AC .43386 The Health of Richmond upon Thames 1967 RICH 36 LONDON BOROUGH OF RICHMOND UPON THAMES ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER For the Year 1967 A. M. NELSON, M.B., Ch.B., D.P.H. Health Department, Elmfield House, High Street, Teddington, Telephone: Middlesex. 01-977 4411-5. CONTENTS page Vital and General Statistics 7 Infectious Diseases 11 Health Services: Care of Mothers and Young Children 17 Midwifery and Home Nursing 24 Health Visiting 28 Vaccination and Immunisation 30 Prevention of Illness, Care and After Care 32 Home Help 38 Mental Health 41 Other Information 46 Sanitary Circumstances of the Borough 54 School Health Service 77 Index 99 2 HEALTH COMMITTEE as at 31st December, 1967. His Worship the Mayor, Councillor B. BLIGH, J.P., B.A. (ex-officio). The Deputy Mayor, Councillor Mrs. M. E. D. LEVER (ex-officio). Councillor F. D. GILDAY-FOX, B.A. (Chairman). Alderman L. DEFRIES-PORTER, LL.B., M.B.I.M. (Vice-Chairman). Alderman H. A. Leon, O.B.E., J.P. Councillor M. A. Beal. Councillor D. J. Child. Councillor C. F. Garrud. Councillor M. Gold, M.R.C.S., L.R.C.P., D.Obst.R.C.O.G. Councillor D. G. Harris, J.P. Councillor B. Hughes. Councillor T. B. Scott, F.B.I.M., F.C.C.S., F.I.A.C., F.S.S. Councillor C. W. Sewell, M.A., F.R.Econ.S. Councillor Mrs. G. D. Smith, J.P. Councillor R. H. Stevens. D. R. Sinclair, Esq., M.B., B.S. (Advisory). EDUCATION COMMITTEE as at 31st December, 1967. Councillor Mrs. H. A. M. CHAMPION (Chairman). Councillor Miss O. J. WILKINS (Vice-Chairman). Alderman E. Bostock, M.A., F.C.A. Councillor G. H. Loman, J.P. Alderman M. W. Garrett, D.L. Councillor L. W. Miller. Alderman L. Defries-Porter, Councillor Mrs. M. E. Owen. LL.B., M.B.I.M. Councillor B. W. C. Pride. Councillor R. A. J. Alcock. Councillor T. H. F. Raison, M.A. Councillor N. F. Barrow, LL.B Councillor B. L. Royle, Councillor J. H. Bedford, F.I.A.C. J.P., A.M.I.E.R.E. Councillor Mrs. H. E. Bell-Wright. Councillor G. J. Samuel, M.A. Councillor E. H. Campion, Councillor C. W. Sewell, B.A., Dip.Ed. M.A., F.R.Econ.S. Councillor F. E. Chapman. Councillor Mrs. G. D. Smith, J.P. Councillor F. L. Eslick, F.C.C.S. Councillor D. J. Neal Smith, M.D., Councillor F. D. Gilday-Fox, B.A. F.R.C.O.G.,; F.R.C.O. (Chm.) Councillor H. Hall, J.P., Councillor G. W. Tremlett. M.P.S., F.S.M.C. Councillor S. D. Wade. Councillor A. B. Hart, Ph.D. Councillor J. E. Woodward, O.B.E. Councillor A. M. Leaney. Councillor Mrs. M. A. Woodward, J.P. Canon F. J. Davys; Rev. T. F. Valentine, M.A.; Rev. D. Landreth, M.A.; Mrs. M. B. Davies; Dr. J. D. Mortimer, M.A.; Mr. F. A. W. Counter; Mr. R. C. Feather, M.A., B.Sc.; Mr. C. Holman; Mr. L. F. Holmes, Mr. T. Telling. 3 EDUCATION SCHOOLS SUB-COMMITTEE as at 31st December, 1967. Councillor Mrs. H. E. BELL-WRIGHT (Chairman). Councillor R. A. J. ALCOCK (Vice-Chairman). Alderman L. Defries-Porter, LL.B., M.B.I.M. Councillor Mrs. M. A. Woodward, J.P. Councillor H. Hall, J.P., M.P.S., F.S.M.C. Councillor Mrs. M. E. Owen. Councillor G. J. Samuel, M.A. Councillor Mrs. G. D. Smith, J.P. Councillor D. J. Neal Smith, M.D., F.R.C.O.G., F.R.C.O. (Chm.). Canon F. J. Davys. Mrs. M. B. Davies. Mr. C. Holman. Mr. L. F. Holmes. Councillor Mrs. H. A. M. Champion (ex-officio). Councillor Miss O. J. Wilkins (ex-officio). OFFICERS Medical Officer of Health and Principal School Medical Officer : A. M. NELSON, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health and Deputy Principal School Medical Officer: J. K. CRAIG, M.B.E., M.A., M.D., B.Ch., B.A.O., D.P.H., D.C.H., D.I.H. Medical Officer for Special Duties : J. MADDISON, M.D., B.S., D.P.H. (retired 16.4.67). Senior Assistant Medical Officers : MARGUERITE E. M. JAMES, M.B.E., M.B., Ch.B., D.P.H. MARY J. O'DONOVAN, M.B., B.Ch., B.A.O., L.M., D.P.H., D.C.H. VIVIENNE SIMMONS, M.R.C.S., L.R.C.P., D.C.H. Chief Dental Officer and Principal School Dental Officer : G. H. TUCKER, L.D.S., R.C.S. Chief Public Health Inspector : E. S. HERBERT, M.A.P.H.I. Chief pursing Officer: MISS G. M. FRANCIS, S.R.N., S.C.M., H.V.Cert. Superintendent Health Visitor: MISS D. M. WOODS, S.R.N., S.C.M., H.V.Cert. Non-Medical Supervisor of Midwives and Home Nursing Superintendent: MISS O. WILLIAMS, S.R.N., S.C.M., QUEEN'S NURSE. Chief Mental Welfare Officer : B. F. F. RADFORD, B.E.M., F.W.I., M.S.M.W.O. Chief Administrative Officer : H. J. PUGH. 4 HEALTH DEPARTMENT, ELMFIELD HOUSE, HIGH STREET, TEDDINGTON, MIDDLESEX. June, 1968. To the Mayor, Aldermen and Councillors of the London Borough of Richmond upon Thames. LADIES AND GENTLEMEN, I have the honour to submit my Annual Report for 1967. As previously envisaged the controlled expansion of the activities of the health department has continued. The details are contained in the succeeding pages. The significance of much of the work carried out during the year will unfold in subsequent Annual Reports. A view is held that the medicine practised outside the walls of the hospital could be termed as community medicine involved in the "world of the well". The family doctor and the local socio-medical services are deeply concerned in the seeking out of disease and disorder, the prevention of ill-health, and the care and support of the stricken patient in the community setting. Medical "checks" and screening techniques are the practical implementation of the philosophy behind the concept of the presymptomatic diagnosis of disease. During the year "well women" clinics were established throughout the Borough. Cervical cytology facilities in the hospitals were such that a higher throughput of pathological data could be handled. It was felt that if a female resident should wish to avail herself of this service, then she should have the benefit of a full physical examination and other screening procedures in addition to the "cervical smear". Hence "well women" clinics were established. In passing it should be pointed out that the individual concerned could present herself to her personal medical attendant for such a consultation, should she so desire. On your instructions a clinic for the elderly was started in Richmond, and a further two at Barnes and Hampton were in an advanced state of preparation at the end of the year. Community medicine has a heavy role in the field of the mentally disordered, and the elderly infirm. Some of the problems of these groups are not economically rewarding to the hospital treatment service and clinical beds can be occupied on social grounds after the disease condition has been ameliorated. The "when" and the "how" of the diagnosis of mental retardation in a child can be an emotionally traumatising situation for the parents so concerned. The extremes of parental reaction can be either rejection or over-protection of the child. Whatever place in the emotional spectrum the parents take up, they need a "listening ear" for all the ensuing facets of care and support. With this need in mind, counselling clinics with a socio-medical team in attendance were set up and have been well received. It is hoped the range of advice for subnormal children will be extended to include adults. 5 If a sick person is being cared for in the community, the burden, after a period of time, on the immediate and extended family can be very heavy. Again due to a portfolio of factors, the family doctor may not be able to arrange admission to hospital immediately. A battery of domiciliary services can be mobilised in support. However a gap does exist in that night surveillance may be too much for relatives. To fill this hiatus in services, a panel of "night sitters" was created and is functioning satisfactorily in a modest way. The arrangements for the 24 hour call-out of domiciliary midwives and mental welfare officers since the Borough was formed were adequate through the good offices of the Metropolitan Police. The latter indicated that this function did not strictly belong to the police service. By coincidence, the British Medical Association Emergency Treatment Service was initiated during 1967 to cover Greater London. One of the services offered was a 24 hour telephone answering service with trained staff in this field. Agreement was reached whereby these two groups of your staff were included in the telephone answering service. With an eye to the future, and the economic deployment of personnel resources, it is hoped that a trial with radio telephones will be conducted, and the results could well be beneficial to all concerned, especially the patient. Dr. John Maddison, who had held the appointments of Medical Officer of Health for Twickenham Municipal Borough since 1938, and Area Medical Officer with the Middlesex County Council since 1948, retired from your service in April, 1967. John Maddison's direct approach is not always understood. However, his sincerity, energy and enthusiasm, especially for the well being of the elderly, has been acknowledged by all. When the history of Public Health over the last three decades comes to be written, John Maddison will have an honoured niche in that volume of fame. It is with regret that the death in January, 1968, of Mr. D. D. Moir, M.Sc., F.R.I.C., your Public Analyst is recorded. His advice at all times, both to the former Barnes and Richmond Boroughs and to you, was sound and helpful. In accordance with Paragraph 7 (c) of Circular 1 /68 from the Ministry of Health, it is noted that you took no further formal action in the fluoridation of water supplies. Grateful acknowledgement is made to the following for their co-operation and collaboration in the common task of promoting the health of the residents of Richmond upon Thames: The family doctors; The hospital services and staff; All voluntary organisations; The Chief Officers of the Borough. The staff of the health department have worked with loyal diligence. I would especially thank Dr. J. K. Craig, Mr. E. S. Herbert and Mr. H. J. Pugh. I conclude by thanking the Health and Education Committees and the respective Chairmen involved for all their encouragement. I am, Yours respectfully, A. M. NELSON, Medical Officer of Health and Principal School Medical Officer. 6 VITAL AND GENERAL STATISTICS 1967 Area in acres 13,873 Population (census 1961) 181,030 Population—estimated to mid-year (as supplied by the Registrar-General) 179,040 Number of inhabited houses 60,518 Rateable value £11,078,221 Sum represented by a penny rate £44,600 Total M. F. Live Births—Legitimate 2,446 1,251 1,195 Illegitimate 235 125 110 Total 2,681 1,376 1,305 Live Birth rate per 1,000 of estimated Population 14.97 Adjusted Live Birth rate per 1,000 of estimated Population 15.12 Illegitimate Live Births per cent, of total Live Births 8.76 Total M. F. Still Births—Legitimate 22 14 8 Illegitimate 4 4 Total 26 18 8 Still Birth rate per 1,000 live and still births 9.60 Total Live and Still Births 2,707 Infant Deaths (under 1 year of age):- Total M. F. Legitimate 42 25 17 Illegitimate 2 2 Total 44 27 17 Infant mortality rate per 1,000 live births 16.41 Legitimate Infant mortality rate per 1,000 legitimate live births 17.17 Illegitimate Infant mortality rate per 1,000 illegitimate live births 8.51 Neo-Natal deaths Under 4 weeks Under 1 week of age of age Total M. F. Total M. F. Legitimate 33 21 12 29 19 10 Illegitimate 2 2 - 2 2 Totals 35 23 12 31 21 10 Neo-Natal mortality rate (deaths under 4 weeks) per 1,000 total live births 13.05 Early Neo-Natal mortality rate (deaths under 1 week) per 1,000 total live births 11.56 Perinatal mortality rate (stillbirths and deaths under 1 week combined) per 1,000 total live and still births 21.05 Maternal mortality (including abortion) deaths — Maternal mortality rate per 1,000 live and still births — Total M. F. Deaths 2,277 1,072 1,205 Crude death rate per 1,000 of estimated population 12.71 Adjusted death rate 10.55 7 POPULATION The Registrar General's estimate of mid-year population for the Borough was 179,040, which is a decrease of 1,160 compared with 1966. The natural increase (excess of births over deaths) was 404. Year Population Population trend Migration excess Total increase or decrease Percentage proportion Natural increase or decrease Inward Outward 1965 181,130 -950 -0.52% +658 - 1,608 1966 180,200 -930 -0.51% +432 — 1,362 1967 179,040 -1,160 -0.64% +404 — 1,564 BIRTHS During the year 2,681 live births were registered (a decrease of 82 compared with 1966) giving a live birth rate of 14.97 per 1,000 of the population or 15.12 when adjusted by the birth comparability factor. The latter makes allowances for differences in the age and sex distribution of the population throughout the country. The birth rate for England and Wales was 17.2. DEATHS The number of deaths registered in 1967 was 2,277 (a decrease of 54 compared with 1966) giving a death rate of 12.71 per 1,000 of the population or 10.55 when adjusted by the comparability factor. The death rate for England and Wales was 11.2. The table on page 9 shows the distribution of deaths by age and cause. Main Causes of Death An analysis of the death returns reveals the following main causes of death: Disease Percentage of total deaths Death rate per 1,000 of the population Diseases of heart and circulatory system 37.46 4.76 Vascular lesions of nervous system 12.86 1.63 Bronchitis, Pneumonia, and other respiratory diseases 12.29 1.56 Cancer 22.39 2.84 Accidents, Violence 3.07 0.39 INFANT MORTALITY During the year there were 44 deaths of infants under one year of age, a decrease of 7 on the previous year. The infant mortality rate was 16.41 per 1,000 live births compared with 18.3 for England and Wales. An analysis of the causes of death is shown on page 10. A large proportion of the deaths—79.5%—occurred in the first four weeks of life. As expected congenital malformation, prematurity, etc., took a high toll. MATERNAL MORTALITY There were no maternal deaths during the year. 8 9 Distribution of Deaths by Age and Cause Registrar General's Official Returns, 1967 Cause of Death Age Group Total Grand Total Under 1 1-4 5-14 15-24 25-44 45-64 65-74 75 and over M F M F M F M F M F M F M F M F M F Tuberculosis, respiratory - - - - - - - - - - - - 3 1 2 1 5 2 7 Tuberculosis, other - - - - - - - - - - 1 1 - - - - 1 1 2 Syphilitic disease - - - - - - - - - - - - - 2 1 4 1 6 7 Diphtheria - - - - - - - - - - - - - - - - - - - Whooping cough - - - - - - - - - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - - Measles - - 1 - - - - - - - - - - - - - 1 - 1 Other infective and parasitic diseases 1 - - - - - - - - - - - - - - - 2 - 2 Malignant neoplasm, stomach - - - - - - - - - - 11 4 10 9 1 10 22 23 45 Malignant neoplasm, lung, bronchus - - - - - - - - - 4 48 13 51 10 21 4 120 31 151 Malignant neoplasm, breast - - - - - - - - - 1 - 21 - 11 - 12 - 43 45 Malignant neoplasm, uterus - - - - - - - - - 1 - 5 - 2 - 5 - 13 13 Other malignant & lymphatic neoplasms - - - 1 - 1 3 - 5 3 26 40 39 29 50 44 123 118 241 Leukaemia, aleukaemia - - - - 1 1 - - - - i - 1 1 4 2 11 4 15 Diabetes - - - - - - - - - 1 1 4 4 3 2 7 7 15 22 Vascular lesions of nervous system - - - - - - - - 5 1 24 14 24 28 47 150 100 193 293 Coronary disease, angina - - - - - - - - 4 - 84 22 96 56 73 123 257 201 458 Hypertension with heart disease - - - - - - - - - - 1 4 2 3 3 8 8 15 23 Other heart disease - 1 - - - - - - - 1 14 7 15 23 49 117 78 149 227 Other circulatory disease - - - - - - - - 1 - 13 8 7 17 22 77 43 102 145 Influenza - - - - - - - - - - - - 1 1 3 1 4 2 6 Pneumonia - 1 - 1 - - - - 1 1 6 4 10 10 43 72 60 89 149 Bronchitis - - - - - - - - - - 18 3 22 7 35 25 75 35 110 Other diseases of respiratory system - - 1 - - - - - - - 4 1 3 - 4 8 12 9 21 Ulcer of stomach and duodenum - - - - - - - - - - 4 - 2 1 4 10 10 11 21 Gastritis, enteritis and diarrhoea - - - - - - - - - - - 3 - - - 1 - 4 4 Nephritis and nephrosis - - - - - - - - - - 1 1 3 2 2 3 6 6 12 Hyperplasia of prostate - - - - - - - - - - - - 1 - 5 - 6 - 6 Pregnancy, childbirth, abortion - - - - - - - - - - - - - - - - - - Congenital malformations 10 6 - - - - - - - 1 - 1 - - - - 10 8 18 Other defined and ill-defined diseases 16 9 1 1 1 1 3 1 4 4 21 10 18 17 12 44 76 87 163 Motor vehicle accidents - - - - - - 4 - 2 3 1 3 1 1 1 3 9 10 19 All other accidents - - - - 2 - - - 1 - 3 4 1 5 3 6 10 13 25 Suicide - - - - - - 2 - 5 3 3 4 2 2 3 2 15 11 26 Homicide and operations of war - - - - - - - - - - - - - - - - - - - 27 17 3 3 4 3 12 1 28 24 289 177 317 241 392 739 1072 1205 2277 10 Infant Mortality, 1967. Net Deaths from stated causes at various ages under one year compiled from returns received. CAUSE OF DEATH TOTAL Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Under one year Under four weeks M F M F M F M F M F M F M F M F Total from all causes 44 35 21 10 2 2 — — — — 3 2 — 2 1 — — 1 Congenital Malformations 17 13 8 3 2 — — — — — 2 1 — 1 — — — — Post-Natal Asphyxia and Atelectasis 5 5 4 1 - - - - - - - - - - - - - - Bronchitis and Bronchopneumonia 4 1 — — — 1 — — — — - 1 — 1 1 — — — Anoxia 3 3 2 1 — — — — — — - — — — — — — — Prematurity 12 12 7 4 — 1 - - - - - - - - - - - - Neuroblastoma 1 - - - - - - - - - - - - - - - — 1 Encephalitis 1 — - - - - - - - - 1 - - - - - - - Volvulus of Small Gut 1 1 - 1 - - - - - - - - - - - - - - INFECTIOUS DISEASES The number of notifications received during the year, compared with 1966, may be summarised as follows : Disease. 1967 1966 Dysentery 3 13 Erysipelas 9 19 Food Poisoning 3 — Infective Hepatitis 34 — Malaria 1 — Measles 1400 888 Meningococcal Infection - 1 Ophthalmia Neonatorum 1 — Pneumonia 27 32 Puerperal Pyrexia 1 4 Scarlet Fever 73 76 Typhoid and Paratyphoid Fever 3 1 Whooping Cough 52 80 The table on page 16 gives the number of cases notified under age groups. Scarlet Fever. The incidence of this disease is still relatively high, the 5—9 age group being particularly susceptible, irrespective of sex. There was a satisfactory decrease in the number of cases of Erysipelas, a similar disease which has its highest attack rate between the ages of 40 and 60 years. Whooping Cough. Although less notifications were received in 1967 compared with 1966, the number of cases still remains fairly high. Of the 52 cases notified, 15 of these had been immunised including 4 who had received a booster dose. There is no record of immunisation of the remaining cases. The fact that so many of the notified cases had recently been immunised seems to indicate that the present vaccine may not be very effective against the current strain of the disease. Measles. Although relatively mild in metropolitan communities, this disease attains epidemic proportions every second year and 1400 cases were notified in 1967. In 1964 a tentative programme of immunisation of young children was commenced and a glance at the histogram on page 12 shows that this has produced a "flattening out" of the incidence curve of the disease probably due to interference in the circulation of the wild virus. Previous years figures are as follows : 1959 1957 1964 234 1960 57 1965 1992 1961 2422 1966 888 1962 112 1967 1400 1963 1885 11 12 NUMBER OF CASES OF MEASLES 1959 TO 1967 The distribution of cases during each quarter of the year was as follows : M. F Total 1st January— 31st March 555 500 1055 1st April—30th June 164 154 318 1st July—30th September 12 12 24 1st October—31st December 1 2 3 Total 732 668 1400 From the table below it will be seen that the first five years of childhood suffer the major incidence of the disease and the sexes are affected equally: M. F. Total Under 1 year 33 24 57 1 year 75 82 157 2 years 114 94 208 3 years 130 91 221 4 years 102 113 215 5—9 years 249 235 484 10—14 years 11 13 24 15—24 years 6 10 16 25 + 12 6 18* Total 732 668 1400 (* includes 12 age unknown). Vaccination and Immunisation (see page 30). Food Poisoning. Of the three notified cases of food poisoning, it was only possible in one case to isolate the causative agent. The patient, after suffering extensive diarrhoea and frequent vomiting was admitted to hospital, where specimens were taken and CI. welchii isolated. A thorough investigation was carried out but the source of the infection was not discovered. Previous years figures are as follows : 1962 14 1965 6 1963 6 1966 — 1964 8 1967 3 Infective Hepatitis. Following the voluntary notification by family doctors of this disease during the latter part of 1966 the Ministry of Health approved the Order made by the Council which makes Infective! Hepatitis officially notifiable in the Borough from the 1st July, 1967 for a period of 3 years, and for which the local authority may pay a notification fee. During the six months ended 31st December, 1967, 34 cases were notified. All cases were investigated but it was not possible to find a common factor suggesting the source of infection. The department continued to participate in the survey which is 13 being conducted by the Public Health Laboratory Service to try and assess the efficiency of British gamma globulin in preventing infective hepatitis. The survey still continues and findings will be published in due course. (See also page 22— Surveys). Smallpox. No cases of smallpox were notified during the year. Under the Public Health (Aircraft) Regulations, 1966 and the Public Health (Ships) Regulations, 1966 arrivals in this country from endemic areas who are not in possession of valid international certificates of vaccination against Smallpox are placed under surveillance by the Port or Airport Medical Officer for a period of fourteen days. 27 such cases of persons proceeding to addresses situated in the Borough were notified during the year. All were kept under surveillance for the stipulated period with the exception of one person who had moved to a new address the day after arrival. The appropriate Medical Officer of Health was duly informed. Typhoid Fever. Three cases of typhoid were notified during the year. Two of the cases occurred in the same family and with the possibility that the source of infection was common in both patients. In one episode, the first patient was that of a wife who had accompanied her husband on a professional trip to Spain accompanied by their son. Two days after arrival in Spain all three were taken ill with diarrhoea and vomiting, but while husband and son quickly recovered the wife continued to feel unwell even after her return home. Approximately threa weeks after sickening the wife was admitted to hospital where the diagnosis of typhoid fever was confirmed. Immediate contacts were excluded from work. Twelve days after the wife's admission to hospital, the son was also admitted to hospital and the diagnosis of Typhoid was again validated three days later. It can be postulated that either the child was infected abroad at the same time as his mother, or he could have been a secondary case infected by her. As a prudent precaution, it was decided to assume that the latter was the case and exclusion of contacts recommenced. The husband had received a protective innoculation in 1953 while serving in the Services but had had no re-inforcing dose since. Neither his wife, son nor other immediate contacts had been protected. The third case notified was that of a child aged 9 years who was taken ill in this Borough ten days after leaving India. Diagnosis was confirmed in hospital and contacts were kept under surveillance. It is reasonable to assume that this infectious incident was an imported one. Venereal Diseases. I am indebted to Dr. N. Rosedale for the following statistics of the patients treated at the Special Clinic at West Middlesex Hospital:— 14 1967 1966 West Middlesex Hospital Male Female Male Female Syphilis 4 1 — 2 Gonorrhoea 24 4 35 10 Other Conditions 123 99 108 93 The number of patients treated at Special Clinics at other hospitals is: Syphilis 1 Gonorrhoea 8 Other Conditions 53 Medical Arrangements for Long-Stay Immigrants. The number of immigrants who gave destination addresses situated in this Borough doubled in 1967 compared with 1966, and the following table shows from which Country their passports were issued : Commonwealth Countries. 1967 1966 Carribean 9 3 India 32 11 Pakistan 6 2 Other Asians 23 5 African 8 4 Other 16 8 Non-Commonwealth Countries. Europeans 49 41 Other 8 — Total 151 74 All addresses were visited by the Public Health Inspectors and where children accompanied the immigrant follow up visits were made by Health Visitors. In 15 cases it was found that the immigrant had not arrived at the address given. All immigrants are advised as to the scope and arrangements of the National Health Service and every effort is made to pursuade them to have a chest X-ray as soon as possible. No immigrant admitted to any history of chest infection. 15 16 Cases of Infectious Diseases Notified during the year 1967 DISEASE CASES NOTIFIED AT VARIOUS AGES (YEARS) Total Cases Notified Deaths Under 1 Year 1 2 3 4 5-9 10-14 15-19 20-24 25-34 35-44 45-64 65 and Over Age not known Dysentery - - - - 1 1 - - 1 - - - - - 3 - Erysipelas - - - - - - - - - - 1 6 2 - 9 - Food Poisoning - - - - - - - - 1 1 1 - - - 3 - Infective Hepatitis - - - - - 2 - 4 7 9 5 4 3 - 34 - Malaria - - - - - - - - - - 1 - - - 1 - Measles 57 157 208 221 215 484 24 10 6 4 1 1 - 12 1400 1 Ophthalmia Neonatorum 1 - - - - - - - - - - - - 1 - Pneumonia - - 1 - - - - - 1 4 2 11 8 - 27 149 Puerperal Pyrexia - - - - - - - - - 1 - - - - 1 - Scarlet Fever - 3 3 7 12 38 4 3 1 1 1 - - - 73 - Typhoid and Para-Typhoid - - - - - 2 - - - 1 - - - - 3 - Whooping Cough 4 5 6 7 7 16 3 2 2 52 Totals 62 165 218 235 235 543 31 17 17 21 14 24 13 12 1607 150 CARE OF MOTHERS AND YOUNG CHILDREN Ante-Natal and Post-Natal Clinics Number of cases attended : Ante-Natal Attendances Post-Natal Attendances 1,032 3,710 236 238 Sessions held (Medical Officer in attendance) 358. Ante-natal relaxation and post-natal exercises are taught in all the clinics. 