LONDON BOROUGH OF MERTON I THE HEALTH OF MERTON 1970 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. MER 24 THE HEALTH OF MERTON 1970 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 6-8 Committees 9 Staff 10-13 GENERAL PUBLIC HEALTH SERVICES: General Information 14 Summary of Vital Statistics 15-16 Causes of Death at Different Periods of Life 17 Comparative Statistics 18 Principal Causes of Death in Order of Frequency 18 Infant Deaths 19 Infant Mortality 19 Perinatal Mortality 19 Maternal Mortality 19 Control of Communicable Diseases 20-22 Tuberculosis: Chest Clinics 23 Domiciliary Visiting 23 B.C.G. Vaccination 23-24 Incidence of Tuberculosis 24 Mass X-Ray 25 Deaths 25 After-Care of the Tuberculous 25 Prophylactic Measures 26-27 Sexually Transmitted Diseases 27 General Medical Services 28 National Assistance Acts 28 Notifications of Birth 29 PERSONAL HEALTH SERVICES: Maternal and Child Care: General 30 Handicap Register 30 Ante-natal and Post-natal Services 31 Relaxation Classes 31 Premature Infants 31-32 Child Health: General 32 Attendances at Child Health Centres 33 2 Page Attendances at Toddlers' Clinics 34 Dental Care 34 Day Nurseries 34-35 Developmental Clinic 35 Care of Unmarried Mothers and their Children 35 Congenital Malformations 36 Welfare Foods and Vitamins 36 PUBLIC HEALTH NURSING AND ALLIED SERVICES: Organisation 37 Health Visiting: Staff 38 Training of Health Visitors 38 General Practitioner Attachments 38 Geriatric Health Visiting 39 Summary of Work of Health Visitors 39-40 Midwifery: Staff 40 Introductory 40-41 Organisation 41 Maternity Cases Attended 41 Inhalational Analgesia 41 Emergency Obstetric Unit 41 Ophthalmia Neonatorum 41 Maternity Outfits 41 Medical Aid 41 Early Discharges from Hospital 42 Midwifery Training 42 Post-Registration Courses 42 Domiciliary Visits 42 Attendances at Clinics 42 Transfers to Hospital 43 Home Nursing: Staff 43 Organisation 43-44 Training of District Nurses 44 Post-Registration Courses for District Nurses 44 Cases Attended 45 Visits Made 45 Marie Curie Foundation Cancer Nursing Service 45 Incontinence Pads 46 Incontinent Laundry Service 46 3 Page Domestic Help Service 46-47 Prevention of Illness, Care and After-Care 48 Other Allied Services: Health Education 49-51 Chiropody Service 51 Ripple Bed Service 51 Sick Room Equipment 52 Recuperative Holidays 52 Cervical Cytology 52 Family Planning 53 Mental Health Services 54-57 Subnormality 58-60 Other Forms of Mental Disorder 61 Social Work Section 61-63 ENVIRONMENTAL HEALTH SERVICES: Services under the Public Health Acts: Water Supply 64 Sewerage and Sewage Disposal 65 Registered Common Lodging Houses 65 District Inspection 65-68 Cleansing Station 70 Services under the Food and Drugs Act: Milk and Dairies (General) Regulations, 1959 70 Milk (Special Designations) (Amendment) Regulations, 1965 70 Milk (Special Designations) Regulations, 1963 70 Brucella Abortus 71 Ice-cream 71 Bacteriological Eamination of Other Foods 71 Poultry Inspection 71 Food Premises 71-72 Bacteriological Examination of Equipment 73 Food Inspection 73-75 Sampling of Food and Drugs 75-80 Services under Housing Acts 81-82 Services under Other Enactments: Rent Act, 1957 82 Shops Acts, 1950-65 82 Offices, Shops and Railway Premises Act, 1963 82-84 Prevention of Damage by Pests Act, 1949 84-85 Pet Animals Act, 1951 85 4 Page Riding Establishments Act, 1964 85 Diseases of Animals Act, 1950 85 Clean Air Act, 1956 85-90 Factories Act, 1961 69-70 Noise Abatement Act, 1960 90 Pharmacy and Poisons Acts, 1933-1941 90 Fertilisers and Feeding Stuffs Act, 1926 90 Burial Act, 1857 91 Caravan Sites and Control of Development Act, 1960 91 Greater London (General Powers) Act, 1967 (Hairdressers and Barbers) 91 5 To the Mayor, Aldermen and Councillors of the London Borough of Merton. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Annual Report on the Health of Merton for the year 1970. The Registrar-General's estimate of population showed a fall from 183,570 to 181,460, thus continuing the steady decline in population which has taken place since 1955. Live births totalled 2,358, being 49 less than in 1969, and the live birth rate fell from 13.27 to 13.20. Of the 2,388 live births 93.3% were born in hospital. The falling number of domiciliary births was, however, accompanied by a compensating increase in the number of early discharges (within 48 hours after birth) from maternity hospitals. There were 40 deaths of infants under one year of age (22 of these being in the first seven days of life) compared with 34 in 1969, and although the infant mortality rate rose from 13.90 in 1969 to 16.77 this still compares favourably with the rate for England and Wales of 18.00. The number of stillbirths fell from 31 to 22 and the stillbirth rate fell from 12.56 in 1969 to the low rate of 9.14 as compared with a rate for England and Wales of 13.00. The real effect of this marked reduction in the number of stillbirths (9 less than in 1969) is shown in the perinatal mortality rate per thousand live and stillbirths (a total of 44 stillbirths and deaths in first seven days of life compared with 52 in 1969) which fell from 20.67 in 1969 to 18.00 and thus compares very favourably with the rate for England and Wales of 23.00. The total loss of infant life (stillbirths plus infant deaths) per thousand live and still births also fell from 26.33 in 1969 to 25.75. There was one maternal death during the year, the circumstances of which are given on page 19. Although there were 20 less deaths during the year (2,084 compared with 2,104 in 1969) because of the fall in population the crude death rate per thousand of the population rose slightly from 11.46 per thousand population in 1969 to 11.50. This is still lower than the rate for England and Wales of 11.70. 69.3% of the 2,084 deaths were attributable to three principal causes—heart disease (33.5%), cancer (23.8%) and cerebrovascular disease (12.0%). In my Annual Report for 1969 I drew attention to the steady fall in the population of the area since 1955 when the estimated population was 195,970 and pointed out that there seemed to be no indication that this tendency to a falling population would be halted. This has proved to be the case. The population figure of 185,130 for 1965 has fallen to 181,460 by 1970. The factors which have produced this are (1) a live birth rate which has fallen consistendy since 1965, (2) a death rate which, although it has fluctuated, is slowly rising, and (3) migration out of the Borough. 6 As the following tables show, although in each year since 1965 there has been a natural increase of live births over deaths, the population is still falling, thus indicating that the greatest single factor is that of migration from the Borough. Year Mid-year estimated population Rate per thousand of population No. of births No. of deaths Natural increase of live births over deaths Live births Deaths 1965 185,130 15.66 11.37 2899 2106 793 1966 184,190 15.55 10.83 2865 1995 870 1967 183,050 15.01 11.15 2747 2041 706 1968 184,220 14.17 11.06 2610 2038 572 1969 183,570 13.27 11.46 2437 2104 333 1970 181,460 13.20 11.50 2388 2084 304 There has been a marked decline in the live birth rate from 15.66 per thousand population to 13.20 (a fall of 2.46 per thousand) and a rise in the death rate of 0.17 per thousand population compared with 1965, and there were 511 less live births in 1970 than in 1965. The actual number of deaths has been a relatively stable figure, but since the population is falling, the death rate inevitably increases. The reduction in the number of annual births over a period of years markedly affects the age structure of the population and this is affected even more by migration from the Borough by people who for the most part are not in the older age group of 65 years and over. It is obvious that migration from the Borough is well in excess of the numbers added to the population by the natural increase of population and people coming into the Borough from other areas. It is estimated that there are in the region of 27,000 people in the Borough over the age of 65 years, or 14.8% of the population. The estimated percentage for England and Wales is 12.8%. By 1976 it is estimated that Merton's percentage of people aged 65 years and over will be 16.7%. It would seem that the most effective means of checking this decline of population would be any measures aimed at slowing down the rate of migration of people from the Borough. The year was one of considerable progress and of impending change. The new Senior Training Centre at Wandle Way, Mitcham, was completed and brought into operation in January with 39 trainees in attendance. By the end of the year 75 trainees were in regular attendance. The Local Authority (Social Services) Act, 1970, made provision for implementation of the main recommendations of the Seebohm Committee on Local Authority Personal and Social Services, which will result in the merging in a single Social Services Department of the services operated by the Welfare Services Department, the Children's Department and the services operated by the Health Department in connection with the provision of local authority day nurseries, the registration and supervision of private day nurseries and child minders, the mental health service, social work services aimed at prevention of break-up of family life, the Home Help Service, and recuperative holidays for adults on the recommendation of their family doctors. By the end of the year plans were already well in hand for the transfer of these services to the new Department in April, 1971, under the Director of Social Services. 7 The Education (Handicapped Children) Act, 1970, made provision for the discontinuation of the procedure under Section 47 of the Education Act, 1944 (as amended by the Mental Health Act, 1959) for ascertaining children as unsuitable for education in school. The Act will operate from 1st April, 1971, and will have the effect of transferring Junior Training Centres for the Mentally Handicapped to the Education Committee, and these will become schools for mentally handicapped children. It is pleasing to be able to report that during 1970 a full complement was reached of Public Health Inspectors and Mental Welfare Officers for the first time since 1965. The policy of attachment of health visitors and district nurses to group practices continued so far as this was possible within the Departmental establishment. Co-operation with general practitioners and the hospital service, and with voluntary and statutory bodies, and with other Departments of the Authority was good throughout the year. I should like to record my appreciation of the ready help and advice which I have at all times received from Dr. Fleck, the Director of the Public Health Laboratory, St. George's Hospital, Tooting, and his colleagues, in dealing with outbreaks of infectious disease. My thanks are also due to all members of the Health Department staff for the loyal and efficient way in which they have carried out 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 ready help and co-operation at all times. I have the honour to be, Your obedient servant, P. J. DOODY, Medical Officer of Health. 8 COMMITTEES AT 31st DECEMBER, 1970 HEALTH, WELFARE AND CHILDREN'S COMMITTEE The Mayor, Councillor A. Leivers, J.P., F.I.D., M.N.I.H. Alderman N. S. Clarke (Chairman) Councillor (Miss) L. Hirst (Vice-Chairman) Aldermen: Sir Cyril Black, J.P., D.L., M.P. J. P. Brown, J.P. T. H. Metcalf V. Talbot, J.P. Councillors: A. M. Anderson, M.A. (Mrs.) W. R. Casde J. B. Garwood R. E. Glencross K. L. Goddard (Mrs.) D. M. Hedges A. S. Hutchin G. S. Lewis (Miss) D. M. Lord F. H. Meakings R. J. H. Pike, M.B.E. Geoffrey N. Smith H. R. Veal G. Watt (Miss) N. K. Watts G. A. J. White Co-opted member: — Representative of the Local Medical Committee (Dr. R. A. Arthur). ENVIRONMENTAL HEALTH AND HOME SAFETY SUB-COMMITTEE Chairman of the Health, Welfare and Children's Committee (Alderman N. S. Clarke) Vice-Chairman of the Health, Welfare and Children's Committee (Councillor (Miss) L. Hirst) Alderman T. H. Metcalf Alderman V. Talbot Councillors: J. B. Garwood R. E. Glencross K. L. Goddard A. S. Hutchin (Miss) D. M. Lord F. H. Meakings R. J. H. Pike, M.B.E. Geoffrey N. Smith H. R. Veal G. Watt (Miss) N. K. Watts G. A. J. White Co-opted member: — Mrs. E. Lim (Home Safety Division, Greater London Area, RoSPA) TOWN CLERK Sydney Astin (Solicitor) 9 WHOLE-TIME STAFF (As at 31st December, 1970) Medical Officer of Health and Principal School Medical Officer P. J. Doody, M.B., B.Ch., B.A.O., D.P.H. Deputy Medical Officer of Health and Deputy Principal School Medical Officer Elza H. Todd, M.B., Ch.B., D.P.H. Senior Medical Officers Marie J. Freeman, M.B., B.S., L.M.S.S.A., D.P.H. (commenced 12.1.70) Elizabeth Qoake, M.B., B.S. (Lond.), D.Obst.R.C.O.G., D.P.H. (commenced 1.7.70) Departmental Medical Officers June P. Cooper, M.B., B.S., M.R.C.S., L.R.C.P., D.Obst. R.C.O.G., D.C.H., D.P.H. 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. Chief Dental Officer M. T. Gibb, L.D.S., R.C.S. School Dental Officers 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. S. P. Motani, L.D.S. E. T. Thompson, L.D.S., R.C.S. (commenced 1.7.70) Dental Auxiliary Miss E. M. Mcintosh (commenced 10.8.70) Chief Public Health Inspector G. H. Cockell, F.A.P.H.I., F.R.S.H. Deputy Chief Public Health Inspector J. P. Smith, Cert.S.I.B., Cert. Insp. of Meat and Other Foods, Smoke Inspector's Cert, (commenced 2.3.70) Principal Nursing Officer Mrs. A. A. B. Poole, S.R.N., S.C.M., H.V. Cert. Superintendent Health Visitor Mrs. I. Brown, S.R.N., S.C.M., H.V.Cert. Superintendent of Midwifery and Home Nursing Service Miss O. Williams, S.R.N., S.C.M., Q.N. Home Help Organiser Miss M. J. Faraday Chief Administrative Officer W. Atkinson, D.P.A., Cert. S.I.B. Deputy Chief Administrative Officer J. R. Richardson, A.R.I.P.H.H. Principal Mental Welfare Officer F. T. Rainer, Dip.Soc. Science, Dip.Soc. Admin., H.O.Cert. Child Care Deputy Principal Mental Welfare Officer F. J. Gerring 10 Mental Welfare Officers Mrs. J. Barber, S.R.N., S.C.M. Mrs. F. M. Coleman, Dip.Soc. Studies & Soc. Admin. M. Cooke, Cert, in Social Work (commenced 3.8.70) E. D. Desai, R.M.N., R.N.M.S. (commenced 1.9.70) F. C. Dorrington H. S. Hein, B.A. (Canada), Bachelor of Social Work (Canada), Master of Social Work (Canada) (commenced 29.7.70) S. G. H. Worrall Mental Health Social Worker Mrs. J. Reed, B.Sc. (Hons.) (commenced 2.3.70) Senior Social Worker Mrs. M. A. Tripet, S.R.N., H.V. Cert., Dip. Soc. Studies, Declaration of Recognition of Experience in Child Care Social Workers M. O. B. Ellis (commenced 3.8.70) Miss R. Newton B.A. (Hons.) Mrs. J. A. Smith, B.A., Dip. in Social Studies (Melbourne) (commenced 16.11.70) Supervisor, Senior Training Centre J. Malinowski, Dip.T.C.M.H. Supervisor, Junior Training Centre Mrs. M. Barlow, Dip.N.A.M.H. Educational Psychologists Mrs. M. J. Badawi, B.A. (Hons.), Lond., Post-Graduate Diploma in Educational Pyschology Miss D. Waldeck, B.A. (Hons.) Psychiatric Social Workers Mrs. B. Litauer, A.A.P.S.W., Mental Health Diploma, London, Social Science Diploma, London C. M. Oakley,A.A.P.S.W.,B.Soc.,Dip.Crim. (Cambridge) (commenced 16.3.70) Mrs. I. Windebank, A.A.P.S.W., Mental Health Diploma, London, Social Science Diploma, London Psychotherapists N. C. Cordell, M.A. Mrs. M. Livesey, N.F.F. Diploma, Assocn. of Child Psychotherapists Speech Therapists Mrs. G. M. Stephenson, L.C.S.T. Mrs. E. Venter, B.A. (Log.) (Univ. of Pretoria) (commenced 1.12.70) Mrs. A. Varah, L.C.S.T. Audiometrician Mrs. M. Dean, S.R.N. 11 PART-TIME STAFF (As at 31st December, 1970) Consultant Psychiatrist M. Markowe, M.D., D.P.M., D.P.H. Ophthalmic Surgeons 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. Orthopaedic Surgeon G. Hadfield, M.R.C.S., L.R.C.P., F.R.C.S. (Eng.) Child Psychiatrists D. Rumney, M.R.C.S., L.R.C.P., D.P.M. Joan C. Wells, M.D., M.R.C.P., D.P.M. (commenced 1.4.70) Departmental Medical Officers Joan M. H. Clarke, M.R.C.S., L.R.C.P. 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. Karen I. Parkes, M.D., M.B., B.S., F.R.C.S. M.R.C.S., L.R.C.P. Aleksandra Nawrocka, L.A.H. (Dublin) (commenced 1.12.70) Daphne P. Pearson, M.B., B.S. (commenced 4.11.70) Douglas W. Sim, M.B., Ch.B. Elizabeth A. South, M.B., Ch.B. Audrey P. Whitfield, M.B., B.S. (commenced 1.4.70) School Dental Officers Wanda Kojder, B.D.S. (commenced 3.8.70) Sheila McDonald, L.D.S. M. G. Smith, L.D.S., R.C.S. Vivien Wilson, B.D.S. (Hons.) (commenced 25.3.70) Dental Orthodontists Linda R. Read, B.D.S., L.D.S., R.C.S. Dental Anaesthetists W. Carpenter, M.A., M.B., B.Ch., B.A.O., D.A. Betty M. Margetts, M.B., B.S., M.R.C.S., L.R.C.P., D.C.H. R. G. Smith, M.B., B.S., M.R.C.S., L.R.C.P., D.A., D.Obst.R.C.O.G. Geriatrician P. H. Millard, M.B., B.S. Hons., M.R.C.S., M.R.C.P. 12 Psychiatric Social Worker Mrs. G. S. Rose, B.A. (Hons. Psychology), M.Sc. (Social Work Studies) (commenced 2.11.70) Physiotherapists Mrs. B. S. Fenner, M.C.S.P. Mrs. R. J. Kempton, M.C.S.P. Mrs. J. Simmons, M.C.S.P. (commenced 3.3.70) Social Workers Mrs. M. C. Hudson, Dip. in Sociology Mrs. A. Martin, B.A. (Hons.), H.O. Training Certificate Speech Therapist Mrs. E. P. Jefferson, L.C.S.T. (commenced 10.11.70) 13 GENERAL PUBLIC HEALTH SERVICES General Information Area of Borough in acres 9,379 Number of private dwellings (1961) 59,482 Number of private dwellings (1970) 62,996 Rateable value, at 1st April, 1970 £11,522,622 Actual product of a penny rate: — 1969/70 £45,964 Estimated product of a penny rate: — 1970/71 £46,490 Population: — Census figure (1961) 186,647 Registrar-General's Estimate of Population at 30th June 1970 1969 181,460 183,570 14 Summary of Vital Statistics Live Births— 1970 1969 Legitimate: Males 1164 1167 Females 1032 1098 2196 2265 Illegitimate: Males 103 89 Females 89 83 192 172 Totals 2388 2437 Live Birth Rate per 1,000 population 13.20 13.27 Corrected Live Birth Rate per 1,000 population 13.7 13.80 Illegitimate live births—percentage of total live births 8.05 7.05 Still Births— Legitimate: Males 7 17 Females 14 12 21 29 Illegitimate: Males — — Females 1 2 1 2 Totals 22 31 Still-birth Rate per 1,000 live and still-births 9.14 12.56 Still-birth Rate per 1,000 population 0.12 0.17 Total live and still-births 2410 2468 Infant Mortality (Deaths of infants under one year of age)— Legitimate: Males 21 24 Females 13 6 34 30 Illegitimate: Males 4 3 Females 2 1 6 4 Totals 40 34 Infant Mortality Rate per 1,000 live births 16.77 13.90 Infant Mortality Rate per 1,000 legitimate live births 15.48 12.80 Infant Mortality Rate per 1,000 illegitimate live births 31.25 23.26 Neo-Natal Deaths (Deaths of infants in first 28 days of life) 28 25 Neo-Natal Mortality Rate 11.74 10.26 Early Neo-Natal Mortality Rate (deaths of infants in first week of life per 1,000 live births) 9.22 8.08 Perinatal Mortality Rate (Still-births plus deaths in first week of life per 1,000 live and still-births) 18.00 20.67 Total loss of infant life (Still-births plus infant deaths) per 1,000 live and still-births 25.75 26.33 Maternal Deaths (including abortion") 1 — Maternal Mortality Rate per 1,000 live and still-births 0.41 — Deaths 2084 2104 Death Rate per 1,000 population 11.50 11.46 Corrected Death Rate per 1,000 population 11.00 11.23 15  1970 1969 Deaths from Bronchitis and Emphysema per 1,000 population 0.52 0.58 Deaths from Pneumonia per 1,000 population 0.85 0.93 Deaths from Cancer of lung and bronchus per 1,000 population 0.78 0.76 Deaths from other forms of Cancer per 1,000 population 1.95 2.00 Marriages 1454 1471 Marriage Rate per 1,000 population 8.01 8.01 16 Causes of Death at different Periods of Life in the London Borough of Merton during 1970 CAUSE OF DEATH AGE GROUP AND SEX Under 4 weeks 4 Wks. & under 1 year 1 to 4 years 5 to 14 years 15 to 24 years 25 to 34 years 35 to 44 years 45 to 54 years 55 to 64 years 65 to 74 years 75 years and over TOTALS M F M F M F M F M F M F M F M F M F M F M F M F Tuberculosis of Respiratory System - - - - - - - - - - - - - - - - - - 2 1 1 - 3 1 Other Tuberculosis, incl. Late Effects - - - - - - - - - - - - - - - - 1 1 - - 1 - 2 2 Appendicitis - - - - - - - - - - - - - - - - - - - - - - 2 - Multiple Sclerosis - - - - - - - - - - - - - 1 - - - 1 - - - - - 2 Other Infective and Parasitic Diseases 1 - - - - - 1 - - - - - - - 1 - 1 - - - - - 4 - Malignant Neoplasm: Buccal Cavity, etc. - - - - - - - - - - - - - - - - - 2 2 2 1 1 3 7 Malignant Neoplasm: Oesophagus - - - - - - - - - - - - - - - - 3 - 1 3 1 3 5 6 Malignant Neoplasm: Stomach - - - - - - - - - - - - - - - - 6 - 12 8 6 19 24 27 Malignant Neoplasm: Intestine - - - - - - - - - - - - - - 4 4 8 7 6 8 11 22 29 41 Malignant Neoplasm: Larynx - - - - - - - - - - - - - - - - 1 - 3 - 2 - 6 - Malignant Neoplasm: Lung, Bronchus - - - - - - - - - - - - 3 1 4 6 37 5 42 4 27 13 113 29 Malignant Neoplasm: Breast - - - - - - - - - - - 1 - 1 - 5 - 11 - 15 - 8 - 41 Malignant Neoplasm: Uterus - - - - - - - - - - - - - _ - - - 1 - 3 - 2 - 6 Malignant Neoplasm: Prostate - - - - - - - - - - - - - - 1 - 3 - 10 -- 8 -- 22 -- Leukaemia - - - - - - - - - - - - - - - - 2 - - - 3 3 6 3 Other Malignant Neoplasms, etc. - - - - - - - 4 - 1 - - 4 4 7 16 13 22 22 12 23 59 69 Benign and Unspecified Neoplasms - - - - - - - - - - - - - - - - - - 1 2 1 1 4 3 Diabetes Mellitus - - - - - - - - - - - 1 - - - - 1 2 1 3 1 7 3 13 Other Endocrine Etc. Diseases - - - - - - - - - - - - - - - - - - - - - -1 - 3 Anaemias - - - - - - - - - - - - - - - - - - - - 1 2 1 2 Mental Disorders - - 1 - - - - - 1 - - - - - 1 1 - 1 -- - - - 3 2 Meningitis 1 1 - Other Diseases of Nervous System, etc. - - 1 - 1 - - - 1 - - - 1 - - 1 - 1 1 2 1 4 6 8 Chronic Rheumatic Heart Disease - - - - - - - - - - - - 1 - 1 1 3 5 7 2 2 10 14 18 Hypertensive Disease - - - - - - - - - - - - - - 1 - 1 1 6 4 8 5 16 10 Ischaemic Heart Disease - - - - - - - - - - - - 6 2 18 5 83 18 104 45 80 159 291 229 Other forms of Heart Disease - - - - - - - - - - - - - - 1 1 3 6 6 11 26 47 36 65 Cerebrovascular Disease - - - - - - - - - - - - - 2 4 4 13 15 26 38 34 114 77 173 Other Diseases of Circulatory System 8 2 9 17 21 44 38 63 Influenza 1 1 - 1 2 3 5 - 3 5 11 Pneumonia - - 1 1 - 1 - - - - - - 1 - - 1 3 6 14 16 49 61 68 86 Bronchitis and Emphysema 1 2 15 1 19 7 28 21 64 30 Asthma 1 1 - 1 1 2 - 1 2 6 3 Other Diseases of Respiratory System 1 1 - 1 1 1 1 3 - 2 8 8 11 Peptic Ulcer - - - - - - - - - - - - - - - - 1 - 1 - 1 4 3 4 Intestinal Obstruction and Hernia - - - - - - - - - - - - - - 1 - - 1 1 2 2 2 4 5 Cirrhosis of Liver - - - - - - - - - - - - - - - 1 1 1 2 1 1 1 4 4 Other Diseases of Digestive System - - - 1 - - - - - - - - - - - 1 2 2 3 6 3 6 8 16 Nephritis and Nephrosis - - - - - - - - - - - - 1 - - 1 2 1 - 3 - 1 3 6 Hyperplasia of Prostate -- - - - - - - - - - - - - - - - - 1 - 3 - 4 - Other Diseases, Genito-Urinary System - - - - - - - - - - - - - - - - - 2 1 - 3 3 4 5 Diseases of Skin, Subcutaneous Tissue - - - - - - - - - - - - - - - - - - - - - 2 - 2 Diseases of Musculo-Skeletal System - - - - - - - - - - - - - - - - 1 - - 2 - 3 1 5 Congenital Anomalies 1 1 3 1 - 1 - - - - - - - - - 1 1 - - 1 1 1 6 6 Birth Injury, difficult Labour, etc. 10 7 - - - - - - - - - - - - - - - - - - - - - 10 7 Other Causes of Perinatal Mortality 5 1 - - - - - - - - - - - - - - - - - - - - 5 1 Other Complications of Pregnancy - - - - - - - - - - - - - - - - - - - - - - - 1 Symptoms and Ill-defined conditions - - - - - - - - - - - - - - - - - - - - 1 3 1 4 Motor Vehicle Accidents - - - - - - 2 1 1 2 2 1 1 1 1 1 2 1 2 1 2 4 13 12 All other Accidents - - -- - -- 2 1 - 1 - 2 - 1 1 1 2 - 1 2 5 3 12 11 23 Suicide and Self-inflicted Injuries - - - - - - - - 2 -- 1 2 2 - 1 1 1 5 2 -- 1 -- 10 8 All other external causes - - 1 - - - - - - - 1 2 - -- 1 - - 1 - - -- - 2 3 TOTAL ALL CAUSES 18 10 7 5 3 4 5 1 13 5 7 8 18 16 48 45 223 118 317 239 349 625 1008 1076 Comparative Statistics, 1970 Merton England and Wales Rates per 1,000 Population: Live births 13.20 16.00 Deaths (all causes) 11.50 11.70 Respiratory tuberculosis 0.04 0.02 Cancer of lung and bronchus 0.78 0.62 Rates per 1,000 live and still births : Still births 9.14 13.00 Maternal mortality 0.41 0.18 Perinatal mortality 18.00 23.00 Rates per 1,000 live births: Infant mortality—deaths of infants under 1 year 16.77 18.00 Neo-natal mortality—deaths of infants in first 28 days of life 11.74 12.00 Early neo-natal mortality—deaths in first week of life 9.22 11.00 Principal causes of Death in order of Frequency Out of the 2,084 deaths occurring during the year 1,794 were attributable to the undermentioned principal causes: — No. of Deaths. Percentage of Deaths from all causes. 