AC. 43397 aclend 21/10/69 WAN 105 London Borough of Wandsworth ANNUAL REPORT of the Medical Officer of Health and Principal School Medical Officer for the Year 1968 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 1968 by J. TUDOR LEWIS, M.D., D.P.H. CONTENTS Page INTRODUCTION 3 Part 1—VITAL STATISTICS 11 Part 2—COMMUNICABLE DISEASES 17 Part 3—ENVIRONMENTAL HEALTH SERVICES 23 Public Health Inspection 24 Housing 34 Food and Food Premies 37 Factories Act, 1961 47 Atmospheric Pollution 49 Miscellaneous Matters 51 Part 4—PERSONAL HEALTH SERVICES Services for Mothers and Young Children 55 Other Personal Health Services 68 Part 5—MENTAL HEALTH SERVICE 81 Part 6—SCHOOL HEALTH SERVICE 91 PHOTOGRAPHIC SUPPLEMENT Centre Pages Plate A—Home help service—Service has been given regularly to this spastic mother since the birth of her child (see page 69). Plate B—Flooding at Earlsfield—Some of the furniture, carpets, etc., which were taken to a local depot for drying (see pages 5 and 24). Plate C—Flooding at Earlsfield—The drying-out process, showing warm air blowers in action (see pages 5 and 24). Plate D—Linden Lodge—This school for blind children was purpose-built in 1964 and accommodates 100 boarders and 20 day pupils (see page 99). INDEX 108 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1968 To the Mayor, Aldermen and Councillors of the London Borough of Wandsworth. Mr. Mayor, Ladies and Gentlemen, I have the pleasure of presenting to you the fourth Annual Report on the health of the London Borough of Wandsworth covering the year ended 31st December 1968. The general health of the Borough again remained good and there is little upon which I need comment. The civilian population of the Borough, as estimated by the Registrar-General, was 321,720, a decrease of 8,750 over the previous year. The total number of births was 5,635 which, compared with 6,013 for 1967, gives an adjusted birth rate of 16.80 per 1,000 of the population compared with 18.06 for 1967. The number of deaths at all ages was 4,571 as against 4,204 so that the adjusted death rate was 11.64 per 1,000 of the population, showing an increase over 1967. The total number of deaths of infants under one year was 110, 20 less than in 1967, giving an infant mortality rate of 19.50 per thousand live births, a reduction of 2.1 per thousand. The perinatal mortality rate, which is based on the sum of the number of still births and the number of deaths at ages under one week per 1,000 total live and still births was 24.19, a decrease over the figure for 1967. In 1968, six women died from causes associated with childbirth, giving a maternal mortality rate of 1.52 per 1,000 live and still births. In the table on pages 14-15 is given a breakdown of the causes of death in Wandsworth in 1968. This table differs in some respects from that published in previous years because during the year an amendment was made to the International Classification of Diseases (the Eighth Revision). This is an internationally recognized list of causes of death which facilitates the statistical study of disease phenomena. Accordingly, instead of 36 causes of death which have previously appeared, 65 causes of death are now shown in the new table. Exact comparisons with previous years are, therefore, a little more difficult but it can be said that there were no outstanding differences in 1968 compared with the previous year. Three diseases, chronic bronchitis, cancer of the lung and coronary 4 arterial disease, bulk very large as causes of death; this is a subject to which I have devoted attention in previous Reports and I need not dilate upon it again. During 1968, 1,280 confirmed cases of infectious disease were reported in comparison with 3,344 in 1967, the decrease being due to the drop in the incidence of measles, since 1968 was not a "measles year Details concerning infectious diseases are to be found in the body of the Report. In 1968, immunization against measles was commenced and by the end of December a total of 1,657 children had been immunized, 624 by general practitioners and 1,033 at our own clinics. One must consider what effect, if any, this comparatively small number of immunized children may have had on the incidence of measles. Comparisons are difficult from one year to another because of the recognized biennial increased incidence of the disease. The year 1968 was not a "measles year" so that to make a reasonably valid comparison we must go back to the previous " non-measles year which was 1966; in fact in the last quarter of 1966, 725 cases of measles were notified whereas in the last quarter of 1968 there were only 398 cases notified. In other words, there were slightly more than half the cases of measles in the last quarter of 1968 than in 1966. The same trend is to be seen in the early part of 1969 compared with the similar period in 1967. Whether or not this reduction can be attributed to the measles immunization undertaken in 1968 cannot, at this stage, be definitely assessed since there are other possible explanations but the trend is certainly interesting and will be carefully watched. In June, 1968, infective jaundice became notifiable and 56 cases were brought to our notice during the remainder of the year. All these were followed up and investigated with reference to possible causative factors. Particular attention was paid to the connection between injections and jaundice with the possibility of linking cases of jaundice with illicit injections of drugs but little of interest was detected. The year opened with a case of typhoid fever in a nurse at one of the large hospitals in the Borough. In investigating the source of infection a widespread survey was carried out among the staff of the various establishments that the nurse had recently visited to take refreshment. Similarly, her own nursing associates and the patients she looked after were investigated and altogether 331 persons were screened without the source of the infection being ascertained. Soon after this investigation was completed, a second case of typhoid fever was reported by another London borough arising in a technician recently arrived in this country from West Africa who worked at the hospital referred to above and although a further 97 persons were examined, no link was established between the infection in the technician and that in the nurse. 5 In September, a typhoid carrier state was discovered in an Asian child who had recently arrived from India where the infection was thought to have been contracted. The child was treated at home by his family doctor and he and his family remained under observation. During the summer, an outbreak of food poisoning occurred in a hospital just outside the Borough which necessitated the closing for several weeks of the hospital's maternity unit situated within our boundary. The causative organism was salmonella oranienburg and 331 persons were investigated by this department. The Health Services and Public Health Act 1968 came into operation in the autumn and, as a result, certain administrative changes in the work of the Health Department took place. Part III of the Act deals particularly with notifiable diseases and food poisoning and together with the Public Health (Infectious Diseases) Regulations, 1968, consolidates the powers and responsibilities of local authorities and Health Departments in relation to infectious disease work. Other important parts of this Act which come into operation on the dates to be specified by the Secretary of State concern maternity and child health, home nurses, domiciliary midwives and home helps. Although these provisions add useful powers to those already possessed by local health authorities, they are not likely to have much impact on a department such as Wandsworth, where the services are already well developed. I mentioned in last year's Report that the new Maternity Unit at Queen Mary's Hospital, Roehampton, was expected to start admitting patients on 1st January, 1968. This duly occurred and, from the start, close relations were maintained between the domiciliary midwives and the staff of the Maternity Unit. Arrangements were completed for the Maternity Unit to run its own ante-natal clinic at our William Harvey Centre, and this started in the new year. We also arranged for the domiciliary midwifery work formerly carried out by the South London Hospital in an area adjacent to the hospital to be undertaken by our domiciliary midwives. Discussions took place with the Hospital Management Committee as to the help which our domiciliary midwives could give in connection with the general practitioner obstetric unit at the Weir Hospital. As regards the former, the new arrangements started from 1st January. 1969, and as regards the latter, it is expected that they will shortly be implemented. It is expected of a Public Health Department that it should be versatile in its functions and so I would like to make brief mention of the efforts of the Department to help with the serious flooding of the River Wandle in the Summerstown area in September. A reference to this is made in the body of the Report with 6 graphs which show the extent of the drying-out process which was necessary. In addition to the work of the public health inspectors and technical assistants, health visitors, home nurses and other staff played their part in helping the unfortunate residents of this area with the many health problems which arose. Close liaison was maintained with officers of the Welfare Department under Mr. North. Chief Welfare Officer, who arranged emergency feeding and temporary accommodation for many of the residents, and with other Corporation Departments. Progress with Smoke Control in 1968 was less rapid than in previous years but we are now in sight of the whole of Wandsworth as a Smoke Control area. The map facing page 49 illustrates the present position. But as one environmental hazard is overcome, or at least ameliorated, others arise. For some time it has been apparent that nuisance from noise is becoming, if it has not already become, a public health problem. The Noise Abatement Act gives powers to deal with domestic and industrial noise but noise due to traffic, and more specifically due to aircraft in flight, is outside the scope of this legislation. In any case, it is extremely difficult to effect any amelioration in traffic noise. The same applies in even greater measure to noise from aircraft and since parts of Wandsworth are situated under the direct flight paths into London Airport, the western part of the Borough is at times subjected to considerable nuisance from aircraft noise. During the year, a survey was undertaken by the Scientific Department of the Greater London Council of noise tolerances in certain boroughs, including Wandsworth, on the approaches to London Airport. Measurement and assessment of aircraft noise is a difficult technical matter. Suffice it here to say that the noise level was estimated by calculating the Noise and Number Index (N.N.I.) based on the average peak level of aircraft noise and the number of aircraft passing. An N.N.I, of about 55 has been looked upon as an undesirable or unacceptable noise level. In fact, in the case of Wandsworth, readings taken at four points in the western part of the Borough showed that in no case did the N.N.I, exceed 55. Compared with other boroughs nearer to London Airport, Wandsworth is probably better placed both as regards aircraft going in to land and those taking off. Nevertheless, the nuisance from aircraft is a factor which cannot be ignored. Another possible nuisance arises from the emission of unburnt kerosene fuel from aircraft. This is a matter to which less attention has been given than to noise but jet aircraft may not infrequently be observed to eject unburnt exhaust fuels which must come down, although undoubtedly widely dispersed. It is not easy to measure this hazard since unburnt fuel being emitted at high temperature would be quickly atomized and, depending on 7 atmospheric conditions, disseminated over a wide area. The coincidence of circumstances which would enable the accurate collection of potentially polluted air and its analysis makes investigation extremely difficult. There is no reason to think that, at present, there is any danger to health from this source. Indeed, the basic question is "what is the effect of nuisance from aircraft in flight on health?" In fact, there is little, if any, really accurate medical or scientific information which can point unequivocally to the direct or primary harmful effects of aircraft noise or emissions. But indirect or secondary effects may cause subnormal health. The annoyance and irritation occasioned by constant aircraft noise, particularly at weekends and in the summer; the lack of sleep caused by night flights; the high-pitched notes to which some people are especially susceptible; all these, if they do not specifically cause illness, may well have an indirect but cumulative deleterious effect on health and well-being. Moreover, it can hardly be doubted that with the certain increase in the number of jet aircraft and the power of their engines, the nuisance caused will become worse and it is those areas which are near to large international airports where the hazard will be the greatest. There is, therefore, every likelihood that we shall be faced with a considerable public health problem in the future, unless something is done now. The authorities concerned are certainly not unaware of the problems and the number of night flights into London Airport is limited. Research is also known to be proceeding into methods of reducing aircraft engine noise and it can only be hoped that this will be successful. We do not wish to see repeated the problem of atmospheric pollution by smoke for it took the near catastrophe of the Great London Smog of 1952 before any really effective powers became available. It is better to prevent the pollution of the atmosphere by noise now in the fairly early stages, rather than to wait until it has become so intolerable that preventive measures would be very much more difficult. Action at national and international levels is the only effective way to achieve this. The Council decided that from the inception of the new municipal year in May, the three Committees, Health, Welfare and Children's, which formerly controlled the respective departments, should be combined into one Social Services Committee, which would be responsible for the work of the three separate departments. This, of course, meant some amendment to the detailed work of the three former Committees but has had the great virtue of making all the social services the responsibility of one single Committee. Although the Chief Officers of these departments, that is to say, Chief Welfare Officer, Children's Officer. Medical Officer of Health, already had close links and liaison, the fact that one Committee is now responsible for all their work has strengthened these links and made liaison even closer. There is little doubt that this was a satisfactory method of bringing the three Social Service departments even closer together. 8 The year 1968 saw the publication of two documents which had been long awaited, namely, the Green Paper on the Administrative Structure of the Medical and Related Services in England and Wales and the Report of the Committee on Local Authority and Allied Personal Social Services (the Seebohm Report). Having a bearing on the subject matter of these Reports were the findings of the Royal Commission on Medical Education (the Todd Report) but a fourth Report, that of the Royal Commission on Local Government, had not been published at the end of the year. No-one concerned with the health and social services can be unaware of the importance which the Green Paper and the Seebohm Report must have on the future administration of the health and social services of this country. Much has already been written and spoken on the subject and it is already apparent that there are many conflicting views which cut across professional groups and different sectional interests. It would serve little purpose here to discuss the many viewpoints and the various hopes and aspirations to which these Reports have given rise. However, it must be apparent to everyone that the time has now come when some revaluation and development of the health and social services is necessary if further advances are to be made. The existing tripartite administration of the health services as between the local health authorities, the local Executive Councils and Regional Hospital Boards with their Hospital Management Committees, has served the country for over twenty years and many advances have been made in hospital and community medical care. Alongside these advances, two trends have become apparent. Firstly, that medicine cannot be practised in isolation and that many professions and disciplines have an important and vital part to play in the health and welfare of the patient, which after all is the prime purpose of all forms of health and social services. Amongst these other services, many of which have already attained the status of a profession, social work and social workers hold an honoured place and, whatever the final decisions taken, must inevitably play an important part in the health and welfare of patients. In other words, the practice of medicine is now becoming predominantly a team effort and many people are involved. The second trend which has become apparent is the improved standards and the increasingly high levels of service which the public have come not only to expect, but to demand. Standards of care and treatment which would have been tolerated ten or even five years ago are no longer regarded as adequate. While every credit must be given to the work of the health and social services over the past 20 years, if further improvements are to be made then the organization of the services must be such as to enable these improvement to be put into effect. In this country, major developments in the Health Services have usually been introduced in periods of about 20 years, the last being in 1948. If the 9 advances in medical treatment and care over the next 20 years are to compare with those which have taken place over the past 20 years, there can be no reasonable doubt that the organization necessary for this to take place must be made viable and competent to meet the problems which will inevitably arise. The question, on which there has so far been no consensus of opinion, is—What is a viable and competent organization ? Whatever final decisions emerge when the answer to this important and weighty question is given, it is certain that all of us who are engaged in the administration and management of the Health and Social Services will be required to give of our best in order to effect the changes which will undoubtedly take place. Mr. K. J. Winton, formerly Deputy Chief Public Health Inspector, was promoted to the position of Chief Public Health Inspector in place of Mr. G. W. P. Weeks, whose retirement I reported last year. Mr. Winton took up his duties on 1st April and I have great pleasure in welcoming him as one of my senior colleagues. My Annual Report provides a happy opportunity to express my thanks and appreciation of the excellent work of my colleagues in the Health Department and for the help given us by other Corporation Departments with which we are inevitably associated. I should like to thank also the Members of the former Health Committee and the Members of the present Social Services Committee for their help during the year and the two Chairmen of these Committees, Mrs. M. F. Sporle and Miss G. A. Morgan, respectively, for their guidance upon the many matters about which I had to consult them. 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 SOCIAL SERVICES COMMITTEE (at 31st December 1968) Chairman : Alderman Miss G. A. Morgan Vice-Chairman : Councillor H. C. A. Turner Deputy Chairman : Councillor P. Handyside Alderman J. Parker Councillor A. H. Barrett B. Clapton Miss N. F. Clark-Lawrence Major W. E. Davidson Mrs. E. Dixon H. K. Lamb, b.sc., m.i.chem.e., m.am.i.chem.e. R. F. A. Marshall, m.r.s.h., s.r.n., r.m.n. P. L. Mitchell Mrs. A. O'Connell Mrs. H. G. Paxton Dr. Brian N. C. Prichard, m.sc., m.r.c.p. Mrs. Diana Pruszak G. Rundle Mrs. J. D. Standing Dr. E. D. M. Tod, m.b., ch.b. Dr. E. G. Wilson, b.a., ph.d. Ex-Officio Members: The Worshipful the Mayor (Alderman H. D. Lester, j.p.) Alderman R. F. Ash, j.p. Alderman S. F. C. Sporle SENIOR OFFICERS OF THE HEALTH DEPARTMENT (at 31st December 1968) 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 K. J. Winton 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 321,720. Movement of Population As in previous years, the work of the Health Department is made more difficult by the continual movement of population into and out of the Borough; much time and effort has to be spent —and much of it wasted—in trying to trace children who are known to need special attention. The records of children under five years of age show that during the year over 3,100 arrived in Wandsworth and over 3,600 moved out. In addition, nearly 2,000 children moved away without leaving any trace of their destinations ; but searching inquiries led to the tracing of over 600 of them. Over 1,800 children 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 1968 the factor for births is 0.96 and for deaths 0.82. 12 Extracts from Vital Statistics Live Births: Male Female Total Legitimate 2,432 2,352 4,784 Illegitimate 426 425 851 Totals 2,858 2,777 5,635 Rate per 1,000 population: Crude 17.51 Adjusted 16.80 Stillbirths: 39 29 68 Rate per 1,000 total live and still births 11.92 Deaths: All ages 2,105 2,466 4,571 Rate per 1,000 population: Crude 14.20 Adjusted 11.64 Infant Mortality Rates: Deaths under 1 year 62 48 110 Total infant deaths per 1,000 live births 19.50 Legitimate infant deaths per 1,000 legitimate live births 20.28 Illegitimate infant deaths per 1,000 illegitimate live births 15.27 Neo-natal Mortality Rate (deaths under four weeks per 1,000 total live births) 14.02 Early Neo-natal Mortality Rate (deaths under one week per 1,000 total live births) 12.40 Perinatal Mortality Rate (stillbirths and deaths under one week combined per 1,000 total live and still births) 24.19 Maternal Mortality Rate (per 1,000 total live and still births) 1.52 Number of deaths from puerperal causes 6 Number of deaths from cancer 883 Number of death from tuberculosis 23 13 Births The total number of live births to residents in the Borough registered during 1968 was 5,635 comprising 2,858 males and 2,777 females. The crude birth-rate was 17.51 per 1,000 population. After taking into account the area comparability factor supplied by the Registrar-General the adjusted rate was 16.80. The live-birth rate for England and Wales was 16.9. During the year there were 851 illegitimate live births to residents of the Borough, representing 15.10% of the total live births for the area. Stillbirths during the year numbered 68 giving a total of 5,703 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 4,571 comprising 2,105 males and 2,466 females. The crude death-rate for the year was 14.20 per 1,000 population but after applying the area comparability factor the adjusted rate was 11.64. The death-rate for England and Wales was 11.9. 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. The causes of death shown in Table 1 are based on the International Abbreviated List of 50 causes (B. list) with some subdivisions, from the manual of the Eighth Revision of the International Classification of Diseases. 14 TABLE 1. CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1968 CAUSES OF DEATH Deaths assigned to Borough in age groups Deaths shown in localities (all ages) 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 Cholera - — — — — — — — - — — - - - - - Typhoid fever - - - - - - - - - - - - - - - - Bacillary dysentery and amoebiasis - - - - - - - - - - - - - - - - Enteritis and other diarrhoeal diseases 5 4 1 4 - - - - - - - - 1 1 2 2 Tuberculosis of respiratory system 18 12 6 - - - - - 2 3 3 3 7 4 7 7 Other tuberculosis, including late effects. 