Ac.4418(1) SuT 4 LONDON BOROUGH OF SUTTON THE HEALTH AND WELFARE OF SUTTON 1967 P.Westcombe MB BS DPH Medical Officer of Health and Principal School Medical Officer THE HEALTH AND WELFARE OF SUTTON. 1967 CORRIGENDA AND ADDENDA Page 26 Infectious Disease (a) second line Delete "reduced" and insert "increased" Page 97 Table - BLIND - Age group 50 - 64 amend as follows:- Delete Insert Male 39 25 Female 42 35 Total 81 60 Page 98 Fifth line final word should read 'added' Page 100 Add under BLIND Employed in Open Industry 1 Warehouseman 1 Secretary No change in total of 25. Page 131 First line for "Twenty-two thousand, four hundred and eighteen" read "Twenty thousand, nine hundred and sixty eight". Third line Animal Boarding Establishments delete and insert '7'. 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 SCHOOL HEALTH SERVICE 65 (Education Act) PART V WELFARE SERVICES 89 (National Assistance Acts) PART VI ENVIRONMENTAL HEALTH SERVICES 105 PART VII MISCELLANY 135 MEMBERS OF THE HEALTH COMMITTEE as at 31st December, 1967 The Worshipful, the Mayor, Alderman Leslie John Hill. Alderman S.J.Barton, J.P. Councillor Mrs.J.S.Buck Councillor F.S.Dixon Councillor G.F.Everitt, J.P. (Vice- Chairman) Councillor B.C.Fleming Councillor H.Fox Councillor Mrs.H.O.Judd, M.A., J.P. Councillor A.JoKenney Councillor D.P.Madden Councillor T.E.Page Councillor N.F.Paul (Chairman) Councillor D.H.T.Salari, J.P. Councillor N.G.Shelley Councillor H.Sunderland Co-opted (5) Miss KoMoBomford Nominated by General Nursing Council Miss G.M.Bates " " Royal College of Midvives Dr.L.J.Ison " " Local Medical Committee Dr.O.G.Potter " " Local Medical Committee Dr.D.N.Lawson " " South West Metropolitan Regional Hospital Boart MEMBERS OF THE WELFARE COMMITTEE as at 31st December, 1967 The Worshipful, the Mayor, Alderman Leslie John Hill. Alderman S.J.Barton, J.P. Councillor P.A.Bishop (Chairman) Councillor Miss F.A.Blackler Councillor Mrs.J.S.Buck Councillor F.S.Dixon (Vice-Chairman) 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.R.Haydon Mrs.D .M .Pettingell Mr.A.E.H.Bailey Mr.A.J.Barker Mr.A.J.Day 2 I wish to acknowledge the assistance of the following officers in the compilation of this Report t- 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., P.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 AND WELFARE DEPARTMENT TOWN HALL, WALLINGTON, SURREY. 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 1967. The production of an Annual Report is a statutory requirement placed on those holding the office of Medical Officer of Health. It is also a privilege to have the opportunity of presenting a comprehensive review of the Council's achievements in promoting and maintaining the health and welfare of the community and in support of those citizens who are unable to provide for themselves. The report would not however be fulfilling its proper function if it did not at the same time point to those areas of need which are as yet incompletely met. Since the inception of the London Borough in 1965 there has been a greatly increased demand for your health and welfare services. This has been experienced in all sections of the work and the provision made for expansion in the Ten Year Development Plan has been more than justified. Many factors may have contributed to creating this situation, not least of which must have been the closer relationship which now exists between your officers, the people they serve and those other agencies which contribute to the community's well-being. Service seems to beget a demand for more service and on all sides has to be rendered with regard to priorities of need rather than to meet its every aspect. Increasing longevity, better medical treatment, greater awareness of social, personal and environmental health problems all bring in their wake increased call for supportive services. Higher standards are continually being demanded by an evolving society and enforced by legislation. These have to be met from existing resources in a climate of financial stringency which limits expansion of the work. Environmental Health A community can achieve its full potential of health and social well-being only if the environment in which it lives is favourable. Services provided for the support of its most vulnerable members tend to occupy a more prominent place in the public mind than those which deal with the more impersonal side of life. Particular attention is drawn to the breadth and depth of the Environmental Health Services as demonstrated in Part VI of this report. The work of this Section has been handicapped by staffing difficulties and it is much to the credit of those concerned that standards have been maintained and work in some fields expanded. 4 Causes of Death Studies of mortality and morbidity can be profitable in directing attention to measures necessary to prevent ill-health and to areas of need for various services. The commonest causes of death in the age-group 45 - 65 years are still cardio-vascular disease (particularly coronary heart disease) and malignant neoplasms (particularly malignant growths of the lung and breast). Large numbers of people have their lives cut off during their most productive years by these diseases. Year by year repeated warnings of the dangers of heavy cigarette smoking fall on heedless ears, although there is some evidence to suggest that the number of non-smokers, particularly in the younger age-groups, is increasing. The majority of persons who die from cancer of the lung do so directly because of heavy cigarette smoking and to this extent can be regarded as dying from a self-inflicted disease. It is unlikely that anyone reaches the age of maturity without being aware of the risk involved in becoming a habitual heavy cigarette smoker, a risk with odds of something of the order of one in eight, somewhat similar though less immediate in their application, to those presented by the game of Russian roulette. Not until cigarette smoking becomes socially unacceptable can we expect to see a significant reduction in the numbers of people dying from this disease. The adult image presented to adolescents is one which includes cigarette smoking as an accepted part of adult behaviour. This is built-in to the portrayal of glamorous cigarette-smoking adult behaviour on television screens, strip cartoons, and cinema films. There is surely a nation-wide responsibility not only on parents but also on advertisers and producers of media for mass public entertainment to be aware of the impact they have on the growing mind. Progress has been made in the early diagnosis of cancers of the womb and of the breast through screening clinics for well-women and the distribution of information describing the technique of self-examination of the breast. Early diagnosis of these conditions ensures early treatment and increases the possibility of a successful outcome. Although during 1967 our scheme for cervical cytology was still at the pilot stage, increasing laboratory facilities are allowing gradual expansion. Constant evaluation of the effectiveness of schemes of this nature in reducing mortality rates is necessary and this is being undertaken on a national basis. We do not yet know if cytological screening can succeed in its aim of lowering the death rate from cancer of the uterine cervix. It is, however, our growing experience that many other conditions of a more minor nature are being revealed at our well-women clinics. Domiciliary Care Wherever possible the sick, the frail, the elderly, the socially, the physically and mentally handicapped are cared for in their own homes. Successful home care depends upon many things, not least of which is the provision of suitable housing accommodation within which the supporting services can provide the help which is necessary. 5 The supporting team consists of workers of many professional disciplines all of whom must combine their efforts to provide an environment in which the handicapped person can live a comfortable, productive and satisfying life within the limits of his handicap. The personal efforts of those involved are assisted by the provision of practical help in the form of nursing aids such as special beds, hoists, mattresses and the independence of those less handicapped is maintained as far as possible by the provision of physical aids to daily living which enable them to carry out many tasks with greater ease than they could otherwise do. Occupational therapy, particularly when it is associated with some financial reward, provides an incentive to continued activity and does much to overcome the inertia which sometimes follows severe physical or mental handicap. The success or failure of nurses and social workers often depends upon the availability of adequate domestic support. The Home Help Service occupies an honorable and essential place in the domiciliary team and it is a continued source of worry that recruitment of home helps shows little sign of improvement. There is need to improve the status and pay of workers in the Home Help Services and although the recruitment position is no worse than it was, every effort that has so far been made has produced only a temporary improvement of the position. I am glad to be able to report further progress in home care of the elderly both by voluntary effort and the Council's services. The number of elderly persons requiring assistance is, however, continually increasing and there is a pressing need for increasing the provision of flatlets with warden supervision both to lessen the demand for scarce residential accommodation and to cater for the very considerable number of elderly persons living in houses too big for their needs and capabilities. In this connection too little regard is paid to the fine way in which many ordinary families care for their elderly relatives. In some cases it is they who need help in situations created by their own efforts rather than the elderly person for whom they are caring, and it is not uncommon to find a "young 60 or 70 year old" needing relief or falling ill when caring for an"older 80 or 90 year old". The Borough's provision for the physically and mentally handicapped has taken a great step forward with the opening of a Work Centre in the old Civil Defence Headquarters in Mulgrave Road, Sutton. Further details of the work of this Centre will be found in Part 5 of this report. At the outset a modest scheme was established which rapidly grew both in terms of the numbers of persons attending and the quality of work done. Voluntary effort has a large part to play in the field of community care and this continues to grow. It would be invidious to mention individual organisations who are undertaking a truly great amount of work in the Borough. Without exception individual voluntary organisations have responded to the challenge of the increased demand for service they have experienced since the formation of the Borough. There' is, however, growing indication that in order to achieve the most effective deployment of voluntary effort some organisations will find it necessary to co-ordinate their services with one another and where two or three of similar nature carry out their work in over-lapping or adjacent areas, they may find advantage in combining their efforts. 6 Infectious Diseases The routine measures in force for the prevention and control of infectious disease continue and there were no significant outbreaks which it is necessary to report. Although not markedly apparent locally, there is a national increase in the incidence of venereal disease and it is wise to consider where the present rise is going to lead. There will almost certainly be a need for increased treatment and contact tracing services. Venereal disease can develop in two days or may not make itself apparent for much longer periods and an intensive epidemiological effort will be necessary if the disease is to be controlled. Basically this can be achieved by the philosophy of one man-one woman and the permissive attitude of modern society belittles the efforts of health education and religious teaching in this respect. It is to be hoped that the present rise in incidence can be halted by methods other than those which have been found necessary in some countries in the past which involve compulsory treatment and examination of contacts. The year closed amid much talk of major re-organisation not only of Local Government but of National Health, Welfare and Social Services generally. In the final event the effectiveness of Family Services depends upon the integrity and devotion to duty of individual people who are members of staff of the departments concerned. I have no doubt that whatever the outcome of present discussions may be those most intimately concerned will continue to discharge their duties in the same loyal spirit of service which they have displayed during this and previous years. P.WESTCOMBE, M.B., B.S., D.P.H., Medical Officer of Health Principal School Medical Officer 7 GENERAL STATISTICS AND SOCIAL CONDITIONS PARTI INDEx Page No. AREA AND POPULATION (1961) Census) 11 DEATHS 16 BIRTHS 20 HOUSING 21 (Figures in Brackets refer to 1966) 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 reportso 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 65O 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 1964 1965 1966 1967 Beddington & 3045 32757 32603 32590 - - - Wallington Carshalton 3346 62721 57484 55730 - - - Sutton & Cheam 4338 80673 79008 79500 - - - TOTAL 10729 176151 169095 167820 - - - London Borough of Sutton 10729 - - - 166790 16584O 165250 (b) Population by Age Groups Registrar General's Estimate of Mid-Year Population 1967 Under 1 year 1-4 years 5 - 14 years 15 - 64 years 65 years & over 2420 9780 21200 1O869O 23160 (2430) (9570) (21000) (over 15 years 132840) Total all ages 165250 (165840) 11 (c) Rateable Value Rateable Value of the Borough 1st April, 1967 £9,634,483 Estimated net product of a penny rate 1967/1968 £39,050 Estimated number of separately assessed properties 64,108 (d) Population by Sex and Age - 10% Census 1966 (in brackets Census 196l) Age Males Females Total 0-4 648O (5466) 5700 (5179) 12180 (1O645) 5-9 5780 (5119) 5430 (4941) 11210 (10070) 10 - 14 4830 (6638) 5140 (6412) 9970 (13050) 15 - 19 6090 (5703) 5660 (5937) 11750 (11640) 20 - 24 5140 (4459) 5250 (5151) 10390 (9610) 25 - 29 4550 (4760) 4980 (4855) 9530 (9615) 30 - 34 4870 (4848) 4980 (5275) 9850 (10123) 35 - 39 4790 (5388) 5150 (5992) 9940 (11380) 40 - 44 5310 (4982) 6060 (5659) 11370 (10641) 45 - 49 4880 (5875) 5160 (6807) 10040 (12682) 50 - 54 5290 (6550) 6150 (7537) 11440 (14087) 55 - 59 6020 (6492) 7010 (7203) 13030 (13695) 60 - 64 5470 (4832) 6210 (5935) 11680 (10767) 65 - 69 3480 (3229) 5040 (4456) 8520 ) (7685) ) 70 - 74 2340 (2004) 3840 (3467) 6180 ) 22810 (5471) ) 21090 75 + 2650 (2523) 5460 (5411) 8110 ) (7934) ) Total 77970(78868) 87220(90227) 165190 (169095) % of Total 60 - 64 7.02 (6.12) 7.12 (6.58) 7.07 (6.3) 65 - 69 4.44 (4.00 5.78 (4.94) 5.16 ) * (4.54) 70 - 74 3.00 (2.54) 4.40 (3.84) 3.74 )13.81% (3.23) 12.48% 75 + 3.40 ( 3.32) 6.26 (5.99) 6.18 ) (4.69) * Residents aged over 65. Projections of population trends are notoriously difficult to forecast with any accuracy and the hazards of comparing census figures (1961) covering the whole population with the census figures (1966) covering only 10% of the population are obvious. Nevertheless the trends illustrated by the above tables indicate significant increases in the population groups aged 0-9 and those over 65 years of age. In 1961 12.48% of the population was aged over 60 and on the 10% sample figures 1966 13.81 %. These figures are in accordance with the national trend and their significance is real when considering services for the vulnerable age groups of the population generally. 12 Acreage, Population, Private Households and Dwellings - 10% Census 1966 Area Acreage 1 Population Private households and dwellings, 10% Census 1966 Total Persons Males Females Persons per acre for the London Borough of Sutton Private households 'Population in private households Structurally separate dwellings occupied Rooms Occupied Density of occupation Persons per room % of Persons at more than 1½ per room Beddington Nth 706 5680 2850 2830 15.05 1830 5680 1870 10430 .43 2.5 Beddington Sth 849 7390 3690 3700 2480 7390 2540 15170 .49 • •54 Belmont 500 696O 2920 4040 2130 6030 2150 12440 .56 1.3 Carshalton Cent. 320 5440 2520 2920 1690 5190 1630 9640 .56 1.8 Carshalton N.E. 330 85OO 4270 4230 2910 8500 2940 14450 .59 5.53 Carshalton N.W 255 7670 3690 3980 2630 7670 2420 13930 .55 3.8 Carshalton S.E 1411 8650 3920 4730 2520 7710 2520 14090 .62 2.4 Carshalton S.W 448 6500 3070 3430 2080 6380 2030 12310 .53 1.2 Carshalton St.Helier N. 249 6230 3000 3230 2160 6090 2180 9460 .66 6.38 St.Helier S. 122 6130 2940 3190 1690 5270 1690 7680 .80 3.26 St.Helier W. 211 6020 2890 3130 2110 6020 2190 9920 .61 3.32 Cheam N 251 6690 3340 3350 2340 6690 2370 13220 .51 .15 Cheam S 866 7060 3810 3630 2210 6840 2360 14710 .50 1.42 Cheam W 241 5840 2840 3000 2060 5840 2110 11710 .50 .17 Sutton Cent 203 5200 2520 2680 1900 5200 1900 9950 .52 .19 Sutton East 342 5030 2360 2670 1900 5030 1720 9130 .55 4.77 Sutton North 437 6100 2890 3210 2070 6100 2070 11400 .54 1.31 Sutton N.E 542 7290 3540 3750 2490 7290 2520 13250 .55 .83 Sutton S.E 361 5100 2250 2850 1920 5030 1760 10930 .47 2.35 Wallington Cent. 144 65OO 2950 3550 2300 6460 2340 12550 .52 .15 Wallington N 362 5360 2540 2820 1810 5360 1780 9740 .55 I.67 Wallington S 369 1400 3460 3940 2500 7260 2300 14310 .52 1.49 Worcester Park N 407 8620 4020 46OO 2810 8220 2820 15030 .57 6.38 Worcester Park S 310 6700 3120 3580 2320 6700 2370 13110 .51 .15 Sutton South 712 7130 3130 4000 2580 7070 2420 13360 .53 1.68 TOTAL 10948 159190 78530 87040 55440 61020 55000 301920 13 (e) Acreage, Population, Private Households and Dwellings - Census 1961 Area Acreage Population Private households and dwellings, 1961 1951 1961 Private house- holds Population in private households Structurally separate dwellings occupied Rooms occuppied Density of occupation Persons Persons Males Females Persons per acre Persons per room % of Persons at more than l£ 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 706 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 l.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 0.64 2.7 6 Wallington Cent. 144 4,049 3,726 1,667 2,059 25.9 1,406 3,701 1,260 6,504 0.58 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 O.69 4.7 Wards: 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 488 6,370 7,098 3,238 3,860 15.8 2,306 7,035 2,248 13,124 0.55 0.8 Sutton & Cheam MB 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 12,974 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 0.63 1.4 14 (f) Socio-economic grouping (Males and Females) from 10% Census 1966 Percentage 1. Professional workers 5.96 2. Employers managers 12.37 3. Other self—employed 3.8l 4. Skilled workers 19.05 5. Non-manual workers 38.77 6. Service, semi-skilled, agricultural 14.84 7. Armed Forces .29 8. Unskilled 4.87 15 (g) Causes of death at different periods of life during 1967 (Figures in brackets are for 1966) Cause of Death Sex Total all ages Under 4 Weeks 4 Weeks & under 1 year Age in Tears 1 5 15 25 35 45 55 65 75 & over 1 Tuberculosis,Respiratory M 7 (4) - - - - - - 1 - 1 4 1 F 2 (3) - - - - - - - 1 1 - - 2 Tuberculosis, Other M 1 (-) — - - - - - - - - 1 — F - (-) - - - - - - - - - - - 3 Syphilitic Disease M 1 (1) — — — - - — — - 1 - - F 4 (1) - - - - - - - - 1 3 - 9 Other Infective and Parasitic Diseases M 2 (-) — — - - — - — — 2 - — F 2 (2) - 1 - - - - - - - - 1 10 Malignant Neoplasm, Stomach M 21 (17) — — — — — — — — 7 9 5 F 13 (19) - - - - - - - 1 3 4 5 11 Malignant Neoplasm, Lung, Bronchus M 100 (102) - - — - - - — - 41 46 13 F 20 (19) - - - - - - - - 7 6 5 12 Malignant Neoplasm, Breast M - (1) - — — — — — - — — — - F 34 (56) - - - - - - — 4 10 11 9 13 Malignant Neoplasm, Uterus F 15 (18) — - — - — — 2 3 4 3 3 14 Other Malignant and Lymphatic Neoplasms M 108 (100) - — — — 1 3 2 8 34 31 29 F 102 (102) - 1 - - - - 5 11 20 31 34 15 Leukaemia, Aleukaemia M 4 (7) — — — — — — — 2 1 1 — F 5 (9) - - 1 - - - - - 1 - 3 16 Diabetes M 7 (7) — — - — - — - — 2 3 2 F 9 (7) - - - - - - A - 1 4 4 17 Vascular Lesions of Nervous System M 114 (103) — - — — — — — 5 13 36 60 F 183 (193) - - - - - - - 7 17 39 120 18 Coronary Disease, Angina M 223 (228) - - — — — 2 5 22 68 66 60 F 177 (146) - - - - - - - 1 22 58 96 19 Hypertension with Heart Disease M 7 (9) - - — - - - - - 1 3 3 F 15 (19) - - - - - — - - - 2 13 20 Other Heart Disease M 93 (66) - — - 1 — - 2 1 11 16 62 F 162 (170) - - - - — — — 1 7 26 128 16 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+ 22 Influenza M 1 (6) — — — — — 1 — — — — — F 2 (6) - - - - - - - - - - 2 23 Pneumonia M 42 (49) 1 1 — — 1 — - - 2 11 26 F 73 (72) - 3 - - - - 1 — 1 9 59 24 Bronchitis M 72 (68) — — — — — — — 4 16 28 24 F 11 (26) - - - - - — — - 1 2 8 25 Other Diseases of Respiratory System M 13 (11) — — — — — - — - 3 7 3 F 8 (5) - - 1 - — — — — — 1 6 26 Ulcer of Stomach & Duodenum M 4 (7) — — — - — — — — — 2 2 F 7 (3) - - - - - - - - - 2 5 27 Gastritis, Enteritis and Diarrhoea M 3 (2) — — — — — — — - - 1 2 F 8 (8) - - - - - - - - - 2 6 28 Nephritis and Nephrosis M 6 (4) — - — — 1 - - - 1 4 - F 4 (3) - - - - - - — — — 1 3 29 Hyperplasia of Prostate M 7 (6) - - - - - - - - - 2 5 31 Congenital Malformations M 6 (10) 4 1 — — — 1 - - - - - F 6 (11) 3 1 - 1 - - - — 1 — — 32 Other Defined and IllDefined Diseases M 53 (50) 12 — — — 1 3 — 3 5 12 17 F 68 (74) 9 2 - - 1 1 2 5 8 10 30 33 Motor Vehicle Accidents M 14 (13) — — 2 1 3 — — 2 2 3 l F 9 (9) - - - - 3 2 - - 1 1 2 34 All Other Accidents M 9 (6) — — — — 1 1 — 1 1 1 4 P 17 (12) - - - - 2 - - 2 — 2 11 35 Suicide M 8 (7) — — — — 1 2 2 - 2 - 1 F 7 (6) - - - - - - — 2 3 1 1 36 Homicide and Operations of War M 1 (-) - - - - - 1 - - - - — P - (2) — — — — — — - — — — TOTAL ALL CAUSES M 965 (932) 17 2 2 2 10 16 12 50 219 295 340 F 1,025 (1,052) 12 8 2 1 6 4 11 42 113 231 595 17 (h) Deaths from all causes Male Female Total Crude rate per 1,000 Home Population Adjusted rate per 1,000 Population (comparability factor 0.90) 965 1025 1990 12.04 11.52 (932) (1052) (1984) (11.97) (10.77) Deaths from certain causes s- Category 1950 1960 1961 1962 1963 1964 1965 1966 1967 Tuberculosis, respiratory 39 9 12 5 3 8 8 7 9 Cancer, Uterus, 11 17 16 10 17 12 15 18 15 Bronchus, Lung 52 83 100 100 103 114 119 121 120 Coronary disease, Angina 291 362 356 381 389 359 379 374 400 Bronchitis 75 82 95 116 135 84 88 94 83 Suicide 15 19 26 31 21 20 14 13 15 Motor vehicle accidents 13 18 14 14 20 22 23 22 23 All other accidents 26 17 23 39 29 20 22 18 26 18 (i) Suicide Male Female Total Suicide rate per 1,000 deaths 8.29 (7.51) 6.83 (5.70) 7.54 (6.55) Total as % of total deaths 0.83 (O.75) 0.68 (0.57) 0.75 (0.65) Rate per 1,000 population 0.09 (0.08) Fifteen persons in the Borough ended their own lives during 1967. 