MER 19 London Borough of Merton THE HEALTH OF MERTON I965 I965 The Annual Report of the MEDICAL OFFICER OF HEALTH and the PRINCIPAL SCHOOL MEDICAL OFFICER P. J. DOODY, M.B., B.Ch., B.A.O., D.P.H. THE HEALTH OF MERTON by P. J. DOODY, M.B., B.Ch., B.A.O., D.P.H. CONTENTS Page INTRODUCTION: Committees 9 Staff 10-13 Introductory Letter 6-8 GENERAL PUBLIC HEALTH SERVICES: General Information 14 Summary of Vital 15-16 Comparative Statistics, 18 Causes of Death at Different Periods of Life 17 Principal Causes of Death in Order of Frequency 18 Infant Deaths 19 Infant Mortality 19 Maternal Mortality 19 Perinatal Mortality 19 Control of Communicable Diseases: Notifications received during 1965 20 Tuberculosis 20-22 Prophylactic Measures 22-23 Venereal Diseases 23 Notifications of Birth 24 PERSONAL HEALTH SERVICES: Maternal and Child Care: General 25 Ante-natal and Post-natal Services 25 Relaxation Classes 25 Premature Infants 25-26 Child Welfare . 26-28 Dental Care 28 Day Nurseries 28-29 Care of Unmarried Mothers and their Children 29 Congenital Malformations 29 Welfare Foods and Vitamins 29 PUBLIC HEALTH NURSING AND ALLIED SERVICES: Health Visiting: Staff 30 Health Visitors' Duties 30-31 Summary of Work of Health Visitors 31 3 Page Health Education 31 Midwifery: Staff 31-32 Organisation 32 Maternity Cases Attended 32 Medical Aid 32 Analgesia 32 Puerperal Pyrexia 32 Ophthalmia Neonatorum 32 Maternity Outfits 32 Early Discharges from Hospital 33 Midwifery Training 33 Post-Graduate Courses 33 Home Nursing: Staff 33 Organisation 33 Training 33 Cases Attended 34 Visits Made 34 Incontinence Pads 34 Incontinent Laundry Service 34 Domestic Help Service: Staff 34-35 Organisation 35 Statistics 35-36 Chiropody Service 36 Ripple Bed Service 37 Sick Room Equipment 37 Recuperative Holidays 37 Fluoridation of Public Water Supplies 37-38 Mental Health Service: Organisation 39 Staff 39 Mental Health Establishments 39 The Casework Services 40 Subnormality 40 Other Forms of Mental Disorder 41 Patients in Hospital 42-43 Guardianship 43 Cases Boarded Out 43 Short-Term Care 43 Social Work Section 43-44 4 Page SANITARY CIRCUMSTANCES OF THE AREA: Services under the Public Health Acts: Water Supply 45-46 Sewerage and Sewage Disposal 46-47 Registered Common Lodging Houses 47 District Inspection 47-50 Services under the Food and Drugs Act: Milk and Dairies (General) Regulations 50-51 Milk (General Designations) (Amendment) Regulations, 1965 51 Milk (Special Designations) Regulations, 1963 51 Brucella Abortus 51 Ice-cream 51 Meat and Other Foods 51-52 Meat Inspection 52 Food Premises 52-53 Bacteriological Examination of Equipment 53 Food Inspection 54-55 Sampling of Food and Drugs 55-62 Services under Other Enactments: Rent Act, 1957 63 Shops Acts, 1950-1965 63 Offices, Shops and Railway Premises Act, 1963 63-64 Petroleum (Regulations) Acts, 1928 and 1936 64 Prevention of Damage by Pests Act, 1949 64-65 Pet Animals Act, 1951 65 Animal Boarding Establishments Act, 1963 66 Riding Establishments Act, 1964 66 Diseases of Animals Act, 1950 66 Clean Air Act, 1956 66-69 Factories Act, 1961 49-50 Noise Abatement Act, 1960 69 Pharmacy and Poisons Acts, 1933-1941 69 Rag Flock and Other Filling Materials Act, 1951 69 Fertilisers and Feeding Stuffs Act, 1926 69 Housing Acts, 1957-1964 69 5 To The Mayor, Aldermen and Councillors of the London Borough of Merton. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the first Annual Report on the health of the London Borough for 1965. The Report shows that the health of the residents has been good during the year and, generally, vital statistics compare favourably with those of the country as a whole. The Registrar-General's estimated mid-1965 home population of 185,130 shows a decrease of 910 compared with the population in 1964. The live births totalled 2,899 giving a live birth rate per 1,000 of the population of 15.66. Of these 2,899 live births, 228 were illegitimate. The live birth rate for England and Wales for the year was 18.1. Deaths from all causes numbered 2,106 giving a death rate per 1,000 of the population of 11.37. The excess of births over deaths was 793. The reduced population followed a trend which has persisted over the past ten years. The population of the area in 1955 was 195,970. It will thus be seen that the population of the area has fallen, since 1955, by 10,840, although in each of the intervening years there has been an excess of live births over deaths. Throughout the years since 1955 the live birth rate of the area has been considerably lower than the national rate, and whilst in 1955 the death rate of the area was 9.1 compared with the national rate of 11.7 for England and Wales, over the intervening years the disparity between the local and the national death rates has narrowed—for 1965 Merton's death rate is 11.37 and that for England and Wales is 11.5. There would appear to be no indication that this tendency to a shrinking population may be altered in the near future. In the summary of the Ten-Year Plan for the Development of Health and Welfare Services of Local Authorities in England and Wales, the Ministry of Health shows the projected population of the Borough as 173,600 by 1976, giving a further anticipated reduction of population of 11,530 during the next 11 years. There was only one case of poliomyelitis during the year. This was a case which produced partial paralysis of the upper arm and shoulder of the patient, which was diagnosed in retrospect some weeks after the onset of the initial symptoms. One case of typhoid fever occurred during the year. This occurred in a child returning from a Continental holiday with her parents. During the incubation period of the disease, the child was attending a private nursery. An investigation was carried out on the staff and pupils at this nursery. All the specimens of stools taken proved to be negative. The child made a satisfactory recovery. There was a high incidence of measles, which is a normal epidemological feature every two years. The demand on the Home Help Service throughout the year was heavy, and the difficulty of recruiting sufficient Home Helps to meet all demands to the full, in an area in which women were able to find many alternative forms of employment, made the task of allocation of help a matter of careful selection of priorities of need. 6 In the operation of the Mental Health Service, the need for establishing a close liaison with mental hospitals to which patients from this area are regularly admitted, became a matter of priority. By the end of the year a close link had been established, both by the medical staff and by the Mental Welfare Officers of the Department. The Authority's Mental Welfare Officers took the initiative in requesting case conferences with hospital staff on patients with specially complex difficulties. Some difficulty was experienced in ascertaining whether patients being discharged from hospital were in need of, or desirous of having, community care even when such patients had been receiving such care before their admission to hospital. The practical difficulties of maintaining a close link with mental hospitals in the area are very real ones. Patients from this Borough are admitted to three mental hospitals, namely Netherne, West Park and Horton Hospitals and if, in accordance with the highest standards of social work practice, a close liaison is to be maintained with patients, whilst in hospital or in the community, close links with three mental hospitals are obviously much more difficult and time consuming with a limited staff, than would be the case if a close link had merely to be established with one hospital serving the area. In addition it is also necessary to maintain some liaison with three hospitals for subnormal patients. Throughout the year, difficulties associated with staffing were an ever-present problem. The establishment framed to meet the needs of the Health Department, comprises a variety of professional and semi-professional workers, and the twofold problem was that of recruiting staff with appropriate professional qualifications and the necessary experience, and of retaining such staff once recruited. In the case of Social Workers it became apparent that the acute shortage was to be a continuing one, especially when one realises that on the establishment of the Health Department there is provision for Medical Social Workers, Psychiatric Social Workers, Mental Welfare Officers and other Social Workers whose period of training leading to eventual qualification varies from two to four years. The choice, therefore, in filling vacancies for Social Workers on the establishment was seldom one of selecting the best applicant from a short list of qualified and experienced candidates but was rather a matter of appointing from the available applicants, one who, although professionally unqualified, had previous practical experience in this field of work, and whose personality was suitable. It was not possible, therefore, to fill all the vacancies on the establishment with qualified staff, and it is obvious that the best hope for the future is for the Authority to train, on an assisted training scheme, persons with the necessary educational background and personality, to embark on training leading to an eventual professional qualification. In the meantime, unqualified staff on the establishment receive guidance and help from the qualified staff. By the end of the year it had not been possible to recruit a Deputy Superintendent of the Midwifery and Home Nursing Service, and the Superintendent, therefore, carried on under considerable difficulties. The inability to appoint a Health Education Officer is very much to be regretted. This is an essential post in a Health Department for, 7 without such an Officer, health education tends to become sectionalised rather than being carried out as a cohesive and carefully formulated plan, placing due emphasis at appropriate times, on various aspects of positive health. As a means of maintaining a close liaison with other branches of the National Health Service and with other London Boroughs, during the year it is necessary for me to attend meetings of St. Helier Group Medical Committee, The Association of London Borough Medical Officers of Health, London Liaison Committee, South West London and Surrey Executive Council, South West London and Surrey Local Medical Committee, Regional Liaison Committee of the South West Metropolitan Regional Hospital Board, and St. Helier Group Maternity Liaison Committee (of which I am the Chairman). A period of reorganisation of such great significance as the London one is bound, in the early stages of its implementation, to present difficult problems of administration, not the least of which has been the change, in the sphere of the Personal Health Services from a system of Divisional Administration formulated by the Surrey County Council, and carried out by the three former County Districts under the guidance of County Council Central Administration, to a system of administration as a directly responsible Local Health Authority. The first year of the new set-up, therefore, has been to some extent a period of transition in which the staff of the Health Department, particularly those in senior administrative posts, have slowly conditioned themselves to the greater responsibilities associated with the assumption by the Authority of direct responsibility, as opposed to responsibility under the umbrella of a County Central Administration. This was inevitable since, with few exceptions, the Health Department staff comprised personnel who had worked in the previous Divisional system. On the Environmental Health side, of course, this was a merging of the Services of three Authorities into one, the change from Divisional to Central Administration not being an attendant problem, although the merging of the policies of three former Districts, particularly under the Clean Air Act, into one procedure for the new Borough presented very real problems. In conclusion, I should like to take this opportunity of expressing my appreciation to the Chairman and Members of the Health Committee for the consideration and courtesy they have shown to me during the year. My thanks are also due to all members of the Health Department for the loyal and efficient manner in which they carried out their duties during a difficult period of reorganisation. I would especially like to thank Mr. Cockell, the Chief Public Health Inspector and Mr. Atkinson, my Chief Administrative Officer, for their contributions in connection with the preparation of this Report. I am also indebted to my colleagues in other Departments for their ready help and co-operation on all occasions. I have the honour to be, Your obedient Servant, P. J. DOODY, Medical Officer of Health. 8 COMMITTEES AT 31st DECEMBER, 1965 HEALTH COMMITTEE The Mayor, Alderman Cyril S. Marsh, J.P. Councillor (Miss) N. K. Watts (Chairman) Councillor G. Waller (Vice-Chairman) Alderman T. H. Metcalf Councillors: J. T. Botten (Mrs.) E. M. Davis A. S. Hutchin Miss S. Knight G. W. A. Pearce, J.P. J. T. Pyne, J.P. G. H. Raymond W. Reay J. Wemms ENVIRONMENTAL HEALTH SUB-COMMITTEE Chairman of the Health Committee, Councillor (Miss) N. K. Watts (Chairman) Vice-Chairman of the Health Committee, Councillor G. Waller Councillors: J. T. Botten (Mrs.) E. M. Davis (Vice-Chairman) A. S. Hutchin G. W. A. Pearce, J.P. G. H. Raymond W. Reay MENTAL HEALTH SERVICES SUB-COMMITTEE Chairman of the Health Committee, Councillor (Miss) N. K. Watts (Chairman) Vice-Chairman of the Health Committee, Councillor G. Waller Councillors: A. S. Hutchin (Miss) S. Knight G. H. Raymond (Vice-Chairman) W. Reay Co-opted members:— Representative of the Local Medical Committee (Dr. R. A. Arthur). Representative of the S. W. Metropolitan Regional Hospital Board (Dr. M. A. Fawkes). TOWN CLERK Sydney Astin (Solicitor) 9 WHOLE-TIME STAFF (At 31st December, 1965) Medical Officer of Health and Principal School Medical Officer Deputy Medical Officer of Health and Deputy Principal School Medical Officer Senior Medical Officer Assistant Medical Officers and School Medical Officers Chief Dental Officer School Dental Officers Chief Public Health Inspector Deputy Chief Public Health Inspector Superintendent Health Visitor Superintendent of Midwifery and Home Nursing Service Home Help Organiser Chief Administrative Officer Deputy Chief Administrative Officer Senior Mental Welfare Officer Deputy Senior Mental Welfare Officer Mental Welfare Officers Mental Health Social Worker P. J. Doody, M.B., B.Ch., B.A.O., D.P.H. W. D. Swinney, M.B, Ch.B., D.P.H. M. D. Sussman, M.B., Ch.B., D.P.H. Alison M. Batten, M.B., Ch.B., L.R.C.P., L.R.C.S., L.R.C.P.S., D.P.H. June P. Cooper, M.B., B.S., M.R.C.S., L.R.C.P., D.Obst. R.C.O.G., D.C.H., D.P.H. V. Feldman, M.D., M.B., B.S., M.R.C.P., M.R.C.S., L.R.C.P., D.P.H. Maria J. Freeman, M.B., B.S., L.M.S.S.A. J. F. Kelly, M.B., B.Ch., B.A.O., D.P.H. L. W. McNamara, M.B., B.S., D.P.H. Elizabeth Pryce-Jones, M.B., Ch.B., D.C.H. Joan P. Tom, M.B., B.S., D.C.H. M. T. Gibb, L.D.S., R.C.S. S. Adorjan. M.D. (U.Vienna), L.D.S., R.C.S. Elizabeth W. Beaver, B.Ch.D. (Leeds). Wanda T. Truscoe, B.D.S. (Lond.), L.D.S., R C S H. W. Freeth, L.D.S., R.C.S., M.R.C.S., L.R.C.P. G. H. Cockell, F.A.P.H.I., F.R.S.H. G. E. Hayne, M.A.P.H.I., M.R.S.H. Miss P. M. Richards, S.R.N., S.C.M., H.V.Cert. Miss B. R. Lamberg, S.R.N., S.C.M., Q.N., M.T.D. Miss J. Forrest W. Atkinson, D.P.A., Cert. S.I.B. J. R. Richardson F. T. Rainer, Dip.Soc. Science. F. J. Gerring F. C. Dorrington S. G. H. Worrall Mrs. H. Yates, S.R.N., Cert. in Applied Social Studies Mrs. F. M. Coleman 10 Social Worker Supervisor, Junior Training Centre Educational Psychologist Psychiatric Social Worker Speech Therapist Mrs. A. Martin, B.A. (Hons.), H.O. Training Certificate Mrs. M. Barlow, Dip.N.A.M.H. Miss D. Waldeck, B.A. (Liverpool), Dip. N.A.M.H. (Lond.) Mrs. A. Litauer, Mental Health Diploma, London, Social Science Diploma, London Miss C. M. Durie, L.C.S.T. 11 Chest Physicians Consultant Psychiatrist Ophthalmic Surgeons Orthopaedic Surgeon Child Psychiatrists PART-TIME STAFF (At 31st December, 1965) ... J. M. Hill, M.D., M.B., B.S., M.R.C.P., M.R.C.S., L.R.C.P. E. Sanders, M.D., M.B., B.S., M.R.C.P., M.R.C.S., L.R.C.P. F. J. H. Walters, M.D., M.B., B.S., M.R.C.P., M.R.C.S., L.R.C.P. ... R. K. Freudenberg, M.D., L.R.C.P., L.R.C.S., L.R.F.P.S., D.P.M. ... W. L. Armstrong, M.A., B.M., B.Ch., (Oxon.), D.O. (Eng.) M. C. Shah, L.M.S.S.A. ... G. Hadfield, M.R.C.S., L.R.C.P., F.R.C.S. (Eng.) ... D. Rumney, M.R.C.S., L.R.C.P., D.P.M. A. R. Wilson, M.A. (Oxon.), B.M., B.Ch., D.P.M. Assistant Medical Officers and School Medical Officers School Dental Officers Dental Orthodontists Dental Anaesthetists Dental Auxiliaries Speech Therapist Audiometrician Cicily M. Clarke, M.A., M.B., Ch.B., D.C.H. Hilda C. Dean, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Joyce M. Havelock, M.B., B.S., M.R.C.S., L.R.C.P., C.P.H. Susan M. S. Turner, M.B., Ch.B., D.P.H. B. S. Sweetman, M.B., B.S., M.R.C.S., L.R.C.P. C. A. J. Heath, L.D.S., R.C.S. Joyce Heath, B.D.S. (Lond.) Ann C. Leonard, L.D.S., R.C.S. Sheila McDonald, L.D.S. J. M. Sturman, L.D.S., R.C.S. M. G. Smith, L.D.S., R.C.S. P. Turnbull, B.D.S. Frances J. Bigg, L.D.S., D.Orth., R.C.S., B.D.S. S. I. Robinson, L.D.S., R.C.S. J. G. Whitelegg, L.D.S., R.C.S., B.D.S. W. Carpenter, M.A., M.B., B.Ch., B.A.O., D.A. Betty M. Margetts, M.B., B.S., M.R.C.S., L.R.C.P., D.C.H. Iris I. Grant-Adams, M.R.C.S., L.R.C.P., D.P.H. R. G. Smith, M.B., B.S., M.R.C.S., L.R.C.P., D.A., D.Obst.R.C.O.G. Miss V. Hooker Mrs. G. V. Gliddon Mrs. S. J. Gold, L.C.S.T. Mrs. M. Dean, S.R.N. 12 Physiotherapists Social Workers 13 Mrs. A. G. Ockleshaw, M.C.S.P. Mrs. T. Puddifoot, M.C.S.P. Mrs. V. Kelly, M.C.S.P. Mrs. M. C. Hudson Miss E. M. Smith, S.R.N., S.C.M., Dip.Nsg. GENERAL PUBLIC HEALTH SERVICES General Information Area of Borough in acres 9,739 Number of private dwellings (1961) 59,482 Number of private households (1961) 64,219 Rateable value, at 1st April, 1965 £10,958,770 Actual product of a penny rate:— 1965-66 £45,005 Population:— Census figure (1961) 186,647 Registrar-General's Estimate of Population 1965 1964 at 30th June 185,130 186,040 14 Summary of Vital Statistics 1965 Live Births— 1965 Legitimate Males 1336 Females 1335 2671 Illegitimate Males 120 Females 108 228 Totals 2899 Live Birth Rate per 1,000 population 15.66 Corrected Live Birth Rate per 1,000 population 16.29 Illegitimate live births—percentage of total live births 8.55 Still Births— Legitimate Males 17 Females 23 40 Illegitimate Males 3 Females — 3 Totals 43 Still-birth Rate per 1,000 live and still-births 14.62 Still-birth Rate per 1,000 population 0.23 Total live and still-births 2942 Infant Mortality (Deaths of infants under one year of age)— Legitimate Males 29 Females 21 50 Illegitimate Males 3 Females 1 4 Totals 54 Infant Mortality Rate per 1,000 live births 18.35 Infant Mortality Rate per 1,000 legitimate live births 18.73 Infant Mortality Rate per 1,000 illegitimate live births 17.54 Neo-Natal Deaths (Deaths of infants in first 28 days of life) 31 Neo-Natal Mortality Rate 10.69 Early Neo-Natal Mortality Rate (deaths of infants in first week of life per 1,000 live births) 9.69 Perinatal Mortality Rate (Still-births plus deaths in first week of life per 1,000 live and still-births) 21.83 Total loss of infant life (Still-births plus infant deaths) per 1,000 live and still-births 24.22 Maternal Deaths (including abortion) 2 Maternal