AC43397 WAN102 London Borough of Wandsworth ANNUAL REPORT of the Medical Officer of Health and Principal School Medical Officer for the Year 1971 by HASTINGS E. A. CARSON M.D., S.M. (Harvard), F.F.C.M., D.P.H. London Borough of Wandsworth ANNUAL REPORT of the Medical Officer of Health and Principal School Medical Officer for the Year 1971 by HASTINGS E. A. CARSON M.D., S.M. (Harvard), F.F.C.M., D.P.H. CONTENTS Page INTRODUCTION3 Part 1—REORGANISATION OF THE HEALTH DEPARTMENT 16 Part 2—VITAL STATISTICS 19 Part 3—COMMUNICABLE DISEASES 25 Part 4—ENVIRONMENTAL HEALTH SERVICES 32 Public Health Inspection 34 Housing 44 Food and Food Premises 47 Factories Act, 1961 59 Atmospheric Pollution 61 Miscellaneous Matters 63 Part 5—PERSONAL HEALTH SERVICES 68 Part 6— MENTAL HEALTH SERVICE 99 Part 7—SCHOOL HEALTH SERVICE 100 PHOTOGRAPHIC SUPPLEMENT Centre Pages Plate A—COVENT GARDEN MARKET DEVELOPMENT AT NINE ELMS—Air-testing a 21-inch concrete surface water drain ; the adjacent 6-inch foul water drain is tested by a water test. Plate B—COVENT GARDEN MARKET DEVELOPMENT AT NINE ELMS—Two specially manufactured intercepting traps, 30 ins. and 20 ins. in diameter. Plate C—HOME DIALYSIS—Installing a self-contained dialysis unit in the rear garden of a patient's house. Plate D—HOME DIALYSIS—The interior of a portable home dialysis unit. INDEX 116 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1971 To The Mayor, Aldermen and Councillors of the London Borough of Wandswarth Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you the seventh Annual Report on the health of the London Borough of Wandsworth covering the twelve months ending the 31st December, 1971. In an age when increasing attention is being focussed on evaluation, it seems especially fitting to give pride of place in the Annual Report to those vital statistics which serve as yardsticks for the overall measurement of the health of the public ; for ease of comparison the figures for the previous year appear in parentheses in this paragraph. 1971 gave much cause for satisfaction. Although the size of the resident population fell noticeably—the mid-year estimate being 300,530 (317,410)—there were only slightly fewer births and there was a small reduction in the number of deaths; statistically, because of the smaller total population, a slight increase was recorded in both the birth rate, 15.70 (15.04) and the general death rate, 11.20 (10.70). Only one death attributable to pregnancy or childbirth occurred during the year, the maternal mortality rate falling to 0.2 (0.4), and an appreciable reduction was recorded in the overall infant mortality rate, 17.0 (19.7) and in the stillbirth rate, 9.0 (13.77); in particular the neonatal mortality rate, related to deaths under the age of one month, and the perinatal mortality rate—which is based on the number of stillbirths and deaths within the first week of life per thousand total live and still births- fell hearteningly to 11.0 (15.07) and 19.0 (27.0) respectively. These mortality rates bear comparison with those for the country as a whole. An even healthier picture would have been portrayed locally but for the adverse influence of illegitimacy. The proportion of illegitimate births in Wandsworth in 1971—roughly one in sixwas representative of Inner London as a whole, being more than double the national average of 8%, and although the illegitimate infant mortality rate fell to 23.0 (30.0) it still remained half as high again as the rate for legitimate infants, 16.0 (17.70). A sad commentary indeed on the inadequate attention paid to human relationships in an increasingly affluent society. Not surprisingly, in a post-war setting in which the general standard of living has risen appreciably, growing attention has been paid in the field of preventive medicine to those diseases associated with excessive personal indulgence. To-day the 4 monest form of malnutrition takes the shape of obesity—a condition aggravated by the lack of exercise which the motor-car in particular encourages, aided and abetted all too frequently by the high calorie content of alcohol. Overweight undoubtedly predisposes to coronary heart disease—responsible in 1971 for not far short of one thousand deaths in Wandsworth—as does cigarette smoking. The latter hazard was highlighted afresh by the publication in January of the Second Report of the Royal College of Physicians on Smoking and Health. Far too many careers are cut short in the prime of life by cardiovascular disease, cancer of the lung and chronic bronchitis precipitated by the lethal fumes of the tobacco leaf. Far too many families are both deprived and disorganized by such totally unnecessary premature bereavement. Certainly the local mortality statistics in relation to heart disease give no cause for optimism, the number of deaths remaining almost stationary ; on the other hand lung cancer deaths again fell—240 compared with 259 in the previous year—offering a crumb of comfort which may yet prove to be illusory. Beyond doubt only a greater sense of personal responsibility for health can effect a significant and lasting improvement. Perhaps a new television series entitled "Your Life in Your Own Hands" is needed to provide the stimulus to individual action on an appropriate scale. The patent need for self-discipline and personal initiative in the cause of better health is equally evident in the sphere of communicable disease control. With the decline in the incidence of measles, thanks to the introduction of an effective vaccine, the commonest serious infection at the present time in this country is gonorrhoea. Indeed venereal disease has now assumed epidemic proportions on a global scale. This is particularly true of the great cities and the position locally is typical of that of London as a whole—in Wandsworth the number of local residents attending special treatment clinics rising from 4,200 in the previous year to 5,170, as many as 817 of these being found to have acquired a gonococcal infection compared with 755 in 1970. No one concerned with the quality of family life can look upon the steadily rising incidence of the sexually transmitted infections with equanimity. In sharp contrast to this melancholy upward trend the number of cases of notifiable infectious disease reported in the Borough fell markedly in 1971, only 1,207 notifications being received as opposed to 1,891 in the previous year. Happily, instead of the customary biennial upsurge anticipated, the number of cases of measles notified fell from 1,090 to 559 and sharp reductions were also recorded in the notifications of dysentery, infective hepatitis and whooping cough. Only one acute episode of note was recorded, namely a small outbreak late in the year of viral gastro-enteritis (popularly known as winter vomiting) which affected 58 children and 5 teachers at a junior and infants school. The reporting of nearly sixty cases of food poisoning underlined the importance of wholesome food and hygienic handling; similarly the two notifications of paratyphoid fever and three of malaria served as a reminder of the need to take well-recognised 5 simple precautions when travelling abroad. Likewise the three instances of gonococcal ophthalmic infection in the newborn—with all the attendant risk of blindness in the absence of prompt treatment—emphasised only too poignantly that education in human relationships and the provision of unobtrusive, easily accessible, confidential (and therefore acceptable) diagnostic and treatment facilities hold the key to success in the campaign against the venereal diseases. The richly deserved tributes paid to Dr. McQueen, the Physician in charge of the Battersea Chest Clinic, on his retirement after 32 years service locally reflected the success which chest clinics have achieved in combating the former scourge of tuberculosis and in coping with the still formidable problems presented by respiratory disease. No case of smallpox, diphtheria or poliomyelitis occurred in Wandsworth in 1971. No greater tribute could be paid to the value of immunization. Full details of the activities of the Health Department in this important field will be found in the body of the Report. In brief, the number of children immunized against diphtheria, poliomyelitis, tetanus and whooping cough was maintained at a high level. Predictably, the number of smallpox vaccinations performed declined appreciably following the implementation of the recommendation of the Joint Committee on Vaccination and Immunization that this protection was no longer necessary as a routine measure—a tribute to the success of the global smallpox eradication campaign of the World Health Organization. During the year the number of girls given rubella vaccine increased markedly, the programme being expanded to include all in the 11-14 years age group. Less satisfactory was a decline in the number of children immunized against measles—a tiresome disease meriting a greater effort to ensure its eradication in the years ahead. B.C.G. vaccination continued to play an important part in the departmental programme. To remain effective the individual protection provided by cholera vaccine needs to be boosted every six months and here a high standard of sanitation represents the real safeguard for the community against the spread of this major communicable disease. 1970 had witnessed the first notification of cholera in this country for more than half-a-century and last year three further individual importations of the disease occurred but once again no secondary cases resulted. Fortunately Wandsworth was not affected. Adequately protected water supplies and generally satisfactory sanitary facilities ensured that there would be no repetition of the epidemics of the nineteenth century which ravaged the whole of Europe. Environmental health thus remains a key component of a modern public health programme and it is satisfying to report a year of solid achievement in Wandsworth. In the spring the Council approved the streamlining of the normally unspectacular but nonetheless essential disinfecting and rodent control services with a 6 common base at the Sheepcote Lane depot. A further reorganisation of the public health inspectorate was effected in June with the appointment of an Assistant Chief Public Health Inspector to exercise day-to-day responsibility for the housing division ; at the same time the Deputy Chief Public Health Inspector became responsible similarly for the activities of the general and food divisions. With a strengthened environmental health service enjoying a full establishment output rose spectacularly, being handsomely reflected in the statistics of sanitary activity to be found in Part 4 of the Report. Particularly satisfying was the real impact made in the field of housing in multiple occupation. Here a carefully compiled rolling programme of action—embracing initial inspection, remedying of unsatisfactory conditions detected, and subsequent annual re-inspection of all houses found to be satisfactory or brought up to standard-—was implemented by teams of public health inspectors and technical assistants. During the year 2,735 houses in multiple occupation were inspected for the first time bringing the total number known to the Department to 7,204 ; in addition 198 such houses were brought up to standard and a further 350 reverted to single occupation. These figures reflect a closely knit effort in which the supporting administrative staff played a full part. Judging from the results achieved performance budgeting is a more than useful technique, given expert local knowledge of the problem to be tackled. Much disappointment had been caused by the suspension in November, 1970, of 40% of the operative smoke control orders in the Borough. This setback led. it was subsequently estimated, to a 7% increase in smoke pollution in the affected areas. Happily —especially so in view of the recent publication of the report of the Royal College of Physicians on Air Pollution and Health—an improvement in the solid smokeless fuels supply position enabled the suspension to be lifted permanently. Accordingly the third smoke control order to be made by the Council became operative in July ; two more smoke control orders will come into operation in 1972. The fruits of the drive against atmospheric pollution are already plain to the eyes of the Londoner—ample confirmation of an increasingly smokeless atmosphere is to be found in the measurements taken locally. Another landmark in the clean air campaign was reached in March with the introduction of regulations to control the emission of grit and dust from furnaces. Traditional environmental health activities in relation to general sanitation, drainage, food and drugs, pest control, factories, offices, shops and railway premises, the follow-up of cases and contacts of infectious disease and food poisoning, disinfection and disinfestation, and housing generally have all continued unabated. The impact on the Department of the New Covent Garden Market project at Nine Elms is well illustrated by the photographs in the centre pages of the Report. With the growth of public 7 concern in relation to environmental pollution, however, the problems created by undue noise, unpleasant odours, and chemical contamination of soil or water steadily loom larger on the horizon of the Health Department. Thanks to the cheerful industry and leadership of the Chief Public Health Inspector, Mr. Winton, the environmental health division is in good fettle and coping well with the challenge presented by an increasingly complex environment. An attractive environment—physically safe, emotionally tranquil and aesthetically pleasing—has become a prized community objective in a bustling and congested island. Growing public priority is similarly accorded to family planning measures and here Wandsworth is well to the fore. In 1971 new weekly sessions were provided at three of the clinics run on behalf of the Council by the Family Planning Association ; compared with the previous year new patients increased by nearly one-quarter and the total number of attendances at the clinics rose from 17,023 to 20,318. The domiciliary service continued to fill a vital need. With the progressive expansion of birth control facilities in the Borough the family planning movement is making a significant contribution to cervical cytological screening. However the screening clinics for the general public provided by the Council still have a part to play, on average eight women attending each session held during the year. The total attendances numbered 2,533 as opposed to 2.352 in 1970. In April a new screening venture commenced in association with the Renal Infection Unit at Charing Cross Hospital with the object of assessing the significance of symptomless urinary infections in adult women. To this end women attending two cervical cytology clinics and one family planning clinic were invited to participate in the survey. By the end of the year over 400 women had been screened and of these roughly one in every twenty had an asymptomatic bacteriuria; further investigation revealed the presence in approximately one in five of such symptomless infections of a local abnormality or associated general condition requiring observation or treatment. The significance of asymptomatic bacteriuria, in the absence of any other abnormality, is also being assessed ; to this end all women in this group are being followed up to determine whether the condition tends to recur following treatment or, alternatively, to disappear naturally. Maternal and child health services, like family planning and cervical cytological screening, are provided by the local health authority in support of the family doctor who has a key role to play in all these fields. The virtual doubling of the number of confinements attended by Wandsworth midwives in the general practitioner obstetric unit at the Weir Maternity Hospital was thus a particularly satisfying feature of 1971. This important domiciliary midwifery commitment and the large number of early discharges from hospital following delivery continue to offset the steady decline in home confinements. During the year well over 12,000 children attended the child health clinic sessions where doctors and health 8 visitors monitor developmental progress, undertake routine immunization and advise on the care of infant and toddler; a dental service is also provided for expectant and nursing mothers and preschool children, under the able supervision of Mr. Weedon, the Principal Dental Officer. Health visitors made no fewer than 58,243 effective home visits including 1,464 to the elderly—a rise in the number of old people visited is one of the benefits to be derived from attaching health visitors to general practices and in Wandsworth the year was notable for the first full attachment of this kind ; the similar attachment of three home nurses was another local landmark in the development of the community health services. The home nursing service also embarked upon a new venture in relation to the nursing care of patients undertaking their own renal dialysis at home, the necessary physical adaptations to this end having been carried out by the Council in close collaboration with the hospital authorities providing the " artificial kidney " equipment. Full details of this important new service will be found in Part 5 of the Report and one of the practical problems encountered is depicted in the photographic supplement. Once again the overall number of home nursing visits increased—the vast majority being paid to the elderly—and the invaluable support rendered by the home bathing attendants received fitting recognition with their redesignation as nursing auxiliaries. Great credit is due to the Chief Nursing Officer, Miss Harding, for the impressive record of the nursing staff epitomised by the thoroughness of the follow-up of the 151 infants included in a trial of a new oral poliomyelitis vaccine, which proved to be as effective and safe as the oral vaccines already in use. Chiropody was another key service to flourish during 1971 reflecting most creditably on the efforts of Mr. Trenter, the Chief Chiropodist. In the course of the year full reviews of both these services were completed and proposals for expansion in 1972 approved by the Council. A detailed survey of another vital facet of the work of the Health Department, namely health education, was also undertaken and a comprehensive report was in the final stages of preparation at the end of the year. The relevance of this preventive approach to the solution of contemporary health problems and the challenge which it represents to a wide variety of interests, both statutory and voluntary, were evident in the excellent attendance at the winter Social Services forum convened to consider the contribution which could be made locally to the prevention of the misuse of drugs. Health educational activities generally grew in volume during the year. Mention has already been made of the further reorganization of the environmental health services. Change was also in the air for the personal health services in 1971. In February Dr. Garland retired after almost half-a-life-time of devoted service in the Borough, having set a model example to all who had the privilege of working with him, and in the following month the child health services were reorganized along the lines recommended in the 9 Sheldon Report. This envisaged continuity of medical supervision from birth to school-leaving age by doctors specially trained for the purpose—ultimately child health will become part of family health and thus an integral part of the work of the general practitioner—with the consequent abolition of the increasingly artificial medical administrative division between the pre-school and school periods of childhood. Two senior public health clinicians, Dr. Anna Frenkiel and Dr. Rosemary Graham, were accordingly appointed as Principal Medical Officers (Child Health), each looking after the child health services in one half of the borough with a special responsibility to maintain jointly the Handicap and Observation Register and to develop close paediatric links with the corresponding hospitals as well as with general practitioners. As part of the in-service training programme for both doctors and nurses, a series of lectures in developmental paediatrics was launched ; this proved so successful that it was recognised by the British Postgraduate Medical Federation as appropriate for the attendance of doctors in general practice locally. The unification of the child health service was quickly followed by the reorganization of the nursing management arrangements in the light of the Mayston Report—this entailed a similar geographical unification of the health visiting and home nursing services, an Area Nursing Officer being appointed in each half of the borough to exercise day-to-day responsibility supported by a number of Nursing Officers. In addition, the importance of the community nursing training and health education commitments was recognized by the appointment of a Divisional Nursing Officer to co-ordinate these activities throughout the Borough as well as to oversee the domiciliary midwifery service. Finally, in October, the major reorganization of the Health Department was completed with the arrival of Dr. Michael Church to take up the new post of Principal Medical Officer (Health Education and Administration) with special responsibility from a medical standpoint for the development of a comprehensive and continuing health education programme—an exciting and challenging task. Reshaping the Health Department for the future proceeded smoothly pari passu with the progressive implementation of the Local Authority Social Services Act, 1970, entailing the transfer of important responsibilities to the newly created Social Services Department. Thus the home help service, social work with families, and functions relating to mental health were transferred in April, day nurseries in May, and the registration of child minders, play groups and private day nurseries in October. In addition the responsibility for the provision and operation of the junior training centres and associated special care units passed from the local health authority to the local education authority when the Education (Handicapped Children) Act, 1970, came into force at the beginning of April. The best wishes of the Health Department for success in their new tasks accompanied transferring staff. It is a special pleasure to place on record my very real gratitude to my friend and colleague, Mr. Higgins, for the part which he played as 10 Director of Social Services in ensuring a smooth transition during a period of extensive reorganization. Close collaboration between the health and social services is indispensable to the successful development of the concept of community health and welfare in the years ahead. The growth points of health care are to be found in the spheres of physical or mental handicap in child or adult, mental illness, chronic sickness and disability, and old age. All demand an interlocking effort. This was the basic theme of some notes, prepared during the summer for the newly elected members of the Council on " The Role of the Health Department which form an appendix to this preface. Hence the significance of the formation in November of a local liaison committee to foster collaboration between the Health and Social Services in Wandsworth. The members comprise five general medical practitioners nominated by the Inner London Local Medical Committee, five senior (area) social workers and the Assistant Director (Community and Social Work Services) of the Social Services Department, a senior medical representative and a senior social worker from each of the three main hospital groups in the Borough, the Chief Nursing Officer of the Health Department, the Consultant Psychiatric Adviser to the Corporation, the Director of Social Services and myself. Communications in the field of mental health and the organization of the Health and Social Services Departments were the main items on the inaugural agenda. Meetings will be held quarterly to review opportunities for co-operation in spheres of mutual concern such as the implementation of the Chronically Sick and Disabled Persons Act, 1970. The local liaison committee has made a most promising start. One other growth point of the health service in the immediate future remains to be mentioned, namely, primary medical and nursing care in the home. Here reference has already been made to the support rendered to the family doctor by the Department in relation to family planning, cervical cytology, maternal and child health, health visiting, home nursing, chiropody and health education. Fostering the closest ties with general medical practice is a basic objective which is undoubtedly furthered by working in close physical proximity—hence the importance of nursing attachment schemes and of the endorsement by the Council of reciprocal arrangements with neighbouring boroughs. Equally welcome in this context is the current upsurge of interest in purpose-built group practice or health centres; the planning of the three firm health centre projects in the Borough—at Bridge Lane. Battersea ; Brocklebank ; and Larch Road, Balham gathered increasing momentum during the year and the possibility of a fourth health centre, in association with a new Council housing site at Burtop Road, was being actively explored following approval of the project in principle. A change in procedure in relation to the medical assessment of priority claims for rehousing on health grounds proved of real assistance to general practitioners. Under the new scheme, 11 duced in August following consultation with the Housing Department and the Inner London Local Medical Committee, a housing applicant, who wishes to adduce medical evidence in support, completes a space specially provided for that purpose on the normal housing application form instead of approaching his family doctor ; in such cases the form is then referred to the Health Department for medical assessment, the general practitioner concerned only being contacted when further information is needed. Assessment is not a task to be undertaken lightly in view of the intricate relationship between health and housing. Change and the prospect of further change have dominated the scene in 1971. The Health Department has been radically reshaped in preparation for the future. Even more radical reorganization is envisaged in the Consultative Document—issued by the Secretary of State for Social Services in the late spring—on the unification of the hospital, general practitioner and local health authority personal health services in April, 1974. The reports of the working party on collaboration between the new health and local authorities and of the study group on future management arrangements within the health service, which have been established to examine these two key aspects of reorganization, will be awaited with keen interest. A great opportunity will have been missed if the national health service of the future does not bear the stamp of the local community. The identical composition of the membership of the Health and Social Services Committees in Wandsworth, with the same chairman and vice-chairman, seems to me to symbolise that unity of interest and effort which alone can promote effectively the community health and welfare. It is with this theme of local participation very much in mind that I wish to express my profound gratitude to His Worship the Mayor, to the Chairman and Members of the Health and Social Services Committees, and to Members of the Council, generally, for their unfailing kindness and encouragement. To the Chief Executive and Town Clerk and to my colleagues in other Departments of the Council and in the health service as a whole, I extend my warm thanks for their ever-ready help. Finally, at the end of an eventful year, I am especially appreciative of the loyal and diligent support which I have received from the staff of the Health Department, and not least from my Deputy, Dr. Gordon, and the Principal Administrative Officer, Mr. Horsnell; I am indeed grateful to them all. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, HASTINGS E. A. CARSON, Medical Officer of Health, and Principal School Medical Officer. 12 APPENDIX THE ROLE OF THE HEALTH DEPARTMENT MAIN FIELDS OF ACTIVITY CURRENT MAJOR PREOCCUPATIONS 1. Environmental Health General sanitation ; drainage ; housing; food; pest control; factories ; offices, shops and railway premises ; clean air; noise; radiological safety. Unsatisfactory Housing in Multiple Occupation. 2. Communicable Disease Control Investigation of cases and contacts; disinfection and disinfestation; protection of susceptibles. Maintenance of satisfactory vaccination and immunization states against serious infectious diseases. 3. Maternal and Child Health Family planning; maternity services including domiciliary midwifery; developmental examinations (and vaccination and immunization) in infancy and early childhood; medical supervision of handicapped children particularly and of school pupils generally; dental service for expectant and nursing mothers, pre-school and school children. Encouragement of family planning. Early detection of physical and mental handicap in order to keep disability to a minimum and preserve educational potential at a maximum. Reduction of present high incidence of dental decay. 4. Prevention of Illness Promotion of health at all ages through the fostering of healthy personal habits and pursuits (and of the specific individual protection provided by vaccination and immunization); the selective screening of the population to detect important symptomless conditions; and the implementation of communal protective measures of proven value. Development of comprehensive health education programme to inculcate sense of individual and communal responsibility for the maintenance of health and, as a corollary, to persuade those most in need of the health services available to make full use of them. 13 5. Support for Medical Care in the Community Provision of supporting services for doctor and patient outside hospital in the form of home nursing; loan of nursing equipment; the incontinent laundry service ; chiropody ; adaptation of homes to accommodate renal dialysing equipment; recommendations for priority rehousing on health grounds ; the attachments of health visitors, district nurses and midwives to general practices; accommodation for general practitioners in health centres. Reinforcement of the service provided by the family doctor to enable as many patients as possible to be cared for at home and, as a corollary, to reduce the length of stay of those requiring admission to hospital. Preservation of the health and mobility of the aged. Creation of close links with the local hospitals, general medical practitioners and the Social Services Department. Plans for the construction of three health centres. 6. Staff Health Advice on the medical fitness of prospective and actual members of the staff of the Council. DEPARTMENTAL ORGANIZATION Recent reshaping in the light of the Local Authority Social Services Act, 1970, and forthcoming unification of health services, with the creation of five functional divisions—environmental, medical, dental, nursing and administrative—embracing a staff of some 375 with an annual revenue budget in the region of £800,000. 1. Environmental Division—Chief Public Health Inspector (Mr. K. J. Winton). Housing, Food and General sub-divisions with strong technical assistant support for public health inspectorate. 2. Medical Division —Deputy Medical Officer of Health (Dr. H. Gordon) supported by two Principal Medical Officers (Child Health) and a Principal Medical Officer (Health Education and Administration). Special features comprise the medical administrative unification of the child health service to provide continuity of supervision from birth to school-leaving age, the priority accorded to health education, and the medical importance attached to the chiropody service which is included in the division. 14 3. Dental Division —Principal Dental Officer (Mr. A. F. Weedon). 4. Nursing Division —Principal Nursing Officer (Miss D. A. Harding). The reorganization of this division is pending in the light of the Report of the Working Party on Management Structure in the Local Authority Nursing Services. Two pilot attachment schemes of nursing staff to general practices are flourishing. 5. Administrative Division—Principal Administrative Officer (Mr.H.J. Horsnell). Management and Services sub-divisions. THE IMPORTANCE OF THE NEXT THREE YEARS The consultative document prepared by the Department of Health and Social Security on the reorganization of the National Health Service envisages the unification of the hospital, general practitioner and local health authority personal health services in April 1974. Just under three years remain in which to establish a lasting community influence through the creation of dynamic up-to-date effective local health and social services. Fortunately the reorganization entailed in the unification of the personal social services has provided a golden opportunity to build for the future. So far as the Health Department is concerned a new streamlined shape is designed to place the emphasis on the relevance of the task and the quality of performance. The promotion of health, the prevention of illness and care in the community have never been more relevant—major preventable factors, frequently within the hands of the individual to control, are to be found in all the leading causes of death and disability, and human and economic considerations both demand that hospital treatment be reserved strictly for those who cannot be cared for at home. The challenge to the community health and social services is great and can only be met by a united effort. Thus, working in close collaboration with the Social Services Department, the new Health Department will have the prime objective of being fully prepared for the further reorganization ahead so that in 1974 the Council can rest assured that medical advice will be readily available in a familiar setting and that the new area health authority will contain a community health division sensitive to local needs and respected on its merits as a relevant, competent, and therefore key part of the reorganized national health service. 15 MEMBERS OF THE HEALTH COMMITTEE (at 31st December, 1971) Chairman : Councillor J. T. Dixon. Vice-Chairman : Alderman Mrs. J. D. Standing. Alderman H. D. Lester Miss G. A. Morgan K. Rodney C. Vimalachandran Councillor W. J. Ballantine Mrs. P. F. B. Campbell G. S. Cooley P. D. Donoghue Mrs. E. D. Goatley L. W. Holmes Mrs. E. M. Marshall Mrs. J. A. Nicholas Mrs. M. E. Rackham Mrs. D. M. Smith H. A. Stephenson J. V. Tilley Mrs. T. S. H. Tilley Mrs. Margaret Williams M. R. Williams Ex-Officio Members : The Worshipful the Mayor (Councillor J. A. Golding) Alderman R. F. Ash, j.p. Councillor I. McGarry SENIOR OFFICERS OF THE HEALTH DEPARTMENT (at 31st December, 1971) Medical Officer of Health H. E. A. Carson Deputy Medical Officer of Health H. Gordon Principal Medical Officers M. A. Church A. L. Frenkiel R. D. Graham Principal Administrative Officer H. J. Horsnell Chief Public Health Inspector K. J. Winton Chief Nursing Officer Miss D. A. Harding Principal Social Worker (Health Services) Mrs. M. J. Koolman Principal Dental Officer A. F. Weedon 16 PART 1 REORGANISATION OF THE HEALTH DEPARTMENT The implementation of the Local Authority Social Services Act. 1970, entailed the transfer of certain services from the Health Department to the newly-formed Social Services Department, the main functions so to be transferred being the Mental Health Service, the Home Help Service, and the services for the day care of children, including the day nurseries hitherto operated by the Health Department. The knowledge that these services were to leave the Department, and that a comprehensive review of the organisation of the Department had not been undertaken since its inception in 1965, prompted a further review as a result of which a scheme for the re-shaping of the Health Department was submitted to a special committee of the Council in December 1970. The new organisation envisaged that there would be five functional divisions within the Department, these being medical, dental, environmental, nursing and administrative. The medical division would be headed by the Deputy Medical Officer of Health and the remaining divisions by the Chief Dental Officer, the Chief Public Health Inspector, the Chief Nursing Officer and the Principal Administrative Officer respectively, these five officers together with the Medical Officer of Health forming the management team of the Department. This new organisation was framed with three basic aims in mind, namely:— 1. To enable the Medical Officer of Health to continue to be a " quality controller " of the services for which he is responsible, keeping a finger on the pulse of the Department as a whole, devising yardsticks to measure achievement in the field and up-dating these in the light of experience, so that the resources available are used to the full and are responsive to the changing needs of the community. 2. To give responsibility for day-to-day management to the head of each division and to supply the senior support necessary for this to be undertaken. 3. To encourage all members of the staff of the Health Department to apply to their work a sense of purpose and enthusiasm which can only be engendered by the relevance and importance of their tasks. 17 In the medical division two of the three Principal Medical Officers now appointed are responsible for the entire child health service, each looking after the services in one half of the Borough. In addition one is responsible for providing a comprehensive inservice training programme in developmental paediatrics for the medical and nursing members of the Health Department staff and for the provision and expansion of developmental paediatric services throughout the Borough. The other has an oversight throughout the Borough of the ante-natal, post-natal and cervical cytology services. Since two major teaching hospitals are in the process of establishing their roots in the Borough, one in each of the child health service areas, there is a consequent stimulus to the medical, nursing and social services locally and an obvious need to establish and foster good liaison with these teaching hospitals during this formative period. A third Principal Medical Officer is responsible for health education throughout the Borough, in which task he is assisted by the Deputy Chief Nursing Officer and an Administrative Officer, and he also provides administrative and clinical support to the Deputy Medical Officer of Health, and as necessary to the two Principal Medical Officers for child health. Whilst the organisation of the dental division was reviewed, very little change was found necessary and this division continues to provide an excellent and expanding service under the able and energetic leadership of the Chief Dental Officer, Mr. A. F. Weedon. Following a complete review of the current responsibilities and workload of the environmental health division, this was reorganised in two main sub-divisions, namely, the general and food subdivision under the day-to-day control of the Deputy Chief Public Health Inspector, and the housing sub-division under the day-today control of the Assistant Chief Public Health Inspector. The general and food sub-division deals with what might be termed the long-standing responsibilities of the Public Health Inspector, whilst the housing sub-division is responsible for slum clearance and all matters relating to housing in multiple occupation. This latter section of course, works in close co-operation with the Housing Improvement Officer, Mr. E. N. Montague and his Housing Improvement Group. The publication of the Report of the Working Party on the Management Structure in the Local Authority Nursing Services (The Mayston Report) and the subsequent circulars from the Department of Health and Social Security commending this Report to Local Health Authorities gave added impetus to the review of the nursing services of the Council. The organisation finally adopted followed similar lines to that proposed for the medical division, in that the nursing division is headed by a Chief Nursing Officer supported by a Deputy Chief Nursing Officer who is responsible primarily for all matters relating to the training of 18 nursing personnel, both those on our own staff and those who are seconded from various hospitals for training under either the General Nursing Council syllabus or the training syllabus of the Central Midwives Board. She is also responsible for all matters relating to health education and has a general oversight of the midwifery services of the Borough. For the health visiting, home nursing, school nursing and clinic nursing services, including their ancillary staff, the Borough is divided into two areas similar to the areas used for medical staffing and in each of these areas all nursing personnel with the exception of the domiciliary midwives are under the control of an area nursing officer. Each such officer has the assistance of four nursing officers, as first line managers of the services in the area. The domiciliary midwifery service is not sub-divided into these areas; the service throughout the whole Borough is controlled by a Non-medical Supervisor of Midwives assisted by a senior midwife. The reorganisation of the administrative division of the Department provided for two main sections under the control of the Principal Administrative Officer, each section being under the day-to-day supervision of a Senior Administrative Officer. The personal health services section, numerically the larger of the two, provides all the necessary administrative and clerical support to the other four divisions of the Department. The management section is responsible for the domestic affairs of the Department, e.g. staffing, finance, secretarial services, maintenance of premises and similar matters. The reorganisation of the Department was instituted in various phases throughout 1971—that relating to the Environmental Health Division having commenced in the previous year, and there has, of course, been a continuing evaluation of the effects of the reorganisation, and changes and improvements have been made where necessary to shape the Department for its new role in the reorganised health services in 1974. A comprehensive review of the potential contribution of preventive medicine to the health of the community, contained in a memorandum to a special Committee of the Council in December 1970, was reprinted as an Appendix to the foreword to my Annual Report of that year. Finally, it is appropriate here to mention that the Director of Social Services, Mr. E. S. Higgins, accepted responsibility for the health services transferable to his new Social Services Department on the 1st March, 1971, and the physical transfer of those services took place during the ensuing spring and summer. Whilst it was with mixed feelings that we witnessed the departure from the Health Department of colleagues with whom we had worked for many years, they took with them our thanks for their work and comradeship over the years and our hopes that they would find satisfying and rewarding careers in their new spheres of activity. 19 PART 2 VITAL STATISTICS Population The civilian population at the middle of the year was estimated by the Registrar-General to be 300,530. Movement of population Although there has been little change in the general picture, with large numbers of children under five years of age moving into and out of the Borough, there do seem to be signs that the net loss of child-population is becoming smaller. Records show that just over 2,700 moved into Wandsworth—much the same as in 1970—and just over 3,100 moved out. The second figure shows a drop of about 14 per cent, from that for 1970. There were more children lost sight of : 1,908 as against 1,739 for the previous year; 625 of these were finally traced either locally or through co-operation with other local authorities. In addition, over 2,700 children moved to other addresses in Wandsworth. Although unspectacular the work in connection with these records is of the highest importance in contributing to the health and wellbeing of the child. 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 1971 the factor for births is 0.96 and for deaths 0.84. 20 Extracts from vital statistics Live Births: Male Female Total Legitimate 2,108 1,951 4,059 Illegitimate 405 428 833 Totals 2,513 2,379 4,892 Rate per 1,000 population: Crude 16.33 Adjusted 15.70 Stillbirths: Rate per 1,000 total live and still births 9 21 24 45 Deaths: All ages 1,902 2,095 3,997 Rate per 1,000 population: Crude 13.30 Adjusted 11.20 Infant Mortality Rates: Deaths under 1 year 46 37 83 Total infant deaths per 1,000 live births 17.00 Legitimate infant deaths per 1,000 legitimate live births 16.00 Illegitimate infant deaths per 1,000 illegitimate live births 23.00 Neo-natal Mortality Rate (deaths under four weeks per 1,000 total live births) 11.00 Early Neo-natal Mortality Rate (deaths under one week per 1,000 total live births) 10.00 Perinatal Mortality Rate (stillbirths and deaths under one week combined per 1,000 total live and still births) 19.00 Maternal Mortality Rate (per 1,000 total live and still births) 0.20 Number of deaths from puerperal causes 1 Number of deaths from cancer 846 Number of deaths from tuberculosis 14 21 Births The total number of live births to residents in the Borough registered in 1971 was 4,892, comprising 2,513 males and 2,379 females. The crude birth-rate was 16.3 per 1,000 population. The rate as adjusted by the area comparability factor was 15.6. The live birthrate for England and Wales was 16.00. During the year there were 833 illegitimate live births to residents in the Borough, representing 17 per cent, of the total live births for the area. The national average was 8 per cent. Stillbirths during the year numbered 45, giving a total of 4,937 live and still births for the whole 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 3,997, comprising 1.902 males and 2,095 females. The crude death-rate was 13.3 per 1,000 population, and the adjusted death-rate, after application of the area comparability factor, 11.2. The death-rate for England and Wales was 11.6. 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 World Health Organisation's Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death (8th revision, Geneva, 1969). 22 TABLE 1. CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1971 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 4 2 2 3 1 — — — — — — — — — 2 2 Tuberculosis of respiratory system 8 5 3 — — — — — — 3 1 4 — 2 3 3 Late effects of respiratory tuberculosis 3 2 1 — — — — — 1 — — 1 1 — 1 2 Other tuberculosis, 3 2 1 — — — — — — — 1 1 1 1 1 — Plague — — — — — — — — — — — — — — — — Diphtheria — — — — — — — — — — — — — — — — Whooping cough — — — — — — — — — — — — — — — — Streptococcal sore throat and scarlet fever — — — — — — — — — — — — — — — — Meningococcal infection 1 1 — 1 — — — — — — — — — — — — Acute poliomyelitis — — — — — — — — — — — — — — — — Smallpox — — — — — — — — — — — — — — — — Measles 1 1 — — — — — — — — — — — — — 1 Typhus and other rickettsioses — — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — — Syphilis and its sequelae 5 2 3 — — — — — — — — 3 2 1 2 2 All other infective and parasitic diseases 4 3 1 — — — — — 1 — 1 1 — — 4 — Malignant neoplasm, Buccal cavity, and pharynx 15 8 7 — — — — — — — 3 7 5 4 6 5 „ „ Oesophagus 12 10 2 — — — — — — — 5 6 1 3 3 6 „ „ Stomach 96 58 38 — — — — — 1 9 12 34 40 26 23 47 „ „ Intestine 136 54 82 — — — — 1 1 8 19 52 55 52 36 48 ,, „ Larynx 8 5 3 — — — — — — — 6 1 1 2 3 3 ,. „ Lung, bronchus 240 181 59 — — — — — 1 22 72 82 63 72 70 98 70 — 70 — — — — — 11 7 17 15 20 25 19 26 „ „ Uterus 21 — 21 — — — — 1 1 4 3 7 5 7 7 7 ,, ,,Prostate 31 31 — — — — — — — — 4 9 18 11 5 15 Leukaemia 19 9 10 1 — 1 1 — — 1 3 5 7 3 4 12 Other malignant neoplasms 198 100 98 1 — 1 1 6 6 23 47 59 54 62 55 81 Benign and unspecified neoplasms 7 1 6 — — — — — — 1 1 2 3 2 2 3 Diabetes mellitus 29 6 23 — — — — — — 4 5 7 13 9 12 8 Avitaminosis and other nutritional ency 2 2 — — — — — 1 — — — — 1 1 — 1 Other endocrine, nutritional and metabolic doiseases 15 4 11 1 — — 1 — — — 6 3 4 6 4 5 Anaemias 10 3 7 — — — — — — — — 4 6 3 4 3 Other diseases of blood and blood-forming organs 3 3 — — — — — — — — — 1 1 1 — 2 Mental disorders 25 24 — — — — — 1 — 1 — 18 6 12 7 Meningitis 3 1 2 — — — — — — — — — — — 1 — Carried forward 969 495 474 7 2 2 3 9 24 84 208 309 321 301 279 389 23 TABLE 1. CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1971—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 Battersea Brought forward 969 495 474 7 2 2 3 9 24 84 208 309 321 301 279 389 Multiple Sclerosis 18 6 12 — — — 1 — 1 5 6 4 1 5 7 6 Other diseases of nervous system and sense organs 53 22 31 — — — 1 2 2 2 7 16 23 29 11 13 Chronic rheumatic heart disease 45 11 34 — — — 1 1 2 7 14 6 14 15 14 16 Hypertensive disease 51 22 29 — — — — — 2 2 4 10 33 11 18 22 Ischaemic heart disease 952 537 415 — — — — 6 13 57 178 256 442 325 — 368 Other forms of heart disease 195 67 128 — — — 1 1 — — — — — — — 58 Cerebrovascular disease 486 171 315 — 1 2 — 1 3 16 43 108 312 183 134 169 Other diseases of the circulatory system 215 76 139 — — — 1 — 3 1 16 47 147 79 55 81 Influenza 4 1 3 — — — — — — — 1 1 2 — 2 2 Pneumonia 304 110 194 8 — — — 1 1 7 18 49 220 90 — — Bronchitis, emphysema 211 149 62 — — — — 1 2 6 32 74 — 65 — — Asthma 11 5 6 1 — — — — 2 3 — 2 3 4 3 — Other diseases of the respiratory system 44 18 26 3 1 — — — 1 — 1 11 27 17 — — Peptic ulcer 41 21 20 — — — — — 1 3 2 10 25 14 11 16 Appendicitis 1 1 — — — — — — — — — — 1 — — 1 Intestinal obstruction and hernia 28 12 16 1 — — — — — 2 1 4 20 10 6 12 Cirrhosis of liver 12 7 5 — — — — — — 3 4 4 1 3 4 5 Other diseases of the digestive system 38 12 26 — — — 1 1 1 4 4 9 18 13 11 14 Nephritis and nephrosis 17 8 9 — — — — — 1 1 2 7 Hyperplasia of prostate 4 4 — — — — — — — — — 1 3 1 1 2 Other diseases of genito-urinary system 25 7 18 — — — — — — 2 2 7 — — — — Other complications of pregnancy, childbirth and puerperium 1 — 1 — — — — 1 — — — — — — 1 — Diseases of the skin and subcutaneous tissue 4 1 3 — — — — — — — — — — 1 1 2 Diseases of the musculoskeletal system and connective tissue 21 2 19 — — 1 ___ 1 — 1 1 4 13 5 9 7 Congenital anomalies 29 17 12 18 1 2 — 1 1 1 1 1 3 7 10 12 Birth injury, difficult labour, and other anoxic and hypoxic conditions 21 8 13 21 — — — — — — — — — 9 5 7 Other causes of perinatal mortality 16 11 5 16 — — — — — — — — — 5 3 8 Symptoms and ill-defined conditions 32 16 16 7 — — — — — — — — 25 6 16 10 Motor vehicle accidents 38 20 18 — 2 1 6 4 2 4 3 9 7 12 11 15 All other accidents 59 44 15 1 3 3 8 3 4 7 12 11 22 5 32 Suicide and self-inflicted injuries 40 18 22 — — — 3 5 6 6 11 2 7 19 9 12 All other external causes 12 3 9 — 1 — 2 1 1 2 1 1 3 6 2 4 Totals 3,997 1,902 2,095 83 11 11 28 39 74 230 584 990 1,947 1,325 1,179 1,493 24 TABLE 2. DEATHS FROM HEART DISEASE Males in age groups Females in age groups : Grand totals under 25 25- 55- 45- 55- 35- 75 + Totals 1 under 25 25- 35- 45- 55- 65- 75 + j Totals Chronic rheumatic heart disease 1 1 — — 6 1 2 11 — — 2 7 8 5 12 34 45 Hypertensive disease — — 1 2 2 7 10 22 — — 1 — 2 3 23 29 51 Ischaemic heart disease 6 10 52 141 172 156 537 — — 3 5 37 84 286 415 952 Other forms of heart disease 1 1 — 3 10 11 41 67 — — — 1 7 15 105 128 195 Totals 2 8 11 57 159 191 209 637 — — 6 13 54 107 426 606 1,243 Infant mortality There were 83 deaths of children under one year, with an infant mortality rate of 17.00 per thousand live births. The infant mortality rate for England and Wales was 18.00. 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 3 — 1 4 4 8 Enteritis and other diarrhoeal diseases — — 1 1 2 3 Congenital anomalies 10 2 — 12 6 18 Prematurity 12 9 — 21 — 21 Other causes 4 12 3 19 14 33 TOTALS 29 23 5 57 26 83 Maternal mortality One death occurred from accidents and diseases of pregnancy or childbirth. This is equivalent to a rate of 0.20 per thousand live and still births. The patient concerned, a 25-year-old expectant mother, died as the result of pulmonary embolism complicating phlebo-thrombosis of leg veins. 25 PART 3 COMMUNICABLE DISEASES During the year, 1,207 notifications were received as compared with 1,891 in 1970. The total number of confirmed notifiable diseases, arranged in age groups and areas in which they occurred, are shown in Tables 4 and 5 which follow. A commentary on the notifications is given below. Vaccination and immunization against serious infectious diseases is an important feature of communicable disease control and details of this personal health service will be found in Part 5 of the Report. Acute encephalitis The one case reported occurred in an elderly woman following smallpox vaccination. Acute meningitis Of the seven cases notified, six were babies of one year or under, the other a school child. All were isolated incidents. One baby of four months died. Cholera No cases were reported but in relation to an outbreak in Spain, 253 residents who arrived back in this country without a valid international certificate of vaccination were kept under surveillance. Diphtheria No cases occurred during 1971. Dysentery A total of 311 notifications of dysentery or suspected dysentery were investigated, 60 being confirmed on bacteriological examination. These were all either single unrelated incidents or family episodes. No outbreaks occurred in schools or similar institutions. 