25/10/73 Ac-4413(i) The Health of Richmond upon Thames 1972 RICH 41 LONDON BOROUGH OF RICHMOND UPON THAMES ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER For the Year 1972 A. M. NELSON, m.b., Ch.b., d.p.h., f.f.c.m. Health Department, Kings Road, Richmond, Surrey, Telephone: TW10 6EF. 01 - 940 9761 CONTENTS PAGE Vital and General Statistics Infectious Diseases 11 Health Services: Care of Mothers and Young Children 17 Midwifery and Home Nursing 22 Health Visiting 26 Vaccination and Immunisation 28 Prevention of Illness, Care and After Care 29 Other Information 31 Sanitary Circumstances of the Borough 41 School Health Service 63 2 HEALTH COMMITTEE as at 31st December, 1972 § His Worship the Mayor, Councillor D. J. NEAL SMITH, M.D., F.R.C.O.G., F.R.C.O. (CHM.). § The Deputy Mayor, Councillor T. A. BLIGH, A.I.B. Aldermen K. I. MORELL (Chairman). Councillor W. K. WARREN, F.P.S. (Vice-Chairman). Alderman H. A. Leon, O.B.E., J.P. Alderman W. F. Nation. Councillor Mrs. H. M. Abell. Councillor Lady G. M. Connor. Councillor Mrs. R. M. Dickson, A.R.I.B.A. Councillor M. Gold, M.R.C.S., L.R.C.P., D.Obst.R.C.O.G. Councillor H. L. Lewis, C.B.E. Councillor Mrs. J. P. Mostyn. Councillor Mrs. D. P. Peters. Councillor Mrs. J. J. Roberts. Councillor J. B. Williams, M.B.E., T.D., D.L. J. K. Bleasdale, Esq., M.B., Ch.B., M.R.C.G.P. (Advisory). § (ex-officio). EDUCATION COMMITTEE as at 31st December, 1972 Alderman R. A. J. ALCOCK (Chairman). Councillor J. F. LAMBETH, F.I.A. (Vice-chairman). Councillor G. M. COOPER (Deputy Vice-Chairman). Alderman L. Defries-Porter, LL.B., Councillor L. W. Newstead, J.P. M.B.LM. Councillor N. J. Otty. Alderman D. G. Harris, J.P. Councillor Mrs. J. M. rardington. Councillor A. F. Arbour, B.Sc. (Econ.). Councillor Mrs. D. P. Peters. Councillor B. A. Bayliss, B.Com. Councillor D. G. Blomfield, M.A. Councillor M. J. Powell. Councillor Lady G. M. Connor. Councillor J. Roberts, B.Sc., F.C.A. Councillor P. T. Z. Goldring. Councillor G. J. Samuel, M.A. Councillor N. A. Grimston. Councillor T. R. Spain. Councillor S. Grose, B.A. Councillor W. V. Tate. Councillor J. L. Hargreaves. Councillor G. Tremlett, G.L.C. Councillor A. M. Leaney. Councillor S. D. Wade. Councillor H. L. Lewis, C.B.E. Councillor E. J. Masters, J.P., Councillor A. West. B.Sc. (Econ.), A.C.I.S., Dip. Soc. Councillor Miss O. J. Wilkins. Co-opted members: The Rev. D. B. Buckingham, B.A.; The Very Rev. Canon F. J. Davys; The Rev. O. Swan; Mrs. H. E. Bell-Wright; Mrs. M. E. Carter; Mrs. H. A. M. Champion; Mr. A. Dunne; Mr. L. F. Holmes; Mr. F. Pateman; Mr. L. Smith. 3 EDUCATION, SCHOOLS AND GENERAL PURPOSES SUB-COMMITTEE as at 31st December, 1972 § Councillor J. F. LAMBETH, F.I.A. (Chairman). Councillor N. A. GRIMSTON (Vice-chairman). § Alderman R. A. J. Alcock. Alderman L. Defries-Porter, LL.B., M.B.I.M. Councillor B. A. Bayliss, B.Com. Councillor D. G. Blomfield, M.A. Councillor P. T. Z. Goldring. 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. Councillor G. Tremlett, G.L.C. Co-opted members: 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; Mrs. H. A. M. Champion. § (ex-officio). OFFICERS Medical Officer of Health and Principal School Medical Officer : A. M. NELSON, M.B., Ch.B., D.P.H., F.F.C.M. 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., M.F.C.M. Senior Medical Officers : BERYL H. BANNER, M.B., Ch.B., D.Obst.R.C.O.G., D.C.H., D.P.H. CICILY M. CLARKE, M.A., M.B., Ch.B., D.C.H., M.F.C.M. SALLY E. FLEW, M.B., B.S., M.R.C.S., L.R.C.P., D.Obst. R.C.O.G., D.C.H., M.F.C.M. 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. (retired 30.6.72). MRS. J. G. JARVIS, S.R.N., Obstetric Cert., H.V.Cert. (from 1.7.72). Non-Medical Supervisor of Midwives and Home pursing 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 (died 9.3.72). D. J. LEGGE (from 3.7.72). 4 HEALTH DEPARTMENT, KINGS ROAD, RICHMOND, SURREY, TW10 6EF. July, 1973. 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 1972. The pace of the impending reorganisation of the National Health Service increased. During the year you took certain decisions to ensure that health activities took place on one site or in one building. The nursing staff property at Ranelagh Avenue, Barnes, was transferred to the Social Services Committee. At the same time accommodation at Essex House used by another Committee, was made available for the community nursing service. Other transfers have and will be completed during 1973. I would direct your attention to the completion of the Clean Air Act programme, the details of which are in the main report. There is fashionable, even fanatical, fervour on the subject of pollution of the environment. However, credit must be given to the substantial contribution made by society in Greater London to combat air pollution and the elimination of smog and "pea-soupers" of former eras. The incidence of commoner infectious diseases has continued to decline over the years. The "killers" and "cripplers" like diphtheria, poliomyelitis and whooping cough have been driven out of our community by protective immunisation against them. Their continuing absence can only be achieved if the immunity indices are kept high. Therefore strict vigilance by the health and medical disciplines is vital to raise these indices further. Health education must be progressed in this field with particular reference to protection against measles and rubella. It is one thing to have health information but it is quite another for the individual to be motivated to translate this information into action. Parents have a responsibility to themselves, their children, and society, to see to it that individual protection against infectious disease is undertaken. The majority does so, but a minority does not. There is a subtle difference between health education and education in the utilization of health and social welfare services. The former is the presentation of health information by facts and reasoned argument, not exaggerated propaganda. The monitoring of success is the reduction of the mortality and morbidity rates due to certain disease processes. The latter is a new facet in health service operations and of which we know little. Obviously individuals and the professions must know of, and how to use, the facilities of community health services. Such examples are youth advice, family planning, and well women clinics. In accordance with Department of Health & Social Security Circular 1/73, paragraph 8 (d), it is noted that you took no further action during the year. Miss D. M. Woods, your Superintendent Health Visitor, retired at the end of June 1972. Her extensive knowledge and calm presence welded together an effective health visiting team, especially during the early days of the Borough's existence. We wish her well in her retirement. 5 The death of Mr. H. J. Pugh, your Chief Administrative Officer, was a grievous and sad loss. Horace Pugh was a wise counsellor and loyal friend to all members of the health department. His contribution to the health of Teddington, Twickenham, and Richmond upon Thames over four decades will never be adequately assessed. It was an honour and pleasure to have known H. J. Pugh. 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 services; The Chief Officers. The staff of the health department have worked hard. I would especially thank Dr. Marguerite James, Mr. E. S. Herbert and Mr. D. J. Legge. I conclude by thanking the Health and Education Committees and their 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 1972 Area in acres 13,971 Population (census 1971) 174,628 Population—estimated to mid-year (as supplied by the Registrar-General) 172,560 Number of inhabited houses 62,832 Rateable value £11,691,258 Sum represented by a lp. rate £110,720 Total M. F. Live Births—Legitimate 2,031 1,084 947 Illegitimate 168 85 83 Total 2,199 1,169 1,030 Live Birth rate per 1,000 of estimated Population 12.7 Adjusted Live Birth rate per 1,000 of estimated Population 11.8 Illegitimate Live Births as percentage of total Live Births 8 Total M. F. Still Births—Legitimate 16 12 4 Illegitimate 2 1 1 Total 18 13 5 Still Birth rate per 1,000 live and still births 8 Total Live and Still Births 2,217 Infant Deaths (under 1 year of age):- Total M. F. Legitimate 24 17 7 Illegitimate 2 2 - Total 26 19 7 Infant mortality rate per 1,000 live births 12 Legitimate Infant mortality rate per 1,000 legitimate live births 12 Illegitimate Infant mortality rate per 1,000 illegitimate live births 12 Neo-Natal deaths Under 4 weeks of age Under 1 week of age Total M. F. Total M. F. Legitimate 19 14 5 16 12 4 Illegitimate - - - - — — Totals 19 14 5 16 12 4 Neo-Natal mortality rate (deaths under 4 weeks) per 1,000 total live births 9 Early Neo-Natal mortality rate (deaths under 1 week) per 1,000 total live births 7 Perinatal mortality rate (stillbirths and deaths under 1 week combined) per 1,000 total live and still births 15 Maternal mortality (including abortion) deaths Nil. Maternal mortality rate per 1,000 live and still births Total M. F. Deaths 2,347 1,094 1,253 Crude death rate per 1,000 of estimated population 13.6 Adjusted death rate 11.2 7 POPULATION The Registrar General's estimate of mid-year population for the Borough was 172,560, which is a decrease of 1,750 compared with 1971. The natural decrease (excess of deaths over births) was 148. 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 1972 172,560 1,750 -0.99% –148 – 1,602 BIRTHS During the year 2,199 live births were registered ( a decrease of 101 compared with 1971) giving a live birth rate of 12.7 per 1,000 of the population or 11.8 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 14.8. DEATHS The number of deaths registered in 1972 was 2,347 (an increase of 104 compared with 1971) giving a death rate of 13.6 per 1,000 of the population or 11.2 when adjusted by the comparability factor. The death rate for England and Wales was 12.1. The tables on pages 9 and 10 show 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 38.69 5.19 Cancer 21.43 2.96 Bronchitis, Pneumonia, and other respiratory diseases 15.00 2.35 Vascular lesions of nervous system 11.89 1.61 Accidents, Violence 3.32 0.45 INFANT MORTALITY During the year there were 26 deaths of infants under one year of age, a decrease of 13 on the previous year. The infant mortality rate was 12 per 1,000 live births compared with 17 for England and Wales. MATERNAL MORTALITY There were no recorded maternal deaths during the year. 8 Distribution of Deaths by Age and Cause Registrar General's Official Returns, 1972 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 - - - - - 1 1 - - 2 1 3 3. Late effects of respiratory T.B. - - - - - - - - - - 1 - - - - - 1 - 1 4. Syphilis and its sequelae - - - - - - - - - - - 1 - 1 - - - 2 2 5. Malignant neoplasm, buccal cavity, etc - - - - - - - - - - 2 2 - - 1 3 3 5 8 6. Malignant neoplasm, oesophagus - - - - - - - - - - 2 1 6 1 - 5 8 7 15 7. Malignant neoplasm, stomach - - - - - - - - - - 4 3 14 6 10 10 28 19 47 8. Malignant neoplasm, intestine - - - - - - - - 1 1 8 5 8 12 9 24 26 42 68 9. Malignant neoplasm, larynx - - - - - - - - - - 2 1 - - - - 2 1 3 10. Malignant neoplasm, lung, bronchus - - - - - - - - 1 2 52 14 42 10 15 9 110 35 145 11. Malignant neoplasm, breast - - - - - - - - - 3 - 14 - 19 - 14 - 50 50 12. Malignant neoplasm, uterus - - - - - - - - - - - 5 - 2 - 6 - 13 13 13. Malignant neoplasm, prostate - - - - - - - - - - 2 - 4 - 11 - 17 - 17 14. Leukaemia - - - - 1 - - - 1 - 1 2 3 - 2 1 8 3 11 15. Other malignant neoplasms - - 1 - - - 1 1 3 3 25 14 24 20 15 29 69 67 136 16. Benign and unspecified neoplasms - - - - - 1 - - - - - 1 - 3 - - - 5 5 17. Diabetes mellitus - - - - - - - - - 1 2 - - 1 4 7 6 9 15 18. Other endocrine etc. diseases - - - - - - - - - - - - - - 2 3 2 3 5 19. Anaemias - - - - - - - - - - - - - 1 - 4 - 5 5 20. Mental disorders - - - - - - 1 - 1 2 1 2 - 1 - 8 3 13 16 21. Meningitis - - - - - - - - 1 - - - - 1 - - 1 1 2 22. Multiple sclerosis - - - - - - - - - 1 2 - - - - - 2 1 3 23. Other diseases of nervous system - - - 2 - - - - 1 - 2 2 1 2 4 9 8 15 23 24. Chronic rheumatic heart disease - - - - - - - 1 - - 3 5 2 4 3 14 8 24 32 25. Hypertensive disease - - - - - - - - - - 4 1 11 3 3 17 18 21 39 26. Ischaemic heart disease - - - - - - - - 3 1 102 31 98 56 101 197 304 285 589 27. Other forms of heart disease - - - - - - - - 1 1 7 2 14 11 35 70 57 84 141 continued NO Distribution of Deaths by Age and Cause Registrar General's Official Returns, 1972 — 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 12 14 30 36 54 132 96 183 279 29. Other diseases of circulatory system - - - - - - - - - - 6 5 9 12 19 51 34 68 102 30. Influenza 1 - - - - - - - - 1 2 - - 2 5 8 8 11 19 31. Pneumonia - 1 - - - - - - 3 - 10 2 16 16 53 117 82 136 218 32. Bronchitis and emphysema - - - - - - - - - - 12 2 20 5 36 21 68 28 96 33. Asthma - - - - - - - - 1 - 1 - 2 - - 1 4 1 5 34. Other diseases of respiratory system 1 - 1 - - - - - - - 2 - - - 3 3 7 3 10 35. Peptic ulcer - - - - - - - - 1 - 2 2 2 1 3 7 8 10 18 36. Intestinal obstruction and hernia - - - - - - - - - - - 1 1 3 4 5 5 9 14 37. Cirrhosis of liver - - - - - - - - - 1 1 2 1 3 - 1 2 7 9 38. Other diseases of digestive system - - - - - - - - 3 - 2 3 3 3 1 11 9 17 26 49. Nephritis and nephrosis - - - - - - - - - - - 2 4 1 1 1 5 4 9 40. Hyperplasia of prostate - - - - - - - - - - - - 1 - 7 - 8 - 8 41. Other diseases, genito-urinary system - - - - - - - - - - - 1 3 2 4 8 7 11 18 42. Diseases of musculoskeletal system - - - - - - - - - 1 - - - 1 - 4 - 6 6 43. Congenital anomalies 2 2 - - - - - - 1 1 6 - - - 2 - 11 3 14 44. Birth injury, difficult labour, etc. 7 3 - - - - - - - - - - - - - 7 3 10 45. Other causes of perinatal mortality 3 - - - - - - - - - - - - - - - 3 - 3 46. Symptoms and ill-defined conditions 4 1 - - - - - - 1 - - - 1 - 1 2 7 3 10 47. Motor vehicle accidents - - - - 1 - 3 1 2 - 2 - 3 2 1 1 12 4 16 48. All other accidents - - - - 1 - - 1 3 1 4 2 1 3 3 5 12 12 24 49. Suicide and self-inflicted injuries - - - - - - 1 - 2 7 5 9 2 3 - 2 10 21 31 50. All other external causes - - - - - - 1 - 2 1 2 - - - - 1 5 2 7 19 7 2 2 3 1 8 4 32 29 291 151 327 248 412 811 1094 1253 2347 10 INFECTIOUS DISEASES The number of notifications received during the year compared with 1971 may be summarised as follows:— Disease. 1972 1971 Dysentery 9 11 Encephalitis (Acute) 2 1 Food Poisoning 5 11 Infective Jaundice 50 30 Malaria 4 2 Measles 161 306 Meningitis (Acute) 12 8 Scarlet Fever 28 26 Whooping Cough 5 24 Paratyphoid 1 1 Typhoid 2 2 Pulmonary Tuberculosis 31 26 Non-Pulmonary Tuberculosis 4 7 The table on page 15 gives the number of cases notified under age groups. Whooping Cough. There was a significant drop in the number of cases notified, 5 in 1972 as compared with 24 in 1971. Of the 5 cases, all are recorded as having been immunised and in one case a booster dose had been given. Measles. As can be seen from the histogram on page 12 the incidence of this disease has again been reduced since the programme of immunisation was commenced in the autumn of 1966. Nevertheless 161 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. The number of cases notified in previous years were:— 1960 57 1966 888 1961 2422 1967 1400 1962 112 1968 262 1963 1885 1969 262 1964 234 1970 380 1965 1992 1971 306 The distribution of cases during each quarter of the year 1972 was as follows : M. F. Total 1st January— 31st March 4 1 5 1st April—30th June 8 9 17 1st July—30th September 44 46 90 1st October— 31st December 22 27 49 Total 78 83 161 11 From the table below it will be seen that the first nine years of childhood are the prevalent period for this disease:— M. F. Total Under 1 year 4 3 7 1 year 9 12 21 2 years 7 4 11 3 years 6 11 17 4 years 14 8 22 5—9 years 32 39 71 10—14 years 6 2 8 15— 24 years – 1 1 25 + – 3 3 Total 78 83 161 Vaccination and Immunisation (see page 28). Dysentery. All nine cases notified were of bacillary dysentry. It was not found necessary to exclude any contacts from their normal employment. Food Poisoning. There was one family outbreak recorded during the year involving a mother and newly born baby both transferred from West Middlesex Hospital to the Infectious Diseases Unit of the South Middlesex Hospital six days after birth. About three weeks before the baby was born the mother and her husband had gastroenteritis but both responded to symptomatic treatment. At the time of her admission to West Middlesex Hospital, she had no diarrhoea or vomiting. Authority was given for the mother and baby to be discharged home, the baby as a confirmed Salmonella carrier (Salmonella Thompson Phage type 4) with arrangements made for stool specimens to be examined until negative results received. Figures for the previous ten years are as follows:— 1962 14 1967 3 1963 6 1968 30 1964 8 1969 22 1965 6 1970 11 1966 — 1971 11 Meningitis. Twelve cases were notified during the year, all of whom were admitted to hospital. The types notified were viral (10) and meningococcal septicaemia (2). Infective Jaundice. The arrangements made with the clinical research team at the West and South Middlesex Hospitals to assist in the pilot survey of the epidemiological aspects of the disease continued throughout the year. There was an increase in the number of cases notified, 50 in 1972 as compared with 30 in 1971, and 14 cases were admitted to hospital. 13 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 — 1 1 4 years — — — 5— 9 years 3 — 3 10—14 2 1 3 15—24 6 12 18 25—34 8 3 11 35—44 5 3 8 45—64 4 — 4 65+ 2 — 2 TOTAL 30 20 50 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. 