AC 433 41 II The Health of Sutton Annual Report 1971 London Borough of Sutoon Dr. W.H. Kinstrie, MB, ChB, DPH Medical Officer of Health/Principal School Medical Officer SUT 7 CONTENTS PAGE NO. INTRODUCTION 4 PARTI GENERAL STATISTICS AND SOCIAL CONDITIONS 6 PART II EPIDEMIOLOGY 10 PART III PERSONAL HEALTH SERVICE 16 PART IV SCHOOL HEALTH SERVICE 34 PART V MISCELLANEOUS 46 PART VI ENVIRONMENTAL HEALTH SERVICES 50 PART VII APPENDIX - STATISTICS 75 W.H. KINSTRIE, MB., Ch.B., DPH. Medical Officer of Health and Principal School Medical Officer Unless otherwise stated, figures in brackets are for the year 1970. 1 MEMBERS OF HEALTH AND HOUSING COMMITTEE AS AT 31st DECEMBER 1971 Councillor F. Knights (Chairman) Councillor E.G. Trevor, FRICS., ARVA., (Vice Chairman) The Worshipful the Mayor, Mr. E.W. Harding Alderman J.L. Bott, O.B.E. Alderman A G. Taylor Councillors ' A.W. Deane A.G.A. Dyson G. Eve G.F. Everitt, J.P. H. Fox, J.P. J.L.Izard D.H. Mullins K.A. Rose, LL.B, MICE R.C. Squire, ACA R.S. Williams, B.Sc (Eng) Co-opted members: Nominated by: Dr. P.E. Heywood Local Medical Committee Dr. D.N. Lawson South West Metropolitan Regional Hospital Board Mrs. J.S. Buck Mr. N.G. Shelley, MIL. 2 HEALTH DEPARTMENT SENIOR STAFF Dr. W.H. Kinstrie, MB., Ch.B., DPH. Medical Officer of Health and Principal School Medical Officer Dr. N. Walter, MB., B.Ch., BAO., DCH. Principal Medical Officer Dr. R.A. Hill, MB., BS., DPH., DObst.RCOG Senior Medical Officer Mrs. B.M. Stewart, LDS., Chief Dental Officer Mr. H.Geo. Cripps MRSH., FAPHI. Chief Public Health Inspector Mr. D.A. Eves, DMA.. MRSH., MAPHI., Deputy Chief Public Health Inspector Mrs. I.M. Adamson, SRN., SCH., HV., DND.,(QN). Chief Nursing Officer Miss D.M. Sammonds, SRN., SCM., HV.Cert., MTD., QN., Principal Nursing Officer (Home Nursing and Midwifery) Mrs. R. Bozeat. SRN., SCM., HV. Principal Nursing Officer (Health Visiting) Mr. D.S. Clapson, DPA(Lond.)., MILGA. Chief Administrative Officer Mr. D.R. Gladwell, Senior Administrative Officer 3 The Worshipful the Mayor, Aldermen and Members of the Council, Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report of the Health Department for the year 1971 incorporating the Statutory Report of the Medical Officer of Health and the Principal School Medical Officer. The Health and Family Services Department officially ceased as a combined department on 1 st April 1971 and was replaced by separate Health, Social Services and Housing Departments. Vital Statistics The birth rate in 1971 was very similar to that of 1970. There was a significant decrease in the death rate partly due to the absence of an epidemic of influenza. It will be noted that there were only two deaths from pulmonary tuberculosis, the lowest figure ever recorded in the Borough. The number of deaths from cancer of the lung fell from 132 in 1970 to 102 in 1971. Deaths from cancer of the lung have varied during the past five years and at this stage it is not possible to forecast a downward trend. I await information as to the number of deaths for 1972 with considerable interest. There is an increasing percentage of the population in the borough over the age of 65 years and compared with other London Boroughs,Sutton has the third highest percentage of population over the age of 65 years associated with a diminishing percentage of population between the ages of 15 and 64 years. The Council must endeavour to increase the percentage of the working age group by encouraging more employment in the borough, e.g. offices and factories, and at the same time by providing additional houses for letting. Infectious Disease It will be noted that the total number of notifiable infectious diseases in 1971 was considerably less than that for 1970 largely due to a marked reduction in the number of cases of measles mainly as a result of vaccination against this disease. There is no doubt that measles could be eradicated if all parents of children accepted the advice that measles vaccination is just as important as immunisation against diphtheria and poliomyelitis. Community Nursing Services The Clinical Centre at Cheam Nurses' Home was completed early in 1971 and during the year the Home Nursing and Midwifery Services were centralised at Cheam Nurses' Home. The majority of health visitors and home nurses were on attachment to general medical practitioners by the end of the year. It will be noted that there was a tremendous increase in the number of visits made by home nurses (from 128253 in 1970 to 151992 in 1971). An increasing number of cases are being nursed at home instead of in hospital and this together with an increasing number of earlier discharges from hospital is making hospital beds more readily available for people on the waiting list for admission. The trend for home nursing instead of admission to hospital will continue provided there is an adequate Home Nursing Service. It is in the national interest to encourage this trend since the cost of nursing cases at home is considerably less than in hospital. Over the years it may be possible to gradually reduce the number of hospital beds. Environmental Health Mr. H. Geo. Cripps, Chief Public Health Inspector, was unfortunately on sick leave during the second half of the year and retired early in 1972. I would like to express my appreciation of the help given to me by Mr. Cripps; his long career was almost entirely with the London Borough of Sutton and its predecessors. As a result he had a considerable knowledge of the borough and his knowledge of the continuous flow of Government circulars on all branches of 4 the work of bis section could not be surpassed. Under these circumstances the report on the Environmental Health Section was prepared by the Deputy Chief Public Health Inspector who was appointed Chief Public Health Inspector early in 1972. There is increasing public interest in Environmental Health Services particularly in the fields of housing, food hygience, and pollution and pest control. The number of complaints regarding the condition of food increases every year. Housing I refer to a report given by the Housing Manager. It will be noted that there is considerable delay in rehousing Category I Medical cases (this category recommends immediate rehousing) particularly when the applicant is an elderly person. There was an increase in the number of applicants for old people's dwellings compared with 1970. Although there are now at long last a number of schemes under consideration for additional old people's dwellings, it will be many years before the total number of old people's dwellings is sufficient to cope with the demand. The provision of old people's dwellings results in additional accommodation for the general housing need since many of the elderly persons are living in accommodation surplus to their needs. The number of dwellings being built or planned for handicapped and disabled persons is completely inadequate. A considerable acceleration in the programme for the provision of old people's dwellings and dwellings for the handicapped is strongly recommended. National Health Service Reorganisation The Consultative Document on National Helath Service Reorganisation produced by Sir Keith Joseph, Secretary of State at the Department of Health and Social Security was received in May 1971. The three branches of the Health Services, i.e. Hospital, General Medical Practitioner and Local Helath Authority Services (except Environmental Health Services) will be integrated and operative from 1st April, 1974. Under these circumstances Local Health Authorities have just over two years to carry out further development in their health services. Reference is particularly made to the continued provision of Health Centres and an adequate Community Nursing Service. It is my hope that this Council will hand over to the Area Health Authority in 1974 a service of the highest order. I have pleasure in recording my grateful thanks to all the staff of the Health Department for their valuable and devoted service to the borough, and particularly to the Principal Medical Officer, Senior Medical Officer, Chief Dental Officer, Chief Nursing Officer, Chief Public Health I nspector and Chief Administrative Officer for their contributions to this report. The helpful advice of the other Chief Officers and their senior colleagues has been much appreciated and I express my thanks to all members of the Council and in particular to members of the Health and Education Committees for their support and guidance throughout the year. W.H. KINSTRIE, MB.,ChB., DPH., Medical Officer of Health and Principal School Medical Officer 5 GENERAL STATISTICS AND SOCIAL CONDITIONS PART I INDEX Page No. AREA AND POPULATION 7 DEATHS 1 BIRTHS 9 W.H. KINSTRIE, MB., ChB., DPH., Medical Officer of Health and Principal School Medical Officer 6 AREA AND POPULATION Population tables on this occasion have been restricted to the Registrar General's estimated mid-year population and population by age-groups. Area in Acres Census Population 1971 1961 1951 10732 168815 169095 176151 Population by Aqe-Groups - Census 1971 Years of Birth 1966/71 1956/65 1936/55 1921/35 1906/20 1896/1905 Before 1896 13145 23765 43410 31580 32405 15855 8660 Rateable Value 1st April 1971/72 1st April 1970/71 1st April 1969/70 £10,698,133 £10,306,369 £10,041,245 Estimated net product of a penny rate 1971/72 1970/71 1969/70 *£103,242 *new penny rate £41,145 £40,520 Estimated number of separately assessed properties: 1971/72 1970/71 1969/70 70,809 68,741 66,559 The following statistics have been supplied by the Registrar General:DEATHS FROM ALL CAUSES Male Female Total Crude rate per 1,000 Home Population Adjusted rate per 1,000 population (Comparability factor 0.89) 1971 874 935 1809 10.8 9.6 1970 950 1022 1972 11.8 10.5 1969 971 1054 2025 12.2 11.1 7 Deaths from certain causes Category 1971 1970 1969 1968 1967 1960 1950 Tuberculosis, respiratory 2 8 4 5 9 9 39 Cancer, Uterus 9 17 15 11 15 17 11 Cancer, Bronchus, Lung 102 132 112 113 120 83 52 Coronary disease 460 443 460 523 400 362 291 Bronchitis 81 98 90 93 83 82 75 Suicide 12 17 24 20 15 19 15 Motor Vehicle accidents 23 26 27 18 23 18 13 All other accidents 25 20 26 23 26 17 26 The number of deaths by cause and sex and age groups is given in full in Table 1 in the Appendix to this report. Infant Deaths Age Under 1 year of age MALES FEMALES Legit. Illegit. Total Legit. lllegit. Total TOTAL 1971 19 3 22 10 1 11 33 1970 8 2 10 16 1 17 27 1969 13 – 13 23 4 27 40 Under 4 weeks of age 1971 15 2 17 8 1 9 26 1970 4 2 6 14 1 15 21 1969 8 – 8 13 4 17 25 Under 1 week of age 1971 14 2 16 8 1 9 25 1970 3 2 5 13 – 13 18 1969 6 – 6 8 4 12 18 Infant Mortality Rates England & Wales 1971 London Borough of Sutton 1971 1970 Infant deaths per 1,000 total live births 18 14 12 Legitimate infant deaths per 1,000 legitimate live births 17 13 11 Illegitimate infant deaths per 1,000 illegitimate live births 24 25 22 Neo-natal deaths under four weeks per 1,000 total live births 12 11 9 Early Neo-natal Deaths under one-week per 1,000 live and stillbirths 10 11 8 Peri-natal Stillbirths and deaths under one week combined per 1,000 total live and stillbirths 22 22 15 8 BIRTHS 1st January - 31st December 1971 LIVE STILL Legit. lllegit. Total Legit. lllegit. Total M 1187 M 83 1270 M 13 M 2 15 F 1024 F 80 1104 F 12 F 1 13 2211 163 2374 25 3 28 93% 7% 100% 89.3% 10.7% 100% Total live and stillbirths Number of Stillbirths 2402 Live Birth Rate per 1,000 Home Population Males 15 Crude Adjusted by Comparability Factor 1.03 Females 13 Total 28 Stillbirth rate per 1,000 live and stillbirths 12.0 14.1 14.5 9 EPIDEMIOLOGY PART II INDEX Page No. PREVALENCE AND CONTROL OF INFECTIOUS DISEASE 11 IMMUNISATION AND VACCINATION 12 VENEREAL DISEASES 13 MASS RADIOGRAPHY 14 IMMIGRATION 15 W.H. KINSTRIE, MB., ChB., DPH., Medical Officer of Health and Principal School Medical Officer (Figures in brackets are 1970 figures) 10 PREVALENCE AND CONTROL OF INFECTIOUS DISEASE The following table gives the total number of infectious diseases notified during 1971 together with the figures for 1970 for comparison I nfectious Diseases Notified during the period 1st January 1971 - 31st December 1971 Disease 1971 1970 Diphtheria - - Dysentery 37 54 Encephalitis 1 1 Food Poisoning 14 6 Infective Jaundice 19 43 Malaria - - Measles 162 387 Meningococcal Meningitis 7 1 Ophthalmia Neonatorium - 1 Poliomyelitis - - Scarlet Fever 41 74 Smallpox - - Typhoid - - Paratyphoid - 1 Tuberculosis (Pulmonary) 8 28 Tuberculosis (Non-Pulmonary) 5 4 Whooping Cough 77 52 It will be noted that there were no cases of diphtheria or poliomyelitis during the year, undoubtedly due to the fact that the great majority of parents have their children immunised against these diseases early in life. There has been a significant drop in the number of cases of infectious diseases notified particularly for Measles, Scarlet Fever and Pulmonary Tuberculosis. 11 IMMUNISATION AND VACCINATION 1st JANUARY - 31st DECEMBER 1971 Type of Protection Completed Primary Courses Receiving Reinforcing Doses (Boosters) 1971 1970 1971 1970 Diphtheria/Pertussis/Tetanus 1932 1748 277 740 Diphtheria/Tetanus 179 135 2277 2361 Diphtheria 4 10 56 43 Tetanus 32 78 714 420 Poliomyelitis (Sabin-Oral Vaccine) 2265 1095 3673 5067 Smallpox 1317 1492 278 437 Measles 2442 2594 - - Rubella 1828 191* Typhoid 1260 919 234 137 Typhoid/Cholera 18 67 3 - Cholera 228 20 8 - Influenza 247 * Scheme commenced in Autumn 1970 Immunisation and vaccination is available at all the Council's Clinics and as the surgeries of general practitioners. An increasing percentage is being carried out by the general practitioners. There has been a continuation of the policy of immunisation and vaccination of school children going on trips abroad against smallpox, typhoid fever and cholera depending on which country is being visited. Circular 54/71 from the Department of Health and Social Security advised that vaccination against smallpox need no longer be recommended as a routine procedure in early childhood. Vaccination continues to be recommended for travellers to and from countries where smallpox is endemic and for health service staff who may come into contact with smallpox cases. This advice was implemented immediately. Vaccination against Tuberculosis (B.C.G.) is offered to all contacts of infectious cases and carried out by the chest physician. It will be noted that there is a decrease in the number of contacts seen by the chest physicians which is directly related to the reduction in the number of cases of pulmonary tuberculosis notified. In addition all school children who have not acquired natural immunity are offered this protection at approximately thirteen years of age. Pupils who may have acquired natural immunity are referred to the chest physician for chest x-ray to ensure that no treatment is necessary following their exposure to the infection. A. Contacts 1971 1970 B. School Children and Students 1971 1970 (1) Skin tested 49 127 (1) Skin tested 1343 1719 (2) Found Positive 0 1 (2) Found Positive 88 66 (3) Found Negative 49 126 (3) Found Negative 1210 1509 (4) Vaccinated 49 126 (4) Vaccinated 1210 1504 12 Influenza Vaccination Influenza Vaccination was offered to the following categories in the year 1971 Staff and residents in old people's homes Staff and children in children's homes Staff at Eldoret Day Nursery Social Workers Home Helps Nurses, Midwives and Health Visitors Key administrative staff. VENEREAL DISEASE Notification of new cases of Sutton residents from hospital treatment centres during the last 3 years are as follows 1971 1970 1969 Syphilis 11 2 5 Gonorrhoea 42 45 56 Other Venereal Conditions 548 518 439 Total 601 565 500 The number of new cases of venereal disease in Sutton residents continues to increase particularly in the younger age groups. As a result of Health Education I am of the opinion that the majority who have been exposed to infection and who have possible symptoms or signs of venereal disease do attend Special Clinics at an early stage in contra-distinction to what has happended in the past when many cases were very late in being diagnosed. In November 1970 the Chief Medical Officer of the Department of Health and Social Security requested local authorities to institute a more vigorous programme to follow-up contacts and discussions have taken place with the Consultant Veneriologists at St. Helier Hospital. Contact tracing is carried out by the nursing staff at the Special Clinics but rarely includes home visits. It is anticipated that during 1971 more active measures will be taken to trace contacts who have failed to attend the Special Clinics for examination. 13 MASS RADIOGRAPHY The Director of the Mass Radiography Unit has supplied the following statistics 1971 1970 Total x-rayed 1158 3018 Cases of Lung Cancer 1 M. 1 F. 2 M. -F. Cases of Pulmonary T.B. - M. - F. -M.-F. It will be noted that there is a considerable reduction in the total number x-rayed in 1971 compared with 1970. During 1970 the Regional Hospital Board reduced the facilities available for the general public to attend the Mass Radiography Unit, as a result of which sessions for the general public only were not held during 1971. There was considerable resistance by members of the Health Committees and Medical Officers of Health to the new policy of the Regional Hospital Board and it is hoped that their policy will be reversed during 1972. 