Robin Hood Lane Health Centre The Health of Sutton Annual Report 1973 London Borough of Sutton Dr W.H.Kinstrie, MB,ChB,MFCM,DPH Medical Officer of Health/Principal School Medical Officer Mon - Main Sequence SUT 9 CONTENTS INTRODUCTION PAGE NO. PART I GENERAL STATISTICS AND SOCIAL CONDITIONS 7 PART II EPIDEMIOLOGY 12 PART III PERSONAL HEALTH SERVICE 17 PART IV SCHOOL HEALTH SERVICE 33 PART V MISCELLANEOUS 40 PART VI ENVIRONMENTAL HEALTH SERVICES 43 PART VII APPENDIX-STATISTICS 74 W.H. KINSTRIE, MB., ChB., MFCM, DPH MEDICAL OFFICER OF HEALTH & PRINCIPAL SCHOOL MEDICAL OFFICER 1 MEMBERS OF HEALTH AND HOUSING COMMITTEE AS AT 31st DECEMBER, 1973 Councillor E.G. Trevor, FRICS, ARVA, (Chairman) Councillor D.H. Mullins (Vice-Chairman) The Worshipful the Mayor, Councillor D.H.T. Salari, J.P. Alderman: W.M.R. King Councillors: H.A. Bennett, M.lnst.P.S. Miss F.A. Blackler, B.Sc. J.C. Cox A.G.A. Dyson G. Eve J.L. Izard Mrs. E.M. McEwen, MA (Cantab.) K.A. Rose, LL.B., MICE. P.L. Spalding R.C, Squire, ACA. R.S. Williams, B.Sc (Eng.) Co-opted Members: Dr. P.E. Heywood Dr. D.N. Lawson Mrs. J.S. Buck Mrs. P. Driscoll Nominated by: Local Medical Committee South West Metropolitan Regional Hospital Board MEMBERS OF EDUCATION (SCHOOLS) SUB-COMMITTEE AS AT 31st DECEMBER, 1973 Alderman Lt.Col. T.F. Gadd, MC., TD., B.Sc. (Chairman) Councillor G.F. Everitt, J.P. (Vice-Chairman) Alderman: L.J. Hill Councillors: H.A. Bennett, M.lnst-P.S. Mrs. P.M. Brennan, J.P. LL.B. R.W. Ellis E.W. Goodall Major H. Haydon R.J. Slater, ARICS, ASVA. Mrs. B.D. Vernon, JP., MA. Co-opted Members: Mrs. A.R. Barty Miss F.A. Bull Rev. L. Duprez 2 HEALTH DEPARTMENT SENIOR STAFF As at 31st December, 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., Deputy Medical Officer of Health and Deputy Principal School Medical Officer Dr. R.A. Hill, MB., BS., MFCM., DPH., D.Obst.RCOG, Principal Medical Officer Dr. D. Shaw, MD., MB., BS., MRCP., Senior Medical Officer Dr. A. Neville, MB., ChB. 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, SCM, HV, NDN. (QN) Chief Nursing Officer Miss D.M. Sammonds, SRN, SCM, HV, 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., FIHA, Chief Administrative Officer Mr. D.R. Gladwell, DMA Senior Administrative Officer Health Department Organisation (see page 4) 3 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 DIVISION Food Control Section 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 4 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 1973 incorporating the Statutory Report of the Medical Officer of Health and the Principal School Medical Officer. , In February 1974 the Chief Medical Officer of the Department of Health and Social Security requested where possible that the Medical Officers of Health should produce an Annual Report for 1973. Since there was a delay in the publication of the 1972 report, I have simplified the report for 1973 and only include the relevant comparable statistics with comments as necessary. The 1973 report should therefore be read in conjunction with the 1972 report. Vital Statistics It will be noted that the birth rate continues to fall. There has been an increase in the number of infant deaths, most of which occurred during the first week in life. There was, however, a fall in the number of stillbirths; many of the infant deaths occurred during the first few hours of life. The death rate has increased but this is not unexpected in a borough with a high percentage of the population over the age of 65 years. Deaths from cancer of the lung were considerably higher than in the two previous years. It will be noted that there has been a continuous increase in the deaths from coronary disease, making it important, in my view, to discontinue water softening. Infectious Disease The number of cases of Measles is similar to those in 1972. Although there is continuous advice given to parents by members of the medical and nursing professions on the advisability of measles vaccine, it is regretted that more than 25% of parents do not take advantage of Measles vaccination. Community Nursing Service The volume of work for the Community Nursing Service continues to increase and for the home nurses will undoubtedly increase further with the closure of hospital geriatric beds. My comments regarding the Psychiatric Community Nursing pilot scheme will be noted in the report. Health Centres After very considerable delay mainly on reaching agreement with the Department of Health and Social Security on cost limits, the conversion of Shotfield Clinic into a Health Centre and the building of Roundshaw Health Centre were commenced during the year. It is anticipated that both Health Centres will be in operation during 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 volume of work continues to increase. The Council has resolved that the Housing Department and Environmental Health Section of the Health Department will be amalgamated on 1st April, 1974. 5 Housing I refer to the report by the Housing Manager. It is regretted that the number of Category I medical cases continues to increase. Urgent action either by the acquisition of new properties or the building of new Council houses or flats is necessary. Category I medical cases should be rehoused within weeks of the recommendation being made not months or in some cases years. National Health Service Reorganisation The Area Health Authority Joint Liaison Committee met regularly throughout the year when your representatives were the Principal Chief Officer and myself. An Area Profile of all the services - Hospital, Family Practitioner and Community Health Services, was prepared for the members of the new Area Health Authority who were appointed in the latter part of the year. There was considerable discussion regarding the division of the area into districts. The borough representatives together with the representatives of the Executive Councils were in favour of coterminosity with the three London boroughs in the area, but unfortunately were out-voted by the hospital representatives who considered that the districts should basically be the catchment areas of the general hospitals in the area. 6 Three districts were formed:- District I - the western half of Wandsworth (together with an over-lap into Richmond-upon-Thames) District II - the eastern half of Wandsworth together with the eastern part of Merton. District III - Sutton and West Merton The division of both Wandsworth and Merton will undoubtedly cause problems in the collaboration with the local authorities, particularly with the Social Services and Education Departments. The Community Health Services continued to improve throughout the year and I am confident that the borough will transfer a first class service to the Area Health Authority on 1st April, 1974. I personally regret that the office of Medical Officer of Health will cease. I am of the opinion that reorganisation was not necessary as far as the London Borough of Sutton was concerned. Since 1965 there has been established a very close working relationship between the Community Health Services, general practitioners and the hospital services. I have enjoyed working in the borough since 1965 and am grateful to the members of the Council who have shown considerable interest in the Health and welfare of all groups in the community. I personally do not know of any borough which has made such progress in the past decade. I have pleasure in recording my grateful thanks to all the staff of the Health Department for their valued and devoted service, particularly to the Deputy Medical Officer of Health, Principal Medical Officer, Chief Dental Officer, Chief Nursing Officer, Chief Public Health Inspector and Chief Administrative Officer. I take this opportunity also of expressing my appreciation of the help given to the department by the Chief Officers and their staff of other departments and to the members of the Health and Housing Committee and Education (Schools) Sub-Committee. W.H. KINSTRIE, MB., ChB., MFCM., DPH GENERAL STATISTICS AND SOCIAL CONDITIONS PART I INDEX Page No. AREA AND POPULATION 8 DEATHS 8 BIRTHS 11 W.H. KINSTRIE, MB., Ch.B., MFCM., DPH., Medical Officer of Health and Principal School Medical Officer 7 AREA AND POPULATION Area in Acres Registrar General's estimated mid-year popqlation 1973 Census Population 1971 1961 1951 10732 168,210 168,815 169,095 176,151 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: 1973/74 1972/73 1971/72 72,313 72,561 70,809 The following statistics have been supplied by the Registrar General: Deaths from all Causes Male Female Total Crude rate per 1000 Home Population Adjusted rate per 1,000 population (comparability factor .90) 1973 1002 1104 2106 12.5 11.3 1972 981 1037 2018 11.9 10.5 1971 874 935 1809 10.8 9.6 8 Deaths from certain causes: Category 1973 1972 1971 1970 1969 1960 1950 Tuberculosis, respiratory 1 2 2 8 4 9 39 Cancer, Uterus 10 7 9 17 15 17 11 Cancer, Bronchus, Lung 142 112 102 132 112 83 52 Coronary disease 506 483 460 443 460 362 291 Bronchitis 69 85 81 98 90 82 75 Suicide 20 8 12 17 24 19 15 Motor Vehicle Accidents 30 21 23 26 27 18 13 All other accidents 19 21 25 20 26 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 1973 28 2 30 12 1 13 43 1972 15 — 15 13 1 14 29 1971 19 3 22 10 1 11 33 Under 4 weeks of age 1973 23 2 25 12 1 13 38 1972 9 — 9 9 1 10 19 1971 15 2 17 8 1 9 26 Under 1 week of age 1973 20 1 21 11 1 12 33 1972 7 — 7 7 1 8 15 1971 14 2 16 8 1 9 25 9 Infant Mortality Rates London Borough of Sutton England and Wales 1973 1972 1973 1972 Infant deaths per 1,000 per live births 21 13 17 17 Legitimate infant deaths per 1,000 legitimate live births 21 14 16 17 Neo-natal deaths under four weeks per 1,000 total live births 18 9 11 12 Early Neo-natal deaths under one week per 1,000 live and stillbirths 16 7 10 10 Peri-natal stillbirths and deaths under one week combined per 1,000 total live and stillbirths 22 15 21 22 10 BIRTHS 1st January - 31st December, 1973 LIVE STILL Legit Illegit. Total Legit. Illegit Total M 974 M 61 1035 M 5 M - 5 F 973 F 68 1041 F 8 F 1 9 TOTAL 1947 129 2076 13 1 14 94% 6% 100% 93% 7% 100% Total live and stillbirths 2090 Live Birth Rate per 1000 Home Population Number of Stillbirths Crude Adjusted by Comparability Factor 1.00 Males 5 Females 9 12.3 12.3 Total 14 Stillbirth rate per 1000 live and stillbirths 7 11 EPIDEMIOLOGY PART II INDEX Page No. PREVALENCE AND CONTROL OF INFECTIOUS DISEASE 13 IMMUNISATION AND VACCINATION 14 VENEREAL DISEASES 15 MASS RADIOGRAPHY 16 IMMIGRATION 16 W.H. KINSTRIE, MB.. Ch.B., MFCM., DPH., Medical Officer of Health and Principal School Medical Officer 12 PREVALENCE AND CONTROL OF INFECTIOUS DISEASE The following table gives the total number of infectious diseases notified during 1973 together with the figures for 1972 for comparison Infectious diseases notified during the period 1st January 1973- 31st December 1973 Disease 1973 1972 Diphtheria — — Dysentery 61 32 Encephalitis 5 3 Food Poisoning 7 2 Infective Jaundice 12 36 Malaria 1 3 Measles 387 379 Meningococcal Meningitis 4 7 Ophthalmia Neonatorum — 3 Poliomyelitis — — Scarlet Fever 69 60 Smallpox — — Typhoid — — Paratyphoid — 1 Tuberculosis (Pulmonary) 19 14 Tuberculosis (non-pulmonary) 3 4 Whooping Cough 13 5 13 IMMUNISATION AND VACCINATION 1st January - 31st December 1973 Type of Protection Completed Primary Courses Receiving Reinforcing Doses (Boosters) 1973 1972 1973 1972 Diphtherta/Pertussis/T etanus 1796 1960 33 142 Diphtheria/T etanus 65 75 1728 2428 Diphtheria 1 3 31 58 Tetanus 17 21 1652 979 Poliomyelitis (Sabit-Oral Vaccine) 1764 2114 3983 3756 Smallpox 296 68 1177 166 Measles 1480 1642 Rubella 192 1572 Typhoid 845 817 261 211 Typhoid/Cholera 115 116 23 - Cholera 97 123 7 8 Influenza 350 371 TAB/Tetanus 6 — It will be noted that there is a considerable reduction in the number of girls immunised against Rubella (German Measles). The sessions held at schools were mainly deferred from the Autumn Term to the Spring Term 1974. During the Spring Term 1974, 742 girls were vaccinated. Vaccination against Rubella for women of child bearing age Following the advice of the Chief Medical Officer of the Department of Health and Social Security, the Medical Officer of Health, in agreement with the Local Medical Committee, advised the Council's staff who are at special risk of acquiring rubella or of transmitting it to others, to have vaccination against rubella. The Medical Officer of Health was responsible for undertaking the preliminary work of ascertaining female staff who were at risk of developing rubella and referred them to their general medical practitioners in order that they could be given the opportunity of receiving rubella vaccination. During 1973 blood samples were taken from the following : Teachers 57 School Meal Helpers 6 Health Visitors 5 Staff nursery nurse 6 Home Helps 2 Health Department staff 1 As a result 14 staff were referred to their own doctors for vaccination against rubella. 