London Borough of Wandsworth ANNUAL REPORT of the Medical Officer of Health and Principal School Medical Officer for the Year 1967 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 1967 by J. TUDOR LEWIS, M.D., D.P.H. CONTENTS Page INTRODUCTION 3 Part 1—VITAL STATISTICS 11 Part 2—COMMUNICABLE DISEASES 16 Part 3—ENVIRONMENTAL HEALTH SERVICES 24 Public Health Inspection 25 Housing 33 Food and Food Premises 35 Factories Act, 1961 46 Atmospheric Pollution 48 Miscellaneous Matters 50 Part 4—PERSONAL HEALTH SERVICES Services for Mothers and Young Children 54 Other Personal Health Services 69 Part 5—MENTAL HEALTH SERVICE 83 Part 6—SCHOOL HEALTH SERVICE 93 PHOTOGRAPHIC SUPPLEMENT Centre Pages Plate A—Water Sampling—Taking a sample of swimming bath water for analysis. Plate B—Infectious Disease—Sealing a room prior to fumigation after a case of smallpox. Plate C—Infectious Disease—Cleaning a room after fumigation following a case of smallpox. Plate D—Offices, Shops and Railway Premises Act— Taking light meter readings in office premises. INDEX 111 3 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1967 To the Mayor, Aldermen and Councillors of the London Borough of Wandsworth. Mr. Mayor, Ladies and Gentlemen, I have the pleasure of placing before you the third Annual Report on the health of the London Borough of Wandsworth, covering the year ended 31st December, 1967. The health of Wandsworth again remained generally good but, as hinted in my Report of last year, the current statistical tools available, while they give a general idea of the health of the community, may not be sufficiently refined to reflect the total sum of ill-health (as opposed to mortality), particularly of some forms of mental ill-health. The civilian population of the Borough, as estimated by the Registrar-General, was 330,470, which again showed a slight drop over the previous year. The total number of births was 6,013 which, compared with 6,350 for 1966, gives an adjusted birth-rate of 18.06 per 1,000 of the population compared with 18.38 for 1966. The number of deaths, at all ages, was 4,204 as against 4,512 so that the adjusted death-rate was 10.55 per thousand of the population, showing a reduction for the third successive year. The total number of deaths of infants under one year was the same as last year, namely 130, but as the total number of births was fewer than last year, the infant mortality rate per thousand live births showed a slight increase to 21.60. The perinatal mortality rate, which is based on the sum of the number of stillbirths and the number of deaths at ages under one week per thousand total live and stillbirths was 28.36, a slight reduction from the figure of 28.81 in 1966. In 1967, four women died from causes associated with childbirth, giving a maternal mortality rate of 0.65 per thousand live and stillbirths. The table on page 14 gives a breakdown of the causes of death in Wandsworth in 1967. Although I have on previous occasions referred to the three diseases, chronic bronchitis, cancer of the lung and coronary arterial disease, I make no excuses for doing so again. Of these, cancer of the lung, widely recognized now as being 4 associated with prolonged and heavy cigarette smoking, caused 267 deaths as against 285 in 1966. Deaths from bronchitis numbered 231 as against 247 in 1966; this disease is also thought to be linked with heavy cigarette smoking as well as with atmospheric pollution. Coronary arterial disease and angina accounted for 742 deaths compared with 758 in 1966. Heavy smoking may well be a factor in causing coronary arterial disease although it is now generally held that the causes are multi-factorial and very complicated and difficult to assess. These illnesses are important, not only as problems in community medicine, but because the age groups in which they occur are predominantly in the most economically productive period of life when many of the victims must be bearing responsibilities both to their own families and to the economy of the country at large. Our measures to deal with atmospheric pollution in Wandsworth should be making some contribution to the reduction in the incidence of and deaths from chronic bronchitis and to some small extent possibly of cancer of the lung. As regards coronary arterial disease, there seems at the moment to be no clear indication of how this disease is to be prevented except by exhortations to avoid excesses in one's mode of life and to be moderate in one's activities and pleasures. How easy it is to preach such a gospel but how difficult to put into effect! There could hardly be a better example of the reaction of people to their sociological and environmental conditions, using these terms in the broadest sense, and of the difficulties of influencing these conditions. During 1967, a total of 3,344 notifications of infectious disease was received, a considerable increase over the previous year which was a result of the anticipated biennial increase in the incidence of measles, since 1967 was a "measles year Details will be found in the body of the Report of the other infectious diseases which occurred and how they were dealt with; here I need only make special reference to the smallpox "outbreak" in Wandsworth in October 1967, an incident of special interest and importance. Although for many years this country has been virtually free from endemic smallpox, I have had occasion in previous years to refer to the introduction of smallpox into the country and to the action we had to take in Wandsworth to deal with contacts of cases and associated problems. In 1967, the only cases of smallpox which were notified in the British Isles arose in Wandsworth. The first case was diagnosed in the late evening and early hours of 16/17th October. No one doubts that the increased volume and speed of air travel has greatly increased the risk of smallpox being imported from those countries where it remains an endemic disease and health authorities near to international airports must be prepared to deal with smallpox at any time and to act quickly and vigorously. Indeed, this would apply to areas of large industrial population to which many travellers likely to be incubating smallpox seem eventually to go. I am glad to say that by speedy and vigorous action (and 5 possibly some element of luck), no further cases occurred in the community, although the mother of the patient was later diagnosed in hospital as suffering from a rare form of smallpox and the father was also thought possibly to have been a very mild case. I would like to take the opportunity of thanking all my colleagues in the Health Department who were engaged with me in handling this incident for their readiness to work at all hours and for long periods in containing the infection. We also received considerable help from Consultants and other experts in other branches of the Health Services. The Consultant Physician at St. George's Hospital and his staff, the Director of the Public Health Laboratory at the Hospital, the Consultant Physician at the Smallpox Hospital and the Virologists at the Public Health Laboratory, Colindale, together with medical officers of the Ministry of Health, were extremely helpful and I would express my appreciation to them for their assistance. The rationalization of the Chiropody Service which was put in train towards the end of 1966 proceeded further in 1967 and the decision to appoint a Chief Chiropodist will give an added impetus to a service which is of particular value to old people. The interesting and pioneering experiment by which flatlets are attached to our Mental Health Hostel continued in 1967 and although it is a little early to say exactly how this new idea will finally develop, at the time of writing I can say that it shows every indication of being a success. More time, however, will be necessary before a final appraisal of this idea can be made. While on the subject of mental health, I should mention the interesting symposium which was held during the year. Invitations were sent to hospitals, some voluntary associations and some individuals who were concerned with mental health services in Wandsworth to meet for discussion and exchange of views upon the mental health services in the Borough. A very encouraging and satisfying number of acceptances was received and a buffet lunch was provided, after which the Chairman of the Health Committee welcomed the visitors and then handed over to me to take the Chair at the formal session. The proceedings were opened by short papers from the Deputy Medical Officer of Health. Principal Mental Welfare Officer, a psychiatrist and a general practitioner, after which there was a general discussion on a variety of problems. The purpose of the symposium was to bring together representatives of those who were concerned with the Mental Health Service in Wandsworth, and an interesting, and at times stimulating and often controversial exchange of views, followed. For our part, we were able to note the feelings and opinions of our colleagues in other sections of the Health Services and this provided us with a good deal of information which will be useful to us in planning services in the future. 6 Perhaps the greatest value was the opportunity this meeting provided for general practitioners, psychiatrists, social workers, public health medical officers, nursing staff and others to meet each other personally and to hear one another's views on a rapidly developing service. The National Health Service (Family Planning) Act received the Royal Assent in June 1967 and this provided us with an opportunity to strengthen and extend our arrangements for providing a comprehensive family planning service through the agency of the Family Planning Association, to whom I would again express our thanks for their continued help and co-operation. We were able to introduce and finalise the provisions as permitted by the Act very quickly and the arrangements are such that women can now obtain advice on family planning with the maximum of privacy and the minimum of inconvenience. The year also was notable for the introduction of a domiciliary family planning team consisting of a doctor and a nurse who visit households to advise women who, for one reason or another, are unable or unwilling to attend at the clinics. As shown later in the Report, this has also been a signal success. With the introduction of the domiciliary service and the increase in the number of sessions available at clinics and hospitals, we can give a very good service in Wandsworth. Our arrangements for offering a gynaecological screening service including examination of cervical smears continued and were extended in 1967. Of particular interest was our offer of facilities to women employed in the Council's service and to certain hospitals and also to some of the larger firms in Wandsworth. We made arrangements with one firm for a team comprising our Senior Medical Officer in charge of this service and a nurse to visit the premises and carry out examinations and tests in the factory. This. I understand, was very greatly appreciated. Statistical details of the examinations will be found in the Report. I dealt at length in last year's Report with the means of liaison between the Health Department, general practitioners and hospitals, making mention of the so-called attachment schemes by which Health Department personnel, particularly health visitors, midwives, home nurses and possibly social workers are attached to particular medical practices. For reasons which are fully set out in last year's Report and which need not be repeated, attachment schemes on a large scale are not easy to introduce in a highly urbanised area such as Wandsworth. Ideally, the staff should be attached to a practice, working at and from the same practice premises as the general practitioners. However, it may well be that surgery premises may not be large enough to make this possible and so the second-best arrangement is to site health visitors at the health clinic premises nearest to their attached doctors. It follows from this that the health visitors and other staff are decentralized. In Wandsworth, as I have indicated before, the policy of 7 ization has been the practice for a great many years. Groups of health visitors have their offices in various local health authority premises distributed throughout the area. In this way, the health visitor groups working in a given area become "linked", as it were, with that area and by implication with other health and medical workers such as general practitioners also working in that area. They become familiar with the particular public health and social problems in the area where they work and also familiar with each other's problems, and although they may be linked with the doctors working in the same area as themselves, the doctors need not necessarily be in partnership or in group practice. This linkage scheme as it applies to an area like Wandsworth may even have some advantages over attachment schemes. Thus, as has been said, a group of health visitors become aware of the problems of their particular area and familiar with and able to work with the doctors in that area so that if one particular health visitor happens not to be available, her colleagues, knowing her problems, will be able to deputize for her. Linkage is also probably more economic in terms of staff time, including travelling time, than attachment, a factor of paramount importance in face of staff shortages. While there seems to be little doubt that with the likely growth of group practices and more practices being undertaken from health centres, full-scale attachment schemes are likely to increase, it seems to me that linkage schemes such as we have in Wandsworth can and do perform a very useful function of little less value than attachment schemes, and with fewer disadvantages. In pursuance of this policy, we have given much thought to whether this idea of linkage could be extended to the Home Nursing Service and have achieved some degree of success in the sense that already groups of home nurses do work in particular areas of Wandsworth corresponding approximately to those of the health visitors. I hope we can extend this and eventually have a complete linkage of home nurses as there is for health visitors. At the end of the year, St. Teresa's Hospital in Wimbledon ceased to admit National Health Service maternity patients. This followed the opening of the new Maternity Unit at Queen Mary's Hospital, Roehampton, which now takes all maternity cases formerly admitted to St. Teresa's. Although the new Unit did not begin to function in 1967, having accepted the first patients on 1st January, 1968, I refer to it here because the inauguration of a new purpose-built modern maternity unit in conjunction with a teaching hospital can hardly fail to have advantages to mothers and babies in Wandsworth and I am glad to say that close links and liaison were quickly established between our own staff of domiciliary midwives and health visitors on the one hand and their colleagues in the Roehampton Unit on the other. A further advantage is that the organization of a mobile resuscitation unit or "flying squad" based on the Hospital will provide much 8 proved cover for those obstetric emergencies which arise at home and particularly for mothers living in the western part of the Borough. I should like to take the opportunity of expressing our very sincere appreciation of the many indications of eagerness to work closely with our domiciliary service which we have experienced from the Consultant Obstetrician of the new Unit and the senior nursing staff. During the year, in consultation with the Public Analyst, whose full report is included within, we reviewed the numbers and types of foods and drugs which under modern conditions of food production and manufacture ought to be submitted for analysis. As a result, the Health Committee approved alterations both in the numbers and also the types of foods and drugs to be sampled and the changes undoubtedly will enable better value to be obtained from the amount of money available for this important work. Housing continued to require a good deal of attention, particularly houses in multiple occupation, and the work here has been pressed with vigour. However, the work of the Environmental Health Section of the Department was again handicapped by shortage of public health inspectors although the extended use of technical assistants has again proved its value, and has enabled the work to proceed of inspecting and, where necessary, reporting upon houses in multiple occupation; of declaring Smoke Control Areas; and inspecting offices and shops. As regards offices and shops, sanction was received to increase the number of technical assistants available for this work. In conjunction with the Establishment Officer and the Training and Recruitment Officer, we formulated new schemes (subsequently approved by the Establishment Committee) for the training of various categories of staff in the Department. As a result, our facilities for training staff were appreciably improved and although lack of suitable candidates, particularly of health visitor students, was a problem, nevertheless these improved resources are bound to produce nothing but good in the long term. There can be no question whatsoever that an enlightened and forward-looking training programme for most of the professional and technical staff in the Health Department is almost the only way by which the Department can ensure an adequate intake of qualified and trained personnel. Having been without a Principal Dental Officer for two and a half years it was a pleasure to welcome Mr. A. F. Weedon to the Department on his appointment to the position. I make further reference to Mr. Weedon's appointment in my Report as Principal School Medical Officer but his work for dental health generally will undoubtedly be of great benefit to the children of the Borough. During the year, Mr. G. W P. Weeks, the Chief Public Health Inspector, decided on medical advice that he must retire from his 9 appointment. This was received by everyone with the greatest regret, for Mr. Weeks has rendered outstanding service in the formative years of the present Borough and before then, for many years, in a like capacity to the Metropolitan Borough of Battersea. He will leave the Department with the very best of good wishes from the Health Committee and all his colleagues. As always, it is a pleasure to express my thanks and appreciation for the excellent work of all members of the staff of the Health Department and for the co-operation of the staff of the other Corporation departments with which the Health Department inevitably is associated. Finally, I should like to thank the Members of the Health Committee and particularly the Chairman of the Committee, Mrs. M. F. Sporle, for the help, guidance and support which we received in unstinted measure throughout the whole of the year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, J. TUDOR LEWIS, Medical Officer of Health and Principal School Medical Officer. 10 MEMBERS OF THE HEALTH COMMITTEE (at 31st December, 1967) Chairman: Councillor Mrs. M. F. Sporle. Vice-Chairman: Councillor Dr. Brian N. C. Prichard, m.sc. Alderman W. J. Malins, j.p. Councillor A. H. Barton E. C. Bond Mrs. O. Haines Mrs. M. Jenkins Dr. D. L. Kerr, m.p. Miss J. Lestor, m.p. Miss G. A. Morgan Norman G. M. Prichard, m.sc., j.p. Mrs. J. D. Standing D. B. Sweaney. C. L. Symons A. R. Tasker, l.i.b.s.t. Co-opted Members: Dr. D. Billig K. A. Broughton Rev. N. D. Gill, b.sc.(soc). Mrs. M. Walkden o.b.e., j.p. Ex-officio Members: The Worshipful the Mayor (Alderman W. A. Carnie, c.b.e., j.p.) Alderman S. F. C. Sporle Councillor R. F. Ash, j.p. Councillor F. E. Sims. SENIOR OFFICERS OF THE HEALTH DEPARTMENT (at 31st December, 1967) 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 (Health Services) Mrs. M. J. Koolman Principal Dental Officer A. F. Weedon 11 PART 1 VITAL STATISTICS Population The civilian population at the middle of the year was estimated by the Registrar-General to be 330,470. 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 1967 over 3,200 children in this age-group were found to have moved into Wandsworth; during the same period over 3,700 were known to leave the Borough and in addition nearly 2,000 children moved away without leaving any trace of their destinations. Of these last, over 600 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 1967, the factor for births is 0.96 and for deaths 0.83. 12 Extracts from Vital Statistics Live Births: Male Female Total Legitimate 2,691 2,461 5,152 Illegitimate 438 423 861 Total 3,129 2,884 6,013 Rate per 1,000 population: Crude 18.19 Adjusted18.06 Stillbirths: 37 49 86 Rate per 1,000 total live and still births 14.10 Deaths: All ages 1,994 2,210 4.204 Rate per 1,000 population: Crude 12.72 Adjusted 10.55 Infant Mortality Rates: Deaths under 1 year 82 48 130 Total infant deaths per 1,000 live births 21.60 Legitimate infant deaths per 1,000 legitimate live births 20.18 Illegitimate infant deaths per 1,000 illegitimate live births 30.19 Neo-natal Mortality Rate (deaths under four weeks per 1,000 total live births) 15.79 Early Neo-natal Mortality Rate (deaths under one week per 1,000 total live births) 14.46 Perinatal Mortality Rate (stillbirths and deaths under one week combined per 1,000 total live and still births) 28.36 Maternal Mortality Rate (per 1,000 total live and still births) 0.65 Number of deaths from Puerperal causes 4 Number of deaths from Cancer 813 Number of deaths from Tuberculosis 21 13 Births The total number of live births to residents of the Borough registered during 1967 was 6,013 comprising 3,129 males and 2,884 females. The crude birth-rate was 18.19 per 1,000 population. After taking into account the area comparability factor supplied by the Registrar-General the adjusted rate was 18.06. The live birth-rate for England and Wales was 17.2. During the year there were 861 illegitimate live births to residents of the Borough, representing 14.31% of the total live births for the area. Stillbirths during the year numbered 86 giving a total of 6,099 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 4,204 comprising 1,994 males and 2,210 females. The crude death-rate for the year was 12.72 per 1,000 population but after applying the area comparability factor the adjusted rate was 10.55. The death-rate for England and Wales was 11.2. 