annual report for the Year 1967 HIL 3 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER 1967 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. Health and Welfare Department, Council Offices, Uxbridge, Middlesex. Contents page Introduction 3-4 Health and Welfare Committees 5 Staff of the Department 6-7 SECTION I Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport 11-24 SECTION II Personal Health Services 27-40 SECTION III Community Care - Welfare Services 43-50 SECTION IV Community Care - Mental Health 53-55 SECTION V General Services 59-63 SECTION VI Environmental Health 67-93 SECTION VII Report of the Principal School Medical Officer 97-110 Index 113-114 3 To: The Mayor, Aldermen and Councillors of the Borough: One of the prescribed duties of a Medical Officer of Health is to present to his Council an annual report, and as a result this document contains an account of the circumstances prevailing in the area during 1967. Because annual reports contain a considerable amount of standardised information, they become sources of information available to future generations, and collectively they will provide essential data for the social scientists of the future. Nineteen sixty-seven was the second complete year in which the Health and Welfare Department carried out its statutory functions. The process of consolidation and integration was continued, and every effort was made to unify the various sections into a composite whole so that overlapping was avoided and the available manpower was used to the maximum possible benefit of the patient. During the year it was possible to link up more closely with a number of voluntary organisations, and as a result these agencies were able to perform most valuable work, for which both the Department and the public owe a deep debt of gratitude. In these days it is no longer necessary to make any extended reference to the incidence of infectious diseases. The killing diseases now are diseases of the heart and vascular system and cancer. The picture will be quite clearly seen by reference to the table on Page 19. The death rate from cancer was 2.12 per thousand of the population, (the national rate being 2.27). This rate is a slight increase over the figure for the previous year. The death rate for cancer of the lung was 0.61 per thousand, compared with the national rate of 0.58. Study of these lung cancer figures leads inevitably to the question as to how this condition can be prevented. It is necessary to say again that in this connection the evidence is overwhelming that prolonged and excessive cigarette smoking is the main underlying cause of lung cancer. A great deal of research has been carried out all over the world, and it has hitherto not been possible to shake the idea that excessive cigarette smoking is the main cause of lung cancer, nor has any method been found to render cigarette tobacco harmless. The prevention of lung cancer, consequently, lies not with the medical practitioner but with the individual himself. The cigarette habit where established should be abandoned, and it is the duty of parents wherever possible to discourage their children from developing a liking for cigarette smoking. Although, as indicated already, no extended reference to infectious diseases is now necessary, it is pertinent to say that there was no case of diphtheria or poliomyelitis in the borough, and in fact there has been no case of diphtheria since 1949. The present satisfactory position in connection with the control of infectious diseases is entirely dependent on the successful prosecution of the immunisation procedures available. It is essential that a high level of immunity is maintained in the community because only in this way will epidemics of infectious diseases be avoided. Because there has been comparative freedom from a number of infectious diseases for a considerable time, their effects are no longer frightening. Consequently it becomes more and more difficult to persuade parents to have their children immunised against diseases which they no longer know and have certainly never seen. In this connection also it is necessary to draw attention to the risk that this borough sustains owing to the nearness of Heathrow Airport and the possible importation of conditions like smallpox. Obviously many airport workers and their families living in the borough are at risk and should be protected by vaccination. The present recommendation is that vaccination should be carried out during the second year, and once this is done, any subsequent re-vaccination, whether because of contact with a case or because of the needs of foreign travel, becomes a simple procedure. The welfare section of the department continued to carry out its statutory duties—mainly of course those prescribed by the National Assistance Act, and the process of integration with the various sections of the Health Department continued. Every effort was made to carry out these duties with the minimum of manpower, and arrangements were introduced so that the information derived from various sources was made available to all those members of the department who could make use of it. During the year two new Part III Homes were opened; Brookfield, Park Road, Uxbridge, (54 beds) and Belle Vue, Harlington Road, Hillingdon, (53 beds). These purpose-built Homes have of course proved of immense value, and the facilities provided are greatly appreciated by the residents. 4 The modern purpose-built Home is much more comfortable and very much easier to run than the converted building, and in the long run a more economical proposition. The position has now been reached where it is no longer possible to define clearly a case suitable for Part III accommodation or a case suitable for a geriatric ward. Consequently, the burden imposed on the staff in Part III Homes is becoming heavier all the time as residents grow older and deteriorate further. The devotion of the staff has been exemplary and the grateful thanks of the residents and of the community as a whole is no less than their due. Incidentally, it is worth recording that the department has been requested to provide training facilities and observation visits for a very wide range of both graduates and students. I have nothing but praise for my colleagues in the Health and Welfare Department. The members of the department have carried out their duties in a most satisfactory manner, very often in the face of difficulties arising from staff shortages. The work has proceeded much more easily than it might otherwise have done because of the willing co-operation of many general practitioners and many members of the staffs of the hospitals in the borough. It is also necessary to place on record the debt of gratitude due to the various voluntary agencies who co-operate so readily in the work of the Health and Welfare Department, and in this connection I would like particularly to mention the four Old People's Associations, the British Red Cross Society and the Women's Royal Voluntary Service. Finally, it would not be fit to close without expressing my gratitude for the unstinting help and encouragement received from the Chairmen and Members of the Health and Welfare Committees. Their help has been most valuable. O. C. DOBSON, Medical Officer of Health. HEALTH COMMITTEE (as at 31st December, 1967) Ex-officio: The Mayor (Councillor G. A. Childs) Chairman: Councillor J. Rowe Vice-Chairman: Councillor L. Sherman Alderman: J. J. Coleman Councillors: J. G. Bartlett T. Cluny D. C. Lorkin R. W. Bossom R. H. Collman C. Nemeth Mrs. E. E. Broughton L. J. Davies J. E. Skidmore N. H. Butler E. Hales Mrs. L. E. Wane Mrs. V. Chalk Advisory: Mr. G. Corran (representing Hillingdon Group Hospital Management Committee) Mr. E. S. Saywell (representing Harefield and Northwood Group Hospital Management Committee) Miss J. McCarthy (representing Royal College of Midwives) Mr. J. Mapstone (representing Pharmaceutical Society of Great Britain) Dr. R. A. P. Paul (representing Middlesex Local Medical Committee) Mr. F. Sym (representing Confederation of Health Service Employees) WELFARE COMMITTEE (as at 31st December, 1967) Ex-officio: The Mayor (Councillor G. A. Childs) 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 R. Perry Mrs. V. Chalk T. J. Parker B. Shaw 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, L.R.C.P., M.R.C.S. 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. E. W. Jones, M.B., B.S., D.I.H., D.P.H. I. Marrable, L.R.C.P., M.R.C.S., D.T.M. & H. A. L. Stuart, L.R.C.P., M.R.C.S. D. Tweedie, M.B., B.Ch., B.A.O. Assistant Medical Officers: D. Barnes, M.B., B.S. (Sydney) J. Drake, M B., B.S., L.R.C.P. M. M. Elias, L.R.C.P., M.R.C.S. M. Fox, M.B., Ch.B., P.H.Cert. W. R. Holton, M.B., B.S., L.R.C.P., M.R.C.S. J. Jones, M.B., Ch.B. G. Malmberg, M.B., B.S., D.P.H. J. V. Moon, M.B., B.S., L.R.C.P., M.R.C.S. M. O'Connor, L.R.C.P., M.R.C.S., D.P.H. M. Rennie, M.B., Ch.B., D.P.H. A. R. T. Wilson, M.B., B.S., D.P.H. 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. Miss M. P. Mackenzie, B.D.S., L.D.S., D.Orth., R.C.S. Dental Officers: G. H. Allen, L.D.S., R.C.S., B.D.S. Mrs. A. K. Barnett, B.Ch.D., L.D.S. Miss H. P. E. Green, B.D.S. Mrs. E. A. Jackson, B.D.S., L.D.S., R.C.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 A. D. Mogford, S.R.N., C.M.B. Part I, H.V. Certificate. Deputy Superintendent Health Visitor: Miss E. M. Brown, S.R.N., S.C.M., H.V. Certificate, Q.I.D.N. Certificate 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 Superintendent 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 M. 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.M.A. D. N. A. McKellar G. D. Shaw Technical and Professional Staff: Airport Nurses Audiometer Operator Chiropodists Clinic Nurses Dental Surgery Assistants Domiciliary Midwives Health Assistants Health Education Technician Health Visitors, Students and Field Work Instructors Home Nurses Home Teachers Marie Curie Nurses Mental Welfare Officers Occupational Therapist 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 7 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 Matrons' Assistants 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 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport 11 General Statistics Area—square miles 42.5 Population—Registrar-General's estimate for mid-year 1967 234,470 Number of inhabited dwellings 71,722 Rateable Value—as at 1st April, 1967 £16,612,642 Product of Penny Rate—1967-68 (Actual) £69,592 6s. 8d. Vital Statistics Total Live Births: Male Female Total Legitimate 1,785 1,721 3,506 Illegitimate 130 120 250 1,915 1,841 3,756 Birth Rate per 1,000 population: Hillingdon Crude 16.0 Corrected 15.4 England and Wales 17.2 Area Comparability Factor:0.96 Illegitimate Live Births: Male Female Total 130 120 250 Per cent. of total live births: 6.7 Still Births: Male Female Total Legitimate 23 16 39 Illegitimate 2 2 4 25 18 43 Rate per thousand live and still births: Hillingdon 11.32 England and Wales 14.8 Total Live and Still Births: Male Female Total Legitimate 1,808 1,737 3,545 Illegitimate 132 122 254 1,940 1,859 3,799 These births occurred as under: Live Births Still Births At home 1,029 4 In hospitals, nursing homes or other maternity establishments 2,727 39 3,756 43 12 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport Infant Deaths (under 1 year of age): Male Female Total Legitimate 24 23 47 Illegitimate 5 — 5 29 23 52 Legitimate—rate per 1,000 legitimate live births: 13.4 Illegitimate—rate per 1,000 illegitimate live births: 20.0 Infant Death Rate per 1,000 total live births: Hillingdon 13.9 England and Wales 18.3 Neo-natal Deaths (under 4 weeks of aee): Male Female Total Legitimate 18 15 33 Illegitimate 5 — 5 23 15 38 Rate ner 1.000 total live births: Hillingdon 10.1 England and Wales 12.5 Early Neo-natal Deaths (under 1 week of age): Male Female Total Legitimate 14 14 28 Illegitimate 5 — 5 19 14 33 Rate per 1,000 total live births: Hillingdon 8.8 England and Wales 10.8 Perinatal Deaths (Still Births and deaths under 1 week combined): Male Female Total Legitimate 37 30 67 Illegitimate 7 2 9 44 32 76 Rate per 1,000 live and still births: Hillingdon 20.0 England and Wales 25.4 Maternal Deaths Total 2 Rate per 1,000 live and still births: Hillingdon 0.53 England and Wales 0.20 (There were no maternal deaths in 1966, and only one in 1965.) 13 Statistics, Infections Diseases, Health Control Unit London (Heathrow) Airport Deaths from All Causes Male Female Total 1,045 1,041 2,086 Death Rate per 1,000 population:— Hillingdon Crude 8.90 Corrected 11.04 England and Wales 11.20 Area Comparability Factor: 1.24 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 1.24, 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 14 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport LIVE BIRTHS Age and parity of mother and place of occurrence during 1967 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 1,102 145 459 330 107 49 12 — 2 51 5 33 9 3 1 — — 3 250 22 133 77 15 1 1 1 4 14 3 9 2 — — — — 1 1 697 26 205 277 127 51 11 - 2 39 — 11 18 7 3 — - 3 423 9 161 176 57 19 1 - 4 6 1 3 2 — — — - 2 1 296 2 39 110 83 49 11 2 2 25 — 1 13 7 3 1 — 3 200 2 42 91 45 19 1 — 4 4 — 2 1 1 — — — 3 1 139 13 39 40 34 13 2 12 — 1 3 6 1 1 — 3 12 — 10 31 24 17 — — 4 3 — — 1 1 1 — — 4 1 66 1 17 18 24 3 3 2 4 — — — 1 2 1 — 3 4 13 — 1 5 2 4 1 — 5-9 1 67 - 1 6 29 22 8 1 2 - 3 13 1 7 4 1 4 — — — — — — — — 10+ 1 — — — — — — — 2 - - - - - - - - 3 - - - - - - - - 4 — — — — — — — — Illegitimate 1 205 70 80 32 15 5 3 - 2 6 2 3 — — 1 — — 3 30 5 7 8 9 1 — — 4 9 3 4 — 1 — 1 — Total 1 2,572 243 798 811 419 234 61 6 2 137 7 49 43 24 11 3 — 3 1,011 38 354 389 159 65 5 1 4 36 7 18 6 3 1 1 — * Place of Delivery 1. N.H.S. Hospitals. 3. At Home. 2. Non-N.H.S. Hospitals (mainly maternity homes). 4. Other. Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport 15 MULTIPLE BIRTHS Age and parity of mother and by place of occurrence 1967 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 6 — 2 2 2 — — — 2 — - — — — — — — 3 — — — — — — — — 4 1 1 — — — — — — 1 1 12 — 5 5 2 — — — 2 1 — 1 — — — — — 3 1 — — 1 — — — — 4 — — — — — — — — 2 1 5 — — 4 — 1 — — 2 — — — — — — — — 3 1 — — — — 1 — — 4 — — — — — — — — 3 1 1 — — — 1 — — — 2 — — — — — — — — 3 — — — — — — — — 4 — — — — — — — — 4 1 2 — — — 1 1 — — 2 — — — — — — — — 3 — — — — — — — — 4 — — — — — — — — 5-9 1 — — — — — — — — 2 — — — — — — — — 3 — — — — — — — — 4 — — — — — — — — 10+ 1 — — — — — — — — 2 — — — — — — — — 3 — — — — — — — — 4 — — — — — — — — Illegitimate 1 4 1 3 — — — — — 2 — — — — — — — — 3 — — — — — — — — 4 — — — — — — — — Total 1 30 1 10 11 6 2 — — 2 1 — 1 — — — — — 3 2 — — 1 — 1 — — 4 1 1 — — — — — — * Place of Delivery 1. N.H.S. Hospitals. 3. At Home. 2. Non-N.H.S. Hospitals (mainly maternity homes). 4. Other. 16 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport STILL BIRTHS Age and parity of mother and place of occurrence during 1967 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 21 2 9 5 4 1 — — 2 — — — — — — — — 3 — — — — — — — — 4 — — — — — — — — 1 1 9 — 4 2 1 1 1 — 2 1 — 1 — — — — — 3 2 — — 2 — — — — 4 — — — — — — — — 2 1 3 — - 1 1 - - 1 2 — — — - - - - - 3 - — - - - - - - 4 — — — — — — — — 3 1 1 - - - 1 - - - 2 - - - - - - - - 3 - - - - - - - - 4 — — — — — — — — 4 1 2 1 - - - - 1 - - - — - - - - 3 — - — - - - - - 4 — — — — - — — — 5-9 1 1 - - - - 1 - - 2 - - - - - - - - 3 - - - - - - - - 4 — - — — - — — — 10+ 1 - - - - - - - - 2 — - — - - - - - 3 — - — — - - - - 4 — - — — - — — — Illegitimate 1 2 1 - - 1 - - - 2 - - — — - - - - 3 — - — — - — — — 4 2 2 — — - — — — Total 1 38 3 13 8 8 4 1 1 2 1 — 1 - - - - - 3 2 - - 2 - - - - 4 2 2 — - — — — — * Place of Delivery 1. N.H.S. Hospitals. 3. At Home. 2. Non-N.H.S. Hospitals (mainly maternity homes). 4. Other. 17 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 Sex Cause of Death 31.10.67 1 minute F Prematurity 29.10.67 2 minutes M Atelectasis 24.4.67 20 minutes F Anencephaly and meningocele 21.1.67 1 hour F Extreme prematurity; pulmonary atelectasis 2.1.67 2 hours F Severe erythoblastosis 5.8.67 2 hours F Extreme prematurity 23.12.67 2 hours F Extreme prematurity 9.8.67 3 hours M Extreme prematurity 5.2.67 4 hours M Extreme prematurity 17.2.67 5 hours M Respiratory failure; respiratory distress syndrome; prematurity 30.4.67 5 hours F Multiple congenital abnormalities 18.8.67 6 hours F Extreme prematurity 11.5.67 6 hours F Extreme prematurity 12.4.67 8 hours M Pulmonary atelectasis; extreme prematurity 3.4.67 9 hours F Atelectasis; extreme prematurity 11.5.67 9 hours F Extreme prematurity 5.8.67 9 hours M Extreme prematurity 18.10.67 10 hours F Respiratory distress syndrome; prematurity 22.12.67 10 hours M Extreme prematurity 21.5.67 11 hours M Extreme prematurity 20.2.67 12 hours M Respiratory distress syndrome of newborn 31.7.67 12 hours M Gross immaturity 16.10.67 12 hours F Extreme prematurity 13.12.67 16 hours M Respiratory distress syndrome 10.1.67 1 day M Pulmonary atelectasis 17.1.67 1 day F Lobar pneumonia 2.6.67 1 day M Prematurity 28.6.67 1 day F Respiratory distress syndrome; low birth weight 24.11.67 2 days M Extreme prematurity 20.3.67 3 days M Peritonitis; ruptured stomach; prematurity 14.2.67 4 days M Primary atelectasis; prematurity; nephromegaly 5.7.67 5 days M Respiratory distress syndrome; premature—34 weeks gestation 19.7.67 6 days M Intra-pulmonary haemorrhage; thrombocytopenia 1.5.67 6 days M Intestinal obstruction; complete large and small bowel atresia 16.9.67 1 week M Prematurity 7.5.67 9 days F Bronchopneumonia 3.4.67 2 weeks M Congenital heart disease 13.7.67 3 weeks M Intestinal obstruction; extreme prematurity 18.12.67 3 weeks M Heart failure; congenital heart disease 10.1.67 1 month M Severe bronchopneumonia; bilateral undescended testes 27.3.67 1 month F Bronchopneumonia due to congenital heart disease 26.6.67 4 weeks F Idiopathic pulmonary haemorrhage of the newborn 14.1.67 2 months F Microcephaly continued 18 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport Infant Mortality—contd. Date of Death Age Sex Cause of Death 4.1.67 2 months F Bronchopneumonia; gastroenteritis 13.4.67 2 months F Bronchopneumonia 14.7.67 10 weeks M Accidental asphyxia 3.10.67 3 months M Bronchopneumonia 16.10.67 3 months M Subarachnoid haemorrhage due to fractured skull 2.12.67 4 months M Bronchiolitis 11.12.67 4 months M Meningitis and pericarditis due to upper respiratory tract infection 10.5.67 8 months F Intestinal obstruction in an intussusception 19.9.67 8 months F Right ventricular failure; congenital malformation of pulmonary vessels; right hemiplegia 15.11.67 9 months F Bronchopneumonia; cerebral palsy 6.12.67 10 months M Congenital heart disease; fibroelastosis DEATHS FROM CANCER Male Female Total 1967 1966 1967 1966 1967 1966 Malignant neoplasm, stomach 31 31 17 29 48 60 Malignant neoplasm, lung, bronchus 116 107 27 26 143 133 Malignant neoplasm, breast — 1 54 40 54 41 Malignant neoplasm, uterus — — 18 16 18 16 Other malignant and lymphatic neoplasms 129 124 104 81 233 205 Totals 276 263 220 192 496 455 Rates per 1,000 of population Hillingdon England and Wales All causes 2.12 All causes 2.27 Lung and bronchus 0.61 Lung and bronchus 0.58 19 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 3 – – – — – 1 1 – 1 – – Tuberculosis, Other M 1 – – – – – – 1 – – – – F – – – – – – – – – – – – Syphilitic Disease M 1 – – – – – – – – – 1 – F – – – – – – – – – – – – Other Infective and Parasitic Diseases M 1 – – – – – – – 1 – – – F — – – – – – – – – — — – Malignant Neoplasm, Stomach M 31 – – – – – 1 — 1 9 12 8 F 17 – – – – – – – 2 6 3 6 Malignant Neoplasm, Lung, Bronchus M 116 – – – – – – 3 13 46 38 16 F 27 – – – – – – – 5 9 9 4 Malignant Neoplasm, Breast M – – – – – – – – – – – F 54 – – – – – 2 6 10 10 13 13 Malignant Neoplasm, Uterus F 18 – – – – – – 2 2 8 — 6 Other Malignant and Lymphatic Neoplasms M 129 — — — 2 — 2 3 17 33 40 32 F 104 — — 1 — 2 2 4 12 20 25 38 Leukaemia, Aleukaemia M 3 – – – – – – – 1 1 – 1 F 7 – – 1 – 1 — 2 – 2 – 1 Diabetes M 3 – – – – – – – – 1 — 2 F 15 – – – – – – 1 — 5 5 4 Vascular Lesions of Nervous System M 103 – – – – – 1 1 4 13 30 54 F 166 – – – – – – 3 2 17 32 112 Coronary Disease, Angina M 269 – – – – – 1 8 30 80 82 68 F 171 – – – – – – 3 4 22 49 93 Hypertension with Heart Disease M 11 – – – – – – – – 3 4 4 F 21 – – – – – – – – 1 5 15 Other Heart Disease M 53 – – – – – – – 1 6 14 32 F 118 – – – – – 1 2 3 8 15 89 Other Circulatory Disease M 41 – – – – – – 1 6 6 10 18 F 61 — — — — 1 — 1 2 10 12 35 Influenza M – – – – – – – – – – – F 1 – – – – – – – – – 1 – Pneumonia M 50 – 3 2 1 – — – – 3 10 31 F 84 2 4 — – – – 1 1 4 10 62 Bronchitis M 64 — — 1 — — – – 3 19 16 25 F 25 — – 1 — – — – — 6 4 14 Other Diseases of Respiratory System M 10 – – – – – – – 1 2 4 3 F 3 – – – – – – – – – 1 2 Ulcer of Stomach and Duodenum M 9 – – – – – – 1 — 1 3 4 F 6 – – – – – – – – – 2 4 Gastritis, Enteritis and Diarrhoea M 4 – – – – – – 1 – 2 – 1 F 5 – – – – – – 1 — 1 1 2 Nephritis and Nephrosis M 4 — — — — 2 — 1 — — 1 — F 6 – – – – – – – 2 2 2 Hyperplasia of Prostate M 3 – – – – – – – – – 1 2 Pregnancy, Childbirth, Abortion F 2 — — — — 1 1 — — — — – Congenital Malformations M 11 4 1 — — — — 1 1 2 2 – F 9 2 2 2 — — — — — 3 — – Other Defined and Ill-Defined Diseases M 73 19 1 1 — 2 3 2 8 12 10 15 F 86 11 2 — 1 1 1 2 6 8 22 32 Motor Vehicle Accidents M 23 – – 1 1 5 2 1 3 5 2 3 F 7 – – – — 3 – 1 — 1 – 2 All Other Accidents M 20 – 1 – 3 2 1 4 3 3 1 2 F 16 – – – 1 2 1 2 1 2 4 3 Suicide M 11 – – — 1 – — 2 2 4 1 1 F 9 – – – – – – 3 4 2 — — Total All Causes M 1,045 23 6 5 8 11 11 30 95 251 283 322 F 1,041 15 8 5 2 11 9 35 54 148 215 539 20 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport Infectious Diseases The following Table shows the incidence of infectious diseases during 1967. 