26 Food poisoning Ninety-six notified cases were investigated during the year. After laboratory examination of faecal specimens 37 of these were not confirmed. All the salmonella infections were single and unrelated incidents. The causative organisms of the 59 positive cases were found to be the following types Salmonella typhimurium ,, bareilly „ panama ,, worthington ,, st. paul „ enteritidis ,, hadar ,, bovis-morbificans „ thompson ,, agona ,, emek „ brandenburg ,, virchow ,, heidelberg „ infantis „ indiana ,,Clostridium welchii 23 1 3 1 2 4 1 2 1 6 1 1 1 1 2 1 8 The eight cases attributed to C. welchii occurred in a minor outbreak at an Old People's Home. Gastro-enteritis An outbreak of acute gastro-enteritis, familiarly known as winter vomiting, occurred in a junior and infants school in the latter half of November. The disease was mild and shortlived in most cases, the symptoms being stomach pain followed by vomiting and occasionally diarrhoea. The disease affected 58 children and five teachers. Bacteriological and virological investigations were negative. Another school which was served with food prepared in the kitchen attached to the school at which the outbreak occurred did not report any cases of illness. In the routine testing of the kitchen staff, one individual was found to be a carrier of Salmonella typhimurium, an incidental finding not related to the episode. Infective jaundice Twenty-five cases were notified as compared with 104 in 1970, there being no outbreak of the kind which occurred in a school last year. 27 Malaria Three notifications were received, all of which were recurrent cases contracted abroad. Measles Contrary to expectation—1971 being regarded in advance as a measles year—a considerable drop occurred in the number of measles cases notified, only 559 as against 1,090 in 1970. Measles vaccination had undoubtedly produced this dramatic improvement. Ophthalmia neonatorum Three cases of ophthalmic infection in the newborn were reported and investigated. All were found to be gonococcal in origin. Poliomyelitis and smallpox No cases of these two serious diseases were notified in Wandsworth during the year. Tuberculosis The number of new cases notified during the year was 120, the sources of information being as follows :— Primary notifications 97 Un-notified at death 5 Transfers from other areas 18 The number of deaths certified as due to various forms of tuberculosis was fourteen. 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 1 3 1 — — — — — 5-9 2 1 1 2 — — — — 10-14 — — — 1 — — — — 15-24 8 3 2 2 — — — — 25-44 15 9 6 3 — — 1 — 45-64 12 8 1 2 3 2 — — 65 and over 9 2 1 2 4 2 1 1 Totals 47 26 12 12 7 4 2 1 28 Tuberculosis—Epidemiological investigations During the year, investigations were carried out at three schools in Wandsworth, details of which will be found in the School Health Section of this report. Typhoid and paratyphoid fevers (Enteric fever) No cases of typhoid fever were reported, but two cases of paratyphoid fever were investigated. The first case was an adult male who had not been abroad in recent years; the source of infection was not traced. A total of 19 faecal and urine specimens were examined. The other case was a young woman who had been travelling abroad for some time and had been taken ill whilst abroad. On arrival in this country she was admitted to hospital where all the necessary investigations were undertaken. Whooping cough There was a noticeable decrease in the number of cases reported —68 as against 223 in 1970—as was to be expected in view of the tendency of this disease to show an unusually high incidence every fourth year. Bacteriological examinations Bacteriological examination of stools and other specimens in connection with food poisoning and infectious disease was carried out by the Joint Microbiology and Public Health Laboratory at St. George's Hospital, Tooting, and 1,828 specimens were examined during the year :— Stool and urine 1,599 Nose and throat swabs 229 International certificates of vaccination against smallpox Persons travelling abroad to certain specified countries are required to possess a certificate of vaccination bearing the authenticating stamp of the local authority of the area in which they were vaccinated. The trend shown in recent years for an increasing number of persons to require such certificates was reversed in 1971 when only 8,879 requests were received, 2,547 less than in 1970. This reflected the outstanding success of the global World Health Organisation Smallpox Eradication Campaign which has led to more and more countries becoming free from this dangerous infection. Occasional requests are made by persons proposing to travel abroad for a certificate to the effect that no recent cases of smallpox have occurred in the area where they reside. In 1971 no such applications were received. 29 Smallpox and cholera—Surveillance Under the Public Health (Aircraft) Regulations, 1966 and the Public Health (Ships) Regulations, 1966, persons arriving in this country from areas abroad where smallpox is endemic and who are not in possession of a valid international certificate of vaccination against smallpox must be placed under surveillance for a specific period. During the year, 43 such persons who were proceeding to addresses in the Borough were kept under observation. Similarly, in relation to another quarantinable disease, cholera, visits were made to 253 persons arriving from infected areas, as mentioned earlier in the Report. Immigrants The number of immigrants taking up residence in the Borough during the year was 858, of whom the public health inspectors were able to contact 518, so that any necessary advice could be given regarding registration with a family doctor and the desirability of having a chest X-ray. 30 TABLE 4 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 25-44 45-64 65 and over Totals Acute encephalitis — — — — — — — — — — 1 1 Acute meningitis 5 1 — — — 1 — — — — — 7 Acute poliomyelitis — — — — — — — — — — — — Anthrax — — — — — — — — — — — — Cholera — — c — — — — — — — — — Diphtheria — — — — — — — — — — — — Dysentery 4 11 8 4 4 13 — 5 11 — — 60 Food poisoning 1 4 4 2 2 4 1 13 13 4 11 59 infective jaundice — — — 1 — 3 1 4 12 3 1 25 Leprosy — — — — — — — — — — — — Leptospirosis — — — — — — — — — — — — Malaria — — — — — — — — 3 — — 3 Measles 41 67 71 80 86 201 8 4 1 — — 559 Ophthalmia neonatorum 3 — — — — — — — — — — 3 Paratyphoid fever — — — — — — — 1 — 1 — 2 Plague — — — — — — — — — — — — Relapsing fever — — — — — — — — — — — — Scarlet fever — — 1 5 4 20 4 1 — — 35 Smallpox — — — — — — — — — — — — Tetanus — — — — — — — — — — — — Tuberculosis — 1 — 2 2 6 1 15 33 23 14 97 Typhoid fever — — — — — — — — — — — — Typhus — — — — — — — — — — — — Whooping cough 6 8 6 7 8 30 3 — — — — 68 Yellow fever — — — — — — — — — — — — Totals 60 92 90 101 106 278 18 43 73 31 27 919 31 TABLE 5 NOTIFIABLE DISEASES NUMBER OF NOTIFIED CASES OF INFECTIOUS DISEASES IN WARDS TOTALS 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 Acute encephalitis — — — — — 1 — — — — — — — — — — — — — — 1 Acute meningitis — — — — 1 1 — 1 — — — — — 2 — 1 — 1 — — 7 Acute poliomyelitis — — — — — — — — — — — — — — — — — — — — — Anthrax — — — — — — — — — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — — — — — — — — — Diphtheria — — — — — —- — — — — — — — — — — — — — — — Dysentery — — — — — — 6 6 — — — — 1 — 1 — — — — — 60 Food poisoning — 1 5 15 4 7 2 — 4 2 2 2 — 4 — 4 2 1 4 — 59 Infective jaundice — — 1 — — 7 — 2 2 — 2 — 1 3 — 1 — 1 — 5 25 Leprosy — — — — — — — — — — — — — — — — — — — — — Leptospirosis — — — — — — — — — — — — — — — — — — — — — Malaria — — — 1 1 — — — 1 — — — — — — — — — — — 3 Measles 10 8 17 39 22 38 32 31 36 48 10 82 12 11 2 32 30 35 25 39 559 Ophthalmia neonatorum — — — — — 1 — — — — 2 — — — — — — — — — 3 Paratyphoid fever — — — — — — — — — — — — — — — — — — — — 2 Plague — — — — — — — — — — — — — — — — — — — — — Relapsing fever — — — — — — — — — — — — — — — — — — — — — 2 — 1 4 4 2 5 5 1 2 1 1 1 2 1 3 — 35 Smallpox — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 8 4 4 5 8 1 7 4 13 9 6 6 2 4 6 1 1 6 97 Typhoid fever — — — — — — — — — — — — — — — — — — — — — Typhus — — — — — — — — — — — — — — — — — — — — — Whooping cough — — 2 9 7 6 8 4 5 1 l 5 — 4 3 2 4 4 — 3 68 Yellow fever — — — — — — — — — — — — — — — — — — — — — Totals 13 11 36 86 47 72 61 50 62 57 34 99 20 37 9 47 42 47 34 55 919 32 PART 4 ENVIRONMENTAL HEALTH SERVICES K. J. Winton, M.A.P.H.I.—Chief Public Health Inspector Happily, the past year was one in which it was possible to say that staff shortages were at a minimum, and the figures shown in Table 6 for the work of the Environmental Health Section throughout last year shows just what can be achieved with an almost complete establishment. The sense of enthusiasm and drive, particularly in the Housing and Food Divisions, which was introduced by the reorganisation of 1970, has again been carried forward throughout this year with renewed effort, and it has been particularly pleasing to see how both the Housing and Food Divisions have actively carried out their programmes of work and have both surpassed their target figures for the year. During the year, the Housing Division was further reorganised into two separate sections—one for the surveillance and detection of houses in multiple occupation and one for the implementation of major action. This has been a great success and, following the initial period of recruitment and training necessary for the new technical assistants, great strides were made towards the implementation of the Council's programme for houses in multiple occupation. In addition, the Housing Division again had to deal with over 1,500 applications for qualification certificates during the year, a burden which, with the introduction of the new Housing Bill, is likely to disappear in 1972. The Food Division successfully caught up on its backlog of work and, additionally, throughout the year under review, had to cope with a very great increase indeed in the number of visits necessary to the cold store within the Borough for the purpose of taking bacteriological samples of exotic foodstuffs, such as Chinese headless prawns, smoked eels, octopuses and other seafoods, which come into this country from all parts of the world. One point of interest in the work of the Food Division is that, during the year, a special drink dispenser survey was carried out in all public houses, clubs and restaurants in the Borough. Attention had been drawn to the fact that metal pourers used to dispense fruit squashes were affected by the acid content of the liquid and ultimately every drink poured from a bottle fitted with such a dispenser contained a high degree of copper. Thirty of these 33 unsatisfactory metal pourers were found and all were replaced by plastic ones. The General Division again carried on its usual day-to-day task of dealing with routine complaints. It is interesting to note that, whilst the nature of the complaints over the last few years has gradually changed, the number, i.e. between 7,000 and 8,000, has never varied over the last decade. There is no doubt that this Division is the heart of the Environmental Health Section, and when one considers that originally public health inspectors were called "nuisance inspectors", one can see how the importance of these particular responsibilities has remained undiminished for well over a century. Within the General Division is the drainage section and, during the past year, one very special item of note has been the supervision of the laying of all sewers and drainage for the new Covent Garden Market Development at Nine Elms. This is a £35 million development, entailing the laying of some 5-6 miles of pipe in diameter sizes varying from four to 42 inches, every joint of which had to be tested (see Plate A—centre pages); in addition, the construction of over 500 interceptor and inspection chambers had also to be supervised and tested. Another photograph (Plate B— centre pages) shows a 30-inch and a 24-inch polypropylene interceptor trap, both of which were installed in the Administration Block. Stoneware traps of this size were unobtainable and these had to be specially manufactured—they have a glass fibre backing to afford strength with a polypropylene skin. We must not forget the work done by the manual workers of the department—the Pest Control Officer and his staff, the disinfectors and the cleansing station and mortuary staff. During the year under review, a work study programme was carried out on these services and, following this, the pest control staff and the disinfecting and cleansing staff were reorganised into a more mobile and efficient service. Tribute must be paid to these members of the staff for the way in which they carried out their duties. The spirit of the Department can usually be judged by the amount of time given voluntarily by the staff outside of normal working hours. In this connection, it is very pleasing to say that inspectors again gave many hours of their free time to lectures and informal talks to various local groups such as scouts, guides, schoolchildren and the staffs of hospitals and multiple stores. Statistically, the year has shown an increase in nearly all aspects of the work of the Department. The enthusiasm of the staff, not least among the younger inspectors, and the appreciation that this arouses is well illustrated by the following extract from a letter received from a complainant:— " Please accept my grateful and sincere thanks for all you have done on my behalf. It is indeed refreshing in this day and age to know that some people really care about others and the position they hold." 34 PUBLIC HEALTH INSPECTION A summary of the inspections and visits carried out during the year by the staff of the Environmental Health Section in given in Table 6 TABLE 6 Primary Visits Revisits Totals To investigate complaints 7,604 7,837 15,441 Offices, Shops and Railway Premises Act 2,647 3,717 6,364 Infectious disease enquiries 1,065 172 1,237 Factories Act 278 — 278 Hairdressing establishments 386 68 454 Outworkers 58 — 58 Housing clearance area schemes 341 138 479 Individual unfit properties 93 225 318 Housing reports 285 — 285 Housing Act 1969 (qualification certificates) 1,528 667 2,195 Houses in multiple occupation 5,790 10,755 16,545 Improvement grants 873 28 901 Housing Act 1957 (permitted numbers) 458 14 472 Housing Associations (conversions) 96 1 97 Long-stay immigrants 421 101 522 New drainage 662 9,097 9,759 Smoke control orders 8,911 900 9,811 Food premises 1,750 6,734 8,484 Markets, stalls and delivery vehicles 162 135 297 Food sampling 467 20 487 Pharmacy and Poisons Act 9 134 143 Caravan sites 6 138 144 Animal boarding establishments 2 2 4 Riding establishments 3 18 21 Pet shops 31 84 115 Rodent control 3,408 6,381 9,789 Disinfestation 562 — 562 Disinfection 347 — 347 Incontinent laundry service 121 4,618 4,739 Others 11,084 1,657 12,741 Totals 49,448 53,641 103,089 Table 7 gives details of the sanitary operations carried out during the year. 35 TABLE 7 Putney Central Battersea Totals Premises cleansed and repaired 120 256 365 741 Drains tested 21 13 10 44 Drains cleansed or repaired 383 506 333 1,222 Water closets cleansed, repaired or renewed 24 45 62 131 Soil pipes altered or repaired 3 2 22 27 Waste pipes provided, altered or repaired 15 20 32 67 Rainwater pipes repaired 6 14 18 38 Roofs and gutters repaired 85 138 229 452 Damp conditions otherwise remedied 60 134 196 390 Yards drained or paved 2 4 6 12 Dustbins provided 3 1 21 25 Water cisterns cleansed, covered or repaired 5 2 3 10 Water supply reinstated 19 52 62 133 Defective stoves and fireplaces remedied — 1 7 8 Animals improperly kept — 1 — 1 Accumulations of rubbish, et al removed 15 19 32 66 Smoke nuisances 17 19 16 52 Other nuisances 3 5 17 25 Totals 781 1,232 1,431 3,444 Number of preliminary notices served 174 338 465 977 Number of preliminary notices complied with 178 329 390 897 Number of abatement notices served 107 165 424 696 Number of abatement notices complied with 82 127 305 514 Legal proceedings During the year, legal proceedings were taken by the Council in 42 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 687 applications were received. 36 There were 3,619 tests made in connection with drainage installations and 36 connections made to the Council's sewers during the year. The clearance and maintenance of public sewers is the responsibility of the Council and maintenance costs are reclaimed from owners of properties connected to the public sewer. A close working liaison with the Technical Services 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. 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. Water supplies from this and other sources proved satisfactory both in quality and quantity throughout the year. All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled ; samples of water are then collected from these treated mains, and the mains are returned to service only after the analytical results are found to be satisfactory. The quality control from the Metropolitan Water Board's laboratories is carried out by means of daily sampling from the sources of supply, from the treatment works or well stations, from the distribution system and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. All dwellings in the borough, numbering approximately 127,000 and catering for a resident population of 300,530 were supplied from the mains of the Metropolitan Water Board. No houses were permanently supplied by standpipe. No artificial fluoride is added to the water supply by the Board and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. The natural fluoride content of the mains water was 0.20 parts per million. There has been no change in policy on the question of the general fluoridation of the water supply in Wandsworth. The Council has already made a decision in favour of fluoridation but the Metropolitan Water Board will take no action until all the authorities whose areas are served by the Board are similarly in favour. 37 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. Periodic visits are 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. There were six nursing homes in the Borough at the end of the year, with a total of 248 beds. Their categories and accommodation are given below together with the number of inspections made during the year :— Mental nursing homes (2) 162 beds Mother-and-baby homes (1) 17 beds Other nursing homes (3) 69 beds Inspections by medical and nursing officers 12 Inspections by public health inspectors 5 Hairdressers and barbers The provisions made under Section 21 of the Greater London (General Powers) Act, 1967, 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: 228 such premises are registered with this Authority. A total of 454 visits were made by 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. In view of the increase in the use of wigs, hairdressers and wigmakers were warned of the dangers of using benzine, carbon tetrachloride and trichloroethylene for cleaning wigs, except in the open air or in well-ventilated rooms. 38 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 pest control officer assisted by four rodent operatives. In the year under review, a work study programme was undertaken in relation to the pest control section, and as a result of the findings, all operatives are now mobile. Consequently, whereas in the past operatives were dependent upon public transport to get about their areas, they are now able to give a much more efficient and speedy service to the public. 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. During the year, 3,408 complaints of infestation were received, in respect of which a total of 9,789 visits were made by the staff. Again, more than two-thirds of these complaints related to the presence of mice, whereas those concerning rats have again decreased. This increase in the number of complaints about mice is one which is causing concern not only to this Authority but also to the Ministry of Agriculture, Fisheries and Food, and in this connection, special surveys are to be carried out in 1972 to enable the true size of the picture to be seen. Many complaints of mice have been received from new blocks of Council flats. It is fairly obvious here, however, that even one mouse travelling through the various ducts and along the various pipes connecting the flats could cause as many as 50 complaints to be received. In addition, with 50 or more tenants all stating they have seen mice, it does give the erroneous impression that the place is overrun with mice, whereas, in actual fact, the infestation is very small. In addition to the work of rodent control, the pest control officer continued to carry out evening "forays" on pigeons roosting under railway bridges in the Borough. These bridges are a favourite breeding ground and by attacking the pigeons at their roosting sites profitable results have been obtained. 980 birds and 266 eggs being taken during the year. 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. 39 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 143 persons registered under the Act. Under the Poisons Rules (No. 2) Order, 1968, the following fees to be paid by listed sellers of Part II poisons are 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 The majority of the provisions of this Act and the Regulations made thereunder are enforced by the public health inspectors. Particular attention was given during the year to secure compliance with the Oil Heater Regulations at premises selling secondhand oil heaters and to ensure that unsafe heaters were not on sale. Reports were received from the Fire Authority during the year concerning fires, some of which were caused by oil heaters that did not comply with the Regulations. Retailers were advised to offer for sale only oil heaters which bore a B.S.I, mark and specific warning notice. Attention was also paid to secondhand gas and electric fires on sale to ensure that they did comply with the Fireguard Regulations. Noise Abatement Act, 1960 During the year, 70 complaints concerning noise were received and investigated by the public health inspectors. Many of these complaints were again concerning launderettes, particularly selfoperated launderettes which are often open until a very late hour. The investigation by the inspectors in connection with these complaints has necessitated their visiting the premises in question often in the very early hours of the morning, during the evening and very 40 late at night. This type of work outside normal working hours does put a considerable burden upon the inspectorate involved. In addition, one visit to the premises is by no means enough, and investigations are often very drawn out in trying to decide whether the best practicable means have been taken to reduce the noise, at least to a reasonable level. In most cases following an informal approach by the public health inspector, offenders have willingly co-operated, but in other cases it was necessary to serve two notices to abate nuisances. Noise other than industrial noise is very difficult to deal with, as it is often of an intermittent character. For example, the sounding of chimes by ice-cream vendors after hours is an offence, but unless an inspector or the police are on the spot at the time the offence is committed, no prosecution can be taken. The Act does provide, however, for any three persons aggrieved by a noise nuisance to initiate action by complaining to the Local Authority. One summons was taken against a trader for the sounding of chimes after hours. He was fined £3 and £1 costs were awarded to the Council. I must again thank the Scientific Branch of the Greater London Council for the assistance which they have given to the inspectors during the past year in recording and making observations on various noise nuisances. Offices, Shops and Railway Premises Act, 1963 General The method of enforcement of the Act has remained unchanged during the past year. Inspections and visits have been carried out by specialist public health inspectors supported by technical assistants. The majority of premises which come within the scope of the Act receive a general inspection, and an annual call was made, in addition, to premises not previously subject to the provisions of the Act to see whether circumstances had altered to an extent which would bring them within the scope of the Act. Follow-up visits were made, when required, to deal with contraventions of the Act detected during general inspections and also in connection with special subjects such as lifts, safety or heating of premises. As a result of the inspections, many improvements were initiated and in no case was it necessary to commence legal proceedings, although in certain instances final warning letters had to be sent before compliance with the requirements of the Act was achieved. Certain occupiers will always maintain standards well above those statutorily required, but many others will only do so when required by the Council, and it is therefore essential that regular visits are made to every part of the borough by the inspectors to ensure that the requirements of the Act are always enforced. 41 Accidents During the past year, few serious accidents were reported, but too much importance cannot be attributed to one year's figures because there is a very narrow dividing line between a serious accident and a relatively minor one. There is obviously a need for occupiers and their staff to think about how accidents may be prevented and it might well be that a member of the staff at each registered premises could be a designated Safety Officer for that particular place. Cleanliness and tidiness In some premises the parts of the premises exposed to the public view are kept in an immaculate state, whereas out of the way parts, accessible only to the staff, are often drab and untidy, and whilst lighting is not inadequate in a legal sense, the overall impression is flat and dull. It must, of course, be pointed out that some of the better known supermarkets and chain stores have the same high standard in every part, whether accessible to the public or not. and it is most obvious that in premises such as these, where the welfare of the staff is looked after in every aspect, there is a happy atmosphere and the business always prospers. Warehouses It would be an advantage to staff if all warehouses could either come within the jurisdiction of the Offices, Shops and Railway Premises Act or the Factories Act and not remain outside the scope of any health, safety and welfare legislation. Working conditions in warehouses generally compare unfavourably with those in offices and shops. Some warehouses are dark and, in consequence, have permanent artificial lighting; the building may be lofty and doors often have to be left wide open or only partly closed, making the inside either very windswept or draughty and, most certainly, uncomfortable. Fork lift trucks Fork lift trucks are now being used in warehouses in increasing numbers and it has been the practice of the Council's inspectors to enquire as to what arrangements occupiers make for training drivers and to ascertain if existing operators are competent. Training courses for operators should be encouraged wherever possible. During the past year, the enforcement of the Act in this borough has proceeded in a methodical and purposeful manner and considerable improvement has again occurred in a wide variety of premises during 1971. The following table shows the classification and number of premises registered at the end of 1971, the number of persons employed and the number of inspections and other visits made during the year:— 42 TABLE 8 Class of premises Number registered Persons employed General inspections Revisits or other visits Offices 950 14,249 657 949 Retail Shops 1,850 8,308 1,812 2,652 Wholesale shops, warehouses 112 1,309 82 101 Catering ments open to the public, canteens 262 2,097 96 14 Fuel storage depots 2 38 — 1 Totals 3,176 25,901 2,647 3,717 Protection of animals The Council has 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 have been made for licences under the various Animal Protection Acts. The main Acts under which action was taken during the year are as follows:— Pet Animals Act, 1951 A pet shop may not be kept except under the authority of a licence granted in accordance with the provisions of the Act, the object of which is to regulate the sale of pet animals with particular reference to their welfare whilst being kept for sale. Thirty licences were issued by the Council during 1971. Animal Boarding Establishments Act, 1963 This Act provides that no person may keep a boarding establishment for animals (defined as cats or dogs) in the Borough except under licence. Two such licences were granted during the year. Riding Establishments Acts, 1964 and 1970 These Acts provide 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 two riding establishments were granted. Performing Animals (Regulation) Act, 1925 Visits were made both to the Battersea Festival Gardens concerning the use of performing dolphins and to Billy Smart's Circus whilst appearing at Clapham Common. 