AS.43397 WAN 110 London Borough of Wandsworth ANNUAL REPORT of the Medical Officer of Health and Principal School Medical Officer for the Year 1973 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 1973 by HASTINGS E. A. CARSON M.D., S.M. (Harvard), F.F.C.M.. D.P.H. VITAL STATISTICS Population The civilian population at the middle of the year was estimated by the Registrar-General to be 294,000 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 1973 the factor for births is 0.92 and for deaths 0.88. Extracts from vital statistics Live Births: Male Female Total Legitimate 1,743 1,687 3,430 Illegitimate 384 294 678 Totals 2,127 1,981 4,108 Rate per 1,000 population: Crude 14.0 Adjusted 12.9 Stillbirths: 21 26 47 Rate per 1,000 total live and still births 11 Deaths: All ages 1,781 2,089 3,870 Rate per 1,000 population: Crude 13.20 Adjusted 11.6 Infant Mortality Rates: Deaths under 1 year 52 35 87 Total infant deaths per 1,000 live births 21.00 Legitimate infant deaths per 1,000 legitimate live births 18.00 Illegitimate infant deaths per 1,000 illegitimate live births 35.00 2 Neo-natal Mortality Rate (deaths under four week per 1,000 total live births) .. 12.00 Early Neo-natal Mortality Rate (deaths under one week per 1,000 total live births) 9.00 Perinatal Mortality Rate (stillbirths and deaths under one week combined per 1,000 total live and still births) 21.00 Maternal Mortality Rate (per 1,000 total live and still births) Nil Number of deaths from puerperal causes 0 Number of deaths from cancer 829 Number of deaths from tuberculosis 11 Births The total number of live births to residents in the Borough registered in 1973 was 4,108 comprising 2,127 males and 1,981 females. The crude birth-rate was 14.0 per 1,000 population. The rate as adjusted by the area comparability factor was 12.9. The live birth-rate for England and Wales was 13.7. During the year there were 678 illegitimate live births to residents in the Borough, representing 17 per cent, of the total live births for the area. The national average was 9 per cent. Stillbirths during the year numbered 47, giving a total of 4,155 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 3,870, comprising 1,781 males and 2,089 females. The crude death-rate was 13.2 per 1,000 population, and the adjusted death-rate, after application of the area comparability factor, 11.6. The death-rate for England and Wales was 12.0. 3 TABLE 1. CAUSES OF. AND AGES AT. DEATH DURING THE YEAR 1973 CAUSES OF DEATH Deaths assigned to Borough in ape groups Deaths shown in localities (all ages) All ages Males Males Under 1 Vr 1-4 5-14 1524 2534 3544 4554 5564 6574 7 Supwards P/ny C/ral B/sea Cholera — — - - - - - - - - - - - - - - Typhoid fever — — — — — — — — — — — — — — — — Bacillary dysentery and amoebiasis — — — — — — — — — — — — — — — — Enteritis and other diarrhoeal diseases 6 4 2 5 — — — — — — — — 1 3 3 — Tuberculosis of respiratory system 8 5 3 — — — — — — 2 1 3 2 2 4 2 Late effects of respiratory tuberculosis 3 3 _ — _ _ 1 2 _ 2 1 — Other tuberculosis — — — — — — — — — — — — — — — — Plague — — — — — — — — — — — — — — — — Diphtheria — — — — — — — — — — — — — — — Whooping cough — — — — — — — — — — — — — — — — Streptococcal sore throat and scarlet fever — — — — — — — — — — — — — — — — Meningococcal infection 2 1 1 1 1 2 Acute poliomyelitis — — - — - — - — — — — — — — — — Smallpox — — — — — — — — — — — — — — — — Measles 1 — 1 — 1 — — — — — — — — 1 — — Typhus and other rickettsioses — — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — — Syphilis and its sequelae 5 3 2 4 1 2 3 — All other infective and parasitic diseases 3 1 2 — — — — — — — 1 1 1 _ 3 — Malignant neoplasm. Buccal cavity. and pharynx 4 3 1 — — — — — — — 2 2 — 1 2 1 Oesophagus 16 9 7 — — — — — — 1 4 2 9 7 5 4 Stomach 75 40 35 — — — — — 1 3 17 32 22 20 33 22 Intestine 110 57 53 — — 1 — 2 10 25 32 40 34 44 32 Larynx 4 3 1 — — — — — — — — 3 1 1 2 1 Lung, bronchus 252 194 58 — — — — 1 2 15 77 102 55 74 76 102 Breast 81 —- 81 —- — — — — 4 15 13 23 26 25 23 33 Carried forward 570 323 247 6 2 - 1 1 9 46 141 206 158 172 199 199 4- TABLE 1. CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1973-contd. CAUSES OF DEATH Deaths assigned to Borough in age groups Deaths shown in localities (all ages) All ages Males Females Under 1 yr 1-4 5-14 1524 2534 3544 4554 5564 6574 75upwards P/ny C/ral B/sea Brought forward 570 323 247 6 2 — 1 1 9 46 141 206 158 172 199 199 Malignant neoplasm. Uterus 25 — 25 — — — — — 1 9 4 6 5 8 9 8 Prostate 30 30 — — — — — — — — 4 7 19 8 12 10 Leukaemia 15 7 8 — 2 2 1 — 1 — 1 3 5 5 5 5 Other malignant neoplasms 217 98 119 — 1 3 3 4 7 21 59 59 60 73 80 64 Benign and unspecified neoplasms 6 — 6 — — — — — — 1 — 3 2 2 1 3 Diabetes mellitus 30 10 20 — — — 1 — — 1 2 12 14 11 13 6 Avitaminosis and other nutritional deficiency — — — _ _ _ — — — — — — — — Other endocrine, nutritional and metabolic diseases 8 4 4 — — — 1 — — — 2 2 3 4 2 2 Anaemias 7 2 5 — — — — — — — 1 1 5 2 3 2 Other diseases of blood and bloodforming organs 2 2 — — — — — — — — — 2 — — 2 Mental disorders 46 7 39 — — — 2 1 1 1 1 7 33 10 26 10 Meningitis 4 2 2 2 — — — — — — — 1 1 4 — — Multiple Sclerosis 14- 5 9 — — — — — 3 2 7 1 1 5 6 3 Other diseases of nervous system and sense organs 40 17 23 1 — — 4 _ 1 4 18 12 15 12 13 Chronic rheumatic heart disease 38 11 27 — — — — 1 — 2 6 11 18 18 9 11 Hypertensive disease 50 17 33 — — — — — — 4 8 14 24 18 18 14 Ischaemic heart disease 878 467 411 — — — 1 2 9 53 141 245 427 290 316 272 Other forms of heart disease 200 66 134 — — — — — 2 6 17 35 140 61 77 62 Cerebrovascular disease 454 159 295 — 1 — — 2 7 14 50 102 278 148 160 146 Other diseases of the circulatory system 187 62 125 1 _ — — 1 3 5 20 44 1 13 57 72 58 Influenza 11 4 7 — — — — — — 2 1 2 6 4 3 4 Pneumonia 403 137 266 12 3 — — 2 1 8 20 57 300 97 176 130 Bronchitis, emphysema 193 127 66 1 — — — — 1 9 21 49 112 53 79 61 Asthma 17 7 10 — — — 2 1 — 1 4 7 2 6 6 5 Carried forward 3,445 1,562 1,883 23 9 5 16 15 45 186 514 892 1 ,740 1,071 1,284 1.090 5 TABLE 1. CAUSES OF. AND AGES AT, DEATH DURING THE YEAR 1973-contd. CAUSES OF DEATH Deaths assigned to Borough in age groups Deaths shown in localities (all ages) All ages Males Females Under 1 yr 1 —4 5-14 1524 2534 3544 4564 6664 6574 75upwards P/ny C/ral B/sea Brought forward 3,446 1.562 1.883 23 9 5 16 15 46 186 614 892 1,740 1,071 1.284 1.090 Other diseases of the respiratory system .. .. .. 35 12 23 1 1 __ _ 2 10 21 13 12 10 Peptic ulcer 41 30 11 3 5 13 20 14 8 19 Appendicitis .. .. 3 2 1 — — 1 — — — 1 — — 1 1 1 1 Intestinal obstruction and hernia 18 9 9 2 — — — — — 1 4 3 8 7 9 2 Cirrhosis of liver •• •• 11 4 7 — — — 1 — 1 1 5 2 1 5 3 3 Other diseases of the digestive system .. .. .. 31 13 18 1 3 3 6 18 6 14 11 Nephritis and nephrosis .. 19 9 10 — — — 2 2 1 1 4 3 6 6 7 7 Hyperplasia of prostate 8 8 1 — 6 2 2 3 3 Other diseases of genito-urinary system .. .. .. 24 10 14 2 _ __ 1 2 2 5 12 6 10 8 Other complications of pregnancy childbirth and puerperium .. Disease of the skin and subcutaneous tissue .. .. 7 7 1 6 1 4 2 Diseases of the musculoskeletal system and connective tissue 20 2 18 _ _ _ . 1 1 3 2 13 4 9 7 Congenital anomalies .. 25 11 14 13 6 1 — 1 2 2 1 — — 8 9 8 Birth injury, difficult labour, and other anoxic & hypoxic conditions 25 16 10 25 3 14 8 Other causes of perinatal mortality 7 6 1 7 2 3 2 Symptoms and ill-defined conditions 27 11 16 10 — — — i — — — 2 14 5 16 7 Motor vehicle accidents .. 23 10 13 — — 4 4 1 1 3 5 3 2 5 7 11 All other accidents .. 46 33 12 1 2 2 4 6 5 4 10 6 5 18 12 16 Suicide and self-inflicted injuries 39 23 16 — — — 2 11 3 11 3 4 5 8 17 14 All other external causes .. 