14 IMMIGRATION Under the Commonwealth Immigration Act 1962 the Medical Officer of Health is notified of all long-stay immigrants who are visited as soon as possible after arrival. Enquiries are made regarding the health of the immigrant, x-ray of chest is recommended and the immigrants are given advice regarding medical services. The number of long-stay immigrants in the Borough remains remarkably small and the majority are employed in hospitals. County where passport was issued as stated by Port Health Authority Number of advice notes received during 1971 from ports and airports relating to the arrival of immigrants Number of first successful visits paid during 1971 Number of Pulmonary Tuberculosis notifications received in respect of immigrants during 1971 (A) Commonwealth Countries 1971 1970 1971 1970 1971 1970 1. Carribbean 9 18 1 2 – – 2. India 9 12 3 9 – – 3. Pakistan 1 6 – 5 – – 4. Other Asian 16 11 7 4 – – 5. African 6 10 4 2 – – 6. Other 11 22 3 11 – – (B) Non- Commonwealth Countries 1. European 19 21 6 4 – – 2. Other 13 16 6 1 – – TOTAL 84 116 30 38 – – In addition Medical Superintendents at hospitals followed up 37 (37 immigrants. 15 PERSONAL HEALTH SERVICE PART III INDEX Page No. MATERNAL AND CHILD HEALTH 17 PREMATURITY 17 CONGENITAL ABNORMALITIES 18 THE OBSERVATION AND HANDICAP REGISTER 18 DETAILS OF CLINICS 19 THE WORK OF CHILD WELFARE CENTRES 19 DISTRIBUTION OF WELFARE FOODS 20 PROPRIETARY WELFARE FOODS 20 THE WORK OF HEALTH VISITORS AND SCHOOL NURSES 20 CARE OF MOTHERS AND YOUNG CHILDREN 20 CLINIC SESSIONS 21 HEALTH VISITORS CASE LOAD 21 HOME VISITS 21 SCREENING PROCEDURES 21 AUDIOLOGY CLINIC 22 THE MOTHER'S CLUBS 22 ADVISORY CENTRES FOR THE ELDERLY 23 HEALTH VISITORS ATTACHED TO GENERAL PRACTITIONERS 23 TRAINING 23 DOMICILIARY MIDWIFERY AND HOME NURSING 24 HOME NURSING 24 LAUNDRY SERVICE FOR INCONTINENT PATIENTS NURSED AT HOME 24 DOMICILIARY MIDWIFERY 25 SUMMONING OF MEDICAL AID 26 NOTIFICATION FROM MIDWIVES 26 OPHTHALMIA NEONATORUM 27 MATERNITY OUTFITS 27 REFRESHER COURSES FOR MIDWIVES, DISTRICT NURSES AND PUPIL MIDWIVES 27 DISTRICT NURSE TRAINING 27 PUPIL MIDWIFERY TRAINING 27 LOCAL SUPERVISING AUTHORITY (MIDWIVES ACT) 27 CERVICAL CYTOLOGY 28 FAMILY PLANNING 28 CHIROPODY 29 DENTAL CARE OF MOTHERS AND YOUNG CHI LDREN 30 NURSING HOMES 31 NURSES' AGENCIES ACT 1957 31 MEDICAL ARRANGEMENTS FOR CHILDREN'S HOMES 32 HEALTH EDUCATION 33 W.H. KINSTRIE, MB., ChB., DPH., Medical Officer of Health and Principal School Medical Officer (Figures in brackets are for the year 1970) 16 PERSONAL HEALTH SERVICES Local Health Authority Personal Health Services are provided under the various sections of Part III of the National Health Service Act 1946 and are complementary to the services provided by the Regional Hospital Boards and Executive Councils. The Local Authority Health Services give particular emphasis to the more vulnerable members of the community - expectant mothers, pre-school children, school children, elderly and handicapped The emphasis is on early detection of abnormality; cases requiring treatment are referred either to the general practitioner or to hospital. Maternal and Child Health Births Notified by Medical Practitioners or Midwives - 1st January - 31st December 1971 (a) (b) In the area including those normally resident elsewhere Resident in the area including those born elsewhere, i.e. adjusted by inward and outward transfers 1971 1970 1971 1970 Live 3447 2965 Live 2398 2363 Still 28 25 Still 28 19 TOTAL 3475 2990 TOTAL 2426 2382 Births in Hospital 2268 2151 Births at Home 158 231 The number of home confinements continue to decrease but the work of the midwives has in fact increased since they delivered 112 cases in hospital and provided additional ante-natal and post-natal service for hospital booked cases. Prematurity Full schedule showing statistics will be seen in Table II in the Appendix to this report. Total Non-Premature Premature 1971 1970 1971 1970 1971 1970 Live births 2398 2363 2262 2229 136 134 Deaths among live births in the first month of life 25 21 11 9 14 12 Stillbirths 28 19 12 9 16 10 The Department of Health and Social Security's definition of a premature birth is one when the infant at birth weighs 5lbs. 8 ozs. or less. 17 Congenital Abnormalities It is a responsibility of the Medical Officer of Health to submit a confidential report to the Registrar General on congenital abnormalities detected at or shortly after birth. The following table shows the total notified to the Registrar General during 1971 1971 1970 Total No. of children born with abnormalities 37 38 Number of those who were stillborn 4 3 Number of those born alive who died within 10 days Nil Nil Number born with serious defects 9 9 Number which were of a comparatively minor nature 28 29 The Observation and Handicap Register There is a growing awareness of the importance of discovering handicapped children as early as possible. Many children acquire their handicapping conditions in the pre-natal, neo-natal or early post-natal periods of life. Infants who have been exposed to unfavourable hereditary or adverse experiences early in life are considered to be at risk and a register is kept of these cases so that they can be offered medical examination at regular intervals. In addition, the growing child may be placed at risk by accident or illness occurring during childhood. In order to ensure that each handicapped child is assisted to the extent necessary to make full use of his ability, a register known as the Observation and Handicap Register is compiled. Children whose names appear on this register are kept under special surveillance until they are aged 5 years by regular medical examination and full assessment of their developmental progress. Close co-ordination of the work of various agencies who are concerned with the well-being of a handicapped child is essential and this involves close contact with the general practitioners, hospitals, social workers and voluntary organisations. The Observation and Handicap Register provides the means by which this is achieved and when necessary ensures the future provision of educational facilities suited to the child's ability and handicap. The early years of the child's life are a vitally important period in his development. The young child with a disability which may interfere with normal learning processes needs early help to minimise or overcome the handicap before the child's optimal learning period has passed. The development of such children is particularly vulnerable because of restrictions which may be imposed by the disabilities on the range and quality of the child's experience and by unfavourable or unelightened attitudes of parents. 18 During 1971 109 (89) pre-school children had special medical examinations and full assessment by the Principal Medical Officer. The following recommendations were made in respect of 48 children Attendance at : Day Nursery 17 Nursery Class in an ordinary school 7 Class for Non-Communicating Children 5 Day School for Physically Handicapped 7 Special Observation/Diagnostic Class 7 Partially Hearing Unit 2 The Spastic Centre, Croydon 3 See tables III and IV in the Appendix of this report. Details of Clinics The Borough is served by Robin Hood Lane Health Centre and eight purposebuilt clinics supplemented by a limited number of sessions held in five premises rented on a sessional basis. The plans for a Health Centre at Roundshaw commenced in 1971 to replace the present termporary clinic which is in two adapted flats. The Health Centre will have accommodation for Local Authority Health and Dental Services, consulting and examination rooms for two general practitioners, offices for a section of an Area Social Work Team and in addition a number of multi-purpose rooms for use by the Child Psychiatrist, Educational Psychologists and voluntary organisations. The plans to adapt Shotfield Clinic into a Health Centre commenced during the year. The Executive Council for South-West London and Surrey requested accommodation for 11 general practitioners but the land available for the extension of the building for general practitioner services was insufficient to accommodate this number. It will only be possible to accommodate the 7 general practitioners who had initially requested Health Centre facilities at Shotfield. It is regretted that by the end of 1971 the detailed plans for both Health Centres were still the subject of discussion with the Department of Health and Social Security causing unnecessary delay The Work of Child Welfare Centres The work of the child welfare centres consists of the supervision of the development of all children under the age of 5 years with particular emphasis being placed on those children who are considered 'at risk' and those on the Observation and Handicap Register. Early detection of abnormality or development is an essential part of the service. Immunisation and vaccination against infectious disease is carried out at clinics as well as by the family doctor. Special Developmental Clinics are held at all the major clinics when children are seen by appointment for assessment of their mental and physical development. Statistics of attendance at the clinics are given in Table V in the Appendix of this report. 19 Distribution of Welfare Foods Government Scheme The Council acts as agent for the distribution of National Dried Milk, Cod Liver Oil, Orange Juice and Vitamin A & D tablets to authorised beneficiaries and the actual distribution is carried out by members of the Women's Royal Voluntary Service whose help in this scheme is greatly appreciated. Issues 1st January - 31st December 1971 National * Dried Milk (packets) Cod Liver Oil (bottles) *Orange Juice (bottles) A & D Tables (packets) Children's Vitamin Drops 1971 1970 1971 1970 1971 1970 1971 1970 1971 1970 8706 12240 736 1661 57795 60206 3085 3574 4514 - * Cod Liver Oil and Orange Juice ceased to be supplied as welfare foods on 30th April, 1971 and 31st December 1971 respectively. They were replaced by Children's Vitamin Drops on 1st April 1971. Proprietary Welfare Foods Infant Welfare Clinics held a stock of proprietary brands of welfare foods approved by the Medical Officer of Health for sale to bona fide clinic attenders at reduced prices. The sale of proprietary foods is undertaken by voluntary committees at all the clinics, working in close co-operation with the health visitors. The small profit made by these voluntary committeess is used to further the work at the clinics. The help given by voluntary workers not only in the sale of proprietary welfare foods but in assisting at infant welfare and other clinics is greatly appreciated. THE WORK OF HEALTH VISITORS AND SCHOOL NURSES Health Visitors Care of Mothers and Young Children Health Visitors carry out a programme of home visits, screening tests, consultations at clinics and group discussions with parents until the child reaches the age of five years. The following tables show the extent of their work 20 Clinic Sessions 1971 1970 Ante-Natal and Post-Natal 356 287 Infant Welfare and Toddlers examination 1801 1901 Mothercraft 326 305 Parentcraft 236 161 Health Education: Schools, Red Cross, St. John's Ambulance Youth and Adult Organisations 248 253 Hearing Tests 195 174 2. Health Visitors Case Load for children aged 0 - 5 years 0 - 1 year 1-5 years Families 1971 1970 1971 1970 1971 1970 2183 2363 9458 9113 8730 9012 Average case load for staff 90 in post 26 (24) 94 394 538 363 360 In addition Health Visitors carried out visits to 914 geriatric cases, 50 mental cases; 115 tuberculosis cases or contacts. The Department of Health and Social Security recommendation for the ratio of health visitors to population is 1 to 4300. The ratio in Sutton is 1 to 6500 (6430). 3. Home Visits 1971 1970 Children 0 - 5 years 23564 26269 Persons over 65 years 2043 2345 Following the retirement of the Chest Clinic Health Visitor all the Health Visitors undertook a case load of Tuberculosis cases and 185 visits were made. Screening Procedures The following screening procedures are offered to the parents of all infants (a) The Guthrie test at 6 days old for phenylketonuria. No cases were detected during 1971. (b) Cystic Fibrosis at 3-4 months of age in conjunction with the Queen Mary's Hospital for Children, Carshalton. One case was detected in 1971 and is under treatment. (c) Hearing test at 6-8 months. 50 (40) cases were referred to the Audiology Clinic. (d) Sickle Cell Anaemia - a condition found in coloured children. Of 11 children screened 2 were positive 21 Research continued in the borough in the following projects (1) National Survey of Health and Development (2) Spina Bifida Survey (G.L.C. Research and Intelligence Unit) (3) British Births Survey (British Births Child Study, St. Mary's Hospital Medical School) (4) Survey of Childhood Cancers (Juvenile Cancer Registry) (5) Mother and Baby follow-up (Banstead Hospital Unit) During 1971 a National Surveillance of Congenital Rubella defects was commenced. The aim of this surveillance is to determine whether the incidence of congenital defects is significantly diminished as a result of Rubella vaccination. Audiology Clinic Children under 5 years of age referred to the Audiology Clinic for a more detailed examination of their hearing in the following circumstances (1) Children failing their screening test of hearing at 6-8 months of age. (2) Any baby whose mother has a history of rubella in pregancy. (3) Where there is a family history of deafness. (4) All children with slow speech development. (5) Any child suspect of any hearing loss. (6) Any child who has had rhesus incompatibility at birth. The work of the Audiology Clinic has increased during 1971. This is due to the awareness of the importance of early detection of hearing loss in young children and the necessity for early treatment. The number referred during 1971 is as follows :- Age New Cases Total Consultations Referred to E.N.T. Dept. No. of Hearing Aids issued Years 1971 1970 1971 1970 1971 1970 1971 1970 0-2 50 40 65 65 1 2 1 2 2-5 100 69 149 108 8 10 2 - The Mothers' Clubs These clubs are held at the Local Health Authority Clinics for any mother with young children under 5 years of age. They are held every week or fortnight in the evening or during the day, and if they are held during the day there is a rota for the mothers to care for the children in another room. The Health Visitors initially form the club, subsequently handing over the responsibility for the actual running of the club to the mothers, but are always available for advice and guidance. Speakers at the club are varied and topical with at least half of the time being spent on Health Education. The Mothers' Clubs are very entertaining and the young mothers make friends outside the home and enjoy social activities coupled with stimulating educational activities which is a morale booster to young mothers and those moving into the area. 22 Advisory Clinics for the Elderly These clinics are held at the major clinics in the Borough and are attended by both men and women after they reach pensionable age. A health assessment is carried out at the first visit and any abnormality detected referred to the family doctor. Subsequent visits include talks on nutrition, prevention of accidents, hobbies, etc. and following the talks; keep-fit exercises These clinics supplement the work of the Day Centres for the Elderly. In addition to the sessions at clinics sessions were commenced at three of the old people's homes in the borough. Bawtree House 16 sessions Braqmbleacres 20 Franklin House 17 Total 53 sessions Health Visitors attached to General Practitioners In accordance with the Department of Health and Social Security Circular 13/69 which recommends attachment of health visitors etc. to general practitioners, the great majority of health visitors were attached by 31st December 1971. (12 in 1970). In addition to attachments to general practitioners liaison arrangements were made with Paediatric Clinics and the Psychiatric Day Centre in Woodcote Road, Wallington. Training In 1971 four student health visitors were sponsored for training. All were successful and were absorbed on the established staff in October 1971. In addition 10 student health visitors were accepted from other local authorities for practical work instruction, under the supervision of Field Work Instructors. A further 3 health visitors undertook the Field Work Instructors Course, and 4 health visitors attended Refresher Courses. Every encouragement has been given to the nursing staff to attend Management Courses. The Chief Nursing Officer attended a Multi-Disciplinary Top Management Course. The Principal Nursing Officer (Health Visiting) and an Assistant Nursing Officer (Health Visiting) attended: Middle Management Courses and 3 health visitors attending First Line Management Courses 23 DOMICILIARY MIDWIFERY AND HOME NURSING The Domiciliary Midwifery and Home Nursing Service continued to be operated from the Nurses Homes at Sutton and Cheam. During 1971 a Nurses Clinical Centre was built in the grounds of Cheam Nurses Home and it is anticipated that early in 1972 the service will be centralised in Cheam with the closure of the Nurses Home in Sutton. HOME NURSING The following table gives some indication of the volume of work carried out by the home nurses 1971 1970 (a) Number of persons nursed 4488 3290 (b) Number of children under 5 years at 1st visit 115 85 (c) Number of persons aged 65 or over 65 1st visit 2971 2186 (d) Number of visits made by home nurses 151992 128253 It will be noted that there was a considerable increase in the total number of cases and visits. By the end of 1971 all the home nurses were attached to general practitioners. Laundry Service for Incontinent Patients Nursed at Home There is a continued demand for the laundry service for incontinent patients both in the borough of Merton and in Sutton. The service is greatly appreciated both by the patient and the relatives as well as by the home nurses. The total number of cases during the year 1971 was as follows Total during year Number of patients on books at end of year. 1971 1970 1971 1970 London Borough of Sutton 89 71 42 32 London Borough of Merton 99 98 48 49 24 DOMICILIARY MIDWIFERY The following table gives some indication of the volume of work carried out by the domiciliary midwives:- No. of domiciliary confinements attended by midwives under NHS arrangements during 1971 No. of confinements attended by D.M. in hospital No. delivered in institution but discharged to D.M. before 10th day Total No. of visits made by D.M. Ante-Natal cases visited by D.M. Doctor Present Doctor not present Total 1971 1970 1971 1970 1971 1970 1971 1970 1971 1970 1971 1970 1971 1970 25 39 133 185 158 224 112 27 614 627 17741 14301 4070 5178 It will be noted that the number of domicilary confinements continue to fall. The Department of Health and Social Security recommends that as far as possible all women should be confined in hospital but discharged home as soon as possible after the delivery. There has been increasing emphasis placed on the attendance of the domiciliary midwives at deliveries in hospital. There were 112 such deliveries in 1971 compared with 27 in 1970. It is not possible to attach midwives to general practitioners since the number of midwives is relatively small but all midwives have established a liaison area with groups of medical practitioners. 