I MER 20 London Borough of Merton THE HEALTH OF MERTON 1966 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. 1966 THE HEALTH OF MERTON by P. J. DOODY, M.B., B.Ch., B.A.O., D.P.H. CONTENTS Page INTRODUCTION: Introductory Letter 7-8 Committees 9 Staff 10-13 GENERAL PUBLIC HEALTH SERVICES: General Information 14 Summary of Vital Statistics 15-16 Comparative Statistics, 1966 17 Principal Causes of Death in Order of Frequency 17 Causes of Death at Different Periods of Life 18 Infant Deaths 19 Infant Mortality 19 Perinatal Mortality 19 Maternal Mortality 19 Control of Communicable Diseases: Notifications received during 1966 20 Food Poisoning 20 Tuberculosis 21-22 Prophylactic Measures 23-24 General Medical Services 24 National Assistance Acts 25 Notifications of Birth 26 PERSONAL HEALTH SERVICES: Maternal and Child Care: General 27 Ante-natal and Post-natal Services 27 Relaxation Classes 27 Premature Infants 27-28 Child Welfare: General 28-29 Dental Care 30 Day Nurseries 30-31 Care of Unmarried Mothers and their Children 31 Congenital Malformations 31 Welfare Foods and Vitamins 31 PUBLIC HEALTH NURSING AND ALLIED SERVICES: Health Visiting: Staff 32 Health Visitors' Duties 32-33 3 Page Summary of Work of Health Visitors 32 Training of Health Visitors 32 Health Education 32 Midwifery: Staff 34-35 Introductory 35 Organisation 35 Maternity Cases Attended 35 Inhalational Analgesia 35 Puerperal Pyrexia 35 Ophthalmia Neonatorum 35 Maternity Outfits 36 Medical Aid 36 Early Discharges from Hospital 36 Midwifery Training 36 Post-Graduate Courses 36 Domiciliary Visiting 36 Attendances at Clinics 37 Transfers to Hospital 37 Home Nursing: Staff 37-38 Organisation 38 Training of District Nurses 39 Post Graduate Courses for District Nurses 39 Cases Attended 39 Visits Made 39-40 Incontinence Pads 40 Incontinent Laundry Service 40 Marie Curie Foundation Cancer Nursing Service 40 Domestic Help Service: Staff 40-41 Organisation 41 Statistics 41-42 Details of Sources of Application 41 Chiropody Service 42 Ripple Bed Service 43 Sick Room Equipment 43 Recuperative Holidays 43 Cervical Cytology 43-44 Mental Health Service: Introductory 45 4 Page Staff 45 Mental Health Establishments 45-46 The Casework Services 46 Subnormality 47 Other Forms of Mental Disorder 48 Patients in Hospital 49 Guardianship 49 Cases Boarded Out 50 Short-Term Care 50 Social Work Section 50-51 SANITARY CIRCUMSTANCES OF THE AREA: Services under the Public Health Acts: Water Supply 52-54 Sewerage and Sewage Disposal 54 Registered Common Lodging Houses 54 District Inspection 54-56 Services under the Food and Drugs Act: Milk and Dairies (General) Regulations 58 Milk (Special Designations) (Amendment) Regulations, 1965 58 Milk (Special Designations) Regulations, 1963 58-59 Brucella Abortus 59 Ice-cream 59 Meat and Other Foods 59 Meat Inspection 60 Food Premises 60-61 Bacteriological Examination of Equipment 61 Food Inspection 61-63 Sampling of Food and Drugs 63-69 Services under Other Enactments: Rent Act, 1957 69 Shops Acts, 1950-1965 69 Offices, Shops and Railway Premises Act, 1963 70-71 Prevention of Damage by Pests Act, 1949 72 Pet Animals Act, 1951 72 Animal Boarding Establishments Act, 1963 72 Riding Establishments Act, 1964 72 Diseases of Animals Act, 1950 72 Clean Air Act, 1956 72-75 Factories Act, 1961 57-58 Noise Abatement Act, 1960 75 5 Page Pharmacy and Poisons Acts, 1933-1941 75 Fertilisers and Feeding Stuffs Act, 1926 75 Housing Acts, 1957-1964 75-76 Caravan Sites and Control of Development Act, 1960 75 6 To The Mayor, Aldermen and Councillors of the London Borough of Merton. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report on the Health of Merton for the year 1966. A study of the vital statistics shows that, in general, the health of the residents has been good during the year. Although there was an increase of live births over deaths during 1966, the Registrar-General's estimated mid-1966 population of 184,190 shows a decrease of 940 on 1965, thus continuing the trend of a falling population to which I drew attention in my Annual Report for 1965. The live births totalled 2,865, being 34 less than the previous year, giving a live birth rate of 15.55 compared with a live birth rate for England and Wales of 17.7. Merton's live birth rate thus showed a slight decline from 15.66 in 1965. It is pleasing to record that the number of illegitimate live births showed a fall, from 228 to 218, with a consequent fall in their percentage of live births from 8.55 to 7.61. Deaths from all causes numbered 1,995 compared with 2,106 in 1965, and this marked fall produced a death rate of 10.83 compared with 11.14 for 1965. This gives a favourable comparison with the rate for England and Wales of 11.7. The infant mortality rate was 15.53, compared with 18.35 for 1965. The infant mortality rate for England and Wales was 18.9. The stillbirth rate per 1,000 live and stillbirths showed a marked fall from 14.62 in 1965 to 11.81 in 1966, although there was a corresponding increase in the neo-natal and early neo-natal mortality rates from 10.69 and 9.69 to 12.91 and 11.52 respectively. The perinatal mortality rate was 22.4, compared with 21.83 for 1965. This compares favourably with the rate for England and Wales of 26.3. There were no serious outbreaks of infectious disease during the year, the incidence of measles being low, following the ' measles' year of 1965, and I am pleased to be able to report that there was no case of typhoid fever or poliomyelitis during the year. The demand on the Home Help Service throughout the year was very heavy, and in the early part of the year there was a serious shortage of Home Helps owing to difficulties of recruitment. The situation regarding recruitment, however, improved steadily from June onwards and the target figure of 111 equivalent whole-time Home Helps was reached, and this target was raised with the approval of the Establishment Committee to 120 equivalent whole-time Home Helps at the end of the year. This was a source of considerable satisfaction, not only as an indication of the success of the recruitment drive, but also because it became possible to provide a more satisfactory service by meeting more fully the increasing demands on the service. There is no doubt that the calls on this service will continue to increase and if the demand is to be met satisfactorily a higher target figure of whole-time Home Helps will be inevitable. 7 The general staffing position improved so that few key posts remained unfilled by the end of the year. On the whole the Department has been fortunate in recruiting, and retaining officers of a high quality. In some Sections, notably the Public Health Inspectorate, recruitment was unsatisfactory and at the end of the year four posts of District Public Health Inspector remained unfilled. It had not been found possible by the end of the year to fill the important post of Health Education Officer, nor had the Authority been able to recruit any Pyschiatric Social Workers. The work of consolidating the services, and planning for expansion proceeded smoothly during the year. Staff co-operation within the Department, and with other Departments and other voluntary and statutory bodies was good. I wish to express 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 staff for the loyal and efficient manner in which they have carried out their duties during the year. 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, 1966 HEALTH COMMITTEE The Mayor, Councillor Sir Cyril Black, J.P. D.L., M.P. Councillor (Miss) N. K. Watts (Chairman) Councillor G. H. Raymond (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. W. Reay G. Waller 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. H. Raymond (Vice-Chairman) Councillors: J. T. Botten (Mrs.) E. M. Davis A. S. Hutchin G. W. A. Pearce, J.P. W. Reay G. Waller MENTAL HEALTH SERVICES SUB-COMMITTEE Chairman of the Health Committee, Councillor (Miss) N. K. Watts (Chairman) Vice-Chairman of the Health Committee, Councillor G. H. Raymond (Vice-Chairman) Councillors: A. S. Hutchin (Miss ) S. Knight W. Reay G. Waller Co-opted members: — Representative of the Local Medical Committee (Dr. R. A. Arthur). Representative of the S. W. Metropolitan Regional Hospital Board (Dr. R. K. Freudenberg). TOWN CLERK Sydney Astin (Solicitor) 9 WHOLE-TIME STAFF (As at 31st December, 1966) Medical Officer of Health and Principal School Medical Officer P. J. Doody, M.B., B.Ch., B.A.O., D.P.H. Deputy Medical Officer of Health and Deputy Principal School Medical Officer W. D. Swinney, M.B, Ch.B., D.P.H. Senior Medical Officer M. D. Susman, M.B., Ch.B., D.P.H. Assistant Medical Officers and School Medical Officers 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. Maria J. Freeman, M.B., B.S., L.M.S.S.A. Ann E. R. Gonet, M.B., B.S. (commenced 15.8.66) W. James, M.R.C.S., L.R.C.P. (commenced 4.4.66) 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. Chief Dental Officer M. T. Gibb, L.D.S., R.C.S. School Dental Officers S. Adorjan, M.D. (U.Vienna) L.D.S., R.C.S. Elizabeth W. Beaver, B.Ch.D. (Leeds). Wanda T. Kojder, 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. Dental Auxiliary Mrs. G. V. Gliddon Chief Public Health Inspector G. H. Cockell, F.A.P.H.I., F.R.S.H. Deputy Chief Public Health Inspector G. E. Hayne, M.A.P.H.I., M.R.S.H. Superintendent Health Visitor Miss P. M. Richards, S.R.N., S.C.M., H.V.Cert. Superintendent of Midwifery and Home Nursing Service Miss B. R. Lamberg, S.R.N., S.C.M., Q.N., M.T.D. Home Help Organiser Miss M. J. Faraday Chief Administrative Officer W. Atkinson, D.P.A., Cert. S.I.B. Deputy Chief Administrative Officer J. R. Richardson, A.R.P.H.H. Senior Mental Welfare Officer F. T. Rainer, Dip.Soc. Science. Deputy Senior Mental Welfare Officer F. J. Gerring Mental Welfare Officers F. C. Dorrington S. G. H. Worrall Mrs. H. Yates, S.R.N., Cert, in Applied Social Studies 10 Mental Health Social Worker Mrs. F. M. Coleman, Dip.Soc. Studies & Soc. Admin. Senior Social Worker Mrs. M. A. Tripet, S.R.N., H.V. Cert.Dip. Soc.Studies (commenced 7.12.66) Social Worker Mrs. A. Martin, B.A. (Hons.), H.O. Training Certificate Supervisor, Junior Training Centre Mrs. M. Barlow, Dip.N.A.M.H. Educational Psychologist Miss D. Waldeck, B.A. (Liverpool), Dip. N.A.M.H. (Lond.) Psychiatric Social Worker Mrs. A. Litauer, Mental Health Diploma, London, Social Science Diploma, London Speech Therapist Miss G. M. Charles, L.C.S.T. (commenced 5.9.66) 11 PART-TIME STAFF (As at 31st December, 1966) Chest Physicians 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. Consultant Psychiatrist R. K. Freudenberg, M.D., L.R.C.P., L.R.C.S., L.R.F.P.S., D.P.M. Ophthalmic Surgeons M. H. Malik, M.B., B.S., D.O. (Eng.), F.R.C.S. (commenced 22.11.66) M. C. Shah, L.M.S.S.A. Orthopaedic Surgeon G. Hadfield, M.R.C.S., L.R.C.P., F.R.C.S. (Eng.) Child Psychiatrists 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 Cicily M. Clarke, M.A., M.B., Ch.B., D.C.H. Dorothy S. Critchley, M.D., M.B., B.S., M.R.C.S., L.R.C.P., D.C.H. Hilda C. Dean, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. E. G. Evans, M.A., M.B., M.R.C.S., L.R.C.P., B.Chir. Joyce M. Havelock, M.B., B.S., M.R.C.S., L.R.C.P., C.P.H. Norah C. Johns,, M.B., B.S., M.R.C.S., L.R.C.P. Karen I. Parkes, M.D., M.B., B.S., F.R.C.S. M.R.C.S., L.R.C.P. Susan M. S. Turner, M.B., Ch.B., D.P.H. School Dental Officers Cynthia A. Cesar, L.D.S., R.C.S., B.D.S. (commenced 27.9.66) 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. Dental Orthodontists N. Upson, L.D.S., R.C.S., D.Orth. menced 12.9.66) J. G. Whitelegg, L.D.S., R.C.S., B.D.S. Dental Anaesthetists 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. K. B. McKay, M.R.C.S., L.R.C.P. R. G. Smith, M.B., B.S., M.R.C.S., L.R.C.P., D.A., D.Obst.R.C.O.G. 12 Dental Auxiliary Mrs. V. Hibbert Speech Therapists Mrs. S. J. Gold, L.C.S.T. Miss P. J. Lewis-Owen, L.GS.T. (commenced 12.9.66) Audiometrician Mrs. M. Dean, S.R.N. Physiotherapists Mrs. A. G. Ockleshaw, M.C.S.P. Mrs. T. Puddifoot, M.C.S.P. Mrs. V. Kelly, M.C.S.P. Social Workers Mrs. M. C. Hudson, Dip. in Sociology Miss E. M. Smith, S.R.N., S.C.M., Dip.Nsg. Mrs. I. Boag, M.A., A.I.M.S.W. Medical Social Worker Mrs. S. N. Coles (commenced 13.1.66) 13 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, 1966 £11,104,727 Actual product of a penny rate:— 1965-66 £44,204 Estimated product of a penny rate:— 1966-67 £44,675 Population:— Census figure (1961) 186,647 Registrar-General's Estimate of Population 1966 1965 at 30th June 184,190 185,130 14 Summary of Vital Statistics Live Births— 1966 1965 Legitimate: Males 1368 1336 Females 1279 1335 2647 2671 Illegitimate: Males 104 120 Females 114 108 218 228 Totals 2865 2899 Live Birth Rate per 1,000 population 15.55 15.66 Corrected Live Birth Rate per 1,000 population 16.17 16.29 Illegitimate live births—percentage of total live births 7.61 8.55 Still Births— Legitimate: Males 19 17 Females 9 23 28 40 Illegitimate: Males 4 3 Females — — 4 3 Totals 32 43 Still-birth Rate per 1,000 live and still-births 11.81 14.62 Still-birth Rate per 1,000 population 0.17 0.23 Total live and still-births 2897 2942 Infant Mortality (Deaths of infants under one year of age)— Legitimate: Males 27 29 Females 12 21 39 50 Illegitimate: Males 5 3 Females 1 1 6 4 Totals 45 54 Infant Mortality Rate per 1,000 live births 15.53 18.35 Infant Mortality Rate per 1,000 legitimate live births 14.73 18.73 Infant Mortality Rate per 1,000 illegitimate live births 27.52 17.54 Neo-Natal Deaths (Deaths of infants in first 28 days of life) 37 31 Neo-Natal Mortality Rate 12.91 10.69 Early Neo-Natal Mortality Rate (deaths of infants in first week of life per 1,000 live births) 11.52 9.69 Perinatal Mortality Rate (Still-births plus deaths in first week of life per 1,000 live and still-births) 22.44 21.83 Total loss of infant life (Still-births plus infant deaths) per 1,000 live and still-births 26.58 24.22 Maternal Deaths (including abortion) 3 2 Maternal Mortality Rate per 1,000 live and still-births 1.04 0.68 Deaths 1995 2106 Death Rate per 1,000 population 10.83 11.14 Corrected Death Rate per 1,000 population 10.83 11.14 15  1966 1965 Deaths from Bronchitis per 1,000 population 0.57 0.65 Deaths from Pneumonia per 1,000 population 0.57 0.65 Deaths from Cancer of lung and bronchus per 1,000 population 0.76 0.68 Deaths from other forms of Cancer per 1,000 population 1.69 1.81 Marriages 1481 1480 Marriage Rate per 1,000 population 8.0 8.0 16 Causes of Death at different Periods of Life in the London Borough of Merton during 1966 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 - - - - - - - - - - - - 2 - - - 1 - 4 1 - - 7 1 Tuberculosis: Other forms - - - - - - - - - - - - - - - 1 - - - - - - - 1 Syphilitic Disease - - - - - - - - - - - - - - - - - - 1 2 1 1 2 3 Other infective and parasitic diseases - - - - - - - - - - - - - - - - - - - - - - - 1 Malignant neoplasm: Stomach - - - - - - - - - - - - - - 3 9 1 10 8 4 8 26 17 Malignant neoplasm: Lung, bronchus - - - - - - - - - - - - - - 12 1 35 9 41 11 26 7 114 28 Malignant neoplasm: Breast - - - - - - - - - - - - - 3 - 5 - 18 - 11 - 6 - 43 Malignant neoplasm: Uterus - - - - - - - - - - - - - - - - - 3 - 3 - 1 - 7 Other malignant and Lymphatic neoplasms - - - - - - - - 1 1 1 1 - 3 10 11 23 21 38 31 30 37 103 105 Leukaemia: Aleukaemia - - - - - - - - 1 - - - 2 - - 3 2 1 - - 1 1 6 5 Diabetes - - - - - - - - - - - - - - - 1 - 1 4 2 3 - 7 4 Vascular lesions of nervous system - - - - - - 1 - - - 1 - 2 - 4 8 13 16 26 35 38 91 85 150 Coronary Diseases: Angina - - - - - - - - - - - - 9 - 23 8 73 19 87 58 74 103 266 188 Hypertension width Heart Diseases - - - - - - - - - - - - - - 1 - 2 - 6 5 2 9 11 14 Other Heart Diseases - - - - - - - - - - - 1 - 1 2 3 6 7 14 13 38 87 60 112 Other Circulatory Diseases - - - - - - - - - 1 - - - - 3 - 10 3 12 16 20 54 45 74 Influenza - - - - - - - - - 1 - - 1 - - - - - - 1 - 2 1 4 Pneumonia 3 - 2 3 - 1 1 - - - - - - - - - 3 5 7 10 29 43 45 62 Bronchitis - - - - - 1 - - - - - - - 2 3 2 12 3 36 9 25 13 76 30 Other Diseases of the Respiratory System - - - - - - - - - - - - - - - - 3 1 1 1 2 6 6 8 Ulcer of Stomach and Duodenum - - - - - - - - - - - - - - - - 2 - 4 - - 2 6 2 Gastritis, Enteritis and Diarrhoea - - - - 1 - - - - - - - - 1 1 - 2 1 2 3 1 3 7 8 Nephritis and Nephrosis - - - - - - - - 1 - - - - - 1 1 - 1 1 2 2 3 5 7 Hyperplasia of Prostate - - - - - - - - - - - - 1 - 1 - - - 2 - 5 - 9 - Pregnancy: Childbirth, abortion 3 Congenital Malformations 4 - 1 2 1 - - - - - - - 1 - - - 1 1 1 - 1 - 10 3 Other defined and ill-defined diseases 22 8 - - 2 - - 1 - - 1 2 3 1 6 4 11 10 13 16 14 35 72 77 Motor Vehicle accidents - - - - - - 2 - 8 - 1 - 1 1 2 - 1 1 2 2 1 - 18 4 All other accidents - - - - 1 - - - - 1 - - 2 - 3 2 2 3 - 2 4 6 12 14 Suicide - - - - - - - - 1 1 1 - 2 - 4 3 1 2 1 1 1 1 11 8 Homicide and operations of war - - - - - - - - - - - 1 - - - - - 1 - - - - - 2 ALL CAUSES 29 8 3 5 5 2 4 1 12 6 5 6 26 13 79 53 212 128 313 244 322 519 1010 985 Comparative Statistics, 1966 Merton England and Wales Rates per 1,000 Population: Live births 15.55 17.7 Deaths (all causes) 10.83 11.7 Respiratory tuberculosis 0.04 0.04 Cancer of lung and bronchus 0.76 0.56 Rates per 1,000 live and still births : Still births 11.81 15.3 Maternal mortality 1.04 0.26 Perinatal mortality 22.44 26.3 Rates per 1,000 live births : Infant mortality—deaths of infants under 1 year 15.53 18.9 Neo-natal mortality—deaths of infants in first 28 days of life 12.91 12.9 Principal causes of Death in order of Frequency Out of 1,995 deaths occurring during the year 1,821 were attributable to the undermentioned principal causes:— No. of Deaths. Percentage of Deaths from all causes. 