Robin Hood Lane Health Centre The Health of Sutton Annual Report 1972 London Borough of Sutton Dr W.H.Kinstrie, MB.ChB.MFCM.DPH Medical Officer of Health/Principal School Medical Officer 54T8 aCONTENTS PAGE NO. INTRODUCTION PARTI GENERAL STATISTICS AND SOCIAL CONDITIONS 5 PART II EPIDEMIOLOGY 12 PART III PERSONAL HEALTH SERVICE 19 PART IV SCHOOL HEALTH SERVICE 37 PART V MISCELLANEOUS 53 PART VI ENVIRONMENTAL HEALTH SERVICES 57 PART VII APPENDIX - STATISTICS 95 W.H. KINSTRIE, MB, ChB., MFCM.DPH Medical Officer of Health and Principal School Medical Officer Unless otherwise stated, figures in brackets are for the year 1971 1 MEMBERS OF HEALTH AND HOUSING COMMITTEE AS AT 31st DECEMBER, 1972 Councillor E.G. Trevor, FRICS., ARVA. (Chairman) Councillor D.H. Mullins (Vice-Chairman) The Worshipful the Mayor, Councillor G.F. Everitt, J.P. Mderman: W.M.R. King Councillors: Miss F.A. Blackler, B.Sc. A.W. Deane A.G.A. Dyson G. Eve J.L. Izard K.J. Martin Mrs. E.M. McEwen, MA (Cantab) K.A. Rose, LL.B., MICE. R.C. Squire, ACA R.S. Williams, B.Sc (Eng.) Co-opted Members: Nominated by: Dr. P.E. Heywood Local Medical Committee Dr. D.N. Lawson South West Metropolitan Regional Hospital Board Mrs. J.S. Buck Vlr. N.G. Shelley, M.I.L. 2 HEALTH DEPARTMENT SENIOR STAFF (As at 1st January, 1973) Dr. W.H. Kinstrie, MB., ChB., MFCM, DPH. Medical Officer of Health and Principal School Medical Officer Dr. N. Walter, MB, BCh., BAO, MFCM, DCH.Principal Medical Officer Dr. R.A. Hill, MB, BS, MFCM, DPH, D.Obst RCOG5 Senior Medical Off Dr. D. Shaw, MD, MB, BS, MRCP. Senior Medical Officer Mrs. B.M. Stewart, LDS Chief Dental Officer Mr. N.G. Campbell, LDS., RCS (Edin) Senior Dental Officer Mr. D.A. Eves, DMA, MRSH, MAPHI, Chief Public Health Inspector Mr. J. Dixon, MAPHI, Assistant Chief Public Health Inspector Mrs. I.M. Adamson, SRN, SCH, HV, DND., (ON) Chief Nursing Officer Miss D.M. Sammonds, SRN, SCM, HV Cert, MTD, (QN) Area Nursing Officer (Home Nursing and Midwifery) Mrs. R. Bozeat, SRN, SCM, HV. Area Nursing Officer (Health Visiting) Mr. D.S. Clapson, DPA (Lond), MILGA, Chief Administrative Officer Mr. D.R. Gladwell, Senior Administrative Officer Health Department Orqanisation (see Page 4) 3 4 LONDON BOROUGH OF SUTTON HEALTH DEPARTMENT MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER PERSONAL HEALTH DIVISION Medical and Supplementary Services Section Dental Services Section Child Guidance and School Psychological Service Section Health Education Service Section NURSING DIVISION Home Nursing and Midwifery Services Section Health Visiting Service Section ENVIRONMENTAL HEALTH Food Control Section DIVISION Housing Control Section Occupational Health and Pollution Control Section Pest Control Section Mortuary Section ADMINISTRATION DIVISION -School Health Section Community Health Section Preventive Services Section Environmental Health Section Management Services Section Secretarial Sections The Worshipful the Mayor, Aldermen and Members of the Council, Mr Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report of the Health Department for the year 1972 incorporating the Statutory Report of the Medical Officer of Health and the Principal School Medical Officer. II is not yet certain mho will be responsible for the preparation of the Annual Report for 1973 as a result of National Health Service Reorganisation. It is not possible to publish annual reports before the second half of the following year by which time in 1974 there will be no such post as Medical Officer of Health and Principal School Medical Officer. Vital Statistics The birth rate in 1972 shows a significant decrease compared with 1971. It is not possible to state whether this is as a result of better family planning services or the result of a diminishing percentage of the population in the age group 16 to 45 years, possibly both factors. The death rate increased in 1972 compared to 1971, but the latter was an exceptional year. For the second year in succession there were only two deaths from pulmonary tuberculosis. The number of deaths from cancer of the lung, which fell considerably in 1971 compared with 1970, has unfortunately increased again. The most interesting death statistic is that of suicide where it will be noted that there has been a diminishing number of suicides every year since 1969, the figures for 1972 being only one third of the 1969 figure. Infectious Disease The increase in the number of cases of Measles notified is regrettable since Measles could be irradicated in the same way as Diphtheria and Poliomyelitis if parents would only take advantage of Measles vaccination as recommended by the family doctors. Local Authority medical officers and health visitors etc. Community Nursing Services The Clinical Centre at Cheam Nurses Home became fully operational during 1972 when the Sutton Nurses Home was closed. I am very grateful to the Cheam and Sutton Nursing Associations for their agreement to meet the cost of the installation of a telecommunications service which will be a tremendous help not only in the midwifery but in the home nursing service. The volume of work of the Community Nursing Services is given in detail in the report. Increasing emphasis has been placed by the health visitors in treating families as a whole rather than their predominant role in the past which was for children under the age of 5 years and the elderly. The number of visits made by the home nurses continues to increase in spite of the fact that a very considerable number of treatments by nurses are carried out at Robin Hood Lane Health Centre 5 In Department of Health and Social Security Circular 13/73 emphasis was placed on the recommendations for the number of community nurses per 1,000 population. In view of the shortage of home nurses and health visitors it was not possible to implement the recommendations in the circular in one year and a phased programme over a period of three years was agreed by the Council. It is sincerely hoped that the Area Health Authority will carry out this programme after 1st April, 1974. Environmental Health There is a full report by the Chief Public Health Inspector on the Environmental Health Services in which it will be noted that the Public Health Inspectors now work in functional teams instead of geographic areas. More and more emphasis is being placed on housing improvements and on prevention of pollution. The work of the Division has continued to increase. Compared with the majority of other London Boroughs there have been very few vacancies in the department, a tribute to the leadership of the Chief Public Health Inspector. Housing I refer to a report by the Housing Manager. There has been an increasing delay in the rehousing of Category I Medical cases (this category recommends immediate rehousing), and it will be noted that the number of cases requiring urgent rehousing as at 31st December, 1972 was 268 compared with 159 at the end of 1971, a state of affairs which must be resolved as quickly as possible. National Health Service Reorganisation Towards the end of 1972 the Secretary of State for Health and Social Security informed London Borough Councils of the grouping of the boroughs to form Area Health Authorities, Sutton to be in the same group as Merton and Wandsworth. Although the Council made every effort to be grouped only with Merton, I regret that the appeals to the Department of Health and Social Security were unsuccessful. An Area Health Authority Joint Liaison Committee was set up at the end of 1972 and included two representatives from the six Hospital Management Committees in the area the three London Boroughs and both the Inner London and the South West London and and Surrey Executive Councils. Sutton representatives were the Principal Chief Officer and myself. The main function of the Joint Liaison Committee was to prepare a comprehensive profile of all the Health Services for the shadow Area Health Authority. The Community Health Services continued to improve during 1972 and further improvements will take place during 1973. I am confident that this borough will transfer to the Area Health Authority a first class service, my only regret being the substantial delays in the programme for Health Centres. I have pleasure in recording my grateful thanks to all the staff of the Health Department for their valuable and devoted service to the borough, and particularly to the Principal Medical Officer, Senior Medical Officer, Chief Dental Officer, Chief Nursing Officer, Chief Public Health Inspector and Chief Administrative Officer for their contribution to this report. W.H. KINSTRIE, MB., ChB., MFCM.,DPH Medical Officer of Health and Principal School Medical Officer 6 GENERAL STATISTICS AND SOCIAL CONDITIONS PART I INDEX Pz.ge No. AREA AND POPULATION 8 DEATHS 8 BIRTHS 11 W.H. KINSTRIE, MB, ChB., MFCM, DPH. Medical Officer of Health and Principal School Msdical Officer 7 AREA AND POPULATION Area in Acres Registrar General's estimated mid-year population 1972 Census Population 1971 1961 1951 10732 169,050 168,815 169,095 176,151 Population by Age-Groups: Census 1971 Years of Birth 1966/71 1956/65 1936/55 1921/35 1906/20 1896/1905 Before 1896 13,145 23,765 43,410 31,580 32,405 15,855 8,660 Estimated number of separately assessed properties: 1972/73 1971/72 1970/71 72,561 70,809 68,741 DEATHS FROM ALL CAUSES Male Female Total Crude rate per 1,000 Home Population Adjusted rate per 1,000 population (comparability factor 0.89) 1972 981 1037 2018 11.9 10.5 1971 874 935 1809 10.8 9.6 1970 950 1022 1972 11.8 10.5 8 Rateable Value 1st April, 1972/73 1st April 1971/72 1st April, 1970/71 £10,886,357 £10,698,133 £10,306,369 Estimated net product of a penny rate 1972/73 1971/72 £105,000 £103,242 Deaths from certain causes Category 1972 1971 1970 1969 1968 1960 1950 Tuberculosis, respiratory 2 2 8 4 5 9 39 Cancer, Uterus 7 9 17 15 11 17 11 Cancer, Bronchus, Lung 112 102 132 112 113 83 52 Coronary disease 483 460 443 460 523 362 291 Bronchitis 85 81 98 90 93 82 75 Suicide 8 12 17 24 20 19 15 Motor Vehicle Accidents 21 23 26 27 18 18 13 All other accidents 21 25 20 26 23 17 26 The number of deaths by cause and sex and age groups is given in full in Table 2 in the Appendix Infant Deaths MALES FEMALES Age under 1 year of age Legit. lllegit. Total Legit. lllegit. Total TOTAL 1972 15 - 15 13 1 14 29 1971 19 3 22 10 1 11 33 1970 8 2 10 16 1 17 27 Under 4 weeks of age 1972 9 9 9 1 10 19 1971 15 2 17 8 1 9 26 1970 4 2 6 14 1 15 21 Under 1 week of age 1972 7 7 7 1 8 15 1971 14 2 16 8 1 9 25 1970 3 2 5 13 - 13 18 9 Infant Mortality Rates London Borough of Sutton England and Wales 1972 1971 1972 1971 Infant deaths per 1,000 total live births 13 14 17 18 Legitimate infant deaths per 1,000 legitimate live births 14 13 17 17 Illegitimate infant deaths per 1,000 illegitimate live births 7 25 21 24 Neo-natal deaths under four weeks per 1,000 total live births 9 11 12 12 Early Neo-natal Deaths under one-week per 1,000 live and stillbirths 7 11 10 10 Peri-natal Stillbirths and deaths under one week combined per 1,000 total live and stillbirths 15 22 22 22 10 BIRTHS 1st January • 31st December 1972 LIVE STILL Legit. lllegit. Total Legit. lllegit. Total M 1058 M 62 1120 M 8 M 2 10 F 990 F 73 1063 F 8 F 8 2048 135 2183 16 2 18 94% 6% 100% 89% 11% 100% Total live and stillbirths 2201 Live Birth Rate per 1000 Home Population Number of Stillbirths Males 10 Crude Adjusted by Comparability Factor 1.00 Females 8 Total 18 Stillbirth rate per 1000 live and stillbirths 8 12.9 12.9 11 EPIDEMIOLOGY PART II INDEX Page No. PREVALENCE AND CONTROL OF INFECTIOUS DISEASE 13 IMMUNISATION AND VACCINATION 14 VENEREAL DISEASES 15 MASS RADIOGRAPHY 17 IMMIGRATION 18 W.H. KINSTRIE, MB., ChB., MFCM, DPH. Medical Officer of Health and Principal School Medical Officer (figures in brackets are 1971 figures) 12 Once again I am pleased to report that there have been no cases of diphtheria and poliomyelitis in the borough during the year 1972 It mill be noted that there is a considerable increase in the number of cases of Measles compared with 1971 This is an unsatisfactory state of affairs since mith immunisation of susceptible children measles can be prevented. It will be noted that there has been an increase in the number of cases of Tuberculosis, half of whom mere of middle-age, indicating the necessity for continuation of mass x-ray periodically to enable the diagnosis to be made at as early a stage of the illness as possible. 13 PREVALEMCE AND CONTROL OF INFECTIOUS DISEASE The following table gives the total number of infectious diseases notified during 1972 together with the figures for 1971 for comparison - Infectious diseases notified during the period 1st January 1972 - 31st December, 1972 Disease 1972 1971 Diphtheria - - Dysentery 32 37 Encephalitis 3 1 Food Poisoning 2 14 Infective Jaundice 36 19 Malaria 3 - Measles 379 162 Meningococcal Meningitis 7 7 Ophthalmia Neonatorum 3 - Poliomyelitis - - Scarlet Fever 60 41 Smallpox - - Typhoid - - Paratyphoid 1 - Tuberculosis (Pulmonary) 14 8 Tuberculosis (Non-Pulmonary) 4 5 Whooping Cough 5 77 IMMUNISATION AND VACCINATION 1st JANUARY - 31st DECEMBER 1972 Type of Protection Completed Primary Courses Receiving Reinforcing Doses (Boosters) 1972 1971 1972 1971 D iphtheria/Pertussis/T etanus 1960 1932 142 277 Diphtheria/Tetanus 75 179 2428 2277 Diphtheria 3 4 58 56 Tetanus 21 32 979 714 Poliomyelitis (Sabin-Oral Vaccine) 2114 2265 3756 3673 Smallpox 68 1317 166 278 Measles 1642 2442 Rubella 1572 1828 Typhoid 817 1260 211 234 Typhoid/Cholera 116 18 3 Cholera 123 228 8 8 Influenza 371 247 Immunisation and vaccination is available at the surgeries of general medical Practitioners and at all the Council's clinics. General Medical Practitioners are being encouraged to carry out immunisation for children on their lists and there is no doubt that with the advent of additional health centres a rapidly increasing percentage of immunisation will in fact be carried out by the family doctors. It will be noted that there is a very considerable reduction in the numbers vaccinated against smallpox. This follows the Department of Health and Social Security circular 54/71 which advised that vaccination against smallpox need not be recommended as a routine procedure in early childhood. Vaccination is only now recommended for travellers to and from countries where smallpox is endemic and for health service staff who may come into contact with smallpox cases. The policy of immunisation and vaccination of school children going on trips abroad has been continued, making certain that children have been immunised against diphtheria/tetanus and poliomyelitis and in addition against smallpox, typhoid and cholera depending on which country is being visited. Vaccination against Tuberculosis (B.C.G.) is offered to all contacts of infectious cases and is carried out by the Chest Physician. Although there has been an increase in the number of cases of Pulmonary Tuberculosis the majority were, in fact, found to be non-infectious as a result of early diagnosis. As a result, the number of contacts vaccinated against Tuberculosis has declined. It is gratifying to note that there has been an increase in the number of school children vaccinated. 14 Vaccination against Tuberculosis (B.C.G.) A. Contacts 1972 1971 (1) Skin tested 26 49 (2) Found positive (3) Found Negative 26 49 (4) Vaccinated 26 49 VENEREAL DISEASE Notification of new cases of Sutton residents from hospital treatment centres during the last three years are as follows 1972 1971 1970 Syphilis 3 11 2 Gonorrhoea 46 42 45 Other venereal conditions 598 548 518 TOTAL 647 601 565 It is regrettable that the number of new cases of venereal disease in Sutton residents continues to rise particularly in the age group 18 - 24 years. 15 Influenza Vaccination Influenza vaccination was offered to the following categories in the year 1972 Staff and residents in old people's homes Staff and children in children's homes Staff at Eldoret Day Nursery Social Workers Home Helps Nurses, Midwives and Health Visitors Key administrative staff Public Health Inspectors Dental Nurses B. School Children and Students (1) Skin tested 1669 1343 (2) Found positive 138 88 (3) Found negative 1531 1210 (4) Vaccinated 1531 1210 The number of cases of Syphilis has fallen and it could reasonably be said that Syphilis is under control in this country in contra-distinction to other parts of the world. During the year a health visitor was appointed to work part-time at the Special Clinic Her speical duties included interviewing new cases to ascertain details of contacts, the follow up of contacts who did not come for investigation on receipt of an appointment and the follow up of those cases who failed to satisfactorily complete their treatment. 16 MASS RADIOGRAPHY The Director of the Mass Radiography Unit has supplied the following statistics:- 1972 1971 Total x-rayed 2606 1158 Cases of Lung Cancer 1 M 1 F 1 M 1 F Cases of Pulmonary T.B. 2 M M F It will be noted that there was a considerable increase in the total number x-rayed in 1970 as compared to 1971. In my report for 1971 I referred to the proposed reduction in the Mass Radiography Service which was resisted by Health Committees and Medical Officers of Health. Although the service is not readily available for general public sessions it continues to be available at fixed centres which includes the regular weekly session at Wallington Town Hall. The Unit is also available for visits to factories etc, particularly for x-ray of contacts of a pulmonary tuberculosis case. 17 IMMIGRATION Under the Commonwealth Immigration Act 1962 the Medical Officer of Health is notified of all long-stay immigrants who are visited as soon as possible after arrival. Enquiries are made regarding the health of the immigrant, x-ray of chest is recommended and the immigrants are given advice regarding medical services. The number of long-stay immigrants in the Borough remains remarkably small and the majority are employed in hospitals. Country where passport was issued as stated by Port Health Authority Number of advice notes received during 1972 from ports and airports relating to the arrival of immigrants Number of first successful visits paid during 1972 Number of Pulmonary Tuberculosis notifications received in respect of immigrants during 1972 (A)Commonwealth Countries 1972 1971 1972 1971 1972 1971 1. Carribbean 6 9 1 1 - - 2. India 15 9 5 3 - - 3. Pakistan 9 1 3 - - - 4. Other Asian 11 16 9 7 1 - 5. African 6 6 5 4 - 6. Other 15 11 3 3 - - (B)Non- Commonwealth Countries 1. European 10 19 6 6 - - 2. Other 26 13 13 6 - - TOTAL 98 84 45 30 1 - 18 PERSONAL HEALTH SERVICE PART III INDEX Page No. MATERNAL & CHILD HEALTH 20 PREMATURITY 20 CONGENITAL ABNORMALITIES 21 THE OBSERVATION & HANDICAP REGISTER 21 DETAILS OF CLfNICS 22 THE WORK OF CHILD WELFARE CENTRES 22 DISTRIBUTION OF WELFARE FOODS 22 PROPRIETARY WELFARE FOODS 23 THE WORK OF THE HEALTH VISITORS AND SCHOOL NURSES 24 CLINIC SESSIONS 24 HEALTH VISITORS CASE LOAD 24 HOME VISITS 24 SCREENING PROCEDURES 25 AUDIOLOGY CLINIC 25 MOTHERS' CLUBS 26 ADVISORY CLINICS FOR THE ELDERLY 26 HEALTH VISITORS ATTACHED TO GENERAL PRACTITIONERS AND LIAISON WITH HOSPITALS 26 TRAINING 27 DOMICILIARY MIDWIFERY AND HOME NURSING 27 HOME NURSING 27 LAUNDRY SERVICE FOR INCONTINENT PATIENTS NURSED AT HOME 28 DOMICILIARY MIDWIFERY 28 SUMMONING OF MEDICAL AID 29 NOTIFICATION FROM MIDWIVES 29 OPHTHALMIA NEONATORUM 29 MATERNITY OUTFITS 29 REFRESHER COURSES 30 TRAINING 30 LOCAL SUPERVISING AUTHORITY (MIDWIVES ACT) 30 CERVICAL CYTOLOGY 31 FAMILY PLANNING 31 CHIROPODY SERVICE 32 DENTAL CARE OF MOTHERS AND YOUNG CHILDREN 33 NURSING HOMES 34 NURSES'AGENCIES ACT 1957 34 MEDICAL ARRANGEMENTS FOR CHILDREN'S HOMES 35 HEALTH EDUCATION 36 DR. W.H. KINSTRIE, MB., Ch.B., MFCM., DPH., Medical Officer of Health and Principal School Medical Officer 19 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 and are complementary to the services provided by the Regional Hospital Boards and Executive Councils. The Local Authority Health Services give particular emphasis to the more vulnerable members of the community, - expectant mothers, pre-school children, school children, elderly and handicapped. The emphasis is on early detection of abnormality; cases requiring treatment