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 1967 1966 1967 1966 Scarlet Fever 1 15 39 61 16 3 2 137 91 – — Diphtheria — — — — — — — — — – — Whooping Cough 8 29 25 35 5 — 5 107 53 – — Measles 129 900 986 1,381 63 10 12 3,481 832 – — Meningococcal Infection – – – – – – – – 1 – — Poliomyelitis (Paralytic) – – – – – – – – – – – Poliomyelitis (Non-Paralytic) – – – – – – – – – – – Acute Encephalitis (Infective) – – – – – – 1 1 2 – — Acute Encephalitis (Post Infective) — — — 2 1 — 1 4 1 – — Smallpox — — — — — — — — — – — Pneumonia 1 — — 1 1 3 17 23 36 134 122 Typhoid — 1 – – – – – 1 – – – Paratyphoid — — — — — 1 — 1 2 — — Dysentery 1 8 9 10 4 11 18 61 4 — — Food poisoning 7 25 49 58 50 43 58 290 7 — — Puerperal Pyrexia – – – – – 65 79 144 143 — — Tuberculosis, Respiratory — 1 4 3 — 6 37 51 45 4 1 Tuberculosis, Other – – – – – 5 13 18 14 1 1 Erysipelas – – – – – 5 5 10 9 — — Food Poisoning During the year there was an outbreak of food poisoning, due to Salmonella organisms, which affected two schools in the Borough. Of 1,214 children (infants and juniors) at risk in both schools, 516 developed symptoms, but Salmonella typhi-murium was isolated from less than half this number. In no case was the illness very severe, but three pupils were admitted to hospital. The two schools affected are situated one mile apart, but the food for both schools was cooked in one kitchen. On investigation five members of the kitchen staff were found to be symptomless excreters of Salmonella organisms, and two teachers were also positive. It is often difficult in outbreaks of this nature to pinpoint the source of the infection and the method of spread, but all of the evidence pointed to the infection being introduced by imported meat which, although rendered harmless itself by cooking, contaminated kitchen equipment and thereby caused the spread to other food. Although the investigations necessary in outbreaks of this size take up a lot of time of doctors, public health inspectors and health visitors, the co-operation of the school staff, parents and, of course, the pupils themselves was always forthcoming and was greatly appreciated. Health Control Unit, London (Heathrow) Airport It was mentioned in the Annual Report for 1966 that policy decisions affecting the working of the Health Control Unit were still awaited. Unfortunately, the position is still indefinite and the working conditions for the Health Control Unit staff have deteriorated as a consequence. The passenger traffic increased once again, 12,606,039 passengers using the airport. In 1966 the number was 11,938,817. 21 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport Staff The establishment at the end of the year was:— Senior Medical Officer 1 Deputy Senior Medical Officer 1 Airport Medical Officers 7 Senior Airport Nurse 1 Airport Nurses 7 Senior Clerk/Receptionist 1 Deputy Senior Clerk/Receptionist 1 Clerk/Receptionists 36 With the extended passenger facilities now being provided, and with the improved facilities being prepared for the "Jumbo" jets, it is inevitable that the establishment will need to be increased. Port Health The number of vaccinations against smallpox carried out in 1967 was 9,158, an increase of 2,000 over 1966. Some countries, notably Pakistan and, to a less extent, India, have not yet completed the introduction of the new form of certificate, which records the origin and batch number of the vaccine in a separate column, and thereby give the health control staffs at ports of entry increased work. The war in the Middle East resulted in many British Jews volunteering their services in Israel. Few of them were in possession of valid international certificates on their return to London, where they had to be revaccinated. Cholera vaccinations rose from 186 to 261; yellow fever from 30 to 47. The total number of arriving passengers who required to be isolated was 20. Statistics 1.1.67 to 30.6.67 1.7.67 to 31.12.67 Total Total number of aircraft arriving on international flights: 33,648 38,206 71,854 Number of passengers arriving:— British 1,160,983 1,464,478 2,625,461 Alien 780,157 992,242 1,772,399 Total 1,941,140 2,456,720 4,397,860 Jan. 1st-June 30th July 1st-Dec. 31st Total Aircraft Passengers Aircraft Passengers Aircraft Passengers From Excepted Area 15,978 855,953 17,802 1,063,841 33,780 1,919,794 Europe Outside Excepted Area 8,089 454,940 9,655 615,459 17,744 1,070,399 North America 4,191 304,234 5,153 404,580 9,344 708,814 Central & S. America 526 50,339 613 53,100 1,139 103,439 Africa 1,496 86,282 1,550 94,239 3,046 180,521 Asia 3,368 189,392 3,433 225,501 6,801 414,893 Totals 33,648 1,941,140 38,206 2,456,720 71,854 4,397,860 22 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport 1967 1966 No. of aircraft issued with Disinsectization Certificates 1,911 3,272 No. of passengers and visitors sick and treated 1,808 1,915 No. of sick staff treated 2,799 2,588 No. of ambulance cases 1,584 1,424 No. of car cases 2,767 2,083 No. of cases in which Mental Welfare Officer was called for 101 74 No. of Aliens inspected under Aliens Order 5,314 4,366 No. of Aliens refused entry 32 30 No. of Forms (Port 12) issued 69 171 No. of Commonwealth Immigrants examined 16,061 12,516 No. of Commonwealth Immigrants refused entry 48 38 No. of Forms (Port 23) issued 112 153 No. of Immigrants X-rayed 6,215 6,949 No. of Long-Stay Immigrant Notifications sent to Medical Officers of Health 26,137 21,158 No. of Surveillance Notifications sent to Medical Officers of Health 2,795 2,333 No. of Smallpox Vaccinations carried out 9,158 7,140 No. of Cholera Vaccinations carried out 261 186 No. of Yellow Fever Vaccinations carried out 47 30 No. of British Airports Authority employees medically examined 244 271 No. of Deaths (4 in flight) 18 10 MEDICAL INSPECTION OF ALIENS During the year 5,314 aliens were referred for medical inspection, compared with 4,366 in 1966. Forms (Port 12) were issued on 69 occasions. After medical inspection 32 aliens were refused entry on grounds of health, and mental instability accounted for 21 of these cases. Of the 5,314 aliens referred, 5,054 were proposing to spend more than six months in the United Kingdom; a further 22 aliens were visiting the country for consultation or treatment. MENTAL ILLNESS The number of mentally ill persons referred at the airport during the year was 166. The mental welfare officers were called on 101 occasions. AMBULANCE CASES The number of invalids requiring National Health Service transport rose from 822 in 1966 to 1,016 in 1967. Comparative figures are:— 1967 1966 1965 (a) National Health Service 1,016 822 851 (b) Private Ambulances 526 520 599 (c) Service Ambulances 42 82 116 The number of calls made upon the British Airports Authority ambulances was 3,720. This figure included 514 patients who were in transit from one aircraft to another. The number of invalids brought to or leaving the airport by car as opposed to ambulance was 2,767, which was an increase of 700 over the previous year. 23 Statistics, Infectious Diseases, Health Control Unit London (Heathrow) Airport MEDICAL INSPECTION OF COMMONWEALTH IMMIGRANTS The figures for 1967 show that there has been a definite increase in the number of Commonwealth passengers referred for medical inspection by the Immigration authorities. Comparative figures are:— 1967 16,061 1966 12,516 1965 13,249 1964 12,531 The trend shown in 1966 continued in 1967. By this is meant that in line with Government policy, there has been a fall in those referred with work vouchers and a rise in those coming to the country for settlement. In 1966, the figure for voucher-holders referred for medical examination was 4,585, whilst the figure relating to those coming for settlement was 7,690. In 1967, the corresponding figures were 4,256 and 11,673. The number of Commonwealth passengers referred because they were coming to this country for treatment or for reasons of health was 117. In 1966, the figure was 219. During the year 112 Forms (Port 23) were completed, and 48 immigrants were refused entry for medical reasons. These figures compare with 153 and 38, respectively, in 1966. The reason for refusal was pulmonary tuberculosis in 39 cases; mental illness in 7 cases. Analysis of Commonwealth passengers referred for medical inspection 1967 1966 1965 Pakistan 2,303 1,933 3,193 India 6,111 4,728 4,089 West Indies 2,403 1,919 3,401 Far East 2,141 1,186 770 West Africa 641 677 269 Malta 520 630 697 Canada, Australia, New Zealand and Rhodesia 402 287 215 Cyprus 167 146 264 East Africa 1,197 776 236 Other Territories 176 234 115 This increase in Commonwealth immigrants has been fairly evenly spread geographically between Pakistan, India, the West Indies, the Far East and East Africa. The number of notifications sent out to Medical Officers of Health regarding long-stay immigrants rose from 21,158 to 26,137. SMALLPOX A smallpox consultant was called to the airport in connection with the arrival of a suspected case on five different occasions. Smallpox was not the diagnosis in any of these. On October 1st a Pakistani girl and her mother arrived at the airport from Karachi, and the girl became ill on October 9th. She developed a rash on the 10th, which became vesicular on the 14th. She was admitted to Long Reach Hospital from the Borough of Wandsworth on the 17th when the diagnosis of variola major was confirmed. The mother, who was also admitted as a direct contact, and who was successfully vaccinated on admission, developed highly modified smallpox and was the only other case. During the year, 20 passengers who were not in possession of valid certificates of vaccination, who could not be vaccinated or who refused to be vaccinated, arrived from infected local areas. These passengers were placed in isolation for the statutory period. 24 Statistics, Infectious Diseases, Health Control Unit London {Heathrow) Airport TYPHOID Ten passengers passed through the airport whilst incubating typhoid. These were subsequently taken ill, and typhoid was diagnosed in each case. In each case, the Medical Officer of Health concerned passed the relevant information to the airport. PULMONARY TUBERCULOSIS During the year one alien and 38 Commonwealth passengers were refused entry owing to pulmonary tuberculosis diagnosed at the airport. Another alien arrived from Turkey known already to be suffering from tuberculosis, and was refused entry. Thirty-five of the passengers were repatriated to their countries of origin. Six passengers with pulmonary tuberculosis were landed contrary to advice given to the Immigration authorities. In 174 cases, destination Medical Officers of Health were advised to refer the immigrant to the local chest clinic for follow-up or observation. This course of action followed the weekly visit to the airport by the consulting radiologist, and resulted in 16 further cases of pulmonary tuberculosis being brought to light. The breakdown shows that the 35 cases that were repatriated came from: India 28; Pakistan 4; Mauritius 1; Thailand 1; Turkey 1. The six patients who were landed contrary to medical advice came from: India 5; Pakistan 1. The 16 cases about whom information was passed to the Health Control Unit by destination Medical Officers of Health came from: India 13; Pakistan 2; Aden 1. X-RAY UNIT During the year a total of 6,215 immigrant passengers were X-rayed on arrival. Of these 6,081 were from Commonwealth countries and 134 were aliens. The figure 6,215 for 1967 compares with 6,949 in 1966. The fall is probably due to the fact that Commonwealth immigrants, more and more, are tending to be X-rayed in the country of origin. This applies particularly to those coming from Hong Kong, Malaysia, Singapore, Sabah, Mauritius and the West Indies. AIRCRAFT EMERGENCIES There were two aircraft emergencies during the year, fortunately without any casualties. An exercise to test the various emergency services was held in May. SECTION II Personal Health Services 27 Personal Health Services DAY NURSERIES The day nursery service continued as in the previous year. There were no changes in the principles governing admission, which were set out in the Report for 1966, and the daily charge remained at 17s. 6d. There was a steady demand for places, 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 49 133 2,315 6,771 9,086 63 144.2 June 43 141 2,363 6,802 9,165 64 143.2 September 45 124 2,094 6,168 8,262 64 129.1 December 36 104 2,265 6,816 9,081 63 144.1 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, 14. 28 Personal Health Services Mobile Clinic—Areas Served Barra Hall Circus. 1, 5. Charville Estate. 1, 5. Cowley. 1, 5. Cranford Cross Estate. 1, 5. Harefield. 1. Harlington. 1. Northwood, The Grange. 1, 5. Ruislip Gardens. 2, 5. Sidraouth Drive, South Ruislip. 1. Sipson. 1, 5. Wise Lane Estate, West Drayton. 1, 5. 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 HEALTH 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 795 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 1,407 31 27 768 795 29 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 744 (b) Domiciliary booked 350 (c) Total 1,094 Total number of attendances during the year 6,623 Child Welfare Clinics Provided by the Council Number of centres provided at end of 1967 Average number of child welfare sessions held per month Number of children who attended during 1967 and who were born in:— Total number of children who attended during 1967 Total attendances during 1967 1967 1966 1962-65 20 195 3,279 3,253 5,970 12,502 82,738 Care of the Unsupported Mother For reasons which are not obvious, the number of unsupported mothers needing help is relatively lower in this borough than in some of its neighbours. A team of medical social workers is therefore shared with the London Boroughs of Ealing and Hounslow. Meetings have been held between this team, the Deanery social worker, and senior medical and nursing staff, in order to co-ordinate effort as much as possible. Close liaison is maintained with the medical social workers in Hillingdon Hospital Maternity Unit, so that the most suitable help can be given to every mother, not only during her pregnancy and confinement, but also after the baby is born. This includes advice regarding adoption procedures or help with day nursery placement, child minding, and so on, depending upon the mother's wishes and the baby's needs. There are no mother and baby homes in the borough but financial responsibility is accepted for Hillingdon mothers in the homes of other local authorities or of voluntary bodies. There is a small but continuing incidence of pregnancy in girls still at school and in these cases it is necessary to make arrangements for their education to continue. This is done in collaboration with the education department and the parents of the girl. The number of unsupported mothers requiring help is given below, and shows a steady decrease in the last three years: 1967 1966 1965 Admitted to local authority homes 15 16 34 Admitted to voluntary homes 33 44 61 48 60 95 Interviewed and advised, but not requiring admission to a home 26 20 11 74 80 106 30 Personal Health Services Priority Dental Service The inspection and treatment of the priority group occupies approximately one tenth of each dental officer's time. Attendances show an increase on the previous years. This trend is in no small measure due to opening of modern clinics and bringing the older surgeries up to date. There are also specially trained dental surgery assistants who promote good relations with the mothers and toddlers. All this work is helping to produce in the coming generation a different outlook towards dentistry. There is no doubt that Local Authority dental clinics working as they do in close conjunction with the Maternity and Child Welfare arrangements have a special place in the community, and many small children adapt very well to dental care in schemes of this nature. PRIORITY DENTAL SERVICE STATISTICS Attendances and Treatment Children Under 5 Expectant and Nursing Mothers First visit 678 166 Subsequent visits 865 544 Total visits 1,543 710 Number of Additional Courses of Treatment Commenced 7 25 Treatment Provided: Number of fillings 1,574 476 Teeth filled 1,315 350 Teeth extracted 357 104 General anaesthetics 181 23 General anaesthetics given by dental officers 2 Emergency visits by patients 54 8 Patients X-rayed — 21 Patients treated by scaling, etc. 11 49 Teeth otherwise conserved 256 — Teeth root filled — 14 Inlays — 10 Crowns — 14 Number of courses of treatment completed during the year 443 125 Prosthetics Patients supplied with full upper or full lower (first time) 24 Patients supplied with other dentures 38 Number of dentures supplied 69 Inspections Children Under 5 Expectant and Nursing Mothers Number of patients given first inspections 627 82 Number of patients who required treatment 408 76 Number of patients who were offered treatment 401 75 31 Personal Health Services Sessions Number of dental officer sessions devoted to maternity and child welfare patients (for treatment) 358 Total Number of Dental Officer Sessions 3,200 MIDWIFERY SERVICE 1967 has been another busy year for the domiciliary midwives, and in fact there were 1,036 domiciliary confinements. In addition, there were three macerated stillbirths of unknown origin found within the borough. Happenings of this sort emphasise the need for adequate ante-natal care for all expectant mothers at as early a stage as possible. During the year 1,244 expectant mothers were booked for domiciliary confinement, and full antenatal care, including blood tests and mothercraft training, was given. However, some of these mothers were transferred to other areas before the expected date of delivery, 187 were taken into hospital before or during labour, and 153 of these were discharged early and nursed at home. In addition, 96 patients booked for hospital delivery had an arranged early discharge. The emergency obstetric squad was called out on nine occasions, and on two occasions the mother and infant had to be taken into hospital, while the remaining seven were dealt with at home. Very satisfactory working arrangements exist with the local general practitioners, and their support is greatly appreciated. The establishment consists of a Non-Medical Supervisor of Midwives and her Deputy, together with 22 full-time Midwives. All the midwives have, where necessary, undergone the prescribed refresher course according to the Central Midwives' Board rules, including the procedure of episiotomy and the use of infiltration anaesthetics. Entonox analgesic is in general use although Trilene is used in some cases. In all 24 Pupil Midwives were accepted for their three months' district training, and all were successful in their midwifery examination. In addition, 47 Obstetric Nurse Students were received for practical training in midwifery. HEALTH VISITING The present establishment of health visitors and clinic nurses, which includes the Superintendent and her Deputy, is 57. In post at the end of the year: Superintendent 1 Deputy Superintendent Full-time health visitors Part-time health visitors Tuberculosis visitor Full-time clinic nurse for Mobile Clinic 1 Part-time clinic nurses 15 Health assistants (a miscellaneous grade whose duties are specifically allocated to schools and clinics) 4 The Role of the Health Visitor The duties mainly fall into three sections: in the home, in the clinic and in the school. (a) Home visiting is undertaken to: Expectant mothers, to advise regarding the services available under the National Health Service Act, to offer health education, which is also carried out at clinic premises, and to make arrangements for other children during the confinement. Children from 10 days old until five years of age. Visiting at intervals if the family needs and welcomes it, and at any time if requested to do so. School children who may be ascertained as handicapped or have particular need of the school health service. 