MER 22. London Borough of Merton 1968 1968 THE HEALTH OF MERTON The Annual Report of the MEDICAL OFFICER OF HEALTH and the PRINCIPAL SCHOOL MEDICAL OFFICER P. J. DOODY, M.B., B.Ch., B.A.O., D.P.H. THE HEALTH OF MERTON by P. J. DOODY, M.B., B.Ch., B.A.O., D.P.H. Printed by H. G. Mather, Ltd., Lower Green, Mitcham, Surrey 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, 1967 18 Principal Causes of Death in Order of Frequency 18 Causes of Death at Different Periods of Life 17 Infant Deaths 19 Infant Mortality 19 Perinatal Mortality 19 Maternal Mortality 19 Control of Communicable Diseases: Notifications received during 1968 20 Food Poisoning 21 Tuberculosis: Chest Clinics 21 Domiciliary Visiting 22 B.C.G. Vaccination 22 Incidence of Tuberculosis 22 Mass X-Ray 23 Deaths 23 After-Care of the Tuberculous 23 Prophylactic Measures 24-25 Venereal Diseases 25 General Medical Services 25 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 3 Page Child Welfare: General 28-29 Attendances at Child Welfare Centres 29 Attendances at Toddlers' Clinics 30 Dental Care 30 Day Nurseries 30-31 Developmental Clinic 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 Training of Health Visitors 33 General Practitioner Attachments 33 Summary of Work of Health Visitors 33-34 Midwifery: Staff 34 Introductory 34 Organisation 34 Maternity Cases Attended 35 Inhalational Analgesia 35 Ophthalmia Neonatorum 35 Maternity Outfits 35 Medical Aid 35 Early Discharges from Hospital 35 Midwifery Training 35 Post-Graduate Courses 35 Domiciliary Visits 36 Attendances at Clinics 36 Transfers to Hospital 36 Maternity Liaison Committee 36 Home Nursing: Staff 36 Organisation 37 Training of District Nurses 37 Post Graduate Courses for District Nurses 37 Cases Attended 38 Visits Made 38 Marie Curie Foundation Cancer Nursing Service 38 4 Page Incontinence Pads 39 Incontinent Laundry Service 39 Domestic Help Service: Staff 39 Organisation 39 Statistics 40 Details of Sources of Application 40 Hours worked by Home Helps 40 Prevention of Illness, Care and After-Care: Clinic for Older People 41 Health Education 41-42 Chiropody Service 42 Ripple Bed Service 43 Sick Room Equipment 43 Recuperative Holidays 44 Cervical Cytology 44 Family Planning 44-45 Mental Health and Social Work Services: Introduction 46 General 46 Staff 46 Training of Staff 47 The work of the Mental Welfare Officers 47 Co-ordination of the Hospital Services 47-48 Community Care of the Mentally Disordered 48 Attachment to Group Practices 48 Subnormality: Cases in Community Care 49 Special Care Unit 49 Junior Training Centre 49-50 Adult Training Centre 50 Short Term Care 50 Other Forms of Mental Disorder: Cases dealt with by Mental Welfare Officers 51 Guardianship 51 Patients receiving Community Care 51 Cases Boarded Out 51-52 Social Work Section: Staff 52 General 52 Social Casework 52 5 Page SANITARY CIRCUMSTANCES OF THE AREA: Services under the Public Health Acts: Water Supply 55-57 Sewerage and Sewage Disposal 57 Registered Common Lodging Houses 57 District Inspection 57-60 Cleansing Station 62 Services under the Food and Drugs Act: Milk and Dairies (General) Regulations, 1959 62 Milk (Special Designations) (Amendment) Regulations, 1965 62 Milk (Special Designations) Regulations, 1963 62 Brucella Abortus 63 Ice-cream 63 Meat and Other Foods 63-64 Meat Inspection 64 Poultry Inspection 64 Food Premises 65 Bacteriological Examination of Equipment 65-66 Food Inspection 66-68 Sampling of Food and Drugs 68-74 Services under Other Enactments: Rent Act, 1957 75 Shops Acts, 1950-65 75 Offices, Shops and Railway Premises Act, 1963 75-76 Prevention of Damage by Pests Act, 1949 76-77 Pet Animals Act, 1951 77 Riding Establishments Act, 1964 78 Diseases of Animals Act, 1950 78 Clean Air Act, 1956 78-83 Factories Act, 1961 61-62 Noise Abatement Act, 1960 83 Pharmacy and Poisons Acts, 1933-1941 83 Fertilisers and Feeding Stuffs Act, 1926 83 Housing Acts, 1957-1964 83-84 Caravan Sites and Control of Development Act, 1960 84 Greater London (General Powers) Act, 1967 (Hairdressers and Barbers) 84 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 1968. The Registrar-General's estimate of population showed an increase from 183,050 in 1967 to 184,220 in 1968. The live birth rate fell from 15.01 in 1967 to 14.17. There were consequently 137 less live births in 1968. The factors which have influenced a falling population in the past, are still present in spite of an increase in the estimated population. There were 2,610 live births compared with 2,747 in 1967. The increasing extent to which the policy of early discharge, within 48 hours, of maternity cases, has been implemented in this area, has produced a steady fall over the last four years in the percentage of total live births which were domiciliary, with a corresponding rise in the percentage of hospital births. The effect of this new policy can be seen from the following figures:— Year Percentage of total live births at home Percentage of total live births in hospital 1965 15.5 84.5 1966 14.1 85.9 1967 13.2 86.8 1968 12.25 87.75 A most pleasing feature of 1968 was the fall in the number of infant deaths from 45 to 38 producing an infant mortality rate of 14.60 compared with 16.38 for 1967. This infant mortality rate of 14.60 compares most favourably with that of England and Wales of 18.0 per 1,000 live births. The number of still births showed a decline from 15 in 1967 to 10. The still birth rate per 1,000 live and still births was thus reduced from 12.93 in 1967 to 9.49. This rate of 9.49 compares most favourably with the national rate of 14.0. Neonatal deaths showed a distinct fall from 36 in 1967 to 27 and the neonatal mortality rate was 10.34 compared with 13.10 for 1967. The rate for England and Wales for 1968 was 12.3. The perinatal mortality rate fell from 24.07 in 1967 to 23.90. The comparable figure for England and Wales for 1968 was 24.7. There were only three fewer deaths in 1968 compared with 1967. The increase in the estimate of population resulted in a fall in the crude death rate from 11.15 for 1967 to 11.06. It is most pleasing to note that there was no maternal death during the year. There were no serious outbreaks of infectious disease during the year. Notifications received totalled only 474, compared with 1,777 in 1967. The operation of the Department's services continued smoothly during the year. Work was begun on the new Senior Training Centre in Wandle Way, Mitcham. 7 Difficulties were encountered during the year in recruiting a full complement of Public Health Inspectors and the Department continued to find it increasingly difficult to recruit qualified Social Workers. This emphasises the comments made in my previous Reports that the best means of ensuring a cadre of qualified Social Workers in the future will be to endorse a continuing policy of recruitment of trainees who may be sponsored by the Authority on approved initial training courses, or approved post-graduate courses. Co-operation with General Practitioners, the Hospital Service, voluntary and statutory bodies and with other Departments of the Authority was good throughout the year. During the year there were published the Green Paper on ' The Administrative Structure of the Medical and Related Services in England and Wales' issued by the then Minister of Health, and the ' Report of the Seebohm Committee on Local Authority and Allied Personal Social Services'. These reports, the implementation of which would have a profound effect on the Health Department Services, are being studied. My thanks are due to all members of the Health Department staff for the loyal and efficient manner in which they performed their duties during the year. My special thanks are due to Mr. Cockell, the Chief Public Health Inspector, and to 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 help and ready co-operation at all times. I should like to express my appreciation to the Chairman and Members of the Health Committee for the support they have given me and for the consideration and courtesy which they have shown to me, during the year. I have the honour to be, Your obedient Servant, P. J. DOODY, Medical Officer of Health. 8 COMMITTEES AT 31st DECEMBER, 1968 HEALTH COMMITTEE The Mayor, Alderman N. S. Clarke, J.P. Councillor A. M. Anderson, M.A. (Chairman) Councillor (Miss) N. K. Watts (Vice-Chairman) Alderman T. H. Metcalf Councillors: (Mrs.) E. M. Davis K. L. Goddard A. S. Hutchin G. S. Lewis R. J. H. Pike G. H. Raymond P. J. Shurville G. N. Smith J. Wemms 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). ENVIRONMENTAL HEALTH SUB-COMMITTEE Councillor G. H. Raymond (Chairman) Councillor A. S. Hutchin (Vice-Chairman) Councillor A. M. Anderson, M.A. (Chairman of the Health Committee) Councillor (Miss) N. K. Watts (Vice-Chairman of the Health Committee) Alderman T. H. Metcalf Councillors: (Miss) L. Hirst R. J. H. Pike G. N. Smith TOWN CLERK Sydney Astin (Solicitor) 9 WHOLE-TIME STAFF (As at 31st December, 1967) Medical Officer of Health and Principal School Medical Officer Deputy Medical Officer of Health and Deputy Principal School Medical Officer Additional Deputy Medical Officer of Health and Deputy Principal School Medical Officer Senior Medical Officer Assistant Medical Officers and School Medical Officers Chief Dental Officer School Dental Officers Dental Auxiliary Chief Public Health Inspector Deputy Chief Public Health Inspector Superintendent Health Visitor Superintendent of Midwifery and Home Nursing Service Home Help Organiser Chief Administrative Officer Deputy Chief Administrative Officer Senior Mental Welfare Officer Deputy Senior Mental Welfare Officer P. J. Doody, M.B., B.Ch., B.A.O., D.P.H. W. D. Swinney, M.B, Ch.B., D.P.H. Elsa H. Todd, M.B., Ch.B., D.P.H D. M. O. Lowry, M.A., M.R.C.S., L.R.C.P. D.P.H., D.I.H., D.T.M. and H. (commenced 3.9.68) 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. W. James, M.R.C.S., L.R.C.P. J. F. Kelly, M.B., B.Ch., B.A.O., D.P.H. L. W. McNamara, M.B., B.S., D.P.H. Elizabeth Pryce-Jones, M.B., Ch.B., D.C.H. Joan P. Tom, M.B., B.S., D.C.H. M. T. Gibb, L.D.S., R.C.S. D. K. Hardy, L.D.S., R.C.S. (commenced 1.10.68) H. W. Freeth, L.D.S., R.C.S., M.R.C.S., L.R.C.P. Ann C. Leonard, L.D.S., R.C.S. (commenced 25.9.67) S. P. Motani, L.D.S. (commenced 22.4.68) Miss A. Chandler G. H. Cockell, F.A.P.H.I., F.R.S.H. G. E. Hayne, M.A.P.H.I., M.R.S.H. Miss P. M. Richards, S.R.N., S.C.M., H.V.Cert. Miss O. Williams, S.R.N., S.C.M., Q.N. (commenced 18.9.68) Miss M. J. Faraday W. Atkinson, D.P.A., Cert. S.I.B. J. R. Richardson, A.R.I.P.H.H. F. T. Rainer, Dip.Soc. Science. F. J. Gerring 10 Mental Welfare Officers Mental Health Social Worker Senior Social Worker Social Workers Supervisor, Junior Training Centre Educational Psychologists Psychiatric Social Workers Psychotherapist Speech Therapists Audiometrician Mrs. J. Barber, S.R.N., S.C.M. F. C. Dorrington Miss D. A. Tilt, Dip. Soc. Studies, Dip. Mental Health S. G. H. Worrall Mrs. H. Yates, S.R.N., Cert. in Applied Social Studies Mrs. F. M. Coleman, Dip. Soc. Studies & Soc. Admin. Mrs. M. A. Tripet, S.R.N., H.V. Cert., Dip. Soc. Studies Mrs. M. J. Jacks, B.Sc. (Hons. Sociology) Miss P. M. S. Cannings, C.I.S.W. Training (commenced 1.8.68) Mrs. M. Barlow, Dip.N.A.M.H. Mrs. M. J. Badawi, B.A. (Hons.), Lond., Post-Graduate Diploma in Psychology Miss D. Waldeck, B.A. (Hons.) Miss M. F. Bosanquet, A.A.P.S.W., B.A. (Hons.) London Mrs. B. Litauer, A.A.P.S.W., Mental Health Diploma, London, Social Science Diploma, London Mrs. I. Windebank, A.A.P.S.W., Mental Health Diploma, London, Social Science Diploma, London Mrs. M. Livesey, N.F.F. Diploma, Assocn. of Child Psychotherapists Miss G. M. Stephenson, L.C.S.T. Mrs. L. F. Kingsley, L.C.S.T. (commenced 16.10.68) Mrs. A. Varah, L.C.S.T. (commenced 12.8.68) Mrs. M. Dean, S.R.N. 11 PART-TIME STAFF (As at 31st December, 1968) Chest Physicians Consultant Psychiatrist Ophthalmic Surgeons Orthopaedic Surgeon Child Psychiatrists Assistant Medical Officers and School Medical Officers School Dental Officers Dental Orthodontists Dental Anaesthetists J. M. Hill, M.D., M.B., B.S., M.R.C.P., M.R.C.S., L.R.C.P. E. Sanders, M.D., M.B., B.S., M.R.C.P., M.R.C.S., L.R.C.P. F. J. H. Walters, M.D., M.B., B.S., M.R.C.P., M.R.C.S., L.R.C.P. R. K. Freudenberg, M.D., L.R.C.P., L.R.C.S., L.R.F.P.S., D.P.M. J. M. McKeogh, L.R.C.P.I., L.R.C.S.I., D.O.M.S. M. H. Malik, M.B., B.S., D.O. (Eng.), F.R.C.S M. C. Shah, L.M.S.S.A. G. Hadfield, M.R.C.S., L.R.C.P., F.R.C.S. (Eng.) D. Rumney, M.R.C.S., L.R.C.P., D.P.M. P. E. Lomas, M.B., Ch.B. 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. Joan D. Ferreira, M.R.C.S., L.R.C.P. 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. Elizabeth A. South, M.B., Ch.B. (commenced 17.4.68) Jayne Vernon-Roberts, M.B., B.S. (commenced 3.10.68) Elizabeth W. Beaver, B.Ch.D. Sheila McDonald, L.D.S. Margaret Moran, L.D.S., R.C.S. (commenced 28.10.68) M. G. Smith, L.D.S., R.C.S. Linda R. Read, B.D.S., L.D.S., R.C.S. N. Upson, L.D.S., R.C.S., D.Orth. 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. R. G. Smith, M.B., B.S., M.R.C.S., L.R.C.P.. D.A., D.Obst.R.C.O.G. 12 Geriatrician Dental Auxiliary Speech Therapist Pyschotherapist Physiotherapists Social Workers Medical Social Worker P. H. Millard, M.B., B.S., Hons. M.R.C.S., M.R.C.P. (commenced 8.9.68) Mrs. V. Hibbert Mrs. L. F. Kennedy, L.C.S.T. Mrs. J. Hogg Mrs. B. S. Fenner, M.C.S.P. Mrs. R. J. Kempton, M.C.S.P. (commenced 7.10.68) Mrs. T. Puddifoot, M.C.S.P. Mrs. M. C. Hudson, Dip. in Sociology Mrs. A. Martin, B.A. (Hons.), H.O. Training Certificate Miss E. M. Smith, S.R.N., S.C.M., Dip.Nsg. Mrs. S. N. Coles 13 GENERAL PUBLIC HEALTH SERVICES General Information Area of Borough in acres 9,379 Number of private dwelings (1968) 62,494 Number of private households (1968) 64,678 Rateable value, at 1st April, 1968 £11,337,123 Actual product of a penny rate:— 1967/68 £45,337 Estimated product of a penny rate:— 1968/69 £45,800 Population:— Census figure (1961) 186,647 Registrar-General's Estimate of Population 1968 1967 at 30th June 184,220 183,050 14 Summary of Vital Statistics Live Births- 1968 1967 Legitimate: Males 1263 1295 Females 1110 1221 - 2373 - 2516 Illegitimate: Males 119 112 Females 118 119 - 237 - 231 Totals 2610 2747 Live Birth Rate per 1,000 population 14.17 15.01 Corrected Live Birth Rate per 1,000 population 14.73 15.11 Illegitimate live births—percentage of total live births 9.08 8.40 Still Births— Legitimate: Males 10 15 Females 14 18 - 24 - 33 Illegitimate: Males 1 - Females — 3 - 1 - 3 Totals 25 36 Still-birth Rate per 1,000 live and still-births 9.49 12.93 Still-birth Rate per 1,000 population 0.14 0.20 Total live and still-births 2635 2783 Infant Mortality (Deaths of infants under one year of age)— Legitimate: Males 17 19 Females 18 18 Illegitimate: Males 1 35 7 37 Females 2 1 3 8 Totals 38 45 Infant Mortality Rate per 1,000 live births 14.60 16.38 Infant Mortality Rate per 1,000 legitimate live births 14.74 17.88 Infant Mortality Rate per 1,000 illegitimate live births 12.74 34.20 Neo-Natal Deaths (Deaths of infants in first 28 days of life) 27 36 Neo-Natal Mortality Rate 10.34 13.10 Early Neo-Natal Mortality Rate (deaths of infants in first week of life per 1,000 live births) 9.58 11.28 Perinatal Mortality Rate (Still-births plus deaths in first week of life per 1,000 live and still-births) 23.90 24.07 Total loss of infant life (Still-births plus infant deaths) per 1,000 live and still-births 22.77 29.10 Maternal Deaths (including abortion) - 1 Maternal Mortality Rate per 1,000 live and still-births - 0.36 Deaths 2038 2041 Death Rate per 1,000 population 11.06 11.15 Corrected Death Rate per 1,000 population 10.94 10.93 15  1968 1967 Deaths from Bronchitis and Emphysema per 1,000 population 0.74 0.49 Deaths from Pneumonia per 1,000 population 0.74 0.82 Deaths from Cancer of lung and bronchus per 1,000 population 0.74 0.69 Deaths from other forms of Cancer per 1,000 population 1.62 1.84 Marriages 1472 1447 Marriage Rate per 1,000 population 7.90 7.90 16 Causes of Death at different Periods of Life in the London Borough of Merton during 1968 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 ] Enteritis and other Diarrhoeal Diseases. - - - 1 - - - - - - - - - - - - - - - - - 1 _ 2 Tuberculosis of Respiratory System - - - - - - - - - - - - - 1 1 - - - 2 - - 1 3 2 Other Tuberculosis, incl. Late Effects - - - - - - - - - - 1 - - - - 1 - 2 - - 1 - 2 3 Other Infective and Parasitic Diseases - - - - - - - - - - - - - - - - - - - - - 1 - 1 Malignant Neoplasm: Stomach - - - - - - - - - - - - - - - - 7 1 11 5 7 4 25 10 Malignant Neoplasm: Lung, Bronchus - - - - - - - - - - - - 3 2 7 4 28 6 49 11 23 5 110 28 Malignant Neoplasm: Breast - - - - - - - - - - - - - 3 - 9 - 8 - 8 - 10 - 38 Malignant Neoplasm: Uterus - - - - - - - - - - - - - - - 2 - 3 - 6 - 6 - 17 Leukaemia - - - - - - - - 1 - 1 - - - 1 1 - 1 - 1 1 6 4 9 Other Malignant Neoplasms, etc. - - - - 1 - - - - - 2 - 6 3 9 7 23 29 28 18 32 38 101 95 Benign and Unspecified Neoplasms - - - - - - 1 - - - - - - - 1 1 1 2 1 - - 5 2 Diabetes Mellitus ... - - - - - - - - - - - - - 1 - l 2 1 - 1 2 5 4 9 Avitaminoses, etc. - - - - - - - - - - - - - - - - - 1 - - - - - 1 Other Endocrine Etc. Diseases - - - - - - - - - 1 - - - - - - 1 - 1 1 - 2 2 4 Anaemias - - - - - - - - - - - - - - - 2 - - - 1 1 2 1 5 Mental Disorders - - - - - - - - - - - - - - - - - - - - 1 6 1 6 Meningitis - - 1 1 - - - - - - - - - - - - - - 1 - - - 2 1 Other Diseases of Nervous System, etc. - - - - - - - - 1 - - - 1 - - 1 4 1 1 1 2 1 9 4 Chronic Rheumatic Heart Disease - - - - - - - - - - - - - - 4 2 3 5 1 4 4 6 12 17 Hypertensive Disease - - - - - - - - - - - - 2 - - 3 3 2 5 8 8 13 18 26 Ischaemic Heart Disease - - - - - - - - - - 1 1 6 1 28 3 92 21 96 53 91 121 314 200 Other forms of Heart Disease - - - - - - - - - - - - - - 3 1 5 3 8 7 26 48 42 59 Cerebrovascular Disease - - - - - - - - - - - - 3 2 4 5 16 19 26 28 51 101 100 155 Other Diseases of Circulatory System - - - - - - - 1 1 - - - - 2 2 1 6 4 9 10 13 43 31 61 Influenza - - - - - - - - 1 - - - - - - - 1 - - 1 1 2 3 3 Pneumonia - 1 2 2 - - - - - - - - 1 - 2 1 6 2 7 13 35 66 53 85 Bronchitis and Emphysema - - - - - - - - - - - - - - 2 1 18 1 40 8 38 28 98 38 Asthma - - - - - - - - 1 1 1 - 1 1 1 1 - 1 - - - 1 4 5 Other Diseases of Respiratory System - - 1 - - - - - - - - - - - 1 - 5 1 3 1 3 5 13 7 Peptic Ulcer - - - - - - - - - - - - - - - - 2 - 1 1 6 3 9 4 Appendicitis - - - - - - - - - - - - - - - 1 - - 1 - 1 - 2 1 Intestinal Obstruction and Hernia - - - - - - - 1 - - - - - - - - - 1 1 4 1 3 2 9 Cirrhosis of Liver - - - - - - - - - - - - - - - - - - 2 1 - - 2 1 Other Diseases of Digestive System - - - - - - - - - - 1 1 - - - 1 1 1 2 5 3 11 7 19 Nephritis and Nephrosis - - - - - - - - 1 1 - - - - 1 - - 1 - 3 1 2 3 7 Hyperplasia of Prostate - - - - - - - - - - - - - - - - - - 2 - 4 - 6 - Other Diseases, Genito-Urinary System - - - 1 - - - - - - - - - - - - 4 - 3 1 2 5 9 7 Diseases of Skin, Subcutaneous Tissue - - - - - - - - - - - - - - - - - - - 1 - - - 1 Diseases of Musculo-Skeletal System - - - - - - - - - - 1 - - - - 1 - 1 2 1 1 4 4 7 Congenital Anomalies 6 5 - 2 2 - - - 1 - - - - - 1 - - - 1 - - 11 7 Birth Injury, difficult Labour, etc. 5 4 - - - - - - - - - - - - - - - - - - - - 5 4 Other Causes of Perinatal Mortality 3 3 - - - - - - - - - - - - - - - - - - - - 3 3 Symptoms and Ill-defined conditions - - - - - 1 - - - - - - - - - - - - - - 1 2 1 3 Motor Vehicle Accidents - - - - - - 1 - 2 1 1 - - - - - 1 2 - 3 - 1 5 7 Ail other Accidents - - - - - - 1 2 2 - 1 - 1 - 1 1 - 1 1 - 3 3 10 7 Suicide and Self-inflicted Injuries - - - - - - - - - 1 2 - 2 - - 1 2 5 - 3 - 1 6 11 All other external causes - - - - - - - - - - - 1 1 1 - - - 1 1 - - - 2 3 TOTAL ALL CAUSES 14 13 4 7 3 1 3 4 11 5 12 3 27 17 69 51 231 126 307 210 363 557 1044 994 Comparative Statistics, 1968 Merton England and Wales Rates per 1,000 Population: Live births 14.17 16.9 Deaths (all causes) 11.06 11.9 Respiratory tuberculosis 0.03 0.03 Cancer of lung and bronchus 0.74 0.59 Rates per 1,000 live and still births: Still births 9.49 14.0 Maternal mortality — 0.24 Perinatal mortality 23.90 24.7 Rates per 1,000 live births: Infant mortality—deaths of infants under 1 year 14.60 18.0 Neo-natal mortality—deaths of infants in first 28 days of life 10.34 12.3 Early neo-natal mortality—deaths in first week of life 9.58 10.5 Principal causes of Death in order of Frequency Out of 2,038 deaths occurring during the year 1,736 were attributable to the undermentioned principal causes:— No. of Deaths. Percentage of Deaths from all causes. 