14 Vaccination against Tuberculosis (B.C.G.) A. Contacts 1973 1972 (1) Skin tested 15 26 (2) Found positive — — (3) Found negative 15 26 (4) Vaccinated 15 26 B. School Children and Students (1) Skin tested 1511 1669 (2) Found positive 57 138 (3) Found negative 1432 1531 (4) Vaccinated 1432 1531 Influenza Vaccination Influenza Vaccination was offered to the following categories in the year 1973 Staff and residents in old people's homes Staff and children in children's homes Staff at Eldoret Day Nursery Social Workers Nurses, Midwives and Health Visitors Public Health Inspectors Venereal Disease Notification of new cases of Sutton residents from hospital treatment centres during the last three years are as follows 1973 1972 1971 Syphilis 5 3 11 Gonorrhoea 47 46 42 Other venereal conditions 613 598 548 TOTAL 665 647 601 There has been a small increase in the number of cases of venereal disease compared with 1972. In conjunction with the London Borough of Merton two Contact Tracers were attached to the St. Helier Hospital Special Clinic. Both have carried out their work with enthusiasm and have been successful in getting many contacts to attend for examination. 15 Mass Radiography The Director of the Mass Radiography Unit has supplied the following statistics 1973 1972 Total X-Rayed 2202 2606 Cases of Lung Cancer — 1M 1F Cases of Pulmonary T.B. — 2 M 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 1973 from ports and airports relating to the arrival of immigrants Number of first successful visits paid during 1973 Number of Pulmonary Tuberculosis notifications received in respect of immigrants during 1973 (A) Commonwealth Countries 1973 1972 1973 1972 1973 1972 1. Carribbean 5 6 — 1 — — 2. India 8 15 2 5 — — 3. Pakistan 2 9 — 3 — — 4. Other Asian — 11 2 9 — 1 5. African 3 6 2 5 — — 6. Other 12 15 5 3 — — (B) Non-Commonwealth Countries 1. European 5 10 1 6 — — 2. Other 32 26 11 13 — — TOTAL 67 98 23 45 — 1 In addition, Medical Superintendents at hospitals followed up 21 (27) immigrants 16 PERSONAL HEALTH SERVICE PART III INDEX Page No. MATERNAL AND CHILD HEALTH 18 PREMATURITY 18 CONGENITAL ABNORMALITIES 19 DISTRIBUTION OF WELFARE FOODS 20 THE WORK OF THE HEALTH VISITORS AND SCHOOL NURSES 21 CLINIC SESSIONS 21 HEALTH VISITORS CASE LOAD 21 HOME VISITS 22 SCREENING PROCEDURES 23 AUDIOLOGY CLINIC 23 ADVISORY CLINICS FOR THE ELDERLY 23 DOMICILIARY MIDWIFERY AND HOME NURSING 24 HOME NURSING 24 PSYCHIATRIC COMMUNITY NURSING PILOT SCHEME 24 LAUNDRY SERVICE FOR INCONTINENT PATIENTS NURSED AT HOME 25 DOMICILIARY MIDWIFERY 25 SUMMONING OF MEDICAL AID 26 NOTIFICATIONS FROM MIDWIVES 26 OPHTHALMIA NEONATORUM 26 REFRESHER COURSE FOR MIDWIVES, HOME NURSES AND PUPIL MIDWIVES 27 LOCAL SUPERVISING AUTHORITY (MIDWIVES ACT) 27 CERVICAL CYTOLOGY 28 CHIROPODY SERVICE 29 NURSING HOMES 30 NURSES' AGENCIES ACT 1957 30 HEALTH EDUCATION 31 W.H. KINSTRIE, MB., Ch.B., MFCM., DPH., Medical Officer of Health and Principal School Medical Officer 17 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, 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 to 31st December 1973 (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 1973 1972 1973 1972 Live 2477 2558 Live 2164 2263 Still 15 22 Still 7 18 TOTAL 2492 2610 TOTAL 2171 2281 Births in Hospital 2085 2153 Births at Home 86 145 Prematurity Full schedule showing statistics will be seen in Table II in the Appendix to this report. TOTAL Non-Premature Premature 1973 1972 1973 1972 1973 1972 Live births 2164 2398 2054 2247 110 151 Deaths among live births in the first month of life 36 19 26 9 10 10 Stillbirths 7 18 1 8 6 10 The Department of Health and Social Security's definition of a premature birth is one when the infant at birth weights 5 lbs. 8ozs. or less. 18 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 1973. 1973 1972 Total number of children born with abnormalities 40 42 Number of those who were stillborn 1 2 Number of those born alive who died within 10 days 2 — Number born with serious defects 8 10 Number which were of a comparatively minor nature 32 32 19 Distribution of Welfare Foods Government Scheme The Council acts as agent for the distribution of Welfare Foods 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 1973 :- National Dried Milk (Packets) A & D Tablets (Packets) Children's Vitamin Drops 1973 1972 1973 1972 1973 1972 4586 4180 4659 2145 16909 10339 Proprietary Welfare Foods Infant Welfare Clinics hold a stock of proprietary brands of welfare foods approved by the Medical Officer of Health for sale to bona fide clinic attenders at reduced prices. 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. 20 THE WORK OF THE HEALTH VISITORS AND SCHOOL NURSES Health Visitors 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 1973 1972 Ante Natal and Post Natal 55 172 Infant Welfare and Toddlers Developmental Sessions 1512 1588 Mothercraft and Parentcraft 275 321 Health Education: Health Centre, Schools, Red Cross, St. John's Ambulance, Youth and Adult Organisations 490 506 Hearing Tests 184 138 2. Health Visitors Case Load for children aged 0 - 5 years 0 - 1 year 1 - 5 years families 1973 1972 1973 1972 1973 1972 2064 1554 10253 9279 8105 8581 In addition health visitors had the following case loads Ante Natal Mothers 925 Geriatric Cases 1031 School children 5 to 16 years 403 Adults 17 -65 years 807 Mentally ill and mentally handicapped 120 T.B. contacts 111 Child Minders, Play Groups and Nurseries 139 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 5250. 21 3. Home Visits 1973 0 - 5 years 20937 5-16 years 923 17 - 64 years 2120 Geriatric cases 2283 Ante Natal visits 925 Mentally ill and mentally handicapped 697 Visits to other groups 1449 TOTAL 29,334 22 Screening Procedures The following screening procedures are carried out:- (a) The Guthrie Test at 6 days old for phenylketonuria No cases were detected in 1973. (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 1973. (c) Hearing test at 6 to 8 months. 39 cases were referred to the Audiology Clinic for further investigation in 1973. (d) Sickle Cell Anaemia - a condition found in coloured children. Of the 29 children screened none 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) 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 1973 1972 1973 1972 1973 1972 1973 1972 0-2 39 30 51 47 1 3 1 2 2-5 80 87 123 125 8 11 2 8 Advisory Clinics for the Elderly Total number of Sessions in 1973 244 Total attendance 4054 Of 360 assessments, 38 were referred to the general practitioner. 23 DOMICILIARY MIDWIFERY AND HOME NURSING Home Nursing 1973 1972 (a) Number of persons nursed 5054 4695 (b) Number of children under 5 years at 1st visit 402 265 (c) Number of persons aged 65 or over 65 at 1st visit 3506 3285 (d) Number of visits made by home nurses 154499 169296 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 5826 resulting in 9607 treatments. Psychiatric Community Nursing Scheme During 1973 a Pilot Scheme for Psychiatric Community Nursing was commenced in conjunction with Belmont Hospital. Case conferences are held on patients prior to discharge from hospital and home visits are undertaken either by the home nurse from the Community Nursing Service or a nurse from Belmont Hospital. Treatment is continued at home and every effort is made to establish the mentally ill person in the community. The Pilot Scheme has been successful and it is anticipated that subject to availability of trained home nurses, it will be extended to all pateints requiring domiciliary visits on discharge from Belmont Hospital. Patients nursed aged 5-64 years 53 aged over 65 years 9 Total 62 No. of visits 1410 24 Laundry Service for Incontinent Patients Nursed at Home Total number of cases during the year was as follows: Total during year Number of patients on books at end of year 1973 1972 1973 1972 London Borough of Sutton 76 73 46 46 London Borough of Merton 105 99 76 53 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 1973 No. of confinements attended by D.M. in Hosp. No. delivered in institutions 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 1973 1972 1973 1972 1973 1972 1973 1972 1973 1972 1973 1972 1973 1972 4 21 83 124 87 145 203 148 681 664 15335 17880 3612 3814 The number of domiciliary confinements continues to fall but with increasing attendance of domiciliary midwives at confinements in hospital. As a result the hospital and domiciliary midwifery services are rapidly becoming completely integrated. 25 Summoning of Medical Aid During 1973 medical aid was summoned under the Midwives Act 1951 by midwives in the following number of cases. 1973 1972 For domiciliary cases: Where the medical practitioner had arranged to provide the patient with maternity medical services under the National Health Service 117 140 For cases in hospital 125 139 Notification from Midwives During 1973 the following notifications were received from midwives: 1973 1972 Sending for medical aid 242 279 Stillbirths 1 1 Liability to be a source of infection (including Pyrexia) 9 21 Death of mother or baby - 1 mother Ophthalmia Neonatorum During the year 1973 midwives sought medical aid for suspected cases of ophthalmia neonatorum in respect of 19 (22) babies, but no cases were notified. 26 Refresher Course for Midwives, Home Nurses and Pupil Midwives Refresher Course attended 1973 1972 Midwives 3 4 Home Nurses 5 8 Practical Work I nstructors Course attended Home Nurses 3 2 Projector Course 3 4 First Line Management Courses Home Nurses 3 5 District Nurse Training Student Home Nurses who completed training and passed the examination 5 5 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) 34 33 Local Supervising Authority (Midwives) Act The Borough Council as the Local Supervising Authority is 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 1973: 162 (121). 27 Cervical Cytology Sessions are held at all the major clinics in the borough and during 1973 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 following tables indicate the work carried out during 1973 1973 1972 Number of visits of women having smears taken for the first time 692 923 Number of visits of women having repeat smears 1999 1450 TOTAL 2691 2373 Classification of Smears Class Number of Smears 1973 1972 I Normal smear pattern 1613 1580 II Inflammatory Pattern 1061 785 III Dyskaryotic (abnormal) cells present 16 7 IV Isolated cells suggest malignancy 1 1 V Malignancy probable - - The family doctors are informed of the results in all cases and where necessary they arrange for hospital investigation. 28 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: 1973 1972 Total number of cases attended 5008 2334 Total number of treatments 17163 11812 Where the elderly or handicapped person is unable to attend the clinic, domiciliary visits are made and 6033 (5457) visits were made in 1973. In spite of the difficulties in employing full time chiropodists, the number of cases treated considerably increased during 1973. Most chiropodists prefer to work on a sessional basis which results in a higher salary compared with the salary of full time chiropodists. The Chief Chiropodist has not only organised the service but has undertaken a very considerable volume of the clinical work. 29 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 1973 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. 30 HEALTH EDUCATION The responsibility shown towards health education has continued to develop and expand throughout a number of professional and non-professional disciplines during the last year. Despite the limitations of its size, the reorganisation of the centre has provided lecture room, workshop and office facilities, which have afforded a focal point for the exchange of ideas and experience between health education of varying professions. In-Service Training Three eight-session courses in health education content were made available to high school teachers, primary school teachers and youth leaders respectively. These well subscribed courses have resulted in increased health teaching activities. Some fifteen primary schools, fourteen high schools and several of the youth centres have made regular use of the health education service. The increased demand made by schools, youth centres, clinics, hospitals and independent troupsfor health speakers has necessitated the introduction of teaching method courses for health visitors, midwives and school nurses. Twenty five in-service training sessions relating to the philosophy of health education were arranged for Public Health Inspectors, student Public Health Inspectors, student Health Visitors, student Nurses, Pupil Nurses, Pupil midwives and college students. The centre has continued to conduct its audio-visual aid courses for health educators. Out of the three courses run 17 of the 19 candidates successfully completed the course. The lecture room facilities have been well used by various officers conducting their own in-service training sessions. Teaching Sessions Health Educators in the field have utilised the Centre for the supply of visual aid material on 1620 occasions. This represents a 100% increase in the visual aid loan service over the last two years. Many of the sessions undertaken were planned with the guidance of the Health Education Officer and assisted by the technical and clerical support of the service. In some of the schools and youth centres courses were initiated and/or supervised by the Health Education Officer. Exhibitions A pollution control exhibition was designed and executed in collaboration with the Environmental Health Service and was subsequently displayed at three public shows, several public buildings and St. Helier Hospital. A float, entered in the Carshalton Carnival, combined the theme of Clean Air and Anti-Smoking. The exhibit for the Carshalton Show took the form of a food hygiene game which owing to its participation nature attracted a great deal of interest from young people. In addition to the teaching undertaken by the Public Health Inspector manning the exhibit, more than 230 small prizes were awarded to successful participants. 