LONDON BOROUGH OF MERTON THE HEALTH OF MERTON 1973 THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH and the PRINCIPAL SCHOOL MEDICAL OFFICER E. H. TODD, M.B., Ch.B., M.F.C.M., D.P.H. MER 27 THE HEALTH OF MERTON 1973 by E. H. TODD, M.B., Ch.B., D.P.H. Printed by H. G. Mather, Ltd., Lower Green, Mitcham, Surrey CONTENTS INTRODUCTION: Pages 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 18-21 Tuberculosis 21-24 Prophylactic Measures 24-25 Sexually Transmitted Diseases 25 General Medical Services 25 National Assistance Acts 26 Asian Immigrants 26 Notifications of Birth 27 PERSONAL HEALTH SERVICES: Maternal and Child Care 28-30 Child Health 30-33 PUBLIC HEALTH NURSING AND ALLIED SERVICES: Health Visiting 34 Midwifery 36 Home Nursing 38 Prevention of Illness, Care and After-Care: Clinics for Older People 42 Health Education 43 Other Allied Services: Chiropody Service 44 Ripple Bed Service 44 Recuperative Holidays 45 Cervical Cytology 45 Family Planning Service 46 Geriatric Service 47 2 ENVIRONMENTAL HEALTH SERVICES: Services under the Public Health Acts: Water Supply 48-49 Sewerage and Sewage Disposal 49 Registered Common Lodging Houses 50 District Inspection 50-54 Cleansing Station 54 Services under the Food and Drugs Act: Milk and Dairies (General) Regulations, 1959 54 Milk (Special Designations) (Amendment) Regulations, 1965 54 Milk (Special Designations) Regulations, 1963 54 Brucella Abortus 55 Ice-cream 55 Bacteriological Examination of Other Foods 55 Food Premises 55-56 Food Inspection 56-60 Sampling of Food and Drugs 60-64 Services under Housing Acts 64-65 Services under Other Enactments: Shops Acts, 1950-65 65 Offices, Shops and Railway Premises Act, 1963 65-67 Prevention of Damage by Pests Act, 1949 67-68 Pet Animals Act, 1951 68 Riding Establishments Act, 1964 68 Diseases of Animals Act, 1950 68 Clean Air Act, 1956/1968 69-70 Factories Act, 1961 53-54 Noise Abatement Act, 1960 70-71 Pharmacy and Poisons Acts, 1933-1941 71 Burial Act, 1857 71 Caravan Sites and Control of Development Act, 1960 71 Caravan Sites Act, 1968 71 Greater London (General Powers) Act, 1967 (Hairdressers and Barbers) 71 3 To the Mayor, Aldermen and Councillors of the London Borough of Merton. Mr. 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 1973 and also the School Health Service Report. This will be my last report since, on the 1st April, 1974, National Health Service Reorganisation meant the transfer of Health Department Staff and Services to the new Area Health Authority for Merton/Sutton/Wandsworth. The impending reorganisation of the National Health Service cast its shadow over the Department throughout the year and there were many staff changes caused by feelings of insecurity by members of staff in view of the lack of information about their prospects under the National Health Service. Consequently, there were periods when the staff position was almost desperate and I should like to express my profound gratitude to those who decided to stay with the Health Department and for the efficient, conscientious and loyal way they supported me during a very difficult period. The Registrar General's mid-year estimate of population was 176,640, 180 less than in the previous year. The rate of decrease in population has slowed down in the last two years, before which it was at an approximate rate of 1,000 a year. The proportion of the population aged 65 and over, continued to increase, from 14.63% in 1971 to 15.64% in 1973. The corresponding percentage for England and Wales is 16.78. There were 2,152 live births in 1973, a decrease on the previous year of 168, and the excess of births over deaths dropped to 98, the lowest ever recorded. The live birth rate of 12.2 is the lowest since 1955. The infant mortality rate, the neonatal and the early neonatal mortality rate, as shown on page 13, were lower than in 1972 and well below the corresponding figure for England and Wales. The still birth rate and the perinatal mortality rate were both somewhat higher than in the previous year but still below the national figure. There were 2,054 deaths in the year, 89 fewer than in 1972. Surprisingly there were 23 fewer deaths from lung cancer, which is contrary to the current trend for England and Wales as a whole. It is pleasing to report that accidental deaths were also fewer, 35 in 1973 as opposed to 42 in 1972. The Patrick Doody Clinic and Child Health Centre in Pelham Road, Wimbledon, was brought into operation in January, 1973. The service, at this Clinic, continued to expand so that a full range of services was operating from the Clinic by the end of the year. The Health Education Service continued to expand and to fulfil its ever increasing and important role in all aspects of our preventive services, and the continued demand for further services remained throughout the year. In the Environmental Health Section progress on smoke control continued so that in approximately two years' time the whole of the Borough will have been covered by smoke control orders. Towards the end of the year the Environmental Health Service System 4 was reorganised on a functional basis. I am indebted to Mr. James Smith, the Chief Environmental Health Officer and his staff, for their unfailing support and co-operation at all times and am grateful to them for the preparation of the Environmental Health Report which is incorporated in this report. The School Health Service Report, including the Chief Dental Officer's Report is incorporated within the main report this year and not presented as a separate item to the Education Committee as was the custom in the past because the post of Principal School Medical Officer ceased to exist on the 1st April, 1974. I am grateful for the help and co-operation received from the Chief Education Officer and his staff, from head teachers and all other teachers, also the dental and nursing staff, for the satisfactory and efficient manner in which they carried out their duties during the year. I am pleased to inform you that the standard of health of Merton schoolchildren remained very high, only two pupils being found unsatisfactory on medical examination, 99.97% of those examined, therefore, were found satisfactory. Medical inspection totalled 9,527, 6,853 routine inspections and 2,674 special inspections and re-inspections, resulting in 4,076 referrals for treatment or observation. Selective medical examination of children on transfer to high schools continued, 1,780 questionnaires being examined at the request of either their parents, the School Medical Officer or the Head Teacher. Following examination, 45 children were referred for treatment. Collaboration between the hospital nursing services and the community nursing staff continued to increase and further General Practitioner attachments were implemented. The night nursing service, which has proved a most valuable service, continued to expand and, in all, 3,874 visits were made during the year. Family Planning Services expanded actively, as described within the Report and the new Counselling Clinic for adolescents grew in proportion as time went on. Towards the end of the year, preparations for the new Health Service Reorganisation were well under way and the senior staff, although subjected to a year of extreme pressure, did their utmost to maintain satisfactory and caring services for the community. In January, Dr. Elizabeth Cloake, Principal Medical Officer, left the Department to take up a post with the Department of Health and Social Services, and Mrs. A. A. B. Poole, the Chief Nursing Officer, left the Department to take up the post of Area Nursing Officer for the Surrey Area Health Authority. I would also like to express gratitude to the General Practitioners for continued co-operation in making the attachment of nursing staff such a success, and to the Director of Social Services and the Director of Housing and their staff, for all their support and ready co-operation. Merton was renowned for its co-operation on all fronts and National Health Service Reorganisation will take a long time to even catch up, far less improve, the type of integration that already existed. 5 I am indebted to the Town Clerk and to all my fellow Chief Officers for help and support during the year, also the Health Committee, the Education Committee and the Council for their constant interest and support. I have the honour to be, Your obedient servant, ELZA H. TODD, Medical Officer of Health. Principal School Medical Officer. 6 COMMITTEES AT 31st DECEMBER, 1973 HEALTH COMMITTEE The Mayor, Councillor (Mrs.) V. M. Bonner, J.P. Councillor Geoffrey N. Smith (Chairman) Councillor (Mrs.) M. E. Chadwick (Vice-Chairman) Alderman J. R. Daniels Councillors: D. L. Davies D. J. Leonard G. H. Raymond A. A. W. Dix D. T. Miller (Resigned 6.7.73) H. C. A. Turner T. L. Harris, J.P. (18.7.73) (Miss) M. J. Minto (Miss) N. K. Watts G. A. J. White Co-opted member:— Dr. R. Arthur, T.D., J.P., 153 Cannon Hill Lane, S.W.20. 7 WHOLE-TIME STAFF (As at 31st December, 1973) 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., M.F.C.M. Chief Administrative Officer J, R. Richardson, A.R.I.P.H.H. Deputy Chief Administrative Officer E. A. Ayling Senior Medical Officers 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. 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. Principal Nursing Officer (Health Visiting) Mrs. I. Brown, S.R.N., S.C.M., H.V.Cert. Principal Nursing Officer (Midwifery and Home Nursing) Miss O. Williams, S.R.N., S.C.M., Q.N. Health Education Officer Mrs. I. Druce, S.R.N., S.C.M., H.V. Cert. Educational Psychologists Miss D. Waldeck, B.A. (Hons.) Mrs. A. Court, B.Sc., Diploma in Educational Psychology 8 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) Senior Speech Therapist Mrs. E. J. Fieldsend, L.C.S.T, Speech Therapists Mrs. A. Varah, L.C.S.T, Mrs. M. L. Harris Audiometrician Mrs. M. Dean, S.R.N. 9 PART-TIME STAFF (As at 31st December, 1973) Ophthalmic Surgeons J. M. Bird. M.B., B.S., D.O. 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. A. David, M.R.C.S., L.R.C.P. 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. 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) Audrey P. Whitfield, M.B., B.S School Dental Officers Mrs. R. E. A. Higgins, B.D.S. Mrs. M. Holt, B.D.S. 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. Physiotherapists Mrs. C. A. Pratt Mrs. E. M. Bowes, M.C.S.P. Mrs. W. J. Heath, M.C.S.P. Mrs. J. Simmons, M.C.S.P. 10 Speech Therapists Mrs. M. Tong, L.C.S.T. Mrs. P. M. Hawkins, L.C.S.T. Miss A. Herdman, L.C.S.T. Miss A. J. Messer, L.A.C.S.T. Psychiatric Social Worker Miss G. E. Stoneham Psychotherapist Mrs. M. Livesey, N.F.F.Diploma, Assn. of Child Psychotherapists Associate Chief Administrative Officer W. Atkinson, D.P.A., Cert.S.I.B. 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, including dwellings over shops, at 31.12.73 64,768 Rateable value, at 1st April, 1973 £29,602,215 Actual product of a penny rate:— 1972/73 £114,777 Estimated product of a penny rate:— 1973/74 £284,790 Population:— Census figure (1961) 186,647 Census figure (1971) 176,524 Registrar-General's Estimate of Population 1973 1972 at 30th June 176,640 176,820 12 Summary of Vital Statistics Live Births— 1973 1972 Legitimate: Males 1017 1063 Females 951 1062 1968 2125 Illegitimate: Males 96 88 Females 88 107 184 195 Totals 2152 2320 Live Birth Rate per 1,000 population 12.18 13.12 Corrected Live Birth Rate per 1,000 population 12.18 13.90 Illegitimate live births—percentage of total live births 8.55 8.40 Still Births— Legitimate: Males 6 5 Females 13 10 19 15 Illegitimate: Males 1 3 Females 2 2 3 5 Totals 22 20 Still-birth Rate per 1,000 live and still-births 10.12 8.55 Still-birth Rate per 1,000 population 0.12 0.12 Total live and still-births 2174 2340 Infant Mortality (Deaths of infants under one year of age)— Legitimate: Males 11 16 Females 12 16 23 32 Illegitimate: Males 2 1 Females 1 2 3 3 Totals 26 35 Infant Mortality Rate per 1,000 live births 12.08 15.08 Infant Mortality Rate per 1,000 legitimate live births 13.21 15.06 Infant Mortality Rate per 1,000 illegitimate live births 16.30 15.38 Neo-Natal Deaths (Deaths of infants in first 28 days of life) 22 24 Neo-Natal Mortality Rate 10.12 10.35 Early Neo-Natal Mortality Rate (deaths of infants in first week of life per 1,000 live births) 7.82 8.62 Perinatal Mortality Rate (Still-births plus deaths in first week of life per 1,000 live and still-births) 17.94 17.09 Total loss of infant life (Still-births plus infant deaths) per 1,000 live and still-births 22.08 23.50 Maternal Deaths (including abortion) — — Maternal Mortality Rate per 1,000 live and still-births — — Deaths 2054 2143 Death Rate per 1,000 population 11.63 12.12 Corrected Death Rate per 1,000 population 10.67 11.36 13  1973 1972 Deaths from Bronchitis and Emphysema per 1,000 population 0.58 0.54 Deaths from Pneumonia per 1,000 population 0.87 1.11 Deaths from Cancer of lung and bronchus per 1,000 population 0.72 0.85 Deaths from other forms of Cancer per 1,000 population 2.00 2.00 Marriages 1375 1460 Marriage Rate per 1,000 population 7.8 8.26 14 Causes of Death at different Periods of Life in the London Borough of Merton during 1973 CAUSE OF DEATH AGE GROUP AND SEX Under 4 weeks 4 Wks. & under 1 year 1 to 4 years 5 to 14 years 15 to 24 years 25 to 34 years 35 to 44 years 45 to 54 years 55 to 64 years 65 to 74 years 75 years and over TOTALS M F M F M F M F M F M F M F M F M F M F M F M F Tuberculosis of Respiratory System - - - - - - - - - - - - - - - - - 1 3 - - - 3 1 Late effects of Respiratory Tuberculosis - - - - - - - - - - - - - - - - - - - - 1 - 1 - Other Tuberculosis - - - - - - - - - - - - - - - - - - - 1 - 1 - 2 Menincocogal Infection - - - - - 1 - - - - - - - - - - - - - - - - - 1 Other Infective and Parasitic Diseases - - - - - - - - - - - 1 - - - 1 1 1 - - - - 1 3 Malignant Neoplasm: Buccal Cavity, etc. - - - - - - - - - - - - - - - 1 1 2 - - - 2 1 5 Malignant Neoplasm: Oesophagus - - - - - - - - - - - - - - - - 1 - 2 3 2 3 5 6 Malignant Neoplasm: Stomach - - - - - - - - - - - - - - 1 - 7 2 9 6 5 10 22 18 Malignant Neoplasm: Intestine - - - - - - - - - - - - 2 1 3 1 7 6 13 7 11 19 36 34 Malignant Neoplasm: Larynx - - - - - - - - - - - - - - - - 2 - 2 - - - 4 - Malignant Neoplasm: Lung, Bronchus - - - - - - - - - - 1 - 2 - 4 5 20 8 34 8 37 8 98 29 Malignant Neoplasm: Breast - - - - - - - - - - - - - 3 - 15 - 11 1 8 1 11 2 48 Malignant Neoplasm: Uterus - - - - - - - - - - - - - - - 2 - 4 - 4 - 3 - 13 Malignant Neoplasm: Prostate - - - - - - - - - - - - 1 - - - 3 - 3 - 14 - 21 - Leukaemia - - - - - - 2 - - - - - - - 3 - 1 1 2 1 1 1 9 3 Other Malignant Neoplasms, etc. - - - - 1 - 2 1 2 1 3 - 2 - 5 11 16 17 8 12 9 30 48 72 Benign and Unspecified Neoplasms - - - - - - - - - - - 1 - - - 2 - 1 1 - - 2 1 6 Diabetes Mellitus - - - - - - - - - - - - - - - - 1 1 1 2 2 6 4 9 Avitaminoses, etc. - - - - - - - - - - - - - - - - - - - 