2 London Borough of Hillingdon annual report of the Medical Officer of Health and Principal School Medical Officer for the Year 1966 HIL2 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER 1966 O. C. DOBSON, M.D., B.S., L.R.C.P., M.R.C.S. Health and Welfare Department, D.P.H., B.Hy., D P.A., Council Offices, Barrister-at-Law. Uxbridge. Contents page Introduction 3-4 Health Committee 5 Staff 6-7 SECTION I Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport 11-23 SECTION II Personal Health Services 27-41 SECTION III Community Care - Welfare Services 45-55 SECTION IV Community Care - Mental Health 59-60 SECTION V General Services 63-66 SECTION VI Environmental Health 69-97 SECTION VII Report of the Principal Medical Officer for the year 1966 101-111 Index 115-116 3 To: The Mayor, Aldermen and Councillors of the Borough: I have pleasure in presenting this report for 1966—the first complete year in which the Health and Welfare Services were administered by the Hillingdon Borough Council. In the department there was a consolidation of the work begun in the previous year and it was possible to tie up a number of loose ends which had become apparent in the take-over process which came to an end on March 31st, 1965. Every opportunity has been taken to integrate the work of the various sections of the Health and Welfare Department with the view of saving manpower, avoiding overlapping and saving costs. As time goes on this process will be extended, as far as it is possible within the scope of this department, to the other organisations, both statutory and voluntary, which deal with the social services. The vital statistics may be regarded as satisfactory. The birth rate is 15.5, compared with that of England and Wales of 17.7, while the death rate is 10.6, compared with the national rate of 11.7. The infant death rate is as low as 13.8, compared with the rate for England and Wales of 19.0. There were no maternal deaths, and the perinatal death rate, i.e. stillbirths and deaths under one week combined, was 20.96, compared with the national rate of 26.3. Infant deaths are still a problem and the details of those that did occur are set out on pages 15-17. From the information given there it will be seen that these infant deaths occurred from causes which at present are not preventable because the real origins are unknown. It is necessary for very careful ante-natal supervision to be given to all expectant mothers; intensive research needs to be continued into the causes giving rise to infant deaths, and it should be realised also that the same causes are responsible for the majority of stillbirths. The main killing diseases are cancer and diseases of the heart and vascular system. In Hillingdon deaths from cancer were 1.95 per thousand of the population, compared with the national rate of 2.25. The death rate for cancer of the lung was 0.57, compared with the national rate of 0.56. While this latter comparison is still disappointing, it will be noted that there were 26 fewer cases of lung cancer than in the previous year. Medical opinion all over the world is still quite definite that most cases of lung cancer are caused by prolonged and excessive cigarette smoking. A great deal of health education has been carried out with a view to securing a reduction in the amount of cigarette smoking in all age groups, but the response has not been very impressive. One can only go on reiterating the connection between cigarette smoking and lung cancer, hoping that by constant repetition the message will get through to at least a proportion of individuals. Particularly, it is the duty of parents to do everything they can to discourage their children from commencing the smoking habit. Formerly in presenting annual reports it was the custom to have a good deal to say on the subject of infectious diseases. In recent years, because of the modern methods of controlling infectious diseases, it has not been necessary to do more than draw attention to the low incidence of the important infections. There has been no case of diphtheria in the Borough area since 1949. The Borough remained free from poliomyelitis, and there was no case of typhoid or smallpox. In connection with smallpox it is necessary once again to draw attention to the peculiar position of Hillingdon in this respect. The presence within the Borough of Heathrow Airport means that travellers are constantly arriving from endemic or epidemic areas, and of course many of the aircraft crews and associated workers are at risk in having contact with these passengers. It is recommended, therefore, that vaccination against smallpox should be the rule, the primary vaccination being carried out preferably in the second year. Because of the constant danger of the importation of smallpox and because of the frequent necessity for vaccination to be carried out to meet the requirements of international travel, it is wise to have this protection established as early as possible. Once primary vaccination has been performed, subsequent revaccination for whatever purpose becomes a trivial and comparatively safe procedure. Although the incidence of serious infectious diseases has been so low, this situation cannot be continued without meticulous attention to the immunisation level reached in the infant population and also with very careful attention to case and contact tracing. The work of health visitors and public 4 health inspectors in this regard is absolutely fundamental, and the thanks of the Borough are due to them for the way in which they have carried out their respective functions. All this work in the control of infectious diseases is apt to be forgotten, especially when there is hardly any infectious disease to report. It is only when an outbreak occurs that attention is drawn to the amount of day to day work that is necessary to secure that the population as a whole has full protection. In the welfare section the work of consolidation has continued. Measures to ensure the well-being of the physically handicapped and aged were brought into an organised system, tying-up where necessary with the health visiting, home hursing, mental health and home help services. I am grateful to all the members of the department for the way in which they have undertaken the work allocated to them. Their constant co-operation has ensured the smooth working of the department and made it possible to overcome the difficulties which inevitably occur in a department of this size. General practitioners and hospital staffs, with whom the department is in constant contact, have always been most helpful. It is necessary also to say how much the co-operation of other departments of the Borough council has been appreciated. Finally, it is necessary to say how much the assistance and encouragement of the Chairmen and Members of the Health and Welfare Committees has meant to the staff of the department in carrying out their day to day tasks. O. C. DOBSON, Medical Officer of Health. 5 HEALTH COMMITTEE (as at 31st December, 1966) Ex-officio: The Mayor (Councillor T. Cluny) Chairman: Councillor J. Rowe Vice-Chairman: Councillor L. Sherman Alderman: J. J. Coleman Councillors: J. G. Bartlett R. H. Collman J. E. Skidmore R. W. Bossom D. C. Lorkin Mrs. L. E. Wane Mrs. E. E. Broughton C. Nemeth J. W. Willis N. H. Butler B. Shaw E. C. Wood Mrs. V. Chalk Co-opted: Mr. G. Corran (representing Hillingdon Group Hospital Management Committee) Miss K. M. Daly (representing Confederation of Health Service Employees) Dr. T. D. Lambert (representing Middlesex Local Medical Committee) Dr. R. A. P. Paul (representing Middlesex Local Medical Committee) Mr. E. L. F. Randle (representing Harefield and Northwood Group Hospital Management Committee) Miss J. McCarthy (representing the Royal College of Midwives) WELFARE COMMITTEE (as at 31st December, 1966) Ex-officio: The Mayor (Councillor T. Cluny) Chairman: Alderman Mrs. D. K. E. Egleton Vice-Chairman: Alderman J. J. Coleman Aldermen: M. B. Everley S. L. Meggeson Councillors: Mrs. E. E. Broughton C. Nemeth B. Shaw Mrs. V. Chalk T. J. Parker J. T. Taylor L. J. Lally 6 STAFF Medical Officer of Health and Principal School Medical Officer: O. C. Dobson, M.D., B.S., L.R.C.P., M.R.C.S., D.P.H., B.Hy., D.P.A., Barrister-at-Law Deputy Medical Officer of Health and Deputy Principal School Medical Officer C. Lydon, M.B., Ch.B., B.A.O., D.P.H., D.C.H. Senior Medical Officers: Maternity and Child Welfare Service: V. M. D. N. Shaw, M.B., Ch.B., D.R.C.O.G., D.P.H. School Health Service: J. W. E. Bridger, M.R.C.S., L.R.C.P. Senior Airport Medical Officer: P. R. Cooper, M.A., B.M., B.Ch., D.T.M., D.P.H. Deputy Senior Airport Medical Officer: F. J. Kinsella, L.R.C.P., L.R.C.S., L.R.F.P.S.(Glas.) Airport Medical Officers: R. H. Clark, M.D., M.R.C.P., D.T.M. & H. I. Marrable, M.R.C.S., L.R.C.P., D.T.M. & H. J. Strahan, M.B., B.Ch., B.A.O., D.P.H., D.T.M. & H. D. Tweedie, M.B., B.Ch., B.A.O. Assistant Medical Officers: J. Drake, M.B., B.S., L.R.C.P. M. M. Elias, M.R.C.S., L.R.C.P. M. Fox, M.B., Ch.B., P.H.Cert. J. Jones, M.B., Ch.B. G. Malmberg, M.B., B.S., D.P.H. J. V. Moon, M.B., B.S., M.R.C.S., L.R.C.P. M. Rennie, M.B., Ch.B., D.P.H. M. O'Connor, M.R.C.S., L.R.C.P., D.P.H. D. R. E. Reeve, M B., B.S., L.R.C.P., M.R.C.S. Chief Dental Officer and Principal School Dental Officer: G. M. Davie, L.D.S., R.F.P.S. Orthodontists: Mrs. H. Levy, L.D.S., R.C.S. J. Halliday, B.D.S., D.D.S. (until October) Dental Officers: G. H. Allen, L.D.S., R.C.S., B.D.S. Miss H. P. E. Green, B.D.S. Mrs. E. A. Jackson, B.D.S., L.D.S., R.C.S. Miss A. E. MacNicol, B.D.S. Miss C. Ralston, B.D.S. Mrs. M. E. Skelton, L.D.S., R.C.S. Miss V. Street, B.D.S. Chief Public Health Inspector: A. Makin, M.R.S.H., F.A.P.H.I. Deputy Chief Public Health Inspector: J. S. Hodgins, M.R.S.H., A.M.I.P.H.E. Chief Welfare Officer: J. L. Stoker, A.I.S.W. Deputy Chief Welfare Officer: N. H. Collier Superintendent Health Visitor: Miss V. Matthews, S.R.N., S.C.M., H.V. Certificate (Retired 30.11.66) Miss A. D. Mogford, S.R.N., C.M.B. Part I, H.V. Certificate (with effect from 1.12.66) Deputy Superintendent Health Visitor: Miss A. D. Mogford, S.R.M., C.M.B. Part I, H.V. Certificate (until 30.11.66) Post vacant until end of year. Superintendent of Home Nursing and Non-Medical Supervisor of Midwives: Miss A. L. Drossou, S.R.N., S.C.M., Q.N. Deputy Superintendent of Home Nursing and Deputy Non-Medical Supervisor of Midwives: Miss P. V. Joachim, S.R.N., S.C.M. Deputy Supervisor of Home Nursing: G. J. W. Hunt, S.R.N., Q.N. Chief Mental Welfare Officer: L. R. Bradbury Deputy Chief Mental Welfare Officer: R. M. Petts, S.R.N., R.M.N. Home Help Organiser: Miss J. Abrahart Assistant Home Help Organisers: Mrs. A. F. G. Benning Mrs. I. E. Pallant Liaison and Administrative Officer: H. N. Ryan, M.R.S.H. Deputy Liaison and Administration Officer: W. H. Knapton Senior Administrative Assistants: A. J. Benson L. R. Doughty F. Hinley D. N. A. McKellar G. D. Shaw 7 Technical and Professional Staff: Airport Nurses Audiometer Operator Chest Clinic Welfare Officer Chiropodists Clinic Nurses Dental Surgery Assistants Domiciliary Midwives Field Work Instructors Health Assistants Health Education Technician Health Visitors and Students Home Nurses Home Teachers Marie Curie Nurses Mental Welfare Officers Orthoptist Physiotherapist Divisional, Specialist, District and Pupil Public Health Inspectors Radiographer (Airport) Social Welfare Officers Speech Therapists Technical Assistants Trainee Mental Welfare Officers Trainee Social Workers Welfare Assistants Administrative and Clerical Staff: Administrative Assistants Airport Clerk Receptionists Clerical Officers Copy Typists Personal Assistants Shorthand Typists Manual Workers: Cleaners Clinic Caretakers Coach Guides Drivers General Assistants Home Helps Male Cleaners in Charge Mortuary Attendant Day Nurseries: Matrons Wardens Deputy Matrons Staff Nurses Staff Nursery Nurses Nursery Assistants Student Nursery Nurses Cooks Domestic Assistants Mental Health Hostel Resident Warden Resident Assistant Warden Resident Housekeeper Cooks Domestic Assistants Hostel for Subnormals Warden Warden's Assistant Assistant Warden Cook Assistant Cook Domestic Assistants Coach Guide Junior Training Centre Supervisor Assistant Supervisors Supply Supervisor Domestic Assistants Cleaners Adult Training Centres: Manager Supervisor/Instructor Instructors Clerical Assistant Cook-in-Charge Assistant Cooks Caretaker/Handyman Weekly Boarding Unit Matron Assistant Matron Cook/Housemother Female Attendants Cleaner Welfare Homes Matrons/Superintendent Assistant Matrons Ward Sisters Clerical Assistants Female Attendants Cooks Domestic Assistants Seamstresses Gardener/Handyman Hostels for the Homeless Wardens Warden's Assistant Welfare Assistant Workshop for the Handicapped: Industrial Work Organiser Work Centre Assistant Workshop for the Elderly Supervisor SECTION I Statistics Infectious Diseases Health Control Unit London (Heathrow) Airport 11 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport General Statistics Area—square miles 42.5 Population—Registrar-General's estimate for mid-year 1966 233,030 Number of inhabited dwellings 70,294 Rateable Value—as at 1st April, 1966 £16,308,816 Product of Penny Rate—1966-67 (estimated) £68,419 Vital Statistics Total Live Births: Male Female Total Legitimate 1,830 1,697 3,527 Illegitimate 120 121 241 1,950 1,818 3,768 Birth Rate per 1,000 population: Hillingdon Crude 16.2 Corrected 15.5 England and Wales Area Comparability Factor: 0.96 17.7 Illegitimate Live Births: Male Female Total 120 121 241 Per cent, of total live births: 6.4 Still Births: Male Female Total Legitimate 21 24 45 Illegitimate 1 2 3 22 26 48 Rate per thousand live and still births: Hillingdon 12.6 England and Wales 15.4 Total Live and Still Births: Legitimate Illegitimate Male 1,851 121 1,972 Female 1,721 123 1,844 Total 3,572 244 3,816 These births occurred as under: ,Live Births Still Births At home 1,038 6 In hospitals, nursing homes or other maternity establishments 2,730 42 3,768 48 12 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport Infant Deaths (under 1 year of age): ] Male Female Total Legitimate 27 19 46 Illegitimate 2 4 6 29 23 52 Legitimate—rate per 1,000 legitimate live births: 13.0 Illegitimate—rate per 1,000 illegitimate live births: 24.9 Infant Death Rate per 1,000 total live births: Hillingdon 13.8 England and Wales 19.0 Neo- natal Deaths (under 4 weeks of age): Male Female Total Legitimate 19 14 33 Illegitimate 1 2 3 20 16 36 Rate per 1,000 total live births: Hillingdon 9.6 England and Wales 12.9 Early Neo-natal Deaths (under 1 week of age): Male Female Total Legitimate 15 14 29 Illegitimate 1 2 3 16 16 32 Rate per 1,000 total live births: Hillingdon 8.5 England and Wales 11.1 Perinatal Deaths (Still Births and deaths under 1 week combined): Male Female Total Legitimate 36 38 74 Illegitimate 2 4 6 38 42 80 Rate per 1,000 live and still births: Hillingdon 20.9 England and Wales 26.3 Maternal Deaths Total 0 Rate per 1,000 live and still births: Hillingdon - England and Wales 0.26 13 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport Deaths from All Causes Male 1,064 Female 919 Total 1,983 Death Rate per 1,000 population:— Hillingdon Crude 8.5 Corrected 10.6 England and Wales Area Comparability Factor: 1.25 11.7 In calculating the Live Birth Rate and the Death Rate, the crude figures have been adjusted by the Registrar General's Area Comparability Factors of 0.96 and 1.25, respectively. These factors may be said to represent a population handicap to be applied to the area, and, when multiplied by the crude rate modifies the latter so as to make it comparable with the rate for the country as a whole or with similarly adjusted rates for any other area; the effect of the comparability factors is to make allowance for the age and sex distribution of the inhabitants of the district. 14 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport LIVE BIRTHS Age and parity of mother and place of occurrence during 1966 Statistics supplied by the General Register Office Parity of Mother *Place of Delivery Age of Mother All Ages Under 20 20-24 25-29 30-34 35-39 40-44 45+ Legitimate 0 1 1,132 168 472 300 145 38 9 2 59 6 29 19 5 — — — 3 203 29 116 50 7 — 1 — 4 8 3 3 2 — — — — 1 1 722 36 219 260 139 58 9 1 2 38 2 10 16 5 4 1 — 3 427 6 135 199 76 11 — — 4 15 3 8 3 — 1 — — 2 1 291 4 52 105 69 45 14 2 2 24 3 8 8 3 2 — 3 231 1 44 96 71 17 2 — 4 — — — — — — — — 3 1 122 7 33 47 23 12 — 2 16 — 1 2 10 3 — — 3 92 — 11 36 26 17 2 — 4 1 — — 1 — — — — 4 1 82 5 26 22 17 12 — 2 5 — — 4 1 — — 3 17 5 4 8 — — 4 1 — — 1 — — — — 5-9 1 67 2 10 22 24 9 — 2 2 1 1 — — — 3 15 2 7 3 3 — 4 — — — — — — — — 10+ 1 1 — — — 1 — — — 2 — — — — — — — — 3 — — — — — — — — 4 — — — — — — — — Illegitimate 1 215 80 68 36 17 10 4 — 2 5 1 3 — — 1 — — 3 22 1 10 7 3 1 — — 4 7 6 1 — — — — — Total 1 2,632 288 825 770 462 215 69 3 2 149 9 46 46 33 12 3 — 3 1,007 37 316 395 194 57 8 — 4 32 12 12 7 — 1 — — * Place of Delivery 1. N.H.S. Hospitals 2. Non- N.H.S. Hospitals (mainly maternity homes). 3. At Home 4. Other 15 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport STILL BIRTHS Age and parity of mother and place of occurrence during 1966 Statistics supplied by the General Register Office Parity of Mother * Place of Delivery /fge o/ Mother All Ages Under 20 20-24 25-29 30-34 35-39 40-44 45+ Legitimate 0 1 22 4 8 4 2 2 2 — 2 — — — — — — — — 3 2 — 2 — — — — — 4 — — — — — — — — 1 1 4 — 2 1 1 — — — 2 — — — — — — — — 3 2 — — 2 — — — — 4 — — — — — — — 2 1 6 — — 3 1 1 1 — 2 — — — — — — — — 3 — — — — — — — — 4 — — — — — — — — 3 1 2 — 1 — — 1 — — 2 — — — — — — — 3 — — — — — — — — 4 — — — — — — — — 4 1 4 — — 2 — 2 — — 2 — — — — — — — — 3 — — — — — — — — 4 — — — — — — — — 5-9 1 3 — — — 1 2 — — 2 — — — — — — — — 3 — — — — — — — — 4 — — — — — — — — 10+ 1 — — — — — — — — 2 — — — — — — — — 3 — — — 4 — — — — — — — — Illegitimate 1 1 — — — 1 — — — 2 — — — — — — — 3 4 2 — — — 1 1 — — Total 1 42 4 11 10 6 8 3 2 — — — — — — 3 4 — 2 2 — — — 4 2 — — — 1 1 — — *Place of Delivery 1. N.H.S. Hospitals 2. Non-N.H.S. Hospitals (mainly maternity homes). 3. At Home 4. Other 16 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport INFANT MORTALITY The following table gives details of deaths of those infants who were resident in the Borough: Date of Death Age Sex Cause of Death 25.2.66 5 minutes F Atelectasis due to Prematurity 12.3.66 10 minutes F Gross hydrocephalus 17.4.66 25 minutes F Atelectasis—prematurity 25.1.66 1 hour M Cerebral haemorrhage—breech delivery 4.2.66 1 hour M Atelectasis of lungs—multiple congenital abnormalities 29.5.66 1 hour F Erythroblastosis Foetalis—prematurity 28.11.66 1 hour F Respiratory insufficiency—extreme prematurity 17.12.66 2 hours M Prematurity 25.6.66 4 hours F Pulmonary atelectasis—extreme prematurity 12.3.66 5 hours M Hydrops Foetalis; haemolytic disease of newborn 9.5.66 5 hours M Pulmonary atelectasis—prematurity 12.11.66 7 hours M Extreme prematurity—28 weeks' gestation 2.12.66 7 hours M Extreme prematurity 16.8.66 8 hours F Respiratory insufficiency; intra partum anoxia 8.8.66 9 hours M Intra-cranial haemorrhage 12.6.66 12 hours M Intra-cranial haemorrhage 2.5.66 16 hours F Prematurity—25 weeks' gestation 16.6.66 20 hours F Foetal pneumonia due to post-maturity; adrenal hypoplasia 18.2.66 21 hours F Pulmonary hypoplasia due to diaphragmatic hernia (repaired) 2.6.66 1 day M Respiratory failure—inhaled vomit; respiratory distress syndrome—hyaline membrane 28.10.66 1 day M Respiratory distress syndrome 10.2.66 2 days M Respiratory distress syndrome 14.7.66 2 days F Pulmonary hyaline membrane—prematurity; pneumothorax 5.10.66 2 days F Respiratory distress syndrome—hyaline membrane disease 31.1.66 4 days F Bronchopneumonia; cervical meningocele; cleft palate 22.5.66 4 days M Congenital heart disease 17.8.66 4 days M Congenital heart disease 24.9.66 4 days F Intracranial haemorrhage; prematurity 12.12.66 4 days F Heart failure—congenital heart disease 12.3.66 5 days F Meconium ileus 24.3.66 6 days M Hyaline membrane disease—prematurity 21.5.66 6 days M Prematurity; multiparity 3.4.66 1 week M Extreme prematurity 17.8.66 1 week M Bronchopneumonia 15.1.66 12 days M Dehydration; prematurity; Rhesus incompatability 23.9.66 12 days M Congenital heart disease 1.4.66 1 month F Acute tracheo-bronchitis 25.4.66 1 month M Anaemia and uraemia due to ascending pyelonephritis 19.8.66 1 month M Fulminating bronchitis 2.11.66 2 months F Cerebral compression; cerebral haemorrhage fractured skull 17.12.66 2 months M Cardiac failure—congenital heart disease; operation for correction of heart disease 22.12.66 2 months M Bronchopneumonia 15.8.66 3 months F Congenital heart disease 9.10.66 4 months F Oesophageal atresia; duodenal atresia continued 17 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport Infant Mortality—contd. Date of Death Age Sex Cause of Death 15.10.66 5 months F Bronchopneumonia 20.9.66 6 months M Chronic malabsorption—lactose intolerance 21.5.66 9 months M Congenital heart disease 13.8.66 9 months F Bronchopneumonia—congenital heart disease—mongolism 25.11.66 9 months M Bronchiolitis 28.10.66 11 months M Bronchopneumonia DEATHS FROM CANCER Male Female Total 1966 1965 1966 1965 1966 1965 Malignant neoplasm, stomach 31 24 29 11 60 35 Malignant neoplasm, lung, bronchus 107 132 26 27 133 159 Malignant neoplasm, breas 1 — 40 34 41 34 Malignant neoplasm, uterus — — 16 11 16 11 Other malignant and lymphatic neoplasms 124 112 81 87 205 199 Totals 263 268 192 170 455 438 Rates per 1,000 of population Hillingdon All causes 1.95 Lung and bronchus 0.57 England and Wales All causes 2.25 Lung and bronchus 0.56 18 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport CAUSES OF DEATH The following table shows causes of death as given in the Registrar-General's statistics, which are classified in accordance with the World Health Organisation Nomenclature Regulations. Cause of Death Sex