17 11 6 3 — — 1 3 — 6 1 2 2 7 6 4 TOTALS 3,870 1,781 2.089 87 17 13 30 42 59 225 562 969 1,876 1,191 1.447 1.232 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). TABLE 2. DEATHS FROM HEART DISEASE Males in age groups Females in foe groups Grand totals under 25 25- 36- 45- 55- 65- 75- Totals under 25 25- 35— 45- 65- 65- 75- Totals Chronic rheumatic heart disease — — — 1 3 4 3 11 — 1 — 1 3 7 15 27 38 Hypertensive disease — — — 3 3 6 5 17 — — — 1 5 8 19 33 60 Ischaemic heart disease _ 2 7 48 105 153 152 467 1 — 2 5 36 92 275 411 878 Other forms of heart disease — — — 3 8 20 36 66 — — 2 3 9 15 105 134 200 Totals — 2 7 65 119 183 195 661 1 1 4 10 53 122 414 605 1166 Infant mortality There were 87 deaths of children under one year, with an infant mortality rate of 21.00 per thousand live births. The infant mortality rate for England and Wales was 17.00. TABLE 3. DEATHS OF CHILDREN UNDER ONE YEAR OF AGE Causes of death Under 24 hours 1-7 days 1-4 weeks TotaIs under 4 wks 1-12 months TOTAL DEATHS UNDER 1 YEAR Pneumonia — 1 2 3 9 12 Enteritis and other dlarrhoeal diseases — — — — 5 5 Congenital anomalies 1 2 3 6 7 13 Prematurity 13 12 — 25 — 25 Other causes 5 6 6 16 16 32 Totals 19 20 11 50 37 87 7 Maternal mortality There were no deaths from accidents or diseases of pregnancy or childbirth, COMMUNICABLE DISEASES During the year 1,457 notifications were received as compared with a total of 1,173 in 1972. The increase is accounted for in the higher incidence of Measles - a biennial factor. The total number of confirmed notifiable diseases reported arranged in age groups and the areas in which they occurred is shown in Tables No.1 and 2. A commentary on the notifications is given below. Acute Encephalitis One case was reported, that of a middle aged woman following vaccination. Acute Meningitis Ten cases were notified of which nine were children and 1 adult Two children, one aged 11/12 and the other 1 year died. The causative organisms are shown below:- 6 Meningococcal 1 Viral 1 Haemophilus Influenzae 1 Lymphocytic 1 Pneumococcal Cholera One case was reported, that of an 8 year old boy recently returned from a holiday in Tunisia. As a result of incidences of Cholera reported in Tunisia and Italy a number of travellers returning from these areas suffering fromdiarrhoea and sickness were investigated and full laboratory tests carried out but no further cases were diagnosed. Diphtheria No cases occurred during 1973. 8 Dysentery A total of 174 cases of Dysentery were notified, 159 being confirmed on bacteriological examination. 73 of these were unrelated incidents, the remaining 86 were concerned with two outbreaks in Day Nurseries and an investigation at a Day Care Unit. At one nursery 31 children and 3 staff were found to be infected and 7 home contacts were also affected. The investigation at the second nursery revealed 22 children and 2 members of staff and home contacts numbered 15 - all confirmed cases of Dysentery. A sibling of a child involved in one of the nursery outbreaks who attends a Day Care Unit in the Borough was confirmed as suffering from Dysentery and investigations at the Unit disclosed a second child and 4 home contacts also infected. Food Poisoning One hundred and sixty nine cases were notified during the year. Of these 46 were confirmed after bacteriological examination, 7 in 2 outbreaks outside the borough, 9 in family outbreaks and the remaining 30 were unrelated cases. Causitive organisms of the 46 cases were found to be of the following types:- Salmonella Typhimurium — 29 Kingston - 1 Dublin - 1 Enteritidis - 2 Bredeney - 2 Agona - 1 SanDiego - 1 Thompson - 1 Infantis - 2 St.Paul - 1 Brandenburg - 1 Derby - 1 Virchow - 1 Redding - 1 Unknown - 1 Infective Jaundice Thirty seven cases were notified, compared with 35 in 1972. 9 Measles A total of 842 cases were notified as against 568 in 1972. The increase was consistent with the normal pattern of incidences which rises and falls in alternate years. Malaria Six cases were notified, all of which were contracted abroad. One person died. Ophthalmia neonatorum One case occurred during 1973. Poliomyelitis and Smallpox No cases of these two serious diseases were notified in Wandsworth during the year. Scarlet Fever Total number of cases were 45, showing an increase from 1972 when the figure was 31. Typhoid Fever One confirmed case of Typhoid Fever occurred in a woman immigrant recently returned from a holiday in her own country. All family contacts were traced and bacteriological examination of all concerned revealed no further spread of infection. Whooping Cough The number of cases notified was 42 as against 16 in 1972. Smallpox Surveillance Under the Public Health (Aircraft) Regulations 1966 and the Public Health (Ships) Regulations 1966, persons arriving in this 10 country from abroad who are not in possession of a valid international certificate against smallpox, must be placed under surveillance for a specified period. During the year 80 persons were kept under observation. International Certificates Requests are made by persons proposing to travel abroad who for medical reasons vaccination would be inadvisable and a certificate is issued to the effect that no recent cases of smallpox have occurred in the Borough. Six such certificates were issued during the year. Tuberculosis The number of new cases reported during the year totalled 137, the sources of information being as follows:- Primary notifications 128 Transfers from other areas 6 Un-notified deaths 3 Primary Notifications Pulmonary N on Pulmonary Deaths Ages Pulmonary NonPulmonary M F M F M F M F Under 1 - - _ _ - - _ - 1 - 4 - 1 1 - - - - - 5-9 2 1 - - - - - - 10 - 14 - 2 3 - - - - - 15 - 24 6 8 7 2 - - - - 25 - 44 19 8 7 8 - - - - 45 -64 22 4 5 3 2 1 1 - 65 up 11 3 2 3 5 1 - 1 TOTAL 60 27 25 16 7 2 1 1 Bacteriological Examination Bacteriological examination of stools and other specimens in connection with infectious diseases are carried out by the Joint Microbiology and Public Health Laboratory at St. Georges Hospital, Trooting and 2,325 specimens were examined during the year. Stool and Urine — 2,283 Throat Swabs — 42 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 3 2 1 — — 2 — 1 — — 1 10 Acute poliomyelitis — — — — — — — — — — — — Anthrax — — — — — — — — — — 1 — Cholera — — — — — 1 — — — — — 1 Diphtheria — — — — — — — — — -— — — Dysentery 3 13 22 28 22 27 6 6 26 4 2 159 Food poisoning 4 2 2 1 1 7 3 6 7 11 2 46 Infective jaundice 1 — 1 — 2 3 3 9 14 3 1 37 Leprosy — — — — — — — — — — — — Leptospirosis — — — — — — — — — — — — Malaria — — — — — — — 2 4 — — 6 Measles 39 63 99 92 135 385 17 11 1 — — 842 Ophthalmia neonatorum 1 — — — — — — — — — — 1 Paratyphoid fever — — — — — — — — — — — — Plague — — — — — — — — — — — — Relapsing fever — — — — — — — — — — — — Scarlet fever — 2 3 3 4 29 4 — — — — 45 Smallpox — — — — — — — — — — — — Tetanus — — — — — — — — — — — — Tuberculosis — 1 — — 1 3 5 19 46 34 19 128 Typhoid fever — — — — — — — — 1 — — 1 Typhus — — — — — — — — — — — — Whooping cough 4 2 4 7 4 20 1 — — — — 42 Yellow fever — —• — — — — — — — — — — Totals 55 85 132 131 169 477 39 54 99 53 25 1.319 21 TABLE 5 TOTALS NOTIFIABLE DISEASES NUMBER OF NOTIFIED CASES OF INFECTIOUS DISEASES IN WARDS PUTNEY CENTRAL BATTERSEA Roehampton Putney , Thamesfield West Hill Southfield Fairfield Earlsfield Springfield i Tooting Gra veney Bedford Furzedown Northcota Balham Ni ghtingale St.John Latchmere St.Mary's Park Shaftesbury Queenstown Acute encephalitis — — — — — — — — — — — — — — — — — — — — 1 Acute meningitis — — 1 2 — 1 1 1 —- 1 —- — — —- — —- 2 —- — 1 10 Acute poliomyelitis — — — — — — — — — — — — — — — — — — — — — —Anthrax — — — — — — — — — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — — — — — — — — 1 Diphtheria — — — — — — — — — — — — — — — — — — — — — Dysentery — 1 5 23 6 12 23 9 3 2 5 1 4 5 1 16 22 7 7 7 1 59 Food poisoning 2 6 3 5 1 6 4 1 3 1 3 1 2 2 — 2 1 2 — 1 46 Infective jaundice — 2 3 — 3 2 3 2 1 1 3 1 1 2 — 2 — 3 5 3 37 Leprosy — — — — — — — — — — — — — — — — — — — — — Leptospirosis — — — — — — — — — — — — — — — — — — — — — Malaria — — 1 — — — — — — — 1 — — 3 — 1 — — — — 6 Measles 6 19 48 92 59 36 41 45 43 45 41 43 16 39 12 24 56 44 22 61 842 Ophthalmia neonatorum.. — — — — — — — — — — — — — — — — — — — — —1 Paratyphoid fever — — — — — — — — — — — — — — — — — — — — — Plague — — — — — — — — — — — — — — — — — — — — — Relapsing fever — — — — — — — — — — — — — — — — — — — — — Scarlet fever _ 2 2 4 3 4 2 3 ? ? 1 2 _ 2 _ 2 7 ? 