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 : 6 : 1. Applying this range of figures to the Sutton cases, between 90 and 150 people may have attempted to terminate their own lives during the year. (J) Infant Deaths Age Total Legit. Illegit. Total Legit. Illegit. TOTAL Under 1 year of age 19(20) 18(17) 1 (3) 20(20) 16(17) 4 (3) 39(40) Under 4 weeks of age 17(16) 16(15) 1 (1) 12(12) 10( 9) 2 (3) 29(28) Under 1 week of age 15(14) 14(14) 1 (-) 10(10) 8( 7) 2 (3) 25(24) (k) Infant Mortality Rates Infant Total infant deaths per 1,000 total live births 15.84 (16.25) Legitimate infant deaths per 1,000 legitimate live births 14.70 (14.76) Illegitimate infant deaths per 1,000 illegitimate live births 33.34 (37.36) Neo-natal Deaths under four weeks per 1,000 total live births. 11.78 (11.38) Early Neo-natal Deaths under one week per 1,000 live and stillbirths 10.04 ( 9.75) Peri-natal Stillbirths and deaths under one week combined per 1,000 total live and stillbirths 20.88 (22.85) Maternal Number of deaths Nil (Nil) Rate per 1,000 total live and stillbirths Nil (Nil) 19 (l) Births 1st January - 31st December, 1967. LIVE STILL Live Birth Rate per 1,000 Home Population Legit Illegit Total Legit Illegit Total Crude Adjusted by Comparability Factor 1.03 M 1229(1207) M 65 (82) M 1294(1289) M 12(20) M - (-) M 12 (20) F 1084(1097) F 85 (75) F 1169(1172) F 12(12) F 3 (1) F 15 (13) 14.9 (14.84) 15.36 (15.29) 2313(2304) 150(157) 2463(2461) 24(32) 3 (1) 27 (33) 93.9(93.6)% 6.1(6.4)% 100 (100)% 88.9(97.00) 11.1(3.00)% 100(100)% Total live and. still births 2490 (2494) Number of Still Births Males 12 (l8), Females 15 (12), Total 27 (30) Still birth rate per 10.84 (13.23) 1,000 live and still births 20 HOUSING (1) During the year 293 (102) units of accommodation were completed 44 of which were flatlets for elderly folk. (2) 55 (12) 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 1967 there were 2267 (2374)applications on the Council's housing waiting list. (4) 465 (170) families were rehoused and a further 30 (55) were re-accommodated from property required for demolition. (5) There were 4253 (4103) premises under the control of the Borough Council's Housing Committee. A number of properties under the control of other Committees were also let, the majority having been purchased in redevelopment areas. 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 208 (147) cases were referred to the Medical Officer of Health for assessment of priorities on medical grounds. On 31st December, 1967 priorities had been recommended as follows Category I (Priority as soon as suitable accommodation is 44 (53) available) Category II (Priority within the individual points group) 81 (59) Category III (No priority on medical grounds) 83 (35) 21 EPIDEMIOLOGY PART II INDEX Page No. PREVALENCE AND CONTROL OP INFECTIOUS DISEASE 25 IMMUNISATION AND VACCINATION 26 VENEREAL DISEASES 28 MASS RADIOGRAPHY 28 IMMIGRATION 29 (Figures in brackets refer to 1966 figures) 23 25 (a) Infectious Diseases notified during the period 1st January to 31st December, 1967 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 4(20) 2(19) 7(36) 11(23) 2 (7 4(11) - (-) - (-) - (-) - (-) - (1) 1 (1) 13(64) 18(54) Encephalitis - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) Erysipelas - (-) - (-) - (-) - (-) 1 (1) 2(-) - (-) 1 (-) - (-) 1 (-) - (-) - (-) 1 (1) 4 (-) Food Poisoning 9 (1) 5 (3) 1 (1) 1 (-) 4 (2) 4 (3) - (-) - (-) - (-) - (l) - (-) 1 (-) 14 (4) 11 (7) Malaria - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) Measles 697(229) 623(228) 405(203) 388(133) 7 (1) 11 (5) - (-) - (-) - (-) - (-) 1 (5) 2 (2) 1110(438) 1024 (368) Meningococcal - (-) - (-) 1 (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) 1 (-) - (-) Ophthalmia neonatorum - (-) 1 (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) 1 (-) Paratyphoid - (-) - (-) - (-) - (-) - (2) 1 (-) - (-) - (-) - (-) - (-) - (-) - (-) - (2) 1 (-) Pneumonia 2 (-) 2 (-) 1 (3) - (1) 3 (1) 1 (l) 3 (2) 1 (1) 1 (2) 3 (4) 1 (-) - (-) 11 (8) 7 (7) Poliomyelitis - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) Puerperal Pyrexia - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) 66(93) - (-) 66(93) Scarlet Fever 16 (6) 17 (9) 32(16) 31(18) 1 (-) 1 (-) - (-) - (-) - (-) - (-) 1 (-) - (-) 50(22) 49(27) Smallpox - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) Typhoid - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) Tuberculosis (pulmonary) - (-) - (1) 2 (-) - (-) 5(11) 4 (7) 3 (2) - (4) 5 (3) 2 (2) - (1) 1 (-) 15(17) 7(14) Tuberculosis (Non Pulmonary) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) Whooping Cough 20 (7) 21 (2) 14 (8) 11 (3) - (2) - (2) - (-) - (-) - (-) - (-) 1 (-) - (-) 35(17) 32 (7) PREVALENCE AND CONTROL OF INFECTIOUS DISEASE Infectious Disease (a) No serious outbreaks of infectious disease occurred during the year. The number of cases of measles notified was much reduced from last year's figure in accordance with the well recognised bi-annual pattern of major measles epidemics. The introduction of large scale vaccination against measles is strongly advocated and may well be available very shortly. With the ever-increasing availability of travel abroad constant vigilance by General Practitioners, Hospitals and Public Health Authorities is necessary to prevent the undetected importation of infection by holiday makers and others who may be infected in a country where a particular infection is prevalent and return to this country before symptoms become obvious. 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 before travelling abroad. (b) Immunisation and Vaccination - 1st January - 31st December, 1967 Type of Protection Completed Primary Courses Received Reinforcing doses (Booster) Diphtheria/Pertussis/Tetanus/ Poliomyelitis 9 (16) 6 (-) Diphtheria/Pertussis/Tetanus 2846 (2430) 1989 (1905) Diphtheria/Pertussis 1 (1) 2 (1) Diphtheria/Tetanus 116 (99) 2995 (2555) Diphtheria 7 (6) 90 (62) Pertussis - (17) 3 (-) Tetanus 843 (84) 367 (61) Poliomyelitis Salk vaccine 1 (3) 2 (4) Sabin (Oral vaccine) 3719 (2908) 4208 (2151) Smallpox 1809 (2006) 92 (132) 26 The following table shows the percentages immunised. London Borough of Sutton Children born in 1966 Smallpox (Children under 2) (4) Whooping Cough (1) Diphtheria (2) Poliomyelitis (3) 85 (64) 85 (64) 85 (68) 34 (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. There is a welcome increase in the percentage of children under two years of age who had by the end of the year completed immunisation against whooping cough, diphtheria and poliomyelitis. There is also a very considerable increase in the numbers of children who were immunised against tetanus. The need for maintaining a high level of immunisation against these diseases cannot be overstated. Although this involves a slightly unpleasant experience for mothers and children, the consequences of failure are very much more unpleasant and may indeed be fatal. Isolated outbreaks of these diseases continually occur in different parts of the country, reminding us of the constant need to encourage parents to bring their children forward and to accept the immunisations which are offered. The percentage of children vaccinated against smallpox continues to decline. With the increasing mobility of the population the chance of smallpox being introduced into this country grows greater year by year. The World Health Organisation is carrying out programmes aimed towards the elimination of smallpox from countries where it is at present endemic, but until these come to fruition the chance of imported disease remains very real. When a case occurs enormous demands are made for the mass vaccination of contacts and those who have had the foresight to obtain vaccination protection previously are at a very great advantage. Vaccination which is delayed until after infection has occurred decreases in its protective efficiency the later it is given and in an extensive outbreak, which can very easily occur, contacts may be unable to be traced and protected until it is too late to prevent their suffering from the disease. Until a reliable and effective treatment is discovered vaccination remains our most potent weapon in protecting ourselves from an epidemic. I would like to see as many mothers bringing their children forward for vaccination against smallpox as do to obtain protection against the other infectious diseases. 27 (c) Venereal Diseases The following table gives the relevant figures:- New Cases 1967 Croydon Hospital Middlesex Hospital St.Thomas' Hospital St.Bart's Hospital St.Helier Hospital TOTAL Syphilis - Not 1 — 2 3 Gonorrhoea 8 available 2 2 29 41 Other Conditions 34 19 14 242 309 MASS RADIOGRAPHY The number of persons x-rayed by the Mass Radiography Unit during its visit to sites in the Borough was more than doubled when compared with the previous two years. Of the more serious conditions discovered, four men were found to be suffering from Pulmonary Tuberculosis and five men suffering from primary lung cancer. Chest x-ray must always form a part of any screening programme for otherwise healthy people and is an important part of the arrangements which are made for well-person screening in the Borough. I am indebted to the Director of the Unit for the following statistics:— Total x-rayed 11,888 (5,420) Males 5,803 (2,380) Females 6,085 (3,040) 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 thenewly 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 1967 from ports and airports relating to the arrival of immigrants. No. of first successful visits paid during 1967 No. of Pulmonary Tuberculosis notifications received in respect of immigrants during 1967 (a) Commonwealth Countries 1. Carribean 9 (9) 1 (8) - (-) 2. India 9 (9) 7 (5) - (-) 3. Pakistan 1 (2) 1 (1) - (-) 4. Other Asian 2 (1) 1 (1) - (-) 5. African 7 (6) 1 (4) - (-) 6. Other 14 (6) 11 (3) - (-) (b) Non-Commonwealth Countries 1. European 39 (44) 18 (41) - (-) 2. Other 10 (6) 6 (3) - (-) TOTAL 91 (83) 46 (39) - (-) In addition Medical Superintendents at hospitals did 45 (41) follow-ups of immigrants joining hospital staffs. 29 PERSONAL HEALTH SERVICES PART III (NATIONAL HEALTH SERVICE ACT) INDEX Page No. MATERNAL AND CHILD WELFARE 33 THE OBSERVATION AND HANDICAP REGISTER 36 THE WORK OF CHILD WELFARE CENTRES 40 DISTRIBUTION OF WELFARE FOODS 41 THE WORK OF HEALTH VISITORS AND SCHOOL NURSES 41 DOMICILIARY MIDWIFERY AND HOME NURSES 45 DAY NURSERY SERVICE 50 CARE OF THE UNMARRIED MOTHER AND HER CHILD 51 RECUPERATIVE HOLIDAYS 51 DENTAL CARE OF MOTHERS AND YOUNG CHILDREN 52 HOME HELP SERVICE 53 THE CARE OF THE MENTALLY HANDICAPPED 54 SUBNORMALITY 55 CERVICAL CYTOLOGY 57 CHIROPODY SERVICES 58 MEDICO-SOCIAL WORK 59 HEALTH EDUCATION 61 HOME SAFETY 61 (Figures in brackets refer to 1966) 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, opticians 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, 1967 t' (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 3266 (3436) 2515 (2450) Still 41 (39) 26 (32) Total 3307 (3475) 2541 (2482) Of the 2541 (2482) births 452 (523) took place at home and 2089 (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 1967 as adjusted by transferred notifications: PREMATURE LIVE BIRTHS PREMATURE STILL BIRTH Weight at Birth Born in Hospital DIED Born at home or in a Nursing Home DIED Transferred to Hospital on or before the 28th day. Born at home or in a Nursing Home Born in Hosp ital T O T A L Within 24 hrs of birth Between 1 and 7 days Between 7 and 28 days T O T A L Within 24 hrs of birth Between 1 and 7 days Between 7 and 28 days T O T A L Within 24 hrs of birth Between 1 and 7 days Between 7 and 28 days 21b.3ozs. or less 5 3 - 1 - - - - - - - - 1 - (3) (-) (3) (-) (-) (-) (-) (-) (-) (-) (-) (-) (4) (-) over 21b.3ozs. up to & inc. 31b.4ozs. 12 - 6 - - - - - - - - - 2 3 (8) (2) (2) (-) (-) (-) (-) (-) (2) (1) (1) (-) (1) (1) over 3 lb.4 ozs. up to & inc. 4 lb.6ozs. 25 4 1 - - - - - - - — — — 4 (28) (2) (1) (-) (-) (-) (-) (-) (1) (-) (-) (-) (6) (-) over 41b.6ozs. up to & inc. 4 lb.15 ozs. 29 2 1 - - - - - 1 1 - - _ 1 (32) (2) (2) (-) (2) (-) (-) (-) (-) (-) (-) (-) (1) (-) over 4 lb.15 ozs up to & inc. 5 lb.8ozs. 60 - - - 2 - - - 1 - - - _ 1 (59) (-) (-) (-) (8) (-) (-) (-) (5) (-) (1) (-) (3) (-) TOTAL 131 9 8 1 2 — - - 2 1 — — 3 9 (130) (6) (8) (-) (10) (-) (-) (-) (8) (1) (2) (-) (15) (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 2515 (2450) 2380 (2302) 135 (148) Deaths among live births in the first month of life 29 (28) 10 (11) 19 (17) Still births 26 (32) 14 (16) 12 (16) 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. 1966 1967 Total children born with abnormalities 75 85 Number of those who were stillborn 5 1 Number of those bom alive who died within ten days 8 7 Number born with Serious defects 34 25 Number which were of a comparatively minor nature 41 60 * The Ministry of Health's definition of a premature birth is one when the infant at birth weighs 5l½ lbs or less. 35 THE OBSERVATION AND HANDICAP REGISTER In recent years it has been increasingly recognised that many of the children who need special educational consideration in school 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 childhood. In oder 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. Prom this diagram it can be seen how the register is compiled. 36 THE OBSERVATION AND HANDICAP REGISTER TABLE I Number of cases on Register Year of Birth TOTAL 1962 1963 1964 1965 1966 1967 As at 31.12.67 - 102 87 98 140 149 576 As at 31.12.66 46 93 78 90 126 - 433 TABLE 2 Number of cases with severe or multiple handicaps As at YEAR OP BIRTH TOTAL 1962 1963 1964 1965 1966 1967 Number of Severely 31.12.67 4 7 3 8 10 32 Handicapped Children 31.12.66 5 1 2 3 0 - 11 Number of Children 31.12.67 — 13 17 10 7 16 63 with Multiple Defects 31.12.66 11 3 8 2 2 - 26 Number of Children in whom the defect 31.12.67 - 12 8 8 11 3 42 developed later (Symptomatic Cases) 31.12.66 5 11 5 5 10 36 37 TABLE 3 The Handicapped Pre-School Child This table shows the number of children with each type of defect born in each of the last five years, but as some children have more than one defect the sum total of defects is not the same as the total number of cases on the Register. The figures given in this table include the cases shown in Table 2. YEAR OP BIRTH Handicap or Defect 1963 1964 1965 1966 1967 TOTAL DEFECTS OP EAR OR FACE including: absence of pinna or meatus, accessory auricle, bat ear, naevae, skin tags, micrognathia. 1 2 7 9 19 DEFECTS OF MOUTH including: hare lip, cleft palate 1 2 7 7 17 DEFECTS OF ALIMENTARY SYSTEM including: pyloric stenosis, oesophageal atresia, jejunal atresia, imperforate anus, defects of liver, hernia, Hirschsprung's disease 1 3 9 13 26 Osteogenesis Imperfecta 1 1 2 SKELETAL DEFORMITIES including: achondroplasia, chondrodystrophy, dwarfism, arachnodactyly, reduction deformities, Pierre Robin Syndrome 4 1 2 3 10 SYNDACTYLY, POLYDACTYLY 1 1 4 5 11 TALIPES, AND OTHER FOOT DEFORMITIES 4 5 7 14 22 52 CONGENITAL DISLOCATION OF HIP 1 1 5 4 4 15 DEFECTS OF UROGENITAL SYSTEM including: Hypospadias, epispadias, undescended testicles, hydrocele, defects of female genitalia, defects of kidney, ureters, etc. pseudo-hermaphrodi sm. 5 3 7 18 33 MUSCULAR DEFECTS including: spastic, absence of muscles, arthogryphosis. torticollis, hemiplegia 3 1 3 4 11 OTHER MINOR PHYSICAL DEFORMITIES including: pilonidal sinus 1 1 6 4 - 12 38 YEAR OF BIRTH  1963 1964 1965 1966 1967 TOTAL BLINDNESS - MICROPHTHAIMOS, BUPHTHALMOS 1 1 SQUINT 4 11 10 11 4 40 NYSTAGMUS 2 4 6 SEVERE VISION DEFECT, CATARACT 1 1 2 4 DEAFNESS 1 1 PARTIAL HEARING, or HEARING DEFECTS 5 5 3 13 SPEECH DEFECTS 20 16 9 8 53 DISEASES AND DEFECTS OF RESPIRATORY SYSTEM including: Hyaline membrane disease, asthma, chronic bronchitis. 6 2 3 4 15 BLOOD DISORDERS including: Christmas Disease 1 2 6 9 SKIN DISORDERS including: ichthyosis congenita, eczema, large naevae 3 5 6 8 22 METABOLIC DISORDERS including: Fibrocystic disease. 3 5 8 PHENYLKETONURIA 1 1 CARDIAC DEFECTS 6 11 10 11 14 52 OTHERS NEEDING OBSERVATION : for suspected physical defect. 18 16 28 30 37 129 MENTAL RETARDATION 4 5 4 1 14 MICROCEPHALY 1 1 2 EPILEPSY, OR SEVERE CONVULSIONS 1 2 4 7 MONGOLISM 2 1 2 5 SPINA BIFIDA,HYDROCEPHALUS 2 4 5 5 6 22 OTHERS NEEDING OBSERVATION FOR MENTAL RETARDATION AND OTHER C.N.S. LESIONS 7 8 5 7 3 30 Number of babies born in 1967 who were reported "At Risk" 1,015 " " " " 1566 " " " " " 922 Total number of children "At Risk" at end of 1967 2,909 " " " " " " " " " 1966 2,122 39 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. 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 has been possible to gradually extend this service and it is the intention to provide 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. A purpose-built Centre at the Roundshaw Estate is included in the Council's Development plan for Health and Welfare Services. The Centre on the Clockhouse Farm Estate which came into use last year is not ideally situated to enable full use to be made of the building for clinic purposes, serving as it does a comparatively small area of the Borough, having been planned and built prior to the re-organisation of London Government. It has, however, been possible to allow the use of the premises by a Play Group which adds considerably to the amenities of the locality. Child Welfare Centres Number of children who attended during period 1st January to 31st December 1967 First attendances No. of Sessions held by Born in Total Total Attendances Asst. G.P's Total Medical employ No.of Officers -ed on Sess session -ions -al basis No. of Children referred elsewhere for consultant advice No. of Children on "At Risk" register at end of year 1967 1966 1962 - 65 2327 1973 4208 8508 52703 1107 143 1250 114 2909 (2241) (1697) (2864) (6802) (57445) (1124) (119) (1243) (108) (2122) ARTE NATAL CLINICS 1030 Ante-natal clinics and 45 post-natal were held in the major centres in the Borough during the year. 40 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. Issues to beneficiaries, 1st January to 31st December, 1967 National Dried Milk (tins) Cod Liver Oil (bottles) Orange Juice (bottles) A & D Tablets (Packets) 16450 (22096) 2012 (2435) 42709 (47835) 3276 (3271) 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 HEALTH VISITING Care of Mothers and Young Children Health Visitors carry out a programme of home visits, hearing screening tests, consultations at clinics and group discussions with parents, which is followed until the child reaches the age of five years. The visiting service extends each year to include groups involving the whole family. The following tables show the extent of their work. 1. Clinic Sessions Ante-Natal and Post-Natal 182 Infant Welfare and Toddlers examination 1250 Mothercraft 328 Parentcraft 38 Health Education 54 Hearing Tests 232 41 2. The case load for children aged 0-5 years 0-1 1 - 5 0-5 Families 1965 1966 1967 1965 1966 1967 1965 1966 1967 1965 1966 1967 TOTAL 2513 2370 2354 8561 8262 8936 11074 10632 11290 79 8 2 8486 8312 Average case load for staff in Post (22) 150 139 1017 503 486 406 651 625 513 470 499 378 The ratio of Health Visitors to population as advised by a Ministry of Health working party reporting in 1961 is 1 - 4300 We have worked towards this by the increase of establishment by one Health Visitor each year since the Borough was formed. Our present ratio is now 1 - 6,600. Home Visits Children 0-5 Persons over 65 Mentally disordered Persons discharged from Hosp. Expectant Mothers Handicapped Persons School Children Illness Subnormal 11095 929 21 101 9 1080 39 289 Miscellaneous T.B. Other Other chest 128 659 202 Research and Screening Procedures Research continues in the Borough with continuous surveys of children born with Spina Bifida, other congenital malformations and mongolism. Three of the screening procedures now in operation in this borough are directed towards the early detection of abnormalities of speech and mental development of the infant. At eight months of age the baby has a hearing test and this is repeated annually. Children who fail to pass the initial screening are referred for further investigation by Medical Officers. Should hearing be considered to be impaired, special treatment and education is commenced immediately to give the baby every opportunity to develop normal speech. One form of progressive mental retardation is caused by an abnormality in the metabolism of the child which can be controlled by a special diet. This condition must be diagnosed at once if brain damage is to be minimised. Screening tests of hearing Retests Referred to Audiologist Referred to E.N.T.Dept. Referred to Partially Hearing Unit 0-2 yrs 1693 66 24 1 2-5 yrs 80 13 1 Guthrie Tests - 260. P.K.Tests - 2500. Referred to Hospital - Nil 42 The Welfare Centres The work of the welfare centres has steadily increased since the Borough was inaugurated in 1965. The preventive services for ante-natal and nursing mothers, pre-school and school children and elderly people continue to expand. I give below the figures for the year, of sessions held at Shotfield Clinic alone, one of the eight permanent centres. Clinic No. of Sessions Ante-natal and cytology 52 Mothercraft and Relaxation 102 Parentcraft 17 Mothers' Club 26 Infant Welfare 104 Toddler 52 Screening tests of hearing for infants 25 Eye clinics 28 General medical clinics for school children 51 Immunisation 52 Physiotherapy and ultra-violet light 153 Chiropody 45 Dental 447 Adult medicals 55 1227 Toddler Clinics An appointment is sent to every mother for a periodic medical assessment of the child by a medical officer. A careful assessment of mental and physical development is carried out at these examinations and parents very much appreciate the opportunity