AC 433G7 EX WAN 103 London Borough of Wandsworth ANNUAL REPORT of the Medical Officer of Health and Principal School Medical Officer for the Year 1966 by J. TUDOR LEWIS, M.D., D.P.H. London Borough of Wandsworth ANNUAL REPORT of the Medical Officer of Health and Principal School Medical Officer for the Year 1966 by J. TUDOR LEWIS, M.D., D.P.H. CONTENTS Page INTRODUCTION 3 Part 1—VITAL STATISTICS 9 Part 2—COMMUNICABLE DISEASES 14 Part 3—ENVIRONMENTAL HEALTH SERVICES Public Health Inspection 21 Housing 28 Food and Food Premises 30 Factories Act. 1961 39 Atmospheric Pollution 41 Miscellaneous Matters 44 Part 4—PERSONAL HEALTH SERVICES Services for Mothers and Young Children 48 Other Personal Health Services 62 Part 5—MENTAL HEALTH SERVICE 81 Part 6—SCHOOL HEALTH SERVICE 88 PHOTOGRAPHIC SUPPLEMENT Centre Pages Plate A—Slum Clearance—An example of old, unfit properties of a type now being demolished. Plate B—Slum Clearance—A typical example of modern redevelopment. Plate C—Mental Health—Self-contained flatlets at Putney —The bed-sitting accommodation. Plate D—Mental Health—Self-contained flatlets at Putney —The kitchenette facilities. INDEX 101 3 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1966 To the Mayor. Aldermen and Councillors of the London Borough of Wandsworth. Mr. Mayor, Ladies and Gentlemen, I have the pleasure of presenting to you the second Annual report on the health of the London Borough of Wandsworth, for the year ended 31st December, 1966. The health of Wandsworth generally remained good within the limits of current standards and statistical information at present available to assess the health of the community. The main features, full details of which are given later, are as follows. The civilian population of the Borough, as estimated by the Registrar General was 331,450, a slight decrease over the previous year. The total number of live births was 6,350 compared with 6,490 for 1965, which gave an adjusted birth rate per 1.000 of the population of 18.38 compared with 18.77 for 1965. The number of deaths at all ages was 4,512 as against 4,447 in 1965 and this gave an adjusted death rate per 1,000 of the population of 11.02, a slight reduction over the previous year. The total number of deaths of infants under one year of age was 130, a reduction of 13 over the previous year, on which figure the infant mortality rate per 1,000 live births was 20.47, a welcome reduction from the rate of 22.03 for 1965. The perinatal mortality rate, which is based on the sum of the stillbirths and deaths under one week per 1,000 total live and still births, was 28.81. Last year four women died from causes associated with childbirth; in 1966 I am happy to state that only two women died from these causes, which gives a maternal mortality rate of 0.3 per thousand live and still births. A detailed breakdown of the causes of death are shown in the Table on page 12, and here I need only make reference to those non-infectious causes of death where there is considered to be a preventable factor. Of these, cancer of the lung which is certainly associated with prolonged and heavy cigarette smoking caused a total of 285 deaths as against 238 for 1965. Deaths from bronchitis numbered 247 as against 243 in 1965 and here again there is a known link between the chronic form of this disease and heavy cigarette smoking as well as with atmospheric pollution. Coronary disease and angina accounted for 758 deaths compared with 804 in 1965 and again, heavy smoking and obesity may well be 4 tributory factors. Considering the age groups at which these deaths took place it is sad to note that in the case of lung cancer and coronary disease, a large number occurred predominantly in the most economically productive and socially effective period of life. One thousand, eight hundred and eighty notifications of infectious diseases were received in 1966 as compared with 3,474 in 1965. This decrease is accounted for, in the main, by the reduction in the incidence of measles, since 1966 was not a "measles" year. Infectious diseases in general did not cause any particular concern and I am glad to report that there was a reduction in the number of Sonne dysentery cases as compared with the previous year, namely, 107 against 263. Five cases of typhoid fever were notified, the same as in the previous year and it is interesting that in four of these, the source of infection was again from abroad. During the year, there were outbreaks of smallpox of a minor type in various parts of the country, notably the Midlands and South Wales and although no case arose in Wandsworth the general alert that the presence of smallpox in the country rightly generates, presented us with a number of problems and various cases were visited where general practitioners had cause to suspect smallpox. Some of these cases presented difficult diagnostic problems and it is a pleasure to acknowledge the help given by, and also to thank, the Consultant Physician to the Infectious Diseases Unit at St. George's Hospital, who saw some of the cases in consultation. Although there were no dramatic health hazards in Wandsworth in 1966, the year was an extremely busy one for the Health Department. It may in fact be described as a year of adjustment and development where the functioning of the provisional organisation set up 1965 was scrutinized and future developments reviewed. The Organisation and Methods team began an independent survey of the administration and staffing structure of the Health Department towards the end of 1965. A departmental review had already been undertaken. As a result, certain modifications and amendments have been made which have had the effect of strengthening the departmental organisation. Thus, on the administrative side the original five sections were reduced to three, namely, Management, Personal Health Services and Environmental Health Services, with some consequential staffing adjustments. The result has been that procedures have been streamlined and give an increasing efficiency. The professional staffing was also reviewed ; as a result the senior nursing staff was strengthened by the introduction of a post of Deputy Principal Nursing Officer and the mental health staff by two posts of Assistant Principal Mental Welfare Officers. These new appointments, both on the nursing and the mental health side, have had the effect of strengthening the services on the professional level. The arrangements for chiropody previously had been the responsibility of three separate departments, namely, the Health 5 ment, the Welfare Department and a Voluntary Association. In conjunction with the Welfare Committee and Department and the Wandsworth Old People's Welfare Council, this position was rationalised and the Health Department given the responsibility for organising this service. As regards the development of the services, fairly full accounts are given in the various sections of the Report and here I need only touch upon one or two of the more interesting features. One development to which I would particularly draw attention was the inauguration of the flatlets for mentally disordered patients in conjunction with Chellow Dene Hostel. The idea of having flatlets linked with the Hostel had been in mind for a considerable time and we were extremely fortunate during the year to obtain, through the help and co-operation of the Housing Committee, the opportunity to acquire this particular house and to put our ideas into practice. I should like to thank the Chairman and members of the Housing Committee for making this possible. The premises consist of a house with ten self-contained bed-sitting rooms, tastefully furnished and provided with all modern amenities (see centre pages for photographs). Bathroom and sanitary accommodation is provided on a communal but fully adequate basis. The residents are selected, mainly but not invariably, from patients residing in Chellow Dene. The idea is to provide a third stage towards their full rehabilitation into the community. Thus, a patient who, following hospital treatment, had recovered sufficiently to enter Chellow Dene would be eligible for one of these flatlets provided that he had made progress in the hostel but had not reached the stage where he was suitable for discharge home. The Warden of Chellow Dene keeps closely in touch with the residents of the flatlets and they in turn usually maintain links with the hostel where they are able to take some of their meals if they so wish. It is not intended that these flats should be let on a permanent basis to the residents and we hope to have a reasonable turnover of lettings. A reasonable stay would be for a year or 18 months after possibly six or twelve months in a hostel. At the time of writing, there is every reason thus far to be satisfied with the results of this experiment but it is, of course, too early to say how it will work out in the long term. A problem which we may have to face is the resident who has become sufficiently recovered to take his place in the community as a normal individual but is yet unwilling, or at least reluctant, to give up a very satisfactory residence. I would hope to deal with this aspect in future reports. During the year, after very helpful discussions with the Chairman and Secretary of the Local Family Planning Association, a new agreement was reached on the financial help which the Corporation would make available to the Family Planning Association. The aim was to effect a streamlining of the arrangements, to avoid unnecessary accounting and to ensure that every woman who 6 needed advice on family planning problems from the health point of view would receive such advice with the least possible delay and the minimum of formalities. I understand that the arrangements which were made were much appreciated by the Association. In conjunction also with the Association, a film show was organised to which staff from the Health, Welfare and Children's Departments were invited, showing the newer methods for family planning. Another feature to which I would like to refer is our arrangements for screening tests for cancer of the womb. There had already been in this area over a period of several years arrangements for offering this service but during the year a good deal of further attention was given to this and a number of reports made to the Health Committee. In the body of the Report, further details will be found about this service. It can be said that it is now on a firm basis and if and when facilities become available for an increased number of smears to be examined at the hospital laboratories, we will be in a position, provided of course adequate experienced doctors are available, to step up the work considerably. This aspect of preventive medicine has received much publicity, undoubtedly well merited, but which in some ways has given rise to misunderstanding. The emphasis in this publicity has been on screening tests for cancer of the womb, particularly of the neck of the womb, and this is justifiable since this is a very serious killing illness of women. It must, however, be pointed out, and this is shown from the figures given in the body of the Report, that there are many other conditions not necessarily as serious as cancer of the neck of the womb, to which women are liable and which undoubtedly cause a great deal of ill-health and mental anguish. It is for this reason that in Wandsworth we have thought in terms, not exclusively of screening tests for cancer of the womb, but as screening gynaecological clinics where a full examination is made. Consequently, although we have considered the matter carefully departmentally, we have not looked with favour on the proposals which have from time to time been made for the smears to be taken by staff such as nurses and midwives trained in the technique of taking smears. We think that the examination should be a gynaecological examination carried out, not only by a doctor, but preferably by a doctor who has a special interest in and experience of this work. To some extent, it is true to say that this might limit the service offered although up to the moment in Wandsworth, this has not been so. There is another important factor which justifies this policy. If there is one thing more serious than a diagnosis of cancer of the neck of the womb it is for a smear or examination to give a wrong result with a false sense of security resulting in the disease being left undiagnosed until it attains a more advanced form at a later stage. The risk of such a happening may not, it is true, be very great, but if reliance is placed solely on the smears, then it can happen. A gynaecological examination minimizes the risk of this happening, as well as diagnosing many 7 other conditions, and is a further reason and a very potent one why we regard these examinations as full gynaecological, not only related to detection of cancer of the neck of the womb, and why we consider that they should be carried out by experienced doctors. Staffing matters continued to present problems during the year and steps were taken to meet them. I have already mentioned the strengthening of the Mental Health and Nursing Services on the senior level, and this undoubtedly will prove beneficial to the services. The Establishment Committee have followed the enlightened policy of sending mental health social workers already working in the department on the various courses that are available as a contribution to our building up a staff of qualified and experienced social workers. I am sure this will pay dividends in the years ahead, and the effect is already being seen in that we have in the Mental Health Section a number of qualified and experienced social workers. As a result, the department becomes known for the high quality of its work and this in turn attracts keen young people to join our service. Shortage of public health inspectors continues but I am happy to say that less difficulties were experienced in recruitment to the Nursing Service (day nurseries excepted), and we have a full complement of domiciliary midwives and home nurses. The Home Help Service which does so much to help people in their own homes suffers from a chronic shortage of applicants, but by means of energetic advertising the situation here also was improved. Finally, I should mention that during the year much time was devoted in conjunction with the Architects in designing and planning the various building projects which have been approved by the Committee. This is time-consuming and requires meticulous attention to detail and design. When these projects come to fruition we will have in the borough some very fine, modern buildings from which our staff will work with added enthusiasm. I should like to express my thanks to the Chairman of the Health Committee, Councillor Mrs. M. F. Sporle, for her help, support and advice throughout the year, and to all my colleagues in the Health Department for their enterprise and application to their duties. Many of the Corporation Departments have health problems with which this Department is involved and I am grateful for the co-operation between the various staffs. I have the honour to remain, Mr. Mayor, Ladies and Gentlemen. Your obedient servant, J. TUDOR LEWIS, Medical Officer of Health and Principal School Medical Officer. 8 MEMBERS OF THE HEALTH COMMITTEE (at 31st December, 1966) Chairman: Councillor Mrs. M. F. Sporle. Vice-Chairman: Councillor Dr. B. N. C. Prichard, M.Sc. Alderman S. F. C. Sporle Councillor R. F. Ash, j.p. A. H. Barton R. B. Bastin, b.a. E. C. Bond Mrs. O. Haines Mrs. E. M. R. Hoare. o.b.e. Dr. D. L. Kerr, m.p. Miss J. Lestor Miss G. A. Morgan N. G. M. Prichard. m.sc., j.p.. g.l.c. F. E. Sims Mrs. J. D. Standing D. B. Sweaney A. R. Tasker, l.i.b.s.t. Co-opted Members: Dr. D. Billig T. E. Parker, j.p. Mrs. M. Walkden, o.b.e., j.p. Ex-officio Member: The Worshipful the Mayor (Councillor A. A. Loughton, j.p.) SENIOR OFFICERS OF THE HEALTH DEPARTMENT (at 31st December, 1966) Medical Officer of Health J. Tudor Lewis Deputy Medical Officer of Health H. Gordon Senior Medical Officers A. Garland A. L. Frenkiel Principal Administrative Officer H. J. Horsnell Chief Public Health Inspector G. W. P. Weeks Principal Nursing Officer Miss W. M. Winch Principal Mental Welfare Officer Miss A. Julia Principal Social Worker Mrs. M. J. Koolman 9 PART 1 VITAL STATISTICS Population The overall civilian population at the middle of the year was estimated by the Registrar-General to be 331,450. Movement of Population The work of the Health Department is complicated by the migrant nature of a considerable proportion of the population. Records are kept of the movement of children under five years of age and during 1966 over 3,400 children in this age group moved into Wandsworth; during the same period a similar number were known to leave the Borough and in addition more than 2,000 children moved away without leaving any trace of their destinations. Of these last, over 500 were traced either inside or outside Wandsworth. In addition, over 2,000 children under five years of age changed their addresses inside the Borough. Area Comparability Factors Each year, the Registrar-General provides area comparability factors relating to births and deaths. These factors take into account the extent to which the age and sex distribution of the local population differs from that of England and Wales as a whole and this enables valid comparisons to be made between the birth and death rates in Wandsworth and those in other areas. For the year 1966, the factor for births is 0.96 and for deaths 0.81. 10 Extracts from Vital Statistics Live Births: Male Female Total Legitimate 2,839 2,688 5,527 Illegitimate 417 406 823 Total 3,256 3,094 6,350 Rate per 1,000 population: Crude 19.15 Adjusted 18.38 Stillbirths: 58 48 106 Rate per 1,000 total live and still births 16.42 Deaths: All ages 2,118 2,394 4,512 Rate per 1,000 population: Crude 13.61 Adjusted 11.02 Infant Mortality Rates: Deaths under 1 year 78 52 130 Total infant deaths per 1,000 live births 20.47 Legitimate infant deaths per 1,000 legitimate live births 19.17 Illegitimate infant deaths per 1,000 illegitimate live births 29.16 Neo-natal Mortality Rate (deaths under four weeks per 1,000 total live births) 14.01 Early Neo-natal Mortality Rate (deaths under one week per 1,000 total live births) 12.59 Perinatal Mortality Rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 28.81 Maternal Mortality Rate (per 1.000 total live and still births) 0.30 Number of deaths from Puerperal causes 2 Number of deaths from Cancer 906 Number of deaths from Tuberculosis 18 11 Births The total number of live births to residents of the Borough registered during 1966 was 6,350 comprising 3,256 males and 3,094 females. The crude birth-rate was 19.15 per 1,000 population. After taking into account the area comparability factor supplied by the Registrar-General the adjusted rate was 18.38. The live birth rate for England and Wales was 17.7. During the year there were 823 illegitimate live births to residents of the Borough, representing 12.96% of the total live births for the area. Stillbirths during the year numbered 106 giving a total of 6,456 live and still births for the area. Deaths There has been no unusual or excessive mortality during the year. The number of deaths assigned to the Borough, after adjustment for inward and outward transfers, was 4,512 comprising 2,118 males and 2,394 females. The crude death-rate for the year was 13.61 per 1,000 population but after applying the area comparability factor the adjusted rate was 11.02. The death rate for England and Wales was 11.7. Table 1 is the general mortality table for the Borough and shows the number of deaths from each cause divided into sexes, age groups and locality. Table 2 shows the deaths from heart disease. 12 TABLE 1. CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1966 CAUSES OF DEATH Deaths assigned to Borough in age groups Deaths shown in localities (all ages) All Ages Males Females Under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 35 35 and under 45 45 and under 55 55 and under 65 65 and under 75 75 and over Putney Central Battersea Tuberculosis, Respiratory 17 14 3 — — — 1 — — 2 7 5 2 4 5 8 Tuberculosis, Other 1 — 1 — — — — — — — — 1 — — 1 — Syphilitic Disease 12 6 6 — — — — — — — 2 5 5 3 8 1 Diphtheria — — — — — — — — — — — — — — — — Whooping Cough — — — — — — — — — — — — — — — — Meningococcal Infections — — — — — — — — — — — — — — — — Acute Poliomyelitis — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — Other Infective and Parasitic Diseases 13 5 8 — — 1 — 1 2 1 1 4 3 l 7 5 Malignant Neoplasm, Stomach 82 45 37 — — — — — 2 5 24 21 30 20 34 28 Malignant Neoplasm, Lung, Bronchus 285 219 66 — — — — — 3 32 104 90 56 86 99 100 Malignant Neoplasm, Breast 86 1 85 — — — — 1 8 12 26 18 21 25 33 28 Malignant Neoplasm, Uterus 25 — 25 — — — — — 3 7 9 1 5 7 10 g Other Malignant and Lymphatic Neoplasms 399 199 200 1 1 — 3 6 14 35 90 99 150 114 144 141 Leukaemia, Aleukaemia 29 21 8 — 3 3 2 1 2 1 4 10 3 11 12 6 Diabetes 27 10 17 — — — — — 1 5 4 6 11 8 11 8 Vascular Lesions of Nervous System 506 180 326 — — — — 3 3 21 59 126 294 141 184 181 Coronary Disease, Angina 758 447 311 — — — — 2 18 58 120 255 305 233 278 247 Hypertension, with Heart Disease 43 13 30 — — — — — 2 1 7 10 23 12 16 15 Other Heart Disease 653 207 446 1 — — — 1 4 6 35 91 515 121 388 144 Other Circulatory Disease 267 97 170 — — — — 1 3 11 22 47 183 77 107 83 Influenza 12 5 7 — 1 — — — — 3 2 — 6 4 5 3 Pneumonia 425 166 259 17 — — — 1 1 11 28 74 293 94 199 132 Bronchitis 247 163 84 4 2 — — — 1 11 36 73 120 71 86 90 Other Diseases of Respiratory System 26 16 10 1 — — — — 2 1 7 9 6 8 10 8 Ulcer of Stomach and Duodenum 34 16 18 — — — — 1 — 4 6 6 17 8 14 12 Gastritis, Enteritis, Diarrhoea 18 6 12 1 1 — — — 1 1 — 2 12 7 7 4 Nephritis and Nephrosis 17 7 10 — — — 1 1 4 4 1 — 6 4 8 5 Hyperplasia of Prostate 12 12 — — — — — — — — — 1 11 3 5 4 Pregnancy, Childbirth, Abortion 2 — 2 — — — 1 1 — — — — — — — 2 Congenital Malformations 36 19 17 25 4 2 1 1 — 2 1 — — 11 14 11 Other Defined and Ill-defined Disease 305 130 175 74 — 4 5 6 11 17 37 42 109 90 111 104 Motor Vehicle Accidents 45 29 16 — — 5 8 1 2 3 8 4 14 11 19 15 All other Accidents 79 50 29 6 3 7 6 5 5 8 10 9 20 21 25 33 Suicide 50 34 16 — — — 5 6 6 12 14 5 2 18 17 15 Homicide and Operations of War 1 1 — — — — — 1 — — — — — — — 1 All Causes 4,512 2,118 2,394 130 15 22 33 40 98 274 664 1,014 2,222 1,213 1,857 1,442 13 TABLE 2. DEATHS FROM HEART DISEASE, Males in age groups Females in age groups Grand Total under 25 25— 35— 45— 55— 65— 75 + J Total under 25 25— 35— 45 — 55— 65— 75 + Total Coronary Disease Angina, etc. — 2 17 56 98 160 114 447 — — 1 2 22 95 191 311 758 Hypertension with Heart Disease — — 1 — 6 3 3 13 — — 1 1 1 7 20 30 43 Other Heart Disease 1 1 — 4 19 53 129 207 — — 4 2 16 38 386 446 653 Total 1 3 18 60 123 216 246 667 — — 6 5 39 140 597 787 1,454 Infant Mortality There were 130 deaths of children under one year, giving an infant-mortality rate of 20.47 per 1,000 live births. The infantmortality rate for England and Wales was 19.0 Table 3 shows causes of death of children under one year of age. TABLE 3. DEATHS OF CHILDREN UNDER ONE YEAR OF AGE Cause of Death Under 24 hours 1-7 days 1-4 weeks Total under 4 weeks 1-12 months TOTAL DEATHS UNDER 1 YEAR Pneumonia — — 2 2 15 17 Bronchitis — — — — 4 4 Gastritis, Enteritis, Diarrhoea — — 1 1 — 1 Congenital Malformations 7 8 1 16 9 25 Prematurity 30 15 2 47 — 47 Other Causes 9 11 3 23 13 36 TOTALS 46 34 9 89 41 130 Maternal Mortality Two deaths occurred from accidents and diseases of pregnancy or child-birth. This is equivalent to a rate of 0.3 per 1,000 live and still births. 14 PART 2 COMMUNICABLE DISEASES There was a considerable decrease in the number of infectious disease notifications received during the year, 1,880 as compared with 3,474 in 1965. The decrease accounted for mainly by the drop in the incidence of measles. The total number of confirmed notifiable infectious diseases reported, arranged in age groups and in the areas in which they occurred, are shown in Tables 1 and 2 on pages 19 and 20. A commentary on the notifications is given below. Vaccination and immunization against certain infectious diseases is one of the personal health services available to certain limited groups of people and a reference to this service will be found on page 63. Diphtheria Once again, no cases of diphtheria have occurred in the Borough but the occasional incidence of this disease in other areas, including London, serves to stress the importance of maintaining a high degree of protection in the community through immunization. Food Poisoning Two hundred and ten notified or otherwise reported cases were investigated during the year. Of these, 186 were found not to be food poisoning after laboratory examination of faecal specimens from those affected. Fourteen of the remaining cases were single unrelated cases, and five involved a total of ten persons. The causative organisms of the 24 cases were found to be of the following types :— Salmonella brandenberg 1 Salmonella london 1 „ enteriditis 1 „ panama 3 „ halle 1 „ Santiago 2 „ indiana 2 „ typhimurium 13 In addition to the above cases an outbreak involving 125 persons occurred at a Training Collese in the boroueh. Bacteriological investigation of a number of those affected indicated the infective agent as heat-resistant Clostridium welchii and a full report was submitted to the Ministry of Health. Measles A total of 1,341 notifications were received, as compared with 2,795 in 1965. The drop in the number of cases was anticipated, as measles incidence rises and falls in alternate years. 