1. Heart Diseases 651 32.6 2. Cancer 454 22.7 3. Vascular lesions of the nervous system 235 11.7 4. Other defined and ill-defined causes 149 7.4 5. Other Circulatory Diseases 119 5.9 6. Pneumonia 107 5.3 7. Bronchitis 106 5.3 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 12 7 1 - - - - - - 20 Congenital Malformations 1 2 - - - - 1 - - 4 Bronchopneumonia — - — — - 6 1 - - 7 Birth Injuries 3 1 - - - - - - - 4 Other causes 4 4 1 - - - 1 - - 10 Totals 20 14 2 - " 6 3 1 45 INFANT MORTALITY Of the 45 infant deaths, 34 occurred in the first seven days of life. None of these was delivered at home. The infant mortality rate of 15.53 and the neonatal mortality rate of 12.91 per 1,000 live births compare satisfactorily with the respective rates of 18.9 and 12.9 for England and Wales. PERINATAL MORTALITY The perinatal mortality rate for Merton was 22.44 per 1,000 live and still-births thus comparing favourably with that for England and Wales of 26.3. 19 MATERNAL MORTALITY There were three maternal deaths during the year all of which occurred in hospital. Details of these deaths are given below: — Age at Cause of death. Death. Remarks. 1. 20 yrs. Toxaemia: Septic in- Spinster: defendant convicted fection of uterus, of manslaughter. following illegal instrument abortion. 2. 26 yrs. Amniotic fluid em- Married woman: died after bolism. very of twins. 3. 37 yrs. Gas gangrene infec- Spinster: insufficient evidence of tion due to septic circumstances. Open verdict, abortion. CONTROL OF COMMUNICABLE DISEASES Notifications received during 1966 (Corrected Notifications) Disease Age Groups of Cases Notified Under 1 1- 2 34 59 1014 1524 2544 4564 65 & over Total Measles 33 208 262 323 15 5 5 - - 851 Scarlet Fever — 4 9 23 6 3 — — — 45 Pneumonia — — — 1 2 2 5 4 4 18 Puerperal Pyrexia — — — — — 4 3 — — 7 Whooping Cough 8 20 19 24 2 — 1 — — 74 Dysentery 1 — 2 19 11 2 4 — — 39 Tuberculosis (Resp.): Males — — 2 — — 6 8 7 5 28 Females — 1 1 3 - 3 8 3 1 20 Tuberculosis (Non-Resp.): Males — — — — — 1 — 1 — 2 Females — — — 2 — — — — 1 3 Erysipelas 1 7 3 11 Food Poisoning — 1 — 2 — 1 — — — 4 Totals 42 234 295 397 36 27 35 22 14 1102 An outbreak of sonne dysentery occurred at the Junior Training Centre in June in which 34 children and six members of the staff were found to be infected, and further cases were found among the families of the children concerned. The London Borough of Sutton assisted in the investigation of this outbreak and more than 400 specimens were taken. As a result of this outbreak, it was found necessary to close the Centre for a month. An outbreak of diarrhoea occurred at ' Half Way House', 10 Church Path, providing temporary accommodation for families dealt with by the Welfare Services Department. An investigation was carried out which revealed that the organism was of non-specific type and there was no further infection. Two cases of infective hepatitis occurred in a Mitcham school during the year and the opportunity was taken to assist the Epidemiological Research Laboratory in their investigation into the prophylactic effect of gamma globulin in infective hepatitis. Eleven children were given injections with the parents' consent, and 25 children acted as ' controls'. No further cases occurred. FOOD POISONING Four cases of food poisoning were confirmed during the year. These comprised two cases of salmonella typhimurium, one case of salmonella derby, and one case of salmonella oranienberg. The one case of salmonella derby occurred in a schoolchild and proved most persistent. Specimens were taken over a period of nine months before the infection was cleared. 20 TUBERCULOSIS There are three chest clinics serving the Borough. All are based at Cumberland Hospital, Mitcham. At these clinics the Tuberculosis Health Visitors assist the Chest Physicians, and help and advise the patients. They do Mantoux tests and follow-up contacts on patients who fail to attend. During 1966 the case load of Tuberculosis Health Visitors was as follows:— Tuberculous cases 617 Lung carcinoma cases 37 Other cases (bronchitis, bronchiectasis, etc.) 42 The new cases examined at the Chest Clinics in 1966 are analysed in the table below:— Respiratory Non-Respiratory Total M F Under 15 yrs. M F Under 15 yrs. Diagnosed Tuberculous 20 11 5 1 — — 37 Non Tuberculous 419 275 95 — — — 789 Domiciliary Visiting Home visiting is very important. Chest patients have many queries and difficulties which the Tuberculosis Health Visitor helps to solve, and she also gives advice on matters of hygiene and the essential examination of contacts. The number of tuberculosis households visited during the year was 567. Details of domiciliary visiting by Health Visitors are given below:— Visits in connection with old cases 981 Visits in connection with new cases 34 Visits in connection with contacts 142 Total 1157 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 1774 Number found negative 1640 Number vaccinated with B.C.G 1631 No children with positive skin tests were known to be contacts with notified cases of tuberculosis. One hundred and eleven of the children with positive skin tests were X-rayed. No case of active disease was found. 21 Incidence and Death Rates per 1,000 Population During the year the following notifications of Tuberculosis were received:— Males. Females. Respiratory 28 20 Non-respiratory 2 3 The death rates per 1,000 population were 0.04 respiratory and 0.005 non-respiratory, the same as those for England and Wales. The death rates for 1965 were 0.07 respiratory and 0.000 nonrespiratory. Mass X-Ray The Mass Radiography Unit of the Regional Hospital Board, in addition to providing a regular service for general practitioners, carried out surveys on industrial sites, 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 979 742 5 1 10 4 Public and Industrial Sessions 6,211 5,645 4 7 8 2 Totals 7,190 6,387 9 8 18 6 Deaths There were eight deaths from respiratory turberculosis during the year. The table of causes of death on page 18 gives an anlysis by age and sex. 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. 22 PROPHYLACTIC MEASURES The table below gives details of initial protection given by the use 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 1966 1965 1964 1963 1959/62 Diphtheria 1,058 1,224 67 30 55 33 2,467 Whooping Cough 1,058 1,225 67 30 35 12 2,427 Poliomyelitis (By injection) 2 14 2 2 3 1 24 Poliomyelitis (Oral) 346 1,637 178 81 121 36 2,399 Tetanus 1,058 1,224 67 30 163 110 2,652 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. Reinforcement Measures In addition to the above measures of primary protection the following numbers were given re-inforcement doses:— Diphtheria 4721 Whooping Cough 1934 Poliomyelitis 1170 Tetanus 3781 Poliomyelitis At the end of the year, 82,616 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 1943-66 54,529 Persons born 1933-42 15,791 Others 12,296 Total 82,616 Fourth Injection At the end of the year 20,232 children, aged not less than five years and not more than 13 years, had received a fourth dose either by injection of by the oral method. 23 Smallpox The following table shows the number of persons vaccinated or re-vaccinated against smallpox, in the various age groups during the year:— 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 11 12 10 35 1,575 280 107 2,030 Number revaccinated — — - - - 11 230 241 Pecentage Index as supplied by Ministry of Health on 19.6.67:— Children born in 1965 Smallpox (Children Under 2) Whooping Cough Diphtheria Poliomyelitis England and Wales 72 73 68 38 London Borough of Merton 78 78 70 56 Venereal Diseases The table below is compiled from figures supplied by the clinics at St. Helier Hospital, Croydon General Hospital, the London Hospital and the Middlesex Hospital. Number of patients resident in Merton and treated for the first time in 1966:— Male Female Total Gonorrhoea 18 9 27 Syphilis 2 3 5 Other conditions 97 122 219 Totals 117 134 251 GENERAL MEDICAL SERVICES During the year the medical staff carried out 779 medical examinations of staff for superannuation purposes. Twenty-three examinations were also carried out on staff, absent from work owing to sickness, to ascertain their fitness to return to duty. 24 NATIONAL ASSISTANCE ACTS The Medical Officer of Health and his Deputy, are authorised by the Council to act under Section 47 of the National Assistance Act, 1948, or, in conjunction with a general practitioner under Section 1 of the National Assistance (Amendment) Act, 1951, in connection with the removal to hospital or other suitable accommodation of persons suffering from grave chronic disease, or persons who are aged and infirm and living in insanitary conditions, and who are not receiving proper care and attention. During the year two applications were made for Orders for removal under Section 47 of the 1948 Act, and one application for an Order was made under Section 1 of the 1951 Amendment Act, for removal to hospital of the persons concerned. In no case was it necessary to apply for an extension of the Order. 25 26 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 ... 214 198 1 1 215 199 1242 1203 18 8 1260 1211 1456 1401 19 9 1475 1410 Births occurring outside Merton attributable to Merton (Inward Transfers) 1 4 - - 1 4 745 682 14 8 759 690 746 686 14 8 760 694 Total of all births notified 215 202 1 1 216 203 1987 1885 32 16 2019 1901 2202 2087 33 17 2235 2104 Births occurring in Merton attributable to other Authorities (Outward Transfers) 3 1 - - 3 1 685 679 11 7 696 686 688 680 11 7 699 687 Total births attributable to Merton 212 201 1 1 213 202 1302 1206 21 9 1323 1215 1514 1407 22 10 1536 1417 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 427 Number of women who attended for post-natal examination 36 There were 334 midwives' clinic sessions at which 571 women attended. The total number of attendances was 2,999. 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 total number of attendances was 2,107. Premature Infants The total number of premature infants born in the area during 1966 was 198. Nineteen premature infants died during 1966. This means that 9.6% of the 198 premature infants born during the year died within a year. Only 1.0% of full-term babies died before reaching the age of one year. 27 The numbers of women who attended were:— (a) Booked for hospital confinement 353 (b) Booked for domiciliary confinement 65 Total 418 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 - - - - - - - Over 2 1b. 3 oz. up to and including 3 1b. 4 oz. - - - - - - - Over 3 1b. 4 oz. up to and including 4 1b. 6 oz. 3 - 3 1 - 1 4 Over 4 1b. 6 oz. up to and including 4 1b. 15 oz. 2 - 2 1 - 1 3 Over 4 1b. 15 oz. up to and including 5 lb. 8 oz 18 — 18 2 — 2 20 Totals 23 — 23 4 — 4 27 CHILD WELFARE General The Local Authority holds Infant Welfare Centres at the fourteen premises listed below. Nine of these are purpose-built, the remainder are 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. 28 Infant Welfare Centres being operated at the end of the year were as follows:— Amity Grove Clinic West Wimbledon Monday 2-4 p.m. Friday 10-12 a.m. Cavendish Road Clinic Colliers Wood Monday 1.30-3.30 p.m. Friday 9.30-11.30 a.m. Church Road Clinic Mitcham Wednesday 1.30-3.30 p.m. Thursday 1.30-3.30 p.m. Churchill Hall* Effra Road, S.W.19 Tuesday 2-4 p.m. Emmanuel Hall* Thursday 2-4 p.m. Lingfield Road, S.W.19 Grand Drive Clinic Raynes Park Monday 10-12 a.m. and 2-4 p.m. Wednesday 10-12 a.m. Meopham Road Clinic Mitcham Wednesday 1.30-3.30 p.m. Middleton Road Clinic Morden Tuesday 2-4 p.m. Friday 2-4 p.m. Morden Road Clinic Merton Tuesday 2-4 p.m. Thursday 2-4 p.m. Pelham Road Clinic Wimbledon Tuesday 2-4 p.m. 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 and St. John's 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 1961-66 1966 1965 1961- 64 Amity Grove 129 306 174 196 676 6,031 Cavendish Road 99 179 223 130 532 4,069 Church Road 104 299 238 236 773 4,497 Churchill Hall 52 127 114 168 409 4,031 Emmanuel Hall 49 112 91 100 303 2,027 Grand Drive 148 298 109 466 873 7,946 Meopham Road 52 81 68 98 247 2,082 Middleton Road 102 155 134 139 428 3,060 Morden Road 120 167 217 246 630 4,369 Pelham Road 101 289 213 265 767 5,921 St. Barnabas Hall 51 230 228 146 604 4,709 St. John's Hall 52 72 62 134 268 2,260 St. Luke's Hall 51 148 91 138 377 3,002 Wide Way 100 188 226 143 557 3,718 Totals 1,210 2,651 2,188 2,605 7,444 57,722 A total of 7,444 children attended during the year. 29 Attendances at Toddlers' Clinics First Attendances Total Attendances Total Sessions (All Clinics) Born In Total 1961-66 1966 1965 1961-64 — 10 544 554 965 80 Dental Care The number of dental sessions devoted to inspection and treatment of expectant and nursing mothers and children under school age has been doubled during 1966. The preventive nature of the treatment of the pre-school children is well illustrated by the fact that, although the number of fillings done for this group increased during the year from 557 to 998, the number of extractions fell slightly from 87 to 84. The increased demand by parents for conservative treatment for these young children may be due, one likes to think, to increased efforts made in the field of dental health education. Examined Commenced treatment Completed course of treatment Expectant and Nursing Mothers 60 48 51 Children under 5 567 276 345 Scaling and gum treatment Fillings Silver Nitrate treatment Cr'ns and Inlays Extrac tions General Anaesthe tics Dentures XRays Full Part Expectant and Nursing Mothers 46 97 - 1 21 3 5 4 24 Children under 5 238 998 168 - 84 46 - - - 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. 30 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. 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 43.35 Middleton Road Day Nursery ... 9 30 39 30.72 At the end of the year there were eighteen private day nurseries registered under the Nurseries and Child Minders Regulation Act, with a total of 453 places. In addition there were 5 daily minders on the register. Care of Unmarried Mothers and their Children Thirty-nine cases 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 following malformations were notified during the year:— Central nervous system 14 Eye, ear 3 Alimentary system 4 Respiratory system 1 Uro-genital system 9 Limbs 20 Other skeletal 4 Other malformations 1 Total 56 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.R.V.S. Centres in Merton and Mitcham. Sales for the year 1966 are shown below:— National Dried Milk 22,760 tins Cod Liver Oil 3,490 bottles Vitamins 'A' and 'D' 3,798 packets Orange Juice 60,187 bottles 31 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 Whole-time Health Visitors/School Nurses. 2 Part-time Health Visitors/School Nurses. 1 Part-time Geriatric Health Visitor. 1 Whole-time Tuberculosis Health Visitor. 2 Part-time Tuberculosis Health Visitors. 1 Part-time Tuberculosis Visitor. 2 Student Health Visitors. Two Health Visitors including the Deputy Superintendent were promoted to senior posts with other Authorities during the year. One Health Visitor left the Service to go abroad with her husband. The new Deputy Superintendent was appointed from the Authority's own Health Visiting staff, and the vacancies which arose during the year, including one additional post on the establishment, were filled by the sponsored Student Health Visitors, all of whom had been successful in qualifying as Health Visitors. Two Student Health Visitors were recruited during the year, who commenced training in September, 1966. There were no staffing difficulties in the Health Visiting service during the year. Health Visitor's Duties During the year the emphasis by Health Visitors in their work was on consolidating their position as members of the Health Team in the new Borough, rather than on rapid expansion of their duties. As always, home visiting was of paramount importance, and increasingly it was found that the Health Visitor was able to introduce colleagues from other Sections and Departments into homes where difficulites were beginning to arise, and where help in time prevented irrevocable damage. There was considerable increase in co-operation between workers in allied fields of work, which led to better help for families with problems, and to much less overlapping of effort. By the end of the year, the great mobility of the Borough's population and the increasing number of immigrants with language difficulties, made great demands on the skill and understanding of the Health Visitors in this area. The attachment to general practitioners has gone forward smoothly, and by the end of the year tiiere were two full-time atachments to general practitioners and one part-time one. The patients definitely benefited by the united approach to their needs and no disruption whatsoever was caused to die Local Authority's Services. Each of the 32 attachments was to a Group Practice. The three Health Visitors on attachments were based at their own clinics, and visited the general practitioners' patients, instead of visiting patients in a geographical area of the Borough. Each Health Visitor ran one Infant Welfare Centre weekly from the general practitioners' surgeries. When visiting homes the Health Visitors encouraged mothers to make use of the Infant Welfare Centres of the Authority, and also to attend special sessions, such as Toddlers' Clinics and Parent craft Classes, and especially to keep their appointments for Audiology, explaining how important it is to assess any hearing loss at a very early age. In this Borough, all the local hospitals notify their ante-natal bookings to the Health Department, which gives the Health Visitors the opportunity of early visiting of expectant mothers and explaining the services to them and advising them on any difficulties they may have. During the year Mothercraft Classes were well attended and the film ' To Janet a Son' was shown several times in the evening to expectant mothers and fathers at Church Road Clinic. The film was followed by discussion and talks. This session was always well attended and similar ones were planned for another part of the Borough in the future. It is the Health Visitor's duty to note at the first visit to a new baby, whether or not the child is ' at risk'. The children ' at risk' have special observation, both at home visits and at the time of attendances at a Clinic or Centre, and are offered regular check-ups to assess their progress. The number of children who attended Toddlers' Clinics increased during 1966, and it is hoped to extend this service in future. The average case-load of each General Health Visitor is as follows:— Under 1 year. 1 to 5 years. Total under 5 years. Number of families. 