1. Heart Diseases 699 33.5 2. Cancer 496 23.8 3. Cerebrovascular disease 250 12.0 4. Pneumonia 154 7.4 5. Other diseases of the Circulatory System 101 4.8 6. Bronchitis and Emphysema 94 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 9- 12 Prematurity 10 7 - 1 18 Congenital Malformations - - 2 - - 3 1 - - 6 Broncho-pneumonia - — — 1 — 2 — 1 _ 4 Birth Injuries 1 1 _ _ — _ - — - 2 Other causes 1 2 - - 2 3 1 1 10 Totals 12 10 2 2 2 8 2 1 1 40 INFANT MORTALITY Of the 40 infant deaths, 22 occurred in the first seven days of life. All but one of these 22 babies were delivered in hospital. The infant mortality rate of 16.77 compares favourably with the rate of 18.00 for England and Wales. PERINATAL MORTALITY The perinatal mortality rate for Merton was 18.00 per 1,000 live and still births, thus comparing favourably with that for England and Wales of 23.00. MATERNAL MORTALITY There was one maternal death during the year, the cause being haemorrhage from a ruptured ectopic gestation. The woman was uncertain as to whether she was pregnant and telephoned to see her doctor, but died suddenly before a consultation was arranged. The pregnancy was of two or three weeks' duration. 19 CONTROL OF COMMUNICABLE DISEASES Notifications received during 1970 (Corrected Notifications) Age Groups of Cases Notified Disease Under 1 I- 2 34 59 1014 15- 24 2544 4564 65 & over Total Measles 17 158 198 329 17 9 10 738 Dysentery 3 3 5 4 — 2 4 — — 21 Scarlet Fever — — 9 23 5 5 — — 42 Whooping Cough 4 8 15 25 1 — — — — 53 Infective Jaundice — 1 1 6 3 4 3 2 — 20 Tuberculosis (Resp.): Males 1 3 5 6 15 Females 1 — — — — 4 3 4 2 14 Tuberculosis (Non-Resp.): Males — — — — — 1 3 — — 4 Females 4 1 1 6 Acute Meningitis 1 — — 1 — — — — 2 Ophthalmia Neonatorum 1 1 Typhoid Fever — — — — 1 — 2 — — 3 Food Poisoning 4 2 4 44 — 5 4 2 — 65 Malaria ~ -- ~ ~ ~ 1 ~ 1 Totals 31 172 232 432 27 31 36 15 9 985 General A total of 985 notifications were received during the year, compared with 1,274 during 1969. The fall was principally accounted for by reductions in the numbers of cases of measles and dysentery reported. Diphtheria Although, since the inception of the Borough in 1965, there has been no case of diphtheria notified, there should be no grounds for complacency, since it is only by a high level of immunisation among children that this serious condition will continue to be controlled. In March a number of carriers of diphtheria were found in a school in a neighbouring borough. Twelve pupils at this school lived in the Borough. All except one of them had been immunised against diphtheria in infancy. Nose and throat swabs from all the children proved negative, but immunisation booster injections for diphtheria were given where it was deemed necessary. Streptococcal Infection In July, mothers, babies midwives and student midwives, were involved in a haemolytic streptococcal outbreak in a Maternity Ward 20 in a hospital in an adjoining borough. Twenty-two patients and five midwives were investigated over a period of six weeks. No midwives became infected. Enteritis outbreak In January, there was an outbreak of diarrhoea at premises used by the Authority as Part III accommodation. Tests were carried out on all families concerned but no organism was isolated. A similar small outbreak in a primary school was investigated and here also, testing proved negative, so it is likely that the outbreaks were due to a virus. In March, there were a number of cases of sickness at a primary school. Investigations again proved negative but the pattern of the illness resembled winter vomiting. Also in July a pathogenic E.Cbli infection was found in a baby in a local hospital. The mother, who had come from a local Mother and Baby Home, and the midwifery staff involved, were investigated. A non-nursing member of the hospital staff was also found to be infected, but the outbreak was soon under control, and no further cases occurred. Tuberculosis In March a resident was removed to a hospital from an Old People's Home on account of rheumatoid arthritis. On investigation she was also found to be suffering from tuberculosis. All contacts in the Home were investigated and the Mass X-Ray Unit was brought to the Home. In all, 28 staff and 37 residents were X-rayed, but no other case was discovered. Typhoid and Paratyphoid Fevers During the year three confirmed cases of typhoid fever occurred in the Borough. The source was known in one case since he was a technician in a bacteriological laboratory. In the other two cases, the source could not be ascertained. In all cases and contacts, the necessary medical surveillance was maintained for a considerable period. A ship's steward who had had typhoid fever in the ' S.S. Oronsay' outbreak in January was bacteriologically investigated and tested for a period of six months until he was proved to be clear. There were also eight cases who had been typhoid contacts who were fully investigated and proved to be negative. Five contacts of paratyphoid fever were investigated and they also proved negative. One lady, who had remained a paratyphoid carrier since 1969, had an operation to remove her gallbladder and she has since been negative. 21 Food Poisoning An outbreak of food poisoning caused by the organism salmonella typhimurium occurred at an Independent School in April. The Health Department had not been notified about the outbreak, but information from a Public Health Laboratory led to inquiries which revealed that positive results had been obtained on specimens from two pupils at the school. The school was then visited and it was ascertained that 42 pupils out of a roll of 155, together with one teacher and the housekeeper had been ill the previous week and absent from school. After full investigation 51 positive cases were found. It was discovered that some of the school meals were cooked at the caterer's home and transported to the school. The caterer and one of her two children were found to be positive. Swabs were taken from the working surfaces and equipment at the school kitchen and the caterer's home, but all these results were negative. The contaminated food causing the outbreak could not be identified owing to the length of time which elapsed before the Health Department found out about the outbreak. A number of boys who had been ill were allowed back to school while still positive, one week after symptoms had ceased, with special arrangements as to toilet and hand washing facilities. In six cases the infection was found to have spread to other members of the boys' families. Since the outbreak a wash-hand basin has been installed in the kitchen toilet and hand washing notices are displayed in the kitchen. The caterer was advised not to use her home for food preparation. The last case was not cleared until late in July and more than 450 specimens were sent to the Public Health Laboratory for pathological examination. Several other local authorities were involved, since the school's pupils come from a very wide area. In addition to this outbreak, there were 21 individual cases as listed below, involving 82 persons: — Salmonella bredeney 1 „ enteritis 4 „ Indiana 2 „ Heidelberg 1 „ Panama 4 „ typhimurium 5 „ Virchow 1 „ untyped 3 Forty suspected cases, involving 73 people were also investigated, all proving negative. Smallpox Twenty-eight persons arriving in the Borough without a valid International Certificate of Vaccination were kept under surveillance for the necessary period. Cholera Four cholera contacts were also kept under surveillance for the prescribed period. 22 TUBERCULOSIS Chest Clinics There are two chest clinics serving the Borough. Both 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. At the end of the year the case load of Tuberculosis Health Visitors was as follows: — Cases of tuberculosis 473 Other chest cases (lung cancer, bronchitis, bronchiectasis, etc.) 751 The new cases examined at the Chest Climes in 1970 are analysed in the table below:— Respiratory Non-Respiratory Total M F M F Diagnosed Tuberculous 3 3 - - 6 Non Tuberculous 385 230 — — 615 Domiciliary Visiting Home visiting continues to be an important part of the work of Tuberculosis Health Visitors. The number of tuberculosis households visited during the year was 303. Details of domiciliary visiting by Health Visitors are given below:— Visits in connection with old cases 633 Visits in connection with new cases 25 Visits in connection with contacts 49 Total 707 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 262 Number found negative 238 Number vaccinated with B.C.G. 222 The numbers are considerably lower than last year, due to the fact that rubella vaccination of girls and various immunisation procedures given prior to pupils proceeding on school cruises, made it impossible to carry out the usual autumn programme of B.C.G. vaccination of 13-year-old children in the schools. This will be reflected in the figures for the year 1971 when two age groups will be dealt with. No children with positive skin tests were known to be contacts of notified cases of tuberculosis. 23 Six 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 15 14 29 Non-respiratory 4 6 10 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 P Non-P No. of cases on Register at 1.1.70 243 228 26 39 471 65 Primary Notifications in 1970 15 14 4 6 29 10 Inward transfers in 1970 13 6 — 1 19 1 Totals 271 248 30 46 519 76 Died during 1970 10 8 — — 18 — Recovered during 1970 43 29 1 2 72 3 Transferred out in 1970 17 7 1 4 24 5 Total ca6es removed from Register 70 44 2 6 114 8 No. of cases on Register 31.12.70 201 204 28 40 405 68 The numbers of cases of respiratory tuberculosis notified continues to decline each year. The following figures show the steady decline in the incidence of respiratory tuberculosis in this area since 1955:— Year. Number of notifications received. Incidence rate per thousand population 1955 122 0.62 1956 125 0.64 1957 115 0.63 1958 85 0.44 1959 81 0.42 1960 69 0.36 1961 86 0.45 1962 69 0.37 1963 44 0.24 1964 61 0.33 1965 45 0.24 1966 48 0.26 1967 41 0.22 1968 46 0.25 1069 38 0.21 1970 29 0.16 24 Two hundred and thirty-nine contacts were examined for the first time during the year and one was found to be tuberculous. Two old contacts were 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 pulmonarv tuberculosis and non-tuberculous abnormalities. The results are tabulated below:— Number X-rayed Pulmonary T.B. found Primary Lung Cancer found Total Males Females Males Females General Practitioner Service 2,084 1 — 9 4 Public and Industrial Sessions 7,081 5 1 5 — Totals 9,165 6 1 14 4 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 eight 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 0.04 respiratory and nil non-respiratory, compared with 0.02 and 0.01 respectively for England and Wales. The comparable figures for the Borough for 1969 were 0.01 and nil. 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. 25 PROPHYLACTIC MEASURES The table below gives details of initial protection given by the use of prophylactics against diptheria, whooping cough, measles, poliomyelitis, tetanus and rubella:— Disease against which protection given Number of primary courses given Year of Birth Others under 16 years Total 1970 1969 1968 1967 1963/66 Diphtheria 63 1445 354 22 66 8 1958 Whooping Cough 63 1443 353 20 26 3 1908 Poliomyelitis (Oral) 71 1420 378 23 62 12 1966 Tetanus 63 1445 355 22 68 38 1991 Measles 7 605 624 389 652 102 2379 Rubella — — — — — 293 293 Below are given the percentages of children, born in 1968, who had been given protection against whooping cough, diphtheria and poliomyelitis by the end of 1970. The figure in brackets is the corresponding percentage for England and Wales:— Whooping cough 81 (79) Diphtheria 81 (81) Poliomyelitis 79 (79) 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 die 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 2,773 Whooping cough 926 Poliomyelitis 2,691 Tetanus 2,821 Poliomyelitis At the end of the year, 91,326 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 1943-70 63,239 Persons born 1933-42 15,791 Others 12,296 Total 91,326 26 Smallpox The following table shows the number of persons vaccinated or re-vaccinated against smallpox during the year:— Age at Time of Vaccination Total 0-3 months 3-6 months 6-9 months 9 months -1 year 1 year 2-4 years 5-15 years Number vaccinated 4 3 2 8 930 354 116 1417 Number revaccinated — — — — — 26 276 302 The percentage of children under two years vaccinated against smallpox was 40 compared with the figure of 31 for England and Wales. SEXUALLY-TRANSMITTED 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 1970:— Clinic Number of new cases seen during year Total all conditions Syphilis Gonorrhea Other Primary & Secondary Other Croydon General Hospital 22 - - 4 18 Dreadnought Seamen's Hospital 1 - - - 1 London Hospital 19 — — 1 18 St. Helier Hospital 379 — 1 43 335 St. Thomas's Hospital 136 1 2 25 108 Westminster Hospital 24 - - 5 19 Totals 581 1 3 78 499 There was an increase in the numbers of new cases of conditions other than syphilis and gonorrhoea from 304 in 1969 to 499. 27 GENERAL MEDICAL SERVICES From 1st January, 1970, to 31st July, 1970, the arrangements for medical examination of staff for superannuation purposes were unchanged and 482 staff were examined. After 1st August, 1970, a new system was adopted whereby all new staff are required to complete a medical questionnaire, the replies to which assist in deciding whether a medical examination is necessary. During the period 1st August, 1970, to 31st December, 1970, 502 questionnaires were received by this department from the employing departments. 180 medical examinations were conducted and 322 staff were accepted without medical examination. It is hoped that the new system will result generally in a quicker medical clearance of newly appointed staff. In 1970 there were 301 medical examinations of Teachers and Teacher Trainees and in all 980 staff medical examinations were conducted. In four cases only were the examinees declared unfit and 17 examinations concerned staff absent from work owing to sickness to determine their fitness or otherwise to return. A total of 1,302 staff were dealt with compared with 1,263 in 1969. 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. No cases were dealt with during the year. 28 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 84 81 - 1 84 82 978 911 6 3 984 914 1062 992 6 4 1068 996 Births occurring outside Merton attributable to Merton (Inward Transfers) — 1 — — — 1 742 653 6 13 748 666 742 654 6 13 748 667 Total of all births notified 84 82 - 1 84 83 1720 1564 12 16 1732 1580 1804 1646 12 17 1816 1663 Births occurring in Merton attributable to other Authorities (Outward Transfers) 1 — — — 1 - 517 479 4 2 521 481 518 479 4 2 522 481 Total births attributable to Merton 83 82 — 1 83 83 1203 1085 8 14 1211 1099 1286 1167 8 15 1294 1182 29 PERSONAL HEALTH SERVICES MATERNAL AND CHILD-CARE General Screening for phenylketonuria by the Guthrie Blood Test method is carried out by our domiciliary midwives on all babies delivered at home, or discharged from hospital before the sixth day. The laboratory work is carried out by the Group Laboratories at Queen Mary's Hospital for Children, Carshalton. The two maternity units in the Borough take blood specimens from all babies present in the unit on the sixth day. Our domiciliary midwives took 626 specimens during the year, 21 of which were repeat samples where the first reading showed a slightly raised phenylalanine level. All specimens eventually gave negative results. Observation and Handicap Register Towards the end of 1970, a revision of the Observation and Handicap Register was begun. The purpose of this Register is to bring to the particular notice of the Clinic Medical Officers those children who have had some adverse factors early in their lives, or even before birth (such as a history of the mother having German Measles in pregnancy). These children are more likely than others to be found to have a defect in early life. If any defects are found which even after treatment are likely to interfere with the normal growth and development of the children concerned (such as deafness), their names are put into the Handicap Section of the Register. Their names are to be kept in this Section throughout school life unless, as in some cases, their defects come to be no longer regarded as handicaps in view of improvement produced by treatment and training. It is hoped that, when complete, this will result in accurate information being available concerning the numbers of young handicapped people in the Borough, and their different age groups and categories. This information should also be of assistance to the Education, Social Services and other Departments, such as Housing, which are concerned with all aspects of the planning of future provision for the handicapped. Child Health Centres During 1970 there was an increase in the developmental assessment aspect of the examination of children in the 0-5 age group. These assessments increase the time which the medical officers need to spend on each child. The more detailed examinations are coming to be appreciated by the mothers, when their purpose is explained. Regular examinations of these children are preferably arranged to coincide with the ages at which screening tests are most suitably performed. The early detection of a defect may prevent or mitigate the development of a handicap. 30 Ante-Natal and Post-Natal Services Six ante-natal sessions are held each week at Clinics in the area, at which a Departmental medical officer and a health visitor are in attendance. At these ante-natal Clinics cases are booked for subsequent hospital confinement. Post-natal examinations are also carried out at these sessions. In addition five ante-natal sessions are held by midwives for patients booked for domiciliary confinement. In view of a decline in the numbers attending ante-natal clinics the sessions held are now for ante-natal and cytology. 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 178 Number of women who attended for post-natal examination 27 There were 290 midwives' clinic sessions at which 214 women attended. The total number of attendances was 1,332. 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 380 Booked for domiciliary confinement 28 Total 408 The total number of attendances was 2,476. Premature Infants The total number of premature infants born in the area during 1970 was 152 compared with 148 in 1969. Eighteen premature infants died in 1970. This means that 11.8% of the 152 premature infants born during the year died within a year as compared with 0.9% for full-term babies. 31 Premature Infants Born at Home— Weight at Birth Born at home and nursed entirely at home Born at home and transferred to hospital on or before 28th day Grand Total Total Died within 24hrs of birth Survived 28 days Total Died within 24hrs of birth Survived 28 days 2 lb. 3 oz. or less - - - - - - - Over 2 lb. 3 oz. up to and including 3 lb. 4 oz. - - - 1 - - 1 Over 3 lb. 4 oz. up to and including 4 lb. 6 oz. - - - - - - - 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. 1 — 1 — — — 1 Totals 1 — 1 1 — — 2 CHILD HEALTH General The Local Authority continues to hold Child Health Centres at the fourteen premises listed below. Nine of these are purpose-built, the remainder are hired for weekly sessions. In addition, there are now four group practices of general practitioners who hold child health sessions at which the health visitor attached to the group attends. These sessions have naturally resulted in a slight reduction in the total attendance at some of the local authority clinics. The overall attendances, however, remain high. Here, great emphasis is made on the early detection and referral of any condition likely to hinder a child's normal physical, mental or emotional development. 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 Baptist Hall* Tuesday 1.30-3.30 p.m. Longley Road, S.W.17 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 32 Grand Drive Clinic Monday 10 to 12 noon and Raynes Park 2-4 p.m. Wednesday 10 to 12 noon 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. 