are referred either to the general practitioner or to hospital. MATERNAL AND CHILD HEALTH Births Notified by Medical Practitioners or Midwives - 1st January - 31st December, 1972 (a) In the area including those normally resident elsewhere (b) Resident in the area including those born elsewhere, i.e. adjusted by inward and outward transfers 1972 1971 1972 1971 Live Still 2558 22 3447 28 Live Still 2263 18 2398 28 TOTAL 2610 3475 TOTAL 2281 2426 Births in Hospital 2153 2268 Births at Home 145 158 The number of home confinements continue to decrease but the work of the midwives has in fact increased since they delivered 148 cases in hospital and provided additional ante-natal and post natal service for hospital booked cases. Prematurity Full schedule showing statistics will be seen in Table 11 in the Appendix to this report. TOTAL Non-Premature Premature 1972 1971 1972 1971 1972 1971 Live births 2263 2398 2247 2262 151 136 Deaths among live births in the first month of life 19 25 9 11 10 14 Stillbirths 18 28 8 12 10 16 The Department of Health and Social Security's definition of a premature birth is one when the infant at birth weights 5 lbs. 8 ozs. or less. 20 Congenital Abnormalities It is a responsibility of the Medical Officer of Health to submit a confidential report to the Registrar General on congenital abnormalities detected at or shortly after birth. The following table shows the total notified to the Registrar General during 1972 :- 1972 1971 Total Number of children born with abnormalities 42 37 Number of those who were stillborn 2 4 Number of those born alive who died within 10 days Nil Nil Number born with serious defects 10 9 Number which were of a comparatively minor nature 32 28 The Observation and Handicap Register There is a growing awareness of the importance of discovering handicapped children as early as possible. Many children acquire their handicapping conditions in the pre-natal, neo-natal or early post-natal periods of life. Infants who have been exposed to unfavourable hereditary or adverse experiences early in life 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. In addition, the growing child may be placed at risk by accident or illness occurring during childhood. In order to ensure that each handicapped child is assisted to the extent necessary to make full use of his 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 they are aged 5 years by regular medical examination and full assessment of their developmental progress. Close co-ordination of the work of various agencies who are concerned with the well-being of a handicapped child is essential and this involves close contact with the general practitioners, hospitals, social workers and voluntary organisations. The Observation and Handicap Register provides the means by which this is achieved and when necessary ensures the future provision of educational facilities suited to the child's ability and handicap. The early years of the child's life are a vitally important period in his development. The young child with a disability which may interfere with normal learning processes needs early help to minimise or overcome the handicap before the child's optimal learning period has passed. The development of such Children is particularly vulnerable because of restrictions which may be imposed by the disabilities on the range and quality of the child's experience and by unfavourable or unenlightened attitudes of parents. During 1972, 84 (109) pre-school children had special medical examinations and full assessment by the Principal Medical Officer. The following recommendations were made in respect of 27 children :- Attendance at: Nursery School 14 Day Nursery 3 Sherwood Park School 1 Short Term Care 2 Physiotherapy 5 Speech Therapy 5 Audiology Clinic 4 Special Schools 3 21 Details of Clinics The Borough is served by Robin Hood Lane Health Centre and eight-purpose built clinics supplemented by a limited number of sessions held in five premises rented on a sessional basis. There was considerable delay in obtaining the final approval of the Department of Health and Social Security for both the Health Centre at Roundshaw and the conversion of Shotfield Clinic into a Health Centre. 11 is anticipated, however, that most of the construction work for these two Health Centres will be completed during 1973. Plans for the conversion of Green Wrythe Lane Clinic into a Health Centre with accommodation for six general practitioners were commenced during the year. A further Health Centre in the grounds of St. Anthony's Hospital, Cheam, was requested by four general practitioners already working in accommodation adjacent to the hospital. After consultation with the South-West London and Surrey Executive Council four general practitioners working in the Cheam area also expressed a wish to work in a Health Centre. A recommendation was therefore made for the purchase of an appropriate site in the grounds of the Hospital. The Work of Child Welfare Centres The work of the child welfare centres consists of the supervision of the development of all children under the age of 5 years with particular emphasis being placed on those children who are considered 'at risk' and those on the Observation and Handicap Register Early detection of abnormality of development is an essential part of the service. Immunisation and vaccination against infectious disease is carried out at clinics as well as by the family doctor. Special Developmental Clinics are held at all the major clinics when children are seen by appointment for assessment of their mental and physical development. Statistics of attendance at the clinics are given in Table V in the Appendix to this report Distribution of Welfare Foods Government Scheme The Council acts as agent for the distribution of National Dried Milk, Cod Liver Oil, Orange Juice and Vitamin A & D tablets to authorised beneficiaries and the actual distribution is carried out by members of the Women's Royal Voluntary Service whose help in this scheme is greatly appreciated. Issues 1st January - 31st December 1972 National Dried Milk (Packets) *Orange Juice (Bottles) A & D Tablets (Packets) Children's Vitamin Drops 1972 1971 1972 1971 1972 1971 1972 1971 4180 8706 13134 57795 2145 3085 10339 4514 'supplies of orange juice ceased in May, 1972 and it is no longer supplied as a welfare food. 22 Proprietary Welfare Foods Infant Welfare Clinics held 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. The sale of proprietary foods is undertaken by voluntary committees at all the clinics, working in close co-operation with the health visitors. The small profit made by these voluntary committees is used to further the work at the clinics. The help given by voluntary workers not only in the sale of proprietary welfare foods but in assisting at infant welfare and other clinics is greatly appreciated. 23 THE WORK OF THE HEALTH VISITORS AND SCHOOL NURSES Health Visitors The work of the health visitors has gradually changed during the past few years, more emphasis now being placed on guidance for all members of a family instead of for the pre-school child and the elderly. The programme of the health visitor not only includes home visits but also consultations in clinics, screening tests and group discussions with parents. The following tables show the extent of their work 1. Clinic Sessions 1972 1971 Ante-Natal and Post Natal 172 356 Infant Welfare and Toddlers Developmental examination 1588 1801 Mothercraft and Parentcraft 321 326 Health Education: Schools, Red Cross, St. John's Ambulance, Youth and Adult Organisations 506 248 Hearing Tests 138 195 It will be noted that there has been a considerable increase in Health Education undertaken by health visitors particularly in Primary Schools. 2. Health Visitors Case Load for children aged 0 to 5 years 0 to 1 year 1 to 5 years families 1972 1971 1972 1971 1972 1971 1554 2183 9279 9458 8581 8730 In addition health visitors had the following case loads:- Ante Natal Mothers 941 Geriatric 912 School children 5 to 16 years 180 Adults 17 to 65 years 268 Mentally ill and Mentally handicapped 92 T.B. contacts 112 Child Minders, Play Groups and Nurseries 87 The Department of Health and Social Security recommendation for the ratio of health visitors to population is 1 to 3000; the ratio for Sutton is 1 to 6000. 3. Home Visits 1972 0 to 5 years 19868 Geriatric cases 1872 Ante Natal visits 941 Mentally ill and Mentally handicapped 397 Visits to other groups 2750 TOTAL 25828 24 Screening Procedures The following screening procedures are carried out: (a) The Guthrie Test at 6 days old for phenylketonuria. No cases were detected in 1972. (b) Cystic Fibrosis at 3 to 4 months of age in conjunction with Queen Mary's Hospital for Children, Carshalton. No cases were detected in 1972. (c) Hearing test at 6 to 8 months. 30 cases were referred to the Audiology Clinic for further investigation. (d) Sickle Cell Anaemia - a condition found in coloured children. Of the 35 children screened one was found to be suffering from sickle cell anaemia. Research continued in the borough in the following projects : (1) National Survey of Health and Development (2) Spina Bifida Survey (G.L.C. Research and Intelligence Unit) (3) British Births Survey (British Births Child Study, St. Mary's Hospital Medical School) (4) Survey of Childhood Cancers (Juvenile Cancer Registry). (5) Congenital Rubella. Audiology Clinic Children under 5 years of age are referred to the Audiology Clinic for a more detailed examination of their hearing in the following circumstances: (1) Children failing their screening test of hearing at 6 to 8 months of age. (2) Any baby whose mother has a history of rubella in pregnancy. (3) Where there is a family history of deafness. (4) All children with slow speech development. (5) Any child suspected of a hearing loss. (6) Any child who has had rhesus incompatibility at birth. The following table gives an indication of the work of the Audiology Clinic : Age New Cases Total Consultations Referred to E.N.T. Dept. No. of hearing aids issued Years 1972 1971 1972 1971 1972 1971 1972 1971 0 - 2 30 50 47 65 3 1 2 1 2-5 87 100 125 149 11 8 8 2 25 The Mothers' Clubs are very entertaining and the young mothers make friends outside the home and enjoy social activities coupled with stimulating educational activities which is a morale booster to young mothers and those moving into the area. Advisory Clinics for the Elderly These clinics are attended by both men and women after they reach pensionable age. A total of 266 sessions were held at the major clinics in the borough, the total attendance during the year being 3968. A health assessment is carried out at the first visit and any abnormality detected is referred to the family doctor. Of the 377 assessments made during the year, 60 were referred to the family doctor. Subsequent visits include talks on nutrition, prevention of accidents, hobbies etc. and following the talks, keep fit exercises. These clinics supplement the work of the Day Centres for the Elderly. In addition to the sessions at clinics, sessions were held at three of the old people's homes in the borough : Bawtree House 24 sessions Brambleacres 21 sessions Franklin House 24 sessions TOTAL 69 sessions Health Visitors attached to General Practitioners and Liaison with Hospitals The majority of health visitors are attached to general medical practitioners as part of a preliminary health care team which includes the general medical practitioners, district nurses and health visitors. In addition to attachments to general medical practitioners, liaison arrangements have been made with paediatric clinics, geriatric clinics, chest clinics and hospitals, and with the psychiatric day centre in Woodcote Road, Wellington. 26 Training In 1972 5 health visitors who were sponsored for training successfully completed their training and were established on the staff in October, 1972. In addition 8 Student health visitors were accepted from other local authorities for practical work instruction. Refresher courses were attended by 6 health visitors and 5 health visitors satisfactorily undertook the projection rourse. One health visitor successfully undertook the field work instructors course. 29 health visitors and clinic nursing sisters attended short courses mainly arranged by the London Boroughs Training Committee. 2 health visitors attended first line management courses. DOMICILIARY MIDWIFERY AND HOME NURSING During 1972 domiciliary midwifery and home nursing services were centralised at the new Clinical Centre in the grounds of Cheam Nurses' Home. The provision of telecommunications for the midwifery service was discussed with Cheam and Sutton Nursing Associations. The total cost of the initial installation with 12 receiving units is approximately £5,000. The Nursing Associations jointly agreed to meet the cost of the installation and I would like to take this opportunity of expressing my appreciation to the Associations. It is hoped that the telecommunications system will be in operation in 1973. Home Nursing The Home Nursing Service has continued to be under constant pressure during the year and the increased volume of work will be noted in the following table : 1972 1971 (a) Number of persons nursed 4695 4488 (b) Number of children under 5 years at 1st visit 265 115 (c) Number of persons aged 65 or over 65 1st visit 3285 2971 (d) Number of visits made by home nurses 169296 151992 In addition to home visits the treatment centre at Robin Hood Lane Health Centre has been manned by district nurses. The total number of persons treated was 3285 resulting in 5436 treatments. 27 Laundry Service for Incontinent Patients Nursed at Home There is a continued demand for the laundry service for incontinent patients both in the borough of Merton and in Sutton. The service is greatly appreciated both by the patient and the relatives as well as by the home nurses. The total number of cases during the year was as follows : Total during year Number of patients on books at end of year 1972 1971 1972 1971 London Borough of Sutton 83 89 46 42 London Borough of Merton 99 99 53 48 Domiciliary Midwifery The following table gives some indication of the volume of work carried out by the domiciliary midwives : No. of domiciliary confinements attended by midwives under NHS arrangements during 1972 No. of confinements attended by D.M. in Hospital No. deliverec in institution but discharged to D.M. before 10th day Total No. of visits made by D.M. Ante Natal visits by D.M. Doctor Present Doctor Not Present Total 1972 1971 1972 1971 1972 1971 1972 1971 1972 1971 1972 1971 1972 1971 21 25 124 133 145 158 148 112 664 614 17880 17741 3814 4070 The number of domiciliary confinements continues to fall but not significantly compared with 1971. The Department of Health and Social Security recommend as far as possible that all women should be confined in hospital but discharged home as soon as possible after delivery. It will be noted that the number of women discharged from hospital before the tenth day increased in 1972. There is increasing emphasis placed on the attendance of domiciliary midwives at deliveries in hospital and the number of such cases shows a significant increase. The number of domiciliary midwives is insufficient for full attachment to general medical practitioners but all have liaison with the groups of practices in the borough. 28 Summoning of Medical Aid During 1972 medical aid was summoned under the Midwives Act 1951 by midwives in the following number of cases: For domiciliary cases: 1972 1971 Where the medical practitioner had arranged to provide the patient with maternity medical services under the National Health Service 140 66 For cases in hospital 139 328 Notification from Midwives During 1972 the following notifications were received from midwives : 1972 1971 Sending for medical aid 279 394 Stillbirths 1 2 Liability to be a source of infection (including Pyrexia) 21 13 Death of mother or baby 1 mother 1 baby It will be noted that one mother died from cerebral haemorrhage as a result of pre-eclamptic toxaemia. This is the first death of a mother for four years. Ophthalmia Neonatorum During the year 1972 midwives sought medical aid for suspected cases of ophthalmia neonatorum in respect of 22 (17) babies, but no cases were notified. Maternity Outfits A maternity outfit is supplied free on request to each expectant mother beingxonfined at home who makes use of one or other of the arrangements for the care of expectant mothers under the National Health Service. 29 Refresher Course for Midwives, Home Nurses and Pupil Midwives Refresher Course Attended 1972 1971 Midwives Home Nurses 4 8 2 6 Practical Work Instructors Course Attended Home Nurses 2 3 Projector Course 4 First Line Management Courses Home Nurses 5 - District Nurse Training Student Home Nurses who completed training and passed the examination 5 9 Pupil Midwifery Training Pupil Midwives from Epsom and St. Helier Hospital Maternity Units receiving their Midwifery Part II training (all were successful in their examination) 33 36 Local Supervising Authority (Midwives Act) The Borough Council as the Local Supervising Authority are responsible for supervising the work of all midwives in the Borough. The following number of state certified midwives gave notice of their intention to practise as midwives in the borough during the year 1972: 121 (100) 30 CERVICAL CYTOLOGY Sessions are held at all the major clinics in the borough and during 1972 frequent evening sessions were arranged for those women who were unable to attend day sessions. In addition to the cervical smears all women have a complete pelvic examination, breast examination, urine test and blood pressure. The National Scheme is for women over the age of 35 years. The Consultant Cytologist at St. Helier Hospital is carrying out a research programme which includes women over the age of 25 years who have had one or more children. In practice any woman who wishes to have a cervical smear is given an appointment. An increasing number of cervical smears are carried out by family doctors. The following tables indicate the work carried out during 1972 1972 1971 Number of visits of women having smears taken for the first time 923 1205 Number of visits of women having repeat smears 1450 1292 2373 2497 Classification of Smears Class Number of Smears 1972 1971 1 1580 1650 II 785 831 III 7 14 IV 1 1 V . 1 The family doctors are informed of the results in all cases and where necessary they arrange for hospital investigation. FAMILY PLANNING The Family Planning Association act as the main agents for the borough when women prefer to attend a Family Planning Clinic rather than attend their family doctor. A small number of residents in the borough, particularly young women, attend the Brook Advisory Agency in Central London. Family Planning is available to all residents in the borough and both advice and supplies were free of charge on medical or social grounds. Family Planning Clinics are held at Priory Crescent Clinic, Green Wrythe Lane Clinic, Shotfield Clinic, Roundshaw Clinic, St. Helier Hospital and Sutton Hospital. There has been an increased attendance at Family Planning Clinics in the borough as a result of which the Family Planning Association arranged additional sessions at most of the clinics. The Domiciliary Family Planning Service was continued throughout the year and the number of domiciliary cases was 23. Authority was given to include Vasectomy as one method of family planning. Arrangements were made through the Family Planning Association for 2 cases on medical or social grounds. 31 CHIROPODY SERVICE The following groups are eligible for chiropody under the Council's scheme (i) Elderly persons, i.e. persons of pensionable age, receiving retirement pensions. (ii) Handicapped persons including registered blind and partially sighted. (iii) Expectant mothers. The following cases were treated at sessions held at the majority of the Council's clinics, at day centres, as well as at the Council's old people's homes and old people's homes run by voluntary organisations, and also at chiropodist's surgeries. 