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. TABLE 1. CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1967 CAUSES OF DEATH All Ages Deaths assigned to Borough in age groups Deaths shown in localities (all ages) Males Females Under 1 year 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 upwards Putney Central Battersea Tuberculosis, Respiratory 17 8 9 - - - - - 1 4 3 5 4 4 6 7 Tuberculosis, Other 4 3 1 - - - - - 2 1 1 1 2 Syphilitic Disease 9 3 6 — — 1 — — — — 2 2 4 3 2 4 Diphtheria — — — — — — — — — — — — — — — — Whooping Cough 1 1 — 1 — — — — — - - - - - 1 Meningococcal Infections 1 1 - - - - - - - - - - - - 1 - Acute Poliomyelitis - - - - - - - - - - - - - - - Measles — — - — - — — - - - - - - - - - Other Infective and Parasitic Diseases 5 2 3 - - - - - - - 1 3 ] 1 2 2 Malignant Neoplasm, Stomach 85 59 26 - - - - - - 10 22 29 24 22 34 29 Malignant Neoplasm, Lung, Bronchus 267 211 56 — — — — 2 5 24 77 108 51 80 91 96 Malignant Neoplasm, Breast 74 — 74 — — — — 1 5 20 12 15 21 21 30 23 Malignant Neoplasm, Uterus 20 — 20 — — — — — — 4 7 6 3 7 6 7 Other Malignant and Lymphatic Neoplasms 349 178 171 — — 2 2 8 9 28 76 101 123 98 124 127 Leukaemia, Aleukaemia 18 9 9 — 1 1 2 2 — 2 5 3 2 6 7 5 Diabetes 40 13 27 — — — — — — 1 8 11 20 11 15 14 Vascular Lesions of Nervous System 493 186 307 — 1 — 1 2 9 21 43 98 318 136 182 175 Coronary Disease, Angina 742 402 340 — — — — 1 16 38 145 224 318 231 266 245 Hypertension, with Heart Disease 42 13 29 - - - - - 1 1 4 7 29 11 16 15 Other Heart Disease 546 165 381 — — — 1 — 3 15 36 69 422 75 347 124 Other Circulatory Disease 249 98 151 — — — — 2 3 7 27 53 157 72 102 75 Influenza 12 6 6 — - — — - - 1 1 2 8 3 5 4 Pneumonia 380 151 229 19 1 2 — — — 7 19 60 272 81 182 117 Bronchitis 231 166 65 2 1 — — — — 12 38 77 101 66 85 80 Other Diseases of Respiratory System 32 16 16 — 1 — — — — 2 5 9 15 9 12 11 Ulcer of Stomach and Duodenum 24 11 13 - - - - - - 1 2 6 15 5 11 8 Gastritis, Enteritis, Diarrhoea 11 2 9 2 - — 1 — — - 1 3 4 3 5 3 Nephritis and Nephrosis 21 9 12 — - — 2 1 2 - 1 6 9 5 8 8 Hyperplasia of Prostate 10 10 - - - - - - - - 1 4 5 2 5 3 Pregnancy, Childbirth, Abortion 4 — 4 — — — 1 3 — — — 1 3 Congenital Malformations 33 19 14 27 1 — — 1 1 1 2 9 12 12 Other Defined and Ill-defined Disease 307 141 166 78 2 1 1 6 9 16 38 57 99 89 11 117 101 Motor Vehicle Accidents 35 22 13 — - 2 8 3 2 3 4 2 12 12 All other Accidents 69 42 27 1 3 1 3 5 8 10 9 12 17 21 23 25 Suicide 69 44 25 — — — 10 8 11 14 10 11 5 23 24 22 Homicide and Operations of War 4 3 1 — — — 1 2 1 — — — — 2 1 1 All Causes 4,204 1,994 2,210 130 11 10 33 47 89 242 597 985 2,060 1,108 1,737 1,359 15 TABLE 2. DEATHS FROM HEART DISEASE, Males in age groups Females in age groups Grand Total under 25 25- 35— 45- 55— 65— 75 + Total under 25| 25- 35- 45 — 55— 65— 75 + Total Coronary Disease Angina, etc. - 1 15 34 116 130 106 402 - - 1 4 29 94 212 340 742 Hypertension with Heart Disease - - - - 3 4 6 13 - - 1 1 1 3 23 29 42 Other Heart Disease — - 2 8 22 27 106 165 1 — 1 7 14 42 316 381 546 Total - 1 17 42 141 161 218 580 1 — 3 12 44 139 551 750 1,330 Infant Mortality There were 130 deaths of children under one year, giving an infant-mortality rate of 21.60 per 1,000 live births. The infantmortality rate for England and Wales was 18.3. 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 Whooping Cough — — — — 1 1 Pneumonia — — 2 2 17 19 Bronchitis — — — — 2 2 Gastritis, Enteritis, Diarrhoea — — 1 1 1 2 Congenital Malformations 9 8 — 17 10 27 Prematurity 30 13 1 44 — 44 Other Causes 14 15 2 31 4 35 TOTALS 53 36 6 95 35 130 Maternal Mortality Four deaths occurred from accidents and diseases of pregnancy or child-birth. This is equivalent to a rate of 0.65 per 1,000 live and still births. 16 PART 2 COMMUNICABLE DISEASES During the year 3,344 notifications of infectious diseases were received, 1,464 more than in 1966. This increase was anticipated as measles is prevalent in alternate years. The total number of confirmed notifiable infectious diseases reported, arranged in age groups and in the areas in which they occurred, is shown in Tables 1 and 2 on pages 22 and 23. 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 71. Diphtheria No confirmed cases were reported in 1967, but early in the year a man receiving routine investigation at a local hospital was thought to be a carrier of the disease. Family contacts and a number of other persons who had been in contact with the patient were closely followed up by the staff of the department, but no further cases came to light. In all, a total of 34 contacts were swabbed. Although the patient was not found to be suffering from diphtheria, this incident is a reminder that the danger of diphtheria still exists and immunity of the population depends largely upon immunisation in childhood. Food Poisoning Investigations were made in 178 notified or otherwise reported cases during the year. One hundred and fifty of these were deemed to be not food poisoning after laboratory examination of faeces specimens taken from those affected. Of the remaining notifications 21 were single unrelated cases, while there were four minor outbreaks involving two or more persons, making a total of 28 confirmed cases. 17 Most of the patients were only slightly affected, the causative organisms being Salmonellae typhimurium (15), indiana (5), enteriditis (2) and Stanley (5). In the remaining case the laboratory was unable to identify the causative organism. In addition there was an outbreak of food poisoning in a Training College involving 67 persons. Bacteriological investigations indicated the causative agent as Clostridium welchii and a full report was submitted to the Ministry of Health. Malaria Three recurrent cases were notified, all of whom had contracted the disease abroad. Measles A total of 2,698 cases were notified compared with 1,341 in 1966. As mentioned earlier, this increase was anticipated. Meningococcal meningitis Three cases were notified and later confirmed. In addition a number of other suspected cases were investigated but the original diagnosis was not confirmed. Sonne Dysentery Of 249 notified cases, 105 were confirmed after bacteriological examination compared with 107 in 1966. Forty-five of these cases occurred at two schools in the Borough, and most of the remaining cases were single unrelated incidents. Tuberculosis The total number of new cases which came to the knowledge of the department in 1967 was 207, the sources of information being as follows:— Primary notifications 140 Unnotified at death 5 Transfers from other areas 62 Total 207 The number of deaths certified as due to various forms of tuberculosis was 21. 18 Particulars of the primary notifications and deaths during the year classified by sex and age, 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 - - - - - - 1- 4 4 5 - 3 - - - - 5-9 - 2 - 1 - - - - 10-14 — 2 - 1 - - - - 15-24 5 7 - 1 - - - - 25-44 14 14 6 9 1 - 2 - 45-64 36 6 2 2 2 5 — 1 65 and over 13 4 — 1 5 4 1 — Totals 73 41 8 18 8 9 3 1 During the year a total of 1,855 home visits were made by tuberculosis visitors, of which 561 were first visits. A reference to the work of the Chest Clinics and to the activities of the Tuberculosis Care Committees will be found on pages 76 to 79. Typhoid Fever Three confirmed cases of typhoid fever occurred during the year, two of which were brothers aged 7 and 9 years who had recently arrived in this country by air from India where it was thought they had first become infected. Both boys attended a local school during the week prior to admission to hospital and class contacts at the school were therefore bacteriologically examined. Health precautions were immediately taken at the school and the homes of children who had been in contact with the patients. In all, 47 contacts were examined and kept under surveillance and all were found to be in good health. The third case arose in a private Old People's Welfare Home in the Borough. A woman domestic aged 54 years contracted the disease and an investigation of residents and staff at the Home revealed that one of the male residents was a carrier of the disease. This man was immediately removed to hospital. It is well known that persons who have had typhoid fever in the past may intermittently excrete the typhoid germ and the Health Department closely follows up notified cases of typhoid fever with this in mind. It was considered likely that the domestic assistant had contracted the disease from the resident who was a carrier and this was confirmed by a test which showed that the germs isolated from these two persons were identical. 19 Close surveillance was made of all the remaining residents and staff in the Home; all were bacteriologically tested but no further cases were found. As the diagnosis of typhoid fever in respect of the woman domestic was made whilst she was an in-patient of a hospital outside the Borough, the case was not included in the statistics for Wandsworth. Smallpox Smallpox is a very serious disease which fortunately does not occur very often in this country. Over the recent years almost all cases have arisen directly or indirectly from persons entering this country from abroad, and with the increasing frequency and speed of air travel, this is a risk which is always present and could well be the cause of an outbreak at any time in the future. In October, the first case in Wandsworth since 1928 was reported. The patient, a Pakistani female child aged three years arrived in this country by air with her parents on 1st October, developed symptoms of fever on 9th October, and a rash had fully developed on 13th October and became vesicular on the following day. The girl was admitted to the receiving ward of a local hospital late on 16th October, and the consultant physician made a clinical diagnosis of smallpox; the consultant immediately informed my Deputy, Dr. Gordon, by telephone. At the hospital a little later I had no difficulty in agreeing the consultant's diagnosis. Arrangements were made to transfer the child to an isolation hospital at once. The mother accompanied the child to the hospital and remained there with her. At a meeting held on the following morning attended by all staff of the department likely to be concerned with the problem, the general lines of action were decided and immediately put into operation. Visits to the home were arranged to ascertain the family and other household contacts of the infected child, to the two doctors' surgeries where the patient had originally attended, and to the Teachers' Training College which the father of the child attended as a student. In order to carry out medical surveillance of all known contacts of the case seven teams were formed comprising a medical officer, a public health inspector and in some cases a health visitor or a clinic nurse. Medical surveillance, entailing physical examination and temperature recording began on the eighth day after the first contact, and was continued daily until the sixteenth day after the last contact. In certain instances surveillance was continued after the sixteenth day. Visits were made every day of the week, including Saturdays and Sundays and, of necessity, many visits were made in the evening. A comprehensive chart setting out the day-to-day commitments was prepared and essential records of the investigation maintained. The clinic in Fairfield Street was staffed and available every day for the surveillance of certain contacts, and 20 for any necessary vaccination and re-vaccination. The surveillance of contacts living in other Boroughs was undertaken by the local health authority for the area of residence. The family of the infected child resided in a house in multiple occupation, and Dr. Gordon took charge of the surveillance and vaccination of the five families living at the premises. The occupants, all of whom were from Pakistan, were confined to the house throughout the period of surveillance, and no one was allowed to enter the house without authorisation. The Council made arrangements for the welfare of the occupants including the purchase of food, collection of milk bottles and the removal of refuse and infected materials for incineration. On 20th October the father of the infected child was reported to be suffering from a fever with pains in the back but no rash. He was immediately removed to the hospital to which his wife and child had been admitted. No rash, in fact, developed in his case and it was considered possible that he was suffering from a rare form of smallpox, in which no eruption appears (variola sine eruptione). Whilst in hospital the mother was found to have contracted a form of smallpox (variola inoculatum), but the attack was comparatively mild. The mother and child made a complete and uninterrupted recovery. We adopted the policy of arranging for the vaccination of only those at risk comprising members of the public in direct or indirect contact with the case, the general practitioners, receptionists and caretakers of the surgeries, doctors and nurses in contact with the case at the hospital to which the child had been first admitted, ambulance personnel and Health Department staff. During the course of the work the medical officers performed 252 vaccinations and made 2,072 examinations at 47 premises in 21 days. As the mild case of smallpox in the mother arose in this Borough, the World Health Organization in accordance with the International Sanitary Regulations, designated the London Borough of Wandsworth an " infected area". The designation was withdrawn on 7th November. All three members of the family were discharged from hospital on 6th November. No further cases of smallpox occurred either in Wandsworth or in any other borough. Photographs depicting some of the work of the disinfecting staff following the incidence of smallpox will be found in the centre pages (Plates B and C). International Certificates of Vaccination and Inoculation During the year 6,271 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 21 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 number of 6,271 certificates authenticated, although over 12,000 less than in 1966, when the very large number received was occasioned by the smallpox outbreak in that year, is still much greater than in the previous years and confirms my earlier view that the tightening up by most countries of their vaccination requirements is causing many more requests to be made to Health Departments for the authentication of international certificates. 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. Four such certificates were issued on request during the year. Under the Public Health (Aircraft) Regulations, 1966, persons travelling to this country by air who are not in possession of a valid international certificate of vaccination against smallpox must be placed under surveillance for a specified period. Thirty such persons who were travelling to addresses in the Borough were kept under observation. Bacteriological Examinations Bacteriological examination of stools and other specimens taken in connection with food poisoning and for infectious diseases was carried out by the joint Microbiology and Public Health Laboratory, St. George's Hospital, Tooting, and 4,337 specimens, made up as follows, were examined during the year. Stool and Urine 3,944 Nose and Throat Swabs 393 Bacteriological examinations in connection with routine food sampling were carried out at the Public Health Laboratory at County Hall. 22 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 1 19 15 39 4 9 16 2 — 105 Encephalitis, Acute — 1 — — — — 2 — — 3 Erysipelas — — — — — — 1 4 4 9 Food Poisoning 4 5 3 2 — 4 6 3 1 28 Malaria — — — — 1 1 1 — — 3 Measles 134 849 757 894 37 20 6 — 1 2,698 Meningococcal Infection 1 1 — — 1 — — — — 3 Ophthalmia Neonatorum — — — — — — — — — — Pneumonia: Acute Influenzal — 1 1 1 — — 1 2 — 6 „ Acute Primary 2 — 1 6 3 3 4 14 18 51 Poliomyelitis, Acute — — — — — — — — — — Puerperal Pyrexia — — — — — 1 — — — 1 Scarlet Fever — 11 19 28 3 2 1 1 — 65 Smallpox — — 1 — — 1 — — — 2 Tuberculosis 2 9 3 3 3 13 43 46 18 140 Typhoid Fever and Paratyphoid Fever — — — 2 — — — — — 2 Whooping Cough 25 62 61 63 11 4 2 — — 228 Total 169 958 861 1,038 63 58 83 72 42 3,344 23 TABLE 2 NOTIFIABLE DISEASES NUMBER OF NOTIFIED CASES OF INFECTIOUS DISEASES IN WARDS Total 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 6 6 15 25 9 2 2 - 1 20 1 1 — 2 - 5 3 1 1 6 105 Encephalitis, Acute — - - — — — — - 1 — 1 - — — - 1 - - - - 3 Erysipelas — - - 1 — 1 — - — — — 1 1 1 3 1 - - - - 9 Food Poisoning — 1 1 3 1 1 3 - 2 I 2 1 1 2 2 — 4 1 2 — 28 Malaria - - - - - - - - 1 1 - - - - - 1 - - - - 3 Measles 176 116 169 244 150 87 142 196 110 103 189 74 69 131 27 149 89 134 173 170 2,698 Meningococcal Infection — — — — — — — — — 1 1 — — — — — — — 1 3 Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - Pneumonia, Acute Influenzal 1 — — 1 — — 1 1 1 - - - - - - - 1 - - - 6 „ Acute Primary - 1 — 3 13 1 4 9 6 — 8 1 — 2 - — 2 1 — - 51 Poliomyelitis, Acute — - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - - - - - - - - - - - - - - 1 Scarlet Fever 2 4 3 4 4 — 4 11 6 3 — 1 3 2 — 5 4 5 3 1 65 Smallpox - - - - - - - - - - 2 - - - - - - - - - 2 Tuberculosis 5 2 4 11 10 9 5 4 4 8 10 7 8 12 5 7 7 5 n 6 140 Typhoid Fever and Paratyphoid Fever - - - - - - - - - - - 2 - - - - - - - - 2 Whooping Cough 4 5 4 17 30 13 21 28 249 25 18 9 9 4 9 4 41 8 6 7 4 3 228 Total 194 134 196 309 217 114 182 158 155 223 97 86 161 177 116 154 194 187 3,344 24 PART 3 ENVIRONMENTAL HEALTH SERVICES The year under review has again been a busy one, but although one student inspector passed the Diploma Examination this only made up for the loss of one inspector who retired. It is quite obvious that, in future, greater use must be made of technical assistants to assist public health inspectors by carrying out the every-day routine inspections of certain types of premises. Housing work, both in connection with slum clearance and multiple occupation, was very actively carried out during the year, and the addition of two technical assistants working full-time on houses in multiple occupation has enabled the section to carry out a great deal of work. Notices under the Housing Act, 1961, were served for the first time for the provision of additional facilities and for fire precautions to certain houses in multiple occupation and this produced the desired effect in that all the work was carried out to these properties. Direction Orders and Management Orders were also made during the year on many properties and these also proved effective. Work in connection with the Offices, Shops and Railway Premises Act, 1963, was not as fruitful as could be hoped, mainly because of lack of staff. However, authority was given during the latter part of the year for the employment of two additional technical assistants for the purpose of carrying out visits under this Act and it is hoped that in the ensuing year far better results will be achieved. The Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966, came into operation on the 1st January, 1967, and whilst it cannot, as yet, be said that every stall complies fully with these Regulations, work to bring them up to standard has progressed throughout the year. During the year, this Authority, together with many other Authorities throughout the country, took part in an elaborate programme drawn up for the sampling of pesticide residues in food. This was 25 probably the first systematic national survey ever undertaken in any country to establish the degree of contamination of food by pesticidal chemicals. The preliminary results from this survey show no cause for alarm. 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 ReInspections Total To investigate complaints 5,852 10,797 16,649 Offices, Shops and Railway Premises Act 487 383 870 Infectious Diseases 1,184 774 1,958 Factories Act 325 - 325 Housing Clearance Area Scheme 444 - 444 Housing Reports 173 - 173 Hairdressers 164 - 164 Other inspections 6,362 3,722 10,084 Totals 14,991 15,676 30,667 Table 2 gives details of the sanitary operations carried out in the Borough during the year. 26 TABLE 2 Putney Central Battersea Total Premises cleansed and repaired 164 268 522 954 Drains tested 135 73 100 308 Drains cleansed or repaired 536 496 359 1,391 Water closets cleansed, repaired or renewed 107 135 181 423 Soil pipes altered or repaired 35 26 23 84 Waste pipes provided, altered or repaired 53 75 66 194 Rainwater pipes repaired 11 21 22 54 Roofs and gutters repaired 91 125 280 496 Damp courses inserted 2 — 5 7 Damp conditions otherwise remedied 87 139 321 547 Yards drained or paved 1 13 12 26 Dustbins provided 1 38 23 62 Water cisterns cleansed, covered or repaired - 1 11 12 Water supply reinstated 56 53 194 303 Defective stoves and fireplaces remedied 2 8 18 28 Animals improperly kept — 1 3 4 Accumulations of rubbish, etc., removed 17 36 40 93 Urinals cleansed or repaired — — 1 1 Smoke nuisances 4 1 8 13 Other nuisances 5 3 1 9 Total 1,307 1,512 2,190 5.009 Number of preliminary notices served 201 321 513 1,035 Number of preliminary notices complied with 208 327 580 1.115 Number of abatement notices served 61 152 376 589 Number of abatement notices complied with 77 158 419 654 Legal Proceedings During the year, legal proceedings were taken by the Council in seventy-one instances in connection with the abatement of nuisances. Drainage Work Drainage work to new premises, reconstruction of drains to existing premises and drainage in connection with conversion schemes are carried out under the supervision of technical assistants of the department in co-ordination with the public health inspectors. Plans are required to be submitted to the Council for approval under the drainage by-laws and during the year 339 applications were received. 27 There were 3,646 tests made in connection with drainage installations and 93 connections made to the Council's sewers during the year. The clearance and maintenance of public sewers is the responsibility of the Council and maintenance costs are reclaimed from 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 Wandsworth, in common with other Inner London Boroughs, is obtained from the mains of the Metropolitan Water Board, who are responsible for its purity. The supply, derived from the River Thames' source via the Board's works and pumping stations at Hampton, Walton and Surbiton, has been satisfactory both in quality and quantity throughout the year. All dwelling houses, numbering approximately 95,000, and the population of 330,470, are supplied from the mains of the Metropolitan Water Board with the exception of a small part of the Council's Latchmere Estate which obtains its supply from deep wells situated at the Latchmere Baths adjoining the Estate. Work was commenced some time ago to provide the whole of the Estate with water piped directly from the mains of the Metropolitan Water Board and while the work of conversion has been in progress, the Housing Department has taken the opportunity of carrying out major improvements to the properties. This has meant rehousing the families concerned and in a few cases more than the usual difficulties have been experienced in finding suitable alternative accommodation for the displaced families; inevitably this has caused delay in the completion of the Metropolitan Water Board's works. 