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 1965-70 1970 1969 196568 Amity Grove 98 207 223 226 656 3,847 Cavendish Road 98 198 329 76 603 4,388 Church Road 105 252 264 190 706 3,876 Churchill Hall 51 86 84 48 218 1,979 Emmanuel Hall 51 75 62 65 202 1,345 Grand Drive 148 225 186 212 623 6,112 Meopham Road 52 72 68 118 258 1,865 Middleton Road 101 67 75 59 201 2,749 Morden Road 99 149 216 233 598 2,535 Pelham Road 105 232 182 127 541 4,651 Longley Road 53 223 205 134 562 3,809 St. John's Hall 53 107 61 120 288 1,811 St. Luke's Hall 50 79 73 29 181 1,376 Wide Way 102 179 191 245 615 3,956 Totals 1,166 2,151 2,219 1,882 6,252 44,299 A total of 6,252 children attended during the year. 33 Attendances at Toddlers' Clinics First attendances Total attendances Total sessions (All clinics) Born In Total 1965-70 1970 1969 1965-68 — 12 1806 1818 2623 264 Dental Care During 1970 there was an increase in the number of children under school age brought to the clinics for inspection, 677 compared to 607 in 1969 and more courses of treatment were completed, 336 compared to 297 in 1969, although the number of sessions devoted to this work was about the same, 215 compared to 210 in 1969. More treatment was also carried out for expectant and nursing mothers for whom 140 fillings were carried out compared to 63 in 1969. There are today, in this Borough at least, very few parents who are not conscious of the importance of dental health for themselves and their children and this is a tribute to the excellent work carried out in Dental Health Education by Health Visitors and others, commencing in the Ante-Natal Clinics and carried on by dental staff throughout a child's school life. Commenced Completed course Examined treatment of treatment Expectant and Nursing Mothers 35 29 25 Children under 5 677 380 336 Scaling Teeth Gen- and Fil- other- Ex- eral Dentures X- gum lings wise trac- anae- Rays treat- cons- tions sthe- ment erved tics Full Part Expectant and Nursing Mothers 16 140 — 16 2 — 5 4 Children under 5 ... 163 817 83 49 34 — — 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. 34 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. 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 38.26 Middleton Road Day Nursery 9 30 39 31.14 At the end of the year there were 47 private day nurseries registered under the Nurseries and Child Minders Regulation Act, with a total of 1,113 places. In addition there were 189 daily minders on the register. Developmental Clinic At this Clinic young children are seen by appointment by Dr. Rona McLean of the Manor Hospital, Epsom, who advises parents on the mental development of their children. A health visitor and a mental health social worker of the authority and a speech therapist from the Manor Hospital, assist Dr. McLean at this Clinic. This Developmental Clinic is made possible by the ready cooperation of Dr. Worters, the Physician-Superintendent of the Manor Hospital, Epsom, in making available a senior member of his medical staff to conduct this highly successful clinic, which is much appreciated by parents of children seen there. Twenty sessions were held during the year at which 28 children were seen for the first time and 62 children were seen for a subsequent case review. Care of Unmarried Mothers and their Children Ten 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. 35 Congenital Malformations The following malformations were notified during the year: — Central Nervous System 9 Eye and Ear 1 Alimentary System 11 Heart and Circulatory System 1 Urino-Genital System 4 Limbs 18 Other Malformations 6 Respiratory System 1 Total 51 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 1970 are shown below: — National Dried Milk 16,584 tins Cod Liver Oil 3,693 botdes Vitamins 'A' and 'D' 4,180 packets Orange juice 64,813 botdes 36 PUBLIC HEALTH NURSING AND ALLIED SERVICES Organisation During 1970, the re-organisation of the nursing services, commenced in 1969, has continued. Three Senior health visitors took up their new posts at the beginning of the year, and three Senior district nurses in the spring and summer. By the end of the year, it had been possible to re-organise the Health Visiting Service in such a way that the Senior health visitors were carrying out first-line management duties as recommended by the Mayston Report on the Management Structure of the Local Authority Nursing Services. Vigorous attempts have been made to relieve health visitors and home nurses of duties that do not require their skills. The appointment of three clinic aides who undertake a variety of non-professional duties proved to be an invaluable asset. They act as receptionists, telephonists and clinic assistants, and give simple clerical assistance to the health visitors. The increased establishment of nursing auxiliaries has been more than overwhelmed by the increased demands for assistance in bathing, washing and dressing elderly persons who do not otherwise require the skilled attention of a trained nurse. The nursing service is very conscious of the increasing needs of the elderly population within the Borough. In addition, attendance by home nurses and nursing auxiliaries and visits paid by health visitors to persons over the age of 65 years, have almost doubled. Throughout the year, with the need for adequate preparation for the future integrated health service very much in mind, liaison with the hospitals adjacent to the Borough has been developed. Regular meetings of senior nursing staff have been held to discuss nursing policy and training. Health visitors are attending certain Paediatric Consultant Clinics, thus forming an important link between hospital and community health services. District nurses have attended study days with ward sisters, and midwives continue to be welcome, with other students, in the Consultant Obstetric Units at St. Helier and Nelson Hospitals. In return nursing officers and ward sisters have visited the Borough to see at first hand the area to which they are discharging patients and how the community services that they request are functioning. Plans are being prepared for extending this two-way visiting between hospital and community nursing staffs, thus developing an understanding of each other's skills and increasing the mutual trust and co-operation that has commenced this year. 37 HEALTH VISITING Staff As at 31st December, 1970, the staff position was: — 1 Superintendent Health Visitor. 3 Group Adviser Health Visitors. 27 Full-time health visitors. 3 Part-time health visitors. 1 Full-time geriatric health visitor. 1 Full-time Tuberculosis health visitor. 1 Part-time Tuberculosis visitor. 4 Health visitor students. Five members of the staff left during the year, two because of marriage, two due to pregnancy, and one to take up a university post. The four student health visitors sponsored by the Borough in 1969 were successful in their examinations and joined the staff as health visitors in October, together with another recently-qualified health visitor who had completed the integrated training. With the growing attachment of staff to general practitioners, it is becoming obvious that with the increased work which the attachments generate, plus the increased travelling time, combined with maintaining the other services provided by the local authority, the point will shortly be reached when additional staff will be a necessity to meet the developing need. General Practitioner Attachments In December, 1970, 14 health visitors were working in attachment schemes with 42 general practitioners. Requests have been received from other general practitioners for staff to work with them, and arrangements are proceeding. There are a large number of general practitioners serving the population of the Borough. Some of them have surgeries outside the Borough and have only a few patients resident in Merton. Many practices cover a large geographical area; some general practitioners work alone. These factors present difficulties when attaching staff, and great care is required to ensure that, whilst wishing to accommodate the general practitioners, the remaining service needs of the Borough are maintained. Training of Health Visitors Four health visitor students were sponsored for training in 1970. Two are undertaking their courses at Ewell Technical College, one at Croydon Technical College, and one at Chiswick Polytechnic. If successful, they will join the health visiting staff in October, 1971. Eight health visitor students received their practical training in the Borough during the year, and the four students sponsored by Merton returned in June for their periods of supervised practice. Two health visitors completed their Field Work Instructor's Courses during the year, bringing the number of staff qualified to undertake the practical training of health visitor students to seven. 38 Two senior health visitors attended a course on ' An Introduction to Management.' This course of five days was organised by the London Boroughs Training Committee. Five health visitors attended postcertificate refresher courses and a number of other health visitors attended Study Days throughout the year. Ten staff were given inservice training on screening infants for possible deafness. This screening is undertaken by health visitors on all infants at the age of seven months. Geriatric Health Visiting The number of elderly persons within the Borough continues to rise and visits paid to them by health visitors this year almost doubled. The health visitor attached to Dr. Millard, Consultant Geriatrician to the local authority, has now undertaken full-time duties as a specialist geriatric health visitor. She acts as a valuable link between the hospital, the general practitioner and the local staff (district nurses, health visitors and social workers). Because of the increasing volume of this work, it is proving impossible for one person adequately to cover the whole Borough, and it is hoped that it will be possible for the service to be developed. Health Education This is a very important function of every health visitor, and in every visit she pays to a home, and in every consultation made in a clinic, surgery or school, some aspect of health education is covered in an informal manner. The attendances at the day-time parentcraft classes in which psychoprophylaxis teaching is also given, remain high. To meet increased demand, extra sessions have been held—60 in 1969, 100 in 1970. The evening parentcraft classes which were increased last year, have been retained and continue to prove very popular. The health education programme in schools has continued and developed with health visitors covering a wide range of health topics. These continue to be very popular and extremely valuable in allaying fears and misconceptions in the young. Summary of Work of Health Visitors The following tables give details of the number of children and other cases visited, and attendances by the Health Visitors at the various clinics and centres:— 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 1970 Born in 1969 Born 196568 Total 2,460 2,519 7,661 12,640 370 110 79 1117 9,921 39 Sessions attended by Health Visitors. At Local Authority Ante-Natal Clinics 18 At G.P. Ante-Natal Clinics 97 At Cytology Clinics 17 At Developmental Clinics 25 Local Authority Child Health Centres 1,804 G.P. Child Health Sessions 329 At Toddlers' Clinics 255 At G.P. Toddlers' Sessions 17 At Parentcraft Sessions (by day) 100 At Parentcraft Sessions (Evening) 55 At Fathercraft Sessions 40 At Geriatric Clinics 107 At Vaccination and Immunisation Sessions 24 At Co-ordination Meetings 2 At Case Conferences 28 Screening Tests of Hearing of Young Children 218 At Meetings 501 Sessions with Students 371 At Mothercraft Sessions 332 Sessions attended by State Registered Nurses. At Ante-Natal and Cytology Clinics 263 At Cytology Clinics 45 At Vaccination & Immunisation Clinics 124 At Developmental Clinics 23 At Child Health Sessions 380 MIDWIFERY Staff As at 31st December, 1970, the staff consisted of: — 1 Non Medical Supervisor of Midwives (also acts as Superintendent of the Home Nursing Service). 1 Deputy Non-Medical Supervisor of Midwives (also acts as Deputy Superintendent of the Home Nursing Service). 7 Whole-time district midwives. 2 district nurse/midwives. Introductory The number of home confinements has continued its downward trend (169 compared with 217 for 1969) but with an increase of 95 planned and unplanned 48-hour discharges from hospital, work has not decreased. Fifty of these early discharges were accepted at short notice in July and August, 1970, when an outbreak of infection in the Maternity Unit at St. Helier Hospital caused the temporary closure of a number of wards. These patients and their babies were nursed by those district nurses who are also qualified midwives. Midwives have continued to obtain blood samples for the testing of phenylketonuria by the Guthrie method for babies delivered at 40 home or discharged from hospital before the sixth day. 585 tests were made during the year and 41 repeat tests were made. Organisation 2 midwives are housed at 28/30 Kings Road, Wimbledon, S.W.19. 1 at ' The Croft', Mitcham. 1 in a flat leased from the Greater London Council, and the remaining three in their own homes. Two district nurse/midwives relieve full-time midwives during holidays, refresher courses, sickness, etc. All midwives are motorists using their own cars or one supplied by the authority. Maternity Cases Attended There were 169 domiciliary confinements reported and 2,308 hospital confinements during the year. This shows a reduction of 34 on the figure for 1969. Midwives employed by the Authority attended all home confinements, a doctor having been booked in all 169 cases. Inhalational Analgesia All the Authority's Midwives are qualified in administering inhalational analgesia (trilene and gas and oxygen) in accordance with the rules of the Central Midwives' Board. During the year, district midwives administered inhalational analgesia to mothers as follows: Gas and oxygen—119 Trilene—9 Ophthalmia Neonatorum One case was notified during the year. Maternity Outfits A free issue of maternity outfits is made in accordance with the instructions of the Department of Health and Social Security, namely to those patients whose confinement will be conducted under the National Health Service arrangements. These are issued by midwives to their patients. Medical Aid Medical aid was summoned by midwives to 79 domiciliary cases where a doctor was already booked for the confinement. The Emergency Obstetric Unit The aid of this unit was summoned on three occasions and the patients were subsequently admitted to hospital: — 1 post-partum haemorrhage. 1 retained placenta. 1 prolapsed cord. 41 Early Discharges from Maternity Hospitals The numbers of discharges from hospital before the tenth day of puerperium were as follows: — 48 hours after confinement 474 Other discharges before the tenth day 133 Total 607 This shows an increase of 95 on those for 1969. Midwifery Training During the year 18 student midwives from the Nelson Hospital completed their domiciliary training. There were a further five in training at the end of the year. Eight midwives are approved by the Central Midwives Board as district midwifery teachers for the practical training of student midwives. Thirty-one patients were delivered at the Nelson Hospital and six patients at St. Helier Hospital, by student midwives accompanied and supervised by domiciliary midwives. Patients are discharged as soon as possible after delivery, home care being continued by the domiciliary midwives. With the continued decrease in home confinements, these deliveries form an important part of the second-period training of student midwives. Eight obstetric students from St. Helier Hospital spent a day with the midwives observing some of the services that the community offers to mothers booked for home confinement and for planned early discharge. Post-Registration Courses The Deputy Non-Medical Supervisor of Midwives attended a refresher course in accordance with the rules of the Central Midwives Board. One district midwife attended a course on methods of parentcraft teaching. 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 1,852 Post-Natal visits to home confinements 3,090 Post-Natal visits to 48-hour and other early discharges from hospital 3,746 Total 8,688 Attendances at Clinics Two hundred and eighty-eight Ante-Natal Clinic sessions were held by midwives during the year and 214 women attended these clinics for the first time. The total number of attendances at Midwives' Ante-Natal Clinics was 1,332. 42 Transfers to Hospital The undermentioned patients booked for home confinements were transferred to hospital:— (a) during pregnancy 34 (b) during labour 4 All patients transferred to hospital during labour are accompanied by a midwife unless the Emergency Obstetric Squad has been called. HOME NURSING General An increasing number of requests throughout the year from general practitioners, hospitals, patients and other relatives for nursing care to be given at home, has resulted in even greater demands being made on the home nursing service. Although this increase has been for patients in the older age range, this year has seen some alteration in the nature of nursing treatment requested for other age groups. This trend is likely to increase markedly over the next few years as hospitals are urged to plan early discharges and as other medical and nursing staffs begin to appreciate fully the technical skills and quality of care given by district nursing sisters. Staff At the 31st December, 1970, the' staff consisted of: — 1 Superintendent of the Home Nursing Service. 1 Deputy Superintendent of the Home Nursing Service. 3 Senior district nurses. 22 Whole-time home nurses (female) — S.R.N, and District Trained. 6 Whole-time home nurses (female) — S.R.N, (not District Trained. 3 Whole-time home nurses (male) — S.R.N, and District Trained. 2 Part-time home nurses, S.R.N. 5 Whole-time home nurses (female) — S.E.N, (not District Trained). 10 Part-time nursing auxiliaries (female). Organisation Recruitment of staff has been maintained, but the lapse of time between a resignation and the appointment of a suitable replacement places great burdens on the remaining staff, particularly during periods of staff sickness and annual leave. The value of the nursing auxiliaries, who work under the supervision of the home nurse, bathing, dressing, getting-up and putting to bed elderly patients who do not require skilled nursing care, is immense. With an increase in establishment, the number of visits made by them increased from 3,851 in 1969 to 7,567. In spite of this, the trained nurses still paid 7,017 43 visits that did not require their expertise (8,780 in 1969). These figures show again the greater demands on the service by an increasing number of elderly people in the Borough who are unable to give adequate care to themselves. Training of District Nurses This Authority continues to be an approved training area for the practical part of the district nurse training leading to the National Certificate of District Nurse Training. Four state registered nurses and one enrolled nurse successfully completed their training. Four of these nurses are still employed by this Authority, and the other is now working overseas. Visiting Hospital Staff Nurses from many hospitals, undertaking a period of nurse training have visited the Department on 132 days during the year, in order to observe the operation of the community services. This is a very important function and one in which all members of staff willingly co-operate. General Practitioner Attachments Eleven district nurses are now working with groups of general practitioners and plans for increasing this number are well advanced. General practitioners, nurses and patients appreciate this closer working relationship. The work of nurses in attachment schemes has continued to increase in the number and variety of cases referred. They include many patients who would previously have required hospital care. Post-Registration Courses for District Nurses During the year the Deputy Superintendent of the Home Nursing Service attended the first part of a First Line Management Course (two weeks). One Senior nurse attended a course in Practical Work Instruction for Senior nurses, one male nurse attended a course of 13 days in Community Psychiatric Nursing, six nurses attended a Practical Work Instructors' Course of five days, three nurses attended a refresher course each of five days and eight other courses of one day were attended by a total of 15 staff. 44 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 1.1.70 Cases added Cases removed Cases on books at end of year 0-5 years 1 16 15 2 5-64 years 152 609 592 169 65 years and over 725 1,517 1,461 781 Totals 878 2,142 2,068 952 The total number of cases attended during the year was 3,020. Visits Made The following table shows the total number of visits made each month: — January 8,830 February 7,639 March 7,788 April 8,637 May 8,184 June 8,713 July 7,987 August 7,468 September 7,814 October 7,621 November 7,784 December 8,101 Total 96,566 Marie Curie Foundation Cancer Nursing Service This Authority acts as agents for the Marie Curie Memorial Foundation who bear the initial costs of the Day and Night Cancer Nursing Service supplied locally to any cancer patient being nursed at home and in need of additional care, especially night attendance. The Authority reimburses the Foundation with one-third of the annual expenditure on this service. The service is staffed by qualified nursing staff and unqualified staff, the appropriate person being sent to each case as necessary. The service is run through the Home Nursing Service. Nineteen patients were nursed during 1970, receiving a total of 90 visits. 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 it is desired that the patient shall remain at home until the end. 45 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 These pads are supplied to patients free of charge at the request of either the general practitioner or district nurse in attendance. With the number of elderly persons increasing and living longer, the demand has continued to rise. Patients who use these pads are provided with tarred paper containers. Soiled pads can then be sealed in these bags and collected for disposal by the refuse collection service. Incontinent Laundry Service In conjunction with a neighbouring authority a collection and delivery service of draw sheets is arranged, twice weekly, to patients where the district nurse advises this. It is a growing and much appreciated service. DOMESTIC HELP SERVICE Staff As at 31st December, 1970, the staff consisted of: — 1 Home Help Organiser. 