1. Heart Diseases 688 33.8 2. Cancer 437 21.4 3. Vascular lesions of the nervous system 255 12.5 4. Pneumonia 138 6.8 5. Bronchitis and Emphysema 126 6.2 6. Other Circulatory Diseases 92 4.5 18 INFANT DEATHS (Under 1 year) Principal certified causes of death Age at Death Total Under 24 hours Days Months 17 814 1521 2228 1- 3 36 69 912 Prematurity 4 4 1 - - - - - - 9 Congenital Malformations 4 6 - - - 1 - - 2 13 Broncho-pneumonia - 1 - 1 - 3 1 1 1 8 Birth Injuries 3 - - - - - - - - 3 Other causes 2 - - - - 1 - 1 - 4 Totals 13 11 1 1 5 1 2 3 37 INFANT MORTALITY Of the 37 infant deaths, 24 occurred in the first seven days of life. One of these was delivered at home and transferred to hospital immediately since the baby had multiple congenital abnormalities. It survived only two hours. The infant mortality rate of 14.60 per 1,000 live births compares most satisfactorily with the rate of 18.0 for England and Wales. PERINATAL MORTALITY The perinatal mortality rate for Merton was 23.90 per 1,000 live and still-births thus comparing favourably with that for England and Wales of 24.7. MATERNAL MORTALITY There were no maternal deaths during the year. 19 CONTROL OF COMMUNICABLE DISEASES Notifications received during 1968 (Corrected Notifications) Disease Age Groups of Cases Notified Total Under 1 12 34 59 1014 1524 2544 45- 64 65 & over Measles 11 82 96 108 5 13 7 - - 322 Scarlet Fever 1 5 21 20 6 2 — — - 55 Whooping Cough 4 7 14 22 1 — — 1 — 49 Dysentery — 1 1 — — 1 1 — 1 5 Tuberculosis (Resp.): Males — 1 1 — — 2 11 10 1 26 Females — — — 1 — 2 4 1 2 10 Tuberculosis (Non-Resp.): Males — — — — — — 2 — — 2 Females — — 1 — — — 2 1 — 4 Infective Jaundice — — — 2 3 2 4 — — 11 Food Poisoning — 1 1 — — 2 3 2 — 9 Meningitis - - - - - - 1 - - 1 Totals 16 97 135 153 15 24 35 15 4 494 During the year erisipelas, membranous croup, acute pneumonia and puerperal pyrexia ceased to be notifiable and leptospirosis, yellow fever and tetanus were added to the list of notifiable diseases. Early in the year a contact of a case of typhoid fever attended a party given at a local hotel. The contact and all the hotel staff were checked and kept under observation for the necessary period but fortunately all results were negative. Five other contacts of typhoid fever, mainly holiday makers returning from abroad, were all kept under surveillance at various times in the year—again with favourable results. Two children living in the Borough attended a camp at which a child was found to be a carrier of a virulent nasal diphtheria. Swabs from the contacts were found to be negative. In November there was an outbreak of sickness and diarrhoea at one of the Borough's primary schools. Routine investigation of the early cases brought to light one case of dysentery and more than 60 specimens were taken from affected children and the kitchen staff. All results were negative and the ready help given by the Headmaster and his staff helped to bring the investigation to a quick and satisfactory end. Following a visit to Jerusalem by a party from the Borough in October, a case of flexner dysentery was notified. Investigation of the contacts brought one other case, in the carrier state, to light. The infection was not long lived. Flexner dysentery was also discovered in a child in hospital, who had previously attended the Special Care Unit of the Bordesley Road Junior Training Centre. Specimens were taken from all other children attending the Special Care Unit but all the results were negative. During the early summer there were a number of cases of infective jaundice at a primary school in the Borough. The school was visited by a Deputy Medical Officer of Health and by the District 20 Public Health Inspector, as a result of which recommendations were made for the improvement of the pupils' lavatory accommodation and additional cleaning of the lavatories was carried out for a period. The outbreak was not severe. The improvements recommended were carried out. In December there were a number of cases of sore throat in one of the Authority's Day Nurseries and investigation revealed the presence of a haemolytic streptococcal infection. Nose and throat swabs were taken from all the children and staff at the Nursery and the positive cases were referred to their family doctors for treatment. The infection, being thus quickly contained, was short-lived. Smallpox Twenty-four persons arriving in the district without a valid International Certificate of Vaccination were kept under surveillance for the required period. Food Poisoning During the year there was one family outbreak, which was traced to the reheating of a chicken meal. Five persons were affected. There were also six single cases of food poisoning infection which could not be ascribed to any particular source. In June information was received of an outbreak of salmonella oranienberg in a London maternity hospital in which 27 mothers and babies from the Borough were involved as contacts. All were investigated and all were found to be free from infection. During the year a child who had been a carrier of salmonella typhimurium for a year was treated with a new drug which cleared the infection. TUBERCULOSIS Chest Clinics 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 and patients who fail to attend. During 1968 the case load of Tuberculosis Health Visitors was as follows:— Cases of tuberculosis 572 Lung carcinoma cases 92 Other cases (bronchitis, bronchiectasis, etc.) 84 The new cases examined at the Chest Clinics in 1968 are analysed in the table below:— Respiratory Non-Respiratory Total M F M F Diagnosed Tuberculous 18 9 — 1 28 Non Tuberculous 443 300 — — 743 21 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 572. Details of domiciliary visiting by Health Visitors are given below:— Visits in connection with old cases 939 Visits in connection with new cases 44 Visits in connection with contacts 113 Total 1,096 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 1,585 Number found negative 1,522 Number vaccinated with B.C.G. 1,518 No children with positive skin tests were known to be contacts with notified cases of tuberculosis. Sixty-three of the children with positive skin tests were X-rayed. No case of active disease was found. Incidence of Tuberculosis Primary notifications of tuberculosis received during the year were as follows:— Males. Females. Respiratory 26 10 Non-respiratory 3 4 The table below shows the state of the Tuberculosis Register at the beginning and end of the year:— Respiratory NonRespiratory Total M F M F M F No. of cases on Register at 1.1.68 386 253 26 39 639 65 Primary Notifications in 1968 26 10 3 4 36 7 Inward transfers in 1968 11 5 - 4 16 4 Totals 423 268 29 47 691 76 Died during 1968 14 3 - - 17 - Recovered during 1968 43 26 - 5 69 5 Transfered out in 1968 23 11 3 3 34 6 No. of cases on Register 31.12.68 343 228 26 39 571 65 22 Two hundred and forty-eight contacts were examined for the first time during the year and six were found to be tuberculous. Three old contacts were also found to be tuberculous. 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 1,081 912 4 1 16 1 Public and Industrial Sessions 3,200 4,118 2 4 6 - Totals 4,281 5,030 6 5 22 1 The figures in respect of public and industrial sessions do not apply to Merton residents only, as the service is available to any member of the public. Deaths There were five deaths from respiratory tuberculosis during the year. The table of causes of death on page 17 gives an analysis by age and sex. The death rates per 1,000 population were 0.03 respiratory and nil non-respiratory, compared with 0.03 and 0.01 respectively for England and Wales. The comparable figures for the Borough for 1967 were 0.04 and 0.005. 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. 23 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 1968 1967 1966 1965 1961/64 Diphtheria 860 1,356 79 49 78 37 2,459 Whooping Cough 860 1,353 75 47 55 8 2,398 Poliomyelitis (Oral) 854 1,352 121 52 110 34 2,523 Tetanus 860 1,356 79 49 79 180 2,603 Measles 6 182 284 276 1,358 53 2,159 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 4,791 Whooping Cough 1,748 Poliomyelitis 3,017 Tetanus 4,430 Poliomyelitis At the end of the year, 88,279 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 1943-68 60,192 Persons born 1933-42 15,791 Others 12,296 Total 88,279 Fourth Injection At the end of the year 24,612 children, aged not less than five years and not more than 13 years, had received a fourth dose either by injection or by the oral method. Smallpox The following table shows the number of persons vaccinated or re-vaccinated against smallpox, in the various age groups, during the year:— 24  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 5 12 17 19 1,292 282 65 1,692 Number revaccinated — - - — 5 20 194 219 VENEREAL DISEASES The table below is compiled from figures supplied by the clinics listed and shows the number of patients resident in Merton who were treated for the first time in 1968:— Clinic Number of new cases seen during year Total all conditions Syphilis Gonorrhea Other Primary & Secondary Other Croydon General Hospital 33 1 — 5 27 Dreadnought Seamen's Hospital 1 - - - 1 London Hospital 18 - — 1 17 St. Helier Hospital 220 2 3 38 177 St. Thomas's Hospital 131 1 - 27 103 Westminster Hospital 17 — — 1 16 Totals 420 4 3 72 341 GENERAL MEDICAL SERVICES During the year the medical staff carried out 1,123 medical examinations of staff for superannution purposes. Twenty-three examinations were also carried out on staff, absent from work owing to sickness, to ascertain their fitness to return to duty. 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 and Orders obtained for removal under Section 1 of the 1951, Amendment, Act. In one case the person concerned was removed to a private nursing home when the Order expired and in the second case a further Order was obtained extending the period of detention by three months. 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 169 148 3 1 172 149 876 833 2 8 878 841 1045 981 5 9 1050 990 Births occurring outside Merton attributable to Merton (Inward Transfers) 2 - - - 2 - 714 638 8 9 722 647 716 638 8 9 724 647 Total of all births notified 171 148 3 1 174 149 1590 1471 10 17 1600 1488 1761 1619 13 18 1774 1637 Births occurring in Merton attributable to other Authorities (Outward Transfers) 1 1 - - 1 1 386 384 1 4 387 388 387 385 1 4 388 389 Totalbirths attributable to Merton 170 147 3 1 173 148 1204 1087 9 13 1213 1100 1374 1234 12 14 1386 1248 PERSONAL HEALTH SERVICES MATERNAL AND CHILD-CARE General Screening for Phenylketonuria by the Guthrie Blood Test commenced on 1st January and was carried out on babies delivered at home, or discharged from hospital before the sixth day. In all, 596 tests were taken by midwives. This number included 21 samples in which there were slightly high readings at the first test, and repeat blood was taken. All specimens eventually gave a negative result. In addition, there were two cases during the year where a urine test carried out by the Health Visitor showed a doubtful result and Guthrie tests were done as a check. Both these cases turned out to be negative. 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 five 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 301 Number of women who attended for post-natal examination 54 There were 296 midwives' clinic sessions at which 361 women attended. The total number of attendances was 2,195. 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 numbers of women who attended were:— Booked for hospital confinement 377 Booked for domiciliary confinement 22 Total 399 The total number of attendances was 2,666. Premature Infants The total number of premature infants born in the area during 1968 was 142, compared with 197 in 1967. Nine premature infants died in 1968. This means that 6.2% of the 142 premature infants born during the year died within a year as compared with 1.2% for full-term babies. 27 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 24 hrs of birth Survived 28 days Total Died within 24 hrs of birth Survived 28 days 2 lb. 3 oz. or less - - - - - - - Over 2 lb. 3 oz. up to and including 3 lb. 4 oz. - - - 1 1 - 1 Over 3 lb. 4 oz. up to and including 4 lb. 6 oz. 1 - 1 - - - 1 Over 4 lb. 6 oz. up to and including 4 lb. 15 oz. - - - - - - - Over 4 lb. 15 oz. up to and including 5 lb. 8 oz. 8 - 8 - - - 8 Totals 9 - 9 1 1 - 10 CHILD WELFARE General The Local Authority holds Child Health 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. Child Health Centres being operated at the end of the year were as follows:— Amity Grove Clinic Monday 2-4 p.m. West Wimbledon Friday 10 to 12 noon Cavendish Road Clinic Monday 1.30-3.30 p.m. Colliers Wood Friday 9.30-11.30 a.m. Church Road Clinic Wednesday 1.30-3.30 p.m. Mitcham Thursday 1.30-3.30 p.m. Churchill Hall* Tuesday 2-4 p.m. Effra Road, S.W.19 Emmanuel Hall* Thursday 2-4 p.m. Lingfield Road, S.W.19 Grand Drive Clinic Monday 10 to 12 noon and Raynes Park 2-4 p.m. Wednesday 10 to 12 noon 28 Meopham Road Clinic Wednesday 1.30-3.30 p.m. Mitcham Middleton Road Clinic Tuesday 2-4 p.m. Morden Friday 2-4 p.m. Morden Road Clinic Tuesday 2-4 p.m. Merton Thursday 2-4 p.m. Pelham Road Clinic Tuesday 2-4 p.m. Wimbledon Friday 2-4 p.m. St. Barnabas Hall* Tuesday 1.30-3.30 p.m. St. Barnabas Road, Mitcham St. John's Hall* Thursday 10 to 12 noon 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 Child Health Centres Name of Centre Total No. of Sessions First Attendances Total Attendances including Firsts Born In Total 1963-68 1968 1967 196366 Amity Grove 100 213 201 247 661 4,126 Cavendish Road 99 171 148 129 448 3,930 Church Road 104 254 221 242 717 3,919 Churchill Hall 53 112 73 146 331 2,770 Emmanuel Hall 52 73 50 84 207 1,606 Grand Drive 151 252 209 237 698 7,209 Meopham Road 51 81 88 110 279 1,855 Middleton Road 102 114 129 277 520 2,767 Morden Road 102 160 134 207 501 3,084 Pelham Road 102 270 351 191 812 5,220 St. Barnabas Hall 53 253 312 144 709 4,251 St. John's Hall 51 61 72 124 257 1,898 St. Luke's Hall 52 129 30 93 252 2,142 Wide Way 100 167 213 245 625 3,604 Totals 1,172 2,310 2,231 2,476 7,017 48,381 A total of 7,017 children attended during the year. 29 Attendances at Toddlers' Clinics First Attendances Total Attendances Total Sessions (All Clinics) Born In Total 1963-68 1968 1967 1963-66 — 28 2277 2305 2787 290 Dental Care Children of pre-school age are being brought by their parents to the Dental Clinics in increasing numbers. This is due to many fatcors such as Dental Health Education, particularly at Parentcraft Classes, the Three-Year Old Birthday Greetings Cards offering appointments for advice, and the generally enlightened view of young parents on the importance of the deciduous teeth. Over the past four years, since the inception of the Borough Dental Service, both the number or children examined and the number of courses of treatment have doubled, the figures being — Number examined Completed courses of treatment 1965 325 1965 169 1968 614 1968 338 Examined Commenced treatment Completed course of treatment Expectant and Nursing Mothers 44 41 31 Children under 5 614 544 338 Scaling and gum treatment Fillings Teeth otherwise conserved Extrac tions General Anaesthe tics Dentures XRays Full Part Expectant and Nursing Mothers 24 67 3 - 1 1 2 Children under 5 210 1188 389 94 51 - - 2 Day Nurseries The Authority had, at the end of the year, two Day Nurseries in operation providing accommodation for 85 children under the age of five years. Admissions are made under the following categories of priority: First Priority—Where the mother is the sole wage earner. Second Priority—Where there is sickness in the family, or where home conditions exist which are likely seriously to prejudice the health of the child. Third Priority—In exceptional cases, where, upon consideration of individual circumstances, it appears to the Council that admission is necessary in the best interests of the child. 30 The following table shows the places available and the average daily attendance at each nursery:— Nursery No. of places 0-2 years No. of places 2-5 years Total number of places Average daily attendance All Saints Day Nursery 12 34 46 44.9 Middleton Road Day Nursery 9 30 39 30.4 At the end of the year there were 28 private day nurseries registered under the Nurseries and Child Minders Regulation Act, with a total of 723 places. In addition there were 23 daily minders on the register. Developmental Clinic At this Clinic young children are seen by appointment by Dr. Worters, the Physician-Superintendent at the Manor Hospital, Epsom, or a senior member of his medical staff, who advises parents on the mental development of their children. A Health Visitor, a Mental Health Social Worker, and a Speech Therapist from the Manor Hospital assist Dr. Worters at this Clinic. Eleven sessions were held during the year at which 33 children were seen for the first time and 31 children were seen for a second time for a case review. Care of Unmarried Mothers and their Children Thirty 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 9 Alimentary system 2 Heart and great vessels 2 Uro-genital system 9 Limbs 20 Other skeletal 2 Other malformations 6 Total 50 Welfare Foods and Vitamins National Dried Milk and vitamins were available at all Child Health 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 1968 are shown below:— National Dried Milk 21,446 tins Cod Liver Oil 3,787 bottles Vitamins 'A' and 'D' 4,231 packets Orange juice 60,859 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. 29 Full-time Health Visitors. 2 Part-time Health Visitors. 2 Part-time Geriatric Health Visitors. 1 Full-time Tuberculosis Health Visitor. 2 Part-time Tuberculosis Health Visitors. 