Total all Ages Under 4 weeks 4 weeks and under 1 year AGE IN YEARS 1 to 4 5 to 14 15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 & over Tuberculosis, Respiratory M 1 — — — — — — — — — — 1 F — — — — — — — — — — — — Tuberculosis, Other M 1 — — — — — — — — — 1 — F — — — — — — — — — — — — Syphilitic Disease M 2 — — — — — — — — — 1 1 F 1 — — — — — — — — — — 1 Other Infective and Parasitic Diseases M 1 — — — — — — — 1 — — — F 1 — — — — — — — — 1 — — Malignant Neoplasm, Stomach M 31 — — — — — — 1 1 10 9 10 F 29 — — — — — — — 2 9 5 13 Malignant Neoplasm, Lung, Bronchus M 107 — — — — — 1 5 9 44 37 16 F 26 — — — — — — 1 5 8 9 3 Malignant Neoplasm, Breast M 1 — — — — — — — — — — 1 F 40 — — — — — 1 4 11 13 5 6 Malignant Neoplasm, Uterus F 16 — — — — 1 — — 7 3 4 6 Other Malignant and Lymphatic Neoplasms M 124 — — 1 2 3 1 8 13 42 30 74 F 81 — — — — — — 6 9 19 77 75 Leukaemia, Aleukaemia M 4 — — — — — 2 — 2 — F 3 — — — — — — — — 7 1 — Diabetes M 4 — — — — 1 — 1 1 1 F 5 — — — — — — — — — 4 1 Vascular Lesions of Nervous System M 72 — — — — — 1 2 3 12 16 38 F 139 — — — — — 2 3 8 16 78 82 Coronary Disease, Angina M 301 — — — — — 1 3 43 106 94 54 F 156 — — — — — — 1 5 16 50 84 Hypertension with Heart Disease M 14 — — — — — — — 1 1 7 5 F 21 — — — — — — — 1 2 4 14 Other Heart Disease M 67 — — — — — — 2 6 11 11 37 F 134 — — — — — 1 2 4 3 17 107 Other Circulatory Disease M 50 — — — — — 1 — 2 9 16 22 F 58 — — — — 1 — — 4 4 12 37 Influenza M 3 — — — — — — — — — 2 1 F 4 — — — — — — — — — — 4 Pneumonia M 61 1 4 1 — — 1 5 10 39 F 61 2 1 — — — — — — 4 13 41 Bronchitis M 78 — 1 — — — — — 5 17 29 26 F 25 — 1 — — 1 1 2 — 4 16 Other Diseases of Respiratory System M 10 — 1 — — — — — 4 3 7 F 5 — 1 — — — — 7 7 — Ulcer of Stomach and Duodenum M 10 — — — — — — — 1 3 2 4 F 6 — — — — — — — — 1 7 3 Gastritis, Enteritis and Diarrhoea M 3 — — — — — 1 — — 1 1 — F 6 — 1 — 3 2 Nephritis and Nephrosis M 9 — — — — — — 1 7 3 1 2 F 5 — — 1 1 1 — 1 — — 1 Hyperplasia of Prostrate M 2 — — — — — — — — — — 7 Congenital Malformations M 10 4 3 — — — — — 1 2 — — F 9 3 3 1 — 1 — — 1 — — — Other Defined and Ill-Defined Diseases M 52 14 2 — 2 1 1 2 3 11 8 8 F 67 11 — 2 — 1 3 17 10 28 Motor Vehicle Accidents M 24 — — 1 2 7 2 1 1 5 2 3 F 7 — — — 1 1 — 1 3 1 All Other Accidents M 13 1 — 2 1 2 1 1 3 2 — — F 5 — 1 — — — — 1 — — — 3 Suicide M 8 — — — — 1 1 4 1 — 1 F 9 — — — — — 2 3 — 3 1 Homicide and Operations of War M 1 — — — — — — — — 1 — — F — — — — — — — — — — — — Total All Causes M 1,064 20 10 6 7 14 11 31 99 290 278 298 F 919 16 7 1 3 6 9 22 60 118 199 478 19 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport Infectious Diseases The following Table shows the incidence of infectious diseases during 1966. DISEASES Ages of Cases Notified Totals Deaths Under One Year 1 to 2 3 to 4 5 to 9 10 to 14 15 to 24 25 and Over 1966 1965 1966 1965 Scarlet Fever 5 29 51 3 3 — 91 104 — — Diphtheria — — — — — — — — — Whooping Cough 4 17 16 16 — — — 53 29 Measles 48 225 272 281 3 1 2 832 3,569 Meningococcal Infection — — 1 — — 1 Poliomyelitis (Paralytic) — — — — — — — — Poliomyelitis (Non-Paralytic) — — — — — — — — Acute Encephalitis (Infective) — — — 1 — 1 — 2 4 Acute Encephalitis (Post Infective) — — — 1 — — 1 — Smallpox — — — — — — — — Pneumonia 4 — — 3 3 3 23 36 47 122 150 Typhoid — — — — — — — — — Paratyphoid — — — — — 2 — 2 Dysentery — 1 — — — — 3 4 17 Food poisoning — — — 1 — 1 5 7 12 — Puerperal Pyrexia — — — — — 69 74 143 144 Tuberculosis, Respiratory — — 1 1 — 6 37 45 59 1 3 Tuberculosis, Non-Respiratory — — — — — 5 9 14 19 1 2 Erysipelas — — — — — — 9 9 13 — — Health Control Unit, London (Heathrow) Airport A comprehensive description of the organisation and function of the Health Control Unit was included in the Annual Report for 1965 and, therefore, the present report will be mainly statistical. It is necessary, however, to mention that during the year the British Airports Authority took over from the Ministry of Aviation on April 1st. In the course of time, the Authority's Board will announce their policy regarding the provision of medical services for passengers, visitors and staff at Heathrow, but, meanwhile, the Health Control Unit is continuing the existing practice of carrying out these services as an extension of their Port Health Duties. The volume of passenger traffic increased during the year, and during 1966, 11,938,817 passengers used the airport. In 1965 the total was 10,615,555. In accordance with the Commonwealth Immigrants Act, 12,516 Commonwealth passengers were referred for medical examination. Port Health Vaccinations against smallpox carried out at the airport have never been subdivided into passengers incoming and passengers outgoing, and the number of such vaccinations performed in 1966 was 7,140. This figure compares with 5,424 in 1965, 3,576 in 1964 and 1,656 in 1963. It may well be that the outbreak of variola minor in the midlands during the year required many more outgoing passengers on holiday to various countries in Europe to be vaccinated that gave rise to this increase. The number of advice notices to medical officers of health placing passengers under surveillance fell from 2,883 to 2,333, which tends to support this view. During the year, five passengers who had arrived in London without valid certificates of vaccination against smallpox had to be isolated as they had come from declared locally infected areas, and revaccination was medically contra-indicated in each case. 20 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport Statistics 1.1.66 to 30.6.66 1.7.66 to 31.12.66 Total Total number of aircraft arriving: 30,434 29,334 59,768 Number of passengers arriving:— British 1,073,759 921,776 1,995,535 Alien 679,268 881,381 1,560,649 Total 1,753,027 1,803,157 3,556,184 1966 1965 No. of aircraft issued with Disinsectization Certificates 3,272 3,452 No. of passengers and visitors sick and treated 1,915 1,723 No. of sick staff treated 2,588 2,561 No. of ambulance cases 1,424 1,566 No. of car cases 2,083 1,654 No. of cases in which Mental Welfare Officer was called 74 40 No. of Aliens inspected under Aliens Order 4,366 4,030 No. of Aliens refused entry 30 39 No. of Forms Port 12 issued 171 129 No. of Commonwealth Immigrants examined 12,516 13,249 No. of Commonwealth Immigrants refused entry 38 44 No. of Forms Port 23 issued 153 167 No. of Immigrants X-rayed 6,949 2,667 No. of Long-Stay Immigrant Notifications sent to Medical Officers of Health 21,158 25,639 No. of Surveillance Notifications sent to Medical Officers of Health 2,333 2,883 No. of Smallpox Vaccinations carried out 7,140 5,424 No. of Cholera Vaccinations carried out 186 85 No. of Yellow Fever Vaccinations carried out 30 12 No. of British Airports Authority employees medically examined 271 — Jan. 1st-June 30th Aircraft Passengers July 1st-Dec. 31st Aircraft Passengers Total Aircraft Passengers From Excepted Area 14,767 795,388 14,248 821,307 29,015 1,616,695 Europe Outside Excepted Area 7,023 405,755 7,158 462,970 14,181 868,725 North America 3,694 258,871 3,481 242,809 7,175 501,680 Central & S. America 536 49,282 400 38,736 936 88,018 Africa 1,470 77,449 1,313 75,510 2,783 152,959 Asia 2,944 166,282 2,734 161,825 5,678 328,107 Totals 30,434 1,753,027 29,334 1,803,157 59,768 3,556,184 21 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport AMBULANCE CASES Figures for ambulance cases show that there was a slight decrease in 1966, the total being 1,424, compared with 1,566 in 1965. On the other hand, the number of invalids to be carried by car rose from 1,654 to 2,083. Comparative figures of ambulance cases are:— 1966 1965 1964 (a) National Health Service 822 851 751 (b) Private Ambulance 520 599 492 (c) Service Ambulance 82 116 121 In addition, there were 119 patients off-loaded by B.A.A. ambulance, in transit from one aircraft to another, who were accommodated in the holding point in the Queen's Building between flights. MENTAL ILLNESS The number of mentally disturbed passengers given assistance during the year was 92—a considerable decrease from 1965, when the figure was 190. The Mental Welfare Officers were called on 74 occasions. MEDICAL INSPECTION OF ALIENS During the last three years the number of aliens referred to the medical inspectors more than doubled, and for the 12 months under review, 4,366 were seen. Of these, 3,367 came from countries in Europe, many of them being in domestic employment, and 999 came from outside Europe. Of the total, 4,045 were coming to the United Kingdom for periods of more than six months. Three hundred aliens were visiting for reasons of health or to seek medical advice. One hundred and seventy-one Forms Port 12 were issued, and 30 aliens who had been referred to the medical inspectors were refused entry. In 21 cases, there was some form of mental disturbance; three were refused owing to pulmonary tuberculosis, and the remainder for various other conditions. MEDICAL INSPECTION OF COMMONWEALTH IMMIGRANTS There has been relatively little change in the number of Commonwealth passengers referred for medical inspection by the Immigration authorities during the past three years. The figures are:— 1966 12,516 1965 13,249 1964 12,531 In 1966 there was a sharp fall in the number of those referred with vouchers and an equally sharp rise of those coming into the country for settlement. In 1965 the figure for voucher-holders referred for examination was 10,407, whilst for 1966 the figure was 4,585; the corresponding figures relating to those coming for settlement was 2,569 in 1965 and 7,690 in 1966. Amongst other categories of Commonwealth passengers referred, 219 were coming for reasons of health or treatment. In addition, there were 22 passengers referred by the Immigration authorities because they appeared to be ill. One hundred and fifty-three Forms Port 23 were completed during the year, and 38 immigrants were refused entry following referral to the medical inspectors. Pulmonary tuberculosis was the causal condition in 28 cases, and mental illness in six. As mentioned in previous reports, a number of passengers from Pakistan and India attempted to enter the country by misrepresenting their age in their passports. As before, the medical inspectors frequently were called upon to give an opinion as to the age of these young persons. In many cases, the passengers were referred for radiological investigation at Hillingdon Hospital. A new feature in 1966 was the number of men, who, according to their passports, were over 60 and who would therefore be 22 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport eligible to enter the country without possessing a voucher from the Ministry of Labour, but who were in fact considerably below the age stated. In this type of case radiology is of no assistance, and to decide whether an Indian or Pakistani is 58, 60 or 62 years merely on appearance is a difficult problem. It is an easier matter where there is a gross disparity. Analysis of Commonwealth passengers referred for medical inspection 1966 1965 1964 Pakistan 1,933 3,193 3,555 India 4,728 4,089 3,382 West Indies 1,919 3,401 2,617 Far East 1,186 770 861 West Africa 677 269 488 Malta 630 697 710 Canada, Australia, New Zealand and Rhodesia 287 215 226 Cyprus 146 264 335 East Africa 776 236 281 Other Territories 234 115 76 This analysis shows that during the year there has been a fall in immigration from Pakistan, the West Indies, Malta and Cyprus, and a rise from India, the Far East and East and West Africa. The number of notifications sent from the airport to medical officers of health advising them of the arrival in their areas of long-stay immigrants was 21,158, but it is a matter of conjecture how many of these immigrants gave in fact a true or accurate address at which they could be found. PULMONARY TUBERCULOSIS This condition is the main medical cause for refusal of entry to a passenger by the Immigration authorities. During the year 30 passengers were so refused, 14 of these from India, nine from Pakistan, two each from Hong Kong and the Caribbean, and one each from Italy, Ceylon and Tanzania. Three Indian immigrants were thought to have active tuberculosis but, despite recommendations for refusal, they were allowed to land as a result of representations to Central Government. Five passengers with active tubercle were landed and admitted immediately to hospital. Their countries of origin, respectively, were Iraq, Libya, Saudi Arabia, Nigeria and Ghana. In 221 cases destination medical officers of health were advised to refer the immigrant to the local chest clinic for follow-up or observation, and the position at 31st December was that 19 of these immigrants had been proved to be positive. More such cases may come to light later. X-RAY UNIT During the year a total of 6,949 immigrants were X-rayed, compared with 2,667 the previous year. Of these, 6,700 were Commonwealth citizens and 249 were Aliens. Four hundred and ninety-six immigrants were referred for X-ray from the Europa Passenger Building. The consultant radiologist visited the unit weekly to report upon the films taken during the previous seven days, and following his visit, destination medical officers of health were advised about the X-ray reports. SMALLPOX For the fourth consecutive year, no case of smallpox was reported, although a smallpox consultant was called on six separate occasions. 23 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport OTHER CONDITIONS There were three confirmed cases of typhoid reported during the year, in January, April and October, and in each case the passenger arrived at the airport during the stage of incubation and only sought medical advice some days afterwards. Other conditions were; one case of acute poliomyelitis (from Bahrain), three cases of chickenpox, and cases of measles, yaws, scabies and amoebic dysentery. FATALITIES During the year 10 deaths were recorded at London Airport. Of these, eight were from natural causes, one resulted from a traffic accident and one was a suicide. Two of the deaths occurred in flight; one was an American woman coming to the United Kingdom, whilst the other was a young baby suffering from advanced dehydration, flying from Venice, a journey which, considering the baby's condition, should never have been allowed. Of the remainder, five were sudden deaths occurring in men of middle or late-middle age and probably attributable to coronary disease. In two of these, one a visitor to the airport, and the other a B.E.A. driver, there was a history of thrombosis. The one remaining death involved a Maltese woman—a pre-booked stretcher case—for whom no hospital arrangements had been made, and who died whilst a hospital bed was being sought. AIRCRAFT EMERGENCIES The year passed, happily, without any incident. The number of aircraft movements in and out of the airport was 223,808; an increase of 17,808 over 1965. SECTION II Personal Health Services 27 Personal Health Services Co-operation with other Agencies concerned with the Personal Health Services In view of the amount of criticism which has been made of the tripartite nature of the health services, it is interesting to review the amount of co-operation which exists between this department and other bodies in the area. The catchment area of Hillingdon Hospital lies almost entirely within the Borough, so it is to be expected that most contact should be here. For some years a liaison health visitor has attended regularly in the maternity department. She is able to help ante-natal patients with information on local authority services available, to follow up defaulters and so on. During the year arrangements were made for a home nurse to visit the geriatric department twice a week to exchange information about old people about to be discharged from or admitted to the unit. This has proved extremely useful and has improved still further the relationship between the services. This arrangement was followed up by a general scheme for receiving direct instructions about other patients about to be discharged from hospital. The Superintendent of Home Nursing or her Deputy calls on the departmental sisters daily to discuss the home nursing needs of patients due for discharge and to contact the appropriate general practitioner. There is a regular interchange of information about specific matters with the paediatric department. The assessment of handicapped children is a specialist function of the borough medical officers and their detailed reports have proved useful to the paediatricians. There is close participation in the varied training programmes for nurses, midwives and health visitors in the schools of nursing at Hillingdon, Harefield and Mount Vernon Hospitals, and facilities are made available for the training visits required for the doctors' postgraduate Diploma in Child Health. For some years case conferences on certain families in the district have been held under the combined chairmanship of the Medical Officer of Health and the Children's Officer. Other services involved here include education, housing, probation, N.S.P.C.C. and the Ministry of Social Security. The pooling of information, ideas and manpower has proved useful to all involved. Service by the Medical Officer of Health and Senior Medical Officers on local hospital management committees has proved a useful exercise in gaining personal contact with hospital staff and also in disseminating information about the local authority services available. DAY NURSERIES There are four day nurseries in the Borough providing a total of 170 places, but in an emergency each nursery can accommodate an additional 10 children. This ensures that places are always available to cover crises, such as a mother's admission to hospital. Two nurseries are situated in Hayes; one in Nestle's Avenue and one, known as Peter Pan Day Nursery, in the Uxbridge Road. One nursery is at the rear of the Council Offices in Uxbridge High Street, and the remaining one is in Station Road, West Drayton. Three of the nurseries are approved as training schools for the National Nursery Examination Board's Certificate. The over-riding principle governing admission to a day nursery is that there shall be a health or social consideration in each case, and the majority of the children admitted come into one of these categories:— (a) the children of an unsupported mother, (e.g. unmarried, widowed, divorced or separated); (b) children whose home conditions are unsatisfactory from the health point of view; (c) children whose mothers are incapable of caring for them adequately; (d) handicapped children (i.e. partially, or completely deaf, maladjusted, or partially sighted). 28 Personal Health Services There was a steady demand for places throughout the year, and the average attendances were:— Quarter Ended No. of children on register at end of quarter Total Attendances Number of Days Open Average Daily Attendances Under 2 2-5 years Under 2 2-5 years Total March 44 135 2,418 6,308 8,726 64 136.4 June 51 130 2,266 6,649 8,915 62 143.8 September 49 141 2,439 6,641 9,080 65 139.7 December 46 144 2,038 6,962 9,000 63 142.9 9,161 26,560 35,721 CLINICS There are 10 purpose-built clinics in the borough, and sessions are also held in various hired premises. In addition there is a mobile clinic which operates at certain points convenient to the users. Purpose-Built Clinics Elers Road, Hayes. 1, 2, 3, 4, 5, 6, 9, 12. Grange Park, Lansbury Drive, Hayes. 1, 2, 3, 4, 5, 6, 7, 9. Harefield, Park Lane, Harefield. 1, 3, 4, 5, 9. Ickenham, Long Lane, Ickenham. 1, 2, 3, 4, 5, 9, 10. Laurel Lodge, Harlington Road, Hillingdon. 1, 2, 3, 4, 5, 6, 9, 13, 14. Minet, Coldharbour Lane, Hayes. 1, 2, 3, 4, 5, 6, 7, 9, 13. Oak Farm, Long Lane, Hillingdon. 1, 2, 3, 4, 5, 6, 9. Ruislip Manor, Dawlish Drive, Ruislip. 1, 2, 3, 4, 5, 6, 7, 9. Uxbridge, Council Offices, High Street, Uxbridge. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. West Mead, West Mead, South Ruislip. 1, 2, 3, 4, 5, 6, 7, 9, 13. Clinics in Rented or Adapted Premises Cavendish Pavilion, Eastcote. 1, 5. Harmondsworth, (Old School), Moor Lane, Harmondsworth. 1, 5. Haydon Hall, Community Building, Joel Street, Eastcote. 1, 2, 3, 5. Hayes End, Methodist Church Hall. 1, 5. Manor Farm, Ruislip. 1, 2, 3, 4, 5. Maurice Child Memorial Hall, Carfax Road, Hayes. 1, 5. Northolt Grange, Edwards Road, Northolt. 1, 5. (London Borough of Ealing premises.) Northwood, Ryefield Court, Ryefield Crescent. 1, 2, 3, 4, 5, 6, 9, 14. Queen's Hall, Station Road, Hayes. 1, 2, 5. Yiewsley, 20 High Street, Yiewsley. 1, 2, 3, 4, 5, 6, 9, 13. 29 Personal Health Services Mobile Clinic—Areas Served Barra Hall Circus. 1, 5. Charville Estate. 1. Cowley. 1, 5. Cranford Cross Estate. 1, 5. Harefield. 1. Harlington. 1, 5. Northwood, The Grange. 1, 5. Ruislip Gardens. 2, 5. Sidmouth Drive, South Ruislip. 1, 5. Sipson. 1, 5. Wise Lane Estate, West Drayton. 1. Yeading. 