5 2 3 - - - - - 1 — 2 1 1 1 1 3 Plague — — — — — — — — — — — — — — — — Diphtheria — — — — — — — — — — — — — — — — Whooping cough - - - - - - - - - - - - - - - - Streptococcal sore throat and scarlet fever - - - - - - - - - - - - - - - - Meningococcal infection - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - Smallpox — — — - — — — — — — — — — — — — Measles — — — — — — — — - - - - - - - - Typhus and other rickettsioses - - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - - Syphilis and its sequelae 6 3 3 - - - - - - 1 - 4 1 1 3 2 All other infective and parasitic diseases 7 3 4 - - 2 - - - 2 - 3 - 2 3 2 Malignant neoplasm, stomach 75 43 32 - - - - - 3 5 16 28 23 21 27 27 Malignant neoplasm, lung, bronchus 257 207 50 — - — — 1 5 30 72 98 51 74 94 89 Malignant neoplasm, breast 82 1 81 — — — - 1 6 18 26 14 17 25 32 25 Malignant neoplasm, uterus 24 — 24 — — — — 1 — 7 5 6 5 8 6 10 Leukaemia 24 9 15 1 2 2 — — 3 1 4 6 5 6 9 9 Other malignant neoplasms, including neoplasms of lymphatic and haematopoietic tissue 409 200 209 1 1 1 2 4 13 47 76 114 150 103 157 149 Benign neoplasms and neoplasms of unspecified nature 12 2 10 - - 1 - - - - 3 3 5 4 3 5 Diabetes mellitus 38 13 25 — — — — — - 4 8 4 22 10 15 13 Avitaminosis and other nutritional deficiency 3 1 2 - - - - - - - 1 1 1 - 2 Other endocrine, nutritional and metabolic diseases 13 6 7 1 1 1 - - 1 - 5 - 4 3 5 5 Anaemias 14 3 11 - - - - - - - 2 4 8 4 6 4 Other diseases of blood and blood-forming organs 3 2 1 - - - - - - 1 - 2 - - 2 Mental disorders 20 5 15 — — — 1 1 2 2 1 5 8 4 9 7 Meningitis 2 — 2 — — — — — — — 1 1 — — 1 1 Other diseases of nervous system and sense organs 51 21 30 1 - 1 2 2 5 5 7 12 16 13 18 20 Carried forward 1 ,068 537 541 8 4 8 6 10 41 126 231 309 335 285 399 384 15 TABLE 1. CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1968—contd. CAUSES OF DEATH Deaths assigned to Borough in age groups Deaths shown in localities (all ages) 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 Batter- sea Brought forward 1,068 537 541 8 4 8 6 10 41 126 231 309 335 285 399 384 Active rheumatic fever 1 1 - — - — - — - 1 - - - 1 - Chronic rheumatic heart disease 56 19 37 - - - - 1 2 8 12 15 18 14 21 21 Hypertensive disease 69 22 47 - — - 1 - 1 9 13 45 20 23 26 Ischaemic heart disease 1,076 556 520 — — — — 2 12 63 171 271 557 286 396 394 Other forms of heart disease 263 73 190 — 1 — 1 — 2 4 15 39 201 66 98 99 Cerebrovascular disease 487 173 314 — — — 1 2 9 17 56 95 307 120 182 185 Other diseases of the circulatory system 250 79 171 — — — — 1 2 6 27 38 176 70 88 92 Influenza 48 16 32 — — — — — 1 1 — 5 41 13 16 19 Pneumonia 442 164 278 16 3 1 1 — 1 5 27 79 309 111 170 161 Bronchitis, emphysema 302 215 87 — 1 — — — 1 13 37 85 165 82 109 111 Asthma 14 9 5 — — — — 1 1 — 4 4 4 3 7 4 Other diseases of the respiratory system 39 21 18 3 — 2 — — — 2 11 5 16 12 13 14 Peptic ulcer 31 16 15 — 1 — — — 3 1 3 9 14 9 11 11 Appendicitis 2 - 2 - - - - - - - - 1 1 1 1 Intestinal obstruction and hernia 22 9 13 2 1 - - — - 1 1 1 16 6 8 8 Cirrhosis of liver 17 8 9 — — — 1 — 1 2 6 4 3 6 4 7 Other diseases of the digestive system 50 16 34 3 — — 2 1 — 3 4 8 29 15 19 16 Nephritis and nephrosis 11 8 3 — — — 1 — — 2 3 4 1 4 3 4 Hyperplasia of prostate 7 7 - - - - - - - - 2 — 5 2 3 2 Other diseases of the genito-urinary system 23 4 19 - - - - 1 1 1 2 4 14 5 10 8 Abortion 4 - 4 - - - 3 1 - - - - - - 3 Other complications of pregnancy, childbirth and puerperium 2 - 2 - - - - - 2 - - - - - 1 1 Diseases of the skin and subcutaneous tissue 3 1 2 - - - - - - 1 - - 2 1 2 — Diseases of the musculoskeletal system and connective tissue 25 6 19 - - - - - - 1 4 3 17 7 8 10 Congenital anomalies 39 19 20 21 3 5 - — 1 2 2 - 5 12 13 14 Birth injury, difficult labour, and other anoxic and hypoxic conditions 25 13 12 25 - - - - - - - - - 6 10 9 Other causes of perinatal mortality 29 16 13 29 - - - - - - - - - 8 10 11 Symptoms and ill-defined conditions 9 6 3 — — — — — — — — - 9 2 5 2 Motor vehicle accidents 32 15 17 — 1 2 6 3 2 4 2 6 6 8 13 11 All other accidents 52 28 24 3 2 3 9 3 4 3 3 10 12 13 20 19 Suicide and self-inflicted injuries 56 38 18 — — — 6 11 6 9 9 6 9 21 18 17 All other external causes 17 10 7 — — — 2 2 4 1 5 2 1 5 6 6 Totals 4,571 2,105 2,466 110 17 21 39 40 96 277 647 1,016 2,308 1,214 1,690 1,667 16 TABLE 2. DEATHS FROM HEART DISEASE Males in age groups Females in age groups Grand totals under 25 25 35- 45- 55— 65— 75 + Totals under 25 25 35- 45— 55— 65— 75 + Totals Chronic rheumatic heart disease - - 1 3 5 8 2 19 - 1 1 5 7 7 16 37 56 Hypertensive disease - — — 1 8 4 9 22 — 1 — — 1 9 36 47 69 Ischaemic heart disease - 2 12 57 139 168 178 556 — — — 6 32 103 379 520 1,076 Other forms of heart disease 2 - - 3 5 13 50 73 - - 2 1 10 26 151 190 263 Totals 2 2 13 64 157 193 239 670 - 2 3 12 50 145 582 794 1,464 Infant Mortality There were 110 deaths of children under one year, giving an infant mortality rate of 19.50 per 1,000 live births. The infant mortality rate for England and Wales was 18. TABLE 3. DEATHS OF CHILDREN UNDER ONE YEAR OF AGE Causes of death Under 24 hours 1-7 days 1-4 weeks Totals under 4 weeks 1-12 months TOTAL DEATHS UNDER 1 YEAR Pneumonia 1 1 2 4 12 16 Enteritis and other diarrhoeal diseases — — — — 4 4 Congenital anomalies 7 5 5 17 4 21 Prematurity 24 12 — 36 — 36 Other causes 10 11 1 22 11 33 TOTALS 42 39 8 79 31 110 Maternal Mortality Six deaths occurred from accidents and diseases of pregnancy or childbirth. This is equivalent to a rate of 1.52 per 1,000 live and still births. 17 PART 2 COMMUNICABLE DISEASES The Health Services and Public Health Act, 1968 (Part III—Notifiable Diseases and Food Poisoning) The Public Health (Infectious Diseases) Regulations, 1968 The above-named Act and Regulations came into operation on 1st October, 1968. Previous provisions relating to the notification procedure for cases of infectious diseases and for cases of food poisoning were different one from another, and were set out in different statutes (Public Health Act, 1936, and Food and Drugs Act, 1955). The 1968 Act repeals the provisions in the 1936 and 1955 Acts relating to notification procedures, and sets out a unified procedure. All provisions governing notification of infectious disease and food poisoning are now to be found in Sections 47-49 of the Act. and in the Regulations. Changes and additions have been made in the list of notifiable diseases, leptospirosis, tetanus, and yellow fever being made notifiable whereas acute primary pneumonia, acute influenzal pneumonia, erysipelas, membraneous croup and puerperal pyrexia cease to be notifiable. The full list of diseases including those defined as "notifiable diseases" in Section 47 of the Act and those diseases for which Section 48 of the Act is applied by the Regulations, is as set out in Tables 1 and 2 on pages 21 and 22. During the year 1,487 cases of infectious disease were reported, the decrease in number compared with the previous year being mainly due to the drop in the incidence of measles. Of the 1,487 cases reported, 1,280 notifications were confirmed and these are shown in Tables 1 and 2 in their age groups and in the areas in which they occurred. A commentary on the notifications is given overleaf. Vaccination and immunization against certain infectious diseases is one of the personal health services available to certain groups of people and a reference to this service will be found on page 70. 18 Dysentery A total of 133 cases were confirmed during the year compared with 105 for 1967, and 80 other cases of suspected dysentery were investigated before the provisional diagnosis was eliminated by bacteriological examination. There was one minor school outbreak involving 17 children and investigation of family contacts revealed a further 9 positive cases. Food poisoning There were 155 cases notified. Of these 127 were found not to be food poisoning after laboratory examination of faecal specimens from those affected. Eighteen of the remaining cases were single unrelated cases and four were minor outbreaks involving ten persons. The causative organisms of the confirmed cases were Salmonellae brandenburg (1), enteritidis (4), montevideo (1), oranienburg (8), panama (1), reading (2), seftenberg (1), and typhimurium (10). In addition to the above cases an outbreak of salmonella infection, which occurred in a hospital outside the borough, involved the department in a fairly intensive investigation of a large number of persons resident in Wandsworth who were either staff of the hospital concerned or persons who had been recent in-patients there. In all a total of 331 persons were investigated, the number of faecal specimens examined being 464. The report to the Ministry of this outbreak was made by the Medical Officer of Health of the borough in whose area the hospital was situated. Infective jaundice This disease became notifiable on 15th June, 1968, under the Public Health (Infective Jaundice) Regulations, 1968. There were 56 cases notified during the remainder of the year. Measles There were 658 notifications received compared with 2,698 in 1967, the latter being an epidemic year. Tuberculosis The total number of new cases which came to the knowledge of the department in 1968 was 164, the sources of information being as follows:— Primary notifications 127 Unnotified at death 6 Transfers from other areas 31 Total 164 19 The number of deaths certified as due to various forms of tuberculosis was 23. 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 - - - - - - - - 1-4 3 2 1 - - - - - 5-9 2 - - - - - - - 10-14 — 2 - - - - - - 15-24 8 11 2 2 — — — — 25-44 25 10 6 — 1 1 1 — 45-64 30 7 — 2 4 2 — 2 65 and over 8 5 — 1 7 3 1 1 Totals 76 37 9 5 12 6 2 3 During the year a total of 1,877 home visits were made by tuberculosis visitors, of which 852 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 74 to 78. Typhoid One confirmed case in the person of a resident female nurse on the staff at a local hospital occurred during the year. In collaboration with the hospital an intensive investigation was carried out by the Health Department involving staff, patients and recent patients of the hospital, and contacts of these persons in an endeavour to trace the source of infection. Where necessary faecal and urine specimens were collected and sent to the laboratory for bacteriological examination. Enquiries were also made at local shops, cafes, etc., which had been visited by patients or others. In the course of the investigation a total number of 554 faecal and 554 urine specimens from 331 persons were bacteriologically examined, with negative results in all cases. The source of infection was not traced. Towards the end of this investigation a patient admitted to hospital in another area was reported to be suffering from typhoid fever. The patient was a Ghanaian who had arrived in this country only three weeks before and although not living in Wandsworth was employed at a limb-fitting factory situated near the abovementioned hospital. In view of the connection of his place of employment and the hospital, together with the fact that meals 20 cooked in the hospital canteen were supplied to the factory employees, a further investigation along lines similar to the earlier one was carried out with special regard to the hospital canteen staff and the work contacts of the patient. In this enquiry, which involved 97 persons, a total of 292 faecal and 292 urine specimens and 76 blood samples were examined at the laboratory. In addition, 38 drain swabs were examined. Despite all our efforts, the source of infection remained untraced. During the year enquiries were also made in connection with a typhoid carrier, a boy of three years of age who had been notified as suffering from infective jaundice. The carrier state was brought to light in the course of the bacteriological examination of faecal specimens from the child. All family and house contacts were investigated but specimens obtained from them proved negative. International certificates of vaccination against smallpox The trend shewn in recent years for an increasing number of persons to require authentication of international certificates of vaccination was again evident in 1968, the number of requests received totalling 8,240. The signature of the person issuing the certificate was verified in each case as that of a registered medical practitioner practising in Wandsworth, and the certificate endorsed accordingly. One certificate was issued during the year to the effect that there had been no recent cases of smallpox in the borough. Such certificates are accepted by certain countries from persons who do not wish to be vaccinated. Under the Public Health (Aircraft) Regulations, 1966, and the Public Health (Ships) Regulations, 1966, persons arriving in this country from abroad who are not in possession of a valid international certificate of vaccination against smallpox must be placed under surveillance for a specific period. Forty-five 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 4,655 specimens, made up as follows, were examined during the year. Stool and urine 4,615 Nose and throat swabs 40 Bacteriological examinations in connection with routine food sampling were carried out at the Public Health Laboratory at County Hall. 21 TABLE 1 NOTIFIABLE DISEASES NO. OF NOTIFIED CASES OF INFECTIOUS DISEASES IN AGE GROUPS Under 1 year 1 2 3 4 5-9 10-14 15-24 25-24 45-64 65 and over Totals Acute encephalitis - - - - - - - - 1 - - 1 Acute meningitis 2 - - - - - - - - - - 2 Acute poliomyelitis - - - - - - - - - - — - Anthrax - - - - - - - - - — — — Cholera - - - - - - - - - — — — Diphtheria - - - - - - - - - — — — Dysentery 5 11 7 12 13 51 10 4 16 4 - 133 Food poisoning 3 2 1 2 - 4 2 5 5 3 1 28 Infective jaundice - - 1 7 2 5 5 19 10 5 2 Leprosy - - - - - - - - - - - 56 Leptospirosis - - - - - - - - - - — Malaria - - - - - - - - - - - — Measles 35 74 102 90 101 218 18 13 6 - — Ophthalmia neonatorum 2 - - - - - - - - 1 658 Paratyphoid fever - - - - - - - - - 2 Plague - - - - - - - - - — Relapsing fever - - - - - - - - - - — — Scarlet fever 1 3 6 7 12 39 11 12 2 - - 93 Smallpox - - - - - - - - - - - - Tetanus - - - - - - - - - - — Tuberculosis - 2 1 1 2 2 2 23 41 39 -- — Typhoid fever - - - - - - - ■ - - 14 127 Typhus - - - - - - - l - — — 1 Whooping cough 9 18 16 18 20 36 9 - 4 1 - - Yellow fever - - - - - - - - - - - 131 Erysipelas* - - - - - - - 2 4 2 — — Pneumonia, acute influenzal* 1 - 1 - - - - 1 - 2 — 8 14 Pneumonia, acute primary* - 1 - - - 1 1 - 1 13 9 Puerperal pyrexia* - - - - - - — 1 3 - 5 22 4 Totals 58 111 135 137 150 356 58 81 93 70 31 1,280 *These diseases ceased to be notifiable on 1st October 1968. 22 TABLE 2 NOTIFIABLE DISEASES NUMBER OF NOTIFIED CASES OF INFECTIOUS DISEASES IN WARDS 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 TOTALS Acute encephalitis - - - - - - - 1 - - - - - - - - - - - - 1 Acute meningitis - - - - - - 1 - - - - - - - - - - - - 1 2 Acute poliomvelitis - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - Cholera — — — — — — — — — — — — — — — — — — — — — Diphtheria - - - - - - - - - - - - - - - - - - - - - Dysentery 4 7 — 18 11 6 17 5 9 10 7 4 7 4 15 2 1 1 5 — 133 Food poisoning 2 — 1 8 1 — 1 5 1 4 — 1 — 2 — — 1 1 — — 28 Infective jaundice 1 2 3 5 1 11 3 3 3 2 1 — 1 3 - 5 4 5 3 — 56 Leprosy - - - - - - - - - - - - - - - - - - - - - Leptospirosis - - - - - - - - - - - - - - - - - - - - - Malaria — - - - - - - - - - — — - - — - - - - — Measles 14 3 11 26 19 22 30 20 49 33 23 42 39 25 10 44 44 28 120 56 658 Ophthalmia neonatorum 1 1 - - - - - - - - - - - - - - - - - - 2 Paratyphoid fever - - - - - - - - - - - - - - - - - - - - - Plague - - - - - - - - - - - - - - - - - - - - - Relapsing fever - - - - - - - - - - - - - - - - - - - - - Scarlet fever 2 — 3 13 12 5 7 10 4 8 2 7 1 2 — 2 5 3 5 2 93 Smallpox — — — — — — — — — — — — — — — — — — — — — Tetanus — — — - - - — - — - - — - — — — — — - — - Tuberculosis 7 5 2 8 4 3 11 3 8 7 9 4 6 8 7 5 8 6 8 8 127 Typhoid fever 1 - - - - - - - - - - - - — - — - - - - 1 Typhus - - - - - - - - - - - - - - - - - - - - - Whooping cough — 8 8 12 8 12 11 12 11 2 — 2 4 10 1 6 10 5 4 5 131 Yellow fever — — — — — — — — — — — — — — — — — — — — — Erysipelas* - 1 - - - 1 - 4 - - - 1 - - 1 - - - - 8 Pneumonia, acute influenzal* — — — — 1 — — 2 6 1 3 - - 1 - - - - - - 14 Pneumonia, acute primary* — — — 5 2 — 1 3 — 2 5 2 — — — — — 2 — — 22 Puerperal pyrexia* — — — — — — 1 1 — — 1 1 — — — — — — — — 4 Totals 32 26 29 95 59 59 84 65 95 69 51 63 59 55 33 65 73 51 145 72 1,280 * These diseases ceased to be notifiable on 1st October 1968 23 PART 3 ENVIRONMENTAL HEALTH SERVICES Shortage of staff has again been a problem during the past year; on the credit side, two student public health inspectors passed the Diploma Examination at their first attempt and two additional public health inspectors joined us from outside authorities. On the debit side, however, two inspectors retired, another left for duties with a rural authority and Mr. C. Jones, one of our experienced inspectors, unfortunately collapsed and died suddenly—thus any gain has been cancelled out. Two additional technical assistants were appointed for work under the Offices, Shops and Railway Premises Act, 1963, and have proved their worth. It is becoming increasingly obvious that with the growth of legislation which has taken place over the last decade, the Environmental Health Section will need to be reorganised in the near future on a more sectional basis, whereby more technical assistants can be employed on special duties as assistants to public health inspectors. New Imported Food Regulations came into force on the 1st August, 1968. These Regulations permit port health authorities to let consignments of foodstuffs go straight to inland authorities without first being inspected at the port. It is then the duty of the recipient authority to carry out inspection of this foodstuff on arrival. These Regulations have not, as yet, caused any undue stress upon the inspectorate but provision will most certainly have to be made in the future when the Covent Garden Market Authority commences operation at Nine Elms. Housing work has increased in tempo during the current year. The five-year slum clearance programme which commenced in 1965 has now been virtually completed, together with representation of several additional areas. In addition, a recent survey has been carried out of the whole Borough for possible clearance areas to be surveyed in detail for the next five-year programme. Work on houses in multiple occupation has really got under way in that numbers of Direction Orders and Management Orders were made and many notices were served under the Housing Act, 1961, for fire precautions and for the provision of extra facilities, etc. In certain cases, where owners failed to comply with these notices, work was carried out in default. Multiple occupation is probably the real housing problem of this Borough; each year approximately 950 persons enter the Borough direct from abroad and, in 24 addition, there is also a fairly large influx from outside authorities —consequently, over the last five years, there has been a considerable build-up of population in certain areas of the Borough. In reviewing this situation of multiple occupation, one must try to envisage 10 to 15 years hence for, during this period, practically all the so-called "slum areas" of the Borough will have been dealt with, and, in consequence of this, the building programme will also have been slowed down. It therefore becomes obvious that action to contain the over-populated areas must now be taken. It is hoped that additional technical assistants will be appointed to help the present staff dealing with this problem but it must be appreciated that a great deal of this work is carried out during the evening hours and at weekends and that to complete an inspection of a house may necessitate up to five or six visits—consequently, progress is always slow. The flooding which occurred in September placed a considerable burden upon the inspectorate who cheerfully responded (as always), many working long hours, every day, for two months, without any time off, in order that assistance and relief could be given to tenants living under appalling conditions (see plates B and C, centre pages). 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 Revisits Totals To investigate complaints 6,565 11,335 17,900 Offices, Shops and Railway Premises Act 552 3,941 4,493 Infectious diseases 1,345 591 1,936 Factories Act 535 — 535 Housing clearance area scheme 775 — 775 Housing reports 141 — 141 Houses in multiple occupation 864 2,884 3,748 New drainage 390 6,849 7,239 Hairdressers 684 — 684 Others 9,128 4,349 13,477 Totals 20,979 29,949 50,928 Table 2 gives details of the sanitary operations carried out in the year. 25 TABLE 2 Putney Central Battersea Totals Premises cleansed and repaired 172 251 396 819 Drains tested 129 80 58 267 Drains cleansed or repaired 636 421 308 1,365 Water closets cleansed, repaired or renewed 138 112 157 407 Soil pipes altered or repaired 46 25 35 106 Waste pipes provided, altered or repaired 87 54 118 259 Rainwater pipes repaired 14 18 40 72 Roofs and gutters repaired 114 169 296 579 Damp-courses inserted 2 — 4 6 Damp conditions otherwise remedied 92 130 270 492 Yards drained or paved 6 3 5 14 Dustbins provided 9 12 7 28 Water cisterns cleansed, covered or repaired 7 5 4 16 Water supply reinstated 116 56 165 337 Defective stoves and fireplaces remedied 1 4 7 12 Animals improperly kept 1 2 — 3 Accumulations of rubbish, etc., removed 26 14 31 71 Urinals cleansed or repaired - - 1 1 Smoke nuisances 4 5 7 16 Other nuisances 4 10 11 25 Totals 1,604 1,371 1,920 4,895 Number of preliminary notices served 220 380 488 1,088 Number of preliminary notices complied with 204 287 441 932 Number of abatement notices served 93 281 221 595 Number of abatement notices complied with 101 284 336 721 Legal proceedings During the year, legal proceedings were taken by the Council in twenty-six 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 383 applications were received. 26 There were 3,073 tests made in connection with drainage installations and 80 connections made to 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 trunk sewers and sewage disposal of London are the responsibility of the Greater London Council, and the local sewers which discharge into the trunk sewers are the responsibility of the Borough Councils. The Council's brick and pipe sewers are regularly cleansed and are reasonably adequate for their purpose. Some surcharging of a few sewers in the Borough did occur, however, during the abnormally heavy and prolonged rainfall on 14th/15th September. Water supply The bulk of the water supply in Wandsworth, as in 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 by the Board's Southern group works and pumping stations, has been satisfactory both in quality and quantity throughout the year. To ensure the quality and purity of the water, the Board carry out daily sampling from the sources of supply, from the treatment works or well stations and from the distribution system. Any sign of contamination or any other abnormality is immediately investigated by the Board, and in this connection a close liaison is maintained with the Board by the Health Department. With the exception of a very small number of houses on the Council's Latchmere Estate, all dwelling houses in the Borough, numbering approximately 95,300, are supplied from the Metropolitan Water Board mains. The few exceptions on the Estate referred to are still supplied from deep wells situated at the Latchmere Baths which adjoin the Estate and the work of converting the whole of the Estate to a piped mains supply, to which reference has been made in my previous reports, is now nearing completion. Regular bacteriological analysis of the well water is carried out. No fluoride is added by the Metropolitan Water Board to the water supply in London, and where it is indicated in the analyses it represents the naturally occurring fluoride. The natural fluoride content of the mains water is 0.30 parts per million. 27 On the question of general fluoridation of the public water supply, which has been the subject of much controversy in recent years, it will be known that Wandsworth, in common with most of the other London Boroughs, has made a decision in favour of fluoridation. The whole question, however, rests with the Metropolitan Water Board whose present policy is to defer any action in the matter, pending uniformity of opinion between the local authorities whose areas its serves. 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 seven registered nursing homes in the Borough at the end of the year. During the year one nursing home and a mother-and-baby home closed down and the registrations were withdrawn. 