31 Photography The photography service of the centre has been well used by various officers and a number of teaching slides were produced on clinic development, environmental health, the Health Centre and various clinical disorders, e.g. general vaccinia. In addition to the preparation of visual aid material the service has been used for other purposes. Home Safety The Home Safety Officer has worked in close liaison with the Health Education Service and during 1973 gave talks to many age groups including schools, old-age pensioners and youth organisations. The annual campaign for the collection of drugs was held with the assistance of the local chemists and public health inspectorate. The 95,000 plus drugs collected were subsequently destroyed. The poster painting competition for school children on the subject of Home Safety attracted more than 230 entrants. The danger from misuse of fireworks was again publicised throughout clinics and public buildings, and in addition the Home Safety Officer lectured with the aid of a publicity film, in fifteen of the schools. Areas of Need There are still many areas where the need to expand health education is obvious, perhaps the most important of these being through the work of the Social Services Department. It is however impracticable to consider developing the service in any new direction as the present staffing and equipment of the centre is inadequate to efficiently meet the increasing demands made by the groups already served and the health educators who are at present highly motivated. 32 SCHOOL HEALTH SERVICE PART IV INDEX Page No. PERIODIC MEDICAL EXAMINATIONS 34 SPECIAL MEDICAL EXAMINATIONS AND RE-EXAMINATIONS 34 HANDICAPPED PUPILS 34 PERSONAL HYGIENE 34 GENERAL MEDICAL CLINICS 34 DEFECTIVE VISION 35 DISEASES AND DEFECTS OF EAR, NOSE AND THROAT 36 ORTHOPAEDIC DEFECTS 35 SPECIAL SERVICES 35 AUDIOLOGY 35 SPEECH THERAPY 35 CHILD GUIDANCE SERVICE 35 OBSERVATION AND DIAGNOSTIC CLASSES 35 SPECIAL SCHOOLS 35 CAREW MANOR E.S.N. SCHOOL 35 SHERWOOD PARK E.S.N. SCHOOL 36 NORTH DOWNS UNIT 36 BELMONT HOSPITAL SCHOOL 36 QUEEN MARY'S HOSPITAL SCHOOL 36 THE FOUNTAIN SCHOOL 36 AUTISTIC UNIT AT QUEEN MARY'S HOSPITAL SCHOOL 37 CLASS FOR NON-COMMUNICATING CHILDREN AGED UNDER 5 YEARS AT QUEEN MARY'S HOSPITAL 38 HOME TUITION 38 EMPLOYMENT MEDICAL ADVISORY SERVICE 38 EMPLOYMENT OF CHILDREN OF SCHOOL AGE 38 PROVISION OF MEALS AND MILK IN SCHOOLS 38 33 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 1973 there were 11074 (10368) pupils in High Schools 14332 (14220) pupils in Primary Schools 292 (299) pupils in full time equivalent places in Nursery Schools. Periodic Medical Examination During 1973 periodic medical inspections were carried out on : (1) all new entrants (2) selective medical examinations were carried out on pupils in their 8th and 11th years. Sutton High School for Girls G.P.D.S. availed themselves of these services with the consent of the Council in 1973. (3) due to the raising of the school leaving age no pupils were due for routine leavers medical examination. Those pupils leaving school at Easter and Summer 1973 had their leavers medical examination during the autumn term of 1972. Special Medical Examinations and Re-examinations The total number of re-examinations in 1973 was 2282 (1680). Full details of defects found at periodic and special medical inspections are given in the appendix to this report. Tables VII and VIII. Handicapped Pupils The following table shows the number of handicapped children attending primary and high schools as at 31st December 1973. 1973 1972 Epilepsy 102 90 Heart Defect 32 30 Hearing Defect 47 45 Diabetes 30 31 Physically Handicapped 63 68 Partially Sighted 11 10 Other Handicaps 15 9 Personal Hygiene The total number of inspections carried out was 9336 (3387) and 57 (60) were found to be infested. General Medical Clinics The total number of pupils treated for minor ailments excluding skin diseases in 1973 was 165 (145). The total number of pupils treated for skin diseases was 482 (397). 34 Defective Vision The total number of pupils treated for defective vision including squint in 1973 was 1587 (1571). Spectacles were prescribed for 505 (583). Diseases and Defects of Ear, Nose and Throat The total number of children treated for these defects in 1973 was 120 (111) of whom 43 (31) had operative treatment, mainly for tonsils and adenoids. Orthopaedic defects The total number of pupils treated at clinics in 1973 was 137 (142). Special Services (a) Audiology New cases supplied with hearing aids during 1973 4 (7) Pupils registered as having been fitted with hearing aids as at 31st December 1973 63 (64) Total number of children seen by Audiometrician 2473 (2415) Number referred for further investigation 101 (103) An additional teacher for the deaf was appointed in 1973. (b) Speech Therapy Apart from speech therapy sessions given to individual pupils, speech therapists co-operate with teachers in schools, special units and parents in planned language development programmes for children with poor speech development. The total number of children attending for speech therapy in 1973 was 385 (239). (c) Child Guidance Service The number of children referred to the Child Guidance Clinic during 1973 was 180 (175). The number of families actually seen and treated at the clinic during 1973 was 227 (190). Observation and Diagnostic Classes During 1973 a total of 55 (43) children attended the classes: of these 19 left and were placed as follows: (a) 4 children transferred to ordinary school (b) 10 children transferred to Carew Manor E.S.N. School (c) 1 child transferred to Sherwood Park School (d) 2 children transferred to a Unit for Maladjusted pupils (e) 1 child transferred to a residential E.S.N. School (f) 1 child transferred to a Day E.S.N./Maladjusted School SPECIAL SCHOOLS Carew Manor E.S.N. School The average number of pupils attending in 1973 was 143. During 1973 Wallington High School for Boys vacated class rooms which they were using in Carew Manor School and it is hoped that during the next year these classrooms will be used for a much needed six year old class at the school. 35 Sherwood Park E.S.N. School 4 children attended the school daily who were resident in Queen Mary's Hospital for Children, 9 from a private community home in the borough, and one who was resident in the reception home of this authority. A speech therapist and physiotherapist carried out 3 sessions and 2 sessions per week respectively in the school and a teacher of the deaf attended 3 times a week. North Downs Unit The number of children who attended that Unit during 1973 was 35. The number of children discharged during 1973 was 13. 5 returned full time to High School 3 returned full time to Primary School 2 were admitted to a Residential School for Emotionally Disturbed Children 1 was admitted to a Day School for E.S.N. Children 1 was admitted daily to Queen Mary's Hospital School 1 moved away from the area. Belmont Hospital School During 1973 14 children received tuition as in-patients and 16 children were seen as out-patients. 2 children attended as day children. 5 children were discharged from the unit during 1973 to the following schools :- 2 day E.S.N. School 1 Nursery School 1 Residential Maladjusted/E.S.N. School 1 Smith Hospital, Henley-on-Thames. Queen Mary's Hospital School The report completed by the Director of Education and the Principal School Medical Officer was submitted and accepted by the Council during 1973. The Fountain School During 1973 there were 104 children receiving education in the Draper Building and 'F' Block and 202 Ward groups. 27 teachers in addition to the head teacher and deputy were in post. In addition 45 classroom assistants have been appointed. 36 The size of classes arid ward groups were subject to variation and the number of staff were allocated accordingly. The school consisted of 12 classes but now comprises of : (1) Draper Building: 4 classes grouped chronologically from 4 - 16 years (plus 2 classes for physically handicapped and one class for the deaf). 'F' Block Class 8- Pupils over 16 years received pre-industrial training Class 9 - Daily children from Sutton, Wandsworth and Croydon Class 10 - Mainly children admitted to hospital for short term care and suitable to attend school. Class 11 - a group of severely mentally handicapped children who were given a trial in school out of the ward. Class 12- a group of 4 children who required individual attention. (2) Teachers were 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 a major disability in all children receiving education at the Fountain School, a high proportion of the children suffer from an additional handicap, i.e. 117 physically handicapped 31 epileptic 16 blind 6 deaf 4 partially sighted 3 partially deaf In addition some children suffered from a degree of emotional disturbance from slight to very severe. The greatest need is for replacement and additional teaching space. There is an urgent need to commence without delay the building of the extension for the Fountain School. The accommodation and facilities in 'F' Block is sub-standard and as soon as alternative accommodation is available in the new extension it will be to the advantage of the children and staff. During the year a great deal of research was made and is still being carried out into the provision of Adventure Playgrounds suitable for the requirements and ability of the children. I would like to take this opportunity of thanking all the staff at the Queen Mary's Hospital for Children for their help and co-operation during the year as without this nothing would have been achieved. Autistic Unit at Queen Mary's Hospital School During 1973 5 new children were admitted to the Unit and 6 discharged. 1 child was admitted to the Fountain School 1 child was admitted to the Sherwood Park School 1 child was admitted to the Day ESN/Disturbed School 1 child was admitted to the Private School 37 1 child was admitted to the Day ESN School 1 child was admitted to the Infants School Class for non-communicating children aged under 5 years at Queen Mary's Hospital During 1973 8 new children were admitted to the class and 7 children discharged to :- 2 Observation/Diagnostic Unit 1 Day ESN School 1 Sherwood Park School 2 Day School for ESN/Disturbed Pupils 1 Normal Nursery School Home Tuition During 1973 home tuition was arranged for 32 children (23) During the year, tuition was also arranged at the following hospitals :- St. Helier Hospital 494 children Royal Marsden Hospital 6 children 7 children who suffer from cerebral palsy received education at The Rutherford Children's Centre, Croydon. EMPLOYMENT MEDICAL ADVISORY SERVICE This service became operative on 1st February 1973. In the first term of a pupil's last year at school a form (Y9) is completed and copies are sent to the family doctor, careers officer and employment medical adviser in respect of those pupils where a certain type of employment is contraindicated; also form (Y10) is completed with the parents consent in respect of those pupils where it is considered they should be registered as disabled. A Conference is held twice a year to discuss each handicapped school leaver who resides in the borough. Headteachers, class teachers, educational psychologists, speech therapists, careers officer, principal medical officer, director of social services and employment medical adviser for the area are invited to attend to discuss each handicapped school leaver and to advise a plan in respect of each pupil's placement when they leave school. 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 1973 was 854 (175). The increase in medical examinations was due to the raising of the school leaving age to 16 years. PROVISION OF MEALS AND MILK IN SCHOOLS 1973 1972 The number of day pupils receiving midday meals per day both at maintained and non-maintained schools was: 16155 16128 38 Milk in Schools The number of pupils receiving free milk in school for medical reasons was 1350during 1973. The number of pupils purchasing milk in non-maintained and maintained schools during 1973 was 2027. 