1, 5. Key to Services 1. Child Welfare 8. Orthoptic 2. Ante-natal 9. Dental 3. Mothercraft and Relaxation 10. Orthodontic 4. School Health 11. Orthopaedic 5. Immunisation and Vaccination 12. Physiotherapy 6. Speech Therapy 13. Chiropody 7. Ophthalmic 14. Cytology MATERNAL AND CHILD WELFARE The following clinics were in use during the year:— Purpose-built Adapted Occupied on a sessional basis Total 10+ Mobile 2 7 20 Ante-natal and post-natal clinics Ante-natal and post-natal clinics are provided at 15 clinics and 780 sessions were held during the year. Number of women in attendance Number of sessions held by Total Number of Sessions For ante-natal examination For post-natal examination Medical Officers Midwives 1,279 50 26 754 780 30 Personal Health Services Mothercraft and Relaxation Ante-natal mothercraft and relaxation classes are held at 14 clinics. Number of women who attended during the year (a) Institutional booked 655 (b) Domiciliary booked 397 (c) Total 1,052 Total number of attendances during the year 6,410 Child Welfare Clinics Provided by the Council Number of centres provided at end of 1966 Average number of child welfare sessions held per month Number of children who attended during 1966 and who were born in:— Total number of children who attended during 1966 Total attendances during 1966 1966 1965 1961-64 20 186 3,337 2,914 5,768 12,019 79,754 Care of the Unsupported Mother and Child This Borough has continued to share the services of an almoner with the London Boroughs of Ealing and Hounslow. Close liaison is maintained between the officers of the Health and Welfare Department, the almoner and the social workers of voluntary organisations in this field. The mothers are given intensive support during pregnancy, and arrangements are made for their confinement and their return to normal life. If the mother wishes to keep the child, she is given all possible advice and assistance, or if adoption is decided upon, then steps are taken to see that this is correctly carried out. Most mothers are concerned for their children and are anxious to make the best possible arrangements for their future. There is no Mother and Baby Home in Hillingdon, and the Council accepts responsibility for the maintenance of cases in the Homes of other Local Authorities, and in those of various voluntary bodies. The numbers of cases dealt with during the year were as follows:— 1966 1965 Admitted to Local Authority Homes 16 34 Admitted to Voluntary Homes 44 61 60 95 Interviewed, but not requiring admission to a Home 20 11 Priority Dental Service The trend, to which reference was made in the previous Annual Report, has continued. This is that there has been a gradual decline in the number of expectant and nursing mothers receiving dental treatment at clinics because a very large proportion seek treatment from their own private dental practitioners. Some young children received treatment, as in the previous year, and it is hoped that this tendency will continue. It is much better that young children are conditioned to the idea of having regular dental treatment rather than that they should only make the acquaintance of a dentist in emergency and merely for the relief of toothache. The one measure which would make a dramatic reduction in the amount of dental caries is fluoridation of water, but this measure seems to be as far away from implementation as ever. It should 31 PersonaI Health Services be pointed out that the average amount of fluoride naturally present in the water supply in this district is only 0.1 parts per million, whereas the ideal amount required is 1.0 parts per million. The dental officers carrying out the Priority Dental Service work also in the School Dental Service, and the shortage of dental personnel reacts equally on both of these services. PRIORITY DENTAL SERVICE STATISTICS Attendances and Treatment Children Under 5 Expectant and Nursing Mothers First visit 617 161 Subsequent visits 835 517 Total visits 1,452 678 Number of Additional Courses of Treatment Commenced 34 5 Treatment Provided: Number of fillings 1,331 509 Teeth filled 994 328 Teeth extracted 402 192 General anaesthetics 185 9 Emergency visits 52 4 Patients X-rayed — 22 Patients treated by scaling, etc. 19 45 Teeth otherwise conserved 281 — Teeth root filled — 5 Inlays — 4 Number of courses of treatment pleted during the year 370 109 Prosthetics Patients supplied with full upper or full lower (first time) 35 Patients supplied with other dentures 31 Number of dentures supplied 71 Anaesthetics General anaesthetics administered by dental officers 4 Inspections Children Under 5 Expectant and Nursing Mothers Number of patients given first tions 734 121 Number of patients who required treatment 476 111 Number of patients who were offered treatment 435 108 Sessions Number of dental officer sessions devoted to maternity and child welfare patients (for treatment) 384 32 Personal Health Services MIDWIFERY SERVICE The Borough has an establishment of 23 Midwives including a Non-Medical Supervisor and Deputy. During 1966 there were 1,049 domiciliary confinements; 261 patients were booked for home delivery but were delivered in hospital for various reasons. Of these, 198 were discharged before the tenth day and cared for at home, and in addition there were 122 cases of arranged early discharge of hospital patients. Midwives had to call for medical aid on two occasions, and in another case assistance was obtained from the emergency obstetric squad. Twenty-four pupils were accepted for practical training from the Hillingdon Hospital Midwifery Training School during the year. In addition, staff of the department co-operated with the hospital in lectures and demonstrations to student nurses taking the general nursing and other training courses. A table has already been given showing the work undertaken at ante-natal and post-natal clinics. Analgesia During Labour In February, 1966, as an experiment, two Entonox analgesic machines were introduced. These machines involve the use of cylinders of already mixed oxygen 50% and nitrous oxide 50%. The advantage over a nitrous oxide and air mixture is that an unvarying proportion of oxygen is always inhaled by the patient and a simple demand valve is used instead of a mixing unit which could be tampered with. The apparatus is also small and easier to carry about. All the midwives were given an opportunity of using these two machines from time to time, and a total of 52 patients used the machines during labour. HEALTH VISITING There is an establishment of 52 Health Visitors and Clinic Nurses, and at the end of the year a full-time equivalent of 49 was employed. The Superintendent Health Visitor and her Deputy are included in these figures. A comprehensive health visiting service is available to members of the public and covers all aspects of health and welfare. Selective visiting to the homes of young families, the handicapped and the aged makes assessment of individual and family needs apparent and presents the opportunity to advise as to the appropriate service or agency that might assist. Being in continual contact with mothers and young children, the health visitor is often the first person to detect deviation from normal health—particularly in the "at risk" groups. During periods of stress advice, guidance and reassurance are offered in an endeavour to prevent mental, physical and emotional ill-health and their consequences. This supportive role is emphasised in the six-monthly visits to families having a mentally subnormal child. Health visitors continue this family contact until the child is approximately 16 years of age when his needs can be further helped as an adult by the mental welfare officers of the department. The medico/social qualifications of the health visitor equip her to be the link between various statutory and voluntary agencies; further, she is also a most important link in joining together the work of the three branches of the National Health Service. For the sixth year a health visitor on behalf of all her colleagues has maintained contact with the Maternity Unit at Hillingdon Hospital. Appreciation of this link has been expressed by the mothers themselves who now know of other services than those offered by the hospital. Similarly, a health visitor has been nominated as the link between the Health and Welfare Department and the Paediatric Unit at Hillingdon Hospital, and it is hoped that this service will develop as the maternity liaison mentioned above has done. Day to day co-operation with family doctors is becoming established with a more complete understanding of each other's role—again resulting in a better service to the public. Health education for expectant mothers is offered in 14 clinics throughout the Borough, and classes for fathers in two clinics; health visitors undertaking the major part of these sessions. 34 Personal Health Services A Fathercraft class 35 Personal Health Services Health education has been given to other groups such as youth clubs and senior pupils in the Borough's schools. The revised training for health visitors is now fully established, and six students, one of whom was sponsored by the Borough, received their practical training under the supervision of the field work instructors. All the students were successful in their examinations. In August, two of them joined the health visiting staff, and in September, five new students, all sponsored by the Borough, commenced their training at Chiswick Polytechnic with arrangements for practical training in the borough under the guidance of the field work instructors. Health Visiting Statistics The following cases were visited by the Health Visitors during the year:— Cases Visited Number of Cases 1. Children born in 1966 4,118 2. Children born in 1965 3,621 3. Children born in 1961-64 8,505 4. Total number of children in lines 1-3 16,244 5. Persons aged 65 or over 460 6. Number included in line 5 who were visited at the special request of a G.P. or hospital 79 7. Mentally disordered persons 74 8. Number included in line 7 who were visited at the special request of a G.P. or hospital 24 9. Persons, excluding Maternity cases, discharged from hospital (other than mental hospitals) 43 10. Number included in line 9 who were visited at the special request of a G.P. or hospital 16 11. Number of tuberculous households visited 2 12. Number of households visited on account of other infectious diseases 37 13. Number of tuberculous households visited by tuberculosis visitors 413 HOME NURSING There is an establishment of 30 home nurses in the Borough, but at the end of the year only 28 were in post. They nursed 3,281 patients during the year, and of these 2,184 were over the age of 65 years. Comparative figures for last year are given in the table overleaf. These were not all chronic cases, but these figures give some indication of the increasing proportion of geriatric work undertaken in the home. Obviously, every effort is made to keep elderly persons in familiar surroundings for as long as possible and thus relieve pressure on hospital beds, but this aim would not be achieved without the constant devotion to duty shown by the home nurses. The Council operates a scheme in conjunction with the British Red Cross Society for the loan of nursing equipment, and during the year 1,692 loans were made. 36 Personal Health Services Home Nursing 1965 1966 Total number of persons nursed during the year 3,121 3,281 Number of persons who were aged under 5 at first visit 58 46 Number of persons who were aged 65 or over at first visit 1,995 2,184 DIPHTHERIA IMMUNISATION I am happy to report that there have been no cases of diphtheria in the Borough area since 1949. The following table shows the reduction brought about by immunisation, and the saving in human suffering, hospital accommodation and nursing is immeasurable. I must emphasise, however, that only by maintaining a high level of immunisation will this disease be held in check. Year Deaths Cases England and Wales Hillingdon area England and Wales Hillingdon area 1940 2,480 8 46,281 126 1945 722 — 25,246 1 1950 49 — 962 - 1955 13 — 155 - 1960 5 — 49 - 1965 — — 26 - 1966 5 - 19 - 37 Personal Health Services POLIOMYELITIS VACCINATION The following table shows the number of vaccinations carried out during the year under arrangements made by the Council. Year of Birth Primary Courses Reinforcing Doses Salk Injection Sabin Oral Total Salk Injection Sabin Oral Total 1966 56 582 638 — — — 1965 150 2,180 2,330 106 82 188 1964 31 361 392 86 143 229 1963 7 152 159 22 51 73 1959-62 10 298 308 285 2,111 2,396 Others under age 16 5 121 126 27 155 182 Totals 259 3,694 3,953 526 2,542 3,068 VACCINATION AGAINST SMALLPOX Vaccination against smallpox is performed on request, without charge, by doctors who have signified their willingness to carry out this work under the National Health Service Act, 1946. In addition, in certain cases, vaccination can be carried out at the Council's clinics. The vaccination of all healthy infants is recommended. During the year the following vaccinations of children were undertaken:— Age Vaccination Re-Vaccination Under 3 months 110 — 3-6 months 88 — 6-9 months 151 — 9-12 months 216 — 1 year 1,382 — 2-4 years 589 97 5-15 years 149 571 Total 2,685 668 38 Personal Health Services The aforementioned figures include 151 children vaccinated and 384 children re-vaccinated at London Airport. No records are available of adults vaccinated by their general practitioners. Vaccination at London Airport In 1966 there were 6,605 adult persons vaccinated. Not all these vaccinations were performed on arriving passengers as in certain circumstances it was necessary to vaccinate outgoing passengers. Vaccination Against Measles The first results of the Medical Research Council investigation of measles vaccines undertaken in 1964 and 1965 were published during the early part of the year. These showed a high degree of protection and indicated that the procedure is worth undertaking. The Ministry, as yet, has made no recommendation that measles vaccination should be offered as a routine. It was, however, recommended strongly in the case of children already attending day nurseries, and all new entrants prior to admission. Family doctors can carry out this vaccination, if they decide it is in the best interest of their patients. The following table shows the numbers of children immunised during the year at Council Clinics or by private medical practitioners. YEAR OF BIRTH Primary Immunisation Reinforcing Injections Diphtheria only Whooping Cough only Tetanus only Combined Diphtherial Whooping Cough Combined Diphtherial Tetanus Combined Diph theria/ Tetanus/ Whooping Cough Quadrilin Diphtheria only Whooping Cough only Tetanus only Combined Diphtherial Whooping Cough Combined Diphtherial Tetanus Combined Diphtherial Tetanus/ Whooping Cough Quadrilin 1966 — — — — 20 1,748 3 — — — — — — — 1965 — — 1 — 40 1,571 70 — — — — 129 487 — 1964 — — — — 31 218 9 2 — 1 — 275 1,003 13 1963 — — 2 — 35 58 — — — — — 120 104 4 1959-62 — — 43 — 84 59 — 10 — 15 — 1,908 474 19 Others under age 16 — — 389 — 38 3 — 4 — 35 — 941 106 2 Totals — — 435 — 248 3,657 82 16 — 51 — 3,373 2,174 38 Personal Health Services 39 40 Personal Health Services HOME HELP SERVICE The number of Home Helps employed at the end of the year was 128 but as many of these were only part-time, it was the equivalent of 81 full-time workers. As the proportion of elderly people increases (from whom come the majority of the requests for assistance), and the opportunities for employment outside the home become ever more varied, it is unlikely that recruitment of home helps will ever keep pace with the demand. The main effort has, therefore, to be directed to dealing with the really needy cases. The standard charge for this service remained at 4s. 9d. per hour throughout the year, but all persons unable to pay this were assessed in accordance with the Council's scale. Recipients of Supplementary Allowances (National Assistance) are allowed a nil assessment, as are patients suffering from toxaemia of pregnancy. The Neighbourly Help Service, which allows for the payment of up to £2 per week to someone undertaking household duties for a sick or elderly neighbour, continued during the year. A summary of the help provided is given below:— Aged 65 or over Aged under 65 Total Chronic sick and tuberculosis Mentally Disordered Maternity Others Number of Cases 721 140 10 172 158 1,201 TUBERCULOSIS—CARE AND AFTER CARE The catchment area of the Uxbridge Chest Clinic has never been coterminous with the area of Hilingdon Borough, and in fact in recent years a considerable proportion of its work has been concerned with Southall. With the completion of the new Hillingdon Hospital it was proposed that in future the Chest Clinic should be based there, and in order to reduce the pressure of work it was decided to divide the catchment area so that the northern part of the borough should be covered by a clinic based at Mount Vernon Hospital. Arrangements were made to have health visitor and tuberculosis visitor cover at both clinics. The welfare officer returned from sick leave at the beginning of the year and resumed her attendance at the Chest Clinic for one day a week. During the year 228 cases were dealt with and of these 121 were tuberculous; of the non-tuberculous cases 44 were carcinoma and 63 chronic bronchitis and other conditions. Housing problems were still very much to the fore and 20 cases of housing difficulty were referred for investigation. The delivery of free milk was arranged to five tuberculous patients during the year, and recommendations from the Chest Physician for five recuperative holidays were dealt with. The National Society for Cancer Relief considered sympathetically all cases recommended to them for assistance, and they donated a total of £377 during the year. The Patients' Aid Society was wound up during the latter part of 1966 before the removal of the Chest Clinic to Hillingdon Hospital. From this fund £25 was distributed to patients during the summer holiday period and the balance later in the year to patients who had not previously received any financial help through the Clinic. A donation of £25 from the Metropolitan Hospital Fund was distributed among 20 patients at Christmas time. 41 Personal Health Services CHIROPODY Chiropody treatment is provided by qualified chiropodists at the following clinics:— Minet, Coldharbour Lane, Hayes. Laurel Lodge, Harlington Road, Hillingdon. West Mead, West Mead, South Ruislip. Yiewsley, 22 High Street, Yiewsley. Elm Park Old Persons' Club, Eastcote. In addition, domiciliary visits are arranged for housebound persons, and chiropodists pay regular visits to the residents in the Council's Welfare Homes. The facilities are available to pensioners, expectant and nursing mothers, children under five years of age, school children and physically handicapped persons. The voluntary organisations have an important part to play in the chiropody service. Ruislip/ Northwood Old Folks Association arranges sessions at Brackenbridge House Aged Persons' Home, attendance at chiropodists' surgeries and domiciliary visits. Uxbridge Old People's Welfare Association arranges sessions at Fassnidge Hall, Uxbridge. The British Red Cross Society, Ruislip Division, arranges sessions at Dawlish Drive, Ruislip Manor. Attendances at the Council's Clinics were as follows:— Aged Persons 2,245 School Children 1,034 Others 25 3,304 In 1965 a total of 2,608 attendances were made at the Council's Clinics. RECUPERATIVE HOLIDAYS Following recommendations from general practitioners and hospital medical staff, arrangements were made for 45 persons (adults and children) to be admitted to recuperative holiday homes. A few applications were withdrawn, one or two people were not well enough to travel when the time came, and eventually 33 holidays were arranged. The usual recuperative holiday lasts a fortnight. In eight cases the "full cost" was paid, and the remainder were charged in accordance with the Council's assessment scale. SECTION III Community Care - Welfare Services 45 Community Care Welfare Services The Chief Welfare Officer, Mr. J. L. Stoker, reports:— WELFARE OF THE AGED This involves the care of aged persons in their own homes as well as in residential accommodation provided either by the Council or by voluntary organisations, and homes run for profit. In all 1,196 visits were made by welfare staff to aged persons living in their own homes, most of them being referred with a view to the provision of residential accommodation. In addition to the statutory arrangements, voluntary organisations have assisted greatly in caring for the elderly in their own homes. The four Old People's Welfare Committees continue to flourish. Services provided include:— Elm Park Recreation and Dining Club, Ruislip. Fassnidge Hall Social Centre, Uxbridge— light meals provided. Chiropody. Meals on Wheels. Visiting service. Christmas parcels. Holidays. Outings. Hairdressing at reduced prices. The Old People's Welfare Co-ordinating Committee met on three occasions during the year to discuss common problems, and a draft booklet was prepared giving information regarding all the services available to elderly people in the Borough. Other matters, including the preparing of budget estimates for committees, were also discussed. Much assistance has been given also by the Red Cross and Women's Royal Voluntary Service in running clubs and providing meals on wheels, and chiropody, and other organisations such as Rotary Clubs, Round Table and Toc H give valuable support. There has been very good liaison between the officers of the Council, hospital geriatric services and voluntary workers so that the best possible service could be offered to old people and the transition from home to "Home" or hospital, or vice versa, was achieved as smoothly as circumstances permitted. Residential Homes for the Aged The Council's Residential Homes at 31st December, 1966, were:— Name of Home Address No. of Beds Male or Female Designated or Non-Designated Coaxden Park Road, Uxbridge 23 Male N.D. Farnham Common House Farnham Common, Bucks. 30 Mixed N.D. Franklin House The Green, West Drayton 49 Mixed Designated Moorcroft Harlington Road, Uxbridge 67 Mixed N.D. Rushymead Coleshill, Nr. Amersham, Bucks. 50 Mixed N.D. Ryefield Ryefield Avenue, Uxbridge 35 Mixed N.D. Whitby Dene Whitby Road, Eastcote 62 Mixed Designated The Burroughs Mill Road, West Drayton 48 Mixed Designated N.B.—Designated Homes have qualified nursing staff and can deal with the more infirm cases. 