LONDON BOROUGH OF MERTON THE HEALTH OF MERTON 1972 THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH and the PRINCIPAL SCHOOL MEDICAL OFFICER E. H. TODD, M.B., Ch.B., D.P.H., M.F.C.M, MER 26 THE HEALTH OF MERTON 1972 by E. H. TODD, M.B., Ch.B., D.P.H., M.F.C.M. Printed by H. G. Mather, Ltd., Lower Green, Mitcham, Surrey CONTENTS INTRODUCTION: Page Introductory Letter 4-6 Committees 7 Whole-Time Staff 8-9 Part-Time Staff 10-11 GENERAL PUBLIC HEALTH SERVICES: General Information 12 Summary of Vital Statistics 13-14 Causes of Death at Different Periods of Life 15 Comparative Statistics 16 Principal Causes of Death in Order of Frequency 16 Infant Deaths 17 Infant Mortality 17 Perinatal Mortality 17 Maternal Mortality 17 Control of Communicable Diseases 18-22 Tuberculosis 22-24 Prophylactic Measures 24-26 Sexually Transmitted Diseases 26 General Medical Services 27 National Assistance Acts 27 Asian Immigrants 27 Notifications of Birth 28 PERSONAL HEALTH SERVICES: Maternal and Child Care 29-32 Child Health 32-35 PUBLIC HEALTH NURSING AND ALLIED SERVICES: Health Visiting 37 Midwifery 40 Home Nursing 42 Prevention of Illness, Care and After-Care: Clinics for Older People 46 Health Education 47-49 Other Allied Services: Chiropody Service 49 Ripple Bed Service 49 Recuperative Holidays 50 Cervical Cytology 50-51 Family Planning Service 52-53 Geriatric Service 53 2 ENVIRONMENTAL HEALTH SERVICES: Services under the Public Health Acts: Water Supply 54-55 Sewerage and Sewage Disposal 55 Registered Common Lodging Houses 55 District Inspection 56-58 Cleansing Station 60 Services under the Food and Drugs Act: Milk and Dairies (General) Regulations, 1959 60 Milk (Special Designations) (Amendment) Regulations, 1965 60 Milk (Special Designations) Regulations, 1963 60 Brucella Abortus 60 Ice-cream 61 Bacteriological Examination of Other Foods 61 Poultry Inspection 61 Food Premises 61-62 Food Inspection 62-65 Sampling of Food and Drugs 65-71 Services under Housing Acts 71-72 Services under Other Enactments: Shops Acts, 1950-65 72 Offices, Shops and Railway Premises Act, 1963 72-74 Prevention of Damage by Pests Act, 1949 74-76 Pet Animals Act, 1951 76 Riding Establishments Act, 1964 76 Diseases of Animals Act, 1950 76 Clean Air Act, 1956/1968 76-78 Factories Act, 1961 59-60 Noise Abatement Act, 1960 78 Pharmacy and Poisons Acts, 1933-1941 78 Fertilisers and Feeding Stuffs Act, 1926 78 Burial Act, 1857 78 Caravan Sites and Control of Development Act, 1960 79 Caravan Sites Act, 1968 79 Greater London (General Powers) Act, 1967 (Hairdressers and Barbers) 79 3 To the Mayor, Aldermen and Councillors of the London Borough of Merton. Madam Mayor, Ladies and Gentlemen, I have the honour to present the report on the work of the Health Department of the London Borough of Merton for the year 1972 and also the School Health Service Report. This may well be the last report to be presented to you since all the Health Department staff, other than the Environmental Health Section of the Department, will be transferred to the new Area Health Authority for Merton/Sutton/Wandsworth on the 1st April, 1974, under National Health Service reorganisation. This year brought several changes in the staff structure. Dr. Patrick J. Doody retired in June having been a Medical Officer of Health and Principal School Medical Officer for almost thirty years; during this long and distinguished service in this area he was for seven years Medical Officer of Health and Principal School Medical Officer of the London Borough of Merton and twenty-three years prior to that in the service of the Wimbledon Borough Council. On his retirement I took up my appointment as Medical Officer of Health and Principal School Medical Officer, and in August, 1972, was joined by Dr. G. S. Sethi as Deputy Medical Officer of Health. In spite of all these changes the year has been one of continuing improvement in all aspects of the work. The decline in population, which has been evident since 1955, continued, but the decrease was smaller in 1972 than in the previous few years. The mid-year estimate of population was 176,820; this being 180 less than the figure for 1971. At the 1971 Census there were 25,855 (or 14.63%) of the population who were aged 65 years or over. The percentage for England and Wales for the same year was 13.17. This high percentage of old people in the Borough inevitably necessitated expansion of services, both in the Health Department and the Social Services Department. With this in mind a night nursing service was introduced which has proved to be a defiinite step in the right direction. The service commences at 8 p.m. when a trained nurse visits the patients who require skilled nursing care and a nursing auxiliary visits those who require only assistance to go to bed. From 11 p.m. onwards the nursing auxiliary may remain with patients who are critically ill and require all night attendance, thereby reducing the pressure on hospital admissions. Live births at 2,320 were 147 fewer than in 1971. The resultant live birth rate of 13.12 was the lowest since 1959. The infant mortality rate rose from 13.78 in 1971 to 15.08 in 1972; also the neo-natal and the peri-natal death rates showed a slight rise, but the neo-natal death rate fell from 10.54 in 1971 to 10.34 in 1972. All these rates, however, are well below the rates for England and Wales as a whole. Deaths in 1972 totalled 2,143, 130 more than in 1971 and the number of deaths from lung cancer rose by 11, which is in keeping with the national trend. Notifications of infectious disease in the Borough declined. The total number of notifications in 1972 was 503 as against 701 in the previous year. Most of the notifications were for childhood diseases 4 and even here there was a general decline, especially in the notification of whooping cough which dropped from 50 in 1971 to 10 in 1972. I am pleased to be able to report that there was a slight general decline in the incidence of venereal diseases in the Borough, 1972 figures being 26 less than in 1971. The Environmental Health Section continues to expand its services and the Clean Air Act provisions have been put into effect over a wider area and it is hoped to make the whole of the Borough a smokeless area by 1975. By the end of the year the Patrick Doody Clinic and Child Health Centre in Wimbledon was nearing completion and plans were already formulated for the expansion and improvement of the services, particularly in the specially built audiology and speech therapy room. This means the release of the Russell Road Clinic for use as a Health Education Centre. The health education service continues to expand and to fulfil an important place in our services and with the continued demand for further services, both in schools and clinics, it was necessary to appoint an Assistant Health Education Officer. Dr. M. Markowe, the Consultant Psychiatrist to the Authority has less need for close contact with this Department since the mental health services were transferred to the Social Services Department but our liaison with the Social Services Department has been most satisfactory, and I am sure Mr. Hutchinson, the Director of Social Services, would wish to join me in expressing our great appreciation for his valuable help and co-operation, when required, and we would also like to express our appreciation of the valuable help given by Dr. E. S. Paykel. In August, 1972, the Government issued a White Paper setting out proposals for establishing an integrated National Health Service operating through Regional Health Authorities and Area Health Authorities and District Management Teams. Merton, along with the Boroughs of Suttcn and Wandsworth, forms an Area Health Authority (Teaching) in the South West Thames Region. Many circulars on this subject issued by the end of the year made it obvious to us all in the Health Department that during 1973 we would be placed under considerable strain in preparing for integration, in addition to the work of providing the Department's routine services and dealing with various emergencies which arise regularly. I would like to offer my Chief Officer colleagues and their Deputies in other Departments of the Council my thanks for their friendly and helpful co-operation at all times, especially the Chief Education Officer, the Director of Social Services and the Director of Housing. I am also much indebted to my other Consultant colleagues in geriatrics, paediatrics, obstetrics and other specialties, and to all general practitioners in the Borough I would like to express my gratitude for their help and support in carrying out the task of serving the residents of this Borough. I owe particular gratitude to the Director of the Public Health Laboratory Service and his staff for their ready support at all times in the control of infectious disease. The loyal and efficient manner in which all members of the Health Department carried out their duties during the year, despite the 5 steadily increasing pressure of work, was greatly appreciated. My special thanks are due to Mr. Smith, the Chief Public Health Inspector, Mrs. Poole, the Chief Nursing Officer, and Mr. Atkinson, my Chief Administrative Officer, for their contributions in connection with the preparation of this report. Finally, I would like to express my thanks to Members of the Council, and particularly to Members of the Health Committee, for their support throughout the year. I have the honour to be, Your obedient servant, ELZA H. TODD, Medical Officer of Health. 6 COMMITTEES AT 31st DECEMBER, 1972 HEALTH COMMITTEE The Mayor, Alderman J. P. Brown, J.P. Councillor Geoffrey N. Smith (Chairman) Councillor (Mrs.) M. E. Chadwick (Vice-Chairman) Alderman J. R. Daniels Councillors: A. A. W. Dix P. H. Glasspool (Miss) L. Hirst (Miss) S. Knight D. T. Miller A. J. Pullman G. H. Raymond H. C. A. Turner (Miss) N. K. Watts Co-opted member:— Representative of the Local Medical Committee (Dr. R. A. Arthur, J.P.) TOWN CLERK Sydney Astin (Solicitor) 7 WHOLE-TIME STAFF (As at 31st December, 1972) Medical Officer of Health and Principal School Medical Officer Elza H. Todd, M.B., Ch.B., D.P.H., M.F.C.M. Deputy Medical Officer of Health and Deputy Principal School Medical Officer G. S. Sethi, M.B., B.S., D.T.M. & H., D.P.H., D.I.H., F.R.S.H., M.F.C.M. (commenced 14.8.72) 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. Senior Medical Officers Marie J. Freeman, M.B., B.S., L.M.S.S.A., D.P.H. Elizabeth Cloake, M.B., B.S. (Lond.), D.Obst.R.C.O.G., D.P.H., M.F.C.M. 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 E. T. Thompson, L.D.S., R.C.S. Senior Dental Officer Mrs. M. A. Libbey, L.D.S., R.C.S. (Eng.) School Dental Officers Ann C. Leonard, L.D.S., R.C.S. S. P. Motani, L.D.S. Miss H. E. Parkinson, B.D.S. (commenced 3.1.72) Dental Auxiliary Miss S. P. Foley Chief Public Health Inspector J. P. Smith, M.A.P.H.I., M.R.S.H. Deputy Chief Public Health Inspector J. T. Woolford, M.A.P.H.I. Chief 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. Health Education Officer Mrs. I. Holloway, S.R.N., S.C.M., H.V. Cert. 8 Educational Psychologists Miss D. Waldeck, B.A. (Hons.) Mrs. A. Court, B.Sc., Diploma in Educational Psychology 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) Speech Therapists Mrs. E. J. Fieldsend, L.C.S.T. (commenced 1.8.72) Mrs. A. Varah, L.C.S.T. Mrs. C. M. Holland, L.C.S.T. Audiometrician Mrs. M. Dean, S.R.N. 9 PART-TIME STAFF (As at 31st December, 1972) Ophthalmic Surgeons J. M. Bird, M.B., B.S., D.O. (commenced 19.6.72) 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. Departmental Medical Officers Zainab E. Asvat, M.B., B.Ch. Joan M. H. Clarke, M.R.C.S., L.R.C.P. Gillian M. Craig, M.B., B.S. (commenced 23.11.72) A. David, M.R.C.S., L.R.C.P. (commenced 6.4.72) E. A. Evans, M.A., M.B., M.R.C.S., L.R.C.P., B.Chir. M. T. Fernandes, M.B.B.S., D.P.H., D.I.H., D.C.H., L.M. (commenced 21.11.72) 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. Daphne M. Pearson, M.B., B.S. Douglas W. Sim, M.B., Ch.B. Elizabeth A. South, M.B., Ch.B. R. A. Syed, M.B., B.S. (Bombay)) (commenced 10.11.72) Audrey P. Whitfield, M.B., B.S. School Dental Officers Mrs. R. E. A. Higgins, B.D.S. (commenced 4.9.72) Mrs. M. Holt, B.D.S. (commenced 1.2.72) Sheila McDonald, L.D.S. Dental Orthodontist 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. 10 Physiotherapists Mrs. E. M. Bowes, M.C.S.P. (commenced 11.4.72) Mrs. W. J. Heath, M.C.S.P. (commenced 19.4.72) Mrs. J. Simmons, M.C.S.P. Speech Therapist Mrs. M. Tong, L.C.S.T. (commenced 16.10.72) Psychiatric Social Worker Miss G. E. Stoneham Psychotherapist Mrs. M. Livesey, N.F.F.Diploma, Assn. of Child Psychotherapists 11 GENERAL PUBLIC HEALTH SERVICES General Information Area of Borough in acres 9,379 Number of private dwellings (1961) 59,482 Number of private dwellings (1972) 64,615 Rateable value, at 1st April, 1972 £11,888,299 Actual product of a penny rate:— 1971/72 £112,594 Estimated product of a penny rate:— 1972/73 £114,400 Population:— Census figure (1961) 186,647 Census figure (1971) 176,524 Registrar-General's Estimate of Population 1972 1971 at 30th June 176,820 177,150 12 Summary of Vital Statistics Live Births— 1972 1971 Legitimate Males 1063 1190 Females 1062 1068 - 2125 - 2258 Illegitimate Males 88 106 Females 107 103 - 195 - 209 Totals 2320 2467 Live Birth Rate per 1,000 population 13.12 13.90 Corrected Live Birth Rate per 1,000 population 13.90 14.45 Illegitimate live births—percentage of total live births 8.40 8.47 Still Births— Legitimate Males 5 6 Females 10 13 - 15 - 19 Illegitimate: Males 3 3 Females 2 1 - 5 - 4 Totals 20 23 Still-birth Rate per 1,000 live and still-births 8.55 9.24 Still-birth Rate per 1,000 population 0.12 0.13 Total live and still-births 2340 2490 Infant Mortality (Deaths of infants under one year of age)— Legitimate Males 16 21 Females 16 11 - 32 - 32 Illegitimate: Males 1 1 Females 2 1 - 3 - 2 Totals 35 34 Infant Mortality Rate per 1,000 live births 15.08 13.78 Infant Mortality Rate per 1,000 legitimate live births 15.06 14.00 Infant Mortality Rite per 1,000 illegitimate live births 15.38 9.57 Neo-Natal Deaths (Deaths of infants in first 28 days of life) 24 26 Neo-Natal Mortality Rate 10.35 10.54 Early Neo-Natal Mortality Rate (deaths of infants in first week of life per 1,000 live births) 8.62 7.70 Perinatal Mortality Rate (Still-births plus deaths in first week of life per 1,000 live and still-births) 17.09 16.87 Total loss of infant life (Still-births plus infant deaths) per 1,000 live and still-births 23.50 22.90 Maternal Deaths (including abortion) - - Maternal Mortality Rate per 1,000 live and still-births - - Deaths 2143 2013 Death Rate per 1,000 population 12.12 11.36 Corrected Death Rate per 1,000 population 11.36 10.68 13  1972 1971 Deaths from Bronchitis and Emphysema per 1,000 population 0.54 0.63 Deaths from Pneumonia per 1,000 population 1.11 0.87 Deaths from Cancer of lung and bronchus per 1,000 population 0.85 0.78 Deaths from other forms of Cancer per 1,000 population 2.00 2.00 Marriages 1460 1425 Marriage Rate per 1,000 population 8.26 8.04 14 Causes of Death at different Periods of Life in the London Borough of Merton during 1972 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 Enteritis and other Diarrhoeal Diseases - - 1 - - 1 - - - - - - - - - - - - - - - - 1 1 Tuberculosis of Respiratory System - - - - - - - - - - - - - - - - - - 1 1 - - 1 1 Syphilis and its sequelae - - - - - - - - - - - - - - - - 1 - - - - - 1 - Other Infective and Parasitic Diseases - - - - - - - - 1 - - - 2 - - - - - 1 - 1 - 5 - Malignant Neoplasm: Buccal Cavity, etc. - - - - - - - - - - - - - - - - - - - 1 - 1 - 2 Malignant Neoplasm: Oesophagus - - - - - - - - - - - - - - 1 - 2 1 4 2 4 1 11 4 Malignant Neoplasm: Stomach - - - - - - - - - 1 - - - 2 1 - 10 3 9 3 8 11 28 20 Malignant Neoplasm: Intestine - - - - - - - - - - - - 2 1 1 1 7 2 7 12 11 14 28 30 Malignant Neoplasm: Larynx - - - - - - - - - - - - - - - - 2 - 1 1 3 1 6 2 Malignant Neoplasm: Lung, Bronchus - - - - - - - - 1 - - - 1 1 9 2 38 10 45 9 26 8 120 30 Malignant Neoplasm: Breast - - - - - - - - - 1 - - - - - 5 - 14 - 9 - 13 - 42 Malignant Neoplasm: Uterus - - - - - - - - - - - - - 1 - 2 - 3 - 6 - 2 - 14 Malignant Neoplasm: Prostate - - - - - - - - - - - - - - 1 - 1 - 6 - 8 - 16 - Leukaemia - - - - - - 1 - - - - - - 1 2 - - - 1 - 3 4 7 5 Other Malignant Neoplasms, etc. - - - - 1 - 2 - 1 - 1 2 1 4 6 10 16 18 18 31 8 28 54 93 Benign and Unspecified Neoplasms - - - - - - - - - - - - - - - - 1 - - 2 - 1 1 3 Diabetes Mellitus - - - - - - - - - - - - - - - - - 1 - 2 4 9 4 12 Avitaminoses, etc. - - - - - - - - - - - - - - - - - - - - 1 - 1 - Other Endocrine Etc. Diseases - - - - - - - - - - - - - - - - 2 1 - - - 3 2 4 Anaemias - - - - 1 - - - 1 - - - - - - - - - 2 - 2 2 6 2 Other Diseases of the Blood, etc. - - - - - - - - - 1 - - - - - - - - - - 1 - 1 1 Mental Disorders - - - - - - - 1 - - - - - - - - - - - 1 - 2 - 4 Meningitis - - - - - - 2 - - - - - - - - - - - - - - - 2 - Multiple Sclerosis - - - - - - - - - - - - - 1 1 2 - - - - - - 1 3 Other Diseases of Nervous System, etc. - - - - - - - - - - - - - - - 1 3 - 2 3 5 7 10 11 Active Rheumatic Fever - - 1 - - - - - - - - - - - - - - - - - - - 1 - Chronic Rheumatic Heart Disease - - - - - - - - - - - - 1 - 3 - 1 7 4 6 3 7 12 20 Hypertensive Disease - - - - - - - - - - 1 - - - 3 - 1 1 6 8 6 10 17 19 Ischaemic Heart Disease - - - - - - - - - - - - 8 - 22 5 68 17 116 61 86 134 300 217 Other forms of Heart Disease - - - - - - - - 1 - - - - - - - 4 1 12 5 23 53 40 59 Cerebrovascular Disease - - - - - - - - - - 1 1 - - 5 4 10 13 25 30 42 112 183 160 Other Diseases of Circulatory System - - - - - - - - - - - - 2 1 2 1 5 2 15 5 13 58 37 67 Influenza - - - 1 - - - - - - - - - - 1 - 1 - - 1 4 1 7 Pneumonia - - 3 2 - - - - - - - - - - 3 3 7 6 18 12 51 91 82 114 Bronchitis and Emphysema - - - - - - - - - - - - - - 2 - 8 3 30 5 30 17 70 25 Asthma - - - - - - - - - - 1 1 - 1 - 1 - - 1 - - 1 2 4 Other Diseases of Respiratory System - - 1 1 2 1 - - - - - - - - - 1 1 - 2 4 5 6 11 13 Peptic Ulcer - - - - - - - - - - - - 1 - - 1 1 - 2 2 5 4 9 7 Intestinal Obstruction and Hernia 1 - - - - - - - - - - - - - - 1 - - 5 1 - 4 6 6 Cirrhosis of Liver - - - - - - - - 1 - - 1 - - 1 1 - 1 - 2 - - 2 5 Other Diseases of Digestive System - - - - 1 1 - - - - - - - - - - 2 1 - 2 2 6 5 10 Nephritis and Nephrosis - - - - - - - - - - - - - - - - 1 1 1 2 - 1 2 4 Hyperplasia of Prostate - - - - - - - - - - - - - - - - - - 1 - 2 - 3 - Other Diseases, Genito-Urinary System - - - - - - - - - - - - - - - 2 - 1 3 1 4 5 7 9 Diseases of Skin, Subcutaneous Tissue - - - - - - - - - - - - - - - - - - - - 1 - 1 - Diseases of Musculo-Skeletal System - - - - - - - - - - - - - - - - 2 1 - 1 - 1 2 3 Congenital Anomalies 2 5 - - 1 - - - - - 1 - - 1 - - - 1 - - - - 4 7 Birth Injury, difficult Labour, etc. 7 3 - - - - - - - - - - - - - - - - - - - - 7 3 Other Causes of Perinatal Mortality 1 5 - - - - - - - - - - - - - - - - - - - - 1 5 Symptoms and Ill-defined conditions - - - 1 - - - - - - - - - - - - - - - - 1 10 1 11 Motor Vehicle Accidents - - - - - - 2 - 4 - 2 - - - 1 2 2 2 2 1 4 5 17 10 All other Accidents - - - - - - - - 1 - 1 - - - 3 1 2 1 4 - 5 4 16 6 Suicide and Self-inflicted Injuries - - - - - - - - 1 - 1 1 3 2 1 2 1 3 2 - - - 9 8 All other external causes - - - - - - - - - - 1 - - 1 1 2 - - - 1 - - 2 4 TOTAL ALL CAUSES 11 13 6 5 6 3 7 1 12 3 10 6 21 17 69 51 199 116 346 232 369 640 1056 1087 Comparative Statistics, 1972 Merton England and Wales Rates per 1,000 Population: Live births 13.12 14.8 Deaths (all causes) 12.12 12.1 Respiratory tuberculosis 0.02 0.02 Cancer of lung and bronchus 0.85 0.65 Rates per 1,000 live and still births: Still births 8.55 12.00 Maternal mortality — 0.15 Perinatal mortality 17.09 22.00 Rates per 1,000 live births: Infant mortality—deaths of infants under 1 year 15.08 17.00 Neo-natal mortality—deaths of infants in first 28 days of life 10.34 11.5 Early neo-natal mortality—deaths in first week of life 8.62 10.00 Principal causes of Death in order of Frequency Out of the 2,143 deaths occurring during the year 1,834 were attributable to the undermentioned principal causes:— No. of Deaths. Percentage of Deaths from all causes. 