1972 1971 Total number of cases attended 2334 1830 Total number of treatments 11812 9247 Where the elderly or handicapped person is unable to attend the clinic, domiciliary visits are made and 5457 (4929) visits were made in 1972. It will be noted that there was a considerable increase in the number of persons requesting chiropody. Every effort was made to cope with the increased demand in spite of the difficulties in recruiting staff, particularly full time staff, no doubt partly due to the poor salary scales both for full time and sessional chiropodists. 32 DENTAL CARE OF MOTHERS AND YOUNG CHILDREN Although The number of pre school children attending dental clinics for inspections was less than the previous year, more children actually received dental treatment and a greater percentage attended for re-inspections. There are still a few children with rampant caries at a very early age and it is difficult to know what dental officers can do to prevent this. By the time the child attends the clinic the damage is usually done and although young parents know the rules for good dental health it is obvious, in these cases that the rules are broken. The number of children attending as emergencies dropped and general anaesthetics administered and extractions, although higher than 1970 were less than in 1971. Expectant nursing mothers attending for treatment at dental clinics remained small in number, the majority being from families new to the area who had not yet found a general dental practitioner. See Tabic No. VI in the Appendix to this report. 33 NURSING HOMES The following registered nursing homes are situated in the borough :- Carshalton Nursing Home Ltd., 28 Salisbury Road, Carshalton. 103, Woodcote Road, Wallington. The Avenue, 32, The Avenue, Cheam. St. Margaret's, 17, Overton Road, Sutton. Woodcote Grove House (Friends of the Poor and Gentlefolks' Help) Woodcote Park, Coulsdon. The following establishment is also registered as a Nursing Home: St. Anthony's Hospital, Cheam. NURSES' AGENCIES ACT 1957 In the year 1972 there were 4 (4) agencies licensed under this Act in the borough :The Empire Nursing Association Home Care Nursing Agency, 1 Langley Park Road, Sutton Trumps Nursing Agency, 40 High Street, Sutton Surrey Nursing Agency, 3 Mulgrave Road, Sutton Licences are issued annually subject to re-inspection and satisfactory report. 34 MEDICAL ARRANGEMENTS FOR CHILDREN'S HOMES Reception Home, Rosebery House, 7/9 Rosebery Road, Cheam Throwley House, 10 Throwley Road, Sutton Malvern House, Foxley Road, Kenley Camperdown Children's Home, 146 Woodcote Road, Wallington Dean House, 95 Nuffield Road, Merstham Working Girls' Hostel, 57 Montague Gardens, Wallington A general practitioner residing near the Reception Home is responsible for the examination of new admissions and discharges as well as for medical treatment. At ail other homes a general practitioner is responsible for medical treatment. Examinations of new admissions and discharges are carried out by Medical Officers in Department. In addition a medical officer visits all the homes regularly, carries out routine medical inspections annually on all children resident in the home and is responsible for seeing that any special investigations and routine immunisations against infectious diseases are carried out. Advice is also given to the house parents on any medical aspect concerned with the care of the children. Each home is inspected regularly by the Principal Medical Officer and a report on the environmental conditions and the health of the children submitted to the Director of Social Services. 35 HEALTH EDUCATION Use of the Health Education Centre has continued to increase throughout the year From the availability of 51 films, of which 22 were block booked from various film libraries, and 112 sets of slides, the number of bookings made was 1,177. In conjunction with the Education Department a set of slides describing the development of the 5 to 9 year old child was produced to complete the teaching material required for human development. Health visitors, midwives, home nurses and clinic nurses have taken advantage of the Centre's facilities when preparing teaching sessions for the expectant and nursing mother, elderly citizens, independent organisations and community nurse students. Following a one-day audio visual aid display held at the Teachers' Centre during March, the number of teachers using visual aids supplied by the Centre increased by about 50%. In High Schools the health education programmes have continued to complement those undertaken by one of the school medical officers. Additionally some 88 health education sessions have been undertaken by health visitors. Primary School teachers have also sought assistance and information for projects and programmes. This has been reinforced by health visitors conducting programmes in some of the primary schools (68 sessions). Photographs and display materials relating to all aspects of health and social services were produced as part of a three day Careers Convention held at one of the high schools. The Centre conducted audio-visual aid courses and of the 18 borough employees who attended, 17 successfully completed their course and were given certificates of proficiency. Assistance was given in arranging a St. John's F irst A id Course for borough employees held at Robin Hood Lane Health Centre, and a 'Resuscitation Course' was organised and conducted at the Teachers Centre for those teachers interested in attending. In collaboration with Environmental Health a 'Clean Food' campaign was designed and produced, and subsequently displayed at the Cheam and Carshalton Shows. To further promote the campaign leaflets and posters were distributed to all schools and club fetes and this was supported by lectures given by the Environmental Health Service officers. Substantial use of the available audio-visual aid material made by St. Helier Hospital Nursing School is shown by the record of 71 film and 8 slide bookings made throughout the year. The HomeSafety Officer has continued to promote the principles of safety within the home having given 38 lectures to independent organisations and 46 talks at schools. Hazard House was displayed on 17 occasions and a total of six home safety courses were successfully completed by girl-guides and school candidates. 36 SCHOOL HEALTH SERVICE PART IV INDEX Page No. PERIODIC MEDICAL EXAMINATIONS 38 SPECIAL MEDICAL EXAMINATIONS AND RE EXAMINATIONS 38 HANDICAPPED PUPILS 39 PERSONAL HYGIENE 39 GENERAL MEDICAL CLINICS 39 DEFECTIVE VISION 40 DISEASES AND DEFECTS OF EAR, NOSE AND THROAT 40 ORTHOPAEDIC DEFECTS 40 SCHOOL DENTAL SERVICE 40 SPECIAL SERVICES 41 AUDIOLOGY 41 SPEECH THERAPY 41 CHILD GUIDANCE SERVICE 42 SCHOOL PSYCHOLOGICAL SERVICE 43 OBSERVATION AND DIAGNOSTIC CLASSES 45 SCREENING PROCEDURE FOR INBORN ERRORS OF METABOLISM 45 HANDICAPPED PUPILS 45 EMPLOYMENT MEDICAL ADVISORY SERVICE 46 SPECIAL SCHOOLS 46 CAREW MANOR E.S.N. SCHOOL 46 SHERWOOD PARK E.S.N. SCHOOL 47 NORTH DOWNS UNIT 47 BELMONT HOSPITAL SCHOOL 48 QUEEN MARY'S HOSPITAL FOR CHILDREN 48 QUEEN MARY'S HOSPITAL SCHOOL 49 THE FOUNTAIN SCHOOL 49 AUTISTIC UNIT AT QUEEN MARY'S HOSPITAL SCHOOL 51 CLASS FOR NON COMMUNICATING CHILDREN AGED UNDER 5 YEARS 51 HOME TUITION 51 EMPLOYMENT OF CHILDREN OF SCHOOL AGE 52 PROVISION OF MEALS AND MILK IN SCHOOLS 52 Figures in brackets are 1971 figures DR. W.H. KINSTRIE, M.B., ChB., MFCM, DPH, Medical Officer of Health and Principal School Medical Officer 37 REPORT OF PRINCIPAL SCHOOL MEDICAL OFFICER SCHOOL HEALTH SERVICE I take this opportunity of thanking the head teachers of all the schools in the borough for their help during the year, particularly in the arrangements for medical inspections at school. On 31st December, 1972 there were 10,368 (10,049) pupils in High Schools 14,220 (14,028) pupils in Primary Schools 299 ( 295) pupils in full-time equivalent places in Nursery Schools. This shows an increase of 515 pupils over the previous year. Periodic Medical Examinations During 1972 periodic medical inspections were carried out on (1) all new entrants to school (2) all school leavers Selective medical examinations are carried out on all pupils in their eighth and eleventh years. 48.6% of children in the 8 year old age group and 47.4% in the 11 year old age group were selected for full medical examination. The selection for full medical examination is carried out by a medical officer after scrutinising each parent's completed questionnaire and the pupil's school medical records. Children also have a full medical examination when this is requested by a parent or head teacher. In addition to periodic medical inspections pupils have a vision test at 5,8,11,13 and 14'/4 years of age and a colour vision test at the age of 11 years. Pupils aged 6 years have a screening test for hearing carried out by an audiometrician. There are three independent schools within the borough who avail themselves of these services with the consent of the Council Homefield School St. Hilda's School Wallington Independent Grammar School (now closed) Special Medical Examinations and Re-examinations Pupils are re-examined when necessary following periodic and selective medical inspections or when referred for examination by the head teacher, school nurse and at the request of parents. These pupils are examined either at the school or at general medical clinics. The total number of re-examinations in 1972 was 1680 ( 2119). Full details of defects found at periodic and special medical inspections are given in the appendix to this report - see Tables VII and VIII in Itie Appendix. 38 Handicapped Pupils The following table shows the number of handicapped children attending primary and high schools as at 31st December 1972 :- 1972 1971 Epilepsy 90 65 Heart Defect 30 26 Hearing Defect 45 38 Diabetic 31 26 Physically Handicapped 68 60 Partially Sighted 10 9 Other Handicaps 9 6 Personal Hygiene Routine hygiene inspection of pupils is carried out at the request of the head teacher or at the school medical officer's or school Nurse's discretion. Regular hygiene inspections each term have not been necessary at any school during 3972. The total number of inspections carried out was 3387 (4994) and 60 (96) were found to be infested. It is the responsibility of the parents to carry out treatment but when necessary children are treated at school clinics. With the co-operation of parents all home contacts are inspected as well as contacts at school. General Medical Clinics These clinics are held throughout the borough and are used to treat minor ailments, examine children brought forward for special examinations, children who require re-examination following periodic medical examination and the re-examination of handicapped children who are receiving education in special schools outside the borough. The principal minor ailments treated are diseases of the skin. One of the school medical officers has specialised in the treatment of diseases of the skin particularly the treatment of verrucae and cases are referred by general medical practitioners as well as by school medical officers. A special clinic for removal of verrucae is held each Friday afternoon at a central clinic, with inspection the next Monday morning, thus ensuring prompt treatment and pupils losing the minimum amount of time from school. The total number of pupils treated for minor ailments excluding skin diseases in-1972 was 145 (305). The total number of pupils treated for skin diseases was 397 (358). There has been an increase in the number of children treated for verrucae, no doubt due to the increased vigilance of teachers in identifying a skin condition of the feet and referring the pupil for treatment. There is no doubt in my mind however that a number of the cases are the result of physical training and dancing being carried out in bare feet. 39 Defective Vision By arrangement with the South West London and Surrey Executive Council treatment of defective vision and squint is carried out at Local Authority Clinics. The total number of pupils treated for defective vision including squint in 1972 was 1571 (1744). Spectacles were prescribed for 583 (545). Diseases and Defects of Ear, Nose and Throat The total number of children treated for these defects in 1972 was 111 (89) of whom 31 (39) had operative treatment, mainly for tonsils and adenoids. Orthopaedic defects Physiotherapy sessions for minor orthopaedic and postural defects are held at clinics, at Carew Manor E.S.N. School, Sherwood Park School and at Observation/Diagnostic classes. In addition many handicapped children, the majority aged under 5 years, receive treatment at the physiotherapy clinics after consultation with the staff of the hospital where the child attends. The total number of pupils treated at clinics in 1972 was 142 (307). An increasing number are treated at schools instead of attending clinics. SCHOOL DENTAL SERVICE There has been a growing awareness of the need for 'prevention' during the past year, probably stimulated by television programmes and the dental service has had many enquiries for preventative dentistry, (i.e. Topical application of flouride and the use of fissure sealants). As the present dental establishment is only just able to cope with the volume of work required to repair the ravages of dental caries, there seems little hope of 'prevention' becoming a part of the School Dental Service in the near future without the addition of extra staff. The need for dental treatment (44.5% in need of treatment at their first inspection during the year.) and the number attending clinics for treatment remains fairly constant, but for the third year in succesion extractions have risen slightly, although there has been a drop in the number of permanent teeth extracted in the 5-9 age group. More time has been spent on dental health education during the year. Sixty nine visits were made to schools, clubs etc. chiefly by health visitors, showing films, slides, models and charts on dental health. One school worked on a dental health project for almost a whole term, great interest being shown by parents who came to inspect the children's work, and watch a film at the end of the project. Much use was made of disposable toothbrushes and disclosing tablets, and about 500 children received individual instruction as to their correct use when attending dental clinics. For the first time for several years there have been very few staff changes. This ensured that good relationships built up between dental staff and schools were maintained and during the past year dental officers were welcomed in twelve schools for re-inspection sessions. 40 SPECIAL SERVICES (a) Audiology The early diagnosis of children with partial hearing loss is essential if normal progress is to be achieved in the development of speech and the child's education. The great majority of cases of deafness are diagnosed by hearing screening tests before the child begins school. All children referred for speech therapy have a routine hearing test at the audiology clinic prior to commencing therapy to ensure that they have not in addition to their speech defect any hearing loss. This is carried out by the Audiometrician but when the child is too young to co-operate they are tested by the Audiologist. All school children who show any defect of hearing on screening are referred to the school medical officer who decides whether it is necessary for them to be referred for further investigation and treatment. I n cases where there is a severe loss of hearing, the pupil is referred to the 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 partially 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 the most advantageous position near the teacher. The teacher for the deaf visits each school or unit at which a child attends who has a hearing loss to discuss the treatment and progress of each child with the head teacher. The co-operation of teachers in this respect is much appreciated. New cases supplied with hearing aids during 1972 7 (10) Pupils registered at having been fitted with hearing aids as at 31st December 1972 64 (51) Total number of children seen by Audiometrician 2415 (2477) Number referred for further investigation 103 (136) (b) Speech Therapy Speech therapy sessions are held at clinics and also at Carew Manor E.S.N. School, Sherwood Park School, Observation/Diagnostic classes and classes for non-communicating children at Queen Mary's Hospital for Children. In addition, a speech therapist attends an independent school for E.S.N./Maladjusted children once a week. It has become increasingly difficult to recruit the services of speech therapists e^iecially to work with mentally handicapped children. It has only been possible to maintain a service by the co-operation and help of the present staff. The total number of children attending for speech therapy in 1972 was 239 (272). 41 (c) Child Guidance Service Many clinics in the country have changed their name to Child and Family Psychiatric Clinics to make it clear that the parents are given as much consideration as the child. Sutton Clinic, although still retaining the old name, is also involved with parents as well as the child or adolescent. The staff of the clinic work closely with their colleagues in the Health, Social Services and Education Departments, psychiatric colleagues in hospitals and with general medical practitioners. Educational psychologists working within the School Psychological Service are based at the Child Guidance Clinic thus creating a closely integrated service. Following diagnostic interviews, treatment may be carried out at the clinic or referred for follow-up by the most appropriate agency. Emotionally disturbed children in need of special schooling are placed either in North Downs Day Special School or in residential schools for maladjusted children. The teachers of North Downs discuss the progress of the children regularly with the Psychiatrist at the clinic. The number of children referred to the Child Guidance Clinic during 1972 was 175 (149). The number of families actually seen and treated at the clinic during 1972 was 190. Full details of the work of the Child Guidance Clinic are given in Table X in the Appendix to this report The clinic is used by the Institute of Education (Diploma in the Education of Maladjusted Children), Croydon Technical College (Applied Social Studies Course), University of London (External Diploma in Applied Social Studies), Queen Mary's Hospital for Children (Diploma of Child Health) Belmont Hospital (student nurses) and Chiswick Polytechnic (Social Work Course), as a field placement for their students who are supervised by professionally qualified members of the clinic staff. Psychiatric Registrars come from nearby mental hospitals for a training in child and family psychiatry. 