25 Summoning of Medical Aid During 1971 medical aid was summoned under the Midwives Act 1951 by midwives in the following number of cases:- For domiciliary cases: 1971 1970 Where the medical practitioner had arranged to provide the patient with maternity medical services under the National Health Service 66 47 For cases in hospital 328 328 Notification from Midwives During 1971 the following notifications were received from midwives:- 1971 1970 Sending for medical aid 394 375 Stillbirths 2 — Liability to be a source of infection (including pyrexia) 13 6 Death of mother or baby 1 (baby) 26 Ophthalmia Neonatorum During the year 1971 midwives sought medical aid for suspected cases of ophthalmia neonatorum in respect of 17 (7) babies, but no cases were notified. Maternity Outfits A maternity outfit is supplied free on request to each expectant mother being confined at home who makes use of one or other of the arrangements for the care of expectant mothers under the National Health Service. Refresher Courses for Midwives, District Nurses and Pupil Midwives Refresher Course Attended: 1971 1970 Midwives 2 2 District Nurses 6 8 Practical Work Instructors Course attended: District Nurses 3 2 District Nurse Training Student District Nurses who completed training and passed the examination (one with distinction) 9 7 Pupil Midwifery Training Pupil Midwives from Epsom and St. Helier Hospital Maternity Units receiving their Midwifery Part II training (all were successful in their examination) 36 25 Local Supervising Authority (Midwives Act) The Borough Council as the Local Supervising Authority are responsible for supervising the work of all midwives in the Borough. The following number of state certified midwives gave notice of their intention to practise as midwives in the borough during the year 1971:- 100 (100) 27 CERVICAL CYTOLOGY Sessions are held at all the major clinics in the borough and during 1971 frequent evening sessions were arranged for those women who were unable to attend day sessions. In addition to the cervical smears all women have a complete pelvic examination, breast examination, urine test and blood pressure. The National Scheme is for women over the age of 35 years. The Consultant Cytologist at St. Helier Hospital is carrying out a research programme which includes women over the age of 25 years who have had one or more children. In practice any woman who wishes to have a cervical smear is given an appointment. An increasing number of cervical smears are carried out by family doctors. Classification of Smears Class Number of Smears 1971 1970 I 1650 1924 II 831 869 III 14 4 IV 1 — V 1 — The family doctors are informed of the results in all cases and where necessary they arrange for hospital investigation. The following tables indicate the work carried out during 1971 1971 1970 Number of visits of women having smears taken for the first time 1205 1234 Number of visits of women having repeat smears 1292 1563 2497 2797 FAMILY PLANNING The Family Planning Association act as agents for the borough when women prefer to attend a Family Planning Clinic rather than attend their family doctor. The Family Planning Association is authorised to give appropriate advice and supplies to all women attending the clinic and may charge the local authority the cost of advice and supplies in medical and social cases. Family Planning Clinics were held at Priory Crescent Clinic, Green Wrythe Lane Clinic, Shotfield Clinic, Roundshaw Clinic, St. Helier Hospital and Sutton Hospital. A domiciliary Family Planning Service was begun during the year. 28 CHIROPODY SERVICE The following groups are eligible for chiropody under the Council's scheme. (i) Elderly persons, i.e. persons of pensionable age, receiving retirement pensions. (ii) Handicapped persons including registered blind and partially sighted (iii) Expectant mothers. The following cases were treated at sessions held at the majority of the Council's clinics, at day centres, as well as at the Council's old people's homes and old people's homes run by voluntary organisations, and also at chiropodist's surgeries. 1971 1970 Total number of cases attended 1830 1685 Total number of treatments 9247 8217 Where the elderly or handicapped person is unable to attend the clinic, domiciliary visits are made and 4929 (4097) visits were made in 1971. 29 DENTAL CARE OF MOTHERS AND YOUNG CHILDREN Although the proportion of teeth conserved to teeth extracted remains better than the national average, the number of young children attending dental clinics as 'emergencies' has shown a considerable increase during the past year, and the number of general anaesthetics administered and teeth extracted has risen in consequence. More than half the emergency cases were seen at Shotfield Clinic. The number attending this clinic will be reduced when the Roundshaw Health Centre is opened thus making it more convenient for mothers on Roundshaw to bring their children to the dental clinic. There is liaison between the medical and dental staff in clinics so that arrangements are made for pre-school children to have regular dental inspections, but unfortunately a number of the mothers do not bring their children for regular dental inspection resulting in an excessive number of emergency treatments. The number of expectant and nursing mothers attending for treatment was higher than in previous years and more dentures were fitted. See Table No. VI in the Appendix to this report. 30 NURSING HOMES The following registered nursing homes are situated in the borough:- Carshalton Nursing Home Ltd., 28 Salisbury Road, Carshalton. 103 Woodcote Road, Wellington The Avenue, 32 The Avenue, Cheam The Red House, 40 Burdon Lane, Cheam St. Margaret's, 17 Overton Road, Sutton Woodcote Grove House (Friends of the Poor and Gentlefolks' Help) Woodcote Park, Coulsdon. The following establishments are also registered as "Nursing Homes:- St. Anthony's Hospital, Cheam The Haven, Camden Road, Sutton (Mother and Baby Home) NURSES ' AGENCIES ACT 1957 In the year 1971 there were 4 (1) agencies licensed under this Act in the Borough:- The Empire Nursing Association Home Care Nursing Agency, 1 Langley Park Road, Sutton Trumps Nursing Agency, 40 High Street, Sutton Surrey Nursing Agency, 3 Mulgrave Road, Sutton Licences are issued annually subject to re-inspection and satisfactory report. 31 Medical Arrangements for Children's Homes Reception Home, Rosebery House, 7/9 Rosebery Road, Cheam Throwley House, 10 Throwley Road, Sutton Malvern House, Foxley Road, Kenley Camperdown Children's Home, 146 Woodcote Road, Wallington Dean House, 95 Nutfield Road, Merstham Working Girls' Hostel, 57 Montague Gardens, Wallington A general practitioner residing near the Reception Home is responsible for the examination of new admissions and discharges as well as for medical treatment. At all other homes a general practitioner is responsible for medical treatment. Examinations of new admissions and discharges are carried out by Medical Officers in Department. In addition a medical officer visits all the homes regularly, carries out routine medical inspections annually on all children resident in the home and is responsible for seeing that any special investigations and routine immunisations against infectious diseases are carried out. Advice is also given to the house parents on any medical aspect concerned with the care of the children. Each home is inspected regularly by the Principal Medical Officer and a report on the environmental conditions and the health of the children submitted. 32 THE HEALTH EDUCATION CENTRE The Health Education Centre continued to build up a library of audio-visual teaching aids. There are now 25 films and 183 sets of teaching slides on a wide variety of subjects. The acquisition of a comprehensive set of obstetric models and a heart and lung models have proved a good investment. With 22 films block booked from different libraries there is a selection of 47 films available at the Centre. A series of slides have been produced by the Health Education Centre illustrating the Local Health and other services. These slides have proved of great interest as teaching aids and for display. Synchronised to an explanatory tape recording, they have been shown at public functions. The increasing use of the Centre by many disciplines is indicated by the record of 515 films and 181 sets of slides booked out during the year. Catalogues were issued to all schools, health visitors, senior members of departments concerned with Health Education, and to interested groups and societies. Health Education in Clinics Health Visitors made considerable use of the Health Education Centre for a wide scope of talks to primary school children, young expectant and nursing mothers and to elderly citizens. Because of their established role in mothercraft and parentcraft courses, the midwives have also been responsible for Health Education in clinics. Health Education in High Schools Complementing the courses in health education carried out by one of the School Medical Officers, schools are undertaking health education on a broad basis within the context of the school curriculum. It is hoped that the biology, home economics and social studies departments will make increasing use of the service. Health Education in Primary Schools Primary schools are gradually making demands on these services, borrowing films, slides, models and requesting help with projects. Adult Further Education The Education Department in conjunction with the Health Education Officer have established pre-retirement courses for staff. Clubs and Societies Requests for speakers on health education topics have increased: doctors, dentists, public health inspectors and physiotherapists have undertaken this work. Home Safety The Home Safety Officer promoted Home Safety throughout the borough with unfailing enthusiasm and energy. Hazard House This invaluable teaching aid was circulated round thirteen schools in the borough and 3,597 children received instructions. Hazard House was also displayed over a period of two months in the Out-Patient Departments of St. Helier, Sutton General, Belmont and Queen Mary's hospitals, as well as to libraries and clinics. Courses in Home Safety 125 students took part in five courses arranged during the year. 33 SCHOOL HEALTH SERVICE PART IV INDEX Page No. PERIODIC MEDICAL EXAMINATIONS 35 SPECIAL MEDICAL EXAMINATIONS AND RE-EXAMINATIONS 35 HANDICAPPED PUPILS 35 PERSONAL HYGIENE 36 GENERAL MEDICAL CLINICS 36 DEFECTIVE VISION 36 DISEASES AND DEFECTS OF EAR, NOSE AND THROAT 36 ORTHOPAEDIC DEFECTS 36 SCHOOL DENTAL SERVICE 37 SPECIAL SERVICES 37 AUDIOLOGY 37 SPEECH THERAPY 38 CHI LD GUIDANCE SERVICE 38 SCHOOL PSYCHOLOGICAL SERVICE 38 OBSERVATION AND DIAGNOSTIC CLASSES 39 SCREENING PROCEDURE FOR INBORN ERRORS OF METABOLISM 39 HANDICAPPED PUPILS 40 SPECIAL SCHOOLS 40 CAREW MANOR E.S.N. SCHOOL 40 SHERWOOD PARK E.S.N. SCHOOL 41 NORTH DOWNS UNIT 41 BELMONT HOSPITAL SCHOOL 42 QUEEN MARY'S HOSPITAL FOR CHILDREN 42 QUEEN MARY'S HOSPITAL SCHOOL 42 THE FOUNTAIN SCHOOL 42 AUTISTIC UNIT 43 HOME TUITION 44 EMPLOYMENT OF CHILDREN OF SCHOOL AGE 44 PROVISION OF MEALS AND MILK IN SCHOOLS 44 Figures in brackets are 1970 figures W.H. KINSTRIE, MB., ChB., DPH. MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER 34 REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER SCHOOL HEALTH SERVICE On 31st December, 1971 there were 10,049 (9,197) pupils in High Schools, 14,028 (13,371) pupils in Primary Schools, and 295 (296) pupils in full-time equivalent places in Nursery Schools. This shows an increase of 1,508 pupils over the previous year attending Local Authority Schools. Periodic Medical Examinations During 1971 periodic medical inspections were carried out on (1) all new entrants to school (2) all school leavers Selective medical examinations are carried out on all children in their eigth and eleventh years. 46% of children in the 8 year old age group were selected for full medical examination, and 48% in the 11 year old age group. In addition to periodic medical inspections, pupils have a vision test at 5, 8, 11, 13and 14½ years of age, and a colour vision test at the age of 11 years. Pupils aged 6 years have a screening test for hearing carried out by an Audiometrician. There are three independent schools within the borough who avail themselves of these services with the consent of the Council:- Wellington Independent Grammar School Homefield School St. Hilda's School Special Medical Examinations and Re-examinations Pupils are examined when necessary following periodic medical inspection or when referred for examination by the head teacher or school nurse and at the request of parents. These pupils are examined either at the school or at general medical clinics. The total number of re-examinations in 1971 was 2,119 (3,048). Full details of defects found at periodic and special medical inspections are given in the appendix to this report - see Tables V11 and VIII. Handicapped Pupils The following table shows the number of handicapped children attending primary and high schools as at 31st December, 1971:- 1971 1970 (i) Epilepsy 65 56 (ii) Heart defect 26 22 (iii) Hearing defect 38 35 (iv) Diabetic 26 19 (v) Physically Handicapped 60 59 (vi) Partially sighted 9 8 (vii) Other handicaps 6 3 35 Personal Hygiene Routine hygiene inspection of pupils is carried out either at the request of the head teacher or at the school medical officer's or school nurse's discretion. Regular hygiene inspections each term have not been necessary at any school during 1971. The total number of inspections carried out was 4,994 (4,676) and 96 (83) children were found to be infested. It is the responsibility of the parents to carry out treatment but when necessary children are treated at school clinics. General Medical Clinics These clinics are held throughout the borough and are used to treat minor ailments, examine children brought forward for special medical examination and children who require re-examination following periodic medical examination. The principal minor ailments treated are diseases of the skin. One of the medical officers has specialised in the treatment of diseases of the skin, particularly the treatment of verrucae and cases are referred by general medical practitioners as well as by school medical officers. The total number of pupils treated for minor ailments, excluding skin diseases in 1971 was 305 (169). The total number of pupils treated for skin diseases was 358 (284). There has been an increase in the number of children treated for verrucae - no doubt due to the increased vigilance of teachers in identifying a skin condition of the feet and referring the pupil for treatment. There is no doubt in my mind, however, that a number of the cases are the result of physical training, including dancing, being carried out in bare feet. Defective Vision By arrangement with the Executive Council treatment of defective vision and squint is carried out at local authority clinics. The total number of pupils treated for defective vision, including squint in 1971 was 1,744 (1,223). Spectacles were prescribed for 545 (484). Diseases and defects of ear, nose and throat The total number of children treated for these defects in 1971 was 89 (124) of whom 39 (24) had operative treatment mainly for tonsils and adenoids. Orthopaedic Defects Physiotherapy sessions for minor orthopaedic and postural defects are held at clinics, at Carew Manor E.S.N. School, Sherwood Park School and the Observation/ Diagnostic Classes. The total number of pupils treated in 1971 was 307 (223). 36 School Dental Service The past year has shown a steady increase in the percentage of school children dentally inspected in spite of a further rise in the school population. Thanks to the co-operation of head teachers it has been possible to arrange re-inspection sessions in some schools, a saving of time out of school for the children concerned, and it is hoped that these sessions will be increased in the coming year. The percentage of children found to require treatment at their first inspection remains fairly constant but of those re-inspected a higher percentage were found dentally fit than in previous years. 