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. The Metropolitan Water Board carries out bacteriological and chemical tests of raw water and water after treatment. Any sign of a contamination or any other abnormality is immediately ininvestigated by the Board and, in this connection, a close liaison is maintained with the Board by the public health inspectors. The fluoride content of water supplied by the Metropolitan Water 28 Board is 0.30 parts per million and in the case of water supplied to the Latchmere Estate 0.60 to 0.65 parts per million. I stated in my report last year that, after careful consideration, this Council had made a decision in favour of fluoridation but the Metropolitan Water Board has deferred action in this matter in view of the lack of unanimity of opinion between the local 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 following Acts and Regulations :— Public Health Act, 1936. Nursing Homes Act, 1963. The Conduct of Nursing Homes Regulations, 1963. and, for mental nursing homes :— Mental Health Act, 1959 The Mental Health (Registration and Inspection of Mental Nursing Homes) Regulations, 1960. The Conduct of Mental Nursing Homes Regulations, 1962. There were nine registered nursing homes in the Borough at the end of the year, with a total of 297 beds. One new home with two beds was registered early in the year but registration was withdrawn when it closed down before the end of the year. Periodic visits were made to all the homes by the Department's medical and nursing officers and public health inspectors, and in addition to the supervision of the nursing care provided and of the sanitary arrangements in the homes, there is a close liaison between the Department's staff and that of the Superintending Architect of the Greater London Council and the London Fire Brigade's Fire Prevention Officers to ensure that fire precautions and means of escape in case of fire are at all times satisfactory. The categories and accommodation of the nursing homes at the end of the year are given below, together 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) 82 beds Inspections by medical and nursing officers 20 Inspections by public health inspectors 16 Hairdressers and Barbers During the year the Council decided that its powers and duties under Part IV of the Greater London Council (General Powers) Act, 1967, be delegated to the Health Committee. Part IV 29 of the Act re-enacts the provisions which applied in Metropolitan Boroughs before the reorganisation of London government which state that no person may carry on a business as a hairdresser or barber at any premises unless he is registered in respect of those premises by the borough council. These provisions are not effective until the borough council passes a resolution fixing an " appointed day " for commencement, and this matter is to be considered by the Health Committee in the forthcoming year. Bye-laws which lay down standards of cleanliness in hairdressers' and barbers' establishments were introduced by this Council in 1966 and are being enforced by the public health inspectors; in this connection, 164 inspections of hairdressers' premises were made during the year. 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 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, 2,262 complaints of infestation were received in respect of which a total of 6,884 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. 30 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 179 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 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, 45 complaints were received in the Health Department and investigated by the public health inspectors, involving a total of 82 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 Staff shortages have again affected the degree of progress which has been achieved in the general inspection of registered premises. 31 It is anticipated however that early in 1968 additional technical assistants will be employed for specific duties under this Act and that a real advance in this work will be possible. Initial inspections under the Act during 1967 numbered 175 and the total inspections including re-inspections numbered 870. In 48 instances contraventions of the Act were found and, in general, very little difficulty was experienced in obtaining compliance with the requirements of the Act. Accidents reported during the year numbered 45 and they fall mainly into three categories:— (i) Use of hand tools. (ii) Falls of various kinds. (iii) Handling goods. One of the accidents related to a girl under 18 years of age who caught her hand in an ice-cream machine whilst cleaning it. The case was referred to the Corporation's Solicitor for legal proceedings to be taken against the employer. The following table shows the classification and number of premises registered since the operative date of the Act, up to the end of 1967, the number of persons employed and the number of inspections made during the year:— Class of Premises Number Registered Persons Employed Initial Inspections Inspections Offices 777 8,957 58 695 Retail shops 1,973 8,569 93 Wholesale shops, warehouses 111 1,273 2,087 5 Catering establishments open to the public, canteens 266 19 Fuel storage depots 4 29 — Total 3,131 20,915 175 695 The photograph which appears in the centre pages (Plate D) shows an inspector taking a light meter reading in office premises. Protection of Animals The Council have an agency arrangement with the City of London Corporation whereby that Authority's veterinary officer carries out inspections of premises in respect of which applications are received for licences under the various animal protection Acts. 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 32 animals, with particular reference to their welfare whilst kept for sale. Thirty-two licences were issued by the Council during 1967. 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. Two 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. Common Lodging Houses There are no registered common lodging houses in the Borough. Land Charges Act, 1925 During the year the Department dealt with 5,826 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. 33 HOUSING Housing Act, 1957 Clearance Areas.—Ninety-three houses were represented under Section 157 of the Housing Act, 1957 ; forty-five houses were demolished following action under Section 42 ; and fifty-two houses were demolished following action under Section 43 (2). Closing Orders.—Under Section 157 of the Act six houses and seven parts of houses were represented for closure; two closing orders were made under Section 17 (1); and eight closing orders were made under Section 18. Under Section 27 Closing Orders were determined in respect of one house and four parts of houses. Housing Act, 1961 Houses in Multiple Occupation The total number of premises known to be in multiple occupation and inspected is 2,792, shown by the following table of occupancies per house : — Occupancies: 2 3 4 5 678910 + No. of Houses: 1,362 737 307 158 91 57 37 24 19 Although a considerable amount of work has been carried out by owners to bring their premises up to a standard acceptable to the Corporation, it has been necessary to serve 17 notices under Section 16 of the Housing Act, 1961. These notices require owners to provide means of escape from fire and where owners do not comply with these notices the work is carried out in default. Notices were also served under Section 15 of the Act which provides for the installation of additional facilities within the premises. In continuation of our efforts to limit the number of tenants in over-occupied premises which do not comply with the required standards, 48 Notices of Intention were served giving notice of the Council's intention to restrict the number of occupants. Subsequently, 44 Direction Orders were served fixing the number of occupants of the premises. In three instances where squalor existed. Management Orders were made ; these orders require the person managing the premises to ensure the cleanliness, repair and maintenance of all the common parts of the property, and since the service of these notices all three now comply fully with the Council's requirements. 34 Control of Movable Dwellings Under the Caravan Sites and Control of Development Act, 1960, four caravan sites containing a total of twenty-three 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 11 Certificates of disrepair refused 2 Decisions to issue certificates of disrepair 9 Certificates of disrepair issued 4 Undertakings received from landlords 3 Applications for certificates re undertakings received from landlords 5 Certificates re undertakings issued to landlords 5 Applications for cancellation of certificates of disrepair received 4 Certificates of disrepair cancelled 3 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 1,275 applications were considered for eligibility for additional points on health grounds in accordance with the Council's points scheme. A further 505 recommendations were made in respect of Council tenants who requested transfer to more suitable alternative accommodation on health grounds. 35 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 41 to 45. The total number of food premises of all kinds on the register in the Borough is 2,558 and during 1967 they were visited on 5,307 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. 36 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 26 26 26 26 Bakers and confectioners 504 482 382 261 Butchers 171 165 171 171 Chemists 42 42 42 42 Dairies and milk depots 10 10 10 10 Fish friers 63 61 63 63 Fishmongers 36 36 36 36 Food factories 21 21 21 21 Greengrocers 195 195 195 156 Grocers 516 516 516 506 Ice-cream manufacturers 13 12 13 13 Market stalls 164 — — — Off licences 150 142 32 32 Public houses 171 165 173 168 Restaurants, cafés and canteens 476 468 482 462 Total 2,558 2,361 2,162 1,867 TABLE 2 VISITS TO FOOD PREMISES Bakehouses 199 Butchers' shops 419 Confectioners' shops 321 Dairies and milk depots 12 Fishmongers' shops 81 Fried fish shops 170 Greengrocers' shops 240 Grocers' shops 1,396 Ice-cream premises 279 Market stalls 780 Restaurant kitchens 976 Other premises 434 5,307 TABLE 3 WORK COMPLETED TO COMPLY WITH STATUTORY REQUIREMENTS Washhand basins provided 9 Sinks provided 5 Provision of hot water over sink and washhand basin 21 Accommodation for clothing provided 2 Premises repaired and redecorated 29 Dustbins provided 2 Water closet accommodation provided 5 37 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 These Regulations which came into operation on 1st January, 1967, lay down requirements as to food hygiene in respect of markets, stalls and delivery vehicles. The principal requirements of these Regulations relate to :— Cleanliness of stalls and delivery vehicles. Cleanliness of persons engaged in the handling of food and of their clothing. Hygienic handling of food. Provision of water supply and washing facilities. Proper disposal of waste material. Granting of certificates of exemption for certain requirements. During the year applications were received from 67 stallholders for certificates of exemption. These were granted by the Corporation and referred to the following Regulations Reg. 15 Water supply 58 Reg. 16 Personal washing facilities 57 Reg. 18 Food and equipment washing facilities 67 The principal difficulty in securing stallholders' compliance with the Regulations related to proper screening to prevent contamination of food and in this respect 23 cases were referred to the Corporation's Solicitor. 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 60 applications for registration under the provisions of Section 16(l)(a) and 19 applications for registration under the provisions of Section 16(l)(b) were submitted to the Council. In all cases the premises were found to be satisfactory and registration was granted. Legal Proceedings—Food and Drugs Act, 1955 Summonses were issued against a number of traders for offences under this Act and the reasons for prosecution and the Court's findings are given below:— Subject of complaint Fine Costs Mouldy pie £5 0s. 0d. £5 0s. 0d. Foreign matter in bread (three summonses) £30 0s. 0d. £10 0s. 0d. £30 0s. 0d. £10 0s. 0d. £50 0s. 0d. £10 0s. 0d. Adulterated milk £5 0s. 0d. £2 0s. 0d. 38 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 19 applications were received from persons to be registered as distributors of milk. In each case the certificate of registration was granted. Seven notices of cancellation of registration were received. At the end of the year there were 232 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, 150 samples of milk were submitted for analysis to which reference is made on page 44. 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 1967 is given below :— Special designation Number of licences issued "Pasteurised" 34 "Sterilised" 15 " Untreated " 7 Milk (Special Designation) (Amendment) Regulations, 1965 These regulations provide for the issue of Dealers (Prepacked Milk) Licences under the special designation "Ultra-Heat Treated" and 13 applications for such licences were received during the year. Brucella Abortus No samples of raw milk were examined for Brucella Abortus during the year. Most of the milk sold in Wandsworth is processed but in previous years we have been 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 171 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 419. 39 Slaughter oi 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 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. Seventy-two visits were made to the above premises during the year, the number of birds processed being 109,750, made up of broilers, hens, ducks, pheasants, turkeys and capons. The percentage of birds rejected as unfit for human consumption was .007 and the weight of poultry condemned as unfit 132 lb. The very small percentage of birds rejected as unfit for human consumption is by reason of the fact that the birds have already been inspected at the farms where they are killed. 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 99 such shops in the Borough and 251 inspections were made during the year. Catering Establishments All restaurants, cafes, canteens and kitchens were regularly inspected throughout the year. There are 476 such premises on the register, and 976 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 780 inspections were made during the year. Liquid Egg (Pasteurisation) Regulations, 1963 There are no egg pasteurisation plants in the Borough. Bakehouses There are 26 bakehouses in the Borough and during the year 199 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. 40 Bacteriological Examination of Food Three hundred and sixty-nine food samples were examined bacteriologically at the Public Health Laboratory during the year, and details are given below:— Milk 24 Ice Cream 106 Prawns and lobsters 219 Miscellaneous 20 Total 369 Milk The 24 samples of milk submitted to the turbidity test were reported to be satisfactory. Ice-cream The 106 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 56 2 3 13 8 4 29 Total 106 Prawns and lobsters The 219 samples submitted were random samples taken from imported consignments held in cold storage prior to release to the importers. Miscellaneous The 20 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; 150 samples of milk, 770 other foodstuffs and 80 drugs. Of these 65 were submitted as formal samples, while 935 were purchased informally. Six of the formal samples and 78 of the informal samples were found to be adulterated or below standard, representing 8.4 per cent, of the total samples submitted. Details of these 84 samples are given in the Report on the work of the Public Analyst which follows. 41 REPORT ON THE WORK OF THE PUBLIC ANALYST FOR 1967 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. For some years it has been the practice, and Committee authority has been given, for the submission to the Analyst of 1,000 samples of food and drugs per year. Of the 1,000 samples, 150 were milk and the remaining 850 were foods and drugs, the majority being of various food commodities. Practically all the milk sold now is produced by the large milk combines which are efficiently run and up-to-date concerns whose products are maintained at a high nutritional level. Despite improvement in methods of food production and manufacture and the lessening tendency for any adulteration to occur, I am firmly of the opinion that samples of milk and, indeed, of all foods, is necessary, but I consider that the number of milks could be reduced from 150 to 100 and the number of other foods sampled raised from 850 to 900 per year. My proposals to this effect were discussed by the Health Committee in the latter part of the year, and approval given by the Committee to the suggested variation in sampling. It was decided to operate the new arrangement as from 1968. Of the 1,000 samples submitted to the Public Analyst during the year under review, 65 were taken with the formalities required by the Act and 935 taken informally. The number of food samples was 920 and the remaining 80 were drugs. The samples submitted for analysis included the following substances : — Beer, Wines and Spirits 3 Beverages (cocoa, coffee, tea, etc.) 24 Cereal preparations 38 Cheese products 23 Confectionery 85 Cream 49 Fats (butter, margarine, etc.) 60 Fish (canned, etc.) 20 Fruit (canned and dried) 41 Ice-cream 21 Meat products (including sausages) 105 Milk 150 Milk products 16 Pickles and condiments (including spices) 100 Preserves 50 Soft drinks 58 Soups 9 Vegetables 68 Drugs 80 42 SAMPLES FOUND TO BE ADULTERATED OR BELOW STANDARD Case No. Nature of Sample Report Formal 112 Fat (frying) Incipient rancidity 121 Milk 2% extraneous water 125 Cheese, soft Excess water: 1'% 130 Meat paste with butter Not more than 0.5 % of butter fat 159 Buttered rolls No butter fat 165 Milk Extraneous water—Certificate (9%) Informal 1539 Jaffa lemon drink Deficient in sugar 1542 Jaffa orange drink Deficient in sugar 1552 Ground nutmeg Deficient in volatile oil 1556 Cream cake (bun) Contained fat other than butter fat 1557 Cream cake (slice) Virtually no butter fat present 1558 Cream cake (bun) Virtually no butter fat present 1559 Cream cake (split) Virtually no butter fat present 1560 Cream cake (finger) Virtually no butter fat present 1561 Cream cake (cornet) Virtually no butter fat present 1562 Cream cake (slice) Virtually no butter fat present 1570 Cream cake (slice) Contained fat other than butter fat 1576 Honey Labelling: no English on label 1577 Honey Labelling: no English on label 1578 Honey Labelling: no English on label 1650 Buttered rolls Contained fat other than butter fat 1651 Buttered rolls Contained fat other than butter fat 1652 Buttered rolls Contained fat other than butter fat 1653 Buttered rolls Contained fat other than butter fat 1659 Beef spread & butter Contained not more than 0.6 % butter 1666 Nutmeg Deficient in volatile oil 1707* Foreign matter in bread Bread contained mouse dirts 1717 Cheese, soft, full fat Deficient in total solids 1746 Ice pops Contained lead in excess of permitted limit 1795* Gravy browning Pine type disinfectant spilt on the packet 1796* Gravy browning Pine type disinfectant spilt on the packet 1799 Beef spread with butter No butter present 1818* Foreign object in corn flakes Contained a compressed lump of filthy paper 1854 Ice cream Slightly deficient in fat 1915 Ice pops (soft drinks) Mould growth and fermentation 1921 Ice pops (soft drinks) Mould growth and fermentation 1930 Ice pops (soft drinks) Mould growth and fermentation 1931 Ice pops (soft drinks) Mould growth and fermentation 1932 Ice pops (soft drinks) Mould growth and fermentation 1933 Ice pops (soft drinks) Mould growth 1954 Nutmeg 66% deficient in volatile oil 1958 Buttered rolls Contained no butter fat 1966 Ice pops (soft drinks) Mould growth 1967 Ice pops (soft drinks) Mould growth and fermentation 1968 Ice pops (soft drinks) Mould growth and fermentation 1969 Ice pops (soft drinks) Mould growth and fermentation 1984 Spaghetti in tomato and cheese sauce No cheese flavour 1989 Ice pops (soft drinks) Mould growth 43 Case No. Nature of Sample Report Informal 1999 Dried milk Labelling: " Non Fat" (contained 0.7% fat) 2012 Milk top 21.5% deficiency of fat 2038 Jaffa orange drink Deficient in fruit juice 2039 Jaffa lemon drink Deficient in fruit juice 2069* Foreign crystals in baby food Contained Epsom Salts 2070* Foreign crystals in baby food Contained Epsom Salts 2111* Foreign matter in tin of baby food Contained a house fly 2131* Foreign matter in tin of baby food Contained a gnat 2132* Foreign matter in bread Contained dirty dough 2133* Foreign matter in bread Contained dirty dough 2135 Stewed steak Deficient in meat 2145 Cooking butter Incipient rancidity 2192 Orange squash Fermenting 2195 Buttered rolls No butter fat 2209* Foreign matter in bread Contained orange mould 2215 Ground mustard Deficient in volatile oil 2221 Fruit and nut chocolate Labelling: More nut than fruit 2251 Table cream Labelling 2253 German mustard Deficient in volatile oil 2258 Jiffi Jelly Labelling: Jelly with fruit but the jelly was labelled with the name of the fruit flavour added to the jelly—not with name of the actual fruit present in the mix. In each case the fruit present was pineapple 2266 Foul Medames Labelling: Beans not in the list of ingredients 2272 Poultry liver with wine Labelling: Poultry liver present in small amount 2277* Foreign matter in tin of baby food— Fruit dessert Contained cooked meat 2322 Pineapple Tidbits Labelling: Not labelled "in syrup" 2394 Pineapple pieces Labelling: No mention of sugar 2401 Spice No English on label 2402 Gourmet powder Labelling: The title is insufficient description 2403 Fried oysters Labelling: No oil mentioned 2404 Instant curry-fish Labelling: Contained no fish 2414 Whole moath Labelling: No English name 2415 Whole maash Labelling: No English name 2418 Dripping No packer's name or trade mark 2428 Milk top Deficient in fat, no "usual " name 2440 Avlochlor tablets Two tablets had wrong coding 2482* Foreign matter in bread roll Contained dirty dough 44 The thirteen 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 ten 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 Report 1575 Rancid butter No rancidity or acidity detected 1627 Bitter taste in milk Bitter taste not confirmed 1648 Milk alleged to have been reconstituted from powdered milk Not confirmed 1667 Chocolate sponge contained safety pin No evidence that pin was baked in cake 1706 Bread and butter: suspected of being margarine Fat was butter 1755 Black specks in dried milk Very small particles of charred milk 1913 Rancid ground nut oil Rancidity not confirmed 2171 Bad beer Not confirmed 2261 Bad cider Not confirmed 2276 Unpleasant flavour of double cream Not confirmed Milk Samples The minimum legal standards relating to the composition of milk are as follows:— Ordinary milk Channel Islands and South Devon milk Milk fat 3.0% 4.0% Non-fatty solids 8.5% 8.5% Total milk solids 11.5% 12.5% During the year, 150 samples of milk were submitted for analysis (135 ordinary milk and 15 Channel Islands or South Devon Milk). Of these, two samples of ordinary milk were found to be below the minimum standard and appropriate action was taken. Pesticide Residues in Foodstuffs The Corporation accepted an invitation from the Association of Municipal Corporations to participate in a scheme which would enable a systematic enquiry to be carried out into the extent of 45 contamination of foodstuffs by toxic chemicals. The foods to be sampled were selected by the Association of Public Analysts and the Corporation was to be responsible for taking 18 samples of specific foodstuffs for submission to the Public Analyst. The results of the examination of samples were as follows:— Sample Pesticide contaminant (parts per million) White loaf B.H.C. 0.007 Wholemeal loaf B.H.C. 0.044 D.D.T. Traces and related compounds Beef B.H.C. 0.009 Cooking apples T.D.E. 0.016 Eating apples D.D.T. 0.042 and traces of related compounds Onions None detected Organic-phosphorous compounds Present Carrots None detected Potatoes Dieldrin 0.005 D.D.E. Trace T.D.E. 0.016 D.D.T 0.028 Cauliflower B.H.C. 0.010 Lettuce B.H.C. 0.024 DDE. 0.008 D.D.T. 0.049 Dried milk Dieldrin Trace DDE. 0.004 D.D.T. 0.007 Oatmeal None detected Baby food (vegetable and beef) B.H.C. 0.021 Tea B.H.C 0.011 Dieldrin 0.013 D.D.T. 0.180 and traces of related compounds Fish (whiting) None detected Sultanas T.D.E. 0.100 and traces of related compounds Beef (skin) T.D.E. 0.008 Milk B.H.C. Traces Dieldrin Traces For the purposes of the scheme it was decided that amounts of these compounds below certain limits (depending on both the type of pesticide and the type of food) should be considered insignificant. 