32 Personal Health Services Mentally handicapped children are visited at approximately six-monthly intervals until the age of 16 years. Aged persons living alone and who do not need the home nursing service or consideration for admission to the department's aged persons' accommodation. Referrals for whatever need from general practitioners, hospital medical and nursing staff, and medical social workers. During home visits to mothers of very young children, advice on infant nutrition, techniques of feeding and the need for supplementary vitamins is readily accepted by most of the mothers whatever their standard of education. Physically children have great opportunities to thrive, but emotional development is greatly affected by increasing stresses of family life and modern day society. Health visitors, who are trained to understand family psychology, listen to parents' anxieties, which often centre on their children, and give guidance and reassurance accordingly. In the course of their duties they offer advice on all matters of health to individuals, urging the seeking of medical opinion when symptoms are of a suspicious nature, and encouraging acceptance of medical screenings such as mass X-ray, and cervical cytology in the apparently healthy. Immigrants present special problems. Many have language difficulties and are unaccustomed to climatic and cultural conditions in this country. Health visitors overcome the communication difficulties by meeting the husbands and senior school children who usually have mastered the language. (b) Clinic activities in which health visitors participate are child welfare sessions, and the health education programmes for expectant mothers. Young children from the age of a few weeks can be brought to the local authority child health clinics for the purpose of supervision of their physical and mental development. Health visitors advise on all aspects of care and management. Assistant medical officers are present at most of these sessions to undertake periodic medical examinations. Children who may need more regular examinations are those from the "at risk" groups due to conditions arising at the time of birth or because of illness or accident. The expectant mother preparation classes consist of the teaching of modern methods of relaxation, and information and discussion sessions. Short courses are arranged at some centres for the husbands of expectant mothers to acquaint them with the facilities that are available and to give them some idea of the content of the information which is being made available to the prospective mothers. (c) School Activities Health visitors are present at medical inspections of infant school children as the persons most probably known to mothers and children prior to admission to school. In some schools health visitors are invited to participate in health education programmes arranged for senior pupils. The health visitor acts as a link between the Maternity Unit at Hillingdon Hospital and the Local Authority. The liaison health visitor to the Maternity Unit is present at the ante-natal clinic three times a week, and the relevant information obtained is passed to the appropriate colleague responsible for the district from which the patient came. One member of the staff acts as a link between the two chest clinics and the local authority services. The care and after-care of individuals suffering from tuberculosis is the local authority's responsibility, and the tuberculosis visitor is employed for this purpose. She attends the chest clinics held at Mount Vernon and Hillingdon Hospitals weekly as a link between the chest physicians and the local authority services. Her functions are to prevent the spread of infection as well as to alleviate any situation causing anxiety or hardship in the family. The tuberculosis visitor works closely with the general health visitors, particularly where there are young children involved. The Qualifications of the Present Health Visitors Most of the senior staff, in addition to being general state registered nurses and qualified midwives, 33 Personal Health Services have held positions of responsibility in the hospital service before undertaking the health visitor's training. The Present Training for Health Visiting As from 1962, the Council for the Training of Health Visitors was established under the Health Visiting and Social Work Training Act of 1962 to promote training and approve suitable courses. Pre-requisite Qualifications Anyone wishing to be trained as a health visitor must be a general state registered nurse with midwifery experience, which may be full qualification as a midwife, or Part I Certificate of the Central Midwives Board, or a three months' approved obstetric course. Candidates should also hold the General Certificate of Education (England and Wales) at Ordinary Level in a minimum of five subjects including English, Welsh or History. Scotland and Northern Ireland require similar qualifications. Training is a mixture of theoretical and practical work which lasts a calendar year and which can be undertaken at any of the 36 training centres in the United Kingdom. Six of these centres organise an integrated course of n urse education for students who have at least two additional "A" Level qualifications. Students undertaking these integrated courses obtain several nursing qualifications, one of which is the Health Visitor's Certificate. On the completion of such a course a candidate obtains a qualification at a much younger age than the present-day senior staff formerly did. One third of the training period is spent in practical work under the guidance of field work instructors, who are health visitors specially trained and qualified to undertake this work. The Health and Welfare Department has four such field work instructors. They are specially trained to impart to the student the practical skills of health visiting and have sympathetic understanding of young students, particularly those undertaking the integrated courses. The department's staff have taken part in two of the six national integrated courses; one linked with Hammersmith Hospital and the University of Surrey (previously Battersea College of Technology) and the other with Hillingdon Hospital linked with Chiswick Polytechnic. Comments on the Present Health Visiting Service The health visitors, who are also the school nurses for this department, have had difficulty in covering the full range of work because of the difficulties of recruitment following retirement of numbers of colleagues. The only replacements have been sponsored students who are under contract to the borough. The number of students being trained is increasing annually, but the national shortage is such that it is only local authorities who are able to offer favourable conditions of service who maintain their full establishment. As suggested by the Ministry of Health, health visitors have been relieved of all duties which do not require their full qualification. Clinic nurses, who are general state registered nurses, with part or full midwifery qualifications, undertake all the clinic activities such as immunisation sessions, school health sessions, attendance at midwives ante-natal sessions and the routine medical inspections carried out in all senior schools. Health assistants, who have only some nursing experience, supervise the cleanliness inspections in all schools and carry out numerous duties in clinics to ensure smooth running of the services. The health visitor may well be in touch with children from birth to the time they leave school, whereas officers of other sections of the department, e.g. midwives, home nurses, mental welfare officers, and social workers from other departments, such as Children's and the Probation Service, only come in contact with the family when it is already in trouble of some kind or needs a specific service. The health visitor's main task is to make contact with untroubled families and when appropriate to anticipate, prevent and ameliorate any potential problems. 34 Personal Health Services Health Visiting Statistics The following cases were visited by the health visitors during the year: Cases Visited Number of Cases 1. Children born in 1967 4,090 2. Children born in 1966 3,846 3. Children born in 1962-65 9,309 4. Total number of children in lines 1-3 17,245 5. Persons aged 65 or over 585 6. Number included in line 5 who were visited at the special request of a G.P. or hospital 67 7. Mentally disordered persons 87 8. Number included in line 7 who were visited at the special request of a G.P. or hospital 16 9. Persons, excluding Maternity cases, discharged from hospital (other than Mental hospitals) 30 10. Number included in line 9 who were visited at the special request of a G.P. or hospital 11 11. Number of tuberculous households visited 2 12. Number of households visited on account of other infectious diseases 558 13. Number of tuberculous households visited by tuberculosis visitors 673 14. Other cases 2,583 15. Families with a subnormal child 117 HOME NURSING Of the establishment of 32 home nurses, 18 are in possession of the Ministry National Certificate and the Queen's Institute Certificate and Badge. The borough is a registered area for district training, and students have been prepared for the Queen's Institute District Nursing Examination by the Superintendent of Home Nursing and her Deputy. During the year 3,139 patients were nursed, and of these 2,129 were over 65 years. There is close liaison between the local authority services and the Geriatric Service based on Hillingdon Hospital. One of the Home Nurses acts as a liaison officer working between the Geriatric Unit and district, keeping her colleagues informed as to the admissions and discharges taking place. Attachment schemes have been introduced in the case of two groups of general practitioners. It is hoped that further progress in this form of working can be brought about. The Home Nurses also take part in the training of third year students from the local training hospitals. In addition, the home nurses take part in the training of students undertaking the integrated course at Hillingdon Hospital. There is an impression that the geriatric patients are requiring a greater amount of care over a longer period, and also that there is an increase in the amount of attention necessary to the young chronic sick. The medical loan scheme operated by the British Red Cross Society continued on the same lines and during the year 1,657 loans were made. 35 Personal Health Services Home Nursing 1967 1966 Total number of persons nursed during the year 3,139 3,281 Number of persons who were aged under 5 at first visit 37 46 Number of persons who were aged 65 or over at first visit 2,129 2,184 Observation Register An observation register has been kept for several years. The register contains the names of children whose ante-natal and perinatal history suggests that they may be likely to have a handicap, e.g. impairment of hearing following maternal rubella in early pregnancy, "at risk" following prolonged or difficult labour or prematurity, mental retardation or paralysis caused by spina bifida or hydrocephalus, a family history of phenylketonuria or diabetes, etc. Extra care is taken to ensure that these children have their routine examinations so that any defect can be found as early as possible and steps taken to correct or alleviate it and to provide any special educational facilities which may be needed later in life. The majority of names on the register can be removed by the time the child is two years old, as development has been normal. The names of those who develop a defect are kept on the register and their progress re-assessed at intervals with the object of providing the most suitable facilities possible for each child. It is by means of this register that an estimate can be made of the future need for special schools for the physically or mentally handicapped, physiotherapy, residential or day care for the severely retarded, and so on. The figures below give some idea of the scope of the register and also indicate the need for close co-ordination between the maternity and child welfare, school health and mental health services. The number of children on the Observation Register at the end of the year was 928. The table shows those who are known to need, or are thought may require, special arrangements to be made for their care and education. Year of Birth Total 1963 1964 1965 1966 1967 Defective Vision — 1 2 — 2 5 Defective Vision with Mental Defect — 1 — — — 1 Defective Hearing 1 1 1 2 1 6 Mental Defect 13 11 4 4 2 34 Mongolism 4 3 4 5 5 21 Spastic 1 3 4 — — 8 Epileptic 1 2 1 — 1 5 Heart Disease 5 3 1 2 4 15 Spina Bifida 1 3 2 2 5 13 Congenital Dislocation of Hip 2 1 2 — 1 6 Fibrocystic Disease of Pancreas 2 2 1 — 1 6 Diabetic — 1 — — — 1 Cretinism — — — 1 — 1 Other Physical Handicap 4 5 4 3 2 18 Totals 34 37 26 19 24 140 36 Personal Health Services 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 — 1967 — — 9 — 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 Sab in Oral Total Salk Injection Sabin Oral Total 1967 — 611 611 — — — 1966 82 2,586 2,668 5 155 160 1965 20 553 573 34 116 150 1964 10 246 256 19 47 66 1960-63 7 464 471 26 2,376 2,402 Others under age 16 4 144 148 10 225 235 Totals 123 4,604 4,121 94 2,919 3,013 37 Personal Health Services 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 46 — 3-6 months 66 — 6-9 months 54 — 9-12 months 107 2 1 year 1,432 10 2-4 years 736 125 5-15 years 190 865 Total 2,631 1,002 These figures include 168 children vaccinated and 854 children re-vaccinated at Heathrow Airport. No records are available of adults vaccinated by their general practitioners. Vaccination at Heathrow Airport In 1967, 8,136 adult persons were vaccinated at the airport. Not all these vaccinations were performed on arriving passengers, as in certain circumstances it was necessary to vaccinate outgoing passengers. Vaccination against Measles As stated in the report for 1966, vaccination against measles was strongly recommended for children attending day nurseries. This recommendation has been accepted readily and children were vaccinated by their family doctors or the borough's medical officers. The numbers of children vaccinated were:— 1967 26 1966 127 No untoward effects have been reported and it was not necessary to close any of the nurseries during an epidemic. 38 Personal Health Services 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 Diphtheria) 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 1967 — — — — 2 1,248 — — — — — — — — 1966 — — — — 62 2,142 3 — — — — 178 681 — 1965 — — — — 24 312 10 — — 4 — 285 1,082 — 1964 — — — — 28 29 1 — — 2 — 129 96 13 1960-63 1 — 16 — 84 99 1 5 — 15 — 1,915 576 13 Others under age 16 — — 242 — 86 9 — 9 — 128 — 1,315 95 2 Totals 1 — 258 — 286 3,839 15 14 — 149 — 3,822 2,530 28 Personal Health Services 39 HOME HELP SERVICE The number of Home Helps employed at the end of the year was 136 but as many of these were only part-time, it was the equivalent of 72 full-time workers—slightly less than the previous 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 756 109 10 148 184 1,207 TUBERCULOSIS—CARE AND AFTER CARE Following the completion of the new wing of Hillingdon Hospital, the services formerly operated from the Uxbridge Chest Clinic were deployed from there, and those cases arising in the northern part of the borough were dealt with at a clinic sited at Mount Vernon Hospital. As in past years, the services of a tuberculosis visitor and health visitors were made available to follow up cases from both clinics. It is gratifying to note that the local general practitioners are making good use of the facilities provided, especially in referring cases for X-ray. This referral and subsequent follow-up are possibly the most useful means available to us of keeping tuberculosis under control. The total number of notifications of pulmonary and non-pulmonary disease is, of course, comparatively small. 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. The voluntary organisations have an important part to play in the chiropody service—as the figures show. Number of persons treated during the year ending 31st December, 1967 By local Authorities By voluntary organisations Total Persons aged 65 and over 1,124 750 1,874 Expectant mothers 18 — 18 Children under 5 4 — 4 Others 8 11 19 Total 1,154 761 1,915 40 Personal Health Services Chiropody Number of treatments given during year ending 31st December, 1967 By local Authorities By voluntary organisations Total In clinics 3,047 2,206 5,253 In patients' homes 635 242 877 In old peoples' homes 1,370 157 1,527 In chiropodists' surgeries — 1,248 1,248 Total 5,052 3,853 8,905 RECUPERATIVE HOLIDAYS The recuperative holiday scheme continued on the same lines. Initially, 51 recommendations were received, some applications were withdrawn, a few patients were unable to accept the placement offered, and eventually 32 holidays were arranged. Most recuperative holidays last two weeks. In five cases the "full cost" was paid, and the remainder were charged in accordance with the Council's scale. SECTION III Community Care - Welfare Services Community Care 43 Welfare Services The Chief Welfare Officer, Mr. J. L. Stoker, reports:— WELFARE OF THE AGED It is desirable that aged persons should be able to maintain independence in their own homes as long as possible, and for this reason the domiciliary services are provided. In this connection great assistance is given by voluntary organisations, including the four Old People's Welfare Associations, which are supported financially by the Council. (£10,217 in the financial year 1967/68). The services provided by these associations include:— Elm Park and Tudor Dining and Recreation Visiting service. Clubs, Ruislip. Christmas parcels. Fassnidge Hall Social Centre, Uxbridge— light meals provided. Holidays. Chiropody. Outings. Meals on Wheels. Hairdressing at reduced prices. Much assistance has also been given by the British Red Cross Society and the Women's Royal Voluntary Service in running clubs and providing meals on wheels. Other voluntary organisations such as Rotary Clubs, Round Table and Toc H have given valuable support. The Welfare staff have made 1,164 visits to aged persons living in their own homes. Most of these visits were made with a view to the provision at a later date of residential accommodation. Residential Homes for the Aged The Council's Residential Homes at 31st December, 1967, were:— Name of Home Address No. of Beds Male or Female Designated or Non-Designated Belle Vue Harlington Road, Hillingdon 53 Mixed Designated Brookfield Park Road, Uxbridge 54 Mixed Designated Coaxden Park Road, Uxbridge 23 Male N.D. Franklin House The Green, West Drayton 49 Mixed Designated Moorcroft Harlington Road, Hillingdon 67 Mixed N.D. Rushymead Coleshill, Nr. Amersham 48 Mixed N.D. Ryefield Ryefield Avenue, Hillingdon 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. 