41% in 1971 (35%). The staff situation has eased during the year and the post of Senior Dental Officer has now been filled. The total of dental officer sessions worked has risen, with a consequent rise in the number of children commencing and completing courses of treatment, the number of teeth filled but unfortunately a further rise in the number of teeth extracted. There is a good liaison between Dental Officers and the Health Education Officer resulting in an increase in dental health education programmes. Films, demonstrations and talks have been given in schools and Parent Teacher Association meetings by the Senior Dental Officer and the Health Visitors. To complement this work in the schools, clinics are now supplied with disposable toothbrushes and these, combined with the use of disclosing tablets (discloses plaque on teeth, a deposit caused by not cleaning teeth) should be of great assistance in the maintenance of good oral hygiene. Full details of the Dental Service statistics are given in Appendix IX to this report. Special Services (a) Audiology The early diagnosis of children with partial hearing is essential if normal progress is to be achieved in the development of speech and the child's education. The great majority of cases of deafness are diagnosed by hearing screening tests before the child begins school. Those children initially referred on account of speech defects which may be associated with partial deafness have a routine hearing test by the audiometrician before speech therapy is commenced. Children who show any defect in hearing are referred to the school medical officer who decides whether it is necessary for them to be referred for further investigation and treatment. In cases where there is a severe loss of hearing the pupil is referred to an ear, nose and throat specialist, and a decision made regarding the supply of a hearing aid. In a small number of cases the pupil is considered sufficiently handicapped to require special educational treatment at a partially hearing unit or special school for the deaf. In the less serious cases it may only be necessary to request the head teacher to make certain that the pupil sits near the front of the class and in the most advantageous position near the teacher. 37 The teacher for the deaf visits each school at which a child attends who has a hearing loss, to discuss the treatment and progress of each child with the head teacher. The co-operation of teachers in this respect is much appreciated. 1971 1970 New cases supplied with hearing aids 10 11 Pupils registered as having been fitted with hearing aids 63 51 Total number of children seen by Audiometrician 2,436 2,477 Number referred for further investigation 90 136 (b) Speech Therapy Speech therapy sessions are held at clinics and also at Carew Manor E.S.N. School, Sherwood Park Special School, Observation and Diagnostic Classes, Autistic Class at Queen Mary's Hospital for Children. The total number of children attending for speech therapy in 1971 was 272 (287). (c) Child Guidance Service The staff of the Child Guidance Clinic work closely with their colleagues in the Health Department, Social Services Department, Education Department and with Probation Officers, psychiatric colleagues in hospitals, and particularly closely with general medical practitioners. Educational Psychologists working within the School Psychological Service are based at the Child Guidance Clinic thus creating a closely integrated service. Following a diagnostic interview, treatment may be carried out at the clinic or referred for follow-up by the most appropriate agency, e.g. the Child Care Officers, progress being followed up by the Child Psychiatrist. Maladjusted children in need of special schooling are placed either in North Downs Day Special School or in residential schools for maladjusted children. The number of children referred to the Child Guidance Clinic during 1971 was 149 (130). Full details of the work of the Child Guidance Clinic are given in Table X in the Appendix to this report. (d) School Psychological Service In 1971 a total of 594 children were seen by the Educational Psychologists, 553 of these were seen under the auspices of the School Psychological Service and the remaining 41 were seen as part of their Child Guidance Clinic duties. From the Table XI in the Appendix to this report it will be seen that the majority of children were referred by head teachers or the Principal School Medical Officer. The Educational Psychologists have been involved in work in every school in the borough and have also maintained their regular commitments including 2 weekly sessions at Carew Manor E.S.N. School Fortnightly discussion sessions at North Downs Unit Counselling sessions at some High Schools. Arrangements are being made for regular visiting at Sherwood Park E.S.N. School and the Infant Observation/Diagnostic Classes. 38 The Educational Psychologists have also participated in further Education courses for pre-school play group staff. The appointment of an I nspector/Adviser for Special Education is welcomed and the Educational Psychologists have begun joint projects in conjunction with the I nspector/Adviser in many spheres of remedial teaching. Details of the work of the School Psychological Service are in Appendix XI to this report. Observation and Diagnostic Classes The two Observation/Diagnostic Classes which were attached to Primary Schools were transferred to a Special Unit at Belmont Hospital since the classes in Primary Schools were required for an increased number of pupils. Each class caters for 10 children aged between 5 and 7 years, and is staffed by a trained teacher and a school helper. The children admitted to the classes are fully assessed before admission. It is considered that pupils admitted would be unable to make progress in a large infant class. Each term a conference is held between the teacher of each class, the educational psychologists, the Principal Medical Officer and Chief Education Officer, to discuss each child's progress and the future placement. The staff of these classes are very happy with their new accommodation, although I still consider it desirable that the Observation/Diagnostic Classes should be attached to Infant Schools. The classes have been most valuable since their establishment and have formed an essential part of observing children's handicapping conditions closely in order to ensure that they are recommended for the type of education best suited to their needs. During 1971 a total of 36 children attended the classes (a) 8 children were transferred to an ordinary school (b) 3 children were transferred to Carew Manor E.S.N. School. (c) 2 children were transferred to Sherwood Park School (d) 1 child was transferred to a special school for maladjusted children (e) 2 children left the area (f) 20 children remained on register at 31/12/71. Screening Procedure for Inborn Errors of Metabolism Research has shown that certain handicapping conditions (i.e. mental retardation, disturbed behaviour and epilepsy) can be caused in a small percentage of children by an inborn error metabolism. In conjunction with Queen Mary's Hospital for Children, screening continues to be carried out for new pupils attending Carew Manor E.S.N. School, Sherwood Park E.S.N. School and the Day Unit for Maladjusted Children. 39 Handicapped Pupils It is the duty of the Council to make suitable provision for handicapped pupils in the borough. The Handicapped Pupils and Special Schools Regulations 1959 specify ten categories of handicapped pupils, namely:- Blind, partially sighted, deaf, partially hearing, educationally sub-normal, epileptic, maladjusted, physically handicapped, delicate and speech defect. The Chronically Sick and Disabled Persons Act, 1970 requires the Education of autistic and dyslectic children, neither of which are among the categories of handicaps listed in the 1959 Regulations. Children who have one or more handicaps may require special educational treatment if they cannot be educated satisfactorily in an ordinary school. The majority, however, do not require to attend a special school since suitable arrangements can be made for them to receive appropriate education in ordinary schools. Table XII giving full details is in the Appendix to this report. Under the Handicapped Children Education Act, 1970 the Local Education Authority is required to make provision to bring within the Education system all those children who were previously considered unsuitable for education in school. On 1st April, 1971, the power to exclude such children from education ceased and Local Health Authorities ceased to have power to provide training for them. No child within the age limits for education therefore is outside the scope of the educational system. The Education Committee therefore became responsible for Sutton Junior Training Centre, re-named Sherwood Park E.S.N. School, and for the Fountain School (Training Centre) at Queen Mary's Hospital for Children. SPECIAL SCHOOLS (a) Carew Manor School This special school is a day school for 140 educational sub-normal boys and girls aged from 7 to 16 years. The average number of pupils attending in 1971 was 139 (139). Before a child is admitted to this or any other special school for educationally sub-normal children a full medical examination is carried out and reports are obtained from an educational psychologist and, if necessary, from a psychiatrist. Every child attending the school has a physical examination annually and is psychologically assessed every 2 years. At the request of the head teacher or the parents, these examinations can be arranged at short notice at any time. In addition to regular weekly sessions at the school by the Senior Medical Officer and Educational Psychologists, three physiotherapy sessions are held each week and four sessions are devoted to speech therapy. The teacher for the deaf also visits regularly. 40 Before a pupil leaves school at the age of 16 years, a full medical and psychological investigation is carried out. A case conference is held during a pupil's last year in the school. The headmaster, careers master, Principal Medical Officer, Senior Medical Officer, educational psychologist, Youth Employment Officer and social workers attend, and a decision is made regarding the type of employment or training best suited to the pupil. In some cases pupils may not be accepted into employment immediately on leaving school, or may drift from one job to another. In these circumstances a recommendation is made that the pupils should be supervised by the Director of Social Services who may arrange for the pupil to have training in a sheltered workshop prior to taking up open employment in the community. It is regrettable that children ascertained as being educationally subnormal cannot be admitted to Carew Manor E.S.N. School before the age of 7 years. Many children are ascertained between the ages of 5 and 7 years and a number have been placed in E.S.N. schools in neighbouring Authorities. There is no doubt that these children should attend a school as near their homes as possible and it is hoped that additional accommodation in Carew Manor E.S.N. School will be made available for children under the age of 7 years as soon as possible. (b) Sherwood Park E.S.N. School This school provides education for 40 severely mentally handicapped pupils in temporary accommodation at 18 Stanley Park Road, Wellington. It is unfortunate that there has been a delay in transfer to the new school in Robin Hood Lane, Sutton. The new school will accommodate 70 pupils and will include a swimming pool, part of the cost of which was contributed by the Sutton & District Society for Mentally Handicapped Children. When the new school opens it will be possible to arrange for the attendance of 9 children resident in a private community home in the borough who at present attend an E.S.N. School in a neighbouring borough. It is also hoped that there will be a nursery class for children between the ages of 3 and 5 years. (c) North Downs Unit This unit caters for three groups of maladjusted children. The children remain on the register of their ordinary school and attend the Unit for varying periods from one to 4½ days each week. The children recommended for admission to the Unit are carefully selected in conjunction with the child psychiatrist and head teacher of the Unit. Many maladjusted pupils require continued contact with their homes and parents which can only be achieved by provision of day school places. The head teacher of the Unit continues to have close contact with the parents of children attending the Unit. At North Downs Unit the child can continue with his or her normal school curriculum. The primary purpose of the Unit is therapeutic and an environment is provided in which the child is helped to come to terms with his disabling emotional difficulties. The number of new admissions to the Unit during 1971 was 15 (22). 41 (d) Belmont Hospital School At Belmont Hospital there is a diagnostic unit for non-communicating children aged 3-8 years. They are referred from a wide area in the South of England. The children have a variety of severe language and emotional disorders. The unit is residential with with accommodation for 12 children. The unit is staffed by a multi-disciplinary team consisting of a consultant psychiatrist, two teachers, an educational psychologist and a specch therapist and also supervistory staff. The children's stay in the unit varies from a few months to two years, when they are then suitably placed in school. During 1971 tuition was arranged for 13 children at this unit. QUEEN MARY'S HOSPITAL FOR CHILDREN Queen Mary's Hospital for Children which is situated within this borough, is the largest children's hospital in the country. It was inaugurated in 1909 and treats all children's illnesses, both acute and chronic. Altogether there are 726 beds, of which 340 are for mentally handicapped children on psychiatric wards, and 386 for paediatric and other cases. In addition to the clinical departments there are, since 1st April, 1971, two London Borough of Sutton schools within the hospital, one for children receiving hospital treatment in the paediatric wards, known as Queen Mary's Hospital School: and the other for mentally handicapped children known as The Fountain School. A limited number of children attend both schools daily from this borough and surrounding boroughs. (a) Queen Mary's Hospital School When a child is admitted to hospital it is essential to continue his or her education as soon as he or she has sufficiently recovered from illness to do so. The school has the responsibility of teaching all children over the age of 2 years who are in hospital for medical or surgical treatment and who are, in the opinion of the medical staff, fit enough to have schooling. In fact most children do receive some form o teaching. Teaching takes place in the wards and in some classrooms set aside for school use. The latter includes the department for cerebral palsy, spina bifida, muscular dystrophy, maladjusted and autistic children. The last two units include children who attend school on a daily basis from outside the hospital. Only a small proportion of all children have homes in the London Borough of Sutton. The average number enrolled for the year to 31st December, 1971, was 167 (145). (b) The Fountain School Under the Education (Handicapped) Act, 1971 the Education Committee became responsible for the education of 340 children over the age of 2 years resident in the psychiatric wards of the hospital. Prior to April, 1971, 114 children aged between 4 and 16 years plus, received education in a training centre in the hospital known as The Fountain School. Twelve of these children came daily from their homes in the London Boroughs of Wandsworth and Sutton. The school consisted of a purpose-built school with 8 classes accommodating 80 children. The rest of the school was accommodated in another building. There are plans to build an extension to the purpose-built Foutain School. In April, 1971 The Fountain School became a school for E.S.N. pupils providing education for all mentally handicapped children in the hospital. Ideally it would be in each child's best educational interests to receive at lease port of his/her education away from the wards, but at present it is not possible to implement this owing to the very limited teaching accommodation at the hospital. 