46 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 I 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 140 47 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,084 239 5 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 107 15 1 - Total 1,331 301 6 — (2) DEFECTS Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 1 1 - 1 - Sanitary Conveniences: (a) insufficient - - - - - (b) unsuitable or defective 19 8 - 4 - (c) not separate for sexes — - — — - Other offences against the Act (not including offences relating to outwork) 1 1 - - - Total 21 10 — 5 — 47 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(l)(c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel— making, etc. 137 - - - - - Household linen 3 - - - - - Curtains and furniture hangings 4 - - - - — Artificial flowers 8 - - - - - Paper bags 4 - - - - - The making of boxes 6 — — — - — The making of baskets 1 — — — — — Carding of buttons 1 - - - - - Brass articles 2 — — — — — Lampshades 9 — — - — — Total 175 — — — — — 48 ATMOSPHERIC POLLUTION CLEAN AIR ACT, 1956 Smoke Control Areas During the year the London Borough of Wandsworth (No. 1) Smoke Control Order—the first Order in the Council's revised smoke control programme—came into operation. A further Order, the London Borough of Wandsworth (No. 2) Smoke Control Order was made and submitted to the Minister of Housing and Local Government but confirmation of this Order had not been received by the end of the year. A map showing existing and proposed smoke control areas will be found facing page 48. Smoke, etc., Nuisances and Observations During the year, 48 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 249 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. Seven 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 Map of London Borough of Wandsworth showing Wards and Smoke Control Areas 49 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 the table below. 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. Roof— 207 Lavender Tooting Queen Mary's Station Municipal Hill Library Hospital Buildings Battersea Roehampton Month—1967 Smoke SO2 Smoke SO2 Smoke SO2 Smoke SO2 January 160 361 182 341 179 246 91 121 February 146 345 160 304 162 261 120 149 March 231 302 141 210 120 191 91 181 April 124 341 92 261 102 221 60 143 May 82 181 76 147 92 146 51 96 June 70 214 60 102 62 121 46 81 July 61 202 51 76 52 66 49 71 August 70 141 39 70 56 83 62 63 September 72 206 140 122 73 210 66 107 October 168 302 172 261 129 242 131 170 November 204 314 206 282 192 241 176 220 December 211 240 214 317 209 271 140 174 Average 133 262 128 208 119 191 90 131 50 MISCELLANEOUS MATTERS Swimming Baths In Wandsworth there are four public baths and one open-air swimming pool belonging to the Corporation and one open-air swimming pool owned by the Greater London Council. 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 (see photograph, centre page, Plate A) and are submitted for bacteriological examination at the Public Health Laboratory at County Hall. During the course of the year 86 samples were submitted for examination and satisfactory results were obtained in 84 instances. In the remaining samples there were slight deviations from normal, but subsequent tests proved satisfactory in all cases. In addition to the baths mentioned above, there are open-air swimming pools at three of the Corporation's Children's Homes, one of which is situated at Banstead in Surrey. Satisfactory samples were taken by Banstead Urban District Council in respect of the Home in their area and by this department's inspectors in respect of the pools at the two children's homes in Wandsworth Several Inner London Education Authority's schools in the Borough have indoor swimming baths and during the year 73 reports were received from the Scientific Branch of the Greater London Council in respect of eight of these baths, all of which were satisfactory. Examination of Water from Artesian Wells and Taps Twenty-six samples were submitted for examination at the PublicHealth 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 effective " 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. 51 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 Seven hundred and fifty treatments were given during the year at the Personal Cleansing Station in Sheepcote Lane to persons suffering from scabies, 361 to adults, 294 to schoolchildren and 95 to children under school age. In addition 442 treatments for verminous conditions were given, 46 to adults, 347 to schoolchildren and 49 to children under school age. Ninety-two treatments to residents of the London Borough of Lambeth were also given under the existing arrangements with that Authority. 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 I referred in my report last year to the need to concentrate these services in one building and in July the use of the disinfecting station at Blackshaw Road, Tooting was discontinued. Some of the more serviceable equipment there was transferred to the Battersea disinfecting station to supplement the existing equipment. Reference was also made last year to the lack of facilities at Tooting and it may be of interest at this time to make some historical reference to the old Blackshaw Road station. At the time this station was first opened on 21st September, 1905, the facilities which it offered, augmented in the following year by the addition of two bath houses, made it one of the most 52 complete disinfecting stations in the country. Until the 1940's the station proved well able to cope with the demands made upon it, but as the years have passed, bringing improved standards of living and housing and changes in social habits, the pattern of the demand has changed. We are now able to provide services such as the laundry service for incontinent persons which hitherto did not exist and which has proved a boon to many aged and infirm persons. 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 1967, are set out in the following table:— Details of Bodies Received Usual Place of Residence Total Wandsworth Merton Elsewhere Unknown Post-mortem only 617 256 137 25 1,035 Post-mortem and inquest 145 44 22 2 213 Total post-mortems 762 300 159 27 1,248 Inquest only — — — 1 1 Total inquests 145 44 22 3 214 Sanitary and other reasons - - - - - Total bodies received 762 300 159 28 1,249 Verdicts at Inquests held— Accidental and Misadventure 56 12 12 — 80 Alcoholism - — 2 — 2 Natural causes - - 1 1 2 Industrial disease 4 1 - - 5 Open verdict 8 - 2 1 11 Suicide 73 25 5 1 104 Homicide 4 5 - — 9 Manslaughter — 1 — — 1 TOTAL 145 44 22 3 214 In addition to the above, a further 74 inquests were held at the Coroner's Court in respect of which no bodies were received into the Mortuary. Crematorium Regulations, 1930 Under these regulations, 1,904 cremations were authorized during the year. 53 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 1967, three inspectors attended a three-day refresher course organised by the Association of Public Health Inspectors and one inspector attended a part-time course extending over six weekly afternoon sessions at the South-East London Technical College on the subject of smoke abatement. Student Public Health Inspectors The number of students who may undertake training with a local authority is limited by the Public Health Inspectors Education Board 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 were filled at the end of the year. Students attend day release courses at the South-East London Day College and their training includes a full programme of visits and practical training with a qualified inspector. At the beginning of the year five student inspectors were under training in the Department. During the year, one of these successfully completed his training and was appointed as a public health inspector and two further students were appointed to undertake training. 54 PART 4 PERSONAL HEALTH SERVICES These services are provided by the Council, in its capacity of local health authority, under those sections of the National Health Service Acts designed to safeguard the health of the individual and to provide care and attention should ill-health occur. A large part of the service is concentrated on expectant and nursing mothers and young children, as pregnancy and early childhood are vital stages in the health and development of the child and the adult. This aspect of the work, as advances in medical and social care have progressed, is admittedly relatively less important as was formerly the case, and the family as a whole—rather than the individual or any single age-group—has come to be regarded as the health " unit". Nevertheless for the purposes of this report it is convenient to divide these services into those for mothers and young children and those which we may term " other services To some extent, of course, the 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 Ante-natal and post-natal care The decrease in the number of home confinements continued— 727 as against 927 in 1966—and correspondingly fewer attendances at ante-natal clinics. There was continued co-operation with general practitioners; midwives attend sessions in two surgeries and one doctor 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 542 First attendances of mothers 2,589 Total attendances of mothers 5,370 55 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 217 First attendances of mothers 453 Total attendances 1,919 Average attendance at each session 8.9 Child Health Clinics All centres have had a very busy year and attendances at all sessions have been steadily maintained. The child health sessions provide much more than advice and immunisation. For many mothers the visit is a social occasion and they receive a great deal of help and support which in other circumstances might have been given by the extended family group. We are now planning to hold an evening child health session for mothers who are at work during the day. In order to ensure that health visitors can give all their time to essential work with mothers attending child health sessions we now have at each centre a state registered nurse to assist with immunisation and a clinic auxiliary to assist with preparation of centres, records, etc. In several centres there are also voluntary helpers, who give valuable service and for whose help we are most grateful. Mothers' Clubs Mothers' Clubs are held in three centres and these are run on a partly social and partly educational basis. They meet a real need especially in new housing areas. We find that a group of mothers will meet together for about two years and then will dissolve itself and a new group is formed. Toddlers' Clinics Special sessions for toddlers (children aged from two to four years) are held at 12 child health clinics. The children are given routine medical examinations and if necessary they are referred for treatment. Toddlers' sessions held during the year 302 Total attendances 3,682 Average attendance at each session 12.2 56 Dental Service A dental service for expectant and nursing mothers and for young children is provided in conjunction with the school dental service at certain of the Council's dental surgeries. During the year there were 61 attendances by mothers and 477 by children under five years of age. Family Planning The Council continued during 1967 the arrangements whereby the Family Planning Association acted as its agent and provided the service for Wandsworth women. In its annual report the Southwest London Branch of the Association referred to the scheme put forward by the Council in May, 1966, as the most comprehensive proposed up to that date by any local authority in England. That scheme, which was in force throughout the greater part of 1967, provided that the Council should accept financial responsibility for advice on birth control and supplies of contraceptives to all patients living in the borough and referred to an Association clinic on medical grounds, whether the reference was by a Council doctor, a general practitioner or an Association doctor. The experimental domiciliary service showed early in 1967 that it was proving as successful as had been hoped and the Council agreed to pay the net cost of visits to mothers who needed contraceptive advice but were unwilling or unable to attend clinics. The extension of the service was under review at the time of writing and is to be continued and where necessary extended. On 28th June, 1967, the National Health Service (Family Planning) Act, 1967, received the Royal Assent and the Ministry of Health wrote to all local health authorities urging them to take full advantage of the powers provided by the Act. One of the most important provisions enabled them to provide advice on contraception and supplies for any persons needing them on social grounds and not, as hitherto, only in medical cases. The Minister emphasized that an adequate family-planning service, fully integrated with other community services, was an essential part of family welfare and would help to relieve the burden placed on other services by the physical ill-health and mental distress arising from lack of knowledge and advice. Advice, examination, prescriptions and supplies should be free in medical cases but a charge could properly be made for prescriptions and supplies in non-medical cases. No distinction was made in the Act between the married and the unmarried. The Minister urged that authorities should consider the provision of a domiciliary service for use in special circumstances, where despite the need for advice a woman could not be persuaded to attend a clinic. In October the Borough became the first local health authority in Britain to implement fully the powers given by the new Act and 57 to offer free family-planning advice to all; the Minister's advice was accepted in full. This means that Wandsworth provides a completely comprehensive service, based on the clinics but providing for home visits where these prove to be necessary. Advice or treatment to unmarried persons between the ages of fifteen and twenty-one years is given at the discretion of the doctors attending such cases at the clinics. There is no hard-and-fast rule, each doctor using his clinical judgment on the merits of the individual case. Where patients are under the age of 16 years they may be seen by a doctor at a clinic, but normally no advice or treatment is offered and the patient is referred to an appropriate hospital. Charges are made for supplies or appliances provided for nonmedical cases, but are subject to abatement in necessitous circumstances. By agreement with the Local Medical Committee, a nonmedical patient who is unable to afford supplies or appliances prescribed by a family doctor may be referred by the doctor to the nearest family planning clinic, where the items can be supplied and the charge assessed in accordance with a scale laid down by the Council. In this way there is complete freedom of clinical judgment for the general practitioner and the patient is able to benefit from the scheme which applies, of course, to all Wandsworth residents. Applications for reduced charges are kept completely confidential and are dealt with by the Association. In order to simplify the financial arrangements between the Council and the Family Planning Association it was decided that the Association would be reimbursed the net approved expenditure on clinics operating in Wandsworth and that that expenditure should include an appropriate proportion of branch-office costs and contributions. This decision has cut out much of the accounting procedure formerly necessary on each individual case and has contributed to the smooth running of the scheme. Much of the credit for the excellent co-operation between the Association and the Department must go to the Association officers, in particular to Mrs. L. Harvey, the Chairman, and to Mrs. R. Crampton Smith, the Organizing Secretary. It is most gratifying to find such amicable relationships between voluntary and official bodies. At the end of the year there were 12 sessions being held weekly in Wandsworth, six in the evening and six during the day. The following tables show the work carried out during the year. A. New patients (Domiciliary work is shown in brackets) (i) Number of cases seen Medical 168 (22) Social 1,287 (65) Total number seen 1,455 (87) 58 (ii) Age at attendance 16-20 160 (4) 21 and over 1,295 (83) (iii) Method chosen Oral contraceptive 710 (27) Cap 376 (2) Intra-uterine device 214 (46) Other methods 146 (3) Advice only 9 (9) (iv) Sources from which patients were referred General practitioner 530 Friend 420 Local authority 296 (87) Hospital 39 Other 170 (v) Number of previous pregnancies of new patients Pregnancies Patients 0 486 (-) 1 314 (-) 2 250 (11) 3 174 (16) 4 108 (20) 5 50 (11) 6 40 (12) 7 and over 33 (17) B. Cases transferred from other clinics 272 C. Established patients attending for the first time during the year 5,727 E. Number of sessions attended by doctor 505 Total number of attendances to see doctor 7,676 F. Number of visits by doctor to domiciliary cases 214 Total number of patients seen at visits 87 G. Number of cytological smears taken from patients : (i) at clinics 629 (ii) at domiciliary visits 17 Number in (i) referred for investigation 3 H. Number of patients (non-medical cases) receiving free supplies 59 Maternity Beds In my last report I mentioned the great improvement brought about by the scheme which set up catchment areas for the main maternity hospitals. This improvement has continued and there is now little or no difficulty in obtaining a maternity bed when it is needed. Plate a Water Sampling-Taking a sample of swimming bath water for analysis (see page 50). Page Plate B Infectious Disease—Sealing a room prior to fumigation after a case of smallpox (see page 19). Plate C Infectious Disease—Cleaning a room after fumigation following a case of smallpox (see page 19). Plate D Offices, Shops and Railway Premises Act—Taking light meter readings in office premises (see page 30). 59 Early Discharge of Maternity Patients In suitable cases mothers are booked for hospital confinement on the basis that, with the agreement of the doctor and the midwife, they may if they wish be discharged 48 hours after delivery. This scheme is very popular with the mothers and with the co-operation of the hospitals concerned works extremely well. Unfortunately, these planned early discharges sometimes have an upsetting effect on the other mothers in the ward, some of whom occasionally take their own discharge against medical advice ; they are then, naturally, given all necessary medical and nursing care but it is not a happy situation. Domiciliary Midwifery Service The number of home confinements continues to decline and some consequential reorganisation of the domiciliary midwifery services has been necessary. Two midwives retired during the year and it was not found necessary to replace them. The area allocated to each midwife has been enlarged and for relief purposes the midwives now work in two groups instead of three, with the result that each midwife may have to travel considerably increased distances to cover her work. The midwives have now been classed as essential car-users and all except four are using cars; two of the four will be retiring shortly. Two midwives are buying their cars with the help of loans from the Corporation. Entenox (gas and oxygen) apparatus has been ordered for all midwives who are car drivers, since this up-to-date type of anaesthetic apparatus is too heavy to carry on a bicycle. Three of the new anaesthetic outfits have been in use for some time. All midwives undertake the care of mothers discharged under the booked early-discharge scheme and for the assessment of caseloads two early discharges rank as one home delivery. On this basis each midwife undertook an average of 40.5 cases during the year. Of the 490 early discharges 159 were unbooked and of these 59 were against medical advice. All cases receive adequate care on discharge but many unbooked cases come home to unsuitable conditions. Two general practitioner obstetricians now attend their own ante-natal patients in Council clinics and six midwives attend antenatal clinics in general practitioners' surgeries. Mothers attended in their own homes during the year were as follows :— Home confinements 725 Booked early discharges 331 Unbooked early discharges 159 60 Health Visiting Service This has been a very busy year for all the health visitors with an increasing shortage of staff from April onwards. This shortage was partly due to vacancies which we were unable to fill and partly due to staff being away on maternity leave and one health visitor having to have special leave for domestic reasons. The six health visitor students who were sponsored by the Council in September, 1966, all qualified and took up duty as health visitors in September, 1967, and were a very welcome addition to the staff. Unfortunately we were able to recruit only four students this year and these should be ready to start work in September, 1968. With limited staff we have had to concentrate our efforts on essential health visiting duties. All babies born during the year to mothers resident in Wandsworth were visited. All families with children under five moving into the area were also visited as soon as their arrival became known to the health visitor. There is a great deal of movement in and out of the area and every effort is made to trace the addresses of those moving out so that the child health and family records can be forwarded to the receiving area. Even so quite a large number move away and cannot immediately be traced. Families with special problems may need a great deal of help and may require frequent visits. As far as possible all children are followed up either by home visiting or at the Child Health Clinics until they go to school at the age of 5 years. A summary of the health visitor's record and any available medical records are then forwarded to the school so as to be available at the child's first school medical examination. The number of first visits made during the year to children under five years of age were :— Children born in 1967 5,946 Children born in 1966 5,207 Children born in 1962/65 11,730 Visits of all kinds paid by health visitors during the year totalled :— Effective visits 55,980 Unsuccessful visits 12,793 Premature Infants Any child weighing 5£ 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. The 61 numbers of premature births during the year were as follows :— (a) Born in hospital 449 (b) Born in hospital and died within 28 days of birth 41 (c) Born at home or in a nursing home 9 (d) Born at home or in a nursing home and died within 28 days of birth 1 (e) Premature stillbirths in hospital 34 (f) Premature stillbirths at home or in a nursing home 1 Handicap and Observation Register During the year the Handicap and Observation Register of children under five years of age was further streamlined. This was achieved through closer co-operation and better communication with paediatricians of hospitals as well as general practitioners. In addition to periodic developmental examinations carried out by the medical officers at child health clinics, family doctors and hospital specialists have provided most helpful information about children likely to develop physical or mental handicaps. In order to establish a continuity of care for the physically and mentally handicapped until and beyond school-leaving age, and following a general agreement with other Greater London Boroughs, a special index system was adopted so that sufficient information could be obtained to allow a wider perspective and better planning of educational facilities before the handicapped child reaches school age. The Handicap and Observation Register comprises all those children who are notified to the Medical Officer of Health as being at risk of developing a handicap as a result of a number