1. Heart Diseases 684 31.9 2. Cancer 512 23.9 3. Cerebrovascular disease 243 11.2 4. Pneumonia 196 9.1 5. Other diseases of the Circulatory System 104 4.9 6. Bronchitis and Emphysema 95 4.4 16 INFANT DEATHS (Under 1 year) Principal certified causes of death Age at Death Total Under 24 hours Days Months 1- 7 814 1521 2228 1- 3 36 69 912 Prematurity 10 2 - - - - - - - 12 Congenital Malformations 3 1 1 - - - - - - 5 Broncho-pneumonia - 1 - - - 2 2 1 - 6 Birth Injuries 2 1 - - - - - - - 3 Other causes - 1 - 1 1 5 1 - - 9 Totals 15 6 1 1 1 7 3 1 - 35 INFANT MORTALITY Of the 35 infant deaths, 21 occurred in the first seven days of life. All but one of these babies were delivered in hospital. The infant mortality rate of 15.08 compares very favourably with the rate of 17.0 for England and Wales. PERINATAL MORTALITY The perinatal mortality rate for Merton was 17.09 per 1,000 live and still births, thus comparing favourably with that for England and Wales of 22.0. MATERNAL MORTALITY There were no maternal deaths in 1972. 17 CONTROL OF COMMUNICABLE DISEASES Notifications received during 1972 (Corrected Notifications) Disease Age Groups of Cases Notified Total Under 1 1- 2 34 59 1014 1524 2544 4564 65 & over Measles 19 73 83 185 14 11 12 - - 397 Dysentery - 1 — 1 — 1 1 — — 4 Scarlet Fever 1 2 7 13 1 3 1 - - 28 Whooping Cough 1 6 2 — 1 — — — — 10 Food Poisoning — 1 — — 1 — — 1 — 3 Malaria - - — — 1 — — 1 - 2 Infective Jaundice — - — 2 2 7 7 2 1 21 Meningitis — 1 1 3 — — — — — 5 Tuberculosis (Resp.) — - — — 1 5 4 12 6 28 Tuberculosis (Non-Resp.) - - - - - 1 1 3 — 5 Totals 21 84 93 204 21 28 26 19 7 503 General A total of 503 notifications of infectious disease was received in 1972 compared with 701 in 1971. The fall was principally in notification of measles, dysentery, scarlet fever and whooping cough. 18 The following table shows the corrected notifications of infectious disease received in 1972 and in the preceding seven years:— Disease 1972 1971 1970 1969 1968 1967 1966 1965 Measles 397 427 738 964 322 1777 851 2428 Dysentery 4 92 21 139 5 20 39 34 Scarlet Fever 28 50 42 48 55 60 45 62 Whooping Cough 10 50 53 8 49 117 74 42 Typhoid Fever — — 3 — — — — 1 Food Poisoning 3 16 65 23 9 3 4 9 Malaria 2 2 1 1 — 1 — — Infective Jaundice 21 29 20 36 11 - - - Acute Meningitis 5 6 2 4 1 — — l Opthalmia Neonatorum — 1 1 1 — — — 1 Tuberculosis: Respiratory 28 20 29 38 36 41 48 45 Non-Respiratory 5 7 10 6 6 3 5 9 Acute Encephalitis — — — 2 — 1 — — Leptospirosis — — — 1 — — — — Paratyphoid — — — 3 — — — — Poliomyelitis (Paralytic) - 1 - - - - - 1 Totals 503 701 985 1274 494 2023 1066 2633 Note: Infective jaundice not notifiable until 1968 Cholera Four persons arriving in this country without valid certificates of vaccination against cholera were kept under surveillance for the required period. All remained well. Diphtheria There were no notifications of diphtheria during the year 1972 but constant efforts were maintained to keep the immunised state of children satisfactory. Dysentery A total of 17 confirmed cases of dysentery were notified in 1972, as against 92 in 1971; but the number in 1971 included 78 children who were involved in a dysentery outbreak after their return from a mediterranean cruise. A total of 52 people were investigated as contacts of the confirmed cases of sonne dysentery. Only four of the 17 cases were notified by a doctor, the remainder coming to the notice of the Health Department through the Public Health Laboratory Service. After being informed of a parent and child who were connected with a private day nursery having Flexner dysentery, it was decided to investigate the staff and all the children concerned; fortunately all were found to be negative. One of the cases of dysentery was a patient in a maternity hospital but no-one else became involved. 19 In addition, 100 notifications of suspected dysentery were received and this necessitated checking and testing 164 people. E. Coli Infections This is an enteritic type of infection which can be fatal in very young children. Fifteen cases were notified during the year, mostly through hospitals, and I am glad to say that all cases investigated made an uneventful recovery. Meningitis Notification was received of five cases of meningitis, one of which was fatal. This was a nine-year-old schoolboy who died after a fourday illness with pneumococcal meningitis. All necessary investigations were carried out at the boy's school and there were no further cases. Three cases of suspected meningitis were also notified and investigated during the year. Poliomyelitis No case of poliomyelitis was notified in 1972 but the immunisation campaign continues constandy. Smallpox Any person entering this country from smallpox endemic or infected areas without a valid certificate of vaccination is notified to the Department by the Principal Medical Officer of the Airport. There were 32 such cases arriving in the Borough who were kept under surveillance for the incubation period by the medical and public health staff. All remained well. In October, 1972, the Medical Officer of Health was informed that a lady who was travelling from Hong Kong to New York and was staying for a few days with friends in Merton had walked into a Hospital Casualty Department in another Borough and as she had an unusual rash, various tests were performed to exclude the possibility of a very mild atypical smallpox, although clinically there was little to support this diagnosis. As preliminary tests proved positive, the patient was removed to Long Reach Isolation Hospital. Further special testing over the next few days proved finally that the case was not one of smallpox. Although the information was received over the weekend, all medical, nursing and public health inspectorate staff were mobilised instantly. The family were isolated, all contacts vaccinated, premises disinfected, all necessary surveillance implemented and plans were drawn up ready for implementation in the event of any emergency that might arise had the case been finally confirmed as positive. Streptococcal Infections Nothing significant happened apart from a very mild and minor outbreak of streptococcal infection in a maternity ward in a local hospital necessitating the testing of midwives and pupils. Alll 20 sary precautions were taken and investigations carried out and there were no further developments. Tuberculosis The Chest Clinic serving the Borough is based at the Cumberland Hospital. Our Tuberculosis Health Visitor there assists the Chest Physician in case finding, contact tracing and follow-up, in addition to giving help and advice to patients. Notification of pulmonary tuberculosis increased from 20 in 1971 to 28 in 1972 but as the figure for 1972 was phenomenally low, this increase was not considered to be of any great significance. The notification rate for respiratory tuberculosis for the Borough this year was 16 per 100,000 population which is below the national average of 19 per 100,000 population. There were five non-pulmonary cases notified, two less than in the previous year. Typhoid and Paratyphoid There was no confirmed case of typhoid in the Borough during the year but the Department was involved in the investigations of 13 contacts of suspected cases of typhoid and three contacts of paratyphoid fever. All investigations proved negative. Minor outbreaks A few small and brief outbreaks of sickness and/or diarrhoea occurred in schools during the year. Bacteriological investigation was carried out in all cases but no organism was isolated. In one middle school where there seemed to be recurring waves of this type of illness, very thorough investigations, including bacteriological and viral examination of specimens from pupils and staff, were carried out. Water supplies were tested bacteriologically and chemically, all aspects of hygiene and food handling were closely considered, but in spite of all this, results of all tests proved negative. Food Poisoning There were no outbreaks of food poisoning in any school, nursery or residential establishment in the Borough during the year 1972. Eleven notifications of confirmed food poisoning were received in 1972 compared with 18 in 1971. Their breakdown is given below:— Salmonella typhimurium 4 Salmonella bredeney 1 Salmonella give 1 Salmonella lille 1 Salmonella enteritidis 1 Salmonella (unidentified) 3 Thirty-four persons were concerned in the investigations and four of these had contracted their infection while abroad. One case of s.typhimurium in a child aged one year continued positive for two months. 21 The only significant group of people who suffered s.typhimurium food poisoning were a group of seven who had a dinner out in London. They were kept under surveillance until clear. In addition, 29 people were investigated, 15 of whom were suspected cases of food poisoning, but all gave negative results. TUBERCULOSIS Chest Clinics The two chest clinics at Cumberland Hospital have now been combined, with Dr. E. Sanders as the chest physician. At this clinic the Tuberculosis Health Visitors assist the Chest Physician and help and advise the patients. At the end of the year the case load of the tuberculosis health visitor was as follows:— Cases of tuberculosis 382 Cases of lung cancer 56 Other chest cases (bronchitis, bronchiectasis, etc.) 62 The new cases examined at the Chest Clinics in 1972 are analysed in the table below:— Respiralory Non-Respiratory Total M F M F Diagnosed Tuberculous 4 1 — - 5 Non Tuberculous 332 194 — — 526 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 175. Details of domiciliary visiting by health visitors are given below: Visits in connection with old cases 449 Visits in connection with new cases 32 Visits in connection with contacts 60 Total 541 B.C.G. Vaccination During the year B.C.G. inoculation of school children in the twelve and thirteen year old age group was carried out:— Number of children skin tested 1,947 Number found negative 1,722 Number vaccinated with B.C.G. 1,713 22 No children with positive skin tests were known to be contacts of notified cases of tuberculosis. Fifty-seven 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. Total. Respiratory 18 10 28 Non-respiratory 2 3 5 This shows an increase of eight in the notifications for respiratory tuberculosis on the figure for 1971, but that figure was abnormally low and some increase was to be expected. The figure for 1972 is still lower than that for 1970. It is interesting to note that the increase is almost entirely in the 'over 60' age group and is considered by expert opinion to be due mainly to the re-activation of old cases which may never have been diagnosed. The total number of respiratory cases on the tuberculosis register continues to decline and is now only just over 400. In 1965 is was just under 900. 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 R NonRespi ratory No. of cases on Register at 1.1.72 253 196 35 32 449 67 Primary Notifications in 1972 18 10 2 3 28 5 Inward transfers in 1972 9 2 — — 11 — Totals 280 208 37 35 488 72 Died during 1972 5 1 - 2 6 2 Recovered during 1972 36 22 1 1 58 2 Transferred out in 1972 13 8 1 1 21 2 Total cases removed from Register 54 31 2 4 85 6 No. of cases on Register 31.12.72 226 177 35 31 403 66 Mass X-Ray The Mass Radiography Unit of the Regional Hospital Board, in addition to providing a regular service for general practitioners, carried out surveys on industrial sites and sessions were held for the general public. The service is of great value in the early diagnosis of pulmonary tuberculosis and non-tuberculous abnormalities. 23 The results are tabulated below:— Number X-rayed Pulmonary T.B. found Primary Lung Cancer found Total Males Females Males Females General Practitioner Service 1,371 3 — 11 1 Public and Industrial Sessions 4,908 — — 3 — Totals 6,279 3 14 1 The figures in respect of public and industrial sessions do not apply to Merton residents only, as the service is available to any member of the public. Deaths There were two deaths from respiratory tuberculosis and its late effects during the year. The table of causes of death on page 15 gives an analysis by age and sex. The death rates per 1,000 population were 0.02 respiratory and nil non-respiratory, compared with 0.02 and 0.007 respectively for England and Wales. The comparable figures for the Borough for 1971 were 0.02 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. 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 1972 1971 1970 1969 1965/68 Diphtheria 28 1363 374 41 44 16 1866 Whooping Cough 27 1359 371 39 25 — 1821 Poliomyelitis (Oral) 26 1363 387 37 34 19 1866 Tetanus 28 1363 374 41 55 71 1932 Measles — 667 485 74 131 13 1370 Rubella — — — — — 392 392 24 Below are given the percentages of children, born in 1970, who had been given protection against whooping cough, diphtheria and poliomyelitis by the end of 1972. The figure in brackets is the corresponding percentage for England and Wales:— Whooping cough 78 (79) Diphtheria 78 (81) Poliomyelitis 80 (80) The continuing need for immunisation and vaccination is brought home to the public at large by the use of leaflets, posters and displays, and by the teaching of the Health Visitors at the clinics and in the course of their district visits. Reinforcement Measures In addition to the above measures of primary protection the following numbers were given re-inforcement doses:— Diphtheria 1,891 Whooping cough 244 Poliomyelitis 2,857 Tetanus 2,568 Poliomyelitis At the end of the year, 95,175 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 1943-72 67,088 Persons born 1933-42 15,791 Others 12,296 Total 95,175 Vaccination against Rubella for Women of Child-Bearing Age Department of Health and Social Security Circular 17/72 was issued on 29th March, 1972, and stated that the Joint Committtee on Vaccination and Immunisation had reviewed the question of vaccinating women of child-bearing age against rubella. They advised that routine vaccination was not recommended, but that certain seronegative women at special risk of acquiring rubella or transmitting it to others, including school teachers, nursery staff, nurses and the staff of ante-natal clinics, could be offered vaccination. Consequently, in November, 1972, the appropriate members of the Council's staff were informed of this and invited to apply for a preliminary blood test if they wished to take advantage of the offer. One hundred and ten women applied, and attended our clinics for blood sampling, with the following results:— 25 Rubella antibody titre negative 20 Rubella antibody titre 1 : 16 8 Rubella antibody titre 1 : 32 27 Rubella antibody titre 1 : 64 27 Rubella antibody titre 1 : 128 19 Rubella antibody titre 1 : 256 9 110 On the advice of the pathologist, titres of 1:16 and below were regarded as negative. Results of all the blood tests were notified to the patients and their general practitioners, and the 28 women who were seronegative were advised to approach their doctors for vaccination against rubella. We are indebted to Dr. Fleck and his staff at the Public Health Laboratory, St. George's Hospital, S.W.17, for undertaking examination of the sera for antibody estimation. Smallpox From 28th July, 1971, on the advice of the Department of Health and Social Security, vaccination against smallpox was deleted from the schedule of recommended routine procedures in early childhood. 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 1972:— Clinic Number of new cases seen during year Total all Conditions Syphilis Gonorrhea Other Genital Infections Other Conditions Primary & Secondary Other Croydon General Hospital 64 - - 6 44 14 Dreadnought Seamen's Hospital - - - - - - London Hospital 17 - 1 — 10 6 Middlesex Hospital 111 - 1 13 51 46 St. Bartholmew's Hospital 52 1 - 5 36 10 St. Helier Hospital 552 2 - 38 397 115 St. Thomas's Hospital 75 1 2 14 47 11 Westminster Hospital 29 - 1 2 19 7 Totals 900 4 5 78 604 209 In comparison with the figures for 1971, new cases of syphilis remained the same at 9, new cases of gonorrhoea at 78 were 10 fewer and other cases were 16 less than in 1971. 26 GENERAL MEDICAL SERVICES All new staff are required to complete a medical questionnaire and the replies assist in deciding whether a medical examination is necessary. During 1972,1,211 questionnaires were received and 273 medical examinations were conducted, 934 staff being accepted following completion and scrutiny of the questionnaire only. Four were found to be unfit for employment. In the majority of cases quicker medical clearance was achieved but incorrect completion of questionnaires and failure to produce an up-to-date chest x-ray result when required still cause unnecessary delays. There were 292 medical examinations of teachers and teacher trainees and, in all, 6C4 staff medical examinations were conducted compared with 598 in 1971. in 20 cases the examinees were found unfit either to commence or return to work and 39 examinations concerned staff absent from duty owing to sickness to determine their fitness or otherwise to return. A total of 1,532 staff were dealt with compared with 1,405 in 1972. 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. Ugandan Asians At the time of the influx of Ugandan Asians the Department was given the names and addresses of those moving into the Borough. Thirty-two such families, comprising 54 adults, 10 children under five years and 22 children between 5 and 16 years were visited by the district Public Health Inspectors. Enquiry was made as to their health and any recent contact with infectious disease, advice was given on the Health Service and chest X-rays were arranged where necessary. In cases where children were involved, a follow-up visit by a health visitor was arranged. In addition to those seen, three addresses were found to be incorrect and 11 families had already moved on to a new address. 7 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 ... 41 41 - - 41 41 1077 1024 6 6 1083 1030 1118 1065 6 6 1124 1071 Births occurring outside Merton attributable to Merton (Inward Transfers) - - - - - - 666 677 8 10 674 687 666 677 8 10 674 687 Total of all births notified 41 41 - - 41 41 1743 1701 14 16 1757 1717 1784 1742 14 16 1798 1758 Births occurring in Merton attributable to other Authorities (Outward Transfers) - - - - - — 627 557 6 3 633 560 627 557 6 3 633 560 Total births attributable to Merton 41 41 — — 41 41 1116 1144 8 13 1124 1157 1157 1185 8 13 1165 1138 28 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 672 specimens during the year, 41 of which were repeat samples where the first reading showed a slightly raised phenylalanine level. There were no positive cases in 1972, but the health visitor continues to carry out a weekly test on the positive case from 1971. Observation and Handicap Register This register was continued during 1972. The purpose of the register is to keep records of those children who have had some adverse factor during the pre-natal period, labour, or after birth which makes them more likely than other children to have a defect. This information is obtained from all possible sources; the domiciliary midwives and the hospital obstetrics departments at birth and the paediatric departments, family doctors, and medical officers and health visitors of the local authority at later stages. Those children found to have a definite handicapping condition are kept under review and the appropriate services are involved to give them and their parents comprehensive advice and care. Information about these children is also given to the Local Authority Departments of Education and Social Services to assist them in their forward planning. Those children who are under observation are reviewed at the age of two years, or before if indicated, and if their development is entirely normal, they are removed from the Register. Table A gives details of the number of handicapping conditions (some children have more than one). Table B gives details of children who were under observation at the end of 1972 in Merton. Both tables apply to children under five years of age. 29 TABLE A List of Handicaps on Observation & Handicap Register December, 1972. 