, etc. and only invoked action under the Acts as a last resort when everything else has failed. During the year, one case was removed under the above Act. This concerned an elderly lady aged 83 who was living in very insanitary conditions. She was an extremely independent old person and very resistent to all offers of help. When it became obvious that her condition had deteriorated to such an extent that her health was in danger, it was decided that the only course of action left was to make application under Section 47 for her removal to a place where she could receive proper care and attention. An application was made to a Justice of the Peace on the 10th August 1966 for an Order for her removal. She was admitted to a Home for the Elderly on the 11th August 1966 where, it is pleasing to report, she settled down very well and is now extremely happy in her new surroundings. Medical Arrangements for Long-Stay Immigrants Long stay immigrants are often very unfamiliar with our customs and, in particular, ignorant of the scope and arrangements of the National Health Service. Accordingly at ports of arrival they are given a hand-out printed in languages which they are likely to understand, the aim of which is to encourage them to get on to the list of a medical practitioner in their place of residence. Destination addresses are also forwarded to the Health Department so that they can be visited to try and persuade them to act on the advice given in the pamphlet. Special emphasis is placed in trying to secure a chest X-Ray as soon as possible after their arrival in this country. This is particularly so from those whose country of origin has a high evidence of tuberculosis. Details of immigrant families with children are particularly noted so that a Health Visitor can call and advise. 85 Country where Passport issued Number of Immigrants Commonwealth Countries: Caribbean 11 India 24 Pakistan 4 Other Asian 6 African 11 Other 6 Non Commonwealth Countries: European 88 Total 150 All addresses were visited and in 23 cases no knowledge of immigrant was known. Laboratory Facilities The examination of clinical material of public health significance is carried out by the Central Public Health Laboratory, Colindale Avenue, London N.W. 10 (Telephone: COLindale 7041). The routine work of the service is essentially bacteriological, virological and epidemiological. Routine specimens fall under two main headings: (a) "Medical" specimens received from medical practitioners, infectious diseases hospitals and local authorities. These are specimens of faeces, throat swabs, blood samples, etc., taken for diagnostic examination from persons suspected of suffering from infectious disease. (b) "Sanitary" specimens received from medical officers of health, public health inspectors, and others concerned officially with the control of public health. They comprise specimens for bacteriological examination of water, shell-fish, milk, cream, sewage, etc, processed foods such as icecream, artificial cream and canned foods, imported products such as meat, fish, coconut and fertiliser. Epidemiological work includes the investigation of outbreaks of infectious disease in co-operation with health departments. The following is a summary of the examination of specimens from the district carried out during the year:— Nose and throat swabs 53 Faeces 685 Sputum 8 Others 7 86 Medical Assessments and Examinations All candidates for appointment to the Council's service complete a medical questionnaire from which they are assessed regarding their medical fitness for the post. In cases where there is any doubt, a full medical examination is carried out. Number of medical forms assessed 1,017 Number of medical examinations 143 Number of medical examinations carried out for other authorities 19 Number of medical examinations carried out under Ministry of Education Circular 249/52: (a) Teachers first appointment 60 (b) Training College Entrants 210 INFECTIOUS DISEASES 89 INFECTIOUS DISEASES The Control of Infectious Diseases The effective control of any infection is only achieved by establishing a balance between the various weapons at the community's disposal and no one factor is of primary importance. Also, unless the Health Department maintains a good relationship with the general public it cannot confidently expect the individual members of the community to play their part and without their whole-hearted co-operation it is impossible to control any infection. Consequently, good public relations are an essential factor and to achieve this it is necessary to interfere as little as possible with the economic and social life, although from time to time restrictions have to be imposed upon individuals. Early recognition and notification are obviously of great importance as once the information is received enquiries can be made by the staff of the department at the home, school, or place of work and families alerted as to the dangers and necessary precautions. Aids to diagnosis, such as the Public Health Laboratory Service, or the obtaining of a second medical opinion are often invaluable in obtaining rapid and accurate diagnosis. It is often necessary to isolate patients at their own homes or, should the occasion warrant it, in hospital. In all cases of infectious disease it is a prudent precaution for those affected to avoid crowds or places of assembly. Moreover some infections are severe enough to justify the exclusion of contacts from their occupations, especially if these involve contact with young children or the handling of food or drink. Infection by typhoid or paratyphoid bacilli tends to result in the production of the carrier state and individuals so affected must be prevented from any work involving the handling of food or drink intended for human consumption. Disinfection and cleansing are carried out wherever necessary by the Department, as is the destruction of contaminated articles of food. 90 Infectious and Other Diseases Prevalence of Notifiable Infectious Diseases (Other than Tuberculosis) TABLE I Disease Und. 1 yr. 1-4 yrs. 5-9 yrs. 10-14 yrs. 15-19 yrs. 20-24 yrs. 25-34 yrs. 35-44 yrs. 45-54 yrs. 55-64 yrs. 65 + yrs. Unknown Total Scarlet Fever - 7 32 3 1 1 1 - - - - - 45 Pneumonia Primary - 2 1 - - 1 - - 2 2 5 - 13 Pneumonia Influenzal - - 2 - - - 1 2 - 1 4 - 10 Diphtheria - - - - - - - - - - - - - Dysentery - 2 1 1 - 1 3 - - 1 - - 9 Erysipelas - - - - -- - - - - 3 1 - 4 Meningococcal Infection - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - - - - - - 1 Ophthalmia Neonatorum - - - - - - - - - - - - - Poliomyelitis, Paralytic - - - - - - - - - - - - - Poliomyelitis, Non ,, - - - - - - - - - - - - - Encephalitis Infective - - - - - - - - - - - - - Measles 27 402 237 2 4 2 1 2 - - - 19 716 Whooping Cough 3 13 9 - 1 - 1 1 - - - - 28 Paratyphoid Fever - - - 9 1 - - - - - - - 10 Typhoid Fever - - - - - - - - - 1 - - 1 Food Poisoning - 2 - 2 1 1 1 - 2 - 4 - 13 Malaria - - - - - - - - - - - - - Although health education and immunisation are important preventative agents for many infections, with certain diseases they are the essential bulwarks preventing the return of endemic conditions. DIPHTHERIA The last two cases of diphtheria to be reported in the Borough occurred during the three years 1947-1949. Consequently we are entering a period where the younger parents have neither seen nor heard of a case of diphtheria and it will become increasingly difficult to maintain the high levels of immunisation which are essential to protect the community. The number of small outbreaks of recent years have only served to indicate that constant vigilance alone will prevent the return of this killing disease. POLIOMYELITIS For the last five years there have been no cases of Poliomyelitis notified in the Borough. In the previous four year period, 1958-1961, there were eight cases whilst in the quadrennium immediately preceeding this there were 92 cases. I feel that this satisfactory trend must be attributed to the successful immunisation programme which commenced in 1956. Once again, the return of this crippling disease will only be prevented whilst the majority of the population are protected. 91 WHOOPING COUGH 28 cases of whooping cough were notified compared with 20 cases in 1965, 61 in 1964 and 105 in 1963. In 1962 only 18 cases were notified. This fluctuation is partly explained by the periodic variation in the virus's infectivity. Nationally, notifications showed a decline from 1950-1961 and this was attributed to the widespread use of effective vaccines. Nevertheless since 1961 despite continued vaccination, the national incidence of cases notified has increased. However, few diagnoses are confirmed by laboratory investigation and, as other infective agents give rise to conditions which cause similar symptoms, the notifications themselves are, therefore, suspect. As mentioned previously in the Report, the Department is collaborating with the Public Health Laboratory Service in a research project associated with whooping cough vaccine. MEASLES 716 cases of measles were notified in 1966 compared with 2,469 in 1965. In 1964 and 1965 the Borough assisted the Medical Research Council in their evaluation of the measles vaccines. This was carried out at the Minister of Health's request and the results of the survey were considered by the Joint Committee on Vaccination and Immunization of the Central and Scottish Health Service. The Joint Committee accepted that the vaccination schedules used in the trials were effective and acceptable procedures, but regarded it as premature to embark on any programme of general measles vaccination. However, they agreed that the vaccines should be available to doctors wno wished to use them for any of their patients. Having regard to the Joint Committee's views, the Minister of Health suggested that local authorities generally, should not, at this time seek to make arrangements under Section 26 of the National Health Service Act, 1946, to offer measles vaccination. This report was considered by the Health Committee in February 1966 and as a result agreed to abide by the Minister's suggestion. SMALLPOX The ease and speed of foreign travel has meant that an increasing number of travellers from abroad have been exposed to the risk of infection with the smallpox virus. As a result there has been and will be a small number of cases of smallpox occurring in this country. Immediately each case is diagnosed the patient is carefully questioned and all those who have been in contact during the infectious state are kept under surveillance and offered vaccination. This constant vigilance remains the backbone of the defence against smallpox and prevents this serious and highly infectious disease from becoming endemic in this country. 92 In addition, recent regulations provide that travellers from countries where smallpox is endemic must have been vaccinated recently, otherwise the local authority is responsible for keeping such travellers under surveillance for three weeks after their arrival in this country. 22 residents of Harrow were kept under surveillance during the year. Vaccination of infants is a very valuable defence, but as the protection conferred only lasts a few years its value can only be regarded as secondary to that of constant vigilance. Primary vaccination can, and often does, give rise to local and constitutional disturbances such as pain and swelling of the arm accompanied by fever and headache. As travellers often have to leave at short notice their malaise tends to occur at the moment of departure. Vaccination for the second and subsequent occasions is usually without such side effects. An additional reason for recommending vaccination during infancy is that, as with all medical procedures, slight risks are involved. These risks are almost solely associated with primary vaccinations and the chances of complications occurring are increased with older patients. ENTERIC FEVER During the four year period 1934-1937, 19 cases of enteric fever were notified. During the three quadrennia 1938-1949, there were great movements of service personnel and the notifications were 34, 14 and 29 respectively. The return of normal peacetime conditions during 1950-1957 led to four year returns of 19 and 14 respectively. A considerable reduction of cases during the latter period 1954-1957 were masked by the notification of 8 cases in 1955. Satisfactory progress was made during 1958-1961 when only three notifications were received. However, the period 1962-1965 showed an increase of 12 cases and this trend continued in 1966 when 11 tourists acquired infection overseas. This rise is coincidental with the increased foreign travel undertaken by all nationalities and serves to indicate that in future years continued vigilance will be required if a return to the high figures prevalent during the war years is to be prevented. However, considering the total population movement the individual risk is slight. There was one case of typhoid notified in the Borough. This lady had just returned from a coach tour of Italy and contracted the infection abroad. All other passengers were traced and their local Medical Officers of Health reported them free from infection. There were 10 cases of paratyphoid amongst a party of local schoolgirls who had visited Paris. Although the source of the infection was never identified, it is certain that the infection was contracted in Paris, as other parties were also infected. This particular outbreak was characterised 93 by the large number of girls who had no symptoms but were found to be carriers of the infection. Because of the high carrier state, it was thought prudent to carry out surveillance over a prolonged period and it is pleasing to be able to report that, by the end of the year, all the girls remained free from infection. The families deserve considerable praise and thanks for their co-operation and for putting up with many inconveniences in order to prevent the spread of this infection to other residents in the Borough. The carrier of paratyphoid mentioned in previous reports underwent a further course of treatment which was successful in curing the infection. Whilst immunisation against enteric fevers is undoubtedly a very valuable procedure, the protection conferred is not of a high order and, consequently, if the infection is heavy or its virulence high, inoculated persons may contract the disease. When these diseases do occur in previously immunised people the severity does not appear to be diminished. Further disadvantages are that an ideal course consists of three doses spread over six months and, that for continued protection, a booster i? required every 12 months. DYSENTERY AND FOOD POISONING Between 1942 and 1953, the total notifications received for dysentery and food poisoning for the consecutive four year periods were as follows:— 95, 64, 91. Between 1954 and 1961 there was a marked generalised increase and the comparable figures were 314 and 237. Between 1962 and 1965 the total notifications received had dropped to 109, the figures for 1965 and 1966 being 31 and 22. Whilst this is a gratifying trend, it is far too early for any relaxation of effort. Control of these diseases lies in the hands of the public themselves in that all that is required are simple routine hygiene measures. All cases are followed up by the Department to try to trace the source of infection. SCARLET FEVER In general, scarlet fever nowadays is a relatively mild condition and the only difference between scarlet fever and acute tonsillitis of streptococcal origin is that the particular strain of the organism produces a toxin which causes a rash. With modern therapy the infection is usually controlled before the notification is received and there is a body of opinion which regards notification of this condition as valueless. 