1 - - - 1 Other Endocrine Etc. Diseases - - 1 - - - - - - - - - - - - - 1 2 2 - - - 4 2 Anaemias - - - - - - - - - - - - - - - - - - - - - 2 - 2 Other Diseases of the Blood, etc. - - - - - - - - - - - - - - 1 - - - - - - - 1 - Mental Disorders - - - - - - - - 1 - - - - - - 1 - - - 1 2 1 3 3 Meningitis - - - - - - - - - - - 1 - - - - - - - - - - - 1 Multiple Sclerosis - - - - - - - - - - - - - - - 1 - 2 - - - - - 3 Other Diseases of Nervous System, etc. - - 1 - - - - - - - - - - 1 - - 2 1 2 1 2 3 7 6 Chronic Rheumatic Heart Disease - - - - - - - - - - - - 1 - 1 - 3 7 2 5 2 7 9 19 Hypertensive Disease - - - - - - - - - - - - - - - - 2 2 2 2 5 13 9 17 Ischaemic Heart Disease - - - - - - - - - - - - 6 - 22 7 68 16 97 67 83 134 276 224 Other forms of Heart Disease - - - - - - - - - - - 1 - - 3 - 3 1 7 10 29 61 42 73 Cerebrovascular Disease - - - - - - - - 1 - 4 1 1 1 4 4 4 10 27 36 42 112 83 164 Other Diseases of Circulatory System - - - - - - - - - 1 1 3 1 7 4 12 12 27 37 50 55 Influenza - - - - - - - - - - - - - - - - - - - - - 4 - 4 Pneumonia 2 - - - - - - - - - - 1 - 1 - - 4 2 19 6 37 83 62 93 Bronchitis and Emphysema - - - - - - - - - - - - - - 3 1 14 2 26 5 32 20 75 28 Asthma - - - - - - 1 - - - 1 - - - - 1 1 2 1 - - 1 4 4 Other Diseases of Respiratory System - - - - - - - - - - - - - - - 1 1 1 6 1 3 4 10 7 Peptic Ulcer - - - - - - - - - - - - - - - - - - 2 4 5 9 7 13 Appendicitis - - - - - - - - - - - - - - - - - 1 - - - - - 1 Intestinal Obstruction and Hernia - - 1 - - - - - - 1 - - - - - - 2 2 - 1 2 6 5 10 Cirrhosis of Liver - - - - - - - - - - - - 1 - 1 2 1 1 - - 1 - 4 3 Other Diseases of Digestive System - - - - - - - - - - 2 - - - 1 - 1 3 4 4 4 7 12 14 Nephritis and Nephrosis - - - - - - - - - - - - 1 - - - 1 - 1 4 1 1 4 5 Hyperplasia of Prostate - - - - - - - - - - - - - - - - - 2 - 3 - 5 - Other Diseases, Genito-Urinary System - - - - - - - - - - - - - - - - 1 2 2 1 3 8 6 11 Diseases of Skin, Subcutaneous Tissue - - - - - - - - - - - - - - - - - - - - - 2 - 2 Diseases of Musculo-Skeletal System - - - - - - - - - - - - - - - - - 1 - 1 1 4 1 6 Congenital Anomalies 2 5 - 1 - 1 1 - - - - - - 1 - - - 1 - - - 3 9 Difficult Delivery and/or Anoxic Condition 3 2 - - - - - - - - - - - - - - - - - - - - 3 2 Other Causes of Perinatal Mortality 3 5 - - - - - - - - - - - - - - - - - - - - 3 5 Symptoms and Ill-defined conditions - - - - - - - - - - - - - - - - - 1 1 - 5 7 6 8 Motor Vehicle Accidents - - - - 1 - 1 - 3 - 7 - - 1 2 - - - 1 3 2 3 17 7 All other Accidents - - - - - - - - - - 1 - 1 - 2 1 2 - 1 4 1 4 8 9 Suicide and Self-inflicted Injuries - - - - - - - - 1 - 2 - - - 2 1 1 2 2 - - - 8 3 All other external causes - - - - - - - 2 - - 1 - - 1 - - - - 1 - 1 1 3 4 TOTAL ALL CAUSES 10 12 3 1 2 2 7 3 8 3 22 6 19 10 61 59 179 121 299 221 376 630 986 1068 Comparative Statistics, 1973 Merton England and Wales Rates per 1,000 Population: Live births 12.18 13.7 Deaths (all causes) 11.63 12.0 Respiratory tuberculosis 0.02 0.02 Cancer of lung and bronchus 0.72 0.65 Rates per 1,000 live and still births: Still births 10.12 12.00 Maternal mortality — 0.13 Perinatal mortality 17.94 21.00 Rates per 1,000 live births: Infant mortality—deaths of infants under 1 year 13.21 17.00 Neo-natal mortality—deaths of infants in first 28 days of life 10.12 11.00 Early neo-natal mortality—deaths in first week of life 7.82 10.00 Principal causes of Death in order of Frequency Out of the 2,054 deaths occurring during the year, 1,753 were attributable to the undermentioned principal causes:— No. of Deaths. Percentage of Deaths from all causes. 1. Heart Diseases 669 32.6 2. Cancer 474 23.1 3. Cerebrovascular disease 247 12.0 4. Pneumonia 155 7.5 5. Other diseases of the Circulatory System 105 5.1 6. Bronchitis and Emphysema 103 5.0 INFANT DEATHS (Under 1 year) Principal certified causes of death Age at Death Under 24 hours Days Months Total 1- 7 814 1521 2228 1- 3 36 6- 9 912 Prematurity 6 5 1 - - - - - - 12 Congenital Malformations 2 3 1 1 - - 1 1 - 9 Broncho-pneumonia - - - - - 1 - - - 1 Birth Injuries - - - - - - - - - - Other causes 1 2 - - - - - - - 3 Totals 9 10 2 1 - 1 1 1 - 25 INFANT MORTALITY Of the 25 infant deaths, 19 occurred in the first seven days of life. All of these babies were delivered in hospital. The infant mortality rate of 12.08 compares very favourably with the rate of 17.0 for England and Wales. PERINATAL MORTALITY The perinatal mortality rate for Merton was 17.94 per 1,000 live and still births, and, although higher than in 1972, is still below the rate of 22.0 for England and Wales. MATERNAL MORTALITY Once again there were no maternal deaths in the year. 17 CONTROL OF COMMUNICABLE DISEASES Notifications received during 1973 (Corrected Notifications) Disease Age Groups of Cases Notified Total Under 1 1- 2 34 59 1014 1524 2544 4564 65 & over Measles 31 180 225 428 44 13 6 - - 927 Dysentery — 5 2 — — — 3 — — 10 Scarlet Fever — 1 9 33 5 — 1 — — 49 Whooping Cough 5 3 2 3 — 1 — — — 14 Food Poisoning — 1 1 — 1 2 1 2 — 8 Malaria - - - - - - - - - - Infective Jaundice — — 1 2 — 3 3 1 1 11 Meningitis — 3 ' — — — — — — — 3 Tuberculosis (Resp.) — — — 1 — 3 8 9 4 25 Tuberculosis (Non-Resp.) — — 1 — — 2 9 1 — 13 Typhoid - - - - - - 1 - - 1 Paratyphoid — — — — — 1 1 — — 2 Leptospirosis - - - - - 1 - - - 1 Totals 36 193 241 467 50 26 33 13 5 1064 General A total of 1,064 notifications was received in 1973, compared with 503 in 1972. The increase was almost entirely due to measles notifications, which were more than doubled. The number of cases of scarlet fever also increased sharply from 28 in 1972 to 49 in 1973. These increases reflect the picture for the whole of England and Wales. 18 The following table shows the corrected notifications of infectious disease received in 1973 and in the preceding eight years:— Disease 1973 1972 1971 1970 1969 1968 1967 1966 1965 Measles 927 397 427 738 964 322 1777 851 2428 Dysentery 10 4 92 21 139 5 20 39 34 Scarlet Fever 49 28 50 42 48 55 60 45 62 Whooping Cough 14 10 50 53 8 49 117 74 42 Typhoid Fever 1 — — 3 — — — — 1 Food Poisoning 8 3 16 65 23 9 3 4 9 Malaria — 2 2 1 1 — 1 — — Infective Jaundice 11 21 29 20 36 11 ... ... ... Acute Meningitis 3 5 6 2 4 1 — — l Opthalmia Neonatorum — — 1 1 1 — — — 1 Tuberculosis: Respiratory 25 28 20 29 38 36 41 48 45 Non-Respiratory 13 5 7 10 6 6 3 5 9 Acute Encephalitis — — — — 2 — 1 — — Leptospirosis 1 — — — 1 — — — — Paratyphoid 2 — — — 3 — — — — Poliomyelitis (Paralytic) - - 1 - - - - - 1 Totals 1064 503 701 985 1274 494 2023 1066 2633 Note: Infective jaundice not notifiable until 1968 Cholera Three separate cases of suspected cholera were admitted to hospital in 1973, all were travellers returning from abroad. Family and other contacts were checked but all three cases proved negative. Diphtheria Following the detection of two cases in a hospital in a neighbouring borough, two families were tested with negative results. Dysentery Nineteen cases in all were investigated during the year, two flexner dysentery and 17 of sonne dysentery. One case was found to be in the daily care of a registered child minder but the child minder's family and the other children she was looking after were all negative. There was one outbreak of dysentery in May, when a meals supervisor at a school for maladjusted children was found to be infected. A check on the staff and pupils showed that three other members of the staff and five pupils were also infected. These were all excluded from school and checking continued until the last case was cleared five weeks later. In addition, 82 suspected cases involving 152 people were also investigated, all results proving negative. E.Coli Infections There were 22 cases of E.Coli infection involving 64 persons. There were also two cases in a local maternity hospital in which some 19 of the Borough's midwifery staff and pupils were involved. One pupil was found to be infected but responded quickly to treatment. Food Poisoning Thirty-eight confirmed cases of food poisoning infection, as tabulated below, came to the notice of the Department during the year from various sources. Twenty-eight families and 87 persons were involved. None of the cases was directly attributable to food and eight of them were contracted abroad. In addition to these, there were 26 cases of suspected food poisoning involving 45 people all of which proved negative on investigation. Type of Salmonella. Number of cases. Number of families. Number of persons. S. Dublin 2 1 5 S. Newport 2 2 6 S. bredeney 1 1 3 S. heidelberg 1 1 4 S. enteritidis* 7 2 8 S. gärtner* 1 1 2 S. typhimurium 16 10 35 S. St. Paul 1 1 3 S. haifa 2 1 4 S. luke 1 1 4 S. eimsbuettel† 1 1 1 S. newingtonf† 1 1 1 S. livingstonef† 1 1 1 S. agona 2 2 6 S. pareilly§ 1 1 2 S. infantis§ 1 1 2 41 28 87 *, †, §=isolated from one patient. Included in the above were two babies who contracted s. typhimurium within 48 hours of birth, in hospital. Although they responded to treatment, they remained carriers of the infection and were still infected at the end of the year. One finally became clear in June, 1974, but the other had to be re-admitted to hospital for special treatment. Ten other Merton babies who were in the hospital remained free from infection. Leptospirosis The only notified case was a girl aged seven years, who was thought to have contracted the infection when she fell into a river and grazed her leg. Meningitis There were three notified cases of meningitis in 1973. One, a girl of two years, died after a very short illness. Contacts were checked and there were no related cases. 20 Smallpox A number of contacts of the smallpox in London were investigated and vaccinated and there were no developments. A certain amount of anxiety was caused when it was found that a bed from the London Hospital concerned had been sent to a local firm, without first being sterilised. A number of the work force were vaccinated and the Works were kept under surveillance for the necessary period. Thirty-nine persons arriving in England without the necessary international certificate of vaccination were also kept under surveillance for the required time. Typhoid and Paratyphoid There was only one confirmed case of typhoid, a young man who contracted the illness while on holiday in India. Two members of his family who were food handlers were suspended from work pending the result of tests, but there were no related cases. Two cases of paratyphoid were also investigated, one contracted in Sardinia and one in Beirut. Contacts were screened, but again there were no associated cases. Two typhoid contacts and their families were tested, results being negative. Late in the year information was received that a family contact of two confirmed cases of typhoid was working as a food handler in the Borough. He was excluded from work and has been excluded ever since. His employer and his family were checked and found to be free from infection. Miscellaneous There were minor outbreaks of sickness and/or diarrhoea in four schools and a day nursery during the year. Extensive testing was carried out in each instance but no specific organisms were isolated. The illness was of brief duration. 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 133 Cases of lung cancer 58 Other chest cases (bronchitis, ectasis, etc.) 89 21 The new cases examined at the Chest Clinics in 1973 are analysed in the table below:— Respiralory Non-Respiratory Total M F M F Diagnosed Tuberculous 3 2 - - 5 Non Tuberculous 302 200 - — 506 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 133. Visits in connection with old cases 434 Visits in connection with new cases 33 Visits in connection with contacts 50 Total 517 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 3,924 Number found negative 3,489 Number vaccinated with B.C.G. 3,481 No children with positive skin tests were known to be contacts of notified cases of tuberculosis. One hundred and fifty-eight children with positive skin tests were X-rayed. One case of active disease was found. Incidence of Tuberculosis Primary notifications of tuberculosis received during the year were as follows:— Males. Females. Total. Respiratory 15 10 25 Non-respiratory 5 8 13 This shows an increase of five in the notifications for respiratory tuberculosis compared with 1972, which is rather disturbing especially as it is contrary to the trend for England and Wales as a whole. However, the total number of respiratory cases on the tuberculosis register continues to decline and is now below 400 for the first time. In 1965 it was almost 900. 22 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 1.1.73 226 177 35 31 403 66 Primary Notifications in 1973 15 10 5 8 25 13 Inward transfers in 1973 2 1 1 1 3 2 Totals 243 188 41 40 431 81 Died during 1973 10 1 - — 11 - Recovered during 1973 17 13 3 4 30 7 Transferred out in 1973 14 10 — - 24 - Total cases removed from Register 41 24 3 4 65 7 No. of cases on Register 31.12.73 202 164 38 36 366 74 Mass X-Ray The Mass Radiography Unit of the Regional Hospital Board, in addition to providing a regular service for general practitioners, carried out surveys on industrial sites and sessions were held for the general public. The service is of great value in the early diagnosis of pulmonary tuberculosis and non-tuberculous abnormalities. The results are tabulated below:— Number X-rayed Pulmonary T.B. found Primary Lung Cancer found Total Males Females Males Females General Practitioner Service 1,298 2 1 8 3 Public and Industrial Sessions 6,527 1 2 8 1 Totals 7,825 3 3 16 4 The figures in respect of public and industrial sessions do not apply to Merton residents only, as the service is available to any member of the public. Deaths There were five deaths from respiratory tuberculosis and its late effects and two deaths from other tuberculosis, during the year. The table of causes of death on page— gives an analysis by age and sex. 23 The death rates per 1,000 population were 0.02 respiratory and 0.01 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 made grants of £150 to the Mitcham T.B. Care Committee and £100 to Merton and Morden T.B. Care Committee in 1973. PROPHYLACTIC MEASURES The table below gives details of initial protection given by the use of prophylactics against diphtheria, 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 1973 1972 1971 1970 1966/69 Diphtheria 48 1361 382 46 32 9 1878 Whooping Cough 48 1359 373 44 29 4 1857 Poliomyelitis (Oral) 50 1345 365 33 16 14 1823 Tetanus 48 1361 382 46 34 19 1890 Measles 9 673 463 93 64 13 1315 Rubella - — — — — 77 77 Below are given the percentages of children, born in 1971, who had been given protection against whooping cough, diphtheria and poliomyelitis by the end of 1973. The figure in brackets is the corresponding percentage for England and Wales:— Whooping cough 72 (79) Diphtheria 72 (81) Poliomyelitis 72 (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 1,784 Whooping cough 106 Poliomyelitis 1,855 Tetanus 1,917 Poliomyelitis At the end of the year, 96,998 persons had completed a full course of immunisation since the scheme began in 1956. The age distribution of these completed cases is given below:— 24 Persons born 1943-73 68,911 Persons born 1933-42 15,791 Others 12,296 Total 96,998 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 1973:— Clinic Number of new cases seen during year Total all Conditions Syphilis Gonorrhea Other Genital Infections Other Conditions Primary & Secondary Other Croydon General Hospital 72 1 - 6 41 24 Dreadnought Seamen's Hospital 2 - - - 1 1 London Hospital 32 1 — 2 20 9 Middlesex Hospital 84 — — 7 42 35 St. Bartholmew's Hospital 46 — — 5 31 10 St. Helier Hospital 635 2 5 55 450 123 St. Thomas's Hospital 96 — 2 15 59 20 Westminster Hospital 26 - 1 1 13 11 Totals 993 3 8 91 657 233 Comparison with 1972 shows an increase of 98 in the total number of cases seen, but it must be pointed out that only about onetenth of the total cases are infected with syphilis or gonorrhoea. There was an increase of three cases of syphilis other than primary or secondary and an increase of 14 new cases of gonorrhoea. This increase is, unfortunately, in keeping with the trend for England and Wales as a whole. 