HARR 40 London Borough of Harrow THE HEALTH OF HARROW 1973 The Annual Report of the Medical Officer of Health and the Principal School Medical Officer Clifford Jansz, m.b.b.s., d.c.h., d.p.h., m.f.c.m. London Borough of Harrow THE HEALTH OF HARROW 1973 The Annual Report of the Medical Officer of Health and the Principal School Medical Officer Clifford Jansz, m.b.b.s., d.c.h., d.p.h., m.f.c.m. LONDON BOROUGH OF HARROW HEALTH COMMITTEE as at December 1973 Thr Worshipful the Mayor (Councillor G. Colborne Hill) (ex-officio) The Deputy Mayor (Councillor E. J. Harjcett) (ex-officio) Alderman Mrs. A, M. Johnson (Chairman) Councillor R. C. Beech (Vice-Chairman) Councillor R. G. Aitken Councillor D. B. I. Clark Councillor Mrs. E. E. Davies Councillor Mrs. J. M. Debell Councillor E. W. H. Feakins, m.inst.m. Councillor D. H. J. Hart Councillor Mrs. J. R. Keen Councillor Mrs. I. L. Koller Councillor Mrs. Tarl Councillor M. A. Murphy, b.a., dip.ed. Councillor E. C. Parker Councillor Mrs. N. Rees Councillor J. Wagner, j.p. Councillor B. M. Warshaw, a.f.inst.pet. Representing the Middlesex Local Medical Committee Dr. H. T. Foot Representing the Pharmaceutical Society of Great Britain Mrs. M. Garner-Patel STAFF DIRECTOR OF HEALTH SERVICES, MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER: Dr. Clifford Jansz, m.b.b.s., d.c.h., d.p.h., m.f.c.m. CONTROLLER OF HEALTH SERVICES, DEPUTY MEDICAL OFFICER OF HEALTH AND DEPUTY PRINCIPAL SCHOOL MEDICAL OFFICER: Dr. Mary K. Astin, m.b.ch.b., m.f.c.m., d.p.h. ASSISTANT CONTROLLER OF HEALTH SERVICES: Dr. R. Fidler, m.r.c.s., l.r.c.p., d.p.h. SENIOR MEDICAL OFFICERS: Dr. E. H. Johnson, m.b.b.s., c.p.h., d.p.h. Dr. L. Rivlin, m.r.c.s., l.r.c.p. DEPARTMENTAL MEDICAL OFFICERS (FULL TIME): Dr. F. B. Morgan, m.b.b.ch., b.a.o. Dr. R. Sundaresan, m.b.b.s., d.p.h. DEPARTMENTAL MEDICAL OFFICERS (PART TIME): Dr. A. T. Roden, m.b.b.s., m.r.c.s., l.r.c.p. Dr. A. R. Wilson, m.b.b.s., d.p.h. CHIEF NURSING OFFICER: Miss M. S. Hirschhorn, s.r.n., cm.b., h.v.cert. PRINCIPAL NURSING OFFICER (HEALTH VISITING): Miss J. D. McFarlane, s.r.n., s.c.m., h.v.cert. PRINCIPAL NURSING OFFICER (MIDWIFERY & HOME NURSING): Mrs. M. P. Harris, s.r.n., s.c.m. CHIEF DENTAL OFFICER: Mr. A. G. Brown, l.d.s., r.c.s.(eng.) CHIEF CHIROPODIST: Mrs. V. K. Brooke-Read, s.r.ch. SENIOR SPEECH THERAPIST: Mrs. R. J. Nicoll, l.c.s.t. PRINCIPAL ADMINISTRATIVE ASSISTANT: Mr. G. P. Phipps HEALTH EDUCATION OFFICER: Mr. D. J. Anderton, r.s.i. CHIEF PUBLIC HEALTH INSPECTOR: S. N. King, m.a.p.h.i. DEPUTY CHIEF PUBLIC HEALTH INSPECTOR: H. Drabble, m.a.p.h.i. CONTENTS Page Introduction 9 Statistics and Social Conditions of the Area 15 Personal Health Services 33 Health Education 45 General Services 49 Infectious Diseases 55 School Health Service 67 Environmental Health Services 87 9 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH Department of Health Services, P.O. Box 25, Hanover House, Lyon Road, Harrow, Middlesex, HA1 2EH. To The Worshipful the Mayor, Aldermen and Councillors of the London Borough of Harrow. Mr. Mayor, Aldermen and Councillors, I have the honour to present my report on the health of Harrow in 1973. For the last thirty years, Harrow has had a full-time Medical Officer of Health and it has been a statutory duty for him to submit an Annual Report. The reorganisation of the Health Services will sweep away this post, so this is the last Annual Report of a Medical Officer of Health for Harrow. The work of the Health Department during the year was dominated by an outbreak of smallpox in the Borough. A man and his wife living in Wealdstone contracted the disease. They had visited a relative in hospital who was in the same ward as an undiagnosed case of smallpox. The two Harrow residents were themselves undiagnosed until they became ill and were transferred to an isolation hospital on suspicion of food poisoning. Their contact with smallpox was not known so the couple had unrestricted movement in the area and the man travelled widely in connection with his work. The number of actual and possible contacts was therefore, very large. The staff of your Health Department traced and vaccinated approximately 3,000 persons. As a result, not a single secondary case of smallpox occurred in Harrow. (See page 53). The Registrar General estimated that the mid-year population was 204,660. This is an increase from 1972 although there was a decline in the birth rate to 2,638. During the year there was an influx of Ugandan Asians which caused an increase in the number of cases of overcrowding in the Borough. 10 I am pleased to report that the infant mortality rate per 1,000 live births dropped from 14.0 in 1972 to 11.0 in 1973. This compares very favourably with the overall rate of 17 for England and Wales. The three main causes of death in the area were heart disease, cancer, and cerebral vascular disease. The deaths from lung cancer continued to rise and reached a figure of 154. In spite of the known association of this disease with smoking, there appears to be little change in the habit amongst the general population. The year saw the start of the popular anti-smoking clinics run by the Health Education Section, which assisted a number of persons who wished to give up smoking but found it difficult to do so on their own. The Health Education Section also started an extensive publicity campaign on family planning. Additional clinic sessions had to be arranged and a vasectomy service was begun by the Family Planning Association acting as this authority's agents and using the facilities available at Northwick Park Hospital. The nursing services were expanded and additional health visitors and district nurses recruited. A night nursing service was started for those seriously ill patients needing nursing care during the night, and a late evening service to assist the chronic sick to get back to bed in the evening. Special emphasis was placed on the developmental assessment of young children. In the school health services attention was directed to the child's first examination at school and particularly to any emotional problems. During the year special arrangements were made for any abnormalities detected at the pupil's last school medical examination to be drawn to the attention of the newly formed Employment Medical Advisory Service. A start was made in setting up a comprehensive Student Health Service at the Harrow and Hatch End Colleges of Further Education. The expansion of the services mentioned above took place against a background of uncertainty and additional work. Staff due to be transferred to the National Health Service were unsure of their future roles. A great deal of preparatory work leading up to the reorganisation of the National Health Services on 1st April, 1974, had to be taken on in addition to the day-to-day tasks. The Department also had to absorb the work of an Assistant Controller because there was an embargo on the filling of senior posts immediately prior to reorganisation. I wish to record my thanks to Alderman Mrs, Amelia Johnson, Chairman of the Health Committee, and to the members of that Committee, for their unfailing help, support, and encouragement at all times, 11 without which assistance, much of this work would not have been possible. I also wish to offer my sincere thanks to Dr. Mary Astin, Controller of Health Services, Mr. George Phipps, Principal Administrative Assistant, Mr. Rex King, Chief Public Health Inspector and to all the Staff of the Directorate, for their loyalty, support and co-operation, and their outstanding contribution to the health of Harrow during the outbreak of smallpox. Mr. Mayor, this is the last report of a Medical Officer of Health for the London Borough of Harrow, but it is my privilege to continue to serve the residents of Harrow in another role. I have the honour to be, Your Obedient Servant, CLIFFORD JANSZ, Director of Health Services Medical Officer of Health and Principal School Medical Officer STATISTICS AND SOCIAL CONDITIONS OF THE AREA 15 STATISTICS AND SOCIAL CONDITIONS OF THE AREA General Statistics Area in acres 12,555 Population (Registrar General's estimate) 204,660 Estimated number of inhabited dwellings 70,268 Rateable Value £37,437,554 Sum represented by a penny rate £309,700 The estimated mid-year population of 204,660 was an increase of 930 compared with the figure for 1972. The natural increase in populationexcess of births over deaths—was 538. The number of occupied houses and flats rose by 359 to 70,268. Vital Statistics Live Births Male Female Total Legitimate 1,295 1,205 2,500 Illegitimate 75 63 138 Total 1,370 1,268 2,638 Live Birth rate per 1,000 population 12.9 Adjusted Live Birth rate 12.5 Birth Rate for England and Wales 13.7 Illegitimate live births per cent of total live births . 5.0 Stillbirths: Male Female Total Legitimate 11 9 20 Illegitimate 1 1 2 Total 12 10 22 Still Birth rate per 1,000 Live and Still Births 8.0 Total Live and Still Births 2,660 Still Birth rate for England and Wales 12.0 Infant Deaths (under 1 year of age): Male Female Total Legitimate 14 14 28 Illegitimate - 1 1 Total 14 15 29 16 Infant mortality rate per 1,000 live births 11.0 Legitimate Infant mortality rate per 1,000 legitimate live births 11.0 Illegitimate Infant mortality rate per 1,000 illegitimate live births 7.0 Infant mortality rate for England and Wales 17.0 Neo Natal Deaths (under four weeks of age): Male Female Total Legitimate 6 11 17 Illegitimate — — — Total 6 11 17 Neo-natal mortality rate per 1,000 live births 60 Neo-natal mortality rate for England and Wales 11.0 Early Neo-natal mortality rate (first week) per 1,000 live births 5.0 Peri-natal mortality rate per 1,000 live and still births 13.0 Maternity Mortality: Maternal deaths 1.00 Maternal mortality rate per 1,000 live and still births 0.37 Maternal mortality rate for England and Wales 0.13 Deaths : Male Female Total 1,020 1,080 2,100 Death rate per 1,000 population: Crude Death Rate 10.3 Comparability Factor 1.0 Adjusted Death Rate 10.3 Death rate for England and Wales 12.0 Deaths The total number of deaths of residents of the Borough was 2,100 giving a death rate of 10.3 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, 17 when applied to the crude death rate of 10.3 gives an adjusted death rate of 10.3. This compares with the death rate of 12.0 per 1,000 population for England and Wales. The three main causes of death were as follows:- Total % of All Deaths Heart Disease 706 33.7 Cancer 504 23.9 Cerebrovascular disease 252 12.0 Deaths from Accidents Motor vehicle and other accidents caused the deaths of 35 residents during 1973. The equivalent figure for the previous year was 39. All members of staff involved in the domiciliary services take every opportunity of advising on house safety measures during the course of their routine visits to houses. Deaths from Suicide Twenty-six people committed suicide during 1973, an increase of twelve compared with the figure for 1972. Deaths from Infectious Diseases There were two deaths from smallpox during the year (see page 53), and seven deaths from tuberculosis (see page 59). TABLE I. Lung Cancer — Deaths with rate per 100,000 Population, 1963-1973. Year Population Number of Deaths Rate per 100,000 1963 209,520 109 52.07 1964 210,250 132 62.73 1965 209,600 155 73.95 1966 208,730 133 63.73 1967 208,200 129 61.96 1968 208,220 152 72.99 1969 207,700 136 65.47 1970 206,060 159 77.16 1971 205,000 132 64.4 1972 203,730 114 55.95 1973 204,660 154 75.16 19 TABLE II Deaths of Harrow Residents during 1973 — Registrar General's Return Causes of Death Males Females Total 1 B.l Cholera — — — 2 B.2 Typhoid Fever — — — 3 B.3 Bacillary Dysentery and Amoebiasis — — — 4 B.4 Enteritis and other Diarrhoeal Diseases — — — 5 B.5 Tuberculosis of Respiratory System 2 2 4 6 B.6 (1) Late effects of Tuberculosis 1 1 2 7 (2) Other Tuberculosis — 1 1 8 B.7 Plague — — — 9 B.8 Diphtheria — — — 10 B.9 Whooping Cough — — — 11 B.10 Streptococcal Sore Throat and Scarlet Fever — — — 12 B.l 1 Meningococcal Infection — — — 13 B.12 Acute Poliomyelitis — — — 14 B.l 3 Smallpox 1 1 2 15 B.14 Measles — — — 16 B.15 Typhus and Other Rickettsioses — — — 17 B.16 Malaria — — — 18 B.17 Syphilis and its sequelae — — — l9 B.l 8 All Other Infective and Parasitic Diseases — 1 1 20 B.19 (1) Malignant Neoplasm—Buccal Cavitv and Pharvnx 1 2 3 21 B.19 (2) Malignant Neoplasm—Oesophagus 8 4 12 22 B.19 (3) Malignant Neoplasm—Stomach 22 19 41 23 B.19 (4) Malignant Neoplasm—Intestine 24 36 60 24 B.19 (5) Malignant Neoplasm—Larynx 4 3 7 25 B.19 (6) Malignant Neoplasm—Lung, Bronchus 119 35 154 26 B.19 (7) Malignant Neoplasm—Breast — 38 38 27 B.19 (8) Malignant Neoplasm—Uterus — 10 10 28 B.19 (9) Malignant Neoplasm—Prostate 16 — 16 29 B.19 (10) Leukaemia 8 4 12 30 B.19 (in Other Malignant Neoplasms 77 79 156 31 B.20 Benign and Unspecified Neoplasms 5 1 6 32 B.21 Diabetes Mellitus 9 18 27 33 B.22 Avitaminoses and Other Nutritional Deficiency — — — 34 B.46 4 2 6 35 B.23 Anaemias 1 — 1 36 B.46 (2) Other Diseases of Blood and Blood—forming Organs — 1 1 37 B.46 (3) Mental Disorders 2 2 4 38 B.46 (4) Multiple Sclerosis 2 1 3 39 B.24 Meningitis — 1 1 40 B.46 (5) Other Diseases of Nervous System & Sense Organs 7 7 14 41 B.25 Active Rheumatic Fever — — — 42 B.26 Chronic Rheumatic Heart Disease 5 10 15 43 B.27 Hypertensive Disease 16 28 44 44 B.28 Ischaemic Heart Disease 324 243 567 45 B.29 Other Forms of Heart Disease 28 52 80 46 B.30 Cerebrovascular Disease 79 173 252 47 B.46 (6) Other Diseases of the Circulatory System 40 69 109 48 B.31 Influenza 2 5 7 49 B.32 Pneumonia 62 99 161 50 B.33 (1) Bronchitis. Emphysema 63 24 87 51 B.33 (2) Asthma 1 2 3 52 B.46 (7) Other Diseases of the Respiratory System 16 10 26 53 B.34 Peptic Ulcer 9 7 16 54 B.35 Appendicitis — — _ 55 B,36 Intestinal Obstruction and Hernia 1 4 5 56 B.37 Cirrhosis of Liver 3 4 7 57 B.46 (8) Other Diseases of the Digestive System 9 10 19 58 B.38 Nephritis and Nephrosis 3 6 9 59 B.39 Hyperplasia of Prostate 2 — 2 60 B.46 (9) Other Diseases of the Genito—Urinary System 6 5 11 61 B.40 Abortion — — — 62 B.41 Other Complications of Pregnancy, Childbirth and Puerperium — 1 1 63 B.46 (10) Diseases of the Skin and Subcutaneous Tissue 1 — 1 64 B.46 (11) Diseases of the Musculo—Skeletal System and Connective Tissue — 9 9 65 B.42 Congenital Anomalies 3 5 8 66 B.43 Birth Injury, Difficult Labour, and Other Anoxic and 4 5 9 67 B.44 Other Causes of Perinatal Mortality 1 1 2 68 B.45 Symptoms and Ill—defined Conditions 1 5 6 69 B.47 Motor Vehicle Accidents 11 6 17 70 B.48 All Other Accidents 5 13 18 71 B.49 Suicide and Self—inflicted Iniuries 12 14 26 72 B.50 All Other External Causes — 1 1 TOTAL 1020 1080 2100 20 TABLE III Causes of Deaths (Males) at various ages, 1973 Causes of Death All Ages Under 4 Weeks 1 Month to 1 year 1- 5- 15- 25- 35- 45- 55- 65- 75- 1 B.l Cholera — — — — — — — — — — — — 2 B.2 Typhoid Fever — — — — — — — — — — — — 