43 Rabies Order, 1938 In July a person was bitten by a dog in Battersea and a policeman called to the scene was also bitten. It was ascertained that, about six weeks previously, the same animal had bitten a small boy. The dog was taken to Battersea Dogs' Home and destroyed and the head and neck were taken away for tests by the Ministry of Agriculture, Fisheries and Food. These proved negative for rabies. Animals (Miscellaneous Provisions) Order, 1957 Under the terms of this Order, the following Orders were advertised in the National Press: — Live Poultry (Restrictions) Order, 1971. Live Poultry (Restrictions) Amendment Order, 1971. Poultry Carcasses (Landing) Order, 1971. Common lodging houses There are no registered common lodging houses in the Borough. Land Charges Act, 1925 During the year, the Department dealt with 7,979 enquiries relating to local land charges. These enquiries necessitate a careful search of records and drainage plans 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 or slum clearance areas. New legislation The following Regulations came into force during the current year:— Clean Air (Measurement of Grit and Dust from Furnaces) Regulations, 1971, on the 1st March, 1971. Clean Air (Emission of Grit and Dust from Furnaces) Regulations, 1971, on the 1st November, 1971. Food Hygiene (General) Regulations, 1970, on the 1st March, 1971. Rag Flock and Other Filling Materials Regulations, 1971, on the 3rd November, 1971. 44 HOUSING Housing Act, 1957 Clearance Areas.—Ninety-three houses were represented under Section 157 of the Housing Act, 1957 ; 44 houses were demolished following declaration of Clearance Areas under Section 42 and a further 58 following compulsory acquisition under Section 43 (2). Closing Orders.—Under Section 157 of the Act, 13 individual houses, one part of a house and 13 basements were represented for closure; six Closing Orders were made under Section 17(1) and six Closing Orders under Section 18. Under Section 27, Closing Orders were determined in respect of two houses and two basements and permission was given for three houses subject to Closing Orders to be used for storage purposes. Housing Act, 1961 Houses in multiple occupation Out of an estimated total of 12,000 houses in multiple occupation, 7,204 have now been fully inspected, 2,735 houses having been visited this year for the first time. An analysis of the register shows the occupation of the 7,204 houses to be as follows:— Occupancies: 2 3 4 5 6 78910+ No. of houses: 4,296 1,434 656 329 192 125 75 47 50 The general practice is to try to get properties in multiple occupation brought up to a standard acceptable to the Corporation by informal action. Although a considerable amount of work has been carried out by some owners voluntarily, others have not been so co-operative ; consequently it has been necessary to serve 11 notices under Section 16 of the Housing Act, 1961, requiring the provision of means of escape from fire, and five 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 198 houses being brought up to standard. In addition, in 350 instances, owners who had received either formal or informal notification that work was required reduced the number of lettings in their premises and in the 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, 19 Notices of Intention were served giving notice of the 45 Council's intention to restrict the number of occupants. Subsequently, one variation was made to a Direction Order where the owner had put in extra facilities. In five 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. Multiple occupation is a serious problem in the Borough, but due to the energetic and forthright manner in which this problem has been tackled over the last two years, it has quite obviously been contained. Work in the field of housing in multiple occupation is extremely arduous for the staff concerned. Visits frequently have to be made at night and weekends, in view of the fact that the majority of occupants are never at home in the daytime, and the inspector is often received with suspicion and even hostility on occasions. Difficulty has been, and always will be, experienced in obtaining the right staff for this type of work. Housing Act, 1969 Qualification Certificates Provided a rent controlled dwelling satisfies the qualifying conditions, a Landlord is empowered to apply to the Rent Officer for an increase in rent. The following is a summary of applications received and action taken during the year:— Section 44(2)—Where a dwelling does not have all the standard amenities:— Applications received 245 Applications withdrawn 13 Certificates of Provisional Approval issued 179 Qualification Certificates issued 99 Applications under consideration 189 Section 44(1)—Where a dwelling already satisfies the conditions:— Applications received 626 Applications withdrawn 28 Notices of Refusal to issue Qualification Certificates 187 Qualification Certificates issued 448 Applications under consideration 842 Caravan Sites and Control of Development Act, 1960 There are five licensed caravan sites containing a total of 21 dwellings in the Borough. 46 Rent Act, 1957 This Act provides, amongst other things, for the issue by the Council of certificates of disrepair to tenants of controlled dwelling houses which are considered to be in disrepair by reason of defects which ought reasonably to be remedied, having regard to the age, character and locality of the dwelling. There is also provision for the issue, by landlords, of undertakings to remedy such defects. The following is a summary of action taken in this connection during the year:— Applications for certificates of disrepair received 2 Certificates of disrepair issued 1 Undertakings received from landlords 1 Applications for cancellation of certificates of disrepair received Nil 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, 730 applications were considered for eligibility for additional points on health grounds in accordance with the Council's points scheme. A further 832 recommendations were made in respect of Council tenants who requested transfer to more suitable alternative accommodation on health grounds. The procedure whereby applicants for rehousing were advised, where appropriate, to ask their family doctors for medical certificates in support of their applications has not proved satisfactory and, following discussions with the Housing Manager and the Inner London Local Medical Committee, this system was changed in August 1971. The new arrangements provide that applicants for rehousing now state on the application form any medical reasons which may warrant priority in rehousing and also give authority for an approach to the family doctor for detailed information. Such forms are then submitted to me for assessment and enquiries made of the doctors concerned by this department where further information is needed. This procedure not only eases the demands on the family doctors for certificates in support of rehousing, but also ensures the availability of more detailed information in those cases where further investigation is indicated. 47 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 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 the public health inspectors in the Food Division. Samples of food and drugs for analysis by the Public Analyst are obtained by the public health inspectors of this division and a detailed account of this work appears later in this section of the report. The total number of food premises of all kinds on the register in the Borough is 2,307 and during 1971 they were visited on 9,411 occasions. Details of the various types of food premises will be found in Tables 9 and 10 which follow. Food Hygiene (General) Regulations, 1970 These Regulations consolidate and amend the Food Hygiene (General) Regulations 1960 and 1962, the principal changes in requirements being (i) raw food which has to be milled or refined to make it fit for human consumption is no longer outside the scope of the regulations (definition of "food", Regulation 2(1)); (ii) before food is offered for sale it must be separated from any food which is unfit for human consumption (Regulation 9(6)); (iii) animal feed must not be kept in a food room unless it is in a closed container that eliminates the risk of contamination (Regulation 9(e)); (iv) any person handling open food (food not adequately protected by wrappings, etc.) must wear clean and washable overclothing, except in specified cases (Regulation 11); (v) the business of packing or storing eggs, fruit or vegetables on farm premises is made subject to certain requirements (Regulation 33). The separate categories of trade carried on in food premises which are subject to these Regulations are shown in Table 9 which also indicates the number of premises which comply with Regulation 18, relating to the provision of washing facilities for food handlers, and Regulation 21 which requires the provision of facilities for 48 washing food and equipment. Table 10 summarises the visits paid to food premises during the year and Table 11 shows the work carried out to comply with statutory requirements. Legal proceedings: Three summonses were issued under the above Regulations as follows:— (a) Against a restaurant proprietor in respect of the condition of his premises. The Court imposed a total fine of £50 for the five offences involved. (b) Against a cafe proprietor for contraventions of the Food Hygiene Regulations. The Court imposed a total fine of £125 for the five offences involved and a sum of £10 for costs was awarded to the Council. (c) Against a restaurant proprietor in respect of the condition of his premises. The Court imposed a total fine of £85 for the five offences involved and a sum of £15 for costs was awarded to the Council. TABLE 9 PREMISES WHERE FOOD IS SOLD, STORED OR PREPARED Number No. fitted to comply with No. to which Regn. 21 No. fitted to comply with Regn. 18 applies Regn. 21 Bakehouses 27 27 27 27 Bakers and confectioners 433 410 362 251 Butchers 158 158 158 158 Chemists 43 43 43 43 Dairies and milk depots 7 7 7 7 Fish friers 58 58 58 58 Fishmongers 31 31 31 31 Food factories 21 21 21 21 Greengrocers 172 172 172 152 Grocers 415 415 415 408 Ice-cream manufacturers 14 14 14 14 Market stalls 162 — — — Off licences 131 125 31 31 Public houses 161 155 161 161 Restaurants, cafes and canteens 474 474 474 474 2,307 2,110 1,974 1,836 TABLE 10 VISITS TO FOOD PREMISES Bakehouses 155 Butchers' shops 854 Confectioners' shops 1,115 Dairies and milk depots 48 Fishmongers' shops 206 Fried-fish shops 318 Greengrocers' shops 578 Grocers' shops 1,867 Ice-cream premises 710 Market stalls 297 Restaurants, cafes and canteens 1,724 Other premises 1,539 9,411 TABLE 11 WORK COMPLETED TO COMPLY WITH STATUTORY REQUIREMENTS Wash-hand basins provided 23 Sinks provided 9 Provision of hot and cold water over sink and washhand basin 56 Accommodation for clothing provided 5 Premises repaired and redecorated 223 Dustbins provided 5 Soap, towels and nailbrushes provided 55 Floors and floor covering repaired 103 Ventilation and ventilated lobbies provided 11 Dirty equipment cleansed 65 Dirty refrigerators cleansed 17 Artificial lighting provided 19 Refuse cleared 14 Wash-hand notices provided 18 Infestation of rodents cleared 5 Yard surfaces cleansed or repaired 11 Trapped sink waste pipes provided 25 Dirty cooking ranges cleansed 4 49 50 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 supply and washing facilities. Proper disposal of waste materials. Granting of certificates of exemption from certain requirements. 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 162 food stalls in the Borough and 297 inspections were made during the year; 47 inspections were also carried out on vehicles under the above Regulations. 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 icecream 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 31 applications for registration under the provisions of Section 16(l)(a) and 15 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. Food complaints During the year 162 food complaints were received from members of the public and appropriate action was taken in every case. 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 Insects in oats £30 £5 Mouldy yoghourt £10 £2 Metal object in milk £50 £20 Nail in sliced loaf £25 £25 Filter tip in French bread £50 £5 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 47 applications were received from persons to be registered as distributors of milk. In each case a certificate of registration was granted. Eighty-nine notices of cancellation of registration were received. At the end of the year there were 211 persons and one dairy on the register. Food and Drugs Act, 1955 During the year, 100 samples of milk were submitted for analysis to which reference is made towards the end of this section of the report. 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 1971 is given below: — Special designation Number of licences issued Pasteurised 49 Sterilised 34 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 30 applications for such licences were received during the year. 51 52 Butchers' shops There are 158 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 854. Slaughter of animals There are no licensed slaughterhouses in the Borough. Poultry processing There is one establishment in the Borough at which the preparation of poultry for sale is carried out on a comparatively large scale. The birds are received from the proprietor's own farms where they have been bred, killed 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. Forty-three visits were made to the above premises during the year, the number of birds processed being approximately 200,000, made up of broilers, hens, ducks, pheasants, turkeys and capons. The percentage of birds rejected as unfit for human consumption was 0.09 and the weight of poultry condemned as unfit 560 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 89 such shops in the Borough and 524 inspections were made during the year. Catering establishments All restaurants, cafes, and canteens were regularly inspected throughout the year. There are 474 such premises on the register and 1,724 inspections were made. Bakehouses There are 27 bakehouses in the Borough and during the year 155 visits by the food inspectors were made to these premises. Five 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. 53 Bacteriological examination of food Eight hundred and fifty-six food samples were examined bacteriologically at the Public Health Laboratory during the year and details are given below : — Milk 18 Ice-cream 64 Shell-fish 749 Fish 16 Eels 9 Total 856 Milk The 12 samples of sterilised milk submitted to the turbidity test were reported to be satisfactory and six samples of pasteurised milk submitted to the methylene-blue and phosphatase test were reported to be satisfactory. Ice-cream The 64 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 33 2 11 3 6 4 14 Total 64 In every case where the sample was considered to be unsatisfactory, the manufacturer was approached with a satisfactory outcome as shown by subsequent sampling. Shell-fish, fish and eels The 774 samples of shell-fish, fish and eels were found to be satisfactory. 54 REPORT OF THE WORK OF THE PUBLIC ANALYST FOR 1971 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. During the year 1,000 samples of food and drugs were submitted for analysis; 100 samples of milk, 818 other foodstuffs and 82 drugs. Of these 10 were submitted as formal samples, whilst 990 were purchased informally. One of the formal samples and 85 of the informal samples were found to be adulterated or below standard, representing 8.6 per cent, of the total samples submitted. The samples submitted for analysis comprised the following substances:— Beers, wines and spirits 23 Beverages (cocoa, coffee, tea, etc.) 18 Cereal preparations 34 Cheese products 31 Confectionery 142 Cream 12 Fats (butter, margarine, etc.) 28 Fish (canned, etc.) 55 Fruit (canned and dried) 44 Ice-cream 26 Meat products (including sausages) 134 Milk 100 Milk products 30 Pickles and condiments (including spices) 84 Preserves 23 Soft drinks 50 Soups 17 Vegetables 67 Drugs 82 TABLE 12 SAMPLES FOUND TO BE ADULTERATED OR BELOW STANDARD Case No. Nature of Sample Report Formal 227 Informal 5497 Beef sausages Cheese spread with Excess preservative (sulphur Deficient in fat [dioxide) 5502 Prepared cuttlefish Contained non-permitted preservative 55 [####]Case No. Nature of Sample Report Informal 5503 Smoked cuttlefish Contained non-permitted preservative 5505 Baked cuttlefish Contained non-permitted preservative 5513 Lambs' tongues (canned) Labelling: should read " cured or pickled lambs' tongues " 5531 Ground marjoram High content of sand and siliceous material 5549 Beefburgers with onion Deficient in meat 5575 Dripping High acid value 5582* Cornflakes: foreign matter Dextrin 5605* Cheese spread with lobster: mouldy Mould confirmed 5606* Butter: foreign matter Mould 5612 Bufferin tablets High free salicylic acid content 5664* Cottage cheese: peculiar smell and taste Sour smell and surface mould 5665 Prepared cuttlefish Contained non-permitted preservative 5666 Smoked cuttlefish Contained non-permitted preservative 5670 Beefburgers with onion Deficient in meat 5671 Beefburgers with onion Deficient in meat 5702 Milk Excess water 5717* Cheese spread: strong flavour Very strong Camembert-like flavour 5718* Butter:" catty " odour A foreign odour confirmed 5719 Bufferin tablets High free salicylic acid content 5769* Foreign matter in sliced bread Mould confirmed 5770 Milk (Channel Islands) Labelling: incorrectly described 5782 Veal cutlet Labelling: incorrectly described 5783 Pork cutlet Labelling: incorrectly described 5791 Ice-cream Slightly deficient in non-fatty milk solids 5792 Ice-cream Slightly deficient in non-fatty milk solids 5794 Dried full-cream milk powder Slightly deficient in fat 5796 Tincture of iodine Excess iodine and potassium iodine 5808 Chopped ham Deficient in meat 5832* Part baked bread: foreign matter Mould confirmed 5844* Glass in ⅓ pint bottle of milk Glass confirmed 5864 Dried full-cream milk powder Deficient in fat 5873 Steak and kidney pie Deficient in kidney 5985 Canadian Cheddar cheese Excess moisture 5987 Cheese spread with extra butter Deficient in fat 6016* ⅓ pint of milk: contained foreign matter Blackboard chalk Case No. Nature of Sample Report Informal 6018* Sliced white bread: contained green patches Mould 6022 Table wine Labelling: labelled " Hock " only, although originating in Cyprus 6023 Dill Deficient in volatile oil 6031 Collis Brown's compound Excess morphine 6036* Milk shake mix: contained glass Glass confirmed 6039 Mixed fruit Labelling: ingredients listed in wrong order 6040 Ghiveci Labelling: ingredients listed in wrong order 6055* Butter: contained black streaks Mould 6060 Sausages Excess preservative 6075 Goats' milk Deficient in fat and non-fatty solids 6077* Bread: contained foreign body Cigarette filter tip 6094 Beef sausages Excess preservative 6100 Lamb tongues Labelling: words " in jelly " omitted from title 6103 New potatoes Labelling: should be " new potatoes in salt water " 6109 Chopped pork Labelling: should be labelled " meat with cereal " or some alternative title 6115* Milk: alleged to have caused illness Foreign substance detected, nature still under investigation 6138 Dill Deficient in volatile oil 6150* Sliced loaf: contained glass Glass confirmed 6173 Austrian smoked cheese Not labelled in accordance with Cheese Regulations 6189 Canned red peppers Labelling: ingredients not listed 6190 Canned roasted pimentos Labelling: ingredients listed in wrong order 6256 Sliced beef in jelly Deficient in meat 6260 Artichoke hearts Vitamin " C " claimed, but none found 6261 Vegetables in wine vinegar Labelling: no list of ingredients 6265* Pork sausage: foreign matter Coloured cardboard 6272 Fruit cocktail in syrup Labelling: ingredients listed in wrong order 6306* Lemonade shandy =: foreign matter Mould 6325* Milk bottle: foreign matter Mould 6329 Hamburgers Deficient in meat 6335 Fruit cocktail in syrup Labelling: several errors 6337 Sliced beef in jelly Slightly deficient in meat 6347* Sliced loaf: contained needle Needle confirmed 56 Case No. Nature of Sample Report Informal 6350 Keo Muscat (Cyprus wine) Labelling: no appropriate designation and country of origin not incorporated into name as directed by the Labelling of Food Order 6351 Saint Panteleimon, Keo Medium (Cyprus wine) ditto 6352 Bellapais (Cyprus wine) ditto 6363 Almond marzipan Deficient in oil 6383 Fruit salad Labelling: ingredients listed in wrong order 6384 Cream of tomato soup Failed to comply with the code of practice for cream soups 6388 Minced steak and onions Deficient in meat 6399* Milk bottle: foreign body Two holly leaves 6402 Almond marzipan Apparently deficient in almond 6439* Bread roll: foreign object Piece of cooked meat 6448 Marzipan Apparently deficient in almond 6451 Fruit salad Labelling: ingredients incorrectly listed 6463* Bread: foreign matter Dirty dough 6464* Frozen garden peas: foreign body Piece of pea haulm compacted by harvester 6465 Mixed fruit Infested with moth 6471 Condensed full-cream milk, sweetened Deficient in milk solids The 24 samples shown above which are marked with an asterisk (*) were complaint samples submitted by members of the public and in each case the complaint was considered justified and appropriate action was taken. A further 11 complaint samples were submitted but, following analysis, it was considered that the complaints were not justified. Details of these cases are aiven below : — TABLE 13 Case No. Nature of Complaint Report 5505 Barley wine: misleading advertisement Advertisement held not to be misleading 5519 Honey: unpleasant odour and taste Australian honey, complaint not confirmed 5573 Baby rice: unpleasant odour Not confirmed 5607 Red wine: suspected of being watered Alcohol content normal 5701 Hairs on veal: foreign matter Identified as calf hairs 6112 Tea: alleged to have caused illness No harmful ingredient detected 6113 Sugar: alleged to have caused illness No harmful ingredient detected 57 58 Case No. Nature of Complaint Report 6348 Spaghetti in tomato sauce: unpleasant grey scum complained of Complaint could not be confirmed 6397 Corned beef: flavour and smell Poor flavour 6416 Corned beef: black specks Iron sulphide stains 6462 Milk bottle: dirty No dirt found. Marks were scratches on outside of glass Milk samples During the year, 100 samples of milk were submitted for analysis (86 ordinary milk, 11 Channel Islands or South Devon milk and three sterilised milk). Of these one sample of ordinary milk and one sample of Channel Islands milk were found to be below the minimum standard and appropriate action was taken. 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% 59 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 Employment and Productivity:— Factories Act (Part I) TABLE 14 Inspections Premises Number on register Number of Inspections Written notices Occupiers prosecuted (1) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 97 10 1 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 966 264 5 — (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 43 4 — Totals 1,106 278 6 — TABLE 15 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 2 2 — 2 — (b) unsuitable or defective 12 12 — 1 (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to outwork) 2 2 — — — Totals 16 16 — 3 — 60 Factories Act (Part VIII) OUTWORK (SECTIONS 133 AND 134) TABLE 16 Nature of work Section 133 Section 134 No. of outworkers in August list required by Section 133(1)(c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel— making, etc. 73 — — — — — Curtains and furniture hangings 7 — — — — — Artificial flowers 3 — — — — — Lampshades 3 — — — — — Total 86 — — — — — 61 ATMOSPHERIC POLLUTION Clean Air Acts, 1956 and 1968 Legislation: The Clean Air (Emission of Grit and Dust from Furnaces) Regulations, 1971 The above Regulations arise from the provisions of Section 2 of the Clean Air Act, 1968, which deals with the emission of grit and dust from certain furnaces. This section empowers the making of regulations which prescribe specific limits to the quantities which may be emitted in particular cases. These Regulations prescribe limits applicable to certain furnaces, and provide that the emission of grit and dust in excess of such limits will constitute an offence. They came into force on 1st November, 1971, but their application to existing furnaces has been postponed till 1st January, 1978. The Clean Air (Measurement of Grit and Dust from Furnaces) Regulations, 1971 These Regulations, which came into operation on 1st March, 1971, re-enact the Clean Air (Measurement of Grit and Dust) Regulations. 