46 Community Care A new residential Home, "The Burroughs", Mill Road, West Drayton, was opened on 4th April, 1966. This is a purpose-built, designated Home accommodating 48 persons. It is comfortably furnished throughout in modern style and has all the facilities needed to deal with the very infirm. The Home was completely occupied before the end of the year. On 31st December, 1966, there were 322 residents in the eight residential homes administered by the Council (68 males and 254 females). Of these 15 were the financial responsibility of other Local Authorities. In addition, the Hillingdon Borough Council was maintaining 88 persons (32 males and 56 females) in homes administered by voluntary organisations and 15 in other Local Authority Homes. The following is a summary of admissions and discharges during the year:— To where discharged Admissions Total Discharges Hospital Deaths Home Address Other Address Borough Homes 131 125 58 48 7 12 Voluntary Homes 29 23 8 11 3 1 Other Authority Homes 5 4 — 2 2 — During the year under review close liaison was maintained with the Geriatric Department of Hillingdon Hospital. Aged persons in Welfare Homes who became in need of permanent specialised nursing care were admitted to geriatric wards. Others were admitted on a temporary basis and later returned to the Homes. Some who had been admitted to hospital from their own homes with acute illness were, on discharge from hospital, admitted to Welfare Homes because they were unable to manage alone. Details:— Number permanently discharged to hospital 38 Number discharged and subsequently returned to Residential Home 20 Number of new cases admitted from hospital 23 Short-Stay Admissions In addition to the admissions noted above, 52 persons (16 males and 36 females) were admitted as short-stay residents during the year, mainly to allow relatives to have a rest or holiday, but also to deal with emergencies such as the sudden admission of a relative to hospital. Homes Administered by Voluntary Organisations In 1966 there were four Homes for the Elderly in the Borough which were administered by Voluntary Organisations:— Brackenbridge House, Ruislip. Elmfield, Fairfield Road, Uxbridge. Denefield, Northwood. (Short-stay Home). Denville Hall, Ducks Hill Road, Northwood. Ruislip and Northwood Aged People's Housing Society. British Red Cross Society. British Red Cross Society. The Actors' Charitable Trust. These Homes have all been inspected during the year by a senior medical officer. 47 Community Care Private Homes for the Aged There are four privately run homes for the aged in the Borough. These are registered and are subject to inspection by authorised officers as regards staffing, facilities provided, number of residents accommodated, etc. Old People's Workshop Early in 1966 the Rotary Club of Yiewsley and West Drayton opened a workshop for elderly persons in West Drayton. This was a very pleasant, purpose-built workshop in Station Road. The Centre was handed over to the Council from 1st April, 1966, and is now administered and staffed by the department. Approximately 20 elderly people attend daily and carry out work which is provided by local industry. Number of Persons in Residential Accommodation at 31st December, 1966, in Various Age Groups and Types of Home Local Authority Number of Residents in Age Groups Under 30 30 to 49 50 to 64 Total Under 65 65 to 74 75 to 84 85 or over Total 65 or over All Ages England/Wales 1,091 2,466 7,849 11,406 19,783 43,295 28,837 91,915 103,321 London Boroughs 172 305 1,112 1,589 3,253 8,121 5,709 17,083 18,672 Hillingdon 3 5 20 28 44 206 132 382 410 Local Authority Number of Residents in Various Types of Home L.A. Homes With Bed Complement Joint User Voluntary Under 31 31 to 50 51 to 70 71 to 150 Over 150 England/Wales 12,486 31,189 17,463 9,304 9,094 8,658 15,127 London Boroughs 1,219 2,186 3,400 3,163 3,813 21 4,870 Hillingdon 37 174 111 — — — 88 Number of Persons in Residential Accommodation at 31st December, 1966, Summarised According to Major Handicap Local Authority Persons Under Age 65 Blind Deaf Epileptic Physically Handicapped Mentally Subnormal Mentally III Other Persons Total England/Wales 776 275 2,038 4,532 1,908 561 1,316 11,406 London Boroughs 131 47 190 821 127 32 241 1,589 Hillingdon 3 2 13 1 1 8 28 Local Authority Persons Aged 65 and Over Blind Deaf Epileptic Mentally Handicapped Other Persons Total England/Wales 7,357 3,254 1,107 10,494 69,703 91,915 London Boroughs 1,299 599 127 1,276 13,782 17,083 Hillingdon 29 21 1 29 302 382 48 Community Care Percentages of Persons in Residential Accommodation at 31st December, 1966, in Various Age Groups and Types of Home Percentages of Residents in Age Groups Residents Age 65 or Over per 1,000 population Aged 65 or Over Local Authority Percentages of Residents in Various Types of Home Under 65 65 to 74 75 to 84 85 or over L.A. Homes with Bed Complement Joint User Voluntary Under 31 31 to 50 51 to 70 71 to 150 Over 150 11.0 19.2 41.9 27.9 15.5 England/Wales 12.1 30.2 16.9 9.0 8.8 8.4 14.6 8.5 17.4 43.5 30.6 17.1 London Boroughs 6.5 11.7 18.2 17.0 20.4 0.1 26.1 6.8 10.7 50.3 32.2 18.2 Hillingdon 9.0 42.4 27.1 — — — 21.5 HOMELESS FAMILIES The Borough has two hostels for homeless families; Highgrove House at Eastcote and Mead House at Hayes, the latter being a rehabilitation hostel where specialised instruction is given. Highgrove House has accommodation for 15 families and Mead House for nine families. During 1966, 38 families were admitted to temporary accommodation. These were all residents of the Borough or families arriving homeless at London Airport. Details of admissions and discharges are:— Highgrove House—Families Admitted Rehoused by Hillingdon Discharged rehoused by other L.A. Discharged to other address To Mead House 29 9 2 11 5 Mead House—Families 9 8 — 1 — At 31st December, 1966, the total number of persons in the Hostels was as follows:— Highgrove House 9 Men 11 Women 41 Children Mead House 6 Men 8 Women 30 Children Included in the above figures are 10 cases which arrived at London Airport. Altogether 173 enquiries were received from families who were homeless or about to become homeless. The department was able to advise many of these families who eventually were able to solve 49 Community Care their own problems. The Social Welfare Officer dealing with homeless families and families at risk continued his efforts to prevent evictions by giving intensive support in appropriate cases. Throughout there was close liaison with the Housing Department and the other agencies concerned with these families. WELFARE OF THE PHYSICALLY HANDICAPPED On 31st December, 1966, 525 persons who were permanently and substantially handicapped were on the Register maintained by this Borough under Section 29 of the National Assistance Act, 1948. During the period under review, there were 109 new registrations, and 72 names were removed, leaving 562 persons registered at 31st December, 1966. In addition to the above, there are 98 people who are on the register of deaf persons but who have no other disability. Adaptations In order to assist them in their daily living, adaptations were carried out in the homes of 40 handicapped persons at a total cost of £1,276 16s. 10d., of which £197 8s. 5d. was recoverable. The adaptations included the installation of handrails, the provision of ramps, widening of doorways and alterations to bathrooms and toilets. Aids Aids were issued to 183 persons at a total cost of £485 16s. 3d., of which £44 16s. Od. was recoverable. Work Centre The Work Centre for Handicapped Persons at the Lynch, Uxbridge, provides an opportunity for over 40 handicapped persons to work for three hours a day for five days a week carrying out work which is provided by local industry. Transport is provided by the Council and by one of the firms providing work. Some of the handicapped persons use public transport, and others travel in their invalid cars. Those who are in receipt of sickness benefit have their earnings limited to 39s. l1d. per week, but the attendance at the work centre is considered to be of considerable therapeutic value. Handcraft Classes Handcraft Classes for handicapped persons are held in Uxbridge, Hayes and Eastcote each week, in conjunction with the British Red Cross Society. The Council assists with transport. Attendances average:— Eastcote—31 Uxbridge—28 Hayes—21 Choral Class There is no choral class for the handicapped held in this Borough, but on average 19 persons from Hillingdon attend a choral class in Greenford, and transport is provided. Gardening Class A gardening class for handicapped persons is held at Norwood Hall, Southall, each week and 10 handicapped people from the borough attend. Transport is provided. Holidays Holidays were arranged for 57 handicapped persons. The majority of these were at a holiday home at St. Leonard's-on-Sea or a guest house at Bognor Regis. A number of the department's staff provided the necessary help and they were assisted by members of the British Red Cross Society. 50 Community Care Car Badges Special badges were issued to 23 handicapped persons who drive invalid cars or adapted vehicles. These badges are easily identifiable and enable the police to assist the handicapped persons to park their vehicles. Visits Social Workers made 2,352 domiciliary visits to handicapped persons during the year. WELFARE OF BLIND AND PARTIALLY-SIGHTED PERSONS During the year changes in the register of blind and partially-sighted persons occurred as follows No. on Register 31.12.65 Additions Removals No. on Register 31.12.66 Blind 310 52 29 333 P.S. 112 14 17 109 Total 422 66 48 442 Of the 31 removed from the register, 22 were due to death and nine for other reasons. Of the 17 partially sighted people removed from the register, seven were because of death, seven were transferred to the blind register, and three removed for other reasons. This is a table showing the age groups of persons on the Blind Register at 31st December, 1966:— 0 I 2 3 4 5 to 10 11 to 15 16 to 20 21 to 29 JO to 39 40 to 49 50 to 59 60 to 64 65 to 69 70 to 79 80 to 84 85 to 89 90 and over Total M — — — — — 3 3 — 4 7 18 9 7 20 29 13 12 7 132 F — — 1 — 1 — 2 4 5 5 6 20 18 11 48 30 25 25 201 Total — — 1 — 1 3 5 4 9 12 24 29 25 31 77 43 37 32 333 This table shows the age at onset of blindness:— 0 1 2 3 4 5 to 10 11 to 15 16 to 20 21 to 29 30 to 39 40 to 49 50 to 59 60 to 64 65 to 69 70 to 79 80 to 84 85 to 89 90 and over Total M 14 2 — — 1 5 5 5 10 15 10 9 13 9 20 9 3 2 132 F 13 3 3 — 1 1 6 2 5 11 16 27 15 10 58 18 12 — 201 Total 27 5 3 — 2 6 11 7 15 26 26 36 28 19 78 27 15 2 333 The Burroughs, Mill Road, West Drayton Community Care 51 A bedroom at The Burroughs Community Care 53 Community Care Information regarding Employment M F Total Employed in Sheltered Workshop 1 1 2 Employed in Homeworker Schemes 4 5 9 Employed under ordinary conditions 34 8 42 Total employed 53 Unemployed, but capable of and available for work 2 1 3 Not available for work 2 25 27 Not capable for work 6 18 24 Not working, 65 and over 76 137 213 With regard to the partially-sighted register, the age groups are as follows:— 0 to 1 2 to 4 5 to 15 16 to 20 21 to 49 50 to 64 65 & over Total M — — 5 4 14 4 8 35 F — — 4 5 11 11 43 74 Total — — 9 9 25 15 51 109 Seven cases were transferred to the blind register during the period under review. Seven partially-sighted children from the Borough attended special schools, and two attended ordinary schools. Clubs and Classes for Blind and Partially-Sighted Persons Uxbridge Handcraft Class is held once a fortnight on Thursday from 2.00-4.00 p.m. at the Providence Church Hall, The Lynch, Uxbridge. Transport is provided. Ruislip Handcraft Class is held fortnightly on Thursday from 2.00-4.30 p.m. at Ruislip Manor Clinic, Dawlish Drive, Ruislip Manor. Transport is provided. Uxbridge Social Club is held on the first Saturday in each month from 3.00-5.00 p.m. at the Bailey Hall, Congregational Church, High Street, Uxbridge. Voluntary transport is provided. Ruislip Social Club is run by the Toc H on alternate Saturdays from 3.00-5.00 p.m. at the Toc H Hall, Manor Farm, Ruislip. Voluntary transport is provided. Hayes Social Club is held fortnightly on Mondays from 2.30-4.00 p.m. at Queen's Hall, Station Road, Hayes. Other classes, such as gardening, cookery and dancing, are held outside the Borough and are attended by Hillingdon residents. Transport is arranged for these classes. A few registered blind persons are employed each day at the Uxbridge Work Centre for the physically handicapped. Holidays Financial assistance was given to 24 blind and partially-sighted persons and 12 escorts were provided. Some of these holidays were at special holiday homes administered by Voluntary Blind Associations, and others were privately arranged holidays. The persons assisted were in receipt of Social Security Benefit or had low incomes. White sticks were supplied by the Rotary Clubs to all blind persons who required them. Other apparatus was obtained through the Royal National Institute for the Blind. 54 Community Care Radio Sets Acting on behalf of the British Wireless for the Blind Fund, the department issued 32 new sets and two secondhand sets to blind persons during the year. The Council keeps the sets in repair and provides batteries when required. Wireless licence exemption certificates were supplied to 41 new cases. Deaf Blind Persons There are two persons on the register who are deaf blind, and two who are deaf/partially-sighted. These people need special attention, and this Borough is sharing the services of a specialist Deaf Blind Home Teacher who is employed by the London Borough of Richmond-upon-Thames. A special holiday at Littlehampton was arranged for the deaf blind during the summer and two persons from this Borough were included. Guide Dogs for the Blind Association One blind person from the Borough received a guide dog. Domiciliary Visits During the year, Home teachers of the Blind made 1,831 domiciliary visits to blind and partiallysighted persons. Middlesex Association for the Blind This voluntary association continued to give valuable support to the blind and partially-sighted persons in the Borough, both by assisting financially and by organising various functions of interest to them. Industrial Rehabilitation In conjunction with the Ministry of Labour, arrangements were made for three persons from the Borough to undergo a period of industrial rehabilitation. Two of these have since been found employment by the Blind Persons Resettlement Officer of the Ministry. PEACE-TIME EMERGENCIES The Council has a scheme for providing temporary shelter for large numbers of people who may be rendered homeless by fire, flood, air disaster or other emergency. Various meeting halls and Civil Defence premises have been earmarked for this purpose, but during the year it was not necessary to use any of them. 55 Community Care BURIALS AND CREMATIONS Section 50 of the National Assistance Act, 1948, imposes on the Council the duty to arrange for the burial or cremation of the body of any person who has died or been found dead, within the Borough, where no other suitable arrangements have been or can be made for disposal. During the year the Council became responsible tor the burial of 14 persons. The following is a summary of the action taken:— (a) Cases where funeral expenses have been fully recovered 8 (b) Cases where part only of the expenses have been recovered 4 (c) Cases where full cost has been borne by the Council 2 £ s. d. Cost of the 14 burials 339 8 0 Amount recovered 273 3 1 Cost to the Council 66 4 11 The above list shows total funeral arrangements under Section 50. The breakdown is as follows:— Section 50(1) Section 50(3) Total (a) 3 5 8 (b) 1 3 4 (c) 2* — 2 6 8 14 £ s. d. £ s. d. £ s. d. Cost of burials 126 5 0 213 3 0 339 8 0 Amount recovered 92 3 5 180 19 8 273 3 1 Cost to the Council 34 1 7 32 3 4 66 4 11 *Two stillborn children. PROTECTION OF MOVABLE PROPERTY Action was taken under Section 48 of the National Assistance Act, 1948, in respect of six patients who were in hospital and where no other arrangements could be made. SECTION IV Community Care - Mental Health 59 Community Care Mental Health STATISTICS RELATING TO THE SUBNORMAL AND SEVERELY SUBNORMAL Number of subnormals cared for in the community at the end of 1966 362 Number of subnormal patients from this Borough in hospital 247 Number of subnormals, adults and children, awaiting admission to hospital at the end of the year 25 Number of children attending the Junior Training Centre 80 They came from the following districts:— L.B. of Richmond L B. of Hounslow L.B. of Hillingdon L.B. of Ealing L.B. of Brent L.B. of Harrow L.B. of Barnet Surrey C.C. 1 4 46 23 2 — 2 2 There were 26 children in the Special Care Unit:— — • 20 3 — 2 — 1 and 19 in the Weekly Boarding Unit:— 1 1 6 2 2 2 2 3 A total of 95 trainees attended Moorcroft Adult Training Centre:— — 16 48 4 — — — 27 and 117 attended the Uxbridge Adult Training Centre:— — — 27 7 20 47 16 — Bourne Hostel During the year progress was made towards the completion of this hostel, and it was expected that the first patients would be received early in 1967. MENTAL ILLNESS Domiciliary care of persons suffering from mental illness and support to their families was maintained by the field staff of the Mental Health Section during 1966. This was a year of consolidation following the trying period of mid-1965, when the available staff comprised the Chief Mental Welfare Officer and his Deputy only. The field staff now consists of:— The Chief Mental Welfare Officer, The Deputy Chief Mental Welfare Officer, Five Mental Welfare Officers. It was found possible to maintain a much closer degree of contact not only with the patients and their families, but also with hospital medical staff and social workers. There were welcome signs that psychiatric hospitals are becoming increasingly aware of the services offered by local authorities in the field of community care. Close contact was maintained with family doctors and other interested agencies. 60 Community Care There was a steady increase in the number of cases referred for assistance, some from general practitioners, but most from hospital doctors requesting after-care visits. It is of interest to note that whereas in the period 1st April, 1965 to 31st December, 1965, 67 cases were referred for after-care, during 1966 there were 189 such referrals. It may safely be assumed that this upward trend will continue, and that in the near future consideration will need to be given to a revision of the mental health field staff establishment. Contact has also been maintained with the families of subnormal adults, and here again more intensive visiting has been possible. Those families in which there was a subnormal child have continued to be visited at regular intervals by health visitors. Active support has continued to be given to the residents of Hayes Park Hostel, and the staff also have been given help wherever possible in their dealings with the residents. Liaison has also been maintained with both voluntary and statutory community care agencies. The Borough mental health service is, of course, available to assist mentally ill persons arriving at London Airport. During 1966 a total of 74 cases were dealt with at the Airport—the majority during out-of-office hours. With the continuing increase of traffic at the Airport this is another facet of the mental health work which will increase. This is a summary of the cases dealt with by the Mental Welfare Officers:— Number of Mentally 111 Patients Referred During the Year Referred by Under Age 16 Aged 16 and over Total M F M F General Practitioners — 1 68 145 214 Hospitals, or discharged from In-Patient treatment — — 71 118 189 Hospitals, after or during Out-Patient or day treatment — — 12 29 41 Local Education Authorities — 1 — — 1 Police and Courts 2 — 24 9 35 Other Sources 2 — 97 74 173 Total 4 2 272 375 653 Work of Mental Welfare Officers (a) Mental Illness Visits made by Mental Welfare Officers 2,083 Compulsory Admissions to Psychiatric Hospitals 193 Informal Admissions to Psychiatric Hospitals 77 Office Interviews 170 (b) Mental Subnormality Visits to those under Borough Community Care 868 Office Interviews 40 SECTION V General Services 63 General Services HOUSING ALLOCATION—MEDICAL GROUNDS The Housing Points Scheme allows the allocation of "points" on medical grounds in certain cases. In the main, these grounds are chronic illness, infection or disability affecting either the applicant, a member of his household or another occupant of the dwelling in which he is living at the time. A doctor's certificate must be submitted for consideration by the Medical Officer of Health. In many instances the general practitioner is consulted personally and any hospital attended by the patient may be approached for an up-to-date report on the condition. Any officer of the Health and Welfare Department who knows the family circumstances will be consulted also. Only after very careful consideration of the medical, social and housing factors involved is any recommendation made. On the recommendation of the Medical Officer of Health, and subject to the confirmation of the Housing Committee, 5, 10 or 15 "points" may be awarded. Applications for transfer from one Council property to another are referred to the Medical Officer of Health, if the transfer is required to alleviate a medical condition. The following cases were dealt with during the year:— No. of Cases Referred Recommendations made for "Medical Points" New applications 398 115 Transfers 119 40 MASSAGE AND SPECIAL TREATMENT All premises used for the reception or treatment of persons requiring massage or special treatment must be licensed and inspected. In this Borough this is carried out by a senior medical officer. In all instances the premises and facilities were found to be satisfactory. Twenty-three licences were issued with standard conditions approved by the Council, as shown in the following summary:— Treatment Carried Out Number of Premises Chiropody 16 Chiropody, massage, radiant heat, and infra-red (below knee) 2 Chiropody, physiotherapy 1 Physiotherapy 1 Physiotherapy, manipulative therapy 1 Massage, chiropody, electric treatment, radiant heat, electric, vapour or other baths, manipulative therapy 1 Massage, manicure, electric treatment, radiant heat, electric, vapour or other baths, manipulative therapy 1 64 General Services MEDICAL EXAMINATION OF STAFF All staff are required to complete a medical history form before appointment. From the information given it may be decided that the candidate is fit to carry out the duties of the appointment, or it may be considered necessary for the candidate to be given a medical examination to determine his fitness. Approximately 19% were so examined. Employees with a history of illness who are being considered for admission to the Manual Workers Sickness Pay Scheme are examined to assess whether they should be excluded from the benefits of this scheme when suffering from that particular illness. Thus those who might otherwise fail to qualify for admission to the scheme can be granted sick pay when absent as a result of other conditions. Medical examinations are also carried out in accordance with the requirements of the Department of Education and Science. This applies to teachers who have not been employed as such previously by a local education authority in this country and to candidates for admission to a Teachers' Training College who are residing in the Borough prior to their admission. The following cases were considered during the year:— (i) Medical Assessments 1,688 (ii) Medical Examinations: Staff—from (i) above 319 Teachers 173 Students—for admission to Training College 159 Carried out at the request of other Local Authorities 14 Total Number of Medical Examinations 665 NURSERIES AND CHILD MINDERS The number of premises in the Borough registered in accordance with the Nurseries and Child Minders Regulations Act, 1948, as private day nurseries, or persons registered as child minders, is as follows:— Number of Registrations Number of Places 1966 1965 1966 1965 Day Nurseries 23 16 666 379 Child minders 16 14 206 233 Totals 39 30 872 612 All premises used as day nurseries, whether Church Halls or private homes where the occupier is looking after children for reward, are inspected at monthly intervals by the health visitors to ensure that the proper standards are maintained and that the conditions of registration imposed by the Council are complied with. NURSING AGENCIES There is only one Agency for the supply of nurses registered with the Borough. This was inspected by a senior medical officer and was found to be satisfactory. This Agency was closed at the end of the year owing to the proprietor's removal to other premises. 