5 45 Smallpox — — — — — — — — — — — — — — — — — — — — — Tetanus — — - — — — — — — — — — — — — — — — — — — Tuberculosis 3 6 4 9 2 9 2 5 6 17 10 10 4 19 2 6 7 1 4 2 1 28 Typhoid fever — — — — — — — — — — — — — — — — 1 — — — 1 Typhus — — — — — — — — — — — — — — — — — — — — — Whooping cough 1 1 1 2 1 1 2 13 6 — — — — 1 — 6 3 1 — 3 42 Yellow fever — — — — — — — — — — — — — — — — — — — — — Totals 12 37 68 137 75 121 78 79 65 69 64 58 28 74 15 59 99 58 40 83 1.319 13 PUBLIC HEALTH INSPECTION A summary of the inspections and visits carried out during the year by the staff of the Environmental Health Section is given in Table 6:- TABLE 6 Primary visits Revisits Total To investigate complaints 8,021 6,890 14,911 Offices, Shops and Railway Premises Act 1,967 2,415 4,382 Infectious Disease Enquiries 666 55 721 Factories Act 747 948 1695 Hairdressing establishments — 195 195 Outworkers 59 — 59 Housing Clearance Area Schemes 123 74 197 Individual unfit properties 64 333 397 Housing reports 343 69 412 Housing Finance Act 1972 (Qualification Certificates) 236 292 528 Houses in multiple occupation 4,056 22,601 26,657 Improvement grants 1,211 190 1,401 Housing Act 1957 (Permitted numbers) 114 — 114 Housing Association (Conversions) 114 7 121 Long stay immigrants 418 278 696 New drainage 1,004 11,840 12,844 Smoke Control Orders 7,534 836 8,370 Food Premises 2,409 2,186 4,595 Market, Stalls and delivery vehicles 192 67 259 Food Sampling — 410 410 Pharmacy and Poison Act 128 1 129 Caravan sites 6 312 318 Animal board establishments 2 — 2 Riding establishments 2 8 10 Pet Shops 27 108 135 Rodent control 3,478 5,730 9,208 Disinfestation 947 — 947 Disinfection 215 — 215 Incontinent laundry service — 5,968 5,968 Flooding emergency 2,171 4,888 7,059 Hotels 35 63 98 Others 5,313 745 6,058 TOTALS 41,602 67,509 109,111 14 Table 7 gives details of the sanitary operations carried out during the year. TABLE 7 Putney Central B/sea Totals Premises cleansed and repaired 120 222 131 473 Drains tested 44 19 33 96 Drains cleansed or repaired 30 52 28 110 Water closets cleansed, repaired or renewed 45 61 37 143 Soil pipes altered or repaired 9 6 7 22 Waste pipes provided, altered or repaired 20 24 20 64 Rainwater pipes repaired 28 19 18 65 Roofs and gutters repaired 97 145 101 343 Damp conditions otherwise remedied 88 161 114 363 Yards drained or paved 1 11 1 13 Dustbins provided 1 6 1 8 Water cisterns cleansed, covered or repaired 2 2 2 6 Water supply reinstated 8 10 12 30 Defective stoves and fireplaces remedied — 2 1 3 Animals improperly kept — —- —- —- Accumulations of rubbish, et al removed 7 54 18 79 Smoke nuisances 134 66 56 256 Other nuisances 12 49 17 78 Totals 646 909 597 2,152 Number of preliminary notices served 298 620 153 1,071 Number of preliminary notices complied with 180 315 81 576 Number of abatement notices served 200 362 407 969 Number of abatement notices complied with 124 249 275 648 Legal proceedings During the year, legal proceedings were taken by the Council in 86 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 15 health inspectors. Plans are required to be submitted to the Council for approval under the drainage by-laws and during the year 952 applications were received. There were 3,025 tests made in connection with drainage installations and 41 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. 16 All dwellings in the borough, numbering approximately 97,559 and catering for a resident population of 294,000 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 0.15 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. 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. 17 There were five nursing homes in the Borough at the end of the year, with a total of 211 beds. Their categories and accommodation are given below together with the number of inspections made during the year:- Mental nursing homes (1) 120 beds Mother-and-baby homes (1) 23 beds Other nursing homes (3) 68 beds Inspections by medical and nursing officers 11 Inspections by public health inspectors .. 6 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. During the year, 3,478 complaints of infestation were received, 524 relating to rats and 2,914 to mice, in respect of which a total of 9,208 visits were made by the staff. 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, 981 birds and 453 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. 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. 18 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 requiret 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 124 persons registered under the Act. Under the Poisons Rules (No.2) Order, 1972, 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, £1.25. (b) for retention of name in the Corporation's list, 75p. a year. Consumer Protection Act, 1961 A Consumer Advisory Officer was appointed and with supportin staff moved into a Tooting Office late in the year. Within the shor operational period 704 enquiries had been received in respect of goods purchased which were not to the satisfaction of the purchaser. Offices, Shops and Railway Premises Act, 1963 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. TABLE 8 Class of premises Number registered Persons employed General inspections Revisits or other visits Offices 1,011 14,849 868 631 Retail Shops 1,774 7,983 866 1,526 Wholesale shops warehouses 112 1,157 57 82 Catering establishments open to the public. canteens 267 2,011 174 174 Fuel storage depots 2 43 2 2 Totals 3,166 26,043 1,967 2,415 19 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. Twentyseven 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. Breeding of Dogs Act, 1973 This Act provides that no person may keep a breeding establishment for dogs in the Borough except under licence. A 'breeding establishment' means any premises where more than two bitches are kept for the purpose of breeding for sale. Common lodging houses There are no registered common lodging houses in the Borough. 20 Land Charges Act, 1925 During the year, the Department dealt with 8,780 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. Flooding Emergency - 1st August 1973. On the evening of 1st August very heavy rainfall within a short period of time resulted in the flooding of 1,235 premises spread over a wide area of the borough. These consisted of 892 dwelling houses and 343 food shops. Many other premises may have been affected but these were neither seen by nor brought to the notice of the department. Every assistance possible was given to the occupants of the flood damaged dwellings by the various departments of the Council to help in their time of trouble. Each dwelling was immediately visited for this purpose. 582 carpets were collected from 359 dwellings to be dried and then returned. 464 dwellings were sprayed with disinfectant. Hot air blowers loaned by the R.A.F. were installed in 154 dwellings to help with the drying out. Arrangements were made for the provision of skips for occupants to deposit water spoiled furniture and furnishings and special refuse collections arranged. All drains and manholes were inspected and areas surveyed by the rodent control section. Damaged foodstuff was condemned at 50 shops. Throughout this period 7,059 visits were made by officers of this department. When the emergency work was completed further visits were made to prepare notices for service on landlords for urgent repairs and to deal with claims made on the Council for damage to property and/or effects. 21 HOUSING Housing Act, 1957 Closing Orders - Under Section 157 of the Act, 16 individual houses, two parts of houses and 16 basements were represented for closure; Closing Orders were made under Section 17(1) and Closing Orders under Section 18. Under Section 27, Closing Orders were determined in respect of four houses and two basements and permission was given for three houses subject to Closing Orders to be used for storage purposes. Housing Act, 1969 Closing Order — Under Section 60 of the Act one order was made when it was not possible to provide proper means of escape in case of fire to two attic rooms. Housing Acts, 1961-1969 Housing in multiple occupation Out of an estimated total of 12,000 houses in multiple occupation, 9,369 have now been fully inspected, 1,639 houses having been visited this year for the first time. An analysis of the register shows the occupation of the 9,369 houses to be as follows:- Occupancies: 2 3 4 5 6 7 8 9 10‡ No.of houses: 5,909 1,714 767 379 252 150 79 51 68 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 202 notices under Section 16 of the Housing Act, 1961, requiring the provision of means of escape from fire, and 48 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 four occasions. 22 The work carried out by owners, both voluntarily and following the service of notices, resulted in 342 houses being brought up to standard. In addition, in 659 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, 118 Notices of Intention were served giving notice of the Council's intention to restrict the number of occupants, and 45 Direction orders were served. Subsequently, three variations were made to a Direction Order where the owners had put in extra facilities and four orders were rescinded. In sixteen 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. Three Section 14 notices were subsequently served on owners who failed to carry out the requirements of the Order. 