of predisposing conditions, and those presenting malformations at or soon after birth. In addition to children placed on the Register at birth, or soon after, all well children attending our child health clinics are given periodic examinations and screening tests for conditions such as phenylketonuria (inborn errors of metabolism), deafness, etc. Whenever abnormalities are discovered, or should a child develop an illness which may result in handicap at a later stage, detailed information is passed to the Senior Medical Officer by the health visitors or by means of discharge reports from hospitals. These children are then placed under observation in order to assess the degree of handicap which may result from the illness. As the criteria for inclusion in the Register are closely defined, approximately 9% of the total live births are placed on the Register within a month of birth; 2% of this figure have been found to have some congenital malformation or abnormalities. Although the majority of the children placed on the Register are under observation for at least a year, some are removed from the Register a little earlier ; that is, when the child's development is seen to be normal. The health visitor plays an important role in detecting delayed 62 development in children up to the age of five years and this is especially important in relation to those children who are seldom taken to any child health clinic. She often reports such cases to the responsible medical officer who in turn initiates investigation through the family doctor in the first instance. In some cases reference to a special clinic for ascertainment is required. When a handicap is confirmed, close liaison is established with all those concerned with the child's future, including educationalists at all levels and consultant medical specialists. While the usefulness of the Handicap and Observation Register has not been questioned, the criteria of choice and the method of follow-up of all children included in these Registers in all parts of the country have come under some professional criticism in the medical press. As I have said above, the criteria for the selection of cases for inclusion in the Register in our Department are quite strict; the selection is carried out by a suitably qualified medical officer with free communication and consultation at all levels and this has resulted in our Register being most comprehensive. This, together with an efficient follow-up scheme for all handicapped children in Wandsworth, leaves no doubt in my mind that the value of the Register is well established. Inevitably a number of physically handicapped children are in the care of the Children's Officer, and indeed some of the children in care are considered to be at such risk of abnormal development that they are placed under observation by reason of emotional deprivation in early childhood. A constant exchange of information about these children is therefore necessary and the liaison between specialists, hospitals and the Children's Officer is often established through the Health Department. Advice is often sought on suitable placement of physically or mentally handicapped children in care and requests are made to assess the needs of some of these children. Symptoms of deprivation and neglect are often first noticed by the health visitor and where it is felt that the child should be received into the care of the Council, the Children's Officer is informed. There is also exchange of information with the Welfare Department relating to the blind and partially-sighted and as the Handicap and Observation Register is now being extended to embrace children of school-age it is planned that particulars of children with serious physical handicaps will be notified to the Chief Welfare Officer just before the child leaves school so that further suitable provision can be made, particularly with regard to the social problems and needs of the handicapped. Close co-operation with the Medical Adviser of the Inner London Education Authority is established as soon as a handicap is diagnosed and always before the child reaches school age. There is also close liaison between the Greater London Boroughs and other authorities when handicapped children change residence. 63 Perhaps of lesser importance is the role of the Handicap and Observation Register in facilitating research projects carried out in the field of preventive medicine; genetics, malformation, malignancy in childhood, blood diseases, etc., which are initiated by various bodies such as the Medical Research Council, the Institute of Child Health or the Greater London Council's Research and Intelligence Unit; an example of this is the investigation into the incidence of spina bifida and anencephaly in London which is referred to on page 68 of this Report. The following tables give some statistical information about the number of children on the Handicap and Observation Register:— Total number of children under five years of age 27,500 Number on the Handicap and Observation Register on 31st December, 1967 1,513 Age (years) On Handicap and Observation Register Observation Handicap Under 5 1,513 1,248 265 Under 1 557 511 46 1 396 349 47 2 289 241 48 3 194 136 58 4 77 11 66 Number of children on the register on 1st lanuary, 1967 1,844 Number placed on the register during 1967 963 Number taken off the register during 1967 1,294 Number placed on the register within three months of birth 583 Notifications (to the Registrar General) of congenital mal-formations observable at birth in live and stillborn children:— Central nervous system 24 Eye and ear 6 Alimentary system 13 Heart and great vessels 4 Respiratory system 1 Urogenital system 7 Limbs 44 Other skeletal 5 Other systems 10 Other malformations 10 Total 124 64 Additional congenital abnormalities (not observed at birth) notified on hospital discharge notices:— Central nervous system — Eye and ear 3 Alimentary system 5 Heart and great vessels 3 Respiratory system — Urogenital system 3 Limbs 34 Other skeletal 1 Other systems — Other malformations 6 Total : 55 (in 54 children) Unmarried Mothers Unmarried mothers need all the personal health 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 health services of the Borough. 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 During the year the department greatly extended the Cervical Cytology Service. Two new clinics were opened and publicity campaigns produced very good responses. All women over 25 years of age are offered the service. A short medical history is taken and there is then a full gynaecological examination during which cervical and vaginal smears are obtained. The sessions are conducted by women doctors with gynaecological experience and in every case the family doctor receives a full clinical and cytological report. Women attending a clinic are notified of the result directly in all negative cases but whenever a clinical condition warranting treatment is found the patient is advised to see her family doctor. Cancer prevention requires constant publicity and unceasing health education of women who are at risk. This has been done 65 through the medium of posters, leaflets and booklets, which were sent to all general practitioners in the area, health clinics and the public libraries. Some family doctors have a particular interest in this work and examine their own patients. In other areas of practice this does not meet the demand and many doctors therefore prefer and encourage their patients to attend our clinics and I should like to thank the family doctors for their co-operation. In October arrangements were made for a doctor and nurse to visit a large factory in the Borough for a weekly cervical cytology clinic. One hundred and five of the female staff had been examined by the end of the year. This clinic resulted from an approach made to all private industrial firms in Wandsworth in which these facilities were offered for their employees. It is envisaged that when the factory staff have been fully screened, similar facilities will be made available at other factories in the Borough. It has been claimed that women at higher risk are likely to be found among factory and manual workers and it is hoped that our attempt to detect cancer in this manner may be particularly valuable if, in the long term, it does show a higher detection rate. During the year, 295 sessions were held in Council clinics and 14 at the factory premises. Examinations carried out were respectively 1,792 and 105. One case of malignancy was found in the 105 persons examined at the Wandsworth factory but the incidence of malignancy at Council clinics was one in 271 examinations. Detailed statistical information covering the whole year is given in the following table :— Number of sessions held weekly in Council clinics 6 Total number of women examined 1,897 Average number of women examined per session 7 Total number of cases cytologically and clinically negative 1,105 Total number of cases with morbid conditions needing specialist care 300 comprising :— (i) positive malignant smears 7 (ii) cervical erosion 97 (iii) cervical polyp 44 (iv) ovarian cyst 12 (v) uterine fibroids 40 (vi) all degrees of prolapse 27 (vii) vulvo-vaginitis and cervicitis 54 (viii) other conditions 19 Detailed statistical information covering the whole year is given in the following table:— Number of sessions held weekly in Council clinics 6 Total number of women examined 1,897 Average number of women examined per session 7 Total number of cases cytologically and clinically negative 1,105 Total number of cases with morbid conditions needing specialist care 300 comprising :— (i) positive malignant smears 7 (ii) cervical erosion 97 (iii) cervical polyp 44 (iv) ovarian cyst 12 (v) uterine fibroids 40 (vi) all degrees of prolapse 27 (vii) vulvo-vaginitis and cervicitis 54 (viii) other conditions 19 66 Total number of cases with morbid conditions in need of general-practitioner care 492 comprising:— (i) non-specific vaginitis 128 (ii) other conditions 364 These figures show a high proportion of other abnormalities in need of treatment. In the Cervical Cytology clinic there are close links between the pathologist, gynaecologist, clinic doctor and general practitioner. It is important to notify the general practitioner of each positive smear as soon as it is diagnosed, and to know what arrangements he makes for his patient so that a full follow-up can be arranged from the cytologist through the gynaecological surgeon to the pathologist. The need for this follow-up is well understood by the clinic doctors who are in a key position to ensure the necessary liaison. It is no less important to mention, as was emphasized in my report for last year, that in addition to the benefit of early detection of malignant disease, the relief from anxiety afforded to all women who undergo the screening tests is of immense value. During the year we have once again had the full support and help of Dr. Elizabeth R. Hicks of the South London Hospital for Women and Dr. Hussain of St. Stephen's Hospital, and we are greatly indebted to them for their co-operation and their prompt reporting on the smears sent for examination. Occasional Creches These three-hour play sessions are extremely popular and it has become necessary to restrict attendances for each individual child to one a week except in special circumstances. Not only does the mother benefit from having a few free hours to herself but the children benefit immensely from the opportunity of having space in which to play and sharing their play with other children. A number of children attend primarily for health or medical reasons. Day Nurseries The demand for nursery places continues to be very heavy and it has only been possible to admit children with a high priority or for short periods during a domestic emergency. These emergency admissions enable many children to remain in their own homes when mother goes into hospital. A number of deaf children have been admitted free for three hours daily and this arrangement has now been extended to other children needing priority admission on medical grounds. The staffing situation in day nurseries has given rise to concern almost continuously throughout the year. Great credit must be 67 given to all the staff who have maintained the service even during very difficult periods but it has been a great strain, especially on senior staff. From time to time it has unfortunately been necessary to restrict admissions until the staffing situation has improved. The increase in the number of nursery students from 14 to 21 last September has eased the situation in our training nurseries and should eventually lead to an increase in trained staff available. 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 illness. These infectious diseases have a considerable nuisance effect as they cause delay in the admission of new children to the nurseries. Private day nurseries and child-minders At the end of 1967 there were 44 private day nurseries with registered places for 1,000 children, 39 statutorily registered childminders with places for 247 children, and five voluntarily registered child-minders with places for 10 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. 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. During the year fourteen cases were agreed to be suitable for adoption and eleven were found suitable for boarding out. In addition, medical advice was sought in respect of 34 prospective adopters. Health Surveys As in previous years, the Health Department has assisted whereever possible in surveys promoted by the Greater London Council and various independent organizations. Details of some of these are set out below : — Schizophrenic illness after childbirth 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. Three cases were referred to this Authority during the year. 68 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 continued to assist the Research and Intelligence Unit of the Greater London Council in a study designed to discover the prevalence of spina bifida in Greater London and to provide information of the various problems connected with this congenital handicap. The intention is to obtain sufficient details to enable more specialised studies to be launched at a later date. A further six cases were notified during 1967. 69 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 3,688 persons was 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 148 426 634 5-64 years 1,083 26,854 27,937 65 years and over 2,457 99,150 101,607 All ages 3,688 126,490 130,178 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 the number of patients being supplied with incontinence pads has increased considerably. Various types are available and are supplied according to need and during the year a total of 28,900 pads were issued, which is more than four times as many as in the previous year. In addition, 82 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 51. 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. The number of occasions on which articles were issued on loan during the year is shown below : — Air rings 12 Beds (hospital or cot) 15 Back rests 15 70 Bed cradles 12 Commodes 225 Fracture boards 8 Hoists 14 Mattresses 5 Ripple beds 3 Rubber sheeting 6 Walking aids 11 Wheelchairs 45 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 1967 Aged under 65 years on first visit in 1967 Total Chronic sick and tuberculous Mentally disordered Maternity Others 3,086 334 23 119 226 3,788 71 Immunization and Vaccination As the figures show, the majority 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 can be completed in three months instead of six. This has helped considerably by halving the number of visits needed for immunization. Immunization and Vaccination Statistics Smallpox vaccination—cases completed:— Primary vaccinations:— Council clinics and schools 2,660 General practitioners 760 Total 3,420 Re-vaccinations:— Council clinics and schools 193 General practitioners 203 Total 396 Diphtheria immunization—cases completed:— Primary courses:— Council clinics and schools 4,774 General practitioners 994 Total 5,768 Reinforcing injections:— Council clinics and schools 6,146 General practitioners 1,463 Total 7,609 Whooping-cough immunization—cases completed:— Primary courses:— Council clinics and schools 3,710 General practitioners 881 Total 4,591 Reinforcing injections:— Council clinics and schools 1,741 General practitioners 852 Total 2,593 Tetanus immunization—cases completed:— Primary courses:— Council clinics and schools 5,040 General practitioners 1,067 Total 6,107 72 Reinforcing injections:— Council clinics and schools 5,952 General practitioners 1,493 Total 7,445 Measles vaccination—cases completed:— Council clinics and schools General practitioners 19 Total 19 Poliomyelitis vaccination—cases completed:— Primary courses:— Council clinics and schools 5,805 General practitioners 919 Total 6,724 Reinforcing doses:— Council clinics and schools 6,255 General practitioners 1,185 Total 7,440 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 6 Other adults 170 Children under five years, not attending school 47 School-children, including nursery school-children 173 Chiropody The Council provides some 45 sessions weekly at foot clinics where treatment is provided for old people, expectant and nursing mothers, school-children and the physically handicapped. In addition, treatment is given in the surgeries of private chiropodists acting on behalf of the Council. Where patients are able to walk but unable to reach the clinic, arrangements are made for them to be provided with ambulance transport. Domiciliary treatment is arranged for housebound patients. Number of sessions held:— (a) at clinics 2,197 (b) at private surgeries 88 (c) at old people's centres 36 Number of patients seen for first time in 1967:— (a) at clinics 2,874 (b) at private surgeries 242 (c) in their own homes 1,372 73 Number of treatments:— (a) at clinics 14,194 (b) at private surgeries 1,142 (c) in patients' own homes 7,024 During the year the Council agreed to appoint a Chief Chiropodist and, although no appointment had been made by the end of the year, I am confident that the appointment will give an added impetus to this growing service. 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 From its inception the Council accepted the need to make the community aware of its services and its own responsibilities, and took the view that we should follow an active policy of health education, the basis of which should be to inculcate and foster the idea of good health and wellbeing of both the community and the individual. This should be done by regarding health education as an integral part of the normal day-to-day work of the Health Department because the services provided by the Department were in themselves a potent means of health education. In 1967 the Council agreed to the appointment of a health education officer who should be suitably qualified. Owing to the need for stringent economies, however, it proved necessary to postpone the appointment. Some of the health education activities which have taken place during the year are described below. (a) In Child Health Clinics Regular courses for expectant mothers are held at six Child Health Clinics and consist of six or eight sessions which include a relaxation session and talks on preparation for labour and the care of the young baby. Health visitors and midwives run these courses jointly. In several of the clinics one or two evening sessions for fathers are also held in conjunction with each course. 74 These classes are limited to those clinics which can accommodate them, since it is obviously not practicable to use church halls or very small, crowded premises, and we are therefore looking forward to being able to extend this work in the future as new premises become available. (b) In Schools Two health visitors undertake regular health education in schools and several others have taken part in short courses from time to time. All teaching in schools is planned in close co-operation with school staff. Informal health education is carried out by all health visitors and school nurses as the opportunity arises in their routine work in schools. Especially good work is done with adolescent girls who frequently seek advice from the nursing staff. We have again 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, drugs and sex education. Ten secondary and five primary schools were visited and 27 lectures were given to 1,449 secondary and 150 primary pupils. In addition, the Inner London Education Authority organised antismoking exhibitions and film shows in Greater London Council Parks during the summer months. (c) In Colleges of Education From time to time we are invited to send a health visitor into Colleges of Education in the area either to talk about her work or to participate in a health education session. We are always pleased to arrange this and feel that it is very important to establish links with the teachers of the future. (d) In Local Clubs and Groups A number of invitations are received to talk to groups of women, such as Young Wives' Qubs, Townswomen's Guilds, etc. We have been able to meet all these requests, and are always delighted to take the opportunity of offering the services of our staff to these more mature groups of citizens. Tooting and Balham Carnival Procession This annual event was held in July and the Corporation entered six floats depicting various aspects of the theme "Learn to Stop Accidents". The Health Department was responsible for planning a float on "Home Safety Home safety—Accidents in the Home Most accidents in the home occur to the old and the very young. Old people sometimes do not realize that their mental powers are failing or that their reactions are slowing down, and the very 75 young child cannot be expected to realize the potential hazards in every home. The safety of old and young may depend largely on how far parents and others are aware of the dangers that exist. Safety booklets and leaflets are distributed regularly but it is often the spoken word which proves most effective. 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 unpublicized 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 these may be lent to the mothers of young children where the mothers cannot afford to buy guards. During the year the Council issued 15 fireguards under these arrangements. It has long been felt that there is insufficient available evidence about accidents in the home, and in an endeavour to overcome this difficulty we adopted a scheme already in use in some other London boroughs. A supply of forms and leaflets was sent to hospitals and general practitioners for issue to the relatives of any patients who had suffered an accident at home. The relative was asked to complete the form, which was prepaid, and post it to the Health Department. Unfortunately the response has so far been disappointing; it appears that many relatives are not bothering to co-operate and are thereby lessening the value of what could be a most valuable study. Family casework and problem families The social workers (health services) are engaged for part of their time in the school health service but their duties also include the family casework relating to problem families. All the families which were supervised during the year had multiple difficulties which included separation of the parents, general inadequacy, unemployment, poor health, debts, gambling and violence. Several families are very large by present day standards (up to 12 children) and some of the mothers have little knowledge of the basic principles of child care. On the other hand, some families do have a high standard of cleanliness with good physical care of the children although many fail to understand the emotional needs of their offspring. The mothers are frequently depressed under the weight of their problems, some bordering on mental illness, and are often unable to make social contacts. Every effort is made to maintain the family as a unit and to raise their standards sufficiently to prevent a repetition of the same problems in the next generation. 