1 Visual Handicap 5 2 Auditory Handicap 9 3 Language and Speech 13 4 Epilepsy 4 5 Cerebral Palsy 6 6 Spina Bifida and Hydrocephalus 8 7 Muscular Dystrophy and other Muscular Disorders - 8 Metabolic and Endocrine 5 9 Alimentary System — 10 Cardio-Vascular System 15 11 Respiratory System 9 12 Genito-Urinary System 6 13 Educationally Subnormal 16 14 Severely Educationally Subnormal 24 15 Maladjusted/Autistic/Psychotic 2 16 Battered Babies 10 17 Blood Disease - 18 Limb and Skeletal Abnormality 14 19 Chronic Illness (neoplastic) 2 20 Skin Disease - 21 Other Conditions 1 22 Chromosomal Abnormalities (including Mongolism) 17 166 TABLE B Nos. of Children under Observation. Under 2 years 550 2-3 years 76 3-4 years 41 4-5 years 39 706 Child Health Centres Special Developmental examinations of babies at about 7 to 8 months old are held on one session per month at two Clinics in the Borough. These are done by Departmental medical officers who have had special training in developmental screening with the assistance of health visitors for some of the screening procedures. These help to provide a more thorough examination for this age group and also to relieve the pressure of work on the medical officers at their normal clinic sessions. 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 a week 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 69 Number of women who attended for post-natal examination 35 There were 311 midwives' clinic sessions at which 110 women attended. The total number of attendances was 663. Since attendances at these clinics are normally low, the remainder of the clinic session is devoted to cervical cytology. 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 436 Booked for domiciliary confinement 7 Total 443 The total number of attendances was 1,777. Premature Infants The total number of premature infants born in the area during 1972 was 153 compared with 128 in 1971. Sixteen premature infants died in 1972. This means that 10.4% of the 153 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 24 hrs of birth Survived 28 days 2 lb. 3 oz. or less - - - - - - - Over 2 lb. 3 oz. up to and including 3 lb. 4 oz. - - - - - - - Over 3 lb. 4 oz. up to and including 4 lb. 6 oz. - - - 2 - 2 2 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. - - - - - - - Totals — — — 2 — 2 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 eight 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 for investigation 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 West Wimbledon Monday 2-4 p.m. Friday 10 to 12 noon Baptist Hall* Longley Road, S.W.17 Tuesday 2-4 p.m. Cavendish Road Clinic Colliers Wood Monday 2-4 p.m. Friday 9.30-11.30 a.m. Church Road Clinic Mitcham Wednesday 2-4 p.m. Thursday 2-4 p.m. Churchill Hall* Effra Road, S.W.19 Tuesday 2-4 p.m. Emmanuel Hall* Lingfield Road, S.W.19 Thursday 2-4 p.m. 32 Toddler sessions are held, by appointment, at Western Road Clinic and at all of the above excepting Churchill Hall, Emmanuel Hall and St. John's Hall. * Denotes hired premises. A total of 6,604 children attended during the year. 33 Grand Drive Clinic Raynes Park Monday 10 to 12 noon and 2-4 p.m. Wednesday 10 to 12 noon Meopham Road Clinic Mitcham Wednesday 2-4 p.m. Middleton Road Clinic Morden Tuesday 2-4 p.m. Friday 2-4 p.m. Morden Road Clinic Merton Tuesday 2-4 p.m. Thursday 2-4 p.m. Russell Road Clinic Wimbledon Tuesday 2-4 p.m. Friday 2-4 p.m. St. John's Hall* High Path, Merton Thursday 10 to 12 noon St. Luke's Hall* Strathmore Road, S.W.19 Friday 2-4 p.m. Wide Way Clinic Mitcham Monday 2-4 p.m. Thursday 9.30-11.30 a.m. Attendances at Child Health Centres Name of Centre Total No. of Sessions First Attendances Total Attendances including firsts Born In Total 1967-72 1972 1971 196770 Amity Grove 99 192 312 280 784 3,945 Cavendish Road 99 158 131 123 412 3,163 Church Road 104 272 275 132 679 3,886 Churchill Hall 51 79 104 73 256 1,810 Emmanuel Hall 51 50 52 24 126 1,011 Grand Drive 148 188 263 223 674 4,652 Longley Road 51 143 293 85 521 3,082 Meopham Road 52 67 94 127 288 1,743 Middleton Road 101 101 200 309 610 2,400 Morden Road 103 116 153 124 393 1,969 Russell Road 101 254 226 198 678 3,813 St. John's Hall 52 45 93 131 269 1,380 St. Luke's Hall 50 104 55 36 195 1,675 Wide Way 100 171 247 301 719 4,694 Totals 1,162 1,940 2,498 2,166 6,604 39,223 Attendances at Toddlers' Clinics First attendances Total attendances Total sessions (All clinics) Born In Total 1967-71 1972 1971 1967-70 — 54 1491 1545 2121 266 Dental Care The number of expectant and nursing mothers treated in 1972 was slightly less than in 1971, but there was a slight increase in the numbers of pre-school children treated. The number of three and four year old children treated in the Borough continues to be well above the national average. Examined Commenced treatment Completed course of treatment Expectant and Nursing Mothers 37 33 26 Children under 5 610 332 330 Scaling and gum treatment Fillings Teeth otherwise conserved Extrac tions General anaesthe tics Dentures XRays Full Part Expectant and Nursing Mothers 13 64 - 18 1 1 2 3 Children under 5 39 823 29 41 19 — — 8 Developmental Clinic This is a clinic held twice monthly for children with suspected developmental delay. The children are seen by Dr. Rona Maclean, a consultant at the Manor Hospital, and one of the local Authority's doctors with training in assessing children with special needs. Also in attendance and playing a particularly important part is the Area Co-ordinator of Social Services. The children are seen in an informal setting with special emphasis on the needs of the whole family in relation to what services the Borough is able to offer to improve the child's potential. This entails close co-operation with various services, including the school psychological service, speech therapy, physiotherapy, audiology service and social workers. In any child in whom there is severe delay and special education will be appropriate, a home visit is made in addition by the local authority doctor. 34 Seventeen sessions were held during the year at which 18 children were seen for the first time and 53 children were seen for a subsequent case review. Congenital Malformations The following malformations were notified during the year:— Central Nervous System 11 Eye and Ear 2 Alimentary System 2 Urino-Genital System 1 Limbs 20 Other Malformations 4 Total 40 The number notified during 1971 was 54. Welfare Foods and Vitamins National Dried Milk and vitamins were available at all Child Health Centres and also at Russell Road Clinic and the W.R.V.S. Centres in Merton and Mitcham. Sales for the year 1972 are shown below:— National Dried Milk 14,059 tins Cod Liver Oil 613 botdes Vitamin Drops 'A', 'D', 'C' 8,394 bottles Vitamin Tablets 'A', 'D', 'C' 5,760 packets Orange Juice 28,843 bottles 35 THE NURSING SERVICES Throughout 1972 the demands made on all members of the community nursing staff have been very great. Requests for the services of health visitors, home nurses and domiciliary midwives are ever increasing. It is a tribute to the conscientiousness and loyalty of all staff that, however great their existing commitments, no request to undertake additional work is ever refused. The re-organisation of the National Health Service is causing considerable apprehension and sadness amongst the staff who will no longer be identified as members of the staff of the London Borough of Merton. Mrs. Poole, Chief Nursing Officer, attended a course for senior members of staff on Integrated Health Care at Manchester University in September. In October she was awarded a Secretary of States Fellowship and the Authority released her to return to Manchester as a Tutor. She was one of three nurses in the country to receive a Fellowship. The excellent relationships which at present exist between the nursing staff and their colleagues in other Departments of the Borough are firm ones and should not be disturbed when re-organisation does occur. It is therefore to be hoped, that with the increased liaison with hospital colleagues that re-organisation should bring, the public will receive an even better service of health care. In the late autumn, approval was granted to commence the much needed night nursing service and by the end of the year staff had been interviewed, appointments made and plans completed for this service to commence in January, 1973. The standards for staff appointed are necessarily very high. They must be professionally experienced and be able to nurse any patient regardless of the condition diagnosed; they must be personally acceptable to both patients and their relatives and be able to deal with any crisis with calmness and efficiency. In hospital, medical and other nursing assistance can be summoned promptly. At home, particularly where there is no telephone, the nurse has to act entirely on her own initiative. A new Clinic Session entitled 'Slimming for Health' was commenced in Church Road Clinic at the beginning of November. This clinic, run by two enthusiastic health visitors, received much publicity from both local and national press. In two months the combined weight loss of the group was 445 lbs.—a figure in itself indicative of the clinic's success. Many clients are referred to the clinic by general practitioners and health visitors. In all cases the would-be slimmer's general practitioner is informed to ensure that there are no medical contra-indications to their attending. Plans are well in hand for a second session at The Patrick Doody Clinic and Child Health Centre when it opens early in 1973. Once more the numbers of visits paid and treatments given to patients in their own homes have increased greatly. This year the district nursing sisters paid 117,297 visits, an increase of 8,655. 77% of these visits were to the elderly. Sometimes it is necessary, in order to prevent a patient being admitted to hospital, for the nurse to pay five or six visits daily. This 36 is indeed a worthwhile undertaking if patients are able to spend their last days of life in the comfort of their homes supported by their relatives. Many visitors were welcomed in the Health Department during the year whose particular interest was the nursing services. Among these were two senior nurses from Greece in March, a professional adviser from the Council for the Training and Education of Health Visitors in May and a nursing officer and administrative officer from the Department of Health and Social Security in November. HEALTH VISITING Staff As at 31st December, 1972, the staff consisted of:— 1 Principal Nursing Officer. 3 Nursing Officers. 27 Full-time health visitors. 4 Part-time health visitors. 1 Full-time specialist geriatric health visiter. 1 Full-time specialist chest diseases health visitor. 1 Full-time clinic school nurse. 9 Part-time clinic school nurses. 3 Full-time clinic a'des. 4 Health visitor students. Eight health visitors left during 1972. Introduction It has not been possible this year to increase the number of health visiting staff working with general practitioners in primary health care teams. A greater number of staff are required to organise work in this way, not only because of the large number of general practitioners who have patients in the Borough, but because the general practitioners soon appreciate the professional expertise of the health visitor. Her work load thus increases steadily and it has become apparent that to promote good health, prevent ill health and give adequate health counselling to the patients on the list of two or three doctors, more than one health visitor is required. To illustrate this increase in work during the year, an additional 210 persons who were suffering from mental illness and 101 persons with mental handicap, were visited by health visitors. These visits are extremely time consuming, not only in their execution but in the necessary discussions and follow-up action required when the visit has taken place. 1,544 elderly persons were visited and supported by health visitors during the year. This figure shows an increase of 350 on 1971. These are old persons not already receiving clinical care from district nursing sisters. It is essential that highly trained staff do not spend time in undertaking duties that can well be done by a less qualified person. With an increase in establishment this year it was possible to appoint an additional four trained nurses. These nurses, who work part-time, are very experienced, and the assistance they give to health visitors in undertaking clinic and school duties is invaluable. 37 Hospital Liaison Over the past years links with hospitals serving the Merton area have been made. This year has seen a continuing development with health visitors attending the Paediatric Departments of the St. Helier and Nelson Hospitals, the Infectious Diseases Department of St. George's Hospital and the Ante-natal Departments of St. Helier and the Nelson Hospitals. Here the health visitor can act as a liaison between the hospital and community services, thus ensuring continuity of care and advice. One nursing officer regularly attends a meeting of nursing officers in St. George's Hospital. This is invaluable in promoting good relationships and ensuring an interchange of ideas between nurses working in different parts of the service. Training of Health Visitor Students The emphasis placed on the care of patients in the community has resulted in an even greater increase this year in the number of training visits undertaken, and visits of observation made by students of various disciplines. 1,131 teaching sessions were given by health visitors—an increase of 261. Four health visitor students were sponsored for training in 1972. Two are undertaking their training at Ewell Technical College, one at Croydon Technical College and one at The Polytechnic of the South Bank. If successful they will join the health visiting staff in September, 1973. Eight health visitor students received their practical training in the Borough during the year and two students sponsored by Merton undertook their period of supervised practice in the Borough. Post Registration Training 3 health visitors attended post graduate refresher courses. 1 health visitor attended a Field Work Instructor's course. 1 health visitor attended Part 1 of a special course on health education. 25 health visitors and clinic nurses attended a special two-day course on Family Planning. 3 nurses attended a course for school nurses. 6 health visitors attended a special two-day course on health education. 12 health visitors attended day courses on various subjects in order to improve and maintain theoretical knowledge. Geriatric Health Visiting The specialist geriatric health visitor is an important member of the geriatric team led by the Consultant Geriatrican. She plays an important role in acting as a liaison between hospital, general practitioner and local authority services. It has not been possible to recruit a second health visitor for this highly specialised work, but a trained nurse, highly experienced in the practical care of the elderly was appointed in the autumn to act as an assistant to the geriatric health visitor. This appointment has proved a very successful one. 38 Health Education The teaching of positive health in some form is an integral part of every contact that a health visitor has with any member of the public. In addition to this personal teaching, more formal group teaching in health topics was undertaken in high and middle schools on 118 occasions. 260 classes were given to expectant mothers to prepare them for the birth and for the subsequent care of their babies. On 57 evenings both expectant mother and father attended classes in parentcraft. Here they saw films and discussed topics on preparing them for their future role as parents. These are highly successful and happy occasions. 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 the mentally ill To the mentally handicapped To geriatric cases Born in 1972 Other children aged under 5 years Total 2,768 9,649 12,417 228 131 1,544 Sessions attended by Health Visitors. Local Authority Ante Natal Cytology G.P. ante natal clinics Developmental (Morden Road) Special developmental 7/12, 9/12 Child health clinics G.P. child health clinics Toddler clinics G.P. toddler/developmenta Parentcraft (day) Parentcraft (evening) Expectant parents evenings G.P. vaccination and immunisation Case conferences Screening tests of hearing of young children Sessions with students Meetings Mothercraft Slimming for health G.P.'s obesity clinic Older person's clinic 73 133 44 65 1,724 495 381 48 37 20 52 57 38 134 1,131 376 260 16 38 147 Sessions attended by State Registered Nurses. Ante Natal/Cytology 268 Vaccination and immunisation 97 Developmental (Morden Road) 18 Child health clinics 512 Cystic fibrosis 55 Staff medicals 178 39 Staff MIDWIFERY As at 31st December, 1972, the staff consisted of:— 1 Principal Nursing Officer (Home Nursing and Midwifery) who is also Non-Medical Supervisor of Midwives. 1 Senior Nursing Officer, who is also qualified to act as NonMedical Supervisor of Midwives. 