1968, which prescribe the requirements to be observed in recording measurements of grit and dust emitted from certain furnaces, in accordance with Section 7 of the Clean Air Act. 1956. The provisions of that section have been considerably affected by Section 5 of the Clean Air Act, 1968, and, in particular, the description of furnaces to which the Regulations can apply has been extended. The 1968 Regulations have accordingly been re-enacted so that they will apply to the extended description of furnaces. Smoke Control Orders The Council's third Smoke Control Order became operative on 1st July, 1971. The fourth Smoke Control Order was due to come into force on the same date but the fuel shortages of the winter of 1970-71 caused a postponement for 12 months. The suspension of five Metropolitan Borough of Wandsworth Smoke Control Orders, owing to the winter fuel crisis, remained in force until 31st March, 1971. Supplies of solid smokeless fuels were generally adequate during the latter half of the year and such problems as arose were usually attributable to distribution difficulties rather than to actual shortage. Liaison with local merchants, who were invariably helpful, sufficed to solve without delay the few problems which arose. The Council made a fifth Smoke Control Order on 16th November, 1971, which was eventually confirmed by the Secretary of State for the Environment on 9th February, 1972. A map showing existing and proposed Smoke Control Orders is shown in this section of the report. 62 Smoke, dust and grit nuisances and observations During the year, 54 complaints were made alleging nuisances from smoke, dust or grit emitted from premises in the Borough. All received careful and sometimes prolonged investigation. Observations are also kept upon the chimneys of industrial premises in the Borough and, when necessary, appropriate action is taken. During 1971, 99 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, as far as is practicable, capable of being operated continuously without emitting smoke. Two such notifications were received during the year. Measurement of Atmospheric Pollution Daily readings of the concentration of smoke and sulphur dioxide (S02) in the atmosphere were continued during the year at the three stations in the Borough where recording apparatus is maintained. A record of these readings in microgrammes per cubic metre for the year under 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. The beneficial effect of the Clean Air Acts is reflected in these figures. Station Roof— Municipal Buildings 207 Lavender Hill Battersea Tooting Library Month—1971 Smoke S02 Smoke S02 Smoke SO2 January 68 242 83 161 82 256 February 62 342 113 325 83 185 March 88 195 56 191 58 141 April 49 132 50 157 73 248 May 32 110 49 193 35 117 June 38 94 45 147 30 130 july 31 146 49 132 28 126 August 32 67 46 119 26 92 September 45 190 40 146 50 151 October 48 158 71 162 52 167 November 49 242 85 221 75 222 December 50 297 98 269 71 201 Averages 50 151 65 185 55 170 PLATE A Covent Garden Market Development at Nine Elms— Air-testing a 21-inch concrete surface water drain: the adjacent 6-inch foul water drain is tested by a water test (see pages 6 and 33) PLATE B Covent Garden Market Development at Nine Elms—Two specially manufactured intercepting traps, 30 inches and 20 inches in diameter (see pages 6 and 33) PLATE C Home Dialysis—Installing a self-contained dialysis unit in the rear garden of a patient's house (see pages 8 and 74) PLATE D Home Dialysis—The interior of a portable home dialysis unit (see pages 8 and 74) 63 MISCELLANEOUS MATTERS Swimming baths The Corporation has three public baths which have indoor swimming pools, at Putney, Balham and Battersea, and two openair pools, at King George's Park and Tooting Bec. The open-air pool at Tooting Bec, previously owned by the Greater London Council, was transferred to the Corporation during the year. 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, 94 samples were submitted for examination and found to be satisfactory. There are open-air swimming pools at two 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. Several Inner London Education Authority's schools in the Borough have swimming baths, and during the year 92 reports were received from the Scientific Branch of the Greater London Council in respect of 13 of these baths. Satisfactory results were obtained in 88 instances; in the remaining samples there were slight deviations from normal but further tests proved satisfactory in all cases. Examination of water from artesian wells and taps Sixty-five samples were submitted for examination at the Public Health Laboratory and found to be satisfactory. 64 Coroner's Court and Mortuary Details of post-mortem examinations and inquests held at the Coroner's Court, and of bodies received into the mortuary during 1971, are set out in the following table:— TABLE 17 Details of bodies received Usual place of residence Totals Wandsworth Merton Elsewhere Unknown Post-mortem only 730 334 123 26 1,213 Post-mortem and inquest 82 36 38 7 163 Total post-mortems 812 370 161 33 1,376 Inquest only 3 1 — — 4 Total inquests 85 37 38 7 167 Total bodies received 815 371 161 33 1,380 Verdicts at Inquests held— Accidental/misadventure 48 15 21 2 86 Alcoholism 1 — — 1 2 Natural causes 5 — 1 1 7 Open verdict 4 1 4 1 10 Suicide 25 18 9 2 54 Homicide 2 3 3 — 8 TOTALS 85 37 38 7 167 In addition to the above, a further 73 inquests were held at the Coroner's Court in respect of which no bodies were actually received in the mortuary. Transportation of bodies abroad The bodies of persons dying in this country, when normally resident abroad, are sometimes transported overseas for burial. This cannot be done without a prior certificate from the Medical Officer of Health of the district in which the death has taken place to the effect that the death was not due to infectious or contagious disease, and that no recent epidemic of such disease had occurred in the district. One such certificate was issued during the year. 65 Cremation Regulations, 1930 Under these Regulations, 2,126 cremations were authorized during the year. 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 occupier that a thorough "spring cleaning" of the room is a very effective "disinfection" process, and should be carried out in addition to the work of disinfection by the Council's staff. Bedding and clothing are collected and steam-treated at the Disinfecting 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 Three hundred and eighty-three treatments were given during the year at the two personal cleansing stations to persons suffering from scabies, 122 to adults, 228 to schoolchildren and 33 to children under school age. In addition, 692 treatments for verminous conditions were given, 78 to adults, 557 to schoolchildren and 57 to children under school age. 66 In addition, the following treatments were carried out under arrangements made with the London Borough of Lambeth relating to their residents and children attending schools in Lambeth:— Adults and pre-school children School children Total Scabies 47 55 102 Vermin 37 38 75 Laundry service for incontinent persons During the year, 4,739 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. STAFF TRAINING Public Health Inspectors, Technical Assistants and Students The Council provides facilities for public health inspectors and technical assistants to undertake refresher courses and to attend conferences and courses relevant to their work. In 1971 the following courses were attended :— A fire prevention course by three public health inspectors; A course arranged by the Coal Utilisation Council for local authority personnel by three student public health inspectors; A rodent control course organized by the Ministry of Agriculture, Fisheries and Food by three student public health inspectors and the disinfecting station superintendent; A senior officers' management course by the Chief Public Health Inspector; A noise course by one public health inspector; A two-day symposium on food control by two public health inspectors; A one-day symposium on salt-glazed pipes by the senior technical assistant (drainage); A weekend school by two public health inspectors. In addition, the Annual Conference of the Association of Public Health Inspectors at Eastbourne was attended by a divisional public health inspector, and the public health inspector in charge of the Offices and Shops section attended the Annual Conference for Shops Acts Administrators. Student Public Health Inspectors Under the limits imposed by the Public Health Inspectors' Education Board, six students are allowed to undertake training 67 within the department. They attend day release courses at the South-East London Day College and the Tottenham Technical College combined with a full programme of visits and practical training with a qualified inspector. Four students were in training in the department at the close of the year. 68 PART 5 PERSONAL HEALTH SERVICES These services are provided by the Council, in its capacity as local health authority, under those sections of the National Health Service Acts and the Health Services and Public Health Act, 1968, which are designed to safeguard the health of the individual and to provide care and attention should ill-health occur. Comprehensive health centres In May 1967, the Health Committee considered a report on the premises then in use for the provision of Local Health Authority Services and approved a provisional programme for the replacement of existing sub-standard or unsuitable premises. It was also agreed that where new clinic premises were to be constructed these should, as far as possible, be planned as comprehensive health centres and the Medical Officer of Health was authorised to enter into discussions with the Inner London Executive Council on the provision of Executive Council facilities at these centres, as and when the planning of new centres took place. When suitable sites have become available, therefore, discussions have ensued with the Executive Council and with any interested general practitioners, as a result of which, at the end of 1971, three health centres were in an advanced stage of planning and the initial preparatory meetings had taken place in respect of a fourth. Details of these centres are as follows:— 1. Bridge Lane Health Centre. This will be in the Home Road (No. 2) Development Area and will be located at the junction of Banbury Road. Battersea Bridge Road and Bridge Lane, S.W.11. Accommodation will be provided for four general practitioners and for a full range of local health authority services. In addition facilities will be provided for a Mobile X-ray Unit to operate at the site as and when necessary. It is hoped that the centre will be operational in the early part of 1974. 2. Brocklebank Health Centre. This centre will be part of the Brocklebank redevelopment project and will be located on the Garratt Lane frontage adjacent to the junction with Swaffield Road, S.W.18. Accommodation will be provided for five general practitioners; for a full range 69 of local health authority services; and for school health service specialist medical and dental services. It is anticipated that the centre will be operational about the middle of 1974. 3. Larch Road Health Centre. This centre will be part of the Larch Road development area and will be located at the junction of Bedford Hill and Elmfield Road, S.W.17. It will provide for five general practitioners: for a full range of local health authority services; and for a school health service dental suite. As with the Bridge Lane centre facilities will also be available for a mobile X-ray unit to operate from the centre as and when necessary. It is anticipated that this centre also will be operational in the early part of 1974. 4. Burtop Road Health Centre. This centre will be part of the Burtop Road redevelopment and will be located at the junction of Garratt Lane and Maskell Road, S.W.17. Accommodation will be provided for two general practitioners and for a full range of local health authority services. The preliminary planning of this centre commenced late in 1971 and no indication is yet available of its completion date. In noting the pleasing progress that has been made in the planning of health centres, I welcome the opportunity to record my appreciation of the excellent co-operation we have enjoyed in our discussions with the general practitioners concerned, the Inner London Executive Council and the staff of the Borough Architect's Department on the many points of detail involved. The enthusiasm and hard work of all concerned, including the relevant staff in the Health Department has ensured that the planning of these centres —a new venture so far as Wandsworth is concerned—has been both smooth and comprehensive. Community nursing service The community nursing service has been involved in considerable change during the year. The community nursing staff were responsible for and much involved with the day care service for children under five years of age and the home help service. Following the setting-up of the Social Services Department, much discussion took place between the staff of the two departments as to the precedures for handing over and future collaboration concerning these two services. The home help service was passed to the Social Services Department in April, the day care service was divided into two separate parts for the purpose of handing over; local authority day nurseries passed to the Social Services Department in May and daily minding, private day nurseries and playgroups in October. 70 The Mayston Structure of Management, as mentioned earlier in this report, was introduced in October, which brought about the complete reorganisation of the management of the nursing division. Managerial skills are scarce and must be deployed economically within a carefully planned line structure, adequate delegation being essential if the services are to be operated effectively. To this end three levels of nursing management—top, middle and first line— were introduced. A Chief Nursing Officer was appointed to co-ordinate the health visiting, home nursing, school nursing and domiciliary midwifery services, thus providing a single channel of communication to the Medical Officer of Health. Three middle managers were appointed, two to operate within a geographical area in respect of health visiting, home nursing and the school nursing service, all exercising programming and personnel functions, the major content of their work being operational. The third middle manager is responsible for health education and training arrangements within the division. The first line manager's chief function is to co-ordinate the work of a group of basic field workers within their own discipline. Finally, it says much for the staff that the reorganisation was implemented without decline of quality or quantity of service to the community. A research project involving the field trial of a new oral poliomyelitis vaccine was satisfactorily completed in October. In all. a total of 150 children received the new vaccine and 300 blood samples were collected in order to assess the efficacy of this new product. This was a good example of a collective community nursing effort. Health visiting service During 1971, we were most fortunate to have a full establishment of health visitors. The nine student health visitors were successful in their final examinations and eight were appointed to the staff in September. A health visitor from Tooting Child Health Centre was "attached" to a group practice of two doctors. The health visitor undertakes all the health visiting work of the practice and visits the surgery regularly. It is intended that in the near future the health visitor will have her office in the surgery premises and so be freely available to patients attending the surgery. The family unit benefits considerably from the health visitor's wide knowledge gained through a close working relationship with general practitioners, and age groups not previously well-known to the health visitor are constituting an important part of her work. Discussions are taking place with other doctors and it is anticipated that more attachment schemes will be introduced in the near future. 71 An evening child health clinic was commenced at Tooting Child Health Centre. This clinic offers similar facilities to the daytime clinics and gives a service to those mothers unable to attend daytime sessions by reason of domestic commitments or because they are at work. Much of the work of the health visitors is concerned with the care of young children and, although the provision and responsibility for the day care service has been passed to the Social Services Department, this has not reduced the health visitors' involvement and all health visitors have established close links with the social workers involved in this work. The number of first visits made during the year to children under five years of age was:— Children born in 1971 4,943 Children born in 1970 3,820 Children born in 1966/69 10,760 Total visits of all kinds paid by health visitors during the year:— Effective visits 58,243 Unsuccessful visits 16.667 Total visits to the elderly 1,464 Domiciliary midwifery service The decline in the number of home confinements has continued. 347 patients have been delivered by the domiciliary midwives, 87 of these confinements taking place in the General Practitioner Obstetric Unit at the Weir Hospital. The early discharge scheme has continued; all hospitals offering maternity service to the residents of Wandsworth now use this service and a total of 750 patients have been nursed in their own homes following hospital confinements. The Educational Supervisor of the Central Midwives Board visited Wandsworth in July and reported that the standard of teaching of pupil midwives and the domiciliary midwifery service was satisfactory. There has been close co-operation with St. George's Hospital, Tooting, by the Wandsworth domiciliary midwives. In September, it was arranged that a midwife should attend an ante-natal clinic each week to be available for consultation with those patients requesting discharge 48 hours after confinement. This close cooperation between the two services ensures a full exchange of information and a continuity of care for patients. There are now five midwives attending general practitioner antenatal clinics. The midwives assist in the examination and advising of all patients attending these general practitioners for routine antenatal care. 72 The midwives have taken 1,122 blood specimens for the Guthrie test. This blood test is carried out on babies delivered at home or discharged after 48 hours, or on babies whose previous tests have shown doubtful results. Mothers attended in their own homes during the year were as follows:— Home confinements 347 Booked early discharges 417 Unbooked early discharges 333 Home nursing service This service has seen considerable changes in its contribution to community care. Whilst initially the requirement was for simple nursing care, the recent tremendous changes in medicine have brought about significant changes in the role of the nurse. The home nurse is now required to carry out more complex forms of treatment. Necessarily she must be prepared to accept more responsibility than her hospital colleague since, although she works under the direction of a general practitioner, medical aid is not so readily available to her as it is in hospital. The home nurse therefore is trained and acknowledged to be an expert in in her own field of nursing and her expertise should be used in full. To this end we have in the service three grades of staff:— District Nurse (State Registered Nurse). District Nurse (State Enrolled Nurse). Nursing Auxiliary—no formal training (formerly known as bathing attendants). The home nursing service is available to all members of the community, regardless of age, who are under treatment at home for an illness not requiring admission to hospital, or who have been discharged from hospital to complete their recovery at home. For the first time the home nursing service was requested by a renal dialysis unit to provide nursing care for patients undertaking their own dialysis at home. This is a highly specialised field of nursing not usually included in training given to student nurses. To ensure that a high standard of care could be given to the patients and because the patient and the nurse do not have such ready access to medical help, it was arranged that a five-day course of training in a renal dialysis unit should be made available for all the nurses involved, and five nurses undertook the training. It was encouraging to all that, as a result of the close co-operation between the hospital and the home nursing service, one particular patient who had experienced considerable difficulty was able to be maintained at home and subsequently had a successful kidney transplant. 73 Three home nurses are fully " attached " to general practitioner practices and two home nurses are working in liaison schemes. Discussions are taking place with other general practitioners and it is anticipated that more attachment schemes will be introduced in the coming year. The following table shows the total number of persons nursed and the visits paid during the year: — TABLE 18 Age First visits Revisits Totals Under five years 36 286 322 5-64 years 844 22,544 23,388 65 years and over 1,638 98,305 99,943 All ages 2,518 121,135 123.653 Home bathing service The designation of home bathing attendants has been changed to that of nursing auxiliaries and this service is now fully integrated with that of the home nursing service. All patients attended by the nursing auxiliaries are routinely visited by the home nurses and the nursing auxiliaries work under the direction of the home nurses. Loan of equipment To ensure the efficient nursing of patients in their own homes the Council operates a scheme for lending, without charge, equipment as distinct from those items which can be prescribed by general practitioners. To avoid duplication of function by the Health Department and the Social Services Department, arrangements were made for the latter department to control all issues of equipment normally provided to handicapped persons. The number of occasions on which articles were issued on loan by the Health Department during the year is shown below :— Air rings 12 Beds (hospital or cot) 12 Back rests 19 Bed cradles 17 Fracture boards 12 Hoists 21 Mattresses 16 Ripple beds 14 Rubber sheeting 2 The Council's provision of home nursing equipment is supplemented by the British Red Cross Society, which provides commodes and wheelchairs and 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. 74 Incontinence pads service The issue of incontinence pads, which are of great assistance in the nursing of incontinent persons in their own homes continues and 132,000 pads were issued during the year. In addition, 46,400 interliners were issued for use in special protective pants provided by the Council. Protective pants and interliners are of particular value to ambulant patients, including subnormal and handicapped children. Most households make their own arrangements for disposal of incontinence pads and interliners, but in some cases it is necessary to arrange collection and disposal by incineration. Home dialysis When, because of illness or other reason, a person's kidneys fail to carry out their task of eradicating waste products from the blood, the result normally is death from a condition known as uraemia. In such cases of kidney damage, however, it is now possible to alleviate the effects of the malfunction of the kidneys by renal dialysis, namely, the extracorporeal circulation of the blood through a special machine known as a dialysis unit or " artificial kidney ". In the early days of renal dialysis, this treatment was carried out only in hospital under medical and nursing supervision, but dialysis units have been developed, which, with appropriate training, the patient can use at home, and there is an increasing tendency to discharge patients from hospital and provide the dialysis at home. Whilst this has the advantage of releasing much needed hospital beds and obviates the necessity for the patient to travel to and from hospital for dialysis, and, of course, remain in the hospital while the treatment is carried out, it nevertheless does mean that special arrangements must be made at the patient's home for this treatment. Wherever possible, patients are trained to be totally independent in undertaking the whole of the dialysing procedures. In circumstances where this is not possible and patients require help with dialysing and/or the " building " of the artificial kidney, assistance is provided by those members of the home nursing service who have been specially trained to undertake these procedures. To enable a patient to undertake home dialysis, it is necessary that the dialysis unit be installed in a specially adapted room set aside for this purpose. The walls and floor of the room should be covered with some impervious material, so that they may be easily washed down, and a sink with hot and cold water supplies, a water softener and certain standard and special electrical sockets are needed, among other things. Whilst it is accepted that the provision of the actual machine is the responsiblity of the hospital concerned, the adaptations to the room necessary to the installation of the machine are regarded as the responsibility of the local health authority for the area where the patient resides. 