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 Finance Act, 1972 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. 23 The following is a summary of applications received and action taken during the year- Section 28(1)-Where a dwelling does not have all standard amenities:- Applications received 69 Certificates of Provisional Approval issued 41 Qualification Certificates issued 50 Section 29(1)-Where a dwelling already satisfies the conditions:- Applications received 120 Notices of Refusal to issue Qualification Certificates 19 Qualification Certificates issued 110 Caravan Sites and Control of Development Act, 1960 There are five licensed caravan sites containing a total of 21 dwellings in the Borough. 24 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 2,280 and during 1973 they were visited on 4,854 occasions. Details of the various types of food premises will be found in Tables 9 and 10 which follow. Food Hygiene (General) Regulations, 1970 The separate categories of trade carried on in food premises which are subject to these Regulations are shown in Table 9 which also summarises the visits paid to food premises during the year. There were nosummonses issued under the Regulations during the year. TABLE 9 PREMISES WHERE FOOD IS SOLD, STORED OR PREPARED Number Number of visits Bakehouses 25 129 Bakers 66 137 Butchers 152 283 Cafes and Restaurants 271 790 Canteens and kitchens 112 133 Chemists 43 61 Clubs 57 32 Confectioners 338 260 Dairies and milk depots 6 16 25 Dining centres 24 9 Fish Fryers 57 187 Fishmongers 28 40 Food Factories 14 63 Greengrocers 164 258 Grocers 399 901 Hostels and Homes 29 28 Market Stalls and Delivery Vehicles 160 259 Off Licences 129 56 Public Houses 159 293 Take Away Foods 33 200 Ice Cream Manufacturers 14 29 Other vitist - 690 2,280 4,854 TABLE 10 The following is a list of WORK COMPLETED TO COMPLY WITH STATUTORY REQUIREMENTS Wash-hand basins provided 29 Sinks provided 4 Provision of hot and cold water over sink and wash-hand basin 51 Accommodation for clothing provided 2 Premises repaired and redecorated 229 Dustbins provided .. 3 Soap, towels and nailbrushes provided 24 Floors and floor covering repaired 71 Ventilation and ventilated lobbies provided 20 Dirty equipment cleansed 28 Dirty refrigerators cleansed 21 Artificial lighting provided 15 Refuse cleared 19 Wash-hand notices provided 25 Infestation of rodents cleared 12 Yard surfaces cleansed or repaired 10 Trapped sink waste pipes provided 12 Dirty cooking ranges cleansed 5 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 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 160 food stalls in the Borough and 202 inspections were made during the year; 57 inspections were also carried out on vehicles under the above Regulations. 26 Food and Drugs Act, 1955 Section 16(1) of this Act provides that no premises shall be used for (a) the sale, or manufacture for the purpose of sale, of ice-cream or the storage of ice-cream intended for sale or (b) the preparat ion 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 17 applications for registration under the provisions of Section 16(1)(a) and 15 applications for registration under the provisions of Section 16(1)(b) were submitted to the Council. In all cases the premises were found to be satisfactory and registration was granted. Food complaints During the year 237 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 two traders for offences under this Act and the reasons for prosecution and the Court's findings are given below Subject of complaint Fine Costs Mouldy Party Pie £75 £10 Metal object in Steak and Kidney pie £20 £10 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 22 applications were received from persons to be registered as distributors of milk. In each case a certificate of registration was granted. Twelve notices of cancellation of registration were received. At the end of the year there were 236 persons and one dairy on the register. 27 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 provided 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 23 Sterilised 16 Untreated Nil 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 15 applications for such licences were received during the year. Butchers' shops There are 152 butchers' shops in the Borough and visits made to these shops during the year numbered 283. Slaughter of animals There are no licensed slaughterhouses in the Borough. 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 85 such shops in the Borough and 227 inspections were made during the year. Catering establishments All restaurants, cafes, and canteens were regularly inspected throughout the year. There are 227 such premises on the register and 881 inspections were made. 28 Bakehouses There are 25 bakehouses in the Borough and during the year 129 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. Three certificates of suitability were granted, but notices were served in respect of the remaining two basement bakehouses requiring work to be carried out before their certificates be granted, Bacteriological examination of food Five hundred and forty-three food samples were examined bacteriologically at the Public Health Laboratory during the year and details are given below:- Milk 61 Ice Cream 84 Shell fish 286 Fresh and artificial cream 33 Meat Products 14 Confectionery 13 Cheese 6 Fish 19 Others 27 Total 543 Milk The 18 samples of milk submitted to the turbidity test were reported to be satisfactory and of the 43 samples of pasteurised milk submitted to test 41 were reported to be satisfactory and 2 unsatisfactory. Ice-cream The 84 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. 29 The following table gives a summary of the results:- Grade Number of Samples 1 35 2 10 3 17 4 22 Total 84 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 305 samples of shell-fish, fish and eels were found to be satisfactory. Fresh and artificial cream The 33 samples were found to be satisfactory. Meat Products The 14 samples were found to be satisfactory. Other samples The results were found to be satisfactory. 30 REPORT OF THE WORK OF THE PUBLIC ANALYST FOR 1973 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, 847 other foodstuffs and 53 drugs. Of these 2 were submitted as formal samples, whilst 998 were purchased informally. One of the formal samples and 129 of the informal samples were found to be adulterated or below standard, representing 13.0 per cent. of the total samples submitted. The samples submitted for analysis comprised the following substances:- Beers, wines and spirits 13 Beverages (cocoa, coffee, tea, etc.) 7 Cereal preparations 18 Cheese products 36 Confectionery 121 Cream 33 Fats (butter, margarine, etc.) 26 Fish (canned, etc.) 26 Fruit (canned and dried) 49 Ice-cream 31 Meatproducts (including sausages) 201 Milk 100 Milk products 67 Pickles and condiments (including spices) 64 Preserves 26 Soft drinks 87 Soups 17 Vegetables 25 Drugs 53 31 TABLE 11 SAMPLES FOUND TO BE ADULTERATED OR BELOW STANDARD Sample No. Nature of Sample Report Formal 230 Processed Cheese Slices Contained excess Sorblc Acid (Preservative) Informal 7504 Canned Oysters Labelling: No surrounding line round ingredients list 7505 Baked Beans and Pork sausages with tomato sauce Labelling: Designation not in uniform print 7506 Baked beans with minced beef in savoury sauce Labelling: Designation not in uniform print 7507 Baked beans with bacon burgers in tomato sauce Labelling: Designation not in uniform print 7509 Ham and tongue paste Labelling: No list of ingredients 7510 Chicken paste Labelling: No list of ingredients 7511 Salmon and shrimp paste Labelling: No list of Ingredients 7512 Liver and bacon paste Labelling: No list of ingredients 7518 Savoury Roll Labelling: These products were not labelled in accordance with the provisions of the labelling of Food Regulations 1970 and "Preserves" was declared in place of "Preservatives". 7519 Ham and egg roll 7520 Chopped pork 7521 Pork luncheon meat 7523 Tomato juice, canned Labelling: This sample consisted of reconstituted tomato juice 7526 Tomato juice, canned Labelling: No list of ingredients in statutory form 7527 Hot dog sausages, canned Labelling: Designation not in uniform size print 7528 Mince meat Labelling: Bore no list of ingredients 7532 Cochineal Labelling: List of ingredients not prefixed by statutory wording 7535 Buttered brazils Centres were not brazil nuts 7537 Lys Cognac bar Labelling: The line surrounding the ingredients, also contained other printed matter 7554* Lard: Foreign body Bundle of textile fibres 7561 Soft drink concentrates Saccharin found but not declared 7563 Soft drink concentrates Saccharin found but not declared 7569 Butter drops Deficient in butter fat 32 Sample No. Nature of sample Report 7573* Bread: Foreign matter Dirty dough containing carbonised bread 7574 Grapes in heavy syrup Labelling: Bore no list of ingredients 7577 Vegetable juice cocktail Labelling: Ingredient list not prefixed by statutory wording 7578 Green olives, canned Labelling: Bore no list of ingredients 7579 Prune juice Labelling: Incorrectly described. A further statement read - "A water extract of dried prune". 