to discuss their problems with medical officers and health visitors. The Mothers' Clubs are flourishing sessions held in welfare centres and organised initially by health visitors who encourage the mothers to form their own committees and arrange their own programmes. The range of subjects covered at these meetings is extensive, and the interests are wide. Speakers and films dealing with medical subjects, home making, intellectual and philosophical matters are all eagerly welcomed. Apart from the opportunity for effective education in health matters, these groups provide opportunity to encourage continued interest in matters other than those immediately connected with the home. The present day pattern of life takes many women out of the home and places them squarely in a professional, commercial or artistic environment of their choice. The advent of a family today is often a temporary phase when the mother spends her time at home with the children before returning to fields where her earning talents or other interests lie. This period at home with a small infant can be strange and lonely. Frequently her own mother and her friends and relations are all working. Opportunities for talking to others are limited and interest may be confined to household chores and the feeding and bathing of the baby. The gregarious world she lived in prior to her pregnancy may have ill-prepared her for a domestic life, and she may become at risk of psychological illness and disturbed personal relationships. The welfare centre with activities such as these clubs provides an opportunity to meet other women with similar 43 problems and together to create a pattern of living which is acceptable to them during these domestic years. Care of the Elderly and Handicapped The special geriatric health visitor continues to act as a liaison between the Geriatric Unit at St.Helier, Sutton General and Wandle Valley Hospitals and the work of the health visitors in the field. Special emphasis is placed on prevention of breakdown of families who care for the elderly and handicapped. Every effort is made to give support to caring relatives and special observation is made of the health of an unmarried daughter, son or spouse who may be themselves past middle age and on whom the responsibility of handicapped relative may lie heavily Advisory Clinics for the Elderly This service was commenced at Rochester Road; in the autumn and together with those held at Rochester Road, Green Wry the Lane and Priory Crescent, has gone from strength to strength. Altogether 137 elderly persons were seen at least once and a health assessment made by the health visitors. Talks on a variety of subjects from qualified people such as the Fire Prevention Officer, an expert from Elizabeth Arden, Constance Spry, the Electricity Board's Cooking Department, the Ministry of Social Security and special music and movement exercises have encouraged regular attendances. A club atmosphere has grown up, making weekly sessions a real event in their lives, with not only companionship but positive preventive medicine and stimulating continued intellectual interest. School Health School Nurses continue to assist health visitors with the care of the school child and the work is carried out in schools, clinics and in the homes. Health Education is a developing service and health visitors are taking every opportunity to give talks in school where Head Teachers are making class periods available for this purpose. Health Education R.M.I. Pre Med Hygiene Immunisation Gen.Meds. in Clinics Misc. 14 353 133 47 217 267 30 Chest Clinic Two health visitors continue to work at the chest clinic at St.Helier Hospital and they find the work expands increasingly to include nontuberculosis chest conditions. Patients with chronic bronchitis and their families are in constant need of support and supervision. Terminal cases of malignant disease of the chest call for the skill and tact of trained health visitors to ease the heavy burdens of grief and despair and the social problems that the death of a wage earner or a mother will bring. The follow up of infectious cases and the prevention of the spread of tuberculosis continues to be of great importance. This involves teaching those in close contact with sources of infection the need for good and healthy daily living, regular screening procedures, hygienic precautions and regular medical attention. 44 New Staff Five of the student health visitors trained by us in 1966/67 passed their examination and were welcomed into the health visiting service of the borough. It is good for the service to have a transfusion of fresh young blood from time to time and the enthusiasm and new ideas that this brings. Two student health visitors are being sponsored by the borough for the 1967/68 course and they have been awarded placed at the Ewell Technical College. One health visitor took the Field Work Instructors' Day Release Course at Bedford College and will be available for the training of students next year. One health visitor attended a refresher course at Leeds and another attended at Bedford College. Refresher courses are taken by all health visiting staff every five years. DOMICILIARY MIDWIFERY AND HOKE NURSING Staff as on 31st December, 1967 Full-time 33 (35) Part-time 21 (l7) Vacancies Full-time 5 (7) Part-time Nil (Nil) The difficulty of maintaining a fully staffed Nursing and Midwifery Service continues in the face of ever-increasing demands on the service. Although the number of home confinements continues its downward trend an increasing number of early discharges from hospital results in a net increase in the work of midwives. In last year's Annual Report attention was drawn to the increasing numbers of patients being discharged from hospital to the care of the community services. This trend continues and is associated with degrees of disability requiring many more visits and nursing of greater intensity and skill. The number of visits made by home nurses has increased since 1966 by 9703 and since 1965 by 14168. These circumstances have placed a heavy burden on a service which has never been fully staffed. The demands have been met with a devotion to duty which is remarkable and which it is doubtful could be paralleled in any other sphere of work. The rapid development of nursing and medical techniques commensurate with advancing knowledge necessitates a considerable amount of in-service training and the training of students and pupils for National examinations continues. During the year the Nurses Homes at 57 Montagu Gardens, Wallington and 64 North Street, Carshalton, were closed and the two were combined at a home at 8 Stanley Park Road, Wallington. This produced some difficulties which will continue until the extensions and improvements in the new premises which have been approved by the Council and included in the 10-year Development Plan can be achieved. These are urgently required and it is confidently expected that when the Development Plan is complete the Service will run more efficiently and enable nurses and midwives to make the best use of their available time by reducing the amount of travelling time and increasing the co-ordination of services in different parts of the Borough. It is hoped by this means that their burden will be lessened and it is vital to achieve the total re-organisation as soon as possible to enable us to meet the ever-increasing demands which are made upon us. 45 During the year 3 midwives and 6 district nurses attended refresher courses, the Deputy Superintendent of Home Nurses and Midwives attended a short course on management and 2 district nurses attended a practical work instructor's course. 7 student district nurses completed their training and all passed their qualifying examination. 33 pupil midwives undertook their three months training within the Borough and 125 student nurses from hospitals were provided with opportunity for observation visits together with 20 nurses who were doing obstetric nurse training. HOME NURSING (a) Total number of persons nursed during period 1st January - 31st December 1967 2902 (2849) (b) Number of persons aged under 5 at first visit during period 1st January - 31st December 1967 59 (54) (c) Number of persons aged 65 or over at first visit during period 1st January - 31st December 1967 1955 (1862) (a) Midwives booked cases transferred to hospital during confinement Of the cases booked for home delivery 28 (30) or 5.5% (5.9%) were transferred to hospital during pregnancy and 29 (23) or 5.6% (4.6%) during labour. The following table analyses the reasons for these emergency admissions:- (1) In Labour (2) In Pregnancy Intra-uterine foetal death 1 Ante-partum haemorrhage 2 (5) Antepartum haemorrhage 3 (1) Post maturity 12 (8) Mal presentation - (2) High head at 39 weeks 1 (3) Foetal distress 1 (3) Mal presentation 3 *Inertia 14 (9) Twins 2 Toxaemia - (-) Unstable lie 1 (1) Prematurity 3 (4) Placenta praevia 1 Retained placenta 1 (1) Pre-eclamptic toxaemia 3 (9) Early rupture membrane 2 (2) Pyelitis 1 Psychiatric reasons 1 (1) Sterilization 1 Post partum haemorrhage 3 (-) Psychiatric reasons 1 29(23) 28 (26) * 1st stage 9 * 2nd stage 5 46 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 125 326 1 452 355 (178) (317) (4) (499) (289) (b) The 2902 (2849) patients attended by home nurses between 1st Januaiy and 31st December, 1967 required nursing at home for the following reasons Heart Disease 203 (237) Circulatory Diseases (including Cerebral 319 (308) Haemorrhage and Thrombosis Diseases of the Blood (including Anaemia,Leukaemia) 338 (338) Diseases of the Central Nervous System 122 (126) Influenza 8 (22) Diabetes 78 (66) Scalds and Burns 14 (12) Other injuries 45 (44) Varicose ulcers 135 (102) Rheumatic and Arthritic Conditions 248 (239) Chest Conditions, Medical 242 (238) Chest Conditions, Surgical 26 (23) Abdominal Conditions, Medical (including Enemas 224 (247) and rectal wash-out) Abdominal Conditions, Surgical 117 (130) Gynaecological, Medical 90 (102) Gynaecological, Surgical 28 (27) Urinary, Medical 51 (38) Urinary, Surgical 41 (35) Breast Conditions, Medical 31 (25) Breast Conditions, Surgical 37 (35) Skin Diseases, Medical 37 (30) Skin Diseases, Surgical 11 (14) Ear, Nose and Throat, Medical 61 (54) Ear, Nose and Throat, Surgical 8 (6) Orthopaedic, Medical 57 (42) Orthopaedic, Surgical 42 (39) Eye Conditions 20 (15) Pedicures j 4 (7) Diagnostic Preparations 7 (lO) Miscarriages 12 (7) Threatened Miscarriages 8 (15) Others ' 228 (204) Tuberculosis 10 (12) (c) Refresher Courses for Midwives,. District Nurses and Pupil Midwives During 1967 3 midwives and 6 district nurses attended a refresher course. The Deputy Superintendent of Home Nurses and Midwives attended a short course on Management and 2 district nurses attended a Practical Work Instructors Course. District Nurse Training During 1967 7 (6) student district nurses completed their training and all passed the examination. Pupil Midwifery Training 33 (35) pupil midwives undertook 3 months of their second period of training with the Borough. In addition the district nurses and midwives took student nurses from hospitals for observation visits. 125 (150) of these students were from general hospitals and children's hospitals. 20 (l8) were nurses doing obstetric nurse training. - 47 - (d) During the calendar year 1966, home nurses made a total of 128,440 (ll8,737) visits as follows :- Ante-Natal Midwifery General Nursing TOTAL 7166 (5567) 9991 (11236) 111283 (101934) 128440 (118737) Of the 2902 (2849) general patients visited, between 1st January and 31st December 1967, 67.36$ (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. 103 (89) State Certified Midwives gave notice of their intention to practise as midwives in the Borough during the calendar year 1967. (f) Summoning of Medical Aid During the period 1st January to 31st December 1967 medical aid was summoned under the Midwives Act, 1951 by midwives in the following number of cases s- (i) For-domiciliary cases :- (a) Where the medical practitioner had arranged to provide ... 119 the patient with maternity medical services under the (99) National Health Service (b) Others 1 (1) (ii) For cases in institutions 421 (322) (g) Ophthalmia Neonatorum Between 1st January and 31st December 1967 midwives sought medical aid for suspected cases of Ophthalmia Neonatorum in respect of 16 (9) babies. No cases were notified by midwives. (h) Notification from Midwives During the period 1st January to 31st December 1967 the following notifications were received from midwives :- Sending for medical aid Stillbirths Liability to be a source of infection (inc.pyrexia) Death of mother or baby 541 (422) 7 (4) 10 (8) - (-) - 48 - (i) Special Investigations The non-medical Supervisor of Midwives undertook the following special investigations during 1st January to 31st December, 1967. Sending for medical aid (all were concerned with 16 (9) conditions of babies® eyes. Stillbirths 7 (4) Liability to be a source of infection (incl.pyrexia) 10 (8) Death of mother or baby 1 (-) (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 1967. (l) Puerperal Pyrexia During the period 1st January to 31st December 1967 66 (93) cases of puerperal pyrexia were reported presenting an attack rate of 25.97 (21.1) per 1000 live and still births. (m) The following table shows the work undertaken at the Ante-Natal and PostNatal Clinics during 1967 No. of Sessions held by Medical Midwives Officers No. of women in attendance No. of attendances Total No. of Sessions For A.N Exam. .For P.N. Exam. M.O. Sessions Midwife Sessions Total Attendances 260 (293) 288 (288) 1030 (1030) 45 (37) 1052 (1421) 2439 (2848) 3491 (4269) 548 (581) (n) Ante-Natal, Mothercraft and Relaxation Classes Number of women who attended during 1967:- Institut- ional booked Domiciliary Booked Total Total No. of Attendances during year 422 (434) 85 (41) 507 (475) 2409 (2270) - 49 - 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 This important service for incontinent patients continued to operate under the administration of the Health and Welfare Department during 1967- The figures show an increased demand for service during the year and it is gratifying to know that some additional degree of comfort is being afforded to patients in their own homes who are unfortunate enough to be in need of such personal help. The following information gives the numbers of patients served Total during year On books at end of year London Borough of Sutton 98 (77) 35 (33) London Borough of Merton 145 (124) 54 (48) Borough of Epsom and Ewe11 1 (1) - (1) Total 244 (202) 89 (82) Number of weekly deliveries 111 (104) 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 9 (lO) children normally resident attended the nursery in Middleton Road by arrangement with the London Borough of Merton and 4(3) children attended nurseries in other Boroughs. 6 (4) 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 35-41 (30.44). Children attending the nursery are medically examined at six monthly intervals and medical officers and health visitors pay frequent visits. - 50 - CARE OF TEE UNMARRIED MOTHER AND HER CHILD In making provision for the residential care of the unmarried mother and her child the Council rely mainly on voluntary organisations. There is an active Moral Welfare Association in Sutton which runs an 18 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, 1967 was 22 (l8) and the number recommended for placement elsewhere was 14 (25) • Ten of these cases accepted the recommendation. 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 address of Home Provided by s "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 61 (69) 9 (9) 42 days Post-Natal 1 (-) 8 (8) 42 " Shelter - (-) - (-) - Total 62 (69) 17 (17) 84 days Number of Cots 9 Number of cases included above for which Authority accepted financial responsibility 22 (18) RECUPERATIVE HOLIDAYS Adults and children recommended on medical grounds for recuperative holidays are sent to convalescent and holiday homes. During the year one child under the age of five years, 32(21) school children and 42 (33) adults were sent for recuperative holidays. Patients, excluding school children and those receiving social security benefit are assessed to pay a contribution towards the cost of their maintenance. - 51 - DENTAL CARE OF MOTHERS AND YOUNG CHILDREN Mothers are encouraged to bring their children for dental inspection when they attend the Toddlers Clinics which are now held at all the main Centres. In addition, expectant and nursing mothers and young children under 5 years can obtain dental inspection and treatment at the Council's dental surgeries. Dental inspection and where necessary, treatment, carried out before the age of 5 years is an important measure in preventive dentistry leading to the early diagnosis of dental defects usually before extensive fillings or extractions are necessary. At this time also advice can be given on diet and oral hygiene and the importance of regular dental inspections is stressed. In a survey in the Borough of 1,516 five year old children 673 had already had some form of dental treatment before the time of their first school dental inspection and 506 had sound teeth. The numbers of children being brought for inspection and treatment before they are five years of age is gradually increasing, although the number of expectant and nursing mothers attending the Council's clinics is low. Many of these, however, obtain their treatment privately. The following table gives details of work undertaken during 1967: Attendances and Treatment Expectant and Nursing Mothers Children Under 5 Inspection 50 726 No.found to require treatment 43 313 No. offered treatment 43 290 Re-inspection 8 180 No. found to require treatment 6 92 First Visits for Treatment 58 385 Subsequent visits 111 621 Total visits 169 1006 Additional courses of Treatment 8 58 Fillings 137 999 No. of Teeth filled 110 878 Extractions 26 136 General Anaesthetics 11 62 Emergency Visits 10 51 Patients X-rayed 14 4 Scalings 21 23 Teeth otherwise conserved 3 160 Teeth root filled - - Crowns 1 - Inlays 1 - No. of Dentures supplied 10 - Courses of Treatment completed 59 330 Sessions devoted to Inspection and Treatment 19«85 167.6 " 52 - 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. 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 than they are. heavier than 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 865 (843) 69.93$ (71$) 118 (48) 3 (3) 146 (162 11.81$ (13$) 108 (135) 1237 (1191) Number of Home Helps (a) Whole time 9 (9) 31.t December 1967 (b) Part time 88 (g2) (c) Whole time equivalent of (b) 49.8 (45.2) (d) Total 58.8 (54.2) 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. 9 (13) cases were being helped in this way in 1967. - 53 - THS CARE OF THE MENTALLY HANDICAPPED Mental Illness During the year 351 referrals were received from various sources. Of this number 141 patients required in-patient treatment in Psychiatric Hospitals, 37 being admitted on an informal basis and 104 under statutory procedures. Within the total number of referrals received, 162 were specifically referred for community care and at 31st December, 1967> 79 patients were being supported in the community. 5 patients have been placed in voluntary homes or hostels outside the Borough for varying periods during the year and at 31st December, 1967 4 were still in residence. A large number of inquiries and interviews connected with mental illness and mental sub-normality are received by all sections of the department and the sum total of the Borough's services in support of the mentally ill far exceeds the statistics recorded above. Hostel Gower House Hostel which opened in April 1966 continues to play an important part in the domiciliary re-settlement of psychiatric patients. During the year a reasonable turnover of patients was experienced resulting in 10 admissions and 12 discharges. It is gratifying to note that only two patients needed to be returned to Psychiatric Hospitals for further treatment during the year. At 31st December, 1967 11 persons were in residence at Gower House. Boarding-Out Scheme The Boarding-Out Scheme launched during Mental Health Week, 1967 was widely publicised through the medium of the press and posters. The response to an appeal for land-ladies wishing to participate in the scheme was very disappointing, only two single flatlets being offered. Two residents from the Hostel were placed in the flatlets at the beginning of December. The Boarding-Out Scheme offers a guaranteed weekly rent for accommodation with a retaining fee for any period when this is not required. Social Club The Social Club run by the Sutton Association for Mental Health continues to function every Tuesday at the Day Centre, 77 Woodcote Road, Wallington from 8.00 p.m. - 10.00 p.m. and the Senior Mental Welfare Officer and other Mental Welfare Officers attend on a rota basis. The Club, which offers a varied programme, is popular and averages a weekly attendance of 24 members and helpers. Participation in social activities makes an important contribution to the rehabilitation of mentally handicapped persons many of whom feel unable to make the necessary effort on their own in an environment which they find to be strange and lacking in understanding of their difficulties. The warmth of welcome they receive at the club together with the support and encouragement of the voluntary woricers and professional staff provides them with a means of overcoming their handicap. - 54 - Sub-normality On 31st December 1967, 102 Sub-normal children and adults were receiving day training at various training centres within and outside the Borough as follows »- ' Sutton Training Centre 28 children Korden Junior Training Centre(London Borough of Merton) 11 " Banstead Adult Training Centre (Surrey County Council) 54 adults Caterham Training Centre (Surrey County Council) 2 " & 1 child Waylands Centre (London Borough of Croydon) 1 " Bensham Training Centre (London Borough of Croydon) 1 " South Side Home (Queen Mary's Hospital, Carshalton) 1 " Croydon Spastic Work Centre 1 " Croydon Spastic Children's Centre 2 children We are grateful to the neighbouring authorities who have made placements available for these sub-normal children and adults. 