The Health Services of Hounslow 1970 Hou LONDON BOROUGH OF HOUNSLOW Annual Report 1970 of the Medical Officer of Health and Principal School Medical Officer Robert L. Lindon MRCS LRCP DPH DCH Department of Health 92 Bath Road Hounslow Middlesex. Telephone: 01-570-7715. Con tents 3 Members of Committees 7 Staff 14 Preface 17 Building Projects 19 Summary of General and Vital Statistics 22 Infectious Diseases 24 Vaccination and Immunisation Health Services Provided by Other Authorities 25 Hospital Service -North West Metropolitan Regional Hospital Board South West Metropolitan Regional Hospital Board 27 Family Doctors -Middlesex Executive Council 27 Ambulance Service -Greater London Council Health Services Provided by the Local Authority 27 Health Centres 29 Midwifery 29 Health Visiting 31 Home Nursing 32 Home Help and Neighbourly Help 32 Prevention of illness, Care and After Care 37 Maternal and Child Health 47 School Health 77 Student Health 79 School Dental 81 Occupational Health 83 Mental Health 91 Environmental Health Genera I 106 Statistical Tables 128 Clinic and other Premises 132 Index 2 Members of the Health Committee 1970-71 His Worship the Mayor Councillor NV Wright ARSH (ex-Officio) Chairman Councillor GAM Greenland JP FCII Vice-Chairman Alderman AC Gurrin FSVA Alderman Mrs EWW Basley Alderman P Betlem Alderman EJ Kenward FACCA MIOM MREconS Councillor Mrs EM Boxall Councillor AF Brazier Councillor WE Gamble Councillor CJ Gray Councillor Mrs L Harvey Councillor VE Hopkins Councillor Mrs J Horley Councillor Mrs VD Marks Councillor T Perkins Councillor BA Williams MPS 3 Members of the Health (Special Purposes) Sub -Committee 1970-71 His Worship the Mayor Councillor NV Wright ARSH (ex-officio) Chairman Councillor GAM Greenland JP FCII Vice-Chairman Alderman AC Gurrin FSVA Alderman Mrs EWW Basley Alderman EJ Kenward FACCA MIOM MREconS Councillor Mrs EM Boxall Councillor VE Hopkins Councillor Mrs VD Marks Councillor BA Williams MPS 4 Members of the Education Committee 1970/71 His Worship the Mayor of the London Borough of Hounslow Councillor NV Wright ARSH (ex-officio) Chairman Councillor D F Ryan BSc Vice-Chaiman Councillor CA Pocock JP MA Alderman Mrs EWW Basley Alderman P Betlem Alderman FJ Jansen JP MlnstM MBIM Alderman AG King JP Alderman EJ Pauling MBE JP Councillor RL Avery Councillor AJA Beal Councillor Mrs EM Boxall Councillor Mrs M Canfield SRN SCM Councillor Mrs MC Downes Councillor E Elliott Councillor L Gainsborough Councillor WE Gamble Councillor CJ Gray Councillor Mrs L Harvey Councillor GE Henniker Councillor FHP Hobbs Councillor DG Magill JP Councillor Mrs VD Marks Councillor H Nixon Councillor RJ Padley Councillor Mrs MT Roebuck Councillor EG Shearer Councillor WJM Spencer Councillor Mrs GF Stinton Councillor MG Venn Councillor BA Williams MPS Councillor BO Wilson Non Council Members Mr KG Berger MA FIFST Mr GR Hawkes BA Professor AV Judges BA DSc FRHistS Miss FM Knowles Mrs KM Saunders MA Miss AN Sharrock BA AIMSW Mr JE White 5 Members of the Primary and Special Education Sub-Commi11ee 1970 -71 His Worship the Mayor of the London Borough of Hounsiow Councillor NV Wright ARSH (ex-officio) Chairman Councillor CA Pocock JP MA Vice-Chairman Councillor Mrs M Canfield SRN SCM Alderman Mrs EWW Basley Alderman EJ Pauling MBE JP Councillor Mrs EM Boxall Councillor E Elliott Councillor WE Gamble Councillor Mrs L Harvey Councillor GE Henniker Councillor FHP Hobbs Councillor DG Magill JP Councillor H Nixon Councillor Mrs MT Roebuck Councillor DF Ryan BSc Councillor Mrs GF Stinton Councillor BO Wilson Non Council Members Mr KG Berger MA FIFST Miss FM Knowles Mrs KM Saunders MA Miss AN Sharrock BA AIMSW 6 Staff of the Department of Health as at 31st December 1970 Staffing establishment Medical Officers 15 Medical Officer of Health and Principal School Medical Officer R L Lindon MRCS LRCP DPH DCH Deputy Medical Officer of Health and Deputy Principal School Medical Officer Megan E Wilkinson MB ChB DPH Principal Medical Officers PA Bennett MB ChB Elizabeth N Christie MB ChB DPH Anne M Jepson MB BS MRCS LRCP DPH DCH Senior Medical Officer Mrs GE Woods MD MB BS DPH DCH Occupational Health Physician AR Broadbent MRCS LRCP DPH DIH Senior Department Medical Officers RHG Charles MA MB BCh DCH Mrs R Prothero MD LRCP LRCS DCH Miss DP Richards MB BS DCH DPH Departmental Medical Officers Mrs HS Allinson BSc MB BCh Mrs LA Gellatly MB BChir MA M Osman IMBBS DCH LMSSA Consultants In conjunction with the Regional Hospital Boards Audiology Unit L Fisch MD DLO Cerebral Palsy Unit N J O'Doherty MD MRCP DCH Child Guidance Clinic WPK Calwell MB BS DPM Ophthalmic Clinics Miss HB Casey MB BCH DOMS J R Holmes MB BCL DOMS D Mishra MB BS 7 In conjunction with the Regional Hospital Boards Orthopaedic Clinics IJD Archibald LRCP LRCS LRFPS JA Cholmeley MB BS FRCS EA Devenish MS FRCS JM Kingsmill Moore FRCS Mental Health Service CF Herridge MA MB BCh DPM Chest Clinic R Heller MD Pathologist E Nassau MD Staffing Establishment Dental Officers and Orthodontists 12 Chief Dental Officer DH Norman BDS LDS RCS Deputy Chief Dental Officer Mrs GM Yates BDS Senior Dental Officers PA Jones BDS LDS Mrs MA Libbey LDS RCS Orthodontist S Levy BDS Dental Officers Miss FH Bowie BDS LDS Mrs ACR Crawford BDS LDS RCS SG Farrar LDS DA Friedman BDS PBV Hunter BDS AG Sharp LDS RFPS Miss EJ Terry LDS RCS Mrs REA Walters BDS Senior Psychologist for special 1 units and special schools Miss Moya C Tyson BA BSc(Econ) PhD Social Work Organiser 1 Adviser on Health Education E Heimler AAPSW 8 Staffing establishment Health Educator 1 W Duffy BSc FRSH DN RNT Physiotherapists 6 Superintendent Physiotherapist Mrs J Biddle MCSP SRP Speech Therapists 6 Senior Speech Therapist Mrs DE Cox LCST Social Workers (Special Duties) 3 Chief Nursing Officer Miss GE Brocklebank SRN HV CMB DIP SOC 1 Health Visitors and School Nurses 50 Principal Nursing Officer Health Visiting Mrs PJ Treleaven SRN SCM BTA HV Deputy Principal Nursing Officer Health Visiting Mrs M Hills SRN SCM HV Student Health Visitors 5 Home Nurses 38 Nursing Auxiliaries 4 Staff/Student Health Nurse Miss AM Griffin SRN OHNC Domiciliary Midwives 14 Principal Nursing Officer Midwifery and Home Nursing Miss SM Douet SRN SCM HV Deputy Principal Nursing Officer Midwifery and Home Nursing Mrs MA Booth SRN SCM HV BT A Public Health Inspectors 21 Technical Assistants 4 9 Staffing establishment Chief Public Health Inspector GE Hayne MAPHI MRSH Deputy Chief Public Health Inspector FV Bell MAPHI MRSH Public Analysts In conjunction with the Greater London Council WB Chapman BSc FRIC EHWJ Burden BSc FRIC MChemA Veterinary Inspector JA Morris MRCVS Pupil Public Health Inspectors 6 Rodent Officer 1 Rodent Operators/General Duties Assistants 8 Mortuary Attendant 1 Psychiatric Social Workers 3 Senior Psychiatric Social Worker Mrs A Lees BSc MHO Mental Health Social Workers 13 Chief Mental Health Social Worker PD Charles CSW Deputv Chief Mental Health Social Worker D Williams RMN CSW Junior Training Schools and Special Care Units Hanworth Senior Teacher 1 Mrs FR Williams NAMH Supervisor/Teachers 9 Welfare Assistants 2 General Duties Assistants 2 Coach Guides 2 Cook 1 Caretaker 1 Cleaner 1 10 Staffing establishment Isleworth Senior Teacher 1 Mrs MS Moodie NAMH Supervisor/Teachers 7 Welfare Assistants 2 General Duties Assistants 2 Coach Guide 1 Cook 1 Cleaner 1 Trainee Teachers for Junior Training 3 Schools Adult Training Centres Acton Lodge Manager 1 F Seaford Deputy Manager 1 Senior Instructors or Instructors 14 (Combined establishment with Brentford ATC) Cooks 2 Domestic Assistant 1 Coach Guides 2 Brentford Adult Training Centre Supervisor/Instructor 1 Senior Instructors or Instructors (Combined establishment with Acton Lodge ATC) Hostel for the Mentally Handicapped Warden 1 R Vincent RMNS Deputy Warden 1 Assistant Warden 1 Attendant 1 Medical Practitioner 1 Cooks 2 Domestic Assistants 2 Weekly Boarding Unit Resident Matron 1 Miss PE Hassall Resident Assistant Matron 1 Resident Cook/Attendant 1 Attendant 1 Night Attendant 1 Domestic Assi stant 1 11 Staffing establishment Hostel for the Mentally III Warden 1 H Marshall SEN Deputy Warden 1 Assistant Warden 1 Attendant 1 Medical Practitioner 1 Cooks 2 Domestic Assistants 2 Day Centre for the Elderly Mentally Confused Superintendent 1 Mrs H Kenneally SRMN Assistant Superintendent 1 Attendants 2 Driver/Attendant 1 Cook 1 Kitchen Hand 1 Cleaner 1 Coach Guide 1 Heston Long Term Home for Mentally Handicapped Children Resident Senior Housemother 1 Mrs PA Ramdhony SRN RNMS Housefather - part time 1 Resident Housemothers 2 Night Attendants 2 Attendant 1 Domestic Assistants 2 Hounslow Day Centre Sister in Charge 1 Mrs 01 McClennon SRN RMN Deputy Sister 1 Staff Nurse 1 Nurse SEN 1 Psychiatric Social Worker 1 Occupational Therapist 1 General Assistant 1 12 Staffing establishment Day Nurseries Matrons 3 Deputy Matrons 3 Wardens 3 Nursery Nurses 18 Nursery Students 14 Cooks 3 Domestic Assistants 7 Hounslow Chest Clinic Almoner In conjunction with the North West Clerk Metropolitan Regional Hospital Board Medical Auxiliaries etc. Psychotherapist 1 Dental Auxiliaries 2 Dental Surgery Assistants 16 Audiometricians 3 Chiropodists 3 Orthoptist 1 Occupational Therapist 1 Welfare Assistants 2 Welfare Officer 1 Clinic Attendants 5 Interpreter/Clinic Worker 1 Home Helps 169 Organiser 1 Miss D Claxton Assistant Organisers 5 Caretakers and Cleaners 12 Administrative and Clerical 86 Chief Administrative Officer JM Murphy Deputy Chief Administrative Officer JW Dean FSS Figures are equivalent full-time to the nearest whole number 13 To the Mayor, Aldermen and Councillors of the London Borough of Hounslow I have the honour to present the sixth Annual Report on the health of the people living in the London Borough of Hounslow and on the health services provided by the Borough Council as local health authority Immediately following this preface is a table showing building projects in various stages of completion and those planned for the future During 1970 four projects have been completed and these include the attractive Maswell Park health centre and the equally pleasing long term home for mentally handicapped children at Heston It is particularly gratifying to see a start being made on the new Nantlv House day nursery in Lampton Road Baroness Serota as Minister of State for Health Services paid an informal visit on 4th May 1970 to see a variety of the health services provided by the Borough Council, Such visits by those responsible for policy in relation to the probabie reorganisation of our health services are of interest to all concerned and encourage those of us who work locally to feel that our local interests and services are the more clearly understood Last year ihe theme of my preface was the prevention of ill health in both the individual and the community as I felt this aspect should not be lost sight of at a time when ail energies and a plethora of reports seemed to be concentrating on bringing about drastic changes in our health and social services For the years immediately ahead it would seem that the greater part of the social services as currently understood will remain firmly within the local government remit wnereas the health services are now clearly to be managed outside local government but in a form which still remains to be decided Local government can however be proud of its fine record of achievement in the preventive field reaching back for many decades and indeed in some areas for well over a century There is much of interest written in this report by members of the many different disciplines that make up the staff of a health department One of the tasks of a preface is to highlight certain of these reports but it remains a dilemma to decide on which to comment as all aspects of health promotion and disease prevention if proven worthwhile are of importance The general and vital statistics relating to the Borough are summarised and commented on later but I would like to state here that illegitimate births were 32 fewer than last year and express the hope that this trend will continue This year the birth rate has dropped further below the national average but is still greater than the overall death rate It is saiutary to realise that there would have been a natural 3½ per cent increase in the population or the Borough in the last five years but for outward migration It is in all our interests to endeavour voluntarily to equate birth and death rates in the areas for which we are particularly responsible if by the summation of our efforts we are to avoid the unpleasantness of statutory population control in the not too distant future To this end we are redoubling our efforts to expand the family planning service in conjunction with out colleagues in hospital and general practice and have set in motion a domiciliary family planning scheme to help those who for various reasons find it difficult to attend a clinic In the preface of my 1969 report I mentioned the increasing incidence of venereal disease particularly in the younger age groups in the country as a whole The local incidence for a variety of reasons is not accurately available but if it mirrors the incidence in London as a whole it must be taken extremely seriously Since the inception of the Borough in 1965 there have been several joint consultations with the Consultant Venereologists concerned They have available the telephone numbers and the names of particular health visitors on the staff of this department with whom thev can make contact for help at any time The provision of health centres continues to be a prime task of local health authorities and in this field the Borough has been a pioneer The main purpose of health centres is to provide attractive and friendly surroundings for patients and a milieu where doctors health visitors home 14 nurses social workers and many others can get to know and trust one another and to provide an efficient and humane service to their patients and at the same time obtain for themselves the satisfaction of a job well done From a morale view point this satisfaction is so essential for those required daily to perform tasks for others Doctors and nurses practising outside hospitals are only now realising the mutual advantages both to their patients and to themselves resulting from attachment schemes and working together in health centres and in this context the report of the Chief Nursing Officer is of interest As she states the work of the nurses particularly in the treatment rooms is expanding at a considerable rate Health visitor and home nurse attachment schemes are increasing the quality and quantity of their work Further the additional need to cope with earlier discharge of patients from hospital will in due course require an increased establishment as indeed will the greatly needed provision for a night nursing service The domino scheme wherebv the Borough's district midwives conduct deliveries in hospital accommodation which in the past thev would have conducted in the patient's own home was successfulIy commenced during the year in conjunction with the West Middlesex Hospital This scheme is in line with modern thinking in that skilled help backed by modern medical facilities is well at hand not only from the family doctor but also from the specialist hospital staff The home help service maintained the high standards it has set itself over many vears in this area and gave during the vear a total of 275 821 hours of help and kindness to their clients many of whom might otherwise have not been able to remain in their own homes and familiar surroundings The report on the mental health service and the additional report by Mr P D Charles Chief Mental Health Social Worker shows a lively and enthusiastic service with very close links being forged with the hospital psychiatric service for the area The vast provision of day centres and hostels so generously provided by the Borough Council during the last six years is supported by the equally zealous joint efforts of the hospital and local authority medical nursing and social work staff The Chief Public Health inspector Mr G E Havne after his first full year with this department comments comprehensively on the many varied and complex tasks accomplished bv the public health inspectorate with an organisation and staff complement which has often been extended to its limits in order to keep up with the vast increase of work caused by the spate of new legislation in this field. The Joint Obstetric Child Health Project commenced in earnest early in the year with the generous support of a £42 000 grant from the Department of Health and Social Security This project is a combined effort on the part of the Institute of Child Health the West Middlesex Hospital and ourselves and together we have built up a research team Dr Anne Jepson Principal Medical Officer describes the research more fully in the bodv of this report A successful pilot research study into the incidence and other characteristics of infective hepatitis in the Borough has encouraged the research team composed of consultants from the West Middlesex and South Middlesex Hospitals and staff of this department to prepare a protocol to obtain a further research grant from the Department of Health and Social Security in order to mount a more comprehensive three year study over a larger geographical area backed by greater technological and computer facilities than were available in the pilot survey Considerable research into facilities for the care of the mentalIy subnormal have also been carried out in the Borough during the year in combination with a team financed by the King Edward Memorial Fund Research in this department named the Hounslow Project' in 1965 was brought to a conclusion after being generously supported by the Borough Council for five years This unique research by the Borough's health department enabled the development of a social function scale which attempts to provide a measurable predictive and therapeutic tool to complement the empirical subjective assessment of a client bv a social worker This scale and the 15 research behind its development is commented on more fully later in the report and we are gratified that a number of university departments including the University of Calgary in Canada and the University of Washington Seattle, are to continue its development and evaluation Interesting preliminary observations by Dr Moya Tyson Senior Psychologist to the special units and special schools on the research into language and other developmental processes of young children in the Borough which she carried out in conjunction with medical and speech therapy staff show that new useful knowledge in this field may soon be available The report on health education in the Borough s secondary schools is worth perusal because of the widespread interest created by the methods used and its enthusiastic acceptance to date by the pupils teachers and parents Work in the Assessment and Medical Advisory Unit for handicapped children at Martindale and at the Heston Hearing Clinic continues at a high standard and as can be seen from their reports the members of staff continue to evaluate their work and carry out original research in their constant endeavour to broaden knowledge into wavs of helping the handicapped to a fuller life The success of the health services in Hounslow is largely dependent on the combined efforts of family doctors hospital staff voluntary organisations and members of this department and I would like to place on record my thanks for the help we have received during the year in this department from all these sources and also many others too numerous to mention I would like to thank my Deputy Dr M E Wilkinson and Mr J M Murphy my Chief Administrative Officer for their very considerable support and also the chief and senior officers of the other departments in the Borough for the essential part they play in the provision of health services in Hounslow On behalf of the department I also wish to express my gratitude to the Chairmen and Members of committees for their support and 16 encouragement. Finally to the statt of the department I give my thanks for another year of sustained and loyal service. Robert.j.luiden Medical Officer of Health and Principal School Medical Officer Department of Health 92 Bath Road Hounslow Middx. Planned year Year Projects of completion Completed Building Projects from 1st April 1965 to 31st December 1969 Hostel for mentally disordered 24 Wood Lane Isleworth 1965/66 1965 Extension to Medical Advisory and Cerebral Palsy Unit Martindale School Hounslow 1966/67 1966 Heston Health Centre Cranford Lane Heston 1966/67 1966 Spring Road Health Centre Feltham 1967/68 1967 Adaptation of Brentford Clinic Albany Road Brentford to provide a Health Centre 1967/68 1967 Chiswick Town Hall - alteration for use as clinic and offices 1967/68 1967 Extension to Audiology Unit Heston School for the Deaf 1967/68 1967 Hanworth Junior Training School Main Street Hanworth 1967/68 1968 Extension to Feltham Clinic. Cardinal Road, Feltham 1967/68 1968 Extension to Hanworth Clinic Grove Crescent Hanworth 1967/68 1968 Weekly Boarding Unit for mentally handicapped children Main Street Hanworth 1968/69 1968 Day Centre for elderly mentally confused New Heston Road Heston (adaptation of clinic premises) 1968/69 1968 Extension to Acton Lodge Adult Training Centre London Road Brentford 1968/69 1968 Home Help Wash Centre 1968/69 1969 Hostel for mentally disordered Staines Road Bedfont 1969/70 1969 Cardinal Road Clinic Feltham - Dental Recovery and Waiting Rooms 1969/70 1969 Hounslow Health Centre - Extension to existing Local Health Authority Clinic and Administrative Offices 92 Bath Road Hounslow - Phase I - Family doctor and child psychiatric units 1969/70 1969 Building Projects from 1st January 1970 onwards Extension to Brentford Health Centre 1969/70 1970 Hounslow Health Centre - Extension Phase II - Mental health services including a day centre for the mentally ill also stores and flats for midwives and caretaker 1970/71 1970 Maswell Park Health Centre Hounslow Avenue Hounslow 1970/71 1970 Long Stay Home for mentally handicapped children New Heston Road Heston 1970/71 1970 Hounslow Day Nursery Lampton Road Hounslow 1971/72 17 Planned year Year Projects of completion Completed Building Projects - Committed Programme Cardinal Road Clinic Feltham - extension to provide a Health Centre 1971/72 Chiswick Health Centre 1972/73 Building Projects - Uncommitted Programme Hounslow Health Centre Phase III - Offices, communal dining and conference rooms and library Brentford Day Nursery - re-building Bedfont Clinic Imperial Road Bedfont - extension to provide a Health Centre Old Isleworth Health Centre Hanworth Clinic Grove Crescent Hanworth - extension to provide a Health Centre Chiswick Day Nursery Hounslow Heath Health Centre Bedfont Day Nursery Osterley Health Centre Heston Day Nursery South Chiswick Health Centre Isleworth Day Nursery Day Centre for the elderly mentally confused Heston - re-building Day Centre for the elderly mentally confused Isleworth/Chiswick area. 18 Summary of general and vital statistics relating to the London Borough of Hounslow Statistics for the area Area (including inland water) 14,469 acres Population - 1961 census 208,893 Population - Registrar General's estimate mid-1970 204,380 Persons per acre 14.1 Number of habitable premises (1st April 1970) 68,259 Number of new dwellings erected during the year 630 Rateable value (31st March 1970) £17,187,223 Product of a penny rate (estimated 1970/71) £70,457 Vital Statistics Live births Number 3,287 Crude rate per 1,000 population 16.1 Adjusted rate per 1.000 population 15.6 (England and Wales 16.0) Illegitimate live births Number 257 Per cent of total live births 8 0 (England and Wales 8.0) St illbirths Number 45 Rate per 1,000 live and stillbirths 14 0 (England and Wales 13 0) Total live and stillbirths 3,332 Infant mortality (deaths under 1 year) 65 Total infant deaths per 1,000 live births 20.0 (England and Wales 18.0) Legitimate infant deaths per 1,000 legitimate live births 19.0 (England and Wales 17 0) Illegitimate infant deaths per 1,000 illegitimate live births 27.0 (England and Wales 26 0) Neonatal mortality (deaths under four weeks) Number 45 Rate per 1,000 total live births 14.0 (England and Wales 12 0) Early neonatal mortality (deaths under one week) Number 38 Rate per 1,000 total live births 12.0 (England and Wales 1.0) 19 Perinatal mortality (stillbirths and death: under one week combined) Number Rate per 1,000 total live and stillbirths Maternal mortality (including abortion) Number Rate per 1,000 total live and stillbirths Deaths (total - all ages) Number Crude rate per 1,000 population Adjusted rate per 1,000 population 20 83 25 0 (England and Wales 23.0) - (England and Wales 0.2) 2,161 10.6 11 2 (England and Wales 11.7) Annual Report of the Medical Officer of Health for the year 1970 Vital Statistics Area and Population The London Borough of Hounslow covers an area of 14,469 acres and contains an estimated population of 204,380 people which is 4,513 fewer than those found during the 1961 census Although the population appears to be decreasing, there were 3,287 live births compared with 2,161 deaths giving a natural increase of 1.127 persons The research and intelligence unit of the Greater London Council provides estimated populations of all London boroughs by age groups and those for Hounslow are Apart from other causes, both birth and death rates will vary according to the age and sex distribution of the population and to enable a valid comparison with other areas the Registrar General provides area comparability factors When the birth comparability factor of 0 98 is applied the borough's live birth rate becomes 15 6 which is almost identical to that for England and Wales Compared with 1969 the rate for Hounslow decreased slightly and is similar to the experience for the whole country. There were 257 illegitimate live births, 32 fewer than last year which gives an illegitimate live birth rate of 8 per cent of total live births which is the same as that for England and Wales. Mid Age in years year Under 1 1 - 4 5 - 14 15 - 64 65 and over all ages No % No % NO % No % No. % No. 1968 3,350 1.6 13,150 6.4 26,500 12.9 137,580 66.8 25,200 12.3 205,580 1969 3,390 1.7 13,010 6.3 27,200 13.3 136,060 66.3 25,400 12.4 205,060 1970 3,230 1.6 12,870 6.3 27,900 13.7 134,980 66.0 25.400 12.4 204,380 Since the borough was formed in 1965 the number of live births has exceeded the number of deaths by 7,149 but despite this the Registrar General estimates that during the same period the local population has decreased by 3,170 which suggests a net outward migration of some 10,319 people to other areas The natural increase of 3½ percent occurring within five years is a local example, although not necessarily typical, of the slow but inexorable upward trend in the number of people in the country as a whole Live births The number of live births registered during the year was 3,287 (1,669 male and 1 618 female) giving a crude live birth rate of 16,1 per 1,000 population Stillbirths Stillbirths again numbered 45 which is equivalent to the mean for those during the previous five years Deaths During the year 2,161 deaths were registered, 106 fewer than for 1969 The adjusted death rate was 11.2 which is a little less than that for the whole country Included in the 1,097 total male deaths are 300 occurring between the ages of 45 and 64 early to late middle age Two thirds succumbed either to heart disease (112) or cancer (87) One hundred and eighty two women of this age group similarly died - again two thirds ascribed to cancer (82) or heart disease (39) These 482 men and women formed almost a 21 quarter of all deaths in Hounslow most of whom would otherwise still be gainfully employed', at home rearing a family and others looking forward to some years of retirement It is a sad reflection in this day and age of high levels of national and local taxation with so much being spent on the diagnostic and curative family doctor and hospital services together with the local authority preventive health services, that so many people should continue to be subject to what can only be regarded as premature death Infant Mortality Sixty five infants died before reaching the age of one year; 42 were male and 23 female. The infant mortality rate was 20 per 1,000 live births compared with a rate of 18 for the country as a whole The illegitimate infant mortality rate was 27 which is 1 per 1,000 more than for England and Wales. Maternal Mortality No deaths were ascribed to maternal causes, Infectious Diseases International certificates of vaccination and inoculation against smallpox, yellow fever and cholera Applications for authentication dealt with by the medical officer of health numbered 7,365 compared with 5,853 for 1969 and 4,949 during 1968 The number of corrected notifications of infectious diseases received during the year compared with previous years are summarised above. ]Disease 1970 1969 1968 Dysentery 7 40 109 Encephalitis, acute 2 3 1 Erysipelas - - 9 Food poisoning 15 29 12 Infective jaundice 61 51 29(a) Malaria 2 2 5 Measles 675 576 466 Meningitis acute 14 5 1 Paratyphoid fever 5 2 3 Pneumonia, acute - - 4 Puerperal pyrexia - - 36 Scarlet fever 50 51 105 T uberculosis pulmonary 71 59 66 non-pulmonary 21 24 22 Typhoid fever 5 2 1 Whooping cough 30 11 78 (a) from 15th June, 1968 The table on page gives the number of cases notified under age groups. SmalI pox There were 34 referrals for supervision of possible smallpox contacts who had arrived in this country from locally infected or declared endemic smallpox areas and who were reported to be proceeding to addresses in Hounslow All these were visited and kept under surveillance for the required period Cholera With effect from 18th September, 1970 anyone entering the country without a valid cholera vaccination certificate must be kept under surveillance for 5 days from the date of leaving an infected area Information regarding these people is telephoned or telegraphed to the department from the Port Health Authorities By the end of the year 14 such notifications were received. All these were visited and kept under surveillance for the required period. 22 Whooping cough There were 30 cases notified compared with 11 in 1969 and 78 in 1968 Of these 6 were under the age of one year Vaccination records show that 5 of the twenty notified cases under the age of six vears had been immunised in infancy. Measles There were 675 cases notified compared with 576 in 1969 and 466 in 1968 Children under 5 years of age were most heavily involved (53% of notifications) followed by children in the 5-9 years age group (44%) If the disease is to be eradicated vaccination rates must be kept at the highest possible level Dysentery There were 7 cases compared with 40 cases in 1969 Typhoid fever There were 5 cases notified. 2 of which occurred in the same family both just returned from Pakistan One case was a 55 vear old symptomless lady whose grandson domiciled outside the borough had typhoid The other two cases were a 2 vear old girl who had recently returned from Pakistan and a 27 year old lady who had recently returned from India Food poisoning Although 48 cases of suspected food poisoning were notified, after full investigation only fifteen cases were confirmed The causative organisms were as follows salmonella typhimurium (3), salmonella seftenberg (1), salmonella heidelberg (3), salmonella enteritidis (2), salmonella reading (2), salmonella Stanley (4) In one other case salmonella Stanley was isolated from a perianal abscess Of the 32 remaining cases notified (24 sporadic and 8 cases in 3 families) all laboratory investigations proved negative Medical arrangements for long-stay immigrants Long-stay immigrants are asked to give their destination addresses at ports of arrival and these are forwarded to the medical officer of health All the addresses situated in the borough are visited by public health inspectors who advise the immigrants on how to use the national health service If the immigrant is accompanied by a child the address in visited by a health visitor Destination addresses in this borough were given by 691 immigrants but in 200 cases it was found that the immigrant had not arrived at the address given. Fever hospital The borough is served by the South Middlesex Hospital but on occasions accommodation in other fever hospitals may be used. During the year 130 patients from the borough were admitted as suffering from or suspected to be suffering from infectious disease Close contact is maintained between the hospitals and the department of health so that any necessary action can be taken without delay In accordance with the Public Health (Infectious Diseases) Regulations, 195 admissions to the South Middlesex Hospital of persons residing outside the borough were referred to the department in addition to those living in the borough Disinfection Where necessarv, disinfection of rooms is carried out by the department During the year 5 rooms were disinfected and 3 lots of clothing were similarly treated before being sent abroad Cleaning of Verminous Persons and their clothing No steam disinfecting or cleansing centre is provided in this borough but arrangements have continued for the use of the Disinfecting Station and Medicinal Baths. Scotts Road Shepherds Bush. W 12 provided by the London Borough of Hammersmith The borough council 23 accepts responsibility for payment of each treatment etc for residents referred to the centre During 1970, 98 persons were treated and in addition, bedding and clothing was disinfested in 9 cases Venereal Diseases The spread of venereal diseases continues to increase in this country and any person, male or female, who suspects that he or she is suffering from any of these diseases, should seek immediate advice and treatment. Clinics are available for both male and female patients at West Middlesex, Central Middlesex, Hillingdon and West London Hospitals and many other London hospitals where examinations and treatment are given in complete privacy. While there is no doubt that competent treatment can control infections, the total incidence continues to grow because of the increase in casual relationships which modern society permits Every endeavour is made to identify and treat contacts of patients and welfare workers are also used for tracing those patients relatively few in number, who default before treatment is completed Mr. Duffy, the borough's health education officer, is engaged on a comprehensive educational programme in the senior schools of the borough concentrating his efforts on all vulnerable young people of fourteen years and upwards He also lectures and shows films to many parent-teacher associations and other groups of people in the borough, who request his services Vaccination and Immunisation The revised immunisation schedule which was introduced in January 1969 was used during 1970 Immunisation against German measles became available for girls in the 11-14 year age group but due to the shortage of vaccine it was possible to offer vaccination only to girls in their 13th year. The purpose of this is to protect girls against the infection at a later date so as to reduce the likelihood of any abnormality occurring to a baby during pregnancy. Measles vaccination is now available to all susceptible children under the age of 16 years, Although first introduced in May 1968 it had previously been provided on a limited basis only due to shortage of vaccine. Every effort is being made to achieve a higher acceptance rate of vaccination of all susceptible children under the age of 16 years. The schedule used is Diphtheria, tetanus, 1st dose at 6 months whooping cough and 2nd dose at 8 months oral poliomyelitis 3rd dose at 14 months Measles 15 months Smallpox 16 months Diphtheria, tetanus, 3½ - 5 years oral poliomyelitis booster German measles 11-13 years (girls only) B C G 13 years Vaccination and immunisation is provided both by family doctors and local health authority services The number of children under the age of 16 years who completed primary courses or were given reinforcing injections during the year are shown below. Primary courses Reinforcing injections Diphtheria 2,355 4133 Whooping cough 1,857 1,264 Tetanus 2,540 4319 Poliomyelitis 2,267 4 050 Measles 2,917 - Smallpox 1,383 332 German Measles 434 - The following table shows the percentage vaccinated in this borough together with the equivalent national figure. 