94 406 500 340 The number of old people visited in their homes by Health Visitors during the year was 367 compared with 369 in 1965. It was noted that many of those seen were in urgent need of practical help as well as friendly visiting, and these Health Visitors' visits were very valuable for assesment purposes. It is with this age group, above all, that good co-operation between Health Visitor, General Practi, doner, District Nurse, Home Help and other statutory and voluntary departments is essential to ensure that the very best service is available for the patients' welfare. The Geriatric Health Visitor works both in Merton and in Sutton. Her duties are mainly in connection with patients who have been in the Geriatric Unit at St. Helier Hospital, and with the patients who attend the Day Centre attached to that hospital. She does, however, pay any special geriatric visit that she is asked to do, and also visits some of die widows or widowers of patients who have died in St. Helier Hospital. Her case-load in Merton during the year was 160. The details of work carried out by Tuberculosis Health Visitors and the Tuberculosis Visitor are shown under the heading ' Tuberculosis' on page 21. 33 Training of Health Visitors Health Visitors in the Borough took many students for training or for observation purposes during the year. Some of these were Health Visitor Students attached for fieldwork from various centrtes of training but others were staff from nursing and allied services. 'In-Service' training of Health Visitors was continued during the year. Three Health Visitors had post-graduate refresher courses, three undertook training as Fieldwork Instructors, and three attended week-end courses in Psychoprophylaxis to enable them to take classes for ante-natal mothers on ' Preparation for Childbirth '. In addition Health Visitors attended several one-day or half-day conferences on subjects of special interest. Summary of Work of Health Visitors The following table shows the number of cases in the various categories visited by the Health Visitors in 1966:— Category. Number of cases visited. Children born in 1966 3,175 Children born in 1965 3,185 Children born in 1961/4 8,868 Total, 1961-1966 15,228 Persons aged 65 and over 367 Mentally disordered persons 276 Total 15,871 Attendances at Clinics and Centres— No. of attendances at Welfare Centre Sessions 2,100 No. of attendances at Ante-natal and Post-natal clinic sessions 333 Health Education This essential aspect of the Health Services was continued by Health Visitors during the year, principally by means of teaching groups which the Health Visitors hold in schools, talks which are given to outside organisations, and the use of leaflets, posters and displays in clinics and other public buildings. In addition to Mothercraft Classes for ante-natal mothers, there were Parentcraft Classes for mothers and their children. This is a worthwhile service as there are many lonely young mothers in the Borough and it helps them to meet other mothers and children since many organisations do not welcome noisy children and the mothers are too shy to go. Parentcraft also helps the ' only children' and those who spend most of their days in flats. Health Visitors were often asked to speak or join in discussion groups with outside organisations. MIDWIFERY Staff At 31st December, 1966, the staff consisted of:— 1 Non-medical Supervisor of Midwives. 10 Whole-time District Midwives. 34 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. Introductory On the whole, the national trend of falling domiciliary confinements, and an increase in planned early discharges from maternity hospitals, in particular 48 hours after confinement, was again apparent during 1966. Organisation It has been found practicable to retain as three midwifery areas the districts of Wimbledon, Merton and Morden, and Mitcham, and to have one group of midwives working in each area. A rota system is in operation which ensures sufficient sleep and rest for midwives between shifts, which is particularly important if a high standard of patient care is to be ensured. Three midwives are housed at the Nurses' Home, Kings Road, Wimbledon, one is housed at ' The CroftCommonside East, Mitcham, one in a flat leased from the Greatef London Council, and the remaining five five in their own homes. All midwives, except one who uses a bicycle, use either their own cars or a car supplied by the Authority. Maternity Cases Attended There were 415 domiciliary confinements reported and 2,538 hospital confinements during the year. This shows a reduction of 41 on the figure for 1965. Midwives employed by the Authority attended 411 cases (409 where a doctor was booked and two where no doctor was booked) of the 415 domiciliary cases. Inhalation Analgesia All the Authority's midwives are qualified to administer inhalational analgesia (trilene, gas and oxygen, gas and air) in accordance with the rules of the Central Midwives Board. During the year district midwives administered inhalational analgesics to mothers as follows:— Gas and air—87. Gas and oxygen—148. Trilene—126. By the end of the year all the remaining ' Minnit' nitrous oxide and air machines had been replaced by ' Entonox' nitrous oxide and oxygen machines. Puerperal Pyrexia Seven cases of puerperal pyrexia were notified, five of which were hospital cases. Ophthalmia Neonatorum No case of ophthalmia neonatorum was notified during the year. 35 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. Medical Aid Medical aid was summoned by midwives in 101 domiciliary cases including 92 cases where the general practitioner had arranged to provide the patient with maternity medical services under the National Health Service Act. The Authority was liable for the payment of the practitioners' fees in the other nine cases. Early Discharges from Maternity Hospitals The numbers of discharges from hospital before the tenth day of puerperium were as follows:— 48 hours after confinement 238 Other discharges before the tenth day 155 Total 393 This shows an overall increase of 42 on those for 1965. Midwifery Training During the year negotiations were concluded with St. Teresa's Maternity Hospital for Second Period Training of pupil midwives from that hospital on the Authority's district, and the approval of the Central Midwives' Board was obtained to these arrangements under which not more than four pupils may be accepted on the district at any one time. The first pupils from St. Teresa's Hospital commenced district training in December. As a result of these arrangements with St. Teresa's Hospital the arrangement with Epsom District Hospital under which four pupils had previously been received on the district for training was varied to provide for not more than two pupils from Epsom. At the beginning of the year, five midwives were approved as Teaching District Midwives by the Central Midwives' Board, and a further two of the Authority's midwives were so approved during the year. Post-Graduate Courses Three midwives attended post-graduate courses in accordance with the Rules of the Central Midwives' Board, and three midwives attended week-end seminars in Psychoprophylaxis. Domiciliary Visits The following visits were carried out by midwives to their patients, other than attendance at the actual confinement:— Visits during the ante-natal period 2,965 Post-natal visits to home confinements 5,511 Post-natal visits to 48-hour and other early discharges from hospital 2,765 Total 11,241 36 Attendances at Clinics Three hundred and thirty-four ante-natal clinic sessions were held by midwives during the year, and 571 women attended these clinics for the first time. The total number of attendances at midwives' antenatal clinics was 2,999. Transfers to Hospital The undermentioned patients booked for domiciliary confinement were transferred to hospital:— (a) During pregnancy 6 (b) During labour 11 Co-operation with General Practitioners Discussions were held during the year on the desirability of general practitioners and district midwives seeing their mutual antenatal patients at the same time. Due to the large number of general practitioner obstetricians in the area and the relatively small number of midwives, only a very limited scheme can be contemplated. Maternity Liaison Committee The Medical Officer of Health continued to act as Chairman of the St. Helier Group Maternity Liaison Committee which ensures cooperation of the hospital, general practitioner and local health authority maternity services. HOME NURSING Staff On 31st December, 1966, the staff consisted of:— 1 Superintendent of the Home Nursing Service. 1 Deputy Superintendent of the Home Nursing Service. 33 Whole-time Home Nurses (female)—S.R.N, and District Trained. 1 Whole-time Home Nurse (male)—S.R.N, and District Trained. 2 Part-time Home Nurses (female)—1 S.R.N, and District Trained. 1 S.R.N. not District Trained. 3 Whole-time Home Nurses (female) — S.E.N, not District Trained. 3 Part-time Nursing Auxiliaries (female). The overall picture in regard to the recruitment of Home Nurses during the year was satisfactory. Most vacancies were filled fairly soon after they occurred. It should be pointed out, however, that most Home Nurses employed by the Authority are married and have children. These nurses have either returned to nursing after bringing up a family, or they employ someone to look after their children whilst 37 they are at work. The familiar spinster nurse, who devoted her life to nursing is disappearing fast, and so is the traditional bicycle which carried her from patient to patient. In the interests of efficiency, a largely motorised transport service is the aim, and this, in effect, is operative in this Authority. The only disadvantage to the Service, so far as the married nurse is concerned, which gave rise to considerable staff shortages throughout the year, is the frequency of requests for maternity leave which, when granted, is of a total duration of 18 weeks. Since the amalgamation of the three former areas of Wimbledon, Merton and Morden, and Mitcham into this Borough, it has become clear that one male nurse would be required for each area if a satisfactory service were to be given. It is not generally realised that very heavy patients, whom female nurses are unable to lift, and where the introduction of a mechanical hoist for lifting purposes is not possible, are often able to remain in their own homes solely because they are attended by a male nurse. The recruitment of male nurses is difficult since they are often married with families and require living accommodation in the area where they work. The provision of accommodation for married male nurses is receiving the attention of the Authority. Two additional part-time Nursing Auxiliaries were added to the establishment during the year, making a total of four part-time Nursing Auxiliaries on the establishment. In-service training is given to these Nursing Auxiliaries by an experienced Home Nurse and the Superintendent or Deputy Superintendent satisfies herself, in each case, that the Auxiliary is competent to carry out her work unsupervised before actually doing so. The Superintendent was absent, due to illness, from June until the end of December, and until late in the year it had not been possible to fill the vacant post of Deputy Superintendent. A considerable burden of responsibility, therefore, fell on the shoulders of Miss Richards, the Superintendent Health Visitor, who, in addition to her own duties, had temporarily to assume responsibility for the supervision of the Midwifery and Home Nursing Service. Organisation The Borough is divided into eight areas of differing population and size, and each area is staffed by a group of Home Nurses. Requests for the services of a Home Nurse are principally referred by general practitioners. These are taken mainly by telephone at the Health Department and are passed to the nurse concerned on the same day. Gradual changes are taking place in the type of nursing required in the patient's own home, as well as in the type of nurse supplying the service. Home Nursing centres more and more around the elderly, infirm and chronically sick patient, very often living alone. Sixty-seven per cent of all patients receiving home nursing are over the age of 65 years. 38 There is an increasing demand for attention to personal hygiene of the elderly no longer able to carry out this for themselves. Skilled nursing care is not required in the majority of these cases. In order to meet this increasing demand, a Nursing Auxiliary Service was established within the Borough last year. So far, the Nursing Auxiliaries employed are female and work on a part-time basis. They have no nursing qualifications as such, but are chosen for this work because they have a genuine desire to help people, and are judged to be acceptable persons to enter patients' homes as well as being capable of carrying out the work required. Transport to and from patients' homes is either by bicycle or public transport. This service is much appreciated by the patients; the Auxiliaries themselves appear to have job satisfaction and the Home Nursing Service can devote its time and skill to its proper function of caring for the sick in their own homes, rehabilitation, supporting patients' relatives, advising them and teaching them simple procedures they can carry out in the nurse's absence. Training of District Nurses This Authority is approved as a training area for the practical part of the District Nurse training, leading to the Queen's Instiute District Nursing Certificate. Students attend the Queen's Institute Headquarters in London for their theoretical instruction. Three nurses were seconded for training during 1966 and all passed their examinations. Post-Graduate Courses for District Nurses Nine nurses attended Refresher Courses during the year. Six were residential courses of one week's duration, and three were nonresident courses of one day's duration. 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 1.1.66 Cases added Cases removed Cases on books at end of period 0-5 years 3 26 27 2 5-64 years 165 732 762 135 65 years and over 620 1,237 1,218 639 Totals 788 1,995 2,007 776 The total number of cases attended during the year was 2,783. 39 Visits Made The following table shows the total number of visits made each month:— January 7,867 February 7,318 March 8,201 April 7,578 May 7,728 June 7,666 July 7,486 August 7,715 September 8,098 October 8,047 November 8,464 December 8,027 Total 94,195 Marie Curie Foundation Cancer Nursing Service This Authority acts as agents for the Marie Curie Memorial Foundation who bear all the costs of the Day and Night Sitting Service supplied locally to any cancer patient being nursed at home and in need of additional care, especially night attendance. This service is staffed by qualified nursing staff and unqualified staff, and the appropriate person is sent to each case. The service is run locally through the Home Nursing Service. The aim of this service is mainly to relieve relatives from night nursing duties to enable them to get sufficient sleep and rest in order to continue the often strenuous task of looking after a really sick patient, particularly when he or his family wish the relative to remain at home until the end. The Authority also operate the Foundation's Area Welfare Grant Scheme under which extra comforts may be supplied to a cancer patient at the expense of the Marie Curie Foundation. 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, 1966, the staff consisted of:— 1 Home Help Organiser. 1 Senior Assistant Home Help Organiser. 2 Assistant Home Help Organisers. 40 2 Clerks. 1 Full-time Home Help. 197 Part-time Home Helps. Organisation Recruitment was more successful than during the previous year and 34 part-time Home Helps were engaged. At the same time the demands on the service also increased, but it was, of course, easier to help the applicants. There is still, however, a shortage of Home Helps. Little progress was made under the Neighbourly Help Scheme, as most neighbours in a Borough where there is plenty of industry are already working. Statistics The following table gives details of the numbers and types of cases attended by Home Helps during the year:— Categories of Cases. Cases on books at 31st Dec., 1965 Cases on books at 31st Dec., 1966 Total cases dealt with during 1966 Chronic Sick and Aged 819 966 1,237 Tuberculosis 9 16 17 Acute Illness 35 19 128 Maternity 4 2 101 Totals 867 1,003 1,483 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, 1966, being 966. Details of Sources of Applications in 1966 General Practitioners 481 Hospitals 254 Health Visitors 15 Home Nurses 1 Welfare Services 5 Blind Welfare 2 Maternity Bookings 152 Others 11 921 The Organiser and the three Assistant Organisers have paid 815 first visits and 2,423 re-visits to homes in connection with the service. 