7582 Butterscotch Deficient in butter fat 7583 Buttermints Deficient in butter fat 7615 Sausage meat (Pork and beef) Labelling: Pork mentioned first, but meat content equivalent to beef 7634 Baby beetroots Labelling: Pack unlabelled and not completely transparent 7649 Pheasant pate Labelling: Ingredient not prefixed by statutory wording 7666 Cherries in syrup Labelling: Bore no list of ingredients 7680 Ice-cream powder Labelling: Non-milk fat not mentioned on front label 7683 Westphalian, canned Labelling: Not an appropriate designation 7694 Processed cheese Deficient in fat, excess water 7702 Milk Deficient m non-fatty solids 7714 Buttered brazils Deficient in butter fat 7716 Buttered brazils Deficient in butter fat 7717 Malt vinegar Labelling: Bore no list of ingredients 7719* Stewed steak in gravy not meaty Total meat content satisfactory, but contained only 50 per cent of the statutory requirement of lean meat 7721* Dirty milk bottle, foreign matter Soil and vegetable debris 7722 Vegetarian Cheshire cheese Labelling: No statement of fat content 7725 Goat milk cheese Deficient in fat 7726 Yoghurt " Labelling: Samples were in fact low fat yoghurts, but the words "Low Fat" were inconspicuous 7727 Yoghurt 7728 Yoghurt 33 Sample No. Nature of sample Report 7751 Beefburger Deficient in meat content 7752 Ratatouille Provenscale Labelling: Ingredients listed in wrong order and without statutory prefix 7780 Sweetened concentrated orange juice Labelling: Glucose syrup described as "Liquid Glucose" 7796 Processed cheese with Ham and paprika Deficient in fat. Labelling: No statutory prefix to Ingredient list 7797 Processed cheese with ham Labelling: No statutory prefix to ingredient list 7798 Processed smoked cheese with ham Labelling: No list of ingredients 7799 Processed cheese with ham Labelling: No statutory prefix to list of ingredients 7800 Hollander processed cheese Labelling: No statutory prefix to list of ingredients 7802 Cheddar spread Deficient in fat 7804 Viennois Chambourcy Labelling: Incorrect designation 7809 Clotted cream Labelling: No address of packer 7821 Lobster pate Labelling: No line enclosing ingredient list 7844* Coco Cola drink "not genuine": too strong Contained too much flavouring essence compared with normal sample 7859 Sea greens Labelling: Label included a claim for minerals without giving details of those alleged to be present 7866 Strawberry sauce | Contained an excess of preservative (Para-hydroxy benzoicesters) 7867 Raspberry sauce 7877 Pork sausage meat Deficient in meat 7892 Grapefruit juice Contained less than 100 per cent grapefruit j uice 7899 Peche Viennoise Labelling: No statutory prefix to ingredient list 7900 Viennois Chambourcy Labelling: No statutory prefix to ingredient Iist 7913* Sliced loaf: foreign matter Carbonised bread on outside, mould present in crumbs 7914* Cooked courgettes, bitter and caused i 11 ness The sample was intensely bitter, probably owing to the natural formation of a bitter principle, cocur bitacin 7915* Plum jam, contained glass The presence of bottle glass in jam was confirmed 34 Sample No. Nature of sample Report 7926 Creamed smatana Labelling: Designation not appropriate. No statutory prefix to ingredient list 7927 Cultured buttermilk Labelling: No Statutory prefix to ingredient list 7936 Chicken and ham pie Deficient in meat 7949 Soft ice cream Deficient in milk solids not fat 7952 Spray dried fat Labelling: Improperly designated 7969 Real fruit yoghurt (Raspberry) Labelling: Should have been designated "Sweetened Yoghurt". 7970 Yoghurt (Apricot) Labelling: Should have been designated "Sweetened Yoghurt". 7971 Live Yoghurt with fruit (Apricot) Labelling: Should have been designated "Sweetened Yoghurt". 7982 Duck with orange soup, canned Labelling: "oranges" appear before "duck" on ingredient list and only just over four per cent of meat was found. "Orange" should thus appear before "duck" in the designation 7990 Orange topping Contained 260 parts per million of Benzoic Acid. No preservative was declared among the ingredients and Benzoic Acid is not allowed in this type of product 7996 Vanilla flavour Labelling: The statutory declaration of ingredients was absent 8020 Breakfast vitamins Deficient in declared amount of Ascorbic Acid 8026 Dried fruits (mixed) Labelling: Bore no statutory list of ingredients 8060 Yoghurt with pear and banana Contained prohibited preservative Benzoic Acid 8064 Orange drinking Yoghurt Labelling: Should have been designated "Sweetened Yoghurt" 8072 Dessert ice cream Labelling: Ingredients not given in explicit terms 8073 Cornish dairy ice cream Labelling: Ingredients not given in explicit terms 8075* Patum peperium, white particles on surface Mould 8086 Fruit salad in syrup Labelling: Ingredients listed in wrong order 8091 Skipjack tuna, canned Labelling: The designation should have included the carrying liquid-oil 35 Sample No. Nature of sample Report 8094 Cheese spread One of the portions showed a vigorous growth of mould 8096* Foreign matter in loaf Dirty dough with iron compounds 8137 Cider vinegar Labelling: The label bore no list of ingredients 8141 Ice Cream Deficient in fat and milk solids not fat 8170 "Liquid of Life" ("Tonic" medicine) Deficient in declared amount of Sodium Bicarbonate 8211 Ice cream powder Labelling: The words "contains non-milk fat" should have been clearly visible on both faces of the packet 8214 Bread sauce Labelling: The product was misdescribed: it is not a sauce but a sauce mix 8215 White sauce Labelling: The product was misdescribed: it is not a sauce but a sauce mix 8216 Marmalade Labelling: The list of inyedients was not prefixed by the statutory wording 8232 Steak and kidney pie Deficient in kidney 8249 Poacher's broth Labelling: Designation not specific 8254* Foreign object in milk bottle Adhesive paper (mouldy) 8260 Stewed steak with gravy Deficient in meat 8262 Casserole meat with gravy Contained a piece of charred fat 8284 Mushroom soup Labelling: Not a soup but a dry mix 8302 Bisque de Homard Labelling: No specific designation 8308 Chocolate confectionery Labelling: Was described as "noncocoa butter chocolate" which is a contradiction 8317 Fruit juicej Labelling: These samples all contained added sugar and should have been labelled "sweetened" 8318 Fruit juice 8319 Fruit juice 8334* Chocolate (Gin and butter lemon flavour) insect infestation Contained dead larvae, excrement and webbing of cocoa-moth 8348 Camomile flowers Labelling: List of ingredients was not in English 8363 Stewed steak with gravy Deficient in meat 36 Sample No. Nature of sample Report 8364 Herbal tonic food Labelling: No statutory prefix before ingredient list 8381 Windsor red cheese Labelling: The label did not bear a statutory declaration of the type of cheese as required by the Cheese Regulations, 1970 8385 Processed Cheddar cheese slices Excess Sorbic Acid 8389* Piccalilli, foreign matter Pieces of wood from packing case 8390* Breakfast cereal foreign matter Mould due to uptake of moisture 8412 Dried fruit salad Labelling: No list of ing-edients 8426 Vegetable goulash Labelling: Not a goulash but a dry mix 8446 Creamed potatoes Labelling: Should have borne an indication that it was a dry mix 8456 Mango j uice Labelling: (1) Should have been labelled "sweetened". (2) No statutory prefix to the ingredient list 8469 Frankfurters, canned Labelling: Salt not declared among the ingredients 8470 Westphalian Labelling: Unsatisfactory designation 8476 Thick chicken soup Labelling: Not a soup but a dry mix 8477 Parmesan Labelling: (1) The word "cheese" has been omitted (2) Did not bear the statutory statement of the type of cheese, as required by the Cheese Regulations, 1970 8479 Duck pate with orange Labelling: Duck was only third on the list of Ingredients 8499 Cocktail sausages Labelling: Sausages were packed in brine but salt was not included among the ingredients The 14 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 