24 Children born in 1968 and vaccinated by 31st December 1970 Whooping cough % Diphtheria % Poliomyelitis % Smallpox (children under 2) % Hounslow 75 83 83 32 England 79 81 79 35 General The local authority does not provide vaccination against yellow fever, cholera, typhoid or paratyphoid fevers and persons desiring such protection should consult their own doctors. Yellow fever vaccination is carried out at the following centres Hospital for Tropical Diseases 4 St Pancras Way London N W 1 Tel: 01 387 4411 Ext 137 Medical Department Unilever House Blackfriars E C 4 Tel: 01 353 7474 Ext 2841 55 Great Cumberland Place W 1 Tel: 01 262 6456. Patients are seen by appointment only. No charge is made Health Centre Grange Road Kingston Surrey Tel: 01 546 7261 Cholera, enteric fever and typhus vaccination is available by appointment only at the Hospital for Tropical Diseases 4 St Pancras Way N W 1 Tel: 01 387 4411 Ext 137. Anthrax vaccine is available from the Central Public Health Laboratory Colindale Avenue N W 9. Tel 01 205 704. B C G Vaccination Details of B C G vaccination given are shown below. Contacts at chest clinic: Number skin tested 163 Number found positive 26 Number found negative 131 Number vaccinated 156 School children and students: Number skin tested 1,534 Number found positive 258 Number found negative 1,203 Number vaccinated 1,025 Services provided for the London Borough of Hounslow by other Authorities North West Metropolitan Regional Hospital Board 40 Eastbourne Terrace W 2. South West Middlesex Group Hospital Management Committee West Middlesex Hospital lsleworth The following are the main West Middlesex Hospital Twickenham Road lsleworth Tel: 01-560 2121 Cases Admitted Approximate no of available staffed beds Mainly acute 865 25 Chiswick Maternity Hospital Netheravon Road W 4 Tel: 01-994 1124 Brentford Hospital Boston Manor Road Brentford Tel: 01-560 6959 South Middlesex Hospital Mogden Lane lsleworth Tel: 01-892 2841 Staines Group Hospital Management Committee Ashford Hospital Ashford Middlesex Ashford Hospital Ashford Middlesex Tel: 01-695 1188 Hounslow Hospital Staines Road Hounslow Tel: 01-570 4448 Hounslow Chest Clinic 28 Bell Road Hounslow Tel: 01-570 6217 Ashford Chest Clinic Ashford Hospital Tel. 01-695 1188 Hospitals for the mentally sub-normal Leavesden Hospital Abbots Langley Watford Tel: 01-477 2222 (North West Metropolitan Regional Hospital Board) Psychiatric Hospitals Springfield Hospital Beechcroft Road Upper Tooting S W 17 Tel: 01-672 1212 (South West Metropolitan Regional Hospital Board) Cases Admitted Approximate no. of available staffed beds Maternity only 51 Acute 33 Mainly acute 145 including isolation Mainly acute 453 Acute 75 - 2,227 - 1,601 26 Psychiatric Hospitals (contd ) Cases Admitted Approximate no of available staffed beds St Bernard's Hospital - 2,267 Southall Middlesex Tel: 01-574 8141 (North West Metropolitan Regional Hospital Board) Smallpox Hospital Joyce Green Hospital Dartford Kent Tel: 01-32 23231 (Admission to this hospital should be arranged through the Medical Officer of Health) Tel: 01-570 7715. Middlesex Executive Council This body is responsible for the provision under the National Health Service Act of the general practitioner dental (other than local health authority provision for expectant and nursing mothers, young children and school children) pharmaceutical and supplementary ophthalmic services. The headquarters of the council are at International Life House Olympic Way Wembley Middlesex: Tel: 01-902 8891, Ambulance Service The borough is included in the area of the Greater London Council Ambulance Service. Provision is made for the conveyance of sick, accident and emergency cases. Tel: 01-204 0251 Health Centres The first phase of the health centre for twelve family doctors at Bath Road was completed in December 1969 and the doctors started practising there in January 1970. On the first floor there are units for the child psychiatric and school psychological services, audiometry and speech therapy rooms and administrative offices for the nursing and other services. The Hounslow hospital and the local authority health department are immediately adjacent. Phase II of the health centre was completed in June, 1970. This includes a day centre for those recovering from mental illness, a health education unit, a library, administrative offices and three flats for nursing personnel and a caretaker. The Maswell Park health centre was also completed during the year and the three family doctors started practising there in August. The centre, which was designed so as to allow for extensions at a later date provides consulting and examination rooms for three family doctors and a local authority medical officer health education, weighing and treatment rooms speech therapy and chiropody rooms and accommodation for health visitors. The reception records and waiting areas are shared by the local authority and the family doctors. A special feature of the centre is the provision of a children's playroom with access to an attractive internal courtyard This is the fifth health centre to be provided by the borough, the other centres being situated at Heston. Feltham and Brentford. Other centres are also planned. Frequent discussions have taken place with groups of family doctors practising from health centres and also with those who are interested in working from such centres. 27 The extension to the Hounslow Health Centre for 12 family doctors and for child Psychiatric and Psychological services Midwifery During the year an arrangement was made with West Middlesex Hospital for domiciliary midwives to conduct the confinements of selected patients in the hospital and to continue to attend the patients after transfer home for a minimum period of ten days after the end of labour This scheme known as Domino' was implemented in November and it is hoped will provide a system of continuous patient care and allow the midwife to maintain her skilis During the year there were 338 domiciliary confinements 589 48 hour discharges and 976 early discharges In addition midwives from Queen Charlotte's Hospital attended 10 domiciliary confinements 75 48-hour discharges and 49 early discharges within the borough The totals for the vear are therefore 348 domiciliary confinements 664 48-hour discha-ges and 1,025 early discharges Staff Thirteen midwives remained in post throughout the year Training Two midwives attended statutory refresher courses and all midwives enjoyed lectures arranged by the chief nursing officer Some of the midwives participated in a two-day in service training on Preparation for Childbirth' Pupils Eighteen pupil midwives completed their twelve weeks domiciliary training during the year eight of whom were undertaking training at Hi11ingdon Hospital In September three students from West Middlesex Hospital commenced their domiciliary training (under the single period midwifery training scheme) The five statutory public health lectures were given by Dr E N Christie to twenty eight students from West Middlesex Hospital Queen Charlotte's Hospital and Hi11ingdon Hospital A programme of weekly lectures on community care' was made possible by the co-operation of the health (including environmental and mental welfare) and children's departments Arrangements were made for these important series of lectures to be organised by the London Boroughs of Hounslow and Richmond upon Thames alternately Co-operation with Family Doctors Greater development in the attachment scheme of midwives has ensued throughout the year Emergency Obstetric Units Units are still at Hi11i ngdon and West Middlesex Hospitals but the services were not required during 1970 Analgesic Apparatus Entonox and trilene machines are used by the borough's midwives Maternity Service Liaison Committee The committee met twice during 1970 when developments and problems of mutual interest were discussed. Health Visiting The year 1970 has been an active and stimulating one within the health visiting section of the department Winds of change have given rise to much thought on the needs within the community and the best way of meeting them However the changes brought about by the implementation of the Social Services Act before the unification of the health services has increased the need for flexibility and communication The opening of the Family Doctor Unit at 92 Bath Road in January 1970 the Health Centre in Maswell Park in August and the attachment of health visiting staff to general medical practices have paved the way for closer communication between family doctors and community nursing personnel General practitioner/health visitor \ 29 ment schemes continued to be implemented and during the year nine health visitor attachment schemes were arranged with seventeen doctors working either in group or single practice At the end of 1970 there was a total of thirty-one doctors working in thirteen groups or single practices with an attachment of fifteen health visitors In January 1971 there will be a further attachment of eight health visitors to seventeen doctors working in ten groups The work of the health visitor remains primarily preventive and is concerned with the health of the family as a whole providing a continuing service to families and individuals in the community The effect of Section 11 of the Health Service and Public Health Act 1968 is to widen the areas within which she may work Health visitors may be expected in future to carry out their duties not only in people's homes but also in doctors' surgeries and health centres usually within general practitioner attachment schemes Her statutory duty to visit the mother with a young baby in the home remains and continuing support to the normal family is her responsibility Early detection of deviation from normal in the mental psychological or social fields is of paramount importance The health visitors supportive role to problem families and families with problems is still retained and is very much the continuing link with the family before after and often during the period of referral to another agency for specialised help Participation in research such as the Obstetric/Chi Id Health Project the Coordination of Services for the Mentally Subnormal and the Infective Hepatitis survey have opened up interesting aspects of work for the health visitor Health education in schools has been requested by several head teachers and health visitors have welcomed the opportunities presented Registration of child minders and pre-school play groups continued with a depleted senior staff During the year 106 child minders and 7 play groups were registered bringing the total registered in each group to 238 and 40 respectively It is abundantly clear that the health visitor is able to give a service to the public which is of great benefit to individuals and families The theoretical training now given in the colleges and the practical work supervision by the field work instructor has given rise to a highly qualified health visitor possessing advanced ideas regarding the work and standard of service she is to provide in the community. The clinic/school nurses have given valuable service both in clinics and schools and offer great support to the health visiting service. Staff The establishment of health visiting staff including tuberculosis visitors clinic nurses and student health visitors was limited to 50 and comprised 42 health visitors, 2 tuberculosis visitors 5 student health visitors and 1 clinic nurse specially appointed to South Hounslcw Health Centre There was a separate establishment of 3 group adviser health visitors and 1 staff/ student health nurse There were many staff changes during the year Miss Harding, Principal Nursing Officer Health Visiting resigned in March to take up an appointment as Chief Nursing Officer in the London Borough of Wandsworth Training Three student visitors successfully qualified and five health visitors completed the field work instructors' course Eighteen health visitors took the two-day course in Psychoprophylaxis in Preparation for Childbirth and three attended refresher courses A General Practitioner Attachment course was attended by the Deputy Principal Nursing Officer Visits were paid by the staff to Ashford Hospital Cassels Hospital and Harefield Hospital the latter in order to see the cardiac pace-makers' The Further Education Teacher's Certificate became an approved course and one health visitor is undertaking this on a day release basis Another member of staff is undertaking the course on her own initiative in the evening as only one place was approved 30 The Chief Nursing Officer organised several lectures and discussions. Lecturers included Miss Lamb Deputy Chief Nursing Officer from the Department of Health and Social Security and Mr J Burrows lecturer in Sociology at London University. Both hospital and community nursing staff participated an interchange of ideas took place and contact with colleagues established. Plans were also made for a series of lectures on the theme Continuity of Patient Care' Sponsorships Five sponsored students commenced training in the autumn 1970 including one taking the integrated course of SRN/ DN / HV Three others, not sponsored by Hounslow also commenced in the autumn Approximately one hundred and fifty other students and post graduate visitors had experience in the department or paid visits of observation including some overseas postgraduate public health nurses Group Advisers These members of staff have contributed greatly in assisting with administration and in giving support to fieldworkers Mothers Clubs The three Mothers groups are active and a wide range of subjects have been covered. Family Planning The establishment of an afternoon family planning clinic at Bath Road and the inauguration of a domiciliary family planning service were welcomed by the health visitors These increased facilities enable more cases to be referred Senior Nursing Officers Weekly Meetings These have continued to be a vital function within the department and the senior staff have as a result developed a wider concept of community care Home Nursing Home nursing has as its aim the patient s physical, psychological and social well being so that he may be restored to health or happily adjusted to his limitations, or in the case of terminal illness given the greatest comfort During 1970 the attachment of home nurses to family doctors continued to develop A pattern of work has emerged which has much to commend it Ten home nurses undertake treatments in the family doctors surgeries daily in addition to treatments in the home Three nurses also return to assist at evening surgeries These surgery treatments relieve the doctor often avoid the necessity for patients to attend hospital out patient departments and allow the family doctor and nurse in liaison to give a wider range of continuous patient care Two nurses were appointed in March 1970 to the Treatment Centre of the Family Doctor Unit Bath Road to assist the twelve family doctors working from the Health Centre These nurses cover the hours of 8 45 a.m. 7.00 p. m. and carry out simple disgnostic tests prophylaxis (immunisation and cervical cvtologv) and active treatments The average number of patients treated each month (during the last quarter of the year) was 1,040 Although the total number of patients treated in their own homes was approximately the same as in 1969 the number of elderly people cared for rose by 24 and visits increased by 1355 to a total of 100 064 The increase in establishment of 11/3(full time equivalent) nursing auxiliaries furthered the policy of maintaining and supporting people within the community Laundry Service The incontinent and infirm benefit from this service which is conducted by the home help organiser under section 13 of the Health Services and Public Health Act 1968 for households to which home help service is being or can be provided under this Act 31 Staff The establishment of home nurses was increased from a total full time equivalent of 34½ to 36½ and was augmented by a total full time equivalent of 3 1/3 nursing auxiliaries Training Staff enjoyed lectures arranged by the Chief Nursing Officer The lecturers included Miss A N Lamb Deputy Chief Nursing Officer from the Department of Health and Social Security Mr John Burrows lecturer in Sociology at London University who presented the Mayston structure and outlined social policy anticipated within the Health Service Dr. Colin Herridge also gave a series of lectures on the role of the community nurse in the psychiatric field. Dr. Herridge's lectures were one of the high lights of the year and were followed by a visit of observation by the staff to Springfield Hospital. Marie Curie Nursing Service Sixteen patients were nursed at home under this scheme during the year Difficulty has been experienced in retaining staff since the work is of a spasmodic nature Home Help Service The Home Help Service continues to meet the needs of people who because of sickness or infirmity are unable to carry out their household duties The need for help in maternity cases has diminished because more babies are being born in hospital but the need for the service for old people has increased The washing centre set up in January 1968 has flourished and proved a useful adjunct to the service both for old people and the incontinent sick. It is apparent that the Home Help Service is increasingly appreciated by the public and the medical nursing and social services. The good neighbour service still continues to supplement the home help service and often enables home care to be continued whereas hospitalisation would be the only other alternative. The residential help service has been used in five homes where children were being cared for temporarily in their own home whilst their mother was in hospital thereby keeping the family united and avoiding them being taken into care. The high standard of integrity and understanding coupled with domestic skill has been maintained and at 31st December 1970 there were 132 full time equivalent home helps on the staff. Two thousand and seventeen homes were given a total of 275,821 hours of help during the year The type of case to which service was given is 1970 1969 Aged (65 years and over) 1 633 1 597 Chronic sick and 166 153 tuberculous Maternity 80 93 Mentally disordered 9 13 Others 129 158 Total 2 017 2,014 Prevention of illness - care and after-care Tuberculosis Tuberculosis prevention care and after care services for patients living at home are provided at the Hounslow and Ashford Chest CIinics. During 1970 there were 71 formal notifications of pulmonary tuberculosis and 21 of non-pulmonary tuberculosis compared with 59 and 24 notifications respectively in 1969 The total number of cases on the register at the end of the year was 1,810 (pulmonarymales 833, females 686 non-pulmonary males 116 females 175). Table 13 shows an analysis of all cases notified during 1970 There was 1 death from tuberculosis in 1970. 32 Loan of nursing equipment The British Red Cross Society continues to operate a scheme for the loan of nursing equipment on behalf of the council Charges for this service are nominal but in certain circumstances are abated or waived Monies received from loan charges enabled the British Red Cross Society to provide replacements for smaller items of worn equipment. Recuperative holiday homes During the year the borough council accepted responsibility under section 12 of the Health Services and Public Health Act 1968 for the maintenance of 116 persons in recuperative holiday homes Seventy one were admitted to such homes, 22 were cancelled or withdrawn. Chiropody Service The chiropody service is available for the elderly physically handicapped and children This is provided at fully equipped council clinics and health centres and in the patients own homes The service is augmented by the Heston and lsleworth Old People's Welfare Committee who acting as agents on behalf of the borough council conduct their own clinics and domiciliary treatment. The demands on the council's directlyprovided service continued to increase during 1970 An average of twenty-six weekly sessions were held throughout the year in local authority premises compared with twenty-four during 1969 A total of l 351 clinic sessions were held at which 2,189 patients made 9,679 attendances for treatment Six chiropodists made 6 468 home visits to aged and infirm patients who were unable to attend the clinics. The number of patients requiring domiciliary treatment increased from 973 to 1,236. The Heston and lsleworth Old People's Welfare Committee works in close co-operation with the department of health and provides an invaluable service as an adjunct to the local authority's directly provided service During the year 136 domiciliary patients received a total of 693 visits and 209 patients made 930 attendances at specially arranged sessions The council paid the organisation an agreed quarterly grant of £475 which was based on the existing case load. Attendances at local authority chiropody clinics Category of patient First attendances Re-attendances Total attendances New Cases Old Cases Elderly persons 485 l 634 7 318 9 437 Physically handicapped 7 21 84 112 School children Others 24 4 5 9 61 27 90 40 Totals 520 1 669 7 490 9.679 Domiciliary visits made under the council's directly-provided chiropody service Category of patient First visits Subsequent visits Total visits New Cases Old Cases Elderly persons 397 766 4.944 6 107 Physically handicapped 12 61 288 361 T otals 409 827 5 232 6,468 \ 33 Problem families There is a small proportion of families which make exceptional demands on the resources of the department because of the multiplicity of their presenting problems A central file containing all known information about such families is maintained in order to provide easier communication and liaison with members of the children's department and voluntary agencies such as the N S P C C who are often also involved with these families. As a matter of routine health visitors now bring forward families about whom they are especially concerned and these ere discussed in detail with the principal nursing officer All staff are well aware of the desirability of prevention rather than cure but where primary prevention has been impossible the new procedure aims at (a) Identifying needs and difficulties and then considering them in the context of the whole family. (b) Effective use and organisation of resources. (c) Early referral where necessary to other departments or agencies. (d) Adequate support to the worker most closely involved and improved communications between all the agencies concerned. Health Education As anticipated many requests were received for talks on matters of health education to be given to various groups and organisations These were met by the professional staff who gave lectures on smoking and health cervical cytology, the care of the elderly, dental caries cancer preparation for retirement and the function of the council's new health centres in the community The talks were often illustrated by films, film strips and visual aids They were well received and an increased demand for this personal dissemination of information on health matters is being maintained A further two mothers clubs were started during the year and with those already established gave mothers the opportunity of meeting and making friends The clubs also afforded an opportunity for the professional staff to teach the mothers parentcraft and instruct them in other aspects of health education. The medical officer responsible for the student health service met several enquiries from lecturers at the two polytechnics in the borough for information and advice on the occupational health aspect of the subjects they taught. These included dermatitis caused by chemicals, skin cancer caused by continuous contact with cutting oil and hazards of inhalation of hair lacquer by hairdressers. The addition to the departmental establishment of a staff/student health nurse in July made it possible to increase the health counselling facilities already available to students. Talks on the social mental and physical problems of adolescence were given to parents of students and several parents asked for individual consultations regarding the health of their teenage sons and daughters who were attending college. Students from colleges within the borough others of various disciplines as well as groups or school girls were shown around the health centres clinics and other departmental establishments and were given short talks on various health subjects by members of the staff. The employment of a full time technical officer to service equipment and project films and the purchase of the more popular 16 mm film projector has been of enormous support to the professional staff Selected members of the health visiting staff have been trained in the use of an increasing variety of projectors being used in the department for health education purposes. Posters concerned with health subjects were regularly displayed in schools health centres clinics and factories as well as on public notice boards About 19,000 pamphlets covering a wide variety of health topics were also distributed throughout the borough. Topical 34 health subjects were featured in the borough's news sheet Progress and in the field of publicity we continued to enjoy the cooperation of Mr R C Skinner the Council's Press and Information Officer Home Safety Mr Jones Home Safety Officer reports as follows The Home Safety Committee continued their efforts over the past year to reduce the number of accidents which occurred in and around the home and particular subjects covered included the misuse of fireworks the door to door distribution of samples the misuse of oil heaters and the new colour coding of flexing electrical cords. Continued support has also been given to provide the assessment for the examinations relating to the Guide Movement and to talks to women s organisations on the question of safety in the home. The Hounslow Project Work on the Hounslow Project begun in summer 1965 by Eugene Heimler then Social Work Organiser in the health department of this borough was brought to a conclusion in September 1970 This research project had set out to develop and experiment with predictive and preventive social work methods for the speedier identification of those at risk in the field of mental and emotional illness An important part of the work was the refining of a scale of social functioning (HSSF) developed by Professor Heimler in the Health Department of Middlesex County Council when working with the long term unemployed The HSSF asked questions regarding satisfactions and frustrations in five basic areas of life work finance. family relationships friendships and personal/ sexual areas - the basic hypothesis being that too little satisfaction and/or too much frustration endangers people to a point where they begin to drop out of society or can only function with massive support from helping agencies such as social workers family members doctors clergy. During the five years of the project's existence many people from helping agencies of all kinds in this country and abroad came to investigate social functioning ideas Large scale validation plans were drawn up with the encouragement of the Ministry of Health but the research grant offered did not materialise Support therefore for this aspect of the research was to be sought overseas and is now forthcoming through the University of Calgary and the Canadian Department of Immigration & Manpower The methods pioneered in Hounslow by Professor Heimler are being integrated into the social work curriculum of the dynamic new Social Work Training School of the University of Calgary In the same university in the Department of Education Professor Philip Vernon world-renowned validation expert is taking an active interest in the scale and will be at hand to guide the further validation plans At government level the Canadian Department of Immigration & Manpower will finance a nationwide survey of the satisfaction/frustration levels of the populations of all the provinces of Canada. In USA both government and social service agencies are training their workers in Social Functioning methods and feeding research material back to the University of Washington Seattle. Meantime in Hounslow basic experiments with social functioning methods and ideas have been continued by Louise Dighton and the results shared in open seminars with interested social workers from a number of borough departments and service agencies. In the mental health division where a great deal of the work has been centred much material has been gathered and patterns of functioning of the well and the sick can now be compared Further the scale has made it possible to demonstrate diagramatically changes resulting from therapeutic intervention. In June 1970 a presentation of the work of the project was made to Professor Caplan's community care course at the Tavistock Clinic Those attending were drawn from community care services over the whole of Great Britain 35 and many requests for further information and involvement have followed. A similar presentation was made in September to a national group of Welsh social workers. For the third year in succession the project was visited by a group of scholars from Asia Africa and the Far East who, under the auspices of the World Council of Churches came to Britain to study British social work experiments. The Hounslow Project is voted the most interesting of many fieldwork visits. With Dr Bennett's encouragement experimental group work using social functioning methods, was tried over twelve months with delinquent boys at a nearby senior boys' approved school Results were compared with the satisfaction/frustration patterns obtained from a study of three of Hounslow's well-known youth clubs and latterly with a large sample of students of the University of Surrey Further plans to add to this study a sample group of handicapped young people could not be completed in the time A paper on this work was presented to the National Youth Service Association and aroused much interest. In August Louise Dighton was invited to visit the West Coast of America to share with social workers there her experiences in the development and use of social functioning ideas Lively interest was shown bv various helping agencies hospitals welfare departments delinquency services and others and engendered a steady demand for training. In Hounslow clergy from the parish of Heston are now adapting social functioning methods and philosophy to the needs of parish work and a studv of personal patterns of satisfaction and frustration forms an integral part of the Preparation for Marriage groups that meet regularly. In conclusion the Hounslow Project has surveyed the satisfaction/frustration patterns of many groups both within and outside the Borough - those who function and those who fail to function under the great pressures of modern life It has proved the value of the new scale of social functioning as a quick and effective diagnostic instrument. At a significant moment in the history of social work it offers social workers a new tool, plus a philosophy whose significance has yet to be fully realised Many plans have not materialised but continuing work supports the researchers belief in the value of this new approach as a way of helping people to live more satisfying lives. Finally, the two principal workers in this research, Professor Heimler and Miss Louise Dighton, wish to express their great indebtedness to the health committee, and in particular to Dr Lindon for unfailing support and encouragement throughout the difficult and often frustrating life of this complex research. Cervical Cytology There has been a slight decrease in the number of women attending the council's clinics for primary smear and other screening tests Some industrial concerns co operated by allowing groups of women to have time off to attend' the clinics and at the invitation of the management a weekly cytology and screening session was held at a large factory in the borough over a period of several months Of the 212 women examined at this factory there were no positive smears but 36 women were referred to their family doctors for gynaecological and other reasons. The Council's service was expanded by the introduction of three-yearly re-tests for women who had attended previously for their primary test and during the year 414 women attended for this purpose all of which produced negative results Apart from taking a cervical smear the examination consisted of routine urine tests recording of blood pressure examination of breasts and bi-manual vaginal examination Two thousand four hundred and one women had cervical smears taken at the Family Planning Association s clinics in the borough Smears are also taken at hospital gynaecological clinics and in family doctors' surgeries the total number of women who have been screened in the borough is therefore not known. The following statistics relate to women examined at the council s clinics. 