41 HOURS WORKED BY HOME HELPS Chronic Sick and Aged T.B. Acute Maternity Payments under Neighbourly Help Scheme Total hours worked £ s. d. January 14,605 172 465 395 41 5 0 15,637 February 12,463 179 314 771 31 0 0 13,727 March 12,972 170 317 655 34 0 0 14,114 April 15,631 194 283 704 41 10 0 16,812 May 14,172 252 366 245 33 0 0 15,035 June 12,952 196 403 199 33 0 0 13,750 July 15,468 290 751 363 37 5 0 16,872 August 12,409 222 549 286 30 0 0 13,466 September 12,985 196 370 248 33 0 0 13,799 October 19,407 310 517 441 41 5 0 20,675 November 16,295 258 429 428 33 2 0 17,410 December 17,878 289 662 261 47 15 0 19,090 Totals 177,237 2,728 5,426 4,996 436 2 0 190,387 CHIROPODY SERVICE The Council's chiropody service caters for the elderly, the registered blind or partially sighted, the physically handicapped and expectant and nursing 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, 1966, 967 new applications for treatment were received. The following table gives figures for the Direct Scheme:— Category Persons treated in 1966 Number of treatments given Number on books at 31.12.66 Elderly 2,725 16,008 2,502 Registered Blind or Partially Sighted 38 123 19 Physically Handicapped 66 421 63 Expectant Mothers 3 2 1 Totals 2,832 16,554 2,585 42 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 62 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 Society have supplied the details given in the table below of issues of sick room equipment during the year:— Item Total loans Item Total loans Air rings 95 Cradles 44 Bedrests 107 Crutches 24 Bed pans 162 Feeding cups 16 Bed tables 14 Waterproof sheets 109 Invalid chairs 145 Urinals 69 Commodes 155 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. Sixty-three such holidays were arranged in the year. Cervical Cytology With effect from 4th July in conjunction with the St. Helier Hospital Pathology Department a screening service for the taking of smears from well women commenced in the Borough. The number of smears to be dealt with at the inception of the scheme for the Borough was ten per week, and the service will expand as the Pathology Department of the Hospital is able to provide increased facilities for the examination of these smears. This service was made available to women of all ages and in most cases the Pathologist requested a repeat smear after one year. In October of this year a memorandum was sent by the Ministry of 43 Health to Local Health Authorities, Regional Hospital Boards, and Local Executive Councils, expressing the hope that Local Health Authorities, hospital and general practitioner services would co-operate in developing screening services for cancer of the cervix. In this memorandum the Minister indicated that the service should be confined to persons of 35 years and over, and that repeat smears should be taken at five-yearly intervals. 44 MENTAL HEALTH & SOCIAL WORK SERVICES Introductory The daily supervision of these services is delegated to a Senior Medical Officer, who is assisted on the mental health aspects by a Senior Mental Welfare Officer and on the other social work aspects by a Senior Social Worker. MENTAL HEALTH SERVICES Staff At 31st December, 1966, 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. Dr. R. K. Freudenberg, the Physician-Superintendent of Netherne Hospital, acts as part-time Consultant Pyschiatrist to advise the Authority on aspects of the Mental Health Services. Training of Staff One Assistant Supervisor from the Junior Training Centre was sponsored for the one-year course beginning in September leading to the Diploma for Teachers of the Mentally Handicapped of the National Association for Mental Health. A period of in-service training over a period of eight weeks was organised by the Mental Health and Social Work Section of the Department. One afternoon each week was devoted to talks and seminars. This was well attended, not merely by the social work staff of the Department, but by social workers from other Departments of this Authority, and by social workers employed by neighbouring Authorities. Mental Health Establishments During the year, the 20-place Special Care Unit built by the Mitcham Round Table in the grounds of the Junior Training Centre, Bordesley Road, Morden, was officially opened. This unit has made it possible to provide day care for physically handicapped subnormal children, and the twelve places in the Junior Training Centre reserved for special care cases are now released for normal Training Centre places, bringing the total number of places for Junior Care to 95— Special Care Unit 20, and Junior Training Centre 75. From June, arrangements were made for the Authority's subnormal persons over the age of 16 years to be transferred from Surrey County Council's Adult Training Centre, ' Bentley', Banstead, to a Training Centre in the grounds of the Manor Hospital, Epsom. This was rendered necessary since Surrey County Council had a large waiting list of their own cases awaiting admission. 45 By arrangement with Surrey County Council the transfer was to be a phased process to avoid upheaval. This necessitated the coaches, for some time, visiting both the Manor Hospital and Bentley Adult Training Centre. By the end of the year 13 trainees had been transferred to the Centre at the Manor Hospital. 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. During the year, 486 cases were referred to the Mental Health Section for their attention and 381 were in the category requiring community care at the end of the year. Progressively, a larger proportion of the subnormal and severely subnormal have been transferred from the care of Health Visitors to the Mental Health Section, but in no case has this been automatic. The best interests of the subnormal person and his or her family have been the first consideration. SUBNORMALITY 1. Cases in Community Care At the end of the year 204 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 11 7 20 22 31 29 60 Severely subnormal patients receiving routine home visits 33 24 51 36 84 60 144 Totals 44 31 71 58 115 89 204 Patients included in above figures who are attending Junior or Adult Training Centres 28 18 29 17 57 35 92 46 2. Special Care Unit The table below gives details of the number of attendances at the Special Care Unit during the year:— Merton Sutton Wands'th Total No. of children attending on 1.1.66 8 5 — 13 No. of children attending on 31.12.66 9 6 2 16 No. of attendances made during year 953 517 50 1,520 3. Junior Training Centre In May of this year 14 Merton children in the age group 9-16 years were withdrawn from the Intermediate Training Centre at Sutton, and 14 Sutton children in this age group were transferred from the Merton Junior Training Centre to their own Centre at Sutton. This will ensure that all Merton children have continuity of observation and training up to the age of 16 years, in Merton's own Centre. The table below gives details of the attendances at the Junior Training Centre during the year:— Merton Sutton Total No. of children in attendance on 1.1.66 24 38 62 No. of children in attendance on 31.12.66 40 17 57 No. of attendances made 3,681 3,851 7,532 The attendances at the Special Care Unit and the Junior Training Centre fell, compared with 1965. This was accounted for by the fact that the premises were closed for one month on account of an outbreak of sonne dysentery. 4. Adult Training Centre At the end of the year 26 males and 20 females were receiving training either at Surrey County Council's Centre at Banstead or at the Manor Hospital Day Centre at the Manor Hospital, Epsom. Details are given below:— Males Females Total No. attending Banstead Centre 22 11 33 No. attending Manor Hospital 4 9 13 Total No. receiving training 26 20 46 The process of transfer from the Banstead Centre to the Manor Hospital Centre is to be completed during the early part of 1967. 47 OTHER FORMS OF MENTAL DISORDER 1. Cases dealt with by Mental Welfare Officers During the year 292 cases were referred to Mental Welfare Officers for attention. One hundred and ninety-one patients were admitted to Mental Hospitals through the Mental Health Service. Details of these admissions are given below:— Males. Females. Total. Admitted informally 26 40 66 Admitted under Section 25 (for observation) 13 9 22 Admitted under Section 26 (for treatment) 1 7 8 Admitted under Section 29 (for observation in case of emergency) 32 43 75 Admitted under Section 60 (by the Courts) — 1 1 Admitted under Section 136 (in conjunction with Police) 9 10 19 Totals 81 110 191 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. Whilst the total number of admissions to hospital has increased, it is worth noting that the number of informal admissions has also increased. Every effort is made to ensure that patients are admitted informally, and where this is not possible, under Section 25 or 26 of the Mental Health Act. However, the emergency admissions for observation are not always within the control of Mental Welfare Officers who are sometimes merely in a position of being called upon to arrange transport to hospital, since the application for emergency admission is made by relatives. There are cases clearly where the doctor might take more advantage of the domiciliary visits by hospital consultants or approved doctors to ensure that no patient is deprived of his or her liberty merely on one medical recommendation. It must be appreciated, however, that the admissions under Section 29 of the Mental Health Act sometimes take place at night or at week-ends, and there are occasions when it is difficult, if not impossible, for a consultant to be available, and the number would not appear to be unduly high. The need for reducing the number of emergency admissions is borne in mind. It is encouraging to see the steady increase of informal admissions indicating that the Mental Health staff have had the opportunity of dealing with calls for help in the early stages. Mental Welfare Officers continue to receive ready co-operation from other Sections of the Department, particularly Health Visitors, District Nurses and Public Health Inspectors, the School Health Service and the Home Help Service. Close contact is also fostered between 48 the Mental Health Service and the Education, Welfare Services, and Children's Departments. Especial thanks are due to the Metropolitan Police, who make an after hours emergency service possible. 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 Fifty-five male and 122 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 238 Merton patients are in long-term care in hospitals for the subnormal and severely subnormal. It is hoped that the actual number of long-term cases in hospitals for subnormal and severely subnormal patients will in fact decrease progressively over the years, but this decrease will be dependent upon alternative facilities being available outside the hospital service. The Ministry of Health are of opinion that no child who does not need nursing care should be admitted to a hospital for the subnormal. It is appreciated that in many cases there is acute hardship and there are also social reasons why a child who is handicapped may have to be cared for away from his own home, for a while at least. The question of educating the community, including many of those closely associated with the care of subnormal children, is necessary to enable them to realise that a child's needs may be met outside the hospital setting in some cases. The challenging work of providing care in the community may only be carried out when supported by suitable facilities. There is also a need for vacancies to be made available for short-term care and ample opportunities for parents to avail themselves of the opportunities. Many parents, although anxious and willing to care for their child in their own homes are subject to many stresses and strains, and should be given opportunities to recharge their energies, both mental and physical. GUARDIANSHIP There are no cases under guardianship in the Borough. 49 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 15 cases, compared with eight cases in 1965. This is an illustration of the increased demand made for facilities when their availability is known to those families in need. SOCIAL WORK SECTION At the end of the year the staff position was:— 1 Senior Social Worker. 1 Whole-time Social Worker. 3 Part-time Social Workers. 1 Part-time Social Worker (joint appointment with St. Helier Hospital Management Committee). The Section continued in its role of rendering social work assistance to the Chest Physicians of the Chest Clinics at Cumberland Hospital. During the year, the work connected with prevention of break-up of family life expanded. In addition to work originating from Health Visitors and the Co-ordinating Committee for the Prevention of Break-up of Families, the social casework for families in the Borough's Homeless Family accommodation was, to an increasing extent, being carried out by the Section. Notification of people under threat of eviction is now made to this Section by the Chief Welfare Officer in order that early casework may begin with the object of preventing homelessness. This side of the work will be greatly enhanced by the appointment, in the latter part of the year, of a Senior Social Worker with considerable experience in this field. In general, it is found that this Section's caseworkers, by reason of their not being involved in emergency statutory duties, are particularly suitable for casework on families with problems. In all aspects of work, a close liaison is maintained with the Children's, Welfare Services, and Housing Departments, as well as with other interested organisations. The Senior Medical Officer acts on behalf of the Medical Officer of Health as Chairman of the Co-ordinating Committe for the Prevention of Break-up of Families, on which all appropriate bodies, statutory and voluntary, are represented. During the year, the Mental Health and Social Work Section of the Department moved to new premises in the grounds of Mitcham Court which has rendered an effective merger of these two social work sections possible. This has led to a greater degree of co-operation than had been possible in the past, to the benefit of all concerned. 50 Social Casework During the year, 135 families with problems were referred to the Section from the various statutory and voluntary bodies. There was a certain amount of movement during the year, and various cases were closed, or referred to other Departments, leaving, at the end of the year, a case load of 81 families with problems. Throughout the year, patients attending the Chest Clinics at Cumberland Hospital were referred by the Chest Physicians for domiciliary visits to help with social and financial problems. The case loads in this category were fairly consistent, and at the end of the year the case load was 122. The average number of cases carried throughout the year was 203. 51 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR The surroundings in which we live can have a profound effect upon our health and development. The elimination of unhealthy conditions is what is known today as Environmental Health. Fundamentally the function of the Public Health Inspector is to secure compliance with legislation designed to protect and promote the health of the community. Environmental Health closely concerns the dayto-day life of the people, and it is a service which must be provided by the local authority and its officers who are in touch with the problems and needs of the people living in or visiting the Borough. This part of the Annual Report deals therefore with this Environmental Health Service, and shows the efforts made to maintain an efficient service, despite continued staff shortages and staff changes. In reviewing the work of the Public Health Inspectorate during 1966, regard has been had to Ministry of Health Circular 1 /67 dated January, 1967. The statistics cover the year ended 31st December, 1966, being the first complete calendar year of the London Borough of Merton. 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. With a few exceptions all the dwelling houses within the Borough are supplied from public water mains direct to the houses but the actual number of 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. I am indebted to the Director of Water Examination, Metropolitan Water Board for the following information so far as the supply from that authority is concerned:— (a) The supply was satisfactory both as to quality and quantity throughout 1966. (b) The supply was derived from the River Thames through the Southern Group of pumping stations, and no new sources of supply were instituted. 1,825 samples were taken for bacteriological examination, and 156 samples for chemical analysis. No fluoride was added, and where fluoride content occurred it represented the naturally occurring fluoride in the water. (c) The supply being hard in character is not liable to be plumbo-solvent. 