2 complaint samples were submitted but, following analysis, it was considered that the complaints were not justified. Details of these cases are given below:- 37 TABLE 12 Case No. Nature of Complaint t 7842 Milk Pudding (Tapioca) "Not what one would expect" The sample was of normal composition and consistency 8074 Foreign matter in loaf Patches of brown dough Milk samples During the year, 100 samples of milk were submitted for analysis (93 ordinary milk, 7 Channel Islands or South Devon milk). Of these one sample of ordinary milk was 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 Milkfat 3.0% 4.0% Non-fatty solids 8.5% 8.5% Total milk solids 11.5% 12.5% 38 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 1) TABLE 13 INSPECTIONS Premises Number on register Number of Inspections Written notices iers prosecuted (i) Factories in which Sections, 1,2,3,4 and 6 are to be enforced by Local Authorities 51 45 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 959 697 24 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 10 5 - - Totals 1020 747 24 - 39 TABLE 14 DEFECTS Particulars Number of cases in which defects were found Number of cases in which prosecutions instituted Found Remedied Referred to H.M. Inspector by H.M. Inspector Sanitary conveniences: (a) insufficient .. 3 3 - - - (b) unsuitable or defective 21 19 - - - (c) not separate for sexes .. - - Other offences against the Act (not including offences relating to outwork) - - - - - Totals 24 22 - - - Factories Act (Part VIII) OUTWORK (SECTIONS 133 AND 134) TABLE 15 Nature of work Section 1 33 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 cutions Wearing apparel making, etc. 52 - - - - - Curtains and furniture hangings 5 - - - - - Artificial flowers Lampshades 3 2 - - - - - Total 62 - - - - - 40 ATMOSPHERIC POLLUTION Clean Air Acts, 1956 and 1968 Legislation: The Smoke Control Areas (Exempted Fireplaces) Order 1973 Subject to certain conditions as to proper operation the Rayburn Prince 101 fireplace and the Rayburn Prince 301 fireplace are exempted by this Order from the provisions of Section 11 of the Clean Air Act 1956 (which empowers a Local Authority to make Smoke Control Orders prohibiting the emission of smoke from chimneys in the whole or any part of their district). Such exemptions will be authorized by the Minister when the amount of smoke emitted is so minimal as to be scarcely noticeable. Smoke Control Orders The Council's sixth Smoke Control Order was confirmed hy the Minister on 9th February 1973 and came into force on 1st November 1973. It had also been hoped that the seventh Order would become operative before the end of 1973, but the Gas Authority covering the proposed area has been unable to guarantee the required extra supplies before April 1975. The delay is especially unfortunate in that this will be the final Order, completing the Council's programme. Smoke, dust and grit nuisances and observations (a) Nuisances Number of Visits 256 Number of Revisits 121 Total 377 (b) Observations 101 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 furnacis 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. Three such notifications were received during the year. 41 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 two 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 Month - 1973 Smoke SO2 Smoke ##] January 55 172 76 272 February 35 100 74 234 March 61 173 64 183 April 30 115 54 173 May 29 101 42 125 June 39 95 27 81 July 24 72 35 91 August 31 101 43 117 September 38 99 54 108 October 32 139 73 178 November 63 168 94 213 December 35 113 57 155 Averages 41 121 58 161 42 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. 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, 57 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 95 reports were received from the Scientific Branch of the Greater London Council in respect of 13 of these baths. Satisfactory results were obtained in 86 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, taps and tanks Thirty-five samples were submitted for examination at the Public Health Laboratory and all but 2 were found to be satisfactory. 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 1973, are set out in the following table:- 43 TABLE 16 Details of bodies received Usual place of residence s Wandsworth Merton Elsewhere Unknown Post-mortem only 624 357 164 25 1170 Post-mortem and inquest 92 27 32 - 151 Total post-mortems 716 384 196 25 1321 Inquest only - - - - - Total inquests 92 27 32 - 151 Total bodies received 716 384 196 25 1321 VERDICTS AT INQUESTS HELD Accidental/misadventure 46 13 18 - 77 Alcoholism - 2 2 - 4 Natural causes 6 - 1 - 7 Open verdict 5 1 1 - 7 Suicide 30 6 8 - 44 Homicide 4 5 2 - 11 Drug Addiction 1 - - - 1 TOTALS 92 27 32 - 151 In addition to the above, a further 71 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 occured in the district. One such certificate was issued during the year. 44 Laundry Service During the first ten months 5,986 bags each containing about 10 lbs of soiled linen were collected and the contents laundered and returned to the owners. The last two months of 1973 the responsibility for administration of this service passed to Social Services. Disinfection and Disinfestation 215 disinfections were carried out during 1973 and 947 disinfestations for vermin etc. Personal Cleansing Station There were 88 cases of scabies treated, of which 42 were school children and 46 adults and children under school age. This involved 90 treatments to school children and 79 to adults and children under school age. Also treated were 818 verminous conditions, of these 650 were school children and 168 adults and children under school age. The total number of treatments in the case of school children was 885 and 201 for adults and children under school age. 45 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 1973 the following courses were attended:- A fire prevention course by one public health inspector and one technical assistant; An Air pollution control course by two public health inspectors; A course on Modern Management for Supervisory public health inspectors by a divisional public health inspector; A course for Diploma in Housing Management by a divisional public health inspector; A two day symposium on Food Hygiene and the E.E.C. by a senior public health inspector; A course on Office and shops inspection by one technical assistant; A one day symposium on Effects of E.E.C. Directive on Meat by a divisional public health inspector; A one day symposium on housing by two senior public health inspectors; A one day metrication course by eight public health inspectors; A one day symposium on air pollution by a public health inspector; 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, the Annual Conference of the National Society for Clean Air at Torquay was attended by the deputy chief 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 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. Two students were successful in obtaining the Diploma Examination for Public Health Inspectors. 46 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. Health visiting service 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 1973 4,048 Children born in 1972 3,064 Children bom in 1968/71 5,924 Total visits of all kinds paid by health visitors during the year- Successful visits 41,816 Unsuccessful visits 12,835 Total visits to the elderly 4,972 Domiciliary midwifery service Mothers attended in their own homes during the year were as follows:- Home confinements 212 Booked early discharges 445 Unbooked early discharges 430 Home nursing service The following table shows the total number of persons nursed and the visits paid during the year 47 TABLE 17 Age First visits Revisits Totals Under five years 61 468 592 5-64 years 932 27,352 28,284 65 years and over 2,213 104,100 106,313 All ages 3,206 131,920 135,126 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 nursi ng 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:- Incontinence pads 188,400 Incontinence rolls 5,760 Interliners 30,500 Henley pads (pkts) 696 Plastic sheets 398 Plastic pants 932 Mattress covers 49 Pads for relieving bed-sores 8 Hoists (all types) 34 Beds with mattresses 17 Ripple mattresses 64 Ripple cushions 13 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. 