44 Community Care During 1967 one residential home was closed and two were opened. Farnham Common House in Buckinghamshire, a Home for 30 aged persons was closed in February, 1967. For years it had been found impossible to keep the Home fully staffed and, consequently, it was never fully occupied. Its situation made it difficult for relatives to visit, and the structure of the building made it unsuitable for the admission of any but fully ambulant patients. When the Home closed the remaining 13 residents were transferred to Belle Vue, Harlington Road, Hillingdon. Belle Vue—a new Home for 53 residents. (See plate 1 following page 64.) This is a particularly interesting development as, in addition to the Residential Home, a number of Aged Persons' Flatlets with warden supervision have been built adjoining. Extra dining room and lounge facilities have been provided in the Home so that the residents of the flatlets may make use of the services provided in the Home. The scheme was planned by the former Middlesex County Council in conjunction with the former Uxbridge Borough Council. Brookfield, Park Road, Uxbridge, is the second new Home to be opened during 1967. This Home provides for 54 aged persons and received its first residents on 3rd April. (See plate 3 following page 64.) On 31st December, 1967, there were 390 residents (95 males and 295 females) in the nine borough residential Homes. Other Local Authorities were financially responsible for 24 of these residents. In addition, the Borough Council was maintaining 100 persons (37 males and 63 females) in Homes administered by voluntary organisations, and 15 (6 males and 9 females) in other Local Authority Homes. The following is a summary of admissions and discharges during the year:— Admissions Discharges To where discharged Hospital Deaths Home Address Other Address Borough Homes 211 143 59 55 7 22 Voluntary Homes 27 25 10 10 2 3 Other Authority Homes 6 4 3 — – 1 During the year 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 illnesses were, on discharge from hospital, admitted to Welfare Homes because they were unable to manage alone. Details:— Number permanently discharged to hospital 36 Number discharged and subsequently returned to Home 23 Number of new cases admitted from hospital 40 Attention has already been drawn in the Home Nursing section to the liaison arrangements between the Geriatric Unit and the Home Nursing Service. Short Stay Admissions The demand for temporary admission to Welfare Homes increased during the year and altogether 89 aged persons were admitted for short periods, as against 52 in 1966. The admissions were arranged mainly to allow relatives to have a rest or holiday, but also to deal with emergencies such as the sudden illness of a relative. Community Care 45 Homes Administered by Voluntary Organisations In 1967 there were four Homes for the Elderly in the Borough which were administered by Voluntary Organisations. They were:— Brackenbridge House, Ruislip. Ruislip and Northwood Aged People's Housing Society. Elmfield, Fairfield Road, Uxbridge. British Red Cross Society. Denefield, Dene Road, Northwood. British Red Cross Society. Denville Hall, Ducks Hill Road, Northwood. The Actors' Charitable Trust. Private Homes for the Aged There are four privately run Homes for the Aged in the borough. These are registered under Section 37 of the National Assistance Act, and are subject to inspection by a Senior Medical Officer of the department. Number of persons in Residential Accommodation at 31st December, 1967, in Various Age Groups Under 30 30-49 50-64 Total Under 65 65-74 75-84 85 or over Total 65 or over All Ages 3 4 17 24 66 251 139 456 480 Number of Persons in Residential Accommodation at 31st December, 1967, Summarised According to Major Handicap Blind Deaf Epileptic Physically Handicapped Mentally Handicapped Other Persons Total Under 65 3 1 2 13 1 4 24 65 and over 35 17 2 — 50 352 456 Old People's Workshop Although the number attending the Council's Old People's Workshop at West Drayton has not increased as had been hoped, the 20 people who do attend carry out work, which is provided by local industry, and also enjoy the social contact and happy atmosphere which is found at the centre. HOMELESS FAMILIES The Council 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 1967 43 families were admitted to temporary accommodation. 46 Community Care Details of admissions and discharges are:— Highgrove House—Families Admitted Rehoused by Hilling don Discharged rehoused by other L.A. Discharged to other address To Mead House 39 11 — 19 8 Mead House—Families 12 including transfers 9 — 3 — At 31st December, 1967, the total number of persons in the Hostels was as follows:— Highgrove House 9 Men 12 Women 41 Children Mead House 6 Men 8 Women 25 Children Altogether 137 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 their own problems. The social welfare officer dealing with 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, 562 permanently and substantially handicapped persons were on the register maintained by this borough under Section 29 of the National Assistance Act, 1948. During the year there were 154 new registrations, and 118 names were removed from the register, leaving 598 persons registered at 31st December, 1967. 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 to retain as much independence as possible, adaptations were carried out in the homes of 48 handicapped persons at a total cost of £1,317 5s. 0d., of which £662 4s. 11d. was recoverable by contributions from the handicapped persons. 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 203 handicapped persons at a total cost of £674 14s. 6d. The Welfare Committee decided that as from 1st October, 1967, no charge should be made for these aids, but that they were to be issued on loan and returned when no longer required by the handicapped person. Community Care 47 Transport In March the Department took delivery of a special coach designed to carry handicapped people. The vehicle was built by Dennis Motors of Guildford, and has the capacity to carry 10 handicapped persons, who can be secured in their seats, as well as up to four persons in wheelchairs. The coach has a hydraulic tail lift to raise the wheelchairs and any persons unable to negotiate the steps. The vehicle is very much used, both during day-time and in the evenings. Handicapped persons are conveyed to various classes and activities both within and without the borough as well as a daily journey to and from the Work Centre. The department also has a minibus which is available to transport the less severely handicapped. Work Centre The Work Centre for Handicapped Persons at The Lynch, Uxbridge, provides for 45 handicapped persons to work for three hours a day, for five days a week. The materials necessary are provided by local industry. In addition to the transport provided by the Council mentioned above, some persons travel in their invalid cars and some even manage by public transport. Those who are getting sickness benefit have their earnings limited to 39s. 11d. per week, but attendance at the work centre is considered to be of considerable therapeutic value. An outing to the coast was arranged for those handicapped persons attending the centre, and this, apparently, was very much enjoyed. Handcraft Classes The department is grateful for the assistance given by the British Red Cross Society in arranging instruction in handcrafts in various parts of the borough. The Council assists with transport. Attendances average:— Eastcote—31 Uxbridge—28 Hayes—21 Choral Class As arrangements for commencing a choral class in this borough had not been completed, handicapped persons were transported to a class in Greenford. On average 19 persons from Hillingdon Borough attended these classes. Gardening Class This class continues to be held at Norwood Hall, Southall, where special facilities are available. Each week 10 handicapped persons from the Borough attend. Holidays During 1967 holidays were arranged for 65 handicapped persons. Some 34 persons travelled to a holiday camp at St. Leonard's-on-Sea where they were assisted by four members of the department's staff and two voluntary workers. One member of the staff, a matron of a Residential Home, was a trained nurse, and her experience and nursing skill proved invaluable during this fortnight's holiday. Other parties enjoyed holidays at Shaftesbury Society camps. In some cases financial assistance was given to persons making private arrangements. Car Badges Special badges were issued to 22 persons who drive invalid cars or adapted vehicles. These badges are easily identifiable and enable the police to assist the handicapped to park their vehicles. Visits Social Welfare Officers made 2,315 domiciliary visits to handicapped persons during the year. 48 Community Care WELFARE OF BLIND AND PARTIALLY-SIGHTED PERSONS This table shows the number of blind and partially-sighted persons:— No. on Register 31.12.66 Additions Removals No. on Register 31.12.67 Blind 333 60 50 343 P.S. 109 25 19 115 Total 442 85 69 458 Of the 50 removed from the register, 42 were due to death and eight for other reasons. Of the 19 partially sighted people removed from the register, seven were because of death, eight were transferred to the blind register and four removed for other reasons. This is a table showing the age groups of persons on the Blind Register at 31st December, 1967:— 0 I 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 — — — 1 — 2 3 1 3 9 18 13 4 14 29 15 10 8 130 F — — — 1 — 2 1 4 4 7 9 18 19 13 49 31 28 27 213 Total — — 2 — 4 4 5 7 16 27 31 23 27 78 46 38 35 343 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 15 3 — — 1 4 5 4 11 14 8 11 10 8 22 9 3 1 130* F 17 3 4 — 1 1 5 2 5 13 19 25 15 11 61 20 11 — 213 Total 32 6 4 — 2 5 10 6 16 27 27 36 25 19 83 29 14 1 343 *Age unknown: 1 Male. Information regarding Employment of Blind Persons M F Total Employed in Sheltered Workshop 2 - 2 Employed in Homeworker Scheme 3 6 9 Employed under ordinary conditions 36 11 47 Total employed 41 17 58 49 Community Care Unemployed, but capable of and available for work 2 1 3 Not available for work 5 26 31 Not capable of work 4 18 22 Not working, 65 and over 70 146 216 Total unemployed 81 191 272 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 — — 6 3 17 4 8 38 F — — 6 5 14 9 43 77 Total — — 12 8 31 13 51 115 Ten partially-sighted children from the borough attended special schools, and two attended ordinary schools. Clubs and Classes for Blind and Partially-Sighted Persons These were continued as in the previous year, and are as follows:— 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. Holidays Financial and other assistance was provided, as in the previous year. Altogether 42 blind and partially-sighted persons were assisted, and in connection with these holidays 18 escorts were provided. The Rotary Clubs continued to provide white sticks for those blind persons who require them. Other apparatus was obtained through the Royal National Institute for the Blind. Radio Sets During the year 40 new sets were issued to blind persons, and wireless licence exemption certificates were supplied to 25 new cases. Talking Book Machines These machines are issued by the Nuffield Talking Book Library, Alperton, at a rental per set of £3 per annum. The Welfare Committee decided that as from 1st April, 1967, the Council should meet the rental charges. During the nine months from 1st April to 31st December the rental was paid in 98 cases. 50 Community Care Deaf Blind Persons During 1967 there were three persons on the register who were deaf and blind and two who were deaf and partially-sighted. These patients need special attention, and this borough is sharing the services of a specialist Deaf/ Blind Social Welfare Officer who is also employed by the London Borough of Richmond-upon-Thames. A special holiday at Littlehampton was arranged for the deaf blind during the summer, and one person from this borough was included. Guide Dogs for the Blind Association In all 11 persons from this borough now have guide dogs. Domiciliary Visits During the year, Social Welfare Officers for the Blind made 1,563 domiciliary visits to blind and partially-sighted 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 functions of interest. The Association is also responsible for the Holiday Home at Littlehampton. Industrial Rehabilitation In conjunction with the Ministry of Labour, arrangements were made for one person from the borough to undergo a period of industrial rehabilitation. 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 halls have been earmarked for this purpose, but during the year it was not necessary to use any of them. 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 for the burial of 12 persons. The following is a summary of the action taken. (a) Cases where funeral expenses have been fully recovered 9 (b) Cases where part only of the expenses have been recovered 1 (c) Cases where full cost has been borne by the Council 2 Nine of these cases were dealt with under Section 50(3) (persons having died in Old Persons' Homes) and three under Section 50(1) (persons who have died or have been found dead elsewhere in the borough). PROTECTION OF MOVABLE PROPERTY Action was taken under Section 48 of the National Assistance Act, 1948, in respect of seven patients who were in hospital and where no other arrangements could be made. SECTION IV Community Care - Mental Health Community Care 53 Mental Health STATISTICS FOR 1967 Number of subnormal persons cared for in the community at 31st December 391 Number of subnormal patients from this borough in hospital 261 Number of subnormal adults and children awaiting admission to hospital at end of year 24 Number of children in Junior Training Centre 76 Number of children in Special Care Unit 24 Number of children in Weekly Boarding Unit 14 Number of trainees in Uxbridge Adult Training Centre 127 Number of trainees in Moorcroft Adult Training Centre 95 These come from the following authorities: Barnet Brent Ealing London Borough of Harrow Hillingdon Hounslow Richmond Surrey C.C. Junior Training Centre 2 1 15 — 51 4 1 2 Special Care Unit — — 5 2 16 1 — — Weekly Boarding Unit 2 1 1 2 4 1 1 2 Uxbridge Adult Training Centre 15 24 7 47 34 — — — Moorcroft Adult Training Centre – – 3 — 48 15 — 29 Bourne Hostel Bourne Hostel in South Ruislip is a purpose-built hostel with accommodation for 30 subnormal adults. The hostel is comfortably furnished and attractively decorated. The majority of the accommodation is in the form of single rooms. There are two lounges, and a grassed area is available for outdoor exercise and games. (See plate 5 following page 64.) At the official opening the Hillingdon North Society for Mentally Handicapped Children presented the Hostel with a fish tank, an electronic organ and other recreational equipment. The first residents were admitted on 8th February, 1967. New residents were admitted from time to time, and at the end of the year there were 16. Another three residents had been admitted but subsequently discharged before the end of the year. Short term care, i.e. to enable relatives to have a rest or a holiday, was also offered to three patients. Considering the variety of cases admitted over the year, the hostel has proved its usefulness. It is not the intention to fill the 30 beds on a permanent basis but to keep a number of beds for emergency or short term care. There are 19 potential cases known who could need admission to the hostel should their home conditions change in any way. 54 Community Care MENTAL ILLNESS During 1967 the staff consisted of:— The Chief Mental Welfare Officer, The Deputy Chief Mental Welfare Officer, Five Mental Welfare Officers The number of cases referred for assistance continues to grow—756 as against 653 in 1966—and it is becoming increasingly apparent that the establishment will have to be amended if the standard of support to patients and their families is to be maintained. It is of interest to note that 105 cases of mental illness were assisted at Heathrow Airport in 1967, as against 74 in 1966. As previously, the majority arrived in out-of-office hours, thus imposing a heavy burden on the staff involved. This is a summary of the cases dealt with by the Mental Welfare Officers: Under Age 16 Aged 16 and over Referred by M F M F Total General Practitioners — 2 95 137 234 Hospitals, or discharged from In-Patient treatment — — 54 138 192 Hospitals, after or during Out-Patient or day treatment — — 19 37 56 Local Education Authorities 1 1 — — 2 Police Courts — — 38 10 48 Other Sources 1 3 122 98 224 Total 2 6 328 420 756 Work of Mental Welfare Officers (a) Mental Illness Visits made by Mental Welfare Officers 2,542 Compulsory Admissions to Psychiatric Hospitals 150 Informal Admissions to Psychiatric Hospitals 91 Office Interviews 111 (b) Mental Subnormality Visits to those under Borough Community Care 778 Office Interviews 32 The subnormal cases visited by the Mental Welfare Officers are over 16 years of age. The Health Visitors visit those under 16 years, of which, at the end of the year, there were 117 cases—involving 238 visits, which are, of course, additional to the figures given above. Community Care 55 Hayes Park Hostel Hayes Park Hostel, for the rehabilitation of persons who have completed treatment at a mental hospital, but who need a further period of care and support before returning to the community, was built by the former Middlesex County Council in 1963. Thirty persons are accommodated in single and three-bedded rooms, and the day rooms include three sitting rooms and a dining room. Residents can also relax in a pleasant garden with a number of mature trees. There is a self-contained flat for the Warden and his family, as well as accommodation for an Assistant Warden. In the latter part of the year the Warden at Hayes Park Hostel had to be replaced, and one of the Mental Welfare Officers took over and was subsequently appointed as the new warden. This left a vacancy for a Mental Welfare Officer, which has since been filled. Naturally, the new Warden required additional support, both from the professional and administrative staff. Also, the change presented problems with certain of the residents who needed careful and diplomatic handling. These difficulties were overcome and the hostel is now functioning in a very satisfactory manner. Statistics The number of residents during the year =18 male, 22 female = 40. These residents came from the following Authorities:— Male Female Hillingdon 8 14 Surrey County Council 1 2 Ealing 3 5 Richmond 1 — Brent 2 — Buckinghamshire 1 1 Enfield 1 — Hounslow 1 – There were 11 male and 8 female patients in residence at the end of the year. SECTION V General Services 59 General Services HOUSING ALLOCATION—MEDICAL GROUNDS The housing points scheme remains as described before, and applications for rehousing continue to be referred to the Medical Officer of Health when medical factors, supported by a general practitioner's certificate or hospital letter are put forward for consideration. Applications from council tenants who wish to transfer to other accommodation for medical reasons are also referred to the Medical Officer of Health. Although the Medical Officer of Health may recommend "points", (5, 10 or 15) on medical grounds, in many cases in which a medical condition is considered not to be aggravated by the existing living conditions no recommendation is made. During 1967, 215 of the 299 cases submitted were considered not to warrant medical support for rehousing. In a small number of cases the applicant may not satisfy the residential qualifications, or it may be considered that he is already adequately housed. If, however, a medical condition is being seriously aggravated by the existing living conditions, the Medical Officer of Health may recommend to the Housing (Selection) Sub-Committee that such a case be given special consideration. During 1967, 18 cases of this nature were put forward for special consideration, and all were sympathetically considered by the Committee. This represents a very small percentage of the total number of applications and shows that such a recommendation is made only in cases of exceptional hardship. No. of Cases Referred Recommendations made for "Medical Points" 1967 1966 1967 1966 New Applications 299 398 84 115 Transfers 176 119 63 40 It will be seen from the statistics that, although the number of new applications in which medical factors were considered has fallen during the year, the number of requests for transfer on medical grounds has increased by one-third. It can also be seen that in only about one third of all applications for rehousing and transfer in which medical factors are put forward for consideration did I feel justified in recommending support to the Committee. Obviously if all applications with medical support were allowed to qualify for extra "points" or other preferential treatment, many applicants could put forward some condition, physical or psychological, which they could claim as worthy of support, and then the whole purpose of a scheme which allows consideration of health factors would be defeated. It is only in cases in which a medical condition affecting the applicant or a member of his family or occupant of the dwelling in which he resides is being aggravated by the existing circumstances do I feel that support should be recommended. MASS RADIOGRAPHY The Mass X-ray Unit paid a visit to the Yiewsley and West Drayton areas during the year, and although the public sessions were not so well attended (1,567 attendances compared with 2,024 in 1963), there was an increase of 1,000 in the attendances from industrial concerns. 60 General Services The attendance figures and results are:— Attendances General Public 1,567 Industrial 3,795 5,362 Cases Found Pulmonary Tuberculosis 4 Carcinoma of Lung 3 MASSAGE AND SPECIAL TREATMENT Premises used for the reception or treatment of persons requiring massage or special treatment must be registered and are subject to inspection by a senior medical officer of this authority. The number of licences issued is shown below. 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, manicure, electric treatment, radiant heat, electric, vapour or other baths, manipulative therapy 1 Three certificates of intention to practise were received during the year from Members of the Chartered Society of Physiotherapists. 