65 General Services NURSING HOMES Under the provisions of the Public Health Act, 1936, and the Nursing Homes Act, 1963, nursing homes must be registered with the local authority, which supervises their conduct, standard of care provided, staff, number of persons admitted, and so on, as laid down in the Conduct of Nursing Homes Regulations, 1963. These provisions apply also to institutions not carried on for profit. There were two such registered Homes in the Borough. One, which cared for 12 patients, closed at the end of the year owing to the removal of the owner outside the Borough. The other is a hospital with a maximum of 145 beds. Both Homes were visited during the year by a senior medical officer and were found satisfactory. PUBLIC MORTUARY The Council Mortuary in Kingston Lane is purpose-built and of modern design. It provides excellent facilities for pathologists, and there is a waiting room and viewing chapel for relatives. The bodies received and post-mortem examinations carried out were:— From Home Address: Residents of Hillingdon 177 Residents of other districts 22 — 199 From Hospitals in the Area: Residents of Hillingdon 286 Residents of other districts 323 — 609 808 CERVICAL CYTOLOGY Following the receipt of approval from the Ministry of Health, two Well Women's Clinics were started in September for screening of women aged 34 years upwards. They are seen by appointment only, and in addition to slides being made for cervical cytology investigation for carcinoma, a physical examination of the pelvis and the breasts is carried out, the blood pressure is recorded and the urine tested. The demand has outstripped the available resources, as was expected, but the service will be expanded as soon as possible. Cytological examinations have been carried out in the pathology departments of Hillingdon and Mount Vernon Hospitals, and I should like to take this opportunity to thank the staff of these laboratories for their help and co-operation. The findings at each clinic are as follows:— (1) Laurel Lodge Number of women seen 107 Healthy 54 Abnormalities found: Pelvic—malignancy 0 cervical erosion 15 cervical polyp 2 fibroids 7 atrophic vaginitis 17 vaginal discharge 6 trichomonas vaginalis 1 prolapse 1 urethral caruncle 3 66 General Services Breasts—mastitis 4 simple tumour 2 Hypertension (diastolic pressure over 100 mm Hg.) 4 Urine—albuminuria 4 glycosuria 0 Women recalled for further examination 6 Women referred to family doctor 9 '2) Northwood Number of women seen 71 Healthy 42 Abnormalities found: Pelvic—malignancy 0 cervical erosion 2 cervical polyp 2 cervicitis 4 atrophic vaginitis 7 vaginal discharge 4 ovarian cyst 1 Breasts 0 Hypertension (diastolic pressure over 100 mm Hg.) 2 Urine—albuminuria 0 glycosuria 0 Women recalled for further examination 8 Women referred to family doctor 7 SECTION VI Environmental Health 69 Environmental Health The Chief Public Health Inspector, Mr. A. Makin, reports:— During 1966, because of the improvement of the staff position, it was possible to make considerable progress, particularly in connection with offices, shops and food premises, and good progress was made on the slum clearance programme. GENERAL Accidents Any accident incapacitating a person from work for three days or more is notifiable and all accidents notified to the department have been investigated. Statistics of the reported accidents, the action taken and the cause of the accident are set out on page 70. Aircraft Drinking Water The pattern of results of bacteriological examinations of drinking water on aircraft remains the same as in previous years. All samples from fixed tanks proved satisfactory. The supply by means of portable flasks on the older type of aircraft is unreliable, although compared with previous years there is an improvement in the percentage of satisfactory samples. Notwithstanding that both steam and chemical sterilization of flasks before each filling is practised by one operating company, many results were unsatisfactory. It can only be assumed that such bad results are caused by unsatisfactory handling of the containers during and after filling. There were 174 samples taken during the year with the following results:— Satisfactory Unsatisfactory Taken from fixed tank systems 62 – Taken from portable flasks 81 24 Taken from bowsers 4 – Foreign bottled waters 3 — Chironomus Midges Problems arising from the discharge of sewage effluent from the Maple Lodge Works of the West Hertfordshire Main Drainage Authority into the Grand Union Canal at Harefield have been of concern for several years past. In particular, the appearance of large numbers of chironomus midges in the spring and summer, and the nuisance to which their presence gives rise, has resulted in many complaints from local residents. The midge incidence depends on climatic conditions, and in 1965 there was only a minor problem and few complaints. In 1966, however, there was a massive infestation and, consequently, a large number of complaints were received. The unusual aspect of the problem in 1966 was that the nuisance began early, and complaints were received from mid-March onwards. The infestation extended several miles southwards—to the centre of Uxbridge. Following urgent consultations with officers of the Thames Conservancy and the Water Pollution Research Laboratory, it was agreed that disinfestation measures along the canal were necessary. Thames Conservancy remained firmly opposed to the use of chlorinated hydrocarbons in the water, and it was therefore decided that the treatment should take the form of applying to the surface of the canal and the banks a Pyrethrum "fog". This treatment was carried out by the Metropolitan Water Board on continued on page 71 70 Environmental Health Reported Accidents Workplace Number Reported Total No. Investigated Action Recommended Fatal NonFatal Prosecution Formal Warning Informal advice No Action Offices — 13 13 — — 5 8 Retail shops — 17 17 — 3 3 11 Wholesale shops Warehouses — 9 9 — — 4 5 Catering establishments open to public, canteens 2 2 1 1 Fuel storage depots — 1 1 — — — 1 TOTALS — 42 42 — 3 13 26 Analysis of Reported Accidents Cause Offices Retail shops Wholesale warehouses Catering establishments open to public, canteens Fuel storage depots Machinery — 2 1 — — Transport 1 — 3 — — Falls of persons 6 6 2 — — Stepping on or striking against object or person 3 1 1 1 1 Handling goods 1 3 — — — Struck by falling object — 2 1 1 — Fires and explosions — — — — — Electricity — — — — — Use of hand tools — 3 — — — Not otherwise specified 2 — — — — 71 Environmental Health Chironomus Midges—continued. behalf of Thames Conservancy and was repeated several times as the summer progressed. This treatment had some effect on the midge population but it did not achieve results which could be regarded as entirely satisfactory. The department co-operated with the Water Pollution Research Laboratory and the Rickmansworth Urban District Council in a series of experiments using "sticky traps" at several points along the canal. These experiments showed that the number of chironomus midges caught was appreciably greater than in the previous year, and, further, that the proportion of midges, as compared with the total catch of flying insects, was of the order of 80%-90% as against 30% in 1965. Common Lodging Houses The common lodging house in Uxbridge continued to function during the year, but it is anticipated that in the near future it will be demolished in order to facilitate the Uxbridge Town Centre Redevelopment Scheme. Disinfection A steam disinfector is installed at Harlington Road Depot and can be brought into use at very short notice. The arrangements for disinfection remained as in previous years. Disinfestation During the year the following treatments were carried out:— Bugs—4 Fleas—10 Wasps—174 Drainage and Sewerage Surcharge of soil and surface water sewers during periods of exceptionally heavy rainfall occurred occasionally, mainly in the northern portion of the Borough. Cases of flooding of front and rear gardens and yards occurred, but no actual flooding of dwelling houses. The areas affected were in Honey Hill and Harefield Road, Uxbridge; Long Lane, Hillingdon; Northview, Field End Road, Eastcote Road and Joel Street, Eastcote. Usually the surcharge of the surface water sewer affected the foul sewer by overflowing into it at various points, thus causing foul sewage to overflow. Steps were taken in all cases to clear up offensive matter and to carry out disinfection where necessary. The situation has in most cases been rectified or substantially improved by relief sewage schemes and the insertion of anti-flooding valves in the drainage systems. While conditions generally are steadily improving throughout the Borough a few trouble spots still remain. Examination of Plans Plans of buildings (other than dwelling houses) deposited with the Borough Engineer & Surveyor for approval under the Building Regulations are passed to the Environmental Health Section for comments. Consequently, in addition to drawing attention to the requirements of any legislation such as the Factories Acts, Offices, Shops & Railway Premises Act, Food Hygiene Regulations, etc., which may not have been fully provided for, it is often possible to make suggestions which will result in the premises having a standard better than the legal minimum and which, if incorporated at the design stage, can be provided at little extra cost. A recent development—the open plan—in the design of new schools is viewed with some concern. This plan provides for water closets to be entered directly from classrooms. When a water closet is flushed organisms present in the faeces are disseminated into the atmosphere, thus facilitating the spread of disease if the organisms are of a pathogenic nature. The usual way of minimising this risk is to have an intervening ventilated space between the water closet and any other room. In many premises, e.g. shops, offices, factories, workplaces, places of entertainment, dwelling houses, food premises, etc., this is a legal requirement. 72 Environmental Health FACTORIES ACT, 1961 There are 752 factories within the Borough, and 261 inspections for the purposes of the Act were made. Twenty-five notices were served requiring works to be carried out. Details of the work carried out are as follows:— Inspections of Factories Premises No. on Register No. of Inspections No. of written notices No. of Prosecutions (1) (2) (3) (4) (5) 1. Factories in which Sections 1-4 and 6 are to be enforced by L.A. 25 — — — 2. Factories not included in Section 1 in which Section 7 is enforced by L.A. 705 261 25 3. Other premises in which Section 7 is enforced by L.A. (excluding Outworkers premises) 22 — — — TOTALS 752 261 25 — Defects found Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) 15 8 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 5 4 — — — Ineffective drainage of floors (S.6) 1 1 — — — Sanitary Conveniences (S.7) — — — (a) Insufficient 1 1 — 1 — (b) Unsuitable or defective 13 16 — 2 — (c) Not separate for sexes 1 1 — — — Other offences against the Act (not including offences relating to Outwork) 7 5 — — — TOTALS 43 36 — 3 — 73 Environmental Health OUTWORKERS—1966 Twice yearly the occupiers of factories must supply to the Council a list of persons employed on specified work outside the factory. This information must be sent to the local authority in whose area the persons, known as Outworkers, reside. The following table shows the notifications received and the visits made to ensure that the conditions under which work is carried out are satisfactory. SECTION 133 SECTION 134 No. of Outworkers in August last required by Section 133(1)(c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices Served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing Apparel 78 — — — — — Christmas Crackers 286 — — — — — Model Toys 1 — — — — — Lampshades 2 — — — — — Confectionery 3 — — — — — Artificial Flowers 22 — — — — — Novelties 32 — — — — — Embroidery 1 — — — — — Clock Repairs 1 — — — — — Furnishings 4 — — — — — Boxes 5 — — — — — Cases 2 — — — — — TOTAL 437 — — — — — ——FERTILIZERS AND FEEDING STUFFS ACT, 192 With the exception of one mill, the only outlets for fertilizers and feeding stuffs are small retailers. Five samples of animal feeding stuffs and 11 of fertilizers were taken and all were found to be satisfactory. LONDON (HEATHROW) AIRPORT, NOISE INSULATION GRANTS SCHEME This scheme, which is a scheme for the protection of dwelling houses near London Airport from noise and vibration attributable to the use of aircraft, came into operation on 1st April, 1966. It provides financial help to householders in the South Ward and that part of Hayes Ward which lies south of the Reading-London railway line to insulate their homes against noise. The grant is only payable to persons who were the owners or occupiers of property prior to the 31st December, 1965, and who make application for the grant before 31st December, 1976. The rate of the grant is one half of the actual cost of the insulation works or £100, whichever is least. 74 Environmental Health Response to the scheme has been extremely poor during 1966 and there are two factors which explain the reluctance of householders to apply for the grant:— (1) The cost of carrying out the works is proving higher than at first anticipated. (2) The probability that the rateable value would be increased if insulation works were carried out. Neighbouring authorities administering the scheme in the "defined area" have the same experience, and there appears to be little enthusiasm for the scheme. Number of applications received 20 Number of applications approved 14 Number of applications withdrawn 6 Number of grants paid 8 Amount paid in grants £777 8s. 6d. Noise There were 87 complaints of noise during the year. All the complaints were dealt with informally, and no notices were served under the Noise Abatement Act. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Inspections It has been possible during the year to accelerate the inspection of offices and shops by the employment of technical assistants, who have been closely supervised by the Public Health Inspectorate. The inspections have shown a large number of premises not fully complying with the Act, but the general basic conditions are good. Special attention was paid to the lighting of premises. The Minister of Labour has power to make regulations in respect of lighting but has not done so at the present time. Legal standards tend to become maximum standards and the freedom to apply Codes of Practice recommended by trade associations, possibly has resulted in better lighting than Regulations would have specified. The table set out below shows the number of premises registered and the inspections made in 1966. Class of Premises Registered General inspections Offices 641 544 Retail shops 1,685 1,277 Wholesale shops and warehouses 54 79 Catering establishments open to the public, canteens 187 40 Fuel storage depot 7 — TOTALS 2,574 1,940 A total of 1,610 contraventions of the Act were noted and by the end of the year 492 of these had been remedied. PORT SANITARY ADMINISTRATION, LONDON (HEATHROW) AIRPORT Improvement in the staffing position has made possible an intensification of the inspection of airport offices and shops. The airport is now controlled by the British Airports Authority, and cooperation under the new arrangements is very satisfactory. Environmental Health 75 As far as catering premises are concerned, the inspections have shown that the standard of hygiene is generally good notwithstanding the extremely difficult conditions under which the caterers operate. The principal difficulties are shortage of trained staff and the problem of operating throughout the 24 hours. IMPORTED FOOD INSPECTION There were 701 inspections made under the Public Health (Imported Food) Regulations 1937-48. The basic requirements are for food to be fit for sale for human consumption, and in respect of meat and meat products, Official Certificates are necessary to ensure the products were prepared in specified approved establishments. There were 272 tons of various foods inspected as shown:— Article lb. Article lb. Meat (various) 185,886 Prawns 1,061 Beef fillets 161,536 Poultry 1,636 Cooked and smoked meats 17,134 Pate de fois 8,076 Bacon and ham 4,409 Milk and cheese 6,956 Meat paste 3,006 Butter and fats 1,553 Sausage 62,827 Fruits 14,231 Salami 1,897 Vegetables 45,229 Offal 3,562 Confectionery 1,240 Casings 4,435 Flour confectionery 2,594 Fish 19,385 Miscellaneous 63,924 The following foods were found unfit and were voluntarily surrendered:— Article lb. Article lb. Meat 575½ Smoked salmon 37 Pork paste 4½ Poultry meat 44 Meat mayonnaise l0¾ Dried snails 1,320 Fish mayonnaise 6½ Vegetables 2,129 Fruit 1,140 Twelve consignments of meat and meat products had no official Certificates attached, and were detained. One consignment of 24 lb. was destroyed, three consignments weighing 837 lb. were exported and eight imports weighing 603 lb. were released on receipt of undertakings that they would not be sold for human consumption. There were 126 samples of imported food submitted for bacteriological examination with the following results:— Satisfactory Unsatisfactory Choriso dry sausage 1 8 Imitace 4 3 Other sausages 53 13 Debreziner roast 4 7 Gipsy pork roast 3 3 Ham 3 5 Cooked and smoked ox tongues — 7 Other cooked meats 2 — Pate 2 — Lobster Newburg 1 — Cheese 2 — Flour confectionery 1 — Watercress — 4 TOTALS 76 50 76 Environmental Health No organisms of the salmonella or dysentery groups were found in the samples. Importations of Choriso dry sausage, gipsy pork roast and Imitace ceased with the agreement of the importers, mainly because of excessive plate counts, in one case rising to 1,550 million per gram. Importers are supplied with copies of laboratory reports, and in cases of repeated unsatisfactory results, the matter is taken up with the suppliers direct. PUBLIC WATER SUPPLIES Water supplies from the three main suppliers to the Borough were all found to be satisfactory. There are five houses within the Borough without a mains water supply. Supplies to these houses are drawn from wells, one house having its own chlorinating plant. Two of the supplies were found to be of doubtful quality. A number of factories draw supplies from deep wells and all of these were found to be satisfactory both bacteriologically and chemically. Of 60 samples taken from public and private supplies, 52 were satisfactory and eight were unsatisfactory. A well supply to a horticultural unit was found to be unsatisfactory and at the end of the year the possibility of securing a mains connection was being explored. Miscellaneous Water Nineteen samples of ice cubes were submitted for bacteriological examination and three were found to be unsatisfactory. These unsatisfactory results were due to inadequate attention to hygiene by operators, and advice was given on the routine cleansing of scoops and other items of equipment. Following a report that water contained in plastic water coolers imported from Hong Kong had been found to be contaminated, a sample was submitted for laboratory examination and was found to be satisfactory. SWIMMING POOLS One indoor and two open air swimming pools are owned by the Borough Council in addition to Ruislip Lido, part of which is used for bathing purposes. A further 13 pools are situated at schools, hotels and clubs. There were 87 samples taken from private and public swimming pools, 13 of which were found to be unsatisfactory. The desired standard of purity in swimming pools is taken to be that of water intended for drinking purposes and such a standard is readily attained in a properly designed and constructed pool with adequate filtration and chlorination. Absolute purity is impossible to obtain at the Lido, but chlorination of the official bathing and paddling areas is carried out. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 RAG FLOCK AND OTHER FILLING MATERIALS REGULATIONS, 1951—1954 Although upholstering is carried out at several premises in the borough, the Act does not apply to any of them as the type of filling used is outside the scope of the Act. All premises used for upholstery and similar trades are visited occasionally so that if circumstances change and the type of work to which the Act applies is undertaken, the provisions of the Act can be enforced. RODENT CONTROL Owing to the difficulty of recruiting suitable staff for this work rodent control in domestic premises in all parts of the Borough except Yiewsley and West Drayton was contracted to a commercial operator. The work is done in accordance with the Council's own standards and the contractor maintains close liaison with the department. The arrangement worked well. Rodent control in domestic premises is a free service; the occupiers of business, commercial and industrial premises are encouraged to make their own arrangements for treatment but where this was done by the Council a charge was made. Environmental Health 77 Details of the work carried out are set out below:— Properties other than Sewers Type of Property NonAgricultural Agricultural 1. Number of properties in district 81,330 107 2. A. Total number of properties cluding nearby premises) inspected following notification 1,779 7 B. Number infested by (i) Rats 1,656 7 (ii) Mice 135 - HOUSING Improvement (a) Improvement Areas During the year the Council's policy to require the improvement of all tenanted dwellings in the Borough was advanced by statutory action being taken in connection with the Hayes and Harlington Improvement Area No. 1. When the area was declared in November, 1964, there were 108 houses lacking in standard amentities. (This number included owner-occupied houses.) Details were as follows:— Dwellings in respect of which Improvement Grants had been applied for 12 Owner/occupier dwellings 29 Tenanted dwellings (tenant willing to have improvements) 33 Tenanted dwellings (tenant not willing to have improvements) 33 Unoccupied dwellings 1 TOTAL 108 In June 1966 when the Notices were served it was found that of the 108 houses in the original survey, 61 had been fully improved or had become owner occupied and were therefore outside the scope of compulsory powers. Of the remaining 47 houses, four were considered to be unfit for human habitation and were included in a Clearance Area. Preliminary Notices requiring works of improvement were served on the owners and occupiers of the remaining 43 houses. These Notices, in addition to specifying the works required, informed the recipients that any proposals or objections they wished to make could be considered. There were 11 objections to the Council's proposals from occupiers who did not wish their houses to be improved. Subsequently Immediate and Suspended Improvement Notices were served and appeals were entered in respect of four Immediate Improvement Notices—these appeals were subsequently withdrawn. (b) Houses Outside Improvement Areas It is possible for tenants to request improvements to their houses by making a representation to the Council in accordance with Section 19 of the Housing Act, 1964. When such a representation is made the same procedure is followed as in the case of Improvement Areas. As so few of these applications are received it appears that this fact is not well-known to the public. 78 Environmental Health Details of the applications received in 1966 and the action taken is shown in the table below:— Dwellings Outside Improvement Areas 1. Number of representations made by tenants 6 2. Number of Preliminary Notices served 2 3. Number of undertakings accepted — 4. Number of Immediate Improvement Notices served 2 5. Number of such dwellings improved: (a) full standard 1 (b) reduced standard Improvement Grants The number of Standard Grant applications during the year continued to be disappointing, although there were 76, compared with 65 in 1965. There were more applications received this year from Landlords of tenanted properties, rather than from owner-occupiers but this was due to service of Notices affecting dwellings in Improvement Area No. 1. The number of Discretionary Grant applications received was negligible, only two being received, neither of which qualified. The reason for the few applications under this scheme is because in the main the type of property in this Borough requiring improvement is such that only the standard amenities are lacking. Therefore, the Standard Grant Scheme is applicable rather than the Discretionary Grant Scheme. Amounts paid in grant under the Discretionary Grant Scheme shown in the table were in respect of applications received by former authorities. Improvement Grants (/) Standard Grants Owner/Occupier Tenanted 1. Number of applications received 33 43 Number of applications approved 28 38 Number of applications refused 5 1 2. Number of dwellings improved 26 23 3. Amount paid in grants £7,078 5s. 7d. 4. Average grant per house £144 9s. Id. 5. Amenities provided:— (a) fixed bath 37 (b) shower — (c) wash hand basin 43 (d) hot water supply (to any fittings) 45 (e) water closet: 1. within dwelling 45 2. accessible from dwelling — (f) food store 27 Environmental Health 79 (2) Discretionary Grants Owner 1 occupier Tenanted 1. Number of applications received 2 — 2. Number of applications approved — - 3. Number of applications refused 2 — 4. Number of dwellings improved 2 5 Amount paid in grants £2,511 5s. Od. Average grant per house £358 15s. Od. The position as far as Improvement Areas is concerned in the Borough is as follows:— Improvement Areas—Housing Act, 1964 Number of: 1. Areas (a) Surveyed 1 (b) Declared 1 2. Houses to be improved (a) full standard 41 (b) reduced standard 2 3. Preliminary Notices served 43 4. Undertakings accepted 8 5. Immediate improvement notices served 21 6. Suspended 11 7. Final — 8. Dwellings improved (a) full standard 2 (b) reduced standard — 9. Dwellings improved by L.A. in default (a) full standard — (b) reduced standard — Of the total number of houses in this area only one house had been improved as the result of Notice by 31st December, 1966. Although every effort is being made to improve houses by means of the legislation available it is nevertheless a slow and cumbersome process. A much simpler method would be to extend the definition of a fit house in Section 4 of the Housing Act, 1957—to include the standard amenities. If this were done it would be possible to serve a Notice to provide the amenities exactly as is done for the repair of an unfit dwelling. Improvement Grants—Publicity To stimulate interest in the Improvement Grant schemes the Ministry of Housing and Local Government's Mobile Exhibition was stationed in various parts of the Borough in July, and was visited by 960 people. REPAIR, DEMOLITION, CLOSURE AND CLEARANCE Repair (Housing and Public Health Acts) During recent years housing defects have been remedied mainly by use of the nuisance provisions of the Public Health Act, 1936. When urgent repairs have been necessary Section 26 of the Public Health Act, 1961, has been used. Although by this action it is possible to remedy the more serious 80 Environmental Health housing defects, not much is possible in the way of comprehensive repair. Until it is possible to secure the proper repair of tenanted dwellings there will continue to be a wastage which will have to be dealt with eventually by Clearance. When the present programme of slum clearance is completed, it is hoped that it will be possible to concentrate on the repair of tenanted dwellings by operating the repair provisions of the Housing Act, 1957. The following table shows action that has been taken by formal and informal action to secure the repair of dwelling houses. Repair—Housing and Public Health Acts Number of houses rendered fit after service of notices:— Section 9, 10 and 16 of Housing Act, 1957 Public Health and similar Local Acts Totals Informal Formal Informal Formal Informal Formal By owner 1 1 109 14 110 15 By Local authority 1 — — — 1 TOTALS 1 2 109 14 110 16 Demolition and Closure of Unfit Houses Three houses were reported to the Council as being unfit for human habitation and not repairable at reasonable expense. As these properties were adjoining fit houses it was not possible to demolish them, and Closing Orders were made. Nine houses were demolished as the result of action taken in 1965. Unfit Houses (Not repairable at reasonable expense) — Housing Act, 1957 Number of: 1. Undertakings accepted (Section 16) — 2. Closing Orders made (Section 17) 3 3. Demolition Orders made (Section 17) — 4. Closing Orders made (rooms) (Section 18) — 5. Closing Orders determined (Section 27) — 6. Closing Orders revoked and Demolition Orders substituted (Section 28) — 7. Houses demolished following Demolition Orders 9 8. Number of people displaced (a) individuals 1 (b) families 1 Clearance Areas Considerable progress was made in dealing with the two-year programme submitted in 1965. In addition, further properties were found which were unfit and these have now been included in the programme. Environmental Health 81 Below is a table showing the progress during the year. Clearance Areas (/) Represented during year 1. Number of Areas 14 2. Houses unfit for human habitation 46 3. Houses included by reason of bad arrangement, etc. — 4. Houses on land acquired under Section 43(2) 2 5. Number of people to be displaced (a) individuals ... 110 (b) families 49 (2) Action taken during the year 1. Houses demolished by Local Auth ori ties or owners (a) unfit 4 (b) others — 2. Number of people displaced (a) individuals 20 (b) families 11 MULTIPLE OCCUPATION The problem of multiple occupation is a continuing one. The majority of dwelling houses in the Borough are of a type suitable only for single-family occupation, and in fact the houses used for multiple occupation are mainly of this type. Consequently, any use of houses for more than one family results in over-occupation. In order to control the problem the Council decided on a policy of serving Direction Orders on all houses used for multiple occupation—the number fixed by the Order being determined on the available rooms and facilities in the dwelling. Therefore, a conventional three-bedroom type house has a number of 5. The effect of Direction Orders was explained in my report for 1965. There were several contraventions of Direction Orders—in most cases it was possible to secure compliance by negotiation. In five instances in order to remedy the unsatisfactory conditions it was necessary to institute legal proceedings—in each case successfully The owners of dwellings in multiple occupation are required to complete at regular intervals Requisitions for Information giving the names of the persons occupying the dwelling. Failure to submit correct information is an offence. Although this procedure is useful, the information obtained is often unreliable. This may be for several reasons, the principal one being that frequently the occupants of this type of accommodation are immigrants who cannot speak or read English. Checks are made on the information given by visits to the premises, in many cases late at night—as this is the only time it is possible to find the residents at home. Houses in Multiple Occupation 1. Known number of houses in multiple occupation 203 2. Number of houses on which Notices of Intention have been served for (a) Management Orders (Section 12) (b) Directions on overcrowding (Section 19) 146 3. Number of houses on which have been made: (a) Management Orders (b) Directions on overcrowding 147 82 Environmental Health 4. Number of notices served (a) to make good neglect of proper standards of management (Section 14) (b) to require additional services or facilities (Section 15) 3 (c) where work has been carried out in default — 5. Number of prosecutions in respect of: (a) Management Orders (b) Direction Orders 5 (c) Overcrowding (Section 90, Housing Act, 1957) — 6. Number of control orders made (Housing Act, 1964) — 7. Number of control orders terminated CERTIFICATES OF DISREPAIR—RENT ACT, 1957 The following table gives details of the types and numbers of certificates applied for and the action taken:— 1. Number of applications for certificates incurred 15 2. Number of decisions not to issue certificates 1 3. Number of decisions to issue certificates (a) in respect of some but not all defects 8 (b) in respect of all defects 6 4. Number of undertakings given by landlords under paragraph 5 of the First Schedule 7 5. Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule — 6. Number of Certificates issued 6 Part II—Application for cancellation of Certificates 7. Applications by landlords to Local Authority for cancellation of certificates 2 8. Objections by tenants to cancellation of certificates — 9. Decisions by Local Authority to cancel in spite of tenants' objections — 10. Certificates cancelled by Local Authority 2 CONTROL OF CARAVAN SITES Caravan Sites and Control of Development Act, 1960 Licensed sites in the Borough No. of temporary licences No. of licences without time limit 11 14 All applications for caravan site licences, both in respect of new sites and renewal of existing licences are dealt with by the Planning Committee, but conditions for inclusion in the Licence are recommended by this department. Environmental Health 83 Gypsies and Other Itinerants The problem of gypsies and other itinerants camping on highway verges and other land is a continuing one. Action to remove them is taken by the Council's Ranger, but a permanent solution to this problem is not yet in sight. CLEAN AIR Measurement and Investigation of Atmospheric Pollution The number of stations for the measurement of atmospheric pollution was increased from five to seven during the year, and one of the existing stations was re-sited. There are now two stations in Hayes, (one close to the highest concentration of industry and the other in a residential area), one each in Hillingdon, Northwood, Ruislip, Uxbridge and West Drayton. The stations are designed to measure the quantity of smoke and sulphur dioxide present in the air. The table on page 84 shows the monthly averages of smoke and sulphur dioxide content in the air. The records for the stations at West Mead and Grange Park School for the last five years are set out below. Both stations are in residential areas; that at Grange Park, however, has been in a Smoke Control Area since 1960, but is influenced, to some extent, by the greater industrial background pollution at Hayes. The January figures include pollution from domestic heating and the full range of industrial and commercial services. Pollution arising from domestic heating is negligible in June while industrial processes (but not space heating) carry on as usual. The ratio between the June and January figures, is therefore, a good guide to the amount of pollution from domestic sources; the greater the difference between summer and winter pollution, the greater the extent of domestic pollution. SMOKE AND SULPHUR DIOXIDE (In Microgrammes per Cubic Metre) YEAR SMOKE SULPHUR DIOXIDE RATIO JUNE TO JANUARY JUNE West Grange Mead Pk. sch. JANUARY West Grange Mead Pk. sch. JUNE West Grange Mead Pk. sch. JANUAR Y West Grange Mead Pk. sch. SMOKE West Grange Mead Pk. sch. SULPHUR DIOXIDE West Grange Mead Pk. sch. 1962 13 24 92 103 43 56 182 218 1: 7.1 1:4.3 1:4.2 1:3.9 1963 15 16 189 107 40 50 296 310 1:12.6 1:6.7 1:7.4 1:6.2 1964 15 15 217 125 55 78 271 243 1:14.5 1:8.3 1:4.9 1:3.1 1965 20 20 85 65 56 54 158 193 1: 4.3 1:3.3 1:2.8 1:3.6 1966 18 16 119 80 55 50 132 110 1: 6.6 1:5.0 1:2.2 1:2.2 Oo -tv MONTHLY AVERAGES FOR SMOKE AND SULPHUR DIOXIDE FOR 1966 Microgrammes Per Cubic Metre 76 High St., Northwood West Mead, South Ruislip Wm. Byrd School, Harlington Coldharbour Lane, Hayes Grange Park School, Hayes High Street, Uxbridge Oak Farm School, Hillingdon Drayton Hall, West Drayton Smoke SO2 Smoke SO2 Smoke SO: Smoke SO2 Smoke SO2 Smoke SO2 Smoke SO2 Smoke SO2 January 131 * 119 132 89 112 115 116 80 110 - - - - - - February 62 * 55 105 39 83 51 87 32 82 - - - - - - March 55 * 55 93 36 64 48 81 36 70 - - - - - - April 38 -. 45 95 (Instruments removed 1/4/66 to Drayton Hall) 47 92 32 87 43 103 40 107 45 104 May 20 * 20 72 25 70 15 59 17 68 15 64 18 68 June 14 ♦ 18 55 — — 24 61 16 50 16 64 15 64 19 51 July 11 * 11 32 — — 16 33 11 40 10 56 11 60 21 40 August 19 * 21 23 — — 27 24 20 35 17 39 21 37 21 28 September 31 * 35 44 — — 48 46 34 52 37 50 31 66 44 54 October 44 ♦ 44 107 — — 48 107 35 133 42 95 44 126 45 98 November 73 * 71 133 — 59 134 41 126 49 110 56 131 63 130 December 57 * 72 119 — 51 115 42 93 70 94 54 81 34 82 Environmental Health * Figures not available. Environmental Health 85 Smoke Control Areas The programme to extend smoke control areas throughout the Borough continued as scheduled; the position at the end of the year is set out below:— No. of Orders Acres Domestic Dwellings Local Authority Private Premises In operation at 31.12.65 33 10,244 6,277 14,549 1,480 Brought into operation during 1966 3 1,004 1,100 2,021 416 Orders confirmed but not yet operative 2 690 142 1,396 252 Orders made but not yet confirmed 1 280 560 962 67 Preparatory work in progress 2 504 976 2,201 130 TOTALS 31.12.66 41 12,722 9,055 21,129 2,345 Grit, Dust and Effluvia Deposits of grit and dust in the vicinity of the Coal Depot, West Drayton and the Gasworks, Uxbridge, have been monitored throughout the year. The locations of the monitoring sites are as follows:— N.C.B. Site 1 Tavistock Road, Yiewsley 300 feet north east of the depot Site 2 Wimpole Road, Yiewsley Site 60 feet north of Site 1. Site 3 Wimpole Road, Yiewsley Site 116 feet north of site 1. Site 4 Fairway Avenue, West Drayton Site 300 feet south of the depot. Control Site in the grounds of Drayton Hall N.T.G.B. Site 1 Bridge Road, Uxbridge 850 feet north east of the gas works Site 2 Andover Close 550 feet north west of the gas works. The total weight of grit and dust, and, where known, the weight of coal dust deposited in the gauges has been set out on page 86, in addition the average weight deposited in five Inner London gauges has also been shown. Improvements and modifications have been made to the dust suppression methods used at the coal depot and further modifications will take place in 1967. All the dust suppression methods are dependent on the human element which is likely to be less reliable at peak handling periods when the dust problem is most acute. GRIT AND DUST DEPOSITS IN GRAMMES—1966 National Coal Board Depot, West Drayton Control Uxbridge Gas Works Inner London Site 1 Site 2 Site 3 Site 4 Month Total Coal Total Coal Total Coal Total Coal Total Coal Site 1 Site 2 Average January 0.29 0.15 0.23 0.09 0.18 0.05 0.23 0.16 — — 0.51 0.15 0.38 February 0.32 0.14 0.13 0.07 0.10 0.04 0.12 0.05 — — 0.27 0.16 0.38 March 0.30 N 0.23 N 0.26 N 0.17 N — — 0.24 0.19 0.31 April 0.54 0.25 0.22 0.10 0.28 0.12 0.27 0.14 — — 0.20 0.14 0.43 May 0.73 N 0.92 N 0.32 N 0.23 N — — 0.17 0.11 0.38 June 0.28 0.15 0.29 0.14 0.17 0.06 0.15 0.10 — — 0.28 0.27 0.33 July 0.22 N 0.24 N — — 0.25 N — — 0.18 0.15 0.32 August — — — — — — — — — — 0.12 0.14 0.27 September 0.27 0.12 0.28 0.09 — — 0.22 0.12 0.17 0.02 0.18 0.21 0.25 October 0.16 0.03 0.16 0.03 — — 0.12 0.06 0.10 0.01 0.12 0.19 0.27 November 0.16 0.05 0.23 0.06 — — 0.11 0.04 0.12 0.01 0.16 0.07 0.24 December 0.12 0.06 0.30 0.09 — — 0.10 0.03 0.13 0.02 0.09 0.05 0.20 Environmental Health N. indicates not known Environmental Health 87 New Furnaces Section 3 (3) of the Clean Air Act, 1956, requires notification to the Local Authority of the intention to install any new industrial furnace or any domestic furnace with a capacity of 55,000 or more BTU/hr. Notifications of 71 installations were received; 30 were gas fired, 34 fired by light oil (which has a sulphur content less than that of solid fuel); five by heavy oil (which has a sulphur content higher than that of solid fuel); one by coal and one related to an incinerator. After discussion, the incinerator and two of the light oil installations were not proceeded with. Dark Smoke (Permitted Periods) Regulations, 1958 These Regulations lay down the maximum length of time that dark and black smoke may be emitted in any given period of time. There were 83 observations made, and no contraventions of the Act were noted. Height of Chimneys Section 10 of the Clean Air Act, 1956, requires that plans of new industrial buildings deposited for approval under Building Regulations be rejected if the height of any chimney shown on the plan is insufficient to prevent smoke, grit, dust or gases from being prejudicial to health or a nuisance. Forty-two plans submitted for approval were passed to the department for a decision on this particular point. In 31 cases the plans were submitted with chimney heights which had already been agreed with the architects or heating engineers concerned, or were acceptable, but in the other 11 cases it was necessary to ask for a higher chimney than originally shown. Industrial Bonfires Section 47 of the Middlesex County Council Act, 1961, prohibits dark smoke from industrial bonfires. No contraventions were observed during the year. A prototype incinerator for burning car bodies, which was under construction in a car breaker's yard, did not prove entirely satisfactory. INSPECTION AND SUPERVISION