1 Senior Assistant Home Help Organiser. 2 Assistant Home Help Organisers. 3 Clerks. 221 Part-time Home Helps. 8 Neighbourly Helps. Organisation Recruitment was more successful than in the previous year, 101 home helps were engaged, 40 more than in 1969. 77 home helps left the service during the year for various reasons. The improved recruitment was mainly due to an article in the local press on the shortage of home helps. Training Course The In-Service Training Courses were continued at intervals throughout the year for the new recruits. They proved a success and lively discussions took place after each speaker had delivered a talk. Neighbourly Help Scheme Three neighbourly helps were recruited during the year—a small and disappointing number. The home helps enjoyed their annual ' get togetherthere was a good attendance and full participation. The Medical Officer of Health and the Director of Social Services Designate joined the home helps to make this function a great success. 46 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., 1969 Cases on books at 31st Dec., 1970 Total cases dealt with during 1970 Chronic Sick and Aged 1,163 1,237 1,628 Tuberculosis 6 10 15 Acute Illness 12 25 104 Maternity — 1 39 Totals 1,181 1,273 1,786 Details of Sources of Applications in 1970 General Practitioners 497 Hospitals 272 Health Visitors 20 Home Nurses 12 Welfare Services 34 Maternity Bookings 59 Others 21 Total 915 The Organiser and the three Assistant Organisers have paid 773 first visits and 5,835 re-visits to homes in connection with the service. HOURS WORKED BY HOME HELPS Chronic Sick and Aged T.B. Acute Maternity Payments tinder Neighbourly Help Scheme Total hours worked £ s. d. January 18,369 182 414 144 40 10 0 19,109 February 15,528 160 319 165 39 2 0 16,172 March 15,111 136 331 153 50 16 0 15,731 April 15,389 172 324 47 52 4 6 15,932 May 15,775 169 324 144 58 6 6 16,412 June 18,040 191 227 243 44 5 6 18,701 July 14,652 137 205 63 54 10 0 15,057 August 16,601 151 230 50 58 14 6 17,032 September 13,971 115 186 46 59 16 0 14,318 October 20,837 178 366 345 71 11 0 21,726 November 16,972 138 518 84 55 16 6 17,712 December 16,017 119 522 78 64 0 0 16,736 Totals 197,262 1,848 3,966 1,562 649 12 6 204,638 47 PREVENTION OF ILLNESS, CARE AND AFTER-CARE Clinics for Older People There are two clinics for older people. Dr. Joan Ferreira reports on the clinic at Amity Grove as follows: — Dr. Whitfield started doing one session weekly in April, 1970, so since then there have been three sessions a week except during holidays. This has enabled us to shorten the time of waiting. The demand for new appointments continues. Some of the patients are self-selected, but there is also a trend for doctors to refer their patients at special times, such as just before retirement or after widowhood when they may be more than usually vulnerable. I hope that the clinic is in this way being of service to those who need it most. Attendances were: — Number of new patients seen in 1970 Male 31 Female 92 Number of re-attendances seen in 1970 Male 116 Female 357 Average age of new patients 60 Dr. W. B. James reports on the clinic at Middleton Road as follows: — Those who attend appear to appreciate the nature of the examination and the thoroughness of the clinical arrangements. I feel however that not much notice is taken of any mild suggestions made for some patients who may require further investigations and treatment. Attendances were: — Number of new patients seen in 1970 Male 18 Female 73 Number of re-attendances seen in 1970 Male 17 Female 39 Average age of new patients 57 The Geriatric Service Dr. Peter Millard, the Consultant Geriatrician to the Borough has contributed the following comments on the Service during the year: — 'During 1970 there were 477 elderly people referred for the first time to the geriatric services. Not all of these were admitted, some being seen at Outpatients or as a domiciliary visit only. 427 patients were admitted and there were 292 discharges to the community. The services were strengthened by the opening of the administrative offices at St. George's and the appointment of Miss Telling as a full-time 48 health visitor to the Unit in May, and of Miss Taylor as a full-time social worker in September. 'A mixed-sex assessment Ward of 13 beds was opened in November at St. George's and during the 1971 year a Day Hospital will be opened at the Cumberland Hospital.' HEALTH EDUCATION General One aim of health education is to widen man's sphere of knowledge, and in doing so to remove his fear and ignorance to enable him to take personal responsibility for safeguarding his own health and that of his family. By both example and teaching, it also encourages the young to do likewise within the limits of their own abilities. Many diseases have been conquered by man and standards of hygiene are accepted to-day as a normal part of everyday living which, not many years ago, would have been regarded as quite unnecessary. Regrettably, though, other standards have been lowered and disease allowed to flourish, partly perhaps, because personal responsibility has been removed almost entirely, and man is not required to participate in the promotion of his own health and that of the community in which he lives. The prime function of health education must surely be to gain the participation of the individual and, in so doing, to increase his or her responsibility for achieving and maintaining higher standards of health, physical, mental and social. Health Education in Clinics At Ante-natal and Expectant Parent Classes, the aim of the health visitors and midwives is to increase the knowledge and understanding of expectant parents of physical and emotional changes which take place during pregnancy and childbirth, and the needs arising therefrom. A general practitioner completes the team who take the evening classes— a series of four— to which the expectant fathers, together with their wives, are invited. These are proving very successful and the opportunity for expectant fathers to learn considerably more about this hitherto sacrosanct period is obviously welcomed by them. The visual aids used during these courses have proved to be of great value. Parentcraft An alternative name has been sought for these groups as the concepts and needs have altered, but as yet without success. The programmes now range over a much wider field of subjects, since a period of relaxation and interest, rather than obvious education, appears to be the stimulus the mothers seek on an afternoon or evening away from home ties. 49 Discussion groups are held with mothers and with older people who attend the clinics and health education topics are much to the fore. Health Education in Schools Both the Health Education Officer and the health visitors continued throughout the year with teaching programmes in schools. Mainly, however, this teaching has perforce only been possible in the High Schools, due to lack of additional staff for this important function. It is hoped that additional staff may be available in the coming year which will enable this service to be extended. Many more schools have become aware of the health education service and its possibilities. This, of course, has meant ever increasing requests for help with teaching and visual aids, etc All requests were met with every assistance where possible. In May, with the help of a schools and medical liaison officer from a large and conscientious footwear manufacturer, a programme to promote foot health was launched throughout many of the schools in the Borough. This was greeted with enthusiasm by teachers and appeared to interest the youngsters at whom it was directed. Courses for the Duke of Edinburgh Award Scheme have commenced in some of the High Schools and are being conducted by health visitors with the help of the Health Education Officer. Health Education in Other Fields Requests are received from youth clubs and other organisations for talks, sometimes illustrated, on topics concerned with aspects of health. These requests are always met since, when education is requested, it is more likely to be remembered and acted upon. Subjects portrayed included Dental Health, Home Safety, Cervical Cytology and Venereal Diseases. This latter subject was one in which a great deal of interest was shown and the supply of handouts needed replenishing frequently. This surely indicates a desire for more knowledge on this problem, which is currently causing so much concern. Displays and Exhibitions No major campaign was undertaken during the year, but displays on differing themes have been erected in clinics and the foyer of the Health Department at regular intervals. At the Civic Exhibition held in November this year, one of the main attractions was 'Smoking Susie.' A great number of people, children, teenagers and adults alike, seemed to want to learn more about the dangers of smoking and many were the requests for help to stop smoking. In Service Training Sessions were held at different centres for medical officers, health visitors and nursing staff, on a variety of subjects and were generally well attended. 50 In-Service Training courses for home helps were held and the health education section was pleased to co-operate fully in them and also with the training programme for student midwives and student nurses. Liaison with all sections of the Health Department and with other departments is maintained and is felt to be of the utmost importance. The help and co-operation received by the health education section is very valuable and is always appreciated. OTHER ALLIED SERVICES Chiropody Service The Council's chiropody service caters for the elderly, the registered blind or partially sighted, the physically handicapped and expectant and nursing mothers. It comprises two separate schemes: — (a) The Direct Scheme whereby application is made to the Medical Officer of Health and authority is given, to those eligible, to have a fixed number of treatments carried out by any chiropodist on the Council's panel. (b) The Indirect Scheme whereby treatment is arranged by Voluntary Organisations. A number of old people are taken for treatment by members of these voluntary organisations whose work is greatly appreciated. Under either scheme, treatment can be given in the patient's home if a doctor certifies that the patient is unable to travel. The number of people receiving treatment under the service is increasing steadily and is likely to continue to do so. In the twelve months ended 31st December, 1970, 1,207 new applications for treatment were received. The following table gives figures for the Direct Scheme:— Category Persons treated in 1970 Number of treatments given Number on books at 31.12.70 Elderly 4,683 24,688 4,359 Registered Blind or Partially Sighted 69 332 69 Physically Handicapped 144 763 139 Expectant Mothers 1 2 1 Totals 4,897 25,785 4,568 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 51 home nurse. The beds are hired from the suppliers and 98 such loans were made in the year. The demand for this service continues to increase. 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. 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 rings 74 Crutches 28 Bed rests 127 Dunlopillo mattresses — Bed pans 62 Feeding cups 10 Bed tables 7 Waterproof sheets 66 Wheelchairs 141 Walking Aids 20 Commodes 142 Urinals 26 Cradles 82 Recuperative Holidays Under Section 28 of the National Health Service Act 1946, the Authority is empowered to provide a recuperative holiday for persons needing it to complete or assist in their recovery to normal health, but who do not need organised medical or nursing care. A recommendation from a medical practitioner is necessary. A number of Homes in Surrey and on the south-east coast are used, the holiday being usually for two weeks. Forty-eight such holidays were arranged in the year. Cervical Cytology The Cytopathology Unit at St. Helier Hospital is able to deal adequately with the Borough's requirements. It is necessary, from time to time, to have a campaign to ensure that all women are aware of the facilities. It is particularly necessary to endeavour to deal with women in the lower income groups, where the prevalence of cervical cancer may be higher. In all, 1,189 new cases were dealt with and 2,549 repeat smears were taken. From the total of 3,738 smears taken during 1970, 15 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 trichinomas, monilia and other organisms, also for other defects found on cervical examination. 52 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, 9.30-11.00 Church Road Clinic, Mitcham Tuesday and Thursday evenings, 6.15-8.00 Thursday mornings, 9.30-11.30 Pelham Road Clinic, Wimbledon Monday, Wednesday and Friday evenings, 6.15-8.15 Wide Way, Mitcham Monday mornings, 9.30-11.00 Monday evenings, 7.30-8.30 An extra session has been provided at Wide Way Clinic to meet the increased demand for this service. The number of cervical smears taken at the Family Planning clinics has greatly increased. Details are given below of the numbers and types of case dealt with during the year:— New Patients:— Number Medical 414 Social 1,113 Total 1,527 Established patients (including transfers) 2,710 Total Attendances to see the Doctor 11,880 Number of Doctor Sessions 709 53 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. Dr. Morris Markowe, Medical Administrator, Springfield Hospital is the Consultant Psychiatrist to the Borough and I am grateful to him for the following report on the Mental Health Service. ' It gives me great pleasure to present my first Annual Report for 1970, and to acknowledge the help I have received from my distinguished predecessor, Dr. R. K. Freudenberg, and from Dr. P. J. Doody, Medical Officer of Health. 'This has been an exceptional year in the evolution of the Mental Health Service in that while a decade has now passed since the implementation of the Mental Health Act 1959, and the community care facilities have expanded, a further landmark appeared in 1970 in the form of the Local Authority Social Services Act. We have held numerous meetings to discuss how the Mental Health Service is likely to develop and to be affected by its transfer from the Health Department to the Social Services Department, and in these we have benefitted by the collaboration of the newly appointed Director of Social Services, Mr. W. Hutchinson, who has given his unstinted advice and guidance. 'There are bound to be growing pains in any new organisation, together with obvious difficulties in that the Social Services Department has no regular Medical Officer, although we trust that Dr. M. J. Freeman, our Senior Medical Officer with special responsibilities for the Mental Health Service, will continue her day to day work in this field as the medical expert available to the new Department. There should certainly be little need to seek expert medical advice from sources outside the Health Department in view of the wealth of experience already developed there. Thus the danger of the overenthusiastic social worker undertaking forms of psychotherapy without medical guidance and control is a real one that we hope can be avoided by our own close links with the Social Services Department through formal discussion groups as well as informal consultations. Liaison at all levels has been forged and developed, and close links are being established through educational visits by the staffs of the new Department to Springfield Hospital, as well as to Horton and Netherne Hospitals. It must be emphasised that liaison and education in Mental Health must inevitably be on a reciprocal basis between the doctor, psychiatric nurse and social work personnel, and ranging between the general practice, pyschiatric hospital and local authority areas of the Health Service. Thus social workers are already attached to a few group practices in the Borough, psychiatric nurses are beginning to follow selected patients into the community, and some social workers are playing their part as professional colleagues in the Consultant's Psychiatric Team at the associated hospitals for the mentally 54 ill. Efforts are made to meet the social workers at least monthly in order to assist them in the management of specific problems, although the planned establishment of four area teams in the new Department may present difficulties in covering the Borough for such consultations. However, rationalisation and expansion of hospital responsibilities for out-patient and day hospital purposes in the foreseeable future, together with additional consultant sessions for community work, may cover such increased needs. Hospital Developments 'As noted in last year's Report, the South West Metropolitan Regional Hospital Board has commenced simplification of the present complex arrangements whereby the Borough is served by some four mental hospitals, two district general hospitals and two hospitals for mentally handicapped. Thus Springfield Hospital accepted joint responsibility (with West Park) for the Mitcham area when an acute unit was opened in Aster Ward on 1st July, 1969, and since 1st July, 1970, has taken all cases requiring hospital admission from this area including informal and compulsory categories, as well as patients of all ages. Closely associated with the Aster Unit is a Day Hospital which offers most forms of psychiatric treatment, with social, occupational and group therapy, on a day basis. This is an extremely important facility in that patients can return to their homes and families at night, so that family relations are not interrupted as they might be by admission. Further, there is ready access to Springfield Hospital by public transport from most parts of the Borough. 'St. George's Hospital, Tooting, at the Grove, which is developing into one of the largest of the London Teaching Hospitals, has an extensive Department of Psychiatry under the vigorous leadership of Professor Arthur Crisp, an international authority. All forms of treatment, research and teaching are already being provided, and it is anticipated that a 30-60 bedded in-patient unit will be available in the foreseeable future at the Grove, to augment the Department's psychiatric beds at Atkinson Morley's Hospital. This unit will then function as a prototype for the district general hospital psychiatric unit, as recommended by the Bonham-Carter Report 1969, and so assist in the treatment of psychiatric patients within or immediately adjoining their local community instead of banishing them to remotely situated hospitals. 'It is expected that eventually all in-patient and day patient hospital care for the mentally ill of the Borough of Merton will be provided locally between Springfield and St. George's Hospitals. This objective includes the concept of special units for the mentally handicapped of all ages, as well as small purpose-built units for children and adolescents. It is only by maintaining close links between the mentally disordered and their families and local community that the most effective psychiatric service can be provided. 'So far I have commented on the social work and hospital aspects of the service. It is intended to enlarge upon particular topics in future reports such as the voluntary health services within the Borough (including resuscitation of the Merton Association for Mental Health), 55 special services for adolescent and marital problems, and day centres (with social clubs) in strategic areas associated with the planned quadripartite division of the social services. 'Meanwhile I wish to refer to three further important matters: general practitioner/social work attachments; psycho geriatrics; and psychiatric case registers. The General Practitioner/Social Worker attachments 'The new emphasis on the teaching of behavioural sciences to medical students will gradually result in an increasing number of family practitioners taking a special interest in psychological medicine. Such interest is being stimulated by post-graduate courses and also by the activities of the Royal College of General Practitioners. In view of the fact that a major part of psychiatric work is being done already by general practitioners outside the hospital setting, and that a large proportion of their patient load is with illness emotional in origin, it will be seen that the Mental Health Service of the future should give the family doctor every opportunity of becoming a member of the psychiatric team itself. The attachment of selected social workers to certain group practices has already been referred to, but I must here mention the danger that with the removal of social workers from the Health Department the general practitioner may be tempted to lose his interest in the social side of his patients' problems, leaving it all to " the other Department". Psycho-Geriatrics 'With increased life expectancy the proportion of the population aged 60 and over continues to rise. Mental and physical disease in old people cannot be considered in isolation, and jointly absorb nearly 30% of expenditure on the National Health Service. No effort should be spared to prevent deterioration arising from isolation, malnutrition and similar remediable causes. Voluntary aid can augment the many and varied provisions from the local authority. Regular medical screening can aid early detection and so the provision of social, clinical and psychiatric advice. That the numbers of elderly residents in our psychiatric hospitals have increased in recent years is only too wellknown, although these are but a small proportion of the total elderly mentally infirm. For this reason I advocate special homes within the community designed to meet their special needs, as well as short-term hostel places to relieve families of their care in times of crises, as has been done in the field of mental handicap. Day centres providing 100 places for 250,000 population, with companionship, purposeful occupation and a good mid-day meal, can often help to avoid premature and unnecessary admission to hospital. 