646 women made 3,590 attendances at these clinics during the year. In accordance with the recommendation of the Cranbrook Committee, who suggested that general practitioner obstetricians could work in the ante-natal clinics of local authorities, approval was given in 1966 to a group of family doctors in Barnes for the use of Essex House on one half day per week for an ante-natal and post-natal session. The object was to incorporate their own session with the existing local authority session. Other individual or group of family doctors would be afforded the same facility if they so desired. A second group of doctors were subsequently afforded facilities for an ante-natal clinic at Essex House and at the end of the year two groups were using the Clinic. Incidence of Congenital Malformations Since 1st January, 1964 the Ministry of Health have required all congenital malformations in new-born babies to be notified by Local Health Authorities to the Registrar General, so as to enable the latter to complete statistical information from which to detect any national or regional changes in the pattern of congenital malformations. The number of babies born with defects during 1967 was 45. Puerperal Pyrexia Regulations One case of puerperal pyrexia was notified during the year from a local maternity unit. The patient lived in a neighbouring borough and subsequently recovered. Family Planning The Council has made arrangements through the Family Planning Association for advice and treatment (including supplies) to be given to women to whom pregnancy would be detrimental to health. This service is provided free of charge to the patients, the Council accepting financial responsibility for patients in this category referred for advice and treatment by its own medical officers. During 1967 fourteen such patients were referred. The Council does not operate family planning clinics but has made available to the Family Planning Association the free use of four of its clinics (Hampton Wick; Kings Road, Richmond; Whitton, and Windham Road, Richmond) for the purpose of holding family planning sessions. The National Health Service (Family Planning) Act, 1967 received the Royal Assent on 28th June, 1967. The Act confers on local authorities the power, though not the duty, to make arrangements to give advice on contraception, medical examination of persons seeking such advice and the supply of contraceptive substances and appliances. It also extends the existing powers of local health authorities enabling them to provide advice on contraception and supplies for any person who needs them on social grounds and not (as hitherto) only in medical cases, namely those to whom pregnancy would be detrimental to health. No distinction is drawn in the Act between the married and the unmarried. 17 Local Councils were asked to report to the Minister of Health by the end of March 1968 on their proposals to implement the Act. There have been protracted discussions between the London Boroughs Association and the Family Planning Association in an effort to formulate recommendations for a common policy amongst the London Boroughs. At the end of the year these discussions were still going on and this Council in common with most of the London Boroughs had not made a decision concerning the implementation of the Act. Care of Unsupported Mothers and Their Babies Miss H. Oliver, Social Welfare Worker, comments:— The means used in the Health Department to assist the unsupported mother are set out below. Satisfactory and economic housing for the unsupported mother is again a gap in the services and this facet was also stressed in previous reports. The problem so far is a small one in this Borough as many of the women return to parents or relatives if they wish to keep their babies. Even so the wish is frequently expressed to have a home of their own. The number of new cases has fallen during the period under review but the volume of the work has increased. There is a steadily growing number of unsupported mothers living within the Borough who from time to time seek fresh help and advice and. when it is possible to give more time to an individual, problems are tested in depth so that the support given is more effective and a better relationship established. A smaller number of women required residential care and if this trend indicates, as I think it does, a greater acceptance and willingness to help by the community, it is realistic and good. It is preferable for the pregnant woman to live in her normal surroundings receiving her ante-natal care from her family doctor or at the local health clinic. She is then encouraged to participate in the various activities conducive to natural childbirth and mothercare. This development is a reasonable and logical attitude to take in the society of today. For those who will continue to need the traditional care of homes and hostels the service continues with adequate financial aid provided by the Council; standards are good in these establishments and continue to improve. They provide a diversity of choice to meet most needs. The patients maintained by the Council are visited regularly by me and are able to discuss a problem if it arises. It is sometimes suggested that adoptions take place because the mothers are homeless but there is never one single factor governing these decisions. The main reason given seema to stem from feelings of guilt at having brought a child into the world who in all probability will never know its father — with all that this situation implies. Even so one would wish to see more women with sufficient earning capacity and stamina elect to keep their children; they should then be given the full support of the social services to enable them to do so. It is difficult to express an opinion in considering those women who are sometimes classified as inadequate. One must ask for how long the community can continue to support them and what is the future of their children because the intensive care needed is difficult to provide. There is a special venture in a nearby London Borough, which seeks to meet this need, and a large house has been taken where six inadequate mothers can be accommodated, each girl having her own room in which to care for her baby. This home will also take a girl who has been unable to reach a decision about adoption, and who needs a longer period in which to consider this step. One mother and baby who was supported in the home by the Council became more self-reliant and was eventually able to take a training. A few girls can be helped by residential work, and if it is carefully selected, can work well. However, the majority of women today are trained in some occupation and do not wish to give it up, so that only a few can be accommodated in this way. 18 It has been possible to arrange fostering in suitable cases, and where it seemed helpful to do so. However, substitute parental care is only arranged on a short-term basis pending other arrangements. This social therapy enables a girl to have a period in which she can use her own initiative along various lines such as finding her own accommodation, getting in touch with relatives, and in some instances being able and wanting to marry the young man concerned. In conclusion a brief word is added about the putative fathers. Whenever the woman concerned will co-operate these men are invited to discuss her well-being and the majority accept. It is hoped to encourage them to take an interest in the coming child, and to provide support and companionship to its mother at a time when it is most needed. The putative father is frequently in need of help himself sometimes being immature and unable to face up to a situation he has helped to create. Valuable work could be done in this field in education and social responsibility. Total Number of Cases referred in 1967 :— Total Unsupported mothers 147 Referred by Medical Social Workers 58 Health Visitors 8 Doctors 36 Statutory Social Workers 10 Voluntary Social Workers 12 N.C.U.M.C . 14 Citizens' Advice Bureau 3 Parents 4 Clergy 1 Own application 1 147 The Mothers Marital Status Single 136 Domicile Occupation Married 2 In area 106 Nurses 12 Separated 6 Outside area 41 Students 14 Divorced 2 Hairdressers 7 Widowed 1 Factory 23 Religion Office Workers 38 C. of E. 97 Domestic and Education Bree Church 6 Hotel Sec. Mod. 88 R.C. 43 Workers 12 Grammar 40 Jewish 1 Housewives 3 Public 3 House Convent 5 Mothers 2 Training Teachers 15 College 5 Cooks 3 University 6 Librarians 2 Radiographers 2 Dress Makers 4 Florists 2 School Girls 7 Actress 1 Ages Countries of origin 15 years 4 other than G.B. 16 „ 6 Eire 17 17 ,, 10 Holland 2 18 „ 13 Italy 2 19 ,, 26 New Zealand 2 20 ,, 21 West Indies 2 21—30 55 Germany 2 31—40 12 America 1 France 2 19 Putative Fathers Marital Status Ages Countries of origin Single 106 14 years 1 other than G.B. Married 21 15 ,, — Eire 24 Divorced — 16 „ 3 Spain 2 Unknown 13 17 „ 4 America 2 Separated 7 18 „ 5 Canada 2 19 ,, 16 S. Africa 2 Occupation 20 „ 15 Malta 1 Actor 1 21—30 79 China 1 Accountant 1 31-49 — Argentine 1 Architect 1 59 „ 1 Ghana 2 Doctors 2 Unknown 1 Italy 1 Teachers 5 Greece 1 Students 24 W. Indies 2 Office Workers 33 Manual and Labourers 49 Chefs and Hotel Workers 5 Soldiers, Sailors and Airmen 6 Busmen 2 Laundry Worker 1 Milkman 1 Taxi Driver 1 Barrow Boy 1 School Boys 2 Librarians 2 Unknown 10 Ways in which unsupported mothers have been helped. By admission to working girls hostels in early pregnancy 26 By admission to maternity homes and hostels 67 By admission to flatlet house for mothers and babies 1 By providing private accommodation 1 By reconciliation with parents and relatives 21 By private financial agreements and affiliation orders 23 By adoption through registered adoption agencies 59 By fostering arrangements and private nurseries 54 By gifts of clothing, cots and prams 11 By temporary care provided by the Children's Department 3 By arrangements made but later cancelled (a'ternative arrangements being made) 15 At the end of 1967 the mothers who decided to keep their babies were living in the following way Had returned to parents or relatives 33 Had married putative father 12 Were co-habiting with putative father 10 Married to other than putative father 2 Had accepted residential work 2 Was living in flatlet house 1 Were living in lodgings 3 Living in own homes 4 Returned to husband 2 Mothers who parted with babies By adoption 57 Pregnancies terminated 1 Arrangements still incomplete 12 Still births 1 Miscarriage 2 Transferred to other social work agencies 2 Still fostered at the end of 1967, future undecided 3 147 20 21 Child Welfare Centres Number of children who attended during the year Number of sessions held by Total number of sessions in columns (5)-(8) Number of children referred elsewhere Number of children under observation at end of year Bom in 1967 Born in 1966 Born in 19621965 Total Medical Officers Health visitors G.Ps. employed on a sessional basis Hospital medical staff (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 2680 2258 2398 7336 1313 73 15 — 1401 302 4181 Total attendances during the year 54,541. Surveys The department has taken part in a number of surveys in association with various research bodies during the year. These include a survey into children suffering from spina bifida (Greater London Council); investigation into accidents occurring to children under 5 years old (Medical Commission on Accident Prevention); survey of childhood cancers (Oxford University); nutrition survey of pre-school children (Ministry of Health); investigation into the possible virus aetiology of mental deficiency (St. George's Hospital Medical School, London). Phenylketonuria A child who had two negative tests carried out at the Child Welfare Clinic in its second month of life was diagnosed at almost a year old as suffering from phenylketonuria. Mental retardation was then present. This occurrence highlights the potential unreliability of urine testing as a screening procedure to exclude the particular metabolic disorder of phenylpyruvic oligophrenia and efforts have been made to introduce for routine screening of infants the more accurate blood test of Scriver or Guthrie. However, so far, laboratory facilities are not yet available to carry out the test within the hospital catchment areas of the Borough. Early Detection of Deafness In order that children who are deaf can benefit from auditory training, testing for hearing is done by the health visitor during the first year. Ophthalmia Neonatorum (See page 48). Child Welfare Centres At the end of the year, there were 12 child welfare centres. (For location of centres etc. see map inside the cover at the end of the report). One centre has 5 sessions a week, two have three sessions a week, 6 have two sessions a week, 3 have one session a week. To augment the above the arrangement made with Surrey County Council for the use of its mobile clinic was continued. Five sessions in alternate weeks are held at sites in Hampton, Twickenham and Whitton. For details of attendances etc. during the year see page 21. Orthopaedic Service Of the 66 children under five years of age treated at the Orthopaedic Clinic during the year, 14 were new cases seen by the surgeon, 52 were re-examinations at the surgeon's clinic. These children made 66 attendances. Dental Treatment — Expectant and Nursing Mothers and Children. Mr. G. Tucker, L.D.S., R.C.S., Chief Dental Officer, reports as follows: The following figures show the number of attendances and the amount of treatment given during the year:— Pre-School Children Examined at clinic 534 Required treatment 291 Commenced treatment 275 Attendances for treatment 612 Fillings inserted 453 Extractions 182 General Anaesthetics 77 22 Expectant and Nursing Mothers Examined 96 Required treatment 82 Commenced treatment 85 Attendances for treatment 293 Fillings inserted 211 Gum treatment 41 Crowns or Inlays fitted 3 Extractions 106 General Anaesthetics 10 Dentures supplied 22 X-rays taken 9 The number of expectant and nursing mothers who commenced treatment was the same this year as last, whilst the number of pre-school children rose by 49. The number of young children examined at clinics was 95 more than the previous year. This increase was no doubt due to efforts made by clinic doctors and health visitors who encouraged these examinations, and to the notice now printed at the foot of the school child's dental treatment consent form which reads "Children under school age may be seen by appointment at any school dental clinic". The Ministry of Health were assisted in their pre-school children's Nutritional Survey by the staff at York House Clinic, who dentally examined a short series of preschool children specially selected by the Nutritional Survey working party. (See also page 22 — Surveys). Deprived Children In order that the health visitor can make her routine visits, when a deprived child under five has moved to a new address, my colleague the Children's Officer, notifies the health department. Nurseries and Child-Minders Regulation Act, 1948 At 31st December, 1967, 62 child-minders were receiving children under the age of five years and 43 private day nurseries (including one factory day nursery), were on the register. These nurseries are regularly visited by a medical officer and a health visitor. It is interesting to note that there has been a significant and continuing increase of registrations under this Act. Since my first annual report on the Health of the Borough there has been a 100% increase in private day nursery registrations and a 35% increase in child minder registrations giving a combined overall increase in registrations of 58%. Daily Minders There were no daily minders receiving fees from the authority at the end of the year. Municipal Day Nurseries There are in the Borough three day nurseries maintained by the Council for necessitous children from the age of six weeks to five years of age. Admission to the day nurseries is determined by priority categories. The standard charge is 13/0d. per day, but this may be reduced according to the financial means of the applicant. Accommodation:— Castelnau, Barnes 45 children Parkshot, Richmond 53 children Gifford Lodge, Twickenham 40 children Children with defects are also admitted to the day nurseries to aid their development emotionally, physically, mentally and socially. 23 Welfare Foods The Council is responsible for the distribution of welfare foods (National Dried Milk, cod liver oil, fruit juices, etc.) supplied by the Ministry of Health. In addition various proprietary brands of dried milk and dietary supplements are sold at the welfare centres on the recommendation of the medical officers, health visitors or family doctor. I gratefully acknowledge the work of all voluntary helpers. Cervical Cytology In October, 1966, the Ministry of Health sent a memorandum to local authorities in which the Minister expressed the hope that local health authorities would co-operate fully with the hospital and general practitioner services in developing screening services on the lines indicated. Further the Minister had approved under Section 28 of the National Health Service Act, 1946, the making of arrangements by the Council in obtaining cervical smears for cytological investigations by hospital authorities. This action provided the Authority with an opportunity to extend its service from a pilot scheme for the cyto-screening for cervical carcinoma of a limited number of women in part of the Borough to a full well-woman screening service. During 1967, well-woman clinics were established in the Borough at the following clinics: — Kings Road, Richmond. Mortlake Clinic, North Worple Way, Mortlake, S.W. 14. Ham Clinic, Ashburnham Road, Ham. Whitton Clinic, Hospital Bridge Road, Whitton. Hampton Clinic, 24, Station Road, Hampton. York House Clinic, York House, Twickenham. In most instances these clinics were run in conjunction with the existing ante-natal clinics. During the year 658 women made 689 attendances at these clinics. Five women had positive smear tests, and two women had breast conditions. All were referred to their personal medical attendant for further investigation. DOMICILIARY MIDWIFERY AND HOME NURSING SERVICES Staff 1 Non-Medical Supervisor of Midwives and Home Nursing Superintendent. 1 Deputy Non-Medical Supervisor of Midwives and Home Nursing Superintendent. 11 Full-time Midwives. 3 Part-time Midwives. (1.0)* 4 Full-time District Nurses/Midwives. 29 Full-time District Nurses. 5 Part-time District Nurses. (2.5)* 2 Part-time District Nurse Assistants. (1)* * equivalent whole-time. 24 MIDWIFERY SERVICE Training Six midwives are approved as teachers. Four midwives attended refresher courses as required by the rules of the Central Midwives Board. Twenty-three pupil midwives from West Middlesex Hospital, Isleworth, and Queen Charlotte's Hospital, Hammersmith, completed their three months period of training on the district. Six nurses from West Middlesex Hospital taking their obstetric training spent a half-day on the district observing the work of the domiciliary midwives. Transport All the domiciliary midwives drive cars. Two use Council vehicles; the remainder have their own cars. Ante-natal Clinics. Total weekly sessions during year (midwives only present) 302 „ ,, „ „ „ (medical officer present) 75 „ „ ,, „ „ at family doctors1 clinics 454 Mothercraft Mothercraft and relaxation classes were held at all clinics. A total of 646 women attended. Two midwives attended the course arranged by the National Childbirth Trust on the psychoprophylactic method for childbirth. This method of preparation for motherhood is becoming increasingly popular and expectant mothers in the Borough are most anxious to attend classes at the Council's clinics. Domiciliary Deliveries Number of domiciliary confinements attended by midwives under N.H.S. arrangements. Number of cases delivered in hospitals and other institutions but discharged and attended by domiciliary midwives before 10th day (1) (2) (3) (4) Doctor not booked Doctor booked Total 5 542 547 492 This table relates to women delivered, and not, in the case of multiple births, to infants. 7,144 visits were made to these mothers. All midwives in the domiciliary midwifery service have been advised that patients, who are to have a domiciliary confinement, should be referred to their family doctor either for booking or for the latter to refer the patient to a practitioner on the obstetric list. Notification of intention to practise Under the rules of the Central Midwives Board, 39 midwives notified their intention to practise within the Borough. Nineteen of these were domiciliary midwives; the remainder of the midwives were practising in hospital. 25 26 Premature Births Number of premature births (as adjusted by any notifications transferred in or out of the area). Weight at birth Premature live births Premature stillbirths Born in hospital Born at home or in a nursing home Nursed, entirely at home or in a nursing home Transferred to hospital on or before 28th day Died Died Died Born Total births within 24 hours of birth in 1 and under 7 days in 7 and under 28 days Total births within 24 hours of birth in 1 and under 7 days in 7 and under 28 days Total births within 24 hours of birth in 1 and under 7 days in 7 and under 28 days in hospital at home or in a nursing home (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) 1 2 lb. 3 oz. or less 7 6 - - - - - - - - - - 2 - 2 Over 2 lb. 3 oz. up to and including 3 lb. 4 oz 5 2 - - - - - - - - - - 2 - 3 Over 3 lb. 4 oz. up to and including 4 lb. 6 oz 20 2 1 - - - - - - - - - 6 - 4 Over 4 lb. 6 oz. up to and including 4 lb. 15 oz. 32 - 1 1 - - - - 1 - - - 1 - 5 Over 4 lb. 15 oz. up to and including 5 lb. 8 oz 56 1 2 - 1 - - - 1 - - - 4 - 6 Total 120 11 4 1 1 - - - 2 - - - 15 - 1 = l,OOOg, or less, 2 = 1,001 - l,500g, 3 = 1,501, - 2,000g, 4 = 2001 - 2.250g, 5 = 2,251 - 2,500g. Medical Aid Medical aid was required for 88 patients as follows:- During Pregnancy Infant In Labour Puerperium Mild Toxaemia 6 Ophthalmia 6 Foetal Distress 6 Ante-partum General illness 5 Premature Pyrexia 5 haemorrhage 2 Asphyxia 2 Labour 3 Phlebitis 3 Post-Maturity 1 Vomiting 1 Malpresentation 4 Pemphigus 1* Multiple pregnancy 1 Jaundice Cord 1 Delay in Labour Retained 10 Sub-involution of uterus 1 Apprehension 1 haemorrhage 2 placenta 6 Positive Kahn Hospitalization for any reason 1 Ruptured perineum 10 test (at onset of labour and Low Haemoglobin 1 Post-partum haemorrhage 5 on discharge from hospital) 1 Varicose vein 1 Inertia on full dilation 2 * This mother was delivered in hospital and discharged to domiciliary care on the 3rd day and then admitted to South Middlesex Hospital. Early Discharges The domiciliary midwives nursed 492 mothers and babies discharged from hospital early in the puerperium. The majority of these mothers had planned discharges. Two thousand nine hundred and seventy-five visits were made to these mothers. Maternity Outfits A maternity outfit is supplied free to each expectant mother arranging her confinement at home under the National Health Service, as well as — if requested — to those entering private nursing homes. A smaller pack is supplied to patients discharged from hospital 48 hours after delivery. Maternity Liaison Committee As Medical Officer of Health, I am a member of the Maternity Services Liaison Committee Catchment Area IV, whose purpose is to discuss midwifery problems of hospital, family doctors, and the local authority health department. HOME NURSING SERVICE Training 4 District Nurses received district training. 2 District Nurses attended Refresher Courses. 69 Student Nurses from West Middlesex, Royal Richmond, Barnes and The Middlesex hospitals and the Institute of District Nursing accompanied the District Nurses on domiciliary visits. This is part of the training programme and enables them to see at first sight some of the services in the community. Cases and Visits Total number of cases nursed 2,824 Number of above over 65 years of age 1,347 Number of above under 5 years of age 28 Total number of visits 86,940 Types of Care given Number of injections 29,522 Number of dressings 11,756 Number of visits for general nursing care 23,134 Number of baths 10,597 The remaining visits were made to patients needing supervision and/or support. 27 District Nurse Assistants Home nursing duties centre more and more around the elderly sick or handicapped persons. Skilled nursing is not required in the majority of these cases. District Nurse Assistants have been added to the establishment, helping the district nurses with baths, dressing patients, etc. They have relieved some of the trained staff to devote more time to the very ill, and for rehabilitation of patients where this is possible. Marie Curie Memorial Foundation. Area Welfare Grant Scheme The Borough continues to participate in the Area Welfare Grant Scheme provid' ing for the urgent needs of cancer patients who are being nursed at home. Such assistance is only given "in kind" and covers for a limited period, day and night nursing, special equipment, linen and bedding, clothing, extra heating and nourishment. Twenty nine patients received help with night and/or day nursing on 117 occasions. HEALTH VISITING Staff 1 Chief Nursing Officer. 1 Superintendent Health Visitor. 24 Health Visitors (includes 2 Field Work Instructors, 1 Group Adviser). 5 (2.5)* Part-time Health Visitors. 10 (4.0)* Part-time Clinic Nurses. 1 Health Assistant. 1 Tuberculosis Health Visitor. 2 Student Health Visitors. * equivalent whole time. Health Visitor Group Adviser The year 1967 saw one new project initiated in the Health Visiting Service by the appointment of a Health Visitor (Group Adviser) with special responsibility for Health Education. The work involves the planning and preparation of material for use as visual aids. This material is available tq anyone in the department who is called on to talk to any groups in the Community. It also entails keeping up-to-date with all available film strips, posters, literature and equipment in the field of health education. As well as giving talks herself and making contact with schools and other organisations to inform them of the help that we can give in this work, this officer is available to advise the health visitors on talks or courses which they are called on to undertake. (See page 37 —Health Education). Training and Refresher Courses Health visitors attended routine refresher courses; the summer school for the Central Council of Health Education; a course for Field Work Instructors; a course for hearing tests for young children and seven attended a course on Psychoprophylaxis. This method of preparation for confinement is now offered at all Ante-Natal clinics and midwives and health visitors are given an opportunity to take the necessary instruction. Family Doctors and Local Authority Nursing Staff The London Boroughs Committee on 21st March, 1966 commended to constituent councils the attachment of health visitors to general medical practitioners as approved by the Inner London Executive Council. Arrangements similar to those envisaged were already in existence in this Borough. 