44 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 Cases of Infectious Diseases Notified during the year 1972 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 - - 3 3 - - 1 - 9 Encephalitis (Acute) - - - - - - - - - 2 - - - - 2 Food Poisoning 1 - - - - - - - 2 - 2 - - - 5 Infective Jaundice - - - 1 - 3 3 5 13 11 8 4 2 - 50 Malaria - - - - - - - - - 3 1 - - - 4 Measles 7 21 11 17 22 71 8 1 - 1 1 1 - - 161 Meningitis (Acute) - - - - - 1 1 - 6 3 - 1 - - 12 Scarlet Fever - - 1 2 7 14 2 2 - - - - - - 28 Whooping Cough - - 1 1 1 2 - - - - - - - - 5 Paratyphoid - - - - - - - - - - - 1 - - 1 Typhoid - - - - - - - - - - 2 - - - 2 Pulmonary Tuberculosis - - - - - - - - 6 5 5 9 6 - 31 Non Pulmonary Tuberculoses - - - - - - - - - 2 1 - 1 - 4 Total 8 21 13 21 31 92 14 8 30 30 20 16 10 - 314 15 Sexually Transmitted Diseases. The following new cases have been notified by the undermentioned hospitals of patients treated from this Borough during 1972. Syphilis Gonorrhoea New Cases Total Other Genital Conditions Other Conditions West Middlesex 7 74 411 258 750 London 1 4 7 7 19 St. Thomas – 6 25 8 39 St. Helier 1 3 14 12 30 Westminster 1 8 38 12 59 St. Bartholomew's – – 15 5 20 Middlesex 1 2 62 33 98 Dreadnought Seamen's – – 1 2 3 Central Middlesex – 1 6 3 10 1028 Although the total cases notified show an increase of nearly 3% over the previous year, the importance of giving guidance to young people on this topic remains. Arrangements were made to display in post offices throughout the Borough the address of the nearest clinic where treatment could be received. Medical Arrangements for Long-stay Immigrants. The number of immigrants giving destination addresses situated in this Borough showed an increase compared with 1971 but there was still a large number (22.4%) who 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. Twelve 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, the figure of 76 for African countries including 63 from Uganda:— Country where passport issued Number of Immigrants Commonwealth Countries. 1972 1971 Carribean 7 4 India 15 21 Pakistan 13 5 Other Asians 58 20 African 76 22 Other 27 27 Non-Commonwealth Countries. European 26 22 Other 19 13 Total 241 134 16 CARE OF MOTHERS AND YOUNG CHILDREN Ante-Natal and Post-Natal Clinics Sessions held in local authority clinics 294 Antenatal Care : Number of women who attended 205 Attendances 1,026 Post-Natal Care: Number of women who attended 28 Attendances 54 Ante-natal relaxation and post-natal exercises are taught in all the clinics. 588 women made 2,896 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 1972 was 30. Family Planning Clinic Service. From the 1st April, 1972, the Council extended its family planning service to include the provision of free advice to all women, in addition to the free consultation and advice to those in medical or social need which was already available. During the whole year, the Council met the cost of advice and supplies for 1,156 women, and in the nine months from April to December the consultation only fee was paid in respect of 5,130 women. The Family Planning Association, acting as the Council's agents, provided the service for the majority of these women; a few residents were seen at Brook Advisory Centres. Domiciliary Service. In accordance with the Councils scheme, 32 cases were referred to the Family Planning Association for home visits up to the end of the year. Youth Counselling Service. In 1972 there was a major change of staff. Dr. Faith Spicer, medical consultant, left in October, having initiated the project in 1969. It was sad to see her go but she has left the clinic with a clear identity of its own, a clinic that not only provides a contraceptive service but can offer advice and counselling for young people with difficulty in other areas of their lives. Dr. Robina Thexton kindly took over the medical role until Dr. Alfred Model, especially experienced in the problems of young people, joined the staff at the end of the year. The receptionist also had to leave at the end of the year due to illness. 17 Despite all these changes at the clinic, patients have continued to come and there were 72 new cases referred during the year. The increase of 20 new referrals was mainly accounted for by an increase in referrals by friends of patients, making them one of the major sources. This is recognized at the clinic as a welcome indication that it is becoming a little better known amongst young people who could be potential patients. It is also interesting to note that the majority of this group of women patients who come for contraceptive advice had not previously been pregnant. The other main source of patients has been from the hospitals in the area, particularly The Royal Hospital, Richmond. The staff have once again been invited to discuss the clinic with other local authorities considering setting up similar services. Problems referred Referral Sources Age on referral Contraception 45 Hospitals 24 Under 21 50 Sexual problems 10 Family doctors 4 21-25 12 Other personal Health department 8 25 + 5 problems 10 Self-referral 1 Unknown 5 Practical problems 3 Friends 23 Miscellaneous 4 Social services 3 72 Other agencies 9 72 72 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 Greater London Council Oxford University Department of Medicine, Charing Cross Hospital Medical School Department of Health & Social Security — Joint Committee on Vaccination and Immunisation London Borough of Hounslow West Middlesex and South Middlesex Hospitals Paediatric Unit, St. Mary's Hospital Medical School, London, W.2. West Middlesex Hospital, Isleworth Subject of Survey Children suffering from Spina Bifida. Childhood Cancers. Urinary Tract Infections in Women. National Surveillance of Congenital Rubella Defects. Combined Obstetric/Child Health Project. Infective Jaundice (reference to this survey is made in the section of the report on infectious diseases, page 13). British Births — Child Study (follow-up of national sample of British Births Survey). Cot Deaths — deaths of children under age 12 months May 1968 — Sept. 1972. 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 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. 18 Special Observation/Handicap Register A register of children who are known to have a handicapping condition or who are regarded as being at special risk of developing a handicap that could impede or deflect their normal development continues to be maintained. Names for inclusion on the register are drawn from many sources including birth notification, hospital discharge reports and reports direct from health visitors and child health doctors. At the end of the year, 223 children under five years of age had been identified as requiring special observation whilst 226 children had a definite physical, mental or emotional handicap. Handicaps recorded:— Cerebral palsy 15 Mental subnormality 34 Congenital heart disease 20 Cleft lip/palate 20 Epilepsy 16 Visual defects 11 Spina bifida 8 Hearing loss 2 Diabetes 5 Other 95 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 had 5 sessions a week, two had 3 sessions a week, 7 had two sessions a week, 2 had 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 were held at sites in Hampton, Twickenham and Whitton. For details of attendances etc. during the year, see page 21. Developmental Assessments All children attending the child health clinics are examined at regular intervals to assess their progress and to advise parents on particular aspects of development and management. Many family doctors are also including this examination in their own child health sessions and where necessary children are referred for further specialist opinion. 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 1971 are also indicated. Table I. Pre-School Children 1972 1971 Examined at clinic 591 561 Requiring treatment 229 253 Commenced treatment 266 252 Attendances for treatment 530 534 Fillings inserted 542 491 Extractions 115 92 General Anaesthetics 58 56 19 Table II. Expectant and Nursing Mothers 1972 1971 Examined 63 74 Requiring treatment 60 70 Commenced treatment 68 68 Attendances for treatment 219 216 Fillings inserted 180 180 Extractions 29 35 Gum treatment 21 25 General Anaesthetics 5 6 Dentures supplied 6 6 X-rays taken 29 18 There has been very little change from 1971 either in the number of visits for treat' ment or the amount of treatment given. I would very much like to see many more young children under 5 years of age attending the dental clinics, especially for inspection. Unfortunately, departmental medical officers and health visitors can only refer young children whose mothers bring them to their clinics. Many young children are not even seen by a dentist until they start school, by which time, on average, each child has had decay in 2.5 teeth. At this age only about 17% of children have no decayed teeth. Welfare Foods The Council is responsible for the distribution of national welfare foods 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. Well Woman Clinics (Cervical Cytology) Well woman clinics were held regularly in the Borough and there were a total of 341 sessions in clinics and 10 sessions in factory and adult education premises. The clinics provide for a full physical examination and blood and urine testing as well as a laboratory examination of a cervical smear to identify early, symptomless cancer of the cervix and pre-cancerous conditions. In the factory and adult education sessions, the emphasis was on screening and only a breast and pelvic examination was performed. Starting in January, a central national cervical cytology registry was set up and any woman who has previously had a smear is automatically recalled in a further five years. From that time, a record has been kept in the registry for each smear taken, but some records had been kept previously and during the year 512 recall forms were received. Of these 267 were already attending either the well woman or older people's clinics in the Borough. The remaining 245 women were invited to make an appointment for a repeat smear : 108 replied that they had already had follow up smears. Many women are now having cervical smears taken in hospital clinics, family planning clinics and by their family doctors and 3,808 copies of results thus taken were received. These women's records were integrated into the Borough's three-year recall system and they will be invited to attend Council clinics at the appropriate time. This has already considerably increased the administrative work-load and will entail extra clinic staff time in the future as well as extra clerical assistance. Number of women who attended well woman sessions 2,072 Number of attendances 2,128 Number of smears taken 2,077 Number of positive results 5 Although only five women were found to have positive smears for cervical carcinoma a significant proportion of women were found to have other conditions , e.g. anaemia, hypertension, breast lumps and infections such as monilia and trichomonas. All were referred to their family doctors for further advice and treatment. 20 Child Health Clinics Number of children who attended during the year Number of sessions held by Total number of sessions in columns (5)-(8) Born in 1972 Born in 1971 Born in 19671970 Total Medical Officers Health Visitors G.Ps. employed on a sessional basis Hospital medical staff (1) (2) (3) (4) (5) (6) (7) (8) (9) 1915 2000 2572 6487 1109 101 207 51 1468 Total attendances during the year 37,826. 21 COMMUNITY NURSING SERVICES Staff as at 31st December, 1972 1 Chief Nursing Officer. o 1 Non-Medical Supervisor of Midwives 2 and Home Nursing Superintendent. 1 Deputy Non-Medical Supervisor of 14 Midwives and Home Nursing Superintendent. 27 2 Full-time Midwives. 1 1 Part-time Midwife. (0.5)* 31 11 Full-time District Nurses/Midwives. 1 Part-time District Nurse/Midwife. (0.5)* 6 1 Full-time Senior District Nurse. 3 37 Full-time District Nurses. 11 4 Part-time District Nurses. 1 (2.0)* 3 Full-time District Nurse Assistants. (7)* Part-time District Nurse Assistants. Sitters-In. Superintendent Health Visitor. Health Visitors (includes 3 Field Work Instructors, 2 Group Advisers). (2.2)* Part-time Health Visitors. Full-time Clinic Nurses. (5.3)* Part-time Clinic Nurses. Tuberculosis Health Visitor. Student Health Visitors. * equivalent whole-time. MIDWIFERY SERVICE Training Six midwives were approved as teachers and one midwife attended a refresher course as required by the rules of the Central Midwives Board. Twenty-four student midwives from Queen Charlotte's Hospital and West Middlesex Hospital completed their domiciliary phase of the single period midwifery training. 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) 133 „ „ „ „ „ (medical officer present) 161 „ „ „ „ „ at family doctors' clinics 345 „ „ „ „ „ at hospital clinics 51 Deliveries attended by Domiciliary Midwives Changes in midwifery patterns are reflected in the figures given below. More and more mothers are having their babies in hospitals and some of these women are attended by the community midwives. Number of deliveries attended:— In the home 107 In hospital 53 Early discharges attended : 461. The majority of discharges before the tenth day were planned. All midwives in the domiciliary service are asked to see that patients having home confinements have made arrangements with their own family doctor or another practitioner on the obstetric list. Doctors were booked for all the 107 patients delivered at home. 22 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 Bom at home or in a nursing home Nursed, entirely at home or in a nursing home Transferred to hospital on or before 28th day Total births Died Total births Died Total births Died Born within 24 hours of birth in 1 and under 7 days in 7 and under 28 days within 24 hours of birth in 1 and under 7 days in 7 and under 28 days 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 2 1 — — — — — — 1 — 1 — 2 — 2 Over 2 lb. 3 oz. up to and including 3 lb. 4 oz. 7 3 1 — — — — — 1 — — — 2 — 3 Over 3 lb. 4 oz. up to and including 4 lb. 6 oz. 31 1 2 — — — — — 1 — — — 2 — 4 Over 4 lb. 6 oz. up to and including 4 lb. 15 oz. 20 1 — — 2 — — — — — — — — — 5 Over 4 lb. 15 oz. up to and including 5 lb. 8 oz. 62 1 1 1 1 — — — — — — 1 — 6 Total 122 7 4 1 3 — — — 3 — 1 — 7 — 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. 23 Visits by Domiciliary Midwives A total of 10,438 visits were made by midwives as follows:— Ante-natal 2,094 During labour 345 Nursing, following domiciliary confinement 1,741 Nursing, following institutional discharge 3,741 Home conditions reports 762 Others 1,755 Total 10,438 Notification of intention to practise Under the rules of the Central Midwives Board, 13 midwives notified their intention to practise within the Borough. Twelve of these were the Council's domiciliary midwives, the other a domiciliary midwife practising privately. Medical Aid Medical aid was required for 28 patients as follows:— During Pregnancy Infant In Labour Puerperium Mild toxaemia 1 Sticky eyes 3 Premature labour Pyrexia 3 Thrush Feeding problems 1 with retained placenta 1 Engorged breasts 2 1 Delay in labour (1st staee) 5 Dysuria 1 Delay in labour (2nd stage) 2 Perineal infection 1 Foetal distress 1 Ruptured perineum 5 Post-partum haemorrhage 1 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. Home Nursing (Night) This service, which commenced as a pilot scheme in August 1971, built up rapidly and fully occupied the number of staff employed. The establishment of trained staff was increased during the year, but the recruitment of district nurse assistants was slower than had been anticipated. The majority of patients nursed were already receiving care from the day staff, but a small number were referred during the night from casualty depart' ments of local hospitals or from family doctors. The night sitters'in continue to work under the supervision of the district nurse when more continuous care is required for a patient. The Council also acts as agents for the Marie Curie Day and Night Nursing Service and Area Grant Scheme. 24 HOME NURSING SERVICE Day Night Total Persons nursed and visits made Total number of persons nursed 3,305 19* 3,326 Number of above over 65 years of age 2,425 13* 2,438 Number of above under 5 years of age 26 — 26 Total number of visits 112,975 6,434 119,409 Types of care given Number of injections 26,556 1,353 27,909 Number of dressings 20,195 14 20,209 Number of visits for general nursing care 31,560 4,889 36,449 Number of baths 19,685 — 19,685 Enemas 423 — 423 Changing of pessaries 189 — 189 Washouts 757 — 757 Attendance at minor operations 29 — 29 Preparation for diagnostic investigation 121 — 121 Other 17,620 678 18,298 Total number of treatments 117,135 6,934 124,069 No. of Patients No. of Nights Sitters-in Service 22 65 Marie Curie Service 25 63 * These figures represent the number of patients who received night nursing care only. The total number of persons visited by night nurses was 265. District Nurse Training Two district nurses received district training and 11 attended refresher courses. Two district nurses attended a first line management course. One student nurse undertaking the S.R.N. Integrated Training at West Middlesex Hospital/Chiswick Polytechnic was assigned to district nurses for the period of practical training qualifying her for the National Certificate of District Nurses. 