8 Whole-time district midwives. Introductory As anticipated, and in line with national trends, the number of babies born at home has continued to decline. There were 82 home confinements in 1972 compared with 135 in 1971. There has, however, been an increase in the number of mothers being taken, when in labour, into hospital by the domiciliary midwife who delivers her in the maternity unit. The mother and baby are, if their condition is satisfactory, quickly discharged home to be nursed. This system has much to commend it, it enables the patient to get to know and trust the midwife who cares for her in the ante-natal period. Any anxiety concerning labour can be allayed by being delivered by someone whom she knows, in the setting of a well-equipped hospital where prompt medical assistance is available should die need arise. When delivered, if she and her new baby are well, she does not then have to be separated for long from her husband and other members of the family. The number of mothers who are otherwise booked for planned early discharge from hospital remains high, and the number of visits paid to mothers discharged early increased in 1972 to 5,609. In 1971 the figure was 4,841. Midwives screened 672 babies by Guthrie test (for phenylketonuria). These were babies delivered at home or discharged from hospital before the sixth day. 41 repeat tests were undertaken. Organisation Two district nurse/midwives relieve the full-time midwives during holidays, refresher courses, sickness, etc. All midwives are motorists using either their own car or one supplied by the Authority. Maternity Cases Attended There were 82 domiciliary confinements reported and 2,281 hospital confinements during the year. This shows a reduction of 53 on the figure for 1971. Midwives employed by this Authority attended all home confinements, a doctor having been booked in all but three of the 82 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—67 Trilene—13 40 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. The Emergency Obstetric Unit The aid of this unit was summoned on two occasions and the patients were subsequently admitted to the hospital:— 2 cases of retained placenta. Early Discharges from Maternity Hospitals The numbers of discharges from hospital before the tenth day of puerperium were as follows:— 48 hours after confinement 341 3-7 days after confinement 237 8-10 days after confinement 59 Patients delivered by domiciliary midwives in hospital 59 Total 696 This shows an increase of 21 on those for 1971. Midwifery Training Following much detailed discussion between the Central Midwives Board and senior nursing staff from St. Helier Hospital and this Borough, an Integrated Midwifery Training Programme was commenced at St. Helier Hospital at the beginning of December, 1972. This training enables the student midwife to undertake the whole of her year's training at one hospital, instead of taking Part I in one hospital and Part II in another. The student spends three months of her training in the community working under the guidance of a teaching midwife. Here she not only learns to give midwifery care in the home, but she also learns about the working of community services, particularly those related to the care of the mother and her child. Six midwives from this Authority are approved by the Central Midwives Board as midwifery teachers. Eighteen student midwives received their training in Merton during the year. Four were still in training at the end of the year. Post-Registration Courses One midwife attended a statutory refresher course of one week and two others attended a clinical study day. 41 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 1,673 Post-natal visits to home confinements 2,725 Post-natal visits to 48-hour and other early discharges from hospitial 5,609 Total 10,007 Attendances at Clinics Three hundred and eleven ante-natal clinic sessions were held by midwives during the year and 110 women attended these clinics for the first time. The total number of attendances at midwives' ante-natal clinics was 663. Transfers to Hospital The undermentioned patients booked for home confinements were transferred to hospital:— (a) During pregnancy 17 (b) During labour 2 All patients transferred to hospital during labour are accompanied by a midwife except on the rare occasions when the Emergency Obstetric Squad has been called from the hospital. HOME NURSING Introduction The demands for nursing care to be given to patients within their own homes continues to rise. The demands come from general practitioners who do not wish to admit their patients to hospital unless and until it is vital to do so, and increasingly from hospital Consultants who are gradually realising the expertise of the highly trained district nursing sisters. During the year district nursing sisters paid 117,297 visits, an increase from 1971 of 8,655. Although 77% of these visits were to the elderly the number of patients under 65 years of age for whom visits were requested for the first time increased by 25%. It has not been possible this year to increase the number of staff working with general practitioners in primary health care teams. To organise work in this way requires extra staff; not only to meet the extra work load that inevitably follows the attachment of nursing staff to groups of general practitioners, but because much increased time is spent travelling over large parts of the Borough to nurse the widely scattered patients on a doctor's practice list, rather than to those confined within a geographical area. During 1972 there has been an increase of 25 % in the number of patients treated by district nursing sisters within general practitioner 42 surgeries. It has been difficult to meet the many requests made for this service and maintain the high standard of care given on seven days a week to patients within their own homes. The hours of work for home nurses were reduced to 40 hours on 1st January, 1972. The organisational problems of meeting service demands are great ones, particularly at times of sickness or during the main holiday periods. Without the loyalty and support of staff who will at times give up or change off-duty at very short notice our problems would be even greater. The work of the nursing auxiliaries continues to grow. They are indeed invaluable members of staff. They work with the district nursing sisters to whom they are responsible, undertaking work that does not require skilled nursing care, such as bathing, dressing, getting-up and putting to bed elderly or handicapped patients. During 1972 they paid 14,606 visits. Staff At 31st December, 1972, the staff consisted of:— 1 Principal Nursing Officer. 1 Senior Nursing Officer. 3 Nursing Officers. 21 Whole-time home nurses (female)—S.R.N. and District Trained. 6 Whole-time home nurses (female)—S.R.N. not District Trained. 2 Whole-time home nurses (male)—S.R.N. and District Trained. 1 Whole-time nurse (male)—S.R.N. not District Trained. 4 Part-time home nurses. 3 Whole time home nurses (female)—S.E.N. and District Trained. 3 Whole-time home nurses (female)—S.E.N. not District trained. 13 Part-time nursing auxiliaries (female). 1 Night nursing auxiliary. Training of District Nurses This authority is an approved training area for the practical part of the district nurse training leading to the National Certificate of District Nurse Training. Two state registered nurses and one state enrolled nurse successfully completed their training. Two of these nurses are still employed by this Authority. Four nursing auxiliaries received in-service training and are still employed by this Authority. Hospital Liaison Throughout the year we have welcomed many visitors from the hospitals situated within this Borough. Nurse tutors and ward sisters have come to learn at first-hand about the problems of caring for patients within their own homes and of the need to ensure that adequate support services are mobilised before a patient is discharged from hospital. Many nurses in training have spent up to a month 43 ing practical domiciliary experience as part of their overall training programme. Training visits or visits of observation were made to the District Nursing Service on 384 days. It has also been possible for some of the district nursing staff to spend some time in hospital learning about new methods of treatment and new drugs. It is hoped that during 1973 this arrangement will continue, and that it will be possible for a nursing officer to go into both St. Helier and St. George's Hospitals to act as a liaison officer, thus ensuring that for patients being discharged into the care of the domiciliary nurses, there is continuity of care. Post-Registration Courses One nursing officer attended a First Line Management Course. One nurse attended a Practical Work Instructors Course and one nurse a general refresher course. 28 staff attended day or half-day courses on various subjects, in order to maintain and improve technical skills and theoretical knowledge. 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 1.1.72 Cases added Cases removed Cases on books at end of year 0-4 years — 16 15 1 5-64 years 175 964 944 194 65 years and over 866 1,789 1,637 1,018 Totals 1,041 2,768 2,596 1,213 The total number of cases attended during the year was 3,809 and the total number of visits made was 117,297. 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. Twenty patients were nursed during 1972, receiving a total of 80 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 44 a really sick patient, particularly when it is desired that the patient shall remain at home until the end. The Authority also operates 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 and Appliances Pads and appliances are supplied to patients free of charge at the request of either the home nurse in attendance, the patient, the general practitioner or the health visitor. With the increase in the number of elderly and handicapped persons being cared for at home the demands continue to rise. 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 home nurse advises this. It is a growing and much appreciated service. 45 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:— 'During 1972, 107 patients were seen at the clinic—an increase of 17 over 1971, and 719 old patients were seen, an increase of 42 over 1971. 'The waiting list has continued to grow and this means that the clinic is meeting a need in older people. 'The occasions when some major abnormality is found during examinations are comparatively few, although it has sometimes been necessary to make immediate consultations with the family doctor or the hospital pathologist. Sometimes conditions are revealed which may require further investigation and treatment in which case the patient is referred to his own doctor. One tries to use the medical examination as a basis for discussion and explanation so that the patient can get his complaint in perspective and can be helped to see how much he can help himself. This reduces anxiety and introspection and, it is hoped, also relieves pressure on the family doctor. 'It is felt that the annual medical inspection is important and that in order to be of maximum benefit, it must be unhurried. At second and subsequent visits, patients know the clinic staff better; they have more confidence, and it is often possible to give them more help than when they first came. 'The health visitor works closely with the doctors and continues the counselling begun at the first visit, paying special attention to the more vulnerable people, i.e., those living alone, the recently bereaved, and those looking after sick or handicapped relatives, and the recently retired. She also sees patients with special health problems, such as obesity, anxiety or depression.' Attendances were:— Number of new patients seen in 1972 Male 27 Female 80 Number of re-attendances in 1972 Male 150 Female 569 Average age of new patients 67 Dr. W. B. James makes the following observations on the Middleton Road Clinic:— 'The clinic continues to fulfil the need for older people to be given a medical assessment and certainly from those who attend one gets the impression of appreciation of the services offered. 'In terms of early warning or early diagnosis of certain cases of diabetes and urinary infection and severe hypertension, there has been an appreciation of the discovery.' Attendances were:— Number of new patients seen in 1972 Male 23 Female 49 Number of re-attendances in 1972 Male 28 Female 68 Average age of new patients 64 46 THE HEALTH EDUCATION SERVICE The chief enemy of health is ignorance, since from this spring a host of other enemies—fear, carelessness, obstinacy, and the belief that the terrible thing always happens to someone else. Health education, consistently carried out by expert staff can dispel ignorance. Since people very so widely in character, attitudes and degree of education, every possible propaganda method must be employed. There are those who like to get together in groups to discuss a variety of subjects—and it is then surprising to discover how wide is the range of their interests. It also becomes apparent how little knowledge some members of a group possess on some matters, which to other members of the group are well known. Health Education in Clinics The Health Education Officer, after due consultation and consideration, prepares a yearly list of themes—generally one for every month. All material needed to reinforce the spoken word is assembled and distributed to clinics throughout the Borough. This material includes posters, pamphlets and indeed every form of visual aid that can possibly be provided. It is a newspaper adage that one picture is worth a thousand words and nowhere does this apply more than in health education. Many people are extraordinarily unimaginative and many more are plain inattentive—and it is to these that the visual aids are so important. Of necessity, the range of subjects is somewhat repetitive—some subjects such as dental health, immunisation, sexually-transmitted diseases, obesity, hygiene, mental health, prevention of accidents in the home, cervical cytology, smoking hazards, are standard, but by varying the method of presentation and including each time the various advances that are constantly being made in the understanding and treatment of the matters discussed, interest can be maintained. Besides this, repetition of a theme reinforces the impression it makes on the minds of those attending, and with a constantly changing population there will always be many to whom the subject is entirely new. Health Education in Schools and Youth Clubs Nowhere is the idea of 'catching 'em young' more important than in health education. It is widely accepted that habits formed in childhood, whether they be good or bad, are those most likely to persist. The younger the child the more ingrained the habit. This is what makes the training of parents so important, for, as William Stern says in ' The Psychology of Early Childhood',: 'Without exception, mothers exercise the strongest suggestive influences Their belief becomes the child's dogma.' Of course, not all parents exercise the right influence and health education staff must try, to the best of their ability, to induce this beneficial influence where it is not evident. 47 Both the health education staff and health visitors try constantly to do this by teaching programmes in schools. Unhappily shortage of time confines such teaching to High Schools at the moment where, although the content of the talks is clearly more advanced, the chances of establishing correct health attitudes are correspondingly less because of the age of the pupils. It is encouraging, however, to find that schools are becoming increasingly aware of the opportunities offered by the health education service. This has meant ever-growing requests for advice to teachers on how to incorporate health education into their own curricula, as well as for literature and visual aids. Recognising the importance of this side of their work, the health education service meet all requests to the best of their ability. YOUTH CLUBS also call increasingly on the health education service. As many of the calls come from the members and not merely from the leaders (and thus do not comprise ' captive audiences') they are always responded to. Since youth clubs consist mainly of adolescents, many of the requests were for information on matters relating to sex. Such lectures attracted large audiences. It is pleasing to record that reports show that an increased sense of responsibility and consideration had occurred in the attitudes of many of the young people who attended. Training The need to train others to follow in the footsteps of the present incumbents is always uppermost in the minds of all concerned in this work. Thus, the Health Education Officer, in addition to her other duties, gives lectures at a Teacher Training College and a Midwife Teacher Training College. She also helps in the training of student nurses and midwives while they are attached to the community nursing services. Displays and Exhibitions The Health Department's contribution to this year's Civic Exhibition covered Food Hygiene and the Prevention of SexuallyTransmitted Diseases. Displays and exhibitions on selected topics were also held in clinics throughout the Borough. Young Wives' Groups These functions are among the most popular of those organised by the health education service. The groups meet at clinics in various parts of the Borough, either during the afternoon (when play and care are provided for their children) or in the evening. A wide range of subjects discussed informally is arranged by the health education staff. There is no doubt that the benefits derived from this kind of gettogether are considerable, if only in an increased ability to communicate with other people. 48 Future Development The great problem facing Health Education at present is how it is to be developed in the future, and serious thought must be given to what sort of health education service is needed and how to implement any policy eventually formulated in view of National Health Service re-organisation. 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 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, 1972, 1,372 new applications for treatment were received. The following table gives figures for the Direct Scheme:— Category Persons treated in 1972 Number of treatments given Number on books at 31.12.72 Elderly 5,544 29,521 5,282 Registered Blind or Partially Sighted 112 481 89 Physically Handicapped 206 1,076 194 Expectant Mothers 7 10 3 Totals 5,869 31,088 5,568 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 home nurse. The beds are hired from the suppliers and 147 such loans were made this year. 49 In addition to the ripple beds, a ripple chair pad is now available to those patients who are able to leave their beds. Since, however, the majority of cases using ripple beds are bedridden, the demand for chair pads is very small. Three such loans were made in 1972. 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 beds 1 Crutches 19 Dunlopillo mattresses 1 Feeding cups 10 Air rings 64 Inhalers 3 Bed rests 76 Waterproof sheets 90 Bed pans 61 Pillow cases 8 Bed tables/trays 11 Urinals 67 Invalid chairs 119 Walking frames and tripods 31 Invalid chairs (self-propelled) 10 Fracture boards 6 Commodes 131 Sundries 61 Cradles 55 Recuperative Holidays Under Section 22 of the National Health Service Act, 1946, the Authority is empowered to provide a recuperative holiday for expectant and nursing mothers needing it to complete or assist in their recovery to normal health, but who do not need organised medical or nursing care. Recommendation from a Departmental Medical Officer is necessary. No holidays were arranged in 1972. Cervical Cytology 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. A press campaign was launched in the latter part of the year and women were invited to attend normal daytime sessions or special evening sessions which were held for a period. The response to evening appointments was not so great as was anticipated and in ten special evening sessions it was possible to deal with all who had requested an evening appointment. 50 The Cytology Clinics are very worthwhile since in addition to being a cancer screening, minor gynaecological conditions are discovered which can be effectively dealt with. During the year 1,016 new cases were dealt with and 1,631 repeat smears were taken. From this total of 2,644 smears taken during 1972, ten required further investigation for possible malignancy. These patients were referred to their own doctors for treatment of infection by trichinomas, monilia and other organisms, also for other defects found on cervical examination. 