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) 171 beds Mother-and-baby homes (2) 38 beds Other nursing homes (3) 67 beds Inspections by medical and nursing officers 15 Inspections by public health inspectors 7 Hairdressers and barbers Section 21 of the Greater London (General Powers) Act, 1967, gave powers to London Borough Councils to require registration 28 of hairdressers and barbers in their areas. The provisions contained in the section 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; the " appointed day " decided upon by this Council for putting these provisions into effect was 1st October, 1968. A total of 684 visits were made by the technical assistants during the year in connection with the work of registration and the enforcement of existing bye-laws which lay down standards of cleanliness in hairdressers' establishments. The 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 five rodent operatives. All infestations coming to light, whether by complaint or otherwise, are systematically investigated and appropriate action taken. Where the cause of the trouble is obviously a defective drain or other structural 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, 2,428 complaints of infestation were received in respect of which a total of 7,400 visits were made by the staff. It is interesting to note that more than two-thirds of these complaints related to the presence of mice, whereas complaints about rats have decreased. The increase in the number of complaints about mice over the last few years appears to be associated with the growth in the number of houses which are in multiple occupation in certain parts of the Borough. Experience shows that when a house is let to an excessive number of families, there is an initial hesitance to call in the local authority to deal with the presence of mice. Eventually, the premises become over-run and, at that stage, complete eradication becomes extremely difficult. In addition to the work of rodent control, the rodent officer, during the year, carried out several evening " forays " on pigeons roosting under the railway bridges within this Borough. These bridges are a favourite breeding ground and one of the causes of the high pigeon population of the Borough and, by attacking them at their roosting sites, profitable results were obtained. 29 Offensive trades There is one establishment in the Borough at which the scheduled offensive trade of fat-melting is carried on. The firm concerned has been established for many years and the trade is conducted satisfactorily. Pharmacy and Poisons Act, 1933 This Act is chiefly concerned with the distribution by sale or otherwise of poisonous substances. The list of poisons is contained in an Order made under the Act and is divided into two parts. The Council are not concerned with the poisons contained in Part I since an " authorised seller" is a pharmacist registered with the Pharmaceutical Society, and enforcement is entrusted to Inspectors appointed by that Society. Substances specified in Part II may be sold by " listed sellers", and these are persons who, on written application in a prescribed form, and on payment of stated fees, are recorded by the Council as " persons entitled to sell poisons in Part II of the Poisons List " at the premises recorded in the Register. The Council are required to enforce the Act and Orders so far as they relate to " listed sellers" and have appointed the Public Health Inspectors as Inspectors under the Act. At the end of the year there were 182 persons registered under the Act. Under the Poisons Rules (No. 2) Order, 1968, which came into operation on 6th December, the following fees to be paid by listed sellers of Part II poisons were authorised :— (a) for entry of name in the Corporation's list, twenty-five shillings; (b) for retention of name in the Corporation's list, fifteen shillings a year. 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. Several reports were received from the Fire Authority during the year concerning fires caused by oil heaters which did not comply with the Regulations. However, in every case, upon investigation, it was impossible to ascertain where these heaters had been purchased ; persons are often reluctant to give information which might be incriminating. Secondhand shops where old-type oil stoves might be sold are constantly being inspected and advice is given to shopkeepers where appropriate. 30 Noise Abatement Act, 1960 Noise has been called the " Symphony of the Machine Age" and is likely to be a permanent part of our everyday life. Noise in our environment will affect us all and will include sound energy from road vehicles, aircraft, industrial and commercial units and social noise (radios, musical instruments, human and animal noises). 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. In most cases an informal approach by the public health inspectors has been met by willing co-operation on the part of the offenders to seek methods of abating or lessening the noise and in no case has it been necessary to serve a notice under the provisions of the above Act. Noise other than industrial noise, however, is 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, 70 complaints were received in the Health Department and investigated by the public health inspectors, involving a total of 180 visits. Many complaints related to noise occurring during the evening, at night, or in the early morning, which necessitated visits and observations by the inspectors outside normal office hours; in other cases investigations proved that little or no justification existed for complaint. The Noise Abatement Act does not apply to noise caused by aircraft, or to noise vibration caused by statutory undertakings in the exercise of their powers. Noise from road vehicles is dealt with by the Police authorities as an element of road safety rather than of environmental health control. It may well be that the legislators of the future might consider the possibility of " noise control zones " or " silent areas " similar to the present " smoke control areas Offices, Shops and Railway Premises Act, 1963 Registration and inspection During the last six months of the year a separate section of the Health Department, consisting of one public health inspector and two technical assistants, was formed to deal specifically with the Offices, Shops and Railway Premises Act, 1963. The technical assistants underwent a three to four months' training period before being allowed to carry out inspections for themselves, and, as can be seen from the annual figures, this section has already proved its worth by the greatly increased number of visits and notices served. Quite obviously, 1969 should be a " bumper" year as far as this Authority is concerned. 31 It was found that where contraventions existed, owners have readily complied with informal notices, and only in very few instances have cases been referred to the Solicitor when, following a warning letter from him, the notice has been complied with. It is surprising that so many employers and employees still appear to have little knowledge of the requirements of the Act. This may be partly explained by the fact that there are frequent changes in staff, both in offices and shops, particularly women and younger staff. Registration by some occupiers is not usually of their own volition and, in these cases, it has been found that, in addition to the initial visit, further revisits and letters have been required before the requisite form has been completed and returned. Operation of the general provisions of the Act Cleanliness.—Parts of some shops away from the selling areas could show improvement in respect of decorative conditions but in the main the rooms concerned were only used by staff at odd intervals. Overcrowding.—The value of this section in this Borough is that, owing to certain areas of extensive redevelopment, many occupiers who are having to move are thinking of their future requirements in relation to space problems, staff, etc. Temperature.—Improvements are constantly being made to the heating arrangements in many offices and shops. It has been noticed that a few shops still persist in keeping their doors open, even during the cold weather, thus allowing an excessive amount of cold air to blow in, nullifying the heating arrangements provided for the shop. Lighting.—Increased awareness of the need for better lighting is now general among occupiers, but many premises still have parts where the lighting could be improved. Sanitary conveniences and washing facilities.—The position is improving but revisits still show that water closets tend to be misused by both sexes and often become fouled and dirty. Many water closet compartments are situated in outside yards and this location seems to predispose to neglect. Floors, passages and stairs.—In many cases, both occupiers and employees seem to have a careless attitude towards such hazards as unguarded openings in floors and staircases obstructed by the storage of goods. It is hoped that revisits will have the effect of making all concerned conscious of such dangers. Dangerous machinery.—It has been found necessary to stress the provisions of Sections 17, 18 and 19, and to draw attention to the number of accidents known to happen nationally. There still appears to be a fatalistic attitude towards accidents occurring in premises covered by the Act. 32 Accidents.—Fifty-seven accidents were reported during the year and, in the main, they fell within the following categories : falls, use of hand tools, handling goods, striking against objects and being struck by falling objects. The injuries resulting from these accidents include fractures and dislocations, sprains and strains, open wounds, surface injury and bruising and crushing. Suggestions for additional precautions made on investigation have been readily accepted. Prosecutions.—Several cases of infringement were referred to the Council's Solicitor who sent warning letters to the proprietors. In no case was it necessary for further action to be taken. The following table shows the classification and number of premises registered at the end of 1968, the number of persons employed and the number of inspections and other visits made during the year : — Class of premises Number registered Persons employed General inspections Revisits & other visits Offices 859 9,353 180 3,941 Retail shops 1,945 8,610 361 Wholesale shops, warehouses 105 1,274 5 Catering establishments open to the public, canteens 260 2,082 6 Fuel storage depdts 4 29 - Totals 3,173 21,348 552 3,941 Protection of animals Under the Miscellaneous Fees (Variation) Order, 1968. the fees for licences issued under certain Acts concerned with the protection of animals were increased with effect from 1st April, 1968. The new fees payable to the Corporation by licensees are as follows : Pet Animals Licence £2, Animal Boarding Establishment Licence £2 and Riding Establishment Licence £10. 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 these Acts. Action was taken during the year as follows:— Pet Animals Act, 1951.—A pet shop may not be kept except under the authority of a licence granted in accordance with the provisions of the Act, the object of which is to regulate the sale of pet animals, with particular reference to their welfare whilst kept for sale. Thirty-eight licences were issued by the Council during 1968. 33 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. One such licence was 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 6,525 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 development programmes, slum clearance areas, etc. 34 HOUSING Housing Act, 1957 Clearance Areas.—Thirty-nine houses were represented under Section 157 of the Housing Act, 1957, forty-seven houses were demolished following action under Section 42, and 223 houses were demolished following action under Section 43 (2). Closing Orders.—Under Section 157 of the Act, five houses and seven parts of houses were represented for closure, five Closing Orders were made under Section 17 (1) and eight Closing Orders were made under Section 18. One undertaking to close a house was received under Section 16 (4). Under Section 27, Closing Orders were determined in respect of three houses 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 3,255, shown by the following table:— Occupancies: 2 3 4 5 6 78910+ No. of houses: 1,581 851 375 172 115 65 45 25 26 It is estimated that there are roughly another 7,000 properties to be inspected, and whilst a very great deal of work has been carried out during the past year, the initial inspections have decreased owing to the greater number of revisits necessary to properties on which notices have been served. The general practice is to try and get properties in multiple occupation brought up to a standard acceptable to the Corporation by informal action, and although a considerable amount of work has been carried out by some owners voluntarily, others have not been so co-operative, and consequently it has been necessary to serve 62 notices under Section 16 of the Housing Act, 1961, requiring the provision of means of escape from fire, and 34 notices under Section 15 of the Act requiring additional facilities within the premises. Where owners do not comply with these notices, the work is carried out in default, and during the past year this was necessary on three occasions. The work carried out by owners, both voluntarily and following the service of notices, resulted in one hundred and forty-seven houses being brought up to standard 35 The following table indicates the extent of these works :— Section 15 Provision of additional facilities Section 16 Means of escape from fire Notices served 17 41 Work completed voluntarily 12 103 Work completed in default — 3 In fifty-two instances, owners who had received either formal or informal notification that work was required had reduced the number of lettings in their premises and in these circumstances no further action was taken. In continuation of our efforts to limit the number of tenants in over-occupied premises which do not comply with the required standards, nine Notices of Intention were served giving notice of the Council's intention to restrict the number of occupants. Subsequently nine Direction Orders were served fixing the number of occupants of the premises, and four variations were made to Direction Orders where owners had put in extra facilities. One summons was taken out during the year for the contravention of a Direction Order. In two 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, both now comply fully with the Council's requirements. Caravan Sites and Control of Development Act, 1960 There are six licensed caravan sites containing a total of 28 dwellings in the Borough. 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. 36 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 3 Decisions to issue certificates of disrepair 8 Certificates of disrepair issued 1 Undertakings received from landlords 5 Applications for certificates re undertakings received from landlords 4 Certificates re undertakings issued to landlords 4 Applications for cancellation of certificates of disrepair received 1 Certificates of disrepair cancelled 1 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 1,180 applications were considered for eligibility for additional points on health grounds in accordance with the Council's points scheme. A further 645 recommendations were made in respect of Council tenants who requested transfer to more suitable alternative accommodation on health grounds. 37 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 43 to 46. The total number of food premises of all kinds on the register in the Borough is 2,459 and during 1968 they were visited on 5,608 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 provisions 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. One summons, issued under these regulations against an icecream manufacturer in respect of the condition of the premises, resulted in the Court imposing a fine of £20 and costs of £10. 38 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 23 23 23 23 Bakers and confectioners 479 456 362 251 Butchers 163 157 163 163 Chemists 41 41 41 41 Dairies and milk depots 9 9 9 9 Fish friers 59 57 59 59 Fishmongers 34 34 34 34 Food factories 19 19 19 19 Greengrocers 189 189 189 152 Grocers 498 498 498 491 Ice-cream manufacturers 14 13 14 14 Market stalls 163 — — — Off licences 142 136 31 31 Public houses 168 162 168 168 Restaurants, cafes and canteens 458 452 458 458 Totals 2,459 2,246 2,068 1,913 TABLE 2 VISITS TO FOOD PREMISES Bakehouses 294 Butchers' shops 596 Confectioners' shops 318 Dairies and milk depots 21 Fishmongers' shops 69 Fried-fish shops 202 Greengrocers' shops 316 Grocers' shops 1,560 Ice-cream premises 335 Market stalls 417 Restaurant kitchens 1,187 Other premises 293 5,608 TABLE 3 WORK COMPLETED TO COMPLY WITH STATUTORY REQUIREMENTS Washhand basins provided 8 Sinks provided 6 Provision of hot water over sink and washhand basin 21 Accommodation for clothing provided 4 Premises repaired and redecorated 28 Dustbins provided 3 Water closet accommodation provided 4 39 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 These Regulations lay down requirements as to food hygiene in respect of markets, stalls and delivery vehicles. The principal requirements 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 suppy and washing facilities. Proper disposal of waste material. Granting of certificates of exemption from certain requirements. During the year applications were received from six stallholders for certificates of exemption. These were granted by the Corporation and referred to the following Regulations :— Reg. 15 Water supply 6 Reg. 16 Personal washing facilities 6 Reg. 18 Food and equipment washing facilities 6 The principal difficulty in securing stallholders' compliance with the Regulations related to proper screening to prevent contamination of food. 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 37 applications for registration under the provisions of Section 16(l)(a) and 13 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 Gravy powder contaminated with disinfectant £15 0s. 0d. £5 0s. Od. Mouldy sausage-rolls £15 0s. 0d. £10 0s. Od. Wire in bun round £10 0s. 0d. £10 0s. Od. Wood splinter in cake £2 0s. 0d. £1 0s. Od. Rat-droppings in loaf £25 0s. 0d. — Unsound sausages £5 0s. 0d. £5 5s. Od. Mouldy loaf (two summonses) £20 0s. 0d. £10 10s. Od. Beetle in sliced loaf £20 0s. 0d. £5 0s. Od. Glass fragment in milk bottle £25 0s. 0d. £5 s. Od. 40 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 24 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 249 persons and two dairies on the register. The bulk of the milk sold by retailers in the Borough is bottled in well-designed dairies and its quality is good. Food and Drugs Act, 1955 During the year, 100 samples of milk were submitted for analysis to which reference is made on page 46. 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 1968 is given below : — Special designation Number of licences issued Pasteurised 27 Sterilised 17 Untreated 4 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 9 applications for such licences were received during the year. Butchers* shops There are 163 butchers' shops in the Borough. The majority are registered under Section 16(l)(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 596. Slaughter of animals There are no licensed slaughterhouses in the Borough. 41 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. Eighty visits were made to the above premises during the year, the number of birds processed being 137,550, made up of broilers, hens, ducks, pheasants, turkeys and capons. The percentage of birds rejected as unfit for human consumption was .005 and the weight of poultry condemned as unfit 175 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 93 such shops in the Borough and 271 inspections were made during the year Catering establishments All restaurants, cafes, canteens and kitchens were regularly inspected throughout the year. There are 458 such premises on the register, and 1,187 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 163 food stalls in the Borough, and 417 inspections were made during the year. Bakehouses There are 23 bakehouses in the Borough and during the year 294 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. 42 Bacteriological examination of food One hundred and forty-one food samples were examined bacteriologically at the Public Health Laboratory during the year, and details are given below : — Milk 24 Cream 15 Ice-cream 93 Miscellaneous 9 Total 141 Milk The 24 samples of milk submitted to the turbidity test were reported to be satisfactory. Ice-cream The 93 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 52 2 15 3 11 4 15 Total 93 Cream The 15 samples were submitted for tests in respect of brucella abortus and salmonella but no organisms were isolated. Miscellaneous The nine 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; 100 samples of milk, 803 other foodstuffs and 97 drugs. Of these 30 were submitted as formal samples, while 970 were purchased informally. Three of the formal samples and 73 of the informal samples were found to be adulterated or below standard, representing 7.6 per cent. of the total samples submitted. Details of these 76 samples are given in the Report on the work of the Public Analyst which follows. 43 REPORT OF THE WORK OF THE PUBLIC ANALYST FOR 1968 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. As stated in the 1967 report, my proposals to the Health Committee in the latter part of that year, for a variation in the make-up of the 1,000 samples of food and drugs per year examined by the Analyst, were approved and the new arrangements for the analysis of 100 milk samples and 900 other foods and drugs became operative from the beginning of 1968. Of the 1,000 samples submitted to the Public Analyst during the year under review, 30 were taken with the formalities required by the Act and 970 taken informally. The number of food samples was 903 and the remaining 97 were drugs. The samples submitted for analysis comprised the following substances : — Beer, wines and spirits 2 Beverages (cocoa, coffee, tea, etc.) 19 Cereal preparations 31 Cheese products 29 Confectionery 112 Cream 24 Fats (butter, margarine, etc.) 75 Fish (canned, etc.) 32 Fruit (canned and dried) 25 Ice-cream 44 Meat products (including sausages) 142 Milk 100 Milk products 26 Pickles and condiments (including spices) 78 Preserves 49 Soft drinks 43 Soups 19 Vegetables 53 Drugs 97 SAMPLES FOUND TO BE ADULTERATED OR BELOW STANDARD Case No. Nature of Sample Report Formal 178 Ice cream Deficient in non-fatty milk solids. 183 Whisky, 70° proof Slightly deficient in alcohol. 187 Ice-cream Deficient in non-fatty milk solids. Informal 2513 Choona Labelling—no English words. Can corroded. 2524 Dripping Labelling—no packer's name or trademark. 2549 Cough medicine Deficient in acetic acid. 44 Case No. Nature of Sample Report 2576 Ice-cream Deficient in non-fatty milk solids. 2577 Ice-cream Deficient in non-fatty milk solids. 2604 Tincture of quinine Deficient in ammonia. 2611 Blue colour (food dye) Contained prohibited colour (Blue VRS). 2671 Tincture of quinine Deficient in ammonia. 2684 Special seasoning Contained undeclared preservative. 2686 Ground nutmeg Deficient in volatile oil. 2121* Foreign matter in bread Contained rodent excrement. 2728* Foreign matter in ginger ale Contained yeast and mould. 2743 Black eye beans Showed signs of insect infestation. 2744 Peeled tomatoes (canned) Part of one whole tomato found. 2823 Rasim powder Excess salt and label did not include a common English name. 2824 Prawn curry Dried, imperfectly-peeled prawns had been used. 2831 Ground nutmeg Deficient in volatile oil. 2833 Milk Deficient in fat. 2868* Courgettes Bitter taste due to development of a natural bitter principle. 2872 Digoxin tablets Deficient in digoxin. 2887* Foreign matter in bread roll Contained dirty dough. 2899 Liquorice, linseed and chlorodyne tablets Excess chloroform. 2908 Ground nutmeg Deficient in volatile oil. 2932 Margarine Labelling offence. 2933 Butter Slight excess of water. 2942 Margarine Slight excess of water. 2975 Ground caraway Deficient in volatile oil. 3017 Katar Labelling label contained no English. 3018 Mikger (flavouring) Labelling—label contained no English. 