13 sub-normal children and adults were maintained in residential establishments for care and training, or received special day training during the year, and at 31st December, 1967, the position was as follows 2 female children resident at the Society of St.Bernadette 1 " child daily attending the Society of St.Bernadette 3 male children resident at Roffey Place, Faygate 1 M adult resident at Ravenswood Foundation, Copthorne 1 female adult resident under Guardianship Society, Hove 1 " child resident Sons of Divine Providence 1 " child daily attending the Link Education Trust School 1 " adult resident St.Mary's Convent, Roehampton 1 " " " St.Mary's, Buxted 1 male child resident Meldreth Training School for Spastics. 6 applications were received for short-term care to enable parents to have a holiday or because of a family crisis, and with the co-operation of The Manor Hospital and Queen Mary's Hospital, all were admitted for periods ranging from two to eight weeks. 3 sub-noimal children and adults were received into permanent residential care during the year ending 31st December, 1967. The Mental Health Section has responsibility for supporting all sub-normal persons over five years of age in the community, and during the year 227 families received support from visits by Mental Welfare Officers. Holiday arrangements for the adults attending Banstead Training Centre were made by Surrey County Council as in previous years. Four of our children under 16 years of age were able to join Surrey parties and we are grateful to our colleagues for their assistance. Training Centres The Council's plan for re-building the Junior Training Centre on its present site at Robin Hood Lane has been welcomed by parents and members of the staff who are at present working in unsatisfactory premises. Unfortunately to enable the re-building to take place, temporary premises have had to be provided which can of necessity be only adequate to meet the need. Handicapped children need the best facilities which can be provided if they are to obtain maximum benefit from their attendance while the exacting and patient woik of the teachers and their assistants merits the kind of building which is now being planned. - 55 - They, together with other professional workers are working with their architectural colleagues in planning the new building and their help is much appreciated. Arrangements for attendance of adults at the Surrey County Council Centre at Banstead continue to work satisfactorily. General For emergency rota duty of Mental Welfare Officers outside normal office hours at night and weekends, the link established with the neighbouring Borough of Merton has been maintained and continues to be effective. An average of three calls per week are received which necessitate the Mental Welfare Officers taking action to admit mentally ill patients to Psychiatric Hospitals. - 56 - CERVICAL CYTOLOGY During the year the scheme for cervical screening for the detection of precancerous changes was continued. The number of smears dealt with per week was increased from 24 to 30. These examinations were carried out at the six major Health Centres in the Borough and, as before all applicants had first to obtain the consent of their General Practitioner before the smear was taken. The General Practitioner was subsequently notified of the result. In each case complete pelvic examination and breast examination, urine testing and blood pressure recording was routinely carried out. There were no changes in the types of cases who qualified for cervical cytology which are as follows (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. The total number of women who had one or more cervical smears taken in 1967 was 1,098 (228). The number of cases having smears taken for the first time 815. The number of repeat smears - 283. Classification of smears Class I 346 Class II 730 Class III 7 Class IV 2 Class V 0 Breast lesions were found in four cases, all of whom were referred to their general practitioners. The Social classes from which the cases originated were as follows Social Class I 15$ Social Class IV 4$ Social Class II 26$ Social Class V less than 1$ Social Class III 49$ Classification of defects As a result of the pelvic screening already mentioned the following defects were found 5- No apparent defect 833 Cervicitis 48 Erosions 114 Fibroid 14 Polyp 22 Bulky uterus 8 Trichomas 5 Prolapse 20 Breast defects 4 Others 30 TOTAL 1,098 Number of women referred to their family doctor for treatment 116. Of the 9 Class III and IV smears taken in 1967* 4 were under 35 years of age. - 57 - CHIROPODY SERVICES ! The Chiropody Scheme developed during the year by increasing the number of treatments carried out in clinics and other centres thus enabling the service to progress towards greater efficiency and economy. This is an important factor in a service for which by natural progression more and more people become eligible. The following groups were eligible for treatment (i) Elderly persons, i.e. persons of pensionable age, receiving retirement pensions. (ii) Handicapped persons including registered blind and partially sighted, and (iii) Expectant mothers. 2641 (2l8l) patients received treatment during 1967 of whom 185 (142) were handicapped persons, 33 (36) were blind persons and 2423 (2011) were elderly persons. The total number of treatments given under the scheme was 12,367 (12,256) of which 2925 (4029) were given by private chiropodists in their surgeries, 4498 (3377) were given at clinics and other fixed centres and 1045 (892) were given in residential homes for elderly persons including the two Local Authority establishments, Maiden Homes and "Brambleacres". 3899 (3958) treatments were given at the patient's own home. - 58 - MEDICO-SOCIAL WORK (l) Prevention of Break-up of Families The close association between ill-health and social need has been recognised increasingly over the last 50 years. This has led to the development of closely inter-related health and social services. Social workers, working closely with their colleagues in other departments of the Council and in hospitals, give valuable support to families handicapped by ill-health. The ramifications of social need are, however, multiple and not always brought to light by known ill-health. A most valuable contribution has been made by regular meetings ) of the Co-ordinating Committee in connection with cases of rent arrears which has been in operation since the Borough was formed. At these meetings representatives of the Town Clerk's, Children"s, Housing and Health and Welfare Departments as well as on occasion Probation Officers, N.S.P.C.C. Inspectors and Voluntary Bodies have the opportunity to consider the total situation in each case and to decide upon appropriate action of which all are aware. Many cases of rent arrears have been investigated by the Social Work Team and there is no doubt of the effectiveness of this system in preventing possible cases of homelessness which would otherwise have arisen. In many cases rent arrears have been successfully reduced or eliminated and the risk of eviction prevented. By this means from many sources early information concerning families who may be in health or social need is obtained, examined and acted upon, an "early warning" system which is capable of extension in the future. No children have been received into care in this Borough as a result of eviction proceedings instigated by the Council and no family has been made hemeless through the Council's action. In some cases, when rent arrears have been intolerable,Temporary Accommodation has had to be provided wherein continuous efforts towards rehabilitation have been pursued. The Council has encouraged rehabilitation by its policy of re-housing families from temporary accommodation when they have demonstrated their ability to respond to this treatment. A progressive policy such as this is bound to have its occasional failure but it has been fully justified by the cases treated with success. Much has been done to prevent the effects of homelessness on growing families who lack the means to support themselves either because of low-earning ability, ill-health or in some few cases fecklessness and wilful failure to co-operate. The Borough can be proud of the progress it has made in this direction since its inception, and although complacency is not justified and much yet remains to be done it is right to record these achievements in the face of a picture of heartless, unco-ordinated and authoritarian action which is sometimes presented and further to record that these results have been achieved by the efforts of a comparatively small staff. The much and often ill-informed publicity attached to the very few cases of failure takes no account of the very much larger number of successes, nor of the many hours of planning, discussion and case work undertaken to help families to help themselves. The close collaboration of other departments, voluntary agencies, statutory undertakings and business organisations is gratefully acknowledged. - 59 - (2) Chest Clinics One Medical Social Worker remains attached to the Chest Clinics at St.Helier Hospital and works, together with two Health Visitors similarly attached, with the Consultant Chest Physicians and the nursing team. This arrangement originated in the days when Chest Clinics were the responsibility of Local Authorities and were dealing in the main with cases of infectious tuberculosis. Although the content of this work has now changed, the majority of patients attending Chest Clinics suffer from chronic illness, in many cases for which there is no cure. Continued social support is necessary for those who can never become fit for normal life such as sufferers from chronic bronchitis, cardiac complaints, tuberculosis and the ever-increasing number of those with cancer of the lung. Many are too ill or breathless to attend at hospital out-patient clinics and receive continuous care through home visiting. 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. 27 (43) such cases were provided with free milk orders during 1967. 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 woiker 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. - 60 - 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 work. 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. There has been very considerable progress in all health education work during the year. This has been most marked in schools and further reference to this aspect of the work is made in the section of this report dealing with the School Health Service. Apart from this there has been a gradual growth based on conventional methods. Talks and discussion groups have been held in clinics and at meetings of voluntary organisations throughout the Borough. Posters and pamphlets have been distributed and films shown. Regular meetings of staff are held at which new materials are demonstrated and health education work generally was stimulated by the appointment of a Deputy Superintendent Health Visitor with special responsibility for this important work. As last year, an anti-smoking clinic was held towards the end of the year organised in association with the British Temperance Society and was attended by approximately 75 people. As an experiment this was followed up by a discussion group to which those attending the main clinic were invited. Some notable success was achieved but for obvious reasons such activities can only cover a comparatively small section of the population. The results were similar to the previous year in that approximately a third of those attending were for the time being able to discontinue the habit and a considerable section of the remainder reported a reduction in the amount smokted.. Health Education is one of the more important aspects of the work of Advisory Centres for the Elderly which are referred to in a previous section of this report. This comparatively new venture is growing but of course reaches only that section of the ageing community who are willing to attend. The lessons learned during the initial period of these Centres will be valuable in planning future expansion. There has been considerable demand for talks on Drug Addiction by Youth Clubs and various other organisations. These have been met by Medical Staff. 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 actB as secretary to the voluntary Home Safety Committees in the Borough. The main Committee met four times and the district committees as follows :- Sutton & Cheam 7 Beddington , Wallington 6 and Carshalton The activities of Home Safety Committees during the year continued on similar lines as previously. - 61 - (1) A Home Safety Course was devised primarily for young people, 5 organisations applied for and took the course, and some 44 young people passed. Certificates of Merit were presented to the successful entrants by The Worshipful the Mayor at a special presentation evening on 27th September, 19^7 at the Town Hall, Wallington0 (2) 90 sets of Poisonous Plants and Fungi Cards were mounted on Boards, one being presented to every school, Infant Welfare Clinic and Children's Library within the Borough, These displays were greatly appreciated by all recipients and many requests were received for duplicates, (3) With the co-operation of the London Fire Brigade an Open Day was held at Fire Stations in the Borough. This again proved to be a most successful activity and the figures for attendance were as follows s- Sutton 1834» Wallington 1100. 4000 handbills were printed and distributed by officers of the Fire Service and information was given out at schools with the co-operation of the Education Department. The attendances were a record and easily the best of all the London Boroughs. With the co-operation of the Fire Brigade, Gas and Electricity Boards, a large display for home fire prevention was erected and manned throughout the day by members of the Home Safety Committees. A film strip on Fire Prevention loaned to the Brigade was on show repeatedly during the day. (4) "Buy for Safety Campaign" This campaign was launched at the Greater London Home Safety Council on 16th September, 1967» Posters were displayed on Public Notice Boards in the Borough. (5) A Home Safety Competition was held as part of the Greater London Home Safety Council "Stop Home Accidents" campaign. 10,000 entry sheets were purchased and distributed to voluntary organisations, youth organisations, old people's clubs, libraries etc. within the Borough. Although a large percentage were returned, we were unfortunate not to qualify for a prize. (6) Home Safety Stands were erected at Queen Mary's Hospital Fete and the Carshalton Carnival. Much interest was shown by the many hundreds of people who visited-these stands. A large quantity of Home Safety literature was distributed. (7) A one-day Conference entitled "Accidents to the Elderly" was held and whilst attendances from organisations was disappointing the attendance by representatives from old people's clubs was good. This function was held at the Public Hall, Wallington and luncheon was supplied to the old people at the Day Centre, Sutton. (8) Lectures given by Home Safety Officer Organisations 24 (13 with films) Home Safety Courses 32 Schools 1 - 62 - Accident Returns 0-1 yrs 1-4 yrs 5-14 yrs 15-24 yrs 25-44 yrs 45-64 65+ yrs yrs Age not stated TOTAL 2 (3) 61 (52) 37 (38) 23 (22) 39 (38) 65 153 (61) (123) 14 (14) 394 (351) 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. - 63 - SCHOOL HEALTH SERVICE PART IV (EDUCATION ACT) INDEX Page No. INTRODUCTION 67 SELECTIVE MEDICAL EXAMINATIONS 68 FINDINGS AT MEDICAL INSPECTION 72 MEDICAL TREATMENT 75 SCHOOL DENTAL SERVICE 76 SPECIAL SERVICES 81 AUDIOLOGY 81 SPEECH THERAPY 8l CHILD GUIDANCE SERVICE 82 INFECTIOUS DISEASE 84 IMMUNISATION AND VACCINATION 84 HANDICAPPED PUPILS AND SPECIAL SCHOOLS 84 EMPLOYMENT OF CHILDREN OF SCHOOL AGE 87 PHYSICAL EDUCATION IN SCHOOLS 87 PROVISION OF MEALS AND MILK 87 HEALTH EDUCATION 88 SCHOOL POPULATION 88 (Figures in brackets refer to 1966) - 65 - SCHOOL HEALTH SERVICE Introduction In the report on the School Health Service for 1966 it was stated that thought was being given to the wisdom of introducing a selective procedure for the medical inspection of school children in place of the previous system whereby children were medically inspected at fixed ages. As the general health of children has progressively improved over the years, the previous function of the service in detecting frank physical and mental disability has changed giving way to greater need for the detection of emotional and behavioural disturbances, speech and language disorders, learning difficulties (including those arising from defective vision and hearing), respiratory disorders particularly asthma, epilepsy and physical handicap from trauma and congenital and hereditary conditions. The responsibility of early detection of conditions present at entry to school and arising during school life to a great extent rests on the School Health Service and it has been felt that this can best be discharged through a process of selection for medical inspection which would involve the participation of parents and teachers as well as doctors, health visitors and school nurses. Additional information obtained in particular cases with the co-operation of family doctors and hospital consultants can then be correlated with any learning, social or health problem and appropriate provision made. Accordingly a report was submitted to the Education Committee in March 1967« This was accepted by the Committee and approved by the Department of Education and Science. It was implemented in September details having been discussed fully with the Chief Education Officer and representatives of the teachers who, together with school medical officers, were able to give considerable assistance in its final form. In outline the scheme is as follows s- (1) At school entry. All children to be medically examined. (2) At ages eight and eleven a questionnaire to be sent to parents to elicit information about conditions which might be missed at school. (3) All school leavers to be medically examined. (4) All children to have an audiometric screening test of their hearing as soon after school entry as possible. (5) All children to have vision tests every two years (to be increased to annual when possible). (6) All children found to have defects either at the entrant or selective examination to be re-examined periodically for as long as necessary. (7) The school doctor and nurse to visit each school at least once in each term to be available to meet the head teacher and class teacherj to observe children at physical education and to carry out medical examinations as appropriate. (8) Medical examination to be carried out on any child at the request of a parent or when referred by a teacher following prior notification to the parent. The questionaire used is reproduced on the following pages - 67 - SECTION I SELECTIVE MEDICAL EXAMINATIONS HFS 315 NAME DATE OP BIRTH ADDRESS SCHOOL PHONE NUMBER FATHER'S OCCUPATION MOTHER'S OCCUPATION 1. How many children have you ? State their christian names and birthdays. Are they all well ? 2. Has any close relative suffered from: Asthma Tuberculosis Diabetes Fits 3. State any illnesses or infectious diseases from which your child has suffered or any chronic condition 4„ Is your child at present attending hospital or your own G.P. or chest Clinic ? Yes/No If yes state the reason 5« Has your child ever been admitted to hospital for any reason ? Yes/No If yes give details below: Illness,Accident or Operation Age at the time Hospital 6o Has your child ever had fainting attacks, black-outs, dizzy spells, Yes/No convulsions, fits, etc ? If yes, give details. 7» Has your child ever had ear trouble or discharging ears, or have you Yes/No ever thought he/she might be deaf ? If yes, please give details. 8. Do you think he/she is overweight/underweight ? Yes/No 9. Is your child a poor eater, or does your child suffer from tummy Yes/No trouble of any kind ? 10. Does your child frequently have a running nose, sore throats or Yes/No catarrh ? 11. Does your child suffer from bronchitis or asthma or wheeziness at Yes/No any time ? 12c Does your child seem easily tired or get unduly short of breath after Yes/No exercise 13. Does your child wear glasses or are you concerned about his eyes ? Yes/No SECTION 2 IMMUNISATION Has your child been vaccinated or immunised against any of the following diseases If so, please srtate when. DATES WHEN IMMUNISED DATE OP BOOSTERS IP ANY 1st 2nd 3rd 1st 2nd 3rd (a) Smallpox (b) Diphtheria (c) Whooping Cough (d) Tetanus (e) Poliomyelitis (f) Measles (g) B.C.G. (Tuberculosis) Arrangements will be made for "boosters" to be given at the appropriate time if you sign the consent form overleaf. - 68 - SECTION I (contd) 14. Does your child have any rashes or suffer from any skin conditions? Yes/No 15. Does your child have flat feet or poor posture ? Yes/No 16. Does your child have any trouble with bones or joints ? Yes/No 17. Does your child wet the bed frequently ? Yes/No 18. Does your child suffer from frequent headaches ? Yes/No 19. Are there any problems connected with your child's speech that Yes/No cause you concern ? 20. Are there any problems connected with your child's behaviour or Yes/No general progress that cause you concern ? 