42 (d) School Psychological Service The largest proportion of the time of the School Psychological Service is spent on the assessment of individual children who are referred to the psychologists for a great variety of reasons. In broad terms, however, most of the children are referred because of learning or emotional difficulties of some sort or, as is often the case, a combination of the two. Since the School Psychological Service was established in Sutton in 1965 there has been an open referral procedure. I n other words any parent, teacher, doctor, social worker or other person in professional contact with children is able to approach the School Psychological Service about any child in their care. It will be seen from Table XI in the Appendix to this report that the majority of referrals in fact come from the schools, with the School Health Service which co-ordinates referrals from many health sources taking an important second place. The Education Department as such does not directly refer many children. During 1972 the work of the School Psychological Service was carried out by two Educational Psychologists. Each nursery, primary and high school in the borough is assigned to one of the psychologists who is therefore independently responsible for all cases involving pupils of those schools. The work in the special schools and units is shared by both psychologists. Table XI (iii) shows that last year children from the age of 2-16 were seen. One tenth of the children atn are in fact of pre-school age. Anticipating the educational needs of these children is an important part of our work. In the case of school referrals, it is normally the head teacher who initially contacts the School Psychological Service. In many cases the referral has been jointly agreed by the parents and the head teacher and in all cases the psychologists ask the head teacher or other referral agency to make sure that the parents are aware of the referral and given their consent to it. Because in this borough parent-teacher relationships are on the whole close and constructive it is rare for a parent to feel the need to approach the School Psychological Service independently, but they have the right to do this if necessary. As well as the assessment of new cases, the Educational Psychologists have aiso been committed for some years to a programme of review of the children attending the special schools and units within the borough. This programme has gradually become more complex and Sutton children attending special schools and units outside the borough are also being seen at regular intervals. Our most long-standing commitment has been with Carew Manor School for E.S.N, children where since 1965 there have been two psychologist sessions per week in term time. The children at Carew Manor School are each seen at least every two years although the staff can raise queries about any child at any time. We are now building up a similar arrangement at Sherwood Park School and the children attending the Infant Observation/Diagnostic Unit are usually seen at least once a year. It is very important for the parents of the children concerned to appreciate that placing a child in a Special Unit is not a once and for all action but one which we are keen to re-examine regularly to ensure that it is still the most appropriate action. We have a system of discussion with the staff plus review for the children attending the North Downs Maladjusted Unit. 43 With the encouragement of the Principal School Medical Officer we also review children attending partially hearing units and schools for deaf children outside the borough and we have begun to review all those attending schools for partially-sighted children. Children attending special boarding schools are usually seen during their holidays although we do visit some at their schools. Besides their work for the School Psychological Service, the Educational Psychologists have a second role as members of the Child Guidance Clinic team. Each new referral to the Child Guidance Clinic is discussed at a weekly meeting and when it is felt necessary an Educational Psychologist will arrange to see a child as part of the diagnostic procedure. Whether the child is assessed individually by the Educational Psychologist or not, the psychologist is informed of the action proposed or taken in each case and undertakes most of the liaison work between the Child Guidance Clinic and the school concerned. A proportion of the children seen under the auspices of the School Psychological Service are referred by the Educational Psychologists to the Child Guidance Clinic. Other responsibilities undertaken by the School Psychological Service include : Regular Conselling sessions at some high schools. Lecturing to In-service Training Courses organised by the Education Department. Lecturing to Probationary Clinical Psychologists, Play-group Leaders, parents' groups etc. Supervision of Trainee Educational Psychologists. Liaison with Queen Mary's Hospital Psychology Department, especially in regard to the work of the Fountain School and Autistic classes. Membership of Working Parties established by the Education Department. Co-operation with Advisory Division of Education Department in screening programme for Remedial Education. 44 OBSERVATION AND DIAGNOSTIC CLASSES During 1972 two extra classes were established to cater for the increased need for this type of educational provision. The total of four classes was transferred to premises at 18 Stanley Park Road. Wallington, to form a special unit under the direction of a teacher in charge. Each class caters for 10 children aged between 5 and 7 years and is staffed by a trained teacher and a school helper. The children admitted to the classes are fully assessed prior to admission some transfer from infant classes in ordinary schools having failed to settle and make progress. Other admissions are for children whom it is considered would be unable to make progress in a large infant class. Each term a conference is held, attended by the teacher in charge, class teachers, the Educationa Psychologist, Speech Therapist, Principal Medical Officer, and Chief Education Officer to discuss each child's progress and future school placement. The staff of these classes are satisfied with their new accommodation although I still consider it desirable that the Observation/Diagnostic Classes should be attached to I nfant Schools. 11 is regrettable that children ascertained as being educationally sub-normal cannot be adrritted to Carew Manor School before the age of 7 years. If a 6 year old class was available at Carew Manor School some children could be transferred from the unit much earlier, thus enabling other children to be admitted for observation. The classes have been most valuable since their establishment and have formed an essential part of observing children's handicapping conditions closely in order to ensure that they are recommended for the type of education best suited to their needs. During 1972 a total of 43 children attended the classes (a) 3 children transferred to Carew Manor E.S.N. School (b) 1 child transferred to Sherwood Park E.S.N. School (c) 1 child transferred to a day school for emotionally disturbed children (d) 1 child transferred to Ravensbury E.S.N. School, Mitcham. (e) 1 child left the area. (f) 36 children remained on the Register at 31.12.72. SCREENING PROCEDURE FOR INBORN ERRORS OF METABOLISM Research has shown that certain handicapping conditions (i.e. mental retardation, disturbed behaviour and epilepsy) can be caused in a small percentage of children by an inborn error of metabolism. In conjunction with Queen Mary's Hospital for Children, screening continues to be carried out for new pupils attending Carew Manor E.S.N. School, Sherwood Park E.S.N. School and the Day Unit for Maladjusted Children. 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. 45 The Chronically Sick and Disabled Persons Act 1970, requires the education of autistic and dyslectic children, neither of which are amongst the categories of handicaps listed in the 1959 regulations. Under the Education (Handicapped Children) Act 1970, local Education Authorities, are required to make provision to bring within the education system all those children who were previously considered unsuitable for education in school. No child within the age limit for education therefore is outside the scope of the educational system. Children who have one or more handicaps may require special educational treatment if they cannot be educated satisfactorily in 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. Table XII in the Appendix to this report gives full details. EMPLOYMENT MEDICAL ADVISORY SERVICE Under the Employnent Medical Service Act 1972 a new Employrrent Medical Advisory Service is being set up under the Department of Employment. It is expected to come into operation early next year. One of the tasks of the new service will be to provide medical supervision where necessary for young people entering employment. This will replace the medical examination under the Factories Act of young people entering factory employment and will concentrate on those young persons in need of medical advice. The appointed factory doctors will be replaced by a much smaller number of doctors (to be known as Employment Medical Advisers). These E.M.A's will have a wider range of duties and more expertise in occupational health matters. The Department of Employment medical advisors will be the nucleus of the new service, they will also take on the medical supervision of persons undergoing training and rehabilitation at Government Training Centres and Industrial Rehabilitation Units. The E.M.A's will accordingly provide a focus for all medical activities within the Department of Employment and will create a corps of experts in the field of occupational medicine to whom anyone needing advice on any aspects of this branch of medicine can turn. The new service will provide for links between the school medical officer, careers officers and employment medical advisor. Under the new service the School Health Service will be responsible for identifying those pupils who have some departure from normal health which might affect their choice of employment. Careers officers will play an important part in ensuring that young people in need of medical advice for employment purposes obtain it from the employment medical advisor. SPECIAL SCHOOLS Carew Manor E.S.N. School This special school is a day school for 140 educationally sub-normal boys and girls aged from 7 to 16 years. The average number of pupils attending in 1972 was 137. Before a child is admitted to this or any other school for educationally sub-normal children, a fu|l medical examination is carried out and reports are obtained from an educational psychologist and if necessary from a psychiatrist. Every child attending the school has a physical examination annually and is psychologically assessed every 2 years or at the request of the head teacher or the parent. In addition to regular weekly sessions at the school by the Senior Medical Officer and educational psychologist, two physiotherapy sessions are held each week and two sessions devoted to speech therapy. The teacher for the deaf also visits regularly. 46 Before a pupil leaves school at the age of 16 years, a full medical and psychological assessment is carried out. A case conference is held during the pupil's last year in the school. The headmaster, careers mistress, principal medical officer, senior medical officer, educational psychologist, youth employment officer and social workers attend and a decision is made regarding the type of employment or training best suited to the pupil. In some cases pupils may not be accepted into employment immediately on leaving school or may drift from one job to another. In these circumstances a recommendation is made that pupils should be supervised by the Director of Social Services, who may arrange for the pupil to have training in a sheltered workshop prior to taking up open employment in the community. Many children are ascertained as being educationally sub-normal before they reach 7 years and a number h»e been placed in E.S.N, schools in neighbouring authorities. There is no doubt that these children should attend a school as near their homes as possible and it is hoped that additional accommodation in Carew Manor E.S.N. School will be made available for children aged under 7 years as soon as possible. Sherwood Park E.S.N. School This school provides education for 70 mentally handicapped children aged between 3-16 years. The school transferred to the new purpose-built premises in April 1972 and was officially opened in October 1972 by Lord Belstead, Under-Secretary at the Department of Education and Science. The accommodation comprises 7 classrooms including a fully equipped nursery. In addition, facilities are available for cookery and pottery. One of the greatest assets of the school is the indoor heated swimming pool, part of the cost of which was contributed by the Sutton and District Society for Mentally Handicapped children. The new school provides a stimulating and educational environment with a wide curriculum which will give every advantage to the mentally handicapped child including the very young, to progress and function to the maximum of his or her ability. The average number on the school roll is 59. Bearing in mind the command paper "Better Services for the Mentally Handicapped" 2 children attend the school daily who are resident in Queen Mary's Hospital for Children, 10 from a private community home in the borough and one who is resident in the reception home of this authority. A speech therapist and physiotherapist each carry out two sessions per week in the school. A conference is held each term to discuss new entrants to the school and any pupil brought forward by the school staff and any problem arising of a general nature. Case Conferences for school leavers are held as reported for Carew Manor fc.S.N. School. North Dowis Unit The Unit caters for three groups of maladjusted children. The children remain on the register of their ordinary school and attend the Unit for varying periods from 1 to 4'A days each week. The children recommended for admission to the Unit are carefully selected in conjunction with the child psychiatrist and head teacher of the Unit. Many maladjusted pupils require continued contact with their homes and parents which can only be achieved by provision of day school places. The head teacher of the Unit continues to have close contact with the parents of children attending the Unit. At North Downs Unit the child can continue with his or her normal school curriculum. The primary purpose of the Unit is therapeutic and an environment is provided in which the child is helped to come to terms with his disabling emotional difficulties. 47 The number of children who attended the Unit during 1972 was 31. The number of children discharged during 1972 was 10. 6 returned full time to High School. 1 returned full time to Primary School. 1 left at school leaving age. 1 left to attend Carshalton College of Further Education on attaining school leaving age. 1 was admitted to a day school for emotionally disturbed children. Belmont Hospital School At Belmont Hospital there is a diagnostic unit for non-communicating children aged 3-8 years. They are referred from a wide area in the South of England. The children have a variety of severe language and emotional disorders. The Unit which is residential with accommodation for 12 children, is staffed by a multi-disciplinary team consisting of a consultant psychiatrist, two teachers, an educational psychologist, a speech therapist and nursing staff. The children's stay in the Unit varies from a few months to two years when they are suitably then placed in school. During 1972 14 children received tuition as in-patients and 16 children were seen as out-patients. 5 children were discharged from the Unit during 1972 to the following schools : 1 Sherwood Park E.S.N. School 1 Rudolf Steiner School, Thornbury, Bristol 1 Bridge House Home School, Reading 1 Hope Lodge School, Southampton 1 Coulsdon Nursery School, Coulsdon Queen Mary's Hospital for Children Queen Mary's Hospital for Children which is situated within this borough is the largest children's hospital in this country. It was inaugurated in 1909 and treats all children's illnesses both acute and chronic. Altogether there are 726 beds of which 340 are for mentally handicapped children on psychiatric wards, and 386 for paediatric and other cases. In addition to the clinical departments, there are since 1st April 1971 two London Borough of Sutton schools within the hospital, one for children receiving hospital treatment in the paediatric wards, known as Queen Mary's Hospital School, and the other for mentally handicapped children known as the Fountain School. A number of children attend the schools daily from Sutton and surrounding boroughs. 48 Queen Mary's Hospital School When a child is admitted to hospital it is essential to continue his or her education as soon as he or she has sufficiently recovered from illness to do so. The school has the responsibility for teaching all children aged over 2 years who have been admitted to hospital and are in the opinion of the medical staff fit enough to have schooling. Teaching takes place in the wards and in some class room set aside for school use. The latter includes the units for cerebral palsy, spina bifida, muscular dystrophy, maladjusted, autistic and non-communicating children aged under 5 years. The school in Queen Mary's Hospital is unique. It enables all children to follow their education at the same level as prior to admission, and in the special units the staff form part of a team, reporting on the educational needs of each child and their opinion as to a child's future school placement when they no longer receive education in the hospital. The average number on the Roll on 31st December 1972 was 175 (167). Approximately 30 children come from the London Borough of Sutton and 20 children attended the school on a daily basis, 12 from the London Borough of Sutton and 8 from surrounding boroughs. (Maladjusted Unit 5; Palsy Unit 3; class for non-communicating children aged under 5 years 7; and Autistic classes 5). The Chief Education Officer and Principal School Medical Officer with the co-operation and help of the medical nursing and teaching staff at Queen Mary's Hospital for Children prepared a detailed report to indicate the educational needs of children who are being taught at Queen Mary's Hospital School, the teaching and auxiliary staff required and the need for teaching accommodation and storage facilities. The compiling of this report was commenced during 1972 and it is hoped it will be submitted to the Education Committee early in 1973. The Fountain School Under the Education (Handicapped Children) Act 1970, the Education Corrmittee became responsible for the education of approximately 340 children aged over 2 years resident in the subnormality wards of the hospital and who are severely mentally handicapped. The detailed report to which I referred in my last annual report was subrritted to the Education Committee and the recommendations have been accepted by the Council. Prior to April 1971, 114 children aged between 4 and 16 years of age received education in a training centre in the hospital known as the Fountain School. It is generally agreed that it would be in the child's best educational interest to receive at least part of his education away from the wards but at present it is not possible to implement this owing to the limited teaching accommodation. The educational provision at the Fountain School on 31st December 1972, as listed below, will give an indication of the expansion of educational services in the Fountain School during the year. The Fountain School now provides education for all mentally handicapped children resident in the hospital either in the Draper Building, 'F' Block and on the wards. Some children attend the school on a daily basis from the London Borough of Sutton to receive education in one of the above sections of the school. There are 108 children receiving education in the Draper Building and 'F' Block and 216 Ward Groups. 28 teachers in addition to the head teacher and deputy were in post. In addition, 42 classroom assistants have been appointed. In school, 1 teacher and 1 classroom assistant work with a group of 10 children. On the wards, 1 teacher and 3 classroom assistants work with a group of 20 children giving individual attention. 49 The school consists of 12 classes as follows:- (1) Draper Building 6 classes grouped chronologically from4-16 years (plus 2 classes for physically handicapped group) 'F' Block Class 8. Pupils over 16 years are receiving ore-industrial training. Class 9. 8 daily children from Sutton and Wandsworth attend. Class 10. 