AC - 43386 The Health of Richmond upon Thames 1971 RICH 40 london borough of richmond upon thames ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER For the Year 1971 A. M. NELSON, m.b., Ch.B., d.p.h. Health Department, Elmfield House, High Street, Teddington, Middlesex, Telephone: TW11 8EJ. 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 31 Other Information 39 Sanitary Circumstances of the Borough 44 School Health Service 69 2 HEALTH COMMITTEE as at 31st December, 1971 § His Worship the Mayor, Mrs. H. CHAMPION, J.P. § The Deputy Mayor, Councillor A. M. LEANEY. Councillor M. GOLD, M.R.C.S., L.R.C.P., D.Obst.R.C.O.G. (Chairman). Alderman W. F. NATION (Vice-Chairman). Alderman H. A. Leon, O.B.E., J.P. Alderman K. I. Morell. Councillor Mrs. H. M. Abell. Councillor Lady G. M. Connor. Councillor Mrs. S. L. Cooper. Councillor Mrs. R. M. Dickson, A.R.I.B.A. Councillor F. D. Gilday-Fox, B.A., J.P. Councillor H. L. Lewis, C.B.E. Councillor Mrs. J. P. Mostyn. Councillor Mrs. D. P. Peters. Councillor W. K. Warren, F.P.S. G. L. Brown, Esq., M.B., B.S., D.Obst.R.C.O.G. (Advisory). § (ex-officio). EDUCATION COMMITTEE as at 31st December, 1971 Alderman R. A. J. ALCOCK (Chairman). Councillor G. TREMLETT, G.L.C. (Vice-Chairman). Councillor J. F. LAMBETH, F.I.A. (Deputy Vice-Chairman). Councillor A. F. Arbour, B.Sc. (Econ.) Councillor B. A. Bayliss, B.Com. Councillor T. A. Bligh, A.I.B. Councillor D. G. Blomfield, M.A. Councillor Lady G. M. Connor. Councillor G. M. Cooper. Councillor Mrs. D. Day, B.Sc. Councillor F. D. Gilday-Fox, B.A., J.P. Councillor P. T. Z. Goldring. Councillor N. A. Grimston. Councillor S. Grose, B.A. Councillor J. L. Hargreaves. Councillor D. J. Harris, J.P. Councillor H. L. Lewis, C.B.E. Councillor E. J. Masters, J.P., B.Sc. (Econ.), A.C.I.S., Dip. Soc. 3 Councillor D. J. Neal Smith, M.D., F.R.C.O.G., F.R.C.O. Councillor L. W. Newstead, J.P. Councillor N. J. Otty. Councillor Mrs. D. P. Peters. Councillor J. Roberts, B.Sc., F.C.A. Councillor G. J. Samuel, M.A. Councillor T. R. Spain. Councillor W. V. Tate. Councillor S. D. Wade. Councillor A. West. Councillor Miss O. Wilkins. Councillor E. W. Wilton, M.A. (Oxon.), F.R.S.A. Co-opted members: The Rev. D. Buckingham, B.A.: The Very Rev. Canon F. J. Davys; The Rev. O. Swan; Mrs. H. E. Bell-Wright; Mrs. M. E. Carter; Mr. A. Dunne; Mr. L. F. Holmes; Mr. F. Pateman; Mr. L. Smith; Mr. L. Wood. EDUCATION, SCHOOLS AND GENERAL PURPOSES SUB-COMMITTEE as at 31st December, 1971 § Councillor G. TREMLETT, G.L.C. (Chairman). Councillor F. D. GILDAY-FOX, B.A., J.P. (Vice-Chairman). § Alderman R. A. J. Alcock. Councillor B. A. Bayliss, B.Com. Councillor T. A. Bligh, A.I.B. Councillor G. M. Cooper. Councillor P. T. Z. Goldring. Councillor N. A. Grimston. Councillor S. Grose, B.A. Councillor J. L. Hargreaves. Councillor H. L. Lewis, C.B.E. Councillor J. Roberts, B.Sc., F.C. A. Councillor G. J. Samuel, M.A. † The Very Rev. Canon F. J. Davys. † The Rev. O. Swan. † Mrs. M. E. Carter. † Mr. L. F. Holmes. † Mrs. H. E. Bell-Wright. † Mr. A. Dunne. Mr. L. Smith. Mr. L. Wood. § (ex-officio). † (Co-opted members). 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: MARGUERITE E. M. JAMES, M.B.E., M.B., Ch.B., D.P.H. Senior Medical Officers: BERYL H. BANNER, M.B., Ch.B., D.Obst.R.C.O.G., D.C.H., D.P.H. (from 1.2.71). CICILY M. CLARKE, M.A., M.B., Ch.B., D.C.H. SALLY E. FLEW, M.B., B.S., M.R.C.S., L.R.C.P., D.Obst. R.C.O.G., 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 Nursing Officer: MRS. M. E. WHEATLEY, S.R.N., C.M.B. (Pt. I), 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 J. T. PARSONS, R.S.C.N., S.R.N., S.C.M., N.D.N.Cert. Chief Administrative Officer: H. J. PUGH. 4 HEALTH DEPARTMENT, ELMFIELD HOUSE, HIGH STREET, TEDDINGTON, MIDDLESEX. TW11 8EJ. July, 1972. 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 1971. Two enactments which became operative during the year were the Local Authority Social Services Act, 1970 and the Education (Handicapped Children) Act, 1970. As I indicated in my report for 1970, a statutory interface has been created between health and the social welfare services. At first sight it might be assumed that the health department has been relieved of many tasks. In reality the socio-medical aspects in relation to individual patients have become more complex. In former times the medical recommendations and administrative acts therefrom were combined in one team of professional officers. During 1971 while the socio-medical facets have remained and expanded within the health department, the administrative acts are dependent on the close collaboration with colleagues in other departments. I must acknowledge the close co-operation which has taken place at all levels with the new evolving Social Services Department. This close working between professional colleagues is welcome and long may it continue for the benefit of the patient. However, the fact that administrative packages have been created does give rise to the possibility and risk of the vulnerable individuals falling between the packages and receiving no care at all. It follows that apparent overlap, which may not appeal to the bureaucratically tidy, does ensure that the patient receives the support which is so necessary for his welfare in the broadest sense of the word. During the year the Secretary of State for Health and Social Services issued his Consultative Document pertaining to a reorganized National Health Service, whereby local health services will merge with the hospital and family doctor facilities within one comprehensive service. It behoves us all to ensure in any future arrangements that the patient comes first, and where appropriate receives the full support of the social and educational services. A third enactment, the Education (Milk) Act, 1971, was placed on the statute book. Whatever the arguments for and against, the advantages and disadvantages taking in the emotional, social, financial and nutritional viewpoints, a considerable amount of effort, time and patience has been expended by the staff of the health department (medical, nursing and administrative) in the implementation of this legislation. A continuing monitoring programme will be required to assess any possible long term effects for good or ill. The National Health Service Act, 1946 has laid a duty on a local health authority to make arrangements by employing nurses for the purpose of attending upon persons who require nursing in their own homes. Over the last two decades this service has been essentially a daytime one. However during 1971 you established a night nursing service, which has been well received. A mention should be made of the Caravan visit in collaboration with the Women's Cancer Campaign during September and October. A detailed account of this successful enterprise is included in the body of the report. 5 In accordance with D.H.S.S. Circular 1/72 paragraph 8(c) it is noted that you took no further action during the year. Grateful acknowledgment is made to the following for their co-operation and collaboration in the field of community medicine pertaining to, and in the service of, the residents of Richmond upon Thames:— The family doctors; All hospital staff; All voluntary organisations; The Chief Officers. The staff of the health department have worked loyally and well. I would especially thank Dr. Marguerite James, Mr. E. S. Herbert and the late Mr. H. J. Pugh. I conclude by thanking the Health and Education Committees and the respective Chairmen involved for their encouragement. I am, Yours respectfully, A. M. NELSON, Medical Officer of Health and Principal School Medical Officer. 6 VITAL AND GENERAL STATISTICS 1971 Area in acres 13,971 Population (census 1961) 181,030 Population—estimated to mid-year (as supplied by the Registrar-General) 174,310 Number of inhabited houses 62,452 Rateable value £11,578,197 Sum represented by a lp. rate £110,640 Total M. F. Live Births—Legitimate 2,124 1,119 1,005 Illegitimate 176 107 69 Total 2,300 1,226 1,074 Live Birth rate per 1,000 of estimated Population 13.2 Adjusted Live Birth rate per 1,000 of estimated Population 13.3 Illegitimate Live Births as percentage of total Live Births 8 Total M. F. Still Births—Legitimate 15 5 10 Illegitimate 2 1 1 Total 17 6 11 Still Birth rate per 1,000 live and still births 7 Total Live and Still Births 2,317 Infant Deaths (under 1 year of age):- Total M. F. Legitimate 37 22 15 Illegitimate 2 1 1 Total 39 23 16 Infant mortality rate per 1,000 live births 17 Legitimate Infant mortality rate per 1,000 legitimate live births 17 Illegitimate Infant mortality rate per 1,000 illegitimate live births 11 Neo-Natal deaths Under 4 weeks of age Under 1 week of age Total M. F. Total M. F. Legitimate 17 17 10 23 15 8 Illegitimate 1 – 1 1 – 1 Totals 28 17 11 24 15 9 Neo-Natal mortality rate (deaths under 4 weeks) per 1,000 total live births 12 Early Neo-Natal mortality rate (deaths under 1 week) per 1,000 total live births 10 Perinatal mortality rate (stillbirths and deaths under 1 week combined) per 1,000 total live and still births 18 Maternal mortality (including abortion) deaths 4 Maternal mortality rate per 1,000 live and still births 2 Total M. F. Deaths 2,243 1,041 1,202 Crude death rate per 1,000 of estimated population 12.9 Adjusted death rate 10.7 7 POPULATION The Registrar General's estimate of mid-year population for the Borough was 174,310, which is a decrease of 240 compared with 1970. The natural increase (excess of births over deaths) was 57. 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 1968 177,130 -1,910 -1.15% + 140 — 2,050 1969 176,600 - 530 -0.42% + 221 — 751 1970 174,550 -2,050 -1.17% + 25 — 2,075 1971 174,310 - 240 -0.14% + 57 — 297 BIRTHS During the year 2,300 live births were registered (a decrease of 96 compared with 1970) giving a live birth rate of 13.2 per 1,000 of the population or 13.3 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 live birth rate for England and Wales was 16.0. DEATHS The number of deaths registered in 1971 was 2,243 (a decrease of 128 compared with 1970) giving a death rate of 12.9 per 1,000 of the population or 10.7 when adjusted by the comparability factor. The death rate for England and Wales was 11.6. The tables on pages 9 and 10 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 39.37 5.06 Cancer 22.78 2.93 Bronchitis, Pneumonia, and other respiratory diseases 10.92 1.41 Vascular lesions of nervous system 13.78 l.77 Accidents, Violence 3.57 0.46 INFANT MORTALITY During the year there were 39 deaths of infants under one year of age, an increase of 4 on the previous year. The infant mortality rate was 17 per 1,000 live births compared with 18 for England and Wales. A major proportion of the deaths —71.8%— occurred in the first four weeks of life. MATERNAL MORTALITY There were four recorded maternal deaths during the year. 8 Distribution of Deaths by Age and Cause Registrar General's Official Returns, 1971 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 1. Enteritis and other diarrhoeal diseases — — — 1 — — — — — — — — — — — — — 1 1 2. Tuberculosis of respiratory system — — — — — — — — — — — 1 — — 2 — 2 1 3 3. Other tuberculosis — — — — — — — — — — — — 1 — — — 1 — 1 4. Other infective and parasitic diseases — — — — — — — — 1 — — — — — — — 1 — 1 5. Malignant neoplasm, buccal cavity, etc — — — — — — — — — — — — — — 4 — 4 — 4 6. Malignant neoplasm, oesophagus — — — — — — — — — — 4 1 5 — 3 4 12 5 17 7. Malignant neoplasm, stomach — — — — — — — — — — 8 3 11 5 6 8 25 16 41 8. Malignant neoplasm, intestine — — — — — — — — 2 1 5 7 11 9 10 29 28 46 74 9. Malignant neoplasm, larynx — — — — — — — — — — 1 — 3 — 2 — 6 — 6 10. Malignant neoplasm, lung, bronchus — — — — — — — — 1 — 31 7 44 9 29 11 105 27 132 11. Malignant neoplasm, breast — — — — — — — — — 4 — 18 — 21 — 9 — 52 52 12. Malignant neoplasm, uterus — — — — — — — — — 1 — 8 — 3 — 5 — 17 17 13. Malignant neoplasm, prostate — — — — — — — — — — 3 — 10 — 8 — 21 — 21 14. Leukaemia — — — — — — — — — — 1 5 1 1 2 3 4 9 13 15. Other malignant neoplasms 1 — — — 1 — — — 1 6 22 35 14 21 10 23 49 85 134 16. Benign and unspecified neoplasms — — — — — — 1 — 1 — 1 1 — — — — 3 1 4 17. Diabetes Mellitus — — — — — — — — — 1 6 1 — 4 3 5 9 11 20 18. Other endocrine etc. diseases — — — — — — — — — — — 2 — — — 2 — 4 4 19. Anaemias — — — — — — — 1 — — — — 1 — — 3 1 4 5 20. Mental disorders — — — — — — — — —1 1 — 2 — — 2 3 3 6 9 21. Meningitis — — 1 — — — — — — — — — — — — — 1 — 1 22. Multiple Sclerosis — — — — — — — — 1 1 2 — — — — — 3 1 4 23. Other diseases of nervous system 1 — — — — — 1 1 — I 1 4 2 4 — 3 5 13 18 24. Chronic rheumatic heart disease — — — — — — — — 1 1 3 2 5 8 1 9 10 20 30 25. Hypertensive disease — — — — — — — — — 1 5 2 6 8 8 23 19 34 53 26. Ischaemic heart disease — — — — — — — — 7 2 86 13 104 59 102 183 299 257 556 27. Other forms of heart disease — — — — — — — — 3 — 4 4 10 9 32 65 49 78 127 continued Distribution of Deaths by Age and Cause Registrar General's Official Returns, 1971 — cont. 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 28. Cerebrovascular disease — — — — — — — — — 1 19 17 31 34 42 165 92 217 309 29. Other diseases of circulatory system — — — — — — — — — — 13 3 12 11 23 55 48 69 117 30. Influenza — — — — — — — 1 — — — — — — — — — 1 1 31. Pneumonia 6 2 — — 1 — — — 1 — 4 1 18 9 37 73 67 85 152 32. Bronchitis and emphysema — — — — — — — — — — 9 1 21 3 26 11 56 15 71 33. Asthma — — — — — — — — — — 1 1 1 — — 1 2 2 4 34. Other diseases of respiratory system 1 1 1 2 — — 1 — — — — 2 1 — — 5 4 10 14 35. Peptic ulcer — — — — — — — — — — 3 — 2 1 4 5 9 6 15 36. Appendicitis — — — — — — — — — — — — — — 1 1 1 1 2 37. Intestinal obstruction and hernia — 1 — — — — — — — — 1 1 1 2 2 5 4 9 13 38. Cirrhosis of liver — — — — — — — — — — — 1 1 — 1 1 2 2 4 39. Other diseases of digestive system — — — — — — — — 1 2 2 4 2 1 3 14 8 21 29 40. Nephritis and nephrosis — — — — — — — — — — 1 1 2 — 1 2 4 3 7 41. Hyperplasia of prostate. — — — — — — — — — — — — 1 — 3 — 4 — 4 42. Other diseases, genito—urinary system — — — — — — — — 1 — 2 3 2 — 2 7 7 10 17 43. Abortion — — — — — — — — — 1 — — — — — — — 1 1 44. Other complications of pregnancy, etc. — — — — — — — 1 — — — — — — — — — 1 1 45. Diseases of skin, subcutaneous tissue — — — — — — — — — — — — — 1 — 1 — 2 2 46. Diseases of musculoskeletal system — — — — — — — — 1 — — 2 — 6 1 2 2 10 12 47. Congenital anomalies 2 2 1 1 1 — — — — — 3 — — — 2 2 9 5 14 48. Birth injury, difficult labour, etc. 5 6 — — — — — — — — — — — — — — 5 6 11 49. Other causes of perinatal mortality 6 3 — — — — — — — — — — — — — — 6 3 9 50. Symptoms and ill—defined conditions — — — — — — — — — — — 1 — — 2 3 2 4 6 51. Motor vehicle accidents 1 — 1 — 1 1 5 4 5 2 5 3 3 — 3 3 24 13 37 52. All other accidents — 1 2 — 2 — 1 — 4 3 3 — 1 2 4 4 17 10 27 53. Suicide and self—inflicted injuries — — — — — — — — — 2 5 1 2 2 — — 7 5 12 54. All other external causes — — — — — — — — — 2 1 — — 1 — — 1 3 4 23 16 6 4 6 1 9 8 32 33 255 158 329 234 381 748 1041 1202 2243 INFECTIOUS DISEASES The number of notifications received during the year, compared with 1970 may be summarised as follows:— Disease. 1971 1970 Dysentery 11 4 Encephalitis (Acute) 1 1 Food Poisoning 11 11 Infective Jaundice 30 37 Malaria 2 7 Measles 306 380 Meningitis (Acute) 8 4 Ophthalmia Neonatorum — — Scarlet Fever 26 48 Whooping Cough 24 17 The table on page 15 gives the number of cases notified under age groups. Whooping Cough. Of the twenty-four cases notified, four are recorded as having been immunised and in two of these booster doses had been given. Measles. As can be seen from the histogram on page 12 the incidence of this disease has been considerably reduced since the programme of immunisation was commenced in the autumn of 1966. Nevertheless 306 cases were notified during the year and we should continue to encourage parents to have their children immunised in an effort to reduce the number of cases still further. Previous years' figures are as follows:— 1960 57 1966 888 1961 2422 1967 1400 1962 112 1968 262 1963 1885 1969 262 1964 234 1970 380 1965 1992 The distribution of cases during each quarter of the year was as follows : M. F. Total 1st January— 31st March 98 76 174 1st April—-30th June 44 42 86 1st July—-30th September 18 22 40 1st October—-31st December 5 1 6 Total 165 141 306 11 12 NUMBER OF CASES OF MEASLES 1960 TO 1971 From the table below it will be seen that the first nine years of childhood suffer the major incidence of the disease: M. F. Total Under 1 year 8 2 10 1 year 14 17 31 2 years 13 11 24 3 years 25 22 47 4 years 18 21 39 5 — 9 years 80 60 140 10 —14 years 4 8 12 IS — 24 years 2 — 2 25 + 1 — 1 Total 165 141 306 Vaccination and Immunisation (see page 30). Dysentery. All eleven cases notified were of bacillary dysentery. As a precautionary measure one person was excluded from her normal employment. Food Poisoning. There was one family outbreak recorded during the year involving two people, one of whom sufFered severe symptoms while the other had no symptoms at all. The cause of the outbreak was an omelette containing Garlic sausage, a sample of which, upon analysis, produced S.Typhimurium. No stocks of the particular batch of this sausage were left at either the retailer or wholesaler but specimens taken from the wholesaler of other batches proved negative and it is thought likely that the sausage may have been contaminated by either of the two persons concerned. Previous years figures are as follows : — 1962 14 1967 3 1963 6 1968 30 1964 8 1969 22 1965 6 1970 11 1966 Meningitis. Eight cases were notified during the year, all of whom were admitted to hospital. The types notified were — viral (4), pneumococcal, mumps, meningococcal septicaemia and lymphocytic. One child, aged 17 months, who attended one of the Council's Day Nurseries, died in hospital and as a precautionary measure throat swabs were taken from all children attending the Nursery. All the throat swabs were clear and it is thought that this was an isolated case and the infection was not acquired from or passed into the Nursery. Infective Jaundice. The arrangements made with the medical research team at the West and South Middlesex Hospitals in December, 1970 to assist in the pilot survey of the epidemiological aspects of the disease continued throughout the year. 13 Thirty cases were notified and of these fourteen were admitted to hospital. Mr. H. D. Smith, Deputy Chief Public Health Inspector, undertook the interviewing of patients and completed a detailed questionnaire designed to facilitate transfer of data to punch cards or tape for computer analysis. The Department of Health and Social Security has now agreed to support the proposal for a three'year survey of infective hepatitis in the London Boroughs of Rich' mond upon Thames, Hounslow and Ealing. The age distribution of the cases notified during the year was as follows:— M. F. Total Under 1 year — — — 1 year — — — 2 years — — — 3 years — — — 4 years — — — 5— 9 years — 1 1 10—14 „ 2 — 2 15—24 „ 4 1 5 25—34 „ 7 2 9 35—44 „ 3 1 4 45—64 „ 5 2 7 65 + 2 — 2 TOTAL 23 7 30 Smallpox. No cases of smallpox were notified during the year. Under the Public Health (Aircraft) Regulations, 1970, and the Public Health (Ships) Regulations, 1970, 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. 130 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. 14 15 Cases of Infectious Diseases Notified during the year 1971 DISEASE CASES NOTIFIED AT VARIOUS AGES (YEARS) Total Cases Notified 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 — 2 2 1 — — 4 — — — — 11 Encephalitis (Acute) — — — — — 1 — — — — — — — — 1 Food Poisoning 1 — — — — — — 1 2 3 3 — 1 — 11 Infective Jaundice — — — — — 1 2 1 4 9 4 1 2 — 30 Malaria — — — — — — — — 1 1 — — — — 2 Measles 10 31 24 47 39 140 12 1 1 — 1 — — — 306 Meningitis (Acute) — 1 — 1 1 1 1 — — 2 — 1 — — 8 Ophthalmia Neonatorum — — — — — — — — — — — — — — Scarlet Fever — — — 7 6 9 4 — — — — — — — 26 Whooping Cough 2 3 4 4 3 7 1 — — — — — — — 24 Total 13 36 29 59 51 161 21 3 8 19 8 8 3 — 419 Sexually Transmitted Diseases. The following new cases have been notified by the undermentioned hospitals of patients treated from this Borough during 1971. Syphilis Gonorrhoea New Cases Total Other Genital Conditions Other Conditions West Middlesex 3 73 391 193 660 London 3 9 7 19 St. Thomas' 1 9 54 24 88 St. Helier — 1 34 18 53 Westminster — 6 35 12 53 St. Bartholomew's 1 2 13 9 25 Middlesex 1 10 54 36 101 These figures show an increase of nearly 32% over the previous year and indicate only too plainly the importance of giving guidance to young people on this topic. Only one request to assist in contact tracing was received from any of the above hospitals. Indestructible notices, giving information as to the nearest hospital and times of treatment have been displayed in all public conveniences, conveniences on railway stations and also at garages which remain open 24 hours per day within the Borough. Medical Arrangements for Long-stay Immigrants. The number of immigrants giving destination addresses situated in the Borough was the lowest for five years but a large proportion (34%) did not arrive at the address given and all trace of them was therefore lost immediately after arrival. All destination addresses are visited by Public Health Inspectors who advise immigrants of the scope of the National Health Service and every effort is made to persuade them to have a chest X-ray as soon as possible. Two immigrants received chest X-ray at the port of entry. Where children accompany the immigrant, follow up visits are made by the Health Visitor. The following table shows from which country the immigrants' passports were issued: Country where passport issued Number of Immigrants Commonwealth Countries. 