3019 Jiffi-Jellie Misleading illustration on cap. 3022 Fruit yoghourt Deficient in fruit. 3027 Orange juice Deficient in fruit. 3028 Chamley Inadequate description on label. 3032 Low-fat spread Excess water, 3071 Ice-cream Deficient in non-fatty milk solids. 3075 Pork sausages Deficient in meat. 3079 Fried chips Incipient rancidity of fat. 3080 Fried roe Incipient rancidity of fat. 3081 Fried chips Incipient rancidity of fat. 3105 Fruit pastilles Contained non-permitted colour. 3123 Soft cheese (medium fat) Excess fat. 3141* Wrapped sliced loaf: contained beetle Beetle appeared to have been cooked in loaf. 3142* Cooked chicken Red stains confirmed as a dye of some kind but not identified. 3144* Creamed macaroni pudding Sourness due to high acidity. 3146 Cream cake Contained fat other than butter fat. 3153 Cream cake Contained fat other than butter fat. 45 Case No. Nature of Sample Report 3154 Cream cake Contained fat other than butter fat. 3157 Buttered roll Contained fat other than butter fat. 3158 Cream cake Contained fat other than butter fat. 3160 Cream cake Contained fat other than butter fat. 3161 Ice-cream Deficient in non-fatty milk solids. 3162 Ice-cream Deficient in non-fatty milk solids. 3164* Mustard piccalilli Several slivers of glass found. 3193 Dried non-fat milk Contained 0.45 per cent. fat. 3195 Margarine Excess moisture. 3202 Cream cake Contained fat other than butter fat. 3234 Margarine Slight excess of water. 3243 Ground cinnamon Deficient in volatile oil. 3247 Ground nutmeg Deficient in volatile oil. 3251 Steakburgers Deficient in meat. 3264 Ice-cream powder Incorrect labelling. 3270 Fried chips Rancidity of fat. 3305 Supari Labelling—no English name. 3318 Sliced ox tongue Labelling—consisted of "oxtongue in jelly 3331* Glass fragment in milk bottle Presence of glass confirmed. 3346 Large beefsteak Deficient in meat. 3366 Tincture of arnica Deficient in alcohol. 3377 Beefcurry with rice Deficient in meat. 3414 Lambs' tongues Labelling—consisted of " lamb tongues in jelly ". 3419 Tuna fish (canned) Labelling—" Tuna fish in vegetable oil 3438 Steakburgers Deficient in meat. 3444 Savoury cheese Excess preservative (sorbic acid). 3461 Sea salt Deficient in iodine. 46 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, 100 samples of milk were submitted for analysis (90 ordinary milk and 10 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 During the year, eighteen samples of food were taken by the Corporation for examination by the Public Analyst for pesticide residues, and the results are shown below. The types of food were selected by the Association of Public Analysts under the scheme initiated bv the Association of Municipal Corporations. The enquiry has been set up to ascertain the extent, if any, of possible contamination of foodstuffs by toxic chemicals. Sample Pesticide contaminant (parts per million) Lettuce B.H.C. 0.008 D.D.T. 0.157 Pears None detected Pears D.D.T. 0.020 Plums None detected Cucumber None detected Onions None detected Cheese B.H.C. Very minute trace Dieldrin Very minute trace Cooking fat D.D.T. 0.004 T.D.E. 0.009 Milk B.H.C. Very minute trace Dieldrin Very minute trace Corned beef B.H.C. Very minute trace Ham None detected Dried milk None detected White loaf B.H.C. Very minute trace Wholemeal loaf B.H.C. 0.037 Pork chops None detected Belly of pork B.H.C. Very minute trace Beef sausages B.H.C. Very minute trace Dieldrin Very minute trace Vegetable and beef broth None detected 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. 47 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 Secretary of State for Social Services:— 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 lo be enforced by Local Authorities 149 46 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,070 436 9 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 96 7 - - Totals 1,315 489 9 — (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 Sanitary conveniences: (a) insufficient — __ (b) unsuitable or defective 20 17 12 __ (c) not separate for sexes — — — __ Other offences against the Act (not including offences relating to outwork) 1 1 __ __ __ Totals 21 18 — 12 — 48 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(lXc) 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 74 — — — — — Household linen 1 — — — — — Curtains and furniture hangings 1 — — — — — Artificial flowers 5 — — — — — Paper bags 4 — — — — — The making of boxes 1 — — — — — Brass articles 2 — — — — — Lampshades 9 — — — — — Total 97 — — — — — 49 ATMOSPHERIC POLLUTION Clean Air Act, 1968 This Act, which amends the Clean Air Act, 1956, received the Royal Assent on 25th October, 1968. The appointed day for some of its provisions is 1st April, 1969, and it will be discussed more fully in next year's report. Smoke control areas During the year, the London Borough of Wandsworth (No. 2) Smoke Control Order was confirmed by the Minister of Housing and Local Government and became operative on 1st October, 1968, The London Borough of Wandsworth (No. 3) Smoke Control Order was submitted to the Council at the end of the year and was eventually made on 4th February, 1969. A map showing existing and proposed smoke control areas will be found opposite. Smoke, etc., nuisances and observations During the year, 44 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 246 such observations were made. Installation of furnaces Notification is required under Section 3 of the Clean Air Act, 1956, of any proposal to install 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. Three such notifications were received during the year. Measurement of atmospheric pollution Daily readings of the concentration of smoke and sulphur dioxide (SO2) in the atmosphere were continued during the year at the three stations in the Borough where recording apparatus is maintained. A record of these readings for the year under 50 review is given in the table below. The readings are taken by members of the staff of the Department and the information is passed to the Department of Scientific and Industrial Research for collation with data received from authorities all over the country. Station Roof— Municipal Buildings 207 Lavender Hill Battersea Tooting Library Month—1968 Smoke SO2 Smoke SO2 Smoke so2 January 132 265 110 310 125 322 February 124 240 133 263 156 262 March 152 318 66 216 75 234 April 96 221 70 178 64 191 May 56 129 53 155 50 142 June 52 194 43 136 34 72 July 51 146 40 93 39 51 August 60 112 40 119 32 49 September 56 167 70 108 62 112 October 138 194 126 165 73 142 November 149 217 190 230 139 204 December 157 192 181 310 162 286 Averages 102 199 97 190 84 172 51 MISCELLANEOUS MATTERS Swimming baths The Corporation has four public baths which have indoor swimming pools, at Putney, Balham, Battersea, and Nine Elms, and one open-air pool at King George's Park. There is also an open-air pool at Tooting Bee owned by the Greater London Council. With the exception of the Battersea bath, the water for which is obtained from deep wells, all Corporation baths are supplied from the mains of the Metropolitan Water Board. The water is chlorinated and circulates continuously through a filtration plant. Samples of water are taken at regular intervals and are submitted to the Public Health Laboratory at County Hall for bacteriological examination. During the year 70 samples were submitted for examination and satisfactory results were obtained in 67 instances. In the remaining samples there were slight deviations from normal but subsequent tests proved satisfactory in all cases. 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 68 reports were received from the Scientific Branch of the Greater London Council in respect of eleven of these baths, all of which were satisfactory. Examination of water from artesian wells and taps Twelve samples were submitted for examination at the Public Health Laboratory, and all 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. 52 Bedding and clothing are collected and steam-treated at the Disinfecting Station. Sheets, pillow cases and hand towels are exposed to formalin vapour in a special chamber prior to being washed in the Council's laundry. 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 sometimes been a cause 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 Six hundred and ten treatments were given during the year at the personal cleansing station in Sheepcote Lane to persons suffering from scabies, 279 to adults, 266 to schoolchildren and 65 to children under school age. In addition, 385 treatments for verminous conditions were given, 37 to adults, 294 to schoolchildren and 54 to children under school age. Included in the above are 72 treatments for scabies and 70 treatments for verminous conditions which were given to residents of the London Borough of Lambeth 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. 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 1968, are set out in the following table:— 53 Details of bodies received Usual place of residence Totals Wandsworth Merton Else where Unknown Post-mortem only 678 305 123 16 1,122 Post-mortem and inquest 99 19 28 8 154 Total post-mortems 777 324 151 24 1,276 Inquest only — — 3 — 3 Total inquests 99 19 31 8 157 Sanitary and other reasons — — — — — Total bodies received 777 324 154 24 1,279 Verdicts at Inquests held— Accidental and misadventure 40 8 26 2 76 Alcoholism 1 — — — 1 Natural causes 1 — 1 — 2 Industrial disease 2 1 — 3 Open verdict — — – — — Suicide 54 10 4 5 73 Homicide — — — 1 1 Manslaughter 1 — — — 1 TOTALS 99 19 31 8 157 In addition to the above, a further 94 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, 1,888 cremations were authorized during the year. Transportation of bodies abroad The bodies of persons normally resident abroad who have died whilst visiting this country are sometimes transported overseas for burial. Before this can be done, it is necessary to obtain a certificate from the Medical Officer of Health of the district in which the death has taken place to the effect that the deceased did not die from any infectious or contagious disease, and that no recent epidemic of such disease had occurred in the district. During the year three such certificates were issued in respect of persons who had died in Wandsworth. 54 STAFF TRAINING Public Health Inspectors Facilities are provided by the Council for public health inspectors to undertake refresher courses and to attend conferences and short courses which are relevant to their work. During the year, three inspectors attended a course at the South East London Technical College on the subject of Noise Prevention and Control extending over seven weekly one-day sessions, and two inspectors attended the Public Health Inspectors' five-day conference at Blackpool. Student Public Health Inspectors The Public Health Inspectors' Education Board limits the number of students who may undertake training with a local authority to an approximate ratio of one to three to the number of qualified inspectors employed. The number of students who may train within the department is therefore at present limited to six. 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 close of the year under review, four students were in training in the department ; two others qualified during the year and were appointed as public health inspectors to fill existing vacancies. 55 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. 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 as "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 With the continued decrease in the number of home confinements it has been possible to reduce the number of ante-natal clinics and to concentrate the work into one centre in each area. This has the advantage of allowing the midwives to work in groups so that a mother will get to know all the midwives who may be likely to attend her during confinement. The midwives work in close co-operation with the general practitioners and four midwives attend ante-natal clinics in doctors' surgeries. Two doctors see their own patients in the Council's ante-natal clinics. Close liaison is maintained with all maternity units serving the area and all hospital bookings and discharges are notified to the Council. Sessions held during the year 467 First attendances 1,687 Total attendances 4,439 Mothercraft and relaxation classes The relaxation classes, talks and films for expectant mothers have been continued. It has not been possible to extend this service mainly because of a lack of suitable premises. The evening 56 sessions for fathers which are included in these courses are always greatly appreciated. Three training sessions on the subject of relaxation were organized for health visitors and midwives who joined the service during the year. Sessions held during the year 194 First attendances of mothers 447 Total attendances 1,663 Average attendance at each session 8.6 Child health clinics There has been a slight fall in the number of attendances at these clinics during the year. This is partly due to a decline in the birth rate and partly to the fact that an increasing number of general practitioners are providing some services in their own surgeries, especially immunization. However, most sessions are very well attended and provide a pleasant social occasion for many mothers in addition to the health services provided. One health visitor attends a session in a general practitioner's surgery every week and arrangements have been made for another session to start early in 1969. The evening child health session which was started at Balham Child Health Centre has become well established and is supplying the needs of many mothers who are at work during the day. It is hoped to have an evening session in the new Tooting centre which will be opened in 1969. We are grateful to a number of voluntary helpers who give valuable service in several centres. Mothers' clubs The success of these clubs seems to vary from year to year and their pattern changes according to the needs of different groups of mothers. Only two clubs have run throughout the year. Toddlers' clinics These have followed the pattern of the other child health sessions and show a slight fall in attendances. Fourteen fewer sessions were held but the average attendances were about the same. These sessions continue to provide a useful means of keeping a check on the health and development of children from 2 to 4 years of age. Toddlers' sessions held during the year 288 Total attendances 3,507 Average attendance at each session 12.2 57 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 60 attendances by mothers and 501 by children under five years of age. Family planning Since the introduction of the Family Planning Act, 1967, we have developed a scheme to ensure that all women in need of advice on family planning can obtain it without difficulty. During the past year there have been some changes in the scheme aimed at developing the service to its full potential. New provisions were made during 1968. and the extension of family planning through the domiciliary service and by the establishment of new clinics increased the cover of the the most vulnerable women in the population ; by this means we extended the service to the families who needed it most of all. The service became fully comprehensive towards the end of the year, reaching married and unmarried women alike. This was achieved through maintaining close links with other departments (such as Children's and Welfare) which deal with social services in the Borough. Continuous co-operation with general practitioners and hospital consultants further helped to extend the service to all those who needed it. We were able also to establish a liaison with the London Borough of Merton and accept residents from their area for treatment on a "knock-for knock" exchange basis. The Family Planning Association continued to act as our agents, and this has simplified the financial arrangements and minimised the accounting and clerical work involved, payment being made to the Association on the basis of approved net costs. Eight sessions a week are held in our health clinics and four sessions a week are held at local hospitals. In addition, there has been a comprehensive and very successful domiciliary scheme. There is no charge for consultation or medical supplies for cases referred on medical grounds, and women referred on social grounds have to pay only for supplies. Whenever there are difficult economic circumstances, a simple assessment scale is used and free supplies are given in case of need. On the medical aspects of treatment, there is very close co-operation between the general practitioner and the Family Planning Association doctor, and where the family doctor prefers to advise and treat his patient, she is referred back to him. In many cases, general practitioners find it easier not to concern themselves with economic matters and the medical follow-up of patients on contraceptives ; these cases are usually referred to the clinics by their own doctors. The service is open to both married and unmarried women over the age of 16 years. 58 The South-West London Branch of the Family Planning Association will shortly be given administrative headquarters in our new purpose-built centre in Mitcham Road, and this arrangement should lead to a reduction in office costs. The expenses connected with the service increased considerably during 1968 but this is commensurate with the growth and development of the service. The approximate annual figure of £10,000 for the Borough population of more than 321,000 constitutes about 1% of health services expenditure which seems to be good value for the money spent. Special acknowledgement of the excellent co-operation between the Family Planning Association and the Health Department is due to the Association's officers, Mrs. R. Crampton Smith, the Organizing Secretary, and Mrs. L. Harvey, the Chairman, while acknowledgements and thanks are due to Dr. J. Duncan Whyte (domiciliary service) and Dr. M. Edge, for the high quality of services rendered, so well reflected in the growing popularity of the Family Planning Service in the Borough. The nursing staff working with these doctors should also receive thanks for their special efforts in this so demanding and difficult work. Mere statistics are rarely a measure of the value of personal health services but the figures presented in the accompanying table give some idea of the work carried out and the trend in comparison with 1967. It is hoped that during the year 1969 two new clinics will be opened in Tooting and Balham, areas which perhaps are in most need of these services. (a) New patients (domiciliary work shown in brackets) (i) Number of patients seen 1967 1968 Medical 168 (22) 92 (26) Social 1.287 (65) 2,293 (213) Totals 1,455 (87) 2,385 (239) (ii) Age at attendance 16-20 160 (4) 376 (22) 21 and over 1,295 (83) 2,009 (217) (iii) Method chosen Intra-uterine device 214 (46) 253 (107) Other methods 1,241 (41) 2,132 (132) (b) Established patients attending for for the first time during year 5,727 3,194 (c) Number of sessions attended by doctor 505 691 Total number of attendances to see doctor 7,676 10,794 Plate A Home help service—Service has been given regularly to this spastic mother since the birth of her child (see page 69). Plate B Flooding at Earlsfield—Some of the furniture, carpets, etc., which were taken to a local depot for drying (see pages 5 and 24). Plate C Flooding at Earlsfield—The drying-out process, showing warm air blowers in action. (see pages 5 and 24). Plate D Linden Lodge—This school for blind children was purpose-built in 1964 and accommodates 100 boarders and 20 day pupils (see pages 99 and 100). 59 (d) Number of visits by doctor to domiciliary cases 214 1,012 Total number of patients seen at visits 87 576 (e) Number of cytological smears taken from patients: (i) at clinics 629 1,499 (ii) at domiciliary visits 17 91 Number referred for investigation 3 13 (f) Number of patients (non-medical cases) receiving free supplies 59 331 Domiciliary midwifery service The number of home confinements attended by the domiciliary midwives continues to decline. There were 526 home confinements this year as against 725 in 1967 but the number of early discharges from hospital has increased from 490 in 1967 to 589 in 1968. The early-discharge scheme is now well established and is very popular with many mothers. It is satisfactory to be able to report that there were fewer unbooked cases who left hospital early although there were still 71 mothers who took their own discharge from hospital. Whether booked or unbooked, all mothers who are discharged before the tenth day after the birth of their babies are attended by the midwives. Unbooked cases sometimes give rise to difficulties because the midwife does not know the mother and adequate preparations may not have been made in the home for the early return of mother and baby. There has been close co-operation with the obstetric units in the local hospitals. Towards the end of the year plans were made for Queen Mary's Hospital. Roehampton, to hold an ante-natal clinic each week in the William Harvey Child Health Centre. This clinic is due to start early in the new year, and one of our midwives will attend each session. Plans are also in hand for a General Practitioner Obstetric Unit at the Weir Hospital, Balham, and it is hoped that midwives will be able to undertake deliveries there. At the end of 1968 we terminated a long association with the South London Hospital by taking over from them the domiciliary midwifery service covering a small area near the hospital. Our existing staff can absorb this small amount of additional work and we shall continue to provide district training and experience for pupil midwives. Tn August, 1968, the Educational Supervisor of the Central Midwives Board visited Wandsworth and she reported that the domiciliary midwifery service and the teaching of pupil midwives were very satisfactory. 