1966 was a "non-measles" year. 15 Meningococcal Infection Six cases were notified during the year, of which five were confirmed. Ophthalmia neonatorum This is an acute inflammatory condition of the eye which sometimes occurs in newborn babies and three cases were notified during the year. Acute Influenzal Pneumonia and Acute Primary Pneumonia These are the notifiable forms of pneumonia and 63 cases of the latter type were notified in 1966. Poliomyelitis One case of suspected poliomyelitis was investigated but the diagnosis was not confirmed. Sonne Dysentery A total of 107 cases were confirmed during the year compared with 263 for 1965, but a great many other cases of suspected dysentery were investigated before the provisional diagnosis was eliminated by bacteriological examination. Seventy-four of the cases were single unrelated cases and there were minor outbreaks at two day nurseries involving 18 cases at one and 15 cases at another. Tuberculosis The total number of new cases which came to the notice of the Department during 1966 was 221, the sources of information being as follows:— Primary notifications 145 Unnotified at death 6 Transfers from other areas 70 Total 221 The number of deaths certified as due to various forms of tuberculosis was 18. 16 Particulars of the primary notifications and deaths during the year, classified by sexes and age-groups, are given in the following table:— Age Groups Primary Notifications Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 year — 1 — — — — — — 1- 4 3 2 1 — — — — — 5-9 4 3 — — — — — — 10-14 1 2 — — — — — — 15-24 6 6 2 3 1 — — — 25-44 34 8 4 4 — — — — 45-64 32 9 1 3 8 1 — — 65 and over 12 3 — 1 5 2 — 1 Totals 92 34 8 11 14 3 — 1 During the year a total of 441 home visits were made by tuberculosis visitors. Over the past decade great advances have been made in the treatment, and hence in the prevention of tuberculosis, and the disease, as the above figures indicate, is much less of a problem than it was in years gone by. Nevertheless, its importance as a public health hazard must not be under-estimated. A reference to the work of the Chest Clinics and to the activities of the Tuberculosis Care Committees will be found on pages 68 to 73. Typhoid Fever Five confirmed cases were notified during the year. In four of these the source of infection was from abroad. Two cases, one a youth of 17 years and the other a woman of 52 years were recent arrivals in this country from India. A third case was a girl of 4 years, recently arrived from Pakistan and the fourth, a boy of 6 years, had been on holiday in Jamaica. All contacts were cleared by bacteriological examination. In the remaining case, that of a boy of 9 years, it was not possible to discover the source of infection, although it is a point of interest that the boy's father, uncle and aunt are all Indian by birth, but have resided in this country for a number of years. All family and close school contacts of this case were thoroughly investigated and no further cases were found. 17 Smallpox No case occurred in the Borough during the year. Notifications are received from Port and Local Authorities whenever persons who may have been in contact with smallpox are known to be coming into the Borough. Observation for the necessary period is kept on these persons by members of the staff of the Health Department but no such notifications were received during the year. Under the Public Health (Aircraft) Regulations, 1952-63, persons arriving in this country by air, who are not in possession of valid international certificates of vaccination against smallpox, must be placed under surveillance for up to 17 days. With the ever-increasing flow of air travel, more and more people come to this country to stay, permanently or otherwise, and during the year 23 such persons who were proceeding to addresses in the Borough were kept under observation. International Certificates of Vaccination and Inoculation During the year 18,975 requests were received from residents in the Borough for a certificate of vaccination or inoculation to be authenticated for the purpose of travel abroad. The signature of the person issuing the certificate was verified in each case as that of a registered medical practitioner practising in Wandsworth and the certificate endorsed accordingly The risk of importation of smallpox to countries by travellers from smallpox endemic areas has caused a tightening up by most countries of their regulations in regard to vaccination, and in consequence, many more requests are now being made to Health Departments for the authentication of international certificates. In 1965 there were only 4,110 requests; the increase of 14,865 during 1966 was occasioned partly by the general tightening-up already mentioned but more especially by the outbreak of a number of mild cases of smallpox in the Midlands and South Wales about the middle of the year. For a few months almost every other country required a traveller from England to produce an international certificate before being permitted to enter. Persons who are proceeding to certain areas abroad but who do not wish to be vaccinated must take with them a certificate to the effect that no recent cases of smallpox have occurred in the borough. Six such certificates were issued on request during the year. 18 Bacteriological Examinations Towards the end of the year a new Joint Microbiology and Public Health Laboratory was opened at St. George's Hospital, Tooting, to which all specimens taken in connection with food poisoning and infectious diseases are now sent for examination. The Director of the Laboratory is Dr. S. Fleck, and I am happy to record that in the short time that has elapsed since the inception of the laboratory close and friendly liaison has been established between Dr. Fleck and his staff and the staff of the Health Department. Bacteriological examination of food specimens continued to be carried out at the Public Health Laboratory at County Hall to whose Director, Dr. A. J. H. Tomlinson, I would once again express my thanks for the continued help and assistance received from his staff during the year. A combined total of 4,350 bacteriological examinations were carried out at the two laboratories during 1966 on specimens submitted by general practitioners and the Health Department. Nature of Specimen No. Stool and Urine 3,876 Nose and Throat Swabs 474 19 TABLE 1 NOTIFIABLE DISEASES NO. OF NOTIFIED CASES OF INFECTIOUS DISEASES IN AGE GROUPS Under 1 1—2 3—4 5—9 10—14 15—24 25—44 45—64 65 and over Total Anthrax — — — — — — — — — — Diphtheria — — — — — — — — — — Dysentery 7 27 13 15 8 5 19 2 11 107 Encephalitis, Acute — — — — — — 1 — — 1 Erysipelas — — — — — — — 1 2 3 Food Poisoning 1 3 5 4 2 1 4 4 — 24 Malaria — — — — — — — — — — Measles 67 360 396 486 19 6 7 — — 1,341 Meningococcal Infection 1 1 — 1 — 1 1 — — 5 Ophthalmia Neonatorum 3 — — — — — — — — 3 Pneumonia: Acute Influenzal — — — — — — — — — — Acute Primary — 1 2 4 — 3 8 14 31 63 Poliomyelitis, Acute — — — — — — — — — — Puerperal Pyrexia — — — — — — 1 — — 1 Scarlet Fever — 3 19 25 2 5 2 — — 56 Smallpox — — — — — — — — — — Tuberculosis 1 2 4 7 3 17 50 45 16 145 Typhoid Fever and Paratyphoid Fever — — 1 2 — 1 — 1 — 5 Whooping Cough 13 32 34 41 3 1 1 1 — 126 Total 93 429 474 585 37 40 94 68 60 1,880 20 TABLE 2 NOTIFIABLE DISEASES NUMBER OF NOTIFIED CASES OF INFECTIOUS DISEASES IN WARDS Total Deaths PUTNEY CENTRAL BATTERSEA Roehampton Putney Thamesfield West Hill Southfield Fairfield Earlsfield Springfield Tooting Graveney Bedford Furzedown Northcote Balham Nightingale St. John Latchmere St. Mary's Park Shaftesbury Queenstown Anthrax Diphtheria — — — — — — — — — — — — Dysentery ... 9 2 8 22 6 14 14 1 5 1 2 2 1 3 5 3 3 107 Encephalitis, Acute — — — — — — — — — — 1 — — — — — — 1 Erysipelas ... — — — 1 — — — — — — — •— — — 1 1 — 3 Food Poisoning 1 — 4 2 2 3 2 — 1 4 — 1 — — 2 2 24 Malaria — — — — — — — — — — — — — Measles 12 46 47 66 108 75 85 85 136 101 39 55 20 34 23 53 90 85 80 101 1,341 Meningococcal Infection ... 1 — — 1 — — 1 — — — — — — — — 1 — — — 1 5 Ophthalmia Neonatorum... — — — — — — — — 1 — 1 — — — — — — 1 —»■ — 3 Pneumonia, Acute Influenzal „ Acute Primary 1 — 2 8 4 4 4 12 1 2 12 — — 3 2 2 4 2 — — 63 Pol iomyelitis, Acute Puerperal Pyrexia ... 1 1 Scarlet Fever — 2 2 13 4 2 4 5 7 4 1 2 — — — 1 3 1 3 2 56 Smallpox — — — — — — — — — — — — — — — — — Tuberculosis 9 5 8 5 4 14 3 8 5 12 2 4 3 9 6 6 5 9 19 9 145 18 Typhoid Fever and Paratyphoid Fever 1 2 _ _ 1 1 5 Whooping Cough ~ — — 4 10 5 6 12 14 19 7 14 4 2 4 2 2 2 6 13 126 — Total 33 55 59 110 155 108 121 138 165 144 69 76 29 51 42 69 109 106 110 131 1,880 18 21 PART 3 ENVIRONMENTAL HEALTH SERVICES The year under review has been as busy as any and although it has not been possible to increase the staff of public health inspectors, the success of one student in passing the Diploma Examination made up for the loss of an inspector who moved to another post. The basic work of the department has been dealt with and the Metropolitan Borough of Wandsworth (No. 7) and the London Borough of Wandsworth (No. 1) Smoke Control Orders were confirmed during the year and conversions in both areas are now well in hand. The Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966, which came into operation on 1st January, 1967. caused a deal of preliminary field work during the year and meetings were held to discuss the application of the Regulations with the stallholders concerned. Much work has still to be done in this connection. More than the usual number of consignments of frozen prawns and lobsters have been dealt with. The Port of London Authority, when unable to deal with consignments, releases them to a cold store within the Borough, and it is then necessary for sampling for bacteriological impurity to be carried out before releasing the consignments for human consumption. PUBLIC HEALTH INSPECTION Work of the Public Health Inspectors A summary of the inspections carried out during the year is given in Table 1. TABLE 1 Inspections Re- Inspections Total To investigate complaints 6,694 11,563 18,257 Offices, Shops and Railway Premises Act 882 652 1,534 Infectious Diseases 1,262 754 2,016 Factories Act 323 — 323 Housing Clearance Area Scheme 447 — 447 Housing Reports 396 — 396 Hairdressers 398 — 398 Other inspections 8,785 5,942 14,727 Totals 19,187 18,911 38,098 Table 2 gives details of the sanitary operations carried out in the Borough during the year 22 TABLE 2 Putney Central Battersea Total Premises cleansed and repaired 172 270 540 982 Drains tested 128 110 101 339 Drains cleansed or repaired 457 600 424 1,481 399 Water closets cleansed, repaired or renewed 76 165 158 Soil pipes altered or repaired 17 71 37 125 Waste pipes provided, altered or repaired 44 107 99 250 Rainwater pipes repaired 18 20 37 75 Roofs and gutters repaired 94 166 298 558 Damp courses inserted 1 1 — 2 Damp conditions otherwise remedied 101 137 331 569 Yards drained or paved 1 3 20 24 Dustbins provided 17 16 15 48 Water cisterns cleansed, covered or repaired 2 — 2 4 Water supply reinstated 93 114 265 472 Defective stoves and fireplaces remedied 1 10 17 28 Animals improperly kept 1 — 2 3 Accumulations of rubbish, etc., removed 16 44 39 99 Urinals cleansed or repaired 3 2 — 5 Smoke nuisances 2 2 — 4 Other nuisances 4 16 12 32 Total 1,248 1,854 2,397 5,499 Number of preliminary notices served 285 444 821 1,550 1,328 659 Number of preliminary notices complied with 246 393 689 Number of abatement notices served 79 129 451 Number of abatement notices complied with 82 136 378 596 Legal Proceedings During the year, legal proceedings were taken by the Council in seventeen instances in connection with the abatement of nuisances. Drainage Work Plans are required to be submitted to the Council in respect of new drainage work or any reconstruction, alteration or repair of existing drainage systems, for approval under the Drainage Byelaws, and during the year 376 applications were received. The actual work on the site is supervised by technical assistants in co-ordination with the public health inspectors. During the year 3,291 tests were carried out in connection with drainage installations and 72 connections were made to the Council's sewers. 23 As referred to in last year's report, the clearance and maintenance of public sewers, formerly designated combined drainage systems, is now the responsibility of the Council, and maintenance costs are reclaimed from the owners of properties connected to the public sewer. A close working liaison with the Borough Engineer and Surveyor's Department implements the rapid clearance and repair of public sewers. Sewerage and Sewage Disposal The sewerage system, in common with other London boroughs, discharges into the Greater London Council's main sewers and disposal is carried out by that Council. The Corporation's brick and pipe sewers are regularly cleansed and are adequate for their purpose. Water Supply The bulk of the water supply in the Borough is provided by the Metropolitan Water Board and this supply has been satisfactory both in quality and quantity throughout the year. All dwelling houses in the Borough, numbering approximately 93,000 and housing a population of 331,450 persons, have a mains water supply provided by the Metropolitan Water Board with the exception of a portion of one of the Council's housing estates, namely the Latchmere Estate, which obtains its supply from deep wells situated at the Latchmere Baths adjoining the Estate. Bacteriological examination of the well-water before chlorination, and prior to its supply to the Estate, is carried out at fortnightly intervals and chemical analysis has shown no significant change in the character of the water. At one time, water for the whole Estate was supplied from the wells, but work is in progress to provide a water supply piped directly from the mains of the Metropolitan Water Board. The Metropolitan Water Board carries out bacteriological and chemical tests of raw water and water after treatment. No specific action has been necessary in respect of contamination of water supply but following inspection of individual premises by the public health inspectors, close liaison has been maintained with the Metropolitan Water Board whenever necessary. The fluoride content of water supplied by the Metropolitan Water Board to Wandsworth is 0.2 to 0.25 parts per million, and in the case of water supplied to the Latchmere Estate 0.60 to 0.65 parts per million. Reference was made in last year's report to the general question of the fluoridation of the water supply in the Borough. A decision in favour of fluoridation was made by the Council, following careful consideration at a number of meetings of the Health Committee, and the Council's views were, therefore, made known to the London Boroughs' Committee, with a recommendation that special legislation be sought to authorise the practice of fluoridation being undertaken nationally. 24 The Council were informed subsequently, however, that the Metropolitan Water Board do not consider the time opportune to decide its policy in this matter, in view of the lack of unanimity of opinion between the local health authorities whose areas are served by the Board. Nursing Homes The Council controls the registration and supervision of all nursing homes within the Borough, and its powers in this connection are contained in the Public Health Act, 1936, the Nursing Homes Act, 1963, the Conduct of Nursing Homes Regulations, 1963, and, for mental nursing homes, the Mental Health Act, 1959. During the year, periodic visits were made to all the homes by the Department's medical and nursing officers and public health inspectors. There were nine registered nursing homes in the Borough at the end of the year, with a total of 287 beds. No new homes were registered during the year, but the registration of one maternity nursing home was withdrawn when it closed down. The categories and accommodation of the nursing homes are given below, with the number of inspections made during the year:— Mental nursing homes (2) 162 beds Mother and baby homes (3) 53 beds Other nursing homes (4) 72 beds Inspections by medical and nursing officers 18 Inspections by public health inspectors 20 Hairdressers and Barbers During the year the Minister of Housing and Local Government confirmed the new Bye-laws relating to hairdressers and barbers made by the Council under Section 77 of the Public Health Act, 1961, and Article 10 (2) of the London Government Order, 1965. These Bye-laws lay down standards of cleanliness in hairdressers and barbers establishments. During the year 398 inspections of such premises were made. Prevention of Damage by Pests Act, 1949 This Act gives the Council power to require steps to be taken to eradicate and, where possible, to prevent infestation by rats and mice. These duties are carried out by the Rodent Officer assisted by Rodent Operatives. All infestations coming to light, whether by way of complaint or otherwise, are systematically investigated and appropriate action is taken. Where the cause of the trouble is obviously defective drains or other defects in the building, the owner is called upon to effect the necessary repairs. This aspect of the work involves close co-operation between the Rodent Control Staff and the Public 25 Health Inspectors. In the case of private dwellings the work of disinfestation is carried out by the Rodent Control staff without charge, and on request at business premises, when the cost is charged in full. During the year, 2,240 complaints of infestation were received in respect of which a total of 10,599 visits were made by the Rodent Control staff. Offensive Trades There is one establishment in the Borough at which the scheduled offensive trade of fat-melting is carried on. The firm concerned has been established for many years and the trade is conducted satisfactorily. Pharmacy and Poisons Act, 1933 This Act is chiefly concerned with the distribution by sale or otherwise of poisonous substances. The list of poisons is contained in an Order made under the Act and is divided into two parts. The Council are not concerned with the poisons contained in Part I since an "authorised seller" is a pharmacist registered with the Pharmaceutical Society, and enforcement is entrusted to Inspectors appointed by that Society. Substances specified in Part II may be sold by "listed sellers and these are persons who, on written application in a prescribed form, and on payment of stated fees, are recorded by the Council as "persons entitled to sell poisons in Part II of the Poisons List" at the premises recorded in the Register. The Council are required to enforce the Act and Orders so far as they relate to "listed sellers" and have appointed the Public Health Inspectors as Inspectors under the Act. At the end of the year there were 201 persons registered under the Act. Consumer Protection Act, 1961 This Act repealed the Heating Appliances (Fireguards) Act, 1952, and the Oil Burners (Standards) Act, 1960, but Regulations made under the former Act concerning fireguards on certain heating appliances offered for sale are still in force. Regulations have been made concerning oil burners, specifying standards of safety, and prohibiting the sale of oil heaters or component parts which do not comply with the Regulations. No contraventions of the Regulations were reported during the year. Noise Abatement Act, 1960 This Act gives local authorities power to deal with "noise which is a nuisance". Industrial noise clearly has a health angle in that it is often continuous and of considerable intensity and the Health Department takes appropriate action on complaints of noise arising in connection with a trade or business. Noise other than industrial noise however is sometimes difficult to deal with as it 26 is often of an intermittent character. The act provides for any three persons aggrieved by a noise nuisance to initiate action by complaining to a Magistrate. During the year, 41 complaints were received in the Health Department and investigated by the public health inspectors, involving a total of 89 visits. Some complaints related to noise occurring during the evening or at night which necessitated evening visits and observations by the inspectors. In other instances investigations proved that little or no justification existed for complaint. The majority, however, related to noise caused by industrial machinery of various kinds and in most cases an informal approach by the inspectors was met by a willing co-operation on the part of the offenders to seek methods of abating or lessening the noise. In no case was it necessary to serve a notice under the provisions of the Act. Offices, Shops and Railway Premises Act, 1963 The staff shortages which continued throughout the year have affected progress being made in the general inspections of registered premises. Initial inspections under the Act numbered 524 and the total inspections and re-inspections was 1,534. In 156 instances contraventions of the Act were found, approximately one-half being due to the non-provision of first aid equipment. As has been generally the case since the inception of the Act, no difficulty was experienced in obtaining compliance with the Act. when contraventions were brought to the notice of the responsible persons. Accidents notified were again of a comparatively minor character and of the 62 notifications received during the year, approximately one-third were caused by falls of various kinds and one-third as the result of handling goods. The following table shows the classification and number of premises registered since the operative date of the Act, up to the end of 1966, the number of persons employed thereat and the number of inspections made during the year:— Class of Premises Number Registered Persons Employed Initial Inspections ReInspections Offices 765 8,137 81 1,010 1 Retail shops 1,964 8,528 404 Wholesale shops, warehouses 110 1,245 9 Catering establishments open to the public 265 2,065 30 Fuel storage depots 5 45 — Total 3,109 20,020 524 1,010 27 Protection of Animals The agency arrangements made in 1965 with the City of London Corporation, under which the Corporation undertook this Council's responsibilities for its functions under the various animal diseases and protection Acts, were reviewed in the early part of the year at the request of the City of London Corporation. The earlier arrangement provided for the payment of a basic annual fee plus additional charges, on an hourly basis, for individual case work. As a consequence of this review, agreement was reached with the City Corporation that the service be continued on the basis of an annual lump sum. The four main Acts under which action was taken during the year are as follows :— Pet Animals Act, 1951.—A pet shop may not be kept except under the authority of a licence granted in accordance with the provisions of the Act, the object of which is to regulate the sale of pet animals, with particular reference to their welfare whilst kept for sale. Thirty licences were issued by the Council during 1966. Animal Boarding Establishments Act, 1963.—This Act provides that no person may keep a boarding establishment for animals (defined as cats or dogs) in the Borough except under licence. Three such licences were granted during the year. Riding Establishments Act, 1964.—This Act provides for the licensing and inspection of any establishment at which a business of keeping horses for hire, for riding or for providing riding instruction is carried on. Licences in respect of three riding establishments were granted. Performing Animals (Regulation) Act, 1925.—One licence was granted during the year. Common Lodging Houses There are no registered common lodging houses in the Borough. Land Charges Act, 1925 During the year the Department dealt with 4,994 enquiries relating to local land charges. These enquiries necessitate a careful search of records, drainage plans, etc., to ascertain the existence of any orders or restrictions on the properties concerned such as outstanding statutory or informal notices, certificates of disrepair under the Rent Acts, inclusion in housing building programmes, slum clearance areas, etc. 28 HOUSING Housing Act, 1957 Clearance Areas.—One hundred and seventeen houses were included in representations made under Section 157 of the Housing Act, 1957, 146 houses were demolished following action under Section 42 and 254 houses were demolished following action under Section 43 (2). Closing Orders.