28 The definitions of attachment and liaison schemes may be summarised as follows:— Attachment Schemes — The midwife/district nurse/health visitor is responsible for all patients on the lists of specified general practitioners within the local authority boundary. (i.e. traditional geographical districts have been given up.) Liaison Schemes — The midwife/district nurse/health visitor is responsible both for a geographical district and for the patients on the lists of specified general practitioners. Where pati' ents live outside the midwife's/district nurse's/health visitor's district though within the local authority boundary, she does not herself visit them but is responsible for liaison between the appropriate midwife/district nurse or health visitor. The situation at the end of 1967 with regard to the liaison of nursing staff with family doctors in the Borough was that there were eleven practices served by our staff and I set out below a table summarising the position : — Local Health Authority Nursing Staff Practice No. Health Visitor Midwife District Nurse Clinic Nurse 1. (a) (b) 2. (a) (b) 3. (a) (c) 4. (a) 5. (a) (b) 6. (b) 7. (d) 8. Ob) 9. (b) 10. (b) 11. (d) (a) the health visitor attends the doctor's child welfare (child health) clinic. (b) the midwife attends the doctor's ante-natal clinic. (c) the district nurse calls at the surgery every day to discuss the cases she is visitng from the practice and to receive instructions from the doctor on these particular cases. (d) In Practice No. 7 the clinic nurse attends the doctor's ante-natal clinic and in Practice No 11 the clinic nurse attends the doctor's session for older people. Each of these various forms of liaison are in the process of evolution and are being adapted to meet the needs of each of the practices concerned and the Chief Nursing Officer is keeping watch on the situation to ensure that they develop most advantageously to all concerned. 29. The Ministry of Health has encouraged such liaison between local authority, medical and health staff and registered medical practitioners contracting to give services through the National Health Service. Health Visiting Cases visited by health visitors Number of cases 1 Total number of cases 13,343 2 Children born in 1967 2,971 3 Children born in 1966 2,943 4 Children born in 1962—65 4,656 5 Total number of children in lines 2 — 4 10,570 6 Persons aged 65 or over 868 7 Number included in line 6 who were visited at the special request of a G.P. or hospital 128 8 Mentally disordered persons 50 9 Number included in line 8 who were visited at the special request of a G.P. or hospital 11 10 Persons, excluding maternity cases, discharged from hospital (other than mental hospitals) 41 11 Number included in line 10 who were visited at th; special request of a G.P. or hospital 32 12 Number of tuberculous households visited 6 13 Number of households visited on account of other infectious diseases 11 14 Other cases 992 15 Number of tuberculous households visited by tuberculosis visitors 332 VACCINATION AND IMMUNISATION In circular 3/67, dated 31st January, 1967, the Ministry of Health introduced a scheme for the payment of fees to family doctors for the vaccination and immunisation of patients on their lists undertaken as part of general medical services in pursuance of public policy. The scheme which came into effect on 1st April, 1967, made Executive Councils responsible for the payment of records submitted by family doctors in respect of vaccination and immunisation procedures carried out instead of Local Authorities. In the circular, the Ministry expressed the hope that local health authorities would send to family doctors details of their patients who had been immunised at the authority's clinics. In order to achieve this liaison a specially designed personal record card, enclosed in a cellophane envelope, was issued to everyone immunised at the clinics and parents were requested to show the card whenever their family doctor was consulted. In addition at the end of the year arrangements were being made to send copies of vaccination and immunisation clinic records to family doctors. The tables on page 31 show the numbers of children under 16 who completed vaccination or immunisation procedures during 1967. The "take-up" of all available types of immunisation has continued to be satisfactory and the figures given in Table I on page 31 are generally comparable with last year's figures. 30 Table 1. Immunisation against Diphtheria/Whooping Cough/Tetanus/Poliomyelitis (separately or combined). Type of Vaccine YEAR OF BIRTH Others Under 16 Total 1967 1966 1965 1964 1960/63 PRIMARY COURSE DIPHTHERIA 1035 1168 105 34 37 16 2395 WHOOPING COUGH 1009 1120 91 21 15 - 2256 TETANUS 1035 1168 105 36 47 215 2606 POLIOMYELITIS 994 1260 159 50 68 31 2562 RE-INFORCING DOSES DIPHTHERIA - 400 873 143 1387 391 3194 WHOOPING COUGH - 342 715 84 252 39 1432 TETANUS - 400 874 143 1384 401 3202 POLIOMYELITIS - 344 525 88 1330 192 2479 Table 2. Vaccination against Smallpox. Age at date of Vaccination Under 1 1 2—4 5—15 Total No. vaccinated 259 1224 208 53 1744 No. re vaccinated - - 19 121 140 B.C.G. Vaccination against Tuberculosis. See page 33. Measles Vaccination During 1967 records of completed courses of measles immunisation were received for 402 children in the age group 9 months to 2 years. Of these, vaccine was supplied by the department for 323 courses, of which 301 were administered in local authority clinics and 22 by family doctors. Protection against Enteric Fever Children visiting abroad in school parties may obtain T.A.B. inoculation either from their family doctor or the authority's clinics in the borough. I consider that all undertaking overseas travel should be so protected. (See also page 14 — Typhoid Fever). 31 PREVENTION OF ILLNESS, CARE AND AFTER CARE Tuberculosis During 1967 there were 53 notifications of pulmonary tuberculosis and 11 notifications of non-pulmonary tuberculosis in the Borough, compared with 71 and 10 notifications respectively, in 1966. The following table shows an analysis of cases notified in 1967. Age Periods. Respiratory Non-Respiratory M F M F 0—4 2 - - - 5—14 - 2 - - 15—24 5 4 1 - 25—44 5 4 2 2 45—64 13 4 1 3 65 and over 10 3 1 1 Age unknown 1 - - - Totals 36 17 5 6 The total number of cases on the register at the end of the year was: Pulmonary 1234 Non-pulmonary 167 As may be seen from the Registrar General's official return 1967 on page 9, there were 9 deaths from tuberculosis in 1967. The Borough was again well served by the Chest Clinics of Ashford, Hounslow, Kingston, and the ad hoc clinic at the Richmond Royal Hospital. Mass Radiography. Mass X-ray facilities were available to the general public without appointment at the West Middlesex Hospital, Twickenham Road, Isleworth on any weekday (excluding Saturday) between the hours of 9.0 a.m.—12.30 p.m. and 1.30 p.m.—5.0 p.m. A mobile mass X-ray unit also visited (he Bus Station at the rear of the Odeon Cinema, Richmond, on Thursday evenings between 5.15 p.m. and 6.15 p.m., and the Car Park, Municipal Offices, Sheen Lane, East Sheen, on Monday evenings between 5.45 and 6.30 p.m. 32 B.C.G. Vaccination against Tuberculosis. B.C.G Vaccination of schoolchildren at about the age of 13 is carried out under Section 28 of the National Health Service Act. During 1967, 1,955 schoolchildren were skin-tested and the details are as follows:- No. skin tested 1955 (1281) No. found positive 229 (1137) No. found negative 1655 (119) No. vaccinated 1638 (119) The figures in brackets show the number of schoolchildren who were re-tested during the year. AFTER CARE FACILITIES. The Richmond upon Thames Chest and Tuberculosis Care Committee continued to undertake the after care of chest cripples for the whole Borough. I am indebted to Mrs. M. Jolliffe, Chairman, and her colleagues for the following report on the progress of the Organisation during the year. "The Care Committee has continued with the work of alleviating the distress and difficulties which come with serious chest illness, by meeting special needs and filling those gaps inevitably left by official schemes of treatment and allowances. The patient and his family are considered as a unit; food, fuel, holidays, clothes, furnishings, and many other items are provided. This has been the first complete year in which the Committee has had the additional responsiblity of handling the scheme for extra nourishment for necessitous cases, as agreed with the Borough Council. Though this is financed by a grant from the Council it has proved a considerable administrative burden. The Committee itself raises funds (£330 in the year ended 31st March, 1967) to help with the special needs and problems of any chest patient. It is still of concern to the Committee that the build up of work in the Twickenham area continues to be slow, nine families being helped while there were 55 helped in the Richmond and Barnes area. The Committee continues its association with similar Care Committees throughout Surrey and in the Greater London Boroughs of South West London and through joint schemes can make available to people in Richmond upon Thames facilities, such as special holidays, which would not otherwise be possible". 33 London Borough of Richmond upon Thames Chest and Tuberculosis Care Committee Statistics 1967 Category of Cases. No. assisted (within scale for Council grant). No. assisted (above scale for Council grant). RICHMOND Tuberculosis Cases 34 1 Other Chest Cripples 14 6 TWICKENHAM Tuberculosis Cases 6 - Other Chest Cripples 3 - Notes: 1. 29 families (tuberculosis and other chest cases) in Richmond, whose income was within Council Grant scale were helped with fuel grants from Care Committee voluntary funds. These families received other help also, and are thus included in Col. 2. 2. The figure3 give the number of sick persons helped. In many cases there is a family involved and help is given with the needs of the whole family. 3. Many of the cases have received several different items of help during the year, (e.g. a weekly extra nourishment grant, a fuel grant, and help with a holiday). Hostel for homeless tuberculous males. This 16-place hostel at 11, Rosslyn Road, Twickenham, provides shelter and care for homeless chest cripples. Many of the residents are the responsibility of other local health authorities. During the year five cases were admitted, two left of their own volition, and four patients died. At the end of the year there were thirteen residents, two of which were temporarily in hospital. The Consultant Chest Physician at the Hounslow Chest Clinic continued to assess the eligibility of prospective residents. I am indebted to Dr. R. Heller and Dr. D. Macintosh of the Hounslow Chest Clinic for their valuable help during the year. Christmas extras at 10/- per head were granted to patients and resident staff. There was no change in the staffing during the year. The Hostel is visited regularly by a Health Visitor, a member of the Chest Clinic medical staff and a General Practitioner. The Occupational Therapist of the London Borough of Brent also visits. Residents are encouraged to find employment if their medical condition allows. CARE OF THE ELDERLY. Preventive care and after care of elderly citizens is very much the concern of the Health Department. The prevention of ill health and the early detection of disorder by screening techniques and the more positive approach by advice on all aspects of keeping well is of paramount importance. 34 The clinic for older people at Church Road, Teddington, continued to cater for residents of the Borough who have attained the age of about 55 years. The clinic was held for six sessions per week, and during the year approximately 2650 patients were seen and of these 241 were new patients. In July, 1967 a satellite clinic for elderly persons commenced at the Kings Road Clinic, Richmond. Sixty-one patients were seen (26 new patients). Two further satellite clinics for one session per week are planned, one at Essex House, Barnes, which will open in January, 1968 and the other at Hampton Clinic, Station Road, Hampton, will open later. General. To assist in the care and guidance of old people a geriatric health visitor has been working in the borough since 21.9.66. In addition, a geriatric health visitor jointly serves the district of Richmond, Kingston, and Esher. The present plight of many elderly people living alone, unloved, unwanted and too often in appalling conditions is largely due to the failure of the community as a whole to look ahead. We have a curious head in the sand attitude to old age in that nothing is done about it until it is upon us and then too little is done too late. We have the position of old people occupying too large houses with too many stairs for them to 'keep up or negotiate, while younger people are urgently in need of accommodation. This situation could be anticipated by : — (1) A continuing adequate housing programme for older people. (2) Education of the public to accept a pattern that when an individual is approaching retirement age then there should be a move to smaller, more suitable accommodation. This step should be contemplated and acted on before the individual becomes too set in his ways to accept change. Other preventive measures would include the mobilization of Home Help and voluntary agencies early enough before conditions have become a major problem. Too often our care of the elderly is merely a patching up system and "first aid" procedures. One hopes that short term hospital care for elderly patients in order to relieve relatives, could be arranged for the area of the Borough on the Middlesex bank of the River Thames. Hospital consultants tend to view community services only as far as these services are adequate to support their discharged patients. One of the most important roles of Community Medicine is that of prevention. At present the Home Help Service can only be used where breakdown has already occurred and because of shortage is faced with allocation according to priority. It would appear more sensible and in the long run cheaper to provide a Home Help earlier but less frequently, rather than have to be called in in an emergency, to provide daily cover. Compulsory Admission to Hospital. During the year one case, aged 70, was admitted to hospital under Section 47 of the National Assistance Act, 1948. Residential Accommodation. Mr. J. D. Elliott, D.P.A., A.I.S.W., Chief Welfare Officer, comments: — "The following table shows the number of persons, analysed by age and sex, who were, on the 31st December, 1967, either accommodated in one of the Homes under 35 the control of the Welfare Committee or for whom that Committee has accepted financial responsibility in a Voluntary Home. Age Borough Homes Voluntary Homes Total Men Women Men 'Women Under 30 - - - 3 3 30-49 1 1 1 2 5 50-64 5 7 8 5 25 65-74 19 48 18 13 98 75-84 31 157 17 33 238 85 and over 23 117 8 35 183 Total 79 330 52 91 552 82 of the persons shown in the table above as being in Borough Hemes were accommodated on behalf of other Local Authorities but a further 43 not included in the table were accommodated in other Local Authorities Homes on behalf of the Council making a net total of 513 persons for whom the Welfare Committee were financially responsible as at 31st December, a net increase of 25 over the previous year. During the year, 195 persons were placed on the waiting list for residential accommodation and 152 were admitted including those who were admitted to Kingsmead on behalf of the Royal Borough of Kingston upon Thames and the London Borough of Merton." My thanks are due to Dr. J. S. Finn, Consultant Geriatrician, Kingston Hospital, and Dr. J. Andrews, Consultant Physician to the Geriatric Service, South West Middlesex Group, West Middlesex Hospital, for their cooperation throughout the year. In their comments on the services for the elderly in 1967 both doctors commented on the need to provide a more frequent meals on wheels service. Dr. Andrews also referred to the shortage of home helps. ACCIDENTAL HYPOTHERMIA. It is, of course, a well-known fact that hypothermia, or the condition of extreme cold leading to a drop in body temperature can be extremely dangerous and sometimes fatal to the elderly and very young. Having regard to the large proportion of elderly persons in the Borough, the arrangements whereby emergency kits were made available on a 24 hour basis for use by medical and nursing staff, in order to ameliorate and prevent such environmental circumstances, were continued. The hypothermia kits consists of self-heating cans of soup, sleeping bags, blankets, hot water bottles, thermometers, convector type oil heaters, matches and change for electricity and gas meters. They are stored in the Hostel at 11, Rosslyn Road, Twickenham, which is reasonably centrally placed in the Borough. The purpose of the kits is that, in an emergency, and wherever practicable on medical advice they are used to raise the temperature of the environs prior to possible urgent admission of a patient to hospital for treatment. During the year the kits were used on three occasions and proved invaluable. The Ministry of Health sent a circular letter reminding the authority of the dangers in winter and a further reminder of the facilities already offered by the Borough was despatched to all family doctors. CHIROPODY. This service continued to expand during the year. Patients were treated mainly in the surgeries of chiropodists. Twickenham patients had the option of attending 36 Council clinics in their district. Domiciliary treatment was available to patients who had medical certificates from their family doctors. During the year the Chiropodists were awarded a salary increase and as a result it was necessary to increase the standard charge to patients from 4/- to 6/- per treat' ment. Children under 5 years, schoolchildren, persons in receipt of Ministry of Social Security Grant, and other persons with total income of £6 single and £10 married received the service free of charge. The £6 limit for a single person was raised to £8 in October, 1967. The number of treatments carried out during the year was as follows:— (a) Treatments at the surgeries of private chiropodists 17,845 (11,337) (b) Treatments at Borough Council clinics 1,169 (1,027) (c) Treatments at sessions arranged by Voluntary Societies 2,097 (2,584) (d) Domiciliary treatments 6,224 (4,155) Figures for 1966 in brackets. RECUPERATIVE HOLIDAYS. During the year arrangements were made for 72 persons to be admitted to re' cuperative holiday homes. Cases referred and the origin of referral are shown below: Family Doctor Hospital referrals. referrals. Elderly Persons 21 6 Adults 14 14 Mothers accompanied by children — Mothers 4 Children 13 Subsequently the arrangements for seven elderly persons, eight adults and seven children were cancelled at the wish of the patient or relatives. One family was sent in collaboration with the Children's Department. HEALTH EDUCATION. Health Education in the Borough continued to be promoted through the depart' mental Health Education Sub-Committee under the Chairmanship of the Deputy Medical Officer of Health. The co-operation of the Borough Safety Officer on such matters as accidents in the home and water safety, etc. was much appreciated. Poster campaigns were held on different subjects each month (see below) and as far as possible these were also held in conjunction with any national campaigns being promoted at that time, e.g. mental health week, anti-smoking. POSTER CAMPAIGNS, 1967. JANUARY Hypothermia. FEBRUARY Coughs & Colds. MARCH Food Hygiene. APRIL Dental Care. MAY Home Safety. TUNE Mental Health. JULY Water Safety. AUGUST Broken Glass. SEPTEMBER Immunisation. OCTOBER Fireworks. NOVEMBER Smoking. DECEMBER Fire Hazards. 37 Use was made of the British Red Cross Society's shop window at Twickenham for display purposes, highlighting various aspects of some of the above campaigns. My thanks are due to Mrs. W. Burrington, Divisional Director of the British Red Cross Society, for her help in this respect. Anti-Smoking Campaign. In October, 1966, the Minister of Health wrote to local authorities asking them to use all their channels of health education to publicise the findings of the Royal College of Physicians report on Smoking and Health and to bring home to the public and to school children the dangers of smoking, particularly cigarette smoking. The Minister hoped that local authorities would continue and increase their health education on this subject. It was decided that the month of November, 1967, should be devoted to an "Anti-Smoking Campaign". A display of posters was arranged on public notice boards throughout the Borough. Lectures were given and films shown in schools, and I am indebted to the Chief Education Officer for his co-operation in this matter. In addition, special mention must be made of the "Anti-Smoking Clinic" held at the Kings Road Clinic, Richmond, from 13th—17th November, 1967, in conjunction with the British Temperance Society. I would like to express my appreciation to Dr. White and Mr. B. Kinman of the Society for giving up their valuable time, free of charge to the Council, to come along and run the clinic on five successive evenings. The press, as well as posters and leaflets distributed in local stores, were used to publicise the event and 57 persons applied for registration. Out of these, 44 persons attended the first night and a total of 35 persons actually completed the course and attended on all five evenings. At the end of the course, the vast majority indicated that they had stopped smoking since the clinic started, and one or two had managed to considerably reduce their intake of cigarettes. It was planned to hold a re-union at Kings Road in January, 1968, to enable an evaluation of the results of the Clinic to be made and an exchange of views between the persons attending. I would like to express my gratitude to Miss B. J. Butcher and Mr. P. R. Clark of the Mass Radiography Service, who arranged special X-Ray sessions in the Borough and also to Dr. C. O. Edwards of Kingston Hospital for his co-operation in providing exhibits for the "Anti-Smoking Clinic". General. Talks are arranged for voluntary associations, parent and youth groups etc. and these are invariably supported by films or slides. The health visitors are very active in this field and group teaching is held by them during clinic sessions at welfare centres. Ante-natal relaxation sessions held in association with parentcraft classes are taken by health visitors and midwives. These take the form of a short talk followed by relaxation exercises and finally a discussion. Midwives are concerned with ante-natal care in the mother's home, at welfare centres and at family doctor clinics. (See page 28 — health visiting). During the year some 272 talks were given by the staff of the Health Department. HOME HELP SERVICE Staff Home Help Organiser 1 Assistant Homo Help Organisers 2 Home Helps — Whole-time 9 — Part-time 104 (Whole-time equivalent) 65 Establishment 100 38 The order of priority of applications for the Home Help Service remain as before, i.e..:- 1. Acute Emergency cases. 2. Domiciliary confinements and 48-hour hospital discharges. 3. The tuberculous. 4. Other cases, i.e., chronic sick, aged infirm, mentally disordered, etc. Applicants in receipt of supplementary benefit from the Ministry of Social Security and those suffering from toxaemia in pregnancy receive the service free of charge. In all other cases patients either pay the standard charge or are assessed to pay according to their financial circumstances. The recruitment of Home Helps continued to show some improvement by the end of the year (60.3 in 1966) (65 in 1967), but the Home Help Service still had difficulties in meeting all requests for assistance. The number of new cases referred to the service was 849, plus 172 Maternity cases. Each case was visited by the Organiser, or one of the assistant organisers, in order to assess the actual need. Approximately 45% were found to be not eligible to receive the service. Hourly payment is made to home helps in accordance with nationally negotiated rates of pay. Additional remuneration is given for work in dirty homes and certain cases of infectious disease. It is interesting to note the difference in the number of hours worked by Home Helps as between the various categories of patients requiring assistance:- A. Patients whose mobility is affected by advancing years and physical disability needing help for normal cleaning, carrying of fuel, cleaning kitchen appliances. 2 hours per week (1 visit). B. Housebound cases requiring help as in A, but able to cook for themselves but unable to do essential shopping. 4-9 hours per week (2-3 visits). C. Housebound and bedfast cases unable to do anything for themselves requiring help as A, and also cooking and essential shopping. 