94 Consequently, it is more than probable that the 45 notifications received by the Borough form only a proportion of those cases actually infected. Moreover, due to its current mildness the risk lies in possible sequelae and, consequently, it would be more logical to regard any cases of acute tonsillitis as a potential case of scarlet fever and take precautions to avoid possible complications. Notification of this disease would appear to be of doubtful value at the present, but no doubt one must always bear in mind the fact that the virulence of a particular germ can undergo changes and the present low grade virulence of the streptococcus could undergo reversion and be the cause of an illness of much more serious consequence. TUBERCULOSIS The following table gives the age and sex distribution both of persons who were resident in the district when it was recognised that they were suffering from tuberculosis, and of those who moved into the district already suffering from the disease:— Primary Notification Brought to notice other than Primary Notification Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F Under 1 1— 4 1 1 — 1 — 5— 9 — 1 — 1 — — 10—14 — 1 — — — 1 — — 15—19 2 2 1 — — 1 — — 20—24 — 5 — — 1 2 1 — 25—34 3 — — 2 7 4 — — 35—44 5 1 — 1 5 5 1 1 45—54 5 3 — — 3 — — 1 55—64 9 — — — 1 3 — — 65 & over 3 1 — 1 1 — — — 28 15 1 5 18 17 2 2 Register The Tuberculosis Register is a compilation of the names of those persons in the district who are suffering from the disease or have recently suffered from it. The names of the newly notified are added to it and entries are made of those persons who have moved into the district suffering from tuberculosis. Names are deleted on the removal of persons from the district or on death, or recovery, an accepted standard of recovery being a lapse of five years in the pulmonary cases and three in nonpulmonary cases from the date the disease was arrested. 95 The following is a summary of the changes which have taken place in the register during the year:— Pulmonary Non-Pulmonary M F M F No. on register January 1st 1966 1,031 886 110 147 No. of new cases added 28 15 1 5 No. of cases other than on a Form "A" 18 17 2 2 No. of cases restored to register — 3 1 — No. of cases removed 102 75 9 5 No. on register December 31st 1966 975 846 105 149 Details of cases removed from register Pulmonary Non-Pulmonary M F M F Left District 29 23 4 2 Deaths 14 6 2 — Recovered 52 41 3 3 De-notified — — — — Lost Sight Of 7 5 — — Deaths Tuberculosis caused the death of 5 male and 3 female local residents. Prevention The satisfactory slight but steady decline in the number of notifications continued during the year. In this context the work of the Chest Clinics and Mass X-ray unit must be mentioned as early recognition of infection in a person is of paramount importance. A permanent Mass X-ray Unit is available at the Central Middlesex Hospital, Park Royal, N.W. 10. and is open between 9-5 p.m. on Mondays to Fridays and 9-12 on Saturdays. Here any person over 14 years can attend without appointment or medical note and without the payment of a fee. In addition, the Chest Clinics at Station Road, Harrow, and Edgware General Hospital provide ready facilities for the examination of all patients referred on suspicion of some chest trouble by hospital departments and also by their own doctors. A vital factor in the control of the disease is the routine examination and re-examination of contacts, especially family contacts of a known case. This has been undertaken by the Chest Clinic and here one would like to record appreciation and grateful thanks to Dr. Grenville-Mathers and Dr. Trenchard, for their co-operation, help and advice which has been given so willingly at all times. 96 The school medical and nursing staff continue to play their part in controlling this infection and whenever a case is notified whether pupil, teacher or other member of staff the question of the need for an epidemiological investigation is discussed with the staff of the appropriate Chest Clinic. During the year a school child was reported as suffering from primary tuberculosis. Full epidemiological investigations were carried out on both staff and pupils. No contacts were isolated. Subsequently it was reported that the child was not suffering from tuberculosis. In addition to the routine B.C.G. inoculation offered to all 13 year old school children, the Chest Clinic have also tested 1001 contacts of actual cases and found 515 to be negative reactors. Inoculation was offered where appropriate and 332 have been vaccinated. All those found to be positive were investigated by the Chest Clinics. PUBLIC HEALTH (LEPROSY) REGULATIONS 1966 On the 1st March, 1966, Public Health (Leprosy) Regulations came into operation. Under these, provision was made for all cases of leprosy to be notified to the Medical Officer of Health instead of directly to the Chief Medical Officer of the Ministry of Health. In turn the Medical Officer of Health is required to notify the Ministry of Health and also maintain a strictly confidential record of persons affected. Certain provisions of the Public Health Act 1936 and 1961, relating to theprevention and spread of disease now also apply to leprosy. Leprosy is rare and unlike most notifiable diseases it is not highly infectious. SOME NON-NOTIFIABLE INFECTIONS INFLUENZA Immunisation: The present position regarding this is that while the protection conferred by immunisation is of brief duration (about 3-6 months) there is a case for immunising certain groups of the population in whom a contact of influenza might aggravate their disability or prove fatal. Such groups include:— (a) Chronic Lung disease, e.g. chronic bronchitis, asthma, bronchiectasis, pulmonary tuberculosis. (b) Chronic heart disease. (c) Chronic kidney disease. (d) Diabetes and possibly other endocrine disorders. The only type of vaccine recommended is an inactivated influenza A + B Saline vaccine, and it should be given during the early part of the autumn. 97 Winter Vomiting: This is an ill defined condition which can be highly infectious and is probably caused by a variety of infective agents. It is thought that the infection mainly occurs amongst children, but adults are also affected. With children, the disease is characterised by an acute onset of vomiting which lasts for about 24 hours. There is little bowel disturbance. However, when adults are affected there tends to be a reversal of manifestations. As a direct consequence of the mildness and short duration of the symptoms, together with the apparent lack of sequelae, little notice is usually taken and, therefore, it is impossible to estimate the prevalence of the disease. Occasionally, however, explosive epidemics occur and a large proportion of a school can be infected in a very short time. Investigation by the department affords little evidence of causation and control of the infection, which appears to be self limiting, rests in simple routine hygiene measures. TETANUS As a result of health education most people are aware that tetanus is a preventive disease. Short term immunisation can be effected by an injection of serum following an accident. Unfortunately this has several disadvantages and, as this knowledge becomes more widespread, an increasing number of people are being immunised with tetanus toxoid as a routine measure. This gives a long term immunity and does not have the same disadvantages as the serum. Provided the medical personnel are aware of the state of immunisation at the time of an accident all the patient then requires is a booster dose of tetanus toxoid. Unfortunately, all too often the serum has to be given because no written record is carried by the patient. ENVIRONMENTAL HEALTH SERVICE 101 ENVIRONMENTAL HEALTH SERVICE WATER SUPPLY Apart from a small area in the extreme south-west part of the district which is supplied by the Rickmansworth and Uxbridge Valley Water Company, the Borough is supplied by the Colne Valley Water Company. Nearly all the water supplied by them is obtained from a series of wells fed from gathering grounds in the Chilterns. The supply has been satisfactory in quantity and quality and no adverse reports were received. Throughout the year samples were taken by the Colne Valley Water Company and in every case the report received was satisfactory. In addition, eight samples were taken by the department and the following is a copy of the report received on a sample submitted for chemical analysis during December, 1966:— Chemical Results in parts per million Suspended Matter absent Appearance clear and bright Colour less than 5 Hazen Units Taste normal Odour absent Total solid residue dried at 105°C 526 parts per million Chlorides as Chlorion 49 „ „ „ Nitrate Nitrogen 2 „ „ „ Nitrite Nitrogen absent Ammoniacal Nitrogen 0.02 „ „ „ Albuminoid Nitrogen 0.01 „ „ „ Oxygen absorbed, 4 hrs. at 27°C. 0.43 „ „ „ Total Hardness as CaC03 222 „ „ „ Non-Carbonate Hardness as CaC03 76 „ „ „ Alkalinity as CaC03 146 „ „ „ Poisonous Metals absent Reaction pH 7.0 "This is a water with a moderate hardness, about a quarter of which is permanent. It is, however, satisfactory from a chemical point of view and is suitable for domestic purposes." There are no houses in the Borough supplied with water by a stand pipe, all the dwellings in the district having a supply direct from the Company's main. No evidence exists that the water is plumbo-solvent and before distribution the new water is chlorinated and partially dechlorinated. The fluoride content of the water supplied is consistently less than 0.1 p.p.m. (F). 102 DRAINAGE AND SEWAGE DISPOSAL The soil sewage from the Borough flows to the West Middlesex Drainage Works at Mogden as it has done since 1936, when the last of the five disposal works in the area went out of use. There are still, however, a few properties in the northern part of the district from which the sewage is treated in small disposal plants, otherwise all the properties within the Borough are connected to the main drainage system. Surface water is disposed of by way of separate sewers that discharge into local water courses. There are five of these: the River Pinn, the Yeading Brook, the Kenton Brook, the Wealdstone Brook and the Edgware Brook. The rate of flow in these water courses varies with the amount of rainfall and during sudden storms they may have to carry very large volumes of water, while during drought the flow may be reduced to a mere trickle. PUBLIC CLEANSING The cleansing services are under the administration and control of the Borough Engineer and Surveyor. The weekly collection service provided in the district is undertaken by direct labour and involves the handling of over 82,000 bins. There was no change in the method of disposal during the year, the collected refuse being conveyed to Harefield where it was disposed of by tipping. DISPOSAL OF THE DEAD There are two cemeteries and five burial grounds situated in the district which are administered by the Council. The grounds under the control of the Church Authorities at Harrow, Roxeth, Pinner, Harrow Weald, Great Stanmore and Whitchurch, apart from reopenings, have little available space. More than 650 bodies were interred in Council controlled cemeteries and burial grounds during the year. Mortuary The mortuary for the district is situated in Peel Road and is under the care of a full-time mortuary attendant. During the year 304 post-mortem examinations were undertaken and inquests were held on 45. SWIMMING BATHS There are two open-air swimming baths in the district, one in Central Harrow and one in Wealdstone. Attendances at the Harrow Baths were 78,326 and at Wealdstone 71,117. The water in each bath is filtered and chlorinated and samples taken at intervals throughout the season revealed a satisfactory standard was maintained. In addition, daily tests were made by the Bath Superintendent. 