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 1973, 1,681 questionnaires were received and 338 medical examinations were conducted 1,343 staff being accepted following 25 completion and scrutiny of the questionnaire; only 14 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 321 medical examinations of teachers and teacher trainees and in all 659 medical examinations were conducted compared with 604 in 1972, In 15 cases the examinees were found unfit either to commence or return to work and 29 examinations concerned staff absent from duty owing to sickness to determine their fitness or otherwise to return. A total of 2,031 staff were dealt with compared with 1,532 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 action was taken under this Act in 1973. Ugandan Asians The main body of immigrant Ugandan Asians had already arrived by the end of 1972, but 14 families comprising 28 adults and 12 children who arrived early in 1973 were visited by the District Public Health Inspector and given advice. Where children were involved they were also contacted by a Health Visitor. 26 Notifications of Birth The table below gives details of all births notified during the year occurring in the home, or in Institutions, and gives the total number of births finally attributable to Merton after outward transfer of births attributable to other Authorities. This figure of attributable notified births does not necessarily coincide with the number of attributable registered births supplied by the Registrar-General. Domiciliary Births Institutional Births Total Births Live Still Total Live Still Total Live Still Total M F M F M F M F M F M F M F M F M F Births notified as occurring in Merton 27 27 - - 27 27 960 982 6 6 966 988 987 1009 6 6 993 1015 Births occurring outside Merton attributable to Merton (Inward Transfers) - - - - - - 710 631 7 12 717 643 710 631 7 12 717 643 Total of all births notified 27 27 - - 27 27 1670 1613 13 18 1683 1631 1697 1640 13 18 1710 1658 Births occurring in Merton attributable to other Authorities (Outward Transfers) - - - - - - 564 568 3 5 567 573 564 568 3 5 567 573 Total births attributable to Merton 27 27 — — 27 27 1106 1045 10 13 1116 1058 1133 1072 10 13 1143 1085 27 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 639 specimens during the year 22 of which were repeat samples where the first reading showed slightly raised phenylalanine level. One positive case was subsequently diagnosed as phenylketonuria, so that there are now two cases in the Borough where the health visitor carries out weekly tests. Observation and Handicap Register This register was continued during 1973. 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. The following table gives details of the number of handicapping conditions (some children have more than one). 28 List of Handicaps on Observation & Handicap Register December, 1973. 1 Visual Handicap 5 2 Auditory Handicap 6 3 Language and Speech 9 4 Epilepsy 4 5 Cerebral Palsy 6 6 Spina Bifida and Hydrocephalus 10 7 Muscular Dystrophy and other Muscular Disorders - 8 Metabolic and Endocrine 10 9 Alimentary System — 10 Cardio-Vascular System 16 11 Respiratory System 3 12 Genito-Urinary System 4 13 Educationally Subnormal 13 14 Severely Educationally Subnormal 20 15 Maladjusted/Autistic/Psychotic — 16 Battered Babies 9 17 Blood Disease 1 18 Limb and Skeletal Abnormality 13 19 Chronic Illness (neoplastic) 1 20 Skin Disease — 21 Other Conditions 1 22 Chromosomal Abnormalities (including Mongolism) 16 147 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. 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. 29 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 89 Number of women who attended for post-natal examination 40 Since attendances at these clinics are normally low, the remainder of the clinic session is devoted to cervical cytology. There were 322 midwives' clinic sessions at which 72 women attended. The total number of attendances was 593. 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, Patrick Doody, Wide Way. The number of women who attended were:— Booked for hospital confinement 480 Booked for domiciliary confinement 11 Total 491 The total number of attendances was 2,155. Premature Infants The total number of premature infants born in the area during 1973 was 123 compared with 153 in 1972. Twelve premature infants died in 1973. This means that 9.7% of the 123 premature infants born during the year died within a year as compared with 0.6% for full-term babies. Premature Infants Born at Home— There were no premature babies born at home in 1973. 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:— 30 Amity Grove Clinic Monday 2-4 p.m. West Wimbledon Friday 10 to 12 noon Baptist Hall* Tuesday 2-4 p.m. Longley Road, S.W.17 Cavendish Road Clinic Monday 2-4 p.m. Colliers Wood Friday 9.30-11.30 a.m. Church Road Clinic Wednesday 2-4 p.m. Mitcham Thursday 2-4 p.m. Churchill Hall* Tuesday 2-4 p.m. Effra Road, S.W.19 Emmanuel Hall* Thursday 2-4 p.m. Lingfield Road, S.W.19 Grand Drive Clinic Raynes Park Monday 10 to 12 noon and 2-4 p.m. Wednesday 10 to 12 noon Meopham Road Clinic Wednesday 2-4 p.m. Mitcham Middleton Road Clinic Tuesday 2-4 p.m. Morden Friday 2-4 p.m. Morden Road Clinic Tuesday 2-4 p.m. Merton Thursday 2-4 p.m. Patrick Doody Clinic Tuesday 2-4 p.m. Pelham Road, Wimbledon Friday 2-4 p.m. St. John's Hall* Thursday 10 to 12 noon High Path, Merton St. Luke's Hall* Friday 2-4 p.m. Strathmore Road, S.W.19 Wide Way Clinic Monday 2-4 p.m. Mitcham Thursday 9.30-11.30 a.m. 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. 31 Attendances at Child Health Centres Name of Centre Total No, of Sessions First Attendances Total Attendances including firsts Born In Total 1968-73 1973 1972 196871 Amity Grove 100 220 226 190 636 4,303 Cavendish Road 100 138 133 122 393 2,808 Church Road 103 212 170 136 518 3,094 Churchill Hall 50 59 53 86 198 1,355 Emmanuel Hall 51 54 31 14 99 549 Grand Drive 105 198 222 281 701 3,810 Longley Road 50 142 40 43 225 2,392 Meopham Road 51 61 61 88 210 1,510 Middleton Road 101 131 95 315 541 2,291 Morden Road 102 111 139 104 354 2,074 Patrick Doody 101 252 232 207 691 4,147 St. John's Hall 52 28 77 65 170 686 St. Luke's Hall 51 85 50 44 179 1,652 Wide Way 101 208 221 271 700 4,715 Totals 1,118 1,899 1,750 1,966 5,615 35,386 A total of 5,615 children attended during the year. Attendances at Toddlers' Clinics First attendances Total attendances Total sessions (All clinics) Born In Total 1973 1972 1968-71 1968-73 — 15 1163 1183 2264 304 Dental Care The number of expectant and nursing mothers treated in 1973 was slightly less than in 1972, and there was also a slight decrease in the numbers of ore-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 38 28 28 Children under 5 594 236 240 32  Scaling and gum treatment Fillings Teeth otherwise conserved Extrac tions General anaesthe tics Dentures XRays Full Part Expectant and Nursing Mothers 16 42 4 1 1 3 7 Children under 5 49 463 8 21 14 - 3 Developmental Clinic This clinic continued to play an essential part in dealing with children of suspected developmental delay. Eighteen sessions were held during the year at which 16 children were seen for the first time and 48 were seen subsequently for review. Congenital Malformations The following malformations were notified during the year:— Central Nervous System 6 Eye and Ear 1 Alimentary System 2 Respiratory System 1 Urino-Genital System 2 Limbs 14 Other parts of Musculo skeletal System 1 Other Malformations 4 Total 31 The number notified during 1972 was 40. 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 of Welfare Foods, 1973 National Dried Milk 11,095 Vitamin Drops, A, D, C 10,493 Vitamin Tablets, A, D, C 5,670 Cod liver oil and orange juice are no longer sold. 33 THE NURSING SERVICES Although the demand on the Community Nursing Services continued to increase in 1973, the home nurses, midwives, health visitors and school nurses maintained their customary high standard of service. Great emphasis is placed on caring for people in their own homes, thus allowing the terminal sick and the elderly to spend their last days in their home surroundings supported by their relations and friends. The nursing staff continue to take part in training students of all disciplines and observation visits were made by many visitors to the Borough during the year. One health visitor was awarded a Florence Nightingale Scholarship to study nurse education in Canada. Slimming for Health sessions were increased from one session per week in November, 1972, to four sessions per week in 1973. These clinics have proved very popular, they are very well attended. The general practitioner is informed of persons attending to ensure there are no medical contra-indications to their attending. Geriatric Health Visiting The specialist health visitor continues to play an important role in acting as the liaison between the general practitioner, hospital and local authority services. We were fortunate in recruiting a second health visitor who works approximately half time for this specialised service. HEALTH VISITING At the 31st December, 1973, the staff consisted of:— 1 Principal Nursing Officer. 3 Nursing Officers. 28 Full-time health visitors. 4 Part-time health visiters. 8 Health vistor students. 1 Full-time specialist geriatric health visitor. 1 Part-time specialist geriatric health visitor. 1 Full-time specialist chest diseases health visitor. 1 Full-time specialist visitor for special clinic. 1 Full-time clinic/school nurse. 11 Part-time clinic school nurses. 5 Full-time clinic aides. 1 Full-time clinic aide/receptionist. Four health visitor students sponsored by the Borough in 1972/ 73, were successful in their examinations and joined the Health Visiting staff in September, 1973. Eight health visitor students are in training this year. Five at Ewell Technical College, two at Croydon Technical College, and one at the Polytechnic of the South Bank. 34 Specialist Visitor (Special Clinic) A specialist visitor joined the staff in May, 1973. She is based at St. Helier Hospital. Her duties include atttendance at clinic sessions, contact tracing and follow up of clinic defaulters in appropriate cases. Training of Health Visitor Students Four health visitor students were sponsored by Merton in 1973. Seven students received their practical training within the Borough. Post Registration Training 5 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. 20 health visitors and clinic nurses attended a special two-day course on family planning. 3 nurses attended a course for school nurses. 1 health visitor attended a first line management course. 22 health visitors attended day courses on various subjects in order to improve and maintain theoretical knowledge. Geriatric Health Visiting It was still not possible to engage a second full-time health visitor for this particular field, but a second part-time trained nurse was recruited in October to help cope with the additional work load. Health Education The health visitors continued to give advice and instruction in health education in high and middle schools, at child health, ante natal and parentcraft sessions, in addition to their work in this field in the course of their home visiting. Summary of Work of Health Visitors Sessions attended by Health Visitors. Local Authority Ante-Natal Cytology 11 G.P. Ante-Natal 212 Developmental (Patrick Doody Clinic) 40 Special Developmental, 7/12—9/12 135 Child Health Clinics 1,742 G.P. Child Health Clinics 586 Toddler/Developmental 329 G.P. Toddler/Developmental 57 Mothers' Groups (Day) 55 Mothers' Groups (Evening) 3 Expectant Parents Evenings 44 Case Conferences 43 Screening Tests of Hearing of young children 64 Sessions with Students 1,190 Meetings 341 Mothercraft 303 35 Mothercraft (Hospital) 14 Slimming for Health (Day and Evening) 179 G.P. Obesity Clinic 46 Older Persons' Clinics 147 Hospital Liaison. Paediatrics Departments 91 Infectious Diseases 41 Sessions attended by State Registered Nurses. Ante-Natal Cytology 289 Vaccination/Immunisation 58 Developmental (Patrick Doody Clinic) 22 Child Health Clinics 635 Cystic Fibrosis 40 Staff Medicals 235 Slimming for Health 30 Older Persons' Clinics 97 Screening Tests of Hearing of young children 40 Health Education Sessions by Health Visitors. G.P. Premises 46 M.O.H. Centres 494 Schools 106 Hospitals 16 Others 41 Case Conferences attended by Health Visitors 43 MIDWIFERY Staff As at 31st December, 1973, 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. 1 Part time district midwife. Introductory As anticipated, and in line with national trends, the number of babies born at home has continued to decline. There were 54 home confinements in 1973 compared with 82 in 1972. 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 36 discharge from hospital remains high, and the number of visits paid to mothers discharged early in 1973 was 5,457. In 1972 the figure was 5,609. Midwives screened 617 babies by Guthrie test (for phenylketonuria). These were babies delivered at home or discharged from hospital before the sixth day. 22 repeat tests were undertaken. Maternity Cases Attended There were 54 domiciliary confinements reported and 2,174 hospital confinements during the year. This shows a reduction of 28 on the figure for 1972. Midwives employed by this Authority attended all home confinements a doctor having been booked in all but five of the 54 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—51 Trilene—6 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 one occasion and the patient was subsequendy admitted to the hospital:— 1 case of post partum haemorrhage. Early Discharges from Maternity Hospitals The numbers of discharges from hospital before the tenth day of puerperium were as follows:— 48 hours after confinement 347 3-7 days after confinement 336 8-10 days after confinement 91 Patients delivered by domiciliary midwives in hospital 60 Total 834 This shows an increase of 138 on those for 1972. Midwifery Training The Integrated Midwifery Training Programme, which commenced at St. Helier Hospital in 1972, continued in 1973. 