Mortality Rate per 1,000 live and still-births 0.68 Deaths 2106 Death Rate per 1,000 population 11.14 Corrected Death Rate per 1,000 population 11.14 15 Deaths from Bronchitis per 1,000 population 0.65 Deaths from Pneumonia per 1,000 population 0.65 Deaths from Cancer of lung and bronchus per 1,000 population 0.68 Deaths from other forms of Cancer per 1,000 population 1.81 Marriages 1480 Marriage Rate per 1,000 population 8.0 16 Causes of Death at different Periods of Life in the London Borough of Merton during 1965 Cause of Death Age Group and Sex Under 4 weeks 4 Wks. & under 1 year 1 to 5 years 5 to 15 years 15 to 25 years 25 to 35 years 35 to 45 years 45 to 55 years 55 to 65 years 65 to 75 years 75 years and over Totals M F M F M F M F M F M F M F M F M F M F M F M F Tuberculosis: Respiratory - - - - - - - - 1 - - - - - - - 2 - 2 - 5 3 10 3 Tuberculosis: Other forms - - - - - - - - - - - - - - - - - - - - - - - - Syphilitic Disease - - - - - - - - - - - - - - - - - - 3 2 2 — 5 2 Diphtheria: Meningococcal - - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal Infections - - - - - 1 - - - - - - - - - - - - - - - - - 1 Acute Poliomyelities - - - - - - - - - - - - - - - - - - - - - - - - Measles - - - — — - - - — — - - - - - - - - - - - - - - Other infections and parasitic diseases — — 1 1 — — — — — — 1 1 — — — 1 — 2 — — — 1 2 6 Malignant neoplasm: Stomach — — — — — — — — — — — — — — 4 — 6 — 10 6 7 7 27 13 Malignant neoplasm: Lung, bronchus - - - - - - - - - - - - 2 1 12 2 40 5 41 6 12 5 107 19 Malignant neoplasm: Breast — — — — — — — — — — — — — 7 — 10 — 13 — 11 — 9 — 50 Malignant neoplasm: Uterus — — — — — — — — — — — — — 2 — 3 — 5 — 5 — 7 — 22 Other malignant and Lymphatic neoplasm - - - - - - 1 - - - 2 1 5 — 15 9 27 25 34 32 32 31 116 98 Leukaemia: Aleukasmia — — — — — 2 1 — — — — — — — 1 1 1 — 1 — — 2 4 5 Diabetes - - - - - - - - - - - - 1 - - 1 1 2 — 4 3 9 5 16 Vascular lesions of nervous system - - - - - - - - - 1 1 —- 4 2 8 2 13 11 27 38 41 96 94 150 Coronary Disease: Angina — — — — — — — — — — 2 — 5 — 38 6 73 19 92 64 76 108 286 197 Hypertension with Heart Disease - - - - - - - - - - - - - - 2 — 1 1 3 3 5 13 11 17 Other Heart Diseases - - - - - - - - - - 2 — 1 1 1 1 8 9 10 26 29 97 51 134 Other Circulatory Diseases - - - - - - - - 1 - - - 1 1 3 1 10 6 15 14 27 45 57 67 Influenza - - - - - - - - - - - - - - - - - 1 - - - 1 — 2 Pneumonia 1 1 4 5 2 — 1 - - - - - - - 2 1 6 5 11 10 31 41 58 63 Bronchitis — — — 1 — — — — — — — — — — 4 — 21 4 38 8 23 22 86 35 Other Respiratory Diseases - - - - - - - - - - - - - - - 1 3 1 5 1 5 3 13 6 Ulcer of Stomach and Duodenum - - - - - - - - - - - - - - - - 1 1 5 2 3 1 9 4 Gastritis, Enteritis and Diarrhoea - - - 1 - - - - - - - - - - - - - - - 3 1 2 1 6 Nephritis and Nephrosis — — — — — — 1 — — — — — — — — — 1 — 2 — — 2 4 2 Hyperplasia of prostate — — — — — — — — — — — — — — — — — — 1 — 4 — 5 — Pregnancy: Childbirth, abortion - - - - - - - - - 1 - - - 1 - - - - - - - - - 2 Congenital Malformations 2 — 2 3 — — — 1 — — 1 — — — — 1 — 1 1 — — — 6 6 Other defined and ill-defined diseases 20 7 2 2 1 — 1 — 2 3 1 — 2 4 9 9 14 5 12 \9 15 29 79 78 Motor Vehicle accidents — — — — 1 — — — 3 — 2 — — 1 — — 2 — 3 1 1 1 12 3 All other accidents — — — 1 3 — — — — — — 1 3 2 2 1 1 — 1 5 2 8 12 18 Suicide - - - - - - - - 2 — 3 1 1 2 1 — 2 3 2 1 1 1 12 8 Homicide and operations of war - - - - - - - - - 1 - - - - - - - - - - - - - 1 ALL CAUSES 23 8 9 14 7 3 5 1 9 6 15 4 25 24 102 50 233 119 319 261 325 544 1072 1034 17 Comparative Statistics, 1965 Merton England and Wales Rates per 1,000 Population: Live births 15.66 18.1 Deaths (all causes) 11.37 11.5 Respiratory tuberculosis 0.07 0.04 Cancer of lung and bronchus 0.68 0.55 Rates per 1,000 live and still births: Still births 14.62 15.8 Maternal mortality 0.68 0.25 Perinatal mortality 21.83 26.9 Rates per 1,000 live births: Infant mortality—deaths of infants under 1 year 18.35 19.0 Neo-natal mortality—deaths of infants in first 28 days of life 10.69 13.0 PRINCIPAL CAUSES OF DEATH IN ORDER OF FREQUENCY Out of 2,106 deaths occurring during the year 1,924 were attributable to the undermentioned principal causes:— No. of Deaths. Percentage of Deaths from all causes. 1. Heart Diseases 696 33.0 2. Cancer 461 21.9 3. Vascular lesions of the nervous system 244 11.5 4. Other defined and ill-defined causes 157 7.5 5. Other Circulatory Diseases 124 5.9 6. Pneumonia 121 5.7 7. Bronchitis 121 5.7 18 INFANT DEATHS (Under 1 year) Principal certified Causes of Death Age at Death Total Under 24 hours Days Months 1- 7 814 1521 2228 1- 3 36 69 912 Prematurity 14 4 - - - - - - - 18 Congenital Malformations 4 - - 1 - 4 - - 1 10 Bronchopneumonia - - 2 1 - 3 3 1 1 11 Birth Injuries 3 1 - - - - - - - 4 Other causes 2 1 - - - 4 - 3 2 12 Totals 23 6 2 2 - 11 3 4 4 54 INFANT MORTALITY Of the 54 infant deaths, 29 occurred in the first seven days of life. The only one of these which was delivered at home died within 30 minutes, the cause being multiple congenital abnormalities. The infant mortality rate of 18.35 and the neonatal mortality rate of 10.69 per 1,000 live births compare satisfactorily with the respective rates of 19.0 and 13.0 for England and Wales. PERINATAL MORTALITY The perinatal mortality rate for Merton was 21.83 per 1,000 live and still-births thus comparing favourably with that for England and Wales of 26.9. MATERNAL MORTALITY Two maternal deaths were attributed to the Authority for 1965. One was a death in hospital in March, the cause of death being antepartum haemorrhage following breech delivery of a full-term infant. The second death actually occurred in November, 1964, but since the cause of death, given as air embolism due to instrumental abortion, was certified by the Coroner following his enquiry in 1965, this death was attributable to 1965, thus producing an unfortunately high maternal mortality rate of 0.68 per 1,000 live and still-births. 19 CONTROL OF COMMUNICABLE DISEASES Notifications received during 1965 (Corrected Notifications) Disease Age Groups of Cases Notified Total Under 1 1- 2 34 59 1014 15- 24 2544 4564 65 & over Measles 81 578 737 934 64 18 16 - - 2428 Scarlet Fever 1 3 16 36 6 — — — — 62 Pneumonia — — 1 — — 3 1 6 — 11 Puerperal Pyrexia — — — — — 8 7 — — 15 Whooping Cough 4 8 9 20 1 — — — — 42 Dysentery 2 4 9 7 1 4 4 3 — 34 Tuberculosis (Resp.): Males — — — 1 — 5 9 11 4 30 Females — — — 1 1 4 3 4 2 15 Tuberculosis (Non-Resp.): Males — — — — — 1 2 — — 3 Females - - - - - - 4 2 — 6 Meningococcal Infection - - - - - 1 - - - 1 Typhoid Fever - - 1 - - - - - - 1 Erysipelas - - - - - - 1 5 1 7 Food Poisoning 1 1 2 2 — 1 1 1 — 9 Ophthalmia Neonatorum 1 - - - - - - - - 1 Poliomyelitis (paralytic) - - - - - 1 - - - 1 Totals 90 594 775 1001 73 46 48 32 7 2666 TUBERCULOSIS There are three chest clinics serving the Borough, one for each of the three constituent areas. All are based at Cumberland Hospital, Mitcham. The Chest Physicians reported that, while the number of new cases of pulmonary tuberculosis remained much the same, lung cancer constituted an increasing problem. The high number of cases of bronchitis and emphysema presents serious difficulties which could only be effectively alleviated if more housing were available. They also reported a waiting list, for the first time, for beds in Cumberland Hospital; due mainly, in their opinion, to respiratory cripples who are kept alive by modern medical practice but require repeated admission to hospital because of recurrent chest illness. It was also reported that the general practitioner service of the Mass X-Ray continues to be increasingly patronised. The Authority employs one whole-time and two part-time Tuberculosis Health Visitors, and one part-time Tuberculosis Visitor, who work in close liaison with the Chest Physicians. In addition, for dealing with social problems of in-patients and out-patients of Cumberland Hospital, suffering both from tuberculosis and other diseases of the chest, the Authority employs a Medical Social Worker. DOMICILIARY VISITING All households from which notifications have been received are regularly visited. Intensive efforts are made to trace all contacts with a known case of respiratory tuberculosis. 20 Details of domiciliary visiting by Health Visitors are given below:— Visits in connection with old cases 963 Visits in connection with new cases 42 Visits in connection with contacts 264 Total 1269 B.C.G. VACCINATION During the year B.C.G. inoculation of school children in the thirteen-year-old age group was carried out:— Number of children skin tested 1753 Number found negative 1544 Number vaccinated with B.C.G 1537 No children with positive skin tests were known to be contacts with notified cases of tuberculosis. One-hundred and fifty-five of the children with positive skin tests were X-rayed. No case of active disease was found. INCIDENCE AND DEATH RATES PER 1,000 POPULATION During the year the following notifications of Tuberculosis were received: — Males. Females. Respiratory 30 15 Non-respiratory 3 6 The death rates per 1,000 population were 0.07 respiratory and 0.000 non-respiratory, compared with 0.04 and 0.006 respectively for England and Wales. AMSS X-RAY In addition to the general practitioner service, visits were made to industrial sites throughout the area and sessions were held for the general public. The service is of great value in the early diagnosis of pulmonary tuberculosis and non-tuberculous abnormalities. The results are tabulated below: — Number X-rayed Pulmonary T.B. found Primary Lung Cancer found Males Females Males Females Males Females General Practitioner Service 912 745 2 2 11 — Public and Industrial Sessions 10,776 6,727 9 6 7 1 Totals 11,688 7,472 11 8 18 1 DEATHS There were 13 deaths from respiratory tuberculosis during the year. The table of causes of death on page 17 gives an analysis by age and sex. 21 AFTER-CARE OF THE TUBERCULOUS The Authority makes an annual grant of £100 to each of the three T.B. Care Committees working within the Borough, to aid them in the much appreciated work which they carry out in connection with the after-care of the tuberculous. PROPHYLACTIC MEASURES The table below gives details of initial protection given by the injection of prophylactics against diphtheria, smallpox, whooping cough, poliomyelitis and tetanus:— Disease against which protection given Number of primary courses given Year of Birth Others under 16 years Total 1965 1964 1963 1962 1958/61 Diphtheria 1,042 1,265 153 29 126 37 2,652 Whooping Cough 1,041 1,255 151 29 45 2 2,523 Poliomyelitis (By injection) 2 6 6 3 5 3 25 Poliomyelitis (Oral) 384 1,723 192 81 183 48 2,611 Tetanus 1,042 1,264 153 29 201 173 2,862 The continuing need for immunisation and vaccination is brought home to the public at large by the use of leaflets, posters and displays, and by the teaching of the Health Visitors at the clinics and in the course of their district visits. RE-INFORCEMENT MEASURES In addition to the above measures of primary protection the following numbers were given re-inforcement doses: — Diphtheria 1802 Whooping Cough 1411 Poliomyelitis 2062 Tetanus 1734 POLIOMYELITIS At the end of the year, 80,193 persons had completed a full course of immunisation since the scheme began in 1956. The age distribution of these completed cases is given below: — Persons born 1943-65 52,106 Persons born 1933-42 15,791 Others 12,296 Total 80,193 FOURTH INJECTION At the end of the year 19,124 children, aged not less than five years and not more than 12 years, had received a fourth dose either by injection or by the oral method. SMALLPOX The following table shows the number of persons vaccinated or re-vaccinated against smallpox, in the various age groups during the year:— 22 Age at Time of Vaccination Total 0-3 months 3-6 months 6-9 months 9 months -1 year 1 year 2-4 years 5-15 years Number vaccinated 15 22 26 78 1,496 177 16 1,830 Number revaccinated ... — — — — — 15 22 37 GENERAL MEDICAL SERVICES During the year the medical staff carried out 667 medical examinations of staff for superannuation purposes. Five examinations were also carried out on staff, absent from work owing to sickness, to ascertain their fitness to return to duty. VENEREAL DISEASES The table below is compiled from figures supplied by the clinics at St. Helier Hospital, Carshalton, and Croydon General Hospital. No figures are available from other clinics in the London area. Number of patients resident in Merton and treated for the first time in 1965: — Male Female Total Gonorrhoea 18 2 20 Syphilis 4 3 7 Other conditions 70 47 117 Totals 92 52 144 23 Notifications of Birth The table below gives details of all births notified during the year occurring in the home, or in Institutions, and gives the total number of births finally attributable to Merton after outward transfer of births attributable to other Authorities. This figure of attributable notified births does not necessarily coincide with the number of attributable registered births supplied by the Registrar-General. Domiciliary Births Institutional Births Total Births Live Still Total Live Still Total Live Still Total M F M F M F M F M F M F M F M F M F Births notified as occurring in Merton 212 233 - 1 212 234 1220 1125 11 16 1231 1141 1432 1358 11 17 1443 1375 Births occurring outside Merton attributable to Merton (Inward Transfers) 4 2 — — 4 2 700 697 13 11 713 708 704 699 13 11 717 710 Total of all births notified 216 235 — 1 216 236 1920 1822 24 27 1944 1849 2136 2057 24 28 2160 2085 Births occurring in Merton attributable to other Authorities (Outward Transfers) - - - - - - 679 616 6 6 685 622 679 616 6 6 685 622 Total births attributable to Merton 216 235 — 1 216 236 1241 1206 18 21 1259 1227 1457 1441 18 22 1475 1463 24 PERSONAL HEALTH SERVICES MATERNAL AND CHILD-CARE GENERAL Maternal and Child Care Services are operated in nine purposebuilt Clinics, and five hired halls throughout the Borough. ANTE-NATAL AND POST-NATAL SERVICES Six ante-natal Clinics are held each week at Clinics in the area, at which an Assistant Medical Officer and a Health Visitor are in attendance. At these ante-natal Clinics cases are booked for subsequent hospital confinement. Post-natal sessions are also held on these occasions. In addition seven ante-natal sessions are held by midwives for patients booked for domiciliary confinement. Relaxation and mothercraft classes are held throughout the Borough at which health education on a personal basis is carried out by health visitors and midwives. Attendances at the ante-natal clinics during the year were as follows:— Number of women who attended for ante-natal examination 1137 Number of women who attended for post-natal examination 36 There were 374 midwives' clinic sessions at which 506 women attended. The total number of attendances was 2,883. RELAXATION CLASSES Ante-natal relaxation classes are held weekly by health visitors and midwives at the following clinics: Amity Grove, Church Road, Grand Drive, Middleton Road, Morden Road, Russell Road, Wide Way. The attendances were:— Number of women who attended during the year— (a) Institutionally booked 354 (b) Domiciliary booked 26 Total 380 The total number of attendances was 2,242. PREMATURE INFANTS The total number of premature infants born in the area during 1965 was 190. 25 Premature Infants Born at Home— Weight at Birth Born at home and nursed entirely at home Born at home and transferred to hospital on or before 28th day Grand Total Total Died within 24hrs of birth Survived 28 days Total Died within 24hrs of birth Survived 28 days 2 lb. 3 oz. or less 1 1 - - - - 1 Over 2 lb. 3 oz. up to and including 3 lb. 4 oz - - - - - - - Over 3 lb. 4 oz. up to and including 4 lb. 6 oz. 1 - 1 - - - 1 Over 4 lb. 6 oz. up to and including 4 lb.15 oz - - - - - - - Over 4 lb. 15 oz. up to and including 5 lb. 8 oz. 11 — 11 1 — 1 12 Totals 13 1 12 1 — 1 14 Twenty-two premature infants died during 1965. This means that 11.6% of the 190 premature infants born during the year died within a year. Only 1.2% of full-term babies died before reaching the age of one year. CHILD WELFARE GENERAL The Local Authority holds Infant Welfare Clinics at the fourteen premises listed below. Nine of these are purpose-built, the remainder being hired for the weekly clinic session. The Toddlers' Clinics provide a service very similar to the School Health Service. The child receives a detailed medical examination and a full range of specialist services are available, including the special clinics provided by the Education Service. Children can be referred to the Child Guidance Clinic, and the visiting Consultant is available to discuss individual problems with medical and nursing staff. These Toddlers' Clinics are an important factor in establishing the means whereby the developmental progress of children may be carefully observed both prior to entry to school and later in their progress through school life. The attendance at these clinics is often disappointing. Infant Welfare Centres being operated at the end of the year were as follows:— Amity Grove Clinic Monday 2-4 p.m. West Wimbledon Wednesday 2-4 p.m. Friday 10-12 a.m. Cavendish Road Clinic Monday 1.30-3.30 p.m. Colliers Wood Friday 9.30-11.30 a.m. Church Road Clinic Wednesday 1.30-3.30 p.m. Mitcham Thursday 1.30-3.30 p.m. Churchill Hall Clinic* Tuesday 2-4 p.m. Effra Road, S.W.19 26 Emmanuel Hall* Thursday 2-4 p.m. Lingfield Road, S.W.19 Grand Drive Clinic Monday 10-12 a.m. and Raynes Park 2-4 p.m. Wednesday 10-12 a.m. Meopham Road Clinic Wednesday 1.30-3.30 p.m. Mitcham Middleton Road Clinic Tuesday 10-12 a.m. and Morden 2-4 p.m. Thursday 2-4 p.m. Morden Road Clinic Tuesday 10-12 a.m. Merton Thursday 2-4 p.m. Pelham Road Clinic Tuesday 2-4 p.m. Wimbledon Friday 2-4 p.m. St. Barnabas Hall* Tuesday 1.30-3.30 p.m. St. Barnabas Road, Mitcham St. John's Hall* Thursday 9.45-11.45 a.m. High Path, Merton St. Luke's Hall* Friday 2-4 p.m. Strathmore Road, S.W.19 Wide Way Clinic Monday 1.30-3.30 p.m. Mitcham Thursday 9.30-11.30 a.m. Toddler sessions are held, by appointment, at Western Road School Clinic and at all of the above excepting Churchill Hall, Emmanuel Hall, St. John's Hall and St. Barnabas Hall. * Denotes hired premises. ATTENDANCES AT INFANT WELFARE CENTRES Name of Centre Total No. of Sessions First Attendances Total Attendances including Firsts Born In Total 1960-65 1965 1964 196063 Amity Grove 113 251 18 5 274 5,380 Cavendish Road 73 158 12 8 178 3,002 Church Road 79 193 58 106 357 3,370 Churchill Hall 38 103 9 66 178 2,760 Emmanuel Hall 39 92 5 52 149 1,692 Grand Drive 108 219 47 125 391 5,789 Meopham Road 39 56 20 29 105 1,443 Middleton Road 76 115 20 39 174 2,165 Morden Road 115 196 33 68 297 4,321 Pelham Road 77 239 47 56 342 4,716 St. Barnabas Hall 38 219 51 16 286 3,227 St. John's Hall 40 38 11 26 75 1,385 St. Luke's Hall- 38 127 8 30 165 2,744 Wide Way 75 160 79 29 268 2,928 Totals 948 2,166 418 655 3,239 44,922 A total of 7,635 children attended during the year. 27 ATTENDANCES AT TODDLER'S CLINICS First Attendances Total Attendances Total Sessions (All Clinics) Born In 1965 1964 1960-63 1960-65 - 13 322 335 733 65 DENTAL CARE A satisfactory feature of the treatment of children under five years was the high proportion of fillings to extractions, 557—87. Forty expectant and nursing mothers were examined during the year and 29 commenced treatment. This comparatively small number is due to the fact that most adults receive treatment under the General Dental Services. Examined Commenced treatment Completed course of treatment Expectant and Nursing Mothers 40 29 33 Children under 5 325 181 169 Scaling and gum treatment Fillings Silver Nitrate treatment Cr'ns and Inlays Extrac tions General Anaesthe tics Dentures X- Rays Full Part Expectant and Nursing Mothers 29 83 - - 25 4 1 3 3 Children under 5 14 557 83 - 87 37 - 1 3 DAY NURSERIES The Authority had, at the end of the year, two Day Nurseries in operation providing accommodation for 85 children under the age of five years. Admissions are made under the following categories of priority: First Priority—Where the mother is the sole wage earner. Second Priority—Where there is sickness in the family, or where home conditions exist which are likely seriously to prejudice the health of the child. Third Priority—In exceptional cases, where, upon consideration of individual circumstances, it appears to the Council that admission is necessary in the best interests of the child. 