'A psycho-geriatric assessment unit based on St. George's Hospital is being developed and will enable joint consultation between our Consultant Geriatrician (Dr. Peter Millard) and myself and my colleague, Dr. Peter Storey. This will enable earlier and better decisions to be taken as to management, especially as no patient will 56 be admitted to this unit without a domiciliary visit and a social worker's report except in cases of special urgency. The overall emphasis must be on the care of the aged in community for clinical, social and humanitarian reasons. It is essential that local resources should be used to evaluate the quality of care given against our local need, and this leads me to my final topic. Psychiatric Case Registers 'Counts of mentally disordered persons based solely on in-patient statistics are no longer considered representative of psychiatry morbidity. Estimates of numbers in contact with both hospital and community services provide a more realistic figure. The needs of these individuals, and those of their relatives, must be known before we can say whether the services we provide meet their needs. How many others, not in touch with our services, are there, and how can we modify our existing services to cater for these additional persons? Ultimately each area must set up such a case register if we are to be able to assess the overall state of mental health, and to study trends in families, neighbourhoods, and in old and new housing estates. I hope that Merton can be one of the first boroughs to implement this important health study.' Staff As at 31st December, 1970, the staff position was: — 1 Principal Mental Welfare Officer. 1 Deputy Principal Mental Welfare Officer. 7 Mental welfare officers. 1 Mental health social worker. Mr. J. O'Neill resigned his post as mental welfare officer in February, 1970, to take up a post in Scotland, and in April, Mr. D. Dunne resigned his post to take up an appointment with the London Borough of Wandsworth. Mrs. J. Reed was appointed as a mental health social worker in March, 1970, and three mental welfare officers were appointed during the year— Mr. H. S. Hein in July, Mr. M. Cooke in August, and Mr. E. Desai in September. Training of Staff The Mental Health Section did not receive any students from Colleges during 1970, but there was an increase in the placements made by St. George's Hospital and Springfield Hospital in connection with the training of mental nursing staff in the community services. Also, with the anticipated re-organisation of the local authority social services, considerable emphasis was put on various aspects of In-Service Training with a view to equipping social work staff with the information and training necessary to assist them in the new setting. 57 THE WORK OF THE MENTAL WELFARE OFFICERS This has continued to expand, in spite of the fact that for a period of several months, the Section was severely undermanned, although it was with some satisfaction that in September of this year, for the first time since the formation of the Section some five years ago, staffing reached the full establishment provided. During the year, 23 men over the age of 65 years, and 63 women over the age of 60 years, were admitted to psychiatric hospitals with the assistance of the mental health service, out of a total of 394 admissions of all types. This means that 25% of all admissions dealt with through the Mental Health Service were in respect of the elderly. These figures take no account of informal admissions arranged directly by general practitioners without the assistance of the Mental Health Service. SUBNORMALITY Cases in Community Care At the end of the year, 229 patients, as shown below, were in the community care of the Authority, as compared with 225 at the end of 1969:— 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 1 6 31 28 32 34 66 Severely subnormal patients receiving routine home visits 40 36 43 44 83 80 163 Totals 41 42 74 72 115 114 229 Patients included in above figures who are attending Junior or Adult Training Centres 36 31 74 29 80 60 140 Special Care Unit This unit continues to play a most important part in the provisions in the community by giving help to those parents with severely subnormal children with additional physical handicaps. It is obvious that with the changed pattern of hospital care, there will be increasing pressure on such units. It had become apparent, by the end of the year, that although it had, in the past, been possible to give limited help to the neighbouring Boroughs of Wandsworth and Sutton, the Special Care Unit would in future be needed solely for Merton cases. 58 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 1.1.70 14 3 2 19 No. of children attending on 31.12.70 16 1 1 18 No. of attendances made during year 2,051 255 215 2,521 Junior Training Centre The table below gives details of the attendances at the Junior Training Centre during the year:— Merton Sutton Total No. of children attending on 1.1.70 56 2 58 No. of children attending on 31.12.70 51 8 59 No. of attendances made during year 8,363 1,032 9,395 Senior Training Centre It was decided to arrange for a phased withdrawal from the Training Centre at the Manor Hospital, Epsom, of Merton trainees (24 male and 15 female) and accordingly half were admitted in the week beginning 5th January, and the remaining trainees were admitted in the week beginning 19th January. This new Centre will give an opportunity to provide, in a modern building, a wide range of activities which will enable each trainee to benefit to the full from the training received, and to realise maximum potential. The workshop area is designed as one space, which can be divided into units by means of moveable partitions, in order to give the maximum flexibility in layout and production methods, so that immediate advantage may be taken of any new contract opportunities. The workshop area caters for 100 trainees, and is capable of extension to cater for 120 trainees; the kitchen can cater for 120 trainees. In the first year it was decided to establish five specific sections, as follows:— 1. DOMESTIC AND SOCIAL TRAINING. The emphasis in this Section is laid on social training and various projects are undertaken, such as use of the Public Library, use of transport and communications, use of local amenities such as launderettes, hairdressers, etc., cultural visits to museums and parks, domestic science, aspects of hygiene. In addition some educational aspects of the trainees are dealt with which it is hoped to develop in future. 59 2. POTTERY SECTION. This provides facilities for the more intelligent and develops their aesthetic appreciation and skills. It is also beneficial as a means of strengthening palm dexterity in the less fortunate handicapped trainees. 3. WOODWORK SECTION. This Section uses advanced machinery and fulfils the needs of more able trainees. 4. INDUSTRIAL SECTION. This Section deals with contract work obtained from industrial firms in the area, such as light packing, collating, coiling, and light assembly work. 5. GARDENING SECTION. A 40ft. by 60ft. hothouse, and a small plot of land provide opportunities for training in simple gardening. This Section also undertook to maintain the grounds of the Centre, with considerable success. The Centre was officially opened by Mr. Walter Lines, C.B.E., on 2nd April, when the guests included representatives from the various statutory and local bodies, and from local industry. Staffing The Authority provided an establishment, exclusive of the Manager, which would give a ratio of one instructor to ten trainees, and the staff of instructors was recruited from applicants with experience suited to the needs of the Sections of the Centre's activities. As will be seen from the table below, the Centre expanded quickly and attendances were good. From 39 trainees in January, the number rose to 78 by the end of the year. Males Females Total No. of trainees at beginning of year 24 15 39 No. of trainees at 31.12.70 46 32 78 No. of attendances made during year 13,011 Day Centre The Day Centre in Queen's Road, Wimbledon, for the Mentally and Physically Handicapped which was jointly operated by the Health and Welfare Departments made steady progress during the year, although there were some staffing difficulties. At the end of the year ten mentally ill persons were in attendance. SHORT-TERM CARE During the year, the Authority provided periods of short-term care in 35 cases, compared with 31 cases in 1969. This is an illustration of the increased demand made for the facilities when their availability is known to those families in need. 60 OTHER FORMS OF MENTAL DISORDER Cases dealt with by Mental Welfare Officers During the year 633 cases were referred to the Mental Welfare Officers for attention and 394 other cases were admitted to mental hospitals through the Mental Health Service. The following table gives details:— Admitted informally 236 Admitted under Section 25 (for observation) 46 Admitted under Section 26 (for treatment) 10 Admitted under Section 29 (for observation in case of emergency) 91 Admitted under Section 60 (by the Courts) 1 Admitted under Section 136 (in conjunction with the Police) 10 Total 394 Patients receiving Community Care At the end of the year 150 male and 261 female patients were being provided with community care by the Authority This shows an increase of 39 males and 11 females compared with 1969. Guardianship There are no cases under guardianship in the Borough. Cases Accomodated away from Home The Authority, at the end of the year, was making financial provision for the accommodation of 28 patients. A particularly close liaison is maintained with the two Cheshire Foundation Homes in the district, and in addition to giving supervision to the Merton cases in residence there, the Authority has, 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. 3 Whole-time Social Workers. 2 Part-time Social Workers. During the year, there were two staff changes. One married social worker left the service for reasons of pregnancy and did not intend to resume work after the birth of her child, and another social worker left to take a year's post-graduate course as an independent student. General The work of the Section continued to provide a service for families and others who ask for help because they do not fall into other 61 well-defined categories. As will be seen from the details of sources of referral on page 63, cases have continued to be referred from a wide variety of sources. The Section continued to provide a social work service for the Chest Clinics at Cumberland Hospital, with the social workers giving, when requested, support to discharged patients and their families, or assisting, if necessary, financially either by an approach to voluntary organisations, the appropriate Care Committee or the Department of Health and Social Security. In obtaining help for the various types of cases referred, the Section works closely with many voluntary agencies. This is particularly true in dealing with requests for assistance with housing problems. The Section has a working relationship with such voluntary housing associations as: The Catholic Housing Aid Society. The Merton Family Housing Trust. The Quadrant Housing Association. The Harding Housing Association. as well as with the Authority's Housing Department. How effective is this working relationship may be judged from the following figures showing the outcome of the 124 applications for assistance in rehousing received during the year:— Rehoused by Voluntary Housing Association 26 Rehoused by the Authority's Housing Department 19 Rehoused in New Town 1 Admitted to Authority's temporary accommodation 7 Total 53 The outcome of the remaining 71 cases was as follows: — Found own accommodation 26 Bought, or in process of buying own accommodation 4 Decision still pending at end of year 33 Did not follow up application 8 Sources of Referral of New Cases Details are given below of the source of referral of new cases during the year. It is interesting to note that the number of self-referrals increased from 60 in 1969 to 70 in 1970. This is some indication of the extent to which the service is becoming better known to the general public. 1. From Departments of the Local Authority. Welfare Services Department 62 Housing Department 45 Medical and Nursing Staff of Health Department 41 Education Department 4 Children's Department 1 Town Clerk's Department 5 Co-ordinating Conference 2 Total 160 62 2. From Other Agencies. Self referrals 52 Department of Health and Social Security 5 Medical Social Workers in Hospitals 9 Guild of Social Welfare and Citizens' Advice Bureau 15 Chest Clinics 22 General Practitioners 2 Voluntary Housing Associations 4 Greater London Council 4 Churches 2 Careers Office 2 Probation Officers 2 Post Office 1 City of Westminster 1 Police Stations 1 Total 122 3. Mortgage Cases. London Borough of Merton 5 Greater London Council 6 Total 11 4. Assessment Cases. Medical and Nursing Staff of Health Department 14 Chest Clinics 6 Greater London Council 1 Citizens' Advice Bureau 3 Voluntary Housing Associations 3 Self referrals 24 Welfare Services Departments 15 Probation Officer 1 Housing Department 11 Children's Department 1 Education Department 1 Churches 1 Department of Employment and Productivity 1 Town Clerk's Department 1 Total 83 Grand Total 376 63 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR This is the Sixth 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 1970 regard has been had to Ministry of Health Circular 1/71 dated January, 1971. 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 quality and quantity throughout 1970. '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, 1970, was 151,594. '(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. 'The supply was derived from the following works and pumping stations: — River Thames-derived water via Hampton, Walton and Surbiton works, and some well water from Merton pumping station. 64 'No new sources of supply were instituted and there were no changes to the general scheme of supply in the area. 'The number of samples collected for bacteriological and chemical analyses of the supply after treatment during 1970 was 8,633. 'On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead.' During 1970 samples of water were taken for bacteriological and chemical examination by the Public Health Inspectors as follows: — Bacteriological— Swimming Baths 210 Dwelling houses:— Well water 16 Other premises:— Sutton District Water Company 3 229 Unsatisfactory Results— Swimming Baths 45* * This apparendy high figure was precipitated by the long, hot summer resulting in the use of swimming baths to maximum capacity. Chemical— Swimming Baths 9 Dwelling houses:— Well water 2 Other premises:— Sutton District Water Company 2 13 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 visits made during the year 1970:— 65 Complaints received— General disrepair and insanitary conditions 244 Dampness 286 Overcrowding 5 Defective drainage system 28 Blocked drainage system 1,125 Defective drainage fittings 17 Defective sanitary accommodation 64 Defective service water pipes 50 Absence of, or defective dustbins 3 Accumulation of refuse, etc 73 Rats and mice 1,685 Pigeons 56 Foxes 13 Insect pests 775 Smoke nuisances 174 Noise 98 Smells and odours 291 Unsound food 287 Water supply 66 Miscellaneous 84 5,424 Visits made— General. P.H. Act (Nuisance) 2,430 P.H. Act (Dwelling houses) 2,240 Storage of refuse 225 Drains testing 78 Choked drains 2,956 Other drainage work 971 Radioactivity 9 8,909 Housing. Housing Act (Dwelling houses) 3,980 Overcrowding 22 Permitted number measurements 127 Rent Act 11 Underground rooms 35 Houses in multiple occupation 169 Improvement grants 923 Caravans 328 5,595 Food and Food Premises. Milk processing dairies 113 Milk vendors 170 Ice cream premises 286 Food factories 17 Food vehicles 512 School kitchens 53 66 Restaurant kitchens 792 Licensed premises 193 Bakehouses 79 Butchers 182 Wet and fried fish shops 105 Other food shops 1,068 Meat inspection 22 Unsound food 459 Sampling: Food and drugs 147 Sampling: Milk 122 Sampling: Ice-cream 58 Sampling: Water 177 Food hygiene swabs 4 4,559 Clean Air Act, 1956. Smoke Control areas 23,237 Other Clean Air Act visits 509 Smoke observations 462 Air pollution recording apparatus 466 24,674 Factories Act, 1961. Factories (powered) 90 Factories (non-powered) 49 Factories (building sites) 20 Outworkers 236 Work places 7 402 Infectious Diseases. I.D. enquiries 494 I.D. contacts 29 Food poisoning 76 Specimens 67 Disinfection 22 Long stay immigrants 194 882 Offices, Shops and Railway Premises Act, 1963. O.S.R. general inspection offices 136 O.S.R. general inspection shops 186 O.S.R. general inspection wholesale/warehouses 22 O.S.R. general inspection catering 48 O.S.R. general inspection canteens 3 O.S.R. all other visits 1,005 1,400 Insects, Pests, Rodents. Rats and mice control 13,789 Insect control 421 Pigeon control 193 Verminous premises 106 14,509 Animals. Stables 12 12 67 Miscellaneous. Places of public entertainment 3 Hairdressers and barbers 88 Fertiliser and Feeding Stuffs Act, 1926 6 Noise Abatement Act, 1960 405 Schools 25 Court proceedings 22 Public conveniences 2 Water courses 89 Shops Act, 1950 2,100 Pet shops 23 Diseases of Animals Act, 1950 6 Other visits 983 3,752 64,694 In considering the foregoing particulars of visits made by the Public Health Inspectorate, it is pleasing to note that the overall total for 1970 exceeds the previous year's total by 13,000 visits. This increase is made up mainly of the investigation of nuisances, the inspection of houses in connection with the Council's slum clearance programme, and the inspection of houses in connection with applications for improvement grants ( + 2,100 visits), and includes an increase of visits under the heading of dean Air Act, 1956, which was attributed mainly to the delivery of circulars in connection with the suspension of Smoke Control Orders in eleven areas. Result of Service of Notices (1) Legal Proceedings. Proceedings were instituted in the following cases: — (a) For failing to comply with an Abatement Notice—Public Health Act, 1936, Sections 91/94. The court adjourned the case to allow the owner's solicitor to agree with the tenant as to who should carry out the work, there being a repairing lease in existence. Agreement was reached and the Abatement Notice was cancelled, and the summons withdrawn. (b) For failing to comply with an Abatement Notice— Public Health Act, 1936, Sections 91 /94. Nuisance Order made. (c) For failing to comply with an Abatement Notice— Public Health Act, 1936, Sections 91/94. Nuisance Order made (28 days) but no costs awarded. (d) For failing to comply with an Abatement Notice— Public Health Act, 1936, Sections 91 /94. Hearing adjourned for attendance at Court of the owner. Upon resumption, Court was informed that Notice had been complied with. Case adjourned sine die, and no costs awarded. (2) Nuisances abated and Defects remedied. Three thousand two hundred and eighteen defects were remedied as a result of the service of verbal, written and statutory notices. 1,453 were in connection with the drainage of buildings; 700 in and around dwelling houses; 967 in connection with food premises; and 98 were of a miscellaneous nature. 68 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 37 49 - - Factories with mechanical power 887 90 6 — Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 52 27 - - Totals 976 166 6 - (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) — — - - - Overcrowding (S.2) — — - - - Unreasonable temperature (S.3) — — - - - Inadequate ventilation (S.4) — — - - - Ineffective drainage of floors (S.6) 2 2 - - - Sanitary Conveniences (S.7):— Insufficient 4 3 - 1 - Unsuitable or defective 5 15 - 1 - Not separate for sexes 3 3 - - - Other offences (excluding offences relating to outwork) 3 3 — — — Totals 17 26 — 2 — 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 31 - - - - - Lampshades - - - - - - Cardboard box- making 93 — — — — — Total 124 — — — — — 69 Number of addresses received from other Councils 45 Number of addresses forwarded to other Councils 105 Number of premises where outwork was carried on at the end of 1970 335 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 gas water heating unit. The premises are maintained and staifed by the Health Department. During the year 1970, 33 local residents and one person from another district received treatment for lice infestation. A fee of £1.50 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 122. 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 remained in force until 31st December, 1970, were issued under these Regulations: — Dealers' (Pasteuriser's) Licences 2 Dealers' (Ultra Heat Treated) Licence 1 Dealers' (Pre-packed Milk) Licences:— Untreated milk 65 Pasteurised milk 203 Sterilised milk 148 Ultra Heat Treated milk 84 70 During the year, 139 samples of designated milk were submitted for prescribed tests. The results were as follows:— Designation. Satisfactory. Void. Unsatisfactory. Pasteurised 106 14 — Sterilised 13 — — Untreated — — — Ultra Heat- Treated 6 — — Brucella Abortus. No samples of raw milk were submitted for examination. Ice-Cream. The number of premises registered for the storage and sale of ice-cream is 521. Supplies are generally from well-known sources, and before premises are registered, compliance with Food Hygiene Regulations requirements is ensured. The Inspectors made 286 visits to these premises during the year, and 58 samples of ice-cream were obtained for bacteriological examination. The results were: — Grade 1 44 Grade 2 6 Grade 3 5 Grade 4 3 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 outbreaks of suspected food poisoning, two samples of foodstuffs were sent to the Public Health Laboratory for special bacteriological examination. No pathogens were isolated. Poultry Inspection. There are no poultry processing premises within the district. 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. 