21. Is there any other matter regarding your child's health you would wish to discuss with the doctor ? If so, please give details s 22. Is there anything else you would like the School Doctor to know ? Yes/No 23. State the name and address of your Family Doctor 24. I would like my child to be medically examined whether selected or not.Yes/No I CONSENT TO THIS EXAMINATION IF SELECTED AND SHALL/SHALL NOT BE ATTENDING THE MEDICAL INSPECTION. Date Signature SECTION 2 (contd.) Child's Name (Block letters please) Date of Birth School Home Address Telephone Number A. * Please arrange to have my child immunised or given a booster dose against Diphtheria, Tetanus and Poliomyelitis as required. B. * I will arrange for my Family Doctor to immunise my child. Date Signature Parent or Guardian * Please delete as applicable. - 69 - An explanatory letter is sent to parents with the questionaire s- Dear Sir/faadam, The School Doctor will be visiting the School in the near future to discuss with the Head Teacher the health and development of the pupils generally and to consider which pupils should be medically examined at the next school medical inspection to be held shortly. The purpose of the examination is to ensure as far as possible that every child remains fit and well to benefit from his or her eduoation to the greatest degree and enjoy life to the full. To enable the Doctor to select the children who require medical examination, please complete the attached form and return it to the Head Teacher in the enclosed envelope, (sealed) marked "Confidential. For School Doctor's attention". Arrangements will then be made for the medical examination to be carried out. | If you wish your child to have a medical examination whether selected by the Doctor or not, please indicate your wishes in answering Question 24 on the form<, If your child is selected a notice stating the date and time of the School Doctor® s visit will be sent to you beforehand and I hope it will be convenient for you to attend. The Doctor will be very pleased to see you and discuss any problems which you may have concerning your childo Yours faithfully, P.WESTCOMBE, Principal School Medical Officer. On the back of this letter is printed the following information »- IMMUNISATION Although the number of children contracting Diphtheria over the past few years has continued to fall, it still remains a dangerous disease among young children. Whooping cough continues to be a very distressing disease and is particularly dangerous during the first two years of life. Tetanus (lock-jaw) is a serious disease and in this era of increasing road accidents, protection by immunisation is essential. Polio is still a dreaded and crippling disease and protection against it is so easy now. Valuable protection against these diseases can be given quite easily and every parent is strongly advised to take advantage of the services offered. Most children about to enter school have been protected against Diphtheria, Whooping Cough9 Tetanus and Poliomyelitis as babies. It is important that immunity against Diphtheria, Tetanus and Poliomyelitis should be maintained during school life, and for this reason a single combined booster injection against Diphtheria and Tetanus, and one oral dose of polio vaccine should be given at school or pre-school entry and at about the age of 8 years when a further booster of Diphtheria and Tetanus will be offered. Those children who were not immunised in infancy should have a complete course of protection when they start school, i.e. 3 injections of Diphtheria/Tetanus and 3 oral doses of Poliomyelitis. Arrangements can be made for your child to be immunised, either at the school or at a nearby clinic. You may wish to make your own arrangements for immunisation to be given by your family doctor; if so please indicate so on the form appended0 _ ^ Questionnaires are distributed by Head Teachers and following completion are scrutinised, together with previous medical records, by school doctorso School Medical Officers visit their schools each term to discuss with Head Teachers any pupils causing concern„ Following this, cases for examination are selected, the parents informed and invited to be present. Some anxiety was felt that the questionaire would not be properly completed, but this has not proved to be a serious difficulty., The scheme will be kept under close review and modified where necessary. - 71 - 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, 1967 Age Groups Inspected (by year of birth) No. of Pupils who have rec'd a full medical examination Physical of Pupils Satisfactory No. Condition Inspected Unsatisfactory No. No. of Pupils found not to warrant medical exam- ation Pupils found to require treatment (excluding dental diseases and infestation with vermin For defective vision(exclud -ing squint) For any other condition Total Individual Pupils (1) (2) (3) (4) (5) (6) (7) (8) 1963 & later 205 204 1 - 3 25 28 1962 1620 1614 6 - 75 182 247 (1343) (1341) (2) (50) (163) (189) 1961 452 451 1 - 17 75 89 (485) (484) (1) (16) (84) (92) 1960 100 100 - - 6 15 18 (80) (79) (1) (8) (11) (19) 1959 1352 1351 1 — 125 130 222 (1206) (1205) (1) (93) (128) (207) 1958 434 432 2 - 43 74 104 (336) (335) (1) (34) (65) (85) 1957 71 69 2 - 6 22 25 (107) (107) (-) (17) (41) (40) 1956 132 132 - 229 24 29 45 (757) (754) (3) (105) (151) (199) 1955 377 374 3 104 58 41 71 (462) (460) (2) (55) (86) (124) 1954 207 205 2 - 24 25 36 (112) (112) (-) (8) (18) (23) 1953 99 99 (-) - 19 14 28 (101) (100) (1) (18) (19) (32) 1952 & earlier 298 1298 — — 235 111 315 (1634) (1631) (3) (289) (179) (366) TOTAL 6347 6329 18 333 635 743 1228 (6788) (6773) (15) (700) (972); (1403) - 72 - I Of the 6347 (6788) pupils examined at periodic medical inspections 1228 (1403) pupils (percentage of total 19.35 (20.67) were found to be in need of treatment for 1662 (1859) defects. (a) Special medical inspections and re-inspections There were 1131 (1378) 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 1028 (1053) 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 6347 (6788) children examined at routine medical inspection, the physical condition of only 18 (15) was considered to be unsatisfactory, (0.28%). (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. 7006 (8988) children were examined by the school nurses and 44 (43) individual children were found to be infested during the year. In all cases the parents carried out the appropriate treatment satisfactorily and without delay. - 73 - 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 28 (l6) 48 (70) 73 (89) 149(175) 347 (458) 0 51 (38) 39 (19) 55 (58) 145(115) 1 (24) 5 Eyes-a.Vision T 97 (73) 260(307) 278(320) 635(700) 84 (87) 0 153(111) 39 (46) 150(156) 342(313) 8 (24) b.Squint T 43 (45) 1 (5) 29 (27) 73 (77) 2 (2) 0 15 (18) - (4) 8 (21) 23 (43) 1 (1) c.Other T 8 (3) - (4) 7 (14) 15 (21) 6 (9) 0 5 (7) 2 (2) 6 (6) 13 (15) 2 (1) 6 3ars a.Hearing T 25 (17) 5 (9) 13 (14) 43 (40) 147 (145) 0 56 (64) 11 (8) 43 (44) 110(116) 10 (14) b.Otitis Media f 4 (5) 3 (1) 3 (4) 10 (10) 4 (-) 0 46 (30) 4 (-) 25 (20) 75 (50) - (-) c.Other T 1 (-) 3 (4) 5 (7) 9 (11) 6 (13) 0 8 (15) - (4) 59 (21) 67 (40) - (-) 7 Nose & Throat T 51 (53) 9 (16) 39 (52) 99(121) 18 (31) 0 435(340) 41 (17) 223(219) 699(576) 11 (6) 8. Speech T 59 (44) 5 (13) 40 (27) 104 (84) 26 (15) 0 89 (80) - !3) 14 (17) 103(100) - (4) 9 Lymphatic Glands T 2 (5) - (1) 1 (11) 3 (17) 2 (4) 0 161(155) 5 (2) 55(112) 221(269) - (-) 10. Heart r 4 (4) 3 (-) 9 (4) 16 (8) 4 (3) 0 41 (37) 15 (4) 28 (42 84 (83 4 (- 11 Lungs T 17 (27) 5 (4) 36 (2l) 58 (52) 20 (26) 0 57 (34) 18 (9) 33 (44) 108 (87) 3 (7) 12 Developmental a Hernia T 1 (2) - (-) 5 (3) 6 (5) - (-) 0 4 (6) - (1) 11 (2) 15 (9) - (1) b Other T 9 (8) 2 (-) 18 (20) 29 (28) 6 (4) 0 72 (78) 1 (10) 74 (79 147(167 1 (2 13 Orthopaedic a.Posture T 13 (14) 15 (15) 30 (46) 58 (75) 21 (24) 0 19 (19) 20 (23) 30 (38) 69 (80) - (6) b.Feet m X 30 (36) 11 (17) 47 (52) 88(105) 57 (92) 0 52 96 22 (25) 60 (91) 134(218) - (11) c.Other T 12 (13) 11 (15) 15 (29) 38 (57) 18 (20) 0 24 (37) 20 (27) 35 (37) 79(5-01) 1 (1) 14 Nervous System T 2 (2) 6 (2) 11 (11) 19 (15) 3 (1) a Epilepsy 0 3 (2) - (1) 1 (8) 4 (11) - (1) b.Other T 0 - (3) 8 (4) 2 (2) 1 (4) 1 (3) 10 (14) 3 (8) 19 (22) 2 (2) - (3) 15 Psychological a.Development T 1 (2) 17 (33) 96(130) 114(165) 21 (11) 0 31 (23) 5 (2) 18 (20) 54 (45) 1 (5) b.Stability T 5 (5) 4 (6) 19 (21) 28 (32) 20 (16) 0 81 (83) 14 (5) 74 (64) 169(152) 7 (2) 16 Abdomen T 2 (1) 2 (-) 10 (1) 14 (2) 1 (11) 0 18 (2) 10 (7) 21 (14) 49 (23) - (1) 17 Other T 0 13 (9) 41 (46] 9 (14) 22 (24) 29 (28) 53 (53) 51 (51) 116(123) 295 (304) 11 (15) - 74 - 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 291 (331) pupils were treated for minor ailments excluding skin diseases. There were no cases of ringworm of the scalp or body and 6 (5) cases of scabies„ There were 4 (-) cases of impetigo. Skin diseases treated were mainly verrucae (plantar warts) and tinea pedis (athlete's foot). A total of 352 (440) pupils were treated for skin diseases. (b) Eye diseases, defective vision and squint 1193 (1221) pupils were treated for these defects, 5 (12) for external eye diseases and 1188 (1209) for defective vision including squint. Spectacles were prescribed for 38l(310) pupils. Ophthalmic surgeons carried out sessions at the following clinics in the Borough 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 222 (235) of whom 28 (24) had operative treatment. The total number of pupils in school known to have been fitted with hearing aids was 37 (19), 6 (2) of which were provided during 1967. (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. - 75 - (e) Ultra-violet light treatment Facilities are available for ultra—violet light treatment carried out by physiotherapists at the following clinics s- Robin Hood Lane Clinic, Sutton Shotfield Clinic, Wallington Priory Crescent Clinic, North Cheam. A total of 36 (22) children attended. SCHOOL DENTAL SERVICE I am indebted to the Chief Dental Officer for the following report : On 31st December 1967 the dental officer staff consisted of two full-time and six sessionally employed officers. There were fluctuations in the strength of the staff during the year and for three months the Borough had only one full-time officer. The need for dental treatment varies very little, the percentage of children found to be in need of treatment at the time of their first inspection during the year was 46.6, slightly higher than the previous year, but still comparing favourably with the national average. The number of fillings was higher and extractions lower than in previous years, showing a trend in the right direction. Orthodontic sessions were held at three of the five dental clinics and a total of 513 children are now under the supervision of the Orthodontist. Orthodontic treatment is a lengthy process, and children are often referred to the Orthodontist at an early age for assessment and kept under review for several years before any treatment is commenced. The survey of the teeth of the five year old children commenced in 1966 was continued during the year and the overall picture was very similar. All 25 Infants Schools were included in the survey and the results are listed below 1- Total number of children examined 1516 Percantage with no_ decayed, extracted or filled teeth 33.37% Total number of decayed, extracted or filled teeth 4481 Average d.e.f. per child 2.95 Average number of decayed teeth per child 1.35 Average number of extracted teeth per child .30 Average number of filled teeth per child 1.30 Percentage of children previously treated but dentally 20.18% fit at time of the inspection Percentage of children previously treated but needing 24.21% further treatment Percentage of children not previously treated but now 22.23% needing treatment Percentage of children with a d.e»f. rate of 10 or over 2.3% As in last year"s survey the percentage of children with perfectly sound teeth varied considerably from school to school - separate figures for the schools are listed with other dental statistics on page 77. - 76 - RESULTS OP SURVEY OF THE TEETH OF 5 YEAR OLD CHILDREN School A B C D E F G H 1 48.07 7.69 21.15 23.07 2.0 1.25 .11 .63 2 46.54 9.9 25.75 17.81 2.85 I.64 .37 .83 3 46.42 13.09 20.24 20.24 2.57 1.37 .31 .89 4 45.45 18.18 21.21 15.15 2 .787 • 151 1.06 5 43.39 18.86 18.86 18.86 2.26 1.15 .13 .98 6 42.5 22.5 25 10 2.325 .65 .15 1.525 7 40 13.33 33.33 13.33 3.266 2 .33 .933 8 38 20.6 17.4 23.8 3.15 1.38 .30 1.47 9 37.03 25.92 18.51 18.51 2.88 •93 .37 1.59 10 35.92 26.56 25 12.5 2.73 1.0 .21 1.52 11 35.05 22.68 21.65 20.61 2.58 1.08 .14 1.36 12 34.66 20 28 17.33 2.7 1.25 .25 1.2 13 33.84 18.46 27.69 20 2.75 1.18 .35 1.21 14 33.33 24-24 24.24 18.18 3.3 1.27 .21 1.81 15 30.76 29.23 24.61 15.38 3.43 • 92 .47 2.03 16 30.23 24.41 29.07 16.28 3.03 1.03 .19 1.80 17 29.68 18.75 21.87 29.68 2.73 1.34 .15 1.23 18 28.81 30.51 20.34 20.34 2.83 .73 .15 1.95 19 26.66 16.66 21.11 35.55 3.16 1.81 .32 1.03 20 26.19 21.42 21.42 30.95 2.97 1.64 .26 1.07 21 24.69 12.34 22.22 40.74 2.88 1.96 .28 .64 22 21.81 20 38.18 20 4.23 2 .6 1.63 23 19.69 29.5 27.86 22.95 3.49 1.73 .21 1.54 24 16.66 33.33 16.66 33.33 3.72 1.5 .5 1.72 25 15 21.66 31.66 31.66 4.31 2.05 .83 1.43 (a) Percentage caries free (b) Percentage previously treated now fit (c) Percentage previously treated needing further treatment (d) Percentage not previously treated needing treatment (e) Average d.e.f. rate (f) Average number of decayed teeth per child (g) Average number of extracted teeth per child (h) Average number of filled teeth per child - 77 - School Dental Service, 1st January to 31st December, 1967 1. Attendances and Treatment 5-9 years 10 - 14 years 15 years & over Total First visit 1899 1540 322 3761 (2133) (1448) (306) (3887) Subsequent Visits 2872 2974 630 6476 (2178) (2756) (656) (5590) Total Visits 4771 4514 952 10237 (4311) (4204) (962) (9477) Additional courses of treatment commenced 415 213 55 683 (518) (296) (63) (877) Fillings in permanent teeth 1284 3265 1066 5615 (1198) (2917) (885) (5000) Fillings in deciduous teeth 4684 470 - 5154 (4714) (287) — 5001 Permanent teeth filled 1105 2682 883 4670 (1052) (2518) (737) (4307) Deciduous teeth filled 3863 369 — 4232 (3762 (233) - (3995) Permanent teeth extracted 71 384 67 522 (72) (302) (81) (455) Deciduous teeth extracted 832 251 — 1083 (921) (241) - (1162) General anaesthetics 420 229 21 670 (495) (250) (32) (670) Emergencies 207 63 14 284 (346) (117) (45) (508) Number of Pupils x-rayed 174 (220) Prophylaxis 409 (698) Teeth otherwise conserved 300 (593) Number of teeth root filled 19 (9) Inlays 2 (-) Crowns 12 (10) Courses of treatment completed 3526 (3803) - 78 - 2. Orthodontics Cases remaining from previous year 321 (252) New cases commenced during year 182 (190) Cases completed during year 70 (45) Cases discontinued during year 51 (35) No. of removable appliances fitted 96 (108) No. of filed appliances fitted - (-) Pupils referred to Hospital Consultant 2 (-) 3. Prosthetics Ages 5 - 9 Ages 10 - 14 Ages 15 & over Total Pupils supplied with F.U or F.L. (first time) - (-) - (-) - (-) - (-) Pupils supplied with other dentures (first time) - (1) 1 (4) - (2) 1 (7) Number of dentures supplied 1 (1) 4 (5) 1 (2) 6 (8) 4. Anaesthetics General anaesthetics administered by Dental Officers Nil (Nil) 5. Inspections (a)First inspection at school. No. of Pupils 16790 (17,526) (b)First inspection at clinic. No. of Pupils 1955 (2,324) No. of (a)+(b) found to require treatment 8748 (8,677) No. of (a)+(b) offered treatment 7295 (7,254) (c)Pupils re-inspected at school clinic 1095 (1,505) No. of (c) found to require treatment 808 (1,184) 6. Sessions Sessions devoted to treatment 1551.15 (1588.75) Sessions devoted to inspection 165 (188) Sessions devoted to Dental Health Education 10 (-) - 79 - In July 1967 Pierre the Clown visited the Borough to talk to about 5,000 young children on the care of their teeth. His visit was sponsored by the General Dental Council and the Fruit Producers Council and after hip visit to the school each child received a certificate entitling them to join the Apple Club, together with a badge, a free apple and a painting sheet. The children thoroughly enjoyed his visit and it was pleasing to note how many were able to give correct answers to his questions on the care of the teeth. Talks on the care of the teeth were incorporated into the general health education programme. All children are encouraged to make regular visits to their dentists, but the opportunity for a personal approach at the chairside by dental officers at routine dental inspection still plays a most important part in dental health education. - 80 - 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 1967. 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 much appreciated. 6 (5) new cases were supplied with hearing aids during the year and a total of 37 (47) pupils are registered as having been so fitted. The total number of children seen by the audiometrician was 2095 (1935) of whom 166 (155) were found to have defective hearing of varying degree and referred to the school medical officers for further investigation. (b) Speech Therapy Speech Therapy Clinics were held at Priory Crescent Clinic, North Cheam, Rochester Road, Carshalton, Green Wrythe Lane, Carshalton, Shotfield, Wallington and Robin Hood Lane, 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 treated for speech therapy during 1967 was 220 (148). One of the Speech Therapists carried out 4 sessions weekly at Carew Manor E.S.N.School. - 81 - (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 Department 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 cases they are all offered treatment} the parents with a psychiatric social worker and the child with the child psycho-therapist. The number of children referred to the Clinic in 1967 was 101. The agencies initiating referral were:- General practitioners 48 School Health Service 16 School Psychological Service 18 Courts 5 Probation Office 1 Children's Department 8 Hospitals or Specialists 4 Schools 1 101 10 families withdrew from the waiting list or failed their diagnostic appointments in 1967• - 82 - 1st January to 31st December 1967 Psychiatrist Sessions Diagnostic interviews with children 86 Treatment interviews 344 Court reports 4 Boarding school reviews 9 Case discussions (supervision) 106 Discussion of North Downs cases 16 Meeting outside agencies 28 Outside visits 3 Appointments arranged but failed 32 Psychiatric Social Worker Sessions Treatment interviews 1100 Case Discussions 246 Meeting outside agencies 12 Home visits 27 Supervision of student 9 Outside visits 11 Appointments arranged but failed 144 Psychotherapist Sessions Treatment interviews 849 Case discussions 169 Outside visits 1 Meeting outside agencies 1 Appointments arranged but failed 105 (d) School Psychological Service During the past year this service was staffed by one full-time Educational Psychologist, one half-time Educational Psychologist and for two days a week by one student Educational Psychologist (University College, London course) commencing in October 1967. The total number of children fully investigated during the year was 397. Source of referrals Principal School Medical Officer 128 E.S.N.School 63 Head Teachers directly 127 Other agencies 16 Referred by Child Psychiatrists _6l 397 Recommendations Made Transfer to E.S.N.School 17 Transfer to other Schools 17 Admission to Diagnostic/Observation Infants Class 17 Admission to Autistic/Psychotic class 4 Referral to Remedial Teachers 24 Recommendations for further investigation 22 Referral to Child Psychiatrists 27 Reports to Child Psychiatrist 63 Reports to Youth Employment Service 22 Re-assessment 73 Reports to Principal School Medical Officer, Head Teachers etc. 111 397 - 83 - (e) 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. (f) 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. SPECIAL SCHOOLS There is one special school provided by the Borough Councils Carew Manor, Wallington, for educationally sub-normal children. There is also North Downs, Belmont, a small unit for maladjusted children. In addition placements are obtained in special 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 1967 was 135 (133). 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 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. - 84 - In addition to a regular weekly session at the school b,y a 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 7years. 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 30 (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. In addition there are hospital schools at Queen Mary's Hospital for Children, Carshalton, and Belmont Hospital, Sutton, also at St.Helier Hospital. 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 friary's Hospital School Ahen 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. 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 1967 was 162. (d) Belmont Hospital School 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 iihgland 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 and one part-time teacher of the deaf both of whom are attached to the unit. - 85 - HANDICAPPED PUPILS Number of pupils registered as handicapped 219 (222) Handicapped Pupils requiring Education at Special Schools approved under Section 9 (6) of the Education Act 1944 or Boarding in Boarding Homes during the year 1st January to 31st December 1967 Blind Partially Sighted Deaf Partially hearing Physic -ally handicapped Delicate Maladjusted E.S.N. Epileptic Speech Defects TOTAL Children newly assessed as needing special - - 2 - 2 7 7 18 1 - 37 educational treatment at special schools (-) (5) (4) (2) (4) (7) (6) (17) (-) (-) (45) Number of children receiving special educational treatment in s- (a) Boarding Special 1 2 1 2 3 10 9 13 - - 41 Schools or Homes (1) (2) (10) (-) (2) (12) (9) (16) (1) (-) (53) (b) — 6 12 4 14 6 4 104 — — 150 Day Special Schools (-) (8) (-) (-) (13) (9) (2) (113) (-) (-) (145) (c) Independent Boarding 1 1 2 16 8 28 Schools (-) (-) (1) (-) (2) (3) (12) (6) (-) (-) (24) - 86 - (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 1967 home tuition was arranged for 35 (3) 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 32 (2l) 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. 