103 STATISTICAL SUMMARY PART I Inspections made and Conditions Found HOUSING Visits (i) On complaint of dampness or other housing defects 962 (ii) On complaint of other nuisances 798 (iii) Routine inspections 612 (iv) Revisits arising from defects found 2,864 (v) Surveys under S.157 Housing Act 1936 51 Conditions Found (i) Number of dwellings or other premises where defects were found 1,681 (ii) Number of cases of overcrowding revealed 5 PUBLIC HEALTH Visits (i) On complaint or request 890 (ii) Routine inspection of premises 796 (iii) Revisits arising from defects found 1,200 (iv) Surveys arising from Rats or Mice complaints 1,926 (v) Inspection of Factories 271 (vi) Inspection of Outworkers' Premises 148 (vii) Inspection of Cinemas and Places of Entertainment 70 (viii) Inspection of Licensed Premises 52 (ix) Visits under Shops Act 1,145 (x) Sunday observations—Shops Acts 12 (xi) Observations made for Smoke Nuisances 128 (xii) Surveys under Clean Air Act 5,382 (xiii) Pet Shops 24 FOOD HYGIENE Visits (i) Slaughterhouses 528 (ii) Butchers' Shops 321 (iii) Cowsheds 14 (iv) Dairies 49 (v) Fish Shops 91 (vi) Bakehouses 84 (vii) Cafes and Restaurants 412 104 (viii) Ice Cream Premises 187 (ix) Provision Merchants 421 (x) Greengrocers 227 (xi) Other Food Premises 301 COMPLAINTS RECEIVED Summary: Accumulations of refuse 99 Animals causing a nuisance 12 Dampness and housing defects 301 Drains and sewers—choked 62 defective 115 Dustbins defective 6 Flooding—Gardens 16 Vermin 11 Insect infestations 47 Overcrowding, alleged 18 Smoke nuisances 44 Watercourses 4 Other complaints (wasps' nests, pigeons, noise, fumes, etc.) 316 Food unfit (excluding requests received from shops to visit and inspect food) 108 NOTICES SERVED Under Housing Act 1957: Statutory Notices served under S.9 requiring execution of repair work Nil Dwellings reported under SS. 16/17 as being unfit for human habitation 4 Dwellings reported under S.18 (closing orders) Nil Informal notices served under S.9 19 Under Public Health Act 1936: Statutory notices served under— (i) S.24—work to a public sewer 53 (ii) S.39—repair or renewal of drains 7 (iii) S.45—repair or renewal of defective water closets 2 (iv) S.56—undrained or badly drained yard area Nil (v) S.75—renewal of a dustbin 1 (vi) S.93—abatement of a nuisance 30 (vii) Informal notices served 1,442 105 ACTION TAKEN Following Housing Act Notices: (i) S.9 Housing Act 1957—dwelling rendered fit— (a) By owners Nil (b) by local authority in default of owners Nil (ii) SS. 16/17 Housing Act 1957, Demolition/Closing Order .. 6 (iii) S.18 Housing Act 1957, Closing Orders Nil (iv) Dwellings rendered fit by owners after receipt of informal notice 12 Following Public Health Act Notices: (i) S.24—Public sewers repaired 53 (ii) S.39— (a) By owners 5 (b) By local authority in default of owners 1 (iii) S.45— (a) By owners 2 (b) By local authority in default of owners Nil (iv) S.56— (a) By owners Nil (b) By local authority in default of owners Nil (v) S.75— (a) By owners 1 (b) By local authority in default of owners Nil (c) By occupier Nil (vi) S.93—Nuisances abated 21 (vii) Nuisances abated and/or other work carried out by owners on receipt of informal notice 1,362 Following Action Under Clean Air Act—S.12(2): Number of notices 8 (a) by owners 8 (b) by local authority Nil SUMMARY PROCEEDINGS It was necessary on five occasions to take action in the Courts in respect of matters concerning nuisances. Two were the result of the failure of owners to comply with Nuisance Orders. In one of these cases the hearing was adjourned to enable the work involved to be carried out, and in respect of the second, a fine was imposed and costs were allowed. The work was subsequently completed. In two of the remaining cases the nuisances had been abated before the date of the hearing and therefore no Order was necessary, but in each case costs were allowed. In the other case an Order was granted. The fines and costs allowed in these cases totalled £21 5s. Od. 106 Under the Food and Drugs Act, action was taken in respect of eight cases involving foreign matter in food-stuff. Fines in these cases totalling £137 5s. Od. were imposed plus costs amounting to £39 13s. Od. HOUSING During the year seven properties were the subject of reports to the Health Committee with a view to action being taken under either the Clearance, Demolition or Closing Order provisions of the Housing Acts. As a result of these reports and of action commenced during 1965, Closing Orders were made in respect of 140 College Hill Road, 77/79 Roxborough Road, 91 Herga Road, 95 High Street, Edgware and 64 Byron Road, Wealdstone, and Nos. 27, 31 and 33 Sheepcote Road were made the subject of a Clearance Order. Properties Demolished Ten unfit properties were demolished during the year, namely, 27.45 (odd numbers inclusive) Northolt Road, South Harrow. In addition, two properties the subject of a Closing Order were reconditioned and the Orders lifted pursuant to Section 27 of the Housing Act, 1957. The properties in question being 15 Middle Road and 16 Crown Street. Unfit Properties The number of families rehoused by the Council from dwellings the subject of Orders made under the provisions of the Housing Acts, relating to unfit properties, was seven. In addition, one family was rehoused from accommodation that was statutorily overcrowded. Overcrowding On the 1st January, 1966 there were eleven known cases of statutory overcrowding in the district. This is the lowest figure recorded since the standard, on which overcrowding is based, was introduced by the Housing Act, 1935. It reveals a position that, by comparison with many areas, is satisfactory, but, at the same time, the true significance of this figure has to be considered in relation to the accommodation that is available for those families who are today sharing accommodation with relatives or friends. For example, in 1936 when the number of cases of overcrowding known to the department was 187, and in 1937 when the number stood at 121, the number of vacant properties in the district was considerable. The overcrowding in these years stemmed from causes other than the shortage of suitable accommodation. Today it is unfortunately the very absence of suitable accommodation that is the cause of current overcrowding problems. During the year five new cases were added to the register and six were removed from it. Of these cases, one family was rehoused by the Council and five other cases were abated by other means, e.g. by a family finding other accommodation for themselves, either within or outside the district. The number of cases on the register on the 1st January, 1967 was ten. 107 CERTIFICATES OF DISREPAIR RENT ACT, 1957 Seventeen applications were received during 1966 from tenants of property for a Certificate of Disrepair and five Certificates were issued. Four Certificates that had been granted were cancelled and in eleven cases undertakings were accepted from the owners agreeing to carry out the repairs required. Comparatively few tenants take advantage of the provisions of the Rent Act, 1957 and it is felt the reason is twofold:— (a) The standard at which the majority of property owners maintain their property, and (b) The difficulty many tenants have in understanding the rather complex provisions of the Act and the forms involved. SUPERVISION OF OTHER PREMISES During the course of the year routine visits were made by the Public Health Inspectors to shops, factories, licensed premises, to places of public entertainment, to riding establishments ana to many other centres of employment. These visits enabled helpful advice to be given on many of the facets of the work of the department and at the same time ensured that the standards being maintained were satisfactory. Today the majority of owners are only too anxious to co-operate and to improve standards of hygiene and working conditions generally, and the routine inspections that are made are more often than not welcomed by those in control of the premises concerned. If unsatisfactory conditions are found, immediate action is generally taken and seldom is it necessary to resort to more formal measures involving the service of statutory notices. As regards environmental hygiene, the major problems remaining unsolved concerns the rubbish that is deposited in out of the way corners or allowed to accumulate in yards and in accommodation roads. Even more disturbing is the material that is dumped on undeveloped sites and in hedgerows. Unfortunately, this is a problem to which there is no simple solution and even the current desirable hygienic practice of enclosing all articles in wrappings of one kind or another militate against tidy conditions, for it means more waste has to be disposed of. Then again, the costs involved in disposing of waste are considerable, even if there is a readily available outlet for the proper disposal of waste matter. Reference has been made to the problems associated with rubbish and dumping in the Annual Reports for 1963, 1964 and 1965, but they remain. There are, however, signs that the general public are becoming more conscious of the existence of this problem and of its attendant dangers and this may well mean that more positive action will be taken in the future. 108 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Section 60 of this Act requires Local Authorities to submit to the Minister of Labour an Annual Report relative to their district and the administration of this Act. The report submitted for 1966 contained the following information:— TABLE A—REGISTRATIONS AND GENERAL INSPECTIONS Class of Premises Number of premises registered during the year Total number of registered premises at end of year Number of registered premises receiving a general inspection during the year (1) (2) (3) (4) Offices 54 498 57 Retail shops 79 1,369 264 Wholesale shops, warehouses 1 36 4 Catering establishments open to the public, canteens 9 124 17 Fuel storage depots — — — Totals 143 2,027 342 TABLE B.—NUMBER OF VISITS OF ALL KINDS BY INSPECTORS TO REGISTERED PREMISES 844 TABLE C.—ANALYSIS OF PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE Class of Workplace Number of persons employed (1) (2) Offices 7,407 Retail shops 6,939 Wholsale departments, warehouses 316 Catering establishments open to the public 943 Canteens 184 Fuel storage depots — Total 15,789 Total Males 6,616 Total Females 9,173 109 TABLE D. Contraventions Found 1966 Contraventions Remedied 1966 Offices Shops Catering/ Canteens Wholesale Total Offices Shops Catering/ Canteens Wholesale Total Cleanliness—Working Areas 2 53 4 — 59 — 18 — — 18 Ventilation 3 7 — — 10 — 6 — — 6 Temperature 1 17 — — 18 — 22 — — 22 Lighting — 7 1 — 8 1 7 — — 8 Seating Facilities — 10 — — 10 — 5 — — 5 Seating—Sedentary Work — — — — — — 1 — — 1 Overcrowding 4 — — — 4 — — — — — First Aid 24 108 10 2 144 8 55 4 1 68 Sanitary Accommodation (i) Insufficient 1 9 — — 10 — — — — — (ii) Unsatisfactory 8 65 4 1 78 3 28 — — 31 Washing Facilities (i) Insufficient — 6 — — 6 — — — — (ii) Unsatisfactory 16 70 4 2 92 8 55 — 1 64 Drinking Water — 4 — — 4 — 3 — — 3 Staff Clothing 1 23 1 — 25 — 7 1 — 8 Eating Facilities — 8 — — 8 — 4 — — 4 Thermometer 26 109 9 1 145 8 65 2 1 76 Abstract 39 171 12 2 224 13 109 5 2 129 Stairs etc. 5 53 6 — 64 1 19 1 — 21 Unguarded Machines 1 7 2 — 10 — 3 2 — 5 Totals 131 727 53 8 919 42 407 15 5 469 110 The Act, among other things, calls upon the occupier of those premises to which it applies to notify the appropriate authority of any accidents that occur involving employees. The following is a summary of the accidents reported during the year:— Place where Accident occurred Workplace Number Reported Total No. Investigated Action Recommended Fatal Non FataI Prosecution Formal warning Informal advice No action Offices — 8 3 — — 1 2 Retail shops — 39 7 — — 4 3 Wholesale Shops Warehouses 4 2 — — 1 1 Catering establishments open to public, canteens — 7 1 — — 1 — Fuel storage depots — — — — — — — TOTALS — 58 13 — — 7 6 Analysis of reported accidents Offices Retail Shops Wholesale warehouses Catering establishments open to public, canteens Fuel storage depots Machinery — 2 — — Transport — — — — — Falls of persons 7 15 — 2 — Stepping on or striking against object or person 1 3 — 2 Handling goods — 9 — 1 — Struck by falling object — 3 2 — — Fires and explosions — — — 1 — Electricity — — — — — Use of hand tools — 7 — 1 — Not otherwise specified — — 1 — — Ill From time to time the Ministry of Labour issue explanatory circulars concerning points arising from this Act. These are most helpful and useful documents as they are, in many instances, based on decisions of the courts or on the experience gained by contacts with a wide range of Local Authorities. These circulars help in achieving uniformity of action by Local Authorities and it is hoped that the practise of issuing them will be continued. FACTORIES The Medical Officer of Health by Section 153(i) of the Factories Act 1961 is required in his Annual Report to the Council to furnish in a set form prescribed particulars about the factories in the district. Prescribed Particulars on the Administration of the Factories Act 1961 PART I OF THE ACT 1.—INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors) Number on Register Number of Premises Inspections Written Notices Occupiers Prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 47 29 - — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 463 209 5 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 40 32 2 — Total 550 271 7 — 112 2.—Cases in which DEFECTS were found (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more "cases") Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred ToH.M. Inspector ByH.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.1) 6 4 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) Insufficient 1 1 — 1 — (6) Unsuitable or defective 7 6 — 1 — (c) Not separate for sexes 1 1 — — — Other offences against the Act (not including offences relating to outwork) — — — — — Total 9 8 — 2 — Part VIII—Outwork Particulars of outworkers as required by Section 133 and 134 of the Act are as follows:— Nature of Work No. on August list Wearing Apparel 103 Household linen 1 Cardboard boxes 1 Brush making 6 Cosaques, Christmas stockings 24 Total 135 Shops At the end of the year there were 2,247 occupied shops on the register, 46 fewer than at the end of the previous year and 101 fewer than five years ago. 113 Since 1961 four new large food stores have been opened; over the same period the number of other food shops has fallen by 109—nearly half being grocers. A large number of the vacated shop premises are now occupied for purposes other than retail trade, e.g. launderettes, betting shops, travel, estate and insurance agencies. The following is a list of the various types of shops in the Borough at the end of the year, classified under their principal trades:— Antiques 13 Motor and accessories 129 Boot repairers 39 Musical 11 Boots and Shoes 48 Newsagents 112 Builders merchants 28 Opticians 18 Butchers 115 Ladies outfitters 114 Chemists 63 Gents outfitters 79 Coal order offices 25 Photographic 20 Confectioners/Cafes 152 Pet stores 11 Drapers 26 Public Houses 54 Radio, T.V. and Electrical 93 Second-hand wardrobes 4 Fish and fried fish 43 Sewing Machines 6 Florists 20 Stationers 18 Fruiterers and Greengrocers 107 Tobacconists 124 Furnishers 69 Toys, sporting equipment 22 Glass and China 10 Wallpaper, paint 34 Grocers 186 Wines and spirits 47 Hairdressers 145 Wools 25 Hardware 67 Timber, woodwork .. 