3,870 visits were made to premises in which foodstuffs intended for human consumption were prepared, stored or sold. In addition, 512 visits were made relative to food vehicles. To a considerable extent, the most satisfactory progress in promoting food hygiene is achieved by discussion and persuasion. For this to be successful the co-operation of all those concerned is necessary. I believe that the advice and assistance given by the Inspectors is generally well received and appreciated. I would like particularly to refer to the inspection of food preparation and service conditions in connection with Shows, Fairs, etc., held in the Borough during the year. I receive requests during the season for approval of catering arrangements at these meetings, and 71 they are given careful attention. During the Annual Tennis Championship Meetings, at Wimbledon, complete inspections of all catering points are made, and facilities are afforded by the caterers for the taking of food samples, and for swabbing of utensils, etc., for bacteriological examination. I would like to record my appreciation of the assistance given on these occasions by the Club Officials and the staff of the catering contractors. The annual Mitcham Fair also receives the attention of the Department, and it is now the practice of the Director of Parks and Cemetries to submit to me applications from food vendors for a site within the perimeter of the Fair, for an opinion as to the standard of food hygiene attained by the applicant. I greatly appreciate the cooperation of the Director in maintaining a high standard. The catering contract at Merton Show was revised for the 1970 show and the inspection arrangements which were put into operation will, I hope, become the pattern for future occasions. Fairs on Wimbledon and Mitcham Commons are visited and food vending points are given particular attention. I think it must be appreciated that most of this work is carried out by the Public Health Inspectors outside normal hours, but it is important work, which is well worth while. The provisional register of food premises includes the following:- Greengrocers 141 Confectioners 218 Ice-cream premises 408 Bakers 67 Grocers and Provision Dealers 186 Butchers 102 Fishmongers and Fish Fryers 55 Milk Distributors 122 Chemists 43 Licensed premises 243 Clubs 49 Restaurants and Cafes 149 Works Canteens 75 School Canteens and Kitchens 100 Food Stalls/Vehicles 187 Places of Public Entertainment 37 2,182 This list does not include manufacturing factory premises. 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 521 Registered for the manufacture and sale of ice-cream 6 Registered for the preparation or manufacture of sausages 75 Registered for the preparation or manufacture of potted, pressed, pickled or preserved food 183 The number of inspections of registered food premises during 1970 was 1,036. 72 Bacteriological Examination of Equipment. During the year 99 swabbings of articles of equipment used in food premises and catering establishments were submitted to the Public Health Laboratory for bacteriological examination. During the year 99 swabbings of articles of equipment used in food premises and catering establishments were submitted to the Public Health Laboratory for bacteriological examination. The results were as follows:— No. of swabs Result. Article. taken. Satisfactory. Unsatisfactory Beer mugs and glasses 10 10 — Plates 15 15 — Cups and beakers 20 20 — Forks 15 15 — Spoons 15 15 — Kitchen equipment 24 24 — The taking of swabs was suspended during the year, on the advice of the Director of the Public Health Laboratory owing to pressure on Laboratory services for investigations with a high degree of priority. 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. The following is a list of unsound food surrendered during 1970:— Tons. Cwts. Lbs. Canned foods 7 19 57 Frozen foods and ice-cream 5 2 56 Meat, bacon and poultry 2 — 82 Confectionery — — 14 Sugar, jam, syrup — 6 94 Beverages — 1 23 Butter, fat and cheese — 5 44 Fruit and vegetables — — 53 Minerals and vegetable juices — 1 17 Puddings and pastry — 5 58 Fish — 4 44 Cereal, bread and flour — 4 21 Vinegar, pickles and sauce — 3 30 Miscellaneous — 1 82 16 17 3 The number of complaints received during the year regarding unsound food was 287. 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 (10)**. Metal in loaf (2)*. Insect in loaf (2). Plastic in loaf. Oil in loaf*. Dirt/foreign matter in loaf (2) Brown stains in loaf. 73 Dirty milk bottles (26)****** Glass in milk (2)*. Insects and sediment in milk*. Paper in milk*. Leaf in milk*. Foreign object in milk*. Specks in milk*. Sour milk. Contaminated milk. Mould in milk. Mouldy fruit pie (2)**. Mouldy potato salad*. Mouldy tea. Mouldy can of baby food. Mouldy briskies*. Mouldy sausage rolls*. Mouldy cheese (5)*. Mouldy butter*. Mouldy Cornish pasties. Mouldy rissoles. Mouldy cakes (2). Mouldy canned meat pie. Mouldy corned beef. Mouldy dried fruit. Mouldy bacon. Glass in jam (2)*. Grease in bottle of Bitter Lemon. Insect in tea. Insect in canned tomatoes (2). Insect in baby food. Insect in canned fruit. Insect in confectionery (3). Insect in fruit cake. Insect in sugar. Insects in dates. Insects in rice. Metal in meat pie. Metal in sugar confectionery. Metal in pork and egg pie. Pins in apple. Bristle in bread roll. Maggot in maplemeat. Maggots on bacon (2)*. Maggots in biscuits. Maggots in chocolate*. Maggots in ground rice and almonds. Stone in peas of frozen dinner. Wood in apricot fruit pie*. Hair in dates. Plastic in chopped ham. Cigarette end in jam. Nail in corned beef. Nail in cheese-cake. Mouse in breakfast cereal. Fly in doughnut. 74 Skin and bristle in pork brawn. Earwig in packet of kippers. Unsound cheese (2). Unsound sausages*. Unsound fried scampi. Low meat content of sausage rolls. Low meat content of cornish pasties. Lump in lambs' liver. Sore on shoulder of lamb. Dirty salad cream bottle. Dirty orange juice bottles (2). Misdescription of sausage meat. Misdescription of maple syrup. Misdescription of chicken casserole. Misdescription of mustard oil. Misdescription of salmon spread. Smell from can of baby food. Smell from sausage meat. Sour cream. Stale and sour doughnuts. Rancid fat in puff pastry mix*. Discoloured corned beef. Decomposed can of meat (2). Contaminated canned tomatoes (2). Contaminated saveloy. Contaminated brussels sprouts. Contaminated canned pineapple Contaminated orange drink. 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 1970, 262 samples were submitted, of which 139 were formal samples, and 123 informal. The Public Analyst reported that of these samples 247 were found to be genuine, and to comply with the relevant Acts, Orders and Regulations, and 15 did not so comply. A full list of genuine samples is not given in this report, but they are included in the Quarterly Returns made to the Minister of Agriculture, Fisheries and Foods, and details are available. I am, however, setting out particulars of non-genuine samples and the action taken in connection with them. Particulars of non-genuine samples and action taken. Onion Sauce Mix. This sample was an incomplete sauce mix requiring the addition of milk to make the sauce. The necessity to add milk was not stated on the label. Stocks were withdrawn and the production of the article was discontinued. 75 Long life Full Cream Milk. As judged by the Sale of Milk Regulations, 1939, this sample was deficient in milk solids other than milk fat, to the extent of 0.5%. The offence was reported to the Health Committee and warning letters were sent to the producer and to the vendor. Cherry and Almond Conserve with Brandy. As judged by the Food Standards (Preserves) Order, 1953, this sample was deficient in soluble solids by 6%. The facts were reported to the Health Committee, and a warning letter was sent to the manufacturers. Top of the Milk. This sample contained 17.7% milk fat and the Public Analyst commented that articles sold as 'Top of the Milk' normally had a milk fat content greater than 18%. The consistency of this figure is such that this is the amount which is now recognised as the normal content. The sample was therefore deficient in milk fat to the extent of 1.6%. The facts were reported to the Health Committee and a warning letter was sent to the manufacturers. Bean Curd. One of the constituents of this sample was glucono-delta-lactose (2%) which is not recommended for use in food by the Food Additives and Contaminants Committee in their report on Further Classes of Food Additives. The Public Analyst considered that the article may be injurious to health. This matter was taken up with the Minister of Agriculture, Fisheries and Food and with the representatives of the Japanese Trade Centre. Pending a final decision, the vendor withdrew the article from sale. Flan Fill (Orange Flavour). This was an article of food made of more than two ingredients, one of which was glucose solids. In the opinion of the Public Analyst, the appropriate designation for this ingredient was glucose syrup solids'. The facts were reported to the Health Committee, and the manufacturers were advised to re-label the article. A further sample will be taken in due course. Lemon Barley Drink. This sample contained cyclamic acid, contrary to the Artificial Sweeteners in Food Regulations, 1969. The facts were reported to the Health Committee, who authorised legal proceedings against both the manufacturers and the retailers. Both defendants pleaded guilty, and they were each fined £5 with £3 costs. Beef Steak and Mushroom Pie. This was an article of food made up of two or more ingredients. The ingredients were declared in two different places on the container, but the two lists of ingredients did not agree. In the 76 opinion of the Public Analyst, the declaration of ingredients where they are given in more than one place, should agree and should be an accurate statement. The facts were reported to the Health Committee, who authorised legal proceedings. The defendants pleaded not guilty and after hearing evidence the magistrates dismissed the case and made no order for costs. Glucose Fruit Drops. This was a sample of sugar confectionery made with glucose syrup. In the opinion of the Public Analyst, the presence of glucose syrup, an article made by the hydrolysis of starch, did not justify the description 'glucose fruit drops'. After correspondence with the manufacturers, agreement was reached as to re-labelling of this confectionery. Glucose Barley Sugar. This was a similar case to the above-mentioned sample. In this case also, agreement was reached as to the re-labelling of this confectionery. Bel Paese Cheese. This sample contravened the Cheese Regulations, 1970, in that the declaration 'Full Fat Soft Cheese' did not appear on the label. Informal action was taken and no further samples were found which bore an improper label. Plain Flour. This sample contained 480 milligrams of chalk per 100 grams of flour, which was in contravention of the Bread and Flour Regulations, 1963, which require that flour must not contain more than 390 milligrams of chalk per 100 grams of flour. Informal action was taken, and as a result of correspondence with the millers, the fault was rectified. Mustard Oil. This sample gave off a perfume-like odour which appeared to arise from the decomposition of the residue of the volatile compounds which were left after incomplete refining. The oil was not of the quality expected. The facts were reported to the Health Committee, who authorised legal proceedings against the manufacturers. The defendants pleaded guilty and were fined £5 with £7 costs. Blackcurrants in Syrup. This sample contravened the Labelling of Food Order, 1953, in that the reference to syrup was omitted from the label. Informal action was taken and the wording on the labels was amended. Plain Flour. This sample contained 55 milligrams of chalk per 100 grams of flour which when judged by the Bread and Flour Regulations, 1963, was deficient of 76% chalk. Informal action was taken and as a result of correspondence with the Local Authority in whose area the flour was milled, the fault was rectified. 77 The following 16 samples were submitted for special examination, the results being as shown:— Apricot Fruit Pie Non-genuine Bitter Lemon Drink Non-genuine Brussels Sprouts Genuine Bread (2) Non-genuine (2) Cheese Non-genuine Chocolate Bar Non-genuine Milk (5) Non-genuine (3) Mustard Oil Genuine Orange Crush Genuine Salad Cream Genuine Sausage Meat Genuine Further particulars regarding the nine non-genuine samples are as follows:— Apricot Fruit Pie. Contained piece of wood—legal proceedings instituted, defendant pleaded not guilty—insufficient evidence to prove origin of wood—case dismissed. Bitter Lemon Drink. Black object in unopened bottle—in Public Analyst's opinion consisted of grease mixed with iron compounds—warning letter sent to firm concerned. Bread (2). Fruit loaf containing piece of metal—legal proceedings instituted—defendant pleaded guilty—fined £20 with £10 costs. Wrapped bread containing foreign matter consisting of metal compounds and oily substance—legal proceedings instituted— defendants pleaded guilty—fined £10 with £7 costs. Cheese. Discoloured area in cheese—found to be shaving of lead from indelible pencil—informal action taken. Chocolate Bar. Peanut chocolate bar found to be infested with insects— number of food depots and stores involved—result of enquiries inconclusive—informal action taken. Milk (3). Dirty one pint bottle of milk—in Public Analysts's opinion caused by wax crayon—no foreign matter dissolved in milk— informal action taken. Dirty one pint bottle of milk containing foreign matter—legal proceedings instituted—defendants pleaded guilty—fined £10 with £7 costs. Dirty one pint botde of milk—in Public Analyst's opinion, foreign matter was residue of adhesive contained in the bottle after it had been emptied following a previous filling—legal proceedings instituted—defendants pleaded guilty—fined £25 with £5 costs. 78 All complaints are investigated, and this includes interviews with 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 food complaints has one end in view—the prevention of a recurrence of the incident. Other Legal Proceedings. Food and Drugs Act, 1955—Section 2. Loaf of bread containing mould growth—defendants pleaded guilty—fined £10 with £7 costs. Wrapped sliced loaf of bread containing mould growth — defendants fined £5 with £7 costs. Bottle of milk containing glass and foil cap—defendants pleaded guilty—fined £10 with £7 costs. Bottle of milk containing fruit fly larvae—defendants pleaded guilty—fined £25 with £7 costs. Bottle of milk containing piece of printed paper—defendants pleaded guilty—fined £25 with £5 costs. Bottle of milk containing mould growth—defendants pleaded guilty—fined £10 with £7 costs. Apple pie containing mould growth—defendants pleaded guilty —fined £10 with £7 costs. Apple pie containing mould growth—defendants pleaded guilty —fined £10 with £7 costs. Potato salad containing mould growth — defendants pleaded guilty—fined £5 with £7 costs. Briskies (meat product) containing mould growth—defendants pleaded guilty—fined £25 with £7 costs. Sausage rolls (4) containing mould growth—defendants pleaded guilty—fined £25 with £7 costs. Cheese slices (in packets) containing mould growth—defendants pleaded guilty—fined £25 with £14 costs. Jar of jam containing a piece of glass—defendants pleaded guilty—fined £10 with £7 costs. Bacon rashers infested with maggots—defendants pleaded not guilty—case proved—fined £30 with £14 costs. Whole-nut chocolate containing insect larvae and eggs—defendants pleaded guilty—fined £10 with £7 costs. Puff pastry mix found to be in a rancid condition—defendant pleaded guilty—fined £15 with £7 costs. Food and Drugs Act, 1955—Section 8. Butter containing mould growth—defendants pleaded guilty —fined £10 with £7 costs. Beef sausages—odorous and covered with slime—prosecuted also for having in possession for the purposes of sale other sausages which were unfit for human consumption—defendant pleaded guilty—fined a total of £15 with £7 costs. 79 Food and Drugs Act, 1955, and Milk and Dairies (Regulations) 1959. One pint bottle of milk containing foreign matter—defendants pleaded guilty—fined £10 with £7 costs. One pint bottle of milk—bottle in dirty condition—defendants pleaded guilty—fined £10 with £7 costs. One pint bottle of milk—bottle in dirty condition—defendants pleaded guilty—fined £10 with £7 costs. One pint bottle of milk—bottle in dirty condition—defendants pleaded guilty—fined £10 with £7 costs. One pint bottle of milk containing mould growth—defendants pleaded guilty—fined £25 with £5 costs. One pint bottle of milk—bottle in dirty condition—defendants pleaded guilty—fined £10 with £7 costs. Food Hygiene (General) Regulations, 1960. Thirty summonses were brought against the proprietor of a bakehouse for offences under these Regulations—defendant pleaded guilty to 25 summonses, and the remaining five were withdrawn prior to the hearing — defendant had been found guilty in respect of similar contraventions by Wimbledon Magistrates Court in 1969—now fined £10 in respect of each offence (£250) with £7 costs. Inspection of Imported Food. In the past imported foodstuffs were inspected at the port of entry. However, with the development of the Container system, a changed procedure has been instituted to allow the inspection to take place at the point where the container is unpacked. When this is done, not at a port, but an inland destination, special provisions are necessary. The Imported Food Regulations, 1968, which came into operation on 1st August, 1968, makes provision for the contents of a food container to receive health clearance at its destination when the container is opened prior to distribution. Inland local authorities have the same powers of inspection and detention as Port Health authorities, since the responsibilities under the Regulations are transferred to them. Unopened food containers have been arriving at two premises in this London Borough at irregular intervals during the past year, although latterly only one firm's premises were concerned. As a general rule, the Port Health authority notifies me by telephone that a container is on the way (on other occasions notification is by post), and a visit is made by an Inspector immediately the notification is received. Despite this arrangement containers do invariably arrive, are unloaded and depart before the arrival of the Inspector. I have made informal arrangements with the local receiving firm to keep container contents apart until the Inspector has visited. The firm is most co-operative in this respect, but there would appear to be no obligation for them to do so. I think there is room for improvement in this procedure, and if the inland receiver was required to notify the local authority immediately a container arrives at his premises, and was also obliged to refrain from opening the container until the expiration of a given period of time, this would overcome the present difficulty and enable the local authority Inspector to be present at the time of opening. 80 SERVICES UNDER HOUSING ACTS A large part of the work of the Environmental Health Section relates to housing conditions; demolition orders, closing orders, repair notices, overcrowding, house improvements and the like. Whatever might be the involvement of other officers, these are all matters which in one way or another concern the Public Health Inspector, and the housing authority of the future, no less than the present, will require a strong staff of Inspectors. The Housing Acts hitherto have not been as effective as they should have been, and more reliance was placed on action under the Public Health Acts. The Housing Act, 1969, introduced new powers to enable local authorities to require the repair of houses, and these are now used when repairs are needed to bring the house up to a reasonable standard, having regard to its age, character and location. The use of these powers is the means to prevent houses from falling into the unfit category. The number of houses inspected during 1970 as the result of applications for Improvement Grants was 421 (Standard 242; Discretionary 179), and these houses were made fit as a condition of the approval of a Grant. Applications for Qualifying Certificates (Part III Housing Act, 1969) increased, and the workload in connection with these was (and still is) considerable. The position on 31st December, 1970, was: — Section 45, Qualifying Certificates— Applications received 766 Certificates granted 289 Certificates refused 188 Section 46, Certificates of Provisional Approval— Applications received 101 Certificates granted 83 Certificates refused — As will be seen from the above figures, at the end of the year there was a considerable backlog of work in connection with these Certificates awaiting attention. Two appeals against the Council's decision as to the granting or refusal to grant a Qualification Certificate were heard at Croydon County Court; 20 houses were involved. The appeal was upheld in each case. The implementation of the Council's Slum Clearance programme continued, and as a result of detailed inspection work, the following Clearance Areas were declared:— London Borough of Merton (Church Road) Areas Nos. 1 to 4 (1970)— 97 unfit houses. London Borough of Merton (Byegrove Road) Area (1970)— 10 unfit houses. London Borough of Merton (Railway Place) Area (1970)— 8 unfit houses. No public local inquiries were held during the year, but an inquiry regarding London Borough of Merton, South Wimbledon 81 (Clearance Areas Nos. 1 to 8) Compulsory Purchase Order, 1970, involving 110 houses was pending at the end of the year. Work in connection with this was in hand. A closing order was made in respect of one individually unfit house (Bungalow, Pig Yard, Aberdeen Road, Mitcham) during 1970. The total number of visits to premises of all kinds was 5,270. Proposed General Improvement Area. The South Wimbledon Area Joint Sub-Committee previously set up by the Council continued their deliberations during the year. Discussion on proposals within the Area excluded those houses and lands already being dealt with under slum clearance procedure (referred to in the Housing Services Section of this Report). A Working Party of officers was set up and I was represented at the six meetings held. Considerable progress was made during 1970 towards the declaration of a General Improvement Area. SERVICES UNDER OTHER ENACTMENTS Rent Act, 1957/68—Certificates of Disrepair. The following is a summary of applications dealt with during 1970:— Applications received (Form I) 3 Decisions not to issue Certificates Nil Certificates issued (Form L) 1 Undertakings given (Form K) 2 Number of visits made II Shops Acts, 1950-65. The Shops Acts regulate the closing hours of shops and the working hours of shop assistants. Shops in the Borough have been kept under observation and contraventions have been remedied. Formal action has also been taken in respect of general closing hours, half-day closing, and Sunday trading. During the year, advice has been given when required to the three Chambers of Commerce, and to individual shopkeepers. Inspection records were added to and the Shops Register kept up-to-date In the Annual Report 1969,1 referred to the likelihood of a further approach being made by certain traders in connection with six-day trading week procedure. I had discussions with certain interested parties during 1970 and in November one particular Supermarket firm undertook to conduct a postal ballot to ascertain the views of all the shopkeepers in the Borough. I supplied a copy of the List of Shopkeepers, and the firm hopes to produce sufficient evidence to warrant the making of an application to the Council to consider the making of a Six-day Trading Order. The result of the ballot was not available at 31st December, 1970. Offices, Shops and Railway Premises Act, 1963. For many years there has been legislation to protect the health and safety of employees in factories, but until 1964 only limited 82 provision was made in public health and shops legislation for those in non-industrial employment. The Offices, Shops and Railway Premises Act, 1963, and subsequent regulations make standards for health, welfare and safety in offices, shops and certain railway premises. Matters covered by the Act include cleanliness, overcrowding, heating and lighting, sanitary facilities, safety and fire precautions. Responsibilities for enforcing the Act are divided between local authorities, the factory inspectorate and fire authorities. The number of visits made for all purposes of the Act during 1970 in Merton was 1,400 and the co-operation of employers has been most encouraging. 