60 During the year five midwives retired and we have engaged three new midwives. All but two of our midwives are now car drivers and the two new midwives are taking their driving tests in the near future. We now have four midwives working in ante-natal clinics in general practitioners' surgeries and two general practitioners work with midwives in the Borough ante-natal clinics. Mothers attended in their own homes during the year were as follows:— Home confinements 526 Booked early discharges 518 Unbooked early discharges 71 Health visiting service This year all the health visitors have continued to concentrate their efforts on essential health visiting duties. As far as possible other work has been taken over by less highly-trained staff and auxiliaries. There have been unfilled staff vacancies throughout the year and this has produced a very heavy case-load on the staff in some areas. The four health visitor students we sponsored in September, 1967, all qualified and joined the staff in September, 1968. We were fortunate in being able to sponsor ten students in September, 1968, and we look forward to having them on the staff next year. In the meantime, the acute shortage of health visitors continues. All the babies born during the year to mothers resident in Wandsworth were visited within about fourteen days of birth. In addition, all families with children under five years of age known to have moved into the Borough were visited. The frequent moves of some families make follow-up difficult but every effort is made to trace families who may need help. Although the basis of the health visitor's work is still home visiting, the pattern of work appears to be changing. There has been a slight but steady decline in the number of home visits paid over the last four years which was not fully accounted for by the decline in the birth rate. After the initial visit to a family many mothers contact the health visitor by telephone when they need help and an increasing number of parents call in at the health visitors' offices. The large number of unsuccessful visits recorded (11,537) is somewhat misleading as in many cases a letter is left by the health visitor inviting the parents to contact her by telephone or to call at her office. With so many mothers working either part-time or full-time, interviews in the office are now an important part of the health visitor's work and provide a better service to the public. This has naturally led to a drop in the number of home visits paid but not in the total amount 61 of service given. In the past, interviews in the office have not been recorded but they are now such an essential part of the health visitor's work that we are planning to maintain such records. In this way we hope to be able to give a more complete picture of the amount of service given to families in the Borough. The help given by health visitors during the floods last autumn is mentioned elsewhere in this report. The number of first visits made during the year to children under five years of age was:— Children born in 1968 5,453 Children born in 1967 4,573 Children born in 1963/66 10,246 Visits of all kinds paid by health visitors during the year totalled :— Effective visits 54,020 Unsuccessful visits 11,537 Premature infants The incidence of prematurity, defined as a weight of less than 5£ lb. at birth, has slightly increased ; the total number of live and still births of premature birth weight was 474, while premature stillbirths numbered 48. Full figures relating to prematurely born infants, both at home and in hospital, are given below. infants, both at home and in hospital, are given below. The total adjusted births for the year was 5,703. Died under Live births 1 month Stillbirths 2 lb. 3 oz. or less 19 14 7 Over 2 lb. 3 oz. up to and including 3 lb. 4 oz. 33 7 17 Over 3 lb. 4 oz. up to and including 4 lb. 6 oz. 88 7 15 Over 4 lb. 6 oz. up to and including 4 lb. 15 oz. 70 3 5 Over 4 lb. 15 oz. up to and including 5 lb. 8 oz. 216 3 4 426 34 48 Handicap and Observation Register During the year the register of handicapped children and of those under observation as at risk of developing a handicap has been extended to include schoolchildren, and a special index system was brought fully into operation. The new method of recording aims at easy analysis of incidence of different handicaps 62 and facilitates the transfer of information and a closer follow-up of the handicapped child. The criteria determining whether or not a child's name is placed on the register are closely defined and only about 8% of the total live-born children are placed on the register within one month of birth. This number includes newborn babies with malformations or congenital abnormalities, and those with a history of genetic defect or pre-natal history with possible relevance to future handicap. All children on the register are regularly examined for defects and developmental screening tests are carried out periodically. This ensures that any abnormality will be detected at an early stage. Clinic doctors, general practitioners, hospital specialists and health visitors continue to play an important part in the follow-up of children on the register. Special visiting of those who are not taken to any child health clinic and often fail to attend hospital is carried out by the health visitor. In some of these difficult cases the health visitor makes arrangements for the child to be taken to hospital, and occasionally helps the mother by taking the child herself. Sometimes a home help has to be provided; at other times a mother may need to be assisted if she has difficulty in travelling to the hospital. In addition to the children initially placed on the register, notifications are received about those whose development is delayed or who have suffered from an acute or chronic illness which may threaten their future health. After accident or injury a child is placed on the register and is visited more often. A number of physically handicapped children are in the care of the Children's Officer, and even those without any physical handicap who happen to be in care are considered to be at risk of abnormal development owing to their emotional deprivation in early childhood. Hence, practically all children in care are considered to be at risk and an exchange of information with the Children's Officer helps us to decide finally about their physical and psychological progress. Sometimes children are taken into care on the special recommendation of the health visitor who is well placed to note symptoms of deprivation and neglect. There is also a constant exchange of information with the Welfare Department about blind and partially-sighted children, and the names of school-leavers who wish to be registered as persons with severe handicaps are notified to the Chief Welfare Officer. The close co-operation established in previous years with the Medical Adviser of the Inner London Education Authority has continued. All young children with severe special handicaps or multiple defects are notified to the Authority well before they reach school age so that planning for educational provision for these most difficult cases can be done whenever there is a hope of the child's being educable. 63 The Handicap Register continues to play an important role in facilitating research projects in special diseases, and we have been co-operating in a number of studies such as research into spina bifida and anencephaly carried out by the Greater London Council and the National Child Development Study of the National Bureau for Co-operation in Child Care. The tables below give the figures concerning handicapped children in the under-five group Number of children under five years of age (approximate) 25,000 Number on Handicap and Observation Register on 31st December, 1968 1,339 Ages Handicap Observation Totals Under 1 year 24 480 504 1 year 37 283 320 2 years 48 170 218 3 years 68 107 175 4 years 74 48 122 Totals 251 1,088 1,339 Number of children on the register on 1st January, 1968 1,513 Number placed on the register during 1968 713 Number removed from the register during 1968 887 Number placed on the register within three months of birth 566 Notification (to the Registrar General) of congenital malformations observable at birth in live and still bom children :— Central nervous system 20 Eye and ear 3 Alimentary system 20 Heart and great vessels 2 Respiratory system 1 Urogenital system 11 Limbs 38 Other skeletal 8 Other systems 1 Other malformations 6 Total malformations 110 (in 91 children) Serious handicaps in children aged under five years Number dealt with during 1968 Number born in 1968 and placed on Register Mongol 33 9 Anencephalus 26 2 Spina bifida 9 3 Microcephalus 6 1 Congenital heart disease 43 9 Fibrocystic disease 8 1 Partially-sighted and blind 18 6 Deaf 13 0 64 Unmarried mothers The special needs of unmarried mothers appear to be changing. The majority of these mothers now use the normal maternity services. Many of them need special help and support from the health visitors and hospital medical social workers. Some seek the help of the Moral Welfare Worker and we are grateful that these workers maintain such a good contact with our staff. One of the great problems for the unmarried mother who wishes to keep her baby and cannot return to her family is to find suitable accommodation at a rent which she can afford. Not all unmarried mothers are unsupported but most of them lack security. During the year, one of the three mother-and-baby homes in the Borough was closed and another one will probably close early in the new year. This emphasizes the changing pattern in this field of work in the country as a whole. Cervical cytology The cervical cytology service continued to be used by women residing or working in the Borough. In spite of the national decline in demand for the service, our clinics were well attended. The average number of eight patients per session allowed the doctor enough time to carry out a full gynaecological and breast examination and also permitted general health counselling. The practising women doctors are usually experienced in gynaecology and obstetrics and are interested in the preventive aspect of this type of work. Some general practitioners in the area wish to provide the services of cervical cytology themselves but the majority encourage their own patients to attend our clinics. It is to be noted that the incidence of malignancy has increased considerably and in the year 1968 one smear in 129 was found to be positive while sixteen cases of obvious or potential cancer were detected. This was more than twice the incidence noted in 1967. In addition to cases of malignancy, numerous morbid conditions were detected, some necessitating hospital treatment. Detailed statistical information for the year 1968 is given in the following table: — Number of clinics held each week 6 Total number of women examined 2,060 Average number of women examined per session 8 Total number of cases cytologically and clinically negative (healthy women) 1,110 Total number of cases with morbid conditions 950 65 Morbid conditions found:— (i) positive malignant smears 16 (ii) cervical erosion 370 (iii) cervicitis 56 (iv) cervical polyp 68 (v) ovarian cyst 7 (vi) uterine fibroids 37 (vii) all degrees of prolapse 29 (viii) vulvo-vaginitis 281 (ix) other conditions 86 950 Occasional creches The popularity of these three-hour play sessions indicates that they meet a real social need and are of great benefit to both mothers and children. In centres where more than one session a week is available, attendances have had to be rationed so as to give as many children as possible the chance of attending. Unfortunately, it is not easy to recruit suitable part-time staff for these sessions and one of our best helpers left during the year in order to undertake teacher training at a College of Education. Day nurseries The demand for places in day nurseries continues to be very heavy and it is possible to admit only children with a high priority. A number of short-term admissions have helped many families over a period of crisis and prevented the need for children to be taken into residential care by the Children's Department. A number of children have been admitted for three hours daily on medical grounds and they nearly all benefit greatly. The shortage of staff has not been quite so acute this year although no nursery has been fully staffed for more than a few weeks at a time. The three training nurseries have been helped by the increase in nursery students and we hope to benefit by having more trained staff available next year. Measles immunization was offered to all children who had not had the disease and most of the mothers accepted. This should help to reduce the incidence of measles in the nurseries and cut out long periods of quarantine and consequent limitation of admissions. 66 Special Unit The special unit at Summerley day nursery, which provides places for up to six children who show signs of being mentally handicapped, continues to provide a very valuable service. The training and care given to these children helps them to make maximum progress before a decision has to be made concerning their future educational needs. The admission of one or two children who are severely subnormal and almost helpless has enabled the mothers to keep these children at home at least for a time. Private day nurseries and child-minders During the year there has been a considerable increase in the number of private day nurseries and pre-school playgroups registered. These registrations have made a considerable amount of work for a Senior Medical Officer and the Deputy Principal Nursing Officer. Every effort has been made to give help and encouragement to organizations and individuals wishing to open a day nursery or playgroup. In addition, there has been a steady flow of applications for registration as child-minders. At the end of the year there were 52 private day nurseries (which include parttime playgroups) with places for 1,249 children and 50 registered child-minders with places for 265 children. These last two figures are, however, only a small proportion of the actual numbers of minders and children concerned. On 1st November, 1968, the Health Services and Public Health Act came into force and voluntary registration ceased from that date. There were then between 500 and 600 known minders who became immediately liable to seek registration. These minders have only one or two children and many of them are well known to the health visitors and will be registered in due course. All minders seeking registration will have to be visited by a senior nursing officer, and it will take many months before this work can be completed. In the meantime, new applications continue to come in as the new regulations receive greater publicity. All minders and nurseries are visited regularly by the Council's medical or health visiting staff and advice is given on child care, including the play needs of children, and general health supervision. Consideration may have to be given later on to the setting-up of training courses for private nursery staff and child-minders. 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 seven cases were agreed to be suitable for adoption and twelve were found suitable for boarding-out. In addition, medical advice was sought in respect of 41 prospective adopters. 67 Health surveys During the year, the Health Department has continued to give as much assistance as possible in surveys which have been initiated by the Greater London Council and various independent organizations. Details of some of those 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' treatment of this illness at their mother-and-baby unit. The immediate results of treatment were said to very good and the inquiry was intended to discover the later effects on the health of the mother and 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. A report on a control family was required for each of the patients from Downview and Banstead Hospitals. Nine such cases were referred to this authority during the year, seven of which were for continued follow-up and two of which were newly referred cases. Childhood malignancies This survey was started in 1961 by the Department of Social Medicine at Oxford University after publication of work on the aetiology of leukaemia. Owing to pressure of work, our medical staff were unable to carry out any interviews during 1967 but in 1968 the parents of seven children who died during 1966 and three children who died during 1967 were interviewed, and those of ten control children. 68 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 The work of the home nurses has continued steadily throughout the year but the following table shows a slight decline in the total numbers of persons nursed and of visits paid, compared with previous years. ]Age First visits Revisits Total Under 5 years 66 267 333 5-64 years 1,168 24,560 25,728 65 years and over 2,200 95,246 97,446 All ages 3,434 120,073 123,507 Towards the end of the year preparations were made to give up the offices of the Home Nursing Service at 109 Clapham Common North Side, and to administer the service from the Municipal Buildings. The move took place early in the new year and provides the opportunity of close co-ordination with the health visiting and midwifery services. The service has been well staffed throughout the year. Four nurses took the District Nursing Training Course at Chiswick Polytechnic and were successful in obtaining the certificate. Home bathing service This service is now more closely linked with the home nursing service and continues to provide a much needed service for many elderly people who do not need full nursing care. All patients receiving home bathing service are visited periodically by a trained nurse. 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 bv eeneral practitioners. general practitioners. The number of occasions on which articles were issued on loan during the year is shown below: — Air rings 8 Beds (hospital or cot) 20 Back rests 22 Bed cradles 36 Commodes 246 Fracture boards 12 Hoists 18 Mattresses 10 Ripple beds 2 Rubber sheeting 8 Walking aids 16 Wheelchairs 48 69 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, bed pans, urine bottles and crutches. The Council is continuing to make a grant to the Society to assist in maintaining stocks of equipment. 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 shown a substantial and continuing growth in the last four years. During the year, a total of 78,200 pads were issued, which is nearly three times as many as in the previous year. In addition, 96 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. Home help service The demands on this service have continued to increase. Recruitment of staff has been slightly easier this year but there are still areas within the Borough which require a great deal of service but produce few staff. Consequently some home helps have to undertake a considerable amount of travelling. In September a male home help was appointed mainly to work with the specially equipped mini-van. Although the van had not been delivered by the end of the year, the home help has already proved to be very successful. He was available at the time of the floods and was able to assist with some of the cleaning-up required. When the fully equipped van is available early in the new year, we hope to be able to send a female home help with him so that together they can tackle especially difficult tasks or carry out an occasional "spring clean". A resident companion was paid as a part-time home help so that a young severely handicapped person could come out of hospital and lead a more normal life in her own flat. Another example of service provided is shown in plate A, centre pages. 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 1968 Aged under 65 years on first visit in 1968 Total Chronic sick and tuberculous Mentally disordered Maternity Others 3,273 361 18 112 227 3,991 70 Immunization and vaccination As in previous years, most of the immunizations and vaccinations performed in Wandsworth were carried out at the Council's clinics, the remainder being performed by general practitioners in their surgeries or at patients' homes. The Council's medical and nursing staff continually remind parents of the need to keep children fully protected against those diseases for which protection is available. As a result of the decision of the Minister of Health measles vaccination was added in May to the approved schedule of prophylactic procedures, and there has been a steady increase each month in the numbers of children vaccinated. Immunization and vaccination statistics Smallpox vaccination—cases completed: — Primary vaccinations: — Council clinics 2,660 General practitioners 990 Total 3,650 Re-vaccinations: — Council clinics 127 General practitioners 198 Total 325 Diphtheria immunization—cases completed: — Primary courses : — Council clinics and schools 4,564 General practitioners 1,135 Total 5,699 Reinforcing injections: — Council clinics and schools 6,363 General practitioners 1,385 Total 7,748 Whooping-cough immunization—cases completed: — Primary courses: — Council clinics and schools 3,460 General practitioners 1,035 Total 4,495 Reinforcing injections: — Council clinics and schools 1,860 General practitioners 826 Total 2,686 71 Tetanus immunization—cases completed : — Primary courses : — Council clinics and schools 5,080 General practitioners 1,205 Total 6,285 Reinforcing injections : — Council clinics and schools 6,492 General practitioners 1,459 Total 7,951 Poliomyelitis vaccination—cases completed : — Primary courses : — Council clinics and schools 4,491 General practitioners 1,130 Total 5,621 Reinforcing doses :— Council clinics and schools 6,960 General practitioners 1,333 Total 8,293 Measles vaccination—cases completed : — Council clinics and schools . 1,033 General practitioners 624 Total 1,657 Note—Although diphtheria, whooping cough and tetanus are shown separately, the great majority of children receive combined antigens which enable a primary course of immunization to be given in only three injections. 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 17 Other adults 302 Children under school age 79 School-children, including nursery school-children 345 Chiropody The Council provides about 50 weekly sessions at foot clinics where treatment is provided for old people, expectant mothers, mothers with children under one year, physically handicapped persons, school-children and children below compulsory school age. In addition, treatment is given in the surgeries of private chiropodists acting on behalf of the Council. Where patients are able to walk 72 but unable to reach a clinic, arrangements are made for them to be provided with ambulance transport. Housebound patients are treated in their own homes. In January the Council appointed a Chief Chiropodist, Mr. Clive L. R. Rees, in accordance with the decision taken in 1967. Number of sessions held :— (a) at clinics 2,188 (b) at private surgeries 72 (c) at old people's centres 280 Number of patients seen for the first time in 1968 (a) at clinics and centres 3,165 (b) at private surgeries 437 (c) in their own homes 1,470 Number of treatments :— (a) at clinics and centres 16,620 (b) at private surgeries 2,565 (c) in patients' own homes 8,487 Venereal disease Welfare officers are employed by six of the Inner London authorities in whose areas V.D. clinics are situated, and these officers follow-up patients who have failed to complete treatment, with the object of persuading them to continue with treatment. Time is spent also 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 authorites (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 Health education is an integral part of the health visitor's work and is one aspect of almost every task she undertakes whether in people's homes, in the Child Health Centres or in schools and colleges. (a) In child health centres Reference has already been made to classes for expectant mothers and small discussion groups in Mothers' Clubs. In addition there are displays of posters and leaflets on such subjects as immunization against various infectious diseases, cervical cytology, prevention of accidents, care of children's feet, dental health, etc. Films are shown in centres which have the necessary facilities. 73 (b) In schools Some health education by health visitors and school nurses is carried out at all comprehensive health surveys when help and advice can be given to individual children as required. Many older boys and girls take this opportunity to seek advice from the school nurse on personal health problems. More formal teaching is undertaken regularly in eight schools in the Borough. In these schools the health visitors or school nurses take part in a course planned in conjunction with the school staff on some aspect of health education or social studies. For instance, one school had a series of studies on " Revolution " and the health visitor discussed with the girls " Revolution in Medicine". Others gave talks on the local health services and arranged visits to local nurseries and clinics for some of the students. One very successful venture has been a regular visit to one of the Colleges of Education in the Borough when a health education film is shown and the health visitors answer questions and take part in the discussion. (c) In local groups and clubs A number of invitations are received to give talks to groups such as Young Wives' Clubs, etc. Many groups ask for a health visitor regularly once or twice a year. We are always pleased to have the opportunity of meeting as wide a section of the local population as possible. Home safety—accidents in the home The majority of accidents in the home occur to the old and the very young. Old people sometimes do not realize that their mental powers may be failing or that their reactions are slowing down and for this reason most accidents to old people take the form of falls. There may be hazards in the home which are a source of danger, e.g., a gas meter which is too high to reach, and the field workers who visit the homes of old people keep a watchful eye for any factors which may give rise to an accident. With young children the pattern of accidents is quite different and one of the commonest types at present is the swallowing of harmful substances such as tablets, medicines, detergents, paraffin, etc. In all such cases which are reported to the Health Department by hospitals or from other sources, the health visitor pays an early visit to the home and stresses the importance of keeping all harmful substances, medicines, etc., out of the reach or preferably locked away. The other types of accident which are frequently associated with young children are burns and scalds. 