SUT3 LONDON BOROUGH OF SUTTON THE HEALTH AND WELFARE OF SUTTON 1966 P.Westcombe MB BS DPH Medical Officer of Health and Principal School Medical Officer CONTENTS PAGE NUMBER INTRODUCTION 4 PART I GENERAL STATISTICS AND SOCIAL CONDITIONS 9 PART II EPIDEMIOLOGY 23 PART III PERSONAL HEALTH SERVICES 31 (National Health Service Acts) PART IV ENVIRONMENTAL HEALTH SERVICES 67 PART V SCHOOL HEALTH SERVICE 99 (Education Act) PART VI WELFARE SERVICES 117 (National Assistance Acts) PART VII MISCELLANY 123 MEMBERS OP THE HEALTH COMMITTEE as at 31st December,1966 The Worshipful the Mayor, Lieut.-Col.Thomas Frederick Gadd, M.C.,T.D.,B.Sc.,J.P. (ex-officio) Alderman S.J.Barton, J.P. Councillor Mrs.J.S Buck Councillor F.S.Dixon Councillor G.F.Everitt, J.P. (Chairman) Councillor B.C.Fleming Councillor H.Fox Councillor Mrs.H.O.Judd, M.A., J.P., Councillor A.J.Kenney Councillor D.P.Madden Councillor T.E.Page Councillor N.F.Paul Councillor D.H.T.Salari, J.P. Councillor N.G.Shelley Councillor H.Sunderland Co-opted (5) Dr.C.R.Nunan Nominated by Local Medical Committee Dr.L.J.Iaon Miss G.M.Bates " " Royal College of Midwives Dr.D.N.Lawson " " South West Metropolitan Regional Hospital Board Miss K.M.Bomford " " General Nursing Council MEMBERS OF THE WELFARE COMMITTEE as at 31st December, 1966 The Worshipful the Mayor, Lieut.-Col.Thomas Frederick Gadd, M.C., T.D.,B.SC., J.P. (ex officio) Alderman S.J.Barton, J.P. Councillor Miss F.A.Blackler Councillor P.A.Bishop (Chairman) Councillor Mrs.J.S.Buck Councillor F.S.Dixon Councillor J.Dowsett Councillor C.R.C.Fenson Councillor E.W.Harding Councillor Mrs.H.O.Judd M.A., J.P. Councillor W.D.Milne Councillor J.J.Nicholls, B.Sc., F.R.I.C. Councillor N.F.Paul Councillor Miss I.S.E.Tomlin, J.P. Councillor A.R.Wakefield Co-opted (5) Mrs .D.M.Pettingell Mr. A.J.Day Mr.P.E.L.Finch Mr.A.E.H.Bailey Mr.A.J .Barker 2 I wish to acknowledge the assistance of the following officers in the compilation of this Report :- Dr.W.H.Kinstrie, M.B.,Ch.B.,D.P.H., Deputy Medical Officer of Health and Deputy Principal School Medical Officer; Dr.E.H.Todd, M.B.,Ch.B., D.P.H., Senior Medical Officer of Health and Senior School Medical Officer Mrs.B.M.Stewart, L.D.S., Chief Dental Officer Mr.H.Geo.Cripps, M.R.S.H., F.A.P.H.I., Chief Public Health Inspector; Mr.W.France, A.C.C.S., A.I.S.W., Chief Welfare Officer; Mr.D.S.Clapson, D.P.A.(Lond.), L.M.R.S.H., Chief Administrative Officer; Miss M.E.Turner, S.R.N., S.C.M., H.V.Cert., Superintendent Health Visitor; Miss D.M.Sammonds, S.R.N., S.C.M., H.V.Cert., M.T.D., Q.N. Superintendent of Home Nurses and Non-medical Supervisor of Midwives; Miss G.E.Bridger, A.I.M.S.W., Senior Social Worker; Mr.L.C.E.London, Senior Mental Welfare Officer; Miss S.M.Bourne, A.A.P.S.W., Senior Psychiatric Social Worker and members of the Administrative and Clerical staff concerned. 3 HEALTH & WELFARE DEPARTMENT, TOWN HALL, WALLIN GTON, Surrey- August, 1967 To The Worshipful the Mayor, Aldermen and Members of the Council of the London Borough of Sutton. Mr.Mayor, Ladies and Gentlemen, I have the honour to present my Annual Report for 1966. The work of the Health and Welfare Department has as its objective the prevention of mental and physical ill-health and the support in the community of those who are frail, handicapped by physical or mental disability, and those who are at risk of becoming so handicapped. This work involves the skills of many professional callings an account of which will be found in the following pages. Many other departments of the Council, however, make a significant contribution to the attainment of positive health and the maintenance of physical and mental well-being in the families which make up the population of the Borough. Positive health is a state which can only be achieved in a favourable environment in which to work and spend leisure time. The Borough remained free of any major epidemics of infectious disease throughout the year. Routine work in connection with the prevention of spread of infection is done in an unspectacular way and it is only when routine measures fail that epidemics are likely to occur. This every day work involves the close collaboration of your staff with general practitioners, hospitals, laboratories, schools, commercial organisations large and small and not least, the infected persons, in notification, investigation and preventive action. It is well-known that protective immunisation is freely available against the more serious infectious diseases such as diphtheria, poliomyelitis, tetanus, smallpox, whooping cough and tuberculosis. A community will only remain free of these diseases if the proportion of persons protected against them is maintained at a high level. The figures of children immunised in the Borough during the year reveal that there are still far too many unprotected persons for safety. In view of the wide publicity which is given to the need for immunisation and the facilities which are available to obtain it, it is difficult to understand why this situation occurs. In the interests of their children's safety it is the duty of every parent to see that their children are protected. 4 The pattern of life of an increasing number of families is being changed by the replacement of conventional houses by blocks of flats and maisonettes of varying size. The implications of this change are many and will, in the future, influence the nature of a number of services. A community consisting of a number of families living under the same roof in close proximity one with another creates problems of personal relationships to a much greater extent, and the activities of each family can affect others. The opportunity for the spread of infection is that much the greater. Young children who need free activity can find this only within the confines of the flat or at some distance from the supervision of their parents. When illness or disability occurs, or when advancing years restrict mobility the situation of a home at first floor level or higher can confine the sufferers to their own dwellings to an extent which would not be apparent at ground floor level. Recreational activities, particularly among the younger folk, tend to be centred away from the home to a greater extent and parental influence is thereby lessened. While this change is a gradual one taking place over the years it is important to recognise its implications in order that existing services can be modified where necessary and expanded in certain new directions to meet the changing needs of increasing numbers of people. The number of children under the age of five for whom places in day nurseries or in nursery schools are desirable is likely to increase and special provision will need to be made to meet the difficulties of the sick and the elderly. During the year the arrangements made for the welfare of the handicapped of all ages has received much attention. A scheme has been evolved which provides for detection of handicapping conditions at the earliest possible stage and the support of persons suffering from them throughout their lives. Circumstances before, during and immediately following birth are notified to the department from a variety of sources. Throughout pre-school years medical supervision is provided and progress recorded at all stages and assessment of future needs is made; medical or surgical treatment is obtained and social support given where necessary. On reaching school age the child's name is placed upon the handicapped pupils register maintained as part of the School Health Service, and recommendations made concerning the type of education which is most suited to the needs of the handicapped child. Throughout school years supervision and support is 5 provided and as school leaving age approaches an assessment is made concerning the type of employment or training which is required. On reaching school leaving age the name of the child is transferred to the adult Register for Handicapped Persons maintained by the Welfare Services and the support which is necessary to enable the handicapped person to lead as normal and independent a life as possible is continued. This scheme is at an early stage of its development but an encouraging start has been made. Although many of its features were previously in operation, it is anticipated that the continuity of support which is now possible will improve the efficiency of the services and will lighten the burden which has to be carried by the disabled person. For this to be done the help of agencies outside the Council's sphere of responsibility is essential and close working relationships between officers of the Council and their colleagues in hospitals, the Ministries of Social Security and Labour and of other local authorities, family doctors and voluntary agencies are being built up. It will be appreciated that for the scheme to be effective close co-ordination of the efforts of widely separated services is necessary and this will take some time to achieve. The policy of population screening for the detection of unsuspected disease has come much into prominence in recent times. It should be appreciated that this process is not new, screening techniques have been in use in infant welfare centres and in the school health service for many years. Like miniature mass-radiography, these have in the past been applied on a general basis to healthy populations and with the realisation that screening techniques applied to populations most at risk are most likely to produce positive findings , have become more selective. The selective method provides a more valuable use of professional time and total resources than when schemes are applied indiscriminately to whole populations. Although it is relatively a simple matter, provided that the necessary finance is available, to establish clinics where the first stage of population screening can be provided, the extent to which this is practical is governed by the availability of hospital laboratory and other services. Priority has to be given to existing services and at the present time extensive whole health screening programmes for healthy people could not be undertaken without seriously embarrassing services for those who are sick. A number of experimental schemes have been carried out in different parts of the country and valuable experience has been gained. It is wise, however, to hasten slowly much more information is needed and new techniques must be developed before health screening can be made available to wide sections of the healthy population. It was possible during the year to commence a pilot scheme of screening for cervical cancer in symptomless women and this will be expanded as fast as laboratory facilities will allow. Screening techniques have also been introduced into the new Advisory Centres for the Elderly which have been set up during the year. 6 Much publicity has recently been given to the increased numbers of young people and others appearing before the Courts in connection with the illegal use of drugs. There is no doubt that this aspect of modern life presents a serious medico-social problem. To a community physician the problem is a symptom of a sickness affecting a section of society. The great majority of those who become drug-dependant do so because of previous mental or physical inadequacy. Young people should not require the artificial stimulation of drugs to enable them to achieve their pleasures, nor should it be necessary for them to seek release from the world in which they live by escaping into a fantasy world created by sedatives and hallucinatory drugs. Experimentation is part of the normal process' of growing up - it must however be guided and controlled by adult experience and a peimissive attitude on the part of adults in connection with the taking of drugs for improper purposes is to be deplored. The person who takes drugs for "kicks" is taking the first steps down a very slippery slope. If he reaches the stage of dependancy upon drugs which are truly addictive, he has probably passed the point of no return and will possibly die from a self-inflicted disease for which there is no certain cure. No punishment is too severe for the drug pedlar or the drug taker who recruits others into his vicious circle. By all possible means youngsters must be made aware of the true nature and consequences of drug taking. The great majority of them are healthy minded people to whom drug taking is repellant. They, probably more effectively than anyone else, are in a position to prevent this disease from spreading amongst themselves, both by stiffening their own resistance to it and by exposing the sources from which it spreads. It is my pleasure to record my appreciation of the support and encouragement given to the department by all members of the Council and in particular by the Chairmen of the Health and Welfare Committees. The first full year of the department's work has not been without its difficulties. Much progress has, however, been made in all sections of the work and this is attributable in no small degree to the interest and encouragement of the members. It is my further pleasure to acknowledge the help I have received from officers of all departments of the Council and in particular to the loyal support of members of my own staff who have worked with great spirit to overcome the problems "they have had to face. P.WESTCOMBE, M.B., B.S., D.P.H., Medical bfficer of Health Principal School Medical Officer. 7 GENERAL STATISTICS AND SOCIAL CONDITIONS PART I INDEX Page No. AREA AND POPULATION (1961 Census) 11 DEATHS 16 BIRTHS 20 HOUSING 21 (Figures in Brackets refer to 1965) 9 AREA AND POPULATION Population tables are again reproduced in some detail. Although not necessarily up-to-date they contain the most recent information available for the Borough and it was felt appropriate to include them in their present form to provide readily accessible information and for purposes of comparison in subsequent reports. Care should be exercised in comparing one table with another to differentiate between Census figures and Registrar General's estimates. It will be noted that between the 1951 and 1961 Census there was a decline of 7056 in total population of the area, an average of approximately 700 persons per year. Subsequent annual average figures between 1961 and 1965 based on Registrar General's estimated mid-year figures show a diminished rate of reduction at approximately 650 persons per year. 1 in 8 of the population was aged 65 years or over at the 1961 Census. (a) District Area in Acres Census Population Registrar General's Estimate of mid-year Population 1951 1961 1953 1964 1965 1966 Beddington & Wallington 3045 32757 32603 32560 32590 - - Carshalton 3346 62721 57484 56020 55730 - - Sutton & Cheam 4338 80673 79008 78770 79500 - - TOTAL 10729 176151 169095 167350 167820 - - London Borough of Sutton 10729 - - - - 166790 165840 (b) Population by Age Groups Registrar General's Estimate of Mid-Year Population 1966 Under one year One to four years five to fourteen years Over fifteenyears 2430 9570 21000 132840 (2440) (9360) (22400) (132590) Total all ages 16584O (166790) Rateable Value Rateable Value of the Borough 1st April, 1966 £9,401,299 Estimated net product of a penny rate 1966/67 £38,175 Estimated number of separately assessed dwellings at 1st April, 1966 62,952 11 (d) Population by Sex and Age - Census 1961 Age Males Females Total 0-4 5,466 5,179 10,645 5-9 5,119 4,951 10,070 10 - 14 6,638 6,412 13,050 15 - 19 5,703 5,937 11,640 20- 24 4,459 5,151 9,610 25 - 29 4,760 4,855 9,615 30 - 34 4,848 5,275 10,123 35 - 39 5,388 5,992 11,380 40 - 44 4,982 5,659 10,641 45 - 49 5,875 6,807 12,682 50 - 54 6,550 7,537 14,087 55 - 59 6,492 7,203 13,695 60 - 64 4,832 5,935 10,767 65 - 69 3,229 4,456 7,685 *21,090 TO - 74 2,004 3,467 5,471 75 - 79 1,416 2,640 4,056 80 - 84 730 1,701 2,431 85 - 89 313 800 1,113 90 - 94 60 241 301 over 95 4 29 33 TOTAL 78,868 90,227 169,095 % of Total 60 - 64 6.12 6.53 6.3 65 - 69 4.00 4.94 4.54 *12.48% 70-74 2.54 3.84 3.23 75-79 1.793 2.93 2.40 80 - 84 O.58 1.89 1.14 over 85 0.46 1.19 0.68 12 13 (e) Acreage, Population, Private Households and Dwellings - Census 1961 \ Area Acreage Population Private households and dwellings, 1961 1951 1961 Private households Population in private households - Structurally separate dwellings occupied Rooms occupied Density of occupation Persons Persons Males Females Persons per acre Persons per room % of persons at more than l½ per room Beddington Wallington M.B 3,045 32,757 32,603 15,227 17,376 10.7 10,927 32,456 10,354 54,685 0.60 1.8 Wards Nos. 1 Beddington Nth 70 6 5,338 5,205 2,534 2,671 7.4 1,638 5,205 1,625 7.715 0.68 2.6 2 Beddington West 458 3,633 3,680 1,735 1,945 8.0 1,243 3,677 1,174 6,233 0.60 1.7 3 Beddington Cent. 157 4,829 4,436 2,072 2,364 28.3 1,510 4,436 1,431 7,030 O.64 2.2 4 Beddington Sth. 849 5.454 5.998 2,841 3,157 7.1 1,916 5,960 1,877 10,839 0.56 0.3 5 Wallington Nth 362 5,235 4,918 2,392 2,526 13.6 1,653 4,918 1,606 7,729 O.64 2.7 6 Wallington Cento 144 4,049 3,726 1,667 2,059 25.9 1,406 3.701 1.260 6,504 O.58 1.1 7 Wallington Sth. 369 4,219 4,640 1,986 2,654 12.6 1,561 4,559 1,381 8,635 0.54 1.8 Carshalton U.D. 3,346 62,721 57,484 27,226 30,258 17.2 17,952 55,254 17,545 81,531 0.69 4.7 Wardss Central 320 5,964 5,725 2,472 3,253 17.9 1,912 5,459 1,807 9,348 0.59 1.8 North East 330 9,940 8,949 4,418 4,531 27.1 2,877 8,925 2,812 12,490 0.72 4.8 North West 255 7,419 6,761 3,171 3,590 26.5 2,298 6,735 2,230 11,030 0.62 1.5 St.Helier North 249 8.624 7.021 3,498 3,523 28. 2 2,187 6,861 2,172 8,173 0.85 10.6 St.Helier South 122 7,710 6,211 2,891 3,320 50.9 1,718 5,352 1,698 6,528 0.83 7.6 St.Helier West 211 8,064 6,606 3,295 3,311 31.3 2,118 6,593 2,086 8,183 0.81 7.8 South East 1,411 8,630 9,113 4,243 4,870 6.5 2,536 8,294 2,492 12,655 0.66 3.1 South West 448 6,370 7,098 3,238 3,860 15.8 2,306 7,035 2,248 13,124 0.55 0.8 Sutton & CheamM.B. 4,338 80,673 79,008 36,415 42,593 18.2 26,630 77,200 25,492 128,938 0.61 2.5 Wards Nos. 1 or North West 364 8,237 8,182 3,842 4,340 22.5 2,869 8,182 2,800 13,974 0.59 0.8 2 or North 437 10,232 9,454 4,391 5,063 21.6 3,104 9,114 3,048 14,264 0.65 3.6 3 or North East 542 11,609 10,772 5,192 5,580 19.9 3,582 10,763 3,488 16,598 0.66 3.4 4 or East 342 7,892 8,239 3,890 4,349 24.1 2,830 8,219 2,621 12,632 0.66 4.9 5 or South East 361 6,231 6,081 2,621 3,460 16.8 2,264 5,945 2,054 10,777 0.57 2.1 6 or South 712 9,720 10,007 4,186 5,821 14.1 3,306 8,956 2,980 16,271 0.57 3.0 7 or South West 890 6,329 7,827 3,455 4,372 8.8 2,502 7,588 2,482 14,591 0.53 0.4 8 or East Central 285 7,571 6,793 3,216 3,577 23.8 2,294 6,780 2,237 11,062 0.62 2.4 9 or West Central 405 12,852 11,653 5,622 6,031 28.8 3,879 11,653 3,782 18,769 O.63 1.4 (f) Census 1961 (10% sample) Proportions in Socio-Economic Groups (Males) Socio- Economic Grouping Definition % Sutton Greater London Area 3 4 Professional workers - self-employed, persons engaged in work normally requiring qualifications of university degree standard. Professional workers - employees, as (3) but employees, not self-employed 7.4 4.7 1 Employers and managers in central and local government, industry, commerce, etc. - large establishments employing 25 or more persons. 17.5 11.6 2 Employers and managers in industry, commerce, etc. - small establishments employing fewer than 25 persons. 13 Farmers - employers and managers. Persons who own, rent or manage farms, market gardens or forests, employing people other than family workers in the work of the enterprise. 8 Supervisory, skilled and self-employed Foremen and Supervisors - manual. Employees (other than managers) who formally and immediately supervise others engaged in manual occupations. 32.1 35.1 9 Skilled manual workers Employees engaged in manual occupations which require considerable and specific skills. 12 Own account workers (other than professional). Self-employed persons engaged in any trade, personal service or manual occupation not normally requiring training of university degree standard and having no employees other than family workers. 14 Farmers - own account Persons who own or rent farms, market gardens or forests, and having no employees other than family workers. 14 Socio Economic Grouping Definition % Sutton Greater London Area 5 Intermediate non-manual workers. Employees, not exercising general planning or supervisory powers, engaged in occupations ancillary to the professions but not normally requiring qualifications of university degree standard. 26.5 22.9 6 Junior non-manual workers. Employees not exercising general planning or supervisory powers, engaged in clerical, sales and non-manual communications and security occupations. 7 Personal service workers. Employees engaged in service occupations caring for food, drink, clothing and other personal needs. 10.7 14.7 10 Semi-skilled manual workers. Employees engaged in manual occupations which require slight but specific skills. 15 Agricultural workers. Employees engaged in tending crops, animals, game or forests, or operating agricultural or forestry machinery. 11 Unskilled manual workers. Other employees engaged in manual occupations. 5.8 11.0 16 Members of armed forces. 17 Indefinite - persons with inadequately stated occupations. 15 16 (g) DEATHS Causes of death at different periods of life during 1966 (Figures in brackets are for 1965) Cause of Death Sex Total all Ages Under 4 Weeks 4 weeks & under 1 year AGE IN YEARS 1 5 15 25 35 45 55 65 75 and over 1. Tuberculosis, respiratory M 4 (6) — — — — — — 1 — 1 — 2 F 3 (2) - - - - - 1 - 1 1 — 3. Syphilitic Disease M 1 (2) — — — — — — — — — — — F 1 (2) - — — — — — — — 1 1 — 9. Other Infective & Parasitic Diseases M — (1) — — — — — — — — — — — F 2 (2) — - — - — — — 2 — — — 10. Malignant Neoplasm, Stomach M 17 (24) — — — — — — — 1 5 5 5 F 19 (22) - - — — — - — — 2 8 9 11. Malignant Neoplasm, Lung, Bronchus M 102 (94) — — — — 1 — 1 11 37 38 14 F 19 (25) - - - - — 3 6 6 4 12. Malignant Neoplasm, Breast M 1 (—) — — — — — — — 1 — — — F 56 (45) - - - - - 1 l 13 13 9 19 13. Malignant Neoplasm, Uterus F 18 (15) — - - - - - 2 4 3 4 5 14. Other Malignant & Lymphatic Neoplasms M 100 (99) - — 1 — 1 1 2 5 36 31 23 F 102(101) — — - - 3 — 5 16 27 20 31 15. Leukaemia,Aleukaemia M 7 (6) _ _ — — — — — 1 — — 1 F 9 (9) — — — — — — — 4 4 1 — 16. Diabetes M 7 (4) — — 1 — — — 1 1 2 1 1 F 7 (10) _ — — — — — — — 2 2 3 17. Vascular Lesions of Nervous System M 103(105) — — — — — 1 — 1 10 29 61 F 193(168) - - — — 1 2 1 2 18 39 131 18. Coronary Disease, Angina. M 228(244) — — — — — — 28 72 70 57 F 146(135) - - — — — — 1 2 19 49 76 19. Hypertension with Heart Disease M 9 (6) — — — — — — — — 4 3 2 F 19 (5) - - — — — — — — 2 6 11 20. Other Heart Disease M 66 (88) — - — — — — — 2 7 12 45 F 170(157) - - — - - - 1 3 7 21 138 21. Other Circulatory Disease. M 48 (46) - - — — — — - 1 7 18 22 F 51 (65) — — - - - - 1 1 5 11 33 22. Influenza. M 6 - - — — — — — 1 1 2 2 F 6 — — — — — — — — 1 1 4 17 Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks & under 1 year AGE IN YEARS 1 5 15 25 35 45 55 65 75 & over 23. Pneumonia M 49 (30) 1 — — — — — l 1 4 9 33 F 72 (63) — 1 — 1 - - 1 1 1 12 55 24. Bronchitis M 68 (66) - - - 1 — — — 2 10 29 26 F 26 (21) — 1 - - - 1 - - 5 6 13 25. Other Diseases of Respiratory System M 11 (11) - - - 1 - - 1 1 3 1 4 F 5 (3) — — — — — 1 1 1 2 26. Ulcer of Stomach and Duodenum M 7 (9) - - - - - - - - 1 4 2 F 3 (2) — — - — — — — — 3 27. Gastritis, Enteritis and Diarrhoea M 2 (2) - - - - - - - - - 1 1 F 8 (6) — 1 — — — — — — — 1 6 28. Nephritis and Nephrosis M 4 (1) - - - - 1 - - - 2 - 1 F 3 (3) — — — — — — — 1 — 2 — 29. Hyperplasia of Prostate M 6 (9) - - - - - - - - - 3 3 31. Congenital Malformations M 10 4 2 - 2 - 1 - 1 - - - F 11 (9) 5 2 — 2 — — — 1 1 — — 32. Other defined and ill-defined Diseases * M 50 (49) 11 2 - 1 1 - 1 3 7 14 10 F 74 (71) 6 2 — 1 — 1 2 3 7 14 38 33. Motor Vehicle Accident M 13 (12) - - 1 - 7 1 - 1 1 1 1 F 9 (11) — 1 — — 1 1 — — 2 1 3 34• All other Accidents M 6 (7) - - - - 2 - 2 1 - - 1 F 12 (15) — — — — — — — — 2 2 8 35. Suicide M 7 (4) - - - - 2 1 1 - 1 1 1 F 6 (10) — — — — — 1 — — 3 2 — 36. Homicide and Operations of War M — (-) — — — — — — — — — — — F 2 1 l — — — — — — — — 1 — TOTAL ALL CAUSES M 932 (934) 16 4 2 5 16 5 11 63 216 275 319 F 1052 (979) 12 8 1 4 4 8 15 58 130 220 592 (h) Deaths from all causes Male Female Total Crude rate per 1,000 population Adjusted rate per 1,000 population (comparability factor 0.90) 932 1052 1984 11.97 10.77 (934) (979) (1913) (11.47) (10.66) 18 Deaths from certain causes:- Category 1950 1960 1961 1962 1963 1964 1965 1966 Tuberculosis,respiratory 39 9 12 5 3 8 8 7 Cancer, Uterus, Lung, Bronchus 11 17 16 10 17 12 15 18 52 83 100 100 103 114 119 121 Coronary disease, Angina 291 362 356 381 389 359 379 374 Bronchitis 75 82 95 116 135 84 88 94 Suicide 15 19 26 31 21 20 14 13 Motor vehicle accidents 13 18 14 14 20 22 23 22 All other accidents 26 17 23 39 29 20 22 18 (i) Suicide Male Female Total Suicide rate per 1,000 deaths 7.51 (4.28) 5.70 (10.22) 6.55 (7.33) Total as % of total deaths 0.75 (0.43) 0.57 (1.02) 0.65 (0.73) Rate per 1,000 population .08 Thirteen persons in the Borough ended their own lives during 1966. A number of surveys have been carried out to determine the frequency of attempted suicide compared to that which is successful. The 1964 report of the Chief Medical Officer of the Ministry of Health records figures varying from 10 : 1 to 6 : 1. Applying this range of figures to the Sutton cases, between 78 and 130 people may have attempted to terminate their own lives during the year. (j) Infant Deaths Age MALES FEMALES TOTAL Total Legit. Illegit. Total Legit. Illegit. Under 1 year of age 20(19) 17(18) 3 (1) 20 (17) 17(16) 3 (1) 40(36) Under 4 weeks of age 16(12) 15(11) 1 (1) 12 (13) 9(13) 3 (-) 28(25) Under 1 week of age 14 (9) 14 (8) - (1) 10 (8) 7 (8) 3 (-) 24(17) (k) Infant Mortality Rates Infant Total infant deaths per 1,000 total live births 16.25(14.41) Legitimate infant deaths per 1,000 legitimate live births. 