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 a medical examination to be carried out to determine his fitness. Approximately 24% were so examined. The following cases were considered during the year:— (i) Medical Assessments 1,639 (ii) Medical Examinations: Staff—from (i) above 406 Teachers 129 Students 240 Authorities 14 Total Number of Medical Examinations 789 General Services 61 NURSERIES AND CHILD MINDERS The number of premises in the Borough registered in accordance with the Nurseries and Child Minders Regulation Act, 1948, as private day nurseries, or persons registered as child minders, is as follows:— Number of Registrations Number of Places 1967 1966 1967 1966 Day Nurseries 28 23 789 666 Child minders 14 16 193 206 Totals 42 39 982 872 All premises used as day nurseries 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 HOMES AND NURSING AGENCIES The local authority is responsible for the registration and supervision of nursing homes, under the provisions of the Public Health Act, 1936, and the Nursing Homes Act, 1963. These apply to institutions not carried on for profit, and there is one such hospital in the borough; it is visited by officers of the department from time to time. There are no longer any private nursing homes or nursing agencies in the borough. PUBLIC MORTUARY The bodies received and post-mortem examinations carried out were:— From Home Address: Residents of Hillingdon 210 Residents of other districts 18 — 228 From Hospitals in the Area: Residents of Hillingdon 273 Residents of other districts 301 574 802 WELL WOMEN'S CLINICS The cervical cytology service commenced in September, 1966. This service proved popular, and in January, 1967, the size of one of the original clinics was doubled by using two doctors in the team. In July another session was started at Yiewsley Clinic. Soon after this there was a fall in demand, especially from women over 35 years of age, and the lower age limit was removed. Thereafter the demand increased again and remained steady, with an average waiting period for appointment of 4-8 weeks, depending on the clinic. 62 General Services In response to an enquiry from one of the industrial firms in the borough, arrangements were made for a number of sessions to be held in the firm's medical department with the assistance of the factory nurse. This proved very successful. No case of malignancy was found, but several gynaecological conditions were brought to light and treatment arranged by the general practitioner concerned. The statistical details from the various clinics are tabulated below. In view of the various symptoms for which the condition of retroversion has been blamed, it is interesting to note its incidence among relatively healthy and symptomless women. Laurel Lodge Northwood Industry Yiewsley* Number of women seen 555 159 97 170 Number of women healthy 262 85 62 47 ABNORMALITIES FOUND Pelvic Malignancy — — — — cervical erosion 125 18 10 59 cervical polyp 37 10 6 12 fibroids 11 9 3 15 atrophic vaginitis/cervicitis 45 15 7 16 vaginal discharge 12 5 7 2 trichomonas vaginalis 10 2 — 1 monilia — – — 1 leukoplakia vulvae 2 – 1 1 prolapse 17 5 3 7 urethral caruncle 3 — — — Bartholin's cyst 2 — — — varicose veins of vagina 4 — — — cervicitis 6 5 4 5 ovarian cyst 3 1 — 2 pregnancy 2 — — — dyspareunia 8 1 — 3 retroversion 173 9 — 63 Breasts mastitis 6 — 1 6 simple tumour 3 — — 2 abscess 1 — — — Hypertension (diastolic pressure 100 mg. Hg or over) 21 8 1 11 Urine—albuminuria 20 1 — 5 —glycosuria 1 — — — Women recalled for further examination 8 21 3 5 Women referred to family doctor 73 21 7 33 *July to December only. General Services 63 VENEREAL DISEASES Information relating to the incidence of venereal disease which has come to the notice of the Special Clinic at Hillingdon Hospital is given below:— Number of new cases in the year Totals all venereal conditions Syphilis Other venereal conditions Primary and Secondary Other Gonorrhoea 881 1 5 71 804 PLATE 1 Belle Vue, Harlington Road, Hillingdon PLATE 2 A game of croquet at Belle Vue—equipment given by voluntary societies PLATE 3 Brookfield, Park Road, Uxbridge PLATE 4 Brookfield—the residents dining room PLATE 5 A general view of Bourne Hostel PLATE 6 One of the lounges at Bourne Hostel PLATE 7 Typical Slum Clearance properties dealt with during the year PLATE 8 Typical Slum Clearance properties dealt with during the year SECTION VI Environmental Health 67 Environmental Health The Chief Public Health Inspector, Mr. A. Makin, reports:— During the year much progress has been made in the eradication of unfit houses and in the improvement of existing houses. The Council's programme for Slum Clearance will be completed during 1968. Photographs of typical Clearance Areas are included (following page 64). The first Improvement Area is proceeding and 1968 should see considerable progress in the provision of standard amenities of bath, internal W.C.'s and hot and cold water services, in houses where these are lacking. Few requests are being received from tenants for the provision of standard amenities. As regards food hygiene, efforts have been made to improve standards by means of lectures to kitchen staff and by advice during the course of inspections. GENERAL Accidents Any accident necessitating absence from work for three days or more is notifiable, and all notifiable accidents were investigated. Statistics of the accidents are set out below. Workplace Number Reported Action Recommended Fatal Non Fatal Prosecution Formal Warning Informal Advice No Action Offices None 7 None — 5 2 Retail Shops None 19 None 3 8 8 Wholesale shops Warehouses None 9 None — 2 7 Catering establishments open to public, canteens None 2 None — 1 1 Fuel Storage Depots None 1 None — — 1 Totals None 38 None 3 16 19 Investigation of the accidents showed some of them to be caused by unsatisfactory conditions which were not necessarily contraventions. The absence from the Offices, Shops & Railways Premises Act, 1965, of a general requirement that a safe means of access and safe place of employment be provided, as is included in the Factories Act, 1961, is a matter that should be rectified in any future legislation. The majority of the accidents were due to falls or caused by handling goods in an awkward manner, and the injuries were mostly sprains or bruises of a not too serious nature. The use of machinery, in offices, shops and warehouses was also responsible for some accidents. One was due to an electric shock. FACTORIES ACT, 1961 Factories There are 802 registered factories in the borough. Some employ one or two persons, others several hundreds; some occupy modern air-conditioned buildings, others temporary structures. Some are situated on planned industrial estates, others are surrounded by residential properties. Their products cover a wide range from aircraft to woven cloth. Some are internationally known, all have an effect on the environment of this borough. 68 Environmental Health The following inspections were carried out:— Part I of the Act Premises No. on Register No. of Inspections No. of written notices No. of Prosecutions 1. Factories in which Sections 1-4 and 6 are to be enforced by L.A. 24 22 — — 2. Factories not included in Section 1 in which Section 7 is enforced by L.A. 758 476 9 — 3. Other premises in which Section 7 is enforced by L.A. (excluding Outworkers premises) 20 30 — — TOTALS 802 528 9 — Defects found Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted (7) Found (3) Remedied (4) Referred To H.M. Inspector (5) By H.M. Inspector (6) Want of cleanliness (S.1) — 7 – — – Overcrowding (S.2) — — – — – Unreasonable temperature (S.3) — — – — – Inadequate ventilation (S.4) — 1 – — – Ineffective drainage of floors (S.6) — — – — – Sanitary Conveniences (S.7) (a) Insufficient 2 2 – — – (b) Unsuitable or defective 14 13 – 3 – (c) Not separate for sexes — — – — – Other offences against the Act (not including offences relating to Outwork) 5 6 – — – TOTALS 21 29 – 3 — Environmental Health 69 OUTWORKERS 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. Several persons in the borough are employed on such work by factories situated outside the borough. During the year 158 visits were made to premises occupied by such persons. Outworkers Wearing Apparel 34 Christmas Crackers 179 Stuffed Toys 2 Lampshades 1 Brushes 1 Embroidery 1 Paper Bags 1 Total 219 FERTILIZERS AND FEEDING STUFFS ACT, 1926 Twelve samples of fertilisers and four samples of animal feeding stuffs were taken during the year and submitted to the Council's Agricultural Analyst for examination. All were found to be satisfactory. NOISE ABATEMENT ACT, 1960 Noise is one of the more serious problems affecting modern life and is one of which the general public are becoming more aware. A total of 25 complaints of noise from sources other than aircraft was received. The complaints varied and included noise from:— Games played in a boy scout hut. Do-it-yourself motor car assembly. Refrigerator motors and industrial processes where the on/off cycle of the noise occurs at any time of the day or night. Pneumatic drills. Ice-cream vehicle chimes. Suitable noise mufflers are available for pneumatic drills, and it is the department's policy to draw attention to this whenever unmuffled drills are observed. The users of the drills have raised no objection to the use of mufflers; use of mufflers is incorporated as a standard clause in Council contracts, and the continued use of unmuffled drills can only be because of complete disregard of the nuisance caused. Chimes on ice-cream vendors' vehicles cause two different nuisances, one from their use outside the legally permitted hours of operation, and the other because the chimes are so loud they can be heard many times when a vehicle is in the vicinity. The traders have been requested to co-operate in preventing annoyance of either sort. 70 Environmental Health OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 The inspection of offices and shops continued, and details of the premises registered, persons employed and inspections made are set out below:— Class of Premises Registered Persons Employed General Inspections Offices 664 14,528 651 Retail Shops 1,681 6,780 1,623 Wholesale Warehouses 61 1,688 61 Catering Establishments open to the Public—Canteens 196 2,026 129 Fuel Storage Depots 7 62 4 Total 2,609 25,084* 2,468 *Males 12,441 Females 12,643. Section Number of Contraventions found Section Number of Contraventions found 4 Cleanliness 301 13 Sitting facilities 21 5 Overcrowding 16 14 Seats (Sedentary workers) 4 6 Temperature 327 15 Eating facilities 2 7 Ventilation 80 16 Floors, passage and stairs 333 8 Lighting 212 17 Fencing exposed parts of machinery 55 9 Sanitary conveniences 77 18 Protection of young persons from dangerous machinery 4 10 Washing facilities 244 19 Training of young persons working at dangerous machinery 11 Supply of drinking water 12 23 Prohibition of heavy work — 12 Clothing accommodation 79 24 First Aid 367 Other matters 680 Total 2,814 Environmental Health 71 Legal proceedings were taken against one occupier for failing to provide satisfactory washing facilities, suitable ventilation between the water closet and the workroom, suitable cloakroom facilities and to maintain the floor in good repair. Fines of £5 were imposed in respect of each offence together with eight guineas costs. Proceedings against another occupier for failure to provide suitable washing facilities resulted in a fine of £3 and seven guineas costs. Proceedings were taken against the occupier of a shop for failing to provide a suitable guard to a slicing machine. A fine of £25 together with seven guineas costs resulted. No applications for exemption from the provisions of the Act were received in 1967. PORT SANITARY ADMINISTRATION, LONDON (HEATHROW) AIRPORT The work of sanitary administration at a busy international airport covers a wide range of duties. INSPECTION OF IMPORTED FOOD Although the volume of food imported by air is quite small in comparison with that imported by sea, it is necessary to maintain an inspection service to ensure (a) that all the food imported is fit for human consumption and that it is free from prohibited adulterants or preservatives, and (b) that meat or meat products are accompanied by an Official Certificate from the country of origin. In order to provide this service Public Health Inspectors are on call duty so as to cover the whole 24 hours. During the year 638 inspections were made under the Public Health (Imported Food) Regulations, 1937-1948, and 239 tons, 1 cwt. 2 qrtrs. 12 lb. of food was inspected. Details of the various foods are:— Article lb. Article lb. Meat (various) 147,840 Shellfish 10,905 Beef Fillets 53,804 Poultry 19,159 Cooked and Smoked Meats 19,528 Pate de fois 6,867 Bacon and Ham 26,322 Milk and Cheese 3,220 Meat Paste 3,509 Butter and Fats 665 Sausage 43,127 Fruits 18,990 Salami 10,641 Vegetables 53,150 Offal 12,596 Confectionery 2,327 Casings 3,891 Flour Confectionery 5,524 Fish 24,086 Miscellaneous 71,269 Of this the following was found unfit and voluntarily surrendered by the Importer. Article lb. Article lb. Meat 128 Meat Mayonnaise 26¼ Smoked Bacon 2½ Mayonnaise 132 Sausage 100 Fruit 1,817 Poultry Meat 73 Vegetables 5,881 Eleven consignments of meat and meat products had no Official Certificates attached, and were detained. Ten imports were released on receipt of Undertakings that they would not be sold for human consumption and the other consignment was destroyed. 72 Environmental Health There were 205 samples of imported food submitted for bacteriological examination with the following results:— Satisfactory Unsatisfactory Cooked sausages 42 5 Salami and Dry Sausage 10 16 Debreziner Roast 15 27 Ham 1 2 Pate 7 - Other cooked meats 18 1 Meat Salad 2 Cured Ham and Pork 4 10 Fresh Meat 15 — Cooked Poultry Meat 4 — Mayonnaise 6 — Cream 1 — Cheese 2 1 Fish 5 — Shellfish 5 1 Snails 1 1 Frogs Legs 1 1 Watercress — 1 Totals 139 66 On the receipt of an unsatisfactory result for any food, both the Importer and Exporter are advised of the position and in most cases there is an improvement in the standard of further imports. In four of the samples examined, Salmonella was isolated. These foods were traced through the trade and withdrawn from sale. Hygiene of Food Premises In an airport of this size, there are numerous catering establishments varying in type and size. There are large restaurants, catering for passengers, buffets and both industrial and non-industrial canteens. Several of these establishments are open throughout the 24 hours, which in itself creates a difficult cleaning problem. In addition to the above there are several establishments carrying out aircraft catering, i.e. preparing meals for serving on aircraft. In some cases the food is prepared, cooked and placed in insulated containers for immediate service without further heating, and in others the food after being prepared, cooked and refrigerated requires reheating on the aircraft. Regular inspections of all these premises are carried out and samples of both the prepared and raw food are taken for bacteriological and chemical examination. Vermin Control In order to exercise adequate control it is necessary to carry out regular inspections of buildings, land and aircraft. Aircraft The amount of infestation on aircraft is quite small but from time to time rats are found and on these occasions the aircraft is fumigated immediately with Hydrogen Cyanide. Occasionally other insects are discovered and disinsectisation is carried out immediately. There were six fumigations carried out for rats in 1967. Environmental Health 73 Land Regular rodent control treatments of the airport are carried out by a Contractor employed by the British Airports Authority. Buildings The buildings at the Airport are inspected regularly for rodents and insects. The main problems are associated with mice and cockroaches, both of which have been troublesome but during the last year expensive treatments have been undertaken by the Contractors and the situation is much improved. Water Supply The whole of the Airport is supplied with mains water and this is satisfactory. Aircraft water supplies do raise problems from time to time and to ensure safety regular samples are taken for bacteriological examination. Most aircraft are now fitted with fixed storage tanks and these rarely cause trouble. However, there are still aircraft using flasks and the water in these is frequently unsatisfactory. There were 293 samples taken during the year with the following results:— Satisfactory Unsatisfactory Taken from fixed tank systems 76 10 Taken from portable flasks 152 47 Taken from bowsers 4 1 Foreign bottled waters 3 - WATER SUPPLIES Main Supplies Water is supplied to the Borough by three Water Companies. The detailed results of chemical analysis of water taken from these three supplies are shown overleaf. Private Water Supplies There are four houses within the Borough supplied from wells; one has its own chlorinating plant. In addition, a number of industrial premises draw water from deep wells for manufacturing purposes. Thirty samples of water from private sources were submitted for laboratory examination. Twentyone were found to be satisfactory, eight unsatisfactory and one suspicious. The use of well water for drinking purposes, by the staff of a horticultural unit was discontinued following unsatisfactory laboratory reports and negotiations are proceeding for a main connection. Swimming Baths In addition to Ruislip Lido, part of which is used for bathing purposes, there are 17 swimming pools in the Borough. Two indoor public pools are in use throughout the year and the remainder, situated at schools, hotels, clubs, etc. during the summer months only. There were 172 samples submitted for bacteriological examination with the following results. Satisfactory Unsatisfactory Suspicious 138 23 11 74 Environmental Health Results of Chemical Analysis of Water Colne Valley Water Co. South West Surburban Water Rickmansworth and Uxbridge Valley Water Co. Appearance Clear Clear Clear Odour Normal Normal Normal Reaction pH 7.2 7.5 7.2 Suspended Solids Absent Absent Absent Parts per million Chlorion as C1 95 67 56 Ammoniacal Nitrogen 0.02 0.02 0.04 Albuminoid Nitrogen 0.01 0.01 0.01 Nitrate Nitrogen 1 3 1 Nitrite Nitrogen Absent Absent Absent Permanganate Value 0.44 1.60 0.04 Total Hardness as CaC03 356 296 294 Total Alkalinity as CaC03 252 204 254 Fluoride as F 0.3 0.2 0.3 Non Carbonate Hardness as CaC03 104 92 40 Thirty-one samples of mains water submitted for bacteriological examination were all classed as satisfactory. Miscellaneous (a) Ice Cubes All 13 samples of ice cubes submitted for examination were found to be satisfactory. These figures contrast favourably with those for 1966, when 10 samples of ice cubes were found to contain B. coli. (b) Water Dispensers Of the 13 samples taken from refrigerated water dispensers, five were found to be unsatisfactory and one suspicious. The unsatisfactory results were due to contamination, either during the filling of the dispenser or from failure to keep the dispenser clean. Further samples taken after these matters had been brought to the attention of the staff concerned, were found to be satisfactory. (c) Storage Tanks Ten samples of water from indirect supplies, i.e. water which has passed through cold water storage tanks were examined. Two were unsatisfactory and five were suspicious. Dead birds were found in two improperly covered tanks. The importance of ensuring that, as far as possible, only direct main connections are used for water required for drinking and culinary purposes was emphasised, together with the necessity for ensuring that storage tanks are kept properly covered at all times and are thoroughly cleansed at regular intervals. Environmental Health 75 THE LIQUID EGG REGULATIONS, 1963 There were 12 samples of liquid egg submitted for the Alpha-Amylase test for adequate pasteurisation and all found to be satisfactory. Liquid egg is not pasteurised within the Borough. HOUSING Improvement (a) Improvement Areas The service of statutory improvement notices on owners of dwellings in the first Improvement Area, bounded by Wood End Green Road, Kingsway, Bishops Road, Judge Heath Lane and Botwell Lane, Hayes, has had good results. Of the 43 dwellings requiring the provision of standard amenities, works of improvement were completed in 16 cases in the year. A further 17 applications were made for improvement grants. No action can yet be taken in respect of the 10 Suspended Notices where the tenants are not willing to have the amenities provided. I anticipate that in 1968 all the notices served, with the exception of the suspended notices, will have been complied with. The second Improvement Area, also in Hayes and bounded by Station Road, Botwell Lane, Botwell Common Road, Dawley Road, Blyth Road, Clayton Road and North Hyde Road, was declared on the 13th July, 1967, and a start has been made on a detailed survey of Area No. 3, which is bounded by Waterloo Road, Cowley Mill Road, Cowley Road, the Greenway, Whitehall Road, rear boundaries of houses in Cotswold Close and Austin Way, Uxbridge. (b) Houses outside Improvement Areas Little use has been made by tenants of the opportunity afforded them in the Housing Act, 1964, to make representations to the Council to require their Landlords to provide standard amenities. Only two applications were received in 1967, compared with six applications in 1966. A tenant, by making a representation to the Council, can initiate action for his house just as though the house was included in a declared Improvement Area. It would appear that tenants are not aware of this procedure or may be unwilling to pay more rent, or may be afraid of upsetting the Landlord. When houses are inspected for any purpose the amenity position is noted. If standard amenities are lacking, the Landlord is asked to consider improvement in advance of the Declaration of an Improvement Area. Details of the applications received during 1967 and the action taken is shown in the table below:— Dwellings Outside Improvement Areas 1. Number of representations made by tenants 2 2. Number of Preliminary Notices served 6 3. Number of undertakings accepted — 4. Number of Immediate Improvement Notices served 4 5. Number of such dwellings improved: (a) full standard 4 (b) reduced standard Improvement Grants The number of applications for Improvement Grants showed a slight increase. In 1965 there were 65; in 1966—76; and during 1967-85. Many of the applications for grants related to dwellings 76 Environmental Health in Improvement Areas. All these figures relate to grants under the Standard Grant Scheme because no application for a Discretionary Grant was received. (I) Standard Grants Owner I Occupier Tenanted 1. Number of applications received 46 39 Number of applications approved 35 39 Number of applications refused or withdrawn 5 6 2. Number of dwellings improved 23 37 3. Amount paid in grants £8,964 12s. 5d. 4. Average grant per house £149 8s. 2d. 5. Amenities provided:— (a) fixed bath 50 (b) shower — (c) wash hand basin 53 (d) hot water supplies—3 points 43 1 or 2 points 11 (e) Food stores 30 (f) Water closets within dwelling 55 (2) Discretionary Grants Nil. Improvement Areas—Housing Act, 1964 Number of: 1. Areas (a) Surveyed 2 (b) Declared 1 2. Houses to be improved (a) full standard 82 (b) reduced standard — 3. Preliminary Notices served — 4. Undertakings accepted — 5. Immediate improvement notices served — 6. Suspended — 7. Final — 8. Dwellings improved (a) full standard 17 (b) reduced standard — 9. Dwellings improved by L.A. in default (a) full standard — (b) reduced standard — Improvement Grants—Publicity By the end of 1967 arrangements had been made to hold exhibitions to publicise the advantages of improvement grants and the work done by the Borough so far, and proposed for the future, in connection with improvement areas. Environmental Health 77 REPAIR, DEMOLITION, CLOSURE AND CLEARANCE (a) Repair (Housing and Public Health Acts) The remedying of housing defects, found either as a result of complaint or by discovery during inspection, has been achieved mainly through the use of the Public Health Act, 1936, or, if urgent repairs were necessary, through the Public Health Act, 1961. Inadequate powers exist to deal effectively with the proper repair of tenanted dwellings. Until the definition of fitness is altered, and the cost definition varied, there will continue to be a wastage of the housing stock. The following table shows formal and informal action taken to secure the repair of dwellings. 