51 FAMILY PLANNING General The Authority continued during the year the arrangement under which examination, advice, treatment and supplies are free to all 'medical' cases, and free examination, advice and treatment to all social cases who must, however, pay for supplies unless, upon assessment, it was found they were unable to do so. Discussions had been held, towards the end of the year with a medical officer of the Family Planning Association with a view to establishing, in the new Patrick Doody Clinic and Child Health Centre when it opens early in 1973, a weekly session for ' Youth Counselling ' for adolescents over the age of 16 who wish advice and guidance. The service continued to expand during the year, and was the subject of much publicity in the local press. Advertising was also carried out by the South-West London Branch of the Family Planning Association, and health visitors, midwives and district nurses also assisted with propaganda on the service. The Future Service At the end of the year, consideration was being given by the Health Committee to the introduction, from 1st April, 1973, of an entirely free contraceptive service, subject to the approval of the Council. Organisation Family planning sessions being held at Local Authority Clinics at the end of the year were 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, 9.30-11.00 Russell Road Clinic, Wimbledon Thursday mornings, 9.30-11.00 Monday, Wednesday, Thursday and Friday evenings, 6.15-8.15. Wide Way, Mitcham Monday mornings, 9.30-11.00 Monday evenings, 7.30-8.30 In addition to these sessions there are two sessions per week of clinics solely for the provision and fitting of intra-uterine contraceptive devices, as follows:— The Wilson Hospital, Cranmer Road, Mitcham Mondays, 6.30 p.m. to 7.30 p.m. The Nelson Hospital, Kingston Road Thursdays, 3 p.m. to 5 p.m. The Authority also accepts financial responsibility for any Merton cases who present themselves at the Brook Advisory Centre, and during the year the following numbers of cases were dealt with:— 52 Statistics Total number of new patients seen 2,053 Total number of patients seen (including new patients) 6,241 Total number of attendances 14,567 Number of cervical smears taken 2,676 Total number of clinic sessions 816 Domiciliary Service The Authority had decided in August, 1971, to extend the Domiciliary Service. It had always been felt that this was a most important aspect of family planning, since it provides a service to families under great stress who have real need of advice on family planning, but who would not avail themselves of the normal service provided at Family Planning Clinics, or by their own family doctors. This had expanded so quickly that by the end of 1972 59 cases had been referred. Geriatric Service I am indebted to Dr. Peter Millard, the Borough's Consultant Physician in Geriatrics, for the following report on this service:— 'During 1972, 525 elderly people were referred for the first time to the Geriatric Service. Not all of these were admitted, some have been seen as out-patients, at the Day Hospital or on a domiciliary visit only. There were 656 admissions and 422 discharges from the beds of the department. Of those admitted 139 died and 95 were in-patients on the 1st January, 1973. Of these, 31 are liable to be long stay hospital patients. There were 15 discharges to Part III homes. 'The work load of the Day Hospital is continuing to increase. A total of 133 new patients attended the Day Hospital and transport was provided for 5,658 attendances during the year. Difficulties arise in running the service for the area because of the scattered nature of the hospital beds but in spite of this at the time of writing the waiting list of admissions to the department from the community is nil, and it is rare for somebody requiring admission from their own home to have to wait more than three days. 'Closer links have been developed between the Health and Social Services Departments of the Borough thus enabling us to provide for the elderly of Merton a service geared to their needs.' 53 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR This is the Eighth Annual Report on the Environmental Health of the London Borough of Merton and the contribution which Public Health Inspectors and the other members of the Environmental Health team are making to improve standards within the Borough. 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. 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 four caravan yards within the Borough, each with a standpipe 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 1972. 'All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after the analytical results are found to be satisfactory. 'The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. 'The Board has no record of the number of structurally separate dwellings supplied in the area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1972, was 147,718 'No houses were permanently supplied by stand-pipe. 'No artificial fluoride is being added and where the fluoride content is indicated in the analyses, it represents the naturally occurring fluoride in the water. 'The supply was derived from the following works and pumping stations:— 54 River Thames-derived water from the Thames Valley group of works. Well water from Merton Pumping Station. 'No new sources of supply were instituted and there were no changes to the general scheme of supply in the area. '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 1972, samples of water were taken for bacteriological and chemical examination by the Public Health Inspectors as follows:— Bacteriological— Swimming Baths 208 Other premises:— Metropolitan Water Board 6 Sutton District Water Company 6 220 Unsatisfactory Results— Swimming Baths 9 Chemical— Swimming Baths 10 Other premises:— Metropolitan Water Board 5 Sutton District Water Company 2 17 All 17 of these samples were satisfactory. The swimming baths mentioned above include installations at certain school premises, and these in the main were satisfactory. 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. 55 District Inspection The following is a summary of the complaints and requests received and visits made during the year 1972:— Complaints received— General disrepair and insanitary conditions 261 Dampness 268 Overcrowding 20 Defective drainage system 132 Blocked drainage system 1,169 Defective drainage fittings 9 Defective sanitary accommodation 62 Defective service water pipes 57 Absence of, or defective dustbins 3 Accumulation of refuse, etc. 378 Rats and mice 2,070 Pigeons 67 Foxes 10 Insect pests 646 Smoke nuisances 169 Noise 119 Smells and odours 182 Unsound food 336 Water supply 68 Miscellaneous 64 6,090 Visits made— General. P.H. Act (Nuisance) P.H. Act (Dwelling houses) Storage of refuse Drains testing Choked drains Other drainage works Radioactivity Child Minders 2,894 2,075 165 46 2,163 1,057 33 336 9,219 Housing. Housing Act (Dwelling houses) Overcrowding Permitted number measurements Rent Act Underground rooms Houses in multiple occupation Improvement grants Caravans Qualification certificates 1,046 40 84 13 57 182 1,740 234 3,513 6,909 56 Food and Food Premises. Milk processing dairies Milk Vendors Ice-cream premises Food factories Food vehicles School kitchens Restaurant kitchens Licensed premises Bakehouses Butchers Wet and fried fish shops Other food shops Meat inspection Unsound food Sampling: Food and drugs Sampling: Milk Sampling: Ice-cream Sampling: Water Clean Air Act, 1956/1968. Smoke control areas Other Clean Air Act visits Smoke observations Air pollution recording apparatus Factories Act. 1961. Factories (powered) Factories (non-powered) Factories (building sites) Outworkers Workplaces Infectious Diseases. I.D. enquiries I.D. contacts Food poisoning Specimens Disinfection Long stay immigrants 107 113 231 17 555 32 894 243 79 310 56 892 120 546 111 329 12 51 9,578 537 406 590 4,698 11,111 128 3 18 12 6 409 10 7 2 11 359 167 798 Offices, Shops and Railway Premises Act, 1963. O.S.R. general inspection offices 198 O.S.R. general inspection shops 320 O.S.R. general inspection wholesale/warehouses 27 O.S.R. general inspection catering/canteens 62 O.S.R. general inspection fuel depots 2 O.S.R. all other visits 870 1,479 57 Insects, Pests, Rodents. Rats and mice control 17,254 Insect control 439 Pigeon control 151 Verminous premises 108 Foxes 32 17,984 Animals. Stables 44 Piggeries 6 50 Miscellaneous. Places of public entertainment 5 Hairdressers and barbers 67 Fertilisers and Feeding Stuffs Act, 1926 16 Noise Abatement Act, 1960 360 Schools 19 Court proceedings 46 Public conveniences 20 Water courses 29 Shops Acts, 1950-1968 330 Pet shops 53 Diseases of Animals Act, 1950 3 Exhumations 7 Other visits 879 1,834 54,249 Result of Service of Notices (1) Legal Proceedings. A defendant was fined £25 and ordered to pay £7 costs for failing to comply with a Nuisance Order made under the provisions of section 94 of the Public Health Act, 1936. (2) Nuisances abated and defects remedied. Six thousand three hundred and thirty-five defects were remedied as a result of the service of verbal, written and statutory notices. 2,002 were in connection with the drainage of buildings; 3,277 in and around dwelling houses; 908 in connection with food premises; and 148 were of a miscellaneous nature. 58 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 34 3 - - Factories with mechanical power 923 128 9 — Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 44 24 1 - Totals 1001 155 10 — (2) Defects found. Particulars Number of Defects Prosecutions Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of cleanliness (S.l) 3 3 - 1 - Overcrowding (S.2) — — - — - Unreasonable temperature (S.3) — — - — - Inadequate ventilation (S.4) 5 1 - — - Ineffective drainage of floors (S.6) — — - — - Sanitary Conveniences (S.7):— Insufficient 3 1 - 1 - Unsuitable or defective 12 12 - 1 - Not separate for sexes 3 — - 1 - Other offences (excluding offences relating to outwork) — — — — — Totals 26 17 — 4 — 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 28 - - - - - Cardboard box- making 57 — — — — - Total 85 — — — — — 59 Number of addresses received from other Councils 66 Number of addresses forwarded to other Councils 65 Number of premises where outwork was carried on at the end of 1972 87 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 staffed by the Health Department. During 1972, 29 local residents received treatment at the Cleansing Station. A fee of £1.50 is payable by outside authorities for each person 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 on the Register kept in accordance with these Regulations is 144. There are four dairies handling milk in botdes 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. A number of Health Certificates were issued to the company concerned for the export of U.H.T. milk. Milk (Special Designation) Regulations, 1963, as amended. The following licences, which will remain in force until 31st December, 1975, have been issued under these Regulations:— Dealers' (Pasteuriser's) Licences 2 Dealers' (Ultra Heat Treated) Licence 1 Dealers' (Pre-packed Milk) Licences:— Untreated milk 1 Pasteurised milk 135 Sterilised milk 80 Ultra Heat Treated milk 89 During the year, 210 samples of designated milk were submitted for prescribed tests. The results were as follows:— Designation. Satisfactory. Unsatisfactory. Pasteurised 183 3 Sterilised 18 — Untreated — — Ultra Heat Treated 6 — Brucella Abortus. No samples of raw milk were submitted for examination. 60 Ice-Cream. The number of premises registered for the storage and sale of ice-cream is 554. Supplies are generally from well-known sources, and before premises are registered, compliance with Food Hygiene Regulations requirements is ensured. The Inspectors made 231 visits to these premises during the year and 18 samples of ice-cream were obtained for bacteriological examination. The results were:— Grade 1 16 Grade 3 2 Bacteriological Examination of Other Foods. Subsequent to outbreaks of suspected food poisoning four 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. 3,640 visits were made to premises in which foodstuffs intended for human consumption were prepared, stored or sold. In addition, 555 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 received requests during the season for approval of catering arrangements at these meetings, and 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 Cemeteries 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 co-operation of the Director in maintaining a high standard. The catering arrangements at the Merton Show were inspected before and during the course of the Show period, and were satisfactory. Fairs on Wimbledon and Mitcham Commons are visited and food vending points are given particular attention. I think it must be 61 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 436 Bakers 60 Grocers and Provisions Dealers 174 Butchers 99 Fishmongers and Fish Fryers 52 Milk Distributors 144 Chemists 43 Licensed Premises 236 Clubs 49 Restaurants 154 Works Canteens 80 School Canteens and Kitchens 100 Food Stalls/Vehicles 152 Places of Public Entertainment 36 2,174 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 554 Registered for the manufacture and sale of ice-cream 7 Registered for the preparation or manufacture of sausages 75 Registered for the preparation or manfacture of potted, pressed, pickled or preserved food 204 The number of inspections of registered food premises during 1972 was 1,158. 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 1972:— Tons. Cwts. Lbs. Canned foods 7 8 49 Frozen foods and ice-cream 5 3 31 Meat, bacon, poultry 3 — 6 Fish — 2 74 Fruit and vegetables — 11 36 Cereals, bread and flour — 5 20 Confectionery — — 18 Vinegar, pickles, spices — — 33 Cheese, butter — — 76 Miscellaneous — 1 84 16 13 91 62 The number of complaints received during the year regarding unsound food was 336. 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:— Mouldy bread (7). Metal in loaf (3)***. Metal bolt in loaf*. Old dough baked in loaf. Discolouration in loaf (2). Grease in bread (3). Rubber ring in loaf. Insects baked in bread (2). Foreign matter in bread (2). Hair in bread roll. Grey colour in bread roll. Foreign matter in bread roll. Dirty milk bottles (25)************** Foil cap in milk (2). Glass in milk. Sour milk (4)**. Black spots in milk (3). Bitter taste to milk. Peach stone in milk*. Black sediment in milk. Slug in milk. Macaroni in milk. Paper in milk. Cigarette in milk*. Plastic drinking straw in milk*. Mouldy pancakes. Mouldy fruit pie (2). Mouldy cheese (7)*. Mouldy canned peaches. Mouldy canned baby food (4). Mouldy apple strudels. Mouldy sausages (3)*. Mouldy pork pie. Mouldy lambs tongues. Mouldy tea. Mouldy pasties (2)**. Mouldy duck pate. Mouldy steak and kidney pie. Mouldy butter*. Mouldy baked beans. No rice in canned rice pudding. Rodent droppings in cake filling*. Insect in canned pineapple. Insect larvae in baby food. Insect in coriander seed*. Insects in canned apricots. Insects in cereal. Insects in yoghurt. 63 Larvae in chocolate confection. Worms in cod (2). Flies in orange juice. Fly in fruit pie. Grasshopper in fruit cocktail. Larder beetles in confectionery. Beetle in canned loganberries. Beetle in canned fruit salad. Ants in bakewell tarts*. Maggots in cheese roll*. Maggots in cheese. Maggots in chicken*. Soapy taste of tea. Cardboard in fish portions. Stale biscuits. Stale gateaux. Stale cake. Stale mushroom pie. Stale meat pie. Stale coleslaw. Rusty can of rhubarb. Stone in peas. Black marks in baked beans. Black particles in luncheon meat. Black particles in flour. Black substance in yoghurt. Dye in steaklets. Green potatoes*. Green colouration in canned pork. Discoloured chocolates (2). Discoloured breakfast slices. Dark substance in frozen peas. White substance in ham*. Decomposed chicken portions (2). Unfit scampi. Unfit breakfast cereal. Unfit meat (2). Unfit herrings. Abcess in pork chop. Abcess in kidney. Plastic in pastry. Plastic in canned peas*. Undercooked pastry. Sour sausages (2). Sour cream (3)*. Sold out of date, 'Fish Bordelaise'. Sold out of date, bacon. Sold out of date, cream. Unsound bacon. Unsound sea island rice. Unsound haddock portions. Unfresh eggs. Smell from fish fingers. Smell from lamb chop. Smell from canned peas. 64 Smell from fruit pie. Fungus in bottle of soft drink (2). Bitter bottle of soft drink. Bitter taste to scotch beef. Strong flavoured cheese. Tainted milk and fruit pudding. Sausage deficient in meat. Staple in cooked ham. Nail in pickle. Nail in cake. Metal in pork pie*. Metal in baby food. Metal in cheese*. Wire in biscuits. Wire in fruit bun. Blown can of baked beans. Watered whisky. Glass in hazelnut spread. Glass granules around bottle neck. Glass in doughnut. Glass in tomato ketchup*. Crystals in canned salmon. Chicken curry not containing chicken. Match in iced cake. Bristle in cream cracker. Wood in canned blackberries*. Wood in marmalade. Dirt on cheese. Dirty bottle of medicine. Foreign matter in can of cheese savoury. Oily taste to corned beef. Twine in can of blackberries. Fermenting yoghurt*. It will be observed that many of these complaints referred to mould growths on food and unsound and sour foods. The Public Health Inspectors Association have been pressing the Government for some time to produce legislation that would provide either for date stamping of perishable foods or, at any rate, a uniform coding that would be easily recognised by all shop keepers. Pressure for a change in the legislation is building up from a number of sources. The housewives today would appear to be becoming more vigilant and the women's organisations in this country are also taking this matter up with the Government. It is to be hoped that in the not too distant future there will be legislation covering this point. 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. 65 During the year 1972, 258 samples were submitted of which 24 were formal samples, and 234 informal. The Public Analyst reported that of these samples 245 were found to be genuine, and to comply with the relevant Acts, Orders and Regulations, and 13 did not so comply. In addition to the samples submitted to the Public Analyst, 48 sampks of spirits were subjected at the time of purchase to a gravity test and were found to be satisfactory. 