23 Jewellers 28 Large mixed stores .. 23 Leather goods 9 Miscellaneous 87 Total 2,247 During the year 1,145 visits were made for the purpose of administering the Shops Acts, 1950/1965. Sunday and evening observations were also made. The following is a summary of the contraventions noted:— Closing Hours Failing to close for a weekly half-day 1 Failing to display notice of early closing day 14 Serving customers with non-exempted goods on early closing day 9 Failing to display mixed trade notices on early closing day 8 Failing to close on Sunday 1 Serving customers with non-exempted goods on Sunday 12 Failing to display mixed trade notices on Sunday 9 114 Conditions of Employment Failing to allow assistants proper intervals for meals 3 Failing to keep records of Sunday employment 2 Failing to allow holiday in lieu of Sunday employment 1 Warnings were given in respect of all the above matters and also fifty-six other instances of failure to either keep records or exhibit notices, as required by the Acts. One trader was prosecuted for selling non-exempted goods on Sundays and was fined £9, plus £5 costs. VERMIN AND OTHER PESTS Pigeons The services of the contractor engaged during 1964 to deal with feral pigeons in the Borough were retained. Regular treatment was carried out in various parts of the district and the number of birds was reduced and kept within reasonable limits. Though at the end of the year the problem had by no means been resolved, it is hoped that by regular treatment and the taking of action in respect of roosting sites, that further improvements will be possible. Rats and Mice During the year 1,846 complaints were received about either rats or mice and infestations were found at 1,569 premises. These figures represent an increase on those for 1965 and almost equal those for 1964—a record year for complaints. No evidence was found of any major infestations in the Borough and a survey of the complaints received does not suggest that one part of the district is more badly affected than another. Two factors, however, undoubtedly play an important part in so far as infestations are concerned. One is the haphazard and careless manner in which many people scatter food scraps for birds. The second is the cover provided by those householders who allow unwanted material to accumulate behind garden sheds around untidy compost heaps and in the various nooks and crannies that are to be found in so many gardens. It is appreciated that many householders find the disposal of debris and unwanted material, other than house refuse, a matter of difficulty and that this is the reason for much unwanted material being retained. The cover, plus the food scraps, provide the rat with ideal conditions and until the problems associated with these two points have been resolved, there is little likelihood of the rodent population in the district being reduced, 115 Wasps The complaints received during the year about wasps totalled 223. Apart from 1958, when only 111 complaints were received, this is the lowest figure for more than ten years. The number of complaints received during 1965 was 859. No serious difficulties were met in dealing with nests that were accessible, though those under eaves and in confined roof spaces often presented problems and on occasions necessitated evening visits being made. FERTILISERS AND FEEDING STUFFS The Fertilisers and Feeding Stuffs Act and Regulations control the composition of fertilisers and feeding stuffs and during the year thirteen samples of fertilisers and three samples of feeding stuffs were taken. Of these, two informal samples of fertilisers were found below the standard required and in consequence two formal samples were taken. In each case these were satisfactory. One retailer received a warning for failing to display the required declaration of content on loose bone meal, and two wholesalers were required to provide declarations in respect of fertilisers being supplied to retailers. PHARMACY AND POISONS There are 163 registered sellers of Part II poisons within the Borough, as listed below:— Builders, Builders' Merchants 9 Hardware Stores 38 General Provisions 99 Nurseries/Corn Merchants 10 Hairdressers 2 Photographers 2 Laboratory/Druggists 3 The poisons retailed by most of the traders listed are the disinfectants, weed killers and insecticides. Most of these are the well-known prop.ietary brands which rarely alter from year to year. OIL HEATERS REGULATIONS AND HEATING APPLIANCES (FIREGUARDS) REGULATIONS The new Oil Heaters Regulations, 1966, made under the Consumer Protection Act 1961 came into force on 1st June, 1966. The effect of these new Regulations was to make the principal Regulations of 1962 apply to 116 all oil-heaters which are offered for sale (whether new or second-hand), irrespective of their date of manufacture. Inspections were made of all types of heating appliances covered by Regulations and though new appliances presented little difficulty, secondhand appliances were occassionally found on offer for sale that failed to meet the standard required. No difficulty was experienced in dealing with these and no proceedings were taken. INSPECTION AND SUPERVISION OF FOOD Slaughterhouses: The three slaughterhouses in the district, namely, 7 Northolt Road, 46 High Street, Wealdstone and 87 Stanmore Hill were used throughout the year. The facilities and conditions at Northolt Road and at Stanmore Hill remain satisfactory, but there were occasions when the situation at 46 High Street, Wealdstone gave cause for concern. The problems here are associated with the limited accommodation that is available, having regard to the number of animals that are handled. Discussions on this point have taken place with those concerned and when alternative slaughtering facilities become available, it is hoped that these premises will cease to be used as a slaughterhouse. The number of animals killed in the district during the year was 7,032. The figures for 1965 being 6,585 and for 1964, 7,140. All the animals killed were inspected by the Health Inspectors, all of whom are qualified Inspectors of meat and other foods. Slaughtering and the dressing of carcases was undertaken by licensed slaughtermen and, as in previous years, the majority of the animals dealt with were young, of good quality, and destined for butchers meat as opposed to older animals that are often slaughtered for manufacturing purposes. The figures relating to the number of Animals killed are as follows (1965 figures in brackets):— Wealdstone South Harrow Stanmore Total Cattle 571 (615) 521 (690) 99 (92) 1,191 (1,397) Pigs 20,30 (2,013) — — 2,030 (2,013) Sheep 2,934 (2,487) — (1) 572 (419) 3,506 (2,907) Calves 293 (267) — 12 (1) 305 (268) Total 5,828 (5,382) 521 (691) 683 (512) 7,032 (6,585) 117 The following is a summary of the post-mortem examination of animals slaughtered in Harrow:— Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Horses Number killed 1,191 — 305 3,506 2,030 — Number inspected 1,191 — 305 3,506 2,030 — All diseases except Tuberculosis and Cysticerciwhole carcases condemned 2 2 3 Carcases of which some part or organ was condemned 247 3 179 229 Percentage of the number inspected affected with disease other than Tuberculosis and Cysticerci 20.7 - 10 5.1 11.3 - Tuberculosis only Whole carcases condemned — — — — Carcases of which some part or organ was condemned - - - 30 Percentage of the number inspected affected with Tuberculosis 1.48 Cysticercosis— Carcases of which some part or organ was condemned 13 - - - - - Carcases submitted to treatment by refrigeration 5 — — — — — Generalised and totally condemned — — — — — — MILK—PRODUCTION AND PROCESSING The number of Dairy farms in the Borough is now four. Two of these are in Pinner, one in Harrow Weald, and one in Harrow. There was no change in the number of dairies licensed for the pasteurising of milk. This remained at 2, namely, Messrs. Braziers of Kenton Lane and Messrs. Hall & Sons of Pinner Park Farm. Both operate plants of the High Temperature Short Time (H.T.S.T.) type. 118 The following summary indicates the position relative to the regulations affecting the distribution of milk and the retailing of the milk affected by a special designation:— Milk and Diaries (General) Regulations, 1959 Number of Persons Registered as Distributors 97 Number of Persons Registered as Dairymen 3 Milk (Special Designations) Regulations, 1963, as amended 1965 Number of Dealers holding a (Pasteurised) Licence 2 (Untreated) Licence 2 Number of Dealers holding a (Pre-Packed) Pasteurised Licence 97 Sterilised Licence 51 Untreated Licence 26 Ultra Heat Treated Licence 35 The designated milk Ultra Heat Treated is now well established and more retailers are applying for licences to sell milk that has been so treated. INSPECTION AND SAMPLING Arising from the visits to the farms and dairies and from the sampling that was undertaken, the department was responsible for bringing to light the presence of Brucella abortus in two herds within the area. At the time the milk was being used in its untreated form for human consumption. Notification from the Public Health Laboratory of the presence of this bacilli resulted in the Department taking action under Regulation 20 of the Milk and Dairies (General) Regulations, 1959. This prevented the milk being used for human consumption in its contaminated form and the milk of each producer was diverted for heat treatment, prior to being sold. The Animal Health Division of the Ministry were informed and were interested, but little help was forthcoming from them in the matter of finding the sources of infection within the herds concerned, there being no eradication scheme at present in operation for this disease. In one case the Local Authority, in conjunction with the Public Health Laboratory and the farmer's Veterinary Surgeon performed this task. The steps taken resulted in preventive measures being introduced, which it is hoped will result in the infection being eradicated. Pending this stage being reached, all the milk produced will be subjected to Heat Treatment. In connection with these investigations, 37 samples were taken and of these 22 were reported by the Public Health Laboratory as positive. In the second case, at the time of writing investigations and sampling are in hand but no decision has been taken in respect of the course to be followed. 119 The following table indicates the number of overall samples taken and the results obtained:— Sampling Returns for Year Ending 31st December, 1966 Milk—Bacteriological Type TAKEN AWAIT'E Phos. Meth. Blue Turb. AntiBiotics Milk Ring Brucellosis Biological Q Fever T.B. U.H.T. Test Sat. U/S Sal. U/S Void Sat. Sat. Void Pos. Neg. Pos. Neg. Neg. Neg. Sat. Void. Pasteurised 24 — 24 — 22 — 2 - - - - - - - - - - - Channel Islands 15 — 15 - 12 — 3 — — — — — — — — — — — Homogenised 15 — 15 - 12 1 2 - - - - - - - - - - - Sterilised 10 - - - - - - 10 - - - - - - - - - - Untreated 49 5 - - - - - - - - 22 19 1 3 4 4 — - Raw 91 — — — 58 18 14 — — — 1 — 1 — — — — — Separated Sterilised 4 — — — — — — 4 — — — — — — — — — — Separated Past. 2 — 2 — 2 — — — — — — — — — — — — — Raw AntiBiotics 64 - - - - - - - 45 19 - - - - - - - - School 3 — 3 — 3 — — — — — — — — — — — — — Ultra Heat Treated 3 - - - - - - - - - - - - - - - 2 1 Totals 280 5 59 — 109 19 21 14 45 19 23 19 2 3 4 4 2 1 120 Milk Bottles During the year eighteen complaints were received about milk bottles and having regard to the number of bottles in daily circulation in the Borough (at least 200,000) this indicates a very high standard of efficiency at the bottling centres, from which milk being retailed in Harrow is processed and handled. The milk bottle, however, remains a problem and one dairy was so perturbed about the condition of bottles being returned to them from a particular establishment, that arrangements were made for cartoned milk to be supplied. There is no doubt that the non-returnable container is the answer to many of the problems associated with the milk bottle. One matter of particular interest resulted from a complaint received about the presence of a brownish deposit in bottles of Homogenised milk. The deposit was invisible until the milk had been stored under refrigeration for a period of twenty-four hours. Protracted investigations followed without any definite conclusions being reached, but, ultimately specimen bottles were supplied to the National Institute for Research in Dairying at Shenfield, who found the deposit was, in fact, the effect of homogenisation on cell and other tissue. Consultations are now in hand with a view to plant being installed that will remove these deposits. ICE CREAM The number of premises registered for the retailing of ice cream fell during the year from 479 to 402. The majority of the premises registered deal only in the prepacked product and most of the seventy-seven who ceased trading were grocers. The number of manufactureis remained at five. Sampling During the year 135 samples were taken and of these 104 were reported as satisfactory, being either Grade I or Grade II. The 34 that were reported as either Grade III or Grade IV (i.e. unsatisfactory) were all the subject of further investigation. A Grade IV report does not mean th?t the sample is unfit for human consumption, but is an indication that somewhere either