14.76(14.06) Illegitimate infant deaths per 1,000 illegitimate live births 37.36(13.2) Neo-natal Deaths under four weeks per 1,000 total live births 11.38 (9.89) Early Neo-natal Deaths under one week per 1,000 total live and stillbirths. 9.75 (6.73) Peri-natal Stillbirths and deaths under one week combined per 1,000 22.85(18.6) Maternal Number of deaths Nil (Nil) Rate per 1,000 total live and stillbirths Nil (Nil) 19 20 (l) BIRTHS 1st January - 31st December, 1966 LIVE STILL LIVE BIRTH RATE PER 1,000 POPULATION Legit. Illegit. Total Legit. Illegit. Total Crude Adjusted by Comparability factor l.03 M 1207(1212) H 82 (78) M 1289(1290) M 20 (17) M - (1) M 20 (18) 14084 (14.97) 15.29 (15.4) F 1097 (1134) F 75 (73) F 1172(1207) F 12 (11) F 1 (1) F 13 (12) 2304 (2346) 157(151) 2461(2497) 32 (28) 1 (2) 33 (30) 93.6% (93°95) 6.4% (60O5) 100% (100) 97.OO%(93°33) 3.00% (6067) 100% (100) Number of Still Births Males Females Total Total live and still births 20 13 33 (18) (12) (30) Still birth rate per 1,000 live and still births 13.23 (11.87) 2494 (2527) HOUSING (1) During the year 102 units (244) of accommodation were completed. (2) 12 (19) applicants on the housing waiting list were re-housed on medical grounds following recommendations for priority made by the Medical Officer of Health. (3) On 31st December, 1966 there were 2374 (2148) applications on the Council's housing waiting list. (4) 170 (389) families were rehoused and a further 55 (96) were re-accommedated from property required for demolition, (5) Excluding miscellaneous properties there were 4103 premises under the control of the Borough Council, of these 89 units are provided for elderly persons under the supervision of wardens. Medical Priorities for Housing Applicants Those applicants whose housing circumstances are such that their health is seriously suffering therefrom are granted a degree of priority on the housing waiting list according to the urgency of the medical circumstances. Each case is thoroughly investigated before a recommendation is made to the Housing Committee. During the year 147 (l00) cases were referred to the Medical Officer of Health for assessment of priorities on medical grounds. On 31st December, 1960 priorities had been recommended as follows Category I (immediate re-housing) 53 (28) Category II (Priority within the points group) 59 (50) Category III (No Priority) 35 (22) 21 EPIDEMIOLOGY INDEX Page No. PREVALENCE AND CONTROL OP INFECTIOUS DISEASE 25 IMMUNISATION AND VACCINATION 26 VENEREAL DISEASES 28 IMMIGRATION 29 MASS RADIOGRAPHY 30 (Figures in brackets refer to 1965 figures) 23 PART II 25 (a) Infectious Diseases notified during the period 1st January to 31st December, 1966 Disease Under 5 5-14 15-44 45-64 65 or over age unknown Total M F M F M F M F M F M F M F Diphtheria - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) -(-) -(-) - (-) - (-) Dysentery 20 (14) 19 (6) 36(28) 23 (21) 7 (5) 11 3 - (-) - (-) - (-) - (-) 1(3) 1 (1) 64 (50) 54 (31) Encephalitis - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) -(-) - (-) - (-) - (-) Erysipelas - (-) - (-) - (-) - (-) 1 (1) - (-) - (-) - (-) - (1) - (1) -(-) - (-) 1 (2) - (1) Food Poisoning 1 (-) 3 (1) 1 (1) - (-) 2 (1) 3 (l) - (-) - (-) - (-) 1 (-) -(-) - (1) 4 (2) 7 (3) Malaria - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) -(-) - (-) - (-) - (-) Measles 229(169) 228(166) 203(91) 133(117) 1 (4) 5 (3) - (-) - (-) - (-) - (-) 5(-) 2 (-) 438(264) 368(286) Meningococcal Meningitis -(-) - (1) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) -(-) - (-) - (-) - (1) Ophthalmia neonatorum - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) -(-) - (-) - (-) - (-) Paratyphoid - (-) - (-) - (-) - (-) 2 (-) - (-) - (-) - (1) - (-) - (-) - (1) - (-) 2 (1) - (1) Pneumonia - (1) - (-) 3 (-) 1 (2) 1 (1) 1 (-) 2 (1) 1 (-) 2 (1) 4 (3) -(-) - (-) 8 (4) 7 (5) Poliomyelitis - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) -(-) - (-) - (-) - (-) Puerperal Pyrexia - (-) - (-) - (-) - (-) - (-) - (-) - (-) -(-) - (-) -(-) -(-) 93(87) - (-) 93 (87) Scarlet Fever 6 (12) 9 (13) 16(33) 18 (23) - (2) - (3) - (-) — (-) — (-) — (-) —(—) - (-) 22 (47) 27 (39) Smallpox - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) -(-) - (-) - (-) - (-) Typhoid - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) -(-) - (-) - (-) - (-) Tuberculosis (pulmonary) - (-) 1 (1) - (-) - (-) 11(12) 7 (8) 2(10) 4 (2) 3 (4) 2 (1) 1(-) - (-) 17 (26) 14 (12) Tuberculosis (Non Pulmonary) - (-) - (-) - (-) - (-) 1 (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) 1 (-) - (-) Whooping Cough 7 (7) 2 (4) 8 (5) 3 (6) 2 (-) 2 (1) - (1) - (-) - (-) - (-) - (-) - (-) 17 (13) 7 (11) PREVALENCE AND CONTROL OF INFECTIOUS DISEASE As mentioned in the introduction there were no epidemics of serious infectious disease during the year. Two cases of paratyphoid fever were notified. The source of infection in one case was almost certainly in France while the other was not identified. Both cases were kept under observation until such time as they were bacteriologically free from infection. The cases notified as food poisoning in the table were of the salmonella type and none were associated with an outbreak of food poisoning in the epidemic sense. Two of the cases of tuberculosis were notified posthumously. In both cases the families were investigated, no other cases being discovered. (b) Immunisation and Vaccination 1st January to 31st December. 1967 Type of Protection Completed Primary Courses Received Reinforcing doses (Booster) Diphtheria/Pertussis/ Tetanus/Poliomyelitis 16 - (3) (6) Diphtheria/Petussis/Tetanus 2430 1905 (915) (1017) Diphtheria/Pertussis 1 1 (2) (3) Diphtheria/Tetanus 99 2555 (42) (1079) Diphtheria 6 62 (5) (28) Pertussis 17 — (-) (4) Tetanus 84 61 (65) (29) Poliomyelitis Salk vaccine 3 4 (6) (1) Sabin (Oral Vaccine) 2908 2151 (1087) (735) Smallpox 2006 132 (958) (23) 26 The following table shows the percentages vaccinated London Borough of Sutton Children born in 1965 Smallpox (Children under 2) Whooping Cough Diphtheria Poliomyelitis (1) (2) (3) (4) 64 64 68 46 Protection against smallpox, diphtheria, whooping cough, tetanus and poliomyelitis is available at all the Council's clinics and at the surgeries of all general practitioners. All mothers of young children are notified by health visitors of the need for immunisation and are constantly reminded by widely displayed posters and leaflets. Vaccination against tuberculosis is offered to all contacts of infectious cases and carried out by the chest physician. In addition all school children who have not acquired natural immunity are offered this protection at approximately thirteen years of age. Pupils who may have acquired natural immunity are referred to the chest physician for chest x-ray to ensure that no treatment is necessary following their exposure to the infection. The recommended programme of protection is At age of 3 months 1st Triple and 1st Poliomyelitis 4 months 2nd " " 2nd " 5 months 3rd " " 3rd " After 1st year Smallpox vaccination 18 months Reinforcing Triple and Poliomyelitis 4½ to 5 years Reinforcing Diphtheria, Tetanus and Poliomyelitis 8 to 9 years Reinforcing Diphtheria and Tetanus 13 years B.C.G. vaccination Persons travelling abroad are strongly advised to take note of the advice given in the "Notice to Travellers" issued by the Ministry of Health, to ascertain what additional protection is advised and to obtain the appropriate inoculations. B.C.G. Vaccination 1st January - 31st December 1966. School children aged about 13 years Skin Tested No.found positive No. found negative No.Vaccinated 2513 166 2308 2297 (401) (323) (291) By Chest Physician Contacts: 169 15 144 131 (includes 4 infants) 27 (c) Venereal Diseases In ray report for 1965 it was only possible to give the notification of cases from the St.Helier Hospital Clinic. New arrangements have been made for the notification of cases in respect of residents of this Borough attending Hospital Clinics outside the Borough for treatment. The following table gives the relevant figures. New Cases 1966 Middlesex Hospital Croydon Hospital St.Helier Hospital TOTAL Syphilis - - 3 (12) 3 Gonorrhoea - 5 23 (31) 28 Other Conditions 15 26 234(211) 275 It is pleasing to note that the number of cases of Syphilis declined during 1966. The number of cases of Gonorrhoea and other venereal conditions has unfortunately remained similar to the 1965 figures. The Venereologists report that about half of the cases attending for treatment are young people but no definite statistical information is available. This trend is in accordance with the national picture and is a cause of some concern as it illuminates the increase in promiscuous intercourse by young people. The tracing of contacts or of cases who have failed to complete treatment is carried out by the staff of the hospital clinics who are in close touch with the Health and Welfare Department in cases of difficulty. 28 IMMIGRATION Under the Commonwealth Immigration Act, 1962, long stay immigrants are required to supply immigration officers with their destination address. This is forwarded to the Medical Officer of Health of the appropriate area and a visit is paid by a member of his staff. This is a useful procedure which enables contact to be made with the newly-arrived immigrant at an early stage. Health aspects of immigration are two-fold. The immigrant may be suffering from ill health which requires treatment and action to prevent the possible spread of infection or he may be exposed to infection in this country against which he has little or no immunity., Many immigrants to the Borough are employed in local hospitals. Those who are not are advised by the health visitors of the facilities available under the National Health Service and encouraged to register with a general practitioner. Where there are families appropriate arrangements are made for their protection against infectious disease and the mothers and children receive the normal health supervision available to the community as a whole. Country where passport was issued as stated by Port Health No.of advice notes received during 1966 from ports & airports relating to the arrival of immigrants. No. of first Successful Visits paid during 1966 No. of Pulmonary Tuberculosis Notifications received in respect of immigrants during 1966 (a) Commonwealth Countries 1. Carribean 9 (4) 8 (2) - (-) 2. India 9 (2) 5 (1) - (-) 3. Pakistan 2 (1) 1 (-) - (-) 4. Other Asian 1 (5) 1 (2) - (-) 5. African 6 (-) 4 (-) - (-) 6. Other 6 (3) 3 (3) - (-) (b) Non-Commonwealth Countries 1. European 44 (80) 41 (14) - (-) 2. Other 6 (4) 3 (2) - (-) TOTAL 83 (99) 39 (51) Nil (-) In addition Medical Superintendents at hospitals did 41 (25) follow-ups of immigrants joining hospital staffs. 29 MASS RADIOGRAPHY The Mass Radiography Unit visited sites in the Borough during the year and I am indebted to the Director of the Unit for the following statistics:- Total x-rayed 5420 (6930) Males 2380 (3630) Females 3040 (3300) As a result of these investigations 3 (1) men were found to be suffering from pulmonary tuberculosis and 1 (2) man and 1 woman from cancer of the lung. 30 PERSONAL HEALTH SERVICES PART III (NATIONAL HEALTH SERVICE ACT) INDEX Page No. MATERNAL AND CHILD WELFARE 33 "AT RISK" & OBSERVATION AND HANDICAPPED REGISTERS 36 THE WORK OF CHILD WELFARE CENTRES 39 DISTRIBUTION OF WELFARE FOODS 40 THE WORK OF HEALTH VISITORS AND SCHOOL NURSES 41 DOMICILIARY MIDWIFERY AND HOME NURSES 46 DAY NURSERY SERVICE 51 CARE OF THE UNMARRIED MOTHER AND HER CHILD 52 RECUPERATIVE HOLIDAYS 53 DENTAL CARE OF MOTHERS AND YOUNG CHILDREN 54 HOME HELP SERVICE 55 THE CARE OF THE MENTALLY HANDICAPPED 56 SUB-NORMAL CHILDREN AND ADULTS 57 CERVICAL CYTOLOGY 58 CHIROPODY SERVICE 59 MEDICAL SOCIAL WORK 61 HEALTH EDUCATION 64 HOME SAFETY 65 (Figures in brackets refer to 1965) 31 PERSONAL HEALTH SERVICES Local Health Authority Personal Health Services are provided under the various sections of Part III of the National Health Service Act 1946. They are complimentary to the services provided by the Regional Hospital Boards (hospitals and specialists) and Executive Councils (general medical practitioners, general dental surgeons, optieians and pharmacists) and with the exception of the ambulance service (Greater London Council) are the responsibility of the Borough Council. They provide health services for all age groups and sections of the population, particular emphasis being laid on the most vulnerable members of the community, the very young, expectant and nursing mothers, the elderly and the handicapped. They do not provide medical treatment except in a few minor instances but are concerned with the maintenance of normal mental and physical health and the early detection of abnormality. This work has many aspects and the account of work carried out during the year,which follows, reports the major activities of the medical, nursing and social work staff of the Health and Welfare Department. MATERNAL AND CHILD WELFARE Births 1st January to 31st December, 1966 (a) (b) In the area including those normally resident elsewhere Resident in the area including those born elsewhere, i.e. (a) adjusted by inward and outward transfers Including outward transfers Live 3436 (2629) 2450 (1883) Still 39 (32) 32 (20) Total 3475 (2661) 2482 (1903) Of the 2482 births 523 took place at home and 1959 took place in hospital. 33 34 PREMATURITY The following table gives details of premature births and stillbirths notified in the London Borough of Sutton during the period 1st January — 31st December 1966 as adjusted by transferred notifications: Weight at Birth PREMATURE LIVE BIRTHS PREMATURE STILL- BIRHS Born in Hospital Born at home or in a Nursing Home Transferred to Hospital on or before 28th day Born at home or in a Nursing Home Born in Hospital T O T A L DIED T O T A L DIED T O T A L Within 24 hrs of birth Between 1 & 7 days Between 7 and 28 days Within 24 hrs of birth Between 1 & 7 days Between 7 & 28 days Within 24 hrs of birth Between 1 & 7 days Between 7 & 28 days 2lb.3ozs. or less 3 — 3 — — - - - - - - - 4 - (4) (3) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (1) (1) over 2lb.3 ozs. up to & incl. 3lb.4ozs. 8 2 2 - - - - - 2 1 1 - 1 1 (7) (4) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (2) (-) over 3lb.4ozs. up to & incl. 4lb.6ozs. 28 2 1 - - - - - 1 - - - 6 - (17) (1) (1) (-) (1) (-) (-) (-) (-) (-) (-) (-) (4) (-) over 4lb.6ozs. up to & incl. 4 lb.l5ozs. 32 2 2 - 2 - - - - - - - 1 - (21) (-) (-) (-) (1) (-) (-) (-) (-) (-) (-) (-) (2) (1) over 4lb.15 ozs up to & incl. 5lb.8ozs 59 - - - 8 - - - 5 - 1 - 3 - (47) (-) (1) (2) (4) (-) (-) (-) (1) (-) (-) (-) (2) (-) TOTAL 130 6 8 - 10 - - - 8 1 2 - 15 1 (96) (8) (2) (2) (6) (-) (-) (-) (1) (-) (-) (-) (11) (1) This table emphasises the serious loss of infant lives associated with prematurity and during the first month of life. The size of the problem can most simply be shown as follows:- Total Non Premature Premature * Live births 2450 2302 148 (1883) (1780) (103) Deaths among live births in the first month of life 28 11 17 (42) (29) (13) Still births 32 16 16 (20) (8) (12) * The Ministry of Health's definition of a premature birth is one when the infant at birth weighs 5½ lbs or less. It will be seen that the 2302 (1780) non-premature live births produced 11 (29) neo-natal deaths and the 148 (103) premature live births produced 17 (13) neo-natal deaths. In addition 50% (60%) of still births are associated with prematurity. CONGENITAL ABNORMALITIES It is a responsibility of the Medical Officer of Health to submit a confidential report in standard form to the Registrar General on congenital abnormalities detected at or shortly after birth. A standard form of birth notification is used in the area which provides for the notification of congenital abnormalities and factors calculated to put the infant 'at risk' when these are detected at birth. Similarly, reports submitted by hospital maternity units and domiciliary midwives on patients discharged from their care after confinement are in standard form providing for the easy recording of congenital abnormalities and 'at risk' factors. Between 1st January and 31st December 1966, 75 congenital abnormalities were reported as compared with 35 between 1st April 1965 and 31st December 1965. Of the 75 congenital abnormalities reported during the calendar year, 41 (11) were of a comparatively minor nature and 24 (24) were more serious defects, 5 (1) of the 75 infants concerned were still-born and of the 70 infants born alive 8 (5) died within ten days of birth. During 1966 births at which congenital abnormalities were detected represented 3.1% (1.3%) of the total live and still births. 35 "AT RISK" AND OBSERVATION AND HANDICAPPED REGISTERS In recent years it has been increasingly recognised that many of the ohildren who need special educational consideration in sohool and support later in life acquire their handicapping conditions in the pre-natal, neo-natal or post-natal periods of life. Those babies who have been exposed to unfavourable heredity or adverse experiences during this period are considered to be "At Risk", and a register is kept of these cases so that they can be offered medical examination at regular intervals until it is certain that their development is normal. In addition the growing child may be placed at risk by accident or illness occurring during child-hood. In order to ensure that each handicapped child, even if suffering from only a minor defect, is assisted to the extent necessary to make full use of ability a register known as the "Observation and Handicap Register" is compiled. Children whose names appear on this register are kept under special surveillance until 5 years of age by medical examination and assessment of their developmental progress. Social circumstances are also taken into account as home conditions and attitudes, together with family relationships, may make a significant contribution to progress. Close co-ordination of the work of various agencies who are concerned with the well-being of the handicapped child is essential and this involves close contact with general practitioners, hospitals and voluntary organisations. The "Observation and Handicap Register" provides the means by which this is achieved and, where necessary, ensures the future provision of educational facilities suited to the child's ability. From this diagram it can be seen how the register is compiled. 36 In 1966 there were 2482 births notified and of these 922 were notified "at risk". The total number of cases on the "Observation and Handicap Register" aged from 6 months to 5 years is 433. OBSERVATION AND HANDICAP REGISTER ANALYSIS OF DEFECTS Type of defect Year of Birth 1962 1963 1964 1965 1966 TOTAL Physical defects Total 6 9 16 28 67 126 Spastic 3 3 Hemiplegia 1 1 Foot deformity 4 5 9 Congenital dislocation of the hip 1 3 2 3 9 Dwarfism 1 1 Hypospadias 1 11 2 Harelip 1 2 3 Talipes 2 6 12 20 Pyloric stenosis 1 4 5 Torticollis 5 1 6 Cleft palate 6 6 Male genital defects 9* 9 Inguinal hernia 5 5 Umbilical (requiring surgery) 2 2 Pilonidal sinus 1 2 3 Large unsightly naevae, skin tags and malformed ears 7 7 Syndactyly and accessory toes 5 5 Polydactyly 2 2 Jejunal atresia 2 2 Other minor deformities 2 3 3 11 7 26 * 6 of these are hypospadias 37 continued from over page Type of defect Year of birth 1962 1963 1964 1965 1966 TOTAL Defects of the Total Central Nervous System 20 18 15 14 10 77 Mental Retardation 9 9 6 3 4 31 Microcephaly 2 1 1 1 5 Epilepsy (or severe convulsions) 3 5 8 Mongols 2 3 3 8 Spina Bifida or hydrocephalus 2 1 4 4 5 16 Others needing observation re: retardation 2 3 1 3 9 Number with chronic Total illness 3 6 4 5 8 26 Fibrocystic disease 1 1 2 Christmas disease 1 1 Others 3 6 4 3 7 23 Hearing defects 6 11 5 5 4 31 Vision defects 5 9 14 13 10 51 Speech defects 13 34 9 2 58 Number with severe handicaps (included in classification elsewhere) 5 1 2 3 11 Number with cardiac defects 6 6 9 7 28 Phenylketonuria 1 1 Number with multiple defects 11 3 8 2 2 26 Number who were put on register for symptomatic reasons. (included in classification elsewhere). 5 11 5 5 10 36 Number requiring observation only 5 16 22 18 31 92 Total number of children with defects (some children have more than one defect). 46 93 78 90 126 433 38 THE WORK OF CHILD WELFARE CENTRES The work of child welfare centres consists of supervision of the development of normal young children and those ascertained as "at risk", early detection of abnormalities of development} provision of facilities for immunisation and vaccination against infectious disease; giving advice concerning the feeding and management of children and the measures necessary for the promotion of family health. The nature and content of this work has changed very considerably since its inception. The emphasis is now directed away from the detection and treatment of the gross defects found in former years towards the more subtle problems of developmental abnormality and family relationships. Advice concerning behaviour problems now forms a very considerable part of the work carried out by medical officers and health visitors in their consultation clinics, work demanding very different skills to those formerly necessary. The demand for this service and the esteem in which it is held by mothers is illustrated by the continuing high attendance figures of children under the age of five years :- Stonecot Hill Clinic 6585 Priory Crescent 6030 Worcester Park (Village Hall) 3103 Cheam (Village Hall) 3245 Robin Hood Lane 12507 Belmont (Village Hall) 1037 Alexandra Gardens 2327 The Mount 1301 Green Wrythe Lane 4673 Rochester Road 6002 Shotfield 4315 Beddington 1294 New Road 1400 During the year special toddlers clinics have been held in all the main clinics where children are seen by appointment annually for assessment of their physical and mental development and where more time can be devoted to mothers who have problems than is possible at the general clinic sessions. It is intended to make available facilities for an annual examination of this kind for all pre-school children as soon as possible. Special sessions are arranged for immunisation and vaccination of children where the numbers attending justify separation from general infant welfare sessions. At 31st December, 1966, 6 purpose-built clinics and 2 adapted buildings were in use for ante-natal and post-natal clinics, mothercraft and relaxation classes and child welfare centres including toddlers' clinics and immunisation. In addition, 5 church and other types of hall were occupied on a sessional basis for child welfare clinics and immunisation. The sessional use of one adapted building was discontinued during the year at 38 The Mount, Clockhouse Farm Estate, Carshalton and was replaced by a new purpose-built clinic in the same area. 39 Child Welfare Centres Number of children who attended during period 1st January to 31st December 1966 First attendances No. of Sessions held by Born In Total Total Attendances Asst. Medical Officers G.P.s employ -ed on session -al basis Total No.of Sess -ions No.of Child -ren referred elsewhere for consultant advice No.of Children on "at risk" register at end of year 1965 1964 1960 -63 2241 1697 2864 6802 57,445 1124 119 1243 108 2122 (1908) (310) (990) (3208) (48,667) (882) (140) (962) (50) (2525) ANTE NATAL CLINICS Ante-natal clinics are held in the major centres in the Borough. 290 patients were seen during the year. DISTRIBUTION OF WELFARE FOODS 1. Government Scheme The Council acts as agent for the distribution of National Dried Milk, Cod Liver Oil, Orange Juice and Vitamin A and D tablets to authorised beneficiaries. The major part of the work is handled on behalf of the Council by members of the W.R.V.S. and other voluntary workers whilst the detailed accounting for the scheme is dealt with by the Medical Officer of Health and the Borough Treasurer. Charges under this scheme are made as follows :- National Dried Milk 2/4d per tin Orange Juice l/6d per bottle Cod Liver Oil l/-d per bottle Vitamin Tablets 6d per packet The Ministry of Social Security issues vouchers for free issue in necessitous cases. 