3 Student Health Visitors. Five Health Visitors left the Borough during 1968. Three were having babies, one left to get married and a fifth retired. Six full-time Health Visitors started work during the year; two of these were students sponsored by the Borough, and a third had done her three months' supervised practice in Mitcham and then applied to come as a Health Visitor. Three student Health Visitors started training under Borough sponsorship in 1968. A Health Visitor was appointed in 1968 whose main duties are in the Geriatric field. She joined the team at St. George's Hospital, Tooting, who work entirely with patients from Merton. The team is a young one and consists of a Geriatrician, a Social Worker from the Welfare Department, a Health Visitor, and a Secretary. The Geriatric Health Visitor visits all referrals and assesses the needs, and then passes them to the correct channels (Hospital, Local Health Visitor, Welfare Department, etc.). She also assesses home conditions before patients are discharged from hospital. The team is proving itself to be much needed and much used. The film shows for ante-natal parents developed during 1968 into a series of evening classes in Fathercraft and have proved tremendously popular. They are run by Health Visitors and Midwives, and in the case of every ante-natal mother's booking that is received in the office, an invitation is sent, addressed to both husband and wife. The response has been sufficient to warrant an increased number of these series in the future. Toddlers' Clinics have continued to gain importance in the sphere of Health Visitors' work. The number of children attending these sessions in 1968 has almost doubled over those of the previous year, and the number of sessions has also increased. An endeavour has been made to have Toddler Sessions near home, and, therefore, Church halls as well as purpose-built Clinics are being used for this purpose. As is the current trend, the emphasis is on the early assessment and developmental progress of the child, both at Child Health Centres and Toddlers' Clinics. A determined effort is being made by Assistant Medical Officers and Health Visitors to dispel the fixed idea in many mothers' minds, that the Child Health Centres are mainly for weighing babies. They 32 are being encouraged to use the Centres for periodic examinations of the babies, for prophylaxis, if not done by the General Practitioners, and for advice and help, with actual weighing very much a secondary consideration. As always, by far the most important part of a Health Visitor's work is visiting. It is only in the atmosphere of her own home that the mother is completely relaxed and can fully discuss her problems be they great or small. Equally, a Health Visitor is gready helped in her assessments if she knows the environment of her families and sees them in their normal living conditions. This opportunity of visiting homes when all is running smoothly, as well as in times of crisis, is unique to the Health Visiting Service, and is quite invaluable. Training of Health Visitors Health Visitors in the Borough who are qualified as Fieldwork Instructors continued to receive students attached for training or for observation purposes during the year from various centres. 'In-Service' training of Health Visitors was continued. Five Health Visitors attended post-graduate refresher courses, four undertook training as Fieldwork Instructors, and two attended a weekend course in Psychoprophylaxis to enable them to take classes for antenatal mothers in ' Preparation for Childbirth '. In addition Health Visitors attended several one-day or half-day conferences on subjects of special interest. General Practitioner Attachments This year has seen great steps forward in the field of Health Visitor attachments to General Practitioners. It has become obvious that this arrangement is mutually beneficial to Doctors and Health Visitors, but above all to the patients, who get unified advice and help, and the families are much better understood when seen from both the preventive and curative angles. By the end of 1968, eight Health Visitors were attached to practices comprising 25 Doctors. The process of attachment is continuing, but it will be appreciated that, in an area such as Merton, where many Doctors whose surgeries are outside the boundaries have patients within the Borough, it will always be necessary to have a certain percentage of the Health Visitor establishment working on a geographical basis. Summary of Work of Health Visitors The following tables give details of visits paid to children and to other types of case and attendances at the various clinics and centres:— VISITS PAID To children under 5 yrs To families with problems To the mentally ill To the mentally subnormal To geriatric cases No. of families visited Born in 1968 Born in 1967 Born 196366 Total 2,518 2,828 8,257 13,603 196 119 62 444 9,327 33 Sessions attended. At Ante-natal Clinics 320 Relaxation Classes 352 Developmental Clinics 31 Child Welfare Centre Sessions 2,069 General Practitioners' Clinics 194 Toddlers' Clinics 290 Parentcraft Classes: Day Sessions 144 Evening Sessions 46 Fathercraft Classes 18 Geriatric Clinics 78 Vaccination and Immunisation Sessions 73 Cytology Clinics 46 Co-ordinating Conferences 21 Case Conferences 35 Audiology 256 Meetings with outside bodies 419 Sessions with students 202 Total 4,594 MIDWIFERY Staff As at 31st December, 1968, the staff consisted of:— 1 Non-medical Supervisor of Midwives. 8 Whole-time District Midwives. 2 District Nurse/Midwives. 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 operate separately. Introductory The number of home confinements continued to decrease, following the pattern of the past few years. Although this has reduced the actual number of home confinements attended by individual midwives, there has been no reduction of the overall work load, since the numbers of planned 48-hour discharges and unplanned early discharges increased during the year. As will be seen from the figures on page 35 there were 413 early discharges from hospital in 1968, compared with 311 in 1967. Organisation Two midwives are housed at 28/30 Kings Road, Wimbledon, S.W.19, one at 'The Croft', Mitcham, one in a flat leased from the Greater London Council, and the remaining three in their own homes. Three District Nurse/Midwives relieve full-time midwives during holidays, Refresher Courses, sickness, etc. All midwives are motorists using either their own cars, or ones supplied by the Authority. One District Nurse/Midwife is a cyclist. A rota system of duty is in operation, ensuring sufficient sleep and rest for the midwives. 34 Maternity Cases Attended There were 321 domiciliary confinements reported and 2,313 hospital confinements during the year. This shows a reduction of 151 on the figure for 1967. Midwives employed by the Authority attended 321 (318 where a doctor was booked and three where no doctor was booked) of the 321 domiciliary cases. Inhalational Analgesia All the Authority's midwives are qualified to administer inhalational analgesia (trilene and gas and oxygen) in accordance with the rules of the Central Midwives Board. During the year district midwives administered inhalational analgesics to mothers as follows:— Gas and oxgen—160 Trilene—38 Ophthalmia Neonatorum No case of ophthalmia neonatorum was notified during the year. Maternity Outfits A free issue of maternity outfits is made in accordance with instructions of the Department of Health and Social Security, 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 81 domiciliary cases where a doctor was already booked for the confinement. Early Discharges from Maternity Hospitals The numbers of discharges from hospital before the tenth day of puerperium were as follows:— 48 hours after confinement 296 Other discharges before the tenth day 117 Total 413 This shows an overall increase of 102 on those for 1967. Midwifery Training During the year 25 Student Midwives completed their domiciliary training, 14 from St. Teresa's Hospital, 11 from Epsom Hospital. Nine of our midwives are approved by the Central Midwives Board as District Midwifery Teachers for the practical training of Student Midwives. Eight obstetric student nurses from St. Helier Hospital spent a day with a midwife, observing at first sight some of the services in the community for the ante- and post- natal care of mothers booked for home confinement and planned 48 hour discharge. Post-Graduate Courses One midwife attended a Refresher Course in accordance with the rules of the Central Midwives Board. Two midwives attended a study 35 day organised by the London Boroughs' Training Committee. One midwife attended the National Childbirth Trust for a week-end seminar on the ' Psychoprophylaxis Method of Childbirth'. 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 2,680 Post-natal visits to home confinements 4,782 Post-natal visits to 48-hour and other early discharges from hospital 2,291 Total 9,753 Attendances at Clinics Two hundred and ninety-six ante-natal clinic sessions were held by midwives during the year, and 361 women attended these clinics for the first time. The total number of attendances at midwives' ante-natal clinics was 2,195. Transfers to Hospital The undermentioned patients booked for home confinements were transferred to hospital:— (a) During pregnancy 24 (b) During labour 14 All patients transferred to hospital during labour are accompanied by a midwife, unless the emergency obstetric squad has been called. The scheme commenced in 1967, for ante-natal clinics held joindy by General Practitioners and District Midwives, continued until August, 1968, and the Student Midwives now also attend. It is hoped to extend this scheme to another group of General Practitioners next year. Maternity Liaison Committee The St. Helier Group Maternity Liaison Committee meets regularly to ensure co-operation of the hospital, general practitioner and local health authority services, and the Medical Officer of Health is an active member. HOME NURSING Staff On 31st December, 1968, the staff consisted of:— 1 Superintendent of the Home Nursing Service. 1 Deputy Superintendent of the Home Nursing Service. 30 Whole-time Home Nurses (female) — S.R.N. and District Trained. 3 Whole-time Home Nurses (male) — S.R.N. and District Trained. 4 Whole-time Home Nurses (female) — S.E.N. not District Trained. 5 Part-time Nursing Auxiliaries (female). 36 Although several nurses retired from district nursing during 1968 following many years of service in the Borough, recruitment of nurses has been satisfactory. Organisation Three male nurses are now included in the establishment, all are motorists, and able to cover the Borough where special care is needed for male patients. Employment of nursing auxiliaries continued, with five working part-time at the end of the year. They work under the supervision of the trained nurse to give general care to those patients not requiring fully skilled nursing. Their addition to the establishment has relieved the trained nurses who can devote more of their time to the very ill, and to rehabilitation of patients wherever possible. District Nurses and Midwives are now using many items of disposable equipment, some of these are pre-sterilised, giving a safer and time-saving method of nursing care to the patients. With the aid of hydraulically operated hoists District Nurses are able to move the heavy handicapped patient with a greater degree of comfort to nurse and patient. Training of District Nurses This Authority is approved as a training area for the practical part of District Nurse training, leading to the National Certificate of District Nurse Training. Students attend Croydon Technical College for their theoretical instruction. Four nurses were seconded for training during the year. General Practitioner Attachments In September, one Home Nurse was attached to a group of general practitioners in the area. She is responsible for all patients on the list of doctors requiring home nursing care within the Borough boundary. A call is made by her each day to the surgery to discuss the cases visited from the practice, and to receive details of any new work. It is anticipated that this attachment of Home Nurses to general practitioners will increase next year. Post-Graduate Courses for District Nurses During the year six nurses attended residential refresher courses of one week's duration and three attended non-residential courses lasting one day. 37 Cases Attended The table below gives details of the numbers 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 1.1.68 Cases added Cases removed Cases on books at end of period 0-5 years 5 14 19 - 5-64 years 155 597 602 150 65 years and over 670 1,306 1,198 778 Totals 830 1,917 1,819 928 The total number of cases attended during the year was 2,747. Visits Made The following table shows the total number of visits made each month:— January 8,337 February 7,488 March 7,309 April 7,620 May 8,344 June 7,342 July 7,977 August 6,850 September 7,320 October 8,228 November 8,047 December 7,635 Total 92,497 Although there is a slight decrease in the number of visits made by the District Nurses in 1968, the care given is still mainly to the elderly, infirm, and chronically sick patient, and is therefore more time consuming. 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. 38 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. There was an increased demand for these pads during the year. 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. This service was more widely used during the year. DOMESTIC HELP SERVICE Staff At 31st December, 1968, the staff consisted of:— 1 Home Help Organiser. 1 Senior Assistant Home Help Organiser. 2 Assistant Home Help Organisers. 3 Clerks. 1 Full-time Home Help. 209 Part-time Home Helps. Organisation Recruitment has been maintained throughout the year, 69 Home Helps being engaged, although 54 resigned during the year for a variety of reasons. This turnover of labour is unfortunately common in most London Boroughs. Talks were given by the Home Help Organiser to Parentcraft groups at Mitcham, Wimbledon and Morden, to Old People's Welfare, and to Nurses and Student Health Visitors. A Training Scheme was started for Home Helps in October which was opened by the Chairman of the Health Committee. A course is run each month from October to May, ceasing during the summer months and re-commencing in the autumn, until all home helps who are willing to attend the course have done so. These have proved popular and instructive. The Neighbourly Help Scheme has not really got off the ground, although it is always stressed, when visiting, and in talks to other interested bodies. For the second year 'A Get Together for Home Helps' was held one Saturday afternoon in December in the Vestry Hall which was well attended, and a speaker was arranged to talk on the Organisation of the Home Help Service. 39 Statistics The following table gives details of the numbers and types of cases attended by Home Helps during the year:— Category of cases Cases on books at 31st Dec., 1967 Cases on books at 31st Dec., 1968 Total cases dealt with during 1968 Chronic Sick and Aged 1,019 1,095 1,457 Tuberculosis 12 13 17 Acute Illness 15 18 111 Maternity 2 - 54 Totals 1,048 1,126 1,639 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, 1968, being 1,095. Details of Sources of Applications in 1968 General Practitioners 524 Hospitals 234 Health Visitors 9 Home Nurses 7 Welfare Services 18 Blind Welfare 6 Maternity Bookings 60 Others 11 Total 869 The Organiser and the three Assistant Organisers have paid 759 first visits and 6,005 re-visits to homes in connection with the Service. HOURS WORKED BY HOME HELPS Chronic Sick and Aged T.B. Acute Maternity Payments under Neighbourly Help Scheme Total hours worked £ s. d. January 14,736 146 431 174 61 8 0 15,487 February 15,962 194 552 96 64 0 0 16,804 March 19,418 223 821 639 85 10 6 21,101 April 14,315 202 330 141 72 10 8 14,988 May 15,950 239 247 170 48 13 2 16,606 June 18,617 281 284 368 58 5 0 19,550 July 15,424 187 292 178 46 12 0 16,081 August 17,792 220 394 24 57 2 10 18,430 September 14,189 215 250 167 40 19 5 14,821 October 16,628 191 328 183 47 15 0 17,330 November 21,303 238 534 119 58 17 6 22,194 December 14,571 170 460 177 48 12 9 15,378 Totals 198,905 2,506 4,923 2,436 690 6 10 208,770 40 PREVENTION OF ILLNESS, CARE AND AFTER-CARE Clinic for Older People The Clinic at Amity Grove, which was only started in 1967, was found to be insufficient for the greatly increased demand and, as a result, a second clinic was opened in April at Middleton Road under Dr. W. James. As in the previous year, it was found that most of the people attending the clinics did so from the preventive point of view. At Amity Grove 58 new patients attended, the average age being 60 years. Fifteen were men and 43 women. There were 258 reattendances. The corresponding figures for Middleton Road, which was open for eight months of the year, were: new attendances 48, 11 men and 37 women. The average age was 61 years. Health Education Health Education progressed well during 1968. Many more teachers requested help in furthering education in this field and requests of this kind were always encouraged and assistance given. Slides illustrating many aspects of the work of the Health Department have been shown extensively to schools and to members of various organisations in the Borough. Judging by the lively sessions of questions and comments which followed, they have created great interest as well as furthering public knowledge. Topical subjects are illustrated at regular intervals both in the clinics and in the entrance hall of the Health Department. The cooperation of health visitors and clinic staff in helping with these displays is invaluable. It is hoped during the coming year to improve on the facilities we have to offer both to members of our own staff and other visitors requesting our aid. General The Health Education Section worked with the Mental Health Section to organise activities during Mental Health Week with the aim of promoting a better understanding of mental illness and handicap and in stimulating a greater awareness of the value of mental wellbeing and the necessity to conserve it. Education for childbirth and parenthood met with an excellent response from the couples invited to attend these classes. The talks and demonstrations given by health visitors, midwives and general practitioners, covering a wide aspect of parenthood, including the father's role, and safety measures to look for when buying the pram, cot, etc. In-Service Training Courses for health visitors and midwives to instruct them in the correct use of projectors were successfully carried out. Assistance in the form of lectures and films on specific subjects were given to the Home Help Section for the In-Service Training Courses arranged for the Home Help personnel. 