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 Food, and details are available. I am, however, setting out particulars of non-genuine samples and the action taken in connection with them. Pork Chipolatas. Pork Sausages. The sausages contained sulphur dioxide as an added preservative which was not declared at the time of purchase, contrary to the Preservatives in Food Regulations, 1962. These irregularities were drawn to the attention of the vendors. Blackcurrant tarts. This sample of tarts was made with blackcurrant jam containing 12.5% fruit and in the opinion of the Public Analyst should be described as blackcurrant jam tarts. Discussions undertaken with producer of tarts. Canned Ham. Sample contained lean (defatted) meat 75.4%, fat 6.6% being 82% total meat. According to the Canned Meat Products Regulations, 1967, there should not be less than 90% meat. This irregularity was drawn to the attention of the canners. Fish Fingers. The ingredients of this sample of coated fish fingers was not declared on the wrapper contravening the Labelling of Food Order, 1953. This sample, with others, had been created by the breaking down of a bulk supply by the staff of a store against the instructions of the management. Steakburghers. Informal sample consisting of meat with cereal contained total meat 76%. The Sausage and Other Meat Product Regulations, 1967, state that meat with cereal must contain not less than 80% meat. Correspondence with packers. Subsequent formal sample was found to be satisfactory. Bulgarian White Brined Sheep's Cheese. The container of the cheese did not bear the description ' Full fat soft cheese' as required by the Cheese Regulations, 1970. Correspondence with the importers. Instant Drinking Chocolate with added Vitamins A, B, B, and C. The sample consisted of drinking chocolate made with low fat cocoa. The sample should contain not less than 20% of cocoa butter, the figure on analysis showed only 15.7% to be present. Discussion undertaken with the manufacturers suggesting revision of label. Cooked Pressed Shoulder. The ingredients contained in this can of cured pork shoulder in natural juices, with gelatine added, was not declared, as 66 required by the Labelling of Food Order, 1953. Correspondence entered into with the producer, and vendor. Self adhesive labels produced for fixing to existing stock. Cream of Tomato Soup. Included in the list of ingredients was the term ' Soluble Protein' which is a generic term and is not an appropriate designation for the purposes of the Labelling of Food Order, 1953. After correspondence, the manufacturers agreed to revise their label for this product. Canned Cooked Ham. A sample of canned ham with natural juices, gelatine added, the ingredients of which were not declared as required by the Labelling of Food Order, 1953. A product from Holland, the importers agreed to provide self adhesive labels for existing stocks, and the canners agreed to revise the printing on the can. Beef Stew. A canned meat product containing 30% total meat. A canned meat product to which the Canned Meat Product Regulations, 1967, apply, must have a meat content of not less than 35%. The sample was therefore deficient in meat to the extent of 14%. This informal sample of stew was repeated formally and found to be satisfactory. Ox Tongue. A canned meat product containing ox tongues 85% and jelly 15%. The description required by the Canned Meat Product Regulations, 1967, did not appear on the label. The attention of the packer was drawn to this irregularity. The following 33 samples were submitted for special examination, the results being as shown:— Bread (2) Non-genuine (2) Cheese savoury Non-Genuine Corned beef Non-Genuine Coriander seed Non-Genuine Cream cakes Non-Genuine Ham Non-Genuine Jam Genuine Milk (19) Non-genuine (15) Milk powder Genuine Mushroom soup powder Genuine Pork pie Non-genuine Peppermint creams Genuine Potatoes Non-genuine Yoghurt Non-genuine Further particulars regarding the 25 non-genuine samples are as follows:— Bread (2). A piece of metal contained in a slice of bread from a sliced loaf—legal proceedings instituted—defendants pleaded guilty —fined £30 with £7 costs. Foreign matter consisting of compounds of copper and zinc with traces of calcium was found in one end piece and one 67 slice of wheatmeal bread. This foreign matter was in the opinion of the Public Analyst a corrosion product, probably derived from a water system, which had fallen into the dough. Letter sent to the bakery concerned. Cheese Savoury. Strained baby food contained foreign matter which proved to consist of a small piece of meat tissue—referred to manufacturer. Corned Beef. The corned beef had a taste of mineral oil—examination indicated presence of traces of paraffin probably derived from the tin plate used in making the can—letter to importers. Coriander Seed. Infested with beetles and larvae—legal proceedings instituted —defendants pleaded guilty—fined £20 with £7 costs. Cream Cake. Rodent droppings in the cream filling of a cake—legal proceedings—defendant pleaded not guilty—cake purchased from canteen—case dismissed. Ham A slice of boiled ham contained six small pieces of white substance which proved to be paint. Legal proceedings— defendant pleaded guilty—fined £15 with £7 costs. Milk (15). Twelve dirty milk bottles gave rise to legal proceedings—in each case defendants pleaded guilty—fines totalling £275 with costs of £89 were imposed. A bent plastic drinking straw in a one-third pint bottle of milk gave rise to legal proceedings—defendants pleaded guilty—fined £5 with £7 costs. A milk bottle had a portion of cigarette consisting of a cork tip, pieces of filter tip and pieces of tobacco floating in the milk—legal proceedings instituted—defendant pleaded guilty —fined £30 with £7 costs. A softened peach stone which was too large to pass through the neck of the bottle was found in a bottle of milk—legal proceedings instituted — defendants pleaded guilty — fined £30 with £7 costs. Pork Pie. Small thin pieces of aluminium embedded in the pastry of a small pork pie—legal proceedings—defendant pleaded guilty—fined £25 with £7 costs. Potatoes. Sixteen potatoes all showing a green colouration of the skin and not considered fit for human consumption—legal proceedings instituted—defendant pleaded guilty—conditional discharge—costs £7. Yoghurt. A fly, probably introduced with the fruit into the carton of raspberry Low Fat Yoghurt. A warning letter was sent to the manufacturers. 68 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. Mouldy Boursin cheese—defendants pleaded guilty—fined £25 with £10 costs. Maggot in cheese and tomato roll—defendants pleaded guilty —fined £40 with £11 costs. Sour condition of cream sold out of date—defendants pleaded guilty—fined £10 with £7 costs. When a packet of skinless sausages were opened they were found to be affected by mould—sold out of date—defendants pleaded guilty—fined £25 with £7 costs. Live maggots under the skin of a cooked hind quarter of chicken—defendants pleaded guilty—fined £10 with £7.50 costs and expenses. A white nylon bearing contained within a can of garden peas —vendors pleaded warranty—proceedings against packers who pleaded guilty—fined £10 with £7 costs. A number of live ants were found in a carton of six bakewell tarts which were purchased from a shop with an ant infestation—defendant pleaded guilty—fined £20 with £10 costs. Two pieces of wood were found in the contents of a can of blackberries—vendors pleaded warranty—proceedings against packers who pleaded guilty—fined £20 with £7 costs. A prewrapped half pound packet of butter which when opened was found to be affected by a mould growth—proceedings against vendor who pleaded not guilty—case not proven—costs of £30 against Council. Fragments of glass in a jar of tomato ketchup—legal proceedings against manufacturers who pleaded guilty—fined £25 with £7 costs. Mouldy meat and vegetable pasty—sold out of date—over one month old—vendor pleaded guilty—fined £10 with £7 costs. Four small pieces of metal were found in the substance of a piece of prewrapped Edam cheese—legal proceedings against vendor who pleaded guilty—fined £20 with £10 costs. A small piece of jagged metal embedded and baked in the surface of a loaf—the bakers of the loaf pleaded guilty and were fined £25 with £10 costs. A piece of metal protruding from a slice of bread taken from a cut loaf, proved to be a headless bolt—the bakers, pleading guilty were fined £30 with £11 costs. 69 A small metal casting was discovered in an un-cut loaf of bread—baker pleaded guilty and was fined £50 with £8 costs. Nine one-third pint bottles of milk delivered by a roundsman to a children's playgroup were found to be sour within half an hour of delivery—dairy pleaded guilty—fined £10 with £7 costs. Twenty-one one-third pint bottles of milk delivered by roundsman to a playgroup, were found on opening within five minutes of delivery to be sour—dairy pleaded guilty— fined £50 with £11 costs. Second similar offence within six weeks. Food and Drugs Act, 1955—Section 8. Two mouldy sausage and onion pasties, unfit for human consumption were sold and a further two pasties, also mouldy were offered for sale—legal proceedings against vendor who pleaded guilty—fined £10 on both counts with £7 costs. Milk and Dairies (General) Regulations, 1959. Two one-pint bottles of milk containing cement deposits— the same defendant in both cases pleaded guilty—fines of £20 and £30 with costs of £10 and £7 were imposed. Food Hygiene (Market Stalls & Delivery Vehicles) Regulations, 1966. For failing to provide for use in a food vehicle from which ice cream was being sold, a wash hand basin with an adequate supply of hot water at a suitably controlled temperature, and for failing to provide suitable and sufficient bandages for first aid treatment, a trader who had pleaded not guilty was fined £15 with 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 at an inland destination, special provisions are necessary. The Imported Food Regulations, 1968, which came into operation on 1st August, 1968, make 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. 70 During the past year several articles have been published in national newspapers and professional journals on this subject and correspondence has ensued. The Association of Public Health Inspectors are endeavouring to establish the degree of difficulties which have arisen in the working of the Regulations, and it is to be hoped that ultimately a satisfactory system of notification and detention will be formulated. Of all the duties carried out by Public Health Inspectors, one of the most important is in the field of housing. The aspects of housing work for which they are responsible include the clearance of houses which are unfit for human habitation; the repair of houses; the improvement of individual houses; the improvement of houses as part of the policy of improving housing areas as a whole; the inspection and control of houses which are in multi-occupation, and miscellaneous duties including the inspection of houses in connection with Rent Act legislation. 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. Applications for Improvement Grants referred to me by the Borough Surveyor numbered 544 (Standard 150; Discretionary 394). All the houses concerned were inspected to Housing Act standards, and by arrangement with the applicants, were made fit as a condition of the approval of a grant. The number of applications received was slightly less than last year, but what is most noticeable is the large increase in the number of Discretionary grants in proportion to Standard grants, the Discretionary grants now forming 73% of the total applications. This is no doubt due in part to the fact that the Council can now pay grant towards the cost of certain essential repairs where they form part of the improvement. Applications for Qualification Certificates (Part III, Housing Act, 1969) referred to me by the Town Clerk, continued to be dealt with, and the position on 31st December, 1972, was:— Section 45, Qualifying Certificates— New applications 139 Certificates granted 126 Certificates refused 25 Section 46, Certificates of Provisional Approval— New applications 65 Certificates granted 44 Certificates refused — Total number of applications dealt with either by approval or refusal 1,251 Number of applications still subject of negotiation at end of year 694 Total 2,344 SERVICES UNDER HOUSING ACTS 71 The implementation of the Council's Slum Clearance programme continued. Ten Clearance Areas were declared during 1972, including 200 houses. 110 houses were demolished, 1 house closed, 2 Closing Orders determined, and three parts of buildings closed (underground rooms). A Public Inquiry was held in March, 1972, into the making by the Council of the London Borough of Merton Byegrove Road (Clearance Area No. 1) Compulsory Purchase Order, 1972, which involved 11 houses and one shop. This Order was confirmed by the Secretary of State for the Environment in July, 1972. One further Clearance Area, namely 1-8 Railway Place, Hartfield Road, S.W.19, was resolved by the owner in an unusual and public spirited manner, in that he made a gift of the properties to the Council. The total number of visits to premises of all kinds was 6,909. SERVICES UNDER OTHER ENACTMENTS 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 The number of visits made during the year for all purposes of the Shops Act, 1950-65, was 330. 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 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 betwen local authorities, the factory inspectorate and fire authorities. The number of visits made for all purposes of the Act during 1972 in Merton was 1,479 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. 72 Registrations and General Inspections. Class of Premises Number of Premises Registered during Year Number of Registered Premises at end of Year Number of Registered Premises Receiving a General Inspection during the Year Offices 52 889 198 Retail Shops 38 1,265 320 Wholesale Shops, Warehouses 8 77 27 Catering Establishments open to the Public, Canteens 3 165 62 Fuel Storage Depots — 5 2 Totals 101 2,401 609 Contraventions rectified. Cleanliness 164 Temperature 56 Ventilation 12 Lighting 5 Sanitary Conveniences 59 Washing facilities 76 Clothing accommodation 22 Floors, passages, stairs 59 Dangerous machinery guarded 14 First Aid provisions 77 Hoists and Lifts 52 Other contraventions 23 Exemptions. No exemptions (Section 46) were granted in 1972. Accidents Reported and Investigated. In offices 3 In retail shops 22 In wholesale shops and warehouses 9 In catering establishments open to the the public, in canteens, etc. 5 Registration. The pattern of Registration has remained much the same as 1971, in that the total number of office premises registered at the end of the year showed an overall increase and the number of retail shops registered showed a slight decrease. Inspection. Inspection of premises continued as in previous years, and in the main, the co-operation of employers and managers continues to be satisfactory. No great difficulty has been met by my staff in persuading employers to comply with the requirements of the Act, but allowance 73 has to be made for the inevitable delays experienced by companies in obtaining services of contractors to carry out the necessary works. Apart from the inevitable loss of thermometers and abstracts, depletion of the contents of the First Aid boxes and lack of cleanliness to parts of some shop premises. I find that broken and worn floors, and floor coverings, and staircase and gangway obstruction to be the most common form of contravention. It is becoming increasingly necessary to request occupiers to deal effectively with very slippery floors, which are the result of the use of industrial polishing machines and some types of polish. Steps and ladders in all types of registered premises are still given particular attention and informal advice is given when they are found to be faulty. An increase in the use of print machines and copiers has led to more ammonia being employed and stored on premises and because of this it has been necessary at times to request additional mechanical ventilation, notwithstanding the fact that machines themselves have ducting and extraction equipment. Mechanical Handling. The increased use of fork lift trucks does not appear to create any particular problems, so long as good floor surfaces are provided in warehouses and adjacent yards, thereby forming a good basis for safety in mechanical handling. The repair or re-surfacing of floors minimises the danger factor and has the advantage of reducing damage to fork lifts and the commodities they handle. Hoists and Lifts. Substantial progress is now being made towards compliance with the requirements of the Offices, Shops and Railway Premises (Hoists and Lifts) Regulations, 1968. There is, however, considerable delay experienced where manual lift service lifts are concerned, due to the very heavy demand for lift mechanics and the necessity to ensure that repairs to passenger lifts and mechanical goods lifts must receive priority. A short course on Hoists and Lifts was attended by an Inspector during the latter part of the year. Knowledge gained during this course will be very useful in the interpretation and administration of the Regulations. Prosecutions. No legal proceedings were instituted during the year, although in some instances it became necessary to warn firms of the risk of prosecution. Accidents. No reports of serious accidents were made during the year and the total number of accidents reported (39) is about average. As in previous years, all accidents reported are investigated. 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, 1972:— 74 Number of properties in district 77,241 Number of properties inspected 4,434 Number of properties infested by rats 1,050 Number of properties infested by mice 1,002 Total number of visits including re-inspection 17,254 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 1972, 1,350 manholes were baited and 192 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 1972, 646 complaints were received concerning insect pests and the following is a list of the infestations dealt with:— Ants 65 Bees 25 Beetles 25 Bedbugs 33 Cockroaches 14 Fleas 62 Flies 17 Earwigs 2 Maggots 4 Mosquitoes 1 Silverfish 7 Slugs 2 Wasps 295 Woodlice 3 Woodworm 2 Where possible, practical help is given by the carrying out of disinfestation work, but in certain cases reference is made to contractors who specialise in control work. The incidence of wasps was lower than in previous years. No charge is made for the destruction of nests, but this work, 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. Sixty-seven complaints of nuisance or damage by feral pigeons were received. Pigeon traps were placed on suitable sites, giving effect to a reduction in the number of birds. 128 pigeons, 120 eggs, and 110 nests were destroyed. Night visits were made to railway bridges to take birds which were roosting. During the year ten complaints were received of the presence of foxes, which were causing some alarm among nearby householders. The Ministry of Agriculture, Fisheries and Food having withdrawn 75 their extermination services, the Council authorised the Public Health Inspectors to supervise this work. Arrangements were made for destruction of the foxes to be carried out by a specialist contractor. During the year it was necessary to employ his services on three occasions and ten foxes were destroyed. There is no doubt that this service is appreciated by householders. Pet Animals Act, 1951. Fourteen licences to keep Pet Shops were issued during 1972. Fifty-three visits were made to these premises to ensure compliance with the conditions attached to these licences. The Riding Establishments Acts, 1964-1970. Two full licences for one year were issued 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). One establishment at Mitcham ceased to operate after its licence had expired. Diseases oj Animals Act, 1950. No outbreaks of disease occurred within the Borough during 1972. Clean Air Act, 1956/1968. During 1972, 169 complaints were received of smoke or grit emissions and the necessary observations were made and remedial action taken. Ten 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. 