40 Issues to beneficiaries, 1st January to 31st December, 1966: National Dried Milk (tins) Cod Liver Oil (bottles) Orange Juice (bottles) A & D Tablets (Packets) 22,096 2,435 47,835 3,271 (18,120) (1,738) (36,803) (2,740) 2. Proprietary Welfare Foods It is customary for infant welfare clinics to hold a stock of proprietary brands of welfare foods approved by the Medical Officer of Health for sale to bona fide clinic attenders at reduced prices., In most clinics this work is the responsibility of voluntary committees working in close co-operation with the professional staff. The profits made by these voluntary bodies are used to further the work of the clinics. THE WORK OF HEALTH VISITORS AND SCHOOL NURSES (a) General A number of vacancies remained unfilled for a considerable part of the year but six students were seconded for training and will, if they are successful in obtaining their qualifications, become available for appointment to the permanent staff in 1967. The services have been expanded during the year by opening Advisory Centres for the elderly at Green Wrythe Lane and Priory Crescent Clinics. The object of these Centres is to maintain health and well being in the elderly for as long as possible. During the formative peried experience has been gained regarding the type of service most needed, and it is hoped to set up new Centres in the future. At present a superficial assessment of health is made by the health visitor, appropriate advice given and referral to the family doctor made if treatment is necessary. To encourage the maintenance of free movement, groups are given -exercises to music and to encourage the maintenance of good general health, talks and discussions are held on various subjects, for example the care of the feet or diet. The Centres are attended by a Chiropodist who is available to give treatment where necessary. Mothercraft classes are held at seven centres in the Borough and were attended by 475 expectant mothers some of whom received ante-natal care from hospitals or their general practitioners. 38 parentcraft sessions, which include the fathers, were held at the clinics with an average attendance of more than 50 at each. These classes are becoming more popular and will be extended during 1967. 41 Use of clinics in general is at a high peak and. I give below some figures to indicate the number of mothers and children that passes through one of our busiest clinics. In 1966 at Robin Hood Lane Clinic in Sutton, 17,280 patients, a large number of whom were children or infants accompanied by adults, entered the clinic for specific purposes as shown below:- Infant Welfare Toddler Examinations Ante-natal Post-natal Cytology Midwives Mothercraft Relaxation Hearing Testing of Babies Physiotherapy 12,507 213 958 490 390 868 Speech Therapy Eye Clinics Chiropody 880 204 780 All approximate figure only can be added with regard to:- Immunisation (held weekly) 2860 General Medical Clinics 216 (held fortnightly) Adult Medical Examinations 20 This brings the minimal total number of people attending Robin Hood Lane Clinic during 1966 to 20,386. There are, of course, miscellaneous consultations and countless numbers of people making enquiries and seeking advice in excess of this figure. (b) Health Education The health visitors continued with the group work they do within the clinics with Mothers' Clubs, Mothercraft Classes and Parentcraft. They visit Social Clubs and attend outside group activities with current health education material and information, and join with the Education Department in health education projects in schools and with Further Education Groups. The health visitors have taken 277 student nurses for whole day visits of observation. Lectures on Public Health Nursing are given to the student nurses by local authority nursing officers before, and discussions are held after these visits of observation. The two health visitors attached to St.Helier Chest Clinic continue to visit 703 patients on the Tuberculosis Register and 36 non-tubercular patients required home visiting during 1966. 42 The Geriatric health visitor attached to St.Helier Hospital attends the three Advisory Centres for the elderly and will be concerned with the opening of further centres in Wallington and Sutton. She keeps the hospital and local authority services informed and in close touch with the needs of the elderly referred to the geriatric unit at St.Helier Hospital. The health visitors' case load was as follows:- 0-1 years 1-5 years 0-5 years Families Total 2370 8262 10,632 8486 (2513) (8561) (11,074) (7982) Average caseload for staff in post 17(17) 139 486 625 499 (150) (503) (651) (470) Average caseload for 22 (21) establishment in December 1966 108 375 487 386 (120) (408) (528) (380) Cases visited by health visitors 1st January to 31st December 1966 Children under 1 year of age Children age 1 and lander 2 years Children age 2 and under 5 years Total No. of children visited 2497 2265 6228 10,990 (2751) (2579) (6821) (12,151) (c) Screening Tests The early diagnosis of abnormalities of hearing and metabolism is essential if speech is to develop and one particular form of mental subnormality prevented. Screening tests were offered to all children for whom birth notifications were received during the year. A screening test of hearing is offered to all children at the age of 8 months. 1710 children were tested and 107 re-tested of whom 9 were referred to audiology clinic for further examination. Phenylketonuria is a condition present at birth which leads to rapid mental retardation. Immediate treatment with successful results can be given if the condition is diagnosed early and a simple urine test has been devised for this purpose which is done between three and eight weeks of age. During 1966 the urine of approximately 2400babies was tested, no positive results were found. 43 (d) Research Much of the field work for national research projects is performed by health visitors who have direct contact with the families in their homes or at the clinics. Four extensive surveys were covered in the first few months of the life of the Borough and the work continued through 1966. (e) Care of Mothers and Young Children The statutory function of health visitors is the care of mothers and young babies and this is carried out by means of home visits, consultations at clinics and group discussions with parents until the child is five years of age. During the period 1st January to 31st December 1966, 1243 (962) infant welfare sessions were held in clinics and 304 (324) other clinic sessions were devoted to the care of mothers and young children apart from home visiting. The care of ante-natal and post-natal mothers is undertaken both at clinics and in homes. Special group meetings are arranged and demonstrations, films and discussions take place to help prospective parents to prepare and adjust to their new roles. The health visitors attended at 581 (230) ante-natal and post-natal clinics and held 38 (275) parentcraft meetings during January to December 1966. (f) Family Welfare The prevention of illness and promotion of health involve the health visitor in a special interest in the continued maintenance of family life. Whether acute problems exist or where the inadequacy is long term, support is necessary. Help from workers in other specialised disciplines on a long or short term basis is available to assist in this time-consuming and exhausting work but the health visitor's knowledge of the families make it imperative that she maintains the continuity of her friendship and support throughout. (g) Care of the Elderly Neighbours, old people's welfare committees, clergy and other organisations draw attention to the elderly who are lonely, ill or in need of skilled assessment. The health visitor is able to call on the services necessary to maintain them in their own homes for as long as possible and her close association with the general practitioners and hospital is particularly valuable in this respect. The geriatric health visitor attached to the Geriatric Unit at St.Helier Hospital acts as a liaison officer between the Local Health Authority services in the assessment of priority of need in each case referred to the unit by general practitioners. Frequent visits are paid to patients on the waiting list for beds and day to day re-assessments are made. In conjunction with the general health visitors she supervises patients in their own homes following discharge from hospital after re-habilitation or temporary illness. 44 Arrangements are made for short-term holidays to relieve families who are permanently caring for their elderly relatives. (h) Care of the Handicapped It frequently falls to the health visitor to recognise incipient mental illness during her routine care of mothers and to maintain support during periods of potential breakdown or during rehabilitation after mental illness. Her longstanding friendship with the family and training make her an invaluable ally at this time. During the year a change was made in the supervision of the mentally sub-normal, health visitors relinquishing responsibility for the supervision of those over the age of five years to mental welfare officers. 279 (259) mentally disordered patients were visited by health visitors during 1966. Where physical handicap occurs the health visitor has a special responsibility to see that adequate treatment is obtained and other advice and assistance is made available should it become necessary. Intensive support may be necessary during the period of adjustment and adaptation to every day living., (i) Care of School Children Health visitors are appointed jointly under the National Health Service Act for the care of mothers and young children and under the Education Act for the care of school children. Continuity of care is thus maintained and close contact is made with the school staffs. This work is concerned not only with medical care and testing of vision and hearing, but also with the personal hygiene and family background of each child. Whendifficulties other than those of an educational nature present themselves the school staff can consult the health visitor and whenever necessary a home visit is made to assist in the resolving of medical, emotional or environmental health problems. They also undertake health education in schools and gave 71½ (50) teaching sessions during the period. All contacts with pupils and teaching staff are utilised for this purpose whenever opportunity arises. During the period 1st January to 31st December 1966 the health visitors were responsible for 207 (162) sessions in school plus 56 (38½) sessions given to hygiene inspections. Periodic medical inspections in secondary schools are now attended by sessional school nurses who spent 136 (252½) sessions on school medical inspections, and minor ailment clinics are held for school children and attended by sessional school nurses where possible. During the period 1st January to 31st December 1966, they attended 252½ (272½) sessions. 45 DOMICILIARY MIDWIFERY AND HOME NURSES Staff as on 31st December, 1966: Full-time 35 Part-time 17 Vacancies : full-time 7 Part-time Nil For most of the year fewer members of staff were in post than those given above. Difficulties are still being experienced in recruitment particularly of midwives, although the policy of the Council in providing housing accommodation where neoessary has eased the position. A new appointment of Nursing Auxiliary was made during the year to work under the supervision of a State Registered Nurse to give general care to those patients who did not require fully skilled nursing. This proved a great success with everyone especially elderly patients with whom the Auxiliary could spend more time. The policy of employing less highly skilled staff in the nursing services allows the qualified District Nurses to give additional attention to those patients who are most in need of their skills and it is hoped to increase the number of Nursing Auxiliaries next year. In order to meet the changing circumstances midwifery in the Sutton and Cheam areas was combined and carried out from the Cheam Nurses' Home. This allowed greater flexibility in the deployment of staff, the mothers continuing to attend the midwives clinic nearest to their homes. There is a need to proceed with the changes recommended to and accepted by the Health Committee to bring the service into a form more suited to the needs of the Borough. The pattern of home nursing is changing still and patients who would have had to remain in hospital are now able to be given highly skilled nursing at home because of the progress made in nursing techniques and the aids, including mechanical aids, now available. District Nurses and Midwives are using many disposal items of equipment increasing the efficiency of their work and saving valuable nursing time. Considerable advance has also been made in the home nursing care of the severely handicapped and with additional social support becoming available the degree of handicap which can be nursed at home is gradually increasing. The number of home confinements remained much the same as in the previous year, although planned early discharges from hospital were slightly increased. The total number of persons nursed at home increased considerably during the year particularly in the over 65 age group. This is indicative of the increasing care being made available to the elderly in their own homes. Analysis of the illnesses from which patients suffered and for which service was provided shows that the greatest increase was in those with diseases of the blood, medical and surgical chest conditions and cardiac disease. Statistical information relating to the home nursing and midwifery services follows:- 46 HOME NURSING (a) Total number of persons nursed during period 1st January - 31st December 1966 2849 (1513) (b) Number of persons aged under 5 at first visit during period 1st January - 31st December 1966 54 (24) (c) Number of persons aged 65 or over at first visit during period 1st Janizary - 31st December 1966 1862 (994) DOMICILIARY MIDWIFERY Number of domiciliary confinements attended by midwives under N.H.S. arrangements Number delivered in institution but discharged to D.M. before the 10th day. Doctor booked Doctor not booked Total Doctor present Doctor not present 178 317 4 499 289 (128) (287) (3) (418) (179) (a) Midwives booked cases transferred to hospital during confinement Of the cases booked for home delivery 30 or 5.9% were transferred to hospital during pregnancy and 23 or 4.6% during labour. The following table analyses the reasons for these emergency admissions:- (1) In Labour Antepartum haemorrhage 1 Mal presentation 2 Foetal distress 3 * Inertia 9 Toxaemia - Prematurity 4 Retained placenta 1 Early rupture membrane 2 Twins (unbooked case) 1 No reason - * 1st stage (7) 23 2nd stage (2) (2) In Pregnancy Antepartum haemorrhage 5 Post Maturity 8 Home conditions 1 Vein condition 1 High head at term 3 Unstable lie 1 Intra Uterine Foetal death for induction 2 Pre-eclampsia toxaemia 9 30 47 (b) The 2849 patients attended by home nurses between 1st January and 31st December, 1966 required nursing at home for the following reasons :- Heart Disease 237 Circulatory Diseases (including Cerebral Haemorrhage and Thrombosis) 308 Diseases of the Blood (including Anaemia, Leukaemia) 338 Diseases of the Central Nervous System 126 Influenza 22 Diabetes 66 Scalds and Burns 12 Other injuries 44 Varicose ulcers 102 Rheumatic and Arthritic Conditions 239 Chest Conditions, Medical 238 Chest Conditions, Surgical 23 Abdominal Conditions, Medical (Including Enemas rectal wash out) 247 Abdominal Conditions, Surgical. 130 Gynaecological, Medical 102 Gynaecological, Surgical 27 Urinary, Medical 38 Urinary, Surgical 35 Breast Conditions, Medical 25 Breast Conditions, Surgical 35 Skin Diseases, Medical 30 Skin Diseases, Surgical 14 Ear, Nose and Throat, Medical 54 Ear, Nose and Throat, Surgical 6 Orthopaedic, Medical 42 Orthopaedic, Surgical 39 Eye Conditions 15 Pedicures 7 Diagnostic Preparations 10 Miscarriages 7 Threatened Miscarriages 15 Others 204 Tuberculosis 12 (c) Refresher Courses for Midwives, District Nurses and Pupil Midwives During 1966, the non-medical supervisor of midwives and 6 district nurses attended refresher courses. District Nurse Training During 1966, 6 student district nurses completed their training and all passed the examination. Pupil Midwifery Training 35 pupil midwives undertook 3 months of their second period of training with the Borough. In addition the district nurses took student nurses from hospitals for observation visits. 150 of these students were from general hospitals and childrens' hospitals. 18 were nurses doing obstetric nurse training. 48 (d) During the calendar year 1966, home nurses made a total of 118,737 visits as follows :- Visits paid by District Nurses and Midwives Ante-Natal Midwifery General Nursing Total 5567 11,236 101,934 118,737 (5585) (14,420) (94,267) (114,272) Of the 2849 general patients visited between 1st January and 31st December 1966, 65.36% were aged over 65 years at the time of the first visit. ( e) Local Supervising Authority (Midwives) The Borough Council as the Local Supervising Authority are responsible for supervising the work of midwives throughout the Borough. 89 State Certified Midwives gave notice of their intention to practise as midwives in the Borough during the calendar year 1966. (f) Summoning of Medical Aid During the period 1st January to 31st December, 1966 medical aid was summoned under the Midwives Act, 1951 midwives in the following number of cases :- (i) For domiciliary cases (a) Where the medical practitioner had arranged to provide the patient with maternity medical services under the National Health Service (b) Others (ii) For cases in institutions (g) Ophthalmia Neonatorum Between 1st January and 31st December, 1966 midwives sought medical aid for suspected cases of Ophthalmia Neonatorum in respect of 9 babies. No cases were notified by midwives. (h) Notification from Midwives During the period 1st January to 31st December, 1966 the following notifications were received from midwives s- Sending for medical aid 422 (26l) Stillbirths 4 (3) Liability to be a source of 8 (8) infection (inc.pyrexia) Death of mother or baby Nil (nil) 99 (96) 1 (6) 322(159) 49 (i) Special Investigations The non-medical suparvisor of midwives undertook the following special investigations during 1st January to 31st December, 1966. Sending for medical aid (all were concerned with conditions of babies' eyes 9 (lO) Stillbirths 4 (3) Liability to be a source of infection (incl:pyrexia) 8 (8) Death of mother or baby Nil (-) (j) Maternity Outfits A maternity outfit is supplied free on request to each expectant mother being confined at home who makes use of one or other of the arrangements for the care of expectant mothers under the National Health Service. (k) Maternal Mortality There were no deaths assigned to the London Borough of Sutton in 1966. (l) Puerperal Pyrexia During the period 1st January to 31st December, 1966, 93 cases of puerperal pyrexia were reported presenting an attack rate of 21.1 per thousand live and still births. (m) The following table shows the work undertaken at the Ante-Natal and Post-Natal Clinics during 1966 :- No. of Sessions held by No. of women in attendance No. of attendances Total No. of Sessions Medical Officers Midwives For A.N. Examination For P.N Examination M.O. Sessions Midwii Sessions 'e Tot. Att end an ces * 293 288 1030 37 1421 2848 ,4269 , 581 (230) (216) (606) (80) (1526) (2340) (3866) (446) (n) Ante-Natal, Mothercraft and Relaxation Classes Number of women who attended during 1966 :- Institutional booked Domiciliary Booked Total Total No. of attendances during year 434 41 475 2270 (330) (26) , (356) (1886) 50 Marie Curie Fund. Visits were made whenever necessary during the year concerning the Marie Curie Fund, chiefly to provide night nurses for the extremely ill. LAUNDRY SERVICE FOR INCONTINENT PATIENTS NURSED AT HOME The scheme for a laundry service for incontinent patients nursed in their own homes continued under the administration of the Health and Welfare Department during 1966. Whereas, resulting from the re-organisation, the schemeipreviously included three other Boroughs, the London Borough of Kingston and the Urban District of Esher; made arrangements early in the year to operate their own service. This enabled the remaining Authorities, the London Borough of Sutton aid the London Borough of Merton to meet the increasing demand for this service from patients in their areas. The following information gives the numbers of patients served :- Total during year On books at end of year London Borough of Sutton 77 33 (34) London Borough of Merton 124 48 (33) Borough of Epsom and Ewell 1 1 Total 202 82 No. of weekly deliveries 104 (170) DAY NURSERY SERVICE Children are admitted to the Council's Day Nursery. (i) Where the mother is the sole wage earner. (ii) When there is sickness in the family or where home conditions are likely seriously to prejudice the health of the child exist. (iii) Where, upon consideration of individual circumstances, it appears to the Council that admission is necessary in the interests of the child. The situation of the nursery near to the North West boundary makes it inaccessable to many parts of the Borough. Consequently 10 (27) children normally resident attended the nursery in Middleton Road by arrangement with the London Borough of Merton and 3 (2) children attended nurseries in other Boroughs. 4 (2) children were placed by the Council in private day nurseries. 52 places are available in the Council's nursery, the average daily attendance at which was 30.44 (32.3). Children attending the nursery are medically examined at six monthly intervals and medical officers and health visitors pay frequent visits. 51 CARE OF THE UNMARRIED MOTHER AND HER CHILD In making provision for the residential care of the unmarried mother and her child the Counoil rely mainly on voluntary organisations. There is an active Moral Welfare Association in Sutton which runs an l8-bed mother and baby home. The Council makes a grant to the association and in return receives the services of a moral welfare social worker and free admission of mothers up to one third of the total number of beds available. A number of girls prefer to go to mother and baby homes some distance from their places of residence and at times the Sutton home is unable to accept all the Sutton cases. Under these circumstances, a suitable home is sought elsewhere, the Council being financially responsible for the girl's maintenance, less any contribution she may make of her own or from financial help from her parents or the putative father. The total number of Sutton girls admitted to the Sutton Mother and Baby Home from 1st January to 31st December, 1966 was 18 (14) and the number placed elsewhere was 25 (l7)« The length of stay at a mother and baby home is normally about twelve weeks - 6 weeks ante-natal and 6 weeks post-natal. Before leaving the home mothers are assisted to find accommodation and employment and in making arrangements for the care of their babies. MOTHER AND BABY HOMES Name and addre-ss of Home Provided by : "The Haven" 2 Camden Road, Sutton Sutton & District Moral Welfare Association Part B Number of cases admitted during year Number of beds at end of year Average duration of stay Ante-Natal 69 (48) '9 (9) 42 days Post-Natal - (2) 8 (8) 42 days Shelter - (") - (-) - Total 69 (50) 17 (17) 84 days Number of Cots 9 Number of cases included above for which Authority accepted 18 (14) financial responsibility 52 RECUPERATIVE HOLIDAYS Adults and children recommended on medical grounds for recuperative holidays are sent to convalescent and holiday homes. During the year 4 children under the age of five years, 21 (7) school children and 33 (54)adults were sent for recuperative holidays. Patients, excluding school children, are normally required to pay a standard charge towards their maintenance. 53 DENTAL CARE OP MOTHERS AND YOUNG CHILDREN The following tables give details of work undertaken during 1966 : (a) Numbers provided with dental care. Persons Examined Persons who commenced treatment Courses of treatment completed Expectant and Nursing Mothers 65 (44) 15 (43) 49 (50) Children under 5 and not eligible for School Dental Service 504(533) 100(222) 431(264) (b) Forms of treatment provided during the period 1st January - 31st December 1966 EXPECTANT AND NURSING MOTHERS Dentures :- No. of fill -ings Teeth filled Teeth extr. Gen. Anaes thetics Emerg. visit -s Patient x-rayed Scaling or removal of stains Teeth Conserv ed Teeth root fill -ed Inlays Crowns Pull Upper or low1" Oth -er Nos. provided 180 147 31 8 13 8 44 - - - 2 2 10 14 CHILDREN AGED UNDER 5 YEARS and NOT ELIGIBLE FOR SCHOOL DENTAL SERVICE s- 1072 912 171 98 94 1 33 371 — — — — — — The number of toddlers attending the clinics for dental inspections continued to rise during 1966. At these sessions advice is given to the parent on diet, oral hygiene and the need for regular dental inspection and treatment whether at the clinic or from a National Health Service practitioner, the choice being left to the parent. It is not always possible for toddlers to be dentally inspected at the toddlers clinics owing to lack of full-time dental officers, and there are still, unfortunately some children whose first visit to the dentist is associated with pain. 94 children under 5 were treated as emergency patients (i.e. attending for the relief of pain not as a routine visit) during the year. The number of expectant and nursing mothers attending for dental treatment continues to be low. The Borough as a whole is well supplied with National Health Service practitioners and most mothers probably prefer to continue their treatment with their usual dental surgeon. 