28 The following table shows the places available and the average daily attendance at each nursery: — Nursery No. of places 0-2 years No. of places 2-5 years Total number of places Average daily attendance All Saints Day Nursery 12 34 46 44.8 Middleton Road Day Nursery 9 30 39 35.4 At the end of the year there were eleven private day nurseries registered under the Act, with a total of 250 places. In addition there were 7 daily minders on the register. CARE OF UNMARRIED MOTHERS AND THEIR CHILDREN Thirty-nine cases including one who paid all her own expenses, were admitted to various Homes during the year. Close co-operation is maintained between the various Homes and the Authority in order to secure the follow-up of the infants. CONGENITAL MALFORMATIONS The Authority continued to operate the system laid down by Surrey County Council by which congenital malformations are noted cn the card notifying the birth. The following malformations were notified during the year:— Central nervous system 6 Eye, ear 4 Alimentary system 4 Heart and Great Vessels 2 Uro-genital system 3 Limbs 12 Other skeletal 1 Other systems 4 Other malformations 3 Total 39 WELFARE FOODS AND VITAMINS National Dried Milk and vitamins were available at all Infant Welfare Centres with the exception of Pelham Road Clinic, and also at Russell Road Clinic and the W.V.S. Centres in Merton and Mitcham. Sales for the year 1965 are shown below:— National Dried Milk 22,660 tins Cod Liver Oil 3,390 bottles Vitamins 'A' and 'D' 3,895 packets Orange Juice 58,837 bottles 29 PUBLIC HEALTH NURSING AND ALLIED SERVICES HEALTH VISITING STAFF At the end of the year, the staff position was:— 1 Superintendent Health Visitor. 1 Deputy Superintendent Health Visitor. 28 Health Visitors/School Nurses. 4 Student Health Visitors. The Authority has continued to operate a Student Health Visitor scheme and recruited four Student Health Visitors during the year, who it is hoped will qualify during 1966. Four Student Health Visitors recruited during 1964 by Surrey County Council, joined the Authority's staff as qualified Health Visitors during the year. Largely owing to their training policy, and that of Surrey County Council prior to 1st April, 1965, the Authority has had no serious staffing difficulties in this sphere. HEALTH VISITOR'S DUTIES The most important of the Health Visitor's duties is family visiting. Each Health Visitor has her own geographical area and, wherever possible, is based on a clinic within that area. She visits all the ' special' people in every family within her area; i.e., expectant mothers, new babies, children under five years, physically and/or mentally handicapped children and old people. The importance of this part of her work cannot be too gready stressed. Having access to the home, she is the one who can detect at an early stage any deviation from normal and can call in any special assistance that may be necessary. In the course of her visiting she is able to instruct mothers in Health Education and stress to them the continued necessity for immunisation and vaccination. In addition to visiting, Health Visitors attend sessions at Clinics in the area which include:— Ante-natal clinics. Relaxation and Mothercraft sessions. Audiology clinics. Vaccination and immunisation clinics. Infant welfare clinics. Toddler clinics. Parentcraft groups. Health Visitors attend case conferences and co-ordinating conferences besides writing reports and keeping records and must maintain contact with colleagues in the allied fields of health work. Long stay immigrants on their arrival in this country are visited to acquaint them with the provisions of the National Health Service. At the close of the year, arrangements were in hand to start a scheme of attachment of Health Visitors to general practitioners, under which they will be attached to certain group practices, rather than to specific areas. There are in Merton at present, two additional aspects of health visiting which should be mentioned. The first is the large number 30 of families moving into and out of the Borough. This is most probably due to a combination of high rents, mobility of labour and the fact that the Borough has housing property outside its boundaries. This often means a changing, and heavier, case load for Health Visitors. The second problem is the increasing number of coloured families in the Borough, mainly in the North Mitcham, Colliers Wood and Wimbledon Park areas. These families occupy more than the usual amount of the Health Visitor's time owing to their different habits and customs, and language difficulties. It is very often found that the women are anxious to go out to work or to resume their studies quickly after a confinement, and great care is needed to ensure that their children are not unsatisfactorily minded, nor left alone, nor inadequately cared for. SUMMARY OF WORK OF HEALTH VISITORS The following table shows the number of cases in the various categories visited by the Health Visitors in 1965: — Category. Number of cases visited. Children born in 1965 3,164 Children born in 1964 3,211 Children born in 1960/3 8,329 Total, 1960-1965 14,704 Persons aged 65 and over 369 Mentally disordered persons 242 Total 15,315 Attendances at Clinics and Centres— No. of attendances at Welfare Centre Sessions 2,109 No. of attendances at Ante-natal and Post-natal clinic sessions 339 HEALTH EDUCATION This essential aspect of Public Health is being rapidly developed by means of teaching groups which the Health Visitors hold in schools, talks which are given to outside organisations, and Mothercraft and Parentcraft sessions which are held at the various Welfare Centres. Use is also made of leaflets, posters and displays. A film on smoking and lung cancer was shown to Parentcraft Classes, and posters were displayed at the various clinics throughout the area. There were no special lectures devoted to venereal diseases, but the topic is generally included in the health education programme, particularly relating to personal hygiene. The policy of displaying posters giving details of treatment centres has been continued. MIDWIFERY STAFF At 31st December, 1965, the staff consisted of:— 1 Non-medical Supervisor of Midwives. 31 9 Full-time Midwives. 1 Part-time Midwife. ORGANISATION The day-to-day supervision of the Midwifery Service is carried out by a Non-medical Supervisor of Midwives, who is also appointed as Superintendent of the Home Nursing Service, although the services are operated separately. For the most part, the arrangements under which three midwives covered the Wimbledon area, three covered the Merton and Morden area, and three covered the Mitcham area, were continued in operation. The three midwives in the Wimbledon area are housed at the Nurses' Home, Kings Road, Wimbledon, one in the Merton and Morden area is housed at the Nurses' Home, 'The CroftCommonside East, Mitcham, and the remaining five are in their own homes. Eight midwives have cars, in respect of which the Authority pays an essential user car allowance, and one midwife is supplied with a bicycle. MATERNITY CASES ATTENDED There were 452 domiciliary confinements reported and 2,486 institutional confinements during the year. Midwives employed by the Authority attended 451 cases (four where no doctor was booked and 447 where a doctor was booked). MEDICAL AID Medical aid was summoned by midwives in 134 domiciliary cases including 126 cases where the medical practitioner had arranged to provide the patient with maternity medical services under the National Health Service Act. The Authority is liable for the payment of the practitioners' fees in the other eight cases. ANALGESIA All the Authority's midwives are qualified to administer analgesia (trilene, gas and air, and pethidine) in accordance with the rules of the Central Midwives Board. During the year municipal midwives administered analgesics to mothers as follows:— Gas and Air Trilene Pethidine 303 130 235 PUERPERAL PYREXIA Fifteen cases of puerperal pyrexia were notified, 14 of which were hospital cases. OPHTHALMIA NEONATORUM One case of ophthalmia neonatorum was notified during the year. MATERNITY OUTFITS A free issue of maternity outfits is made in accordance with Ministry of Health instructions, namely, to those patients whose confinement will be conducted under the National Health Service arrangement. These are issued by midwives to their patients. 32 EARLY DISCHARGES FROM MATERNITY HOSPITALS During 1965 351 patients were discharged from hospital before the tenth day of puerperium. MIDWIFERY TRAINING The Authority continued to operate the Part II (District) Training arrangements formerly operated by Surrey County Council in this area, under which not more than five pupils from Epsom Hospital, and one from Woking Maternity Hospital, were received on the district for their second-period training. The pupil midwives are accommodated either at the Nurses' Home, Kings Road, Wimbledon, or in lodgings arranged with private householders. One midwife in the Mitcham area is able to provide accommodation in her own home for the pupil attached to her. POST-GRADUATE COURSES Three midwives attended Post-Graduate Courses during the year. HOME NURSING STAFF At 31st December, 1965, the staff consisted of:— 1 Superintendent of Home Nursing Service. 32 Whole-time Home Nurses. 5 Part-time Home Nurses. ORGANISATION There is a group of Home Nurses for each of the three former districts sufficient to provide for demands on the service. In the Wimbledon area, calls for the service are made by general practitioners to the Nurses' Home, Kings Road, whilst calls for the Merton and Morden and Mitcham areas are made on the Health Department. It is intended to make arrangements at an early date for calls for the Wimbledon area to be made on the Health Department, to provide for completely central administration of the Borough service. TRAINING Two Home Nurses were seconded for District Training. Five Home Nurses attended a Refresher Course. 33 CASES ATTENDED The table below gives details of the number of cases on the books at the beginning and end of the year, the cases added and disposed of during the period and the age groups into which they fall:— Age group Cases on books at 1.4.65 Cases added Cases removed Cases on books at end of period 0-5 years 1 28 26 3 5-64 years 182 611 628 165 65 years and over 627 1,139 1,146 620 Totals 810 1,778 1,800 788 The total number of cases attended during the year was 2,588. VISITS MADE The following table shows the total number of visits made each month:— January 8103 February 8025 March 8064 April 8370 May 7972 June 7933 July 8086 August 7794 September 7804 October 7938 November 8396 December 8285 Total 96770 INCONTINENCE PADS The Authority continued the practice of issuing incontinence pads at the request of the general practitioner or nurse in attendance. Those patients who use these pads are provided with tarred paper containers for disposal of the soiled pads through the refuse collection service. INCONTINENT LAUNDRY SERVICE In conjunction with a neighbouring Authority, a collection and delivery service of draw sheets is arranged, twice weekly, to patients who have been recommended by a District Nurse. DOMESTIC HELP SERVICE STAFF At 31st December, 1965, the stalf consisted of:— I Home Help Organiser. 34 1 Senior Assistant Home Help Organiser. 2 Assistant Home Help Organisers. 2 Clerks. 1 Full-time Home Help. 163 Part-time Home Helps. ORGANISATION During the year there was a decrease in the number of Home Helps employed owing to the general shortage of labour. Despite strenuous efforts throughout the year to find additional staff there were 15 fewer Home Helps in December, 1965, than in January, 1965. Owing to this shortage it was not always possible to give as much help as might have been wished. The situation was somewhat eased by making fuller use of the Neighbourly Help Scheme whereby a small payment is made to near neighbours in return for assistance given to patients. STATISTICS The following table gives details of the numbers and types of cases attended and the hours worked by Home Helps during the year:— Categories of Cases. Total cases dealt with during 1965 Total hours worked Cases on books at 31st Dec., 1965 Chronic Sick and Aged 971 161,334 819 Tuberculosis 13 1,551 9 Acute Illness 147 5,380 35 Maternity 118 6,687 4 Totals 1,249 174,952 867 As in previous years the demands of the aged category have absorbed the greatest proportion of the increased help available, the number of current cases in this category on 31st December, 1965, being 819. DETAILS OF SOURCES OF APPLICATIONS IN 1965 General Practitioners 441 Hospitals 241 Health Visitors 1 Home Nurses 1 Welfare Services 2 Blind Welfare 1 Maternity Bookings 142 Others 6 835 The Organiser and the three Assistant Organisers have paid 413 first visits and 3,668 re-visits to homes in connection with the service. 35 HOURS WORKED BY HOME HELPS Chronic Sick and Aged T.B. Acute Maternity Payments under Neighbourly Help Scheme Total hours worked £ s. d. January 15,775 160 449 528 31 5 0 16,912 February 12,962 141 467 654 20 10 0 14,224 March 13,120 100 596 418 19 0 0 14,234 April 13,017 95 473 704 19 0 0 14,289 May 16,560 147 563 877 23 15 0 18,147 June 12,149 125 578 326 19 0 0 13,178 July 14,341 144 469 488 23 15 0 15,442 August 10,655 110 366 439 27 7 6 11,570 September 11,094 74 362 590 26 10 0 12,120 October 15,602 153 331 799 32 0 0 16,885 November 13,215 148 364 267 24 10 0 13,994 December 12,844 154 361 596 32 0 0 13,955 Totals 161,334 1,551 5,379 6,686 298 12 6 174,950 CHIROPODY SERVICE The Council's chiropody service caters for the elderly, the registered blind or partially sighted, the physically handicapped and nursing and expectant mothers. It comprises two separate schemes:— (a) The Direct Scheme whereby application is made to the Medical Officer of Health and authority is given, to those eligible, to have a fixed number of treatments carried out by any chiropodist on the Council's panel. (b) The Indirect Scheme whereby treatment is arranged by Voluntary Organisations. A number of old people are taken for treatment by members of these voluntary organisations whose work is greatly appreciated. Under either scheme, treatment can be given in the patient's home if a doctor certifies that the patient is unable to travel. The number of people receiving treatment under the service is increasing steadily and is likely to continue to do so. In the twelve months ended 31st December, 1965, 1,267 new applications for treatment were received. The following table gives the statistical picture for the year:— Category Persons treated in 1965 Number of treatments given Number on books at 31.12.65 Elderly 2,187 12,989 2,094 Registered Blind or Partially Sighted 31 144 29 Physically Handicapped 58 381 56 Expectant Mothers 4 4 Nil Totals 2,280 13,518 2,179 36 RIPPLE BED SERVICE Ripple beds (air beds having a mechanically induced rhythmic undulation designed to prevent bed sores), are available on loan to patients of the Home Nursing Service at the request of a doctor or Home Nurse. The beds are hired from the suppliers and 65 such loans were made in the year. SICK ROOM EQUIPMENT There are three Medical Loan Depots, one each in Merton, Mitcham and Wimbledon. Loans of medical equipment are made to residents in the Borough on request from the family doctor or from a Home Nurse. Owing to the heavy demand loans are reviewed every three months. The depots are staffed on a voluntary basis by members of the British Red Cross Society. The following table shows the total loans made during the year: — Item Total loans Item Total loans Air rings 113 Commodes 145 Bed rests 116 Cradles 63 Bed pans 162 Crutches 27 Bed tables 13 Feeding cups 18 Invalid chairs 138 Waterproof sheets 151 Invalid chairs (self-propelling) 3 Urinals 85 RECUPERATIVE HOLIDAYS Under Section 28 of the National Health Service Act 1946, the Authority is empowered to provide a recuperative holiday for persons needing it to complete or assist in their recovery to normal health, but who do not need organised medical or nursing care. A recommendation from a medical practitioner is necessary. A number of Homes in Surrey and on the south-east coast are used, the holiday being usually for two weeks. Forty-five such holidays were arranged in the year. FLUORIDATION OF THE PUBLIC WATER SUPPLIES In accordance with Ministry of Health Circular 15/65 a recommendation was made to the Council that fluoridation of the public water supplies should be undertaken under Section 28 of the National Health Service Act, 1946. After giving consideration to this the Council passed the following resolution:— ' That the Council does not participate in any arrangements with the Water Undertakings concerned for the addition of fluoride to the public water supplies, but that the Medical Officer of Health in consultation with the Chief Education Officer, arrange for the supply and distribution of fluoride in tablet form to all children attending schools within the Borough 37 whose parents request such medication, and that the Finance Committee be requested to make the required financial provision.' It was later ascertained from the Ministry of Health that the Minister's general approval under Section 28 of the National Health Service Act 1946, was limited to the fluoridation of water supplies and did not extend to the making available of fluoride tablets as part of a Local Health Authority's arrangements for the prevention of illness, care and after care. The Council, therefore, decided to take no action in connection with fluoridation of public water supplies. 38 MENTAL HEALTH SERVICES ORGANISATION On 1st April, 1965, responsibility for Local Health Authority Services under the Mental Health Act, 1959, previously operated by Surrey County Council, passed to this London Borough. The dayto-day organisation of these services is the concern of the Mental Health and Social Work Section of the Department. A Senior Medical Officer and a Senior Mental Welfare Officer have been appointed to this Section. The arrangements under which persons may be admitted to hospital under the procedures laid down for compulsory admission under the Mental Health Act, are operated by Mental Welfare Officers acting as Statutory Officers under the Act. The Mental Welfare Officers also assist general practitioners in arranging informal admission of patients to Mental Hospitals. Where compulsory powers of admission are used, the decision whether to take action or not, in any particular case, is solely that of the Mental Welfare Officers concerned, who may thus be regarded, on occasions, as the trustees of the patient's liberty. The Department was doubly fortunate in being able to appoint as Senior Mental Welfare Officer a well qualified and experienced Social Worker, and also in retaining the services of two former Surrey Mental Welfare Officers who operated in this area prior to the re-organisation. They brought with them a wealth of experience, local knowledge, and goodwill. One of these two Officers became the Deputy Senior Mental Welfare Officer. STAFF At 31st December, 1965, the staff position was:— 1 Senior Medical Officer. 