8 children admitted to hospital for short term care and suitable to attend school. Class 11. A group of severely mentally handicapped children who are being given a triai in school out of the ward. Annexe to E.6 (extension) A group of 6 blind children Class 13. A group of 4 deaf children. (2) Teachers have been allocated to the following wards :- C 1/2; C 3/4; C 5; C 6; F 1/2; F 4; F 5/6; E 5/6; E 7/8; D 9; D 10. Although severe mental handicap is regarded as the major disability in all children receiving education at the Fountain School, a high proportion of the children suffer from an additional handicap, i.e. 125 physically handicapped, 6 deaf, 5 partially sighted, 15 blind, 34 epileptic. In addition some children suffer from a degree of emotional disturbance from slight to very severe. Although most children with mental handicap are now cared for in the corrmunity due to the increased services now available, I would envisage that the more profoundly and multiple handicapped child will continue to receive education in the future at the Fountain School Much research has to be done and knowledge yet to be gained concerning the techniques of teaching the profoundly and multiple handicapped. Queen Mary's Hospital for Children has much to contribute in the future. The full implementation of the Education (Handicap Children) Act 1970 has only been made possible by the co-operation and help of all the hospital staff. Case conferences are held regularly at all levels and each discipline contributes their own particular skill, exchanging ideas and working as a team for the advancement of each child. This year has been memorable in that it has seen the extension of education to all children aged over 2 years. The greatest need is for additional classes and it is hoped that the new extension to the Draper School will be commenced without delay. It is too early to assess the full benefit of education to all the children. Many children have improved in responsibility and functioning level, especially the profoundly retarded. A start has been made - much work remains to be done. I would like to take this opportunity of thanking all the staff at the Queen Mary's Hospital for their help and co-operation during the year as without this nothing would have been achieved. 50 Autistic Unit at Queen Mary's Hospital School This Unit consists of two classes which provide education for children aged over 5 years who have been diagnosed as suffering from autism. Each class caters for 4/5 children and is staffed by a full-time teacher and a helper from Queen Mary's Hospital. Children attending the classes are either resident in Queen Mary's Hospital or attend daily from homes within the borough, or occasionally from other boroughs. The classes are attended regularly by a speech therapist, psychologist, psychiatrist and teacher of the deaf. Each term a conference is held to discuss the progress and placement of the children. Children are also admitted to the classes for a diagnostic and assessment period which has proved most useful. During 1972, 3 new children were admitted to the Unit and 2 discharged, one child to the Fountain School and one to receive education in a Ward Group. Class for Non-comnunicating Children aged under 5 years at Queen Mary's Hospital This is a class for children aged under 5 years who have failed to develop speech. The class is divided into two groups with usually four children attending the group during the morning or afternoon. Each class is staffed by a trained teacher and classroom assistant. Children are admitted to the class from a very early age which has proved most valuable as it enables small children with this disability to receive early education and observation by experienced staff. The classes are attended regularly by a speech therapist, psychiatrist, psychologist and teacher of the deaf. Case conferences are held every term. Children attending the class are either resident in the hospital or attend daily from within the borough or from other boroughs. During 1972 6 new children were admitted to the class and 5 children discharged to:- 1 E.S.N. Special School 1 Ordinary Nursery School 1 Belmont Hospital Unit 1 Residential School for Autistic Children 1 Observation/Diagnostic Unit HOME TUITION A small number of children are so severely handicapped either temporarily or permanently as to be unable to attend school. Home tuition is arranged in these cases for as long as is necessary. During 1972, home tuition was arranged for 23 children (15 including 3 severely mentally handicapped children.) During the year, tuition was also arranged at the following hospitals St. Helier Hospital 426 children Royal Marsden Hospital 19 children St. Anthony's Hospital 1 child 51 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. The number of children examined during 1972 was 175 (251). PROVISION OF MEALS AND MILK IN SCHOOLS School Meals The number of day pupils receiving midday meals per day both at maintained and non-maintained schools during 1972 was as follows :- 1972 1971 Average meals (maintained schools) 15,713 14,841 (non-maintained schools) 415 350 It is gratifying to note that an increased number of children are receiving midday meals in school. Milk in Schools Free milk is provided in maintained schools for the following categories of children :- (a) Pupils in Special Schools (b) Pupils in other maintained schools up to the end of the summer term after they attain the age of 7 years. (c) Other pupils in Primary Schools where the school medical officer certifies that the pupil's health requires that he/she should be provided with milk at school. During 1972 medical examinations were carried out on children in the age group where free milk was withdrawn as follows (a) all children where any medical defect was known (b) all children receiving free meals in school (c) any children recommended for medical examination by the Director of Social Services (d) all children brought forward by the head teacher of the school (e) the parent of any child who requested the child's medical examination to ascertain whether he would benefit from free milk in school. In addition, school medical officers recommended free milk in necessary cases following periodic and selective medical examinations in schools and re-examination of school children in the appropriate age group. Average number of day pupils receiving milk in school Maintained Schools 5,732 (5,953) Non-maintained Schools 702 (739) At 31st December 1972, 1,487 pupils were receiving free milk in school. The approximate number of children purchasing milk each day was 2,025. 52 MISCELLANEOUS PART V INDEX Page No. STAFF MEDICAL EXAMINATIONS 54 OFFICERS 54 MANUAL STAFF 54 GENERAL 54 HEAVY GOODS VEHICLE DRIVING LICENCES 54 MEDICAL EXAMINATIONS UNDERTAKEN DURING 1972 54 HOUSING DEPARTMENT 56 (Figures in brackets are 1971 figures) DR. W.H. KINSTRIE, MB., ChB., MFCM., DPH MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER 53 MISCELLANEOUS STAFF MEDICAL EXAMINATIONS Officers In order to ascertain fitness for employment, the candidate either completes a medical questionnaire or a full medical examination is carried out by 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. Manual Staff A medical examination to ascertain fitness for employrrent is carried out 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 before commencing employment and at the discretion of the Medical Officer of Health, bacteriological examination of stools or any other investigation considered necessary. Employees of the Council generally Certain members of staff having close contact with children are required to have a periodic x-ray examination of the chest, for example, health visitors, district nurses, social workers, etc. A similar condition of employment was introduced for teaching and ancillary staff at schools appointed after 1st September 1969. Under certain circumstances members of the staff are granted an extension of sick leave when their normal sick leave period has expired. Members of staff referred by Chief Officers to determine fitness to continue employment after the age of 65 years are required to pass a medical examination and are re-examined periodically. Heavy Goods Vehicle Driving Licences - Road Transport Act 1968 A medical examination is now required to ascertain fitness prior to prospective drivers of heavy goods vehicles being granted a licence. Medical Examinations undertaken 1972 1971 Officers (excluding teachers) 223 161 Teachers 280 313 Manual Staff 261 235 Extensions of sick pay 7 9 Retirement due to ill health 12 11 Extensions of service beyond retiring age 126 128 Heavy Goods vehicle drivers 40 35 Trainee Teachers 246 174 54 1972 1971 Medical Questionnaire (without Medical examination) 194 211 Other Medical Examinations Officers (including teachers) who had chest x-ray only 254 160 School Canteen staff who had chest x-ray only 329 261 School Canteen staff who had chest x-ray and bacteriological investigations 21 84 Routine triennial chest x-ray examinations 287 56 HOUSING DEPARTMENT New Properties During 1972, 164 (252) properties were completed. These were all at Benhill Avenue, Sutton and were part of the total developrrent. Casual Vacancies, Mutual Exchanges and Transfers 256 (246) properties were vacated and re-let during the year; 129 (82) mutual exchanges and 169 (152) transfers were arranged. Rehousing from Clearance and Redevelopmnt Areas To provide for the closing or demolition of dwellings 21 (9) families were rehoused. Housing Waiting List At 31st December 1972, there were 2497 (2337) applicants on the Council's Housing Waiting List of which 746 (656) were elderly people. Housing of Special Cases The number of applicants housed during 1972 under the delegated authority granted to the following officers was :- Medical Officer of Health 95 (59) Housing Manager 16 (17) Director of Social Services 17 (18) At the 31st December 1972 there were 268 (159) further cases in which urgent rehousing had been authorised under delegated powers, and awaiting solution. Total Number of Properties The total number of properties owned by the Council and let by the Housing Department as at 31st December 1972 was 8650 (7535). This figure includes the 951 properties transferred by the Greater London Council (Roundshaw Estate) in April 1972 to this authority. Shanklin Road, Belmont Part of the Greater London Council's housing scheme on the site of the former prefabricated bungalows at Shanklin Road was completed during 1972. In accordance with the agreement between London Borough of Sutton and the Greater London Council, the first thirty nominees were housed out of a total of one hundred and forty on this estate. 56 ENVIRONMENTAL HEALTH DIVISION PART VI 1.1 At the time of publication of this report the day on which the new Health Authorities become operative, the 1st April, 1974, will be close. On that date the Environmental Health Service will constitute the whole of the Local Authorities health responsibility. During the last few months many people, including, unfortunately, some Council members, have spoken in terms of the loss of the Health Department from the Local Authority Service. The duties that will remain include functions upon which the modern local government service was founded and it is hoped that the readers of this report will realise that the Environmental Health Service plays an important part in the comfort and well-being of those who live, eat and work within the Borough. Traditional links will be broken. This is perhaps the most fitting time to express my thanks to my medical colleagues whose help and guidance I have appreciated in 1972 and eerlier years. My gratitude is also due to the Chairman and members of the Committee, the Medical Officer of Health and all members of the staff of the Environmental Health Team who have helped to make my task in serving the London Borough of Sutton a pleasant one. D.A. EVES, D.M.A.,M.R.S.H.,M.A.P.H.I. Chief Public Health Inspector 57 1.2 STAFF LIST (A) = Appointed 1972 (R) = Resignation or Retirement 1972 NAME DESIGNATION ALLEN, Miss L. Clerical Assistant (T ransferred) ANSELL, Mrs. C. Clerical Assistant (A) BAILEY, C. Technical Assistant BARNES, MissS.A. Clerical Assistant BENNETT, P.J. Clerical Assistant (A) BISHOP, D.F. Assistant Mortuary Superintendent BROWN, T.S. General Assistant CARROLL, Mrs. D.E. Administrative Officer CHARMAN, B.W. General Assistant COLLINS, L. Clerical Assistant CONWAY-SMITH, R. Pest Operative DIXON, J.P. Assistant Chief Public Health Inspector EDWARDS, R.H. Mortuary Superintendent EVES, Q.A. Chief Public Health Inspector FORD, Mrs. E.P. Cleaner FREEMAN, J.A. Pupil Public Health Inspector GUNNELL, P.W. Public Health Inspector HAMILTON, Mrs. A. Clerical Assistant (R) HAMILTON, R.J. Public Health Inspector HARE, Miss J. Clerical Assistant (R) HAYES, R.S. Pest Operative HUTCHISON, R. Pest Operative KILLBY, E. Public Health Inspector LE PETIT, Mrs. A.C.N. Audio Typist LIGGETT, N.F. Technical Assistant LOWE, S.S. Public Health Inspector LOWTH, MissS. Clerical Assistant (R) MAY, D.G. Technical Assistant MILNE, Mrs. C.M. Clerical Assistant MORAM, T.W. Technical Assistant (A) MURPHY, P.B. Pupil Public Health Inspector MYERS, W.G. Public Health Inspector O'BRIEN, Mrs. M. Temporary Audio Typist (R) PORTER, Mrs. C.E. Clerical Assistant REAVLEY, J.W. Senior Public Health Inspector (A) ROGERS, L.A. Technical Assistant ROUTLEDGE, E.A. Public Health Inspector RUSSELL, MissS. Secretary SELL, W.A. Pest Operative STOLLERY, J.D. Pupil Public Health Inspector SOUTHERBY, C.W. Public Health Inspector STACEY, J.E. Senior Public Health Inspector STILWELL, J. Technical Assistant STONE, B.H. Senior Public Health Inspector THOMAS, L.H. Public Health Inspector TREW, P.A. Pupil Public Health Inspector (A) WAGHORN, A.G. Administrative Assistant WILLIS, F.T.H. Caretaker WILLIS, Mrs. P.F. Part-time Cleaner WREN, E.G. Public Health Inspector 58 Page Nos. 1.3 INDEX 1.1 INTRODUCTION 57 1.2 Staff List 58 1.3 Index 59 2.1 FOOD 62 2.2 Clean Food Campaign 62 2.3 Food Premises and Vehicles 62 2.4 Food Complaints 62 2.5 Unsound Food Surrendered or Condemned 62 2.6 Chemical Analysis of Food and Drugs 62 2.7 Labelling and Trade Descriptions 63 2.8 Special Sampling - Pesticide Residuals 63 2.9 Milk 63 2.10 Ice Cream 63 2.11 Bacteriological Examination of other Food Stuffs 63 2.12 Slaughter Houses 63 2.13 Poultry 63 2.14 Imported Food Regulations 1968 63 2.15 Water Supply 63 2.16 Swimming Baths 64 2.17 Fertilisers and Feeding Stuffs Act 1926 64 2.18 Rag Flock and other filling Materials Act 1957 64 3.1 OCCUPATIONAL HEALTH 72 3.2 Offices, Shops and Railway Premises Act 1963 72 3.3 Accidents Reported 72 3.4 Offices, Shops and Railway Premises (Lifts and Hoists) Regulations 1968 72 3.5 Factories Act 1961 72 3.6 Work Places 73 3.7 Fairgrounds 73 3.8 Hairdressers and Barbers 73 3.9 Pharmacy and Poisons Act 1933 73 3.10 Massage Establishments 73 3.11 Employment Agencies 73 4.1 POLLUTION CONTROL 80 4.2 Smoke Control Areas 80 4.3 Industrial Furnaces and Chimneys 80 4.4 Obnoxious Effluvia 80 4.5 Coffee Roasting 80 4.6 Accumulations 80 4.7 Disposal of Toxic Wastes 81 4.8 Rivers, Streams, Ponds and Ditches 81 59 Page Nos. 4.9 Dry Cleaning Establishments 81 4.10 Noise Abatement Act 1960 81 4.11 Radioactive Substances Act 1960 81 5.1 HOUSING 84 5.2 Inspection and Action Under Statutory Powers 84 5.3 Formal Action Under the Housing and Public Health Acts 84 5.4 Qualification Certificates - Housing Act 1969 84 5.5 House Improvement 84 5.6 Houses in Multiple Occupation 84 5.7 Common Lodging Houses 85 5.8 Survey - Housing Act 1969 85 5.9 Repair 85 5.10 Drainage and Sewerage 85 5.11 Moveable Dwellings 85 5.12 Infectious Disease Enquiries 85 6.1 PEST CONTROL 89 6.2 Prevention of Damage by Pests Act 1949 89 6.3 Block Treatments 89 6.4 Sewer Infestations 89 6.5 Inject Pests 89 6.6 Land Pests 92 7.1 MISCELLANEOUS DUTIES 92 7.2 Licences, Permits and Registrations 92 7.3 Animal Health 92 7.4 Soiled Dressing Disposal 92 7.5 School Premises 92 8.1 MORTUARY SERVICE 94 9.1 OPEN DAY 94 10.1 STAFFING 94 10.2 Examination Successes 94 10.3 Student Training 94 11.1 ADMINISTRATIVE/CLERICAL SUPPORT 94 60 ENVIRONMENTAL HEALTH DIVISION FOOD SECTION 1972 was designated by the Public Health Inspectors Association as a National Clean Food Year. The fly on the unwrapped cheese portion was a message used in the Carshalton Carnival procession. 61 2.1 FOOD The work of the Food Team ranges from law enforcement to advising the trade and members of the public on many aspects of food control and hygiene. New problems frequently arise, for example, a special interest was taken in the condition of frozen foods during the period, when the dispute in the electricity industry was causing long power cuts. At the end of the year the Team was giving attention to date coding of food stuffs, and there was considerable concern about the difficulty that retailers and members of the public had in interpreting date codes, which indicate the freshness of food. It was disappointing that on more than a dozen occasions the Authority had to resort to legal proceedings. In the cases heard in 1972 fines totalling more than £500 were imposed. 2.2 CLEAN FOOD CAMPAIGN During 1972, as part of a national campaign sponsored by the Public Health Inspectors Association, a special campaign was held to try and promote good food handling practices. Two separate exhibitions were designed and constructed with the very essential help of the Health Education Service and a float was entered in the Carshalton Carnival in order to focus public attention on the problems caused by careless food handling. The exhibitions were also shown at a number of centres throughout the Borough, including clinics and school premises. The response and interest of members of the public was encouraging. It was, however, disappointing that whilst time was being spent on these methods of emphasising the problems of food hygiene and to lecturing to various groups, there was a serious decline in the standard of some food premises. 2.3 FOOD PREMISES AND VEHICLES In spite of the other activities involving the Food Team the number of visits and inspections increased to 3,814. 221 notices were served regarding unsatisfactory conditions, an indication of the type of infringements found are contained in the table in appendix 2.a. 2.4 FOOD COMPLAINTS The number of complaints received continue to run at a high level. Bread and flour confectionery, the condition of milk and milk bottles and of meat and meat products continued to be the main groups which were the subject of food complaints. Appendix 2.b gives examples of the complaints dealt with and the proceedings which followed. 2.5 UNSOUND FOOD SURRENDERED OR CONDEMNED The condition of food stuffs displayed in shops and at manufacturers and wholesalers premises is continuously monitored throughout the area. Appendix 2.c indicates in quantative terms the amount of food stuffs which is surrendered or condemned as unsound, diseased, unwholesome or unfit for human consumption. 2.6 CHEMICAL ANALYSIS OF FOOD AND DRUGS During the year 476 samples were taken for chemical analysis and their constituents were examined in relation to statutory standards and many other factors, including a check that harmful preservatives and colouring matters were not being used. The sampling programme was often adjusted to arrange for checks on food stuffs which had been the subject of complaint. 4 formal and 12informal samples were reported by the Public Analyst, Mr. J.A. Palgrave, B.Sc., M.Chem.A., F.R.I.C., to be unsatisfactory. Further investigations were carried out in respect of each of these reports and details of examples are set out in appendix 2.d. A schedule of the sampling results is contained in appendix 2.e. 62 2.7 LABELLING AND TRADE DESCRIPTIONS The labelling of food stuff is checked as part of the normal sampling procedure and with the co-operation of the Public Analyst. Advice was given to a number of manufacturers where their product was labelled unsatisfactorily, either in relation to existing legislation or the new regulations which were scheduled to come into force on the 1st January, 1972. The London Borough of Sutton co-operated with other authorities during 1972 in a repeated programme of checking samples of food stuffs with specific reference to pesticide residuals. 19 samples were taken, no unsatisfactory reports were received from the samples taken in Sutton. 225 licences under the Milk (Special Designation) Regulations 1963 were current in 1972. Very little untreated milk is sold in the Borough and no samples of raw milk were taken 21 samples of milk were chemically examined. The two unsatisfactory results relating to the chemical composition of milk were in respect of two samples of UHT milk from the same company which were low in milk solids not fat but had not been adulterated by the addition of water. Representations were made to the company regarding the blending of milks to ensure that the SNF composition reached the standard set by the Sale of Milk Regulations 1939. Appendix 2.f shows the results received of samples submitted for bacteriological examination. 