3 B.3 Bacillary Dysentery & Amoebiasis — — — — — — — — — — — — 4 B.4 Enteritis & Other Diarrhoeal Diseases — — — — — — — — — — — — 5 B.5 Tuberculosis of Respiratory System 2 — — — — — — — — 1 — 1 6 B.6 (1) Late effects of Tuberculosis 1 — — — — — — — — — 1 — 7 B.7 (2) Other Tuberculosis — — — — — — — — — — — — H B.7 Plague — — — — — — — — — — — — 9 B.8 Diphtheria — — — — — — — — — — — — 10 B.9 Whooping Cough — — — — — — — — — — — — 11 B.10 Streptococcal Sore Throat & Scarlet Fever — — — — — — — — — — — — 12 B.11 Meningococcal Infection — — — — — — — — — — — — 13 B.12 Acute Poliomyelitis — — — — — — — — — — — — 14 B.l3 Smallpox 1 — — — — — 1 — — — — — 15 B.14 Measles — — — — — — — — — — — — 16 B.l5 Typhus & Other Rickettsioses — — — — — — — — — — — — 17 B.16 Malaria — — — — — — — — — — — — 18 B.17 Syphilis and its Sequelae — — — — — — — — — — — — 19 B.l8 All Other Infective and Parasitic Diseases — — — — — — — — — — — — 20 B.19 (1) Malignant Neoplasm, sitic Diseases etc. 1 — — — — — — — — — 1 — 21 B.19 (2) Malignant Neoplasm, Oesophagus 8 — — — — — — 1 2 2 1 2 22 B.19 (3) Malignant Neoplasm, Stomach 22 — — — — — — — 2 7 9 4 23 B.19 (4) Malignant Neoplasm, Intestine 24 — — — — — — — 3 6 8 7 24 B.19 (5) Malignant Neoplasm, Larynx 4 — — — — — — — 1 — 3 — 25 B.19 (6) Malignant Neoplasm, Luna. Bronchus 119 — — — — — — 1 11 29 48 30 26 B.19 (7) Malignant Neoplasm, Breast — — — — — — — — — — — — 27 B.19 (8) Malignant Neoplasm Uterus — — — — — — — — — — — — 28 B.19 (9) Malignant Neoplasm, Prostate 16 — — — — — — — 1 3 5 7 29 B.19 (10) Leukaemia 8 — — — 1 — — — — 2 3 2 30 B.19 (11) Other Malignant Neoplasms 77 — — — — 1 1 3 8 21 33 10 31 B.20 Benign & Unspecified Neo- plasms 5 — — — — — — — 1 1 2 1 32 B.21 Diabetes Mellitus 9 — — — — — — — — — 6 3 33 B.22 Avitaminoses & Other Nutritional Deficiency — — — — — — — — — — — — 34 B.46 (1) Other Endocrine, Nutri tional & Metabolic Diseases 4 — — — — — — — 1 — — 3 35 B.23 Anaemias 1 1 — — — — — — — — — — 36 B.46 (2) Other Diseases of Blood & Blood-forming Organs — — — — — — — — — — — — Carried forward 302 1 — — 1 1 2 5 30 72 120 70 21 Table III continued Causes of Deaths (Males) at various ages, 1973 Causes of Death All Ages Under 4 Weeks 1 Month to 1 year 1— 5— 15— 25— 35— 45— 55— 65— 75— Brought forward 302 1 — — 1 1 2 5 30 72 120 70 37 B.46 (3) Mental Disorders 2 — — — — 1 — — — — — 1 38 B.46 (4) Multiple Sclerosis 2 — — — — — — — — — 2 — 39 B.24 Meningitis — — — — — — — — — — — — 40 B.46 (5) Other Diseases of Nervous System & Sense Organs 7 — 1 — — — — — — — 1 5 41 B.25 Active Rheumatic Fever — — — — — — — — — — — — 42 B.26 Chronic Rheumatic Heart Disease 5 — — — — — — — — 1 3 1 43 B.27 Hypertensive Disease 16 — — — — — — — 1 2 9 4 44 B.28 Ischaemic Heart Disease 324 — — — — — — 1 30 86 112 93 45 B.29 Other Forms of Heart Disease 28 — — — — — — — — 2 8 18 46 B.30 Cerebrovascular Disease 79 — — — 1 — — — 4 10 23 41 47 B.46 (6) Other Diseases of the Circulatory System 40 — — — — — 1 1 2 7 14 15 48 B.31 Influenza 2 — — — — — — — — — 2 — 49 B.32 Pneumonia 62 1 2 — — — — 2 1 4 10 42 50 B.33 (1) Bronchitis, Emphysema 63 — — — — — — 1 — 12 25 25 51 B.33 (2) Asthma 1 — — — 1 — — — — — — — 52 B.46 (7) Other Diseases of the Respiratory System 16 — — 1 — — — 1 1 2 6 5 53 B.34 Peptic Ulcer 9 — — — — — 1 — — 1 2 5 54 B.35 Appendicitis — — — — — — — — — — — — 55 B.36 Intestinal Obstruction & Hernia 1 — — — — — — — — — 1 — 56 B.37 Cirrhosis of Liver 3 — — — — — — — 1 1 1 — 57 B.46 (8) Other Diseases ot the Digestive System 9 — — — — — — — — 1 6 2 58 B.38 Nephritis & Nephrosis 3 — — — — — — — — 1 1 1 59 B.39 Hyperplasia of Prostate 2 — — — — — — — — — 1 1 60 B.46^ (9) Other Diseases of the Genito—Urinary System 6 — — — — — — — — — 2 4 61 B.40 Abortion — — — — — — — — — — — — 62 B.41 Other Complications of Pregnancy, Childbirth & Puerperium — — — — — — — — — — — — 63 B.46 (10) Diseases of the Skin & Subcutaneous Tissue 1 — — — — — — — — — 1 — 64 B.46 (11) Diseases of the MusculoSkeletal System & nective Tissue — — — — — — — — — — — — 65 B.42 Congenital Anomalies 3 — 3 — — — — — — — — — 66 B.43 Birth Injury, Difficult labour & Other Anoxic & Hypoxic Conditions 4 3 1 — — — — — — — — — 67 B.44 Other Causes of Perinatal Mortality 1 1 — — — — — — — — — — 68 B.45 Symptoms & Ill—defined Conditions 1 — 1 — — — — — — — — — 69 B.47 Motor Vehicle Accidents 11 — — — 2 — 1 2 2 1 2 1 70 B.48 All Other Accidents 5 — — — 1 — — 2 — — 1 1 71 B.49 Suicide & Self—inflicted Injuries 12 — — — — 1 2 2 1 3 2 1 72 B.50 All Other External Causes — — — — — — — — — — — — TOTAL—All Causes 1020 6 7 1 6 3 7 17 73 206 355 338 22 TABLE IV Causes of Deaths (Females) at various ages, 1973 Causes of Death All Ages Under 4 Weeks 1 Month to 1 year 1— 5— 15— 25— 35— 45— 55— 65— 75— 1 B.1 Cholera — — — — — — — — — — — — 2 B.2 Typhoid Fever — — — — — — — — — — — — 3 B.3 Bacillary Dysentery & Amoebiasis — — — — — — — — — — — — 4 B.4 Enteritis & Other Diarrhoeal Diseases — — — — — — — — — — — — 5 B.5 Tuberculosis of Respiratory System 2 — — — — — — — — 1 — 1 6 B.6 (1) Late effects of Tuberculosis 1 — — — — — — — — — 1 — 7 (2) Other Tuberculosis 1 — — — — — — — — 1 — — 8 B.7 Plague — — — — — — — — — — — — 9 B.8 Diphtheria — — — — — — — — — — — — 10 B.9 Whooping Cough — — — — — — — — — — — — 11 B.10 Streptococcal Sore Throat & Scarlet Fever — — — — — — — — — — — — 12 B.11 Meningococcal Infection — — — — — — — — — — — — 13 B.12 Acute Poliomyelitis — — — — — — — — — — — — 14 B.13 Smallpox 1 — — — — — 1 — — — — — 15 B.14 Measles — — — — — — — — — — — — 16 B.15 Typhus & Other Rickettsioses — — — — — — — — — — — — 17 B.16 Malaria — — — — — — — — — — — — 18 B. 17 Syphilis and its sequelae — — — — — — — — — — — — 19 B.18 All Other Infective and Parasitic Diseases 1 — — — — — — — — 1 — — 20 B.19 (1) Malignant Neoplasm, Buccal Cavitv. etc. 2 — — — — — 1 — — — 1 — 21 B.19 (2) Malignant Neoplasm, 4 — — — — — — — — 1 2 1 22 B.19 (3) Malignant Neoplasm, Stomach 19 — — — — — — 1 — 3 8 7 23 B.19 (4) Malignant Neoplasm, Intestine 36 — — — — — — 1 — 9 11 15 24 B.19 (5) Malignant Neoplasm, Larvnx 3 — — — — — — — — 1 — 2 25 B.19 (6) Malignant Neoplasm, Lung, Bronchus 35 — — — — — — — 6 6 13 10 26 B.19 (7) Malignant Neoplasm, Breast 38 — — — — — 2 3 5 6 17 5 27 B 19 (8) Malignant Neoplasm, Uterus 10 — — — — — — — — 3 4 3 28 B.19 (9) Malignant Neoplasm, Prostate — — — — — — — — — — — — 29 B.19 (10) Leukaemia 4 — — — 2 1 — — — — 1 — 30 B.19 (11) Other Malignant Neoplasms 79 — — — 2 — — 2 11 18 25 21 31 B.20 Benign & Unspecified Neo— plasms 1 — — — — — — — — — — 1 32 B.21 Diabetes Mellitus 18 — — — — — — — — 2 8 8 33 B.22 Avitaminoses & Other Nut— ritional Deficiency — — — — — — — — — — — — 34 B.46 (1) Other Endocrine, Nutri— ritional & Metabolic Diseases 2 — — — — — — — — — 1 1 35 B.23 Anaemias — — — — — — — — — — — — 36 B.46 (2) Other Diseases of Blood & Blood—forming Organs 1 — — — — — — — — — — 1 Carried forward 257 — — — 4 1 4 7 22 52 92 72 23 Table IV continued Causes of Deaths (Females) at various ages, 1973 Causes of Death All Ages Under 4 Weeks 1 Month to 1 year 1— 5— 15— 25— 35— 45— 55— 65— 75— Brought forward 257 — — — 4 1 4 7 22 52 92 72 37 B.46 (3) Mental Disorders 2 — — — — — — — — — — 2 38 B.46 (4) Multiple Sclerosis 1 — — — — — — — — — 1 — 19 B.24 Meningitis 1 — — — — — — — — — 1 — 40 B.46 (5) Other Diseases of Nervous System & Sense Organs 7 — — — 1 1 — — — 1 2 2 41 B.25 Active Rheumatic Fever — — — — — — — — — — — — 42 B.26 Chronic Rheumatic Heart Disease 10 — — — — — — — — 2 1 7 43 B.27 Hypertensive Disease 28 — — — — — — — 1 2 4 21 44 B.28 Ischaemic Heart Disease 243 — — — — — — — 6 25 59 153 45 B.29 Other Forms of Heart Disease 52 — — — — — — — — 2 9 41 46 B.30 Cerebrovascular Disease 173 — — — — — — 2 5 12 24 130 47 B.46 (6) Other Diseases of the Circulatory System 69 — — — — — 1 — 2 2 14 50 48 B.31 Influenza 5 — — — — 1 — — — — — 4 49 B.32 Pneumonia 99 2 1 1 — 2 1 — 1 3 9 79 50 B.33 (1) Bronchitis. Emphysema 24 — — — — — — — — — 12 12 51 B.33 (2) Asthma 2 — — — — — — — 1 — 1 — 52 B.46 (7) Other Diseases of the Respiratory System 10 1 — — — — — — — — 3 6 53 B.34 Peptic Ulcer 7 — — — — — — — 1 1 — 5 54 B 35 Appendicitis — — — — — — — — — — — — 55 B.36 Intestinal Obstruction & Hernia 4 — — — — — — — — — 1 3 56 B.37 Cirrhosis of Liver 4 — — — — — — 1 — 2 — 1 57 B.46 (8) Other Diseases of the Digestive System 10 — — — — — — — — — 3 7 58 B.38 Nephritis & Nephrosis 6 — 1 — — — — — — — 1 4 59 B.39 Hyperplasia of Prostate — — — — — — — — — — — — 60 B.46 (9) Other Diseases of the Genito—Urinary System 5 — — — — — — — 1 1 — 3 61 B.40 Abortion — — — — — — — — — — — — bJ B.41 Other Complications of Pregnancy, Childbirth St Puerperium 1 — — — — — 1 — — — — — 63 B.46 (10) Diseases of the Skin & Subcutaneous Tissue — — — — — — — — — — — — 64 B.46 (11) Diseases of the MusculoSkeletal System St Connective Tissue 9 — — — — — — 1 — 2 4 2 65 B.42 Congenital Anomalies 5 2 1 — 1 — — — — — 1 — 66 B.43 Birth Injury, Difficult labour St Other Anoxic St Hy— poxic Conditions 5 6 — — — — — — — — — — 67 B.44 Other Causes of Perinatal Mortallity 1 1 — — — — — — — — — — 68 B.45 Symptoms & Ill—defined Conditions 5 — 1 — — — — — — — 1 3 69 B.47 Motor Vehicle Accidents 6 — — — — 1 — — — 1 1 3 70 B.48 All Other Accidents 13 — — — — 1 1 1 — — 4 6 71 B.49 Suicide & Self—Inflicted Injuries 14 — — — — 2 1 4 — 3 3 1 72 B.50 All Other External Causes 1 — — 1 — — — — — — — — TOTAL—All Causes 1080 11 4 2 6 9 9 16 40 111 251 621 24 Infant Mortality During the year 29 (14 male and 15 female) infants in the district, or born to mothers ordinarily resident here, died under one year of age. This was a decrease of 10 on the figure for 1972 and with 2,638 live births gives an infant mortality rate of 11.0 compared with that of 14.0 in 1972. The rate for England and Wales was 17-0. Seventeen (59 %) of these infant deaths occurred during the first four weeks of life which gives a neo-natal mortality rate of 6.0 per thousand live births. Thirteen 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 perinatal mortality rate of 13.0 per thousand, live and still births, compared with a rate of 17.0 for 1972. 25 TABLE V Causes of Deaths of Harrow Infants under 1 year of age, 1973 Under 1 day 1-7 days 1-2 weeks 2-3 weeks 3 w'ks -1 month TOTAL UNDER 1 MONTH 1-3 months 3-6 months 6-9 months 9-12 months TOTAL UNDER 1 YEAR Prematurity 3 1 1 - - 5 1 - - - 6 Common Ventricle Transposition Great Vessels - - - - - - - 1 - - 1 Congenital Nephotic Syndrome - - - - - - - 1 - - 1 Multiple Congenital Abnormalities 1 - - - - 1 - - - - I Hyaline Membrane Disease 1 1 - - - 2 - - - - 2 Cerebral Birth Trauma 1 - - - - 1 - - - - 1 Wernig-Hoffman Disease - - - - - - 1 - - 1 Bronchiolitis - - - - 1 1 - - - - 1 Sudden Infant Death Syndrome - - - - 1 1 - 1 - - 2 Intra Ventricular Haemorrhage 1 - - - - 1 - - - - 1 Congenital Anomalies of Heart - 1 - 1 2 - 1 - - 3 Duodenal Atresia - 1 - - - 1 - - - 1 Bronchopneumonia - 1 - - 1 1 1 - 1 4 Acute Viral Pneumonitis - - - 1 1 - - - - 1 Sub Glottic Stenosis - - - - - 1 - - - 1 Perinatal Anoxia 1 - - - - 1 - - - - 1 Pulmonia Atresia - - - - - 1 - ' - 1 TOTALS 8 5 1 1 3 18 4 6 - 1 29 26 Maternal Mortality One death occurred during 1973 due to causes associated with pregnancy and childbirth. Still Births A total of 22 still births was registered during the year giving a still birth rate of 8.0 per 1,000 live and still births, which compares favourably with the rate of 12.0 for England and Wales. 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. (i) Number of notifications received during year 24 (ii) Number of live births included in (i) above 19 (iii) Number of still births included in (i) above 5 (iv) Total number of malformations notified as apparent at birth 31 (v) Number of children with multiple malformations 5 Analysis of Malformations Notified Number of Cases Central Nervous System Spina Bifida 3 Hydrocephalus 1 Eye and Ear Microphthalmos 1 Alimentary System Cleft Lip 2 Unspecified malformation of alimentary system. 1 Heart and Circulatory System 2 cord vessels only 2 Respiratory System Malformation of nose 2 Respiratory Distress Syndrome 1 Number of Cases Urino-Genital System Hypospadias 1 Limbs Syndactyly 1 Talipes 7 Congenital dislocation of hip 1 Other parts of Musculoskeletal System Malformation of sternum and ribs 2 Other Malformations Hepatomegaly 1 Multiple congenital malformations not specified 3 Down's Syndrome 2 27 Social Conditions The Borough lies at the edge of the green belt. Its population of 204,660 has a larger than usual proportion of social classes 1 and 2. During the year the Borough received 485 long stay immigrants. The environmental conditions are generally good. There are three areas designated for conservation because of their historical interest: Harrow-on-the-Hill, Little Common, Stanmore and High Street Pinner. Wealdstone has been marked as an area for general improvement. Progress towards clean air is proceeding and the final smoke control order will come into operation in November, 1975. On the industrial front Kodak (photographic material), Winsor and Newton (artists' materials) and Whitefriars (glass) continue to be the largest employers of labour in the Borough. 28 TABLE VI Summary of Vital Statistics 1949-1973 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 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 220,000 131 9.5 22.1 — 1 00 23.9 1952 219,000 131 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 208,730 151 9.7 12.0 8.6 Nil 15.9 1967 208,200 14.9 9.9 17.0 14.8 Nil 11.6 1968 208,220 15.2 10.4 12.3 8.9 Nil 131 1969 207,700 14.6 10.4 12.0 9.0 Nil 13.0 1970 206,060 14.5 10 3 14.0 9.0 Nil 110 1971 205,000 14.7 10.3 12.0 7.0 Nil 12.0 1972 203,370 14.0 10 1 14.0 9.0 Nil 9.0 1973 204,660 12.5 10.3 110 6.0 0.37 8.0 29 TABLE VII Comparative Vital and Mortality Statistics for the Borough of Harrow and for England and Wales for years 1963.1973 Birth Rate Death Rate Infant Mortality Rate Year Harrow England and Wales Harrow England and Wales Harrow England and Wales 1962 16.1 180 12.1 11.9 22.5 20.7 1963 15.5 18.2 11'2 12.2 16.3 21.6 1964 16.2 18.4 100 11.3 12.2 300 1965 16.1 18.1 101 11.5 100 190 1966 154 17.7 10.2 11.7 12.0 190 1967 15.2 17.2 10.3 11*2 17.0 18.3 1968 15.5 16.9 10.8 11.9 12.3 18.0 1969 149 16.3 10.8 11.9 120 18.0 1970 14.5 16.0 106 11.7 140 18.0 1971 14.7 160 10.6 11.6 12.0 18.0 1972 140 14.8 10.1 12.1 14.0 17.0 1973 12.5 13.7 10.3 120 110 17.0 . . : . j" . . '■ t : v: PERSONAL HEALTH SERVICES 33 PERSONAL HEALTH SERVICES Care of Mothers Arrangements for the care of expectant and nursing mothers and their children continued. The trend towards hospital confinements was such that few babies were delivered at home. During the year the domiciliary midwifery service was integrated with that of the hospital, giving an improvement in continuity between hospital delivery and domiciliary after-care. Developmental Assessment All births notified in the area were recorded on the computer and recall arranged at regular intervals, e.g. 6 months, 1 year, 18 months, etc. At these ages the child's mental and physical development were tested and compared with accepted norms. Any gross deviation was referred for full assessment to the Assessment Clinic at Northwick Park Hospital. The Controller of Health Services, who had special expertise in testing the intelligence of babies, worked with the Paediatrician in making a complete assessment of the child's conditions and requirements. Physiotherapists, occupational therapists, speech therapists, health visitors and social workers all played a role in this comprehensive assessment of the child. The computer was also programmed to recall children at the age of 7 months for a hearing test and at appropriate ages for the various immunisation procedures. The following table gives the total numbers of children who attended child health clinics from 1968 to 1973:- Year Number of Children who attended Clinics 1968 10,833 1969 10,986 1970 11,486 1971 11,036 1972 10,618 1973 8,918 34 Clinic attendances during the Year Clinic Child Health Sessions Toddlers' Sessions Alexandra Avenue 2,796 384 Broadway 2,832 465 Caryl Thomas 2,770 445 Cecil Park 1,999 459 Elmwood 1,933 284 Honeypot Lane 3,381 450 Kenmore 3,190 457 Northolt Road 4,491 582 Tenby Road 2,188 408 Whittlesea Road 1,461 192 Memorial Hall .. 