the required standard of cleanliness is not being maintained or there is something wrong with either the plant or materials. If vendors operating from premises outside the district were involved, then the Local Authority concerned was advised. In all of these cases, follow-up samples were taken. Ice Lollies were also sampled—all were satisfactory. FOOD AND DRUGS ACT, 1955 During the year 1,165 samples of foodstuff, water, milk or drugs were examined, and of this number 1,042 were found to be satisfactory. Misleading descriptions or incorrect labelling accounted for the majority of the unsatisfactory reports. In every one of these cases, on the attention of 121 those responsible being drawn to the matter in default, action was taken to deal with the infringement. With one exception, the other adverse reports were in respect of minor deficiencies and were dealt with by way of warning letters. The exception concerned a case where rolls being retailed as buttered rolls were found to contain margarine. Summary proceedings were taken in this case and a fine of £10, plus costs, was imposed. Reference was made in the Annual Report for 1965 to samples being tested by the department. During 1966, 188 samples of milk and 40 samples of other commodities were dealt with in this way. It has the advantage of saving both time and money in that, only in the event of an adverse or doubtful result being obtained, was it necessary to submit samples for examination by the Public Analyst. The following is a summary of the results of the samples submitted to Mr. Eric Voelcker, A.R.C.S., F.R.I.C.:— Taken Satisfactory Unsatisfactory Informal Formal Informal Formal Informal Formal Drugs 26 25 1 24 1 1 - Foods 397 383 14 364 11 19 3 Complaints During the year 90 complaints were received about the condition of foodstuff or about the presence of foreign matter. All were investigated and taken up with either the manufacturers, the wholesalers or whoever was responsible. Seven of the cases resulted in action being taken in the Courts, two were in respect of glass in milk, two were about cigarette ends in loaves of bread, one was about mouldy sausages, another was about mould in a pork pie and the seventh case concerned a finger dressing in a bread roll. In each case a fine was imposed and costs were allowed. The Liquid Egg (Pasteurisation) Regulations, 1963 Ministry of Health circular 1 /67 refers to these regulations. There are no egg pasteurisation plants in use in the Borough, but liquid egg is used at a number of establishments. Eight samples were taken during the year of supplies coming into the district and all were satisfactory. The countries of origin of the eggs sampled being Australia, South Africa, China and the United Kingdom. Food Hygiene (General) Regulations, 1960 Reference is made earlier in this Report to the total number of shops in the district and the number in the various categories. Almost without exception, food premises in each group comply with Regulation 16 and Regulation 19 of the Food Hygiene (General) Regulations of 1960. 122 CONSUMER PROTECTION Today a great deal is heard about Consumer Protection, a matter which has no doubt exercised the minds of individuals since the days when trading or the exchanging of goods commenced. From these early days we have proceeded via a multiplicity of statutes and regulations to the point of having a Consumer Council. This is an independent body, financed by government grant. Its job is to inform itself about consumer problems and matters affecting consumer interests, to promote action to deal with such problems and provide advice for the customer. On the behalf of the public the Consumer Council is therefore interested in all the various services that are provided for the public, for goods of all kinds and, in fact, for almost everything that affects the daily life of every individual. Much of the work Local Authorities have been undertaking for many years has been within the field of Consumer Protection. The Food and Drugs Act, the Food Hygiene Regulations, the dozens of statutory instruments relating to the composition of food, the Orders relating to the labelling of food, the legislation relating to milk, to ice cream, to the slaughtering of animals and to meat inspection are but a few of the more obvious services through which this form of protection is given. Health Education and the advice and instructions given to the public on matters relating to health, welfare and hygiene are further examples of the work already being done in this field. Then, too, there is a wealth of legislation relating to Weights and Measures, and to the standards to which various articles and materials must conform. In this Report reference is made to the sampling that has been undertaken during the year in respect of milk, water and food-stuffs of all kinds. This is all done in the interest of Consumer Protection. Perhaps the most interesting aspect of the terms "Consumer Protection" and "Consumer Council" is the image theyaie creating in the mind of the general public; an image that there is a Council in no way connected with Town Halls, who will give publicity to any shortcomings in respect of commodities or services. This is all to the good, for public opinion remains one of ihe most powerful of forces and is able to achieve a great deal in a very short space of time. The publicity that a Consumer Council can provide will help Local Authorities by drawing the attention of the public to the many services that are provided and which, for their complete success, demand the co-operation of the public. MERCHANDISE MARKS ACT, 1926, et seq This is an Act closely linked with Consumer Protection in that it relates to the marking and description of both imported and home produced foodstuffs. During the year some 200 inspections were made pursuant to this Act and the orders relating to the labelling of food. 123 It was necessary on several occasions to draw the attention of retailers to produce being incorrectly marked. In the main, however, the standard of marking was extremely good. This is probably due to a variety of factors, not the least being the degree of publicity that is today given by the Television Authorities to the buying and selling of produce. The housewife too plays a most important role in this matter, being not only knowledgeable about food-stuffs and their place of origin, but also being aware of the action that can be taken in cases of doubt. Then, too, there are few traders indeed who wish to either mislead or even confuse the customer. If, however, one is found, then the wise shopper not only transfers her custom elsewhere, but makes known her experience to others, including the Health Department. During the year there were two unusual incidents concerning labelling. These were noted during routine inspections—one involved honey and the other, apples. Both incidents were taken up with those concerned and the necessary alterations were made. CLEAN AIR Smoke Control Two Smoke Control Orders became operative during the year affecting some 3,832 dwelling houses. A total of eleven Orders are now in operation covering an area of 2,093 acres and 18,028 premises, 17,301 of which are dwellings. Approximately 25 % of the dwellings in the Borough are now within areas covered by operative Smoke Control Orders. During 1967 it is planned to bnng under control a further 5,400 dwellings which will take the total number of dwellings affected up to 34 %. The following statistical summary shows the position at the end of the year. SMOKE CONTROL ORDERS—Position at 31st December 1966 Order No. Date of Operation No. of dwellings Area in Acres Claims for Grant Total cost of Work Grant Paid Total cost to Local Authority Private Corporation £ £ £ 1. 1. 9.61 1,981 198 225 702 12,169 6,930 3,018 2. 1. 9.62 790 329 105 222 3,266 1,599 712 3. 1.11.62 1,009 60 132 369 5,215 2,236 973 4. 1. 7.63 1,518 41 208 471 9,079 3,338 1,463 5. 1.10.63 1,695 2 212 650 12,676 6,243 2,819 6. 1.11.63 935 441 161 289 5,562 1,907 877 7. 1. 7.64 1,378 — 176 455 11,939 6,300 2,792 8. 1.12.64 1,461 233 228 634 17,435 9,802 4,433 9. 1.12.65 1,396 2 171 299 11,194 5,813 2,517 10. 1. 7.66 1,429 2 171 434 17,650 7,908 3,246 11. 1.12.66 2,124 276 304 458 17,445 6,589 2,824 12. 1. 7.67 1,643 126 288 2 98 64 27 Totals 17,359 1,490 2,381 5,296 134,739 64,409 27,782 124 The staff engaged on the survey and inspection of premises made 5,382 visits during the year and inspected and approved completed adaptation work to fireplaces to the value of £46,204 in some 1,205 dwellings. NATIONAL SURVEY OF AIR POLLUTION The four stations in the Borough which record daily levels of sulphur dioxide and smoke in the atmosphere remained in operation during the year. Two of these were operated by pupils and staff of secondary schools, one by the laboratory staff of a local factory and the other by staff of the Health Department. Without the help and assistance from the schools and factory concerned it is doubtful if the survey could have been maintained and the assistance we received from the schools and factory concerned is appreciated. The readings recorded were passed at monthly intervals to the Warren Spring Laboratory of the Ministry of Technology as the coordinating body for the survey and who produce periodical reports showing pollution levels over the whole country. The level of air pollution is considerably affected by climatic and meteorological conditions and it is, therefore, intended that recordings shall be taken for a period of five years before the results of the survey are made known. Satisfactory averages which can be used for the purpose of comparison should be available. From our own observations, it appears that the level of atmospheric pollution in Harrow continues to fall. The effect has been to nearly double the cost as can be seen in the following fieures:— Amount of Grant Paid No. of Claims for Grant Average per Claim {to nearest £) Years 1961/64 £30,985 3,294 £9 1965 £13,183 797 £17 1966 £20,241 1,205 £17 The cost of adaptations has risen considerably since the greater free dom of choice in types of appliances attracting grant aid was introduced. This followed the White Paper on "Domestic Fuel Supplies and the Clean Air Policy", which was presented to Parliament in December, 1963. Householders are still, on average, spending on adaptations double the amount of the grants received. SCHOOL HEALTH SERVICE 126 EDUCATION COMMITTEE Members of the General Purposes and Finance Sub-Committee:— Mayor Councillor E. G. Buckle, F.R.I.C.S., J.P. Chairman Alderman A. E. P. F. MacRae, R.N.V.R., A. Inst.M.S.M. Alderman W. O. Allen, O.B.E., J.P. Councillor Mrs. D. I. Edwards Councillor W. E. Jones, A.M.A.S.E.E. Councillor H. A. Maun, A.F.I.C.D. Ex-officio Alderman O. G. Collins Alderman C. E. Jordan Alderman S. R. Miller, F.R.I.B.A. Councillor G. F. Gibbons, J.P. Councillor Mrs. D. A. Nott Cock, S.R.N., S.C.M., F.R.S.H. Councillor G. Colborne Hill Co-opted Members Mr. W. F. H. Johnson Mr. F. L. Le Franc, M.B.E. W. H. J. Knight, M.A., Director of Education 127 SCHOOL HEALTH SERVICE NUMBER OF CHILDREN ON ROLL The number of pupils attending maintained primary and secondary schools including nursery and special school, on re-opening in January 1967 was 26,723. The numbers attending each group of schools were as follows:— Boys Girls Total Secondary Grammar 2,423 2,462 4,885 Secondary Modern 2,809 2,528 5,337 Primary 8,162 7,945 16,107 Nursery 75 60 135 Day Spec'al School 44 39 83 Hospital School 40 54 94 Residential Special School 56 26 82 13,609 13,114 26,723 MEDICAL INSPECTIONS The main function of the School Health Service is to promote the health and welfare of the school child in order that he may derive the maximum benefit from the education provided. The basic "instrument" used to achieve this end is the medical inspection of children with the purpose of:— (i) detecting actual defects present and, (ii) eliciting signs indicative of developing defects which could interfere with a child's educational progress. Section 48 of the Education Act 1944 makes it the duty of a local education authority to provide for the medical inspection, at appropriate intervals, of pupils in attendance at any school maintained by them, and the authority may require the parent of any pupil, in attendance at such a school, to submit the pupil for medical inspection in accordance with arrangements made by the authority. Although the Act thus provides a legal obligation on the parent to submit the child for examination, the parent is free, should he so desire, to refuse treatment. Under the School Health Service and Handicapped Pupils' Regulations, 1953, a local education authority is free to experiment in the ages at which periodic medical inspection shall be carried out, although a minimum of three general medical inspections is prescribed. 