1971 1970 Carribean 4 9 India 21 15 Pakistan 5 8 Other Asians 20 15 African 22 19 Other 27 36 Non-Commonwealth Countries. European 22 31 Other 13 15 Total 134 148 16 CARE OF MOTHERS AND YOUNG CHILDREN Ante-Natal and Post-Natal Clinics Sessions held in local authority clinics 381 Ante-Natal Care: Number of women who attended 351 Attendances 1,433 Post-Natal Care: Number of women who attended 49 Attendances 49 Ante-natal relaxation and post-natal exercises are taught in all the clinics. 947 women made 3,082 attendances at these clinics during the year. Incidence of Congenital Malformations Since 1st January, 1964 the Ministry of Health (now the Department of Health and Social Security) 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 1971 was 30. Family Planning Medical Cases. In the first three months of the year, 18 women were referred by the Council's medical officers for family planning on medical grounds. From 1st April, 1971, the service was extended to include any women whose health, in the opinion of the examining doctor, would be expected to suffer by the increased mental, physical or social burdens placed on her by pregnancy. The cost of advice and supplies for 498 women was met by the Council under this new scheme during the remaining nine months. Domiciliary Cases. In accordance with the Council's scheme, 50 cases were referred to the Domiciliary Service of the Family Planning Association up to the end of the year. Youth Counselling Service. During 1971, 52 clients were referred for help for the first time, an increase of 22% over last year's figures. 62% of the persons referred were under 21; only 7 were males. 27 young people were referred for contraceptive advice and 9 for other sexual problems which included such difficulties as unwanted pregnancy and non-consummation of marriage. 14 young people were referred with problems in other aspects of their lives; altogether 31 of the clients were given contraceptive advice and of these 19 had already had a pregnancy, 18 ending in termination. 17 The referring agents were as follows:— Gynaecologists and Medical Social Workers 19 General Practitioners 4 Health Department 5 Social Services 2 Voluntary Agencies 7 Other Social Workers 3 Schools 2 Relatives 5 Friends 5 Total 52 The clinic is seen both as a specialist service in sexual problems, and as a counselling service for young people with other problems who are not in touch with other advisory agents. The Youth Counselling Service worked closely with a number of other agencies referring clients to them, as well as accepting their referrals, but often found it impossible to obtain help for those few clients with long-standing psychological difficulties. Towards the end of the year the social worker's sessions were increased to two per week and this proved to be a very necessary addition; the clinic was fortunate enough to have the help of Mrs. M. Boylette as receptionist, and of Dr. Robina Thexton whose valued assistance was much appreciated. The service is known to a number of workers in settings where young people are found, schools, hospitals, the Citizens Advice Bureau, etc., and members of the staff have been asked to give a number of talks about their work. However, if this is to be a preventive service further attempts must be made to publicise its existence so that young people are referred before situations become acute: the figures show that there is still a long way to go before this aim can be achieved. Too many of the young clients do not come for contraceptive advice until they have already needed termination and too few come directly for help for either sexual or other problems because the service is not as well known to the public as it should be. 18 Surveys The department has taken part in a number of surveys during the year (either during the actual period of the survey or research project or later in the various followup functions) which has included the following:— Sponsoring Body Subject of Survey Greater London Council Children suffering from spina bifida. Institute of Child Health A study of mothers of children born with anencephaly or spina bifida cystica in the Greater London area. Oxford University Childhood cancers. Department of Medicine, Charing Cross Hospital Medical School Urinary Tract Infections in Women. Department of Health & Social Security —Joint Committee on Vaccination and Immunisation National Surveillance of Congenital Rubella defects. National Survey of Health and Development (Medical Research Unit) National Survey of Health and Development, Education and Employment of children born in 1946. London Borough of Hounslow Combined Obstetric/Child Health Project. West Middlesex and South Middlesex Hospitals Infective Jaundice (reference to this survey is made in the section of the report on infectious diseases, page 13. Guthrie Tests — Phenylketonuria All infants continued to be tested for hyperphenylalaninaemia (phenylketonuria), a rare but important metabolic condition, by taking a blood sample on or soon after the sixth day of life. I am grateful to Dr. R. L. Newman for the prompt and efficient laboratory service provided at Queen Mary's Hospital, Carshalton. I am happy to report that during the year no positive result was recorded. Special Observation/Handicap Register This combined register of children with known handicap and those whose progress appears to be in doubt or who appear at special risk of developing a handicap whether physical, mental or emotional continues to be of value. At the end of the year 270 children under five years of age had been identified as requiring special observation whilst 131 children had been classified as having a definite continuing physical and/or mental handicap. There will undoubtedly be more young children in these categories living in the Borough and the extensive task of considering every child will take some time to complete. Child Health Clinics At the end of the year, there were 12 child health clinics. (For location of clinics etc. see map inside the cover at the end of the report). One clinic has 6 sessions a week, two have 3 sessions a week, 7 have two sessions a week, 2 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 23. 19 Developmental Assessments Children attending the child health clinics are examined at regular intervals to assess their general development and progress. These assessments have a number of aims:— (1) To identify as early as possible any deviation from or abnormality of development that could lead to continuing disability. (2) If such deviation is found to institute further investigation and/or treatment in conjunction with the family doctor, parents or others concerned. (3) To identify any child at special risk of abnormal development and ensure that progress is observed at regular intervals. (4) To help parents to understand the principles of child development in general and of their own child in particular. In relation to the last point it is worth noting that many mothers have shown great interest in these screening procedures and have been anxious to discuss how they can best help their child's general progress The routine assessments are carried out six-monthly during the first two years of life and thereafter at yearly intervals until the child enters school. This involves special training in child development and the majority of medical officers have attended courses to help them in this work. Dental Treatment — Expectant and Nursing Mothers and Young Children Mr. G. H. Tucker, L.D.S. R.C.S., Chief Dental Officer, reports as follows:— The number of attendances and the amount of treatment given during the year are shown in Tables I and II below. Comparative figures for 1970 are also indicated. Table I. Pre-School Children 1971 1970 Examined at clinic 561 600 Requiring treatment 253 274 Commenced treatment 252 264 Attendances for treatment 534 613 Fillings inserted 491 365 Extractions 92 146 General Anaesthetics 56 72 Table II. Expectant and Nursing Mothers 1971 1970 Examined 74 96 Requiring treatment 70 81 Commenced treatment 68 79 Attendances for treatment 216 193 Fillings inserted 180 122 Extractions 35 48 Gum treatment 25 23 General Anaesthetics 6 7 Dentures supplied 6 8 X-rays taken 18 12 The figures in Table I show that slightly fewer pre-school children were brought to the clinics for inspection in spite of continued efforts by health visitors and medical officers to encourage mothers to do so. It is encouraging to see that in both tables the number of fillings has increased while the number of extractions decreased. 20 Welfare Foods The Council is responsible for the distribution of welfare foods (National Dried Milk, cod liver oil, fruit juices, etc.) supplied by the Department of Health and Social Security. In addition various proprietary brands of dried milk and dietary supplements are sold at the child health clinics on the recommendation of the medical officers, health visitors or family doctors. I gratefully acknowledge the work of all voluntary helpers. Cervical Cytology (Well Woman Clinics) Thirteen sessions each fortnight were held at seven clinics in the Borough. During the early autumn a four-week campaign was mounted to encourage more women to attend for cervical cytology and to advertise the well woman clinics in the Borough using a caravan loaned by the Women's National Cancer Control Campaign. A total of 1,128 women were seen and examined and smears were taken from all but fifteen. The age range of women attending the caravan was:— Under 20 years 10 21—30 years 164 31—40 years 268 41—50 years 350 51—60 years 258 Over 61 years 78 As can be seen, the vast majority of women were over the age of 30 years, and almost one-third of all those seen were in the age range 41—50 years. This fact may be considered very satisfactory as it is the older woman who is more vulnerable to developing cervical cancer, although it is emphasised that younger women may also develop carcinoma in situ. An analysis of the occupations of the husbands of those women who had smears taken during the campaign (based on the Registrar General's five classes) shows:— I (professional) 152 II (intermediate) 177 III (skilled) 442 IV (semi-skilled) 82 V (unskilled) 18 OTHER (occupation not stated, unmarried etc.) ... 242 The information required on the forms from which the figures were taken was not really adequate to provide an accurate allocation and in cases of doubt the lower class was chosen. Very few women from social groups IV and V were seen. This feature was disappointing when statistics have shown that these are the women who have an increased risk of cervical cancer. Following the physical examination and/or the cytology result 159 women from the mobile clinic were referred for either further investigation or treatment. This represents about one in every seven women seen. Two women were found to have positive smears and were referred for specialist treatment. Apart from those women who were referred to their family doctors, the laboratory recommended further smears to be taken from 134 women. Thus, of the 1,128 women examined, 293 were either referred to their family doctors or recommended to undergo a further test within the next twelve months. This represents nearly 26% of all those seen during the campaign. Whilst the prime object of the campaign was to detect a pre-cancerous condition, many minor disorders (which women often consider as "their lot" and are hesitant in seeking medical advice) were detected. Following therapy, the physical and mental wellbeing of these women is often markedly improved. 21 Doctors to staff the caravan were obtained with the help of the Family Planning Association and, in the main, the sessions were covered by four doctors appointed to the staff as part-time medical officers. With the exception of the four evening sessions, the nurses were voluntary and there was a voluntary clerk at each session, and to all these individuals I extend my grateful thanks. Posters and leaflets to advertise the campaign were obtained from the Women's National Cancer Control Campaign and local details added. The posters were sited throughout the Borough and family doctors were asked to display them in their surgeries. Volunteers delivered pamphlets to houses surrounding the chosen sites for the caravan and all local business concerns were notified of the campaign and asked to draw it to the attention of their female staff. The campaign was mentioned several times in the local press and this proved to be the best source of publicity. Posters and leaflets were valuable and about 10% of the women said that they had come because they had seen the caravan. The campaign was featured on television but this proved to provide little publicity. The following table shows attendances at the normal clinic sessions and at the mobile clinic:— Well Woman Clinics WNCCC Caravan Number of women 1,780 1,128 Number of attendances 1,827 1,128 Number of positive results 1 2 As a result of the interest in cervical cytology occasioned by the caravan campaign consideration had to be given to increasing the normal clinic sessions. 22 23 Child Health Clinics Number of children who attended during the year Number of sessions held by Total number of sessions in columns (5M8) (9) Number of children referred elsewhere (10) Born in 1971 (1) Born in 1970 (2) Born in 19661969 (3) Total (4) Medical Officers (5) Health Visitors (6) G.Ps. employed on a sessional basis (7) Hospital medical staff (8) 2246 1934 2390 6570 1201 113 129 49 1492 362 Total attendances during the year 44,866. COMMUNITY NURSING SERVICES Staff as at 31st December, 1971 1 Chief Nursing Officer. 1 Non-Medical Supervisor of Midwives 1 and Home Nursing Superintendent. 1 Deputy Non-Medical Supervisor of 31 Midwives and Home Nursing Superintendent. 5 Full-time Midwives. 7 1 Part-time Midwife. 11 (0.5)* i 7 Full-time District Nurses/Midwives. j 1 Part-time District Nurse/Midwife. o (0.5)* 1 Full-time Senior District Nurse. 34 Full-time District Nurses. 4 Part-time District Nurses. (2.0)* 1 Full-time District Nurse Assistant. 13 Part-time District Nurse Assistants. (6.5)* 22 Sitters-In. Superintendent Health Visitor. Health Visitors (includes 3 Field Work Instructors, 3 Group Advisers). (2.8)* Part-time Health Visitors. (5.3)* Part-time Clinic Nurses. Health Assistant. Tuberculosis Health Visitor. Student Health Visitors. * equivalent whole-time. MIDWIFERY SERVICE Training Five midwives are approved as teachers. Two midwives attended a refresher course as required by the rules of the Central Midwives Board. Eight midwives attending a statutory refresher course spent a day in the Borough and two Midwifery Tutor Diploma students spent a week observing the local commuity services as part of their training. Twenty one student midwives from West Middlesex Hospital, Isleworth, and Queen Charlotte's Hospital, Hammersmith, completed their three months domiciliary instruction as part of an experimental single period of midwifery training. Ten 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. One uses a Council vehicle; the remainder have their own cars. Ante-natal Clinics Total weekly sessions during year (midwives only present) 206 „ „ „ „ „ (medical officer present) 175 „ „ ,, „ „ at family doctors' clinics 329 24 Deliveries attended by Domiciliary Midwives 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 — 222 222 509 This table relates to women delivered, and not, in the case of multiple births, to infants. 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. The majority of discharges before the tenth day were planned. Visits by Domiciliary Midwives A total of 11,566 visits were made by midwives as follows: — Ante-natal 2,820 During labour 459 Nursing, following domiciliary confinement 2,339 Nursing, following institutional discharge 4,158 Home conditions reports 898 Others 892 Total 11,566 Notification of intention to practise Under the rules of the Central Midwives Board, 15 midwives notified their intention to practise within the Borough. Fourteen of these were the Council's domiciliary wives; the other a domiciliary midwife practising privately. Medical Aid Medical aid was required for 49 patients as follows: — During Pregnancy Infant In Labour Puerperium Mild Toxaemia 1 Sticky eyes 4 Premature Engorged Anaemia 1 Jaundice 2 Libour 2 breasts 1 Thrush 3 Delay in Labour Puerperal ?Congenital (1st stage) 1 sepsis 1 malformation 2 Delay in Labour Pyrexia 1 Coryza 3 (2nd stage) 2 Subinvolution 3 Feeding Ruptured Raised blood problems 2 perineum 8 pressure 1 Abnormal Post-partum Thrombo respiration 1 haemorrhage 2 phlebitis 2 Early ruptured Haemorrhoids 1 membranes 1 Secondary post-partum haemorrhage 2 Anaemia 1 Depression 1 25 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 4 4 — — — — — — — — — — 4 — 2 Over 2 lb. 3 oz. up to and including 3 lb. 4 oz 10 4 1 1 - - - 4 - 3 Over 3 lb. 4 oz. up to and including 4 lb. 6 oz 13 1 1 1 1 _ 2 - 4 Over 4 lb. 6 oz. up to and including 4 lb. 15 oz. 29 1 1 - - - - - 5 Over 4 lb. 15 oz. up to and including 5 lb. 8 oz 43 1 1 1 1 - - - - - 6 Total 99 10 3 2 3 — 1 — 1 — — — 10 — 1 = l,000g, or less, 2 = 1,001 - l,500g, 3 = 1,501 - 2,000g, 4 = 2,001 - 2,250g, 5 = 2,251 - 2,500g. 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 department. HOME NURSING SERVICE Home Nursing (Day) The home nursing service provides nursing care for patients in their own homes or, in the case of district nurses attached to family doctor practices, in the doctor's surgery. The types of care given are indicated in the table of statistics shown below. Home Nursing (Night) In August 1971, the day home nursing service was extended to provide 24 hour nursing care when a pilot night nursing service commenced. One state registered nurse with district training is on duty from 7 p.m. to 8.30 a.m. She uses a special van provided by the Council which is equipped for nursing needs and emergencies. A telephone answering service is used to maintain contact. Part-time district nurse assistants cover evening duties until 11 p.m. and early morning duties from 7 to 8.30 a.m. The night nurse, in addition to her district nursing visits, acts in a supervisory and supportive role to the district nurse assistants, and to the night sitters in who work with the district nurse team to provide emergency all night care for any patient who is seriously ill and alone. Night "Sitters-In" Service This service, which commenced in 1967, provides assistance during the night for emergency cases and has been absorbed into the night nursing service. The "sitters in" now work under the supervision of the qualified district nurse on night duty. Help is provided where either no relative or neighbour is immediately available or where relief can be given to relatives who have been caring for chronically ill patients. The service is normally limited to three nights per week, with a maximum of 12 nights for any one patient. During 1971, help was given to 14 patients referred by family doctors, district nurses, relatives or neighbours. HOME NURSING SERVICE Persons nursed and visits made Day Night (Aug.