OF FOOD MILK Milk and Dairies (General) Regulations 1959 The Milk (Special Designation) Regulations The following premises are registered or licensed in the Borough:— Registered Milk Distributors 118 Registered Dairies 2 Licences to use Special Designations: (a) Pasteurised 78 (b) Sterilised 40 (c) Ultra-heat treated 4 (d) Untreated 15 Dealer's Licence (Pasteurised) 2 Milk Production At the beginning of the year there were 19 dairy farms in the Borough, two of which discontinued during the year. The hygiene of milk production is the responsibility of the Ministry of Agriculture, Fisheries and Food, but sampling of milk for the determination of composition and purity is a duty of the department. There were 188 samples examined for Brucella and 12 were found to be positive. The initial test is the 88 Environmental Health Brucella ring test and if this is positive, individual cow samples are taken to identify the animal concerned. As a result of these tests, three cows were found to be producing milk containing Brucella abortus. All the milk concerned was being supplied for heat treatment, with the exception of milk consumed by the farmer and his family. The information obtained was submitted to the farmers, and in all cases, the affected cows were eventually removed from the herds. There were 81 samples tested for antibiotics and all were found to be satisfactory. Two samples of goat's milk were also submitted for bacteriological examination and were found to be satisfactory. Two samples examined to determine the presence of Tubercle bacilli were negative. Distribution All milk samples submitted for statutory tests were found to be satisfactory. Methylene Blue Test Phosphatase Test Turbidity Test Colony Counts Total Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory 21 — 25 — 3 — 1 50 Following a complaint, rinses were taken from five empty churns supplied to a farmer by a wholesale dairy, and two were found to be most unsatisfactory. The results obtained were made known to the dairy concerned and to the Health Department of the district in which the dairy was situated. As a result, churn washing arrangements were improved at these wholesale dairy premises. Milk in Catering Establishments The supply of milk through catering sales was the subject of bacteriological investigation during the year. It was noted that milk was in some cases, being handled in a very careless manner. Delivery to canteens and restaurants by way of small churns is common practice, and instances were noted of staff dipping jugs and other receptacles into the milk with consequent danger of contamination. In other cases, milk was drawn from refrigerated units and doubts were raised as to whether staff were carrying out correct cleansing routines on this equipment. There were 10 samples of milk submitted for bacteriological examination, two being control samples taken from newly delivered five-gallon churns, three from jugs used by canteen staff and five from refrigerated dispensers. E. coli was found in the three samples dispensed by means of jugs and in two of the samples obtained from a refrigerated dispenser. The correct handling and dispensing of milk and the hygiene of associated equipment was discussed fully with the managements concerned. Processing The two pasteurisation plants continue to operate. One is a small dairy, while the other is very large and employs full-time laboratory staff. In addition to the supervision of general hygiene, checks are made to ensure that the pasteurisation process is being carried out correctly and that the bottles and churns are being washed efficiently. Washed bottles and churn rinses are sent for laboratory examination; temperature records are checked and the methylene blue and phosphatase tests are carried out. There were 30 washed bottles submitted for laboratory examination. Only one bottle was classed as unsatisfactory. Rinses were taken from four churns and found to be satisfactory. Environmental Health 89 ICE CREAM Ice Cream Samples There were 76 samples taken during the year. Grade Number Percentage 1 35 46 2 11 14.5 3 10 13.2 4 20 26.3 The percentage of unsatisfactory samples is a matter for great concern. Grade 4 samples originated in the main from sales vehicles. Considerable difficulty is experienced in this class of trading. The main cause of the unsatisfactory gradings of ice cream obtained from vehicles and premises was unsatisfactory cleansing of equipment. As far as premises are concerned, the main fault lay with the staff neglecting to follow the recommended routine for serving up ice cream and for sterilising equipment. Two large catering premises were particularly troublesome in this respect. Three samples of water from storage tanks on ice cream sales vehicles were examined bacteriologically, together with rinse water from an ice-cream scoop. The rinse and a sample of water was found to be unsatisfactory. Advice was given to the vehicle operator and this led to the more extensive use of a chemical sterilising agent. INSPECTION OF MEAT AND OTHER FOOD Slaughterhouse Act, 1958 The only slaughterhouse within the Borough remained in operation during the year, there being a slight decrease in the number of animals slaughtered. Three cattle were found to be affected with cysticercus bovis, all carcases being released after the requisite period of refrigeration. It was necessary on several occasions to draw the owner's attention to various lapses of hygiene, and by the end of the year a number of structural repairs had become necessary. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 305 33 103 772 2,718 Number not inspected — — — — — All diseases except Tuberculosis and Cysticerci Whole carcases condemned 2 2 4 Carcases of which some part or organ was condemned 43 8 2 27 303 Tuberculosis only Whole carcases condemned 1 _ 2 Carcases of which some part or organ was condemned - - - 29 Cysticerci Carcases of which some part or organ was condemned 1 2 Carcases submitted to refrigeration 1 2 - - - Generalised and totally condemned 90 Environmental Health Disposal of Condemned Food Meat condemned at the slaughterhouse is stained and despatched to a by-products factory. All other food is disposed of at the controlled tip operated by the Greater London Council. Slaughter of Animals Act, 1933-1958 During the year four licences were issued to slaughtermen. No contraventions were observed. Diseases of Animals Act, 1950 In addition to the dairy farms, there are 42 piggeries. The surveillance of stock moved into the area under the Movement of Swine Order is carried out by the Council's veterinary officer except when animals are destined for the local slaughterhouse, or requiring a further movement licence for the purpose of removal to the slaughterhouse. There are within the Borough 36 licensed boiling plants. Number of Movement Licences received 344 Number of Movement Licences issued 32 No cases of notifiable disease occurred within the Borough. Unsound Food The total amount of food surrendered for destruction during the year was 13 tons 5 cwt. 108 lb. This includes food condemned at No. ll.L Buffer Depot, Harmondsworth, which closed down during the year, but not foods surrendered at London Airport. Class of Food Quantity (lb.) Tinned Meat 9,174 Frozen Meat 3,314 Tinned Fish 169 Frozen Fish 879 Tinned Fruit 7,307 Frozen Fruit 139 Tinned Vegetables 4,703 Frozen Vegetables 1,023 Cereals 500 Tinned Milk 574 Butter/Fats and Margarine 165 Mousse 49 Poultry 199 Jam—Marmalade 6 Sweet Confectionery 218 Flour Confectionery 691 Mayonnaise 6 Cream 46 Tinned Soup 532 Ice Cream 94 29,788 Environmental Health 91 FOOD AND DRUGS SAMPLING During the year 222 informal samples and 72 formal samples were submitted to the Public Analyst for examination. They comprised the following:— Arrowroot 1 Fruit Juice 6 Baby Food 3 Gelatine 1 Baking Powder 1 Honey 2 Bread 14 Ice Cream 6 Bread and Butter 1 Jam 12 Butter 1 Jelly 1 Buttered Toast 1 Margarine 1 Cake Mixes, etc. 2 Meat Products 20 Canned Fruit 7 Milk 53 Canned Meat and Chicken 6 Mineral and natural waters 1 Canned Shellfish 3 Olive Oil 2 Canned Vegetables 1 Pasta 2 Cereal 2 Pickles 4 Cheese and Cheese Products 12 Pie Filling 2 Cocktail mixture 1 Preserved dried fruit 8 Coffee 2 Proprietory medicines 4 Cooking Oil 7 Salad, salad dressing 5 Cream 8 Salt 1 Curry, Curry Paste, etc. 2 Sausages 6 Drugs 16 Shellfish 4 Fish products 10 Skimmed Milk 1 Flavoured drinks 10 Soup 3 Flavoured spreads 4 Stuffing 1 Flavouring 1 Sugar confectionery 4 Flour confectionery 6 Tea 2 Food colouring 2 Vending machine samples 6 Fresh Fruit and Vegetables 6 Wines and Spirits 6 Of the total number submitted, six samples of milk originating from two farms were deficient in fat, three of the samples being Channel Island milk. The deficiency was not due to adulteration and the farmers took advice to improve the quality of the milk. Both farms have now discontinued milk production. Preservative was found to be absent from a sample of Prawn Balchow labelled as containing preservative. This matter was taken up with the manufacturers. A sample of Cola and Rum was found to contain 1.2% proof spirit and the Analyst was of the opinion that a more accurate description would be "Rum Flavoured Cola". The description of the article was subsequently altered by the manufacturers. A calcium drink was held to be a food and not a medicine, and was therefore required to conform to the Artificial Sweeteners Order. This involved replacing the sodium cyclamate by saccharin. The manufacturers had not appreciated this factor, having consulted the Dunlop Committee on the safety of drugs before putting the product on the market. A sample of white coffee with sugar obtained from a vending machine was classed as poor. The reason was found to be malfunctioning of the machine due to inadequate maintenance. Margarined toast supplied as buttered toast at a canteen resulted in a successful prosecution. 92 Environmental Health A sample of gin alleged to be watered was found to contain 22.7 % proof gin instead of 70 % proof. The sample was brought to the office in a mineral water bottle and the evidence, therefore, did not justify a prosecution. Action was confined to warning the Company concerned. Further samples from the premises were found to be satisfactory. Imported Food Samples The following samples of imported food taken from London Airport were also submitted for examination. With the exception of a consignment of dried snails found to be infested with mites and contaminated with insect debris, all samples were found to be satisfactory. contaminated with insect debris, all samples were found to be satisfactory. Vegetables and fruits were found to be free from residual pesticides. Type of Food Number of Samples Cheese 2 Cooked Meats 2 Dried Snails 1 Fish and Fish Products 1 Flour Confectionery 2 Fresh Fruit 12 Fruit Juice 1 Mayonnaise 3 Meat Paste 2 Milk 2 Salad 1 Sausages 29 Vegetables 28 86 Departmental Samples There were 59 samples examined within the department, as follows:— Article Satisfactory Unsatisfactory Cream 8 — Milk 1 — Minced Meat 2 1 Sausage Rolls — 1 Spirits 41 1 Vinegar 4 ~ A repeat sample of the minced meat was found to be satisfactory. A sample of vodka was found to be adulterated and this was borne out by examination of a formal sample. A warning letter was sent. Food Complaints The number of complaints received from members of the public showed an increase over the previous year. Investigation of these complaints is time-consuming, involving as it does a full assessment of the incident and consideration of the comments of all concerned. In many cases, identification of the Environmental Health 93 foreign body or contamination can be made in the department or, if not, the article is submitted for examination by the Public Analyst. During the year 19 such articles were referred in this way examination by the Public Analyst. During the year 19 such articles were referred in this way. The total number of food complaints received during the year was 135. The foods involved were:— Number of Complaints Number of Complaints Unsound Foreign Bodies Unsound Foreign Bodies Description of Article Description of Article Beer — 1 Fresh Meat 5 1 Bread 6 23 Fresh Vegetables 2 1 Butter 1 1 Ice Cream — 1 Canned Fruit 6 4 Jam 1 4 Canned Meals — 1 Milk — 12 Canned Vegetables 1 1 Other foods 1 3 Cereals 1 2 Pasta — 1 Cheese 1 2 Poultry 2 — Cooked canned meat pies 14 5 Sausages and Sausage meat 2 2 Dried Fruit — 1 Soup 1 — Eggs 1 — Spirits 1 (adulterated) Fish and Fish products 1 2 Sugar Sweet confectionery — 2 Flavoured drinks 1 — Vinegar 1 — Flour confectionery 6 9 Yoghourt 1 — Foreign Bodies Bakery products remained the largest source of complaints of foreign bodies which included a 1 inch nail, rusty metal, glass, carbonised dough, paper, matchsticks, wasps and flies and contamination by bird droppings. Dirty milk bottles were another major cause for complaint and it was emphasised to all companies concerned that staff difficulties in carrying out visual inspection could not be accepted as mitigation, and the use of returnable containers meant that an effective inspection system was essential at all times. The new electronic scanning apparatus would appear to present an efficient but expensive answer to this problem, and, failing this, bottling speeds should be maintained at a rate which would allow for adequate visual inspection. The use of a non-returnable container is the only really effective solution to the problem, although the public could make a large contribution by returning clean bottles and preventing misuse. A complaint of a bandage in a bacon joint was found on investigation to be the remains of a salt bag. A complaint of ice cream contaminated by petrol was found to be due to a leaking refrigerant plate. Other complaints included sausages affected with dye from a marking stamp, fish and fish products affected by filaria bicolor, wire and cotton-wool in baked beans, and cats' urine on vegetables. Lettuces were found to be contaminated with a fungicide, Thiuran Disulphide. This fungicide is normally washed to the roots of the lettuce when the plants are watered and the complaint arose due to the fact that watering had not been carried out and some of the fungicide dusted around the plants had remained on the plants themselves. All affected lettuces were immediately withdrawn from sale. Unsound Food The chief cause for unsound food complaints was faulty stock rotation, and retailers still do not appreciate the need for careful rotation of stock supported by an effective code system of their own. As a result of food complaints, five prosecutions were taken under the Food and Drugs Act, 1955, and one under the Milk and Dairies (General) Regulations, 1959. Convictions were obtained in each case. 94 Environmental Health FOOD HYGIENE The maintenance of a satisfactory standard of hygiene is one of the most important duties of a Public Health Inspector. Standards of cleanliness and hygienic methods are laid down in the Food Hygiene Regulations and associated legislation. They represent minimum standards and if these are not complied with an offence is committed. The standards laid down are designed to ensure that the food supplied to the consumer, whether it be from a luxury hotel, mobile snack bar or an automatic machine on the factory floor, is both clean and safe to eat. The terms "clean and safe" when applied to food are by no means complementary as a visually acceptable food may contain large numbers of pathogenic organisms while a food aesthetically objectionable might have no injurious effect on health if eaten. The achievement of an acceptable hygiene standard depends upon the co-operation of all concerned in the handling of food, their appreciation of their responsibilities and the underlying reasons for the various statutory requirements. It is of no avail if a food handler will only use tongs for serving meat, refrain from licking fingers, smoking, etc., when an Inspector is present and promptly reverts to these bad habits when he leaves. The Public Health Inspector has a duty to ensure that not only do the premises comply structurally with the various statutory requirements, but also to ensure that the food is stored, handled, prepared and supplied in such a manner and under such conditions which, as far as possible, eliminate all dangers of contamination. Structural conditions are assessed by visual inspection but, handling methods, etc. necessitate careful study and require a detailed knowledge of all aspects of the trade together with the problems and conditions involved and call for close co-operation from the food handlers and management. The bacteriological tests on food provide an indication as to the hygiene of food handling. There are no fixed bacteriological standards for foods generally and some authorities deplore this, arguing that action cannot be taken if high bacterial counts are obtained. The answer, of course, is that it is the conditions which give rise to the high counts that require attention and not the figures obtained. High counts are invariably attributable to some failure in complying with the statutory standards laid down in the Regulations. The inspectors' work in food premises has been followed up in the Public Health Laboratory. Food samples have been submitted for bacteriological examination and in some cases, swabs from equipment. Although there are no legal standards for these matters, the results are a good guide to the general standard of hygiene. (See table opposite) Foods submitted for Bacteriological Examinations Food Satisfactory Unsatisfactory Suspicious Total Cream Confectionery 1 1 - 8 Cooked Chicken 6 2 1 9 Cooked Ham 9 14 1 24 Cooked Meat other than Ham 13 5 2 20 Cream (fresh) 4 3 — 7 Delicatessen goods 1 1 — 2 Oysters, Prawns, etc. 3 1 — 4 Raw Meat 1 - — 1 Environmental Health 95 Inspection of Food Premises Type of Premises Total Number Visits Made Butcher shops 136 605 Aircraft Catering 9 92 Dairies and Milk distributors 60 91 Fishmongers and poulterers 43 279 Food Factories: 55 Bakery and Confectionery 3 Biscuits 1 Butter Blending 1 Caramel 1 Coffee and Chocolate 1 Confectionery 1 Manufacture of Drugs etc. 2 Meat Products 2 Soft Drinks and Mineral Works 2 14 Grocer shops 205 979 Greengrocers' shops 97 438 Ice Cream premises and confectioners 202 322 Ice Cream distributors 38 85 Bakehouses 20 174 Bakers' shops 52 190 Aged Persons' Homes, Hostels and Day Nurseries 19 62 Staff Canteens 128 508 Hospital kitchens 10 64 School kitchens 57 — School kitchens (private) School Dining Centres 6 21 159 Hotels, restaurants, cafes, public houses and clubs 260 970 Totals 1,377 5,073 The proprietors of two restaurants were prosecuted during the year for offences under the Food Hygiene Regulations. Both were found guilty. Some of the bacteriological counts have been millions per gram. As has been mentioned, the plate count does not reveal pathogenic organisms but highlights failures in hygiene. A number of multiple shops within the Borough make a practice of displaying cooked meats at ambient temperatures which of course fluctuate considerably. Temperature checks of shop windows revealed cooked meat on display in temperatures ranging from the upper sixties to the lower seventies (Fahrenheit). The companies concerned were approached and the dangers inherent in this form of display were emphasised. It was claimed that the methods adopted, namely exposure of cooked meats in small 96 Environmental Health quantities, and for short periods only, were sufficient to safeguard against any bacterial multiplication. Such arrangements of course involve the human element and invariably some cooked meats were removed for overnight storage under refrigeration and placed on display again the following day. The only adequate safeguards are the display and storage of cooked meats at properly controlled temperatures. Samples of meat displayed in unrefrigerated conditions were submitted for laboratory examination and the very unsatisfactory results obtained were brought to the attention of and discussed with the firms concerned, who by the end of the year were giving the matter their closest attention. The unsatisfactory samples of cream involved two producer-retailers and a dairy company. The hygiene standards at the producer-retailers' premises, one of which was situated outside the Borough, is the concern of the Ministry of Agriculture, Fisheries and Food to whom the results were forwarded. In the remaining case the unsatisfactory result was undoubtedly due to overlong storage. Some concern was felt when a food shop was found to be selling pet food. The owner, however, overcame the risk of contamination to food for human consumption by providing separate facilities for handling and displaying the pet food, samples of which were also submitted for bacteriological examination. Food Hygiene Codes of Practice No. 6 "Hygiene in the Bakery Trade and Industry" was published by the Ministry of Health and Ministry of Agriculture, Fisheries and Food during the year. This very welcome addition to the codes of practice already in existence was brought to the attention of all bakehouse managers within the Borough. The Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 were also received, their operative date being 1st January, 1967. A circular letter summarising the requirements of these Regulations was prepared for the benefit of all persons concerned in an endeavour to ensure that all the requirements would be implemented by the New Year. An innovation in the field of health education and publicity was the allocation of a window in the Uxbridge High Street for display purposes. It was devoted to the subject of Food Hygiene for one month and featured photographs of public health inspectors carrying out their various activities in this field, together with prepared cultures of bacteria, posters, etc. The