36 1970 Primary tests yearly re-tests 1969 Primary tests Women tested 1,117 414 1,326 Negative results 1116 414 1,319 Positive results 1 - 7 Gynaecological defects referred to fami ly doctors 183 42 91 Referred to family doctors for other reasons 12 3 9 Carcinoma in situ was confirmed in the one patient with a positive smear and she had a cone biopsy followed by a hysterectomy. The patient was a married woman aged 42 years The following table shows the number of cases referred to family doctors with gynaecological and other conditions. Primary tests 3-yearly re-tests Trichomonas 21 6 Monilia 22 4 Vaginal cyst 4 - Fibroids 5 1 Erosion of the cervix 25 1 Cervical polyp 16 2 Other gynaecological conditions 90 28 Breast conditions 5 - Reasons other than those stated above 7 3 Totals 195 45 Care of mothers and young children Ante-natal clinics Ante-natal care is concerned with the health of pregnant women and the diagnosis and treatment of disorders and diseases of pregnancy. The local authority has a duty to provide ante-natal clinics but increasingly family doctors are providing these for their patients so that attendances at local authority clinics are diminishing not only locally but nationally Not many general practitioners however provide clinics for mothercraft and relaxation and this educational side of antenatal work in local authority clinics is greatly appreciated by expectant mothers though it is an aspect difficult to satisfy without teamwork in clinic premises With the advent of health centres it is envisaged that family doctors will be more closely associated with all aspects of ante natal care and that hospital doctors will also come out to clinics to see ante natal patients as is already happening in the Brentford Health Centre. One hundred and eighty one medical officer sessions were held this year the attendances at which totalled 549 One hundred and fifty nine sessions with a midwife only in attendance were held the attendances at which totalled 664. Attendances at the mothercraft and relaxation clinics numbered 2318 84 more than last year Only 49 mothers took advantage of the council's facilities for post natal examinations. Many patients booked for confinement in hospital are supervised at the clinics during the middle months of pregnancy and return to the direct care of the hospital obstetricians as they approach term. Child Health Clinics During the year l,475 sessions were held at which 7 930 children made a total of 42 404 attendances representing a fall of 3,127 attendances compared with 1969 The provision of child health clinics with attendant dental and immunisation clinics forms a significant part of a local authority s services but it is hoped Renal dialysis in the home A request for adaptation of premises was received on behalf of one patient during the year Half the cost was met bv the borough council the balance is to be paid by the patient by means of an interest free loan over three years 37 that interested family doctors in association with the health visitor will cake on more of this work in health centres as part of family medical care providing routine supervision of children under 5 years in their practices. Welfare Foods National welfare foods and approved proprietary preparations are stocked at child welfare centres for sale or if the need is proved for free issue During the vear £12 895 was received for the sale of proprietary preparations The quantities of national welfare foods issued were National dried milk (tins) 6 418 Orange juice (bottles) 66 996 Vitamin tablets (packets) 3 017 Cod liver oil (bottles) 2 155 Notification of congenital defects apparent at birth Since 1st January 1964 it has been a statutory requirement that all congenital malformations apparent at birth be notified to the medical officer of health at the same time as the notification of birth The names of children so notified are included in the department's observation register as children at risk, and particulars are also sent each month to the Department of Health and Social Security. The following is a list of defects notified during 1970. Central nervous system Anencephalus 5 Spina bifida 3 Hydrocephalus 1 Microcephalus 1 Other specified malformations of brain or spinal cord 2 Eye and ear Other specified malformations of eye 1 Alimentary system Cleft lip 6 Cleft palate 8 Other specified malformations of alimentary system 1 Heart and circulatory system Specified malformations of heart and circulatory system 2 Unspecified malformations of heart and circulatory system 1 Respiratory system Other specified malformations of respiratory system 1 Urino-genital system Indeterminate sex and true hermaphroditism 1 Hypospadias epispadias 3 Undescended testicle 1 Limbs Polydactyly 1 Syndactyly 4 Reduction deformity hand or arm 1 Reduction deformity leg or foot 1 Talipes 5 Congenital dislocation of hip 1 Other specified malformations of leg or pelvis 1 Unspecified limb malformations 1 Other parts of muscolo-skeletal system Other malformations of musculoskeletal system (including congenital hernias except hiatus hernia) 5 Other systems Other malformations of face and neck 1 Exomphalos, omphalocele (excluding umbilical hernia) 1 38 Other systems (contd.) Other unspecified malformations of muscles skin and fascia 1 Pigmented naevus 1 Other malformations Other and unspecified congenital malformations 2 Multiple congenital malformations not specified 2 Down's syndrome (mongolism) 3 For our own purposes the only children we follow up are those whose defect is likely to be a handicap to them in their future progress. As the notifications are made within the first 48 hours of birth often before a doctor has examined the baby it is possible that a considerable number of congenital defects are not notified by this method, notably such conditions as pyloric stenosis fibrocystic disease, various congenital heart defects and various renal defects. We therefore still rely upon the hospital paediatricians for their cooperation with regard to notifying these defects Joint Obstetric Child Health Project and Observation Register I am grateful to Dr Anne Jepson for the following report Aim, to determine whether the selective population screening method is a practical method of screening children for handicapping conditions. Twelve years ago there was increasing concern about the number of children found to have handicapping conditions It was felt that the adverse effects of a handicap on the normal development of many of these school children would have been lessened by earlier diagnosis and treatment. Dr Fisch suggested that a register should be compiled of children thought to be particularly at 'risk' of developing a hearing loss and Dr Robert Lindon suggested that all local authorities should maintain a register of children known to have a handicapping condition or who were likely to develop such a condition Dr Mary Sheridan amplified the principles set out by Dr Fisch and Dr Lindon, and at the same time drew up a list of factors occurring during pregnancy and the perinatal period which appeared to be connected with the subsequent development of a handicapping condition Many local authorities, including Hounslow began to keep At Risk' or 'Observation' registers The latter is a more satisfactory name for these registers, since the chiIdren are in fact under observation, but the factors which determine their inclusion on these registers are referred to as 'risk factors'. The early detection of any handicap is vitally important. The severity of the condition can then be lessened by early diagnosis and treatment For example the limb deformities which develop in a child with cerebral palsy can be greatly ameliorated by early treatment and the prognosis for speech and language development in the deaf child is greatly improved when a hearing loss is diagnosed within the first eighteen months of life. Early detection also enables the child's family to make the adjustment to his problems at an early age and helps them to come to accept him as an individual in his own right The authorities concerned in child care are also alerted to future needs and are able to plan suitable services Lastly, early detection enables research to be carried out into the effects of early treatment and makes possible the comparison of different methods of treatment At present there are three methods of detecting children with defects or developmental delay Firstly the symptomatic method which relies on the children being brought for treatment after the onset of symptoms which ha/e become apparent to the parents Often this may be too late for the most effective treatment to be given For example the treatment of a dislocated hip is effective and relatively simple within the first few weeks of life but much less so later on. The second method is total population screening. By this method the whole population is examined or screened for defects In theory this is the most satisfactory method 39 A mother and her baby taking part in the Joint Obstetric Child Health Project being conducted in the Borough. but in practice it is not possible due to the cost in manpower time and money The third method is that of selective population screening By this method a section of a given population is identified in which the likelihood of defects occurring is much higher than average Once such a group is identified the concentration of available medical resources on this group would seem to be justified The method of selective population screening is the one used by local authorities who keep observation registers but recently these registers have been criticised The criticism has been directed towards the size of the registers in some areas 50% of the children born in a year have been included but also and more seriously towards the fact that a sizeable proportion of children who are found to have handicapping defects have not in fact been placed on the observation register Consequently the method of selective populascreening is in danger of falling into disrepute The workers on the project believe that the concept of selective population screening is basicallv sound but that in the past insufficient attention has been given to the criteria used for identifying the at risk groups resulting in large registers and the identification of a low proportion of children with handicapping conditions The Joint Obstetric-Child Health Project set up in Hounslow aims to determine whether it is possible for a method of selective population screening to be effective or whether the deficiencies inherent in the method and its application are so great that total population screening is the onlv method of value During the study 2000 Hounslow children born consecutivelv at Chiswick maternity hospital or as the result of domiciliary confinements within the borough are being screened for developmental defects at regular intervals until they are four years old During the period of the project the observation register will be maintained as at present all the criteria or relevant risk factors having been carefully defined The group of children from the total 2000 thought to be at risk of developing a defect will be placed on this register At the end of the five year period it will be possible to see whether the majority of children with handicaps are to be detected as the result of inclusion on an observation register or whether thev are detected onlv as the result of total population screening Hounslow was chosen as the area best suited for the purpose of the project as it has an observation register already in operation there is excellent liaison between the health department general practitioners and hospital obstetric services and the population is relatively stable There is an outward removal of some 7% annually of children under five considerably less than that shown by other London boroughs The cost of the project over the five years is to be met by a grant from the Department of Health and Social Security The paediatrician to the project is Dr Zinkin senior lecturer at the Institute of Child Health overall direction being given by Dr Holt from the Institute of Child Health and by Dr Lindon There is a full time research medical officer to the project a full-time health visitor and a secretary The obstetric direction of the project is under Mr Matthews and Mr Dunsier of the West Middlesex Hospital A great deal of information about each child will be available information will be computerised and a statistician to the project has been appointed The planning of such a project was extensive A great deal of administrative work and the clinical application of the screening tests used in this project is being undertaken by the borough medical officers under my guidance Before the project was started an in-service course in developmental paediatrics was run for the medical officers of the borough attended by representatives from the nearby boroughs who it was hoped would be able to help trace families who move into their areas Meetings were held with the general practitioners of the area and a course in developmental paediatrics was held at the Post Graduate Centre of the lAest Middlesex Hospital Several meetings were held with the health visitors during the first few months of the project the co-operation between everybody concerned has been excellent and most important of all there has been great 41 interest in the project by the mothers of the babies concerned Phenylketonuria Screening for phenylketonuria is undertaken by the Guthrie blood test and is normally conducted by midwives in hospital or domiciliary practice during the first 14 days of a baby's life or it may be done by health visitors Two children were found to be positive to the test during the year Care of the unsupported mother and her child The work of caring for unsupported mothers in the borough is shared between the medical social workers based on the health department of the London Borough of Ealing and those of Hounslow and District Welcare Association 153 new cases were dealt with by Welcare in 1970 and 10 by Ealing As in 1969 considerably more mothers kept their babies than those who offered them for adoption The corollary of which is that more after care work needs to be undertaken as the majority then face considerable problems as well as being subject to great mental and physical strain Accommodation and relative isolation present constant problems particularly during the first two years and to help combat this Welcare have now instituted group meetings for these mothers once a month These meetings have not only provided opportunities for companionship and discussion and for the children to play together but also an informal atmosphere which enables social workers to obtain a deeper understanding of the individual needs and problems of the mothers and the children The size and complexity of the problems require constant attention A high illegitimacy rate is symptomatic of of a troubled society and one in which education in its fullest meaning needs to be more positive which among other things will help to reduce illegitimacy No matter how effective the after-care services they still fall far short of the love aid security to be found in a stable happy home with the influence of a father During the year the borough, subject to the usual assessment procedure accepted financial responsibility for 20 mothers placed in mother and baby homes Day Nurseries The three day nurseries in the borough provide 136 places - 50 children at Danesbury Road Feltham 32 at Portsdown House Brentford and 54 at Nantly House Hounslow During the first five months of the year the three nurseries cared for their usual complement of children but in June part of Nantiy House was demolished to enable a start to be made on building a new nursery which reduced the places to 44 and restricted the children s outdoor play area Fortunately the magnificent garden which the children have enjoyed greatly over the years has enabled enough ground to be allocated for the new building without closing the nursery The land remaining will be attractively landscaped and provide a setting for outdoor play Good progress has been made but it will be the autumn of next year before the nursery is finished and ready for the admission of 56 children qualifying for admission under the current priority arrangements In addition there will be accommodation for nine severely handicapped young children for whom a special unit has been designed including facilities for physiotherapy To a certain extent the smaller number of places for priority children in Nantly House since June has been offset by the placement of some children with registered child-minders or nurseries with a high standard of care Charges for these services are determined by individual childminders or supervisors of day nurseries and parents are assessed according to their means by the borough treasurer who applies the same scales as those made for placement to the local authority s day nurseries Other children requiring less than a full day's care and stimulation, have with the co-operation of the borough education officer been placed in nursery schools or classes in the borough Despite these measures some needs of the under fives are still unmet or at best 42 delayed beyond the optimum time for intervention and support as is evidenced by the fact that each day nursery still has a waiting list as also by information reaching me from other sources Suggestions and proposals continue to be put forward for additional day nursery provision in the borough so as to provide an effective and comprehensive service for young children in need but the lack of suitable sites has been a factor in delaying implementation The attendances made by children during the year were: Feltham day nursery 11,107 Portsdown House day nursery 6,926 Nantly House day nurserv 8,866 Total 26,899 Nurseries and Child Minders Regulation Act 1948 as amended by the Health Services and Public Health Act 1968 The following were registered at the end of the year Private day nurseries (including playgroups) 40 with accommodation for 881 children Child Minders 238 with accommodation for 457 children It is a widely acknowledged fact today that many pre school children benefit emotionally intellectually and socially from attending nurseries and playgroups The increased number of private nurseries and playgroups within the borough is therefore seen as part of a national trend towards the development of such facilities. Indeed the Hounslow branch of the Pre-School Playgroups Association has been extremely active in both developing and co-ordinating private efforts within the borough and there has been much useful liaison with both the health and education departments in the formulation of their plans and subsequent registration and afterwards in the departments fulfilling supportive roles etc The in training of supervisory staff has also continued and been much appreciated and the contributions to the courses made by my staff greatly appreciated The increase in the number of child minders has been even greater than in nurseries many mothers registering in order to care for only 2 or 3 children but often supplying a local and neighbourhood need which at least obviates children being involved in lengthy journeys and generally shortening the time in which they are awav from their own homes Unfortunately very few single-handed child minders find it possible to attend an appropriate course though some do take advantage of an evening class now provided at Chiswick Polytechnic The educational work undertaken by health visitors on the occasions of home visits can here be invaluable in supporting and advising mothers who not only care for their own children but also those of other parents The importance of the pre school years cannot be over emphasised since it is in these years that intellectual curiosity development and confidence can be most fruitfully encouraged The Nurseries and Child Minders Regulation Act 1948 refers to children who are minded during the day but many enlightened parents nowadays have recognised the desirability of a service that is much more positive than that implied in the term "minding" and have been able to demonstrate their readiness to take an active part in the provision of their young children s needs Future social historians I have little doubt will recognise the development of the Pre School Playgroups Association in the 1960 s as of crucial importance in the effort to develop human potentialities to the maximum The greater awareness of children s needs is of the highest significance and the intelligent young mothers of today who have involved themselves in meeting these needs have performed an inestimable service to thousands of children whose capacities might never have been stimulated but for their courage vision and drive often against many odds Volunteer effort still has much to contribute to the well being of the nation and it is pleasing to report that in this borough the local authority has been able to afford considerable support and advice, when needed to those playgroup workers who have 43 the best interests of our young children at heart Family Planning Since the 1st January 1969, the council has provided free advice on family planning to borough residents, married or unmarried Free supplies are available for those in medical or social need The Family Planning Association acting as agents for the borough council operate sessions at six clinics within the borough of which one with the permission of the hospital authority is held at the West Middlesex Hospital There has been a steady expansion of clinic services and the number of sessions has been increased to 19 a week The greatest demand from patients has been for evening sessions Family planning arrangements for the whole area were discussed at meetings of the local maternity services liaison committee so that close co-operation has been established with the staff of the local hospitals in publicising our respective clinics Visits to maternity wards by a team of voluntary workers recruited by the Family Planning Association, offering leaflets and clinic lists to individual patients was found to be particularly helpful The services available are publicised at clinics health centres libraries and other public buildings also at doctors surgeries and factories Leaflets in several languages are also available. In co-operation with the Family Planning Association afree domiciliary family planning service was introduced towards the end of the year for women, who for a variety of reasons are unable or unwilling to attend the clinics and for whom family planning seems particularly important Twenty-three cases were attended Hospital staff family doctors social workers and our own medical and nursing staff have been made aware of the domiciliary service so that they can refer appropriate cases Clinic statistics 1970 Clinic New cases Old cases F P A transfers Total attendances Cervical cytology NHS (Family Planning) Act 1967 Free advice Free supplies Bedfont 201 228 98 1,680 303 429 4 Brentford 140 119 31 1,192 248 259 20 Feltham 285 395 52 2,597 80 680 8 Heston 305 362 90 2,374 345 667 3 Hounslow 895 820 164 7,361 1,299 1,715 32 West Middlesex Hospital 202 9 49 786 126 211 6 44 Of the total of 2,028 new cases it was possible to classify 1 894 according to age marital status and social class as shown in the table below - Age at first attendance Social class 1 2 3 4 5 Total Married 15 - 20 3 11 55 6 3 78 21 - 24 14 64 293 45 3 419 25 - 29 22 71 221 32 8 354 30 - 34 14 43 105 25 3 190 34 + 9 30 134 25 2 200 Total 62 219 808 133 19 1,241 Pre marriage 15 - 20 3 15 80 5 2 105 21 - 24 12 57 147 13 - 229 25 - 29 6 9 15 1 - 31 30 - 34 2 2 2 - - 6 34 + 1 - 1 1 - 3 Total 24 83 245 20 2 374 Single 15 - 20 - 33 93 8 1 135 21 - 24 3 27 71 8 - 109 25 - 29 - 3 12 3 - 18 30 - 34 2 1 9 2 - 14 34 + - 1 2 - - 3 Total 5 65 187 21 1 279 45 Report of the Chief Dental Officer for the year 1970 Continuing efforts to persuade more parents to seek early dental treatment for their children was reflected in a slight increase in the number of pre school children, examined, and treated during the year More treatment was also provided for expectant and nursing mothers, which was a reversal of the trend exhibited in past years Both these increases probably substantiate the prediction made in my report as Principal School Dental Officer for the year 1968 concerning the increasing importance of local authority dental service in future years. 46 Report of the Principal School Medical Officer for the year 1970 Organisation This is the sixth annual report on the School Health Service provided since 1st April, 1965 by the London Borough of Hounslow. The arrangement whereby the school health service was closely integrated with the other health services administered by the Department of Health has continued Joint use is made of medical, dental, nursing and other staff as well as of clinic premises. Co-operation It is important that there is an exchange of information between hospital general practitioner and school medical staff. On the whole local hospitals send reports to the school medical officers on children who have been in-patients; others tend not to do so automatically but will send reports on request. Before any child is referred for specialist or hospital treatment it is the practice, except in emergencies, to ask the family doctor whether he is in agreement, or whether he wishes to treat or refer the child himself. School Health Service School Population At the end of the year the maintained school population was Nursery schools and classes 290 Primary schools 19,389 Secondary modern schools 854 Grammar schools 1,967 Comprehensive schools 9,219 Special schools 580 Total 32,299 Periodic Medical Inspection Under the provisions of the Education Act it is the duty of a local authority to provide at appropriate intervals for the medical inspection of pupils in attendance at any school provided by them. The authority may require the parent of any pupil, in attendance at such school, to submit the pupil for medical inspection in accordance with the arrangements made for such inspection Periodic medical inspections are carried out on school entry, at the ages of eight and eleven years, and at school leaving age Efforts are made to examine children in nursery classes each term. The medical examination at eleven years includes a colour vision test When a periodic medical inspection is arranged, the head teacher is asked to submit the names of any other pupils in whose case special medical inspection is thought to be advisable. Pupils requiring follow-up from previous medical inspections can also be seen so that the visit of the medical officer to the school is used to cover a wider field than a selected age group. If the best results are to be obtained from these visits to school there should be close collaboration and consultation between medical officer and head teacher At the leavers examination. Form Y9 is completed for each pupil and forwarded to the Youth Employment Officer. This form indicates if there are any health reasons for avoiding certain types of occupation. The number of pupils submitted to periodic medical inspection during the year was 8 168 and the results are shown in Table 29 The physical condition of 80 (0.98%) was considered to be unsatisfactory. The concept of unsatis factory physical conditions varies with the examining doctors but the important point is that efforts are made to bring the pupil to a satisfactory physical state. Special Examinations and Re-examinations Any parent head teacher school nurse, speech therapist physiotherapist or audiometrician and others may request the medical examination 47 of a pupil and these special examinations are examinations and found lice or their eggs in usually carried out at clinics. Regular school the hair of 185 individual pupils. Today there clinic sessions are held at which a medical is no excuse for such infestation and the officer is in attendance. Where necessary infested pupils are now usually members of special sessions are arranged. a hard core of families on whom neither The examinations carried out during the persuasion nor threats seem to have any year were as follows effect. In most cases the parents deal with the matter as soon as their attention is Special Re- drawn to it, but 12 formal notices requiring examinations examinations the parent to cleanse the child had to be issued, and in 9 cases where the parent had School medical failed to respond to the formal notice a inspection sessions 503 - cleansing order was issued for the pupil to Routine clinic be dealt with by the school nurses, sessions 1,900 1,425 Employment of Foot Inspections school children 632 1 Children being School nurses make regular foot inspections taken into care 36 - to discover the presence of plantar warts Freedom from and other contagious skin conditions of the infection 148 - foot. During the year 6,768 foot inspections Pupils at special were carried out and 177 new cases of plantar schools 481 209 warts and 7 cases of re-infection were found- Attending hearing A pamphlet was prepared for and was issued clinic 378 1,246 to school children. Possibly requiring special education 219 Medical Treatment Epidemiological surveys 92 89 Certain treatment facilities continue to be Total 4,394 2,970 provided under arrangements made by the local education authority and parents may use The defects found at periodic and special these or seek treatment otherwise under the medical inspections are shown in table 30. National Health Service. The following notes refer to the treatment facilities provided as Uncleanliness and Verminous Conditions part of the school health service. School clinics are listed on page of the report. School nurses make examinations of children in regard to cleanliness of person and clothing Minor Ailment Clinics and the presence of lice or their eggs (nits). At one time all pupils were examined at least These are staffed by nurses and are held at once each term but as uncleanliness of clinic premises each morning to treat slight person or clothing is now rare, flea or body injuries, skin infections and minor defects of lice infestation almost unknown, and the eye or ear. incidence of head lice greatly reduced such regular examinations are not now held, The School Consultation Clinics nurse now visits schools to carry out these examinations at the request of the head These are staffed by a medical officer and teacher or where there are grounds for regular sessions are held at the various clinic suspecting the presence of infestation. During premises. Parents are free to take their the year the school nurses carried out 15,928 children for advice on any condition and 48 pupils may be referred by head teachers. school nurses and others, These sessions also provide facilities for the follow up of conditions found at periodic and special inspections. Where active treatment is required, the pupils are referred to their own doctors or specialist clinics as most of the work done by the medical officer is advisory, educational or supportive. Ophthalmic Clinics The vision of entrants is tested during their first year in school and is repeated at age seven, eleven and fifteen years, When an eye disease, squint or defect of sight is found parents may use the facilities of our ophthalmic clinics where refraction is carried out by ophthalmic surgeons, A total of 2,084 children were seen at these clinics during the year and spectacles were prescribed for 487 pupils. The examination of the vision of spastic and other children with severe physical handicaps requires special care and an ophthalmic surgeon visits Martindale School for the physically handicapped approximately once a month during term time. Some of these pupils also need special training to make the best use of their vision and the services of an orthoptist are also available. Second pairs of glasses are provided for those children whose vision is considered by the ophthalmic surgeon likely to suffer damage if they were without glasses for any period. Orthopaedic Clinics These clinics are staffed jointly by the Regional Hospital Board who provide the orthopaedic surgeons and the local authority who employ the physiotherapists. Two clinics are held in the borough, one at Brentford Health Centre where Mr I D Archibald attends monthly from West Middlesex Hospital and the other at Hounslow Health Centre where Mr F Godsalve Ward has attended monthly until his retirement in March, Mr Ward was associated with Mr Ashford at Hounslow Hospital and his work at the Hounslow orthopaedic clinic was very much appreciated, He has been succeeded by Mr KingsmiIl Moore, 438 children were seen by the orthopaedic surgeons during the year and 105 children required treatment by physiotherapists at council clinics. In addition to attendances made at the Brentford and Hounslow clinics, a physiotherapist attends Busch House School daily to provide treatment for children suffering from asthma, bronchitis cystic fibrosis and other conditions, A physiotherapist also attends twice weekly at the Marjory Kinnon School for educationally subnormal pupils because of the increasing number of children with additional physical disabilities who are admitted to this school, Speech Therapy The establishment of speech therapists in the borough was increased during 1970 by 4 sessions a week. The deployment has remained the same with 18 sessions per week at the Martindale School for the physically handicapped and 6 sessions per week at the special language classes these are termed diagnostic and developmental and take children currently functioning below their potential level, The children are given specific work according to their needs planned jointly by Dr Tyson, the teacher and the speech therapists. There are 4 sessions at the 2 junior training schools and 4 sessions at the Marjory Kinnon School for educationally subnormal children At one session two speech therapists see children newly referred for speech therapy in order to assess their difficulties. The remaining sessions are spread between the various school clinics. Once again the speech therapists took part in the survey of children entering school in the year 1970-71. The 1969 survey was held in Chiswick. and this year a survey commenced in Heston The speech therapists were responsible for giving the Reynell Language Development Test, Considerable information collected