54 HOME HELP SERVICE The level of provision of home help for households unable to meet their own domestic commitments because of frailty, illness or maternity, was approximately the same as during the previous year. The demands for this service continue to be heavy and are likely to increase with increasing emphasis being placed upon home care. It is difficult to see how in this area the level of service can be improved. The financial attractions of private domestic work are considerable and opportunities for other part-time work provide severe competition to the less well-paid and less attractive home help service. i It has not yet been possible to substantially improve recruitment in this Borough but an answer must be found if increasing commitments are to be fully met. Much credit is due to those home helps who have been employed in the service for many years. If it were not for their loyal service the demands made upon residential accommodation, upon families and upon their professional colleagues would be much heavier then they are. heavier then they are. No praise is too high for the way in which they support the sick and the elderly in their own homes over long periods of time, often in the face of great difficulties. Home Help to Households for Persons: Aged 65 or over on first visit Chronic Sick and T.B. Mentally Disordered Maternity Others Total Number of Cases 843(563) 48(58) 3 (2) 162(125) 135(130) 1191(878) 7l/o(64$) 13*(15*) Number of Home Helps 31st December 1966 (a) Whole time (b) Part-time (c) Whole-time equivalent of (b) (d) Total 9 (1) 82 (92) 45.2(51.3) 54.7(52.3) The scheme for Neighbourly Helps, whereby neighbours in return for payment up to £2 per week, carry out simple domestic duties for one or more persons in need living in the immediate neighbourhood has much promise; there are some who are reluctant to accept help from their neighbours and some who would be willing to give help are deterred by the legal necessity of obtaining an insurance card. I am sure this scheme is capable of expansion and additional helpers are urgently needed. 13 (9) cases were being helped in this way in 1966. 55 THE CARE OF THE MMTALLY HANDICAPPED Mental Illness During the year 305 referrals were received by the Mental Health Section from various sources. Of this number, 129 patients required in-patient treatment in Psychiatric Hospitals, 23 being admitted on an informal basis and 106 under statutory procedures as follows :- Section 25 24 " 26 6 " 29 76 In addition a substantial number of enquiries and interviews connected with mental illness and mental subnormality have been attended to at the Town Hall. Mental Welfare Officers are on call to render assistance outside normal office hours at night and week ends and for emergency rota duty a link has been maintained with the neighbouring Borough of Merton. This arrangement operates very satisfactorily and will continue. The number of calls received which necessitated emergency action to arrange hospital admission averaged 3 per week during the past year. The co-operation of Sutton Police is an important factor in maintaining an adequate emergency service and this is much appreciated. Included in the total number of referrals were 123 specifically referred for community care. Of this number, 86 referrals were made directly to the Senior Psychiatric Social Worker from the following sources: Psychiatric Hospitals 34 Day Hospital 1 General Practitioners 14 Children1s Department 8 School Health Service 1 Social Welfare Officers 5 Health Visitors 8 Other Authorities 5 Self Referrals 5 Other Sources 5 At 31st December 1966, 24 of the above patients and their families were receiving continuing after-care and of the remaining 62 :- 8 entered hospital 2 were admitted to Gower House Hostel 8 left the district 30 received short-term community care 4 were treated in Day Hospitals 7 were referred to other agencies 3 refused after-care. 56 The number of mentally ill patients being supported in the community at 31st December 1966 totalled 76; 41 by the Senior Psychiatric Social Worker and 35 by the Mental Welfare Officers„ 10 patients have been supported in voluntary homes or hostels outside the Borough for varying periods during the year and at 31st December 1966 only 5 were in residence. Qower House Hostel Gower House Hostel was furnished and equipped in February 1966 and the Warden and House-keeper took up residence towards the end of that month. The Hostel was opened to receive residents on 1st April, 1966 and during the remainder of the year 17 persons (l re-admission) were accepted, 16 being referred by Consultant Psychiatrists and one by a General Practitioner. 5 persons left the Hostel during the year and returned to private accommodation in the community and at 31st December 1966, 12 persons were in residence. Social Club The newly formed Sutton Branch of the National Association for Mental Health opened a Social Club for Mentally 111 patients on 1st November 1966 at the Day Centre, 77 Woodcote Road, Wallington and the Senior Psychiatric Social Worker together with the Mental Welfare Officers attend the Club which meets each Tuesday evening from 8 p.m. - 10 p.m. This has been a most promising innovation, not only providing a practical aid towards the rehabilitation of the mentally ill, but also a useful meeting place for patients and social workers concerned with their care. Further developments in this field will necessitate the provision of larger and more permanent premises for the Association's various activities. The average attendance during the year was 14. SUB-NORMAL CHILDREN AND ADULTS At 31st December, 1966, 105 subnormal children and adults were receiving day training in various training centres within and outside the Borough; as follows :- Sutton Training Centre Morden Junior Training Centre (London Borough of Merton) Banstead Adult Industrial Training Centre (Surrey County Council) Caterham Training Centre (Surrey County Council) Crossfield Training Centre (London Borough of Croydon) Bensham Sheltered Workshop (London Borough of Croydon) Newlands Training Centre (London Borough of Wandsworth) Croydon Spastic Children's Centre Croydon Spastic Work Centre 29 children 23 " 44 adults 1 child 1 adult 1 adult 1 adult 1 adult 2 children 2 adults 57 During the year the waiting list of adults for attendance at the Banstead Industrial Training Unit was reduced by 6 leaving a total of 11 waiting admission at the end of the year. Further places are expected to be available during the coming year when the total number attending the Banstead Centre is expected to rise to 60. 10 sub-normal children and adults were maintained in residential establishments or attended special Day Training Centres during the year and at 31st December 1966 the position was as follows :- 2 female children resident at The Society of St.Bemadette 1 female child attending daily, Lourdes House, Wallington 2 male children resident at Roffey Place, Faygate. 1 male adult resident at Ravenswood Foundation, Copthorne 1 female adult resident under Guardianship Society, Hove. 1 female child attending daily The Link Education Trust, Beddington 1 female child resident at Sons of the Devine Providence, Colombo House, Teddington 1 female adult resident at St.Mary's Convent, Roehampton. 8 applications were received during the year for permanent hospital care for various reasons and all have been admitted. 11 applications were received for short-term care to enable the parents to have a holiday or because of a family crisis. All were accepted and with the co-operation of the Manor Hospital and Queen Mary's Hospital for Children, were admitted for periods ranging from 2-8 weekso Towards the end of the year the Mental Health Section was given responsibility for supervising all sub-normal persons over five years of age in the community, health visitors retaining responsibility for those under five. During the year 222 mentally handicapped persons suffering from sub-normality and their families received support in their own homes from health visitors or mental welfare officers. Holiday placements for the adults attending the Banstead Centre were made by the Surrey County Council as in previous years and 8 children under 16 years of age joined parties of children for 2 weeks holiday at Pirate Springs, Dymchurch. CERVICAL CYTOLOGY On 1st July, 1966 a pilot scheme for cervical screening for the detection of pre-cancerous changes was started with the assistance of Dr.Levine, Consultant Pathologist at St.Helier Hospital. In view of the limited number of specimens that could be dealt with by the laboratory, certain cases only could be dealt with and 10 smears a week were accepted up to September, the number increasing to 24 a week. The examinations were carried out at ante-natal clinics in the six major health centres in the Borough. All applicants had first to obtain the consent of their general practitioner who was subsequently informed of the result. In every case complete pelvic examination was carried out by the examining doctor together with examination of the breast in an endeavour to detect abnormality at an early stage. 58 The types of cases who were accepted for cervical cytology included (1) Any cases referred from Post-Natal clinics who were over 25 years of age and had more than one child. (2) Cases making direct application provided they were over 25 years of age and had more than one child. (3) Cases referred from the Family Planning Clinics who had applied there for cytology only. (4) Any patient referred by a general practitioner. (5) Mothers of large families. By 31st December, 1966, 228 smears had been taken with the following classification : Class I (satisfactory) 112 Class II (Very slight defect - referred 113 to general practitioner for treatment). Class III (Needing serious investigation) 3 The opportunity to diagnose other pelvic pathology besides smear taking revealed 124 defects, some women having more than one defect. Erosion 44 Polyp 3 Cervicitis 25 Fibroid 2 Bulky uterus - positive pelvic findings 11 Batholin Cyst 2 Discharge 23 Trichomonas 3 Prolapse 9 Bircornnate Uterus 1 Suspected Neoplasm 1 31 cases were assessed as requiring to be referred to their general practitioners with requests for treatment. CHIROPODY SERVICE The Chiropody Scheme operated during the year on the lines established by the Council in October 1965. The following groups were eligible for treatment (i) Elderly persons, i.e. persons of pensionable age, receiving retirement (ii) Handicapped persons including registered blind and partially sighted, and (iii) Expectant mothers. 59 2181 patients received Chiropody under the Council's scheme during 1966, of whom 142 were handicapped persons, 26 were blind persons, two were expectant mothers and the remainder, 2011 (92.3%) were elderly persons. The total number of treatments given under the scheme was 12,256 of which 4029 were given by private chiropodists in their surgeries, 3377 were given at clinics and other fixed centres and 892 were given in residential homes for elderly persons including the two Local Authority establishments, Maiden Homes and "Brambleacres". The balance of 3958 treatments were given in the dwellings of the patients and is worthy of comment since it represents a high proportion of the total treatments given and reflects the increasing age and infirmity of the patients dealt with. The total number of patient# treated during 1966 represents an increase of 22.2% over the number treated in 1965» whilst the number of treatmehts given in 1966 represents an increase of 22.5% over the 1965 figure. 60 MEDICAL SOCIAL WORK (l) Prevention of Break-up of Families The work of the section has continued along the lines indicated in last year's report. As this is essentially in the nature of long term, intensive casework support, figures are apt to be misleading. The amount of time devoted to a very small number of families or even a single family in a time of crisis, cannot readily be measured in a statistical return. It is by no means unusual for one or two families to occupy almost the whole of one person's working week, until they have been tided over the crisis, by which time major difficulties have often arisen in another family whose social problems have been quiescent for a time. The work follows very much this pattern, making it difficult to plan a work schedule and demands flexibility of organisation and of working hours. The year started with 56 families all of whom needed long term support in varying degrees of intensity. A further 37 were added during the year. Most of these families' problems are due to a combination of factors, the commonest of which are poor mental or physical health, personal inadequacy, marital difficulties, marginal employability, low incomes and large families, or financial mismanagement even when there is a high income, leading to potential homelessness through rent arrears. This last factor is often the presenting problem and the means by which many families in difficulty are brought to our notice. Well over 100 cases of rent arrears are regularly considered by the co-ordinating meetings to decide upon the most appropriate action to be taken on each. Heavy debts are almost always a symptom of deeper social distress of which the client may well be unaware until the practical consequences of failing to pay gas and electricity bills, of facing possible eviction through rent arrears or even imprisonment for contempt of court when a judgment summons is not paid, are forced upon them. Sometimes it is not until families reach this stage that they come to light though the various early warning procedures which have been instituted are proving effective. In many instances the biggest difficulty is to try and persuade the clients to face reality and to accept the need to tackle their problems. It is all too easy to ignore repeated bills or not to answer the door to callers and to hope that nothing further will happen. This is a situation that is often met particularly with wives who do not wish their husbands to know that they have squandered the housekeeping money. It may take weeks of patient effort and of apparently fruitless visiting before it is possible to bring both husband and wife into the picture. Even then the social worker has to help them to work through the recriminations and arguments which the truth precipitates before there can be any hope of an improvement, not only in financial management, but in family relationships generally. It is by no means uncommon to visit regularly over a period of weeks before the client is willing to confide in the social worker. 61 These families have so many problems which bring them into conflict with authority in many of its forms, that in the nature of things many different workers either statutory or voluntary are involved at some point. It follows that co-operation and co-ordination at all levels are vital if the clients are to be helped properly and skilled workers' time is to be used to the best advantage. The system of regular meetings of Health and Welfare Department staff with representatives from the Housing, Town Clerk's Education and Children's Departments together with other interested parties under the Chairmanship of the Deputy Medical Officer of Health, as well as Bimilar meetings with the Greater London Council Housing Welfare Officers', has developed and is the basis of much of our work and the source of many referrals. Without this and the individual case conferences called when necessary, the work would be much more difficult and less effective. Without this degree of consultation and co-operation it is certain that many more evictions would have taken place. Much valuable preventive work has been undertaken by this means. It is impossible to define terms of reference too clearly or to lay down too hard and fast rules as to who does what. The borderline between the several forms of social work can become blurred and sometimes family casework falls more naturally into the sphere of one worker, statutory or voluntary, than another. An open mind must be maintained and a flexible attitude adopted towards the various responsibilities. Through constant co-ordination and co-operation overlapping must be prevented and measures adopted to ensure by mutual consent that whoever seems best fitted to deal with any particular situation is the worker most involved. Throughout the year regular contact has been maintained with the social workers in all types of hospitals. They have been most willing to ask for our co-operation. This is the field in which there is great scope for development and there seems to be a strong case for the medical social worker in the community having an even closer contact with the hospital so that the patient has continuity of support. Contact with voluntary services can never be tod close and the Department has been well supported by every branch of voluntary service in the Borough. For this much appreciation is felt by members of the staff who are constantly receiving their help. 62 (2) Chest Clinics Many patients attending chest clinics suffer from severely disabling and chronic illness or require a prolonged course of treatment. The needs for social worker support for these cases is sufficient to justify the attachment of a full-time medical social worker to the chest clinic at St.Helier Hospital who attends seven clinic sessions weekly and devotes three half-days to visiting. The Disablement Resettlement Officer from the Ministry of Labour visits weekly to discuss problems of rehabilitation, special training and employment. The medical social worker receives referrals of new cases from the chest clinics and from the chest wards on their discharge from hospital. Many of these patients are suffering from carcinoma of the bronchus, chronic bronchitis and chronic tuberculosis. The work in connection with these cases consists mainly of re-habilitation, dealing with housing queries, providing the essential material needs for recovery and problems connected with the occupation and care of patients at home. Many of the patients are anxious and because of the nature of their illness have lost confidence in their own ability to work and support their families. Many need practical help to overcome the effects of their disability. Patients with chronic pulmonary tuberculosis and chronic bronchitis may never become fit for a normal life and, including some who have been attending the chest clinics over periods of 20 years and more, are able to contact the medical social worker for advice and help. Some are too ill or too breathless to come to-hospital and these are visited at home. For those who cannot make their own arrangements, help is given in providing holidays, usually for patients and their families. This is an important feature of the support given to patients suffering from chronic illnesses and makes a significant contribution to their well-being. Free Milk The Borough Council continues to operate a free milk scheme for those patients who require extra nourishment for medical reasons which they are unable to provide themselves. 43 such cases were provided with free milk orders during 1966. Care Committees The voluntary care committees continue to give excellent service to patients who attend the chest clinics. The committees receive reports from the medical social worker on those patients who need financial assistance and help is given by the provision of essential needs which cannot be met from statutory sources. Assistance towards the cost of holidays, fuel, transport, insurance premiums, television licences, clothing and many other aspects of family life which are unable to be met by the disabled patient is provided. Although the Borough Council makes an annual grant to the care committees much of their work depends upon the raising of funds from voluntary sources. 63 HEALTH EDUCATION All members of staff concerned with health services are responsible for education in health as part of their normal duties. Although each makes only a small contribution the aggregate constitutes a considerable volume of worko The Council appointed a part-time officer to deal with the home safety aspect of this work and health visitors and medical officers undertake formal and informal health educational activity so far as other commitments will allow. Progress has been made with this work during the year but in the absence of an officer specifically Tesponsible for promoting health education activities, this has necessarily depended upon the initiative of individual members of the staff. Talks and discussion groups have been given in schools, clinics and at many meetings of organisations throughout the borough. Posters and pamphlets have been distributed and films shown. Regular meetings of staff are held at which new materials available are demonstrated and stimulus givenntfcothe furtherance of this important work. A health education group, consisting of representatives of the medical, health visiting and teaching professions has been formed to discuss methods which can be used and subjects which are most needed to be dealt with. It is hoped in the not too distant future to have the services of an officer specifically responsible for health education work to provide a positive approach and direct and co-ordinate the very considerable amount of work which is at present being carried on. Of particular interest was the anti-smoking clinic which was held towards the end of the yearu This was organised in association with the British Temperance Society and was attended by approximately 100 people. The interest shown was enormous and illustrated the point that has often been made that very many people would like to discontinue smoking in the interests of their health but are unable to do so without assistance. A follow-up showed that approximately a third of those attending were able to discontinue the habit and of the remainder approximately one half reported a reduction in the amount smoked. Many of those attending said how much better their general health had been since they had given up the habit. The lessons learned from this pilot scheme will be applied and it is hoped to repeat the venture during the coming year. In the older age group education in health can make a significant contribution to health and well-being. Continued good health with advancing years depends to a great extent upon persistant awareness of those features of daily living necessary for its maintenance. In the face of increasing disability this becomes more difficult and reminders axe necessary if standards are to be maintained, tauch of the work in the Advisory Centres for the Elderly which were started during the year consists of health education, and health visitors when visiting are much concerned with giving advice on hygiene, diet, home safety and the means of avoiding many of the health hazards which beset the elderly„ 64 For the younger age groups talks hare been given on various subjects by medical and health visiting staff to youth organisations, schools and clubs. Articles have been written for local publications and in this connection the assistance of the weekly press is very much appreciatedo Home Safety Although a part of general health education, special activities in connection with the prevention of accidents in the home are undertaken by the Home Safety Officer who also acts as secretary to the voluntary Home Safety Committees in the Borough„ The main Committee met four times and the district committees as follows :- Sutton and Cheam 9 Beddington & Wallington 6 Carshalton 4 In addition, representatives attended four meetings of the Greater London Home Safety Council. On 8th September the Carshalton Committee ceased to function and amalgamated with the Beddington and Wallington Committee, the Carshalton Committee agreeing to continue with their activities within the Carshalton area. With the object of protecting children against all types of avoidable accidents commonly associated with childhood, a "Protect Your Child" campaign was carried out during the year. Suitable pamphlets and posters were placed in all infant welfare centres and book-marks provided in library books. Considerable interest was shown in the messages conveyed. In September, by arrangement with the Pharmaceutical Society of Great Britain, a campaign aimed at publicising the danger from the careless use of poisons was used. The Pharmaceutical Society provided an extensive exhibition which was displayed in the Public Hall at Wallington for one week and at the Public Hall at Sutton for a second weekc Despite extensive publicity to this exhibition the attendance was disappointing. 596 persons, including pupils from six schools, attended at Wallington, and 1019 persons, including pupils from seven schools, rangers and guide companies, attended at Sutton* However, 7600 book-marks and 5000 leaflets were distributed during the two weeks and posters displayed in all schools, libraries, old people's day centres, labour exchanges and hospitals. Displays were placed at the Town Hall, Wallington and the Sutton, Wallington and Cheam Libraries. During the exhibitions requests were made from schools and other organisations for speakers to visit them in the future. As part of this campaign members of the public were encouraged to hand in unused bottles ofmedicines and boxes of pills to chemists shops throughout the Borough. These were subsequently disposed of safely, by Public Health Inspectors. 