—Under Section 17 of the Act seven houses were represented for closure and six Closing Orders were made. Under Section 18 of the Act, representations for the closure of parts of houses numbered seven and five Closing Orders were made under this Section during the year. Under Section 27, Closing Orders were determined in respect of two houses and five parts of houses. Houses in Multiple Occupation House-to-house inspections were continued in the Balham and Battersea districts, and in addition, individual houses coming to the notice of the department from other sources were inspected. A total of 2,277 premises, known to be in multiple occupation, have now been inspected, and it may be of interest to show the following occupancies per house: Occupancies: 2 3 4 5 678910+ No. of Houses: 1,117 593 234 123 84 48 34 23 21 There is still a considerable amount of work being carried out by owners, on a voluntary basis, but it is anticipated that in 1967 it will be necessary to serve notices under Sections 15 and 16 of the Housing Act, 1961, on landlords who have not complied with requests to bring their properties up to a standard acceptable by the Council. Sixteen Direction Orders were made and this is proving an effective way of limiting numbers in over-occupied houses. A Direction Order has the effect of limiting the number of persons who may occupy premises which do not comply with the Council's standards. Two technical assistants were appointed earlier in the year and work under the direction of a senior public health inspector employed full-time on houses in multiple occupation. This work requires a considerable number of visits being made during the evening and at weekends. The problem of multiple occupation appears to be increasing and it may be necessary for additional technical staff to be employed if real progress is to be made. 29 Control of Movable Dwellings Under the Caravan Sites and Control of Development Act, 1960, three caravan sites containing a total of eight dwellings were licensed during the year. Mobile and temporary homes provided on open sites by the Greater London Council are exempt from the licensing requirements of the Act. Rent Act, 1957 This Act provides, amongst other things, for the issue by the Council of certificates of disrepair to tenants of controlled dwelling houses which are considered to be in disrepair by reason of defects which ought reasonably to be remedied, having regard to the age, character and locality of the dwelling. There is also provision for the issue, by landlords, of undertakings to remedy such defects. The following is a summary of action taken in this connection during the year :— Applications for certificates of disrepair received 8 Certificates of disrepair refused 2 Decisions to issue certificates of disrepair 6 Certificates of disrepair issued 1 Undertakings received from landlords 5 Application for certificates re undertakings received from landlords 10 Certificates re undertakings issued to landlords 10 Applications for cancellation of certificates of disrepair received 7 Certificates of disrepair cancelled 6 Housing Accommodation Applications Applications made to the Council are normally dealt with by the Housing Manager who refers to me those cases in which the application is based wholly or partly on health grounds. These cases include applications for transfer from Council tenants. Any case involving some special feature concerning the Health Department (e.g. fitness of basement rooms) is also referred to me. During the year 1,335 applications were considered for eligibility for additional points on health grounds in accordance with the Council's points scheme. A further 410 recommendations were made in respect of Council tenants who requested transfer to more suitable alternative accommodation on health grounds. 30 FOOD AND FOOD PREMISES In order to ensure that food businesses are supervised systematically, an up-to-date register is maintained of all premises where such business is carried on. Supervision is governed mainly by powers under the Food and Drugs Act, 1955 and regulations made thereunder but there are numerous other Acts of Parliament, etc., which relate to specific types of food. The supervision of catering establishments and premises where food is sold, stored, manufactured or prepared for sale is carried out by all public health inspectors. The district public health inspectors obtain samples of food and drugs for analysis by the Public Analyst, and a detailed report on this work appears on pages 35 to 38. The total number of food premises of all kinds on the register in the Borough is 2,579 and during 1966 they were visited on 4,402 occasions. Details of the various types of food premises will be found in Tables 1 and 2 which follow. Food Hygiene (General) Regulations, 1960 Work in connection with food hygiene continued throughout the year, and occupiers of food premises proved receptive to suggestions made by the inspectors for necessary improvements to their premises. The separate categories of trade carried on in food premises which are subject to these Regulations are shown in Table 1 which also indicates the number of premises which comply with Regulation 16, relating to the provision of washing facilities for food handlers, and Regulation 19 which requires the provision of facilities for washing food and equipment. Table 2 summarises the visits paid to food premises during the year and Table 3 shows the work carried out to comply with statutory requirements. 31 TABLE 1 PREMISES WHERE FOOD IS SOLD, STORED OR PREPARED Number No. fitted to comply with Regn. 16 No. to which Regn. 19 applies No. fitted to comply with Regn. 19 Bakehouses 27 27 27 27 Bakers and confectioners 506 506 382 250 Butchers 175 175 175 175 Chemists 42 42 42 30 Dairies and milk depots 10 10 10 10 Fish friers 65 65 65 65 Fishmongers 38 38 38 38 Food factories 23 23 23 23 Greengrocers 198 198 198 150 Grocers 520 520 520 500 Ice-cream manufacturers 6 6 6 6 Market stalls 164 — — — Off licences 150 150 32 32 Public houses 173 173 173 173 Restaurants, cafes and canteens 482 482 482 460 Total 2,579 2,415 2,173 1,939 TABLE 2 VISITS TO FOOD PREMISES Bakehouses 120 Butchers' shops 323 Confectioners' shops 400 Dairies 19 Fishmongers' shops 81 Fried fish shops 125 Greengrocers' shops 225 Grocers' shops ... 1,051 Ice-cream premises 141 Market stalls ... 633 Restaurant kitchens 975 Other premises 309 4,402 TABLE 3 WORK COMPLETED TO COMPLY WITH STATUTORY REQUIREMENTS Washhand basins provided 7 Sinks provided 10 Provisions of hot water over sink and washhand basin 29 Accommodation for clothing provided 4 Premises repaired or redecorated 38 Dustbins provided 3 W.C. accommodation provided 17 First-aid materials provided 5 32 Food and Drugs Act, 1955 Section 16(1) of this Act provides that no premises shall be used for (a) the sale, or manufacture for the purpose of sale, of ice-cream or the storage of ice-cream intended for sale or (b) the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale, unless they are registered under this section for that purpose with a local authority. During the year 30 applications for registration under the provisions of Section 16(l)(a) and 13 applications for registration under the provisions of Section 16( 1 )(b) were submitted to the Council. In all cases the premises were found to be satisfactory and registration was granted. Milk Supply Milk and Dairies (General) Regulations, 1959 These regulations require local authorities to keep a register of all persons carrying on the trade of distributor in their district and of all premises within their district which are used as dairies, not being dairy farms. During the year 23 applications were received from persons to be registered as distributors of milk. In each case the certificate of registration was granted. Twenty-five notices of cancellation of registration were received. At the end of the year there were 220 persons and two dairies on the register. The bulk of the milk sold by retail within the Borough is sent out in bottles filled in properly constructed dairies and its quality is good. Food and Drugs Act 1955 During the year, 151 samples of milk were submitted for analysis to which reference is made on page 38. A Court Summons was taken out by the Council against a trader for the sale of milk not being of the nature or of the substance or of the quality of the food demanded and a fine of £8 and costs of £3 were awarded by the court. Milk (Special Designation) Regulations, 1963 These regulations provide for the issue of Dealers (Prepacked Milk) Licences under certain designations and the number of licences granted during 1966 is given below : — Special designation Number of licences issued " Pasteurised" 24 " Sterilised" 10 "Untreated" 10 Milk (Special Designation) (Amendment) Regulations, 1965 These regulations provide for the issue of Dealers (Prepacked Milk) Licences under the special desienation " Ultra-Heat Treated" and 53 applications for such licences were received during the year. 33 Brucella Abortus No samples of raw milk were examined for Brucella Abortus during the year. Following the issue on 24th October, 1966, of Ministry of Health Circular 17/66 on the subject of Brucellosis, we were in touch with producing and marketing organizations which sell milk in the Borough and with the Medical Officers of Health of areas where raw milk is produced. Butchers' Shops There are 175 butchers' shops in the Borough. The majority are registered under Section 16 (1) (b) of the Food and Drugs Act, 1955, for the preparation or manufacture of sausages or potted, preserved, pickled or pressed foods. Visits made to these shops during the year numbered 323. Slaughter of Animals There are no licensed slaughterhouses in the Borough. Poultry Processing There is one establishment in the Borough at which the preparation of poultry for sale is carried out on a comparatively large scale. The birds are received from the proprietor's own farms where they have been bred, killed, dressed and de-feathered and at this stage the carcasses are subject to a preliminary inspection. On arrival at the premises in this Borough, the carcasses are eviscerated and dressed, following which a further inspection is made. The majority of these birds go to cafes and hotels and some are for retail sale. Two other smaller traders in the Borough obtain their supply of birds direct from Smithfield Market where a full inspection has already been made. Fish Shops Shops in which fish, either cooked or uncooked, is sold, or where the curing or smoking of fish is carried on, are regularly inspected. There are 103 such shops in the Borough and 206 inspections were made during the year. Catering Establishments All restaurants, cafes, canteens and kitchens were regularly inspected throughout the year. There are 482 such premises on the register, and 975 inspections were made. Food Stalls All street stalls from which food for human consumption is sold are regularly inspected and, where the food sold is stored in the Borough, the storage places are also inspected. There are 164 food stalls in the Borough, and 633 inspections were made during the year. Liquid Egg (Pasteurisation) Regulations, 1963 There are no egg pasteurisation plants in the Borough. 34 Bakehouses There are 27 bakehouses in the Borough and during the year 120 visits by the food inspectors were made to these premises. Eleven of the bakehouses are in basements and, as such, are subject to the provisions of section 70 of the Factories Act, 1961. Certificates of suitability under this Act were granted in all cases. Bacteriological Examination of Food One hundred and sixty-one food samples were examined bacteriologically at the Public Health Laboratory during the year, and details are given below Milk 24 Ice Cream 73 Prawns and lobsters 37 Miscellaneous 27 Total 161 Milk The 24 samples of milk submitted to the turbidity test were reported to be satisfactory. Ice-cream The 73 samples of ice-cream were examined at the Public Health Laboratory by the methylene-blue test. The grading is determined by the length of time taken to decolourize the methylene blue, grade 1 indicating the highest standard bacteriologically. The following table gives a summary of the results: — Grade Number of Samples 1 34 2 13 3 12 4 I4 Total 73 Prawns and lobsters The 37 samples submitted were random samples taken from imported consignments held in cold storage prior to release to the importers. Miscellaneous The 27 miscellaneous food samples proved to be free from pathogenic organisms. Analysis of Food and Drugs During the year 1,000 samples of food and drugs were submitted for analysis: 151 samples of milk, 785 other foodstuffs and 64 drugs. Of these, 63 were submitted as formal samples, while 937 were purchased informally. Seven of the formal samples and 81 of the informal samples were found to be adulterated or below standard, representing 8.8 per cent, of the total samples submitted. Details of these 88 samples are given in the Report on the work of the Public Analyst which follows. 35 REPORT ON THE WORK OF THE PUBLIC ANALYST FOR 1966 The analysis of samples of food and drugs purchased formally and informally under the Food and Drugs Act, 1955 is carried out by the Public Analyst, D. G. Forbes, Esq., B.Sc., F.R.I.C., and during the year 1,000 samples were submitted by the Council's food inspectors. Sixty-three of these samples were taken with the formalities required by the Act and 937 were taken informally. The number of food samples was 936 and the remaining 64 were drugs. The samples submitted for analysis included the following substances : — Beer, Wines and Spirits 13 Beverages (cocoa, coffee, tea, etc.) 20 Cereal preparations 48 Cheese products 45 Confectionery 80 Cream 24 Fats (butter, margarine, etc.) 61 Fish (canned, etc.) 23 Fruit (canned and dried) 20 Ice-cream 20 Meat products (including sausages) 181 Milk 151 Milk products 13 Pickles and condiments (including spices) 125 Preserves 19 Soft drinks 52 Soups 18 Vegetables 23 Drugs 64 SAMPLES FOUND TO BE ADULTERATED OR BELOW STANDARD Case No. Nature of Sample Report Formal 55 Ham and tongue— canned Deficient in meat 65 Milk Deficient in fat 66 Milk Deficient in fat 75 Milk 1.5% deficient in fat 76 Milk Excess acidity—sourness; contained a small fly 83 Ice-cream 18% deficient in non-fatty milk solids 103 Curry powder Excess ash and silica Informal 620* Canned peaches Contained cobwebs, grit, insect fragments, etc. 699 Decolourised tincture of iodine Deficient in iodine 36 Case No. Nature of Sample Report Informal 700 Tincture of iodine Deficient in potassium iodine 714 Blackeye beans Insect infestation 719 Tartare sauce Incipient rancidity 747 Canned strawberries in heavy syrup Deficient in added sugar 762 Tincture of iodine Deficient in iodine 782 Lemon Barley Water Excess saccharin 786 American Cream Soda Excess saccharin 787 Orangeade Excess saccharin 796 Beef sausages Deficient in meat 799 Milk 13% deficient in fat 817 Ice-cream Slightly deficient in non-fatty milk solids 829 Luncheon meat 4% deficient in meat 836 Curry powder High acid-insoluble ash 869* Pork pie Contained burnt pastry plus a small amount of mineral oil 905 Orangeade Slight excess of saccharin 908 Pork sausages Slight excess of preservative 924 Curried chicken and mushrooms Deficient in meat content 941 Milk Excess acidity 954 Meat pie Slightly deficient in meat 965 Orangeade Excess saccharin 975 Strawberry syrup Excess sugar had crystallised in the bottle and the cap had split allowing leakage of syrup 997 Ice-cream 20% deficient in non-fatty milk solids 1032 Steak and kidney pie Contained only 0.4% of kidney 1037 " Black oil " Rancid; unlabelled 1047 Cream oyster cakes " Cream " contained not more than 5% butter fat 1054 Cal Fresh Drink Contains a sodium cyclamate as sweetening agent. This is permitted only in liquid soft drinks, but Cal Fresh is a powder 1059 Turkey with sweet corn Deficient in meat content 1065 Steak and kidney pie Deficient in meat 1091 Best of the milk 4.5% deficient in fat 1099 Turkey with sweet corn Deficient in meat 1102 Ice-cream mix Labelling—not labelled" contains vegetable oil " 1106 Fruit cocktail in heavy syrup— canned Ingredients not listed in correct order 1107 Jelly creams Misleading name 1126 Kelp powder Minerals claimed but quantities not declared 1132 Steak and kidney pie Deficient in kidney 1139 Gateau Labelling—no common name— couverture not genuine ice cream 1140 Sorbet (water ice) No common or usual name 1142 Yoghurt—real fruit Deficient in fruit 1149 Steak and kidney pie (canned) Deficient in kidney 37 Case No. Nature of Sample Report Informal 1150 Prawn curry and rice Deficient in prawns 1157* Sliced bread Contained a geometrid moth 1158 Yoghurt—real fruit Deficient in fruit 1159 Yoghurt—real fruit Deficient in fruit 1172 Minced beef loaf Deficient in meat 1205 Fish paste (anchovy) Labelling inadequate 1210 Steak casserole Deficient in meat 1211 Malt drink powder Labelling—energy claim disputed 1237 Minced beef loaf Deficient in meat 1254 Egg and chicken delight Deficient in meat 1275 Real cream cake Fat contained only about 40% butter fat 1287 Friars Balsam High total solids 1291 Breakfast vitamins Deficient in vitamin C 1293 (Elixir of ) Oil of Peppermint Incorrectly labelled 1305 Steak and kidney pudding Deficient in kidney 1308 Steak and kidney pie Deficient in kidney 1312 Steak and kidney pudding Deficient in kidney 1313 Steak and kidney pie Deficient in kidney 1317 Curry powder Excess ash and silica 1329 Malt Drink Powder (Milo) Labelling " Energy " claim not justified 1330 Cheese spread Deficient in fat 1336 Mint sauce Labelling: Labelled " Garden Mint " 1372 Egg and chicken delight Deficient in meat 1390 Steak and kidney pudding Deficient in kidney 1392' Bread : foreign matter Foreign matter in sample was mould 1394* Steak and kidney pie —foreign matter Piece of cowhide with hair attached 1398 Steak and kidney pie Deficient in kidney 1399 Steak and kidney pie Deficient in kidney 1402 Steak and kidney pie Deficient in kidney 1403 Steak and kidney pie Deficient in kidney 1404 Steak and kidney pudding Deficient in kidney 1409 Steak and kidney pudding Deficient in kidney 1423 Sauce, prepared Labelling—" Oil " quoted instead of edible oil. Peeled tomatoes quoted but tomato peel found 1441 Chicken supreme Deficient in meat 1453* Rice: Unpleasant odour and flavour Customer had been sold West Indian par-boiled rice by mistake 1455 Dripping Excess fatty acids 1458 Buttered rolls Contained fat other than butter fat 1484 Milk Deficient in fat 1489 Ham and beef roll Deficient in meat 1538 Christmas pudding Deficient in fruit 38 The six samples shown above which are marked with an asterisk (*) were complaint samples submitted by members of the public and in each case the complaint was considered justified and appropriate action was taken. A further eleven complaint samples were submitted but, following analysis, it was considered that the complaints were not justified. Details of these cases are given below: — Case No. Nature of Sample Subject of complaint 619 Apples Unpleasant odour and taste 721 Sugar Foreign matter 741 Leg of rabbit Chemical odour on cooking 761 Poppy seeds White foreign matter 868 Veal and ham pie Rancid taste 1098 Sliced bread Black marks 1138 Corned Beef Foreign body 1248 Bread Mould 1340 Ruffle Bun Infestation 1393 Potatoes, boiled Part of caf£ meal alleged to taste like soap powder 1395 Butter Alleged rancidity Milk Samples The minimum legal standards relating to the composition of milk are as follows: — Channel Islands Ordinary and South Devon milk milk Milk fat 3.0% 4.0% Non-fatty solids 8.5% 8.5% Total milk solids 11.5% 12.5% During the year, 151 samples of milk were submitted for analysis (129 ordinary milk and 22 Channel Islands or South Devon milk). Of these, seven samples of ordinary milk were found to be below the minimum standard and appropriate action was taken. 39 FACTORIES ACT, 1961 Under Section 153 (1) of the Factories Act, 1961, the Medical Officer of Health of the Council of any Borough or County District is required in his Annual Report to the Council to report upon and furnish prescribed particulars of matters under Part 1 and Part VIII of the Act which are administered by the Council. These particulars are given below in the form required by the Minister of Health:— Factories Act (Part I) (1) INSPECTIONS Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 155 13 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,116 209 6 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 69 7 - - Total 1,340 229 6 — (2) DEFECTS Number of cases in which defects were found Particulars Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 1 1 — - - Sanitary Conveniences: (a) insufficient 1 1 - 1 - (b) unsuitable or defective 20 18 - 14 - (c) not separateforsexes - - - . Other offences against the Act (not including offences relating to outwork) 2 2 1 1 - Total 24 22 1 16 — 40 Factories Act (Part VIII) OUTWORK (SECTIONS 133 AND 134) Nature of Work Section 133 Section 134 No. of outworkers in August list required by Section 133(1X0 No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel— making, etc 113 - - - - - Household linen 1 - - - - - Curtains and furniture hangings 4 - - - - - Artificial flowers 8 - - - - - Paper bags 4 - - - - - The making of boxes or other receptacles or parts thereof made wholly or partially of paper 2 - - - - - Cosaques, Christmas crackers, etc. 1 - - - - - Lampshades 4 - - - - - Total 137 - - - - - 41 ATMOSPHERIC POLLUTION CLEAN AIR ACT, 1956 Smoke Control Areas During the year the Metropolitan Borough of Wandsworth (No. 7) Smoke Control Order came into operation and the London Borough of Wandsworth (No. 1) Smoke Control Order was made and confirmed. The latter is the first Order in our revised smoke control programme by which it is proposed that the whole of the Borough will become a smokeless zone by 1970. The survey of the area covered by the proposed London Borough of Wandsworth (No. 2) Smoke Control Order was nearing completion at the end of the year and the Order is likely to be made during the early part of 1967. A map showing the existing and proposed smoke control areas will be found facing page 42. Smoke, etc., Nuisances and Observations During the year, 38 complaints were made alleging nuisances from smoke, dust, grit, etc., emitted from premises in the Borough. All these complaints received careful and sometimes prolonged investigation. In addition to dealing with specific complaints, observations are kept upon the chimneys of industrial plant in the Borough and appropriate action is taken when necessary. During the year 146 such observations were made. Installation of Furnaces Notification is required under Section 3 of the Clean Air Act, 1956, of any proposal to instal a furnace with a heating capacity of 55,000 or more British thermal units per hour. This Section, which does not apply to furnaces designed solely or mainly for use for domestic purposes, is designed to ensure that any new furnaces installed shall be, so far as is practicable, capable of being operated continuously without emitting smoke. Six such notifications were received during the year. Chimney Heights A Circular and Memorandum from the Minister of Housing and Local Government places a duty on local authorities to satisfy themselves that new chimneys, to which Section 10 of the Clean Air Act applies, will be high enough to prevent, so far as practicable. smoke, grit, dust or gases emitted from the chimneys from becoming prejudicial to health or a nuisance. Guidance is given on the calculation of chimney heights, based on the amount of 42 flue gases which the chimney is expected to emit as a function of the maximum rate of emission of sulphur dioxide. This is not applicable to all chimneys and affects only:— (a) chimneys of industrial boiler plant of maximum continuous rating greater than approximately 650 lb. steam/hr. and not exceeding 450,000 lb. steam/hr. or (b) to chimneys serving furnaces burning fuel at a maximum rate greater than approximately 100 lb./hr. of coal or 50 lb./hr. of oil, and not exceeding 50,000 lb./hr. of coal or 30,000 lb./hr. of oil. The method of calculation advised by the Minister is to be regarded more as a guide rather than a mathematically precise way of reaching a final decision on chimney height and is open to modification in the light of particular local circumstances. Discussions have taken place in the past with other local authorities in an endeavour to arrive at an acceptable standard for the inner London areas. Measurement of Atmospheric Pollution Daily readings of the concentration of smoke and sulphur dioxide (S02) in the atmosphere were continued during the year at the four stations throughout the Borough where recording apparatus has been installed. A record of these readings for the year under review is given in Table 1 and details of smoke and S02 concentration during the year is shown in Table 2. The readings are taken by members of the staff of the Department who pass the information to the Department of Scientific and Industrial Research for collation with data received from authorities all over the country. TABLE 1 Station Roof— Municipal Buildings 207 Lavender Hill Battersea Tooting Library Queen Mary's Hospital Roehampton Month—1966 Smoke SOs Smoke SO, Smoke SOs Smoke So2 January 131 421 161 316 190 280 70 110 February 162 390 153 321 172 265 no 161 March 261 311 136 230 141 201 82 190 April 108 360 109 261 91 241 51 136 May 70 210 65 136 63 131 43 90 June 64 236 54 94 51 101 39 72 July 59 193 45 80 42 53 36 66 August 71 139 40 62 41 80 54 64 September 76 220 131 130 70 222 60 107 October 190 368 162 272 136 260 129 169 November 207 321 210 309 201 276 183 231 December 221 270 218 320 214 289 165 201 Average 135 286 123 211 118 199 85 133 TABLE 2 ATMOSPHERIC POLLUTION COMPARISON OF SMOKE AND SO, CONCENTRATION 1965 and 1966 43 44 MISCELLANEOUS MATTERS Swimming Baths In Wandsworth there are four public baths and one open-air swimming pool belonging to the Corporation, one open-air swimming pool owned by the Greater London Council and one privately owned open-air swimming pool, to which the public may be admitted. The source of water for two of the Corporation's baths is from deep wells and, for the other baths mentioned above, from the mains supply of the Metropolitan Water Board. At all of these baths the water is chlorinated and circulates continuously through a filtration plant. Samples of water are taken at regular intervals and submitted for bacteriological examination at the Public Health Laboratory at County Hall. During the course of the year 135 samples were submitted for examination and satisfactory results were obtained in 131 instances. In the remaining samples there were slight deviations from normal, but subsequent tests proved satisfactory in all cases. Five chemical examinations of swimming bath water were also made by the Public Analyst with satisfactory results. In addition to the above-mentioned baths, three Corporation Children's Homes, one of which is situated outside the borough, have open-air pools and a number of Greater London Council schools in the area have indoor swimming baths. Twenty-seven reports were received from the Scientific Department of the Greater London Council in respect of eight of these baths. All were satisfactory. Examination of Water from Artesian Wells and Taps Twenty-nine samples were submitted for examination at the Public Health Laboratory, all of which proved satisfactory. One chemical examination of domestic water supply was made by the Public Analyst and this also was satisfactory. Disinfection and Disinfestation Methods of Disinfection: Following the notification of a case of infectious disease requiring disinfection, an inspection is made and the following methods used. The patient's room is sprayed with a formaldehyde solution. The doors and windows are closed and the room can be used again after five or six hours. Advice is also given to the occupiers that a thorough "spring cleaning" of the room is a very elfective "disinfection" process, and should be carried out in addition to the work of disinfection by the Council's staff. Bedding and clothing are collected and steam-treated at the Disinfecting Stations. Sheets, pillow cases and hand towels are exposed to formalin vapour in a special chamber prior to being washed in the Council's laundry. 