in these two surveys is being processed by Dr Tyson and the figures are awaited with interest. The percentage with speech defects and severely delayed language are of particular value in 49 projecting future needs for speech therapy. A further project has been undertaken by the speech therapists using the same language test, assisting the education department in evaluating the role of the nursery school in the development of language. All entrants to Cranford Infants School are to be tested over a long-term period. We are grateful to Mrs Barfield and her staff who have given every assistance with this work. The new building at 3ath Road has brought great benefits to the speech therapy service. One of the two adjoining sound proofed rooms is provided with equipment and toys and used as a play-room, while the other, designated as a shared room for audiometry and the senior speech therapist, is used for interviewing parents at assessment sessions,, A happy and relaxed atmosphere is created for the investigation of children's speech difficulties. At the height of the summer two speech therapists left the borough the early marriage rate in the profession once more taking it's toll! This is always an unfortunate time for recruitment and there were delays in bringing the establishment up to strength which resulted in the closure of some school clinics and to the central assessment clinic being held at Bath Road, Although this occupies two speech therapists they are able to see children under ideal conditions. The child's abilities in speech and language are assessed, its speech is recorded and parents are advised of the type of help needed. An outline plan of treatment can also be suggested to the therapist who will treat the child. The speech therapists at Martindale continue to work as part of a harmonious team in developing their work in the school. During the year, afternoon meetings for the mothers of out-patients and nursery age children were started, one being held each holiday. These were informal and gave parents opportunities to air their difficulties with their children's speech and language, when questions could be asked and answered not only by the speech therapists but also by shared experience. At the Marjory Kinnon School the excellent work being done in the junior school was halted by the speech therapist leaving at the end of the summer term, and it was found impossible to staff the sessions adequately during the second six months of the year. There is little doubt of the need for a full time speech therapist at the school and it is hoped that this can be arranged when the new building is completed. Screening of pre-school children in Heston July/ August/September 1970 Dr Moya C Tyson BA BSc (Econ) PhD. The Chiswick pre-school survey of 1969 (see Annual Report 1969) attempted to provide not only a useful service to parents of children about to start in infant schools or in nursery or reception classes, but also some valuable information about general levels of hearing, language and motor development in a farily large population of predominantly four to five year olds. However, there were reasons why the results, although interesting, required checking by comparison with another large sample of four to five year olds. First of all the response by parents to the offer of a developmental check had been approximately 60% therefore without other information it could be argued that this 60% was not typical of the whole population of the area. and that if everyone had taken up the offered appointments, a greater or lesser proportion of children with difficulties might have been discovered in the remaining 40% although it was conjectured that because many names on the lists were from Health Visitors records dating back to the infancy of these children, and there is thought to be a fair amount of mobility in this part of London, it was possible that some of the children offered appointments were no longer in fact in the area thus reducing the 40% non attendance figure (Head Teachers' lists covered a large number of the young children who would definitely be in Chiswick infant schools in September), Secondly, pre-school or nursery experience had been shown to be quite an important factor in good language development, and it was important to see whether this finding held for another area of the Borough. Lastly, it would be useful to discover in another area whether 50 parents saw this pre-school check as helpful, and this could be judged only by assessing their responses in availing themselves of the appointments offered. Because the Heston Hearing Clinic with its soundproofed rooms for testing hearing adjoins Heston School for the Deaf, where extra rooms could be found for the large team of workers needed to assess motor and language development of groups of children simultaneously, it was decided to continue the pre-school survey in Heston. The Director of Education very kindly gave permission for the use of some rooms in Heston School for the Deaf (and indeed Mr Wain Assistant Director of Education spent some time observing assessment during the period of the survey). The survey took place, as at Chiswick, over two separate weeks during the school holidays, one at the beginning and one at the end of the holidays. Five of the Council's medical officers, six speech therapists and one psychologist, as well as Dr N O' Doherty Consultant Paediatrician of West Middlesex Hospital, Miss Dorothea Meyerhoff Educational Psvchologist of London Borough of Hillingdon and Miss Dorothea Waldeck Senior Educational Psychologist of London Borough of Merton took part in the assessment procedures. Other med'cal staff assisted with administration, as did a finalist undergradude student from the University of Surrey, as part of a summer research assignment. On this occasion only head teachers' lists were used. Appointments were offered to 320 children and of this number 239 were brought to the Clinic (approximately 75%). In large scale research studies, 75% of a particular total population is considered to be a reasonable response. Obviously it would have been preferable to have a 100% response, but even if it is not possible to make confident statements about the total group that could have been seen, the response is sufficiently substantial to warrant reporting on it and comparing it with the Chiswick group. Figure 1 shows the age range and numbers at each age of both Chiswick and Heston children, a total of 452 children. It will be seen that the Heston group contains no children below the age of 4 years 2 months, as there were no nursery classes attached to Heston infant schools. Figure 2 shows the number of boys and girls in each group - roughly 51% boys and 49% girls in each area and in line with findings in other studies. Figure 3 shows the percentage of children with some form of pre-school experience in Chiswick and Heston, either in a play group or nursery. It will be noted that a considerably higher proportion of children in Heston had pre-school experience, but there were 45 children below 4 years 2 months in the Chiswick group, and of these 15 had some pre-school experience, while 30 had none however, if the percentages are calculated in Chiswick for children of 4 years 2 months and above only, the percentage change is from 42 to 44%, a comparatively small shift. Proportions might suggest, however, that there is a greater tendency for parents to try and arrange for pre-school experience in the 4 to 5 age group than for the 3 to 4 year olds, Family size was compared for both groups, and is shown in Table 1. It will be observed that the peak size in both Chiswick and Heston is the two child family, with Chiswick having a slightly greater number of larger families than Heston it may be that there were greater numbers of young parents in Heston who have not yet completed their families. The place of the chiId in the family - birth order - was established at the same time, and is shown in Table 1 also. Here the greatest number in both areas was of first children, more in Heston than in Chiswick, possibly lending support to the idea that there were more as yet incomplete young families in Heston. One small but nteresting fact emerging from the assessment of language development was that both in Chiswick and Heston, proportion ately more of the children who had immature or defective speech were youngest children as against all other children whose articulation of speech did not arouse comment. Hearing In Chiswick as reported last year 20 children were found to have some hearing difficulty of which 6 were bilateral and 14 unilateral, 51 while 3 children were untestable. In Heston 21 children were found to have some difficulty of which 9 were bilateral and 12 unilateral. There were difficulties in testing one child, but on a second visit testing was successful and hearing normal. (Table 2). Language Figure 4 shows the percentage distribution of children in Chiswick and Heston with average or above average language scores, poor language scores or scores with a marked disparity between understanding and production of speech. It can be seen that the great majority of children in both areas showed average or above average language development. However, apart from the small percentages of children with poor or disparate language scores, there are small groups of children who are possibly more vulnerable and may need help. These include the children speaking a foreign language at home - about 11% of the sample in Chiswick and 6% of the sample in Heston and the children who had immature or defective speech - 8% in Chiswick and 4% in Heston. Again, the children who were difficult to test some particularly shy or unco-operative - may have had slower language development also and therefore ought to be included in the groups who were possibly in need of some help. 25% of the total group in Chiswick, and 14% in Heston come into this category of children whose language development should be kept under review, so that if special help is required it can be given sooner rather than later, because of the need to support the more sophisticated language skills of reading and writing, as children progress through school. One final figure, Figure 5, shows the relationship between pre-school experience and language scores for both areas. These percentages are on the main groups of children only, and exclude those who spoke a foreign language at home, were difficult to test or had articulation problems It is noteworthy that the proportion of children with high or good average language scores is in both areas greater for children with pre-school experience of some kind In Chiswick fewer children with pre-school experience had average or below average scores whereas in Heston there are more children with pre-school experience in all these groups, but with the difficulties in proportion becoming less at each drop in language ability It has been regularly established in research on language development that socio-economic factors also account for difficulties in growth of language complexity and vocabulary and therefore without more information and a finer analysis it is not valid to draw firm conclusions but nevertheless the finding was of interest Motor The medical examination was altered slightly dropping some items that appeared to show little discrimination at this age A more rigorous classification of pencil grasp was used, and also an adaptation of an adult test of colour blindness for young children (a) Handedness Of the main sample of 205 Heston children, 174 used their right hands for drawing and 20 their left hands (see Table 3) and the rest alternated hands This is a slightly lower proportion of left handed choice than Chiswick, but it has been shown in studies on hand preference that there is a slight shift towards right handedness with increasing age among those children who are not strongly right handed possibly due to convenience and social pressure (shaking hands using a knife and fork etc) Among the children with articulation problems there were more children using the left hand than the main sample of this population as at Chiswick (b) Colour Blindness Two boys were found with colour blindness (and one father of a child!), (c) Responses to other questions about pregnancy and birth and early medical history of the child have been analysed but would be out of place in this report. It is proposed to submit two papers to specialised journals dealing with child development and speech on some of the findings in this large group of predominantly four to five year old chiIdren 52 53 54 Table 1, Family size and place in family. Number in family 1 2 3 4 5 6 7 8 9 10 Chiswick 34 80 49 29 15 1 2 1 0 1 Heston 30 128 62 11 5 1 0 0 0 0 Position in family 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th Chiswick 100 59 28 16 4 1 2 1 0 1 Heston 113 32 30 9 1 1 0 0 0 0 Table 2 Children who had hearing difficulty Type of loss Chiswick Heston Failed both ears on screening test 6 9 Failed one ear on screening test 13 Right 7 12 Right 4 Left 6 Left 8 Impossible to test 3 0 Table 3, Hand preference for drawing Chiswick Heston RH LH RH LH Main Sample 132 21 174 20 Children with immature speech and articulation difficulties 11 4 7 3 plus one refusal to hold a pencil 55 Hearing Clinic Asthma and Allergy Clinics I am grateful to Dr R Prothero M D L R C P, L R C S, D C H senior departmental medical officer for the following report During the year the allergy clinic was attended by 126 children. 84 boys and 42 girls Eleven children were of pre-school age 81 suffered from asthma 24 from pollenosis, 9 from vasomotoric coryza 6 from migraine 3 from urticaria and 3 from prurigo The general impression is that with more advances in treatment the asthma problem has become less serious Yet there was one death in status astmaticus of an eleven year old boy suffering from chronic asthma since his infancy and resistant to all methods of treatment! INTAL has now replaced the potentially dangerous medi-haler and remains the most successful treatment in extrinsic asthma yet some patients have fallen back on ventolin (Salbutamol) as the chromoglycates seemed to become less powerful in action INTAL too is a strong competitor to preseasonal hyposensitisation but severe pollenasthma still warrants this form of treatment effected with 8-9 injections of alum precipitated vaccines Six children received injections of alavac ana during a summer of exceedingly high and prolonged pollencount were completely (4 cases) or considerably relieved (2 cases) During August and September 1970 there was an unexpected increased incidence of asthma in children who had remained free during the summer and unusually high cladosporium count was judged responsible Many children where in the past parentectorny was the treatment considered as they were we 11 away from home to relapse immediately on return are now often found to react strongly to dermatophagoides pteronyssinus the housedust mite! Which of course does not negate the importance of psychotherapy in childhood asthma The number of cases seen at the hearing clinic during the year was 1.246 of which 378 were new cases and 868 were cases for re-examination The practice of screening all children entering primary school by screen audiometry was continued The children who fail the audiometric test are referred to the school medical officer who decides whether the child should be re tested in the school clinic or referred for further investigation. The number of tests performed during the year is shown in Table 1 Table 1 First test in school Re- test at school clinic Total seen Re test failure Infants (under 7) 2,585 376 2,961 163 Junior (7-11) 2 326 184 2,510 93 Total 4 911 560 5,471 256 The children seen in the school clinic for special audiometry were referred by school medical officers speech therapists general practitioners and from the school psychological service as shown in Table II Table II First test Re test Total Failures Under 5 years 201 10 211 38 5 - 7 years 410 59 469 81 8 - 11 years 403 45 448 94 12 years and over 192 15 207 59 Total 1,206 129 1,335 272 The audiometricians took a total of 573 impressions during the year for use with hearing aids, 69 Medresco (N H S) aids were issued during the year and 317 aids were replaced or exchanged A total of 23 commercial aids were issued 7 post aural and 16 body worn The method of distribution and the number 56 of national health service Medresco hearing aids available are most unsatisfactory. The insert impressions have to be sent by post to the firm which makes the moulds this results in considerable delay before each insert becomes available to the deaf child There are also difficulties in obtaining the most suitable tvpes of Medresco hearing aids for an individual child due to fluctuations in supplies The Department of Health & Social Security has further ruled that after a hearing impaired child who wears a hearing aid has left school repairs can be made to this aid providing this involves the receiver or connector and can be done by the technician If a more serious repair or replacement of the aid is needed the post aural aid is to be withdrawn and a body aid supplied or the young person pavs the full cost of a new post aural appliance During the year the children at Hanworth and Isleworth junior training schools were screened for a hearing loss by the audio metricians 111 hearing tests were performed it was necessary to see some of the children more than once to make a satisfactory assessment of their hearing 53 vision tests were also carried out on the children in these schools and similarly it was necessary to see some of them more than once before making a satisfactory assessment Mr Wall senior peripatetic teacher of the deaf made a total of 738 visits to homes and schools during the year He is responsible for hard of hearing children in both Hounslow and Ealing 8 children attended secondary schools 21 children attend primary schools 8 children attend special schools and 6 children are in junior training centres 12 children of pre school age were visited Four parents meetings were held during the year and Mr Wall spoke on the problem of deafness to 4 interested organisations 3 students from Dr Dale s course at the London University were attached to him to study peripatetic fieldwork for one week Several research projects have been under taken during the year As the result of the head teacher of Beaver s Lane School expressing concern about the possibility of his pupils suffering hearing loss from the effects of aircraft noise a study into the effect of aircraft noise on the children in the school was undertaken 250 children were Drought to the Hearing Clinic and audiograms obtained The BBC filmed this testing for a Man Alive programme The incidence of hearing loss in this group of children did not appear to be significantly higher than in other schools more favourably situated in the the borough It has been decided to test the children of Norwood Green school which is not in the direct flight path for comparison Dr Fisch is a member of a working party set up by the Department of Health and Social Security to evaluate screening procedures for hearing loss in the elderly He was particularly interested in testing the hearing of a group of old people and then trying to treat the hearing defects discovered Audiometric testing was performed on the residents of Heston House 85 audiograms were done 1 only was quite normal 13 of these people already had hearing aids but only 4 of these aids were working satisfactorily Dr Fisch hoped to be able to see all the old people with hearing difficulty and prescribe a suitable aid where necessary He has found however that the present provisions are inadequate to deal with a group such as this During the summer holidays all the Heston children due to start school in the September term were seen at the hearing clinic Each child had a hearing test a test of their speech and language development and a test of their motor function The result of this survey will be published in full in a later report and will be compared with a similar survey performed at Chiswick in 1969 A film strip was made by Dr Fisch on the reaction to audiometric testing of 4 sets of twins The teaching activities of the clinic continued this year Ten post graduate doctors from the Wolfson centre spent a day at the clinic Medical students from St Batholomew s Hospital attended in groups of ten for clinical instruction in audiology. Speech therapists from two schools of speech therapy attended and also student health visitors and student midwives Audio 57 metricians from other centres have visited the clinic and peripatetic teachers of the deaf from the University of London In February a four day course in developmental paediatrics for in-service training of the borough medical officers was held This was also attended by representatives from Hillingdon Ealing and Richmond Visitors from many parts of the world came to the clinic during the year, A group of 18 Japanese on their way to the congress at Stockholm and a group of psychology students from America also post graduate doctors and medical students from America and Turkey, Several groups of people from different areas of the United Kingdom came to see the clinic facilities. Amongst these were representatives from several Regional Hospital Boards who were hoping to set up similar facilities in their areas Dr Fisch gave the following lectures and papers during the year. Lectures, Deaf teachers course Oxford 3 lectures at the Aldrey Fleming college for speech therapy. School for the deaf Liverpool, Course for doctors at the centre for spastic children Assessment of hearing in children with double handicaps Hospital for Sick Children Great Ormond Street International Symposium Sonnenberg Germany on assessment of hearing in the multiply handicapped Course on developmental paedia tries Cambridge Course on developmental paedia tries Bristol Course on developmental paedia tries Bournemouth Health visitors course Tottenham Papers; System Analysis of neuro-sensori hearing loss paper given at British Society of Audiology meeting. In print. The probability of response to test sounds in young children paper read at British Society of Audiology meeting published in Sound, The selective differential vulnerability of the auditory system published in Cioa Foundation. Symposium on sensori neural hearing loss 1970 Mrs M Home was seconded to the audiology technician's course at the Institute of Laryngology and Otology at Gray s Inn Road, London W C 1. Medical Advisory Unit and Cerebral Palsy Unit The referral of multiply handicapped children to this unit for diagnosis assessment and recommendation for educational placement continues During the year a total of 112 children were seen as outpatients of whom 50 were of school age and 62 of pre school age 34 of the children of pre-school age had cerebral palsy 21 had spina bifida and 7 had other physical defects 23 of the children of school age had cerebral palsy, 8 had spina bifida and 19 had other defects 97 pupils attending Martindale School were examined during the year. The following table shows the type of handicaps dealt with at the unit in 1970 Martindale School pupils Outpatients Cerebral palsy 55 57 Spina bifida 11 29 Muscular dystrophy 3 4 Poliomyelitis 4 1 Spinal atrophy 0 2 Brain damage (a) 5 8 Haemophilia 2 1 Rheumatoid arthritis 1 2 Congenital deformities 4 0 Congenita! heart disease 3 1 Other 4 7 58 (a) The children classified as brain damaged include those who have been handicapped following a head injury or following an infection such as meningitis. During the first six months of 1970 the unit was understaffed by physiotherapists but in September the full staff establishment was completed. An increasing number of children under school age now attend the unit regulaly for treatment after school closes each day The figures for the last three years are 1968 1969 1970 50 45 53 The increase in the number of spina bifida children attending both the school and the pre-school group has produced new problems in management and needs necessary reasses sment of the time allotted to treatment For manv of the children daily visits to the department are essential in order to have adequate supervision of their backs and skin Group classes for the spina bifida children have been started in an attempt to stimulate them and to increase their mobility and co ordination. An evening meeting was held for the parents of these children in conjunction with the headmaster of the school At the meeting the staff tried to give the parents a broader understanding of the programme for the physical and educational development of their chi Idren. 82 children received speech therapv during the year. The defects treated being Dysarthria 36 Dysphasia 9 Stammer 2 High frequency loss and dvslalia 1 Retarded speech and language develop ment 20 Multiple congenital deformities 4 Spina bifida 10 A group of children with spina bifida was seen by Dr Joan Reynell educational psychologist from the Wolfson centre who is particularly interested in the language development of these children Many of the children with spina bifida speak fluently but with poor language content Dr Reynell tested these children together with the speech therapist at the school and devised a programme of therapy She hopes to re assess them after one year. A high proportion of children with cerebral palsy attend the Paul Sandifer centre at the Hospital for Sick Children Great Ormond Street During the year a scheme was started whereby a group of Martindale children are seen at the centre on one morning thus enabling the doctor and therapist concerned with the care of the children to be present at the interview This is most helpful to all concerned. Sports activities have continued under the supervision of the physiotherapists Teams were coached and entered for the Stoke Mandeville Games and the Triangular Inter Schools Match At the invitation of the Inner London Education Authority a team of swimmers participated in a gala at Putney baths. During the year Mr Scrutton remedial physiotherapist from the Spastics Society gave a useful lecture on walking aids and Mrs Horton the physiotherapist from the Wolfson centre same to talk about the normal develop ment of hand and arm function. The teaching activities of the unit have continued Ten medical students from St Bartholomew s hospital attended a lecture demonstration and the physiotherapy students from the West Middlesex hospital attended for their paediatric experience Post graduate students from the West Middlesex Hospital on the DCH course pay regular visits to the unit. Baroness Serota visited the unit when Minister of State at the Department of Health and Social Security and appeared to be very interested in the activities Dr Jessie Parfitt from the National Bureau of Child Care who 59 is carrying out a survey of the methods of physical and mental assessment in this country also spent a morning at the unit Child Guidance Clinic I am grateful to Dr Calwell MB BS DPM for submitting the following information. During the first two months of 1970 we were preparing to move to our new premises in Bath Road. On 5th March 1970 we moved to the new building and this occurred with a minimum of disorganisation of the work of the clinic as much planning had taken place There was for a short time a separation from the school psychological service which fortunately did not persist Thanks to the co operation between the health and education departments it was arranged that new rooms were made available enabling resumption of the close liaison between the school psychological service and the clinic. The brief separation has proved how difficult it was for the clinic to function effectively as a team from separate bases. In many wavs we have appreciated and enjoved our fine new rooms and buildings In particular the provision of a comfortable staff conference room and excellent psychotherapy rooms have been most welcome. The situation of the new clinic above the Familv Doctor Unit has enabled unusually close co operation with local general practitioners. During the year we regrettably lost several members of our staff First Mr Barnett was promoted to senior research officer educa tional guidance project National Foundation for Educational Research We were sorry to lose the services of Mrs G Henry psycho therapist who left to have a daughter but we are delighted that at last we were able to fill our increased establishment of psychotherapists through the appointment of three new psycho therapists Mrs Oxford Miss Rankin and Miss Hodgson all of whom we are very pleased to welcome We lost the services of Miss Ison who left to serve in the social service depart ment of the RAF in Cyprus She had been at the clinic for two years and has been greatly missed. Staff from the children s department continue to attend regular weekly seminars Cases of special difficulty were discussed as well as general problems Additionally the children s department has been able to refer cases directly to Dr Calwell who has carried out a series of diagnostic interviews which have in fact taken up the majority of his clinic sessions Dr Brafman has worked mainly with the clinic staff and general referrals to the clinic We were most disappointed that the chronic shortage of psychiatric time was not relieved by the provision of extra sessions by the Regional Hospital Board. We seem to be having increased demands for talks On two occasions the clinic entertained officers from two probation departments to a discussion during the lunch hour Dr Calwell conducted two tutorials for students reading for the Diploma in Child Health and Mrs Lees has given talks to the health visitors students from Isleworth Polvtechnic matron housekeepers students of Applied Social Studies from Chiswick Polytechnic Reading University social workers school counsellors- to student teachers from St Mary s College Twickenham with Mrs Pears and to supervisors of play groups Some of these groups also attended clinic conferences Mrs Lees also has a student school counsellor from Reading who attends the clinic once a week Two other counsellors under training also spent a three week period with the child guidance clinic. At our inter clinic meeting Dr Brafman led a discussion on Hopeless Cases. Mrs Lees started a group for the mothers of children at the autistic unit. The staff meetings of the group on persistent non attendance (P N A groups) met child care officers and education welfare officers at the clinic to discuss their most difficult cases 60 Analysis of cases referred to child guidance clinic i970 Referrals 1970 194 Diagnosed by psychiatrist 118 New cases seen by psychiatric social workers 85 Number of families helped by psychiatric social workers 220 Total attendances to see psychiatric social workers (paints) 1 605 Total attendances to see psychiatrist (parents and/or chi Idren) 461 Number of cases treated by psycho therapist 20 Total attendances to see psychotherapist 349 Waiting list for psychiatric social worker at 31.12.70 44 Waiting list for psychiatrist at 31.12 70 (i e cases prepared by psychiatric social workers child care officer etc ) 11 Treatment waiting list (a) Analysis of referrals Education department 56 Health department 49 Parents 38 Children s department 18 Probation officers 11 General practitioners 9 Hospitals 8 Transfers 2 Others 3 Recommendations for special education Day special schools 23 Residential schools 19 (a) No number has been put against the treatment waiting list as it has been found in practice that it has not been possible to provide psychotherapy for all of even the most urgent cases as and when required Additionally there are a number of cases which would theoretically benefit from psychotherapy if only more sessional time were available Numbers are kept down to produce an artificially low waiting list which nevertheless is alwavs currently in double figures Senior Psychologist for Special Units and Special Schools Dr Mova Tyson BA BSc (Econ) Senior Educa tional Psychologist for special units and special schools reports as follows While increasing numbers in the special schools and a continuously growing number of referrals from colleagues in educational psychological and meoical fields meant that more children about a third more than in 1966 were seen for assessment and advice other projects also required a fair amount of time and attention Among these were the special classes for children with developmental problems in the area of language particularly and a pre school survey in Heston (a repetition of the Chiswick survey) during the summer holidays Both these projects are commented on in detailearlier in this report The flow of visitors continued as did requests to give lectures and talks at conferences and meetings Among the many lectures given was one at Didsburv College of Education in late July to the first national conference of the Joint Council for Handicapped Children (a joint committee of all the major associations dealing with special and remedial education and handicapped children) and another at Dartington Hall Devon to parents of pre school hearing impaired or dysphasic children At these lectures use was made of videotape recordings produced in the special class held every Friday in my room at Heston Hearing Clinic and run by Mrs Cox Senior Speech Therapist and myself The lectures especialIv those at which video recordings were used have stimulated a great deal of interest among teachers speech therapists and psychologists in the experimental teaching which we are undertaking A major publication was a chapter entitled The Design of Remedial Programmes in the massive handbook for psychologists and 61 others edited by Dr Peter Miller on The Psychological Assessment of Mental and Physical Handicap I continued to act as external examiner of teaching practice to the 2 year course for teachers of the mentally handicapped at Chiswick Polytechnic and continued as a member of the Training Councils' Review Panel and also became an assessor to the Durham training course for teachers of the mentalIv handicapped. Special Classes What began as a small experimental class at Heston Hearing Clinic run by Mrs Cox Senior Speech Therapist and myself to provide continuity of help for children who seemed to have benefitted from our summer school has increased greatly in size spawned an off shoot at Isleworth Clinic and has been much visited and discussed. The two classes have diverged somewhat in approach in that the class at Heston Hearing Clinic covers a wider age range of children at least half of whom come from Marjory Kinnon School This class is held weekly on Friday morning and is now taking 12 children. Because of the demand for places it has become increasingly difficult to cope satisfactorily with the larger number of children as well as adults and visitors in the accommodation provided The Isleworth class on the other hand normally takes five children of a rather more homogeneous younger age span The class functions five mornings a week some children attend every day others two or three days a week which means that in fact seven children get some special help The classes are similar in that they are both examples of team teaching with a teacher and a speech therapist in joint control each taking the lead alternately in directing activities. Whereas more of the children at the Isleworth Clinic class are given places because it is felt that they may have a variety of developmental lags which usually include language the heterogeneous group at the Heston Hearing Clinic caters rather more specifically for language difficulties including some children who it is thought are doubly at a disadvantage because another language is spoken at home and they appear to be having difficulties in both languages. Because the Isleworth class functions every day the teacher and the speech therapist are able to ensure that a great variety of activities for all areas of development is covered through out the week The Hearing Clinic class has perforce to be more restricted and in any case with a larger number of slightly older children is working on more advanced activities particularly in sequencing and classification. Because so many visitors and lecture audiences - particularly teachers and speech therapists - have shown an interest in the various activities and the teaching purposes for which they have been devised I am now engaged in writing a handbook which might be broadly described as the impecunious teacher s do it yourself kit of remedial activities'. A well known educational publisher is interested in publishing this and it is hoped that in this way it may be possible to share the learning experiences from our experimental work with other workers in the field. 