76 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 17 and 18. There is close liaison between the Chest Clinics and the staff of the Health Department and periodic meetings are held between the three Chest Physicians and the Health Department medical staff. The welfare officers, tuberculosis visitors and clerical assistants concerned with the after-care of tuberculous patients are seconded from the Health Department so that there are close links at all levels. Additional benefits are provided for chest clinic patients through the agencies of the Battersea and Wandsworth Tuberculosis Care Committees and I have pleasure in appending reports of the activities of these two Committees during the year. I would like to place on record my appreciation of excellent work they have undertaken during the year on behalf of their patients. 77 WANDSWORTH TUBERCULOSIS CARE COMMITTEE ANNUAL REPORT FOR 1967 The year has been one of change as well as activity. There were several changes on the Committee. Mrs. Morgan resigned. Mr. Morris of the Ministry of Social Security retired and was succeeded by Mr. J. W. Daniel. Miss Knight has joined our Committee representing the Family Welfare Association. The Handicraft Class has continued but its activity has been limited owing to the difficulty of finding an Instructress. We hope to be able to solve this problem very soon. In the meantime the Class continues to meet and provides a much welcome social occasion. There were many calls for assistance in such items as clothing, bedding, holidays and monetary gifts to cover a variety of needs— the number has increased. At Christmas we gave our usual presents to patients and their families which were greatly appreciated. The patients enjoyed an outing to Eastbourne in May and to Brighton in September. Our thanks are due to Mr. and Mrs. Ireland who accompanied them and brought them safely back. The Sale of Work this year was on a smaller scale than usual but none the less it was most successful. It was opened by Alderman Carnie, C.B.E., J.P., the Mayor of Wandsworth, who was accompanied by the Mayoress. The Mayor made a very appreciative speech. I would like to place on record once again my thanks to all who have assisted and co-operated with us during the year, including the Women's Royal Voluntary Service 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. Simpkin. DEODORA CASSELS, Chairman. 78 BATTERSEA TUBERCULOSIS CARE COMMITTEE ANNUAL REPORT FOR 1967 In presenting our Report for the year 1967 we must first note several changes in the membership of this Committee. It is with regret that we report the death of Dr. H. L, Gulati, J.P., who had served the Committee in the first years of its formation, and after an absence had then rejoined the Committee in 1962. Mr. L. H. Parker, our Treasurer, retired in June and we are happy that his successor as Borough Treasurer, Mr. C. C. Hinge, agreed to become Treasurer of our Committee. We were sorry to receive the resignation of Mr. R. Wackett. Mr. Wackett had represented Battersea Park Rotary Club since 1963 and the Committee owes a great deal to his keen interest and readiness to help. He has given personal attention to many of our cases and we would place on record our appreciation and thanks for the valuable services he has rendered. Mr. Mark Landsberg has succeeded Mr. Wackett as representative of Battersea Park Rotary Club, Mrs. L. Chesterman filled the vacancy created by the resignation of Mrs. Cooper, and Mr. J. E. Davis, Warden of the Katherine Low Settlement joined the Committee in November; Miss J. Knight succeeded Miss U. Malleson as Principal Family Social Worker, Family Welfare Association. We welcome all these new members. The Committee has continued to meet at monthly intervals and our thanks go to the Battersea, Putney and Tooting Group Hospital Management Committee for providing us with facilities for our meetings. The work of the Committee has continued as before in response to the many calls for help which have been received, and we have managed to meet these needs from our funds. The provision of clothing and footwear has accounted for the largest proportion of the year's expenditure. Although the statutory benefits are just adequate, in most cases there is little margin for saving for even the most essential items of clothing. We have received a large amount of secondhand clothing from members and other friends and all has been put to good use. £75 was disbursed as Christmas gifts to out-patients attending the Chest Clinic, and further cash gifts were made to patients spending Christmas in the Chest Wards in St. John's Hospital. Toys were received from the Evening News " Toy for a Sick Child " Fund and were distributed in time for Christmas. We also received some splendid gifts of toys from various child donors and other friends. Two Old Tyme Dances held during the year have helped in great measure to improve our financial position. We thank Wandsworth Borough Council for the concession granted to us for the use of the large hall at Battersea Town Hall. £72 and £117 respectively were credited to funds. Mr. T. E. Collyer again undertook all the arrangements for these two events. Apart from the very gratifying results, we thank Mr. Collyer for the time and effort 79 which he has given so freely to make these occasions both happy and profitable. It was decided to discontinue the Autumn Draw which has hitherto been an Annual event. However, it was agreed that an approach should be made to the firms who had responded in the past to our appeal in connection with the Draw. It is with pleasure that we record our thanks to the following firms who contributed donations and prizes which added to the credit of the Old Tyme Dances:— Messrs. Carsons-Paripan Limited. Messrs. Dawson & Company Limited. Messrs. J. Lyons & Company Limited. Messrs. The Rom River Company Limited. Messrs. Stanley Bridges Limited. Continuing our money-raising activities it was decided to hold a Jumble Sale. This took place in October, at the Katherine Low Settlement, Battersea, with the kind permission of the Settlement Committee. The event was a successful one and raised the sum of £27 14s. Od. It is hoped to hold further sales of this nature. It should be mentioned here that we still continue the collection and sale of milk bottle tops and tin foil. It is hoped to increase our revenue from this source with the help of the Pensioners' Clubs. No report would be complete without recording our thanks and appreciation of the support we have received during the year. Our close co-operation with the officers of the Ministry of Social Security and the Disablement Resettlement Officers of the Ministry of Labour has continued and contributed in great part to the welfare of our patients. Our thanks must be expressed to Queen Mary's London Needlework Guild, the Wireless for the Bedridden Society, the Morganite Carbon Company Limited and the Battersea Park Rotary Club. We also remember with appreciation the gifts of money, clothing, books and toys donated by our many friends. 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 (Miss) N. F. CLARK-LAWRENCE. Chairman. Care of Old People I would like to place on record my appreciation of the co-operation I have received during the year from officers of the Welfare Department and the expert advice of medical consultants, especially the geriatricians at St. John's Hospital, Battersea, and St. Benedict's Hospital, Tooting and those other individuals and bodies concerned with the welfare and health of old people resident in the Borough. 80 Inevitably there are times when it becomes essential for old people to enter a home or to be admitted to hospital. Before that takes place however it is the constant endeavour of the staff of my department to provide every possible assistance to them. In this connection I am grateful to the health visitors, district nurses, public health inspectors, social workers and home helps for their excellent work. I also express my gratitude to the general practitioners, whose care for the elderly patients in their charge contributes so much towards the alleviation of ill-health and the reduction of disability. General practitioners have many opportunities of detecting disorders in old people during the early stage of illness. A complementary service could be provided by clinics for old people who would not otherwise come under the observation of a doctor. I have held discussions about setting up advisory health clinics for the elderly, but as yet the discussions have been purely exploratory. A frail old person living alone presents special problems, and the problems become even greater if the old person decides not to accept any domiciliary service, and neither relatives nor neighbours are at hand to give the help and support which the occasion demands. The general practitioner and the consultant geriatrician may reach the conclusion that admission of an old person to hospital is essential in order to treat the condition which is threatening the patient's life. If despite advice the patient refuses to be treated in hospital, the question of compulsory removal may require consideration. Under the National Assistance Acts the Medical Officer of Health is empowered to apply for an Order for the compulsory removal to hospital of persons needing care and attention, and who are living in adverse circumstances specified by the Acts. On several occasions during the year the possibility has arisen of having to resort to legal action in order to facilitate medical treatment, but by dint of much perseverance and effort on the part of the domiciliary workers all difficulties were overcome and compulsory powers were never invoked. With the agreement of the Chief Welfare Officer I list below the seven old people's homes which his department maintains for the care of the elderly:— Brockle Bank, 77 Swaffield Road, S.W.18 Ashmead, 201 Cortis Road, S.W.15. Carlton Lodge, 21 Victoria Parade, Broadstairs, Kent. Holybourne, Holybourne Avenue, S.W.15. Milton Close, 78 Swaffield Road, S.W.18. Park Lodge, 6 Victoria Drive, S.W.19. Yew Tree Lodge, 2 West Drive, Streatham, S.W.16. In addition there are nine day centres for the elderly, three day centres for the physically handicapped and six luncheon clubs. 81 MEDICAL EXAMINATION OF STAFF The medical examination of existing and prospective staff is undertaken in the Health Department on behalf of all departments of the Council. Before appointment, every prospective new entrant to the service is requested to complete a medical questionnaire and a physical examination follows only in those cases where the information disclosed or the nature of the employment indicate that it is desirable. STAFF TRAINING AND STUDENT TRAINING Staff Training and Refresher Courses Three health visitors and two midwives attended refresher courses during the year and a number of other staff attended short courses arranged by the London Borough Training Committee. The non-medical supervisor of midwives also attended a refresher course. Four health visitor students were sponsored in September and should be qualified and ready to join the staff in September, 1968. Eight nursery students sat for the examination of the National Nursery Examination Board in July, 1967. Six of them passed and one re-sat and passed in November, 1967. Three of the successful students were appointed as nursery nurses and the other four left to take up other appointments or to take further training. The remaining student has been appointed as a nursery assistant. During the year four home nurses took either the three- or fourmonth course of district nurse training at Chiswick Polytechnic, the practical work for this course being carried out in Wandsworth. The Principal Nursing Officer attended a one-week's course on "Management" arranged by the London Boroughs Training Committee and two Day Nursery Matrons attended a week's course at Sunningdale. Four midwives and four health visitors attended a course on "Teaching Mothercraft and Relaxation to Expectant Mothers" organized by the Centre Superintendent at Putney Health Centre. Health visitor students As in previous years, arrangements were made for eight health visitor students from the University of Surrey to undertake the three periods of practical work required during their year of training. We also arranged two weeks' practical experience for two students from another area. 82 Student nurses from local hospitals A programme of single-day visits was arranged for 321 student nurses. A health visitor gave one or more talks in the hospitals concerned prior to these visits and attended a discussion and question session after the visits. These arrangements entail a great deal of work for the staff but do help to forge links between the hospital and community services. Senior Hospital Nursing Staff From time to time arrangements are made for departmental or ward sisters from hospitals to spend a day or half-day to learn about the home nursing, midwifery and health visiting services of the Council. This is especially useful in relation to the hospital and domiciliary midwifery services. 83 PART 5 MENTAL HEALTH SERVICE The year 1967 saw a substantial increase in the number of patients referred to the Mental Health Section of the Department. The service continued to expand and we have been able to achieve a marked increase in the number of professionally trained social workers. The reputation of the Department is consequently attracting highly skilled staff, and this, together with the casework consultation offered to all the social workers, is constantly raising the standard of help offered to the community. An increase in the number of staff in the Training School and Training Centres has made it possible to widen the teaching programme, and two trainee teachers have also been appointed. A very successful Mental Health Week, run in conjunction with the Boroughs of Lambeth and Merton. drew the attention of the community to the problems of mental disorder, to the services provided to help the mentally ill and mentally handicapped, and to the ways in which the community itself—family, neighbours, friends, employers—can contribute to the rehabilitation of the patient. Several voluntary bodies and individual people expressed interest in this work, and already volunteers have made a valuable contribution by helping in clubs, escorting patients to hospital and in other ways. In addition, a Steering Committee has been formed to look into the development of voluntary effort in the mental health field in the Borough. STATUTORY DUTIES UNDER MENTAL HEALTH ACT, 1959 As the statistics show, admissions of patients to hospital under the Act continue to be numerous and make heavy demands on the service, although the continuous co-operation of hospitals in offering beds is very helpful to the mental health social workers in 84 coping with the increased numbers who have to enter or re-enter hospital. This is of course a twenty-four hour service and the night and weekend work is still undertaken "on call" from home in combination with the London Boroughs of Lambeth and Southwark. COMMUNITY CARE OF THE MENTALLY DISORDERED Co-ordination with hospital services A major event in the area has been the opening of Oak House, a hostel for working psychiatric patients, run by Tooting Bec Hospital in its grounds. The majority of the patients living in the hostel are Wandsworth residents and each week one of the assistant principal mental welfare officers meets the social workers and the warden thus securing the maximum co-ordination for the rehabilitation of the residents. The warden spent one week in our own hostel, Chellow Dene, so that our residential staff there could share their experiences with him. We look forward to even closer cooperation with the staff of Oak House in the future. The two assistant principal mental welfare officers continued their weekly liaison work with West Park and Tooting Bec Hospitals respectively, and a mental health social worker attended Queen Mary's Hospital, Carshalton, on a fortnightly basis. The social work in the three day hospitals in the area, i.e. West Park and St. George's, Tooting Bec, and Springfield, is carried out by the mental health social workers, and it has been possible to offer an increase of two sessions to West Park and St. George's. The mental health social workers also undertook the social work for three out-patient clinics at St. James' Hospital, West Park and St. George's Day Hospital and at the William Harvey Centre. Facilities for attending conferences at West Park, Tooting Bec and Queen Mary's Hospitals are offered to the mental health social workers, who can also attend, as observers, an out-patient clinic for mentally handicapped children run at St. George's Hospital, where they are able to observe a consultant psychiatrist's diagnostic and consultative work. Chellow Dene Hostel This hostel for patients who have been psychiatrically ill aims to rehabilitate them in a supportive community setting. Patients are admitted either directly from hospital or from the community, where they may not be functioning adequately, and with the guidance and assistance of the social workers in the department and the hostel staff, the majority of those admitted are able to live 85 pendently on discharge from the hostel. The following figures give details of admissions and discharges during the year 1967:— Male Female Total Patients in residence on 1.1.67 10 8 18 Admissions during the year 11 11 22 Discharges during the year 14 12 26 Discharged patients—disposal (a) to home 1 1 2 (b) to lodgings 4 6 10 (c) to self-contained flatlets — 2 2 (d) to other hostels 3 — 3 (e) to hospital 4 3 7 (f) other (including one died) 2 — 2 The hostel has been in existence since July, 1962 with very satisfactory results and it was felt the time had come to start a new venture. Accordingly in July a "week-end" scheme was introduced. The purpose of this scheme is to dispel any uncertainties felt either by patients or by the staff about admission to Chellow Dene. Of the three patients admitted in this way, the first confirmed our own doubts, and his, that he would be unable to live in the hostel. In the second case, a woman patient was observed to be too ill for admission to the hostel, and the third, after two weekends at the hostel felt positive about the help he had from the hostel and requested admission. The patients from hospital spend Saturday and Sunday at Chellow Dene (when there are beds available) and make a contribution towards the cost. Self-contained flatlets The first residents of these self-contained flatlets moved from Chellow Dene to their new homes in November, 1966. Of the ten residents, two have since had to be readmitted to hospital. The eight other residents have successfully lived almost independent lives in the flatlets. There have been three admissions to the flatlets during 1967 (one directly from the community). There can be no doubt that the residents of the flatlets are greatly helped by the proximity of the hostel and by being invited to use the facilities offered there—i.e. the group on Monday nights, meeting friends and relations at the hostel, having the occasional meal and having the support of the residential staff. In September of this year a Committee from the Ministry of Health visited Chellow Dene and the flatlets. The object was to discuss the setting up of hostel accommodation for epileptics. Both the hostel and the flatlets had several visitors during the year, all with a view to learn from our experience and to follow the lead given in this development by this Borough. 86 Social Clubs The Tooting and Putney social clubs continue to provide a very valuable service to both mentally ill and mentally handicapped patients. Very successful parties were held during the year and the combined annual outing to the coast was attended by a record number of club members. A mental health social worker attends the Gateway Club run by the Wandsworth Society for Mentally Handicapped Children. This club, which is extremely successful, is now meeting weekly instead of fortnightly and has a membership of approximately 50 handicapped young people. The Council helps with transport each week by providing a minibus and driver. The Society has also organised a swimming club which meets every Sunday at Crystal Palace. The members are so enthusiastic that attendance has been very high throughout the winter. Group for Depressed Mothers and their Husbands The group, which helps families to adjust to depressive illness following childbirth, continued to meet fortnightly. Group for Mothers of Handicapped Children The Mothers' Group at Tooting, which had met for two years was finally disbanded when most of the mothers attending felt that they had been helped over their problems. The Department is now planning to start another group in a different area. Group for Mothers of Disturbed Children One of the mental health social workers was able to take on a group for mothers of disturbed children run at Roehampton Child Guidance Clinic when the social worker from the clinic left to take a new appointment. This is a valuable group which enables mothers to get together to work out ways in which they can help their children. Liaison with Health Visitors Senior mental health social workers are now attending weekly sessions at Child Health Clinics, where they can see patients and their families in an office nearer to their homes. They are also able to discuss mutual problems with the health visitors and this provides a most useful contact and co-operation which no doubt benefits the patients who are known both to health visitors and mental health social workers. 87 Occupational Therapy During the year, 33 patients were visited by our two occupational therapists. Of these 29 were mentally ill and four mentally subnormal. Most of them were seen once a week, a few once a fortnight, on a regular basis. Some short term cases were also visited. These mainly involved assessment and acquisition of industrial outwork. The ages of those visited ranged from 17 to 82 years. As in hospitals, occupational therapy at home involves many activities, by which the patient can benefit. These should always be concrete and of purposeful direction, and this must wherever possible, be explained to the patient. The majority of people visited are chronically ill, and interests range from traditional handicrafts which encourage initiative and provide a basic interest, to household management, cookery, decorating, hair-dressing and dressmaking. Whenever possible social activities are encouraged, particularly participation in a group. Close co-operation with voluntary bodies such as Task Force, the Women's Royal Voluntary Service and the Christian Service Centre has proved to be most beneficial. The invaluable work carried out by these organisations cannot be overestimated. The occupational therapist has obtained outwork for the training centres though this has been seriously impeded due to the credit squeeze. This work involves many contacts with manufacturers, numerous telephone calls and interviews, and close liaison between patient and manufacturer. In all their work, our occupational therapists maintain close contact with the psychiatrist, general practitioners and social workers who may also be in touch with the patient. Day Centres Although there are three day hospitals in the area, the Council itself does not at present run a day centre for the occupation and rehabilitation of mentally ill patients. However, it has been possible to place five patients in the day centres run by the Borough of Southwark and the City of Westminster, and I am very grateful for the help offered by these authorities. Special Clinics Special Clinics for diagnosis and consultation for subnormal children continued to be held at Balham Child Health Clinic and at St. Christopher's Clinic, Battersea. 