45 Books and other articles which cannot be steam disinfected are also treated by exposure to a formalin vapour. Disinfestation of Verminous Rooms: Articles in the room requiring treatment are removed for steam disinfestation. The room is sprayed with an insecticide containing Pybuthrin and Lindane/ D.D.T., which has a prolonged residual effect. Where there is heavy infestation, architraves and mouldings are required to be eased for deeper penetration of the insecticide. Control of Insect Pests: The construction of large blocks of flats containing covered ducts taking hot water, plumbing and drainage pipes has raised a problem of insect infestation. These ducts form an ideal harbourage for insects which would be difficult to deal with by normal hand spraying. A Microsol Mist Generator is therefore used for the purpose and this apparatus, which has a small motor unit, is capable of spraying a fine mist or fog of insecticide to a distance of 50 feet, the mist settling on to the surfaces of the duct and the piping contained therein. Personal Cleansing Station During the year, 366 treatments were given at the Council's personal cleansing station at Sheepcote Lane to persons suffering from scabies—199 to adults, 126 to schoolchildren, and 41 to children under school age. In addition 50 adults, 252 schoolchildren, and 57 children under school age were treated for verminous conditions. The arrangement made in 1965 with the London Borough of Lambeth for those of their residents who require treatment to attend the Wandsworth Personal Cleansing Station continued to operate satisfactorily. During the year 47 treatments were given. Laundry Service for Incontinent Persons During the year approximately 4,000 bags, each containing about 10 lb. of soiled linen were collected, and the contents laundered and returned to the owners. This valuable service continues to be in great demand by old and infirm persons. Disinfection and Laundry Services—Rationalisation Since the formation of the London Borough of Wandsworth on 1st April, 1965, it has become apparent that the services provided at the Council's existing disinfecting stations at Tooting and Battersea could well be concentrated in one building. Facilities exist at both stations for general disinfecting work and the laundering of linen from incontinent old people. At Battersea however there is also a personal cleansing station adjacent to the main building offering facilities for the personal cleansing of adults and children suffering from skin conditions, e.g. scabies and infestation. At Tooting, the hot water and steam services are derived from boilers which have been in use for over 60 years whereas at 46 Battersea these services are provided from the boiler plant in the adjacent baths establishment which also serves the needs of the personal cleansing station and the adjacent County Court and Mortuary. So far as disinfection is concerned, the demand for this service has shown a steady decline over the years and the equipment at Battersea can cope adequately with the present need. After full consideration of all the relevant factors it was decided that the Battersea station would be the more suitable in which to concentrate these services and to close the station at Tooting. There is an increasing demand for special laundry services and it will be necessary to supplement the equipment at Battersea to meet present needs and this can be done by the transfer of the Tooting station equipment to Battersea. Coroner's Court and Mortuary Details as to the number of inquests held at the Coroner's Court, and bodies received into the Mortuary, during 1966, are set out in the following table:— Details of Bodies Received Usual Place of Residence Total Wandsworth Else where Residence unknown Post-mortem only 615 369 11 995 Post-mortem and inquest 112 83 2 197 Total post-mortems 727 452 13 1,192 Inquest only 2 3 1 6 Total inquests 114 86 3 203 Sanitary and other reasons — — 1 1 Total bodies received 729 455 15 1,199 Verdicts at Inquests held Accidental and Misadventure 61 46 1 108 Alcoholism 3 — — 3 Natural causes — — 1 1 Industrial disease 1 1 2 Open verdict 2 5 1 8 Suicide 45 33 — 78 Homicide 1 1 Referred to higher court 1 1 — 2 TOTAL 114 86 3 203 In addition to the above, a further 114 inquests were held at the Coroner's Court in respect of which no bodies were received into the Mortuary. 47 As stated in last year's report, an agreed payment is made to the Corporation by the London Borough of Merton in respect of the use of the mortuary for the reception of bodies of dead persons from Merton. Crematorium Regulations, 1930 Under these regulations, 1,756 cremations were authorized during the year. STAFF TRAINING Public Health Inspectors The Council provides facilities for Public Health Inspectors to undertake refresher courses and to attend conferences and short courses which are relevant to their work. During 1966, one Inspector attended a week-end refresher course organised by the Association of Public Health Inspectors and another Inspector attended a part-time course extending over six weekly afternoon sessions at Kingston College of Technology on the subject of noise abatement. Student Public Health Inspectors The recruitment and retention of student public health inspectors is a matter of particular concern, especially in view of the serious shortage of qualified inspectors. The Public Health Inspectors Education Board at present limits the number of students who may undertake training with a local authority to an approximate ratio of 1 to 3 to the number of qualified inspectors employed. The number of students who may train within the Department is therefore at present limited to six and all these posts are filled. In view of the Council's concern at the need for more student public health inspectors to be trained, representations were made to the Greater London Whitley Council stressing the need and the difficulties in achieving this with the existing quota restrictions. The Greater London Employers endorsed the Council's observations and have sent a letter to constituent authorities asking them to play their full part in the training field, since it was apparent that if all London Boroughs were to take up their full quota of students it would be possible to undertake training of a further 50 students. Students attend day release courses at South-East London Dav College and their training includes a full programme of visits and practical training with a qualified inspector. During the year. one student successfully completed his training and is now employed as a qualified inspector and a further student was appointed to undertake training. 48 PART 4 PERSONAL HEALTH SERVICES The Personal Health Services are those services provided by the Council, as the local health authority, under the sections of the National Health Service Acts directed to safeguarding the health of the individual and if, in spite of our efforts, any ill-health supervenes, of ameliorating its consequences in both the individual and the family of which he is a member. Proper care during pregnancy and the early years of life is vital to the healthy and full development of the child and the individual and a large part of this service is concentrated on expectant and nursing mothers and young children. Although this service is less important than it was in days gone by, and it may be said that the family and the family group, comprising all ages, is now more the unit of health than any one individual or age group, it is convenient to divide descriptively the parts of the services into those directed to improving the health and well-being of mothers and young children and those other health services directed not exclusively to mothers and young children. To some extent these two categories overlap and many services described under " other personal health services " are available to mothers and young children. SERVICES FOR MOTHERS AND YOUNG CHILDREN The main features of the Council's services for the care of mothers and young children are described in the following sections. The aim is to safeguard the health of the expectant mother because on her health depends, in large measure, the well-being of her baby, and to safeguard and supervise the health of the baby during infancy and early childhood. Particular attention is paid to the diagnosis of abnormalities in the early months and years of life and the work connected with maintaining the Handicap and Observation Register, described later in this report, now forms a very important section of the work of the department. Maternity and Child Welfare Centres The large attendance at all our centres indicates that these centres fulfil a social need which is probably as valuable as the need for medical or ancillary advice. Families are now frequently isolated from relatives and the friendly informal atmosphere of the child welfare centre is obviously fulfilling a deep felt need for social support. In most centres there are classes and discussion groups on many topics of interest to parents and some of them take the form of mothers clubs. Three centres offer an occasional evening to fathers and these are well attended. There are also creches where children may play while the mother attends these classes. 49 In some parts of the Borough there is a large immigrant population and at times there are language difficulties but it is usually possible to find an interpreter. This may necessitate an evening visit when father is at home but quite often a school child can help overcome this difficulty. The Children's Department notify the Health Department of all children placed with foster mothers who are encouraged to make use of the Child Welfare Services. Ante-natal and post-natal care The number of attendances at ante-natal clinics has fallen as the number of home confinements has declined and most mothers attend their own general practitioners for post-natal examinations. In consequence, it has been possible to discontinue using some rather unsuitable premises and concentrate the work in more appropriate centres. Midwives attend sessions in two doctors' surgeries and one general practitioner attends a session in one of the Council's clinics. Some hospital maternity units recommend suitable patients to attend relaxation classes at our clinics and close liaison is maintained with all the maternity units serving the area. Sessions held during the year 653 First attendances of mothers 2,666 Total attendances of mothers 6,954 Mothercraft and relaxation classes Relaxation classes and talks and discussion groups on pregnancy and allied subjects are held for expectant mothers in several centres. and one or two evening sessions are held to which fathers are invited. These activities, together with the showing of films covering every aspect of maternity and child care, are always greatly appreciated and are becoming an increasingly important part of the work of the clinics. Sessions held during the year 248 Total attendances 1,839 Average attendance at each session 7.4 Infant welfare clinics Infant welfare clinics have continued to attract very large attendances. In addition to health supervision, immunization and advice on health and allied matters available at these sessions, the opportunity for mothers of young children to meet together is an important factor. This is especially evident on new housing estates when young mothers may be rather lonely and at some distance from the help and support of relatives. Tnfant welfare sessions held during the year 1,730 First attendances of children under five years 15,063 Total attendances of children under five years 80,348 Average attendance at each session 46.5 50 Toddlers' Clinics Special clinics for toddlers (children aged from two to four years) are held at 12 welfare centres. The children are given routine medical examinations and if necessary are referred for treatment. Toddlers' sessions held during the year 261 Total attendances of toddlers 3,305 Average attendance at each session 12.7 Dental services A dental service for expectant and nursing mothers and children is provided in conjunction with the school dental service at certain of the Council's dental surgeries. During the year there were 120 attendances by mothers and 400 by children under five years of age. Family Planning The Council has made arrangements for advice on methods of contraception to be given to married women where pregnancy would be dangerous or detrimental to health. Sessions are organized by the Family Planning Association who are provided with rent-free accommodation at some of the Council's welfare centres. No charge is made except for appliances supplied to the patient. During the year 300 such sessions were held. Towards the end of the year the Family Planning Association introduced an experimental scheme to provide a domiciliary service for mothers who needed contraceptive advice but were unwilling or unable to visit a clinic and it seems probable that it will prove a valuable addition to the service provided in Wandsworth. Co-operation with the Family Planning Association is effective at all levels and the harmonious relationships between the staffs of the Association and the Council ensure that any local difficulties are easily overcome. Health Visiting Service Home visiting is the basic essential of the health visitors duties. Nearly every mother is visited about fourteen days after the birth of her baby. Further visiting is discretional and depends on the needs of the mothers a very large number of whom attend clinics run either by general practitioners or by ourselves. Children who are on the " Handicap and Observation Register" are followed up as often as necessary. Every effort is made to encourage parents to have their children fully immunized and a phenylketonuria test is carried out for nearly every child. Frequent visiting and continuing support is needed for a certain number of families, and immigrant families may need special help in settling into a new environment. The supervision of childminders is becoming an increasingly important part of a health 51 visitor's work. Health visiting however includes the whole family and frequent requests are received from general practitioners and hospitals for visits to patients discharged from hospital or to assess the needs of an elderly person. Many of these people may need other community services and the health visitor works closely with all Borough and voluntary services. The number of first visits made during the year to children under five years of age were :— Children born in 1966 6,301 Children born in 1965 6,656 Children born in 1961/64 12,542 Visits of all kinds paid by health visitors during the year totalled :— Effective visits 59,626 Unsuccessful visits 12,976 Domiciliary Midwifery Service The number of women having home confinements has continued to decline. All expectant mothers needing hospital confinement on medical or social grounds can be accommodated and even those preferring hospital confinement can now be booked by one of the local maternity units. A high standard of domiciliary midwifery has been maintained and all patients are booked with a doctor. The emergency call service operated in conjunction with the London Boroughs of Lambeth and Southwark has worked very well throughout the year, the three boroughs sharing a rota so that a supervisor of midwives is always available in an emergency. One midwife resigned in June, 1966 and has not been replaced as the volume of work did not justify an appointment being made. All the midwives are now undertaking the nursing care of a proportion of the mothers booked under the early discharge scheme which is referred to later in this report. Mothers attended in their own homes during the year were as follows:— Home confinements 927 Booked early discharges 374 Unbooked early discharges 115 Maternity Beds The shortage of maternity beds in parts of the London area and their uneven distribution has been a source of anxiety for many years and medical officers and general practitioners have continued to exercise great care in the selection of cases for hospital confinement. 52 The position has greatly improved as a result of a scheme introduced in 1963 which set up "catchment areas" for the main maternity hospitals. Expectant mothers are booked for admission to certain hospitals which have agreed to accept cases from the mother's area of residence. This scheme has led to a greater flexibility and has gone a considerable way towards avoiding the highly unsatisfactory situation that formerly sometimes arose when it was not possible to book a bed for an expectant mother and reliance had to be made on emergency procedure for admission. There is little doubt that this scheme has proved its worth and alleviated a good deal of anxiety and worry on the part not only of the expectant mothers themselves but also of their attendants. The Maternity Liaison Committees represent all local interests in co-ordinating administrative and executive action and provide a valuable link between the three arms of the health service, namely, hospital, general practitioner and local health authority, where common problems and difficulties can be discussed. Early Discharge of Maternity Patients In suitable cases mothers are booked for hospital confinement but, with the agreement of the doctor and the midwife, on the basis of their being discharged 48 hours after delivery. This scheme is very popular with the mothers and with co-operation of the hospitals concerned works extremely well. Unfortunately, the planned discharges sometimes have a slightly upsetting effect on the other mothers in the ward, some of whom occasionally take their own discharge against medical advice. These mothers are, of course, given all necessary medical and nursing care but it is not a happy situation. If the number of booked early discharge cases increases, the possibility of having separate wards for them may have to be considered. Premature Infants Any child weighing lb. or less at birth is regarded as premature, and great care is taken to ensure that adequate help and advice are available for mothers with premature babies. advice are available for mothers with premature babies. The numbers of premature births during the year were as follows:— (a) Born in hospital 479 (b) Born in hospital and died within 28 days of birth 8 (c) Born at home or in a nursing home 21 (d) Premature stillbirths in hospital 49 (e) Premature stillbirths at home or in a nursing home 4 Handicap and Observation Register The Health Department maintains a combined Handicap and Observation Register of children under five years of age at risk of 53 developing physical or mental defects and of those deemed handicapped. The register is designed to arrange for the supervision of those specially liable infants where an abnormal pregnancy, delivery or puerperium has been noted or when deviation from the normal is observed. The register enables therapeutic or remedial measures to be applied, thus preventing or modifying gross defects. The initial information about the children is obtained from birth notifications, Paediatric Departments of hospitals, general practitioners, midwives, health visitors and clinic doctors. The completeness of the register has been achieved only through the co-operation of all concerned. When a handicap is confirmed closer liaison is established with all those concerned with the child's future, i.e. the hospital specialists, education officers, head teachers of ordinary or special schools, or superintendents of hospital schools. There is also a continuous exchange of information with the Children's Officer about those children in care who are physically or mentally handicapped. The health visitors, who are trained to recognize the social and medical symptoms of deprivation and distress, advise about children who are under stress and request that they be placed on the Observation Register. The Children's Department is contacted whenever it is felt that the child should be received into care. The Children's Department is also notified whenever a child in care is placed on the Handicap and Observation Register. Whenever necessary advice is given to child care officers on the most appropriate placing for physically or mentally handicapped children. There is exchange of information with the Welfare Department about those who have been ascertained as blind or partially sighted so that arrangements can be made for suitable placing in Sunshine Homes when required. Every handicapped or potentially handicapped child is individually assessed before the age of five years when a decision is reached with regard to its future education and those concerned in this care, i.e. paediatricians, psychiatrists, surgeons, education officers, etc., are often asked for advice before a placement at school or in a training centre is offered. There is close co-operation with the Inner London Education Authority's Medical Adviser and his psychological medicine team. The following tables give some statistical information about this work including details of the number of children on the handicap and observation register in relation to the child population under 5 years of age. It will be noticed that, whereas the majority of those put on the register in the first year of life are being kept under observation, about two-thirds of the children in the 3-4 years age group who are still on the Register have been assessed as handicapped. 54 TABLE 1 NUMBER OF CHILDREN ON THE REGISTER (a) Number of children under five years of age 32,550 (b) Number on Register on 1.1.66 2,091 (c) Number placed on Register during 1966 1,605 (d) Number taken off Register during 1966 1,852 (e) Number on Register on 31.12.66 1,844 TABLE 2 MALFORMATIONS DETECTED IN THE PERINATAL PERIOD Number Incidence per 1,000 notified live and still births 1. Spina bifida and hyrocephalus 19 2.9 2. Anencephalus 7 1.1 3. Other central nervous system 4 0.6 4. Cardivascular 15 2.3 5. Renal tract 4 0.6 6. Genital system 8 1.2 7. Alimentary 2 0.3 8. Exomphalos 4 0.6 9. Skeletal 8 1.2 10. Face and mouth 14 2.2 11. Respiratory tract 1 0.2 12. Limb abnormalities 52 8.1 13. Cystic fibrositis of pancreas 2 0.3 14. Mongolism 6 0.9 15. Other chromosomal and genetic defects 6 0.9 16. Other abnormalities 1 0.2 Single malformations 139 21.0 Multiple malformations 14 2.2 TABLE 3 NUMBER OF CHILDREN ON THE REGISTER ON 31.12.66 EXPRESSED AS A PROPORTION OF EACH AGE GROUP Year of birth Number of live births On the Register for handicap observation Total number %of live births Total number %of live births 1966 6,460 47 0.73 706 10.9 1965 6.490 50 0.8 590 9.1 1964 6,636 48 0.7 248 3.7 1963 6,605 49 0.7 40 0.6 1962 6,359 54 0.8 12 0.2 55 TABLE 4 NUMBER OF CHILDREN REVIEWED DURING THE YEAR EXPRESSED AS AS A PROPORTION OF EACH AGE GROUP Year of birth Number of live births Number on the Register at some time during 1966 % of live births 1966 6,460 1,336 20 1965 6,490 1,641 25 1964 6,636 446 6½ 1963 6,605 141 2 1962 6,359 132 2 (Note—As the London Borough of Wandsworth did not come into existence until 1st April, 1965, figures relating to births in the area of the new Borough are estimated before 1966.) Unmarried Mothers Unmarried mothers need all the maternity and child welfare services available to married women and in addition many of them need a great deal of special help and continuous sympathetic support. In addition unmarried mothers seeking the help of the health visitors are, where appropriate, given the address of a Moral Welfare Worker from whom they may seek advice if they so desire. In many cases the Moral Welfare Worker and health visitor work together to ensure that an unmarried mother who wishes to remain at home and keep her baby shall receive as much help as possible. Many women in this position of course prefer to remain quite independent and make their own arrangements through the normal maternity and child welfare services of the Borough. The Southwark Diocesan Moral Welfare Association has now rearranged its area boundaries so that the local area coincides with the area of the Borough of Wandsworth and the three staff work from a local office, an arrangement which has made co-operation with the Borough field staff much easier. The three mother and baby homes in the area are registered as nursing homes and inspected regularly by medical officers and public health inspectors. The health visitor for the area visits each home regularly and follows up the mothers and babies on discharge. Cervical Cytology I have already made a general comment on cervical cytology in my introduction to this Report which appears on page 6 and details of the developments in this service over the past year are given in the ensuing paragraphs. 