65 With the co-operation of the Greater London Council Fire Brigade an open day was held at Sutton Fire Station in October in conjunction with a poster painting competition in the schools. The posters submitted had to deal with some aspect of home safety and prizes were presented at the fire station by a divisional fire officer. The event was honoured by the attendance of The Worshipful the Mayor who performed the opening ceremony. The Home Safety Officer gave 40 lectures to different organisations 24 of which were associated with a film show and 10 lectures were given in schools. Posters and pamphlets dealing with general aspects of home safety were extensively distributed throughout various organisations and with the assistance of libraries, clinics, fire stations, schools, youth clubs and doctors' surgeries. Accident Returns 0-1 yrs 1-4 yrs 5-14 yrs 15-24 yrs 25-44 yrs 45-64 yrs 65+ yrs Age not stated TOTAL 3 52 38 22 38 61 123 14 351 (2) (39) (31) (16) (49) (44) (70) (16) (261) These figures relate only to those accident cases of sufficient severity to warrant the calling of an ambulance. The total of those requiring first aid or treatment by the general practitioner or who attended hospital by their own transport is unknown but is obviously much greater. 66 ENVIRONMENTAL HEALTH SERVICES PART IV INDEX _ „ Page No. INTRODUCTION 69 HOUSING TO RENT ACT, 1957 71 CARAVANS 72 POOD AND DRUGS 72 INSPECTION OP PREMISES AND ACTION TAKEN 8l CLEAN AIR ACT, 1956 - SMOKE CONTROL AREAS 82 SUMMARY OP RAINFALL AND DEPOSITED MATTER 1966 83 SUMMARY OF AIR POLLUTION MEASUREMENTS FOR 1966 84 WATER SUPPLY 85 PREVENTION OF DAMAGE BY PESTS ACT 89 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 90 SWIMMING BATHS 92 DISEASES OF ANIMALS ACT, 1950 92 DISEASES OP ANIMALS (WASTE FOODS) ORDER, 1957 92 ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 93 PET ANIMALS ACT, 1951 93 RIDING ESTABLISHMENTS ACT, 1964 93 SLAUGHTER OF ANIMALS ACT, 1958 93 ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT 93 PHARMACY AND POISONS ACT, 1933 93 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 93 REFRESHMENT HOUSES ACTS, 1860 and 1964 93 FERTILISERS AND FEEDING STUFFS 93 HAIRDRESSERS AND BARBERS 94 MORTUARIES 94 SUMMARY OF COMPLAINTS, INSPECTIONS AND WORK DONE 94 67 INTRODUCTION During the year under review no major new duties were added to the work of the Environmental Health Section and this has permitted work to continue over the whole field of duties which have become the responsibility of the public health inspectors,, These have included the repairs, closure or demolition of unfit houses, the conditions under which food is manufactured, prepared or sold and the investigation by inspection and sampling of the bacteriological and chemical condition of food when sold and of the water supply,, Steps to measure the pollution of the air in conjunction with the Warren Spring Laboratory of the Ministry of Technology have continued, and in this connection it is a matter for regret that the programme of establishing smoke control areas has, on financial grounds, been slowed downD It is hoped that circumstances will shortly permit the work to be resumed without extending the period required to bring the whole Borough under smoke control orders» The condition of premises in which people are employed, such as factories, offices and shops, has continued to be a major part of the section's work; numerous inspections have been made and improvements effected,. Under the supervision of the public health inspectors the rodent control staff have investigated all cases of rat and mouse infestation brought to the notice of the section and have made surveys to ascertain the source of such infestations» Complaints of obstructed drains and sewers have received prompt attention, not only during normal working hours but also at week-ends and during the evenings, and this service has been very much appreciatedo The staff of the section now includes two trainee public health inspectors who, in addition to receiving theoretical training for six months in each year of a four-year course at the South East London Technical College, receive instruction in the practical duties of the office from the qualified members of the staff* This work is of the greatest importance in view of the continuing shortage of public health inspectors0 In this connection it is pleasing to report that despite the general shortage this Authority has maintained a full establishment. In addition to the general duties referred to» talks have been given to local organisations concerning the public health inspectors" duties generally, including two talks to pupil nurses at Cuddington Hospital. Details of the work, mainly in statistical form, are set out in the following pages. The volume of work is considerable and could not have been achieved without the ready and active co-operation of the other sections of the Department and the other Departments of the Council. 69 HOUSING Clearance of Unfit Houaes. Nine unfit houses were demolished and six persons comprising two families were re-housed. Inspection and Action taken under Statutory Powers. (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 7,336 (b) Number of inspections for the purpose 9,909 1. Number of dwelling houses found not to be in all respects reasonably fit for human habitation 271 2. Remedy of defects during the year without service of formal notices. Number of defective dwelling houses rendered fit in consequence of informal action by local authority or their officers (including houses inspected during 1965) 238 3. Action under Statutory Powers during the year. (a) PROCEEDINGS UNDER SECTIONS 9, 10 and 12 OF THE HOUSING ACT, 1957- Number of dwelling houses in respect of which notices were served requiring repairs Number of dwelling houses which were rendered fit after service of formal notices: - (a) By owners (b) By Local Authority in default of owners (b) PROCEEDINGS UNDER PUBLIC HEALTH ACTS. (1) Number of dwelling houses in respect of which formal notices were served requiring defects to be remedied 77 (2) Number of dwelling houses in which defects were remedied after service of formal notices: - (a) By owners 6 (b) By Local Authority 41 Houses in Multiple Occupation. Of the 87 houses inspected 67 were found to be houses to which the Houses in Multiple Occupation Regulations apply. At the end of the year 13 of the houses were brought up to the standard acceptable to the Council. 70 Housing Act , 1957 - Part IV (Overcrowding). All known cases of overcrowding were reviewed during the year and as a result 16 dwellings were found to be still overcrowded, involving 17 families with 83 equivalent adults in occupation. Ten cases of overcrowding were abated, 4 formally and 6 informally,, (a) (l) Number of dwelling houses overcrowded at the end of the year . 6 (2) Number of families dwelling therein 6 (3) Equivalent number of adults dwelling therein 28 (b) Number of new cases reported during the year (c) (1) Number of cases of overcrowding relieved during the year 10 (2) Number of persons concerned in such cases 54 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding RENT ACT. 1957 The following details show the action which has been taken during the years Part I - Application for Certificate of Disrepairs (1) Number of applications for certificates 3 (2) Number of decisions not to issue certificates Nil (3) Number of decisions to issue certificates (a) in respect of some but not all defects 3 (b) in respect of all defects (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 2 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil (6) Number of certificates issued Nil Part II - Application for Cancellation of Certificatess (7) Application by landlords to Local Authority for cancellation of certificates Nil (8) Objections by tenants to cancellation of certificates Nil (9) Decisions by Local Authority to cancel in spite of tenants' objection Nil (10) Certificates cancelled by Local Authority Nil (11) Work done before expiry of Form 1 71 CARAVANS The Council, by proceeding under Section 57 of the Surrey County Council Act, 1931, now have Orders prohibiting the use of the land for the parking of moveable dwellings within a radius of 880 yards of the sites at Cuddington Way, Cheam, and Green Lane, Worcester Park. FOOD AND DRUGS Inspection and Supervision of Food Premises: Two thousand, six hundred and twenty-one inspections of food premises were made and 177 formal notices were served drawing attention to unsatisfactory conditions. In addition, 207 complaints alleging adulteration or unsoundness of food were investigated thoroughly and appropriate action was taken in each case. Seventy-two complaints of adulterated food were received regarding food which contained glass, insects, mould, oil, rodent droppings, plastic material or other foreign matter. The articles and number of complaints received are summarised below:- Article No. Article No. Baby Food 1 Fish Cake 1 Bread 21 Fruit 1 Biscuits 2 Honey 1 Butter 2 Ice Lolly 1 Cereals 4 Lemonade 1 Cheese Spread 1 Marmalade 1 Cherry Syrup 1 Meat 1 Colouring Matter 4 Meat Pie 3 Confectionery Flour 9 Milk 4 Confectionery Sugar 3 Sausages 3 Corned Beef 3 Vegetables 2 Egg Rusk 1 Yoghurt 1 72 In an effort to maintain satisfactory food standards<, the following samples were taken for bacteriological examinations - Milks Classification of the milk samples and the results of the tests are as followss - Designation under which sold No. of samples Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 90 89 1 90 - - - Untreated 4 4 4 - - - Sterilised 14 - - •* - 14 - 108 93 1 94 - 14 - Two samples of raw milk submitted for examination were found free of tubercle bacilli or brucella after animal inoculation. Ice Creams Of the sixty-seven samples of ice cream procured for bacteriological examination 50 were Grade I, 9 Grade II, 4 Grade III, and 4 Grade IV„ All registered retailers draw their supplies of ice cream from reputed manufacturers outside the district. There are four manufacturerretailers of soft ice cream. Advice was given following the receipt of unsatisfactory reports and further samples obtained until a satisfactory result was achieved. Other Foods? Black Pudding 2 Haslet 1 Cheese 3 Meat 75 Confectionery (Flour) 11 Meat Pies 12 Cream 12 Preserves 1 Eggs 1 Salad 3 Faggots 1 Sausages 15 Fish 6 Sausage Rolls 7 Hamburger 1 In one case organisms of food poisoning were found. 73 Waters: Thirty-eight samples of water were reported as satisfactory» Registration of Milk Distributors: The number of Milk Distributors registered under the Milk and Dairies (General) Regulations, 19599 is 49. Designated licences in forces, under the Milk (Special Designation) Regulations;, 1963 (as amended)9 during the year were as follows: - Dealer"s (Pre-packed Milk) Sterilised 59 Pasteurised 69 Untreated 25 Ultra Heat Treated 19 Dealer's (Pasteurisers) 1 Unsound Foods The following quantities of food found to be unsound, diseased or unwholesome and unfit for human consumption were surrendered and destroyed» Type of Pood Unwrapped Food Wrapped Food lbs. OZS. Number of Containers Beverages 181 Cereals 3,493 Cheese 32 Confectionery Flour 1,O24 Cream 7 Fat 122 Fish 299 12 2,556 Fruit 1,936 Ice Cream 266 Meat 1,714 11 19,561 Milk 67 Preserves 12 Pies 56 Sauce 6 Soup 37 Vegetables 560 0 2,566 Miscellaneous 44 2,574 7 13,966 Slaughterhouses: There are no slaughterhouses in the Borougho 74 Adulteration of Food: During the year9 463 samples of various foodstuffs and drugs were purchased for examination by the Public Analyst;, Mr. D.D. Moir, M.Sc., F.R.I.C., to whom I am indebted for the following observations on the year" s work and for his valuable and ready advice at all times* Public Analyst's Comments: " New legislation during the year has been confined largely to a tidying up process involving amendments to or revision of earlier Regulations,, A brief notice of each of these Regulations might be of interesto The Salad Cream Regulations. 1966, although re-enacting the basic requirement for typically British Salad Cream or Mayonnaise, naMely minima of 25% edible vegetable oil and 1,35% of egg yolk solids, recognise the existence of a large variety of other salad dressings. Hitherto, these latter dressings had to bear a specific disclaimer on the label, the enforcement of which sometimes put the enforcement authority in an embarrassing position. The need for this disclaimer for an article which is not described as Salad Cream or Mayonnaise and does not come within a definition thereof has been dropped,, The Mineral Oil in Food Regulations, 1966. The previous Regulation (1964) included a limit test for polycyclic hydrocarbons, a potentially toxic constituent of wax. but in practice this test was found to be unworkable* The new test, which is set out in considerable detail, requires a sample of over 2 pounds of solid mineral hydrocarbon, and although the Regulations are designed to control the composition of articles like chewing gum, the test can only be carried out on the wax ingredient as used in the factory, The Butter Regulations, 1966, (not yet in force) include more definitions and labelling requirements for butter (including whey butter) and salted and unsalted butter. The Colouring Matters in Food Regulations, 1966. Six of the previously permitted colours are withdrawn aid one (a black colour) has been added. thereby reducing the pennitted number of artificial coal tar colours from 30 to 25. Many people would say there is room for further reduction, but further legislation will no doubt follow attempts to co-ordinate food colours on an international scale. Similarly, The Antioxidant in Food Regulations, 1966. make technical adjustments to this type of food additive to conform with recent scientific research. Finally, The Skimmed Milk and Non Milk Fat (Amendment) Regulations, 1966. make it permissible to use a new liquid product containing vegetable oil as a Baby Food. These six examples emphasise the wide scope of modern Food Legislation, but we are still anxiously awaiting the Regulations for Meat and Canned Meat, Sausages and Meat Pies which will serve to complete, together with the Cheese Regulations (coming into force in 1967), the essential control of foods used in large quantities. 75 The labelling of food continues to be one of my major preoccupations and the second of Food Standards Committee's Reports has now been published, the first being mentioned in my Annual Report for 1965. This second report, called the Food Standards Committee Report on Claims and Misleading Descriptions, makes some 27 recommendations with regard to claims and 19 in regard to misleading descriptions. It also lays down 3 general principles which are worth repeating in this Annual Report as they have undoubtedly influenced and will continue to influence our judgment of what consitutes a misleading claim or description. We Public Analysts have had to erect such principles in the past and it is encouraging to find that the Committee supports our views not only in principle but in their specific recommendations. The principles are that s 1) No claim should be made in respect of a food unless the value claimed is wholly contributed by the food and not partially by other foods with which it may be consumed; 2) Comparisons should not be on a false basis, i.e. a low moisture food compared with one consumed in large quantities; 3) Claims of specific benefit to health must be justified on composition and the quantity normally consumed in one day. Presumably proposals for Regulations and Regulations will follow this Report and will receive mention in a future Annual Report. Reference must also be made to the scheme of procuring data for the amounts of Pesticide Residues in Food in which the London Borough of Sutton and many other Authorities throughout England and Wales have co-operated. The first year of the scheme ends in July 1967 and no doubt the report on the first year's figures will be ready for the Annual Report for 1967. So far no cases of the presence of abnormally large amounts of residues have been found." 76 Food Samples - Chemical Analysis Formal Informal Adulterated Total Formal Informal Beverages 9 29 1 2 38 Cereals and Cereal Products 3 25 - 2 28 Cheese - 6 - - 6 Confectionery Flour 4 6 - 10 Confectionery Sugar 5 32 2 2 37 Cream 7 - - 7 Drugs 1 55 1 1 56 Fat and Oils 9 4 1 1 13 Fish and Fish Products 1 9 - - 10 Fruit 1 18 - _ 19 Ice Cream 20 3 - = 23 Meat and Meat Products 5 22 - 1 27 Milk 34 60 _ 1 94 Milk Products — 11 - 2 11 Preserves = 14 - - 14 Sauce 1 11 - - 12 Sausages 8 2 - 10 Soup 1 6 - 1 7 Spices 7 - 7 Vegetables and Vegetable Products 14 - - 14 Miscellaneous 3 17 - - 20 105 358 5 13 463 TOTAL 463 77 The samples described as adulterated or irregular were reported upon by the Analyst as follows and action was taken as indicated:- Informal Sample - Aspirin Tablets B.P. A sample of 300 milligram Aspirin tablets containing 278 milligrams acetylsalicylic acid per tablet of average weight„ The content of acetylsalicylic acid prescribed by the British Pharmacopoeia should be not less than 285 milligrams per 300 milligram tablet. The deficiency of acetylsalicylic acid was due to the average weight of the tablet being 299 milligrams. A formal sample obtained,, Formal Sample - Aspirin Tablets B.P. A sample of 300 milligram Aspirin tablets containing 320 milligrams per tablet of average weight. The content of acetylsalicylic acid as prescribed by the British Pharmacopoeia should be 285-315 milligrams per 300 milligram tablet. The excess of acetylsalicylic acid to the extent of 1o6 per cent was due to the weight of the tablets being more than 300 milligrams. Warning letter sent to manufacturer regarding compliance. Informal Sample - Brandv-Flavoured Butter A sample of a spiced mixture of sugar and butter flavoured with brandy which, in the opinion of the Public Analyst;, should not be described as 1 Brandy-Flavoured Butter® as the article contained 67 per cent of sugar, 2-3 per cent of spice and only 30 per cent of butter. A formal sample obtained. Formal Sample - Brandv-Flavoured Butter A sample of a spiced mixture of sugar and butter flavoured with brandy which, in the opinion of the Public Analyst, should not be described as Brandy-Flavoured Butter' as the article contained 67 per cent of sugar, 2-3 per cent of spice and only 30 per cent of butter. The question as to whether the article was falsely described, or described calculated to mislead,, is still being pursued with the manufacturers. Informal Sample - Clear Beef Soup Mix The label on the container described the article as 'Clear Beef', and as no other ingredients were stated the Public Analyst considered the label misleading as to the general nature and substance of the soup mix. The Analyst's report has been forwarded to the manufacturer in Germany for observations, and a reply is awaited. 78 Informal Sample-Cultured Buttermilk The Public Analyst was of the opinion that the sample was a sample of cultured skimmed milk and should not, therefore, be called 'Buttermilk. The manufacturer did not agree and quoted "Dairy Bacteriology" by Dr« Bernard Hammer regarding Buttermilk made from skimmed milk. As there might be considerable difficulty in succeeding in legal proceedings no further action was taken. Formal Sample - Glucose D The Public Analyst was of the opinion that as the sample was labelled "a scientifically prepared combination of pure glucose, calcium glycerophosphate and vitamin D" the quantity of each should be stated on the labels The manufacturers agreed to amend the label to include the words "with calcium glycerophosphate". Informal Samples - Lemon Juice (Unsweetened) Two samples of lemon juice with additional flavouring, one containing only 32 parts per million sulphur dioxide9 and the other 40 parts per million sulphur dioxide. The importer stated that the sulphur dioxide content was usually 340-350 parts per million and that the deficiency in the samples was due to prolonged exposure of the casks as a result of the shipping strike. Formal and Informal Samples - Liqueur Chocolates TBrandy Kirsch Ratsherrn and Scotch Whisky) Four samples were procured and the syrup filling of the chocolate contained alcohol equivalent to between 19.2 per cent and 28 per cent by volume. In the opinion of the Public Analyst the alcohol content should be one-third of the volume of syrup. The question of how much alcohol should be contained in the syrup is one which is not easily resolved but in the absence of a legal standard the Public Analyst was agreeable to accept a standard of 6 per cent of alcohol volume in weight on the whole chocolate for chocolate liqueurs of normal size provided the alcohol was proof spirit, although he still maintains that the filling should contain not less than one-third of liqueur or spirit of normal strength. Informal Sample - Milk A sample deficient in milk fat to the extent of 27 per cent. The sample was procured from a ten-gallon chum containing five gallons of milk from which five gallons had been removed before delivery to the consumers. Due to the milk not being properly plunged before transfer,the sample was deficient in milk fat. 79 Informal Sample - Ravioli The label on the container of this article included the word 'Seasoning' which is a generic description and therefore not an appropriate designation for the purpose of the Labelling of Food Order, 1953. The importer agreed to alter the wording of the label. Informal Sample - 'Redi-Milk' A sample of genuine dried skimmed milk incorrectly labelled due to the declaration that the dried milk contained one per cent of milk fat„ Schedule 2 of the Dried Milk Regulations, 1965s does not allow reference to the milk fat content when the description is "Dried Skimmed Milk". The manufacturers submitted a new label which was approved by the Public Analyst. Informal Sample - Rice Creamed Milk Pudding In the directions printed on the label attached to the container this article was described as "extra creamy" but the pudding contained only 2.9 per cent milk fat, no cream having been addedo The manufacturer agreed to alter the label„ Informal Sample - Wheat Germ The declaration on the label that the sample contained carbohydrates 36 per cent and calories 126 per ounce was incorrect, the analysis showing the former to be 55.4 per cent and the latter 97 per ounce. The manufacturer, an American Company, stated that the label was an old one and that the new label declared carbohydrates to be 53 per cent and calories 126 per ounce, The Public Analyst accepted the new label in respect of the carbohydrates but was unable to agree in regard to the number of calories per ounce. The manufacturer has been sent the Analyst's observations and a reply is awaited. 80 81 INSPECTION OF FOOD PREMISES AND ACTION TAKEN SANITAfff ACCOMODATION FOOD STORAGE AND PREPARATION ROOMS Number of Premises Number of Premises registered undersells of Food & Drugs Act Repaired Cleansed and/or Decorated Lighting provided Washing Facilities (incl. Hot and Cold Water) Nail Brush and Soap provided •Wash Your Hands' Notices Repaired Cleansed and/or Decorated Lighting provided Ventilation provided Washing Facilities for Food and Equipment First Aid Matarlals presided Aeeonmodation for Clothing provided Aceumula^ions removed Bakehouses 14 • - - - - - » - - - - - - - - Bakers & Confectioners 48 6 1 3 - - - - 2 4 - - — 1 - - Butchers 103 94 5 7 4 2 1 2 6 8 - 1 4 2 1 1 Canteens 106 - 1 2 1 1 - 1 1 2 1 - - 1 - - Chemists 37 1 — — — — — —— — — — — — - Confectioners (Sugar) 204 184 1 2 - - - 1 - 1 - 2 - 1 - - Fishmongers 40 18 - - - 2 - - 3 3 - - 2 - - 1 General Stores 16 11 - 1 - - - - - 3 - - - - - - Greengrocers & Fruiterers 112 22 - 2 - - 1 - - 2 - - 1 - - - Grocers 233 125 2 2 2 2 - - 3 12 - 2 1 1 3 4 Licensed Premises 52 7 - - - - - - 2 3 - - - - - - Milk Storage Depots 3 - - - - - - - - - - - - - - - Restaurants & Cafes 91 57 m 2 - 3 2 - 1 10 1 3 2 - - 5 Factory Food 5 5 - - - - - - - - - - - - - - 530 10 21 7 10 4 4 ,8 48 2 8 10 6 4 11 CLEAH AIB ACT„ 1956 - SMOKE CONTROL AREAS Smoke Control Area No.15 covering a part of Wallington was confirmed by the Minister of Housing and Local Government on the 1st May, This Area became operative on 1st December, 1966, and together with Area No.14 which came into operation on 1st October, 1966, brought the number in operation in the Borough up to 15, covering an area of 3111.89 acres and affecting 20,141 dwellings. In August, 1966, a letter from the Ministry of Housing and Local Government advised that future smoke control Areas should no longer be based on the assumption that the demand for solid smokeless fuel could be met wholly by gas coke. This will, in effect, allow grants to be payable on the replacement of an existing improved open grate by an appliance capable of burning hard coke or by a solid fuel gas or oil room heater or electric storage heater. This will apply to all future Smoke Control Areas from and including No.16 Area and will inevitably result in an increase in the cost of each Areao The survey of Nos. 16 and 17 Areas was completed and re-estimated in the light of the Minister's letter. An Order in respect of No.16 Area was made by the Council on 8th December, 1966, and is awaiting the Minister's confirmation. Consideration of an Order with regard to No.17 Area was deferred for one year. Daily records of atmospheric pollution by smoke and sulphur dioxide are obtained by means of sulphur dioxide apparatus, and of grit deposit by deposit gauges. Volumetric S02/Smoke filter apparatus is installed ats- (1) The Health Centre, Shotfield, Wallington (2) The Library, Manor Road, Sutton (3) The Lodge, Honeywood Walk, Carshalton. Grit deposit gauges (5) are sited at:- (1) Buckhurst Avenue Pumping Station, Carshalton (2) Winchcombe Road School, Carshalton (3) Crown Road School, Sutton (4) Sutton General Hospital, Brighton Road, Sutton (5) Cheam Hospital, London Road, Cheam. The recordings taken during 1966 were as follows:- 82 83 SUMMARY OF RAINFALL AND DEPOSITED MATTER 1966 SIS* Crowri Road School Sutton Genaral Hospital Brighton Roads Sutton Cheam Hospital Londora Road, Cheam Wiaeheonbe Road Sghool CarshaltM Buckhurst Avenus Garshalton Bona D 517 D 580 D 1246 D 1976 D 1967 Gauge 2 6 7 B C Rainfall in Im. Total SolJds (Tons per sq. mile) Raiofall is ins. Total Solids (Tons per sq. mile) Rainfall in ins. Total Solids (Tons per sq. mile) Rainfall in ins. Total Solids (Tons per sq. mile) Rainfall in ins. Total Solids (Tons per sq. mile)[/$$$] JAN. 0.84 8.52 0.86 6.72 0.85 6.24 0.79 8.19 0.86 9.83 FEB. 2.88 8.17 3.54 8.89 2.74 8.67 2.93 8.54 2.80 9.50 MAR. 0.47 10.57 0.36 4.51 0.41 5.04 0.42 3.35 0.47 9.23 APL, 3.00 14.32 3.00 9.55 3.00 12.21 2.90 15.03 3.00 16.53 MAY 2.28 21.80 2.68 10.23 1.89 9.86 2.01 13.15 2.09 16.17 JUNE 2.25 20.77 2.09 21.88 N N 2.09 11.09 2.28 13.12 JULY 3.07 9.38 2.75 16.86 3.22 7.50 2.73 8.09 3.19 6.51 AUG. 2.72 10.07 2.80 8.79 2.68 6.34 2.80 7.24 2.84 6.71 SEPT. 1.03 11.54 1.03 7.54 1.03 6.67 0.95 9.79 1.03 8.83 OCT. 4.37 12.86 4.57 8.00 4.14 8.68 4.22 11.90 4.14 9.10 NOV. 1.54 10.30 1.62 5.74 1.54 20.07 1.54 7.38 1.69 6.95 DEC. 2.96 7.78 3.07 5.73 2.80 6.16 No readings due to damage to equipment 2.84 6.48 TOTAL 27.41 146.08 28.37 114.44 24.30* 79.44* 23.38 * 105.73 * 27.23 118.96 MEAN 2.28 12.18 2.36 9.53 2.21 * 7.22* 2.13 * 9.61 * 2.27 9.91 * 11 Readings Only 84 SUMMARY OF AIR POLLUTION MEASUREMENTS FOR 1966 BEDDINOTON & WALLINGTON NO. 1. GARSHALTON N0. 