37 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. Seven 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. 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 1,385 Post-natal visits to home confinements 2,492 Post-natal visits to 48-hour and other early discharges from hospital 5,457 Total 9,334 Attendances at Clinics Three hundred and twenty-two ante-natal clinic sessions were held by midwives during the year and 72 women attended these clinics for the first time. The total number of attendances at midwives' ante-natal clinics was 593. Transfers to Hospital The undermentioned patients booked for home confinements were transferred to hospital:— (a) During pregnancy 2 (b) During labour 3 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 demand for nursing care to be given to patients within their own homes continues to increase. During the year staff continued to work with the General Practitioner Primary Health teams and some were assigned to the single doctor practices. 38 During the year 127,512 visits were made by the nursing sisters, compared with 117,297 in 1972, and the number of cases attended increased from 3,809 to 4,156. The nursing auxiliaries continue to be an indispensible part of the service since, without their help in dealing with the unskilled tasks, the nursing sisters would be quite unable to meet the demands made on them and the service would of necessity decline. The auxiliary nurses made 19,406 visits during the year. Staff As at 31st December, 1973, 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, but undergoing training. 3 Whole-time home nurses (male)—S.R.N. and District Trained. 1 Night nurse (female)—S.R.N. and District Trained. 2 Night nurses (female)—S.R.N. not District Trained. 7 Part-time home nurses. 4 Whole-time home nurses (female) — S.E.N. and District Trained. 1 Whole-time home nurse (female)—S.E.N. not District Trained. 1 Whole-time nursing auxiliary. 13 Part-time nursing auxiliaries (female). 1 Night nursing auxiliary. Training of District Nurses Four nurses attended a Practical Work Instructors' Course, three nurses a General Refresher Course and one a Management Course. Thirty-one staff attended day or half-day courses on various subjects in order to maintain and improve technical skills and theoretical knowledge. 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 gaining practical domiciliary experience as part of their overall training programme. It has been possible for some of the district nursing staff to spend some time in hospital learning about new methods of treatment and new drugs. 39 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 1.1.73 Cases added Cases removed Cases on books at end of year 0-4 years 1 17 18 — 5-64 years 194 1,109 1,106 197 65 years and over 1,018 1,817 1,840 995 Totals 1,213 2,943 2,964 1,192 The total number of cases attended during the year was 4,156 and the total number of visits made was 127,512. 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 1973, receiving a total of 53 visits. The aim of this service is mainly to relieve relatives from night nursing duties to enable them to get sufficient sleep and rest in order to continue the often strenuous task of looking after a really sick patient, particularly when it is desired that the patient shall remain at home until the end. 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. 40 Night Nursing Service This new service was started in late January, when two district nursing sisters were allocated covering four nights weekly, and two auxiliaries covering five nights weekly; a third nursing sister was appointed in May. The full complement of nursing auxiliaries has still not been reached. The service is based at 28-30 Kings Road, Wimbledon, where an Ansaphone is installed. Commencing at 8 p.m. the nurse and an auxiliary visit together patients requiring attention from both of them. The auxiliary then visits patients not requiring skilled care, e.g., those who are incontinent and those who need help in getting to bed. The nurse visits the ill requiring skilled care. From 11 p.m. the auxiliary remains with any patient requiring all night attendance. The nurse visits patients throughout the night as often as she deems necessary. Three thousand eight hundred and seventy-four visits were made to 146 patients, continuous night care being given by nursing auxiliaries on 175 occasions. Requests for the service are received from the Day Staff, General Practitioners, Casualty Departments, relatives, etc. When approval to commence this service was sought, there was definitely felt to be a need, and this is borne out not only by the figures, but by the positive help in relieving the anxieties of both patients and relatives. 41 PREVENTION OF ILLNESS, CARE AND AFTER-CARE Clinics for Older People The Older Person's Clinic at Amity Grove. This clinic continues to be well attended—the waiting list is perpetual. The medical examination continues to be a basis for discussion and explanation, with a 3-6 monthly return visit to the health visitor for reassurance. These 'mini' attendances are reinforced by the yearly medical examination, thus maybe relieving the pressure on the family doctors, who are of course notified if a condition is thought to need further treatment. Attendances were:— Number of new patients seen in 1973 Male 17 Female 70 Number of re-attendances in 1973 Male 157 Female 588 Average age of new patients 66 years. Dr. W. B. James makes the following observations on the Middleton Road Clinic:— Attendances, 1973:— Number of new patients Male 23 Female 66 Number of re-attendances Male 33 Female 89 Average age of new patients 60.9 years. Those who attend the clinic continue to appreciate the Service offered. During the course of the year cases of diabetes/mellitus, myxoedema, p. anaemia, hypertension, and prostatic hypertrophy were observed and referred to their General Practitioners for further investigation and treatment. The clinic performs a useful function for those middle aged and older people who have not had an opportunity of having a medical examination. Those who are reassured or have confirmation of being well and fit appreciate this knowledge and those who need reference for further study are appreciative of the advice given. 42 THE HEALTH EDUCATION SERVICE The aim of Health Education continues to be the spreading of information on how each person and family can learn as far as possible by observation, common-sense, practice, to avert health troubles. It is our aim and function to teach people to look after themselves, to learn how to avoid situations that, unnoticed, could lead to pain and sorrow and prolonged treatment. In other words the purpose of health education is to teach people of all ages, to regard their own health (and that of their families) as primarily their own responsibility. To this end, we employ all possible media: the spoken word, the written word and the pictorial. Lectures—usually supplemented by films and other visual aids— are given in schools, youth clubs, and to adult groups, such as groups of expectant parents (fathers as well as mothers). All these talks are supplemented by free discussion and question-and-answer sessions. In the written word field, many pamphlets and booklets are distributed among those interested in various aspects of health learning, and it is astonishing how wide are their interests. But undoubtedly, for mass education, the most telling means of instruction is the pictorial. There is no doubt that the propaganda that has attracted the widest attention—and therefore has had the strongest impact—has been the series of ' shocking ' posters put out by the Health Education Council. They have succeeded because they have drawn attention to themselves; and whether the feelings aroused have been of fear or revulsion, they have gripped the attention of the masses by the publicity they have received in the press. Health Education, of course, aims at persuading rather than threatening, but one feels that the occasional well-publicised 'scare' poster might produce tangible results. The Merton Health Education Service has continued to expand its activities with talks and meetings among schools, youth clubs and adults. The emphasis has always been on youth—for the vouths of today are the adults of tomorrow, and good habits learned young are hopefully carried into future life. A special campaign to boost the falling figures for immunisation against measles was mounted at the Merton Annual Show. In addition to the customary display of posters and leaflets, balloons bearing an appropriate slogan were distributed to children. In March of this year the Health Education Service moved to independent premises at Russell Road. The building, though old (it was originally designed as a war-time Day Nursery), could scarcely be more suitable, even had it been purpose designed. The team has been strengthened by the appointment of Mr. Peter White, as Assistant Health Education Officer, whose background as a First Aid Training Officer, and a member of the St. John Ambulance Brigade has greatly widened our scope. 43 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, 1973, 1,154 new applications for treatment were received. The following table gives figures for the Direct Scheme, with the corresponding figure for 1972 in brackets:— Category Persons treated in 1973 Number of treatments given Number on books at 31.12.73 Elderly 5,612 (5,544) 30,517 (29,521) 5,299 (5,282) Registered Blind or Partially Sighted 94 (112) 469 (481) 83 (89) Physically Handicapped 254 (206) 1,365 (1,076) 236 (194) Expectant Mothers 7 (7) 14 (10) 4 (3) Totals 5,967 (5,869) 32,365 (31,038) 5,622 (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 140 such loans were made this year. 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. 44 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 77 Crutches 1 Dunlopillo mattresses — Feeding cups 1 Air rings — Inhalers — Bed rests 78 Waterproof sheets 43 Bed pans 83 Pillow cases — Bed tables/trays 8 Urinals 52 Invalid chairs 188 Walking frames and tripods ... 42 Invalid chairs (self-propelled) 1 Fracture boards - Commodes 167 Sundries - Cradles 57 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 such holidays were requested in 1973. Cervical Cytology As there was a press campaign to publicise this service in the latter part of 1972, no special publicity efforts were considered necessary in 1973. The number of new cases dealt with in 1973 was somewhat less than in 1972. Well over 8,000 women have taken advantage of this service since it began in 1967. 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 830 new cases were dealt with and 2,148 repeat smears were taken. From this total of 2,978 smears taken during 1973, 15 required further investigation for possible malignancy. In addition, 498 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. 45 FAMILY PLANNING General The service that the South West London Branch of the Family Planning Association provided, acting as agents for the Council, continued to expand during the year and from time to time was the subject of publicity in the local press. On the 1st April, 1973, a free contraceptive service for all Merton residents of 16 years of age or over, was provided in the clinics in the Borough and at certain hospital Family Planning Clinics in the area. The service did not include persons working in Merton but not resident there. It was also agreed that prescriptions (other than N.H.S. prescriptions) issued by general practitioners to any of their patients resident in Merton could be dispensed free of charge at the Family Planning Clinics, the only proviso at that time was that items prescribed were those normally stocked in the clinics. In July, 1973, a scheme was introduced under which the prescriptions of G.P.s (other than N.H.S. prescriptions) could be dispensed in respect of any person resident in Merton at any pharmaceutical chemist free of charge, as well as at any Family Planning Clinic in the area. During the year an Adolescent Advisory Service with a Youth Counselling Clinic was opened at the Patrick Docdy Child Health Centre. The aim in opening this clinic was to help young people who were experiencing difficulty either emotionally or physically with adolescent adjustment to a balanced approach to sexual relationships. Vasectomies The Authority also agreed, with effect from the 1st April, 1973, to implement their powers under the National Health Service (Family Planning Amendment Act, 1972) to provide a free vasectomy service for male residents in the Borough who were referred on the advice of their general practitioners to a centre where free counselling and operative treatment could be provided. This was also operated as part of the South West London Branch of the Family Planning Association acting as the Council's agents. A counselling service at a special clinic session was provided and arrangements were made for subsequent operative treatment, where this was eventuallv decided upon. Clinics Family Planning sessions being held at Local Authority and other clinics at the end of the year were as follows:— Colliers Wood—Cavendish Road Clinic. Tuesday, 9.30—11.00 a.m. Wednesday, 5.30—7.00 p.m. Merton Park—Dr. Barley's Surgery, 2 Church Lane, S.W.19. Thursday, 1.30—3.30 p.m. (including I.U.D.) Mitcham—Church Road Clinic. Tuesday, 6.15—8.00 p.m. Thursday, 9.30—11.00 a.m. (including I.U.D.) Thursday, 6.15—8.00 p.m. 46 Pollards Hill—Wide Way Clinic. Monday, 9.30—11.00 a.m. Monday, 7.00—8.30 p.m. Raynes Park—Amity Grove Clinic. Monday, 6.15—8.15 p.m. —Grand Drive Clinic. Tuesday, 1.30—3.00 p.m. Wimbledon—The Patrick Doody Clinic and Child Health Centre, Pelham Road, S.W.19. Monday, 6.15—8.15 p.m. Tuesday, 1.30—3.15 p.m. Tuesday, 4.30—6.00 p.m. (Youth Counselling) Wednesday, 6.15—8.15 p.m. Friday, 6.15—8.15 p.m. Statistics Total number of new patients seen 2,193 Total number of patients seen (including new patients) 7,840 Total number of attendances 17,474 Number of cervical smears taken 2,760 Total number of clinic sessions 953 The domiciliary service was continued in 1973, 33 new cases being seen in the year. The Authority also accepts financial responsibility for any Merton cases who present themselves at the Brook Advisory Centres. During the year 147 such cases were dealt with. Geriatric Service I am indebted to Dr. Peter Millard, the Borough's Consultant Physician in Geriatrics, for the following report:— During 1973, 664 elderly people were referred for the first time to the Geriatric Service, an increase of 13% on 1972. Not all of these were admitted, some were seen as out-patients, at the Day Hospital or on a domiciliary visit. The number of admissions to the department increased by 99 to 755. Twenty-two patients were admitted to Welfare accommodation, the remainder of those who were discharged went to their own homes. The policy of running an active rehabilitive service for elderly people with no waiting list for hospital admission means that more people can benefit from treatment. It is, however, necessary that close links are maintained between the community nurses and the Geriatric Unit and without a common policy the service given to the elderly would deteriorate. The biggest gap in the services at present is that there is no coordination of the services between the geriatricians, the psychiatrists and the Social Services department about the elderly confused. We are hoping to improve this over the next year. With the re-organisation of the Health Service and the splitting of the catchment area into new districts it is essential that the boundaries for patients remain related to the local authority. 