52 (d) All new and repaired mains are disinfected with chlorine, after a predetermined period of contact the pipes are flushed out and refilled. Samples of water are then collected from these treated mains and the mains are returned to service only after the results are found to be satisfactory. The quality control from the laboratories is carried out by means of daily sampling from sources of supply, through the treatment works and well stations, from the distribution system and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (e) The Board has no record of the number of structurally separate dwellings in the area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1966, was 153,875. No houses were permanently supplied by standpipe. (f) There were no changes to the general scheme of supply to the Borough during 1966. (g) The following additions to the mains took place during 1966 —trunk mains 400 yards; other mains 336 yards. During the year 1966, samples of water were taken for bacteriological and chemical examination by the Public Health Inspectors as follows:— Bacteriological— Swimming Baths 153 Paddling Pools 23 Dwelling houses:— Metropolitan Water Board 6 Well water 8 — 14 Other premises:— Metropolitan Water Board 3 Sutton District Water Co. 4 Well water 3 — 10 200 Unsatisfactory Results— Swimming Baths 14 Paddling Pools 16 30 Immediate action was taken in respect of the unsatisfactory swimming bath water and subsequent samples proved satisfactory. Chemical— Swimming Baths 8 Dwelling houses:— Metropolitan Water Board 1 Well water 1 —2 53 Other premises:— Metropolitan Water Board 1 Sutton District Water Co. 1 Well water 2 — 4 14 The chemical samples were satisfactory. Sewerage and Sewage Disposal I am advised that the arrangements for sewerage and sewage disposal are adequate. There are 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 1966:— Complaints received— General disrepair and insanitary conditions 343 Dampness 304 Overcrowding 27 Defective drainage systems 46 Blocked drainage systems 665 Defective drainage fittings 42 Defective sanitary accommodation 84 Defective service water pipes 34 Absence of or defective dustbins 7 Accumulation of refuse, etc. 220 Rats and mice 1,309 Pigeons 63 Insect pests 379 Smoke nuisances 131 Noise 95 Smells and odours 178 Unsound food 258 Water supply 60 Miscellaneous 157 4,402 Visits made— General. P.H. Act (Nuisances) 1,753 P.H. Act (Dwelling houses) 2,192 Storage of refuse 185 Drain testing 95 Choked drains 2,032 Other drainage work 901 Radioactivity 2 — 7,160 54 Housing. Housing Act (Dwelling houses) 1,579 Overcrowding 73 P. No. measurements 31 Rent Act, 1957 49 Underground rooms 7 Houses in multiple occupation 353 Improvement grants 259 Caravans 22 — 2,373 Food and Food Premises. Milk processing dairies 94 Milk vendors 127 Ice-cream premises 348 Food factories 8 Food vehicles 362 School kitchens 61 Restaurant kitchens 639 Licensed premises 157 Bakehouses 90 Butchers 258 Wet and fried fish shops 155 Other food shops 1,136 Meat inspection 390 Unsound food 647 Sampling: Food and Drugs 217 Sampling: Milk 196 Sampling: Ice-cream 122 Sampling: Water 231 Food hygiene swabs 116 — 5,354 Clean Air Act, 1956. Smoke control areas 10,639 Other Clean Air Act visits 478 Smoke observations 352 Air pollution recording apparatus 1,516 —12,985 Factories Act, 1961. Factories (powered) 233 Factories (non-powered) 17 Factories (building sites) 7 Outworkers 27 Workplaces 25 — 309 Infectious Diseases. I.D. enquiries 272 I.D. contacts 22 Food poisoning 26 Specimens 33 Disinfection 24 — 377 55 Offices, Shops and Railway Premises Act, 1963. O.S.R. general inspection offices 422 O.S.R. general inspection shops 217 O.S.R. general inspection wholesale/warehouses 13 O.S.R. general inspection catering 17 O.S.R. general inspection canteens 2 O.S.R. general inspection fuel stores 2 O.S.R. all other visits 3,613 — 4,286 Insects, Pests, Rodents. Rats and mice control 14,692 Insect control 432 Pigeon control 108 Verminous premises 37 —15,269 Animals. Stables 24 Piggeries 4 Slaughterhouse (hygiene) 80 — 108 Miscellaneous. Hairdressers and barbers 75 Fertilisers and Feeding Stuffs Act, 1926 3 Noise Abatement Act, 1960 279 Places of public entertainment 2 Schools 9 Court proceedings 16 Public conveniences 7 Water courses 33 Shops Act, 1950 87 Pet shops 25 Miscellaneous 980 — 1,516 49,737 Result of Service of Notices (1) Legal Proceedings. Proceedings were instituted against the owner of a dwelling house let in mutiple occupation for failing to comply with notices served under Sections 15 and 16 of the Housing Act, 1961. The defendant, who pleaded guilty, was fined £50 on each of two summonses, and £10 10s. costs were granted. (2) Nuisances abated and Defects remedied. As the result of the service of verbal, written and Statutory Notices, 3,499 defects were remedied. 1,334 were in connection with the drainage of buildings; 1,049 in and around dwelling houses; 940 in connection with food premises and 176 were of a miscellaneous nature. 56 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 44 17 1 — Factories with mechanical power 937 233 36 1 Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 43 32 1 — Totals 1,024 282 38 1 (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) 2 3 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 1 1 — — — Inadequate ventilation (S.4) 11 12 — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7):— Insufficient 30 16 — — — Unsuitable or defective 63 32 — 2 — Not separate for sexes 11 10 — — 1 Other offences (excluding offences relating to outwork) 1 5 — — — Totals 119 79 — 2 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 65 — — — — — Lampshades 42 — — — — — Total 107 — — — — — 57 Number of addresses received from other Councils 110 Number of addresses forwarded to other Councils 61 Number of premises where outwork was carried on at the end of 1966 158 Underground bakehouses in use at the end of the year 1 Cleansing Station One of the occasional but important duties of a local authority is to ensure the disinfestation of verminous persons and their clothing. To this end, the former Merton and Morden U.D.C. maintained a Cleansing Station at Aston Road, S.W.20. The premises formed part of a building containing slipper baths for public use, and the Cleansing Station section contained two slipper baths, and incidental rooms. A Dodwell and Dunning electric dlsinfector for clothing had been installed, and the whole of the premises are maintained and staffed by the Baths Manager. Although the use of the facilities may be infrequent, when the need arises in an area which does not possess these facilities, the attendant difficulties can be hard to overcome. During the year 1966, 36 local residents and five persons from other districts received treatment for scabies or lice infestation. A fee of 30s. is payable by outside authorities for persons sent by them for treatment. It will be necessary during the coming year to transfer staffing arrangements to the Health Department, and it is hoped to install an independent hot water supply and space heating unit. 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 141. 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. 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 the dairy processing this milk. Many enquiries were received during the year from other Councils to whom applications had been made for licences in respect of the sale of U.H.T. milk, and a number of Health Certificates were issued to the company concerned for the export of U.H.T. milk. Milk (Special Designation) Regulations, 1963, as amended. The following licences, which will remain in force until 31st December, 1970, have been issued under these Regulations:— Dealers' (Pasteuriser's) Licences 2 Dealers' (Ultra Heat Treated) Licence 1 Dealers' (Pre-packed Milk) Licences:— Untreated milk 61 Pasteurised milk 145 Sterilised milk 116 Ultra Heat Treated milk 27 58 During the year 247 samples of designated milk were submitted for statutory tests. The results were as follows:— Designation. Satisfactory. Void. Unsatisfactory. Pasteurised 213 — — Sterilised 27 — — Untreated 3 2 1 Ultra Heat Treated 1 — — The unsatisfactory sample of untreated milk failed the Methylene Blue Test. An investigation was made and a further sample taken from the same source was satisfactory. Brucella Abortus. No positive samples of milk were found. Ice-Cream. During the year 120 samples were submitted for bacteriological examination. The results were as follows:— Grade 1 68 Grade 2 10 Grade 3 25 Grade 4 17 The Grade 4 samples were mainly of soft ice-cream. Investigations invariably proved incomplete sterilisation of apparatus or careless handling. Appropriate action was taken in each case until satisfactory samples were obtained. Bacteriological Examination of Other Foods. Samples of sausages, sliced cooked meat, soup powder, egg albumen (10). and jellied eels, were sent to the Public Health Laboratory for special bacteriological examination. None of the samples showed the presence of pathogenic organisms, and they were reported upon as being satisfactory. Meat and Other Foods. There is one licensed slaughterhouse in the Borough which is in private ownership. These premises which have been in use for a number of years, are old and there are many inherent defects. The layout of the premises is poor and facilities for meat inspection are inadequate. In February, 1965, the (then) Mitcham Borough Council renewed the licence for the year ending 31st March, 1966. In February, 1966, the new London Borough Council renewed the licence for the year ending 31st March, 1967, but asked other Committees who were concerned in negotiations with the licensee to expedite their completion, in order that a proposed new slaughterhouse might be constructed, and the existing premises closed. In the meantime slaughtering continued throughout 1966 daily each week (with the exception of Saturdays) and from 6 a.m. to 12 noon each Sunday. A 100 per cent meat inspection service was maintained during 1966, but it was found necessary to employ two Inspectors on Sundays towards the end of the year, to the prejudice of work on the District during the week. During the year 14 slaughtermen's licences were issued under the provisions of the Slaughter of Animals Act, 1958, one being a licence to slaughter under supervision. 59 Meat Inspection. Carcasses inspected and condemned where necessary Cattle Calves Sheep & lambs Pigs Animals slaughtered 296 96 300 20,680 Diseases except Tuberculosis and Cysticerci Whole carcasses condemned Nil 1 Nil 39 Carcasses of which some part or organ was condemned 60 Nil 47 3,335 Tuberculosis only Whole carcasses condemned Nil Nil Nil Nil Carcasses of which some part or organ was condemned 1 Nil Nil 406 Cysticerci Carcasses of which some part or organ was condemned 1 Nil Nil Nil Carcasses submitted to refrigeration 1 Nil Nil Nil Generalised and totally condemned Nil Nil Nil Nil The total weight of meat condemned as unfit for human consumption was 8 tons 14 cwts. 18 lbs. Three hundred and ninety visits were made to the slaughterhouse for the purpose of meat inspection during the year. Food Premises. All food which is intended for sale is subject to inspection from the point of production until final sale to the consumer. Closely related to food inspection is the control of the conditions under which food is stored, handled, transported and exposed for sale, and the enforcement of satisfactory standards of hygiene. The inspection of food premises has formed an important part of the work of the Public Health Inspectors during the past year. 4,761 visits were made to premises in which foodstuffs intended for human consumption were prepared, stored or sold. A considerable amount of work was done under the provisions of the Food Hygiene (General) Regulations, 1960, and in general it has been found that food traders are co-operative. I believe that the advice and assistance given by the Inspectors is generally well received and appreciated. The provisional register of food premises includes the following: Greengrocers 160 Confectioners 273 Ice-Cream premises 477 Bakers 61 Grocers and Provision Dealers 328 Butchers 104 Fishmongers/Fish Fryers 59 Milk Distributors 141 Chemists 51 Licensed premises 84 Carried forward 1,738 60 Brought forward 1,738 Clubs 79 Restaurants and cafes 140 Works canteens 54 School canteens and kitchens 100 Food stalls/vehicles 33 Places of public entertainment 84 2,228 The information required by Circular 1/67 in connection with the provision of ablution facilities, sinks and hot and cold water supplies has not yet been compiled. 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 470 Registered for the manufacture and sale of ice-cream 6 Registered for the preparation or manufacture of sausages 72 Registered for the preparation or manufacture of potted, pressed, pickled or preserved food 157 The number of inspections of registered food premises during 1966 was 874. Bacteriological Examination of Equipment. During the year 397 swabbings of articles of equipment used in food premises and catering establishments were submitted to the Public Health Laboratory for bacteriological examination. The results were as follows:— Article. No. of swabs taken. Result. Satisfactory. Unsatisfactory. Beer mugs and glasses 37 37 — Wine and spirit glasses 17 17 — Plates 94 90 4 Cups and beakers 72 63 9 Saucers 2 2 — Knives 50 46 4 Forks 66 62 4 Spoons 58 53 5 Vending machine nozzle 1 1 — In addition 17 samples of ice-cream server water were submitted for bacteriological examination, six of which were unsatisfactory. Special visits were made to premises from which unsatisfactory swabs were taken, and the occupiers were advised upon principles of hygiene to effect an improvement. Food Inspection. Unsound food which is surrendered to the Health Department is destroyed at the refuse disposal works by arrangement with the Greater London Council. 61 Excluding meat condemned at the slaughterhouse, the following is a list of the unsound food surrendered during 1966:— Tons. Cwts. Lbs. Canned meat 1 19 101 Canned soup — 6 31 Canned fish — — 98 Canned vegetables — 16 15 Canned fruit 1 3 7 Canned pies and puddings — 3 82 Canned milk and cream — 3 43 Canned spaghetti — — 31 Miscellaneous canned foods — 1 87 Meat, bacon and poultry 3 3 24 Sausages — — 1 Fish — — 54 Spaghetti — — 15 Puddings and pastry — — 5 Butter, fat and cheese — 3 76 Flour, bread and cereals — 4 30 Pie fillings — 3 5 Sugar, jam and syrup — 3 105 Sage, salt and salad cream — 1 35 Fruit and vegetable juices — 2 67 Dried Fruit — 3 64 Frozen foods — 17 21 Beverages — 1 4 Confectionery — 5 43 Fruit and vegetables — 2 21 Miscellaneous foods — 1 62 10 9 7 The number of complaints received during the year regarding unsound food was 258. 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, but certain of the items marked * in the following list were the subject of legal proceedings. Foreign bodies found in loaves of bread—mould growth on wrapped bread (5); insects (2); carbon and grease (3); plastic material; wire; dirty and stale dough; flour bag labels*; foreign matter. Biscuits infested with insects (2)*. Milk stone in milk. Stones and glass in bottle of milk. Metal in bottle of milk. Dirty milk bottles (16)*. See note below. Mould growth in prepacked bacon*. Slug in fried chipped potatoes*. Mould growth on cooked chicken*. Maggots in rolled roast lamb. Black matter in canned braised beef. Discolouration of canned corned beef. Wire in smoked luncheon meat. Rust in canned ham. 62 Black substance in canned luncheon meat. Mould growth on sliced tongue. Metal, fat and flour in jam tart. Electric cable in congress tart. Mould growth on custard tarts. Mould growth on wrapped chocolate cake. Maggots in packet of oat cakes. Mould growth in packet of puff pastry. Wasp in doughnut. Insect in pastry confection. Silverfish in pie. Coke in canned beans. Bandage in canned tomatoes. White particles in canned grapefruit. Fly in canned raspberries. Snail in blackcurrant jam. Bone in sausage. Hide and hair in sausage. Mould growth in packet of skinless sausages. Crystals in canned tuna fish. Paper in frozen fish finger. Cyst in liver. Mould growth in prepacked cheese. Metal in bar of chocolate. Maggot and frass in box of chocolates. Cigarette end in packet of roasted peanuts. Mould growth in packet of beef dripping. Mould growth in pot of relish. Charred paper in bottle of wine. The number of dirty milk bottles listed above might appear to be excessive. By arrangement with other local authorities, complaints of this nature which are received by them are referred to me when the bottle has been found to have been filled at one of the establishments within the London Borough of Merton. After investigation (and after report has been made to the Health Committee when necessary) the facts are notified to the local authority concerned. Sampling of Food and Drugs. Samples of food and drugs are sent to the Public Analyst, Messrs. Moir & Palgrave, 16 Southwark Street, S.E.1, for examination and report. During the year 1966, 286 samples were submitted of which 236 were formal samples and 50 informal. The Public Analyst reported that of these samples, 277 were found to be genuine, and to comply with the relevant Acts, Orders and Regulations, and that nine did not so comply. Particulars of genuine samples. Almonds, salted 1 Anadin 1 Avomine 1 Beans, butter 1 Beef—dinner 1 minced 3 Beer, ginger 1 63 Brandy 1 Bread and butter 4 Breakfast food 1 Bronchial mixture 1 Butter 3 peanut 1 Cabbage, stuffed 1 Capriton 1 Carrots, canned whole 3 Cheese—English Cheddar 1 Port Salut 1 Caerphilly 1 Cherries, black canned 1 Chicken croquettes 1 Chutney, cranberry 1 Cinnamon, ground 1 Cockles in vinegar 1 Cocoa powder 1 Coffee, instant 1 Condiment, non-brewed 1 Cordial—lime and lager 1 raisin flavour 1 Crabmeat, fancy 1 Cream 1 Crispbread, rye 1 Crystals, orangeade 1 Curry powder 1 Custard powder 2 Drink—bitter lemon 1 blackcurrant 3 lemon 1 orange 5 Dripping 2 Ex-Lax 1 Flavour, almond 1 Fling 1 Flour confectionery 4 Fruit salad in syrup 1 Fruit filling, apple and blackberry 1 Galantine, nut meat 1 Gin—Booths 1 dry 1 Grapefruit in syrup 1 Ginger Ale 1 Haddock, smoked 1 Herbs, prepared 1 Honey, orange blossom 1 Honeycomb mould mix 1 Horlicks, chocolate flavour 1 Horseradish, creamed 1 Ice cream—coffee 1 Pineapple Royal 1 soft 10 powder 2 64 Iron and Yeast Tonic Tablets 1 Jam—blackcurrant 2 strawberry 2 tarts 1 Ketchup—tomato 1 tomato, salt-free 1 Kippers 1 Malt loaf, fruit and honey 1 Margarine 1 Marmalade—orange (jar) 1 orange (tin) 1 Marzipan, Golden almond 1 Meat, pork luncheon 1 Mincemeat 1 Mousse, lemon 2 Mycardol 1 Milk—Unspecified 7 Channel Island 7 Pasteurised 10 Untreated 3 Nite-cup 1 Oranges 1 Oil—sunflower seed 1 olive 1 Papaya nectar 1 Peach slices 2 Peas, processed 1 Pectin, liquid fruit 1 Peel, cut mixed 2 Piccalilli 1 Pineapple—canned 1 cubes 1 Poppadums 1 Pork pie 1 Potato, instant powder 1 Quickset 1 Raspberry powder 1 Raspberry Splice 1 Rennies Indigestion Tablets 1 Rhubarb, canned 1 Rice, long grain 1 Rum 2 Old Navy 1 Saccharine Tablets 1 Salad cream 1 Sauce—bread 1 parsley 1 Worcestershire 1 Sauerkraut 1 Sausage meat, pork 1 Sausage—rolls 5 Pork 7 Beef (Chipolatas) 1 Saveloys 1 65 Shandy, lemon 1 Slippery Elm Food 1 Soup—carton (vending machine) 1 cream of chicken 1 cock-a-leekie 1 mix 2 Spice, ground mixed 1 Sponge, butter 1 Spread—chocolate 1 sandwich 1 smoked meat 1 Squash—orange 1 pineapple 1 Steak—frying 1 minced 1 stewed 1 Sugar confectionery 52 Sulphur tablets 1 Tart—apple 1 custard 1 egg custard 1 mince 1 Thyme 1 Tomatoes, canned 1 Trimmets, Bourbon Creams 1 Trout, pate of smoked Rainbow 1 Veal, jellied 1 Vegetable and Turkey Dinner 1 Vinegar 1 Vitamin C Tablets, Sparkling 1 Vodka 1 Whisky 5 Wine—apricot 1 ginger 1 peach 1 sweet white 1 tonic 1 Particulars of non-genuine samples and action taken. Minced beef. Sample consisted of minced beef containing proportion of 38.8 per cent. fat to total meat, whereas proportion should not, in the opinion of the Public Analyst, exceed 25 per cent. Informal action taken to ensure improvement. Canned Black Cherries. Cherries in syrup and containing two ingredients. Contravention of Labelling of Food Order, 1953. Label amended. Ice-Cream. Sample contained 4.2 per cent. fat. Contravention of Food Standards (Ice-Cream) Regulations, 1959, which require not less than 5 per cent. fat content. Legal proceedings instituted against vendor who was fined £5 with £5 5s. costs. 