2.10 ICECREAM The 29 samples which were subjected to bacteriological examination and the 6 samples examined for chemical content during the year all satisfied the tests applied to them. 2.11 BACTERIOLOGICAL EXAMINATION OF OTHER FOODSTUFFS In addition to the milk and ice cream samples referred to above, 32 other foods were examined by the Public Health Laboratory Service and satisfactory reports were received. 2.12 SLAUGHTER HOUSES There are no slaughter houses in the Borough. 2.13 POULTRY There are no poultry processing plants in the Borough. A very small number of birds are killed from time to time at three of the smallholdings. Some birds prepared for sale were examined and found to be satisfactory. The premises were inspected and comply with the Food Hygiene (General) Regulations 1970. 2.14 IMPORTED FOOD REGULATIONS 1968 When containers holding food stuffs pass directly through the ports without inspection for unpacking at wholesale and commercial premises in the Borough, all food contents are subject to the Public Health Inspectors check. The 24 samples taken from containers were all found to be satisfactory. 2.15 WATER SUPPLY Reports of the water undertakings, which between them are responsible for a supply service covering the whole Borough, and the results of samples taken by Public Health Inspectors, indicated that the water was satisfactory both as regards bacteriological and chemical quality. A piped main supply is available direct to 2.8 SPECIAL SAMPLING - PESTICIDE RESIDUALS 2.9 MILK 63 houses throughout the district. Fluoride is not added to the water. Samples from private wells serving manufacturing companies were sent for laboratory examination and satisfactory results were received. 2.16 SWIMMING BATHS Samples were taken and tests applied to public and school swimming bath water. During the year 10 samples taken from four baths were found to be below standard and the management was advised on the remedial action necessary. 2.17 FERTILISERS AND FEEDING STUFFS ACT 1926 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. 5 informal samples were taken under this Act, during the year, all of which were found to be satisfactory. 2.18 RAG FLOCK AND OTHER FILLING MATERIALS ACT 1957 5 samples taken during the period satisfied the requirements of the Act. 64 65 APPENDIX 2 . INSPECTION OF FOOD PREMISES AND DEFECTS REMEDIED 1972 SANITARY ACCOMMODATION FOOD STORAGE AND PREPARATION ROOMS Inspections No. of premises No. of premises registered under Sec.16 of Food and Drugs Act Repaired I Cleansed and/or decorated Lighting provided Washing Facilities (incHot 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 62 6 - 1 - 1 1 - 1 1 - - - - 1 2 Bakers and Confectioners 179 41 20 3 3 - 4 1 4 4 13 - 1 2 1 1 1 Butchers 385 95 77 3 10 1 9 2 4 4 20 - - 5 1 - 4 Canteens 161 121 - - - - 2 3 3 3 9 - 1 2 - 1 1 Chemists 97 47 - - - 1 2 1 3 - - - - - - - - Confectioners (Sugar) 322 163 160 - 1 - 3 3 7 - 1 1 - - - - - Fishmongers 60 15 2 - 2 - - 1 1 - 2 - - - - - - Fish Fryers 83 26 6 1 3 - 3 1 1 3 5 - 1 2 - - 1 Greengrocer and Fruiterers 268 94 22 1 5 1 2 - 5 - 3 - - 2 5 - 1 Grocers I 212 84 66 - 4 2 3 - 1 1 11 - - 3 1 1 1 General Stores 163 65 60 - - - - 1 - 1 2 - - - - - 3 Licensed Premises 365 116 11 1 8 1 6 3 3 1 7 - - 2 1 - 3 Milk Storage Depots 29 3 - - - - 1 1 1 - - - - - - - - Restaurants and Cafes 603 119 34 1 11 1 8 5 6 3 31 - 1 3 - - 5 Factory Food 22 6 - - - - . - - - - - - - - - - - Stalls and Vehicle Food Supermarkets 305 498 49 20 1 5 - - - 15 1 11 - - 4 - - 3 10 - - TOTALS 13814 1070 464 10 48 7 60 34 39 21 109 1 4 24 19 4 22 APPENDIX 2.b. FOOD COMPLAINTS Food Complaint 5/72 -Baby Food containing Insects A pack of cereal baby food purchased from a shop in the Borough was found by the customer to be infested with beetles. The food was packed in May 1970 and coded for sale before February 1971. The insect infestation arose as a result of prolonged storage by the retailer. The company pleaded guilty to the offence and were fined £35 with £10 costs. Food Complaint 6/72 - Bread containing Foreign Matter An uncut loaf was found to have foreign matter embedded in the crust which was indentified by the Public Analyst as flakes of rust which had fallen onto the loaf prior to baking. It appeared that the rust originated from a piece of equipment which had been inadequately maintained. The bakery company pleaded guilty and were fined £30 with £10 costs. Food Complaint 41/72 - Milk containing Cigarette End A bottle of milk delivered to a house in the Borough was found by the customer to contain part of a filter tipped cigarette end. The Public Analyst attended court and gave evidence that the filter tip was present in the bottle before it was filled. The dairy company pleaded guilty and were fined £75 with £51 costs. Food Complaint 89/72 - Mouldy Sliced Loaf A wrapped sliced loaf delivered to a childrens home in the Borough was found to be badly affected by mould growth on the day after delivery. The bakery company agreed that the bread was stale but pleaded not guilty. On conviction they were fined £25 with £8 costs. Food Complaint 121/72 - Mouldy Steak and Kidney Pie A steak and kidney pie purchased from a cafe was found by the customer to be mouldy. Investigation showed that it had been delivered at least five days before sale, the recommended maximum shelf life being 48 hours. The proprietor of the cafe pleaded guilty and was fined £5 with £5 costs. Food Complaint 140/72 - Mouldy Steak and Kidney Pie A steak and kidney pie purchased from a grocers shop was found to have patches of mould on the top surface. Investigation showed that the pie had been delivered to the shop six days before sale. The retailer pleaded guilty and was fined £25 with £9 costs. Food Complaint 179/72 -Loaf containing part of Insect An uncut loaf purchased from the premises from which it was baked was found to have part of a bee or wasp embedded in it. It was apparent that the insect had been baked in the bread. The baker pleaded guilty and was fined £20 with £5 costs. Food Complaint 183/72 - Chocolate containing piece of Hack Saw Blade One of a box of chocolates purchased from a confectioners shop was found by the customer to consist of a chocolate coated portion of hack saw blade approximately ½" square. Metal detection devices were not employed by the manufacturer, who pleaded guilty and was fined £40 with £10 costs. 66 APPENDIX 2.c UNSOUND FOOD SURRENDERED OR CONDEMNED Lbs. Lbs. Alcoholic Drinks 7005 Ice Cream 50 Beverages 193 Meat (fresh - home killed) 439 Cereals 164 Meat (fresh - imported) 1089 Cheese 109 Meat Canned 445 Condiments 8 Meat Cooked 1521 Confectionery Flour 243 Meat Products 311 Confectionery Sugar 205 Milk 26 Cream 22 Offal 10 Drugs 9 Preserves 2011 Fats and Oils 1336 Sausages 257 Fish (wet) 322 Soup 54 Frozen Food 5977 Vegetables (canned) 475 Fruit (fresh) 3 Miscellaneous Canned Foods 334 Fruit (canned) 14640 Other Foods 2353 Fruit Juice 477 TOTAL 30713 TOTAL 9375 67 APPENDIX 2.d. CHEMICAL ANALYSIS OF FOOD AND DRUGS Informal Sample 7/72 - Prepacked Cheddar Cheese The cheese was found to be deficient in milk fat and to contain excess water. Investigation suggested that cheese intended for processing had been wrapped for retail sale in error. Subsequent sample proved satisfactory. Informal Sample 56/72 - Asprin Tablets B.P. Asprin tablets found to be beyond the weight variation allowed by the British Pharmacopoeia. The manufacturer claimed that this was an isolated instance. Subsequent samples were found to be satisfactory. Informal Sample 81/72 - 100% Orange Juice The label on the container stated that the orange juice was rich in natural vitamins but the minimum quantity present was not declared. Importation of this item ceased. Informal Samples 132 and 133/72 - Chocolate Easter Eggs These items were found to contain a high proportion of vegetable fat substituted for cocoa butter and were therefore considered to be an inferior article which should not be described as chocolate. The fault was attributed to an inexperienced shop assistant who was not aware that these items could not properly be described as chocolate Easter eggs. Informal Sample 258/72 - Strawberry Topping Sauce This sauce was found to contain 230 parts per million sulphur dioxide which was not declared on the label. The manufacturer subsequently changed to another sauce of strawberry puree which was free from preservative. Informal Sample 361/72 - Vitamin and Mineral Capsules A claim was made on the packet for the presence of vitamins and minerals but the quantities present were not declared as required by the Labelling of Food Order 1953. The amended pack was produced which complied with the Order. Informal Samples 452, 453, 454 and 455/72 - Cheese Spreads with Mushrooms, Shrimp, Crab Meat and Smoked Salmon respectively The appropriate designations of these items were less conspicuous than the brand names which appeared to include a description. This was held to be misleading to the purchaser and amended labels were subsequently produced. Informal Sample 178/72 - Non-Permitted Colouring Matter Coal tar colouring was in use in a restaurant for colouring meat although it had been deleted from the list of permitted colours specified by the Colouring Matter in Food (Amendment) Regulations 1970. The manufacturer had ceased supplying this colour in 1969. The remainder in the possession of the restaurant was surrendered for destruction. 68 APPENDIX 2.e. CHEMICAL ANALYSIS OF FOOD AND DRUGS SATISFACTORY ADULTERATED TOTAL Forma Informal Formal Informal Alcoholic Drinks 20 1 - - 21 Beverages 1 9 - - 10 Cereals and Cereal Products 3 11 - 1 15 Condiments and Sauces 4 17 - 1 22 Confectionery Flour 2 20 - - 22 Confectionery Sugar 1 37 - 2 40 Dairy Products 15 18 1 4 38 Drugs 1 10 3 14 Fat and Oils - 2 - - 2 Fish and Fish Products 7 17 - - 24 Fruit and Fruit Products 2 46 - - 48 Food Additives 1 4 - - 5 Meat and Meat Products 12 51 - - 63 Milk 8 17 2 - 27 Prepared Compound Baby Foods - 9 - - 9 Sugar and Preserves • 11 - - 11 Slimming Foods - 1 - - 1 Soft Drinks 5 19 1 - 25 Spices and Flavourings - 14 - - 14 Vegetables and Vegetable Products - 13 - - 13 Miscellaneous 3 29 - - 32 85 356 4 11 456 69 APPENDIX 2.f. MILK : BACTERIOLOGICAL TESTING Designation under which sold Number of Samples METHYLENE BLUE TEST PHOSPHATASE TEST TURBIDITY TEST Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised . 42 39 2 42 - - - Ultra Heat Treated 3 3 - 3 - - - Untreated - - - - - - - Sterilised 1 - - - 1 - TOTAL 46 42 2 45 - 1 - * One sample could not be submitted for Methylene Blue Test due to atmospheric conditions 70 EVIRONMENTAL HEALTH DIVISION (para 1) ATUTORY INSTRUMENTS 1968 No. 849 SHOPS AND OFFICES and Railway Premises (Hoists and Lifts) Regulations 1968 le 27th May 1968 & before Parliament 11th June 1968 ning into Operation 28th May 1969 f State— f her powers under sections 20 and 80(5) and (6) of the Offices, Railway Premises Act 1963(a) and of all other powers enabling it behalf ; and publication, pursuant to Schedule 1 to the said Act of 1963, of the proposal to make the Regulations and no objection to the ving been received in regard to which an inquiry is required by Schedule to be held, the following special R«gulations:— vnmencem&nt and interpretation These Regulations may be cited as the Offices, Shops and Railway (Hoists and Lifts) Regulations 1968 and shall come into operation May 1969. Interpretation Act 1889(b) shall apply to the interpretation of thewions as it applies to the interpretation of an Act of Parliament. n these Regulations, unless the context otherwise requires, the following poisons have the meanings hereby assigned to them respectively, that OCCUPATIONAL HEALTH "the district " means, as respects any premises, district in which the premises are situ " in section 53(1) of the sifting machine Nine notices were served during the year when lifts and hoists were found that failed to conform with the offices,shops and Railway Premises (Lifts and Hoists) Regulation 1968 71 3.1 OCCUPATIONAL HEALTH One of the tasks of the Occupational Health Team within the Environmental Health Division is to concern iteself with health, welfare and safety conditions in more than 2,400 commercial and industrial premises throughout the Borough where people are employed. These premises are visited as a matter of routine. The pattern of trading and of employment is changing continuously and as an example 235 new registrations of offices and shops were recorded during 1972. 3.2 OFFICES. SHOPS AND RAILWAY PREMISES ACT 1963 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 560 6,763 Retail Shops 971 5,362 Wholesale Shops, Warehouses 29 469 Catering Establishments and Canteens 121 947 Fuel Storage Depots 4 23 375 informal notices were served in relation to non-compliance with regulations made under the Act. An indication of the unsatisfactory conditions found is set out at the end of this section - appendix 3.a. 3.3 ACCIDENTS REPORTED 62 accidents were reported in accordance with the requirements of the Act. In only 14 cases was it considered necessary for an Inspector to investigate the circumstances of the accidents and advice was given in respect of one accident which had occurred at retailer premises. An analysis of the reported accidents is set out in appendices 3.b. and 3.c. 3.4 OFFICES, SHOPS AND RAILWAY PREMISES (LIFTS AND HOISTS) REGULATIONS 1968 During the year special attention was given to the Local Authority's responsibilities in connection with the safety of lifts and hoists in various commercial premises throughout the Borough. 9 notices were served on occupiers of premises in respect of unsatisfactory conditions and 5 notices were complied during 1972. Form 54, which requires that a certificate of a competent person who has inspected the lift be sent to the Local Authority within 28 days of the inspection whenever defects are found, is not always received. Frequently forms are incorrectly completed, so that an Inspector is unaware of the defects that have been drawn to owners attentions during the course of the official inspection of the lift or hoist. A further difficulty arises because the regulations do not require that the certificate should be kept on the actual premises where the lift or hoist is situated. 3.5 FACTORIES ACT 1961 The inspection in respect of the health provisions at factories and at out-workers premises is another routine task which is carried out without the need to report frequently to the Health and Housing Committee as all of the infringements found have been dealt with in an informal manner. An indication of the number of premises on the register, of the inspections carried out and of the defects found are set out in appendices 3.d and 3.e and an indication of the number of out-workers in the Borough in appendix 3.f. 72 3.6 WORK PLACES 45 inspections of work places, including building sites, were made during the year. 3.7 FAIRGROUNDS A Circular from the Home Office with regard to safety in fairgrounds came into the Department and it was decided that an inspection of fairs would be carried out. It would appear that all members of the Showmans Guild have an agreement with the Government that they will have all mechanical equipment inspected annually and that they will then be able to produce an engineer's certificate in respect of the inspection. Fairs at Wrythe Green and Carshalton Carnival were visited and appeared to be quite satisfactory. In each case an engineer's certificate was available. 3.8 HAIRDRESSERS AND BARBERS The Council adopted on the 4th April 1968, the provisions of the Greater London Council (General Powers) Act 1967 insofar as they relate to the registration of Hairdressers and Barbers, and fixed the first day of June 1968, as the appointed day for the purpose of registration in accordance with Section 21 of the Act. One hundred and forty one premises were registered. Inspections to ensure compliance with bye-laws requirements have been made. 3.9 PHARMACY AND POISONS ACT 1933 At the time of the annual renewal of licences for sales under Part 2 of the above Act inspections were made of all the premises which applied to retain their name on the list and the provisions of the Act were drawn to the shop-keepers wherever there were contraventions. Special attention was given to the display of poisons in positions where children could easily reach them. 3.10 MASSAGE ESTABLISHMENTS All licenced premises were inspected during the year. 3.11 EMPLOYMENT AGENCIES These were inspected during the first quarter of the year when the annual licences were being reconsidered and no particular difficulties were found. 73 APPENDIX 3.a. OFFICES, SHOPS & RAILWAY PREMISES ACT 1963- UNSATISFACTORY CONDITIONS DEALT WITH NOTICES Unsatisfactory conditions found Unsatisfactory conditions remedied (inc. items from 1971) 1972 1972 Overcrowding 2 1 Ventilation 2 10 Cleanliness 11 22 Temperature (inc. thermometers) 122 118 Lighting 7 14 Sanitary Conveniences 59 55 Washing Facilities 14 15 Water Supply 19 16 General Conditions 20 28 Stairs/Passages 7 4 Clothing Storage 1 4 Drying Facilities 3 1 Seats 2 5 Machinery 1 1 First Aid Equipment 118 129 Notices 241 220 Registration 213 178 Lifts and Hoists 9 5 74 APPENDIX 3.b ACCIDENTS REPORTED Workplace Number Fatal Reported Non- Fatal Total No. Investigated ACTION RECOMMENDED Prosecution Formal Warning Informal Advice No Action Offices - 6 1 - - - 6 Retail Shops - 44 11 - - 1 43 Wholesale Shops Warehouses - 2 1 - - - 2 Catering establishments open to public, canteens - 10 1 - - - 10 Fuel Storage Depots - - - - - - TOTALS - 62 14 - - 1 61 75 APPENDIX 3.c ANALYSIS OF REPORTED ACCIDENTS Offices Retail Shops Wholesale Warehouses Catering Establishments open to public, canteens Fuel Storage Depots Machinery - 2 - - - Transport - 6 - - - Falls of persons 4 6 1 4 - Stepping on or striking against object or persons - 2 - 1 - Handling goods 1 10 - 4 - Struck by falling object - 1 - - - Fires and explosions - - - - - Electricity - - - - - Use of hand tools - 14 1 - - Not otherwise specified 1 3 - 1 - 76 APPENDIX 3.d. FACTORIES ACT 1961 Inspections for the purpose of provisions as to health:- PREMISES (1) NUMBER OF:- No. on Register (2) Inspections (3) Written Notices (4) Occupiers Prosecuted (5) (i) Factories in which Sections 1,2,3,4, & 6 are to be enforced by Local Authorities 46 23 2 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 716 360 13 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) Nil 45 - - TOTALS 762 428 15 - APPENDIX 3.e. Cases in which Defects were found:- PREMISES (1) Number of cases in which defects were found Number of cases in which prosecution were instituted (6) Found (2) Remedied (3) Referred to H.M. Inspector (4) by H.M. Inspector (5) Want of cleanliness 6 7 - - - Overcrowding 1 - - - - Unreasonable temperature 1 - - - - Inadequate ventilation 2 2 - - - Ineffective drainage of floors 1 - - - - Sanitary Conveniences:- (a) Insufficient - - - - - (b) Unsuitable or defective 4 8 - - - (c) Not separate for sexes 3 1 - - - Other offences against the Act (not including offences relating to Outwork) 6 5 - - - 77 APPENDIX 3.f. Outwork (Sections 133 and 134) Nature of Works (1) Section 133 Section 134 No. of Outworkers in Aug. list required by Sect. 133(1) (c) (2) No. of cases of default in sending lists to the Council (3) No. of Prosecutions for failure to supply lists (4) No. of instances of work in unwholesome premises (5) Notices served (6) Prosecutions (7) Wearing apparel making etc. 25 - - - - - Boxes (Cardboard) 48 - - - - - Brass & Brass Art - - - - - - Curtain making 1 - - - - - Toys - - - - - - Flowers 1 - - - - - Umbrellas 10 - - - - - Lampshades 27 - - - - - Miscellaneous 23 - - - - - TOTALS 135 - - - - - 78 ENVIRONMENTAL HEALTH DIVISION POLLUTION CONTROL This graph indicates the improved conditions of the air in Sutton during the winter months of a decade 79 4.1 POLLUTION CONTROL Public interest in pollution matters is well illustrated in the almost doubled level of complaints received by the Environmental Health Service. Fortunately most of the complaints related to very low level and localised pollution. In addition to investigating these complaints Public Health Inspectors have to be vigilant in carrying out their own checks and observations of possible pollution sources. 