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 (a) By owner — 1 152 18 152 19 (b) By Local authority — — — — — — TOTALS — 1 152 18 152 19 (b) Demolition and Closure of Unfit Houses Twenty-eight houses were reported to the Council as unfit for human habitation and not capable of repair at reasonable expense, in respect of which, 7 Closing Orders and 21 Demolition Orders were made. Twelve houses have been demolished. Unfit Houses (Not capable of repair at reasonable expense) — Housing Act, 1957 Number of: 1. Undertakings accepted (Section 16) — 2. Closing Orders made (Section 17) 7 3. Demolition Orders made (Section 17) 21 4. Closing Orders made (rooms) (Section 18) — 5. Closing Orders determined (Section 27) — 6. Closing Orders revoked and Demolition Orders substituted (Section 28) 1 7. Houses demolished following Demolition Orders 13 8. Number of people displaced (a) individuals 28 (b) families 13 (c) Clearance Areas By the end of the year the two year programme was practically complete, and other properties which were found to be unfit have been dealt with. 78 Environmental Health Below is a table showing progress during the year. Clearance Areas (I) Reported during the year 1. Number of Areas 16 2. Houses unfit for human habitation 55 3. Houses included by reason of bad arrangement, etc. — 4. Houses on land to be acquired under Section 43(2) 4 5. Number of people to be displaced (a) individuals 117 (b) families 49 (2) Action taken during the year 1. Houses demolished by Local Authorities or owners (a) unfit 4 (b) others — 2. Unfit houses purchased by Local Authority and demolished 5 3. Number of people displaced (a) individuals 60 (b) families 26 MULTIPLE OCCUPATION Multiple occupation is still a problem. During the year the Council's policy to control the problem was implemented. Direction Orders have been served, where applicable, on the 3 and 4 bedroomed type of dwellings found in multiple occupation, and facilities, as required by Section 15 of the Housing Act, 1961, have been requested in those houses where it has been appropriate to require them. In addition, when fire precautions are needed, the Building Control Section of the Engineer and Surveyor's Department makes recommendations to ensure compliance with Section 16 of the Housing Act, 1961. This requires houses in multiple occupation to be provided with proper means of escape in case of fire. The forwarding of addresses of long-stay immigrants arriving in this country is of some assistance as a means of controlling multiple occupation. These persons are visited at the addresses given, and when multiple occupation is discovered, the necessary measures are put into operation. The number of houses known to be in multiple occupation is slightly less than last year, although 34 new cases were discovered, which required Direction Orders. The reason is because quite a number of houses previously in multiple occupation have, since the service of Direction Orders, reverted to single family occupation. Requisitions for Information are still sent out at intervals of four months to occupiers of houses on which Direction Orders have been served and re-inspections are made to verify the information given. During the year three contraventions were discovered, which resulted in prosecutions in the Magistrates Court. Houses in Multiple Occupation 1. Known number of houses in multiple occupation 201 2. Number of houses on which Notices of Intention have been served for (a) Management Orders (Section 12) — (b) Directions on overcrowding (Section 19) 34 3. Number of houses on which have been made: (a) Management Orders — (b) Directions on overcrowding 34 Environmental Health 79 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 3 (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 8 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 — (b) in respect of all defects 6 4. Number of undertakings given by landlords under paragraph 5 of the First Schedule 3 5. Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule - 6. Number of Certificates issued 1 Part II—Application for cancellation of Certificates 1. Applications by landlords to Local Authority for cancellation of certificates 3 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 1 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 15 14 Gypsies and Other Itinerants Itinerants continued to be a problem in certain parts of the Borough, particularly in Harmondsworth. 80 Environmental Health CLEAN AIR The Council's programme for extending Smoke Control throughout the Borough by 1976 was affected by the financial restrictions imposed by the Government. As a result only one Smoke Control Area was declared during the year, instead of four which were planned. It is hoped that later it will be possible to make up the leeway as there is growing evidence of the welcome acceptance by the public of smoke control. The position as at 31st December, 1967, is:— Number of Orders Acres Covered Domestic Dwellings Other Premises Local Authority Private In operation at 31.12.66 36 11,248 7,377 16,570 1,896 Brought into operation during 1967 3 970 702 2,358 319 Total 39 12,218 8,079 18,928 2,215 The borough includes areas of high, medium and low density housing and areas of industrial development, but air pollution from one type of area tends to spread to surrounding areas. The measures to reduce smoke from domestic and industrial services are working well. The position with regard to emissions of dust and grit is not so favourable and the proposed new Regulations are not helpful as they apply only to boiler and furnace emissions and not to dust and grit from other processes, e.g. coal depots, roadstone works, etc. Standards for the emission of noxious and dangerous vapours, such as the exhaust from dry cleaning machinery using perchlorethylene, are also required. Details of the steps taken to deal with atmospheric pollution in the borough are set out below under various headings. SMOKE AND SULPHUR DIOXIDE (In Microgrammes per Cubic Metre) YEAR SMOKE SULPHUR DIOXIDE RATIO JUNE TO JANUARY JUNE JANUARY JUNE JANUARY SMOKE SULPHUR DIOXIDE West Mead Grange Pk. sch. West Mead Grange Pk. sch. West Mead Grange Pk. sch. West Mead Grange Pk. sch. West Mead Grange Pk. sch. West Mead Grange Pk. sch. 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 1967 10 14 65 47 49 53 155 137 1:6.5 1:3.4 1:3.1 1:2.4 Environmental Health MONTHLY AVERAGES FOR SMOKE AND SULPHUR DIOXIDE FOR 1967 Microgrammes Per Cubic Metre 76 High St., Northwood West Mead, South Ruislip Coldharbour Lane, Hayes Grange Park School, Hayes High Street, Uxbridge Oak Farm School, Hillingdon Drayton Hall, West Drayton Smoke SO2 Smoke S02 Smoke SO2 Smoke SO2 Smoke SO2 Smoke SO2 Smoke SO2 January 60 79 65 155 45 155 47 137 66 122 53 128 51 132 February 53 78 59 137 43 136 40 168 68 138 56 118 48 119 March 29 75 19 130 18 159 20 133 24 103 23 108 17 77 April 32 47 31 87 22 117 22 117 36 100 28 119 31 84 May 19 65 22 85 24 95 18 86 15 80 18 104 23 65 June 12 42 10 49 16 57 14 53 12 53 13 63 16 40 July 9 36 8 52 14 59 9 54 5 43 8 56 8 29 August 11 48 8 37 18 64 17 67 7 57 13 66 7 35 September 20 26 15 44 25 50 19 33 9 34 20 39 13 19 October 33 17 16 44 32 63 19 32 22 48 21 35 17 20 November 72 77 58 128 75 143 63 154 69 136 73 132 78 107 December 90 93 80 170 70 131 56 134 76 130 66 124 64 99 81 82 Environmental Health Measurement and Investigation of Atmospheric Pollution Seven stations for measuring smoke and sulphur dioxide in the atmosphere were operated in 1967. The daily volumetric system is used (see table page 81). The records for the stations at West Mead, South Ruislip, and Grange Park School, Hayes, 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 will be 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 figure 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. 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. During the year the gasworks ceased to produce gas by coal carbonisation, and the coke stocks in the depot were removed. Attempts to minimise dust emissions from the coal depot continued, but when a breakdown in the dust suppression system has occurred, inconvenience is caused to the inhabitants in the immediate vicinity of the depot. The steps so far taken, although reasonably effective under normal conditions, are much less effective under dry and windy conditions. The National Coal Board have been requested to deal with this nuisance more energetically. The table on page 81 shows monthly averages of daily readings of smoke and sulphur dioxide. Undue significance should not be attached to a comparison between the results for two adjoining years; a more reliable picture can only be obtained by taking the trend over at least five years, and preferably even longer than this. 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 131 Registered Dairies 2 Licences to use Special Designations: (a) Pasteurised 85 (b) Sterilised 44 (c) Ultra-heat treated 14 (d) Untreated 16 Dealer's Licence (Pasteurised) 2 Milk is now one of the safest foods. All milk supplied in the Borough, with the exception of supplies from three farms, is heat treated. Two of these farms are within the Borough, producing milk for the special needs of members of the Jewish faith; in the third case the farmer sells direct to the public from a farm outside the Borough. Samples are submitted to ensure that milk has been correctly heat treated, particular attention being paid to milk processed at the two pasteurising plants situated within the Borough. In the case of raw milk supplies, biological tests are also carried out to determine whether or not the organisms causing tuberculosis or brucellosis are present. Environmental Health 83 Tuberculosis is not a matter of great concern at present, as all herds are now free from the disease; brucellosis, however, is of extreme public health importance when untreated milk is consumed. In view of this, and the possibility that farm workers and their families will be supplied with raw milk direct from the farm, samples are regularly taken from all the supplying farms in the borough and submited 10 the Public Helth Laboratry For examination. All blologtct ana blological and tests are carried out by this laboratory including the T.T.C. tests for the presence of antibiotics in milk. Details of milk tests are set out below. Methylene blue test Phosphatase test Brucella ring test T.T.C. test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory 5 — 22 — 170 5 89 — The number of dairy farms within the borough remains the same—19. The hygiene of milk production on the farm is a responsibility of the Ministry of Agriculture, Fisheries and Food. Milk Distribution It is essential to ensure that there is no post-treatment contamination of milk supplies and so churns and bottles washed at the processing plants have been examined bacteriologically to assess the effectiveness of the washing process. Samples taken at supply points in catering establishments have proved disappointing. Of a total of 41 samples, 23 were unsatisfactory. The method of storage is to some extent at fault, but the greatest source of contamination appears to be from unsatisfactory handling—this is illustrated by the table below. Method of Storage and Handling Churn and Dipper Refrigerated Dispensers Disposable Pack Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory 6 5 11 18 1 0 Failure to comply with the manufacturer's recommendations for cleaning undoubtedly accounted for the very high percentage of unsatisfactory results obtained from refrigerated dispensers. When the cleaning of this equipment was properly carried out under supervision, satisfactory results were obtained. The use of disposable packs would be a ready solution to this problem, but unfortunately, at the moment, cost weighs against their use. Cream Whilst the bacteriological safety of milk is safeguarded by statutory requirements, the same does not apply to cream. However, samples of cream were submitted to assess the degree of cleanliness of preparation and packing and the correctness of storage and stock rotation. The tests applied were the 84 Environmental Health methylene blue reduction test and the coliform count. A high percentage of unsatisfactory results was obtained:— Samples of Cream Taken Satisfactory Unsatisfactory 37 23 14 ICE CREAM Results of Ice Cream Samples:— Grade Number Taken Percentage 1 40 57.1* 2 11 15.7* 3 9 12.9† 4 10 14.3† Totals 70 100 *Satisfactory †Unsatisfactory Origin of Unsatisfactory Samples Soft Ice Cream Other Ice Cream Vehicles Shops, etc. Vehicles Shops, etc. 2 4 3 10 Ice Cream sales from vehicles continue to present particularly difficult control problems. The number of unsatisfactory samples obtained from premises is a reflection on the hygienic practices of staff, as control samples give good results. In the case of soft ice cream, failures were due to inadequate cleansing of the equipment. Environmental Health 85 INSPECTION OF MEAT AND OTHER FOOD Slaughterhouse Act, 1958 There is only one slaughterhouse in the Borough. The number of animals killed at the premises during the year decreased slightly:— Carcases Inspected and Condemned Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Total Number killed 283 30 53 984 2,312 3,662 Number not inspected — — — — — — All diseases except Tuberculosis and Cvsticerci Whole carcases condemned 1 2 1 - 15 19 Carcases of which some part or organ was condemned 50 14 1 36 270 371 Tuberculosis only Whole carcases condemned — — — - 3 3 Carcases of which some part or organ was condemned - - - - 57 57 Cysticerci Carcases of which some part or organ was condemned 7 - - - - 7 Carcases submitted to refrigeration 7 - - - - 7 Generalised and totally condemned - - - - — - All animals are inspected in accordance with the Meat Inspection Regulations, 1963. The increase in the number of cattle affected with Cysticercus bovis is noteworthy. In 1965 and 1966 the numbers were, respectively, nil and three. If the condition is generalised, condemnation of the entire carcase is necessary. When localised, the affected part only is condemned and the remainder of the carcase is released following a period of cold storage, either for three weeks at 20°F or two weeks at 14°F. The cases reported were all localised, and after removal of the affected portions, the remainder of the carcases were refrigerated and released for consumption in accordance with the regulations. In view of the increasing number of incidents, the origin of the affected cattle was traced, where possible, and the information passed to the Authority concerned. Laboratory Examination of Slaughterhouse Specimens On those occasions when it has been considered necessary to submit specimens for bacteriological examination, the Central Public Health Laboratory at Colindale and the Pathological Laboratory at Hillingdon Hospital have been most co-operative. 86 Environmental Health Bacteriological Examination of Specimens and Samples from the Slaughterhouse Description of Specimen Surface Plate count per g. 35° C Coliform present Salmonella Non-faecal Faecal Beef Carcase 50,000 0.01g. 0.1g. Not found Beef Carcase 45,000 0.01g. 0.01g. Not found 3 Beef Carcases — — — Not found Pig Carcase >1,000 million 0.001 g. 0.01 g. Not found Pig Carcase 55 million — 0.000001 g. Not found Pig Carcase 40 million 0.0lg. 0.01g. Not found 16 Pig Carcases — — — Not found 2 Sheep Carcases — — — Not found Bovine faeces (3) - — — S. dublin S. senftenburg Pig faeces (15) - — — Not found Sheep faeces (4) - - - Not found Plate Count 24 hrs. at 37°C Probable Number of Coliforms Non-faecal Faecal Scalding Tank Water 4 million per ml. 5 0 Scalding Tank Water 4 million per ml. 25 0 *Offal Washing Tank 250,000 >18,000 >18,000 *Offal Washing Tank 150,000 18,000 18,000 *The use of this tank has now been discontinued. Slaughterhouse During the year considerable structural work has been carried out in the slaughterhouse and lairages and as a result conditions are much improved. Poultry Inspection One major poultry processing establishment continues to operate in the district. Very few birds are killed at the premises except during the Christmas period; usually poultry are killed and plucked elsewhere and brought into the Borough for evisceration, packing, freezing, etc. As a result 100% inspection is neither possible nor necessary. General surveillance is exercised by regular visiting of the premises. Details of Poultry Processed Hens Ducks Geese Turkeys Total 103,972 2,579 163 38 991 107,743 Environmental Health 87 Other Food The total amount of food surrendered for destruction during the year was 16 tons 19cwt.3 qrtrs. 