128 Mention was made last year of examination of pupils by the "selective" method and in pursuance of introducing a fourth periodic medical examination at the age of 7-8 years using this technique, a series of new questionnaires were compiled during the year and it is hoped to introduce a pilot scheme in selected schools during 1967. During the year 1966, in Harrow the periodic inspections were carried out as follows:— (1) Entrants—on admission for the first time to school; (2) Intermediates—during the first year of secondary school; (3) Leavers—during last year at school. Pupils who miss a medical inspection are automatically examined at the next routine medical inspection arranged at the school. All children who are found to have some defect or who require observation are seen again (Re-inspections) as necessary, either at the school or by special appointment at the school clinic. In addition to the routine school inspections, arrangements are made to carry out Special Inspections of pupils, usually at the request of a parent, doctor, nurse, teacher or other person. The number of pupils inspected during the year at maintained schools was as follows:— Periodic inspections 9,077 Special inspections 1,469 Re-inspections 2,443 Tables IV and V show the number of defects found at both periodic medical inspections and special inspections and the number of individual children found to require treatment or observation. General Condition of Children Inspected An estimate of the child's physical condition at the time of the inspection is made and the children classified as follows:— (a) Satisfactory: Number 9,059 Percentage 99.8 (b) Unsatisfactory: Number 18 Percentage 0.2 PERSONAL HYGIENE Inspections totalling 27,315 were made by school nurses or health assistants to determine the cleanliness and general state of health of pupils. The number of children found to be infested with nits or head lice was 139. Cleansing notices under Section 54 (2) Education Act 1944, were issued in respect of 66 pupils. No cleansing orders under Section 54 (3) were required during the year. 129 PROVISION OF MILK AND MEALS IN SCHOOLS During the year 1966, the total number of meals served was 3,479,089 of which 80,375 were free. 60 departments were served by kitchens on the premises and 12 by container meals. The milk in Schools Scheme has continued and one-third pint bottles of milk are provided for all primary and secondary school children who wish to have them. The figures of the number of children in maintained schools taking meals and milk on a selected day are submitted for purposes of comparison. Selected Day Number Present Number taking Meals Dinners % Number taking Milk Milk % 1961 24,711 17,473 70.7 19,580 79.2 1962 24,006 17,206 71.7 19,287 80.3 1963 23,598 17,701 75 0 19,273 81.7 1964 23,906 17,926 75.0 19,291 80.7 1965 24,403 18,432 75.5 19,383 79.8 1966 25,190 19,440 77.2 19,504 77.4 MEDICAL TREATMENT Children with defects are referred to their family doctor, to hospital for specialist opinion or treatment, or to the School Clinic for treatment for minor ailments and other special defects. List of School Health Clinics as at 31st December 1966 Type No. of Weekly Sessions 1. Alexandra Avenue Clinic, Alexandra Avenue, South Harrow. Minor ailment 1 Dental 2 Ophthalmic 1 *Chiropody 2 2. Broadway Clinic, The Broadway, Wealdstone. Minor ailment 1 *Chiropody 4 3. Elmwood Clinic, Francis Road, Kenton. Minor ailment 1 Dental 5 *Chiropody 2 130 Type No. of Weekly Sessions 4. Honeypot Lane Clinic, Honeypot Lane, Stanmore. Minor ailment 1 Dental 6 Ophthalmic 1 Speech 2 *Chiropody 7 5. Harrow Child Guidance Centre, 82 Gayton Road, Harrow. Child Guidance 7 6. Kenmore Road Clinic, Kenmore Road, Harrow. Minor ailment 1 *Chiropody 1 7. Northolt Road Clinic, Northolt Road, South Harrow. Minor ailment 1 Dental 10 Speech 2 *Chiropody 7 8. Whittlesea Road Clinic, Whittlesea Road, Harrow Weald. Minor ailment 1 Dental 6 Speech 2 *Chiropody 2 9. Tenby Road Clinic, Tenby Road, Edgware. Minor ailment 1 Dental 4 Speech 2 *Chiropody 1 10. Cecil Park Clinic, Cecil Park, Pinner. Minor ailment 1 Dental 4 Speech 2 *Chiropody 4 11. Caryl Thomas Clinic, Headstone Drive, Wealdstone. Minor ailment 1 Dental 9 Dental (orthodontic) 1 Ophthalmic 2 Orthoptic 2 Speech 14 *Chiropody 6 *Shared with Section 28, National Health Services Act cases. 131 These clinics, in addition to being used as treatment centres are available for consultation purposes. Here children are seen at the request of the parents or of the teachers or for a more detailed examination of a particular child seen at a periodic medical inspection in school. Minor Ailment Clinics These clinics deal mainly with odd slight injuries, such as sprains, burns, cuts, a few of the common skin infections and minor defects of the eye and ear. Despite the growth in the school population, the number attending these "minor ailment" sessions has tended to fall over the past few years. However, as mentioned above, the sessions are also used much more for consultation and special examination purposes at which the medical and nursing staff can devote much more detailed attention to a particular child's problems. Eye Diseases, Defective Vision and Squint During the year, 191 cases of disease of the eye (including minor defects treated at minor ailment clinics) were treated. Through arrangements made with the Regional Hospital Board, children with defective vision are referred to either the Honeypot Lane Clinic, the Caryl Thomas Clinic or the Alexandra Avenue Clinic, where refraction is carried out by an ophthalmic surgeon. 1,056 such cases were referred during the year and in 325 cases glasses were prescribed. Orthoptic Clinic An Orthoptist attends the Caryl Thomas Clinic for two sessions each week to deal with cases referred by the visiting ophthalmic surgeon. These cases include the pre and post-operative treatment of cases of squint. Vision Testing The accurate recording of a child's vision is of primary importance and every effort is made to obtain an as accurate as possible result in all school entrants. Both the rotating 'E' Card and the Sheridan-Pugmire Cards are used. Doubtful results are carefully followed up by repeat examinations either in school or at the clinic. Vision is again tested at future periodic school medical inspections. Ideally a child's vision should be recorded annually but this is not possible at present. However, as a compromise, efforts are made to conduct a biennial test of vision by having additional vision sweep tests carried out by the health visitor/school nurse or clinic nurse. In order to test vision by standardised procedures which are independent of the conditions of test, a Keystone Telebinocular Vision Screener is in use—this machine indicates near point and distance seeing ability easily and rapidly. Tests for colour vision can be introduced for screening of the 11 year age group. All pupils failing this screening procedure are referred to the ophthalmic surgeon. The test tends to be very selective but this is not considered to be a drawback. 132 Colour Vision All children have a test for colour vision at their intermediate periodic medical inspection. The importance of this test lies in the fact that children with defective colour vision know at an early age that they will be unsuitable for certain occupations. Diseases and Defects of Ear, Nose and Throat Children suffering from these defects are examined and treated either at the minor ailment clinic or referred to family doctor or to hospital out-patient departments for specialist advice, after prior discussion with general practitioner. Hearing in School Children Gross defects of hearing are usually fairly obvious and appropriate arrangements are made for the child's education. Lesser defects are not so easily identified and can, if missed, interfere with a child's educational progress. In order to find these children, audiometer sweep tests are carried out with the following criteria:— (1) Children to have their hearing tested three times in their school lives; (2) Each child to have its first routine check of hearing not later than the age of seven; (3) Special cases (e.g. children failing to develop proper speech, children suffering from cerebral palsy, children failing without apparent reason to make progress at school) to be seen as "specials". Children failing a sweep audiometer test are called to the school clinic, where a full puretone audiometric test is given, followed by a medical examination to exclude any pathological condition which might be the cause of deafness. Simple conditions, such as wax in ears, are dealt with at the clinic but a child with more serious defects is referred to hospital for specialist opinion. In cases where no obvious cause can be found, further investigation is arranged at the Audiology Unit at Neasden in the London Borough of Brent. Children Wearing Hearing Aids in Ordinary Schools Children wearing hearing aids in ordinary schools are kept under regular supervision. In addition, peripatetic teachers of the deaf attached to the Audiology Units act as links between the Unit and school, and are also able to advise teachers over difficulties experienced with the children in class. Number of children wearing hearing aids in ordinary schools. 45 Number of commercial hearing aids supplied during the year 12 133 Orthopaedic and Postural Defects Children found at periodic school medical inspections or at the minor ailment clinics to have orthopaedic or postural defects are referred for specialist advice to the Harrow Hospital Physical Treatment Centre. Cases requiring physiotherapy are dealt with at the Centre, working under the direction of the visiting orthpaedic surgeons. During the year, 65 pupils received treatment at the Centre. Speech Therapy At the beginning of the year 1966 the Speech Therapy Service in the London Borough of Harrow was staffed by three Speech Therapists. 1 full-time (Therapist left in January, 1966 and was replaced in July, 1966). 1 part-time (Six sessions a week. Appointed full-time senior Speech Therapist, March 1966). 1 part-time (Five sessions a week. Therapist left in April, 1966. Fulltime Therapist appointed in August, 1966). Therapists worked together one day a week at Caryl Thomas Clinic which is the centre of the area. Clinics were held at the following centres:— Caryl Thomas Clinic 8 sessions per week. Honeypot Lane Clinic 2 sessions per week. Cecil Park Clinic 1 session per week Northolt Road Clinic 2 sessions per week. Whittlesea Road Clinic 1 session per week. Shaftesbury School 1 session per week. Stanmore Orthopaedic Hospital 1 session per week. Due to changes in the staff all Clinics except Caryl Thomas Clinic had to be closed from April until September. By October, 1966 all the Clinics had been re-opened, and in addition sessions were started at Tenby Road Clinic and Whittlesea Road Training School. It was felt that one session a week at Shaftesbury School was insufficient, and two Therapists working together started to visit twice a week. Sessions were also increased at Cecil Park, Whittlesea Road and Caryl Thomas Clinic. In October, 1966, Speech Clinics were held at the following centres:— Caryl Thomas Clinic 14 sessions per week. Honeypot Lane Clinic 2 sessions per week. Cecil Park Clinic 2 sessions per week. Northolt Road Clinic 2 sessions per week. Whittlesea Road Clinic 2 sessions per week. Tenby Road Clinic 2 sessions per week. Shaftesbury School 4 sessions per week. Whittlesea Road Training School 1 session per week. Stanmore Orthopaedic Hospital 1 session per week. 134 Children came to the various Clinics from thirty nine of the forty three schools in the area. They were referred by Assistant Medical Officers, Head Teachers, Orthodontists and General Practitioners in the area. Children were also referred by Surgeons, Neurologists and Speech Therapists at the following hospitals:— Great Ormond Street Hospital for Sick Children. Mount Vernon Hospital. Edgware General Hospital. During 1966 twenty schools were visited and good co-operation with the teachers established. Good co-operation continued with the staffs of the Nursery Schools in the area and also with the Health Visitors. Principals of two of the Speech Therapy Training Schools in London sent students for a period of a term each. They came once a week to observe work in the clinics in the area. One student taking a degree in Speech at Newcastle University came for two weeks to observe Speech Therapy treatment in the clinics. A total of seven students came to the clinics in the area during 1966. A meeting was arranged in November for Speech Therapists working in the areas adjoining Harrow, and those working in the hospitals in or near the area. It was attended by fifteen therapists, and was felt to be of considerable value. The total case load during 1966 was 440. This number consisted of:— 122 Pre-school children. 318 School children. 238 children were referred in 1966 73 children were referred for an opinion, and did not require regular treatment. Most of these were seen during school visits. 129 children admitted during 1965 were still having treatment. 440 Total 147 cases were discharged during 1966. The majority of these children now have speech that is within the normal range. However twenty children left the district or country before treatment was finished—(most of these were seen at Stanmore Orthopaedic Hospital). Six were discharged because of non attendance. Three were discharged because they were not benefiting from treatment. 