4.2 SMOKE CONTROL AREAS The programme designed to bring the whole of the Borough within smoke control areas continued throughout 1972 and visits of initial inspection to give advice and relating to the payments of grants were carried out, mainly in the following areas:- LOCATION Approximate Position Order Confirmed Order in Force Area 23 Carshalton 6.10.71. 1.10.72. Area 24 St. Helier North 23.9.71. 1.7.72. Area 25 Hackbridge 15.3.72. 1.12.72. Area 26 South Cheam & Belmont confirmation expected 1973 - Area 27 South Sutton & Belmont 1973 - Area 28 Sutton & Carshalton Beeches 1974 - 4.3 INDUSTRIAL FURNACES AND CHIMNEYS Industrial boiler houses were visited both with regard to flue gas, and grit and dust emission. Notices were received relating to the installation of three new furnaces and three applications for the approval of chimney heights. 4.4 OBNOXIOUS EFFLUVIA 95 complaints were investigated and acted upon. Once again a great many of these related to domestic bonfires and were levels of pollution and nuisance which could have been avoided by the use of a little common sense and concern for neighbours. All the infringements of the dark smoke regulations noted were dealt with informally. 4.5 COFFEE ROASTING During the year there was a rapid deterioration in the effluent from the flues of coffee roasters, at factory premises close to the boundary with the London Borough of Croydon. The management reported their intention to replace the old plant with a new roaster, equipped with specially designed after burning equipment, intended to minimise the emission of smoke, odour and particulate matter. It was planned that this new equipment should be installed early in 1973 and in the interim period the management undertook a number of steps intended to reduce the nuisance caused to residents of nearby houses. By the end of 1972 there was still a great deal of concern as the standards reached were by no means satisfactory. 4.6 ACCUMULATIONS 134 complaints were received in respect of accumulations and deposits. Fortunately, from the health point of view, most of these complaints related to accumulations that were not noxious, not harbouring pests and could not be regarded as a public health nuisance. 24 notices were served for the removal of accumulations and many of the remaining matters were referred to be dealt with as Civic Amenity matters. 80 4.7 DISPOSAL OF TOXIC WASTES During the first quarter of 1972 there was a great deal of public concern in respect of disposal of chemical wastes. A survey was made of all the areas in the Borough where dumping is known to take place but no toxic waste containers were found. Public Health Inspectors also visited all factory premises where it was thought there might be a problem of toxic waste disposal. Detailed enquiries were made at 8 premises where chemicals were used that might result in waste disposal problems but in each case the management had made satisfactory arrangements. 4.8 RIVERS, STREAMS, PONDS AND DITCHES 107 visits and inspections were made either following complaints or as a result of routine observations. During the early months of the year there was particular concern about the condition of the Carshalton Ponds. During a period of no natural flow there was an excessive growth of algae and weeds and an offensive odour from the ponds. Arrangements were made for the Sutton District Water Company to increase their pumping to the west pond and the Greater London Council undertook a programme of spraying and clearing the algae. 4.9 DRY CLEANING ESTABLISHMENTS A number of complaints were received regarding the smell from solvents at dry cleaning establishments and alterations were effected following advice from Public Health I nspectors. 4.10 NOISE ABATEMENT ACT 1960 The number of complaints received in respect of noise rose from 59 in 1971 to 78 in 1972. Details of these complaints are contained in appendix 4.a. During the year statutory action was taken in connection with the excessive use of chimes on ice cream vehicles. 4.11 RADIOACTIVE SUBSTANCES ACT 1960 A list of the firms is contained in appendix 4.b to whom certificates of registration or certificates of authorisation for the disposal of accumulation of radioactive waste have been issued by the Department of the Environment under the Act. 81 APPENDIX 4.a. NOISE ABATEMENT ACT 1960 Number of:- Industrial Premises Commercial Premises Roadworks Construction Demolition etc. Domestic Premises Other * TOTAL 1. Complaints receives 13 23 10 24 8 78 2. Cases complained of 10 21 9 23 8 71 3. Cases investigated 10 21 9 23 8 71 4. Nuisances confirmed 8 16 7 8 3 42 5. Nuisances remedied informally 8 16 7 8 3 42 * goods deliveries, garbage collections etc. APPENDIX 4.b RADIOACTIVE SUBSTANCES ACT 1960 Section 1 - Registration - Keeping and use of Radioactive Material : London Fire Brigade, Sutton and Wellington Stations. Medical Research Council, Woodmansterne Road, Carshalton. Mullard Radio Valve Co., New Road, Mitcham Junction Nuleaf Ltd. Beddington Lane, Croydon. Pye Unican Ltd., 30, Devonshire Road, Sutton. Vinyl Products Ltd., Mill Lane, Carshalton. Section 3 - Registration - Mobile Radioactive Apparatus : Inspection Services Ltd., Oldfields Road, Sutton. Radiographic and Associated Testing Services, 43Senga Road, Hackbridge. Section 6/7 - Authorisation - Disposal and Accumulation of Radioactive Waste: Radiological Protection Service, Clifton Avenue, Belmont. Royal Marsden Hospital and the Institute of Cancer Research, Downs Road, Belmont. 82 ENVIRONMENTAL HEALTH DIVISION HOUSING SECTION IN 1973 THIS MUST BE REGARDED AS A "FIT" HOUSE, having regard to present housing legislation. The plan represents a house which lacks a number of basic amenities. The reader is invited to check those noted against the list in paragraph 5.5 of this section of the report. 83 5.1 HOUSING The pattern of the Public Health Inspectors interest in housing in 1972 followed that which has been so familiar for many years. 5.2 INSPECTION AND ACTION UNDER STATUTORY POWERS More than 6,000 visits were paid during the year to houses in the Borough in connection with the Authority's responsibilities under the Public Health and Housing Acts, 5.3 FORMAL ACTION UNDER THE HOUSING AND PUBLIC HEALTH ACTS 110 formal notices were served in accordance with this legislation. Three houses were demolished in a clearance area made in 1971 and one closing order was made during the year. Details of the notices served are set out in appendix 5.a. 5.4 QUALIFICATION CERTIFICATES - HOUSING ACT 1969 During 1972, 135 applications for Qualification Certificates were made. 142 certificates were issued and 26 provisional certificates. Defects found at 99 premises surveyed were remedied and in 75 cases applications were refused. 5.5 HOUSE IMPROVEMENT 1972 was the year of the London House Improvement Campaign. Public Health Inspectors participated in the exhibition that was held in Sutton. The inspectorate is particularly interested in applications where support is sought for the provision of additional accommodation. It is also concerned with the standard of the repair of properties where improvement grant applications are made and the assessment of the expectation of life of such houses. It is particularly disappointing that in 1972, although the London Borough of Sutton can enforce a reasonable standard of repair of tenanted property in the private sector, except in those cases where the tenants make specific application, the Local Authority is unable to ensure that basic amenities are available. The planned drawing which forms the frontage sheet of this section of the report indicates a small terraced house which, if it is in a good state of repair, must be regarded as a fit property under housing legislation although it lacks, amongst other things 1. Internal w.c. 2. A bath or shower 3. A hot water supply 4. Adequate means of heating 5. Artificial lighting 6. Power points 7. Wash hand basin 8. A draining board to the sink 9. A kitchen of adequate size Despite all the publicity which has been given to house improvement and letters that have been sent to owners following inspections throughout the Borough, there are still a number of properties lacking one or more of these amenities. 5.6 HOUSES IN MULTIPLE OCCUPATION 129 houses to which the houses in multiple occupation regulations apply were inspected during 1972. Although in many parts of London property let in this manner gives rise to 84 problems of real public health concern, the vast majority of those inspected in Sutton were found to be of an acceptable standard. The properties inspected were, however, only a small proportion of the total number of buildings let for multi use in Sutton Borough and during the last quarter of 1972 a comprehensive survey of the situation commenced. 5.7 COMMON LODGING HOUSES There are no common lodging houses in the Borough. 5.8 SURVEY - HOUSING ACT, 1969 At the request of the Ministry of the Environment a sample survey of one thousand dwellings selected at random by computer was carried out. The results of the survey reported to the Health and Housing Committee on the 18th October, 1972 is repeated in appendix 5.b. 5.9 REPAIR Using the provisions of the Public Health and Housing Acts the Public Health Inspectors were able to arrange for many items of disrepair of private houses to be attended to. In nearly 100 cases damp conditions were remedied. At 75 properties gutters or down pipes were repaired or renewed. 173 defective windows were repaired or renewed and many other items of disrepair were dealt with. It is distressing that it is still the occasional duty of a Public Health Inspector to deal with a home which has deteriorated through failure to maintain normal levels of household maintenance to the level of dirty premises and which has become a public health nuisance. 5.10 DRAINAGE AND SEWERAGE The service is justly proud of the prompt attention which is given to drainage problems. 1,922 drainage and sewer system were cleared, an increase of 250 over the 1971 figures which were 100 more than 1970. Drainage repairs and reconstruction were supervised. One feature is that damage was found to be occurring to the private frontage drains of residents as a result of the inefficient work of contractors employed on pipe laying in the public highway. The whole of the Borough is covered by a sewerage system, and main drainage is available to all but a few isolated properties. Sewage disposal arrangements are adequate. 5.11 MOVEABLE DWELLINGS During the year work commenced to improve the Council's caravan site in Carshalton Road, Woodmansterne and to raise it from the status of a temporary to permanent site. Regular visits are paid to this site in order to ensure that no fouling or misuse of the land for storage purposes would cause a threat to the water supply, as Carshalton Road is part of the general catchment area for mains supply. At the same time on the eastern edge of the Borough the London Borough of Croydon was creating a site for travellers. 5.12 INFECTIOUS DISEASE ENQUIRIES Enquiries on behalf of the Medical Officer of Health are generally carried out by the Public Health Inspectors in the Housing Team and disinfections and disinfestation treatments are carried out under their supervision. 85 APPENDIX 5.a. FORMAL ACTION UNDER THE HOUSING AND PUBLIC HEALTH ACTS The number of houses in respect of which formal notices were served requiring repairs: Housing Acts Public Health Acts Formal Notices served 9 101 Rendered fit after service of Formal Notices: - By Owners - 36 By Local Authorities in default of owners - 23 Formal Notices were served under the following Acts: Public Health Act 1936 - Section 45 5 Public Health Act 1936 - Section 24 64 Public Health Act 1936 - Section 39 6 Public Health Act 1936 - Section 93 21 Public Health Act 1961 - Section 17 1 Public Health Act 1961 - Section 26 3 Housing Act 1957 - Section 9 1 86 APPENDIX 5.b HOUSING STOCK IN THE LONDON BOROUGH OF SUTTON Number of Dwellings Owned by local Other authority or ownership new town Unfit dwellings I n areas already declared under Part 111 Housing Act 1957 - 8 In other areas to be declared under Part III Housing Act 1957 2 4 Not in Part 111 areas - 1 Total of unfit dwellings 2 13 Dwellings not unfit Up to 12 point standard 6,375 50,556 Capable of improvement to 12 point standard 738 1,187 Not capable of improvement to 12 point standard - 232 7,113 51,988 87 ENVIRONMENTAL HEALTH DIVISION PEST CONTROL During the year the Authority co-operated SECTION in a sample census throughout London in order to assess the extent of rodent infestations and the need for the development of new rodenticides 88 6.1 PEST CONTROL Residents continue to look for the assistance of the Environmental Health Service in the clearance of rat and mouse infestations, advice and practical help in dealing with insect pests and the culling of foxes, squirrels and pigeons. 6.2 PREVENTION OF DAMAGE BY PESTS ACT 1949 The treatment of nearly 1500 rodent infested premises took place during the year (details are shown in appendix 6.a). No rodenticide has come into general use to successfully deal with infestations where anti-coagulate baits prove ineffective. This Authority took part in a survey of the London Boroughs designed to help assess this situation. First results indicated that local levels of infestations were typical of those throughout the London area and stressed the need for more research in the development of alternative rodenticides. 6.3 BLOCK TREATMENTS A number of areas where there was a high level of infestations and re-infestations were thoroughly inspected and dealt with as one block infestation. Some difficulty in dealing with mouse infestations in flats is experienced because of high proportion of residents that are away from their home throughout the day. 6.4 SEWER INFESTATIONS The 10% test indicated that the infestation level of the sewer system continues to be a small one. It is important to continually treat those parts of the system where infestations occur in order to avoid the re-infestation of large areas of the system as it was some years ago. 6.5 INSECT PESTS 803 insect pest complaints were received during 1972. Advice or assistance was given in each case and 550 wasp nests were destroyed. 6.6 LAND PESTS This is another service where there is an increase demand (from 185 in 1971 to 253 in 1972). Frequently the work of the Pest Operatives is made more difficult by disputes among neighbours. It is only practical to attempt to control the number of foxes, squirrels and pigeons and the service is concentrating on those areas where damage or distress is caused or is likely to be caused. Many foxes destroyed were found to be in a very poor condition. 89 APPENDIX 6.a. PREVENTION OF DAMAGE BY PESTS ACT 1949 Complaints of rat and mouse infestations 1,676 Infestations found on survey (not subject of complaint) 54 Premises found to be infested 1,472 Informal Notices under Section 4 of the Act 1 90 ENVIRONMENTAL HEALTH DIVISION OTHER SERVICES 91 7.1 MISCELLANEOUS DUTIES This section of the report is concerned with duties which do not fall directly into the terms of reference of the functional teams. 7.2 LICENCES, PERMITS AND REGISTRATIONS Appendix 7.a indicates the number and type of licences, permits and registrations in existence at 31st December 1972. It is frequently the practice before licences or re-registrations are dealt with, for premises to be visited and inspected by officers from the appropriate team. 7.3 ANIMAL HEALTH All matters relating to animal health, including the Local Authority's responsibility under Diseases of Animals Act 1950, Animal Boarding Establishments Act 1963, Animals Act 1951 and the Riding Establishments Act 1964 are carried out by the Veterinary Officer to the City of London on agency basis for this Authority. 202 visits were made to 68 premises in respect of the provisions of the Diseases of Animals Act 1950 and those premises where a boiling plant was in use were licenced during the year. Satisfactory conditions were found to exist at these premises almost without exception. 13 premises licenced under the Pet Animals Act 1951 received quarterly inspections and the licensing fees were collected. 2 riding establishments were inspected and reports and recommendations submitted. 5 establishments were inspected in respect of the Animal Boarding Establishments Act 1963 and reports and recommendations submitted. 18 special orders were dealt with, including the Swine Vesicular (Infected Areas) Special Orders. The first outbreak of this disease occurred on the 11th December in Staffordshire and up to the 31st December 1972 there had been 34 outbreaks. Pigs could only be moved under controlled area licences and letters were sent to the owners of swill boiling plants advising them of the extreme precautions necessary. A small circus visited Poulter Park in July. On inspection it was found that there were no infringements of the Performing Animals (Regulation) Act 1925. It was very well run and in good order. 7.4 SOILED DRESSING DISPOSAL The Environmental Health Service continues to provide for the disposal of soiled dressings and other medical wastes from more than 60 households in the Borough where weekly collection is necessary, in order to avoid problems that would arise if this sort of material was treated as ordinary household refuse. 7.5 SCHOOL PREMISES During the year the Division became concerned at the deteriorating standard of some sanitary facilities at one of the older schools in the Borough. On the instruction of the School Medical Officer a programme was commenced which involved the comprehensive survey of the facilities available at school buildings. 92 APPENDIX 7a LICENCES, PERMITS AND REGISTRATIONS The following licences, permits and registrations existed at 31st December 1972 Animal Boarding Establishments Act 1963 5 Betting, Gaming and Lotteries Act 1963-Small Lotteries - Registrations 112 Diseases of Animals (Waste Foods) Order 1957 - Licences 19 (Personal Once Only) Game Act 1831 - Game Dealer's Licences 18 Gaming Act 1968 - Amusement Machines - Permits (3 year period) 33 Greater London Council (General Powers) Act 1967 - Hairdressers and Barbers - Registrations (Personal Once Only) 136 Late Night Refreshment Houses Act 1969 3 Milk (Special Designation) Regulations 1963- Licences (5 year period expiring 31.12.75.) 213 London Government Act 1963 - Employment Agency Licences 23 Surrey County Council Act 1931 (Part IV) - Massage/Special Treatment Establishment Licences 18 Moneylenders Act 1927 - Moneylenders Licences 4 Greater London Council (General Powers) Act 1968 - Night cafes - Registrations 1 Pet Animals Act 1951 - Licences 14 Pharmacy & Poisons Act 1933 - Sellers of Part II poisons - Registrations 108 Rag Flock and Other Filling Materials Act 1951 - Registrations (Once Only) 4 Riding Establishments Act 1964 - Licences 2 Theatrical Employers Registration Act 1925 and 1928 - Licences (Personal Once Only) 39 Scrap Metal Dealers Act 1964 - Registrations (3 year period) 12 Slaughter of Animals Act 1958 - Licences 1 War Charities Act 1940 and National Assistance Act 1948 - Registrations (Once only) 6 Nursing Homes - Registration 8 Nursing Agencies - Licences 4 93 8.1 MORTUARY SERVICE The Mortuary at Alcorn Close, Sutton, which is equipped with refrigerated storage and facilities for post mortem examination, was used to receive 591 bodies during 1972. In 1972 post mortems were performed on 276 bodies admitted from local hospitals, 191 from homes within the Borough, and 124 other ambulance removals. 9.1 OPEN DAY The Team Leaders took the opportunity on a Saturday morning to welcome to 'The Lodge' 15 members of the Council and senior officers who were entertained with a short film on part of the work of the Public Health Inspectors and discussed the work of the Teams and some of the equipment and methods used by the Service. 