75 The adaptations at the patient's home are carried out to the specification of the hospital concerned, although the pattern is largely standard, and the provision may be by adapting an existing room or by providing an extra room to be used solely for this purpose. This was necessary in one case in 1971, where a selfcontained unit was installed in the rear garden of the patient's house and the photographs shown in the centre pages of this report (Plates C and D) show this installation in progress and the interior of the unit. Before 1971, conversions had been undertaken by this Authority in two homes, and during that year three further cases were completed and four more were initiated. The average cost per case was £1.186, although the cost varied considerably from case to case according to the special problems associated with each. Table 19 below gives details of the three cases completed in 1971, and Table 20 shows cases where action was initiated during the year for proposed completion in 1972:— TABLE 19 Hospital Date of completion of adaptations Cost Fulham February 1971 £739.86 Lambeth April 1971 £1,040.29 Fulham October 1971 £1,778.87 (portable unit provided) TABLE 20 Hospital Estimated cost Fulham £1,015 London £950 St. Helier £850 Fulham £1,000 76 Family planning Our Borough has taken a leading part in implementing the 1967 National Health Service (Family Planning) Act and the service provided to those who live or work in Wandsworth has continued to grow steadily. Throughout the year we have enjoyed excellent communications with hospital consultants, general practitioners and with the neighbouring boroughs of Merton, Richmond and Lambeth, with whom reciprocal arrangements are in force. As in previous years, the South-West London Branch of the Family Planning Association has acted as the agent of the Council in operating the clinics held in our maternal and child health centres and on hospital premises. There is no charge for consultation or medical supplies for patients recommended on medical grounds and patients referred on social grounds pay only for supplies although in cases of economic difficulty supplies may be given free of charge. Further expansion of the service took place in 1971, three new weekly sessions being provided at the Fairfield. St. Christopher's and Stormont Centres respectively. These augmented the fifteen sessions already held each week in Wandsworth—ten at our maternal and child health centres and five in a hospital setting (at St. James', Balham, and Queen Mary's, Roehampton). Oral contraceptives remain the most popular form of birth control prescribed. In the course of the year, 3,336 new patients were seen, an appreciable increase on the comparable figure for 1970 (2,729). The total attendances increased similarly from 17,023 in 1970 to 20,318 in 1971. In marked contrast the number of domiciliary patients declined from 194 to 154—reflecting the increasing success of the domiciliary family planning team in weaning from home to clinic, so to speak. This key domiciliary service is fully comprehensive, free of charge, and easily available. Any doctor, health visitor, social worker or probation officer can recommend that the domiciliary service be given and every case receives prompt attention. Wandsworth ranks high amongst local health authorities in terms of per capita expenditure on family planning and the record of steady expansion in this field reflects most creditably on the quality of service provided by the Family Planning Association doctors and the other members of their teams. In this connection our special thanks are due to Mrs. CramptonSmith. the Organising Secretary, Dr. Duncan-Whyte, Dr. Edge and all the nurses and clerical staff of the Family Planning Association. 77 Our future plans include the opening of a family planning clinic (to be operated on our behalf by the Family Planning Association) at St. George's Hospital, Tooting, subject to the agreement of the Board of Governors. Discussions to this end were in progress at the end of the year. Allowance for appreciable further expansion has been made in the 1972/73 budget since family planning and the quality of domestic life are closely related. Close liaison with family doctors and hospital obstetricians and gynaecologists is essential if timely advice is to be given to all mothers who have recently been delivered and to those whose pregnancies have had to be terminated. The avoidance of unwanted pregnancies and the reduction in the number of abortions is wholly in the interests of the public health. Even more important in the years ahead must be the expansion of our health education programme in secondary schools so that every boy and girl is fully acquainted with the biological facts of life set in the wider context of human relationships and thus of personal and civic responsibility. The statistical analysis which follows (Tables 21 and 22) shows the number of patients who were helped and the methods of contraception which were chosen. TABLE 21 New patients seen :— 1971 1970 Medical 220 62 Social 3,116 2.667 Totals 3,336 2,729 Contraceptive methods advised :— Sheath 66 — Oral contraceptive 2,074 — Diaphragm 493 — Intra-uterine device 519 368 Other methods 52 2,361 No method advised 132 — Established patients attending for first time during the year 4,909 4,074 Number of attendances (including new patients) 20,318 17,023 Number of premises in use as family planning clinics at end of year 8 7 Number of sessions held 1.162 930 78 TABLE 22 Domiciliary Service 1971 1970 1971 1970 New cases Pregnant on referral (advised or for advice after delivery) 14 11 Medical 14 18 Social 140 176 Totals 154 194 Number of children on referral Termination of pregnancy 4 5 1 13 16 Cervical smears taken 50 55 2 31 34 3 40 55 First method chosen: Intra-uterine device 57 67 4 23 33 5 16 21 6 13 16 Oral contraceptive 60 77 7 18 19 Cap 5 10 Age of mot referral Sheath, etc. 10 12 Advice 22 28 16-20 29 26 Total visits made by doctors ... 857 967 21-24 33 47 25-29 44 67 30-35 25 28 Total visits made by nurses 1.832 2.007 35+ 23 26 Unplanned Dree nancies Intra-uterine device 5 4 Total number of patients seen by doctors 407 446 Oral contraceptive 8 7 Cap 1 1 Sheath, etc. 6 12 20 24 1971 1970 Withdrawn from domiciliary service : Transferred to local clinics 55 78 Left district, transferred where possible 40 35 Transferred to other domiciliary services 26 11 Discharged (e.g. to care of G.P., gynaecologist, etc.) 11 15 Refused advice 1 2 Termination and sterilisation 8 7 Sterilisation—female 20 12 Vasectomy 3 7 Totals 164 167 Total number of patients referred since April, 1967—873. Number of patients being advised at 31st December, 1971—374. 79 Cervical cytology 1971 was the sixth consecutive year of a comprehensive cervical cytology service available to all women of vulnerable age residing or working in the Borough. Our clinics continued to be well attended and in all 2,533 women were examined compared with 2,352 in the previous year. The average number of eight patients who were seen at each session gave the doctor sufficient time for obtaining a good history of previous health, and carrying out a full gynaecological and breast examination. It also allowed for general health counselling. The women doctors in charge of the clinics are experienced in gynaecology and obstetrics and in particular are concerned with the preventive aspect of the work. They initiate the follow-up of those women whose clinical or cytological findings are suggestive of disease or disorder of the genital and reproductive organs, and this entails close liaison with hospital specialists on the one hand and general practitioners on the other. Some general practitioners in the borough prefer to provide a cervical cytology service themselves, but the majority advise and encourage their patients to attend the Council's clinics. During the year, approximately four women in every thousand screened were found to have a positive cervical smear. Once again the detection of minor but nonetheless frequently troublesome infections or abnormalities proved an important by-product of cervical cytological screening, such conditions being present in almost exactly one-third of the women who attended the clinics in 1971. The value of routine palpation of the breasts is illustrated by the discovery of three cases of mammary cancer; in addition much anxiety regarding the possible presence of a malignant growth is relieved, particularly in those women who have a family history of breast cancer. The detailed statistical information for 1971 is given in the following table :— TABLE 23 Number of clinics held each week 6 Total number of women examined 2,533 Total number of sessions held 310 Average number of women examined at each session 8 Total number of cases cytologically and clinically negative (healthy women) 1,661 Total number of cases with morbid conditions 872 80 Morbid conditions found:— (i) positive malignant smears 11 (ii) cervical erosion 155 (iii) cervicitis 47 (iv) cervical polyp 76 (v) ovarian cyst 8 (vi) uterine fibroids 33 (vii) all degrees of prolapse 21 (viii) breast tumours 44 (ix) vulvo-vaginitis:— (a) monilia 66 (b) trichomoniasis 71 (c) non-specific 124 (d) other 46 (x) other conditions 342 Total morbid conditions *1,044 * Some patients had more than one condition. Ante-natal and post-natal care The clinics for ante-natal and post-natal care are now largely conducted by the midwives, and medical officers are present at only approximately 20% of these sessions. For the first time in three years there was an increase in the number of mothers attending the clinics, as the following figures demonstrate :— Number of sessions attended by doctors 109 Number of sessions attended by midwives only 389 Number of women attending for ante-natal care 2,037 Number of women attending for post-natal care 16 Total attendances 2,394 Mothercraft and relaxation classes Relaxation classes and talks on mothercraft are held at eight centres. The teaching is a combined operation, both health visitors and midwives being involved in the talks, demonstrations and films that are shown. These classes continue to be popular with the mothers. Details are as follows :— Sessions held during the year 89 Number of mothers attending 162 Total attendances 587 Average attendance per session 6.6 81 Premature infants During 1971 the proportion of premature births was similar to that of previous years. Out of the total of 4,892 live births in Wandsworth, 383 babies were born prematurely. In addition there were 28 premature stillbirths. The table below gives details of premature births in Wandsworth :— TABLE 24 Live births Died under 1 month Stillbirths 2 lb. 3 oz. or less 11 8 7 Over 2 lb. 3 oz. up to and including 3 lb. 4 oz. 31 15 5 Over 3 lb. 4 oz. up to and including 4 lb. 6 oz. 47 3 9 Over 4 lb. 6 oz. up to and including 4 lb. 15 oz. 94 1 Over 4 lb. 15 oz. up to and including 5 lb. 8 oz. 200 2 6 Totals 383 28 28 Child health clinics During the year, the clinics at St. Peter's Hall, Beechcroft Road, S.W.I7, and at St. Michael's Hall, Merton Road, S.W.I8, were closed and replaced by sessions at the Gatton Centre, Gatton Road, S.W.17, and at the King George's Park Sports Centre, Burr Road, S.W.I8, respectively. Statistics in relation to child health sessions are shown below :— Number of sessions held during the year 2,217 Number of children attending : — Born 1971 4,019 Born 1970 3,837 Born 1966-69 4,596 Total number of children attending 12,452 Total attendances 60,818 Average attendance per session 27.4 82 Occasional creches These creches are provided for the children of mothers who are attending a clinic or class on the premises and they also give occasional relief to mothers who for various reasons, such as visits to hospitals, shopping, laundering and other domestic duties, wish to be relieved of their young children for two or three hours during the day. In addition, they provide an opportunity for an only child to mix with children of similar age. The three-hour sessions are extremely popular, but the recruitment of staff continues to be a problem. Developmental assessment and assessment clinics The concept of early identification of handicap by periodic developmental screening of all young children has its logical counterpart in the provision of special clinics where further investigation, treatment and comprehensive care can be initiated. The exact localisation of assessment clinics, that is whether they should be attached to a hospital, a special school, or run by the local authority is immaterial—such divisions are artificial. What is essential is that hospital specialists, family doctors and those working in community paediatrics, teachers working in special schools or therapists in specialised departments should combine in their efforts to see the child as a whole, for only then is it possible to offer constructive advice to the parents and plan realistically for the child's future. With this in mind during 1971, closer links have been established with the Paediatric Departments of the hospitals associated with the Wandsworth area. Senior doctors from the hospitals are now undertaking clinical sessions at the child health centres whilst local authority doctors experienced in developmental paediatrics have become part of the team helping to assess handicapped children either in hospital or in special sessions held in local authority clinics. At present the following arrangements are in existence:— St. James' Hospital, Balham Weekly attendance by a local authority doctor for the purpose of helping to assess handicapped children. St. George's Hospital, Tooting Weekly attachment of a Principal Medical Officer to the assessment clinic. This clinic is held twice a month at St. George's Hospital, and once a month at Tooting Child Health Centre and Braidwood Audiology Unit respectively. A Paediatric Registrar undertakes a weekly clinical session in the Tooting Child Health Centre. 83 Queen Mary's, Roehampton A medical officer attends the Paediatric Department twice weekly to help in the assessment of children attending the Cerebral Palsy Unit. A Paediatric Registrar undertakes two weekly clinical sessions in local authority child health centres. Further association with the Paediatric Departments of these hospitals is in the planning stage. The recognition that the assessment of a handicapped child is but the beginning of an on-going process of planning for his follow-up, both immediate and long-term and requiring the specialist knowledge of the hospital paediatrician and the doctor familiar with the facilities in the community, is one of the most important facets of child care today. Medical students, hospital nurses and administrative staff continue to attend the local authority clinics and schools to gain experience of the facilities which cater for all children who live in the community. Handicap and observation register For the past six years a comprehensive register of handicapped children and of children at risk of developing a handicap has been kept in the Health Department. It has proved a most useful statistical guide but more important it has continued to alert us to the value of the early detection and treatment of defects. In 1971, 1,366 children under the age of five were included in the Register out of a total pre-school population of about 25,000. All children on the Register are examined regularly for defects and developmental screening tests are carried out periodically. The completeness of the register depends on co-operative effort. Throughout the year the collaboration of all concerned, that is, clinic doctors, hospital specialists, general practitioners and others, has been excellent and the exchange of information has made it possible to follow-up handicapped children in the Borough on a selective basis. Many of the children who are under the supervision of the Social Services Department are also placed on the register for, even when not handicapped physically or mentally, they may be considered to be socially deprived and at risk of being disturbed emotionally. The development of the closer liaison with hospital paediatric departments already mentioned cannot help but benefit the service provided for handicapped children. 84 The table below gives the figures concerning handicapped children under five years of age: — TABLE 25 Number on handicap and observation register on 31st December, 1971 1,366 Ages Handicap Observation Totals Under 1 year 27 419 446 1 year 41 272 313 2 years 48 176 224 3 years 79 126 205 4 years 94 84 178 Totals 289 1,077 1,366 Number of children on the register on 1st January, 1971 1,091 Number placed on the register during 1971 905 Number removed from the register during 1971 630 Number placed on the register within three months of birth 305 Notification (to the Registrar General) of congenital malformations observable at birth in live and stillborn children:— Central nervous system 11 Eye and ear 1 Alimentary system 11 Heart and great vessels 1 Respiratory system 1 Urino-genital system 7 Limbs 40 Other parts of the musculo-skeletal system 4 Other systems 1 Other malformations 9 Total malformations 86 (in 71 children) Serious handicaps in children under five years:— Number deat with during 1971 Number born in 1971 and placed on register Mongol 26 4 Hydrocephalus/Spina bifida 24 3 Congenital heart disease 26 4 Fibrocystic disease 6 1 Partially-sighted and blind 16 5 Deaf 12 Chronic metabolic 10 3 Epilepsy 26 1 Blood disease 20 2 Autistic / psychotic 2 Cerebral palsy/spastic 30 3 85 Provision of physiotherapy at Summerley Special Care Unit Following discussion between the Health Department and St. George's Hospital, Tooting, it was agreed that a physiotherapist from the Paediatric Department should attend the Special Care Unit at Summerley Street Day Nursery on a weekly basis commencing February 1971, for a trial period of six months. The Unit admits up to eight children at a time, most of whom are severely physically handicapped and require physiotherapy. In addition to carrying out actual treatment, the physiotherapist was able to advise the nursery staff on how to handle the children in order to prevent or mitigate the appearance of secondary handicaps. Attention was drawn to means whereby opportunity could be provided to enable the children to achieve their maximum potential and numerous practical improvements such as the provision of suitable chairs, tables, toilet fittings and toys were introduced. The association has been of the greatest benefit and has proved to be a very practical link between the hospital and local authority. It has demonstrated beyond doubt that there is a need for an extension of the service to other handicapped children in the community. Day nurseries and child-minders With the passing of the Health Services and Public Health Act, 1968, responsibility for the supervision of day nurseries and childminders was transferred to the Director of Social Services. This changeover was carried out in two stages, the responsibility for the Council's day nurseries being handed over to the new Department in May 1971, whilst the registration and supervision of private day nurseries and child-minders was transferred in the following October. The medical officers of the Health Department continue to visit the Council's day nurseries for routine and special examinations of the children attending and in particular to offer advice on the problems of those who are handicapped. The registration of child-minders, playgroups and private day nurseries continued to make heavy demands on the staff of the community nursing service. A total of 339 new applications were received, 281 were withdrawn and 36 applications were cancelled. Considerable time was given advising applicants wishing to be registered as to the requirements of the amendments contained in the Health Services and Public Health Act, 1968. There was an additional burden of work in that all those persons previously registered had to be advised as to the arrangements taking place later in the year when the Social Services Department would become responsible for their continuing registration and supervision. 86 The responsibility for the daily minding, playgroup and private day nurseries service was passed to the Social Services Department in October and for one entire week after the handing-over the Principal Nursing Officer who had previously been engaged fulltime on this work was available to any member of the Social Services Department for advice concerning this aspect of work. During the nine months from January to the beginning of October, 65 child-minders and two private day nurseries were registered. A further 39 completed files were passed to the Social Services Department for the issue of registration certificates. Adoption and boarding out The advice of the medical staff continues to be sought in appropriate cases by the Director of Social Services on health aspects of children under consideration for adoption ; during the year 24 such cases were submitted. Similar inquiries are made when necessary in respect of prospective adopters and of children who need to be boarded-out. Home help service This important service was transferred to the newly-created Social Services Department in April and all the staff concerned took with them the best wishes of their colleagues in the Health Department. Immunisation and vaccination One of the significant events of the year was the ending of routine vaccination of young children against smallpox. The Joint Vaccination and Immunisation Sub-committee of the Central Health Services Council came to the conclusion that the chances of the introduction of smallpox into Britain had substantially diminished and that the public were therefore far less likely to be exposed to infection with smallpox than at any previous time since the disease was first recorded in this country. Vaccination continues to be a safe and reliable method of protection against smallpox for the vast majority of persons but the number of serious complications in childhood, though few, is out of proportion to the risk to them from smallpox in Britain. Although vaccination against smallpox is not now recommended as a routine procedure in early childhood it is important that travellers to and from areas of the world where smallpox is endemic, or countries where eradication programmes are in progress, should be protected by recent vaccination. This is equally true of doctors, nurses, public health inspectors and other health service staff who may be exposed to the risk of infection in the course of their work. 87 There has been little change in the pattern of prophylaxis carried out in Wandsworth, most immunisations being given by the Council's whole-time or sessional medical staff. The medical and nursing staff take every opportunity to persuade parents of the importance of keeping children fully protected against those diseases for which protection is recommended. It appears that the slow decline in completed primary courses, which I mentioned last year, has not yet been halted ; but the level of protection in the community still remains adequate. Nonetheless, there are no grounds for complacency. Efforts continued to ensure that all children under 16 years of age should be vaccinated against measles unless there were contraindications but at the end of the year there was still a long way to go. It is hoped that during the next few years measles can become as rare as diphtheria but this cannot happen unless even more parents co-operate by having their children protected. Good progress was made with the vaccination against rubella of girls aged from eleven to thirteen. The great majority of vaccinations against rubella and measles take place in schools, thanks to the help and co-operation of the head teachers and their staffs. TABLE 26 Immunisation and vaccination statistics for children under 16 years Number of completed cases (Note—Although diphtheria, whooping cough and tetanus are shown separately, most children receive combined antigens which enable protection against two or three diseases to be given in only three injections.) 1971 1970 Smallpox vaccination : Primary vaccinations : Council clinics 1,340 1,806 General practitioners 587 750 Total 1,927 2.556 Revaccinations : Council clinics 43 223 General practitioners 370 400 Total 413 623 Diphtheria immunisation: Primary courses : Council clinics and schools 3,527 3,555 General practitioners 1,029 948 Total 4,556 4,503 88 Reinforcing injections: Council clinics and schools 4,903 5,272 General practitioners 1,492 1,511 Total 6,395 6,783 Whooping-cough immunisation: Primarv courses : Council clinics and schools 3,253 3,226 General practitioners 950 890 Total 4,203 4,116 Reinforcing injections: Council clinics and schools 1,992 1,735 General practitioners 701 695 Total 2,693 2,430 Tetanus immunisation: Primary courses: Council clinics and schools 3,618 3,817 General practitioners 1,104 1,031 Total 4,722 4,848 Reinforcing injections: Council clinics and schools 4,883 4,714 General practitioners 1,565 1,600 Total 6,448 6,314 Poliomyelitis vaccination : Primary courses: Council clinics and schools 3,515 3,543 General practitioners 915 945 Total 4,430 4,488 Reinforcing doses: Council clinics and schools 4,958 4,896 General practitioners 1,362 1,335 Total 6,320 6,231 Measles vaccination : Council clinics and schools 2,503 2,970 General practitioners 648 733 Total 3,151 3,703 Rubella vaccination : Council clinics and schools 3,760 148 General practitioners 58 3 Total 3,818 151 89 Dental service A dental service for expectant and nursing mothers and for preschool children is provided in conjunction with the school dental service. During the year there was a total of 671 visits by preschool children during which 686 fillings were provided and 51 visits by mothers, 53 fillings being provided. A combined total of 262 courses of treatment were completed. Chiropody service A. E. Trenter, M.Ch.S., S.R.Ch., M.R.S.H.—Chief Chiropodist. Chiropody services are available to expectant and nursing mothers, schoolchildren, the physically handicapped and persons of pensionable age, treatment being available at twelve clinics in various parts of the Borough. The service is also available in nine homes for old people run by the Council, eight voluntary service homes, three private homes, one nursing home and in the surgeries of private chiropodists acting on behalf of the Council; and last but not least there is an extensive domiciliary service for those patients who are housebound. In cases where patients are able to walk but are unable to reach the clinic by themselves, transport may be provided. The chiropody service continues to play a major role in keeping the elderly and handicapped mobile which is vital to their health and welfare. The growing realisation of the basic relationship between foot care and total health has produced increasing demand for the service and I am pleased to report that the continued expansion of the chiropody service has enabled us to cope with the increase. As the feet often show symptoms of other disorders, the chiropody service provides an increased diagnostic programme which assists in early disease detection. During the year, three Senior Chiropodists and two additional sessional chiropodists were appointed. The staff at the end of the year numbered four Senior Chiropodists and twenty sessional chiropodists working directly or indirectly under the supervision of the Chief Chiropodist. At the beginning of the year the Penfold Day Centre was opened. This building incorporated a purpose-built chiropody surgery. Although primarily this facility was for people attending the day centre, arrangements were made whereby the patients who attended the Fairfield Clinic were transferred to the Penfold Day Centre and the chiropody clinic at Fairfield Street was discontinued. There have been increasing numbers of requests during 1971 for talks and films on foot health to be arranged in centres throughout the Borough. I should particularly like to stress the importance of talks to mothers and children in order that ways of safeguarding the health of the feet can be discussed. Foot health education must be stepped up in the schools if the children of today are to escape the painful deformities that are so common in later life. 90 Statistics for the year 1971 are given below:— TABLE 27 Number of sessions held :— at clinics 3,074 at day centres and homes for old people 463 Number of patients seen for the first time in 1971 :— at clinics, day centres and homes for old people 4,096 at private surgeries 755 in their own homes 1,919 Number of treatments :— at clinics, day centres and homes for old people 24,044 at private surgeries 6,919 in patients' own homes 11,424 Venereal disease For statistical purposes, the Department of Health and Social Security now divide venereal infections into four categories, as follows:— Syphilis. Gonorrhoea. Other genital infections :— Chancroid. Lymphogranuloma venereum. Granuloma inguinale. Non-specific genital infection. Non-specific genital infection with arthritis. Trichomoniasis. Candidiasis. Scabies. Pubic lice. Herpes simplex. Warts (condylomata acuminata). Molluscum contagiosum. Other conditions :— Other treponema conditions. Other conditions requiring treatment in the centre. Other conditions not requiring treatment in the centre. In relation to the fourth category, it is important to emphasize that the attendance at the clinic of patients found in fact to be free from infection is well worth while in that they have been exposed to the risk of contracting such diseases. 