793 — Walton Avenue 1,159 — Hatch End 658 130 St. John Fisher 1,266 298 Vaughan Road 1,131 684 Elstree 1,400 — RAF Stanmore Park 689 — TOTAL 34,137 5,238 35 Priority Dental Services This service is provided for expectant and nursing mothers and children under five years and is available at the eight dental clinics in the Borough. During the year 34 expectant or nursing mothers and 379 children under five years received treatment. Marriage Guidance The Marriage Guidance Council have a local office in the Borough. This is at 88/89 College Road, Harrow. Telephone: 427 8964. VACCINATION AND IMMUNISATION The following schedule of immunisation recommended by the Joint Committee on Vaccination and Immunisation and in use since January 1968 was used during the year:- Diphtheria/Tetanus/Pertussis and oral Polio 1st dose at 3 months 2nd dose at 5 months 3rd dose at 9 months Measles 13 months Diphtheria/Tetanus and oral Polio 4½ years Management of immunisation procedures by computer which was introduced during 1967 continued to work well during the year. The following table shows the number of children under sixteen who completed immunisation during 1973. Immunisation against Diphtheria/Whooping Cough/Tetanus/Poliomyelitis/ Measles Year of birth Others under Age 16 Total 1973 1972 1971 1970 19661969 Diphtheria Primary course 195 2,287 311 38 29 24 2,884 Reinforcing dose — 26 71 27 2,669 95 2,888 Whooping Cough Primary course 193 2,280 311 37 27 2,848 Reinforcing dose — 21 66 23 54 7 171 Tetanus Primary course 195 2,287 311 38 29 52 2,912 Reinforcing dose — 26 71 27 2,692 266 3,082 Poliomyelitis Primary course 193 2,286 312 38 25 19 2,873 Reinforcing dose — 26 71 27 2,561 123 2,898 Measles 2 1,318 940 122 165 22 2,569 36 In addition to the above schedule, vaccination against rubella is offered to all girls between their 11th and 14th birthdays. The purpose of the vaccination being to ensure that girls are offered protection against rubella before child-bearing age because of the known association between the development of foetal abnormalities and rubella infection in pregnancy. There was a very poor uptake of this facility. Out of 1,600 girls who were offered vaccination only 285 (17.8%) were vaccinated. FAMILY PLANNING During the year there was a publicity campaign for family planning. Two posters designed by the health education team were used widely during the campaign. The posters offered information on the family planning clinics in the Borough. A recorded telephone message, of two minutes duration, was made for the new Ansaphone. By dialling 427 9565 Harrow residents were able to obtain up-to-date information about the family planning clinics. Family Planning Clinics Caryl Thomas Clinic, Monday 7.00-8.00 p.m. Headstone Drive, Wealdstone Wednesday 1.30-3.00 p.m. Wednesday 7.00-8.00 p.m. Youth Advisory Clinic Monday 5.00—7.00 p.m. I.U.D. Session alternate Fridays 10.00-12.00 noon Alexandra Avenue Clinic, Tuesday 10.00-11.00 a.m. South Harrow Thursday 7.00-8.00 p.m. I.U.D. Session Tuesday 1.30-3.00 p.m. Cecil Park Clinic, Friday 7.00-8.00 p.m. Cecil Park, Pinner Youth Advisory Clinic Tuesday 7.00-8.00 p.m. Honeypot Lane Clinic, Thursday 1.30-3.00 p.m. Stanmore Thursday 7.00-8.00 p.m. I.U.D. Session Thursday 10.00-12.00 noon Kenmore Clinic, Kenton Tuesday 7.00-8.00 p.m. The domiciliary service was used very little during the year. Approximately 6,000 patients attended the family planning clinics and when the Council commenced a free service on 1st April, 1973 there was a 26% rise in attendance. 37 Vasectomy As a result of the provisions in the National Health Service Family Planning Amendment Act 1972 the Council made arrangements with the Family Planning Association for a free vasectomy service for Harrow residents. Patients previously had to attend Vasectomy Clinics in the Greater London Area. In June 1973 the Northwick Park Hospital Management Committee entered into an agreement with the Family Planning Association whereby the F.P.A. would undertake vasectomy operations on the hospital premises for a trial period of six months. The pre-operative counselling sessions were arranged at Honevnot Lane Clinic and commenced in November 1973. out at Northwick Park Hospital. The vasectomies were then carried out at Northwick Park Hospital. Age Number of men who received vasectomy during 1973 Under 20 Nil 20-24 1 25-29 6 30-39 32 40 and over 7 CHIROPODY With an ever increasing demand and difficulty in recruiting trained staff it became obvious early in the year that new measures would have to be taken if the service was to be able to continue meeting the needs of the patients, particularly those requiring domiciliary treatment. In an attempt to improve recruitment a scheme was introduced whereby chiropodists who undertook a minimum of three sessions weekly at the clinics were permitted to carry out treatment in patients' homes on a per capita payment basis, up to a maximum of ten patients per week. Although this reduced the waiting time between appointments it produced no marked improvement in the recruitment of chiropodists. 38 Attendances and Treatments for the year 1973 Category of patient No. of New Cases No. of Old Cases Total Attendances Elderley persons 942 3,850 17,500 Physically handicapped 6 35 177 Expectant and nursing mothers 15 7 69 School children 75 33 524 Others 6 13 82 Total number of treatments given at clinics 14,590 Total number of treatments given at home 3,762 Total 18,352 Number of sessions held at clinics 1,982 Number of sessions for domiciliary treatment 656 Total 2,638 WELL-WOMEN CLINICS Well-women clinics continued to be well attended. Towards the end of the year due to the increased demand two further sessions were started, one at Caryl Thomas Clinic and one at Northolt Road Clinic. The increased demand was partly the result of the first recall, which became due during the year, of those women who attended the mobile unit in 1972. ATTENDANCES AT WELL-WOMEN CLINICS No. of women seen 2,040 No. of new patients 805 No. of positive smears .. 6 No. of minor disorders .. 409 ADVISORY CLINICS FOR THE ELDERLY Weekly advisory clinics for the elderly continued during the year with sessions at Broadway Clinic, Wealdstone; Tenby Road Clinic, Edgware; Kenmore Road Clinic, Kenton; Cecil Park Clinic, Pinner and Whittlesea Road Clinic, Harrow Weald. 39 These clinics offer advice on personal problems, diet, accident prevention, and all aspects of social welfare. A great deal of time is given to each patient and their needs. Small problems such as a change of glasses or treatment by a chiropodist can make a great deal of difference to an elderly patient and give improvement in mobility and in general well-being. Any person found to have a condition requiring further investigation or treatment is referred to his or her own general practitioner. A very friendly atmosphere is maintained at these clinics. REPORT OF THE CHIEF NURSING OFFICER The community nursing services have been administered under a Mayston Management Structure since 1st April, 1971. The duties of the senior nursing staff have remained functional under the supervision of the Chief Nursing Officer. 40 Training The post of Principal Nursing Officer (Training) was filled on 1st September, 1973. The role covers all in-service training needs for the community nursing staff, community care training for student nurses from Northwick Park and the Middlesex Hospital. Six weeks community training is arranged for the student nurses. One day a week is devoted to theoretical training. Specialist lectures are given with the help of other departments. This type of training will continue and form an essential part of nurse training in an integrated Health Service. Midwifery Service The domiciliary midwifery service of the London Borough of Harrow and the midwifery services of Northwick Park Hospital, were combined into a unified service run from Northwick Park Hospital on an agency basis for the Borough. The day-to-day management was in the control of the Principal Nursing Officer (Midwifery) from Northwick Park. This was the result of the reduction of home deliveries in the Borough and the recommendation for hospital confinement (Peel Report). The total number of home confinements for the year was 54. Home Nursing Service (A) District Day Service The total home nursing service has been attached to general practitioners in the Borough. Home nurses assist during surgery hours with nursing treatments and carry out domicilary visits to patients on the doctors' lists. The new system is well liked by patients and nursing staff. More co-operation thus occurs between doctor and nurse for the benefit of the patient. One nursing officer acts as a liaison officer for Northwick Park Hospital to assess patients suitability for planned early discharge after certain operations. (B) District Night Service The night nursing service began on 1st August, 1973. The aim was to provide a visiting service to those patients requiring actual nursing care during the night, chiefly those in terminal stages of illness and the very incapacitated chronically sick patients. Staff were specially recruited as permanent night staff. The nurses in post, both S.R.N.s, have considerable nursing experience. The supervision of the service is carried out by a nursing officer from the Home Nursing team. The service has its base at Northwick Park Hospital. Co-operation from the hospital staff enables the nurses to have the facilities and communications which are necessary at night. The nurses are based in the Night Superintendent's office. The switchboard is notified of their movements during the night and they carry a "bleep" which will operate within a 3-mile radius of the hospital thus enabling the switchboard to contact them on their rounds if necessary. 41 All requests for the night service must be channelled through the nursing officer except in the case of a G.P. requiring a nurse during the night when he contacts the hospital direct. A further duty of the night staff is to maintain contact with and help where necessary, the Marie Curie nurses who stay all night with patients in terminal stages of carcinoma. The amount of work varies from time to time, the average being between 7-8 patients per night (some receiving 2 or even 3 visits). One nurse can handle this task. When not working on the district the night nurse helps on the wards at Northwick Park Hospital at the discretion of the night superintendent—but district work takes priority at all times. During the first 5 months the number of visits were :August 102 September 150 October 206 November 232 December 195 There is no doubt that the service has fulfilled a need and is running well. (C) District Late Evening Service A new service was begun for the purpose of helping those chronically sick patients who need assistance back to bed in the evening. Formerly, those patients who needed assistance were helped by the day staff before 6.00 p.m. With an evening service operating between 6.00 p.m. and 10.00 p.m. they can stay up a little longer. Demand for this service is increasing. The total visits during the first 5 months were:August 247 September 299 October 286 November 273 December 275 The Health Visiting Service The health visitor attachment or liaison schemes with general practitioners either single-handed or in group practices were continued and further developed. Many G.P.s have started their own Baby Clinics with the help of the health visitors. 42 During the year Health visitors have received tuition in Relaxation methods by a physiotherapist, a consultant obstetrician and gynaecologist from Northwick Park Hospital with a view to giving adequate preparation for confinement. Health visitors have joined the Northwick Park staff in giving mothercraft classes in the hospital. Geriatric Liaison Geriatric liaison has been continued by a health visitor who visits wards in Harrow Hospital and Northwick Park Hospital. Paediatric Liaison The paediatric liaison schemes with Northwick Park Hospital have continued this year and have resulted in better continuity of care between hospital and community. Training Seven sponsored health visitor students started their training in September, 1973. The three Principal Nursing Officers have received management training during the year and new first line managers have attended courses in lower middle management. Health visitors had refresher courses. Health Education (see also page 45) Health visitors participated in health education in Junior, Middle and Secondary schools. Films and visual aids were used and many pupils joined discussion groups. In one secondary school 1,250 children received a basic course in sex education; the courses were supported by the teachers who were able to continue discussion later. All parents were invited to hear what their children were told. The raising of the school leaving age has brought about some special problems. A special group of 20 boys and girls of mixed I.Q. who had hoped to leave school at 15 years of age received tuition in an informal setting. All children in this group had special problems—many were in trouble with the police. This group chose to take part in a community care course based on "the seven ages of man", with emphasis on the care of children. Visits were arranged to play groups, health clinics and homes for the elderly. 