10 1b. Class of Food Quantity (lb.) Fresh Meat 7,922 Frozen Meat 1,027 Canned Meat 7,072 Fresh Fish 504 Frozen Fish 1,114 Canned Fish 390 Fresh Fruit 6 Frozen Fruit 3 Canned Fruit 8,809 Fresh Vegetables 42 Frozen Vegetables 936 Canned Vegetables 4,104 Poultry 1,309 Canned Meals 221 Cereals 949 Canned Soup 754 Canned Milk and Cream 520 Flour Confectionery 650 Sugar Confectionery 1,215 Cheese 2 Fruit Juice 117 Other Foods 396 Disposal of Condemned Food Condemned food is disposed of by tipping and burial under supervision at a refuse tip. Meat condemned at the slaughterhouse is treated in accordance with the Meat (Staining and Sterilisation) Regulations 1960, before being released to an animal products factory for processing. Slaughter of Animals Act 1933-1958 During the year four licences were issued to slaughtermen. No contraventions in connection with the slaughtering of animals were observed. Diseases of Animals Act 1950 The rural nature of some parts of the district makes the correct administration of the various requirements relating to diseases of animals extremely important. The widespread epidemic of Foot and Mouth disease which occurred during the year led to the introduction of a Foot and Mouth Control Area Order which included the Borough. Great care has always been given to the correct handling and treatment of swill in accordance with the Diseases of Animals (Waste Food Order) 1957 and during the year samples of swill have been submitted for examination for the presence of Salmonellae, but none were isolated. There are 34 licensed boiling plants in the Borough:165 visits were made to piggeries and boiling plants. The surveillance of stock moved into the area under the Movement of Swine Order is carried out by the Council's Veterinary Officer, with the exception of animals arriving at the slaughterhouse or requiring a further Movement Licence for the purpose of removal for slaughter. Number of Movement Licences received 248 Number of Movement Licences issued 38 There were no cases of notifiable disease during the year. 88 Environmental Health Specimens submitted for Salmonella Investigation Type of Specimen Number examined Number positive Serotypes Animal faeces (a) Bovines 3 2 S.dublin, senftenburg (b) Pigs 15 — (c) Sheep 4 — Animal feeding stuffs 4 — Pig swill (boiled and unboiled) 14 — Fertilisers (bone meal) 5 5 S. cubana, magwa, senftenburg, mensta, newport, bareilly, paratyphi B. Carcase meat (a) Bovines 5 — (b) Pigs 19 — (c) Sheep 2 — Poultry (skins and viscera) 8 1 S. virchow Water Cress The chemical sterilisation of water cress produced within the Borough continues. Four samples of water cress were submitted for bacteriological examination and one was found to be unsatisfactory. FOOD AND DRUGS SAMPLING Samples Taken Number of Samples Unsatisfactory Reports Legal Proceedings Instituted Total No. of Convictions secured Examined by Public Analyst Examined in Health Dept. Analysis Labelling Formal Informal Informal Foods 11 385 79 12 9 1 — Drugs — 9 — — — — — Commodities sampled (other than imported food at London Airport) Artificial Sweeteners 1 Food Enhancers 1 Bamboo Shoots 1 Fresh Cream 18 Barley Kernels 1 Ground Almonds 1 Bread 6 Instant Mashed Potato 1 Bread Crumbs 1 Iced Lolly 1 Butter and Margarine 4 Jams and Marmalade 7 Buttered Rolls 1 Kernel Oil 1 Buttered Toast 1 Liquid Glucose 1 Cake Mixes etc. 1 Liquorice 1 Environmental Health 89 Canned Cream 3 Marzipan 1 Canned Fruit 6 Meat Products 32 Canned Meals 1 Milk 53 Canned Meat and Chicken 8 Oil from Fryers 4 Canned Shellfish 3 Pickles 1 Canned Vegetables 7 Pickling Spice 1 Cheese and Cheese Products 16 Rice 1 Coffee 1 Rye 1 Condensed Milk 1 Salt 1 Cooking Oil 5 Sauces and Sauce Mixes etc. 6 Curry, Curry Paste, etc. 3 Sausages 11 Custard Powder 1 Seasoning 2 Dried Fruit 2 Soup 1 Drugs 9 Sugar Confectionery 3 Egg Noodles 1 Tea 2 Evaporated Milk 2 Tonic Water 2 Fish Products 8 Vending Machine Samples 8 Flavoured Drinks 12 Vinegar 2 Flavoured Spreads 6 Wines and Spirits 4 Flour Confectionery 5 Yoghourt 2 Samples of Imported Food taken at London Airport Bread 4 Pate de Fois 2 Canned Meat 1 Peppers 1 Cheese 3 Salad and Salad Dressing 9 Dried, Smoked and Cooked Meats 11 Salami 6 Fish Products 6 Sausages 8 Flour Confectionery 15 Snails 1 Fresh Cream 1 Soup 1 Fresh Fruit 4 Sugar Confectionery 1 Fresh Vegetables 38 Tea Bags 1 Milk 1 Tripe 1 Pastes 2 Truffles 1 Samples examined within the Department Satisfactory Unsatisfactory Milk 4 - Spirits 57 5 Cream 3 — Mince 6 — Vinegar 4 — Three samples of "coffee with milk" taken from vending machines were found in fact to be coffee with skimmed milk. After consultations the proprietors of the machines arranged for the necessary amendments to be made to the descriptive labels. Samples of white and brown vinegarine, bottled within the Borough for export only, were found to be satisfactory upon analysis although the labelling was considered by the Public Analyst to be insufficiently detailed. A blended vegetable oil was reported as not complying with the Labelling of Food Order. Legal proceedings were eventually instituted and the Court held that the product was correctly labelled. Costs were awarded against the Council. 90 Environmental Health Sulphur dioxide in apricot chutney was found to be due to its presence in the dried apricots from which the chutney was made. A sample of imported mayonnaise and herrings in jelly was found to contain sorbic and benzoic acid and a sample of imported herrings in jelly, benzoic acid. The matter was taken up with the importers and no further importations have been received. Three samples of frying oils and fats taken from catering establishments were found to be rancid. Specific gravity readings on five samples of spirits from four public houses were suspicious and repeat formal samples were taken. These were found to be satisfactory. Food Complaints There were 114 food complaints received during the year, a slight reduction from 135, the figure for 1966. The undermentioned table gives details of the complaints. Commodity Nature of Complaint Unsound (mould etc.) Foreign matter Cause of Complaint Bacon 1 1 Maggots Beer 1 - Mould due to loose stopper Bread 12 10 Discoloured dough, insects, nail Butter 1 1 Nail, mould on packet Canned cream 1 — Sour Canned fruit 1 - Canned meat 7 4 Fibres, sulphiding, metal nut and mould Canned shellfish 1 - Discolouration Cereals — 1 Insects Cheese 1 — Chipped potatoes — 1 Alleged dirt Crisps — 1 Perspex, in the packet Fish and Fish products 2 3 Mould, beetle, fly Flavoured spreads 1 1 Glass Flour Confectionery 6 6 Dirt, wasps, hair, glass Fresh cream — 1 Dirt Fresh fruit 1 — Decomposition Fresh meat 5 2 Decomposition. Suspected horseflesh—not confirmed Frozen vegetables 1 — Decomposition Jam and Marmalade — 1 Meals 1 2 Broken china, metal particles Meat products 7 3 Glass, dental filling, beetle Milk 1 13 Glass, dirt, bottle caps Pickles 1 1 Caterpillar Sausages and Sausage meat 2 4 Twine, metal Sugar confectionery 3 1 Wire 57 57 Environmental Health 91 Legal proceedings were instituted in 10 cases, eight being prosecutions under Section 2 of the Food and Drugs Act 1955 (Food not of the nature, substance or quality demanded), one under Section 8 (Food unfit for human consumption) and one under the Milk and Dairies (General) Regulations 1959 (using a dirty bottle for milk). Convictions were obtained in each case and the total amount of fines and costs imposed was £164 2s. 6d. Bakery products once again were the largest source of complaints, both for foreign bodies and mould. FOOD HYGIENE There are 1,377 food premises in the borough. The consequences of any break-down in hygiene were amply illustrated by the cases of food poisoning which occurred during the year. The risk of break-down is increased by staff shortages, the congestion of premises due to increased trade and the lack of properly trained staff. While automation of the food trade is generally increasing there is, in many cases, an alarming lack of knowledge of the routine cleansing that such equipment requires. Many managements show lack of knowledge about suitable materials, finishes etc., available for use. Science is constantly providing the trade with the answer to many of its handling and cleaning problems and it is unfortunate that manufacturers are not more successful in bringing their products to the attention of those concerned. New Premises The considerable expansion and redevelopment taking place affords an excellent opportunity for ensuring that premises are constructed to the highest possible standards. All plans involving the construction or alteration of food premises are closely scrutinised and advice given on compliance with the various regulations. During the year 60 plans were submitted and many improvements in design, layout and equipment were obtained after discussion with architects and their clients. Inspection of Food Premises Type of Premises Total Number Visits Made Aircraft Catering 9 86 Bakehouses 20 178 Bakers' Shops 52 168 Butchers' Shops 136 553 Catering Premises Factory Canteens 128 421 Hospital Kitchens 10 72 Hotels, restaurants, cafes, public houses and clubs 260 1,218 School Kitchens 84 284 Dairies and Milk Distributors 60 37 Fishmongers and Poulterers 43 294 92 Environmental Health Type of Premises Total Number Visits Made Food Factories Bakery and confectionery 3 r 75 > 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 Greengrocers' shops 97 497 Grocers' shops 205 845 Ice Cream Distributors 38 37 Ice Cream Premises and Confectioners 202 446 Other food preparation premises 19 62 Totals 1,377 5,273 Vending Machines The use of automatic vending machines for food distribution has increased rapidly in recent years. Machines are being installed in a wide variety of premises and surroundings, often under conditions not conducive to the maintenance of satisfactory hygiene standards. The publication of No. 7 in the series "Food Hygiene Codes of Practice", produced by the Ministry of Health and the Ministry of Agriculture, Fisheries and Food, dealing with hygiene in the operation of food vending machines was most welcome; the recommendations it contains have been brought to the attention of all those responsible for such equipment. Bacteriological Examination of Food Investigation of unsatisfactory bacterial counts often reveals malpractices not evident during normal routine inspections. Bacteriological Results of Food Samples The fact that 66 % of the samples submitted were regarded as having unnecessarily high bacterial counts again illustrates that there is a considerable need for improvement in the standard of food handling. This type of sampling has been particularly useful in demonstrating the dangers associated with the unrefrigerated display of cooked meat and also in illustrating the contamination which can result from the use of equipment which has been ineffectively cleansed. Investigations into a food poisoning outbreak at a school caused suspicion to fall on supplies of raw boneless meat. Bacterial contamination was found to be generally very heavy, and the presence of pathogens was demonstrated. (The outbreak is described on page 20). The results obtained were used as an object lesson in talks to food handlers to illustrate the importance of the correct handling of raw food supplies. Pre-packed minced meat found to have a very high bacterial count revealed inadequate hygiene measures at the premises concerned, and Salmonella isangi was isolated from pre-packed steak and kidney. 93 Environmental Health Food No. of Samples Submitted Satisfactory Unsatisfactory Suspicious Bean Shoots 1 1 Cooked Chicken 12 6 5 1 Cooked Ham 37 26 11 – Cooked Meat 8 6 2 – Egg Noodles 5 2 3 – Frozen Meals 4 4 — – Meat Pies 2 2 — – Prawns (frozen) 5 3 1 1 Raw Chicken 1 — — 1 Raw Meat 24 8 15 1 Sausages 3 2 1 – Other Food 12 9 2 1 Totals 114 68 41 5 Bacteriological Assessment of Hygiene During the year the agar sausage technique was introduced. It was used at food premises where the cleansing routine was felt to be unsatisfactory. Briefly, the method involves the use of an agar-filled plastic casing. The end of the casing is cut off and the exposed agar surface is used to take an impression from the surface to be tested, e.g., work-top, equipment or utensil. The slice of agar is then removed and placed in a petri dish for incubation. The number of colonies developing provides an indication as to the state of cleanliness in a form which can be readily appreciated by the staff concerned. Departmental Laboratory The appointment of a Technical Assistant for duties in the departmental laboratory, and for assisting with the work associated with food control, has proved invaluable. A portable ultra-violet light has been purchased and is proving an effective means of demonstrating contaminated surfaces, etc. It was particularly beneficial when used for demonstration purposes during food hygiene talks. Health Education Education of the food handler in hygienic methods and practices is a continuing process and is effected by the inspector during his routine inspection of food premises, by his contacts with management and staff, discussions of sample results, and in many other ways. Food premises are also kept supplied with the various posters relating to matters of food hygiene. During the year 19 talks on food hygiene were given by inspectors to a total of 560 people. The talks were given to staff of the School Meals Service, Health and Welfare establishments, food shops, hospitals and to domestic science students. The window in Uxbridge High Street used by the Department for display purposes was, for one month, devoted to food poisoning and its prevention—a subject which at the time was particularly topical. Displays relating to the work of the public health inspector in connection with the control of food and food hygiene also featured in the "Welcome to Citizenship" Exhibition and the Civic Stand at the Borough Show. SECTION VII Report of the Principal School Medical Officer for the year 1967 Report of the Principal School Medical Officer for the Year 1967 97 THE SCHOOL HEALTH SERVICE The medical inspection of pupils was carried out in a similar manner to that in the previous year, and a full account of the procedures adopted was given in the Annual Report for 1965. 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 1963 and later 49 49 1 1962 1,144 1,143 1 77 1961 1,830 1,828 2 131 1960 282 282 — 21 1959 167 165 2 15 1958 167 166 1 14 1957 500 498 2 49 1956 1,369 1,365 4 83 1955 806 805 1 55 1954 263 260 3 16 1953 1,404 1,398 6 60 1952 and earlier 1,513 1,511 2 61 TOTALS 9,494 9,470 24 583 Percentage of children inspected with satisfactory physical condition 99.74 Percentage of children inspected with unsatisfactory physical condition 0.26 Percentage of children inspected who were found to require treatment 6.14 Percentage of children inspected who were found to require treatment (excluding vision defects) 4.24 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). 98 Report of the Principal School Medical Officer for the Year 1967 Defect Code No. (1) Defect or Disease (2) Periodic Inspections Special Inspection Entrants Leavers Others Total 4 Skin T 5 2 29 36 22 O 6 3 8 17 16 5 Eyes (a) Vision T 45 36 99 180 206 O 270 50 176 496 217 (b) Squint T 1 1 1 3 4 O 1 — — 1 2 (c) Other T 2 — 1 3 1 O 1 1 2 4 3 6 Ears (a) Hearing T 96 20 51 167 266 O 59 1 17 77 272 (b) Otitis Media T 3 — 2 5 3 O 3 — 2 5 3 (c) Other T 6 I 2 9 7 O 3 — 3 6 22 7 Nose and Throat T 7 1 4 12 14 O 75 6 23 104 60 8 Speech T 25 3 10 38 79 O 69 5 7 81 52 9 Lymphatic Glands T 1 — — 1 — O 13 — 2 15 2 10 Heart T 2 1 1 4 3 O 18 4 10 32 28 11 Lungs T 3 — 3 6 7 O 43 3 14 60 65 99 Report of the Principal School Medical Officer for the Year 1967 Defect Code No. (1) Defect or Disease (2) Periodic Inspections Special Inspection Entrants Leavers Others Total 12 Developmental (a) Hernia T — — 1 1 2 O 4 — 2 6 1 (b) Other T 6 — 10 16 8 O 24 5 25 54 25 13 Orthopaedic (a) Posture T 1 1 4 6 6 O 12 13 30 55 4 (b) Feet T 10 13 28 51 109 O 41 11 37 89 108 (c) Other T 3 — 6 9 6 O 4 3 11 18 11 14 Nervous System (a) Epilepsy T — — 1 1 — O 2 1 5 8 7 (b) Other T — 1 — 1 7 O 6 1 5 12 28 15 Psychological (a) Development T 2 — — 2 9 O 7 3 11 21 31 (b) Stability T — — 6 6 8 O 21 2 13 36 81 16 Abdomen T 2 — 1 3 1 O 5 — 6 11 3 17 Other T 9 8 15 32 24 O 72 19 51 142 185 100 Report of the Principal School Medical Officer for the Year 1967 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: 6,492. 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 4th Friday 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 Last 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 101 Report of the Principal School Medical Officer for the Year 1967 Premises School Health Sessions isation / 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 2nd, 4th and 5th Friday 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 Errors of refraction (including squint) 19 1,352 1,371 Number of pupils for whom spectacles were prescribed 731 Orthopaedic and Postural Defects Number known to have been treated Pupils treated at clinics or outpatients departments 92 102 Report of the Principal School Medical Officer for the Year 1967 Child Guidance Treatment Number known to have been treated Pupils treated at Child Guidance Clinics 214 Speech Therapy Number known to have been treated Pupils treated by speech therapists 328 Infestation Total number treated Pupils found to be infested and subsequently treated 100 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 17 Pupils who received B.C.G. Vaccinations 1,902 Routine Audiometry The routine audiometry service was continued as in the previous year with the audiometer operator working on a part-time basis of three days a week. The investigations were continued in the junior and infant departments of primary schools, and the results of the work performed can be summarised as follows: Number of individual children tested 6,546 Number found to have normal hearing 6,193 Number found to have a hearing loss 353 Report of the Principal School Medical Officer for the Year 1967 103 Of the 353 children found to have a hearing loss: 77 were found to have a hearing loss in the right ear; 96 were found to have a hearing loss in the left ear; 180 were found to have a hearing loss in both ears. The 353 children were referred for examination by the assistant medical officers with the following results: 97 were found to have normal hearing on clinical testing, 188 were noted for re-examination, 8 were referred for specialist consultation at Ear, Nose and Throat Departments, 24 were referred to general practitioners, 9 were referred to Audiology Units, 17 were already attending hospital, 1 was already attending an Audiology Unit, 9 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 3,998 Number referred for the opinion of school medical officer 172 Of these: 53 were referred to the Authority's ophthalmic clinics, 32 were referred for treatment via general practitioners, at the request of parents, 37 were deferred for re-examination at school health clinics, 22 were considered to have normal vision, 20 were already having ophthalmic treatment, 8 left the area while investigations were proceeding. Of the 53 children referred to the Authority's ophthalmic clinics: 44 were prescribed glasses, 9 were noted for re-examination. ORTHOPTIC CLINIC During 1967 the orthoptic service was continued to a more consistent pattern. The number of new patients fell by 22, follow-up attendances for tests and observation increased by 16, and a total of 29 patients were discharged. Seven were transferred to other areas due to family removals. 104 Report of the Principal School Medical Officer for the Year 1967 Monthly Attendance Record—Orthoptic Clinic 1967 New Patients Attending for Exercises Attending for test and / or Observation Total Failed to Attend January 7 2 59 68 17 February 4 9 40 53 10 March 7 17 34 58 15 April 1 9 41 51 29 May 4 8 37 49 18 June 5 10 35 50 8 July 2 7 16 35 7 August 5 25 48 78 33 September 6 13 29 48 22 October 6 5 31 42 7 November 2 12 35 49 22 December 5 10 27 42 12 TOTALS 54 134 436 624 201 New Patients 1967 Type of Case Convergent strabismus Including: (1) With amblyopia (2) Referred for surgery TOTAL Divergent strabismus (1) Latent (2 post-operative) (2) Manifest, referred for surgery TOTAL 16 6 33 13 1 14 Type of Case Heterophoria and I or convergence deficiency 3 Amblyopia due to Anisometropia 2 Apparent Squint due to epicanthus, narrow I.P.D., etc 2 Total New Patients Referred from School Clinics 54 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 Report for 1965. Handicapped Pupils—Indicative Trends Category A—Blind Fortunately, there are very few blind children, and for many years the total figure of blind pupils in this borough has not exceeded 5. Report of the Principal School Medical Officer for the Year 1967 105 Category B—Partially Sighted Here again, the figure is not very great and there has been little variation over the years. Unfortunately, the nearest day school for partially sighted pupils is at Hammersmith (the John Aird School) and I understand that there is now great pressure on places at this particular school. I feel that a reappraisal of the provision for partially sighted pupils should be made on the basis of the Greater London area as a whole. Categories C—Deaf, and D—Partially Hearing With the facilities available through the routine audiometry scheme, and the excellent provision made at the Heston Hearing Clinic, I feel that all those children with a serious hearing defect are known. The figures have not varied greatly over the years. Category E—Educationally Subnormal There is little doubt that there are many educationally subnormal children who are accommodated in ordinary schools, but these will be offered more suitable provision with the opening of the new Hedgewood School and the facilities already offered at the Meadow School, which has been functioning now for two years. As one can see from the figures available for previous years, there has been a gradual increase in the number of children ascertained as educationally subnormal and needing education in special schools. Category F—Epileptic In view of the excellent co-operation with the hospitals I think that most of those children with epilepsy are known. There has been little variation in the figures over the years, and in fact most of these children attend ordinary schools. Category G—Maladjusted There has been no great variation in the figures for the past three years, but one feels that there will be an increase in the number of ascertained maladjusted pupils when further provision is available for them. As I stated in the 1965 Report, there is a small number of children who show severe mental illness, especially in the age group 12 to 16. There is an urgent need in the London area for a hospital unit which will cater for in-patient treatment of these children. They are neither suitable for the paediatric department of a general hospital, nor should they be placed in the adult wards of a mental hospital. This type of problem does not occur very often, fortunately, but when it does it is a serious one which taxes the resources of the medical and education departments to the utmost; in fact, the solution is usually a very inadequate compromise, almost always to the child's disadvantage. Category H—Physically Handicapped The facilities for the physically handicapped child are good, with the co-operation of the Martindale School at Hounslow and our own St. Michael's School for Physically Handicapped Pupils at Eastcote. The figures have been fairly constant for the past three years, but there are times when there are pressures for places at the two schools mentioned. Category I—Speech Defect Most of these children are receiving speech therapy at local clinics whilst attending ordinary schools. The figures are dependent on the number of therapists available, and during 1967 there were three full time therapists. Consequently, the numbers attending for treatment tend to be high. Category J—Delicate This is the residual category, and most of these children are accommodated in ordinary schools, being excused physical activities or allowed to go at their own pace. The figures have varied little during the past three years. Children With Multiple Defects The problem of the child suffering from multiple handicaps is an increasing one, and there is a grave shortage of suitable educational facilities for these children throughout the country. 