41 Early in the year a programme was drawn up for children aged 13-15 years, covering various subjects in the field of community health and with the co-operation of head teachers, teachers, health visitors and public health inspectors it appears that the lessons taught have been applied with considerable success. The programme scheduled to last one term with weekly sessions, was followed by a simple questionnaire and it is this latter which suggests that the programme met with some success. School children are encouraged to visit the Health Education Section and have done so freely—at times bringing parents along— particularly when seeking aid with projects they have undertaken. During the year there have been several requests by Parent/ Teacher Associations for talks on Health Education and for parents to have the opportunity to see some of the films shown to their children. The parents were also able to discuss some of their worries with regard to the problems confronting the adolescent of today. These have been most worthwhile, not only we hope to the parents, but to the Teaching and Health Department Staff as well. In order to comply with the Ministry of Health's request to promote anti-smoking teaching in schools, it was decided to engage the services of the Inner London Education Authority, which has a Health Education Unit for this specific purpose. With the co-operation of the Education Department, the Unit carried out a two-week programme during July, visiting the senior schools in the Borough. Civic Exhibition The work of the Health Department was this year portrayed under the heading 'The Seven Ages of Man (Variations on a Theme) and His Environment'. Services available to each group of the community were shown under appropriate symbols and attracted much attention. 'Old People's Week' Display stands illustrating the needs of the elderly and the dangers which beset them were exhibited in various department stores and libraries throughout the Borough, with encouraging results. More than 50 offers were received for friendly visiting, one part-time driver for the meals on wheels service and one business man offered to provide work which could be done in the workshops for the elderly, and many enquiries were dealt with. I should like to convey my thanks to the Guild of Social Welfare for their co-operation and help during this campaign. 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. 42 (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, 1968, 978 new applications for treatment were received. The following table gives figures for the Direct Scheme:— Category Persons treated in 1968 Number of treatments given Number on books at 31.12.68 Elderly 3,757 20,776 3,503 Registered Blind or Partially Sighted 65 353 59 Physically Handicapped 106 600 102 Expectant Mothers 2 2 — Totals 3,930 21,731 3,664 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 76 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 to whom thanks are due for the maintenance of a most essential service. 43 The Society has supplied the details given in the table below of issues of sick room equipment during the year:— Item Total loans Item Total loans Air bellows 1 Crutches 43 Air rings 66 Douche cans 3 Bed rests 117 Dunlopillo mattresses 2 Bed pans 80 Feeding cups 24 Bed tables 26 Inhalers 2 Invalid chairs 100 Steam kettles 2 Commodes 106 Urinals 61 Cradles 60 Waterproof sheets 75 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. Fifty-nine such holidays were arranged in the year. Cervical Cytology There was a further expansion of this service during 1968 and by the end of the year the Cytopathology Unit at St. Helier Hospital was in a position to handle up to 100 smears per week from this Borough, in addition to repeat specimens. This has proved more than sufficient to cope with the public demand and no applicants were kept waiting. In all, 2,035 new cases were dealt with and 1,041 repeat smears were taken. The new cases included 250 employees at Telephone House, Worple Road, Wimbledon, where, over a period of weeks, twice weekly visits were made by a doctor and a nurse, at the request of the Welfare Officer of the South West London Telephone Area. From the total of 3,076 smears taken during 1968. eight required further investigation for possible malignancy. These patients were referred to their own doctors for follow-up or gynaecological review. In addition many patients were referred to their doctors for treatment of infection by Trichomonas, Monilia and other organisms, also for other defects found on cervical examination. Family Planning Family planning sessions are held at Local Authority Clinics as follows:— Amity Grove Clinic. Raynes Park Monday evenings, 6.15-8.15 Cavendish Road Clinic, Colliers Wood Tuesday mornings, 9.30-11.30 Church Road Clinic, Mitcham Tuesday evenings, 6.30-8.30 and Thursday mornings, 9.30-11.30 Pelham Road Clinic, Wimbledon Wednesday and Friday evenings, 6.15-8.15 Wide Way, Mitcham Monday mornings, 9.30 to 11.30 44 From 1st January, 1968, the South-West London Branch of the Family Planning Association operated, as agents of the Local Health Authority, a Family Planning Service providing free advice, treatment and supplies to all medical cases and free examination and advice to all married social cases. In social cases a charge is made for supplies unless the patient's financial circumstances are such that hardship would be caused, in which case supplies are made available free, or at a reduced charge. A simple form of assessment is used. The use of clinic premises by the South-West London Branch is made available free of cost by the Authority. Details are given below of the numbers and types of case dealt with during the year:— New Patients:— Number Medical 521 Social 793 Total 1,314 Age Under 16 1 16 to 20 134 21+ 1,179 Advice IUD 265 Other 1,099 Established patients (including transfers):— Medical 156 Social 577 Total 732 Supplies for Social Hardship cases:— Paying part cost Nil Free 17 Cytological Smears:— Number taken 1,256 Referred for Investigation 3 Out of Borough patients 70 Total Attendances to see the Doctor 6,944 Number of Doctor Sessions 398 45 MENTAL HEALTH & SOCIAL WORK SERVICES Introductory The daily supervision of these services is delegated to a Senior Medical Officer, who is assisted in the mental health aspects by a Principal Mental Welfare Officer, and in the other social work aspects by a Senior Social Worker. MENTAL HEALTH SERVICES General The work of the Mental Health Section has steadily increased since the inception of the Borough. There have been, and still are, many practical problems which are not within the control of the Mental Health staff themselves. However, if 1968 has not seen a remedy to all problems, it has perhaps pointed a way to a more realistic appraisal of the situation. The South West Metropolitan Regional Hospital Board, which is responsible for all the Catchment Hospitals serving the London Borough of Merton, is now actively engaged in planning their future services with a clear relationship to Borough needs, though it may well be that the needs in the total area, rather than in the Borough, will eventually decide the projects to be developed in the first instance. There are plans in hand for the provision of acute beds to be available to the Borough in Sutton and in conjunction with St. George's Hospital, Tooting. Staff As at 31st December, 1968, the staff position was:— 1 Principal Mental Welfare Officer. 1 Deputy Principal Mental Welfare Officer. 4 Mental Welfare Officers. 1 Mental Health Social Worker. 1 Part-time Mental Health Social Worker. 1 Trainee Mental Welfare Officer. Dr. R. K. Freudenberg, Physician Superintendent of Netherne Hospital, continues to act as part-time Consultant Psychiatrist to advise the Authority on aspects of the Mental Health Services. In February, Dr. M. D. Susman resigned to take up an important post in the Home Office Children's Department. His vacancy was filled by Dr. D. M. O. Lowry, who took up his appointment early in September, and in the short time he has been associated with the Mental Health Service he has shown an interest and concern which will doubtless prove to be of great support to the staff, clients and colleagues. Later in the same month Miss Tilt, a Psychiatric Social Worker, resigned her post to take up a new Course at the University of Essex. 46 Training of Staff The Mental Health Section continues to accept students from neighbouring colleges to work under the supervision of qualified staff as part of their training for the Certificate in Social Work Training. The happy arrangement with Bedford College to take a student for the month of July has been repeated and a further request for a two-month placement from Bromley College of Technology for 1969 has been received. In-Service Training this year was held for eight consecutive Thursday afternoons on the theme of ' Communication and Support We were pleased to have eminent speakers and the support of our neighbouring Boroughs of Sutton, Wandsworth and Lambeth. Hospital Social Workers from St. Helier Hospital and St. George's Hospital, and General Practitioners in the Borough also attended. Once again we are indebted to the London Boroughs' Training Committee for their support and encouragement and it was with regret that Mrs. Strauss, the Deputy Director of Training, could not join the Course because of ill health, but her place was ably taken by Miss Grace Jackson. Mrs. Sargeant, Assistant Principal Mental Welfare Officer London Borough of Wandsworth, and Mrs. P. Angel, Senior Mental Welfare Officer for the London Borough of Lambeth, acted as Group Leaders. THE WORK OF THE MENTAL WELFARE OFFICERS The work of the Mental Health Service has continued to expand in all aspects. Unfortunately, the staffing of the Section has not expanded to the level which was envisaged in the Ten-Year Plan for the Development of the Health Services, and limited staff inevitably limit expansion of the needed services. With the steady expansion of the Services it has become apparent that there is a real need in this Section for a competent and experienced Administrative Officer to relieve Senior Social Work Staff of administrative duties to release them for their normal social work functions. Co-ordination of the Hospital Services With the decline of trained social workers in the hospitals the demands on the Borough to co-ordinate more closely with the catchment hospitals become more important. At the present time there are few days in the week when some member of the staff is not, in fact, at a hospital attending a conference, or at an out-patient clinic assisting the Consultant from the hospital. There are regular conferences at Horton Hospital, when one officer attends two conferences each Monday. There is also a monthly psycho-geriatric conference at this hospital. At West Park Hospital there is a weekly conference and at Netherne Hospital there are conferences once or twice most weeks. The work with the out-patient clinics continues and a Mental Welfare Officer from the Borough attends the out-patient clinic at the Nelson Hospital, which is run by a Consultant from Horton Hospital. 47 A Social Worker also attends the psychiatric out-patient clinic held at the Wilson Hospital by a Consultant from West Park Hospital. The Mental Health Social Workers also attend clinical conferences at Queen Mary's Hospital when Borough cases are discussed. Community Care of the Mentally Disordered The number of patients receiving a case work service continues to increase. Unfortunately, many cases cannot be followed through because of lack of staff and, at the present time, it is only possible for the Mental Welfare Officers to deal with those cases who are specifically referred by the Hospital or General Practitioner for community care. This means, in practice, that when a patient is admitted to hospital the supervision is considered to have lapsed unless, and until, the case is referred on discharge. This means, of course, that we are unable to give the support to patients in hospital which would be reassuring and helpful towards their return to the community. This break in our services we try to overcome by our contacts with the hospital staff, but it is clearly not always in the patient's interest to have no contact with the social workers whilst they are in hospital, and there is always the possibility that on discharge the Borough will either not be notified or asked to recommence supervision. The position is complicated by the fact that Merton is not part of a catchment area for one hospital and patients are admitted to three different psychiatric hospitals. Some more requests are being made for preventive work with people who have not yet experienced breakdowns leading to hospitalisation and it is clear that, with an improved casework service the Mental Welfare Officers will be spending less time on dealing with emergencies. Emphasis on the preventive field offers new opportunities for a positive approach to mental health. Attachment to Group Practice The important feature which was reported in last year's Annual Report, where a Mental Welfare Officer commenced a weekly session undertaking interviews on the premises of a Group Practice of Doctors, has proved to be a most valuable and useful part of the community services, so much so, that in the present year this scheme has been extended to two other practices. The Doctors in the Group Practice have also attended the InService Training Seminars, led by Dr. Brook, Consultant Psychiatrist of the Cassel Hospital, and were actively co-operative in the venture. Such attachments should form the basis of a good community Health Service. 48 SUBNORMALITY Cases in Community Care At the end of the year 182 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 5 9 18 39 23 48 71 Severely subnormal patients receiving routine home visits 29 28 30 24 59 52 111 Totals 34 37 48 63 82 100 182 Patients included in above figures who are attending Junior or Adult Training Centres 33 26 25 19 58 45 103 Special Care Unit The Special Care Unit continues to meet the needs of severely subnormal children who suffer additional handicaps. Although a 20place unit might well still be adequate for the needs of the Borough, the fact that our neighbouring Boroughs do not at present possess Special Care Units does mean that with the applications for help from Sutton and Wandsworth the Unit is always full. However, we have not had to delay the admission of any Merton case, since the acceptance of cases from other Boroughs is conditional upon there being no Merton case awaiting admission. 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 1.1.68 11 4 2 17 No. of children attending on 31.12.68 14 4 3 21 No. of attendances made during year 1,800 660 294 2,754 Junior Training Centre The number of children on the Register of the Juinor Training Centre at the end of the year was 49. However, in the course of the year it has been possible to make some alterations to facilitate the reception of Merton children under the age of five. This will enable us to make more efficient use of the premises and provide a further service to parents. 49 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 1.1.68 42 8 50 No. of children in attendance on 31.12.68 45 4 49 No. of attendances made 7,409 868 8,277 Adult Training Centre The major facility used by the Borough for Adult Day Training is centred on the Adult Day Training Centre at the Manor Hospital. However, work has commenced on a 100-120 place Senior Training Centre in Wandle Way, Mitcham, and it is hoped that this new purpose-built unit will be in operation by the autumn of next year. In die course of the present year, however, the Adult Day Training Centre at the Manor Hospital was rehoused in the purpose-built Workshop Block, with special adaptations. The table below gives details of those attending the Training Centre at the Manor Hospital:— On register at 31.12.68 Males Females Total No. attending Manor Hospital 24 18 42 SHORT-TERM CARE During the year, the Authority provided periods of short-term care in 28 cases, compared with 24 cases in 1967. This is an illustration of the increased demand made for the facilities when their availability is known to those families in need. 50 OTHER FORMS OF MENTAL DISORDER Cases dealt with by Mental Welfare Officers During the year 425 cases were referred to the Mental Welfare Officers for attention and 338 other cases were admitted to mental hospitals through the Mental Health Service. Again, these figures do not include the large number of informal admissions arranged directly by the General Practitioner or admitted informally through psychiatric out-patient clinics. In those informal cases listed above the Mental Health staff have actively made it possible for the patient to be admitted to hospital in the easiest way and in many instances they are taken into hospital by private car, perhaps accompanied by a relative. The actual number of informal cases dealt with in this way is high and certainly higher than in some Boroughs with a larger population and a much larger staff. It is felt that this is a particularly valuable way of helping the families of persons who are mentally ill and a particularly important way of alleviating the anxiety of the patient. Again, it will be seen from the breakdown of large groups that the elderly continue to figure largely as a percentage of the total figure. The following table gives details:— Males Males Females Females Total Under 65 Over 65 Under 60 Over 60 Admitted informally 54 20 85 39 198 Admitted under Section 25 (for observation) 15 5 17 11 48 Admitted under Section 26 (for treatment) 8 - 1 1 10 Admitted under Section 29 (for observation in case of emergency) 20 6 26 19 71 Admitted under Section 60 (by the Courts) 1 - - - 1 Admitted under Section 136 (in conjunction with the Police) 7 1 2 — 10 Totals 105 32 131 70 338 Patients receiving Community Care At the end of the year 93 males and 252 female patients were being provided with community care by the Authority. This shows a decrease of eight males and an increase of 93 females compared with 1967. Guardianship There are no cases under guardianship in the Borough. Cases Boarded out The Authority, at the end of the year, was making financial provision for the boarding-out of 19 patients. A particularly close 51 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, when requested to do so, undertaken supervision of patients from other Authorities accommodated there. SOCIAL WORK SECTION Staff 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). One Social Worker, who had recently obtained the Certificate in Social Work was appointed during the year, but apart from this, the staffing position was rendered difficult by the Authority being unable, when vacancies arose, to recruit qualified Social Workers. General The work of this Section is to provide a social work service: (a) for the Chest Clinic at Cumberland Hospital, and (b) for families with problems, referred by medical staff of the Department, general practitioners, health visitors, Medical Social Workers in hospitals in the catchment area, other Social Service Departments (particularly the Welfare Services, Children's and Housing Department) and other statutory and voluntary agencies. In addition cases involving arrears of mortgage repayments precipitating possible threat of eviction, are also referred to this Section by the Authority, the Greater London Council and some private Building Societies. Preliminary inquiries with families rendered homeless, or with potentially homeless families are dealt with by this Section, which is also responsible for casework on families provided with temporary accommodation under Section 21 (1) (b) of the National Assistance Act, 1948. As a result of the wide extent of these varied activities and shortage of staff, case loads are high and the extent of intensive case work has to be carefully considered on a strict priority basis. Social Casework At the beginning of the year there were 345 active cases (i.e., cases requiring continued casework supervision) being dealt with by the Section. During the year 550 new cases were referred to the Section and on 31st December, 1968, there were 490 active cases being dealt with. The following tables give details of the cases referred during the year, the sources of referral, and the disposal of cases. It should be explained that some of the cases require an initial visit and assessment of the situation with no continuing casework. Only those cases found to require continuing casework are registered as active cases. 