382 + 50 re-examinations (292) children were medically examined during 1967. (b) Physical Education in Schools General arrangements for physical education are to a large extent similar to those of 1966, 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 1967 was s- Primary Schools 8797 Meals 74.38% 10385 Milk 94.1% (8492) (73.6%) (9768) (94.8%) Secondary Schools 6063 " 76.03% 4139 " 53.81% (5492) (71.7%) (4273) " (57.2%) Independent 426 " 1748 " (558) 614 children received free school meals. (583) - 87 - HEALTH EDUCATION In the early part of the year a School Medical Officer who was particularly interested in this work was asked to approach Head Teachers to put before them a scheme for Education in Health which could be applied in their schools and to enquire whether this would be acceptable to them as being of value in the total education of the child. Almost without exception the approach was welcomed and subsequently schools were visited by a medical officer who made use of films, discussions and talks with selected groups of pupils. In many instances these were extended to include Parent-Teacher Associations and in all instances parents were advised of the content and manner in which these matters were to be presented to the pupils. The result of the pilot scheme was to create a demand for these activities which far outreached the available resources0 All Secondary Schools have indicated their wish to participate in this work and the interest shown is most encouraging to those who feel that education in positive health is an essential part of preparation for adult life. If for no other reason the response of the pupils themselves in demanding further information on matters of health and personal relationships is sufficient to justify the continuation and expansion of this work. The interest of Head Teachers and other members of school staffs is very much appreciated and the time that they have made available in crowded school curricula is highly valued by those concerned with this work. There is no doubt that additional resources will have to be made available in the future to meet the demands which have become apparent. SCHOOL POPULATION The Registrar-General's estimated population of the Borough at mid-year 1967 was 165,250 (165,840) of whom 21,200 (21,000) were children between the ages of 5 - 14 years inclusive„ The number of children on the register of the local Education Authority Schools was 19,690 (19,348). The number of children continuing full-time education at school after the compulsory school leaving age of 15 years continues to increase. - 88 - WELFARE SERVICES PART V (NATIONAL ASSISTANCE ACTS) INDEX Page No. INTRODUCTION 91 SERVICES FOR THE ELDERLY 91 MEALS ON WHEELS 92 THE PHYSICALLY HANDICAPPED 92 CARE OF THE DEAF 96 CARE OF THE BLIND AND PARTIALLY SIGHTED 96 TEMPORARY ACCOMMODATION 102 RECEIVERSHIP AND CARE OF MOVEABLE PROPERTY 103 DISPOSAL OF THE DEAD 103 (Figures in brackets refer to 1966) - 89 - 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 22,994 (22,100) Number of old people in care of this Authority in 183 (219) directly controlled old people's homes Number of old people of Sutton origin elsewhere in 119 (125) old people's homes Services for the Elderly As indicated in the introduction to this report, care of the elderly involves many departments of the Council, a great deal of voluntary effort and the close co-operation of other statutory agencies who have responsibilities in this matter. Information concerning elderly people living in their own homes continues to be received from many sources and the number of elderly persons whose names are included in the register of old persons who are "at risk" shows a steady rate of growth. Much of the work of Social Welfare Officers is concerned with the continuing effort to maintain elderly people in their own homes for as long as possible. Many require home nursing services and domiciliary support of home helps. The Meals-on-Wheels Service is invaluable, not only in providing a basis of nourishing meals but also in establishing a point of contact with the many elderly people who are served. This often leads to early recognition of signs of distress which can be referred to the Social Welfare Officers who are then often in a position to prevent a crisis occurring. The right of an old person to continue to live in his or her own home, even at a standard which might not be acceptable to some, is very well recognised and although it is necessary to spend much time in maintaining even this standard, it is considered to be time well spent. Much of the work of Social Welfare Officers is concerned with minor or major crises in the lives of elderly people, leaving less time than could be wished for routine visiting. Sources of information are, however, so varied that early signs of deterioration are very frequently reported to the Social Welfare Officers who are either able to deal with the problem themselves or to bring it to the attention of the particular agency best able to help. The number of residential places in homes administered by the Council did not change during the year. In addition the Council has continued to accept financial responsibility for some admissions to voluntary homes registered under Section 37 of the National Assistance Act. So far as possible accommodation is made available within the Sutton area and near to the former place of residence or to friends and relatives. The places at St.Anne's, Redhill, are not fully taken up because relatives find visiting difficult and the residents feel isolated from familiar people and surroundings. The waiting list for admission to Old People's Homes maintains a fairly constant level and plans are now well advanced for the building of two additional homes which will provide 90 more places. - 91 - As, however, the Council will ultimately lose the 83 places allocated at St.Anne's, the capital development programme includes two additional homes with a further home projected into the future. In addition to the Council's homes there are 22 private old people's homes in the Borough providing 290 places. These are registered by the Council and are all regularly inspected. Private Housing Associations are helping to provide more accommodation by converting houses into flatlets for elderly people and the Borough's own housing programme includes similar schemes. 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 67/70 70/80 80/90 90/100 Over 100 (a) 7.19% 2.05% 24.33% 48.97% 16.78% 0.68% (b) 2.31% 6.15% 43.08% 43.08% 5.38% - 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. 56,446 (52,000) meals were served during 1967* The Physically Handicapped The pattern of services for the physically handicapped has now become well established. The Health and Welfare Department has become the focal point of all manner of services to the handicapped and to those citizens of the Borough who work with them towards the realisation of a more complete and independent life. Section 29 of the National Assistance Act 1948 imposes a duty to provide Welfare Services for the Handicapped (General Classes) and the Deaf and Hard of Hearing. These duties may be defined as follows 1- (a) Informing handicapped persons of the services available to them. (b) Giving instruction in their homes or elsewhere in methods of overcoming the effects of handicap. (c) Providing workshops where such persons may be engaged in suitable work. (d) Providing handicapped persons with suitable work in their own homes. (e) Helping handicapped persons to dispose of the product of their work. (f) Providing handicapped persons with recreational facilities in their own homes or elsewhere. (g) Compiling and maintaining registers of handicapped persons. (h) Providing residential accommodation in cases where the handicapped persons can no longer support themselves at home. - 92 - The Register of Handicapped Persons for the year ended 31st March, 1967 is as follows 8- Noo of handicapped people on the register at 31/3/67 789 No. of Removals and Deaths 146 No. of Newly registered handicapped persons 290 No. of Handicapped people on the register as at 31/3/68 933 and the extract of statistics from the statutory register shows the following classifications Classification of Disabilities and Age Groups Disabilities Under 16 16 - 29 30 - 49 50 - 64 65+ Total at 31/3/68 Total at 31/3/67 Amputation - 2 3 15 24 44 43 Arthritis 1 - 14 68 214 297 256 Congenital malformation 2 5 5 - 1 13 8 Digestive - 3 6 35 73 117 92 Injuries 1 4 5 11 42 63 23 Organic N.D. 13 39 81 100 104 337 208 Neurosis - 2 - 6 2 10 9 TB Resp. - - 3 4 4 11 9 TB Surg. - - 4 4 4 12 9 Any other - 2 - 6 21 29 52 17 57 121 249 489 933 789 Deaf Deaf with Speech 3 9 12 1 6 31 30 Deaf without Speech 1 4 9 5 6 25 26 Hard of Hearing 1 2 3 7 47 60 39 5 15 24 13 59 116 95 Not all those persons appearing on the register are very severely handicapped some are included so that the partially handicapped may have the benefit of services statutorily provided for those who are registered. - 93 - An analysis of the employment and facilities for work for the registered handicapped persons follows :- So far as employment is concerned, the 933 registered handicapped persons fall into the following groups:- 1. Capable of normal employment 112 In normal employment 112 2. Capable of sheltered In such sheltered employment in accordance employment 23 with definition of the 36 Ministry of Labour 3. Capable of some work on 111 Attendance at Work Centre 57 part-time basis in very sheltered conditions (e.g.Work Centre) 4. Available as Homeworkers 46 Receiving outwork and/or 23 occupational therapy 5. Not available for work 613 6. Under 16 years of age 15 7. As yet not classified 9 Work Centre, Mulgrave Road The Work Centre which is situated in former Civil Defence premises was opened in May of 1967. A small number of handicapped persons commenced attendance with a minimum of furniture and equipment then available. The success of this venture was immediately apparent not only in its provision of an occupational centre but also as a social centre where disabled persons might meet together. The appointment of a Supervisor together with a Technical Instructor to assist allowed an expansion to an attendance of 28 - 35 handicapped persons a day, not all attending every day but serving about 75 people in all. The specially constructed ambulances have been extensively used for the transport of handicapped people to the Work Centre and the extent to which this service can be made available is one of the limiting factors to the number of persons who can benefit by attendance. The chief activity of the Centre is light industrial assembly work, a smaller group still carry on with all the traditional handicrafts. It is hoped that with a larger number of persons attending, other diverse occupational activities will play an increasing part in the life of the Centre, e.g. art groups, musical appreciation, discussion groups, social evenings for the younger disabled and so on. - 94 - Social Work and Domiciliary Visiting Work with the disabled in their own homes is largely the responsibility of two specialist Social Welfare Officers. Visits are also paid by our Occupational Therapists who are also concerned with the Work Centre described in the preceding paragraph. Case loads are high and it is hoped to improve routine visiting to handicapped persons by altering the case loads of Social Welfare Officers generally to include all handicapped persons within his or har area. The need for specialist visiting will continue but will be confined to those most needing specialised case work. Case loads remain high and the amount of routine visiting through the year is barely adequate to meet the need. Visits made by Social Welfare Officers from 1st April 1967 - 31st March 1968 Visits made in connection with handicapped social work and registration 1261 " " 11 " " escort duties to and from Work Centre 103 " " " " " aids and adaptations 697 " " " " " outwork 12 " " " " " occupational therapy 239 " " " " " " " at Brambleacres 21 " " " " " " " at Maiden Homes 26 Aids to daily livings Number of aids on loan ... 510 Adaptationss Adaptations have been carried out in the homes of 47 handicapped persons during the year at an approximate cost of £1,500. Transport The two ambulances have been kept fully occupied during the year. They are used regularly for the transport of handicapped persons to Red Cross Clubs, the Invicta Club, the British Polio Fellowship Club meetings, the British Rheumatism and Arthritis Club meetings, the Spastic Centre at Croydon. They are also used in conveying patients to Holiday Homes under the Council's Holiday Scheme. Voluntary organisations are also assisted wherever possible. Part-time Clubs for the Disabled The Red Cross Society continues to operate four Clubs for the disabled in the Borough. Disabled Drivers Disabled drivers' windscreen badges have been issued as followss No. of badges issued as at 31st March, 1967 82 No. of removals since 31st March 1967 4 No. of new badges issued since 31st March, 1967 16 Total number of badges issued at 31st March 1968 94 - 95 - Holidays for the Handicapped After circularising all registered handicapped persons, the final holiday arrangements for 1967/68 were as indicated below:- Centre Handicapped Persons Blind Persons Escorts Maddieson's Holiday Camp 34 22 24 Lulworth Court,Wetcliffe 5 Grange Farm, Chigwell 10 Crabhill House, Redhill 6 Private arrangements 13 Total number of persons and relations to be assisted with holidays. 114 Estimated cost to the Borough of this project in the year under review £1,020. The sum of £2,000 (gross) is included in the revenue estimates 1968/69 for the holiday scheme against which provision is made for an estimated income of £1,000. Voluntary Organisations and Social Activities During the year close association has been maintained with all the voluntary bodies in the Borough working in the field of services for the handicapped. In particular the Sutton Association for the Disabled, the British Red Cross, the Townswomen's Guilds and many^locaL Church organisations have done valuable work assisting with exhibitions, sales of work, coffee mornings, Help the Disabled Week and many other activities. Care of the Deaf The number of deaf and hard of hearing on the register is now ll6compared with 90 in the previous year. Work in this field is carried out by general social work staff, one of whom attended a specialist course dealing with the subject. Deaf welfare is one of the fields in which expansion is required and consideration will be given to this as part of the development of Welfare Services generally. Care of the Blind and Partially Sighted The total number of registered persons on 31st December 1967 was:— Blind 350, Partially-Sighted 80, making a total of 430. The corresponding figures for last year were Blind 347, Partially-Sighted 65 making a total of 412. - 96 - Age Periods of Registered Blind and Partially-Sighted Persons BLIND Years 0-5 5-15 16-49 50-64 65 + Total Male - 2 18 39 83 128 Female - 1 12 42 174 222 Total at 31.12.67 - 3 30 81 257 350 PARTIALLY-SIGHTED Male - 5 10 7 10 32 Female - 4 8 4 32 48 Total at 31.12.67 - 9 18 11 42 80 47 of the 350 registered blind persons have other defects, e.g. four have multiple defects in addition to that of blindness (a combination of disabilities, i.e. physically handicapped and deaf), 20 are physically handicapped, 7 are mentally defective or mentally disordered, 4 deaf with speech, 11 hard of hearing, and one deaf without speech. Most of these doubly handicapped persons live at home; they are always made the subject of special and frequent visitation by the Social Welfare Officers for the blind. Register of Blind and Partially-Sighted Persons Notification of suspected blindness received in the course of the year for whom examination was arranged with consultant ophthalmologists, with the following results: Notification of Suspected Blindness during period Notification from: TOTAL Certified Blind RESULT OF EXAMINATION Certified Partially- Sighted Found not blind or partiallysighted. Ministry of Social Security 6 4 - 2 Relatives, friends or individual enquiries 22 10 7 5 Home teaching staff 7 3 4 - General practitioners 2 - 1 1 Hospitals 26 21 5 - Voluntary agencies 1 — — 1 Total 64 38 17 9 - 97 - It will be appreciated that although the total number of blind persons does not vary to any great extent from year to year, there is nevertheless considerable fluctuation in the actual persons included in these statistics. To illustrate this, details are given of the number of persons whose names were for various reasons asded to or removed from the Blind and Partially-Sighted registers. Movement on Blind and Partially-Sighted Registers 'A' BLIND Total number of cases on register at 31st December 1966 347 During the year there were ADDITIONS As a result of ophthalmic examinations 38 55 Persons moving into Borough 15 Partially-sighted found to be blind on re-examination 2 DEDUCTIONS Blind persons deceased 41 Blind persons removed from Borough 11 52 Giving a net increase of 3 TOTAL number of cases on register 31st December, 1967 350 'B' PARTIALLY-SIGHTED Total number of cases on the register at 31st December 1966 65 During the year there were ADDITIONS As a result of ophthalmic examinations 17 25 Persons moving into Borough 8 DEDUCTIONS Partially-sighted deceased 5 P.S.removed from Borough 3 P.S.transferred to Blind Register (slight deterioration) 2 10 Giving a net increase of 15 Total number of cases on register 31st December, 1967 80 Blind and partially-sighted persons registered as new cases (excluding re—certification and transfers from other areas during period:— Age at Date of Registration Years 0-15 16-29 30-49 50-64 65+ TOTAL 65-69 Further breakdown of 65+ 70-79 80-84 85-90 90+ BLIND 1 9 10 1 3 3 2 Male Female — - - 3 25 28 2 13 2 4 4 Total — - 1 3 34 38 3 16 5 6 4 PARTIALLY-SIGHTED 4 3 7 1 2 Male - - Female - - - 3 7 10 1 6 - - - Total — — - 7 10 17 2 8 - - - GRAND TOTAL - - 1 10 44 55 5 24 5 6 4 iiducation. Training and Employment of Blind and Partially-Sighted Persons EMPLOYED NOT EMPLOYED Children receiving education Open Industry In Work shops Homeworkers Scheme Awaiting Placement Incapable of work Not avail able for work TOTAL BLIND Males 2 10 1 5 - 6 96 128 Females 1 7 - 2 2* 10 200 222 Total 3 25 1 7 2 16 296 350 PARTIALLY-SIGHTED Hales 5 14 - - 1 - 12 32 Females 4 6 — — 1 — 37 48 Total 9 20 - - 2 - 49 80 GRAND TOTAL 12 45 1 7 4 16 345 430 * These were two workers made redundant by the closure of the flat knitting department at the London Workshops for the Blind, They were found alternative open employment but this did not appear to be suitable so they left after only two weeks. The Blind Persons' Resettlement Officer of the Ministry of Labour is endeavouring to find an alternative form of employment. In addition, two others attended courses of industrial rehabilitation at Torquay, sponsored by the Ministry of Labour. The above table indicates the work done in the education, rehabilitation, training and employment of blind and partially-sighted persons. The total number of males in employment is 38, of whom 32 are in open employment, one in workshops or sheltered employment and 5 are homeworkers. The total number of females in employment is 15, 13 of whom are in open employment and 2 are homeworkers. A detailed list of occupations is appended on next page - 99 - BLIND Homeworkers Workshop Employees Employed in Open Industry 1 basket maker 1 operative in soap factory 1 audio typist 1 piano tuner 1 carpenter 1 chair caner 1 kiosk manager 1 piano teacher 1 physiotherapist 2 physiotherapists 2 shorthand typists 1 teacher of dancing 5 assembly workers 1 consultant (Engineering) 1 packer 1 Social Welfare Officer for the Blind 1 bench fitter 4 factory operatives 1 housekeeper 1 shopkeeper 2 telephonists 7 1 25 PARTIALLY-SIGHTED 2 cleaners 2 nursery gardeners 2 laundry hands 1 receptionist 2 clerical workers 6 factory operatives 1 salesman 1 electrician 1 master builder 1 pastry hand 1 telephonist 20 A specialist placement service is provided by the Ministry of Labour and the work of the Blind Persons' Resettlment Officer in liaison with the Social Welfare Officers for the Blind, plays a prominent part in successfully placing and keeping blind and partially-sighted persons in employment. Many follow-up calls are required in settling blind persons in open employment, and although those who are capable and available for employment are relatively few, a great amount of perseverance and patience is required in securing the successful placement of a blind man and woman in employment. Home Teaching. Visiting and Advisory Service The total of blind persons "not available for employment" and "not capable of employment" account for a large proportion of elderly persons who are not in the employment field. The 312 people not working represents 89% of the grand total of 350 blind persons, and the total of 49 partially-sighted persons represent 61% of the total register of 80 persons. It can therefore be seen that most of the time of the two Social Welfare Officers for the Blind is spent in home visiting and a total of 1,362 visits were made to the homes of blind and partially-sighted persons during the year. 365 lessons were given in either Braille or Moon, or in pastime occupations in the homes of blind persons, and 128 escort duties in connection with blind persons' visits to hospitals, rehabilitation centres, eye units, clinics, etc. were undertaken. It is gratifying to report that the social activities and handicraft centres have had excellent support during - 100 - the year, and undoubtedly filled a great need of the blind. A total of 7 Sales of Work were held during the year and goods were sold to the value of £122. A display of specialised equipment available to blind persons was on show at the Town Hall, Wallington, in May and this proved most interesting., Sutton Association for the Blind This newly formed Sutton Association for the Blind has again proved of great assistance to the department throughout the year. £89 was spent at Christmas on presents for blind people in hospital and those bedridden in their own homes. Assistance has also been given in cases of hardship towards holidays, redecorations, and the following items were purchased and issued by the Association 36 radio batteries} 50 white sticks} 24 walking frames; 50 packets of self-threading needles. I would like to take this opportunity of expressing my most sincere thanks for the Association's good work in the field of blind welfare. In addition, the following aids are issued by the Welfare Department :- Braille alarm clocks; wristlet watches} playing cards; dominoes} jig-saw puzzles} writing paper} special writing frames} Braille or Moon books. Wireless for the Blind Fund The department acts as agents to this fund in the distribution of wireless sets to persons who will benefit and during the year 30 sets were issued. Mention should also be made of the work of the Sutton Friendly Club for the Blind, which in conjunction with the Social Welfare Officers for the Blind organise a very successful social and recreational club for the blind each fortnight. The club undoubtedly fills a great need of the blind and it is pleasing to note that the attendance at the meetings average 70. General Welfare of the Blind The Royal National Institute for the Blind advises that there are 130 talking book machines on rental to blind persons throughout the Borough of Sutton. Of this number, 32 rentals at £3 per annum are met by the Welfare Committee on behalf of blind people in receipt of Ministry of Social Security allowance. In addition to this service, a grant was also made to the National Library for the Blind in respect of 23 blind readers who regularly obtained books from this source. Guide Dogs for the Blind There are now 7 guide dog owners in the Borough, one of whom is both deaf and blind. Guide dogs are not normally granted to people with a serious hearing defect, but in this particular case an exception was made. The guide dogs make a very significant contribution to the mobility of non-sighted persons and enable them to enjoy a freedom of travel and independence as well as companionship in a world that can sometimes be extremely lonely. - 101 - Concessional Travel The London Transport Board, issue concession tickets for registered blind persons every three years and the last issue expired on 31st December, 1967. The department assisted the London Transport Board on the redistribution of 150 new tickets to blind persons in the Borough. Holidays for Blind Persons 39 holiday grants at £5 each were approved to enable blind persons to have a holiday during 1967, so that the expenditure incurred by the Sutton Association for the Blind for this purpose was £234• A further total of 21 blind and partially-sighted persons was included in a party of physically disabled persons who went to Maddiesons Holiday Camp at Littlestone on the Kentish Coast. The holiday demonstrated that blind and handicapped persons could participate very successfully in a group holiday, and consequently similar arrangements for 1968 will be made at a Holiday Camp on Hayling Island. Outings A most enjoyable outing was held in August when a party of 40 blind members of the Handicraft Class and their friends went by coach to Bognor Regis. A further outing was held in September, when a party of approximately 100 blind people from the Friendly Club for the Blind visited Eastbourne. 