25 HEALTH VISITING Cases visited by Health Visitors. Total number of cases seen Number of cases included in col (1) seen at special request of:— (1) Hospital (2) GP (3) 1. Children born in 1972 2608 33 26 2. Other children aged under 5 5710 13 40 3. Persons aged between 5 and 16 825 8 44 4. Persons aged between 17 and 64 1114 24 190 5. Persons aged 65 and over 1815 259 496 6. Households visited on account of tuberculosis 110 106 — 7. Households visited on account of other infectious diseases 20 4 8. Households visited for any other reason 365 6 40 9. TOTAL 12567 449 840 Number of persons included in lines 1—5 above who are:— 10. Mentally Handicapped 113 - 2 11. Mentally ill 214 97 23 Health Visitor Training Type of course Number of health visitors who attended Family Planning Association/National Childbirth Trust 6 Family Planning Training Course 1 Field Worker Instruction Course 2 Royal College of General Practitioners — Inter-professional Conference with doctors, social workers 1 Hearing Assessment Course 1 Management Appreciation 1 First line management course 1 group adviser A number of other health visitors attended day courses on various topics. Two students from Chiswick Polytechnic undertaking the Integrated S.R.N. Course were assigned to health visitors for one week's practical experience. COMMUNITY NURSING TRAINING The following made visits of observation to the Borough in 1972:— 5 Student teachers 2 Medical Practitioners (post graduate) 3 Medical students (Guy's Hospital) 1 Social worker 178 Student/pupil nurses 1 University graduate (hons. biology) 2 Sister Tutor Diploma students. 26 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. l½ 1 4. 1 5. 1 6. 1 7. 2 8. 1 9. 1 10. 1 1 11. 1 1 12. 1 13. 1 14. 1 15. i 16. 1 In practices 3, 4, 9, 10, 12, 14, 15 (and 11 in the case of the health visitor only), members of the nursing staff were fully attached to the practices, i.e. they provided, in consultation with the family doctors, the community health services in their particular sphere for the patients of the practices exclusively. In practices 1 and 2 the health visitor attended the doctors' child welfare (child health) clinics and liaised between the doctors and the appropriate health visitors for those patients who did not live within her own geographical area. In practices 1, 5, 6, 7, 8, 11, 13 and 16 the midwife attended the family doctors' ante-natal 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 community staff available. 27 VACCINATION AND IMMUNISATION Immunisation against Diphtheria/Whooping Cough/Tetanus (separately or combined), Poliomyelitis, Measles, German Measles. Type of Vaccine YEAR OF BIRTH Others Under 16 Total 1972 1971 1970 1969 1965/68 PRIMARY COURSE DIPHTHERIA 51 917 428 39 28 7 1470 WHOOPING COUGH 48 886 407 30 14 1 1386 TETANUS 51 918 428 39 28 54 1518 POLIOMYELITIS 33 926 423 37 23 19 1461 MEASLES 16 873 318 61 86 3 1357 GERMAN MEASLES — — — — 2 611 613 RE'INFORCING DOSES DIPHTHERIA 1 42 87 16 1118 244 1505 WHOOPING COUGH - 14 31 6 89 19 159 TETANUS 1 43 88 17 1123 535 1807 POLIOMYELITIS 1 40 79 19 1194 538 1871 28 Immunisation against Diphtheria, Whooping Cough, Tetanus, Poliomyelitis The decrease in the number of children immunized gives cause for some concern. Parents are encouraged to go to their family doctors for these immunisation procedures and this may well have had some influence on the figures. Measles Vaccination Some parents appear to be unconcerned about measles vaccination. Quite clearly, measles vaccination is having an overall effect on the number of cases. It is a pity that more parents do not take advantage of immunisation against this unpleasant and unnecessary infectious disease. Rubella Vaccination Apathy continues to exist and the take-up for rubella vaccination is still not all that could be hoped for. In 1971, twelve and thirteen year old girls were vaccinated and in 1972 the twelve year olds only. Maternal rubella can give rise to handicapping conditions in unborn children — tragedies that could be prevented by twelve year old girls having simple injections. Smallpox Vaccination Smallpox as a routine was discontinued in 1971. However, school children going abroad and persons travelling to smallpox endemic areas were advised to be protected. 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 doctors or, failing this, at the local clinic. B.C.G. Vaccination against Tuberculosis Primary Re-tests Number skin tested 3895 2283 Number found positive 318 1939 Number found negative 3364 184 Vaccinated 3416 177 The lowering of the age limit in September 1971 from 13 years to 11 years accounts for a continued increase in numbers. PREVENTION OF ILLNESS, CARE AND AFTER CARE Tuberculosis During 1972 there were 31 notifications of pulmonary tuberculosis and 4 notifications of non-pulmonary tuberculosis in the Borough, compared with 26 and 7 notifications respectively, in 1971. 29 The following table shows an analysis of cases notified in 1972. Age Periods. Respiratory Non-Respiratory M F M F 0—4 - - - - 5—14 - - - - 15—24 3 3 - - 25—44 8 2 3 - 45—64 3 6 - - 65 and over 4 2 1 - Age unknown - - - - Totals 18 13 4 - The total number of cases on the register at the end of the year was: Pulmonary 1128 Non-pulmonary 180 As may be seen from the Registrar General's official return there were 4 deaths from tuberculosis of the respiratory system and no deaths from non-respiratory tuberculosis in 1972. 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. Baldry, Consultant Physician, Ashford Chest Clinic:— 'I am gratified to note that we have only had four new cases of tuberculosis in your Borough during the past year and would say how pleased I am that the control of tuberculosis would appear to be maintained.' (b) Dr. C. O. Edwards, Consultant Physician, Kingston Chest Clinic:— 'We have notified the same number of cases in the last year as in the previous year. There is, therefore, still a reservoir of infection in the area, as in all other areas, and we must continue vigilance for some years to come, before this disease will be finally eradicated.' (c) Dr. D. Mcintosh, Chest Physician, Hounslow Chest Clinic:— 'As compared with 1971 there has been a further slight increase in the total number of notifications of tuberculosis in the area. In the main these are predominantly pulmonary infections occurring 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. 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. 30 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 1972, was as follows:— Adults 24 (24) Children - (-) Total 24 (24) Patients receiving free milk only 11 (11) Patients receiving extra nourishment only 2 (2) Patients receiving both free milk and extra nourishment 11 (11) (Figures in brackets show comparable figures for 1971). 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. 'Our Committee has been benefiting from two favourable trends during 1972. Firstly our income has been greater, partly due to a greater response to the Christmas Seals Sale appeal and partly to a grant from the Richmond Parish Charity Lands. Secondly — almost the more important — we are feeling the impact of the steady development of the Borough's Social Services Department in that more patients who need our help are coming to our notice. Financially the Seals Sale appeal brought in over £400, a figure that has not been reached since 1967, although the cost of the appeal continues to rise each year. The Richmond Parish Charity Lands' grant of £50 a year, although very useful, cannot be spent freely as recipients must be resident in the old parish. Unfortunately — or perhaps fortunately — there are few patients known to us who live there. From the welfare point of view there is no doubt that our new closer liaison with the Social Services Department at Rosslyn Road and with the Church Road Clinic, Teddington, are bringing chest patients to our notice whose existence would otherwise be unknown to us. It is to be hoped that this happy relationship will grow, enabling us to use our resources to the full for the benefit of new patients as well as the old. It may seem strange, almost extravagant, that we give grants for somewhat unusual items such as TV licences, school uniform, electric blankets, hospital cotton blankets, etc., but it is just these items that enable patients with a particular medical background or living in grim circumstances to receive help over and above that given by the authorities, national or local.' CARE OF THE ELDERLY Older People's Clinics The clinics for older people continued to be well attended. Unfortunately the many requests for appointments at the clinics have resulted in long waiting lists which cannot be resolved without increase in staff. 31 Clinics were held at the following 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 11 3,490 90 Kings Road Clinic, Richmond 1 1 392 21 Whitton Clinic 1 2 378 42 Mortlake Clinic 1 1 231 27 Both patients and staff have sorely missed the invaluable advice and guidance of Dr. Alfred Torrie, consultant psychiatrist, who died in April. Dr. Torrie was a valued member of the clinical team at the Kings Road Clinic and the Maddison Clinic at Ted' dington. He also held a very lively group discussion at the Day Clinic. Day Clinic The Day Clinic at Stanley Road continued to provide a special day each week for a small number of very disabled people who attended the Maddison Clinic and were considered to need more frequent support. The nature and cause of the disablements varied greatly, but all had much difficulty in getting about and thus were liable to be lonely, introspective and even depressed. Remedial exercises were an important part of the programme, supervised by a physiotherapist who also gave individual treatments. Health visitors advised on matters of weight, diet and food values, and also wise shopping to ensure maximum benefit for individual needs. Mental stimulation was equally important and, following Dr. Torrie's death, one of my senior medical officers held discussions on topics of general interest. Everyone was encouraged to participate and the exchange of views proved rewarding. On occasion an outside expert was invited to join the group to answer questions following a particularly created discussion. Tutors from the Richmond Adult College held special occupational classes and films on a wide variety of subjects were shown. All these provided a balance to the day's programme and were popular. Older People in the Community Liaison work in the community for the benefit of the senior citizens continued, both with colleagues in the hospital service and with the family doctors. My thanks are due to Dr. Phyllis D'Netto, consultant geriatrician at Kingston Hospital and to Dr. J. Andrews, consultant physician to the geriatric service at West Middlesex Hospital for their co-operation during the year. Close links were maintained with other departments such as the Social Services Department and the Housing Department and with the very many voluntary associations so that continuity of care could be given. Communication remained one of the key words where the welfare of the elderly were concerned, to ensure that there were neither gaps nor unnecessary overlaps in the total service. It is to be hoped that with the strengthening of the bonds between all agencies the elderly may become more aware of existing services 32 and benefits and be happy to avail themselves of such aids. Unfortunately, today certain elderly people come to our notice at a stage when it is seldom possible to do more than support them in their chosen way of life. During the year it was not found necessary to apply 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, Waldegrave 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) Domiciliary treatments. Categories of Persons Eligible for Treatment and Charges:— Category. Inclusive Charge Surgery. Domiciliary. (a) Expectant mothers 55p. 70p. (b) Nursing mothers 55p. 70p. (c) Elderly persons 55p. 70p. (d) Physically handicapped 55p. 70p. (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 September, 1972. Marginal hardship cases can receive special consideration within the assessment scales. Number of Persons Treated (a) Aged 65 and over By private chiropodists 5,546 In Social Services establishments 360 (b) Expectant Mothers By private chiropodists 13 (c) Disabled persons under 65 By private chiropodists 105 (d) Others By private chiropodists 528 Number of Treatments Given 1. In Patients' Homes — by private chiropodists 8,769 (8,219) 2. In Old People's Homes 2,112 (1,953) 3. In Private Chiropodists' Surgeries 24,988 (24,237) (Figures in brackets show the position in 1971). 33 Out of the 35,869 treatments given, 21,668 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. 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. The Sub-Committee of professional officers on Health Education has continued in its co-ordinating capacity. The subjects chosen for the monthly poster campaigns during 1972 were:— January Protection against Measles and Rubella * February Smoking March Care of the hair (infestation) April Diet (obesity) May Dental Care June Water Safety * July Sexually Transmitted diseases * August Poisonous Berries * September Home Safety (Elderly Persons) * October Care of the Handicapped (Mental and Physical) November Fireworks, Burns, Bonfires December Drink and Driving During those months marked with an asterisk a display was mounted in the window of the British Red Cross Society at Twickenham, for this facility I wish to thank Mrs. Burrington, Divisional Director. Mr. J. Dennett, Borough Safety Officer kindly co-operated on all Safety themes. Smoking The Borough was fortunate in obtaining the services of Dr. Charles Fletcher who preceded an Anti-Smoking Clinic by giving a public lecture entitled "Improving your Health." The Anti-Smoking Clinic was held the following week and was attended by 67 persons. I would like to thank the members of the British Temperance Society for supplying lecturers and films. Both these occasions were held at the Richmond Adult College and I am most grateful to the Principal Mrs. Lesley for allowing the use of these premises, also for the reunion which was held in March. On this occasion persons from previous clinics were also invited. This proved to be most beneficial in supporting the earlier clients and giving the later ones an opportunity of discussing their problems with those who had recently been through similar experiences. Sexually Transmitted Diseases Wide publicity throughout the Borough was given to this subject in July. 34 Exhibition of Association for the Handicapped The department was happy to contribute a stand to this exhibition and assist with publicity. Mind Week In addition to wide publicity for this week and its activities the department, in collaboration with the Social Services department produced a leaflet informing readers of the continuing help available in this sphere and the particular activities arranged for the week. I am indebted to the Richmond & Barnes and Twickenham & District Associations for Mental Health, Dr. Higgins of the Child Guidance Service and Mr. Richards, Director of Social Services. Health Education in Schools Talks by members of the Health Department staff were given to six secondary schools. Three of these had a Health Education series, and a further two borrowed from the resources available. Help was also given during the course run by the Adult College for some school leavers from Gainsborough School. Health Visitors gave talks on personal hygiene to girls in the top form of three junior schools, and several talks on care of the teeth to one infant school. Three Parent Teachers Associations were given talks by Medical Officers. Voluntary Organisations 22 organisations were given 27 talks and three received the services of a projectionist and projector. A wide range of subjects was covered. The annual meeting of leaders of womens' organisations had an increased attendance. Firms and Stores One store has given a series of four talks to their staff during their training period. Additional contact was made with 12 other firms and stores. Health Education in Clinics (1) Preparation for Childbirth Classes have continued with tuition from Health Visitors, Midwives and outside speakers. Good use has been made of the film 'Ready for Baby1 purchased at the beginning of the year. (2) Mothers Clubs. A Mothers Club has been formed at York House Clinic and one now started at Princes Road Youth Club has considerable help from the local Health Visitors. Both should prove very helpful when fully established. (3) Stanley Road Day Clinic. Educational films have been supplied each week. (4) Clinics for Older People. The informal weight-watchers group continues to receive talks on Health subjects from a Health Visitor. 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 1972 was as follows : Maternity Homes only Nil. Other Homes 5 Total number of beds 110 35 NURSES AGENCIES At the end of 1972, there were two nurses agencies on the register of this Local Authority. LOAN OF NURSING EQUIPMENT The Council owns some special nursing equipment including hoists, mechanically and electrically operated beds, etc. and all such items were loaned, free of charge, to patients who required nursing care. The British Red Cross Society continued to operate a scheme on behalf of the Council for the loan of standard items of nursing equipment. During 1971, the system by which the Council paid the Society's nominal charges for patients in receipt of supplementary benefit was discontinued and 1972 has shown conclusively that the direct grant method is far more satisfactory. I am indebted to Mrs. W. Burrington, Divisional Director of the Richmond upon Thames Branch of the British Red Cross Society for her continued help and co-operation. INCONTINENT LAUNDRY SERVICE The Borough's free incontinent laundry service continued to operate during 1972 and the year was marked by a considerable increase in the number of patients receiving the service. In December, 1971, about 100 patients were supplied but, by the end of 1972, approximately 200 residents were receiving the service following recommendations from the District Nurses. Linen sheets, which were laundered by a local firm, incontinence and polyweb pads, waterproof pants with disposable linings and night attire were included as appropriate and distribution and a >1 lection undertaken by one driver with a Corporation van. TELEPHONE ANSWERING SERVICE The facilities provided by Telephone Answering Services Ltd. (Air Call) continued to be used by the midwifery and night nursing services during 1972. 