-Dec.) Total Total number of persons nursed 3,107 106 3,213 Number of above over 65 years of age 2,220 80 2,300 Number of above under 5 years of age 13 — 13 Total number of visits 108,477 2,140 110,617 Types of care given Number of injections 25,798 331 26,129 Number of dressings 19,131 41 19,172 Number of visits for general nursing care 29,840 1,627 31,467 Number of baths 19,743 1 19,744 Enemas 445 2 447 Changing of pessaries 167 — 167 Washouts 969 1 970 Attendance at minor operations 2 — 2 Preparation for diagnostic investigation 57 — 57 Other 15,517 320 15,837 Total number of treatments 111,669 2,323 113,992 27 Marie Curie Memorial Foundation. Day and Night Nursing Service and Area Welfare Grant Scheme The Borough continues to administer the Marie Curie scheme providing for the urgent needs of cancer patients who are being nursed at home. Such assistance is given only "in kind" and covers for a limited period, day and night nursing, special equipment, linen and bedding, clothing, extra heating and nourishment. Thirty one patients received help with night and/or day nursing on 101 occasions. Six patients received assistance under the Area Welfare Grant Scheme. District Nurse Training Four district nurses received district training. Fifty four student nurses and 28 pupil nurses from West Middlesex, Royal Richmond, Barnes, Surbiton and The Middlesex Hospitals 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. Eight student nurses from the Chiswick Polytechnic undertaking the S.R.N. Integrated Training were assigned to district nurses in the Borough, for varying periods, for district nursing observation and experience. Health Visiting Fifty-four students and ten pupil nurses from West Middlesex, Royal Richmond, and The Middlesex Hospitals accompanied health visitors on domiciliary visits and/or also attended the local health authority clinics. Four students from Chiswick Polytechnic undertaking the integrated S.R.N./ D.N./H. V. Course were assigned to health visitors for one week's observation in practical health visiting. Cases visited by health visitors Number of cases 1 Total number of cases (families) 10,277 2 Children born in 1971 2,890 3 Children born in 1970 2,431 4 Children born in 1966-69 ... 4,091 5 Total number of children in lines 2 — 4 9,412 6 Persons aged 65 or over 1,603 7 Number included in line 6 who were visited at the special request of a G.P. or hospital 623 8 Mentally disordered persons ... 60 9 Number included in line 8 who were visited at the special request of a G.P. or hospital 26 10 Persons, excluding maternity cases, discharged from hospital (other than mental hospitals) 29 11 Number included in line 10 who were visited at the special request of a G.P. or hospital 14 12 Number of tuberculous households visited ... 1 13 Number of households visited on account of other infectious diseases 14 14 Other cases 611 15 Number of tuberculous households visited by tuberculosis visitor 127 Training and Refresher Courses One health visitor attended a Field Work Instructor course, and four attended other refresher and training courses. Three sponsored student health visitors were placed with fieldwork instructors for supervised practice during their last ten weeks of training. 28 Family Doctors and Community Nursing Staff The table below summarises the position at the end of the year concerning the attachment/liaison of nursing staff with family doctors in the Borough. Practice No. No. of Health Visitors No. of Midwives No. of District Nurses 1. 1 1 2. 2 3. 1½ 1 4. l 5. 1 6. 1 7. 2 8. 1 9. 1 10. 1 11. l 1 12. 1 13. 1 In practices 3, 4, 9, 10, 11 (health visitor) and 12, members of the nursing staff are fully attached to the practices, i.e. they provide, in consultation with the family doctors, the local authority health services in their particular sphere for the patients of the pract' ices exclusively. In practices 1 and 2 the health visitor attends the doctors'1 child welfare (child health) clinics and liaises between the doctors and the appropriate health visitors for those patients who do not live within her own geographical area. In practices 1, 5, 6, 7, 8, 11 and 13 the midwife attends the family doctor's antenatal clinics. These schemes are kept under constant review and new applications for attachment or liaison are considered in relation to the family doctors' requirements and the local authority staff available. 29 VACCINATION AND IMMUNISATION Immunisation against Dipththeria/Whooping Cough/Tetanus (separately or combined), Poliomyelitis, Measles, German Measles. Type of Vaccine YEAR OF BIRTH Others Under 16 Total 1971 1970 1969 1968 1964/67 PRIMARY COURSE DIPHTHERIA 80 1030 389 23 26 12 1560 WHOOPING COUGH 77 999 372 14 12 2 1476 TETANUS 81 1030 390 24 33 141 1699 POLIOMYELITIS 57 1025 398 26 18 22 1246 MEASLES 19 1000 409 129 136 30 1723 GERMAN MEASLES. — — — — 1 1344 1345 REINFORCING DOSES DIPHTHERIA 2 50 124 61 1622 763 2622 WHOOPING COUGH 1 17 47 18 168 57 308 TETANUS 2 50 125 69 1648 1201 3095 POLIOMYELITIS 1 32 111 59 1554 977 2734 30 Immunisation against Diphtheria, Whooping Cough, Tetanus, Poliomyelitis The phasing out of the old schedule of immunisations has meant a slight decrease in the number of children receiving primary doses over last year's considerably increased figures. Measles Vaccination The number of children receiving measles vaccination decreased by 251, there having been an epidemic the previous year. Rubella Vaccination The programmes of vaccinating 13-year'old girls against german measles got well under way during the year. Apathy seems to continue to exist and there was only about 50% take-up. Smallpox Vaccination In accordance with Government policy, smallpox vaccination as a routine was discontinued in August and 1046 primary vaccinations were carried out during the year. Smallpox vaccine is still available for persons travelling to smallpox endemic areas. Protection against Typhoid Fever Typhoid innoculation was recommended for all persons travelling overseas and children going abroad in school parties were innoculated either by their family doctor or, failing this, at the local clinic. B.C.G. Vaccination against Tuberculosis In September 1971 the age limit for BCG vaccination was lowered from 13 years to 11 years, and 29 schools were visited, 14 more than in 1970. As a result, the number of children involved was more than twice that in 1970. Primary Re-tests Number skin tested 2803 1466 Number found positive 273 1340 Number found negative 2356 126 Vaccinated 2407 114 PREVENTION OF ILLNESS, CARE AND AFTER CARE Tuberculosis During 1971 there were 26 notifications of pulmonary tuberculosis and 7 notifications of non-pulmonary tuberculosis in the Borough, compared with 37 and 5 notifications respectively, in 1970. 31 Children with Grade 1 positive reactions are vaccinated. The following table shows an analysis of cases notified in 1971. Age Periods. Respiratory Non-Respiratory M F M F 0—4 - - - - 5—14 - - - - 15—24 4 1 - 2 25—44 5 3 - 3 45—64 6 3 1 1 65 and over 2 1 - - Age unknown - 1 - - Totals 17 9 1 6 The total number of cases on the register at the end of the year was: Pulmonary 1122 Non-pulmonary 194 As may be seen from the Registrar General's official return there were 3 deaths from tuberculosis of the respiratory system and 1 death from non-respiratory tuberculosis in 1971. The Borough was again well served by the Chest Clinics of Ashford, Hounslow, Kingston, and the ad hoc clinic at the Richmond Royal Hospital. The following comments have been received from (a) Dr. P. E. Baldrey, Consultant Physician, Ashford Chest Clinic: — Although I have only had four new cases of tuberculosis from your Borough, as I only deal with a small section of it, from the area covered by this Chest Clinic I am surprised to find that we are still picking up cases of quite extensive tuberculosis.' (b) Dr. C. O. Edwards, Consultant Physician, Kingston Chest Clinic: — 'Tuberculosis instant mortality continues to decline at a slowing rate. There is no doubt a reservoir of tuberculosis still present, not only in Richmond, but throughout the country and until these are eradicated tuberculosis will remain undefeated. As these cases are becoming more difficult to find we have to increase our efforts. Therefore, it is my opinion that there are no grounds for reducing tuberculosis services at the moment.' (c) Dr. D. Mcintosh, Chest Physician, Hounslow Chest Clinic: — 'The upward trend in notifications of cases of tuberculosis, continues to be maintained in the past year. It would seem that this trend is mainly in the Immigrant population, where there is a correspondingly larger number of non-pulmonary forms of tuberculosis than in the indigenous population.' 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. 32 A mobile mass X-ray unit also visited the 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. AFTER CARE FACILITIES. The Council operates a free milk and extra nourishment scheme for chest cripples. Persons in need are recommended for this service by the Medical Social Workers of the chest clinics serving the Borough. Persons in receipt of supplementary benefit from the Department of Health and Social Security are automatically eligible, others are assessed according to income to ascertain their eligibility. Persons whose income does not allow them to come within the Council's scheme may, if appropriate, be referred to the Richmond upon Thames Chest and Tuberculosis Care Committee. The number of patients who received help during 1971, was as follows: — Adults 24 (27) Children - (1) Total 24 (28) Patients receiving free milk only 11 (14) Patients receiving extra nourishment only 2 (2) Patients receiving both free milk and extra nourishment 11 (11) (Figures in brackets show comparable figures for 1970). The Richmond upon Thames Chest and Tuberculosis Care Committee also continued to undertake 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. "During 1971 our Committee has struggled to keep its head above water, fighting against rising costs. We are still solvent but there is a feeling that we are mainly paying out routine grants to routine patients, so easy but very unrewarding. Our constant concern is to find new patients, patients whom we are certain must exist but who are never reported to us. Fortunately one or two new sources of patients who need help have come to our ears and we are indebted to Dr. James in acquainting us with some patients attending the Teddington Health Clinic. We see in the telephone directory that there are many more such clinics with which contact could be made. We have already been in touch with the Personal Services Division of the Social Services Department. It is pleasing to report that our Christmas Seals Sale this year actually produced more money than of late, possibly due to an appeal letter that made more impact than usual but also to regular subscribers increasing their contributions. As a new venture we have applied to and received from the Richmond Parish Charity Lands an annual grant which can be used to help any patient resident in what is known as the 'Old Parish of Richmond'. Once again our help has been largely concentrated on gifts of fuel, Christmas parcels and arrangements for holidays for patients and/or their families. There have been occasional requests for larger sums of money for special cases. There is no doubt that supplies of fuel are of major importance to chest patients and such help must continue to be given to the full. The gesture of Christmas parcels is greatly appreciated by the undernourished and underprivileged patients. We suggested that we should seek new patients in the fringe areas round our Borough but attempts failed because we were informed that the neighbouring authorities were then organising their own chest clinics and other welfare services. Our main theme in 1971 was 'Bring us some new patients'. This we can only repeat." 33 CARE OF THE ELDERLY. There is a danger that older people may attribute their disabilities to old age alone and are thus not motivated towards seeking treatment for remediable conditions. The clinics for older people continue to be well attended and the length of the waiting list is clearly an indication of the need for such clinics. Since normally every new patient becomes a regular clinic attender it was only possible to see 189 new patients during the year, as opposed to 278 in 1970 and in some cases patients had to wait more than nine months for a first appointment. Clinics for older people are held in five centres in the Borough : — Clinic Number of sessions per week Number of Attendances Number of New Cases Clinic sessions Doctor sessions Maddison Clinic, Church Road, Teddington 6 9 3,531 105 Kings Road Clinic, Richmond 1 1 456 27 Whitton Clinic 1 2 267 19 Mortlake Clinic 1* 1 137 38 * The sessions at Mortlake were held at fortnightly intervals from January to March and were weekly for the remainder of the year. A screening service is provided at these clinics for residents of the Borough over 55 years of age. Each patient, in addition to a comprehensive initial physical examination, has a complete re-examination annually and is seen at intervals in between according to need. The emotional health of older people is very important because depression readily occurs in the older age group especially if living alone or physically handicapped, and the Council was fortunate enough to have the services of Dr. Alfred Torrie, consultant psychiatrist, at Kings Road Clinic, Richmond, the Maddison Clinic and the Day Clinic at Stanley Road, Teddington. Dr. Torrie reports as follows: — "During the year under review, apart from a short spell in hospital, I have continued to see the Clinic patients who have emotional and psychological problems. The commonest one is depression. It is confusing for medical men to differentiate between the two types of depression. The constitutional, or endogenous, type responds to the modern anti depressant medications. These generally take some weeks to produce their effect. The other type is reactive to increasing infirmity, and resentment at the inevitable ageing process. Old age reactivates previous personalityfeatures, and with increasing physical infirmity, former traits are exaggerated. "The group discussions at the Stanley Road Clinic have proved rewarding. The patients are mainly housebound and have severe disabilities—crippled, blind or nearly blind, and one is confined to a wheel chair. They are of all types of intelligence, and some are more articulate than others. I am grateful to my colleague, the physiotherapist Miss Caink, for assisting me in conducting this discussion group. For many in this group the clinic day is their red letter day in the week." The Day Clinic held weekly at Stanley Road, Teddington, has met a real need in providing care and stimulation for patients considered by the examining doctors to require more frequent visits to a clinic. Health visitors advised on all aspects of keeping well. A physiotherapist was in attendance to give individual treatments and take simple 34 ment classes and weekly group discussions were taken by the consultant psychiatrist. Films were shown and occupational classes provided by tutors from the Richmond Adult College. Many fit, elderly people live happily in the Borough, either with their spouse, or with some younger relation. Some live on their own, only calling upon the services of their family doctor when need arises. Unfortunately, others, and especially those living alone, may come to our notice only when there is a crisis, e.g. because of ill health, impoverished circumstances or danger of hypothermia. Then heroic measures are called for from all available services to enable such persons to live satisfactorily in the community. Close liaison is necessary between the Health Department and the Department of Social Services as well as co-operation with the various voluntary associations which exist to help the elderly. In this regard I am happy to report that there have been discussions both at professional level and on an informal basis throughout the Borough to ensure that all those concerned with helping the elderly keep in close touch. My thanks are due to Dr. Josephine Finn and Dr. Phyllis DNetto, consultant geriatricians at Kingston Hospital, and Dr. J. Andrews, consultant physician to the geriatric service, South West Middlesex Group, West Middlesex Hospital, for their co-operation during the year. During 1971 it was not considered appropriate to admit anyone to hospital under Section 47 of the National Assistance Act, 1948. ACCIDENTAL HYPOTHERMIA. Emergency accidental Hypothermia Kits are made available on a 24-hour basis for use by medical and nursing staff. These kits consist of sleeping bags, blankets, hotwater bottles, low reading thermometers, convector type heaters, matches, change for electricity and gas meters and hand lanterns. The kits are normally maintained in the Nursing Store, Waidegrave Road, Teddington. Mothers attending clinics are continually reminded by poster and pamphlet of the dangers of hypothermia in infancy. All nursing staff are provided with low reading thermometers. CHIROPODY SERVICE. Details of the chiropody scheme at present operating within the Borough are as follows: — Method of Provision (a) Treatment at the surgeries of private chiropodists. (b) Treatment at Borough Council clinics. * (c) Treatment at sessions arranged by Voluntary Societies. * (d) Domiciliary treatments. * Treatments ceased to be arranged by Voluntary Societies in February, 1971 and were discontinued in Council Clinics from September, 1971. Categories of Persons Eligible for Treatment and Charges: — Inclusive Surgery. Charge Domiciliary. Category (a) Expectant mothers 5Op. 60p. (b) Nursing mothers 5Op. 60p. (c) Elderly persons 50p. 60p. (d) Physically handicapped 50p. 60p. (e) Children under 5 years Nil. Nil. (f) Schoolchildren Nil. Nil. (g) Persons in receipt of Supplementary Benefit or Rate Rebate Nil. Nil. The charges detailed above became operative from 1st June, 1971. Marginal hardship cases can receive special consideration within the assessment scales. 35 The monthly poster campaigns continued in 1971 and the subjects chosen were : — January — Oil Heaters February — Scalds March — Feet & Shoes April — Smoking May Rubella June — Food Hygiene July — Sunburn August — Water Safety September — Well Woman Clinics October — Mental Health Fire Works November — Toys December — Hypothermia. 36 Number of Persons Treated (a) Aged 65 and over By private chiropodists 4,739 In Council clinics 155 In Welfare Dept. establishments 403 (b) Expectant Mothers By private chiropodists 6 In Council clinics 1 (c) Disabled persons under 65 By private chiropodists 57 (d) Others By private chiropodists 476 In Council clinics 2 (e) British Red Cross Society 2 Number of Treatments Given 1. In Council Clinics 768 (1,093) 2. In Patients'Homes — by private chiropodists 8,219 (7,491) 3. In Old People's Homes 1,953 (1,879) 4. In Private Chiropodists' Surgeries 24,237 (23,757) 5. By British Red Cross Society 4 (53) (rigures in brackets show the position in 1970). Out of the 35,181 treatments given, 23,359 were free of charge. The main reason for this, of course, is that the majority of persons availing themselves of the service are elderly and of low income. The normal number of treatments allowed is six per person per annum, but this number may be exceeded where clinically necessary. I would like to express my appreciation of the co-operation I have received from the chiropodists serving the Borough and to the British Red Cross Society for their valuable contribution. The fact that many elderly persons are able to go to the chiropodist of their choice with the minimum of travelling on public transport enables them to have the treatment which is considered to be so vital if they are to remain ambulant. HEALTH EDUCATION. Health education in the Borough has continued to expand. The Sub-Committee met regularly for the co-ordination of activities. Daily work has been supervised by the Group Adviser/Health Visitor for Health Education. I am indebted to Mr. J. Dennett, the Borough Safety Officer, for his Co-operation during the three months in which safety themes were pursued. During the months of May, June and September displays were mounted in the Red Cross window at Twickenham and for this facility I wish to thank Mrs. Burrington, Divisional Director of the British Red Cross Society. Feet & Shoes In March I was pleased to have the services of a speaker from one of the leading shoe manufacturers who showed films and gave talks to children in six senior schools. Rubella In May a drive was made to encourage more parents to take advantage of the offer of vaccination for their daughters. In addtition to a wide poster coverage, information was supplied to the local press. Well Woman Clinics During the month of September, the caravan of the Womens National Cancer Control Campaign was in operation on four sites in the Borough and this was given extensive publicity. Further reference to this campaign may be found on page 21. Mind Week Mind Week took place from 17th to 24th October. The Health Department cooper' ated by holding a co-ordinating meeting and by providing considerable publicity of the week and of the events taking place in the Borough. A display was mounted in Teddington Library with the helpful co-operation of the Borough Librarian and his staff. Toys In November a selection of suitable toys was kindly loaned to the department by a toy manufacturer and a demonstration using these toys and other material was given to mothers in ten child health clinics and to children in two schools. Posters on Refuse Disposal Vehicles I would like to thank the Borough Engineer and Surveyor for his help in facilitating