39 MISCELLANEOUS PART V INDEX Page No. STAFF MEDICAL EXAMINATIONS 41 HOUSING DEPARTMENT 42 W.H. KINSTRIE, MB., Ch.B., MFCM., DPH., Medical Officer of Health and Principal School Medical Officer 40 MISCELLANEOUS STAFF MEDICAL EXAMINATIONS Medical Examinations undertaken 1973 1972 Officers (excluding teachers) 168 223 Teachers 113 280 Manual Staff 203 261 Extensions of sick pay 2 7 Retirement due to ill health 15 12 Extensions of service beyond retiring age 90 126 Heavy Goods vehicle drivers 12 40 Trainee Teachers 187 246 1973 1972 Medical Questionnaire (without Medical examination) 555 194 Other Medical Examinations Officers (including teachers) who had chest x-ray only 698 254 School Canteen staff who had chest x-ray only 483 329 School Canteen staff who had chest x-ray and bacteriological investigations - 21 Routine triennial chest x-ray examinations 267 287 It is regretted that the number of routine triennial chest x-ray examinations carried out during 1973 is less than in 1972. The number should have increased considerably during 1973 since it has been a condition of service since 1969 that staff in regular close contact with children should have a triennial x-ray examination of chest. 41 HOUSING DEPARTMENT New Properties During 1973 no new properties were completed. Casual Vacancies, Mutual Exchanges and Transfers 272 (356) properties were vacated and re-let during the year. 115 (129) mutual exchanges and 95 (169) transfers were arranged. Rehousing from Clearance and Re-development areas etc. 48 (21) families were rehoused during the year to facilitate the closing or demolition of dwellings. Housing Waiting List At the 31st December 1973 there were 3079 (2497) applicants on the Council Housing Waiting List, of which 743 (746) were elderly persons. Housing of Special Cases The number of applicants housed during 1973 under the delegated authority granted to the following officers was:- Medical Officer of Health 113 (95) Housing Manager 12 (16) Director of Social Services 19 (17) At the 31st December 1973 there were 242 (168) further cases for which urgent re-housing had been authorised under the delegated powers and awaiting solution. Shanklin Road, Belmont At the end of the year 387 of the 424 properties on Shanklin Estate had been accepted from the contractor and in accordance with the agreement between the London Borough of Sutton and the Greater London Council, 111 of the 140 nominations granted to this authority had been housed. 42 1.1 INTRODUCTION Once again the principle features of my report indicate an increased demand, of a changing nature, on most sections of the Environmental Health Service. The report also indicates that these were effectively met. Such an achievement was made possible by the extra effort of the staff, in areas beyond the boundaries of their paid responsibility and despite the justifiable disappointment in the job evaluation exercise in 1971. Clearly this situation cannot continue and of necessity the current standards of service may have declined somewhat by the time of my next report. The year closed with a sense of pride and achievement but with a natural curiosity towards the inevitable changes that 1974 will bring. New relations will have to be established with Health Officers being transferred to the new Area Health Authorities and with the Council's Housing Service, with whom we will be departmentally associated. Additional responsibilities regarding communicable disease control and home safety will need to be fulfilled and on behalf of the Local Authority I will be asking the staff of the Environmental Health Service to endeavour to meet this increased area of work. This introduction to my report gives me the opportunity to extend my thanks to the support given to me by the Environmental Health Services staff, of the Medical Officer of Health and his staff, and the Chairman and members of the Health and Housing Committee. 43 1.2 STAFF LIST (A) = Appointed 1973 (R) = Resignation or Retirement 1973 NAME DESIGNATION ALLEN, Miss L. Clerical Assistant (Transferred to Personal Health) ANSELL, Mrs. C. Clerical Assistant ARNOLD, S.J. New Entrant (A) BAILEY, C.J. Technical Assistant BENNETT, P.J. Clerical Assistant BISHOP, D.F. Assistant Mortuary Superintendent BROWN, T.S. General Assistant BURTON, Mrs. S.A. (nee Barnes) Clercial Assistant CARROLL, Mrs. D.E. Administrative Officer CHARMAN, B.W. General Assistant COLLINS, L.K. Clerical Assistant CONWAY-SMITH, R. Pest Operative DERWENT, J. Public Health Inspector (A) DIXON, J.P. Assistant Chief Public Health Inspector EDWARDS, R.H. Mortuary Superintendent EDWARDS, R.J. Clerical Assistant (A) EVES, D.A. Chief Public Health Inspector FORD, Mrs. E.P. Part-time Cleaner FREEMAN, J.A. Pupil Public Health Inspector ) Public Health Inspector ) GUNNELL, P.W. Public Health Inspector HAMILTON, R.J. Public Health Inspector (R) HAYES, R.S. Pest Operative HUTCHISON, R. Pest Operative KILLBY, E. Public Health Inspector LE PETIT, Mrs. A.C.N. Audio Typist LIGGET, N.F. Technical Assistant LOWE.S.S. Public Health Inspector MAY, D.G. Technical Assistant Ml LNE, Mrs. C.M. Clerical Assistant MORAM.T.W. Technical Assistant MURPHY, P.B. Pupil Public Health Inspector MYERS, W.G. Public Health Inspector PORTER, Mrs. C.E. Clerical Assistant (R) REAVLEY, J.W. Senior Public Health Inspector ROGAN, Miss M.A. Administrative Assistant (Transferred from Co-ordination & Supply Section) ROGERS, L.A. Technical Assistant ROUTLEDGE, E.A. Public Health Inspector RUSSELL, MissS. Secretary SELL, W.A. Pest Operative SHARP, C.J. Pupil Public Health Inspector (A) 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 I nspector THOMAS, L.H. Public Health Inspector TREW, P.A. Pupil Public Health Inspector WAGHORN, A.G. Administrative Assistant WATKINS, Mrs. P. Typist (Salaried Temporary) (A) WATKINS, B. Technical Assistant (A) WILLIS, F.T.H. Caretaker Wl LLIS, Mrs. P.F. Part-time Cleaner WREN, E.G. Public Health Inspector 44 1.3 INDEX 1.1 INTRODUCTION 43 1.2 Staff List 44 1.3 Index 45 2.1 FOOD 47 2.2 New Legislation 47 2.3 Frozen Pet Meat 47 2.4 Cadmium Content of Toy Bricks 47 2.5 Food Premises and Vehicles 47 2.6 Food Complaints 47 2.7 Unsound Food Surrendered or Condemned 47 2.8 Chemical Analysis of Food and Drugs 48 2.9 Milk 48 2.10 Ice Cream 48 2.11 Bacteriological Examination of Other Foods 48 2.12 Slaughter Houses 48 2.13 Poultry 48 2.14 Imported Food Regulations 1968 48 2.15 Water Supply 48 2.16 Swimming Baths 49 2.17 Fertilisers and Feeding Stuffs Act 1926 49 2.18 Rag Flock and Other Filling Materials Act 1957 49 2.19 Date Coding Survey 49 3.1 OCCUPATIONAL HEALTH 56 3.2 Offices, Shops and Railway Premises Act 1963 56 3.3 Accidents Reported 56 3.4 Offices, Shops and Railway Premises (Hoists and Lifts) Regulations 1968 56 3.5 Factories Act 1961 56 3.6 Work Places and Building Sites 56 3.7 Hairdressers and Barbers 57 3.8 Pharmacy and Poisons Act 1933 57 3.9 Massage Establishments 57 3.10 Employment Agencies 57 3.11 School Premises 57 3.12 Shops Act 1950 - Six Day Trading 57 4.1 POLLUTION CONTROL 63 4.2 Smoke Control Areas 63 4.3 Measurement of Pollution 63 4.4 Heavy Metals 63 4.5 Industrial Furnaces and Chimneys 63 4.6 Obnoxious Effluvia 63 4.7 Coffee Roasting 64 4.8 Accumulations 64 4.9 Noise Abatement Act 1960 64 4.10 Noise Insulation Regulations 64 4.11 Radioactive Substances Act 1960 54 45 5.1 HOUSING 66 5.2 Inspections and Action under Statutory Powers 66 5.3 Clearance Areas 66 5.4 Demolition and Closing Orders 66 5.5 House Improvement 66 5.6 Repair 66 5.7 Formal Action under the Housing and Public Health Acts 66 5.8 Qualification Certificates 66 5.9 Houses in Multiple Occupation 67 5.10 Common Lodging Houses 67 5.11 Survey - Housing Act 1969 67 5.12 Drainage and Sewerage 67 5.13 Moveable Dwellings 67 5.14 Infectious Disease Enquiries 67 6.1 PEST CONTROL 69 6.2 Prevention of Damage by Pests Act 1949 69 6.3 Block Treatments 69 6.4 Sewer Infestations 69 6.5 Insect Pests 69 6.6 Land Pests 69 MISCELLANEOUS SERVICES 71 7.1 Licences, Permits and Registrations 71 7.2 Animal Health 71 7.3 Health Education 71 7.4 Exhibitions 71 7.5 In-Service Training 72 7.6 Student Training 72 7.7 Mortuary Service 72 7.8 Soiled Dressing Disposal 72 7.9 Communicable Disease 72 7.10 Administrative/Clerical Support 72 46 2.1 FOOD For many years the emphasis of the Public Health Inspectors employed within the Food Team has been on the achievements of improved standards in premises and on vehicles, in equipment and containers and in the condition of the food stuff Itself. During 1973 a great deal of effort was directed towards the food handlers themselves. Public Health Inspectors visiting food premises and talking to employees within the food trade throughout the Borough set out to encourage them to re-think about the very real responsibility that they owe members of the public, to maintain standards which will keep the foods they handle both clean and wholesome. 2.2 NEW LEGISLATION The Labelling of Food Regulations 1970 came into force on the 1st January 1973: sampling the results indicated that many companies had not taken effective steps to ensure that their products were properly labelled from that date. The Farm and Garden Chemicals Regulations 1971 came into force on the 1st May, 1973. Six samples taken were all found by the Public Analyst to be satisfactory. 3.3 FROZEN PET MEAT Following the report of the death of a dog fed on cooked cow beef we became concerned about the possibility that meat for pet food might be available in the area which had not been sterilised in accordance with The Meat Sterilisation Regulations, be inadequately labelled, and be available for sale in shops where food for human consumption was also on display. All the premises within the London Borough of Sutton where pet food was believed to be sold were inspected and the retailers advised regarding this matter. No evidence was found of hazard to the public at any of these stores. 2.4 CADMIUM CONTENT OF TOY BRICKS Following a B.B.C. television Nation Wide programme some alarm was expressed alleging possible danger to children playing with plastic toy bricks. After a great deal of investigation and after samples had been examined by the Council's Public Analyst it was established that no hazard existed. 2.5 FOOD PREMISES AND VEHICLES The routine monitoring of conditions in food premises and on food vehicles and stalls is an important part of the Food Teams responsibility. During the year 3,389 visits and inspections were made in this connection. 202 notices were served regarding unsatisfactory conditions and an indication of the type of infringements found is contained in the table in Appendix 2.a. 2.6 FOOD COMPLAINTS The investigation of complaints about conditions of food stuffs is part of the comprehensive process of food control and the Food I nspector is able to co-ordinate his investigation with his sampling programme and with his knowledge of the condition of the premises at which the complaint conditions arose. 211 such complaints were investigated in 1973 and Appendix 2.b gives examples of the types of complaints and the legal proceedings which followed in some instances. 2.7 UNSOUND FOOD SURRENDERED OR CONDEMNED The condition of food stuffs displayed m shops and at manufacturers and wholesalers premises is continuously monitored throughout the area. Appendix 2.c indicates in quantative terms the food stuffs which were surrendered or condemned as unsound, diseased, unwholesome or unfit for human consumption. 47 2.8 CHEMICAL ANALYSIS OF FOOD AND DRUGS During the year 520 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. 9 formal and 40 informal 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. 2.9 MILK The number of milk distributors registered under the Milk and Dairies (General) Regulations 1959 is 81. Designated licences in force under the Milk (Special Designation) Regulations 1963 (as amended) during the year numbered 231. Milk was sampled for both bacteriological and chemical examination. One sample of pasteurised milk taken in the year failed to satisfy the methylene blue test. Investigations showed that it had been kept too long at retail premises. Appendix 2.f shows the results received of samples submitted for bacteriological examination. 2.10 ICE CREAM Among the samples taken for bacteriological examination were ten of soft ice cream taken from ice cream vans. 6 were grade 1, 1 was grade 3 and 3 were grade 4. I nvestigations suggest that the grade 4 samples were bacteriologically unsatifactory when manufactured. This matter was raised with the appropriate Local Authority. 3 water ices were examined and found to have a Ph value of less than 4.5. 2.11 BACTERIOLOGICAL EXAMINATION OF OTHER FOODS In addition to the milk and ice cream samples referred to above, 11 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 I nspectors check. 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 houses throughout the district. Flouride is not added to the water. 48 2.16 SWIMMING BATHS Samples were taken and tests applied to public and school swimming bath water. During the year particular attention was given to school pools. Where unsatisfactory results were received the matter was taken up with the co-operation of the Assistant Baths Superintendent and ultimately an improved standard was maintained. 