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. The number involved over the year was:— Total number of medical assessments 1,951 (1,802) Total number of physical examinations. 522 (479) Total number examined for continued service 18 (19) Total number found unfit for further service 9 (4) The figures for 1971 are given in brackets. Further medical advice is given as requested by any member of the Council's staff. 36 ARTIFICIAL DIALYSIS The Council continued to adapt the homes of patients referred by various hospitals for home dialysis purposes. Arrangements were made, with the co-operation of the Borough Engineer and Surveyor, for two premises to be suitably equipped during 1972 and, in one case, a Portakabin unit was supplied as no room was available for adaptation. Patients were assessed by the Borough Treasurer and required to pay a contribution towards costs although one patient received a nil assesment. The Council had, by 31st December, 1972, adapted eight premises for this purpose and the maximum individual cost was £2,000. Portakabin — Home Dialysis Installation. 37 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 through' out 1972. 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 estimates at 30th June, 1972, was 172,547. (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: River Thames-derived water from Hampton Works. 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 39. 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 from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead." During the year the Department took the following water samples for examination: a) Eighty-eight 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. Fifty-eight samples were satisfactory and 30 were below the recommended standard. Repeat samples produced satisfactory results. (See page 61 — Swimming Pools). b) Twenty-eight 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) Fourteen 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. 38 AVERAGE RESULTS OF THE CHEMICAL EXAMINATION of the water supplied to the London Borough of Richmond upon Thames during 1972. Milligrams per litre (unless otherwise stated). Description of the Sample Number of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMn044 hrs. at 27° C. B.O.D 5 days at 20° C. Hardness (total) CaCO, Hardness (noncarbonate) CaCO, Magnesium as Mg Sodium as Na Potassium as K Chloride as C1 Phosphate as P04 Silicate as SiO, 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 52 0.030 0.071 7.4 1.14 — 282 82 5.5 25.0 5.7 35 3.2 11 58 0.15 0.02 - 0.1 14 7.8 580 BACTERIOLOGICAL RESULTS — YEARLY AVERAGES, 1972 Source of supply BEFORE TREATMENT AFTER TREATMENT Agar plate count per ml. Coliform count Escherichia coli count Number of samples 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. 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 1,821 77.6 — 40.14 12.9 50.63 7.5 1,183 9.8 — 100.0 100.0 39 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., Engineer and Manager, Mogden Sewage Treatment Works for the following reports:— "(a) Sewerage The programme of replacement of compressed air ejectors by electric pumps is con' tinuing and one station in Hampton Court Road, Hampton Wick has been completed with a further station in that road in hand. Work has commenced on a contract for similar work on two stations in Hampton Court Road, Hampton. The foul relief sewer in Hampton Road, Twickenham is progressing and the surface water relief sewer for that area should be put in hand in the near future". "(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 improve ments are nearing completion and will be commissioned in early 1973. Sewage from the remainder of the Borough flows to the Mogden Sewage Treatment Works, which deals with some 104 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 12.4 tonnes (metric tons) per day from 15.3 tonnes per day in 1971". 40 SANITARY CIRCUMSTANCES OF THE BOROUGH E. S. HERBERT, M.A.P.H.I. Chief Public Health Inspector. 1. HOUSING (1) Unfit Houses. Work has been concentrated on 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. Inspections during the year show that this item of unfitness occurs in most of the older houses and is costly and can be difficult to remedy, particularly with stairways and landings. Several houses subject to Closing Orders have been rehabilitated during the year and 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:— 9/9a, Albany Road, Richmond; 3, Clifden Road, Twickenham (Second Floor); 6, Connaught Road, Teddington; 80a, Mount Ararat Road, Richmond; 34, Queens Road, East Sheen; 319, Richmond Road, Twickenham (Basement); 98. Amyand Park Road, Twickenham (Basement); 33, Eleanor Grove, S.W.13; 15, The Embankment, Twickenham; 72, Kings Road, Teddington; 7, Lion Road, Twickenham; 30, York Road, Teddington; 2a, Darrell Road, Richmond; 16, Gomer Place, Teddington; 97, High Street, Teddington; 10b, Udney Park Road, Teddington; 8, Elfin Mansions, Elfin Grove, Teddington; 2, Elfin Mansions, Elfin Grove, Teddington; 3, Elfin Mansions, Elfin Grove, Teddington; 10, Hampton Road, Teddington; 15, Tudor Road, Hampton; 3, Victor Road, Teddington; 80, York Road, Teddington; 37, Church Street, Twickenham (First & Second Floors); 1, Elfin Mansions, Elfin Grove, Teddington; 6, Elfin Mansions, Elfin Grove, Teddington; 41 43, Park Road, Teddington; 2, Trinity Road, Richmond; 41, Watts Lane, Teddington; 29, York Road, Teddington; 74, Clonmel Road, Teddington; 2, Darrell Road, Richmond; 4, Elfin Mansions, Elfin Grove, Teddington; 5, Elfin Mansions, Elfin Grove, Teddington; 9, Field Lane, Teddington; 11a, Onslow Road, Richmond; 12, Springfield Road, Teddington; 169, Staines Road, Twickenham; 46, Windsor Road, Teddington; 75, Amyand Park Road, Twickenham (Basement); 7, Elfin Mansions, Elfin Grove, Teddington; 17, Gilpin Avenue, East Sheen; 30, Ashleigh Road, Mortlake (First Floor); 30, Queens Road, Twickenham (Basement); 23, Windmill Road, Hampton Hill. The Council made Closing Orders or accepted from the owners undertakings in respect of the following premises:— Closing Orders and Undertakings 20a, Quens Road, Twickenham (Basement); 28, Queens Road, Twickenham (Basement); 183, Hampton Road, Twickenham; 9, Sheen Road, Richmond (First & Second Floors); 115, Waldegrave Road, Teddington (Ground Floor); 45, Windsor Road, Richmond; 6, Connaught Road, Teddington; 135, Sandycombe Road, Richmond; 139, Sandycombe Road, Richmond; 28, Crown Road, Twickenham (Basement); 9, Lion Road, Twickenham (First, Second & Part Ground Floors); 72, Victor Road, Teddington; 9/9a, Albany Road, Richmond; 3, Clifden Road, Twickenham (Second Floor); 80a, Mount Ararat Road, Richmond (Basement); 34, Queens Road, East Sheen; 319, Richmond Road, Twickenham (Basement); 27, Church Street, Teddington (Shed r/o); 72, Kings Road, Teddington; 98, Amyand Park Road, Twickenham (Basement); 33, Eleanor Grove, Barnes; 30, York Road, Teddington; 42 97, High Street, Teddington (Part of Ground & First Floors); 16, Gomer Place, Teddington; 2a, Darrell Road, Richmond; 15, The Embankment, Twickenham; 7, Lion Road, Twickenham; 8, Elfin Mansions, Elfin Grove, Teddington; 10b, Udney Park Road, Teddington (Ground Floor); 2, Elfin Mansions, Elfin Grove, Teddington; 3, Elfin Mansions, Elfin Grove, Teddington; 10, Hampton Road, Teddington (Ground Floor & Basement); 15, Tudor Road, Hampton; 3, Victor Road, Teddington; 80, York Road, Teddington; 37, Church Street, Twickenham (First & Second Floors); 1, Elfin Mansions, Elfin Grove, Teddington; 4, Elfin Mansions, Elfin Grove, Teddington; 5, Elfin Mansions, Elfin Grove, Teddington; 6, Elfin Mansions, Elfin Grove, Teddington; 43, Park Road, Teddington; 41, Watts Lane, Teddington; 29, York Road, Teddington; 74, Clonmel Road, Teddington; 2, Darrell Road, Richmond (Ground Floor); 9, Field Lane, Teddington; 12, Springfield Road, Teddington; 11a, Onslow Road, Richmond (First & Second Floors); 169., Staines Road, Twickenham; 46, Windsor Road, Teddington; 2, Trinity Road, Richmond; 75, Amyand Park Road, Twickenham (Basement); 7, Elfin Mansions, Elfin Grove, Teddington. The following properties were made fit for human habitation during the year and in each case the Order was determined or the undertaking cancelled : 38, Thames Street, Hampton (Ground Floor); 16, May Road, Twickenham; 7, Springfield Road, Teddington; 3, Avoca Villas, Blue Anchor Passage, Richmond; 69, Park Road, Teddington; 65, Queens Road, East Sheen; 22, The Embankment, Twickenham; 36, First Avenue, Mortlake; 46, York Road, Teddington; 24, Park Lane, Teddington; 35, Burtons Road, Hampton Hill; 43 12, First Cross Road, Twickenham; 76, Lonsdale Road, Barnes; 153, Amyand Park Road, Twickenham; 8, Station Road, Twickenham (Basement); 50, Upper Grotto Road, Twickenham; 5, Albany Passage, Richmond; 7, Albany Passage, Richmond; 31, Cross Street, Hampton Hill (Ground Floor); 73a, Church Road, Richmond (Basement); 51, Bushy Park Road, Teddington; 23, The Embankment, Twickenham; 43a, Onslow Road, Richmond (Basement). Existing Demolition Orders were revoked in respect of the following premises : 8, Briar Road, Twickenham; 12, Stanmore Road, Kew. All the above-mentioned dwellings were the subject of formal action under the Housing Act, 1957; in addition, repairs were effected at 319 dwellings after informal consultation with the owners, and 94 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 Nil (d) Dwellings represented for Demolition or Closing Orders 45 (e) Undertakings received to carry out repairs 1 (f) Closing Orders made in respect of — (i) Whole of building 29 (ii) Part of building 23 (g) Demolition Orders made Nil (h) Closing Orders determined on a building being made fit 21 (i) Demolition Orders revoked 2 (j) Undertakings cancelled on a building being made fit 2 (k) Dwellings in which defects were remedied after service of formal notice 94 (1) Dwellings in which defects were remedied after informal action 319 (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. Formal action taken during the year is shown below : (1) Number of Management Orders made Nil (2) Number of Directions made 1 (3) Number of Notices served requiring additional amenities 8 (4) Number of Management Orders revoked Nil 44 (3) Certificates of Disrepair Tenants of controlled premises are continuing to disregard the Rent Act as it no longer appears to provide a means whereby an owner is required to carry out repairs in order; to receive the prescribed rent. No applications were received during the year from tenants for a Certificate of Disrepair to be issued whereas in the 14 years following the introduction of the Act in 1957, 697 applications were received — 668 of. these during the period 1957/63. Two Certificates of Disrepair were cancelled during the year following application by the landlord. (4) Qualification Certificates Part III and Schedules 2 and 3 of the Housing Act 1969 has been repealed and replaced by Part III of the Housing Finance Act 1972. An interesting point in Section II of the Housing Finance Act, 1972 dealing with Slum Clearance subsidies, is the definition of slum clearance functions, which includes action under Sections 16 to 32 of the Housing Act 1957 (individual unfit houses). 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 1972 was as follows : Number of applications received 1456 Number of certificates issued 760 (5) Medical Priorities During the year 47 families who had been given priority on medical grounds were rehoused whilst a further 94 families were recommended for preferential treatment. I am grateful to the Housing Manager for his valuable assistance in rehousing so many families with medical priority during the year. (2) INSPECTION AND SUPERVISION OF FOOD (1) Meat Inspection Imported meat from the Continent has continued to arrive at one establishment in the Borough and this is inspected when off-loaded. (2) Food Complaints All food traders were again reminded in the early part of the year of the importance of proper rotation of perishable foods, and indeed the number of complaints arising from this dropped a little during the year, the total of 133 being 17 less than the previous year. FOOD AND DRUGS ACT, 1955 During 1972 legal proceedings were taken in 17 cases with the following results : 1. A bakery was fined £15 with £11 costs for selling a loaf of bread containing an insect. 2. A dairy was fined £20 with £5 costs for selling a packet of cheese affected with mould. 3. A manufacturer was fined £20 with £5 costs for selling a packet of cheese containing a piece of rubber. 45 4. A manufacturer was fined £25 with £5 costs for selling a sweet containing a piece of wire. 5. A bakery was fined £25 with £5 costs for selling a fruit slice containing a brass screw. 6. A grocer was fined £20 with £3 costs for selling a pork pie affected with mould. 7. A bakery was fined £25 with £5 costs for selling a loaf of bread affected with mould. 8. A manufacturer was fined £25 with £20 costs for selling a bottle of lemonade containing insects. 9. A supplier was fined £30 with £10 costs for selling a carton of rice containing mouse droppings. 10. A stallholder was fined £25 with £5 costs for selling escallops found to be unsound. 11. A garage company was fined £50 with £6 costs for selling a bottle of lemonade containing oil. 12. A grocer was fined £40 with £5 costs for selling a carton of potato salad affected by fungus growth. 13. A manufacturer was fined £25 with £5 costs for selling a pork pie containing a piece of wood. 14. A grocer was fined £25 with £6 costs for selling a carton of yoghurt affected with mould. 15. A dairy was fined £25 with £5 costs for selling a carton of yoghurt containing an insect. 16. A grocer was fined £15 with £3 costs for selling a flan case affected with mould. 17. A dairy was fined £30 with £5 costs for selling a bottle of milk containing a piece of glass. The following is a list of foods which were voluntarily surrendered and destroyed: Baby Foods (Tins) 139 Meat (Frozen) (Pkts.) 1784 Beverages (Pkts. & Tins) 96 Meat (Tins) 822 Butter (Pkts.) 40 Meat (Fresh) (lbs.) 3085 Cakes 312 Meat Extracts (Jars) 8 Cereals (Pkts.) 1140 Milk (Fresh) (Pints) 178 Cheese (Pkts.) 48 Pies, Pastries, etc. (Dozens) 60 Condiments (Pkts.) 7 Pie Fillings (Tins & Pkts.) 36 Drinks-—Soft (Bottles) 534 Pickles, Sauces (Jars) 77 Fats, Oils, etc. (Bottles) 114 Poultry (Whole) (Fresh) 133 Fish (Frozen) (Pkts.) 3361 Poultry (Frozen) (Pkts.) 247 Fish (Wet) (lbs.) 215 Puddings (Tins & Pkts.) 1053 Fish (Tins) 316 Sausages (lbs.) 8 Flour (Pkts.) 37 Salt (Pkts.) 46 Fruit (Tins & Pkts.) 4961 Soups (Pkts. & Tins) 684 Fruit (Fresh) (lbs.) 53 Sugar (lbs.) 244 Ice Cream (Pkts.) 1356 Sweets (Pkts. & Tins) 38 Ice Cream (2½ gallon tin) 2 Vegetables (Pkts. & Tins) 5239 Jam (Jars) 379 Vegetables (Fresh) (lbs.) 958 (3) Food Premises These received regular inspections during the year and in general the standard of hygiene is quite good. There are, of course, one or two premises which require extra supervision and the district inspectors pay particular attention to them. 46 Legal procedings were taken against the proprietors of three food premises for contraventions of the Food Hygiene (General) Regulations 1970 resulting in fines totalling £35 with £13 costs. 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 f No. of Premises which comply with Reg 21 No. of Visits carried out. Bakehouses 23 23 23 23 76 Butchers' Shops 117 116 117 116 247 Confectioners (Flour) 58 57 - - 107 Confectioners (Sugar) 236 235 - 248 Dairies 8 8 8 8 15 Fishmongers and Poulterers 32 32 32 32 50 Fried Fish Shops 26 25 26 26 35 Greengrocers and Fruiterers 119 117 119 119 233 Grocers 262 255 262 260 522 Ice Cream Premises—Manufacture 10 10 10 10 64 Ice Cream Premises—Sale and Storage 429 429 — Public Houses and Licensed Premises 246 243 246 245 368 Restaurants, Cafes and Canteens 352 345 352 350 721 Food Manufacturing Premises 3 3 3 3 29 1921 1898 1198 1192 2715 * Regulation 18 deals with the provision of hand washing facilities for all persons engaged in the handling of food. f Regulation 21 deals with the provision of facilities for washing food and equipment. (4) Stalls and Vehicles During the Spring and Summer Bank Holidays, visits were made to food stalls on the fairgrounds at Hampton Court and Richmond and the stalls in the area of Kew Gardens. There was a marked improvement in the standards of cleanliness after the first visits and it is intended to continue these inspections during the coming year. Legal proceedings were taken against six stall holders for contravening the Regula' tions and fines totalling £149 with £20.50 costs were imposed. (5) Sampling of Food During the year a request was received from the White Fish Authority to sample frozen oysters sold from a public house in the Borough. The Authority was endeavouring to promote the sale of frozen ready to cook oysters and were anxious to ensure that the quality remained high. Oysters on sale were in three forms, namely plain, in breadcrumbs and in batter, and all were found to be satisfactory when examined by the Public Health Laboratory Service. Samples of watercress were purchased from different sources to check for the presence of lesser pond snails and liver flukes, of which the snails are an intermediate host but none was detected. The food processing plant in the Borough which supplies prepacked meals continues to expand and samples have been taken in conjunction with their Laboratory service and the results compared. All samples taken were of a good bacteriological standard. 