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 ten applications received during the year, all were approved after alterations in two cases. Legal Proceedings. Proceedings under Section 1 of the Clean Air Act, 1968, were taken against a firm of demolition contractors for burning rubber tyres on site from which was emitted dark smoke. The defendants pleaded guilty and were fined £20 with £7 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. It is clear that since the Clean Air Act became law in 1956 there has been a steady reduction in emissions into the air, but there is still an urgent need for a more vigorous application of the Clean Air Acts in some areas of Great 76 Britain. So much depends upon an adequate supply of the right fuels, and I believe that with the ever increasing use of natural gas for domestic heating, a still further improvement in the condition of the atmosphere can be achieved in this field. The position regarding Smoke Control Orders is now 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. No. 19 1971 Operative date 1.9.72. No. 20 1971 Operative date 1.10.72. No. 21 1971 Operative date 1.11.72. No. 22 1971 Operative date 1.1.73. No. 23 1972 Operative date 1.7.73. Area No. 24 Awaiting confirmation. Area No. 25 Awaiting confirmation. Area No. 26 Awaiting confirmation. Area No. 27 Under survey. The area of the Borough covered by Orders either in operation. or confirmed but not operative, is 7,831 acres. The total number of premises involved in these areas is 50,279. Comparable figures at the commencement of the year were 7,136 acres and 45,686 premises. 77 In addition, Areas 24, 25 and 26 will cover an additional 474 acres with 4,498 premises. On 1st January, 1972, 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 79.7% and the comparative figures for the London Borough of Merton was 77.0%. The total number of visits made during 1972 in connection with the Clean Air Acts for all purposes, was 11,111. After the operative date of any Order, observations are made from time to time by Public Health Inspectors and Technical Assistants to ensure compliance, and I am pleased to report that no obvious contraventions have been recorded. 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 1972, 119 complaints regarding noise were received, and the investigation of these entailed 360 visits, many of which were made outside normal office hours. The most common cause of noise complaint were domestic (32), commercial (28) and roadwork, construction, demolition (16). 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 during the year, under Section II (3) of the Noise Abatement Act, 1960, against a person sounding loud-speaker chimes attached to an ice-cream vehicle outside permitted hours. The defendant pleaded guilty and was fined £10 with costs. The Pharmacy and Poisons Acts, 1933-1941 One hundred and one 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. Five licences under this Act, for the removal of human remains, were received from the Home Office during the year. Exhumation work is normally carried out in the early hours of the morning, and in the interests of public health, a Public Health Inspector attends at the cemetery on each occasion. 78 Caravan Sites and Control of Development Act, 1960. The number of sites at 31st December, 1972, which were subject to licence or consent was four, and the permitted number of caravans was 29; this figure including those kept on two sites occupied by members of the Showmen's Guild. The four sites are:— 33 South Road, Wimbledon, S.W.19. Consent on 2.2.61 for seven caravans. 46 Deburgh Road, Wimbledon, S.W.19. Consent on 2.2.61 for two caravans. Swing's Yard, 37a Western Road, Mitcham. Licensed on 27.1.61 for four caravans. Gray's Yard, 230-232 London Road, Mitcham. Licensed on 27.1.61 for sixteen caravans. The Caravan Sites Act, 1968. The periodic survey of sites occupied by caravans without licence or consent was continued. During the year the Council provided a caravan site with 15 pitches at Durnsford Road, S.W.19, for gypsy families in the District. All the pitches were occupied, with one of the occupiers acting as a paid supervisor. There was one family only on an unauthorised site at the year's end. An application to the Department of the Environment for designation under Section 12 of the Caravan Sites Act, 1968, has been made. 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 157 premises were registered and 67 visits were made during the year. CONCLUSION The establishment of Public Health Inspectors was considerably changed during the year. Four Inspectors left and three others retired, including my predecessor, Mr. G. H. Cockell. Of the vacancies created, whilst I was able to fill senior posts, only one Inspector was appointed to replace five District Inspectors, leaving four vacancies for most of the year. Three Pupil Inspectors were under training at the commencement of the year, and a fourth was appointed during the year. All are making satisfactory progress. The shortage of Inspectors puts a considerable strain on the remaining staff of the Environmental Health Section and if continued over a long period, will result in a lowering of the standards of hygiene maintained throughout the Borough. This is particularly true in the case of food premises, where it is important that regular visits are made if standards are to be maintained and improved. It is my intention during the coming year to consider what changes could be made in the manner in which our functions are carried out, in the hope that the Inspectors' time can be used most effectively. 1973 will be the final year in which the Health Department exists in its present format. The Medical Officer of Health, together with the 79 Personal Health Services will be transferred to the new Area Health Boards. It is essential that the Environmental Health Services are retained as a single unit so that there will still be a Department of the Council directly responsible for Environmental Health matters and that adequate liaison can be maintained with the Medical Officer at the new Area Health Board on matters relating to the control of infectious disease. On behalf of my predecessor, Mr. G. H. Cockell, Chief Public Health Inspector for the first four months of the year, and myself, I would like to express my appreciation of the support of the Chairman and Members of the various Committees concerned with the work of the Public Health Inspectors and my thanks to the Inspectors, Technical Assistants and Clerical Staff for their willing help and loyalty during the year. J. P. SMITH, Chief Public Health Inspector. 80 ANNUAL REPORT to the EDUCATION COMMITTEE on the work of the SCHOOL HEALTH SERVICE for the year 1972 CONTENTS Page Introductory Letter by Principal School Medical Officer 83-84 Schools and Special Services Sub-Committee as at 31st December, 1972 85 School Clinics provided by the Local Education Authority 86-87 The Service 88 Medical Inspections 88 Employment Medical Advisory Service 89 Audiometry 89-90 Speech Therapy 90 Audiology 91 Enuresis 91 The Work of the School Nurses 91-92 Child Guidance Service 92 Handicapped Pupils 93 The School Dental Service: Report by Chief Dental Officer 93-94 Statistics for year 1972 94-95 Infectious Diseases and Prophylactic Measures: 1. Infectious Diseases: — Table 1—Infectious Diseases 95 Table 2—Contagious Diseases .. 95 Epidemiological Surveys 96 2. Prophylactic Measures 97 Ancillary Services: Nursery Schools and Classes 98 Provision of Milk and Meals 98 Appendix ' A': Section 'A'— Routine Medical Inspections 99 Other Medical Inspections 99 Return of Defects Found at Medical Inspections 100 Children Found to Require Treatment 101 Section ' B '— Uncleanliness and Verminous Conditions 101 Diseases of the Skin 101 Eye Diseases, Defective Vision and Squint 102 Diseases of the Ear, Nose and Throat 102 Orthopaedic and Postural Defects 102 Other Treatment Given 102 Appendix ' B ': Attendances at Clinics 103 Other Medical Examinations by School Medical Officers 103 Recuperative Holidays 103 82 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 1972. This may well be my last Annual Report to you in view of the impending reorganisation of the National Health Service which is going to be operative with effect from 1st April, 1974. I am, however, glad to inform you that the health of school children in Merton during the year was very satisfactory indeed, only one child being found unsatisfactory on medical examination. This being the case, one could say that the general condition was better than that in 1971, namely better than 99.7%. Medical inspections of school children totalled 12,731 (9,123 routine inspections and 3,608 special inspections and reinspections) compared with 13,594 (10,752 routine inspections and 2,842 special inspections and reinspections) in 1971. At routine and other medical inspections 3,627 defects, mostly minor in character, were found of which 2,078 were referred for treatment and 1,549 for observation, compared with 4,979 (2,380 for treatment and 2,599 for observation) in 1971. The system of selective medical examinations continued, 623 questionnaires were 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, 273 children were medically examined. As a result of these examinations, 12 children were referred for treatment or observation, these being followed up by the private doctor, or at a school clinic. We have, however, been asked by the Department of Employment to take note of the Employment Medical Advisory Service which came into operation as a result of legislation in June, 1972, and the necessary machinery has been put into operation to deal with the responsibilities placed by it, on us. Even though there is a great deal of reorganisation work to be done by the administrative and medical staff, we will try to see that we are able to meet the commitments imposed by this Act to the fullest extent. A new Unit was established at Ravensbury School for observation and assessment of children who were handicapped and/or in need and this has been working satisfactorily since its establishment in September, 1972. The liaison between the Principal School Medical Officer, the Education Department and the Social Services Department have been excellent. I should especially like to thank my Deputy, Dr. G. S. Sethi, Mr. Atkinson, my Chief Administrative Officer, and Mr. E. A. Ayling, the Administrative Assistant of the School Health Section, for their contribution in the preparation of this Report. 83 I would also express my gratitude for the support given to me since my appointment by the Chairman and the Members of the Education Committee and the Schools and Special Services SubCommittee. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, ELZA H. TODD, Principal School Medical Officer. 84 SCHOOLS AND SPECIAL SERVICES SUB-COMMITTEE (As at December, 1972) Chairman: Councillor (Mrs.) H. Bramsted Councillor D. F. Connellan (Vice-Chairman) Aldermen: V. Talbot, J.P. Councillors: E. A. Chapelow (Mrs.) E. M. Davis (Mrs.) C. A. Fletcher W. E. R. Haddow, J.P. J. N. Healey D. J. Hempstead W. A. Hillhouse (Miss) S. Knight J. A. Watson Co-opted Members: Miss S. C. Auger Mr. C. H. Davies, B.A., J.P. Rev. R. Lewis Canon J. O'Donnell Ex-Officio: Councillor B. N. Clifford (Chairman of the Education Committee) Alderman R. S. Scorer, M.A., Ph.D., F.R.S.H., F.I.M.A. (Vice-Chairman of the Education Committee) Chief Education Officer: R. Greenwood, M.A. 85 SCHOOL CLINICS PROVIDED BY THE LOCAL EDUCATION AUTHORITY General Medical Clinics Amity Grove, Raynes Park: 1st and 3rd Thursday mornings. Grand Drive Raynes Park : Tuesday mornings. Middleton Road, Examination of cases Morden: 1st, 3rd and 5th referred by Teachers Monday afternoons. Education Department, Morden Road, Merton: 1st, 3rd and 5th Monday mornings. Health Visitors, etc Russell Road, Treatment of Wimbledon: 2nd and 4th minor ailments. Wednesday mornings. Western Road, Mitcham: Monday mornings. Wide Way, Mitcham: 1st, 3rd and 5th Wednesday mornings Child Guidance Clinics 97 Worple Road, Wimbledon: Sherwood House, Monday to Friday all day. Commonside East, Mitcham: (Cases seen by appointment by Psychiatrist or Educational Psychologist, with the assistance of Psychiatric Social Workers) Ophthalmic Clinics Amity Grove, Raynes Park: Friday afternoons. Grand Drive, Raynes Park: Friday afternoons. Examination and Morden Road, Merton: Wednesday afternoon treatment of errors and Friday mornings. of refraction and Western Road, squint. Mitcham: Wednesday afternoons. Wide Way, Mitcham: Tuesday mornings. J Orthopaedic Clinic Russell Road, Wimbledon: Every fourth WednesExamination of referred day afternoon each cases by an Orthopaedic month. Surgeon. Audiology Clinic Morden Road,Merton: 1st Friday (all day) Other Fridays— Detailed investigation of mornings only. cases referred. Remedial Exercises Amity Grove Raynes Park: Monday mornings. Remedial and breathing Cavendish Road, exercises as recommended Comers Wood: Thursday mornings. by School Medical Wide Way, Mitcham: Tuesday afternoons. Officers. 86 Speech Therapy Clinics Amity Grove, Raynes Park: Tuesday afternoons and Wednesday all day. Grand Drive, Raynes Park: Monday all day, Thursday afternoons and Friday all day. Middleton Road, Morden: Wednesday all day. Treatment of speech Morden Road, Merton: Tuesday and Thursday mornings. Russell Road, Wimbledon: Monday and Friday mornings. Thursday all day. Western Road, Mitcham: Tuesday all day and Thursday mornings. Wide Way, Mitcham: Friday all day. J 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 to Friday all day. Morden Road, Merton: Monday, Wednesday and Friday all day. Western Road, Mitcham: Monday to Wednesday all day. 87 THE SERVICE The Service provides for periodic inspection of all children: (a) for whom primary or secondary 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, i.e., those affecting eyes, dental, speech, postural and breathing defects, etc., and of children with behaviour problems, is provided at clinics in the area. Attendance of children is normally by appointment. Other ailments of a more serious nature are dealt with by general practitioners or the hospital service. There is a close co-operation between the School Health Service, general practitioners and the hospital service. MEDICAL INSPECTIONS 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 on reaching school leaving age. 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. Schools are asked to provide details during the summer holidays of all pupils who could leave the following Easter or July, whether they are to leave or not. Those pupils requiring medical inspection are then seen during the autumn and spring terms, thus avoiding the examination period. These pupils are not seen again unless full-time education at school continues for any length of time, or any specific medical condition warrants it. This arrangement is of considerable help to schools. 88 EMPLOYMENT MEDICAL ADVISORY SERVICE Before the introduction of the Employment Medical Advisory Service expected in February, 1973, the medical supervision of young people entering employment was arranged in two parts:— (i) During the young person's last year at school the School Medical Officer considered whether limitations should be imposed in relation to different work conditions. If so, these were indicated on form Y9 (Y10 in respect of substantially handicapped young people) which was sent to the local careers officer. (ii) In employment subject to the Factories Act, 1961, young people had to be medically examined by the appointed Factory Doctor within 14 days of starting work in a factory and thereafter annually until they became IB. There was little contact between the two systems. In 1964 the Industrial Health Advisory Committee set up a Subcommittee to review the appointed Factory Doctor service in the light of modern social conditions and their recommendations were embodied in the Employment Medical Advisory Service Act which received Royal Assent on 11th May, 1972. The Employment Medical Advisory Service which is due to commence in February, 1973, replaces the appointed Factory Doctors and depends on close co-operation between School Medical Officers, careers officers and the new Employment Medical Advisers. The School Health Service will continue to be responsible for identifying those pupils who are not unconditionally fit for employment and the Department of Education recommendation that this assessment by them should be carried out at the beginning of the pupil's last year of education, whether school leaving is intended or not, had already been put into effect in the Borough previously. The fitness of school leavers for certain types of employment having regard to any disability they have, will be considered by School Medical Officers within the criteria of the existing form Y9. If completed, a copy of the form will be sent to the Employment Medical Adviser, the careers officer and the general practitioner. When the service is in operation, the responsibility of the School Health Service in relation to potential school leavers will be increased as it will be necessary to ensure as far as possible that all are medically examined and that any who are not examined are followed up. AUDIOMETRY Details are given below of audiometric primary testing carried out during the year:— Number of primary schools visited 49 Number of children tested 2,659 Number of primary failures 149 Number of middle schools visited 15 Number of children tested 2,760 Number of middle failures 140 89 A total of 5,419 children in primary and middle schools were tested, of these 385 failed the audiometric test. In 1971, 6,421 children were tested and there were 335 failures. SPEECH THERAPY There was some staff shortage in the first half of the year, but in August a Senior Speech Therapist was appointed to be responsible for co-ordination of the activities of the speech therapy staff. By that time, a full establishment of speech therapists had been recruited. Their effort was spread over seven clinics, two primary schools, three special schools one assessment unit, two day nurseries and one special language group at the Mitcham Child Guidance Clinic. Developments that have resulted from co-ordinated activity of this service have been concerned with the early referral and assessment of pre-school children and, in particular, the physically and mentally handicapped. In addition to the introduction of pre-school groups, meetings have been arranged for parents to discuss language stimulation and preventative work undertaken in alleviating parental anxiety. School age intensive groups have been introduced in the school holidays to reinforce the individual therapy carried out during the school term. A special language group at the Mitcham Child Guidance Clinic has been organised by an educational psychologist and a speech therapist for observing, assessing and treating children with severe language disorders. Sessions at Ravensbury Special School have been increased to meet the demand for daily therapy in the Assessment Unit and the main school. Proposals for 1973 are to develop group therapy centred at the Patrick Doody Clinic and Child Health Centre, the preventive measures already begun, and to introduce speech therapy at the Senior Training Centre. Details of cases dealt with are given below:— Number of sessions held: (a) for treatment 985 (b) for consultation 84 Number of cases on register at beginning of year 297 Number of cases added during the year 153 Number of cases discharged during year 174 Number of cases on register at end of year 276 Analysis of cases discharged during year. Children who:— Achieved normal speech 50 Were greatly improved 47 Showed some improvement 9 Showed little or no improvement 9 Left for various reasons 59 Analysis of cases treated during year:— Stammering 40 Dyslalia 194 Dysarthria 6 Cleft Palate 4 Defects of voice 5 Aphasia 3 Dyseria 11 Retarded speech and/or language 139 90 AUDIOLOGY With the opening of the Patrick Doody Clinic in January, 1973, audiology clinics will be held each Friday in a purpose-built unit. Although at present the number of attendances continues to increase, it is hoped that more G.P.s will make use of the new facilities available. The unit for partially-hearing nursery class children, attached to a primary school in the Borough, continues with maximum attendances and these children now continue their education in primary units in Surrey. Two part-time audiometricians share the work in the Boroughs of Sutton and Merton, enabling full clinic coverage to be given. ENURESIS The problem of the bedwetting child is very real to the family concerned and improvement is not easy to achieve. The School Health Service has 18 sets of enuresis alarm apparatus, which are issued on the recommendation of the school or family doctor for six weeks to each case, this period being sufficient if the system is to prove effective. During 1972, 66 children used an enuresis alarm supplied by the service. As in previous years, about 45% proved completely successful, there was some improvement in 30% and 25% were unsuccessful. These unsuccessful cases were referred back to the doctor who originally requested the use of the apparatus for further treatment. THE WORK OF THE SCHOOL NURSES Throughout 1972 the health visitors and school nurses played an important role in promoting and maintaining the health of school children in the Borough. They liaise between the home, the school, the general practitioner and the School Medical Officers. During 1972 there was an increase in head infestation amongst the school children of the Borough. 