the display of waterproof posters on refuse disposal vehicles on various occasions during the year. Anti-Smoking Clinics Unfortunately it was not possible to hold another Anti-Smoking Clinic during the year although a re-union for those who attended the November 1970 clinic was held in January, 1971. Health Education in Schools Two further meetings with teachers associated with health education instruction were held. I am grateful to the Chief Education Officer and his Deputy for initiating these meetings. Five senior schools and one junior school received talks from members of this department as a supplement to the work undertaken by the teachers. One of the schools was given a course of twenty-six talks. Short explanatory talks about the Mantoux test and B.C.G. vaccination were given by Health Visitors who form part of the B.C.G. Team visiting the schools. In-Service Training Much help has been given to the Home Help Section — both before and after their transference to the Social Services Department. Films have been shown to midwives on 37 four occasions and student midwives have been given tutorials on Health Education. Student health visitors, student nurses, pupil public health inspectors and those on induction courses have all received help from the department. Dental Hygiene A large number of Dental Hygiene Kits have been issued at schools to all children on the occasition of their first dental examination. Many expressions of gratitude have been received from parents and it is pleasing to record the success which the campaign has achieved in changing the dental habits of children. Preparation for Child Birth Classes These classes were held successfully at ten clinics. During the year good use was made of the visual aids of the department; slides, film strips and films were used to help health visitors in their coverage of a wide range of subjects. On occasions outside speakers were invited to talk at the classes. Voluntary Organisations Sixteen separate organisations requested talks on various Health subjects. Eighteen lectures were given, five of which related to Well Woman Clinics and four to AntiSmoking. A projector and projectionist were made available on two occasions. The Annual Meeting of leaders of women's and mothers' clubs was well attended. A copy of the Guide to Health Education, listing suggested subjects was widely circulated producing an increased demand for talks. Clinics for Older People At the Maddison Clinic a weight watchers' club has been formed and discussions on diet and kindred subjects were led by a Health Visitor. At Stanley Road Day Clinic a film was shown each week. SOCIAL SERVICES. As a result of the implementation of the Local Authority Social Services Act, 1970, the following services were transferred from the Health Department to the newly formed Social Services Department — 1. Mental Health Services — (1) Adult Training Centre; (ii) Hostel for sub-normals; (iii) Day Centre for the mentally ill; (iv) The Social Workers (Mental Welfare Officers and Mental Health Social Workers); (v) Administration of the services for the mentally ill and mentally normal. 2. Home Help Service. 3. Service for the unsupported mother. 4. Local Authority day nurseries. 5. Registration of child-minders and private day nurseries. 6. Provision of recuperative holidays for adults. An additional effect of the Social Services Act was to transfer the provision of junior training centres and associated facilities from the Health Department to the Social Services Department. The Education (Handicapped) Children Act, 1970, however, placed responsibility for the education of mentally handicapped children upon the Council as education authority from 1st April, 1971. It was therefore considered to be administratively more convenient to leave the medical supervision of the Local Authority's junior training centre to the Medical Officer of Health until 1st April, 1971. The Junior 38 Training Centre has now become the Strathmore Day Special School and the medical supervision by the Health Department continues. This is particularly important in view of the opening of the 20 place special care unit in March, 1971. The transfer of the functions detailed has necessitated a constant and continuing liaison and consultation between the two departments and the Health Department thus remains heavily involved in nearly all the transferred functions, e.g. the medical supervision of the Adult Training Centre, the Hostel for Sub-normals and the Day Nurseries; the annual medical inspection of mentally handicapped persons placed in residential accommodation outside the Borough continues as far as possible; the suitability and medical assessment of applicants for registration under the Nurseries and Child Minders Regulation Act and participation in Home Help training courses. This continuing liaison between the two departments is essential to ensure that the community receives the best possible service. INCIDENCE OF BLINDNESS I am indebted to Mr. D. L. Richards, Director of Social Services, for the following information: — Follow-up of Registered Blind and Partially Sighted Persons for the year ended 31st December, 1971. 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 ... 6 3 26 (b) Treatment (medical, surgicil or optical and supervision) (ii) Number of cases at (i) (b) above which on follow-up action have received treatment 12 13 - 24 3 11 - 23 There were no cases of Ophthalmia Neonatorum notified during the year. At the 31st December, 1971, there were 408 persons on the Blind Register. 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 1971 was as follows : Maternity Homes only Nil. Other Homes 6 Total number of beds 126 NURSES AGENCY At the end of 1971, there were two nurses agencies on the register of this Local Authority. 39 LOAN OF NURSING EQUIPMENT The British Red Cross Society continued to operate a scheme on behalf of the Borough for the loan of standard items of nursing equipment. Until 1st April, 1971, the Council paid the small loan charges in respect of patients in receipt of supplementary benefit. Thereafter the procedure was simplified by the introduction of an annual grant to the Society. The Council own some special equipment including hoists, mechanical and electrically operated beds, etc. These items were loaned free of charge to patients requiring nursing care. In April, 1971, the Council made available a store in the Waldegrave Road, Teddington which has enabled the central storage of nursing equipment. Alternate Pressure Pads. Alternate Pressure Pads known as "Ripple Beds" and "Ripple Pads" are hired by the Council for the use of certain patients. One hundred and six ripple beds and 5 ripple chair cushions were hired for varying periods during the year. INCONTINENT LAUNDRY SERVICE A free incontinent laundry service is provided throughout the Borough. Sheets are loaned to patients on the recommendations of the District Nursing Service as also are night clothes, should these be considered necessary, and are laundered regularly. Normally deliveries and collections are made twice weekly by Corporation van. The laundering is undertaken by a local firm. At the end of the year there were approximately 100 patients receiving this service. Pads, waterproof pants with disposable linings are also provided. Incontinence pads, instead of sheets, are used where appropriate, thus reducing the laundering of soiled bed linen. These are normally distributed by the district nurses. Used pads are collected and destroyed whenever disposal is requested. TELEPHONE ANSWERING SERVICE Until 1st April, 1971, the service provided by Telephone Answering Services Limited was used for emergency calls by the midwifery, mental health services and to some extent by the home help service. Following the establishment of the Social Services Department, this facility was used only by the midwives until the introduction of the Night Nursing Service later in the year. RADIO TELEPHONE SERVICE Radio telephones continued to be used until 30th September, 1971, when the agreement with Telephone Answering Services Ltd. was cancelled. This move followed various difficulties which were being experienced in this Borough. MEDICAL ASSESSMENTS The assessment of medical fitness of new entrants to the Council's service continued to make heavy demands. 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, on all new entrants to the teaching profession, all entrants to teacher training colleges and all drivers of heavy goods and public service vehicles. In addition, recommendations as to medical fitness to continue in the Council's service were made following consultation with the family doctors and/or consultants concerned, physical examinations, and personal interviews. 40 The number involved over the year was: — Total number of medical assessments 1,802 (1,830) Total number of physical examinations 479 (467) Total number examined for continued service 19 (18) Total number found unfit for further service 4 (12) The figures for 1970 are given in brackets. Further medical advice is given as requested by any member of the Council's staff. ARTIFICIAL DIALYSIS In accordance with the general approval issued by the Ministry of Health in January, 1968, arrangements continue to be made, in collaboration with the Housing Officer and the Borough Engineer, for home renal dialysis units to be installed in council and private properties for patients referred by various hospitals. Six residents of the Borough have been helped under the scheme; one in 1968, one in 1969, three in 1970 and one in 1971. The cost of adaptations has been as little as £15 in one case and as much as £940 in another. 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 (i) quality, and (ii) quantity throughout 1971. 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 analytical results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. 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 estimate at 30th June, 1971, was 180,935. (ii) No houses were permanently supplied by standpipe. d) No artificial fluoride is being added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2 a) The supply was derived from the following works and pumping stations: Thames Valley Group. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on page 42. b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not plumbo-solvent. It should however, be appreciated that all types of water pick up varying amounts of metal 41 AVERAGE RESULTS OF THE CHEMICAL EXAMINATION of the water supplied to the London Borough of Richmond upon Thames during 1971. Milligrams per litre (unless otherwise stated). Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO44 hrs. at 27° C. B.O.D 5 days at 20° C. Hardness (total) CaCO3 Hardness (noncarbonate) CaC03 Magnesium as Mg Sodium as Na Potassium as K Chloride as CI Phosphate as P04 Silicate as SiO2 Sulphate as S04 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) River ThamesDerived 364 0.029 0.084 6.1 1.04 — 281 90 5 23.5 5.1 34 2.3 10 64 0.15 0.02 — 0.1 13 7.8 580 BACTERIOLOGICAL RESULTS — YEARLY AVERAGES, 1971 Source of supply BEFORE TREATMENT AFTER TREATMENT 1 Agar plate count per ml. Coliform count Escherichia coli count Agar plate count per ml. Coliform count E. coli count Number of samples 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. Number of samples 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. River Thames-Derived 8,154 53.9 - 40.37 12.2 54.91 5.1 3,901 8.4 — 99.51 99.97 from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead." 3 a) During the year, 38 samples of swimming bath water were taken from the six public 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. 31 samples were satisfactory and 7 were below the recommended standard. Repeat samples produced satisfactory results. (See page 66 — Swimming Pools). b) Fifteen samples of swimming bath water were taken from school or privately owned pools. Five were below the recommended standard but repeat samples proved bacteriologically satisfactory. c) Six samples of mains water thought to be causing illness or to be abnormal in taste were submitted for bacteriological examination. One was below the recommended standard but a repeat sample proved satisfactory. SEWERAGE & SEWAGE DISPOSAL I am indebted to (a) Mr. M. S. Hebron, B.Sc., C.Eng., M.I.C.E., A.M.I.Mun.E., Borough Engineer and Surveyor, and (b) Mr. A. J. Berry, B.Sc., M.I.W.P.C., M.I.Biol., Regional Engineer, Greater London Council for the following reports: — “(a) Sewerage The replacement of compressed air ejectors by electric pumps has been completed at Sandy Lane and Lower Teddington Road, Hampton Wick and similar work is commencing shortly at two further pumping stations in Hampton Court Road, Hampton Wick. Design is in hand for the conversion of two pumping stations in Hampton Court Road, Hampton. Work will be starting shortly on the provision of relief sewers for both the foul and surface water sewers in Hampton Road, Twickenham. The sewer survey for the Richmond area will be completed in the summer of 1972 and a start made on the Barnes area of the Borough". "(b) Sewage Disposal Sewage for the Borough is treated at two Treatment Works of the Greater London Council. Kew Sewage Treatment Works receives sewage from the 11 square miles south of the Thames, (with the exception of parts of Ham). The Works treat an average daily flow of million gallons before discharging to the River Thames, between Kew and Chiswick bridges. Work commenced in 1970 on improvements to the aeration plant, in order that treatment standards keep pace with the increasing load on the Works. These improvements are nearing completion and will be commissioned in 1972. Sewage from the remainder of the Borough flows to the Mogden Sewage Treatment Works, which deals with some 99 million gallons per day from the whole of the former West Middlesex area. The effluent is discharged into the River Thames at Isleworth. An automatic pumping station at Ham commissioned in June, 1970, conveys sewage to Mogden, and replaces the former station which pumped to Kew. The standard of effluent as required by the Port of London Authority was maintained throughout the year. In spite of the marginal increase in flow to the Mogden Works, the average effective oxygen load imposed on the river by the effluent (including storm water) was further reduced to 15.3 tonnes (metric tons) per day from 22 tonnes per day in 1970. 43 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 1966-70 has been completed and work has been concentrated on other individual unfit properties which came to the notice of the Department from various sources. The amendment of Section 4, Housing Act 1957 which allows internal bad arrangement as an item of unfitness has enabled proper consideration to be given to poorly laid out and "inconvenient" houses. Several houses subject to Closing Orders have been rehabilitated during the year and it is pleasing to note that full use has been made of Improvement Grants in this connection. Dwellings reported as unfit for human habitation not capable of repair at reasonable expense were: — 4, Garfield Road, Twickenham (First & Second Floors); Old Station House, Mortlake, S.W. 14; 60, Park Lane, Teddington; 34a, Queens Road, Twickenham (Basement); 68, Kings Road, Teddington; 46, South Worple Way, S.W.14; 14, St. George's Road, Richmond; 2, Broad Street, Teddington (Second Floor); 26, Brook Road, Twickenham; 22, The Embankment, Twickenham; 9a, St. Margarets Road, Twickenham (Basement); 29, Rosedale Road, Richmond; 3, Thames Street, Hampton; 27, Church Street, Twickenham (Shed R/O); 23, The Embankment, Twickenham; l83a, Hampton Road, Twickenham; 20a, Queens Road, Twickenham (Basement); 28, Queens Road, Twickenham (Basement); 135, Sandycombe Road, Richmond; 139, Sandycombe Road, Richmond; 28, Crown Road, Twickenham (Basement); 9, Lion Road, Twickenham (First, Second part Ground Floors); 9, Sheen Road, Richmond (First & Second Floors); 72, Victor Road, Teddington; 115, Waldegrave Road, Teddington (Ground Floor); 45, Windsor Road, Richmond. 44 The Council made Closing Orders, Demolition Orders or accepted from the owners undertakings in respect of the following premises : — Closing Orders and Undertakings 10, Chestnut Road, Twickenham; 6, Clifton Road, Teddington; 12, Ferry Road, Teddington; 98, Uxbridge Road, Hampton Hill; 73a, Church Road, Richmond; Willoughby House, Willoughby Road, Twickenham (Part); 4, Garfield Road, Twickenham (First & Second Floors); 10, Marchmont Road, Richmond; 68, Kings Road, Teddington; 34a, Queens Road, Twickenham; 20, Priory Road, Hampton; 9a, St. Margarets Road, Twickenham (Basement); 22, The Embankment, Twickenham; 26, Brook Road, Twickenham; 2. Broad Street, Teddington; 14. St. George's Road, Richmond; 46, South Worple Way, S.W. 14; 60, Park Lane, Teddington; 29, Rosedale Road, Richmond. Demolition Orders Eel Pie Island Hotel, Twickenham; Old Station House, Mortlake, S.W. 14. The following properties were made fit for human habitation during the year and in each case the Order was determined or the undertaking cancelled : 3, Waterloo Place, Richmond; 2 & 3, Queens Bench, Hampton; 8, May Road, Twickenham; 1, Popesgrove, Twickenham (Basement); 21, Onslow Road, Richmond (Basement); 54, Lion Road, Twickenham; 2, May Road, Twickenham; 1, Rosslyn Road, Twickenham (Basement); 23, St. Leonards Road, S.W. 14; Redholme, The Hermitage, Richmond (Basement); 25, Rosemont Road, Richmond; 65, Park Road, Teddington; 52, Park Road, Hampton Wick; 111, Church Road, Richmond (Room 2b); 67, Park Road, Teddington; 9, Springfield Road, Teddington; 21, Kew Foot Road, Richmond; 228, Kingston Road, Teddington. 45 Existing Closing Orders were varied in respect of the following premises: 47, Church Street, Twickenham; 61, Colne Road, Twickenham. All the above-mentioned dwellings were the subject of formal action under the Housing Act, 1957; in addition, repairs were effected at 221 dwellings after informal consultation with the owners, and 70 other dwellings were made fit for human habitation after the service of statutory notices under the Public Health Acts. The action taken to remedy unfit houses is summarised in the table below: (a) Clearance Areas represented to Council Nil (b) Dwellings included in (a) above Nil (c) Dwellings demolished after Clearance Orders made 6 (d) Dwellings represented for Demolition or Closing Orders 26 (a) Undertakings received to carry out repairs Nil (0 Closing Orders made in respect of — (i) Whole of building 16 (ii) Part of building 3 (g) Demolition Orders made 2 (h) Closing Orders determined on a building being made fit 19 (0 Demolition Orders revoked Nil (j) Undertakings cancelled on a building being made fit Nil (k) Dwellings in which defects were remedied after service of formal notice 70 (1) Dwellings in which defects were remedied after informal action 221 (2) Houses in Multiple Occupation Progress has been made in implementing the Council's standard in such houses, and as previously this standard has been adopted by owners after informal consultation. During the year the appointment of a Technical Assistant in housing has enabled a more efficient reinspection system to be evolved. Formal action taken during the year is shown below : (1) Number of Management Orders made Nil (2) Number of Directions made 4 (3) Number of Notices served requiring additional amenities 4 (4) Number of Management Orders revoked Nil (3) Certificates of Disrepair 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 1964/70 1971 1. Number of applications for Certificates 668 27 2 2. Number of decisions not to issue Certificates 24 2 - 46 $] Number of decisions to issue Certificates: 1957/63 1964/70 1971 (a) in respect of some but not all defects 520 10 1 (b) in respect of all defects 124 15 1 4. Number of undertakings given by landlords under paragraph 5 of the First Schedule 415 16 - 5. Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule 3 4 - 6. Number of Certificates issued 252 13 2 Applications for Cancellation of Certificates : 7. Applications by landlords to Local Authority for cancellation of certificates 134 23 1 8. Objections by tenants to cancellation of certificates 54 3 - 9. Decisions by Local Authority to cancel in spite of tenant's objection 18 3 - 10. Certificates cancelled by Local Authority 98 23 1 (4) Qualification Certificates Part III of the Housing Act, 1969 provides a procedure whereby an owner of a rent controlled property may apply to the local authority for a qualification certificate to enable the rent to be regulated in accordance with the Rent Act, 1968. A qualification certificate may be issued by the local authority only if the statutory conditions are satisfied, namely — (a) that the dwelling is provided with all the standard amenities for the exclusive use of the occupants; (b) that the dwelling is in good repair having regard to its age, character and locality, and (c) that the dwelling is in all other respects fit for human habitation. Applications made by owners, as shown below, have required the complete inspection of these dwellings by district public health inspectors to ensure that the qualifying conditions have been satisfied; further reinspections have been made in cases where the application has been held in abeyance while the owner has carried out essential works of repair to enable the qualifying conditions to be met. The position at the end of 1971 was as follows : Number of applications received 1299 Number of certificates issued 596 (5) Medical Priorities During the year 72 families who had been given priority on medical grounds were rehoused whilst a further 113 families were recommended for preferential treatment. The difficulty in rehousing many of these cases lies, of course, in the shortage of the particular type of accommodation required viz: ground floor flats, warden-controlled flats, etc. 47 I am grateful to the Housing Manager for his valuable assistance in rehousing so many families with medical priority during the year in the limited accommodation which became available. (2) INSPECTION AND SUPERVISION OF FOOD (1) Meat Inspection During the past year, the Borough has continued to receive meat imported from the Continent and although generally of good quality, a relatively small quantity had been condemned on inspection because of oedema and bruising presumably caused during transportation prior to slaughter. (2) Food Complaints Complaints have occurred mainly in the same pattern as before and the number of complaints that are due to faulty rotation of perishable foods seem to underline the necessity for date coding to be introduced on a much wider basis. Visits are made to all foodshops in the early part of the year specially to advise traders on the importance of a proper rotation system but errors continue to arise particularly during periods when the regular staff are on holiday. During the past year, 150 complaints were received, a considerable increase over the preceding year. FOOD AND DRUGS ACT, 1955 During 1971 legal proceedings were taken in 16 cases with the following results : 1. A bakery was fined £30 with £10 costs for selling a cake affected with mould. 2. The proprietor of a fish bar was given an absolute discharge with £5 costs for selling a piece of fried fish which contained a piece of wood. 3. A dairy was fined £10 with £5 costs for selling a bottle of milk containing a piece of glass. 4. A bakery was fined £5 with £7 costs for selling a loaf of bread containing an insect. 5. A bakery was fined £10 with £10 costs for selling a loaf of bread containing an insect. 6. A bakery was fined £15 with £5 costs for selling a loaf of bread containing a piece of metal. 7. A dairy was fined £20 with £5 costs for selling a bottle of milk containing a piece of rubber. 8. A manufacturer was fined £20 with £5 costs for selling a pork pie containing a piece of cloth. 9. A bakery was fined £25 with £10 costs for selling a loaf of bread containing an insect. 10. A grocer was fined £25 with £15 costs for selling a pack of bacon affected with mould. 11. A baker was fined £25 with £2 costs for selling an apple pie affected with mould. 12. A baker was fined £25 with £10 costs for selling an apple pie containing a metal staple. 13. A dairy was fined £20 with £5 costs for selling a bottle of milk containing a piece of wood. 14. A bakery was fined £10 with £10.50 costs for selling a loaf of bread affected with mould. 15. A bakery was fined £15 with £10.50 costs for selling a loaf of bread affected with mould. 16. A grocer was fined £20 with £10 costs for selling fresh cream dessert affected with mould. 48 The following is a list of foods which were voluntarily surrendered and destroyed : Baby Foods (Tins) 18 Meat (Frozen) (Pkts.) 2133 Beverages (Pkts. & Tins) 291 Meat (Tins) 1495 Bread (lbs.) 118 Meat (Fresh) (lbs.) 2169 Butter (Pkts.) 236 Meat Extracts (Jars) 29 Cakes 196 Milk (Tins) 328 Cereals (Pkts.) 1384 Milk (Fresh) (Pints) 20 Cheese (Pkts.) 160 Milk Products (Pkts.) 636 Condiments (Pkts.) 22 Pies, Pastries, etc. (Dozens) 986 Cough Mixture (Bottles) 31 Pie Fillings (Tins & Pkts.) 211 Drinks — Soft (Bottles) 873 Pickles, Sauces (Jars) 627 Eggs (box containing 360) 1 Poultry (Whole) (Fresh) 132 Fats, Oils, etc. (Bottles) 513 Poultry (Frozen) (Pkts.) 154 Fish (Frozen) (Pkts.) 2769 Puddings (Tins & Pkts.) 2601 Fish (Wet) (lbs.) 224 Sausages (lbs.) 32 Fish (Tins) 1439 Salt (Pkts.) 113 Flour (Pkts.) 700 Soups (Pkts. & Tins) 1152 Fruit (Tins & Pkts.) 9362 Sugar (lbs.) 430 Fruit (Fresh) (lbs.) 5 Sweets (Pkts. & Tins) 545 Ice Cream (Pkts.) 1047 Vegetables (Pkts. & Tins) 7946 Ice Cream (2½ gallon tin) 1 Vegetables (Fresh) (lbs.) 53 Jam (Jars) 1060 (3) Food Premises The Food Hygiene (General) Regulations, 1970, came into force on 1st March, 1971, and these Regulations widened the scope of current legislation. Protection of open food against contamination by customers was introduced as well as the exclusion of pet food from food rooms unless in sealed cans or covered containers. The majority of handlers of open food are now required to wear clean and washable overclothing and separation and storage of unsound food is also introduced. Good co-operation from food premises was generally forthcoming although legal proceedings were taken against the proprietors of four food premises for contraventions of the above mentioned Regulations resulting in fines totalling £330 with £25 costs. Sampling of a range of prepacked meals from a food processing plant in the Borough in conjunction with the Public Health Laboratory Service was completed during the year. The Company's own laboratory exercises a strict monitoring and quality control on the food ingredients and on the prepared meals, and the results of the examinations carried out by the Public Health Laboratory Service confirmed that the factory maintains satisfactory bacteriological standards. 49 Food Hygiene (General) Regulations, 1970. Type of Premises. No. of Premises No. of Premises which comply with Reg. 18* No. of Premises to which Reg. 21 applies † No. of Premises which comply with Reg 21 No. of Visits carried out. Bakehouses 28 27 28 28 93 Butchers' Shops 120 117 120 120 328 Confectioners (Flour) 66 66 — — 93 Confectioners (Sugar) 248 247 — — 103 Dairies 7 7 7 7 24 Fishmongers and Poulterers 34 33 34 34 37 Fried Fish Shops 27 26 27 27 40 Greengrocers and Fruiterers 126 124 126 125 171 Grocers 276 271 276 274 376 Ice Cream Premises—Manufacture 10 10 10 10 36 Ice Cream Premises—Sale and Storage 590 590 - - Public Houses and Licensed Premises 246 243 246 246 158 Restaurants, Cafes and Canteens 380 373 380 376 490 Food Manufacturing Premises 4 4 4 4 24 2162 2138 1258 1251 1973 * Regulation 18 deals with the provision of hand washing facilities for all persons engaged in the handling of food. † Regulation 21 deals with the provision of facilities for washing food and equipment. (4) Stalls and Vehicles Street trading in the areas of Hampton Court in the summer and the Twickenham Rugby Ground in the winter, has continued to cause concern. Visits were made by Inspectors at weekends to inspect the stalls and the Police have co-operated to obtain names and addresses of owners and operators of these stalls. Legal proceedings were taken against four stall holders for contravening the Regulations and fines totalling £104 with £24 costs were imposed. (5) Sampling of Food Sampling was curtailed during the year due to the acute shortage of inspectors. Bacteriological 128 samples of ice cream were taken and of these 23 were not up to standard. Visits were made to the various shops and the sterilising technique was checked. Further samples were then taken until a satisfactory standard was reached. 24 samples of other types of food were examined and found to be satisfactory. Chemical Analysis 306 samples were submitted to the Public Analyst. The majority of cases where irregularity was found was due to non-compliance with the requirements of the Labelling of Food Order, 1953. The following samples were found to be irregular: Pork Sausages and Beef Sausages Both samples contained preservatives although they were sold as being free from preservatives. On investigation it was found that the firm which supplied seasoning to the butcher had been taken over and later batches of seasoning contained preservatives. Pâté with Herbs The label claimed the article was rich in Vitamin B, but the minimum quantity of Vitamin B in each case was not declared. The manufacturers agreed to amend the label. 50 Vegetable Cubes The ingredients were not declared on the label. The manufacturers now include a list of ingredients. Cornish Pasties Two samples contained 10% instead of the accepted minimum of 12½% of meat. Formal samples were taken and these were satisfactory. Dried Apple Dessert The sample contained 500ppm by weight of sulphur dioxide and this was not declared on the label. The manufacturers agreed to amend the label. Multi Cake Mix Plain Sponge Mix Vanilla Delight Apple & Blackberry Sponge Fruit Cake Mix Scone Mix All these articles contained antioxidant, the presence of which was not indicated on the label. The manufacturers agreed to amend the label. Dandelion Coffee Bags This contained chicory not declared on the label and the manufacturers agreed to amend the label. Health Drink A sample of rosehip and honey drink with a claimed content of Vitamin C, but the minimum amount in one ounce was not stated. The manufacturers have ceased production. Pasta Slimex This was claimed to contain vitamins and iron which were not declared on the label; labelling has now been correctly amended. Diet Day This was found to contain insect webbing. No other packets in the shop were affected and it would appear that this was an isolated case. Tonic Vegetable Concentrate The label claimed it was for sleeplessness, but none of the ingredients had any recognised sedative effect. The manufacturers agreed to amend the label. Golden Mint Candy The sample had a mould growth on the surface. All remaining stocks in the shop were surrendered. Although further investigation did not reveal any irregular storage conditions, the manufacturer discontinued this line. Nut Cooking Chocolate This was a sample of nut chocolate substitute made with a high proportion of vegetable fat other than cocoa butter. Investigations found that the manufacturers issued proper labels with this product, but these had been mislaid in the shop and the article incorrectly described. Kirsch-Filled Milk Chocolate The sample was found to contain 0.5% of proof spirit only. Stocks were withdrawn from the shop and a further sample taken of a new consignment. This had a satisfactory spirit content of 5.2%. 51 The following table shows the types of samples analysed and the results obtained: Article. Number Analysed Number Irregular Dairy Products 25 - Meat and Meat Products 58 4 Fish and Fish Products 24 1 Sugar and Preserves 9 — Sugar Confectionery and Chocolate 20 4 Vegetables and Vegetable Products 16 1 Fruit and Fruit Products 19 1 Cereals and Cereal Products 19 - Flour Confectionery 24 6 Soft Drinks 11 — Alcoholic Drinks 2 - Meat and Meat Pastes 6 - Condiments and Sauces 11 - Soups 4 — Spices and Flavourings 11 — Food Additives 2 - Oils and Fats 20 - Beverages 4 2 Drugs 9 - Miscellaneous 12 3 306 22 (6) The Liquid Egg (Pasteurisation) Regulations, 1963 No pasteurising plants exist within the Borough. No samples were taken during the year. (7) Milk Supplies and Sampling Licences granted authorising dealers to store and sell designated milk were as follows: Ultra Heat Treated 77 Pasteurised 105 Sterilised 57 Untreated 18 52 samples of milk were examined and all found to be satisfactory. There are no processing plants in the Borough and farm-bottling was discontinued at the Petersham dairy farm. (8) Ice-Cream Manufacturing and Sampling There are 10 manufacturing premises and 590 premises registered for the storage and sale of ice-cream. 3. ATMOSPHERIC POLLUTION This was a year of quiet but positive progress towards cleaner air, during which the following Smoke Control Order became operational. Order. Acreage. Number of Dwellings Number of Other Premises Twickenham No. 11 14.6 1 3 There are now 12,916 acres including 62,277 premises subject to Smoke Control Orders. This represents 96% of the area of the Borough and 91% of the premises within the Borough boundary. During the last year the Council finalised its programme of making smoke control areas. On the 14th January, 1971, the Department of the Environment confirmed the Twickenham No. 10 Smoke Control Order and when this becomes operational on the 1st July, 1972, the whole of the Borough will be subject to smoke control. 52 The control of smoke emissions has, over the years, resulted in a remarkable reduction in atmospheric pollution and the inhabitants of the Borough now enjoy and can take for granted a reduced level of smoke in the air equalled only in the past by rural communities. There are now five stations monitoring the amounts of smoke and sulphur dioxide present in the air. These are located at Barnes, Hampton, Whitton, Teddington and Kew. The first three are operated by the Health Department and the latter two by Central Government Departments. The following table gives the processed daily average figures over the year so far available for the nine years up to March, 1971: Year Ended March STATION (results in microgrammes per cubic metre) Twickenham No. 1 Twickenham No. 5 Barnes No. 6 Smoke SO2 Smoke SO2 Smoke SO2 1963 98 181 98 187 — — 1964 98 151 89 164 96 106 1965 74 140 67 139 77 120 1966 53 111 56 115 57 102 1967 33 100 40 105 48 119 1968 35 106 42 110 49 122 1969 37 103 45 110 41 105 1970 36 89 43 102 34 94 1971 34 109 38 113 33 126 The figures show the remarkable diminution in smoke levels reducing down to one third of that of the earlier years. Unfortunately, the SO2 level has not reduced as in the past and it is hoped that the increase in 1971 is not indicating a reversal of the trend. It is thought that the high SO2 measurements are due mainly to the continued, if not increased use of fuels having a comparatively high sulphur content. Such fuels are generally burnt in furnaces of highly efficient large boilers. Many of these furnaces burn heavy fuel oils having up to 3.5% of sulphur and give rise to emission of SO2 amounting to hundreds of pounds per hour. An obvious method of reducing the concentration of SO2 is by limiting the percentage of sulphur in fuels and this has been successfully tried in other countries. A limitation of allowable sulphur in fuels is currently being advocated for the large conurbations in this country. Natural gas, being for all intents and purposes free of sulphur, is the ideal substitute for sulphurous oils and coals and it is gratifying to note that a few of the larger furnaces both old and new are now using gas in preference to other fuels. If this trend develops one may anticipate a marked reduction in the levels of SO2 in the years to come. Contaminated air affects the whole ecology and it is hoped as pollution reduces in the not too distant future, that lichens which are inherently susceptible to air pollution, especially SO2, will in time colonize and decorate the roof pitches in the area in addition to the very small but encouraging colony of lichen on stones and brickwork scattered in the most favoured sites about the borough. 53 The Clean Air (Suspension of Smoke Control — Richmond upon Thames) Order, 1970, suspended the following Orders until 31st March, 1971:— Smoke Control Order. No. of Premises in Area. The Barnes No. 1 Smoke Control Order, 1960 1815 The Barnes No. 2 Smoke Control Order, 1961 1482 The Barnes No. 3 Smoke Control Order, 1962 1673 The Barnes No. 4 Smoke Control Order, 1963 187 The Richmond (Surrey) No. 1 Smoke Control Order, 1959 341 The Richmond (Surrey) No. 2 Smoke Control Order, 1960 1603 The Richmond (Surrey) No. 3 Smoke Control Order, 1961 1989 The Richmond (Surrey) No. 4 Smoke Control Order, 1962 1553 The Richmond (Surrey) No. 5 Smoke Control Order, 1963 2558 The Twickenham No. 1 Smoke Control Order, 1961 1918 The Twickenham No. 2 Smoke Control Order, 1962 3815 The Twickenham No. 3 Smoke Control Order, 1962 4640 Total 23574 It was in some ways an embarrassment that these Orders were suspended by the Secretary of State. It arose because the solid fuel manufacturers and producers had failed to meet the demand. The fuel merchants serving the area had found it impossible to forecast the likely short-fall in the supplies of solid smokeless fuel but fortunately in the event the shortage was small and little bituminous coal was burnt. This was mainly due to the large majority of consumers demanding smokeless fuels in preference to coal. Indeed the greatest proportion of this coal was taken up by old aged pensioners because of its initial low cost when compared with premium cokes such as Coalite and Rexco, although the cost of heat produced is the most expensive. This is illustrated in the table to follow. In July 1971, the Secretary of State for the Environment assured all local authorities that supplies of solid smokeless fuels seemed likely to meet consumer demand indicating that it was not expected that there would be any further need to suspend smoke control orders. No supply difficulties were experienced until the miners' strike at the end of the year and at the time of writing supplies of solid smokeless fuels are not seriously affected. When discussing heating costs and the pensioners' preference for coal it is interesting to compare the figures in the following table which are based on the appliance efficiencies and annual fuel consumption set out in the 1963 White Paper "Domestic Fuel Supplies and the Clean Air Policy." Gas coke is no longer sold retail in the borough. The Estimated Average Weekly Cost of Room Heating Using SO cwts of Bituminous Coal per Annum compared with Alternate Fuels. Fuel Appliance 1966 1969 1970 1971 Coal Stool and Fret £0.64 £0.67 £0.82 £1.06 (Gas Coke) Improved open fire £0.59 £0.63 £0.91 — (Coalite) Improved open fire — — — £0.90 Hard Coke Openable Room heater £0.40 £0.44 £0.58 £0.60 Gas Gas room heater £0.50 £0.55 £0.55 £0.60 Electric Electric Fire £0.78 £0.90 £0.89 £1.00 Electric (off Peak) Electric Storage Heater £0.40 £0.43 £0.38 £0.57 Paraffin Fixed Flued Heater £0.41 £0.41 £0.42 £0.49 54 Householders continue to have freedom of choice for grant purposes in the selection of replacement appliances. Listed below are the percentages of the appliance types selected during the year compared with previous years. Appliance Selected 1966 1967 1968 1969 1970 1971 Gas Room Heaters 51% 66% 69% 65% 57% 67% Open Fires 33% 19% 14% 19% 22% 20% Solid Fuel Heating Stoves 14% 10% 12% 9% 8% 5.5% Electric Storage Heaters 2% 5% 5% 5% 11% 5.5% Electric Fires 2% 2% 2% These figures confirm that people much prefer the radiant heat given off by the Gas Room Heaters and Open Fires and that of the two they choose the gas appliance which is more convenient and cheaper to run. The cost of solid fuel has in fact gone up so much that even the benefit arising from the use of the high efficient stove has now disappeared and fewer are now being installed. The electric storage heater which in 1970 was the cheapest appliance to run is now only 3p a week less costly than a gas room heater. In addition, it does not have the advantage of an immediate turn down in heat output and consequently it has again fallen out of favour. During the year The Clean Air (Emission of Grit & Dust from Furnaces) Regulations, 1971 and The Clean Air (Measurement of Grit & Dust from Furnaces) Regulations 1971 came into operation. The first Regulations set out standards of emissions from furnaces having an input of over 1.25 million B.Th.Us. per hour and the second enables the emissions to be measured. The effects of these Regulations are being brought to the attention of persons who will be responsible for compliance and it is anticipated that in future there will be a closer control of the grit and dust from the larger furnaces in the area. The Smoke Control Areas (Exempted Fireplaces) Order, 1971, was another significant piece of legislation made during the year. It permits a specially designed fireplace to burn coal in smoke control areas on condition that it is installed, maintained and operated in accordance with the manufacturer's instructions. If these are not adhered to, noticeable smoke can result. In view of this, it is unfortunate that the proposed installation is not notifiable to the local authority, as it is most difficult subsequently to demonstrate that the appliance has been incorrectly fixed. Consequently, excessive smoke might have to be tolerated. Five applications were made for approval of proposed chimney heights as required by Section 6 of the Clean Air Act, 1968 and two were refused because the height was inadequate having regard to the amount of SO2 which it was intended to discharge from the chimneys. Five occupiers of buildings in smoke control areas were found to be emit' ting smoke through burning coal or incorrectly operating an oil-fired furnace. All offenders complied upon informal requests. On three occasions the owners of newly-purchased incinerators were found not to be complying with Section 3 of the 1956 Act which requires that all incinerators must be so designed that they are capable of being operated continuously without emitting smoke. These incinerators had been installed without proper notification to the Council and it was alleged in all instances that the salesman had failed to give information on these provisions of the Act. The burning of materials in the open continues to cause concern to many people and gave rise to the majority of the 119 complaints of nuisance from smoke. All the nuisances were abated on an informal approach. A warning letter was sent to a demolition contractor who had caused dark smoke to arise in contravention of Section 1 of the 1968 Act. The fact that no prosecutions were necessary indicates the very strong public support for cleaner air. 55 4. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 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 779 475 Retail Shops 1,069 1,045 Wholesale Shops 36 38 Catering Establishments 228 157 Fuel Storage Depots 2 1 2,134 1,716 Part 1 — Registrations and Inspections The level of inspections of registered premises has remained relatively high and of the total of 2,134 premises on the register at the end of the year, 1,716 received a comprehensive general inspection. This represents 80% of the total and is a very satisfactory proportion. The outstanding 20% will be seen during the early months of 1972. A total of 2,255 re-inspections illustrates the number of return visits which have to be paid to make sure that contraventions found are rectified. A little over one half the registered premises are shops (1,089) with offices numbering 779 and catering premises (restaurants, hotels, etc.) 228. Of the personnel employed in premises subject to the Act, it is perhaps predictable that females should outnumber males by approximately 1000 — 8,637 females to 7,628 men. The total personnel in offices showed a distinct increase in the year whilst the numbers employed in shops decreased by a comparable number. This situation probably reflects the trend towards more and more office premises in the area as, for example, one premises newly registered during the year and occupied by an international company which added 314 employees to the list. Part II — Operation of the Act Temperature & Ventilation (Sections 6 & 7). Inadequate heating and ineffective ventilation remain essentially the two most serious problems in the administration of the Act. As previously recorded shops continue to be built or renovated with little or no consideration for ventilation. Curiously this problem seldom seems to arise with new offices and one wonders why architects allow these differing standards to persist. Warehouses occasionally present difficulties under these headings. A typical example concerned a large warehouse, illuminated by natural light through transparent roof panels, from which an employee issued stock for part of his working day. The building was without ventilation of any sort other than an opening door, and in hot weather the internal atmosphere became excessively oppressive whilst in winter it was very cold. A small office totally within the warehouse was provided for the employee. It was unrealistic to call for full heating of the warehouse during cold weather and the problem has been met by the provision of local heat at the point of activity by the employee — in this case by means of an electric fan heater. Ventilation was, however, required for the whole warehouse and electric extraction was advised. Considerations of security have continually to be borne in mind and govern the methods adopted for securing adequate ventilation. 56 The need for sufficient ventilation, not merely to extract the vitiated air, but to provide the flow of air so important to the dispersal of body heat and exhalation is all too often not fully understood. Employees may suffer a general lack of alertness and a tendency to 'sag' particularly during close weather conditions, but these symptoms are seldom associated by the employer with an inefficient ventilation system until the problem is pointed out. Co-operation is generally then forthcoming and, indeed, one shop occupier displayed a commendable willingness to comply with our suggestion that, in order to secure through-ventilation, he should provide a ventilation opening at the front to complement the existing opening at the rear. He effected the improvement by taking the metal flap off the letter box in the front door. An unusual problem arose from the use of a reproduction machine for the copying of large drawings, etc., in a special room in one block of offices. The difficulty occurred when there was a build-up of ammonia fumes in the room arising from the chemicals involved in the reproduction process. This became essentially a ventilation problem which was eventually solved and it was also felt advisable to request the provision of rubber gloves for the staff handling the process. Cleanliness & Washing Facilities (Sections 4 & 10). These sections as applied to food premises —- foodshops, restaurants, hotels, bakehouses, etc., overlap the requirements of the Food Hygiene (General) Regulations and in most cases it has been found more satisfactory for the latter authority to be used to obtain satisfactory standards because of their more specific application and wider scope. Obstruction (Section 16). Office buildings are being built in some cases with service lines for power and telephones, etc., built into the structure and emerging at strategically placed points in the form of raised connection pedestals on the floor. This system has one unfortunate effect — it imposes a rigidity upon the layout of desks and appliances in the offices which an occupier can find very frustrating. Any movement of furniture away from the preconceived layout exposes the junction boxes and trailing wires as potential accident hazards. Our experience has included more than one problem of this type and one is forced to conclude that the standard practice of providing service connections on the wall remains the most satisfactory system. Food Slicing Machines (Sections 17, 18 & 19). Copies of the leaflet "The safe use of food slicing machines" issued by the Department of Employment & Productivity were obtained by the Health Department and issued to selected and suitable premises. It is difficult to assess the effectiveness of this form of educational propaganda, but the pamphlet coupled with the frequent checking on the presence of guards appears to have had two consequences:— (1) the relatively common practice of employees, to simplify their work, removing the guards and storing them in cupboards appears to have become markedly less frequent. This situation could however be attributable to employees becoming accustomed to the presence of guards, and (2) no notified accidents occurred during the year in the Borough involving the use of the cleaning of food slicing machines. Thermometers, Abstracts, First Aid Boxes (Sections 6, 50 & 24). Under the heading of less serious contraventions are the very common ones of lost thermometers, missing Abstracts of the Act and failure to maintain the contents of first aid boxes up to a satisfactory standard. These occur with considerable frequency and it is a commentary on the successful application of the Act that they form a large proportion of the contraventions recorded. 57 Hoists & Lifts Regulations. To date 158 registered premises in the Borough have been found to contain hoists or lifts. The total number of such appliances is 219 of which 103 are hand-operated and 116 power-driven. The matter of enclosing the liftway of hand-operated crate hoists has continued during the year. Many owners have procrastinated in the hope and expectation that representations to the Minister for exemption from these requirements would be successful. This has not proved to be the case and three years after the Regulations became enforceable many of these appliances still await enclosure. Part III — Accidents The number of accidents has remained almost static, a total of 33 compared with 34 in the previous year. As before all accidents were investigated for cause and possible contravention. In no case was a contravention found to be a contributory factor to the accident. The majority of accidents, fortunately, proved to be minor mishaps and ranged from electric shock to scalds. Falls, slips, and trips formed the majority category whilst minor injury from handling goods followed. As usual injury from the use of tools, especially knives, figured high on the list. No case required formal action but in three instances informal advice was given and accepted. One involved injury from use of a caustic substance in cleaning waste pipes whilst another concerned maintenance of electrical appliances. The third instance arose from an operator of a rotary copying-machine sustaining an injured hand due apparently to ill-fitting rubber gloves and ill-advised maintenance with a guard plate removed. Part IV — Prosecutions Two summonses were issued during the year under the Act relating to incidents recorded at the end of 1970. Both referred to failure to guard gravity feed slicing machines and occurred in different branches of the same multiple retail food shop. A conviction and a fine of £10 plus £5 costs was secured in each case. Legal action was only resorted to, after repeated warnings over a lengthy period had failed to secure a permanent fitting of satisfactory guards. 58 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 125 — Milk 50 — Other Foods 15 Clean Air Act—Inspections and Observations 4906 Control of Caravans 87 Diseases of Animals Act: Waste Food Order - Drainage and Sanitary fittings examination 3014 Food and Drugs Sampling 206 Houses inspected—Housing Acts 3105 Houses Let in Multiple Occupation 233 Housing Applications 34 Houses inspected—Public Health Acts 4040 Houses inspected re Permitted Numbers 25 Houses inspected re Vermin and Disinfestation 565 Infectious Diseases enquiries, disinfection, etc. 1104 Noise Abatement Act 751 Offices, Shops and Railway Premises Act—General Inspections 1716 Offices, Shops and Railway Premises Act—Other Visits 2255 Pet Animals Act 10 Prevention of Damage by Pests Act 14451 Rag Flock and Other Filling Materials Act 14 Rent Act, 1968 3 Swimming Baths—Sampling 50 Unsound food examination 765 Water Supply—Inspection 165 Water Supply—Sampling 8 Agricultural Holdings 1 Animal Boarding Establishments 1 Bakehouses 93 Butchers Shops 328 Confectioners (Flour) 93 Confectioners (Sugar) 103 Dairies 24 Factories (Mechanical) 56 Factories (Non-Mechanical) 23 Factory and School Canteens 27 Fishmongers and Poulterers 37 Fried Fish Shops 40 Greengrocers and Fruiterers 171 Grocers 376 Hawkers 112 Hairdressing Establishments 5 Ice-Cream Premises 36 Massage and Chiropody Establishments 55 Outworkers 120 Places of Public Entertainment — Public Houses and Licensed Premises 158 Restaurants and Cafes 490 Riding Establishments 1 Schools 13 Scrap Metal Dealers — Interviews 607 Miscellaneous Visits 2749 Inspections other than Houses—Public Health Acts 1785 Food Manufacturing Premises 24 Total number of visits and inspections 45,225 59 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 321 Choked and defective drains and sewers 834 Defective water closets 92 Accumulations of offensive matter 199 Unsound food 150 Verminous and other Infested premises: (a) Bugs 47 (b) Rats and Mice 1277 (c) Wasps 501 (d) Fleas 141 (e) Others 185 Keeping of Animals 9 Nuisance from Pigeons 55 Smoke Nuisances 119 Noise Nuisances 104 Fumigation of Rooms 7 Miscellaneous 359 Condemned Food 107 Total 4507 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 Acts. Food and Drugs Act. Number of Informal Notices served 262 75 Number of Informal Notices complied with 221 56 Number of Statutory Notices served 59 - Number of Statutory Notices complied with 70 — 6. DISINFECTION AND DISINFESTATION After the occurrence of an infectious disease, premises and articles therein can be disinfected free of charge and in cases other than infectious disease on payment by the individual. Disinfestation work to eradicate bed bugs, fleas, etc., is paid for by the individual and is not a charge on the Council. During July a number of complaints were received from Ham residents of plagues of mosquitoes. The houses from which the complaints originated were sited near Ham Common, which is a wooded area. A sample of the mosquitoes was obtained and investigation revealed them to be Aedes Rusticus which is a rather large mosquito with dark legs and a banded abdomen. They are mainly found in woodland areas and they breed in temporary pools of water The larvae hatch out in the winter, the adults appearing in the spring, producing troublesome bites during the summer near their breeding areas. At the time the complaints were received there was no evidence of pools of water providing breeding places. It was thought that the heavy rainfall during the earlier part of the year would have provided suitable sites for larval growth. Due to the fact that this species of mosquito breeds only once a year, the only means of control in this case was to eradicate the adult mosquitoes. Persons suffering from scabies or infested with lice are taken, with their bedding, to Hammersmith Medicinal Baths for cleansing, and I am indebted to Dr. A. D. C. S. Cameron, Medical Officer of Health and Director of Social Services of the London 60 Borough of Hammersmith and to Mr. F. C. Baldwin, Superintendent of the Baths, for their valuable assistance during the year. 17 patients received treatment against scabies. In addition the bedding of 9 further cases who were being treated by their family doctor was cleansed. 31 persons were treated for lice infestation, the bedding of a further 15 persons disinfested; 5 premises were disinfected following infectious diseases and 144 premises disinfested. Costs amounting to £472.80 were recovered. 7. PEST CONTROL (a) Rats and Mice. The number of complaints received from the public showed a welcome if relatively small decrease from the level of the preceding years. 1971 1970 1969 Number of complaints received 1,277 1,360 1,347 Number of infestations found 1,284 1,074 1,091 Total number of visits by rodent control staff 13,873 10,401 10,748 The higher number of infestations found compared with complaints received reflects the availability of staff to initiate surveys which led to the discovery of infestations not reported to the Department by the public. This situation also contributed to the higher total of visits paid by the staff compared with 1970. Of the 1,284 infestations found 928 were caused by rats and 356 by mice. 88% of the total occurred in other than business premises or local authority controlled areas. The domestic garden remains the most common site for rat infestation in this Borough. Proportionately the increase in mice infestations recorded was substantially higher than the increase in rat infestations and this confirms the growing problem of mice. A total of 4,294 premises of all types received visits for rodent control purposes within the year. The staff of rodent operatives remained at full strength throughout the year once the vacancy was filled in the early days of 1971. This was a fortunate situation in view of the difficult position over recruitment of staff for this work at the wage levels involved. It is perhaps pertinent to comment here on the necessity for a high level of integrity amongst rodent operatives because of their readily available access to all forms of property. They must be capable of training in special skills and able to carry out their work conscientiously without direct supervision. Perhaps most vital of all is the need for them to maintain a relationship of mutual respect with the wide cross section of the public for whom they provide a, not always appreciated, service. It should be added that this service, freely available to all but business premises, does not by law relieve the occupiers of the premises of their obligations under the Prevention of Damage by Pests Act to eradicate rats and mice on the property they occupy. The fortunate staff position meant that during the year we were able to sustain a steady survey operation carried out by the Foreman Rodent Operative. Over 30 areas were carefully scrutinized for rodent activity. Although some of these surveys produced negative results the value of such an approach was demonstrated in one of the first areas selected. This consisted of a well-defined district of quality domestic properties with large gardens. In all 23 properties were involved and only two of these having reported rat activity. The survey revealed that 7 of the properties and a common back passage were infested. A wide range of land and properties both public and private came under scrutiny in this way and it is hoped that by this method a more effective degree of rodent elimination will be achieved. 61 The battle is a continuous and fluid one however and success is often tempered with disappointment. This is illustrated by the unsatisfactory position over mice infestations. As mentioned in the previous annual report the elimination of mice is, at present, no quick and easy process. It calls for patience and perseverance on the part of both the occupier and the rodent operative, and for a variety of tactics and techniques amongst which the lowly mousetrap is not overlooked. Sewer treatment with the acute poison fluoroacetamide continues to be one of our major weapons against the rat population of the Borough. The annual test baiting programme carried out at the end of 1970 indicated some disquieting increase in the rat population of the sewers on the Middlesex side and it was therefore decided, as envisaged in last year's report, to carry out a quarterly treatment of selected manholes throughout the whole sewer system and this decision was implemented. The success of this action could not be gauged before the end of the 1971 year as, for various reasons, a decision was taken to transfer the 10% test baiting operation from early December to the Spring. In consequence the current position of infestation in the sewers will be assessed in March, 1972. During the year tests and field trials were carried out using different techniques and materials. Small sachets consisting of bait enclosed in thin transparent plastic were given some tests and in certain conditions they were found to have some distinct advantages although their ready portability by children and animals presented a major disadvantage. A double strength warfarin with wholewheat grain base is also under trial and preliminary tests suggest some preference for this type of bait. In all these tests the over-riding consideration has to be one of safety for both man and domestic animals and this inevitably places serious limitations upon the methods and materials which can be used. The criterion cannot be solely the assessment of their effectiveness in killing rodents. Towards the end of the year steps were being taken to implement the purchase of a small lightweight inexpensive dinghy for use on rivers, especially the tributaries such as the Crane and Duke of Northumberland rivers. Here infestations have been found in the bank which are impossible to reach from the riverside whilst thigh waders have proved impracticable because of the silt. It is hoped, by the use of this small craft, to deal effectively with another persistent reservoir of rats in the area. A total of 142 premises (local authority and private) were treated as business premises for which a charge is made for rodent control work. Compared with the 1970 figure of 145 the total remains remarkably static The problems of rodent control are inseparable from accumulations of rubbish. Whether it be the rather haphazard tipping of lawn mowings and cabbage leaves in the bottom corner of the garden to form what is blithely referred to as the "compost heap" or the hoarding of scrap timber, metal and paper behind or in the garden shed or the indiscriminate dumping of old mattresses and even domestic waste on vacant land, they each contribute an invitation to and provide a harbourage for rats. Thoughtless neglect on one's own property is perhaps understandable if regrettable, but the wilful depositing of any rubbish on open