316 bacteriological samples were taken during the year of which 45 ice-cream samples were below standard. Visits were made to the premises and their sterilization methods checked, followed by repeat samples until a satisfactory standard was attained. 47 498 samples were submitted for chemical analysis to the Public Analyst. The following were found to be irregular : Natural Yoghurt The foil cap did not carry a full description. This was referred to the Chief Weights and Measures Inspector for action under the Trades Description Act, 1968. Black Currant Yoghurt The ingredients were not declared as required by the Labelling of Food Order, 1953. The manufacturers agreed to amend the wording on the carton. Boursin Cheese This is a soft cheese in which the water content was not declared as required by the Cheese Regulations, 1970. The importers discontinued this brand and sent specimen labels of their new imports which did comply with the Regulations. Decaffeinated Instant Coffee This was incorrectly described on the label. The manufacturers amended the label. Soft Cheese The sample contained an excess of 0.6% water. A further sample was taken and this proved satisfactory. Butter Ring Biscuits The sample contained fat of which 50% was butter fat. Consideration was given to the Code of Practice agreed in 1949 between the Ministry of Food and the trade and after receiving legal advice it was decided to take no further action on this sample. Butter Sultana Crunch The sample contained 20% of fat of which 9% was butter and the labelling was regarded as misleading. Further samples were taken and the matter is now being considered for formal action. Artichoke Bottoms The sample contained 330 parts per million of tin. This was found to be old stock and the existing stocks were surrendered. Chees'n Lobster The sample did not comply with the Labelling of Food Order, 1953. The importers agreed to amend the label. Indian Tonic 'Water The sample did not contain the required amount of quinine. It was found that the bottles had been stored in a position where sunlight had caused the quinine to break down. Further samples proved satisfactory. Glycerine Lemon and Honey The sample did not contain the required amount of honey. The manufacturers withdrew the existing stocks and further samples were satisfactory. Plus Vitamin C The sample was found to be deficient in Vitamin C and also did not comply with the requirements of the Labelling of Food Order, 1953. The manufacturers withdrew the existing stocks and amended the label. Further samples were satisfactory. Milk Loaf The sample was found to contain no milk solids. The manufacturers stated that it had been wrongly described by the sales staff and instructions have now been given to them on this matter. 48 Pate de Foie The sample did not have the appropriate description on the label. This was old stock and the wholesaler could not be traced. All existing stocks were surrendered. Milk Loaf The sample contained no whole milk solids. The manufacturers stated the sales staff had wrongly described the loaf as he did not make milk loaves. Instructions have now been given to the staff. Milk Loaf The sample contained no whole milk solids. The manufacturers admitted their error in omitting whole milk solids and their recipe has now been amended to include them. The following table shows the types of samples analysed and the results obtained Article. Number Analysed Number Irregular Dairy Products 52 5 Meat and Meat Products 90 - Fish and Fish Products 22 - Sugar and Preserves 35 - Sugar Confectionery and Chocolate 24 - Vegetables and Vegetable Products 34 1 Fruit and Fruit Products 47 - Cereals and Cereal Products 9 3 Flour Confectionery 18 5 Soft Drinks 29 1 Meat and Meat Pastes 23 1 Condiments and Sauces 4 — Soups 4 — Spices and Flavourings 40 — Food Additives 3 1 Oils and Fats 17 — Beverages 20 1 Drugs 17 1 Miscellaneous 10 1 498 20 (6) The Liquid Egg (Pasteurisation) Regulations, 1963 No pasteurising plants exist in the Borough and no samples were taken during the year. (7) Milk Supplies and Sampling Licences authorising dealers to store and sell designated milk were as follows : Ultra Heat Treated 74 Pasteurised 118 Sterilised 61 Untreated 17 63 samples of milk were examined and all were found to be satisfactory. (8) Ice-Cream Manufacturing and Sampling There are 10 manufacturing premises and 429 premises registered for the storage and sale of ice-cream. 49 3. ATMOSPHERIC POLLUTION The last of the Smoke Control Orders became operative on the 1st July, 1972 and details are as follows :— Order. Acreage. Number of Dwellings Number of Other Premises Twickenham No. 10 538 5778 600 The whole of the Borough is now subject to 31 Smoke Control Orders which govern 68,055 premises and cover 13,454 acres. It is most satisfying to report the conclusion of a programme which was begun on the 20th November, 1959 when the first Order was made and which had given the community such great benefits. It is hard to believe that twenty years ago 4,000 people in Greater London died in December 1952 as a result of smog and that again in 1956 a thousand Londoners died in the January smog. As late as December 1962, 750 persons died as a result of another smog incident and now thanks largely to the smoke control programme in Greater London few of the younger generation have experienced smog. The cost of the programme to the community has been met by proportional charges of 30% to the applicant, 30% to the Council and 40% to the Government in respect of approximately £440,000 worth of grant aided works. In addition it is conservatively estimated that at least a further £500,000 will have been spent in heating alterations which were not in any way eligible for grant purposes. The total cost of Air Pollution in this country was estimated in November, 1972 to be £1,190,000,000 per annum. This was stated in the Government Report "An Economic & Technical Appraisal of Air Pollution in the United Kingdom" which included in this sum £410,000,000 for direct costs of pollution, £510,000,000 for health and £100,000,000 for amenity losses. In considering these figures there is little to be complacent about and the need for vigilance remains. Now that smoke emissions from chimneys are only permitted under strict conditions, smoke from other sources has become far more conspicuous. In particular, smoke, grit and dust from open site burning behind business premises and on demolition sites and the black smoke arising from the "burning off" of roads prior to resurfacing, give rise to many complaints. In addition some householders are unaware that it is an offence to allow smoke from bonfires to be a nuisance to the inhabitants of the neighbourhood. In the case of demolition contractors, many seem unaware that they should not burn rubber, flock or feathers and that additionally they should only burn permitted waste matter if there is no other reasonable method of disposal. The burning itself must be carried out so as to minimise the emission of dark smoke and under direct and continuous supervision. These two latter conditions are frequently ignored. Burning off of public roads prior to resurfacing is unfortunately wholly exempt from the provisions of the Clean Air Acts. Technically this process can now be carried out without smoke emissions, and with up-to-date equipment becoming more readily available it is to be hoped that the road surfacing contractors will now modernize their equipment and play their part in reducing pollution. Despite the foregoing problems the overall picture for the future is bright, with further reductions in pollution levels envisaged. For example the smaller industrial and domestic boiler is now generally fired by natural gas, a sulphur free fuel, and in this Borough oil is becoming a less-used fuel for furnaces notified under the provisions of Section 3 of the 1956 Act. It would be most unfortunate if the change to sulphur-free gas should loose its impetus, for it is the reduction of the SO2 level in the atmosphere which is now proving intractable. 50 The following table illustrates this SO2 problem. Given are the daily average figures which are so far available over recent years. These figures relate to the three stations monitoring air pollution levels at Barnes, Hampton and Whitton and operated by this Department. Two other stations in Teddinszton and Kew are ooerated bv the Denartment of the Environment. of the Environment. It will be seen that whilst the concentration of smoke continues to lessen, the levels of SO2 are on the increase. 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 35 109 32 126 1972 35 130 34 118 33 151 During the year two Exemption Orders were made in respect of coal burning domestic appliances. The Smoke Control Areas (Exempted Fireplaces) Order, 1972 permits the installation, on conditions, of the Parkway Coalmaster, and the Smoke Control Areas (Exempted Fireplaces) (No. 2) Order, 1972 permits, on conditions, the installation of the Trianco TGB17. The coal miner's strike in February created difficulties for the fuel merchants but they managed to supply all who were in need and there was never any need to suspend smoke control orders. Six applications were made for approval of proposed chimney heights as required by Section 6 of the Clean Air Act, 1968. One was refused because the height was inadequate having regard to the amount of SO2 which it was intended to discharge from the chimney. Two occupiers of buildings in smoke control areas were found to be emitting smoke from fuels other than those authorised. Both complied with the Acts upon an informal request. In all 86 complaints were received concerning smoke emissions, approximately a 30% reduction on last year. All nuisances were abated on an informal approach. The fact that no prosecutions were necessary indicates the strength of public support for a cleaner environment. 51 4. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 The provision and maintenance of satisfactory standards of hygiene, welfare and safety for employees in offices, shops, warehouses, is broadly what the Act seeks to achieve and this work occupies the services of two full-time officers and approximately half the time of a Senior Public Health Inspector. The total of premises registered within the Borough at the end of 1972 and the number of such premises which had been subjected to a general inspection in the year are as follows : Total number of registered premises. Number of general inspections during year. Offices 758 677 Retail Shops 1,055 877 Wholesale Premises 36 27 Catering Establishments 218 191 Fuel Storage Depots 2 2 2,069 1,774 Part 1 — Registrations and Inspections Of the total of 2,069 registered premises 208 were newly registered during the year. In the same time 267 were removed from the register. The general inspections carried out represented 85% of the total premises. This is considered to be a very satisfactory coverage and ensures that conditions in our shops and offices are maintained at not less than the minimum statutory level in the interests of the 16,236 men and women employed in them. Few intractable problems arose over registration and in the few cases of doubt demarcation discussions with H.M. District Inspector of Factories decided the issue. It is perhaps indicative of the pressure on space in business that an unusual case arose of the use of a single premises by two entirely different businesses at different times. From Monday to Friday the premises operated as an employment agency but on Saturday it became a retail gramophone record shop — from pick of the jobs to top of the pops. Part II — Operation of the Act General. It is gratifying to report that no specific instances arose of exceptionally poor stand' ards for employees in offices and shops within this Borough. It is, however, necessary to add that few instances have been observed of exceptionally high standards. The provision of amenities above the minimum required by the Act such as staff rest rooms, kitchens, etc., imposes upon employers substantially higher costs due largely to the. inflated price of floor space in offices and shops. It is therefore perhaps unrealistic to expect any other than the most wealthy organisation to provide the staff with these extra refinements. In an assessment of those sections of the Act most frequently contravened, it is worth recording that absence of the Abstract of the Act (Section 50) easily heads the list. One wonders what happens to all the Abstracts placed on display. Inadequate first aid equipment (Section 24), obstructed floors, passages and stairs (Section 16), were the next most frequent contraventions whilst the failure to notify the fact of employment of persons on Form O.S.R. 1. (Section 49) arose 87 times. Remarkably few businesses appear to initiate registration of their own volition despite the requirements of the Act. They are gathered into the fold only as a result of the vigilance of the officer responsible for the area. Only 11 instances arose of failure to fence machinery (Section 17) and 4 cases of inadequate lighting (Section 8) were recorded. 52 Floors, Passages and Stairs (Section 16). Space becomes more and more the crux of the problems under this heading. With room for expansion in many successful businesses being either unavailable or prohibitive in cost the degree of congestion in stock rooms, passages and stairs increases markedly. Most Managers would appear to prefer these congested conditions to the obvious alternative of lower stock levels with more frequent deliveries — no doubt on the basis of the 'bird in the hand'. With present day standards of dependability of service this is perhaps understandable but the problems of cleanliness and accident hazards escalate alarmingly in overstocked and obstructed premises and the responsibilities of management for this situation are clear and inescapable. 92 contraventions arose under this heading. Hoists and Lifts Regulations. The Secretary of State's report on the administration of the Act for the year 1969 contained the statement that "when reports of unsafe lifts were received authorities ensured that the lifts were not used until the necessary repairs had been completed". For the most part, this statement is valid but there are aspects of the problem which are less than satisfactory. The Hoists 6? Lifts Regulations contain a built-in delay factor which allows a period of up to 28 days from the date of the lift examination within which the examiner should notify the Local Authority of a faulty lift (by forwarding a copy of the report of examination). This could and often does include a lift where the repairs required are classed as "immediate" if it is to continue to be used with safety. The Regulations are silent as to the next step available to the Local Authority to secure either (a) that the lift ceases to be used at once or (b) that immediate repairs are carried out. Recourse must be had to Section 22 of the principle Act which, however, compels 3 days notice to the Occupier before application is made to a Court for an order to prohibit its use until repaired. In the majority of cases, of course, responsible occupiers co-operate in adopting, on advice, either of the courses referred to above, but the occasional recalcitrant occupier or those anxious to postpone the evil day for reasons of expense present a day by day hazard with which the Local Authority can deal only within the limits referred to above. Manual service lifts (dumb waiters) still present the major problem of hoists failing to comply with the Regulations. The practical problems involved in providing for the liftway shutters or doors to be closed before operation of the ropes are unquestionably proving difficult to solve. Part III — Accidents Accidents reported in the year totalled 28 which was lower than the previous year's figure of 35. There is no information upon which to assess the number of accidents in registered premises which were not reported but it seems unlikely that any serious injury could be easily concealed. It is a pleasure to report that in no case was a contravention of the Act found to be a contributory factor in the accident and in consequence, the only action taken involved the offering of informal advice by letter in 4 cases and verbally in three. Sprains and strains, cuts and bruising were fortunately the majority of the injuries sustained and no fatal or serious results were reported. Strains from the handling of goods — lifting or pushing heavy loads were a recurring story and is a surprising factor in the context of modern methods of goods handling. Falls on steps, stairs or level ground were an equally common accident. Only 2 incidents involved power driven machinery. By far the largest number of all accidents were reported from retail shops (21), only 3 occurring in offices, 2 in wholesale premises and 2 in catering premises. An office accident of a somewhat unusual character occurred in which an employee was injured, 53 fortunately not seriously. The accident involved a vertical plan filing cabinet which is a heavy metal container in which large sheets of plans are suspended vertically from twin overlapping spikes. The front of the cabinet is hinged at the bottom to allow a tilt forward so as to disengage the spikes and permit the removal of the selected sheet. In this instance the cabinet was heavily loaded with plans and when the frontage was opened the entire cabinet toppled forward on to the employee. The transference of weight when the cabinet was opened had clearly moved the centre of gravity outside the base and perhaps assisted by some measure of leaning from the employee, the cabinet tipped over. In subsequent discussions with the manufacturer of the