91 The treatment of venereal disease is the responsibility of the hospital authorities, the local health authorities being concerned mainly with following up patients who have failed to complete treatment. Welfare officers are employed by the six Inner London Boroughs in whose areas VD clinics are situated and on behalf of all Inner London authorities—including Wandsworth—they try to persuade patients to continue their attendances. They also trace contacts identified by patients with the object of getting them to attend the special clinics. Each year the physicians in charge of the VD clinics notify the appropriate medical officers of health of the numbers of cases treated. Although the accuracy of the figures cannot be guaranteed, as a patient may give a false address, they do give a good indication of the numbers seeking treatment and of the steady increase that has occurred during the past five years, the period during which records have been kept. It should be noted that column (7) applies to 1971 only. From 1967 to 1970 columns (6) and (7) were combined, and those figures are shown in column (6). To obtain a fair comparison the 1971 figures in columns (6) and (7) should be added together. As these statistics deal with cases it is not possible to ascertain the numbers of patients ; one patient may come into more than one category. TABLE 28 Numbers of new cases living in Wandsworth and attending hospitals During the year (1) All conditions (2) Syphilis Gonorrhoea (5) Other genital infections (6) Other conditions (7) Primary and secondary (3) Other (4) 1967 2,855 25 47 509 2,274 - 1968 3,387 23 63 604 2,697 - 1969 3,858 29 48 640 3,141 - 1970 4,200 34 40 755 3,371 - 1971 5,170 34 58 817 2,938 1,323 Health education General With the reshaping of the Health Department in 1971, the third Principal Medical Officers' role reflected the importance attached to health education, the object being to organise and co-ordinate a comprehensive and continuing programme of health education in the Borough. Within the Health Department, health education 92 became the special responsibility also of the Principal Nursing Officer and a Senior Administrative Assistant. The post of Principal Medical Officer (Health Education and Administration) was filled in October by the appointment of Dr. Michael Church. In the last two months of the year a start was made at assessing priorities and discussing practical possibilities for health education. There was active participation in the preparing of publicity material for forthcoming campaigns in Family Planning and Cervical Cytology. Health education forms an integral part of the work of all health personnel, since all have the opportunity to influence those with whom they come into contact. Some, such as health visitors, have training in health education and arrange sessions for teaching various groups. During the year there were nearly 1.000 health education sessions led by health visitors or nurses in child health centres, mothers' clubs, old people's clubs and schools. A two-day Health Conference and Exhibition was held at Garnett College at the end of March, 1971. Nursing staff from the Health Department prepared and manned an exhibit about the services and functions of the Health Department in the community. This was very much appreciated by the organisers and the many people who visited the stand. Schools Health visitors give talks in schools in the Borough by invitation and altogether more than 100 sessions were held during the year. In addition, the Inner London Education Authority Health Education Team have continued to visit schools but their coverage is inevitably limited in view of their heavy commitments throughout the Inner London area. Care of old people Old people, despite all the services available, often do not avail themselves until they become very ill. The health visitor has a unique opportunity to reach old people and discover needs before they become too serious. The link between the health visitor, the home nurse and the family doctor is obviously essential for the effective care of old people in their homes and to encourage this liaison the system of G.P. attachment is being tried out in the Borough. With the many different services relating to old people the role of co-ordination and co-operation becomes vital if their various needs are to be met. Besides health visiting and home nursing the Health Department also provides home bathing services and chiropody for old people. 93 Family casework and problem families In accordance with the Local Authority Social Services Act, 1970, the supervision of problem families which had hitherto been undertaken by the Social Workers (Health Services) was assumed by the Social Services Department with the exception of four families who remained under the guidance of the Social Workers attached to the Health Department. Chest clinics The three Chest Clinics in the Borough are Wandsworth, in the Municipal Buildings; Battersea, in St. John's Hospital; and Balham, in St. James' Hospital. Most of the patients attending Wandsworth and Battersea Chest Clinics live in Wandsworth, but many of the Balham patients come from the adjoining London Borough of Lambeth. There is close liaison between the staffs of the Chest Clinics and the Health Department and there is satisfactory co-operation at all levels in relation to the prevention, care and after-care of patients suffering from tuberculosis and other chest conditions. The medical social worker at Wandsworth Chest Clinic is attached from Brompton Hospital; the social worker at the Balham and Battersea Clinics was transferred during the year to the newly formed Social Services Department but has remained seconded to the Health Department. The health visitors and the administrative officers for after-care and preventive work at the three clinics are attached from the Health Department, so that there are close links at all levels. In addition, there is good co-operation with the social workers in the Social Services Department. Although tuberculosis is no longer a major problem diseases of the chest—principally chronic bronchitis—continue to figure prominently as a leading cause of ill-health and disability. There is thus still the need to help not only tubercular patients in whom the disease is active or quiescent but also to assist an increasing number of bronchitics. Closely supporting the work of the medical and nursing staff are the Wandsworth Tuberculosis Care Committee and the Battersea Chest Clinic Care Committee, whose activities on behalf of the patients are set out in their reports. I should like to thank all members of both Committees for the fine work they have carried out during the year. Statistics relating to tuberculosis will be found in Part 3 of this report. Dr. J. G. S. McQueen, Chest Physician at the Battersea Chest Clinic at St. John's Hospital, retired in October after 32 years' service in Battersea and Wandsworth. The Health Committee and Council recorded their appreciation of Dr. McQueen's long and valuable service. Dr. Citron, Chest Physician at the Wandsworth Chest Clinic, assumed the additional responsibility of Chest Physician at the Battersea Clinic and consultant for the "chest ward " at St. John's Hospital. 94 BATTERSEA CHEST CLINIC CARE COMMITTEE ANNUAL REPORT FOR 1971 In presenting the Report of the year 1971, we must first record the retirement of Dr. McQueen in October. During his thirty-two years as Chest Physician, Dr. McQueen took a keen interest in the work of the Committee and his sound advice was greatly appreciated. We shall miss his regular attendance at our meetings and at all our fund raising functions. We extend to him our warmest wishes for a long and happy retirement. Dr. K. M. Citron, Chest Physician at Wandsworth Chest Clinic has now taken over the additional duties of Chest Physician at Battersea. During the year Mrs. L. Chesterman and Mrs. P. Burrow were nominated to replace Mrs. Crooks and Mrs. Romilly as representatives of the London Borough of Wandsworth. We were delighted that Mrs. Crooks and Mrs. Romilly were able to continue as co-opted members of the Committee. Monthly meetings have been well attended, and we are grateful to the Battersea, Putney and Tooting Group Hospital Management Committee for allowing the use of the Committee Room for our meetings. There have been many demands on Care Committee Funds, and a great proportion of our cases have been elderly patients needing help with fuel bills and the provision of warm bedding and clothing. A parcel of useful and attractive new garments from the Queen Mary's London Needlework Guild was of great assistance in meeting the need for clothing. Once again at Christmas we were able to make gifts to out-patients and those spending Christmas in St. John's Hospital Chest Wards, and these totalled £80. For many years Mr. Collyer has organised Old Tyme Dances to help our funds, and the two which he arranged during this year were successful as ever, resulting in a total profit of £184. Our sincere thanks are due to Mr. Collyer for his untiring efforts to make these dances such happy and profitable occasions. We are most grateful to the London Borough of Wandsworth for allowing us the free use of Battersea Town Hall, and to members of the W.R.V.S. who not only give so freely of their time to provide refreshments, but also donate their entire profits to the proceeds of the dances. We are indebted to the managements of Carson-Paripan Limited, Prices Patent Candle Company Limited. J. Lyons & Company Limited, and Dawson & Company Limited, for once again providing raffle prizes for the dances. As in the previous year, we were invited to join with the Army Cadet League in organising a Spring Fair. As a result our funds benefited by £41, and when a jumble sale was held later to dispose of articles unsold at the Fair, a further £22 was added to this. 95 The co-operation and help of the Officers and Cadets contributed greatly to the success of both events. This year, for the first time, we received a cheque for £30 from the School Council of Sir Walter St. John's School. This very generous gift from the boys enabled us to provide some extra amenities for one of our chest wards in St. John's Hospital. We are most grateful for the interest of the school in our work and for this very welcome donation. No report would be complete without recording our thanks to the Battersea Park Rotary Club and the Morganite Carbon Company Limited, for their continued financial support. Our thanks too are extended to our friends who have so kindly provided us with clothing, toys and books throughout the year. Finally, we express our appreciation of the work carried out on behalf of the Committee throughout the year by Miss R. M. Greenaway, Social Worker, Miss M. Clifford, Health Visitor and Mr. I. Faithfull, Secretary. N. F. CLARK-LAWRENCE (Miss), Chairman. WANDSWORTH TUBERCULOSIS CARE COMMITTEE ANNUAL REPORT FOR 1971 1 think we can record another successful year for the Care Committee. We have helped many patients both financially and practically but, unfortunately, now that we have lost our storage room we are unable to keep any of the furniture offered to us and this is a great pity. The two outings to the coast were greatly appreciated and at Christmas £150 was given as grants to the less fortunate patients both in hospital and at home. Once again our Sale of Work was a success and the net proceeds amounted to just over £220. Unfortunately the Mayor, Councillor J. Golding, could not perform the opening ceremony but managed to come along in time to pick the prize winners in the draw. Although it was only a brief visit we enjoyed the opportunity of meeting him and his wife. I should like to take this opportunity of again thanking everyone for their help in making the Sale of Work such a success and especially those friends, like Mrs. Cross, Mr. and Mrs. Ireland, Mrs. Quertier and Miss Wright, who are not members of the Committee. 96 We were very sorry to lose Miss Macdonald. the Medical Social Worker from Wandsworth Chest Clinic, but she is now working at Brompton Hospital and we send her our best wishes. I know the patients at Wandsworth Chest Clinic will miss her as she has known many of them for a very long time. We were, however, happy to welcome Mrs. Willoughby who has come from the Bristol Chest Clinic, to take over as social worker at Wandsworth and trust we shall have the pleasure of working with her on the Committee for a long while. We were pleased to welcome Miss Cholmeley and Councillor Rowe to the Committee this year and hope they will find our work rewarding. I must, however, thank all my old friends on the Committee for their continued support, also my Vice-Chairman, Hon. Treasurer, Social Workers and Secretary. To the organisations whose help we depend upon but, I trust, do not take for granted, the Women's Royal Voluntary Service, the officers of the Department of Health and Social Security and the Employment Exchanges, I also extend my thanks. I believe there is still a great need for committees such as ours and I hope we can continue for many years more. DEODORA CASSELS, Chairman. 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 for scrutiny by a medical officer and 982 questionnaires were scrutinised in the year. 220 prospective entrants were subsequently called for a physical examination either because of their age, the nature of the employment they were taking, or because of their medical history. In addition to its work in relation to new entrants to the service, the Health Department carried out 57 special medical examinations of existing staff at the request of the Council's Establishment Officer, arising from extended sick leave or other medical reasons, and 58 examinations related to employment with the Council, including drivers of heavy goods vehicles. 97 STAFF TRAINING AND STUDENT TRAINING During 1971 the Health Department started a vigorous programme of in-service training of the medical and nursing staff. This was concerned mainly with developmental paediatrics and reflected the increasing recognition of the importance of this subject in relation to the quality of life in childhood. A series of lectures, extending over the academic year, dealing with the physical, emotional and mental growth of children, proved of interest not only to our own staff but to general practitioners and doctors from the Paediatric Departments of the Hospitals in the Wandsworth area. Recognition and approval of the extended course on developmental paediatrics was given by the British Postgraduate Medical Federation under Section 63 of the Health Services and Public Health Act, 1968, and in consequence attracted the attendance of one-in-four of the local general practitioners. The cross-fertilisation of ideas that resulted has proved extremely valuable. Demonstrations of the screening procedures used in the routine examination of the pre-school child were held in clinics and surgeries. An extension of this practical programme is envisaged for 1972. A Deputy Chief Nursing Officer responsible inter alia for staff and student training and health education was appointed in August. The Chief Nursing Officer attended a senior management course of ten weeks duration at the King's Fund College of Hospital Management. A Principal Nursing Officer attended Chiswick Polytechnic on a half-day per week release scheme to study for part 'A' of the Diploma in Nursing and was successful in her examinations. Nine student health visitors who commenced training in 1970, were successful in their examinations and eight were appointed to the staff in September. One student was not appointed as she married and moved away from the area. Five student health visitors commenced training in September. Five health visitors and two midwives attended post-graduate refresher courses arranged by the Health Visitors' Association and the Royal College of Midwives. Two health visitors and one home nurse successfully completed courses to work as fieldwork instructors to students undertaking health visitor or district nurse training. Eight home nurses were sponsored for district training during the year and all completed the course and were successful in their examinations. The domiciliary midwifery service provided district midwifery training of three months duration for twenty-three pupil midwives. Throughout the year 114 nurses taking the obstetric nurse course 98 in local hospitals each attended for one day to undertake visits of observation. Thirty-two student nurses from St. George's Hospital spent eight weeks with the staff of the community nursing service to gain an insight into their work and its relationship to other services provided by the local authority and to the general practitioner service. Two senior home nurses organised and ran an in-service training course on " Hypothermia of the Elderly which was attended by all the nursing auxiliaries. As a result of a new demand for home nursing service for patients undergoing renal dialysis at home, a short course on the techniques of renal dialysis was arranged with Fulham Hospital Renal Dialysis Unit. Five nurses attended the five-day course and were subsequently able to undertake the home nursing care of such patients. All in all, an extremely active year so far as training was concerned ! 99 PART 6 MENTAL HEALTH SERVICE Under the Local Authority Social Services Act, 1970, one of the services transferred from the Health Department to the new Social Services Department was mental health. Since its formation in 1965 the section had been expanding and steadily improving the quality and scope of its work. The social workers were already organised in area teams and had established excellent links with statutory and voluntary workers in their successful attempts to achieve maximum co-ordination of Borough and other services. The transfer to the new Department was effected early in the year, and although we were naturally sorry to lose the staff we knew that their services would still be available when needed to help and support the residents of Wandsworth. 100 LONDON BOROUGH OF WANDSWORTH PART 7 SCHOOL HEALTH SERVICE ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1971 CONTENTS Introduction Special Schools Pupils on School Rolls Audiology and Audiometry Medical Inspection of Special Investigation Clinics Schoolchildren Tuberculosis—Epidemiological Vision Investigations Personal Hygiene B.C.G. Vaccination Infectious Illness reported of Schoolchildren from Schools School Dental Service Medical Treatment of Free School Milk Schoolchildren Health Education in Schools Handicapped Pupils Sanitary Conditions in Schools Introduction I have the honour to present the seventh annual report on the School Health Service of the London Borough of Wandsworth for the year ended 31st December, 1971. As described in earlier Reports, the Inner London Education Authority is responsible for the School Health Service but, by virtue of an agreement under 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 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. 101 The activities of the school health service are so many and varied that these introductory comments can only highlight those features of special moment in 1971. Nutrition was very much to the forefront during the year with the ending of the provision of free school milk for all junior schoolchildren. Under the Education (Milk) Act, which received the Royal Assent in the late summer, children aged from seven to eleven years are now eligible to be provided with free milk at school by a local education authority only if this is certified to be necessary on health grounds; milk continues to be supplied free of charge for all pupils attending special schools. Accordingly, arrangements were put in train to medically examine all those children in the affected age-group possibly in need of free school milk on health grounds, entailing the closest liaison between school doctor, nurse, teacher, parent and general practitioner. By the end of the year some 300 children out of nearly 16,000 junior schoolpupils attending ordinary schools in the Borough had been recommended for free milk at school on health grounds. The rapid and smooth manner in which this formidable assignment was completed reflected the greatest credit on all concerned. Milk is an excellent nutrient in childhood in view of its protein and calcium content and the increasingly familiar sight of the overweight child does not gainsay this value. Obesity is readily recognisable but in the absence of florid signs it is extremely difficult to detect other forms of malnutrition clinically. Thus, although height, weight, general health record and school performance are clearly relevant in the assessment of general nutrition, only blatant undernourishment is likely to be detected on medical examination. It is precisely because of this difficulty that the view has been put forward that all young children should receive free school milk as an essential preventive measure. In Wandsworth the Council decided to provide free milk at primary schools to all pupils resident in the Borough who were no longer eligible for free school milk from a local education authority following the enactment of the Education (Milk) Act, 1971. In general the incidence of infectious illness reported from schools remained at a low level. Only one outbreak of note occurred—an episode of acute viral gastro-enteritis affecting 58 children and five teachers at a junior and infants school in the latter part of November; fortunately the illness was not severe. Nonetheless epidemic winter vomiting is an unpleasant disease often mistaken for food poisoning until laboratory investigations prove negative. Ironically enough, one of the kitchen staff routinely tested in relation to this outbreak was found to be a carrier of a Salmonella organism commonly associated with food poisoning, illustrating the continuing necessity for scrupulous personal hygiene on the part of food handlers. 102 Three accounts in the text of epidemiological investigation in relation to tuberculosis infection at school illustrate vividly the invaluable assistance rendered in this field by the staff of the local Chest Clinics and of the South-West London Mass X-Ray Service. I welcome the opportunity to express my sincere thanks to Dr. McQueen (who retired during the course of the year), Dr. Citron, Dr. Millard, Dr. Nash and their colleagues. Gradually the age at which routine Mantoux or Heaf testing and, where necessary B.C.G. vaccination are undertaken is being lowered from 13 to 11 years. Similarly the rubella immunisation programme has been extended to the whole of this age-group with the intention in future of vaccinating girls when they reach the age of 11. The help of the schools in enabling these programmes to be developed successfully is greatly appreciated. Both campaigns flourished in 1971. A much less welcome increase in activity related to the detection and treatment of head infestation. Clearly a far more intensive effort is needed in relation to the family as a whole if this problem is to be tackled realistically. Merely to treat the infested school pupil is to invite reinfestation. Fortunately, in view of the increasing evidence of resistance of head lice to D.D.T. preparations, a new malathion insecticide which is very effective against pediculosis capitis has now been marketed ; active consideration was therefore being given at the end of the year to a comprehensive assault upon this tiresome public health problem in which, as a preventive measure, a determined effort will be made to treat every member of the family of an infested child. Once again it is a pleasure to record the continuing development of the comprehensive service provided by the school dental staff under the lively and capable leadership of Mr. Weedon, the Principal School Dental Officer. Specially noteworthy was the marked expansion in health educational and orthodontic activities. The cause of dental health is indeed well served in relation to Wandsworth schoolchildren. Unification of the child health service to provide continuity of supervision from birth to school-leaving age has long been advocated. This was the prime objective of the local reorganisation which followed the retirement of Dr. Garland who had given more than two decades of exemplary service in Battersea and Wandsworth. To achieve the goal of continuity in the field of child health the Borough was divided into western and eastern halves for medical administrative purposes under the day-to-day supervision of Dr. Frenkiel and Dr. Graham respectively. In addition to their administrative responsibilities — which include the maintenance jointly of a handicap and observation register catering for children of all ages—these two Principal Medical Officers (Child Health) act as clinical consultants to their colleagues and foster close links with general practitioners and consultant paediatricians. A similar 103 geographical reorganisation of the administration of the nursing service locally was effected in the autumn. The abolition of the traditional medical administrative separation of maternal and child welfare from school health cannot but help to give a greater sense of purpose and continuity to all concerned in clinical supervision, with a correspondingly more effective service. Equally in the interests of child health, and just as strongly advocated in recent years, was the ending of the legal concept of ineducability. Thus the implementation in April of the provisions of the Education (Handicapped Children) Act of 1970, referred to in the body of the Report, was warmly welcomed as a major advance. In conclusion I am indeed glad to have the opportunity to thank all members of the staff of the school health service for their cheerful efficiency throughout the year, and to express to Mr. Kingdom, the Divisional Education Officer, and the Heads of schools in Wandsworth my warm appreciation of their continued help and support which I deeply value. The Medical Adviser to the Inner London Education Authority, Dr. Stewart, and his colleagues have again given me constant encouragement and invaluable advice for which I am