1 Senior Mental Welfare Officer. 1 Deputy Senior Mental Welfare Officer. 3 Mental Welfare Officers. 1 Mental Health Social Worker. In addition, during the year, the Authority was fortunate in obtaining the services, in a part-time capacity, of Dr. R. K. Freudenberg, the Physician-Superintendent of Netherne Hospital as Consultant Psychiatrist to advise the Authority on aspects of the Mental Health Services. MENTAL HEALTH ESTABLISHMENTS The Authority operates a Junior Training Centre which provides 75 places (12 of which were temporarily in use as a Special Care Unit pending the building of the proposed Special Care Unit by the Mitcham Round Table), 32 places being taken by Merton children, and 43 by Sutton children. In addition 13 places are filled by Merton children at the Intermediate Centre (for children aged 13 to 16 years) in the London Borough of Sutton. The Authority provides transport for the conveyance of Merton children to and from these Centres. The Authority's provision for adult training of subnormal patients over the age of 16 years is by arrangement with Surrey County Council under which 36 places are available at Surrey's Adult Training Centre at Banstead. 39 In their Ten-Year Plan for the Development of the Health Services, the Authority have included the following:— One 80 to 100-place Adult Training Centre. One 15-place Hostel for adult subnormals. One 15-place Hostel for female subnormals. One 50-place Day Centre. In addition, by the end of the year plans were nearing completion for the building of a 20-place Special Care Unit by the Mitcham Round Table in the grounds of the Junior Training Centre. THE CASEWORK SERVICES These Services are operated by both Mental Welfare Officers, and Mental Health Social Workers, with the general aim of the prevention, care and after-care of mental illness. Mental disorder, or mental illness generally ranges through personality disorders, psychopathic personalities, subnormality and severe subnormality, to the educationally subnormal school leaver with problems. Over this whole range, cases need casework support to enable them to live in the community. Prior to 1st April, 1965, these Casework Services were administered from County Hall, Kingston, and the major part of the casework was carried out by staff based at this administrative centre. Since the setting-up of this Borough, however, the work of Mental Welfare Officers and Mental Health Social Workers has been integrated so far as practicable. A proportion of the supervision of the subnormal and severely subnormal is in the hands of the Health Visitors who pay routine visits to them and report direcdy to the Mental Health Section. There is a good liaison between Mental Welfare Officers and Health Visitors. SUBNORMALITY 1. CASES IN COMMUNITY CARE At the end of the year, 217 patients, as shown below, were in the community care of the Authority:— Category of patient Under 16 years 16 years and over Total Grand Total Male Female Male Female Male Female Subnormal patients receiving routine home visits 8 8 25 38 33 46 79 Severely subnormal patients receiving routine home visits 38 24 47 29 85 53 138 Totals 46 32 72 67 118 99 217 Patients included in above figures who are attending Junior or Adult Training Centres 30 18 24 13 54 31 85 40 2. JUNIOR TRAINING CENTRE The numbers of children attending the Junior Training Centre were as follows:— 32 from the London Borough of Merton. 43 from the London Borough of Sutton. Within the Junior Training Centre there is a Special Care Unit, temporarily housed there until the proposed purpose-built unit is completed, for the care of subnormal children with physical handicaps such as spasticity. Children attending this Special Care Unit, who are unable to travel in the coaches provided, are collected from their own homes. Under the present arrangement for training, children attend the Junior Training Centre up to the age of 13 years, at which age they are transferred to the 'Intermediate' Training Centre operated by the London Borough of Sutton. It is hoped to rationalise this arrangement in the near future to ensure that all Merton children being cared for at the Junior Training Centre, as well as the 'overflow' of 13 to 16 years old at Sutton should attend this Authority's Junior Training Centre, thus giving a continuity of training at one Centre for Merton children up to the age of 16 years. The table below gives details of the attendances at the Junior Training Centre during the year:— Merton Sutton Total No. of children attending at end of year 32 43 75 No. of attendances made during year 4,545 6,834 11,379 3. ADULT TRAINING CENTRE The facilities for the training of subnormals over the age of 16 years are provided, by arrangement, with the Surrey County Council, at their Adult Training Centre at Banstead. At the end of the year 24 males, and 13 females were in attendance. There was also a waiting list for admission of three males and nine females, but in view of the pressure for admission of Surrey's own cases to this Centre, there was little hope of any further Merton cases being admitted. To provide for the increasing numbers requiring adult training, and, as an interim measure, until the Authority are able to provide a purpose-built Adult Training Centre, negotiations were in progress at the end of the year, with the Physician-Superintendent of the Manor Hospital whereby facilities could be made available for Merton cases attending the Banstead Training Centre, and for those Merton cases on the waiting list, to attend a Day Centre at the Manor Hospital, Epsom. It was also realised that the facilities provided by Surrey County Council could be made available only so long as the arrangements did not prevent admission of their own cases to Banstead Adult Training Centre. OTHER FORMS OF MENTAL DISORDER 1. CASES DEALT WITH BY MENTAL WELFARE OFFICERS During the year, 365 cases were referred to Mental Welfare Officers for attention. 41 One hundred and eighty-six patients were admitted to Mental Hospitals through the Mental Health Service. Details of these admissions are given below:— Males :. Females. Total. Admitted informally 19 29 48 Admitted under Section 25 (for obvation) 8 16 24 Admitted under Section 26 (for treatment) 2 7 9 Admitted under Section 29 (for observation in case of emergency) 35 60 95 Admited under Section 60 (by the Courts) 1 - 1 Admitted under Section 136 (in conjunction with Police) 4 6 10 Totals 68 118 186 These figures do not include a large number of informal admissions arranged directly by general practitioners, or admitted informally through Psychiatric Out-patient Clinics. The informal cases listed above are only those where the Department has rendered assistance, and are probably but a fraction of the total number of informal admissions from the Borough. Mental Welfare Officers received ready co-operation from other Sections of the Department, particularly from Health Visitors, but also from Public Health Inspectors, the School Health Service, and the Home Help Service. There is also a close liaison, and frequent contact, with the Education, Welfare Services, and Children's Departments. Especial thanks are due to the Metropolitan Police, who make possible an after-hours emergency service. Doctors requiring the duty Mental Welfare Officer out of office hours telephone the Police who refer them to the appropriate Mental Welfare Officer. 2. PATIENTS RECEIVING COMMUNITY CARE Forty-nine male and 75 female patients were being provided with community care by the Authority, at the end of the year. The supervision of mentally ill persons within the community is carried out by Mental Welfare Officers and Social Workers and covers a very wide range of activities. This may be to assist patients with their material problems, or in supporting them through bouts of depression, or periods of more serious illness where admission to hospital is being avoided. Some of these are chronic cases and could not survive in the community otherwise. It is in this sphere that the Mental Welfare Officer often has the care of elderly people and the chronically ill. In all activities associated with community care a close liaison is maintained with the general practitioner and with hospital staff, wherever possible. PATIENTS IN HOSPITAL It is known from records maintained by the Mental Health Section, that 229 Merton patients are in long-term care in hospitals for the subnormal and severely subnormal. 42 Whilst, ideally, it would be comforting to think that it is possible for the Local Health Authority to be an effective link between the hospital and families, in many cases this is simply not possible, since the patients were admitted so long ago and have settled in their hospital environment, and their relatives have come to accept this position. However, in any case where one of the hospitals, or any of the parents or patients require any help, this Authority gives it through its Mental Welfare Officers. It is important to bear in mind that, when the Authority is able to acquire its own hostel accommodation, a number of these patients who are suitable for hostel accommodation, will return to the community. The actual numbers involved will, however, represent only a small proportion of those in hospital, due to the tendency for long-term care in hospital to render a subnormal patient unsuitable for life in the community. GUARDIANSHIP There are no cases under guardianship in the Borough. CASES BOARDED OUT The Authority, at the end of the year, was making financial provision for the boarding-out of eight patients. A particularly close liaison is maintained with the two Cheshire Foundation Homes in the district, and in addition to giving supervision to the Merton cases in residence there, the Authority has undertaken supervision of patients from other Authorities accommodated there, when requested to do so. SHORT-TERM CARE During the year, the Authority provided periods of short-term care in eight cases. SOCIAL WORK SECTION The Authority continued the arrangements intitiated by the Surrey County Council whereby Social Work staff are attached to the Cumberland Hospital, Mitcham, to render assistance to the Chest Physicians with both in-patients and out-patients afflicted with chest diseases. This staff is housed in a suite of rooms adjacent to the Chest Clinic in the hospital building and rented by the Authority from the Hospital Management Committee. This staff is also (increasingly concerned with case work on families at risk of break-up. Cases are referred to the Social Workers by the Co-ordinating Committee for the Prevention of Break-up of Families, and by the Health Visitors. This Section is under the day-to-day control of a Senior Medical Officer. At the end of the year, the Authority's staff in this Section comprised:— 1 Whole-time Social Worker. 2 Part-time Social Workers (equivalent to one whole-time Social Worker). 43 The whole-time Social Worker is qualified, and whilst the two part-time Social Workers have no approved social work qualifications, their previous training, it was felt, was of use in their present sphere. Great difficulty was experienced in recruiting qualified Social Workers up to the establishment approved by the Authority, and to ease the case-load in this Section, when a qualified Medical Social Worker left the Authority's service, a qualified Social Worker from the Mental Health Section was temporarily seconded for duty at Cumberland Hospital. The Medical Officer of Health is designated by the Authority as Chairman of the Co-ordinating Committee for the Prevention of the Break-up of Families. The Senior Medical Officer and the Social Workers in this Section, working closely with Health Visitors, maintain a close liaison with the Education, Children's, Welfare Services, and Housing Departments. 44 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR INTRODUCTION This part of the Annual Report deals with the Environmental Health Service, and shows the efforts which have been made to maintain a service to the public, despite the upheaval caused by amalgamation. Initial difficulties were experienced in April, 1965, in channelling all the records into one basic administrative system and in applying the new system to the great variety of duties carried out by the Environmental Health Section. Staff changes and staff shortages were two factors which had to be, and are still having to be, overcome and although work was proceeding smoothly by the end of the year, some of the statistics given show that arrears of work are accruing. Much of the work of the Environmental Health Section is uuspectacular and anonymous in character, but the very nature of the duties involved bring the staff into close contact with the personal problems and difficulties of both occupiers and owners of houses and business premises. It is most necessary, therefore, that good public relations be maintained, but this is not possible if routine visits are few and far between, or if prompt attention is not given to requests for visits to be made, or if made, follow-up procedure is neglected. It is the endeavour of the Public Health Inspectorate not only to maintain but to improve the environmental standards in the district and though the volume and quality of work during the year 1965 has been good, it is hoped that the staffing situation during the coming year will improve so that a more complete Environmental Health Service may be put into operation. In reviewing the work of the Public Health Inspectorate during 1965 regard has been had to Ministry of Health Circular 1 /66 dated 11th January, 1966. The statistics given are for a complete year (1965) and the figures for the first three months have been obtained from records of the Boroughs of Mitcham and Wimbledon and the Urban District of Merton and Morden. SERVICES UNDER THE PUBLIC HEALTH ACTS WATER SUPPLY The Metropolitan Water Board and the Sutton District Water Company are responsible for the supply of water to the Borough and regular periodic examinations are made by these undertakings. Reports on examinations are also exchanged with adjoining Local Authorities who are supplied by the Sutton District Water Company. The supply of water has been satisfactory in both quality and quantity. With a few exceptions all the dwelling houses in the London Borough of Merton are supplied from public water mains direct to the houses but the actual number of such houses is not available. A number of industrial premises have an additional supply of water from their own deep wells. There are seven caravan yards within the Borough, each with a stand-pipe supplying mains water. 45 During the year 1965 samples of water were taken for bacteriological and chemical analysis as follows:— Bacteriological— Swimming Baths 111 Paddling Pools 17 Dwelling houses:— Metropolitan Water Board supply 4 Sutton District Water Co. supply 2 Well water 8 14 Other premises:— Sutton District Water Co. 2 144 Unsatisfactory Results— Swimming Baths 18 Paddling Pools 14 32 Immediate action was taken in respect of the unsatisfactory swimming bath water and subsequent samples proved satisfactory. The treatment of water in a number of paddling pools in the Borough will be the subject of a special study during the 1966 season. Chemical— Swimming Baths 6 Dwelling Houses:— Metropolitan Water Board supply 2 Sutton District Water Co. supply 1 Well water 1 4 Other premises:— Sutton District Water Co. supply 1 11 These samples of water proved satisfactory. Fluoride Content Information was obtained during 1965 that the fluoride content of the water supplies was as follows:— Sutton District Water Co.—a trace: less than .2 parts per million (not added). Metropolitan Water Board—.25 milligrammes per litre. Plumbo-Solvent Action One well water supply is known to be liable to have plumbosolvent action and the galvanised iron service pipe line to a dwelling house was replaced by Alkathene tubing in 1958. Subsequent samples have been free of metallic content. SEWERAGE AND SEWAGE DISPOSAL The previous Annual Reports of the three constituent Authorities indicate that the arrangements for sewerage and sewage disposal are 46 adequate. There is a number of cesspools in the Borough and arrangements to empty them at intervals are made by the respective owners. REGISTERED COMMON LODGING HOUSES There are no registered common lodging houses in the Borough. DISTRICT INSPECTION The following is a summary of the complaints received and the visits made during the year 1965:— Complaints received— General disrepair and insanitary conditions 239 Dampness 139 Overcrowding 24 Defective drainage systems 36 Blocked drainage systems 468 Defective drainage fittings 44 Defective w.c. pans and/or flushing apparatus 90 Defective water service pipes 17 Absence of, or defective dustbins 15 Accumulation of refuse, etc 145 Rats and mice 923 Pigeons 31 Insect pests 537 Smoke nuisances 141 Noise 115 Smells and odours 132 Unsound food 210 Miscellaneous 150 3,456 Visits made— General. P.H. Act (Nuisances) 1,314 P.H. Act (Dwelling houses) 1,695 Storage of refuse 124 Drain testing 184 Choked drains 1,613 Other drainage work 917 - 5,847 Housing. Dwelling houses (Housing Act) 964 Overcrowding 446 P. No. measurements 28 Rent Act 1957 56 Underground rooms 7 Houses in multiple occupation 477 Improvement grants 40 Caravans 60 2,078 47 Food and Food Premises. Milk processing dairies 113 Milk vendors 138 Ice-cream premises 233 Food factories 28 Food vehicles 383 School kitchens 138 Restaurant kitchens 482 Licensed premises 65 Bakehouses 67 Butchers 253 Wet and fried fish shops 47 Other food shops 1,165 Meat inspection 455 Unsound food 383 Sampling: Food and Drugs 335 Sampling: Milk 190 Sampling: Ice-cream 176 Sampling: water 211 Food hygiene swabs 107 4,969 Clean Air Act, 1956. Smoke control areas 11,681 Other Clean Air Act visits 505 Smoke observations 335 Air pollution recording apparatus 1,014 13,535 Factories Act, 1961. Factories (powered) 351 Factories (non-powered) 31 Factories (building sites) 19 Outworkers 102 Workplaces 24 527 Infectious Diseases. I.D. enquiries 403 I.D. contacts 22 Food poisoning 11 Specimens 98 Disinfection 7 541 Offices, Shops and Railway Premises Act, 1963 O.S.R. general inspection offices 269 O.S.R. general inspection shops 552 O.S.R. general inspection wholesale/warehouse 7 O.S.R. general inspection catering 21 O.S.R. general inspection canteens 10 O.S.R. all other visits 2,364 3,223 Insects, Pests, Rodents. Rats and mice control 13,702 Insect control 335 Pigeon control 155 Verminous premises 38 14,230 48 Animals. Stables 55 Piggeries 37 Slaughterhouse (hygiene) 56 148 Miscellaneous. Hairdressers and barbers 29 Diseases of Animals Act, 1950 5 Fertilisers and Feeding Stuffs Act, 1926 13 Noise Abatement Act, 1960 448 Places of public entertainment 4 Schools 20 Court proceedings 21 Public conveniences 11 Water courses 26 Shops Act 1950 217 Pet shops 27 Miscellaneous 1,071 1,892 46,990 RESULT OF SERVICE OF NOTICES (1) Legal Proceedings. Proceedings were instituted against the owners of a dwelling house for failing to comply with the requirements of Abatement Notices (Public Health Act, 1936: Section 93). The Notices were complied with after the summonses had been issued. Application was made to the Court for costs and a total of £15 15 s. was granted. (2) Nuisances abated and Defects remedied. As the result of the service of verbal, written and Statutory Notices, 2,454 defects were remedied. 