10—30 hours per week. (Daily visits — Monday to Sunday). D. Maternity cases. Home confinements requiring daily help until baby is 10 days old and 48-hour confinements needing daily care after discharge from hospital, until baby is 10 days old. 10-40 hours (daily visits excepting Saturdays/Sundays). E. Acute cases, i.e., emergencies and post-operation cases especially affecting the under 65's. Help is given according to need and accommodation and number of children, etc. Cases who do not go to convalescent homes and/or are recuperating, due to domestic need. 2-6 hours per week (1-3 visits). 39 The standard charge for the service at the end of the year was 6/- per hour. Cases given help were as follows :- 1967. 1966. Chronic sick 81 Tuberculous 7 Mentally disordered 3 2 Maternity 116 100 Others 93 114 Aged 65 or over 780 805 Total cases helped 1080 1106 (Included above are 517 (Included above are 595 cases brought forward cases brought forward from 1966). from 1965). Average number of cases receiving this type of help in any week :- A. 367 patients. Receiving 2-3 hours per week. B. 137 „ „ ' 4-9 „ „ „ C. 26 „ „ 10-30 „ D. 3 „ „ 10-40 „ „ „ E. 2 „ „ 2-6 „ „ „ Miss J. Tinch, was appointed as an Assistant Home Help Organiser to fill the vacancy left by the appointment of Mrs. J. E. M. Roberts as Home Help Organiser. During September Mrs. M. Yates, Assistant Home Help Organiser left to join her husband in Germany, and Mrs. R. Norgate-Bennett was appointed to this post. Good Neighbour Service. A good neighbour scheme is operated to supplement the home help service thus saving wastage of valuable home help time. Good neighbours help the aged and chronic sick by doing daily chores such as shopping, cooking, seeing to fires or other forms of heating and various other necessary daily duties. The good neighbours are paid from 10/- to £2 per week according to the extent of the duties allocated by the Home Help Organiser. Cases receiving the Good Neighbour service are excluded from the above figures and are set out below:- Chronic sick (aged under 65) 6 Chronic sick over 65 84 Total cases helped 90 (Included above are 37 cases brought forward from 1966). Night "Sitters-In" Service. Certain patients, mainly the elderly, who are ill at home and possibly awaiting admission to hospital do occasionally cause considerable anxiety when they are left alone at night without a relative or friend to look after them. Relatives normally undertake the care of their "own sick" but there are times when it is not possible to obtain the services of a relative at short notice and some emergency arrangements are necessary to ensure that patients receive adequate care at night. In January 1967 the Council agreed to the provision of an emergency service to provide assistance in the night-time care of patients who require to be cared for at home where no relative or neighbour is immediately available. The service is also available to relieve relatives who find themselves under considerable mental or physical strain through caring for chronically ill patients over a long period of time. The service is not a night nursing service but the 'sitters-in' are required to have a commonsense outlook and capable of giving sympathetic care and attention to patients. The Council pay the sitters-in at the rate of 3/6d. per hour, or up to 35/- for a night's duty of ten hours. Persons receiving the service are assessed to pay to the Council a charge according to means subject to a maximum charge of 35/- per night of ten hours. Persons in receipt of benefit from the Ministry of Social Security receive the service free of charge. Patients are referred for the sitters-in service by family doctors and nursing staff, etc., to the Superintendent of District Nurses. In an emergency, outside office hours, 40 requests for the 'sitters-in' service are made direct by telephone to the Superintendent of District Nurses or her Deputy. The number of cases receiving this service during the year was 8. One case was carried over into 1968. MENTAL HEALTH SERVICES The need to rely on voluntary societies and other local authorities for the placement of mentally disordered persons in training establishments and residential accommodation continued. During 1967 negotiations were concluded with the Hounslow, Twickenham and District Society for Mentally Handicapped Children, for the use of Harle House as a temporary 40-place junior training centre. This centre is due to open in January 1968. It is also proposed to start a Day Centre for the mentally ill at the Hostel, 11 Rosslyn Road, Twickenham, in January 1968, initially for one session per week. The provisions for establishments for the mentally disordered included in the Council's plan for the development of the Health and Welfare Services over the ten year period 1966-76 were curtailed by financial restrictions, but at the end of the year the proposal to set up a purpose-built junior training centre at Strathmore Road, Teddington was in the initial stage of preparation. Mental Illness. The Borough continues to be served by two psychiatric hospitals for the mentally ill as follows:- Banstead Hospital, Sutton, Surrey. (Districts served: Richmond and Barnes); Springfield Hospital, Beechcroft Road, Upper Tooting, S.W.17. (District served : Twickenham, Teddington, Hampton and Hampton Wick). The following table shows the number of patients admitted to psychiatric hospitals under the Mental Health Act during the year: Seotion M F Total Section 5 26 (29) 39 (38) 65 (67) Section 25 26 (18) 48 (35) 74 (53) Section 26 4 (10) 5 (12) 9 (22) Section 29 8 (31) 17 (49) 25 (80) Section 60 (5) (-) - (5) Section 136 2 (-) 1 (-) 3 (-) Total ... 66 (93) 110 (134) 176 (227) (Figures in brackets are those as at 31st December, 1966). Co-operation with the hospitals providing psychiatric cover for the Borough is considered to be a very important factor in the care and after-care of the mentally ill. Mental welfare officers continue to attend out-patient clinics at the West Middlesex and Richmond Royal Hospital. Arrangements have been entered into with Springfield 41 Hospital Management Committee for the services of a social worker to be allocated to Springfield Hospital for three sessions per week subject to the Council being re-imbursed the cost involved. This social worker has been appointed and commences duties in January, 1968. The joint use of social workers in hospitals and the community is another important factor in this co-operation. The fieldwork for the after-care of the mentally ill is carried out by the following officers who were on the staff of the department at the end of the year:- 1 Chief Mental Welfare Officer. 1 Senior Mental Welfare Officer. 4 Mental Welfare Officers. 1 Mental Health Social Worker. One mental welfare officer continues to attend a full time two year course of study for the Certificate in Social Work. Dr. Alfred Torrie continued to hold his valuable "in-service training" sessions for mental welfare officers. Towards the end of the year, however, Dr. Torrie joined the professional team at the Geriatric Clinic held weekly at Kings Road, Richmond. From the 1st January, 1967 until 31st December, 1967, mental welfare officers and social workers made a total of 1930 (2679) home visits and approximately 274 (72) office interviews were held during the same period. The total number of mentally ill persons residing in the community and under care at the 31st December, 1967, was 315 (294) i.e., 148 (138) males, 167 (156) females. The figures in brackets show comparable figures for 1966. Residential Accommodation for the Mentally 111. At the end of 1967, there were 22 patients for whom the Borough had accepted financial responsibility in mental after-care homes and hostels run by voluntary societies and other local authorities. The Mental After-Care Association is particularly helpful in this respect. Community Care of the Subnormal and Severely Subnormal. Referrals to the Mental Health Service. During 1967, the following referrals were received:- Subnormal Severely Subnormal Total Over 16 Under 16 Over 16 Under 16 M F M F M F M F Referrals under Section 57 (as amended) Education Act, 1944 - - - - - - 4 - 5 Referrals of educationally subnormal children requiring supervision after leaving school 1 1 - - 1 1 - - 4 Referrals from other sources 1 5 1 1 1 2 2 8 21 Total 2 6 2 1 2 3 6 8 30 42 Supervision in the Home. With support from social workers and health visitors, many subnormal and severely subnormal patients of all ages are able to live satisfactorily in the community. It is essential that they and their parents are able to obtain assistance with their problems and this is readily available through visiting officers. In this connection, it is with regret that I report the loss of the benefit of specialist advice on individual patients, by the death in November, 1967 of Dr. D. Watterson. T'he total number of subnormal and severely subnormal persons under community care at the end of 1967 was 228 compared with 224 in 1966. This does not include those patients placed in residential accommodation under Guardianship and informal foster care arrangements. Guardianship and Informal Foster Care. At the end of 1967, there were three patients under the Guardianship of the Council (three at the end of 1966). There were also 17 under informal foster care arrangements in homes or hostels run by voluntary societies and private homes (15 at 31st December, 1966). In order to avoid formal guardianship procedures, informal placements are made wherever practicable. The Guardianship Society, Hove, is most helpful in assisting in the placement of patients in suitable homes. As Medical Officer of Health of the London Borough of Richmond upon Thames, I represent the London Boroughs Association on the General Committee of the Guardianship Society, Hove. Admissions to Hospital. The Borough is in the catchment area of Normansfield Hospital, Teddington, which serves the districts of Twickenham, Teddington, Hampton and Hampton Wick; Botleys Park Hospital, Chertsey, Queen Mary's Hospital, Carshalton, and St. Ebba's Hospital, Epsom, which cover the districts of Richmond and Barnes. The majority of patients from the Richmond and Barnes area are admitted to Botleys Park Hospital. Younger children are admitted to Queen Mary's Hospital, Carshalton. The following table shows the number of admissions which have taken place from 1st January, 1967 to the 31st December, 1967, all of which were on an informal basis:- Subnormal Severely Subnormal Total Over 16 Under 16 Over 16 Under 16 M F M F M F M F Normansfield Hospital - - - - - 1 3 1 5 Botleys Park Hospital - - - - - - - - - Queen Mary's Hospital - - - - - - - 1 1 Total - - - - - 1 3 2 6 43 The number of patients awaiting admission to psychiatric hospitals for the subnormal at the end of the year was as follows:- Subnormal Severely Subnormal Total Over 16 Under 16 Over 16 Under 16 M F M F M F M F In urgent need of hospital care - - - - 2 2 1 1 6 Not in urgent need of hospital care - - - - - - 1 1 2 Total - - - - 2 2 2 2 8 During the year there were 6 admissions to hospital on a permanent basis compared with 14 in 1966. I am indebted to Dr. N. Langdon-Down of Normansfield Hospital, Dr. J. M. Crawford of Botleys Park Hospital, and Dr. B. Kirman of Queen Mary's Hospital, Carshalton, for their invaluable help. Temporary Care. One way in which the parents can be given a measure of relief is for the depart' ment to arrange short stay care for periods of up to eight weeks in psychiatric hospitals or arrangements may be made with voluntary societies, etc. for placement in private homes. During 1967 arrangements were made for 15 patients to be sent to hospitals; four patients were accommodated in privately run establishments. Training. (a) Attendance at junior training centres. At the present time children from the Borough attend the Hanworth Junior Training Centre, Bear Road, Hanworth, which is administered by the London Borough of Hounslow, and the Kingston Training Centre, Dukes Avenue, Kingston upon Thames, administered by the Royal Borough of Kingston upon Thames. The numbers attending these centres from the Borough are set out below: The numbers attending these centres from the Borough are set out below: Name of Establishment. Area Served. Number attending. Kingston Training Centre Richmond and Barnes 12 Hanworth Junior Training Centre Twickenham, Teddington, Hampton 6? Hampton Wick 26 Total 38 Certain older girls at the Hanworth Junior Training Centre are paid monetary rewards up to 15/- per week for helping in the kitchen and with the nursery class children within a ratio of one orderly to every 30 places. Medical inspection and treatment for children attending training centres is provided in the same way as for children attending primary and secondary schools. 44 (b) Attendance at special care units. Certain severely subnormal children are unable because of their unsuitability, to attend a junior training centre. These children may be admitted to a special care unit attached to the centre. These care units cater specifically for mentally handicapped children who also suffer from a physical handicap, or are very over active, and provide mothers with much needed relief and a measure of habit training for the child. (c) Attendance at adult training centres. Adult subnormal and severely subnormal patients from the Borough attend the Acton Lodge and Brentford Adult Training Centres situated within the London Borough of Hounslow, and the Kingston Training Centre situated within the Royal Borough of Kingston upon Thames. The approximate numbers attending these centres from the Borough are set out below: Name of Establishment Area Served Number attending Acton Lodge Adult Training Centre Twickenham, Teddington, Hampton 6? Hampton Wick 37 Brentford Adult Training Centre Ditto 8 Kingston Training Centre Richmond and Barnes 13 TOTAL 58 The aim of the adult training centres is to train those attending to function at the very highest possible level whether that be to work within the centre or in outside employment. In this way the trainees become more independent and are able to lead as full a life as possible. Work is undertaken at the centres for local firms on a contract basis and includes assembly of electrical components and television parts, toy assembly, carpentry and joinery, involving the use of heavy machinery, gardening, etc., etc. At the Brentford and Acton Lodge Adult Training Centres the Trainees work a 40 hour week, i.e. eight hours daily, Monday to Friday, including a lunch break. They are paid on a scale ranging from 8/- to £2 per week according to diligence, ability, and application to the job. At the Kingston Training Centre the trainees work a 32½ hour week, i.e six-anda-half hours per day Monday to Friday, including a lunch break. The trainees are paid monetary rewards on a scale ranging from 5/- to 30/- per week. I am indebted to Dr. R. L. Lindon, Medical Officer of Health, London Borough of Hounslow, and Dr. J. C. Birchall, Medical Officer of Health, Royal Borough of Kingston upon Thames, for their co-operation and help throughout the year. Hounslow was occasionally able to take children into its training centres, but it became necessary for the Royal Borough of Kingston to close the waiting list for the Kingston Centre. This difficulty will be partially overcome, however, with the opening in January, 1968 of the Harle House Training Centre, Feltham. 45 Holiday Camps. By arrangement with the London Boroughs of Hillingdon, Hounslow, and the Royal Borough of Kingston upon Thames, arrangements were made for children and adults from Richmond upon Thames to attend holiday camps as follows:- Borough. Place. Dates. Number Attended. London Borough of Hillingdon (Junior Camp) Park Place Residential School, Henley-on-Thames. 27.8.67 — 2 1 male. 8.9.67 1 female. London Borough of Hounslow (Adult Camp) St. Mary's Bay, Romney Marsh, Kent. 30.8.67 — 7 6 male. 8.9.67 1 female. Counselling Clinics. In April, 1967 Counselling Clinics were inaugurated for parents of children with impaired mental development. Their purpose is to ensure that each slow developing child does have the advantage of physical examinations in the same way as the child attending a child welfare centre and to provide counselling facilities for all parents of mentally handicapped children including discussion of day to day problems. The clinics at present held at Kings Road, Richmond, Hospital Bridge Road, Whitton, and Windham Road, Richmond, are staffed by a senior medical officer, health visitors, mental welfare officers and social workers, and are confined to the attendance of children from birth to 15 years. These clinics have proved to be most successful and parents are appreciative of the help given and the opportunity of meeting parents with similar problems. Number of attendances 91 (of which 43 were first attendances). INCIDENCE OF BLINDNESS I am indebted to Mr. J. D. Elliott, D.P.A., A.I.S.W., Chief Welfare Officer, for the following information:- v. Follow-up of Registered Blind and Partially Sighted Persons for the year ended 31st December, 1967. Cause of Disability Cataract Glaucoma Retrolental Fibroplasia Others (i) Number of cases registered during the year in respect of which Section F of Forms B.D.8. recommends: (a) No treatment 4 8 - 15 (b) Treatment (medical, surgical or optical and supervision 5 10 - 27 (ii) Number of cases at (i) (b) above which on follow-up action have received treatment 2 9 - 23 46 B. Other Statistics for the year ended 31st December, 1967. Number of B.D.8 Forms received during the year 69 Number of Registered Blind Persons at 31.12.67 Male 133; Female 243; Total 376 Number of Registered Partially Sighted Persons at 31.12.67 Male 41; Female 59; Total 100 The total number on the Blind Register at 31st December, 1967 was 376, a net increase of 9 as compared with the total at 31st December, 1966. During this period 60 persons were added to the Register, 51 of these being new cases, including 4 who were transferred from the Partially Sighted Register. The remainder were transfers from the areas of other Local Authorities. 38 persons died during the period and 12 persons removed from the Borough. The following table shows the classification of the Register by age groups and by incidence of blindness:- Classification by age groups. Classification by incidence of blindness. Birth - 30 Under 1 year of age - - Aged 1 year 1 1 ,, 2 years - 2 „ 3 years - 1 „ 4 years - - ,, 5-10 years 1 9 ,,11-15 „ 5 5 „ 16-20 „ 5 8 „ 21-29 „ 6 11 „ 30-39 „ 14 12 „ 40-49 „ 12 28 „ 50-59 „ 28 34 „ 60-64 „ 21 18 „ 65-69 „ 37 41 „ 70-79 „ 94 89 „ 80-84 „ 61 47 „ 85-89 „ 62 29 „ 90 and over 29 4 Age of incidence unknown - 7 It will be seen that there are 304 persons on the register who were aged 60 and over, 228 of whom did not lose their sight until they were over this age. Of the children under 16, 1 was under school age, 3 were attending special schools for the blind, 1 attending a special unit for the deaf-blind, 1 attending a special rschool for E.S.N, pupils and 1 was residing in a Hospital for Mentally Sub-Normals. 103 people were suffering from other handicaps in addition to blindness, 24 were in Residential Homes under Part III of the National Assistance Act, 1948, 3 were in hospitals for the mentally ill and 11 in other hospitals. Of the 65 people aged between 16 and 59, 2 were still engaged in full time studies and 31 were in employment. There were also 7 persons aged 60 and over who were still working. There were no persons employed in special workshops for the blind and only 2 working under the Homeworkers Scheme The Table below shows the occupatitions followed by those in employment:- Professional, Technical, Administrative, etc. Masseurs, Physiotherapists 4 Musicians (including Teachers) 4 Others 2 Clerical and Related Workers Typists, Secretaries 4 Braille Proof Readers 1 Clerical Workers 1 Telephone Operators 1 47 Sales Workers Shop Managers or Assistants 2 Craftsmen, Production Process Workers, Labourers Machine Tool Operators 3 Fitters and Assemblers 2 Viewers, Inspectors, Testers 2 Production Process Workers 4 Agricultural and Horticultural Workers Gardener 1 Service and Miscellaneous Workers Domestic, Cleaners, Caretakers 6 Miscellaneous 1 C. Register of Partially Sighted Persons. The Register of Partially Sighted Persons at 31st December, 1967 showed a total of 100 persons, the same as for the period ended 31st December, 1966. A total of 24 were added to the Register during the period, 18 of these being new cases and the others new residents in the Borough. 4 persons were transferred to the Blind Register, 10 died and 7 removed to other areas. The sight of 3 persons improved and they were de-registered. The classification of the Register by age groups was as follows:- Under 5 years 1 5-15 years 2 16-20 „ 8 21-49 „19 50-64 „ 10 65 and over 60 Of the total on the Register, 52 were expected to become blind within the near future, and 9, while not expected to become blind, were considered to be industrially handicapped. Ophthalmia Neonatorum (i) Total number of cases notified during the year 1 (ii) Number of cases in which:— (a) Vision lost - (b) Vision impaired - (c) Treatment continuing at end of year - NURSING HOMES All registered Nursing Homes within the Borough are supervised regularly by medical and nursing officers of the department. The number of Nursing Homes on the register at the end of 1967 was as follows: Maternity Homes Nil. Other Homes 6 Total number of beds 108 There were no cancellations during 1967. 48 NURSES AGENCY At the end of 1967 there were 30 State Registered Nurses and 6 State Enrolled Nurses on the register of one licensed agency. The licence for this agency was renewed for a further period of one year. LOAN OF NURSING EQUIPMENT The British Red Cross Society continued to operate a scheme on behalf of the Borough for the loan of nursing equipment. A total of 1,987 loans of varying articles were made during the year. A small charge was made for articles loaned. This enabled replacements to be made. The Council purchases special equipment and larger items such as hospital type and special beds and hoists, etc. Where patients are unable to pay, the Council pays the hire charge. A grant of £100 was made to the British Red Cross Society towards the expenses of running the scheme. Alternate Pressure Pads. These pads known as "ripple beds" save a great deal of unnecessary suffering to bed-ridden patients in the prevention and healing of pressure sores. 44 were hired for varying periods during 1967. INCONTINENT LAUNDRY SERVICE A free laundry service for incontinent patients is provided under Section 28 of the National Health Service Act, 1946 and Section 84 of the Public Health Act, 1936. The service is provided twice weekly. Sheets make up the bulk of the laundry but night clothes and other articles are included where necessary. A Corporation van carries out the transport and distribution of the laundry which is- laundered, under contract, by a local firm. This service has proved invaluable and is greately appreciated by the patients and their relatives. At the end of the year there were 70 cases receiving this service compared with 50 at the end of 1966. In accordance with the recommendation from the Ministry of Health in a Circular to Local Authorities (14/66) pads, waterproof pants, and knickers with disposable linings are also provided for incontinent individuals. Incontinent pads, instead of sheets, are used where the degree of incontinence is minimal and where the patient is doubly incontinent thus reducing the laundering of soiled bed linen. The pads are normally distributed by the district nurses, but where a laundry service for incontinent persons is also in operation, pads are sometimes delivered by the van driver. Used pads are collected and destroyed whenever disposal is requested because the householder has difficulty in dealing with this type of refuse. Soiled dressings (including maternity debris) are also collected and disposed of in the same manner, generally at the request of the domiciliary nursing staff. TELEPHONE ANSWERING SERVICE The Telephone Answering Service operated by the British Medical Association Emergency Treatment Service was used for emergency calls by the Midwifery and Mental Health services in the Borough as from August, 1967. This service replaces the method whereby these officers could be contacted from the police stations. 49 The service operates on a full-time basis for midwives and at nights, week-ends, and holidays for Mental Health Staff. At the end of the year negotiations were proceeding for the use of radio telephones for a trial period. MEDICAL ASSESSMENTS The assessment of medical fitness of new entrants to the Council's service continued to make heavy demands on medical and clerical time. A completed medical questionnaire and a satisfactory chest X-ray examination undertaken within the last twelve months are required of each new entrant. A full physical examination is carried out in any case of doubt, and on all entrants to teacher training colleges. In addition, recommendations as to medical fitness to continue in the Council's service were made following consultation with the family doctors concerned and physical examinations. The number involved over the year was:— Total number of medical assessments 1,610 (1,636) Total number of physical examinations 490 (364) Total number examined for continued service 59 (53) Total number found unfit for further service 6 (6) The figures for 1966 are given in brackets. WATER SUPPLY All the dwellings in the Borough are supplied from the Metropolitan Water Board's mains, and I am indebted to Dr. E. Windle Taylor, Director of Water Examination, Metropolitan Water Board, for the following report: "1 a) The supply was satisfactory both as to quality and quantity throughout 1967. b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from 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. c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar General's estimates at 30th June, 1967 was 179,026. (ii) No houses were permanently supplied by standpipe. d) No Fluoride was added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2 a) The supply was derived from the following works : River Thames via Hampton works. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area, except that the Board's wells in your area were not in use. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on page 53. 50 b) The Board's river and well sources have not been considered to have a plumbo-solvent action, on account of their hardness content and alkaline reaction. It should, however, be appreciated that all types of water pick up varying amounts of metal from piping, particularly when it is newly installed; this applies to copper, zinc, iron and also lead. Tests for lead have been carried out in connection with chemical analyses of samples of running water collected from premises in the distribution system and I set out below the information obtained over the period 1st January to 31st December. 1967: Lead content (mg/1. Pb) water from main taps in consumers' premises Number of samples Per cent. Less than 0.01 64 66.7 0.01 22 22.9 0.02 3 3.1 0.03 4 4.2 0.04 2 2.1 0.05 0 - 0.06 1 1.0 96 100.0 The above figures apply to the whole of the Board's area but it should be pointed out that the general characteristics of the water are similar throughout the area so that the findings are applicable to individual Boroughs. The regular system of examination for lead in water in domestic premises will continue during 1968." 3 (a) During the year, 104 samples of swimming bath water were taken from the six pools in the Borough and were submitted for bacteriological examination to the Public Health Laboratory Service. The recommended standard is that 75% of samples should have a colony count of less than 10 per ml., the remainder less than 100; 89 samples were satisfactory and the remaining 15 were below the recommended standard, but on each occasion repeat samples produced satisfactory results. All samples taken from three of the open air pools were satisfactory. In another case the overall results were not satisfactory. This failure to obtain the required standard was due to a mechanical breakdown and I am glad to report that with the close co-operation of the Baths Manager the last 9 samples were all satisfactory, thus indicating that the trouble had been remedied well before the end of the season. In two other pools out of a total of 57 samples taken, four were below standard, although over 75% of the samples were within the recommended standard. Coliform bacilli, which indicates faecal contamination, were absent in all samples. (b) Two samples of water were taken after illness thought to be caused by drinking mains water, and one following a complaint of peculiar smell connected with mains water. A further sample was taken from a flooded basement to trace possible faecal contamination. All four samples were bacteriologically satisfactory. (c) One sample of well water was submitted to the Public Analyst for chemical examination for lead content following a circular from the Ministry of Housing and Local Government to all local authorities suggesting that supplies from this source should be checked. The Analyst's report was that no lead was detected. 51 SEWERAGE & SEWAGE DISPOSAL I am obliged to (a) Mr. A. S. Knolles, B.Sc., M.Inst.C.E., M.I.Mun.E., Chartered C.E., the Borough Engineer and Surveyor, and (b) Mr. L. H. Thompson, A.M.I.C.E., A.M.I.S.P., Regional Engineer, Greater London Council for the following reports: (a) The laying of a new surface water sewer in Heath Road, Twickenham has been completed, as also has the renewal and extension of a surface water sewer in Station Road, Barnes and the renewal of the soil sewer in Fourth Cross Road, Twickenham. During the past year a number of new manholes have been constructed on both soil and surface water sewers where the distance between existing manholes has been too great to permit adequate cleansing of the sewers. (b) On 1st April, 1967, the ownership of two fairly large sewers leading from Station Road, Twickenham to the existing trunk sewers at the disused works south of the Chertscy Road were transferred from the Borough to the Greater London Council, the sewers falling within the definition of "Main sewers" under the 1963 London Government Act. As explained in the 1966 report, sewage from parts of the Borough which were formerly in the County of Middlesex, is conveyed to the Mogden Works, Hounslow for treatment. This works now deals with about 100 million gallons per day and the purified effluent is discharged to the river between Isleworth Ait and the Old Deer Park. During the year, the quality of this effluent has been consistently good, in fact containing less than half the impurities permitted by the standards laid down by the Port of London Authority which is the body responsible for pollution control in the River Thames below Teddington Lock. Improvement works, both at Mogden and the ancillary sludge disposal works at Perry Oaks near London Airport, have proceeded satisfactorily and the odour nuisance problem has been negligible at either works. The construction of additional sludge digestion tanks is nearing completion and their commissioning later in 1968 should provide further insurance against any smell nuisance Work is expected to commence shortly on the construction of a new pumping station and rising main for conveying sewage from Ham to Mogden. Sewage from the town of Richmond is treated at the Kew Works of the Greater London Council. This works deals with flows less than one-tenth of that treated at Mogden, but the effluent discharged to the River Thames has been of very similar quality throughout the year. 52 AVERAGE RESULTS OF THE CHEMICAL EXAMINATION of water supplied to the London Borough of Richmond upon Thames Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMn044 hrs. at 27° C. B.O.D. 5 days at 20° C. Hardness (total) CaC03 Hardness (noncarbonate) CaC03 Magnesium as Mg Sodium as NA Potassium as K Chloride as CI Phosphate as P04 Silicate as SiO2 Sulphate as SO4 Natural Fluoride as F Surface-active material as Manoxol OT Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) Hampton 52 0.019 0.090 4.2 1.10 284 72 5 22.6 5.1 30 1.9 10 64 0.30 0.01 0.1 11 7.9 590 53 BACTERIOLOGICAL RESULTS — YEARLY AVERAGES, 1967 Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Number of samples Agar plate count per ml. Coliform count E. coli count 20-24 hours at 37° C. 3 days at 22° C. Per cent. samples negative in 100 ml. Count per 100 ml. Per cent. samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37° C. 3 days at 22° C. Per cent. samples negative in 100 ml. Per cent. samples negative in 100 ml. Hampton 1,158 7.3 99.91 100.0 SANITARY CIRCUMSTANCES OF THE BOROUGH E. S. HERBERT, M A.P.H.I. Chief Public Health Inspector. 1. HOUSING (1) Unfit Houses. The unfit housing programme for the period 1966-1970 has continued to receive attention in the past year and in addition other individual unfit properties have been represented for action as the result of routine inspection on complaint. The progress made on Clearance Areas comprised : (a) the representation of 1-27 (odd) Station Road, Hampton in respect of which a Clearance Order was made : (b) the demolition of 1-6 (consecutive), St. George's Place, Church Street, Twickenham: and (c) the demolition of 1-28 (consecutive), Wilton Avenue, Richmond. Dwellings reported as being unfit for human habitation and not capable of repair at reasonable expense were: 11, Broad Street, Teddington (1st and 2nd floors); 6, Jocelyn Road, Richmond (Basement); 2 and 8, May Road, Twickenham; 213, Stanley Road, Teddington; 113 to 119 (odds inclusive), Kneller Road, Whitton; 36, Church Street, Hampton; 4 and 6, Nelson Road, Whitton; 71, St. Margarets Road, Twickenham (Ground Floor and Basement); 5a, High Street, Hampton; 8, Windmill Road, Hampton Hill; 65 and 67, Holly Road, Twickenham; 20, Wick Road, Teddington (Basement); 22, Wick Road, Teddington (Basement); 11, Cambridge Park, Twickenham (Basement room); 2, Curtis Road, Hounslow; The Lodge, Upper Sunbury Road, Hampton; 1, Church Road, Teddington (Part ground, first and second floor); 73, High Street, Hampton Hill; 88, Sheen Road, Richmond (Basement); 45a, Onslow Road, Richmond (Basement); 35, Burtons Road, Hampton Hill; 8, Talbot Road, Twickenham; 54 7a, Cardigan Road, Richmond (Basement); 4a, Church Grove, Hampton Wick (Basement); 2, 6 and 8, Avenue Road, Hampton; 32, Lewin Road, East Sheen, S.W.14; 10a, Victoria Road, Twickenham (Basement); 39, Onslow Road, Richmond (Basement). The Council made Closing Orders, Demolition Orders or accepted from the owners undertakings in respect of the following premises: 213, Stanley Road, Teddington (Undertaking); 4 and 6, Nelson Road, Whitton (Closing Order); 2 and 8, May Road, Twickenham (Closing Order); 36, Church Street, Hampton (Closing Order); 8, Windmill Road, Hampton Hill (Closing Order); 5a, High Street, Hampton (Closing Order); 93, High Street, Hampton Wick (Closing Order); 13, Gloucester Road, Teddington (Basement) (Closing Order); 24, 26, 28 and 30, Wick Road, Teddington (Basements) (Closing Order); 11, Broad Street, Teddington (1st and 2nd floors) (Closing Order); 71, St. Margarets Road, Twickenham (Basement and Ground Floor) (Closing Order); 11, Cambridge Park, Twickenham (Basement) (Closing Order); 20 and 22, Wick Road, Teddington (Basements) (Closing Order); 1, Church Road, Teddington (part ground, first and second floors) (Closing Order); 6, Jocelyn Road, Richmond (Basement) (Closing Order); 113, 115, 117 and 119, Kneller Road, Whitton (Demolition Order); 88-98 (evens inclusive), Colne Road, Twickenham (Demolition Order); 16a and 16b, May Road, Twickenham (Demolition Order); 65 and 67, Holly Road, Twickenham (Demolition Order); 2, Curtis Road, Hounslow (Demolition Order); The Lodge, Upper Sunbury Road, Hampton (Demolition Order). The following properties were made fit for human habitation during the year and in each case a Closing Order was determined or an undertaking cancelled : 24, 26, 28, 30 and 32, Wick Road, Teddington; 2, 5 and 6, Waterloo Place, Richmond; 93, High Street, Hampton Wick; 209, Petersham Road, Richmond; 20, Haggard Road, Twickenham. All the dwellings included in the above report were dealt with by way of formal action under the Housing Act, 1957; in addition, repairs were effected at 254 dwellings after informal consultation with the owners, and 95 other dwellings were made fit for human habitation after the service of statutory notices under the Public Health Acts. 55 The action taken to remedy unfit houses is summarised in the table below: (a) Clearance Areas represented to Council 1 (b) Dwellings included in (a) above 14 (c) Dwellings demolished after Clearance Orders made 34 (d) Dwellings represented for Demolition or Closing Orders 36 (e) Undertakings received to carry out repairs 1 (f) Closing Orders made in respect of — (i) Whole of building 7 (ii) Part of building 13 (g) Demolition Orders made 16 (h) Closing Orders determined on a building being made fit 11 (i) Undertakings cancelled on a building being made fit (j) Dwellings in which defects were remedied after service of formal notice 95 (k) Dwellings in which defects were remedied after informal action 254 (2) Houses in Multiple Occupation The problem of houses in multiple occupation does not appear to have grown significantly in the past year. Cases are referred to the health department by the Housing Officer when applications for rehousing suggest that lettings are lacking the essential amenities required by the Housing Act, 1961, namely, the lighting and ventilation of habitable rooms, the provision of a water supply, personal washing facilities, and cooking and food storage facilities. In a case of extreme mismanagement, the Council will apply to the house a Management Order and thereafter the owner faces the possibility of legal proceedings whenever the Order is contravened. The Housing Act powers also enable the Council to make a Direction which limits the number of people who can occupy each letting, and to serve notice requiring additional amenities to be provided for the various lettings. During the year formal action was taken as shown below: (1) Number of Management Orders made Nil (2) Number of Directions made 13 (3) Number of Notices served requiring additional amenities 6 Legal proceedings were taken in two cases; in one an owner was fined £45 plus ,£10 costs under the Management Regulations, and in the other, an owner was fined £25 with £7 7s. Od. costs for contravening a Direction. (3) Certificates of Disrepair The Rent Act, 1957 contained two important provisions; it first released from rent control those dwelling-houses which, in the London area, had in 1956 a rateable value exceeding £40, and secondly, it entitled owners of rented dwellings below that limit to a prescribed rent income. Where the owner assumed responsibility for all repairs (except internal decorative repairs), and this applied generally in the Borough, the rent limit was to be equal to twice the 1956 gross value of the dwelling provided it was maintained in a reasonable state of repair having regard to its age, character and locality. The tenant's interest was protected to the extent that if the owner failed to carry out necessary repairs, application could be made to the local authority for a certificate of disrepair. This certificate had to be granted unless the owner gave a satisfactory undertaking to put the house in a proper state of repair within six months, and once granted the tenant could make an adjustment in the amount of rent he paid the owner until such time as the local authority cancelled the certificate. 56 Whereas nearly 100 applications were received annually in the seven years following the introduction of the Rent Act, in recent years it has been almost ignored by tenants of controlled premises and no longer provides a means whereby an owner is required to carry out repairs in order to receive the prescribed rent. Applications for Certificates of Disrepair: 1957/63 1964 1965 1966 1967 1. Number of applications for certificates 668 10 — 6 3 2. Number of decisions not to issue certificates 24 1 — - 1 3. Number of decisions to issue certificates : (a) in respect of some but not all defects 520 4 — - 1 (b) in respect of all defects 124 5 — 6 1 4. Number of undertakings given by lords under paragraph 5 of the First Schedule 415 7 - 6 1 5. Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule 3 - - 1 1 6. Number of Certificates issued 232 2 — 1 2 Applications for Cancellation of Certificates: 7. Applications by landlords to Local Authority for cancellation of certificates 134 2 2 6 - 8. Objections by tenants to cancellation of certificates 54 - - 1 - 9. Decisions by Local Authority to cancel in spite of tenants objection 18 - - 1 - 10. Certificates cancelled by Local Authority 98 2 2 6 - (4) Medical Priorities All applications for rehousing on medical grounds, when supported by a medical certificate, receive preliminary screening during periodical meetings held at the Housing Department and during the year 155 of these cases were subsequently referred by the Housing Officer for further investigation. In order to preserve a uniform standard of assessment these applications continue to be dealt with by the Deputy Medical Officer of Health, and after receiving investigation reports from either the Health Visitor or the Public Health Inspector, priority was recommended in 112 cases. Special consideration is given to these cases by the Housing Sub-Committee and when a case has been approved allocation of suitable accommodation is made as soon as it becomes available. During the year 71 families who had received special consideration were rehoused. 2. INSPECTION AND SUPERVISION OF FOOD (1) Food Inspection The year brought a significant increase in the number of complaints alleging unfitness in food sold by retail, there being 140 compared with 87 in 1966. The majority of the complaints arose because either the food trader failed to rotate stock in a proper manner or the food contained a foreign substance. If this increase reflects the public's growing determination to demand fresh and wholesome food, the vears work has been most encouraging in this field of environmental health. 57 Retailers in the Borough were again reminded by letter of the need to adopt a system of visual-aid coding when receiving prepacked perishable foods so that stock can be withdrawn and destroyed as soon as its shelf-life is finished. There were inevitably some instances of unusual happenings in the handling of food. In one instance the housewife stewed some beef and found that the meat had developed a bright blue colouring. She could find no explanation in her home nor could the butcher offer any suggestions. However, enquiry showed that the butcher used a "chinagraph" pencil, for marking meat prices on plastic labels. The crayon is soft and a small piece must have broken off and have been picked up by the meat thus imparting the blue colour on cooking. A second episode concerned a prepacked slice of Brie cheese in which the housewife was alarmed to find what she thought to be a rodent dropping. A visit to the shop showed that several varieties of cheese were sliced for retail from whole cheeses at a special table, and on the surface lay objects similar to that found in the Brie. They were grape pips found on the outside of cheeses from the Haute Savoie area -— in this case Tome au Raisin, and examination confirmed that the "dropping" was indeed only a grape pip. During the year legal proceedings were taken in 17 cases with the following results: 1. A wholesale baker was fined £25 and the retailer fined £10 with £3 3s. 0d. costs and £1 10s. 0d. witness fees for selling mouldy chocolate eclairs. 2. A grocer was fined £20 with £5 5s. 0d. costs for selling a mouldy pork pie. 3. A baker was fined £5 with £5 5s. 0d. costs for selling mouldy bread rolls. 4. A baker was fined £20 with £5 5s. 0d. costs for selling a mouldy cornish pasty. 5. A wholesale baker was fined £25 for selling a Croissant roll containing a piece of string. 6. A baker was fined £5 with £13 0s. 6d. costs for selling a rum trifle containing a bolt and washer. 7. A manufacturer was fined £25 with £10 10s. 0d. costs for selling a packet of frozen peas containing a slug. 8. A baker was fined £30 with £6 6s. 0d. costs for selling a loaf of bread taining a piece of metal. 9. A confectioner was fined £5 for selling cream which was sour. 10. A wholesale confectioner was fined £5 with £1 1s. 0d. costs for selling a bar of chocolate crunch containing a screw and washer. 11. A grocer was fined £25 with £5 5s. 0d. costs for selling a mouldy pork pie. 12. A manufacturer was fined £5 with £3 3s. Od. costs for selling a tin of peas containing a caterpillar. 13. A baker was fined £10 with £10 10s. 0d. costs for selling a loaf containing brush bristles. 14. A grocer was fined £15 with £5 5s. 0d. costs for selling a mouldy veal, ham and egg pie. 15. A wholesaler was fined £40 with £10 10s. 0d. costs for selling a rissole taining a fragment of glass. 16. A multiple stores was fined £50 with £5 5s. 0d. costs for selling mouldy cheese. 17. A wholesale baker was fined £15 with £5 5s. 0d. costs for selling a loaf of mouldy bread. 58 Throughout the year the Inspectors received requests from food traders to examine doubtful consignments of food and the following table lists the articles voluntarily surrendered and destroyed after such examination: Baby Food (tins) 12 Meat (fresh) (lbs.) 2059 Cream (tins or cartons) 36 Meat and Poultry (frozen) (pkts.) 1064 Cheese (lbs.) 82 Puddings (tins) 252 Cereals (pkts. or tins) 72 Pies 219 Cakes 450 Shell Fish 46 Fruits (lbs.) 638 Preserves (jars) 25 Fruit and Fruit Juices (tins) 6088 Poultry (lbs.) 147 Frozen Foods: Fish (pkts.) 774 Pickles, Sauces etc. (bots. & jars) 56 Fish (tins) 705 Pastry (pkts.) 1600 Fish Paste (tins) 527 Sweets (pkts.) 4 Fats (margarine/butter etc.) (pkts.) 96 Sausages (lbs.) 18 Ice Cream (cartons) 96 Soup (tins/pkts.) 196 Milk (tins/cartons) 65 Vegetables (lbs.) 11 Meat (tins) 1208 Vegetables (pkts.) 2683 (2) Food Premises The classification of food premises in the Borough by trade or principal business is shown in the following table together with the visits made to each class of premises. There are no poultry processing establishments in the Borough. Every effort has been made to ensure the regular inspection of all food premises and the general standard of hygiene has been maintained at a satisfactory level. Experience has shown that catering premises find most difficulty in achieving acceptable standards, partly because of staff changes and shortages and partly because the need for basic routine cleaning is not always understood. Regular visits by the health inspectorate help to dispel such elementary misconceptions. Food Hygiene (General) Regulations, 1960. Type of Premises. No. of Premises No. of Premises which comply with Reg. 16* No. of Premises to which Reg. 19 applies † No. of Premises which comply with Reg. 19 No. of Visits carried out. Bakehouses 29 29 29 29 133 Butchers' Shops 154 154 154 154 544 Confectioners (Flour) 74 74 - — 193 Confectioners (Sugar) 265 265 —• — 275 Dairies 10 10 10 10 26 Fishmongers and Poulterers 45 45 45 45 94 Fried Fish Shops 28 28 28 28 89 Greengrocers and Fruiterers 161 161 161 161 456 Grocers 336 336 336 336 1033 Ice Cream Premises—Manufacture 8 8 8 8 228 Ice Cream Premises—Sale and Storage 539 539 — — Public Houses and Licensed Premises 217 217 217 217 322 Restaurants, Cafes and Canteens 346 346 346 346 942 2212 2212 1334 1334 4335 * Regulation 16 deals with the provision of wash-hand basins for the use of all persons engaged in the handling of food. † Regulation 19 deals with the provision of facilities for washing food and equipment. 59 The control of out-door food trading is exercised by registration under the provisions of Section 11, Middlesex County Council Act, 1950, and during the year 2 persons and 2 premises were registered. Legal proceedings were taken in 9 cases in respect of food premises and food stalls which failed to maintain proper standards with the following results : 1. A restaurant proprietor was fined £15 and £10 with a total of £5 5s. 0d. costs in respect of two summonses. 2. A grocer was fined £15 with £3 3s. 0d. costs. 3. A butcher was fined £5 for wilfully obstructing the Chief Public Health Inspector and £5 on each of seven summonses (totalling £35) with £10 10s. 0d. costs. 4. A hotel proprietor was fined £50 with £10 10s. 0d. costs. 5. A grocer was fined £20 with £5 5s. 0d. costs. 6. A hotel proprietor was fined £5 with £1 1s. Od. costs on each of eight summonses (totalling £40 with £8 8s. Od. costs). 7. A butcher was fined £10 with £1 1s. 0d. costs on each of four summonses ing £40 with £4 4s. 0d. costs). 8. A cafe proprietor was fined £10 with £1 1s. 0d. costs on each of four summonses (totalling £40 with £4 4s. 0d. costs). 9. A stall holder was fined £2 2s. 0d. on each of five summonses (totalling £10 10s. Od.) with a total of £2 2s. 0d. costs. (3) Food Sampling The effectiveness of food sampling in 1967 owed much to the assistance given by both the staffs of the Public Health Laboratory Service and the Public Analyst's office. During the year four hundred and ninety nine samples were submitted for chemical analysis. The following table shows the various types of samples analysed and the results obtained: Article. Number Analysed Number Irregular Artificial sweetners 4 — Baking Powder 3 — Beverages 9 — Cereals and cereal products 12 3 Colourings 2 — Custard Powder 6 — Fats and Oils ... 27 — Fish and fish products 9 — Flavourings 20 — Flour and flour confectionery 12 2 Fruit and fruit products 25 2 Health foods ... 9 1 Herbs and spices 12 — Ice cream powders 2 — Jellies 11 — Meat and meat products 57 3 Medicines and drugs ... 46 2 Milk and milk products 46 2 Miscellaneous 17 7 Salad dressings 5 — Sauces, pickles and relishes 35 2 Savoury spreads 5 — Seasonings 9 1 Soft drinks 35 — Soups 6 — Sugar and chocolate confectionery 15 — Sugar and preserves 25 1 Vegetables and vegetable products 21 8 Vinegar 11 3 Yeasts 3 2 Total 499 39 60 The irregular samples comprised : (a) Dried Brewers Yeast, High Protein Food, Pre-cooked Flakes from Pure Rye, Dried Apricots, Pectozyme, 'Wine Yeast ~Hutrient, Beer and Stout Yeast, Beer Yeast J^utrient, Blac\ Molasses, Dried Sliced Onions (four samples), Natural Sea Salt, Stea\burgers, Wheat Diet, Yeast Energiser, Wine Stabiliser, Beer Heading Liquid, Pumpkin Seeds, Tahin, Sweet and Sour Sauce. The labelling of these products was not in accordance with the requirements of the Labelling of Food Order, 1953. As a result of representation to the respective manufacturers and packers concerned, appropriate labels were brought into use. (b) Processed Cheese Spread without added Salt. This product was found to contain sodium and chloride in excess of that declared on the label. In addition the other ingredients were not specified. Stocks were withdrawn from sale and the importers cancelled further supplies from abroad. (c) Lemon Curd. This article had deteriorated due to a separation of the syrup, whereas Lemon Curd of ordinary commercial quality is a homogeneous product. It was not possible to discover the specific cause of the separation and stocks were withdrawn from sale. (d) Cough Syrup. This sample was considered to be irregular in view of the statement on the label that it "contained vitamin C to replace the vitamin C lost under the stress of a cold". Although the matter was discussed with the manufacturers it was considered that there was insufficient evidence to justify formal proceedings and no further action was taken. (e) Cider Vinegar. This sample contained a bacterial growth. The growth was considered to be harmless and probably originated from the fermentation of the vinegar. Stocks of the product showed a similar condition and were destroyed. (f) Tomato Paste. Upon analysis this product was found to contain an amount of tin in excess of that recommended by the Food Standards Committee in their report on Tin in Canned Goods. Stocks of the product were surrendered and destroyed. (g) Skimmed Milk Powder. The size of the lettering for part of the declaration on the label was less than prescribed under the Dried Milk Regulations, 1965. The manufacturers were informed and stocks of the product were withdrawn from distribution for appropriate labelling. (h) Carrot Tablets. The claim on the label regarding the quantity of carotene was not consistent with that found in the sample. The packers were notified and new labels were introduced. (i) Chilli Sauce. This sample contained the preservative Benzoic Acid but its presence in this type of food is not permitted. Stocks of the product were surrendered and destroyed. (j) Blackcurrant Crumble. The Analyst reported that this article contained two human hairs. The manufacturers were unable to account for this contamination as the food was produced in a modern factory in which a high standard of hygiene and quality control is practised. This was confirmed by a report from the Health Department in whose district the factory is situated. 