vacant sites or any small patches of accessible land is a deplorable commentary on the social consciousness of all too many of the public. The Council is constantly being exhorted to remedy situations quite deliberately created by the irresponsible element amongst residents and the frequency with which these situations arise is cause for disquiet. Grey Squirrels The presence of the grey squirrel still remains a problem. They begin breeding during the spring and normally raise two families a year in dreys built on branches or holes in trees. During the winter and early spring they feed on nuts, acorns and wild fruits stored from the previous autumn. Contrary to common belief they do not hibernate during the winter months except in extremely cold weather as they can be seen to be very active during the lesser cold days of the winter period. As the spring progresses 62 into summer their store of food gets shorter and then they begin to feed on bulbs, birds' eggs and shoots and stems of trees. As the autumn approaches they continue foraging for stores for their winter supply thus completing a year's cycle of much destruction to natural plant life. Although such damage causes concern, the main problem arises when they establish themselves in houses, generally in roof spaces. When this occurs they cause damage to external woodwork, roof timbers, lagging of water pipes, and, it is known that, in some instances, they cause damage even to the water pipes resulting in extensive dampness and possible internal flooding in the house. Despite the annoyance and damage caused by the grey squirrel the department has no statutory powers or obligation to deal with infestations but whenever complaints are received investigations are carried out and the most apropriate advice is given. Feral Pigeons The control of feral pigeons in built-up areas is becoming more difficult and indeed more costly. Although it is known that they tend to establish themselves on bridges, the roofs, alcoves and ledges of large buildings in town centres there are now many instances where they settle down as isolated flocks on private dwellings. It is generally found that they are initially attracted by one or more persons in the area placing food for the feeding of smaller birds but by doing this they entice pigeons. Except in the most adverse winter conditions there are ample supplies of natural food available for birds to enable them to survive and the practice of feeding them is quite unnecessary. No powers are available to prevent people from feeding birds and requests to people to discontinue the feeding of birds generally incurs their wrath rather than their co-operation. The Public Health Act, 1961 gives permissive but not obligatory power to a Local Authority to deal with pigeons where a serious nuisance exists. Trapping by baiting and destruction by humane means is the most efficient method of control but unless there are appropriate trapping sites in an affected area and no other immediate sources of food supply are available the cost of carrying out an isolated operation is uneconomical and not worth while. Because of serious nuisance being caused in four areas in the Borough it was necessary for the Council to take action. A specialist firm was engaged, and 378 pigeons were trapped and humanely destroyed. Wasps Nests During the months of July to October 501 requests were received from residents in the Borough requiring advice or help regarding the destruction of wasps' nests. This was a slight reduction from the similar period in the previous year when 588 requests were received. Advice was given where necessary but when complainants requested the nests to be destroyed, arrangements were made for two private contractors in the Borough to carry out the work of destruction where possible, for which they charged a reasonable fee to the complainant. 63 8. 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 6 23 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 587 56 4 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — — — — Totals 593 79 4 — (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) 5 1 — 1 — Overcrowding (S. 2) — — — — — Unreasonable temperature (S. 3) — — — — — Inadequate ventilation (S. 4) 4 4 — — — Ineffective drainage of floors (S. 6) — — — — — Sanitary Conveniences (S. 7) (a) Insufficient — — — — — (b) Unsuitable or defective 7 2 — 1 — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to outwork) — — — — — Totals 16 7 — 2 — 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 20 — — — — — Electrical Fuse Makers 43 — — — — — Artificial Flowers 31 — — — — — Lampshades 16 — — — — — Total 110 — — — — — 64 9. MORTUARY. The Mortuary at Hampton continued to function satisfactorily and the number of bodies admitted during the year was 783. 10. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 There is one small business in the Borough using rag flock and other filling materials, a firm manufacturing quilts, sleeping bags and similar quilted material. The filling materials used are now almost exclusively man-made fibres, principally Terylene. 11. DISEASES OF ANIMALS ACT, 1950 PET ANIMALS ACT, 1951 ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 RIDING ESTABLISHMENTS ACTS, 1964 and 1970 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, 1971 is as follows:— Diseases of Animals Act, 1950 Tuberculosis Order, 1964 Following the purchase of a Friesan bull calf by a local farmer from Slough Cattle Market, enquiries were made which ascertained that the calf had not been tagged before sale as required by the terms of the above Order. This information was passed to the Ministry of Agriculture, Fisheries and Food who deal with the tagging of such animals. Regulation of Movement of Swine Order, 1959 Three licences were received under the above order. Unfortunately, these had been sent by Slough Cattle Market to the London Borough of Hounslow who forwarded them to your Borough. When they reached this office it was too late for verification. I therefore requested Slough Cattle Market to forward licences direct to me in the future and they have agreed to do this. Pet Animals Act, 1951 Visits of inspection were made regularly to pet shops and 14 were recommended for re-licensing. One shop closed down during the year and two new shops opened. Animal Boarding Establishments Act, 1963 Inspections were carried out at 5 animal boarding establishments and reports submitted recommending that they be re-licensed. By the end of the year one owner had still not intimated that she intended to re-open her establishment. Riding Establishments Acts, 1964 and 1970 Four riding establishments received veterinary inspections and recommendations were submitted. All were recommended for re-licensing. The Riding Establishments Act, 1970 came into operation on the 1st January, 1971 and is combined with the 1964 Act. The new Act makes regulations with regard to accommodation for animals, provisional licences, qualifications of applicant and manager, health of animals etc. For the purpose of the new Act, a revised report form and licence form are now used. 65 Performing Animals (Regulation) Act, 1925 Three visits of inspection were made to Television Studios in connection with the use of animals in productions. Licences were verified and the health and conditions in which the animals were kept were inspected. These were found to be satisfactory. General Regular visits of inspection were made by Diseases of Animals Inspectors to the following Premises: Piggery, Harvey Road, Hounslow Four visits were made and conditions were satisfactory. Dairy Farm, Petersham Meadows Fawn, Richmond Dairy herd and poultry; very good standard maintained. Kosher Butcher, Red Lion Street, Richmond Shop kept very clean. Bushy Park and Richmond Park Grazing sheep, deer and cattle. Conditions excellent. Poultry Keeper, Oak Avenue, Hampton It is to be ascertained whether the owner has given up keeping poultry. Animals (Miscellaneous Provisions) Order, 1927 Under the terms of this Order, the following were advertised in a national daily newspaper:— Live Poultry (Restrictions) Order, 1971. Live Poultry (Restrictions) Amendment Order, 1971. Poultry Carcases (Landing) Order, 1971. 12. ESTABLISHMENTS FOR MASSAGE and/or SPECIAL TREATMENT Thirty 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. 13. 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 66 on the "marginal" principle. The pool water at the Twickenham and Teddington Pools is turned over once every 6½ hours, whilst that at the Hampton Pool operates on a 4 hour turnover rate. 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. Bacteriological tests of the water at each of the pools and Richmond Baths are made monthly and, during the past year 38 samples have been taken, of which 31 were satisfactory and, whilst the remaining 7 were below the recommended standard, repeat samples in each case have produced satisfactory results. Richmond Baths (Indoor and Open Air) The 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 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 sterilisation is carried out by chlorine gas treatment on "breakpoint" principle. A system of pool water sampling and testing is installed and all indications are automatically recorded 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." 14. FERTILISERS AND FEEDING STUFFS ACT, 1926 Fifteen samples of fertilisers were taken during the year, five of which were reported upon by the Agricultural Analyst as being irregular : Bone Meal The percentage of nitrogen was 1.4 above the percentage stated on the statutory statement and this difference was in excess of the limits of variation allowed for this ingredient. The retailer was notified but, as the excess was not considered to be prejudicial to the purchaser, no further action was taken. Dried Blood The percentage of nitrogen of this sample was 1.7 below the percentage stated on the statutory statement. The error occurred because of the supplier misinforming the retailer and an assurance was received from the supplier that in future the correct information would be given to the retailer. Growmore The percentage of nitrogen and phosphoric acid insoluble in water was in excess, and the percentage of potash below those stated on the statutory statement. There was doubt as to the source of this supply and as the retailer held no further stocks of the product no further action could be taken. Basic Slag The particulars on the statutory statement were not in the form as required by the Act. The retailer was notified and the statutory statement was appropriately amended. 67 Growmore The percentage of nitrogen was 1.1 above the percentage stated on the statutory statement and the amount of phosphoric acid was not described in the form required by the Act. The retailer was informed and the statutory statement was satisfactorily amended. 15. COMMON LODGING HOUSES There are no common lodging houses in the Borough. 16. HAIRDRESSERS AND BARBERS At the end of the year 164 hairdressers' premises were registered, and in no case was it necessary to take legal proceedings for enforcement. 68 SCHOOL HEALTH SERVICE POPULATION. The population of Richmond upon Thames at mid-1971 was 174,310 (1970— 174,550) of which 21,433 (1970—21,187) were school children in maintained schools. I am indebted to Miss V. C. King, B.Sc., Deputy Chief Education Officer, for the information given in Table I. below, Table XVII on pages 81 and 82 and for the information on Meals and Milk in schools on page 90. Table I. SCHOOL POPULATION (as at 20.1.72) No. of schools Number on Registers Total Boys Girls Secondary Grammar 5 1,582 1,566 3,148 Secondary Modern 11 2,493 2,337 4,830 Primary 52 6,581 6,407 12,988 68 10,656 10,310 20,966 Nursery 2 45 55 100 Day Special Schools/Units for (i) Educationally subnormal children 2 113 75 188 (ii) Severely sub-normal children 2 58 35 93 (iii) Maladjusted children: Junior 1 39 15 54 Infant 1 22 4 26 Autistic Unit 1 5 1 6 9 282 185 467 Total 77 10,938 10,495 21,433 An increase of 246 pupils compared with the number in the previous year should be noted. 69 MEDICAL INSPECTION AND TREATMENT Year ended 31st December, 1971 Table II. Medical 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) 1967 and later 96 96 100.00 — — 1966 812 807 99.38 5 0.62 1965 1255 1253 99.84 2 0.16 1964 146 145 99.32 1 0.68 1963 92 91 98.91 1 1.09 1962 91 90 98.90 1 1.10 1961 81 80 98.77 1 1.23 1960 117 115 98.29 2 1.71 1959 847 843 99.53 4 0.47 1958 477 474 99.38 3 0.62 1957 684 683 99.85 1 0.15 1956 and earlier 726 722 99.45 4 0.55 TOTAL 5424 5399 99.54 25 0.46 B. — OTHER INSPECTIONS. Number of Special Inspections 3,619 Number of Re-Inspections 2,508 6,127 Periodic Medical Inspections. The number of children inspected at routine periodic medical inspections was 5,424 (1970—6,986). Special examinations and re-inspections were 6,127 compared with 5,740 for the previous year. 70 Physical Condition of Pupils Inspected. The general physical condition of school children remains high. Out of 5,424 children examined only 25 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) 1967 and later — 13 13 1966 23 138 149 1965 44 197 228 1964 7 45 48 1963 10 39 47 1962 7 42 45 1961 7 48 48 1960 11 39 45 1959 55 108 156 1958 28 85 107 1957 57 79 127 1956 and earlier 41 64 100 TOTAL 290 897 1113 The 5.3 per cent of children inspected who were found to require treatment or under treatment for defective vision, compares with 6.5 per cent in 1970, 7.6 per cent in 1969, 9.8 per cent in 1968, 8.6 per cent in 1967, 6.3 per cent in 1966 and 9.0 per cent in 1965. 71 Table IV. Defects found by medical inspection in the year ended 31st December, 1971. 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 64 68 43 40 83 65 190 173 5 Eyes: a. Vision 82 170 81 136 127 229 290 535 b. Squint 51 58 8 11 20 27 79 96 c. Other 8 18 2 16 6 32 16 66 6 Ears: a. Hearing 20 139 4 29 5 71 29 239 b. Otitis media 23 68 3 6 5 28 31 102 c. Other 10 7 1 13 6 7 17 27 7 Nose and throat 67 282 6 30 19 101 92 413 8 Speech 61 99 4 9 35 12 100 120 9 Lymphatic glands 16 90 — 5 2 21 18 116 10 Heart 4 32 2 9 1 15 7 56 11 Lungs 21 73 4 22 16 35 41 130 12 Developmental: a. Hernia 9 21 1 2 — 4 10 27 b. Other 18 129 2 11 20 49 40 189 13 Orthopaedic: a. Posture 11 30 2 12 12 18 25 60 b. Feet 26 91 5 18 9 49 40 158 c. Other 9 45 3 6 5 29 17 80 14 Nervous system: a. Epilepsy 6 9 2 5 14 12 22 26 b. Other 1 22 1 10 4 25 6 57 15 Psychological: a. ment 31 49 4 8 161 40 196 97 b. Stability 26 93 1 20 73 95 100 208 16 Abdomen 5 19 - 4 3 11 8 34 17 Other 48 202 21 87 55 114 124 403 (T) Requiring treatment. (O) Requiring observation. 72 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 750 41 5 Eyes: a. Vision 69 122 b. Squint 6 7 c. Other 22 7 6 Ears: a. Hearing 93 461 b. Otitis media 12 38 c. Other 23 8 7 Nose and throat 35 134 8 Speech 40 38 9 Lymphatic glands 3 6 10 Heart 4 25 11 Lungs 9 62 12 Developmental: a. Hernia 2 4 b. Other 29 88 13 Orthopaedic: a. Posture 1 9 b. Feet 70 57 c. Other 11 38 14 Nervous system: a. Epilepsy 4 6 b. Other 3 11 15 Psychological : a. Development 10 50 b. Stability 32 63 16 Abdomen 5 13 17 Other 131 429 73 Table V. Recorded incidence of certain defects found to require treatment at periodic inspection per 1,000 pupils examined. 1971 1970 Total children examined 5,424 6,986 Skin 35.0 35.4 Eyes: a. Vision 53.5 65.4 b. Squint 14.6 7.9 c. Other 2.9 2.1 Ears: a. Hearing 5.3 5.6 b. Otitis media 5.7 3.1 c. Other 3.1 5.9 Nose and Throat 17.0 8.4 Speech 18.4 6.6 Lymphatic Glands 3.3 0.6 Heart 1.3 0.4 Lungs 7.6 3.4 Developmental: a. Hernia 1.8 0.6 b. Other 7.4 3.6 Orthopaedic: a. Posture 4.6 2.6 b. Feet 7.4 7.9 c. Other 3.1 3.1 Nervous System: a. Epilepsy 4.1 2,1 b. Other 1.1 0.4 Psychological: a. Development 36.1 12.7 b. Stability 18.4 12.5 Abdomen 1.5 0.9 Other 22.9 34.1 Table VI. Number of children examined other than at Periodic Medical Inspections Pupils examined for any condition, ailment or defect. 3,04! Other special examinations, freedom from infection, employment byelaws, etc. 57( 3,615 Re'inspections of pupils previously found to have some defect 2,50? 74 Table VII. CLINICS. School Health Service facilities available (as at 31.12.71) 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 (including X-Ray) Minor Ailments Vaccination and Immunisation HAMPTON WICK 20, Seymour Road, Hampton Wick, Kingston-upon-Thames, Surrey. Minor Ailments 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. Minor Ailments Orthopaedic (Physiotherapy) Speech Therapy Vaccination and Windham Road, Richmond, Surrey. Child Guidance Service Dental (including X-ray) Minor Ailments Ophthalmic (including Orthoptic) Speech Therapy Vaccination and Immunisation TEDDINGTON Church Road, Teddington, Middlesex. Dental (Orthodontic and X-ray only) Vaccination and Immunisation Stanley Road, Teddington, Middlesex. Minor Ailments Ophthalmic (including Orthoptic) 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 (including X-ray) Minor Ailments Vaccination and Immunisation 75 Eye Diseases, Defective Vision and Squint. Number of cases known to have been dealt with External and other, excluding errors of refraction and squint 44 Errors of refraction (including squint) 2077 Total 2121 Number of pupils for whom spectacles prescribed 475 Keystone Telebinocular Vision Screener. The use of Keystone Telebinocular Vision Screeners continued in the schools during 1971. The instruments are operated by the audiometer/vision screener operators. The statistics relating to this screening procedure are given below: Table IX. Age Group. First Tests Failures TOTAL TOTAL % of Col. 2 (1) (2) (3) (4) Infant 1951 102 5.23 Junior 2189 333 15.21 Senior 552 99 17.92 TOTAL 4692 534 11.38 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 23 (c) for other nose and throat conditions — Received other forms of treatment 344 Total 367 Total number of pupils in schools who are known to have been provided with hearing aids: (a) in 1971 7 (b) in previous years 38 76 AUDIOMETRY At the end of 1971 two audiometer/vision screener operators were on the staff of the department. Audiometers are kept in condition by regular calibration by the manufacturers. Children who fail the audiometric test arc referred for further investigations. Sixty five new cases were seen and 54 re-examinations were carried out in 1971 at the Heston Hearing Clinic to which the majority of referrals are made. Table XI. (a) Audiometer Tests — Routine Failures. Age Group 1st Tests * Rctests. Total % of Col 1 (1) (2) (3) (4) Up to 7 yrs. 2537 350 340 13.40 9 to 10 yrs. 1243 145 139 11.18 Total 3780 495 479 12.66 * In Schools. (b) Audiometer Tests — Specials Age. 1st Tests. Re-tests. Failures. Total. % of Col. 1 (1) (2) (3) (4) Under 5 156 47 86 55.13 5 289 85 198 68.51 6 277 130 154 55.59 7 227 85 112 49.78 8 177 53 95 53.67 9 130 42 56 43.08 10 134 34 53 39.55 11 108 22 44 40.74 12 107 23 40 37.38 13 79 19 35 44.30 14 80 7 27 33.75 Over 14 134 14 86 64.12 Total 1898 561 986 51.95 77 Table XII. INFESTATION WITH VERMIN. (i) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 20,868 (ii) Total number of individual pupils found to be infested 132 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) - (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. Rinworm: (a) Scalp 3 (b) Body - Scabies — Impetigo 1 Other skin diseases 475 Total 479 Table XIV. OTHER TREATMENT GIVEN. Number of cases known to have been treated. (a) Pupils with minor ailments 1751 (b) Pupils who received convalescent treatment under School Health Service arrangements 7 (c) Pupils who received B.C.G. vaccination †*2521 (d) Other than (a), (b) and (c) above — Heart 3 Lungs 30 Developmental defects 23 Nervous system 26 Lymphatic Glands 2 Psychological defects 21 Abdomen 22 Total 4406 †Children with Grade I positive re-actions are now being vaccinated. *includes 114 re-vaccinations. 78 Table XV. HANDICAPPED PUPILS. Pupils ascertained during the year requiring education at a special school: (a) Blind 1* (b) Partially sighted — (c) Deaf 1 (d) Partially hearing 4 (e) Educationally sub-normal 5 (f) Epileptic 1 (g) Maladjusted 64 (h) Physically handicapped 7 (i) Speech — (j) Delicate 5 *Child 'blind / physically handicapped. 