product, it was agreed that these cabinets should be anchored to either wall or floor, or where more than one are in use to each other in a back to back position. It would seem that no specific instructions to this effect are issued with the cabinets. Part IV — Prosecutions In no case was it necessary to resort to legal proceedings under this Act. 54 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 technical and general assistants. The assistance given by the pupil public health inspectors has also been greatly appreciated. Bacteriological sampling — IceCream 235 — Milk 52 — Other Foods 28 Clean Air Act — Inspections and Observations 3392 Control of Caravans 107 Diseases of Animals Act: Waste Food Order - Drainage and Sanitary fittings examination 3477 Food and Drugs Sampling 165 Houses inspected — Housing Acts 5107 Houses Let in Multiple Occupation 514 Housing Applications 19 Houses inspected —Public Health Acts 3845 Houses inspected re Permitted Numbers 24 Houses inspected re Vermin and Disinfestation 553 Infectious Diseases enquiries, disinfection, etc. 1102 Noise Abatement Act 628 Offices, Shops and Railway Premises Act—General Inspections 1774 Offices, Shops and Railway Premises Act — Other Visits 1906 Pet Animals Act 11 Prevention of Damage by Pests Act 12810 Rag Flock and Other Filling Materials Act 4 Rent Act, 1968 2 Swimming Baths — Sampling 58 Unsound food examination 838 Water Supply — Inspection 123 Water Supply — Sampling 25 Agricultural Holdings 1 Animal Boarding Establishments 3 Bakehouses 76 Butchers Shops 247 Confectioners (Flour) 107 Confectioners (Sugar) 248 Dairies 15 Factories (Mechanical) 89 Factories (Non-Mechanical) 8 Factory and School Canteens 106 Fishmongers and Poulterers 50 Fried Fish Shops 35 Greengrocers and Fruiterers 233 Grocers 522 Hawkers 184 Hairdressing Establishments 54 Ice-Cream Premises 64 Massage and Chiropody Establishments 45 Outworkers 116 Places of Public Entertainment 1 Public Houses and Licensed Premises 368 Restaurants and Cafes 721 Riding Establishments - Schools 11 Scrap Metal Dealers 1 Interviews 800 Miscellaneous Visits 2505 Inspections other than Houses — Public Health Acts 1973 Food Manufacturing Premises 29 Total number of visits and inspections 45411 55 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 246 Choked and defective drains and sewers 636 Defective water closets 69 Accumulations of offensive matter 179 Unsound food 133 Verminous and other Infested premises : (a) Bugs 36 (b) Rats and Mice 1256 (c) Wasps 377 (d) Fleas 87 (e) Others 234 Keeping of Animals 3 Nuisance from Pigeons 50 Smoke Nuisances 84 Noise Nuisances 91 Fumigation of Rooms 4 Miscellaneous 383 Condemned Food 93 Total 3961 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 227 161 Number of Informal Notices complied with 319 94 Number of Statutory Notices served 49 - Number of Statutory Notices complied with 94 — 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. 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, Director of Health Services of the London Borough of Hammersmith and to Mr. F. C. Baldwin, Superintendent of the Baths, for their valuable assistance during the year. 20 patients received treatment against scabies. In addition the bedding of 2 further cases who were being treated by their family doctor was cleansed. 7 persons were treated for lice infestation and the bedding of 1 person disinfested; 3 premises were disinfected following infectious diseases and 113 premises disinfested. Costs amounting to £443.80 were recovered. 7. PEST CONTROL Rats and Mice. The number of complaints received from the public again registered an overall small reduction over the preceding years. 56  1972 1971 1970 Number of complaints received 1,256 1,277 1,360 Number of infestations found 1,127 1,284 1,074 Total number of visits (first plus follow-up visits) by rodent control staff 11,512 13,873 10,401 Of the 1,127 infestations found, it is gratifying to report that the 730 caused by rats is an appreciably lower figure than the 928 for 1971— a 21% reduction. 88% of rat infestations occurred in domestic premises. The expected increase occurred in mice infestations, 397 compared with 356 for 1971 and further escalations must be expected in the light of the eradication problems when dealing with mice. The lower total visits made by the staff reflects the longer time devoted to survey work which, it is believed, is making a definite contribution towards the reduction of the rat infestations referred to above. Business premises treated under contract for rats or mice totalled 92 under private ownership (61 for rats and 31 for mice) with a further 38 under Local Authority ownership. Rats in the Sewers The annual test of 10% of approximately 3,500 sewer manholes in the Borough was completely revised in 1972. completely revised in 1972. Using the 18 municipal wards as units to ensure an even distribution, test baits were laid in approximately 20 manholes throughout each ward. A final total of 354 manholes were test baited and later re-examined for indications of rat activity. The results were as follows : Estimated number of manholes in the Borough 3,500 Manholes test baited 354 Number of manholes showing rats present 38 % of manholes showing rats present 10.7% The Surrey side of the Borough revealed greater sewer rat activity than the Mid' dlesex side. In one ward in central Richmond 50% of the manholes baited showed some activity. In two Surrey wards and four Middlesex wards no takes at all were recorded. A programme of poisoning in the affected areas was undertaken immediately following the test baiting. 131 manholes were poison baited on this occasion, and the process was repeated at quarterly intervals throughout the year — 4 poison treatments in all. The poison used was Fluoroacetamide. Surface Rat Infestations The mapping of every recorded rat infestation was continued through the year and ultimately a noticeable change was apparent in the distribution of surface rat reports. Hitherto there had appeared, not unexpectedly, concentrations of incidents in the centres and older parts of the Borough with suburban and more modern areas of property showing fewer indications. The trend revealed during 1972 was towards a more even distribution of rat reports with few areas of the Borough now entirely escaping the depredations of the vermin. No clear evidence of the reason for this change is available but one factor may well be the continued demolition or renovation of older areas of property in the urban centres. These operations reduce the harbourage available to rats and at the. same time the suburban residential areas have registered a steady increase in activity producing a levelling up pattern. Surveys of defined areas for evidence of rats continued successfully during the year, 45 such areas having been subjected to this close scrutiny. Many of them consisted of open lands, river banks, waste lands and allotments. Several rat infestations caused considerable havoc amongst the crops on some allotments although part of the damage may well have been due to rabbits. 57 Domestic gardens still form by far the commonest site of rat infestations in this Borough and most are confined to the exterior of the property. In the few cases where rats were found inside the building the principal cause arose from the eroding away or the breaking of the ventilator gratings in the external walls which are provided for underfloor ventilation. A hole in but one of these provides entry for the rat to considerable areas of underfloor space and from there to all parts of the house. One rat infestation discovered in a shop on the street level of a very new multistorey office building provided a problem as to its source — until it was eventually revealed that some pet rats had escaped from a cage in a pet shop in the same block and that not all of them had been recovered. Mice That mice are a growing problem is generally agreed. This is due to several factors the principal ones being the acquired resistance of mice to warfarin and to the widespread subdivision of large properties into smaller accommodation units. Fully alive to the need for a re-assessment of the future mice policy, the Ministry of Agriculture, Fisheries and Food in 1972 initiated a rodent survey in the Greater London area. The method adopted involved the random selection by computer of some 500 premises (domestic and business) each of which was visited over a period of one month and enquiries made as to infestations past or present. The overall results have yet to be published. The Department's enquiries into so many premises revealed a tendency of occupiers to regard mice with considerably more tolerance than is desirable and for the occupier himself to undertake the treatment of the premises using, all too often, materials which have already been found largely ineffective Grey Squirrels The presence of grey squirrels still remains a problem especially when they invade roof spaces of houses. The department has no statutory obligation to deal with infestations but when complaints are received appropriate advice is given. It is hoped that, in the reasonably near future, legislation will be introduced giving authority for more positive action to be taken to deal with the destruction of these pests. Feral Pigeons By virtue of Section 74 of the Public Health Act, 1961 a local authority may take action for mitigating nuisance from pigeons. Routine treatment of three bridges providing harbourage for pigeons which caused such fouling of the pavements as to be a hazard to pedestrians was maintained. The work being carried out is proving successful and the pigeon population under the bridges has been reduced to a minimal number. It is, however, necessary to continue appropriate treatment so as to keep the matter under control and prevent a recurrence of serious nuisance. Wasps Nests During the months of July to October 439 requests were received from residents in the Borough requiring advice or help regarding the destruction of wasps. This showed a reduction for the similar periods of 1971 and 1970 when 501 and 588 complaints were respectively received. The Council has no statutory power to deal with the problem of wasps nests but when complaints are received advice is given or arrangements are made for two private contractors in the Borough to carry out the work of destruction for which they charge a reasonable fee to the complainant. The reduction in the number of complaints of infestation over the past three years may be due to natural conditions but there is no doubt that the efficiency of the work carried out by the contractors in destroying the nests and hence breaking down the life cycle of the insects has contributed much to the reduction of infestations. 58 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 8 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 577 89 8 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — — Totals 583 97 8 — (2.) Cases in which DEFECTS were found. Particulars Number of cases in which defects were found Number of cases in which pros*' cutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S. 1) 1 - - 1 - Overcrowding (S. 2) - - - - - Unreasonable temperature (S. 3) - - - - - Inadequate ventilation (S. 4) - - - - - Ineffective drainage of floors (S. 6) - - - - - Sanitary Conveniences (S. 7) (a) Insufficient - - - - - (b) Unsuitable or defective 6 5 - 5 - (c) Not separate for sexes - — — — — Other offences against the Act (not including offences relating to outwork) 1 - - - - Totals 8 5 - 6 - Part VIII of the Act, Outwork. Nature of Work Section 110 Section 111 No of outworkers in August list required by Section 110 (1)C No. of cases of default in sending lists to Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing Apparel 22 — — — — — Electrical Fuse Makers 48 — — — — — Artificial Flowers 28 — — — — — Lampshades 10 - — — — — Total 108 - - - — — 59 9. MORTUARY. The Mortuary at Hampton continued to function satisfactorily and the number of bodies admitted during the year was 793. 10. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 There are no premises in the Borough using rag flock and other filling materials. 11. DISEASES OF ANIMALS ACT, 1950 RIDING ESTABLISHMENTS ACTS, 1964 and 1970 ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 PET ANIMALS ACT, 1951 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, 1972 is as follows Riding Establishments Acts, 1964 and 1970 Inspections were carried out at three riding establishments and recommendations were submitted for re-licensing. One establishment closed down during the year. Animal Boarding Establishments Act, 1963 Seven animal boarding establishments were inspected and recommended for relicensing. One of these was a new establishment while another had re-opened having been closed since 1969. Pet Animals Act, 1951 Visits of inspection were made regularly to pet shops and 17 were recommended for re-licensing. Three new shops were opened during the year. Regulation of Movement of Swine Order, 1959 Two movement licences were received authorising the movement of pigs. Performing Animals (Regulation) Act, 1925 Three visits of inspection were made to Television Studios in connection with the use of animals in productions. Performances were witnessed, animals and certificates inspected, etc., and all was found to be in order. Two circuses were visited and inspections carried out of animals, quarters, equipment, certificates etc., and all was found to be satisfactory. General Regular visits of inspection were made to the following premises:— Piggery, Harvey Road, Hounslow Seven visits were made and the premises were satisfactory. Dairy Farm, Petersham Meadows Farm, Richmond Conditions were excellent. Kosher Butcher, Red Lion Street, Richmond Conditions were very good. Bushy Park and Richmond Park Cattle, deer and sheep grazing in excellent conditions. 60 Acts and Orders The following were received and advertised as necessary: — Newcastle Disease (England and Wales) Order, 1971. Brucellosis (Eradication Areas) Orders. Brucellosis (Area Eradication) Orders. Diseases of Animals (Approved Disinfectants) Order, 1972. Diseases of Animals (Approved Disinfectants) (Amendment) Order, 1972. Tuberculosis (Compensation) Amendment Order, 1972. Diseases of Animals (Miscellaneous Fees) Order, 1972. Live Poultry (Restrictions) Amendment Order, 1972. Foot and Mouth Disease (Infected Areas) (Vaccination) Order, 1972. Foot and Mouth Disease (Infected Areas) Special Orders Nos. 1-4, 1972. Swine Vesicular Disease (Infected Areas) Special Orders Nos. 1-5, 1972. 12. ESTABLISHMENTS FOR MASSAGE and/or SPECIAL TREATMENT Thirty'two 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. A. Woodward, N.D.H., F.I.P.A. (Dip.), Recreation Manager, for the following report :— "Swimming Pools (Open Air) Bathing facilities are provided at three Open Air Pools, during the summer period, within the Borough, each of these properties being owned by the Council. The water capacity of each of the Pools is as follows : Twickenham Open Air Pool 280,000 gallons Hampton Open Air Pool 206,000 gallons Teddington Open Air Pool 180,000 gallons this water being supplied by the Metropolitan Water Board. The pools' water is filtered through pressure sand filters and sterilized by chlorine gas treatment operating on the "marginal" principle. The pool water at the Twickenham and Teddington Pools is turned over once every 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 above pools and including Richmond Baths are made monthly and, during the past year 88 samples have been taken, of which 58 were satisfactory and, whilst the remaining JO were below the recommended standard, repeat samples in each case have produced satisfactory results. Richmond Baths (Indoor and Open Air) The new Richmond Baths establishment, of a "combination" nature, situated in the Old Deer Park, Richmond, was opened to the public in August, 1966. The establishment consists of one main Indoor Pool 110' x 42', water capacity of 210,000 gallons and a turnover rate of 3 hours; one Indoor Learner's pool 42' x 24', 61 water capacity of 17,000 gallons and a turnover rate of 1½ hours, and an, Open Air pool 110' x 42', water capacity of 160,000 gallons and a turnover rate of 4 hours. The filtration of all pools' water is through Pre-coat filters, and sterilization is carried out by chlorine gas treatment on "breakpoint" principle. A system of pool water sampling and testing is installed and all 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 Ten samples of fertilisers were taken during the year of which five were found to be irregular. The Agricultural Analyst reported that, upon analysis, the percentage of certain ingredients in samples of Blood Fish and Bone, Superphosphate, Hoof and Horn and two samples of Growmore differed from those declared on the statutory statement and were in excess of the limits of variation allowed. The respective retailers and manufacturers were informed but, as it was considered that the differences were not to the prejudice of the purchaser, no further action was necessary. 15. COMMON LODGING HOUSES There are no common lodging houses in the Borough. 16. HAIRDRESSERS AND BARBERS At the end of the year 167 hairdressers' premises were registered and in no case was it necessary to take legal proceedings. 