47 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR This is the Ninth 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 (i) quality and (ii) quantity throughout 1973. '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, 1973, 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:— 48 Thames—derived water from the Thames Valley group of stations. '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 1973 samples of water were taken for bacteriological and chemical examination by the Public Health Inspectors as follows:— Bacteriological— Swimming Baths 180 Dwelling Houses:— Metropolitan Water Board 2 Sutton District Water Company 2 Other premises:— Metropolitan Water Board 3 Sutton District Water Company 1 188 Unsatisfactory Results— Swimming Baths 8 Chemical— Swimming Baths 8 Dwellings:— Sutton Water Company 2 Other premises:— Metropolitan Water Board 2 12 All twelve 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. 49 Registered Common Lodging Houses There are no registered common lodging houses in the Borough. District Inspection The following is a summary of the complaints and requests received and visits made during the year 1973:— Complaints received— General disrepair and insanitary conditions 355 Dampness 227 Overcrowding 18 Defective drainage system 165 Blocked drainage system 1,255 Defective drainage fittings 18 Defective sanitary accommodation 65 Defective service water pipes 38 Absence of, or defective dustbins 21 Accumulation of refuse, etc. 171 Rats and mice 1,845 Pigeons 52 Foxes 15 Insect pests 796 Smoke nuisances 166 Noise 172 Smells and odours 196 Unsound food 366 Water supply 76 Miscellaneous 70 6,087 Visits made— General. P.H. Acts (Nuisance) 2,806 P.H. Acts (Dwelling houses) 2,064 Storage of refuse 192 Drains testing 57 Choked drains 3,017 Other drainage works 941 Radioactivity 8 Child minders 174 9,259 Housing. Housing Acts (Dwelling houses) 920 Overcrowding 42 Permitted number measurements 13 Rent Acts 9 Underground rooms 30 Houses in multiple occupation 218 Improvement grants 2,873 Caravans 43 Qualification certificates 2,684 6,832 50 Food and Food Premises. Milk processing dairies 120 Milk vendors 119 Ice-cream premises 275 Food factories 27 Food vehicles 410 School kitchens 44 Restaurant kitchens 734 Licensed premises 256 Bakehouses 68 Butchers 91 Wet and fried fish shops 87 Other food shops 764 Meat inspection 164 Unsound food 859 Sampling: Food and drugs 113 Sampling: Milk 141 Sampling: Ice-cream 34 Sampling: Water 172 4,478 Clean Air Act, 1956/1968. Smoke control areas 9,519 Other Clean Air Act visits 423 Smoke observations 314 Air pollution recording apparatus 956 11,212 Factories Act, 1961. Factories (powered) 96 Factories (non-powered 6 Factories (building sites) 9 Outworkers 17 Workplaces — 128 Infectious Diseases. I.D. enquiries 567 I.D. contacts 40 Food poisoning 10 Specimens 50 disinfection 10 Long stay immigrants 358 1,035 Offices, Shops and Railway Premises Act, 1963. O.S.R. general inspection offices 231 O.S.R. general inspection shops 207 O.S.R. general inspection wholesale/warehouses 42 O.S.R. general inspection catering/canteens 94 O.S.R. general inspection fuel depots 1 O.S.R. all other visits 709 1,284 51 Insects, Pests, Rodents. Rats and mice control 16,597 Insect control 440 Pigeon control 237 Verminous premises 94 Foxes 10 17,378 Animals. Stables 17 Piggeries 3 20 Miscellaneous. Places of public entertainment 5 Hairdressers and barbers 71 Fertilisers and Feeding Stuffs Act, 1926 9 Noise Abatement Act, 1960 364 Schools 19 Court proceedings 36 Public conveniences 21 Water courses 51 Shops Acts, 1950-1968 297 Pet shops 40 Diseases of Animals Act, 1950 2 Exhumations 6 Other visits 700 1,621 53,247 Result of Service of Notices (1) Legal Proceedings. Three Nuisance Orders were made by the Courts under the provisions of Section 94 of the Public Health Act, 1936, against landlords who failed to comply with Abatement Notices served upon them. In one case a landlord was ordered to pay £20 costs. (2) Nuisances abated and dejects remedied. Five thousand, seven hundred and sixty defects were remedied as a result of the service of verbal, written and statutory notices. 2,003 were in connection with the drainage of buildings; 2,426 in and around dwelling houses; 1,149 in connection with food premises; and 182 were of a miscellaneous nature. 52 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 60 6 - Factories with mechanical power 808 96 21 - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 9 9 1 - Totals 877 111 22 - (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) 15 7 - 5 - Overcrowding (S.2) — — - 4 Unreasonable temperature (S.3) 1 1 — - Inadequate ventilation (S.4) 6 6 - — - Ineffective drainage of floors (S.6) — — - — - Sanitary Conveniences (S.7):— Insufficient 2 7 1 - Unsuitable or defective 45 27 - 3 - Not separate for sexes 2 4 - — - Other offences (excluding offences relating to outwork) 9 8 — — — Totals 80 60 — 13 — 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 19 — — — — - Total 19 — — — — — 53 Number of addresses received from other Councils 62 Number of addresses forwarded to other Councils 23 Number of premises where outwork was carried on at the end of 1973 33 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 1973, nine 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 150. There are four dairies handling milk in bottles or sealed churns, and two pasteurising establishments, one of which also processes milk by ultra high temperature treatment. Milk (Special Designation) (Amendment) Regulations, 1965. Schedule 1 of the Regulations which refers to the special conditions subject to which licences to use the special designation 'Ultra Heat Treated' may be granted, was applied to the dairy which processes this milk. 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 158 Sterilised milk 98 Ultra Heat Treated milk 100 During the year, 206 samples or designated milk were submitted for prescribed tests. The results were as follows:— Designation Satisfactory Void. Unsatisfactory. Pasteurised 161 3 3 Sterilised 14 — — Untreated — — — Ultra Heat Treated 25 — — 54 Brucella Abortus. Two samples of raw milk were submitted for examination, and passed the test satisfactorily. Ice-Cream. The number of premises registered for the storage and sale of ice-cream is 522. Supplies are generally from well known sources, and before premises are registered, compliance with Food Hygiene Regulations requirements is ensured. The Inspectors made 275 visits to these premises during the year and 26 samples of ice-cream were obtained for bacteriological examination. The results were:— Grade 1 22 Grade 2 2 Grade 3 2 Bacteriological Examination of Other Foods. Subsequent to outbreaks of suspected food poisoning seven samples of foodstuffs were sent to the Public Health Laboratory for special bacteriological examination. No pathogens were isolated. 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. 3,896 visits were made to premises in which foodstuffs intended for human consumption were prepared, stored or sold. In addition, 410 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 were given careful attention. During the Annual Tennis Championship Meetings, at Wimbledon, complete inspections of all catering points are made. 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 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 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. 55 The provisional register of food premises includes the following: Greengrocers 156 Confectioners 216 Ice-cream premises 419 Bakers 55 Grocers and Provisions Dealers 183 Butchers 108 Fishmongers and Fish Fryers 52 Milk Distributors 150 Chemists 42 Licensed Premises 235 Clubs 55 Restaurants 146 Works Canteens 127 School Canteens and Kitchens 100 Food Stalls/Vehicles 211 Places of Public Entertainment 35 2,290 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 522 Registered for the manufacture and sale of ice-cream 7 Registered for the preparation or manufacture of sausages 75 Registered for the preparation or manufacture of potted, pressed, pickled or preserved food 209 The number of inspections of registered food premises during 1973 was 867. 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 1973:— Tons. Cwts. Lbs. Canned foods 11 5 37 Frozen foods and ice-cream 4 7 72 Meat, bacon, poultry 2 10 13 Fish — 7 99 Fruit and vegetables — 6 65 Cereals, bread and flour — 10 57 Sugar, jam — 2 82 Confectionery — — 13 Minerals, fruit juices — 4 45 Vinegar, pickles, spices — 7 105 Beer, wine, spirits — 3 41 Cheese, butter — 5 53 Spaghetti — 6 18 Miscellaneous — 4 50 21 2 78 56 The number of complaints received during the year regarding unsound food was 366. 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:— Foreign matter in loaf (5)**. Mouldy bread (11). Tobacco in loaf. Glass in loaf. Oil in loaf. Black spots in loaf. Metal in loaf*. Plastic in loaf*. String in loaf*. Rubber in loaf*. Beetle in loaf. Fly in loaf. Pink loaf. Doughy loaf. Dirty milk bottles (24)************* Glass in milk (2)*. Defective milk botde. Foil cap in milk (2). Fishbone in milk*. Syringe in milk. Black spots in milk (2). Particles in milk. Grit in milk. Foreign object in milk (2). Contaminated milk (4). Watered milk. Sour and rancid milk (2). Mould in baby food. Mouldy carrots. Mouldy cheese (2). Mouldy cheese and ash in roll. Mouldy meat pasty. Mouldy pork pie (5)**. Mouldy sausages (3). Mouldy meat pie (2). Mouldy apple pie. Mouldy Christmas pudding. Mouldy cakes. Mouldy crumpets (2). Mouldy Swiss roll. Mouldy jam. Mouldy lemon cream. Mouldy strawberries. Mouldy chocolate fingers. Mouldy potatoes*. Mouldy chutney. Mouldy brussels sprouts. 57 Mouldy coconut. Mould in canned bean shoots. Glass in butter. Glass in jam. Glass in apple turnover. Glass in prawn crackers. Glass in canned tuna. Glass in take-away meal. Bone in nougat. Bone in canned pork meat. Snail in frozen peas. Snail in blackcurrant jam*. Slug in ham and tomato sandwich*. Bluebottle fly in butter. Beetle in roll*. Fly in canned grapefruit (2). Fly in pre-packed salad. Fly in canned minced beef*. Weevil in chocolate*. Wire in chocolates. Maggots in cheese (2). Maggots in chocolates (2). Maggots in mint creams. Maggot in frozen pie. Maggots in curry powder. Plastic in sausages. Plastic in frozen rissole*. Wood in piece of beef. Cigarette end in almond slice*. Cigarette burn on roll. Nail in canned beef casserole. Grit in kelp powder. Black substance in canned cream (2). Cardboard in packet of haddock. Bristle in pre-packed meal. Screw in baked beans. Match stick in spinach. Match stick in bun (2)*. Dirty beer bottle. Dirt in sugar (2). Insect in sugar. Insect in pork pie. Insect in canned oranges (2). Insect in canned apricots. Insect in can of powdered milk. Insect in packet of biscuits. Insect in fried potato chips*. Insect in bread roll. Grub in flour. Infested pearl barley. Mouse in sausage roll. Mouse droppings in butter. Mice in meat pie. Mice in sausage roll. Mice in breakfast cereal. 58 Mice nibbled biscuits. Moths in chocolate confection. Mildewed potato crisps. Mildewed leg of pork*. Foreign object in apricot pie. Foreign object in grapefruit juice (2). Foreign object in frozen beans. Foreign object in orange squash. Foreign object in chocolates. Foreign object in porridge oats. Foreign object in minced beef. Foreign object in cheese roll*. Foreign object in cream dessert. Unsound pork pie. Unsound oranges. Unsound bacon (4). Unsound prawns (2). Unsound chicken. Unsound cheese cake. Unsound cooked meat. Unsound canned beans. Unsound apples. Unsound gammon knuckles. Unsound leg of pork (2). Unsound beef meal (2). Unsound fruit cocktail. Unsound chicken pieces. Unsound eggs (3). Unsound tongue. Unsound custard tarts. Unsound pre-packed cooked ham. Unsound fish fingers. Unsound yoghurt (6)*. Unsound take-away meal. Unsound beef burghers. Unsound corned beef. Unsound canned fruit. Unsound herring fillets. Unsound fried rice. Unsound celery and apple salad. Unsound potato crisps. Unsound fish. Green colour in butter*. Green colour in ham and egg roll. Rusted inside of canned tomatoes. Defective lacquer in can of rhubarb. Rancid corned beef. Taste of scone mixture. Taste of rice. Taste of sponge gateaux. Taste of Veal Escalope. Taste of margarine. Taste of marshmallows. Taste of corned beef. Taste of skimmed milk. 59 Out-dated milk powder. Stale cakes. Stale biscuits. Meatless pork pie. Lamb's liver alleged to be pig's liver. No chicken in chicken curry. Raw cooked chicken. Pink liquid from sausages. Decomposing sausages. Adulterated beef dripping. Sour ice-cream. Sour carton of cream*. Substandard cream. Diluted canned fruit syrup. Marks on apple. Misleading label of breakfast cereal. In the last four years the number of food complaints has increased by 27%. This, in my opinion, is due to a greater awareness on the part of the public that the Health Department can take action both to prevent further complaints arising and, where necessary, to institute legal proceedings against companies who fail to take sufficient precautions to prevent unsound or stale food reaching the customer. Sampling of Food and Drugs. Samples of food and drugs were sent to the Public Analyst, Messrs. Moir & Palgrave, 16 Southwark Street, S.E.I, for examination and report. During the year 1973, 178 samples were submitted of which eight were formal samples, and 170 informal. The Public Analyst reported that of these samples 160 were found to be genuine, and to comply with the