theme was that the co-operation of food handlers and all members of the public was essential to secure the hygienic handling and production of food. Poultry Inspection There is one large poultry processing establishment in the district although, of course, poultry is also killed and dressed at numerous farms and similar premises. Food Hygiene (General) Regulations, 1960 No. of premises fitted to comply with Regulation 16 (provision of wash hand basins) 1,377 No. of premises to which Regulation 19 applies (facilities for washing food and equipment) 1,360 No. of premises fitted to comply with Regulation 19 1,360 Food and Drugs Act, 1955 Number of premises registered: Manufacture of Ice Cream 4 Storage and Sale of Ice Cream 407 Manufacture of sausages, pickled, pressed and preserved food 107 Environmental Health 97 Liquid Egg Thirteen samples of liquid egg were tested for adequate pasteurisation, and all were found to be satisfactory. There are no egg pasteurisation plants within the Borough. Watercress Samples of watercress from the beds within the Borough were all found to be satisfactory. The water in the beds is of a very unsatisfactory quality, but the use of hypochlorite wash ensures a satisfactory end product. SECTION VII Report of the Principal School Medical Officer for the year 1966 101 Report of the Principal School Medical Officer for the Year 1966 THE SCHOOL HEALTH SERVICE An indication was given in the report for 1965 as to the procedure adopted to arrange for the medical inspection of pupils in accordance with the requirements of the Education Act. During 1966 the School Health Service has been carried on in much the same manner as in the previous year, and the following table gives an indication of the extent of the work during the year:— Year of Birth Number of Pupils who Have Received a Full Medical Examination Physical condition of Pupils Inspected Number of Individual Pupils Found to require Treatment (Excluding Dental Diseases and Infestation with Vermin) Satisfactory Unsatisfactory 1962 and later 85 85 — 4 1961 1,275 1,273 2 70 1960 1,566 1,566 — 114 1959 230 229 1 17 1958 191 191 — 14 1957 166 166 — 14 1956 629 626 3 44 1955 1,603 1,602 1 99 1954 859 856 3 50 1953 269 268 1 10 1952 1,575 1,572 3 61 1951 and earlier 2,837 2,835 2 96 TOTALS 11,285 11,269 16 593 Percentage of children inspected with satisfactory physical condition 99.86 Percentage of children inspected with unsatisfactory physical condition 0.14 Percentage of children inspected who were found to require treatment 5.25 Percentage of children who were found to require treatment (excluding vision defects) 3.46 As time goes on it is becoming more obvious that facilities and time ought to be made available, particularly in the senior schools, for the medical officer to be able to undertake consultations in those cases where particular problems have been presented. It would be a distinct advantage if this were possible so as to encourage pupils to make the fullest possible use of the facilities available. Unfortunately, it is not at present possible to set aside sufficient time for this purpose. DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS DURING THE YEAR NOTE:—All defects noted at periodic and special medical inspections are included in this Table, whether or not they were under treatment or observation at the time of the inspection. This Table includes separately the number of pupils found to require treatment (T) and the number of pupils found to require observation (O). 102 Report of the Principal School Medical Officer for the Year 1966 Defect Code No. (1) Defect or Disease (2) Periodic Inspections Special Inspection Entrants Leavers Others Total 4 Skin T 5 1 11 23 18 O 11 1 8 20 41 5 Eyes (a) Vision T 51 55 113 219 223 0 263 77 182 522 185 (b) Squint T 8 — — 8 6 O 4 — 3 7 1 (c) Other T — 2 1 3 2 O — — 3 3 5 6 Ears (a) Hearing T 60 12 55 127 248 O 69 4 36 109 290 (b) Otitis Media T 3 1 4 8 7 O 3 1 2 6 3 (c) Other T 2 3 3 8 8 O 5 — 9 14 26 7 Nose and Throat T 13 5 10 28 10 O 91 2 26 119 83 8 Speech T 27 5 7 39 58 O 56 — 11 67 39 9 Lymphatic Glands T — — 1 1 2 0 21 1 4 26 7 10 Heart T 2 — 2 4 6 O 34 8 15 57 61 11 Lungs T 3 — 2 5 7 O 39 4 18 61 84 Report of the Principal School Medical Officer for the Year 1966 103 Defect Code No. (1) Defect or Disease (2) Periodic Inspections Special Inspection Entrants Leavers Others Total 12 Developmental (a) Hernia T — — 2 2 1 O 2 — 1 3 2 (b) Other T 2 6 9 17 15 O 33 6 26 65 33 13 Orthopaedic (a) Posture T — 1 8 9 1 O 7 9 25 41 13 (b) Feet T 8 10 24 42 123 O 43 9 43 95 84 (c) Other T 2 1 3 6 9 O 13 5 7 25 25 14 Nervous System (a) Epilepsy T — — 1 1 4 O 2 2 2 6 13 (b) Other T 3 — — 3 11 O 9 3 5 17 18 15 Psychological (a) Development T 3 1 8 12 21 O 14 5 14 33 37 (b) Stability T — — 5 5 11 O 15 3 14 32 65 16 Abdomen T — 2 — 2 3 O 7 1 6 14 13 17 Other T 10 9 18 37 27 O 39 13 58 110 194 104 Report of the Principal School Medical Officer for the Year 1966 SCHOOL CLINICS School clinics were carried out on the same lines as previously, that is to say, they were used as consultative clinics where detailed examination of pupils and discussion with parents was possible. Number of special inspections and re-inspections carried out during the year: 7,143. Premises School Health Sessions Immunisation/ Vaccination Sessions Cavendish Pavilion, Field End Road, Eastcote 1st Thursday a.m. in the month Elers Road Clinic, Elers Road, Hayes Every Thursday a.m. in the month 1st Friday a.m. in the month Grange Park Clinic, Lansbury Drive, Hayes Every Tuesday a.m. in the month 2nd and 4th Thursday a.m. in the month Harefield Clinic, Park Lane, Harefield Every Thursday a.m. in the month 4th Friday p.m. in the month Haydon Hall Clinic, Joel Street, Eastcote 1st Thursday a.m. in the month Hayes End Clinic, Methodist Church Hall, Uxbridge Road, Hayes 1st Thursday a.m. in the month Ickenham Clinic, Long Lane, Ickenham 1st and 3rd Tuesday a.m. in the month 1st and 3rd Tuesday a.m. in the month Laurel Lodge Clinic, Harlington Road, Hillingdon 1st and 3rd Wednesday a.m. in the month 2nd and 4th Wednesday a.m. in the month Manor Farm Clinic, Ruislip 2nd and 4th Tuesday a.m. in the month 3rd Tuesday a.m. in the month Maurice Child Memorial Hall, Carfax Road, Hayes 5th Tuesday p.m. in the month Minet Clinic, Coldharbour Lane, Hayes Every Friday a.m. in the month 2nd Monday a.m. in the month Northwood Clinic, Ryefield Court, Ryefield Crescent, Northwood Hills 1st and 3rd Tuesday a.m. in the month 2nd Wednesday a.m. in the month Oak Farm Clinic, Long Lane, Hillingdon 2nd, 4th and 5th Thursday a.m. in the month 2nd Friday a.m. in the month 105 Report of the Principal School Medical Officer for the Year 1966 Premises School Health Sessions Immunisation! Vaccination Sessions Queen's Hall, Station Road, Hayes 3rd Wednesday p.m. in the month Ruislip Manor Clinic, Dawlish Drive, Ruislip 2nd and 4th Friday a.m. in the month 1st Friday a.m. in the month Uxbridge Clinic, Council Offices, High Street, Uxbridge Every Friday a.m. in the month 1st Wednesday a.m. in the month West Mead Clinic, West Mead, S. Ruislip 1st and 3rd Friday a.m. in the month 2nd Tuesday a.m. in the month Yiewsley Clinic, 20 High Street, Yiewsley Every Tuesday a.m. in the month Alternate Wednesday a.m. in the month 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 228 Errors of refraction (including squint) 1,290 1,518 Number of pupils for whom spectacles were prescribed 813 Orthopaedic and Postural Defects Number known to have been treated Pupils treated at clinics or outpatients departments 99 106 Report of the Principal School Medical Officer for the Year 1966 Child Guidance Treatment Number known to have been treated Pupils treated at Child Guidance Clinics 296 Speech Therapy Number known to have been treated Pupils treated by speech therapists 294 Other Treatment Given Number known to have been dealt with Pupils who received convalescent treatment in accordance with Section 48 of the Education Act, 1944 Pupils who received B.C.G. Vaccinations 7 2,120 Routine Audiometry The routine audiometry service was maintained during the year with the audiometer operator working on a part-time basis of three days per week. The investigations were continued in the junior departments and infant departments of primary schools, and the results of the work performed can be summarised as follows:— Number of individual children tested 7,347 Number found to have normal hearing 6,865 Number found to have a hearing loss 482 Of the 482 children found to have a hearing loss:— 119 were found to have a hearing loss in the right ear; 156 were found to have a hearing loss in the left ear; 207 were found to have a hearing loss in both ears. 107 Report of the Principal School Medical Officer for the Year 1966 The 482 children were referred for examination by the assistant medical officers with the following results:— 174 children were found to have normal hearing on clinical testing, 250 children were noted for re-examination, 11 children were referred to Ear, Nose and Throat Departments, 17 children were referred to General Practitioners, 4 children were referred to Audiology Units, 9 children were already attending hospital, 8 children were already attending Audiology Units, 9 children had left the area. Vision Testing The vision testing of schoolchildren at approximately the age of seven years continued throughout the year. These tests are additional to those carried out at the time of periodic routine medical inspections. They are conducted in school by the health visitor/school nurses. Vision tests are given also to children aged between eight and ten, if for any reason it is felt to be necessary. During the year under review, the number of routine vision tests and results under this heading were as follows:— Number of children tested 3,416 Number referred for the opinion of medical officer 153 Of these:— 48 were referred to the Authority's ophthalmic clinics; 39 were referred for treatment via general practitioners, at the request of parents; 30 were deferred for re-examination at the School Health Clinics; 13 were considered to have normal vision; 19 were already having ophthalmic treatment; 4 left the area while investigations were proceeding. Of the 48 children referred to the Authority's ophthalmic clinics:— 41 were prescribed glasses; 7 were noted for re-examination. ORTHOPTIC CLINIC The orthoptic service continued along the lines established in 1965. Early in the year it became apparent that it would be necessary to change the weekly sessions from two to three because the number of children referred for orthoptic examination and training had increased steadily. A total of 76 new cases were seen during the year, most of whom were suffering from convergent strabismus. Full details are given in the table on page 108. 108 Report of the Principal School Medical Officer for the Year 1966 Monthly Attendance Record—Orthoptic Clinic 1966 New Patients Attending for Exercises Attending for test and/or Observation Total Failed to Attend January 3 19 29 51 8 February 3 29 31 63 16 March 8 24 40 72 13 April 8 12 34 54 14 May 10 8 38 56 10 June 9 31 45 85 17 July 3 11 43 57 20 August 5 6 37 48 11 September 5 18 45 68 16 October 6 23 20 49 18 November 9 24 28 61 23 December 7 9 30 46 16 TOTALS 76 214 420 710 182 New Patients 1966 Type of Case Type of Case Convergent strabismus Heterophoria and/or convergence deficiency 5 Including: (1) With amblyopia 23 (2) Referred for surgery 5 Amblyopia due to Anisometropia 3 TOTAL 55 Divergent strabismus Apparent Squint due to epicanthus, narrow I.P.D., etc. 3 (1) Latent 10 (2) Manifest, referred for surgery 0 — Total New Patients Referred from School TOTAL 10 Clinics 76 EDUCATION ACT, 1944—SECTION 34 The Education Authority is required to ascertain how many children in its area require special education. The various categories of handicapped pupils are defined, and an explanation of these conditions was given in the previous year's report. The "At Risk" Register was continued on the same lines as previously, and the information made available through this means was used to get some idea of the provisions that would be necessary for handicapped children in future. 109 Report of the Principal School Medical Officer for the Year 1966 HANDICAPPED PUPILS REGISTER FOR 1966 Category Number of Children Placed in Total New Cases Referred to Local Education Authority during 1966 Day Special Schools Special Classes Residential Special School Ordinary Schools Home Tuition etc. Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls A Blind — — — — 1 3 1 3 — — B Partially Sighted 5 3 — — 1 2 1 1 7 6 1 4 C Deaf 4 3 — — 2 2 1 — 7 5 1 1 D Partially Hearing 1 4 8 1 2 — 26 14 37 19 7 9 E Educationally Sub-normal 64 44 7 2 8 4 16 11 95 61 37 13 F Epileptic — — — — 1 — 16 10 17 10 4 4 G Maladjusted 21 7 14 3 32 10 30 12 97 32 23 7 H Physically Handicapped 16 11 — — 5 — 64 50 85 61 17 9 I Speech Defect — — — — 1 — 128 48 129 48 45 19 J Delicate 3 1 — — 10 11 115 68 128 80 38 25 Children with Multiple Defects 14 5 3 2 16 6 15 9 48 22 11 10 TOTALS 128 78 32 8 79 38 412 223 651 347 184 101 The number of children under five being dealt with under various categories is as follows:— Year of Birth Total 1962 1963 1964 1965 1966 Defective Vision 1* — 1 2 4 Defective Vision with Mental Defect — — 1 — — 1 Defective Hearing 6 1 1 1 2 11 Mental Defect 21 13 11 4 4 53 Mongolism 6 4 3 4 5 22 Spastic — 1 3 4 — 8 Epileptic 3 1 2 1 — 7 Heart Disease 9 5 3 1 2 20 Spina Bifida 2 1 3 2 2 10 Congenital Dislocation of Hip — 2 1 2 — 5 Muscular Atrophy — — — — — — Fibrocystic Disease of Pancreas 1 2 2 1 — 6 Achondroplasia 1 — — — — 1 Diabetic 1 — — — — 1 Cretinism — — — — 1 1 TOTALS 51 30 31 22 16 150 * Already being educated in a Boarding School for Blind Pupils. In cases of severe mental subnormality arrangements need to be made as soon as possible, so that a correct placement can be ensured at the appropriate time. Formal action is rarely taken before a child is seven, and informal placement is frequently made. 110 Report of the Principal School Medical Officer for the Year 1966 The following table gives an indication of the number of children between five and 15 years of age who have been reported under Section 57 during the past few years and those who are placed informally. NORMAL ENVIRONMENT HOSPITAL CASES INFORMAL FOSTER CARE CASES GRAND TOTAL Year of Birth Section 57 cases Informal cases Section 57 cases Informal cases Section 57 cases Informal cases Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls 1962 — — 4 8 1 2 7 8 1961 — — 4 4 1 — — — — — — — 5 4 1960 1 2 4 5 — — 1 — 1 — — — 7 7 1959 7 — — — — — — — — — — — 7 — 1958 6 2 — — 2 — — — — — — — 8 2 1957 3 5 — — 1 — — — — — — — 4 5 1956 6 2 — — 2 2 1 — — — — — 9 4 1955 2 1 — — — 1 — — — — — — 2 2 1954 5 1 — — 3 — — — — — — — 8 1 1953 2 5 — — 3 1 — — — — — — 5 6 1952 2 4 — — 3 2 — — 1 — — — 6 6 TOTALS 34 22 12 17 15 6 3 — 2 — 2 — 68 45 Recuperative Holidays for Children Seven children were recommended under Section 48 of the Education Act, 1944, and recuperative holidays were arranged for them. These holidays are provided free of charge. Tuberculosis Occurring in Teachers and Pupils I am happy to report that there was only one case of pulmonary tuberculosis in a schoolchild. Contact tracing had already been undertaken by the staff of the Chest Clinic, and no action was required from the School Health Service. SCHOOL DENTAL SERVICE STATISTICS Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total Attendances and Treatment First visit 3,181 2,208 413 5,802 Subsequent visits 5,500 5,135 1,117 11,752 Total visits 8,681 7,343 1,530 17,554 Additional courses of treatment commenced ... 244 142 62 448 Fillings in permanent teeth ... 1,740 5,047 1,496 8,283 Fillings in deciduous teeth 6,501 444 — 6,945 Permanent teeth filled 2,370 4,377 1,250 7,997 Deciduous teeth filled 5,026 339 — 5,365 Permanent teeth extracted 103 665 125 893 Deciduous teeth extracted 2,449 557 — 3,006 General anaesthetics 809 233 22 1,064 Emergencies 444 163 26 633 111 Report of the Principal School Medical Officer for the Year 1966 Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total Prosthetics Pupils supplied with full upper or full lower (first time) 18 - 2 20 Pupils supplied with other dentures (first time) 17 15 18 50 Number of dentures supplied 35 15 20 70 Number of Pupils X-rayed 290 Anaesthetics Prophylaxis 639 General anaesthetics administered by dental officers 136 Teeth otherwise conserved 157 Number of teeth root filled 35 Inlays 11 Inspections Crowns 95 First inspection at school. Number of pupils 18,868 Courses of treatment completed 4,718 First inspection at clinic. Number of pupils 2,311 Orthodontics Number found to require treatment 8,300 Cases remaining from previous year 269 Number offered treatment 7,985 New cases commenced during year 143 Pupils re-inspected at school or clinic ... 856 Cases completed during year 133 Number found to require treatment 537 Cases discontinued during year 7 Number of removable appliances fitted 222 Sessions Number of fixed appliances fitted 51 Number of sessions devoted to treatment 2,982 Pupils referred to Hospital Consultant 47 Number of sessions devoted to inspection 184 Index 115 Index Accidents 69, 70 Adaptations 49 Adult Training Centres 59 Aged, Welfare of 45-48 Aids 49 Aircraft Emergencies 23 Aliens, Medical Inspection of 21 Animals, Diseases of Act, 1950 90 Slaughter of Acts, 1933-1958 90 Ante-natal Clinics 29 Atmospheric Pollution, Measurement of 83,84 Audiometry, Routine in Schools 106 Births 11, 14, 15 Blind, Welfare of 50, 53, 54 Bourne Hostel 59 Cancer, Deaths from 17 Caravan Sites 82 Car Badges 50 Cervical Cytology Service 65, 66 Chief Public Health Inspector, Report of 69-97 Chief Welfare Officer, Report of 45-55 Chimneys, Height of 87 Chironomus Midges 69 Chiropody 41 Classes for Handicapped Persons 49 Clean Air 83-87 Clearance Areas 80, 81 Clinics 28, 29 Clubs for the Blind 53 Community Care 45-60 Condemned Food, Disposal of 90 Dark Smoke Regulations 87 Day Nurseries 27,28 Deaths — All Causes 13 — Cause of, Statistics 18 — Infant 12 — Maternal 12 Defects Found at School Medical Inspection 102, 103 Dental Service — Priority 30, 31 — School 110, 111 Disinfection and Disinfestation 71 Disrepair, Certificates of 82 Diphtheria Immunisation 36, 39 Education Act, 1944 108 Emergencies, Peace Time 54 Environmental Health 69-97 Factories Act, 1961 72 Fatalities at London Airport 23 Fertilizers and Feeding Stuffs Act, 1926 73 Food — Complaints 92, 93 — Food and Drugs, Sampling of 91 Food — Hygiene 94 — Inspection at London (Heathrow) Airport 75 — Premises, Inspection of 95 — Unsound 90 Furnaces 87 Grit, Dust and Effluvia, Measurement of 85 Gypsies 83 Handcraft Classes 53 Handicapped Pupils Register 109 Health Committee, Members of 5 Health Control Unit, Heathrow Airport 19-23 Health Visiting 32-35 Heathrow — Health Control Unit 19-23 Highgrove House 48 Hillingdon Junior Training Centre 59 Holidays, Recuperative 41 Holidays, Children's Recuperative 110 Holidays for the Handicapped 49 Homeless Families 48 Home Help Service 40 Home Nursing 35,36 Homes for the Aged 45-46 Hostels — for the Homeless 48 — for the Mentally 111 60 — for Subnormal Adults 59 Housing — Allocation, Medical Grounds 63 — Clearance Areas 80, 81 — Improvement Areas, Repairs, Demolition 77-81 — Multiple Occupation 81 — Unfit Houses 80 Ice Cream 89 Immigrants, Commonwealth 21 Immunisation — Diphtheria 36, 39 — Measles 38 — Poliomyelitis 37 — Smallpox 37 — Statistics 39 Improvement Areas Improvement Grants 78 Industrial Bonfires 87 Infant Mortality 16, 17 Infectious Diseases 19 Inspection of Food Premises 95 Introduction 3,4 Junior Training Centre 59 Lodging Houses, Common 71 Massage and Special Treatment 63 Maternal and Child Welfare 29, 30 Mead House 48 Measles Vaccination 38 Meat, Inspection of 89 Medical Examination of Staff 64 Medical Inspection, School 101, 103 Mental Health 59, 60 Mental Illness, Statistics 60 Mental Welfare Officers, Work of 60 Midges, Chironomus 69,71 Midwifery Service 32 Milk and Dairies Regulations 87, 88 Moorcroft Weekly Boarding Unit 59 Mortuary 65 Mothercraft 30, 32 - 34 Multiple Occupation 81,82 116 Index Noise 74 Noise — Insulation Grants Scheme 73 Nurseries and Child Minders, Registration of.64 Nursing Agencies 64 Nursing (see Home Nursing) 35, 36 Nursing Homes 65 Observation and Treatment of School Children 101-103 Offices, Shops and Railway Premises Act, 1963 74 Orthodontics 111 Orthoptic Clinic 107, 108 Outworkers, Statistics 73 Personal Health Services 27-41 Poliomyelitis Immunisation 37 Port Health, Heathrow Airport 19, 20 Post-natal Clinics 29 Priority Dental Service 30, 31 Pulmonary Tuberculosis 22,40 Radio Sets for the Blind 54 Rag Flock and Filling Materials Act, 1951 76 Recuperative Holidays 41 Registrar General, Comparability Factor 13 Relaxation 30 Residential Homes for the Aged 45-48 Rodent Control 76, 77 Sampling of Food and Drugs 91 School Clinics and Sessions 104, 105 School Dental Service 110, 111 School Health Service 101-111 Section 57 Cases — Statistics 110 Slaughterhouses 89 Smallpox 22 Smoke Control Areas 85 Smoke and Sulphur Dioxide, Statistics 83,84 Staff of the Department 6, 7 Staff, Medical Examination of 64 Statistics 11-18 Subnormals, care of Swimming Pools 76 Training Centres, Junior and Adult 59 Tuberculosis, Care and After-Care 40 Tuberculosis Occurring in Teachers and Pupils 110 Unsound Food 90 Unsupported Mothers, Care of 30 Uxbridge Adult Training Centre 59 Vaccination Against Smallpox 37 Vaccination, Heathrow Airport 38 Vaccination Against Measles Vision Testing 107 Water — Aircraft Drinking 69 — Public Supplies 76 Watercress Beds 97 Welfare of the Aged 45-48,51, 52 Welfare of the Blind 50, 53, 54 Welfare Committee, Members of Welfare of the Physically Handicapped 49, 50 Work Centre for the Physically Handicapped 49 Workshop, Old People's 47 X-ray Unit, Heathrow Airport 22