2.17 FERTILISERS AND FEEDING STUFFS ACT 1926 6 samples of fertilisers and feeding stuffs were purchased during the year. 5 were satisfactory. 1 exceeded marginally the limits of variation allowed for chemical composition. 2.18 RAG FLOCK AND OTHER FILLING MATERIALS ACT 1957 The prescribed Analyst, Mr. G.E. Green, B.Sc., A.R.I.C., British Standard Institute Centre, Maylands Avenue, Hemel Hempstead, Herts, examined 7 samples for the authority during the period. These were found to satisfy requirements of the Act. 2.19 DATE CODING SURVEY The survey of coding of perishable food stuffs on display in supermarkets, grocers and general stores which had been commenced in the last quarter of the previous year was completed in January 1973. It was apparent that few shop-keepers fully understood and used coding systems. Advice was given to the managers of all the stores and local publicity given to the problem. 49 50 APPENDIX 2-a- INSPECTION OF FOOD PREMISES AND DEFECTS REMEDIED 1973 SANITARY ACCOMMODATION FOOD STORAGE AND PREPARATION ROOMS Inspections No. of premises No. of premises registered under Sec.16 of Food and Drugs Act Repaired Cleansed and/or decorated Lighting provided Washing Facilities (incl. Hot and Cold Water) Nail brush and soap provided "Wash your Hands" Notices Repaired Cleansed and/or decorated Lighting provided Ventilation provided Washing Facilities for Food and Equipment First Aid Materials provided Accommodation for Clothing provided Accumulations removed Bakehouses 32 6 – – 1 – 2 – – 3 15 – – – – – 1 Bakers and Confectioners 177 39 20 – 4 – 3 1 1 – 4 – – 2 1 – 1 Butchers 304 91 77 2 1 1 2 – – 2 19 – – 4 – – 4 Canteens 244 135 – – 2 – 1 – 1 – 2 – – 2 1 – – Chemists 126 52 – – – – – – – – 1 – – – – – – Confectioners (Sugar) 144 166 165 – – – – – – – 1 – – – – – – Fishmongers 54 14 2 – – – 1 – 1 – – – – – – – – Fish Fryers 87 26 6 – 1 – 4 1 1 1 2 – – 1 – – 2 Greengrocers and Fruiterers 194 90 23 1 1 – 3 – 2 – 5 – – 1 1 – 3 Grocers 229 69 68 – – 1 1 2 1 1 14 – – – 2 – 8 General Stores 156 56 61 – – 1 – 1 1 – 1 – – – 1 – – Licensed Premises 348 117 11 2 3 – 7 – – 3 16 – 1 4 3 – 3 Milk Storage Depots 15 4 – – – – – – – – – – – – – – – Restaurants & Cafes 555 119 36 – 6 – 7 3 3 – 25 – 2 10 1 – 9 Factory Food 32 8 1 – 1 – – 1 – – 4 – 1 1 – – – Stalls and Vehicle Food 259 70 1 1 1 – 12 3 1 1 – – – – 5 – – Supermarkets 398 31 9 – 8 – 8 4 1 2 10 – – 1 – – 7 Homes 35 16 – – – – – – – – – – – – – – – TOTALS 3389 1109 480 6 29 3 51 16 13 13 119 – 4 26 15 – 38 APPENDIX 2-b- FOOD COMPLAINTS Food Complaint 21/73 - Bottle of milk containing a straw A one pint bottle of milk delivered to a school was found to contain a coloured drinking straw. This had been present when the bottle was filled. Legal proceedings were taken against the dairy and a fine of £20 imposed with a £10 sum for costs. Food Complaint 83/73 - Insect larvae on spare ribs A portion of cooked space ribs purchased from a take-away food store in the Borough was found to have dead fly larvae adhering to the surface. An inspection of the premises revealed that similar items were stored in a refrigerator. They were found to be infested with live larvae, decomposing and mouldy. They were seized, taken before a magistrate and a condemnation order was given. Subsequent proceedings for the sale and possession of unfit food resulted in a fine of £100 and £20 costs. Food Complaint 84/73 - Foreign object in pork pie A pork pie purchased from a shop in the Borough was found to contain a piece of hard opaque plastic material. Legal proceedings taken against the manufacturer resulted in a £40 fine with £10 costs. Food Complaint 72/73 - Rancid butter A half pound pack of butter purchased in the Borough was found to be rancid. Other packs in the retail premises were in a similar condition. No system of coding was used by the shop to ensure stock rotation and freshness and a subsequent inspection of the premises found further items out of code. Legal proceedings were taken and a fine of £75 imposed with £15 costs. Food Complaint 92/73 - Packeted Vermicelli containing insects A packet of curled egg Vermicelli was found by the purchaser to contain small beetles (the Australian Spider Beetle). Other packs in the shop were in a similar state of infestation. They had been delivered approximately a year earlier. The company was fine £25 with £ 10 costs. Food Complaint 94/73 - Slice loaf containing a rusty metal bolt A rusty bolt approximately 1" x1/8 " in diameter fractured at one end was found embedded in a sliced wrapped loaf. Although a metal detector was available at the bakehouse it was not automatically used to check all the products. The bakery company were fined £75 with £12 costs. Food Complaint 153/73 - Milk bottle containing an insect A one pint bottle of pasteurised milk was found on delivery to have a moth floating on the surface of the milk. A fine of £60 was imposed on the dairy company and £12 costs were allowed. Food Complaint 208/73 - Caterpillar in canned tomatoes As the tomatoes were packed in Spain this complaint was taken up through the importers with the factory premises. Assurances were received that stricter controls would be introduced to ensure against further complaints of a similar nature. In this case amendments to the label also had to be made. Food Complaint 197/73 - Wheatmeal loaf containing an earwig The loaf was baked locally and as a satisfactory report was received on the general condition of the bakehouse this matter was dealt with by means of a warning letter. 51 APPENDIX 2.c. UNSOUND FOOD SURRENDERED OR CONDEMNED lbs Beverages 7 Cereals 23 Cheese 617 Confectionery Flour 184 Confectionery Sugar 90 Cream 35 Eggs 22 Fats and Oils 20 Fish (wet) 7990 Frozen Food 1320 Fruit (canned) 15784 Fruit Juice 605 Meat (fresh - home killed) 1167 Meat (fresh - imported) 1212 Meat Canned 327 Meat Cooked 986 Meat Products 700 Milk 1 Other Foods 1015 Other Canned Foods 5246 Preserves 58 Sausages 772 Soup 119 Vegetables (fresh) 1094 Vegetables (canned) 1660 Yoghurt 115 52 APPENDIX 2.d. CHEMICAL ANALYSIS OF FOOD AND DRUGS Informal Sample 21/73 - Golden Savoury Rice In the opinion of the Analyst the description contained on the label did not indicate the true nature of the food and the ingredients were not listed in the order of the proportion by weight in which they were present as required by the Labelling of Food Regulations 1970. After some prolonged correspondence with the manufacturer a revised label was agreed. Informal Sample 25/73- Eccles Cakes Although the container bore a statement saying that over half the shortening used was butter, the proportion of butter in the added fat amounted to 25% as determined by analysis. An error had arisen because labels associated with one recipe had been affixed to packs containing eccles cakes manufactured by another recipe. Assurances were given by the retailing and manufacturing company and the matter was dealt with by means of a warning. Informal Samples 245 and 282/73 - Coffee Break The article was described as having as "an extract of coffee with milk and cream added " but analysis indicated skimmed milk in concentrated form had been used. As a result of correspondence the manufacturers amended their label. Informal Sample 375/73- Chocolate A sample was found to be of chocolate substitute made with a high proportion of vegetable fat other than cocoa butter. The item sold was of a small fancy sweet nature and should have been described as neapolitans. The retailing company undertook to ensure that displays of this item were clearly labelled in the future. Informal Sample 411/73- Instant Dried Skimmed Milk The sample was found to have a moisture content of 5.3%. The Dried Milk Regulations 1965 require that dried milk shall contain no more than 5% moisture. Stock with a similar batch number was withdrawn. 53 APPENDIX 2.8. FOOD SAMPLES - CHEMICAL ANALYSIS SATISFACTORY ADULTERATED TOTAL Formal Informal Formal Informal Alcoholic Drinks 11 9 – – 20 Beverages 1 8 1 2 12 Cereals and Cereal Products 1 11 1 1 14 Condiments and Sauces – 13 – 1 14 Confectionery Flour 4 22 – 1 27 Confectionery Sugar – 18 – 2 20 Dairy Products 1 58 – 7 66 Drugs 3 28 – – 31 Fat and Oils – 7 – – 7 Fish and Fish Products 1 32 3 7 43 Fruit and Fruit Products 4 28 2 4 38 Food Additives – – – 2 2 Meat and Meat Products 15 69 2 6 92 Milk 12 6 – – 18 Prepared Compound Baby Food – 1 – – 1 Sugar and Preserves 4 17 – 2 23 Slimming Foods – 2 – – 2 Soft Drinks 4 17 – 1 22 Spices and Flavourings – 13 – 1 14 Vegetable and Vegetable Products 1 14 – 1 16 Miscellaneous 5 20 – 2 27 67 393 9 40 509 54 55 APPENDIX 2.f. MILK : BACTERIOLOGICAL TESTING Designation under which sold Number of Samples METHYLENE BLUE TEST PHOSPHATASE TEST TURBIDITY TEST OTHER TEST Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 17 16 1 16 1 – – – – Ultra Heat Treated – – – – – – – 1 – Untreated – – – – – – – – – Sterilised 1 – – – – 1 – – – TOTAL 18 16 1 16 1 1 – 1 – 3.1 OCCUPATIONAL HEALTH One of the tasks of the Occupational Health Team within the Environmental Health Division is to concern itself 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 174 new registrations of offices and shops were recorded during 1973. 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 638 7657 Retail Shops 990 5379 Wholesale Shops, Warehouses 30 548 Catering Establishments and Canteens 133 1035 Fuel Storage Depots 4 23 402 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. Special concern was expressed in respect of the use of flueless gas heaters in some shop premises and the problem examined in conjunction with SEGAS officials. A lighting survey scheduled for the winter months was cancelled due to the national power difficulties. 3.3 ACCIDENTS REPORTED 42 accidents were reported during the year as opposed to 62 during 1972. An analysis of the reported accidents is set out in appendices 3.b and 3.c. 3.4 OFFICES, SHOPS AND RAILWAY PREMISES (HOISTS AND LIFTS) REGULATIONS 1968 The special survey commenced in 1972 was completed in 1973. There was some reluctance in certain instances by the owners of premises to give instructions for safety works to be carried out. There was a general change of attitude after the Committee authorised legal proceedings in some instances. 3.5 FACTORIES ACT 1961 The Local Authority's responsibilities in respect of the above legislation were met by the routine inspection of premises to which the Act applies throughout the Borough. An indication of the number of premises on the register, of the inspections carried out and the defects found are set out in appendices 3.d and 3.e and an indication of the number of outworkers in the Borough in appendix 3.f. 3.6 WORK PLACES AND BUILDING SITES A comprehensive inspection of the building sites within the Borough was made during one two week period and a number of notices served on the contractors in respect of contraventions of the Sanitary Accommodation Regulations. 56 3.7 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 purposes of registration in accordance with Section 21 of the Act. 141 premises were registered. Inspections to ensure compliance with bye-laws requirements have been made. 3.8 PHARMACY AND POISONS ACT 1933 At the time of the annual report 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. The number of contraventions found this year were minimal compared with last year which indicates a success of the special effort made during 1972 in respect of the provisions of this legislation. 6 informal samples were taken and found to be satisfactory. 3.9 MASSAGE ESTABLISHMENTS New licence conditions were reported to the Committee and approved. All licenced premises were inspected during the year and licence holders received advanced notification of any amendments that might be necessary as a result of the new licence conditions. 3.10 EMPLOYMENT AGENCIES All the premises in receipt of annual licences were inspected during 1973. 3.11 SCHOOL PREMISES Following a discussion with the School Medical Officer about the standard of health facilities at schools, a survey was made of the school premises throughout the Borough and a memorandum sent to the Chief Education Officer recommending repairs and adaptations to bring the buildings up to a more modern standard. 3.12 SHOPS ACT 1950 -6 DAY TRADING A proposal initiated by the local Chamber of Trade to extend the six day trading arrangement at present in operation in the central part of Sutton was not proceeded with as the general response from shop-keepers indicated that there was no majority in favour of six day trading. 