56 Whilst efforts have continued to be made to expand the service in Wandsworth to help in the diagnosis of cancer of the womb, the limiting factor in any large-scale expansion is the shortage of hospital pathologists and trained technicians experienced in the screening methods. For this reason screening tests were continued during the first half of the year only, on a limited basis. In July, 1966, Dr. Anna Frenkiel joined our staff as Senior Medical Officer and, among other duties, took over responsibility for this service. Subsequently, we were able to secure the co-operation of additional hospitals which made it possible to open two new clinics, one at Balham Welfare Centre and one at William Harvey Centre at Roehampton. At the end of the year we were able to provide for up to 160 smears a month to be taken. The service is now available to all women over 25 years of age, irrespective of parity, either on individual application for appointment or when referred by their family doctors. The clinic medical officer takes a short general and gynaecological history for each patient, followed by a pelvic examination when cervical and vacinal smears are taken; when indicated, the breasts are also examined. The clinics are conducted by medical officers with special experience in gynaecology and in every case the family doctor receives a full clinical and gynaecological report. Where the result of the test is positive, the practitioner concerned is telephoned so that no delay in arrangements for treatment ensues. Women attending for screening are notified of the result directly in all negative cases, but whenever a clinical condition warranting treatment is found to exist they are advised to see their family doctors. Some doctors in the area who have a particular interest in this work have expressed a desire to examine their own patients, but the majority have readily agreed that their patients should avail themselves of our clinic services. In addition to the service offered to the patient, each clinic is open to those general practitioners who wish to learn the technique of cervical cytology and a number of doctors have visited our clinics to see the equipment and the techniques used. During the year, 142 sessions were held in Council Clinics and 1.104 examinations were carried out. Detailed statistical information has been prepared relating to the work achieved during the second half of 1966 which shows the results of over 800 examinations which were carried out during the period, and this is set out in the following table:— Number of clinics held weekly 4 Total number of women examined 839 Average number of women examined per session 8 Total number of cases cytologically and clinically negative 492 Total number of cases with morbid conditions 347 57 Number of cases with morbid conditions needing specialist care 222 comprising:— (i) positive malignant smears 6 (ii) cervical erosion 110 (iii) cervical polyp 21 (iv) ovarian cyst and fibroids 20 (v) all degrees of prolapse 17 (vi) vulvo-vaginitis and cervicitis 30 (vii) other conditions 18 Number of cases with morbid conditions in need of general practitioner care 125 comprising:— (i) non-specific vaginitis 45 (ii) other conditions 80 The high proportion of abnormalities detected justifies the clinical procedures adopted, and the existence of the clinic. There must be a close link between the pathologist, gynaecologist, clinic doctor and general practitioner because it is imperative for women showing abnormal smears to have further investigations and/or treatment, and whenever this is not carried out in the hospital where the smear was diagnosed the patient is followed-up and the pathologist concerned is notified. The need for this service is emphasized by the results obtained. Six cases of malignancy have been detected in the pre-symptomatic stage, i.e. when treatment can assure 100% cure ; in addition, two cases of malignancy were ultimately discovered on further hospital investigation suggested by the clinic doctor after the examination. Many other conditions requiring specialist treatment or general practitioner's attention were discovered, usually in women with minimal symptoms. The relief from anxiety afforded to all our asymptomatic cases has also proved of immense value. Special acknowledgment is due to Dr. Elizabeth R. Hicks of the South London Hospital for Women (reporting on 120 smears per month) and Dr. G. T. Allen of St. James' Hospital (reporting on 40 cases per month). Without their co-operation the service would not be possible. There are prospects of further development of this service and at the time of writing (June, 1967) two additional clinics have been opened, one in Fairfield Centre and one at Stormont Road Centre. This will allow screening of approximately 2,200 women annually. It is hoped that action now being taken by the Ministry of Health and the Regional Hospital Board will result in increased laboratory facilities being made available. 58 In October a film about cytology technique and method was shown to medical and nursing staff of the Council and to all general practitioners who wished to attend. Dr. Hicks kindly attended and answered questions on the subject. Day Nurseries Throughout the year there has been a steady demand for places and admission has had to be limited to children of mothers who are without the support of a husband, parents where the mother is unable to care for the child because of ill-health, and parents whose living conditions are likely to affect the health of the child unfavourably, and widowed or deserted fathers. It has been possible to admit a number of children for short periods during a domestic emergency. Every consideration is given to special applications but it is possible only to admit cases of urgent need. There have been outbreaks of infectious diseases from time to time but most of the children are very healthy and normally have only mild attacks of these illnesses. These infectious diseases have a considerable nuisance effect as they cause delay in the admission of new children to the nurseries. Deaf Children in Day Nurseries Children under five years of age likely to benefit from beins in a "hearing" environment may be admitted for part-time attendance at day nurseries, a charge being made for any refreshments provided but none for the attendance. They may have a hearing defect themselves, or may have deaf parents and be suffering from retarded speech owing to the lack of being in a hearing environment. The admissions are normally limited to children under three years of age. as children over that age are generally treated through the education service and would be taken into day nurseries only for some special reason and with the prior consent of the consultant otologist. Most of the children attend ud to three hours a day, but a child occasionally stays for a whole day provided that his weekly attendance does not exceed 15 hours. During the year there were nine such children in the Council's nurseries, seven of these being still in attendance at the end of the year. Private day nurseries and child-minders At the end of 1966 there were 35 private day nurseries with registered places for 780 children, 30 statutorily registered childminders with places for 197 children, and 12 voluntarily registered child-minders with places for 24 children. All three categories of minders are regularly visited by the Council's medical staff and health visitors, and advice is given on child care, immunization, general health supervision and the training of young children. 59 Occasional creches These creches are provided for the children of mothers who are attending a clinic or class on the premises and also give occasional relief to mothers who for various reasons, such as visits to hospitals, shopping, laundering and other domestic duties, wish to be relieved of their young children for two or three hours during the day. In addition, they provide an opportunity for an only child to mix with other children of similar age. During the year 447 creche sessions were held in the centres and attendances numbered 8,004. Adoption and boarding-out Medical advice is sought by the Children's Officer whenever a child in care is being considered for adoption or boarding-out. The number of cases dealt with during the year, and the decisions reached, were as follows:— Adoption cases: Suitable for adoption 23 Suitable for adoption subject to certain conditions 1 Boarding-out cases: Suitable for boarding-out 4 Suitable for boarding-out subject to certain conditions — Total 28 In addition, medical advice was sought in respect of 34 prospective adopters. Health Surveys From time to time surveys are carried out by "outside" organizations on some aspect of health or on the growth and development of children and the Health Department is asked to assist. These surveys usually mean a great deal of extra work for the staff and they may be very time-consuming but it is felt that wherever possible we must give all the help we can in the hope that the mass of detailed information provided will contribute to the success of the research or survey and thus add to our knowledge of health problems. Details of some of the surveys in which the department has participated during the year are given below:— National Survey of Health and Development This study was started in 1946, when every woman who bore a child in the first week of March of that year was interviewed as part of a survey of the economic and social aspects of childbearing. Five thousand of these babies have been followed up from birth with the aid of school nurses, health visitors, teachers. 60 school doctors, youth employment officers and staff at technical colleges. The mothers themselves have not been approached since 1961 and it is felt that the young people are now old enough to co-operate directly in the attempts which are being made to keep the records of their health, hospital admissions and accidents upto-date. In fact, if the information is to be accurate it is very desirable that it be obtained from the young people themselves. The study is being organised by the Medical Research Unit of the London School of Economics, who have asked Medical Officers of Health to arrange for short annual visits to be made to the young people themselves to collect this information together with a few facts about employment. A number of visits were made during the year to young people living in Wandsworth who have been concerned in this survey. National Child Development Study In 1958 a survey of virtually every baby born from the 3rd to 9th March, 1958, was carried out with the co-operation of all the mothers as well as many doctors and midwives throughout the country. As a result of this study a great deal was learned about the children's growth, health and education. For this reason, it was decided to follow-up the children (some 16,000 in all, about 90 of whom are Wandsworth residents) who were included in the survey. The proposals necessitated asking the school staff about each child's progress, collecting samples of his reading, writing and arithmetic, arranging a visit by a health visitor to ask some questions about the child's health and development, and a medical examination at which a parent was to be invited to be present. The second part of the survey, in which we agreed to co-operate, was completed during the year. Schizophrenic illness after child-birth In 1962, the Consultant Psychiatrist at Downview and Banstead Hospitals asked for help in assessing the long-term results of the hospitals' mother-and-baby unit, which provides treatment for this illness. The immediate results of treatment were said to be very good and the inquiry was intended to discover the later effects on the mother's health and the health of the family as a whole. For this, the hospital required the opinion of the health visitor and it was proposed that a member of the hospital staff should interview the mother at yearly intervals. For each of the patients from Downview and Banstead Hospitals, a report on a control family was required. The former London County Council undertook to assist in the work, and we have continued to co-operate during the past year. 61 Childhood malignancies This survey was started in 1961 by the Department of Social Medicine at Oxford University after publication of work on the aetiology of leukaemia. We have continued to co-operate by providing information and finding control children, but pressure of work prevented the medical staff from being able to carry out any interviews during the year. Arrangements were therefore made for a doctor from Oxford to undertake the work, and she interviewed the parents of four children who died during 1965 and those of four control children. Spina bifida The new surgical approach to spina bifida, involving operations within hours of birth, has meant that many children who would formerly have died are now living although with varying degrees of handicap. It is necessary to know more about the number and condition of these children if their future health, welfare and educational needs are to be met. The Department is co-operating in a survey designed to discover the prevalence of spina bifida in Greater London on 30th September, 1966, and during the following year, and to provide information on the various problems connected with this congenital handicap. The intention is to obtain enough details to enable more specialized studies to be launched later. There were on that date 29 known cases in Wandsworth; two of them have since moved out of the borough. 62 OTHER PERSONAL HEALTH SERVICES There are also numerous personal health services provided which benefit persons other than mothers and young children, and these are summarized below. Home Nursing Service A total of 3,865 persons were nursed during the year and the following table shows their age groups and the number of visits made:- Age First visits Revisits Total Under 5 years 197 643 840 5-64 years 1,516 28,922 30,438 65 years and over 2,152 100,094 102,246 All ages 3,865 129,659 133,524 Home Bathing Service This service is closely linked with the Home Nursing Service so as to make the best possible use of both trained and untrained staff. It is greatly appreciated by many elderly people and provides help for those not requiring full nursing care. Incontinence Pads Service Home nursing of incontinent persons is made much easier by means of this service and a growing number of patients are being supplied with incontinence pads. Various types are available and are supplied according to need and during the year a total of 6,600 pads were issued. In addition, 35 persons were provided with protective pants and interliners. Most households make their own arrangements for disposal but in some cases it is necessary to arrange for collection and disposal by incineration. A laundry service for incontinent persons is also provided where necessary and this is referred to on page 45. Loan of Equipment To ensure the efficient nursing of patients in their own homes the Council operates a scheme for lending, without charge, equipment as distinct from those items which can be prescribed by general practitioners. During 1966 the following articles were issued on loan : 206 commodes 60 wheelchairs 31 walking aids 16 hoists 19 rubber sheets 23 backrests 14 hospital beds with mattresses 6 fracture boards 14 bed cradles 3 ripple beds 63 The Council's provision of home nursing equipment is supplemented by the British Red Cross Society. In addition to commodes and wheelchairs, the British Red Cross Society provides smaller items of equipment such as air rings, bedpans, urine bottles and crutches. The Council is continuing to make a grant to the Society to assist in maintaining stocks of equipment. Home Help Service Without this service many of the other health and welfare services of the Borough would be seriously jeopardized. The overriding problem is the difficulty of recruiting sufficient staff to meet the demands and the service has to be spread so that all applicants are given some service. Whenever possible some help is provided but in many cases we should like to be able to give considerably more. At weekends and Bank Holidays some staff are always available to carry out emergency visits and give essential service to people who are entirely dependent on the services of a home help. Where possible neighbours, or in special cases relatives, are employed to give assistance to a particular person or group of people. Some of the work of home helps is carried out in very difficult circumstances and it is not surprising that in an area of high employment many people tend to seek a more congenial and remunerative occupation. It is therefore greatly to their credit that a large number of devoted home helps give such good service. The following table shows the number of persons who received home help service during the year:— HOME HELP PROVIDED FOR PERSONS Aged 65 years or over on first visit in 1966 Aged under 65 years on first visit in 1966 Total Chronic sick and tuberculous Mentally disordered Maternity Others 2,918 297 12 69 233 3,529 Immunization and Vaccination As the figures show, about 80% of the immunizations and vaccinations performed in Wandsworth were carried out at the Council's centres, the remainder being performed by general practitioners. Health visitors and school nurses keep up a constant drive to persuade parents to complete a full programme of protection against infectious diseases for their children. Now that the combined injection against diphtheria, tetanus and whooping cough is given at the same time as oral vaccine for protection against poliomyelitis, primary immunization against these diseases 64 can be completed in three months instead of six. This has helped considerably by halving the number of visits needed for immunization. The general pattern of prophylaxis was much as in previous years but during the year the Council obtained the approval of the Minister of Health for the payment of general practitioners for records of vaccination against measles in suitable cases. Immunization and Vaccination Statistics Smallpox vaccination—cases completed :— Primary vaccinations:— Council clinics and schools 2,691 General practitioners 761 Total 3,452 Re-vaccinations:— Council clinics and schools 600 General practitioners 107 Total 707 Diphtheria immunization—cases completed:— Primary courses:— Council clinics and schools 4,288 General practitioners 895 Total 5,183 Reinforcing injections:— Council clinics and schools 4,680 General practitioners 1,157 Total 5,837 Whooping cough vaccination—cases completed:— Primary courses:— Council clinics and schools 3,910 General practitioners 880 Total 4,790 Reinforcing injections:— Council clinics and schools 2,011 General practitioners 755 Total 2,766 Tetanus immunization—cases completed:— Primary courses:— Council clinics and schools 4,330 General practitioners 918 Total 5,248 Reinforcing injections:— Council clinics and schools 4,578 General practitioners 1,144 Total 5,722 65 Poliomyelitis vaccination—cases completed:— Council clinics, schools and general practitioners:— Salk vaccine—primary courses Born 1962-66 133 Born 1951-61 18 Born 1950 and earlier 1 Total 152 Salk vaccine—persons given reinforcing injections 169 Sabin (oral) vaccine—primary courses :— Born 1962-66 5,806 Born 1951-61 980 Born 1950 and earlier 151 Total 6,937 Sabin (oral) vaccine—persons given reinforcing doses 3,851 Recuperative Holidays The following were sent away during the year under the Council's scheme for providing holidays for adults and children needing rest, good food and fresh air:— Expectant and nursing mothers 10 Other adults 216 Children under five years, not attending school 41 School children, including nursery school children 219 Chiropody The Council provides some 40 sessions weekly at foot clinics where treatment is provided for old people, expectant and nursinc mothers and the physically handicapped. Where patients are able to walk but unable to reach the clinic, arrangements are made for them to be provided with ambulance transport. During the year 2,088 sessions were held : 604 people made a total of 13,190 attendances. In November the Department took over the service formerly provided by the Old People's Welfare Council through the Welfare Department. The following figures show the extent of this complementary service during 1966:— Number of centres at which sessions were held 3 Number of sessions held:— (a) at clinics 310 (b) privately 122 Number of individual patients seen:— (a) at clinics 320 (b) privately 190 (c) at home 798 Number of treatments at clinics 1,982 Number of home visits made 4,790 Number of treatments at chiropodists' private surgeries 1,427 66 Venereal Disease Welfare Officers are employed by six of the Inner London authorities in whose areas V.D. clinics are situated and follow-up patients who have failed to complete treatment, with the object of persuading them to continue with treatment. Time is also spent in tracing contacts named by patients and persuading them to obtain treatment. This work is carried out on behalf of all Inner London authorities, an annual payment being made by those authorities (of which Wandsworth is one) without any venereal disease clinics in their areas and therefore not directly employing any welfare officers on follow-up work. Health Education In my Annual Report for 1965 I dealt with this subject in some detail. During 1966 we have continued our programme of health education on similar lines, for basically this is an integral part of the day-to-day work of the field staff of the Department. In certain schools a number of talks and discussions were arranged at the request of head teachers on various aspects of health. One of the schools concerned was for deaf girls and at which a mothercraft class was undertaken in close co-operation with the domestic science teacher. Consideration has been given to the question of appointing a Health Educator to organize and co-ordinate the work of health education but no appointment had been made by the end of the year. In the meantime, we have had the advantage of the services of the Health Educator employed by the Inner London Education Authority who visited a number of Wandsworth schools during the year to talk on health subjects such as smoking and lung cancer. Tooting and Bolham Carnival Procession The Council decided that a number of floats depicting various aspects of the work of the departments should take part in the procession which was held in July, and it was left for each department to decide the topics to be represented. Two floats were designed in the Health Department, one on the subject of vaccination against poliomyelitis, and the other relating to atmospheric pollution and smoke control. Home safety—Accidents in the Home The greatest incidence of home accidents is found among the old and the very young. Old persons sometimes do not realise that their mental powers are failing or that their reactions are slowing down. On the other hand, the very young child cannot be expected to realise the potential hazards which exist in every home and here the child's safety could depend largely on the awareness of parents to these dangers. Many leaflets are available on these matters and have been in use for some time but it is 67 often the spoken word which has the greater effect. The opportunities for this form of health education clearly offer themselves to those field staff who have access to people in their own homes, i.e. health visitors, public health inspectors, home nurses, social workers, home helps, etc., and much unpublicised health education in this form has gone on steadily throughout the year. Many accidents are caused every year through failure to fit suitable fireguards. The Council has a scheme whereby arrangements are made for the loan of fireguards to mothers of young children where there are insufficient resources to enable the mother to make her own provision. During the year, 17 fireguards were issued under these arrangements. Family casework and problem families In my Annual Report for 1965, I made detailed reference to the Council's Co-ordinating Committee of Members and to the Case Committee comprising representatives of the Social Services Departments (Health, Welfare and Children's). Their work has continued during 1966 and the Case Committee met on ten occasions and discussed 41 families, most of whom had a mixture of problems. Of these, 17 families were referred because of rent arrears. Families who are in arrears of rent have become so numerous that information has been circulated confidentially to all the departments concerned to ascertain which field workers are currently in contact with the families. When this has been established, the field worker has discussed the position with the parents to assess whether help was needed or advisable and only those cases where it was considered that eviction might endanger the future of the children have been referred to the Case Committee. The following table shows the source of reference of the families discussed at the Case Committee:— Referred by New Cases Reviews Total Greater London Council Housing Manager 8 4 12 Wandsworth Corporation Housing Manager 4 1 5 Principal Mental Welfare Officer 1 3 4 Principal Nursing Officer 2 1 3 Children's Officer 2 4 6 Chief Welfare Officer 1 1 2 Principal Social Worker (Health Services) 1 2 3 Divisional School Care Organiser 1 1 2 Ministry of Social Security 1 — 1 St. George's Child Guidance Unit 1 — 1 Other — 2 2 Total 22 19 41 68 The time of the social workers (health services) is divided between two main functions : — (i) Intensive case work.