10.1 STAFFING In a Division employing the expertise of nearly 50 people there are always a number of staff changes. In 1972 the principle changes involved the appointment of Mr. J.P. Dixon as Assistant Chief Public Health Inspector and Mr. J.W. Reavley as Senior Public Health Inspector in charge of the Housing Team. 10.2 EXAMINATION SUCCESSES Mr. Peter Gunnell obtained the Diploma in Atmospheric Pollution 10.3 STUDENT TRAINING The Pupil Public Health Inspectors employed in the Department successfully passed the examination at the end of each of their respective academic year. Mr. John Stollery passed the intermediate examination for the Diploma for Public Health Inspectors. 11.1 ADMINISTRATIVE/CLERICAL SUPPORT Every matter mentioned in this report at some stage involves the Administrative/Clerical Section. As the demand for additional Environmental Health Services increases so necessarily the work of the administrative/clerical officers also increases. In addition, there is a continuous review of the procedures of the Division, in an attempt to transfer routine clerical duties away from the professional and technical officers. The efficiency of a field service depends to no small degree on the calibre of the support that it gets in the office. No separate reception staff exists and clerical officers process the 5,776 complaints dealt with by the Environmental Health Services and at the same time respond to many thousand enquiries on subjects as diverse as smoke control area grants and public control licences. Derek A. Eves Chief Public Health Inspector The Pest Control cartoon was produced from an idea from the Mortuary staff. The frontage sheets to each section of the report were produced with the assistance of the Health Education staff. 94 APPENDIX • STATISTICS PART VII INDEX Table No. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1972 I PREMATURITY II THE OBSERVATION AND HANDICAP REGISTER III THE HANDICAPPED PRE SCHOOL CHILD IV CHILD WELFARE CENTRES V DENTAL CARE OF MOTHERS AND YOUNG CHILDREN VI MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY SCHOOLS (INCLUDING NURSERY & SPECIAL SCHOOLS) VII PERIODIC MEDICAL INSPECTIONS DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS VIII SCHOOL DENTAL SERVICE IX CHI LD GUIDANCE CLINIC X SCHOOL PSYCHOLOGICAL SERVICE XI HANDICAPPED PUPILS XII (Figures in brackets are 1971 figures) DR. W.H. KINSTRIE, MB., ChB., MFCM., DPH Medical Officer of Health and Principal School Medical Officer 95 96 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1972 TABLE I Causes of Death Sex All Ages Under 4 weeks 4 weeks and under 1 year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Enteritis and Other Diarrhoel Diseases M 1 - - 4 - - - - - - - - F 1 - - - - - - - - - - 1 Tuberculosis of Respiratory System M 2 - - - - - - - - - - 2 F - - - - - - - - - - - - Late Effects of Respiratory Tuberculosis M 1 - - - - - - - - - 1 - F 1 - - - - - . - - - 1 - Meningococcal Infection M 1 - - - - - - - - - 1 - F - - - - - - - - - - - Syphilis and its Sequelae M 1 - - - - - - - - - 1 - F 3 - - - - - - - - - 1 2 Other Infective and Parasitic Diseases M - - - - - - - - - - - - F 2 - - - - - - - - - - 2 Malignant Neoplasm, Buccal Cavity Etc. M 1 - - - - - - - - - - 1 F - - - - - - - - - - - - Malignant Neoplasm, Oesophagus M 5 - - - - - - - - - 3 2 F 2 - - - - - - - - - 2 - Malignant Neoplasm, Stomach M 22 - - - - - - 1 - 5 11 5 F 13 - - - - - - 1 2 4 6 Malignant Neoplasm, Intestine M 36 - - - - - - - 3 6 17 10 F 25 - - - - - - - - 2 6 17 Malignant Neoplasm, Larynx M 1 - - - - - - - - - 1 - F 1 - - - - - - - - 1 - - Malignant Neoplasm, Lung, Bronchus M 85 - - - - - - 2 3 17 46 17 F 27 - - - - - - 2 1 6 12 6 Malignant Neoplasm, Breast M 1 - - - - - - - - - - 1 F 55 - - - - - - 6 11 9 17 12 Malignant Neoplasm, Uterus F 7 - - - - - - - 2 2 1 2 Malignant Neoplasm, Prostate M 14 - - - - - - - - 2 5 7 97 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1972 (Continued) Causes of Death Sex All Ages Under 4 weeks 4 weeks and under 1 year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Leukaemia M 7 - - - 1 - 1 - 1 - 2 2 F 7 - - - - 1 - - - - 3 3 Other Malignant Neoplasms M 52 - - 1 - - 1 2 4 14 19 11 F 57 - - - - 1 1 1 6 16 16 16 Benign & unspecified Neoplasms M - - - - - - - - - - - - F 4 - - - - 1 - - 1 - 1 1 Diabetes Mellitus M 5 - - - - - 1 - - 1 1 2 F 8 - - - - - - - 1 1 2 4 Other Endocrine etc. Diseases M - - - - - - - - - - - - F 1 - - - - - - - - - - 1 Anaemias M 2 - - - - - - - - - 4 1 F 2 - - - - - - - - - - 2 Other diseases of Blood etc. M - - - - - - - - - - - - F 1 - - - - - - - - - - 1 Mental disorders M - - - - - - - - - - - • F 2 - - - - - - - - - 1 1 Meningitis M - - - - - - - - - - - - F 1 - - - - - - - - - - 1 Other diseases of Nervous system M 7 - - - - 4 - 1 - - 2 3 F 7 - - - - - - - - 1 1 5 Chronic Rheumatic Heart Diseases M 5 - - - - - - - 1 3 - 1 F 17 - - - - - - 1 1 2 4 9 Hypertensive Disease M 16 - - - - - - 1 3 4 2 6 F 14 - - - - - - - - 1 4 9 Ischaemic Heart Disease M 282 - - - - - 1 5 32 58 104 82 F 201 - - - - - - - 3 22 48 128 Other forms of heart disease M 51 - - - - - - 1 - 4 17 29 F 77 - - - - - - - - 1 12 64 Cerebrovascular Disease M 126 - - - - - 2 - 3 9 39 73 F 222 - - - - - - 1 4 14 46 157 98 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1972 (Continued) Causes of Death Sex All Ages Under 4 weeks 4 weeks and under 1 year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Other Disease of Circulatory System M 33 - - - - - - - 1 3 10 19 F 53 - - - - 1 - - 2 3 10 37 Influenza M 5 - - - - - - - - 1 - 4 F 11 - - - - - - 1 1 2 3 4 Pneumonia M 57 - 1 - 1 - - - 2 5 12 36 F 100 - 1 - - 1 - 1 2 6 11 78 Bronchitis & Emphysema M 70 - - - - - - - 4 15 23 28 F 15 - - - - - - - - 4 4 7 Asthma M - - - - - - - - - - - - F 2 - - - - - - - 1 - - 1 Other diseases of Respiratory System M 7 - 1 - - - - - - - 1 5 F 6 - 2 - - - - - 1 - - 3 Peptic Ulcer M 4 - - - - - - - - - 1 3 F 7 - - - - - - - - 1 - 6 Appendicitis M 2 - - - - - - - - 1 1 - F 4 - - - - - - - - - - 4 Intestinal Obstruction & Hernia M 5 - - - - - - - - - 1 4 F 4 - - - - - - - - - - 4 Cirrhosis of Liver M 3 - - - - - - - 2 1 - - F 2 - - - - - - 1 - 1 - - Other diseases of Digestive System M 6 - - - - - - - - 1 1 4 F 9 - - - - - - 4 - - 3 5 Nephritis and Nephrosis M 5 - - - - - - 1 - 1 2 1 F 4 - - - - - - - 1 - - 3 Hyperplasia of Prostate M 3 - - - - - - - - - - 3 Other Diseases, Genitourinary System M 10 - - - - - - - - 1 3 6 F 9 - - - - - - - 2 1 1 5 Other complications of Pregnancy, etc. F 1 - - - - - 1 - - - - - 99 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1972 (Continued) Causes of Death Sex AM Ages Under 4 weeks 4 weeks and under 1 year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Disease of Musculoskeletal System M 7 - - - - - - - 1 - 1 5 F 9 - - - - - - - - 2 2 5 Congenital anomalies M 8 2 3 - 1 1 - - - - - 1 F 7 3 1 - - 2 - - - - - 1 Birth Injury, difficult Labour, etc. M 3 3 - - - - - - - - - - F 2 2 - - - - - - - - - - Other causes of Perinatal Mortality M 4 4 - - - - - - - - - - F 5 5 - - - - - - - - - - Symptoms and III Defined Conditions M - - - - - - - - - - - - F 3 - - - - - - - - - - 3 Motor Vehicle Accidents M 13 - - - 1 3 2 2 - 3 1 1 F 8 - - - 1 1 - - 3 - 1 2 All other accidents M 11 - 1 - - 2 1 1 1 1 2 2 F 10 - - - - - 1 1 - 1 2 5 Suicide & Self-Inflicted Injuries M 1 - - - - - - - - 1 - - F 7 - - - - - 1 - 4 1 - 1 All other external causes M - - - - - - - - - - - - F 1 - - - - - - 1 - - - - TOTAL ALL CAUSES M 981 9 6 2 4 7 9 17 61 157 332 377 F 1,037 10 4 - 1 8 4 17 48 102 219 624 100 PREMATURITY TABLE II The following table gives details of premature births and stillbirths notified in the London Borough of Sutton during the period 1st January31st December 1972 as adjusted by transferred notifications: Weight at Birth PREMATURE LIVE BIRTHS PREMATURE STILLBIRTHS Bom in Hospital Born at home or in a Nursing Home Transferred to Hospital on or before the 28th days Born in Hospital Born at Home or in a Nursing Home Total Births DIED Total Births DIED Total Births Within 24 hrs. of birth Between 1 and 7 days Between 7 and 28 days Within 24 hrs. of birth Between 1 and 7 days Between 7 and 28 days Within 24 hrs. of birth Between 1 and 7 days Between 7 and 28 days 2lb. 3ozs. or less 5 1 2 - - - - - - - - - 1 - (5) (5) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (6) (-) Over 2lb. 3ozs. up to and inc. 3lb. 4ozs. 9 2 2 1 - - - - - - - - 2 - (7) (1) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (5) (-) Over 3lb. 4ozs. up to and inc. 4lb. 6ozs. 27 1 _ 1 _ - - - - - - - 4 - (24) (2) (4) (-) (-) (-) (-) (-) (-) (-) (-) (-) (3) (-) Over 4lb. 6ozs. up to and inc. 4lb. 15ozs. 32 - - - - - - - - - - - 3 - (21) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (2) (-) Over 4lb. 15ozs. up to and inc. 5lb. 8ozs. 78 - - - - - - - - - - - - - (75) (1) (1) (-) (3) (-) (-) (-) (1) (-) (-) (-) (-) (-) TOTAL 151 4 4 2 - - - - - - - - 10 - (132) (9) (5) (-) (3) (-) (-) (-) (1) (-) (-) (-) (16) (-) TABLE III THE OBSERVATION AND HANDICAP REGISTER NUMBER OF CASES ON REGISTER As at Year of Birth TOTAL 1972 1971 1970 1969 1968 1967 31.12.72. 194 230 197 130 106 - 857 31.12.71. - 173 220 130 162 81 766 101 TABLE IV THE HANDICAPPED PRE SCHOOL CHILD LIST OF HANDICAPS, IN DEFINED CATEGORIES, ON THE OBSERVATION AND HANDICAP REGISTER Category No. Nature of Handicap 1 Visual handicaps 11 2 Auditory handicaps 9 3 Language and speech handicaps 3 4 Epilepsy 5 5 Cerebral palsy 5 6 Spina bifida and hydrocephalus 17 7 Muscular dystrophy and other muscular disorders 3 8 Metabolic and endrocrine handicaps 5 9 Alimentary disorders 7 10 Cardiovascular disease 27 11 Respiratory disease 14 12 Genito-urinary disorders 11 13 Educationally subnormal 21 14 Severe educational subnormality 14 15 Maladjusted/Autistic/Psychotic 1 16 Battered Baby Syndrome 11 17 Blood disease 5 18 Limb and skeletal abnormalities 23 19 Chronic illness (neo-plastic) - 20 Skin diseases 5 21 Other conditions 17 22 Chromosomal abnormalities (including monogolism) 14 TOTAL HANDICAPS 228 Number of children included above who have multiple handicaps 15 102 103 CHILD WELFARE CENTRES TABLE V YEAR Number of Children who attended during period 1st January - 31st December 1972 No. of children referred elsewhere for consultant advice First Attendances of Children Born in No. of Sessions held by:- 1972 1968/71 TOTAL Total Attendances Assistant Medical Officers G.P's employed on sessional basis Total No. of Sessions 1972 2503 6312 8815 45839 1075 52 1588 59 YEAR Number of Children who attended during period 1st January-31st December 1971 No. of children referred elsewhere for consultant advice First Attendances of Children Born in No. of Sessions held by:- 1971 1967/70 TOTAL Total Attendances Assistant Medical Officers G.P's employed on sessional basis Total No. of Sessions 1971 2441 8398 10839 49952 1061 17 1801 53 TABLE VI DENTAL CARE OF MOTHERS AND YOUNG CHILDREN Attendances and Treatment Expectant & Nursing Mothers Children under 5 1972 1971 1972 1971 Inspection 25 47 689 791 No. found to require treatment 20 38 319 333 No. offered treatment 19 36 307 323 Re-inspection 1 4 177 137 No. found to require treatment 1 3 98 71 First visits for treatment 28 45 398 387 Subsequent visits 26 77 603 670 Total visits 54 122 1001 1057 Additional courses of treatment - 6 46 41 Fillings 40 87 962 1036 No. of teeth filled 38 69 870 936 Extractions 11 20 175 208 General anaesthetics 1 2 98 109 Emergency visits 5 2 58 79 Patients x-rayed 3 9 9 3 Scalings 10 19 103 85 Teeth otherwise conserved - 1 18 21 Teeth root filled - - - - Crowns 3 - - - Inlays - - - - No. of Dentures supplied - 7 - - Courses of treatment completed 21 28 371 334 Sessions devoted to inspection and treatment 16.5 14.2 155 162 Sessions devoted to Health Education 1 1 1.5 2 104 106 TABLE VII MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) TABLE (a) PERIODIC MEDICAL INSPECTIONS 1st JANUARY-31st DECEMBER 1972 Age Groups Inspected (by year of birth) No. of Pupils who have received a full medical examination Physical Condition No. of Pupils not selected for examination Pupils found to require treatment (excluding dental diseases and infestation with vermin) Satis. Unsatis. For defective vision (excl. squint) For any other Condition Total Individual Pupils (1) (2) (3) (4) (5) (6) (7) (8) 1968 and later 396 395 1 - 7 25 32 1967 2147 2144 3 - 41 137 172 1966 226 226 - - 8 17 23 1965 185 185 - - 4 17 19 1964 765 765 - 853 45 110 133 1963 411 411 - 352 22 67 80 1962 149 149 - - 10 15 19 1961 115 115 - - 8 14 14 1960 643 643 - 697 45 57 84 1959 362 362 - 293 22 39 53 1958 1034 1033 1 - 68 47 101 1957 651 651 - - 38 29 66 TOTAL 7084 7079 5 2195 318 574 796 106 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS TABLE VIII 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 (O). Defect Code No. Defect or Disease Entrants PERIODIC INSPECTIONS Special Instructions 1972 1971 Leavers Others Total 1972 1971 1972 1971 1972 1971 1972 1971 4 Skin T 23 25 10 28 36 70 69 123 397 357 O 55 78 32 66 70 80 157 224 1 - 5 Eyes (a) Vision T 48 66 106 144 164 211 318 421 45 28 O 111 98 100 157 128 226 339 481 8 8 (b) Squint T 37 65 6 7 51 59 94 131 - - O 31 26 7 4 20 25 58 55 - - (c) Other T 4 4 - 1 3 5 4 10 - 3 O 4 2 1 8 7 13 12 23 - 1 6 Ears (a) Hearing T 11 8 2 6 23 14 36 28 49 46 O 58 56 15 12 53 49 126 117 28 12 (b) Otitis Media T 9 13 1 1 8 30 40 22 - 2 O 34 44 1 4 28 29 63 77 3 - (c) Other T 3 2 1 - 4 2 8 4 - 2 O 6 5 1 3 9 4 16 12 - - 7 Nose & Throat T 28 50 17 13 113 93 158 156 7 6 O 429 287 50 70 302 308 781 665 9 2 8 Speech T 33 45 2 34 17 69 62 8 6 O 72 88 7 2 35 28 114 118 5 2 9 Lymphatic Glands T 5 3 - - 8 3 13 6 - - O 109 76 5 7 54 41 168 124 - - 107 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 (O). Defect Code No Defect or Disease Entrants PERIODIC INSPECTIONS Special Instructions Leavers Others Total 1972 1971 1972 1 971 1972 1971 1972 1971 1972 1971 10 Heart T 2 2 - 1 6 5 8 8 1 1 O 21 31 6 8 25 38 52 44 4 - 11 Lungs T 6 12 5 5 17 27 28 44 8 5 O 64 78 24 24 81 103 169 205 3 2 12 Developmental (a) Hernia T 3 5 3 - 7 4 13 9 - 1 O 2 3 2 - 4 5 8 8 - - (b) Other T 4 6 2 - 17 19 23 25 7 2 O 18 17 2 4 20 25 40 46 2 2 13 Orthopaedic (a) Posture T 2 5 1 6 14 12 17 23 2 2 O 12 7 10 12 16 20 38 39 - - (b) Feet T 14 11 7 7 24 35 45 53 17 12 O 27 40 17 19 29 58 73 117 8 1 (c) Other T 6 2 8 6 14 15 28 23 1 14 O 19 29 17 23 30 43 66 95 1 3 14 Nervous System (a) Epilepsy T 3 4 5 6 11 9 19 19 1 - O 8 7 3 7 19 10 30 24 1 - (b) Other T - - - 2 1 1 1 3 - 2 O 6 8 4 1 13 9 23 18 - 3 108 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 Entrants PERIODIC INSPECTIONS Special Instructions Leavers Others Total 1972 1971 1972 1971 1972 1971 1972 1971 1972 1971 15 Psychological (a) Development T 3 - 3 2 3 10 9 12 2 7 O 26 24 22 14 81 89 129 127 2 3 (b) Stability T - - 5 1 10 12 15 13 2 1 O 30 43 22 15 77 67 131 125 1 - 16 Abdomen T 7 - 1 3 11 6 19 9 - 3 O 17 15 5 8 26 25 48 48 2 - 17 Other T 5 6 5 7 24 30 34 43 145 110 O 31 33 12 28 45 56 88 117 61 11 109 SCHOOL DENTAL SERVICE TABLE IX 1. Attendances and Treatment 5-9 years 10-14 years 15 years and over TOTAL 1972 1971 1972 1971 1972 1971 1972 1971 First Visit 2265 2165 1793 1650 435 349 4493 4164 Subsequent Visits 3310 3455 3060 3150 997 825 7367 7430 Total Visits 5575 5620 4853 4800 1432 1 174 11860 11594 Additional courses of treatment commenced 426 476 292 316 72 60 790 852 Fillings in permanent teeth 1523 1742 3753 3754 1433 1312 6709 6808 Fillings in deciduous teeth 4636 4653 362 353 - - 4998 5006 Permanent teeth filled 1323 1484 3192 3222 1170 1112 5685 5818 Deciduous teeth filled 3942 4222 305 320 - - 4247 4542 Permanent teeth extracted 79 101 524 462 119 101 772 664 Deciduous teeth extracted 1624 1365 575 574 - - 2199 1939 General Anaesthetics 720 605 355 327 47 38 1122 970 Emergencies 301 320 123 97 20 15 444 432 1972 1971 Number of pupils x-rayed 544 486 Prophylaxis 538 473 Teeth otherwise conserved 81 94 Number of teeth root filled 51 15 Inlays 0 1 Crowns 16 9 Courses of treatment completed 4453 4275 2. Orthodontics 1972 1971 New cases commenced during 1972 79 64 Cases completed during year 73 71 Cases discontinued during year 3 - No. of removable appliances fitted 121 101 Pupils referred to Hospital Consultant 6 13 3. Prosthetics Ages 5-9 Ages 10-14 Ages 15 & over TOTAL 1972 1971 1972 1971 1972 1971 1972 1971 Pupils supplied with F.U. or F.L. (first time) - - - - 1 - 1 - Pupils supplied with other dentures (first time) 1 - 1 - 5 5 7 5 Number of dentures supplied 1 - 1 - 9 6 11 7 4. Anaesthetics 1972 1971 General anaesthetics administered by dental officers:- Nil Nil 5. Inspections 1972 1971 (a) First inspection at school. No. of pupils 19,156 18,832 (b) First inspection at clinic. No. of pupils 1,822 2,232 No. of (a) + (b) found to require treatment 9,238 10,131 No. of (a) + (b) offered treatment 7,122 8,807 (c) Pupils re-inspected at school clinic 2,458 2,917 No. of (c) found to require treatment 1,737 1.719 6. Sessions 1972 1971 Sessions devoted to treatment 1798.4 1743.8 Sessions devoted to inspection 209.3 201.2 Sessions devoted to Dental Health Education 5 5 110 TABLE X CHILD GUIDANCE CLINIC-STATISTICS 1972 Psychiatric sessions 1972 1971 Diagnostic interview with children 90 51 Treatment interviews 201 289 Court reports 2 6 Boarding school reviews 4 13 Case discussion (supervision) 53 139 Discussion of North Downs cases 15 28 Meeting outside agencies 5 27 Outside visits 5 - Appointments arranged but failed 70 19 Psychiatric Social Worker Sessions Treatment interviews 706 1445 Case discussions (supervision) 65 230 Meeting outside agencies 15 26 Home visits 8 25 Supervision of students 40 46 Outside visits 4 1 1 Appointments arranged but failed 155 177 Diagnostic interviews with families 50 31 Psychotherapist Sessions Diagnostic interviews with families 21 36 Treatment interviews 1708 2177 Case discussions (supervision) 90 185 Outside visits 5 - Meeting outside agencies 13 7 Appointments arranged but failed 260 152 The number of children referred to the Clinic during 1972 was 175 (149) The agencies initiating referral were General practitioners 22 34 School Health Services 45 23 School Psychological Service 50 39 Courts - 6 Social Services 11 5 Hospital or Specialists 15 13 Schools 3 14 Parents 29 15 111 TABLE XI SCHOOL PSYCHOLOGICAL SERVICE In 1972 a total of 586 (544) children presented a variety of learning and behaviour problems and were assessed by the psychologists, the main source of referral being head teachers and the Principal School Medical Officer. Other sources of referral and the recommendations made are as follows (i) Source of Referrals other than by the Child Guidance Clinic during 1972 1972 1971 Principal School Medical Officer 231 164 Head Teachers directly 220 295 Carew Manor E.S.N. School 66 62 Other 37 27 Education 9 5 563 553 Child Guidance Clinic cases seen in 1972=23. (ii) Recommendations made TO Carew Manor E.S.N. School 44 25 Training Centre 9 9 Infant Observation/diagnostic classes 30 15 Borough Remedial Units 17 27 Other schools 24 24 Psychiatric Investigation 27 39 Medical Investigation 13 15 Youth Employment Officer 2 15 Speech Therapist 10 8 Social Services 4 8 Specific review and re-assessment 262 225 Report and advice only 144 143 586 553 (iii) Children-ages when seen 2 years 3 10 years 48 3 " 13 11 " 29 4 " 33 12 " 40 5 " 59 13 " 39 6 " 63 14 " 20 7 " 83 15 " 23 8 " 57 16 " 4 9 " 72 Total 586 112 113 HANDICAPPED PUPILS TABLE XII Number of pupils registered as handicapped Handicapped Pupils requiring education at Special Schools approved under Section 9(6) of the Education Act 1944, or Boarding in Boarding Homes during the years 1st January-31st December 1972 and 1971 Blind Partially Sighted Deaf Partially Hearing Physically Handicapped Delicate Maladjusted E.S.N. Epileptic Speech Defects Total 72 71 72 71 72 71 72 71 72 71 72 71 72 71 72 71 72 71 72 71 72 71 Children newly assessed as needing special educational treatment at special schools 1 - 3 2 2 2 2 3 4 8 8 8 4 10 39 22 - 1 - 1 63 57 No. of children receiving special educational treatment in (a) Boarding Special Schools or Homes 2 1 2 - 6 4 2 1 13 7 8 7 5 6 14 14 1 2 1 - 54 42 (b) Day Special Schools - - 13 12 11 12 8 - 70 26 13 11 12 3 237 179 - - - - 364 243 (c)Independent Boarding Schools - - - 1 1 - - - 3 3 - - 22 19 11 9 - - - • 37 32