61 (k) Creamed Potatoes. This was a dry mix consisting of various ingredients and it was considered that "Creamed Potatoes" was not an appropriate name or description for a dry article of this nature. A sample taken in the district where the product was manufactured was also adversely commented upon by the Public Analyst for that district. Accordingly the local authority concerned agreed to finalise the matter. (1) Rizotto. This sample was infested with spider beetles. Remaining stocks of the product were seised, condemned and destroyed as unfit for human consumption. Legal proceedings against the company resulted in a fine of £20 with £5 5s. Od. costs. (m) Wine Vinegar. This product was found to be contaminated with extensive fungoid growth considered to have been the result of prolonged storage. Remaining stocks of the article, although not so extensively affected, were surrendered and destroyed. (n) Anti-Sat Tabsules. This was a sample of capsules each containing about 0.5 gram of safflower oil. The report of the Analyst states "the glycerides of safflower oil contain a high proportion, perhaps 70% or more of highly unsaturated fatty acids, and these capsules were assumed to contain about 0.35 of a gram of unsaturated glycerides of the linoleic type. By substituting in the diet oils or fats containing these unsaturated glycerides for animal fats consisting largely of saturated glycerides the blood cholesterol content may be lowered, but it is difficult to conceive how the minute addition of half a gram of safflower oil to the daily diet would have any significant effect, as was implied by the claim on the label, namely, "unsaturated fatty acids to help counteract cholesterol." By virtue of Section 6 of the Food and Drugs Act, 1955, it can be an offence if the label is calculated to mislead as to the nature, substance, or quality of a food or drug. In considering the report of the Analyst it was borne in mind that there is a divergence of medical opinion regarding the effects of unsaturated glycerides of vegetable oils and the saturated glycerides of animal fats on the blood cholesterol content and furthermore notice had to be taken of the fact that the label merely stated "to help counteract cholesterol". The report was submitted in the quarterly return to the Ministry of Agriculture, Fisheries and Food and no further action was taken. (o) Lemon Meringue Pie. The ingredients in this article were as listed on the label and two of the ingredients were citric acid and dried egg white. The illustration on the carton, however, depicted whole eggs and whole lemons and, by association of ideas, this was considered to be misleading. The manufacturers were interviewed and agreement was reached to amend the illustration on the carton. (p) Tonic Medicine. The label on this bottle did not conform with the requirements of the Pharmacy and Medicines Act. The importers of the product, and the local authority in whose district their premises are situated, were informed and arrangements were made for the medicine to be appropriately labelled. (q) Pork Sausages. This was a sample of non-preserved sausages which contained the preservative sulphur dioxide. Although this is a permitted preservative, and the quantity found was within the prescribed limit, its presence was not declared. 62 The retailer was unaware of the presence of the preservative as the seasoning mix supplied to him was labelled as non-preserved. It was ascertained that there had been a mistake in the marking of the seasoning mix at the factory and a subsequent sample proved to be genuine. (r) Pate de Cailles. This sample was in a badly soiled can the internal surface of which was discoloured. The pate was considered to be still fit for human consumption but the retailer surrendered his stocks for destruction. There was also an infringement regarding one of the ingredients listed on the label. The distributors were informed but it was found that they had no further stocks of the product and were ceasing its distribution. (4) Milk Supplies and Sampling. Licences granted authorising dealers to store and sell designated milks were as follows: Ultra Heat Treated 30 Pasteurised 92 Sterilised 61 Untreated 31 There are no processing plants in the Borough but there is one Dairy Farm which is registered by the Ministry of Ariculture, Fisheries and Food. Seventy-three samples were submitted for examination and all were found to satisfy the prescribed tests. Three samples of raw milk were also submitted for examination for the presence of brucella abortus, brucella melitensis and mycobacterium tuberculosis. These were reported upon as being negative. (5) Ice-Cream Manufacture and Sampling. There are eight manufacturing establishments in the Borough and 539 registered for the storage and sale of ice-cream. The manufacturing establishments comprise one in which the ice-cream is pasteurised by heating to a temperature of not less than 160° F for at least ten minutes, and 7 in which a sterilised mixture is used and the process of manufacture is completed by freezing only. Two hundred and eighty eight samples were taken and upon examination were graded as follows: Grade 1 — 182 Satisfactory. Grade 2-45 Grade 3 — 54 Grade 4-7 Unsatisfactory. Samples were taken from premises where ice-cream is manufactured, and cafes and restaurants where it is served from a bulk supply. Investigations regarding unsatisfactory samples were carried out and appropriate advice given in order to effect an improvement. (6) Other Foods. Three hundred and nine samples of other foods were examined comprising raw and cooked meats, pies, sausage rolls, natural and artificial creams, cream cakes, shellfish and water cress. All were reported upon as being satisfactory with the exception of four samples of natural cream (three of which were considered to be fairly satisfactory and one unsatisfactory), and a sample of boned ox cheek. Appropriate investigations regarding the creams were carried out and repeat samples proved to be satisfactory, The sample of boned ox cheek was found to contain organisms of the salmonella group and identified as Salmonella dublin. An investigation was carried 63 out at the retail shop where the sample was procured and the matter was also referred to the Health Department of the Authority from whose district the retailer had obtained this meat. A follow up sample was taken and reported upon as being satisfactory. (7) The Liquid Egg (Pasteurisation) Regulations, 1963. There are no pasteurisation plants in the district and the fourteen samples of liquid egg taken were submitted for bacteriological examination only and not for the Alpha-Amylase test. 3. ATMOSPHERIC POLLUTION The following Smoke Control Orders became operative during the year : Acreage. Number of Dwellings. Number of other Premises. Barnes No. 8 Order 688 1,483 96 Richmond No. 8 Order 153 1,953 127 Twickenham No. 6 Order 2,441 4,722 526 There are now 10,564 acres including 47,466 premises subject to such Smoke Control Orders. The smooth and trouble-free implementation of the exceptionally large area in Twickenham was only made possible bv the efforts of all three Technical Assistants and the Clerical Staff. The Council also made the following Smoke Control Orders during the year intending them to be operative in 1968. Acreage. Number of Dwellings. Number of other Premises. Barnes No. 9 Order 93 1,337 98 Richmond No. 9 Order 817 1,469 146 Twickenham No. 7 Order 163 1,473 123 The map on page 65 shows the progress made to 31st December, 1967. The Gas Boards have honoured their past assurances that adequate supplies of coke will be available for areas made before late 1966, and no difficulty is known in obtaining sufficient supplies of other solid smokeless fuels. Some householders in Smoke Control Areas have, however, been purchasing bituminous coal and informal approaches to these users and the suppliers resulted in the cessation of the practice in each instance. Householders continue to have freedom of choice, for grant purposes, in the selection of replacement appliances and their preferences are listed below, the 1966 percentage being bracketed for comparison. Gas room heaters 66% (51%) Open fires 19% (33%) Solid fuel heating stoves 10% (14%) Electric storage heaters 5% ( 2%) This is a remarkable move away from the open fire and illustrates that the demand is for convenience and cleanliness which, at the same time, reduces the pollution potential to a minimum. It was necessary during the year to serve a notice upon an Owner of a tenanted house requiring him to adapt a fireplace to enable the occupier to comply with the Act. This action was necessitated by the policy of the Council of not approving 100% grant payments to tenants. No prosecutions were taken during the year, but operators of under feed stokers burning bituminous fuel often required reminders about the proper maintenance of the plant. Experience has shown that the installation of new furnaces will readily give rise to the emission of dense smoke. On two occasions stern warnings resulted in vigorous action being taken to abate such nuisances. The law as it now stands cannot require the prior testing of an oil burner or stoker off-site so as to ensure that it will operate satisfactorily when initially fired. 64 Plans for proposed chimneys for factories were examined under the provisions of Section 10 of the Clean Air Act to ensure that the chimney height would be sufficient to prevent the smoke or gas from becoming prejudicial to health or a nuisance. During the year the Minister of Housing and Local Government issued a second edition of the "Memorandum on Chimney Heights" which recommends that the small furnace chimney is now considered not likely to create a problem and accordingly excludes such chimneys from the reference tables. Notifications under the provisions of Section 3 of the Act of new furnaces over 55,000 B.ThUs. are registered but it is apparent that many installers are completely unaware of this section, and far too many reminders have had to be made. Area not covered by Smoke Control Order. Area where Smoke Control Order made by Council but not confirmed by Minister. Area covered by Smoke Control Order. 65 There are within the Borough five stations where daily measurements of smoke density and sulphur dioxide are taken. One of these stations is operated by the Ministry of Technology at the National Physical Laboratory, Teddington and the other four by the Health Department. The following short table gives processed yearly average figures so far available for four years : The following short table gives processed yearly average figures so far available for four years: Year Ended March STATION (results in microgrammes per cubic metre) Twickenham No. 3 Twickenham No. 4 Teddington No. 3 Barnes No. 1 Smoke SO2 Smoke SO2 Smoke SO2 Smoke SO2 1963 98 181 98 187 107 200 — — 1964 98 151 89 164 100 167 96 106 1965 74 140 67 139 81 153 77 120 1966 53 111 56 115 61 108 57 102 It will be noted that there is in all cases a progressive drop in the level of pollution over the four years. It might be fairly stated that this would be due, to a great extent, to the operation of Smoke Control Orders in the Borough area and in adjoining districts. 4. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 At the 31st December, the Act had been in force for more than three years, and in that time very satisfactory progress has been made in implementing the improved standards for the health, welfare and safety of employees in offices, shops and railway premises. All office employees are within the scope of the Act whether they work in separate office buildings or in offices forming part of other buildings (e.g. schools, factories, hotels, etc.). Shops are widely defined to include wholesale and retail trade premises, restaurants, laundrettes, dry-cleaning receiving premises and fuel storage depots. The Act does not apply to premises (a) in which only self-employed persons work, or (b) used for "family businesses", i.e., in which no-one is employed other than close relatives of the employer, or (c) in which the total time worked by employees is less than 21 hours weekly. 66 During the year 179 additional premises were registered under the Act and the total number of premises registered and inspected at the end of the year is summarised below: Total number of registered premises. Number of general inspections during year. Offices 709 468 Retail Shops 1,188 1,022 Wholesale Shops 57 57 Catering Establishments 217 125 Fuel Storage Depots 5 1 2,176 1,673 During the year the following matters of interest arose in implementing the various provisions of the Act: (1). Registration and Inspection. New registrations (due to change of ownership, new businesses, etc.) involved approximately 8.5% of total registrations. The obligation to register and the Act itself are now well known to employers and accepted by them. There are less attempts to avoid registration. Most premises have received their second general inspection. The response to requests to remedy contraventions has been generally good with the usual number of recalcitrant employers necessitating prosecution. The readiness to remedy defects in connection with machinery has improved. The emphasis this year by the inspectorate has been on accident prevention. (2). Operation and General Provisions of the Act. (a) Temperature. It is still necessary to make special checks in shops on cold days; when heating has been found inadequate the general reaction of employers has been co-operative. Instances do occur in which shop doors remain open, whatever the weather, as a policy of the proprietor or company in the belief that sales are thereby encouraged, but increasingly this practice is shown to add considerably to the difficulty of maintaining the minimum statutory temperature (60.8°F) in such shops. (b) Ventilation. Although there is no statutory standard by which to measure means of adequate ventilation, unsatisfactory conditions were found in some hairdressing salons, in some laundrettes with self-service dry-cleaning service and in the smaller type of shop. (c) Lighting. There is still a lack of understanding of the importance of good lighting in the prevention of accidents, especially on stairways, in passages and basements. Unsuitable lighting on stairways has been found to result in shadows being cast in such a way that obstructions are not seen. In a dinner-dance-hall the use of ultra violet lighting caused some concern. It proved unsatisfactory for staff coming from the kitchen area in which fluorescent lighting was used, and the manufacturers admitted that a blurring effect on the eyes could be caused. A substantial improvement was obtained when some of the ultraviolet lights were replaced by more traditional fittings, and confirmation was given, by the Scientific Adviser of the Greater London Council, that the ultra-violet lighting afforded no radiation hazard. (d) Overcrowding. Notice was taken that the 1st August, 1967 marked the operation of an overcrowding standard in those premises operating three years earlier when the Act came into force; these overcrowding provisions have not presented any problem. (e) Clothes Drying. In a small number of instances, difficulty was experienced in persuading employers to make adequate provision for drying outdoor clothing in wet weather. (f) Sanitary Conveniences and Washing Facilities. The shortcomings which existed before the Act, have now been largely overcome. (g) Floors. Defective floor covering has often been noted and has been the cause of one serious accident. Floor covering deteriorates rapidly, especially in the service sections of 67 restaurants and in some instances becomes an obstruction on stairways and passageways. Older basement staircases often showed evidence of worn nosings and bowed treads which could be hazardous. (h) Hand Rails. Although hand rails were provided they were sometimes fitted so close to the wall that they could not be effectively gripped. (i) Lifting. There have been a number of minor injuries due to bad lifting technique, and suitable advice was given when investigating reported accidents. (j) Accidents. Notification of accidents by the smaller firms has increased as the Act has become better known. Accidents have again been mostly due to falls when slipping and to the use of improvised stands for reaching to shelves. There were no accidents this year from the use of gravity feed slicing machines and the persistent propaganda and the enforcement of providing and keeping guards on the machines has had some effect. The correct positioning of machines has been found to be an important factor making for ease of use and reduction of accident risk, but some operators have still failed to overcome the initial effort needed when machines are used with guards fitted. (k) Business Machinery. More attention has been given to the safety measures and staff training required in operating modern sophisticated business machines. (1) Lifts and Hoists. Unsatisfactory lifts and hoists have been more in evidence this year and have caused two accidents. One fatal accident resulted from a mechanical lift of a van. There are some very old lifts in existence especially in licensed premises, in which bottles are loaded for cellars. (After one recent accident the Manager was explaining and demonstrating the safeguards and improvements that had been effected to prevent any further accidents, when he suffered a minor injury from a defect not previously realised). Such old lifts should be taken out and replaced with modern lifts. (m) Boiler plants in laundrettes were the subject of a special leaflet distributed to these businesses; attention was drawn to the need for regular and frequent servicing of such plants. (n) Refrigerator Motors have received more attention in protective fencing. (o) Protective aprons for butchers are now regularly advised when meat is being boned; the Act does not appear to create a contravention in the failure of an employer to provide such protection, although an appropriate Regulation could be made under Section 20 of the Act. (p) There were 11 prosecutions and 11 convictions under the Act during the year: A carpet retailer was fined £20 and £15 with a total of £5 5s. Od. C06ts on two summonses. A laundry was fined £5 with £5 5s. 0d. costs. A hotel was fined £20 with £2 12s. 6d. costs. A hotel was fined £20 with £2 12s. 6d. costs. A ladies clothier was fined £10 with £5 5s. 0d. costs. The owner of an office block was fined £5, £10, £20 and £5 (totalling £40) with a total of £3 3s. Od. costs on four summonses. A hotel Was fined £25 with £10 10s. 0d. costs. 68 5. PUBLIC HEALTH INSPECTIONS The extent to which the law seeks to control our environment can be judged from the wide range of visits made during the year and shown in the following table. Satisfactory progress in performing these varied duties has only been achieved because of the enthusiasm and interest shown by senior and district inspectors and by the technical and general assistants. The assistance given by the pupil public health inspectors has also been greatly appreciated. Bacteriological sampling — Ice Cream 204 — Milk 81 — Other Foods 183 Clean Air Act — Inspections and Observations 8461 Control of Caravans 62 Diseases of Animals Act: Waste Food Order 6 Drainage and Sanitary fittings examination 3054 Food and Drugs Sampling 235 Houses inspected—Housing Act 779 Houses Let in Multiple Occupation 712 Housing Applications 129 Houses inspected — Public Health Act 4827 Houses inspected re Permitted Numbers 18 Houses inspected re Vermin and Disinfestation 325 Infectious Diseases enquiries, disinfection, etc. 781 Merchandise Marks Act 11 Noise Abatement Act 362 Offices, Shops and Railway Premises Act—General Inspections 1673 Offices, Shops and Railway Premises Act — Other Visits 3734 Pet Animals Act 9 Prevention of Damage by Pests Act 6892 Rag Flock and Other Filling Materials Act 15 Rent Act, 1957 26 Swimming Baths — Sampling 52 Unsound food examination 567 Water Supply—Inspection 116 Water Supply — Sampling 4 Agricultural Holdings — Animal Boarding Establishments 12 Bakehouses 133 Butchers Shops 544 Confectioners (Flour) 193 Confectioners (Sugar) 275 Dairies 26 Factories (Mechanical) 273 Factories (Non-Mechanical) 33 Factory Canteens 52 Fishmongers and Poulterers 94 Fried Fish Shops 89 Greengrocers and Fruiterers 456 Grocers 1033 Hawkers 155 Hairdressing Establishments 25 Ice Cream premises 228 Massage and Chiropody establishments 34 Outworkers 191 Places of Public Entertainment 14 Public Houses and Licensed Premises 322 Restaurants and Cafes 942 Riding Establishments 8 Schools 107 Scrap Metal Dealers 8 Interviews 558 Miscellaneous Visits 2589 Inspections other than Houses — Public Health Act 1368 Total number of visits and inspections 43,080 69 The complaints received during the year are classified in the table below and they reflect a pattern similar to that of previous years. Nature of Complaint. Number Received Housing Defects 339 Choked and defective drains and sewers 697 Defective water closets 62 Accumulations of offensive matter 142 Unsound food 140 Verminous and other Infested premises : (a) Bugs 42 (b) Rats and Mice 1381 (c) Wasps 7 (d) Fleas 49 (e) Others 41 Keeping of Animals 7 Nuisance from Pigeons 19 Noise Nuisances 60 Smoke Nuisances 103 Miscellaneous 284 Total 3373 Every effort is made by inspectors to carry out their work through informal action, and to seek co-operation by interview and letter; in certain cases recourse to statutory proceedings is unavoidable, and a summary of notices served during the year is given below: Subject of Notice. Public Health Act. Food and Drugs Act. Number of Informal Notices served 320 381 Number of Informal Notices complied with 254 211 Number of Statutory Notices served 102 — Number of Statutory Notices complied with 114 — 6. DISINFECTION AND DISINFESTATION The cleansing and disinfection of premises and any articles therein likely to retain infection after infectious disease is carried out at the expense of the Council and in cases other than after infectious disease at the expense of the individual. The only type of disinfestation carried out is that of premises for the eradication of bed bugs, fleas, etc., the cost of the work being charged to the individual. All persons suffering from scabies or infested with lice are, by arrangement, sent to Hammersmith Medicinal Baths for treatment and I am grateful to Dr. A. D. C. S. Cameron, Medical Officer of Health of the London Borough of Hammersmith, and the Superintendent of the Baths, Mr. F. G. Baldwin, for their valuable assistance during the year. There was an increase in the number of cases of scabies treated during the year — 89 as compared with 16 in 1966 and only 1 in 1965. 8 persons were treated for lice infestation compared with 5 in 1966. 100 premises were disinfested during the year and costs amounting to £100 19s. 5d. were recovered. 7. PEST CONTROL (a) The rodent control staff have again done much useful work in eradicating rats and mice: No. of complaints received 1,381 No. of infestations found 899 Total number of visits 6,584 70 The treatment of foul sewers in the Richmond town area was carried out in May and November. The anti-coagulent, "Warfarin" was again used and baiting was concentrated in those areas known to be infested. In the Twickenham area, four treatments using Fluoracetamide (direct poisoning) were carried out. Test baiting was carried out in the Barnes area and direct poisoning is scheduled early in 1968, when it should be possible to achieve uniformity throughout the Borough by using Fluoracetamide. Progress has been maintained and close liaison has been kept with the Ministry of Agriculture, Fisheries and Food who are most helpful in providing courses for the rodent operatives thus enabling them to keep abreast of the latest developments and techniques in eradication methods. (b) Complaints are received from time to time of squirrels invading roof spaces, and advice on treatment and proofing is freely available from the Ministry of Agri culture, Fisheries and Food (Field Section) at Guildford, or from the local Ministry Inspector at 15, West Tenter Street, London, E.l. (telephone ROYal 6801). One complaint of unusual interest concerned a squirrel which entered the garden of a dwelling house and attacked the householder's young daughter. Before trapping could be put in hand, a further report was received of children being attacked by a squirrel in the nearby grounds of a cemetery. The squirrel was killed by a passer-by and the absence of any later incident suggests that these attacks had been made by one "rogue" squirrel. (c) Pest infestations can cause serious inconvenience to the householder and one complaint during the year came from a new block of flats where a tenant reported millions of tiny insects invading the bathroom and kitchen areas. The invader was identified as the Clover Mite (Bryobia Praetiosa). The females normally lay eggs on trees, but when land is developed they may make their way up any vertical surface available. as for example, the walls of newly-built property. Swarming into new dwellings has been recorded in the spring and less frequently in the autumn, and it is thought that the females arc in search of places in which to lay their eggs. Treatment is by soaking grass and vegetation adjoining the wall being attacked with an emulsion of malathion or lindane. The mites are harmless to human beings. 