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 60 832 134 Retail Shops 35 1,283 268 Wholesale Shops, Warehouses 9 67 23 Catering Establishments open to the Public, Canteens 6 157 41 Fuel Storage Depots — 6 3 Totals 110 2,345 469 Contraventions rectified. Cleanliness 129 Temperature 65 Ventilation 19 Lighting 21 Sanitary conveniences 68 Washing facilities 73 Supply of drinking water 2 Clothing accommodation 18 Seats 5 Floors, passages, stairs 18 Dangerous machinery guarded 5 First Aid provisions 80 Other contraventions 35 Exemptions. No exemptions (Section 46) were granted in 1970. Accidents Reported and Investigated. In offices 3 In retail shops 15 In wholesale shops and warehouses 10 In catering establishments open to the public, in canteens, etc 1 83 Reports upon 29 accidents were received during the year. In most cases, accidents were of a minor character, only involved the injured party, and were due in the main to carelessness. The percentage of accidents in food premises was lower than in previous years. All reported accidents, however small they appeared to be, were investigated. No legal proceedings were instituted during the year, although in some instances it was necessary to send warning letters to offenders. In this, the first full year of the operation of the Hoists and Lifts Regulations, 1968, all premises where lifts are installed have been visited, and attention has been drawn to the requirements of the regulations. Reports on examination of lifts by engineers or insurance companies have been received, and action taken to ensure that any works recommended in those reports are carried out. I greatly appreciate the co-operation of examining engineers in this work. Prevention of Damage by Pests Act, 1949. The following summarises a report on rodent control work made to the Ministry of Agriculture, Fisheries and Food for the year ended 31st December, 1970:— Number of properties in district 73,510 Number of properties inspected 5,457 Number of properties infested by rats 955 Number of properties infested by mice 645 Total number of visits including re-inspections 13,789 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 1970, 978 manholes were baited and 144 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 1970, 775 complaints were received concerning insect pests and the following is a list of the infestations dealt with:— Ants 52 Bees 29 Beetles 48 Bedbugs 37 Cockroaches 17 Fleas 50 Flies 8 Lice 5 Maggots 9 Mosquitoes 7 Silverfish 5 Slugs 2 Wasps 451 Woodlice 1 Woodworm 1 84 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 much higher than in previous years. No charge is made for the destruction of nests, but this work, which must invariably be carried out during the evening, 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. Fifty-six 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, 61 pigeons and 49 eggs were destroyed. This includes night visits to four railway bridges to take birds which were roosting, and one treatment with narcotic bait which was carried out on local authority property, with the co-operation of the Ministry of Agriculture, Fisheries and Food. Pet Animals Act, 1951. Fifteen licences to keep Pet Shops were issued during 1970. Twenty-three visits were made to these premises to ensure compliance with the conditions attached to these licences. The Riding Establishments Act, 1964. The Riding Establishment Act of 1970, amended the 1964 Act by giving power to local authorities to grant a provisional licence for a period of three months. This enables the authority to observe carefully the operation of any particular riding establishment during a trial period before consideration is given to the granting of an annual licence. Three applications to renew existing licences were received, and after inspection of the premises by the Inspectors, and by the Council's Veterinary Officers (Gates and Serth, Members R.C.V.S., 102, Brighton Road, Purley), the applications were approved and licences granted. Diseases of Animals Act, 1950. No outbreaks of disease occurred within the Borough during 1970. A puppy dog, obtained by a local householder from a Surrey district, affected by a Rabies Order, was the subject of a Notice issued by the Ministry of Agriculture, Fisheries and Food. Visits were made whilst the Notice was effective. Clean Air Act, 1956/1968. During 1970, 174 complaints were received of smoke or grit emissions and the necessary observations were made and remedial action taken. Twenty-four notices of proposals to instal a furnace, to which Section 3 (1) of the Act applied, were received and the installations were inspected and recorded. 85 86 87 Section 6 of the Clean Air Act, 1968, authorises the local authority to approve or disapprove an application in respect of the height of a chimney without reference to the Building Regulations. I was authorised by the Council to act in accordance with the new provisions, and of eight applications received during the year, six were approved. Legal Proceedings. Clean Air Acts, 1956/1968. Public Health Act, 1936. Smoke nuisance from bonfire on demolition site—continued after warnings—defendant pleaded guilty—fined £20 with £7 costs. Smoke nuisance from open incinerator—continued after warnings — defendant found guilty — Nuisance Order made — no costs. Measurement oj Atmospheric Pollution. Eight 8-port instruments are maintained by the Health Department, and these are sited in approved positions within the Borough. These instruments, which record smoke density and sulphur-dioxide contained in the atmosphere are visited weekly. Recordings are standardised, and results are sent monthly to the Department of Trade and Industry, Warren Spring Laboratory. The graphs which appear on adjoining pages of this report are compiled from a summary of these results, and they indicate the great improvement in the condition of the atmosphere resulting from the application of the Clean Air Acts. It is interesting to note that there is very little rise in the line on either graph for the winter of 1970 despite the suspension of Smoke Control Orders referred to later in this Report. The fact that the early months of winter were indeed very mild undoubtedly contributed to the improved quality of the atmosphere, but in addition, the work which is going on in this Borough, and in adjoining areas in connection with smoke control, appear to be having a most beneficial effect. Smoke Control Areas. The Clean Air Acts 1965/1968, embody 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, but the programme was hindered towards the end of 1970 by the possibility of a shortage in the supply of solid smokeless fuel. In September, the Health Committee recommended that the making of Smoke Control Order No. 19 be deferred until adequate supplies of such fuel were available, and in October the Health Committee considered Circular No. 63/70 in conjunction with recommendations of the London Boroughs Committee relating to the suspension of the operation of certain Orders. The Council did in fact suspend the operation of 11 Orders in the western part of the Borough for a period 1st November, 1970, to 31st March, 1971. The effect of the suspension is that any kind of fuel may be burned on appliances in the 12,700 dwelling houses within the area of 2,800 acres covered by the 11 Orders, without contravening those Orders. These are indeed retrograde steps brought about by a shortage of solid smokeless fuel, and will doubtless in the long run have the effect of 88 delaying the completion of the overall programme. It is to be hoped that the winter of 1970/71 will continue to remain mild, and that steps will be taken nationally to ensure that this emergency will not arise again. There is increasing evidence that more and more people are determined to have a cleaner atmosphere, and this will not be achieved unless ample supplies of authorised fuels are made available. The position regarding Smoke Control Orders to date is 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. No. 13 1969 Operative date 1.7.70. No. 14 1969 Operative date 1.7.70. No. 15 1969 Operative date 1.9.70. No. 16 1970 Operative date 1.5.71. No. 17 1970 Operative date 1.7.71. No. 18 1970 Operative date 1.7.72. Area No. 19 Under survey. Area No. 20 Under survey. The area of the Borough covered by Orders either in operation, or confirmed but not operative, is 6,807 acres. The total number of premises involved in these areas in 42,573. Comparable figures at the commencement of the year were 6,315 acres and 39,035 premises. 89 The two Smoke Control Areas under survey at the end of the year will cover an additional 421 acres with 3,770 premises. On 1st January, 1970, 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 73 and the comparative figure for the London Borough of Merton was 72.5. The total number of visits made during 1970 in connection with the Clean Air Acts, for all purposes, was 24,674. After the operative date of any Order, observations are made from time to time by Public Health Inspectors and Technical Assist tants to ensure compliance. Noise Abatement Act, 1960. Excessive and unwanted noise is one of the great problems of life. In areas where residential housing ends and industrial development begins, it is sometimes difficult to strike a balance between what is acceptable, considering the nature of the area, and what standards should be used to determine the degree of nuisance or annoyance. Assistance is given in this respect by the use of noise level meters, and by the application of British Standards and of recommendations contained in the Wilson Report. During the year 1970, 98 complaints regarding noise were received, and the investigation of these entailed 405 visits, many of which were made outside normal office hours. The most common causes of noise complaint were factories (26), domestic premises (25) and motor vehicles (10). The Council has associated itself with the Local Authorities Aircraft Noise Council, and I attended several meetings of this organisation during the year. Legal proceedings were instituted in two instances during the year, under Section II (3) of the Noise Abatement Act, 1960, against persons sounding loud-speaker chimes attached to ice-cream vehicles outside permitted hours. In each case the defendants pleaded guilty, and fines totalling £25 together with costs of £14 were imposed. The Pharmacy and Poisons Acts, 1933-1941 One hundred and sixteen 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. Twelve samples of fertiliser were submitted to the Agricultural Analyst. Four were found to be unsatisfactory, and after investigations had been made with the manufacturers or suppliers, the Ministry of Agriculture, Fisheries and Food were notified on Returns. Burial Act, 1857. Three licences under this Act, for the removal of human remains, were received from the Home Office during the year. In two cases exhumation and re-interment was carried out, but in the third case, where it was proposed to transport the remains to Italy, the licence was allowed to lapse. Exhumation work is normally carried out in the 90 early hours of the morning, and in the interests of public health, a Public Health Inspector attended at the cemetery on each occasion. Caravan Sites and Control of Development Act, 1960. The number of sites which were subject to licence or consent at 31st December, 1970, was seven, and the permitted number of caravans, including those kept at four sites occupied by members of the Showman's Guild is 41. A monthly survey of sites occupied without consent was made, and at the end of the year, sixteen caravans sited upon vacant sites on a slum clearance area were recorded. There is no doubt that this number is likely to increase. The total number of visits made to the sites was 328. The Caravan Sites Act, 1968 (Part II) Commencement Order, 1970, came into force on 1st April, 1970. The Council formed a SubCommittee for the purpose of considering their responsibilities under the provisions of the Act, and to submit recommendations upon the provision of a caravan site within the Borough. Further discussion upon this matter was still taking place at Committee level at the end of the year. Registration of Hairdressers and Barbers. The Council have adopted the provisions of the Greater London Council (General Powers) Act, 1967, insofar as they relate to the registration of Hairdressers and Barbers. At the end of the year, 163 premises were registered, and 88 visits were made during the year. CONCLUSION Whilst it is hoped that this Report reflects the good standard which has been maintained by the staff of the Environmental Health Section, it may also serve to indicate problems which are still to be overcome, and will therefore, be a stimulus to further action. In November, 1969, my Deputy, Mr. G. E. Hayne, left to take up his new appointment as Chief Public Health Inspector to the London Borough of Hounslow. His successor, Mr. J. P. Smith, from the County Borough of Dudley, was appointed in November, 1969, but did not take up his new duties until March, 1970. Three pupil Public Health Inspectors qualified during the year, and were appointed as District Inspectors. Other vacancies occasioned by District Inspectors leaving to take up appointments elsewhere were filled, and in November, 1970,1 had a full establishment of District Inspectors for the first time since 1965. I hope that this position will be maintained in order that arrears of routine work may be dealt with. One further pupil Inspector was appointed during the year, leaving two vacancies unfilled. My thanks are due to the technical staff for the extra effort required of them in maintaining coverage of those areas of 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. 91 ANNUAL REPORT to the EDUCATION COMMITTEE on the work of the SCHOOL HEALTH SERVICE for the year 1970 CONTENTS Page Introductory Letter by Principal School Medical Officer 95 Primary Education and Special Services Sub-Committee as at 31st December, 1970 96 School Clinics provided by the Local Education Authority 97-98 The Service 99 Medical Inspections 99 Audiometry and Audiology 99 Speech Therapy 100 The Work of the School Nurses 100 Child Guidance Service 101 Survey of Physically Handicapped Children 102 Handicapped Pupils 103 Provision of Special Education 104 Children Unsuitable for Education at School 104 The School Dental Service: Report by Chief Dental Officer 104-105 Statistics on School Dental Service 105-106 Infectious Diseases and Prophylactic Measures: Table 1—Infectious Diseases 107 Table 2—Contagious Diseases 107 Enteritis Outbreaks 107 Diphtheria 107 Food Poisoning 108 Prophylactic Measures 108 Ancillary Services: Nursery Schools and Classes 109 Provision of Milk and Meals 109 Appendix ' A' : Routine Medical Inspections 110 Other Medical Inspections 110 Return of Defects Found at Medical Inspections 111 Children Found to Require Treatment 112 Classification of General Condition of Pupils 112 Uncleanliness and Verminous Conditions 112 Diseases of the Skin 113 Eye Diseases, Defective Vision and Squint 113 Diseases of the Ear, Nose and Throat 113 Orthopaedic and Postural Defects 113 Other Treatment Given 114 Appendix ' B': Attendances at Clinics 114 Other Medical Examinations by School Medical Officers 114 Recuperative Holidays 114 94 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 1970. The health of school children in Merton during the year was very good, the percentage whose general condition was found to be satisfactory being 99.97 compared with 99.93 in 1969. Medical inspections of school children totalled 12,508 (9,040 routine inspections and 3,468 special inspections and reinspections) compared with 9,299 (6,741 routine inspections and 2,558 special inspections and reinspections) in 1969. At routine and other medical inspections 5,151 defects, mostly minor in character, were found of which 1,827 were referred for treatment and 3,324 for observation, compared with 4,983 (2,211 for treatment and 2,772 for observation) in 1969. The system of selective medical examinations approved by the Education Committee in July, 1969, became fully operative in 1970. 2,145 questionnaires had previously been distributed to school children on entry to High Schools and on the recommendation of the School Medical Officer or at the request of the parent or both, 752 children were medically examined. 74 children, who were absent, were seen at a later date and special arrangements for examination were made in respect of 44 children whose parents were initially unco-operative. As a result of these examinations 73 children were referred for treatment or observation these being followed up by the private doctor or at a school clinic. The arrangement resulted in a fewer number of children in the age group being seen and thus enabled School Medical Officers to concentrate on those who most required attention. A report on the first year of operation was considered by the Education Committee and approval was given for the system to continue. 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 Administrative Assistant 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. 95 PRIMARY EDUCATION AND SPECIAL SERVICES SUB-COMMITTEE (As at 31st December, 1970) Chairman: Councillor P. S. Gill Councillor F. H. Meakings (Vice-Chairman) Alderman E. J. Mills Councillors: (Mrs.) W. R. Castle B. N. Clifford R. G. Cooper M. C. Gardner J. N. Healey R. L. Mackenzie, F.C.A. W. G. Terrett Co-opted Members: Reverend Walter Dunstan 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 96 SCHOOL CLINICS PROVIDED BY THE LOCAL EDUCATION AUTHORITY General Medical Clinics Amity Grove, Raynes Park 1st and 3rd Thursday mornings. Examination of cases referred by Teachers, Education Department, Health Visitors, etc. Treatment of minor ailments. Grand Drive Raynes Park Tuesday mornings. Middleton Road, Morden 1st, 3rd and 5th Morden Road, Merton Monday afternoons. 1st, 3rd and 5th Monday mornings. Pelham Road, Wimbledon Monday mornings. Western Road, Mitcham Wide Way, Mitcham Monday mornings. 1st, 3rd and 5th Wednesday mornings. Child Guidance Clinics 97 Worple Road, Wimbledon: Monday to Friday all day. Sherwood House, Commonside East, Mitcham: (Cases seen by appointment by Psychiatrist or Educational Psychologist, with the assistance of Psychiatric Social Workers) Ophthalmic Clinics Amity Grove, Raynes Park Friday afternoons. Examination and treatment of errors of refraction and squint. 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. Orthopaedic Clinic Pelham Road, Wimbledon Every fourth Wednesday afternoon each month. Examination of referred cases by an Orthopaedic Surgeon. Audiology Clinic Pelham Road, Wimbledon Friday mornings. Detailed investigation of cases referred. Remedial Exercises Amity Grove, Raynes Park Monday mornings. Remedial and breathing exercises as recommended by School Medical Officers. Pelham Road, Wimbledon: Wednesday mornings and Thursday afternoons. Wide Way, Mitcham Tuesday afternoons. 97 Speech Therapy Clinics Amity Grove, Raynes Park: Tuesday afternoons and Wednesday all day. Treatment of speech defects. Grand Drive, Raynes Park: Thursday all day and Monday afternoons and Friday mornings. 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. Dental Clinics Amity Grove, Raynes Park: 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, Wednesday, Thursday and Friday all day. Morden Road, Merton: Monday, Wednesday and Friday, all day. Pelham Road, Wimbledon: Monday to Friday all day. Western Road, Mitcham: Monday to Wednesday all day. 98 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. 