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. Young children cannot be expected to realize the potential hazards in every home and it is for this reason that publicity on these matters is directed towards the parents of young children by means 74 of posters and leaflets in the child health centres. 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 goes on continuously as part of their day-to-day work. Experience shows that certain households are accident prone and it is only by having complete information about all accidents that intensive home safety propaganda can be concentrated in the places where it is needed most. Family casework and problem families The five social workers spend at least half their time supervising problem families. During the spring and summer the work was handicapped by shortage of staff. The families, who are referred through the Case Committee, are usually well known to several other social agencies before being transferred to a case worker. At the beginning of the year 15 families were being visited, but by the autumn this number had increased to 27 ; six cases were closed during the year. All had numerous problems which included marriage disputes and poor care or control of the children. Often the parents wish to live beyond their usually low means or are irresponsible in other ways. Not all can be said to be of low intelligence, but with three exceptions all the parents could be described as having " deprived " home backgrounds. In three cases there was no father living in the home. Often debts are so pressing that attention has first to be paid to this problem before others can be considered. The aim is to maintain the family as a unit and to raise the standard of child care. On the first point there was one failure when all the children in a family were taken into care, but there has been limited success with other families in improving their standards of child care. 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 18 and 19. 75 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 should like to place on record my appreciation of the excellent work they have undertaken during the year on behalf of their patients. BATTERSEA TUBERCULOSIS CARE COMMITTEE ANNUAL REPORT FOR 1968 In presenting our Report for the year 1968, it is with regret that me must note the resignation on retirement of our Honorary Treasurer, Mr. C. C. Hinge. We thank Mr. Hinge for his services to the Committee and wish him a very happy retirement. We are pleased to welcome Mr. F. T. Haynes, successor as Borough Treasurer to Mr. Hinge, who has agreed to follow his predecessor as Treasurer of our Committee. 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 has continued as before to provide financial and material support to patients. In particular, we have worked to alleviate some of the worries affecting the older members of the community living on reduced incomes. Clothing has been our largest item of expenditure. Statutory allowances, good as they are, allow little margin for saving for clothing. Our patients must be warmly clad, and we feel that this form of help is of the utmost importance. In addition, we have made grants towards household items such as curtaining in cases where patients have been re-housed. We have also helped with grants towards the cost of holidays and with pocket money for holidays in certain cases. Queen Mary's London Needlework Guild has once again sent us a parcel of new garments for our needy patients. We are indeed grateful for this gift which is particularly valuable in emergencies. Our thanks go to members of the Battersea Park Rotary Club and our other friends who have helped in great measure with their gifts of second-hand clothing. At Christmas we disbursed £75 in cash to out-patients, while patients spending Christmas in the chest ward in St. John's Hospital also received cash gifts. Once again the Evening News "Toy for 76 a Sick Child " Fund provided us with a large carton of toys and these were parcelled and distributed in time for Christmas. Of our money-raising activities, the most important were the two Old Tyme Dances organised by Mr. T. E. Collyer in the Spring and Autumn of the year. All the organisation and arrangements were undertaken by Mr. Collyer and it is most gratifying to note that his efforts on our behalf achieved the highly successful result of adding the sum of approximately £223 to our funds. We are indeed most grateful to Mr. Collyer for giving of his time so freely and for making both events such happy and profitable occasions. We thank the London Borough of Wandsworth for the use of the Grand Hall at Battersea Town Hall—a facility which is greatly appreciated. Our thanks also go to the members of the Women's Royal Voluntary Service who not only provided and staffed the refreshment bar but also donated their entire profits to the proceeds of the Dances. It is with pleasure that we record our thanks to the following associations and firms who contributed donations and prizes which went towards making the Old Tyme Dances such successful events : — Women's Royal Voluntary Service. Battersea Park Rotary Club. Messrs. Dawson & Company Limited. Messrs. Decca Radio and Television. Messrs. Festival Gardens Battersea Park Limited. Messrs. Price's Candle Company Limited. Messrs. The Rom River Company Limited. Messrs. Stanley Bridges Limited. The Committee has also organised two small Jumble Sales which resulted in £35 being credited to funds. In addition to these activities we still continue the collection and sale of milk bottle tops and metal foil. In this we have been assisted by our usual band of friends as well as one or two of the Pensioners' Clubs and by the Caius Hall Youth Club. 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 Ministry of Labour continues as in previous years. Our thanks must also be recorded to the Wireless for the Bedridden Society, the Morganite Carbon Limited, the Society of St. Patrick and the Battersea Park Rotary Club. To all our friends who have provided gifts of money, clothing, books and toys during the year we express our sincere thanks. In conclusion we place on record our thanks to Miss R. M Greenaway, the Committee's Secretary, and Miss M. Clifford, Health Visitor, for their work on behalf of the Committee during the year (Miss) N. F. CLARK-LAWRENCE, Chairman. 77 WANDSWORTH TUBERCULOSIS CARE COMMITTEE ANNUAL REPORT FOR 1968 I again have pleasure in reporting yet another successful year for the Care Committee. We have again been able to help many patients and their families with such items as clothing, bedding, coal and gas bills and rent arrears. All of which, we hope, have helped to make them a little more comfortable or lessen some of their worries. During the year we have had some changes on the Committee. In April our Secretary, Miss Oakey, retired after fifteen years' service, and at a small party we were able to wish her every happiness in her retirement and to thank her for all her work for the Care Committee. Mrs. Ireland, our Vice-Chairman, also retired after many years' service, but has kindly offered to help us whenever time permits. Major Lawden was voted our new Vice-Chairman and Mrs. Simpkin succeeded Miss Oakey as Secretary. We also welcomed two new members to the Committee, Councillor Mrs. Williams and Mrs. Beauchamp. Miss Greenaway is now the Social Worker for Balham Chest Clinic and will present the cases needing help from that Clinic. The Annual Sale of Work was a financial success and an enjoyable afternoon for all those who attended. The Mayor, Alderman Lester, J.P., accompanied by the Mayoress, graciously opened the Sale which was held in the Civic Suite at the Town Hall. This year we resumed our Christmas Draw which, as well as benefiting the funds of the Committee and the prize winners, caused a little excitement. Two outings were provided for patients this year, one to Hastings in the spring and one to Brighton in the late summer. Mr. and Mrs. Ireland kindly made themselves responsible for these outings, for which we offer our thanks, and two very happy days were had by all. We were again able to give Christmas presents to our needy patients and their families and these, judging by the letters of thanks, were greatly appreciated. This year the Wandsworth Rotary Club kindly gave us six Christmas parcels which were delivered to local families. The Handicraft Class continues to meet weekly, and while enjoying each other's company, they make some very attractive articles for the Sale of Work. Once again I would like to record my thanks to all who have assisted and co-operated with us during the year, including the Women's Royal Voluntary Service and the officers of the Ministry of Social Security and Labour Exchanges. To my Vice-Chairman, Hon. Treasurer and every member of the Committee I extend my grateful thanks for their help and support throughout the year, 78 and also to Mrs. Simpkin, Miss Macdonald and Miss Greenaway who keep me in touch with the patients and their needs and problems. DEODORA CASSELS, Chairman. Care of old people The Health Department is mainly responsible for services provided for the elderly in their own homes—home help, home nursing and home bathing services. Closely linked with these services and mainly, but not exclusively, for old people is the loan of home nursing equipment and the incontinence laundry service and disposable incontinence pads. These services enable many old people to remain in their own homes either alone or with the help of relatives. Many requests for visits to old people are received from general practitioners, hospital medical social workers, relatives and neighbours. The health visitors pay an initial visit to assess their needs and either follow-up themselves or pass the case on to another appropriate social service. From time to time, very frail old people who are presenting special difficulties are visited by a senior medical officer with either a senior nursing officer or health visitor. The health visitors made 1,444 visits to old people during the year. I should like to express my appreciation of the co-operation and help I have had during the year from other branches of the services connected with the aged, in particular from the Chief Welfare Officer, hospital medical consultants, geriatricians and many others who devote their time for the benefit of the old people in Wandsworth. Liaison with general practitioners I refer again this year to the question of co-operation and liaison with general practitioners, hospitals and other health and social agencies. I dealt with the subject at length in both 1966 and 1967 and so need not repeat what was said in those Reports. I should, however, stress that we do not in Wandsworth consider that the term " attachment" or " secondment" of workers in the fields of health and social services is a true or accurate description of the arrangement. By far the better term, certainly as it applies to a highly urbanised area like Wandsworth, is " linkage ". The staff work in groups in a given area of the Borough and are thereby linked to all the agencies concerned with health and social work in that area. Such arrangements we call " linkage schemes ". This policy of working closely with other branches of the health services has been furthered during the year and at the present time two health visitors are specifically linked with two group 79 practices (seven doctors); two home nurses are linked part-time with one group practice (four doctors) and three mental health social workers are linked specifically with three practices (six doctors). Under these arrangements, the worker concerned attends on particular days at the doctor's surgery, discusses the cases with him and undertakes duties which he requires. In addition, two of our mental health social workers now work half-time at the Tooting Bee Hospital, being involved with rehabilitation of patients living in the hostel situated in the hospital grounds. Similarly, a mental health social worker spends half her time at the I.L.E.A. Wandsworth Town Child Guidance Unit. The Council receives reimbursement of the social worker's salary by the appropriate authority and these arrangements have worked well and are in addition to the existing arrangements by which mental health social workers and occupational therapists give assistance at the day hospitals in the Borough. 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 Four midwives, two health visitors and one school nurse attended refresher courses during the year. A number of staff attended short courses run by the London Boroughs' Training Committee. Four home nurses attended the District Nurse Training Course at Chiswick Polytechnic. The practical part of the training was carried out in the district in Wandsworth under the supervision of one of the Assistant Nursing Officers in the Home Nursing Service. This year, we were able to sponsor ten health visitor students and they are at present attending courses at the University of Surrey, Chiswick Polytechnic, Croydon Polytechnic and The Royal College of Nursing. They should be qualified and ready to join the health visiting staff in September, 1969. Seven day nursery students sat for the examination of the National Nursery Examination Board in July, 1968. Six of them passed and two of them were appointed to our day nurseries as staff nursery nurses. The one who failed was appointed as a nursery assistant in a non-training nursery. 80 In-service education A short course on " Teaching Mothercraft and Relaxation to Expectant Mothers " was again organised by the Centre Superintendent at Putney Child Health Centre. In addition, two midwives and one health visitor attended a course on " Relaxation " at the Weir Maternity Hospital. Two midwives and four health visitors attended a day conference on the " West Indian Background Health education films have been shown on a number of occasions. Some of the films were of special interest to staff and some were viewed mainly to assess their value for their use in health education sessions in schools and child health centres. Health visitor students Arrangements were made for eight health visitor students from the University of Surrey to undertake the three periods of practical worked required during their training. They were supervised by four of our health visitors who are qualified Field Work Instructors. Student nurses from local hospitals During the year, a total of 447 student nurses spent one day with either the health visitors or home nurses. Obstetric nurse students These hospital students are required to spend one day with a domiciliary midwife. We provided these facilities for : — one student every week from St. George's Hospital, Hyde Park Corner; one student every week from St. George's Hospital, Tooting Grove; two students every week from Queen Mary's Hospital, Roehampton ; and 28 students during the year from the Weir Maternity Hospital. In addition, arrangements were made for a number of social work students to see something of the work of the health visitors Several parties of schoolchildren visited day nurseries in the Borough. Talks were also given in two schools on nursery nursing and the Principal Nursing Officer met a group of Careers Mistresses and Youth Employment Officers. As a result, we have a much better standard of applicants for nursery nurse training. 81 PART 5 MENTAL HEALTH SERVICE There was a further expansion of the service in 1968 by the addition of two mental health social workers to the staffing establishment who took up appointments at Oak House Residential Unit, which forms part of Tooting Bee Hospital, and the Wandsworth Town Child Guidance Unit which is run by the Inner London Education Authority. These appointments, together with the linkage of social workers to general medical practices, represent a marked development in the relationship of the local authority Mental Health Service with, on the one hand, the hospital services, and on the other, the general practitioner service. Mental Health Week was again organised in conjunction with the London Boroughs of Lambeth and Merton, and the Open Days held at training centres, hospitals and the Gateway Club were very well attended. The Mental Health Section continues to attract highly-skilled social workers, and is one of the local authority Mental Health Departments selected by the London School of Economics for the training of their professional students. CO-ORDINATION WITH OTHER SERVICES Secondment of Mental Health Social Workers to Oak House Residential Unit at Tooting Bee Hospital Oak House is a residential unit for psychiatric patients run by Tooting Bee Hospital and situated in the hospital grounds. Patients are encouraged to return to their normal work while resident in the unit. Two Health Department social workers, each on a half-time basis, are seconded to the hospital as part of the team of consultant and nurses. The job of the senior social worker is to liaise with the team in the initiation of new developments in this rehabilitation unit. Community meetings were started to help the residents gain increased confidence and independence, and decisions taken at these 82 meetings led to a most successful party which was organised mainly by the residents (with perhaps a measure of secret background support from the staff !). Residents also organised a most enjoyable river trip and other outings to the cinema and local authority clubs. As well as being involved in these social and communal activities, both social workers spent a great deal of their time doing individual case work with patients. This included the assessment of the residents' social problems when they first arrived in the unit and helping them to return to work and cope with the consequential stresses and strains. One reason why this residential unit appears to be very necessary is that there are many socially-isolated patients who, although able to work and, in this sense, to leave hospital, are unable to cope with other aspects of ordinary life, such as making friends and being responsible for the day-by-day details of normal living. The unit serves as a bridge between hospital and outside life and so helps patients to acquire these attributes so important to successful existence in the modern world. Working in the unit is proving to be an interesting new venture in inter-disciplinary co-operation, and it is a fruitful experience for the social worker to work so closely with psychiatrist and nursing staff. Secondment of Mental Health Social Worker to Wandsworth Town Child Guidance Unit At the request of the Inner London Education Authority, a mental health social worker was appointed on a half-time basis to this unit, and took up her appointment in August, 1968. This has already proved a most useful venture, close relationships having been formed between clinic and local health authority staff. Mental Health Social Workers linked with General Practices One of the most important developments in the mental health service in 1968 was the project of linking social workers to general medical practices. Following on the symposium held in 1967, at which a general practitioner suggested that it would be helpful to link social workers with general practitioners, arrangements were made for a psychiatric social worker to spend one afternoon session a week in the surgery of a general practitioner in the Wandsworth Central area. The social worker has been carrying out this work for 12 months, and in the year has had 68 surgery interviews. Most of the patients referred were young married women at home, perhaps because the session was held in the afternoon. Many of the patients were presenting physical symptoms and would not 83 normally have seen a social worker, but it was felt by the family doctor that there were unexplored emotional factors for which the patient needed help. Some patients showed problems in the management of their young children, others were at a crisis point in their life, e.g. separation from husband. The social worker endeavoured to identify certain specific areas of difficulty either in the patient herself or relating to her family, where it might be possible after a few interviews to alleviate the situation. Three school girls were referred, two with serious problems of growing up and getting on with people, and these were seen for regular sessions. The social worker also acted as a liaison with many other social work agencies, co-ordinating, referring on, or putting families in touch with appropriate agencies. The work was particularly rewarding because relatively little help seemed to produce satisfactory results. It seems that in the setting of the surgery patients can be helped with their emotional problems long before they have reached a chronic or severe state. This is the purpose of preventive mental health work. Since October, another psychiatric social worker has been linked to a group practice of general practitioners in the Putney area. The social worker spends one afternoon a week in the surgery seeing suitably selected patients for either short or long periods, varying with the needs of the patient. During the three months that this scheme has been in operation, the doctors have referred eleven of their patients to the social worker. Referrals have been carefully made so that the patient does not feel that he is being rejected by the doctor, but rather that this is an additional service thought by the doctor to be helpful to the patient. Of these eleven patients, two failed to turn up or answer the doctor's letter, and one woman cancelled an appointment with no reason given after having been seen twice by the social worker. After an exploratory interview, two patients were referred for community care to the Mental Health Section and one family, with extremely complicated problems needing very careful handling, was taken on to the social worker's own caseload within the department. Two adolescents and one elderly lady have received social worker support over a long period whilst the remainder of the referrals have been seen for a limited period only, knowing that they could make further appointments to see the social worker if they wished to do so. In three cases, other members of the family were seen at the request of the patient. The doctors have tried to refer cases not likely to receive help from a social work agency under normal circumstances. Examples of the type of referrals are cases in which the doctor feels that emotional factors are the prime cause of the patient's continual attendance at the surgery, even though the patient may not be aware of this; situations where the doctor feels that the social worker may be able to offer support, or perhaps investigate the 84 actual nature of the problem which is being presented by the patient; and crisis situations, such as a death in the family, in which the patient may need actual help in overcoming or at least alleviating grief. Some recent publications have indicated that " grief " usually due to bereavement may be regarded as a psychiatric syndrome. There is some discussion at present as to whether the social worker would be of value to the doctors in aiding a more accurate medical diagnosis by allocating time to taking social histories in selected cases. Our experience over the past 12 months of social workers working in general practitioners' surgeries indicates that this is a most important and rewarding field for preventive work. FURTHER DEVELOPMENTS IN MENTAL HEALTH FIELD Liaison with Manor Hospital, Epsom Liaison with this hospital for subnormal cases has been strengthened by the opening of an out-patient clinic in this Borough at the William Harvey Centre. The clinic is giving a much needed service of consultation and assessment for the subnormal patient. A mental health social worker attends this clinic and also acts as liaison social worker with the Manor Hospital. Club for E.S.N, school leavers With the co-operation and valued support of Mr. Davis, Warden of the Katherine Low Settlement, a club was started this year to cater for young people leaving special schools for the educationally subnormal. The club is run by a mental health social worker supported by voluntary helpers. The membership has varied from 6 to 15 members. This service meets the need of the young person who lacks the confidence to join ordinary clubs and also caters for the more disturbed young person whose behaviour would possibly not be contained in less specialised clubs. Voluntary services for the mentally handicapped The Gateway