52 New Cases Referred During 1968 New referrals registered as active cases 329 Internal transfers 7 Mortgage cases: London Borough of Merton 7 Greater London Council 24 31 Assessment cases 70 Cases necessitating initial enquiries only, followed by transfer to other Departments 113 Total 550 Disposal of Cases During 1968 Active cases brought forward from previous years 345 New active cases registered during year 329 Internal transfers 7 Mortgage cases 31 712 Deduct cases closed during year 222 Number of active cases registered on 31st December, 1968 490 Reasons for Closure of Cases During 1968 Moved away from area 33 Satisfactorily closed 161 Unsatisfactorily closed 7 Transferred to other Departments 21 Total 222 Sources of Referral of New Cases During 1968 (a) From Council Departments. Welfare Services Department 79 Housing Department 53 Medical and Nursing staff of Health Department 48 Education Department 9 Children's Department 1 Town Clerk's Department 1 Co-ordinating Conference 1 192 (b) From other Agencies. Chest Clinics 104 Self referrals 20 Medical Social Workers of Hospitals 6 Greater London Council 3 Citizens' Advice Bureau 2 Ministry of Social Security 2 South-Eastern Gas Board 2 General Practitioner 1 Probation Officer 1 Catholic Housing Aid Society 2 Coal Merchant 1 144 53 (c) Mortgage Cases. London Borough of Merton 7 Greater London Council 24 31 (d) Assessment Cases. Housing Department 41 Welfare Services Department 9 Medical and Nursing staff of Health Department 9 Self referrals 3 South-Eastern Gas Board 2 Town Clerk's Department 1 London Borough of Camden 1 Probation Officer 1 Medical Social Worker in Hospital 1 Youth Employment Officer 1 General Practitioner 1 70 Total 437* * This figure does not include 113 cases requiring initial enquiries followed by transfers to other Council Departments. 54 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR This is the Fourth Annual Report on the Environmental Health of the London Borough of Merton and the contribution which Public Health Inspectors are constantly making to improve standards in this important public service. In reviewing the work carried out during the year 1968 regard has been had to Ministry of Health Circular 1/69 dated January, 1969. 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. 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:— 'The supply was satisfactory both as to (i) quality, and (ii) quantity, throughout 1968. '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 results are found to be satisfactory. 'The quality control from the laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. '(i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar General's estimates at 30th June, 1968, was 153,900. '(ii) No houses were permanently supplied by standpipe. 'No artificial fluoride is added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 55 'The supply was derived from the following works and pumping stations:— River Thames (Southern Group). 'No new sources of supply were instituted and there were no changes to the general scheme of supply in the area. On account of hardness content and alkaline reaction the Board's river and well water supplies are not considered to be plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. 'Special tests for lead have been carried out during 1968 on 100 premises where a lead supply pipe is installed. The premises were chosen to give an even distribution of samples throughout the whole of the Board's area. Two samples were collected from each premises; one was the first running of water standing in the lead pipe overnight and the other was a sample of water after running the tap for a few minutes. 'The results are set out in the accompanying table:— Lead content (mg/1. Pb) water from main taps in consumer's premises. Lead content (mg/1 Pb) Samples of water standing in lead pipe overnight Samples of water after running the tap Less than 0.01 10 37 0.01 31 57 0.02 21 4 0.03 8 1 0.04 9 0 0.05 5 0 0.06 5 0 0.07 4 1 0.08 1 0 0.09 3 0 0.10 1 0 0.12 1 0 0.16 1 0 100 premises 100 premises 'The above results are very satisfactory and the figures are within the limits of the World Health Organisation European Standards for Drinking Water Quality. This states that the upper limit for lead in running water in the supply should not be more than 0.1 mg/1 (Pb); but where water undertakings continue to use lead piping the concentration of lead (as Pb) should not exceed 0.3 mg/1 after 16 hours contact with the pipes.' Sampling of water supplies is an integral part of sampling duties, and a growing responsibility is the bacteriological control of water in swimming baths. 56 During 1968 samples of water were taken for bacteriological and chemical examination by the Public Health Inspectors as follows: — Bacteriological— Swimming Baths 206 Dwelling houses:— Well water 12 Other premises:— Sutton District Water Company 4 222 Unsatisfactory Results— Swimming Baths 31 Dwelling houses:— Well water 1 32 Chemical— Swimming Baths 10 Dwelling houses:— Well water 1 Sutton District Water Company 2 3 13 Unsatisfactory Results— Swimming Baths 1 The Council-owned swimming baths are closely controlled by the Department concerned, and the co-operation of the Baths Manager in taking action in respect of unsatisfactory samples is gratefully acknowledged. 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 and requests received and the visits made during the year 1968:— Complaints received— General disrepair and insanitary conditions 358 Dampness 366 Overcrowding 18 Defective drainage system 113 Blocked drainage systems 1,127 Defective drainage fittings 73 Defective sanitary accommodation 84 57 Defective service water pipes 35 Absence of, or defective, dustbins 12 Accumulation of refuse, etc. 242 Rats and mice 1,291 Pigeons 60 Insect pests 436 Smoke nuisances 157 Noise 103 Smells and odours 290 Unsound food 289 Water supply 129 Miscellaneous 313 5,496 Visits made— General. P.H. Act (Nuisance) 1,577 P.H. Act (Dwelling houses) 2,633 Storage of refuse 243 Drain testing 270 Choked drains 2,360 Other drainage work 816 Radioactivity 1 Flooding 520 Housing. 8,420 Housing Act (Dwelling houses) 1,294 Overcrowding 30 Permitted No. measurements 7 Rent Act 74 Underground rooms 9 Houses in multiple occupation 114 Improvement grants 396 Caravans 91 Food and Food Premises. 2,015 Milk processing dairies 147 Milk vendors 214 Ice-cream premises 476 Food factories 32 Food vehicles 554 School kitchens 54 Restaurant kitchens 667 Licensed premises 200 Bakehouses 46 Butchers 257 Wet and fried fish shops 130 Other food shops 1,034 Meat inspection 350 Unsound food 555 Sampling: Food and Drugs 185 Sampling: Milk 210 Sampling: Ice-cream 86 Sampling: Water 156 Food hygiene swabs 104 5,457 58 Clean Air Act, 1956. Smoke control areas 7,335 Other Clean Air Act visits 484 Smoke observations 440 Air pollution recording apparatus 644 8,903 Factories Act, 1961. Factories (powered) 299 Factories (non-powered) 27 Factories (building sites) 13 Outworkers 31 Workplaces 33 403 Infectious Diseases. I.D. enquiries 215 I.D. contacts 16 Food poisoning 41 Specimens 23 Disinfection 9 304 Offices, Shops and Railway Premises Act, 1963. O.S.R. general inspection offices 201 O.S.R. general inspection shops 191 O.S.R. general inspection wholsesale/warehouses 35 O.S.R. general inspection catering 8 O.S.R. general inspection canteens — O.S.R. general inspection fuel stores — O.S.R. all other visits 2,436 2,871 Insects, Pests, Rodents. Rats and mice control 15,042 Insect control 263 Pigeon control 170 Verminous premises 91 15,566 Animals. Stables 19 Piggeries 9 Slaughterhouse (hygiene) 34 62 Miscellaneous. Places of public entertainment 2 Hairdressers and barbers 112 Fertiliser & Feeding Stuffs Act 3 Noise Abatement Act, 1960 327 Schools 13 Court proceedings 23 Public conveniences 3 Water courses 24 Shops Act, 1950 254 Pet shops 18 Other visits 972 1,751 45,752 59 Result of Service of Notices (1) Legal Proceedings. Proceedings were instituted against the owners of two dwelling houses for failing to comply with Abatement Notices served under Section 93 of the Public Health Act, 1936. In both cases the Court made Nuisance Orders for the work to be carried out within 28 days. Costs of £5 5s. Od. were granted to the Council. Neither Nuisance Order was complied with within the stipulated time and the defendants were fined £10 in each case. For failing to comply with Nuisance Orders for a period of 44 days a fine of £22 in each case was also imposed. The nuisances were finally abated. Proceedings were also instituted against the occupier of a house for failing to comply with an Abatement Notice, Public Health Act, 1936, Section 93, arising from the filthy and insanitary condition of his kitchen. A 14-day Nuisance Order was made by the Court on the defendant who was charged £3 3s. Od. costs and court fees of 8s. 6d. (2) Nuisances abated and Defects remedied. Two thousand seven hundred and eighty-nine defects were remedied as the result of the service of verbal, written and Statutory Notices. 1,176 were in connection with the drainage of buildings; 984 in and around dwelling houses; 575 in connection with food premises; and 54 were of a miscellaneous nature. 60 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 42 27 1 - Factories with mechanical power 933 299 16 - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 45 46 1 - Totals 1,020 372 18 — (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) 3 - - - - Overcrowding (S.2) — - - - - Unreasonable temperature (S.3) 1 - - - - Inadequate ventilation (S.4) - 1 - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7):— Insufficient 2 4 - - - Unsuitable or defective 37 39 - - - Not separate for sexes 8 4 - - - Other offences (excluding offences relating to outwork) — — — — — Totals 51 48 - — — 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 52 - - - - - Lampshades 19 - - - - - Carboard box-making 97 - - - - - Total 168 — — — — — 61 Number of addresses received from other Councils 68 Number of addresses forwarded to other Councils 155 Number of premises where outwork was carried on at the end of 1968 318 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. A Cleansing Station is maintained at Aston Road, S.W.20, and the equipment consists of two slipper baths with incidental rooms, a Dodwell and Dunning electric disinfecting chamber for clothing and a recently installed gas water heating unit. The premises are maintained and staffed by the Health Department. During the year 1968, 61 local residents and 4 persons from other districts received treatment for scabies or for lice infestation. A fee of 30s. is payable by outside authorities for persons sent by them for treatment. 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 134. 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, was applied to the dairy which processes this milk. 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 64 Pasteurised milk 171 Sterilised milk 134 Ultra Heat Treated milk 48 During the year, 159 samples of designated milk were submitted for statutory tests. The results were as follows:— Designation. Satisfactory. Void. Unsatisfactory. Pasteurised 141 3 5 Sterilised 8 — — Untreated — — — Ultra Heat Treated 2 — — 62 All the unsatisfactory samples of milk had failed the Methylene Blue Test. Investigations were made into the cause of these failures. Brucella Abortus. At the request of the West Sussex County Council samples of raw milk are taken in Merton from supplies sent into this district for processing, from farms in the West Sussex area. Sixty such samples were taken during the year and the results of examinations were all negative. These results were notified to the West Sussex County Council. Ice-Cream. During the year 96 samples were submitted for bacteriological examination. The results were as follows: — Grade 1 65 Grade 2 21 Grade 3 3 Grade 4 7 Investigation into Grade 4 samples invariably proved that there was incomplete sterilisation of apparatus or careless handling of either ice-cream, or apparatus, or both. Appropriate action was taken in each case until satisfactory samples were obtained. Bacteriological Examination of Other Foods. Subsequent to suspected outbreaks of food poisoning, 19 samples of various foodstuffs were sent to the Public Health Laboratory for special bacteriological examination. None of the samples showed the presence of pathogenic organisms except three samples taken from the same address. These consisted of cooked chicken, chicken with stuffing, and chicken broth. Cultures from these three samples yielded heavy growths of Staphylococcus aureus. Meat and Other Foods. In the Annual Report, 1967, I reported upon the action which had been taken in respect of the one licensed slaughterhouse in the Borough which was in private ownership. The position at the end of 1967 was that the licensee had appealed to the Magistrates Court against the Local Authority's refusal to grant a licence and that the Court had allowed the Appeal with costs. On behalf of the Local Authority, Notice of Appeal was lodged with the Divisional Court and on 10th July, 1968, the Appeal was heard before the Lord Chief Justice (Lord Parker), Mr. Justice Melford Stevenson and Mr. Justice Bridge. The Court did not hear argument in the case but expressed its disapproval of the manner in which the Council had acted and here appeared to be an unmistakable invitation to the Council to withdraw from the proceedings. After further consideration, this the Council did, and judgment was found for the respondent with costs. Since these proceedings the Council obtained possession of the slaughterhouse and the occupier vacated the premises on 28th October, 1968. No slaughtering has taken place since that date and ultimately the premises will be demolished. In October, 1968, representations were made to the Council to consider under Section 70 of the Food and Drugs Act, 1955, as to the 63 adequacy of, or the necessity to provide, slaughtering facilities for the Borough in view of the (then) pending closure of the private slaughterhouse. All the retail and wholesale butchers within the Borough were communicated with, as well as other known butchers who had previously obtained supplies of meat from the slaughterhouse. The result of the enquiries were as follows:— Number of butchers from whom enquiries were made 135 Forms completed and returned 91 Butchers already having arrangements for supplies, and those 'not affected' 84 Butchers who had not made satisfactory arrangements for supplies 3 Butchers who were interested in a new slaughterhouse 4 Of these latter seven, the total average weekly requirements did not constitute a sufficient demand to warrant the provision of a slaugherhouse within the London Borough of Merton and the Council so RESOLVED. During the year eight slaughterman's licences were issued under the provisions of the Slaughter of Animals Act, 1958. Meat Inspection (up to and including 28-10-68.) Carcasses inspected and condemned where necessary Cattle Calves Sheep & lambs Pigs Animals slaughtered 183 5 88 16,842 Diseases except Tuberculosis and Cysticerci Whole carcasses condemned Nil Nil 3 27 Carcasses of which some part or organ was condemned 38 Nil 2 3,212 Tuberculosis only Whole carcasses condemned Nil Nil Nil Nil Carcasses of which some part or organ was condemned 1 Nil Nil 402 Cysticerci Carcasses of which some part or organ was condemned 8 Nil Nil Nil Carcasses submitted to refrigeration 8 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 0 cwts. 48 lbs. Three hundred and fifty visits were made to the slaughterhouse for the purpose of meat inspection and 100% inspection service was maintained. Poultry Inspection. With the closing of the slaughterhouse, the slaughtering and dressing of hens and broilers, which had taken place there on one day each week, ceased. A tentative proposal for constructing a poultry slaughterhouse at the rear of a retail butcher's shop was made during the year but the idea appears to have been abandoned. 64 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. 4,747 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 164 Confectioners 236 Ice-cream premises 491 Bakers 64 Grocers and Provision Dealers 295 Butchers 108 Fishmongers and Fish Fryers 57 Milk Distributors 134 Chemists 50 Licensed premises 221 Clubs 49 Restaurants and Cafes 141 Works Canteens 74 School Canteens and Kitchens 100 Food Stalls/Vehicles 96 Places of Public Entertainment 39 2,319 The further information required by Circular 1/69 in connection with the provision of ablution facilities, sinks and hot and cold water supplies is not available. 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 491 Registered for the manufacture and sale of ice-cream 6 Registered for the preparation or manufacture of sausages 73 Registered for the preparation or manufacture of potted, pressed, pickled or preserved food 166 The number of inspections of registered food premises during 1968 was 1,133. Bacteriological Examination of Equipment. During the year 311 swabbings or 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:— 65 No. of swabs Result. Article. taken. Satisfactory. Unsatisfactory. Beer mugs and glasses 47 40 7 Wine and spirit glasses 14 13 1 Plates 73 64 9 Cups and beakers 59 50 9 Knives 19 18 1 Forks 54 49 5 Spoons 43 40 3 Serving trays 2 2 — In addition 19 samples of ice-cream server water were submitted for bacteriological examination, ten 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 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. Excluding meat condemned at the slaughterhouse, the following is a list of unsound food surrendered during 1968:— Tons. Cwts. Lbs. Canned foods 4 7 17 Frozen foods 1 17 34 Meat, bacon and poultry — 16 39 Flour, bread and cereals — 9 92 Confectionery — — 90 Sugar, jam and syrup — 1 53 Beverages — 3 48 Butter, fat and cheese — 8 63 Salt — 5 66 Spices — 7 21 Fruit and vegetables — 1 24 Wines, spirits and liqueurs 1 12 44 Minerals and vegetable juices 4 1 48 Puddings and pastry — — 52 Fish — 2 79 Sausages — — 41 Vinegar, pickles and sauce 1 5 67 Miscellaneous 7 9 — 23 10 94 The quantity of unsound food (7 tons 9 cwts. under the heading 'Miscellaneous') was mainly as the result of the extensive flooding in the area which was occasioned by the excessive rainfall on 15 th September, 1968. The examination and destruction of food and drink which was contaminated by flood water caused a great deal of work during the period immediately following 15th September and the actual quantity of foodstuffs surrendered and destroyed under supervision was 12½ tons, in addition to 9,350 bottles of beer, wine, spirits and soft drinks. This inspection work was greatly facilitated by the ready co-operation of shopkeepers, licensees and the manufacturing and brewery firms concerned. 