17. POISONOUS BEADS A B.B.C. programme in the West of England on 25th May, 1972 sparked off a widespread concern over a somewhat unusual health hazard. It was revealed that certain necklaces made from local products in Africa, Asia and Central America often contained a brightly coloured pea grown in these areas. The pea known as Abrus Precatorius or Rosary pea is a small orange/red oval object with a black patch at one end where it joins the pod. They have for a very long time been used in rosaries and because of their bright colour and high gloss have been incorporated in many links of beads or other souvenir objects sold to tourists. The anxiety was created by the realisation that the peas contain a poisonous alkaloid — abrin. However it has now become clear that undamaged peas could be swallowed with little risk as the outer coat is so hard that the peas escape disintegration and the toxin is not freed. Taken intravenously or subcutaneously the poison is much more dangerous although this is an unlikely circumstance. A more predictable risk lies in the pea pierced for stringing in necklaces or other beaded objects which if chewed or sucked could release some of the abrin into the system. As children and indeed wearers of necklaces are often prone to suck such objects it was considered advisable for items containing the offending pea to be destroyed with the owners' approval. Some 35 objects were examined by the Health Department many of them received through the Police. The majority were necklaces consisting of a variety of naturally colourful peas or beans but included a beaded table mat and a brooch. One consignment of approximately 100 necklaces were examined and all proved safe. A total of 16 necklaces consisted wholly or in part of the Abrus Precatorius as did the table mat and the brooch and in addition we received a specimen branch of the climbing plant with peas in pod. The remainder of the specimens proved harmless and were returned to their owners. The advice of Dr. Polhill of the Kew Herbarium in this matter was much appreciated. 62 SCHOOL HEALTH SERVICE POPULATION. The population of Richmond upon Thames at mid-1972 was 172,560 (1971— 174,310) of which 21,209 (1971—21,433) were school children in maintained schools. I am indebted to Mr. M. J. Gifford, B.Sc., Chief Education Officer, for the inform ation given in Table I. below, Table XVI on pages 74 and 75 and for the information on Meals and Milk in schools on page 83. Table I. SCHOOL POPULATION (as at 25.1.73) No. of schools Number on Registers Total Boys Girls Secondary Grammar 5 1,598 1,471 3,069 Secondary Modern 11 2,609 2,337 4,946 Primary 52 6,362 6,354 12,716 68 10,569 10,162 20,731 Nursery 2 52 48 100 Day Special Schools/Units for (i) Educationally subnormal children 2 108 75 183 (ii) Severely sub-normal children 2 59 39 98 (iii) Maladjusted children 2 68 21 89 Autistic Unit 1 6 2 8 9 293 185 478 Total 77 10,862 10,347 21,209 A decrease of 224 pupils compared with the number in the previous year should be noted. 63 MEDICAL INSPECTION AND TREATMENT Year ended 31st December, 1972 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) 1968 and later 154 152 98.70 2 1.30 1967 805 802 99.63 3 0.37 1966 1112 1103 99.19 9 0.81 1965 178 177 99.44 1 0.56 1964 93 93 100.00 - - 1963 63 63 100.00 - - 1962 83 82 98.80 1 1.20 1961 191 187 97.91 4 2.09 1960 874 868 99.31 6 0.69 1959 402 399 99.25 3 0.75 1958 289 286 98.96 3 1.04 1957 and earlier 752 747 99.34 5 0.66 TOTAL 4996 4959 99.26 37 0.74 B. — OTHER INSPECTIONS. Number of Special Inspections 4,457 Number of Re-Inspections 2,767 7,224 Periodic Medical Inspections. The number of children inspected at routine periodic medical inspections was 4,996 (1971—5,424). Special examinations and re-inspections were 7,224 compared with 6,127 for the previous year. 64 Physical Condition of Pupils Inspected. The general physical condition of school children remains high. Out of 4,996 children examined only 37 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) 1968 and later — 17 17 1967 17 103 111 1966 43 190 213 1965 10 50 55 1964 3 26 28 1963 5 32 35 1962 7 37 40 1961 14 58 67 1960 54 103 148 1959 28 54 76 1958 22 36 54 1957 and earlier 77 105 172 TOTAL 280 811 1016 The 5.6 per cent of children inspected who were found to require treatment or under treatment for defective vision, compares with 5.3 per cent in 1971, 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. Table IV. Defects found by medical inspection in the year ended 31st December, 1972. 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 48 92 25 48 56 84 129 224 5 Eyes: a. Vision 67 135 90 120 123 204 280 459 b. Squint 40 62 5 7 11 35 56 104 c. Other 6 29 3 13 7 42 16 84 6 Ears: a. Hearing 21 121 3 21 8 72 32 214 b. Otitis media 25 85 2 5 8 24 35 114 c. Other 11 22 3 17 8 13 22 52 7 Nose and throat 55 302 13 69 34 179 102 550 8 Speech 56 49 3 3 99 21 158 73 9 Lymphatic glands 4 130 3 36 2 77 9 243 10 Heart 3 41 2 6 2 28 7 75 11 Lungs 17 61 1 8 4 50 22 119 12 Developmental: a. Hernia 1 5 — - - 5 1 10 b. Other 9 109 1 5 10 40 20 154 13 Orthopaedic: a. Posture 12 20 3 10 21 20 36 50 b. Feet 31 95 2 21 24 70 57 186 c. Other 7 61 5 21 7 58 19 140 14 Nervous system: a. Epilepsy 10 6 4 2 22 10 36 18 b. Other 1 21 — 9 - 42 1 72 15 Psychological: a. Development 28 41 10 2 220 34 258 77 b. Stability 34 86 1 19 120 116 155 221 16 Abdomen 1 25 1 8 6 34 8 67 17 Other 41 196 18 48 62 175 121 419 (T) Requiring treatment. (O) Requiring observation. 66 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 709 112 5 Eyes: a. Vision 86 123 b. Squint 5 13 c. Other 19 6 6 Ears: a. Hearing 72 483 b. Otitis media 22 70 c. Other 22 14 7 Nose and throat 91 320 8 Speech 35 53 9 Lymphatic glands 5 58 10 Heart 3 43 11 Lungs 21 107 12 Developmental: a. Hernia 2 5 b. Other 14 82 13 Orthopaedic: a. Posture 3 15 b. Feet 57 97 c. Other 15 35 14 Nervous system: a. Epilepsy 2 10 b. Other 1 13 15 Psychological: a. Development 7 22 b. Stability 24 61 16 Abdomen 3 18 17 Other 347 436 67 Table V. Recorded incidence of certain defects found to require treatment at periodic inspection per 1,000 pupils examined. 1972 1971 Total children examined 4,996 5,424 Skin 25.1 35.0 Eyes : a. Vision 56.0 53.5 b. Squint 11.2 14.6 c. Other 3.2 2.9 Ears : a. Hearing 6.4 5.3 b. Otitis media 7.0 5.7 c. Other 4.4 3.1 Nose and Throat 20.4 17.0 Speech 31.6 18.4 Lymphatic Glands 1.8 3.3 Heart 1.4 1.3 Lungs 4.4 7.6 Developmental: a. Hernia 0.2 1.8 b. Other 4.0 7.4 Orthopaedic: a. Posture 7.3 4.6 b. Feet 11.4 7.4 c. Other 3.8 3.1 Nervous System: a. Epilepsy 7.3 4.1 b. Other 0.2 1.1 Psychological: a. Development 51.6 36.1 b. Stability 31.0 18.4 Abdomen 1.6 1.5 Other 24.2 22.9 Table VI. Number of children examined other than at Periodic Medical Inspections: Pupils examined for any condition, ailment or defect 3,407 Other special examinations, freedom from infection, employment byelaws, etc. 1,050 4,457 Re-inspections of pupils previously found to have some defect 2,767 Table VII. CLINICS. School Health Service facilities available (as at 31.12.72) BARNES Essex House, Station Road, Barnes, S.W.13. 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 Immunisation 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) Stanley Road, Teddington, Middlesex. Minor Ailments Ophthalmic (including Orthoptic) Vaccination and Immunisation TWICKENHAM York House, Richmond Road, Twickenham, Middlesex. Dental Minor Ailments Ophthalmic Vaccination and Immunisation 58, Hampton Road, Twickenham, Middlesex. Child Guidance Service Speech Therapy WHITTON Hospital Bridge Road, Twickenham, Middlesex. Dental (including X-ray) Minor Ailments Vaccination and Immunisation 69 OPHTHALMOLOGY Dr. Helena Bridget Casey, M.B., B.Ch., D.O.M.S., ophthalmologist, reports on the work of the ophthalmic clinics : — "The ophthalmic clinics of the Borough have been well attended during the year. The school children provide the usual defects of visual refractive errors; hypermetropia, astigmatism and especially the development of axial myopia, which is marked towards the end of the primary school years. "The pre'School medical examinations contribute many children for investigation of strabismus. This is an excellent thing as early investigation will reduce the number of amblyopia ex-anopsia or 'lazy' eyes which were in the past so commonly found in the first year of primary school. It is to be noted how Co-operative the parents of today are in their willingness to seek advice and treatment. "The handicapped children from the various special schools of the Borough are not forgotten and attend regularly. "Mrs. Butterworth, our orthoptist continues to give an excellent service and is of great help to me in the diagnosis and treatment of strabismus". Table VIII. Eye Diseases, Defective Vision and Squint. Number of cases known to have been dealt with External and other, excluding errors of refraction and squint 61 Errors of refraction (including squint) 1892 Total 1953 Number of pupils for whom spectacles prescribed 528 Keystone Telebinocular Vision Screener. The use of Keystone Telebinocular Vision Screeners continued in the schools during 1972. 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 981 58 5.91 Junior 946 121 12.79 Senior 570 98 17.19 TOTAL 2497 277 11.09 70 Table X. DISEASES AND DEFECTS OF EAR, NOSE AND THROAT. Number of cases known to have been dealt with Received operative treatment: (a) for diseases of the ear - (b) for adenoids and chronic tonsillitis 30 (c) for other nose and throat conditions — Received other forms of treatment 322 Total 352 Total number of pupils in schools who are known to have been provided with hearing aids: (a) in 1972 5 (b) in previous years 30 AUDIOMETRY At the end of 1972 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 are referred for further investigations, sixty-eight new cases were seen and 66 re-examinations were carried out in 1972 at the Heston Hearing Clinic to which the majority of referrals are made. Table XI. (a) Audiometer Tests — Routine Failures. Age Group 1st Tests * Re-tests. Total % of Col. 1 (1) (2) (3) (4) Up to 7 yrs. 2,428 415 395 16.27 9 to 10 yrs. 2,346 182 170 7.25 Total 4,774 597 565 11.83 *In Schools. 71 (b) Audiometer Tests — Specials Age. 1st Tests. Re-teats. Failures. Total. % of Col. 1 (1) (2) (3) (4) Under 5 165 40 67 40.61 5 354 88 198 55.93 6 257 114 143 55.64 7 242 98 87 35.95 8 223 71 96 43.05 9 180 43 86 47.78 10 165 46 60 36.36 11 153 38 66 43.14 12 103 24 35 33.98 13 91 24 45 49.45 14 103 19 39 37.86 Over 14 140 21 65 46.43 Total 2176 626 987 45.36 Table XII. INFESTATION WITH VERMIN. (i) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 22,803 (ii) Total number of individual pupils found to be infested ... 122 (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.). Ringworm : Number of cases known to have been treated. (a) Scalp 4 (b) Body — Scabies 2 Impetigo 4 Other skin diseases 400 Total 410 72 Table XIV. OTHER TREATMENT GIVEN. Number of cases known to have been treated. (a) Pupils with minor ailments 1,842 (b) Pupils who received convalescent treatment under School Health Service arrangements 7 (c) Pupils who received B.C.G. vaccination †*3,593 (d) Other than (a), (b) and (c) above— Heart 4 Lungs 31 Developmental defects 16 Nervous system 17 Lymphatic Glands 2 Psychological defects 22 Abdomen 20 Total 5,554 † Children with Grade I positive re-actions are now being vaccinated. * includes 117 re-vaccinations. Table XV. HANDICAPPED PUPILS. Pupils ascertained during the year requiring education at a special school: (a) Blind (b) Partially sighted 1 (c) Deaf — (d) Partially hearing 1 (e) Educationally sub-normal 2 (f) Epileptic 1 (g) Maladjusted 41 (h) Physically handicapped 4 (i) Speech — (j) Delicate 2 73 RESIDENTIAL SPECIAL SCHOOLS — Table XVI. Blind Partially Sighted Deaf Partially Hearing Educationally Subnormal Maladjusted Delicate Physically Handicapped Speech Defects Epileptic TOTAL Maintained Schools (L/42) Beechcroft (I.L.E.A.) 1 1 Compton Diagnostic (Hants.) l 1 Elmers Court (Harrow) 3 3 Park Place (Hillingdon) 1 1 St. Nicholas (Surrey) 2 2 Suntrap (Haringey) 3 3 Swaylands (Barnet) 2 2 Tewin Water (Hertfordshire) l 1 Wey House (Surrey) 2 2 Non-Maintained (L/42) Breckenbrough 1 1 Burton Hill House l 1 Condover Hall 1 1 Halliwick 1 1 Mary Hare Grammar l 1 Meath 1 1 Muntham House 3 3 Ovingdean Hall 3 3 Pield Heath House 1 1 Pilgrims 1 1 Port Regis 1 1 Red Hill 1 1 St. Catherine's 1 1 St. Margaret's 1 1 Independent Recognised (L/70) Bethany 1 1 Box Hill 2 2 Bridge House 3 3 Childscourt 1 1 Craig-y-Parc l 1 Dennington College 4 4 Falcon Manor 3 3 Farmhill House 1 1 Farney Close 1 1 Forest Grange 1 1 Frensham Heights 5 5 Friends 1 1 Grangewood Hall 1 1 Great Sanders 1 1 The Hall 1 1 Hamilton Lodge l 1 Hengrove 1 1 Hilbre 2 2 Hollington Park 1 1 Horncastle 1 1 Jolliffes 1 1 Leighton Park 1 1 More House 1 1 The Mount 1 1 Normansal 1 1 Northaw 2 2 Peredur 1 1 Philpotts Manor 1 1 Pottersbury Lodge 2 2 St. Agnes & St. Michael 1 1 St. Christopher's 1 1 St. David's 1 1 St. George's 1 1 St. Mary's (Bexhill) 1 1 St. Peter's 1 1 St. Stephens 1 1 Salesian 2 2 Carried Forward 1 - 3 3 8 55 13 4 - - 87 74 RESIDENTIAL SPECIAL SCHOOLS — Table XVI. continued Blind Partially Sighted Deaf Partially Hearing Educationally Subnormal Maladjusted Delicate Physically Handicapped Speech Defects Epileptic TOTAL Brought Forward 1 3 3 8 55 13 4 87 Shoreham Grammar 1 1 Sheiling Curative 1 1 Shotton Hall 2 ? The Shute 1 1 Sibford 2 2 Stanbridge Earls 1 1 Westonbirt 1 1 Woodbridge 1 1 Other Independent Schools Dedisham 1 1 Great Sanders 1 1 Pagem's 1 1 Warleigh Manor 1 1 Whitestone Head 1 1 Hospital Schools Lingfield 5 5 Smith's 1 1 Queen Mary's 7 7 Harperbury 2 2 Tolworth 1 1 Church Hill House 1 1 Clarefield Court 1 1 Botley's Park 2 2 St. Lawrence's 1 1 1 - 3 3 24 70 13 4 - 5 123 75 RESIDENTIAL SPECIAL SCHOOLS. Table XVI on pages 74 and 75 shows that the number of Handicapped Children maintained by the Richmond upon Thames Education Committee in Residential Special Schools as at 31st December, 1972 was 123. This compares with 111 at 31st December, 1971. DAY SPECIAL SCHOOLS. St. Hilda's Day Special School for Educationally Sub-normal Children, Barnes. Admissions during 1972 10 Discharges during 1972 12 Transferred to senior day school for educationally subnormal pupils 7 Transferred to ordinary schools 4 Left district 1 Number of children on roll as at 31st December, 1972 37 Clarendon Day Special School for Educationally Sub-normal Children, Hampton. Admissions during 1972 22 Discharges during 1972 20 Left school for employment 8 Transferred to ordinary schools 2 Transferred to residential school 1 Transferred to residential schools for educationally subnormal pupils 2 Transferred to day school for severely sub-normal pupils 1 Transferred to day school for maladjusted pupils 1 Transferred to day special school for educationally subnormal pupils 1 Left district 4 Number of children on roll as at 31st December, 1972 145 Strathmore Day Special School for Severely Mentally Handicapped Children, Teddington. Admissions during 1972 9 Discharges during 1972 6 Left to attend Adult Training Centre 3 Transferred to residential schools 2 Left district 1 Number of children on roll as at 31st December, 1972 78 Normansfield Hospital Day Special Unit for Mentally Handicapped Children, Teddington. Admissions during 1972 Nil Discharges during 1972 Nil Number of children on roll as at 3'lst December, 1972 17 Oldfield House Junior Day Special School for Maladjusted Children, Hampton. Admissions during 1972 24 Discharges during 1972 18 Transferred to ordinary schools 8 Transferred to day school for educationally sub-noraml pupils 1 Left for private school 1 Transferred to residential schools 5 Transferred to day school for infant maladjusted pupils 1 Left district 2 Number of children on roll as at 31st December, 1972 60 76 Oldfield House Infant Day Special School for Maladjusted Children, Hampton. Admissions during 1972 12 Discharges during 1972 18 Transferred to residential schools 3 Transferred to ordinary schools 2 Transferred to Oldfield Junior School 11 Transferred to day school for educationally sub-normal children 1 Left district 1 Number of children on roll as at 31st December, 1972 20 Athelstan House Autistic Unit, Hampton. Admissions during 1972 1 Discharges during 1972 1 Left district 1 Number of children on roll as at 31st December, 1972 6 Handicapped Pupils. All handicapped children attending special schools, either day or residential, are clinically 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. 