relevant Acts, Orders and Regulations, and 18 did not so comply. In addition to the samples submitted to the Public Analyst, 26 samples of spirits were subjected at the time of purchase to a gravity test and were found to be satisfactory. All 18 non-genuine samples comprised various contraventions of those sections of the Labelling of Food Regulations, 1970, which came into force on 1st January, 1973. These cases were taken up with the manufacturers concerned, and resolved informally. The following 28 samples were submitted for special examination, the results being as shown:— Bread (2) Non-genuine (2) Butter Non-genuine Chocolates Non-genuine Cooked Veal Non-genuine Fried Potato Chips Non-genuine Frozen beans Non-genuine Milk (17) Non-genuine (14) Party Pie Non-genuine Rissoles Non-genuine Sausage Roll (2) Non-genuine (2) Further particulars regarding the 25 non-genuine samples are as follows:— 60 Bread (2). Foreign matter consisting of fruit tissue, flour, particles of iron and traces of mineral oil embedded in crumb of wrapped loaf—legal proceedings—defendants pleaded guilty— lined £15 with £10 costs. Wheat husks, vegetable hairs and bran made up the foreign matter embedded into the crumb of a wrapped, sliced loaf of wheat germ bread—extraneous material part of the original wheat—letter to the bakers. Butter. A piece of black foamed plastic contained within a i lb. packet of butter which had been blended from butter from three countries—letter to packers. Chocolate. Three bars of chocolate from two different manufacturers affected by insect infestation—old stock— legal proceedings against vendors who pleaded guilty—fined £30 with £10 costs. Cooked Veal. It was the opinion of the Public Analyst that veal cooked in breadcrumbs and batter, should not be described as escalopes of veal—letter to owners of restaurant concerned. Fried Potato Chips. A beetle was found in a paper bag of chips. It was the opinion of the Public Analyst that the beetle had been in contact with heated oil — legal proceedings — defendant changed plea to guilty—fined £30 with fees and costs £37.10. Frozen Beans. Contained within a 2 lb. bag of frozen sliced green beans was foreign matter which was found to consist of a piece of skin with bird feathers attached—correspondence with producers. Milk. Twelve dirty milk bottles gave rise to legal proceedings being instituted in respect of eleven of them—in each case defendants pleaded guilty—fines totalling £250 with costs of £49 were imposed. A deposit of black material consisting of flies, larvae, pupae, vegetable and gritty matter in a bottle of school milk—legal proceedings—defendant pleaded not guilty—case proved— fined £50 costs and fees £31. A pint bottle of milk contained fragments of glass—legal proceedings—defendant pleaded guilty—fined £30 with costs of £11. Party Pie. A pork party pie giving rise to a complaint of bitter taste, was found on analysis to contain fat which indicated some rancidity—letter to producer. Rissoles. A piece of glass was found in a rissole as it was about to be consumed—legal proceedings—defendant pleaded guilty —fined £20 with £7 costs. 61 Sausage Rolls (2). A sausage roll contained a piece of animal skin and hair within the sausage meat—legal proceedings—defendant pleaded guilty—fined £50 with £7 costs. A sausage roll contained a piece of animal skin within the sausage meat—a warning letter was sent to manufacturers. 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. Mould on the meat of a party pie kept in deep freeze for over two weeks before sale from a works canteen—vendors not claiming warranty were fined £30 with £7 costs after pleading guilty. A slug in a ham and tomato sandwich, later to be identified as the larva of a potato tuber moth, gave rise to proceedings against the bakery firm who made and sold the sandwich —defendant pleaded guilty—fined £40 with £7 costs. One of four buttered buns purchased from a baker's shop contained a used match-stick—defendants pleaded guilty— fined £30 with £7 costs. A carton of cream opened 11 hours after delivery by a milk roundsman was found to be sour—product sold out of date —defendants pleaded guilty—fined £60 with £7 costs. A small piece of blue plastic baked in a fruit loaf—vendor pleaded warranty— bakers against whom proceedings were taken pleaded guilty—fined £40 with £11 costs. A missing split pin from bakery machinery was found in a a wrapped sliced loaf of bread purchased within this Borough —vendors pleaded warranty—bakers of the loaf pleaded guilty—fined £10 with £3 costs. A five inch long fish's backbone contained in one-third pint bottle of school milk—the dairy company pleaded guilty to an offence and were fined £10 with £3 costs. A large piece of red plastic was discovered in a loaf of bread as it was being cut—the bakery concerned admitted losing a red plastic dough scraper from which the piece had come— the bakers pleading guilty, were fined £10 with £3 costs. A 3 lb. bag of potatoes delivered by milk roundsman contained one potato which was mouldy and others infested with maggots—plea of not guilty submitted—date of sale disputed —case dismissed. Eating a miniature pork pie purchased five minutes previously, complainant discovered mould on the surface of the 62 meat within the pie—vendor pleaded guilty—fined £3 and shared costs of £7. A small white bread roll, one of six purchased, contained within its substance a small beetle—vendor claimed warranty —baker pleaded guilty—fined £15 with £5 costs. Starting to eat a cheese roll purchased from a restaurant, complainant found a piece of china embedded in the substance of the roll—vendor claimed warranty—baker pleaded guilty—fined £15 with £5 costs. A snail protruding from the untouched surface of some blackcurrant jam—vendors claimed warranty—manufacturers pleaded guilty—fined £25 with £10 costs. Cigarette end found in an almond slice cake—baker pleaded guilty—fined £35 with £10 costs. A black rubber suction cap which had fallen from a detinning machine during production of the loaf was eventually found in eight slices of a wrapped cut loaf of bread—warranty was claimed by the vendor—baker pleaded guilty— fined £25 with £7 costs. A large fly in a can of minced beef with onions and gravy— vendors claimed warranty—defendants pleaded guilty—fined £25 with £10 costs. A piece of string found in a currant loaf—bakers pleaded guilty—fined £50 with costs of £10. Food and Drugs Act, 1955—Section 8. Proceedings were instituted against a cash and carry store for selling a leg of roast pork unfit for human consumption in as much as it was mouldy, and also for exposing for the purpose of sale, three large garlic sausages which were mouldy—defendants pleaded guilty—fined £50 for each of the two offences, with £7 costs. Yoghurt opened fifteen minutes after purchase was noticed to have a bubbly appearance and a fermenting smell. A visit to the shop exposed another eight yoghurts which were fermenting—shopkeeper pleaded guilty to the offence of selling unfit yoghurt—fined £3—also to the offence of displaying for sale unfit yoghurt—fined £10 with £7 costs which were shared with another case brought under Section 2 of the Act. For selling a ½ lb. packet of rancid butter a supermarket pleaded guilty to an offence, and for offering for sale 134 ½lb. packets of butter, also rancid, a similar plea was made— fined £30 for each offence with total costs of £7. Milk and Dairies (General) Regulations, 1959. Two one-pint botdes of milk, one containing cement deposits and the other containing matter consisting of paper fibres, traces of milk solids and patches of dead mould—same defendant in both cases pleaded guilty—fines of £50 and £30 with costs of £11 shared with other offences. 63 Inspection of Imported Food. Regular consignments of food which have not been inspected at the port of entry continue to be received by certain food companies in the district. The system of notification by the ports concerned has worked satisfactorily, and the companies concerned have co-operated fully in ensuring that the Public Health Inspectors were able to inspect the food before it was sold or processed. SERVICES UNDER HOUSING ACTS 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. Applications for Improvement Grants referred to me by the Borough Surveyor numbered 419 (Standard 106; Discretionary 313). All the houses concerned were inspected to Housing Act standards, and by arrangement with the applicants, were made fit as a condition of the grant. Discretionary Grants now form 75% of the total applications. The fall in applications compared with last year is in part due to the cessation of bulk applications from the G.L.C. in respect of the St. Helier Estate. 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, 1973, was:— Section 45, Qualifying Certificates— New applications 66 Certificates granted 59 Certificates refused 13 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 1,313 Number of applications still subject of negotiation at end of year 671 Total 1,984 No Clearance Areas declared in 1973; 45 houses were demolished; one part of a building (lower ground floor) was closed; one Closing Order determined. A Public Inquiry was held in April, 1973, into the making by the Council of the London Borough of Merton, Church Road (Clearance Areas Nos. 1—4), Compulsory Purchase Order, 1972, which 64 involved 105 houses, lock-up garages and sundry other buildings. This Order was confirmed with modification by the Secretary of State for the Environment in September, 1973. The total number of visits to premises of all kinds was 6,832. 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 297. 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 1973 in Merton was 1,284 and the co-operation of employers has been most encouraging. 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 57 913 230 Retail Shops 31 1,243 331 Wholesale Shops, Warehouses 15 80 41 Catering Establishments open to the Public, Canteens 8 170 94 Fuel Storage Depots — 5 1 Totals 111 2,411 697 65 Contraventions rectified. Cleanliness 73 Temperature 40 Ventilation 15 Lighting 10 Sanitary Conveniences 44 Washing facilities 44 Clothing accommodation 4 Floors, passages, stairs 56 Dangerous machinery guarded 18 First Aid provisions 59 Hoists and Lifts 37 Other contraventions 39 Exemptions. No exemptions (Section 46) were granted in 1973. Accidents Reported and Investigated. In offices 6 In retail shops 20 In wholesale shops and warehouses 8 In catering establishments open to the public, in canteens, etc. 4 Registration. The pattern of Registration has remained much the same a; 1972, 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. The number of full general inspections carried out during the year was approximately 28% of the total number of registered premises. More time has been spent with employers, managers and surveyors discussing problems that arise in complying with the requirements of the Act. The number of plans proposing new buildings and extensions tc premises has greatly increased, which inevitably entails more time being spent on checking that the provisions of the Act are being met. 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 still 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. 66 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. Accidents. There was a total of 38 accidents reported during the year, one, which related to a goods lift was considered to be serious. Details of that particular accident were sent to H.M. Factory Inspectorate. Mechanical Handling. There is a great increase in the use of fork lift trucks throughout the Borough, and certain hazards relating to the stacking of goods are becoming apparent. It is hoped to carry out a survey of hazards associated with mechanical handling in the coming year. 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. Following the accident which occurred in connection with a goods lift (as mentioned above) the observations of the Central Advisory Inspectorate were sought. The defect in the lift was subsequently corrected. Prosecutions. No legal proceedings were instituted during the year, although in some instances it became necessary to warn firms of the risk of prosecution. 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, 1973:— Number of properties in district 77,491 Number of properties inspected 4,322 Number of properties infested by rats 766 Number of properties infested by mice 1,421 Total number of visits including re-inspection 16,597 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 1973, 1,800 manholes were baited and 496 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 1973, 796 complaints were received concerning insect pests and the following is a list of the infestations dealt with:— 67 Ants 53 Bees 32 Beetles 15 Bedbugs 38 Bluebottles 1 Cockroaches 23 Fleas 82 Flies 8 Earwigs 1 Maggots 10 Mites 1 Mosquitoes 6 Silverfish 1 Wasps 415 Woodlice 1 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 higher than last year. 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. Fifty-two 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. 315 pigeons, 142 eggs, and 95 nests were destroyed. Night visits were made to railway bridges to take birds which were roosting. During the year 15 complaints were received of the presence of foxes, which were causing some alarm among nearby householders. During the year it was necessary to employ the services of the Council's specialist contractor on two occasions when six foxes were destroyed. There is no doubt that this service is appreciated by householders. Pet Animals Act, 1951. Fifteen licences to keep Fet Shops were issued during 1973. Forty visits were made to these premises to ensure compliance with the conditions attached to these licences. The Riding Establishments Acts, 1964-1970. One full licence for one year was 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 Wimbledon ceased to operate as a licensed riding establishment. Diseases of Animals Act, 1950. No outbreaks of disease occurred within the Borough during 1973. 68 Clean Air Act, 1956/1968. During 1973, 166 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 14 applications received during the year, all were approved. Measurement of 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 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. 69 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. No. 24 1972 Operative date 1.8.73. No. 25 1972 Operative date 1.8.73. No. 26 1973 Operative date 1.7.74. No. 27 1973 Operative date 1.10.74. No. 28 Awaiting confirmation. No. 29 Under survey. The area of the Borough covered by Orders either in operation, or confirmed but not operative, is 8,409 acres. The total number of premises involved in these areas is 57,116. Comparable figures at the commencement of the year were 7,831 acres and 50,279 premises. On 31st December, 1973, the percentage of the total 'black area' acreage in the Greater London Area, which was covered by Smoke Control Orders confirmed or awaiting decisions was 94% and the comparative figure for the London Borough of Merton was 89%. The total number of visits made during 1973 in connection with the Clean Air Acts for all purposes, was 11,212. 