—During 1966, support has been given to 19 families and seven new cases were taken on during the autumn. One case was closed as the parents refused all advice and two families have left the area. The problem families, which are referred to previously in relation to the work of the Case Committee, fall into two broad categories. Firstly, there are the families where the parents are chronically inadequate to fulfil their accepted role ; the number of children in these families varies from three to twelve. The father may be unemployed and/or violent towards his wife. The mother is often unable to give the children much beyond their physical needs. Families such as these will need the support of social workers in some form at least until the children have left school and particularly during the children's adolescent years when there is a risk of delinquency and poor school attendance. Secondly, there are the families where one or both parents appear to be bordering on mental illness; in such cases the children are usually better cared for but the parents' emotional problems and marital difficulties are more intangible and can have a very disturbing effect on the children. (ii) School treatment centres.—Attendances at ear, nose and throat clinics have been falling and the number of sessions has consequently been reduced. The special investigation clinics dealing with enuresis, behaviour problems and obesity have increased particularly in the Tooting area where many of the new cases are immigrant families living in overcrowded conditions. Since May, 1966, a monthly audiology session has been held at Stormont Centre to serve the Battersea children and this, as well as the sessions at Wandsworth and Tooting School Treatment Centres, has been well attended. Chest Clinics There are in the Borough three Chest Clinics, namely, the Wandsworth Chest Clinic situated in the Municipal Buildings, the Battersea Chest Clinic at St. John's Hospital and the Balham Chest Clinic at St. James' Hospital. The Wandsworth and Battersea Chest Clinics draw their patients mainly from the Borough but the Balham Chest Clinic draws patients also from the adjoining London Borough of Lambeth. Statistics relating to tuberculosis will be found on pages 15 and 16. It is never easy to differentiate between the prevention and treatment of an illness and this is particularly so in the case of tuberculosis. Close liaison, therefore, is necessary between the Chest Clinics and the staff of the Health Department and I am happy to state that this exists. Meetings are held from time to time between the three Chest Physicians and the Health 69 ment medical staff, and the health visitors attached to the Chest Clinics are seconded from the Health Department so that there are close links at all levels. I am grateful to the three Chest Physicians in the Borough and their staffs for their help and guidance on matters relating to the prevention and control of tuberculosis on the occasions when we have sought their opinion. Since tuberculosis has become less of a problem so have the arrangements for the care and after-care of patients become less important, but there is still a very definite need to help patients suffering from tuberculosis. This is done in large measure in Wandsworth through the agencies of the two Tuberculosis Care Committees, the "Wandsworth Tuberculosis Care Committee" and the "Battersea Tuberculosis Care Committee". I have pleasure in appending herewith reports of the activities of these two Care Committees during the year, which will, I think, provide an indication of the extent and quality of their services. I should like to thank both Committees for the excellent work they have carried out in helping patients suffering from tuberculosis, during the year. At the end of the reports which follow, a well-deserved tribute is paid to the work of Mrs. Elizabeth A. Cooper, J.P., the retiring Chairman of the Battersea Tuberculosis Care Committee and I would like to endorse all that has been said about the contribution she has made for Battersea patients 70 WANDSWORTH TUBERCULOSIS CARE COMMITTEE ANNUAL REPORT FOR 1966 There have been many changes during the year. Mr. Bignall, our Hon. Treasurer, has retired. We were sorry to lose him and we thank him for his guidance and for keeping our funds in a satisfactory position. To his successor, Mr. H. J. Bates, we extend our cordial welcome. Dr. Garland is no longer able to attend our meetings as his duties prevent it. In March, Councillor Mrs. Jenkins, Mrs. J. Dixon and Mrs. M. Cormack were appointed to represent the London Borough of Wandsworth on the Committee. Mrs. Cassidy resigned in June also Miss Malleson who on her retirement from the Family Welfare Association, retired from our Committee and Miss G. Knight has now been appointed to take her place. There has been no decline in the number of cases coming before us. In fact the number has slightly increased. We have had many calls for assistance, in such items as clothing, holidays and money to satisfy a variety of needs. At Christmas we gave the usual presents to patients and their families and that involved an expenditure of £128. Some of our cases require immediate assistance, some a monetary grant, and some help over long term periods. The Handicraft Class continues to meet weekly under Mrs. Sadler, the Instructress, and this is very much enjoyed as a social occasion by the patients who attend, and it also turns out some very beautiful and useful work for our Sale. Our thanks are due to Mr. and Mrs. Ireland and Mrs. Morgan, who accompanied the patients on outings to Hastings in May and to Brighton in September. Our Autumn Sale and Draw, which is our chief money raising event of the year, was held on November 5th at the Civic Suite, Town Hall, Wandsworth, and opened by the Mayor, Councillor A. A. Loughton, J.P. The Appeal Letter was sent out in May, but the response was disappointing. However, a number of generous donations were received during the course of the year. We much regret the resignation of Mrs. Tweed as she is leaving the neighbourhood. For many years she has been a very energetic personality on our Committee. We wish her a happy future in her new home. I would like to place on record my thanks to all who have assisted and co-operated with us during the year, including the W.V.S. and Officers of the Ministry of Social Security and Labour Exchanges. To my Vice-Chairman, Hon. Treasurer, and all the Committee, for their interest and help. I give my grateful thanks also, to Miss Oakey, Miss Macdonald and Mrs. Gilbert. DEODORA CASSELS, Chairman. 71 BATTERSEA TUBERCULOSIS CARE COMMITTEE ANNUAL REPORT FOR 1966 The Battersea Tuberculosis Care Committee has pleasure in presenting the Annual Report for 1966. The Committee has continued to meet at monthly intervals during the year and we must thank the Battersea, Putney and Tooting Group Hospital Management Committee for providing us with facilities for our meetings. We must record several changes in our membership during the year. We received with regret the resignation of Miss Malleson, Family Welfare Association, upon her retirement and look forward to welcoming her successor. We welcome with pleasure two representatives appointed by the Council of the London Borough of Wandsworth, Councillor L. Goodwin and Councillor F. Shaw, as well as Dr. H. Gordon, Deputy Medical Officer of Health of the Borough. The Committee's work during the year under review has been varied and active, and has kept pace with the speed of diagnosis and treatment which now does so much towards expediting the patient's full recovery. There have been many calls for help from Care Committee funds but by far the greatest number have been for clothing and footwear. Not only have we helped the patient returning to work after his period of treatment, but we have found that the elderly suffering from chronic illness have benefited by this practical help. Queen Mary's London Needlework Guild has once against sent us a parcel of new garments for our needy patients. We are indeed grateful for this gift which has come regularly for many years and which provides a most valuable stock for issue in emergencies. Our thanks go to members of Battersea Park Rotary Club and our other friends who have given us various articles of clothing all of which have been greatly appreciated by the recipients. At Christmas we disbursed £75 in cash to out-patients, while patients in the Chest Wards in St. John's Hospital also received cash gifts. The toys which were received from the Evening News "Toy for a Sick Child" Fund, were parcelled up in time for Christmas and gave pleasure, not only to the children but also to their parents who were thus relieved of the anxiety to find from their slender resources the means to cover the visit bv Father Christmas. Just before Christmas we had a surprise gift of some food parcels from the Grosvenor Arms Social Club. The parcels contained an excellent assortment of groceries for the festive season and the lucky families were delighted. Of our money-making activities the most important was the Old Tyme Dance. Once again Mr. T. E. Collyer undertook the organisation of this event which proved highly successful and added the sum of nearly £65 to our funds. We are indeed grateful 72 to Mr. Collyer for the time and effort which he so freely devoted on our behalf. Our thanks also go to the Wandsworth Borough Council for allowing us the free use of the Hall and amenities. The Autumn Draw, which has now become an annual event, produced £27 17s. 6d. and although this amount was less than that raised in the previous year, it was nevertheless valuable. It is with pleasure that we record our thanks to the following firms who contributed donations and prizes for the Draw:— Messrs. Carsons-Paripan Limited. Messrs. Dawson & Company Limited. Messrs. Festival Gardens Battersea Park Limited. Messrs. Stan Gilbert (Battersea) Limited. Messrs. J. Lyons & Company Limited. Messrs. Prices Patent Candle Company Limited. Messrs. The Rom River Company Limited. Messrs. Stanley Bridges Limited. In addition to these activities we still continue the collection and sale of milk bottle tops and tin foil. Although the proceeds are much reduced it is still thought that it is worth the effort involved. The year 1966 has seen the emergence of the Ministry of Social Security, but this change has not altered in any way the sympathetic consideration which has been shown to our patients by the officers of the former Assistance Board and Ministry of Pensions and National Insurance. The officers of the Ministry of Labour have also been most helpful in their dealings and efforts to place our patients in suitable work or to arrange training. No report would be complete without recording our thanks and appreciation of the support we have received during the year. The Wireless for the Bedridden Society has been most generous to three of our patients; the provision of a means to afford interest and entertainment to those who are housebound or bedridden has been of inestimable value. We must thank the Battersea Park Rotary Club not only for the practical help given to individual patients but also for a generous donation to our funds. The Morganite Carbon Co.. Ltd., has continued the steady support which has now covered a span of a great many years: we very much appreciate the interest indicated in our work, as well as the benefit to our funds. To all our friends who have provided gifts of money, clothing, books and toys during the year we express our sincere thanks. In conclusion we place on record our thanks to Miss R. M. Greenaway, the Committee's Secretary, and Miss M. Clifford, Health Visitor, for their work on behalf of the Committee during the year. (Mrs.) E. A. COOPER. Chairman. 73 Tribute to Alderman Mrs. Elizabeth A. Cooper, J.P. In December we said a very regretful "good-bye" to our Chairman, Alderman Mrs. Elizabeth A. Cooper, J.P. Mrs. Cooper has been a member of the Battersea Tuberculosis Care Committee since 1942 and Chairman of the Committee since 1947. Throughout her many years of service she was meticulous in attending our meetings, although the claims of her Civic duties and her many other interests must have made this difficult at times. She was devoted to the welfare of the people of Battersea and brought to her work in our Committee a humanity tempered by a wealth of practical experiences gained in other spheres which will be remembered with pleasure and gratitude. Mrs. Cooper did not spare herself in the giving of her time and now that she and her husband have retired to Wales, we wish them both a long, happy and peaceful retirement. (Miss) N. F. CLARK-LAWRENCE, Chairman. Care of Old People The effective care of the aged depends largely on the close liaison and co-ordination of effort of the statutory bodies and voluntary organizations engaged in this essential work. I am glad to say that in Wandsworth there is full co-operation from all concerned with the welfare of old people. In addition to the ties between the Health and Welfare Departments and the Women's Royal Voluntary Service, close contact is maintained with the local hospital geriatric services, which have been most helpful when old people have needed urgent admission to hospital. Many of these have been seriously ill but have recovered sufficiently to be able to go home with the support of the appropriate personal health and welfare services. Valuable help is given by geriatric departments of hospitals which take old people as in-patients for short periods to relieve the strain on the families looking after them. Requests for visits to old people are received from many sources and it is often the health visitor who makes the first visit to see what is needed. She may then arrange for a service or call in the Welfare Department or a voluntary agency. If the old person is very frail and likely to need medical care the health visitor will continue to visit. During the year 1,500 first visits were paid by health visitors to persons aged 65 years or more, 225 of these visits being paid at the request of a general practitioner or hospital. Under Section 47 of the National Assistance Act. 1948, amended by the National Assistance (Amendment) Act, 1951, the Medical Officer of Health is empowered to apply for an Order for the compulsory removal to hospital of persons who are 74 ing from grave chronic disease or who, being aged, infirm or physically incapacitated, are living in insanitary conditions, unable to devote to themselves and not receiving from others proper care and attention. Most aged persons in need of care and attention do avail themselves of the services provided but occasionally every service is refused and then compulsory removal may be necessary, although that step is invariably taken reluctantly. Fortunately, it was not found necessary to invoke this statutory power during the year. Co-operation and Co-ordination of Health Department Services with the Hospital and Family Doctor Services In a tripartite service consisting of three quite separate and distinct sections, each of which in itself is high complicated and personalised and each of which includes practitioners of many disciplines, it is obviously necessary that for the best results to be achieved there should be close links between the three sections. Indeed, as has been said, the remarkable thing is that with the existing trichotomy, the general level of the health services of this country is so high. In Wandsworth, we have tried to achieve co-ordination and co-operation as described below. (1) General At Member level, the Health Committee has invited the Local Medical Committee and the various hospital services to nominate members to serve on the Committee. Consequently, one general practitioner is a co-opted member of the Health Committee as a nominee of the Local Medical Committee and one member represents the hospital service, nominated by the Teaching Hospitals Association On the medical side, some of the senior members of the Health Department have served in the Borough for a considerable period, during which time there have, of course, been many opportunities for making personal and close contacts with general practitioner colleagues and those holding consultant posts in hospitals. This applies more particularly to those sections of the Health Department such as maternity and child welfare, mental health and infectious diseases, which are primarily of joint concern. Close contacts are maintained with the Secretary of the Local Medical Committee but in Inner London, since this Committee covers the whole area of the 12 Inner London Boroughs, these contacts are not perhaps as intimate as they might be in provincial areas. Nevertheless, links are still quite close and through the good offices of the Secretary, the Local Medical Committee agendas and reports are made available to me. This latter also applies in equal degree to the Inner London Executive Council. 75 Since there is no Local Medical Committee exclusive to the area of the London Borough of Wandsworth, the tendency is to look to the local professional organisations for professional contacts on a Borough basis. For many years, I have acted as Honorary Treasurer of the Local Division of the British Medical Association and this has brought me into close contact with most of the practitioners in the area and certainly on any matters with which the profession is locally concerned. I have found these contacts of the greatest possible value. Consideration has from time to time been given to the issuing of a weekly news sheet to general practitioners. During the course of a year, numerous items of information need to be transmitted from the local health department to general practitioners in the area. Up to the present this has been done by means of a circular letter as occasions arise, but whilst a weekly news sheet might develop into a mere routine, it is now thought that a periodic bulletin might serve both to disseminate useful information or items of interest to the general practitioner, and at the same time strengthen the link between these two branches of the health service. This possibility was under consideration at the end of the year. (2) Hospitals At one time I was a member of one of the Local Hospital Management Committees. The Health Department through its senior medical side is, however, represented on various Hospital Committees such as the Control of Infection Committee and and senior nursing staff are also members of the Nursing Education Committees. There is also close liaison with all the local hospital maternity units. The maternity liaison committees provide the opportunity to discuss local policy regarding the arrangements for maternity patients. The non-medical supervisor of midwives has a good contact with each maternity unit and makes arrangements for domiciliary experience of pupil midwives. The South London Hospital provides the domiciliary midwifery service for one small area of the Borough and their midwives attend one of our antenatal clinics. As mentioned above, there are close personal links between the consultants at the hospitals and the medical staff of the Health Department, particularly in relation to paediatrics, midwifery, infectious disease and mental health. The Department of Paediatrics at one of the hospitals sends junior members of the staff to obtain experience in our infant welfare sessions, these usually being in connection with their studies for the Diploma in Child Health, and there are opportunities for medical officers from the Department to visit the paediatric wards and out-patients departments. We regard ourselves as fortunate in Wandsworth in that the infectious diseases unit for this area of South West London is 76 situated at St. George's Hospital, Tooting, to which unit most of our cases of infectious disease are admitted and thus we are able to maintain close contacts with the Consultant in Infectious Disease and his staff. Towards the end of last year, a branch of the Public Health Laboratory Service was opened at St. George's Hospital and we have already found this link to be very useful. Bacteriological specimens are sent to the Laboratory and we have close and cordial contacts with the Director of the Laboratory, Dr. S. Fleck, and his colleagues and staff. With the psychiatric hospitals close links have been forged by the mental health section of the Health Department and full details are given in the section of this Report on page 81. Arrangements have been made for social workers to visit the two hospitals admitting our mentally ill cases, that is to say, West Park Hospital and Tooting Bee Hospital and our social workers also assist at the day hospitals attached to those hospitals. The same applies in the case of Queen Mary's Hospital, Carshalton, to which many of our mentally subnormal children are sent. For many years we have provided facilities for two mental hospitals to see their outpatients at William Harvey Centre and Putney Health Centre. Arrangements also are in being for ante-natal patients booked for confinement at St. Teresa's Hospital to be seen at our William Harvey clinic by medical and nursing staff from the hospital. In fact, we place the premises at the disposal of the hospital and the Regional Hospital Board for this purpose, free of charge. This has proved a considerable convenience to the expectant mothers in saving them the journey to Wimbledon. (3) General Practitioners There have always been close and cordial relationships between the public health medical staff and general practitioners in this area and, as mentioned earlier, I have for many years acted as Honorary Treasurer to the local branch of the British Medical Association. In order to foster these close relations, particularly after the inauguration of the new London Borough of Wandsworth, his Worship the Mayor, as described in my report for last year, held an evening reception for general practitioners which was extremely well attended and was welcomed by everybody. As to the medical work of the Department in its relation to general practitioners, our medical officers, working in clinics, are actively encouraged to consult personally or by telephone or letter with general practitioners on a clinical and professional basis upon any cases needing discussion which they come across in their work in the clinics. Since some of our doctors have been working in the area for a considerable time and since as far as is practicable they work in fairly circumscribed areas of the Borough, 77 the clinic doctors become known to the general practitioners. We are very insistent that there should be this close contact on a clinical basis. Co-ordination of effort also shows itself in the sphere of the care of the aged. From time to time, a senior medical officer of the Health Department is called upon to visit the homes of old persons, at the request of general practitioners, to advise on suitability for care in a hospital geriatric unit and this also calls for consultations with the hospital geriatricians. The nursing of patients in their own homes is carried out by home nurses under the direction of the family doctor. The initial request for nursing care may come from the family doctor or it may be arranged by a hospital prior to the patient being discharged home. In the latter case the family doctor is informed. Home nurses are encouraged to discuss their cases with the family doctor whenever necessary. All midwives work closely with the general practitioner obstetrician booked for each case. It is not possible to attach midwives to the practice of a particular general practitioner obstetrician, but a eroup of midwives tend to work mainly with a limited number of general practitioner obstetricians and they get to know each other well. With a decreasing number of home confinements the midwives are now working over larger areas and may have to work with an increasing number of doctors. Two midwives regularly attend ante-natal clinics in doctors' surgeries and one general practitioner obstetrician attends his own ante-natal cases in one of our centres. All midwives use the ante-natal co-operation cards on which both doctor and midwife keep their records. The health visitors in Wandsworth work in decentralized groups with headquarters at clinics in various parts of the Borough. The general practitioners are aware of this and every insistence is placed on health visitors in the group getting to know and work closely with the family doctors practising in the particular area of their group. This applies to work in the infant welfare clinics as well as in the schools. In this way, continuity of contact is maintained since although the individual health visitors may change, the group remains a fairly static unit. From time to time also, apart from the purely professional contacts, health visitors in a group organize an "at home" at the clinic with modest refreshments, to which other health workers, including general practitioners, are invited and this again helps to foster good relationships. Very considerable thought has been directed to those more formal attachments, to which a great deal of publicity has been given. In theory, this is an excellent innovation and in some parts of the country has apparently proved successful and where general practice is conducted on a group basis, undoubtedly to be actively encouraged. Thus, in predominantly rural areas or self-contained 78 communities in small urban districts, attachment offers great scope. In thickly populated, highly urbanized centres of population where the pattern of life is more impersonal, the difficulties are many, and these are the conditions found in Inner London. From careful investigations we have from time to time conducted in Wandsworth, the conclusion has been reached that with the present predominant pattern of