Club, organised by the Wandsworth Society for Mentally Handicapped Children, continued their weekly meetings with a membership of 65. Experimentally, a group of members attend each week at the Culvert Youth Centre in Battersea where a varied programme of an educational type is organised for them by teachers and students. The Gateway members are able to take advantage of the excellent equipment at this Youth Centre. The Swimming Club now meets in the Putney Baths each Friday evening. Half a dozen of the members are now good swimmers. This year the Wandsworth Society for Mentally Handicapped Children also started a club for mentally handicapped children under 16, About 30 children attend and enjoy the programme 85 of music, dancing and games specifically designed to meet their needs. The Council help with transport by providing a minibus and a driver. A further project started by the Wandsworth Society for Mentally Handicapped Children is a playgroup for mentally handicapped children under five. This started as a two-day project, but has proved so successful that it is now open five mornings per week and caters for 10 children. The playgroup meets the needs of both parents and children, providing a much needed respite for parents and also a stimulating play environment for the mentally handicapped child. The playgroup is affiliated to the Wandsworth Pre-school Playgroups Association. COMMUNITY CARE Chellow Dene and self-contained flatlets As the following details of admissions and discharges during the year show, we have continued to achieve a satisfactory degree of success in the rehabilitation of residents at Chellow Dene hostel and the associated flatlets:— Chellow Dene Male Female Totals Patients in residence on 1.1.68 7 7 14 Admissions during the year 17 9 26 Discharges during the year 13 12 25 Patients in residence on 31.12.68 11 4 15 Number of patients discharged during 1968 :— (a) to home 2 2 4 (b) to normal lodgings 4 4 8 (c) returned to hospital 4 2 6 (d) to self-contained flatlets — 3 3 (e) others 3 1 4 13 12 25 Self-contained flatlets Patients in residence on 1.1.68 4 5 9 Admissions during the year 3 3 6 Discharges during the year 5 3 8 Patients in residence on 31.12.68 2 5 7 Number of patients discharged during 1968:— (a) to home 1 — 1 (b) to normal lodgings 4 2 6 (c) returned to hospital — — — (d) others — 1 1 5 3 8 86 Training School and Centres We continued to experience staff shortages, but in spite of this the staff have enthusiastically embarked on many new projects. Arrangements were made this year for regular outings of trainees on a Council minibus. The School has a weekly outing and each of the Adult Centres a fortnightly outing. Excursions are made to places such as museums, the heliport, a telephone exchange, nature walks in parks and alongside the river, and are followed by discussions and projects which afford a good learning experience to the trainees. Wandsworth Training School This year all the children from Lambeth who had been attending our School were transferred to a school in Lambeth. This meant that we were able to bring into our School our own children who had been attending Fulham Training Centre, and now all children attending Wandsworth Training School are Wandsworth residents. At our invitation, two School Inspectors from the Inner London Education Authority visited the School and were most helpful in discussing with the staff the latest teaching theories and arranging for them to visit an exhibition on Teaching of Infants at County Hall. Progressive teaching methods are being followed at the School. The teaching is based on free activity, with the emphasis on creative work. Painting, needlework, carpentry and leather work, cooking and simple laundry are all subjects which the children enjoy along with reading, writing and figure work. A lending library has been started in the School with the help of the Council's Children's Librarian. University College, London, has included the School in a research programme. This is a pilot scheme whereby children are taught to read words and form sentences with apparatus without having to write words. Several London schools are participating in this research scheme, but Wandsworth School is the only Training School included in the project. A special programme for prospective school leavers was initiated as a project, with these young people spending part of the week travelling by public transport with a teacher to adult centres where they participated in the adult activities, and to Chellow Dene hostel where they received simple domestic training. It is hoped to develop this scheme in the future. Balham and Newlands Training Centres The annual outings this year—Balham to Hampton Court and Newlands on a riverboat to the Tower of London—were, as usual, a great success. 87 Two girls were placed in outside employment from Balham Training Centre. A small group of men have been introduced into Newlands Training Centre, and this marks the beginning of the integration of the sexes at our adult centres. Home teaching for the mentally handicapped During the year the Home Teacher paid 524 home visits to mentally handicapped people in Wandsworth. Short-term care During 1968 the numbers of children and adults placed in shortterm care were:— Aged under 16 years 38 Aged 16 years and over 38 76 Long-term care A total of 69 patients were maintained in long-term care at some time during the year, 49 of whom were in residence at the end of the year. The organizations responsible for their care are shown below :— Guardianship Society 11 Mental After-Care Association 10 St. Mary's Convent 6 Sheltered accommodation 3 St. Jude's Hostel, Westminster 3 Cheshire Foundation 2 St. Michael's Convent, S.W.I6 1 St. Joseph's Special School 1 Easton House 1 Ravenswood Foundation 1 Hampton Manor Home 1 Rudolph Steiner School, Aberdeen 1 Other approved accommodation 8 49 88 STAFF TRAINING AND STUDENT TRAINING Staff training The three mental health social workers seconded for training, two to the Certificate in Social Work Course and one to the Mental Health Course, returned to the department this year. Two other members of staff, one a mental health social worker and the other a trainee mental health social worker, were seconded on full salary to the one-year Mental Health Course. The Assistant Supervisor at Balham Training Centre successfully completed her one-year Diploma Course. Two trainee teachers have been seconded to the two-year Diploma Course, and a teacher from Wandsworth Training School has been seconded to the oneyear Diploma Course for older and more experienced staff. Another trainee teacher was appointed this year. The qualifications of social workers in the Mental Health team at the end of 1968 were as follows : — Professionally qualified social workers : Psychiatric Social Workers 10 Certificate in Social Work 3 Social Science Degree or Diploma 4 Unqualified 2 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 ... 5 Letter of Recognition 1 Teaching Qualification recognised by Education Department 2 B.A. Degree 1 Registered Nurse, Mental Subnormality and Certificate of Royal Medico-Psychological Association 1 Untrained 7 T rainees 1 Student training This year two students on professional courses at the London School of Economics were attached to the mental health section. Two other students taking a Mental Health Course in Manchester spent a period of two months in the department. Over the year, four students taking the Younghusband Course at the North Western Polytechnic and one student from the Chiswick Polytechnic were accepted for casework placements for a period of 5½ months each. Two students taking the Child Care Course at Croydon Polytechnic, spent a period of five months in the department. Five students on 89 Social Science and Social Administration Courses at the London School of Economics, London University, Bedford College, Dublin University and Chiswick Polytechnic, spent a period of a few weeks on casework placements, one student from the London Boroughs Training Committee Course for part-time workers also had a casework placement and three students from the North Western Polytechnic and three students from Hillcroft College spent a period of observation in the department. One student from Edinburgh University had a residential placement at Chellow Dene Hostel. Nurses from Springfield Hospital Nurses Training School and West Park Hospital continued to visit the department for periods ranging from an afternoon to one whole week. The training of social work students imposes certain extra burdens on the existing staff which, however, are gladly accepted. Where a department enjoys a measure of confidence on the part of the academic institutions, there is an obligation to make the experience of the department available from the practical point of view to students studying sociology and kindred subjects. This reacts favourably on the department in that it becomes known Tor its work and is, therefore, more likely to attract keen and competent personnel to its staff. The high proportion of trained staff in the mental health team is an indication of how this works and it is hoped that this will continue. 90 MENTAL HEALTH ACT, 1959 STATISTICS for the year 1968 Mentally ill Psychopathic Subnormal and severely subnormal Totals Persons referred (a) By general practitioners 305 — 6 311 (b) By hospitals (on discharge after in-patient treatment) 122 — 4 126 (c) By hospitals (during or after out-patient or day hospital treatment) 133 — 5 138 (d) By Inner London Education Authority 20 — 69 89 (e) By Police and/or Courts 48 — 1 49 (f) From other sources 543 — 51 594 Totals 1,171 — 136 1,307 Admissions to hospital (a) As informal patients 81 — 3 84 (b) By statutory action (Sees. 25, 26 and 29) 261 — 1 262 (c) By Order of a Court (Sec. 60) 5 — 1 6 Totals 347 — 5 352 Persons receiving community care at 31st December, 1968 (a) Attending day training centre or workshop 3 _ 197 200 (b) Receiving home training 16 — 6 22 (c) Resident in local authority home/hostel 10 10 (d) Resident at local authority's expense in other home/ hostel 13 — 22 35 (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) 505 311 816 Totals 547 — 550 1,097 91 LONDON BOROUGH OF WANDSWORTH PART 6 SCHOOL HEALTH SERVICE ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1968 CONTENTS Pupils on School Rolls Special Investigation Clinics Medical Inspection of Ear, Nose and Throat Clinics Schoolchildren Rheumatism Clinics Vision School Nursing Service Personal Hygiene B.C.G. Vaccination Infectious Illness reported of Schoolchildren from Schools Tuberculosis Medical Treatment of Foot Health c oo c ren School Dental Service Handicapped Pupils Special Schools Helth Education in Schools Audiometry Student Health Service Audiology Clinics and Sanitary Conditions in Schools Deaf Register Medical Staff Meetings Introduction I have pleasure in presenting the fourth report on the School Health Service of the London Borough of Wandsworth for the year ended 31st December, 1968. The Inner London Education Authority is responsible for the School Health Service, but by virtue of an agreement required by Section 32 of the London Government Act, 1963, there is joint use by the Authority and the Borough of professional staff, premises and equipment. The Medical Officer of Health is the Principal 92 School Medical Officer of the Inner London Education Authority for the area and is responsible to that Authority for the day-to-day running of the Service. Under the Education Act of 1944, Section 48, the local education authority is required to provide for the medical inspection of pupils attending maintained schools or colleges. In accordance with this requirement the school physicians carry out periodic and selective examinations, with the object of assessing whether, both physically and mentally, the pupil is in a fit condition to attain the maximal benefit from standard methods of education. A satisfactory physical condition was recorded in 99.6% of children attending schools in Wandsworth during 1968, compared with 99.5% in 1967. Compared with the schoolchild of former generations, the modern schoolchild shows considerable improvement in hygiene and physical well-being. Perhaps in the light of this improvement more attention is now directed towards the management of children with behaviour problems. To some extent, distorted patterns of behaviour may be correlated with the stress engendered by living in the twentieth century and the risk of exposure to the harmful influence of tobacco and drugs. Active steps have been taken in order to help those children who suffer from the effects of disordered behaviour. To this end, much good work has been accomplished at the child guidance units including the Wandsworth Town Child Guidance Unit, which was opened in January and which is the only self-contained purposebuilt clinic of its kind in the Inner London area. Consultations have been held with the Divisional Education Officer, and arrangements are in hand for members of the medical and nursing staff to meet Headmasters and Headmistresses in order to discuss methods of health education and the techniques which are most likely to prove effective in combating adverse trends in behaviour patterns among schoolchildren. The Principal Dental Officer reports favourably upon the expansion of the dental inspection programme in schools, but less favourably upon the number of children who are in need of treatment. With the co-operation of parents, however, it is to be hoped that a greater proportion of children will attend for treatment next year. Statistics concerning infectious diseases indicate a decrease in the number of cases of measles, a decrease which was expected in view of the regular rise and fall in incidence which characterizes the epidemiology of this disease. A sharp increase occurred in the incidence of German measles and, as compared with 1967, in 1968 there were more cases of chicken-pox, scarlet fever, impetigo and scabies. On the other hand, the reports show a diminution in the 93 incidence of whooping cough, mumps, dysentery and enteritis. A small outbreak of Sonne dysentery occurred at a primary school. Although the symptoms were mild the Health Department staff carried out a full epidemiological investigation, and the outbreak was soon brought under control. After extensive investigations at two schools where the possibility of a risk of tuberculous infection had arisen, it was concluded that no infection had been transmitted to either the staff or the children. As the school roll in Wandsworth is more than 46,000, one of the largest school populations in London, the medical supervision demands a high degree of organization. It is gratifying to record increasing co-operation between the school physicians and the family doctors, with beneficial results for all concerned. Co-ordination of this type is an extremely valuable aid in promoting and safeguarding the health of the schoolchild. I wish to express my deep appreciation of the work carried out by the School Health Service staff throughout the year, and I am indebted to the Divisional Education Officer and the Heads of schools in the London Borough of Wandsworth for their constant support of activities which link health and educational objectives. Pupils on school rolls In May, 1968, there were 46,682 pupils on the rolls of schools in Wandsworth, including primary and secondary day schools together with special day and boarding schools and classes for handicapped pupils. Medical inspection of schoolchildren Routine medical examinations are performed by medical officers working in either a full-time or part-time capacity. Whenever the necessity arises the family doctor is consulted about the results of the examination, and parents are invited to attend, so that 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. Tn this respect, examination of children before a school journey is of proven value. During the year no case of cross-infection occurred as a sequel to holidays organized for groups of children either in this country or abroad 94 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. Routine general medical inspections during 1968 totalled 18,067 compared with 17,288 in 1967. Of those children inspected, 14.5% were referred for treatment of defects, 7.9% being referred for treatment of defects other than vision. The corresponding percentages for 1967 were respectively 14.1 and 7.1. The following table shows the number of children referred for treatment or observation of the defects listed at routine general medical inspections during 1968, expressed as a rate per 1,000 children inspected, together with the corresponding rates for 1967. 1967 1968 Numbers examined 17,288 18,067 Rate per thousand Treatment Observation Treatment Observation Skin diseases 9.31 7.69 12.90 6.92 Eyes—vision 77.86 50.44 73.84 46.55 squint 6.30 6.25 6.25 6.03 other 2.26 2.43 1.72 2.10 Defective hearing 6.30 15.10 7.36 13.51 Otitis media 2.02 3.12 1.38 3.43 Enlarged tonsils and adenoids 7.35 24.00 6.09 19.87 Defective speech 3.24 9.02 4.37 7.36 Enlarged cervical glands 0.52 4.69 0.72 3.99 Heart and circulation 1.62 13.25 2.16 11.62 Lung diseases other than tuberculosis 4.16 11.74 4.98 10.90 Orthopaedic defects 9.55 32.16 8.52 22.75 Defects of nervous system 1.04 3.24 1.27 3.10 Psychological defects 4.86 10.01 4.48 11.90 Developmental—hernia 0.81 2.37 1.05 1.55 other 1.27 6.30 1.44 3.93 Abdomen 0.23 2.02 0.50 1.72 95 Details of non-routine medical inspections carried out in 1967 and 1968 are as follows :— 19 67 1968 Reinspections 9,617 10,084 Secondary school annual surveys 220 96 Other non-routine inspections (see table below) 6,557 6,190 7-plus experimental scheme inspections 113 93 Totals 16,507 16,463 Total routine and non-routine inspections 33,795 34,344 Analysis of non-routine medical inspections Nature of Inspection Number inspected Bathing centre inspections : 1967 1968 Scabies 71 11 Other 6 1 Employment certificates 907 651 Theatrical children — 44 School journeys 3,246 3,270 Recuperative holidays : Before holiday 153 68 On return — — Outward Bound courses 8 9 Infectious disease investigation — 2 Boarding Schools for the Delicate : Pre-departure inspections 10 5 On return from school 3 3 Handicapped pupils : Statutory examinations 147 161 Periodic special defect examinations 918 946 Research investigations and enquiries 8 1 Special examinations at request of : Head Teacher : Child's name entered in special book 160 117 Others 369 338 School Nurse : After health survey 37 35 Others 166 162 Divisional Officer (Education) 108 92 Divisional School Care Organiser or Care Committee 40 55 Parent 123 146 School Medical Officer 62 65 All other non-routine inspections 15 8 Total 6,557 6,190 96 Physical condition of pupils Proportion satisfactory and unsatisfactory : 1967 1968 Satisfactory 99.5% 99.6% Unsatisfactory 0.5% 0.4% Attendance of parents and Care Committee representatives 1967 1968 Number of pupils inspected 17,288 18,067 Parent present 49.9% 47.6% Care Committee representative present 90.0% 87.0% Vision In the majority of primary schools routine tests have been introduced for children soon after entry. Although vision-testing of young children requires a modified technique and additional staff it is hoped that in due course the service will become available in every school. During the year vision tests were carried out on 7,083 boys and 6,615 girls, a total of 13,698 children, compared with 6.644 boys and 6,311 girls (12,955 children) in 1967. The percentage of the number tested with and without glasses who were referred for treatment or observation was 15.9, compared with 17.1 in 1967. 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 5.9 4.6 2.3 2.3 2.6 Girls 75.9 7.5 5.7 6.2 5.7 2.7 2.5 6.2 Boys 79.5 6.9 5.8 6.0 4.5 1.8 1.5 1.8 1968 Girls 76.3 7.4 6.2 6.7 5.0 2.6 2.5 5.1 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 1968 20,226 192 0.95 Additional health surveys 1967 17,445 307 1.76 1968 14,937 191 1.28 97 During both types of survey, vermin were found on 383 occasions, representing 1.09% of the total number of examinations. The number of individual pupils found to be verminous was 263 or 0.56% of the school roll of 46,682. On 313 occasions the parents or children, or both, were advised about treatment and in many cases were given Lorexane shampoo for home treatment. On a further 70 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 in the following table. A "case" is a child discharged after a course of treatment (e.g. 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 212 Total attendances 236 Scabies Cases treated 106 Total attendances 256 Impetigo Cases treated 2 Infectious illness reported from schools Cerebro-spinal meningitis 1 Chicken-pox 848 Dysentery, diarrhoea or enteritis 40 Food poisoning 4 German measles 931 Glandular fever 4 Impetigo 36 Influenza 4 Jaundice 47 Measles 300 Mumps 164 Ophthalmia and conjunctivitis 12 Ringworm (body) 5 Scabies 29 Scarlet fever 86 Sore throat 18 Tonsillitis 73 Whooping cough 40 98 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 December a child at a primary school was found to be suffering from Sonne dysentery. Additional hygiene precautions were taken at the school, and all absentees were visited. As a result of the investigations it was ascertained that the illness had affected 17 children attending the school, seven pre-school children and two adults. The indisposition was slight, and the children and adults recovered without any complications. Medical treatment of schoolchildren The number of sessions, new cases and total attendances at school treatment centres during 1968 were as follows:— Type of clinic Sessions New cases Attendances Minor ailments (nurse) 924 1,421 9,860 Minor ailments (doctor) 85 241 Special investigation (i.e. enuresis, obesity and behaviour problems) 223 188 1,326 Dental 2,510 4,459 13,965 Vision 352 838 4,573 Orthoptic 250 82 448 Ear, nose and throat 46 48 298 Audiology 58 179 488 More detailed information about some of these clinics will be found on pages 102 and 103 of this report. Handicapped pupils Handicapped pupils who may need special educational treatment are referred from many sources. In some cases (e.g. delicate children or those with physical handicaps) 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. children who are 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. 99 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 cases presenting special difficulty. Special schools There are eleven schools in Wandsworth providing special educational treatment. Not all the pupils at these schools reside in Wandsworth and some children who live in the Borough attend special schools in other areas. At the end of 1968 the number of children receiving special education at schools in Wandsworth were as follows:— Number of places Type of handicap Day Residential Blind 11 69 Deaf 42 42 Delicate 253 — Educationally subnormal 743 — Maladjusted 58 72 Physically handicapped 72 — The importance of social training is emphasized at these special schools. 