318 health surveys (compared with 163 in 1971) were carried out. Home visits were made in the evenings when the parents were at home and treatment was explained. All cases were followed up. The programme of vision screening has continued to expand in 1972. 300 sessions have been held (compared with 177 in 1971). Health Education teaching has continued in Middle and High Schools. The Health Education Officer's help in planning programmes and supplying visual aid materials is greatly appreciated. The health visitors and school nurses maintain their varied duties in the School Health Service. 91 The following tables give details of visits paid by them in 1972: 1. Visits. To pupils found at school medical examinations to require observation or treatment 69 To educationally subnormal children 141 To verminous cases 230 To infectious or contagious cases 54 To miscellaneous cases (arising from School Medical inspections at request of Head Teacher, etc.) 165 To children with handicaps 21 2. Sessions attended. Pre-medical and vision testing 300 School medical inspections 553 Health surveys 318 General medical clinics 216 Health teaching 118 Immunisation 68 Freedom from infection inspections 22 CHILD GUIDANCE SERVICE 1. General The pressure of work in the two Child Guidance Clinics has continued to increase and despite an increase in establishment the situation has worsened particularly in the Mitcham area, owing to a serious lack of staff. A suitably qualified teacher has been found for the assessment unit attached to Ravensbury School. The first pupils have been received and some are about to be transferred to the appropriate special schools in Merton. 2. Remedial Classes The three classes based at Manor House, Malmesbury and Garth Primary Schools, continue to flourish and the services of Miss Matthews, Peripatetic Remedial Teacher, were supplemented by the appointment of Mrs. El-Nagdy, who is specially responsible for the teaching of English to immigrants. Plans for a Remedial Centre are in hand. 3. Places for Maladjusted Children Melrose School for Senior Maladjusted Children was opened in 1971 and at the end of the year 26 children were attending. ASSESSMENT AND DIAGNOSIS UNIT Ravensbury School for E.S.N. Children of primary age opened in June, 1971, accommodating 75 pupils. In September, 1972, a Unit for the assessment and diagnosis of children with more than one handicap was established at Ravensbury School. This Unit is in the charge of one teacher who is supported by a nursery assistant. Up to eight children of pre-school age can be accepted and during their stay they are seen by an Educational Psychologist and are visited by a School Medical Officer for the purpose of determining the type of special education, if any, to be recommended. 92 HANDICAPPED PUPILS The following table shows the numbers of pupils on the Handicapped Pupils' Register as at 31st December, 1972, together with the special educational facilities which have been provided by the Authority:— Classification Numbers of pupils ascertained during 1972 Total number ascertained as at 31.12.72 Attending Special schools as: Awaiting placement at end of year Day pupils Boarders Blind - 7 3 4 Partially-sighted — 5 5 — — Deaf — 20 13 7 — Partially-hearing 4 21 16 4 1 Educationally sub-normal 34 260 243 10 7 Epileptic — 1 — 1 — Maladjusted 32 97 51 41 5 Physically-handicapped 2 44 31 13 — Delicate 6 39 26 11 2 Totals 78 494 388 91 15 Two handicapped pupils, both classified as delicate, received education at home under Section 56 of the Education Act, 1944, during 1972. Numbers of pupils with physical or mental handicaps who are being educated within the ordinary school system as at 31st December, 1972:— Handicap No. of pupils Partially sighted 2 Partially-hearing 12 Epileptic 51 Diabetic 23 Physically handicapped 46 Delicate 46 THE SCHOOL DENTAL SERVICE Mr. E. T. Thompson, the Chief Dental Officer, has contributed the following report on the operation of the School Dental Service:— ' At 31st December, 1972, the dental staff consisted of the Chief Dental Officer, four full-time Dental Officers, four part-time Dental Officers and one part-time Orthodontist giving a full-time equivalent of 7.1 Dental Officers compared with 5.5 in 1971. The Authority also employs one part-time Dental Auxiliary for six sessions per week. Four sessions per week were devoted to orthodontics by the Orthodontist and two by one of the Dental Officers. 93 ' The increase in staff for this year has brought the service to full strength with a satisfying increase in the number of children inspected at school. 'As will be seen from the statistics, over half of the extractions of permanent teeth were for orthodontic purposes at the request of the Orthodontists. The deciduous teeth extracted are again slightly down, with some orthodontic extractions. This reflects on the fillings figures that show in the early age group nearly a thousand more teeth saved by conservation. There has been an increase in the number of fillings in the two younger groups. ' Dental Health Education has been given by the Dental Auxiliary, Dental Officers and Health Visitors, with the co-operation of the Health Education Officer. The statistics relating to the School Dental Service are given below: — Statistics for Year 1972 Number of pupils on the register of maintained Primary, Middle and High Schools including nursery and special schools in January, 1973, as in Forms 7, 7m and 11 schools: 26,862. Attendances and Treatment. Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First Visits 2,500 2,253 461 5,214 Subsequent Visits 4,261 4,950 1,041 10,252 Total Visits 6,761 7,203 1,502 15,466 Additional courses of treatment commenced 374 241 227 842 Fillings in permanent teeth 2,492 4,927 1,251 8,670 Fillings in deciduous teeth 5,284 578 — 5,862 Permanent teeth filled 2,162 4,304 1,143 7,609 Deciduous teeth filled 5,171 548 — 5,719 Permanent teeth extracted (emergency) 19 176 37 232 Permanent teeth extracted (orthodontics) 11 220 31 262 Deciduous teeth extracted (emergency) 702 274 — 976 Deciduous teeth extracted (orthodontics) 23 65 — 88 General anaesthetics 213 86 12 311 Emergencies 395 159 29 583 Number of pupils X-rayed 832 Prophylaxis 589 Teeth otherwise conserved 46 Number of teeth root filled 76 Inlays 7 Crowns 16 Courses of treatment completed 4,876 Orthodontics. Cases remaining from previous year 424 New cases commenced during year 142 Cases completed during year 191 Number of removable appliances fitted 289 Number of fixed appliances fitted 8 Pupils referred to Hospital Consultant 2 94 Prosthetics. 5 to 9 10 to 14 15 and over Total Pupils supplied with F.U. or F.L. (first time) — — — — Pupils supplied with other dentures (first time) — 3 6 9 Number of dentures supplied — 5 7 12 Anaesthetics. General Anaesthetics administered by Dental Officers—Nil. Number of sessions where an Anaesthetist attended—27. Inspections. (a) First inspection at school. Number of pupils 19,296 (b) First inspection at clinic. Number of pupils 3,295 Number of (a) + (b) found to require treatment 10,641 Number of (a) + (b) offered treatment 9,903 (c) Pupils re-inspected at school clinic 2,725 Number of (c) found to require treatment 1,484 Sessions. Sessions devoted to treatment 2,873 Sessions devoted to inspection 201 Sessions devoted to Dental Health Educauon 3 INFECTIOUS DISEASES AND PROPHYLACTIC MEASURES 1. Infectious Diseases Table 1. Disease Suffering Excluded on suspicion Infection at home Total exclusions Scarlet Fever 22 1 2 25 Measles 203 2 1 206 Whooping Cough 18 — — 18 German Measles 568 6 5 579 Chicken Pox 239 — 2 241 Mumps 622 3 3 628 Jaundice 6 — — 6 Other 243 2 — 245 Totals 1921 14 13 1948 Table 2. Contagious Diseases. Disease Suffering Excluded on suspicion Total exclusions Impetigo 8 1 9 Scabies 2 — 2 Other 13 — 13 Totals 23 1 24 95 Compared with 1971 there were 1,200 more cases of communicable disease notified by schools. This was mainly due to the increased incidence of mumps and german measles. During the year, all schools were issued with a circular giving careful guidance on the procedure regarding notification of infectious disease, and explicit instructions were issued regarding precautions necessary, so far as teaching staff are concerned, when cases of german measles occur in schools. Diptheria There were no notifications of diphtheria during the year 1972, but constant efforts were maintained to keep the immunised state of the children satisfactory. Epidemiological Surveys There were two instances during 1972 involving cases of tuberculosis when, on the advice of the Chest Physician, an epidemiological survey was arranged. (i) A pupil of a middle school visited her country of origin during the summer holidays 1971. She returned to school and after a short time was admitted to hospital. The diagnosis on her discharge in March, 1972, was tuberculous pleural effusion and a limited survey of staff and children who had been in contact was arranged. 62 children were tested and 12 teaching staff had chest x-rays. Only one child was omitted from the survey as the parents were unco-operative. The result of this limited survey indicated that there had been no spread of infection to pupils or staff. (ii) In April, 1972, it was reported that a pupil in another middle school had apparently developed an adult type of tuberculosis. The Chest Physician advised that a contact survey of all pupils and staff should be conducted. During the summer of 1972, 471 children were tested and 31 of them (6.5%) were referred to the chest clinic for further investigation. Children who had moved out of the Borough or who had been transferred to a High School were followed up. In spite of advice and several approaches to the parents, two children were not included in the survey. Of the 49 staff all but five submitted chest x-ray results and of the latter, two, with some justification, did not wish to undergo an x-ray. After an almost complete check of all possible contacts there was no evidence of any spread of infection. These surveys involve considerable organisation and their successful conduct is dependent on the co-operation of the Head Teacher and the staff of the school concerned. Their help is gratefully acknowledged. Meningitis Notification was received of two cases of meningitis, one of which was fatal. This was a nine-year-old schoolboy who died after a four days' illness. All the necessary investigations were carried out at the school concerned and there were no further cases. 96 Minor Outbreaks A few small and brief outbreaks of sickness and/or diarrhoea occurred during the year. Bacteriological investigations were carried out but no organism was isolated. There were no outbreaks which caused any real concern. Prophylactic Measures 1. Poliomyelitis Vaccination. Vaccination of school children against poliomyelitis continued during the year. The actual number vaccinated or receiving reinforcing doses during 1972 was as follows:— Number of children vaccinated 53 Number of children given re-inforcing doses 2,700 2. Diphtheria/Tetanus Immunisation. Number of children given immunisation 126 Number of children given re-inforcing doses 2,416 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. 3. Tetanus Vaccination. Tetanus vaccination of school leavers was added to the prophylaxis schedule during the year and the following numbers were vaccinated:— In School Clinics By General Practitioners Total Primary courses 39 16 55 Booster injections 601 73 674 4. Protection of School Children against Tuberculosis. B.C.G. Vaccination. Percentage of age group dealt with Number in age group 2,417 Number of consents 2,091 86.51 Number skin tested 1,932 80.00 Number Mantoux positive 57 1.64 Number B.C.G. vaccinated 1,707 70.62 The low percentage of those children showing a Mantoux positive reaction indicates the continuing low incidence of tuberculosis in the community. 5. Rubella Vaccination. To enable pupils to obtain vaccination without disruption of school activities, late afternoon sessions were held in school clinics at which 345 girls in the prescribed age group were vaccinated. In addition 47 girls were vaccinated by general practitioners. No vaccination sessions were held in schools. 97 ANCILLARY SERVICES 1. Nursery Schools/Classes There were 762 children attending the nursery schools and nursery classes at 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 1971:— Year Number in attendance Taking Milk Taking Meals Number Percentage Free Paid Total Percentage September, 1972 24,287 •6,367 97.9 1,661 13,114 14,775 60.8 September, 1971 23,880 6,371 96.8 1,594 12,422 14,016 58.6 * These are pupils up to the age of seven years attending primary schools who were entitled to, and received, free milk. A further 121 pupils were entitled to free milk but did not partake of it. The figure of 6,367 pupils includes 485 pupils in primary and middle schools over the age of seven years who were receiving free milk on health grounds. 98 Appendix 'A' MEDICAL INSPECTION AND TREATMENT (Excluding Dental Inspection and Treatment) Return for the year ended 31st December, 1972 Number of pupils on registers of maintained primary, middle, high, special and nursery schools in January, 1973:— (a) Ordinary Schools 25,815 (b) Special Schools 285 (c) Nursery Schools and Classes 762 Total 28,862 SECTION A. Routine Medical Inspections. Age Groups Inspected (By year of birth) Number of Children Inspected Number of Children found not to warrant medical examination* 1968 and later 528 1967 2,138 — 1966 430 — 1965 249 — 1964 228 — 1963 768 — 1962 700 — 1961 395 — 1960 242 — 1959 196 — 1958 582 225 1957 and earlier 2,687 72 Total 9,123 297 * i.e., after a School Medical Officer had considered a medical questionnaire completed by the parents and the medical records. Other Medical Inspections. Type of Inspection Number of Children Inspected Special Inspections 2,537 Re-Inspections 1,071 Total 3,608 The increase in the number of special inspections from 1,259 in 1971 to 2,357 in 1972 is largely accounted for by the inclusion of 789 assessments for free school milk purposes. 99 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 138 176 45 21 Eyes (a) Vision 1164 471 148 77 (b) Squint 129 13 5 — (c) Other 19 16 2 7 Ears (a) Hearing 83 56 64 51 (b) Otitis Media 27 16 4 2 (c) Other 8 3 3 4 Nose and Throat 53 189 8 18 Speech 76 63 11 5 Lymphatic Glands 6 24 — 3 Heart 10 42 2 1 Lungs 68 51 10 25 Development (a) Hernia 5 13 - - (b) Other 68 72 3 1 Orthopaedic (a) Posture 5 7 1 1 (b) Feet 25 35 7 5 (c) Other 40 72 7 4 Nervous System (a) Epilepsy 18 5 6 1 (b) Other 14 9 3 Psychological (a) Development 11 24 4 6 (b) Stability 12 33 17 20 Abdomen 13 23 1 2 Other defects and diseases 86 138 30 122 Totals 2,078 1,549 378 379 Three thousand six hundred and twenty-seven defects were found in children at routine medical inspections of which 2,078 were referred for treatment and 1,549 for observation. 757 defects were found at special inspections, 378 being referred for treatment and 379 for observation. The total number of defects referred for treatment and observation in 1972 was 4,384. 100 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 % 1968 and later 528 54 10.23 1967 2,138 285 13.35 1966 430 43 17.27 1965 249 38 16.66 1964 228 125 10.40 1963 762 164 23.43 1962 700 107 28.53 1961 375 61 25.25 1960 242 64 32.65 1959 196 135 23.20 1958 582 234 20.58 1957 and earlier 2,687 447 16.63 Totals 9,123 1,775 19.20 In one case only was the condition of a child regarded by the School Medical Officer as unsatisfactory. SECTION B. Treatment Uncleanliness and Verminous Conditions. 1. Total number of individual examinations of pupils by Health Visitors and School Nurses in schools 18,330 2. Number of individual pupils found to be infested 315 3. Number of exclusions: — First time 58 Second time ■ ■ • • • • • • • ■ • 4 62 4. Number of pupils cleansed 49 5. Number of Cleansing Notices issued under Section 54 of the Education Act, 1944 74 Diseases of the Skin (excluding uncleanliness) Number of cases known to have been treated Diseases of the Skin. during the year. Ringworm—scalp 1 Ringworm—body — Scabies 1 Impetigo — Other skin diseases (including verrucae, eczema, allergic skin conditions, acne, etc.) 175 Total 177 101 Eye Diseases, Defective Vision and Squint. Number of cases known Eye Diseases and Defects. to have been dealt with. External or other, excluding errors of refraction and squint 45 Errors of refraction (including squint) 2,677 Total 2,722 Number of pupils for whom spectacles were prescribed 686 Diseases of the Ear, Nose and Throat. Number of cases known Diseases and Defects. to have been treated. Received operative treatment:— (a) for diseases of the ear 7 (b) for adenoids and chronic tonsillitis 27 (c) for other nose and throat conditions 9 Received other forms of treatment 148 Total 191 Orthopaedic and Postural Defects. Number of cases known to have been treated in Clinics or Out-Patient Departments 211 Remedial Exercises. During 1972, 122 sessions for remedial exercises were held in clinic premises, 48 new cases being admitted and 49 old cases discharged. 236 sessions were held in all at St. Christopher's, Ravensbury and St. Ann's Special Schools, 44 new cases being admitted and 38 old cases discharged. Other Treatment Given. Ailments. Number of cases treated. Miscellaneous minor ailments 106 Lymphatic Glands 1 Heart and Circulation 15 Lungs 65 Development (Hernia and Other) 59 Nervous System 32 Psychological, Development and Stability 6 Diabetes 5 Enuresis 29 Obesity 17 Miscellaneous 59 Total 394 102 Appendix ' B ' 1. General Medical/Minor Ailments Clinics. Attendances made by children at General Medical/Minor Ailments Clinics 2,455 2. Other Medical Examinations undertaken by School Medical Officers. Children examined for part-time employment 198 In addition to the above, 291 medical examinations of teachers and teacher trainees were carried out during the year. 3. Recuperative Holidays. Children sent for recuperative holidays on the recommendation of School Medical Officers 15 All these children were examined on their return and all were found to have benefited from the holidays provided. 103