77 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., M.R.C.Psych., report as follows:— Dr. Robin Higgins— The following table summarises the number of cases referred, seen and treated at the Richmond Child Guidance Clinic during 1972 : — Referred Seen Under Intensive Treatment Under Supervision or Annual Review 173 142 57 77 Referring Agents: General Practitioners 17 School Medical Officers and Health Visitors 52 Consultants 3 Educational Sources 50 Parents 48 Speech Therapists 1 Social Services Department 1 Miscellaneous (Courts, N.S.P.C.C., etc.) 1 173 We are most grateful for the additional voluntary assistance in psychotherapy we received from Miss Elizabeth Cartwright, attached to us during her period of advanced training at the Tavistock Clinic, and also from the voluntary assistance of two students on an advanced course at the Institute of Education. Regular monthly meetings have continued to be held with the school medical officers, and regular visits paid to a number of schools by the psychiatrist and psychiatric social workers. A number of lectures were given at conferences involving statutory and voluntary organisations. Arising out of discussions over the "mind-week" campaign, improved systems of communication have now been established with mental health services in general and the provisions for maladjusted children in particular. Dr. Agnes Main— The following table summarises the number of cases referred, seen and treated at the Twickenham Child Guidance Clinic during 1972. Referred Seen Under Intensive Treatment Under Supervision or Annual Review 189 109 157 93 Referring Agents: General Practitioners 18 School Medical Officers 24 Head Teachers 54 Educational Psychologists 10 Speech Therapists and Health Visitors 4 Social Services Department 5 Parents 67 Miscellaneous Agencies 7 189 78 The Clinic is still badly in need of extra psychiatric and psychotherapeutic help which, in spite of the enlarged school population has only marginally increased in 25 years. We are fortunate indeed in having the continued service of two psychotherapists who together provide the minimum number of sessions necessary to cope with our present waiting list, together with one full-time psychiatric social worker, one sessional psychiatric social worker and the clerical assistance for the work of a busy Clinic. It has now become a regular feature of the Clinic that we are included in the training programme for mature post graduate students attending Courses in the Education of Handicapped Children at London University Institute of Education and the Maria Grey College, Isleworth. A limited amount of supervision is given to each student, as time allows, and although we are not primarily educationalists this work has, nevertheless, enabled us to provide some help and support for the increasing numbers of children being referred with associated behaviour and learning problems. With the larger number of pupils at the Oldfield Schools for Maladjusted Children there has been a continued regular interchange of visits and case conferences aimed at a better understanding of the problems of the children attending there and in dealing with them. Regular visits also continue to be made to Athelstan House Unit for Autistic Children which continues to provide care and education for the most severely handicapped children in the Borough. Our psychiatric social workers continue to attend various Infant Welfare Clinics for talks with mothers concerning problems with very young children. This is particularly helpful since it is in the best interests of preventive medicine. Table XVII. Child Guidance Treatment. Number of oases known to have been treated. Pupils treated at Child Guidance Clinics 299 Table XVIII. Orthopaedic and Postural Defects. Number of cases known to have been treated. (a) Pupils treated at clinics or out-patient departments 112 (b) Pupils treated at school for postural defects 47 159 79 SPEECH THERAPY. The year 1972 was difficult owing to several changes of staff in this department. Mrs. Pletts, who worked so efficiently in the Mortlake area for over five years, left at the end of June for a teaching appointment in Birmingham. She was missed greatly, but it was fortunate that Mrs. Bawcombe was able to succeed her without a break. Mrs. Walker, who visited Clarendon daily during the early part of the year, left at Easter for personal reasons and pupils at this school were still without treatment at the end of the year. St. Hilda's School and Essex House Clinic also had a lapse in speech therapy which lasted several months, as Mrs. Kay, who treated children at Barnes, moved to Newcastle in July. Happily, by the end of the year all staff vacancies were filled, and it is hoped that 1973 will be successful in maintaining regularly the usual routine, which normally is as follows:— Sessions held at:— Child Guidance Clinic, Twickenham. Windham Road Clinic, Richmond. Kings Road Clinic, Richmond. Mortlake Clinic. Essex House, Barnes. Ham Clinic. Special Schools visited regularly:— Oldfield House Infant. Oldfield House Junior. Clarendon E.S.N. St. Hilda's E.S.N. Strathmore Day Special School. Many pre-school children were referred during 1972, mostly having slow development of language and articulation. Parents were given advice and shown how to help these children. In some cases so much pressure had been applied and anxiety shown at home that children had withdrawn from talking. Such cases were seen frequently at the clinic in order to lessen the family stress from which the children suffered. During the year 34 visits were made to nurseries and talks on "Speech" were given to leaders of play groups. Schools (other than special schools) had 62 visits from speech therapists and teachers were found most co-operative in observing children with speech difficulties. There were 43 visits to homes of children who had been referred for therapy. Older children frequently attend clinics unaccompanied since often nowadays both parents are working. Good liaison between the homes of the children having treatment and the speech therapists is essential for success. Progress, in most cases, is not possible without assistance from parents, who need constant encouragement to keep up helping their children. 80 Table XIX. Number of pupils treated by Speech Therapists under arrangements made by the Authority. Number of Children treated 385 Number of New Patients 168 Total Number of Attendances 3184 Number on Waiting List, 31.12.72 15 Number of Children Discharged 165 Normal Speech 77 Much Improved 27 Improved 38 Left district 23 Referred elsewhere, etc. Uneventuated (non-attendance, etc.) Table XX. Types of cases treated during the year. Dyslailia 143 Language and articulation 102 Stammering 21 Indistinct Speech 54 Tongue tie (post operative) 2 Sigmatism 50 Cleft palate 3 Dysphasia 2 Autism 3 Cluttering 3 Partially deaf 2 81 SCHOOL DENTAL SERVICE. Report of the Principal School Dental Officer, Mr. G. H. Tucker, L.D.S., R.C.S. In 1972 there was only one change in the dental staff. Mr. I. Shrimpton replaced as a dental apprentice Mr. M. Perry who completed his apprenticeship in March. During the year 145 sessions were devoted to the dental inspection of the mouths of 13,012 children in schools, and a further 2,967 were inspected for the first time in the year at clinics. A total of 6,580 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 6,063, and of these 4,021 accepted it. The number of sessions devoted to treatment was 1,800 and details of treatment are shown below arranged in age groups. 1,964 pupils were re-inspected at clinics and 1,307 of them were found to require treatment. Table XXI. Age 5—9. Age 10—14. Age 15+ First visit to clinic 1866 1726 373 Subsequent visits 2664 3730 811 Total visits 4530 5492 1184 Additional courses commenced 490 286 68 Fillings: Permanent teeth 1124 3192 1014 Fillings: Deciduous teeth 3490 627 — Permanent teeth filled 977 2855 917 Deciduous teeth filled 3335 588 — Permanent teeth extracted 40* 445** 84*** Deciduous teeth extracted 951 357 — General anaesthetics 441 257 24 Emergencies 308 192 43 Pupils supplied with dentures 2 6 4 Number of dentures supplied 2 6 4 * This figure includes 9 teeth extracted for orthodontic purposes. ** This figure includes 3 30 teeth extracted for orthodontic purposes. *** This figure includes 26 teeth extracted for orthodontic purposes. The next table shows a wider range of treatment but not divided into age groups Table XXII. No. of pupils X-Rayed 218 Prophylaxis 212 Teeth otherwise conserved 49 No. of teeth root filled 12 Inlays or crowns fitted 45 Courses of treatment completed 4180 Orthodontics: New cases pending from 1971 208 New cases commenced 96 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 toothpaste, together with a letter encouraging parents to take an increased interest in their child's oral hygiene. 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. 82 The orthodontic surgeon at Church Road Clinic treated 304 patients with 237 removable and 55 fixed appliances. Treatment was completed for 84 children, but 24 courses of treatment were discontinued by reason of non-attendance of the patient. The dental laboratory which has an establishment of one chief technician, 6 technicians and 2 apprentices is run on a non profit making basis. This year it completed 163 dentures, 1,877 orthodontic appliances, 168 crowns or inlays and 810 study models for the London Boroughs of Brent, Ealing, Harrow, Hillingdon, Hounslow and Richmond upon Thames. Total costs for each year are charged to the six boroughs in proportion to the amount of work done. The major cost is labour and although the apprentices are not highly paid they are relatively unproductive and time is spent by the technicians on their training. The cost of the laboratory's products are somewhat higher than that of commercial laboratories, but we do offer a quicker and more personal service. However, as the difference between our prices and those of the commercial laboratories increases, we may have difficulty in maintaining the support of our customers. NUTRITION. Meals. The number of children receiving mid-day dinners at maintained schools on a selected date in 1972 was as follows:— Date Number of dinners Number of children in School % of children having dinner 3.10.72 *14,015 19,677 71 (approx.) * In addition, approximately 1,380 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 3rd October, 1972 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) 4,946 4,790 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) 6,879 600 C. At Maintained Special Schools 315 313 TOTAL at maintained schools 12,140 5,703 The number of children receiving milk at non-maintained schools on the 3rd October, 1972, was 914 (number of children present who qualify for free milk on age grounds was 993). In September, 1972 meals were being cooked at 44 school kitchens and 3 central kitchens. 83 THE EDUCATION (MILK) ACT, 1971 Under the above Act and accompanying Regulations, free school milk is provided for the following classes of pupils:— (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 years; (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. At the end of 1972, 645 pupils were receiving free milk. Table XXIII. ROAD ACCIDENTS TO CHILDREN, 1972. Mr. M. S. Hebron, Borough Engineer and Surveyor, has kindly supplied th following details of road accidents to children under 16 years of age:— Casualties Total Casualties Month (1) Accidents (2) Fatal (3) Serious (4) Slight (5) Total (2) + (3) + (4) January 16 - 5 13 18 February 20 - 1 21 22 March 9 — 1 11 12 April 14 *1 3 11 15 May 16 — 3 13 16 June 15 - 6 11 17 July 20 - 4 18 22 August 17 †l 3 14 18 September 16 - 4 12 16 October 17 — 2 15 17 November 11 — 2 10 12 December 11 — — 13 13 Totals 182 2 34 162 198 * Pedestrian (male, aged 4) struck by car in Richmond Park. † Pedestrian (male, aged 6) struck by car in Stanley Road, Teddington. Table XXIV. DEATHS OF SCHOOLCHILDREN. It is with regret that I include the following details of local schoolchildren living in the Borough who died in 1972:— Sex Age Cause of Death. M F 1 7 Relapse of acute lymphatic leukaemia. 1 6 Cerebral contusions due to head injury. Accidental death. 1 13 Drowning. Accidental death. 1 12 Craniopharyngiona. 84 INDEX A Page No. Accidental Hyphothermia 33 Acreage 7 After-care facilities, tuberculosis and other chest illnesses 31 Animal Boarding Establishments Act, 1963 60 Ante-natal Clinics 17 Anti-Smoking 34 Artificial Dialysis 37 Atmospheric pollution 50 Attachment and Liaison Schemes, Family Doctors 27 Audiometry 71 B Baths 61 B.'C.G. Vaccination 29 Beads, Poisonous 62 Births 7, 8 Births, premature 23 Birth Rate 7, 8 c Cancer, cervical cytology 20 Care and after care, tuberculosis and other chest illnesses 29 Care of the Elderly 31 Care of mothers and young children 17 Certificates of disrepair 45 Cervical cytology 20 Chest and Tuberculosis Care Committee 31 Chest Clinics 30 Chief Public Health Inspector, report of 41-62 Child Guidance Service 78 Child Health Clinics 19, 21 Children, physical condition of 65 Chiropody Service 33 Clean Air Acts 50 Cleanliness inspections 72 Clinics, list of school health service facilities 69 Committees:— Education 3 Education, Schools Sub-Com. 4 Health 3 Common Lodging Houses 62 Community Nursing Services 22 Community Nursing Training 26 Compulsory admission to hospital 33 Congenital malformations, incidence of 17 D Page No. Death rates 7, 8 Deaths 7, 8 Deaths, age and cause 9, 10 Deaths, main causes 8 Deaths, school children 84 Deaths, tuberculosis 9 Dental Officer, report of Chief 19 Dental Officer, report of Principal School 82 Dental inspection 19 Dental laboratory 83 Dental treatment 19 Developmental Assessments 19 Diphtheria immunisation 28, 29 Diseases and defects, ear, nose and throat 66, 67 Diseases, infectious 11 Diseases of Animals Act, 1950 60 Diseases of the skin 72 Diseases, sexually transmitted 16 Disinfection and disinfestation 56 District Nurses 23, 25 Domiciliary deliveries 22 Dysentery 13 E Ear, nose and throat diseases and defects 71 Early Discharges 22 Early Neo-Natal mortality 7 Education Committee 3 Education (Milk) Act, 1971 84 Education Schools Sub-Committee 4 Elderly, care of 31 Environmental Health 41-62 Establishments for Massage and/or Special Treatment 61 Eye diseases 70 Exhibition of Association for the Handicapped 35 F Factories Act 1961 59 Family Doctors, Attachment and Liaison Schemes 27 Family Planning 17 Feral Pigeons 58 Fertilisers and Feeding Stuffs Act, 1926 62 Fluoridation 5 Food and Drugs 45 Food Complaints 45 85 Page No. Food Hygiene (General) Regulations, 1970 47 Food inspection 47 Food poisoning 13 Food premises 46 Food sampling 47 Foods, welfare 20 G General physical condition of children 65 General statistics 7 Geriatric service 31 Grey Squirrels 58 H Hairdressers and Barbers 62 Handicapped pupils 73, 77 Health Committee 3 Health Education 34 Health Visiting 26 Health Visiting, Training 26 Home Nursing Service 24 Home Nursing, Cases and Visits 25 Home Nursing, Type of care given 25 Hospital confinements 22 House improvement 45 Houses in multiple occupation 44 Houses, number of inhabited Houses, unfit 41 Housing 41 Housing, medical priorities 45 Hypothermia, accidental 33 I Ice-cream, manufacture and sampling 49 Illegitimacy 7 Immigrants, medical arrangements for long stay 16 Immunisation and Vaccination 28, 29 Incontinent laundry service 36 Infant mortality 7, 8 Infectious diseases 11-16 Infective Jaundice 13 Infestation with vermin 72 Inspection and supervision of food 45 Inspections:— Factories Acts 59 Food Premises 47 Offices, Shops and Railway Premises 52 Public Health 55 Introductory letter— Medical Officer of Health 5 K Page No. Keystone Telebinocular Vision Screener 70 L Laundry Service, incontinent 36 Legal Proceedings 45 Liquid Egg (Pasteurisation) Regulations, 1963 49 Loan of nursing equipment 36 M Manufacture, ice cream 49 Map, Clinics and Administrative Centres Inside back cover Mass Radiography 30 Massage etc. establishments 61 Maternal mortality 7, 8 Maternity Liaison Committee 24 Meals and milk (schools) 83 Measles 11, 12 Measles vaccination 28, 29 Meat inspection 45 Medical aid 24 Medical arrangements for long-stay immigrants 16 Medical assessments, staff, etc. 36 Medical inspection — school children 64 Medical priorities, housing 45 Medical treatment — school children 64 Meningitis 13 Midwifery:— Service 22 Training 22 Transport 22 Milk in schools 83, 84 Milk supplies and sampling 49 Mind Week 35 Mortality, early neo-natal 7 Mortality, infant 7 Mortality, maternal 7, 8 Mortality, neo-natal 7 Mortality, perinatal 7 Mortuary 60 Mothers and young children, care of 17 N National Assistance Act, 1948 Section 47 33 Neo-natal deaths 7 Night "Sitters-In" Service 24 Noise Abatement 55, 56 Nose, diseases and defects 71 86 Page No. Notices complied with 56 Notices served 56 Notifiable diseases 11—15 Notification of intention to practise 24 Nurses agencies 36 Nursing equipment, loan of 36 Nursing Homes 35 Nutrition 83 o Offices, Shops and Railway Premises Act, 1963 52 Officers 4 Older People's Clinics 31, 32 Older People in the Community 32 Ophthalmology 70 Orthopaedic and postural defects 79 Other treatment given — school children 73 Outworkers 59 P Perinatal mortality 7 Pest control 56 Pet Animals Act, 1951 60 Phenylketonuria 18 Pigeons 58 Poisonous Beads 62 Poliomyelitis immunisation 28, 29 Pollution, atmospheric 50 Population 7, 8 Population (school) 63 Post-natal clinics 17 Premature births 23 Premises, food 46 Prevention of illness, care and after-care 29 Proprietary foods 20 Prosecutions 45 Public health inspections 55 Pupils, handicapped 73, 77 Q Qualification Certificates 45 R Radiography, mass 30 Rag Flock Act, 1951 60 Rateable Value 7 Rats and Mice 56 Renal Dialysis 37 Rent Act — certificates of disrepair 45 Residential Special Schools 74, 76 Page No. Richmond upon Thames Chest and Tuberculosis Care Committee 31 Riding Establishments Acts, 1964 and 1970 60 Road accidents to school children 84 Rodent control 56 Rubella vaccination 29 s Sampling:— Food 47 Ice-cream 49 Milk 49 Water 38 Sanitary circumstances of the Borough 41 Scarlet Fever 11, 15 School children, deaths 84 School children, road accidents 84 School Dental Service 82 School Health Service 63-84 School meals and milk 83 School population 63 Sewage disposal 40 Sewerage 40 Sexually Transmitted Diseases 16, 34 Shops, offices, etc. 52 Skin, diseases of 72 Smallpox 14 Smallpox vaccination 29 Smoke control 50 Special Observation/Handicap Register 19 Special schools, day 76 Speech therapy 80 Squint 70 Squirrels, grey 58 Staff 4,22,27,78,80,83 Statistics, general 7 Statistics, vital 7 Stillbirths 7 Surveys 18 Swimming Pools 61 T Telebinocular Vision Screener 70 Telephone Answering Service 36 Tetanus immunisation 28, 29 Throat, diseases and defects 71 Training, midwives 22 Training, health visitors 26 Tuberculosis 29 Tuberculosis, deaths 9 Tuberculosis, vaccination 29 Typhoid Fever, innoculation 29 87 Page No. u Unfit houses 41 Unsound food 46 V Vaccination and immunisation 28, 29 Vaccination, B.C.G. 29 Vermin infestation — school children 72 Vision, defective 70 Vital Statistics 7 Page No. w Wasps 58 Water supply 38, 39 Welfare foods 20 Well Woman Clinics 20 Whooping cough 11 Whooping cough, immunisation 28, 29 x X'ray, mass 30 Y Youth Counselling Service 17 88 J. H. Broad & Co. Ltd. ( Printers), 8 King Street, Richmond, Surrey.