especially grateful. Pupils on school rolls In May, 1971, there were 49,133 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 staff of the Education Welfare Service and the teaching staff. Immunisation records receive special scrutiny and, if indicated, the attention of the parents is directed towards completing the immunisation schedule, particularly with regard to the prevention of diphtheria, poliomyelitis, tetanus and tuberculosis. Nowadays, attention is also paid to measles and rubella prophylaxis, where appropriate. Control of infection and infestation is facilitated by means of the medical inspections and the health surveys made by the school nurses. In this respect, examination of children before a school journey is of proven value. Relatively frequent medical examinations take place at the schools for the handicapped. Specially approved medical officers 104 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 1971 totalled 17,713 compared with 17,915 in 1970. Of those children inspected, 15.8% were referred for treatment of defects, 7.1% being referred for treatment of defects other than vision. The corresponding percentages for 1970 were 16.2 and 8.0 respectively. The following table shows the number of children referred for treatment or observation of the defects listed at routine general medical inspections during 1971, expressed as a rate per 1,000 children inspected, together with the corresponding rates for 1970. TABLE 1 Numbers examined 1971 1970 17,713 17,915 Defects Rate per thousand Treatment Observation Treatment Observation Skin diseases 10.22 4.80 8.82 4.30 Eyes—vision 94.45 41.55 88.98 42.70 squint 6.83 3.84 7.87 5.36 other 1.02 1.02 1.40 1.23 Ears—hearing 7.62 9.26 6.31 11.55 otitis media 1.98 3.16 1.95 2.18 Nose and throat 3.39 16.03 4.41 15.85 Speech 4.18 6.61 4.19 7.09 Enlarged cervical glands 0.45 3.78 0.28 2.57 Heart and circulation 1.52 8.52 1.96 8.59 Lungs 5.70 7.62 5.80 7.54 Orthopaedic 9.43 10.73 13.11 12.78 Nervous system 2.31 1.75 2.34 1.67 Psychological 5.70 13.10 5.52 12.84 Developmental—hernia 0.90 1.24 0.95 1.28 other 1.52 3.50 1.51 4.19 Abdomen 0.45 1.13 0.67 1.28 105 Details of non-routine medical inspections carried out in 1970 and 1971 are as follows:— TABLE 2 1971 1970 Reinspections 7,895 8,262 Secondary school annual surveys 50 66 Other non-routine inspections (see Table 3 below) 5,346 5,690 7-plus experimental scheme inspections 120 128 Totals 13,411 14,146 Total routine and non-routine inspections 31,124 32,061 Analysis of non-routine medical inspections TABLE 3 Nature of Inspection Bathing centre inspections : Number inspected 1971 1970 Scabies 2 — Other — 4 Employment certificates 425 411 Theatrical children 60 70 School journeys 2,946 3,309 Recuperative holidays: Before holiday 59 62 On arrival — — Outward Bound courses 14 3 Infectious disease investigation 4 2 Boarding Schools for the Delicate: Pre-departure inspections 13 — On return from school — — Handicapped pupils: Statutory examinations 114 157 Periodic special defect examinations 724 838 Research investigations and enquiries 2 1 Special examinations at request of: Head Teacher: Child's name entered in special book 114 140 Others 273 299 School Nurse: After health survey 13 22 Others 78 114 Divisional Officer (Education) 61 81 106 Divisional Education Welfare Officer or Care Committee 29 29 Parent 100 93 School Medical Officer 25 40 All other non-routine inspections 290 15 Total 5,346 5,690 Routine medical inspections TABLE 4 Physical condition of pupils Proportion satisfactory and unsatisfactory: 1971 1970 Satisfactory 99.06% 99.40% Unsatisfactory 0.94% 0.60% Attendance of parents and Care Committee representatives TABLE 5 1971 1970 Number of pupils inspected 17,713 17,915 Parents present 50.0% 49.3% Care Committee representative present 63.9% 75.9% Vision All children entering school are given a vision test at their first routine medical examination and further tests are carried out at each successive routine medical examination throughout the child's school life. Should concern be felt as a result of the school vision tests, the child will be referred either to his doctor or to the ophthalmologist. Visual acuity standards expressed as percentages of the numbers of children whose eyes were tested are set out in the following table:— TABLE 6 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 1971 Boys 82.3 6.2 5.6 5.4 3.2 1.5 1.3 3.3 Girls 79.3 7.0 6.9 7.5 3.5 1.6 1.8 4.1 1970 Boys 81.0 5.3 5.0 5.0 5.0 1.9 1.8 4.3 Girls 78.3 6.5 6.4 6.2 4.6 2.1 2.1 4.9 107 Personal hygiene TABLE 7 Year Number examined Number found verminous Pupils found to be verminous % of number examined Annual comprehensive health surveys 1971 19,211 175 0.91 1970 23,221 243 1.05 Additional health surveys 1971 15,918 336 2.11 1970 18,037 371 2.06 During both types or survey, vermin were found on 511 occasions, representing 1.45% of the total number of examinations. The number of individual pupils found to be verminous was 397 or 0.81% of the school roll of 49,133. On 418 occasions the parents or children, or both, were advised about treatment and in many cases were given Lorexane shampoo for home treatment. On the further 93 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 425 Total attendances 557 Scabies Cases treated 106 Total attendances 228 Impetigo Cases treated Nil 108 Infectious illness reported from schools TABLE 8 Chicken-pox 329 Dysentery, diarrhoea or enteritis 78 Erysipelas 1 Food poisoning 2 German measles 124 Glandular fever 2 Impetigo 20 Influenza 4 Jaundice 4 Measles 182 Mumps 21 Ophthalmia and conjunctivitis 19 Pneumonia 1 Ringworm (body) 24 Ringworm (scalp) 6 Scabies 23 Scarlet fever 29 Sore throat 2 Tonsillitis 29 Whooping cough 24 Other illnesses 3 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. Medical treatment of schoolchildren The number of sessions, new cases and total attendances at school treatment centres during 1971 were as follows:— TABLE 9 Type of clinic Sessions New cases Attendances Minor ailments (nurse) 588 886 | 7,789 Minor ailments (doctor) 58 147 Special investigation (i.e. enuresis, obesity and behaviour problems) 245 235 1,557 Dental 4,626 9,424 22,998 Vision 331 929 4,208 Orthoptic 187 71 397 Audiology 64 151 574 More detailed information about some of these clinics will be found later in this report. 109 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. Children who, because of some handicap or combination of handicaps, are considered not fit for education at school may be recommended for home tuition. Prior to 1st April, 1971, examination of educationally subnormal children was carried out by specially qualified medical officers in accordance with Sections 34 and 57 (as amended) of the Education Act, 1944. Since that date, Section 57 has been repealed. In practical terms, this means that no child is considered ineducable and the Junior Training Centres either with or without Special Care Units have been recognised as separate special schools. In Wandsworth this has meant the re-designation of Wandsworth Junior Training Centre in Spencer Park which is now known as Paddock School. Children who are recommended for admission will have been examined under Section 34 of the Education Act and will be considered either Educationally Subnormal (Severe) or Educationally Subnormal (Special Care), depending upon the degree of handicap present. Parents have the right to appeal in those cases where they indicate that they do not accept the recommendation and advice will then be sought from the Medical Adviser of the Inner London Education Authority. 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 1971 the number of children receiving special education at schools in Wandsworth was as follows :— TABLE 10 Type of handicap Day Residential Blind 9 81 Deaf 36 22 Delicate 289 — Educationally subnormal 778 — Maladjusted 54 79 Physically handicapped 63 — 110 The importance of social training is emphasised 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. During the year a social worker has continued to work in contact with Greenmead School for the Physically Handicapped, and this help has been extended to the Chartfield Open Air School. Unfortunately owing to a shortage of staff the Oak Lodge School for Deaf Children has been without a social worker since August. Audiology and audiometry Loss of hearing constitutes such a handicap to a child in the learning situation that continued vigilance must be kept for its detection. All children on entry to school are screened by sweep audiometry to exclude deafness. This test is carried out by one of three specially trained school nurses. Any child suspected by his parents, teachers, school nurse or doctor of having a hearing loss can be referred to one of the four audiology clinics in the Borough. An otologist appointed by the Inner London Education Authority is in attendance at these clinics and advises on treatment and management, with particular reference to the difficulties which may arise in the school. Children who have a slight but variable loss as well as those with permanent deafness have their progress checked at the clinics. A total of 574 children attended during the year. During 1971 increasing use was made of the Braidwood Audiology Unit at Tulse Hill (Lambeth) where children can be given a comprehensive assessment. The specialists of the Unit contact schools to give advice on children with poor hearing. A peripatetic teacher of the deaf visits pre-school children in their homes as well as children with a hearing loss who attend ordinary schools. The numbers of children given audiometer tests during 1971 are as follows : — Pupils given screening tests 6,953 Pupils given pure-tone tests after failing screening tests 789 Pupils referred to otologist 374 Special investigation clinics There are six special investigation clinics in the Borough, which are run jointly with the Inner London Education Authority. Children are treated for enuresis, obesity and behaviour problems, or a combination of these difficulties. Most cases are referred following Ill medical inspection in school, but a few also from private doctors and the parents themselves. The doctors are assisted in the clinics by a school nurse and a social worker; the latter provides information about the social background of the patients, visits the homes, and maintains contact with the Education Welfare Service. During the summer months there was a reduction in the referrals of enuretic children. During the year. 235 new cases were dealt with and the total attendances numbered 1,557. Tuberculosis—epidemiological investigations Full epidemiological investigations were undertaken at three schools in the Borough where cases of tuberculosis had been notified in order to trace the source of infection and, equally important, to exclude the possibility of other children or staff having been infected. At one school an 18-year-old boy was found to have active pulmonary tuberculosis and in consequence the parents of his 375 fellow pupils were asked to co-operate in an investigation of contacts as too were 39 members of staff. The parents of five boys were unwilling to take part in the survey. Excellent co-operation on the part of the staff, parents and pupils resulted in establishing that there were no other cases of infection in the school. I wish to thank Dr. Citron, Chest Physician of the Wandsworth Chest Clinic for his help and advice. At another school a teacher and a pupil were notified as suffering from pulmonary tuberculosis within one month of each other, which necessitated the investigation of 1,120 children and 60 staff. Parental refusal excluded 85 children from the epidemiological survey. The Mass X-ray Unit had already visited the school and X-rayed all the pupils who were close contacts (461), 41 teachers and 68 other staff when the notification of the infection in a teacher was received. The original programme was therefore broadened to include the whole school. No evidence of active pulmonary tuberculosis was found among pupils or staff. I am indebted to Dr. De Silva of the Battersea Chest Clinic and to the Mass X-ray Service for their co-operation. In the third case, a ten-year-old schoolgirl was referred to hospital with tuberculosis lymphadenitis. It was not bacteriologically 112 confirmed and she was not infectious, but as a precautionary measure her 29 classmates were examined and it was found that 10 (33%) of them were tuberculin positive, indicating that they had been exposed to infection. Six of the ten were strongly positive. The rest of the school were then investigated; 314 were found to be tuberculin negative and 36 (11%,) clearly positive. The existence of a source of infection in the child's class seemed likely, but none was discovered on investigation. No cases of tuberculosis have been reported from the school. I am most grateful to Dr. Citron, Chest Physician of the Wandsworth Chest Clinic, for his help in this case. B.C.G. vaccination of schoolchildren The vaccination of children against tuberculosis with B.C.G. (Bacillus Calmette-Guerin) 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 summarises the results :— TABLE 11 (a) Number of eligible children 5,408 (b) Number of consents received 4,746 (c) Number of consents received for alleged contacts of known cases of tuberculosis (included in (b)) 3 (d) Number of children skin tested and read 4,233 (e) Positive reactors among (d) not previously vaccinated 401 (9.5%) (f) Positive reactors among (d) known to have been previously vaccinated 775 (18.3%) (g) Negative reactors among (d) 3,057 (72.2%) (h) Number of children skin tested, but not read (absentees) 390 (i) Number of children vaccinated 3,057 Vaccination against tuberculosis is also available to students in training colleges. Of 138 students skin tested, 15 were vaccinated. 113 School dental service Report by A. F. Weedon, B.D.S., D.D.P.H., R.C.S., Principal School Dental Officer. Once again it is a pleasure to report a happy and productive year due to the enthusiastic approach to their work by a full and stable staff. This continuity in staff ensures good relations with both parents and children, promoting a goodwill which is very valuable in carrying out regular treatment and helps to keep the failure rate low. Staff changes were minimal again this year and the establishment was kept very full throughout the year, making it relatively easy to fill the occasional vacancy with new personnel of good calibre. Staff morale has thus remained very high, the only cause for concern being the re-organisation of the health services scheduled for 1974. Members of the staff have expressed a desire to see a definitive framework for the dental service emerge from the current uncertainty which they naturally find rather unsettling. There is no doubt that a situation is arising in which the dental profession has an unrivalled opportunity to arrange, in co-operation with the Department of Health and Social Security, a framework for the comprehensive dental care of the whole community, with special emphasis on prevention. Within such a framework there will be a vital role for the present local authority and school dental services. Because of the larger reservoir of dental treatment available, we have to keep running to meet the demand. For this reason, dental health education has largely been provided on an individual basis at the chairside in the surgery. In March we were fortunate to acquire the services of a dental auxiliary who is very keen on dental health education. Miss Mutter has been encouraged to contact progressively more and more primary school head-teachers, and with their co-operation has been providing group instruction in oral hygiene, its necessity and its benefits. This is reinforced in the surgeries by continuing with the individual chairside instruction. As we see the minor percentage of the school population, it is necessary to expand this service and maintain a continuing programme of instruction throughout the primary schools. The statistics record a good year. An orthodontic service has been growing throughout the year, expanding from 121 sessions last year to 354 this year. Another figure worth recording separately is that dental health education sessions rose from eight sessions last year to 115 this year. Both these increases are a tribute to the individuals responsible for the work involved. I.L.E.A. mobile surgeries were used again for a total of thirteen weeks at the special schools. 114 Finally I would like to record my personal appreciation of the valuable work of a loyal and enthusiastic staff. Some details of this year's work are as follows :— TABLE 12 Sessions: Health education 115.0 Number of treatment sessions 4.147.4 Number of inspection sessions in schools and clinics 363.2 Total 4,625.6 Inspections : Number of first inspections in schools 37,766 Number of first inspections in clinics 7,049 Total 43,815 Percentage requiring treatment 54.2 Reinspections at clinics or schools 1,323 Percentage requiring treatment 66.0 Attendances: First visits 9,424 Subsequent visits 13,574 Emergency visits 598 Total 23,596 Treatments: Courses of treatment completed 7,046 Fillings done 25,586 Other operations, including crowns, inlays, X-rays, etc 12,494 Free school milk The Education (Milk) Act, 1971, restricts the general provision of free milk in ordinary schools to pupils who are not more than seven years of age, whilst continuing the issue as before to pupils in special schools. Children over the age of seven years in junior schools can only receive free milk under Education Act powers when so recommended by the Principal School Medical Officer on health grounds. Following a report to the London Borough Council outlining the general beneficial effects of daily milk intake by children of junior school age, that Council, not being the Education Authority, decided in September 1971 to utilise its power under Section 6 of the Local Government (Financial Provisions) Act, 1963, to provide free milk to children in junior schools not otherwise entitled to daily milk. 115 There are 65 junior schools in the Borough with approximately 16,000 children on roll. Following examination by school medical officers, 313 children were recommended for free milk on health grounds, and the cost of provision of milk to the remaining children was borne by the London Borough Council. Each recommendation for free milk on health grounds is notified to the child's general practitioner, and is subject to annual review. Health education in schools Health visitors give talks in schools by invitation and altogether more than 100 sessions were held during the year. In addition, the Inner London Education Authority Health Education Team have continued to visit schools, but their coverage is inevitably limited in view of their heavy commitments throughout the Inner London area. 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 Officer of the I.L.E.A. for attention. 116 INDEX PAGE Accidents 41 Acute encephalitis 25 Acute meningitis 25 Adoption 86 Aged persons 8,13,92 Alcoholism 64 Analysis of food and drugs 54 Animal Boarding Establishments Act, 1963 42 Animals, protection of 42 Ante-natal care 80 Area comparability factors 19 Atmospheric pollution 6,61,62 Attachment schemes 8,10,13,14,70,73,92 Audiology 108,110 Audiometry 110 Bacteriological examinations 28,53,63 Bakehouses 52 Barbers 37 Bathing centres 33,65107 Baths, home 73 „personal cleansing station 33,65,107 „swimming 63 Battersea Chest Clinic Care Committee Report 94 B.C.G. vaccination of schoolchildren 5,102,112 Birth control 7,12,76,92 Births 3,20,21 Blind and partially-sighted children 109 Boarding-out 86 Braidwood Audiology Unit 110 Bridge Lane Health Centre 68 Brocklebank Health Centre 68 Bronchitis 4,93 Burtop Road Health Centre 69 Butchers' shops 52 Cancer 4,20,79 Caravans 45 Care of old people 8,13, 92 Catering establishments 52 Cervical cytology 7,17, 79, 92 Chest clinics 5, 93,102 Child health clinics 81 Child-minders 85 117 PAGE Chiropody 8,13,89,92 Cholera 5,25,29 Chronically Sick and Disabled Persons Act, 1970 10 Cigarette smoking 4 Clean Air Acts, 1956 and 1968 6,61,62 Clean Air Regulations, 1971 43,61 Cleansing station 33,65,107 Clearance areas 44 Closing Orders 44 Common lodging houses 43 Communicable diseases 4,12,25, 30, 31 Community health8,14 Community Nursing Service 69 Comprehensive health centres 10,13,68 Comprehensive health surveys (schoolchildren) 107 Consumer Protection Act, 1961 39 Coroner's Court 64 Covent Garden Market (Nine Elms) 6, 33 Creches 82 Cremation Regulations, 1930 65 Day nurseries, Council 9, 85 „ „ private 9,85 Day nursery, special unit 85 Deaf children 109,110 Death, causes of 22 „ rates 3,20,21 Deaths, cancer 3, 4, 20 „ heart disease 4,21,24 „ infant 3,20,24 „ maternal 3,20,24 „ tuberculosis 20 Delicate children 109 Dental service, mothers and young children 8,12,14, 17, 89 schoolchildren 12,14,17,102,108,113 Developmental paediatrics 9,12,17,82 Diphtheria 5,25,87 Disinfection and disinfestation 5, 33, 38, 65 Domiciliary midwifery service 7,9,12,71 Drainage 33, 35 Drugs, misuse of 8 Dysentery 4,25 Early discharge of maternity patients 7, 71 Education (Handicapped Children) Act, 1970 9,103 Education (Milk) Act, 1971 101,114 118 PAGE Education Welfare Service 103,110 Educationally subnormal children 104, 109 Enteric fever 28 Enuresis 108,110 Environmental health services 5,12,17,32 Environmental pollution 7 Epidemiological investigations 28,102,111 Factories Act, 1961 59 Family casework 9,93 Family planning 7,12,76,92 Fireguards 39 Fish shops 52 Fluoridation of water supply 36 Food and Drugs Acts 47, 50, 51, 54 Food hygiene 43,47,50,101 Food poisoning 4,26, 101 Food premises 47,48,49 Food sampling 32,53 Food stalls 50 Food, unsound 51 Foot clinics 8,13,89 Free school milk 101,114 Furnaces, installation of 62 Gastro-enteritis 26,101 German measles, vaccination 5,87,88,102,103 Guthrie test 72 Hairdressers 37 Handicap and observation register 9,83,102 Handicapped children 12,82,83,85,109 Head infestation 102 Health centres 10,13,68 Health Committee 15 Health Department re-organisaton 16, 32 Health education and publicity 8, 9, 12, 13,17, 77, 89, 91, 102, 113, 115 Health surveys 107 Health visiting service 8,9,70 Heart disease 4,21,24 Home bathing service 8, 73, 92 Home dialysis 8,13,72,74,98 Home help service 9,86 Home nursing equipment, loan of 13, 73 Home nursing service 8,9,13,72 Home tuition 109 Houses in multiple occupation 6, 12, 32,44 119 PAGE Housing 10,13,32,44 Housing accommodation applications 10,46 Housing Improvement Group 17 Hygiene inspections of schoolchildren 107 Ice-cream sampling 53 Illegitimate children 3,20,21 Immigrants ... ... ... 29 Immunisation and vaccination 5,12,25,86,102,103 Incontinence pads service 74 Incontinent persons, laundry service 13,66 Infant mortality 3,20,24 Infectious diseases 4,12,25, 30, 31 Infectious illness in schools 101, 108 Infective hepatitis 4 Infective jaundice 26 Inquests 64 International vaccination certificates 28 Jaundice 26 Junior training centres/schools 109 Laboratory facilities, bacteriological 28,53,63 Land Charges Act, 1925 43 Larch Road Health Centre 69 Laundry services 66 Legal proceedings 35,40,48,51 Liaison with other services 9, 10,13,17, 37,71, 76, 79, 83, 85, 93 Loan of home nursing equipment 73 Local Authority Social Services Act, 1970 9, 13, 16 Local Government (Financial Provisions) Act, 1963 114 Lung cancer 4 Maladjusted children 109 Malaria 4,27 Maternal mortality 3,20,24 Mayston Report 9,14,17,70 Measles 4,27 „vaccination 4,5,27,87,88,103 Medical examination of staff 96 Medical inspection of schoolchildren 103 Medical treatment of schoolchildren 108 Mental health service 9, 99 Midwifery service 7, 9,12, 71 Milk, provision for schoolchildren 101,114 Milk sampling 51,53,58 Milk supply 51 Minor ailments 108 120 PAGE Mortality, infant 3,20,24 „ maternal 3,20,24 Mortuary 33,64 Mother and baby homes 37 Mothercraft classes 80 Movable dwellings 45 National Health Service, re-organisation 11,13,14,113 Neo-natal mortality 3,20 Nine Elms Market6, 33 Noise Abatement Act, 1960 39 Noise complaints 7,39 Nursing auxiliaries 8 Nursing homes 37 Nutrition 101 Obesity4,101,108,110 Occasional creches 82 Offensive trades 38 Offices, Shops and Railway Premises Act, 1963 40 Oil heaters 39 Old people, care of 8,13,92 Ophthalmia neonatorum 27 Orthodontics 102,113 Orthoptics 108 Outworkers 60 Paratyphoid fever4,28 Partially-hearing children 109 Performing Animals (Regulation) Act, 1925 42 Perinatal mortality ... 3,20 Personal cleansing station 33,65,107 Personal health services 68 Personal hygiene 107 Pest control 33,38,65 Pet Animals Act, 1951 42 Pharmacy and Poisons Act, 1933 39 Physically handicapped children 109 Pigeon control 38 Playgroups 9,85 Poliomyelitis 27 Poliomyelitis vaccination 5, 8, 70, 88 Pollution 61 Population 3,19 Post-mortem examinations 64 Post-natal care 80 Poultry processing43, 52 121 PAGE Premature infants24,81 Pre-school playgroups 9,85 Prevention of Damage by Pests Act, 1949 38 Problem families 93 Prophylaxis5,12,25, 86 Prosecutions 35,40,48,51 Public Analyst, report on work of 54 Public Health Laboratory Service 28, 53,63 Pupils on school rolls 103 Rabies Order, 1938 43 Relaxation classes 80 Renal dialysis 8,13,72,74,98 Rent Act, 1957 46 Riding Establishments Acts, 1964 and 1970 42 Rodent control 5, 38 Rubella vaccination 5,87,88,102, 103 Samples, adulterated 50, 54 „ fish and eels 53 „ food and drugs 32,47, 54 „ ice-cream 53 milk 51,53,54,58 „ shell-fish53 „ water 63 Sanitary conditions in schools ... ... 115 Scabies 65,107 School dental service 113 School health service 100 „ „ „ health education102,113,115 Sewage disposal 36 Sewerage 36 Sexually transmitted diseases 4, 5, 90 Shell-fish sampling 53 Slaughter of animals 52 Smallpox 27,28,29 Smallpox, international vaccination certificates 28 „ vaccination 5,86,87 Smoke control 6, 61 „ „ measuring stations 62 Smoking 4 Special educational treatment 109 Special investigation clinics 108,110 Special schools, blind 109 „ „ deaf and partially hearing 109 „ „ delicate 109 122 PAGE Special schools, educationally subnormal 109 „ „ maladjusted 109 „ „ physically handicapped 103,109 Special unit, day nursery 85 Staff13,15 Staff, medical examination 13 Staff training 66,97 Statistics, dental 114 „ immunisation and vaccination87,88 „ vital 3,19 Stillbirths 20,21 Students, training of 66, 97 Swimming baths 63 Tetanus immunisation 5,88 Training centres/schools 109 Training of staff 66, 97 Training of students 66, 97 Transportation of bodies abroad 64 Tuberculosis 5,27,93,102, 111 „ deaths 20,27 „ epidemiological investigations 28 „ notifications 27 Typhoid fever 28 Unsound food 48,51,54 Vaccination and immunisation 5,12,25,86,102,103 Vaccination, international certificates 28 Venereal diseases 4,5,90 Vermin 65,102,107 Vision testing 106, 108 Vital statistics 3,19 Wandsworth Tuberculosis Care Committee Report 95 Water supply 5,36,63 „ „ fluoridation of 36 Whooping cough 4, 5, 28, 88 Winter vomiting 26,101 Rowling & Sons Ltd. (TU), 1 & 3 Haydons Road, SW19 1HG