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 find employment appropriate to their abilities when the time comes for them to leave school. The work of each school is set out in more detail belo: — School for blind children Linden Lodge was established in a large Victorian-type dwelling on Wandsworth Common in the year 1881. The London Education Authority assumed responsibility for it in 1901 and it remained a boarding school for senior boys until 1934, when the day schools 100 for blind children in London were closed. Boys of primary-school age were transferred to Linden Lodge in that year. During the second World War, the school was evacuated to Kent and thence to Oxford. In 1948, North House (designed by Sir Edwin Lutyens) in Princes Way, Wimbledon Park, was purchased and this became the primary department. To meet the demands of the increased numbers of blind children, a hostel for senior girls was opened in Augustus Road, Wimbledon Park in 1955; in 1964 the new purpose-built school on the North House site was completed to give total accommodation for 100 boarders and 20 day pupils. At the end of the year there were 80 pupils in attendance including 11 day pupils aged from five to eighteen. The building contains a medical block consisting of three isolation rooms and a duty room. There is also a medical inspection room, used by the visiting medical officer each week and containing ophthalmological apparatus for use by the visiting specialist. The school's health record is good. A photograph of the new school appears in the centre pages (plate D). Schools and classes for deaf and partially-hearing children Oak Lodge school for deaf children is a purpose-built secondary school with places for 84 children, including 32 who can be accommodated in an attached hostel as five-day boarders. In September, 1968, there were 43 children on the roll, with 27 boarders. A steady increase in the roll is to be expected, for the children come from all parts of London. The classroom accommodation, the hearing-aid equipment and the practical rooms are outstanding features. Sellincourt Primary School has a partially-hearing unit for 29 children. The three classrooms have been equipped with a loop aid, and desks in two classrooms have been fitted with a group aid. Southfields Secondary School had a partially-hearing unit established in September, when six children were admitted under the care of a teacher of the deaf. School for physically handicapped children Greenmead has five classes, each of approximately 15 children aged from four to eleven. Cerebral palsy, spina bifida and heart defects are the main physical handicaps. In some cases, additional disabilities are present, e.g. educational subnormality, speech and hearing defects, poor vision, specific learning difficulties due to brain damage, behaviour disturbances and fits. A normal primary-school curriculum is provided but children are taught to use the electric typewriter if the physical handicap makes handwriting difficult. Children are encouraged to make the maximal physical effort within the limits of their disabilities. A group of children use the learners' pool at Putney Swimming Baths 101 and, by arrangement with the Handicapped Adventure Playground Association, three severely handicapped children have horse-riding lessons at Buckingham Palace Mews. The school nurse attends full-time. Nursing activities include supervision of drug treatment and daily attention to children with spina bifida. At present there are 20 incontinent children at the school and about 60% of the total number of the pupils need physiotherapy. A specially equipped room is available for the use of the physiotherapists from Queen Mary's Hospital, Roehampton. A speech therapist carries out remedial work for 20 children who have a speech defect. Day school for delicate children Chartfield has places for boys and girls aged from five to sixteen or more, and the school roll is 150. The main disabilities are asthmaeczema (48 children), general debility (42 children) and chronic chest infection (11 children). Breathing exercises are required for 50 children, the exercises being held under the immediate direction of the school nurse. Springwell House has a roll of 125 children aged from five to eleven. On admission many children are backward in education, largely owing to their poor school-attendance. When their health improves their school attendance improves, and they begin to learn well. To an increasing extent Springwell House is becoming a remedial school. During the year 70 children returned to ordinary schools. Schools for the educationally subnormal Meadway (primary and secondary) has 200 pupils, with 20 pupils in each class. There is a waiting list for admission. Emphasis is placed upon remedying any physical defects or emotional and behaviour problems which may exist. Education is directed towards preparing children to become self-supporting when they leave school. Shillington (secondary) has increased its roll to 337 pupils. A senior club has been developed for informal meetings on a social basis and children are given the opportunity to meet the Careers Officer and local employers. During the year every school-leaver found employment. Wycliffe (primary and secondary) now has 200 pupils, including a sixth form. Physical activities constitute valuable aids to school training. Special activities comprise skating (20 children per week) and pony or horse riding (10 children per week). Schools and classes for maladjusted children Beechcroft is a boarding school for 50 maladjusted boys. Priority of admission is given to those who need to be near home or require 102 the facilities which are most easily available in London. Most pupils are within the bounds of at least average intelligence. A psychiatric social worker attends on a full-time basis and sessions are held at the school every week by a consultant psychiatrist and a psychotherapist. Northcote Lodge is a school for maladjusted girls aged from 10 to 16;22 boarders and three day pupils. The school is visited once a week by a family doctor, a psychiatrist and a psychologist. Apart from education and medical attention, however, great importance is attached to the social development of children living in a community and helping one another. Gideon Day School accepts maladjusted children of primary and secondary school age and in addition there are day classes for the maladjusted children at four ordinary schools, viz. Earlsfield, Gatton, Huntingfield and John Burns Schools. Audiometry Hearing loss may be detected not only by clinical examination but also by the use of audiometers (machines 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 a further increase this year in the number of children tested before 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 prevents 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. The numbers of children given audiometer tests during 1968 are as follows:— Pupils given screening tests 7,644 Pupils given pure-tone tests after failing screening tests 1,284 Pupils referred to otologist 400 Audiology clinics and deaf register At the end of 1968 there were 296 children living in Wandsworth whose names were on the deaf register, as their hearing in one or 103 both ears was below normal. Medical reports are maintained on these children and the school medical officer, assisted by a social worker, ensures that these children have the necessary medical care and are kept under observation at school. Of the children, 133 have hearing aids, nine of which were supplied during 1968. A total of 309 children attend the I.L.E.A. audiology clinics in Wandsworth ; many suffer from a slight but permanent hearing loss. Most children come to the clinic after a preliminary "sweep" test which is carried out in school by a School Nurse. At the end of 1968 the services of a peripatetic teacher of the deaf, who will be working part-time in Wandsworth, were a welcome addition to the teams of otologist, social worker and nurse. Special investigation clinics At the end of 1968, 261 children were attending the six special investigation clinics. There is a noticeable difference in the clinics in different areas as regards the type of problems investigated. Obese children predominate in some clinics, while those with behaviour problems both at home and at school comprise a majority of those attending other clinics. The clinics are run jointly with the I.L.E.A. and the social worker who attends the clinic with a doctor makes her contacts with the home and schools through the School Care Organiser of the Education Department. 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 107 children were in attendance. Until April, 1968, the specialists at these clinics were able to send children in need of surgery to the South Western Hospital. With the changeover at that hospital to a geriatric unit, this service for Wandsworth children came to an end and attendances at the clinics consequently fell. It is hoped and expected, however, that during the coming year the South West Metropolitan Regional Hospital Board will be able once again to arrange for a direct link between the school treatment centres and local hospitals. Rheumatism clinics During the year 61 children attended the two clinics in the Borough but, due to the decline in children's rheumatism and the availability of hospital cardiac units, attendances are falling. As a result, the question of closing down these clinics was under active discussion at the end of the year and at the time of writing the decision has been taken to do so. 104 School nursing service The immunization drive in primary schools in Wandsworth was commenced in September, 1967, and completed by July, 1968. Immunization against diphtheria, tetanus and poliomyelitis was offered to all children needing either primary or booster immunization. We are very grateful for the co-operation received from Head Teachers and staffs of the schools concerned. With the more wide-spread use of the Sheridan Gardiner Vision Testing Method, we have been able greatly to increase the number of five-year-old children tested. Next year we hope to be able to test the vision of all five-year-old schoolchildren by this method. Two new schools opened in the Borough during 1968—the Ethelburga Primary School. S.W.ll, and John Griffiths Secondary Boys' School, S.W.I9. Once again, two school nurses accompanied school journey parties for two weeks from Chartfield School and Springwell House School. Both these schools are for delicate children. B.C.G. vaccination of schoolchildren The vaccination of children against tuberculosis with B.C.G. (Bacillus Calmette-Gu6rin) was first introduced in London Schools in 1954 and has now become a routine procedure. This is normally carried out every year in the autumn and spring terms and this protective measure is offered to all eligible children aged 13 years. Children whose skin tests show a negative result and who have not been subject to tuberculous infection are vaccinated ; children showing a positive result are referred to the Chest Physicians for X-ray and any further necessary investigation and treatment. The following table summarizes the results :— (a) Number of eligible children 3,757 (b) Number of consents received 3,311 (c) Number of consents received for alleged contacts of known cases of tuberculosis (included in (b)) 11 (d) Number of children skin tested and read 2,967 (e) Positive reactors among (d) not previously vaccinated 259 (8.7%) (f) Positive reactors among (d) known to have been previously vaccinated 177 (6.0%) (g) Negative reactors among (d) 2,531 (85.3%) (h) Number of children skin tested, but not read (absentees) 264 (i) Number of children vaccinated 2,531 105 Tuberculosis In July and October, epidemiological investigations were held at two secondary modern schools where it was considered possible that staff and children had been exposed to tuberculous infection. Skin tests were performed on 456 children and X-ray examination was required for 130 adults and 226 children. No evidence of tuberculosis was discovered. I thank the Chest Physicians of Wandsworth and Balham Chest Clinics for advice about the investigations and the Medical Director of the South West London Mass X-ray Service for arranging the necessary X-ray examinations. 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 exercises. In addition, a remedial gymnast visits in an advisory capacity and to assist in the organization of new groups. Classes 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. School dental service Report by Mr. A. F. Weedon, Principal Dental Officer The year 1968 proved to be an interesting one. With the cooperation of Head Teachers and the dental staff, the school inspection programme was again expanded, and the results were very good ineed. The average number of children inspected per session rose from 64 in 1967 to 117 in 1968. Once again the usual depressing picture emerged with 60% needing treatment. As this figure is obtained from a quick visual examination without the benefit of an operating light or X-rays, a full clinical examination in a surgery would undoubtedly raise this percentage. In terms of medical conditions such a percentage would be classed as a major epidemic, and yet this state persists year after year. It is therefore necessary to reach the school dental service ideal of a yearly inspection of each child as soon as possible, in order to remind both child and parents, constantly, that dental treatment is desirable for complete health. When this has been achieved, the next step will be to mount an extensive and continuous campaign of dental health education for the whole family. Staffing has remained constant at full establishment resulting in an increase in both the inspection and clinical sessions, coupled with a gain in productivity. Changes in the appointing system have resulted in a decline in the failure rate from 4.8 per session in 1967 to 3.4 per session in 1968. 106 Satisfying progress has also been made in re-equipping the dental surgeries. They have all had the latest air bearing drills installed, and modern gas anaesthetic machines, X-ray machines, dark rooms and automatic mixers of filling materials have also been installed where necessary. During the year the dental staff met on three occasions. At the first meeting in June, the London Ambulance Service provided a very interesting and useful resuscitation demonstration and individual staff members were able to practice mouth-to-mouth breathing on their special dummy. We were joined on this occasion by the Principal Dental Officer from Lambeth, together with half his staff. In September a representative from a leading dental manufacturing company showed a very interesting film on the latest operating techniques in dentistry, and afterwards demonstrated the maintenance of hand pieces. In December a further meeting of the staff took place in the Municipal Buildings to discuss the service in the Borough. These sessions are useful for discussion of policy and treatment, the meeting of other members of the staff who may be only voices on the telephone, and the demonstration and discussion of valuable techniques. During the course of the year an I.L.E.A. mobile dental surgery was used for the first time in the Borough. It was used twice at Linden Lodge School for blind children for periods of one and two weeks, and for a period of three weeks at the Wandsworth Training School. It was obvious from these visits that taking dentistry to the patients, especially the handicapped, has many advantages and this will be developed further in the future. Sessions: 1968 Number of treatment sessions 2,510 Number of inspection sessions in schools 187 Total 2,697 First inspections: Number of first inspections in schools 22,104 Number of first inspections in clinics 4,952 Total 27,056 Percentage requiring treatment 59.7 Reinspections at clinics or schools 1,081 Percentage requiring treatment 69.4 Attendances: First visits 4,459 Subsequent visits 9,206 Emergency visits 300 Total 13.965 Course of treatment completed 3,819 Fillings done 13,513 Other operations including crown, inlays, X-rays etc. 5.128 107 Health education in schools Some health education by health visitors and school nurses is carried out at all comprehensive health surveys when help and advice can be given to individual children as required. Many older boys and girls take this opportunity to seek advice from the school nurse on personal health problems. More formal teaching is undertaken regularly in eight schools in the Borough. In these schools the health visitors or school nurses take part in a course planned in conjunction with the school staff on some aspect of health education or social studies. For instance, one school had a series of studies on "Revolution" and the health visitor discussed with the girls "Revolution of Medicine". Others gave talks on the local health services and arranged visits to local nurseries and clinics for some of the students. One very successful venture has been a regular visit to one of the Colleges of Education in the Borough when a health education film is shown and the health visitors answer questions and take part in the discussion. The health education team employed by the Inner London Education Authority have again given their valuable services in Wandsworth and have visited a number of schools in the area by direct arrangement with the Heads of Schools. The team have also organized health education publicity in the Greater London Council Parks. Student health service This service continued to operate satisfactorily at the Southwest London College, Tooting Broadway. In addition, routine medical examinations were carried out at four of the Colleges of Education in Wandsworth, viz. Whitelands College, Garnett College, Furzedown College of Education and Battersea College of Education. Sanitary conditions in schools All school premises are inspected annually by the medical staff who offer advice concerning the sanitary conditions and standards of hygiene. Reports concerning defects are passed on to the Divisional Education Officer of the I.L.E.A. for attention. 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. A number of subjects were discussed including the question of immunization schedules. Immunization is a subject which must be constantly under review due to the new techniques which are introduced from time to time. The medical officers also discussed the indications for the transfer of pupils between ordinary and special schools. 108 INDEX PAGE Accidents in the home 73 Adoption and boarding-out 66 Aged persons ■ ■ ■ 78 Aircraft noise ■■■ 6,7,30 Analysis of food and drugs 42,43 Animal Boarding Establishments Act, 1963 33 Animals, protection of 32 Ante-natal care 55 Area comparability factors 11 Atmospheric pollution 6,7,49 Audiology 102 Audiometry 102 Bacteriological examinations 20,42,51 Bakehouses 41 Barbers 27 Bathing centres 52,97 Baths, home 68 „ personal cleansing station 52,97 „ swimming 51 B.C.G. vaccination of schoolchildren 104 Births 3,13 Blind and partially-sighted children 62,98,99 Boarding-out 66 Butchers' shops 40 Cancer 12,64 Caravans 35 Care of old people 78 Catering establishments 41 Cervical cytology 59,64 Chellow Dene hostel 85 Chest clinics 74 Child guidance 79,81,82,92 Child health clinics 56 Childhood malignancies 67 Child-minders 66 Chiropody 71 Clean Air Acts, 1956 and 1968 6,49 Cleansing station 52,97 Common lodging houses 32 Communicable diseases 17 Community care, mentally disordered persons 85 Comprehensive health surveys (schoolchildren) 96 Consumer Protection Act, 1961 29 109 page Coroner's Court 52 Creches 65 Crematorium Regulations, 1930 53 Day nurseries, Council 65 „ „ private 66 Day nursery, special unit 66 Deaf children 100, 102 Death, causes of 3,14,15 „ rates 3,12,13 Deaths, cancer 12 „ heart disease 16 „ infant 12,16 „ maternal 3,12,16 „ tuberculosis 12, 19 Delicate children 101 Dental service, mothers and young children 57 „ „ schoolchildren 92,105 Diphtheria immunization 70 Disinfection and disinfestation 51 Domiciliary midwifery service 5,59 Drainage 25 Dysentery 18,93,98 Ear, nose and throat clinics 103 Early discharge of maternity patients 59 Educationally subnormal children 99,101 Environmental health services 23 Factories Act, 1961 47 Family casework 74 Family planning 57 Fireguards, loan of 73 Fish shops 41 Flooding 5,24,69 Fluoridation of water supply 26, 27 Food and Drugs Acts 39,40 Food hygiene 37,39 Food, imported 23 Food poisoning 5,18 Food premises 37 Food sampling 37,40,42 Food stalls 41 Food, unsound 39,42,43 Foot clinics 71 Foot health in schools 105 Furnaces, installation of 49 110 PAGE General practitioners, liaison 60,78,81,82,93 Hairdressers 27 Handicap and observation register 61 Handicapped pupils 98 Health education and publicity 72, 107 Health Services and Public Health Act, 1968 5,17,66 Health surveys 67 Health visiting service 60 Heart disease, deaths from 16 Home bathing service 68 Home help service 69 Home nursing equipment, loan of 68,78 Home nursing service 68 Home safety 73 Home teaching (mental health) 87 Home tuition 99 Hostel for mentally ill persons 85 Houses in multiple occupation 23,34 Housing 23,34,36 Hygiene inspections of schoolchildren 96 Ice-cream sampling 42 Illegitimate children 13,64 Immunization and vaccination 4,70,104 Imported food 23 Incontinence pads service 69 Incontinent persons, laundry service 52 Infant mortality3,12,16 Infectious diseases, statistics 17,21,22 Infectious illness in schools 92,97 Infective jaundice 4, 18 Inquests 52 International vaccination certificates 20 laundice 4,18 Laboratory facilities, bacteriological 20,42,51 Land Charges Act, 1925 33 Laundry services 52 Legal proceeding 25, 32, 37, 39 Loan of fireguards 73 Loan of home nursing equipment 68, 78 Long-term care (mental health service) 87 Maladjusted children 101 Maternal mortality 3, 12, 16 Measles 4,18,92 „ vaccination 4,65,71 1ll page Medical examination of staff 79 Medical inspection of schoolchildren 93 Medical staff meetings 75, 107 Medical treatment of schoolchildren 98 Mental health service 81 „ „ „ clubs 84 „ „ „ community care of the mentally disordered 85 „ „ „ co-ordination with other services 81,84 „ „ „ home teaching 87 „ „ „ long-term care 87 „ „ „ Manor Hospital, Epsom 84 „ „ „ Oak House Residential Unit 81 „ „ „ residential hostel 85 „ „ „ self-contained flatlets 85 „ „ „ short-term care 87 „ „ „ staff training 88 „ „ „ statistics 90 „ „ „ students 88 „ „ „ training centres and school 86 „ „ „ voluntary services for the mentally handicapped 84 „ „ „ Wandsworth Town Child Guidance Unit ... 82 Midwifery service 5,59 Milk sampling 40,42,46 Milk supply 40 Mortality, infant 3,12, 16 „ maternal 3, 12,16 Mortuary 52 Mother and baby homes 27, 64 Mothercraft classes 56 Mothers' clubs 56 Movable dwellings 35 Neo-natal mortality 12 Noise Abatement Act, 1960 6, 30 Noise from aircraft6, 7, 30 Nursing homes 27 Occasional crèches 65 Offensive trades 29 Offices, Shops and Railway Premises Act, 1963 23, 30 Oil heaters 29 Old people, care of 7 8 Outworkers 48 Partially-hearing children100, 102 Partially-sighted children 62,98 Perinatal mortality 12 112 PAGE Personal cleansing station 52, 97 Personal health services 55 Personal hygiene 52. 96 Pest control28, 52 Pesticide residues in food 46 Pet Animals Act, 1951 32 Pharmacy and Poisons Act, 1933 29 Physically handicapped children61,62,98,100 Playgroups 66, 85 Poliomyelitis vaccination 71 Population 11 Post-mortem examinations 53 Post-natal care 55 Poultry processing 41 Premature infants 61 Pre-school playgroups 66, 85 Prevention of Damage by Pests Act, 1949 28 Problem families 74 Prophylaxis 4,70,104 Public Analyst, report on work of 43 Public Health (Infectious Diseases) Regulations, 1968 17 Pupils on school rolls 93 Recuperative holidays 71 Relaxation classes 56 Rent Act, 1957 35 Rheumatism clinics 103 Riding Establishments Act, 1964 33 Rodent control 28 Samples, adulterated 42,43 „ food and drugs 37,42 „ ice-cream 42 „ milk 40,42,46 „ water 26,51 Sanitary conditions in schools 107 Schizophrenic illness after childbirth 67 School dental service 92, 105 School health service 91 „ „ „ health education73, 107 School nursing service 104 Seebohm Report 8 Sewage disposal 26 Sewerage 26 Short-term care (mental health service) 87 Slaughter of animals 40 113 page Smallpox, international vaccination certificates20 „ vaccination 70 Smoke control 6,49 „ „ measuring stations 49 Social Services Committee 7,10 Sonne dysentery 8 Special educational treatment 99 Special investigation clinics 103 Special schools, blind 99 „ „ deaf and partially-hea ring 100 „ „ delicate 101 „ „ educationally subnormal 101 „ „ maladjusted 101 „ „ physically handicapped 100 Special unit, day nursery 66 Spina bifida 63,100,101 Staff 10,23,60,65,69,105 Staff, medical examinations 79 Staff training 54, 68, 79, 88 Statistics, mental health 90 vital 11,12 Stillbirths 12 Student health service 107 Students, facilities for training 54, 60,65, 79, 88 Surveys 67 Swimming baths 51 Tetanus immunization 71 Toddlers' clinics 56 Training centres and school (mal health) 86 Training of staff 54,68,79,88 Training of students 54, 60, 65, 79, 88 Transportation of bodies abroad 53 Tuberculosis 18,105 „ deaths 12, 19 „ notifications 18, 19 Tuberculosis Care Committee reports 75, 77 Typhoid fever 4, 19 Unmarried mothers 64 Unsound food 39,42,43 Vaccination and immunization 4,65,70,104 Vaccination, international certificates 20 Venereal diseases 72 Verminous premises 52 Vision testing 96,104 114 page Vital statistics 3,11,12 Voluntary helpers 56 Wandsworth Town Child Guidance Unit 79,81,82,92 Water supply 26, 51 „ ,, fluoridation of 26,27 Whooping cough immunization 70 Printed by H. J. Rowling & Sons Ltd. (tu) 1-3 Haydons Road, Wimbledon London, S.W.I9