4. SUTTON Sc GHEAM NO, 8, Highest Lowest Average Highest Lowest Average Highest Latest Average Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 Smoke So2 JAN. 144 299 11 30 67 146 202 452 21 32 91 166 213 414 17 34 91 184 FEB. 69 185 04 15 25 64 90 341 11 19 38 94 89 30? 09 22 35 96 MAR. 124 264 05 15 33 78 175 239 16 36 55 94 145 310 10 37 48 107 AFL. 58 222 02 18 25 85 78 275 07 25 29 106 66 210 06 30 29 103 MAY 30 142 04 14 13 55 45 147 03 18 16 55 35 144 04 19 15 59 JUNE 25 96 01 21 11 48 28 153 03 12 12 43 30 156 03 19 12 59 JULY 20 89 03 15 09 37 29 88 04 18 13 41 26 82 06 12 12 39 AUG. 40 133 03 14 14 48 42 178 03 18 14 56 41 208 04 12 15 57 SEPT. 77 299 03 21 30 90 69 378 04 18 29 98 70 412 05 18 30 116 OCT. 68 246 08 23 30 78 92 216 04 12 36 80 73 217 06 24 31 90 NOV. 119 255 12 08 51 136 279 319 18 39 81 160 194 285 13 47 62 152 DEC. 177 266 08 09 41 87 225 233 14 19 68 86 180 274 08 29 49 101 ALL FIGURES REPRESENT QUANTITIES EXPRESSED IN MICRO (MILLIONTHS) GRAMMES PER CUBIC METRE OF AIR. WATER SUPPLY All houses in the Borough have piped water supply. The majority are supplied by the Sutton District Water Company, a few near the northern boundary are supplied by the Metropolitan Water Board. There are private wells at hospitals, factories and a school. The average fluoride content of the water is 0.1 parts per million. The Sutton Company draws its supplies from wells in the chalk at Woodmansterne, Sutton and Cheam, and is under statutory obligation to soften the water to 9° of hardness. The following is a copy of a routine sample taken by the Public Health Inspector:- " Report on Examination of a Sample of Water Sources Sutton District Water Company Date Received! 10th March, 1966. Particulars on Labels London Borough of Sutton Sample No. 4 (Chemical) 10. 3. 6. Sample No. 6 (Bacteriological) Physical Characterss Reaction (pH): 7.3 Tastes Normal Odours None Colours Paint blue Appearances Bright and Clear Electrical Conductivity at 20°C: 240 reciprocal megohms Chemical Characterss Parts per million (milligrams per litre) Total Solids dried at 180°C 165 Chlorine in Chlorides at Chlorion 17.5 Nitrite Nitrogen 0.01 Nitrate Nitrogen 5.8 Ammoniacal Nitrogen 0.00 Albuminoid Nitrogen 0.00 Oxygen absorbed in 4 hours at 27°C 0.00 Alkalinity as CaCO3 84 Hardness as CaCO3 Carbonate Non-carbonate 84 ) Total 113 29 ) Free Carbon dioxide as CO2 - Residual Chlorine 0.01 Iron None Other Metals None 85 Bacteriological Examinations Number of colonies developing per millilitre of waters on agar in 2 days at 37°C 25 on agar in 3 days at 22°C 47 Bacteria of indication enumeration: Organisms of the coliform group 0 in 100 ml. Streptococci 0 - " - CL. Welchii 0 - " - Remarks: This water is of excellent organic purity, attractive in appearance and is free from contaminating metalso It is of very moderate hardness and corresponds in chemical composition to a partially softened water from a chalk supply. The bacteriological condition of the water is satisfactory, the few organisms developing being harmless types of no adverse significance. As judged by this examination, the water is pure and wholesome and is suitable for the public supply. (signed) Daniel Do Moir, M.Sc., F.R.I.C., Public Analyst. „ I am indebted to Mr. E„G.B. Gledhill, B„Sc., M.I.Mech.E., M.I.W.E., A.M.I.C.E., AoM.I„Struc E„, Engineer and Manager of the Sutton District Water Company, for his comments which are as follows: - " Maximum and Minimum Temperatures: The maximum temperature of 83°F. occurred on Fridays, 10th June, 1966. The lowest temperature during the year, of 21°F., occurred on the 18th January. Rainfall (Sutton,, Carshalton Road) Rain fell on 172 days in 1966. The heaviest rainfall amounted to 1.41 inches. The total rainfall during the year amounted to 28.28 inches compared with the 35 year average of 25.72 inches. Consumptions Maximum daily consumption - 30th July, 1966 17,005,000 gals. Average daily consumption throughout the area during the year 11,960,000 gals. This represents an increase over the 1965 figure of 564,000 gallons or 4.95%. No restrictions of any kind were imposed during the year and all consumers had an adequate supply of water for all purposes. 86 Two thousand, two hundred and eighty-five samples were examined by the Company's Chemist & Bacteriologist during the year: see table below:- No. of bacteriological examinations No. of full chemical analyses Noo & % of samples showing ColiAerogenes in 100 ml. (excluding B.Coli I) No. & % of samples showing B.Coli present in 100 ml. of sample (Type I) Total No. of ColiAerogenes organisms in 100 ml. of sample No. % No. % Sutton Raw 309 53 34 10.7 4 10.3 38 Sutton Finished 315 12 4 1.3 3 1.0 7 Woodmansteme Raw 308 53 4 1.3 Nil Nil 4 Woodmansteme Finished 308 12 1 0.3 Nil Nil 1 Cheam 313 100 12 3.9 3 0.1 15 Reservoir 319 Nil 6 1.9 3 1.0 9 District 345 Nil 26 7.6 2 0.6 28 Epsom Finished 42 26 Nil Nil Nil Nil Nil Oaks Borehole 26 59 2 8.0 2 8.0 4 Totals 2,285 315 89 17 106 In relation to those parts of the Borough at Worcester Park and on the St. Helier Estate at the northern end of the former Carshalton Urban District Council's area, Dr. Go Windle Taylor, Director of Water Examination to the Metropolitan Water Board, has supplied the following information:- " (a) The supply was satisfactory both as to quality and quantity throughout 1966. (b) (i) The supply was derived from the following works and pumping stations:- River Thames (Southern Group) No new sources of supply were instituted. (ii) The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown as follows:- 87 Bacteriological Results - Yearly Averages, 1966. After Treatment Number of Samples Agar plate count per ml. Coliform count E. coli count 20-24 hours at 37°C. 3 days at 22°C. Per cent samples negative in 100 ml. Per cent samples negative in 100 ml. 1,825 10.8 99.18 99.95 Average Results of the Chemical Examination of Water, 1966. Milligrammes per litre (unless otherwise stated) No. of Samples 156 Chloride as C1 32 Ammoniacal Nitrogen 0.029 Phosphate as PO4 1.8 Albuminoid Nitrogen 0.090 Silicate as Si02 9 Nitrate Nitrogen 4.4 Sulphate as SO4 62 Oxygen abs. from KMn04 4 hrs at 27°C 1.27 Natural Fluoride as P 0.20 Surface-active material as Manoxol OT 0.01 Hardness (total) CaC03 279 Hardness (non-carbonate) CaC03 77 Turbidity units 0.1 Magnesium as Mg 5 Colour (Burgess units) 15 Sodium as Na 24.2 pH value 7.8 Potasium as K 5.0 Electrical Conductivity (micromhos) 560 No fluoride was added, and where the fluoride content is indicated it represents the naturally occurring fluoride in the water. (c) The supply, being hard in character, is not liable to be plumbosolvent. (d) All new and repaired mains are disinfected with chlorine; after a predeteirained period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactoiy. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, through 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. (e) (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, 1966, was 1s892o 88 (ii) No houses were permanently supplied by standpipe. Other observationss (f) There were no changes to the general scheme of supply in your area. (g) There were no additions to the Board's mains in your area." PREVENTION OF DAMAGE "BY PESTS ACT One thousand, five hundred and ninety-four complaints of rat or mouse infestation were received and investigatedo At 1,244 premises infestations were confirmed and treatments were carried out. Eleven informal notices were served under Section 4 of the Act. NOISE ABATEMENT Seventy-nine complaints indicating nuisance from noise were investigatedo Informal action was taken in appropriate cases to reduce the noise level, SHOPS There are 1,874 shop premises on the register and inspections were made during the year under the Shops Act, 1950, and the Offices, Shops and Railway Premises Act 19^3. Six Dav Trading: A referendum was carried out in accordance with Section 1 of the Shops Act, 1960, in respect of shops situated in and around the High Street, Sutton, area, with the following results:- No. of occupiers canvassed 471 No. of replies received 255 Of the replies received, 52 related to trades or businesses already exempted by Schedule I of the Shops Act, 1950, whilst the other 203 replies relating to the following non-exempted trades indicated either a majority in favour of exemption or the voting was equal:- Mixed Shops Bookseller and Printer Coal and Fuel Iyer, Clearner and Launderer Drapery and Haberdashery Electrical Applicances and Accessories Floor Covering Footwear and Shoe Repairs Gas Appliances and Accessories Glass Merchant Hairdresser, Ladies and Gents. Ironmonger, Hardware, Tools, Brush and Basketware Jeweller, Silversmith, Watches, Clocks Optician, Scientific Instruments Pets, Pet Foods and Accessories Photographic Supplies, Cameras etc. Shop, Office Supplies including Registers Travel Bureau Surgical Appliances. 89 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 During the year 128 premises were registered in accordance with the Act9 making the total number 1,5850. The number of persons employed in the classes of premises as reported to the Minister of Labour at the end of the year is as follows! Class of Premises Total Number Registered at end of Year Number of Persons Employed Offices 452 6,184 Retail Shops 1,018 5,491 Wholesale Shops, Warehouses 30 299 Catering Establishments and Canteens 83 690 Fuel Storage Depots 2 20 Total 1,585 12,684 One application for exemption in respect of sanitary accommodation and one in respect of sanitary and washing facilities were granted. One application for exemption in respect of sanitary accommodation was refused. Preliminary notices were served relating to non-compliance with the Act in respect of the following:- Notices Served during 1966 Complied (incl. Notices served in 1965) Overcrowding 2 3 Ventilation 21 22 Cleanliness 46 43 Temperature (incl. thermometers) 120 133 Lighting 24 32 Sanitary Conveniences 84 72 Washing Facilities 64 78 Water Supply 22 10 General Conditions 20 4 Stairs/Passages 50 42 Clothing Storage 24 35 Drying Facilities 13 21 Seats 4 3 Machinery 2 3 First Aid Equipment 103 111 Notices 312 206 Canteen Facilities 1 - 90 Factories and Outworkers: Inspections for the purpose of provisions as to healths - Premises (1) Noo on Register (2) Number of - Inspections (3) Written Notices (4) Occupiers Prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4 & 6 are to be enforced byLocal Authorities 113 56 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 508 292 4 - (iii) Other premises in which Section 7 is enforced by the Local Authority *(excluding outworkers' premises) 22 23 - - 643 371 4 - * Electrical Station (Section 123 (l) ), Institutions (Section 124) and sites of Building Operations and Works of Engineering Construction (Section 127)« Slaughterhouses, (Section 175 (1) (d) and (e) and Railway Running Sheds (Section 175 (2) and (10). Cases in which Defects were Founds Premises Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred - to H.M. Inspector by H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness 1 - - - - Overcrowding - - - - - Unreasonable temperature _ _ _ - Inadequate ventilation - - - - - Ineffective drainage of floors - _ _ - -- Sanitary Conveniencess (a) Insufficient - - - - - (b) Unsuitable or defective 2 - - - - (c) Not separate for sexes 1 1 - - - Other offences against the Act (not including offences relating to Outwork) - - - - - 91 Outwork (Sections 133 and 134) Nature of Works Section 133 Section 134 No. of outwo rkers in Aug. list required by Sect. 133(1)(c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No, of instances of work in unwholesome premises Notices Served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing apparel Making etc. 51 - - - - - Boxes (Cardboard) 2 - - - - - Curtains and Furniture Hangings 4 - - - - - Cosaques 12 - - - - - Brass and Brass Art 3 - - - - - Flowers 1 - - - - - Lampshades 1 - - - - - Total 74 - - - - - SWIMMING BATHS Visits were made to the three public swimming baths and five school pools during the year. Thirty-seven samples of water were submitted for bacteriological examination. Checks for pH value and free chlorine were made in appropriate cases- The close co-operation which exists between the Borough Engineer, the Chief Education Officer and this Department is much appreciated. DISEASES OF ANIMALS ACT. 1950 Functions of the Council in connection with the Diseases of Animals Act, 1950, are carried out on an agency basis by the Council of the City of London, through that Council's Veterinaiy Officer. In addition to those functions, an offer by the Council of the City of London to make inspections required in connection with applications for licences under the Animal Boarding Establishments Act, 1963, Animals Act, 1951 > and the Riding Establishments Act, 1964? was accepted. DISEASES OF ANIMALS (WASTE FOODS) ORDER, 1957 Twenty-seven licences are in force in respect of premises where waste food is treated for animal feeding, and at the end of the year nineteen boiler plants were in use. 92 ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 Seven licences have been issued for the boarding of cats and dogs. PET ANIMALS ACT. 1951 Thirteen licences have been issued to persons to keep Pet Shops„ RTTVTHft EOTABT.TSffMTttTTS ACT, 1964 Two licences were issued during the yearo SLAUGHTER OF ANTVATS ACT. 1958 One licence was issued during the year. ESTABLISHMENTS FOR MASSAGE AFP SPECIAL TREATMENT Twenty-six licences were renewed during the year, four of which were for chiropody only. Inspections indicated that all establishments were being conducted satisfactorily,, PHARMACY AND POISONS ACT, 1913 One hundred and fifty-five applications for retention of names on the Council's list of sellers of Poisons listed in Part II of the Poisons List were dealt with, and eleven new applications for names to be added to the List were grantedo RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Four premises used for upholstery are registered in accordance with Section 2 of the Rag Flock and Other Filling Materials Act, 1951. Two samples of unused cotton felt were taken and proved to be satisfactory,, The prescribed Analyst is Mr» George Noel Ginger of R«T„SoA<, (Chiltern Research), Westfield House, Henley-on-Thames, Oxfordshire. REFRESHMENT HOUSES ACTS, 1860 and 1964 Four licences were issued during the yearo OTHER MATTERS Fertilisers and Feeding Stuffss Three informal samples of Poultry Food were taken during the year,, One sample was reported by the Public Analyst to be unsatisfactory due to the protein content being in excess of the limits of variation allowed. All the Public Health Inspectors of the Borough have been approved by the Ministry of Agriculture, Fisheries and Food as Inspectors and Official Samplers under the Fertilisers and Feeding Stuffs Act, 1926. 93 Hairdressers and Barbers: Rye-laws made under Section 77 of the Public Health Act, 1961, were confirmed by the Minister of Housing and Local Government and came into operation on the 1st June, 1966. Bye-laws made under Section 125 of the Surrey County Council Act, 1936, by the former Authorities of Sutton & Cheam Borough Council and Carshalton Urban District Council were revoked. Mortuaries s The Council maintains a mortuary at Cemetery Road, Sutton Common Road, Sutton, which is equipped with refrigeration storage and facilities for post-mortem examination. The number of bodies9 on all of which autopsies were performed, admitted during the year was as follows:- Ambulance removals 74 From local hospitals 221 From homes within the Borough 226 521 Summary of Complaints., Inspections and Work Done? Investigations were made with regard to 5,070 complaints, as follows:- Accumulations 59 Animals so kept etc. 22 Burst pipes 7 Caravan Sites . 5 Clean Air - Contraventions 115 Dampness 130 Drainage defects 80 Drains obstructed 1,809 Dustbins 4 Factories Act 1 Food contaminated 72 Food unsound 135 Fouling of Footpaths 18 General Defective conditions 160 Insects and Pests 501 Litter Act Contraventions 17 Miscellaneous 15 Noise 79 Obnoxious effluvia 144 Overcrowding 13 Public Conveniences 3 Refuse Collection 15 Rivers 11 Rodents 1,594 Roofs Defective 14 Sewer Obstructions 22 Shops Act - Contraventions 3 Sink Waste Pipes 8 Verminous Premises 5 Water Supply 9 5,070 74 Twenty-two thousand, four hundred and eighteen inspections and re-inspections were made for the purposes set out belows - Animal Boarding Establishments 15 Caravan Sites 1 Clean Air Act 892 Consumer Protection Act 5 Cowsheds 13 Diseases of Animals Act 111 Employment Agencies 5 Establishments for Massage and Special Treatment 26 Factories (Mechanical Power - inclc Laundries) 292 Factories (non-Mechanical Power) 56 Factories (Building Sites) 23 Fertilisers and Feeding Stuffs 6 Food and Drugs (incl. Food Bye-laws) 1,240 Food Premises: Bakehouses 73 Bakers & Confectioners 123 Butchers 369 Canteens 115 Canteens - Schools 84 Chemists 54 Confectioners (Sugar) 187 Factory Food 15 Fishmongers 110 General Stores 290 Greengrocers & Fruiterers 210 Grocers 363 Ice-Cream Factories 3 Ice-Cream Vehicles 14 Licensed Premises with Catering Facilities 98 Licensed Premises without Catering Facilities 39 Milk Storage Depots 15 Restaurants and Cafes 322 Stalls, Food 118 Tea Packers 16 Vehicles, Food 3 2.621 2,621 Hairdressers 203 Housing Act 823 Housing Land Charges 40 Infectious Disease Premises (inclo food poisoning enquiries) 1,440 Insect Pests 364 Licensing Act 9 Merchandise Marks Act 170 Noise 526 1,830 f r\ Offices, Shops & Railway Premises Act Outworkers Premises 62 95 Pet Animals Act 5 Pharmacy and Poisons Act 14 Piggeries 36 Premises re cesspools 13 Public Conveniences 347 Public Health Act (houses) 6,510 Public Health Act re-inspections 2,576 Rag„ Flock and Other Filling Materials Act 18 Rent Act 38 Riding Establishments Act 1 Rivers, Ditches and Ponds 46 Rodents 1,455 Schools 59 Shops 371 Verminous Premises 12 Water Sampling 91 Work Places 53 22,418 Seven hundred and thirty-seven notices were served concerning the following matters:- Accumulations and Deposits 8 Animals so kept 1 Clean Air Act 7 Drainage Defects 69 Dustbins 5 Factories Act 4 Food and Drugs Act (incl. Food Hygiene) 177 General Defective Conditions 136 Housing Act 54 Noise 8 Offices, Shops and Railway Premises Act 247 Prevention of Damage by Pests Act 11 Shops Act 4 Water Supply 6 737 Formal notices were served by authority of the Council under the following Acts:- Public Health Act, 1936, Section 24 45 „ „ „, „, „ 39 16 „ „ „, „, „ 45 2 „ „ „, „, „ 93 27 „ „ „, „, „ 277 1 Public Health Act, 1961, Section 17 1 Clean Air Act, 1956, Section 12 23 115 96 As a result of investigations made and notices served, the following work was carried out:- Accumulations removed 11 Brickwork repaired 2 Ceilings repaired and/or made good 8 Chimneys and flues repaired 4 Damp conditions remedied 17 Doors and frames repaired, including locks and fasteners 1 Drainage repaired and/or reconstructed 45 (houses) Drainage inspection chambers repaired 9 Soil pipes renewed 4 Drains cleared 1,521 Waste gullies repaired, renewed or provided 7 Waste pipes repaired, renewed or provided 6 Surface water drainage provided 1 Dustbins provided 6 Fireplaces, ranges or stoves repaired or renewed 1 Floors renewed or replaced 7 Food storage accommodation provided 2 Roofs repaired and made weatherproof 11 Downpipes, guttering repaired and/or renewed 9 Stairs repaired 3 Sinks renewed 3 Walls repaired 8 re-plastered and/or repaired 18 cleansed and redecorated 16 Wash basins and baths provided 15 Water supply renewals or repairs 8 W.c. provided 1 W.c. accommodation repaired 20 WoCo pans and seats repaired, renewed or provided 3 flushing apparatus repaired or renewed 7 Windows repaired and/or renewed 17 Ventilation provided 9 97 SCHOOL HEALTH SERVICE PART V (EDUCATION ACT) INDEX Page No. INTRODUCTION 100 AREA AND SCHOOL POPULATION 101 ARRANGEMENTS FOR MEDICAL INSPECTION 101 FINDINGS AT MEDICAL INSPECTION 102 MEDICAL TREATMENT 105 SCHOOL DENTAL SERVICE 106 SPECIAL SERVICES 111 AUDIOLOGY 111 SPEECH THERAPY 111 CHILD GUIDANCE 112 INFECTIOUS DISEASE 112 IMMUNISATION AND VACCINATION 113 HANDICAPPED PUPILS AND SPECIAL SCHOOLS 113 EPLOYMENT OF CHILDREN OF SCHOOL AGE 116 PHYSICAL EDUCATION IN SCHOOLS 116 PROVISION OF MEALS AND MILK 116 (Figures in brackets refer to 1965) 99 SCHOOL HEALTH SERVICE INTRODUCTION The work of the school medical and nursing staff has proceeded on the same lines as previously. During the year further thought has "been given to the wisdom of introducing a more selective type of procedure for the medical inspection of school children and it is anticipated that a modified scheme will be introduced during 1967* Progress has been made with education in health for school pupils, medical officers and health visitors carrying out series of talks and discussions with groups of pupils and with parents. This is important work which will be expanded in the future. Many young people leave school with adequate educational achievements but ill-equipped to deal with the problems of personal relationships and hazards to mental and physical health which they must face. Understanding and knowledge of the elementary dynamics of healthy living can help them to avoid many of the pitfalls which are ahead of them. The findings at medical inspections carried out during the year show little variation from the previous year. In one respect, however, some comment is relevant. The number of pupils noted as requiring investigation for suspected defects of psychological development has increased from l46 in 1965 to 165 in 1966. Due to the difficulties created by the re-organisation, the figure for 1965 may be inaccurate and there is no evidence to suggest that there is an increasing number of backward pupils in schools; it is more likely that pupils are being more closely observed and the necessary investigations carried out with increasing frequency. This is suggested by the number of those recommended for special schools remaining approximately the same. The number of pupils found to require observation or treatment for psychological instability is also increased though to a smaller degree. This again reflects increasing attention to the mental health of young people and is an encouraging feature of the work of the Service. The Chief Dental Officer and her staff have completed a survey of the dental health of five year old children in the Borough which is of particular interest in view of the continued controversy surrounding the question of adjusting the fluoride content of domestic water supplies. The results reveal widely differing standards of dental health in different parts of the Borough but an average rate of only one third of our children at this age being in a state of maximum dental health leaves something to be desired. The School Health Service has a continuing and important part to play in achieving a high standard of mental and physical health of the oommunity as a whole. It must modify its aims and methods to keep abreast of the changing needs of modern society. To carry out its work effectively, the doctors, dentists, health visitors, school nurses and administrative staff request the co-operation and assistance of teachers and administrative officers in the schools and in the Education Department. This is most readily given and I wish on behalf of all members of my staff to record my appreciation. 