711 were in connection with the drainage of buildings; 948 in and around dwelling houses; 759 in connection with food premises and 36 were of a miscellaneous nature. FACTORIES ACT, 1961—PART I. (1) Inspection for Purposes of Provisions as to Health. Premises Number on Register Number of Inspections Written Notices Prosecutions Factories without mechanical power 45 31 1 - Factories with mechanical power 903 351 33 - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 12 19 1 - Totals 960 401 35 — 49 (2) Defects found. Particulars Number of Defects Prosecutions Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of cleanliness (S.l) 4 - - - - Overcrowding (S.2) — - - - - Unreasonable temperature (S.3) — - - - - Inadequate ventilation (S.4) 15 - - 1 - Ineffective drainage of floors (S.6) — - - - - Sanitary Conveniences (S.7):— Insufficient 2 1 - - - Unsuitable or defective 23 19 - - - Not separate for sexes 19 5 - - - Other offences (excluding offences relating to outwork) 18 3 — — — Totals 81 28 — 1 - FACTORIES ACT, 1961—PART VIII Outwork—Sections 133 and 134. Nature of work Section 133 Section 134 No. of outworkers in August list required by Sec. 133(l)(c) No. of cases of default in sending lists to the Council No. of prosecutions for failing to supply lists No of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel -making 54 - - - - - Furniture and upholstery 1 1 - - - - Lampshades 58 — — - - — Total 113 1 - — — — Number of addresses received from other Councils 110 Number of addresses forwarded to other Councils 69 Number of premises where outwork was carried on at the end of 1965 100 Underground bakehouses in use at the end of the year 1 SERVICES UNDER FOOD AND DRUGS ACT, 1955 Milk and Dairies (General) Regulations, 1959. The number of Distributors of milk in the Borough as shown by the register kept in accordance with these Regulations, is 139. 50 There are four dairies handling milk in bottles or sealed churns, and two pasteurising establishments, one of which also processes milk by ultra high temperature treatment. Milk (Special Designation) (Amendment) Regulations, 1965. These Regulations came into operation on 1st October, 1965, to amend the Milk (Special Designation) Regulations, 1963. Schedule 1 of the Regulations which refers to the special conditions subject to which licences to use the special designation ' Ultra Heat Treated ' may be granted, were applied to a dairy processing this designated milk. Milk (Special Designation) Regulations, 1963, as amended. The following licences, which will remain in force until 31st December, 1970, have been issued under the Regulations:— Dealers' (Pasteuriser's) Licences 2 Dealers' (Ultra Heat Treated) Licence 1 Dealers' (Pre-packed Milk) Licences:— Untreated milk 57 Pasteurised milk 121 Sterilised milk 101 Ultra Heat Treated milk 9 During the year 279 samples of designated milk were submitted for statutory tests. The results were as follows:— Designation. Satisfactory. Unsatisfactory. Pasteurised 243 — Sterilised 26 — Untreated 9 1 The unsatisfactory sample of untreated milk, which was taken from a vending machine, failed the Methylene Blue test. A further sample taken from the same machine proved satisfactory. Brucella Abortus. No positive samples of milk were found. lce-Cream. During the year 154 samples were submitted for bacteriological examination. The results were as follows:— Grade 1 114 Grade 2 11 Grade 3 16 Grade 4 13 Grade 1 and 2 samples can be considered satisfactory; only 20% of the samples taken from any one vendor should be of Grade 3 quality, and none of Grade 4. Appropriate action was taken in the cases of unsatisfactory samples. Meat and Other Foods. There is one licensed slaughterhouse in the Borough, which is privately owned. This slaughterhouse, which has been in use for a number of years, is old and there are many inherent defects. The layout of the premises is poor and facilities for meat inspection are inadequate. Following action by the Town Planning Authority in 51 1961 a Compulsory Purchase Order was made, and in 1962 the Mitcham Borough Council made an offer to the occupier of a new site within the Borough. It is hoped that steps will be taken during 1966 to finalise arrangements whereby the use of the existing premises will cease. In the meantime slaughtering continues throughout the week (except on Saturday) and from 6 a.m. to noon on Sundays. A 100% meat inspection service has been maintained throughout 1965. During the year, thirteen slaughtermen's licences were issued under the provisions of the Slaughter of Animals Act, 1958, two being licences to slaughter only under supervision. Meat Inspection. Carcasses inspected and condemned Cattle Calves Sheep & lambs Pigs Number killed 248 116 405 19,273 Diseases except Tuberculosis and Cysticerci Whole carcasses condemned 2 Nil 1 32 Carcasses of which some part or organ was condemned 37 Nil 9 2,994 Tuberculosis only Whole carcasses condemned Nil Nil Nil Nil Carcasses of which some part or organ was condemned Nil Nil Nil 396 Cysticerci Carcasses of which some part or organ was condemned 6 Nil Nil Nil Carcasses submitted to refrigeration 6 Nil Nil Nil Generalised and totally condemned Nil Nil Nil Nil The total weight of meat condemned as unfit for human consumption was 7 tons 16 cwts. 80 lbs. Four hundred and fifty-five visits were made to the slaughterhouse for the purpose of meat inspection during the year. Food Premises. The inspection of food premises has formed an important part of the work of the Public Health Inspectors during the past year. 4,375 visits were made to premises in which foodstuffs, intended for human consumption, were prepared, stored or sold. All food premises must comply with the Food Hygiene (General) Regulations, 1960, and a considerable amount of work has been done under the Regulations during the year. In general, it has been found that food traders within the Borough are co-operative and I have reason to believe that the assistance and advice given by the Department is appreciated. The provisional register of food premises includes the following: Greengrocers 157 Confectioners 273 Ice-Cream premises 496 Bakers 48 Grocers and Provision Dealers 295 Butchers 104 Carried forward 1373 52 Brought forward 1373 Fishmongers/Fish Fryers 60 Milk distributors 139 Chemists 51 Licensed premises 84 Clubs 79 Restaurants and Cafes 168 Works canteens 55 School canteens and kitchens 100 Food stalls/vehicles 33 Places of public entertainment 73 2,215 The information required by Circular 1/66 in connection with the provision of ablution facilities, sinks and hot and cold water supplies is not available at this time. The number of food premises registered in accordance with Section 16 of the Act is as follows:— Registered for the storage and sale of ice-cream 464 Registered for the manufacture and sale of ice-cream 6 Registered for the preparation or manufacture of sausages 70 Registered for the preparation or manufacture of potted, pressed, pickled or preserved food ... 150 The number of inspections of registered food premises during 1965 was 784. Bacteriological Examination of Equipment. During the year 312 swabbings of articles used in food premises and catering establishments, were submitted to the Public Health Laboratory for bacteriological examination. The results were as shown:— Article. No. of swabs taken. Result. Satisfactory. Unsatisfactory. Beer mugs and glasses 39 35 4 Wine and spirit glasses 9 7 2 Plates 59 52 7 Cups and beakers 77 65 12 Saucers 4 4 — Knives 37 33 4 Forks 43 42 1 Spoons 38 36 2 Dishes 1 1 — Scoops and ladles 2 2 — Draining boards 1 — 1 Food slicing machines 2 2 — In addition 17 samples of ice-cream server water were submitted for bacteriological examination, eight of which were unsatisfactory. Special visits were made to premises from which unsatisfactory reports were received, and the occupiers were advised upon principles of hygiene to effect an improvement. 53 Food Inspection. Unsound food surrendered to the Health Department is destroyed at the Council's refuse disposal works. Excluding meat condemned at the slaughterhouse, the following is a list of unsound food surrendered during 1965:— Cwts. Qrs. Lbs. Canned meat 41 3 9 Canned soup 6 1 4 Canned fish 2 — 16 Canned vegetables 9 2 21 Canned fruit 25 — 14 Canned puddings — — 14 Canned milk/cream 5 — 24 Miscellaneous cans 24 3 20 Meat, bacon, poultry 18 1 9 Meat pies, sausages — — 14 Meat and fish paste — 2 5 Fish 2 2 10 Fruit and vegetables — 3 19 Fruit and vegetable juices 2 — 12 Flour, bread, cereals, biscuits 1 2 20 Spaghetti — — 27 Pie fillings — 2 18 Sugar, jam, syrup — 1 9 Salt, pickles, salad cream 1 2 18 Frozen food 22 1 23 Beverages 4 2 7 171 cwts. 2 qrs. 5 lbs. The number of complaints received during the year regarding unsound food was 210. These included references to extraneous matter in food and a detailed investigation was made in each case. Informal action was taken in the majority of cases. The complaints of extraneous matter in food included the following:— Foreign bodies found in loaves of bread—matchsticks (2); carbon and grease (7); nail; poppy seeds; fly; mould in wrapped bread; mould on loaf; metal; pellet of dirt; dried fruit skin; wheat bran. Fruit fly larvae in botde of milk. Solidified polyester resin in bottle of milk. Bird dropping in botde of milk. Maggot in botde of milk. Mould in can of stewed steak. Mould in can of corned beef. Mould in pork pie (3). Insect in can of pears. Wasp in can of apricots. Beetle in can of strawberries. Fly in can of oranges. Glass rod in jar of marmalade. Slug in packet of frozen peas. Smoked cigarette in potato crisps. Caterpillar in can of broad beans. Jute fibre in Dundee cake. jute fibre in marshmallow pastry. 54 Mould in currant bun. Pellets of dirt in cream meringues. Tobacco in cream slice. Stone in scone. Ants in sugar. Mould in jar of clotted cream. Mould in can of milk pudding. Maggots in gammon bacon joint. Calcium and sodium salts in cooking salt. Algae in botde of lemonade. Wire in lamb chop. Sampling of Food and Drugs. The following samples were submitted to the Public Analyst foi chemical examination during 1965, with the results shown:— Articles. Total. Formal. Informal. Genuine. Non-genuine or irregular. Antussin cough treatment 1 1 - 1 - Apples—liquid 1 1 - 1 - toffee 1 1 - 1 - Bakewell tart mix 1 - 1 1 - Bananas 1 1 - 1 - Beef—corned loaf 1 1 - 1 - curry with rice 1 1 - 1 - minced 1 1 - 1 - potted with butter 1 1 - 1 - salt 1 1 - 1 - Beefburgers—frozen 1 1 - 1 - Beetroot in vinegar 1 1 - 1 - Bisto 1 1 - 1 - Blancmange powder—chocolate 1 1 - 1 - Brandy 2 2 - 2 - Bread—milk loaf 1 1 - 1 - and butter 1 1 - 1 - Butter 7 7 - 7 - rum flavoured 2 1 1 2 - Butter beans 2 1 1 2 - Cal-Fresh—drink 1 1 - 1 - Cannelloni 1 1 - 1 - Celab 1 1 - 1 - Celery salt 1 1 - 1 - Cereal—breakfast 1 1 - 1 - high protein 1 1 - 1 - mixed, with fruit and nuts 1 1 - 1 - Cheese—Cheddar 1 1 - 1 - spread 1 1 - 1 - Cherries—cocktail 1 1 - 1 - Cherryade—drink 1 1 - 1 - Chicken in jelly—minced 1 1 - 1 - Chocolate—drinking 2 2 - 2 - Chow-Chow—Sweet Prairie 1 1 - 1 - 55 Articles. Total. Formal. Informal. Genuine. Non-genuine or irregular. Cochineal food colour 1 1 1 Cockles—cooked 1 1 - 1 - Cocktail—damson cream 1 1 - 1 - wine 1 1 - 1 - Coconut—desiccated 2 2 - 2 - Codeine phosphate, syrup of 1 — 1 1 - Codis tablets 1 1 - 1 - Coffee—and chicory essence 1 1 - 1 - instant 2 1 1 2 - with creme and sugar 1 1 - — 1 white with sugar 1 1 - 1 - Conserve—raspberry 1 1 - 1 - Cordial—ginger 1 1 - 1 - lime 2 2 - 2 - Crispbread—starch reduced 2 1 1 2 - Crumbs—golden 2 2 - 2 - Crush—sparkling orange 1 1 - 1 - Crystals—lemon foam 1 1 - 1 - Currants 1 1 - 1 - Custard powder 2 2 - 2 - Dairy topping 1 1 - — 1 Dates 2 2 - 2 - chocolate 1 1 - 1 - Dessert—pineapple 1 1 - 1 - Drink—bitter lemon 1 1 - 1 - glucose 1 1 - 1 - lemon—low calorie 1 1 - 1 - orange 2 2 - 2 - sparkling lemon 1 1 - 1 - Dripping 3 3 - 3 - Dubonnet 1 1 - 1 - Fish cakes 2 1 1 2 - Flour—cake 1 - 1 - 1 confectionery 10 8 2 9 1 self-raising 2 2 — 2 - Frankfurters 1 1 — 1 - Fritter mix—tomato 1 1 — 1 - Garlic—instant powder 1 — 1 1 - Gin 3 3 — - - Ginger—beer 1 1 — 1 - crystallised 1 1 — 1 - non-alcoholic 1 1 — 1 - shandy 3 2 1 - - Glycerine and thymol pastilles 1 — 1 1 - Gravy browning 1 1 — 1 - Groats 1 1 — 1 - Ham 1 1 — 1 - Hamburgers with gravy 1 1 — 1 - Health salts 1 1 — 1 - 56 Articles. Total. Formal. Informal. Genuine. Non-genuine or irregular. Honey 1 1 - 1 - Horse radish 1 1 - 1 - Ice-cream 4 3 1 4 - —cherry pie 1 — 1 1 - chocolate carnival 1 — 1 1 - dairy 1 1 - 1 - lemon neapolitan 1 — 1 1 - maple walnut 1 — 1 1 - peach melba 1 — 1 — 1 powder 1 — 1 1 - raspberry ripple 1 — 1 1 - Instant Whip—butterscotch 1 1 - 1 - Jam—strawberry 1 — 1 1 - Jelly—greengage I 1 - 1 - lemon 1 1 - 1 - table 1 1 - 1 - with fruit 1 1 - 1 - Juice—lemon 1 1 - 1 - tomato 1 1 - 1 - Kalms 1 1 - 1 - Ketchup—tomato 2 2 - 2 - Kipper fillets—butered 1 — 1 1 - Lard 1 1 - 1 - Lemon curd 1 — 1 1 - Lentils 1 1 - 1 - Liquid paraffin—B.P 1 1 - 1 - Macaroni 1 1 - 1 - —cheese 1 1 - 1 - Margarine 2 2 - 2 - Marmalade—orange 1 — 1 1 - lime 1 1 - 1 - Marzipan 1 1 - 1 - Mayonnaise—lemon 1 — 1 1 - Meat patties 2 2 - 2 - Menthol and Eucalyptus B.P.C. 1 1 - 1 - Milk 49 48 1 48 1 —condensed 2 — 2 2 - drink ' Bengers' 1 1 — 1 - hot 1 1 — — 1 powder 1 1 — — 1 skimmed—instant dried 2 2 — 2 - Mincemeat 1 1 — 1 - Mint 2 2 — 2 - —sauce 1 1 — 1 - Nuts 3 2 1 2 1 Oil—cooking 2 1 1 2 - corn maize 2 2 — 2 - ground nut 2 2 — 2 - olive 1 1 — 1 - 57 Articles. Total. Formal. Informal. Genuine. Non-genuine or irregular. Opas 1 1 - 1 - Ovaltine 1 1 - 1 - Oxo cubes 2 2 - 2 - Parsley—dried, rubbed 1 1 - 1 - Paste—anchovy 1 — 1 1 - chicken 1 — 1 1 - chicken and ham 2 1 1 2 - crab 1 — 1 1 - crab and tomato 1 1 - 1 - ham and beef 1 — 1 1 - ham and tomato 1 — 1 1 - ham and tongue 1 — 1 1 - lobster 1 — 1 1 - pilchard and tomato 1 — 1 1 - salmon and anchovy 1 — 1 1 - sardine and tomato 1 — 1 1 - Pastry mix—short 1 1 - 1 - Patum peperium 1 — 1 1 - Pears—strained 1 1 - 1 - Peas—frozen, garden 1 1 - 1 - processed 1 1 - 1 - yellow —split 1 1 - 1 - Pease pudding 1 1 - 1 - Pectin—liquid fruit 1 1 - 1 - Pepper—white 1 1 - 1 - Pepsi-Cola 1 1 - 1 - Pie—apricot 1 1 - 1 - Pilchards 1 1 - 1 - Pork—brawn 1 — 1 1 - chopped 1 1 - 1 - luncheon meat 2 2 - 2 - roll-stuffed 1 1 - 1 - Potato—chips, ready to eat 1 1 - 1 - crisps 1 1 - 1 - Pudding—Christmas 1 1 - 1 - ginger sponge 1 1 - 1 - milk—macaroni 1 1 - 1 - Puree—condensed, tomato 1 1 - 1 - Raisins 1 1 - 1 - Relish—corn 1 1 - 1 - Yorkshire 1 1 - 1 - Rennet—essence of 1 1 - 1 - Rice 1 1 - 1 - Rum 4 4 - 4 - Salad cream 2 2 - 2 - Salmon—pink 1 — 1 1 - Salt—table 1 1 - 1 - Sandwiches—buttered salmon 1 1 - 1 - Sarmi—stuffed vine leaf dish 1 1 - 1 - 58 Articles. Total. Formal. Informal. Genuine. Non-genuine or irregular. Sauce—chop 1 1 - 1 - mustard 1 — 1 1 - tartar 1 1 - 1 - Sausages—beef 9 9 - 8 1 calf liver 1 1 - 1 - cocktail 1 1 - 1 - pork 15 15 - 14 1 pork chipolatas 1 1 - 1 - rolls 2 2 - 2 - Seven-Up—drink 1 1 - 1 - Shrimps 1 — 1 1 - Smatana—creamed 1 - 1 - 1 Soft drink 1 1 - 1 - Soup—cream of tomato 1 1 - 1 - Swiss celery 1 1 - 1 - Spam 1 1 - 1 - Squash—lemon 1 1 - 1 - orange 5 4 1 5 - Steak—casserole, stewed 1 1 - 1 - and kidney 1 1 - 1 - and kidney pie 1 1 - 1 - and kidney pudding 1 — 1 1 - minced 1 1 - 1 - Stew—Irish 3 1 2 3 - Strawberries in heavy syrup 1 1 — — 1 Stuffing—parsley and thyme 2 2 — 2 - sage and onion 1 1 — 1 - Suet 1 1 - 1 - Sugar—brown 1 1 — 1 - confectionery 35 33 2 35 - Syrup—ice lolly 1 1 — 1 - maple 1 1 — 1 - milk shake 2 2 — 2 - morello cherry 1 1 — 1 - orange flavour 1 1 — 1 - raspberry 1 1 — 1 - rose hip 1 1 — 1 - Tea 3 3 3 Throaties 1 1 1 Tizer 1 1 1 Tongue and turkey roll 1 — 1 - 1 Vinegar—malt 5 4 1 4 1 Vital restorers 1 1 1 Vitamin health drink 1 1 1 Whisky 6 6 — 6 Yeast—vitamin 1 - 1 1 - Yogurt—low fat 1 1 — 1 Zing—drink 1 1 — 1 - Totals 409 352 57 394 15 59 The following samples were submitted for special examination: Articles. Total. Formal. Informal. Genuine. Non-genuine or irregular. Apple wine 1 1 1 Bread loaves 3 - 3 - 3 Bread roll 1 - 1 1 — Canned rhubarb 2 - 2 2 — Cooking salt 1 - 1 — 1 Cream slice 1 - 1 — 1 Fruit scone 1 - 1 — 1 Lemonade 1 - 1 — 1 Marshmallow pastry 1 - 1 — 1 Meringues 1 - 1 — 1 Milk 1 - 1 — 1 Sardines 1 - 1 1 — Totals 15 - 15 5 10 It will be seen that adverse reports were received upon 25 samples and following is a brief account of the action taken in respect thereof: Coffee with Creme and Sugar. Purchased from vending machine. Description misleading purchaser to expect coffee with cream. No evidence of cream added. Machine re-labelled ' Coffee White' after correspondence. Dairy Topping. Sample of sterilised and homogenised top of the milk containing 18.5% butterfat. Description generic—not specific. Correspondence with producer. New label to meet requirements of Labelling of Food Order, 1953. Cake Flour. Not being wholemeal and wheat malt flour must contain added chalk (The Bread and Flour Regulations, 1963). Imported from America. Stocks withdrawn from shops within Borough. Ministry of Health informed of breach of Regulations in flour imported from America. Cream Slices. Imitation cream. No notice displayed at time of purchase. Omission rectified. Peach Melba Ice Cream. Sample of imitation peach melba made with ice-cream and fruit ice flavoured with peach puree. Carton changed to Peach Delight. 60 Milk. Sample contained 1.40% milk fat as against the 3% requirement of the Sale of Milk Regulations, 1939. Deficiency 53%. Vendor prosecuted. Pleaded guilty. Fined £15. Costs £5 5s. Hot Milk. 5% deficiency in milk solids. 8.04% against 8.5%. Investigations at vendor's premises and bottling plant showed no reason for deficiency. Babies' Milk Powder. Labelled ' The nearest approach to Mother's Milk'. Vegetable fat or oil—not milk fat. Misleading. Correspondence with manufacturers to amend label. Nuts. Common or usual name of the article and the ingredients not included on label. (Labelling of Food Order, 1953.) Packed by importers. Verbal warning. Beef Sausages. Contained preservative. No notice displayed. Letter to butcher. Pork Sausages. Contained preservative. No notice displayed. Letter to butcher. Creamed Smatana. Cultured milk enriched with milk fat. Ingredients not specified on label. Informal action taken to amend label. Strawberries in Heavy Syrup. Imported from Holland. Syrup density below normal. Ministry of Agriculture, Fisheries and Food informed. Tongue and Turkey Roll. Contravention of Labelling of Food Order, 1953. Two ingredients specified on label generic and another ingredient not adequately described. Label amended. Malt Vinegar. Sample of non-brewed condiment sold as vinegar. Written warning sent to vendor. Bread. Sliced white loaf. Black pellet of foreign matter consisting of cotton fibres, wheat flour and miscellaneous dirt baked in the bread. Informal action taken. Bread. White loaf containing poppy seeds baked in the bread (was alleged to be contaminated with mouse excreta). Informal action taken. Bread. Sliced white loaf containing small pieces of brown foreign matter found to consist of a mixture of wheat bran and wheat flour. Informal action taken. 