42 In order to determine the most suitable education for each child not attending the Fountain School, case conferences have been held at Queen Mary's Hospital for Children at regular intervals. These have been attended by the consultant psychiatrist with a team of experts from all disciplines within the hospital, senior officers in the Health and Education Departments of the borough, and the Head and Deputy-Head Mistress of The Fountain School. In addition, each ward has been visited by a team consisting of the Principal Medical Officer, the Inspector/Adviser (Special Education), the Headmistress of The Fountain School and the Assistant Matron. During these visits each child is observed individually and after considerable discussion involving both medical and nursing staff, recommendations are made in respect of each child's educational needs. Following these recommendations an increased number of children are receiving education in small off-ward groups and a limited number are receiving education in on-ward groups. It is intended to have a teacher on every ward with assistants and, where possible, when accommodation is available, to take as many children as possible off the ward for part of each day. In view of this unique situation, where there are 340 mentally handicapped children living in a hospital, some with dual and multiple handicaps, the Chief Education Officer considered it essential, in conjunction with me and with the co-operation and help of the medical nursing and teaching staff at Queen Mary's Hospital for Children, to prepare a detailed report to indicate the educational needs of all the children, the staff required to teach them, and the provision of additional accommodation and storage space needed to enable each teacher to function adequately. The compiling of the report was commenced this year and it is hoped it will be submitted to the Education Committee early in 1972. Having laid the foundations of the multi-disciplinary approach to the education of mentally handicapped children in all aspects of their education and care, I look forward to the challenge that lies ahead. I take this opportunity of thanking the staff at Queen Mary's Hospital for Children for all their help and support during the year. (c) Autistic Unit at Queen Mary's Hospital School This unit consists of three classes. Two classes provide education for children over the age of 5 years who have been diagnosed as suffering from autism. The third class is a class for children aged under 5 years who are unable to communicate. The class for children aged under 5 years is divided into two groups with usually four children attending the group during the morning or afternoon. All classes are staffed by a full-time teacher and nurse from Queen Mary's Hospital for Children. Children attending these classes may either be resident in Queen Mary's Hospital or attend daily from homes in the borough and occasionally from other boroughs. The class for very young children has proved most valuable as it enables small children with this disability to receive early education and observation by experienced staff in this particular handicap. All the classes are attended regularly by a speech therapist, psychologist, psychiatrist, and teacher of the deaf. Each term a conference is held to discuss the progress and placement of the children. Children are also admitted to the classes for a diagnostic and assessment period. This has proved most helpful in deciding a child's best future school placement. During 1971, 20 (17) children attended this unit including 8 children who were not resident in the hospital. 43 Home Tuition A small number of children are so severely handicapped either temporarily or permanently as to be unable to attend a school. Home tuition is arranged in these cases for as long as is necessary. During 1971 home tuition has also been arranged for three severely mentally handicapped children unable to attend an E.S.N. School. During 1971 home tuition was arranged for 15 (6). Tuition has also been arranged at the following hospitals St. Helier Hospital - Children's Unit Royal Marsden Hospital. Employment of Children of School Age The by-laws regulating the employment of children provide for their medical examination prior to employment and annual re-examination. The number of children being examined during 1971 was 251 (247). PROVISION OF MEALS AND MILK IN SCHOOL School Meals The number of day pupils receiving midday meals per day both at maintained and non-maintained schools during 1971 was as follows:- 1971 1970 Average meals (maintained schools) 14,841 16,250 (non-maintained schools) 417 350 TOTAL 15,258 16,600 There is a decrease of 1,342 compared with 1970; possibly due to the increased cost of school meals. Milk in Schools The provision of Milk and Meals (Amended) No. 2 Regulations 1971 which brought the provision of the Education (Milk) Act into effect, came into operation on 1st September, 1971. Under the regulations, Authorities were under a duty to provide free milk only for the following categories of pupils in maintained schools:- (a) Pupils in special schools (b) Pupils in other maintained schools up to the end of the summer term after they attain the age of 7 years (c) Other pupils in primary schools where the school medical officer certifies that the pupil's health requires that he/she should be provided with milk at school. These changes in the provision of milk in primary schools caused much comment both in the Press and in the Houses of Parliament. I personally regret the withdrawal of free milk in schools which would appear to have been done for economic reasons. 44 Towards the end of 1971 arrangements were being made for medical examination of children in the age group where free milk was withdrawn as follows (a) all children where any medical defect was known (b) all children receiving free meals in school (c) any children recommended for medical examination by the Director of Social Services (d) all children brought forward by the head teacher of the school (e) the parent of any child who requested the child's medical examination to ascertain whether he would benefit from free milk in school on health grounds. Of necessity the medical examinations had to be arranged over a period of months and the total number recommended to receive free milk will not be known until early in 1972. The number of day pupils receiving milk in maintained and non-maintained schools was as follows:- 1971 1970 Maintained schools 5,953 10,296 Non-maintained schools 739 1,359 total 6,692 11,655 45 MISCELLANEOUS PART V INDEX Page No. STAFF MEDICAL EXAMINATIONS 47 OFFICERS 47 MANUAL STAFF 47 GENERAL 47 HEAVY GOODS VEHICLE DRIVING LICENCES 47 MEDICAL EXAMINATIONS UNDERTAKEN DURING 1971 47 HOUSING DEPARTMENT 49 46 MISCELLANEOUS Staff Medical Examinations Officers In order to ascertain fitness for employment, the candidate either completes a medical questionnaire or a full medical examination is carried out by a member of the medical staff as soon as possible following interview and before an appointment is confirmed. The medical examination includes a routine x-ray examination of chest for all members of the staff having close contact with children and those who have been exposed to tuberculous infection. X-ray examination of other members of the staff is carried out when the examining medical officer considers it is desirable. Bacteriological and other investigations may be requ ired at the discretion of the Medical Officer of Health. Manual Staff A medical examination to ascertain fitness for employment is carried out within 6 months of first being employed and no further medical examination is required prior to acceptance into the Superannuation scheme. Manual staff who are in close contact with children and those who have been exposed to tuberculous infection have an x-ray examination of chest before commencing employment and at the discretion of the Medical Officer of Health, bacteriological examination of stools or any other investigation considered necessary. Employees of the Council generally Certain members of staff having close contact with children are required to have a periodic x-ray examination of the chest, for example, health visitors, distri ct nurses, child care officers, etc. A similar condition of employment was introduced for teaching and ancillary staff at schools appointed after 1st September, 1969. Under certain circumstances members of the staff are granted an extension of sick leave when their normal sick leave period has expired. Members of staff referred by Chief Officers to determine fitness to continue employment after the age of 65 years are required to pass a medical examination and are re-examined periodically. Heavy Goods Vehicle Driving Licences - Road Transport Act, 1968 A medical examination is now required to ascertain fitness prior to prospective drivers of heavy goods vehicles being granted a licence. Medical Examinations undertaken during 1971:- 1971 1970 Officers (excluding teachers) 161 188 Teachers 313 298 Manual Staff 235 297 Extensions of sick pay 9 11 Retirement due to ill-health 11 14 Extensions of service 128 129 47  1971 1970 Heavy goods vehicle drivers 35 21 Trainee Teachers 174 196 Medical Questionnaires 211 209 Other Medical Examinations Officers (including teachers) who had chest x-ray only 160 84 School Canteen staff who had chest x-ray only 261 241 School Canteen staff who had chest x-ray and bacteriological investigations 84 144 48 HOUSING DEPARTMENT New Properties During 1971, 252 (477) properties were completed. These were all at Benhill Avenue, Sutton and were part of the total development; Casual Vacancies, Mutual Exchanges and Transfers 246 properties were vacated and re-let during the year. 82 mutual exchanges and 152 transfers were arranged. Rehousing from Clearance and Redevelopment Areas To provide for the closing or demolition of dwellings 9(11) families were rehoused. Housing Waiting List At the 31st December, 1971, there were 2,337 (2,239) applicants on the Council's Housing Waiting List, of which 656 (588) were elderly persons. Housing of Special Cases The number of applicants housed during 1971 under the delegated authority granted to the following officers was\ : Medical Officer of Health 59 Housing Manager 17 Director of Social Services 18 (NOTE: Prior to the 1st January, 1971, the delegated power to authorise the housing of families in urgent need was vested in the former Director of Health and Family Services and during 1970/71 families were housed under this authority). At the 31st December, 1971 there were 159 further cases in which urgent rehousing had been authorised under delegated powers. Broadly, these fall into two categories. Firstly those who face the prospect of becoming homeless because the property in which they reside is to be demolished (either by the Council or privately), or because of personal domestic circumstances. These applicants are being rehoused as expeditiously as possible. The second category consists of applicants in ill health for whom better and/or more suitable accommodation is essential. Of the 159 cases 138 fall into this second group, of which 66 are elderly persons who health is being seriously impaired by the conditions in which they are living. Many of these elderly persons are handicapped and there is little hope of helping them until suitable accommodation is provided and attention is again drawn to the urgent need for more dwellings to be built for handicapped and disabled persons. Total Number of Properties The total number of properties owned by the Council and let by the Housing Department as at 31st December, 1971, was 7,535 (5,628). This figure includes the 1,655 properties transferred by the Greater London Council (St. Helier Estate) in April, 1971, to this Authority. 49 PART VI ENVIRONMENTAL HEALTH SECTION INDEX Page No. 1.1. INTRODUCTION 52 2.1 Food - Water supply and sampling 53 2.2 Food premises and vehicles 53 2.3 Food complaints 53 2.4 Unsound food surrendered or condemned 55 2.5 Chemical analysis of food and drugs 55 2.6 Labelling and trade descriptions 57 2.7 Milk 57 2.8 Ice cream 58 2.9 Bacteriological examination of other food stuffs 58 2.10 Slaughter houses 59 2.11 Poultry 59 2.12 Imported food regulations 1968 59 2.13 Water supply 59 2.14 Swimming Baths 59 2.15 Fertilisers & Feeding stuffs Act 1926 60 2.16 Rag flock & other filling materials Act 1957 60 3.1 OCCUPATIONAL HEALTH 61 3.2 Offices, shops & railway premises Act 1963 61 3.3 Accidents reported 63 3.4 Factories Act 1961 64 3.5 Work places 65 3.6 Hairdressers and barbers 65 3.7 Pharmacy and poisons Act 1933 65 4.1 POLLUTION CONTROL 66 4.2 Smoke control orders 66 4.3 Industrial furnaces and chimneys 66 4.4 Obnoxious effluvia 66 4.5 Accumulations 66 4.6 Rivers, streams, ponds and ditches 67 4.7 Noise Abatement Act 1960 67 4.8 Radioactive substances Act 1960 67 5.1 HOUSING 68 5.2 Inspection and action under statutory powers 68 5.3 Formal action under the Housing & Public Health Acts 68 5.4 Qualification Certificates - Housing Act 1969 69 50 Page No. 5.5 Overcrowding - Housing Act 1957 69 5.6 Houses in multiple occupation - Housing Act 1961 69 5.7 Common Lodging Houses 69 5.8 Survey - Housing Act 1969 69 5.9 Improvement 70 5.10 Rent Act 1957 70 5.11 Repair 70 5.12 Drainage and sewerage 70 5.13 Moveable dwellings 70 5.14 Infectious disease enquiries 71 6.1 PEST CONTROL 72 6.2 Prevention of damage by pests Act 1949 72 6.3 Insect pests 72 6.4 Land pests 72 7.1 MISCELLANEOUS DUTIES 73 7.2 Licences, permits and registrations 73 7.3 Diseases of animals Act 1950 74 7.4 Student training 74 7.5 Technical library 74 7.6 Soiled dressings disposal 74 8.1 MORTUARY SERVICE 74 9.1 ADMINISTRATIVE/CLERICAL SUPPORT 74 51 During 1971 two factors considerably affected the work of the Environmental Health Division. Mr. H. George Cripps, the Chief Public Health Inspector, who had worked in this area for more than 35 years, was forced to withdraw from the arena due to ill health. The many tributes that were paid to Mr. Cripps by members of the Council, his colleagues, and by members of the general public, were an indication that his services were very highly valued. The re-organisation of the work of the service on a functional rather than area basis took place in the second half year. Many reasons of varying importance contributed to the decision to make this important change. Among these were included the need to ensure that many responsibilities which might be regarded as being on the fringe of a Public Health Inspectors duty were properly met; to improve the supervision and to re-establish greater feeling of job satisfaction, too frequently an expensive casualty in the ever chaning pattern of departmental re-structuring and management survey applications, which are so aften a destructive influence in a modern Local Government service. It is with some feeling of uneasiness that the Public Health Inspectors approach a future when the traditional links with the Medical Officer of Health and the Personal Health Services will be broken, and the Environmental Health Services may represent the whole of the Local Authorities responsibilities for health matters. I believe that this report shows that these remaining duties are of a wide range and important nature, directly affecting the day-to-day well-being of all citizens of the London Borough of Sutton, and that they have been performed by ah understanding and enthusiastic group of officers. It represents a summary of thirty-nine thousand, one hundred and sixty-five (39,165) inspections and visits by Public Health Inspectors and Technical Assistants during 1971, of thousands of visits by Pest Operatives and General Assistants, and innumerable calls dealt with by clerical staff relating to complaints, enquiries grant payments, licence applications etc. D.A. EVES, D.M.A.,M.R.S.H.,M.A.P.H.I. Chief Public Health Inspector 2.1 FOOD-WATER SUPPLY AND SAMPLING The condition of the food we eat, and the manner in which it is prepared and handled, is a prime health consideration. The Public Health Inspector can influence the position by ensuring that a high standard of hygiene is maintained at food premises. The condition of food premises can be readily judged when routine inspections are carried out, but methods of handling which may be performed in an exemplary manner when an Inspector is present can be carelessly carried out a few minutes later. During the Clean Food Campaign to be held in 1972 it is intended to emphasise the importance of good handling practices to housewives and to all staff employed in the food trade. Housewives can do a great deal to raise standards of food hygiene by selecting to make their purchases at shops where assistants do not lick their fingers, blow into bags, unnecessarily handle food, wear grubby overalls smoke or expose food to the risk of contamination. 2.2 FOOD PREMISES AND VEHICLES Two thousand eight hundred and thirty visits and inspections were made during the year and one hundred and eighty-three notices were served regarding unsatisfactory conditions. Details are shown in the table on the next page. 2.3 FOOD COMPLAINTS The number of complaints received from members of the public continues to rise, not necessarily because standards are deteriorating but because of increasing public interest in food hygiene and standards and their awareness that a Health Department Service exists. The complaints relating to foreign bodies or mould involved the following foods: Article Article Alcoholic Drinks 1 Meat 3 Baby Food 1 Meat Pies 11 Beverage 3 Milk 18 Bread 27 Milk Bottles (contaminated or chipp 14 ed) Cereals 8 Cheese 5 Other Foods 8 Confectionary Flour 18 Sausages 7 Confectionary Sugar 1 Shell Fish 1 Cordial 2 Vegetables 3 Fish 3 Yoghurt 3 Fruit 7 Ice Cream 1 53 54 FOOD PREMISES INFRINGEMENTS OF FOOD HYGIENE (GENERAL) REGULATIONS 1970 No. of Premises No. of Inspections Carried out in premises No. of Premises registered under Sec. 16 of Food and Drugs Act Unsatisfactory Sanitary Accommodation Unsatisfactory Washing Facilities Defective and Dirty Premises Ventilation and Lighting Inadequate Washing Facilities for Food and Equipment Unsatisfactory First Aid Materials Inadequate Accumulations and Refuse Storage Inadequate Unsatisfactory Food Storage and Displays Unsatisfactory Personal Hygiene ]Miscellaneous Bakehouses 6 41 - - 1 7 - 1 - - 2 - - Bakers and Confectioners 43 166 14 6 5 13 1 1 1 2 4 - 3 Butchers 91 275 67 12 13 19 1 4 4 3 3 1 4 Canteens 103 209 - 4 - 7 - - - 1 - - - Chemists 44 73 - 1 - - - - - - - - - Confectioners (Sugar) 166 185 149 3 6 7 - - 4 1 9 1 - Fishmongers 16 28 4 - 2 1 - 2 - - - Fishfryers 23 68 23 2 3 6 - 3 1 - - 1 - Greengrocers & Fruiterers 91 203 20 7 12 6 - 1 4 4 4 4 - Grocers 99 238 61 3 3 9 - - 1 2 - - 2 General Stores 77 350 77 15 5 21 - 1 3 8 6 - 2 Licenced Premises 104 331 7 2 - 14 - 2 - - - 1 - Milk Storage Depots 3 25 - - - - - - - - 1 - Restaurants & Cafes 111 366 34 7 8 30 1 3 4 20 4 2 6 Food Factories 7 22 - - - - 1 - - - - - - Stalls & Vehicles 12 234 1 - 5 1 - - - - 1 1 4 996 2,806 457 62 63 141 4 18 22 41 34 11 21 Legal actions were authorised in regard to sixteen of the complaints received and fines and costs totalling £465 were imposed. 