66 The number of complaints received during the year regarding unsound food was 289. 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 bread—mould growth on wrapped bread *(4); stale dough baked in loaf (3); glass in bread *(2); grease and carbon (2); metal; wire*; rubber band*; insect; jute fibres; brown mark through loaf. Glass fragments in botdes of milk (3)*. Tea leaves in botde of milk. Machine oil in bottle of milk. Blade of grass in botde of milk. Foreign matter in bottles of milk (3)**. Unusual smell or taste of milk (2). Alleged stale milk. Dirty milk botdes (15)******. Mouldy pork briskies*. Mouldy chicken briskies*. Mouldy sausages*. Mouldy cereals (2). Mouldy double cream. Mouldy pork pie. Mouldy cheese savoury. Moud in can of baby food. Mould growth on Scotch eggs. Mould growth in can of chicken Capri. Glass in stewed steak dinner. Glass in can of red salmon. Nail in box of dates. Screw in bar of nougat. Tainted can of pineapple pieces. Tainted cake. Worm in rumpsteak. Ants in fruit pie. Fly in veal and ham pie. Fly in shepherds' pie. Insects in packet of milk food powder. Insect in canned pineapple. Insect in rice. Insect in cheese. Blowfly eggs on pork sausages. Maggots in leg of lamb. Abscess in leg of lamb. Cigarette end in sausage meat. Cigarette end in fruit pie. Holed can of corned beef. Brown substance in can of corned beef. Foreign matter in packet of breakfast cereal. Metal in packet of breakfast cereal. Metal in can of peas. Metal in canned sponge pudding. Pin in sausage. Sour pork sausages. 67 Unsound beef and pork sausages. Pebble in can of baked beans. Leaking can of herring fillets. Cardboard in Madeira cake. Discoloured chocolates. Larvae in nut chocolate sweets. Caterpillar in Swiss roll. Pearl in dried milk powder. Unsound frozen fish fingers. Bristle in Gouda cheese. Yellow colouring in cauliflower. By arrangement with other local authorities, complaints concerning dirty milk bottles 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 were sent to the Public Analyst, Messrs. Moir & Palgrave, 16 Southwark Street, S.E.I, for examination and report. During the year 1968, 426 samples were submitted of which 240 were formal samples and 186 informal. The Public Analyst reported that of these samples 405 were found to be genuine and to comply with the relevant Acts, Orders and Regulations, and that 21 did not so comply. Particulars of genuine samples. Alka Seltzer tablets 1 American lard 1 Apple filling 1 Apple and strawberry jam 1 Apricot jam—whole fruit 1 Apricot sauce 1 Asparagus soup— condensed 1 Aspirin tablets B.P. 1 Baked beans in tomato sauce 6 Beef curry with rice 1 Beef steak in gravy 1 Beef suet—shredded 1 Birchermuesli 1 Biscuits 17 Blackberries in heavy syrup 1 Black cherries in heavy syrup 1 Black cherry jam 1 Blackcurrant and apple pie 1 Blackcurrant cordial 1 Blackcurrant health drink (Vitamin C) 1 Blackcurrant jam 3 Blackcurrant juice syrup 1 Brandy 1 Bread loaf 2 Bread loaf—low starch 1 Broad beans 1 Bronchial mixture 1 Brussell sprouts 1 Butter 13 Butter beans 1 Butermilk—cultured drink 1 Butered toast 1 Cake fruit mixture 1 Canadian clover honey 1 Carrots—whole 3 Cheese—Full fat soft 1 Cheese—English Wensleydale 1 Cheese spread 2 Cheese spread with mushroom 1 68 Cheese spread with onion 1 Cheese wafers 1 Cherryade 1 Cherry fruit flavoured drink 1 Chicken curry with rice 1 Chicken and ham roll 1 Chicken supreme with rice 1 Chicken supreme with vegetables and rice 1 Chili powder 1 Chocolate flavoured drink 2 Chocolate Malt drink— Milo 1 Cocoa 1 Coffee—instant 4 Corianda powder 1 Corned beef 1 Cottage pie—frozen 1 Crab meat—canned 1 Cranberry jelly 1 Cream—canned 2 Cream—double 4 Cream—single 1 Creamed macaroni milk pudding 1 Creamed rice milk pudding 2 Cream of tomato soup 1 Custard powder 1 Cut green beans (stringless) 1 Desiccated coconut 1 Dried rubbed thyme 1 English pork pie 1 Evaporated milk 3 Farina potao flour 1 Fish fingers 1 Flour confectionery 12 Fried hamburgers with gravy 1 Fruit pudding 1 Ginger beer 2 Ginger beer shandy 1 Glacé cherries 1 Gooseberry pie filling 1 Grape juice 1 Green beans—sliced 1 Gripe mixture 1 Ground almonds 1 Ground ginger 1 Ground nut cooking oil 1 Ham—canned 1 Ham—lean 1 Ham and tongue pate 1 Heather honey 1 Honey—pure clear 1 Honey—pure set 1 Horse radish—grated 1 Hot pepper sauce 1 Ice-cream 9 Ice-cream flan with raspberry jelly 1 Ice-cream sponge sandwich 1 Instant low fat milk— skimmed 1 Kipper fillets—canned 1 Lard 2 Lemonade 1 Lemonade shandy 1 Lemon Barley water 1 Lemon drink 1 Lemon drink with glucose 1 Lime juice cordial 1 Lobster soup 1 Macedoine 1 Malt vinegar 1 Malt vinegar with caramel 1 Mandarin orange drink 1 Margarine 2 Marmalade sponge pudding 1 Mashed potato—instant 1 Meat pudding 1 Milk—unspecified 32 Milk—Channel Island 19 Milk—Pasteurised 3 Milk—separated 2 Milk—sterilised 3 Milk—ultra heat treated 1 Milk shake—banana flavour 1 Milk shake syrup— pineapple 1 Milk top 1 Minced beef 2 Minced beef with onions and gravy 2 Minced steak 1 Minced steak with gravy 1 Mixed fruit jam 1 New potatoes—canned 1 Orange crush 2 Orange drink 4 Orange marmalade 3 69 Orange and rose hip syrup 1 Orange squash 1 Orange squash— concentrated 1 Orange wine 1 Ox tongue 1 Oxo cubes 1 Parsley sauce mix 1 Party pies 1 Pear halves 1 Peas—garden 5 Peas—processed 2 Phyllosan tablets 1 Pickle 1 Pickled beetroot 1 Pickled walnuts 1 Pineapple cubes in syrup 1 Pineapple and grapefruit squash 1 Porage—instant (porridge) 1 Pork luncheon meat 4 Pork pie 1 Puffa puffa rice 1 Puff pastry 1 Purified glucose 1 Raspberries in syrup 2 Rhubarb in syrup 1 Risotto 1 Risotto beef 1 Roasted salted peanuts 1 Rose hip syrup 2 Royal game soup 1 Runner beans—sliced 1 Rye bread—sliced 1 Saffron powder 1 Salad fruits in extra heavy syrup 1 Salmon—red (canned) 4 Sardine and tomato toasty grill 1 Sardines in pure olive oil 1 Self-raising flour 1 Semolina milk pudding 1 Sild 1 Skona 1 Smoked bacon 1 Soft herring roes 1 Soured cream 1 Spaghetti in tomato and cheese sauce 1 Spiced ham spread 1 Spinach leaf 1 Starch reduced rolls 1 Steak and kidney pie 2 Steaklets preserved 1 Stewed steak 1 Sugar confectionery 23 Sugar frosted flakes 1 Sweet corn 1 Sausages—pork 2 Sausages—preserved beef and pork 1 Sausages—preserved pork 4 Sausages—preserved skinless 1 Sausage meat—pork 1 Sausage rolls 1 Table jellies 5 Table salt 1 Tapioca flakes 1 Tea 5 Thick farmhouse vegetable soup 1 Tizer 1 Tomato pickle—home style 1 Tomatoes—canned 5 Tuna—canned 1 Tuna in oil 1 Turkey and veal loaf 1 Viennese coffee 1 Vita-cup 1 Vodka 1 Whisky 3 Whole orange drink 3 Whole pineapple—canned 1 Yeast-vite tablets 1 Yogurt 5 Zinc and castor oil ointment B.P. 1 Particulars of non-genuine samples and action taken. Apricot Jam. The sample was deficient in soluble solids to the extent of 1.7%. Attention of manufacturers drawn to discrepancy and further samples to be taken in due course. Beef Chow Mein. In the opinion of the Public Analyst this sample should have had a meat content of not less than 35% whereas in fact the 70 total meat content of the sample was 8%. Product was imported from U.S.A. and as the result of correspondence, arrangements were made for the label to be amended. Low Calorie Blackcurrant Health Drink. The label attached to the container described this article as: 'Triple Vitamin "C" Enriched' and a minimum Vitamin 'C' content of 60 mg. per fluid ounce was declared. In the opinion of the Public Analyst there was no justification for this statement and he considered the claim was liable to mislead as to the quality of the drink. After report to the Health Committee, warning letter was sent. Cheese. This sample of processed Cheddar cheese was not so described on the label in accordance with the Cheese Regulations, 1965. Informal action resulted in proper labelling of cheese. Frozen Chips. The ingredients (potatoes and edible vegetable oil) were not declared on the label as required by the Labelling of Food Order, 1953. Label amended. Cooking Butter. The can containing this sample was marked: 'Specially packed for the West Indian Trade'. The sample did, in fact, consist of rancid butter and in the opinion of the Public Analyst 'Cooking Butter' was not an adequate description. Informal action taken. Jersey Slice. This sample of flour confectionery with synthetic cream filling contained 40% butter. In the opinion of the Public Analyst is should have contained not less than 50% butter. Informal action taken. Fruit Salad in Heavy Syrup. The proportions of the various fruits were not in accordance with Code of Practice No. 4 of the Local Authorities Joint Advisory Committee on Food Standards, in that the sample contained an excess of apricots. Informal action was taken. Canned Peas. The salt content (0.7%) was not declared on the label— Labelling of Food Order, 1953. Informal action taken. Honey. The name of this article (Boyne Valley Imported Honey) was, in the opinion of the Public Analyst, misleading in that it implied that it was a product of Boyne Valley. It was, in fact, blended imported honey. Informal action taken. Irish Stew. This sample contained beef and fat but no mutton. In the opinion of the Public Analyst it was wrongly described and should have been called Stewed Beef and Vegetables. Following correspondence with the manufacturers the label was reworded and a further sample will be taken in due course. 71 Mushroom Cubes. These cubes were intended to be added to meat dishes to impart a flavour resembling mushroom. In the opinion of the Public Analyst ' Mushroom Cubes' was not an appropriate designation since the major component was starch which was not found in mushrooms. In addition the list of ingredients given on the carton and on the wrappers of the individual cubes did not agree. Informal action was taken—small remaining stock destroyed and warning letters sent to manufacturers concerned. Olive Loaf. This was an article of food containing more than two ingredients which were not listed in a proper manner on the label—Labelling of Food Order, 1953. Label amended. Frozen Peas. The appropriate designation (Frozen Peas) was not declared on the label. Label amended. Pickled Herrings. This sample was in a state of fermentation. The label was inscribed 'Will keep in a cool place for two weeks or in a refrigerator for one month'. Since there was no indication as to when the article was packed this statement had very little meaning. Informal action taken and further sample to be taken in due course. Canned Pork Brawn. This sample was affected by sulphide staining and the appearance of the meat was objectionable. Informal action taken. Sweetening Tablets. These tablets were discoloured on one side and upon examination traces of iron were found. This probably originated from the mould used to form the tablets. The amount of iron was small but the discolouration could give rise to complaint. Informal action taken. Beef Sausages. The sample contained sulphur dioxide which was not declared at the time of sale. Informal action taken. Pork Sausages. The sample contained sulphur dioxide which was not declared at the time of sale. Informal action taken. Thick Vegetable Soup with Beef. This sample contained noodles (25%) and the label made no reference to noodles. In the opinion of the Public Analyst both the name and the illustration on the label were misleading. Label amended. Wine Aperitif. This was a sample of genuine sweetened, fortified wine, but it was incorrectly labelled—Labelling of Food Order, 1953. Label amended. 72 The following twenty samples were submitted for special examination, the results being shown:— Bread (5) Non-genuine (4) Cake Non-genuine Cauliflower Genuine Cherry fruit pie Non-genuine Chicken fry crisps Genuine Frozen chicken Non-genuine Milk (6) Non-genuine (6) Pineapple, canned Non-genuine Rice Non-genuine Shepherd's Pie Genuine Tea Genuine Further particulars regarding the fifteen non-genuine samples are as follows:— Bread (4). Glass in loaf of bread—legal proceedings instituted—three defendants each fined £5 plus £2 2s. 0d. costs; Foreign matter (pieces of stale brown dough) in loaf—informal action taken; Wire in loaf of bread—legal proceedings instituted—defendants fined £10 plus £8 8s. 0d. costs; Loaf containing foreign matter—jute fibres from hessian gloves used in bakery— warning letter sent to bakery firm. Cake. Foreign matter found in Madeira cake was found to be a piece of cardboard, probably from one of the packages used in the bakehouse—warning letter sent to bakery firm. Cherry fruit pie. Found to contain a filter tip from a cigarette—warning letter sent to bakery firm. Frozen Chicken. A complaint referred to a 'chemical' taste after the chicken had been roasted. In the opinion of the Public Analyst the taste was probably caused from the use of an excessive concentration of Hypochlorite in the water used in the processing plant—informal action taken. Milk (6). Dirty 1-pint milk botde containing particles of sand and cement mortar—informal action taken; Dirty 1 pint milk bottle containing mixture of cement and milk—legal proceedings taken—defendants fined £20 plus £5 5s. 0d. costs; Foreign matter in 1-pint milk bottle which proved to be a living mould growth—warning letter sent to dairy company; Foreign matter in botde of school milk—this foreign matter proved to be tea leaves—informal action taken; Dirty 1-pint milk bottle containing tea leaves and dried milk solids. The milk solids were covered with a mould growth—warning letter sent to dairy company; 1-pint bottle of milk containing a small piece of glass which proved to be part of the base of a botde—legal proceedings instituted—defendants fined £20. 73 Canned Pineapple. An insect identified as Carpophilus Humeralis Fab. was found in a can of pineapple. The insect was of foreign origin and after investigation a warning letter was sent to the canners concerned. Rice. Rice was found to contain insects which were identified as rust-red flour beetles. There was no evidence of long term infestation and after investigation a warning letter was sent to the vendors. 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. Other Legal Proceedings. Food and Drugs Act, 1955—Section 2. Bread roll containing elastic band. Defendants pleaded guilty; fined £20 plus £6 6s. 0d. costs. Piece of metal in a can of peas. Defendants pleaded guilty; fined £25 plus £6 6s. 0d. costs. Bread containing mould growth. Defendants pleaded guilty; fined £10 plus £6 6s. 0d. costs. Mould growth on chicken croquettes. Defendants pleaded guilty; fined £10 plus £6 6s. 0d. costs. Mould growth on pork briskies (pork croquettes). Two defendants pleaded guilty and were fined £10 each plus £3 3s. 0d. costs each. Mould growth in pork sausages. Two defendants pleaded guilty; fined £10 each plus total costs of £6 6s. 0d. Food and Drugs Act, 1955, and Milk and Dairies (General) Regulations, 1959. Dirty 1-pint milk bottle delivered in Caterham and Warlingham U.D.C. area. Defendants pleaded guilty; fined £20. Dirty 1-pint milk bottle delivered in Banstead U.D.C. area. Defendants pleaded guilty; fined £20 plus £6 6s. 0d. costs. Dirty 1-pint milk botde delivered in area of London Borough of Wandsworth. Defendants pleaded guilty; fined £20. Dirty 1-pint milk bottle delivered in Merton area. Defendants pleaded guilty; fined £20 plus £5 5s. 0d. costs. Dirty 1-pint milk bottle delivered in area of London Borough of Wandsworth. Defendants pleaded guilty; fined £10 plus £6 5s. 0d. costs. Dirty 1-pint milk botde delivered in Banstead U.D.C. area. Defendants pleaded guilty; fined £10. Dirty 1-pint milk bottle delivered in Caterham and Warlingham U.D.C. area. Defendants pleaded guilty; fined £10. Dirty 1-pint milk bottle delivered in Merton area. Defendants fined £20. 74 SERVICES UNDER OTHER ENACTMENTS Rent Act, 1957—Certificates of Disrepair. The following is a summary of applications dealt with during 1968:— Applications received (Form 1) 5 Decisions not to issue Certificates Nil Certificates issued (Form L) 3 Undertakings given (Form K) 2 Number of visits made 74 Shops Acts, 1950-65. Shops in the Borough have been kept under observation and contraventions of Shops legislation have been remedied informally. Excellent relations exist between the three Chambers of Commerce and the Department and advice has been given throughout the year, both to the Chambers and to individual shopkeepers. Action has also been taken in respect of general closing hours, half-day closing and Sunday trading. Inspection records were added to and by the end of the year an up-to-date Shops Register consisting of some 3,000 shops had been compiled. During the year an application was received from a trader asking the Council to consider the making of a six-day trading week Order. This application was still under consideration at the end of the year. Offices, Shops and Railway Premises Act, 1963. Work under this legislation was continued during 1968, with the specialist staff appointed for the purpose. The majority of owners and occupiers of premises which require 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. 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 52 740 201 Retail Shops 35 1,261 191 Wholesale Shops, Warehouses 14 55 35 Catering Establishments open to the Public, Canteens 1 146 8 Fuel Storage Depots 1 6 Nil Totals 103 2,208 435 75 Contraventions rectified. Cleanliness 140 Overcrowding 3 Temperature 79 Ventilation 18 Lighting 15 Sanitary conveniences 80 Washing facilities 67 Eating facilities 7 Clothing accommodation 13 Sitting facilities 1 Floors, passages, stairs 56 Dangerous machinery guarded 24 First Aid provisions 87 Abstract of Act posted 100 Not registered 15 Other contraventions 6 Exemptions. No exemptions (Section 46) were granted in 1968. Accidents Reported and Investigated. In offices 3 In retail shops 25 In wholesale shops and warehouses 4 In catering establishments open to public; in canteens, etc. 3 No reports of serious accidents were received during the year. Every accident reported, however, was followed up and advice given to the employers concerned. It is interesting to note that the majority of the accidents reported during 1968 occurred in retail food premises. A list of premises in the Borough where lifts and hoists are installed has been prepared in order that action will be taken where applicable as from the effective date of the Regulations which come into force on 24th May, 1969. The total number of visits of all kinds made by the specialist staff and by the Public Health Inspectors during 1968 was 2,871. Prevention of Damage by Pests Act, 1949. The following table summarises surface rodent control work which was carried out during 1968. 