79 80 Table XVI. HANDICAPPED PUPILS, YEAR ENDED 31st December 1971 ASCERTAINMENT DISTRIBUTION (As at last day of year) No. of ascertained cases known on 31.12.70 No. of new cases ascertained during year No. of ascertained cases known on 31.12.71 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 — — — 1 — — — — — — — 1 Partially-sighted 3 2 — — 3 2 2 2 1 - - - - - - - 3 2 Deaf 5 — 1 — 4 — 2 — 1 — — — 1 — — — 4 — Partially-Hearing 11 4 4 — 16 5 10 4 3 — 3 1 — — — — 16 5 Educationally Sub 66 27 3 2 45 21 34 17 5 2 3 1 3 1 — — 45 21 Epileptic 5 — 1 — 6 — — — — 6 — — — — — — 6 — Maladjusted 102 38 43 21 127 46 68 21 8 — 5 4 43 17 3 4 127 46 Physically Handicapped 23 12 1 6 19 20 16 11 — 3 1 2 2 — — 4 19 20 Speech Defects — 1 - - - - - - - - - - - - - - - - Delicate 14 6 3 2 17 5 3 2 9 1 3 — 2 2 — — 17 5 TOTAL 229 90 56 32 237 100 135 57 33 7 15 8 51 20 3 8 237 100 GRAND TOTALS 319 88 337 192 40 23 71 11 337 RESIDENTIAL SPECIAL SCHOOLS — Table XVII. Blind Partially Sighted Deaf Partially Hearing Educationally Subnormal Maladjusted Delicate Physically Handicapped Speech Defects Epileptic TOTAL Maintained Schools (LI42) Beechcroft (I.L.E.A.) i 1 Compton Diagnostic (Hants.) l 1 Elmers Court (Harrow) 2 2 Park Place (Hillingdon) 2 2 St. Nicholas (Surrey) 3 3 Suntrap (Harringey) 4 4 Swaylands (Barnet) 2 2 Non-Maintained (L/42) Bessels Leigh l 1 Breckenbrough I 1 Burton Hill House l 1 Condover Hall 1 1 Mary Hare l 1 Meath 2 2 Muntham House 4 4 Ovingdean Hall 3 3 Pield Heath House 1 1 Red Hill 1 1 St. Catherine's 1 1 St. Margaret's l 1 Southerndown l 1 Independent Recognised (L/70) Badgeworth Court I 1 Bladon House 1 1 Box Hill 1 1 Childscourt 2 2 Cokethorpe 1 1 Craig-y-Parc l 1 Dartington Hall 1 1 Dene Park 1 1 Falcon Manor 3 3 Farmhill House 1 1 Farney Close 2 2 Forest Grange 1 1 Frensham Heights 4 4 Guestling House 1 1 Grangewood Hall 1 1 The Hall, Wincanton 1 1 Hamilton Lodge 1 1 Hawthorne 1 1 Hengrove 1 1 Hilbre 1 1 Hollington Park 1 1 Horncastle 1 1 Hurn Court 1 1 Jollifies 1 1 Leighton Park 1 1 Monkton Wyld 1 1 The Mount 1 1 Normansal 1 1 Northaw 2 2 Peredur 1 1 Philpotts Manor 1 1 Potterspury Lodge 2 2 St. Agnes & St. Michael 1 1 St. Christopher's l 1 St. George's 1 1 St. Mary's Abbey 1 1 St. Mary's Wrestwood 1 1 St. Peter's 1 1 Salesian 2 2 Sandon House 1 1 Carried Forward 1 l 2 3 11 49 13 4 - - 84 81 RESIDENTIAL SPECIAL SCHOOLS — Table XVII. continued Blind Partially Sighted Deaf Partially Hearing Educationally Subnormal Maladjusted Delicate Physically Handicapped Speech Defects Epileptic TOTAL Brought Forward 1 l 2 3 11 49 13 4 - - 84 Seaford College 1 1 Sheiling 1 Shotton Hall 1 2 Sibford 2 2 Stanbridge 2 4 Westonbirt 4 1 Woodbridge 1 1 Other Independent Schools 1 Berrow Wood 1 Dedisham 1 1 Dennington 1 4 Pagem's 4 1 Hospital Schools 1 Lingfield 6 6 Smith's Hospital 1 Chailey Heritage 1 1 1 1 1 2 3 11 68 14 5 - 6 111 82 RESIDENTIAL SPECIAL SCHOOLS. Table XVII on pages 81 and 82 shows that the number of Handicapped Childre maintained by the Richmond upon Thames Education Committee in Residential Sped Schools as at 3 1st December, 1971, was 111. This compares with 81 as at 3 1st Decembe 1970. St. Hilda's Day Special School for Educationally Sub-normal Children, Barnes. Admissions during 1971 12 Discharges during 1971 9 Transferred to senior day school for educationally sub' normal pupils 7 Transferred to day school for severely sub-normal pupils 1 Left district 1 Number of children on roll as at 31st December, 1971 39 Clarendon Day Special School for Educationally Sub-normal Children, Hampton. Admissions during 1971 38 Discharges during 1971 16 Left school for employment 1 Transferred to ordinary schools 8 Transferred to residential school 1 Transferred to autistic unit 1 Left to attend Adult Training Centre 1 Left district 4 Number of children on roll as at 31st December, 1971 143 Strathmore Day Special School for Severely Sub-normal Children, Teddington. 61 severely sub-normal children were transferred from the Mental Health services and became the responsibility of the Education Committee under the Education (Handicapped Children) Act, 1970. Admissions since Education Committee took responsibility 19 Discharges since Education Committee took responsibility 4 Transferred to E.S.N, school 1 Left district 3 Number of children on roll as at 31st December, 1971 75 Normansfield Special Care Unit, Teddington. 27 severely sub-normal children were transferred from the Mental Health services and became the responsibility of the Education Committee under the Education (Handicapped Children) Act, 1970. Admissions since Education Committee took responsibility Nil Discharges since Education Committee took responsibility 10 Transferred to day school for educationally sub-normal pupils 1 Transferred to day school for severely sub-normal pupils 9 Number of children on roll as at 31st December, 1971 17 Oldfield House Junior Day Special School for Maladjusted Children, Hampton. Admissions during 1971 23 Discharges during 1971 22 Transferred to ordinary schools 11 Transferred to residential schools 5 Left for employment 1 Left district 5 Number of children on roll as at 31st December, 1971 54 83 Oldfield House Infant Day Special School for Maladjusted Children, Hampton. Admissions during 1971 19 Discharges during 1971 11 Transferred to residential schools 2 Transferred to ordinary schools 2 Transferred to Oldfield Junior School 6 Left district 1 Number of children on roll as at 31st December, 1971 26 Athelstan House Autistic Unit, Hampton. Admissions during 1971 1 Discharges during 1971 1 Left district 1 Number of children on roll as at 31st December, 1971 6 Handicapped Pupils. The year 1971 saw the implementation of the Education (Handicapped Children) Act, 1970, which became effective from 1st April, 1971. Under this Act severely sub' normal children became the responsibility of the Local Education Authority. I have therefore included this year under the heading of day special schools, Strathmore School for Severely Subnormal Children (previously known as Strathmore Road Junior Train' ing School) and Normansfield Special Care Unit. 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. 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 following table summarises the number of cases referred, seen and treated at the Clinic during 1971:— Referred Seen Under Intensive Treatment Under Supervision or Annual Review 109 90 61 86 Referring Agents: General Practitioners 10 School Medical Officers and Health Visitors 34 Consultants 1 Educational Sources 22 Parents 30 Speech Therapists 2 Social Services Department 6 Miscellaneous (Courts, N.S.P.C.C., etc.) 4 109 The task of psychotherapy has been shared between the psychiatrist and the psychotherapist. Two students from the Institute of Education have been attached to the Clinic and have assisted with remedial teaching. A Certificate in Social Work Course student from Chiswick Polytechnic was with us for 4 months. Some links have been established with Kingston College of Art. An analysis of case load including referral and symptom patterns and test results is in the process of preparation. Dr. Agnes Main— The following table summarises the number of cases referred, seen, and treated at the Clinic during 1971:— Referred Seen Under Intensive Treatment Under Supervision or Annual review 151 103 137 90 Referring Agents : General Practitioners 19 School Medical Officers 18 Head Teachers 34 Educational Psychologists ... 8 Parents 49 Speech Therapists and Health Visitors 6 Social Services Department 8 Miscellaneous Agencies 9 151 85 In December, 1971, Miss Marriott left the Clinic after 6 years to further her studies in adult and child psychotherapy. Her excellent services are missed by both the children and staff. Mrs. Powell, however, continues to provide us with unfailing psychotherapy time but the need remains, greater than ever, for further skilled help if we are adequately to cover the needs of the treatment waiting list in an area with an increased school and pre-school population. In January, 1971, Mrs. G. Doelly rejoined the Clinic after an absence of some 14 years, replacing Mrs. MacMillan, since retired. As a qualified psychiatric social worker also, she. joins Mrs. P. Lomax who has been at the Clinic some 14 years. We are indeed fortunate in having Mrs. Doelly as, in addition, she already has a good working knowledge of the Borough, its environs and the facilities available, to the benefit of all. I would once again mention our appreciation of the help provided by the Maria Grey College and Institute of Education (London University) mature students who, with supervision, have greatly assisted us in absorbing a number of children from our treatment and remedial teaching waiting lists. The Oldfield Day Schools for Maladjusted Children, with their increased numbers, continue to provide a firm and sympathetic background for a large number of children whose difficulties and problems cannot be absorbed into large classes of ordinary schools. In some cases, their attendance at Oldfield School runs parallel with psychotherapy at the Clinic. Contact with the parents and home background of all children attending the Oldfield Schools is maintained throughout the year. We look forward to the proposed establishment of a Senior Oldfield School as soon as possible since not all problems are resolved at secondary school age; indeed, some have only just begun. We have seen the progress of several children from Athelstan House to ordinary and residential schools. This has proved a mainly heartening step to the parents and all those concerned in the diagnosis and treatment of the autistic child the numbers of whom, fortunately, do not appear to be on the increase in this area. Table XVIII. Child Guidance Treatment. Number of cases known to have been treated. Pupils treated at Child Guidance Clinics ... 193 Table XIX. Orthopaedic and Postural Defects. Number of cases known to have been treated. (a) Pupils treated at clinics or out-patient departments 92 (b) Pupils treated at school for postural defects 53 145 86 SPEECH THERAPY. Therapists working in the Borough during 1971 were: — Miss Kathleen Buckman (Senior — Full-time). Mrs. Mary Pletts (Full-time). Mrs. Lesley Prout (Full-time until September; Part-time September to December). Mrs. Mary Hughes (Part-time). Mrs. Pleonie Tooley (Part-time until September). Mrs. Jennifer Kay (Part-time from September). During the year, 338 children attended for treatment at one of the following clinics or special schools:— Child Guidance Clinic, Twickenham; Windham Road, Richmond; Kings Road, Richmond; Mortlake; Essex House, Barnes; Ham. The special schools visited regularly were:— Oldfield House Infant; Oldfield House Junior; Clarendon E.S.N.; St. Hildas E.S.N.; Strathmore Road Junior Training School (Strathmore Day Special School as from 1st April, 1972). In the Autumn, Mrs. Hughes who treated children at the Strathmore Day Special School, increased her sessions from three to five visits each week. Almost every child would benefit from special therapy, but only a certain number can be admitted and owing to the slow progress of these cases discharges seldom occur. After the Summer term, visits to Athelstan House Autistic Unit were discontinued as it was felt by the speech therapists that unless these autistic children were visited daily the majority would not benefit from treatment. Since the Autumn, a few parents have brought their children to one of the clinics in the Borough and this has seemed to be a more satisfactory arrangement. During the year much work has been done among pre-school children. Parents have brought those of pre-school age to a clinic for advice and help. Day nurseries have had frequent visits, special care being given to watch children likely to need help in the future. Talks to parents have taken place at day nurseries and much preventive work can be done during a child's formative years. It is of course preferable to see children at a clinic but in some instances those who would not attend regularly have been treated at school where accommodation was made possible by the kindness of head teachers. There has been good co-operation between staff and therapists. As in past years students from Speech Therapy Training Schools attended regularly. 87 Table XX. Number of pupils treated by Speech Therapists under arrangements made by the Authority. Number of Children treated 338 Number of New Patients 121 Total Number of Attendances 4096 Number on Waiting List, 31.12.71 34 Number of Children Discharged 121 Normal Speech 72 Much Improved 31 Improved 3 Left district 3 Referred elsewhere, etc. 12 Uneventuated (non-attendance, etc.) - Table XXI. Types of cases treated during the year. Dyslalia 124 Retarded Speech and Language Development 87 Stammering 30 Indistinct Speech 30 Sigmatism 43 Nasality 4 Cleft palate 5 Dysphasia 4 Autism 3 Dysarthria 3 Dypraxia 2 Multiple Handicaps 2 Deaf 1 88 SCHOOL DENTAL SERVICE. Report of the Principal School Dental Officer, Mr. G. H. Tucker, L.D.S., R.C.S. During the year 1971 there were few changes in the staff. Miss A. Betteridge was appointed part-time orthodontist in January and Mrs. A. E. Cranfield resigned as a dental officer in April when her post was taken by Miss R. Terry. Mrs. D. Yerby was appointed as a dental surgery assistant early in the year. During the year 139 sessions were devoted to the dental inspection of the mouths of 10,956 children in schools, and a further 3,101 were inspected for the first time in the year at clinics. A total of 6,021 children were found to require treatment after inspection and all were offered treatment except those already attending their own practitioner. The number offered treatment was 5,390, and of these 4,066 accepted it. The number of sessions devoted to treatment was 1,810 and details of treatment are shown below arranged in age groups. 1,747 pupils were re-inspected at clinics and 1,288 of them were found to require treatment. Table XXII. Age 5—9. Age 10—14. Age 15 + First visit to clinic 1891 1792 383 Subsequent visits 2697 3502 679 Total visits 4588 5294 1062 Additional courses commenced 483 280 79 Fillings: Permanent teeth 1294 3493 1054 Fillings: Deciduous teeth 3253 433 Permanent teeth filled 1109 3075 950 Deciduous teeth filled 3002 396 Permanent teeth extracted 56* 461† 86‡ Deciduous teeth extracted 1087 326 — General anaesthetics 457 244 23 Emergencies 331 177 44 Pupils supplied with dentures — 4 1 Number of dentures supplied — 4 1 *This figure includes 11 teeth extracted for orthodontic purposes, f This figure includes 315 teeth extracted for orthodontic purposes. J This figure includes 34 teeth extracted for orthodontic purposes. The next table shows a wider range of treatment given but not divided into age groups. Table XXIII. No. of pupils X-Rayed ... 196 Prophylaxis 394 Teeth otherwise conserved 177 No. of teeth root filled ... 5 Inlays or crowns fitted ... 16 Courses of treatment completed 4102 Orthodontics : New cases pending from 1970 ... 90 New cases commenced ... 117 89 As in previous years all entrants to infant schools at the time of their first dental inspection were presented with a dental hygiene kit, consisting of a bathroom beaker, toothbrush and toohpaste, together with a letter encouraging parents to take an increased interest in their child's oral hygiene. Perhaps as a result of the encouragement given by these kits and the equivalence of 16 sessions devoted to Dental Health Education there have been marked increases in the number of attendances and the amount of treatment for children in the 5-9 year old group over the past four years. Table XXIV. 5-9 Age Group 1968. 1971. Change. No. of children at school 9402 9943 + 5.75% No. of attendances 3771 4588 + 21.5% No. of teeth filled 2542 4111 + 61% No. of teeth extracted 935 1143 + 22% No. of emergencies 385 331 - 16% Five clinics in the Borough have sessions devoted to general anaesthetics at regular intervals. One consultant and one appropriately qualified anaesthetist are employed on a sessional basis. The orthodontic surgeon at Church Road Clinic treated 207 patients with 320 removable and 51 fixed appliances. Treatment was completed for 19 children, but 9 courses of treatment were discontinued by reason of non-attendance of the patient. The dental laboratory which has a staff of one chief technician, 5 technicians and 2 a pprentices, supplies the needs not only of this Borough, but also of the London Boroughs of Brent, Ealing, Harrow, and Hounslow. The output of the laboratory, slightly increased from previous years, except that the number of dentures made continues to decrease, was as follows:— Table XXV. Dentures Ortho. appliances Inlays and Crowns Misc. 134 1901 114 994 NUTRITION. Meals. The number or children receiving mid-day dinners at maintained schools on a selected date in 1971 was as follows:— Date: Number of dinners Number of children in School % of children having dinner 6.10.71 *13,368 20,029 66 (approx.) *In addition, approximately 1,600 meals per day to Teaching, Kitchen and Cooking staff. Milk. The number of pupils present and number taking milk under the Milk-in-Schools Scheme on the 6th October, 1971 was as follows:— At maintained primary and secondary schools: Present. Taking Milk. A. Entitled to free milk on age grounds (pupils are entitled to free milk up to the end of the Summer Term after they reach the age of 7) 5070 4863 90 B. Entitled to free milk on health grounds. (Free milk may be recommended by the School Medical Officer for other pupils in Primary Schools. The number of pupils present in this section is the total number of pupils who fall into the category) 6691 Nil. C. At Maintained Special Schools 319 319 TOTAL at maintained schools 12080 5182 The number of children receiving milk at non-maintained schools on the 6th October, 1971, was 951 (number of children present who qualify for free milk on age grounds was 1,037). In September, 1971 meals were being cooked at 43 school kitchens and 3 central kitchens. THE EDUCATION (MILK) ACT, 1971 The Education (Milk) Act, 1971 and the Provision of Milk and Meals (Amendment No. 2) Regulations, 1971 came into effect on 1st September, 1971, and required local authorities to provide free school milk only for the following classes of pupils in maintained schools. (a) Pupils in special schools; (b) Pupils in other maintained schools up to the end of the summer term next after they attain the age of 7; (c) Other pupils in primary schools and junior pupils in all-age and middle schools where a school medical officer certifies that the pupil's health requires that he should be provided with milk at school. This legislation placed a new and continuing duty upon the authority to identify pupils in the 7-11 years age group, who may need milk on health grounds. A circular letter was sent out by the Chief Education Officer to the Head Teachers of all junior, and junior and infants' schools on 7th September, 1971, requesting them to inform the Principal School Medical Officer of any child who for any reason should be considered for a supply of free school milk. I subsequently asked for the names of all children in the appropriate age group who were in receipt of free school dinners as I am of the opinion that they should all be considered for free milk. Various trials were carried out by medical officers assisted by administrative staff to try to ascertain the best method of assessing the number of children overall who should have this free provision. This exercise inevitably meant a cut back in the number of periodic medical inspections that could be carried out which is reflected in the figures shown on page 70. These trials were found to be unsatisfactory and arrangements were put in hand to screen and to medically examine as necessary all children in the age group who appeared to be in need of free milk on health grounds. At the end of the year 276 children had been medically examined and 239 children were recommended for the issue of free milk. The process of screening continues. 91 Table XXVI. ROAD ACCIDENTS TO CHILDREN, 1971. Mr. M. S. Hebron, Borough Engineer and Surveyor, has kindly supplied the following details of road accidents to children under 16 years of age:— Month Fatal. Serious. Slight. Total. January *1 3 12 16 February — — 12 12 March — 1 11 12 April †2 2 11 15 May - 3 17 20 June — 3 15 18 July — 2 16 18 August — 2 15 17 September ‡1 5 18 24 October - 5 20 25 November - 10 10 December - 3 12 15 Totals 4 29 169 202 *Passenger, 2 in car in Sandy Lane, Teddington, which collided with lamp post. †Scooterist and passenger, both aged 15, in Broad Lane, Hampton, struck telegraph pole. ‡Pedestrian, aged 15, in Lower Richmond Road, struck by car. Table XXVII. DEATHS OF SCHOOLCHILDREN. It is with regret that I include the following details of local schoolchildren living in the Borough who died in 1971:— Sex Age Cause of Death. M F 1 16 Acute influenzal pneumonia. 1 15 Contusion and lacerations of brain with fractures of skull. 1 15 Multiple injuries — accidental death. 1 6 Drowning (Accident). 1 11 Fractured skull and lacerated brain. Accidental death. Pedal cycle/motor car. 1 10 Congenital bicuspid aortic valve. 1 14 Fractured neck with severe spinal cord damage consistent with injuries received in a road traffic accident. Struck by private motor car while crossing road on foot — Accidental. 1 10 la. Carcinomatosis. b. Papillary renal cell carcinoma of right kidney. 1 7 Asphyxia from drowning — Accidental death. 1 9 Cerebral abscess. 92 31-12-71