61 Cooking Salt. Dark grey foreign matter in two layers in a block of salt found to consist of a compacted mass of calcium and sodium salts. Not an uncommon contaminant of lump salt. Manufacturers advised. Cream Slice. Foreign matter embedded in the jam layer consisted of shreds of tobacco baked in the slice. Warning letter to bakers. Fruit Scone. Dried fruit tissue mixed with wheat flour formed a hard pellet. Informal action taken. Lemonade. Opened bottle containing foreign particles and coloured deposit found to be algae. Informal action taken. Marshmallow Pastry. Alleged insect found to consist of jute fibres twisted together, partly covered with marshmallow. Informal action taken. Meringues. Pellets of black foreign matter present in the meringue mixture, found to consist of flour and egg white rubbed up with dirt to produce black pellets. They were baked in the meringues. Warning letter to bakers. Milk. Amorphous foreign matter having characteristics of a bird dropping. Informal action taken. Other Legal Proceedings. Milk and Dairies (General) Regulations, 1959—Article 27. Two cases of dirty one pint milk bottles being used for delivery of milk. Defendants pleaded guilty. Fined £10 each case. Costs £3 3s. Food Hygiene (General) Regulations, 1960—Regulation 9. Smoking in food room in which there was open food. Defendants pleaded guilty. Fined £10. Costs £5 5s. Food Hygiene (General) Regulations, 1960. Condition of premises and other matters. Fined £25. Costs £5 5s. Public Health Act, 1936—Section 107. Appeal against consent of Local Authority for the establishment of an offensive trade (fat rendering) for a period of two years. Appeal upheld. Period extended to three years. Application for costs refused. 62 SERVICES UNDER OTHER ENACTMENTS Rent Act, 1957—Certificates of Disrepair. The following is a summary of applications dealt with dining 1965:— Applications received (Form I) 9 Decisions not to issue certificates Nil Certificates issued (Form L) 4 Undertakings given by landlords (Form K) 5 Applications by landlords for cancellations (Form M) 3 Objections by tenants to cancellation Nil Certificates of Disrepair cancelled 3 Number of visits made during 1965 in connection with the Rent Act, 1957, were 56 Shops Acts, 1950-65. Prior to amalgamation the Public Health Inspectors of the three constituent Authorities carried out all the duties under this legislation. On 1st April, 1965, it was intended that the Town Clerk would administer those Sections of the Shops Act, 1950, relating to hours of closing, Sunday trading, etc. In May, 1965, however, these functions were transferred to the Public Health Inspectors. The Shops (Early Closing Days) Act, 1965, which came into force during the year, clarified the position created by previous Closing Orders which had been made by the three constituent Authorities. Shops in the Borough have been kept under observation and contraventions have been remedied. Action has also been taken in respect of general closing hours, half-day closing and Sunday trading. The total number of inspections made during 1965 was 217. Offices, Shops and Railway Premises Act, 1963. Work under this legislation was continued during 1965 and specialist technical staff was appointed on 1st April, 1965, for this purpose. In general, the co-operation of employers in meeting the requirements of Informal Notices served has been most encouraging and no serious objection has been raised as to the manner in which the enforcement of the Act has been carried out. Registrations and General Inspections. Class of Premises Number of Premises Registered During Year Number of Registered Premises at end of Year Number of Registered Premises Receiving a General Inspection During the Year Offices 538 525 269 Retail Shops 1,118 1,104 552 Wholesale Shops, Warehouses 28 28 7 Catering Establishments open to the Public, Canteens 128 128 31 Fuel Storage Depots 4 4 — Totals 1,816 1,789 859 63 Contraventions rectified. Cleanliness 130 Overcrowding 6 Temperature 259 Ventilation 26 Lighting 26 Sanitary conveniences 153 Washing facilities 118 Supply of drinking water 2 Clothing accommodation 5 Sitting facilities 2 Eating facilities 4 Floors, passages, stairs 26 Dangerous machinery guarded 3 First aid provisions 298 Abstract of Act posted 176 Not registered 39 Other contraventions 46 1,319 Exemption. One exemption (Section 46), for a period of two years was granted from the requirement to provide a sanitary convenience in respect of a Coal Order Office. Accidents Reported and Investigated. In Offices 5 In Retail Shops 16 In Wholesale Shops, Warehouses 5 In Catering Establishments open to public; in Canteens, etc. 9 35 The total number of visits of all kinds made by Inspectors during the year was 3,223. Petroleum (Regulations) Acts, 1928 and 1936. The Chief Public Health Inspectors of the three constituent Authorities were designated ' Petroleum Officers' and carried out duties in connection with petroleum installations. On 1st April, 1965, by virtue of Section 50 of the London Government Act, 1963, the Greater London Council became the Petroleum Authority and all the records were accordingly transferred. Prevention of Damage by Pests Act, 1949. The table below summarises surface rodent control work which was carried out during 1965. The inspection and treatment of sewers was undertaken in collaboration with the Borough Surveyor's Department. 10% of the total manholes in the whole sewer system were test baited, and maintenance treatment was carried out on these, and other manholes known to be infested, three times during the year. During 1965, 356 manholes were baited and only 32 showed evidence of rodent infestation. The Department continued to deal with rodent treatment and disinfestation work in Council-owned property within the Borough. 64 Type of Property Number of Properties inspected as a result of Number of Properties found to be infested by Number of treatments carried out including retreatments Number of inspections made including reinspections Notification Survey under Act Total Rats Mice Local Authority 35 46 81 42 11 57 296 Dwellings 809 3,620 4,429 593 248 840 9,342 All other including Business Premises 186 545 731 82 70 155 4,064 Totals 1,030 4,211 5,241 717 329 1,052 13,702 Other Pest Control Work. During the year 1965, 537 complaints were received concerning insect pests and the following is a list of the infestations dealt with:— Ants 36 Beetles 23 Bed Bugs 14 Caterpillars 1 Crickets 1 Cockroaches 1 Earwigs 3 Fleas 11 Flies 13 Gnats 2 Lice 1 Mosquitoes 14 Maggots 5 Silverfish 7 Spiders 2 Woodworm 7 Wasps 396 The incidence of wasps was again generalised during 1965, and it is considered that the service provided by the Department in the destruction of wasps nests plays a great part in the Council's Food Hygiene Policy. Ponds, ditches, open spaces and other mosquito breeding grounds were sprayed with insecticide during the year, with satisfactory results. Thirty-one complaints of nuisance or damage caused by feral pigeons were received. Pigeon traps were placed at suitable sites within the Borough, giving effect to a reduction in the number of pigeons. It is to be hoped that more concerted action by London Borough Authorities in respect of feral pigeons may be organised during the coming year. Pet Animals Act, 1951. Twelve licences to keep pet shops were issued during 1965. Twenty-seven visits were made to these premises and any infringements of the conditions of licence were rectified. 65 Animal Boarding Establishments Act, 1963. There is one licensed animal boarding establishment in the Borough. The Riding Establishments Act, 1964. This Act came into operation on 1st April, 1965, and provides that no person shall keep a riding establishment except under the authority of a licence granted in accordance with the provisions of the Act. Four applications for licences were received, three of which were granted. The fourth application was not granted, the refusal being based on the report of the Council's Veterinary Officer. Diseases of Animals Act, 1950. No outbreaks of disease occurred within the Borough during 1965. Copies of Orders made by the Ministry of Agriculture, Fisheries and Food in respect of outbreaks elsewhere of foot and mouth disease, anthrax, swine fever and fowl pest were received. Numerous Movement Licences authorising the transfer of pigs from areas covered by Orders to the slaughterhouse at Mitcham, were received during the year. Thirty-seven visits were made to the five piggeries which are licensed under the Diseases of Animals (Waste Foods) Order, 1957. for the boiling of foodstuffs for the feeding of animals. Clean Air Act, 1956. During the year 1965, 141 complaints were received with regard to smoke or grit emission, and the necessary observations were made and remedial action taken. Legal proceedings were instituted against a Company for contravention of the Dark Smoke (Permitted Periods) Regulations, 1958. The defendants pleaded guilty and were fined £10 with £6 6s. costs. An application was made to the Magistrates Court under Section 16 (2) for an Order prohibiting the recurrence of a smoke nuisance created by a demolition contractor. The service of the Summons could not be proved and the case was not proceeded with. The nuisance was abated and did not recur. Twelve notices of proposal to install a furnace to which Section 3 (1) of the Act applied were received, and the installations were inspected and recorded. In 11 instances plans which were deposited for building byelaw approval showed in each case the proposed construction of a chimney. After examination of the plans, followed by discussions with the applicants, opinions upon the heights of chimneys in relation to Section 10 of the Act were sent to the Borough Surveyor. National Survey of Atmospheric Pollution. The Health Department maintains seven daily smoke filter and sulphur dioxide (volumetric) instruments which are sited in approved positions in the Borough. These instruments, which record smoke density and sulphur dioxide content in the atmosphere, are visited daily throughout the year and recordings are sent to the Ministry of Technology's Warren Spring Laboratory. Two standard deposit gauges are also sited within the Borough. These have a somewhat limited 66 use, but, nevertheless, serve to indicate localised atmospheric pollution. Recordings from these instruments are also sent periodically to the Ministry of Technology. DEPOSIT GAUGE RECORDINGS 1965 Jan Feb Mar Apl May Jun Jul Aug Sep Oct Nov Dec Total Solids in Tons per Sq. mile Garth Road Cemetery 9.26 9.73 8.55 9.64 9.30 8.40 9.50 6.63 10.13 168.30 82.4 8.43 Morden Park Bandstand 9.93 8.53 17.11 8.04 13.74 9.47 7.78 9.28 8.30 7.70 12.61 7.37 AVERAGE DAILY SMOKE CONCENTRATION (MICROGRAMS PER CU. METRE) 1965 Site Town Hall Atkinson Morley Hospital Public Baths Sewage Works Leopold Road School Lombard Road Grand Drive Number Wimbledon 3 Wimbledon 4 Wimbledon 5 Wimbledon 6 Wimbledon 7 Merton & Morden 2 Merton & Morden 3 Jan. 114 61 144 103 58 115 129 Feb. 110 58 142 113 65 137 120 Mar. N 52 107 86 55 130 N Apr. N 27 71 53 28 49 N May N 23 N N 15 55 N Jun. N 22 N N 14 16 N Jul. N N 18 22 9 18 N Aug. N N 19 40 18 24 N Sep. N 36 46 47 43 N 27 Oct. N 109 146 129 115 105 117 Nov. N N N N N N N Dec. N 93 123 124 N 97 62 N indicates No Recording AVERAGE DAILY SULPHUR DIOXIDE CONCENTRATION (MICROGRAMS PER CU. METRE) 1965 Site Town Hall Atkinson Morley Hospital Public Baths Sewage Works Leopold Road School Lombard Road Grand Drive Number Wimbledon 3 Wimbledon 4 Wimbledon 5 Wimbledon 6 Wimbledon 7 Merton & Morden 2 Merton & Morden 3 Jan. 172 189 262 241 201 183 183 Feb. 250 243 303 319 231 283 269 Mar. N 208 262 241 223 254 N Apr. N 107 150 112 91 158 N May N 62 N N 73 110 N Jun. N 88 N N 66 116 N Jul. N N 56 56 53 66 N Aug. N N 75 71 75 83 N Sep. N 63 64 78 79 N 55 Oct. N 185 210 199 242 148 162 Nov. N 190 212 209 242 132 181 Dec. N 141 176 182 N 96 133 N Indicates No Recording 67 These tables, which it is proposed to publish year by year, indicate, so far as smoke concentration is concerned, an improvement in the area of Wimbledon No. 4 instrument. This is in a smoke control area, the Order upon which became operative in 1963, and the area is adjoined on the west by smoke control areas within the Royal Borough of Kingston-upon-Thames. It is hoped that, as time passes, a comparison may be made with the past year's recordings. Graphs based on records are maintained in the Department and these are beginning to demonstrate the effect of smoke control. The records of sulphur dioxide concentration, however, do not indicate quite such a marked improvement and comparisons in future years will be the subject of further comment. Smoke Control Areas. During the year the Council reviewed the Smoke Control Area programmes of the three constituent authorities and a new programme was adopted. This provides for the division of the remainder of the Borough into 32 areas so arranged as to allow for linking up with those areas already covered by Smoke Control Orders. The position on 31st December, 1965, was as follows:— Wimbledon Smoke Control Orders— Order No. State. Made. Confirmed. Opera- tive. (No. 1) 1962 Operative 2.2.62 13.2.63 1.12.63 (No. 2) 1962 Operative 10.8.62 19.11.62 1.6.64 (No. 3) 1963 Operative 27.6.63 7.11.63 1.10.64 (No. 4) 1963 Operative 12.12.63 31.8.64 1.7.65 Merton and Morden Smoke Control Orders— (No. 1) 1961 Operative 13.3.61 13.9.61 1.10.62 (No. 2) 1961 Operative 24.7.61 20.12.61 1.10.62 (No. 3) 1962 Operative 29.1.62 14.6.62 1.10.63 (No. 4) 1963 Operative 22.4.63 30.8.63 1.10.64 (No. 5) 1963 Operative 22.7.63 11.12.63 1.10.64 (No. 6) 1964 Operative 22.6.64 24.9.64 1.10.65 (No. 7) 1965 Confirmed 8.2.65 16.9.65 1.10.66 Mitcham Smoke Control Orders— (No. 1) 1963 Operative 24.1.63 14.5.63 1.12.63 (No. 2) 1963 Operative 3.10.63 14.1.64 1.11.64 (No. 3a) 1964 Operative 16.7.64 15.10.64 1.11.65 Merton Smoke Control Areas— (No. 1) 1965 Confirmed 21.7.65 11.10.65 1.10.66 (No. 2) 1965 Awaiting 8.12.65 Confirmation Areas Nos. 3 and 4 under survey. The area covered by Orders either in operation, confirmed but not operative, or awaiting confirmation is 4,355 acres. The total number of houses involved in these areas is 22,514. Comparable figures at the commencement of the year were 3,797 acres and 17,245 houses. The two Smoke Control Areas under survey at the end of the year will cover an additional 291 acres with 3,162 houses. 68 The total number of visits made during 1965 in connection with the Clean Air Act, 1956, for all purposes, was 13,535. Work in connection with Smoke Control Areas presented considerable difficulties on 1st April, 1965, inasmuch as it involved three separate systems of administration and varying stages of completion in respect of surveys, Areas and Orders, and a depleted staff. Nevertheless, these difficulties were overcome and the work was proceeding satisfactorily on one system by the end of the year, except in the case of Merton and Morden (No. 7) Smoke Control Order, 1965. The changeover was completed whilst maintaining good relations with residents in the Areas concerned. After the operative date of any Smoke Control Order, observations are made from time to time by Public Health Inspectors and Technical Assistants, to ensure compliance with the Order. Noise Abatement Act, 1960. During 1965, 115 complaints regarding noise were received and 448 visits were made. Many of the complaints referred to alleged noise nuisances at night and the majority of these visits were made outside normal office hours, for the purpose of observation and the taking of Noise Level Meter readings. Legal proceedings were instituted against the driver of an icecream vehicle for sounding his loudspeaker chimes outside the permitted hours. The defendant pleaded guilty and was fined £3. The Pharmacy and Poisons Acts, 1933-1941 (a). The Rag Flock and Other Filling Materials Act, 1951. The Fertilisers and Feeding Stuffs Act, 1926. The administration of the Council's powers under these enactments is the responsibility of the Public Health Inspectors. It was not possible to make any progress in connection with this legislation during 1965 with the exception of (a) above, where the issue of licences was undertaken by the Town Clerk's Department. Housing Acts, 1957-1964. In accordance with the Ministry of Health Circular 17/55, details of housing matters are omitted from this Report, but I think that some reference should be made to the work carried out in this field. The implementation of the Slum Clearance Programmes of the three constituent Authorities continued, and, in addition, a number of houses were inspected, either for repair or for Closing Order or Demolition procedure. During the year the Council adopted Standards to be Applied to Houses let in Multiple Occupation, and 477 visits were made to such houses. The total number of visits made to premises of all kinds, for the purposes of housing administration, was 2,078. CONCLUSION Despite an obvious slowing down process immediately before, and for some time after, 1st April, 1965, a good standard and variety of work has been maintained by the staff of the Environmental Health Section of the Department. The continuity of the service has been maintained but staffing difficulties are reflected in some of the statistics given in this Report. 69 On 1st April, 1965, the establishment of Public Health Inspectors was 18 but, in fact, there were two vacancies. During the year two more Inspectors left to take up appointments elsewhere and one new Inspector joined the staff so that at the end of the year there were three vacancies. These vacancies represent several hundred visits, and whilst duties such as requests for visits, food inspection, meat inspection at the slaughterhouse, infectious disease enquiries and the like were given priority, work of a routine nature, i.e., inspections of food premises, factories and work places, stables, etc., and sampling work, tended to be curtailed or neglected. The Inspectors are also required to carry out a great deal of work in connection with the Housing Acts and by the end of the year arrears of this and other work were becoming an embarrassment. The assistance of the seven Technical Assistants in the fields of rodent control, smoke control, and offices, shops and railway premises administration must be acknowledged but, valuable though these Officers are, they cannot replace Public Health Inspectors in the carrying out of statutory duties. It is to be hoped that the staff situation may be improved during 1966 so that more time may be devoted to other aspects of environmental hygiene. G. H. COCKELL, Chief Public Health Inspector. 