88 Social Counselling for Pre-school Playgroups Arrangements were made for mental health social workers to act as social counsellors to some of the pre-school playgroups in the area to help them over the problems that might arise from having mentally handicapped children in the group. As a result three children have already been placed in these groups and are deriving benefit from mixing with and being stimulated by normal children. Training School and Centres During the year we were faced with problems of staff shortages as well as a shortage of places for trainees, and other boroughs, who already had waiting lists, were unable to offer us any further places in their training centres. By the end of the year, however, we had been able to recruit our full increased establishment of staff and had appointed in addition two trainee teachers. We were thus enabled to introduce many progressive changes. Wandsworth Training School The change of name from Wandsworth Junior Training Centre to Training School indicates the changed attitude towards the teaching programme for mentally handicapped children. An extra class was opened so that the teachers now have smaller classes to teach, and a special class for brighter children was started with a concentration on the teaching of the "3 Rs". There is in fact a greater emphasis on education in all the classes, as opposed to mere training. For instance a very successful "tuck shop "was started and by this means the children can be taught the value of money and independence in making their own small purchases. A group of children were invited to attend the Sports Day run by St. Anne's Primary School and greatly benefited from their contact with the primary schoolchildren. The staff were helped in developing their work by the kind invitation extended by Meadway E.S.N. School for our staff to spend some time at this school observing their teaching methods. A member of the staff was also seconded to a day release course held by the London Boroughs Training Committee. The staff at the school organized a very successful bazaar which helped to raise £50 for the school fund. This will be used for outings and improvements in the school. The sessions for speech therapy at the school were increased from one to two. A Parents/Teachers meeting held one evening was very successful and enabled the parents to discuss the progress of their children at school. 89 Balham Training Centre fur Adult Girls A very successful laundry is now being run at this centre. The girls do the laundry work for their own centre, as well as for Wandsworth Training School. They also undertake the laundry for some Child Health Clinics. The standard of work is extremely high and the girls are very proud of their achievements. A very high standard has also been attained in cookery. Many mothers are now ordering their Christmas cakes, jams, marmalades and pickles from the centre, which also prepares the refreshments for any special gatherings at Wandsworth Training School. Here again the trainees are deservedly proud of their work. Many mothers have told the staff how delighted they are as their daughters are doing quite skilled cooking at home. At a very successful Open Day all articles exhibited were sold to parents and friends attending the Centre. The standard of dressmaking and craft work is extremely high and the centre has no difficulty in selling all the articles it produces. Orders for stools have been received from Canada and America. Both the trainees and the staff enjoyed an outing to Kew Gardens and they also attended a School Leavers' Exhibition run at Wandsworth Town Hall. Newlands Training Centre The extra room which has now been obtained for use as storage for industrial work has enabled the centre to accept larger orders. One of the firms supplying industrial work is so pleased with the high standards achieved by the centre that they are proposing to offer more advanced and difficult work. The television set which was very kindly supplied by the Wandsworth Society for Mentally Handicapped Children for a trial period at the Centre proved to be a most successful experiment and the television is now being hired by the Health Committee on a permanent basis. Contact was made with the Children's Librarian in the Borough, as a result of which a stock of books is being held at the centre and a lending library has been started and is being used very enthusiastically by all the girls, who take books home from the centre. An outing was organised to Chessington Zoo, as well as to the School Leavers' Exhibition. Home Teacher A home teacher visits mentally handicapped children who are too physically handicapped to attend training centres. Although her services are shared with other boroughs, the proportion of work that she is carrying out for Wandsworth has increased this year. 90 Special Care Units Our minibus transports ten severely handicapped children to Queen Mary's Hospital, Carshalton, and to Morden Special Care Unit on a daily basis. This does not, by any means, meet the full needs of the Borough for Special Care Unit places, and we are maintaining a waiting list for this service. Short-term Care Temporary relief was offered to many families of handicapped children and adults. In 1967 the numbers of children and adults placed in short-term care were:— Under 16 years 37 Over 16 years 37 Total 74 Long-term Care This is a developing service and during the year a total of 85 patients were maintained in long-term care. Fifty-six of these were still in residence at the end of the year in the care of the homes or organizations shown below:— Mental After-Care Association 12 Guardianship Society 10 Richmond Fellowship 5 St. Mary's Convent 5 Cheshire Foundation 3 Sheltered accommodation 3 St. Jude's Hostel, Westminster 2 Easton House, Hackney 2 St. Joseph's Special School 1 Hampton Manor Home 1 National Society for Mentally Handicapped Children 1 Other approved accommodation 11 Total 56 STAFF TRAINING AND STUDENT TRAINING Staff Training The two mental health social workers who were seconded to the two-year Younghusband course successfully completed their first year. Another member of the staff was seconded on full salary to the one-year Mental Health Course at the London School of Economics. These three members of the staff have been replaced temporarily by qualified staff. An Assistant Supervisor from Balham Training Centre was seconded to the one-year Diploma Course at Chiswick Polytechnic. 91 The qualifications of social workers in the Mental Health team at the end of 1967 were as follows:— Professionally Qualified Social Workers : Psychiatric Social Workers 8 Master's Degree in Social Work (equivalent to Mental Health Certificate) 1 Certificate in Social Work 3 Social Science Degree or Diploma 4 Unqualified 1 Greater difficulty was experienced this year in recruiting trained staff for the Training School and Centres. The qualifications of training centre staff in our service at the end of the year were as follows:— Diploma for Teachers of the Mentally handicapped 7 Letter of Recognition (General Nursing Council) and Certificate of Royal Medico-Psychological Association 1 Registered Nurse, Mental Subnormality and Certificate of Royal Medico-Psychological Association 1 Untrained 6 Trainees (untrained) 2 Student Training Heavy demands continued to be made on the Mental Health team for the training of social work students and nurses. In 1967 two students from the Mental Health Course in Manchester spent a period of two months in the Department. Seven students taking the Younghusband Course at the North Western Polytechnic were placed in the Borough for five and a half months each. A student from the Child Care Course, Croydon Polytechnic, is spending a period of five months in the Department. Six students taking the Younghusband Course were attached to the Department for a period of five weeks for visits of observation. In addition three students on Social Science courses at the London School of Economics and London University spent a period of a few weeks in the Department and a student from London University spent one month at Chellow Dene Hostel. A student from abroad spent a month in the Department prior to starting the Mental Health Course at the London School of Economics. Fourteen nurses from Springfield Hospital Nurses' Training School spent one week in the Mental Health office and arrangements were made for nurses from West Park Hospital to spend an afternoon visiting with the mental health social workers. The training of students is extremely valuable. Contact with the various Universities and Colleges helps to maintain and develop the high standards of casework offered by the social workers and enhances the reputation of the department. This in turn contributes to the recruitment of keen and qualified staff. 92 MENTAL HEALTH ACT, 1959 STATISTICS for the year 1967 Mentally ill Psychopathic Subnormal and severely subnormal Total Persons referred (a) By general practitioners 288 1 6 295 (b) By hospitals (on discharge after in-patient treatment) 121 - 7 128 (c) By hospitals (during or after out-patient or day hospital treatment) 145 1 6 152 (d) By Inner London Education Authority 9 - 52 61 (e) By Police and/or Courts ... 53 - 3 56 (f) From other sources 549 2 64 615 Total 1,165 4 138 1,307 Admissions to hospital (a) As informal patients 108 1 11 120 (b) By statutory action (Secs. 25, 26 and 29) 252 1 5 258 (c) By Order of a Court (Sec. 60) 7 - 2 9 Total 367 2 18 387 Persons receiving community care at 31st December, 1967 (a) Attending day training centre or workshop 5 - 208 213 (b) Receiving home training 17 - 5 22 (c) Resident in local authority home/hostel 9 - - 9 (d) Resident at local authority's expense in other home/ hostel 14 - 20 34 (e) Boarded-out at local authority's expense in private household - - 14 14 (f) Receiving home visits and not in any of the foregoing categories (a) to (e) 463 - 303 766 Total 508 - 550 1,058 93 LONDON BOROUGH OF WANDSWORTH PART 6 SCHOOL HEALTH SERVICE ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1967 CONTENTS Introduction Pupils on school rolls Medical Inspection of Schoolchildren Vision Personal Hygiene Infectious Illness reported from Schools Medical Treatment of Schoolchildren Handicapped Pupils Audiometry Audiology Clinics and Deaf Register Special Investigation Clinics Ear, Nose and Throat Clinics Rheumatism Clinics School Nursing Service B.C.G. Vaccination of Schoolchildren Tuberculosis Foot Health School Dental Service Health Education in Schools Student Health Service Sanitary Conditions in Schools Medical Staff Meetings 94 Introduction I have pleasure in presenting the third report on the School Health Service for the London Borough of Wandsworth covering the year ended 31st December, 1967. The total school population in Wandsworth numbers over 45,000, and it is the primary duty of the School Health Service to safeguard the general health of these pupils. The statistical tables and other information given in this Report provide some indication of how this task has been carried out in the year under review but they cannot give a clear picture of the personal interest which doctors, dentists, nurses and other staff employed in the School Health Service take in the health problems of many individual pupils, usually in conjunction with the child's own doctor. When a child leaves the comparative security of his own home and family circle to enter school, he moves into a new and unknown world. He experiences for the first time the independence and need for self-reliance which will increasingly pattern his future life and will determine in great measure his ultimate success as a responsible citizen. The early years in school are a very formative and important but often difficult period in a child's life and everything must be done to keep him healthy and to guide and help him in his search for security in his new environment. In this way, throughout his schooldays, he is enabled to derive the greatest benefit from his education and he can only do this if he is both healthy and happy. This applies to the child with no obvious defects or abnormalities but even more so to any child who is in any way handicapped. It is also our responsibility, therefore, to "ascertain" those children who are handicapped and who might require help by means of special educational methods to derive the greatest benefit from their school days. All this work requires close liaison with other agencies who might have an interest in the child's health and well-being, such as general practitioners, hospitals, social workers and not least with all the head-teachers and teachers in the schools themselves. During 1967, although there were no very marked changes in the school health statistics, one or two points may be noted. Thus, there was a rise in the number of measles cases reported from the schools, namely, 842 as against 432 in 1966, this being accounted for by the expected biennial increase in the number of measles cases. Whooping cough also showed some increase but for the most part the other infectious diseases did not show very material alterations. In one school two cases of typhoid fever were reported and were fully investigated. They arose in children who had contracted the disease abroad. The presence of this disease not unnaturally caused some anxiety amongst some of the parents, but with the help of the School Head the parents were re-assured and no other cases occurred in the school. In two schools small 95 outbreaks of a mild form of dysentery (Sonne) arose and these also were investigated and appropriate measures taken to deal with the cases. In three schools cases of pulmonary tuberculosis were discovered and full epidemiological investigations were undertaken in close liaison with the Chest Physicians of the Wandsworth and Battersea Chest Clinics. Short reports on all these incidents are found in the body of the Report. There were indications that there was an increase in the number of cases of scabies amongst the schoolchildren. As regards the physical condition of schoolchildren, 99.5% were found to be satisfactory, a figure identical with last year. The early detection and treatment of hearing defects is an important function of the general health and school health services. So far as early detection is concerned, I have described in the first part of this Report the purposes of the Handicap and Observation Register. Once hearing defects have been diagnosed, their treatment becomes an urgent necessity. We already have in Wandsworth audiology clinics which deal with this problem but there is no co-ordinated and fully staffed service to call on. Consideration was given in 1967 to this problem and plans were submitted for the erection of a new purpose-built audiology unit in the Putney area which would be fully staffed and equipped to deal with all problems related to hearing defects. This would serve not only Wandsworth but parts of the I.L.E.A. area adjacent to Wandsworth and would provide a complete and comprehensive service for children suffering from hearing defects. There can be no question that an expanded and fully staffed audiology service will be of the greatest benefit not only to schoolchildren but also to pre-school children and even to some adults, and we look forward to the implementation of this project. Amongst the activities of the School Health Service, none is more important than the care of the children's teeth. For two and a half years, in the absence of a Principal Dental Officer, the immediate responsibility for the administration of the school dental service devolved on me, with the advice and help, greatly valued, of Mr. Webster, Dental Adviser to the I.L.E.A., and during the year progress was made in extending dental inspection to all children in primary schools and in overcoming certain staffing problems. Although under this temporary arrangement the standard of the school dental service was maintained and was even expanded, the position was not satisfactory. Fortunately, in the latter half of the year, it was possible to appoint a Principal Dental Officer in the person of Mr. A. F. Weedon. Mr. Weedon took up his appointment in the fourth quarter of the year and so his report for 1967 is short and circumscribed. It is a great pleasure to be able to say that in the short time he has 96 been with us, further improvements have been made in the School Dental Service, both from the point of view of equipment and staffing, and consequentially in the dental care given to the children. Mr. Weedon has a particular interest in dental health education and this is something that we are very anxious to press forward with. I should like to thank my colleagues in the School Health Service for their work and initiative shown during the year. I am grateful also to the Divisional Education Officer and his staff and also to the heads of the schools in the London Borough of Wandsworth 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, 1967, there were 45,408 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. This was slightly below last year's figure. 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 any matters relating to the child's health may 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. 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 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. 97 Routine general medical inspections during 1967 totalled 17,288, compared with 17,289 in 1966. Of the 17,288 children inspected, 14.1 per cent were referred for treatment of defects, 7.1 per cent being referred for treatment of defects other than vision. The corresponding percentages for 1966 were 14.9 and 7.5 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 1967, expressed as a rate per 1,000 children inspected, together with the corresponding rates for 1966. Numbers examined 1966 1967 17,289 17,288 Rate per thousand Treatment Observation Treatment Observation Skin diseases 10.70 7.17 9.31 7.69 Eyes—vision 80.22 59.57 77.86 50.44 squint 6.30 6.88 6.30 6.25 other 1.68 2.54 2.26 2.43 Defective hearing 5.67 11.92 6.30 15.10 Otitis media 1.79 4.34 2.02 3.12 Enlarged tonsils and adenoids 7.81 25.16 7.35 24.00 Defective speech 3.64 10.47 3.24 9.02 Enlarged cervical glands 0.46 4.92 0.52 4.69 Heart and circulation 1.91 13.19 1.62 13.25 Lung diseases other than tuberculosis 4.40 13.94 4.16 11.74 Orthopaedic defects 9.89 26.31 9.55 32.16 Defects of nervous system 1.91 3.54 1.04 3.24 Psychological defects 3.42 11.86 4.86 10.01 Developmental—hernia 0.46 1.85 0.81 2.37 other 0.92 7.40 1.27 6.30 Abdomen 0.52 1.04 0.23 2.02 Details of non-routine medical inspections carried out in 1966 and 1967 are given below:— 1966 1967 Reinspections 9,441 9,617 Secondary school annual surveys 140 220 Other non-routine inspections 5,992 6,557 (see table overleaf) 7-plus experimental scheme inspections 98 113 Total 15,671 16,507 Total routine and non-routine inspections 32,960 33,795 98 Analysis of non-routine medical inspections Nature of Inspection Number inspected Bathing centre inspections : 1966 1967 Scabies 6 71 Other 5 6 Employment certificates 886 907 Theatrical children 1 — School journeys 3,154 3,246 Recuperative holidays : Before holiday 37 153 On return — — Outward Bound courses 24 8 Infectious disease investigation 1 — Boarding Schools for the Delicate: Pre-departure inspections 10 10 On return from school 2 3 Handicapped pupils: Statutory examinations 33 147 Periodic special defect examinations 901 918 Research investigations and enquiries 5 8 Special examinations at request of: Head Teacher: Child's name entered in special book 116 160 Others 284 369 School Nurse: Following health survey 23 37 Others 152 166 Divisional Officer (Education) 94 108 Divisional School Care Organiser or Care Committee 18 40 Parent 161 123 School Medical Officer 57 62 All other non-routine inspections 22 15 Total 5,992 6,557 Physical condition of pupils Percentage satisfactory and unsatisfactory: 1966 1967 Satisfactory 99.5% 99.5% Unsatisfactory 0.5% 0.5% Attendance of parents and Care Committee representatives 1966 1967 Number of pupils inspected 17,289 17,288 Parent present 49.1% 49.9% Care Committee representative present 89.1% 90.0% 99 Vision During the year vision tests were carried out on 6,644 boys and 6,311 girls, a total of 12,955 children compared with 6,566 boys and 6,449 girls, a total of 13,015 children in 1966. The percentage of the number tested with and without glasses who were referred for treatment or observation was 17.1, compared with 18.6% in 1966. 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 1967 Boys 78.1 7.2 5.5 5.7 5.9 4.6 2.3 23 26 Girls 75.9 7.5 5.7 6.2 5.7 2'7 25 6'2 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 Personal Hygiene Year Number examined Number found verminous Pupils found to be verminous % of number examined Annual comprehensive health surveys 1967 24,223 178 0.73 1966 27,983 324 1.16 Additional health surveys 1967 17,445 307 1.76 1966 17,193 259 1.51 During both types of survey, vermin were found on 485 occasions, representing 1.16 per cent of the total number of examinations. The number of individual pupils found to be verminous was 354, or 0.78 per cent of the school roll of 45,408. On 398 occasions the parents and/or children were advised about treatment and in many cases were given Lorexane shampoo for home treatment. On a further 87 occasions pupils were referred to bathing centres for appropriate treatment. 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. 100 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 320 Total attendances 329 Scabies Cases treated 116 Total attendances 289 Impetigo Cases treated Nil Infectious illness reported from schools Chicken-pox 699 Dysentery, diarrhoea or enteritis 67 German measles 194 Glandular fever 5 Impetigo 17 Influenza 9 Jaundice 42 Measles 842 Mumps 590 Ophthalmia and conjunctivitis 19 Pneumonia 2 Ringworm (scalp) 2 Ringworm (body) 4 Scabies 13 Scarlet fever 49 Sore throat 13 Tonsillitis 60 Whooping cough 74 A close watch is maintained on the incidence of infectious disease in schools and 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. Sonne Dysentery In May an outbreak of dysentery occurred at a primary school, and control measures were rapidly instituted. During the course of investigation of the outbreak it was necessary to arrange for laboratory tests on specimens obtained from 88 children and nine adults. Positive results for Sonne dysentery were obtained from 21 school children, four pre-school children and one adult. 