62 School Psychological Service I am grateful to Mrs M Pears BA for submitting the following report This was a difficult year for the school psychological service Illness shortage and changes of staff and the difficulty of working from School Road when the child guidance clinic had moved to the new health centre, combined to reduce the efficiency of the service as a whole though great efforts were made to make school needs a priority and to maintain the usual close contact with head teachers Source Head teacher 163 Health 21 Parents 12 Hearing clinic 4 Education 3 Child guidance clinic 2 Remedial reading teacher 2 Speech 1 Educational Welfare Officer 1 Prooation officer 1 Central Middlesex Hospital 1 Great Ormond Street (clinic psychologist) 1 Total referrals 217 Problem Learning 92 Behaviour 57 Assessment 47 Learning and behaviour 14 Persistent non attenders 7 Total 217 Disposal No further action 37 Transferred to child guidance clinic 28 Educational social worker visiting 26 Follow up 25 Parents advised 20 Remedial help 19 Head teacher advised 12 Disposal (contd.) Educationally subnormal recommended 11 Individual help (4 of these on waiting list still) 11 Moved away 11 School placement 5 Speech therapy 3 West Middlesex Hospital 3 Dr Tyson 2 Belmont remedial centre 1 Busch House 1 Other 2 Total 217 Staff Mrs Edmonds Smith carried the main responsi bility for all clerical duties through a long period of temporary help after the departure of Mrs Brown in April She was joined by Mrs Fishei in July and a satisfactory routine was once again established in the office. Mr Barnett left in July to take up a research post at the National Foundation for Educational Reseach and in September Mrs Pears was appointed senior psychologist in his place. Miss P Jaeger (from Tasmania) joined the team as a temporary psychologist in November during Mrs de Speville's illness and hopes to remain until the appointment of the third permanent psychologist when the school psychological service should be back to full strength. Remedial Centres In September a team of five full time and fourteen part time remedial teachers was formed so that remedial teaching could be given daily in the child's own primary school to all children requiring help either individually or in small groups. These teachers some of whom are peripatetic are visited by the educational psychologists and it is hoped thattime will be made for regular discussion with them about difficult cases who have not responded to the help offered. Where it is considered that an individual child requires specialist teaching which cannot 63 be provided either in the child's own school or at the school psychological service clinic alternative arrangements are considered but it is interesting to note that in one case where arrangements were made for a dyslexic child to visit the Word Blind Centre in central London the centre gave notice of impending closure and subsequently explained that the decision to close had been taken because it was felt that remedial teaching could be best provided by trained staff suitably equipped in the child's own school. Emotionally disturbed children The special class for disturbed infants at Isleworth Town School had to be discontinued at the end of the Spring Term when the teacher in charge resigned and despite repeated advertisements it was not possible to find a suitable replacement The lack of provision for emotionally disturbed children of all ages emphasises the borough's need for a day school for maladjusted children and the authority continues to seek approval for inclusion of this project in an early building programme. Work with families Social work with the parents of children with learning and behaviour problems referred to the school psychological service continued and has become an essential part of the long term work of the school psychological service The amelioration of tensions in the home often frees a child to take advantage of facilities offered him in school thus contributing directly to his improved functioning in class Quick intervention by the psychologist in the school si tuation and the social worker in the home is often more effective than more extensive help at a later date when the crisis has subsided. Summary of families in treatment Cases Carried over from 1969 38 New referrals 1970 55 Current 93 Working closely with (matrimonial and crises work) 22 Visited 2 3 times a term or at crises 46 Visited occasionally to maintain contact for child's sake 25 Total 93 Of the 93 children Individual remedial help at child guidance clinic 13 Psychiatric assessment °2 Few education authorities have anticipated the trend now widely accepted and practised in the psychiatric and social work field of treating the problem child in the context of his family The Hounslow school psychological service is thus somewhat unique in being so well equipped to work effectively in this way. School psychological service remedial department The remedial department part time teachers Mrs M A Kinnon and Mrs S Thrift who joined the staff in September ha/e continued to provide help for children who have failed not only in a class situation but in the small remedial group. These children have suffered through failure and may have shown personality difficulties in addition to academic ones A total of 27 children are being seen individually. Ages range from eight + to the non reader about to leave school recommended by the probation officer and head teacher for special help. One child has recently transferred to the Marjory Kinnon School for educationally subnormal children Three children show marked symptoms of the specific develop mental dyslexia syndrome and several have visual and auditory difficulties. All children show progress some very limited in the initial period The greatest advance is in 64 personal confidence and in a willingness to try again in a situation which has so far resulted only in humiliation and failure. Grateful thanks are due to Dr Lindon and to Mr P J Lee for help and encouragement in the varied work of the service '. Handicapped Pupils The Education Act places on local education authorities the duties of ascertaining which pupils in their area are handicapped and of providing special educational treatment for such pupils. The several categories of pupils requiring special educational treatment are defined in the Handicapped Pupils and Special School Regulations as follows Blind Epileptic Partially sighted Maladjusted Deaf Physically handicapped Partially hearing Suffering from speech Educationally defects sub normal Delicate For the purposes of these regulations ascertainment applies from the age of two years, A blind or deaf child must be educated at a special school unless the Minister approves otherwise Special educational treatment for other handicaps may be provided in an ordinary school with the stipulation that the special educational treatment must be appropriate to the disabilitv The number of handicapped pupils and the arrangements made for their special educational treatment are shown in the table overleaf 65 Handicapped Pupils requiring education at Special Schools approved under Section 9 (5) of the Education Act 1944 or boarded in Boarding Homes During the calendar year ended 31st December, 1970:- Blind Partially sighted Deaf Partially hearing Physically handicapped Delicate Maladjusted Educationally sub-normal Epileptic Speech defects Total A Number of handicapped children newly assessed as needing special educational treatment at special schools or in boarding homes Boys . . 3 1 2 7 38 21 2 - 74 Girls 2 4 5 1 11 12 - - 35 B Number of children newly placed in special schools (other than hospital special schools) or boarding homes a of those included in A above Boys - - 2 1 - 4 21 14 1 - 43 Girls - 1 - 3 2 1 6 7 - - 20 b of those assessed prior to January 1970 Boys 1 - 1 - 6 5 8 2 1 - 24 Girls - - - - 1 7 7 4 - - 19 c Total newly placed B(a) and B(b) Boys 1 - 3 1 6 9 29 16 2 - 67 Girls - 1 - 3 3 8 13 11 - - 39 C On 21st January. 1971 children were awaiting places in special schools other than hospital special schools as follows:- a Under 5 years of age (i) Waiting before 1st January 1970 1 day places Boys - - - - 1 - - - - - Girls - - - - - - - - ■ - boarding places Boys - - - - - - - - - - - Girls - - - - - - - - - - - (ii) Newly assessed since 1st January 1970 day places Boys - - - 3 - - 1 - - 4 Girls - - - 1 3 - - 1 - - 5 boarding places Boys - - - - - - - - - - - Girls - - - - - - - - - - - b Aged 5 years and over (i) Waiting before 1st January 1970 (a) whose parents had refused consent to their admission to a special school day places Boys - - - - - - 1 - - 1 Girls - - - - - - - - - - - boarding places Boys - - - - - - - - - - Girls - - - - - - - - - - - (b) others day places Boys - - - - 1 - - 1 - - 3 Girls - - - - 3 - - - - - 3 boarding places Boys - - - - - - - - - - - Girls - - - - - - - - - - - 67 66 Partially hearing Physically handicapped Delicate Maladjusted Educationally sub-normal Epi leptic Speech defects Total - - - - 1 - - 1 - - - - - - - - - - - - - - - - - - - - - . _ _ - - - 3 2 - - 5 - - - 2 3 - - 5 - - - 6 - - - 6 - - - 1 - - - 1 - 5 - 4 6 - - 15 1 6 - 2 4 - - 13 - - - 6 - - - 6 - - - 1 - - - 1 7 28 21 42 86 195 14 14 12 21 74 - - 148 - - 5 4 4 - - 13 - - 7 1 1 - - 9 - - - - - - - - - - - - - - - - - - 2 6 - 2 - 23 1 1 - 5 1 - - 10 - - - 8 - - - 8 - - - - . - - - - - 1 22 1 1 - 25 - - 1 6 - - - 8 68  BIind Partially sighted Deaf (ii) Newly assessed since 1st January 1970 (a) whose parents had refused consent to their admission to a special school day places Boys - - Girls - - boarding places Boys - - Girls - - (b) Others day places Boys - - Girls - - boarding places Boys - - Girls - - c Total number of children awaiting admission to special schools other than hospital special schools total of (a) and (b) above day places Boys - - Girls - - boarding places Boys - - Girls - - D On 21st January 1971 the following number of pupils were on registers of: (a) Maintained Special Schools (other than hospital Special Schools and special classes and units not forming part of a special school) regardless of what authority they are maintained day Boys 4 7 Girls 7 6 boarding Boys - - Girls - - (b) Non maintained Special Schools (other than hospital special schools and special classes and units not forming part of a special school) wherever situated day Boys - - Girls - - boarding Boys 4 1 8 Girls 1 - 1 (c) Independent schools under arrangements made by the Authority, day Boys - - Girls - - boarding Boys - - Girls - 1 69 Busch House School (Isleworth) This school caters for delicate and maladjusted children Because of the nature of handicaps, seriously aggressive children are not admitted. The delicste children include maiy with chronic physical conditions The school has places for 100 children divided equally between delicate and maladjusted pupils. The maladjusted children are under the psychiatric care of the psychiatrist from the child guidance clinic except for a few children who are treated by a psychiatrist in hospital or from another borough. A senior school medical officer visits the school weekly to advise on the care of the delicate children and to supervise the health of the maladjusted group. Many of the maladjusted children suffer from a temporary or chronic physical illness or from overt physical symptoms It is valuable to be able to obtain psychiatric advice for many of the delicate children who are as much handicapped by emotional disorders consequent on their illness and associated hospitalisation as by the physical illness itself In such a mixed school these children are able to receive the special handling they need without making them conspicuous by treating them differently from their peers. The figures in the following table relate to the position in December 1970 and show the number of children who attend from Hounslow and neighbouring authorities Boys Girls Total London Borough of Ealing 5 5 10 London Borough of Hounslow 54 30 84 London Borough of Richmond 2 2 4 North Surrey 1 - 1 Total 62 37 99 Special schools Four special day schools for handicapped pupils are maintained by the education committee. High quality diagnostic and therapeutic services continued to be provided at the special schools by the borough s doctors, psycholo gists nurses speech therapists, physiotherapists audiometricians orthoptist and social workers Provision is also made in recommended cases for some handicapped pupils under five years of age to be admitted to day nurseries. Martindale School (Hounslow) This is a day school for physically handicapped children with a closely associated medical unit. Furniture and apparatus capable of being adapted to the needs of the pupils is in use and facilities are available for hydrotherapy, physiotherapy and speech therapy. The majority of the pupils suffer from cerebral palsy and many are dependent on wheel chairs for locomotion Close co operation between the teaching and medical staff is necessary to secure a reasonable balance between the educational and treatment needs of the child and to make the best of his physical and intellectual potentials Many of these chiIdren have learning difficulties and here the services of the senior educational psychologist are particularly useful The figures in the following table relate to the position in December 1970 and show the number of children who attend from Hounslow and neighbouring authorities Boys Girls ; Total London Borough of Ealing 18 12 30 London Borough of Harrow 3 3 6 London Borough of Hillingdon 7 8 15 London Borough of Hounslow 29 15 44 London Borough of Richmond 10 7 17 Buckinghamshire County Council 2 3 5 Surrey County Council 10 3 13 Total 79 51 130 The number of children on the waiting list has 72 increased during the last two years largely due to a lack of nursery facilities. In 1971, however,two nursery classes for a total of 20 children will be opened which should greatly reduce this waiting list. Heston School for the Deaf (Heston) This day school with its associated classes for the partially hearing in Townfield and Harlington Secondary Schools Springwell Infant Springwell Junior Norwood Green Infant Norwood Green Junior and Oriel Junior Schools provides accommodation for 160 deaf and partially hearing pupils. The medical officer to the hearing clinic gives general medical supervision of these pupils and there is full discussion of hearing and learning difficulties between the clinic and teaching staff. The figures in the following table show the numbers of children who attend the school from Hounslow and neighbouring authorities. Deaf Boys Girls Partially Boys Hearing Girls Total London Borough of Brent 4 6 2 4 16 London Borough of Ealing 7 9 11 12 39 London Borough of Harrow 2 3 3 5 13 London Borough of Hillingdon 8 5 6 10 29 London Borough of Hounslow 7 5 12 9 33 London Borough of Richmond 2 - 6 5 13 Bucks Couity CounciI 2 1 1 4 Surrey Couity Council 4 2 2 - 8 Herts County Council 1 1 - - 2 ILEA - 1 - - 1 Total 37 33 43 45 158 The Marjory Kinnon School (Bedfont) During the year a senior medical officer visited the school twice a week All children in the school were examined during the year and in the majority of instances one or both parents were able to attend to discuss their child s health and educational progress. With the consent of the family doctors some children were referred to the Great Ormond Street and other hospitals for further investigations. Electro encephalographic examinations which were arranged with Chevne Walk Centre for spastic children yielded useful information. Over ninety of the children were found to have a definite organic condition which could be associated with mental backwardness and over sixty were found to have had an abnormal birth In many cases the cause was considered to have been multifactorial Letters were sent to consultants and family doctors where it was felt that the school could give additional useful information about illness, fits or behaviour The psychologist physiotherapist and speech thera pist made a point of seeing parents where this would be useful Visits by the social worker were particularly helpful and often it was only with her help that medical work could be carried out particularly with problem families. The headmaster and his staff appreciated the interest shown bv the medical staff and were always ready to co operate in frequent discussions about the children by giving information about difficulties with sight hearing learning problems and changes in behaviour. A need was felt for extra help by a member of staff with nursing experience and a part time appointment was made in September, 1970 A new school building which is being erected will when completed give much larger space for medical and psychological examination and for physiotherapy and speech therapy. It will then be possible to extend the combined work which is going on between the psychologist and speech therapist on language development and it is hoped that it will be possible to allocate more speech therapy sessions to the school. The figures on the following table show the numbers of children who attend the school from Hounslow and neighbouring authorities 73  Boys Girls Total London Borough of Brent 1 1 London Borough of Ealing 2 2 London Borough of Hounslow 78 70 148 London Borough of Richmond 5 2 7 North Surrey 17 12 29 Total 101 86 187 Aftercare of handicapped pupils Case conferences are called by the head teachers of the special schools and the principal school medical officer concerned to discuss the special problems which arise when handicapped children reach school leaving age. The youth employment officer and representatives of the welfare department attend and where appropriate those repre senting voluntary organisations such as the Spastic Society and Fel lowship for RdI iomyel it is are also invited. Arrangements are fully discussed with the parents and where assist ance from the Depa-tment of Employment and Productivity scheme for disabled persons is required this is arranged by the youth employment officer. Martindale School is fortunate in having a further education unit which provides largely for its own pupils who on reaching the age of 16 require further instruction before they can satisfactorily be placed in employment It has now become possible for pupils from the Marjory Kinnon and Busch House schools to share the facilities which this unit offers. There remain always some children who are so severely handicapped that no employment is possible and for these particularly the welfare department is able to provide help. Education otherwise than at school Consideration is given to providing home tuition to handicapped children awaiting admission to special schools children having a long convalescence following acute illness and others who for some specific reason may not be able to attend ordinary schools. Statistics relating to the provision of home teaching are included on the handicapped pupils table on page 70. No hospital special schools are provided at hospitals within the borough but arrangements are made for children to have tuition in the wards at West Middlesex hospital and Ashford hospital. Children excluded from school as unsuitable No formal decisions were recorded under Section 57 of the Education Act 1944 excluding children as unsuitable for education in school nor were any reviews conducted under the provisions of Section 57A or any decisions cancelled under Section 57A (2). Six children however were found unsuitable to attend either ordinary or special schools and these were dealt with informally. Similarly 2 children dealt with informally were re admitted to a special school. Medical and dental inspection and treatment of children excluded from school as unsuitable The medical and dental facilities are available to the severely sub normal children attending the two junior training schools in the same way as for those attending ordinary schools. A physiotherapist attends each school to give treatment to those children in the special care units who additionally have severe physical handicaps principally cerebral palsy. It has been possible to arrange for speech therapy at both junior training schools for the treatment of selected cases and to enable the staff to be instructed in the constant use of speech therapy techniques. Day Nursery In some cases physically and mentally handi capped children of pre school age can benefit from the training, sheltered atmosphere and the companionship provided by a day nursery Where recommendations are made for such admission for children over the age of two years, the cost is borne by the Education Committee under Section 56 of the Education Act, 1944 Twelve 74 such children were admitted to day nurseries during the year Social Workers Report I am grateful to Mrs J Harding B Sc (Soc) and Mrs G Wisdom AIMSW social workers (special duties) for the following report. We now feel ourselves established in the special schools and units as integral members of the specialist team concerned with the handicapped child We are more than satisfied with the way our colleagues refer cases to us and take our advice as social workers Work is also easier now that we have an established relationship with all the relevant social work agencies in Hounslow and the other boroughs covered by us This liaison with case workers schools and organisations is an essential part of our work and to this end between us we have visited during the last year:St Nicholas School Redhill Turners Court School St Christopher s Working Boys Hostel Leavesden Hospital the Wolfson Centre and have attended various meetings of social workers,teachers and social workers,school leavers conferences,parent teacher association conferences on the handicapped child and his family. We have also read papers and given lectures on our work. On a practical level new referrals to us have been of the same order as before Mrs Wisdom has been working full time attached to Marjorv Kinnon school and to the Medical Advisory Unit and Ma-tindale School and has had 106 new cases referred between Mav 1970 1971 and Mrs Harding returned from her special lea^e in August 1970 is working part time at the hearing clinic and Heston School for the Deaf has had 45 new cases referred Analysis of referrals 1970/71 Martindale and Medical Advisory Unit 49 Marjory Kinnon School 53 Hearing Clinic 25 Heston School for the Deaf and physically handicapped units 17 Analysis of referrals (contd.) 1970/71 General (Mrs Harding) 3 General (Mrs Wisdom) 4 Total 151 151 new cases compared with 122 last year At present there is no social worker working with Busch House School and so we have an establishment of ½ social workers-our current case load is high Mrs Wisdom has 158 cases and Mrs Harding 101 and to give these cases the attention they require we did 571 visits last year between us Our case load of 259 for 1½ social workers must be compared with the number of 180 on our files at the writing of the last report. The new cases referred fall into the same broad categories as before viz new school entrants contact with school and parents help for depressed and unsupported mothers of a handicapped child housing problems arrangement of holidays matrimonial problems liaison with immigrant mothers etc In fact any problem caused bv or exacerbated by the presence of a handicapped child in the family We have both noticed recently that the social problems seem to be more complex and we have each found one particular tvpe of handi capped child whose families are taking up an increasing proportion of our time and thought With Mrs Wisdom it is the families of spina bifida children who were specificallv mentioned in our last report and Mrs Harding is now finding that the problem of the deaf/blind children and their families need to be studied in greater depth These unfortunate chiIdren particularly although few in number (there are 5 in Mrs Harding s caseload) need so much help both at home and school that it would be possible for a social worker to devote all her time to helping the parent to adjust to and cope with the child and liaising with the numerous medical/educational and social work agencies involved. We find that earlv referral of children with these complex handicaps is of assistance to us in helping the familv come to terms with 75 their child s disabilities Indeed problems can be removed before they are manifested if we can get to know the familv immediately after diagnosis This is one of the advantages of having a social worker as a member of the special unit teams. Recuperative holidays During the year the borough council accepted responsibility under Section 48 of the Education Act 1944 for the maintenance of 50 children in recuperative holiday homes Forty five were admitted to such homes and 4 were cancelled or withdrawn and 1 was awaiting placement at the end of the year. Health education in schools Every young person has certain basic needs that are outgrowths of his physiological and emotional development and also of his mode of living. These needs should be met satisfactorily if growth is to proceed in orderly fashion. It is generally accepted that it is not enough to do things for the child in the name of health, He himself should learn at his level of understanding what these needs are and should share in efforts for meeting them. As a result of a survey carried out during 1969 a pilot health education project in secondary schools was commenced in Januarv The pilot project was formulated according to known needs resources and social conditions and the actual teaching was planned from the standpoints of concepts to be developed and problems to be solved On many aspects of the programme emphasis was laid on activities and experience rather than on didactic instruction. Five secondary schools were selected to participate in the pilot project and the teaching procedure was as follows The talks were given by the health education officer who attended each of the five schools for half a day each week. The pupils received the talks form by form in their own classrooms in the presence of their form teacher. The head teachers also attended one lecture on each of the five selected subjects Other people who attended the talks included doctors the deputy education officer social workers students from four teacher training colleges, health visitors and other nursing staff. When one of the subjects was completed in any particular school. the next subject was tackled. The subjects were Health hazards associated with cigarette smoking The misuse of drugs and alcohol Positive health the development of good mental and physical habits and the emotional needs of the family unit. The future years marriage sex and the responsibilities of the adult in society. Venereal diseases gonorrhoea syphilis and non specific urethritis. When the five subjects were completed in a school the following 16 m.m. colour sound films were presented. Boy to Man Girl to Woman Drugs and the Nervous System A Quarter Million Teenagers (concerned with V D ) The films reinforced the previous teaching and group discussions and they also enabled a number of pupils to ask supplementary questions or submit useful observations. The head teachers and their staff co operated fully and throughout the six months project the health education officer held informal discussions with individual teachers parents and chiIdren. Evaluation Various tests conducted throughout the project and the interim and final reports submitted by the head teachers proved that the talks were well received and that the subject matter was of considerable interest to teachers parents and pupils. Many parents reported that it was only after their children had received the talks on inter family relationships sex and venereal diseases that mother and teenage daughter had been able to discuss certain aspects of health and mode of living On the other hand children repeatedly stated that the course of lectures and discussions had broadened their horizon and given them valuable insight into personal 76 social and health problems and enabled them to appreciate their parents point of view With the consent of all concerned a B B C TV 2 Man Alive camera team attended one of the lectures and the resulting documentary will be shown at a later date. Research Research is currently being carried out into other aspects of health education and it is also planned to increase the number of lectures being given to other sections of the community School Meals and Milk The following information concerning the provision of school meals and milk relates to a check made on one day in September Maintained Schools Meals Pupils present in school 29 736 Pupils taking meals 20 234 Percentage taking meals 68% Milk Pupils in school (primary and special schools only) 18 531 Pupi Is taking mi Ik 17,426 Percentage taking milk 94% Non maintained schools Number of schools (primarv only) taking milk 9 Number of children present 585 Number of chi Idren taking mi Ik 505 Percentage taking milk 86% First Aid in Workshops. Offices Colleges and Schools The council has a legal obligation under the Factories Act 1961 and the Offices Shops and Railway Premises Act 1963 to provide qualified first aid personnel to treat accidents in council workshops and offices. Because of this requirement and that of providing trained first aid staff for schools and colleges, it was decided to organise two first aid courses each year. During the year the spring and autumn courses were well attended and all the twenty eight candidates entering for the British Red Cross examination passed at proficiency grade. A member of staff who has been well trained in the principles and practice of first aid is a valuable member of a working group,be this in a school an office or a workshop. He is not only competent to treat injuries but also to help prevent accidents by giving advice to fellow members of staff on safe methods of working. Infectious Diseases The following numbers of cases of infectious disease are known to have occurred among school children during the year Chickenpox 346 Encephalitis 1 German measles 710 Infective jaundice 17 Measles 352 Meningitis Mumps 268 Scarlet fever 29 T uberculosis Whooping cough 23 There were no cases of diphtheria or poliomvelitis When pulmonary tuberculosis is found in a pupil or teacher the chest physician is consulted and where considered advisable investigations of school contacts are under taken Schoolchildren between their thirteenth and fourteenth birthdays are offered a test for susceptibilitv to tuberculosis and BCG vaccination. During the year 1025 school children and students received BCG vaccination. Student Health The borough's student health service serves Chiswick and Isleworth polytechnic colleges The number of full-time and part time students 77 increased slightly over the 1969 figure The Colleges continue to provide a wide range of training courses for such occupations as engineering scientific work photography fine art hairdressing and work in the health services During the year several course lecturers asked for information and advice on the occupational health aspect of the subjects they taught. These included contact dermatitis caused by chemicals used in photography, skin cancer caused by continuous contact with cutting oils in engineering and the hazards of inhalation of hair lacquer in hairdressers An important part of student health work is the counselling aspect. Students sometimes need urgent advice on health and welfare matters in order to prevent illness. It was possible to increase the counselling facilities considerably in September 1970 on the appoint ment of Miss Anne Griffin SRN OHNC to the post of student health nurse Thus after some four years of the polytechnic student health services's existence the team of tutor, welfare officer nurse and doctor is complete. It is to be regretted that both Colleges decided not to hold their annual induction course for new students in 1970. These courses provided an opportunity for new students to learn about the health and welfare services of the colleges as well as to receive advice on student health matters. It is hoped that these induction courses will be re organised in future years Talks on the social mental and physical problems of adolescence were given to the parents of students and several parents asked for individual consultations on specific young people s health problems Nurse Griffin held a group discussion with women students on the health problems of young people and this was well received It appears that the individual health consultation and group discussion of health problems are more accept able to most students thai the didactic health lecture 78 Report of the Principal School Dental Officer for the year 1970 It is with regret that it must again be recorded that the development of the school dental service has been seriously hampered by staffing difficulties. It became virtually impossible to fill vacant posts for dental surgery assistants. During the year a number of admirable candiddes having previous experience of surgery work were interviewed and offered posts. All rejected the offer on consideration of the commencing salary offered even though it should be pointed out that in 1965 the borough council agreed to some discretion in the commencing salary related to the nationally agreed scale At the time this was partially successful inasmuch that it attracted a higher standard of applicant although few had previous experience of the work and required training which was not easy to arrange. Similar difficulties have occurred in providing adequate clerical assistance and during the first three months of the year it was impossible to replace a clerical assistant who had been promoted to another section. The recruitment of dental surgeons improved but towards the end of the year some were working at reduced efficiency due to the failure to provide adequate surgery assistance. The improvement of this situation is a matter of urgency and is at present the subject of detailed discussion. Due to the loyalty of staff in post these difficulties were minimised and thanks are due in particular to surgery assistants who helped in more than one surgery for extended periods of time. As a result more children were inspected and treated than in the previous year the output of work was above the national average and the ratio of teeth filled to teeth extracted continued to be favourable. The number of emergency cases however showed a slight increase and although it would be unwise to draw any conclusion from one year s increase in emergency treatments it will give cause for alarm if the trend continues in 1971. A considerable amount of advanced conservative treatment was provided for special classes of children including the provision of 102 crowns which usually became necessary as the result of accidental fracture of incisor teeth. Sickle cell anaemia a blood condition which may result in a hazard during a general anaes thetic is related to the race of the patient in particular those who ethnically originate from Africa Patients may be screened by a comparatively simple test and during the year arrangements were made to screen all patients thought to be at risk before referral for extraction with a general anaesthetic Records will be kept and the value of the screening process reassessed from time to time. The results of the toothpaste trial undertaken in Hounslow and commenced in 1965 by Professor G L Slack and his team, were published in the British Dental Journal The newer type of paste was shown to have slightly greater ability to reduce dental decay than conventional pastes. The degree of prevention however was not sufficient for its use to make a significant impact on dental decay in the community as a whole. At the present time fluroidation of domestic water supplies remains the most effective method of reducing dental decay on a community basis. Water fluoridation however remains a matter of controversy and although the London Borough of Hounslow has given approval in principle, implementation of this preventive measure is not possible until there is a unanimous demand from all the Authorities drawing water from the Metropolitan Water Board and the South West Suburban Water Board. Research has continued into the significance of the appearance of the tongue in relation to possible vitamin deficient states The increasing school population throws additional responsibility on the local authority dental service and a survey has been commenced to assess the probable demands for dental care during the next ten years Prelimina-y results suggest that the local ajthority service in 79 Hounslow treats at least half the school children in the borough and that this percentage is tending to rise. If this is confirmed by more extensive surveys it will follow that consideration will need to be given to ways of increasing the dental facilities provided by the council. 