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. The Council provides 16 units of temporary accommodation in three houses situated at Sutton, Beddington and Carshalton. The first two accommodate both parents and dependent children, whereas the last provides accommodation for mothers and children only. The majority of families admitted are temporarily homeless because they have been evicted from their previous residences for non-payment of rent. In the case of evictions from Council property, these are planned only as a last resort and when temporary accommodation is available for them. During families' stay in temporary accommodation every effort is made to encourage them to re-establish themselves and to help in this work long-stay units have been made available in which re-habilitation work has met with some success. Further comment on this work is to be found in the Section of this report dealing with Prevention of Break-up of Families. - 102 - Conditions in one of the Council's units of temporary accommodation are unsatisfactory and intensive effort is being made to find a suitable alternative. The problem of homelessness in the Borough is not acute though the temporary accommodation provided is for the most part fully usedo Receivership and Care of Moveable Property Under Section 48 of the National Assistance Act, the Borough Council 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 deceasedo - 103 - ENVIRONMENTAL HEALTH SERVICES PART VI INDEX Page No. INTRODUCTION 107 HOUSING 108 RENT ACT, 1957 109 CARAVANS 110 FOOD AND DRUGS 110 INSPECTION OF FOOD PREMISES AND ACTION TAKEN 119 CLEAN AIR ACT, 1956 - SMOKE CONTROL AREAS 120 SUMMARY OF AIR POLLUTION MEASUREMENTS FOR 1967 121 WATER SUPPLY 122 PREVENTION OF DAMAGE BY PESTS ACT 125 NOISE ABATEMENT 125 SHOPS 126 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 126 SWEMMING BATHS 128 DISEASES OF ANIMALS ACT, 1950 128 DISEASES OF ANIMALS (WASTE FOODS) ORDER, 1957 128 ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 128 PET ANIMALS ACT, 1951 129 RIDING ESTABLISHMENTS ACT, 1964 129 SLAUGHTER OF ANIMALS ACT, 1958 129 ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT 129 PHARMACY AND POISONS ACT, 1933 129 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 129 REFRESHMENT HOUSES ACTS, 1860 - 1967 129 FERTILISERS AND FEEDING STUFFS 129 HAIRDRESSERS AND BARBERS 130 MORTUARIES 130 SUMMARY OF COMPLAINTS, INSPECTIONS AND WDRK DONE 130 - 105 - INTRODUCTION Staff difficulties in the Environmental Health Section limited the progress which was possible during the year. It had been hoped to commence a survey of houses with a view to ascertaining the need for compulsory improvement and to re-commence sewer baiting for the destruction of rats. Both these projects had to be postponed because of unfilled staff vacancies and sickness. It is with deep regret that reference must be made to the sudden deaths of Miss Lucas and Mr. Snowsill. Miss Lucas had served the former Borough of Sutton and Cheam for twenty-one years as Secretary to the Chief Public Health Inspector and was respected and valued by her former employers. Mr. Snowsill had been with the Authority as rodent operative for a comparatively short time but by his zeal and enthusiasm had made an extremely good impression. Despite difficulties, however, some progress has been made. In most fields of responsibility effort has been maintained and in others speeding up has been effected or greater productivity achieved. Two examples of this are in the establishment of Smoke Control Areas and the investigation, in co-operation with other London Boroughs, of samples of specified foods for pesticidal residues. These are referred to more fully in the body of the report. "Speeding up' is perhaps the wrong term to use in relation to the Smoke Control programme 5 but the early return to two areas a year after the reduction to one on the grounds of economy, was a pleasing and undoubtedly correct decision. It has been truly said that "we cannot afford not to have clean air". Slum Clearance was notable only for the early signs of interest by Preservation Societies and individuals in older houses considered worthy of preservation, an interest which was undoubtedly stimulated by the Civic Amenities Act and the powers contained therein to enable local authorities to preserve buildings of special architectural value. The interest in preserving houses which were represented as unfit twelve years ago and made the subject of redevelopment proposals is more difficult to understand. It is certain that they could have been preserved more economically at that time. A subject to which reference has not previously been made is that of keeping up to date with technological developments and legislation. During the year, Inspectors attended courses of instruction in Noise Control, Poultry Inspection, Bacteriology, and revision courses in Meat Inspection. New legislation included three statutes, fifteen statutory instruments, twenty-two circulars and numerous official reports, leaflets and memoranda, all of which they were required to study and apply in the field. The time-consuming nature of this task and its effect on inspections is generally overlooked. In the field of consumer protection, with particular reference to food, the normal programmes of sampling for bacteriological and chemical examination have been maintained and the inspections of food premises increased by about twenty per cent over the previous year. Every effort is made during inspections of such premises to educate food handlers in hygienic methods by the detection of faulty practices and by drawing immediate attention to them. This approach is more valuable than the alternative of arranged classes, which is generally less successful because of limited attendances and, more particularly;, the difficulty of achieving the level of instruction likely t© make an impact. As in previous years, details of the work of the Public Health Inspectors is set out in the following pages. - 107 HOUSING Clearance of Unfit Houses. Thirteen families were re-housed from unfit houses and sixteen houses were demolished. The owners of one unfit house gave an undertaking under Section 16 of the Housing Act, 1957, that the premises would not be used for human habitation. At a later date the house was made fit for habitation and the owners released from their undertaking. Inspection and Action taken under Statutory Powers. Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 7,207 Number of inspections for the purpose 9,161 Number of dwelling houses found not to be in all respects reasonably fit for human habitation 298 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 1966) 163 Action under Statutory Powers during the year. PROCEEDINGS UNDER SECTIONS 9, 10 and 12 OP 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 By owners - By Local Authority in default of owners - PROCEEDINGS UNDER PUBLIC HEALTH ACTS. Number of dwelling houses in respect of which formal notices were served requiring defects to be remedied 76 Number of dwelling houses in which defects were remedied after service of formal notices By owners 40 By Local Authority 54 Legal proceedings were instituted against the owner of premises to enforce a notice served under Section 93 of the Public Health Act, 1936. An order was made by the Court for repairs to the premises to be carried out within 28 days. - 108 - Houses in Multiple Occupation. Of the 18 houses inspected, all were found to be houses to which the Houses in Multiple Occupation Regulations apply. During the year 10 houses were brought up to the standard acceptable to the Council. Housing Act, 1957 - Part IV (Overcrowding). All known cases of overcrowding were reviewed during the year and as a result 7 dwellings were found to be still overcrowded, involving 7 families with 42 equivalent adults in occupation. Three cases of overcrowding were abated, 1 formally and 2 informally. (a) (1) Number of dwelling houses overcrowded at the end of the year 7 (2) Number of families dwelling therein 7 (3) Equivalent number of adults dwelling therein 42 (b) Number of new cases reported during the year 4 (c) (l) Number of cases of overcrowding relieved during the year 3 (2) Number of persons concerned in such cases 15 (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 BENT ACT. 1957. The following details show the action which has been taken during the year ;• Part I - Application for Certificate of Disrepair: (1) Number of applications for certificates 2 (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 Nil (b) in respect of all defects 2 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule Nil (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil (6) Number of certificates issued 2 - 109 - Part II - Application for Cancellation of Certificates: (7) Application by landlords to Local Authority for cancellation of certificates 2 (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 2 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. On three occasions vans were found to have been parked on the land at Cuddington Way and on one occasion on the land at Green Lane, Worcester Park. Steps were taken to ensure their early removal. FOOD AND DRUGS Inspection and Supervision of Food Premises: Three thousand, one hundred and sixty-four inspections of food premises were made and 167 notices were served drawing attention to unsatisfactory conditions. In addition, 175 complaints alleging adulteration or unsoundness of food were investigated thoroughly, and three prosecutions taken during the year were for tobacco in a loaf of bread - fine £25: mould on sausages - fine £20: and dirt in milk bottle - fine £20 - with costs in each case. Seventy-nine complaints were received regarding food which contained metal, glass, insects, mould, oil, tobacco or other foreign matter, or was otherwise unsatisfactory. The articles and number of complaints received are summarised below : Article No. Article No.  Baby Food 2 Irish Stew 1 Baked Beans 2 Meat 9 Beverage 1 Meat Pie 4 Bread 19 Milk 3 Cereals 2 Milk Bottles (contaminated or chipped) 6 Cheese 1 Confectionery Flour 7 Potato Crisps 1 Confectionery Sugar 4 Rum Flavouring 1 Cordial 1 Sausages 3 Cream 3 Sausage Rolls 1 Fish 1 Sugar 2 Fruit 1 Vegetables 2 Ham Roll 1 Yoghurt 2 The following samples were taken for bacteriological examination :- Milk. Classification of the milk samples and the results of the tests are as follows Designation under which sold No. of samples Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 109 107 2 109 - - - Untreated 1 1 - - - - - Sterilised 5 - - - - 5 1 115 108 2 109 - 5 1 Thirteen samples of raw milk submitted for examination were found to be free from tubercle bacilli or brucella after animal inoculation. Ice Cream. Of the ninety samples of ice cream procured for bacteriological examination 72 were Grade I, 8 Grade II, and 10 Grade III. All registered retailers draw their supplies of ice cream from reputed manufacturers outside the district. There are five manufacturer-retailers of soft ice cream. Advice was given following the receipt of unsatisfactory reports and further samples obtained until a satisfactory result was achieved. Other Poods. Cheese 3 Haslet 1 Confectionery (Hour) 25 Meat & Meat Products 56 Confectionery (Sugar) 1 Meat Pies 8 Cream 7 Preserves 1 Egg Product 1 Sausages 16 Fish 2 Sausage Rolls 4 Fruit (canned) 2 Sausage Meat 5 Hamburger 1 Vegetables 1 In two cases, organisms of food poisoning type were found. - 111 - Water. Thirty-nine samples of water were reported as satisfactory. Registration of Milk Distributors. The number of Milk Distributors registered under the Milk and Dairies (General) Regulations. 1959. is 61. Designated licences in force, under the Milk (Special Designation) Regulations, 1963, (as amended), during the year were as follows Dealer's (Pre-packed Milk) Sterilised 61 Pasteurised 80 Untreated 25 Ultra Heat Treated 30 Dealer's (Pasteuriser's) 1 Unsound Pood. 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 Pood Wrapped Pood lbs. ozs. Number of Containers Beverages - - 5 Cereals - - 69 Cheese - - 1 Confectionery Flour 164 8 559 Confectionery Sugar 529 8 1,797 Cream - - 2 Fish 445 9 142 Prozen Pood 392 - 12,331 Fruit 38 12 257 Fruit Juice - - 149 Ice Cream 50 - 35 Meat 1,396 5 - Meat Canned - - 541 Meat Cooked 4 2 - Milk - - 9 Preserves 20 - 2 Soup - - 15 Vegetables 8 - 151 ! Miscellaneous 1 - 14 3,049 12 16,079 - 112 - Slaughterhouses. There are no slaughterhouses in the Borough* Food Hygiene (Markets. Stalls and Delivery Vehicles) Regulations. 1966 as amended. The inspection of stalls and vehicles was carried out during the year and notices were sent to the person responsible in cases where contravention of the Regulations was found. Two stallholders were the subject of legal proceedings which were withdrawn upon the Regulations being complied with. Three exemption certificates were issued under the Pood Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966, as amended, in respect of Regulations numbers 15, 16 and 17. Adulteration of Food. During the year, 498 samples of food and drugs were purchased for examination by the Public Analyst, Mr, D.D. Moir, M.Sc., F.R.I.C., whose sudden death early in 1968 severed a long and successful association with the Borough and two of the constituent Authorities. Mr. Moir's dedication to his duties and his ready and experienced advice will be sadly missed. I am indebted to Mr. J.A. Palgrave, B.Sc., F.R.I.C., Deputy Public Analyst (who has subsequently been appointed to the senior position) for the following observations on the year's work and for the assistance he has given The year 1967 saw the publication of a large number of Regulations which affect the work of the public analyst, and hence the public at large. These were: The Meat Pie and Sausage Roll Regulations 1967; The Canned Meat Product Regulations 1967; The Sausage and Other Meat Products Regulations 1967; The Solvents in Food Regalations 1967; The Artificial Sweeteners in Food Regalations 1967; The Toys (Safety) Regulations 1967; The Labelling of Food Regulations 1967; The Coffee and Coffee Product Regulations 1967; The Ice Cream Regulations 1967; The Margarine Regulations 1967• In addition there were proposals for Regulations dealing with Claims and Misleading Descriptions on Labels and a document concerned with Skimmed Milk containing non-milk fat. Two reports were published by the Food Standards Committee of the Ministry of Agriculture, Fisheries and Food, one on compositional standards for Cream, the other on Cyclamate sweetening substances. The first three Regulations mentioned above will bring a certain amount of order into situations where differing opinions exist on the amount of meat which various meat products ought to contain. The Regulations themselves are so complex, however, that manufacturers must be forgiven if they find it a little difficult to understand what the standard for any product should be. - 113 - The Artificial Sweeteners in Food Regulations 1967 came into force in two stages during the year and as a result cyclamate sweeteners were permitted to be used in all foods except ice cream. The Food (Control of Irradiation) Regulations 1967 became operative in June and prohibit the use of ionising radiation in the preparation of food intended for human consumption; presumably because certain very important food bacteria are difficult to kill by means of radiation and might grow more resistant. The Toys (Safety) regulations 1967 became operative on 1st November 1967 and provide for the prohibition of toys which contain cellulose nitrate (except ping-pong balls) and those on which any paint film contains lead in excess of 1.1 per cent. Food Samples - Chemical Analysis 1967 Formal Informal Adulterated Total Formal Informal Alcoholic Drinks 8 2 — — 10 Beverages 1 4 - - 5 Cereals and Cereal Products 1 21 - 1 22 Cheese 2 21 1 8 23 Confectionery Flour 7 11 - - 18 Confectionery Sugar 4 15 - - 19 Cream - 7 - - 7 Drugs - 44 - - 44 Egg and Egg Products - 2 - - 2 Fat and Oils 1 15 - - 16 Fish and Fish Products 3 5 - - 8 Fruit and Fruit Products 5 19 1 - 24 Ice Cream 23 - - - 23 Meat and Meat Products 14 29 3 - 43 Milk 39 76 1 5 115 Milk Products 1 5 - - 6 Preserves 2 11 - - 13 Sausages 5 4 - - 9 Soft Drinks 3 11 - - 14 Vegetables and Vegetable Products 3 11 - 1 14 Miscellaneous 2 61 - 1 63 124 374 6 16 498 TOTAL 498 - 114 - The samples described as adulterated or irregular were reported upon by the Analyst as follows and action was taken as indicated : — Informal Sample - Carrot Tablets: The product was labelled "Dehydrated Vegetables in concentrated tablet form prepared by special evaporation to remove bulk and retain the essential nutrients. Average daily requirements: 10 tablets." The weight of 10 tablets is 606. grams and if only water has been extracted during dehydration this would be the equivalent of about 6 oz. of fresh boiled carrots. This quantity of carrots would be expected to contain about 5»000 micrograms of Carotene, whereas the 10 tablets analysed contained only 225 micrograms. The Public Analyst held that the label was misleading, as the claim that the essential nutrients are retained is not true, the tablets only providing one twentieth of the essential nutrient B Carotene, A new label submitted by the manufacturer of the tablets was approved by the Public Analyst. Informal Samples - The Admiral's Cheese with Port: Ilchester Cheese blended with Beer: Samples of compound cheese contaminated with mould growth due to the cheese not being kept in refrigeration. The vendor has given instructions to managers of shops regarding the storage of such cheeses. Formal and Informal Samples - Double Cream Cheese: Two samples of cheese, one formal sample and one informal sample, contained respectively 38.5 per cent and 37.5 per cent milk fat instead of 65 per cent milk fat as prescribed in The Cheese Begulations, 1965. As the vendor had ceased importing the brand of cheese in question pending alteration of the label to comply with the Cheese Regulations, no further action was considered necessary. Informal Samples - Gorgonzola and Lactic Cheese: Samples of full fat soft cheese not properly described on the wrapper in accordance with The Cheese Regulations, 1965. Letter sent to vendor's head office. Informal Samples - Austrian Smoked Cheese and Smoked Cheese with Ham: Due to a packet of full fat processed cheese being divided by the retailer, the portion of the sample submitted for analysis did not have a proper description of the cheese. The retailers have agreed not to divide whole packets unless portions for sale remain properly labelled. Informal Sample - Crema Bel Paese (Cheese Spread): In the Public Analyst's opinion the label of the sample is misleading, as Bel Paese is a whole milk soft cheese and not a cream cheese and should not, therefore, be described as 'Crema Bel Paese' with a sub-title 'Cheese Spread1. As the words 'Crema Bel Paese' are a registered trade mark in Italy and because of the difficulty in proving that the label was calculated to mislead, no further action was taken. - 115 - Formal Sample - Fruit Pie, Apple and Blackberry Filling: A sample which, on receipt by the Public Analyst, exhibited bluish-green mould growths. The mould was a species of Aspergillus which, in the opinion of the Analyst, formed after sampling. The vendor stated that due to error in rotation of stock the pie was sold after the date stated on the wrapper. A warning letter was sent to the vendor. Formal Sample - Ham with Egg: A sample of meat, cereal and egg labelled as 'Ham with Egg'. As the article contains cereal the Public Analyst held that the description 'Ham with Egg* on the label is not appropriate. The vendor agreed to label the article 'Ham Roll with Egg'. Formal Sample - Hamburger Flavoured Beef Slicing Meat: An article incorrectly described as 'Hamburger Flavoured Beef Slicing Meat' which, in the opinion of the Public Analyst, was a sample of beef sausage meat containing 57 per cent of meat instead of not less than 80 per cent of meat. The