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 1,109 The Red Cross depot is at 39 Sheepcote Road, Harrow—Telephone 01-427 8788. HEALTH EDUCATION 45 HEALTH EDUCATION Several new projects were undertaken during the year. A series of seminars on Elementary First Aid were arranged for teachers and were well received. A Home Safety project was undertaken in schools, incorporating a follow up survey of accidents in the pupils' homes. The first of a series of anti-smoking clinics, organised in co-operation with the British Temperance Society was started. It proved very popular and was over-subscribed. Family Planning activity included a two day seminar for the staff of the Health and Social Service Departments. A special poster on family plannihg was produced for use in an extended publicity campaign. A recorded message listing times and addresses of local family planning clinics was prepared for the Ansaphone service. A campaign arranged to collect unused Medicines received good response from the general public. Major exhibitions were held on Home Safety and on the work of the Health Department. A review of the Health Education projects was arranged at the Harrow Show. Monthly exhibits on Health Education were held at clinics throughout the area. Dental Health Education activities in schools were timed to coincide with the visit of the Schools' Dental Officer. A comprehensive catalogue of visual aids was produced to support the work of clinic and school staff. Expectant mothers' film evenings were increased. Talks on a variety of subjects were given to Home Helps, Pupil Midwives, Pre-Nursing Students, Senior Citizens, Youth Clubs and Schools. GENERAL SERVICES 49 GENERAL SERVICES OCCUPATIONAL HEALTH An occupational health service offers the benefits of medical advice to employer and employee alike both before and during the latter's term of contract. Most employees are medically assessed before they commence their employment with the Authority. The primary objectives of this assessment are to ensure that the candidates are fit to carry out the duties of the post without either risk to themselves or to others in the same environment; for example, freedom from any transmissible infection is extremely important especially in those working in close relationship with children. At the same time the Authority is protected from either employing people liable to suffer from an undue amount of sick leave or who would be an unacceptable risk for the superannuation fund. The following table gives some indication of the amount of work undertaken in attempting to ensure that both employer and employee are protected:- Number of medical forms assessed 2,130 Number of medical examinations 39 Number of medical examinations—extensions of service 7 Number of medical examinations—heavy goods vehicle drivers 4 Number of medical examinations carried out for other Authorities 12 Number of medical examinations carried out under Ministry of Education Circular 249/52:- (a) Teachers first appointment 77 (b) Training College Entrants 229 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 to encourage them to get on to the list of a medical practitioner near 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 for those whose country of origin has a high incidence of tuberculosis. Details of immigrant families with children are particularly noted so that a health visitor can call and advise. 50 Country where Passport issued Number of Immigrants Commonwealth Countries: Caribbean 6 India 109 Pakistan 12 African 239 Other 33 Other Asian — Non Commonwealth Countries: European 7 Other 79 TOTAL 485 All addresses were visited and in 74 cases no knowledge of immigrants was known. 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 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. M. A. Taylor 11 Chronic Calvary Nursing Home, Sudbury Hill, Harrow. Mother Superior 42 Medical or Chronic Hillmede Nursing Home, 3 Landsdowne Road, Harrow. Mrs. D. M. Woodman 11 Chronic Westwood Nursing Home, 22 Hindes Road, Harrow. Mrs. D. M. Woodman 7 Medical or Chronic St. Michael's Nursing Home, 11 Hindes Road, Harrow. Mrs. M. T. Nolan 6 Medical or Chronic 51 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 Borough 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 names 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 end of the year 23 establishments were licensed. HOME DIALYSIS Adaptations required in the home preparatory to the installation of the dialysis (artificial kidney) machine can be carried out by the local health authority under Section 12 of the Health Services and Public Health Act 1968. There are three patients in Harrow whose homes have been adapted or extended to provide facilities for dialysis. During the year these premises were adapted so that emergency electrical power could be provided from standby generators. This was to allow the patients to continue to use the dialysis machines in the event of a power cut lasting more than 24 hours. INFECTIOUS DISEASES 55 INFECTIOUS DISEASES Smallpox On the 4th April, 1973 at approximately 4.20 p.m. a telephone call was received from the Health Department of the London Borough of Barnet, that Mr. & Mrs. H who were normally resident in Wealdstone, Harrow, had been found to have smallpox. They were in West Hendon Isolation Hospital and were being transferred to the smallpox isolation hospital in Dartford. At that time information regarding contact with a case of smallpox was not available, but it was subsequently learned that Mr. & Mrs. H had visited St. Mary's Hospital to visit Mr. H's mother who was in the same ward as a technician from the London School of Hygiene & Tropica] Medicine who was subsequently found to have had smallpox. Mr. H fell ill on the 29th March but continued to go to work. His fellow workers noticed he was ill but attributed this to his hand which had been injured and was bandaged. On the 31st March he drove some of his friends to work in the morning but he felt too ill to work himself and slept in the car. In the afternoon of the same day he felt too ill to continued and went to the Red Lion Public House in Harrow Weald. His wife became ill shortly afterwards and they were both seen on a number of occasions by their doctors who on 2nd April arranged for admission to West Hendon Hospital with suspected food poisoning. On receipt of the information that the couple had smallpox, control measures were set into operation immediately with the aim of preventing any secondary cases. The staff on duty in the Health Department were vaccinated and the house in Wealdstone was visited at once and the household contacts vaccinated. All G.P's and local hospitals were given early warning of the outbreak by telephone. The ambulance service was contacted and the ambulance that conveyed Mr. & Mrs. H to West Hendon Hospital was taken out of service. Supplies of smallpox vaccine in the Health Department were checked and additional supplies ordered. The Medical Officer of Health for Brent was informed that the couple's children (two boys) were staying with their paternal grandmother in Brent. A control centre was initially set up at Hanover House and later moved to the Civic Centre, Station Road, Harrow. The help and co-operation of 16 M.O.H's of other authorities was obtained during the period of this outbreak with the tracing, vaccination and surveillance of contacts. Circulars were sent to G.P's setting out local policy regarding vaccination. The Harrow Observer assisted by giving front page coverage 56 setting out vaccination policy and also requesting contacts from the Red Lion to come forward for vaccination. Subsequently, Mr. & Mrs. H died at the Dartford Isolation Hospital. The conveyance of contacts to Mrs. H's funeral on the 9th April and to Mr. H's funeral on the 20th April was arranged. The vehicle used for transport was subsequently disinfected. PRIMARY CONTACTS (i.e. those in contact with the patients or articles that they had handled). A. Primary Household Contacts 2 boys Mr. H's sister A Lodger. These contacts were excluded from work and the two boys from school. B. Other Primary Contacts (i) The five doctors who called at the house during the illness were vaccinated and kept under surveillance and were taken off work during the last week of incubation period. (ii) Work contacts: Mr. H worked for a firm of electrical contractors as foreman to a gang of workers. He travelled around with this gang doing contract work and in the preceding week had been to Aylesbury, Hemel Hempstead and Basildon. The local M.O.H's were informed and vaccination and surveillance of this gang was carried out at their place of work. On the occasions when they did not turn up for work the local Medical Officer of Health was informed so that he could continue surveillance at their homes. (iii) Friends and relatives in the neighbourhood were traced and vaccinated. SECONDARY CONTACTS (i.e. contacts of the primary contacts) were numerous. As Mr. & Mrs. H had unrestricted movements during the whole of their incubation period, it was not possible to dispute any claim of a person that he or she had casual contact with them in the street. A large number of persons claiming such contact were vaccinated. Mr. H's sister worked in a large firm. Consultation with the workers' Medical Officer revealed that a great number of employees had come into contact with her at work and arrangements were made for them to be vaccinated. The lodger worked in a firm supplying dental equipment and his works contacts were also vaccinated. The class-mates of the schoolboys were vaccinated. 57 The World Health Organisation declared London an infected area. A large number of travellers, therefore, needed vaccination certificates at very short notice. This included several large parties of school children from this Borough who were going abroad. The additional burden of undertaking these vaccinations was dealt with by the Health Department and approximately 850 travellers were vaccinated. A party of German school children holidaying in Harrow needed to be vaccinated before their return. The organisers of the holiday insisted on the use of German vaccine. Arrangements were made by them for a German doctor to be flown out with supplies of the special vaccine and authority was requested for Customs clearance for importation of the vaccine. Following discussions with the Department of Health & Social Security it became apparent that little was known in this country about the German vaccine, and it was decided that the medical staff in Harrow should not be asked to use this foreign vaccine. Arrangements were made with the German Embassy regarding the vaccination of these children. The contacts at the Red Lion Public House were traced with the helpful co-operation of the landlord. Tradesmen: Milkmen, coalman, newspaper boys and the Tallyman. The tallyman sold dresses on the doorstep. He had been to numerous houses in the area. Mrs. H tried on a dress but did not buy it. The dress was returned and put back amongst the rest of the tallyman's stock. This dress was later sold to another customer. The tallyman was traced to Enfield and appropriate action was taken by the Medical Officer of Health of that Borough. The laboratory staff at Edgware General Hospital who were resident in Harrow and had handled some specimens of blood from Mr. & Mrs. H were kept under surveillance. They had been vaccinated previously at Edgware General Hospital. West Hendon Hospital employees who lived in Harrow, received appropriate attention. The car which conveyed Mr. H and his fellow workers to their work was traced and dealt with by the Medical Officer of Health at Billericay. Ambulance staff: The ambulance that conveyed Mr. & Mrs. H to the West Hendon Hospital on 2nd April, was taken out of service on 4th April after the notification of smallpox. In the interim period it had conveyed a number of patients to hospitals and institutions. These patients were traced and vaccinated. One of these patients was an elderly gentleman who was transported from hospital to the Old People's Home where he was normally resident. All the staff and residents at the Old People's Home were vaccinated. The ambulance itself and the ambulance personnel were dealt with by the Medical Officer of Health of Brent, in whose area the ambulance station was situated. 58 Primary Contacts Household contacts 4 Doctors 5 Work 19 Friends and relations 28 Red Lion 147 Tradesmen 5 Edgware General Lab. staff 7 West Hendon Hospital staff 2 Ambulance contacts 14 231 The total number of vaccinations carried out was 3,050. Vaccinations Primary contacts 231 Secondary contacts 1,969 Travellers 850 3,050 Mr. & Mrs. H's house in Wealdstone was disinfected on 5th April and their bedroom sealed. The two remaining inmates were confined to the house and food was supplied to them. The inmates were troubled with frequent telephone calls from newspaper reporters of the national press. One visited the house against advice in order to obtain an interview. When he returned to his newspaper office the Editor telephoned to enquire what action should be taken to protect the rest of the staff. The Medical Officer of Health in the City was informed. He visited the newspaper office and took appropriate action. Numerous visits were paid by the Health Department's medical staff to general practitioners' surgeries and patients' homes to inspect patients with suspicious rashes. The Borough was declared free of smallpox on 20th April. The household contacts were released from surveillance and allowed to leave their house. Terminal disinfection of Mr. & Mrs. H's bedroom was carred out on 24th April. Many articles of personal clothing, bedding and soft furnishings were destroyed by burning. OUTCOME : Not a single secondary case of smallpox occurred. 59 Dysentery and Food Poisoning Details of the 16 cases of food poisoning which occurred during the year are set out in the tables below Food Poisoning: Incidents and Cases Causative Agent General Outbreaks Family Outbreaks Sporadic Cases notified or ascertained Total No. of outbreaks and sporadic cases cols. (1 3 5) Total No. of cases columns (2 4 5) No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained 1 2 3 4 5 6 7 1. S. typhimurium — — — — 5 5 5 2. Other Salmonellae (a) — — 1 5 6 7 11 3. CI. welchii — — — — — — — 4. Staph aureus — — — — — — — 5. Other causes — — — — — — — 6. Cause unknown — — — — — — — 7. TOTAL — — 1 5 11 12 16 (a) Details of Food Poisoning due to Salmonellae other than S. Typhimurium. Type of Salmonellae Havana — — — — 1 1 1 Bredeney — — — — 2 1 1 Enteritidis — — 1 5 — 1 5 Thompson — — — — 1 1 1 Not Typed — — — — 2 1 2 In addition 14 cases of dysentery were notified during 1973, giving a combined total of 30 notified cases of dysentery and food poisoning. This compares with 18 during 1972. 60 Every case notified is investigated and wherever possible the cause identified. These diseases can be eradicated only by the general public themselves. All that is required are simple routine hygiene measures, particularly in association with food handling and preparation. 