80 Occupational Health The organisation and mode of operation of the Staff (Occupational) Health Service was set out in fair detail in the 1968 annual report Only advances and developments in the service during 1970 will be described here There was again an increase in the number of staff requesting medical consultations and medical examinations The medical check idea seems to be gaining ground slowly Also it was found at these medical consultations that employees appear to be increasingly aware of the health aspects of their occupations, The number of staff referred by departmental heads for advice on medical fitness with respect to occupation increased slightly The difficulty of finding suitable work for the physically handicapped manual worker increased with the introduction of more team work in road repair and cleansing work The annual survey of toxic substances used in the council s establishments showed that no new toxic substanceswere apparently being used bv staff During a dry very hot spell of weather in September 1969 a coarse black dust was found in considerable amount on the grass at Cranford Park The dust was thrown up in clouds by the grass mowing machines and was causing respiratory and skin disease in the two grounds men The source of the black dust was a complete mystery. There are no factories within half a mile of Cranford Park and exhaust fumes from aircraft and motor vehicles was discounted as the cause on account of the great amount of the dust present Samples were sent for laboratory analysis and the dust was eventually identified as the grass fungus Pithomvces chartarum This is a very rare fungus in England but it is common in New Zealand where it causes disease in sheep who have ingested the infected grass Research on the effect of this mvcotoxic fungus on human beings was commenced in 1970 in collaboration with Dr P H Gregory of the Rothampstead Experimental Station Harpenden and Dr M B Ellis of the Commonwealth Mycological Institute at Kew, Dr P H Gregory along with Dr M E Lacey were the first persons to discover this fungus in England Miss Anne Griffin SRN( OHNC was appointed occupational health nurse to the borough in July 1970 The London Borough of Hounslow is the first local health authority to make such an appointment in this country, Miss Griffin assisted with the health couselling of staff with the training of first aid personnel and supervision of first aid work and with the occupational environmental hygiene visits to the council s offices and workshops 81 During the year the following examinations and assessments were made Medically assessed 1970 1969 1968 1967 With pre employment medical examinations 318 385 387 360 Without pre employment medical examinations 1,499 1,304 1,434 1,370 Left before completion of medical assessment 86 107 106 162 Staff medical consultations (including medical examination of existing staff for purpose of admission to the superannuation scheme sickness pay scheme continued fitness for employment and registered disabled persons examinations) 394 343 173 36 Heavy Goods Vehicle Licence medical examination (Road Traffic Act 1967) 62 Nursing consultations (July December 1970) 56 Nursing occupational health visits (July December 1970) 74 Medical examination of other local authority staff 11 10 4 7 Medical examination carried out by other local authorities 8 15 1 35 Medical examination for first teaching appointments 41 99 93 104 Medical examination of student teachers (College Entrants) 110 213 230 217 82 Mental Health Continuing the policy approved by the health committee of extending facilities for community care of the mentally disordered two new establishments were brought into use during the year, The purpose built psychiatric day centre was an integral part of phase II of the develop ment of the health centre at Bath Road. There is provision for 45 mentally ill patients to attend daily and admission started in July 1970 This is intended as a further step in helping patients requiring treatment and/or rehabilitation whilst remaining in the community. The regional hospital board at present provide one consultant psychiatrist session and two registrar sessions a week these sessions will need to be increased as the centre becomes full The borough council provides a fully trained nursing staff backed up by an occupational therapist and a social worker Thus a wide range of patients can be provided for The early results appear to be very encouraging and are also providing a good example of close co operation between the various parts of the National Health Service Westbrook home designed for the full time care of twelve mentally handicapped children started admitting children in December 1970 and at the time of writing is already more than half full There is no doubt that this type of facility will reduce the need for hospital accommodation for such children and provide a more homely natural and stimulating environment than a large institution can hope to do In addition being sited near to the children s families a closer link is possible with their own homes and visiting by relatives is made easier Parents are also encouraged to take the children home when possible at weekends and for various holiday periods By retaining these family ties it is hoped that when the children have responded to training and teaching at the junior training school which they will attend daily and when the social stress at home which may have necessitated their admission has abated- some of the families will be able to accept the children at home again. Junior Training Schools The two schools atlsleworth and Hanworth ha/e both had successful years Mrs Williams the head teacher at Hanworth for a number of years retired in October 1970 She had been an inspiration to children and staff alike I am pleased to report on the appointment of a worthy successor in Mrs Carter who started in January 1971 During the course of the year both the borough of Richmond and Surrey county council withdrew children from Hanworth and this has enabled the teacher child ratio to be reduced to near 1:10 the figure recommended by the Scott Committee report. The demand for special care unit places persists and the proportion of children with severe physical handicaps is increasing; some of these it is thought should ideally be catered for by day hospital care! but this is not at present being provided in the area. During the latter part of the year preparations were made for the education department to take over the admi nistration of these schools. Meetings were held between departmental heads and the school staff and were followed by public meetings at each school. These measures almost entirely eliminated the anxieties that might have otherwise arisen Physiotherapy report by Mrs J Biddle superintendent physiotherapist, Isleworth junior training school The physiotherapist has made regular visits to the school and has had 16 children on treatment She has made home visits to discuss problems with the parents and hospital visits to promote better handling through which the children learn the correct patterns of movement for daily living. Staff from the 83 The Mayor and Mayoress join the children after the official opening of Heston Long Term Home for mentally handicapped boys and girls. (Photograph by permission of the Evening Mail) The main recreation room at Heston Long Term Home. Wolfson centre have visited the school and discussed the problems of caring for the children at home Parents have been welcomed at the school where thev have been given advice and help Hanworth junior training school The physiotherapist attended the school for two sessions a week if the needs of the 18 children whom it is thought might benefit bv treatment are to be met it is felt that more time for physiotherapy should be made available Several of these children require dailv supervision of walking etc which is undertaken by the helpers whenever their other duties permit There are many situations which require skilled hands particularly the management of spina bifida ileostomies and children prone to fits There is no qualified nurse employed at the school at present but provision has been made to meet this deficiency in the near future Knowledge of the full medical histories of cases is of paramount importance in treatment bv physiotherapy and thought is now being given to making this knowledge available to the physiotherapist at the school Another responsibility of the physiotherapist is the choice of the correct apparatus for standing sitting mobility etc for each child The appropriate apparatus can usualIv be supplied This is a very happv school which by its very essence is run under great difficulties and anything done to ease the burdens of the staff is always much appreciated Speech therapv report by Mrs DE Cox senior speech therapist, During 1970 speech therapy in the junior training schools continued as in the previous year with mixed individual and group therapv The increasing number of children requiring individual help has curtailed the more general work in the classroom that was started earlier at Isleworth Junior Training School There are still only two sessions per week at each training school but although limited this amount of help allows progress to be made especially when speech therapy is closely backed up by the teacher in the class room There is a great need for a closer link with the parents The holiday period has many demands on the speech therapy service and home visits during these times are necessarily restricted in number It is hoped to try various methods of establishing contact with parents during the coming year The present number of sessions per week at each school allows only a small proportion of the children needing help to be seen while the remainder are kept under supervision with advice given to the teacher concerned and parents where this is possible Current trends in speech therapy are heavily weighted in favour of intensive treatment This enables the length of treatment to be considerably cut where there is a favourable prognosis, Where the child has multiple disabilities isolated speech therapv on a once a week basis shows negligible progress and the treatment must be regular long term supportive and fully integrated into the child s environment both home and school This applies to both speech defects from physical causes and retarded language development involving perception and other difficulties Where daily speech therapy is dovetailed into the teaching programme much greater progress has been made Therefore much more time is needed for the speech therapist in the junior training schools so that children can receive intensive short term treatment regular long term help in association with their general training programme and so that the therapist has sufficient time to make the maximum contact with the parents both to give advice on the parent s role in the training needed and to help and support the parents in their anxiety over their childrens difficulties with speech and language Other Day Establishments Heston Day Centre This centre now in its second year provides a service for 60 elderlv people Although the 86 centre has been staffed to cater for 40 it is possible to meet the needs of a larger number by having some attend on a part time basis At present 75% attend full time Most of those attending are brought to the centre each day in a council owned coach but a coach is hired to bring 12 from the Chiswick area, Without the care provided by the centre it is felt that about 50% of those who attended for the first time during the year would have been admitted to geriatric beds in a psychiatric unit On admission to the centre our clients are often restless,agitated,confused and a number are incontinent Regular visits by Dr Herridge and his registrar ensure that medication can be provided quicklv where necessarv and progress observed to present deterioration At present 75% are receiving medication,six are diabetic requiring strict control of diet and urine testing,six receive injections everv two weeks Another six have received special treatment at West Middlesex psychiatric day hospital- We are grateful for the regular visits made by the chiropodist. Another service provided at the day centre concerns hygiene About ten clients have a weeklv bath at the centre and a change of clothes This service is necessary for various reasons. Some have elderly relatives who are not able to give the help thev need in their own homes others who live on their own do not bother because thev are either too confused or too phvsicallv tired. A varietv of activities are offered at the centre some industrial work knitting making trays,soft toys,stools etc All are designed to give our elderly folk interests^ sense of achievment and increase their confidence and feeling of worth, Thev are often pleasantly surprised at what thev discover thev are still capable of doing and the sense of pride they get in finishing an article. Out of the net proceeds returned to the centre by the borough council it was possible to take the elderly folk to a pantomime in January and to the seaside for a dav during the summer. Very sincere thanks are due to Messrs Stenner Ltd who again invited some of the clients to accompany employees of their firm on their annual outing The centre is fortunate to have excellent support and coverage from Mr Charles and his team of social workers Thanks are also due to the family doctors for their help during the year and last but not least Mr Brickman the local chemist who is most understanding and co operative when medicines are required urgently. This centre has now matured and developed to a high degree The staff under the enthusiastic leadership of Mrs Kenneally has always been prepared to accept the challenge constantly presented by this work but all are aware that so much could not have been achieved without the support of many people outside the centre Heston day psycho geriatric unit is thus serving a most useful purpose and it seems there is scope for at least another similar centre sited preferably at the eastern end of the borough to save long coach trips, Acton Lodge Adult Training Centre Acton Lodge is continuing its role as a progressive adult training centre The laundry was brought fully into operation during the year and this is not only a very valuable training medium but adds appreciably to the income earned by the centre Brentford Adult Training Centre This centre continues as a stepping stone for some trainees into industry and provides a more demanding environment for the higher grade subnormals than does Acton Lodge Holiday Camp for Mentally Handicapped Adults In September a holiday was arranged for those adult trainees who wished to attend at St Mary s Bay holiday camp Dvmchurch It was a great success. Other Residential Establishments Weekly Boarding Unit Hanworth This has fulfilled a most useful function 87 during the year and has remained full through out. Miss Hassal who has proved to be an outstanding matron is unfortunately leaving in the near future for personal reasons, During August when the children normally in residence were on holiday a period of two weeks short term care was arranged for twelve other children whose parents needed a break.. The regular staff was augmented by student teachers seconded from Chiswick polytechnic and volunteers. The children enjoyed this period and the outings to the seaside,zoo and other places of interest which were organised for them. Wood Lane Hostel The hostel is serving a most useful purpose There can be no doubt that if cases that are suitable for community care are to be kept out of hospital further provision will be necessary in the near future the need might best be met by a series of satellite houses within a reasonable distance of Wood Lane and Acton Lodge. The following report has been submitted by Mr M Vincent the resident warden. Admissions from Discharges to Home/ Community 13 Home/Community 6 Hostels 3 Hostels 2 Mental after care 1 Leavesden 4 ChiIdren sdept. 2 Springfield 1 Hospitals 4 Total 23 Total 13 Discharges Unsuitable 3 (4 to hospital 3 to community 1 to hostel) Left against advice 3 For treatment 1 Others (to own borough) 1 Miss 3aunders,deputy warden was appointed on 6th December when Mrs Farey left, Mr L Knight was appointed to the post of assistant warden in January With the help of voluntary organisations the residents are becoming increasingly involved in activities in the community A local branch of the Gateway club has attracted full membership from the residents and the weekly club night at Brentford youth centre is well attended A camping holiday in the Lake District was arranged for four bovs with the minimum of supervision and proved to be so successful that arrangements are being made to extend this next year, A variety of events were arranged to encourage local residents to visit the hostel and each function was well supported. Suitable employment was found for a number of residents and only one girl was unable to retain the employment found and had to return to an adult training centre Orchard Hostel Bedfont It is encouraging to note that this hostel has been accepted verv well into the local community and has been befriended by a group of Feltham residents who are giving help and support to the hostel. It is clear that in addition to this medium term recuperation type of hostel there is a need for a more basic and possibly unstaffed hostel more suited to chronically ill patients which could be regarded by them as home and in which thev would stay for manv years 88 The following report has been submitted by Mr H Marshall the Warden There were 20 admissions and 19 discharges during the year Admissions Discharges Schizophrenia 8 Schizophrenia 4 Inadequate personality / 5 Schizophrenia with 1 Personality disorder 3 drug abuse Obsessional depres 1 Inadequate personalit y 6 sion in schizoid state Personality disorder 4 Depression with 1 Chronic anxiety state 1 paranoid features Chronic anxietv 1 Manic depression 1 depression psychosis Agrophobia 1 Depression 1 Manic depression 1 T ota I !0 Total 19 4 residents were re-admitted to hospital 2 of which subsequently returned to the hostel. Our own borough council was responsible for 16 residents Surrev county council 1 Ealing 2 and Haringey 1. 1970 was the first full year of the hostel s existence at its new site continued interest has been shown by the churches voluntary workers and local inhabitants. In Mav 1970 a public meeting was held at Feltham council chambers entitled community care and concern in Bedfont Hanworth and Feltham, Following this meeting a small studv/ project group met at The Orchard and many ideas of this studv group have been implemented to the benefit of this hostel, A flourishing weekly social evening was started and this proved to be a valuable link with ex-residents also allowing the local social services to introduce local residents in need of socialisation, in line with current thoughts and ideas on the problem of institutionalization the length of stay at the hostel should be 9 months or less, A period of over 12 months could be regarded as making a resident a chronic Two ex residents were married in September the reception at a nearbv hotel was enjoyed by residents and staff, Dr Herridge and Dr Clarke continued to attend weeklv^iving valuable support to the staff and attending to the psychiatric and medical needs of the residents as necessary, Supportive help was given bv officers of the health department, Some difficulty was experienced in obtaining residential staff. One of the main difficulties is that staff have to live in the main building with the resulting lack of privacy, noise and the feeling of never oeing off duty, Considera tion should be given to accommodation which is detached from the main building. It is thought that this would lead to better staffing., people would stav in post longer and a more efficient service would result, Mental Health Social Work During the course of the year Mr W N Carev the chief mental health social worker resigned and Mr P D Charles is proving a very capable successor, Mr F Vallerelli and Mr David Mason both obtained the national certificate in social work and have returned to duty,, Mr Jikiemi and Mrs Cohen were both seconded to course to obtain certificates. One additional worker was added to the establishment, Meetings were arranged by the newly appointed hospital advisory committee concerning the various liaisons between hospital and local authorities and the department gave evidence at Springfield hospital where a plea was made for acute psychiatric beds to be made available within the borough possibly at West Middlesex hospital so that a local and closely integrated service could be established between this suggested unit and the various mental health facilities in the borough Evidence was also given at Normansfield hospital where it was suggested that Normans field should be made the catchment subnormality hospital for this borough as it is in close proximity and would enable easy visiting by relatives and a much closer integration than is possible with Leavesden which is 25 miles away Report by Chief Mental Health Social Worker, During the year new ventures have been started some consolidation of old practices has continued and the overall picture is yet another vear of considerable progress in the borough s services for the mentally ill,. In February 1970 it was agreed to allocate in Springfield hospital a 43 bed unit named Dahlia Ward specifically for Hounslow residents, This unit has successfully coped with all the patients resident in that part of the hospital catchment area within the borough of Hounslow except for psvchogeriatric cases. Other benefits have accrued from this experiment It has made possible a much closer working relationship between local health authority and hospital staff,, Each is now better able to appreciate problems arising in the other s sphere of the work. The fact that patients come from the same area means that they are more likely to have interests in common and this in turn tends to create a warmer and more intimate atmosphere in the ward. It also encourages a sound relationship between the patients and 89 local authority mental health social workers who visit frequently. The close liaison between Dr Herridge and the community services continues to prove most helpful particularly in obtaining early medical assessment and effective use of the council s resources and has on many occasions obviated the need for hospital admission The psychiatric clinic at Hounslow hospital is now able to deal with acute referrals quickly due to a close co-operation between the mental health section Dr Herridge and Hounslow hospital. At first the clinic had a long waiting list and many patients referred did not keep their appointments. As new referrals are received by the hospital they are immediately notified to the mental health section who carry out an initial investigation This has helped considerably in assessing degrees of priority and ensuring more economical use of the consultant s time Dr Herridge s meetings at the health department s mental health office continue to form a very useful link between the hospital service and the local authority and now involve the nursing staff from Dahlia ward. The pro portion of qualified social workers has increased over the years and it is now possible to discuss cases in greater depth, arriving at more accurate assessment and providing long term prognosis During 1970 it has become increasingly recognised that there is considerable value in bringing in workers from other disciplines to case discussions which are also their concern There has been no significant change in the number of visits paid to the mentallv ill during the year but the admission rate to psychiatric hospitals has been reduced No doubt the amount of support being provided in the community through the familv doctors and the mental health and other social workers has influenced this trend The formation of teams with a senior mental health social worker in each of the three areas has enabled a more parochial service to become available This should enable a closer liaison with the family doctor and other services in the areas to develop. A good relationship has been maintained between the mental health team and St Bernard s hospital but there has so far been minimal involvement bv the hospital in the community services The club formed by the steering committee of the Hounslow mental health association was originally housed in St Stephen s church hall When the health centre was opened at Bath Road the club was granted the use of the psychiatric day centre building for club meetings on Thursday evenings The club membership has grown gradually and a stage has now been reached when club members are anxious to form their own constitutional committee The Industrial Therapy Organisation (Thames) Ltd continues to receive some of the borough s mentally ill for periods of full time training We are grateful to this organisation for providing virtually the only type of sheltered workshop facility in the area We are pleased to welcome as new members of the staff Mr F Klette and Mr N Ramdhony who joined us at the end of the year as mental health social workers Mr 0 Jikieme and Mrs P Cohen both started courses for the certificate in social work in the middle of the vear and we welcome back and congratulate Mr F Vallarelli and Mr D Mason who returned to us in the summer after successfully completing courses of professional training During the year we have been involved in the training of students from various agencies including Chiswick polytechnic Bedford college Springfield hospital Queen Charlotte s hospital West Middlesex hospital and other services. The overall picture then of the mental health service in general is one of continued growth and development A satisfactory level of service has been obtained and the council s resources are being well used When the service is transferred to social services department in 1971 it is to be hoped that especially in the initial stages the existing quality of service can be maintained for an/ falling off from its present level is likely to have an adverse effect on the confidence built up so far between the medical profession the social work profession and the public and would inevitably leave to a greater number of hospital admissions. 