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 1,517 2,417 3,934 1,305 351 1,656 15,042 76 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 1968, 878 manholes were baited and only 68 showed evidence of rodent infestation. The Department continued to deal with rodent treatment and disinfestation work in Council-owned property within the Borough. Other Pest Control Work. During the year 1968, 436 complaints were received concerning insect pests and the following is a list of the infestations dealt with:— Ants 41 Bees 61 Beetles 30 Bedbugs 25 Caterpillars 2 Cockroaches 19 Fleas 75 Flies 12 Lice 1 Maggots 10 Mealworms 1 Mites 4 Mosquitoes 8 Silverfish 6 Slugs 5 Wasps 132 Woodlice 1 Worms 3 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 lower than in previous years. 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 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 complaints of nuisance or damage by ferral 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 but, nevertheless, upwards of 200 birds and a number of eggs were destroyed as the result of action by the Department. Pet Animals Act, 1951. Twelve licences to keep Pet Shops were issued during 1968. Eighteen visits were made to these premises to ensure compliance with the conditions attached to the licences. 77 The Riding Establishments Act, 1964. Three applications for licences to keep riding establishments were received during the year, all of which were granted. The Council have appointed Messrs. H. S. Gates and G. W. Serth, Members of Royal College of Veterinary Surgeons, of Purley, Surrey, as their Advisory Veterinary Surgeons for the purposes of this Act. Diseases of Animals Act, 1950. No outbreaks of disease occurred within the Borough during 1968. Movement licences authorising the transfer of pigs from areas affected by Swine Fever Orders to the slaughterhouse at Mitcham were received during the year. Numerous copies of Orders made by the Ministry of Agriculture, Fisheries and Food were received in respect of the unprecedented widespread epidemic of Foot and Mouth Disease which began in 1967 and continued into 1968, the whole of England and Wales having been declared a controlled area for the purpose of preventing the spread of the disease. No movement of animals was permitted except under licence signed by me as the Inspector of the local authority into whose district the animals were to be moved. Licences continued to be issued until the end of February, 1968, permitting the movement in total of 14,934 pigs, 16 sheep and 38 cattle to the Mitcham Slaughterhouse for slaughter. Clean Air Act, 1956. During 1968, 157 complaints were received with regard to smoke or grit emission, and the necessary observations were made and remedial action taken. Twenty-two notices of proposals to install a furnace to which Section 3 (1) of the Act applied were received, and the installations were inspected and recorded. In 25 instances plans which were deposited for Building Regulations 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. Measurement of Atmospheric Pollution. The Health Department now maintains eight eight-port 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 weekly. Recordings are standardised and the results are sent monthly to the Ministry of Technology. It is of value to the practical aspects of the control of air pollution to be able to equate action taken with measurements which show improvement. The average monthly results are depicted by means of graphs which appear on following pages of this report. It is pleasant to again note a fall during the winter months in smoke concentrations in the atmosphere due undoubtedly, in some 78 measure, to the coming into operation of Smoke Control Orders. The peak concentration in December was lower than it has been for many years. It is known that there is an increased use of oil fuels, particularly in industry. The graph indicating the monthly concentrations of sulphur dioxide show some increase up to December, 1968, and a fall in the early part of 1969. This high level in December is considerably lower than in 1962/3 and 1964 but it is certainly higher than has been recorded during the last three years. The use of higher chimneys, more refined fuels and advanced boilerhouse equipment all have an effect upon the average reduction of sulphur dioxide concentration. 79 80 81 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. 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, 1968, 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. London Borough 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 1966 Operative date 1.10.67. No. 5 1966 Operative date 1.11.67. No. 6 1966 Operative date 1.12.67. No. 7 1967 Operative date 1.10.68. No. 8 1967 Operative date 1.11.68. No. 9 1968 Operative date 1.7.69. No. 10 1968 Operative date 1.7.69. No. 11 1968 Operative date 1.9.69. No. 12 1968 Operative date 1.10.69. Area No. 13 Under Survey. Area No. 14 Under Survey. The area of the Borough covered by Orders either in operation, or confirmed but not operative, is 5,927 acres. The total number of premises involved in these areas is 34,942. Comparable figures at the commencement of the year were 5,517 acres and 30,398 premises. The two Smoke Control Areas under survey at the end of the year will cover an additional 277 acres with 3,125 premises. It is interesting to note that whereas on 1st January, 1969, the percentage of the total 'black area' acreage in the Greater London Area, which was covered by Smoke Control Orders confirmed or awaiting decision was 65.18, the comparative figure for the London Borough of Merton was 63.0 82 The total number of visits made during 1968 in connection with the Clean Air Act, 1956, for all purposes, was 8,903. 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. Noise levels in this and many other countries are becoming intolerable, and unnecessary noise is a menace of modern living. The growth of motor traffic, the jet plane, complicated industrial machinery, building operations, music from public halls, all contribute their quota of noise. There is an increasing public awareess that noise, which has been described as the wrong sound in the wrong place at the wrong time, interferes with the comfort of the community. During the year 1968, 103 complaints regarding noise were received, and the investigation of these entailed 327 visits, many of which were made outside normal office hours. The most common causes of noise complaint were in factories (26), domestic premises (12), and business premises (10). Records are being kept in accordance with the requirements of Ministry of Housing and Local Government Circular 22/67. Public Health Inspectors have attended courses of instruction in noise abatement and particular attention has been given during the year to the problem of noise. The Pharmacy and Poisons Acts, 1933-1941 One hundred and thirty-three 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 spring granular fertiliser, compound turf spring fertiliser, summer base fertiliser, and pre-seed turf fertiliser, were submitted to the Agricultural Analyst and found to be satisfactory. The Ministry of Agriculture, Fisheries and Food were notified on Returns. 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 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 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 2,015. During the year three Clearance Areas were declared, involving a total of 78 dwelling houses, but no Closing Orders were made. 83 Applications for Standard and Discretionary Grants received by the Borough Surveyor are referred to me for an opinion as to the fitness and anticipated life of the dwelling houses concerned. It is normal to carry out an inspection and to apply the Statutory Standards of Fitness (Housing Act, 1957). The total number of houses so inpected during 1968 was 602. Caravan Sites and Control of Development Act, 1960. The number of site l0icences operating at 31st December, 1968, was five, and the permitted number of caravans, including those kept on two sites occupied by members of the Showmen's Guild, was 41. Ninety-one visits were made to sites during the year. From time to time itinerant caravans were found to be parked on unauthorised sites and as the result of visits, the occupiers were persuaded to remove their vehicles. Registration of Hairdressers and Barbers. The Council adopted the provisions of the Greater London Council (General Powers) Act, 1967, insofar as they relate to the Registration of Hairdressers and Barbers. By Resolution the Council fixed the First day of April, 1968, as the appointed day for the purpose of Section 21 of the Act and authorised me to deal with Applications for Registration. A new system of inspection and recording of these premises was instituted and 167 premises were registered during 1968 after each had been inspected and any necessary works carried out. CONCLUSION It is hoped that this Report reflects the good standard which has been maintained and the variety of work which has been covered by the Public Health Inspectors, Technical Assistants and clerical staff. On 1st January, 1968, there were two vacancies for District Public Health Inspectors. During 1968 four further Inspectors left, having obtained appointments elsewhere and four Inspectors were appointed leaving the same deficiency at the end of the year. Despite these upsetting changes, it is pleasing to record that the overall number of inspections increased by 4,455. It is becoming apparent that the volume of work in the Borough is increasing and, in order to strengthen the inspectorate, it is hoped that early consideration might be given to the appointment of further Senior Inspectors for supervisory duties. The four Pupil Public Health Inspectors were all successful in passing their respective annual examinations, and two are expected to qualify during 1969. 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 to the clerical staff for their excellent supporting administrative work. G. H. COCKELL Chief Public Health Inspector. 84 ANNUAL REPORT to the EDUCATION COMMITTEE on the work of the SCHOOL HEALTH SERVICE for the year 1968 CONTENTS Page Introductory Letter by Principal School Medical Officer 87 Special Services (Education) Sub-Committee as at 31st December, 1968 88 School Clinics provided by the Local Education Authority 89-90 The Service 91 Medical Inspections 91 Audiometry and Audiology 91 Speech Therapy 92 The Work of the School Nurses 92-93 Child Guidance Service 93-97 Handicapped Pupils 98 The School Dental Service: Report by Chief Dental Officer 98-99 Statistics on School Dental Service 99-100 Infectious Diseases and Prophylactic Measures: Infectious Diseases 101 Prophylactic Measures 101 Ancillary Services: Nursery Schools and Classes 102 Provision of Milk and Meals 102 Appendix 'A': Routine Medical Inspections 103 Other Medical Inspections 103 Return of Defects Found at Medical Inspections 104 Children Found to Require Treatment 105 Classification of General Condition of Pupils 105 Uncleanliness and Verminous Conditions 105 Diseases of the Skin 106 Eye Diseases, Defective Vision and Squint 106 Diseases of the Ear, Nose and Throat 106 Orthopaedic and Postural Defects 106 Other Treatment Given 107 Appendix 'B': Attendances at Clinics 107 Other Medical Examinations by School Medical Officers 107 Recuperative Holidays 107 86 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 1968. The health of school children in Merton during the year was very good, only two children out of 10,401 examined were found to be unsatisfactory, and thus the percentage whose general condition was found to be satisfactory was 99.98 compared with 99.3 in 1967. School medical inspections totalled 12,906 (10,401 routine inspections and 2,505 special inspections and re-inspections) compared with 12,780 (9,607 routine inspections and 3,173 special inspections and re-inspections) in 1967. At routine and other medical inspections 6,491 defects, mostly minor in character, were found of which 3,170 were referred for treatment and 3,321 for observation, compared with 7,174 (3,742 for treatment and 3,432 for observation) in 1967. It is pleasing to be able to report that by the end of the year the Authority had been able to recruit a full establishment of three Speech Therapists. It is also satisfactory to know that no case of tuberculosis in school children or in teaching staff was notified during the year. I am grateful for the help and co-operation received from the Chief Education Officer and his staff, from Head Teachers and from the many School Secretaries in the Borough. My thanks are also given to the medical, dental, nursing and other staff of the Department 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 grateful for the continued support and encouragement so kindly extended to me at all times by the Chairman and Members of the Education Committee and the Primary Education and Special Services Sub-Committee. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, P. J. DOODY, Principal School Medical Officer. 87 PRIMARY EDUCATION AND SPECIAL SERVICES (EDUCATION) SUB-COMMITTEE (As at 31st December, 1968) Chairman: Councillor P. S. Gill Councillor (Mrs.) W. R. Castle (Vice-Chairman) Alderman E. J. Mills Councillors: B. N. Clifford P. Corbishley J. N. Healey R. L. Mackenzie, F.C.A. F. H. Meakings D. C. Nye W. G. Terrett Co-opted Members: Reverend H. B. Jamieson Reverend Douglas Noble Mr. C. H. Davies, J.P., B.A. Ex-Officio: Alderman V. Talbot, J.P. (Chairman of the Education Committee) Alderman Sir Cyril Black, J.P., D.L., M.P. (Vice-Chairman of the Education Committee) Chief Education Officer: R. Greenwood, M.A. 88 SCHOOL CLINICS PROVIDED BY THE LOCAL EDUCATION AUTHORITY General Medical Clinics Amity Grove, West Wimbledon: 2nd and 4th 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. Western Road, Mitcham: Monday and Friday mornings. Wide Way, Mitcham: Wednesday mornings. Examination of cases referred by Teachers, Education Department, Health Visitors, etc.: Treatment of minor ailments. Child Guidance Clinics 97 Worple 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: Friday afternoons. Grand Drive, Raynes Park: Friday afternoons. 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 each cases by an Orthopaedic month. Surgeon. Audiology Clinic Pelham Road, Wimbledon: Friady mornings. Detailed investigation of cases referred. 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. 89 Speech Therapy Clinics Amity Grove, West Wimbledon: Tuesday afternoons and Wednesday all day. Grand Drive, Raynes Park: Thursday all day and Friday afternoons. Middleton Road, Morden: Tuesday and Wednesday mornings. Morden Road, Merton: Monday mornings and Wednesday afternoons. Russell Road, Wimbledon: Monday and Thursday all day. Western Road, Mitcham: Tuesday all day and Thursday mornings. Wide Way, Mitcham: Friday all day. Treatment of speech defects. Dental Clinics Amity Grove, West Wimbledon: Monday to Friday all day. Church Road, Mitcham: Wednesday morning (Orthodontic Clinic) and Thursday and Friday all day. Grand Drive, Raynes Park: Monday to Wednesday all day. Thursday morning Orthodontic only. Meopham Road, Mitcham: Monday to 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 Wednesday all day. 90 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, general practitioners and 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 schedule of medical inspections was under review at the end of the year. 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. Details are given below of audiometric primary testing carried out during the year:— Number of primary schools visited 39 Number of children tested 2,546 Number of primary failures162 91 All children in secondary schools are now tested in their eleventh year, the details for 1968 being as follows:— Number of secondary schools visited 22 Number of children tested 2,010 Number of secondary failures 66 A total of 4,556 children (primary and secondary) were tested, of these 228 failed the audiometric test. SPEECH THERAPY There was a shortage of staff for part of the year, but by the end of 1968 the Authority had been able to recruit the full complement of three speech therapists, and a speech therapist is allocated in each case to the Mitcham area, the Merton and Morden area, and the Wimbledon area. The staff shortage for part of the year accounts for a reduction in the number of sessions compared with the previous year. Number of sessions held: (a) for treatment 762 (b) for consultation 47 Number of cases on register at beginning of year 314 Number of cases added during year 201 Number of cases discharged during year 145 Number of cases on register at end of year 370 Cases discharged during the year who:— Achieved normal speech 60 Were greatly improved 32 Showed some improvement 25 Showed little or no improvement 12 Other reasons 16 Analysis of cases treated during the year:— Stammering 53 Dyslalia 292 Cleft palate 13 Dysarthria 2 Guttering 2 Aphasia 2 Defects of the voice 12 Defective speech due to deafness 11 Retarded speech and language 143 THE WORK OF THE SCHOOL NURSES The Health Visitors/School Nurses have continued to visit the primary schools for routine medical inspections, and all schools for hygiene, unless it has been suggested by the school that hygiene visits are unnecessary. In many schools, Health Visitors look in regularly to discuss children with the Head Teacher and other teachers. 92 The state registered nurses, who operate as School Nurses, visit with School Medical Officers all the secondary and grammar schools for routine medical inspections, and in 1968 they carried out vision tests for the first time on the 13-year old age group. These nurses staff the general medical clinics, and also go with the doctor on all visits to schools for Diphtheria and Tetanus innoculations and the Mantouz/B.C.G. injections at thirteen, and the occasional surveys following any new cases of tuberculosis in schools. Teaching in schools by School Medical Officers or Health Visitors/ School Nurses has not progressed in 1968 because of the impending re-organisation of secondary and grammar schools in 1969. It was felt that new teaching projects on such subjects as preparation for adult life, etc., should wait until the re-arrangements had fully settled in. However, consolidation of several established teaching sessions has gone ahead, and it can be said with some confidence that this work of the Health Visitor/School Nurse (helped gready by the Health Education Officer) has been appreciated both by staff and pupils. The following tables give details of visits paid, and clinic sessions attended by Health Visitors/School Nurses during the year:— 1. Visits. To pupils, found at school medical examinations to require observation or treatment 50 To educationally subnormal children 199 To verminous cases 80 To infectious or contagious cases 31 To miscellaneous cases (arising from school medical inspections at request of Head Teacher, etc.) 102 2. Sessions attended. For school medical inspections 151 Hygiene inspections 82 General medical clinics 197 Health teaching 20 Vision testing 4 Audiology clinics 256 CHILD GUIDANCE SERVICE 1. Staffing During the year the two clinics have been almost fully staffed. A second psychotherapist was recruited in Mrs. J. Hogg who commenced duties at the Mitcham Child Guidance Clinic in October, undertaking four sessions per week. This only leaves a vacancy for two sessions per week. 2. Accommodation The Wimbledon Child Guidance Clinic is now well established at 97 Worple Road. The Mitcham Clinic continues in the limited accommodation at Sherwood House, Abbotts Road, Mitcham. The extension to provide 93 four additional small rooms will be put in hand when funds are available. 