57 APPENDIX 3.a. OFFICES, SHOPS & RAILWAY PREMISES ACT 1963- UNSATISFACTORY CONDITIONS DEALT WITH NOTICES Unsatisfactory conditions found Unsatisfactory conditions remedied (inc. items from 1972) Overcrowding 3 2 Ventilation 11 9 Cleanliness 14 1 Temperature (inc. thermometers) 141 109 Lighting 18 7 Sanitary Conveniences 73 71 Washing Facilities 20 10 Water Supply 25 13 General Conditions 25 22 Stairs/Passages 14 9 Clothing Storage 5 1 Drying Facilities 1 – Seats – 1 Machinery 3 2 First Aid Equipment 196 115 Notices 212 172 Canteen Facilities 4 – Registrations 181 158 Lifts 12 9 58 APPENDIX 3.b. ACCIDENTS REPORTED Workplace Number Fatal Reported Non Fatal Total Investigated ACTION RECOMMENDED Prosecution Formal warning Informal advice No action Offices – 4 3 – – – 4 Retail Shops – 30 12 – – – 30 Wholesale shops Warehouses _ 3 3 – – 1 2 Catering establishments open to public, canteens – 6 1 – – – 6 Fuel Storage Depots – – – – – – – TOTALS: – 43 19 – – 1 42 59 APPENDIX 3.c. ANALYSIS OF REPORTED ACCIDENTS Offices Retail Shops Wholesale warehouses Catering establishments open to public, canteens Fuel Storage Depots Machinery – 2 1 – – Transport – 2 – – – Falls of persons 2 6 2 1 – Stepping on or striking against object or person – – – 1 – Handling goods 1 10 – 4 – Struck by falling object – 2 – – – Fires and explosions – – – – – Electricity 1 – – – – Use of hand tools – 8 – – – Not otherwise specified – – – – – 60 FACTORIES ACT 1961 Inspections for the purpose of provisions as to health :- NUMBER OF PREMISES (1) 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 45 10 7 – (ii) Factories not included in (i) in which Section is enforced by the Local Authority 737 297 12 _ (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) NIL 85 3 – TOTALS 782 392 22 – APPENDIX 3.e. Cases in which Defects were found Number of cases in which defects were found Number of cases in which prosecutions were instituted (6) PREMISES (1) Found (2) Remedied (3) to H.M. Inspector (4) Referred By H.M. Inspector (5) Want of cleanliness 4 2 – – – Overcrowding – – – – – Unreasonable temperature – – – – – Inadequate ventilation 1 1 – – – Ineffective drainage of floors – – – – – Sanitary Conveniences:- (a) Insufficient 8 8 – – – (b) Unsuitable or defective 15 6 – – – (c) Not separate for sexes – – – – – Other offences against the Act (not including offences relatinc to Outwork) – – – – – 61 APPENDIX if. Outwork (Sections 133 and 134) Nature of Works Section 133 No. of Prosecutions for failure to supply lists Section 134 Prosecutions No. of Outworkers in Aug. list required by Sect. 133( 1) (c) (2) No. of cases of default in sending lists to the Council No. of instances of work in unwholesome premises Notices serviced (1) (2) (3) (4) (5) (6) (7) Wearing apparelmaking etc.0 29 – – – – – Boxes (Cardboard) 48 – – – – – Brass and Brass Art – – – – – – Curtain making 1 – – – – – Toys – – – – – – F lowers 1 – – – – – Umbrellas 12 – – – – – Lampshades 27 – – – – – Miscellaneous 24 – – – – – TOTALS 142 – – – – – 62 4.1 POLLUTION CONTROL A very high level of interest continues within the community on matters of pollution control.lt is particularly encouraging that young people, especially 5th and 6th formers in our schools, take such a serious view of pollution problems. 4.2 SMOKE CONTROL AREAS The programme designed to bring the whole of the Borough within smoke control areas continued throughout 1973 and visits of initial inspection to give advice and relating to the payment of grants were carried out, mainly in the following areas LOCATION Approximate Position Order Confirmed Order In Force Area 26 South Cheam & Belmont 18.4.73 1.11.73 Area 27 South Sutton & Belmont 26.3.73 1.12.73 Area 28 Sutton & Carshalton Beeches 28.6.73 1.7.74 Area 29 Carshalton & Coulsdon 16.1.74 1.10.74 Area 30 Beddington Confirmation expected in 1974 Area 31 Town Centre 1975 The Department of the Environment recommended new maximum prices in respect of grant payments. 4.3 MEASUREMENT OF POLLUTION The three stations in the Borough which monitor continuously the sulphur and smoke content of the area indicate the continuing improvement resulting from the smoke control programmes throughout London. During the last quarter of the year a special exercise was arranged for measurements to be taken in Bushey Road, Sutton. The results indicated a lower level of SO2 than expected but the smoke level was slightly higher than average. 4.4 HEAVY METALS Samples of dust were examined from various points in the district in order to check for lead pollution. A unit designed to indicate the amount of zinc which was in the atmosphere was set up on the roof of Wallington Town Hall and was analysed by the laboratories of the Central Electricity Generating Board. 4.5 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 eleven new furnaces and seven applications for the approval of chimney heights. 4.6 OBNOXIOUS EFFLUVIA During the year complaints in this section more than doubled. It was particularly disappointing to find that 130 complaints related to bonfires, which once again were generally found to be incidents when thoughtless action caused annoyance and distress to neighbours and took a great deal of office time to investigate. All the infringements of the dark smoke regulations noted were dealt with informally. 63 4.7 COFFEE ROASTING The problem reported in the 1972 report continued into the first months of 1973 and a petition was received from local residents in respect of the conditions. Pressure was also applied on the Department by our colleagues in the London Borough of Croydon, whose residents were particularly affected by this problem. A new roasting plant, together with newly designed after-burning equipment, was ultimately fitted, and the factory management after many trials and experiments, adaptations and new developments of the plant, were able to reduce the problem to a more acceptable level. 4.8 ACCUMULATIONS 169 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. 20 notices were served for the removal of accumulations and many of the remaining matters were referred to be dealt with as Civic Amenity matters. 4.9 NOISE ABATEMENT ACT 1960 Noise complaints which numbered 59 in 1971, 78 in 1972 rose to 93 during 1973. The detail is contained in appendix 4.a. The excessive use of chimes on ice-cream vehicles again featured in the work of this section and two particularly serious noise problems arose from the use of an automatic car washing plant and from the motors servicing deep freeze equipment. The Service is grateful for the co-operation of our colleagues in the Planning Department in dealing, as far as possible, with noise problems by anticipation. 4.10 NOISE INSULATION REGULATIONS The Regulations, which came into force in 1973, allow for the payment of grant to householders exposed to high levels of noise from new road schemes. A traffic noise survey was carried out for the Director of Engineering in the Angel Hill area before the Regulations came into operation. 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. 64 APPENDIX 4.a. NOISE ABATEMENT ACT 1960 Number of Industrial Premises Commercial Premises Roadworks Construction Demolition etc. Domestic Premises Other* TOTAL 1. Complaints received 13 24 10 33 13 93 2. Cases complained of 12 18 8 33 11 82 3. Complaints investigated 13 24 10 33 13 93 4. Nuisances confirmed 7 10 5 4 7 33 5. Nuisances remedied informally 7 10 5 4 7 33 *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 Wallington Stations Medical Research Council, Woodmansterne Road, Carshalton Mullard Radio Valve Co., New Road, Mitcham Junction Nuleaf Limited, Beddington Lane, Croydon Oakleigh, Benhill Avenue, Sutton Pye Unican Limited, 30 Devonshire Road, Sutton Vinyl Products, Mill Lane, Carshalton Mitcham Cardboard Limited, 99 Beddington Lane, Croydon Clark's Bakeries Limited, Restmor Way, Hackbridge Mills Estate, Hackbridge Section 3 (Registration - Mobile Radioactive Apparatus) Inspection Services Limited, Oldfields Road, Sutton Radiographic and Associated Testing Services, 43 Senga Road, Hackbridge Material Measurements Limited, 22 Station Road, Belmont 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. 65 5.1 HOUSING The year proved to be a particularly busy one for Public Health Inspectors employed within the Housing Team. There was an increasing demand for their services in respect of public health defects, action on unfit houses and in connection with moveable dwellings and the provision of special reports where medical and social aspects were under consideration in respect to possible rehousing. 5.2 INSPECTIONS AND ACTION UNDER STATUTORY POWERS More than 15,500 visits and re-visits were made during the year to houses in the Borough in connection with the Authority's responsibilities under the Public Health and Housing Acts. 5.3 CLEARANCE AREAS Properties within the Sutton central development area-continue to deteriorate and it was necessary to report the condition of unfitness on the properties known as 40-50 (even numbers) George Street, Sutton. The Committee made a Clearance Order. The tenants of the remaining occupied houses in Golden Terrace, Goat Road, Mitcham Junction were rehoused and the terrace demolished. 5.4 DEMOLITION AND CLOSING ORDERS A Demolition Order was made in respect of two properties in Upper Road, Wallington and the Council purchased two houses in Sandy Lane North by compulsory purchase procedures. Closing Orders were made in respect of seven other properties in the area and a house in Longfellow Road, upon which a Closing Order had previously been made, was renovated and the Order revoked. 5.5 HOUSE IMPROVEMENT Public Health Inspectors continued to support officers in other Departments implementing the Council's policy in respect of the improvement of houses. A particular area of consideration with those that were crowded and where recommendations were made for the improvement grant to include provision of additional bedroom accommodation in cases where it was desirable to provide adequate accommodation for the occupying family. There was involvement in four properties where the tenants had made application for compulsory improvement and where repair work to the property, in accordance with the standards set by Section 4 of the Housing Act 1957, was the subject of statutory procedure. Consideration was given to the possibility of reporting on two general improvement areas but no firm progress was made. 5.6 REPAIR Using the provisions of the Public Health and Housing Acts, the Public Health Inspectors were able to arrange for many items of disrepair at private houses to receive attention. Many of the defects had resulted in damp conditions, roofs were repaired and made weatherproof, down pipes and gutters repaired or renewed and defective plaster replaced. 5.7 FORMAL ACTION UNDER THE HOUSING AND PUBLIC HEALTH ACTS 123 formal notices were served in accordance with this legislation. Details are set out in Appendix 5.a. 5.8 QUALIFICATION CERTIFICATES During the year 58 applications were received. 78 Qualification Certificates and 16 Provisional Certificates were issued. 43 applications were refused. 66 5.9 HOUSES IN MULTIPLE OCCUPATION The Housing Team continued to carry out routine inspection of houses in multiple occupation. It is desirable to have a programme of re-inspection and re-visiting as public health standards in premises of this character deteriorate very quickly. 5.10 COMMON LODGING HOUSES There are no common lodging houses in the Borough 5.11 SURVEY - HOUSING ACT 1969 No comprehensive survey was carried out during the year but a token survey of pre-war Council houses was made in order to prepare a report for the Health and Housing Committee on the adequacy of the basic amenity facilities. 5.12 DRAINAGE AND SEWERAGE Once again arrangements were made for a round-the-clock service for the clearance of obstructed drainage and sewer systems and nearly 2,000 such obstructions were cleared by the Operatives during 1973. Drainage repairs and reconstruction were supervised at more than 100 premises. The whole of the Borough is covered by a sewerage system and main drainage is available to all but a few isolated premises. Sewerage disposal arrangements in the area are adequate. 5.13 MOVEABLE DWELLINGS The Council's caravan site for travellers in Carshalton Road, Woodmansterne was improved to the standard of a permanent site. Due to misuse and vandalism the site was frequently found to be in an unsatisfactory condition. At one period more than 40 caravans were parked on land previously part of the sewerage works, without any adequate facilities for disposal of waste or waste water and without provision for adequate water supply. The general condition of the site caused great concern. 5.14 INFECTIOUS DISEASE ENQUIRIES Enquiries on behalf of the Medical Officer of Health were generally carried out in 1973 by Inspectors within the Housing Team. More than 1,000 visits were made. Specimens were dispatched for examination at the Pathological Laboratories and disinfections and disinfestations carried out under supervision where necessary. 67 APPENDIX 5.a. FORMAL ACTION UNDER THE HOUSING AND PUBLIC HEALTH ACTS Formal Notices were served under the following Acts Public Health Act 1936 Section 24 - Power of the Local Authority to serve notice and recover expenses reasonable incurred, in the maintenance of certain lengths of public sewers. 