2.4 UNSOUND FOOD SURRENDERED OR CONDEMNED Food is subject to routine inspection at manufacturing, wholesaling and retailing stages. The majority of the items surrendered for destruction are examined as a result of requests from the management of food businesses. The following quantities of food found to be unsound, diseased or unwholesome and unfit for human consumption were surrendered and destroyed:- lbs lbs Alcoholic Drinks 16 Ice Cream 225 Beverages 30 Meat (fresh - home killed) 395 Cereals 191 Meat (fresh - imported) 1,424 Cheese 85 Meat Canned 2,076 Condiments 16 Meat Cooked 202 Confectionary Flour 398 Meat Products 225 Confectionary Sugar 66 Milk 59 Cream 56 Offal 277 Drugs 1 Other Canned Foods (e.g. fish) 556 Fats and Oils 910 Other Foods 334 Fish (wet) 387 Preserves 309 Frozen Food (cabinet breakdown) 12,691 Sauce 214 Frozen Food (general) 237 Sausages 19 Soup 35 Fruit (fresh) 60 Vegetables (fresh) 192 Fruit (canned) 5,174 Vegetables (canned) 405 Fruit Juice 984 21,302 6,947 2.5 CHEMICAL ANALYSIS OF FOOD AND DRUGS During the year five hundred and thirty-four samples were taken for chemical analysis and their constituents were examined in relation to statutory standards and many other factors, including a check that harmful preservatives and colouring matters are not being used. The sampling programme were often adjusted to arrange for checks on food stuffs which have been the subject of complaint. Fourteen formal and twenty-one informal samples were reported by the Public Analyst to be unsatisfactory. Further investigations were carried out in respect of each of these reports and details of the most significant cases are set out below The majority of food complaints are dealt with informally with the assistance of the Public Analyst, manufacturer, retailer, and often Public Health Inspectors in other Local Authorities. The following cases are selected from those where legal proceedings were instituted Food Complaint 10/71 - Loaf of Bread found to contain a cigarette end Legal proceedings were instituted against the Bakery and a fine of £5 was imposed with £5 costs. Food Complaint 67/71 - Custard Tart found to contain glass Legal proceedings were instituted against the Bakery and a fine of £5 was imposed with £5 costs. Food Complaint 78/71 - Sausages Skinless pork sausages were sold in a mouldy condition. Legal proceedings were instituted against the retailer and a fine of £5 was imposed with £5 costs. Food Complaint 108/71 Bread A wrapped sliced loaf was sold in a mouldy condition seven days after it should have been withdrawn from sale. Legal proceedings were instituted against the retailer who successfully cross summoned the Bakery Company. A fine of £20 was imposed with £5 costs. Food Complaint 106/71 - Milk Bottle A one third pint bottle of milk delivered to a school was found to contain a snail shell. Legal proceedings were instituted against the Dairy Company and a fine of £25 was imposed with £10 costs. Food Complaint 124/71 - Milk Bottle A bottle of milk was found to contain a filter tip cigarette end. Legal proceedings were instituted against the Dairy Company and a fine of £50 was imposed with £10 costs. Food Complaint 144/71 - Milk Bottle A complaint was received from outside the Borough concerning a bottle of milk bottled within the Borough. It was found that the bottle had not been thoroughly cleaned before filling. Legal proceedings were instituted against the Dairy Company and a fine of £50 was imposed with £20 costs. The Company have since installed electronic scanning equipment in an effort to reduce the possibility of further complaints of this nature. 56 Chopped Pork - An informal sample of chopped pork was reported to contain insufficient meat and also to be labelled in a manner which might mislead the customer. The manufacturer disputed these observations and protracted correspondence ensued. A subsequent formal sample was found to have an adequate meat content but still to be labelled in a misleading manner. Legal proceedings were instituted and the Ministry of Agriculture, Fisheries and Food notified as is required in cases related to misleading labelling. Proceedings were withdrawn on evidence from the manufacturer that this product was no longer marketed and that the item sampled had been delivered to the retailer four months before purchase, although surprisingly it was still apparently fit for human consumption at that time. The manufacturer has now adopted a simpler form of coding which has been explained to the retailers. Aspirin B.P. A formal sample of Aspirin B.P. was found to contain Salicylic Acid in excess of the amount allowed by the BritishPharmacopeia. Legal proceedings were instituted against the retailer who successfully cross summoned the manufacturers of the tablets. The manufacturers were found guilty but given an absolute discharge. Gin - A formal sample of gin purchased from a public house was found to contain 5.4% added water. The publican was unable to give any explanation as to how this could have occurred and legal proceedings were instituted. A fine of £10 was imposed with costs of £5. Apple Turnovers - An apple turnover was found to contain only 11% apple. Although no legal standards exist for apple content, in the view of the Public Analyst it should be a minimum of 25%. This particular product was withdrawn from sale. A survey of apple turnovers manufactured by other Companies showed a wide variation in apple content, although the majority contained more than 25% some were marginally below this figure. 2.6 LABELLING AND TRADE DESCRIPTIONS The labelling of food stuff is checked as part of the sampling procedure. During 1971 special attention was given to the claims made in advertising foods on the television, in newspapers and magazines sold in the Borough. Most of the advertisements made no claims for their products at all, but consisted of the frequent repetition of a trading name or made a rather meaningless statement, as in the case of an advertisement for nuts "You don't have to eat with a knife and fork" or for throat lozenges "Brings law and order to your sore throat". 2.7 MILK Two hundred and thirteen licences under the Milk (Special Designation) Regulations 1963 were in existence during the year. 57 Almost all of the milk sold in the Borough is heat treated and no samples of raw milk were taken during the year. Twenty-one samples were chemically examined and satisfactory reoorts were received. —" The following table shows the results from samples taken for bacteriological examination:- Designation under which sold No. of Samples Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised *96 68 25 96 - - - Ultra Heat Treated 8 8 - 8 _ _ Untreated - - - - - - - Sterilised 1 - - - - 1 - TOTAL 105 76 25 104 - 1 . *Three samples could not be submitted for Methylene Blue Test due to atmospheric conditions. The Methylene Blue failures were investigated and a further programme for sampling arranged. The disturbing factor was the number of samples from one particular bottling plant which failed the Methylene Blue test. The milk was bottled outside the Borough and the failures related to deliveries in bottles and churns to members of the public and to hospital kitchens. No satisfactory conclusion as to the reason for these failures was discovered and legal proceedings were initiated. 2.8 ICE CREAM Bacteriological examination of ice cream samples taken were reported upon as follows Grade I 43 Grade 11 1 Grade III 1 Grade IV Nine samples were submitted for chemical examination and satisfied the tests applied to them. 2.9 BACTERIOLOGICAL EXAMINATION OF OTHER FOOD STUFFS In addition to the milk and ice cream samples referred to above, seventy-four other foods were examined by the Public Health Laboratory Service and satisfactory reports were received. 58 2.10 SLAUGHTER HOUSES There are no slaughter houses in the Borough. 2.11 POULTRY There are no poultry processing plants in the Borough. A very small number of birds are killed from time to time at three of the smallholdings. Some birds prepared for sale were examined and found to be satisfactory. The premises were inspected and comply with the Food Hygiene (General) Regulations 1970. 2.12 IMPORTED FOOD REGULATIONS 1968 The container traffic through the ports and direct to wholesale depots in the Borough is increasing. Thrity-two samples were taken from containers checked - all were found to be satisfactory. 2.13 WATER SUPPLY Reports of the water undertakings, which between them are responsible for a supply service covering the whole of the Borough, and the results of the samples taken by Public Health Inspectors, indicated that samples were satisfactory both as to quality and quantity throughout 1971. No houses were permanently supplied by a stand pipe. There is no addition of artificial fluoride to the water and where a fluoride content is indicated in the analysis it represents the naturally occuring fluoride in the water. Average results for the water supplied by the Sutton and District Water Company to the major part of the district, where one hundred and sixty-six thousand, one hundred and seventy-two people lived, indicated a fluoride content of 0.1 mg/1 per litre and from the Metropolitan Water Board, which supplies the remaining part of the district serving one thousand, nine hundred and eighteen people, the fluoride content was 0.15 mg/1 per litre. Forty-six chemical and bacteriological samples were taken by the Public Health Inspectors and all but one were reported upon as satisfactory. The unsatisfactory result showed a very low level of contamination which occurred at the house where the sample was taken and there was no indication that the public supply was in any way affected. 2.14 SWIMMING BATHS Samples were taken and tests were applied to public and school swimming bath water. During the year eight samples taken from four baths were found to be below standard and the management was advised on the remedial action necessary. 59 2.15 FERTILISERS AND FEEDING STUFFS ACT, 1926 All the Public Health Inspectors of the Borough have been approved by the Ministry of Agriculture, Fisheries and Food as I nspectors and Official Samplers under the Fertilisers and Feeding Stuffs Act, 1926. Eleven informal samples were taken under this Act, during the year, of which two were found not to be within the prescribed limits of variation. The two samples in question will be followed up by formal samples in 1972. 2.16 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1957. Three samples taken during the period satisfied the requirements of the Act. 60 3.1 OCCUPATIONAL HEALTH One of the routine responsibilities of the Environmental Health Service relatec to the Health and working conditions at more than sixteen hundred shops, five hundred offices, one hundred warehouses, catering facilities, etc., and nearly seven hundred and fifty factories in the Borough. Appalling conditions are rarely found, nevertheless routine surveillance is necessary as standards fall quickly. During 1971 five hundred and fifty notices were served for infringements under the Offices, Shops and Railway Premises Act, 1963 and the Shop's Acts and twenty notices in respect of factories. Special attention has been given to safety standards for lifts and hoists. Some Managements did not appear to treat this part of the legislation seriously and at the end of the year it seemed that legal action will be necessary in respect of the conditio of some lifts and hoists in public houses. 3.2 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 243 premises were registered in accordance with the Act, making the total number 1,484. The number of persons employed in the classes of premises as reported to the Minister of Labour at the end of the year is as follows:- Class of Premises Total Number Registered at end of Year Number of Persons Employed Offices 508 7,749 Retail Shops 854 4,987 Wholesale Shops, Warehouses 24 405 Catering Establishments & Canteens 94 818 Fuel Storage Depots 4 23 Preliminary notices were served relating to non-compliance with the Act in respect of the following:- 61  Notices Served Complied (inc. Notices served in 1970) 1971 1971 Overcrowding - - Ventilation 10 3 Cleanliness 20 17 Temperature (inc. thermometers) 194 157 Lighting 42 24 Sanitary Conveniences 51 36 Washing Facilities 21 14 Water Supply 41 29 General Conditions 24 6 Stairs/Passages 8 4 Clothing Storage 5 5 Drying Facilities - 1 Seats 5 2 Machinery 2 1 First Aid Equipment 209 153 Notices 344 242 Canteen Facilities - - Registration 174 129 Lifts 6 4 62 3.3 ACCIDENTS REPORTED Workplace Number Fatal Reported Non Fatal Total No. Investigated Action Recommended Prosecution Formal warning Informal advice No action Offices - - - - - - - Retail Shops - 20 20 - - 3 17 Wholesale shops Warehouses - - - - - - - Catering establishments open to public, canteens - 7 7 - - - 7 Fuel storage depots - - - - - - - TOTALS: - 27 27 - - 3 24 ANALYSIS OF REPORTED ACCIDENTS Offices Retail Shops Wholesale warehouses Catering establishments open to public, canteens Fuel Storage Depots Machinery - 1 - 1 - Transport - - - - - Falls of persons - 9 - 2 - Stepping on or striking against object or person - - - - - Handling goods - 8 - 1 - Struck by falling object - - - - - Fires and explosions - - - - - Electricity - - - - - Use of hand tools - 1 - - - Not otherwise specified - 1 - 3 - 63 3.4 FACTORIES ACT 1961 Inspections for the purpose of provisions as to health:- Number of - Premises No. on Register Inspections Written Notices Uccupiers Prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4, & 6 are to be enforced by Local Authorities 39 12 9 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 670 240 9 - (iii) Other premises in which Section 7 is enforced by the Local Authority 38 51 1 - * (excluding outworkers' premises) 747 303 19 - *Electrical Station (Section 123(1)), Institutions (Section 124) and sites of Building Operations and Works of Engineering Construction (Section 127) Slaughterhouses (Section 175( 1)(d) and (e)) and Railway Running Sheds (Section 175(2) and (10)). Cases in which Defects were found:- Premises Number of cases in which defects were found Number of Cases in which prosecutions were instituted Found Remedied Referred to H.M. Inspector by H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness 5 5 - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation 1 - - 1 - Ineffective drainage of floors - - - - - Sanitary Conveniences::- (a) Insufficient - - - - - (b) Unsuitable or defective 12 8 - - - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) - - - - - 64 Outwork (Sections 133 and 134) Nature of Works Section 133 Section 134 No. of Outworkers in Aug. list required by Sect. 133( 1)(c) No. of cases of default in sending lists to the Council No. of Prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing apparel - 1971 making etc. 59 - - - - - Boxes (Cardboard) 50 - - - - - Brass and Brass Art 1 - - - - - Curtain making 3 - - - - - Toys 1 - - - - - Flowers 2 - - - - - Umbrellas 9 - - - - - Lampshades 19 - - - - - 144 - - - - - 3.5 WORK-PLACES Forty inspections of work places, including building sites, were made during the year. 3.6 HAIRDRESSERS AND BARBERS The Council adopted on the 4th April, 1968, the provisions of the Greater London Council (General Powers) Act, 1967 insofar as they relate to the registration of Hairdressers and Barbers, and fixed the first day of June 1968, as the appointed day for the purpose of registration in accordance with Section 21 of the Act. One hundred and thirty six premises were registered. Inspections to ensure compliance with bye-laws requirements have been made. 3.7 PHARMACY AND POISONS ACT, 1933 Only a limited number of inspections to premises registered for the sale of Part 2 poisons were possible during the year, but arrangements were put in hand for a comprehensive survey to take place at the time of re-registration in 1972. 65 4.1 POLLUTION CONTROL Pollution in all its forms continues to be an active concern to Public Health Inspectors and a subject, not only of international importance, but of considerable local interest. The Council's Smoke Control Programme has been one of the quiet success stories, judged by the gradual decrease in smoke levels measured daily at the three test points. Unfortunately the indication of improved sulphur-dioxide readings of the atmosphere is now showing signs of levelling out. Many complaints regarding noise levels, accumulations, odours and effluvia, and the condition of ponds and streams, were received and investigated. 4.2 SMOKE CONTROL ORDERS During the first quarter of 1971 eight Smoke Control Orders were in a state of suspension due to the shortages of solid smokeless fuel. Fortunately few people seemed to have great difficulty with regard to their supplies. The work towards the declared objective of a Smoke Control Borough by 1975 was continued energetically. Visits of inspection, advice, and to agree the payments of grants, took place mainly in the following areas:- LOCATION Approximate Position Order Confirmed Order In Force Area 21 Cheam 21. 5.70. 1. 7.71. Area 22 North Sutton & Rosehill 21. 5.70. 1. 9.71. Area 23 Carshalton 6.10.71. 1.10.72. Area 24 St. Helier North 23. 9.71. 1. 7.72. Area 25 Hackbridge - - Area 26 South Cheam & Belmont - - 4.3 INDUSTRIAL FURNACES AND CHIMNEYS Industrial boiler houses were visited both with regard to flue gas, and grit and dust emission. Notices were received relating to the installation of three new furnaces and two applications for the approval of chimney heights. In one case alterations were required. 