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 The system of medical inspections, modified to include a selective medical examination of pupils entering High Schools and approved by the Education Authority in July, 1969, was subject to committee review in September, 1970, after a year in operation. A full report was submitted and approval was given for the system to continue. The following schedule of examinations is now carried out: — (a) PRIMARY SCHOOL (i) Full medical inspection during the first year. (ii) Hearing test at six years. (iii) Vision test at seven years. (b) MIDDLE SCHOOL (i) Full medical inspection during the first year, including colour vision test. (ii) Hearing tested during last year in middle school. (c) HIGH SCHOOL (i) Selective medical examination plus vision during first year. (ii) Full medical inspection during the school leaving year. The selective medical examination involves the sending of a confidential questionnaire to the parents of all pupils in the age group. Following scrutiny of the completed medical questionnaires by school medical officers, pupils are selected for medical examination. The child's progress at school is also taken into account. AUDIOMETRY AND AUDIOLOGY Details are given below of audiometric primary testing carried out during the year:— Number of primary schools visited 39 Number of children tested 2,755 Number of primary failures 233 Number of middle schools visited 15 Number of children tested 2,029 Number of middle failures 196 99 A total of 4,784 children (primary and middle) were tested, of these 429 failed the audiometric test. In future children in Middle Schools will be tested a year earlier, Le., when aged 10-11 years instead of 11-12 years. SPEECH THERAPY The Authority was fortunate in having a full complement of three Speech Therapists, and it was thus possible to allocate a Speech Therapist in each case to the Mitcham area, the Merton and Morden area, and the Wimbledon area. Details of cases dealt with are given below: — Number of sessions held: (a) for treatment 696 (b) for consultation 77 Number of cases on register at beginning of year 342 Number of cases added during year 136 Number of cases discharged during year 108 Number of cases on register at end of year 370 Analysis or cases discharged during year. Children who:— Achieved normal speech 46 Were gready improved 29 Showed great improvement 27 Showed little or no improvement 6 Analysis of cases treated during year:— Stammering 40 Guttering 1 Dyslalia 155 Dysarthria 10 Cleft Palate 8 Defects of voice 6 Aphasia 4 Dyseria 19 Retarded speech and/or language 108 THE WORK OF THE SCHOOL NURSES The Health Visitors and School Nurses have continued during the past year to play an important role in promoting and maintaining the health of children in schools throughout the Borough. They visit the schools regularly to attend the Medical Officer at either routine or selective medical examinations. They are also in attendance at prophylactic sessions for B.C.G. diphtheria, tetanus, poliomyelitis and rubella. They ensure by regular visiting that any recommendations, e.g., the wearing of glasses or of hearing aids are being carried out. Health surveys are undertaken, when necessary, in order to prevent the spread of infection such as vermin, athlete's foot and verrucae. 100 The vision testing of all children at six and a half, nine, thirteen and fifteen years was commenced in September following the recommendation made to local authorities by the Department of Education and Science. This programme of screening is in addition to testing performed prior to any medical examination. Children are thus, where a defect is suspected, referred as soon as possible to their General Practitioners or the School Medical Officer. The increased amount of health teaching undertaken by Health Visitors in high and middle schools has been maintained. This is a very valuable and much appreciated part of the borough's health education programme. It is, however, very time consuming, and we are still receiving more requests for talks than we can accept. The Health Education Officer gives much help and advice in the planning and preparation of these programmes. Her assistance is valued by all members of the staff. The health visitors and school nurses maintain through their many and various duties in the School Health Service, a valuable link between the school, the parent, the general practitioner and the local authority Medical Officer. The following tables give details of visits paid by them during the year:— 1. Visits. To pupils found at school medical examinations to require observation or treatment 35 To educationally subnormal children 145 To verminous cases 70 To infectious or contagious cases 59 To miscellaneous cases (arising from School Medical inspections at request of Head Teacher, etc.) 54 To children with handicaps 22 2. Sessions attended. Pre — medical inspections 65 School medical inspections 541 Health surveys 98 General medical clinics 262 Health teaching 101 Vision testing 37 Immunisation 49 Freedom from infection inspections 10 CHILD GUIDANCE SERVICE 1. General The pressure of work on the Service has continued unabated with prospects of additional responsibilities having to be undertaken and no sign of any falling off in the number of children finding difficulty in establishing acceptable relationships within the family circle and the school community. 101 2. Staffing Wimbledon Child Guidance Clinic has remained fully staffed with the arrival of Mr. Oakley, Psychiatric Social Worker, whilst for the first time for many months Mitcham Child Guidance Clinic had its full complement with the return of Mrs. Windebank, Pyschiatric Social Worker vice Miss Bosanquet and the appointment by the Hospital Board of Dr. Wells, Consultant Psychiatrist. 3. Remedial Classes The class based on Malmesbury site was transferred to Garth Primary School and the services of Miss Matthews, the sole peripatetic remedial teacher, continued to be in great demand by middle and high schools. 4. Places for Maladjusted Children Plans were inaugurated for the opening in September, 1971, of a day school for senior maladjusted pupils in the former Merton C. of E. Secondary School. 5. Places for Backward Children It is hoped that Ravensbury School will be completed early in 1971. Survey of Physically Handicapped Children Receiving Education in Ordinary Schools Early in 1970 the Department of Education and Science approached all Principal School Medical Officers for assistance in obtaining information about the number of physically handicapped children in ordinary schools. The purpose was to learn more of the nature and degree of their handicaps, the amount of time spent by school staff on these children and whether they obtained as much benefit educationally and as much attention, as they might in a special school. The survey took the form of a questionnaire to provide information about each school, regarding the frequency and nature of visits by school health staff and also a medical report following an examination on each child who, it was felt, should be included in the survey. Each school, other than the special schools, was asked to give details of all children unable to take part in normal school activity or who were frequently absent as a result of physical handicap. It was realised that much of the information would have been recorded already but it was possible that some children may have developed handicaps after their last medical inspection. The schools co-operated fully and gave details of all children in attendance whose inclusion in the survey appeared necessary. When all cases were considered there were 50 children remaining who were handicapped to such an extent that they required to be included in the survey. 102 Detailed medical examinations were conducted and a report on each child submitted to the Department of Education and Science. Some delay was experienced as parents often required a second appointment before attending. The opportunity was taken at the same time to obtain information about epileptic and diabetic children in ordinary schools although neither condition was necessarily regarded as a handicap. It was ascertained from the details given by the schools that there were 48 epileptic and 24 diabetic children attending at the time. The following table gives details of the numbers of children who were found to have physical handicaps:— Handicapped Children Attending Ordinary Schools Classification of Defects Perthe's Disease 2 Cerebral Palsy (various defects) 11 Cardiac conditions 8 Phenylketonuria 1 Thalassaemia 1 Post Polio defects 2 Cystic Fibrosis 2 Congenital Malformations 11 Spina Bifida 2 Post accident defects (amputation) 1 Others (Rh. fever; dislocations; post-encephalitic conditions; etc.) 9 Epileptics 48 Diabetics 24 Total 122 103 HANDICAPPED PUPILS Numbers of Handicapped Pupils The following table gives the numbers of pupils on the Handicapped Pupils' Register on 31st December, 1970, together with the numbers ascertained during the year:— Classification Number ascertained during 1970 only Total ascertained as at 31.12.70 Speech Defects 1 1 Blind 1 10 Partially-sighted — 6 Deaf — 16 Partially-hearing 6 11 Educationally subnormal 27 187 Epileptic — 1 Maladjusted 9 82 Physically-handicapped 5 39 Delicate 5 44 Totals 54 397 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 4 5 - - 9 Partially-sighted 5 1 — — 6 Deaf 11 6 — — 17 Partially-hearing 12 3 — — 15 Educationally-subnormal 174 18 — — 192 Epileptic — 1 — — 1 Maladjusted 37 37 — 3 77 Physically-handicapped 28 8 — — 36 Delicate 29 10 — 2 41 Totals 300 89 — 5 394 Children unsuitable for Education at Schools During the year ten 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:— 104 'At 31st December, 1970, the dental staff consisted of the Chief Dental Officer, four full-time Dental Officers, five part-time Dental Officers and one part-time Orthodontist giving a full-time equivalent of 6.6 Dental Officers compared with 6.3 in 1969. The Authority also employs one Dental Auxiliary. Four sessions per week were devoted to orthodontics by the Orthodontist and two by one of the Dental Officers. 'The staff changes throughout the year, particularly among the part-time or sessional Dental Officers resulted in 312 fewer sessions devoted to treatment as compared with the previous year, but in spite of this nearly 2,000 more conservations were carried out, an increase of 16% in output by the Dental Officers. 'Dental inspections in schools and clinics were also the best we have achieved; of the school population of 25,767, 22,293 received first inspections and 4,677 were re-inspected. 'The number of teeth extracted was about the same as in 1969. Most of the permanent teeth extracted were for orthodontic purposes to relieve overcrowding. 'More orthodontic cases were completed during the year and there was also an increase in the number of appliances supplied, both removable and fixed. It is satisfactory to note that only eight cases were discontinued during the year as compared to 30 cases in 1969 indicating a higher level of patient co-operation. 'Dental Health Education has been given to Ante-Natal and Parentcraft Groups mostly by Health Visitors, 112 sessions being devoted to this and on 101 sessions talks and demonstrations were given in schools, some by the Dental Auxiliaries and the Dental Officers. The Health Education Officer and the Health Visitors have been most helpful in this field.' The statistics relating to the School Dental Service are given below:— Statistics for Year 1970 Number of pupils on the register of maintained Primary, Middle and High Schools including nursery and special schools in January, 1971, as in Forms 7, 7m and 11 schools: 25,767. Attendances and Treatment. Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First Visits 2,270 2,123 421 4,814 Subsequent Visits 4,352 5,116 996 10,464 Total Visits 6,622 7,239 1,417 15,278 Additional courses of treatment commenced 569 385 75 1,029 Fillings in permanent teeth 2,952 5,274 1,446 9,672 Fillings in deciduous teeth 4,419 290 — 4,709 Permanent teeth filled 2,476 4,565 1,223 8,264 Deciduous teeth filled 3,773 241 — 4,014 Permanent teeth extracted 56 381 60 497 Deciduous teeth extracted 828 399 — 1,227 General anaesthetics 359 198 12 569 Emergencies 250 82 24 356 105 Number of pupils X-rayed 536 Prophylaxis 997 Teeth otherwise conserved 230 Number of teeth root filled 14 Inlays 2 Crowns 8 Courses of treatment completed 4,661 Orthodontics. Cases remaining from previous year 285 New cases commenced during year 165 Cases completed during year 148 Cases discontinued during year 8 Number of removable appliances fitted 315 Number of fixed appliances fitted 22 Pupils referred to Hospital Consultant 1 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 2 1 4 Number of dentures supplied 1 4 2 7 Anaesthetics. General Anaesthetics administered by Dental Officers—Nil. Inspections. (a) First inspection at school. Number of pupils 19,451 (b) First inspection at clinic. Number of pupils 2,842 Number of (a) + (b) found to require treatment 9,565 Number of (a) + (b) offered treatment 8,870 (c) Pupils re-inspected at school clinic 4,677 Number of (c) found to require treatment 2,346 Sessions. Sessions devoted to treatment 2,515 Sessions devoted to inspection 192 Sessions devoted to Dental Health Education 11 106 INFECTIOUS DISEASES AND PROPHYLACTIC MEASURES 1. Infectious Diseases Table 1. Infectious Diseases notified by Schools. Disease Suffering Excluded on suspicion Infection at home Total exclusions Scarlet Fever 30 1 1 32 Measles 162 1 2 165 Whooping Cough 40 — 1 41 German Measles 217 2 — 219 Chicken Pox 343 — 1 344 Mumps 269 — 2 271 Jaundice 8 — — 8 Other 49 4 3 56 Totals 1,118 8 10 1,136 Table 2. Contagious Diseases notified by Schools. Disease Suffering Excluded on suspicion Total exclusions Impetigo 15 — 15 Scabies 1 — 1 Other 1 — 1 Totals 17 — 17 Compared with 1969, there were 249 fewer cases of communicable disease notified by schools as a result of which children were excluded. Enteritis Outbreak In January there was a small outbreak of sickness and diarrhoea in a Primary School, but after all necessary investigations were carried out testing proved negative, so it was felt that the outbreak was due to a virus. In March there were a number of cases of sickness resembling winter vomiting at a Primary School, but investigations again proved negative. Diptheria There have been no cases of diphtheria since the inception of this Borough in 1965. In March a number of carriers of diphtheria were found in a school in a neighbouring Borough. Twelve pupils at this school lived 107 in this Borough. All, except one, had been immunised against diphtheria in infancy. Nose and throat swabs from all the children proved negative, but immunisation booster injections for diphtheria were given where it was deemed necessary. Food Poisoning An outbreak of food poisoning caused by the organism salmonella typhimurium occurred at an Independent School in April. The Health Department had not been notified about the outbreak, but information from a Public Health Laboratory led to inquiries which revealed that positive results had been obtained on specimens from two pupils at the school. The school was then visited and it was ascertained that 42 pupils out of a roll of 155, together with one teacher and the housekeeper, had been ill the previous week and absent from school. After a full investigation 51 positive cases were found. It was found that some of the school meals were cooked at the caterer's home and transported to the school. The caterer and one of her two children were found to be positive. Swabs were taken from the working surfaces and equipment at the school kitchen and the caterer's home, but all these results were negative. The contaminated food causing the outbreak could not be identified owing to the length of time which elapsed before the Health Department found out about the outbreak. A number of boys who had been ill were allowed back to school while still positive, one week after symptoms had ceased, with special arrangements as to toilet and hand washing facilities. In six cases the infection was found to have spread to other members of the boys' families. Since the outbreak a washhand basin has been installed in the kitchen toilet, and hand washing notices are displayed in the kitchen. The caterer was advised not to use her home for food preparation. The last case was not cleared until late in July and more than 450 specimens were sent to the Public Health Laboratory for pathological examination. Several other local authorities were involved, since the school's pupils came from a very wide area. 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 1970 was as follows: — Number of children vaccinated 74 Number of children given re-inforcing doses 1,998 No case of Poliomyelitis occurred in the Borough in 1970. 2. Diphtheria /Tetanus Immunisation. Number of children given immunisation 106 Number of children given re-inforcing doses 2,121 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. 108 3. Protection of School Children against Tuberculosis. B.C.G. Vaccination. Owing to various immunisation procedures given prior to school cruises, also the introduction of rubella vaccination of girls, it was not possible to carry out the usual autumn programme of B.C.G. vaccination of 13-year-old children in the schools. This will be reflected in the figures for 1971 as two age groups will then be included. The only children given B.C.G. vaccination during 1970 were 211 absentees from the previous year. ANCILLARY SERVICES 1. Nursery Schools/Classes There were 757 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 1969:— Year Number in attendance Taking Milk Taking Meals Number Percentage Free Paid Total Percentage September, 1969 22,393 12,597 *13,732 91.0 1,239 16,082 17,321 77.3 September, 1970 22,999 12,368 *13,285 93.0 1,294 15,536 16,830 73.1 * Number in attendance entitled to milk (i.e., pupils in Primary and Middle Schools). 109 Appendix 'A' MEDICAL INSPECTION AND TREATMENT (Excluding Dental Inspection and Treatment) Return for the year ended 31st December, 1970 Number of pupils on registers of maintained, primary, middle, high, special and nursery schools in January, 1971: — (a) Ordinary schools 24,821 (b) Special schools 189 (c) Nursery schools and classes 757 Total 25,767 SECTION A. Routine Medical Inspections. Age Groups Inspected (By year of birth) Number of Children Inspected 1966 and later 1,022 1965 1,940 1964 873 1963 207 1962 163 1961 455 1960 653 1959 950 1958 958 1957 137 1956 833 1955 and earlier 849 Total 9,040 Other Medical Inspections. Type of Inspection Number of Children Inspected Special Inspections 1,539 Re-Inspections 1,929 Total 3,468 110 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 78 178 96 35 Eyes (a) Vision 828 796 120 234 (b) Squint 80 28 — — (c) Other 15 11 — 1 Ears (a) Hearing 58 80 20 89 (b) Otitis Media 26 48 1 1 (c) Other 4 26 — 1 Nose and Throat 54 294 4 17 Speech 87 146 6 10 Lymphatic Glands 1 61 1 1 Heart 29 57 4 11 Lungs 56 158 9 23 Development (a) Hernia 10 39 1 - (b) Other 38 146 — 6 Orthopaedic (a) Posture 10 33 — — (b) Feet 34 67 2 10 (c) Other 39 135 10 21 Nervous System (a) Epilepsy 13 18 5 3 (b) Other 11 19 1 7 Psychological (a) Development 4 31 6 16 (b) Stability 7 68 10 17 Abdomen 12 53 4 8 Other defects and diseases 25 266 8 55 Totals 1,519 2,758 308 566 Four thousand two hundred and seventy-seven defects were found in children at routine medical inspections of which 1,519 were referred for treatment and 2,758 for observation. 874 defects were found at special inspections, 308 being referred for treatment and 566 for observation. The total number of defects referred for treatment and observation in 1970 was 5,151. Ill 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 % 1966 and later 1,022 75 7.34 1965 1,940 266 13.20 1964 873 149 17.18 1963 207 39 18.84 1962 163 20 12.27 1961 455 64 14.06 1960 653 99 15.16 1959 950 165 17.37 1958 958 173 18.06 1957 137 27 19.71 1956 833 166 19.93 1955 and earlier 849 119 14.01 Totals 9,040 1,362 15.06 Classification of General Condition of pupils inspected during 1970 Group Number of children inspected Percentage found satisfactory Percentage found unsatisfactory % % 1966 and later 1,022 100 1965 1,940 99.95 0.05 1964 873 99.89 0.11 1963 207 100 — 1962 163 100 — 1961 455 100 — 1960 653 100 — 1959 950 99.90 0.10 1958 958 100 — 1957 137 100 — 1956 833 100 — 1955 and earlier 849 100 — Totals 9,040 99.97 0.03 SECTION B. Treatment Uncleanliness and Verminous Conditions. 1. Total number of individual examinations of pupils by Health Visitors in Schools 7,042 2. Number of individual pupils found to be infested 94 3. Number of exclusions:— First time 16 Second time 5 21 4. Number of pupils cleansed 12 5. Number of Cleansing Notices issued under section 54 of the Education Act, 1944 21 112 Diseases of the Skin (excluding uncleanliness) Diseases of the Skin. Number of cases known to have been treated during the year. Ringworm—scalp — Ringworm—body — Scabies 11 Impetigo 4 Other skin diseases (including verrucae, eczema, allergic skin conditions, acne, etc.) 112 Total 127 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 65 Errors of refraction (including squint) 2,984 Total 3,049 Number of pupils for whom spectacles were prescribed 738 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 8 (b) for adenoids and chronic tonsillitis 22 (c) for other nose and throat conditions 3 Received other forms of treatment 109 Total 142 Orthopaedic and Postural Defects. Number of cases known to have been treated in Clinics or Out-Patient Departments 165 79 sessions were held at Pelham Road Remedial Exercises Clinic during 1970. 17 new cases were admitted and 12 old cases discharged. 12 sessions were held at Amity Grove Remedial Exercises Clinic during 1970. 13 new cases were admitted and 7 old cases discharged. 38 sessions were held at Wide Way Remedial Exercises Clinic during 1970. 8 new cases were admitted and 5 old cases discharged. 113 75 sessions were held at St. Christopher's Special School and Eagle House Annexe Remedial Exercises Clinic during 1970. 26 new cases were admitted and 26 old cases discharged. Other Treatment Given. Ailments. Number of cases treated. Miscellaneous minor ailments 224 Lymphatic Glands 1 Heart and Circulation 24 Lungs 63 Development (Hernia and Other) 37 Nervous System 21 Total 370 Appendix 'B' 1. General Medical/Minor Ailment Clinics. Attendances made by children at General Medical/Minor Ailments Clinic 2,564 2. Other Medical Examinations undertaken by School Medical Officers. Children examined for part-time employment 269 In addition to the above, 1,285 newly appointed members of staff were cleared medically for superannuation purposes and 17 reports were provided on employees after prolonged absence from duty because of illness. 3. Recuperative Holidays. Children sent for recuperative holidays on the recommendation of School Medical Officers 17 All these children were examined on their return and all were found to have benefited from the holidays provided. 114