general practice, it is not practicable to arrange for secondment of staff, except on a minimal scale. This is because of the very " patchwork " structure of general practice. Thus, there is in Wandsworth a large number of single-handed practitioners and comparatively few large groups of practitioners working in group practice. The result is that one finds that in any one of the densely populated, thouch territorially small, areas of the Borough, many general practitioners may have patients. In other words, it is unusual for there to be any heavy concentration of patients attached to any one doctor in any one locality. Indeed, this pattern is found in some of the large blocks of flats which have gone up and it is not uncommon to find quite a large number of doctors from different practices with patients on their lists from one single block of flats. Under these conditions, it has been concluded that it would not be feasible to attach health visitors, midwives or home nurses to any one practice, still less to any one doctor. To do so would be impracticable from the work organization point of view, apart from its being extremely uneconomic in terms of staff time. Reluctantly, therefore, we have decided that while these ideas are forward-looking and may be the norm in the future, there are no opportunities in Wandsworth to put them into practice. We must await more group practices, more partnerships and possibly a more circumscribed area of practice, although this latter is probably the most difficult to achieve. Nevertheless, all health visitors work in close co-operation with the general practitioners in their areas and most health visitors find that they make fairly frequent contact with from 10-14 doctors. While attachment of health visitors to a particular group practice has not as indicated above been possible, one health visitor does most of the work arising from one group practice. This practice mainly covers a very limited geographical area and has been found suitable for this type of liaison for it is not practical to have health visitors travelling over large areas to visit the families on the list of one particular practice. The health visitor is responsible for visiting the children of all the mothers on the lists of these three doctors and these families comprise about one half of her cases. Any families which live right outside this area are passed over to the health visitor for that area. In fact, this group of doctors keep in touch with the whole group of health visitors in that area and realise that they benefit by being able to call on the services of several health visitors from time to time. In another area one health visitor regularly visits a group practice each week. 79 As to the future it seems likely that closer liaison between family doctor and health visitor will develop on an area basis so that a group of health visitors will work mainly with several groups of doctors. Some years ago, discussions took place with groups of doctors with a view to offering facilities for them to see their own antenatal cases in some of our clinics with the midwife in attendance. At the time, these offers were not taken up, but at the present time one general practitioner sees his ante-natal cases in one of our clinics. MEDICAL EXAMINATION OF STAFF The medical examination of staff is undertaken by the Health Department on behalf of all departments of the Council. During the year the arrangements were reviewed and it was decided that a routine medical examination of every new entrant to the service would no longer be required. Staff are now asked to complete a medical questionnaire and examinations are undertaken where information disclosed on the questionnaire or the nature of the employment indicate that it is desirable. STAFF TRAINING AND STUDENT TRAINING In-Service Education From time to time throughout the year we have shown films on various subjects of professional interest to the health visitors and nursing staff. When possible the film is shown twice so that all staff have the opportunity of attending. These occasions make an opportunity for staff to meet one another and have been much appreciated. Social workers from the Health, Welfare and Children's Departments have also been invited when films were likely to be of interest to them. Staff Training The six student health visitors sponsored by the Borough in 1965 all passed the Health Visitors' Examination and commenced duty in September, 1966. Another six students were sponsored and commenced training in October, 1966. Five of these are at Battersea College of Advanced Technology (University of Surrey) and one at the North Western Polytechnic. A number of staff attended short courses arranged by the London Boroughs Training Committee. Two health visitors attended a ten-day course for Field Work Instructors to enable them to supervise the practical training of health visitor students. Four midwives and four district nurses attended one-day courses and two health visitors attended a weekend course on the teaching of " Relaxation and Preparation for Parenthood 80 The usual arrangements were made for the five-yearly refresher courses for midwives and health visitors. These courses are arranged by the Royal College of Midwives, the Royal College of Nursing, the Health Visitors' Association and the Central Council for Health Education and are recognised by the Ministry of Health. The senior staff in the day nurseries have remained unchanged throughout the year but there is a rapid turnover of young nursery nurses and nursery assistants. Newly qualified nursery nurses tend either to go on to further training in hospital or else apply for posts with private families. Many return to day nursery work later on. On the whole the staffing position has been slightly better this year than last but with such small staffs even one vacancy can create difficulties during periods of sickness and holidays. It is also very difficult to recruit suitable domestic staff but cooking and cleaning have to go on, however few staff are available. Some relief has been obtained by extending the use of a commercial laundry service leaving only emergency washing to be done in the nursery. Seven student nursery nurses completed their two-year training and sat for the National Nursery Examination Board examination in July. Six passed and the one who failed re-sat in November and passed. Facilities for Student Training During the year practical health visiting experience was provided for eight students from Battersea College of Advanced Technology (University of Surrey). These students spend approximately three months with us, one month each term. Two students are allocated to a Welfare Centre and their training is supervised by a Field Work Instructor. We have continued to provide a one-day programme of experience for about 200 student nurses from the various local hospital Nurse Training Schools. In addition a number of talks were given to the student nurses in hospitals in preparation for, or following, these visits. The domiciliary midwifery service provided a period of three months' training for 40 pupil midwives and a single day of district experience for 24 student nurses taking an obstetric course. Visits and talks were also arranged for a number of students and visitors from various fields of public health and social work including a number of overseas students. 81 PART 5 MENTAL HEALTH SERVICE The mental health service continued to expand in 1966. New services have been developed and an important increase in the number of qualified mental health social workers meant a strengthening of the organization on a fieldwork level, an expansion of work, and an improvement in the quality of the service given. Two assistant principal mental welfare officers have been appointed. One of their most important duties will be to extend and improve our contact with the hospitals which serve the area and they will also make an important contribution to staff development. Casework supervision can now be offered to all staff who may require this and this will no doubt lead to the recruitment of further staff of high calibre. Consultation on the problems of mental illness can also be offered to other departments and agencies. CO-ORDINATION WITH HOSPITAL SERVICES The two assistant principal mental welfare officers meet each week with the social workers at West Park and Tooting Bee Hospitals respectively. At these meetings ways in which improved co-ordination can be attained are discussed. A mental health social worker attends Queen Mary's Hospital, Carshalton, on a weekly or fortnightly basis, working in close accord with and under the general supervision of the senior social worker there. Our mental health social workers continue to carry out the social work for the three day hospitals in the area, viz. West Park and St. George's Day Hospital, Tooting Bee Day Hospital and Springfield Day Hospital. They also attend out-patient clinics at St. James' Hospital, and West Park and St. George's Day Hospital. The mental health social workers are able to attend clinical conferences at West Park, Tooting Bee and Queen Mary's Hospitals and these conferences have proved extremely valuable for staff development. COMMUNITY CARE OF THE MENTALLY DISORDERED The number of patients receiving a casework service continued to increase. With the extra staff available it was possible to allocate additional personnel to work in the busiest areas. More and more requests are being met for preventive work with people who have not yet experienced breakdowns leading to hospitalisation. As the casework service improves and the mental health social workers spend less time dealing with emergencies, the preventive field offers new opportunities for a positive approach to mental health. 82 Chellow Dene — Residential Hostel This hostel caters for adult, convalescent mentally-ill patients of both sexes, most of whom have been discharged from hospital but who are not ready to lead an independent life in the community. During the year, 42 patients were admitted and 41 were discharged ; as this is primarily a short-stay hostel, this is a satisfactory turnover of patients but at the same time we have been able to maintain the number of occupied places at a high level. The following statistics show the disposal of the residents who were discharged and the length of their stay in the hostel:— Patients in residence on 1.1.66 Admissions during the year Discharges during the year Patients in residence on 31.12.66 Discharged patients—disposal (a) to home (b) to normal lodging (c) returned to hospital (d) others (including 7 transferred to flatlets at Gwendolen Avenue) Total Male 9 19 18 10 1 2 8 7 18 Female 8 23 23 8 4 7 7 5 23 Total 17 42 41 18 5 9 15 12 41 Discharged patients—length of stay Under 1 month 1-2 months 2-3 „ 3-4 „ 4-5 „ 5-6 „ 6-7 „ 7-8 „ 8-9 „ 9-10 „ 12-13 „ 13-14 „ 17-18 „ Total 3 3 2 3 – – 1 1 1 1 2 1 18 3 4 4 1 2 2 3 1 1 1 – – 23 – 6 7 6 4 2 2 4 2 2 1 3 1 1 – 41 – During the year a very pleasant extra room was provided for the residents and this is used for reading or for watching television away from the general activities of the lounge or common room. This additional facility has made a considerable contribution towards increasing the comfort at Chellow Dene and has been very much appreciated by the residents. 83 Self-contained flatlets at Putney These flatlets are an extension of the service offered at Chellow Dene, our psychiatric rehabilitation hostel. It has been found that some patients are in need of longer-term environmental support to consolidate the progress they have already made in their rehabilitation into the community. There are no resident staff on the premises, but there is very close contact between Chellow Dene and the flatlets. The residents cater and care for themselves as a preparation to leading a fully independent life in the community. They are welcome to spend their evenings and weekends at the hostel, and some of the residents make good use of this service, keeping in touch with the staff and their friends at the hostel. In this way none of the residents need feel isolated in their flatlets. The first residents moved in during November, 1966. The majority were transferred from Chellow Dene but some have been admitted to the flatlets direct from the community and from other residences. It is hoped that after a period of 12 to 18 months patients will be able to take the final step into the community. This is a pioneer project and Wandsworth is leading the way in implementing the recommendation made by the Ministry of Health that alternative forms of residential accommodation should be considered in addition to hostels. Social Clubs The work of the clubs continued to expand during the year. A discussion group was formed at the Tooting Club and club members are making very good use of the group to discuss the mutual problems that they share owing to their mental illness. At the Putney Club dancing lessons were started. Both clubs had very successful parties during the year and an outing to Southend was enjoyed by the many members who attended. A mental health social worker attends the Brierley Hall Club for subnormal teenagers run by the Wandsworth Society for Mentally Handicapped Children and the Baird Hall Club for educationally subnormal boys, and acts as the liaison worker between our Department and these clubs. Group for Depressed Mothers At the invitation of the Rev. Peter Bide of St. Luke's Church, Balham, a group was started in May for depressed mothers and their husbands. This meets fortnightly under a psychiatric social worker to discuss problems occasioned by depressive illness following childbirth and has been attended regularly by a small group of families 84 Training Centres Difficulty was experienced during the year at Wandsworth and Newlands Training Centres when staff left to take up work outside London, to go to training courses or for other private reasons. It was some time before suitable new staff could be recruited, but by the end of the year the problem of staffing was being partly solved not only with the replacement of the staff who had left, but also by an increase of staff which will enable the work of the training centres to improve and expand. The increase in the ratio of staff to trainees will mean smaller classes and an improvement in the quality of the teaching and training. Staff will be able to experiment with new teaching methods and to carry out many of the ideas that have had to be shelved in the past owing to staff shortages. Balham Training Centre now has some excellent kitchen equipment and the trainees there are doing some very expert cookery. A washing machine has been delivered and will be installed in a newly-formed laundry. The Wandsworth Society for Mentally Handicapped Children very kindly hired a television set for use at Newlands Training Centre to assess the value of television as a teaching aid for the mentally subnormal and the suitability of the educational programmes. This has proved very successful and our thanks and appreciation are due to the Society for their interest in this work and for their generosity in enabling the experiment to be undertaken. The occupational therapist has made very useful contacts with some manufacturers who are giving industrial outwork to the centres. By this means the trainees are able to do a useful piece of work for which they are paid, albeit a small sum. helping them to feel that they are useful members of the community, and giving them a feeling of independence is itself a useful therapeutic measure. Special care units A mini-bus which can accommodate 10 children was acquired during the year and has proved of immense value in the problem of transporting the young subnormal and often helpless children to the special care units. The mini-bus has been specially adapted for the conveyance of these children and is fitted with special seating, safety belts, etc. Regular use was made during the year of the special care units at Queen Mary's Hospital for Children, Carshalton, and at Morden and I am very grateful both to the Hospital Authorities and the Medical Officer of Health of the London Borough of Merton for making these facilities available and enabling us to provide a very valuable extension of our service. 85 Short-term care This service provides a means whereby parents who are caring for a subnormal child at home may be offered the opportunity of a temporary relief once or twice a year and is very valuable in times of family crisis, ill-health, etc. The number of children and adults sent on short-term care during 1966 was as follows:— Under 16 years 35 Over 16 years 32 Total 67 Long-term care The number of patients maintained in long-term care increased in 1966 and at the end of the year 37 patients were resident in the following homes :— Guardianship Society Mental After-Care Association Richmond Fellowship Hampton Manor Homes Cheshire Foundation Homes St. Joseph's Special School National Society for Mentally Handicapped Children St. Mary's Convent Other approved accommodation 10 9 2 1 3 1 1 5 5 STAFF TRAINING AND STUDENT TRAINING Staff Training Two senior mental health social workers successfully completed their courses at the North Western Polytechnic and at the National Institute of Social Work Training and have returned to work in the Department. Two other senior mental health social workers were seconded on full salary to the two-year Younghusband Course and were replaced temporarily in the mental health team by two qualified social workers. The qualifications of social workers in the mental health team at the end of 1966 were as follows:— Psychiatric Social Workers Certificate in Social Work or Social Science Diploma or Degree Unqualified 6 10 1 86 As a result of the progressive policy in this Borough in the secondment of staff for training we have been able to increase our proportion of trained staff during the year and this has undoubtedly helped to attract qualified staff to come to work with us in Wandsworth. Student Training In 1966 five Younghusband students from the North Western Polytechnic were placed in the Borough for 5½ months each. In addition, six students were placed for periods of a few weeks, two from the London School of Economics' Social Science course, two from the University of London's extension course and two students from abroad as a preliminary to their joining the Mental Health Course at the London School of Economics. Two students were placed for a week's observation placement by the London School of Economics' Mental Health Course. Twelve nurses from Springfield Hospital Nurse Training School spent one week in the mental health office. Arrangements were made for nurses from West Park Hospital and St. George's Hospital to spend an afternoon visiting with the mental health social workers. A nurse from Tooting Bee Hospital also spent a week in the mental health office with a view to gaining some knowledge of the mental health service as a preliminary to starting a domiciliary nursing service from the hospital. We are steadily gaining a high reputation for the quality and variety of training which we are able to offer students in mental health and we receive constant requests from Universities, Colleges, Nurse Training Schools, etc., to send students to us for training. 87 MENTAL HEALTH ACT, 1959 STATISTICS for the year 1966 Menially ill Psychopathic Subnormal and severely subnormal Total Persons referred (a) By general practitioners 292 2 1 295 (b) By hospitals (on discharge after in-patient treatment) 116 1 4 121 (c) By hospitals (during or after out-patient or day hospital treatment) 122 – 12 134 (d) By Inner London Education Authority 15 – 68 83 (e) By Police and/or Courts 63 63 (f) From other sources 381 3 42 426 Total 989 6 127 1,122 Admissions to hospital (a) As informal patients 91 – 4 95 (b) By statutory action (Sees. 25, 26 and 29) 297 – 2 299 (c) By Order of a Court (Sec. 60) 12 — — 12 Total 400 — 6 406 Persons receiving community care at 31st December, 1966 (a) Attending day training centre – – 196 196 (b) Receiving home training 16 — 5 21 (c) Resident in local authority home/hostel 13 13 (d) Resident at local authority's expense in other home/ hostel 11 – 22 33 (e) Boarded-out at local authority's expense in private household – – 11 11 (f) Receiving home visits and not in any of the foregoing categories (a) to (e) 379 – 294 673 Total 419 — 528 947 88 LONDON BOROUGH OF WANDSWORTH PART 6 SCHOOL HEALTH SERVICE ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1966 CONTENTS Introduction Pupils on school rolls Medical Inspection of Schoolchildren Vision Personal Hygiene Infectious Illness reported from Schools Medical Treatment of Schoolchildren Audiometry Handicapped Pupils School Nursing Service B.C.G. Vaccination of Schoolchildren Foot Health School Dental Service Health Education Sanitary Conditions in Schools Medical Staff Meetings 89 Introduction I have pleasure in presenting the second report on the School Health Service in the London Borough of Wandsworth for the period ended December 31st, 1966. The tables and statistics in the report show that the work of the School Health Section of the Department continued unabated during 1966. As I mentioned in my report for last year the entry of a child into school is an important landmark in his experience. This is the first occasion when he will be separated from the family for any length of time, and thus begins his independent existence as an individual, which will increasingly become the pattern of his future life. It is, therefore, verv important in this formative period of the child's life that everything should be done to guide him in his search for independence and to help him make the adjustments that will become increasingly necessary as he grows up. It can be said, in general, that this is one of the most important if not the most important function of the school health work, and its full performance demands close co-operation with the Education Service as a whole. The fieures as presented in the body of the report do not reveal any major deviation from last year. In a service such as this, which has been established for many years sudden alterations are not to be expected, and it is by the overall assessment of the figures that the work is to be judged but comments on some of the figures are made in the report. Here I may mention that the percentage of children found to be of unsatisfactory general condition at the routine medical inspections was one half of one per cent, the same as last year. It is interesting to reflect that within living memory this figure was considerably higher although the medical description used to denote this finding was different, and was often described as unsatisfactory nutrition. At the present time, some concern is felt at the number of over-weight children who are to be seen in many schools, in contrast to the underweight children and those of poor nutrition which were to be seen in the schools in years gone by. Towards the end of the year some thought was given to the improvement of the services for deaf children. Although this is not exclusively a function of the School Health Service it is predominantly so, and there is little doubt that a re-organised audiology service on a firmer basis than now exists would provide a much needed improvement to the present service. At the end of the year, however, no decision had been arrived at. It is not possible to provide a formal report from the Principal Dental Officer because at the end of the year no appointment had yet been made. At the time of writing, however, it is hoped that this will soon be rectified. Nevertheless, a short section dealing 90 with the School Dental Service is included from which it will be seen that a good deal of attention was paid to the service during the year, improved equipment was ordered, and the policy of arranging for an annual dental inspection in the schools was initiated, although a start was only possible, owing to staffing problems, with the 5- and 6-year-olds. Mr. Webster, the Dental Adviser to the Inner London Education Authority, has been very helpful in advising on dental matters in the absence of a Principal Dental Officer and I am very grateful to him for his assistance. I should like to express my thanks to all my colleagues in the School Health Service for their work and enterprise during the year. I am grateful also to the Divisional Education Officer and his staff and also the Heads of Schools in the Borough for their continued co-operation with us in our efforts to maintain and improve the health of the children in their schools. Pupils on school rolls In May, 1966, there were 45,605 pupils on the rolls of Wandsworth schools, including primary and secondary day schools, together with special day and boarding schools and classes for handicapped pupils. Medical Inspection of Schoolchildren Routine medical examinations are performed by medical officers working in either a full-time or part-time capacity. Whenever the necessity arises the family doctor is consulted about the results of the examination, and parents are invited to attend, so that anv matters relating to the child's health mav be discussed without delay. Much valuable information is also obtained from the school nurses, the Care Committee workers and the teaching staff. Immunization records receive special scrutiny and, if indicated, the attention of the parents is directed towards completing the immunization schedule, particularly with regard to the prevention of diphtheria, poliomyelitis, tetanus and tuberculosis. Control of infection and infestation is facilitated by means of the medical inspections and the health surveys made by the school nurses. In this respect, examination of children prior to a school