vendor agreed to amend labelling accordingly. Informal Sample - Lemon Meringue Pie: In the opinion of the Public Analyst, the illustration on the carton containing this article is calculated to inform the purchaser that the pie ingredients contain whole egg and whole lemon, whereas only the white of egg is used in the form of dried egg albumen, and lemon flavouring in the form of lemon oil. The manufacturer agreed to print a new design on the carton. Formal and Informal Samples - Milk: One formal and three informal samples of milk taken in the months of February and March were found to be deficient in solids not fat to the extent of 1% in two cases, 3% in one case, and a slight deficiency in the fourth case. In three cases tests did not indicate the presence of added water. In one case a trace was found to be present. The vendors claimed that the deficiency in solids not fat was due to feeding difficulties which are not uncommon at this season of the year. Informal Sample - Pasteurised Milk: A sample of Pasteurised milk taken in March was found to be deficient in solids not fat to the extent of 1% and the presence of a small quantity of added water was detected. The vendor claimed that feeding difficulties accounted for the low percentage of milk solids and assumed that the presence of added water may have been due to a small quantity of water left in a filter pipe after steam sterilisation. Informal Sample - Pasteurised Milk; The sample was deficient in milk solids other than milk fat to the extent of 4 per cent. A further sample proved to be satisfactory. - 116 - Informal Sample - Onion Sauce Mix: The Public Analyst considered that the label should name the additional ingredients required to make the sauce. The manufacturer stated that no objections to the label had been received in respect of previous samples submitted to public analysts and did not consider a change in label necessary. Formal Sample - Pure Pork: The sample contained, in addition to pork, salt, emulsifying salts, flavourings, sodium nitrite and potassium nitrate. The Public Analyst held that the word 'Pure' was misleading due to the additions contained in the pork. The vendor agreed to change the label for the product. Food Samples - Pesticide Residues Survey Seventeen samples of food were taken for analysis in connection with the Pesticides Residues Survey. Details of the samples taken, and results, are set out below :- No, of Sample Description Organo-chlorine Insecticides p.p.m. Fly Test Organo-phosphorus Insecticides p.p.m. P 9. Apples 30/5/67 DDE — 0.05 DDT - 1.8 -ve 0 - P Not detected Lead - 0.1 Arsenic -ve. P 3. Beef 10/5/67 Total BHC less than 0.02 Dieldrin - trace -ve Not detected P 10. Beer 22/6/67 Not detected -ve Not detected P 1. Bread 9/5/67 -BHC less than 0.02 Dieldrin " 0.02 -ve Not detected P 15. Bread 4/7/67 Total BHC less than 0.02 DDT and allied compounds less than 0.05 -ve Not detected P 12. Cabbages 26/6/67 -BHC less than 0.02 -ve Not detected P 2. Cornflakes 9/5/67 -BHC less than 0.02 Heptachlor epoxide less than 0.02 DDE less than 0.05 TDE less than 0.05 -ve Not detected P 4. Chicken (oven ready) 16/5/67 -BHC less than 0.02 -BHC 0.09 Dieldrin less than 0.02 -ve Not detected - 117 - No. of Sample Description Organo-chlorine Insecticides p.p.m. Fly Test Organo-Phosphorus Insecticides p.p.m. P 5. Eggs (large) 16/5/67 BHC less than 0.02 -ve 0 - P Aldrin " " 0.02 Not detected Mercury less than 0.04 Dieldrin " " 0.02 DDT " " 0.05 P 7. Margarine 24/5/67 Not detected Not detected P 6. Milk (Pasteurised) 24/5/67 BHC 0.005 -ve 0 - P Dieldrin less than 0.002 Not detected DDT - a trace 16 Milk -BHC ... 0.01 -ve Not detected 19/7/67 -BHC ... 0.006 P 11 Potatoes 22/6/67 Dieldrin - a trace Less than 0.02 -ve Not detected 17 Potatoes 25/7/67 -BHC less than 0.02 -ve Not detected Aldrin less than 0.023 Dieldrin less than 0.061 P 8. Sugar 30/5/67 Not detected -ve Not detected P 14 Tea 4/7/67 Total BHC less than 0.02 -ve Not detected DDT and allied compounds less than 0.05 P 13 Tomatoes 29/6/67 -BHC 0.037 -ve Not detected Mercury - not detected DDT 0.21 DDE less than 0.05 - 118 - - 119 - SANITARY ACCOMMODATION FOOD STORAGE AND PREPARATION ROOMS No. of Premises No. of Premises registered under Sec.16 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 Materials provided Accommodation for Clothing provided Accumulations removed Bakehouses 14 • - - - - - - - - - - - - • - Bakers & Confectioners 44 12 - 1 - - - - 1 2 1 - 2 1 - 2 Butchers 105 95 4 3 - 2 1 1 8 5 - 1 1 3 1 2 Canteens 105 - 2 5 - 1 1 - 2 5 - - 3 - 1 - Chemists 41 1 - - - - - - - - - - - - - Confectioners (Sugar) 207 187 - 3 1 - - - 2 2 - - - - - 1 Fishmongers 42 18 - 1 - 1 - 1 - 3 - - 2 - - - Greengrocers & Fruiterers 107 27 1 3 1 1 1 3 1 4 1 1 2 - 2 1 Grocers & General Stores 193 158 1 2 - 2 1 3 5 11 - - 3 - - 1 Licensed Premises 52 7 1 2 - 1 - - 2 6 - 1 - - - - Milk Storage Depots 3 - - - - - - - - - - - - - - - Restaurants & Cafes 85 57 2 6 - 3 3 4 3 5 1 - 2 2 3 2 Factory Food 5 5 - - - - - - - - - - - - - - Stalls & Vehicles Food VARIABLE - - - - 7 1 - 1 3 - - 6 3 - 2 567 11 26 2 18 8 12 25 46 3 3 21 9 7 11 CLEAN AIR ACT, 1956 Smoke Control Areas. Smoke Control Order No. 16, affecting an area in the former Carshalton Urban District, was confirmed by the Minister of Housing and Local Government on the 1st March, 1967, and came into operation on the 1st October. The area of the Borough covered by Smoke Control Orders was, by the end of 1967, 3,332 acres and included 21,691 dwellings. In November, Order No. 17 was made by the Council and submitted to the Minister for confirmation. This covers a part of the Borough at Worcester Park containing 2,142 dwellings and having an area of 278.2 acres. Allowance has been made in the Estimates for a further Order to be made and come into operation in 1968. Air Pollution Records. In view of their limited application and on the grounds of economy the use of deposit gauges was discontinued on the 31st December, 1966. Daily recordings of air pollution by smoke and sulphur dioxide are made by means of apparatus installed at (1) The Health Centre, Shotfield, Wellington. (2) The Lodge, Carshalton. (3) The Library, Manor Park, Sutton. The highest, lowest and average readings for the three stations are set out as follows !- - 120 - t—1 rv> h-1 I SUMMARY OF AIR POLLUTION MEASUREMENT FOR 1967 Station BEDDINGTQN & WALLINGTON NO. 1„ CARSHALTQN NO. 2. SUTTON & CHEAM NO. 3. Highest Lowest Average Highest Lowest Average Highest Lowest Average Smoke So2 Smoke So2 Smoke S02 Smoke S02 Smoke So2 Smoke S02 Smoke S02 Smoke So2 Smoke S02 JAN. 130 337 11 20 49 121 179 323 12 25 74 123 145 312 14 30 61 144 FEB. 143 407 04 25 38 109 191 445 09 25 58 111 170 465 06 25 48 122 MAR. 54 108 06 18 16 52 49 125 07 30 25 59 37 122 09 31 21 67 APL. 51 223 08 35 26 106 68 255 17 44 40 121 57 291 15 56 32 123 MAY 42 123 04 11 15 52 49 163 03 23 17 62 43 187 04 19 17 61 JUNE 25 101 04 11 11 45 32 111 04 25 12 57 258 126 05 24 23 57 JLY. 24 130 03 11 10 40 23 205 04 18 11 50 24 168 04 17 11 55 AUG. 32 170 02 16 12 37 36 208 02 12 13 40 37 217 03 17 14 48 SEPT. 52 112 05 17 18 42 70 133 04 06 21 45 57 117 07 19 21 49 OCT. 25 59 04 11 12 31 36 59 04 14 16 32 37 73 04 18 15 41 NOV. 141 296 12 34 49 121 205 324 20 13 71 134 186 452 11 33 62 169 DEC. 132 347 09 35 51 144 196 362 09 12 79 152 215 396 11 41 67 165 ALL FIGURES REPRESENT QUANTITIES EXPRESSED IN MICRO (MILLIQNTHS) 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. I am indebted to Mr. E.G.B. Gledhill, B.Sc., M.I.Mech.E., M.I.W.E., A.M.I.C.E., A.M.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 84°P. occurred on Tuesday, 11th July, 1967. The minimum temperature during the year, of 20°F., occurred on Friday, 8th December. Rainfall (Carshalton Road, Sutton): Rain fell on 168 days in 1967- The heaviest rainfall amounted to 1.57 inches in one day. The total rainfall during the year amounted to 29.58 inches compared with the 35 year average of 25.72 inches. Water Consumption: Maximum daily consumption - 10th July, 1967 18,658,000 gals. Average daily consumption throughout the area during the year 12,290,000 gals. This represents an increase over the 1966 figure of 330,000 gallons or 2.76%. No restrictions of any kind were imposed during the year and all consumers had an adequate supply of water for all purposes. - 122 - Two thousand, two hundred and eighty-eight samples were examined by the Company's Chemist & Bacteriologist during the year: see table below :- No. of bacteriological examinations No. of full chemical analyses No. & % of samples showing ColiAerogenes in 100 ml. (excluding B.Coli I) No. & % of samples showing Bo Coli present in 100 ml. of sample (Type I) Total No. of ColiAerogenes organisms in 100 ml. of sample No. % No. % Sutton Raw 310 52 17 5.5 29 9.4 46 Sutton Finished 321 12 7 2.1 2 0.6 9 Woodmansterne Raw 308 52 3 1.0 1 0.3 4 Woodmansterne Finished 308 12 1 0.3 Nil Nil 1 Cheam Raw 314 96 10 3.3 1 0.3 11 Reservoirs 318 Nil 3 0.9 1 0.3 4 District 338 Nil 11 3.3 4 1.2 15 Epsom Finished 62 45 2 3.2 Nil Nil 2 Merton 9 4 Nil Nil Nil Nil Nil Totals 2,288 273 54 38 92 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. E. 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 1967. (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 :- - 123 -  Bacteriological Results - Yearly Averages, 1967. 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. 1,887 8.8 99.52 99.95 Average Results of the Chemical Examination of Water, 1967. Milligrammes per litre (unless otherwise stated) No. of Samples 156 Chloride as C1 30 Ammoniacal Nitrogen 0.021 Phosphate as PO4 1.9 Albuminoid Nitrogen 0.088 Silicate as Si02 9 Nitrate Nitrogen 4.2 Sulphate as S04 64 Oxygen abs. from KMnO4 4 hrs at 270c. 1.12 Natural Fluoride as F 0.30 Hardness (total) CaCO3 272 Surface-active material as Manoxol 0T 0.01 Hardness (non-carbonate) CaC03 69 Turbidity units 0.1 Magnesium as Mg 5 Colour (Burgess units) 12 Sodium as Na 22.6 pH value 7.9 Potasium as K 5.1 Electrical Conductivity (micromhos) 580 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 predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, 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. - 124 - (e) (i) The Board has no record of the number of structurally separate dwellings supplied in the area, but the population supplied direct according to the Registrar General's estimates at 30th June, 1967, was 1,918. (ii) No houses were permanently supplied by standpipe. (f) There were no changes to the general scheme of supply in the area, (g) There were no additions to the Board's mains in area. (h) Tests for lead have been carried out in connection with chemical analyses of samples of running water collected from premises in the distribution system and I set out below the information obtained over the period 1st January to 31st December, 1967 *~ Lead content (mg/l. Pb) water from main taps in consumers' premises No. of Samples Per cent Less than 0.01 64 66.7 0.01 22 22.9 0.02 3 3.1 0.03 4 4.2 0.04 2 2.1 0.05 0 - 0.06 1 1.0 96 100.0 The above figures apply to the whole of the Board's area but it should be pointed out that the general characteristics of the water are similar throughout the area so that the findings are applicable to individual Boroughs. PREVENTION OF DAMAGE BY PESTS ACT One thousand, five hundred and forty-seven complaints of rat or mouse infestationswere received and investigated. At 1,672 premises infestations were confirmed and treatments were carried out. Ten informal notices were served under Section 4 of the Act. NOISE ABATEMENT Thirty-four complaints indicating nuisance from noise were investigated. Informal action was taken in appropriate cases to reduce the noise level. - 125 - SHOPS There are 1,839 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, 1963. OFFICES. SHOPS AMD RAILWAY PREMISES ACT, 1963 During the year 267 premises were registered in accordance with the Act, making the total number 1,675. 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 487 6,498 Retail Shops 1,066 5,794 Wholesale Shops, Warehouses 30 297 Catering Establishments and Canteens 90 750 Fuel Storage Depots 2 20 One application for exemption in respect of sanitary accommodation and washing facilities was granted, and in one case legal proceedings were taken against the occupier of premises for failure to provide washing facilities. A fine of £25 was imposed. Preliminary notices were served relating to non-compliance with the Act in respect of the following Notices Served during 1967 Complied (incl. Notices served in 1966) Overcrowding - 2 Ventilation 19 23 Cleanliness 37 31 Temperature (incl. thermometers) 150 78 Lighting 23 18 Sanitary Conveniences 78 78 Washing Facilities 71 57 Water Supply 18 20 General Conditions 30 24 Stairs/Passages 26 31 Clothing Storage 33 21 Drying Facilities 22 12 Seats 5 3 Machinery 3 1 First Aid Equipment 151 89 Notices 219 123 Canteen Facilities 5 1 - 126 - Factories and Outworkers. Inspections for the purpose of provisions as to health :- Premises (1) No. 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 he enforced by Local Authorities 48 29 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 577 316 7 - (iii) Other premises in which Section 7 is enforced by the Local Authority * (excluding outworkers' premises) 16 26 - - 641 371 7 - * Electrical Station (Section 123 (1) ), 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 Found: 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 - - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors - - - - - Sanitary Conveniences: (a) Insufficient — — - - - (b) Unsuitable or defective 7 4 - - - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) - - - - - - 127 - Outwork (sections 133 and 134) Nature of Works Section 133 Section 134 No. of outworkers 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. 56 - - - - - Boxes (Cardboard) 28 - - - - - Curtains and Furniture Hangings 1 - - - - - Cosaques - - - - - - Brass and Brass Art - - - - - - FLowers 1 - - - - - Lampshades 1 - - - - - Total 87 - - - - - SWIMMING BATHS Visits were made to the three public swimming baths and five school pools during the year. Thirty-five 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, Animal Boarding Establishments Act, 1963, Pet Animals Act, 1951, and the Riding Establishments Act, 1964, are carried out on an agency basis by the Council of the City of London through that Council's Veterinary Officer. DISEASES OF ANIMALS (WASTE FOODS) ORDER. 1957 Twenty 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. ANIMAL BOARDING ESTABLISHMENTS ACT. 1963 Seven licences have been issued for the boarding of cats and dogs. - 128 - PET ANIMALS ACT. 1951 Sixteen licences have been issued to persons to keep Pet Shops. RIDING ESTABLISHMENTS ACT. 1964. Two licences were issued during the year. SLAUGHTER OP ANIMALS ACT. 1958 One slaughterman's licence was issued during the year. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT Twenty-four 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. 1933 At the end of the year there were one hundred and fifty-two names on the Council's list of sellers of Poisons listed in Part II of the Poisons List. 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. Three samples of unused cotton felt and one sample of coir fibre were taken and proved to be satisfactory. The prescribed Analyst is Mr. George Noel Ginger of R.T.S.A. (Chiltern Research), Westfield House, Henley-on-Thames, Oxfordshire. REFRESHMENT HOUSES ACTS. 1860 TO 1967 Five licences were issued during the year. OTHER MASTERS Fertilisers and Feeding Stuffs. Four informal samples of Poultry Food and two informal samples of Fertilisers were taken during the year. All the samples were reported by the Public Analyst to be satisfactory. 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. - 129 - Hairdressers and Barbers. Bye-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. Mortuaries. 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 bodies, on all of which autopsies were performed, admitted during the year was as follows :- 91 Prom local hospitals 192 Prom homes within the Borough 229 512 Summary of Complaints, Inspections and Work Done. Investigations were made with regard to 41799 complaints, as follows :- Accumulations 73 Animals so kept etc. 12 Burst pipes 3 Clean Air - Contraventions 117 Dampness 83 Drainage defects 25 Drains obstructed 1,649 Dustbins 8 Factories Act 1 Pood contaminated 79 Food unsound 96 Fouling of Footpaths 9 General Defective Conditions 76 Insects and Pests 693 Litter Act Contraventions 1 Miscellaneous 115 Noise 34 Obnoxious effluvia 106 Overcrowding 2 Public Conveniences - Refuse Collection 30 Rivers 2 Rodents 1,547 Roofs defective 25 Sink Waste Pipes 4 Verminous Premises 5 Water Supply 4 4,799 - 130 - Twenty-two thousand, four hundred and eighteen inspections and re-inspections were made for the purposes set out below Animal Boarding Establishments - Clean Air Act 598 Consumer Protection Act 41 Cowsheds Diseases of Animals Act 36 Employment Agencies 13 Establishments for Massage and Special Treatment 3 Factories (Mechanical Power - incl. Laundries) 316 Factories (non-Mechanical Power) 29 Factories (Building Sites) 26 Fertilisers and Feeding Stuffs 11 Food and Drugs (Sampling, Unsound Food etc.) 1,407 Food Premises: Bakehouses 76 Bakers & Confectioners 112 Butchers 313 Canteens 163 Canteens - Schools 68 Chemists 5 Confectioners (Sugar) 154 Factory Food 11 Fishmongers 138 General Stores 284 Greengrocers & Fruiterers 245 Grocers 423 Ice Cream Factories 16 Ice Cream Vehicles 20 Licensed Premises with Catering Facilities 110 Licensed Premises without Catering Facilities 71 Milk Storage Depots 61 Restaurants and Cafes 385 Stalls, Food 252 Tea Packers 4 Vehicles, Food 253 3,164 3,164 Hairdressers 113 Housing Act 1,001 Housing (Land Charges Enquiries) 25 Infectious Disease Premises (incl. food poisoning enquiries) 864 Insect Pests 376 Merchandise Marks Act 40 Noise 227 Offices, Shops & Railway Premises Act 1,877 Outworkers Premises 16 - 131 - Pet Animals Act 10 Pharmacy and Poisons Act 6 Piggeries 37 Premises re cesspools 1 Public Conveniences 251 Public Health Act 6,209 Public Health Act re-inspections 1,954 Rag, Flock and Other Filling Materials Act 8 Rent Act 53 Riding Establishments Act 1 Rivers, Ditches and Ponds 41 Rodents 1,799 Schools 41 Shops 228 Water Sampling 77 Work Places 62 20,968 Eight hundred notices were served concerning the following matters Accumulations and Deposits 3 Animals so kept 1 Clean Air Act 3 Drainage Defects 76 Dustbins 1 Factories Act 7 Food and Drugs Act (incl. Food Hygiene) 167 General Defective Conditions 190 Housing Act (unfit houses) 17 Noise 1 Offices, Shops and Railway Premises Act 319 Prevention of Damage by Pests Act 10 Shops Act 3 Water Supply 2 800 Formal notices were served under the following Acts Public Health Act, 1936, Section 24 59 " " " ", " 39 4 " " " ", " 45 2 " " " ", " 93 13 " " " ", " 277 1 Housing Act, 1957, Section 170 6 Clean Air Act, 1956, Section 12 2 87 - 132 - As a result of investigations made and notices served, the following work was carried out Accumulations removed 19 Brickwork repaired 2 Ceilings repaired and/or made good 17 Chimneys and flues repaired 7 Damp conditions remedied 28 Doors and frames repaired, including locks and fasteners 10 Drainage repaired and/or reconstructed 73 (houses) Drainage inspection chambers repaired 21 Soil pipes renewed 12 Drains cleared 1,351 Waste gullies repaired, renewed or provided 5 Waste pipes repaired, renewed or provided 5 Surface water drainage provided - Dustbins provided 2 Fireplaces, ranges or stoves repaired or renewed 1 Floors renewed or replaced 11 Food storage accommodation provided 9 Roofs repaired and made weatherproof 66 Downpipes, guttering repaired and/or renewed 31 Stairs repaired 4 Sinks renewed - Walls repaired 6 re-plastered and/or repaired 31 cleansed and redeoorated 4 Wash basins and baths provided 4 Water supply renewals or repairs 14 W.c. provided — W.Co accommodation repaired 5 W.c. pans and seats repaired, renewed or provided 1 flushing apparatus repaired or renewed 11 Windows repaired and/or renewed 36 Ventilation provided 2 - 133 - MISCELLANY PART VII INDEX Page No, NURSING HOMES 137 NURSES' AGENCIES ACT, 1957 137 NURSERIES AND CHILD MINDERS REGULATION ACT, 1948 137 MEDICAL ARRANGEMENTS FOR CHILDREN'S HOMES AND RESIDENTIAL NURSERIES 138 STAFF MEDICAL EXAMINATIONS 139 (Figures in brackets refer to 1966) - 135 - 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 Woodcote Grove House, Woodcote Park, Coulsdon (Friends of the Poor and Gentlefolk's Help). The following establishments are also registered as "Nursing Homes":St.Anthony's Hospital, Cheam Lourdes House, Wellington (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 Ehipire 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 14 (ll) child minders and 8 (8) day nurseries were approved for registration by the Health Committee. The following table gives the numbers registered as at 31st December, 1967 - 137 -  Nurseries & Child Minders Regulation Act 1948 National Health Service Act, 1946 Section 22. Premises Ragistered 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 - 34 (26) 45 (31) 3 (2) (b) Number of places and number of children minded at end of year - 799(589) 318(245) 4 (4) MEDICAL ARRANGEMENTS FOR CHILDREN'S HOMES AND RESIDENTIAL NURSERIES At 31st December, 1967 there were 4 Children's Homes and one Reception Home under the control of the Children's Committee Reception Home, Rosebery House, 7/9 Rosebery Road, Cheam Throwley House, 10 Throwley Road, Sutton Malvern House, Kenley Camperdown Children's Home, Wallington Dean House, Merstham. 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 as necessary. - 138 - 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. 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 1967:- Officers (excluding teachers) 245 (220) Teachers 219 (194) Manual Staff 247 (181) Extensions of Sick Pay 100 (74) Retirement due to ill-health 26 (12) Extensions of service 82 (70) Trainee Teachers It is part of the duty of school medical officers to medically examine entrants to teachers' training colleges. 155 (175) such examinations were carried out in 1967 and the reports were forwarded to the Principals of the Training Colleges concerned. - 139 -