106 Report of the Principal School Medical Officer for the Year 1967 HANDICAPPED PUPILS REGISTER FOR 1967 Category Number of Children Placed in Total New Cases Referred to Local Education Authority during 1967 Day Special Schools Day Special Classes Residential Special Schools Ordinary Schools Home Tuition etc. Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls A Blind 2 1 _ – 2 1 2 – B Partially Sighted 5 2 – — 3 1 2 1 10 4 3 1 C Deaf 4 3 – 1 4 2 8 6 1 1 D Partially Hearing 1 2 7 5 2 1 17 10 27 18 3 2 E Educationally Sub-normal 82 53 2 – 5 5 12 11 101 69 18 13 F Epileptic — — — — 2 16 9 18 9 8 3 G Maladjusted 20 2 15 4 30 15 16 6 81 27 14 5 H Physically Handicapped 19 15 — — 2 60 41 81 56 8 10 I Speech Defect — — — — 1 — 162 70 163 70 78 29 J Delicate 3 2 — 9 5 103 69 115 76 22 20 Children with Multiple Defects 7 1 2 5 14 5 14 7 37 18 6 1 TOTALS 141 80 26 15 74 35 394 220 635 350 163 85 The following table gives an indication of the number of children between 5 and 15 years of age who have been reported to the Local Health Authority in accordance with Section 57 of the Education Act, 1944, during the past few years, together with those who are in the informal care of the Local Health Authority. During 1967 8 children (6 boys and 2 girls) were referred under Section 57. Year of Birth NORMAL ENVIRONMENT HOSPITAL CASES INFORMAL FOSTER CARE CASES GRAND TOTAL 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 1963 7 8 – – – – – – – – 7 8 1962 — — 4 7 – – 1 1 1 – 1 1 7 9 1961 1 — 3 4 1 – – – – – – – 5 4 1960 1 3 4 4 1 1 1 1 8 8 1959 8 – – – – – – – – – – – 8 1958 5 1 – – – – – – – – – – 6 1 1957 3 5 — — 2 – 5 5 1956 6 3 1 — 2 2 1 – – – – – 10 5 1955 2 1 — — — 1 1 2 3 1954 6 1 – – 3 – – – – – – – 9 1 1953 1 6 2 — 4 – – – – – – – 7 6 TOTALS 33 20 21 23 14 3 3 1 2 2 1 1 74 50 Report of the Principal School Medical Officer for the Year 1967 107 CHILDREN WITH SPECIAL MEDICAL AND EDUCATIONAL PROBLEMS Mention has been made in previous reports of the duty of the Local Education Authority to ascertain which children in its area require special education. In the main, children present with a single handicap which can be dealt with either by arranging special facilities in the ordinary school or providing, if the numbers warrant this, a special class or school. Children with defined handicaps such as partial sight, partial hearing, delicate, epilepsy and certain minor physical handicaps may often be kept in an ordinary school, providing certain precautions are taken or suitable arrangements made, and the disability is not gross. Educationally subnormal children are sufficiently numerous to be grouped into special classes or given a special school. There remains a small but important group of children who present with multiple handicaps, and these do not always fit into the educational facilities available. Many of these children derive their handicaps from congenital causes. A pregnant woman who contracts German measles or certain other virus infections during the first three months of her pregnancy could possibly produce a child who might suffer from partial or complete hearing loss, poor vision, mental retardation, microcephaly, or heart disease, or any combination of these handicaps. The decision which must be made is how to fit the individual child into the special educational facilities available and this decision depends upon many factors, not least of which is what facilities the Authority has to offer. If mental defect is the outstanding feature, clearly the training must be consistent with the child's mental ability. If the child is able to benefit from education, then the decision must be based on the child's capability in visual, auditory, and physical areas. For example, sub classes usually can be provided in partially hearing classes for children who are also partially sighted, or partially hearing children with limited academic ability can be dealt with in a school for educationally subnormal children. Where more than two handicaps occur in a child, the decision becomes more difficult. Many of these children are referred to the school medical officers in the early months of life; accurate assessment can only be achieved by the accumulation of evidence in the following years from parents, health visitors, family doctors, consultants in the various fields of medicine, educational psychologists, education officers, teachers, etc., and from this data a provisional plan prepared for the child's entry into formal education at the appropriate age. Advances in paediatric medicine and surgery are also posing problems for the School Medical Officer. The treatment of spina bifida is an example. This condition is a developmental abnormality of the spinal cord which frequently results in failure of the vertebrae to develop completely and close over the cord. There is thus a protrusion of the coverings of the spinal cord through the vertebral arch, and as these then lie immediately beneath the skin, the spinal cord is extremely vulnerable. The majority of these children are affected in the lower part of the spine, with damage to the spinal cord and often paralysis in the lower limbs and bladder. In the absence of surgical treatment, a number of children would develop increasing cerebro-spinal fluid pressure, resulting in the condition known as hydrocephalus; and, since the growing brain is the part under greatest stress, the mental ability of the child deteriorates rapidly due to thinning and destruction of brain tissue. Surgeons can now overcome this problem by inserting a drainage tube incorporating a valve into one of the ventricles of the brain and allowing the excess fluid to escape into the blood stream via a vein. The child's mental powers are preserved, although he may be left with weakness or paralysis of his lower limbs and lack of function and bladder control. The increasing number of children being saved in this way is bound to increase the number of places required in schools for the physically handicapped. A considerable part of the child's time in a school for physically handicapped children is spent in physiotherapy and training in the use of aids to walking and movement, and preserving or increasing the power to use groups of muscles. Apart from those with spina bifida, children suffering from cerebral palsy, in all its varied forms, muscular dystrophy and polio paralysis—now, happily, becoming a rarity—all need close and expert supervision of medical and teaching personnel. Since the classes are small by comparison with ordinary schools, the teachers are able to devote more time to individuals, and educational time is therefore not lost. It is fortunate that there is a school for physically handicapped children in the borough, but the indications are that the school will need to be expanded if we are to care for all the physically handicapped children who will need special education in future. 108 Report of the Principal School Medical Officer for the Year 1967 Recuperative Holidays In accordance with the provisions of Section 48 of the Education Act, 1944, arrangements were made for 9 boys and 8 girls to have a recuperative holiday free of charge. In addition, 2 diabetic girls had a holiday provided through the Diabetic Association and 2 epileptic boys and 1 girl had a holiday provided through the Epileptic Association. Tuberculosis Occurring in Teachers and Pupils A teacher at a secondary school had come to this country from Canada, where her chest had been X-rayed at annual intervals until 1965. In 1967 she decided to return to Canada, and thus she had a chest X-ray in a routine manner. This X-ray showed evidence of a tuberculous lesion, but no cavity was present. During the time that the teacher was in this country her general condition had remained good, and she denied any chest symptom of significance. The Chest Physician recommended that the appropriate school contact investigation should be carried out. This was done with perfectly satisfactory results. During the year, three schoolchildren were notified as cases of pulmonary tuberculosis. In each case, the source of infection was known, and I was advised by the Chest Physician that epidemiological investigation in schools was not necessary. Enuresis Alarm Apparatus During the year the number of enuresis alarms in general use was increased to 46, and this made it possible to make 121 separate issues during 1967. A particular advantage of having a sufficient number of alarms is that it enables a replacement issue to be made at once when a set is returned for repair, thus allowing continuity of treatment. During the year 47 successful results were recorded, and after sustained use it was regretted that in 21 cases it had to be accepted that the result was not successful. In other cases treatment was still in progress at the end of the year, but there were a few instances where the system had not been given a fair trial or where the child was found to be afraid of the apparatus. School Dental Service The shortage of dental officers continued throughout the year. Repeated advertisements were placed in the British Dental Journal and other professional publications without response. It would appear that the application of the Whitley Agreement is too rigid and additional incentives should be introduced if more dental surgeons of suitable calibre are to be encouraged to enter the Public Dental Service. During 1967 there was a fall in the total work done compared with the previous year. Of the 19,597 children examined, 35.6% were found to require treatment. There is no doubt that more and more children are receiving regular dental treatment through the various services available, including, of course, their private dental practitioners. In all 6,066 children were treated at the clinics and 4,674 had had their treatment completed; in other words, were made dentally fit. The interesting feature was the ratio of fillings to extractions in the various age groups. Age Groups 5-9 years 38:1 permanent dentition 3:1 deciduous dentition Age Groups 10-14 years 21:1 permanent dentition 1:1.3 deciduous dentition Age Group 15 Plus 13:1 permanent dentition Extractions for orthodontic reasons have been ignored. These figures show the importance of regular visits and the high proportion of patients who are receiving conservative treatment. Staff shortage necessitated curtailing the number of schools inspected, Report of the Principal School Medical Officer for the Year 1967 109 and fewer treatment sessions were undertaken during the year. The total number of treatment sessions was, at 2,677, a considerable fall from 1966. Treatment sessions include the special 'gas' sessions held at each clinic approximately once a month. In addition to treatment of children attending primary and secondary schools, handicapped pupils were seen as and when the necessity arose. The Special School at Henley was visited by a member of the staff. It was very difficult to deal with special cases, i.e. children with toothache and/or injury to the teeth. Where no dentist was in attendance at the clinic these children were seen at the nearest available clinic. In many cases unfortunately quite long journeys were involved. This position has remained unchanged for a very long time. Orthodontics continue to play a vital part in the Dental Service. Two part-time dental surgeons undertake this important work. All patients proceeding to orthodontic treatment are referred by the dental surgeons, and 553 cases came under care during the year. Of this number, 120 were completed or transferred to other centres because of change of address. SCHOOL DENTAL SERVICE STATISTICS Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total Attendances and Treatment First visit 3,303 2,347 416 6,066 Subsequent visits 5,281 5,565 1,032 11,878 Total visits 8,584 7,912 1,448 17,944 Additional courses of treatment commenced 75 65 38 178 Fillings in permanent teeth 2,480 5,168 1,298 8,946 Fillings in deciduous teeth 6,629 444 — 7,073 Permanent teeth filled 2,219 4,386 1,050 7,655 Deciduous teeth filled 4,964 362 — 5,326 Permanent teeth extracted 116 524 151 791 Deciduous teeth extracted 2,241 596 — 2,837 General anaesthetics 800 194 20 1,014 Emergencies 341 130 21 492 Number of Pupils X-rayed 540 Prophylaxis 453 Teeth otherwise conserved 163 Number of teeth root filled 54 Inlays 27 Crowns 91 Courses of treatment completed 4,674 Orthodontics Cases remaining from previous year 360 New cases commenced during year 193 Cases completed during year 87 Cases discontinued during year 33 Number of removable appliances fitted 359 Number of fixed appliances fitted 10 Pupils referred to Hospital Consultant 41 110 Report of the Principal School Medical Officer for the Year 1967 Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total Prosthetics Pupils supplied with full upper or full lower (first time) 1 1 Pupils supplied with other dentures (first time) 8 12 4 24 Number of dentures supplied 9 12 4 25 Inspections First inspection at school. Number of pupils 17,022 First inspection at clinic. Number of pupils 2,575 Number found to require treatment ... 6,995 Number offered treatment 6,761 Pupils re-inspected at school or clinic 727 Number found to require treatment 496 Anaesthetics General anaesthetics administered by dental officers 301 Total general anaesthetics 1,014 Sessions Number of sessions devoted to treatment 2,677 Number of sessions devoted to inspection 165 Index Accidents 67 Adaptations 46 Adult Training Centres 53 Aged, Welfare of 43-45 Aids 46 Aircraft Emergencies 24 Aliens, Medical Inspection of 22 Animals, Diseases of Act, 1950 87 Slaughter of Acts, 1933-1958 87 Ante-natal Clinics 28 Atmospheric Pollution, Measurement of 82 Audiometry, Routine in Schools 102 - 103 Bacteriological Examination of Food 92-93 Births 11, 14 - 16 Blind, Welfare of 48-50 Bourne Hostel 53 Burials and Cremations 50 Cancer, Deaths from 18 Caravan Sites 79 Car Badges 47 Cervical Cytology Service 61-62 Chief Public Health Inspector, Report of 67-93 Chief Welfare Officer, Report of 43-50 Child Guidance 102 Chiropody 39-40 Classes for Handicapped Persons 47 Clean Air 80-82 Clearance Areas 77, 78 Clinics 27,28 Clubs for the Blind 49 Community Care 43-55 Condemned Food, Disposal of 87 Day Nurseries 27 Deaths — All Causes 13 — Cause of, Statistics 19 — Infant — Maternal 12 Defects Found at School Medical Inspection 97-99 Dental Service — Priority 30, 31 — School 108-110 Diseases of Animals Act, 1950 87 Disrepair, Certificates of 79 Diphtheria Immunisation 36 Education Act, 1944 104 Emergencies, Peace Time 50 Enuresis Alarm Apparatus 108 Environmental Health 67-93 Factories Act 67-69 Fertilizers and Feeding Stuffs Act 69 Food and Drugs, Sampling of 88-90 Food — Complaints 90 — Hygiene 91 — Inspection at London (Heathrow) Airport 71 — Poisoning 20 — Premises, Inspection of 91, 92 — Unsound 87 Index 113 Grit, Dust and Effluvia, Measurement of ... 82 Gypsies 79 Handcraft Classes 47 Handicapped Pupils Register 106 Hayes Park Hostel 55 Health Committee, Members of 5 Health Control Unit, Heathrow Airport 20-24 Health Education 93 Health Visiting 31-34 Heathrow — Health Control Unit 20-24 Highgrove House 45 Hillingdon Junior Training Centre 53 Holidays, Recuperative 40 Holidays, Children's Recuperative 108 Holidays for the Handicapped 47 Homeless Families 45,46 Home Help Service 39 Home Nursing 34, 35 Homes for the Aged 43, 44 Hostels — for the Homeless 45, 46 — for the Mentally 111 55 — for Subnormal Adults 53 Housing — Allocation, Medical Grounds 59 — Clearance Areas 77, 78 — Improvement Areas, Repair, Demolition, Closure and Clearance 75-78 — Multiple Occupation 78, 79 — Unfit Houses 77 Ice Cream 84 Immigrants, Commonwealth 23 Immunisation — Diphtheria 36 — Measles 37 — Poliomyelitis 36 — Smallpox 37 — Statistics 38 Improvement Areas 75, 76 Improvement Grants 75, 76 Infant Deaths 12 Infestation 102 Infant Mortality 17, 18 Infectious Diseases 20 Inspection of Food Premises 91,92 Introduction 3,4 Junior Training Centre 53 Liquid Egg Regulations, 1963 75 Live Births 14 Massage and Special Treatment 60 Mass X-ray Unit 59, 60 Maternal and Child Health 28, 29 Mead House 45 Measles Vaccination 37 Meat, Inspection of 85 Medical Examination of Staff 60 Medical Inspection, School 97 Mental Health 53-55 Mental Illness, Statistics 54 Mental Welfare Officers, Work of 54, 55 114 Index Midwifery Service 31 Milk and Dairies Regulations 82 Moorcroft Weekly Boarding Unit 53 Mortuary 61 Mothercraft 29 Multiple Births 15 Multiple Occupation 78,79 Noise Abatement Act, 1960 69 Nurseries and Child Minders, Registration of 61 Nursing Agencies and Nursing Homes 61 Nursing (see Home Nursing) 34, 35 Observation Register 35 Offices, Shops and Railway Premises Act, 1963 70, 71 Orthodontics 109 Orthoptic Clinic 103, 104 Outworkers, Statistics 69 Peace Time Emergencies 50 Personal Health Services 27-40 Physically Handicapped, Welfare of 46, 47 Poliomyelitis Immunisation 36 Port Health, Heathrow Airport 21 Port Sanitary Administration, Heathrow 71-73 Post-natal Clinics 28 Poultry Inspection 86 Priority Dental Service 30, 31 Protection of Property 50 Pulmonary Tuberculosis 39 Radio Sets for the Blind 49 Recuperative Holidays 40 Registrar General, Comparability Factor 13 Relaxation 29 Residential Homes for the Aged 43-45 Rodent Control 73 Salmonellae Investigation 88 Sampling of Food and Drugs 88 School Clinics and Sessions 100 School Dental Service 108-110 School Health Service 97-110 Section 57 Cases — Statistics 106 Short-Stay Admissions 44 Slaughterhouses 85,86 Smallpox Vaccination 37 Smoke Control Areas 80 Smoke and Sulphur Dioxide, Statistics 80,81 Speech Therapy 102 Staff of the Department 6, 7 Staff, Medical Examination of 60 Statistics 11-20 Stillbirths 11, 16 Subnormal Persons, Care of 53 Swimming Pools 73 Training Centres, Junior and Adult 53 Treatment of School Children 101, 102 Tuberculosis, Care and After-Care 39 Tuberculosis Occurring in Teachers and Pupils 108 Unsound Food 87 Unsupported Mothers, Care of 29 Uxbridge Adult Training Centre 53 Vaccination Against Smallpox 37 Vaccination, Heathrow Airport 21 Vaccination Against Measles 37 Vending Machines 92 Venereal Diseases 63 Vision Testing 103 Water — Aircraft Drinking 73 — Public Supplies 73, 74 Watercress 88 Welfare of the Aged 43-45 Welfare of the Blind 48-50 Welfare Committee, Members of 5 Welfare of the Physically Handicapped 46, 47 Well Women's Clinics 61-62 Work Centre for the Physically Handicapped 47 Workshop, Old People's 45 X-ray, Mass Survey 59, 60 X-ray Unit, Heathrow Airport 24