4.4 OBNOXIOUS EFFLUVIA Forty-nine complaints were investigated and acted upon. Many of these related to domestic bonfires which had been lit without proper neighbourly consideration. Such action is not merely anti-social but involves a considerable amount of officer time, and is therefore a charge on the rates. All the infringements of the dark smoke regulations noted were dealt with informally. 4.5 ACCUMULATIONS Inspections were made following the receipt of seventy-four complaints. Informal Notices were served for the removal of twenty-five accumulations or deposits Nineteen people complained about the condition of neighbours gardens. Formal action in these cases is only possible where noxious accumulations or harbourage for rats occurs. 66 4 6 RIVERS. STREAMS, PONDS AND DITCHES Fifty-three visits and inspections were made, either following complaints or as a result of routine observations. 4.7 NOISE ABATEMENT ACT 1960 Fifty-nine complaints with regard to noise were received from members of the public during the year, all of which were brought to a satisfactory conclusion without statutory action. Number of :- Industrial ^remises Commercial Premises Roadworks Construction Demolition etc. Domestic Premises Other*  1. Complaints received 15 9 4 20 9 57 2. Cases complained of 10 7 4 20 9 50 3. Cases investigated 15 9 4 20 9 57 4. Nuisances confirmed 6 7 3 9 6 31 5. Nuisances remedied informally 6 7 3 9 6 31 *goods deliveries, garbage collections etc. 4.8 RADIOACTIVE SUBSTANCES ACT, 1960 The following are firms within the district to whom Certificates of Registration or Certificates of Authorisation for the disposal and accumulation of radioactive waste have been issued by the Ministry of Housing and Local Government under the Act:- Section 1 - Registration - Keeping and use of Radioactive Material: London Fire Brigade, Sutton and Wallington Stations. Medical Research Council, Woodmansterne Road, Carshalton Mr. M. Milian, 44A Sherwood Park Road, Sutton. Mullard Radio Valve Co., New Road, Mitcham Junction. Nuleaf Ltd., Beddington Lane, Croydon. Pye Unican Ltd., 30 Devonshire Road, Sutton. Vinyl Products Ltd., Mill Lane, Carshalton. Section 3 - Registration - Mobile Radioactive Apparatus: Inspection Services Ltd., Oldfields Road, Sutton. Radiographic and Associated Testing Services, 43Senga Road, Hackbridge. Section 6/7 - Authorisation - Disposal and Accumulation of Radioactive Waste: Radiological Protection Service, Clifton Avenue, Belmont. Royal Marsden Hospital, and the Institute of Cancer Research, Downs Road, Belmont. 67 5.1 HOUSING In Sutton it is becoming financially viable to improve and renovate even the most badly maintained properties. It is, therefore, unlikely that in the next few years more than a handful of houses will be the subject of Clearance Order procedures or Demolition Orders. Many of the sub-standard houses remaining in the Borough are being dealt with as part of the Town Centre Re-development Scheme. Public Health Inspectors' will continue to have an interest in the state of repair and standards of fitness of rented houses in the private sector of ownership. It is a pity that standards of fitness which can be enforced do not embrace a requirement that the full range of standard amenities must be available to every householder. It is hoped that the London House Improvement Campaign scheduled for 1972 will result in a big increase of applications for grants to bring older properties to modern standards. 5.2 INSPECTION AND ACTION UNDER STATUTORY POWERS Total Number of Properties Affected Total Number of dwelling houses inspected for Housing defects (under Public Health or Housing Acts) 9,591 Number of inspections for the purpose 11,977 Number of dwelling houses found not to be in all respects reasonably fit for human habitation 440 Number of dwelling houses in respect of which informal notices were served requiring repairs 440 Number of dwelling houses in which defects remedied 397 5.3 FORMAL ACTION UNDER THE HOUSING AND PUBLIC HEALTH ACTS The number of houses in respect of which formal notices were served requiring repairs:- Housing Acts Public Health Acts Normal Notices served - 55 Rendered fit after service of Formal Notices By Owners 1 19 By Local Authorities in default of owners - 22 Formal Notices were served under the following Acts Public Health Act, 1936 - Section 24 30 Public Health Act, 1936 - Section 39 7 Public Health Act, 1936 - Section 93 17 Public Health Act, 1936 - Section 277 4 Public Health Act, 1961 - Section 17 1 Housing Act, 1957 - Section 159 7 Housing Act, 1957 - Section 170 5 One clearance area was declared effecting three properties. Eight houses were demolished in clearance areas. One Closing Order was made during the year. 68 5.4 QUALIFICATION CERTIFICATES - HOUSING ACT, 1969 Number of applications for Qualification Certificates received 261 Number of applications for Certificates of provisional approval received 48 Number of applications withdrawn/invalid 44 Number of applications deferred pending compliance with requirements relating to defects of repair 131 Number of dwellings where defects had since been remedied 330 Number of inspections rnade in connection with defects of repair 1,025 Total number of inspections for all purposes (excluding unsuccessful visits) 1,299 Number of Qualification Certificates issued 378 Number of Certificates of provisional approval issued 27 Number of applications refused 70 5.5 OVERCROWDING - HOUSING ACT, 1957 Cases of overcrowing were reviewed during 1971. The information obtained is summarised below (a) (1) Number of dwelling houses overcrowed at the end of the year 6 (2) Number of families dwelling therein 8 (3) Equivalent number of adults dwelling therein 48 (b) Number of new cases reported during the year 1 (c) (1) Number of cases of overcrowding relieved during the year 1 (2) Number of persons concerned in such cases 9 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding 5.6 HOUSES IN MULTIPLE OCCUPATION - HOUSING ACT, 1961 Of the 77 houses inspected in the period, all were found to be houses to which the House in Multiple Occupation Regulations apply. During the period seven houses were brought up to the standard acceptable to the Council. 5.7 COMMON LODGING HOUSES There are no common lodging houses in the Borough. 5.8 SURVEY - HOUSING ACT, 1969 The staffing situation has precluded the organisation of a proper survey as required by Section 70 of the Housing Act, 1969, but it has been possible to obtain certain information by the use of Technical Assistants' making enquiries in proposed Smoke Control Areas. Advice has been given to the owners of houses lacking standard amenities and information has been supplied to the Director of Development. 69 5.9 IMPROVEMENT In addition to the survey work, the Department has been involved in the inspection of houses where applications for standard and improvement grants have been received, particularly those where the condition of the occupying family has justified the provision of additional bedroom accommodation. The London House Improvement Grant Campaign, to be held in 1972, will no doubt increase the number of applications for improvement grants. 5.10 RENT ACT, 1957 No applications were received under this legislation. 5.11 REPAIR Ensuring that houses, particularly tenanted properties, are in a proper state of repair continues to be a major part of the Public Health Inspectors work. Dampness is an important health hazard and during the year remedial work was carried out in one hundred and twenty-eight houses following the service of informal notices. Seventy eight roofs were made sound and waterproof and the gutters and soil pipes of one hundred and seventeen properties repaired or renewed. Undoubtedly an interest in bringing the property up to proper housing standards, in order to be able to obtain a Qualification Certificate under the Housing Act, 1969 procedure, resulted in a considerable increase in the works of repair, particularly repairs to doors, windows, perished pointing rendering and paint work, and to the provision of new wash hand basins, w.c's and baths. 5.12 DRAINAGE AND SEWERAGE The quick and effective attention of draining problems is the traditional Health Department interest. During 1971 one thousand, six hundred and forty-six obstructions were cleared from drainage and sewerage systems (over a hundred more than during 1970). The figures of repairs were also up on the 1970 totals. The whole of the Borough is covered by a comprehensive sewerage system. 5.13 MOVEABLE DWELLINGS The establishment of the Local Authority site in Carshalton Road, Woodmansterne, enabled the itinerant caravans to be removed from the open spaces at St. Helier. "It's astonishing how personal possessions accumulate." The site is at present a temporary one and it is not possible to preclude the casual and semi-permanent use of other land by caravan dwellers. Despite previous protestations to the contrary, some caravan dwellers prefer the use of casual sites to the Local Authority site which is provided with a wide range of amenities. 5.14 INFECTIOUS DISEASE ENQUIRIES Enquiries on behalf of the Medical Officer of Health are generally carried out by the Public Health I nspectors in the Housing Tearn and disinfections and disinfestation treatments are carried out under their supervision. 71 6.1 PEST CONTROL Rat destruction, both on the surface and in the sewers, and the control of the house mouse, is a task made more difficult and time obsorbing by the rise in resistance of rodents to anti-coagulate baits. 6.2 PREVENTION OF DAMAGE BY PESTS ACT, 1949 Complaints of rat and mouse infestation 1,872 Infestations found on survey (not subject of complaint) 27 Premises found to be infested 1,725 Informal Notices under Section 4 of the Act 1 Routine 10% test baiting and follow-up treatments of the sewerage system have been carried out. 6.3 INSECT PESTS Work on insect pest control varies seasonally. Complaints of flea and bed bug infestations were among the eight hundred and sixty-four insect pest complaints received. Six hundred and seventy-one wasps nests were destroyed. 6.4 LAND PESTS Officers and Operatives are gaining increasing experience in the control of the urban pests since the responsibility for killing was taken over from the Ministry of Agriculture Pest Operatives. "We're having trouble with foxes." Foxes Squirrels Pigeons No. of complaints received and investigated No. of animals destroyed 62 94 29 34 110 36 72 7.1 MISCELLANEOUS DUTIES The work of the Environmental Health Section includes many facets which do not readily fall within the main headings of this report or which, as in the case of licensing, overlap the boundaries of team responsibilities. 7.2 LICENCES, PERMITS AND REGISTRATIONS The following licences, permits and registrations existed at 31st December, 1971 Animal Boarding Establishments Act, 1963- Licences 4 Betting, Gaming and Lotteries Act, 1963 - Small Lotteries - Registrations 117 Diseases of Animals (Waste Foods) Order, 1957 - Licences (Personal Once Only) 19 Game Act, 1831 - Game Dealers' Licences 18 Gaming Act, 1968 - Amusement Machines - Permits (3 year period) 33 Greater London Council (General Powers) Act 1967- Hairdressers and Barbers - Registrations (Personal once only) 136 Late Niglt Refreshment Houses Act, 1969 3 Nursing Homes - Registrations 9 Nursing Agencies - Licences 4 Milk (Special Designation) Regulations, 1963- Licences (5 year period expiring 31.13.70) 213 London Government Act, 1963 - Employment Agency Licences 21 Surrey County Council Act, 1931 (Part IV) - Massage/Special Treatment Establishment Licences 18 Moneylenders Act, 1927 - Moneylenders Licences 4 Greater London Council (General Powers) Act, 1968- Night Cafes-Registrations 1 Pet Animals Act, 1951 - Licences 12 Pharmacy and Poisons Act, 1933 - Sellers of Part II Poisons- Registrations 115 Rag Flock and Other Filling Materials Act, 1951- Registrations (Once Only) 4 Riding Establishments Act, 1964 - Licences 2 Theatrical Employers Registration Act, 1925 and 1928 - Licences (Personal Once Only) 39 Scrap Metal Dealers Act, 1964 - Registrations (3 year period) 13 Slaughter of Animals Act, 1958 - Licences 1 War Charities Act, 1940 and National Assistance Act, 1948- Registrations (once Only) 6 73 7.3 DISEASES OF ANIMALS ACT, 1950 Functions of the Council in connection with the Diseases of Animals Act, 1950, Animal Boarding Establishments Act, 1963, Pet Animals Act, 1951, and the Riding Establishments Act, 1964 are carried out on an agency basis by the Council of the City of London through that Council's Veterinary Officer. 7.4 STUDENT TRAINING The three Public Health I nspectors employed by the Department successfully passed exams at the end of their respective academic years. They assisted in the work of the Department in many ways by being involved in sampling, up-dating the noise level survey information, and carrying out re-inspection visits. 7.5 TECHNICAL LIBRARY The books, literature and other information available for reference to meet the many services mentioned in this report, were reorganised during the year with the very real assistance of the Pupil Public Health Inspectors. 7.6 SOI LED DRESSINGS DISPOSAL Each week a special collection is made from more than sixty householders of soiled dressings which cannot be disposed of with normal household waste. 8.1 MORTUARY SERVICE The Council maintains a mortuary at Alcorn Close, Sutton Common Road, Sutton which is equipped with refrigeration storage and facilities for post-mortem examination. During 1971 the Authority was fortunate in obtaining the permanent appointment of an Assistant Mortuary Superintendent. This vital service was maintained for a very long period by Mr. R.H. Edwards, working with a minimum of assistance. The number of bodies, on all of which autopsies were performed, admitted during the year was as follows From local hospitals 255 From homes within the Borough 191 Other ambulance removals 121 567 9.1 ADMINISTRATIVE/CLERICAL SUPPORT No "field" service will function efficiently for any length of time without keen back-up service from administrative/clerical officers. This year they must be particularly commended for the cheerful and helpful way in which they overcame the extra difficulties resulting from the change of working of the professional and technical officers. from area to functional teams. D.A. EVES, Chief Public Health Inspector Cartoons produced with permission of Methuen & Co. 74 APPENDIX-STATISTICS PART VII INDEX Table No. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1971 I PREMATURITY II THE OBSERVATION AND HANDICAP REGISTER III THE HANDICAPPED PRE-SCHOOL CHILD IV CHILD WELFARE CENTRES V DENTAL CARE OF MOTHERS AND YOUNG CHI LDREN VI MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY SCHOOLS (INCLUDING NURSERY & SPECIAL SCHOOLS.) PERIODIC MEDICAL INSPECTIONS DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS VIII SCHOOL DENTAL SERVICE IX CHILD GUIDANCE CLINIC X SCHOOL PSYCHOLOGICAL SERVICE XI HANDICAPPED PUPILS XII 75 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1971 TABLE I Causes of Death Sex Total all ages Under 4 weeks 4 weeks and under 1 year 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Enteritis arid other Diarrhoeal diseases M - - - - - - - - - - - - F 1 - - - - - - - - - 1 - Tuberculosis of Respiratory System M 2 - - - - - - - - - 1 1 F - - - - - - - - - - - - Lafe Effects of Respiratory Tuberculosis M 2 - - - - - - - - - 2 - F - - - - - - - - - - - - Syphilis and its Sequelae M - - - - - - - - - - - - F 3 - - - - - - - - - 2 1 Other Infective and Parasitic Diseases M - - - - - - - - - - - - F 2 - - - - - - 1 - - - 1 Malignant Neoplasm, Buccal Cavity etc. M 2 - - - - - - - - - 1 1 F 2 - - - - - 1 - - 1 - - Malignant Neoplasm, Oesophagus M 2 - - - - - - - 1 - - 1 F 5 - - --- - - - - - 2 - 3 Malignant Neoplasm, Stomach M 18 - - - - - - - - 7 6 5 F 12 - - - - - - - - 2 6 4 Malignant Neoplasm, Intestine M 23 - - - - - 1 1 1 5 10 5 F 30 - - - - - - 1 2 8 7 12 Malignant Neoplasm, Larynx M 2 - - - - - - - - - 1 1 F 1 - - - - - - - 1 - - - -Malignant Neoplasm, Lung, Bronchus M 82 - - - - - - 2 4 19 42 15 F 20 - - - - - - 2 2 4 7 5 Malignant Neoplasm Breast M - - - - - - - - - - - - F 49 - - - - - - 4 8 10 13 14 Malignant Neoplasm, Uterus F 9 - - - - - - - 1 3 1 4 Malignant Neoplasm, Prostate M 10 - - - - - - - - - 4 6 Leukaemia M 10 - - - - 1 - 2 1 - 4 2 F 3 - - - - - 2 - - - - 1 Other Malignant Neoplasms M 43 . 2 1 2 5 13 8 12 F 51 1 - 1 - - - - 5 18 14 12 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1971 Causes of Death Sex Total all ages Under 4 weeks 4 weeks and under 1 year 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Benign and Unspecified Neoplasms M 2 - - - - - - - 1 - 1 - F 3 - - - - - - - - 2 1 Diabetes Mellitus M 1 - - - - - - - 1 - - - F 8 - - - - - - - 1 1 2 4 Other Endocrine Etc. Diseases M 1 - - - - - 1 - - - - F 7 1 - - 1 - - - 2 - 1 2 Anaemias M 1 - - - - - - - - - 1 F 2 - - - - - - - - 1 1 Other Diseases of Blood etc. M 2 - - - - - - - 1 1 - F - - - - - - - - - Mental Disorders M 1 - - - - - - - - - 1 F 2 - - - - - - - 1 - 1 Meningitis M - - - - - - - - - - F 1 - - - - - - - - - 1 Multiple Sclerosis M - - - - - - - - - - F 4 - - - - - - 1 2 1 - - Other Diseases of Nervous System M 11 - - - - - 1 1 - 7 2 F 8 - - - - 1 - - 1 2 4 Chronic Rheumatic Heart Disease M 5 - - - - - - 1 2 - 2 F 10 - - - - - - 1 1 1 4 3 Hypertensive Disease M 9 - - - - - - - 2 3 4 F 12 - - - - - - - 1 - 2 9 Ischaemic Heart Disease M 269 - - - - - 4 6 19 69 94 77 F 191 - - - - - - 1 2 18 59 111 Other forms of He?rt Disease M 39 - - - - - - - 2 4 4 29 F 78 - - - - - - - 2 2 8 66 Cerebrovascular Disease M 78 - - - - - - - 1 8 26 43 F 171 - - - - - - 1 4 8 35 123 Other diseases of Circulatory System M 31 - - - - - - - 1 3 7 20 F 57 - - - - - - - - 1 8 45 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1971 Causes of Death Sex Total all ages Under 4 weeks 4 weeks and under 1 year 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Influenza M 1 - - - - - - - - - 1 - F 1 - - - - - - - - - 1 - Pneumonia M 53 -. 