71 3. FACTORIES ACT, 1961, Part I of the Act. (1.) INSPECTIONS, for purposes of provisions as to health. Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4, and 6 are to be enforced by Local Authorities 40 33 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 612 273 7 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 37 37 2 — Totals 689 343 9 — (2.) Cases in which DEFECTS were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S. 1) - - - 1 - Overcrowding (S. 2) - - - - - Unreasonable temperature (S. 3) - - - - - Inadequate ventilation (S. 4) 1 - - 1 - Ineffective drainage of floors (S. 6) - - - - - Sanitary Conveniences (S. 7) (a) Insufficient 2 - - - - (b) Unsuitable or defective 16 13 - 3 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to outwork) 1 - - 1 - Totals 20 13 - 6 - Part VIII of the Act, Outwork. Nature of Work Section 110 Section 111 No of outworkers in August list required by Section 110 (1) c No. of cases of default in sending lists to Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing Apparel 42 - — — - - Electrical Fuse Makers 59 — — — — — Artificial Flowers 30 — — — — — Lampshades 16 — — — — — Total 147 - — - — — 72 9. MORTUARIES On the 8th March, 1967, a report was made to the Health Committee that no bodies had been received at the Richmond Mortuary since the 14th February, H.M. Coroner having indicated on the 25 th February that he had arranged for bodies to be received elsewhere. After full consideration it was decided that the Richmond Mortuary should be closed for the time being and later in the year the building was demolished and the site incorporated in an extended area for car parking. Up to the time of closure 48 bodies were received. The mortuary at Hampton has continued to function satisfactorily and the number of bodies admitted during the year was 734. 10. NOISE ABATEMENT ACT, 1960 Noise has been defined as "unwanted sound" and increasingly members of the community find cause to protest against the unwanted sound of aircraft, motor vehicles, ice-cream vehicle chimes, and those un-neighbourly actions which assault the hearing. The problem is a subjective one and so far as industrial noise is concerned the residents of today often suffer the neglect of proper planning yesterday. Sixty complaints alleging noise nuisance were received in the year and 362 visits carried out by public health inspectors. One complaint took the form of a petition signed by residents near a factory in which hot plastic moulding machines had been installed. An ancillary cooling system included a wooden-slatted tower on which a fan was fitted. As the temperature rose during the summer weeks the fan cut in to increase the speed of air through the tower to improve the cooling effect. This was an automatic action controlled thermostatically. The result was that during hot weather when residents had open windows and were enjoying the use of their gardens, the fan was in most frequent use and gave rise to the complaints. Readings with a sound-level meter indicated that there was a basis for complaint. The factory management were co-operative and approached the manufacturers of the tower who suggested a remedy comprising a new fan unit of modified fan blades and a fan silencer which included baffles and sound insulation. This was expected to reduce the level by 18-20 decibels measured at the source. After the completion of these modifications, tests showed a marked reduction of noise level and the rise when switching on the fan was recorded at 2 - 3 decibels above the ambient level. The nuisance would seem to have been abated to the satisfaction of the residents. 11. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Four samples of filling materials utilised in two local factories for the filling of cot mattresses and quilting were taken in the year. The materials included man-made fibres such as terylene 'and natural fibres, e.g. wool and cotton or mixtures of these materials. Two of the samples were reported by the Prescribed Analyst to be satisfactory. One of the remaining — a 60% wool mixture material — was reported to contain only 5 1 % animal fibre but, by reason of an amendment to the Regulations made under the Act, this was considered not to be an offence as the Animal Fibre Content Test had been removed from the requirements and utilised only as a means of classifying the material. As there appeared some possibility that misrepresentation may have taken place the matter was referred to the Public Control Department for consideration under the Merchandise Marks Act. 73 The other sample (a cotton nylon wadding) was certified as being unsatisfactory because a chloride content of 60 pts per 100,000 was recorded, the maximum permitted figure being 30 pts per 100,000. This test is used as an indication of the presence in material of human excretions, in particular perspiration, and is therefore a measure of the degree to which the material has been cleansed. The portion of this particular sample handed to the factory was later submitted to two independent analysts by the manufacturer of the material and in both cases the result of the analysis differed from that of the Prescribed Analyst. Accordingly when the matter came before the magistrates the Court was asked, as provided in the Act, to order the third portion of the sample to be submitted to the Government Laboratory. At the end of the year this report was still awaited. 12. DISEASES OF ANIMALS ACT, 1950 PET ANIMALS ACT, 1951 ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 RIDING ESTABLISHMENTS ACT, 1964 The Corporation of London act as agents for the Council in respect of the above Acts. The arrangements have worked very well and I am indebted to Mr. G. S. Wiggins, M.R.C.V.S., Veterinary Officer to the Corporation of London, for his valuable advice and help. His report on the work carried out on behalf of the Council for the year ended 31st December, 1967 is as follows: Riding Establishments Act, 1964 The five riding establishments were inspected and all were found to be in suitable condition. Reports were submitted recommending the renewal of licences in each case. Animal Boarding Establishments Act, 1963 Visits of inspection were made to the four animal boarding establishments for the purpose of re-licensing. All four received favourable reports. One of these establishments had been inspected in June and was found to be in an unsatisfactory condition. Suggestions for the improvement of the premises were set out in my letter of the 23rd June, 1967. The premises were found, in December, to have been much improved. Pet Animals Act, 1951 All fifteen pet shops were recommended for re-licensing in my letter to you of the 28th December, 1967. These shops had been inspected by one of my Diseases of Animals Act Inspectors. An inspection was made of a proposed pet shop at Kew Road, Richmond and my report of the 25 th October, 1967 recommended that a conditional licence should be issued. I was later informed that a pet shop would not be opened at this address as a lease could not be obtained. Visits were made, by the Diseases of Animals Act Inspectors, to the following premises: Piggery, Harvey Road, Hounslow. Five visits were made to this piggery. An average of 100 pigs are kept. Conditions were satisfactory. Dairy Farm, Petersham Road, Richmond. Very good conditions were found to exist on this farm. About 2,500 poultry and 35 dairy cows are kept. Seven visits were made. 74 Piggery, Ham Fields, Richmond. Four visits were made to this piggery in an effort to contact the owner. On the final visit, in September, it was discovered that the premises had been burnt by vandals and were a total loss. I understand it is not the intention to keep pigs on these premises again. Poultry Keeper, Oak Avenue, Hampton. Five visits were made. On the first of these the owner was found to be ill and on the subsequent four visits the premises were locked and unattended. Further enquiries will be made regarding these premises as soon as possible. Kosher Butcher, Richmond. Two visits — Premises in good condition. Richmond and Bushy Parks. Frequent visits were made to Richmond and Bushy Parks. Large numbers of cattle, deer and sheep were observed grazing in the parks, conditions being very satisfactory. Foot and Mouth Disease (Controlled Areas Restrictions) General Order, 1938. On the 17th November, 1967 the Ministry of Agriculture, Fisheries and Food declared the whole of England and Wales to be a controlled area (as from 18th November) under the above Order. This means that the movement of all cloven hoofed animals must be licensed by the Local Authority. Two such licences were issued on behalf of your Authority for the movement of 27 and 35 pigs from premises in Surrey to the Piggery, Harvey Road, Hounslow. It was noted that disinfectant pads were installed at the entrances to the parks. These were very well maintained at all times." 13. ESTABLISHMENTS FOR MASSAGE and/or SPECIAL TREATMENT Twenty-six establishments where massage or special treatment is carried on are licensed under the Middlesex County Council Act, 1944. All new licensees are required, where applicable, to possess the qualifications necessary for registration by the Board established under the Professions Supplementary to Medicine Act, 1960. New byelaws regulating the conduct of the licensed establishments came into operation on the 1st April, 1967 and copies were distributed to all licensees. 14. SWIMMING POOLS I am obliged to Mr. T. Lindley, F.Inst.B.M., Baths Manager for the following report: "Swimming Pools (Open Air) Bathing facilities are provided at three Open Air Pools, during the summer period, within the Borough, each of these properties being owned by the Council. The water capacity of each of the Pools is as follows: Twickenham Open Air Pool 280,000 gallons Hampton Open Air Pool 206,000 gallons Teddington Open Air Pool 180,000 gallons this water being supplied by the Metropolitan Water Board. The pools' water is filtered through pressure sand filters and sterilized by chlorine gas treatment operating on the "marginal" principle. The pool water at the Twickenham and Teddington Pools is turned over once every 6% hours, whilst that at the Hampton Pool operates on a 4 hour turnover rate. 75 Colourmetric tests and water samples at each pool are taken three times daily to determine free-available/residual chlorine content of the water, the pH values of the same, and both shallow and deep end water temperatures. Each of the results obtained are recorded in a standard log-book. Richmond Baths (Indoor and Open Air) The new Richmond Baths Establishment, of a "combination" nature, situated in the Old Deer Park, Richmond, was opened to the public in August, 1966. The establishment consists of one main Indoor Pool 110' x 42', water capacity of 210,000 gallons and a turnover rate of 3 hours; one Indoor Learner's pool 42' x 24', water capacity of 17,000 gallons and a turnover rate of 1½ hours, and an, Open Air pool 110' x 42', water capacity of 160,000 gallons and a turnover rate of 4 hours. The filtration of all pools' water is through Pre-coat filters, and sterilization is carried out by chlorine gas treatment on "breakpoint" principle. A system of pool water sampling and testing is installed and all records are recorded automatically on graphs. A plenum heating system is installed and the whole establishment is operated electrically utilising "off-peak" electricity. The private baths suite consists of 12 private baths for both ladies and gentlemen respectively together with the necessary waiting rooms, toilets, etc. The grounds are landscaped and well laid out and provide some two acres of grass and banked areas which are available for sunbathing, games, etc. Sampling of Bath Water Bacteriological tests of the water at each of the Pools are made monthly and, during the past year, 104 samples have been taken of which 89 were satisfactory and, whilst the remaining 15 were below the recommended standard, repeat samples in each case have produced satisfactory results." 15. FERTILISERS AND FEEDING STUFFS ACT, 1926 Thirteen informal samples of fertilisers were taken during the year and submitted to the Agricultural Analyst. Ten of the samples were satisfactory but the following irregularities were found in three of the samples : No. 12 (Crushed Hoof and Horn) Nitrogen 3% above percentage stated in statutory statement and in excess of limits of variations allowed. The manufacturer's attention was drawn to this, but as the irregularity was not to the prejudice of the purchaser, no further action was necessary. No. 18 (Compound Fertiliser) Statutory Statement not in correct form Nitrogen 1.7% above percentage stated in statutory statement; Soluble Phosphoric Acid 6.8% above; Insoluble Phosphoric Acid 0.7% below that shown on statutory statement. Differences were in excess of limits of variation allowed. The manufacturers were contacted and assurances given that every effort would be made to avoid this sort of occurrence in future. No. 20 (Dried Blood) Nitrogen 1.4% above percentage stated in Statutory Statement and in excess of limits of variation allowed. The manufacturer's attention was drawn to this, but as the irregularity was not to the prejudice of the purchaser, no further action was necessary. 16. COMMON LODGING HOUSES There are no common lodging houses in the Borough. 76 SCHOOL HEALTH SERVICE POPULATION. The population of Richmond upon Thames at mid-1967 was 179,040 (1966— 180,200) of which 20,195 (1966—19,988) were school children in maintained schools. Table I. SCHOOL POPULATION (As at 18.1.68) No. of schools Number on Registers Total Boys Girls Secondary Grammar 5 1,618 1,642 3,260 Secondary Modern 14 2,647 2,379 5,026 Primary 50 6,090 5,595 11,685 69 10,355 9,616 19,971 Nursery 2 46 54 100 Day Special Schools for E.S.N, children 2 56 25 81 Day Special School for Maladjusted children 1 20 15 35 Autistic Unit 1 6 2 8 6 128 96 224 Total 75 10,483 9,712 20,195 An increase of 207 pupils compared with the number in 1966 should be noted. 77 MEDICAL INSPECTION AND TREATMENT Year ending 31st December, 1967 Table II. Mcdical Inspection of Pupils attending Maintained Primary and Secondary Schools (including Nursery and Special Schools). A. — PERIODIC MEDICAL INSPECTIONS. Year of Birth Number of pupils inspected Physical Condition of Pupils Inspected Satisfactory Unsatisfactory Number %of column 2 Number %of column 2 (1) (2) (3) (4) (5) (6) 1963 and later 109 107 98.17 2 1.83 1962 693 689 99.42 4 0.58 1961 514 511 99.41 3 0.59 1960 166 166 100 — — 1959 71 71 100 — — 1958 38 38 100 — — 1957 55 55 100 — — 1956 70 70 100 — • — 1955 856 852 99.53 4 0.47 1954 571 569 99.64 2 0.36 1953 471 468 99.36 3 0.64 1952 and earlier 1855 1850 99.73 5 0.27 TOTAL 5469 5446 99.58 23 0.42 B. — OTHER INSPECTIONS. Number of Special Inspections 3,041 Number of Re-Inspections 3,128 6,169 Periodic Medical Inspections. The number of children inspected at routine periodic medical inspections was 5,469 (1966—5,442). Special examinations and re-inspections were 6,169 compared with 5,601 for the previous year. 78 Physical Condition of Pupils Inspected. The general physical condition of school children remains high. Out of 5,469 children examined only 23 were found to be of unsatisfactory physical condition. The co-operation and collaboration of the teaching staff is gratefully acknowledged. Without their help and understanding it would not have been possible to arrange these routine medical inspections. Table III. TABLE A. — Pupils found to require treatment at Periodic Medical Inspections (excluding Dental Diseases and Infestation with Vermin). Year of birth For defective vision (excluding squint) For any of the other conditions in table IV(A) Total individual pupils (1) (2) (3) (4) 1963 and later 1 10 11 1962 19 82 96 1961 15 80 93 1960 6 31 35 1959 5 15 18 1958 3 10 13 1957 1 10 10 1956 5 9 14 1955 95 99 180 1954 85 86 156 1953 86 48 124 1952 and earlier 147 202 335 TOTAL 468 682 1085 The 8.6 per cent of children inspected who were found to require treatment or under treatment for defective vision, compares with 6.3 per cent in 1966. 79 Table IV. Defects found by medical inspection in the year ended 31st December, 1967. TABLE A. — PERIODIC INSPECTIONS. Defect code number Defect or disease Periodic inspections Entrants Leavers Others Total (T) (O) (T) (O) (T) (O) (T) (O) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) 4 Skin 33 46 115 96 84 66 232 208 5 Eyes: a. Vision 53 80 220 254 195 160 468 494 b. Squint 31 20 2 10 11 9 44 39 c. Other 3 3 — 36 3 38 6 77 6 Ears: a. Hearing 4 61 9 37 3 39 16 137 b. Otitis media 12 50 5 15 1 12 18 77 c. Other 16 8 26 6 30 6 72 20 7 Nose and throat 32 270 7 49 8 99 47 418 8 Speech 12 40 2 5 3 12 17 57 9 Lymphatic glands 6 152 1 19 1 20 8 191 10 Heart 1 54 2 36 — 35 125 11 Lungs 7 53 2 40 4 39 13 132 12 Developmental: a. Hernia 3 17 — 5 2 3 5 25 b. Other 8 59 5 18 7 30 20 107 13 Orthopaedic: a. Posture 9 12 6 17 18 19 33 48 b. Feet 39 73 13 60 34 58 86 191 c. Other 15 29 9 39 8 29 32 97 14 Nervous system: a. Epilepsy 2 8 1 14 3 6 6 28 b. Other 1 6 1 12 3 9 5 27 15 Psychological: a. ment 3 30 — 7 1 37 4 74 b. Stability 3 103 5 34 3 81 11 218 16 Abdomen 3 14 6 14 4 17 13 45 17 Other 11 74 28 136 28 73 67 283 (T) Requiring treatment. (O) Requiring observation. 80 Table IV. — continued. TABLE B. — SPECIAL INSPECTIONS. Defect code number Defect or disease Pupils requiring Treatment Pupils requiring Observation (1) (2) (3) (4) 4 Skin 741 37 5 Eyes: a. Vision 107 77 b. Squint 6 6 c. Other 31 10 6 Ears: a. Hearing 88 212 b. Otitis media 8 18 c. Other 46 8 7 Nose and throat 48 56 8 Speech 22 20 9 Lymphatic glands 2 9 10 Heart 7 28 11 Lungs 7 32 12 Developmental: a. Hernia 2 7 b. Other 15 32 13 Orthopaedic: a. Posture 5 12 b. Feet 57 58 c. Other 26 27 14 Nervous system: a. Epilepsy 2 7 b. Other 4 4 15 Psychological : a. Development 12 36 b. Stability 32 68 16 Abdomen 5 8 17 Other 83 74 81 Table V. Recorded incidence of certain defects found to require treatment at periodic inspection per 1,000 pupils examined. 1967 1966 Total children examined 5,469 5,442 Skin 42.4 25.2 Eyes: a. Vision 85.6 63.4 b. Squint 8.0 12.1 c. Other 1.1 3.7 Ears: a. Hearing 2.9 8.8 b. Otitis media 3.3 3.3 c. Other 13.2 17.8 Nose and Throat 8.6 20.0 Speech 3.1 8.5 Lymphatic Glands 1.5 0.9 Heart 0.6 1.1 Lungs 2.4 4.6 Developmental: a. Hernia 0.9 1.5 b. Other 3.7 9.7 Orthopaedic: a. Posture 6.0 3.9 b. Feet 15.7 17.8 c. Other 5.9 6.4 Nervous System: a. Epilepsy 1.1 1.8 b. Other 0.9 1.1 Psychological: a. Development 0.7 0.9 b. Stability 2.0 5.0 Abdomen 2.4 3.1 Other 12.3 32.2 82 Table VI. Number of children examined other than at Periodic Medical Inspections: Pupils examined for any condition, ailment or defect 2,351 Other special examinations, freedom from infection, employment byelaws, etc. 690 3,041 Re-inspections of pupils previously found to have some defect 3,128 Table VII. CLINICS. School Health Service facilities available (as at 31.12.67) BARNES Essex House, Station Road. Barnes, S.W.I3. Dental (including X-ray) Minor Ailments Orthopaedic (physiotherapy) Speech Therapy Vaccination and Immunisation HAM Ashburnham Road, Ham, Richmond, Surrey. Dental (including X-ray) Minor Ailments Ophthalmic Orthopaedic (physiotherapy) Speech Therapy Vaccination and Immunisation HAMPTON 24, Station Road, Hampton, Middlesex. Dental Minor Ailments Vaccination and Immunisation HAMPTON WICK 20, Seymour Road, Hampton Wick, Kingston-upon-Thames, Surrey. Dental X-ray Minor Ailments Orthopaedic (Consultant) Orthopaedic (Physiotherapy) Vaccination and Immunisation MORTLAKE North Worple Way, Mortlake, S.W.14. Minor Ailments Ophthalmic Orthopaedic (physiotherapy) Speech Therapy Vaccination and Immunisation RICHMOND Kings Road. Richmond, Surrey. Windham Road, Richmond, Surrey. Minor Ailments Orthopaedic (Physiotherapy) Child Guidance Service Dental (including X-ray) Minor Ailments Ophthalmic Speech Therapy Vaccination and Immunisation Orthopaedic (physiotherapy) Speech Therapy Vaccination and Immunisation TEDDINGTON Church Road, Teddington, Middlesex. Stanley Road, Teddington, Middlesex. Dental (Orthodontic only) Minor Ailments Ophthalmic Vaccination and Immunisation TWICKENHAM York House, Richmond Road, Twickenham, Middlesex. Dental Minor Ailments Ophthalmic Vaccination and Immunisation 58, Hampton Road, Twickenham, Middlesex. Child Guidance Service Speech Therapy WHITTON Hospital Bridge Road, Twickenham, Middlesex. Dental — (Equipped but not operational) Minor Ailments Vaccination and Immunisation 83 Table VIII. Eye Diseases, Defective Vision and Squint. Number of cases known to have been dealt with External and other, excluding errors of refraction and squint 101 Errors of refraction (including squint) 2418 2519 Number of pupils for whom spectacles prescribed 565 Keystone Telebinocular Vision Screener. Keystone Telebinocular Vision Screeners were used in the schools during 1967. The instruments were operated by the audiometer/vision screener operators. The statistics relating to this screening procedure are given below: Table IX. Age Group. (1) First Tests Failures TOTAL (2) TOTAL (3) % of Col. 2 (4) Infants 1837 167 9.09 Junior 1650 279 16.91 Senior 2012 308 15.31 TOTAL 5499 754 13.71 Table X. DISEASES AND DEFECTS OF EAR, NOSE AND THROAT. Number of cases known to have been dealt with Received operative treatment: (a) for diseases of the ear — (b) for adenoids and chronic tonsillitis 11 (c) for other nose and throat conditions - Received other forms of treatment 264 Total 275 Total number of pupils in schools who are known to have been provided with hearing aids: (a) in 1967 2 (b) in previous years 40 84 AUDIOMETRY At the end of 1967 two audiometer/vision screener operators were on the staff of the department. Children have their hearing tested by audiometer three times in their school lives. The first routine test is done before the age of seven; the next in the third year in junior school, and finally in the second year in the senior school. Special instances, for example, children who are failing to make progress in school, are dealt with expeditiously. Audiometers are kept in condition by regular calibration by the manufacturers. Children who fail the audiometric test are referred for further investigation. Fortyone new cases were seen and 115 re-examinations were carried out in 1967, at the Heston Hearing Clinic to which the majority of referrals are made. Table XI. (a) Audiometer Tests — Routine Age Group 1st Tests * (1) Re-tests. (2) Failures. Total (3) % of Col. 1 (4) Up to 7 yrs. 1263 192 161 12.75 10 to 11 yrs. 1381 106 90 6.52 12 to 13 yrs. 1456 91 83 5.70 Total 4100 389 334 8.15 * In Schools. (b) Audiometer Tests — Specials Age. 1st Tests. (1) Re-tests. (2) Failures. Total. (3) % of Col. 1 (4) Under 5 39 12 15 38.46 5 132 31 65 49.24 6 230 57 136 59.13 7 154 81 92 59.74 8 113 36 40 35.40 9 135 25 64 47.41 10 104 40 55 52.88 11 73 16 34 46.58 12 78 12 47 60.26 13 83 26 55 66.27 14 45 11 26 57.78 Over 14 55 8 38 69.09 Total 1242 355 667 53.70 85 Table XII. INFESTATION WITH VERMIN. (i) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 14,871 (ii) Total number of individual pupils found to be infested 68 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 2 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) Table XIII. DISEASES OF THE SKIN (excluding uncleanliness — see Table XII.). Number of cases known to have been treated. Ringworm: (a) Scalp 7 (b) Body — Scabies 6 Impetigo 6 Other skin diseases 370 Total 389 Table XIV. OTHER TREATMENT GIVEN. Number of cases known to have been dealt with. (a) Pupils with Minor ailments 1653 (b) Pupils who received convalescent treatment under School Health Service arrangements... 5 (c) Pupils who received B.C.G. vaccination *1757 (d) Other than (a), (b) and (c) above — Heart 10 Lungs 77 Development — Other 7 Nervous — Epilepsy 2 — Other 3 Abdomen 12 Lymphatic Glands 3 Psychological — Development 4 — Stability 7 Total 3540 * includes 119 re-vaccinations. 86 Table XV. HANDICAPPED PUPILS. Pupils ascertained during the year requiring education at a special school: (a) Blind 1 (b) Partially sighted - (c) Deaf - (d) Partially hearing 2 (e) Educationally sub-normal 17* (f) Epileptic — (g) Maladjusted 31* (h) Physically handicapped 6 (i) Speech — (j) Delicate 2 *Includes one child educationally sub-normal / maladjusted. 87 00 00 Table XVI. HANDICAPPED PUPILS, YEAR ENDED 31st December 1967 ASCERTAINMENT DISTRIBUTION (As at last day of year) No. of ascertained cases known on 31.12.66 No. of new cases ascertained during year No. of ascertained cases known on 31.12.67 In special day schools In special residential schools In maintained Primary & Secy. Schools In Independent Schools Not at School TOTAL B G B G B G B G B G B G B G B G B G Blind 1 — 1 — 2 — 2 — — — - — - — — — 2 — Partially-sighted 5 4 — — 4 3 3 2 — — 1 — — 1 — — 4 3 Deaf 2 3 — — 2 2 1 1 1 1 - - - - - - 2 2 Partially-Hearing 9 6 2 — 11 4 8 3 1 — 1 — 1 1 — — 11 4 Educationally Sub. 90 41 9 7 82 35 67 30 10 2 4 2 — 1 1 — 82 35 Epileptic 3 1 — — 2 1 — — 2 1 — — — — — — 2 1 Maladjusted 70 28 20 9 75 30 27 8 10 — 9 2 27 18 2 2 75 30 Physically Handicapped 19 10 3 3 19 8 11 5 3 1 2 — 1 1 2 1 19 8 Speech Defects - - - - - - - - - - - - - - - - - - Delicate 13 7 1 1 10 7 4 3 5 1 1 2 — 1 — — 10 7 Multiple Defects 7 3 1 — 5 3 3 2 — — 1 — 1 1 — — 5 3 TOTAL 219 103 37 20 212 93 126 54 32 6 19 6 30 24 5 3 212 93 GRAND TOTALS 322 57 305 180 38 25 54 8 305 B G Children NOT ascertained as H.P. but recommended convalescence in a Holiday Home or Camp School during year ended 31st December 1967. 