70 ANNUAL REPORT to the EDUCATION COMMITTEE on the work of the SCHOOL HEALTH SERVICE for the year 1965 CONTENTS Page Special Services (Education) Sub-Committee as at 31st December, 1965 73 School Clinics provided by the Local Education Authority 74-75 Introductory Letter by Principal School Medical Officer 76-77 The Service: Medical Inspections 78 Audiometry and Audiology 78 Speech Therapy 78-79 The Work of the School Nurses 79-80 Handicapped Pupils 80 Infectious Diseases and Prophylactic Measures 81 Ancillary Services: Nursery Classes 82 Provision of Milk and Meals 83 Epidemiological Survey at Wimbledon Secondary Boys' School 83 The School Dental Service: Report by Chief Dental Officer 84 Statistics on School Dental Service 85 Appendix ' A': Routine Medical Inspections 86 Other Medical Inspections 86 Return of Defects Found at Medical Inspections 87 Children Found to Require Treatment 88 Classification of General Condition of Pupils 88 Uncleanliness and Verminous Conditions 88 Diseases of the Skin 89 Eye Diseases, Defective Vision and Squint 89 Diseases of the Ear, Nose and Throat 89 Orthopaedic and Postural Defects 89 Other Treatment Given 90 Appendix ' B': Attendances at Clinics 90 Other Medical Examinations by School Medical Officer 90 Recuperative Holidays 90 Child Guidance Service 90 72 ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1965 SPECIAL SERVICES (EDUCATION) SUB-COMMITTEE (As at 31st December, 1965) Chairman: Councillor A. Leivers Alderman N. S. Clarke Councillors: A. M. Anderson, M.A. E. H. Ceci P. Corbishley D. J. Hempstead G. N. Smith R. A. Spalding W. G. Terrett (Mrs.) J. E. Vowles The Rev. C. H. Smith, M.A. Ex-Officio: Sir Cyril Black, J.P., D.L., M.P. (Chairman of the Education Committee) Alderman V. Talbot, J.P. (Vice-Chairman of the Education Committee) Chief Education Officer: R. Greenwood, M.A. 73 SCHOOL CLINICS PROVIDED BY THE LOCAL EDUCATION AUTHORITY General Medical Clinics Amity Grove, West Wimbledon: Thursday mornings. Grand Drive, Raynes Park: Tuesday mornings. Middleton Road, Morden: Wednesday mornings. Morden Road,Merton: Monday mornings. Examination of cases Pelham Road, referred by Teachers Wimbledon: Monday and Wednesday morning Education Depart- Thursday and Friday ment, Health Visitors, 9-10 a.m. (Health Vis- etc.:aitments. itors only). minor ailments. Western Road, Mitcham: Monday and Friady mornings. Wednesday 9-10 a.m. (Health Visitors only) Wide Way, Mitcham: Wednesday mornings. Child Guidance Clinics All Saints Road, Wimbledon: Sherwood House, Monday to Friday all day. Commonside East, Mitcham: (Cases seen by appointment by Psychiatrist or Educational Psychologist, with the assistance of Psychiatric Social Workers) Ophthalmic Clinics Amity Grove, West Wimbledon: Tuesday afternoons. Grand Drive, Raynes Park: Tuesday mornings. Examination and Morden Road, Merton: Wednesday afternoons. treatment of errors Pelham Road. of refraction and Wimbledon: Friday mornings. squint. Western Road, Mitcham: Wednesday afternoons. Wide Way, Mitcham: Tuesday mornings. Orthopaedic Clinic Pelham Road, Wimbledon: Every fourth Wednes- Examination of referred day afternoon. cases by an Orthopaedic Surgeon. Audiology Clinic Russell Road, Wimbledon: Alternate Friday morn- Detailed investigation of ings. cases referred. Psychological Clinic Pelham Road, Wimbledon: Every third Monday Cases referred for special morning. attention. 74 Remedial Exercises Amity Grove, West Wimbledon: Tuesday mornings. Remedial and breathing Pelham Road, exercises as recommended Wimbledon: Tuesday and Thursday by School Medical afternoons. Officers. Wide Way, Mitcham: Tuesday afternoons. Speech Therapy Clinics Amity Grove, West Wimbledon: Thursday afternoons. Grand Drive, Raynes Park: Wednesday all day and Friday afternoons. Middleton Road, Treatment of speech Morden: Tuesday mornings and defects. Wednesday afternoons. Morden Road, Merton: Thursday mornings. Russell Road, Wimbledon: Monday all day and Tuesday afternoons. Dental Clinics Amity Grove, West Wimbledon: Monday to Friday all day. Church Road, Mitcham: Monday all day, Tuesday and Thursday mornings. Friday all day. Grand Drive, Raynes Park: Monday to Friday all day. Meopham Road, Mitcham: Monday to Friday all day. Middleton Road, Morden: Monday to Friday all day. Morden Road, Merton: Monday to Friday all day. Pelham Road, Wimbledon: Monday to Friday all day. Western Road, Mitcham: Monday to Friday all day. 75 To the Chairman and Members of the Education Committee: Mr. Chairman, Ladies and Gentlemen, I have the honour to present the first Report of the School Health Service for the London Borough of Merton for the year 1965. It should be pointed out that for the first three months of the year, the Service was that operated by Surrey County Council as a Divisional Service comprising three separate Divisions (Wimbledon, Merton & Morden and Mitcham) each with its own Divisional School Medical Officer. With effect from 1st April, 1965, the London Borough of Merton assumed responsibility as a Local Education Authority. Since the area itself has remained unchanged geographically, the collation of information for the whole year has presented no serious difficulty. The operation of the School Health Service during the year, however, has presented some administrative problems precipitated by the amalgamation of three Divisions each with their three separate systems and each with their own records comprising in all some 24,000 school children's medical records. This has inevitably caused some dislocation in the School Health Service, but by the end of the year most of the difficulties had been overcome, although much still requires to be done. On the whole, in spite of difficulties of amalgamation, the Service has run quite smoothly. There was little change in the establishment of Medical, Dental and Health Visiting staff employed in connection with the Service. The principal change was the retirement of Dr. A. R. Graham, as Divisional School Medical Officer for Mitcham, on 31st March, 1965. School Departments now number 83 and compared with 1964, the school population increased by 228. The percentage of school children whose general condition was found to be satisfactory on inspection was 99.98% compared with 99.90% in 1964, an increase of .08%. This percentage reflects the continuing high standard of the health of school children in this area. 14.95% of the 1965 school population were found at routine medical inspections to require treatment for various defects mostly minor in character compared with 16.59% of the 1964 school population. On notification of a case of tuberculosis in a pupil, an epidemiological survey was necessary during the year at a Secondary Boys' School in Wimbledon. A detailed report of this survey is given on page 83. There was a relatively high incidence of measles and chickenpox during the year, but apart from this there were no serious outbreaks of infectious disease. I am grateful for the help and co-operation received from Mr. R. Greenwood, Chief Education Officer, and his staff, and from Head Teachers, Teaching Staff and Secretaries of the many schools in the area. My thanks and appreciation are also due to the Medical, Dental, Health Visiting and other staff of the School Health Service for the satisfactory and efficient manner in which their respective duties were carried out in this inaugural year of the London Borough of Merton. I should like to make special mention of the valuable work of the 76 Chief Administrative Officer, Mr. W. Atkinson, who joined the department in May, 1965, and to Mr. E. A. Ayling, the Senior Clerk of the School Health Service section. I am also grateful for the support and encouragement so kindly extended at all times by the Chairman and Members of the Special Services (Education) Sub-Committee. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, P. J. DOODY, Principal School Medical Officer. 77 THE SERVICE The Service provides for periodic inspections of all children: (a) for whom primary, secondary or further education is provided by the Local Education Authority at any school or college maintained by them, and (b) receiving primary or secondary education under special arrangements made by the Local Education Authority otherwise than at school. The treatment of minor ailments, eye, dental, speech, postural and breathing defects, and of children with behaviour problems, is provided at Clinics in the area. Attendance of children is normally by appointment. Most other forms of treatment are provided by general practitioners or the hospital services. There is close co-operation between the School Health Service and general practitioners and the hospitals. MEDICAL INSPECTIONS Medical inspections are carried out as follows:— 1. On entry to school for the first time (including a vision test). 2. During the year in which eight years of age is reached. 3. On entry to Grammar, Technical and Secondary Schools. 4. During the year in which 15 years of age is reached. 5. During the last year in school if not inspected in the previous twelve months. In addition, special inspections are carried out at the request of teachers, school nurses, parents or other bodies when children are thought to be requiring medical or other educational treatment, and also on children to ascertain their fitness for part-time employment. The statistics of medical inspection and treatment together with other statistics are contained in the Tables in Appendices 'A' and 'B'. AUDIOMETRY AND AUDIOLOGY A sweep audiometric test is carried out by the Audiometrician on six-year-old children attending primary schools. All children who fail this test are referred to the school clinic for aural examination by the school medical officers. If the hearing failure remains unexplained, a second audiometric test is carried out by the audiometrician, and, if necessary, the case is referred to the audiologist for further investigation and possible referral to a specialist hospital department if required. Details are given below of audiometric primary testing carried out during the year:— Number of schools visited 38 Number of children tested 2,177 Number of primary failures 116 SPEECH THERAPY Number of sessions held (a) for treatment 550 (b) for consultation 62 Number of cases on register at beginning of year 187 78 Number of cases added during year 66 Number of cases discharged during year 69 Number of cases on register at end of year 184 Cases discharged during year who:— Achieved normal speech 27 Were greatly improved 24 Showed some improvement 9 Showed little or no improvement 9 Analysis of cases treated during year: — Stammering 19 Dyslalia 139 Cleft palate 5 Nasal obstruction 1 Cluttering 1 Aphasia 1 Nasality 1 Defective speech due to amontia 1 Defective speech due to deafness 2 Retarded speech 18 THE WORK OF THE SCHOOL NURSES In this Local Education Authority the Health Visitors are also School Nurses, and each Health Visitor has the responsibility of two or three school departments. Where it is possible, the Health Visitor is attached to a primary school in her own area, since she often knows the children and their families well. This is of value as there is in the main, very good co-operation between the Head Teacher, School Medical Officer and the Health Visitor. Hygiene inspections are carried out regularly in the majority of schools by the Health Visitor early in each term and 'follow-up' visits are paid either in school or at home where necessary. There is a link here with the Education Welfare Officers who are notified in cases of exclusion and are told the probable length of children's absences from school and the names of the School Clinics where children will be seen before re-admission to school. Routine medical inspections in primary schools are carried out with a Health Visitor in attendance. She tests vision and is present during the medical inspection by the School Medical Officer. This is of value because the Health Visitor can often give details of the past history of the children and she also knows the parents, which promotes a more friendly atmosphere altogether. At routine medical inspections in grammar and secondary schools there is usually a state registered nurse present. This has been found to be a practical idea, since the Health Visitor rarely knows the older children who often travel long distances to school. The state registered nurse, wherever possible, is allocated to a particular School Medical Officer, which builds up a good team relationship. Vision tests are carried out by Health Visitors in all schools where there are 13-year-old children, since there is not now a medical inspection for this age group. Where a possible defect is discovered by the Health Visitor at this primary vision test, the child's parents are offered the choice of an appointment with the Ophthalmologist at the School Clinc, or to make their own arrangements for eye testing. 79 The reinforcing injections against diphtheria and tetanus are given shortly after entry to school and Mantoux testing and B.C.G. vaccination are carried out by School Medical Officers with a state registered nurse in attendance at the age of 13 years. There are few minor ailments being treated at sessions of General Medical Clinics these days, but a considerable number of children are referred back to those Clinics from routine medical inspections by the School Medical Officers, who wish to see them and their parents for a 'follow-up'. The state registered nurses act as school nurses for these sessions. Health education in schools is a service which is generally on the increase in the Borough, and is proving of great value, although its scope is still more limited than is hoped for in the future. In general, the Health Visitor visits a secondary girls' school for one period each week, and takes a small group of children aged between 11 and 15 years for a variety of mothercraft and hygiene subjects. Because of the smallness of these groups, there is ample opportunity for discussion, and both the girls and the teachers are well pleased with the results so far achieved. HANDICAPPED PUPILS NUMBERS OF HANDICAPPED PUPILS The following table gives the numbers of pupils on the Handicapped Pupils' Register on 31st December, 1965, together with the numbers ascertained during the year: — Classification Total ascertained during year Total ascertained at 31.12.65 Blind 1 12 Partially-sighted — 9 Deaf 1 11 Partially-hearing 1 8 Delicate 8 27 Physically-handicapped 7 27 Educationally subnormal 37 150 Maladjusted 19 43 Totals 74 287 80 PROVISION OF SPECIAL EDUCATION The table below gives details of the numbers of pupils for whom special educational facilities have been provided by the Authority:— Classification Attending special school as Receiving education under arrangements made under Section 56 of the Education Act, 1944 Total Day Pupils Boarders In Hospital At home Blind 5 7 - - 12 Partially-sighted 8 1 - — 9 Deaf 4 7 - — 11 Partially-hearing 6 — - — 6 Delicate 17 8 - 3 28 Physically-handicapped 18 3 - 2 23 Educationally-subnormal 135 10 - — 145 Maladjusted 6 33 - 3 42 Totals 199 69 — 8 276 CHILDREN UNSUITABLE FOR EDUCATION IN ORDINARY SCHOOLS During the year seven children were reported as suffering from a disablity of mind of such nature and to such extent as to make them unsuitable for education at school. INFECTIOUS DISEASES AND PROPHYLACTIC MEASURES 1. INFECTIOUS DISEASES Infectious Diseases. Disease Suffering Excluded on suspicion Infection at home Total exclusions Smallpox — — — — Diphtheria — — — — Scarlet Fever 42 — — 42 Enteric Fever — — — — Measles 654 4 11 669 Whooping Cough 16 — 16 32 German Measles 134 1 4 139 Chicken Pox 464 6 4 474 Mumps 17 1 — 18 Jaundice 1 — — 1 Influenza 23 — — 23 Other 118 2 7 127 Totals 1,469 14 42 1,525 81 Contagious Diseases. Disease Suffering Excluded on suspicion Total exclusions Ringworm 1 — 1 Impetigo 2 — 2 Scabies — — — Other 9 — 9 Totals 12 — 12 Compared with 1964 there were 24 fewer cases of communicable disease notified and 15 fewer children excluded from schools. 2. PROPHYLACTIC MEASURES 1. Poliomyelitis Vaccination. Vaccination of school children against Poliomyelitis continued during the year. The actual number vaccinated or receiving reinforcing doses during 1965 was as follows:— Number of children vaccinated 240 Number of children given re-inforcing doses 1,993 I am pleased to say that no case of Poliomyelitis occurred among schoolchildren during 1965. 2. Diphtheria/ Tetanus Immunisation. Number of children given immunisation 163 Number of children given re-inforcing doses 596 I have much pleasure in being able to report again that there was no case of Diphtheria among school children or otherwise in this area, but the importance of immunisation for all children is in no way diminished. 3. Protection of School Children against Tuberculosis. B.C.G. Vaccination. Percentage. Number in age group 1,987 Number of consents 1,721 86.61% Number skin tested 1,712 86.11% Number Mantoux positive 194 9.81% Number B.C.G. Vaccinated 1,518 76.39% ANCILLARY SERVICES 1. NURSERY CLASSES There were 215 children atending the nursery classes at the infants' schools during the year. 82 2. PROVISION OF MILK AND MEALS The following table gives details of milk and meals supplied together with the percentage of pupils partaking; compared with 1964:— Year Numbers in attendance Taking Milk Taking Meals Number Percentage Free Paid Total Percentage September, 1965 22,494 18,578 82.5 343 15,673 16,016 71.2 September, 1964 22,835 18,784 82.2 316 15,190 15,506 67.9 Epidemiological Survey at Wimbledon Secondary Boys' School In Janaury, 1963, a pupil attending the above school was referred to the Chest Clinic because of a strong positive reaction to the Mantoux skin test, prior to B.C.G. vaccination. At the time, clinical examination and chest X-ray showed nothing abnormal. The boy was admitted to hospital in February, 1965, for investigation of a small haemoptysis, and in March, 1965, he was notified as a case of pulmonary tuberculosis. The Chest Physician recommended an epidemiological survey as follows:— 1. All pupils who had not been B.C.G. vaccinated, or who were not know to be tuberculin positive should be Mantoux tested, and, 2. All previous and present positive reactors, as well as those who had received B.C.G. vaccination should be chest X-rayed. Notification of the proposal to conduct the survey was given to the Chief Education Officer in May, 1965, and with the fullest possible co-operation of the Head Teacher and his staff, consent forms were distributed to parents of boys attending school to be included in the survey. Of the 875 boys in attendance (excluding the notified case of tuberculosis) consent was not forthcoming, or was refused, in 30 cases only. On 10th June, 1965, 280 boys were given tuberculin skin tests and seven proved positive (two of whom had already been tested previously with positive results). Arrangements were made for the Mass Radiography Unit to visit the school on 2nd July, 1965, when 413 pupils were examined, including the five unexplained positive reactors. Fourteen were already under the supervision of the Chest Clinic and 143 were absent for the X-ray as examinations were in progress at the school when the Unit visited. Sixty members of the teaching and ancillary staff were X-rayed at the same time. A further five who did not avail themselves of the opportunity had undergone recent X-rays. Twelve were absent, one had left, and one refused to have an X-ray. A note was sent to the parents of the boys who had missed the chest X-ray examination, similarly for those boys who had left school at the end of the Spring term 1963, when the possibility of infection first existed, advising a chest X-ray as a precautionary measure. 83 Following the survey, a member of the teaching staff was referred to the Chest Clinic for further investigation, and it was discovered that he was suffering from infectious tuberculosis, notification being made on 12th August, 1965. He was excluded from school, and admitted to hospital for treatment, his return to teaching being dependent on satisfactory recovery and freedom from infection. The Chest Physician recommended a further epidemiological survey, in consequence, after a period of six months has elapsed from the last attendance at the school of the teacher concerned. THE SCHOOL DENTAL SERVICE I am indebted to Mr. M. T. Gibb, the Chief Dental Officer, for the following report on the operation of the School Dental Service during the year. 