90 Environmental Health The following is submitted by Mr G E Hayne MAPHI MRSH Chief Public Health Inspector This is the first full year s report which I have been able to produce since taking up my appointment in 1969, During the year a number of changes have been made to the section s approach to its duties and the effects of these changes will not be positively apparent until the position has settled and a full year worked. In reviewing the work carried out during the vear 1970 regard has been had to the department of health and social security s circular 1/71 dated 1st Januarv 1971, Water supply The water supply to the borough is derived from the River Thames and distributed either by the Metropolitan Water Board or the South West Suburban Water Company to all dwellings within the borough. Periodic samples of the water are taken for examination and in all cases have been found to be satisfactory. In addition I am grateful to the director of water examination for the Metropolitan Water Board for the following information which relates to the water supplied by that authority 1, (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1970, (b) All new and repaired mains are disinfected with chlorine after a predeterminea period of contact the pipes are flushed out and refilled samples of water are then collected from these treated mains and the mains are returned to service only after the analytical results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the comsumer, Any sign of contamindion or any other abnormality is immediately investigated, (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area but the population supplied direct according to the Registrar General s estimates at 30th June 1970 was 168 235, (ii) No houses were permanently supplied by stanapipe (d) No artificial fluoride is being added and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water, 2, (a) The supply was derived from the following works and pumping stations River Thames derived from Hampton works No new sources of supply were instituted and there were no changes to the general scheme of supply in your area The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets (b) On account of their hardness content and alkaline reaction the Board s river and well water supplies are shown to be not plumbo solvent , It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed this applies to copper zinc iron and also to lead He also advises that the average natural fluoride content of the water supplied to the borough is 0,2 milligrammes per litre. During the year 7 samples of drinking water were taken from various taps throughout the borough Of these samples 3 were considered to be not up to the usually maintained standard Investigations were carried out by the distributors which resulted in further samples being satisfactory In addition test samples were continued to be taken from the flasks providing water for aircraft, 91 Although 9 samples were again considered unsatisfactory, further cleansing and steril ization produced satisfactory results. Twelve test samples were also taken from the water tanks at the service stations on the M4 motorway at the request of the service engineers following works of construction on the tanks. Of these 3 samples were unsatisfactory and further sterilization was carried out to produce the satisfactory results. Swimming baths responsible persons over the unsatisfactory results and further samples were found to be of the required standard. Sewerage and sewage disposal I am satisfied that the arrangements for sewerage and sewage disposal are satisfactory A limited number of isolated premises are served by pail closets or cesspools, Adequate arrangements are made for the disposal of their contents Common lodging houses There are no common lodging houses in the borough. Services under the food and drugs legislation In addition to the general baths manager s routine tests, bacteriological samples are also taken by the department of health. During the year 165 samples were taken as follows Samples Unsatisfactory Swimming pools 136 14 Paddling pools 16 6 Remedial pool 11 1 (Hanworth Junior Training Centre) Foot baths 2 1 Discussions took place with the appropriate This legislation provides the council s control over the fitness for human consumption of food which is sold throughout the borough and the conditions under which it is handled or stored prior to sale. Milk The persons who sell milk within the borough must be registered as distributors in accordance with the Milk and Dairies (General) Regulations 1959 The number of persons so registered is 146. Licences are also required in order that milk may be treated or that designited milk mav be sold. These licences are issued under the Milk (Special Designation) Regulations 1965 as amended for a 5 yearly period which expired on 31st December 1970 The following licences are in operation Dealers (Pasteurisers) licence 1 Dealer s (Pre-packed) licences - Pastuerised mi Ik 129 Sterilised milk 64 Ultra heat treated mi Ik 68 Untreated mi Ik 4 During the year 194 samples of designated 92 The general baths manager has advised as detailed below, on the attendances at the various swimming baths under his control Swimming baths Annual attendance Max, No. in any one day Brentford 107 735 379 Chiswick open air 68.964 2.461 Feltham 286,778 1,676 Heston 171,592 1.100 Isleworth 171,854 934 Hounslow 204 714 573 Private baths Annual attendance Brentford 6.883 Hounslow 15,068 Chiswick private 19 938 baths Isleworth 9.770 milk were submitted to the Kind Edward Memorial Hospital pathological laboratory for statutory tests. The results were Designation No, of Samples Satisfactory Unsatis factory Pasteurised 150 129 21 Steri lised 26 26 - Untreated - - - Ultra heat 13 18 - treated The failure of some of the samples of pasteurised milk to pass the methylene blue test were investigated and where appropriate further samples taken Brucella abortus During the year 59 samples of raw milk were taken as it arrived at the processing dairy in the borough. The samples were submitted to Harefield Hospital pathological laboratory, 11 of these samples were found to be positive and the county public health officer in the producing area was notified for action. Tuberculin test of raw milk 59 sample of raw milk from the same source as above were also submitted for tuberculin test. All samples, where the complete test could be carried out were found to be satisfactory. Ice cream During the year 193 samples of ice cream were submitted for bacteriological examination. The results were Grade 1 120 Grade 2 51 Grade 3 10 Grade 4 12 Thorough investigations were carried out into the procedures and methods of handling of the grade 3 and 4 samples, The premises were kept under close observation until satisfactory samples had been obtained In addition 9 ice lollies were also sent for examination and found to be sdisfactory, Food premises The inspection of premises where food is stored handled prepared or from where it is sold is a very important part of the public health inspectors duties, The control of such premises is under the Food Hygiene (General) Regulations 1960 and the office system is so organised that all food premises are frequently inspected throughout the year During the year 3 610 visits were paid to food premises throughout the borough for the purpose of food hygiene inspection. The various types of such premises include Butchers 110 Bakehouses 12 Cafe s, canteens, clubs 488 Fish shops 39 Greengrocers 156 Grocery and provisions 247 Hotels and public houses 222 Food manufacturers 33 Confectioners (sweet) 240 Confectioners (flour) 48 Chemists 67 School canteens 60 Places of public entertainment 28 Food stalls and delivery vehicles are also subject to inspection under the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regula tions 1966, These are inspected regularly as are the fair ground stalls which appear occasionally in the borough. Certain food premises have to be registered under Section 16, Food and Drugs Act 1955 and must comply with the Food Hygiene legislation, before they can be entered in the register, The premises so registered are Manufacture, storage or sale of 370 ice cream Preparation or manufacture of 29 sausages only 93 Preparation or manufacture of 129 potted pressed pickled or preserved food and preparation or manufacture of sausages Contraventions of the appropriate regulations were mainly dealt with informally but the health committee instructed that legal proceedings be instituted in 5 cases and fines totaling £125.15 were imposed , Food Inspection Meat and poultry inspections There are no slaughter houses or poultry processing establishments within the borough Unsound food Unsound food which is surrendered to or seized by the public health inspectors is destroyed in a Greater London Council incinerator. The following amounts of food were dealt with during the year tons cwt. lbs. Carcase meat from retail shops 2 15 68 Cooked meat and meat products 3 24 Canned meats 6 19 27 Fresh fish 3 82 Fresh fruit and vegetables 43 17 63 Frozen foods due to cabinet 41 9 68 break down Other foods 55 11 38 Total 151 0 84 During the year 124 complaints were made to the department, alleging unsoundness or foreign bodies in the food, All cases were fully investigated with the vendors and manufacturers. Most cases were dealt with informally but where the circumstances warranted firmer action they were reported to the health committee. Legal proceedings were taken in 13 cases which resulted in fines totaling £293. Sampling of food and drugs Samples of food and drugs were taken oy the public health inspectors either formally or informally and suomitted to the public analyst. 166 formal samples and 435 informal samples were submitted together with 25 specimens from members of the public. Of the samples sent for analysis the following results were given Total samples irregularities Informal Formal Private Milk 6 4 4 Other 320 165 16 64 (including foods 24 labelling) Drugs 109 1 11 (including Others - - 6 10 labelling) The Public Analyst reported that all samples other than those listed under irregularities were genuine and complied with all relevant Acts, Orders and Regulations, Details of the irregular samples together with the action taken by the department. Food samples found to be deficient of legal standards. Twenty-four such samples were reported, details of which are set out below A steak pie was found to have a total meat content of 2l% deficient of the legal minimum of 25% The manufacturers attention was drawn to the deficiency and formal samples were taken These did not reveal a similar deficiency'. A sample of Pork with Egg was found to have a meat content of 74% deficient of the legal minimum of 95% Regulations permit the description of Egg Loaf to be applied to products containing this meat content and this description was adopted by the manufacturers. Four samples of cordials were found upon analysis to contain cyclamic acid , the use of which was prohibited with effect from 1st January 1970. The manufacturers arranged for 94 stocks to be withdrawn from the premises in question and warning letters were sent to the vendors, A sample of Chicken and Mushrooms in Savoury Sauce was found upon analysis to contain 30% meat deficient of the legal standard of 40%. After discussion the manu facturers withdrew all stocks from the market, A sample of Indian tonic water was found to contain 0.33 grains per pint of quinine sulphate deficient of the legal standard of 0.5 grains Further samples were taken but these did not reveal a similar deficiency Several samples of flavoured yoghurts were taken from a local manufacturer four of which were found to contain benzoic acid and three contained sorbic acid contrary to the Preservatives in Food Regulations, These are technical offences and legal action was not considered appropriate, The addition of these preservatives, which were contained in the added fruit, although not permitted by the regulations created an anomaly which is at present being considered by the Food Additives and Contaminants Committee of the Ministry of Agriculture, Fisheries and Food Two samples of cheese were found to be deficient of the legal standards for fat content one of which is no longer available and the other was found to comply after the attention of the Swiss manufacturers had been drawn to the deficiency. Two samples of an almond flavour drink were found to contain excess quantities of sacchain a warning letter was sent to the manufacturer, A sample of banana svrup, upon analysis was found to contain less than 1% fruit and the manufacturers adopted after discussion an alternative description including the word flavour , A sample of margarine and a sample of milk powder were found to contain a small amount of excess moisture Further samples were taken. No similar deficiency was found. A sample of mustard oil was found to contain less thai 2% mustard and a warning letter was sent to the manufacturer, A sample of Bordeaux wine was found to contain 530 parts per million of sulphur dioxide in excess of the legal maximum of 450 parts per million. The manufacturers were contacted and the product was withdrawn from sale. Food samples found to be inaccurately labelled. Twenty samples submitted to the analyst revealed labelling omissions and included four samples which did not have the name and address of the manufacturer packer or importer on the label and the remainder related to omissions in the list of ingredients, Typical examples include the presence of undeclared mineral oils preservatives and mineral hydrocarbons. These are technical offences and in each case the manufacturers have agreed to amend their labels following informal discussions. Drug samples found to be deficient of legal standards. Eleven samples were found to be deficient. Ten of these were due to contraventions of the Pharmacy and Medicines Act which requires preparations recommended as a medicine to have stated upon them a list of the active ingredients, eight of these contraventions were in respect of sun tan preparations which claimed healing or soothing properties and two were of talcum powder claiming similar benefits, One sample of halibut liver oil capsules was found to be deficient of the stated amount of Vitamin A containing 1500 units per capsule and claiming the presence of 4500 units. Further investigation revealed the manufacturer to have gone out of business and no further supplies were available Consumer complaints Twenty samples were sent to the analyst following consumer complaints. Eight of these were bread and included A loaf affected by moulds a warning letter was sent to the vendor 95 A loaf containing paint flakes proceedings were taken resulting in a £10 fine and £8 costs, A loaf contaminated with dust and natural fibres a warning letter was sent to the manufacturer Four were loaves containing overheated dough together with particles of crust and natural and synthetic fibres warning letters were sent to the respective manufacturers A loaf containing particles of aluminium investigation revealed that the bakerv had ceased production Three samples were of sausages two of which contained foreign bodies in one case fragments of aluminium the other particles of course paper, these resulted in warning letters being sent to the manufacturers The third sample was identified as typical deterioration resulting from refrigerated storage It was not proved that this deterioration occurred whilst the sausages were in the possession of the vendor and no further action was taken Four samples concerned milk three of which were milk bottles containing foreign bodies One contained a cementitious deposit a warning letter was sent The second contained tea leaves and bread dough and investigations suggested that the foreign matter was introduced after retail sale. The third bottle contained a cigarette end and proceedings were instituted resulting in a £30 fine and £10 costs. One sample was of adulterated sterilized milk which was found to contain 60% added water the sample consisted of an opened bottle and doubt was expressed as to when the water had been added Five other consumer complaint samples were examined and included cooking oil containing fragments of paper a soda syphon containing an earwig flour containing steel wool and babv food containing dark streaks identified as grease, warning letters were sent in each case A further sample rice was found to contain live and dead larvae of the tobacco moth and fragments of adult flour beetles proceedings were instituted and a fine of £5 was imposed with £10 costs, Clean Air Acts 1956 and 1968, Smoke control areas During the year concern was expressed over an anticipated shortage of solid smoke less fuel. On 23rd July 1970 the ministry of housing and local government wrote to the council asking that consultation take place with the fuel distributors to determine whether there would be adequate stocks for the coming winter Subsequently the council recommended to the minister that 15 smoke control areas be suspended from 1st November 1970 to 31st March 1971, The proposal was confirmed by the minister and an area of 2727 acres covering 18624 dwellings was suspended from the effects of the smoke control orders, This was approximately 40% of the dwellings within the borough. In addition the 4 orders made by the council had their date of operation postponed by the ministry from 1st December 1970 until 1st July 1971, Thus the area of the borough covered oy smoke control orders did not increase throughout the vear but the surveys continued and 3 further smoke control orders were made by the council with the date of operation being 1st December 1971, The work necessitated 7279 visits to various premises throughout the borough bv the public health inspectors and technical assistants. Furnaces The legislation requires that new furnaces being installed shall be so far as practicable capable of operating smokelessly and plans may be submitted for the council s approval 15 notifications were received during the year and in two cases modifications were required before approval was given Chimnev heights Before constructing a chimney to serve a furnace which is rated in excess of Vh million B Th Us per hour the approval of the local 96 authority must be obtained. During the year 21 applications were received all of which were approved although 6 required alteration to the proposals. During the year 179 complaints were received from members of the public concerning alleged smoke nuisances. All were fully investigded but the majority referred to neighbours bonfires. Factories Act 1961. Table 26 refers to the work of the department carried out under the Factories Act. 1526 visits were paid to factory premises by the public health inspectors and an additional 31 inspections were made to outworkers premises. Offices Shops and Railway Premises Act, 1963. The work under this legislation has proceeded smoothly throughout the year and table 25 indicates the premises registered and inspected. 4069 visits were made to such premises by the public health inspectors. An analysis of the contraventions found is Cleanliness 43 Clothing 6 Overcrowding 4 modation Sitting facilities 1 Temperature 47 Venti lation 29 Seats (Sedentary workers) 1 Lighting 23 Sanitarv conveniences 42 Eating facilities 3 Floors, passages and stairs 68 Washing facilities 41 Supply of drinking 4 Fencing of exposed parts of machines 9 water First aid 54 Other matters 63 Total 438 The act also requires thit where an accident to a person renders them unable to carry out their duties for 3 days or more a report must be submitted to the local authority. An analysis of the accidents reported is Machinery 10 Transport 7 Persons falling 30 Stepping on or striking against object 4 or person Handling goods 14 Struck by falling objects 4 Fires and explosions 1 Use of hand tools 4 Others 2 76 Convictions were obtained in two cases involving accidents. Both of these involved bacon slicing machines. Noise abatement A total of 71 complaints were received concerning 55 noise sources. 18 were confirmed as a nuisance after investigation. It is often a time consuming occupation investigating noise nuisances and solutions are generally not easy to secure due to the complexity of the machinery causing the noise. The 18 confirmed cases related to Noise nuisance from concrete breakers 3 Noise nuisance from industry 5 Noise nuisance from commerce 3 Others 7 Total 18 Of these. 15 were satisfactorily abated but the remainder are still under active con sideration. A total of 287 visits were made in connection with these complaints. Aircraft During the year investigation into possible pollution from aircraft trails was carried out. To date no evidence of pollution has been recorded. However this may be due to the difficulty in obtaining accurde measurement and investigations are continuing. 97 Housing Acts 1957 1969 New Houses The borough architect has advised that during 1970, 362 permanent new council dwellings were erected and the borough engineer and surveyor has given the following figures on other new permanent dwellings Houses F lats Total Private enterprise 58 95 153 Housing associdions 88 88 Other authorities 19 8 27 77 191 268 Houses unfit for human habitation The ministry of housing and local government requested details of the council s next 4 year programme for dealing with houses which were unfit for human habitation, No such programme was in being but a survev of the housing throughout the borough revealed that there were 615 houses which were of an age and type of construction as to indicate that they should be inspected in detail for action under the housing legislation. A positive programme of inspection of these houses was initided and throughout the vear nearly 4.000 visits were paid by the public health inspectors and technical assistants in connection with housing work. This is a con siderable increase compared with the numbers last year and the results of the department s efforts are tabulated below. a) 4 clearance areas were declared comprising in total 43 houses. b) 46 houses demolished due to clearance area action. c) 160 houses made fit for human habitation by informal action. d) 1 house made fit for human habitation by formal action. e) 14 houses closed as being unfit for human habitation. f) 4 houses upon which demolition orders were made. g) 9 closed houses made fit by the owners and the closing orders subsequently determined. h) 15 houses demolished because of unfitness. i) 1 underground room closed because of unfitness, At the end of the year there were still 18 houses occupied which had formed part of 2 clearance area declarations. These areas had been declared bv the council in 1968 and 1969. This positive approach to unfit dwellings was made possible by Mr A E. Canovan district public health inspector taking over the co ordination for housing work Subsequently he was promoted to senior public health inspector (housing). Houses in multiple occupation During the year I expressed to the health committee concern over the number of houses which were let in multiple occupation. From available information it appeared that there were over 5500 such houses in the borough and it was obviously necessary to carry out a detailed programme of inspection to locate these houses in order that the appropriate action could be initiated, The problems associated with such housing may be summarised as follows a) overcrowd ing. b) lack of or insufficiency of adequate facilities and amenities for all the occupants c) lack of proper means of escape in case of fire. d) disrepair. The council subsequently agreed to the employment of two additional technical assist ants within the town clerk s department who would be under the day to day control of the valuation and estates department These two officers would then be loaned to the environmental health section to commence the survey. It is hoped that thev will be able to start early in the new year. Although 291 visits were made in connection with this work it was mainly of an informal 98 nature. Underground rooms It appears that there are probably in excess of 200 houses within the borough having inhabited rooms which fall within the definition of under ground rooms Many of these are in houses which are let in multiple occupation and it was considered that these should be dealt with as the houses in multiple occupation programme proceeds. Qualification certificates It is in this field that most housing work has has been carried out during the year. This action was initided under the Housing Act, 1969 and allows the landlord of rented property to convert controlled tenancies to regulated tenancies with a subsequent rent reassessment provided the property is fit for human habitation in all respects and has all the basic standard amenities. The procedure falls within one of two categories - a) Provisional qualification certificates those where some or all of the standard amenities are lacking. b) Qualification certificates - those which have all the necessary amenities. Each house which is the subject of an application has to be inspected and where items of disrepair are noted an informal letter is sent advising the applicant of the defects in order thd thev may be rectified. It can be seen that this work involves several visits to the properties concerned with additional meetings with owners and builders. During the year the following statistics were recorded Certificates of provisional approval Applications received 79 Applications granted 62 Applications refused 3 Applications withdrawn 2 involving a total of 115 visits by the public health inspectors. Qualification certificates Applications received 516 Applications granted 113 Applications refused 205 involving a total of 998 visits by the public health inspectors. The health committee considered that a boiler provided behind an open fire could not be regarded as a satisfactory means of providing constant hot water during the summer months. Where this is the sole means of heating water the applications have been rejected on the grounds that all the standard amenities were not provided. Three notices of appeal against this decision were given but subsequently with drawn Moveable dwellings There are seven site licences under the Caravan Sites and Control of Development Act 1960 which relates to 9 caravans stationed within the borough The council is required to provide a site for a minimum of 15 caravans to be stationed within the borough The selection of the ideal site has proved difficult but, in order to assist the caravan dwellers action has been withheld against vans being stationed on land in Church Road, Cranford, It was hoped that this could be a temporary site with the minimal facilities of a water supplv, a sewer connection and refuse disposal points. This to continue until a permanent site could be found and suitably developed. This matter is still under consideration. However action has been taken against all other vans unlawfully stdioned within the borough. 155 such cases were dealt with and the whole work under this heading necessitated 507 visits. Improvement of dwellings Following applications to the council for improvement grants the public health inspectors inspect each dwelling,, During the year 140 such applications were received and in each case a report was given on the condition of the property and its estimated life. 99 Land charge searches During the sale of any premises, the solicitor acting for the prospective purchaser requests that the Land Charge register be searched to ascertain whether any notices have been served upon the property- 5581 searches were made during the 12 months. Rodent control Details of the work carried out by the rodent control team is set out in table 24. It had been the practice of the council to enter into agreements with various firms throughout the borough to maintain a control over any rodent infestations. This often necessitated visits to premises which were free of rodents and was wasteful of manpower It also placed the council in a difficult position when it came to enforcing the owners responsibi lities. A proposal was accepted by the council that these agreements should cease although everv assistance would be given upon request The manpower thus saved could be directed towards a positive system of inspection and treatment of infested sewers. By the end of the year a programme of sewer treatments was being drawn up in conjunction with the borough engineer and surveyor who is responsible for sewers. In addition to the rodent operatives visits the public health inspectors made 8 655 visits in connection with rodent control inspection in food premises and other establishments. Other pest control work During the year 371 complaints were made to the department concerning insect pests and 27 concerning pigeons. 497 pigeons were either trapped or shot during the year. The council agreed to cease chaging for the treatment of insect pests. The charge had been known in some cases to deter people from applying for help. 100 Mortgage Applications Again where applications are made to the council for a mortgage the public health inspectors inspect the property 204 houses were so inspected during the year Certificates of disrepair One application was received for a certificate of disrepair. Rehousing on medical grounds Where the medical officer of health has been requested to give medical priority for rehousing and the condition of the applicant s dwelling is not satisfactory, the public health inspectors are requested to report on the conditions existing, 51 such reports were given during the year, CounciI housing Concern has been expressed over the conditions prevailing in some of the accommodation provided by the council both for the normal council tenants and also concerning the accommodation provided for homeless families In the latter case one house was found to be overcrowded and lacking in the necessary facilities. Discussions with the appropriate departments resulted in improvements to the house and a reduction of the number of families housed there- Following complaints from council tenants 228 visits were paid to 76 council properties with subsequent recommendations to the director of housing. Three units of accommodation were declared unfit for human habitation. General improvement areas Detailed discussions between various council departments has continued on the proposed South Street general improvement area. A public meeting was held with the residents of the area and the council authorised the preparation of a detailed scheme, Discussions are also proceeding on the other suitable areas Pet Animals Act 1951 There were 17 licences issued to keep pet shops during 1970 and 66 visits paid in connection with this work. Riding Establishments Act 1964 Two licences were issued to keep riding establishments and 6 visits were paid by the public health inspectors during the year. Animal Boarding Establishments Act 1963 Two licences are in force and 6 visits were paid in connection with this work. Agricultural premises 22 visits were paid to agricultural premises in connection with the health and welfare provisions of the appropriate legislation. Long term immigrants Where immigrants notify that they are intending to reside in this borough they are visited by the public health inspectors and advised to register with a general practitioner. During the year 496 visits were made in connection with these immigrants. Hairdressers and barbers During the year the council agreed to the recommendation that all hairdressers and barbers should register with the council under the provision of Greater London Council (General Powers) Act 1967. This was to ensure that all premises used for hairdressing were known to the department so that regular inspection could be carried out. 151 such premises were registered. General district inspections Summarised below are details of the complaints received by the environmental health section together with a record of the visits made Complaints received General disrepair of premises 196 Dampness 182 Overcrowding 18 Defective drainage systems 254 Defective water supply and/or fittings 47 Accumulation of refuse or insufficient or defective refuse storage facilities 222 Rats and mice 1,650 Pigeons 27 Insect pests 371 Smoke 179 Noise 71 Unsound food 132 Caravans 30 Miscellaneous 491 Visits made Smoke control areas 6,548 Other clean air 969 Drainage 1,102 Factories 1.557 Food premises 8 610 Unsound food 532 Food and drugs sampling 484 Housing 3 985 Infectious diseases 664 (+van drivers visits) Rodent control 21 365 Offices, shops and railway premises General inspections 493 Other inspections 3 475 Accident investigations 101 Rag flock and other filling materials 3 Pet animals establishment 66 Animal boarding establishment 6 Riding establishment 6 Agricultural premises 22 Schools 21 Noise nuisance 287 Caravans 507 Premises licensed for public entertainment 64 Hairdressers and barbers 320 Nuisances (general) 1,580 101 Piggeries 25 Stables 21 Swimming baths and pools 166 Accumulations of refuse 477 Verminous premises 489 Work places 42 Treatment of premises for bugs 52 Treatment of premises for fleas 51 Treatment of premises for cockroaches 10 Treatment of premises for ants 12 Treatment of premises for other insects 5 Destruction of wasps nests 52 Drains tested 123 Conclusion In order that additional senior public health inspector positions could be created without incurring greater expenditure the establish ment of 6 pupils was reduced to 4. Miss F E Stimson was appointed as a pupil to attend the University of Birmingham to take the BSc (environmental health) course The much needed additional senior positions were filled by the appointment of Mr A E Canovan (senior public health inspector housing) and Mr D J Wells (senior public health inspector food) and the two specialist teams set up by reducing the districts from 15 to 11 Although there were staffing difficulties towards the end of the year the framework was established to enable the environmental health section to pursue its duties and responsibilities to greater effect. However further staffing readjustments wiII be necessary. A small effort has been made towards centralisation of the section by housing the specialist teams and 5 district inspectors at 92 Bath Road and leaving 3 district and 1 senior public health inspector at the two divisional offices. However, the environmental health section will never be wholly efficient both from the technical or administrative aspect until all personnel are contained in one buiIding My thanks are again due to Mr Bell the deputy chief public health inspector for his assistance and encouragement. I am also grateful to all the public health inspectors technical assistants and administrative and clerical staff for their co operation and help. Rehousing on Medical grounds During the year 321 applications for rehousing on medical grounds were received from the Director of Housing.. All these applications were supported by medical certificates and were assessed after visits had been paid by either the health visitor or public health inspector. Public Health Act 1936 Nursing Homes Section 1 of the Nursing Homes Act 1963 made provision governing the conduct of nursing homes with respect to the standard of accommodation staff and the care provided for patients and limitations on the number of patients maintained in each home. At the end of the year two nursing homes were registered to which principal medical officers made periodic visits of inspection, The Diploma of Public Health assisted training scheme The scheme whereby a medical officer is seconded each year to a diploma of public health course and granted leave of absence on full pay and payment of course and examination fees continued, Dr Daphne P Richards senior departmental medical officer who was seconded to the 1969/70 course gained the diploma Dr R H G Chales senior departmental medical officer was nominated to attend a course during 1970/71. Establishments for massage or special treatment During the year 11 establishments were licensed by the council for the following purposes Massage and electrical treatment 2 Epilation by electrolysis 2 Chiropody 4 Chiropody and massage 1 Chiropody and electrical treatment 1 102 Chiropody, massage and electrical treatment 1 Each establishment was inspected by a medical officer on one occasion during 1970. Mortuary services The borough council maintains a public mortuary in Feltham to which bodies were admitted from the urban districts of Staines Sunbury on Thames, Chertsey, Egham Esher Walton & Weybridge and Woking the rural district of Bagshot. and the Royal Borough of Kingston-on Thames until the 5th Mav 1970. Bodies are still received from the Richmond and Barnes areas which form part of the London Borough of Richmond on Thames A nominal charge is made for the use of the mortuary to the councils of the above mentioned districts. The coroner has directed that deceased persons who were resident within the London Borough of Hounslow and require to be removed to a public mortuary shall be sent to the Hampton Mortuary maintained by the London Borough of Richmond-on-Thames. The council pays a nominal charge for the use of this mortuary. Burials Under Section 50 of the National Assistance Act 1948 it is the duty of the council to arrange the burial of any person who has died in the district, where it appears that there are no suitable arrangements for the disposal of the body. During 1970 four burials were arranged in accordance with this section. Co ordination of Social Services Co-ordination between the children's education health housing and welfare departments continued successfully throughout the year and there was a good relationship with the many voluntary organisations working in the borough. 