66 Marzipan. This contained 500 parts per million by weight of Sorbic Acid, which was not described on the label, contrary to the Labelling of Food Order 1953. Label amended. Milk. Sample consisted of a glass of milk purchased in a cafe. It was deficient in milk solids other than milk fat to the extent of 1 per cent., contrary to the Sale of Milk Regulations, 1939. Informal action taken. Prunes in Syrup. This article was canned in a mixture of cane syrup and glucose syrup, and no distinction was indicated on the label, contrary to the Labelling of Food Order, 1953. Label amended. Pork Sausages (Preserved). The sample contained 58 per cent. meat and 8 per cent. excess rind. In the opinion of the Public Analyst pork sausages should not contain more than 4 per cent. rind, and he considered that the meat content should be at least 65 per cent. The sausages were not intended for sale to the public, and informal action was taken. Sparkling Muscatel. A non-alcoholic aerated mineral water, coloured and flavoured, and containing no fruit. The wording of the label was contrary to the Labelling of Food Order, 1953. Informal action taken and production discontinued. Vinegar. Although sold as 'vinegar', this was in fact 'non-brewed condiment' containing 2.3 per cent. Acetic Acid. The Acetic Acid content should have been 4 per cent. Appeared to be old stock, and informal action taken which stopped further sales. The following samples were submitted for special examination:— Apples—1. Genuine—1. Bread—2. Non-genuine—2. Cheese cake—1. Non-genuine—1. Fried chipped potatoes—1. Non-genuine—1. Jam tart—1. Non-genuine—1. Luncheon meat—1. Non-genuine—1. Milk—8. Genuine—1; non-genuine—7. Roasted peanuts—1. Non-genuine—1. Parboiled rice—1. Genuine—1. Peeled tomatoes—1. Non-genuine—1. Wine—1. Non-genuine—1. Further particulars regarding the 16 non-genuine samples are given below:— Bread (1). Complaint by purchaser; foreign matter in bread found to be stale dough, dirt and oil. Informal action taken. 67 Bread (2). Complaint by purchaser; red fibres in bread found to be cord and label. Vendor prosecuted; pleaded guilty; given conditional discharge on payment of £5 5s. costs. Cheese cake. Complaint by purchaser; contained shreds of tobacco. Informal action taken. Fried potato chips. Complaint by purchaser; slug found in chips. Vendor prosecuted; fined £5. Jam tart. Complaint by purchaser; grey streaks in tart found to be a mixture of wheat flour, fat, and metal particles baked in pastry. Informal action taken. Luncheon meat. Complaint by purchaser; small piece of insulated wire found in can of imported meat. Referred to Ministry of Agriculture, Fisheries and Food. Milk (6). Complaints by purchasers; dried milk solids in bottles (2); 'milk stone' derived from processing, in bottle; lime-mortar residue in bottle; mould growth in bottle; leaf tissues in bottle. Informal action taken. Milk (1). Complaint by purchaser; dark deposits adhering to inside of bottle found to consist of mixture of dried milk solids, vegetable debris, dirt, and mould growth. Vendor prosecuted; pleaded guilty; fined £20 with £6 6s. costs. Roasted peanuts. Complaint by purchaser; cigarette end alleged to have been found in packet of peanuts. Informal action taken. Peeled tomatoes. Complaint by purchaser; strip of cloth similar to bandage found in can; free from massive residue of tomato juice. Informal action taken. Wine. Complaint by purchaser; partially filled bottle of wine containing black flakes found to consist of charred paper. Informal action taken. All food complaints are thoroughly investigated, and this includes interviews with the complainants, and with vendors; visits to places of sale, storage and manufacture or processing, and consultations with the Public Analyst and with other persons concerned. Informal action is taken when it appears impracticable to recommend legal proceedings, or when the complainant is unwilling to give evidence as to purchase. Investigation of these matters has one end in view—the prevention of a recurrence of the incident. 68 Other Legal Proceedings. Milk and Dairies (General) Regulations, 1959—Article 27. Three cases involving dirty milk bottles being used for delivery of milk. Defendants pleaded guilty; fined £10 with £3 3s. costs on each of three counts. One case involving dirty one-third pint milk bottle being used for delivery of milk to a school. Defendants pleaded guilty; fined £50 with £10 10s. costs. Food and Drugs Act, 1955—Section 2. Loaf of bread containing label from flour sack. Defendants pleaded guilty; fined £20 with £6 6s. costs. Portion of chicken affected with mould growth. Defendants pleaded guilty; fined £5 with £5 5s. costs. Prepacked sliced bacon affected with mould growth. Defendants pleaded guilty; fined £10 with £5 5s. costs. Food Hygiene (General) Regulations, 1960. Bakehouse premises in insanitary condition, and other matters. Defendants pleaded guilty; fined £150 with £15 15s. costs. Cafe premises in insanitary condition, and other matters. Defendants pleaded not guilty to 11 summonses; one case dismissed; ten cases proved and defendants fined £85 with £10 10s. costs. Food and Drugs Act, 1955—Sections 2 and 8. Food Hygiene (General) Regulations, 1960. Food premises; two summonses relating to sale of biscuits containing insects; twelve summonses in relation to unsound food; premises in insanitary condition and other matters; quantity of food seized and taken before Magistrate. Defendant pleaded guilty; one case dismissed; fined total of £82 with £21 costs. SERVICES UNDER OTHER ENACTMENTS Rent Act, 1957—Certificates of Disrepair. The following is a summary of applications dealt with during 1966: — Applications received (Form I) 7 Decisions not to issue Certificates 1 Certificates issued (Form L) 1 Undertakings given (Form K) 5 Number of visits made 49 Shops Acts, 1950-65. Shops in the Borough have been kept under observation and contraventions have been remedied. Excellent relations exist between the three Chambers of Commerce and the Department, and advice has been given both to the Chambers and to shopkeepers. Action has also been taken in respect of general closing hours, half-day closing and Sunday trading. 69 Offices, Shops and Railway Premises Act, 1963. Work under this legislation was continued during 1966, with the specialist staff appointed for the purpose. The majority of owners and occupiers of premises which requite to be registered have submitted Form OSR 1. It has been found necessary to maintain a record of unoccupied premises in order that observation may be made to ensure registration when they are reoccupied. During cold spells in November and December, a temperature check was made of 105 premises, of which 78 were found to be above the minimum standard. Nineteen shops were slighdy below the standard, and in three cases the temperature was well below. Appropriate action was taken in these cases. No office premises were found to be below the standard required. The co-operation of employers has been most encouraging and no serious objection has been raised as to the manner in which the enforcement of the Act is being 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 146 657 422 Retail Shops 73 1,168 217 Wholesale Shops, Warehouses 8 35 13 Catering Establishments open to the Public, Canteens 16 141 19 Fuel Storage Depots 1 8 2 Totals 244 2,009 673 Contraventions rectified. Cleanliness 322 Overcrowding 2 Temperature 304 Ventilation 32 Lighting 23 Sanitary conveniences 268 Washing facilities 183 Supply of drinking water 3 Clothing accommodation 21 Sitting facilities 2 Floors, passages, stairs 83 Dangerous machinery guarded 42 First aid provisions 234 Abstract of Act posted 339 Not registered 29 Other contraventions 16 Exemption. One exemption (Section 46) granted for a period of two years in connection with the provision of a sanitary convenience will expire in January, 1967. 70 Accidents Reported and Investigated. In offices 3 In retail shops 31 In wholesale shops and warehouses 6 In catering establishments open to public; in canteens, etc. 3 The total number of visits of all kinds made by the specialist staff and by the Public Health Inspectors during 1966 was 4,304. Prevention of Damage by Pests Act, 1949. The following table summarises surface rodent control work which was carried out during 1966. The inspection and treatment of sewers was undertaken in collaboration with the Borough Surveyor. Ten per cent, of the total manholes in the whole sewer system were test baited, and maintenance treatment was carried out in these, and other manholes known to be infested four times during the year. During 1966, 562 manholes were baited and only 42 showed evidence of rodent infestation. The Department continued to deal with rodent treatment and disinfestation work in Council-owned property within the Borough. Number of Properties inspected as a result of Number of Properties found to be infested by Number of premises treated including retreatments Visits made including reinspections Notification Survey under Act Total Rats Mice 1,299 1,249 2,548 1,041 258 1,289 14,692 Other Pest Control Work. During the year 1966, 379 complaints were received concerning insect pests and the following is a list of the infestations dealt with:— Ants 26 Beetles 36 Bedbugs 20 Cockroaches 21 Fleas 16 Flies 20 Mosquitoes 20 Maggots 2 Silverfish 3 Spiders 3 Woodworm 1 Wasps 211 Where possible practical help is given by the carrying out of disinfestation work, but in certain cases reference is made to contractors who specialise in control work. The incidence of wasps was again generalised during 1966. No charge is made for the destruction of nests, but this work can only be undertaken when the nest is readily accessible. If the number of 71 requests for assistance exceeds our capabilities, householders are advised as to the best, and safest, methods of destruction. Ponds, ditches and other mosquito breeding grounds were sprayed with insecticide as found necessary, with satisfactory results. Sixty-three complaints of nuisance or damage caused by feral pigeons were received. Pigeon traps were placed on suitable sites, giving effect to a reduction in the number of birds. The situation regarding the positive reduction in the number of pigeons is still very unsatisfactory, and it is to be hoped that a definite policy might be adopted by either London Borough Authorities collectively, or by the Ministry of Agriculture, Fisheries and Food. Pet Animals Act, 1951. Twelve licences to keep Pet Shops were issued during 1966. Twenty-five visits were made to these premises to ensure compliance with the conditions attached to the licences. Animal Boarding Establishments Act, 1963. There is one licensed animal boarding establishment in the Borough. Only cats are boarded and cared for, and the premises were inspected several times during the year. The Riding Establishments Act, 1964. Four applications for licences were received during the year, three of which were granted. The fourth application in respect of premises in Mitcham was not granted, the refusal being based upon the report of the Council's Veterinary Officer. The applicant did not appeal against the refusal. Diseases of Animals Act, 1950. No outbreaks of disease occurred within the Borough during 1966. Copies of Orders made by the Ministry of Agriculture, Fisheries and Food in respect of outbreaks elsewhere of foot and mouth disease, swine fever and foul pest were received. Numerous Movement Licences authorising the transfer of pigs from areas covered by Swine Fever Orders to the slaughterhouse at Mitcham, were received during the year. Clean Air Act, 1956. During 1966, 131 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 the occupier of a dwelling house situated in the area covered by the Wimbledon (No. 3) Smoke Control Order, 1963, for permitting smoke to be emitted from a chimney, caused by the burning of unauthorised fuel. The defendant, who pleaded guilty, was fined £5 with £3 3s. costs. During 1966 also, the London Borough of Croydon appealed against the refusal of the London Borough of Merton to allow the continued burning of rubbish on a site near Hundred Acre Bridge, Mitcham Common. An Inquiry was held by the Minister of Housing and Local Government, and I was instructed to give evidence. The appeal was dismissed. 72 Twenty-two 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 nine 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 height of the chimneys in relation to Section 10 of the Act were sent to the Borough Surveyor. National Survey of Atmospheric Pollution. The Health Department maintains six single port (daily) instruments and two eight port (weekly) 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 in the case of single port instruments and weekly in the case of eight port instruments. Recordings are standardised and the results are sent monthly to the Ministry of Technology. The two standard deposit gauges referred to in my last; Report were taken out of use during the year. The average monthly results are indicated in the following tables: — AVERAGE DAILY SMOKE CONCENTRATION (MICROGRAMS PER CU. METRE) 1966 Site Town Hall Atkinson Morley Hospital Public Baths Sewage Works Leopold Road School Lombard Road Grand Drive Morden Primary School Number Wimbledon 3 Wimbledon 4 Wimbledon 5 Wimbledon 6 Wimbledon 7 Merton & Morden 2 Merton & Morden 3 Merton & Morden 6 Jan. N 123 171 121 N 125 119 N Feb. N 36 75 56 N 71 54 38 Mar. N 38 55 50 37 N 38 49 Apr. N 19 60 63 38 N 34 38 May 50 16 26 32 29 N 27 19 Jun. 27 15 22 27 15 22 13 20 Jul. 23 11 20 24 11 19 8 18 Aug. 26 15 20 25 18 23 10 22 Sep. 50 37 48 49 40 46 26 42 Oct. 54 32 56 58 36 52 26 48 Nov. 59 51 86 87 49 77 46 58 Dec. 72 43 94 54 41 63 42 54 N indicates No Recording 73 AVERAGE DAILY SULPHUR DIOXIDE CONCENTRATION (MICROGRAMS PER CU. METRE) 1966 Site Town Hall Atkinson Morley Hospital Public Baths Sewage Works Leopold Road School Lombard Road Grand Drive Morden Primary School Number Wimbledon 3 Wimbledon 4 Wimbledon 5 Wimbledon 6 Wimbledon 7 Merton & Morden 2 Merton & Morden 3 Merton & Morden 6 Jan. N 236 263 254 N 139 197 N Feb. N N 141 133 N 86 105 92 Mar. N 132 143 157 123 N 127 76 Apr. N 148 166 174 152 N 133 113 May 72 68 74 91 67 N 63 64 Jun. 68 66 74 84 65 81 57 49 Jul. 59 44 60 69 50 65 40 47 Aug. 60 60 70 77 65 82 48 58 Sep. 129 134 147 144 134 131 89 104 Oct. 114 96 129 135 111 69 76 86 Nov. 164 160 204 206 165 122 141 123 Dec. 136 120 155 102 109 83 103 91 N indicates No Recording Smoke Control Areas. The Clean Air Act, 1956, embodies provisions designed to reduce pollution from both industrial and domestic sources, including the creation of smoke control areas. Air pollution has an intimate effect upon people's lives and its control is, in my opinion, essential. I consider the prohibition of the use of bituminous coal, and of other smoke producing fuels, and their replacement by smokeless fuels in the form of manufactured solid fuel, gas and electricity, and, under certain approved conditions, oil fuel, to be one of the greatest environmental improvements of our time. The Council has already approved a scheme to cover the Borough with Smoke Control Orders by 1975, and this work is proceeding steadily. The position on 31st December, 1966, was as follows:— Wimbledon Smoke Control Orders— No. 1 1962 Operative date 1.12.63. No. 2 1962 Operative date 1.6.64. No. 3 1963 Operative date 1.10.64. No. 4 1963 Operative date 1.7.65. Merton and Morden Smoke Control Orders— No. 1 1961 Operative date 1.10.62. No. 2 1961 Operative date 1.10.62 No. 3 1962 Operative date 1.10.63. No. 4 1963 Operative date 1.10.64. No. 5 1963 Operative date 1.10.64. No. 6 1964 Operative date 1.10.65. No. 7 1965 Operative date 1.10.66. Mitcham Smoke Control Orders— No. 1 1963 Operative date 1.12.63. No. 2 1963 Operative date 1.11.64. No. 3a 1964 Operative date 1.11.65. 74 L.B. of Merton Smoke Control Orders— No. 1 1965 Operative date 1.10.66. No. 2 1965 Operative date 1.11.66. No. 3 1966 Operative date 1.10.67. No. 4 1967 Operative date 1.10.67. No. 5 1966 Order made 19.10.66 and awaiting confirmation. Area No. 6 Under' survey. Area No. 7 Under survey. The area of the Borough covered by Orders either in operation, confirmed but not operative, or awaiting confirmation is 4,888 acres. The total number of houses involved in these areas is 25,780. Comparable figures at the commencement of the year were 4,335 acres and 22,514 houses. The two Smoke Control Areas under survey at the end of the year will cover an additional 511 acres with 2,566 houses. The total number of visits made during 1966 in connection with the Clean Air Act, 1956, for all purposes, was 12,985. After the operative date of any Order, observations are made from time to time by Public Health Inspectors and Technical Assistants to ensure compliance. Noise Abatement Act, 1960. Excessive and unwanted noise is one of the great problems of modern life, and is often the cause of much suffering. Local authorities have the power to deal with noise nuisances in certain circumstances, and this work often involves Public Health Inspectors in technical problems. During 1966, 95 complaints regarding noise were received, and these entailed the making of 279 visits. Many of the complaints referred to alleged noise nuisance during the night-time, and consequently the majority of the visits were made outside normal office hours, in order to make observations and to record Noise Level Meter readings. All these incidents were dealt with informally, and no legal proceedings were necessary. The Pharmacy and Poisons Acts, 1933-1941 One hundred and thirty-seven applications were received for Certificates of Entry, Retention or Alteration from persons who wished to sell poisons included in Part II of the Prescribed Poisons List. The Fertilisers and Feeding Stuffs Act, 1926. Four samples, consisting of basic slag, bone meal, sulphate of potash and superphosphate, were submitted to the Agricultural Analyst. The sample of basic slag was found to be unsatisfactory, but the origin of this substance could not be established. After consultation with the Ministry of Agriculture, Fisheries and Food further investigation was abandoned. 