135 CHILD GUIDANCE AND SCHOOL PSYCHOLOGICAL SERVICES I am indebted to the Director of Education Mr. W. H. J. Knight M.A. for the following reports on the work of the Child Guidance and School Psychological Services during the year. Child Guidance Service Dr. J. R. Hood M.B., D.P.M. Consultant in Child Psychiatry reports as follows:— The Child Guidance centre provides a consultative service to the School Health Service, head teachers, general practitioners, paediatricians and other hospital specialists, the Courts and the social agencies. Its chief agents are the Consultant Psychiatrist and the Educational Psychologists, to whom all formal requests for an opinion are addressed. The other members of the team—Psychiatric Social Workers and Child Psychotherapists provide a special form of psychological treatment, i.e. psychotherapy, as a means of dealing with emotionally disturbed children and their parents. In addition to the Consultative and psychotherapeutic treatment services provided by the permanent professional staff, the following activities should be noted : (1) Case Conferences held at least once weekly confined to staff members, or opened to include students and/or people referring children, such as Medical Officers, Head Teachers, General Practitioners. These reach decisions, mediate responsibility and facilitate communication. (2) Fortnightly group discussions with case-workers from the Probation and Mental Health Services, as a means of increasing their skills in work with their own clients. (3) Co-operative work, with shared responsibility for cases, based on consultation and case discussions, with Health Visitors, Mental Welfare Officers and Probation Officers. (4) Attachment of a staff member to the Children's Department for one half day a week so that help and advice can be given informally to parents and staff there. (5) Establishment of the Specialist teacher as an integral member of the Centre staff. She now deals with emotionally disturbed and educationaly retarded children who attend classes at the Centre part-time, in addition to children who are unable to attend normal school in the usual way. (6) Training through supervised work, child observation and participation in Conferences, etc., of social work students, psychology students and students from the London University Senior Course for Teachers of Maladjusted Children. A Psychiatric Registrar was also attached during the year. 136 (7) Co-ordination and policy planning meetings with the Assistant Education Officer, Special Services, and the Principal Medical Officer, Mental Health. Number of new cases 121 Other attendances 1,305 (This includes children seen for therapy and parents attending with them for advice, annual re-examinations of boarding school children; parents seen alone, apart from treatment sessions, and lastly interviews with representatives of medical, educational and Social Services, such as medical practitioners, school welfare officers, health visitors, etc.). Total attendances 1,547: (1) Pupils 782 (2) Parents 735 (3) Others 30 Diagnostic cases seen by Psychiatrist: Total number of cases seen 121 Reasons for Referral: Nervous Disorders (Fears, Depression, Anxiety, Refusal to attend school) 26 Behavious Disorders 37 Psychosomatic Disorders (Asthma) 1 Anti-Social Behaviour 18 Habit Disorders (Enuresis, Soiling, Speech difficulties, Sleeping difficulties, Eating difficulties, Masturbation 21 Lack of School Progress/Backwardness 18 Source of Referral: Medical Officer of Health 11 General Practitioner 44 Children's Officer 2 Educational Psychologist 25 Probation Officer 1 Hospital Paediatrician/Psychiatrist 6 Health Visitor 1 Director of Education 2 Head Teacher 17 Parent 8 Transfers from other clinics 4 137 School Psychological Service Mr. W. R. Wilson M.A. (Hons) Senior Educational Psychologist reports as follows:— (2) Details of Referrals: (a) No. of referrals 115 (b) No. of interviews with children 736 (c) No. of interviews with parents and others (e.g., Child Care Officers) 149 (in addition to first appointment) (d) No. of visits to schools 269 (in addition to first appointment) (e) No. of children referred to Psychiatrist 28 (f) No. of children receiving individual remedial teaching at Centre 18 (g) No. of children recommended and placed in special boarding schools 2 (h) No. of children in treatment by Psychologists 13 (i) No. of children referred for group teaching (Mrs. Newton, Specialist Teacher) 6 (j) No. of children recommended to, and receiving tuition at the Word Blind Centre 3 During this period emphasis has been placed on forging as close links as possible with the schools. Most children referred are first seen in school, their parents also being invited to attend, although subsequent interviews may be held at the Child Guidance Centre. (3) Sources of Referral: Director of Education (including Education Welfare Officers) 9 Principal School Medical Officer including Principal Medical Officer Mental Health; School Medical Officers 19 Head Teachers 61 Outside (Probation Officers; Youth Employment Officer General Practitioners; Hospitals, etc. 9 Direct by Parents 17 Consultant Psychiatrist to Educational Psychologists for psychological assessment 31 (4) Remedial Teaching: Only a small number of children can be offered individual remedial teaching at the Centre. Both full-time Educational Psychologists undertake some of this work, and Miss Hammond has devoted her time exclusively to remedial teaching. Mrs. Newton's appointment has enabled us to offer such help to an additional small group. 138 The problem of providing remedial help for children with severe reading difficulties, frequently described as "dyslexic" or "word blind", has proved particularly difficult to solve. These children are frequently well above average intelligence but have specific difficulties relating to reading skill, and frequently spelling, which require intensive individual remedial teaching. For this reason, four such children have been referred to the Word Blind Centre in London and three of them are receiving tuition, and all are responding to the help available there. (The fourth child is on their waiting list). The Senior Educational Psychologist is at present teaching two such children individually and others are included in the remedial teaching programmes of the other two psychologists and the specialist teacher. (5) Teaching Groups at the Child Guidance Centre: We have been fortunate in obtaining the services of Mrs. Newton as teacher. She works under the direction of the Senior Educational Psychologist, but is also closely associated with the clinical work of the Centre. The nature of the teaching groups tends to vary according to changing needs. At present three groups meet regularly at the Centre: (i) a group of phobic children who are unable to attend school. These children, in addition to attending this group, may be receiving psychotherapy while case-work is carried out with their parents. In addition to individual case-work, a therapeutic group of five mothers meets weekly with Miss Gray, Psychiatric Social Worker. (ii) a group of children who come from unstable home backgrounds, and who also have learning difficulties. (iii) a group of children of secondary school age with persistent learning difficulties. In addition to these groups, Mrs. Newton also provides a limited amount of individual teaching as well as seeing parents of children attending any of her three main groups. (6) Special Education: (a) Shaftesbury Day Special School for E.S.N. Children: No. of children admitted 18 (a) Ascertained 12 (b) Informal admission 6 (b) Elmers Court Residential School for Delicate Children: Both full-time Educational Psychologists make periodic visits to the school in order to discuss educational problems, suitable educational techniques and materials, etc. 139 (7) Visits: Greater efforts are being made to visit special boarding schools at which Harrow children are placed, and to visit schools in order to ascertain their suitability for children being recommended for residential school placement. This is an important matter as the character of such schools can alter very rapidly following changes of staff. (8) Conclusions: The School Psychological Service continues to expand, and the majority of maintained schools make use of the service. As it proves possible to add to the staff the service hopes to offer wider facilities, e.g., there is little doubt that many more adolescents would make good use of a counselling service if this were more generally available. The Educational Psychologists continue to provide an important link between the clinical service and the schools in addition to working within their own sphere in the educational system. The Director of Education and his staff give the service their whole-hearted support and are at present considering ways of expanding the service to meet the needs of the borough. HANDICAPPED PUPILS The Local Education Authority have a statutory duty under the Education Act 1944, of ascertaining handicapped pupils in their area and of providing for the special educational treatment of such children. Ten categories of pupils requiring special educational treatment are defined in School Health Service and Handicapped Pupils' Regulations. These are as follows:— (a) Blind Pupils, that is to say pupils who have no sight or whose sight is, or is likely to become, so defective that they require education by methods not involving the use of sight. Number of blind pupils newly assessed 1 Number of blind pupils admitted to special schools during the year 1 Total number of blind pupils in special schools for the blind as at 31st December 1966 8 (b) Partially-Sighted Pupils, that is to say, pupils who by reason of defective vision cannot follow the normal regime of ordinary schools without detriment to their sight or to their educational development, but can be educated by special methods involving the use of sight Number of partially sighted pupils newly assessed Nil. Number of partially-sighted pupils admitted to special schools during the year 1 Total number of partially-sighted pupils in special schools for partially-sighted children as at 31st December 1966 8 140 (c) Deaf Pupils, that is to say, pupils who have no hearing or whose hearing is so defective that they require education by methods used for deaf pupils without naturally acquired speech or language. Number of deaf pupils newly assessed 1 Number of deaf pupils admitted to special schools during the year Nil. Total number of deaf pupils in special schools for the deaf as at 31st December 1966 5 (d) Partially Deaf Pupils, that is to say, pupils who have some naturally acquired speech and language but whose hearing is so defective that they require for their education special arrangements or facilities, though not necessarily all the educational methods used for deaf pupils. Number of partially deaf pupils newly assessed 4 Number of partially deaf admitted to special schools during the year 3 Total number of partially deaf pupils in special schools/ classes for partially deaf children as at 31st December 1966 7 (e) Educationally Subnormal Pupils, that is to say, pupils who, by reason of limited ability or other conditions resulting in educational retardation, require some specialised form of education wholly or partly in substitution for the education normally given in ordinary schools. Number of educationally subnormal pupils newly assessed13 Number of educationally subnormal pupils admitted to special schools during the year 14 Total number of educationally subnormal pupils in special schools/classes for educationally subnormal children as at 31st December 196666 (f) Epileptic Pupils, that is to say, pupils who by reason of epilepsy cannot be educated under the normal regime of ordinary schools without detriment to themselves or other pupils. Number of epileptic pupils newly assessed 2 Number of epileptic pupils admitted to special schools during the year 2 Total number of epileptic pupils in special schools for epileptic children as at 31st December 1966 3 141 (g) Maladjusted Pupils, that is to say, pupils who show evidence of emotional instability or psychological disturbance and require special educational treatment in order to effect their personal, social or educational readjustment. Number of maladjusted pupils newly assessed 5 Number of maladjusted pupils admitted to special schools/classes during the year 4 Total number of maladjusted pupils in special schools for maldjusted children as at 31st December 1966 33 (h) Physically Handicapped Pupils, that is to say, pupils not suffering solely from a defect of sight or hearing who by reason of disease or crippling defect cannot, without detriment to their health or educational develepment, be satisfactorily educated under the normal regime or ordinary schools. Number of physically handicapped newly assessed 5 Number of physically handicapped admitted to special schools/classes during the year 3 Total number of physically handicapped pupils in special schools for physically handicapped children as at 31st December 196618 (i) Pupils suffering from Speech Defect, that is to say, pupils who on account of defect or lack of speech not due to deafness require special educational treatment. Number of pupils newly assessed for special educational treatment in special schools Nil. Number of pupils with speech defect admitted to special schools during the year Nil. Total number of children with speech defect in special schools as at 31st December 1966 Nil. (j) Delicate Pupils, that is to say, pupils not falling under any other category, who by reason of impaired physical condition need a change of environment or cannot, without risk to their health or educational development, be educated under the normal regime of ordinary schools. Number of delicate pupils newly assessed 11 Number of delicate pupils admitted to special open-air schools during the year 8 Total number of delicate pupils in open-air schools as at 31st December 1966 15 142 The following table shows the number of children on the Register of Handicapped Pupils at the end of the year:— Residential Special School Day Special School Ordinary School Hospital School At Home Total Blind 8 - - - 2 10 Partially-sighted - 8 - - - 8 Deaf 3 2 - - - 5 Partially Deaf - 7 7 - 4 18 Educationally subnormal 6 60 3 - 1 70 Epileptic 2 - 1 1 1 5 Maladjusted 23 2 17 - 2 44 Physically handicapped 3 14 4 1 2 24 Speech - - - - - - Delicate 12 3 7 - 1 23 Children "At Risk" of Developing a Handicap The problems associated with the rearing and education of a handicapped child are manifold—so much so that, the earlier observation and advice, and even treatment, can be instituted, the better the end result for the child and very often for the parent as well. The whole exercise must be a combined operation between parent, general practitioner, specialist, local health authority and school health service personnel. Registers of children who, because of some handicap may require special education at a later date, have been kept for some time now. The recently-instituted scheme for the notification to the Registrar General of any malformations observed at the time of birth, plus the information from the "At Risk" registers maintained of children who thought apparently normal are at risk of developing some handicap because of some adverse factor during pre-natal, peri-natal or post-natal life, will all help towards this aim of early diagnosis and treatment. Day Nurseries—Admission of Handicapped Children In order to help in the work of rehabilitation of handicapped children, admission to a day nursery is arranged in certain cases. 