1 - 1 1 - - - 7 12 31 F 73 1 - - - - - - 1 1 9 61 Bronchitis and Emphysema M 64 - 1 - - - - - 1 12 20 30 F 17 - - - - - - - 2 4 6 5 Asthma M 2 - - - 1 - - - 1 - - - F 4 - - - 1 - - - - 1 1 1 Other Diseases of Respiratory System M 6 - - 1 - - - - - 1 2 2 F 7 - - 1 - - 1 - - 1 - 4 Peptic Ulcer M 12 - - - - - - - - 2 5 5 F 8 - - - - - - - - - 2 6 Appendicitis M 1 - -. - - - - - - - 1 - F - - - - - - - - - - - Intestinal Obstruction and Hernia M 2 - - - - - - - - 1 - 1 F 8 - - - - - - - - 1 4 3 Cirrhosis of Liver M 1 - - - - - - - 1 - - - F - - - - - - - - - - - Other Disease of Digestive System M 11 - 1 - - - - 1 1 4 3 F 16 - - - - 1 1 - - 2 6 6 Nephritis and Nephrosis M 4 - - - - - - - 1 2 1 - F 5 - - - - - - - - 1 2 2 Hyperplasia of Prostate M 7 - - - - - - - - - 2 5 Other Disease Genitourinary System M 4 1 - - - - 1 - - - 1 1 F 5 - - - - - - 1 - 1 1 2 Diseases of Musculoskeletal System M 1 - - - - - - - - - - 1 F 7 - - - - - - - 2 1 1 3 Congenital Anomalies M 6 3 - 2 - - - - - - 1 - F 7 1 2 2 - - 1 - - - - 1 Birth Injury, Difficult Labour, etc. MM 6 6 - - - - - - - - - - F 3 3 - - - - - - - - - - Other cases of Perinatal Mortality MM 8 7 1 - - - - - - - - - F 2 2 - - - - - - - - - - CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1971 Causes of Death Sex Total all ages Under 4 weeks 4 weeks and under 1 year 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Symptoms and III Defined M 3 - - - - - - - - - - 3 Conditions F 3 - - - - - - - - - - 3 Motor Vehicle Accidents M 14 - - - - 7 2 1 - 1 1 F 9 - - - - 1 - - - - 1 7 All other Accidents M 15 - 1 - - 2 - - 2 2 1 7 F 10 - - 1 - - - - - 1 1 7 Suicide and Self-inflicted M 6 - - - - - 4 1 1 - - - Injuries F 6 - - - - 1 - - 3 1 1 - All other External Causes M 1 - - 1 - - - - - - - - F 2 - - - - - 1 - - - - 1 TOTAL ALL CAUSES M 874 17 5 4 2 13 15 18 45 162 275 318 F 935 9 2 5 2 4 7 13 42 100 211 540 PREMATURITY TABLE II The following table gives details of premature births and stillbirths notified in the London Borough of Sutton during the period 1st January 31st December 1971 as adjusted by transferred notifications; (1970 figures in brackets). Weight at Birth Premature Live Births Premature Stillbirths Born in Hospital Born at home or in a Nursing Home Transferred to Hospital on or before the 28th day Born in Hospital Born at Home or in a Nursing Home Total Births DIED DIED Total Births Within 24 hrs. of birth Between 1 and 7 days Between 7 and 28 days Within 24 hrs. of birth Between 1 and 7 days Between 7 and 28 days Total Births Within 24 hrs. of birth Between 1 and 7 days Between 7 and 28 days 2lb. 3ozs. or less 5 5 - - - - - - - - - - 6 - (4) (3) (-) (1) (-) (-) (-) (-) (-) (-) (-) (-) (1) (1) Over 2lb. 3ozs. up to and inc. 3lb. 4ozs. 7 1 - - - - - - - - - - 5 - 10) (2) (1) (-) (-) (-) (-) (-) (-) (-) (-) (-) (-) (1) Over 3lb. 4ozs. up to and inc. 4lb. 6ozs. 24 2 4 - - - - - - - - - 3 - (28) (2) (1) (1) (-) (-) (-) (-) (-) (-) (-) (-) (-) (3) Over 4lb. 6ozs. up to and inc. 4lb. 15ozs. 21 - - - - - - - - - - - 2 - (24) (-) (-) (-) (1) (-) (-) (-) (-) (-) (-) (-) (-) (1) Over 4lb. 15oz up to and inc. 5lb. 8ozs. 75 1 1 3 1 (68) (-) (-) (-) (2) (1) (-) (•) (-) (-) (-) (-) (•) (3) TOTAL 132 9 5 3 - - - 1 - - - - - (134) (7) (2) (2) (3) (1) (-) (-) (-) (-) (-) (-) (-) (9) TABLE III THE OBSERVATION AND HANDICAP REGISTER NUMBER OF CASES ON REGISTER As at Year of Birth TOTAL 1971 1970 1969 1968 1967 1966 31.12.71 173 220 130 162 81 - 766 31.12.70. - 199 121 138 128 106 692 TABLE IV THE HANDICAPPED PRE SCHOOL CHILD This table shows the number of children with each type of defect born in each of the last five years, but as some children have more than one defect the sum total of defects is not the same as the total number of cases on the Register. The figures given in this table include the cases shown in Table 2. Handicap of Defect Year of Birth 1971 1970 1969 1968 1967 Total DEFECTS OF EAR OR FACE including: absence of pinna or meatus, accessory auricle, bat ear, naevae, skin tags, micrognathia - 1 1 - 1 3 DEFECTS OF MOUTH including: hare lip, cleft palate 1 5 - 2 3 11 DEFECTS OF ALIMENTARY SYSTEM including: pyloric stenosis, oesophagael atresia, jejunal atresia, imperforate anus, defects of liver, hernia, Hirschsprung's disease 4 7 9 7 4 31 Osteogenesis Imperfecta - - - - 2 2 SKELETAL DEFORMITIES including: achondroplasia, chondrodystrophy, dwarfism, arachnodactyly, reduction deformities, Pierre Robine Syndrome 2 - - 2 4 SYNDACTYLY, POLYDACTYLY - 1 1 - 2 4 TALIPES, AND OTHER FOOT DEFORMITIES 3 9 3 6 8 29 CONGENITAL DISLOCATION OF HIP 1 5 5 2 3 16 DEFECTS OF UROGENITAL SYSTEM including: Hypospadias, epispadias, undescended testicles, hydrocele, defects of female genitalia, defects of kidney, ureters, etc. pseudo- hermaphrodism 4 3 5 3 5 20 MUSCULAR DEFECTS including: spastic, absence of muscles, arthogryphosis, torticollis, hemiplegia 1 4 1 3 1 10 OTHER MINOR PHYSICAL DEFORMITIES including: pilonidal sinus 1 2 3 2 - 8 Handicap or defect Year of Birth 971 1970 1969 1968 1967 Total BLINDNESS - - - - - - MICROPHTHALMOS, BUPHTHALMOS - 1 - - - 1 SQUINT - - 1 1 2 4 NYSTAGMUS - - - - - - SEVERE VISION DEFECT, CATERACT - - 1 1 1 3 DEAFNESS - - 2 1 - 3 PARTIAL HEARING or HEARING DEFECTS - 1 3 3 1 8 SPEECH DEFECTS - - - 1 3 4 DISEASES AND DEFECTS OF RESPIRATORY SYSTEM INCLUDING: Hyaline membrane disease, asthma, chronic bronchitis - 7 2 7 2 18 BLOOD DISORDERS, including: Christmas Disease 7 3 3 4 2 19 SKIN DISORDERS, including: Ichthyosis congenita, eczema 1 1 3 2 3 10 METABOLIC DISORDERS INCLUDING: Fibrocystic disease 3 - 1 1 1 6 PHENYLKETONURIA - - - - - - CARDIAC DEFECTS -7 6 3 8 9 33 OTHERS NEEDING OBSERVATION for suspected physical defect 132 157 77 96 35 497 MENTAL RETARDATION - - - 1 1 2 MICROCEPHALY - - - - - - EPILEPSY, OR SEVERE CONVULSIONS - 2 - 2 1 5 MONGOLISM 3 1 2 2 1 9 SPINA BIFIDA, HYDROCEPHALUS 4 3 4 3 1 15 OTHERS NEEDING OBSERVATION FOR MENTAL RETARDATION AND OTHER C.N.S. LESIONS 1 1 2 5 1 10 TABLE V CHILD WELFARE CENTRES Number of children who attended during period 1st January 1971 to 31st December 1971 YEAR 1st Attendances of Children Born in: No. of Sessions held by No. of children referred elsewhere for consultant advice 1971 1970 1967/69 TOTAL Total Attendances Asst. Medical Officers G.P.s employed on sessional basis Total No. of Sessions 1971 2441 3357 5041 10839 49952 1061 17 1801 53 Number of children who attended during period 1st January 1970 to 31st December 1970 YEAR 1st Attendances of Children Born in: No. of Sessions held by No. of children referred elsewhere for consultant advice 1970 1969 1965/68 TOTAL Total Attendances Asst. Medical Officers G.P.s employed on sessional basis Total No. of Sessions 1970 2490 2857 5000 10347 51459 1003 75 1078 30 TABLE VI DENTAL CARE OF MOTHERS AND YOUNG CHILDREN Attendances and Treatment Expectant and Nursing Mothers Children under 5 1971 1970 1971 1970 Inspection 47 33 791 867 No. found to require treatment 38 31 333 355 No. offered treatment 36 30 323 352 Re-inspection 4 5 137 139 No. found to require treatment 3 5 71 65 First visits for treatment 45 38 387 348 Subsequent visits 77 73 670 707 Total visits 122 111 1057 1055 Additional courses of treatment 6 3 41 47 Fillings 87 97 1036 1152 No. of teeth filled 69 73 936 1061 Extractions 20 31 208 152 General anaesthetics 2 6 109 84 Emergency visits 2 3 79 46 Patients x-rayed 9 13 3 5 Scalings 19 23 85 35 Teeth otherwise conserved 1 - 21 41 Teeth root filled - 3 - - Crowns - - - - Inlays - - - - No. of Dentures supplied 7 2 - - Courses of treatment completed 28 24 334 353 Sessions devoted to inspection and treatment 14.2 12 162 162.5 Sessions devoted to Health Education 1 3 2 7 TABLE VII MADICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) TABLE(a) PERIODIC MEDICAL INSPECTIONS 1st JANUARY - 31st DECEMBER, 1971 Age Groups Inspected (By year of birth) No. of Pupils who have received a full medical examination Physical Condition No. of Pupils not selected for examination Pupils found to require treatment (excluding dental diseases and infestation with vermin) Satis. Unsatis. For defective vision (excl. squint) For any other condition Total Individual Pupils (1) (2) (3) (4) (5) (6) (7) (8) 1967 and later 443 443 - - 11 34 38 1966 2287 2287 - - 55 173 212 1965 302 302 - - 12 27 38 1964 249 248 1 - 8 24 28 1963 781 781 - 759 51 101 138 1962 437 437 - 328 27 58 76 1961 137 137 -- - 7 13 17 1960 95 95 - - 6 9 4 1959 696 696 -- 632 60 109 186 1958 525 524 1 291 40 73 110 1957 1267 1267 - - 88 56 132 1956 and earlier 807 804 3 - 56 40 95 TOTAL 8026 8021 5 2010 421 717 1074 TABLE VIII DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS NOTE:- All defects, including defects of pupils at Nursery and Special Schools, noted at periodic and special medical inspections are included in this table, whether or not they were under treatment or observation at the time of the inspection. This table includes separately the number of pupils found to require treatment (T) and the number of pupils found to require observation (O). Defect Code No. Defect or Disease Entrants PERIODIC INSPECTIONS Special Instructions Leavers Others Total 1971 1970 1971 1970 1971 1970 1971 1970 1971 1970 4 Skin T 25 12 28 17 70 53 123 82 357 283 O 78 60 66 58 80 116 224 234 - 1 5 EYes (a) Vision T 66 67 144 217 211 206 421 490 28 51 O 98 97 157 201 226 251 481 549 8 12 (b) Squint T 65 67 7 10 59 54 131 131 - 1 O 26 23 4 3 25 25 55 51 - - (c) Other T 4 3 1 4 5 7 10 14 3 2 O 2 3 8 6 13 12 23 21 1 - 6 (a) Hearing T 8 15 6 3 14 16 28 34 46 83 O 56 48 12 20 49 70 117 138 12 5 (b) Otitis Media T 13 4 1 2 8 7 22 13 2 - O 44 38 4 11 29 44 77 93 - - (c) Other T 2 - 1 2 1 4 2 2 2 O 5 1 3 2 4 8 12 11 - - 7 Nose & Throat T 50 36 13 9 93 51 156 96 6 8 O 287 302 70 77 308 412 665 791 2 1 8 Speech T 45 35 - 2 , 17 27 6? 64 6 22 O 88 98 2 6 28 27 118 131 2 3 9 Lymphatic Glands T 3 3 - - 3 3 6 6 - - O 76 38 7 3 41 49 124 90 - 2 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS NOTE:- All defects, including defects of pupils at Nursery and Special Schools, noted at periodic and special medical inspections are included in this table, whether or not they were under treatment or observation at the time of inspection. This table includes separately the number of pupils found to require treatment (T) and the number of pupils found to require observation (O) Defect Code No. Defect or Disease Entrants PERIODIC INSPECTIONS Special Inspections Leavers Others Total 1971 1970 1971 1970 1971 1970 1971 1970 1971 1970 10 Heart T 2 2 1 1 5 9 8 12 1 1 O 31 30 8 11 38 32 44 73 - 1 11 Lungs T 12 9 5 1 27 12 44 22 5 20 O 78 74 24 41 103 116 205 231 2 2 12 Developmental (a) Hernia T 5 31 - 4 8 9 39 1 1 O 3 5 - 2 5 1 8 8 - 1 (b) Other T 6 22 - 3 19 12 25 37 8 10 O 17 23 4 12 25 41 46 76 2 13 Orthopaedic (a) Posture T 5 5 6 8 12 6 23 19 2 9 O 7 2 12 30 20 20 39 52 - - (b) Feet T 11 19 7 13 35 15 53 12 23 O 40 52 19 25 58 62 117 139 1 1 (c) Other T 2 6 6 7 15 6 23 19 14 16 O 29 25 23 39 43 37 95 101 3 1 14 Nervous System (a) Epilepsy T 4 2 6 2 9 4 19 8 - 2 O 7 7 7 3 10 11 24 21 - - (b) Other T - - 2- 1 1 3 1 2 - O 8 9 1 5 9 9 18 23 3 - DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS NOTE:- All defects, including defects of pupils at Nursery and Special Schools, noted at periodic and special medical inspections are included in this table, whether or not they were under treatment or observation at the time of the inspection. This table includes separately the number of pupils found to require treatment (T) and the number of pupils found to require observation (O). Defect Code No. Defect or Disease Entrants PERIODIC INSPECTIONS Special Inspections Leavers Others Total 1971 1970 1971 1970 1971 1970 1971 1970 _ 1971 1970 15 Psychological (a) Development T - 1 2 10 5 12 7 23 O 24 27 14 11 89 73 127 111 3 1 (b) Stability T - 2 1 1 12 7 13 1 8 O 43 45 15 31 67 62 125 138 2 16 Abdomen T - 3 3 1 6 2 g - O 15 16 8 12 25 30 48 58 - 1 17 Other T 6 7 3 30 - 43 3 110 O 33 15 28 11 56 2 117 28 11 24 TABLE IX SCHOOL DENTAL SERVICE 1. Attendances and Treatment 5-9 years 10-14 years 15 years and over TOTAL 1971 1970 1971 1970 1971 1970 1971 1970 First Visit 2,165 1,901 1,650 1,394 349 295 4,164 3,590 Subsequent Visits 3,455 3,366 3,150 2,827 825 748 7,430 6,941 Total Visits 5,620 5,267 4,800 4,221 1,174 1,043 11,594 10,531 Additional courses of treatment commenced 476 447 316 227 60 42 852 716 Fillings in permc.-.ent teeth 1,742 1,711 3,754 3,246 1,312 1,072 6,808 6,029 Fillings in deciduous teeth 4,653 4,366 353 319 - - 5,006 4,685 Permanent teeth filled 1,484 1,454 3,222 2,621 1,112 834 5,818 4,909 Deciduous teeth filled 4,222 3,982 320 296 - - 4,542 4,278 Permanent teeth extracted 101 75 462 391 101 89 664 555 Deciduous teeth extracted 1,365 1,254 574 360 - - 1,939 1,614 General Anaesthetics 605 620 327 265 38 30 970 915 Emergencies 320 297 97 85 15 12 432 394 1971 1970 Number of pupils x-rayed 486 488 Prophylaxis 473 320 Teeth otherwise conserved 94 166 Number of teeth root filled 15 12 Inlays 1 1 Crowns 9 10 Courses of treatment completed 4,275 3,869 2. Orthodontics 1971 1970 New cases commenced during 1971 64 72 Cases completed during year 71 79 Cases discontinued during year 2 No. of removable appliances fitted 101 114 Pupils referred to Hospital Consultant 13 18 3. Prosthetics Ages 5-9 Ages 10-14 Ages 15 & over TOTAL 1971 1970 1971 1970 1971 1970 1971 1970 Pupils supplied with F.U. or F.L. (first time) - - - - - - - - Pupils supplied with other dentures (first time) - - - 1 5 • 5 1 Number of dentures supplied - 1 1 2 6 2 7 5 4. Anaesthetics General anaesthetics administered by dental officers Nil Nil 5. Inspections (a) First inspection at school. No. of pupils 18,832 17,847 (b) First inspection at clinic. No. of pupils 2,232 2,073 No. of (a) + (b) found to require treatment 10,131 9,620 No. of (a) + (b) offered treatment 8,807 8,173 (c) Pupils re-inspected at school clinic 2,917 2,406 No. of (c) found to require treatment 1,719 1,465 6. Sessions 1971 1970 Sessions devoted to treatment 1743.8 1552.85 Sessions devoted to inspection 201.2 179.15 Sessions devoted to Dental Health Education 5 5 TABLE X CHILD GUIDANCE CLINIC - STATISTICS 1970 Psychiatric sessions 1971 1970 Diagnostic interview with children 51 84 Treatment interviews 289 259 Court reports 6 6 Boarding school reviews 13 13 Case discussion (supervision) 139 133 Discussion of North Downs cases 28 22 Meeting outside agencies 27 16 Outside visits - 6 Appointments arranged but failed 19 20 Psychiatric Social Worker Sessions Treatment interviews 1,445 1,336 Case discussions (supervision) 230 297 Meeting outside agencies 26 15 Home visits 25 43 Supervision of students 46 43 Outside visits 1 14 Appointments arranged but failed 177 155 Diagnositc interviews with families 31 - Psychotherapist sessions Diagnostic interviews with families 36 Treatment interviews 2,177 1,353 Case discussions (supervision) 185 187 Outside visits - 2 Meeting outside agencies 7 6 Appointments arranged but failed 152 126 The number of children referred to the Clinic during 1971 was 149 (130) The agencies initiating referral were General Practitioners 34 58 School Health Services 23 23 School Psychological Service 39 22 Courts 6 6 Social Services 5 4 Hospitals or Specialists 13 9 Schools 14 - Parents 15 - Although this has not been included in the figures, the Psychiatrist sessions include a good deal of teaching of students, such as Registrars from Hospitals, a student from Reading University Course for School Counselling, social work students, etc. TABLE XI SCHOOL PSYCHOLOGICAL SERVICE In 1971 a total of 594 (544) children presented a variety of learning and behaviour problems and were assessed by the psychologists, the main source of referral being head teachers and the Principal School Medical Officer. Other sources of referral and the recommendations made are as follows Source of Referrals other than by the Child Guidance Clinic during 1971 1971 1970 Principal School Medical Officer 164 173 Head Teachers directly 295 205 Carew Manor E.S.N. School 62 56 Other 27 44 Education 5 10 553 488 Child Guidance Clinic cases seen in 1971 = 41. Main Recommendations made : To Carew Manor E.S.N. School 25 37 To Training Centre 9 6 To Infant Observation/Diagnostic Classes 15 22 To Borough Remedial Units 27 27 To other Schools 24 42 Psychiatric Investigation 39 22 Medical Investigation 15 24 Youth Employment Officer 15 7 Speech Therapist 8 3 Social Services 8 8 Specific review and re-assessment 225 170 Report and advice only 143 98 553 466 TABLE XII HANDICAPPED PUPILS Number of pupils registered as handicapped Handicapped pupils requiring education at Special Schools approved unser Section 9(6) of the Education Act, 1944, or Boarding in Boarding Homes during the years 1st January - 31st December 1971 and 1970. Blind Partially Sighted Deaf Partially handicapped Physically handicapped Delicate Maladjusted E.S.N. Epileptic Speech Defects Total Children newly assessed as needing special educational treatment at special schools 71 70 71 70 71 70 71 70 71 70 71 70 71 70 71 70 71 70 71 70 71 70 - - 2 3 2 - 3 2 8 10 8 4 10 7 22 29 1 - 1 1 57 56 Number of children receiving special educational treatment in (a) Boarding Special Schools or Homes 1 1 - - 4 3 1 1 7 8 7 5 6 7 14 10 2 1 - - 42 36 (b) Day Special Schools - - 12 9 12 9 - - 26 17 11 7 3 - 179 129 - - - - 243 171 (c) Independent Boarding Schools - - 1 - - - - - 3 2 - - 19 21 9 1 - - - 32 24