4 2 Table XVII. Handicapped Children maintained by the Richmond upon Thames Education Committee in Residential Special Schools as at 31st December, 1967. Blind Partially Sighted Deaf Partially Hearing Educationally Subnormal Maladjusted Delicate Physically Handicapped Speech Defects Epileptic TOTAL Maintained Schools (L/42) 3 East Quinton 3 Broxbournebury 1 1 Elmers Court 3 3 Gosden House 2 2 Hephaistos 1 1 Palingswick House 1 1 Red House 4 4 St. Nicholas 5 5 Shephall Manor 1 1 Swaylands 5 5 Tylney Hall 2 2 Wavendon House 1 1 Wishmore Cross 1 1 Non- Maintained Schools ( L142) 1 Besford Court 1 Larchmoor 1 1 Lord Mayor Treloar 1 1 Muntham House 1 1 Ovingdean Hall 1 1 1 Red Hill 1 Royal Cross School for Deaf 1 1 Royal School for Deaf 1 1 St. Patrick's Open Air 1 1 Shotton Hall 1 1 Victoria School 1 1 Worcester College for the Blind 2 2 Recognized Ind. Schools (L/70) 1 Arts Educational Trust 1 Bethany 1 1 Camphill, Rudolph Steiner 1 1 Cokethorpe 1 1 1 1 Con. H/maids Sac. Heart of Jesus Crookham Court 1 1 Falcon Manor 3 3 Fosse Bank 1 1 Frensham Heights 1 1 Ingfield Manor 1 1 Netherfield 2 2 Normansal 2 2 Ncrthaw 1 1 Peredur Homes 2 3 5 Royal Wanstead 1 1 St. George's College St. Mary's Abbey 1 1 1 1 St. Mary's, Wrestwood 2 2 Salesian College 2 2 Sandon House 2 2 Sheiling Curative 1 1 Sibford 1 1 Spinney, Horam 1 1 Stanbridge 1 1 The Hall, Wincanton 1 1 Wells Cathedral 1 1 Wennington 2 2 Other Independent Schools 1 Box Hill 1 Gaveston Hall 1 1 Horncastle 4 4 New School, Kings Langley 1 1 St. Christopher's 1 1 Stinsford 2 2 Hospital School 3 Lingfield 3 2 3 1 19 55 7 5 3 95 The total number of handicapped children maintained by the Richmond upon Thames Education Committee in Residential Special Schools as at 31st December, 1966, was 93. 89 90 DAY SPECIAL SCHOOLS. St. Hilda's Day Special School for Educationally Sub-normal Children, Barnes. Admissions during 1967 10 Discharges during 1967 13 Transferred to ordinary schools 1 Transferred to senior day E.S.N, school 7 Transferred to residential E.S.N, school 1 Transferred to Junior Training Centre 2 Left district 2 Number of children on roll as at 31st December, 1967 20 Clarendon Day Special School for Educationally Sub-normal Children, Twickenham. Admissions during 1967 17 Discharges during 1967 17 Transferred to senior day E.S.N, school 3 Transferred to ordinary schools 2 Transferred to Junior Training Centre 4 Transferred to residential E.S.N, school 2 Transferred to residential school for epileptic pupils 1 Transferred to day school for delicate/maladjusted pupils 1 Transferred to day school for physically handicapped pupils 1 Left district 2 Found unsuitable after trial period 1 Number of children on roll as at 31st December, 1967 60 Oldfield House Day Special School for Maladjusted Children, Hampton. Admissions during 1967 13 Discharges during 1967 10 Transferred to ordinary schools 4 Transferred to senior day E.S.N, school 1 Transferred to residential schools 2 Transferred to Day Special School for delicate/maladjusted pupils 1 Left district 2 Number of children on roll as at 31st December, 1967 38 Athelstan House Autistic Unit, Hampton. Admissions during 1967 3 Discharges during 1967 Nil. Number of children on roll as at 31st December, 1967 7 Handicapped Pupils. All handicapped children attending special schools, either day or residential, are medically reviewed by the School Health Service at least once a year, and sometimes more frequently so that their progress and special educational treatment can be assessed. During 1967 reports were issued to the Local Health Authority under Section 57 (4) of the Education Act, 1944, regarding five children who were found unsuitable for education at school. Information was passed to the Local Health Authority about eight educationally sub-normal children who required supervision after leaving school. CHILD GUIDANCE SERVICE. The Medical Directors of the Child Guidance Clinics, Dr. Robin Higgins, M.A., M.B., B.Chir., D.P.M., and Dr. Agnes Main, M.B., B.S., report as follows: — Dr. Robin Higgins — The basic pattern of work was not markedly different from that reported last year: — CASE LOAD New Cases Referred 67 Seen 43 *Current Cases In regular or intensive treatment 31 On supervision 45 Cases Closed 64 *monthly average. The increase of cases in regular or intensive treatment resulted from the welcome addition of a psychotherapist who divides her time between the two clinics. The return of a psychiatric social worker from a year's stay in the U.S.A. was also very welcome and stimulated a fuller development of the Clinic's work into the area of adolescence, particularly around the turbulent point of leaving school. An initial report of this work is now under active consideration and future thoughts include : 1. Assisting interested agencies to extend their own work by providing the opportunity for consultation. 2. Introducing a specialist worker into a social agency. 3. Setting up a counselling service with premises of its own — away from a Clinic conventionally seen as for Child Guidance. Another growing point stems from the work of the art therapist and it is hoped to be able to organise an exhibition of some of the statements children are currently making about themselves here in paint and clay. Dr. Agnes Main — During the past year, the numbers of children referred to the Child Guidance Clinic have been 134, and re-referrals 12. The main bulk of our referrals come from Head Teachers, and the remainder from general practitioners, parents, Children's Department, Probation Officers, and rarely, direct from the child concerned. This last type is, of course, confined entirely to the adolescent group. Our links with the Maria Grey; College and the Institute of Education continue and remedial teachers in training give valuable help to those of less severely disturbed children whose difficulties lie mainly in school and with learning. We are always in close touch with Oldfield House Day School for Maladjusted Children and with Athelstan House, our Unit for Autistic Children. We look forward to increasing numbers at Oldfield with the opening of the new building. At Athelstan House this year, the provision of an additional full-time and one part-time teacher has enabled us to increase the number of pupils to ten. Applications for places still come in and we now have ten children on the waiting list. 91 92 Table XVIII. Child Guidance Treatment. Number of cases known to have been treated. Pupils treated at Child Guidance Clinics 259 ORTHOPAEDIC CLINIC. Mr. R. H. Maudsley, F.R.C.S., Consultant Orthopaedic Surgeon reports: Mr. A. R. Taylor, F.R.C.S. (Senior Orthopaedic Registrar jointly between Heatherwood Hospital, Ascot, and the Royal Free Hospital) has attended the Hampton Wick Orthopaedic Clinic on the 4th Monday afternoon of each month. Over the past year the Clinics have tended to become smaller and fewer new cases have been referred. The work consists mainly of foot and knee problems; mostly valgus conditions of the knees and feet, requiring little or no treatment other than reassurance. The figures are as follows: New Cases: Pre-school children 14 School children 14 Old Cases: Prcschool children 52 Schoolchildren 112 192 The responsibility for the Clinic has now passed to Mr. Malcolm Swann who was appointed Consultant Orthopaedic Surgeon in May, 1967, but by general agreement between the Board and ourselves, our Senior Registrar will for the time being continue to attend. Table XIX. Orthopaedic and Postural Defects. Number of cases known to have been treated. (a) Pupils treated at clinics or out-patient departments 298 (b) Pupils treated at school for postural defects 298 SPEECH THERAPY. Therapists working in the Borough at the end of the year were: — Miss K. S. Buckman (Senior). Mrs. M. M. Pletts. Miss E. Reed. During the year 266 children were treated, their ages ranging from 2½—17 years. The very young children were kept under observation and advice was given to the parents. Sessions were held at the following clinics:— Essex House, Barnes; Mortlake; Windham Road, Richmond; Kings Road, Richmond; Ham; and Twickenham Child Guidance Clinic. In addition regular visits were made to Oldfield House School for Maladjusted Children, Hampton; St. Hilda's (E.S.N.), Barnes; and during the early part of the year, Clarendon (E.S.N.), but unfortunately when Mrs. Thrift resigned, sessions at this school were discontinued. Children were also treated at St. John's, St. Elizabeth's and Darell Road Infants — all Richmond schools in close proximity, each of which had pupils in need of regular and frequent therapy. As a general rule it is preferable for treatment to take place at clinics which are more suitably equipped than schools, and also a closer relationship can be formed between parents and therapists. There are however, a few children in the Borough who through defective speech are seriously handicapped, and such pupils need frequent therapy — daily if possible. Parents who are often both working, or a mother who has several young children at home, cannot get to a clinic more than once or twice each week. For this reason consideration may have to be given to the possibility of forming a small class in a primary school, for all children in the Borough who suffer from severe speech difficulties. These children would then have regular speech therapy, and would work in a small class by themselves, with a teacher who could consult the therapist as to special ways of helping them. It will be understood that children with severe speech disabilities cannot learn to read or write without special help, and some aphasic children do not fully comprehend speech. It would be suitable if a group of such children could be attached to an ordinary school, so that they would be stimulated by joining many activities with normal pupils. Owing to changes of staff during 1967, progress has been somewhat hampered. Mrs. Thrift left in the early part of the year, and we were sorry also to lose Miss Patricia Knight who went in May to live in Greece. They were replaced by Mrs. Pletts, a therapist experienced in both Hospital and School clinics, and Miss Elizabeth Reed, a newly qualified young therapist who joined the department in mid-September. Mrs. Pletts had to undergo an operation early in November which necessitated absence of three months. She expects to return early in 1968 and to make a complete recovery. With a full staff of three therapists, the present work of the Borough can be accomplished efficiently. However, the opening of the new Clarendon School (E.S.N.) involving an increase in the number of pupils, and the establishment of the Junior Training Centre at Harle House, Feltham, would necessitate thinking around the case for the addition of another speech therapist. Speech therapy consists not only in treating the children, but in making contact with their parents and others concerned in their welfare. During 1967 at least twenty schools were visited — some on more than one occasion. Homes were visited, and talks at Parent-Teacher Meetings given as required. 93 Table XX. Number of pupils treated by Speech Therapist under arrangements made by the Authority. Number of Children treated 266 Number of New Patients 107 Total Number of Attendances 2660 Number on Waiting List, 31.12.67 32 Number of Children Discharged 117 Normal Speech 40 Improved 59 Transferred 12 Uneventuated 6 Table XXI. Types of cases treated during the year. Dyslallia 173 Retarded Speech and Language Development 33 Stammering 22 Dysarthria 6 Deaf 1 Sigmatism 15 Psychotic 1 Aphasia 6 Dysphraxia 3 Cleft palate 5 Hypernasality 1 94 REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER. The year 1967 was again an unsettled one from the staffing point of view. Four dental officers resigned, three to enter general practice and one returned to Australia. One part-time dental officer was appointed on 24th January. A senior technician retired from the laboratory and another died in hospital after a long illness. One dental apprentice completed his training and left for employment and his replacement was soon appointed. Miss W. Coatsworth gained her certificate, with distinction, from the Association of British Dental Surgery Assistants. During the year 88 sessions were devoted to dental inspection and the mouths of approximately half the school children in the Borough were examined at least once during the year. More than half of these were found to require treatment. In order to obtain more useful information from periodic school dental inspections, a survey was commenced at the beginning of the academic year. For this survey every tenth child at school has a detailed dental examination which is recorded on a special form so that information can easily be transferred to punched cards for analysis. (See also page 22 — Surveys). All children found to require treatment at periodic school dental inspections whose parents wished them to be seen at the clinic were able to be treated. Table XXIII shows the number of pupils inspected, offered treatment and requiring treatment during the year. Table XXII. Number of pupils inspected at school 6827 Number of pupils inspected at clinic 4403 Number of pupils offered treatment 4241 Number of pupils requiring treatment 5692 The number of sessions devoted to treatment numbered 1611 and details of this treatment are shown below arranged in three age groups. Table XXIII. Age 5—9. Age 10—14. Age 15 + First visit for treatment 1657 1388 366 Subsequent visits 2303 3092 882 Total visits 3960 4480 1248 Additional courses commenced 344 244 77 Fillings in permanent teeth 1307 2946 1270 Fillings in deciduous teeth 2254 139 — Permanent teeth filled 1004 2167 934 Deciduous teeth filled 1715 118 - Permanent teeth extracted 54a 380b 68c Deciduous teeth extracted 907 275 — General anaesthetics 372 193 9 Emergencies 322 121 45 Pupils supplied with full dentures — 1 — „ „ „ partial „ — 4 6 Number of dentures supplied — 5 6 A includes 24 orthondontic extractions. B includes 234 orthondontic extractions. C includes 17 orthondontic extractions. 95 The) next table shows a wider range of treatment given but not divided into age groups. Table XXIV. No. of pupils X-Rayed 525 Prophylaxis 366 Teeth otherwise conserved 160 No. of teeth root filled 12 Inlays or crowns fitted 18 Courses of treatment completed 3038 Orthodontics: Cases pending from 1966 260 New cases commenced 135 Cases completed 58 Cases discontinued 14 No. of appliances fitted 250 No. of patients referred to consultant 13 A measure of the success of the combined attack on dental disease by conservative treatment and dental health education (equivalent of 13 sessions) is shown by the ratio of fillings to extractions due ta decay of the permanent dentition of more than 24:1, whilst the ratio for deciduous teeth is 2:1. The national averages are less than 6:1 and 0.7:1 respectively. (Taken from the latest available figures). Four clinics in convenient parts of the Borough had a session devoted to the extraction of teeth under a general anaesthetic once a fortnight. For three of these sessions a consultant anaesthetist is employed on a sessional basis and for the other a medical officer who is an experienced anaesthetist. Orthodontic diagnosis and treatment was available to all children who went to maintained schools and lived in the Borough. The majority of patients attended at a central clinic in Teddington where there was virtually no waiting list for treatment. The dental laboratory which had a staff of one chief technician, five senior technicians and two apprentices, supplied the needs not only of this Borough but also of the London Boroughs of Brent, Ealing, Harrow, Hillingdon and Hounslow, and also parts of Kent County Council. The output from the dental laboratory was as follows : —• Table XXV. Dentures Ortho. appliances Inlays and Crowns Misc. 259 1953 137 575 A figure not usually published is the number of failed appointments. These occur when a patient who has agreed to attend fails to do so without giving prior notice. The number of such failed appointments this year was 2768. It is difficult to assess the cost of this wasted time or to understand the reason for it, since few appointments were given without a parent's prior consent for treatment. All appointment cards carry a reminder in heavy type to "please notify the clinic as soon as possible if this appointment cannot be kept". It is interesting to note that the National Health Service practitioner is allowed to make a charge to patients for loss of chairside hours due to failed appointments. 96 NUTRITION. I am indebted to Mr. W. R. Wainwright, B.A., D.P.A., for the following: — Meals and Milk. The number of children receiving mid-day dinners and milk at maintained schools on a selected date in 1967 was as under : — Date Number of 1/3 pints Number of % of dinners milk children children at school having dinners 26th September, 1967 *15,170 14,935 18,397 82.45 *In addition approximately 1575 meals per day to Teaching, Kitchen and Cooking Staff. The number of children receiving milk at non-maintained schools on 26th September, 1967 was 2,625 (3,265 children in school). In September, 1967 meals were being cooked at 36 schools and at three central kitchens. Table XXVI. ROAD ACCIDENTS TO SCHOOLCHILDREN, 1967. Mr. W. H. Jones, Town Clerk, has kindly supplied the following details of road accidents to school children. Killed Seriously Injured Slightly Injured Total January — 2 9 11 February - — 9 9 March — — 12 12 April — 4 18 22 May — 1 20 21 June — 12 14 July — 5 17 22 August — — 13 13 September — 3 18 21 October - 5 25 30 November — 5 9 14 December — - 13 13 - 27 175 202 97 Table XXVII. DEATHS OF SCHOOLCHILDREN. It is with regret that I include the following details of local schoolchildren who died in 1967. Sex Age Cause of Death. M F 1 5 Acute Leukaemia. 1 5 Third Ventricular Cerebral Cyst. 1 5 Acute Lymphoblastic Leukaemia. 1 7 Sarcomatosis. Osteo-sarcoma—right tibia. 1 10 Carbon monoxide poisoning and drowning. (Accidental death). 1 12 Shock and haemorrhage due to lacerations of small intestine. (Accidental death). 1 14 Status asthmaticus. 98 INDEX. A D Page No. Page No. Accidental Hypothermia 36 Daily minders 23 Acreage 7 Day nurseries, municipal 23 After-care facilities, tuberculosis Deafness, early detection of 22 and other chest illnesses 33 Death rates 7,8 Animal Boarding Establishments Deaths 7-10 Act 1963 74 Deaths, age and cause 9 Ante-natal Clinics 17, 25 Deaths, main causes 8 Anti-Smoking Campaign 38 Deaths, school children 98 Atmospheric pollution 64 Deaths, tuberculosis 9, 32 Attachment & Liaison Schemes, Dental Officer, report of Chief 22 Family Doctors 28 Dental Officer, report of Principal Audiometry 85 School 95 Dental inspection 22,95 Dental laboratory 96 B Dental treatment 22,95 Deprived children 23 Diphtheria immunisation 31 Baths 75 Diseases and detects, ear, nose B.C.G. Vaccination 33 and throat 84 Births 7,8 Diseases, infectious 11-16 Births, premature 26 Diseases, venereal 14 Birth Rate 7,8 Diseases of Animals Act 1950 74 Blindness, Incidence of 46 Diseases of the skin 86 Disinfection and disinfestation 70 District Nurse Assistants 28 C District Nurses 27 Domiciliary deliveries 25 Cancer, cervical cytology 24 Cancer, Marie Curie Memorial Foundation 28 E Care and after care, tuberculosis and other chest illnesses 33 Ear, nose and throat, diseases and Care of the Elderly 34 defects 84 Care of the Elderly, General 35 Early discharges 27 Care of mothers and young Early Neo-Natal mortality 7 children 17 Education Committee 3 Care of unsupported mothers and Education Schools Sub-Committee 4 their babies 18 Elderly, care of 34 Certificates of disrepair 56 Enteric fever, protection against 31 Cervical cytology 24 Environmental health 54-76 Chest and Tuberculosis Care Establishments for Massage and/or Committee 33 Special Treatment 75 Chest Clinics 32 Eye diseases 84 Chief Public Health Inspector, report of 54—76 Child Guidance Service 91 F Child Minders 23 Child Welfare Centres 21, 22 Factories Act 1961 72 Children, physical condition of 79 Family Doctors, Attachment and Chiropody Service 36 Liaison Schemes 28 Clean Air Act 64 Family Planning 17 Cleanliness inspections 86 Fertilisers & Feeding Stuffs Act, 1926 76 Clinics, list of school health Fluoridation 6 service facilities 83 Food and Drugs 60 Committees:— Food Hygiene (General) Education 3 Regulations 59 Education, Schools Sub-Com. 4 Food inspection 57 Health 3 Food poisoning 13 Common lodging houses 76 Food premises 59 Complaints received 70 Food sampling 60 Compulsory admission to hospital 35 Foods, other 63 Congenital malformations, Foods, welfare 24 incidence of 17 Foot & Mouth Disease 75 99 G L Page No. Page No. General physical condition of Laundry Service, incontinent 49 children 79 Liquid Egg (Pasteurisation) General statistics 7 Regulations 1963 64 Geriatric service 34 Loan of nursing equipment 49 Good neighbour service 40 Grey Squirrels 71 M Manufacturers, ice-cream 63 H Map, Child Welfare Centres, etc. Inside back cover Handicapped pupils 87—90 Map, Smoke Control Areas 65 Health Committee 3 Marie Curie Memorial Foundation 28 Health education 37 Mass Radiography 32 Health Visiting 28 Massage, etc., establishments 75 Health Visiting, Group Adviser 28 Maternal mortality 7, 8 Health Visiting, Training and Maternity Liaison Committee 27 Refresher Courses 28 Maternity outfits 27 Hepatitis, infective 13 Meals and milk (schools) 97 Holidays, recuperative 37 Measles 11 Home Help Service 38 Measles vaccination 31 Home Nursing Service 27 Medical aid 27 Home Nursing, Assistants 28 Medical arrangements for long-stay Home Nursing, Cases and visits 27 immigrants 15 Home Nursing, Training 27 Medical assessments, staff, etc. 50 Home Nursing, Type of care given 27 Medical inspection—school children 78-82 Hospital confinements 25 Medical priorities, housing 57 Hostel for homeless tuberculous Medical treatment—school children 78-82 males 34 Mental health services 41—46 Houses in multiple occupation 56 Mental illness 41 Houses, number of inhabited 7 Mental subnormality 42 Houses, unfit 54 Mental Welfare Officers 42 Housing 54 Midwifery:— Housing, medical priorities 57 Service 24 Hypothermia, accidental 36 Training 25 Transport 25 Milk in schools 97 Milk supplies and sampling 63 Mortality, early neo-natal 7 I Mortality, infant 7,8, 10 Mortality, maternal 7, 8 Ice-cream, manufacture and Mortality, neo-natal 7, 8 sampling 63 Mortality, perinatal 7 Illegitimacy 7, 18 Mortuaries 73 Immigrants, medical arrangements Mothercraft and relaxation classes 25 for long stay 15 Mothers and young children, care Immunisation and Vaccination 30 of 17 Incontinent laundry service 49 Municipal day nurseries 23 Infant mortality 7, 8, 10 Infectious diseases 11—16 Infective Hepatitis 13 Infestation with vermin 86 N Inspection and supervision of food 57 Inspections;— National Assistance Act, section 47 35 Factory Acts 72 Neighbourly help scheme 40 Food premises 59 Neo-natal deaths 7,8 Offices, Shops and Railway Night "Sitters-In" Service 40 premises 66 Noise Abatement Act 1960 73 Public health 69 Nose, diseases and defects 84 Introductory letter— Notices complied with 70 Medical Officer of Health 5—6 Notices served 70 Notifiable diseases 11-16 Notification of intention to practise 25 Nurseries and child minders 23 K Nurses agency 49 Nursing equipment, loan of 49 Keystone Telebinocular Vision Nursing Homes 48 Screener 84 Nutrition 97 100 o Page No. Page No. Offices, Shops and Railway Premises School Health Service 77—98 Act 1963 66 School meals, and milk 97 Officers 4 School population 77 Ophthalmia neonatorum 48 Sewage disposal 52 Orthopaedic and postural defects 92 Sewerage 52 Orthopaedic, clinic 22,92 Shops, offices, etc. 66 Other foods 63 Skin, diseases of 86 Other treatment given—school Smallpox 14 children 86 Smallpox vaccination 31 Outworkers 72 Smoke control 64 Special schools, day 90 Speech therapy 93 P Squint 84 Squirrels, grey 71 Partially-sighted persons 48 Staff 4, 24 28, 38, 42, Perinatal mortality 7 85,93,95,96 Pest control 70 Statistics, general 7 Pet Animals Act 1951 74 Statistics, vital 4 Phenylketonuria 22 Stillbirths 7 Poliomyelitis immunisation 31 purveys 14,22,23,95 Pollution, atmospheric 64 Swimming pools 75 Population 7,8,77 Population (school) 77 Post-natal clinics 17 T Premature births 26 Premises, food 59 Telebinocular Vision Screener 84 Prevention of illness, care and Telephone Answering Service 49 after-care 32 Tetanus immunisation 31 Proprietary foods 24 Throat, diseases and defects 84 Public health inspections 69 Training of pupil midwives 25 Puerperal pyrexia regulations 17 Training etc., health visitors 28 Pupil midwives, training 25 Tuberculosis 32 Pupil public health inspectors 69 Tuberculosis, deaths 9, 32 Pupils, handicapped 87 Tuberculosis, hostel for homeless males 34 Tuberculosis, vaccination 33 r Typhoid Fever 14 Radiography, mass 32 Rag Flock etc. Act 1951 73 U Rateable value 7 Recuperative holidays 37 Unfit houses 54 Relaxation classes 25 Unsound food 59 Rent Act, 1957, certificates of disUnsupported mothers and their repair 56 babies, care of 18 Residential accommodation:— Mentally ill 42 Mentally sub-normal 43 V Welfare Department 35 Richmond upon Thames Chest and Vaccination and immunisation 30,3 3 Tuberculosis Care Committee 33 Vaccination, B.C.G. 33 Riding Establishments Act 1964 74 Venereal diseases 14 Road accidents to school children 97 Vermin infestation—school children 86 Rodent control 70 Vision, defective 84 Vital statistics 7 S W Sampling, Fertilisers etc. 76 Sampling, food 60, 63 Water supply 50, 53 Sampling, ice-cream 63 Welfare foods 24 Sampling, milk 63 Whooping cough 11 Sampling, water 50,51,53,76 Whooping cough, immunisation 31 Sanitary circumstances of the Borough 54-76 Scarlet Fever 11 X School children, deaths 98 School children, road accidents 97 X-ray, mass 32 101 J. H. Broad & Co. Ltd. ( Printers ), 8, King Street, Richmond, Surrey.