143 The classes of handicapped children for whom these arrangements apply are as follows:— (1) Deaf and partially hearing children for whom continuation of auditory training in a hearing, and therefore, talking environment is advised; (2) Maladjusted children for whom absence from the home environment for some time daily is considered advisable; (3) Partially-sighted children whose need for training and companionship should be met in a sheltered environment; (4) Children over the age of one year of deaf and dumb mothers. The cost of attendance is borne by the Education Committee under Section 56 of the Education Act 1944, for children over the age of two years. Those under two years of age are dealt with under Section 22 of the National Health Service Act 1946. No charge is made to the parents of either category. One handicapped child was admitted to a day nursery during 1966. Home Tuition In certain cases where a child cannot attend either a day or residential school, arrangements are made for the provision of home tuition. Four children were receiving home tuition at the end of 1966. Recuperative Holidays These holidays are provided in certain cases where children, following some acute illness, are considered to need a period of convalescence, in order to make a full recovery. Three children were recommended and placed for a recuperative holiday in 1966. INFECTIOUS DISEASES The number of cases of infectious diseases among children aged from 5—14 during 1966:— Scarlet Fever 35 Acute Pneumonia 1 Dysentery 2 Measles 259 Whooping Cough 9 Paratyphoid Fever 9 Food Poisoning 2 Tuberculosis: Pulmonary 1 Non-pulmonary - 144 Immunisation Every effort is made to see that children receive full protection against Diphtheria, Whooping Cough, Tetanus and Poliomyelitis in the pre-school period. Primary immunisation should be completed during the first twelve months and booster doses given at 18 months and at 4½ years, i.e. before starting school, when special emphasis is placed on ensuring that children are fully protected against poliomyelitis and diphtheria. The immunisation state of all children is checked at the first periodic medical inspection and protective immunisation offered to all who require it. B.C.G. Vaccination The B.C.G. vaccination of school children aged 13 against tuberculosis continued during the year. This vaccination scheme is operated under Section 28 of the National Health Service Act and is, therefore, offered to children attending both maintained and private schools. The following is a summary of the work carried out under this scheme during the year 1966:— (A) Type of School No. of Pupils Eligible No. of Acceptance Negative Reactors Positive Reactors Secondary Modern 1,177 818 743 50 Secondary Grammar 762 602 553 40 Independent 512 437 382 30 Special 4 1 1 — Junior Training School 13 5 5 — Total (1965) 2,468 (2,550) 1,863 (1,842) 1,684 (1,658) 120 (157) For comparison, the final figures for 1965 are shown in brackets. (B) 1966 1965 No. eligible 2,468 2,550 No. accepting 1,863 1,842 Acceptance rate 74.6% 72.2% Positive reactors 120 157 Percentage positive 6.4% 8.7% Negative reactors 1,684 1,658 No. given B.C.G. vaccination 1,681 1,655 All positive reactors are referred to the Chest Clinic for x-ray and investigation. These investigations include x-ray examination of all domiciliary contacts. 145 EMPLOYMENT OF CHILDREN Under Section 59 of the Education Act 1944, education authorities are empowered to prohibit or restrict the employment of a child if they consider it would be prejudicial to his health or otherwise render him unfit to obtain the full benefit of the education provided for him. All children must, therefore, be medically examined before taking up employment. Number of children examined and found fit for employment during 1966 434 REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER The year 1966 was the first complete year as a Borough Service. Staffing still continued to be a problem, in particular the recruitment of full-time dental officers. This difficulty is however a national one. We were fortunate at the end of the year to appoint a very well qualified part-time orthodontist. There is no falling off in the number of children found to require this form of treatment. Irregularities of the dentition in the young primary teeth, and thus the avoidance of extractions, can do a lot to reduce the number of such cases. The new Tenby Road Clinic in Edgware was completed and sessions were started there in June. Attendances prove that the clinic is well sited for the schools that are dealt with. It is gratifying to note that we were able to inspect a greater number of children in the schools than in the previous year. The percentage of the total roll being 79% inspected compared with 75% in 1965. Dental Health Education A main event of the year was the launching of a pilot dental health campaign, covering five thousand school-children, from7th-18th November. It is hoped that this scheme will be extended to cover more of Harrow's twenty-six thousand school-children in 1967. The programme covered fourteen schools, and one Grammar School was included in addition to four Secondary Modern and nine Junior and Infant departments. The Head Teachers and staff were most co-operative. It was decided to take the campaign to the schools rather than have a central venue. Thanks are due to the Oral Hygiene Service and to Mr. D. J. Anderton, Health Education Officer, for their great contribution to the success of the campaign. The children were taken in groups varying in composition from twenty five in the case of infants to two hundred in the case of senior pupils. 146 The talks involved practical demonstrations and audience participation and were consolidated by films selected to suit the age group concerned. These films were supplied by the Oral Hygiene Service and included their new film "Johnny and the D. K. Robot". There was also a new recruiting film "Why Dentistry" which was shown to senior Grammar School pupils. All infants and junior children received a sample tube of toothpaste, an "Apple Club leaflet" and an apple. Three thousand of these apples were donated by the Fruit Producers Council. Children of all age groups took home a consolidatory letter to their parents. As a result of this campaign there has been a higher acceptance rate for treatment by the School Dental Service in those schools which have received a dental inspection since the campaign. HEALTH EDUCATION IN SCHOOLS Whereas some aspects of health education may be integrated in the school curriculum, some schools take advantage of talks, courses, and visits made available through the Department, and in this respect there is no doubt that a talk from a specialist speaker can have considerable impact. An example is the Course of 13 lectures arranged by the Health Visitors for school-leavers in secondary schools for girls—"Preparation for Life" which, in addition to Mothercraft, covered many other aspects of personal hygiene and community health. In another school, girls received lectures in preparation for the Duke of Edinburgh's Award up to gold medal standard. Talks were also given to Biology, Pre-nursing and Social Studies Groups in the schools—the topics covering the Department's services such as Environmental Health, Smoking and Health, Mental Health and Home Safety. In some cases the talks were consolidated by visits to clinics, water purification works, farms and dairies. The importance of keeping informed, those who come into day to day contact with school-children who may, in turn, educate their elders within the home, was realised, and as a contribution to educating the educators, Harrow's domestic science teachers were invited to a symposium on Home Safety arranged in co-operation with the London Borough of Hillingdon. The good attendance on a Saturday revealed the great interest of all concerned and a most successful, interesting and instructive meeting ensued. Routine medical and dental inspections afford an important outlet at person to person level for the Department Staff to get across many aspects of personal health to our school-children. 147 TABLE I—MEDICAL INSPECTION RETURNS Age groups inspected {By year of Birth) No. of pupils having received a full medical examination Physical Condition of Pupils Inspected No. of pupils found not to warrant a medical examination Pupils found to require treatment {excluding dental diseases and infestation with vermin) Satisfactory No. Unsatisfactory No. For defective vision {excluding squint) For any other condition recorded at Part II Total individual pupils (1) (2) (3) (4) (5) (6) (7) (8) 1962 and later 194 194 - - 3 39 39 1961 1708 1705 3 - 122 349 420 1960 2053 2049 4 - 96 473 519 1959 654 652 2 - 46 137 159 1958 157 157 — - 13 51 60 1957 237 236 1 - 16 49 61 1956 235 233 2 - 15 42 51 1955 139 139 — - 7 23 30 1954 1126 1124 2 - 59 192 224 1953 581 580 1 - 34 97 116 1952 208 208 — - 5 23 27 1951 & earlier 1785 1782 3 - 103 291 365 Total 9077 9059 18 - 519 1766 2071 Column (3) total as a percentage of Column (2) total: 99.8% Column (4) total as a percentage of Column (2) total: 0.2% 148 TABLE II OTHER INSPECTIONS Number of Special Inspections 1,469 Number of Re-inspections 2,443 Total 3,912 TABLE III INFESTATION WITH VERMIN (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 27,315 (b) Total number of individual pupils found to be infested 139 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2) Education Act 1944). . 66 (d) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(3) Education Act 1944). . - TABLE IV DEFECTS FOUND BY MEDICAL INSPECTION DURING THE YEAR Periodic Inspections and Special Inspections Defect Code No. (1) Defect or Disease (2) Periodic Inspections Special Inspections Entrants Leavers Others Total 4 Skin T 87 76 75 238 238 O 32 5 11 48 3 5 Eyes: (a) Vision T 249 102 168 519 70 O 253 40 70 363 18 (,b) Squint T 40 4 44 1 O 8 — 3 11 1 (c) Other T 12 1 6 19 5 O — — 1 1 1 6 Ears: (a) Hearing T 83 10 34 127 50 O 22 — 7 29 15 (b) Otitis Media T 8 1 1 10 — O 6 1 — 7 — (c) Other T 3 5 8 6 O — — — — — 149 Defect Code No. (1) Defect or Disease (2) Periodic Inspections Special Inspections Entrants Leavers Others Total 7 Nose and Throat T 186 25 75 286 24 O 143 6 30 179 13 8 Speech T 31 - 7 38 15 O 23 — 8 31 7 9 Lymphatic Glands T 6 — 2 8 - O 18 — 1 19 — 10 Heart T 23 7 17 47 18 O 40 1 14 55 2 11 Lungs T 63 8 23 94 12 O 55 — 16 71 12 12 Developmental: (a) Hernia T 10 1 4 15 10 O 4 — 1 5 3 (ft) Other T 54 7 28 89 5 O 46 1 17 63 2 13 Orthopaedic: (a) Posture T 8 5 12 25 1 O 12 4 5 21 — (ft) Feet T 89 62 63 44 51 O 28 5 6 39 8 (c) Other T 32 16 34 82 15 O 30 8 12 50 3 14 Nervous System: (a) Epilepsy T 10 4 5 19 1 O 6 — 3 9 2 (ft) Other T 105 3 31 139 83 O 45 2 4 51 9 15 Psychological: (a) Development T 8 - 9 17 9 O 34 — 4 38 4 (ft) Stability T 12 2 9 23 6 O 33 2 13 48 5 16 Abdomen T 7 3 6 16 4 O 4 1 2 7 1 17 Other T 61 67 80 208 45 O 35 4 15 54 19 T — Treatment O — Observation 150 TABLE V TREATMENT OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (including Nursery and Special Schools) EYE DISEASES, DEFECTIVE VISION AND SQUINT Number of cases known to have been dealt with External and other, excluding errors of refraction and squint 191 Errors of refraction (including squint) 1,056 Total 1,247 Number of pupils for whom spectacles were prescribed 325 DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Number of cases known to have been dealt with Received operative treatment: (a) for diseases of the ear (b) for adenoids and chronic tonsillitis 24 (c) for other nose and throat conditions 1 Received other forms of treatment 61 Total 86 Total number of pupils in schools who are known to have been provided with hearing aids: (a) in 1966 13 (b) in previous years 51 ORTHOPAEDIC AND POSTURAL DEFECTS Number of cases known to have been treated (a) Pupils treated at clinics or out-patient departments 65 (b) Pupils treated at school for postural defects — Total 65 151 DISEASES OF THE SKIN (excluding uncleanliness, for which see Table III) Number of cases known to have been treated Ringworm: (a) Scalp — (b) Body 1 Scabies Impetigo — Other skin diseases 289 Total 290 CHILD GUIDANCE TREATMENT Number of cases known to have been treated Pupils treated at Child Guidance Clinics 444 SPEECH THERAPY Number of cases known to have been treated Pupils treated by speech therapists 440 OTHER TREATMENT GIVEN Number of cases known to have been dealt with (a) Pupils with minor ailments 125 (b) Pupils who received convalescent treatment under School Health Service arrangements 3 (c) Pupils who received B.C.G. vaccination 1,681 (d) Other than (a), (b) and (c) above: Heart 9 Lungs 9 Nervous System: (i) Epilepsy 1 Psychological: (i) Development 8 (ii) Stability 6 Total (a) to (d) 1,842 TABLE VI DENTAL INSPECTION AND TREATMENT CARRIED OUT BY THE AUTHORITY ATTENDANCES AND TREATMENT Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First Visit 2,401 1,789 372 4,562 Subsequent Visits 2,915 2,563 630 6,108 Total Visits 5,316 4,352 1,002 10,670 Additional courses of treatment commenced 157 130 36 323 Fillings in permanent teeth 1,911 3,715 1,110 6,736 Fillings in deciduous teeth 4,373 349 — 4,722 Permanent teeth filled 1,584 2,954 776 5,314 Deciduous teeth filled 3,174 239 — 3,413 Permanent teeth extracted 28 191 48 267 Deciduous teeth extracted 996 340 — 1,336 General anaesthetics 450 205 14 669 Emergencies 109 94 11 214 Number of Pupils X-rayed 257 Prophylaxis 595 Teeth otherwise conserved 490 Number of teeth root filled 15 Inlays 4 Crowns 17 Courses of treatment completed 3,330 ORTHODONTICS Cases remaining from previous year 68 New cases commenced during year 51 Cases completed during year 54 Cases discontinued during year 10 No. of removable appliances fitted 95 No. of fixed appliances fitted 3 Pupils referred to Hospital Consultant PROSTHETICS Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total Pupils supplied with F.U. or F.L. (first time) - - - - Pupils supplied with other dentures (first time) 1 - 2 3 Number of dentures supplied 1 - 2 3 INSPECTIONS (a) First inspection at school. Number of Pupils 20,507 (b) First inspection at clinic. Number of Pupils 706 Number of (a) + (b) found to require treatment 8,315 Number of (a) + (b) offered treatment 6,944 (c) Pupils re-inspected at school clinic 899 Number of (c) found to require treatment 687 SESSIONS Sessions devoted to treatment 1,756 Sessions devoted to inspection 224 Sessions devoted to Dental Health Education 23