3. Remedial Classes The three remedial classes based at Manor House Nursery School, Malmesbury Primary School and Lonesome Junior School continue to provide a much needed service. 4. School Provision for Educationally Sub-normal Children The Authority's proposal to build a new E.S.N. School on the site of the Round School at Camp Road, Wimbledon, had to be deferred due to difficulties which arose concerning the preservation of the Round School. Plans have, therefore, been put in hand for this new school to be built on the Hall Place site at Mitcham. 5. Visits to Schools The Assistant Education Officer for Primary Schools and Special Services continued to visit residential special schools where Merton children are placed to inspect the educational and living facilities. Visits are also made by staff of the Child Guidance Clinics when necessary to ensure the correct placement of maladjusted children. (A) The General Work of the Child Guidance Clinics 1. New Referrals. M. F. Total. (a) Referring agencies:— Courts or probation officers 4 — 4 School Health Service 20 19 39 Hospitals or specialists 3 1 4 General practitioners 9 8 17 Schools 68 24 92 Parents 19 13 32 Others 34 8 42 Total 157 73 230 (b) Predominant reasons for referral:— Nervous disorders 24 26 50 Behaviour problems 99 34 133 Habit disorders 9 3 12 Educational problems 24 9 33 Pyschosomatic disorders 1 — 1 Others — 1 1 Total 157 73 230 (c) Number of cases on diagnostic waiting list 23 10 33 94 (d) Reasons why no diagnostic interview undertaken:—  M. F. Total. Transferred to other areas 1 3 4 Failed to attend appointments 9 4 13 Improved 3 1 4 Other reasons 5 3 8 Total 18 11 29 (e) Ages of children when referred:— Under 5 years 10 10 20 5-6 years 31 11 42 7-8 years 42 15 57 9-10 years 27 13 40 11-12 years 25 13 38 13-14 years 10 6 16 Over 14 years 12 5 17 Total 157 73 230 2. New Cases Seen. (a) Referring agencies:— Courts or probation officers 3 — 3 School Health Service 18 13 31 Hospitals or specialists 2 1 3 General practitioners 8 5 13 Schools 56 23 79 Parents 16 10 26 Others 23 6 29 Total 126 58 184 (b) Range of intelligence quotients of cases:— Inferior I.Q. below 71 3 6 9 Limited I.Q. 71-85 15 8 23 Low average I.Q. 86-95 17 7 24 Average I.Q. 96-105 28 6 34 Good average I.Q. 106-115 24 9 33 Above average I.Q. 116-130 17 7 24 Superior I.Q. 131-150 3 1 4 Exceptional I.Q. 151+ — — — Not tested 18 13 31 Untestable 1 1 2 Total 126 58 184 (c) Action taken:— Consultation and advice 37 16 53 Pyschotherapy 17 9 26 Placed on waiting list for psychotherapy 16 2 18 Remedial tuition 2 1 3 Case-work with parents only 14 9 23 Placement in special schools, etc. 4 1 5 Placement in special schools, etc., being sought 9 1 10 Periodic supervision 22 13 35 Other action 5 6 11 Total 126 58 184 95 (d) Results of action taken, insofar as it present:— is possible to judge at M. F. Total improved 27 18 45 Slightly improved 19 16 35 Not yet improved 24 7 31 Doubtful 14 7 21 Not applicable 42 10 52 Total 126 58 184 3. Current case-load on 31st December, 1967. Casts under treatment 35 12 47 Cases under supervision 289 94 383 Cases awaiting treatment 32 6 38 Total 356 112 468 4. Summary of Work Involved. Psychiatrists:— Interviews for diagnosis or assessment 352 Interviews for treatment 432 Interviews with parents or guardians 58 Interviews with social workers or other officials 15 Other interviews 12 Visits, meetings, etc., outside the Clinic 13 Appointments arranged but not attended 124 Total 1,006 (b) Psychotherapists:— Interviews for treatment 678 Interviews with parents or guardians — Interviews with social workers or other officials — Other interviews — Visits, meetings , etc., outside the Clinic 1 Appointments arranged but not attended 41 Total 720 (c) Educational Psychologists:— Interviews with children for examination 145 Interviews with children for remedial tuition 168 Interviews with parents or guardians 8 Interviews with other officials 21 Visits outside clinic (not schools) 48 Appointments arranged but not attended 33 Total 423 (d) Pyschiatric Social Workers:— Interviews with parents or guardians at Clinic 1,518 Interviews with parents or guardians at home 124 Interviews with children 7 Interviews with other social workers or officials 122 Visits to schools, hostels, etc. 24 Other visits 76 Appointments arranged but not attended 167 Total 2,038 96 (B) The Work of the Educational Psychologists in the Schools 1. Referring agencies:— M. F. Total (a) Chief Education Officer 12 12 24 (b) Schcol 111 38 149 (c) Parent 7 4 11 (d) School Medical Officer 6 3 9 (e) Other 4 2 6 Total 140 59 199 2. Types of Schools attended:— (a) Nursery 1 1 2 (b) Infant 24 10 34 (c) Juionr 89 27 116 (d) Secondary 9 7 16 (e) Grammar 3 1 4 (f) Private 3 4 7 (g) To be placed 10 8 18 (h) Other 1 1 2 Total 140 59 199 3. Main Problem:— (a) Learning 68 31 99 (b) Behaviour 53 16 69 (c) Other 19 12 31 Total 140 59 199 4. Disposal:— (a) Remedial class 31 3 34 (b) Remedial tuition at Clinic 3 1 4 (c) Child Guidance Clinic (general) 41 12 53 (d) Supervision 45 15 60 (e) Recommendation for special school 3 3 6 (f) Recommendation to Chief Education Officer 11 11 22 (g) Recommendation to Principal School Medical Officer 1 4 5 (h) Others 5 10 15 Total 140 59 199 5. Supervision from previous years 61 13 74 Supervision from 1968 46 15 61 Total under supervision 107 28 135 Total Discharged from Supervision end of 1968 23 17 40 6. Parents of children seen 39 9 48 7. Schools—Group Testing for Remedial Classes:— 23 schools. Number of children 8+ tested 763 8. Total number of school visits 416 97 HANDICAPPED PUPILS Numbers of Handicapped Pupils The following table gives the numbers of pupils on the Handicapped Pupils' Register on 31st December, 1968, together with the numbers ascertained during the year:— Classification Total ascertained during year Total ascertained at 31.12.68 Blind — 6 Partially-sighted 1 8 15 Deaf 1 Partially-hearing 4 7 Educationally subnormal 9 168 Epileptic — 1 Maladjusted 12 80 Physically-handicapped 8 41 Delicate 11 29 Totals 46 355 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 3 — — 6 Partially-sighted 8 — — 1 9 Deaf 8 7 — — 15 Partially-hearing 7 — — — 7 Educationally-subnormal 156 12 — — 168 Epileptic — 1 — — 1 Maladjusted 37 43 — 3 83 Physically-handicapped 29 12 — 1 42 Delicate 18 11 — 1 30 Totals 266 89 — 6 361 Children unsuitable for Education at Schools During the year three 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:— 98 'At 31st December, 1968, the dental staff consisted of the Chief Dental Officer, four full-time Dental Officers, four part-time Denial Officers and two part-time Orthodontists giving a full-time equivalent of 7.3 Dental Officers compared with 7.9 in 1966 and 7.4 in 1967. The Authority also employs two Dental Auxiliaries (full-time equivalent 1.6). Four sessions per week were devoted to orthodontic treatment by Orthodontists and two by one of the Dental Officers. 'The difficulty in obtaining full-time permanent Dental Officers continued throughout the year and shows no sign of improving. At three of the Borough's eight Clinics where Dental Officers resigned, four months elapsed before the vacancies were filled. This necessitates patients being referred to other Dental Officers and sometimes to other Clinics and also makes it difficult to carry out school dental inspections. Nevertheless of the Borough's 24,000 school children, 21,229 were inspected during the year and of these, 2,666 were reinspected. In addition, 614 pre-school children were examined, twice as many as in 1965. 'The Orthodontic service is particularly valuable to those who require this type of treatment as in many cases the alternative would be to attend a London Dental Hospital involving travelling expense and loss of school time. New cases commenced during the year numbered 452 as against 253 in 1967, and 142 cases were completed as against 123 in 1967. 'The School Dental Service is ideally placed for the task of instructing children and parents in the value of prevention of dental disease and this we do by directing as much effort and time as can be spared to Dental Health Education. The increasing number of pre-school children brought to us shows that this is having the desired effect. The Chief Dental Officer, Dental Officers, Auxiliaries and Health Visitors are all engaged in this work, talks being given to selected groups in schools and to parentcraft groups in Clinics. Films, pamphlets and posters are used and the three-year-old Birthday Greetings Cards introduced last year are proving effective in bringing more children to the Clinics for check-ups. 'I have referred in previous reports to the damage done to children's teeth by the eating of sweet substances and snacks between meals, and in this connection I find that in Merton, one Junior and one combined Infant and Junior School sell only items which do not cause decay, such as apples and nuts. This is probably the best dental service that a Head Teacher can perform for his pupils and it is hoped that more schools will take similar action.' The statistics relating to the School Dental Service are given below:— Statistics for Year 1968 Number of pupils on the register of maintained primary and secondary schools including nursery and special schools in January. 1969, as in Forms 7, 7m and 11 schools: 24,868. 99 Attendances and Treatment. Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First Visit 2,273 1,963 481 4,717 Subsequent Visits 3,767 5,273 1,431 10,471 Total Visits 6,040 7,236 1,912 15,188 Additional courses of treatment commenced 515 280 73 868 Fillings in permanent teeth 2,376 4,462 1,635 8,473 Fillings in deciduous teeth 3,687 295 — 3,982 Permanent teeth filled 1,977 3,797 1,417 7,191 Deciduous teeth filled 3,188 245 — 3,433 Permanent teeth extracted 86 447 84 617 Deciduous teeth extracted 876 355 — 1,231 General anaesthetics 429 257 22 708 Emergencies 146 62 22 230 Number of pupils X-rayed 383 Prophylaxis 873 Teeth otherwise conserved 216 Number of teeth root filled 8 Inlays — Crowns 4 Courses of treatment completed 3,957 Orthodontics. Cases remaining from previous year 171 New cases commenced during year 452 Cases completed during year 142 Cases discontinued during year 46 Number of removable appliances fitted 316 Number of fixed appliances fitted 15 Pupils referred to Hospital Consultant 5 Prosthetics. 5 to 9. 10 to 14. 15 and over. Total. Pupils supplied with F.U. or F.L. (first time) — — — — Pupils supplied with other dentures (first time) — 1 1 2 Number of dentures supplied — 1 1 2 Anaesthetics. General Anaesthetics administered by Dental Officers—Nil. Inspections. (a) First inspection at school: number of pupils 18,682 (b) First inspection at clinic: number of pupils 2,547 Number of (a) + (b) found to require treatment 9,444 Number of (a) + (b) offered treatment 8,684 (c) Pupils re-inspected at school clinic 2,666 Number of (c) found to require treatment 1,517 Sessions. Sessions devoted to treatment 2,896 Sessions devoted to inspection 186 Sessions devoted to Dental Health Education 26 100 INFECTIOUS DISEASES AND PROPHYLACTIC MEASURES 1. Infectious Diseases Infectious Diseases notified by Schools. Disease Suffering Excluded on suspicion Infection at home Total exclusions Scarlet Fever 42 1 1 44 Measles 94 — 1 95 Whooping Cough 22 5 1 28 German Measles 447 2 13 462 Chicken Pox 501 1 9 511 Mumps 53 — 1 54 Jaundice 4 — — 4 Other 49 — 1 50 Totals 1,212 9 27 1,248 Contagious Diseases notified by Schools. Disease Suffering Excluded on suspicion Total exclusions Impetigo 8 8 Scabies 1 — 1 Other 16 — 16 Totals 25 25 Compared with 1967 there were 170 more cases of communicable disease notified as a result of which children were excluded from School. 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 1968 was as follows:— Number of children vaccinated 144 Number of children given re-inforcing doses 2,029 No case of Poliomyelitis occurred in the Borough in 1968. 2. Diphtheria/Tetanus Immunisation. Number of children given immunisation 261 Number of children given re-inforcing doses 3,233 No case of Diphtheria or Tetanus occurred among school children, or otherwise, in this area but the importance of immunisation for all children is in no way diminished. 101 3. Protection of School Children against Tuberculosis. B.C.G. Vaccination. Percentage. Number in age group 1,894 Number of consents 1,597 84.32% Number skin tested 1,585 83.63% Number Mantoux positive 63 3.32% Number B.C.G. Vaccinated 1,518 80.14% ANCILLARY SERVICES 1. Nursery Schools/Classes There were 651 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 1967:— Year Numbers in attendance Taking Milk Taking Meals Number Percentage Free Paid Total Percentage September, 1967 22,497 17,634 78.3 643 16,050 16,693 74.2 September, 1968 22,937 12,115 13,037 92.9 2,099 14,976 17,075 74.4 102 Appendix 'A' MEDICAL INSPECTION AND TREATMENT (Excluding Dental Inspection and Treatment) Return for the year ended 31st December, 1968 Number of pupils on registers of maintained, primary, secondary, special and nursery schools in January, 1968:— (a) Ordinary schools 24,033 (b) Special schools 184 (c) Nursery schools and classes 651 Total 24,868 SECTION A. Routine Medical Inspections. Age Groups Inspected (By year of birth) Number of Children Inspected 1964 and later 817 1963 1,873 1962 478 1961 179 1950 1,782 1959 190 1958 129 1957 1,143 1956 846 1955 168 . 1954 269 1953 and earlier 2,527 Total 10,401 Other Medical Inspections. Type of Inspection Number of Children Inspected Special Inspections 1,767 Re-Inspections 738 Total 2,505 103 Return of Defects found in the course of Medical Inspections. Defect or Disease Periodic Inspections Special Inspections No. referred for Treatment No. referred for Observation No. referred for Treatment No. referred for Observation Skin 123 173 162 71 Eyes (a) Vision 1,185 656 802 34 (b) Squint 68 18 — 1 (c) Other 24 44 12 26 Ears (a) Hearing 40 89 31 160 (b) Otitis Media 18 57 1 9 (c) Other 14 25 5 15 Nose and Throat 110 310 30 65 Speech 61 73 27 38 Lymphatic Glands 5 41 1 5 Heart 21 66 3 14 Lungs 60 117 6 25 Development (a) Hernia 15 26 1 3 (b) Other 53 152 18 25 Orthopaedic (a) Posture 21 51 — 11 (b) Feet 35 87 11 25 (c) Other 51 89 7 36 Nervous System (a) Epilepsy 13 14 — 2 (b) Other 11 20 — 9 Psychological (a) Development 8 39 3 10 (b) Stability 13 89 18 50 Abdomen 5 39 1 12 Other defects and diseases 54 204 23 196 Totals 2,008 2,479 1,162 842 Four thousand four hundred and eighty-seven defects were found in children at routine medical inspections, of which 2,008 were referred for treatment and 2,479 for observation. 2,004 defects were found at special inspections, 1,162 being referred for treatment and 842 for observation. The total number of defects referred for treatment and observation in 1968 was 6,491. 104 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 % 1964 and later 817 67 8.20 1963 1,873 288 15.38 1962 478 69 12.34 1961 179 38 21.23 1960 1,782 321 18.01 1959 190 37 19.47 1958 129 21 16.28 1957 1,143 243 21.26 1956 846 189 22.34 1955 168 45 26.78 1954 269 58 21.18 1953 and earlier 2,527 480 18.99 Totals 10,401 1,856 17.84 Classification of General Condition of pupils inspected during 1967 Group Number of children inspected Percentage found satisfactory % Percentage found unsatisfactory % 1964 and later 817 100 - 1963 1,873 99.89 0.11 1962 478 100 — 1961 179 100 — 1960 1,782 100 — 1959 190 100 - 1958 129 100 - 1957 1,143 100 — 1956 846 100 — 1955 168 100 - 1954 269 100 - 1953 and earlier 2,527 100 — Totals 10,401 99.98 0.02 SECTION B. Treatment Uncleanliness and Verminous Conditions. 1. Total number of individual examinations of pupils by Health Visitors in Schools 12,142 2. Number of individual pupils found to be infested 96 3. Number of exclusions:— First time 19 Second time 1 20 4. Number of pupils cleansed 30 5. Number of Cleansing Notices or Cleansing Orders issued under Section 54 of the Education Act, 1944 17 105 Diseases of the Skin (excluding uncleanliness) Diseases of the Skin. Number of known cases treated during the year. Ringworm—scalp — Ringworm—body — Scabies 9 Impetigo 1 Other skin diseases (including verrucae, eczema, allergic skin conditions, acne, etc.) 262 Total 272 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 and squint 19 Errors of refraction (including squint) 3,544 Total 3,563 Number of pupils for whom spectacles were prescribed 924 Diseases of the Ear, Nose and Throat. Diseases and Defects. Number of cases known to have been treated. Received operative treatment:— (a) for diseases of the ear 1 (b) for adenoids and chronic ton sillitis 31 (c) for other nose and throat conditions 1 Received other forms of treatment 204 Total 237 Orthopaedic and Postural Defects. Number of cases known to have been treated in Clinics or Out-Patient Departments 163 82 sessions were held at Pelham Road Remedial Exercises Clinic during 1968. 27 new cases were admitted and 26 old cases discharged. 41 sessions were held at Amity Grove Remedial Exercises Clinic during 1968. 9 new cases were admitted and 10 old cases discharged. 38 sessions were held at Wide Way Remedial Exercises Clinic during 1968. 14 new cases were admitted and 10 old cases discharged. 72 sessions were held at St. Christopher's Special School and Eagle House Annexe Remedial Exercises Clinic during 1968. 33 new cases were admitted and 44 old cases discharged. 106 Other Treatment Given. Ailments. Number of cases treated. Miscellaneous minor ailments 423 Lymphatic Glands 4 Heart and Circulation 23 Lungs 59 Development (Hernia and Other) 64 Nervous System 21 Total 594 Appendix 'B' 1. General Medical/Minor Ailment Clinics. Attendances made by children at General Medical/Minor Ailments Clinic 3,027 2. Other Medical Examinations undertaken by School Medical Officers. (a) Children examined for part-time employment 483 (b) Children examined for Entertainment Licences — In addition to medical examinations specified as above, School Medical Officers in their capacity as Assistant Medical Officers of Health also carried out 1,146 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 38 All these children had seaside holidays and when examined on their return were all found to have benefited. 107