14 Section 39 - Power of the Local Authority to serve a notice for the renewing, repairing or cleansing of existing drains. 17 Section 45 - Power of the Local Authority to serve a notice for repair of defective closets. 4 Section 93 - Nuisances, as defined by the Act, which may be dealt with summarily and the power of the Local Authority to serve an "Abatement Notice" requiring such steps to be taken as are necessary for the nuisances to be abated. 46 Section 277 - Power of the Local Authority to require information as to ownership of premises. 24 Public Health Act 1961 Section 17 - Power of the Local Authority to remedy stopped up drains 1 Section 26 - Power of the Local Authority to serve a notice for remedying defective conditions in premises where unreasonable delay would be occasioned by following the procedure prescribed by Sections 93/94 of the Public Health Act 1936. 3 Housing Act 1957 Section 170 - Power of the Local Authority to require information as to ownership of premises. 11 Section 9 - Power of the Local Authority to require repair of an unfit house which is repairable at a reasonable cost. 4 68 6.1 PEST CONTROL Routine control methods have continued to be used for the treatment of rats and mice. There is no evidence to suggest any increased resistance to anti-coagulant poisons mentioned in the last annual report. The greatest problems so far as mice are concerned is gaining regular access to premises infested, particularly in the case of multi-occupied dwellings. 6.2 PREVENTION OF DAMAGE BY PESTS ACT 1949 The level of complaints received from residents, nearly 1500, was similar to the figure for 1972. There were no special circumstances during the year worthy of report. Statistics are set out in Appendix 6.a. 6.3 BLOCK TREATMENTS In a number of areas infestations were dealt with by means of block treatment. This is an expensive and not always highly successful method of treatment but it is the only practicable way of dealing with mouse infestations in blocks of property where re-infestation quickly follows the treatment of single units. Once again the Borough co-operated in a survey, this time providing the British Medical Research Council with bodies of rats and mice. Reports on their investigation have not been received to date. 6.4 SEWER INFESTATIONS The 10% sewer treatment was carried out during October 1973. The infestation of the sewer system continues to be maintained at a low level. 6.5 INSECT PESTS 845 insect pest complaints were received during 1973. Advice or assistance was given in each case and nearly 600 wasp nests were destroyed. Many residents were particularly troubled with ant infestations during the summer months. Cockroaches proved a problem in district and central heating ducts and there was a small increase in the number of requests for the treatment of bed bugs. 6.6 LAND PESTS In response to complaints from members of the public effort is made to control the numbers of foxes, squirrels and pigeons throughout the area. Foxes were trapped and shot and squirrels controlled by the special hoppers recently approved for baiting and by use of Legge traps. Cage traps are used for the control of pigeons but it is necessary to have a suitable site for their use and treatments during 1973 were not particularly successful. 69 APPENDIX 6.a. PREVENTION OF DAMAGE BY PESTS ACT 1949 Complaints of rat and mouse infestations 1,474 Infestations found on survey 82 Premises found to be infested 1,302 Informal Notices under Section 4 of the Act 8 70 MISCELLANEOUS SERVICES 7.1 LICENCES, PERMITS AND REGISTRATIONS Appendix 7.a includes the number and type of licences, permits and registrations in existence at the 31st December 1973. It is frequently the practice before licences or registrations are processed for premises to be visited by the officers from the appropriate team. 7.2 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. 7.3 HEALTH EDUCATION There is an increasing need to develop the Health Education element of the work of the Environmental Health Service. Advice, information and propaganda that can be spread through clubs and organisations, through lecturing to school children and youth clubs, talking to groups of professional people and particularly people employed in the food industry is a very real and important insurance against problems arising in the future. There was in 1973 an increase in requests for talks and lectures, many of which were, of course, outside normal working hours. The success of Health Education programmes organised by the Service was to a large extent due to the availability of equipment from the Health Education Centre and the advice, guidance and assistance given by the Health Education Officer and her staff. 7.4 EXHIBITIONS During the year exhibition material was prepared on two subjects. The pollution exhibition was, undoubtedly, the best static exhibition that the Service has presented and had a real impact in introducing pollution control messages to members of the public when it was displayed at various shows and vantage points throughout the Borough. A float was prepared for the Carshalton Carnival. The food exhibit which was circulated during the second half of the year took the form of a game where children, with or without the help of their parents, were invited to spot various bad food handling practices, and the successful ones offered small prizes. The exhibit proved to be exremely successful and the importance, wherever possible, of introducing some element into an exhibition where the public can practically participate in the project is very important. All the exhibits were manned during the public shows by members of the Health Department staff, who answered innumerable queries and discussed the reason why the exhibits had been set out in the way they were designed. The design was very largely a joint function between the leaders of the teams concerned and the Health Education Officer and the construction of the exhibits was largely a function of the Rochester Road staff, together with Student Public Health Inspectors. 71 7.5 IN-SERVICE TRAINING The in-service training of staff within the Environmental Health Division was put on a more formal basis during the year and on a number of occasions groups used audio visual material. 7.6 STUDENT TRAINING The four Pupil Public Health Inspectors passed the various appropriate stages of their course successfully during 1973. Mr. John Freeman obtained his Diploma qualification and was appointed as a Public Health Inspector. 7.7 MORTUARY SERVICE The Mortuary at Alcorn Close, Sutton, which is equipped with refrigerated storage and facilities for post mortem examination, was used to receive 637 bodies during 1973. In 1973 post mortems were performed on 280 bodies admitted from local hospitals, 209 from homes within the Borough and 148 other ambulance removals. 7.8 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. 7.9 COMMUNICABLE DISEASE It is, of course, the communicable disease element that draws together the various areas of responsibility within the Environmental Health Service. The Division is involved each year in a great many enquiries and arrangements under the immediate direction of the Medical Officer of Health in the investigation of and in cases of communicable disease and the control of contacts. 7.10 ADMINISTRATIVE/CLERICAL SUPPORT Each year indicates an increasing demand for Environmental Health Services. In order to meet demand the work of the professional officers is continuously under review and wherever practicable routine duties are transferred to the clerical officers. In addition to the work evolving from this process, the clerical staff have processed the paper and record keeping which is necessarily generated from each additional complaint and each additional inspection or visit carried out by the Service. In 1972 the field staff reorganised on the basis of functional teams and during this year, as far as was practicable, the administrative and clerical support has been re-organised in order to parallel the work of the professional and technical officers. There are many areas where real improvements can still be effective, particularly the support given to the Housing Team. It is not, however, possible to continuously feed additional responsibilities and additional volume of work to one group of officers and it was accepted long before the end of the year that a review of both salaries and staffing of the administrative/clerical section would be necessary as a matter of some urgency. Derek A. Eves Chief Public Health Inspector 72 APPENDIX 7.a. LICENCES. PERMITS AND REGISTRATIONS The following licences, permits and registrations existed at 31st December 1973. Animal Boarding Establishments Act 1963 5 Betting, Gaming and Lotteries Act 1963 - Small Lotteries - Registrations 112 Diseases of Animals (Waste Foods) Order 1957 - Licences (Personal Once Only) 13 Game Act 1831 - Game Dealer's Licences 17 Gaming Act 1968 - Amusement Machines - Permits (3 year period) 31 Greater London Council (General Powers) Act 1967 - Hairdressers and Barbers- Registrations (Personal Once Only) 141 Late Night Refreshment Houses Act 1969 2 Milk (Special Designation) Regulations 1963- Licences (5 year period expiring 31.12.70) 229 London Government Act 1963- Employment Agency Licences 14 Surrey County Council Act 1931 (Part IV) - Massage/Special Treatment Establishment Licences 18 Moneylenders Act 1927 - Moneylenders Licences 5 Greater London Council (General Powers) Act 1968 - Night cafes - Registrations 1 Pet Animals Act 1951 - Licences 13 Pharmacy & Poisons Act 1933 - Sellers of Part II poisons - Registrations 109 Rag Flock and Other Filling Materials Act 1951 - Registrations (Once only) 4 Riding Establishments Act 1964- Licences 1 Theatrical Employers Registration Act 1925 and 1928- Licences (Personal Once Only) 39 Scrap Metal Dealers Act 1964 - Registrations (3 year period) 11 Slaughter of Animals Act 1958 - Licences 2 War Charities Act 1940 and National Assistance Act 1948 - Registrations (Once only) 6 Nursing Homes - Registration 8 Nursing Agencies-Licences 4 73 APPENDIX-STATISTICS PART VII INDEX Table No. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1973 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 AND SPECIAL SCHOOLS) VII PERIODIC MEDICAL INSPECTIONS DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS VIII SCHOOL DENTAL SERVICE IX CHILD GUIDANCE CLINIC X SCHOOL PSYCHOLOGICAL SERVICE XI HANDICAPPED PUPILS XII W.H. KINSTRIE, MB., Ch.B., MFCM., DPH., Medical Officer of Health and Principal School Medical Officer 74 75 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1973 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 Diarrhoeal Diseases M 1 - - - - 1 - - - - - - F - - - - - - - - - - - - Late Effects of Respiratory Tuberculosis M 1 - - - - - - - - - - 1 F - - - - - - - - - - - - Meningococcal Infection M - - - - - - - - - - - - F 1 - - - - - - - - - - 1 Syphilis and its sequelae M 2 - - - - - - - - 1 1 - F - - - - - - - - - - - - Other Infective and Parasitic Diseases M 1 - - - - - - - - - - 1 F 1 - - - - - - - - - - 1 Malignant Neoplasm Buccal Cavity etc. M 7 - - - - - - - 2 1 2 2 F 1 - - - - 1 - - - - - - Malignant Neoplasm Oesophagus M 10 - - - - - - 1 - 3 5 1 F 5 - - - - - - - - 1 - 4 Malignant Neoplasm Stomach M 20 - - - - - - - 1 5 9 5 F 16 - - - - - - - 1 3 1 11 Malignant Neoplasm Intestine M 25 - - - - - - - 4 3 9 9 F 35 - - - - - - 2 1 2 13 17 Malignant Neoplasm Larynx M 3 - - - - - - - - - 1 2 F - - - - - - - - - - - - Malignant Neoplasm Lung, Bronchus M 113 - - - - - - - 8 31 50 24 F 29 - - - - - - 1 3 6 14 5 Malignant Neoplasm Breast M - - - - - - - - - - - - F 43 - - - - - - 1 8 8 13 13 76 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1973 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 Malignant Neoplasm Uterus F 10 - - - - - - - 2 2 2 4 Malignant Neoplasm Prostate M 17 - - - - - - - 1 - 7 9 Leukaemia M 5 - - - - - - - - 1 1 3 F 10 - - - - 1 - 2 1 2 1 3 Other Malignant Neoplasms etc. M 66 - - - 2 - 2 9 4 13 20 16 F 73 - - - - 1 1 2 9 16 21 23 Benign and unspecified Neoplasms M 2 - - - - 1 - - - - 1 - F - - - - - - - - - - - - Diabetes Mellitus M 6 - - - - - - - - - 3 3 F 7 - - - - - - 1 - - 2 4 Other Endocrine etc. diseases M 1 - - - - - - - - - - 1 F - - - - - - - - - - - - Anaemias M 1 - - - - - - 1 - - - - F 3 - - - - - 1 - - - 1 1 Mental Disorders M 3 - - - - - - 1 - - 1 1 F 1 - - - - - - - - - 1 - Multiple Sclerosis M - - - - - - - - - - - - F 6 - - - - - - 1 - 3 1 1 Other diseases of Nervous System etc. M 6 - 1 - - 1 - - - 1 1 2 F 4 - - - - - - - - - 2 2 Chronic Rheumatic Heart Disease M 8 - - - - - - - 3 2 3 - F 21 - - - - - - 1 4 1 4 11 77 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1973 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 Hypertensive Heart Disease M 13 - - - - - - - 1 2 3 7 F 13 - - - - - 1 3 4 5 Ischaemic Heart Disease M 274 - - - - - 12 27 62 91 82 F 232 - - - - - - - 6 19 49 158 Other forms of Heart Disease M 42 - - - - - - - - 7 14 21 F 78 - - - - - - - - 1 12 65 Cerebrovascular