100 AREA AND SCHOOL POPULATION The Registrar-General's estimated population of the Borough at mid-year 1966 was 165,840 (166,790) of whom 21,000 (22,400) were children between the ages of 5-14 inclusive. The number of children on the register of local education authority schools was 19,348 (18,950). The number of children continuing full-time education at school after the compulsory school leaving age of 15 years continue to increase. MEDICAL INSPECTION (a) Maintained Schools Under the provisions of the Education Act 1944 it is the duty of the local Education Authority to provide for the medical inspection, at appropriate intervals, of pupils in attendance at any school or county college maintained by them and the Authority may require the parent of any pupil in attendance at such school to submit the pupil for medical inspection in accordance with the arrangements made by the Authority. Medical officers and health visitors are employed jointly by the Health and Education Committees thus achieving continuity of medical supervision from birth until school leaving age. Arrangements for medical inspection at present in force are Primary School 1. On entry - complete medical examination. 2. At age of six years - hearing test. 3. During the year in which the age of eight years is reached - complete medical examination. Secondary School 1. On entry aged 11 - 12 years - complete medical examination. 2. During the year in which the age of 13 years is reached vision test only. 3. During the year in which the age of 15 years is reached complete medical examination. 4. During the year prior to leaving school if more than two years after last routine inspection - complete medical examination. The number of children examined in primary and secondary schools was 6,788 (6,773). 4,026 (3,695) parents were present at these examinations (i.e. 59.3% (54.5%)). (b) Independent Schools Medical inspection and treatment and dental inspection of children attending independent schools are made available on application by the Principal of the school and subject to the school itself being recognised as efficient by the Department of Education and Science. 101 The following schools have taken advantage of these facilities which are offered free of charge : St.Hilda's School, Carshalton Wellington Independent Grammar School. Findings at Medical Inspection Medical Inspection of Pupils attending Maintained Primary and Secondary Schools (including Nursery and Special Schools) Table A. Periodic Medical Inspections 1st January - 31st December,1965 Age Groups Inspected (by year of birth) No.of Pupils who have rec'd a full medical examination Physical Condition of Pupils Inspected No. of Pupils found not to warrant medical examination Pupils found to require treatment (excluding dental diseases and infestation with vermin Satisfactory No. Unsatisfactory No. For defective vision (excluding squint) For any other condition Total individual Pupils (1) (2) (3) (4) (5) (6) (7) (8) 1962 & later 165 165 - - 7 27 27 1961 1343 (142) 1341 (142) 2 (-) - 50 (-) 163 (25) 189 (25) 1960 485 (1307) 484 (1301) 1 (6) — 16 (52) 84 (235) 92 (268) 1959 80 (538) 79 (535) 1 (3) — 8 (17) 11 (91) 19 (103) 1958 1206 (74) 1205 (74) 1 (-) — 93 (4) 128 (13) 207 (14) 1957 336 (1283) 335 (1280) 1 (3) — 34 (97) 65 (174) 85 (221) 1956 107 (229) 107 (229) - (-) — 17 (13) 41 (29) 40 (41) 1955 757 (49) 754 (49) 3 (-) — 105 (4) 151 (4) 199 (8) 1954 462 (883) 460 (883) 2 (-) — 55 (27) 86 (30) 124 (51) 1953 112 (588) 112 (586) (2) — 8 (83) 18 (86) 23 (156) 1952 101 (105) 100 (105) 1 (-) — 18 (12) 19 (18) 32 (25) 1951 & earlier 1634 (86) 1631 (86) 3 (-) 289 (19) 179 (9) 366 (25) TOTAL 6788 (6773) 6773 (6759) 15 (14) - 700 (577) 972 (965) 1403 (1330) 102 Of the 6788 pupils (6773) examined at periodic medical inspections 1403 pupils (1330) (percentage of total 20.67 (19.62)) were found to be in need of treatment for 1859 (1612) defects. (a) Special medical inspections and re-inspections There were 1378 (1242) special inspections, i.e. pupils referred to the school medical officers by head teachers and health visitors or requested by the parents. These pupils were either seen at school or at general medical clinics. There were 1053 (1204) re-inspections, that is re-examination of children who were found at the previous medical examination to have defects requiring either treatment or observation. (b) Physical condition Of the 6788 (6773) children examined at routine medical inspection, the physical condition of only 15 (14) was considered to be unsatisfactory, (0.2%). (c) Personal hygiene The routine inspection of personal hygiene of pupils each term has been carried out at the school nurses' discretion or at the request of the school. 8988 (5546) children were examined by the school nurses and 43 (48) individual children were found to be infested during the year. In all cases the parents carried out the appropriate treatment satisfactorily and without delay. 103 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS NOTE: All defects, including defects of pupils at Nursery and Special Schools, noted at periodic and special medical inspections are included in this table, whether or not they were under treatment or observation at the time of the inspection. This table includes separately the number of pupils found to require treatment (T) and the number of pupils found to require observation (0) Defect Code No. Defect or Disease Periodic Inspections Special Inspections Entrants Leavers Others Total 4 Skin T 16 (36) 70 (54) 89(113) 175(203) 458(364) 0 38 (52) 19 (51) 58 (43) 115(146) 24 (21) 5 Eyes-a. Vision T 73 (69) 307(249) 320(259) 700(577) 87(103) 0 111(116) 46 (83 156(272) 313(471) 24 (40) b. Squint T 45 (29) 5 (9) 27 (29) 77 (67) 2 (8) 0 18 (15) 4 (4) 21 (16) 43 (35) 1 (2) c. Other T 3 (6) 4 (2) 14 (14) 21 (22) 9 (15) 0 7 (5) 2 (16) 6 (12) 15 (33) 1 (1) 6 Ears a. Hearing T 17 (12) 9 (5) 14 (27) 40 (44) 145(162) 0 64 (74) 8 (12) 44 (25) 116(111) 14 (19) b.Otitis Media T 5 (9) 1 (6) 4 (8) 10 (23) - (10) 0 30 (36) - (2) 20 (11) 50 49) (-) (2 c. Other T - (8) 4 (13) 7 (13) 11 (34) 13 (25) 0 15 (17) 4 (17) 21 (23) 40 (57) - (4) 7 Nose and Throat T 53 (65) 16 (3) 52 (52) 121(120) 31 (40) 0 340(310) 17 (26) 219(165) 576(501) 6 (15) 8 Speech T 44 (35) 13 (4) 27 (13) 84 (52) 15 (28) 0 80 (62) 3 (4) 17 (24) 100 (90) 4 (2) 9 Lymphatic Glands T 5 (14) 1 (3) 11 (3) 17 (20) 4 (1) 0 155 (114) 2 (4) 112 (72) 269(187) - - 10 Heart T 4 (4) - (1) 4 (4) 8 (9) 3 (1) 0 37 (26) 4 (11) 42 (33) 83 (70) - (3) 11 Lungs T 27 (l6) 4 (6) 21 (17) 52 (39) 26 (30) 0 34 (45) 9 (10) 44 (44) 87 (99) 7 (2) 12 Developmental a. Hernia T' 2 (5) - (l) 3 (6) 5 (12) - (3) 0 6 (8) 1 (2) 2 (13) 9 (23) 1 (-) b. Other T 8 (9) - (8) 20 (10) 28 (27) 4 (9) 0 78 (53) 10 (30) 79 (75) 167(158) 2 (1) 13 Orthopaedic a.Posture T 14 (10) 15 (14) 46 (41) 75 (65) 24 (35) 0 19 (13) 23 (44) 38 (42) 80 (99) 6 (8) b. Feet T 36 (59) 17 (l) 52 (66) 105(126) 92 (91) 0 96 (70) 25 (33) 97 (76) 218(179) 11 (8) c. Other T 0 13 (28) 37 (65) 15 (l) 27 (33) 29 (33) 37 (58) 57 (62) 101(156) 20 (24) 1 (6) 14 Nervous System a. Epilepsy T 2 (1) 2 (-) 11 (1) 15 (2) 1 (4) 0 2 (3) 1 (1) 8 (9) 11 (13) 1 (-) b. Other T 3 (3) 2 (l) 3 (3) 8 (7) 2 (5) 0 4 (18) 4 (5) 14 (8) 22 (31) 3 (2) 15 Psychological a.Development T 2 (2) 33 (9) 130 (5) 165(146) 11 (85) 0 23 (23) 2 (3) 20 (20) 45 (46) 5 (3) b. Stability T 5 (3) 6 (2) 21 (4) 32 (9) 16 (10) 0 83 (39) 5 (2) 64 (38) 152 (79) 2 (11) 16 Abdomen T 1 (1) - (2) 1 (9) 2 (12) 11 (29) 0 2 (9) 7 (7) 14 (18) 23 (34) 1 (14) 17 Other T 9 (21) 14 (17) 28 (16) 51 (54) 304(181) 0 46 (42) 24 (36) 53 (88) 123(166) 15 (23) 104 MEDICAL TREATMENT Medical treatment is the responsibility of general practitioners and the hospital service. The Local Education Authority arranges preventive physiotherapy and actinotherapy and, by arrangement with the Executive Council, treatment for defective vision and squint. These forms of treatment are carried out when requested by the family doctor or after his consent has been obtained except in the case of defective vision when reference for treatment is direct. Certain minor ailments are also treated at the Authority's clinics. (a) Minor Ailments The principal minor ailments treated are diseases of the skin and ear and external disease of the eyes. One of the school medical officers has specialised in the treatment of diseases of the skin and many cases are referred to her by general practitioners. A total of 331 (618) pupils were treated for minor ailments excluding skin diseases. There were no cases of ringworm of the scalp or body and 5 (-) cases of scabies. There were no (7) cases of impetigo. Skin diseases treated were mainly verrucae (plantar warts) and tinea pedis (athlete's foot). A total of 440 (36l) pupils were treated for skin diseases. (b) Eye diseases, defective vision and squint 1221 (1427) pupils were treated for these defects, 12 (53) for external eye diseases and 1209 (1374) for defective vision including squint. Spectacles were prescribed for 310 (413) pupils. Ophthalmic surgeons carried out sessions at the following clinics in the Borough s- Sutton Clinic Green Wrythe Lane Clinic Rochester Road Clinic Shotfield Clinic (c) Diseases and defects of ear, nose and throat The total number of children treated for these defects was 235 (235) of whom 24 (33) had operative treatment. The total number of pupils in school known to have been fitted with hearing aids was 19 (48), 2 (ll) of which were provided during 1966. (d) Orthopaedic and postural defects After consultation with the family doctor pupils requiring orthopaedic treatment are referred to the orthopaedic surgeons at Queen Mary's Hospital for Children or St.Helier Hospital. Sessionally employed physiotherapists undertook remedial exercises for minor defects at the following clinics Priory Crescent Rochester Road Stonecot Hill Green Wrythe Lane Robin Hood Lane Shotfield Sessions are also held at Carew Manor Special School. 105 (e) Ultra-violet light treatment Facilities are available for ultra-violet light treatment carried out by physiotherapists at the following clinics Robin Hood Lane Clinic, Sutton, Shotfield Clinic, Wallington, Priory Crescent Clinic, North Cheam, A total of 22 children attended. SCHOOL DENTAL SERVICE I am indebted to the Chief Dental Officer for the following report : In 1966 the School Dental Service maintained a satisfactory rate of inspection and treatment, 17,527 children being inspected at routine school dental inspections during the year. The percentage of children found to be in need of treatment at their first inspection was 43.7, very slightly higher than in 1965 but comparing favourably with the national average for 1965 which was 58.49%. Several staff changes during the year resulted in the work being a little in arrears in one of the five clinics but by the 31st December, 1966 the total staff of full-time and part-time dental officers was equivalent to 4.75 full-time officers. There was little significant change in the number of children treated, or in the number of courses of treatment completed during the year, but the number of temporary teeth filled and the number of younger children (i.e. 5 to 9 years) attending for treatment increased. Unfortunately there are still some children in the Borough who receive no routine dental treatment from any source, and whose occasional visits to the dentist are only for the relief of pain, this in spite of repeated reminders after school inspections that dental treatment is necessary. It is hoped that this number will decrease so that eventually all children will be examined and treated if necessary at least twice a year. In 1965 a survey of the teeth of five year old children was started and continued during 1966. The d.e.f. method of assessment was employed i.e. the number of decayed, extracted and filled teeth in each mouth were recorded and aggregated and the results expressed in several ways. As many 5 year old children have already lost their anterior teeth through natural means and some already have permanent teeth erupted, the remaining twelve deciduous teeth only were included in the survey figures. Recordings were made during routine dental inspections, and as several dental officers took part in the survey, allowances must be made for some slight differences of clinical opinion. In all a total of 1237 five year old children were examined and the results of the recordings are listed over page : 106 No. of children examined 1237 No. with no decayed, extracted or filled teeth 409 Percentage with no d.e.f. 33.06% Total number of d.e.f. teeth 3700 Average d.e.f. rate per child 2.99 Average number of decayed teeth per child 1.34 Average number of filled teeth per child 1.28 Average number of extracted teeth per child .37 Percentage of children previously treated and 19.32% dentally fit at time of inspection Children previously treated but needing 25.94% further treatment Children not previously treated but now 21.66% needing treatment Children with a d.e.f. rate of 10 or over 2.8% The percentage of caries free children varied from school to school from a low of 10.77 "to a high of 46.93 and the d.e.f. rates from 2.22 to 4.30. Separate figures for the schools are listed with other dental statistics as follows RESULTS OF SURVEY OP THE TEETH OP 5 YEAR OLD CHILDREN Schools a b C D E P g H 1 46.93 28.57 20.40 4.08 2.44 .55 .26 1.63 2 46.42 32.15 21.42 0 2.42 .321 .071 2.03 3 42.10 15.79 17.54 24.56 2.22 1.33 .12 .77 4 40.45 29.21 13.48 16.85 2.49 1.01 .30 1.17 5 39.77 29.54 21.59 9.09 2.70 .54 .35 1.81 6 39.08 19.52 26.43 14.94 2.74 .88 .51 1.34 7 37.5 20 27.5 15 2.78 1.12 .25 1.42 8 34.84 13.63 27.27 24.24 2.87 1.36 .36 1.15 9 33.96 11.32 30.18 24.52 2.88 1.678 .358 .849 10 32.43 21.62 27.02 18.91 2.75 .94 .78 1.02 11 30.76 25 15.38 28.84 3.42 1.615 .173 1.634 12 30.23 17.42 25.60 26.74 3.1 1.48 .52 1.11 13 29.16 20.83 20.83 29.16 2.66 1.44 .5 .73 14 29.11 22.79 27.84 20.253 2.72 .97 .20 1.55 15 29.05 8.57 29.05 33.33 3.43 2.28 .316 .83 16 29.03 6.46 16.12 48.38 3.09 2.16 .32 .61 17 26.66 8.89 31.11 33.33 3.84 2.46 .37 1 18 23.21 26.78 32.14 17.85 3.76 1.196 .464 2.10 19 10.77 9.23 58.46 21.54 4.3 1.86 .75 1.69 * (a) Percentage of children caries free (B) Percentage of children previously treated and dentally fit at time of the inspection. (C) Percentage of children previously treated and needing further treatment. (D) Percentage of children not previously treated but in need of treatment. (E) Average d.e.f. rate (P) Number of decayed teeth per child. (G) Number of teeth extracted per child. (H) Number of teeth filled per child. 108 School Dental Service, 1st January to 31st December, 1966 1. Attendances and Treatment Ages 5 to 9 Ages 10 to 14 Ages 15 & over Total First visit 2133 1448 306 3887 (1926) (1494) (382) (3802) Subsequent Visits 2178 2756 656 5590 (3116) (2937) (692) (6745) Total Visits 4311 4204 962 9477 (5042) (4431) (1074) (10547) Additional courses of treatment commenced 518 296 63 877 (621) (341) (77) (1039) Fillings in permanent teeth 1198 2917 885 5000 (1397) (2848) (951) (5196) Fillings in deciduous teeth 4714 287 5001 (3681) (293) (3974) Permanent teeth filled 1052 2518 737 4307 (1285) (2544) (759 (4588) Deciduous teeth filled 3762 233 - 3995 (3319) (251) (3570) Permanent teeth extracted 72 302 81 455 (60) (327) (145) (532) Deciduous teeth extracted 921 241 — 1162 (784) (237) (1021) General anaesthetics 495 250 32 777 (446) (225) (38) (709) Emergencies 346 117 45 508 (232) (104) (29) (365) number of Pupils x-rayed 220 (291) Prophylaxis 698 (84O) Teeth otherwise conserved 593 (603) Number of teeth root filled 19 (16) Inlays - (-) Crowns 10 (13) Courses of treatment completed 3803 (3820) 2. Orthodontics Cases remaining from previous year 252 (181) New cases commenced during year 190 (172) Cases completed during year 45 (56) Cases discontinued during year 35 (11) No. of removable appliances fitted 108 (104) No. of fixed appliances fitted - (1) Pupils referred to Hospital Consultant - (2) 3. Prosthetics Ages 5 to 9 Ages 10-14 Ages 15 & over Total Pupils supplied with F.U. or F.L. (first time). - (-) - (-) - (3) - (3) Pupils supplied with other dentures (first time) 1 (-) 4 (2) 2 (8) 7 (10) Number of dentures supplied 1 (-) 5 (2) 2 (11) 8 (13) 4. Anaesthetics General Anaesthetics administered by Dental Officers 2 (Nil) 5 Inspections (a) First inspection at school. No. of Pupils 17,526 (16,526) (b) First inspection at clinic. No. of Pupils 2,324 (1,660) No. of (a)+(b) found to require treatment 8,677 (7,899) No. of (a)+(b) offered treatment 7,254 (6,579) (c) Pupils re-inspected at school clinic 1,505 (1,441) No. of (c) found to require treatment 1,184 (1,122) 6. Sessions Sessions devoted to treatment 1,588.75 (1,825.7) Sessions devoted to inspection 188 (185.8) Sessions devoted to Dental Health Education - (2.0) SPECIAL SERVICES (a) Audiology Service The early diagnosis of children with partial hearing is essential if normal progress is to be achieved in the development of speech and the child's education. The great majority of cases are diagnosed by hearing screening tests before the child begins school. Those children initially referred on account of speech defects which may be associated with partial deafness have a routine hearing test by the audiometrician before speech therapy is commenced and all pupils have a further screening test during their second year at school. Those children who show any defect in hearing are referred to the school medical officer who decides whether it is necessary for them to be referred for further investigation and treatment. Since the more serious cases of partial hearing are detected before school age, only a small number of school children are seen for the first time over the age of 5 by the audiologist, only one in 1966. In cases where there is a severe loss of hearing the pupil is referred to an ear, nose and throat specialist and a decision made regarding the supply of a hearing aid. In a small number of cases the pupil is considered sufficiently handicapped to require special educational treatment at a partial hearing unit or special school for the deaf. In the less serious cases it may only be necessary to request the head teacher to make certain that the pupil sits near the front of the class and in those cases with loss of hearing in one ear, be placed with the good ear towards the teacher. The co-operation of teachers in this respect is mueh appreciated. 5 (11) new cases were supplied with hearing aids during the year 1966 and a total of 47 (48) pupils are registered as having been so fitted. The total number of children seen by the audiometrician was 1935 (2433) of whom 155 (200) were found to have defective hearing of varying degree and referred to the school medical officers for further investigation. (b) Speech Therap.V Speech Therapy Clinics were held at :- Priory Crescent Clinic, North Cheam Rochester Road Clinic, Carshalton Green Wrythe Lane Clinic, Carshalton Shotfield Clinic, Wallington Robin Hood Lane Clinic, Sutton There is a national shortage of speech therapists and it has been necessary to employ all the speech therapists on a part-time basis. The total number of children attending for speech therapy during 1966 was 148 (155) of whom 62 (22) were discharged as cured and 22 (17) discharged as greatly improved. One of the speech therapists carried out 4 sessions weekly at Carew Manor E.S.N. School. 111 (c) Child Guidance Service The staff of the Child Guidance Clinic work closely with their colleagues in other sections of the Health and Welfare Department, Children's and Education Departments and with probation officers, psychiatric colleagues in hospitals and particularly closely with general medical practitioners and teachers. Educational psychologists working in the School Psychological Service are based at the Child Guidance Clinic thus creating a closely integrated service. Because of the nature of the work and the widely varying factors which are connected with psychiatric disturbance both in family welfare and in education, it is essential to achieve the closest possible working arrangements. In many cases referred to the Clinic, after diagnostic interview,treatment at the Clinic is not regarded as appropriate but referral is made to the most appropriate agency, while support is given and progress followed by the Child Guidance Clinic staff. Maladjusted children in need of special schooling are referred through the Education Officer to the school considered most appropriate. Work is at times continued in the Clinic with the parents while the child is at a boarding school for maladjusted children. A close relationship has evolved between the Child Guidance Clinic and the North Downs Special School where the work that is done for the child is therapeutic in a school setting. In all cases both parents as well as the child are given psychiatric interviews and in many oases they are all offered treatment; the parents with a psychiatric social worker and the child with the child psycho-therapist. Educational psychologists working in the School Psychological Service attempt to assess the potential and difficulties of any preschool or school child referred for advice. 293 children were assessed during the year, the majority being referred by head teachers or school medical officers. Referrals also came from the Education Department and other agencies dealing with children and some directly from parents themselves. In a proportion of cases no specific therapy proved necessary apart from advisory discussions with the parents or teachers. Following assessment the most frequent recommendation is for the provision of some type of remedial education, 90 pupils being treated in this way during the year at 8 primary and 2 secondary schools. A few children may need transfer to special schools and in other cases a more specialised investigation is undertaken at the Child Guidance Clinic. No child is accepted for treatment by the Child Guidance Clinic team without prior reference to the general practitioner who is very often in a position to be of very considerable assistance in the treatment of the case. (d) Infectious Diseases Pull information concerning infectious disease is given in that part of the report dealing with infectious disease generally. It should be noted that there were no cases of serious infectious disease in schools during the year and it was not necessary to carry out any special investigation in respect of cases of pulmonary tuberculosis in members of school staffs or pupils. There were minor outbreaks of sonne dysentery all of which were fully investigated. 