'At 31st December, 1965, the Dental Staff consisted of five full-time officers, one part-time salaried officer, and ten sessionally employed officers, equivalent to 2.9 full-time officers. The employment of 1.4 Dental Auxiliaries forms a useful addition to the team. There were no variations in the full-time staff during the year, apart from my own appointment, which I took up in June, but various changes occurred among the sessionally employed staff. Orthodontic treatment was carried out on six sessions a week at the Church Road, Amity Grove and Grand Drive Clinics, and a smaller amount of Orthodontic treatment was also carried out by Dental Officers, either on their own initiative or in consultation with an Orthodontist. 'The dental scheme in the Borough begins, as regards each child, with its entrance into school life, and provides for an annual re-examination, together with arrangements for recall inspections up to the end of school life, with the opportunity for treatment, if necessary, after each inspection. The recall system leads to many more teeth being saved and thus there is a consequent reduction in the number of general anaesthetic extraction sessions. 'Children of pre-school age and expectant and nursing mothers are also offered treatment under the Maternity and Child Welfare scheme. 'The work of our two Dental Auxiliaries is confined to the four two-surgery clinics in the Borough, as their regulations lay down that they must work under the direct supervision of a qualified Dental Surgeon. They are permitted to do simple fillings, scaling, cleaning and polishing of the teeth, and applying prophylactic solutions. They are also trained to give instructions in oral hygiene, and to assist in giving dental health education talks to parents and children. They are particularly good with young children, and their work is of a high standard. 'Dental health education will form a more important part of our work, and talks, illustrated with films and demonstrations, will be given to Parentcraft Classes, perhaps the most receptive audience. Head Teachers have also been most cooperative in promising to arrange for groups of children to be given instruction in oral hygiene, either by Dental Officers or by Dental Auxiliaries'. 84 The statistics relating to the School Dental Service are as follows:— STATISTICS FOR YEAR 1965 Number of pupils on the register of maintained primary and secondary schools including nursery and special schools in January, 1966, as in Forms 7, 7m, and 11 schools—24,401. Attendances and Treatment. Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First Visit 1,896 2,103 768 4,767 Subsequent Visits 3,658 6,126 2,574 12,358 Total Visits 5,554 8,229 3,342 17,125 Additional courses of treatment commenced 391 382 176 949 Fillings in permanent teeth 1,865 4,857 2,351 9,073 Fillings in deciduous teeth 3,159 344 3,503 Permanent teeth filled 1,534 4,240 2,042 7,816 Deciduous teeth filled 2,919 322 3,241 Permanent teeth extracted 68 420 107 595 Deciduous teeth extracted 948 333 1,281 General anaesthetics 486 284 67 837 Emergencies 141 87 36 264 Number of pupils X-rayed 480 Prophylaxis 1,270 Teeth otherwise conserved 1,678 Number of teeth root filled 34 Inlays 4 Crowns 10 Courses of treatment completed 4,548 Orthodontics. Cases remaining from previous year 115 New cases commenced during year 147 Cases completed during year 86 Cases discontinued during year 54 Number of removable appliances fitted 310 Number of fixed appliances fitted 3 Pupils referred to Hospital Consultant 6 Prosthetics. 5 to 9 10 to 14. 15 and over. Total. Pupils supplied with F.U. or F.L. (first time) — — — — Pupils supplied with other dentures (first time) — — 1 1 Number of dentures supplied — — 4 4 Anaesthetics. General Anaesthetics administered by Dental Officers—15. Inspections. (a) First inspection at school: number of pupils 16,620 (b) First inspection at clinic: number of pupils 2,228 Number of (a)+(b) found to require treatment 7,528 Number of (a)+(b) offered treatment 6,678 (c) Pupils re-inspected at school clinic 4,353 Number of (c) found to require treatment 2,219 85 Sessions. Sessions devoted to treatment 2,996 Sessions devoted to inspection 205 Sessions devoted to Dental Health Education 1 Appendix 'A' MEDICAL INSPECTION AND TREATMENT (Excluding Dental Inspection and Treatment) Return for the year ended 31st December, 1965 Number of pupils on registers of maintained, primary, secondary, special and nursery schools in January, 1966:— (a) Ordinary Schools 24,033 (b) Special Schools 153 (c) Nursery Schools and Classes 215 Total 24,401 SECTION A. Routine Medical Inspections. Age Groups Inspected (By year of birth) Number of Children Inspected 1961 and later 623 1960 1,817 1959 503 1958 137 1957 1,532 1956 228 1955 93 1954 92 1953 1,112 1952 465 1951 68 1950 and earlier 2,286 Total 8,956 Other Medical Inspections. Type of Inspection Number of Children Inspected Special Inspections 2,454 Re-Inspections 706 Total 3,160 86 Return of Defects found in the course of Medical Inspections. Defects or Disease Periodic Inspections Special Inspections No. referred for Treatment No. referred for Observation No. referred for Treatment No. referred for Observation Skin 92 154 200 39 Eyes (a) Vision 753 505 735 86 (b) Squint 83 24 4 (c) Other 20 45 17 14 Ears (a) Hearing 31 103 48 120 (b) Otitis Media 18 73 7 6 (c) Other 10 25 7 2 Nose and Throat 71 469 57 58 Speech 41 80 12 17 Lymphatic Glands 5 111 — 7 Heart and Circulation 30 118 5 16 Lungs 65 148 10 22 Development (a) Hernia 9 15 1 5 (b) Other 20 113 12 27 Orthopaedic (a) Posture 23 57 3 7 (b) Flat Foot 43 177 17 37 (c) Other 64 157 27 32 Nervous System (a) Epilepsy 8 5 — 4 (b) Other 8 20 3 4 Psychological (a) Development 4 18 1 1 (b) Stability 9 83 10 17 Abdomen 18 36 4 8 Other defects and diseases 45 225 76 132 Totals 1,470 2,761 1,256 661 Four thousand two hundred and thirty-one defects were found in children at routine medical inspections of which 1,470 were referred for treatment and 2,761 for observation, 1,917 defects were found at special inspections, 1,256 being referred for treatment and 661 for observation. The total number of defects referred for treatment and observation in 1965 was 6,148 87 Number of Individual Children found at Routine Medical Inspections to require treatment (excluding uncleanliness and dental disease) Group Number of children inspected Number of children requiring treatment Percentage requiring treatment 1961 and later 623 35 % 5.62 1960 1,817 245 13.48 1959 503 64 12.72 1958 137 22 16.06 1957 1,532 230 15.01 1956 228 43 14.47 1955 93 15 16.13 1954 92 15 16.30 1953 1,112 184 16.55 1952 465 90 19.35 1951 68 21 30.88 1950 and earlier 2,286 375 16.33 Totals 8,956 1,339 14.95 Classification of General Condition of Pupils Inspected during 1965. Group Number of children inspected Percentage found satisfactory Percentage found unsatisfactory 1961 and later 623 % 100 % 1960 1,817 100 — 1959 503 100 — 1958 137 100 — 1957 1,532 99.94 0.06 1956 228 99.57 0.43 1955 93 100 — 1954 92 100 — 1953 1,112 100 — 1952 465 100 — 1951 68 100 — 1950 and earlier 2,286 100 — Totals 8,956 99.98 0.02 SECTION B. TREATMENT Uncleanliness and Verminous Conditions. 1. Total number of individual examinations of pupils by Health Visitors in Schools 9,102 2. Number of individual pupils found to be infested 66 3. Number of exclusions:— First time 18 Second time 7 Third time 1 26 4. Number of pupils cleansed 12 5. Number of cases referred to the N.S.P.C.C. with satisfactory results — 6. Number of Cleansing Notices or Cleansing Orders issued under Section 54 of the Education Act, 1944 — 88 Diseases of the Skin (excluding uncleartliness) Diseases of the Skin. Slumber of cases treated or under treatment during the year. Ringworm—scalp — Ringworm—body — Scabies 1 Impetigo — Other Skin Diseases 296 Total 297 Eye Diseases, Defective Vision and Squint. Number of cases known Eye Diseases and Defects. to have been dealt with. External or other, excluding errors of refraction and squint 28 Errors of refraction (including squint) 3,474 Total 3,502 Number of pupils for whom spectacles were prescribed 956 Diseases of the Ear, Nose and Throat. Number of cases known Diseases and Defects. to have been treated. Received operative treatment: — (a) for diseases of the ear — (b) for adenoids and chronic litis 12 (c) for other nose and throat conditions — Received other forms of treatment 124 Total 136 Orthopaedic and Postural Defects. Number of cases known to have been treated in Clinics or Out-Patient Departments189 83 sessions were held at Pelham Road Remedial Exercises Clinic during 1965. 45 new cases were admitted and 44 old cases discharged. 41 sessions were held at Amity Grove Remedial Exercises Clinic during 1965. 14 new cases were admitted and 10 old cases discharged. 41 sessions were held at Wide Way Remedial Exercises Clinic during 1965. 13 new cases were admitted and 19 old cases discharged. 78 sessions were held at St. Christopher's Special School and Eagle House Annexe Remedial Exercises Clinic during 1965. 47 new cases were admitted and 57 old cases discharged. 89 Appendix ' B ' 1. General Medical/Minor Ailment Clinics. Attendances made by children at General Medical/Minor Ailment Clinics 3,015 2. Other Medical Examinations undertaken by School Medical Officers. (a) Childen examined for part-time employment 430 (b) Children examined for Entertainment Licences 4 In addition to medical examinations specified as above, School Medical Officers in their capacity as Assistant Medical Officers of Health also carried out 672 medical examinations of Teachers, Teacher Trainees, School Cooks, School Caretakers, and other staff for superannuation purposes. Arrangements are also made for Chest X-ray where this is necessary. 3. Recuperative Holidays. Children sent for recuperative holidays on the recommendation of School Medical Officers 74 All these children had seaside holidays and when examined on their return were all found to have benefited. CHILD GUIDANCE SERVICE I am indebted to the Chief Education Officer for the following report on the Child Guidance Service:— GENERAL The work of the Wimbledon Clinic proceeded satisfactorily during 1965 and no interruption was caused by the transfer of responsibility to the new Borough. For the Mitcham Clinic, on the other hand, the year's work was disrupted by the resignations of the psychiatrist and educational psychologist. This is reflected in the attached statistics. Each of the posts of psychiatrist, psychiatric social worker and educational psychologist was vacant for some part of the year, and the last-named has still not been filled owing to the national scarcity of educational psychologists. 90 Other Treatment Given. Ailments. Number of cases treated. Miscellaneous minor ailments 452 Lymphatic Glands 5 Heart and Circulation 31 Lungs 75 Development (Hernia and Other) 39 Nervous System 13 Total 615 ESTABLISHMENT For the Committee's information the total establishment of professional staff to be shared between the two clinics is as follows:— 2 Psychiatrists— six half-day sessions per week each. 2 Educational Pyschologists—full-time. 3 Psychiatric Social Workers—full-time. 1 Psychotherapist—full-time. REMEDIAL CLASSES Two of these classes exist in the Borough. The children attending the classes are all of at least average intelligence, and often well above this, but for one reason or another have fallen behind in their school work. The class in Wimbledon caters for seven schools, the Morden class for six schools from both Mitcham and Morden. Children attend for three sessions a week. The teachers spend some Friday afternoons in visiting the children's base schools and discussing their progress with the class teachers. Each class has an Open Evening on an average once a term and these have been much appreciated by the parents, a large percentage of whom have attended to discuss their children's progress. Initially children are selected through group intelligence and attainment tests administered in general by Heads or class teachers, and then seen by the Educational Psychologist for individual assessment. As a result of the latter, the child may be recommended for the Remedial class, individual tuition, in need of investigation at the Child Guidance Clinic, or for supervision. Frequent contact with both the base school and the Remedial class is maintained by the Educational Psychologist. Thus every child is kept under review and returned full-time to its own school as soon as this seems advisable. In concluding this section on Remedial classes, it should be mentioned that both classes are only able to function so successfully because of the help and support given by the Heads of the schools in which they are accommodated. There is a need to extend this service if teachers could be found. (The wider question of what special provision can be made for children who are backward but not ' educationally subnormal' is at present under consideration.) DIAGNOSTIC CENTRE FOR FIVE-YEAR-OLDS. One of the needs which, the Educational Psychologist reports, has emerged clearly over the last year is the need for a diagnostic centre for 5-year-olds. It is often difficult to decide whether such a young child is in fact ESN, maladjusted, merely immature, etc., and in any case one hesitates to label children of this age. The child may not be ready for the reception class and yet is too old to stay at the Nursery School or at home. Where a query arises, a few months in a small group under a teacher trained to observe such children and with the help of experts available, would provide opportunity for careful assessment. Where a child is minimally handicapped, careful observation over a few months can help to establish the area affected and how far the child can cope with a particular type of school. More success in ultimate placement of these children would be achieved, and the fear of failure and subsequent change under stress to another type of education would be minimised. Consideration will be given to the inclusion of this type of centre in the Authority's new ESN school. 91 PREMISES The Wimbledon child guidance team continued to work in the cramped and unsatisfactory clinic in All Saints Road, but it is hoped that they will be able to move to the newly-acquired Rokeby building, 97 Worple Road, in the near future. The Mitcham clinic premises at Sherwood House, Commonside East, are generally satisfactory. CHILD GUIDANCE SERVICE STATISTICS FOR 1965 (A) THE GENERAL WORK OF THE CHILD GUIDANCE SERVICE 1. New Referrals. Wimbledon. Mitcham. Boys Girls Total. Referring agencies:— Courts or probation officers 4 5 7 2 9 School Health Service 30 7 27 10 37 Hospitals or specialists 6 1 3 4 7 General practitioners 13 6 11 8 19 Schools 41 28 52 17 69 Parents 7 6 7 6 13 Others 9 5 10 4 14 Totals 110 58 117 51 168 Predominant reasons for referral:— Nervous disorders 24 13 20 17 37 Behaviour problems 47 18 50 15 65 Habit disorders 13 10 17 6 23 Educational problems 26 11 25 12 37 Psychomatic disorders — 2 1 1 2 Others — 4 4 — 4 Totals 110 58 117 51 168 Number of cases on diagnostic waiting list 16 14 15 15 30 2. New Cases Seen. Referring agencies:— Courts or probation officers 4 5 7 2 9 School Health Service 25 6 24 7 31 Hospitals or specialists 8 — 5 3 8 General practitioners 13 4 9 8 17 Parents 7 4 6 5 11 Others 9 3 10 2 12 Totals 100 44 107 37 144 92 Range of intelligence quotients of cases:— Wimbledon. Mitcham. Boys. Girls. Total. Inferior I.Q. below 71 5 1 6 - 6 Limited I.Q. 71-85 7 4 7 4 11 Low average I.Q. 86-95 16 5 12 9 21 Average I.Q. 96-105 26 4 21 9 30 Good average I.Q. 106-115 14 7 16 5 21 Above average I.Q. 116-130 17 4 15 6 21 Superior I.Q. 131-150 7 1 7 1 8 Exceptional I.Q. 151+ - - - - - Not tested 6 12 17 1 18 Untestable 2 — 2 — 2 Totals 100 38 103 35 138 Action taken: — Consultation and advice 9 13 16 6 22 Psychotherapy 9 8 16 1 17 Placed on waiting list for pyschotherapy 29 2 22 9 31 Remedial tuition 1 — — 1 1 Casework with parents only 3 2 3 2 5 Placement in special schools, etc. 9 - 8 1 9 Placement in special schools, etc., being sought - - - - - Periodic supervision 31 8 27 12 39 Other action 9 — 6 3 9 Totals 100 33 98 35 133 Results of action taken insofar as it is possible to judge at present: — Improved 20 10 15 15 30 Slighdy improved 30 — 24 6 30 Not yet improved 32 — 21 11 32 Doubtful 18 1 16 3 19 Totals 100 11 76 35 111 3. Current case-load on 31st December, 1965. Cases under treatment 26 10 24 12 36 Cases under supervision 135 9 106 38 144 Cases awaiting treatment 44 5 30 19 49 Totals 205 24 160 69 229 93 4. Summary of Work Involved. Psychiatrist:— Wimbledon. Mitcham. Total. Interviews for diagnosis or assessment 188 16 204 Interviews for treatment 491 153 644 Interviews with parents or guardians 6 32 38 Interview with social worker or other officials 13 10 23 Other interviews — — — Visits, meetings, etc., outside the Clinic 2 10 12 Appointments arranged but not attended 185 42 227 Total 885 263 1148 Psychotherapist: — Interviews for treatment 95 33 128 Interviews with parents or guardians — — — Interviews with social workers or other officials - - - Other interviews — — — Visits, meetings, etc., outside the Clinic — — — Appointments arranged but not attended 10 7 17 Total 105 40 145 Educational Psychologist (work in schools excepted): — Interviews with children for examination 96 10 106 Interviews with children for remedial tuition 132 132 Interviews with parent or guardian 4 — 4 Interviews with other officials 18 — 18 Visits outside clinic (not schools) 21 — 21 Appointments arranged but not attended 20 — 20 Total 291 10 301 Psychiatric Social Worker:— Interviews with parents or guardians at Clinic 767 26 793 Interviews with parents or guardians at home 93 3 96 Interviews with children — — — Interviews with other workers or officials 61 6 67 Visits to schools, hostels, etc. 6 4 10 Other visits 40 2 42 Appointments arranged but not attended 139 7 146 Total 1106 48 1154 (B) THE WORK OF THE EDUCATIONAL PSYCHOLOGIST IN THE SCHOOLS Wimbledon Area. Statistics for 1965 Boys. Girls. Total. I. Number of referrds 77 24 101 II. Source of referral— (a) Chief Education Officer 10 4 14 (b) School 63 20 83 (c) Parent 2 — 2 (d) School Medical Officer 2 — 2 Total 77 24 101 94 III. Type of school attended— Statistics for 1965. Boys. Girls. Total. (a) Nursery 1 1 2 (b) Infant 14 2 16 (c) Junior 49 14 63 (d) Secondary 4 — 4 (e) Grammar — 1 1 (f) Private 1 3 4 (g) To be placed 8 3 11 Total 77 24 101 IV. Main problem— (a) Learning 44 15 59 (b) Behaviour 24 5 29 (c) Other 9 4 13 Total 77 24 101 V. Disposal— (a) Remedial class 18 8 26 (b) Remedial tuition at the Clinic 2 1 3 (c) Child Guidance Clinic (general) 30 5 35 (d) Supervision 15 5 20 (e) Recommendation for special school 4 1 5 (f) Recommendation to Chief Education Officer 7 4 11 (g) Recommendation to Principal School Medical Officer 1 - 1 Total 77 24 101 VI. Supervision from previous years 47 17 64 Supervision from 1965 52 14 66 Total under supervision 99 31 130 VII. Parents of children seen— new referrals 32 9 41 Parents of children seen— under supervision 6 3 9 /III. Schools—Group Testing for Remedial Classes— 12 schools. Number of children 8+ tested 428 95