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. The following table lists the notifications in 1973:- Primary Notification Other Notifications Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F Under 1 — — — — — — — — 1— 4 1 — — 1 — — — — 5— 9 1 1 — — — 10—14 1 — — 1 — — — — 15—19 3 — — 1 — — — — 20—24 4 12 — 3 — 1 — 1 25—34 6 3 1 4 2 2 1 2 35—44 2 3 5 1 — 1 1 — 45—54 3 2 — 3 — 1 — — 55—64 4 1 — 1 — 1 — — 65 & over 4 — — 2 1 — — 1 Age unknown — — — — — — — — 29 22 6 17 3 6 2 4 61 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 a co-ordinated service continued to be centred on the two chest clinics under the general supervision of the physicians 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. Home Visiting During the year 1,603 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 The Occupational Therapist based at the Chest Clinic works in close co-operation with the Clinic's Medical Staff, Medical Social Workers and Health Visitors. Her duties include home visits to long-term home-bound patients as well as terminal cases, and running a weekly class in the Clinic for those patients fit enough to attend. A new venture this year was a trip to Windsor by car which was greatly enjoyed by everyone. B.C.G. Vaccination Part of the routine measures to prevent the spread of tuberculosis is the offer of B.C.G. vaccination to susceptible contacts of actual cases. The susceptible contacts are identified by means of a simple skin test, which indicates whether the additional protection of vaccination is required. During the year 933 contacts of actual cases were tested. Vaccination was offered to and accepted by 306 individuals. 62 Mass X-Ray Throughout the year, mass X-ray units were available at the following places and locations Mobile Unit—The Car Park, Grant Road, Wealdstone Static Unit—Central Middlesex Hospital, Park Royal, N.W.10 2nd & 4th Thursday of each month. MondayFridays Saturdays 10 a.m.12 noon 9 a.m.5 p.m. 9 a.m.12 noon The Tuberculosis Register The tuberculosis register is a valuable statistical weapon in the control of this infection. In this disease, the morbidity and infectious state can extend over considerable periods of time and accurate information is essential. Inter-authority co-operation ensures, firstly, that incoming infected residents can be speedily informed of local treatment facilities and, secondly, that the register is an accurate summary of the local situation. In this way, information is provided as to the age and sex distribution of those residents who have become infected whilst living in Harrow or who have moved into the district already suffering from the disease. The table below is a summary of the changes which took place in the register during 1973:- Pulmonary Non-Pulmonary M. F. M. F. No. on register January 1st, 1973 799 749 103 174 No. of new cases added 29 22 6 17 No. of cases other than Primary Cases 3 6 2 4 No. of cases restored to register 1 1 — — No. of cases removed. 54 49 6 4 Left District 19 14 2 1 Deaths 10 4 — — Recovered 23 26 3 3 De-notified 1 — — — Lost Sight of . . 1 5 1 — No. on registere December 31st, 1973.. 778 729 105 191 63 Pulmonary Tuberculosis Deaths with rate per 100,000, 1963-1973. Year Population Deaths/Pulmonary Tuberculosis Number Rate per 100,000 1963 209,520 4 1.91 1964 210,250 10 4.75 1965 209,600 5 2.39 1966 208,730 8 3.83 1967 208,200 4 1.92 1968 208,220 6 2.88 1969 .. 207,700 3 1.44 1970 206,060 7 3.39 1971 205,000 3 1.46 1972 203,730 2 0.98 1973 204,660 4 1.95 I would like to take the opportunity to record my 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. Laboratory Facilities The examination of clinical material of public health significance is carried out by the Public Health Laboratory, Neasden Hospital, Brentfield Road, London, N.W.10 (Telephone: 459-1422). 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 ice-cream, artificial cream and canned foods, imported products such as meat, fish and fertiliser. 64 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:- Blood 1 Nose and Throat Swabs 12 Faeces 353 Sputum — Urine 1 Total 373 I wish to express my thanks to the Director of the Public Health Laboratory Service and his staff for their continued assistance and advice during the year. Incidence of Infectious Diseases Diseases 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 & over Age Unknown Total Acute Encephalitis — — — — — — — — — — — — — Acute Meningitis — — — — — — 1 — — — — — 1 Anthrax — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — Diphtheria — — — — — — — — — — — — — Dysentery — — 4 1 1 2 3 1 1 — 1 — 14 Food Poisoning — 1 — 1 1 2 2 4 2 2 — — 15 Infective Jaundice — — — 1 1 2 1 — — — 1 — 6 Leprosy — — — — — — — — — — — — — Leptospirosis — — — — — — — — — — — — — Malaria — — — — — 2 — 1 — — — — 3 Measles 20 176 215 17 4 2 — — — — — 4 438 Ophthalmia Neontorum — — — — — — — — — — — — Paratyphoid Fever — — — — 1 — — — — — — — 1 Plague — — — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — Relapsing Fever — — — — — — — — — — — — — Scarlet Fever — 7 25 1 — — — — — — — — 33 Smallpox — — — — — — 2 — — — — — 2 Tetanus — — — — — — — — — — — — — Tuberculosis(Pulmonary) — l 2 1 3 16 9 5 5 5 4 — 51 Tuberculosis (Other) — 1 - 1 1 3 5 6 3 2 1 — 23 Tuberculosis (Men.) — — — — — — — — — — — — Typhoid Fever — — — — — — — 1 — — — — 1 Typhus — — — — — — — — — — — — — Whooping Cough 1 2 4 1 — — — — — — — — 8 Yellow Fever — — — — — — — — -— — — — — TOTAL 21 188 250 24 12 29 23 18 11 9 7 4 596 SCHOOL HEALTH SERVICE 67 SCHOOL HEALTH SERVICE Medical Examinations in Schools A concerted effort was made throughout the year to clear the backlog of school children due for the statutory physical examination during their primary, middle and senior years, so that, as far as possible, the programme for each school doctor would allow them to visit their schools at least once in each term, in order to encourage a close liaison between teachers and medical staff on an informal basis. Special emphasis has been placed on the medical examination during the child's first year of school, with particular reference to any emotional problems. A close link has been built up with the Paediatric Department at Northwick Park Hospital, and many teachers have furnished valuable reports on children presenting both physical and emotional problems. With the establishment of the Employment Medical Advisory Service the third school leaver examination now takes place in the year of the child's 15th birthday, so that Employment Officers have all the necessary medical information before giving careers advice in the last three terms of school life. The service now only requires a special form (Y9 and Y10) to be filled in for children with some disability or severe handicap. This has meant that far more realistic information is passed to the Careers Advisory Service officers and the new service is working well in Harrow. There is no doubt that the whole Question of the routine examination of all school children needs a fresh approach, and it is hoped that the Departments concerned will do this in the very near future. The present system, devised in 1908 has altered very little over the years and the needs of school children have shifted in a significant way from a service designed to prevent and cure physical disability to one that will detect emotional disturbances and learning difficulties at an early age. It is to be hoped that in the near future far more attention will be focussed on the crucial period when children first enter school, so that greater insight into a child's development, learning patterns and the identification of potential emotional problems may be possible. This will mean far more time must be spent on each child and that medical officers may well have to undergo a programme of further training. During the middle years of the child's school life frequent consultation between the school doctor and the teachers and repeated examinations will continue to pick up defects of vision, hearing, etc. but with the transition to a senior school, often of terrifying size and impersonal atmosphere, other pressures and tensions and influences crowd in on the young adolescent. Few children survive many years without some emotional problems, some severe enough to be referred to the Child Guidance Clinic—a service often overworked and understaffed and by its very remoteness from the rough and tumble of school life, often viewed 68 with suspicion by teachers and parents alike. For other children, problems of drink, experimenting with drugs, teenage sex and pregnancies, venereal disease, truancy, violence and vandalism and general problems of adolescence outweigh physical problems, and the school health service is doing little to help the teachers, the parents or the children. It might be better value for money, if trained and experienced School Counsellors were appointed to all Senior Schools rather than attempting to carry out routine physical examinations on reluctant teenagers. The number of pupils attending maintained primary and secondary schools including nursery and special schools, on re-opening in January 1973 was 32,579. The numbers attending each group of schools were as follows:- Boys Girls Total Secondary 5,528 5,070 10,598 Primary 10,815 10,393 21,208 Nursery 235 211 446 Special Schools 182 145 327 16,760 15,819 32,579 Specialist Services for School Children and Students 1. Eyes The beginnings of academic learning in the classroom inevitably throw up eye defects and a close watch must be kept on the Primary School child. Sweep tests are scheduled to be carried out by Clinic Nurses at the age of 5 and 8 years but only one Keystone machine is available. 2. Ears In order to detect hearing loss in young children sweep tests should be carried out at the age of 5, 8 and 12 years at all schools. Teachers and parents are also encouraged to report suspected deafness. The volume of work has increased and a second trainee audiometrician has recently been appointed. Cases are referred by the Audiometrician, teachers, or from other clinics to special Audiology Clinics held at Caryl Thomas, and Alexandra Avenue, when a Clinic doctor with specialised training and interest in deafness, the audiometrician and the peripatetic teachers of the deaf, work as a team. Cases requiring further investigation are then referred to Dr. Fisch at the Neasden Audiology Clinic as in the past. 69 Much closer links with Dr. Fisch, and with the Peripatetic Teachers of the Deaf employed by the Education Department, have resulted in a much improved service for Harrow school children. 3. Feet The chiropody service is used increasingly for dealing with foot defects and infections. A close link has been established with the Chief Chiropodist and the Clinic Doctors and Nurses and an all out attack on verrucae in school children was launched in 1973 with encouraging results. 4. Tuberculosis In October a case of pulmonary tuberculosis was diagnosed in a member of the ancillary staff in a grammar school. Although the risk of infection was judged to be slight, radiography examination was arranged for all purpils and staff. There was an extremely high response and no further cases of infection were found. 5. Overweight School Children In view of the problems of obesity in young children, highlighted by the Milk Certificate survey; a Pilot Clinic has been started at Northolt Road Clinic on Friday mornings. Realistic diet sheets have been drawn up by the medical staff in co-operation with the Chief Dietrician for Northwick Park Hospital who has shown a great interest in the project. Care has been taken to balance the needs and likes of children against the cost of a high protein/vegetable and fruit diet. 6. Student Health Services Harrow College of Technology and Art and the Hatch End College of Further Education provide tertiary education for full-time and parttime students. Many of these students are from overseas with all the attendant problems of settling down to live and study in a foreign culture, and many more come from areas outside the Borough living away from home for the first time. A start was made in setting up a comprehensive student health service by the appointment of Mrs. Cooper a qualified and experienced student counsellor to the Harrow College. At the same time a teacher at the Hatch End College was seconded to a year's full time course in counselling at Keele University. Throughout the year additional counselling sessions were covered at both colleges by Dr. Fidler. In December, Dr. Arthur, a general practitioner, was appointed a part-time student health doctor. The nucleus of a comprehensive service to the Borough has thus been laid down, but so far senior colleges have not been covered, nor to any realistic extent has the whole field of the adult student. 70 Speech Therapy The year started with only two speech therapists working a total of nine sessions at the following places: Caryl Thomas Clinic, Northolt Road Clinic, Whittlesea School and Vaughan Assessment Clinic. In January a speech therapist was appointed for a further three sessions. Between September and December recruitment continued and by 31st December there were six speech therapists in post working a total of 34 sessions at the following places Caryl Thomas Clinic Alexandra Avenue Clinic. Northolt Road Clinic Marlborough School Honeypot Lane Clinic Vaughan Assessment Unit Cecil Park Clinic Whittlesea School Whittlesea Clinic Shaftesbury School Kenmore Road Clinic Visits to schools were resumed and a good liaison with the Head Teachers rebuilt. Visits were also made to Northwick Park Hospital for consultations about patients. Patients were referred for speech therapy by Medical Officers, General Practitioners, Head Teachers, Parents, Northwick Park Hospital, The Nuffield Centre and Mount Vernon Hospital. At the beginning of the year 354 children were already receiving therapy. The total number of children receiving therapy at the end of the year was 598. The number of children discharged as not needing further therapy was 161. CHILD GUIDANCE AND SCHOOL PSYCHOLOGICAL SERVICES I am indebted to the Director of Education Mr. R. S. Ball, for the following reports on the work of the Child Guidance and School Psychological Services during the year. Child Guidance Service Dr. James Hood, Consultant Psychiatrist, North West Metropolitan Regional Hospital Board, to Harrow Child Guidance Clinic, reports as follows:- The clinic offers (1) A Consultation Service, to outside agencies, general practitioners, paediatricians and other professional personnel. (2) A Treatment Service, of which the main agents are the psychiatric social workers and the child psychotherapists. This is a highly specialised service which takes account of the professional training of the child psychotherapists and of the special experience and interests (supplemented by extra training), of the psychiatric social workers. 