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. Public Health Inspectors are concerned with Slum Clearance, the repair and 75 reconditioning of houses, the control of houses in multiple occupation and the improvement of houses. The implementation of the Council's slum clearance programme was continued, and a number of houses were inspected for repair, or for Closing Order or Demolition procedure. The total number of visits made to premises of all kinds for the purposes of the Housing Acts was 2,373. Caravan Sites and Control of Development Act, 1960. One licence authorising land to be used as a site for a caravan for a limited period of time was issued during 1966. The number of site licences operating at 31st December, 1966, was six, and the permitted number of caravans, including those kept on two sites occupied by members of the Showmen's Guild, was 42. Twenty-two visits were made to all sites during the year. CONCLUSION The administrative difficulties occasioned by amalgamation have been largely overcome, and this Report reflects the good standard and variety of work which has been maintained by the Public Health Inspectors, Technical Assistants and clerical staff. On 1st January, 1966, there were three vacancies for Public Health Inspectors. During the year one post was filled, but another became vacant, leaving a shortage of three Inspectors at the end of the year. During the year also one pupil Public Health Inspector left, leaving three others in training, and this was the position at 31st December, 1966. My thanks are due to the technical staff for the extra effort required of them in maintaining coverage of those Districts in the Borough where there was no Inspector, and at the same time ensuring a 100 per cent. meat inspection service at the slaughterhouse. It is to be hoped that the staff situation may be improved during 1967, so that more time may be devoted to other aspects of environmental work. G. H. COCKELL Chief Public Health Inspector. 76 ANNUAL REPORT to the EDUCATION COMMITTEE on the work of the SCHOOL HEALTH SERVICE for the year 1966 CONTENTS Page Introductory Letter by Principal School Medical Officer 79-80 Special Services (Education) Sub-Committee as at 31st December, 1966 81 School Clinics provided by the Local Education Authority 82-83 The Service 84 Medical Inspections 84 Audiometry and Audiology 84 Speech Therapy 85 The Work of the School Nurses 85 Psychological Clinic 85-86 Child Guidance Service 86-90 Handicapped Pupils 90 The School Dental Service: Report by Chief Dental Officer 91-92 Statistics on School Dental Service 92-93 Infectious Disease and Prophylactic Measures: Infectious Diseases 94 Prophylactic Measures 94 Epidemiological Surveys 95-96 Ancillary Services: Nursery Schools and Classes 96 Provision of Milk and Meals 96 Appendix 'A': Routine Medical Inspections 97 Other Medical Inspections 97 Return of Defects Found at Medical Inspections 98 Children Found to Require Treatment 99 Classification of General Condition of Pupils 99 Uncleanliness and Verminous Conditions 99 Diseases of the Skin 100 Eye Diseases, Defective Vision and Squint 100 Diseases of the Ear, Nose and Throat 100 Orthopaedic and Postural Defects 100 Other Treatment Given 101 Appendix ' B': Attendances at Clinics 101 Other Medical Examinations by School Medical Officer 101 Recuperative Holidays 101 78 To the Chairman and Members of the Education Committee: Mr. Chairman, Ladies and Gentlemen, I have the honour to present the Annual Report on the School Health Service of the London Borough of Merton for the year 1966. In this second year of operation of this Service, since assuming responsibility as a London Borough, many of the administrative problems present during the initial year had been eliminated; the administration was working more smoothly, and effective liaison had been made, both with schools, and other agencies. This improved administration was reflected in the increased number of school medical inspections—14,078 in 1966 compared with 12,116 in 1965. There was a similar improvement in school dental inspections which numbered 20,024 compared with 16,620 in 1965. Defects found at medical inspections totalled 6,490, an increase of 343 on 1965, being a natural result of an increase in inspections. There were some staff changes during the year. Two School Medical Officers left the Service, Dr. V. Feldman proceeding on normal retirement and being replaced by Dr. W. B. James, and Dr. Alison M. Batten returning to Surrey County Council being replaced by Dr. A. R. Gonet. One Speech Therapist, appointed in the latter part of 1965 resigned in February, but die Authority was fortunate in being able to replace her. The additional post of Speech Therapist provided on the establishment had been filled by the end of the year, although the Speech Therapist appointed was unable to commence duty until early 1967. In the Child Guidance Service, although it was found possible to appoint a second Pyschiatric Social Worker, a third post is still vacant. One Pyschotherapist was also recruited during the year. As a result of a measure of reorganisation of School Departments, their number has been reduced from 83 to 74, but the school population increased by 121. The percentage of school children whose general condition was found to be satisfactory was 99.91 compared with 99.98 in 1965, thus reflecting the continuing high standard of the health of school children in the Borough: 19.35 of the 1966 school population were found at routine medical inspections to require treatment for various defects, mostly minor in character, compared with 14.95 during 1965. As a result of notifications received of two cases of tuberculosis, one of a pupil, and subsequently one of a teacher, two epidemiological surveys were carried out during the year. Regular hygiene inspections of schools had, in the past, only been conducted in the Wimbledon area, but in order to provide a periodic medical check on conditions in schools, and to enable suggestions for improvements made by the school staff or visiting medical staff, to be brought to the notice of the Education Authority, I instructed the School Medical Officers to make these a regular feature of their service to all schools. I am grateful for the help and co-operation received from Mr. R. Greenwood, Chief Education Officer, and his staff, from Head Teachers, and from Secretaries of the many schools in the Borough. 79 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 during the year. I should especially like to thank Mr. W. Atkinson, my Chief Administrative Officer and Mr. E. A. Ayling, the Senior Clerk of the School Health Service Section for their contributions in connection with the preparation of this Report. I am also grateful for the support and encouragement so kindly extended to me at all times by the Chairman and Members of the Special Services (Education) Sub-Committee. I am, Mr. Chairman, Ladies and Gendemen, Your obedient Servant, P. J. DOODY, Principal School Medical Officer. 80 SPECIAL SERVICES (EDUCATION) SUB-COMMITTEE (As at 31st December, 1966) Chairman: : Councillor A. Leivers, J.P., F.I.D., M.N.I.H. Councillor (Mrs.) W. R. Castle (Vice-Chairman) Alderman N. S. Clarke Councillors : E. H. Ceci P. Corbishley D. J. Hempstead G. N. Smith R. A. Spalding W. G. Terrett (Mrs.) J. E. Vowles Co-opted Member: The Rev. C. H. Smith, M.A. Ex-Officio: Alderman V. Talbot, J.P. (Chairman of the Education Committee) Councillor A. M. Anderson, M.A. (Vice-Chairman of the Education Committee) Chief Education Officer: R. Greenwood, M.A. 81 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: Monday afternoons. Morden Road, Merton: Monday mornings. Pelham Road, Wimbledon: Monday and Wednesday mornings. Thursday and Friday 9-10 a.m. (Health Visitors only). Western Road, Mitcham: Monday and Friday mornings. Wednesday 9-10 a.m. (Health Visitors only) Wide Way, Mitcham: Wednesday mornings. Examination of cases referred by Teachers, Education Department, Health Visitors, etc.: Treatment of minor ailments. Child Guidance Clinics All Saints Road, Wimbledon: Sherwood House, Commonside East, Mitcham: Monday to Friday all day. (Cases seen by appointment by Psychiatrist or Educational Psychologist, with the assistance of Psychiatric Social Workers) Ophthalmic Clinics Amity Grove, West Wimbledon: Tuesday mornings. Grand Drive, Raynes Park: Monday and Friday Morden Road, Merton: Wednesday afternoons. Pelham Road. Wimbledon: Friday mornings. Western Road, Mitcham: Wednesday afternoons. Wide Way, Mitcham: Tuesday mornings. Examination and treatment of errors of refraction and squint. 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 morning Detailed investigation of cases referred. Psychological Clinic Pelham Road, Wimbledon: Every third Monday morning Cases referred for special attention. 82 Remedial Exercises Amity Grove, West Wimbledon: Tuesday mornings. Pelham Road, Wimbledon: Tuesday and Thursday afternoons. Wide Way, Mitcham: Tuesday afternoons. Remedial and breathing exercises as recommended by School Medical Officers. Speech Therapy Clinics Amity Grove, West Wimbledon: Thursday afternoons. Grand Drive, Raynes Park: Wednesday all day. Middleton Road, Morden: Tuesday mornings and Wednesday afternoons. Morden Road, Merton: Thursday mornings. Russell Road, Wimbledon: Monday all day and Tuesday afternoons. Western Road, Mitcham: Tuesday mornings and afternoons. Wide Way, Mitcham: Friday mornings and afternoons. Treatment of speech defects. Dental Clinics Amity Grove, West Wimbledon: Monday to Friday all day. Church Road, Mitcham: Monday and Wednesday all day. Grand Drive, Raynes Park: Monday to Thursday all day. Meopham Road, Mitcham: Monday, Tuesday, Thursday, Friday, all day. Middleton Road, Morden: Monday to Friday all day. Morden Road, Merton: Monday, Wednesday Friday, all day. Pelham Road, Wimbledon: Monday to Friday all day. Western Road, Mitcham: Monday to Friday all day. 83 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 39 Number of children tested 2,129 Number of primary failures 240 Since it was felt that some of the older children had not had the opportunity of having a hearing test, to ascertain the number of children who might be so affected, the audiometrician visited six secondary schools during the year. 1,694 school children in the six 84 secondary schools visited were tested, 57 of whom failed the audiometric test. SPEECH THERAPY Number of sessions held (a) for treatment 1,038 (b) for consultation 160 Number of cases on register at beginning of year 190 Number of cases added during year 126 Number of cases discharged during year 135 Number of cases on register at end of year 181 Cases discharged during the year who:— Achieved normal speech 54 Were greatly improved 39 Showed some improvement 23 Showed little or no improvement 19 Analysis of cases treated during year:— Stammering 24 Dyslalia 166 Cleft palate 7 Dysarthria 3 Cluttering 2 Aphasia 3 Defects of voice 3 Defective speech due to deafness 6 Retarded speech 39 THE WORK OF THE SCHOOL NURSES Talks in schools on preparation for adult life, have been given for the first time to a mixed group of children. This experiment has been initiated in Western Road Secondary School, under which groups of 16 school leavers are given four talks each by the Senior Medical Officer and a Health Visitor. Two talks are given to eight girls and boys separately, and the first and last talks are given to mixed groups. First-aid talks have also been given to mixed groups by a Health Visitor in Alphea Secondary School. Results, so far, are encouraging, and it is hoped to extend the experiment gradually in 1967. In other respects, the work of the Health Visitor/School Nurse continued on similar lines to 1965. PSYCHOLOGICAL CLINIC Dr. Cicily Clarke, the Assistant Medical Officer in charge of this Clinic has contributed the following comments on the Psychological Clinic held at Pelham Road Clinic every Monday morning each month:— 'In my opinion, this clinic for special cases has provided a much-needed service—a sort of " half-way house " between the routine "toddlers" or "school" clinics, and the Child Guidance Service. 85 'Children of all ages have been seen, and time has been available to ascertain the reasons behind their difficulties. Parents and children have been interviewed separately and together, as required. Recall appointments have been made according to individual need. 'Often there has been a failure in communication between parent and child, or else unfortunate attitudes have been adopted. Either or both of these can often be modified by an outsider. 'Some children with special problems and behaviour difficulties are substantially helped and discharged, others can be partially helped, yet others, for a variety of reasons are sent into the Child Guidance Clinic. 'I submit that the special cases clinic, if adequately used, can be an ideal way to decrease the load on the Child Guidance Service.' CHILD GUIDANCE SERVICE I am indebted to the Chief Education Officer for the following report on the work of the Child Guidance Clinics during the year:— 1. General During 1966 the staffing position in the Child Guidance Service fluctuated, but by September, when the second educational psychologist was appointed, both the Wimbledon and Mitcham Clinics were fully staffed, with the exception of the third post of psychiatric social worker. This has gready facilitated the work of the service in the Borough. 2. Establishment The combined establishment of professional staff for the two Child Guidance Clinics as at 31st December, 1966, was as follows:— 2 Psychiatrists—six half-day sessions per week each. 2 educational psychologists—full-time. 3 psychiatric social workers—full-time (one post vacant). 1 psychotherapist—full-time (0.2 vacant). The appointment of an additional psychotherapist is under consideration. 3. Remedial Classes Since the last report a third remedial class has been opened at Lonesome Junior School, Mitcham, for children who for one reason or another have fallen behind with their school work. 4. Visits to Schools (a) The further development of Cambridge House as a school for primary maladjusted children has been most advantageous and co-operation has developed between the Head Teacher and the Child Guidance Service. This is proving most beneficial to all concerned. (b) The Assistant Education Officer (Special Services), the educational psychologists and psychiatric social workers have 86 visited a number of independent special schools outside the Borough where Merton pupils are placed to ensure that both the educational and living facilities are satisfactory. In conclusion it should be mentioned that there has been the fullest co-operation between the Child Guidance Service and the Medical Officers especially in the cases of children ascertained as educationally sub-normal but who in addition have symptoms of maladjustment or emotional disturbance. This co-operation ensures that children are placed in the most suitable educational environment. The work of the Merton Child Guidance Service is given in statistical form as follows:- (A) The General Work of the Child Guidance Clinics 1. New Referrals. M. F. Total. (a) Referring agencies:— Courts or probation officers 8 - 8 School Health Service 45 24 69 Hospitals or specialists 3 1 4 General practitioners 8 4 12 Schools 36 29 65 Parents 7 4 11 Others 11 6 17 Total 118 68 186 (b) Predominant reasons for referral:— Nervous disorders 18 14 32 Behaviour problems 55 25 80 Habit disorders 9 6 15 Educational problems 36 20 56 Pyschosomatic disorders - 3 3 Others — — — Total 118 68 186 (c) Number of cases on diagnostic waiting list 16 15 31 (d) Reasons why no diagnostic interview undertaken: — Transferred to other areas 3 — 3 Failed to atend appointments 3 3 6 Improved — 1 1 Total 6 4 10 (e) Ages of children when referred:— Under 5 years 11 3 14 5-6 years 21 9 30 7-8 years 33 12 45 9 - 10 years 18 16 34 11-12 years 17 11 28 13 -14 years 15 13 28 Over 14 years 3 4 7 Total 118 68 186 87 2. New Cases Seen. M. F. Total. (a) Referring agencies:— Courts or probation officers 7 — 7 School Health Service 38 20 58 Hospitals or specialists 2 — 2 General practitioners 8 5 13 Schools 34 23 57 Parents 6 2 8 Others 10 6 16 Total 105 56 161 (b) Range of intelligence quotients of cases:— Inferior I.Q. below 71 2 2 4 Limited I.Q. 71-85 11 6 17 Low average I.Q. 86 - 95 16 11 27 Average I.Q. 96 - 105 32 14 46 Good average I.Q. 106-115 15 8 23 Above average I.Q. 116- 130 14 11 25 Superior I.Q. 131-150 1 — 1 Exceptional I.Q. 151+ 1 — 1 Not tested 10 4 14 Untestable 3 — 3 Total 105 56 161 (c) Action taken:— Consultation and advice 19 12 31 Psychotherapy 12 7 19 Placed on waiting list for psychotherapy 19 13 32 Remedial tuition 4 1 5 Case work with parents only 17 4 21 Placement in special schools, etc. 8 5 13 Placement in speecial schools, etc., being sought 3 3 Periodic supervision 18 14 32 Other action 5 — 5 Total 105 56 161 (d) Results of action taken, insofar as it is possible to judge at present:— Improved 14 14 28 Slightly improved 23 10 33 Not yet improved 17 10 27 Doubtful 32 9 41 Not applicable 