48 Home dialysis Arising mainly out of recurrent crises in general power supplies as a result of industrial action, it was considered essential that in the event of a failure of mains power supplies to patients on home dialysis, a scheme should be prepared to provide emergency power generators to patients' homes. Although hospitals could, for a time, allow one or two patients to dialyse in hospital renal units if power failure was very localised, this would not be possible for a large number of patients affected by a widespread interruption to power supplies. The scheme provided for the loan by the Army of two trailers, each carrying two generators (one a reserve) which could be taken to patients' homes and connected to special wiring which had already been installed in the patient's home, thus providing full power and lighting to the dialysis unit. I am pleased to report that in Wandsworth the scheme proved highly effective and field trials were completely successful. Full credit for the implementation of the scheme should go to the staffs of the Director of Development and the Director of Technical Services whose enthusiastic support and effort (often on a voluntary basis) ensured complete success. Table 18 below gives details of the one case completed in 1973:- TABLE 18 Hospital Date of completion of adaptations Cost Fulham April 1973 £1,683.30 49 TABLE 19 New patients seen:- Medical 112 Social 5,637 Totals 5,749 Contraceptive methods advised:- Sheath 229 Oral contraceptive 3,566 Diaphragm 340 Intra-uterine device 512 Other methods 151 No method advised 951 Number of attendances (including new patients) 32,654 Number of premises in use as family planning clinics at end of year 12 Number of sessions held 1,620 TABLE 20 DOMICILIARY SERVICE New cases Medical 9 Pregnant on referral (advised or for advice after delivery) 18 Social 160 Totals 169 Number of children on referral Termination of pregnancy 22 1 27 2 38 Cervical smears taken 73 3 41 4 22 First method chosen: 5 14 Intra-uterine device 77 6 8 Oral contraceptive 66 7 + 16 Cap 2 Sheath, etc. 8 Age of mother on referral Advice 16 16-20 40 21-24 43 Total visits made by doctors 723 25-29 37 30-35 28 35+ 18 Total visits made by nurses 1,816 Unplanned pregnancies Intra-uterine device 5 Total number of patients seen by doctors 573 Oral contraceptive 9 Cap 4 Sheath,etc. 7 25 50 Withdrawn from domiciliary service: Transferred to local clinics 70 Left district, transferred where possible 41 Transferred to other domicil iary services 8 Discharged (e.g. to care of G.P., gynaecologist, etc.) 21 Refused advice 2 Termination and sterilisation 7 Sterilisation - female 8 Vasectomy 4 Total 161 Total number of patients referred since April, 1967 —1,234 Number of patients being advised at 31st December 1973—442. Cervical cytology The detailed statistical information for 1973 is given in the following table:- TABLE 21 Number of clinics held each week 6 Total number of women examined 2,753 Total numberof sessions held 303 Average number of women examined at each session 9 Total number of cases cytologically and clinically negative (healthy women) 1,847 Total number of cases with morbid conditions 906 Morbid conditions found:- (i) positive malignant smears 11 (ii) cervical erosion 187 (iii) cervicitis 47 (iv) cervical polyp 71 (v) ovarian cyst 6 (vi) uterine fibroids 49 (vii) all degrees of prolapse 36 (viii) breast tumours 36 (ix) vulvo-vaginitis:- (a) monilia 66 (b) trichomonas 161 (c) non-specific 169 (d) senile vaginitis 64 (e) other 11 (x) other conditions 68 Total morbid conditions * 982 * Some patients had more than one condition. 51 Ante-natal and post-natal care Number of sessions attended by doctors 80 Number of sessions attended by midwives only 310 Number of women attending for ante-natal care 1,577 Number of women attending for post-natal care 7 Total attendances 1,788 Mothercraft and relaxation classes These classes continue to be popular with the mothers. Details are as follows:- Sessions held during the year 302 Number of mothers attending 61 Total attendances 2,212 Average attendance per session 7.3 Premature infants During 1973 the proportion of premature births was similar to that of previous years. Out of the total of 4,108 live births in Wandsworth, 329 babies were born prematurely. In addition there were 37 premature stillbirths. The table below gives details of premature births in Wandsworth:TABLE 22 Live births Died under 1 month Stillbirths 2lb.3oz. or less 9 9 2 Over 2 I b.3 oz. up to and including 3 lb.4oz. 25 3 13 Over 3 lb.4oz. up to and including 4 lb.6oz. 66 4 12 Over 4 lb.6oz. up to and including 4 lb. 15oz. 83 4 10 Over 4 lb. 15oz. up to and including 5 lb. 8oz. 146 2 - Totals 329 22 37 52 Child health clinics Statistics in relation to child health sessions are shown below:- Number of sessions held during the year 1,943 Number of children attending:- Born 1973 3,553 Born 1972 3,558 Born 1968/71 3,565 Total number of children attending 10,676 Total attendances 45,725 Average attendance per session 23 Handicap and observation register For the past eight years, a comprehensive register of handicapped children and of children at risk of developing a handicap has been kept in the Health Department. 11 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 1973, 1,625 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 undertaken. The completeness of the register depends on co-operative effort and, throughout the year, the collaboration of all concerned, that is, clinic doctors, hospital specialists, general practitioners, health visitors and others, has been excellent. The Chronically Sick and Disabled Persons Act, 1970 enabled greatly increased provision to be made for the welfare of handicapped people and has stressed even further the necessity for close association with the Social Services Department when dealing with the handicapped child. Much practical effort has gone into meeting the needs of any child or his family who can derive benefit from the additional facilities which may now be provided under the Act. The following tables set out the statistics relating to handicapped children under five years of age:- 53 TABLE 23 CHILDREN ON HANDICAP REGISTER Visual 22 Auditory 23 Language and speech 16 Epilepsy 28 Cerebral palsy 38 Spina bifida/hydrocephalus 28 Muscular dystrophy and other neuromuscular diseases 3 Metabolic and endocrine disorders 23 Alimentary disorders 10 Cardiovascular disease 43 Respiratory disease 14 Genital and urinary disorders 10 E.S.N. 10 E.S.N. (Severe) 52 Maladjusted, austistic and psychotic 2 Battered babies 16 Blood disease 18 Limb and skeletal abnormalities 22 Chronic illness (neoplastic) 1 Skin conditions 2 Other conditions 9 Total number of handicaps 390 Total number of handicapped children 278 Number of children with multiple handicaps 62 Number of children with chromosomal abnormalities (including Down's syndrome) 20 CHILDREN ON OBSERVATION REGISTER Under 2 years 774 2 and under 3 years 246 3 and under 4 years 193 4 and under 5 years 134 Total 1,347 54 Immunisation and vaccination TABLE 24 Immunisation and vaccination statistics for children under 16 years. Number of completed cases. (Note-A I though 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.) Smallpox vaccination: Primary vaccinations: Council clinics 407 General practitioners 426 Total 833 Revaccinations: Council clinics 949 General practitioners 873 Total 1,822 Diphtheria immunisation: Primary courses: Council clinics and schools 1,987 General practitioners 650 Total 1,637 Reinforcing injections: Council clinies and schools 3,097 General practitioners 824 Total 3,921 Whooping-cough immunisation: Primary courses: Council clinics and schools 1,807 General practitioners 600 Total 2,407 Reinforcing injections: Council clinics and schools 1,098 General practitioners 319 Total 1,417 Tetanus immunisation: Primary courses: Council clinics and schools 2,060 General practitioners 762 Total 2,822 55 Reinforcing injections: Council clinics and schools 3,219 General practitioners 906 Total 4,125 Poliomyelitis vaccination: Primary courses: Council clinics and schools 1,945 General practitioners 635 Total 2,580 Reinforcing doses: Council clinics and schools 3,118 General practitioners 843 Total 3,961 Measles vaccination: Council clinics and schools 1,119 General practitioners 335 Total 1,454 Rubella vaccination: Council clinics and schools 1,599 General practitioners 36 Total 1,635 Chiropody service Statistics for the year 1973 are given below:- TABLE 25 Number of sessions held:- at clinics 3,442 at day centres and homes for old people 458 Number of patients seen for the first time in 1973:- at clinics, day centres and homes for old people 5,304 at private