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 1973, 172 complaints regarding noise were received, and the investigation of these entailed 364 visits, many of which were made outside normal office hours. 70 The most common causes of noise complaint were domestic (30), industrial (29) and roadwork, construction, demolition (24). The Council has associated itself with the Local Authorities Aircraft Noise Council, which forms a useful pressure group whose main aim is to see the noise from aircraft flying from Heathrow Airport is reduced to an acceptable level. Legal proceedings were instituted during the year, under Section II (3) of the Noise Abatement Act, 1960, against two ice-cream vendors for sounding loud-speaker chimes attached to ice-cream vehicles outside permitted hours. The defendants pleaded guilty and were fined £10 in one case and £8 in the other case. The Pharmacy and Poisons Acts, 1933-1941 Ninety-four 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. Rag Flock and Other Filling Materials Act, 1951. Two factory premises were inspected for the purpose of issuing certificates of registration under this Act. Both premises were satisfactory and certificates were issued. Burial Act, 1857. Four 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. Caravan Sites and Control of Development Act, 1960. The number of sites at 31st December, 1973, 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 Giuld. The Caravan Sites Act, 1968. The periodic survey of sites occupied by caravans without licence or consent was continued. The Council provide a caravan site with 15 pitches at Durnsford Road, S.W.19, for gypsy families in the district. All the pitches are 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, was granted and came into operation on 1st August, 1973. 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 155 premises were registered and 71 visits were made during the year. 71 CONCLUSION It was not possible to fill all the vacancies for Public Health Inspectors during the year, and for the majority of the time there were three vacancies, although one of these was taken up when Mr. Grant, Pupil Public Health Inspector, qualified in November, 1973. The four Pupil Public Health Inspectors under training continue to make satisfactory progress. The Council accepted certain changes in the organisation of the Environmental Health work with the result that from November, 1973, work is carried out by four teams operating on a functional basis. It is anticipated that by specialising in this way it will be possible to more readily control the work that is carried out and to set priorities and targets that will enable better use to be made of the scarce manpower resources available. The work of the Public Health Inspectors will be supplemented by increased use of Technical Assistants who can carry out some of the more routine duties previously performed by the Public Health Inspectors. This is the last complete year in which the Health Department will function in its present form, and in April, 1974, the personal Health Services will be divorced from the Environmental Health Services. I would like to take this opportunity to thank Dr. Todd for the manner in which she has conducted the affairs of the Health Department, and for the co-operation that has always been available in those matters in which we worked closely together. Finally, I would like to express my appreciation for the support of the Chairman and members of the various committees concerned in 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. 72 ANNUAL REPORT on the work of the SCHOOL HEALTH SERVICE for the year 1973 CONTENTS Page Schools and Special Services Sub-Committee as at 31st December, 1973 75 School Clinics provided by the Local Education Authority 76-77 The Service 78 Medical Inspections 78 Audiology 79 Audiometry 79 Speech Therapy 80 Enuresis 81 The Work of the School Nurses 81 Child Guidance Service 82 Handicapped Pupils 83 The School Dental Service: Report by Chief Dental Officer 83 Statistics for year 1973 84 Infectious Diseases and Prophylactic Measures: 1. Infectious Diseases:— Table 1—Infectious Diseases 85 Table 2—Contagious Diseases 85 Epidemiological Surveys 86 2. Prophylactic Measures 87 Ancillary Services: Nursery Schools and Classes 88 Provision of Milk and Meals 88 Appendix ' A': Section 'A'— Routine Medical Inspections 89 Other Medical Inspections 89 Return of Defects Found at Medical Inspections 90 Children Found to Require Treatment 90 Section ' B '— Uncleanliness and Verminous Conditions 91 Diseases of the Skin 91 Eye Diseases, Defective Vision and Squint 92 Diseases of the Ear, Nose and Throat 92 Orthopaedic and Postural Defects 92 Other Treatment Given 92 Appendix ' B ': Attendances at Clinics 93 Other Medical Examinations by School Medical Officers 93 Recuperative Holidays 93 74 SCHOOLS AND SPECIAL SERVICES SUB-COMMITTEE (As at December, 1973) Chairman: Councillor D. F. Connellan Alderman R. S. Scorer (Vice-Chairman) Aldermen: V. Talbot, J.P. Councillors: (Mrs.) H. Bramsted J. N. Healey (Miss) S. Knight E. A. Chapelow D. J. Hempstead D. T. Miller (Mrs.) E. M. Davis W. A. Hillhouse J. A. Watson (Mrs.) C. A. Fletcher Co-opted Members: Miss S. C. Auger Mr. F. G. Mullens 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 Oificer: R. Greenwood, M.A., F.R.S.A. 75 SCHOOL CLINICS PROVIDED BY THE LOCAL EDUCATION AUTHORITY General Medical Clinics Amity Grove, Raynes Park: 1st and 3rd Thursday mornings. Examination of cases referred by Teachers, Education Department "Health Visitors, etc. Treatment of minor ailments. Grand Drive Raynes Park: Tuesday mornings. Middleton Road, Morden: 1st, 3rd and 5th Monday afternoons. Morden Road, Merton: 1st, 3rd and 5th Monday mornings. Patrick Doody, Wimbledon: 2nd and 4th Wednesday mornings. Western Road, Mitcham: Monday mornings. Wide Way, Mitcham: 1st, 3rd and 5th Wednesday mornings. Child Guidance Clinics 97 Worple Road, Wimbledon: -Monday to Friday all day. Sherwood House, Commonside East, Mitcham : (Cases seen by appointment by Psychiatrist or Educational Psychologist with the assistance of Psychiatric Social Workers) Ophthalmic Clinics Amity Grove, Raynes Park: Alternate Monday afternoons. 1 Examination and treatment of errors of refraction and squint. Grand Drive, Raynes Park: Friday afternoons. Morden Road, Merton: Wednesday afternoons. Western Road, Mitcham: Wednesday afternoons. Wide Way, Mitcham: Tuesday mornings. Patrick Doody, Wimbledon: Friday mornings. Orthopaedic Clinic Patrick Doody, Wimbledon: Every fourth Wednesday afternoon each month. Examination of referred cases by an Orthopaedic Surgeon. Audiology Clinic Patrick Doody, Wimbledon: 1st Friday (all day) Other Fridays— mornings only. Detailed investigation of cases referred. Remedial Exercises Amity Grove, Raynes Park: Monday mornings. Remedial and breathing exercises as recommende by School Medical Officers. Wide Way, Mitcham: Tuesday mornings. Patrick Doody, Wimbledon: Thursday mornings. 76 Speech Therapy Clinics Amity Grove, Raynes Park: 1 Tuesday afternoons and Wednesday all day. Treatment of speech defects. Grand Drive, Raynes Park: Monday all day, Thursday afternoons and Friday all day. Middleton Road, Morden: Wednesday all day. Morden Road, Merton: Tuesday and Thursday mornings. Patrick Doody, Wimbledon: Monday and Thursday mornings and Friday afternoons. Western Road, Mitcham: Tuesday all day and Thursday and Friday mornings. Wide Way, Mitcham : Tuesday mornings and Friday afternoons. Dental Clinics Amity Grove, Raynes Park: Monday to 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 Friday all day. 77 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. Ailments of a more serious nature are dealt with by general practitioners or the hospital service. There is 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 test during the 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. EMPLOYMENT MEDICAL ADVISORY SERVICE The Employment Medical Advisory Service came into operation fully in February. The Factory Doctor Service which formerly was 78 responsible under the Factories Act, 1961, for the medical examination of persons under 18 years of age working in factories ceased to exist. Under present arrangements pupils are medically examined by the School Medical Officer in the year in which they reach school leaving age whether or not they intend to leave school. A form, Y.9, is completed for any pupil not found unconditionally fit for employment. A copy of this form is forwarded to the Employment Medical Adviser, the Careers Officer and the General Practitioner. While every effort is made to ensure that all children reaching school leaving age are seen by the School Medical Officer, inevitably a few students fail to attend on the appointed dates. Should the Careers Officer have knowledge of a child who is possibly not unconditionally fit for employment and for whom he either has no form Y.9 or requires further help regarding the details given on the Y.9, he may contact the Health Department. Up to date information may then be sought from Hospital Consultants and general practitioners. With regard to severely handicapped pupils a form, Y.10 replaces the Y.9 for use at leavers' medicals. Form Y.10 is more elaborate than the Y.9 and is only passed on with the consent of the parent or guardian. The long standing arrangement between Careers Officers and Disablement Resettlement Officers regarding the employment of substantially handicapped pupils continues as before but advice may be sought from the Employment Medical Adviser. AUDIOLOGY Audiology Clinics are held weekly at the purpose-built unit at the Patrick Doody Clinic. Children who fail the audiometry test at school are referred via clinics throughout the Borough to the Patrick Doody Clinic. It is hoped to hold extra clinics at Pollards Hill when more staff are available. Children referred for speech therapy or special education are screened at the Audiology Clinic and general practitioners make use of the available facilities. The peripatetic teacher of the deaf visits all children with a hearing impairment; visits are made to both homes and schools. Regular visits are made to the Partially Hearing Nursery Unit within the Borough, by both the medical officer and the peripatetic teacher. AUDIOMETRY Details are given below of audiometric primary testing carried out during the year:— Number of primary schools visited 37 Number of children tested 2,648 Number of primary failures 164 Number of middle schools visited 11 Number of children tested 1,570 Number of middle failures 80 79 A total of 4,218 children in primary and middle schools were tested, of these 244 failed the audiometric test. In 1972, 5,419 children were tested and there were 385 failures. SPEECH THERAPY The opening of the Patrick Doody Clinic in January, 1973, gave the Speech Therapists a base from which to organise their work. The clinic provides facilities for extending intensive group treatment with pre-school and school age children. An increase in the establishment from four to six full-time posts allowed further developments to take place within the Service. Preventative measures have been extended. Advice on stimulating speech and language in young children has been given to parents attending Parent Craft Classes. As part of the Health Education course organised for sixth form pupils, Speech Therapists have visited schools. They have described the development of speech and language in children, and the nature of their work in general. Courses organised at Merton Technical College for play group leaders have included lectures from Speech Therapists. These have provided an opportunity to emphasise the need for verbal communication and developing speech and language in the pre-school child. Speech Therapy has been introduced at the Senior Training Centre in Mitcham. Details of cases dealt with are given below:— Number of sessions held: (a) for treatment 1,373 (b) for consultation 92 Number of cases on register at beginning of year 302 Number of cases added during the year 300 Number of cases discharged during year 201 Number of cases on register at end of year 401 Number of cases receiving group therapy at end of year 56 Analysis of cases discharged during year. Children who:— Achieved normal speech 132 Were greatly improved 15 Showed some improvement 7 Showed little or no improvement 12 Left for various reasons 35 Analysis of cases treated during year:— Stammering 50 Dyslalia 191 Dysarthria 6 Cleft Palate 5 Defects of voice 10 Aphasia 15 Dyseria 9 Retarded speech and/or language 323 80 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 1973 46 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 NURSE Throughout the year the health visitors and school nurses continued to give valuable assistance in promoting and maintaining the good health of school children in the borough. They attended routine and selective school medical examinations with School Medical Officers and vision testing was carried out on children in the appropriate age range. Nursing staff were also in attendance at prophylactic sessions for BCG, diphtheria, tetanus, polio and rubella. Health surveys took place periodically in schools and home visits were paid in some instances where follow up of unsatisfactory pupils was required. Health Education teaching continued in Middle and High Schools with liaison between nursing staff and the Health Education Officer. The following tables give details of visits paid by them in 1973: 1. Visits. To pupils found at school medical examinations to require observation or treatment 71 To educationally subnormal children 124 To verminous cases 245 To infectious or contagious cases 42 To miscellaneous cases (arising from School Medical inspections at request of Head Teacher, etc.) 114 To children with handicaps 16 2. Sessions attended. Pre-medical and vision testing 358 School medical inspections 505 Health surveys 389 General medical clinics 250 Health teaching 112 Immunisation 76 Freedom from infection inspections 58 81 CHILD GUIDANCE SERVICE 1. General In August a third psychologist, Mr. R.M.Bulkeley, was appointed to replace Mrs. Badawi in the Mitcham Child Guidance Clinic, but the vacancies for pyschotherapists continue to exist. This means, particularly at Mitcham, that a number of the patients cannot be offered the full range of clinic treatment. The Wimbledon Clinic, apart from a vacancy for a part-time psychotherapist, was adequately staffed. 