71 The psychiatrist, the psychiatric social workers and the psychologists work together, and separately, to provide this service. Occasionally the service is offered direct to clients, usually in cases in which they have approached the clinic and subsequently been contacted by a psychiatric social worker. The psychiatrist prefers the client or referring agent to be in touch with a primary care physician in all cases with which he is concerned. The 1973 figures, set out below, illustrate trends towards:- (a) increasing numbers of consultations with personnel from outside agencies, without the clients/patients being seen by clinic professional staff. (b) increasing numbers of referrals from hospital paediatric units (especially Northwick Park). There is a corresponding slight fall in direct referrals from general practitioners, but these have continued to provide the bulk of direct work with patients on the clinical side. These trends which were noted in the Annual Report for 1972 have continued into 1973. Psychiatric responsibility for treatment is vested in the consultant psychiatrist, and conducted through case conferences and/or periodic reviews of the case. The specialist teacher, who is a full member of the clinical organisation, plays an important part in the treatment of a small number of cases. The treatment service backs up the consultation service and is essentially related to it. There is no treatment 'waiting list'. This enables the psychiatrist to attempt therapeutic consultations during his first contacts with the case. He can then act with confidence knowing that, should the need for alternative approaches (such as intensive child psychotherapy, extended casework) become apparent during the consultation, then resources are available for them immediately. His work, and that of his specially experienced colleagues, ensures that psychotherapeutic skills, which can be developed within the setting of the clinic, or enhanced by contact with its staff members, are widely applied. At the same time, the child psychiatrist's responsibility for the on-going treatment or supervision of quite large numbers of cases is maintained and exercised. Number of New Cases 100* Source of Referral: (a) Medical Officer of Health 9 (b) General Practitioner 45 (c) Hospital Paediatrician/Psychiatrist 9 (d) Department of Social Services 5 (e) Director of Education 2 (f) Educational Psychologist 6 72 (g) Head Teacher (through Educational Psychologist) 14 (h) Head Teacher direct 4 (i) Parent 4 (j) Transfers from other clinics 2 Presenting Symptoms: (a) Nervous Disorders (Fears, depression, anxiety, refusal to attend school) . 30 (b) Behaviour Disorders 44 (c) Psychosomatic Disorders (Asthma) 3 (d) Habit Disorders (Enuresis, soiling, speech difficulties, masturbation) 11 (e) Anti-Social Behaviour 6 (f) Lack of School Progress/Backwardness 6 Other Attendances 2,707 Total Attendances 2,907 Children 974 Parents 1,777 Others 156 * This figure does not take account of case consultations in which professional workers from outside agencies were helped to deal with their own clients. School Psychological Service Mr. W. R. Wilson, Senior Educational Psychologist, reports as follows (1) Staffing: Senior Educational Psychologist W. R. Wilson, M.A., A.B.Ps.S. Educational Psychologist Mrs. A. M. Williams, B.Sc. Educational Psychologist Mrs. J. H. Parnell (One vacancy) Specialist Teacher Mrs. D. Schiller Advisory Peripatetic Remedial Teacher Mrs. M. Zurawski Peripatetic Remedial Teacher Mrs. G. Branch Peripatetic Remedial Teacher Mrs. B. Evans Assessment Unit Mrs. J. M. Whitmarsh Chantry Unit (Class 6) Mrs. D. E. Harper 73 (2) Details of Referrals: Boys Girls Total 1. Number of Children Referred 132 52 184 2. Age Range of Referral: (a) Under 5 years (pre-school) 9 — 9 (b) 5 - 7 + years (Infant School) 28 12 40 (c) 7+ - 11+ years (Junior School) 75 22 97 (d) 11+ - 16+ years (Secondary—Grammar and Modern 20 18 38 (e) Over School Age — — — 3. Source of Referral: (a) Director of Education 7 1 8 (b) Social Services 1 5 6 (c) Controller of Health Services 14 4 18 (d) Head Teachers 84 32 116 (e) Parents 7 2 9 (f) Other Agencies 19 8 27 4. Reasons for Referral: (a) Educational Difficulties 89 33 122 (b) Behaviour Problems 42 20 62 (3) Outcome of Referral: (a) Number of children referred to Psychiatrist 19 1 20 (b) Number of children seen by Psychiatrist 12 1 13 (c) Number of children seen by Educational Psychologists for treatment/counselling 5 3 8 (d) Number of children recommended for Day E.S.N, education 18 4 22 (e) Number of children receiving remedial teaching from Peripatetic Remedial Teachers 56 17 73 (f) Additional remedial teaching carried out by student from Maria Grey Training College. 2 — 2 (g) Number of children recommended for Assessment Unit 7 3 10 (4) Phobic Children and Children out of School for Other Reasons: 4 5 9 (5) The Assessment Unit: The Assessment Unit continues to provide a useful service for young children. The number of referrals remains fairly steady and there was no undue pressure on places. (6) Class 6 Chantry School: The scheme of admitting children on a part-time basis has continued as this has proved successful in a small number of cases. However, the difficulty of operating such a unit successfully within an ordinary school is increasingly evident and supports the view that the borough would benefit from purpose-built premises in order to cater for such children. 74 (7) Remedial Teaching : There was a further expansion of the Remedial Teaching Service. A fourth teacher was appointed in September although she did not take up her duties during the present year. The service appears to be increasingly valued by the schools and provide effective help for children with specific learning difficulties. (8) Special Schools : Number of visits to special boarding schools : 7. (9) Unit for Partially Hearing Children : The Unit for partially hearing children of Infant School age, referred to in my last report, was opened in September 1973, so that special educational provision for all such children of primary school age is now available in the borough. (10) Conclusions : As noted in my previous report, the main area of expansion has continued to be in the provision of specialised remedial teaching. However, it has become obvious that social and family problems are frequently the reason for children being referred on account of learning difficulties with associated behaviour problems. Although it has not yet been possible to introduce a screening procedure in connection with the teaching of reading, plans for this have continued. HANDICAPPED PUPILS The Local Educational Authority has 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 2 Total number of blind pupils in special schools for the blind as at 31st December, 1973 6 75 (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 2 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 at as 31st December, 1973 9 (c) Deaf Pupils, that is to say, pupils who have no hearing or whose hearing is defective that they require education by methods used for deaf pupils without naturally acquired speech or language. Number of deaf pupils newly assessed 4 Number of deaf pupils admitted to special schools during the year 3 Total number of deaf pupils in special schools for the deaf as at 31st December, 1973 6 (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 of facilities, though not necessarily all the educational methods used for deaf pupils. Number of partially deaf pupils newly assessed 3 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, 1973 16 (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 assessed 5 Number of educationally subnormal pupils admitted to special schools during the year 4 Total number of pupils ascertained as educationally subnormal and educated in special schools/classes as at 31st December, 1973 39 (/) 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 - Total number of epileptic pupils in special schools for epileptic children as at 31st December, 1973 2 76 (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 12 Number of maladjusted pupils admitted to special schools/ classes during the year 8 Total number of maladjusted pupils in special schools for maladjusted children as at 31st December, 1973 26 (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 development, be satisfactorily educated under the normal regime of ordinary schools. Number of physically handicapped newly assessed 7 Number of physically handicapped admitted to special schools/classes during the year 7 Total number of physically handicapped pupils in special schools for physically handicapped children as at 31st December, 1973 37 (i) Pupils Suffering from Speech Defects, that is to say, pupils who on account of defects or lack of speech not due to deafness require special educational treatment. Number of pupils newly assessed for special educational treatment in special schools — Number of pupils with speech defects admitted to special schools during the year — Total number of children with speech defects in special schools as at 31st December, 1973 1 (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 20 Number of delicate pupils admitted to special open-air schools during the year 18 Total number of delicate pupils in open air schools as at 31st December, 1973 54 77 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 Day Nursery or Ordinary School Hospital School At Home Total Blind 2 4 - - - 6 Partially-sighted - 9 2 - - 11 Deaf 1 5 - - - 6 Partially Deaf 3 13 6 - - 22 Educationally Subnormal 8 30 1 - - 39 Epileptic 2 - 1 - - 3 Maladjusted 24 2 9 - - 35 Physically Handicapped 8 29 5 2 2 46 Speech - 1 - - - 1 Delicate 53 1 19 - - 73 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. Handicapped Register A Register is maintained of children who, because of some handicap, may require special education. 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, in conjunction with the Social Services Department. The categories 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; 78 (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. Two children from category 1 and one from category 2 were admitted to a day nursery during 1973. 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. One child was receiving home tuition at the end of 1973. INFECTIOUS DISEASES (see also page 53) 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 4½ years, i.e. before starting school, when special emphasis is placed on ensuring that children are fully protected against poliomyelitis, diphtheria and tetanus. 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 independent schools. The following is a summary of the work carried out under this scheme during the year 1973:(A) Type of School No. of Pupils Eligible No. of Acceptances Negative Reactors Positive Reactors Secondary Modern 1,406 1,079 985 31 Secondary Grammar 925 741 674 10 Independent 476 401 371 4 Special — — — — TOTAL 2,807 2,221 2,030 45 (1972) (2,829) (2,159) (1,935) (65) 79 $$] 1972 1973 Number eligible 2,829 2,809 Number accepting 2,151 2,221 Acceptance rate 76% 79.1% Positive reactors 65 45 Percentage positive 3.2% 2.2% Negative reactors 1,935 2,032 Number given B.C.G. vaccination 1,922 2,030 All positive reactors are referred to the chest clinic for x-ray and investigation. These investigations include x-ray examination of all domiciliary contracts. Rubella Vaccination (see page 34). PROVISION OF MILK AND MEALS IN SCHOOLS During 1973 the total number of meals served was 3,737,937 of which 227,095 were free. Forty-seven schools were served by kitchens on the premises and seven by container meals. Under the Regulations governing free milk for school children requiring it on medical grounds 57 certificates were issued. 227 children were still receiving milk. 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 1973 741 80 TABLE I—MEDICAL INSPECTION RETURNS Age groups inspected (By year of Birth) No. of pupils having received a full medical examination Physical Conditions of Pupils Inspected No. of pupils found not to warrant a medical examination Satisfactory Unsatisfactory (1) (2) (3) (4) (5) 1969 and later 223 223 — — 1968 1,203 1,203 — — 1967 1,653 1,652 1 — 1966 1,312 1,312 — — 1965 172 172 — — 1964 82 82 — — 1963 57 57 — — 1962 66 66 — — 1961 72 72 — — 1960 131 131 — — 1959 178 178 — — 1958 and earlier 1,592 1,592 — — TOTAL 6,741 6,740 1 — Column (3) total as a percentage of Column (2) total: 99.98% Column (4) total as a percentage of Column (2) total: 0.02% TABLE II OTHER INSPECTIONS Number of Special Inspections 1,870 Number of Re-inspections 3,411 TOTAL 5,281 TABLE III INFESTATION WITH VERMIN (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 32,961 (b) Total number of individual pupils found to be infested 209 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2) Education Act 1944) 112 (d) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(3) Education Act 1944) - 81 TABLE IV 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 63 Errors of refraction (including squint) 1,526 TOTAL 1,589 Number of pupils for whom spectacles were prescribed 381 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 12 (b) for adenoids and chronic tonsilitis 75 (c) for other nose and throat conditions - Received other forms of treatment 42 TOTAL 129 Total number of pupils in schools who are known to have been provided with hearing aids:- (a) in 1970 12 (b) in previous years 64 ORTHOPAEDIC AND POSTURAL DEFECTS Number of cases known to have been treated (a) Pupils treated at clinics or out-patient departments 29 (6) Pupils treated at school for postural defects — TOTAL 29 82 DISEASES OF THE SKIN (excluding uncleanliness, for which see Table III) Number of cases known to have been treated Ringworm: (a) Scalp - (b) Body — Scabies — Impetigo 1 Other skin diseases 495 TOTAL 496 CHILD GUIDANCE TREATMENT Number of cases known to have been treated Pupils treated at Child Guidance Clinics 498 SPEECH THERAPY Number of cases known to have been treated Pupils treated by Speech Therapist 450 OTHER TREATMENT GIVEN Number of cases known to have been dealt with (a) Pupils with minor ailments 19 (b) Pupils who received convalescent treatment under School Health Service arrangements - (c) Pupils who receive B.C.G. vaccination 2,030 (d) Other than (a), (b) and (c) above: Heart 2 Lungs 5 Developmental—other 106 Nervous System 46 Psychological (i) Development 15 (ii) Stability 24 TOTAL (a) to (d) 2,247 83 REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER This was the last complete year that the School Dental Service operated as a local authority service. On 1st April, 1974 the new unified national health service is due to come into being, and the dental service will be part of this. Equipment In accordance with the planned programme of replacement of outmoded dental equipment, referred to in my last report, new equipment was installed in No. 2 surgery at Caryl Thomas Clinic, and at the Alexandra Avenue Clinic. Steps were taken with regard to ordering new equipment for the Cecil Park and Whittlesea Road Clinics. Staffing Dental officer coverage remained adequate. To help overcome the difficulty of obtaining dental surgery assistants, the decision was taken to appoint a girl of school leaving age as a trainee, extra to establishment, for the first year of her service. 