surgeries 742 in their own homes 2,142 Number of treatments:- at clinics, day centres and homes for old people 27,018 at private surgeries 4,414 in patients' own homes 11,789 56 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. TABLE 26 Numbers of new cases living in Wandsworth and attending hospitals During the year All conditions Syphilis Gonorrhoea Other genital infections Other conditions Primary and secondary Other (1) (2) (3) (4) (5) (6) (7) 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 1972 5,466 33 47 845 3,059 1,482 1973 5,761 30 36 859 3,266 1,570 57 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 1,248 questionnaires were scrutinised in the year. 170 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 106 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 120 examinations related to employment with the Council, including drivers of heavy goods vehicles. STAFF TRAINING AND STUDENT TRAINING 1973 - Courses and Training Numbers attended Health Visitors' Refresher Course 3 School Nurses Refresher Course 2 Fieldwork Instructors' Course 3 Management Courses Lower Middle Management C 3 Management Appreciation C 4 Other short courses for: Health Visitors, District Nurses, School Nurses and Clinic Nurses 14 Health Vi sitor Students Sponsored 1972—73 7 Health Visitor Students Sponsored 1973-74 9 Communi ty experience for Pupil Midwives, Obstetric Nurses, Student Nurses and Pupil Nurses. Pupil Midwives - 13 weeks 24 Student Nurses - 6 weeks 32 Observation Visits Obstetric Nurses - 1 day 26 Obstetric Nurses - ½day 104 Student and Pupil Nurses - 1 day 142 58 SCHOOL HEALTH SERVICE Report of the Principal School Medical Officer for the year 1973. Pupils on school rolls In May, 1973, there were 49,871 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 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 1973 totalled 15,500. Of those children inspected, 16.3% were referred for treatment of defects. 7.1% being referred for treatment of defects other than vision. 59 The following table shows the number of children referred for treatment or observation of the defects listed at routine general medical inspections during 1973, expressed as a rate per 1,000 children inspected. TABLE 27 Numbers examined 1973 15,500 Defects Rate per thousand Treatment Observations Skin diseases 6.97 5.03 Eyes—vision 92.97 56.06 squint 5.81 4.39 other 0.97 1.68 Ears — hearing 9.55 11.16 otitis media 2.26 1.81 Nose and throat 3.87 10.00 Speech 5.35 7.29 Enlarged cervical glands 0.52 1.42 Heart and circulation 2.58 7.87 Lungs 7.16 6.26 Orthopaedic 6.26 6.97 Nervous system 3.23 2.12 Psychological 8.45 22.77 Developmental—hernia 0.71 1.42 other 1.55 3.61 Abdomen 0.77 1.55 Details of non-routine medical inspections carried out in 1973 are as follows:- TABLE 28 Reinspections 8,923 Secondary school annual surveys 136 Other non-routine inspections (see Table 29 below) 5,190 7-plus experimental scheme inspections 140 Totals 14,389 Total routine and non-routine inspections 29,889 60 Analysis of non-routine medical inspections TABLE 29 Nature of Inspection Number Inspected Bathing centre inspections: Scabies 7 Other — Employment certificates 505 Theatrical children 45 School journeys 2,962 Recuperative holidays: Before holiday 88 On arrival 1 Outward Bound courses 6 Infectious disease investigation 1 Boarding Schools for the Delicate: Pre-departure inspections — On return from school — Handicapped pupils: Statutory examinations 117 Periodic special defect examinations 698 Research investigations and enquiries 9 Special examinations at request of: Head Teacher: Child's name entered in special book 62 Others 240 School Nurse: After health survey 13 Others 90 Divisional Officer (Education) 38 Divisional Education Welfare Officer of Care Committee 35 Parent 111 School Medical Officer 86 All other non-routine inspections 76 Total 5,190 61 Routine medical inspections TABLE 30 Physical condition of pupils Proportion satisfactory and unsatisfactory: Satisfactory 99.20% Unsatisfactory 0.80% TABLE 31 Attendance of parents and Care Committee representatives Number of pupils inspected 15,500 Parents present 54.9% Care Committee representative present 51.7% 62 Personal hygiene TABLE 33 Year Number examined Number found verminous Pupils found to be verminous % of number examined Annual comprehensive health surveys 1973 28,141 504 1.79 Additional health surveys 1973 18,100 604 3.4 During both types or survey, vermin were found on 1,108 occasions, representing 2.40% of the total number of examinations. The number of individual pupils found to be verminous was 694 or 1.39% of the school roll of 49,871. On 849 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 259 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 650 Total attendances 885 Scabies Cases treated 42 Total attendances 90 Impetigo Cases treated Nil 63 Infectious illness reported from schools TABLE 34 Chicken-pox 213 Dysentery, diarrhoea or enteritis 16 Erysipelas - Food poisoning - German measles 225 Glandular fever 2 Impetigo 29 Influenza 4 Jaundice 4 Measles 409 Mumps 121 Ophthalmia and conjunctivitis 8 Pneumonia - Ringworm (body) 4 Ringworm (scalp) 8 Scabies 21 Scarlet fever 49 Sore throat 10 Tonsillitis 35 Whooping cough 14 Other illnesses 2 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 school children The number of sessions, new cases and total attendances at school treatment centres during 1973 were as follows:- TABLE 35 Type of clinic Sessions New cases Attendances Minor ailments (nurse) 620 1,645 ) 7,192 Minor ailmerits (doctor) - - Special investigation (i.e. enuresis, obesity and behaviour problems) 272 222 1,782 64 Dental 5,022 5,787 18,221 Vision 244 689 3,548 Orthoptic 91 48 261 Audiology 56 80 237 More detailed information about some of these clinics will be found later in this report. 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 1973 the number of children receiving special education at schools in Wandsworth was as follows:- TABLE 36 Type of handicap Day Residential Blind 10 82 Deaf 30 31 Delicate 110 — Educationally subnormal 691 — Maladjusted 64 68 Physically handicapped 58 — 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 65 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 237 children attended during the year. During 1973 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 1973 are as follows:- PupiIs given screening tests 4,551 Pupils given pure-tone tests after failing screening tests 480 Pupils referred to otologist 47 Special investigation clinics These are six special investigation clinics in the Borough, which are run jointly with the Inner London Education Authority. Children are teated for enuresis, obesity and behaviour problems, or a combination of these difficulties. Most cases are referred following 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, 222 new cases were dealt with and the total attendances numbered 1,782. 66 B.C.G. vaccination of school children 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 37 (a) Number of eligible children 5,408 (b) Number of consents received 4,851 (c) Number of consents received for alleged contacts of known cases of tuberculosis (included in (b)) 10 (d) Number of children skin tested and read 4,163 (e) Positive reactors among (d) not previously vaccinated 306 - 7.3% (f) Positive reactors among (d) known to have been previously vaccinated 387 - 9.2% (g) Negative reactors among (d) 3525 - 84.6% (h) Number of children skin tested, but not read (absentees) 290 (i) Number of children vaccinated 3,525 School dental service Some details of this year's work are as follows:- TABLE 38 Sessions: Health education 434 Number of treatment sessions 3,920 Number of inspection sessions in schools and clinics 309 Total 4,663 67 Inspections: Number of first inspections in schools 33,249 Number of first inspections in clinics 7,168 Total 40,417 Percentage requiring treatment 47.3 Reinspections at clinics or schools 2,758 Percentage requiring treatment 47.4 Attendances: First visits 5,787 Subsequent visits 12,434 Emergency visits 700 Total 18,921 Treatments: Courses of treatment completed 6,293 Fillings done 19,018 Other operations, including crowns, inlays, X-rays, etc. 11,917 Free school milk There are 65 junior schools in the Borough with approximately 16,000 children on roll. Following examination by school medical officers, the number of children receiving free school milk on health grounds at the end of the year was 457, 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.