2. Remedial Classes In September the Merton Reading Centre opened with an establishment of teacher in charge, deputy teacher in charge and four specialist teachers (Scale 2). Subsequently, the Manor House Nursery Class was closed leaving remedial classes in Greenwood and Garth Primary Schools. The peripatetic remedial teacher left the service in August and was replaced by Mr. J. Gibson who subsequently resigned in December. 3. Provision for the Maladjusted Melrose School became more fully established with a roll of rising 40. Cambridge House had one or two vacancies but in both these schools difficulties were experienced with finding suitable and experienced staff. 4. Assessment and Diagnostic Unit This unit is now fully established and working successfully. A number of children have been transferred to other suitable places for education following careful diagnosis. 5. William Wilberforce ESN School Discussions have taken place and a brief submitted to the Architect for the planning stage for this new ESN school to be established at Camp Road, Wimbledon, which will integrate the 'Round School' as part of the new buildings. The school will be for 120 pupils plus a diagnostic unit and will ultimately replace St. Christopher's. 82 HANDICAPPED PUPILS The following table shows the numbers of pupils on the Handicapped Pupils' Register as at 31st December, 1973, together with the special educational facilities which have been provided by the Authority:— Classification Numbers of pupils classified during 1973 Total number classified as at 31.12.73 Attending Special schools as: Awaiting placement at end of year Day pupils Boarders Blind 6 2 3 1 Partially-sighted — 5 4 — 1 Deaf — 16 7 9 — Partially-hearing 5 23 17 5 1 Educationally Sub-normal (M) 24 192 183 5 4 „ (S) 5 89 68 21 — Epileptic 2 3 — 3 — Maladjusted 22 114 69 41 4 Physically-handicapped 4 46 32 13 1 Delicate 2 35 20 14 1 Autistic — 2 — 2 — The number of pupils receiving education at home under Section 56 of the Education Act, 1944, was four. Numbers of pupils with physical or mental handicaps who are being educated within the ordinary school system as at 31st December, 1973:— Handicap No. of pupils Partially sighted 4 Partially-hearing 16 Epileptic 54 Diabetic 22 Physically handicapped 57 Delicate 51 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, 1973, the dental staff consisted of the Chief Dental Officer, four full-time Dental Officers, one part-time Dental Officer and one sessional Dental Officer. This includes the part-time service of an Orthodontist, making a full-time equivalent of 6.1 Dental Officers. 'The facilities of the service were increased with the opening of two new dental surgeries at the Patrick Doody Clinic, and three other clinics were equipped with the latest units. All clinics were equipped 83 with the up to date method of processing X-rays, which did not require a dark room. 'Dental Health Education talks were given to school children by health visitors and on two occasions by Dental Officers. Unfortunately fewer sessions were devoted to Dental Health Education as this Authority was operating with one Dental Officer under strength.' The statistics relating to the School Dental Service are given below:— Statistics for Year 1973 Number of pupils on the register of maintained Primary, Middle and High Schools including nursery and special schools in January, 1974, as in Forms 7, 7m and 11 schools: 27,328. Attendances and Treatment. Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First Visits 2,261 2,407 556 5,224 Subsequent Visits 3,244 4,432 1,087 8,763 Total Visits 5,505 6,839 1,643 13,987 Additional courses of treatment commenced 308 173 48 529 Fillings in permanent teeth 1,933 4,298 1,563 7,794 Fillings in deciduous teeth 4,528 577 — 5,105 Permanent teeth filled 1,600 3,871 1,478 6,949 Deciduous teeth filled 4,194 544 — 4,738 Permanent teeth extracted 24 353 94 471 Deciduous teeth extracted 483 422 — 905 General anaesthetics 170 79 11 260 Emergencies 334 146 47 527 Number of pupils X-rayed 807 Prophylaxis 670 Teeth otherwise conserved 29 Number of teeth root filled 83 Inlays 7 Crowns 13 Orthodontics. New cases commenced during year 166 Cases completed during year 190 Number of removable appliances fitted 285 Number of fixed appliances fitted 14 Pupils referred to Hospital Consultant 4 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) — 2 2 4 Number of dentures supplied — 2 3 5 84 Anaesthetics. General Anaesthetics administered by Dental Officers—Nil. Number of sessions where an Anaesthetist attended—25. Inspections. (a) First inspection at school. Number of pupils 21,778 (b) First inspection at clinic. Number of pupils 3,905 Number of (a) + (b) found to require treatment 11,401 Number of (a)+(b) offered treatment 10,356 (c) Pupils re-inspected at school clinic 2,028 Number of (c) found to require treatment 1,163 Sessions. Sessions devoted to treatment 2,679 Sessions devoted to inspection 229 Sessions devoted to Dental Health Education— INFECTIOUS DISEASES AND PROPHYLACTIC MEASURES 1. Infectious Diseases Table 1. Disease Suffering Excluded on suspicion Infection at home Total exclusions Scarlet Fever 44 - — 44 Measles 485 1 2 488 Whooping Cough 11 — — 11 German Measles 353 9 — 362 Chicken Pox 287 2 — 289 Mumps 284 2 — 286 Jaundice — — — — Other 372 2 — 374 Totals 1836 16 2 1854 Table 2. Contagious Diseases. Disease Suffering Excluded on suspicion Total exclusions Impetigo 31 — 31 Scabies 1 — 1 Other 4 — 4 Totals 36 — 36 85 Epidemiological Surveys In March, 1973, a child attending a primary school was found to be suitering from a tuberculous condition of the lungs and the Consutant Physician of the hospital in which she was an in-patient advised that a complete survey of pupils and staff at the school should be conducted. Immediate contact was made with the Headmaster who was given full details of the survey procedure. A nominal roll of pupils and staff was provided by the school and an explanatory letter was sent to the parents of each child in attendance seeking their consent to the skin test and to possible referral to the chest clinic should this prove strongly positive. The teaching and ancillary staff were advised to attend for a chest X-ray. The School Health Services of areas to which some pupils had moved during the period of possible infection were given details of the children so that any follow up investigation considered necessary could be arranged. During a session at school in March, 1973, and another for absentees in May, 1973, a medical team skin tested by heaf method 305 of the 324 children concerned with parental consent. 301 proved negative or were only weakly positive and four were strongly positive. The latter were referred to the Chest Clinic for any further investigation and the skin test re-action in three cases was immediately explained by previous B.C.G. vaccination against tuberculosis. The fourth child did not attend the Chest Clinic and no further action was taken by the Chest Physician. Twelve children were excluded from the survey for various reasons, e.g., already under Chest Clinic supervision or on the advice of their doctor and at the end of the survey sessions seven children still had to be tested. Letters were sent to their parents emphasising the importance of the health check provided by the survey and offering special arrangements for the skin tests to be carried out if they wished. Of the 36 teaching and ancillary staff 32 produced evidence of a recent and satisfactory chest X-ray examination. A chest X-ray was contra-indicated in one case and three who still had to be X-rayed were reminded. The result of this almost complete survey of pupils and staff indicated that there had been no spread of infection in the school. Such surveys as this involve considerable organisation and their successful conduct are dependent on the co-operation of the Head Teacher and staff of the school concerned. Their help is gratefully acknowledged. 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. During the year all schools were supplied with a booklet giving careful guidance on procedure regarding the notification of infectious disease and explicit instructions were issued regarding precautions necessary, so far as school staff are concerned, when German measles occurs in schools. 86 Prophylactic Measures 1. Poliomyelitis Vaccination. Vaccination of school children against poliomyelitis continued during the year. The actual number vaccinated or receiving reinforcing doses during 1973 is as follows:— Number of children vaccinated 30 Number of children given reinforcing doses 1,746 2. Diphtheria/Tetanus Immunisation. Number of children given immunisation 50 Number of children given re-inforcing doses 1,657 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. In School Clinics By General Practitioners Total Primary courses 6 6 12 Booster injections 84 57 141 4. Protection of School Children against Tuberculosis. B.C.G. Vaccination. Percentage of age group dealt with Number in age group 4,984 Number of consents 4,086 84.70 Number skin tested 3,679 73.81 Number Mantoux positive 63 0.63 Number B.C.G. vaccinated 3,470 69.62 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 33 girls in the prescribed age group were vaccinated. In addition 44 girls were vaccinated by general practitioners. No vaccination sessions were held in schools. The numbers are much smaller than last year as the campaign normally undertaken in September had to be postponed until 1974 due to a request from the Chief Education Officer that an additional age group should be given B.C.G. vaccination in the autumn term 1973 in order to avoid problems in the swimming season. Figures for 1974 will restore the balance. 87 ANCILLARY SERVICES 1. Nursery Schools/Classes There were 874 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 1972:— Year Number in attendance Taking Milk Taking Meals Number Percentage Free Paid Total Percentage September, 1973 24,438 *6,702 92.5 1,624 13,131 14,755 60.3 September, 1972 24,387 6,367 97.9 1,661 13,114 14,775 60.8 * These are pupils up to the age of seven years attending primary schools who were entitled to, and received, free milk. A further 207 pupils were entided to free milk but did not partake of it. The figure of 6,702 pupils includes 322 pupils in primary and middle schools over the age of seven years who were receiving free milk on health grounds. A further four children were eligible for free milk on medical grounds but did not partake of it. 88 Appendix 'A' MEDICAL INSPECTION AND TREATMENT (Excluding Dental Inspection and Treatment) Return for the year ended 31st December, 1973 Number of pupils on registers of maintained primary, middle, high, special and nursery schools in January, 1974:— (a) Ordinary Schools 26,673 (b) Special Schools 302 (c) Nursery Schools and Classes 874 Total 27,849 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* 1969 and later 487 1968 2,056 — 1967 314 — 1966 194 — 1965 151 — 1964 119 — 1963 730 — 1962 380 — 1961 69 — 1960 125 — 1959 673 619 1958 and earlier 1,153 206 Total 6,451 825 * 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 Re-Inspections 1,645 1,029 Total 2,674 89 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 93 74 8 17 Eyes (a) Vision 823 362 194 82 (b) Squint 95 10 5 1 (c) Other 4 10 1 1 Ears (a) Hearing 51 42 80 97 (b) Otitis Media 24 25 1 2 (c) Other 1 2 1 1 Nose and Throat 55 75 10 7 Speech 81 48 11 2 Lymphatic Glands 2 15 — — Heart 13 17 2 4 Lungs 60 45 11 2 Development (a) Hernia 7 12 — — (b) Other 40 95 5 2 Orthopaedic (a) Posture 5 — 1 — (b) Feet 15 15 5 3 (c) Other 21 27 11 2 Nervous System (a) Epilepsy 13 1 5 5 (b)Other 15 13 1 — Psychological (a) Development 5 25 6 5 (b) Stability 6 33 16 15 Abdomen 7 15 6 12 Other defects and diseases 72 158 37 165 Totals 1,508 1,119 417 425 Two thousand six hundred and twenty-seven defects were found in children at routine medical inspections of which 1,508 were referred for treatment and 1,119 for observation. 842 defects were found at special inspections, 417 being referred for treatment and 425 for observation. The total number of defects referred for treatment and observation in 1973 was 3,469. 90 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 1969 and later 487 55 % 11.29 1968 2,057 320 15.55 1967 314 48 15.28 1966 194 35 18.04 1965 151 31 20.52 1964 119 13 10.92 1963 730 133 18.21 1962 381 90 23.62 1961 69 8 11.59 1960 125 30 26.59 1959 673 179 26.27 1958 and earlier 1,553 408 26.27 Totals 6,853 1,350 19.69 Classification of General Condition of pupils inspected during 1973:— In two cases 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 22,748 2. Number of individual pupils found to be infested 187 3. Number of exclusions:— First time 43 Second time 4 47 4. Number of pupils cleansed 20 5. Number of Cleansing Notices issued under Section 54 of the Education Act, 1944 21 Diseases of the Skin (excluding uncleanliness') Number of cases known to have been treated during the year. Ringworm—scalp— Ringworm—body 1 Scabies— Impetigo— Other skin diseases (including verrucae, eczema, allergic skin conditions, acne, etc.) 185 Total 186 91 Eye Diseases, Defective Vision and Squint. Number of cases known to have been dealt with. External or other, excluding errors of refraction and squint 36 Errors of refraction (including squint) 2,224 Total 2,260 Number of pupils for whom spectacles were prescribed 561 Diseases of the Ear, Nose and Throat. Number of cases known to have been treated. Received operative treatment:— (a) for diseases of the ear16 (b) for adenoids and chronic tonsillitis 26 (c) for other nose and throat conditions 1 Received other forms of treatment 75 Total 118 Orthopaedic and Postural Defects. Number of cases known to have been treated at School, in Clinics or Out-patient Department 158 Remedial Exercises. During 1973, 119 sessions for remedial exercises were held in clinic premises, 37 new cases being admitted and 15 old cases discharged. One hundred and ninety-eight sessions were held in all at St. Christopher's, Ravensbury and St. Ann's Special Schools, 43 new cases being admitted and 36 old cases discharged. Other Treatment Given. Ailments. Number of cases treated. Miscellaneous minor ailments 66 Lymphatic Glands 2 Heart and Circulation 14 Lungs 51 Development (Hernia and Other) 29 Nervous System 23 Psychological Development and Stability 4 Diabetes 5 Enuresis 12 Obesity 5 Miscellaneous 66 Total 277 92 Appendix ' B ' 1. General Medical/Minor Ailments Clinics. Attendances made by children at General Medical/Minor Ailments Clinics 2,355 2. Other Medical Examinations undertaken by School Medical Officers. Children examined for part-time employment 610 In addition to the above, 300 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 12 All these children were examined on their return and all were found to have benefited from the holidays provided. 93