1 am pleased to report that at the time of writing an entirely new and satisfactory salary structure has been implemented which should make the job more attractive as a career. May I express my appreciation of the close co-operation that always existed with all departments of the Council. TABLE V DENTAL INSPECTION AND TREATMENT CARRIED OUT BY THE AUTHORITY Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First Visit 2,580 1,881 640 5,101 Subsequent Visits 3,536 2,950 972 7,458 Total Visits 6,116 4,831 1,612 12,559 Additional courses of treatment commenced 407 220 29 656 Fillings in permanent teeth 1,999 3,741 1,367 7,107 Filiings in deciduous teeth 4,442 344 — 4,786 Permanent teeth filled 17,142 3,248 1,226 6,188 Decidupus teeth filled 4,158 314 — 4,472 Permanent teeth extracted 67 285 74 426 Deciduous teeth extracted 1,086 448 — 1,534 General anaesthetics 365 206 25 596 Emergencies 198 97 27 322 Number of Pupils X-rayed 467 Prophylaxis 1,194 Teeth otherwise conserved 545 Number of teeth root filled 19 Inlays — Crowns 11 Courses of treatment completed 4,039 84 ORTHODONTICS New cases commenced during year 100 Cases completed during year 72 Cases discontinued during year - No. of removable appliances fitted 186 No. of fixed appliances fitted 12 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) 3 1 - 4 Number of dentures supplied 3 1 - 4 INSPECTIONS (a) First inspection at school. Number of Pupils 24,361 lb) First inspection at clinic. Number of Pupils 1,937 Number of (a) + (b) found to require treatment 10,271 Number of (a) + (b) offered treatment 8,095 (c) Pupils re-inspected at school clinic 1,379 Number of (c) found to require treatment 1,169 SESSIONS Session devoted to treatment 2,317 Sessions devoted to inspection 251 Sessions devoted to Dental Health Education 59 ENVIRONMENTAL HEALTH SERVICES 87 ENVIRONMENTAL HEALTH SERVICES GENERAL REVIEW The effect of the arrival of Ugandan Asians during the early months of 1973 and the unexpected notification of a case of smallpox on 4th April were the two outstanding events of the year. The influx of Ugandan Asians caused a sharp rise in the number of cases of overcrowding. The number rose from four on 1st September, 1972 to sixty-two on 31st March, 1973. However towards the end of the year the problems in this field eased and by the 31st December the number of cases had fallen to thirty-one. The notification of a case of smallpox—the first in the history of the district since it was formed in 1934 served to underline (a) the importance of local authorities maintaining a team of officers experienced in dealing with such cases; (b) the need in the field of investigation for close liaison between the Community Physicians and Public Health Inspectors; and (c) the importance of the work and responsibilities of Health Committees and the vital part they play particularly in times of emergency. (see p.53). In most other spheres of activity the year for the inspectorate was one of frustration due to the difficulties experienced in obtaining staff. Complaints were dealt with at a level of 100% and much was accomplished in the field of noise control. There was however a shortfall in the work done in connection with the Offices, Shops and Railway Premises Act, and in spite of the efforts made ground was lost in the fight against litter and the dumping of rubbish, likewise in respect of pest control, health education and home safety. These are all important areas of activity. As regards food and food hygiene, the year was satisfactory, the sampling work done and the visits to shops and other premises revealing an all-round desire on the part of manufacturers and traders to cooperate with the local authority in their efforts towards higher standards. Apart from the foregoing, 1973 was a year of general interest and a number of matters are, perhaps, worthy of note. Firstly, the 31st December brought to a close the first complete calendar year of operations from the Civic Centre. Secondly it heralded the approach of a year that will bring unprecedented changes in its wake in so far as the health and kindred services of the district are concerned. Thirdly, it saw the retirement of an officer, namely Mr. Drabble, who for forty years had served the Council and its predecessors as an outstanding member of the staff of the Health Department. 88 STATISTICAL SUMMARY Inspections Made and Conditions Found HOUSING Visits (i) On complaint of dampness or other housing defects 1,470 (ii) On complaint of other nuisances 805 (iii) Revisits arising from defects found 2,960 (iv) Survey Housing Act 1957 (Overcrowding) 177 (v) Surveys Housing Act 1969—Qualification Certificates 210 CONDITIONS FOUND (i) Number of dwellings or other premises where defects were found 2,840 (ii) Number of cases of overcrowding revealed 62 PUBLIC HEALTH Visits (i) On complaint or request 368 (ii) Routine inspection of premises 457 (iii) Revisits arising from defects found 2,560 (iv) Surveys arising from Rats and Mice complaints 3,014 (v) Inspection of Factories 105 (vi) Inspection of Outworker's Premises 10 (vii) Inspection of Cinemas and Places of Entertainment 10 (viii) Inspection of Licensed Premises 56 (ix) Visits under Shops Act 1,285 (x) Observations made for Smoke Nuisances 78 (xi) Surveys under Clean Air Act 2,497 (xii) Pet Shops 17 FOOD HYGIENE Visits (i) Butchers' Shops 161 (ii) Dairies 40 (iii) Fish Shops 50 (iv) Bakehouses 55 (v) Cafes and Restaurants 308 (vi) Ice Cream Premises 53 (vii) Provision Merchants 240 (viii) Greengrocers 104 (ix) Other Food Premises 188 89 COMPLAINTS RECEIVED Summary: Accumulations of refuse 211 Animals causing a nuisance 37 Dampness and housing defects 310 Drains and sewers—choked 72 defective 107 Dustbins defective 1 Flooding—Gardens 11 Insect infestations 81 Overcrowding, alleged 30 Smoke nuisances 54 Watercourses 17 Other complaints 102 Food unfit (excluding requests received from shops to visit and inspect food) 186 NOTICES SERVED Under Housing Act, 1957 : Statutory Notices served under S.9 requiring execution of repair work 6 Dwellings reported under SS. 16/17 as being unfit for human habitation 16 Informal notices served under S.9 29 Under Public Health Act 1936 : Statutory notices served under"- (i) S.24—work to a public sewer 98 (ii) S.39—repair or renewal of drains 21 (iii) S.45—repair or renewal of defective water closets (iv) S.93—abatement of a nuisance 36 (v) Informal notices served 1,982 Under Public Health Act, 1961 (i) S.26 4 (ii) S.17 3 ACTION TAKEN Following Public Health Act Notices : (i) S.24—Public sewers repaired 32 (ii) S.39— (a) By owners 12 (b) By local authority in default of owners 3 (iii) S.93—Nuisances abated 24 (iv) Nuisances abated and/or other work carried out by owners on receipt of informal notice 1,587 90 Following Action under Clean Air Act—S.12(2) : Number of Notices 5 (a) by owners 5 (b) by local authority — Following Public Health Act Notices : S.26—(a) by owner 1 (b) by Local Authority in default 2 S.17—(a) by owner 1 (b) by Local Authority in default 1 SUMMARY PROCEEDINGS It was necessary on four occasions to apply to the Magistrates for abatement orders; in each case the order was granted. Fines totalling £70 were imposed, plus costs totalling £30. Pursuant to the Food and Drugs Act, action was taken in respect of ten cases following foreign matter being found in food stuff. Fines totalling £310 were imposed. The costs allowed in respect of these cases was £120. Under the Food and Drugs Act action was also taken in respect of two premises where the standard of cleanliness failed to measure up to that required by the Food Hygiene Regulations. Fines totalling £635 were imposed, plus costs totalling £200. Action was also taken pursuant to the Housing Act in respect of a case of overcrowding, fines totalling £55 were imposed plus £20 costs. HOUSING During the year 16 properties were made the subject of Closing Orders. These were:- 8a High Street, Wealdstone 97 Canning Road, Wealdstone 3, 9, 19, 21, 23 Kymberley Road, Harrow 28 Crown Street, Harrow-on-the-Hill 8 High Street, Wealdstone 90 Uxbridge Road, Harrow Weald 14 Grove Hill Road, Harrow 6 Frognal Avenue, Wealdstone 25 Marlborough Hill, Harrow 15a Peel Road, Wealdstone 8 Greenhill Crescent (Ground Floor), Harrow 3 Middle Road, Harrow 91 One property the subject of a C losing Order was reconditioned and the Order lifted namely:- 31 St. Kilda's Road, Harrow Three properties the subject of Orders were demolished:71, 81, 83 Byron Road, Wealdstone During the year 10 families were rehoused by the Council from dwellings the subject of Orders made pursuant to the Housing Acts. Overcrowding Reference was made in the Annual Report for 1972 to the arrival in the Borough of Asian families from Uganda and to the effect they were having on overcrowding. From three cases on the 1st January, 1972, the number rose to 48 on the 31st December. The peak however was reached during March 1973 when the register contained details of 62 families living under conditions of statutory overcrowding. Thirty-one of these cases of overcrowding were abated during the year, the number on the register on 31st December, 1973 being 31. During 1948 the number of recorded cases was 628. CLEAN AIR Survey of Air Pollution The Council continued to maintain two recording stations at which daily measurements of the amount of smoke and sulphur dioxide in the atmosphere were made. The results were sent to the Warren Spring Laboratory of the Department of Trade and Industry where similar readings from other parts of the Country were collated and assessed. Smoke Control — Progress during 1973 During the year Smoke Control Orders Nos. 26 and 27 came into operation covering 1,015 acres involving 6,415 premises including 6,190 dwellings. The total acreage now subject to Smoke Control Orders in the Borough is 10,359 covering 57,697 dwellings. This represents approximately 82% of the total number of dwellings in the Borough. In addition Smoke Control Orders Nos. 28 and 29 were confirmed by the Department of the Environment. These will come into operation in July and November 1974 respectively and will bring a further 6,372 dwellings under control, raising the percentage of dwellings the subject of Smoke Control Orders to 91%. In the year under review 2,497 visits were made in connection with smoke control matters, including the investigation of complaints of nuisance from domestic and industrial premises. Work to the value of £29,373 was completed at 373 dwellings as compared with 249 during 1972. The average cost per claim rose during the year reflecting increases in the cost of appliances and labour, plus the effect of Value Added Tax. 92 The table set out below shows the amount of grant paid over the past six years :- Year Amount of grant paid No. of claims for grant Average per claim (to nearest £) 1968 £16,195 656 £24 1969 £23,341 877 £27 1970 £19,760 693 £28 1971 £14,517 506 £28 1972 £4,355 249 £17 1973 £13,267 373 £36 The number and types of premises affected by Smoke Control Orders, is as foliows:- Year Total number Premises Number of Dwellings Number of premises 1961/67 22,406 21,278 1,128 1968 6,185 5,246 939 1969 6,130 5,831 299 1970 2,648 2,526 122 1971 9,355 9,196 159 1972 7,804 7,430 374 1973 6,415 6,190 225 Total 60,943 57,697 3,246 It is hoped that the target date set for the completion of the programme in 1960 namely 1975 will be met. 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. 93 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 was satisfactory in quantity and quality and no adverse reports were received. In addition to samples taken by the Colne Valley Water Company, twenty-four samples were taken by the Department—all were satisfactory, likewise five samples taken from the deep boring of Messrs. Braziers, Kenton Lane. The supply in this case is used for cooling and other purposes within the dairy. The following is a copy of a report received on a sample submitted for chemical analysis :- PHYSICAL EXAMINATION Suspended matter Absent Appearance Clear and Bright Colour Less than 5 Hazen Units Taste Normal Odour Normal CHEMICAL EXAMINATION Determinations Results in Parts per Million Total Solid Residue dried at 105°C 446 Chlorides as Chlorion 48 Nitrate Nitrogen — Nitrite Nitrogen — Ammoniacal Nitrogen 0.024 Albuminoid Nitrogen 0.054 Oxygen absorbed, 4 hrs. at 27°C 0.08 Total Hardness as CaC03 288 Non-carbonate hardness as CaC03 — Alkalinity as CaC03 207 Poisonous Metals — pH 7.8 This is a satisfactory water showing no signs of contamination and, in my opinion, is chemically suitable for domestic purposes. 