19 13 32 Total 105 56 161 3. Current case-load on 31st December, 1966. Cases under treatment 32 11 43 Cases under supervision 158 70 228 Cases awaiting treatment 31 22 53 Total 221 103 324 88 4. Summary of Work Involved. (a) Psychiatrists: — Interviews for diagnosis or assessment 257 Interviews for treatment 745 Interviews with parents or guardians 94 Interviews with social workers or other officials 46 Other interviews 10 Visits, meetings, etc., outside the Clinic 31 Appointments arranged but not attended 174 Total 1,357 (b) Psychotherapists:— Interviews for treatment 630 Interviews with parents or guardians 3 Interviews with social workers or other officials 12 Other interviews — Visits, meetings, etc., outside the Clinic 8 Appointments arranged but not attended 33 Total 686 (c) Educational Psychologists:— Interviews with children for examination 105 Interviews with children for remedial tuition 115 Interviews with parents or guardians 5 Interviews with other officials 30 Visits outside Clinic (not schools) 21 Appointments arranged but not attended 6 Total 282 (d) Pyschiatric Social Workers:— Interviews with parents or guardians at Clinic 1,557 Interviews with parents or guardians at home 108 Interviews with children 17 Interviews with other social workers or officials 82 Visits to schools, hostels, etc. 24 Other visits 35 Appointments arranged but not attended 135 Total 1,958 (B) The work of the Educational Psychologist in the Schools 1. Referring agencies:— M. F. Total. (a) Chief Education Officer 19 10 29 (b) School 74 55 129 (c) Parent 8 5 13 (d) School Medical Officer 6 3 9 (e) Other 4 2 6 Total 111 75 186 89 2. Types of Schools attended:— M. F. Total. (a) Nursery 1 — 1 (b) Infant 18 13 31 (c) Junior 65 39 104 (d) Secondary 11 8 19 (e) Grammar 1 — 1 (f) Private 1 5 6 (g) To be placed 14 10 24 Total 111 75 186 3. Main Problem:— (a) Learning 79 52 131 (b) Behaviour 16 12 28 (c) Other 16 11 27 Total 111 75 186 4. Disposal:— (a) Remedial class 24 5 29 (b) Remedial tuition at the Clinic 3 1 4 (c) Child Guidance Clinic (general) 14 13 27 (d) Supervision 45 41 86 (c) Recommendation for special school 7 2 9 (f) Recommendation to Chief Education Officer 16 10 26 (g) Recommendation to Principal School Medical Officer 2 2 (h) Others 2 1 3 Total 111 75 186 5. Supervision from previous years 99 31 130 Supervision from 1966 37 32 69 Total under supervision 136 63 199 Total discharged from supervision, end of 1966 33 12 45 6. Parents of children seen 25 14 39 7. Schools—Group Testing for Remedial Classes:— 16 schools. Number of children 8+ tested 494 8. Total number of school visits 322 HANDICAPPED PUPILS Numbers of Handicapped Pupils 90 The following table gives the numbers of pupils on the Handicapped Pupils' Register on 31st December, 1966, together with the numbers ascertained during the year:- Classification Total ascertained during year Total ascertained at 31.12.66 Blind 2 9 Partially-sighted 1 8 Deaf 1 13 Partially-hearing - 6 Educationally subnormal 46 197 Epileptic - 2 Maladjusted 27 69 Physically-handicapped 6 32 Delicate 10 30 Totals 93 366 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 3 5 - - 8 Partially-sighted 7 1 - — 8 Deaf 5 7 - — 12 Partially-hearing 6 - - — 6 Educationally-subnormal 164 9 - — 173 Epileptic - 2 - — 2 Maladjusted 22 42 - 4 68 Physically-handicapped 22 8 - 1 31 Delicate 21 9 - 4 34 Totals 250 83 - 9 342 Children unsuitable for Education in Ordinary Schools During the year 13 children were reported as suffering from a disability of mind of such nature and to such extent as to make them unsuitable for education at school. THE SCHOOL DENTAL SERVICE Mr. M. T. Gibb, the Chief Dental Officer, has contributed the following report on the operation of the School Dental Service during the year:— 'At 31st December, 1966, the Dental Staff consisted of the Chief Dental Officer, four full-time Dental Officers, seven part-time Dental Officers, and two part-time Orthodontists, giving a whole-time equivalent of 7.9 Dental Officers. The Authority also employs two Dental Auxiliaries (whole-time equivalent 1.6). Five sessions per week are devoted to orthodontic treatment. 91 'There were no changes in the full-time staff during the year, but there were many changes among the sessionally employed Dental Officers and Orthodontists. 'Improvements in equipment and amenities have been carried out in most of the Dental Clinics and approval has been obtained for the installation of two new units in the second surgeries at Amity Grove and Pelham Road Clinics next year. ' In accordance with Ministry of Health requirements regarding the use of X-rays, tests of our four X-ray machines have been carried out by the Radiological Protection Service and all staffs using the machine have undergone a six-month monitoring test with satisfactory results. ' In spite of a slight reduction in staff in 1966, some 3,400 more children were inspected at schools and 69 sessions were devoted to Dental Health Education compared with only one in 1965. 'It would appear that more of the older children are receiving their dental treatment in the General Dental Service and we in the School Service are getting a higher proportion of the younger children. The amount of work carried out for pre-school children has nearly doubled in the last year. This early regular treatment, coupled with advice to the parents on diet and oral hygiene, greatly reduces the risk of a child requiring extensive dental treatment later on. 'A sustained campaign of Dental Health Education has been carried on during the year with talks and films at Parentcraft Classes by the Chief Dental Officer and by speakers from the Oral Hygiene Service. Extensive use has been made of posters and pamphlets. This campaign is carried into the schools with the co-operation of Head Teachers and their staffs by the Dental Auxiliaries who give suitable talks and demonstrations to children in different age groups. Health Visitors are also co-operating with us in this field.' Statistics for Year 1966 Number of pupils on the register of maintained primary and secondary schools including nursery and special schools in January, 1967, as in Forms 7, 7m, and 11 schools—24,522. Attendances and Treatment. Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First Visit 2,295 2,047 654 4,996 Subsequent Visits 4,255 5,275 2,049 11,579 Total Visits 6,550 7,322 2,703 16,575 Additional courses of treatment commenced 541 438 165 1,144 Fillings in permanent teeth 1,845 3,812 1,411 7,068 Fillings in deciduous teeth 3,733 331 4,064 Permanent teeth filled 1,571 3,339 1,247 6,157 Deciduous teeth filled 3,368 302 3,670 Permanent teeth extracted 63 382 81 526 Deciduous teeth extracted 1,152 460 1,612 General anaesthetics 570 303 31 904 Emergencies 157 61 19 237 92 Number of pupils X-rayed 515 Prophylaxis 2,325 Teeth otherwise conserved 1,880 Number of teeth root filled 38 Inlays — Crowns 6 Courses of treatment completed 5,130 Orthodontics. Cases remaining from previous year 65 New cases commenced during year 197 Cases completed during year 117 Cases discontinued during year 27 Number of removable appliances fitted 276 Number of fixed appliances fitted 1 Pupils referred to Hospital Consultant 2 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) 3 1 — 4 Number of dentures supplied 3 1 — 4 Anaesthetics. General Anaesthetics administered by Dental Officers—Nil. Inspections. (a) First inspection at school: number of pupils 20,024 (b) First inspection at clinic: number of pupils 2,193 Number of (a) + (b) found to require treatment 8,161 Number of (a) + (b) offered treatment 7,201 (c) Pupils re-inspected at school clinic 5,473 Number of (c) found to require treatment 2,992 Sessions. Sessions devoted to treatment 3,208 Sessions devoted to inspection 215 Sessions devoted to Dental Health Education 69 93 INFECTIOUS DISEASES AND PROPHYLACTIC MEASURES 1. Infectious Diseases Infectious Diseases notified by Schools. Disease Suffering Excluded on suspicion Infection at home Total exclusions Smallpox — — — — Diphtheria — — — — Poliomyelitis — — — — Scarlet Fever 22 1 5 28 Enteric Fever — — — — Measles 167 — 1 168 Whooping Cough 22 1 — 23 German Measles 82 2 — 84 Chicken Pox 198 — — 198 Mumps 255 2 4 261 Jaundice - — — — Influenza 20 — — 20 Other 41 2 — 43 Totals 807 8 10 825 Contagious Diseases notified by Schools. Disease Suffering Excluded on suspicion Total exclusions Ringworm — — — Impetigo 6 — 6 Scabies — — — Other 6 — 6 Totals 12 — 12 Compared with 1965 there were 662 fewer cases of communicable disease notified and 700 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 1966 was as follows: — Number of childen vaccinated 161 Number of children given re-inforcing doses 1,108 I am pleased to say that no case of Poliomyelitis occurred in the area in 1966. 2. Diphtheria/Tetanus Immunisation. Number of children given immunisation 273 Number of children given re-inforcing doses 3,018 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. 94 3. Protection of School Children against Tuberculosis. B.C.G. Vaccination. Percentage. Number in age group 2,105 Number of consents 1,807 85.84% Number skin tested 1,740 82.66% Number Mantoux positive 126 5.98% Number B.C.G. Vaccinated 1,614 76.70% EPIDEMIOLOGICAL SURVEYS During the year, two epidemiological surveys were carried out, details of which are given below:— 1. Survey at Secondary Boys' School A survey was conducted in June, 1965, on the admission of a pupil to hospital suffering from tuberculosis. With the notification of a member of the teaching staff in September, 1965, as suffering from infectious tuberculosis, a second limited survey became necessary. On the advice of the Chest Physician arrangements were made in February, 1966, with parental consent for all pupils in attendance who were not known positive reactors to a tuberculin skin test to be so tested, and subsequendy in March, 1966, for positive reactors from these tests to be chest X-rayed together with those already known to be positive reactors and members of the teaching and ancillary staffs. Three hundred and twenty-nine pupils were skin tested and 35 proved positive. Six were already under chest clinic supervision and were not included in the survey. In March, 1966, the Surrey Mass X-ray Unit attended the school and 419 boys were chest X-rayed including the 35 positive reactors from the skin tests. Six boys were referred to the chest clinic for further investigation but none subsequently showed evidence of tuberculosis. There were 76 teaching and ancillary staff of whom 54 were X-rayed, all with satisfactory results. The parents of all pupils who were absent or who failed to reply to the survey notice or who sent refusals were advised of the importance of chest X-ray examinations and were sent details of public mass X-ray sessions for their children to attend. No further cases of tuberculosis were discovered at the school following the above measures. 2. Survey at Primary School In December, 1965, a teacher employed on the staff of a primary school was notified as a case of pulmonary tuberculosis and the Chest Physician advised that an epidemiological survey should be conducted to establish whether any other cases existed at the school and the spread (if any) of infection. The parents of all children attending the school were notified of the proposal to conduct a survey and the opportunity for children to be included was extended to those who had been transferred to other schools in the area since the teacher commenced at this primary school. 95 The survey was carried out in February, 1966, at which time there were 257 children on the nominal roll of the school. 245 children were skin tested of whom eight were regarded as definite positive reactors to the test. Refusals were received in four cases only and, finally, only two children were absentees for the skin test and these two children later received a skin test. Nine children who had already received B.C.G. vaccination were under the supervision of a chest clinic and were not included in the survey. Two children had moved outside the area of the authority and in these cases the appropriate school health authority was notified of the circumstances necessitating the survey. All positive reactors to the skin tests were referred to the chest clinic for chest X-rays and in addition 20 members of the teaching and ancillary staff obtained chest X-ray examinations. All the X-rays were satisfactory. No further case of tuberculosis was discovered as a result of this survey. ANCILLARY SERVICES 1. Nursery Schools/Classes There were 570 children attending the nursery schools and nursery classes at the infants' schools during the year. 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 1965: — 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, 1966 22,544 18,475 81.9 506 15,864 16,370 72.6 96 Appendix ‘A’ MEDICAL INSPECTION AND TREATMENT (Excluding Dental Inspection and Treatment) Return for the year ended 31st December, 1966 Number of pupils on registers of maintained, primary, secondary, special and nursery schools in January, 1967:— (a) Ordinary schools 23,782 (b) Special schools 170 (c) Nursery Schools and Classes 570 Total 24,522 SECTION A. Routine Medical Inspections. Age Groups Inspected (By year of birth) Number of Children Inspected 1962 and later 605 1961 1,841 1960 397 1959 189 1958 1,739 1957 188 1956 140 1955 1,160 1954 1,958 1953 674 1952 263 1951 and earlier 2,051 Total 11,205 Other Medical Inspections. Type of Inspection Number of Children Inspected Special Inspections 1,857 Re-Inspections 1,016 Total 2,873 97 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 115 169 204 32 Eyes (a) Vision 1,053 713 859 53 (b) Squint 97 40 16 — (c) Other 33 46 16 4 Ears (a) Hearing 42 95 41 111 (b) Otitis Media 12 62 — 2 (c) Other 6 23 3 3 Nose and Throat 80 371 28 23 Speech 68 82 42 9 Lymphatic Glands 7 89 3 2 Heart and Circulation 24 76 2 4 Lungs 71 151 4 12 Development (a) Hernia 6 18 — — (b) Other 31 129 4 16 Orthopaedic (a) Posture 22 60 3 9 (b) Flat Foot 50 117 10 14 (c) Other 60 159 26 35 Nervous System (a) Epilepsy (b) Other 9 4 7 29 - 2 Psychological (a) Development 8 38 2 - (b) Stability 31 81 8 13 Abdomen 10 45 3 7 Other defects and diseases 48 247 31 100 Totals 1,887 2,847 1,305 451 Four thousand seven hundred and thirty-four defects were found in children at routine medical inspections of which 1,887 were referred for treatment and 2,847 for observation, 1,756 defects were found at special inspections, 1,305 being referred for treatment and 451 for observation. The total number of defects referred for treatment and observation in 1966 was 6,490. 98 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 1962 and later 605 32 % 5.29 1961 1,841 274 14.88 1960 397 6C 15.11 1959 189 33 17.41 1958 1,739 273 15.70 1957 188 32 17.02 1956 140 18 12.86 1955 1,160 231 19.91 1954 1,958 295 15.07 1953 674 93 13.80 1952 263 38 14.45 1951 and earlier 2,051 351 17.11 Totals 11,205 1,730 15.44 Classification of General Condition of pupils inspected during 1966 Group Number of children inspected Percentage found satisfactory Percentage found unsatisfactory 1962 and later 605 % % 99.84 0.16 1961 1,841 99.84 0.16 1960 397 99.75 0.25 1959 189 100 1958 1,739 99.94 0.06 1957 188 100 - 1956 140 100 - 1955 1,160 99.91 0.09 1954 1,958 99.95 0.05 1953 674 99.85 0.15 1952 263 100 1951 and earlier 2,051 99.95 0.05 Totals 11,205 99.91 0.09 SECTION B. Treatment Uncleanliness and Verminous Conditions. 1. Total number of individual examinations of pupils by Health Visitors in Schools 10,519 2. Number of individual pupils found to be infested 97 3. Number of exclusions:— First time 12 Second time 8 20 4. Number of pupils cleansed 26 99 Diseases of the Skin (excluding uncleanliness) Diseases of the Skin. Number of cases treated or under treatment during the year. Ringworm—scalp — Ringworm—body — Scabies 1 Impetigo 1 Other skin diseases 314 Total 316 Eye Diseases, Defective Vision and Squint. Eye Diseases and Defects. Number of cases known to have been dealt with. External or other, excluding errors of refraction or squint 37 Errors of refraction (including squint) 3,495 Total 3,532 Number of pupils for whom spectacles were prescribed 934 Diseases of the Ear, Nose and Throat. Diseases and Defects. Number of cases known i to have been treated. Received operative treatment:— (a) for diseases of the ear — (b) for adenoids and chronic tonsillitis 7 (c) for other nose and throat conditions - Received other forms of treatment 85 Total 92 Orthopaedic and Postural Defects. Number of cases known to have been treated in Clinics or Out-Patient Departments 246 83 sessions were held at Pelham Road Remedial Exercises Clinic during 1966. 35 new cases were admitted and 22 old cases discharged. 42 sessions were held at Amity Grove Remedial Exercises Clinic during 1966. 13 new cases were admitted and 10 old cases discharged. 38 sessions were held at Wide Way Remedial Exercises Clinic during 1966. 25 new cases were admitted and 14 old cases discharged. 71 sessions were held at St. Christopher's Special School and Eagle House Annexe Remedial Exercises Clinic during 1966. 27 new cases were admitted and 36 old cases discharged. 100 Other Treatment Given. Ailments. Number of cases treated. Miscellaneous minor ailments 410 Lymphatic Glands 7 Heart and Circulation 25 Lungs 66 Development (Hernia and Other) 35 Nervous System 12 Total 555 Appendix ‘B’ 1. General Medical/Minor Ailment Clinics. Attendances made by children at General Medical/Minor Ailment Clinics 3,843 2. Other Medical Examinations undertaken by School Medical Officers. (a) Children examined for part-time employment 523 (b) Children examined for Entertainment Licences 7 In addition to medical examinations specified as above, School Medical Officers in their capacity as Assistant Medical Officers of Health also carried out 845 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 44 All these children had seaside holidays and when examined on their return were all found to have benefited. 101