Disease M 128 1 - - - - 2 1 1 11 38 74 F 240 - - - - - 3 - 4 10 47 175 Other Diseases of Circulatory System M 41 1 - - - - - - 4 4 15 16 F 43 - - - - - - - - 4 6 33 Influenza M 1 - - - - - - - - - 1 - F 3 - - - - - - - - 1 1 1 Pneumonia M 46 1 4 - - - - 1 - 3 12 24 F 106 1 - - - - - 1 3 1 16 84 Bronchitis and Emphysema M 59 - - - - - - - 4 8 19 28 F 10 - - - - - - - - 3 2 5 Asthma M - - - - - - - - - - - - F 1 - - - - - - - - - - 1 Other Diseases of Respiratory System M 6 - - - - - - - 1 1 1 2 F 5 - - - - - - - - - - 5 Peptic Ulcer M 6 - - - - - - - - - 3 3 F 9 - - - - - - - - 1 4 4 Appendicitis M 1 - - - - - - - - - - 1 F - - - - - - - - - - - - 78 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1973 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 64-74 75 and over Intestinal Obstruction and Hernia M 6 - - - - - - - - - 3 3 F 8 - - - - - - - - 1 2 5 Cirrhosis of Liver M 1 - - - - - - - 1 - - - F 3 - - - - - - - 2 - - 1 Other Diseases of Digestive System M 8 - - - - - - 2 1 2 2 1 F 17 - - - - 1 - - - 1 2 13 Nephritis and Nephrosis M 4 - - - - - - - - 2 2 - F 5 - - - - - - 1 - 1 2 1 Other Diseases, Genitourinary System M 2 - - - - - - - - - - 2 F 9 - - - - - - - 1 - 2 6 Diseases of Skin, Subcutaneous Tissue M - - - - - - - - - - - - F 1 - - - - - - - - - - 1 Diseases of Musculo-skeletal System M - - - - - - - - - - - - F 3 - - - - - - - - 1 2 Congenital Anomalies M 6 4 - - 1 - - - - - - - F 5 3 - - 1 - - - - - - 1 Difficult Delivery and/or Anoxic Condition M 7 7 - - - - - - - - - - F 4 4 - - - - - - - - - - Other Causes of Perinatal Mortality M 11 11 - - - - - - - - - - F 5 5 - - - - - - - - - - Symptoms and ill-defined Conditions M 3 - - - - - - - 1 - - 2 F 6 - - - - - - - - - 1 5 Motor Vehicle Accidents M 22 - - - 1 6 2 1 2 3 6 1 F 8 - - - - 2 - 2 1 - 1 2 79 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 64-74 75 and over All Other Accidents M 8 - - 1 - - 1 - - - 2 4 F 11 - - - • - - - - 1 4 6 Suicide and self-inflicted Injuries M 7 - - - - 2 2 2 - - 1 - F 13 - - - - - - - 6 4 2 1 All Other External Causes M 2 - - - - 1 - - - - - 1 F - - - - - - - - - - - - 80 The following table gives details of premature births and stillbirths notified in the London Borough of Sutton during the period 1st January 31st December 1973 as adjusted by transferred notifications : PREMATURE LIVE BIRTHS PREMATURE STILLBIRTHS Weight at Birth Born in Hospital Born at home or in a Nursing Home Transferred to Hospital on or before the 28 days Born in Hosp. Born at home or in Nursing Home DIED DIED DIED Total Births Within 24 hrs. of birth Between 1 and 7 days Between 7 and 28 days Total Births Within 24 hrs. of birth Between 1 and 7 days Between 7 and 28 days Total Births Within 24 hrs. of birth Between 1 and 7 days Between 7 and 28 days 2 lb 3oz. or less 11 (5) 3 (1) 1 (2) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) 3 (1) - (-) Over 21b 3oz. up to and inc. 31b 4ozs. 11 (9) 3 (2) - (2) - (1) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) 1 (2) - (-) Over 31b 4ozs. up to and inc. 41b. 6 ozs. 19 (27) 1 (1) - (-) - (1) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) 2 (4) - (-) Over 41b 6 ozs up to and inc. 4 lb 15 ozs. 23 (32) 1 (-) 1 (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (3) - (-) Over 4lb 15 ozs up to and inc. 5 lb 8oz. 46 (78) 1 (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) TOTAL 110 (151) 8 (4) 2 (4) - (2) - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) 6 (10) - (-) TABLE III THE OBSERVATION AND HANDICAP REGISTER NUMBER OF CASES ON REGISTER as at:- Year of Birth 1973 1972 1971 1970 1969 TOTAL 31.12.73 343 289 241 189 111 1173 31.12.72 81 TABLE IV THE HANDICAPPED PRE SCHOOL CHILD List of Handicaps, in defined categories, on the Observation and Handicap Register Category No. Nature of Handicap 1973 1972 1 Visual handicaps 12 11 2 Auditory handicaps 9 9 3 Language and speech handicaps 5 3 4 Epilepsy 8 5 5 Cerebral palsy 6 5 6 Spina Bifida and Hydrocephalus 15 17 7 Muscular Dystrophy and other muscular disorders 3 3 8 Metabolic and endrocrine handicaps 8 5 9 Alimentary disorders 10 7 10 Cardiovascular disease 34 27 11 Respiratory disease 15 14 12 Genito-urinary disorders 12 11 13 Educationally subnormal 20 21 14 Severe educational subnormality 13 14 15 Maladjusted/Autistic/Psychotic 1 1 16 Battered Baby Syndrome 21 11 17 Blood disease 6 5 18 Limb and Skeletal abnormalities 25 23 19 Chronic illness (neo-plastic) - - 20 Skin diseases 5 5 21 Other conditions 20 17 22 Chromosomal abnormalities (including mongolism) 16 14 TOTAL HANDICAPS 264 228 Number of children included above who have multiple handicaps 14 15 Families at Risk 6 82 83 CHILD WELFARE CENTRES TABLE V YEAR Number of Children who attended during period 1st January - 31st December 1973 No. of children referred elsewhere for consultant advice First Attendances of Children Born in No. of Sessions held by:- 1973 1969/72 TOTAL Total Attendance Assistant M.O's G.P's employed on sessional basis Total No. of Sessions 1973 2258 7532 9790 38302 1007 92 1512 58 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 Attendance Assistant M.O's G.P's employed on sessional basis Total No. of Sessions 1972 1503 6312 8815 45839 1075 52 1588 59 TABLE VI DENTAL CARE OF MOTHERS AND YOUNG CHILDREN Attendances and Treatment Expectant and Nursing Mothers Children under 5 1973 1972 1973 1972 Inspection 31 25 757 689 No. found to require treatment 25 20 290 319 No. offered treatment 25 19 290 307 Re-inspection 5 1 127 177 No. found to require treatment 5 1 66 98 First visits for treatment 33 28 360 398 Subsequent visits 69 26 494 603 Total visits 102 54 854 1001 Additional courses of treatment 1 34 46 Fillings 92 40 850 962 No. of teeth filled 72 38 736 870 Extractions 38 11 148 175 General anaesthetics 3 1 77 98 Emergency visits 2 5 73 58 Patients x-rayed 7 3 3 9 Scalings 19 10 85 103 Teeth otherwise conserved - - 79 18 Teeth root filled 1 - - - Crowns 1 3 - - Inlays - - - - No. of Dentures supplied 8 - - - Courses of treatment completed 30 21 336 371 Sessions devoted to inspection and treatment 12.9 16.5 138.6 155 84 85 TABLE VII MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) Table (a) PERIODIC MEDICAL INSPECTIONS 1st JANUARY - 31st DECEMBER 1073. 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) 1969 and later 359 359 - - 2 26 27 1968 2020 2020 - - 28 132 42 1967 204 204 - - 2 20 20 1966 401 401 - - 18 50 58 1965 850 850 - 738 32 97 112 1964 446 446 - 317 11 34 45 1963 151 151 - - 6 10 18 1962 137 137 - - 1 7 7 1961 698 698 - 723 40 55 80 1960 337 337 - 270 15 14 31 1959 43 43 - - 1 2 9 1958 and earlier 70 70 - - 5 5 9 TOTAL 5716 5716 - 2048 161 452 452 86 TABLE VIII 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 1973 1972 1973 1972 1973 1972 1973 1972 1973 1972 4 Skin T 19 23 - 10 37 36 56 69 O 26 55 5 32 72 70 103 157 5 Eyes (a) Vision T 30 48 6 106 125 164 161 318 O 64 111 6 100 124 128 194 339 (b) Squint T 34 37 - 6 47 51 81 94 O 13 31 - 7 13 20 26 58 (c) Other T 2 4 - - 10 3 12 4 O 5 4 - 1 12 7 17 12 6 Ears (a) Hearing T 6 11 1 2 19 23 26 36 O 38 58 2 15 51 53 91 126 (b) Otitis Media T 9 9 - 1 15 8 24 40 O 14 34 - 1 22 28 36 63 (c) Other T 1 3 1 1 6 4 8 8 O 12 6 - 1 7 9 19 16 7 Nose and Throat T 41 28 1 17 79 113 121 158 O 227 429 5 50 304 302 536 781 8 Speech T 21 33 - 2 28 34 49 69 O 91 72 1 7 28 35 120 114 9 Lymphatic Glands T 2 5 - - 5 8 7 13 O 66 109 1 5 45 54 112 168 87 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 Leavers Others Total Special Instructions 1973 1972 1973 1972 1973 1972 1973 1972 1973 1972 10 Heart T 3 2 - - 10 6 13 8 O 16 21 1 6 25 25 42 52 11 Lungs T 8 6 - 5 16 17 24 28 O 49 64 2 24 74 81 125 169 12 Developmental (a) Hernia T 2 3 - 3 7 7 9 13 O 6 2 - 2 10 4 16 8 (b) Other T - 4 - 2 3 17 3 23 O 14 18 1 2 25 20 40 40 13 Orthopaedic (a) Posture T 1 2 - 1 3 14 4 17 O 9 12 - 10 15 16 24 38 (b) Feet T 8 14 1 7 21 24 30 45 O 19 27 - 17 29 29 48 73 (c) Other T 4 6 1 8 8 9 14 28 O 14 19 - 17 23 30 37 66 14 Nervous System (a) Epilepsy T 3 3 1 5 8 11 12 19 O 2 8 2 3 12 19 16 30 88 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 1973 1972 1973 1972 1973 1972 1973 1972 1973 1972 14 Nervous System (b) Other T 6 6 - 4 8 13 14 23 O 6 6 - 4 8 13 14 23 15 Psychological (a) Development T 1 3 - 3 3 3 4 9 O 14 26 7 22 89 81 110 129 (b) Stability T 27 30 3 22 54 77 84 131 16 Abdomen T 6 7 1 1 10 11 17 19 O 19 17 - 5 20 26 39 48 17 Other T 4 5 1 5 17 24 22 34 O 25 31 1 12 37 45 63 88 89 SCHOOL DENTAL SERVICE TABLE IX 1. Attendances and Treatment 5 - 9 years 10- 14 years 15 years and over TOTAL 1973 1972 1973 1972 1973 1972 1973 1972 First visit 2086 2265 1592 1703 453 453 4131 4493 Subsequent visits 3231 3310 2957 3060 897 997 7085 7367 Total visits 5317 5575 4549 4853 1350 1432 11216 11860 Additional courses of treatment commenced 392 426 260 292 69 72 721 790 Fillings in permanent teeth 1379 1523 3281 3753 1342 1433 6002 6709 Fillings in deciduous teeth 4383 4636 393 362 - - 4776 4998 Permanent teeth filled 1208 1323 2685 3192 1089 1170 4982 5685 Deciduous teeth filled 3747 3942 329 305 - - 4076 4247 Permanent teeth extracted 109 79 472 524 106 119 687 772 Deciduous teeth extracted 1619 1624 491 575 - - 2110 2199 General Anaesthetics 730 720 338 355 36 47 1104 1122 Emergencies 354 301 140 123 38 20 352 444 1973 1972 Number of pupils x-rayed 632 544 Prophylaxis 588 538 Teeth otherwise conserved 126 81 Number of teeth root filled 54 51 Inlays - - Crowns 24 16 Courses of treatment completed 4146 4453 2. Orthodontics 1973 ] New cases commenced during 1973 142 79 Cases completed during year 53 73 Cases discontinued during year - 3 No. of removable appliances fitted 195 121 Pupils referred to Hospital Consultant 5 6 3. Prosthetics Ages 5 - 9 Ages 10 - 14 Ages 15 & over TOTAL 1973 1972 1973 1972 1973 1972 1973 1972 Pupils supplied with F.U. or F.L. (1st time) - - - - 1 1 1 1 Pupils supplied with other dentures (1st time) - 4 1 1 10 5 11 7 Number of dentures supplied = 1 2 1 14 9 16 11 4. Anaesthetics 1973 1972 General anaesthetics administered by dental officers: Nil Nil 5. Inspections 1973 ] (a) First inspection at school. No. of pupils 19850 19156 (b) First inspection at clinic No. of pupils 1632 1822 No. of (a) + (b) found to require treatment 9437 9238 No. of (a) + (b) offered treatment 7222 7122 (c) Pupils re-inspected at school clinic 2277 2458 No. of (c) found to require treatment 1551 1737 6. Sessions 1973 1972 Sessions devoted to treatment 1677.4 1798.4 Sessions devoted to inspection 202.5 209.3 Sessions devoted to Dental Health Education 42 5 90 TABLE X CHILD GUIDANCE CLINIC- STATISTICS 1972 1973 1972 Psychiatric sessions Diagnostic interview with children 126 90 Treatment interviews 190 201 Court reports - 2 Boarding school reviews 17 4 Case discussion (supervision) 15 53 Discussion of North Downs cases 19 15 Meeting outside agencies 21 5 Outside visits 8 5 Appointments arranged but failed 55 70 Psychiatric Social Worker Sessions Treatment interviews 812 706 Case discussions (supervision) 17 65 Meeting outside agencies 4 15 Home visits 46 8 Supervision of students 44 40 Outside visits 10 4 Appointment arranged but failed 253 155 Diagnostic interviews with families 1 50 Psychotherapist Sessions Diagnostic interviews with families 26 21 Treatment interviews 1568 1708 Case discussions (supervision) 64 90 Outside visits 15 5 Meeting outside agencies 4 13 Appointments arranged but failed 229 260 The number of children referred to the clinic during 1973 was 180 (175) The agencies initiating referral were General practitioners 26 22 School Health Services 29 45 School Psychological Service 57 50 Courts - - Social Services 6 11 Hospital or Specialists 24 15 Schools 12 3 Parents 29 29 91 SCHOOL PSYCHOLOGICAL SERVICE TABLE XI (i) Source of Referrals other than by the Child Guidance Clinic during 1973 1973 1972 Principal School Medical Officer 201 231 Head Teachers directly 312 220 Carew Manor E.S.N. School 44 66 Other 48 37 Education 13 9 636 563 Child Guidance Clinic cases seen in 1973 + 18 (ii) Recommendations Made TO Carew Manor E.S.N. School 23 44 Training Centre 10 9 Infant Observation/Diagnostic Classes 26 30 Borough Remedial Units 24 17 Other schools 16 24 Psychiatric investigation 40 27 Medical Investigation 10 13 Youth Employment Officer 5 2 Speech Therapist 7 10 Social Services 13 4 Specific review and re-assessment 301 262 Report and advice only 161 144 636 586 92 93 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 1973 and 1972. Blind Partially Sighted Deaf Partially Hearing Physically capped Delicate Maladj. E.S.N. Epileptic Speech Defects TOTAL 73 72 73 72 73 72 73 72 73 72 73 72 73 72 73 72 73 72 73 72 73 72 Children newly assessed as needing special educational treatment at special schools 1 2 3 2 2 2 5 4 3 8 10 4 43 38 1 - - - 66 63 No. of children receiving special educational treatment in (a) Boarding Special Schools or Homes 1 2 2 2 9 6 2 2 6 13 8 8 8 5 12 14 3 1 1 1 52 54 (b) Day Special Schools - - 14 13 7 11 8 8 33 70 11 13 11 12 246 237 - - - - 330 364 (c) Independent Boarding Schools - - - - 1 1 - - 2 3 - - 14 22 10 11 - - - - 27 37