journey is of proven value. During the year no major epidemiological investigation was required at the schools and no case of crossinfection occurred as a sequel to holidays organized for groups of children either in this country or abroad. Relatively frequent medical examinations take place at the schools for the handicapped. Specially approved medical officers examine educationally subnormal children. Although the emphasis rests upon the educational status of these children, any physical abnormality is carefully assessed, for the successful treatment of a physical defect may well enhance the child's prospects of securing gainful employment after leaving school. Behaviour problems 91 in children of all ages continue to present difficulties. To solve a behaviour problem is often an exacting task, demanding intensive application of medical and educational resources. Routine general medical inspections during 1966 totalled 17,289, compared with 17,464 in 1965. Of the 17,289 children inspected, 14.9 per cent were referred for treatment of defects, 7.5 per cent being referred for treatment of defects other than vision. The corresponding percentages for 1965 were 12.9 and 6.1 respectively. The following table shows the number of children referred for treatment or observation of the defects listed at routine general medical inspections for the year 1966, expressed as a rate per 1,000 children inspected, together with the corresponding rates for 1965. Numbers examined 1965 1966 17,464 17,289 Rate per thousand Treatment Observation Treatment Observation Skin diseases 6.99 4.75 10.70 7.17 Eyes—vision 74.50 66.02 80.22 59.57 squint 5.04 7.27 6.30 6.88 other 2.29 1.83 1.68 2.54 Defective hearing 4.81 15.00 5.67 11.92 Otitis media 1.49 3.72 1.79 4.34 Enlarged tonsils and adenoids 8.76 31.95 7.81 25.16 Defective speech 2.00 8.93 3.64 10.47 Enlarged cervical glands 0.34 4.58 0.46 4.92 Heart and circulation 1.15 13.34 1.91 13.19 Lung diseases other than tuberculosis 2.86 13.97 4.40 13.94 Orthopaedic defects 11.56 26.91 9.89 26.31 Defects of nervous system 1.32 4.87 1.91 3.54 Psychological defects 2.35 8.13 3.42 11.86 Developmental—hernia 1.09 1.78 0.46 1.85 other 1.03 5.21 0.92 7.40 Abdomen 0.17 0.97 0.52 1.04 Details of non-routine medical inspections carried out in 1965 and 1966 are given below :— 1955 1955 Reinspections 9,007 9,441 Secondary school annual surveys 174 140 Other non-routine inspections 5,625 5,992 (see table overleaf) 7-plus experimental scheme inspections 122 98 Total 14,928 15,671 Total routine and non-routine inspections 32,392 32,960 92 Analysis of non-routine medical inspections Nature of Inspection Bathing centre inspections : Scabies Other Employment certificates Theatrical children School journeys Recuperative holidays: Before holiday On return Outward Bound courses Infectious disease investigation Boarding Schools for the Delicate: Pre-departure inspections On return from school Handicapped pupils: Statutory examinations Periodic special defect examinations Research investigations and enquiries Special examinations at request of: Head Teacher: Child's name entered in special book Others School Nurse: Following health survey Others Divisional Officer (Education) Divisional School Care Organiser or Care Committee Parent School Medical Officer All other non-routine inspections Total Number inspected 1965 2 2 533 – 3,181 89 1 – – 5 2 16 979 64 126 269 28 109 62 20 90 19 28 5,625 1966 6 5 886 1 3,154 37 – 24 1 10 2 33 901 5 116 284 23 152 94 18 161 57 22 5,992 Physical condition of pupils Percentage satisfactory and unsatisfactory: Satisfactory Unsatisfactory 1965 99.5% 0.5% 1966 99.5% 0.5% Attendance of parents and Care Committee representatives Number of pupils inspected Parent present Care Committee representative present 1965 17,464 49.0% 91.9% 1966 17,289 49.1% 89.1% 93 Vision During the year vision tests were carried out on 6,566 boys and 6,449 girls, a total of 13,015 children compared with 6,678 boys and 6,453 girls, a total of 13,131 children in 1965. The percentage of the number tested with and without glasses who were referred for treatment or observation was 18.6, compared with 18.7% in 1965. Visual acuity standards expressed as percentages of the numbers of children whose eyes were tested are set out in the following table:— Not wearing spectacles Wearing spectacles 6/6 6/9 6/12 or worse Referred for treatment 6/6 6/9 6/12 or worse Referred for treatment 1966 Boys 76.9 7.7 6.0 6.5 4.9 2.5 2.1 2.3 Girls 75.8 6.6 6.3 6.2 5.7 3.2 2.4 6.3 1965 Boys 78.3 6.7 6.3 6.3 4.3 2.5 1.9 2.2 Girls 74.6 6.6 6.8 6.9 6.1 3.3 2.6 4.4 Personal Hygiene Number examined Number found verminous Pupils found to be verminous % of number examined Annual comprehensive health surveys 1966 27,983 324 1.16 1965 27,924 244 0.87 Additional health surveys 1966 17,193 259 1.51 1965 14,389 187 1.30 During both types of survey, vermin were found on 583 occasions, representing 1.29 per cent of the total number of examinations. The number of individual pupils found to be verminous was 368, or 0.81 per cent of the school roll of 45,605. On 438 occasions the parents and/or the children were advised about treatment and in many cases were given Lorexane shampoo for home treatment. A further 145 pupils were referred to bathing centres where appropriate treatment was given. The work done at the two bathing centres in the Borough in connection with vermin, scabies and impetigo is shown below. A "case" is a child discharged after a course of treatment (e.g. 94 a child attending three courses of treatment during the year counts as three cases). These figures include not only schoolchildren referred after a health survey, but also those attending on their own initiative. Vermin Cases treated 409 Treatments given658 Scabies Cases treated 61 Impetigo Cases treated 1 Infectious illness reported from schools Chicken-pox 611 Dysentery, diarrhoea or enteritis 92 Food poisoning 1 German measles 236 Glandular fever 4 Impetigo 9 Influenza 53 Jaundice 27 Measles 432 Mumps 709 Ophthalmia and conjunctivitis 17 Pneumonia 1 Rheumatic fever 1 Ringworm (scalp) 2 Ringworm (body) 6 Scabies 13 Scarlet fever 44 Sore throat A close watch is maintained on the incidence of infectious disease, particularly Sonne dysentery. Although not usually serious, this disease requires rapid application of control measures. In this context, I am indebted to the teaching staff for supplying early information about illness in the schools and to the general practitioners, medical officers, public health inspectors and health visitors for co-ordinating the investigation and management of cases and contacts. 95 Medical treatment of schoolchildren The number of sessions, new cases and total attendances at school treatment centres during 1966 were as follows : — Type of clinic Sessions New cases Attendances Minor ailments (nurse) 1,082 1,541 12,002 Minor ailments (doctor) 121 346 Special investigation (i.e. enuresis, obesity and behaviour problems) 213 241 1,356 Dental 2,502 8,007 19,753 Vision 329 877 4,689 Orthoptic 213 69 513 Ear, nose and throat 69 106 486 Audiology 61 174 432 Audiometry The detection of gross deafness is a relatively simple matter, but the reverse applies if the hearing loss is slight. The audiometer is an apparatus used for routine tests in order to ascertain whether deafness has escaped notice despite examination by other methods. Although loss of hearing may be minimal its detection is of particular importance in a child with learning difficulties. Routine audiometer tests are performed by two school nurses working full-time, assisted by a third nurse employed part-time. Of the five machines, three can be transported from school to school. The "sweep technique" is the term applied to the screening test, but in appropriate cases the "pure tone" test may be required for determining the exact degree of hearing loss. All school entrants are examined. Audiometry also forms part of the examination of any child who appears to be educationally subnormal. During 1966 there was an increase in the number of pupils given screening tests (7,923 compared with 5,737 in 1965) this being mainly due to additional nursing staff being employed for this purpose. In common with other Authorities, Wandsworth has a need for additional audiology services, such as could be supplied by a centrally-based unit, supplemented by the various clinic and other services which at present are concerned with the detection and management of deafness. The number of children given audiometer tests during 1966 was as follows :— Pupils given screening tests 7,923 Pupils failing screening tests given pure-tone tests 1,138 Pupils referred to otologist 338 96 Handicapped pupils Handicapped pupils who may need special educational treatment are referred from many sources. In some cases (e.g. physical handicaps, delicate children) examinations are carried out by school medical officers and recommendations made by the Principal School Medical Officer either direct to the Education Officer or to the Medical Adviser of the Inner London Education Authority. In other cases (e.g. partially sighted, blind, deaf or maladjusted) the examinations are carried out by staff of the Medical Adviser, who makes his recommendations to the Education Officer. Children who, because of some handicap or combination of handicaps, are considered not fit for education at school may be recommended for home tuition. The examination of educationally subnormal children is carried out by specially qualified medical officers in accordance with Sections 34 and 57 (as amended) of the Education Act, 1944. In cases presenting no special difficulty the examination is carried out by a medical officer of the Health Department, who makes an appropriate recommendation to the Education Officer. The Medical Adviser of the Inner London Education Authority deals with all appeals against recommendations which may be made for special educational treatment, and with the placing of children who are considered to be unsuitable for education at school through disability of mind, together with any other cases presenting special difficulty. There are eleven schools in Wandsworth providing special educational treatment. Not all the pupils at these schools reside in Wandsworth, whilst some children who live in the Borough attend special schools in other areas. At the end of 1966, the numbers of children receiving special education at schools in Wandsworth were as follows : Blind : Residential 77 91 Day school 14 Deaf 30 Physically handicapped 74 Delicate 260 Day schools Educationally subnormal 568 Maladjusted: Residential 47 | 93 Day school 46 | In addition, one school has a partially-hearing unit and four schools hold special day classes for maladjusted children. The latter group attend ordinary schools for part of the week and 97 attend the special classes during the remainder of the week, when up to five sessions may be required, depending upon the nature and severity of the behaviour problem. As the classes are small, the child has the maximal opportunity of receiving benefit from the tuition. Schools for the educationally subnormal are as follows : — Meadway (primary and secondary) with 200 pupils. The building is modem and was built on the site of a school which was formerly attended by physically handicapped children. Shillington (secondary) with 262 pupils. Wyclifje (secondary) with 106 pupils. This school is at present in temporary accommodation pending rebuilding. At these special schools, the importance of social training is emphasized. The scope of education has been broadened to stimulate and maintain the children's interest in the daily activities of the community and to prepare them to take their place as citizens and to find employment appropriate to their abilities when the time comes for them to leave school. Deaf Register. At the end of the year there were 271 names on the deaf register, 66 of which were new cases notified during 1966. School Nursing Service This service is staffed by health visitors and school nurses assisted by clinic nurses. Experience has proved that the nursing staff can make a considerable contribution to the smooth running of infants' schools where, in particular, the health visitor's knowledge of the family background is most valuable. The health visitor also contributes towards promoting health education in senior schools and co-ordinates the work of the team in this direction. All the staff work in close co-operation with the teaching staff, the School Care Committee and the Health Department Social Workers. B.C.G. vaccination of schoolchildren In the autumn and spring terms the annual arrangements were made to vaccinate children against tuberculosis, with B.C.G. (Bacillus Calmette-Guerin). Children selected for this protective measure were aged 13 years, and the following table summarizes the results :— (a) Number of eligible children 4,067 (b) Number of consents received 3,440 (c) Number of consents received for alleged contacts of known cases of tuberculosis (included in (b) 47 (d) Number of children skin-tested and read 3,100 98 (e) Positive reactors among (d) 270 (8.7%) (f) Negative reactors among (d) 2,830 (91.3%) (g) Number of children vaccinated 2,814 This B.C.G. vaccination campaign was introduced in 1954 and has now become routine procedure in schools. Children whose negative results show that they have not been subject to tuberculous infection are vaccinated; children with positive results are referred to the Chest Physicians for X-rays and any further necessary investigation and treatment. Foot Health Foot defects in schoolchildren are brought to the notice of the school medical officer either at routine inspections or by reference for special examination. Where necessary the children concerned are referred to the family doctor for advice. The school nurse may discover defects such as warts and athlete's foot during comprehensive health surveys or at special inspections. A medical officer and a remedial gymnast attend ten primary schools to examine the children for foot deviations. Selected cases are formed into a class supervised by a teacher who has received training in the technique of foot exercises. Remedy of a foot deviation may be considered to be a specialized approach to the correction of faulty posture in general. School Dental Service During the year the Inner London Education Authority decided to revise the school dental scheme in order to improve the service generally, the main change being in relation to dental inspections held in schools. Since 1965 only pupils aged five years had been dentally examined in schools. Parents of older children were invited by letter to use the school dental service, and appointments for examination at the clinics were offered to those wishing to avail themselves of the service. The revised scheme provides for an annual inspection at school for children of all ages with a consequent need for additional dental staff. Until such time as additional staff can be provided, the scheme is being introduced in phases. Arrangements have been made for all children in infants' schools, up to seven years of age, to be examined at school. The parents of older children will continue to be invited to bring their children to the school dental clinics. The scheme involves the preparation of a dental record card for all children examined at school who are found to require treatment, whether or not the parents decide to use the school dental service, and additional clerical assistance is to be provided for this purpose. 99 In order to improve the service generally, additional and more up-to-date equipment is to be provided in the dental surgeries, the first item to be supplied being new dental operating lamps. During the year all pupils age five years were inspected at school, together with some six-year-olds towards the end of the year under the revised scheme: 3,551 inspections were carried out at schools, compared with 800 inspections in 1965. In addition, 6,314 children received first inspections at clinics, compared with 6,798 in 1965. The slight downward trend in the proportion of children inspected who needed treatment, noted in 1965, when it was 69.0 per cent., continued in 1966, when it was 66.1 per cent., but this still leaves much to be desired. The response rate of new cases attending for treatment also allows scope for improvement, being 50.8 per cent. for 1966, which is practically the same as the rate for 1965 (50.2 per cent.). For "on-treatment" cases the response rate was 72.0 per cent. in 1966, compared with 72.5 per cent. in 1965. Information on dental sessions and attendances is given in the following table. Sessions and attendances Sessions : Number of treatment sessions 2,502 Number of inspection sessions in schools 73 Total 2,575 First inspections : Number of first inspections in schools 3,551 Number of first inspections at clinics 6,314 Total 9,865 Number inspected found to require treatment 6,519 Percentage requiring treatment 66.1 Number offered treatment 5,820 Percentage of number requiring treatment offered treatment 89.3 Percentage of number requiring treatment who elected for private treatment 10.7 Reinspections: Reinspections at clinics or schools 2,047 Number reinspected found to require treatment 1,076 Percentage of number reinspected found to require 52.6 treatment Number of appointments given to: New cases 15,772 On-treatment cases 15,533 100 Number of attendances made by : New cases 8,007 On-treatment cases 11,182 Emergencies 564 Total attendances 19,753 Response rate (attendances as percentage of ments): New cases 50.8 On-treatment cases 72.0 Cases discharged dentally fit 6,325 Lapse rate (number not completing treatment expressed as a percentage of new cases and emergencies attending) 26.2 Health Education This subject was dealt with fully in my Annual Report for 1965 and it is only necessary to report that during 1966 we continued our efforts in close liaison with the teaching and other staff employed by the Inner London Education Authority. As stated elsewhere in this Report, a number of sessions were held in schools at the request of head teachers to deal with subjects such as mothercraft, including a school for deaf girls. Consideration has been given to the question of appointing a Health Educator to organize and co-ordinate the work of health education but no appointment had been made by the end of the year. In the meanwhile, we have had the advantage of the services of the Health Educator employed by the Inner London Education Authority who visited Wandsworth schools during the year to talk on health subjects such as smoking and lung cancer. Sanitary conditions in schools Medical officers carry out detailed inspections of school premises annually and advise about the sanitary conditions and standards of hygiene. Reports concerning defects, with appropriate recommendations are brought to the notice of the Education Officer. The reports indicate that improvements are mainly needed in the older types of school. Medical staff meetings Current problems relating to the school health service were discussed from time to time at meetings with the senior medical officers and the school physicians. The subjects, which covered a wide field, ranged from immunization and epidemiology to management of school clinics and procedure relating to inspections. 101 INDEX Page Accident in the home 66 Adoption and boarding-out 59 Aged persons 73, 77 Analysis of food and drugs 34,35 Animal Boarding Establishments Act, 1963 27 Animals, protection of 27 Ante-natal clinics 49 Atmospheric pollution 41, 42, 66 Audiometry 95 Bacteriological examinations 18, 23, 34, 44 Bakehouses 34 Barbers 24 Bathing centres 45, 93 Baths, home 62 „ personal cleaning station 45, 93 „ swimming 44 B.C.G. vaccination of schoolchildren 97 Births 10, 11 Boarding-out 59 Brucella abortus 33 Butchers' shops 33 Cancer 6, 10, 55 Caravans 29 Case of old people 73, 77 Case Committee 67 Catering establishments 33 Cervical cytology 6,55 Chellow Dene hostel 82 Chest clinics 68 Child-minders 58 Childhood malignancies survey 61 Chimney heights 41 Chiropody 4,65 Clean Air Act, 1956 41 Cleansing stations 45, 93 Clearance areas 28 Closing Orders 28 Common lodging houses 27 Communicable diseases Co-ordinating Committee 67 Co-ordination with other health services 53, 56, 68, 74, 81 102 PAGE Coroner's Court 46 Creches 59 Crematorium Regulations, 1930 47 Day hospitals 81 Day nurseries, Council 58 „ „ private 58 Deaf children 58,89.95,97 Death, causes of 12 „ rates 10, 11 Deaths, cancer 10 „ heart disease 13 „ infant 10, 13 „ infectious diseases 15,20 „ maternal 10,13 „ tuberculosis 10 Dental services, mothers and young children 50 „ „ schoolchildren 89,98 Diphtheria 14 „ immunisation 14,63 Disinfection and disinfestation 44,45 Domiciliary midwifery service 51 Drainage 22 Dysentery 15 Early discharge of maternity patients 52 Educationally subnormal children 90,96,97 Environmental health services 21 Factories Act, 1961 39 Family casework 67 Family planning 5,50 Fireguards, loan of 67 Fish shops 33 Fluoridation of water supply 23 Food and Drugs Acts 30,32 Food hygiene 30 Food poisoning 14 Food premises 30, 31 Food sampling 34 Food stalls 33 Food, unsound 35 Foot clinics 4,65 Foot health in schools 98 Furnaces, installation of 41 Hairdressers 24 Handicap and observation register 50, 52 Handicapped pupils 96 103 PAGE Health Committee 8 Health education and publicity 66, 97, 100 Health surveys 59 Health visiting service 50 Heart disease, deaths from 13 Home bathing service 62 Home help service 63 Home nursing equipment, loan of 62 Home nursing service 62 Home safety 66 Home tuition 96 Hostel for mentally ill persons 82 Houses in multiple occupation 28 Housing 28, 29 Hygiene inspections of schoolchildren 93 Ice-cream sampling 34 Illegitimate children 11, 55 Immunization and vaccination 63, 97 Incontinence pads service 62 Incontinent persons, laundry service 45 Infant mortality 10, 13 Infant welfare clinics 49 Infectious diseases, statistics 19, 20 Infectious illness in schools 94 Inquests 46 International vaccination certificates 17 Laboratory facilities, bacteriological 18, 23, 34, 44 Land Charges Act, 1925, 27 Laundry services 45, 62 Legal proceedings 22 Loan of fireguards 67 Loan of home nursing equipment 62 Long term care (mental health service) 85 Lung cancer 66, 100 Maternal mortality 10, 13 Maternity beds 51 Measles 14 „ vaccination 64 Medical examination of staff 79 Medical inspection of schoolchildren 90 Medical treatment of schoolchildren 95 Meningococcal infection 15 Mental health service 81 „ „ „ community care of the mentally disordered 81 „ „ „ day hospitals 81 104 PAGE Mental health service long term care 85 „ „ „ mothers' groups 83 „ „ „ occupational therapy 84 „ „ „ out-patient clinics 81 „ „ „ residential hostel 82 „ „ „ self-contained flatlets 5, 83 „ „ „ short-term care 85 „ „ „ social clubs 83 ,, „ „ special care units 84 „ „ „ staff training 85 „ „ „ statistics 87 „ „ „ students 86 „ „ „ training centres 84 Midwifery service 51 Milk sampling 34, 38 Milk supply 32 Mortality, infant 10, 13 „ maternal 10, 13 Mortuary 46 Mother and baby homes 24, 55 Mothercraft classes 49, 66 Movable dwellings 29 National Assistance Act, 1948—section 47 73 National Child Development Study 60 National Survey of Health and Development 59 Neo-natal mortality 10 Noise Abatement Act, 1960 25 Notifiable diseases 19,20 Nursing homes 24 Occasional creches 59 Occupational therapy, mentally ill persons 84 Offensive trades 25 Offices, Shops and Railway Premises Act, 1963 26 Old people, care of 73, 77 Ophthalmia neonatorum 15 Outworkers 40 Performing Animals (Regulation), Act, 1925 27 Perinatal mortality 10 Personal cleansing stations 45, 93 Personal health services 48, 62 Personal hygiene 45, 93 Pest control 24, 45 Pet Animals Act, 1951 27 Pharmacy and Poisons Act, 1933 25 Phenylketonuria 50 105 PAGE Pneumonia, acute influenzal 15 „ acute primary 15 Poliomyelitis 15 „ vaccination 63 Population 9 Post-mortem examinations 46 Poultry inspection 33 Premature infants 52 Prevention of Damage by Pests Act, 1949 24 Problem families 67 Prophylaxis 63 Public Analyst, report on work of 35 Pupils on school rolls 90 Recuperative holidays 65 Relaxation classes 49 Rent Act, 1957 29 Riding Establishments Act, 1964 27 Rodent control 24 Samples, adulterated 34, 35 „ food and drugs 34 „ ice cream 34 „ milk 34, 38 „ water 23, 44 Sanitary conditions in schools 100 Schizophrenic illness after childbirth 60 School dental service 89,98 School health service 88 „ „ „ health education 97,100 School nursing service 97 Sewage disposal 23 Sewerage 23 Short term care (mental health service) 85 Slaughter of animals 33 Smallpox 17 „ international vaccination certificates 17 „ vaccination 63 Smoke control 41, 66 „ „ measuring stations 42, 43 Smoking and lung cancer 66, 100 Social clubs for the mentally disordered 83 Sonne dysentery 15 Special care units (mental health service) 84 Special educational treatment 96 Spina bifida 61 Staff 7, 8 106 PAGE Staff, medical examinations 79 Staff training 47, 79, 85 Statistics, mental health 82, 87 „ vital 9 Stillbirths 10, 11 Students, facilities for training 47, 80, 86 Surveys 59 Swimming baths 44 Tetanus immunization 63 Toddlers' clinics 50 Tooting and Balham carnival procession 66 Training centres (mental health) 84 Training of staff 47, 79, 85 Training of students 47, 80, 86 Tuberculosis 15 „ deaths 10 „ notifications 15 Tuberculosis Care Committee reports 70, 71 Typhoidfever 16 Unmarried mothers 55 Unsound food 35 Vaccination and immunization 63, 97 Vaccination, international certificates 17 Venereal diseases 66 Verminous premises 45 Vision testing 93 Vital statistics 9 Water supply 23, 44 „ „ fluoridation of 23 Whooping cough immunization 63 Rowling & Sons Ltd. (T.U.). 34 & 36 York Road, S.W. II.