94 SWIMMING POOLS During the year routine samples were obtained from the Council's two public swimming pools and from those pools forming part of educational or similar establishments. Of the 71 samples taken for bacteriological examination, 67 were satisfactory. Follow up samples taken after the receipt of the four adverse reports revealed the cause of the trouble had been found and dealt with. Three samples submitted for chemical analysis were satisfactory. OFFICES, SHOPS AND RAILWAY PREMISES ACT Working conditions in shops, offices and railway premises are regulated by the Offices, Shops and Railway Premises Act 1963 and the regulations made thereunder. Pursuant to Section 60 of this Act an Annual Report is submitted to the Department of Employment. The following is an extract from the year under review. TABLE A—REGISTRATIONS AND GENERAL INSPECTIONS The figures submitted to the Department of Employment for 1973 were as follows:- Class of Premises No. of premises registered during the year Total No. of registered premises at end of year No. of registered premises receiving a general inspection during the year (1) (2) (3) (4) Offices 21 616 28 Retail Shops 54 1,223 168 Wholesale Shops, Warehouses 2 39 1 Catering establishments open to the public, canteens 9 151 13 Fuel Storage Depots — — — TOTALS 86 2,029 210 TABLE B—NUMBER OF VISITS OF ALL KINDS BY INSPECTORS TO REGISTERED PREMISES 1,256 95 TABLE C—ANALYSIS OF PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE Class of Workplace Number of persons employed (1) (2) Offices 10,211 Retail Shops 5,929 Wholesale Departments, Warehouses 272 Catering establishments open to the public 1,023 Canteens 253 Fuel Storage Depots — TOTAL 17,688 Total—Males 8,506 Total—Females 9,182 Offices, Shops and Railway Premises Act, 1963 Place where Accident Occurred Workplace Number reported Total No. Investigated Action Recommended Fatal NonFatal Prosecution Formal Warning Informal Advice No Action Offices — 9 2 — — 2 — Shops — 26 5 — — — 5 Warehouses — 9 1 — — 1 — Catering — 5 2 — — — 2 Fuel Storage Depots — — — — — — — TOTALS — 49 10 — — 3 7 96 Analysis of Reported Accidents Offices Retail Shops Wholesale Warehouses Catering establishments open to Public/ Canteens Fuel Storage Depots Machinery — 2 1 1 — Transport — — — — — Falls of persons 4 8 — — — Stepping on or striking against object or person 1 1 - - - Handling goods 4 3 4 2 — Struck by falling object — 1 — — — Fires and Explosions — 1 — — — Electricity — - — 1 — Use of hand tools — 10 1 1 — Not otherwise specified — — 3 — — 97 Offices, Shops and Railway Premises Act CONTRAVENTIONS FOUND 1973 CONTRAVENTIONS REMEDIED 1973 Offices Shops Catering/ Canteens Wholesale Total Offices Shops Catering/ Canteens Wholesale Total Cleanliness—Working Areas — 1 2 — 3 — — — — — Ventilation 2 1 — — 3 — — — — — Temperature — 2 — — 2 — — — — — Lighting — — — — — — — — — — Seating Facilities — — — — — — — — — — Seating—Sedentary Work — — — — — — — — — — Overcrowding — — — — — — — — — — First Aid 4 14 4 — 22 4 9 - — 13 Sanitary Accommodation: (i) Insufficient - - - - - - - - - - vii) Unsatisfactory 1 — 2 — 3 — — — — — Washing Facilities: vi) Insufficient - 1 - - 1 - - - - - (ii) Unsatisfactory 1 6 — — 7 — — — — — Drinking Water — — — — — — — — — — Staff Clothing — 3 1 — 4 — - — — — Eating Facilities — — — — — — — — — — Thermometer 6 25 5 — 36 18 4 - — 22 Abstract 2 26 7 — 35 9 20 1 — 30 Stairs, etc. — 2 1 — 3 — — — — — Unguarded Machines — 1 — — 1 — — — — — TOTALS 16 82 22 — 120 31 33 1 — 65 98 SHOPS The number of occupied shops on the register at the end of the year was 2,131—nine more than on the 31st December, 1972. The following is a list of the various types of shops in the Borough classified under their principal trade—the figures for 1972 are shown in brackets :- Antiques 19 (18) Mixed Stores 28 (27) Boot repairs 27 (27) Motors and Accessories 143 (142) Boots and Shoes 42 (41) Musical 16 (16) Builders' Merchants 26 (26) Newsagents 106 (105) Butchers 91 (93) Opticians 19 (19) Chemists 55 (54) Outfitters Ladies 113 (107) Coal Order Offices 17 (17) „ Gents 75 (75) Cafes/Restaurants 106 (104) Paint and Wallpaper 40 (38) Confectionery 59 (58) Photographic 20 (21) Drapers 21 (22) Pet Shops 11 (12) Electrical, Radio and TV. 96 (94) Public Houses 54 (54) Fish Shops 39 (39) Second-hand Wardrobes 2 (2) Florists 28 (27) Sewing Machines 5 (5) Fruit and Greengrocery 92 (95) Stationers 16 (16) Furnishers 68 (69) Tobacconists 84 (85) Glassware 14 (14) Toys and Sports 23 (25) Grocers 129 (132) Wines and Spirits 46 (46) Hairdressers 134 (138) Wools 19 (19) Hardware 54 (53) Woodwork, Timber 24 (24) Jewellers 23 (22) Miscellaneous 138 (132) Leather goods 9 (9) During the 1,285 visits made, 248 infringements were noted and dealt with. The majority were in respect of the keeping of records—failure to maintain plant and equipment to the required standard and the cleanliness of staff rooms. All were dealt with and in no instance was it necessary to resort to statutory action. VERMIN AND OTHER PESTS Foxes Twenty-three complaints were received about foxes, many referring to the "mangy" state of the animals seen. Advice was given but owing to staff problems it was seldom possible to do more. There is no doubt the fox population in the area is increasing. Rodent Control No major reservoirs of infestation were found in the district and the distribution of the 1,517 complaints received, indicated that one part of the Borough is no more heavily infested than another. The majority of the complaints received appeared to be associated with either the feeding of birds or pet animals. The investigations that were made also revealed rubbish and the cover afforded by sheds and outbuildings a likely cause of infestation. 99 During the year mice were particularly troublesome in many parts of the Borough. This problem (common throughout the London area) was referred to in the Annual Report for 1972 and unfortunately it has not to date been resolved. Pigeons Work in connection with the control of the feral pigeons continued throughout the year and the number of birds was kept down to within reasonable limits. The clearance of the feral pigeons from town centres and indeed from residential areas could be achieved if only members of the public would refrain from feeding them. There are flocks that congregate almost to a regular timetable knowing that food will be available and while this feeding continues limitation of numbers is all that can be hoped for. The number of birds taken during the year was 1,545. Squirrels Many complaints were received about squirrels being a nuisance and causing damage to trees and garden plants and to property. Squirrels in roof spaces can be particularly destructive creatures. A service for the destruction of these pests is not provided by the Local Authority, but advice is tendered on methods of control and traps are loaned to individuals. These, if properly baited, are very effective. As a result of their use dozens of these creatures were destroyed. Wasps The number of nests destroyed during the year was 374. This was 70 fewer than during 1972. The number dealt with during the wasp season is generally of the order of 450. FOOD AND DRUGS The work in this field falls into two main parts: (1) the investigation of complaints and (2) the sampling of food stuffs and other commodities. The investigation of complaints and the organisation of the sampling programme was undertaken by a Senior Inspector, Mr. F. W. Fowler. On the 1st April, 1973 the Council appointed Mr. J. H. Shelton, F.R.I.C., as joint Public Analyst with Mr. E. Voelcker, A.R.C.S. M.Chem. A., F.R.I.C. Samples of food for chemical analysis were submitted to the Public Analysts, while samples of fertilizers and feeding stuffs were sent to Mr. E. Voelcker, the Council's Agricultural Analyst. The practice of examining milk and other dairy products within the Department continued while the bacteriological examination of food was carried out by the Public Health laboratories at Central Middlesex Hospital and at Colindale. The coming into force during the year of the Labelling of Food Regulations 1970 required detailed attention being given to the size, position and contents of the words appearing on labels affixed to prepacked foods and to the description applied to foods sold other than 100 pre-packed. Where necessary the packers or vendors, as the case may be, were required to make suitable amendments to labels, etc. and while discussions were in many cases prolonged, particularly when imported foods were involved, the problems arising were generally resolved without serious difficulties being encountered. The following is a summary of the samples taken and the results obtained:- Analysis Commodity No. Taken Satisfactory Unsatisfactory Bacteriological Milk 220 203 17 Milk bottles 3 3 — Ice Cream 160 92 68 Cream 198 153 45 Swimming Pool Water — — — Drinking Water 16 16 — Other Foods 17 16 1 Miscellaneous — — — Chemical in Office Milk 151 145 6 Other Foods 101 94 7 Miscellaneous — — — Chemical by Public Analyst Drugs 26 26 — Food 316 294 22 Fertiliser & Feeding Stuffs Act 1926 10 8 2 Consumer Protection Act 1961 — — — Pharmacy & Poisons Act 1933 — — — Swimming Pool Water — — — Drinking Water 2 2 — Miscellaneous — — Total Bacteriological 614 483 131 Total Chemical 606 569 37 GRAND TOTAL 1,240 1,052 168 101 FOOD COMPLAINTS The number of complaints received concerning the presence of foreign matter in, or the condition of, food continued to increase as it has done for some years. The following table reveals the trend since 1968:- Year Number of Complaints 1968 93 1969 123 1970 145 1971 206 1972 241 1973 262 While this trend is expected to continue it should not be taken as an indication that the quality of food stuff is falling, but rather to the increasing publicity given to food and food hygiene and to increasing interest taken in these matters by the public. 102 The following is a Summary of the Complaints received Commodity Foreign Bodies Mouldy Otherwise out of Condition Miscellaneous Total Beverages 3 — 8 — 11 Bread/Flour 21 11 8 — 40 Butter and Fats — 1 1 — 2 Cakes/Biscuits/Tarts 11 4 6 1 22 Canned and Bottled Food 22 4 11 2 39 Cheese 3 5 — — 8 Cream — — 2 2 4 Fish 1 — — — 1 Frozen Foods 4 — 1 — 5 Fruit and Vegetables 4 1 5 — 10 Jam/Marmalade/Pres. 5 — — — 5 Meals 4 — — 1 5 Meat/Poultry/Meat Products 12 5 22 2 41 Miscellaneous 3 1 3 1 8 Nuts — — 1 — 1 Rices and Farinaceous Foods 1 — 1 — 2 Sausages — 1 4 — 5 Sugar and Sugar Conf. 3 1 4 — 8 Yoghurts/Desserts 1 1 4 1 7 TOTAL 98 35 81 10 224 Foreign Bodies Dirty Bottles Poor Quality Milk 15 16 7 38 TOTAL 262 103 MILK Production Milk was produced in the Borough at four farms, namely Pinner Park Farm, Pinner Wood Farm, Oxhey Lane Farm and Harrow School Farm. Processing The number of pasteurizing plants remained at two. They are located at Kenton Lane Farm, Kenton and Pinner Park Farm, Pinner. High Temperature Short Time pasteurizing plant is in use at both dairies. Distribution The majority of milk retailed within the Borough is processed and bottled elsewhere and distributed mainly by the well known Companies from local or nearby receiving depots. In addition milk is sold in an increasing number of retail shops and here the introduction of Ultra Heat Treated milk has been of considerable help. Ultra Heat Treated milk which has a long shelf life without refrigeration is particularly suitable for retail sale in the supermarket and other shops and it appears to be coming increasingly popular with the housewife, particularly as a stand-by supply. At the end of the year 122 persons were registered as distributors and three as dairymen. Inspection and Sampling In all 220 samples of milk were obtained for bacteriological examination. Of these 203 were found to be satisfactory. Investigations were made into each case where an unsatisfactory result had been obtained and appropriate follow-up action was taken. One hundred and fifty-one samples of milk were examined within the Department and 145 of these were found to satisfy the prescribed standards. Minor deficiencies in milk fat or solid not fat contents were found in the remaining samples. These deficiencies were investigated and action as appropriate to the case was taken. Further samples from the sources were found to be satisfactory. Complaints A total of 38 complaints were received about milk or milk containers. Of these 15 referred to the presence of foreign matter, 16 to the dirty condition of the bottles and 7 to the quality of the milk. All complaints were investigated and action appropriate to the case was taken with the Companies concerned. While the problems associated with the misuse of milk bottles by the general public continues to appear to be on the decline, it is still a matter of concern. This matter has been commented on in previous years and it is felt the "bottle problem" will only be resolved when the glass bottle is replaced by a non-returnable carton or similar container. 104 The undesirable practice of some rounds-men of stacking crates of empty bottles adjacent to highways and public footpaths was also the subject of many representations to the managers of milk distribution centres. The position is improving but the 100% co-operation that is necessary from all concerned has not yet been achieved. ICE CREAM Number of Premises Registered at the end of the Year : (a) For the storage and sale of ice cream 458 (b) For the manufacture of ice cream 11 Sampling During the year 160 samples of ice cream and ice cream mix were obtained for bacteriological examination. Of these 92 were placed in provisional grades 1 and 2 and the remainder in provisional grades 3 and 4. Where a sample is placed in grade 3 or 4 it is not an indication that the product from which it was obtained was unfit for human consumption. It is however, an indication that either greater care is needed in the selection of ingredients, in its processing, in its storage for sale, or in the cleasning and sterilisation of equipment used for these purposes. Where unsatisfactory results had occurred investigations were made, appropriate action was taken and follow-up samples obtained. Eight samples were examined within the Department to ascertain the percentage of milk fat present, seven were found to satisfy the standards prescribed. The remaining sample (of soft ice cream) is the subject of further investigations. FRESH DAIRY CREAM During the year 198 samples of cream were taken for bacteriological examination, of these 153 satisfied the Methylene Blue test. This is essentially a screening test and the results are indicative of the standard of hygiene maintained during the course of production and handling. It is perhaps of interest to note that no complaints were received during the year about our sour cream being sold from dairy vehicles or from shops. Nevertheless where an unsatisfactory result was received, investigations were made and further samples taken. Sixty-three samples of various types of dairy cream were examined in the Department to ascertain the percentage of milk fat present in each. All were found to be up to the required standard. 105 EMPLOYMENT AGENCIES The number of employment agencies registered at the end of the year was 41. During the year 11 new licences were issued, while over the same period 11 licences, where agencies either changed hands or closed down, were cancelled. Visits were made to the agencies to ensure that the byelaws relative to records and other matters were being observed. No serious contraventions were noted. Pharmacy & Poisons The number of persons listed as sellers of poisons to which Part II of the Pharmacy & Poisons Act 1933 relates was 96. The following table shows the type of premises from which these poisons were sold:- The 1972 figures are shown in brackets:- Position at as 1st May, 1974 Builders, Builders' Merchants 3 (5) Hardware Stores 30 (35) General Provisions 49 (56) Nurseries, Corn Merchants 6 (7) Hairdressers 1 (1) Motor & Cycle Accessories 3 (1) Laboratory/Druggists 3 (4) Pet Stores 1 (1) 96 (110) Sampling Fifteen samples were obtained from the premises of persons listed as sellers of Part II Poisons and were submitted to examination by the Public Analyst. All were reported as being satisfactory. CONSUMER PROTECTION Nineteen samples of toys and two samples of cooking utensils were submitted to the Public Analysts for examination. All satisfield the requirements of the regulations made under the Consumer Protection Act 1961.