101 The incident coincided with a similar outbreak at another primary school, where 50 children required laboratory tests. The presence of Sonne dysentery was confirmed in 13 school children and six pre-school children. Symptoms were not severe in these outbreaks, and recovery from infection took place in all cases. Typhoid Fever Three confirmed cases of typhoid fever occurred during the year, two of which were brothers aged 7 and 9 years who had recently arrived in this country by air from India where it was thought they had first become infected. Both boys attended a local school during the week prior to admission to hospital and class contacts at the school were therefore bacteriologically examined. Health precautions were immediately taken at the school and at the homes of children who had been in contact with the patients. In all, 47 contacts were examined and kept under surveillance and all were found to be in good health. Medical treatment of schoolchildren The number of sessions, new cases and total attendances at school treatment centres during 1967 were as follows:— Type of clinic Sessions New cases Attendances Minor ailments (nurse) 961 1,417 9,914 Minor ailments (doctor) 154 335 Special investigation (i.e. enuresis, obesity and behaviour problems) 250 238 1,626 Dental 2,376 7,023 17,583 Vision 338 737 4,576 Orthoptic 250 79 506 Ear, nose and throat 63 97 456 Audiology 58 141 478 More detailed information about some of these clinics will be found on pages 104 and 105 of this report. 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. 102 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 1967, the numbers of children receiving special education at schools in Wandsworth were as follows:— Blind: Residential 71 Day school 11 82 Deaf 30 Physically handicapped 67 Day schools Delicate 253 Educationally subnormal 707 Maladjusted: Residential 69 Day school 48 117 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. Partially hearing unit. A partially hearing unit which was formed at a primary school in September. 1966, is now fully integrated with the school. The unit comprises three classrooms with an additional room for auditory training. The twenty-three children attending the classes quickly adjusted themselves to their surroundings, even in the instances where the children had limited verbal communication. In three cases there was a family history of 103 ness and four cases showed a history of maternal rubella. Five children had suffered from neo-natal disorders. The age at which the presence of deafness was first suspected ranged from six months to eight years and in one case a hearing aid was provided before the child had reached the age of one year. Day classes for maladjusted children are held in four schools in Wandsworth. Children attend ordinary school for part of the week and attend the special classes during the remainder of the week, when up to five sessions may be required, depending on the nature and severity of the behaviour problem. As the classes are small, each child has the maximal opportunity of receiving benefit from the tuition. Schools for the educationally sub-normal are as follows:— Meadway (primary and secondary) with 198 pupils. This is a modern building and was erected on the site of a school formerly attended by physically handicapped children. Shillington (secondary) with 316 pupils. Wycliffe (primary and secondary) with 193 pupils. The rebuilding of this school at Wickersley Road was completed in June and the increased accommodation in the new building allowed for the admission of children of primary school age for the first time. The school can now accommodate 200 educationally subnormal boys and girls aged from five to sixteen years. Audiometry Hearing loss may be detected not only by clinical examination but also by the use of machines termed audiometers which provide an accurate assessment of the hearing defect. Routine audiometry forms part of the health examination of school entrants, and preschool children are tested whenever possible. The tests are performed by three school nurses with special experience in the use of the apparatus. An audiometry test is employed as a preliminary measure in the investigation of educational subnormality as a deaf child of normal intelligence may sometimes give the impression of being educationally subnormal. Audiometry is of particular value in investigating learning difficulties which are sometimes found to be due to a relatively slight degree of defective hearing. There has been an increase this year in the number of children tested prior to speech therapy. It is important to appreciate that abnormal speech patterns may develop in a child with hearing impairment. Limitation in the number of available staff prevented extensive use of audiometry at secondary schools, but the tests may be required in certain circumstances, as for example in the case of a child who has recently arrived in this country. 104 The number of children given audiometer tests during 1967 was as follows:— Pupils given screening tests 7,200 Pupils failing screening tests given pure-tone tests 1,232 Pupils referred to otologist 343 Audiology Clinics and Deaf Register There are 274 children living in Wandsworth who are considered to have a hearing impairment and whose names are entered on the deaf register. Of these, 84 were new cases notified during 1967. A school medical officer supervises this register and, with the assistance of a social worker, ensures that all children with defective hearing are under supervision. Where children do not attend the audiology clinic, reports are obtained from hospitals and contact is maintained with the parents by home visits. Hearing aids have been provided for 88 children on the deaf register but, unfortunately, some are reluctant to use them. In such cases, every encouragement is given by the peripatetic teacher of the deaf, whose services are shared with the London Borough of Lambeth, or by the social worker A total of 272 children were attending the three audiology clinics at the end of the year. Most of these are children who have been found by means of the audiometry test to suffer from some hearing loss. The clinic staff comprises an otologist, a social worker and a school nurse. Appointments are made by the social worker who, in liaison with the School Care Organiser, follows-up all children to ensure that the specialist's advice is followed. Special Investigation Clinics In Wandsworth an average of six clinics a week are held at six school treatment centres and they are staffed by a team of medical officers, social workers and school nurses. New cases are referred from various sources such as school medical inspections, the Social Service Departments and by the parents themselves. The social workers discuss problems with the parents, and maintain home and school contacts through the school care organiser. Children are referred to the Special Investigation Clinics for a variety of reasons including behaviour problems, enuresis (bedwetting), obesity, refusal to eat, etc. The behaviour problems in children, including enuretics and those who are deemed to be out of control at home or at school, can often be traced to the marital problems of the parents, and these symptoms frequently show themselves in the children of divorced or separated parents. 105 The problems of obese children are dealt with in the clinics but undernourished children are now a rarity. At the end of the year 200 children were currently attending these clinics. Ear, Nose and Throat Clinics An average of five clinics a month are held in four school treatment centres and at the end of the year 142 children were in attendance. The specialists in the clinics are able to secure direct admission for tonsillectomy at the South Western Hospital which reduces waiting time for the operation. Admissions are arranged by social workers in liaison with the family doctors. Rheumatism Clinics Acute rheumatism in children is declining and most affected children are in hospital care. During the year 64 children attended the two clinics in the Borough which are run in conjunction with the South West Metropolitan Regional Hospital Board. Blood tests are carried out either at the clinic or at hospital and the social workers arrange any restriction of activity which may be advised by the specialists. School Nursing Service The nursing duties in the School Health Service are undertaken partly by health visitors and partly by school nursing sisters and school nurses. As far as possible health visitors undertake duties in the primary schools in their own areas. Shortage of staff has made it essential for many health visitors to be relieved of routine school work, but they do maintain close contact with the schools. During the year we took part in a survey of heights and weights of London school-children being undertaken by Dr. J. M. Tanner of the Institute of Child Health. The very precise weighing and measuring for this survey was undertaken by two school nurses who were specially briefed for the work, and altogether some 3,000 children were included. One school nurse accompanied a party of school children from Chartfield School who spent two weeks in the Isle of Wight, while another school nurse spent two weeks in Swanage with a party of children from Springfield House School. Both these schools are for delicate children where the presence of a nurse can be of great help to any of the children suffering from ailments, major or minor. 106 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 4,585 (b) Number of consents received 4,027 (c) Number of consents received for alleged contacts of known cases of tuberculosis (included in (b)) 42 (d) Number of children skin-tested and read 3,399 (e) Positive reactors among (d) 423 (12.4%) (f) Negative reactors among (d) 2,976 (87.6%) (g) Number of children vaccinated 2,974 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. Tuberculosis Epidemiological investigations were undertaken at three schools during the year, following the occurrence of cases of pulmonary tuberculosis. The patients suffering from the disease comprised a girl, aged seven, attending a special school, a boy, aged 15, attending a secondary school, and a teacher at a primary school. The Chest Physicians of the Wandsworth and Battersea Chest Clinics advised on the measures to be taken, and their staff co-operated with the School Health Service staff in carrying out the investigations. In all, 200 children and 54 adults were examined, but these contacts were found to be free from tuberculous infection. Foot Health Classes for remedial foot exercises are held in nine primary schools, the classes being conducted by teachers who have attended a course of instruction at the College of Physical Education. A medical officer visits the schools and selects children whose foot deviations are considered likely to benefit from the exercises. In addition, a remedial gymnast visits in an advisory capacity and to assist in the organization of new groups. Gasses are held on from three to five days a week. A significant improvement in the feet and in general posture is usually achieved after two terms, but children are encouraged to continue the exercises after discharge from the group. 107 School Dental Service Report of the Principal Dental Officer During the year the arrangements for school dental inspections were extended to incorporate the whole infant school population and some junior schools, in accordance with the Inner London Education Authority's recommendation for an annual inspection of all schoolchildren. An inspection of the total school population of 45,408 was not possible because of lack of staff. The present permitted establishment is up to strength but the possibility of increasing our staff is being investigated. Our inability to inspect all schoolchildren during the year was compensated for by the issue of 34,000 forms to parents inviting them to bring their children for an inspection at a clinic, or alternatively requesting them to make an appointment with the dentist of their choice. These forms pointed out to parents the need for regular dental inspections of their children. Over 31,000 forms were returned and 9,000 parents opted for treatment in the school dental clinics. Since 1 took up my appointment as Principal Dental Officer at the end of September, the existing scheme of inspection and treatment has been closely examined and during the coming year various changes will be introduced to streamline procedures and improve the efficiency of the School Dental Service. Orders have been placed for a large part of the equipment needed to modernise the dental surgeries and so enable the Dental Officers to provide the best types of treatment available. The most urgently needed items, the latest air-bearing drills, are expected to be installed early in the New Year. As a result of the change of policy involving the introduction of annual dental inspections of all schoolchildren, the total number of children inspected during 1967 shows an increase of 41% over the previous year, but otherwise the statistics for the year vary only a little from 1966. Comparisons can be made from the following table:— Sessions and attendances Sessions: 1966 1967 Number of treatment sessions 2,502 2,246 Number of inspection sessions in schools 73 130 Total 2,575 2,376 First inspections: Number of first inspections in schools 3,551 8,264 Number of first inspections at clinics 6.314 5,691 Total 9,865 13,955 108 Number inspected found to require treatment 6,519 8,723 Percentage requiring treatment 66.1 62.5 Number offered treatment 5,820 7,702 Percentage of number requiring treatment offered treatment 89.3 88.3 Percentage of number requiring treatment who elected for private treatment 10.7 11.7 Reinspections: Reinspections at clinics or schools 2,047 1,593 Number reinspected found to require treatment 1,076 944 Percentage of number reinspected found to require treatment 52 6 59.3 Number of appointments given to: New cases 15,772 14,085 On-treatment cases 15,533 13,502 Number of attendances made by: New cases 8,007 7,023 On-treatment cases 11,182 10,049 Emergencies 564 511 Total attendances 19,753 17,583 Response rate (attendances as percentage of appointments): New cases 50.8 49.9 On-treatment cases 72.0 74.4 Cases discharged dentally fit 6,325 5,343 Lapse rate (number not completing treatment expressed as a percentage of new cases and emergencies attending) 26.2 29.1 Health Education in Schools Two health visitors undertake regular health education in schools and several others have periodically taken part in short courses of instruction for the pupils. All health teaching in schools is planned in close co-operation with the school staff. Informal health education is carried out by all health visitors and school nurses as the opportunity arises in their routine work in schools. Especially good work is done with adolescent girls who frequently seek advice from the nursing staff. 109 In 1967 the Council agreed to the appointment of a health education officer who should be suitably qualified. Partly owing to the need for stringent economies however, it proved necessary to postpone the appointment. We have again 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, drugs and sex education. Ten secondary and five primary schools were visited and 27 lectures were given to 1,449 secondary and 150 primary pupils. In addition, the Inner London Education Authority organized anti-smoking exhibitions and film shows in Greater London Council Parks during the summer months. Student Health Service Routine medical examinations are conducted at four Colleges of Education. Students are examined prior to entering and leaving college. Medical officers also visit the colleges to carry out immunization against a number of infective diseases, notably tuberculosis and poliomyelitis. In October a student health service was inaugurated at the South-West London College, Tooting Broadway. This college is attended by 1,500 full-time students, including approximately 1,000 from abroad. Rooms have been equipped to form a medical suite, and a medical officer visits the college regularly in order to advise on health matters and to examine students, as necessary. Students are required to complete a questionnaire before their medical examination. Although at the end of the year the service had been in existence for only a few months its benefits have already been demonstrated, particularly with regard to the management of psychological and emotional disturbances. The College Welfare Officer takes an active interest in maintaining the efficiency of the service. 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 Developments in the school health service were discussed by the Senior Medical Officers and the school physicians at meetings of the medical staff which took place during the year. 110 Subjects discussed included immunization and the constant need to ensure that as high a proportion as possible of schoolchildren were fully immunized against diseases such as poliomyelitis, diphtheria, tetanus and tuberculosis. In this context, the periodic medical examinations of schoolchildren offer a good opportunity to check that the pupils are fully protected. 111 INDEX PAGE Accidents in the home 74 Adoption and boarding out 67 Aged persons 79 Analysis of food and drugs 8,40,41 Animal Boarding Establishments Act, 1963 32 Animals, protection of 31 Ante-natal clinics 54 Atmospheric pollution 4,48,49 Audiology 95, 104 Audiometry 103 Bacteriological examinations 21,40,50 Bakehouses 39 Barbers 28 Bathing centres 51,99 Baths, home 69 „ personal cleansing station 51,99 „ swimming 50 B.C.G. vaccination of schoolchildren 105 Births 12,13 Blind and partially-sighted children 62 Boarding-out 67 Brucella abortus 38 Butchers' shops 38 Cancer 3,12,64,74,109 Caravans 34 Care of old people 79 Catering establishments 39 Cervical cytology 6,58,64 Chellow Dene hostel 84 Chest clinics 76 Child Health clinics 55 Child-minders 67 Chimney heights 48 Chiropody 5,72 Clean Air Act, 1956 48 Cleansing stations 51,99 Clearance areas 33 Closing Orders 33 Common lodging houses 32 Communicable diseases 16 Community care, mentally disordered persons 84 Comprehensive health surveys 99 Consumer Protection Act, 1961 30 Coroner's Court 52 112 PAGE Creches 66 Crematorium Regulations, 1930 52 Day centres 87 Day hospitals 84 Day nurseries, Council 66 private 67 Deaf children 66,102,104 Death, causes of 14 „ rates 12, 13 Deaths, cancer 12 „ heart disease 15 „ infant 12 „ maternal 12,15 „ tuberculosis 12,17,18 Dental services, mothers and young children 56 „ „ schoolchildren 95, 107 Diphtheria 16 „ immunization 16,71 Disinfection and disinfestation 50,51 Domiciliary midwifery service 59 Drainage 26 Dysentery 17,95,100 Ear, nose and throat clinics 105 Early discharge of maternity patients 59 Educationally subnormal children 102,103 Environmental health services 24 Factories Act, 1961 46 Family casework 75 Family planning 6,56 Fireguards, loan of 75 Fish shops 39 Fluoridation of water supply 27 Food and Drugs Acts 35, 37,41 Food hygiene 24,35,37 Food poisoning 16 Food premises 35,36 Food sampling 8,40,41 Food stalls 39 Food, unsound 40,42 Foot clinics 5,72 Foot health in schools 106 Furnaces, installation of 48 General practitioners, attachment schemes 6 Hairdressers 28 Handicap and observation register 61,95 113 PAGE Handicapped pupils 94, 101 Health Committee 10 Health education and publicity 73, 108 Health surveys 67 Health visiting service 60 Heart disease, deaths from 15 Home bathing service 69 Home help service 70 Home nursing equipment, loan of 69 Home nursing service 69 Home safety 74 Home teacher (mental health) 89 Home tuition 102 Hostel for mentally ill persons 84 Houses in multiple occupation 24, 33 Housing 33, 34 Hygiene inspections of schoolchildren 99 Ice-cream sampling 40 Illegitimate children 13, 64 Immunization and vaccination 71, 105 Incontinence pads service 69 Incontinent persons, laundry service 51 Infant mortality 12,15 Infectious diseases, statistics 16,22,23 Infectious illness in schools 100 Inquests 52 International vaccination certificates 20 Laboratory facilities, bacteriological 21,40,50 Land Charges Act, 1925 32 Laundry services 51,69 Legal proceedings 26, 37 Loan of fireguards 75 Loan of home nursing equipment 69 Long term care (mental health service) 90 Lung cancer 3, 74, 109 Maladjusted children 103 Malaria 17 Maternal mortality 12,15 Maternity beds 58 Measles 17,94 „ vaccination 72 Medical examination of staff 81 Medical inspection of schoolchildren 96 Medical staff meetings 109 Medical treatment of schoolchildren 101 114 PAGE Meningococcal meningitis 17 Mental health service 5,83 „ „ „ community care of the mentally disordered 84 „ „ „ day hospitals 84 „ „ „ day centres 87 „ „ „ home teacher 89 „ „ „ long term care 90 „ „ „ mothers' groups 86 „ „ „ occupational therapy 87 „ „ „ out-patient clinics 84 „ „ „ residential hostel 84 „ „ „ self-contained flatlets 5,85 „ „ „ short term care 90 „ „ „ social clubs 86 „ „ „ special care units 90 „ „ „ special clinics 87 „ „ „ staff training 90 „ „ „ statistics 92 „ „ „ students 90 „ „ „ training centres and school 88 Midwifery service 59 Milk sampling 38,40,44 Milk supply 38 Mortality, infant 12,15 „ maternal 12, 15 Mortuary 52 Mother and baby homes 28, 64 Mothercraft classes 54,55,73 Mothers' clubs 55 Movable dwellings 34 Neo-natal mortality 12 Noise Abatement Act, 1960 30 Nursing homes 28 Occasional creches 66 Occupational therapy (mental health service) 87 Offensive trades 29 Offices, Shops and Railway Premises Act, 1963 24, 30 Old people, care of 79 Outworkers 47 Partially-hearing children 102, 104 Perinatal mortality 12 Personal cleansing stations 51,99 Personal health services 54 Personal hygiene 51,99 Pest control 29,51 115 PAGE Pesticide residues in food 24,44 Pet Animals Act, 1951 31 Pharmacy and Poisons Act, 1933 29 Population 11 Post mortem examinations 52 Poultry processing 39 Premature infants 60 Pre-school playgroups 88 Prevention of Damage by Pests Act, 1949 29 Problem families 75 Prophylaxis 71 Public Analyst, report on work of 41 Pupils on school rolls 96 Recuperative holidays 72 Relaxation classes 54, 55, 73 Rent Act, 1957 34 Rheumatism clinics 105 Riding Establishments Act, 1964 31 Rodent control 29 Samples, adulterated 40,42 „ food and drugs 35,40 „ ice-cream 40 milk 38,40,42 „ water 27,50 Sanitary conditions in schools 109 Schizophrenic illness after childbirth 67 School dental service 95, 107 School health service 93 „ „ „ health education 108 School nursing service 105 Sewage disposal 27 Sewerage 27 Short term care (mental health service) 90 Slaughter of animals 39 Smallpox 4, 19 „ international vaccination certificates 20 „ vaccination 71 Smoke control 48 „ „ measuring stations 49 Smoking and lung cancer 3, 74, 109 Social clubs for the mentally disordered 86 Sonne dysentery 17,95,100 Special care units (mental health service) 90 Special educational treatment 94, 102 Special investigation clinics 104 116 PAGE Spina bifida 68 Staff 9, 10 Staff, medical examinations 81 Staff training 8, 53, 81, 90 Statistics, mental health 92 „ vital 12 Stillbirths 12 Student health service 109 Students, facilities for training 53, 81, 90 Surveys 67 Swimming baths 50 Tetanus immunization 71 Toddlers' clinics 55 Tooting and Balham carnival procession 74 Training centres and school (mental health) 88 Training of staff 8,53,81,90 Training of students 53,81,90 Tuberculosis 17,95,106 „ deaths 12,17,18 „ notifications 15 Tuberculosis Care Committee reports 76,77,78 Typhoid fever 18,94,101 Unmarried mothers 64 Unsound food 40,42 Vaccination and immunization 71, 105 Vaccination, international certificates 20 Venereal diseases 73 Verminous premises 51 Vision testing 99 Vital statistics 12 Water supply 27 „ „ fluoridation of 27 Whooping cough immunization 71 Rowling & Sons Ltd. (T.U.), 34 & 36 York Road, S.W.11.