103 Statistical Tables 105 Table 1 Causes of death at different periods of life for 1970 Cause of death Age group Age group Total all ages Under 4 weeks 4 weeks & under 1 year 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over M F M F M F M F M F M F M F M F M F M F M F M F Enteritis and other diarrhoeal diseases - 3 - - - 3 - - - - . - - - - - - - - - - - - - Tuberculosis of respiratory system 5 2 - - - - - - - 1 - - 1 - - 1 - 2 - - - 1 1 Late effects of respiratory T B 1 1 - - - - - - - - - - - - 1 - - - 1 - - - Other tuberculosis 1 - - - - - - - - - - - - - - - - - - - - 1 - Meningococcal infection 1 - - - 1 - - - - - - - - - - - - - - - - - - Syphilis and its sequelae 1 - - - - - - - - - - - - - - - - - - - 1 - - - Other infective and parasitic diseases 4 2 - - 1 1 - - - - - - - - 1 - - - 2 1 - - - - Malignant neoplasm, buccal cavity etc. 1 4 - - - - - - - - - - - - - - - 1 - - - 1 1 2 Malignant neoplasm, oesophagus 10 6 - - - - - - - - - - - - - - 2 - 3 2 4 2 1 2 Malignant neoplasm, stomach 23 25 - - - - - - - - - - - - 1 - - - 6 4 9 11 7 10 Malignant neoplasm, intestine 32 38 - - - - - - - - - - 1 - - 1 2 1 6 9 13 10 9 17 Malignant neoplasm, larynx 5 2 - - - - - - - - - - - - - - 1 - - 1 2 - 2 1 Malignant neoplasm, lung, brochus 102 31 - - - - - - - - - - - - 3 - 9 5 29 5 43 10 18 10 Malignant neoplasm, breast - 55 - - - - - - - - - - 1 - 5 - 13 - 11 - 12 - 13 Malignant neoplasm, uterus - 8 - - - - - - - - - - - - - 1 - 2 - 3 - 2 - - Malignant neoplasm, prostate 19 - - - - - - - - - - - - - - - - - 4 - 9 - 6 - Leukaemia 7 4 - - - - - - 1 - - - - - - 1 1 - 1 1 2 - 2 2 Other malignant neoplasms 62 74 - - - - - 1 1 1 1 2 1 1 3 7 9 16 16 18 19 16 23 Benign and unspecified neospasms 3 3 - - - - - - - - - - - - - 1 - 1 - 1 1 - 2 Disbetes mellitus 4 7 - - - - - - - - - - - - - - 1 - 1 1 2 2 - 4 Avitaminoses, etc. - 1 - - - - - - - - - - - - - - - - - - - - - 1 Anaemias - 2 - - - - - - - - - - - - - - - - - 1 - - - 1 Meningitis - 1 - - - - - - - - - - - - - ~ - - ~ - 1 - - Chronic rheumatic heart disease 12 24 - - - - - - 1 - - - - - - - 1 1 1 3 8 8 1 12 Hypertensive disease 17 20 - - - - - - - - - - - - - - 2 2 4 1 4 2 7 15 Ischaemic heart disease 320 227 - - - - - - - - - - 1 - 3 - 25 5 77 25 131 61 83 136 Other forms of heart disease 45 97 - • - - - - - - - - - - 2 - - 1 2 1 11 11 30 84 Cerebrovascular disease 86 149 - - - - - - - - - 1 - - 2 3 - 4 12 13 31 31 41 97 Influenza 8 9 - - - - - - - - 1 1 - - - - 2 - 1 - 3 5 1 3 Pneumonia 68 67 2 - 4 2 - - - - - - - - -1 - 2 3 7 2 15 8 37 52 Bronchitis and emphysema 63 19 - - - - - - - - - - - - - - 1 - 17 - 25 9 20 10 Asthma 2 1 - - - - - - 1 - 1 - - - - - - - - 1 - - - - Peptic ulcer 9 10 - - - - - - - - - - - - - 1 - - 1 1 3 1 5 7 Intestinal obstruction and hernia 3 10 - - - - - - - - - - - - 1 - - 2 1 - - 4 1 4 Cirrhosis of liver 3 3 - - - - - - - - - - - - 1 - 2 3 - - - - Nephritis and nephrosis 2 6 - - - - - - - - - - - " - - 1 - 1 1 - 3 - 2 Hyperplasia of prostate 5 - - - - - - - - - - - - 1 - - - - 2 - - - 3 - Congenital anomalies 8 6 5 4 2 - - - - 1 " " - - - - - - 1 - - - - - Birth injury, difficult labour, etc. 14 3 13 3 1 - - - - - - - - " - - - - - - - - - - Other causes of perinatal mortality 8 8 8 8 - - - - - - - - " - - - - - - - - - - - Symptoms and ill defined conditions 2 1 - - 2 - - - - - " - - - - - - - - - - - - 1 106 107 Table 1 (Continued) Cause of death Age group Age group Total all ages Under 4 weeks 4 weeks & under 1 year 1 - 4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over M F M F M F M F M F M F M F M F M F M F M F M F Other endocrine etc, diseases 4 6 - 1 - - - - 1 - - - - - - - - - 3 2 - 2 - 1 Other diseases of blood etc. - 1 - - - - - - - - - - - - - - - - - - - - - 1 Mental disorders 1 1 - - - - - - - - - - - 1 - - 1 - - - - - - - Multiple sclerosis 2 3 - - - - - - - - - - - - - - 1 1 - 1 1 1 - - Other diseases of nervous system 16 9 - - - - - - - - 1 1 - - - - 1 - 3 1 5 2 6 5 Other diseases of circulatory system 41 42 - - - . - - - - - - - - 1 - 2 1 10 5 10 11 18 25 Other diseases of respiratory system 8 6 - - 2 1 - - - - - - - - - - - - 1 - 2 - 3 4 Other diseases of digestive system 9 19 - - - - - - - - - - - - - - 1 - 2 1 4 3 2 14 Other diseases genito-urinary system 13 8 1 - - - - - - - - - - - 1 - - - 5 2 2 1 4 5 Diseases of musculoskeletal system 4 8 - - - - - - - - - - - - - - - - 3 4 - 1 1 3 Motor vehicle accidents 16 13 - - - - - - 1 - 4 2 3 1 1 - - 1 1 1 4 3 2 5 All other accidents 14 9 - - - - 2 1 1 - 2 1 - 1 1 - 1 - 2 1 1 - 4 6 Suicide and self inflicted injuries 11 9 - - - - - - - - - 1 1 - 3 2 1 2 2 3 3 - 1 1 All other external causes 2 1 - - - - - - - - - 1 1 - 1 - - - - - - - - - Total all causes 1097 1064 29 16 13 7 2 2 7 2 12 9 9 8 23 18 68 55 232 127 368 238 334 582 Table 2 Infant deaths according to age and cause 1970 Cause of death Age in days Under Age in months 1 1 2 3 4 5 6 7-13 14-20 21-28 1 2 3 4 5 6 7 8 9 10 11 Total Enteritis and other diarrhoeal diseases - - - - - - - - - - 1 - - - - - - - - 2 - 3 Meningococcal infection - - - - - - - - - - 1 - - - - - - - - - - 1 All other infective and parasitic diseases - • - - - - - - - - - 1 - - - - - 1 - - - 2 Pneumonia - - - - - - - 2 - - 3 1 1 - 1 - - - - - - 8 Congenital anomalies 1 - 2 - 1 - - 2 1 2 - - - - 2 - - - - - - 11 Birth injury difficult labour and other anoxic and hypoxic conditions 11 2 2 1 - - - - - - 1 - - - - - - - - - - 17 Other causes of perinatal mortality 10 1 - 2 1 1 1 - - - - - - - - - - - - - - 16 Symptoms and ill defined conditions - - - - - - - - - - - 2 - - - - - - - - - 2 All other diseases - 1 - - 1 - - - - - - - 1 - - - 2 ~ - - - 5 Total 22 4 4 3 3 1 1 4 1 2 6 4 2 - 3 - 2 1 - 2 - 65 108 109 Table 3 Corrected notifications of infectious disease 1970 Disease Total Age in years under 2 3 4 5-9 10-14 15-19 20-34 35-44 45-64 65 and over Age unknown Cases admitted to hospital 1 1 Dysentery 7 - 1 - - - 2 2 1 1 - - - - 3 Encephalitis, acute 2 - - - - - 1 - 1 - - - - - 2 Food poisoning 15 - - 1 1 1 1 1 1 7 - 1 1 - 7 Infective j aundice 61 - - - 1 1 10 11 11 15 9 3 - - 29 Malaria 2 - - - - - - 1 1 - - - - - 2 Measles 675 29 62 92 90 83 298 10 5 5 1 - - - 22 Meningitis acute 14 2 1 1 - - 1 1 3 3 1 1 - - 14 Paratyphoid fever 5 1 1 - - - - 2 - 1 - - - - 2 Scarlet fever 50 - 2 5 6 3 26 4 2 2 - - - - 2 Tuberculosis pulmonary 71 - 1 - - - 1 2 5 23 9 16 14 - 28 non pulmonary 21 - - - - - 2 - 3 10 3 3 - - 14 Typhoid fever 5 1 1 1 - - - - - 1 - 1 - - 4 Whooping cough 30 6 - 3 - 5 2 13 1 - - - - - 1 110 111 Table 4 Venereal disease patients treated at West Middlesex Hospital Persons dealt with for the first time and found to be suffering from Syphi lis 25 Gonorrhoea 284 Other conditions 1793 Total 2102 Table 5 Ophthalmia neonatorum Total number of cases notified during the year - Number of cases in which: Vision lost - Vision impaired - Treatment continuing at end of year - The figures include patients who do not normally reside in the borough and exclude borough residents attending other hospitals for similar treatment for the first time. Table 6 Vaccination and immunisation Completed primary courses number of persons under age 16 Type of vaccine Year of birth 1968 1967 1963-66 Others under 1970 1969 Age 16 Total Quadruple DTPP - - - - - - - Triple DTP 100 1479 176 20 50 1 1826 Diphtheria/whooping cough - - - - - - - Diphtheria/tetanus 2 304 48 28 55 88 525 Diphtheria - 1 - - 1 2 4 Whooping cough 1 3 4 13 10 - 31 Tetanus 1 1 2 1 26 158 189 Salk - - 1 - - - 1 Sabin 76 1746 217 42 104 81 2266 Measles 4 1124 1074 245 366 104 2917 Rubella - - - - - 434 434 Lines 1+2+3+4+5 (Diphtheria) 102 1784 224 48 106 91 2355 Lines 1+2+3+6 (Whooping cough) 101 1482 180 33 60 1 1857 Lines 1+2+4+7 (Tetanus) 103 1784 226 49 131 247 2540 Lines 1+8+9 (Poliomyelitis) 76 1746 218 42 104 81 2267 Reinforcing doses number of persons under age 16 Type of vaccine Year of birth 1968 1967 1963-66 Others under 1970 1969 Age 16 Total Quadruple DTPP - - - - - - - Triple DTP - 77 856 42 238 21 1234 Diphtheria/whooping cough - - - - - - - Diphtheria/tetanus - 7 164 54 2157 461 2843 Diphtheria - - - - 13 43 56 Whooping cough - - 5 5 19 1 30 Tetanus - 1 1 5 14 221 242 Salk - - 1 - 3 - 4 Sabin - 77 969 80 2384 536 4046 Measles - - - - - - - Lines 1+2+3+4 + 5 (Diphtheria] - 84 1020 96 2408 525 4133 Lines 1 + 2 + 3+6 (Whooping cough) - 77 861 47 257 22 1264 Lines 1+2+-4+-7 (Tetanus) - 85 1021 101 2409 703 4319 Lines 1-J-8+-9 (Poliomyelitis) - 77 970 80 2387 536 4050 112 Table 7 Smallpox vaccination of persons aged under 16 Age at date of vaccination Number of persons vaccinated or revaccinated during 1970 Number vaccinated Number revaccinated 0 - 2 months 28 - 3 - 5 months 13 - 6-8 months 33 - 9 - 11 months 26 - 12 - 23 months 984 1 2 - 4 years 204 66 5 - 15 years 95 265 Total 1,383 332 Table 3 Midwives who notified their intention to practise within the London Borough of Hounslow during the year 1970 Domiciliary Employed by borough council 13 Employed by Queen Charlotte's hospital 5 In private practice - Institutional Hospitals 101 Nursing homes - Total 119 Table 9 Deliveries attended by domiciliary midwives during 197 By midwives employed by borough council 338 By midwives employed by Queen Charlotte's hospital 10 Total 348 Number of cases delivered in hospitals and other institutions but discharged and attended by domiciliary midwives before the 10th day: Borough council midwives 1565 Queen Charlotte's hospital midwives 124 Midwives employed by London Borough of Ealing specially for 48 hour planned discharges (Brentford and Chiswick area) 23 Total 1712 Table 10 Health Visiting Number of visits paid by health visitors during 1970 First visits Total visits Expectant mothers 933 1452 Children born in 1970 3326 8592 Children born in 1969 2453 6737 Children born in 1965 68 6926 17525 Other classes 5783 11888 All classes 19421 46194 This table does not include a. Visits made by tuberculosis visitors. b. Visits to families by health visitor/school nurses whilst acting solely in their capacity as school nurses. 113 Table 11 Home nursing Patients attended by home nurses during 1970 a. number of cases 3561 b. number of visits 100064 Patients included in (a) above who were 65 or over at the time of the first visit Number of cases 1972 Children included in (a) above who were under 5 at the time of the first visit Number of cases 59 Number of visits included in (b) above of over one hour duration 1199 Table 12 Home help Number of cases in which home help was provided during 1970 Aged 65 or over at time of first visit during year 1633 Aged under 65 at time of first visit during year Chronic sick and tuberculous 166 Mentally disordered 9 Maternity 80 Others 129 Total 2017 Table 13 New cases of tuberculosis notified formally or otherwise to the medical officer of health and deaths ascribed to tuberculosis during 1970. Age in years New Cases Pulmonary Non-pulmonary Deaths Pulmonary Non-pulmonary M F M F M F M F Under 1 - - - - - - - - 1 1 - - - - - - - 5 - 1 2 - - - - - 10 1 1 - - - - - - 15 4 1 1 2 - - - - 20 4 5 1 2 - - - - 25 7 7 4 2 - 1 - - 35 3 6 - 3 - - - - 45 6 3 1 1 - - - - 55 3 2 - - - - - - 65 and over 10 6 1 1 - - - - Age unknown - - - - - - - - All ages 39 32 10 11 - 1 - - Table 14 Tuberculosis Summary of the work of chest clinics Persons examined for the first time 5314 Persons found to be tuberculous 105 New contacts seen for the first time during the year 609 New contacts found to be tuberculous - Cases on register at 31st December, 1970 941 Home visits made by tuberculosis visitors during 1970 1089 114 Table 15 Ante natal and post-natal clinics Number of Clinics provided at end of 1970 (a) 7 Number of sessions held by Medical Officers 181 Midwives 159 Total 340 Number of women who attended in 1970 (b) Ante natal 306 Post natal 49 Total number of attendances by women shown above Ante natal 1213 Post natal 67 Table 13 Child health clinics Number of clinics in use at end of 1970 (a) 13 Number of child health sessions held by Medical officers 1172 Health visitors 252 Hospital medical staff 51 Total 1475 Number of children who attended during the year and who were born in 1970 2821 1969 2527 1965-68 2582 Total 7930 Number of attendances made by children shown above 42404 (a) Includes sessions staffed by obstetricians employed by Queen Chalotte's hospital, (b) Excludes women referred by Queen Charlotte s hospital. (a) The number of clinics includes one mobile unit fully staffed by the counciI, and a clinic held at Queen Charlotte s Hospital at which the council provides a health visitor only. Table 16 Ante-natal mothercraft and relaxation classes Number of women who attended during 1970 institutionally booked 472 Domiciliary booked 76 Total 548 Total number of attendances during 1970 2318 Table 19 Day nurseries provided by the borough council as at 31st December, 1970 Number 3 Number of approved places 126 Number of children on register at end of year Age under 2 years 33 Age 2 - 5 years 95 Average daily attendance during the year (a) Age under 2 years 26 Age 2 5 years 79 Table 17 Care of premature infants Number of premature babies born alive to mothers normally resident in the Borough, but excluding babies born in maternity homes or hospitals in the National Health Service Born at home or in a private nursing home Born at home or in a private nursing home and nursed entirely at home, or in a private nursing home 10 number born died survived during to end of first 28 days 24 hours 10 10 (a) These are arithmetical averages which reflect absencesdue to infectious and other illness, and also the postponement of new admissions during outbreaks of infectious illness. 115 Table 20 Priority dental service Expectant and nursing mothers and pre-school children Number of cases Number of persons examined during the year Number of persons who commenced treatment during the year Number of courses of treatment completed during the year Expectant and nursing mothers 73 62 27 Children aged under 5 and not eligible for school dental service 976 564 415 Dental treatment provided Scalings and/or stain removal Fillings Teeth filled Teeth root filled Crowns & inlays Teeth extracted General anaesthetics Dentures provided FulI upper or lower Partial upper or lower Radiographs Expectant and nursing mothers 31 185 114 - - 56 6 3 6 24 Children aged under 5 and not eligible for school dental service 255 1906 1423 - - 632 258 . - 39 Sessions devoted to priority dental service are shown on table 33 116 Table 21 Mentally disordered patients under the care of the borough at 31st December 1970 Mentally III Mentally handicapped and severely mentally handicapped Under age 16 Aged 16 and over Total Under age 16 Aged 16 and over Total M F M F M F M F 1 Number of patients under care at 31st December 1970 1 89 197 287 88 66 146 148 448 2 Attending training centre - - 34 54 88 66 45 50 56 217 3 Awaiting entry to training centre 1 - - - 1 4 7 1 2 14 4 Receiving home training - - - - - - - 1 - 1 5 Awaiting home training - - - - - - - - - 6 Resident in LA home/hostel - - 13 6 19 12 1 11 7 31 7 Awaiting residence in LA home/hostel - - - - - 6 1 2 2 11 8 Resident at LA expense in other homes/hostels - - 5 10 15 5 4 4 5 18 9 Resident at LA expense by boarding out in private households - - - - - 1 1 - 3 5 10 Attending day hospitals - - - - - - - - - - 11 Receiving home visits and not included in lines 2-10 (a) suitable to attend a training centre - - - - - 2 4 16 19 41 (b) others - - 39 128 167 6 9 76 68 159 12 Number of children not included in item 2 above because they do not come within the categories covered - - - - - - - - - - 13 Number of persons included in item 6 above who reside in accommodation provided under the National Assistance Act 1948 - - - - - - - - - - 14 Number of patients on waiting list for admission to hospital at 31.12.70 (a) In urgent need of hospital care - - - - - - 2 - - 2 (b) Not in urgent need of hospital care - - - - - - 1 1 1 3 15 Number of admissions for temporary resident care (e.g. to relieve the family) during 1970 To NHS Hospitals - - 3 - 3 4 1 8 4 17 L A residential accommodation - - - - - 1 - - 1 2 Elsewhere - - - - - 1 - 2 3 16 Admissions to guardianship during the year - - - - - - - - - - 17 Total number under guardianship at end of year - - - - - - - - - - 118 Table 22 Number of patients referred during year ended 31st December 1970 Mentally III Mentally handicapped and severely mentally handicapped Referred by Under age 16 Aged 16 and over Total Under age 16 Aged 16 and over Total M F M F M F M F General practitioners - 1 124 211 336 1 - 1 - 2 Hospi tals. on discharge from inpatient treatment - - 36 68 104 - 3 6 1 10 Hospitals after or during outpatient or day treatment - - 38 76 114 - - - - - Local education authorities - - - - - 7 10 8 5 30 Police and courts - - 17 13 30 - - - - - Other sources 1 - 101 146 248 7 5 6 7 25 Total 1 1 316 514 832 15 18 21 13 67 Table 23 Work of mental health social workers during 1970 Mental illness Mentally handicapped and severely mentally handicapped Visits made 4790 1257 Office interviews 525 88 Compulsory admission to psychiatric hospitals 133 1 Informal admissions to psychiatric hospitals 64 8 Table 24 Ministry of Agriculture, Fisheries and Food - Prevention of Damage by Pests Act 1949 - Report for 12 months ended 31st December 1970 Properties other than sewers Type of property Non Agricultural Agricultural Number of properties in district 79887 - Total number of properties (including nearby premises) inspected following notification 7482 - Number infested by rats 1784 - mice 1567 - Total number of properties inspected for rats and/or mice for reasons other than notification 13293 - Number infested by rats 443 - mice 179 - Sewers Were any sewers infested by rats during the year? Yes 119 Table 25 Offices, Shops and Railway Premises Act 1963 - Annual Report for 1970 Section 60 of the above Act requires a local authority as soon as practicable after 31st December each year and not later than the end of March following to make to the Minister of Employment a report on their proceedings under this Act containing particulars as prescribed in an order made by the Minister These prescribed particulars, as set out below, were forwarded to the Minister of Employment on the 5th March, 1971. Table A. Registrations and general inspections Class of premises Number of premises newly registered during the year Total number of registered premises at end of year Number of registered premises receiving one or more general inspections during the year Offices 34 672 349 Retail shops 107 1090 630 Wholesale shops, warehouses 10 134 42 Catering establishments open to the public, canteens 39 218 131 Fuel storage depots - - - Total 240 2114 1152 Table B. Number of visits of all kinds (including general inspections) to registered premises 4069 Table C. Analysis by workplace of persons employed in registered premises at end of year. Class of workplace Number of persons employed Offices 20083 Retail shops 5899 Wholesale departments, warehouses 2011 Catering establishments open to the public 1062 Canteens 1583 Fuel storage depots 9 Total 30647 Total males 15820 Total females 14827 Table D. Exemptions - One exemption granted under Part IV - washing facilities One exemption under Part IV - washing facilities expired during the year Table E. Prosecutions instituted of which the hearing was completed in the year. Section of act or title of regulations or order Number of informations laid Numbers of informations leading to a conviction Sec. 10 (2) 1 - Sec. 10 (2) 9 (2) 2 2 Number of persons or companies prosecuted 2 Number of complaints (or summary applications) made under section 22 Nil Number of interim orders granted Nil 120 Table 25 Offices. Shops and Railway Premises Act 1963 - Annual Report for 1970 (Continued) Table F. Staff Number of inspectors appointed under section 52 (1) or (5) of the Act 20 Number of other staff employed for most of their time on work in connection with the Act 1 Table 26 Factories Act 1961 Part 1 of the Act Inspections for purposes of provisions as to health made by public health inspectors Premises Number on register Inspections Number of written notices Occupiers prosecuted a. Factories in which sections 1. 2, 3, 4 and 6 are to be enforced by local aut horities 67 63 1 - b. Factories not included in (a) in which section 7 is enforced by the local authority 859 1453 55 - c. Other premises in which section 7 is enforced by the local authority (excluding outworkers premises) 28 10 - - Total 954 1526 56 - Cases in which defects were found Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To HM Inspector By HM Inspector Want of cleanliness (S1) - - - - - Overcrowding (S2) - - - - - Unreasonable temperature (S3) - - - - - Inadequate ventilation (S4) - - - - - Ineffective drainage of floors (S6) - - - - - Sanitary conveniences (S7) a. insufficient 2 1 - - - b. unsuitable or defective 63 57 - 9 - c. not separded for sexes - - - - - Other offences against the Act (not including offences relating to outwork) - - - - - Total 65 58 - 9 - 121 Table 26 Continued Outwork - Part VIII of the Act Nature of work Section 133 No. of outworkers in August list required by Section 133 (1) (c) No. of cases of default in sending lists to the council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Section 134 Notices served Prosecutions Wearing apparel Making etc. cleaning and washing 26 - - - - - Lace, lace curtains and nets 2 - - - - - Curtains and furniture hangings 1 - - - - - Brass and brass articles 30 - - - - - Artificial flowers 2 - - - - - Lampshaies 1 - - - - - Total 62 - - - - - Table 27 Meteorology Extract from records supplied by the Chief Engineer, Mogden Sewage Works Week ending Barometer Temperature (C°) Days with rainfalI Total rainfall (inches) 1970 Highest Lowest Highest Lowest Jan 3rd 29.89 29.40 6.0 5.0 5 0.07 10th 29.96 29.10 10.0 5.5 4 0.67 17th 29.90 28.98 10.0 3.0 6 0.38 24th 30.02 29.24 10.0 4.0 7 0.64 31st 30.11 29.35 10.0 -1.5 7 0.60 Feb 7th 29.86 29.19 12.0 -1.0 6 0.36 14th 29.93 28.95 9.5 -3.5 3 0.36 21st 29.99 29.47 12.0 -2.0 6 0.61 28th 30.38 29.36 13.0 0.0 5 0.12 Mar 7th 30.21 28.90 9.5 -4.2 4 0.54 14th 30.20 29.54 8.0 -3.5 2 0.56 21st 30.32 29.45 14.0 2.5 5 0.06 28th 30.04 29.70 12.0 -1.5 5 0.56 April 4th 29.96 29.28 11.5 -2.0 7 0.35 11th 29.90 29.30 11.5 -1.5 7 0.67 18th 30.20 29.36 16.0 1.0 7 0.60 25th 29.98 29.20 15.5 2.0 7 0.60 May 2nd 30.20 29.40 18.0 1.0 5 0.24 9th 30.06 29.44 23.0 8.0 3 0.27 16th 30.05 29.56 20.0 7.5 5 0.56 23rd 30.39 29.71 21.5 6.0 2 0.01 30th 30.26 29.74 22.5 3.5 1 0.06 122 Table 27 Continued Week ending Barometer Temperature (C 0 ) Days with rainfall Total rainfall (inches) 1970 Highest Lowest Highest Lowest June 6th 30.27 28.88 24.5 10.5 0 0.00 13th 30,00 29.68 29.5 9.0 3 0.59 20 th 30.15 29.31 26.0 9.5 1 Trace 27th 30.14 29.65 27.0 10.0 3 0.44 July 4th 30.03 29.43 27.5 11.5 5 0.43 11th 30.08 29.43 31.5 9.0 5 0.53 18th 30.19 29.52 26.0 10.5 3 0.99 25th 29.55 29.49 23.0 7.0 6 0.63 Aug 1st 30.12 29.73 27.0 11.0 3 0.18 8th 30,04 29.80 27.5 12.0 3 0.99 15th 30.00 29.36 25.8 10.5 3 0.15 22nd 29.93 29.38 21.2 6.7 4 1.27 29th 30.10 29.82 24.0 10.5 0 0 Sept 5th 30.08 29.58 25.5 9.0 2 0.11 12th 30.08 29.24 24.0 7.0 6 1.47 19th 30.20 29.49 23.0 7.0 3 0.25 26th 30.21 29.88 26.0 6.0 1 Trace Oct 3rd 30.13 29.60 26.0 8.0 2 0.09 10th 30.10 29.40 19.5 2.5 3 0.19 17th 30.25 29.98 20.0 4.0 1 Trace 24th 30.34 29.60 19.0 3.5 3 0.09 31st 30.20 29.76 17.0 3.5 4 0.26 Nov 7th 30.12 29.64 16.5 1.5 5 1.50 14th 30.07 29.10 15.0 1.0 6 2.36 21st 29.83 28.56 13.5 1.5 6 1.19 28th 30.23 29.26 15.0 3.0 5 0.80 Dec 5th 30.20 29.10 14.0 2.6 5 1.00 12th 30.72 29.87 12.5 -1.0 3 0.18 19th 30.47 30.03 12.0 -0.5 3 0.01 26th 30.46 29.73 11.5 -3.0 7 0.34 Table 28 Wind direction Summary of daily records for 52 weeks N 29 days SSW 5 days NNE 7 days SW 68 days NE 23 days WSW 20 days ENE 5 days W 42 days E 25 days WNW 21 days ESE 3 days NW 25 days SE 18 days NNW 9 days SSE 9 days Calm 41 days S 13 days No record 1 day 123 Table 29 Medical inspection of pupils attending maintained primary and secondary schools (including nursery and special schools) Periodic medical inspections Age groups inspected (by year of birth) No. of pupils who have received a fulI medical examination Physical condidion of pupils inspected Satisfactory Unsatisfactory 1966 and later 200 194 6 1965 1370 1347 23 1964 1658 1644 14 1963 184 179 5 1962 443 441 2 1961 119 119 - 1960 32 32 - 1959 726 726 - 1958 1021 1012 9 1957 258 253 5 1956 930 920 10 1955 and earlier 1227 1221 6 Total 8168 8088 80 Special inspections Number of special inspections 4393 Number of re-inspections 2970 Total 7363 Table 30 Defects found by periodic and special medical inspections Defects or disease Number of defects found at Periodic medical inspections Special inspections Requiring treatment Requiring to be kept under observation Requiring treatment Requiring to be kept under observation Skin 220 277 259 38 Eyes a. Vision 292 422 157 123 b. Squint 63 58 12 4 c. Other 22 61 11 9 Ears a. Hearing 57 251 95 147 b. Otitis media 21 96 10 18 c. Other 37 96 69 39 Nose and throat 93 336 29 50 Speech 35 108 21 16 Lymphatic glands 2 75 2 5 Heart 7 140 8 35 Lungs 27 230 18 32 Developmental a. Hernia 5 38 6 5 b. Other 30 180 22 82 Orthopaedic a. Posture 10 81 6 10 b. Feet 59 200 48 34 c. Other 39 141 29 27 Nervous system a, Epilepsy 15 34 4 7 b. Other 12 179 9 36 Psychological a. Development 22 79 14 28 b. Stability 19 473 27 100 Abdomen 19 90 9 25 Other 66 350 58 173 Pupils found to require treatment (excluding dental diseases and infestation with vermin) For defective vision (excluding squint) For any other condition Total individual pupiIs Age groups inspected (by year of birth) 3 12 15 1966 and later 38 161 186 1965 45 140 179 1964 8 19 26 1963 27 39 62 1962 9 15 24 1961 - - - 1960 49 60 102 1959 61 155 202 1958 33 43 67 1957 38 69 101 1956 81 108 178 1955 and earlier 392 821 1142 Total 125 Table 31 Treatment known to have been provided by the council at hospitals etc. Condition No. of cases known to have been dealt with Eye diseases, defective vision and squint - External and other excluding errors of refraction and squint 109 Errors of refraction (including squint) 1855 Total 1964 Number of pupils for whom spectacles were prescribed 487 Diseases and defects of ear, nose and throat Received operative treatment a. for diseases of the ear - b. for adenoids and chronic tonsillitis - c. for other nose and throat conditions - Received other forms of treatment 249 Total 249 Number of pupils known to have been provided with hearing aids a. in 1970 26 b. in previous years 63 Orthopaedic and postural defects a. pupils treated at clinics and out-patients departments 438 b. pupils treated at schools for postural defects 284 Total 722 Diseases of the skin (excluding uncleanliness) Ringworm - Scabies 1 Impetigo 2 Other skin diseases 905 Total 908 Child guidance Pupils treated 353 Speech therapy Pupils treated 556 Other treatment given a. pupils with minor ailments 361 b. pupils who received convalescent treatment under school health service arrangements 45 c. pupils who received BCG vaccination 835 d. allergy clinic 110 Total 1351 Table 32 Head and foot inspection (a) Infestation with vermin Total number of pupils examined in schools by nurses or other authorised persons 15928 Total number of individual pupils found to be infested 185 Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2) Education Act, 1944) 12 Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3) Education Act, 1944) 9 (b) Foot inspections Total number of pupils examined 6768 Number of new cases of plantar warts 177 Number of cases where re-infection found 7 Table 33 Dental inspection and treatment Number of pupils Total Age 5-9 Age 10-14 Age 15 & over Inspections First inspections at school 13990 First inspection at clinic 4687 No of first inspections requiring treatment 11148 No of first inspections offered treatment 11148 Pupils re inspected at clinic or school 896 No of re inspections requiring treatment at clinic or school 694 Attendances and treatment First visit 3280 2680 601 6561 Subsequent visits 6970 7017 1576 15563 Total visits 10250 9697 2177 22124 Additional courses of treatment commenced 288 145 20 453 Fillings in permanent teeth 4046 7465 2212 13723 Fillings in deciduous teeth 8958 1145 - 10103 Permanent teeth filled 3035 5285 1524 9844 Deciduous teeth filled 5839 720 - 6559 Permanent teeth extracted 33 342 52 427 Deciduous teeth extracted 3251 955 - 4206 General anaesthetics 1254 556 56 1866 Emergencies 888 477 109 1474 Number of pupils X-rayed 1174 Prophylaxis 2315 Teeth otherwise conserved 52 Number of teeth root filled 43 Inlays - Crowns 102 Courses of treatment completed 4875 Anaesthetics - General anaesthetics administered by dental officers - Orthodontics New cases commenced during year 210 Cases completed during year 110 Cases discontinued during year 52 No. of removable appliances fitted 311 No. of fixed appliances fitted 1 Pupils referred to hospital consultant - Prosthetics Pupils supplied with full upper or full lower dentures (first time) - - 1 1 Pupils supplied with other dentures (first time) - 7 1 8 No.of dentures supplied - 7 2 9 Sessions relating to school dental service Sessions devoted to treatment - - - 3565 Sessions devoted to inspection at school - - - 149 Sessions devoted to dental health education 267 Sessions relating to maternity and child welfare dental service Sessions devoted to treatment 301 Sessions devoted to dental health education 15 127 List of clinics held in the borough at 31st December 1970 Except for child health and minor ailments attendance at all clinics is by appointment Premises Child health Antenatal Cervical cytology Immunisation Chiropody Dental School Minor aiIments Ophthalmic & orthoptic Orthopaedic Physiotherapy Speech therapy AIlergy Mental health counselIina Child psychiatry Otology Cerebral palsy Imperial Road Bedfont Mon pm Wed pm Thur pm Fri am (relaxation) Fri pm (alt) Fri pm (alt) Mon pm fortnightly Tues am/pm Mon to Fri am/pm except Wed pm Wed am Mon to Fri am Albany Road Brentford Wed pm Thur pm Tue am Mon pm (2nd & 4th) Wed am Thur am/pm Mon to Fri am/pm Thur am Mon to Fri am Tue pm (2nd 4th & 5th) Mon pm (1st & 3rd) Mon pm Tue pm (2nd & 4th) Town HalI Chiswick Tue pm Wed pm Thur pm Fri pm Tue am (relaxation) Thur pm (alt) Thur pm (alt) Mon pm Tue am/pm Wed am/pm Thur am/pm Fri am/pm Mon to Fri am/pm Mon am Mon to Fri am Wed pm Thur am Memorial Hall High Street Cranford Fri pm Cardinal Road Feltham Mon pm Tue pm (HV only) Wed pm Tue am (relaxation & mother craft) Tue pm (2nd, 3rd & 4th) Mon am Tues am Mon to Fri am/pm Wed am Fri am Mon to Fri am Mon am Thur pm (1st) Grove Crescent Hanworth Tue pm Thur pm (1st & 3rd) (2nd & 4th) HV only) Fri pm (alt) Mon pm (relaxation & mothercraft) Fri pm (alt) Tues am (alt) Thur am/pm T ue am/ pm Mon am Mon to Fri am Cranford Lane Heston Tue pm Wed pm Thur pm Mon pm (alt) Fri am (relaxation) Wed pm (Midwives) Mon pm (alt) Fri pm (1st, 2nd & 3rd) Thur am/pm Mon to Fri am/ pm Mon am Mon to Fri am Mon am Tues am Wed am Thur am 92 Bath Road Hounslow Tue pm Wed pm Thur pm Fri pm Tue am Tue am (relaxation) Wed pm (Midwives Mon pm (alt) Mon pm (1st, & 3rd) Wed am Mon pm Wed am/pm Thur am/pm Fri am/pm Mon to Fri am/ pm Mon am Fri am Mon to Fri am Tue pm (1st 3rd) Thur am/ pm Tues am (orthoptist Tue pm (4th) T ue pm (4th) Wed pm Fri pm except 4th Fri pm Fri pm Tue pm (1st) held at 6 Lampton Road) Park Road Busch Corner Isleworth Mon pm Wed pm Tue pm (Midwives) Thur pm (alt) Thur pm (alt) Tue pm (1st only) Thur am (2nd & 3rd) Tue am Fri pm Wed pm Mon to Fri am/ pm Mon am Mon to Fri am Tue pm Mon am Tue am Wed am Thur am Fri am Tue am/pm Wed am/pm Fri am/pm Spring Road Feltham Mon pm Wed pm Wed am (relaxation) Fri pm (alt) Tue am (alt) Mon pm Tue pm Fri am Mon to Fri am Premises Child health Antenatal Cervical cytology Immunisation Chiropody Dental School Minor ailments Ophthalmic & orthoptic Orthopaedic Physio therapy Speech therapy Allergy Mental health counselling Child psychistrv Otology Cerebral palsy Child Guidance Old Town School School Road Hounslow Tue am/ pm Wed am/pm Fri pm Hearing Clinic Vicarage Farm Road Heston Mon am Tue am/ pm Medical Advisory Unit Martindale Road Hounslow. Mon am (occasional) Mon to Fri am/ pm Mon to Fri am/pm Mon pm Maswell Park Hounslow Ave Hounslow Mon pm Thur am (relaxation & mot herercraft) Wed am Mon pm Mon to Fri am 130 131 Index Accidents in the home 35 Deaths 20, 21, 106-108 Agricultural premises 101 Dental services 46, 79, 116, 127 Ambulance service 27 Disinfection 23 Animal boarding establishments 101 DPH training scheme 102 Ante natal clinics 37, 115 Environmental health 91-102 Appreciation 16 Factories 97, 121-122 Asthma and allergy clinic 56 Family doctors 16, 27, 29, 31, 37 Audiology 56-58 planning 31, 44-45 Births 19, 21, 113 First aid in workshops, offices, schools and colleges 77 Building projects 17-18 Fluroide 79, 91 Burials 103 Food and drugs 93-96 Caravans 99 Foot inspections 48, 126 Cerebral palsy unit 58-60 Handicapped children 65-76 Cervical cytology 36-37 Hairdressers and barbers 101 Chest clinics 26 Health centres 14, 27 Child guidance clinic 60-61 education 34, 76 health clinics 37, 115 services - unification 14 minders 30, 42-43 visiting 29, 113 Chiropody 33 Hearing clinic 56-58 Clean air 96 Home help 32, 114 Clinics and other premises 128-131 nursing 31, 114 Committee members 3-6 safety 35 Co-ordination and co-operation 15, 33, 44, 47, Hospitals 23, 25-27 103 Day centres 83, 86-87 Hostels 83, 87-89 nurseries 42-43, 74, 115 Hounslow proiect 35-36 132 Housing 98-100 Nursing homes 102 Illegitimate births 19 21 Observation/Risk register 38-39 Immunisation & vaccination 24/25. 112-113 Occupational health service 81-82 Incontinent laundry service 31 Offices, shops and raiIway premises 120-121 Infant mortality 19, 22, 108 Perinatal mortality 20 Infectious diseases 22, 77, 110 Pests 100, 119 Infective hepatitis 15 Pet animals 101 Joint Obstetric Chi Id Health Project 39-42 Phenylketonuria 42 Language development 49-55 Physiotherapy 59, 83, 86 Loan of nursing equipment 33 Population 14, 19, 21, 47 Massage and special treatment 102 Post natal clinics 37 115 Maternal mortality 20 Premature births 115 Medical advisory unit 58-60 Problem families 34 inspection and treatment 47-48, 74, Recuperative holidays 33, 76 124-126 Mental illness 83-90, 118-119 Rehousing 100, 102 Mentally handicapped 83-90, 118-119 Renal dialysis in the home 37 Meteorology 122 Research projects 15, 39-42, 79 Middlesex executive council 27 Riding establishments 101 Midwifery & maternity services 29, 113 Risk/Observation register 38-39 Milk 77, 92-93 Rodent control 100, 119 Mortuary 103 School health service 47 Mother and baby homes 42 meals and milk 77 Neonatal mortality 19 population 47 Noise abatement 97 psychological service 61-65 Notification of congenital defects 38-39 Sewerage 92 Nurseries and child minders 30, 42-43 Social workers 75, 89-90, 119 133 Special schools and classes 61-62,72-74 Tuberculosis 32,114 Speech therapy 49-55, 59, 86 Uncleanliness and verminous conditions 23, 48, 126 Staff health service 31 Unsupported mothers and babies 42 training 29, 30, 32, 102 Vaccination and immunisation 24-25, 112-113 Staffing establishment 7-13 Venereal disease 14, 24, 112 Statistical tables 106-127 Vital statistics 19-22 Stillbirths 19, 21 Voluntary organisations 33, 34 42, 44, 88 Student health 77-78 Water 91 Swimming baths 92 Welfare foods 38 Tongue conditions - malnutrition 79 134