112 (e) Immunisation and Vaccination Responsibility for immunisation and vaccination is placed on the local health authority by Section 26 of the National Health Service Act, 1946. Sessions are held regularly at primary schools mainly for reinforcing injections for protection against diphtheria and tetanus. B.C.G. vaccination against tuberculosis is carried out at the age of approximately 13 years in secondary schools. The Education Committee decided on a policy of adequate protection against enteric fevers and smallpox for those children going abroad in school parties. This policy has been carried out, the protection necessary being dependent upon the country to which the party was travelling. It was also considered necessary to recommend poliomyelitis vaccination for parties going abroad. HANDICAPPED PUPILS It is the duty of the Council to make suitable provision for handicapped pupils in the Borough. The Handicapped Pupils and Special Schools Regulations, 1959 specify ten categories of handicapped pupils, namely : Blind, partially-sighted, deaf, partially hearing, educationally sub-normal, epileptic, maladjusted, physically handicapped, delicate and speech defect. Children who are handicapped in one or more of these ways may require special educational treatment since they cannot be educated satisfactorily under the normal conditions of an ordinary school. The majority, however, do not require to attend a special school since suitable arrangements can be made for them to receive appropriate education in ordinary schools. The accompanying table gives information regarding the number of handicapped children newly assessed in 1966 and the total number as at 31st December, 1966 attending special schools. SPECIAL SCHOOLS There are two special sohools provided by the Borough Council: Carew Manor, Wallington, for educationally sub-normal children and North Downs, Belmont, a small unit for maladjusted children. In addition placements are obtained in speoial schools of other Local Education Authorities and in a few cases in specialised private schools. (a) Carew Manor School This special school is a day school for 140 educationally sub-normal boys and girls aged from 7-16 years. The average number of pupils attending during 1966 was 133 (130). Before a child is admitted to this or any other special school for educationally sub-normal children a full medical examination is carried out and reports are obtained from an educational psychologist and if necessary from a psychiatrist. Every child attending the school has a physical examination annually and is psychologically assessed every 2 years. At the request of the headmaster or the parents these examinations can be arranged at short notice at any time. In addition to a regular weekly session at the school by a 113 school medical officer and educational psychologist two physiotherapy sessions are held each week and 4 sessions are devoted to speech therapy. Before any pupil leaves the school at the age of 16 a full medical and psychological investigation is carried out and, in conjunction with the headmaster, a decision is made regarding the type of employment that might be suitable for the pupil. In some cases because the pupil might not be accepted into employment or may drift from one job to another, supervision and community care by mental health social workers is recommended. To assist in finding suitable employment the Principal Youth Employment Officer devotes several sessions at the school to interviewing school leavers and their parents. It is regrettable that educationally sub-normal pupils cannot be admitted to Carew Manor School before the age of 7 years. An increasing number of pupils at ordinary schools are now ascertained as educationally sub-normal by the age of 6 years and these children have to be found places in schools in neighbouring Authorities. (b) North Downs Unit, Belmont This unit caters for 15 maladjusted children. The children remain on the register of their ordinary school and attend the unit from varying periods from two to four days each week. • The children recommended for admission to the unit are carefully selected in conjunction with the child psychiatrist and the head teacher of the unit. Many maladjusted pupils require continued contact with their homes and parents which can only be achieved by the provision of day school places. It is hoped that new premises will become available enabling the number of places to be increased to 30. In addition to these two special schools there are hospital schools at Queen Mary's Hospital for Children, Carshalton and Belmont Hospital, Sutton. I take this opportunity of expressing my appreciation of the work carried out for sick children by the head teachers and their staffs. (c) Queen Mary's Hospital School When a child is admitted to hospital it is essential to continue his or her education as soon as he or she has sufficiently recovered from illness to do so. At Queen Mary's Hospital School some of the pupils can attend classrooms but the majority have individual tuition in bed. A number of children are only in hospital for a short time but a large percentage are in hospital for a period of months or even years. In addition to the head teacher there are 29 assistant teachers and the curriculum at the school is as varied as in any other school. The total number of children on the register at 31st December, 1966 was 157 (168). (d) Belmont Hospital Sohool At Belmont Hospital there is a diagnostic unit basically for deaf children. The children are referred from a very wide area in the South of England and the unit specialises in the examination of children for deafness. Many of these children are found to be not suffering from deafness but to be non-communicating (autistic) children. A number may be in the unit for a few days only when the diagnosis has not proved difficult but others remain for a period of months. There are 12 beds in the hospital for these children, the beds almost always being occupied, and the children suitable for education attend classes run by a teacher of the deaf who is attached to the unit. 114 115 HANDICAPPED PUPILS Number of pupils registered as Handicapped - 222 Handicapped Pupils requiring Education at Special Schools approved under Section 9(5) of the Education Act 1944 or Boarding in Boarding Homes during the year 1st January to 31st December, 1966 Blind Partially Sighted Deaf Partially hearing Physic -ally handicapped Delicate Maladjusted E.S.N. Epileptic Speech Defects Total Children newly assessed as needing special educational treatment at special schools - 5 (-) 4 (2) 2 (3) 4 (4) 7 (12) 6 (6) 17 (16) - (-) - (-) 45 (43) Number of children receiving special educational treatment in (a) Boarding Special Schools or Homes 1 (3) 2 (1) 10 (4) - (4) 2 (7) 12 (18) 9 (21) 16 (18) 1 (1) - (1) 53 (78) (b) Day Special Schools - 8 (4) - (6) - (3) 13 (13) 9 (6) 2 (2) 113 (117) - - 145 (151) (c) Independent Boarding Schools - - 1 - 2 3 12 6 - - 24 (e) Home Tuition Some children may be so severely handicapped as to be unable to attend a day school. During the waiting period for admission to a residential school or if the handicap is only of a temporary nature the education of the children is continued in their own homes. During the period 1st January - 31st December 1966 home tuition was arranged for 3 (9) children. (f) Convalescent Treatment School children are recommended for convalescence or recuperative holidays either by the family doctor, hospital or school medical officer. Holidays were arranged for 21 (15) children during 1966. The normal holidays vary from two to four weeks. I am grateful to the Chief Education Officer for the following information (a) EMPLOYMENT OF CHILDREN OF SCHOOL AGE The by-laws regulating the employment of children provide for their medical examination prior to employment and annual re-examination. 292 (205) children were medically examined during 1966. (b) PHYSICAL EDUCATION IN SCHOOLS General arrangements for physical education are to a large extent similar to those of 1965, but the number and range of physical education activities have increased and become more varied. There has been considerable growth in interest, and in the realisation of the scope of activities available. Groups have taken advantage of the facilities at the National Recreation Centre at Crystal Palace, and more schools have become interested in the Duke of Edinburgh Award Scheme. Courses in recreational activities e.g. fencing,' judo, swimming, ice-skating, were arranged for school leavers at the end of the summer term. There is still a dearth of teaching swimming pools. Time allotted to local schools at the public swimming baths is fully used. (c) PROVISION OF MEALS AND MILK The number of day pupils receiving mid-day meals and milk per day both at maintained and non-maintained schools in September 1966 was Meals Milk Primary Schools 8,492 (73.6%) 9768 (94.8%) Secondary Schools 5,492 (71.7%) 4273 (57.2%) Independent 558 1740 583 children received free school meals. 116 WELFARE SERVICES PART VI (NATIONAL ASSISTANCE ACTS) INDEX Page No. INTRODUCTION 119 SERVICES FOR THE ELDERLY 119 MEALS ON WHEELS 120 PHYSICALLY HANDICAPPED 120 CARE OF THE DEAF 121 CARE OF THE BLIND 121 TEMPORARY ACCOMMODATION 122 RECEIVERSHIP AND CARE OF MOVEABLE PROPERTY 122 DISPOSAL OF THE DEAD 122 (Figures in brackets refer to 1965) 117 NATIONAL ASSISTANCE ACTS- WELFARE SERVICES Introduction The Borough is an all-purpose welfare authority and is responsible for the welfare of the aged, the blind and partially-sighted, the deaf and the physically handicapped as well as dealing with homeless families. Whilst in the main these duties are carried out by staff employed directly by the Council, there is close co-operation with the many voluntary organisations engaged in the various fields in the Borough,, Estimated number of people over pensionable age in the Borough 22,100 (21,090) Number of old people in care of this authority in directly 219 controlled old people's homes (237) Number of old people of Sutton origin elsewhere in 125 old people's homes (133) 1. SERVICES FOR THE ELDERLY Information concerning elderly people living in their own homes is received with ever increasing frequency as the Council's services increase and become more widely known. This means that much of the work of social welfare officers is concerned with such visits and every effort is made to maintain elderly people in their own homes for as long as possible. Where necessary other domiciliary services are deployed in support, such as meals-on-wheels, home help and chiropody. Introductions are given to Day Centres, Darby and Joan Clubs and old people's voluntary welfare organisations which organise visiting services. Often old people are unaware of financial help which is available to them and in these cases the social welfare officers give the necessary advice and make contact with the Ministry of Social Security. When even with the support whioh is available an old person is unable to care for himself or herself, arrangements are made for admission to residential homes administered by the Council:- "Brambleacres", Sutton 43 places Maiden Homes, Worcester Park 112 " or to St.Anne's at Redhill (83 places), which is administered by Surrey County Council but where we have an allocation of beds. It is sometimes necessary to arrange for admission to voluntary homes registered under Section 37 of the National Assistance Act, the Council accepting financial responsibility. So far as possible, accommodation is made available within the Sutton area and for this reason we have not taken up our full allocation of beds at St.Anne's because relatives find visiting difficult and the residents feel isolated from familiar people and surroundings. Many of the residents in the Council's homes have been there for a number of years and are becoming increasingly frail. The same comment also applies to those applying for admission to homes and it is significant that the great majority of applicants and residents are in the 80/90 age group. The admission of elderly frail people means that staff in the homes have to make greater use of geriatric equipment and have to give a greater degree of personal care than in previous years. For this reason staff are not inclined to stay for long periods and it is extremely difficult to recruit and retain suitable staff. At the present time, the waiting list for admission to old people's homes is around 120 and to meet this need three new homes are being planned within the Borough. The first is at "Roundshaw" where it is hoped that actual building will commence quite soon; the second on the site adjoining "Brambleacres" and the third is included in the Benhill Housing Development at Sutton. 119 There are 21 private old people's homes in the Borough providing 280 places and six homes owned and controlled byvoluntary organisations providing 186 places. These are registered by the Council and regularly inspected. Many old people are reluctant to enter an old people's home which, to some extent, means sacrificing their independence. The less frail prefer to have their own flatlets the number of which is less than the demand. Private housing associations such as "Abbeyfield" and "Castlemead" are helping in this work by converting houses into flatlets for elderly people, and the Borough's own schemes of flatlets with a warden to provide general assistance meet a real need. At the end of 1966 there were 226 old people in Council's residential homes, 62 in other authorities' homes and 61 in voluntary homes for whom this Council was financially responsible. It is estimated that the proportion of elderly will continue to increase and this will require even greater provision of residential accommodation. The following table shows the age groups, (a) of old people actually in homes and (b) of old people on the waiting list. Under 66 60/70 70/80 80/90 90/100 over 100 (a) — 6.2% 26.8% 51.3% 14.4% 1.3% (b) 1.7% 12.1% 22.4% 52.6% 10.3% 0.9% Meals on Wheels The meals-on-wheels service which is administered by voluntary workers throughout the Borough, makes a very significant contribution to the health and well-being of many elderly folk living in their own homes. 52,000 meals were served during 1966. To improve the efficiency of the service and increase the number of meals supplied, the Carshalton and Wallington/Beddington services were combined during the year and the meals-on-wheels facilities at 8 Alcester Road were expanded to cope with extra work. The Physically Handicapped The Council has a statutory responsibility for maintaining a register of handicapped persons and ensuring that they are aware of the services available to them. There is also responsibility for providing them with some form of occupation and recreation and helping them to dispose of the work they produce. This work has increased rapidly and whereas at the beginning of 1966 there were approximately 570 people on the handicapped persons register, this increased during the year to nearly 800. The National Assistance Act specifies a handicapped person as one who is deaf or dumb, or substantially and permanently handicapped by illness, injury or congenital deformity, and it therefore includes persons suffering from a wide variety of disability. Much of the work is concerned with the adaptation of homes of the handicapped to make life easier. Walking aids and gadgets to assist with household duties and personal needs are made available on loan and in the year under review, 280 appliances were distributed within the Borough. 120 In conjunction with the Ministry of Labour and other organisations working for the handicapped, rehabilitation courses have been arranged and support given to social rehabilitation of handicapped persons. Particular mention should be made of the holiday scheme whereby 100 handicapped persons went on holidays organised by the Council or were assisted with their own privately arranged holidays. 31 relatives and escorts assisted with the scheme. A Work Centre for the handicapped has been planned to open next year and the accent will be on productive outwork, perhaps even the assembly of light industrial products. Although the Work Centre will begin in a small way, it is hoped that 40/45 persons will ultimately attend. In this field much work is done by the voluntary organisations such as the British Red Cross Society, W.R.V.S., and the Societies dealing with specific handicaps or "illnesses. The Sutton Association for the Disabled has been formed to co-ordinate the work of the voluntary organisations and the department and it is hoped that the Association will play an important part in this way. Visits by Welfare Officers Social work with the physically handicapped and registration 2244 (1236) Aids and adaptations 762 (362) Occupational therapy 993 (673) Industrial outwork 321 (185) (b) Care of the Deaf The number of deaf and hard of hearing on the register is now 90 compared with 94 in 1965. A qualified welfare officer for the deaf not being available, a social welfare officer of the staff was sent on a 6 weeks course (full-time) for deaf welfare during 1967. (c) Care of the Blind A Welfare Authority has responsibility for maintaining a register for the blind and partially sighted. At the beginning of the year there were 327 blind and 62 partially-sighted people registered in Sutton but by the end of the year these figures had increased to 347 and 65 respectively. Two social welfare officers for the blind are employed, one blind and one sighted. They visit blind and partially sighted people in their own homes for general welfare purposes and also teach crafts, Braille and Moon. A well-attended craft class has been held fortnightly at Highfield Hall throughout the year and registered blind persons have been sent on social rehabilitation courses and assisted holidays. As in the case of other handicapped classes, aids and gadgets to assist daily living are distributed and the social welfare officers act as agents for the distribution of radio sets and talking books. Particular mention should be made of the efforts to obtain employment for blind persons, particularly on discharge from training or from residential schools. The Friendly Club for the Blind meets in Sutton every fortnight and provides a valuable social and recreational outlet for blind people, many of whom have few such opportunities. The Sutton Association for the Blind has been formed to take over the work formerly done by the Surrey Association and this organisation has given valuable help. 121 Visits by social welfare officers for the blind. Blind and partially-sighted 1,612 (1,926) Number of lessons in Braille, occupational therapy etc. 283 ( 204) Escort duties to hospitals, etc. 93 ( 248) d) Transport arrangements The Department has a specially designed ambulance capable of carrying handicapped people in their wheelchairs to and from their own homes to work centres, hospitals, etc. and has proved invaluable in the year under review. A great deal of assistance is given also by voluntary drivers and this is much appreciated. Temporary Accommodation The Council is responsible for providing temporary accommodation for "persons who are in urgent need thereof, being need arising in circumstances which could not reasonably have been foreseen, or in such other circumstances as the authority may in any particular case determine." The original interpretation of this definition was that temporary accommodation was available for victims of fire, flood or similar disasters, but a more liberal view was taken by the Council and the only qualification for admission is that parents with dependent children are actually homeless. This interpretation was confirmed by a joint Ministry Circular issued on the 31st October, 1966 which proposed new standards to be observed., To meet the demand for temporary accommodation, three houses are provided at Sutton, Beddington and Carshalton. The first two accommodate both parents and dependent children, whereas the last provides accommodation for mothers and children. Altogether, 16 units are available and they are generally fully occupied. At the present time, 10 out of the 16 families are in temporary accommodation because they have been evicted from Council property or private property for non-payment of rent and their circumstances are such that it is unlikely that they will be able to pay off the substantial arrears, thus necessitating their continued stay in Council accommodation. Every effort is made to encourage the families to re-establish themselves in their own homes and during the year these efforts have met with some success. It is hoped that some long-stay units will shortly be available where families can be more closely supervised on their way to rehabilitation. Receivership and Care of Moveable Property Under Section 48 of the National Assistance Act, the Welfare department has a duty to provide temporary protection of property of persons admitted to hospital or residential accommodation where there is no other person capable of accepting such responsibility and, during the year, five such cases were dealt with. This is an important responsibility which sometimes involves application to the Court of Protection for a "Receivership " to be set up or to the Official Solicitor for authority to deal with property. Inventories of furniture and personal effects are made by the social welfare officers. Disposal of the Dead Under Section 50 of the same Act, the Council is responsible for disposing of bodies where no other person will undertake this duty, and during the year four such cases have been dealt with, the expense or proportion of expense being recovered from any assets which were left by the deceased. 122 MISCELLANY PART VII INDEX NURSING HOMES NURSES' AGENCIES ACT, 1957 NURSERIES AND CHILD MINDERS REGULATION ACT, 1948 MEDICAL ARRANGEMENTS FOR CHILDREN'S HOMES AND RESIDENTIAL NURSERIES STAFF MEDICAL EXAMINATIONS TRAINEE TEACHERS (Figures in brackets refer to 1965) 123 NURSING HOMES The following registered nursing homes are situated in the Borough:- Carshalton Nursing Home Ltd., 28 Salisbury Road, Carshalton 103 Woodcote Road, Wallington Dunollue, 38 Woodcote Road, Wallington The Avenue, 32 The Avenue, Cheam The Red House, 40 Burdon Lane, Cheam * St.Margaret's, 17 Overton Road, Sutton Weedcote Grove House, Woodcote Park, Coulsdon (Friends of the Poor and Gentlefolk's Help). * (Home re-registered in 1966 for 32 patients) The following establishments are also registered as "Nursing Homes":- St.Anthony's Hospital, Cheam Leurdes House, Wallington (re-registered during 1966 for 12) (For Mentally Subnormal Children) The Haven, Camden Road, Sutton (Mother and Baby Home) Nursing Homes are visited regularly by medical officers, the Superintendent Health Visitor and Superintendent of Home Nursing and Midwifery. NURSES' AGENCIES ACT. 1957 There are 3 nurses' agencies licensed under this Act in the Borough The Empire Nursing Association Worcester Trained Nurses' Co-operation Carshalton Nurses' Co-operation Licences are issued annually subject to re-inspection and satisfactory report. NURSERIES AND CHILD MINDERS REGULATION ACT, 1948 Applications are received for registration in accordance with the above Act. Suitable applicants are registered as daily minders when the number of children is under 10 and as day nurseries when the number of children to be cared for is 10 or over. During the year 11 (4) child minders and 8 (6) day nurseries were approved for registration by the Health Committee. The following table gives the numbers registered as at 31st December, 1966:- 125  Nurseries & Child Minders Regulation Act, 1948 National Health Service Act, 1946 Section 22 Premises Registered at end of year Daily Minders registered at end of year Daily Minders receiving fees from the Authority at the end of year Factory Other Nurseries (a) Number - 26 (18) 31 (20) 2 (2) (b) Number of places & number of children minded at end of year - 589(413) 245 (173) 4 (2) MEDICAL ARRANGEMENTS FOR CHILDREN'S HOMES AND RESIDENTIAL NURSERIES At 31st December, 1966 there were 5 Children's Homes under the control of the Children" s Committee Reception Home, Rosebeiy House, 7/9 Rosebery Road, Cheam Throwley House, 10 Throwley Road, Sutton Malvern House, Kenley Camperdown Children's Home, Wallington Dean House, Mersthama The residential nursery at Hayes Court, Kenley, closed in July 1966. A general practitioner residing near the Reception Home has been appointed as medical officer and is responsible for the examination of new admissions and discharges, as well as for medical treatment. At the other Homes a general practitioner is responsible for medical treatment, examination of new admissions and discharges being carried out by an assistant medical officer. In addition, an assistant medical officer visits all the Homes regularly, carries out routine medical inspections every six months and is responsible for seeing that any special investigations, immunisation etc. are carried out. The Children's Homes are inspected every six months and a report on environmental conditions and the health of the children submitted to the Children's Committee. 126 STAFF MEDICAL EXAMINATIONS (a) Officers A medical examination to ascertain fitness for employment is carried out by the Medical Officer of Health or a member of the medical staff as soon as possible following interview and before an appointment is confirmed. The medical examination includes a routine x-ray examination of chest for all members of the staff having close contact with children and those who have been exposed to tuberculous infection. X-ray examination of other members of the staff is carried out when the examining medical officer considers it is desirable. Bacteriological and other investigations may be required at the discretion of the Medical Officer of Health. (b) Manual Staff A medical examination to ascertain fitness for employment is carried out by the Medical Officer of Health or a member of the medical staff within 6 months of first being employed and no further medical examination is required prior to acceptance into the Superannuation Scheme. Manual staff who are in close contact with children and those who have been exposed to tuberculous infection have an x-ray examination of chest and at the discretion of the Medical Officer of Health, bacteriological examination of stools or any other investigation considered necessary. (c) Employees of the Council Certain members of the staff having close contact with children are required to have an x-ray examination of chest annually, e.g. health visitors, district nurses, home helps. It is hoped that similar conditions will be introduced for the teaching and other staff at schools, child care officers and any other members of the staff in close contact with children. Members of staff making application for extension of sick leave are referred to the Medical Officer of Health for an independent medical examination and report to the Establishment Committee. Members of staff referred by Chief Officers to determine fitness to continue employment are medically examined. Members of staff who wish to continue employment after the age of 65 years are required to pass a medical examination and are re-examined annually. The following medical examinations were undertaken during 1966 - Officers (excluding teachers) 220(282) Teachers 194(141) Manual Staff 181 (67) Extensions of Sick Pay 74 (23) Retirement due to ill-health 12 (2) Extensions of service 70 (15) TRAINEE TEACHERS It is part of the duty of school medical officers to medically examine entrants to teachers' training colleges. 175 (113) such examinations were carried out in 1966 and the reports were forwarded to the Principals of the Training Colleges concerned. 127